The Japanese Journal of Urology
Online ISSN : 1884-7110
Print ISSN : 0021-5287
ISSN-L : 0021-5287
Volume 80 , Issue 10
Showing 1-16 articles out of 16 articles from the selected issue
  • Jun Shimazaki
    1989 Volume 80 Issue 10 Pages 1407-1416
    Published: October 20, 1989
    Released: July 23, 2010
    JOURNALS FREE ACCESS
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  • Haruo Ito, Kunio Yamaguchi, Yasuyo Nishikawa, Tadashi Kotake
    1989 Volume 80 Issue 10 Pages 1417-1421
    Published: October 20, 1989
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Oxalic acid seems to be more important for the formation of calcium oxalate stone than calcium. Three grams of calcium lactate and 3g of uraly U® were administered to 35 urolithiasis patients, whose stones were mainly composed of calcium oxalate. Urinary oxalate level was reduced significantly without raising urinary calcium lavel by the administration of the two drugs for two weeks. The reduction of oxalic acid was particularly remarkable in patients without hypercalciuria. The mechanism of action of these drugs and the relation to dietary management were discussed.
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  • Michitaka Yajima
    1989 Volume 80 Issue 10 Pages 1422-1429
    Published: October 20, 1989
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Recently, intracavernous injection of some vasoactive drugs has been performed for the diagnosis and treatment of impotence. Despite extensive studies the mechanism of erection is still obscure.
    Therefore, the author studied the effects of some vasoactive drugs on isolated rabbit corpus cavernosum penis.
    Norepinephrine, phenylephrine or clonidine caused contraction of isolated rabbit corpus cavernosum strips in a concentration-dependent manner. This contractile effect was more potent with norepinephrine and phenylephrine than with clonidine. Prazosin was more effective than yohimbine in inhibiting norepinephrine-induced contractions. Papaverine and verapamil strongly relaxed the strips contracted by norepinephrine. Prostaglandin E1 also showed a relaxant effect. Low concentrations of isoproterenol caused relaxation, but in high concentrations it caused contraction. Acetylcholine relaxed norepinephrine-contracted strips in a concentration-dependent manner. Although the relaxant effect of acetylcholine was weaker than that of papaverine at high concentrations, acetylcholine and papaverine were almost equally effective at low concentrations. Vasoactive intestinal polypeptide relaxed the strips, and it was significantly more potent than papaverine.
    These findings suggest that both postsynaptic α1-adrenoceptors and α2-adrenoceptors are present in rabbit corpus cavernosum penis, and that α1-adrenoceptors are predominant. The flaccid state of the rabbit penis seems to be maintained mainly by α1-adrenoceptors. Verapamil seems to be useful for the diagnosis and treatment of impotence as papaverine. Acetylcholine and vasoactive intestinal polypeptide may be neurotransmitters involved in erection.
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  • Katsumi Kaneko, Toru Suzuki, Etsuji Takasaki
    1989 Volume 80 Issue 10 Pages 1430-1435
    Published: October 20, 1989
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The immunohistochemical study of tissue polypeptide antigen (TPA) was performed by Avidin-Biotin-Peroxydase complex method (ABC method) in the human bladder tumors.
    Thirteen bladder tumors (4 cases with transitional cell carcinoma grade 1, 6 cases with grade 2 and 3 cases with grade 3; 7 cases with pTa, 3 cases with pT1 and 3 cases with pT3) were subjected to this study.
    Prior to the experiment, it was confirmed that the TPA reactivity was not diminished by the tissue fixation with buffered formalin within 72 hours.
    Bladder tumors of grade 1 and 2 were strongly stained for TPA, whereas bladder tumors of grade 3 appeared to be stained weakly. There were no relationships between TPA stainings and the tumor staging, and between the TPA stainings and the prognosis of the patients.
    We have concluded that the TPA staining might be a useful method for determination of the bladder tumor grading.
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  • Yuichiro Shinno
    1989 Volume 80 Issue 10 Pages 1436-1442
    Published: October 20, 1989
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Simultaneous recordings of electromyography of the external urethral sphincter (EUS) and bladder pressure were performed in 73 patients. The majority (69 cases) were afflicted with neurogenic vesical dysfunction, while four with benign prostatic hypertrophy (BPH) were also examined as control. Detrusor sphincter dyssynergia (DSD), whereby EUS failed to relax on voiding attempt, was noted in 64 patients. By examining the patterns of DSD throughout the voiding, it was possible to calssify them into three distinct types as done by Blaivas. Type 1 was found in 7 patients, Type 2 in 10 patients, and Type 3 in 47 patients. Synergic urethral sphincter activity (Type 0) was found in other 9 patients including all four with BPH. Voiding dysfunction as evaluable by residual urine rate tended to increase as the type deteriorated from 1 to 3. Analysis of motor units revealed that the units noted during continent phase of the bladder disappeared (A0), decreased (A1), and retained or rather increased their activity (A2) during voiding attempt with (B1) or without (B0) recruitment of new units. A0B1 was found in 3 patients, A1B1 in 7, A2B1 in 32, A2B0 in 4, and A1B0 in 2. Again there was a tendency for voiding function to deteriorate as motor units sub-type changed from A0 to A1 and A2. The analysis of these motor units activities suggested that abnormal continence reflex (i. e. failure of vesicourethral and urethrourethral relaxation reflex and exaggeration of urethrourethral contraction reflex) might be contributing to the genesis of DSD.
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  • Yuichiro Shinno
    1989 Volume 80 Issue 10 Pages 1443-1450
    Published: October 20, 1989
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The relevance of the type of detrusor sphincter dyssynergia (DSD) and motor unit analysis as examined by simultaneous recordings of electromyography (EMG) of the external urethral sphincter (EUS) and bladder pressure was discussed in the first report. In this report, they were analysed similarly before and after radical transurethral resection of the prostate (TUR-P) to see how it was effective in relieving DSD. Furthermore, the response of the EUS to alpha-adrenergic stimulation was examined by analyzing its motor unit activity. Radical TUR-P was performed in 18 cases. After radical TUR-P, there was an improvement in the type of DSD (3 cases) or in its sub-types (8 cases), associated with decrease in residual urine rate in 16 cases. EUS responded to alpha-adrenergic stimulation with an increase in the frequency of pre-existing motor units and recruitment of new motor units. After radical TUR-P, EUS was similarly activated when stimulated with alpha-adrenergics. These data indicated that radical TUR-P was effective in relieving DSD by suppressing or abolishing abnormal continence reflex. Moreover, alpha-adrenergic activation of EUS also seemed to suggest a possible sympathetic role in the genesis of DSD, although exact mode of its involvement in the somatomotor innervation of the EUS remains to be settled.
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  • Toshiaki Gotoh, Hidehiro Kakizaki, Hajime Morita, Tomohiko Koyanagi, D ...
    1989 Volume 80 Issue 10 Pages 1451-1458
    Published: October 20, 1989
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A retrospective study on antireflux surgery for primary vesicoureteral reflux at Hokkaido University Hospital was performed. One hundred and seventy-nine patients (299 ureters) underwent antireflux surgery in these 17 years and 7 months. When the period was divided into 3, success rate was 96.5, 93.8 and 100 per cent, respectively. Overall success rate was 96.6 per cent. There was a combined failure or complication in 9 patients. The records of these 9 were reviewed in detail. Three were believed to be a technical error: 2 stricture and one persistent reflux. The remaining 6 were all children except one and had no clear reason for failure: 2 persistent reflux and 4 contralateral appearance of reflux (“missing VUR”). Four of these 6 patients were characterized by voiding dysfunction, namely uninhibited bladder. In 3 patients reflux disappeared spontaneously by administration of anticholinergic agent. In many of these, vesical diverticulum formation was also noted to precede or to coincide with recurrence or appearance of reflux. Thus other 3 patients with diverticulum formation after antireflux surgery were added and re-evaluated. All 3 children had voiding dysfunction with uninhibited bladder. Diverticulum formation was believed to be related to uninhibited bladder in at least one child. It seems that the child with uninhibited bladder and reflux is particularly at risk for failure or complication of antireflux surgery. Patients with symptoms of voiding dysfunction deserve a complete evaluation, including cystoscopy and urodynamics.
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  • Masaaki Tachibana, Seido Jitsukawa, Tomohiko Iigaya, Taro Shibayama, S ...
    1989 Volume 80 Issue 10 Pages 1459-1465
    Published: October 20, 1989
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    In this study we evaluated 77 patients with superficial bladder cancer who were treated with either intravesical bacillus Calmette-Guerin (BCG) (44 patients) or doxorubicin hydrochloride (Adriamycin, ADR) (33 patients) for prophylaxis of tumor recurrence after transurethral resection. The estimated actuarial probability of non-recurrence rate at three years for the BCG group was 73.0%, and the actuarial non-recurrence rate for the ADR group was 27.3%; a statistically significant difference (p=0.0013). A comparison between the two groups was also made according to the patient's background, including whether the tumor was initial or recurrent, solitary or multiple, and the tumor grade. In all areas of the study, except for grade-1 tumors, the BCG group was significantly superior to the ADR group.
    The efficacy of BCG therapy as a result of different BCG treatment protocol was evaluated for six weekly instillations 1) without further maintenance instillation, 2) followed by 12 months of maintenance, and 3) followed by more than 18 months of maintenance. Long-term maintenance BCG instillation group (more than 18 months) showed the most favorable results, however, the differences were not statistically significant.
    These results indicate that intravesical BCG instillation was significantly superior to ADR in the prevention of bladder cancer recurrence and that six weekly intravesical BCG instillations may provide adequate prophylactic effects against recurrence of superficial bladder cancers.
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  • Koichiro Isurugi, Yasushi Kondo, Kiyoshi Hirasawa, Tsuneo Oyamatsu, Yu ...
    1989 Volume 80 Issue 10 Pages 1466-1473
    Published: October 20, 1989
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Six patients with advanced prostatic cancer who had been treated by long-term administration of LH-RH agonistic preparations (Buserelin or Leupron) were tested for their pituitary-testicular endocrine functions. Serum levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone (T), prolactin (PRL), estradiol (E2) and dihydrotestosterone (DHT) were measured consecutively. In all medically castrated patients, serum levels of LH, FSH, T, DHT anbd E2 were suppressed and particularly serum T levels were below the castration level of 1.0ng/ml. On the other hand, serum PRL levels were unchanged after the long-term treatment with the agonists. Serum LH and FSH levels failed to respond to LH-RH stimulation after the treatment, whereas serum T responded to stimulation by human chorionic gonadotropin (hCG) to various degrees. It was remarkable that, in 4 out of 6 medically castrated patiejnts treated up to more than 3 years, serum T response levels above 1.0ng/ml were noted. It is suggested that testicular endocrine function to secrete T and DHT in patients under treatment with long-term LH-RH agonist administration are still preserved in response to hCG stimulation.
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  • Tokumi Ishii, Chisato Takamura, Atsunobu Esa, Young Chol Park, Shigeru ...
    1989 Volume 80 Issue 10 Pages 1474-1480
    Published: October 20, 1989
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    With respect to prostatectomies carried out in clinic since the opening of the Kinki University Hospital in 1975, incontinence after prostatectomy was investigated with 470 patients as subjects for whom a follow-up study after the operation was possible. Also, the usefulness of the urodynamic tests for diagnosing underlying diseases was investigated.
    1) Overall incidence of incontinence after transurethral resection of the prostate (TUR-P), retropubic prostatectomy (RPP) and cryoprostatectomy was 5.7 percent.
    2) The incidence of incontinence was 7.1 percent of the patients with TUR-P and 3.5 percent of patients with RPP. The incidence of incontinence after cryoprostatectomy was none.
    3) There was no clear differences among the incidence of incontinence after prostatectomy and the weight of resected tissues.
    4) There was no clear differences among various types of incontinence after each procedures of prostatectomies.
    5) The incontinence was satisfactorily treated and disappeared in 18 patients within one year after the operation. In patients who failed to get continence within a year, the incontinence was likely to persist furthermore.
    6) The cure rate was low in patients with abnormal findings in a cystometrogram performed prior to the operation. Associated diseases which could cause disorders in nervous system were frequently encountered in such patients.
    7) Drugs and functional electrical stimulation (FES) were introduced for the treatment of incontinence after prostatectomy. FES was effective in 36.4 percent in which drug therapy was not effective. Since multiple drug regimen was administered in most of the patients, it was difficult to make a precise evaluation of judgement for effect of each of drugs.
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  • Yuji Nakagawa
    1989 Volume 80 Issue 10 Pages 1481-1488
    Published: October 20, 1989
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    This paper is the 10th report in a series of studies on the application of microexplosion to medicine and biology.
    In the application of microexplosion for destruction of ureteral calculi, the mechanical property of the ureter is an important factor for the prevention of complication. To clarify the factor in humans, tensile and expansive tests were performed on the middle portion of the normal ureter taken from fresh cadavers.
    Tensile test:
    Tensile test was performed using 11 ureters in the longitudinal direction and 7 in the transverse direction.
    1) In the both directions a 3-phase curve was obtained between the elongation of the specimen and the load, turning at the two yield points. It was presumed that a small part of the mural element of the ureter was first torn at the first yield point, then all the element followed at the second point.
    2) At the each yield point the tensile strength and maximum tensile stress of the transverse direction of the ureter were weaker than those of the longitudinal direction, although the elongation ratio at the two yield points was similar in the both directions. It was presumed, accordingly, that ureteral injury first occurred in the transverse direction.
    3) The maximum tensile stress of the ureter was higher than that of the bladder.
    Expansive test:
    Expansive test was performed using 10 ureters.
    1) At a leakage point, the internal pressure of the ureter was 1.9kgf/cm2 and the internal diameter was 6.4mm on average.
    2) At the leakage point, the tensile strength and elongation ratio of the external diameter were 0.71kgf/cm and 0.80 on average, respectively. The values were approximately equal to those of the tensile strength and elongation ratio measured by tensile test in the transverse direction.
    It was thought from the results that the ureter was more suitable than the bladder for the application of microexplosion. However, if a conventional apparatus for the method is employed directly in the ureter, ureteral injury may occur by the generated gas because of the too small diameter of the ureter at the leakage point. The development of a new type of device is required for microexplosion ureterolithotripsy.
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  • Atsushi Fukuzaki, Isao Numata, Seiichi Orikasa
    1989 Volume 80 Issue 10 Pages 1489-1496
    Published: October 20, 1989
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Factors affecting the progression of autosomal dominant adult type polycysic kidney disease were analysed in 27 cases. The patients ages ranged from 10 to 74 (mean 44) years old and the serum creatinine values were within the normal limits except two cases, in which the valnes were 2.4mg/dl and 2.1. They were followed for from 2 years to 12 years (mean 5.6 years). During the followup period, 6 cases showed elevation of the serum creatinine values and hemodialysis was necessary in 4 cases. There was a tendency of higher morbidity rate of hypertension, proteinuria, hematuria and pyria in the cases with decreased renal function. These factors may have participated in the progression of polycystic kidney disease.
    Cystic fluid analysis was performed by percutaneous puncture of more than hundred cysts in 27 cases. The results showed that the cystic fluid components of most cysts of the well functioning kidneys were similar to those of serum values: so-called proximal cysts. On the other hand, in the cases with decreased renal function, there were many cysts with lower sodium concentration and higher creatinine values: so-called distal cysts. The results suggest that the existence of so-called distal cysts may indicate poorer prognosis.
    DMSA renoscintigraphy was useful for followup the polycystic kidney patients because of the uptake of the radionuclide was decreased before rising the serum creatinine value. In 6 cases, the cysts were instilled with 95% ethanol. Followup ultrasonography and DMSA renoscintigraphy revealed a marked reduction of the cystic size and an improvement of DNSA uptake. Those results indicate that the increment of the cystic size may be one of the most important contributing factors in the progression of polycystic kidney disease. And percutaneous reduction of the cystic size will be beneficial for preserving renal function in polycystic kidney disease.
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  • Takashi Deguchi, Manabu Kuriyama, Ikuo Shinoda, Manabu Okano, Yoshihit ...
    1989 Volume 80 Issue 10 Pages 1497-1501
    Published: October 20, 1989
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Enzyme immunoassays (EIAs) using rabbit anti-γ-seminoprotein (γ-Sm) antibody and rabbit anti-prostate-specific antigen antibody (PA) for measurements of γ-Sm and PA were developed in order to determine the correlation between serum γ-Sm levels and serum PA levels in patients with prostate cancer. Each EIA for measurement of γ-Sm or PA was revealed to be sensitive and reproducible by fundamental analysis of the quality of EIAs. A significant correlation was established between serum γ-Sm levels and serum PA levels which were measured by these assays and expressed as protein concentration of seminal plasma (r=0.99). This result coincided with our previous observation that γ-Sm and PA are immunologically identical materials. We conclude, therefore, that γ-Sm and PA should be regarded as tumor markers identical to each other for serodiagnosis of prostate cancer.
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  • Nozomu Kawata, Yasuo Satoh, Kiyoaki Kitajima, Kiyoki Okada, Takashi Ki ...
    1989 Volume 80 Issue 10 Pages 1502-1508
    Published: October 20, 1989
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The interrelationship among localization of tumor, local extention, lymph node metastasis and various histological grades was investigated in 31 consecutive series of prostate cancer treated by radical prostatectomy. Surgical specimens were examined by step sections cut perpendicular to the urethra. Each tumor was graded histologically in accordance with WHO-Mostofi grading (evaluated by nuclear anaplasia and structural differentiaion), Gleason's and M. D. Anderson's grading systems. The areas of the prostate was divided into 4 quadrants delimitated vertically along the urethral axis and transversly at the level of utricle, i. e. anterior/superior, anterior/inferior, posterior/superior and posterior/inferior quadrants. Topographical localization and extention of each tumor was examined in accordunce with the above area subdivision. Every tumor was growing at least in the posterior/inferior area. All cases with tumor progression to the anterior/superior area also revealed extensive tumor growth in the other two or three quadrants. Therefore, prostate cancer appears to be originated from the posterior/inferior area of the prostate and terminated in the anterior/superior area as local extention. In 31 cases examined, capsular invasion was noted in 22, seminal vesicle invasion in 16, and lymph node metastasis in 12 cases. All cases with seminal vesicle invasion also showed capsular invasion. None of the cases without capsular and/or seminal vesicle invasion had lymph node metastasis. Thus, it is inferred that prostate cancer is initially growing locally, extending to the capsule and seminal vesicle and then metastasizes to the pelvic lymph nodes. As for the histological grading, higher grade tumors tended to show higher incidence of capsular and seminal vesicle invasion and lymph node metatasis. From the reults, it was suggested that degree of nuclear anaplasia was an especially useful predictor of capsular invasion, and every grading system examined was a feasible predictor for seminal vesicle invasion and metastasis.
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  • Hiroshi Misaki, Taro Shuin, Masahiro Yao, Yoshinobu Kubota, Masahiko H ...
    1989 Volume 80 Issue 10 Pages 1509-1513
    Published: October 20, 1989
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    In order to understand the role of myc family genes (c-myc, N-myc and L-myc) in the development and progression of human testicular cancer, we have analyzed the expression of myc family genes in three different types of primary human testicular cancer (seminoma, embryonal carcinoma and teratocarcinoma) and normal testis using Northern blot analysis.
    Expression of N-myc gene, which is usualy limited in the neoplasms derived from neuroectoderm, was detected in seven out of ten cases of seminomas and two out of two cases of embryonal carcinomas. Gene amplification was not observed in these cases. Expression of N-myc gene was not detected in teratocarcinomas and normal testes. Expression of c-myc gene was observed in seminomas, embryonal carcinomas, teratocarcinomas and normal testes, but specific expression of c-myc gene was not seen in these cancers and normal testes. Expression of L-myc gene was not detected in all cases examined in our studies.
    Since N-myc gene expression was observed only in undifferentiated testicular neoplasm, such as seminoma and embryonal carcinoma, its expression may be positively related to the development and progression of special types of human testicular cancer.
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  • Senji Hoshi, Kazuyuki Yoshikawa, Tatsuo Tochigi, Sizuichi Kageyama, Na ...
    1989 Volume 80 Issue 10 Pages 1514-1517
    Published: October 20, 1989
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Fourteen malignant cases of gonadal stromal tumor were found among the cases reported in literature, but the roles of chemotherapy and radiotherpy have not been defined. We treated a malignant case and achived 98.9per-cent remission of lung metastases by salvage chemotherapy (cis-platinum+VP-16).
    A 34 year-old desk-worker, underwent left orchiectomy for testicular tumor on March 20, 1984. Histologic examination showed a malignant gonadal stromal tumor invading into the epididymis. Three course of adjuvant chemotherapy with cis-platinum, vinblastin, and peplomycin (PVP) were performed. However, chest X-ray films 13 months later revealed multiple lung metastases. Although 3 courses of combination chemotherapy with cyclophosphamide, adriamycin, vincristine, and predonisolone (CHOP) were given, no remission was obtained. However following 4 courses of combination chemotherapy with cis-platinum and VP-16, 98.9per-cent remission of lung metatases was achieved. Subsequent bilateral residual lung tumors were resected. However, lung metastases recurred 3 months later, and the patient died on Feburary 29, 1988. The autopsy revealed extensive lung, liver and pancreas metatases, but no lymph node metastases.
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