Aim:In order to clarify the initial step of the mechanism by which bacillus Calmette-Guérin (BCG) exhibits antitumor activity via the immune response induced in the bladder submucosa after intravesical BCG therapy for human bladder cancer, various cytokines secreted in the urine after BCG instillation were measured. Methods: After transurethral resection of bladder cancer, a 6-week course of BCG instillation was performed. At the first and sixth weeks' dosings, spontaneously excreted urine was collected before and 4, 8, and 24 h after BCG instillation. The urinary cytokines were determined by Sandwich enzyme-linked immunosorbent assay using monoclonal antibodies against granulocyte-macrophage colony-stimulating factor (GM-CSF), tumor necrosis factor (TNF)-a, granulocyte colony-stimulating factor (G-CSF), interleukin (IL)-1b, IL-8, interferon (IFN)-g, and IL-12. Results: After the BCG therapy, various cytokines, such as GM-CSF, TNF-a, G-CSF, IL-1b, IL-8, IFN-g, and IL-12 were secreted , comprising the immune response cascade. The mean urinary excretions of GM-CSF and TNF-a 4 h after the sixth week's instillation were significantly higher than the pre-instillation levels. There were no significant increases in the urinary IFN-g or IL-12 levels between 4 and 24 h after the sixth week's instillation. The TNF-a level 4 h after the sixth week's instillation had a strong tendency towards the absence of recurrence, with a mean follow-up of 54.1 months. The Kaplan-Meier curve showed the 2, 5, and 10-year recurrence-free survival rates were 72.4%, 65.8%, and 56.4%, respectively. Conclusions: We suggested that the urinary levels of TNF-a might be essential in antitumor activity after BCG therapy and might play an important role in the prevention of bladder tumor recurrence.

These results indicate that metabolic syndrome causes the changes in urinary constituents, leading to increased risk of both uric acid and calcium stone formation. Improvement in insulin resistance, a central cause of metabolic syndrome, might prevent uric acid stone formation by raising urinary pH.

Objectives:The Japanese Association for the Surgery of Trauma (JAST) classification is widely applied to select strategies in the treatment of blunt renal trauma in Japan. We retrospectively investigated the applicability of the JAST classification. Methods: The JAST classification comprises type I (subcapsular), type II (superficial), type III (deep) and pedicle vessel traumas. According to these criteria, we reviewed 70 patients with blunt renal trauma (types I, II, III and PV; n = 23, 22, 22 and 3, respectively) who were admitted to our institution between 1991 and 2007. Results: All patients with type I trauma were managed conservatively and three patients with PV trauma underwent nephrectomy. Whereas two patients with underlying acquired cystic disease of the kidney underwent nephrectomy among type II trauma, the other patients were treated conservatively. As four patients with type III trauma underwent nephrectomy, injury type subclass and hemorrhage severity were significant prognostic factors indicating the need for nephrectomy in this group. Since we introduced transcatheter arterial embolization in 1999, none of our patients have needed nephrectomy due to a hemorrhage, but one patient underwent nephrectomy because of persistent urine leakage. Conclusion: Injury type and the hemorrhage severity are useful for determining treatment strategy. After the introduction of transcatheter arterial embolization, the proportion of nephrectomies due to exsanguination decreased and urine leakage also seems to be more important as a prognostic factor.

Objectives: To identify the prognostic factors and determine which pT3 prostate cancer patients can be safely followed up after surgery without any adjuvant treatment. Methods: A retrospective review was carried out on 106 patients with pT3 prostate cancer. All preoperative and postoperative parameters, including the postoperative serum prostate-specific antigen (PSA) level at 3 months after surgery, were assessed by univariate and multivariate analyses. Results: Mean follow-up period was 18 months. The overall biochemical recurrence-free rate was 53.7% and 34.1% at 12 and 36 months, respectively. On univariate analysis, all preoperative clinical factors were significantly correlated with biochemical progression. On multivariate analysis, pathological Gleason score, pathological stage and postoperative PSA were significant predictors. Among those with undetectable PSA after surgery, 38 patients (88.4% of 43) did not have disease progression during the follow-up period. On the other hand , of the 27 patients with detectable PSA that was not defined as progressive (range 0.01-0.20), 22 (81.5%) had biochemical disease progression. The progression free probability was significantly different between these two groups (P-value < 0.0001). Conclusions: pT3 prostate cancer patients showing low pathological Gleason score, without seminal vesicle invasion, and undetectable postoperative PSA values have low probability of PSA progression. Careful follow up including periodic PSA assessment and clinical observation represents an adequate strategy in the management of these patients.

Older age adversely affected the outcome of patients with NMIBC, which is particularly apparent in patients 80 years or older. Further prospective studies to confirm these findings are warranted.