The Japanese Journal of Urology
Online ISSN : 1884-7110
Print ISSN : 0021-5287
ISSN-L : 0021-5287
Volume 80 , Issue 8
Showing 1-17 articles out of 17 articles from the selected issue
  • Joichi Kumazawa
    1989 Volume 80 Issue 8 Pages 1123-1126
    Published: August 20, 1989
    Released: July 23, 2010
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  • Kiyoharu Okamura, Souhei Tokunaka, Masanobu Miyata, Hiromitsu Fujii, M ...
    1989 Volume 80 Issue 8 Pages 1127-1133
    Published: August 20, 1989
    Released: July 23, 2010
    Male rabbit's external urethral sphincter was examined by histochemical muscle fiber typing (myosin ATP-ase staining), and the analysis with construction of histograms regarding to muscle fiber types were performed. Rabbit's external urethral sphincter was predominantly composed of fast twitch (type 2) fibers (87.3%) as a whole. But the proportion of constituent fiber types varied according to the layers, i. e., the slow twitch (type 1) fibers constituted a relatively high percentage (33.4%) in the inner third layer, while few of the type 1 fibers were found in the outer third layer. The all histograms regarding to fiber type in different layers were normal bell-shaped distribution curves. The mena diameter of type 2 fibers (14.7um.) was evidently larger than that of type 1 fibers (20.5um.). All three kinds of muscle fibers equally tended to increase in size toward the outer direction, and in every three layers, the diameter of type 2 was larger than that of type 1 also. The definite differences in the proportion of fiber types and fiber sizes between layers may implicate that the inner and outer layers play different roles, i. e., continuous tonic constriction in the former and sporadic strong constriction of short duration in the latter, under different neural regulations. As far as rabbit's external urethral sphincter is concerned, sporadic strong constriction should be mainly dependent on the muscle fibers of large size composing the outer layer, especially the fast twitch fibers. It is possible that the rabbit is so adapted that it could interrupt urination promptly.
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  • Takahide Sugiyama
    1989 Volume 80 Issue 8 Pages 1134-1140
    Published: August 20, 1989
    Released: July 23, 2010
    Responses to electrically evoked cremasteric reflex with bulbocavernous reflex and cystometrogram were observed on 55 male adults who have complaints of micturition or sexual disorders. As the reflex centers for these reflexes were localized in the lower spinal segments, the observed results were used for the estimation of the injured loci in combination with clinical symptoms.
    The cremasteric reflex which was dealt with in this paper was the cremasteric EMG responses evoked by single electric shock applied to the ventromedial surface of the thigh or to the dorsum of the penis. The stimuli used have usually tenfold intensity of the sensory threshold, having 0.2msec duration.
    The EMG recording was made with a coaxial needle electrode insertd into the ipsilateral cremasteric muscle at the level of the pubic bone.
    All 20 controls without neurological disorders showed positive cremasteric responses, and the normal range of the latency and the burst length were 68-77msec and 52-59msec, respectively, in case of thigh stimulation.
    More than half of the patients suffered from the disorders of neural origins showed no reflex even for stronger stimulation. Combining with these data, the diagnostic usefulness for the localization of injuries in patients having disordes in either spinal cord or in cerebral vessels was positive. Cerebral influence to the cremasteric reflex was deduced to be a potentiating factor to elongate the burst duration for stronger stimuli. Further detailed observations would yield usuful clues for neurourological diagnosis of the lower spinal cord injuries.
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  • Tatsuya Okano, Shigeo Isaka, Jun Shimazaki, Tatsuo Igarashi, Shino Mur ...
    1989 Volume 80 Issue 8 Pages 1141-1147
    Published: August 20, 1989
    Released: July 23, 2010
    Eighty-three patients with renal pelvic and ureteral carcinoma operated in Chiba University Hospital were followed. Age ranged between 23 and 79 years old (average 61.8 years) with the male-to-female ratio of approximately 2:1. Localization of tumors was in renal pelvis in 41 (49.4%), ureter in 29 (34.9%) and both in 13 (15.7%).
    Significant correlation in prognosis was obtained with macroscopic hematuria, histological classification, grade, stage and regional lymph node involvement.
    Recurrence was found on 49 cases (59%), 21 had intra-vesical tumor and 28 showed retroperitoneal recurrence or distant metastasis. In the former the mean tumor free interval was 14.8 months and 5 year survival rate was 62.1%. In the later the mean tumor free interval was 6.5 months and 3 year survival rate was 5%. 8 (38.1%) in 21 cases with low stage papillary transitional cell carcinoma showed recurrence and it was all intra-vesical tumor. 25 (56.8%) in 44 cases with high stage papillary transitional cell carcinoma showed recurrence. Retroperitoneal recurrence or distant metastasis was recognized in 12 cases. On the other hand 14 (87.5%) in 16 cases with non-papillary transitional cell carcinoma showed recurrence, which was all retroperitoneal recurrence or distant metastasis.
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  • Hidenori Takaba, Atsuo Kondo, Kuniaki Tanaka, Tsutomu Kinjo, Kumiko Ka ...
    1989 Volume 80 Issue 8 Pages 1148-1153
    Published: August 20, 1989
    Released: July 23, 2010
    One hundred female patients with stress incontinence have been operated on by means of modified stamey's endoscopic bladder neck suspension procedure, i. e. quantifying the thread tension for bladder neck suspension. Twelve patients had 1, 000grams in the nylon loop, 5 800grams, 9 700grams, 25 600grams and 49 400grams. A follow-up period varied from 10 to 32 months (mean: 20.5 months). A 60-min pad-weighing test revealed urinary loss of 1.0 to 196.0grams/hour (mean: 36.0) prior to operation.
    1. The modified Stamey's procedure was successful in 95 patients (95%). The appropriate thread tension for bladder neck suspension was 400grams.
    2. Various complications were encountered: removal of unilateral nylon suture was necessitated in 2 patients, bleeding from operative wound in 2, bladder tamponade in 2, and clean intermittent catheterization for more than one month in 4.
    3. Micturition parameters, i. e. maximum and average flow rates, temporarilly got worse post-operatively. Mazimum urethral closure pressure decreased and functional profile length elongated which were significantly differenct from those of pre-operative values.
    4. Questionnaire sent to the patients revealed that 89 percent of them were satisfied with the operative results but 11 percent were not.
    5. The modified Stamey's procedure is simple to perform and prevents over-tightness of nylon loops. We conclude that this operative method is the treatment of choice for correction of stress incontinence.
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  • Terufumi Fujiwara
    1989 Volume 80 Issue 8 Pages 1154-1161
    Published: August 20, 1989
    Released: July 23, 2010
    IgG-FcR+-T cell ratio was measured in 50 patients with bladder tumor as a parameter to estimate the cell mediated immunity before the treatment.
    IgG-FcR+-T cell was detected by the double rosette method, employing sheep erythrocytes and rabbit IgG antibody coated chicken erythrocytes.
    IgG-FcR+-T cell ratio in 50 patients with bladder tumor was 7.6±5.7% (mean±standard deviation), while that in controls consisting of 20 patients with other diseases but bladder tumor was 5.2±2.4%. There was no significant difference between them.
    IgG-FcR+-T cell ratio in the group in early stages (pTa, pT1 & pT2) was 5.4±4.5%, and that in the group in advanced stages (pT3a, pT3b & pT4) was 10.8±6.0%. —significant difference between them (p<0.001)—.
    IgG-FcR+-T cell ratio in the low graded group (G0 & G1) was 5.5±4.4% and that in the high graded group (G2 & G3) was 9.7±6.2%. —significant difference between them (p<0.01)—.
    IgG-FcR+-T cell ratio in patients with the serum level of CEA over 2.6ng/ml was 12.5±6.3% and that under 2.5ng/ml was 5.6±3.7%. —significant difference between them (p<0.001)—.
    In patients having IgG-FcR+-T cell ratio over 9%, there was a correlation between IgG-FcR+-T cell ratio and PHA-induced lymphocyte blastogenesis ratio (r=-0.81, p<0.01).
    In patients with the serum level of CEA over 2.6%ng/ml, PHA-induced lymphocyte blastagenesis was decreased significantly and IgG-FcR+-T cell ratio was increased significantly.
    These findings suggest that serum CEA may play a role to proliferate the IgG-FcR+-T cells in association with an inhibition of PHA-induced lymphocyte blastogenesis.
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  • Naoki Nishiyama, Ichiro Nagakubo, Ryuichiro Moriguchi, Koichi Ishiguro ...
    1989 Volume 80 Issue 8 Pages 1162-1167
    Published: August 20, 1989
    Released: July 23, 2010
    Based on study of 274 cases of prostate cancer treated in our clinic, selection of patient for radical surgical treatment and choice of procedures were discussed.
    The radical surgical procedures experienced in our clinic were classfied as 31 cases of radical prostatectomy, 4 cases of radical cyctoprostatectomy and 7 cases of pelvic exenteration. The endocrine therapy was added to non curative cases postoperatively.
    In the radical prostatectomy group, the 5-year survival rate of patients with stage A and stage B prostatic adenocarcinoma were 100 and 93 per cent, respectively, and 5-year survival rate of patients who had stage C prostatic adenocarcinoma was 75 per cent. The 5-year survival rates of patients with stage C prostatic adenocarcinoma treated by radical cystoprostatectomy and pelvic exenteration were 50 per cent and 66 per cent, respectively.
    Cancer recurrence has not seen in the bladder in the patients with stage C prostatic adenocarcinoma treated by radical prostatectomy. Operation of urinary diversion had improved the quality of life.
    From this data, radical prostatectomy would be indicated for the treatment of patients with stage A, stage B and stage C prostatic adenocarcinoma.
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  • Iichiro Kondo, Masatoshi Moriyama, Tetuo Murai
    1989 Volume 80 Issue 8 Pages 1168-1174
    Published: August 20, 1989
    Released: July 23, 2010
    Preservation surgeries have been applied for cancer of the urinary bladder in 202 cases during the past twenty years.
    We herein report the result of a statistical analysis on the background factors which determine the tumor recurrence rates and metastatic rates.
    The background factors analysed were as follows: size of tumors, number of tumors, histological staging, grading, lymph vessel permeation (ly) and vessel invasion (v).
    Each factor was analysed by Kaplan-Meier method and multiple regression analysis.
    By Kaplan-Meier method, tumor size, stage, grade, ly and v were closely related to the tumor recurrence and metastasis. By multiple regression analysis, tumor size, stage and ly were important for recurrence, while tumor size, stage and v were important for metastasis.
    In this study, histological grading was not so closely related to tumor recurrence and metastasis.
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  • Masanori Akiyama, Akira Numata, Akio Imagawa
    1989 Volume 80 Issue 8 Pages 1175-1180
    Published: August 20, 1989
    Released: July 23, 2010
    We studied the influence of protein intake on the phytohemagglutinin (PHA) skin test and purified protein derivative (PPD) skin test in 45 patients on maintenance hemodialysis. The patients were 23 males and 22 females, the ages ranging from 19 to 80 years, with an average of 53.6 years. All patients were being maintained on long-term hemodialysis (mean 37.3 months). They were divided into three groups according to protein intake: Group A; less than 1.1g/kg/day, Group B; 1.1-1.5g/kg/day, Group C; more than 1.5g/kg/day. There were no significant differences among the three groups with respect to age, causative diseae and the period of maintenance hemodialysis. We measured protein intake, PHA skin test and PPD skin test.
    Significant differences were found between Group B and Group C with respect to the PHA skin test values and PPD skin test values, the values of Group C being very low compared with those of Group B. The PHA skin test values and PPD skin test values were only slightly lower in Group A than in Group B. The negative reaction rate of PPD in Group A and Group C was much higher than in Group B. The results suggest that excess intake of protein impaired cellular immunity in maintenance hemodialysis patients, and that protein deficiency can also have a detrimental effect on cellular immunity. Therefore, adequate protein intake should be maintained for optimizing cellular immunity.
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  • Kenji Shimada, Takayuki Matsui, Toshihiro Ogino, Shyozou Hosokawa, Mas ...
    1989 Volume 80 Issue 8 Pages 1181-1186
    Published: August 20, 1989
    Released: July 23, 2010
    It is well recognized that reflux nephropathy is one of the commonest causes of end-stage renal failure (ESRF) in children. We made a retrospective study of 28 children with vesicoureteral reflux (VUR) who showed impaired renal function, as defined by either the serum creatinine of more than 1.0mg/dl or BUN of more than 20mg/dl. There were 20 boys and 8 girls, and the incidence of both sexes was 4.8% and 1.9% respectively. Of patients, proteinuria was detected in 22, and hypertension in 7. Five patients progressed to ESRF during his or her clinical course.
    About half of the patients in this series presented proteinuria or growth retardation which had led to urological check-up. Bilateral reflux was demonstrated in 24 patients, and all of the remaining 4 with unilateral reflux had hypoplastic or dysplastic contralateral kidney. Micturition cystourethrography revealed moderate or severe reflux in 86% of the ureters either at the first examination or during the follow-up periods. Urographic findings which suggested reanl dysfunction included bilateral small kidney, unilateral small kidney with contralateral renal scarring, and bilateral generalized renal scarring.
    According to the pattern of the progression of renal dysfunction, patients were subdivided into 3 groups. Group I; patients showed bilateral renal hypoplasia on urography, and renal dysfunciton progressed to ESRF before the age of 10 years despite surgical treatment. In patients of group II, gradual decrease of renal function led to ESRF at the age of pubery, although SCr was around 1.2-1.5mg/dl when they were about 10 years old. In group III, renal function was stable at about 1.0mg/dl of SCr during childhood. Temporary improvement of renal function was observed in only 3 of 21 children who were followed for more than 1 year after antireflux surgery. Deterioration of renal function was caused within 6 months to one year. Antireflux surgery had only little influence on the improvement of renal function in this series. We emphasize the need for early detection and management of reflux to prevent progression of renal dysfunction.
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  • Makoto Fujisawa, Mitsuru Morikawa, Shigeru Arima, Sunao Yachiku
    1989 Volume 80 Issue 8 Pages 1187-1194
    Published: August 20, 1989
    Released: July 23, 2010
    Since incidence of idiopathic calcium oxalate urolithiasis in children was very low, a study was made to analyze the risk factors of calcium oxalate stone in male volunteers without any episode of urolithiasis. They were divided into four groups, group I: eight years old, group II: 11 years old, group III: 18 to 24 years old, group IV: 41 to 45 years old.
    Inhibitory activities of urine were significantly higher in groups of children than in groups of adults. However, inhibitory activities of filtered urine, extracted through filters with conservable limit of 25000 of molecular weight, were reduced significantly. Therefore, it was suggested that materials with molecular weight over 25000 participated in the inhibitory activities.
    Furthermore, the activities of filtrated urine of group I were still higher than those of the non-filtrated urine in groups of adults. Accordingly it was considered that substances less than 25000 of molecular weight also participated in the inhibitory activities in children.
    An analysis of uric acid, cirtrate, magnesium and uronic acid in urine revealed that magnesium excretion volume and magnesium concentration ratio to creatinin were higher in children than in adults. Magnesium seemed to boost the inhibitory activities in children.
    In the measurement of crystalloid materials, the concentraiton of calcium was significantly lower in children groups than in groups of adults. It seemed that calcium also take part in reduction of incidence of urinary stone in children.
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  • Masayuki Sawamura, Kunio Odajima, Kazuhiko Nagakura, Hiroshi Nakamura
    1989 Volume 80 Issue 8 Pages 1195-1202
    Published: August 20, 1989
    Released: July 23, 2010
    Sensitivity of human transitional cancer cells to anticancer agents was evaluated utilizing cultured cell lines. T-24, MGH-U1 and KU-1. Simultaneously, chemosensitivity tests combined with 42°C hyperthermia wer performed.
    Cells inoculated in 96-well multiplates for 48 hours, were exposed to graded concentrations of doxorubicin (DOX), mitomycin C (MMC), bleomycin (BLM), peplomycin (PEP), cis-diammine-dichloroplatinum (II) (CDDP) for 2 to 48 hours. Aafter additional culture for 48 hours, viable cell numbers were estimated by the dye exclusion assay (DEA) and tetrazolium-based colorimetric assay (MTT-assay).
    In 2-hour exposure, most of anti-cancer agents did not significantly suppress the growth of the cell lines. Only DOX suppressed the cell growth. In 6-hour and 48-hour exposure, DOX, MMC and CDDP showed significant growth inhibitory effect on the transitional cancer cell lines. The effect of BLM and PEP was insufficient. The hyperthermia of 42°C enhanced the growth inhibitory effect of MMC and CDDP, but did not influence the effect of DOX.
    In comparison of DEA and MTT-assay, viable cell numbers measured by DEA well correlated with the optical density in MTT-assay. Since MTT-assay is a semiautomated, rapid and inexpensive assay with good reproducibility, it can be a useful substitute for DEA in chemosensitivity testing of cancer cells.
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  • Toshiyuki Mizuo, Akiko Tanizawa, Tetuo Okuno, Masao Ando, Hiroyuki Osh ...
    1989 Volume 80 Issue 8 Pages 1203-1206
    Published: August 20, 1989
    Released: July 23, 2010
    A modified Stamey technique was applied to nineteen women to control their stress incontinence. Needle puncture was reduced to one time for each side of the urethra by placing the Dacron sleeve parallel to the urethra. Postoperatively, the urethrovesical angle was reduced to be within normal limit, and functional urethral length and maximum urethral closure pressure increased significantly.
    All patients receiving the modifided operation restored urinay continence without any significant complications.
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  • Iwao Fukui, Hideyuki Ohashi, Shuhei Sumi, Ichiro Satake, Kazunori Kiha ...
    1989 Volume 80 Issue 8 Pages 1207-1210
    Published: August 20, 1989
    Released: July 23, 2010
    We invented a new surgical approach to the kidney through the flank to perform a radical nephrectomy for renal cell carcinoma. With the patient in usual lateral decubitus position keeping the dorsum vertical to the operating table, a skin incision is made over the XII rib from the posterior axillary line to the lateral edge of the rectus muscle. After the tip of XII rib is resected by about 5cm, the retroperitoneal space is entered. Blunt dissection of the posterior aspect of Gerota's fascia from fasciae of the quadratus lumborum and psoas muscle is easily carried out with a liver retractor or intestinal spatula. The pulsating renal artery can be identified through Gerota's fascia when the renal hilus is exposed. Following ligation and division of the artery, renal vein is exposed. On the left side, adrenal, gonadal and occasionally lumbar veins are also ligated and severed in addition to the renal vein. Then, the kidney in Gerota's fascia is removed en bloc with perinephric adipose tissue and adrenal gland.
    Of 21 patients with renal cell carcinoma seen during 1 year and 3 months from June 1987, 11 underwent this operation, and other 10 patients transperitoneal radical nephrectomy because of the possible tumor extension into the renal vein, inferior vena cava or adjacent organ, the severe spinal deformity or metastases and the necessity of additional surgical procedures for concomitant benign intraperitoneal diseases. The blood loss was smaller and operating time was shorter significantly in the translumbar group than the evaluable transperitoneal group. None of those in the translumbar group received blood transfusion. As complications, pneumothorax due to pleural injury during operation and postoperative incisional hernia occurred each in one patient, but no other serious one was found. From the above results, this approach seems to be one of choices for the surgical treatment of renal cell carcinoma, as long as the tumor is not likely to extend to adjacent organs, ipsilateral nodes or the inferior vena cava.
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  • Shiro Baba, Takeshi Masuda, Hirotaka Asakura, Masaaki Tachibana, Nobuh ...
    1989 Volume 80 Issue 8 Pages 1211-1217
    Published: August 20, 1989
    Released: July 23, 2010
    By September 1988, we performed 58 ureterorenoscopies (52 for primary ureteral calculi, 3 for ureteral biopsy, 2 for ureteral stricute and 1 for ureteral foreign body) using a Ureteromat (Uromat Storz, West Germany). Continuous saline irrigation with the Ureteromat has obviated mechanical dilation of the ureteral orifice in 93.1% of the cases, which made this endoscopy as easy as the conventional cystourethroscopy. In 4 cases (6.9%), however, balloon dilation of the ureteral orifice was necessary for the passage of a rigid ureterorenoscope.
    Of 52 ureteral calculi, 37 were assigned for transurethral ureterolithotripsy (TUL), whereas transurethral ureterorenoscopy (TUURS) was indicated to flush the remaining 15 calculi up into renal pelvis for later extracorporeal shock wave lithotripsy. TUL was successful in 81.1% (30/37). The causes of failure were stone migration in 6 cases and ureteral avulsion by electrohydraulic lithotripsy necessitating open surgery in 1 case. The irrigation with the Ureteromat facilitated the manipulation of intraluminal ureteral lesions always under clear vision; by-passing the impacted stone with a guide wire and flushing-up of the calculi were successfully performed in 100%, in spite of the co-existing edematous and inflammatory mucosal changes.
    In 7 cases where ureteroscope could not be advanced well up to the lesion because of spasm in the iliac ureter, the irrigation pressure was transiently increased up to 200mmHg to allow safe and easy dislodgement of impacted calculi under fluoroscopic guidance. This procedure was also effective to introduced a ureteral stent over a guide wire in 2 cases of ureteral stricture, which could not be achieved by conventional cystoscopic procedure.
    Immediate postoperative complications were fever in 8.6% and gross hematuria lasting for more than 4 days in 8.6%. Intravenous urogram obtained in 50 patients after 3, 6 and 12 months disclosed no remarkable adverse effects on the upper urinary collecting system, except for a mild hydroureter in one patient requiring no surgical intervention.
    It is concluded that TUURS using a Ureteromat is a safer and more feasible method than any technique previously reported for the passage of a rigid ureterorenoscope.
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  • Hirotaka Asakura, Masaaki Tachibana, Shirou Baba, Nobuhiro Deguchi, Se ...
    1989 Volume 80 Issue 8 Pages 1218-1223
    Published: August 20, 1989
    Released: July 23, 2010
    The incidence of transitional cell carcinoma (TCC) of the bladder has been increasing in men with a peak incidence occurring in the sixth decade. However, developement of tumors under the age of 30 is relatively rare. In this regard, it has been reported that vesical tumors in the young group is less malignant and rare to recur when compared with those in the elderly group. Recently, flow cytometric DNA histograms (FCM) provides quantitative and objective informations for detection and evaluation of malignant potential of bladder neoplasms. Here we report patients with tumor of the bladder under 30 years old and assess the clinical properties and biological characteristics of their tumors based on FCM. A total of 11 patients from 1975 through 1988 were reviewed Their mean age at the diagnosis was 22.6 years old (range from 22 to 29 years old). Male/female ratio was 2.7:1. The mean follow-up period was 4 years and 7 months (range from 8 months to over 13 years). An asymptomatic gross hematuria was found in all of the patients, which is the most common sign. Filling defects of the bladder on excretory urograms were observed in six out of the 11 patients (54.5%). Cystoscopically, the size of tumors was less than 2cm in diameter. Ten patients had a single tumor and one patient had multiple tumors at the time of the initial diagnosis. Endoscopically tumors were papillary in all but one patient, who had a non-papillary tumor. Their urine cytology showed class I in one, class II in eight, class III in one, class IV in one and class V in none. The stage of the tumors at the initial diagnosis was stage A in all patients and the grade of the tumors was grade I in four and grade II in seven. All patients underwent transurethral resection of the tumor and instillation therapy followed with mitomycin C in three, BCG in one, thiotepa in one and cytarabine in one. Recurrent tumor developed 10 months after transurethral resection of the tumor in only one patient. FCM analysis of bladder biopsy and irrigation specimens were performed in six patients. Two out of six biopsy spicemens (33.3%) and three out of six bladder irrigation specimens (50%) showed distinct aneuploid patterns.
    These results indicate that some bladder tumors occurring in young patients express the potentiality for an aggressive disease when assessed by flow cytometric DNA-histograms, despite the overall benign nature of the disease. Therefore, a long-term follow-up is necessary in these patients.
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  • Tadaichi Kitamura, Yoshiaki Yogo, Naoto Doi, Tetsuo Ueki, Nobuo Moriya ...
    1989 Volume 80 Issue 8 Pages 1224-1227
    Published: August 20, 1989
    Released: July 23, 2010
    Last year, we reported that human papilloma virus type 16 genome (HPV 16 genome) was detected in a case (S. Y.) of bladder carcinoma in situ (bladder CIS) (Cancer Res., 1988). Since then, a number of bladder tumors other than CIS were searched for HPV genome. However, no HPV genome was detected in the bladder tumors. From the results, we consider that HPV may not have a relation with all types of bladder tumor but with only a part of it.
    In the current report, the case (S. Y.) is presented more precisely than before, in particular on the characteristic bladder lesion. The patient was a 40-year-old female with immunodeficiency and anemia who was referred from a hospital with a complaint of asymptomatic pyuria. Cystoscopic examinaiton revealed a bladder tumor, well-demarcated, white and velvety lesion with slight elevation.
    On November 25, 1987, she underwent total cystectomy, resection of the anterior vaginal wall and of a part of vulval skin, and ileal conduit formation. Postoperative course was stormy because of bleeding from the wounds and thrombophlebitis in the right femoral vein. In spite of the episodes, she eventually recovered and was discharged 2 months later. However she was readmitted 9 months later due to severe anemia which was ascribed to acute myelogenous leukemia. She is now on cancer chemotherapy for leukemia.
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