The Japanese Journal of Urology
Online ISSN : 1884-7110
Print ISSN : 0021-5287
ISSN-L : 0021-5287
Volume 81 , Issue 1
Showing 1-21 articles out of 21 articles from the selected issue
  • Yoshiaki Satomi
    1990 Volume 81 Issue 1 Pages 1-13
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    An account was given of the current status of treatment of renal cell carcinoma and reference made to problems that remain unsolved as follows: (1) Failure to keep biological characteristics of renal cell carcinoma in mind may be misleading in deciding on a therapeutic policy, (2) already eastablished as it may appear, operation for renal cell carcinoma is still open to discussion, (3) indication for operation upon metastatic lesions, (4) widespread use of interferon based on insufficient theoretical grounds to provide ample justification, (5) future development and possible usefulness of multiple drug combination therapy including interferon as a main component and (6) how to make best use of neo-adjuvant therapy for renal cell carcinoma.
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  • Takafumi Gotoh, Koji Aoyama
    1990 Volume 81 Issue 1 Pages 14-18
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Double ureters are not a rare anomaly. In the great majority of duplex-ureter systems, both components are functionally normal. Some may present medical problems such as abdominal cystic masses and recurrent urinary tract infections, even from the newborn period. The choice of the best method of the operation depends on residual renal function, the form of ureters, the shape and the position of the ureter orifice, and other factors. So, there are many methods by which to operate on duplex-ureter systems. Total heminephroureterectomy may be the best method of choice, if the duplex-ureter portion is non-functional. It is however, very difficult to resect the pathological ureter with the mate ureter uninjured, when the mate is covered by a common sheath or the patient is very small. Recently, two patients were admitted to our hospital because of abnormal findings of intrauterine echogram. One of them had a large ureterocele with a dilated ureter whose upper pole duplex kidney was non-functioning and cystic. The other patient had an upper ureter orifice opening ectopically to vagina, a ureter dilated, and a non-functioning upper pie duplex kidney. For heminephroureterectomy, resection of the upper one-fourth of the upper pole ureter was easy. But further excision of ureter seemed threatening to the mate ureter. We applied the mucolysis method, which we had been using as the operation of Sowve's method for the patients with Hirschsprung diseases. The method was technically easy and safe. There have been no complications after 1 year of follow up.
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  • Yoshifumi Asano, Katsuya Nonomura, Tomohiko Koyanagi
    1990 Volume 81 Issue 1 Pages 19-24
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Furosemide, a potent natriuretic agent, is well known to increase urinary calcium excretion. We study the effects of long term administration of furosemide on the calcium balance, renal function and histopathological changes of the kidneys and the parathyroid glands in the rat.
    Furosemide (20mg/kg) was administered 3-4 times per week for 62 weeks intraperitoneally in 10 male rats. The same volume of normal saline was administered intraperitoneally in 9 male rats as control. All were given with standard diet (CE-2) and deionized water. While urinary calcium and creatinine were measured every 1-4 weeks, serum calcium and creatinine were measured in the first week and at the end of examination.
    24 hours urinary excretion of calcium was elevated to two to three folds (a significant increase over the control: p<0.01) after the furosemide loading, though serum calcium and creatinine levels remained as in control. Despite a marked hypercalciuria in the furosemide loaded rats, there was no evidence of stone formation in the kidney or in the urinary tract. On histopathological examination renal parenchyma showed some pyelonephritic changes but without evidence of crystal formation, while no significant change was noted in the parathyroid glands.
    Based on these data we concluded that in our model, 1) there was a significant calcium loss in the absence of any change in the serum calcium, but 2) this hypercalciuria alone was not lithogenic, and 3) parathyroid glands showed no discernible secondary morphological changes.
    Some disscussion was made on the possible mechanism of (a) failure in stome fomation, (b) lack of hyperplasia in the parathyroid glands, and (c) calcium homeostasis in the furosemide loaded rats.
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  • Masahiko Saito, Momokazu Gotoh, Kumiko Kato, Atsuo Kondo
    1990 Volume 81 Issue 1 Pages 25-30
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    To investigate the etiology of unstable bladder in elderly people, we performed pharmacological experimetns using the body of the rat urinary bladder. Responses to acethylcholine, norepinephrine and isoproterenol were examined in vitro in aged rats (16 and 24 months old) in comparison with young rats (6 months old). The results of the pesent study were summarized as follow:
    1) The body weight of 16 and 24 months rats was significantly greater than that of the control.
    2) There was no significant difference in the response to acetylcholine among three age groups.
    3) The contraction strength of 16- and 24-month-old rat urinary bladder induced by norepinephrine was significantly greater than that of the control.
    4) The relaxation response of the detrusor strips induced by isoproterenol in 24-month-old rats was significautly smaller than that of the other two groups.
    It is concluded that responses to alpha-adrenergic agonists were enhanced in the aged rat urinary bladders. In the assumption that a similar change occurs in the human bladders, the age-related increase in the resposiveness to alpha-adrenergic agonists is one of the etiologies or contributing factors for unstable bladder.
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  • Masahiko Saito, Momokazu Gotoh, Kumiko Kato, Atsuo Kondo
    1990 Volume 81 Issue 1 Pages 31-36
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    To investigate the possible etiology of unstable bladder in the elderly, we investigated the responses of the aged rat bladder (16 and 24 months old) to 5 non-cholinergic, non-adrenergic neurotransmitters in comparison with the young rat bladder (6 months old). The drugs used were adenosine triphosphate, prostgalandin F, serotonin, angiotensin II and vasoactive intestinal polypeptide.
    1) The responses of 24-month-old rat bladders to adenosine triphosphate (ATP) were significantly greater than those of 6- and 16-month-old rats.
    2) Prostaglandin F made no difference in responses among three age groups.
    3) The responses to serotonin of 24-month-old rat bladders were greater than those of the other two groups.
    4) There was no difference in responses to angiotensin II in three age groups.
    5) No response to vasoactive intestinal polypeptide was observed in all age groups.
    It is probable that the supersensitive responses to ATP and serotonin, observed in the aged rat bladders, may contribute to the development of unstable bladder in elderly people.
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  • Awato Fujino, Akira Ishibashi, Ken Koshiba, Osamu Hoshiai, Sadakazu Ai ...
    1990 Volume 81 Issue 1 Pages 37-44
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Gamma seminoprotein (γSm), a glycoprotein isolated from human seminal plasma with a molecular weight of 29, 000 and possibly a serine protease, has been demonstrated to be one of the prostate organ-sepecific antigens. We established a murine monoclonal antibody (MoAb) to γ-Sm in order to prove the presence and localization of this protein in the prostate.
    The hybrid clones were obtained by fusing mouse SP2/O-Ag-14 myeloma cells with splenocytes from Balb/c mouse immunized with the major fractions of γ-Sm. The enzyme-linked immunosorbent assay was done for antibody screening. After cloning twice in soft agarose, the stable clone, termed 43-21-1-1, was finally chosen. This MoAb, IgG1(κ), recognized γ-Sm specifically, which was verified by an immunoblotting assay.
    The specificity of the MoAb was further evaluated by immunohistochemical study by the avidinbiotin complex method. Periodate-lysine-paraformaldehyde-fixed surgical specimens, including the prostate associated with fibromuscular hyperplasia, seminal vesicles, bladder, testis and epididymis, were examined. Formaldehyde (10%)-fixed surgical specimens from patients with adenocarcinoma of the prostate and primary transitional cell carcinoma arising from the periurethral prostatic ducts were also examined. Positive reactions of γ-Sm were recognized only in the cytoplasm of prostatic glandular epithelial cells and along the luminal surface. Fibrous and muscular tissues always gaven negative staining. Neither nonprostatic tissues nor transitional cell carcinoma of the prostate were stained positively for γ-Sm.
    These results show that this MoAb (43-21-1-1) is quite specific to γ-Sm and may be useful for the immunohistochemical study with prostatic tissue.
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  • Shuichi Gotoh, Masahide Mine, Kazuhiro Ishizaka, Humihisa Kaneoya, Mas ...
    1990 Volume 81 Issue 1 Pages 45-48
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Using electron microscope, distribution of lanthanum tracer in the seminiferous epithelium was evaluated in adult male rats 2, 7, 25 and 53 days after single intraperitoneal injection of 3mg/kg of CDDP. Lanthanum penetrated beyond the tight junction between Sertoli cells and the maximum penetration around the spermatid was found on the 7th day, when any degenerative changes of seminiferous epithelium were not recognized light microscopically. And 4 weeks pretreatment with Cephalantin and Kallikulein had no effects on this lanthanum tracer penetration around the spermatid. On decreasing this lanthanum tracer penetration after 7 days, some lanthanum was also found around the spermatocytes on the 53th day but not around the spermatid.
    It is proposed that lanthanum tracer penetration beyond the Sertoli cell tight junction may be a morphological marker of early Sertoli cell dysfunction after CDDP administration.
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  • Teruhiro Nakada, Hidenori Sumiya, Yoshio Shizeki, Jun Shimazaki
    1990 Volume 81 Issue 1 Pages 49-53
    Published: January 20, 1990
    Released: July 23, 2010
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    In young rats consuming 1% NaCl drinking solution, unilateral nephrectomy and bilateral adrenal enucleation caused a hypertension. Plasma caoricosterone concentration in hypertensive rats was not significantly higher than that of normotensive control rats in early hypertensive or chronic hypertensive stage. At the end of experiment, each rat received an intravenous injection of 0.4μCi/g of 3H-lysine and was sacrificed 2 hours after the injection. Incorportain of 3H-lysine into collagen or elastin of the mesenteric artery and heart in hypertensive rats was greater than that of normotensive rats. Administration of phenoxybenzamine hydrochloride lower the blood pressure of hypertensive rats and reduced the incorporation of 3H-lysine into collagen and elastin of the mesenteric artery and heart.
    From these findings, increased protein synthesis of collagen and elastin in hypertensive rats apears to play an inportant role for the maintenance of adrenal regeneration hypertension.
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  • Hideari Ihara, Kurt Rimkus, Hidekazu Takiuchi, Hiroshi Koike, Toshihir ...
    1990 Volume 81 Issue 1 Pages 54-60
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    With the purpose to avoid the risk of homologous transfusion, autologous blood transfusion was performed in 26 patients who underwent transurethral resection of the prostate (TUR-P).
    Autologous blood (200-400ml/time, 1-3times, total 200-800ml, mean 381ml) was predeposited 4 days to 3 weeks prior to elected TUR-P and was transfused during or just after the operation.
    Since the start of this program in February 1988, homologous transfusion rate was decreased to 13.1%, whereas it has been 22.3% in 203 cases between January 1984 and January 1988.
    The mean hemoglobin level fell to 81.6% of the predepositon level. However, the hemoglobin level recovered to 90.1% one month after operation. The circulatory condition of the patients with autologous transfusions was stabler than that of the patients with homologous transfusion or no transfusion. No clinical hemostatic problems occurred.
    In cases with mild to moderate volume resection of the prostate, this autologous blood transfusion is recommended.
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  • Masaki Sakurai, Takuichi Hioki, Toshiyuki Okuno, Yoshiki Sugimura, Ken ...
    1990 Volume 81 Issue 1 Pages 61-67
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    99mTc-DMSA renal scintigraphy was carried out in 54 patients with unilateral renal stones before and after PNL. Four to 8 weeks after PNL the DMSA renal uptake significantly decreased to 17.2±6.0% from 18.2±6.7% before PNL. DMSA renal uptake did not change in the contralateral side. Since in some patients changes in the DMSA renal uptake of 5-7% were observed after PNL not only in the PNL side but also in the contralateral side, the renal function was assessed by the formula: DMSA renal uptake in the PNL side/DMSA renal uptake in the contralateral side, and the change of this ratio was evaluated in 44 patients, in whom the renal DMSA uptake in the PNL side was less than two times that in the contralateral side. The DMSA renal uptake ratio decreased to 95.6±8.7% from the base line 4-8 weeks after PNL. This change was statistically significant. Some functional risks such as massive bleeding with PNL, the fever after PNL and the number of nephrostomy tract did not affect the decrease in the renal function.
    In 29 patients in whom renal function was reevaluated one year after PNL, the DMSA renal uptake ratio significantly decreased to 94.2±9.6% from the base line 4-8 weeks after PNL. But the ratio significantly imporved to 99.6±11.6% about one year after PNL. In two patients with a cold area on the renal image, the renal function of the operated side still remained at about 80% levels from the base line even one year after PNL.
    It is concluded that although renal function slightly decreased 4-8 weeks after PNL, it is expected to improve within one year after PNL. But in the case with a cold area on the renal image, the complete functional recovery would not be expected. 99mTc-DMSA renal scintigraphy is a useful adjunct to evaluate the renal function before and after PNL.
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  • Yutaka Iwase, Jiro Kato, Takaichiro Ito, Kazuo Ohtaguro, Masayuki Tsug ...
    1990 Volume 81 Issue 1 Pages 68-74
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We made clinical trials of the extracorporeal shock wave lithotripter (MEDSTONE-1000) in patients with upper urinary tract stones. Thirty-five cases (total 40 trials) treated during the period of October 1987 through March 1988 were enrolled in this study. The ages of the cases ranged from 22 to 65 (average 43.9) years old, comprising 23 men and 12 women. The site of presence of urinary tract stones was the renal plevis and calyx in 28 cases and the upper ureter in 7 cases. The size of the stone was smaller than 1cm in 15 cases, 1 to 2cm in 12 cases, 2 to 3cm in 7 cases and larger than 3cm in 1 case. 13 patients with renal stones were treated with double-J stent catheter and all patients with ureteral stones were treated with the ureteral balloon catheter or flexible-tip ureteral catheter as preoperative manipulation. In 26 cases epidural anesthesia was used and the others were treated under general anesthesia. Stone targetting was determined by two oblique radiographs from separate axes. The intensity of shock waves was mainly 24KV and the maximum shock wave counts to break up stones were 6800 shots. The size of the broken stone fragments was less than 2mm in 24 cases (68.5%) and 2 to 5mm in 10 cases (28.6%), which indicated that the procedure was very effective. However, one case in whom the stone could not be broken was with cystinuria. After three months the fragments completely passed in 22 cases (64.7%) and the residual fragments larger than 5mm were left in 2 cases (5.9%). Among the transient side effects were grosshematuria, suggillation, and fever. We are confident that this device can break urinary tract stones effectively without serious complications and is useful for ESWL.
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  • Masahiko Saito, Kumiko Kato, Momokazu Gotoh, Atsuo Kondo
    1990 Volume 81 Issue 1 Pages 75-81
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We have analyzed long-term follow-up data of the lower urinary tract in 58 myelodysplastic patients. The patients consisted of 16 males and 42 females, whose age varied from 3 months to 16 years old (mean of 7). The follow-up periods ranged from 18 to 100 months (mean of 82).
    1. While the bladder compliance of 41 patients conservatively treated with clean intermittent catheterization increased significantly from 5.1 to 11.1ml/cmH2O, that of 17 patients who underwent anti-reflux surgery failed to do so.
    2. A significant correlation was observed between bladder deformity and bladder complicance. A severe deformity was encountered more in the patients surgically treated.
    3. Uninhibited contractions decreased in magnitude or disappeared in 26 patients, and increased in strength or developed newly in 8. The remaining 24 cases did not demonstrate them at all.
    4. The maximum urethral closure pressure changed±20 percent of the initial value in 27 of 38 patients (71%). The mean value tended to fall at 60cmH2O.
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  • Hidekatsu Furuta, Teruhiro Nakada, Takashi Katayama
    1990 Volume 81 Issue 1 Pages 82-88
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    we studied the number and affinity of catecholamine receptos in SD rat kidney by radioreceptor technique.
    The following conclusions were obtained:
    1) By using 3H-prazosin, the numbers of α1-receptor (Bmax) in rat renal cortex were greater than those in rat kidney medulla. As for affinity (Kd), the significance was not recognized between the two. Bmax of the rat renal cortex to 3H-prazosin binding was 96.1fmol/mg protein, and Kd was 0.17nM, and for the rat renal medullar these values were 44.5fmol/mg protein and 0.13nM, respectively.
    2) By measurement of D1-receptor using 3H-SKF38393 in the rat renal cortex in the Scatchard plot analysis, positive cooperativity was observed under the low concentration of hot ligand which was less than 1nM. But at the concentration of hot ligand over 1nM, the plots showed a straight line. Bmax of the rat renal cortex to 3H-SKF38393 was 2.5pmol/mg protein and Kd was 5.3nM.
    3) Based on displacement by dopamine for 3H-prazosin binding to rat renal cortex, it was surmised that high concentration of dopamine had an affinity to α1-adrenoceptors.
    4) There was no change in the Kd and Bmax of α1-receptor in the rat renal cortex after incubation of samples with low concentration of dopamin. However, in the case of hih concentration of dopamine, a remarkable decrease of the affinity (Kd) of α1-adrenoceptor was observed.
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  • Yoshikazu Katayama, Tohru Umekawa, Yasuaki Ishikawa, Mitsumasa Kodama, ...
    1990 Volume 81 Issue 1 Pages 89-95
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Bone mineral contents of calcium urolithiasis patients (105 males and 52 females) were measured by the microdensitometry (MD) method, and the patients were divided into the MD normal group and the MD abnormal group. The patients were also divided into the group (21 males and 3 females) treated with thiazides for 1 year or more and the nontreated group to examine various factors in blood and urine.
    [Nontreated group]
    The rate of MD abnormality was higher in younger males. The rate tended to increase with age in females. Alkaline phosphatase values were significantly higher in MD abnormal group males than in MD normal group males. Urinary calcium excretion and PTH values were significantly higher in MD abnormal group females than in MD normal group females. Comparison of hypercalciuria and normocalciuria revealed no significant difference between the MD normal rate and the MD abnormal rate. Comparison of single of stone formers and recurrent stone formers also revealed no significant difference between the MD normal rate and the MD abnormal rate.
    [Treated group]
    PTH and alkaline phosphatase values were significantly higher in the treated group than in the nontreated group. Alkaline phosphatase values were significantly higher in the MD abnormal group.
    From the viewpoint of stone recurrence prevention, the monitoring of bones where the majority of calcium in the body is present is considered important besides behavior of calcium in blood and urine.
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  • Kazuo Suzuki, Koji Obata, Hidetoshi Fukatsu, Norimasa Ohgushi, Norihik ...
    1990 Volume 81 Issue 1 Pages 96-102
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    During the 7 years from 1980 to 1986, 2860 cases of bladder tumors were registrated in the Tokai Urological Cancer Registry. Among the 2860 cases, 2304 cases were selected from the registered cases for the present study.
    The 5-year relative (actual) survival rates were 73.8% (61.9%) of all patients; 48.9% (42.4%) in those with malignant neoplasma of urinary bladder excluding transitional cell carcinoma; 48.8% (41/3%) in those with mixed tumor. In patients with transitional cell carcinoma, the 5-year relative (actual) survival rates were 93.7% (78.8%) for G1, 87.2% (74.1%) for G2 and 47.3% (38.9%) for G3. As to staging, the 5-year survival rates were 101.9% (88.0%), 87.6% (75.3%), 57.9% (47.8%), 33.7% (28.2%) and 6.1% (5.0%) in patients with stage of Ta, T1, T2, T3 and T4, respectively. The tumors with muscle infiltration and high grade malignancy obviously deteriolated patients' survival.
    The 5-year relative (actual) survival rate for patients treated with TUR was 98.1% (82.2%). As to grading, the 5-year survival rates were 102.2% (86.6%) for G1, 104.3% (88.3%) for G2 and 56.9% (48.3%) for G3. The 5-year survival rates of those with Ta, T1 and T2 were 103.9% (89.7%), 96.0% (82.6) and 61.1% (49.1%), respectively.
    The 5-year relative (actual) survival rate for patients undergoing total cystectomy was 62.4% (52.3%). In those patients, the 5-year survival rates were 96.7% (80.9%) for G1, 63.6% (55.7%) for G2 and 55.4% (47.1%) for G3. As to staging, the 5-year survival rates were 102.3% (90.6%), 77.8% (68.2%), 56.3% (47.9%), 41.8% (34.9%) and 15.2% (13.1%) in patients with stage of Ta, T1, T2, T3 and T4, respectively.
    The 3 and 5-year relative (actual) survival rates in patients with advanced bladder tumors were 5.3% (4.8%) and 0.87% (0.73%), respectively.
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  • Masamichi Hayakawa, Seiichiro Sisido, Isao Higa, Yuzo Koyama, Tadashi ...
    1990 Volume 81 Issue 1 Pages 103-109
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Human autologous peripheral blood lymphocytes (PBL) and lymphocytes infiltrating renal cell carcinoma (TIL) were cultured with medium containing 1000IU/ml of human interleukin 2 (IL-2). A high cytotoxic activity against fresh autologous as well as cultured allogenic tumor cells was developed. By culturing these lymphocytes with OKT3 monoclonal antibody during the initial 2 days of long-term culture, in terms of T cell activation signal, IL-2-driven lymphocyte proliferation was remarkably accelerated with maintenance of appreciable level of cytotoxic activity. The same culture method also induced an increase in OKT3 and IL-2 receptor positive lymphocyte population in LAK cells and TIL. This method may enable us to gain more autologous TIL in vitro for adoptive immunotherapy of renal cell carcinoma than the usual culture method with IL-2 alone.
    Five patients with metastatic renal cell carcinoma were treated with adoptive immunotherapy with TIL, LAK and IL-2. One patient with pulmonary metastsis has had a minor response which has lasted for 3 months so far. We have not experienced any serious side effects during the treatment.
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  • Kousuke Ueda, Koji Obata, Kazutoshi Isogai, Osamu Mori, Shinichi Ohshi ...
    1990 Volume 81 Issue 1 Pages 110-115
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Registration of renal pelvic and ureteral tumor was done from 1980 through 1986, in the Tokai Urological Tumor Registry. Among the 404 cases of the carcinoma, 384 cases (210 renal pelvis, 174 ureter) were subjected to the present study.
    A total of 319 cases (83.1%) showed a complete cure, while 20 cases (5.2%) were considered as partial cure, and 45 cases (11.7%) were classified to progressive disease group. Chemotherapy was performed on 151 patients including systemic administration to 141 patients (33.9%) and 11 patients received combined intravesical instillation therapy. Irradiation was performed on 49 patients (12.8%). Degree of histological and morphorogical differentiation of renal pelvis and ureter tumor were studied in 341 cases of transitional cell carcinoma (88.8%); G0, 0.3%, G1, 12.9%, G2, 49.3%, Gx, 5.2%. Stage of the tumor were T1, 33.6%; T2, 12.5%; T3, 14.6%; T4, 13.3%; Tis, 0.3%; Tx, 24.7%.
    Five-year relative survival for carcinoma of the renal pelvis was 46.6%, and for the ureter it was 53.1%. Five-year survival according to histological differentiation of transitional cell carcinoma and according to the stage of the tumor were as follows; G1, 91.6%; G2, 58.5%; G3, 27.2%; Ta, 84.6%; Ti, 74.2%; T2, 48.5%; T3, 24.1%, T4, 7.3%.
    The rate of survival was correlated with histological differentiation of the tumor cells. The survival was poor in cases who had the components of squamous cell carcinoma and/or adenocarcinoma.
    Overall survived case were 177, 122 patients died of cancer, 20 patients died of other causes than cancer, and 1 patient died from immediate surgical effect. Thus, early recognition and complete surgical removal were suggested to be important in order to improve the results of treatment for carcinoma of the renal pelvis and the ureter.
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  • Munehisa Takashi, Takao Sakata, Tatsuro Murase, Yasuharu Takagi, Tatsu ...
    1990 Volume 81 Issue 1 Pages 116-121
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    To evaluate clinical and pathological factors present at the initial consultation which affect disease progression, we reviewed data from 223 patients with superficial bladder cancer (pTa and pT1) who were initially treated at Nagoya University Hospital between January 1973 and December 1987. The factors included in the present analysis were age, sex, symptoms, interval between initial symptoms and first consultation, location of tumor, size, number, endoscopic shape, histological pattern of growth, grade and stage. The median duration of the follow-up after initial treatment was 46 months. Of the 223 patients, 17 died: 8 (3.6%) of bladder cancer and the remaining 9 (4.0%) of unrelated causes. Disease progression developed in 12 patients (5.4%): muscle invasion of the bladder wall in 11 and lung metastasis in one. The interval between initial treatment and progression ranged from 4 to 108 months, with a median of 11.5 months. Of the 12 patients, 9 (75%) had disease progression within 2 years. Progression was significantly associated with poor prognosis (p<0.001): the 5-year actuarial survival rates were 47.1% and 92.8% in patients with and without progression, respectively. Univariate analysis by Cox's proportional hazards model demonstrated that characteristics such as irritative bladder symptoms, higher-grade tumors, invasion into lamina propria, and nonpapillary growth seen at initial consultation were significantly related to disease progression. Cox's proportional hazards model produced hazard ratios of 10.2 in irritative bladder symptoms (yes vs. no), 6.3 in histological grade (grade 3 vs. grades 0-2), 4.9 in stage (pT1 vs. pTa), and 4.7 in pattern of growth (papillary vs. nonpapillary). Multivariate analysis by the proportional hazards model confirmed that irritative symptom was the most important factor affecting progression (p<0.001), followed by grade (p<0.05), stage and pattern of growth in this order. We conclude that meticulous follow-up is mandatory for patients with irritative bladder symptoms, tumors of grade 3, pT1 and nonpapillary growth which are present at the initial consultation.
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  • Kenji Shimada, Keizo Taguchi, Shozo Hosokawa, Toshihiro Ogino, Fumihik ...
    1990 Volume 81 Issue 1 Pages 122-129
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The routine use of maternal ultrasonography has led to frequent discovery of fetal anatomical abnormalities of the urinary tract. Herein we report on 35 cases with congenital urogenital anomalies which were found during the last 5 years by the prenatal ultrasonography and referred to our clinic either for treatment or consultation.
    1. Findings of prenatal ultrasonography
    There were 12 cases of hydronephrosis, 7 of multicystic dysplastic kidney, 4 of megaureter, 3 of posterior urethral valve, 2 of ureterocele, 2 of vesicoureteral reflux and 5 other cases. Fetal anomalies were diagnosed durign routine maternal examination, as intrauterine growth retardation, oligohydramnios, or the recurrent risk secondary to genetic risk factor or previous abnormal pregnancies. Prenatal diagnosis was made as eraly as 20 weeks of gestation in a case of hypoplastic urethra with large bladder diverticula. In about 30% of cases, abnormalities were found before 30 weeks of gestation. Oligohydramnios was evident in 5 cases. Prenatal diagnosis was correct in about 60% of cases. In the remainder the diagnosis was either incomplete or incorrect. Errors in the diagnosis resulted from difficulties in the differentiation of dilated ureter, intestinal dilatation or intraperitoneal cystic masses.
    2. Management in newborn periods
    Of the patients, 12 were treated urologically in newborn periods. Although patients with distended bladder and dilatation of upper tracts first underwent therapeutic placement of the urethral catheter, upper tract diversion with nephrostomy or tubeless ureterocutaneostomy was required in 2 because of continued elevation of serum creatinine levels. In 2 neonates nephrectomy was indicated for unilateral multicystic kidney, because the large cystic mass might compress the intestine. In addition, the serial perinatal ultrasonography demonstrated a gradual increase in the renal size.
    3. Treatment and prognosis
    Two neonates with polycystic kidney disease and one with bilateral multicystic kidney died of respiratory dysfunction within 24 to 48 hours after birth. One neonate with posterior urethral valve died of multiple anomalies including tracheoesophageal fistula, congenital heart anomaly and 18 trisomy. One infant of Beckwith-Wiedemann syndrome who presented megaureters on prenatal sonography died of respiratory infection when he was 3-month-old. Surgical treatment was performed on 15 patients.
    1) Pelvi-ureteric junction stenosis: Three patients underwent pyeloplasty at the age of 1 month to 7 months. Patients with mild hydronephrosis were followed carefully by sonography and diuretic renography at an interval of 3 to 6 months. We experienced no case who showed progression of hydronephrosis during clinical courses.
    2) Multicystic dysplastic kidney: Two neonates underwent nephrectomy and one died of bilateral renal involvement. Other patients showed a relative decrease in the size of affected kidney during the follow up periods.
    Until recently patients with urinary tract anomalies presented with clinical manifestations such as urinary tract infection or renal dysfunction. The prenatal detection of asymptomatic urinary tract dilatation has presented us both progression and new question in the management of congenital urogenital anomalies.
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  • Satoru Kawakami, Iwao Fukui, Katsushi Nagahama, Shuhei Sumi, Shin-ichi ...
    1990 Volume 81 Issue 1 Pages 130-133
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A 41-year-old miller undergoing hemodialysis for 9 years presented with recurrent episodes of asymptomatic gross hematuria of a 7 years' duration and left flank pain with slight fever of a four months' duration. CT scans revealed bilateral acquired cystic disease of the kidney (ACDK) and a mass (∅4cm) in the medial portion of the left kidney, which was angiographically a hypovascular tumor. Cystoscopic examination revealed multiple papillary tumors arising from the entire bladder wall. These findings suggested that the renal mass was a renal pelvic tumor. Bilateral nephroureterectomy with left paraaortic lymphnodes dissection and radical cystectomy were carried out, followed by urethrectomy two weeks later. Histologically, multiple papillary transitional cell carcinomas with G2>G3 anaplasia were found in the left renal pelvis, the lower portion of the left ureter and the bladder. The tumors were predominantly superficial, although the renal pelvic one focally invaded into the muscular layer. Lymphnode metastasis and renal cell carcinoma were not recognized. Postoperative course was uneventful with normal blood pressure, though anemia was slightly progressive. He has been free of disease for six months.
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  • Takashige Namima, Fumihiko Sohma, Kenichi Imabayashi, Seiichi Orikasa, ...
    1990 Volume 81 Issue 1 Pages 134-136
    Published: January 20, 1990
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A 6-year-old girl, with urinary incontinence for the past 3 years, showed an overactie bladder and detrusor-sphincter dyssynergia (DSD) in urodynamic study.
    An epileptic focus in the right occipital area, as well as a large arachnoid cyst in the left middle cranial fossa was revealed by EEG and intracranial CT.
    After surgery for the arachnoid cyst, urinary incontinence was improved with disappearance of the epileptic focus in EEG, and an alteration of overactive bladder into normoactive one and improvement of DSD were observed in urodynamic study.
    It was considered that the urinary incontinence of this case might be associated with the ectopic epileptic focus due to the arachnoid cyst.
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