摘要:

This review outlines the current treatment of many causes of male infertility, including idiopathic spermatogenic disorder, varicocele, obstruction of the seminal tract, and emission disorders. Recommendations regarding future treatments are presented.

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00529.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: It is well recognized that the histology of renal cell carcinoma (RCC) is often heterogenous. It is also believed that the prognosis of patients with large tumors is generally poorer than those with small tumors. However, there has been no detailed study on changes in histological features of RCCs associated with tumor growth. This study was conducted to investigate whether there are any specific histological changes related to tumor size and to study the prognostic value of histological parameters in RCCs.Methods: The presence or absence of each histological component (3 cell types and 5 histological architectures) was investigated in 110 RCCs. The tumor size‐associated changes in the histological composition of the RCCs were evaluated, and the prognostic significance of the histological parameters was analyzed using univariate and multivariate analysis.Results: The percentage of RCCs with multiple cell types increased with tumor size, whereas increases in multiplicity were not as prominent in the histological architectures. Several characteristic changes, however, were observed in both cell types and architectures. RCCs with a pure clear cell, pure alveolar pattern or cystic architectural pattern decreased, while those with granular or spindle/pleomorphic cell types, or papillary or solid architectural patterns increased with tumor size. A univariate analysis revealed that a clear cell type and an alveolar or cystic architectural pattern were associated with a better prognosis, while spindle/pleomorphic cells and a solid architecture pattern correlated with a poorer prognosis. Multivariate analysis of cell types and architectures showed, however, that only the presence of spindle/pleomorphic cell types and a solid architecture were independent prognostic variables.Conclusion: The histological composition of RCCs varied according to the size of the tumor. Sarcoma‐tous components increased with tumor size and were independently associated with a poor prognosis. Further study is warranted to correlate specific genetic alterations with tumor growth‐related histo‐logical changes

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00530.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Standard severity criteria for benign prostatic hyperplasia (BPH) are needed to facilitate clinical and epidemiologic investigations in the common terminology.Patients and Methods: A total of 692 BPH patients from 8 institutions were judged by specialized physicians for their overall disease severity and severity in 4 domains: symptom, function, anatomy, and quality of life (QOL). The items measuring severity in these 4 domains were the International Prostate Symptom Score (I‐PSS) questionnaire, uroflowmetry, transrectal ultrasonography (TRUS), and questionnaires on bother and I‐PSS QOL index, respectively. By Spearman's rank correlation and multiple regression analysis using physicians' judgement as the criterion variable (gold standard) the items and their cut‐off levels were selected so that high predictivity, practicality and clinical significance were maintained, while the number of items in use was minimized.Results: The item(s) and their ranges of values for each severity grade were summarized as follows; the evaluation domain (the selected item(s): range of mild, moderate, severe): symptom (I‐PSS: 0–7,8–19, 20–35), function (maximum flow rate and residual urine volume: ≥ 1 5 mL/s and<50 mL, ≥ 5 mL/s and<1 00 mL,<5 mL/s or ≥ 100 mL), anatomy (prostate volume on TRUS:<20 mL,<50 mL, ≥ 50 mL), QOL (QOL index: 0 and 1, 2 to 4, 5 and 6). The overall severity was efficiently predicted when defined according to the combinations of severity grades of the 4 domains. These criteria predicted physicians' judgement with accuracy of about 80% for overall severity and severity of individual domains.Conclusion: The proposed criteria are valid, practical, and would be useful for the common scale of the BPH severity in clinical and

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00531.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Various treatment modalities for benign prostatic hyperplasia (BPH) have emerged and are now in use or await evaluation of clinical usefulness. It is difficult, however, to compare their efficacies on a single scale, because standardized criteria for therapeutic efficacy of BPH treatments have not been established.Patients and Methods: A total of 692 BPH patients from 8 institutions in Japan received various treatments, and were judged by specialized physicians for overall efficacy, and for efficacy in 4 domains: symptom, function, anatomy, and quality of life (QOL). Efficacy of treatment was graded as excellent, good, fair or poor, and assessed using items based on conventional clinical measurements. These items included 1) the difference (post‐pretreatment value), 2) relative ratio (post/pre) and, 3) the individual values of pre or posttreatment measurements. The cut off levels for each grade were heuristically selected by Spearman's rank correlation and multiple regression analysis so that the results accurately predicted physicians' judgement, while the feasibility was maintained.Results: The results for each efficacy grade (range of excellent, range of good, range of, fair, range of poor) were summarized as follows:Symptom: (post/pre treatment ratio of I‐PSS) ≤ 0.25, ≤ 0.5, ≤ 0.75,>0.75.Function: (post‐pre of Qmax) ≥ 10 mL/s, ≥ 5 mL/s, ≥ 0.25 mL/s,0.9.QOL: (pre‐post of QOL index) ≥ 4, 3, 2 and 1, ≤ 0.The overall efficacy grade was defined as the median of efficacy grades of 3 domains: symptom, function and QOL. The agreement rates between the criteria and physicians' judgement on the dichotomous efficacy (either excellent plus good, or fair plus poor) were approximately 80% in individual domains and overall estimate, and consistent among various treatments.Conclusion: The proposed criteria are fairly accurate, simple, and practical, and thus may be useful as a standard method for assessing the clinic

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00532.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: About 20% of all undescended testes are nonpalpable. Although surgical exploration was previously the method of choice for management, laparoscopy from the inferior edge of the umbilicus has been established as a useful method of examining a testis that is nonpalpable. However, conventional subumbilical laparoscopy is unnecessary when the testis or its remnant is located below the internal inguinal ring. We evaluated the efficacy of transinguinal laparoscopy after inguinal exploration performed for nonpalpable testis.Methods: Twelve children with 14 nonpalpable testes (2 children had bilateral nonpalpable testes) were considered for a novel method of laparoscopy. We performed laparoscopy through the internal inguinal ring after opening the inguinal canal.Results: Inguinal exploration revealed the testis or its remnant in 5 patients, and thus prevented unnecessary laparoscopy in these individuals. Transinguinal laparoscopy identified the anatomy in 7 patients. Four of the latter were found to have blind‐ending vas deferens and spermatic vessels, while in 3 patients, the testes were located in the peritoneal cavity.Conclusion: Transinguinal laparoscopy may become the accepted method for managing nonpalpable testes, as inguinal exploration can eliminate the need for laparoscopy in some cases, and the visualization achieved with transinguinal laparoscopy is just as good as that with conventional laparoscop

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00533.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Laparoscopic bladder‐neck suspension for women with urinary stress incontinence avoids the problems associated with a large abdominal incision. This study reviews the short‐term outcome of this minimally invasive operation.Methods: Between September 1993 and February 1995, 20 female patients with type II urinary stress incontinence underwent laparoscopic bladder‐neck suspension at our institution (mean age, 46.6 years; mean weight, 59.5 kg; mean duration of symptoms, 3.75 years; mean follow‐up, 7 months). The extraperitoneal space was created with a preperitoneal distention balloon system; dissection of the bladder and bladder neck was done via 3 working ports. In 16 patients, the paraurethral vagina on either side of the bladder neck was hitched up to the iliopectineal ligament by 2–0 sutures. In the remaining 4 patients, the bladder‐neck suspension was performed using hernia mesh and staples. Four patients had intraperitoneal suspension.Results: The operative time ranged from 75 to 205 minutes, with a mean of 111.5 minutes. The period of urethral catheterization ranged from 2 to 7 days, with a mean of 3.1 days. The hospitalization stay ranged from 5 to 15 days, with a mean of 6.35 days. Thirteen patients (65%) had complete resolution of symptoms, 5 patients (25%) reported significant improvement, and 2 patients (10%) did not benefit from the operation.Conclusion: Long‐term follow‐up is necessary to determine the efficacy of this laparoscopic technique. The success rate for any incontinence procedure is usually inversely proportional to the durati

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00534.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Although several studies indicate that larger varicoceles are associated with greater impairment of spermatogenesis, others suggest that the response to surgery is independent of varicocele size. In order to elucidate these seeming contradictions, correlations between the preoperative evaluation of varicoceles and improvement in semen quality after varicocelectomy were investigated.Methods: Forty men with left unilateral varicocele, followed for at least 6 months after varicocelectomy, were included in this study. The relationships between the grade of varicocele by palpation, Doppler examination, ultrasound, or scintigraphy were correlated with a postoperative improvement in sperm density or sperm motility.Results: Greater improvement in sperm density was observed in the patients with a large varicocele graded by palpation or measured by ultrasound, and greater improvement in sperm motility was observed in the patients with high uptake of radioactivity in the left side by scrotal scintigraphy.Conclusion: An improvement in semen quality after varicocelectomy is greater in patients with a large varicocele than in the patients with a small one. The significance of surgical repair of a small varicocele should be reconsidered.

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00535.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The effects of castration on the biological features of an androgen‐responsive carcinoma were examined in order to clarify the mechanism responsible for the relapse of an androgen‐responsive carcinoma after androgen ablation therapy.Methods: A well‐characterized androgen‐responsive mammary carcinoma, Shionogi carcinoma 115 (SC115), was used for these experiments. Male mice were examined for the effects of castration on the growth rate of the tumor, the number of androgen receptor‐positive cells, and the karyotype of the SC115 tumors. Castration was performed 1 week prior to tumor transplantation, or 2 or 3 weeks after tumor transplantation.Results: SC115 tumors did not develop when transplanted into castrated male mice. When castration was performed 2 weeks after transplantation, the tumor showed androgen‐independent growth with temporary regression of growth rate. However, when castration was performed more than 3 weeks after transplantation, the tumor showed androgen‐independent growth not associated with any temporal regression of growth rate. There were no significant differences in histological features or the number of androgen receptor‐positive cells between SC115 tumors in untreated or castrated mice. To test whether SC115 tumors growing under androgen‐deprived conditions became fully androgen‐independent, SC115 tumors were transplanted in both male and female mice. A transplanted tumor piece grew progressively only in male mice. This indicates that the SC115 tumor maintains its androgen response in the next generation, even though growth of the tumor resumed after temporary suppression due to castration. Chromosomal analyses revealed no apparent cytogenetic changes in the SC115 tumors that resumed growth under androgen‐deprived conditions.Conclusion: These results suggest that no gross changes in the number of androgen receptor‐positive cells or karyotype are necessary for androgen‐independent growth in this system once th

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00536.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Estrogens are suspected to play a role in the pathogenesis of benign prostatic hyperplasia (BPH) and prostate cancer. In this study, the expression of aromatase messenger ribonucleic acid (mRNA) was determined, and these levels were quantitated, in human prostatic tissues to evaluate the role of estrogens in the pathogenesis of BPH and prostate cancer.Methods: Prostatic tissues were obtained either by retropubic prostatectomy, radical prostatectomy, or radical cystectomy from patients with BPH, prostate cancer, and bladder cancer. The expression of aromatase mRNA in the prostatic tissues was studied by Southern blot analysis of the reverse transcription and polymerase chain reaction technique (RT‐PCR) products. Aromatase mRNA levels were measured in human prostatic tissues by the RT‐PCR using a fluorescent primer.Results: Aromatase mRNA was identified in all specimens by Southern blot analysis of the RT‐PCR products. The concentrations of aromatase mRNA (mean ± SD) which were measured by fluorometric quantitation in 16 of 19 patients with BPH and in 3 of 4 patients with prostate cancer, were 1.81 ± 3.02, and 0.84 ± 0.27, ± 10‐‐3attomoles/μg of total RNA, respectively.Conclusions: These results demonstrate local formation of estrogen in the prostates of patients with BPH and prostate cancer. Controlled studies will be necessary to determine whether this may be a faclor in the development of BPH and p

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00537.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Enkephalin is one of the opioids, which is expressed widely in reproductive organs. However, the function of enkephalin in male reproduction is not completely understood. The effect of metenkephalin on sperm motility remains especially controversial. In this study we examined the level of metenkephalin in seminal plasma from men with normal sperm production and patients with asthenospermia, oligospermia, and azoospermia to investigate the role of metenkephalin in seminal plasma on sperm function. We also investigated the effect of metenkephalin on sperm motility in vitro.Methods: Sixty nine infertile patients (31 oligospermic, 21 asthenospermic, and 17 azoospermic) were included in this study. The level of metenkephalin in seminal plasma of these men was measured and the effect of the peptide on the motility of human sperm was examined in vitro. Seventeen men with normal seminograms were a control group.Results: The level of metenkephalin in the seminal plasma of semen from asthenospermic men was significantly lower than that from the controls (P<0.05). No significant correlations between the level of metenkephalin and the mean pathing or progressive velocity of sperm, or serum hormone levels were observed. In the in vitro study, which used semen from the controls, treatment of sperm with metenkephalin (50–200 pg/mL) maintained sperm motility for 4 hours. On the other hand, motility of sperm incubated without metenkephalin began to decrease at 3 hours. Metenkephalin levels of 50 pg/mL in seminal plasma is considered to be necessary for maintaining sperm motility.Conclusion: These results suggest that metenkephalin in seminal plasma is an important clue in the investigation of decreased sperm motilit

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00538.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY