The Japanese Journal of Urology
Online ISSN : 1884-7110
Print ISSN : 0021-5287
ISSN-L : 0021-5287
Volume 100, Issue 3
Displaying 1-6 of 6 articles from this issue
Original Articles
  • Nozomu Furuta, Haruhisa Koide, Hiroshi Sasaki, Jun Miki, Takahiro Kimu ...
    2009 Volume 100 Issue 3 Pages 479-485
    Published: 2009
    Released on J-STAGE: February 01, 2012
    JOURNAL FREE ACCESS
    (Purpose) Diagnostic criteria for preclinical Cushing’s syndrome (PCS) were reported in 1996. However, requirement of postoperative steroid hormone replacement is still controversial issue. In this study, we observed recent surgical cases retrospectively and evaluate the use of postoperative steroid hormone replacement.
    (Materials and methods) Eighteen patients with PCS underwent surgery from 1997 to 2007 in Jikei University Hospital. Thirteen of them received postoperative steroid hormone replacement. We investigated preoperative hormone activity by 131I-adosterol scintigraphy and suppression of ACTH and evaluated the requirement of postoperative steroid hormone replacement.
    (Results) Preoperative serum cortisol was normal range in all patients. Serum ACTH was suppressed in 10 of them (56%). In 131I-adosterol scintigraphy, accumulation in ipsilateral side was observed in all patients. Accumulation in contralateral side was observed in 13 patients whose serum ACTH had tendency to be suppressed. Mean period of steroid hormone replacement was 19.8 weeks. Patients with lower preoperative ACTH tended to require longer period until withdrawal of steroid hormone replacement. In addition, patients received steroid hormone replacement with higher starting dose significantly required longer period. Three of them had complications during tapering of steroid hormone.
    (Discussions and conclusions) Postoperative adrenal insufficiency is important issue as postoperative management of PCS patients whose function of contralateral adrenal or pituitary gland is suppressed. 131I-adosterol scintigraphy and preoperative serum ACTH were important factors to evaluate the requirement of postoperative steroid hormone replacement. Especially, patients with low preoperative serum ACTH tended to require long duration of postoperative steroid hormone replacement. On the other hand, patients with accumulation of contralateral side in 131I-adosterol scintigraphy and without suppression of serum ACTH may not require steroid hormone replacement. Decrease starting dose of steroid hormone replacement for appropriate patients could shorten the period of steroid hormone replacement safely.
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  • Satoshi Washino, Masaru Hirai, Fumihito Terauchi, Atsushi Matsuzaki, Y ...
    2009 Volume 100 Issue 3 Pages 486-494
    Published: 2009
    Released on J-STAGE: February 01, 2012
    JOURNAL FREE ACCESS
    (Purpose) To evaluate intra-arterial chemotherapy for bladder preservation in patients with locally advanced bladder cancer.
    (Patients and methods) A total of 34 patients with locally advanced bladder cancer (T2, n=25; T3, n=9) were treated with intra-arterial chemotherapy. Chemotherapy was consisted of intra-arterial administration of cisplatin (100mg/body), and adriamycin or pirarubicin (50mg/body) every 4 weeks for two cycles. The response was evaluated by TUR, urine cytology, CT and/or MRI 4weeks after the treatment. In 4 patients, we combined this treatment with radiotherapy.
    (Results) Among all 34 patients, 12 (35%) patients presented complete response (CR) and 24 patients (70%) presented in objective response (OR). During mean follow up period of 28.7 months, five patients had locally advanced recurrence and one had distant metastasis. The 5-year survival rate was 69.3%. Bladder was conserved in 19 (56%) of all 34 patients. Hematological and gastrointestinal toxicity (more than grade 3) was occurred in 5 and 3 patients. Risk factors on the outcome of this therapy were tumor size>20mm, multiple tumors and clinical stage≥cT3. Patients with no or one risk factor had favorable outcomes; the OR rates of 75-100%, the bladder preservation rates of 71-75% and the 5-year cancer specific survival rates of 83%. Whereas patients with two or three risk factors had unfavorable outcomes; the OR rates of 50-58%, the bladder preservation rates of 25-42% and the 3-year cancer specific survival rates of 0-69%.
    (Conclusion) The treatment of locally advanced bladder cancer with intra-arterial chemotherapy seems to be good for patients with less risk factor, but not so good for patients with more risk factors.
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Case Reports
  • Naoya Satake, Yoshio Ohno, Kunihiko Yoshioka, Noboru Sakamoto, Hisashi ...
    2009 Volume 100 Issue 3 Pages 495-499
    Published: 2009
    Released on J-STAGE: February 01, 2012
    JOURNAL FREE ACCESS
    Skeletal muscle metastasis is a rare event in renal cell carcinoma (RCC). Only thirty-two cases have been reported until now. A 69-year-old female had a nephrectomy for right RCC (clear cell carcinoma, grade 2, pT1) in 1994. She has been followed up every three months after nephrectomy. After twelve years from nephrectomy, computed tomography (CT) showed a 3 cm mass in the right iliopsoas muscle. CT guided needle biopsy revealed tumor cells suspicious of renal cell carcinoma metastasis. The tumor was surgically removed and histologically diagnosed as renal cell carcinoma metastasized to the iliopsoas muscle.
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  • Keisuke Yamamoto, Yasuhiro Matsuoka, Tetsuya Takao, Akira Tsujimura, A ...
    2009 Volume 100 Issue 3 Pages 500-503
    Published: 2009
    Released on J-STAGE: February 01, 2012
    JOURNAL FREE ACCESS
    We report a case of idiopathic elephantiasis of penis.
    A 41-year-old man was refered to our hospital with a painful penile swelling and severe miction pain. He had no particular past or familial history, and had never been to tropical or semitropical region. Physical examination showed a prominent swelling and flection of his penis. Magnetic resonance imaging revealed a significant thickening of the penile skin and subcutaneous tissue. Due to the difficulty of voiding, an urethral catheter was placed. The penile skin biopsy showed no malignancy. Under the diagnosis of penile elephantiasis, the resection of abnormal penile skin and penile plasty with the split skin graft from his thigh was performed. Histopathological findings showed non-specific inflammation. The skin graft was successfully adapted. He could urinate smoothly without pain after the urethral catheter was removed. There has been no recurrence 6 months after the operation. He recovered normal micturition and sexual function.
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  • Takayuki Nakayama, Minato Yokoyama, Kazutaka Saito, Shunsuke Takenaka, ...
    2009 Volume 100 Issue 3 Pages 504-507
    Published: 2009
    Released on J-STAGE: February 01, 2012
    JOURNAL FREE ACCESS
    A 46-year-old woman with sudden on set strong right flank pain was transferred to our hospital with the diagnosis of right renal infarction. Cardiac ultrasonography revealed a vegetation on the posterior cusp of the mitral valve, and the renal infarction was thought to be caused by renal artery embolism from infective endocarditis. Since the vegetation remained after antimicrobial therapy as conservative management, the patient was surgically treated by mitral annuloplasty.
    It has been known that infective endocarditis can cause renal infarction. Infective endocarditis requires immediate and adequate treatment because of high mortality. Therefore, the appropriate diagnosis of infective endocarditis is needed for patients with renal infarction without any other disorder causing renal infarction.
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Procedure
  • Tomonori Minagawa, Yasushi Murata, Satoshi Seki
    2009 Volume 100 Issue 3 Pages 508-512
    Published: 2009
    Released on J-STAGE: February 01, 2012
    JOURNAL FREE ACCESS
    Abstract: Intraurethral catheters are effective in the treatment of elderly patients with benign prostate hyperplasia (BPH) who have severe complications. However, it is not easy to measure the length of the prostatic urethra and to determine an appropriate location for the urethral catheter using only fluoroscopy, especially in patient with severe mid-lobe enlargement. We attempted to place a shape-memory alloy intraurethral catheter (MEMOKATH®) by transrectal ultrasonography and fluoroscopy to measure the precise length of the prostatic urethra and to determine an appropriate location for an intraurethral catheter placement.
    Patients were given urethral infiltration anesthesia with 2% lidocaine hydrochloride jelly and placed in the supine position. Both transrectal ultrasonography and fluoroscopy were performed to observe the bladder neck, the apex of the prostate gland, and the prostatic urethra. Transrectal ultrasonography was shown to depict them more clearly than fluoroscopy. Transrectal ultrasonography was also shown to be more suitable than fluoroscopy for measuring the prostatic urethra length, as well as for accurately positioning the MEMOKATH® stent, especially in cases of BPH with mid-lobe enlargement.
    The MEMOKATH® stent was placed in 7 patients with BPH. Urethral catheters had been put in place in 6 of these patients because of urinary retention, and large amounts of residual urine were found in the remaining patient. Three patients had severe mid-lobe enlargement. All patients were able to urinate without much residual urine after the procedure. No severe complications were noted.
    Transrectal ultrasonography is useful for accurately placing the MEMOKATH® stent, as it provides more objective and detailed anatomical findings than fluoroscopy.
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