The advent of molecular biology has made a great progress for HPV research. It is now considered that more than 90% of cervical carcinomas are caused by HPV infection. However, it is the problem that penile lesions associated with cancer-related HPV types are subclinical, resulting in accerelation of HPV transmission by male reservoir. We urologists should make an effort to treat HPV infection and to prevent HPV prevalence. On the other hand, any pathological role of JCV has not been revealed in humans except for PML. Nowadays, it is considered unlikely that there is a pathogenetic relationship between JCV and human tumors. However, since archetypal JCV has been discovered, it has been thought that archetypal JCV receives DNA rearrangements during latency in the kidney by some immunological derangements of the host and is subsequently altered to PML-type JCV. Additionally, there is a possibility that archetypal JCV causes asymptomatic hematuria. More investigation will be necessary for elucidating pathological role of archetypal JCV in the field of urology.
Transurethral microwave thermotherapy using Prostatron was performed in 31 patients with benign prostatic hypertrophy, and the clinical effectiveness was evaluated by analyzing the subjective and objective responses following the treatment. The 22F balloon catheter to be placed in the prostatic urethra incorporates the microwave antenna, a cooling system and a fiberoptic thermosensor which allow an effective delivery of microwave energy to the center of the prostate, while preserving the mucosa and periurethral tissue. The maximum urethral temperature during the treatment ranged from 43.3 to 45.5°C (44.7±0.96°C: mean±S. D.) and the average power output was 27.4 Watt. The treatment was performed in a single session of an hour on the outpatient basis. In one patient who could not be relieved of the indwelling catheter underwent a transurethral resection, and the histological effect of thermotherapy on the resected specimen was examined. In the prostatic tissue, heat-induced necrotic change of the interstitial tissue as well as degenerative change of the acinar epithelium were remarkable, whereas the urethral mucosa was well preserved. In the remaining 30 patients, the clinical effects were evaluated 8 weeks after the treatment by a score scale for subjective symptoms, residual urine and maximum urinary flow rate, which was compared with the pretreatment score. Improvement of both subjective symptoms and objective findings was observed in 13 subjects (43.3%), that of subjective symptoms only in 14 cases, and that of objective findings only in 2 cases, resulting in a notable improvement in total 29 cases (97.7%). When post-treatment total score decreased by 25% or more is categorized as “excellent”, and 24-10% as “fair”, the clinical effectiveness (excellent & fair) was 53.3 and 37%, respectively. Throughout the follow-up period, not a single case presented such severe adverse effects as fever, infection and urethral stenosis. Due to the acute local edema caused by the thermotherapy, 3 patients noted transient urinary retention, but it was resolved by indwelling a catheter for a few days. It is concluded that the thermotherapy by Prostatron is safe and effective, and can be applied to patients with symptomatic benign prostatic hypertrophy who are reluctant to undergoing surgery.
The accumulating data have shown that a single or certain combinations of proto-oncogenes are genetically altered and acquire oncogenic activities in certain tumor types, through a point mutation and/or overexpression. In the present study, Northern blotting analysis was applied to clinical samples of renal cell carcinomas (RCC) to elucidate expression levels of the c-myc, c-fos and Harvey ras genes in this tumor form. In 11 cases of 23 tumors examined (48%) was shown more than 3-fold expression level of the c-myc gene compared with the matching normal RNA, the c-fos gene in 6 cases (26%), and the Harvey ras gene in one case (4%) showing the concomitant overexpression of two other genes. Overexpression of both the c-myc and c-fos genes was detected in 5 cases (22%). Although the distinct correlation between overexpressions of any genes and the clinical background was not induced, it is considered that these aberrations of proto-oncogenes are involved in oncogenesis of a certain subgroup of RCC.
We applied restriction fragment length polymorphism (RFLP) analysis to 24 cases of renal cell carcinomas (RCC), 18 cases of prostate adenocarcinomas (PC), and 11 cases of transitional cell carcinomas (TCC) in the renal pelvis to study the oncogene amplification and inactivation of tumor suppressor genes. All of the cases showed no amplification nor gross rearrangements of the Harvey ras, c-myc, c-fos, c-myb, EGFR and PDGFR. In contrast, RFLP analyses demonstrated allelic losses interpreted as inactivational events of TSGs among the tumor forms studied. RCC had allelic losses on the short arm of chromosome 3 (3p) (68%), the long arm of chromosome 18 (18q) (33%), Y chromosome (29%), and 17p (27%) at high frequencies. PC showed frequent allelic losses on 16q (67%), 8p (50%), 18q (43%), lop (40%), and 10q (38%). TCC had allelic losses on 17p (73%), 11p (64%), and 9p (40%). It was likely that the cases with the more malignant grade tumor had the more allelic losses.
Nocturnal penile tumescence (NPT) is a physiological phenomena that is recognized in almost all normal males. This paper presents a study of NPT and the relation of this phenomenon to age, sexual maturation and physical growth in children. In 30 subjects, ranging from 3 to 18 years old, NPT was measured continuously throughout the night. The following results were obtained: 1. The frequency of NPT had a tendency to increase with age with a maximum frequency at 13 or 14 years of age, although the frequency ranged widely. 2. The maximum increase in penile circumference was below 10mm in all cases below 10 years of age but was greater in children over 12 years old. 3. Tumescence time and percent tumescence time [tumescence time (min.)/sleep period time (min.)]×100 was greater in children of over 12 years of age. Percent tumescence time showed a positive correlation with serum LH. Percent tumescence time was clearly higher in children with LH pulse, which indicates the onset of puberty, than in those without it. 4. These results suggest that NPT measurement in children can predict the onset of puberty, when coupled with endocrinological findings.
Pharmacologic characteristics of the human neurogenic bladder to KCl, carbachol, ATP and CaCl2 was investigated in vitro in comparison with the control bladder. Patients with neurogenic bladder underwent augumentation enterocystoplasty because of low bladder compliance or uninhibited contraction which resulted in urinary incontinence and/or vesicoureteral reflux. 1. There was no difference in the contractile strength to KCl between the neurogenic bladder and the control. 2. The contractility (both contractile strength and the value of ED50) to carbachol was than in the control. 3. The contractile strength of the neurogenic bladder to ATP showed greater efficacy than that of the control bladder. 4. The contractility of the neurogenic bladder (contractile strength and the value of ED50) to CaCl2 was significantly greater than that of the control. 5. In the neurogenic bladder there was no correlation between pharmacological responsiveness and the clinical parameters including the data of cystometry. In conclusion, the human neurogenic bladder demonstrated supersensitive responses to carbachol, ATP and CaCl2.
Bone mineral density (BMD) of the 3rd lumbar spine was measured by dual photon absorptiometry (DPA) in 8 patients with primary hyperparathyroidism (PHP) and 39 patients with idiopathic urolithiasis (IU). Of the patients, 15 were classified into idiopathic hypercalciuria (IH) which were further classified into 2 types of IH—renal hypercalciuria (RH) and absorptive hypercalciuria (AH)—by Ca restriction and load test. BMD of the IH patients tended to be lower than patients with normocalciuria, but significantly higher than the PHP patients. BMD of the RH patients was significantly lower than the AH patients. In conclusion, DPA may be a simple method for classifying the types of idiopathic hypercalciuria.
A 15-year-old, legally male patient came to our department with chief complaint of gynecomastia. Serum testosterone was at a low level of 1.6ng/ml, and prolactin a high level of 23ng/ml. Blood type was a mixed type of both type A and type B, and a chromosomal analysis with peripheral blood lymphocytes demonstrated a mosaic of 46, XX/46, XY. During the follow-up, he complained a painful swelling in his right scrotum, and received an emergent surgery. A large amount of blood was noted in the right scrotum. Unicorn uterus, Fallopian tube and finbriae were observed, and a thumb-sized gonad with hemorrhage and fissure was also seen in the upper part of the scrotum. The right gonad was an ovary and no testicular tissue was confirmed in the right scrotum, whereas the right vas deferens was noted. The left testis was accompanied by an induration on its upper pole which was histologically found to be ovarian tissue. The patient was diagnosed as a true hermaphrodism with 46, XX/46, XY chimera that had an ovary with inguinal uterus hernia and an unusual vas deferens in the right scrotum and an ovotestis in the left. It was considered that an adequate amount of testosterone secreted from the left testis during the early embryonal period might have affected the descent of the right ovary into the scrotum and on the development of the right vas deferens.
From March 1987 to the end of February 1991, we performed Kock pouch construction as a urinary diversion on 20 patients who had undergone radical cystectomy due to bladder cancer. The operation was done according to the method of Skinner et al. We fully utilized an auto-suture instrument to ensure safe and stable suturing of the ileum and to shorten the operating time. It was of great concern that the staples placed at several portions might cause stone formation or aggravate infection. However, stone formation was observed only in one patient (5%) at the tip of a nipple valve in which a staple became the nucleus of the stone. Staples are usually not regarded as an obstacle as they are usually covered by the mucous membrane. In all patients, the maximum capacity of the pouch was more than 500ml, intra-pouch pressure was kept low even when the pouch was inflated up to the maximum capacity, and reflux of urine into the upper urinary tract was not observed. As for complications, there was a slight degree of obstructive uropathy in 4 patients (20%), difficulty in catheter insertion was noted in 3 patients (15%), and stress incontinence-like urinary leakage was present in one patient when the capacity exceeded 500ml. However, there were no complications which necessitated reoperation. In terms of blood chemistry, although there was a tendency towards a slight increase in BUN or hyperchloremia, no specific treatment was necessary as far as the kidney function was normal. We have not conducted any kind of treatment for the time being against pyuria or bacteriuria which is frequently observed in the urine sediments. However, we consider it necessary to follow up these cases over a long period of time. We performed Kock pouch construction using metal staples with few complications we had anticipated previously, thereby confirming the safety, reliability and shortening of operating time of this technique.
The value of autotransfusion is widely recognized in the surgical community and may be of increasing importance in prevention of acquired immunodeficiency syndrome and hepatitis. The concern of possible contamination of the blood with urine, bacteria in urine or viable tumor cells has limited the wide use of intraoperative autotransfusion (IAT) in urological operation. There have been no experimental reports about protection of the blood from such contamination. To investigate separation of the blood from a contaminated mixture by using an autotransfusion machine, Haemonetic Cell Saver, a study composed of three experiments was performed. First, 200ml of blood was mixed 200 ml of urine, and thereafter, the mixture was processed by the machine and the concentrated erythrocytes were collected in a bag. Biochemical analysis of the collected erythrocyte solution (CES) was performed. Second, 200ml of blood was mixed with 200 ml of urine that was adjusted to contain each 107/ml of four bacterial strains. The bacteriological study of the CES was performed. Third, 200 ml of blood was mixed with 200 ml of urine that was adjusted to contain 107 cancer cells. Two cell lines, KK47 originated from human bladder cancer and ACHN originated from human renal cell carcinoma was used. The cytological study of the CES was performed. The results of these experiments were: Urine constituents were completely removed from the mixture. However, all strains of bacteria could not be separated, although the number of bacteria decreased. Cancer cells were found in the CES. In conclusion IAT should be done at urological operation in selected patients that have sterile urine and do not have tumor cells in the operation field.
Erythropoietin (EPO) with an established clinical efficacy in renal anemia has in recent years become applied as an aid to autologous blood transfusion in surgical patients. This report describes our experience with autotransfusion along with the use of EPO in transurethral resection of the prostate (TUR-P), indicating its usefulness. Ten patients with benign prostatic hypertrophy aged 60 to 74 years received 3000 units of EPO, with an iron preparation, nine times beginning 3 weeks prior to operation. Autologous blood of 300ml was collected from the patient each at 2 and 1 week before operation and was used at TUR-P. Five other patients who underwent TUR-P with the same volume of autotransfusion accompanied by preparative medication with the iron alone served as controls. In the EPO treated group (mean age, 68.3 years) the mean value for hemoglobin concentration (Hb) was 14.0±1.6g/dl on the day of operation, which showed a recovery rate of 94.9±5.4% (Hb recovery rate) as against the pre-EPO treatment value (mean: 14.8±1.3g/dl). This Hb recovery rate was significantly greater (p<0.001) when compared to 82.2±2.5% in the control group (mean age, 68.2 years). Of the EPO treated patients, those in their sixties (n=6; mean age, 66.3 years) exhibited a significantly higher Hb recovery rate (98.3±3.5%) than the rate (89.9±3.0%) for patients in their seventies (N=4; mean age, 71.3 years) (p<0.01). The blood pressure monitored during operation in every patient of the EPO treated group did not reveal any significant fall due to bleeding; all treated patients remained stable in hemodynamic features. The results showed that the use of EPO permitted a safe preoperative collection of blood for autotransfusion even in eldery patients and also facilitated early initiation of intraoperative blood transfusion, thereby maintaining a satisfactory general status of the patient. The procedure reported herein is considered to be of value in surgical treatment of patients with advanced benign prostatic hypertrophy in whom hemorrhage at operation is anticipated.
We report a case of bilateral renal cell carcinoma which developed during about 14 years of hemodialysis. The patient of male was a 39-year-old with a chief complaint of macrohematuria 14 years prior to dialysis therapy. Computed tomography revealed multiple cystic changes of bilateral kidneys and a high density area in the right kidney. He was admitted to our department in April 1988. He was suspected of renal cell carcinoma of the right kidney and underwent transperitoneal radical nephrectomy on the right kidney. The left kidney was also resected simultaneously in part because it failed to function and in part because the long-term hemodialyzed patients are considered to have a complication of renal cell carcinoma at a high frequency. Pathological diagnosis was bilateral acquired cystic disease of the kidney (ACDK) with renal cell carcinoma. The kidney develops multiple cystic changes following long-term hemodialysis, which forms a high risk for development of renal cell carcinoma. This is a case of bilateral renal cell carcinoma which occurred after long-term hemodialysis, was reported with discussion and reference to the literature.
Cystic mesothelioma of perinephric retroperitoneum origin are very uncommon tumors and considered potentially malignant. We report one such case and discuss the clinical and pathological findings. A 70-year-old man was seen with complaint of discomfort in the right flank and hospitalized in May 1989. Computerized tomography revealed multiple cystic masses in the right retroperitoneal space which appeared to be infiltrating the kidney and the iliopsoas muscles. Magnetic resonance imaging showed deformation of the right kidney with many impressions in the parenchyma. The cystic lesions and the right kidney were extirpated on June 2, 1989. Grossly the specimen was 16×10×8cm in size and 630g in weight. The multiple cysts surrounding the kidney were each approximately 10mm in diameter and had thin outer walls. The cyst fluid was clear and serous. The kidney had not been infiltrated but had only external impressions caused by the cystic lesions. Microscopically, the cysts were lined by a single layer of cuboidal cells accompanied by some hobnail-shaped cells, and no evidence of malignancy was found. The epithelium was focally positive for periodate acid Schiff and slightly positive for Alcian blue. It was strongly positive for cytokeratin and vimentin, and slightly positive for EMA but negative for lectins. The diagnosis was diffuese benign multicystic mesothelioma. However, CT taken four months after the operation revealed local recurrence and radiotherapy (40Gy) was instituted. Since the cystic mass tended to grow in size thereafter, the lesion appeared to be malignant clinically. We consider this is the first case of cystic mesothelioma of perinephric retroperitoneum origin reported in Japan.