The Japanese Journal of Urology
Online ISSN : 1884-7110
Print ISSN : 0021-5287
ISSN-L : 0021-5287
Volume 83, Issue 4
Displaying 1-12 of 12 articles from this issue
  • Preliminary Results and 3 Months of Follow-up
    Ryoji Yasumoto, Hidetaka Yoshihara, Hidenori Kawashima, Masazumi Asaka ...
    1992 Volume 83 Issue 4 Pages 473-482
    Published: April 20, 1992
    Released on J-STAGE: July 23, 2010
    JOURNAL FREE ACCESS
    A prospective noncontrolled study of the safety and potential efficacy of the metallic stent was performed on 32 patients with benign prostatic hypertrophy. Mean age was 76.6 years (range, 56-98 years), and mean prostatic volume was 24.2cm3. The patients were selected on the basis of a quantitative symptom score (QSS), uroflowmetry measurements, and residual urine volume (RU). Nineteen patients had urinary retention and remaining 13 patients had moderate symptoms and signs of prostatism. Placing the stent was successfully done in 31 patients (97%). It took 15 minutes to place the stent using transabdominal and/or endorectal sonography. After 3 months, 27 patients (87%) showed improved QSS. In patients with dysuria, maximum flow rate (MFR) and RU before treatment were 6.9±1.7ml/sec and 112.3±61.8ml, respectively. After treatment, they improved to 12.3±2.7ml/sec and 12.7±6.7ml, respectively. On the other hand, all patients who had urinary retention were able to urinate just after treatment, and MFR and RU were 12.9±3.6ml/sec and 24.4±43.3ml, respectively. Evaluation on the basis of improvement in MFR and reduction in RU showed that the stent was effective in 71% of total patients (22 out of 31 patients), 94% of the patients with urinary retention (17 out of 18 patients).
    The overall clinical efficacy of this stent was 68% (21 patients). There were no major complications such as urge incontinence and urinary tract infection during follow-up. Although proximal migration of the stent was observed in 6 patients, the stent could be taken out and replaced in 4 patients. From the above results, we conclude that the metallic stent is useful for the treatment of prostatism and urinary retention.
    Download PDF (5624K)
  • Masafumi Sahashi, Yoshinari Ono, Shigeru Kanai, Toshio Shimoji
    1992 Volume 83 Issue 4 Pages 483-487
    Published: April 20, 1992
    Released on J-STAGE: July 23, 2010
    JOURNAL FREE ACCESS
    We installed a Kock continent reservoir in 103 patients after radical cystectomy or pelvic excentration between Feb. 1986 and Dec. 1989. They consisted of 81 male and 22 female patients. Patients'age ranged from 30 to 78 years with the average being 63 years. Their original diseases were bladder cancer (96 patients), prostatic cancer (2), sigmoid colon cancer (2) and others (3), The Kock reservoir was made by the procedure described by D. G. Skinner et al.
    The mean operation time for reservoir creation was 220 minutes. In 99 patients with a Kock reservoir for more than 3 months, the capacity of the reservoir was 200-900ml with the average being 490ml and the frequency of self-catheterization was 4 to 6 times a day.
    Early complications occurred within 3 months in 27 (26%) patients. Complications directly related to the reservoir were urine leakage (5 patients), intestinereservoir fistula formation (3) and necrosis of the reservoir (1). Late complications occurred after 3 months in 25 (25%) patients. They consisted of difficulty of catheterization (9 patients), ureteral reflux from reservoir (2), hydronephrosis (8), abscess (4), metabolic acidosis (2) and others.
    The results indicated that this procedure is an appropriate urinary diversion since the quality of life in the patients with a Kock reservoir is better. However, after this procedure surgical complications were not infrequent. Therefore, this procedure should be performed in selected patients.
    Download PDF (668K)
  • Zenjiro Masaki, Norio Kinoshita, Atsushi Iguchi, Shinichiro Komine, Ya ...
    1992 Volume 83 Issue 4 Pages 488-492
    Published: April 20, 1992
    Released on J-STAGE: July 23, 2010
    JOURNAL FREE ACCESS
    We report a new operative technique for plastic correction of uretero-pelvic junction (UPJ) obstruction: dismembered spiral flap pyeloplasty. It is similar to the method described by Culp & DeWeerd in that a flap is made spirally but different in that UPJ is detached. Relatively a long and wide spiral (oblique) flap, the apex of which directs cranioventrally or craniodorsally., is made using the dilated pelvis. The apex of the flap is reflected downward and anastomosed to the split ureteral end. Because the flap is made obliquely, one side of the flap base is approximated to the opposite pelvic margin; this helps to make gradual funnelling of pelvio-ureteric transition.
    The method seems to be fit for cases with considerably long stenosis of UPJ and with the UPJ locating relatively close to the medial margin of the renal parenchyma.
    Seven of 26 pyeloplasties were done by this method in our institute, and all the 7 cases had satisfactory results.
    Download PDF (3138K)
  • Sohei Tokunaka, Hiromitsu Fujii, Kiyoharu Okamura, Masanobu Miyata, Su ...
    1992 Volume 83 Issue 4 Pages 493-497
    Published: April 20, 1992
    Released on J-STAGE: July 23, 2010
    JOURNAL FREE ACCESS
    The proportion of fast and slow myosin molecules in external urethral sphincter (EUS) was studied. The contents of fast and slow myosin light chains in EUS from 6 female rabbits (Japanese White, 6-month-old) were estimated using two-dimensional electrophoresis. The percentages of fast and slow myosin molecules were 54.5±14.9 and 46.0±14.9, respectively. It was thus shown that female rabbits EUS is composed of both fast and slow muscle fibers. The ratio of fast to slow myosins in female EUS was different from that in male EUS (fast myosin 90%). These results implicate that female and male EUS would be functionally distinct.
    Download PDF (2270K)
  • Kumiko Kato, Atsuo Kondo, Soichiro Hasegawa, Masahiko Saito, Yukitaka ...
    1992 Volume 83 Issue 4 Pages 498-504
    Published: April 20, 1992
    Released on J-STAGE: July 23, 2010
    JOURNAL FREE ACCESS
    Pelvic floor muscle training is the mainstream of the non-operative treatment for female stress urinary incontinence. However, in order to make this method effective, it is mandatory to learn how to correctly contract pelvic floor muscles. Thirty adult women suffering from mild stress incontinence were instructed to train their pelvic muscles using vaginal cones. They retained cones of increasing weight in the vagina by contracting pelvic floor for 15 minutes twice a day.
    Twenty-seven of 30 (90%) patients could complete the training in five weeks. Both incidence and degree of incontinence decreased significantly after the training. The subjective improvement rate (incontinence cured or decreased by 50%) was 70%. The cone weights which they could hold over one minute and the voluntary pelvic floor contractions measured with the perineometer increased significantly, which indicated strengthening of pelvic floor muscles.
    Vaginal cones have a shape similar to tampons and are accepted by Japanese women with little psychological resistance. This device helps the patients to understand how to contract pelvic floor muscles and to motivate them to continue training, thus contributing for the treatment of stress incontinence.
    Download PDF (2857K)
  • Teruaki Iwamoto, Michitaka Yajima, Masanari Yamagoe, Koichi Kuroko, Ta ...
    1992 Volume 83 Issue 4 Pages 505-511
    Published: April 20, 1992
    Released on J-STAGE: July 23, 2010
    JOURNAL FREE ACCESS
    We evaluated fertility in fourteen patients after surgical repair of membranous urethral strictures associated with pelvic fractures. Eight patients were operated on using Badenoch's method (pull through) and six patients by end-to-end anastomosis of the urethra. All of them have maintained libido and potency after urethroplasty. No ejaculatory disturbance had ever occurred since surgery. Semen analysis was evaluated three months to four years after urethroplasty and serum hormone levels were measured in four patients.
    The results were as follows: 1) All except 2 patients had normal semen volume (more than 2ml). 2) Nine patients (64%) had a sperm density of more than 40×106/ml. Two patients had a sperm density of 20 to 40×106/ml and three patients less than 20×106/ml. 3) Nine patients (64%) had a sperm motility of more than 50%, three 30-50% and two less than 30%. 4) Seven patients (50%) had normal semen findings with a sperm density of more than 20×106/ml and a sperm motility of more than 50% according to the WHO laboratory manual. 5) Pyospermia (WBC≥10/hpf) was observed in three patients. However, they never had subjective symptoms or objective findings of inflammation. 6) Serum LH, FSH, testosterone and PRL levels were within normal limits. 7) After urethroplasty, two patients married and their wives became pregnant.
    In conclusion, these results indicate that surgical repair of membranous urethral strictures associated with pelvic fractures has little effect on fertility.
    Download PDF (5349K)
  • Masato Tamura, Atsuko Furukawa, Tadayuki Miyamoto, Kazunori Kimura, Ya ...
    1992 Volume 83 Issue 4 Pages 512-517
    Published: April 20, 1992
    Released on J-STAGE: July 23, 2010
    JOURNAL FREE ACCESS
    It is important to evaluate the autonomic nervous function which controls penile erection. One method utilizes intradermal injection of acetylcholine to produce localized sweat response. The sweat response depends on the peripheral autonomic nervous supply. Therefore, the response can be used to detect peripheral autonomic nervous dysfunction. We tried to evaluate the peripheral autonomic dysfunction in 29 impotents using a sweat spots test.
    We classified the 29 impotents into 6 groups with standard tests such as the papaverine test, nocturnal penile tumescence monitoring, recordings of bulbocavernous reflex, etc. The results were as follows: psychogenic IMP; 8, neurogenic IMP; 8, arterial insufficiency; 5, corporeal veno-occlusive insufficiency; 6 neurogenic with arterial insufficiency; 1, and neurogenic with corporeal veno-occlusive insufficiency; 1.
    The score of sweat spots test was 25.3±10.9, being in normal, nineteen severe in 3 and slightly abnormal in 7. Many cases of severe and slightly abnormal patients were DM patients classified into neurogenic IMP.
    We found 2 cases that were not detected by bulbocavernous reflex but found to be abnormal by sweat spots test. Therefore we conclude that this test effective to detect the autonomic nervous dysfunction in impotence.
    Download PDF (2447K)
  • Masahiko Yoshida
    1992 Volume 83 Issue 4 Pages 518-527
    Published: April 20, 1992
    Released on J-STAGE: July 23, 2010
    JOURNAL FREE ACCESS
    The in-vivo effects of recombinant human granulocyte colony-stimulating factor (rhG-CSF) on the number and function (phagocytosis and superoxide production) of peripheral neutrophils were studied in time sequence in cyclophosphamide (CPA) treated mice. The neutrophil function was evaluated by the phagocytosis of fluorescent particles, analyzing the number of fluorescence-positive cells and the fluorescence intensity of each neutrophil by flow cytometry and also by the superoxide production, measuring chemiluminescence of the leukocyte suspension by a photometer.
    In CPA-treated (100mg/kg) mice, the neutrophil function including both the phagocytosis and the superoxide production declined significantly (p<0.01) as the peripheral neutrophil count (PNC) decreased, reached the nadir on the same day as PNC and returned to the normal level 8 days after first CPA treated day (day 0).
    When rhG-CSF (100μg/kg) was administered subcutaneously daily for 5 consecutive days initiating at day 1, a decrease in PNC and a decline in the neutrophil function were prevented and a significant (p<0.05-p<0.01) increase of PNC was observed after day 4. In addition, the function of increased neutrophils was significantly (p<0.05-p<0.01) enhanced after day 4 and even at day 3, when an increase in PNC was not observed yet.
    The study shows that rhG-CSF appears to enhance neutrophil function by a direct effect on mature neutrophils, which have been impaired by CPA at the phase of progenitor cells in the bone marrow and subsequently have appeared in the peripheral blood and that rhG-CSF is effective on the impaired host defense mechanism in CPA-treated mice, improving not only drug-induced neutropenia but also the deteriorated function of neutrophils.
    Download PDF (1398K)
  • Kazunari Tanabe, Kota Takahashi, Kazunori Sonda, Takashi Yagisawa, Shi ...
    1992 Volume 83 Issue 4 Pages 528-535
    Published: April 20, 1992
    Released on J-STAGE: July 23, 2010
    JOURNAL FREE ACCESS
    We performed in total 528 kidney transplantations from Feb. 1983 to Dec. 1988 in Kidney Center of Tokyo Women's Medical College. Of the 528 kidney transplantations, 450 were living related kidney transplantations.
    The living related renal transplant recipients treated with CYA were devided into 3 groups: high dose CYA double drug therapy group (group 1), high dose CYA triple drug therapy group (group 2) and low dose CYA triple drug therapy group (group 3).
    Group 1 (n=263) was treated with CYA (initial dose 12mg/kg) and methylprednisolone (MP). Group 2 (n=106) was treated with CYA (initial dose 10mg/kg), MP and azathioprine (AZ) (1mg/kg). Immunosuppression of group 3 (n=81) consisted of CYA (initial dose 6mg/kg), MP and AZ (2mg/kg) (or mizoribine (MZ) (3-5mg/kg).
    CYA serum trough level (polyclonal) was lowered according to the initial dose of CYA, and in particular trough level in group 3 was controlled at a low level (50-150ng/ml in induction phase) to reduce CYA nephrotoxicity.
    However, even if strict control of serum trough level was accomplished, we could not get improvement of renal function in Group 3.
    Group 3 had more frequent and severe accelearted acute rejections (AAR) than the other groups. These data showed that inadequate immunosuppression in group 3 caused more frequent and severe rejection episodes.
    Also, renal biopsy revealed CYA nephrotoxicity even in group 3 and this nephrotoxicity may have been caused by ischemic damage by severe rejections.
    We think 6mg/kg/day of CYA is not adequate for immunosuppression and 8mg/kg/day of CYA may be the optimal initial dose for living related renal transplantation.
    Download PDF (905K)
  • Nobuo Moriyama, Atushi Tajima, Satoru Takahashi, Yukio Homma, Eiji Hig ...
    1992 Volume 83 Issue 4 Pages 536-541
    Published: April 20, 1992
    Released on J-STAGE: July 23, 2010
    JOURNAL FREE ACCESS
    The distribution of selective α1-adrenoceptor agonist 1-(2′, 5′-dimethoxyphenyl)-2-glycinamidoethanol hydrochloride, midodrine, and its active metabolite 1-(2′, 5′-dimethoxyphenyl)-2-aminoethanol, DMAE, was evaluated on bladder and urethra of 8-weeks and 52-weeks old female rats. Prior to the intravenous injection of 14C-labeled midodrine and DMAE, bilateral ureters were ligated to prevent drug uptake from the urinary tract. In 8-weeks rats, 14C-midodrine activity was significantly (p<0.01) higher in the bladder than in the femoral muscle, which served as a control for drug distribution. Similarly, higher uptake of 14C-DMAE was observed in the bladder than in the femoral muscle (p<0.01) and the urethra (p<0.05). In 52-weeks rats, there was no significant difference of midodrine uptake among these tissues. However, significantly higher uptake of 14C-DMAE was observed in the urethra than in the femoral muscle (p<0.05). Compared with midodrine, the concentration of DMAE was significantly increased in the bladder of 8-weeks rat and in the urethra of 52-weeks rats (respectively, p<0.05). In autoradiogram, the grains corresponding to midodrine and DMAE were diffusely distributed on the smooth muscles of bladder (mainly bladder neck and trigone) and urethra. The grains were also recognized on the vessels and perivascular areas of these tissues. These findings support that midodrine and DMAE could be effective for stress incontinence, because these drugs are known to bind specifically to α1-adrenoceptor.
    Download PDF (3553K)
  • Kensho Noto, Kyoichi Tomita, Tetsuyuki Fujishiro, Kenji Uekane, Takesh ...
    1992 Volume 83 Issue 4 Pages 542-545
    Published: April 20, 1992
    Released on J-STAGE: July 23, 2010
    JOURNAL FREE ACCESS
    An eighty year-old woman was diagnosed as left ureteral carcinoma and right disfunctional kidney in 1984. Left partial ureterectomy, partial cystectomy, and left ureterocutaneostomy were performed and her bladder was left behind after the operation. In 1990 (72 months after the operation), she was aware of bleeding from the urethra. A bladder wash was performed, demonstrating malignant cells on cytological examination, and cystoscopy revealed a papillary tumor in the defunctionalized bladder. Total cystectomy was performed and the histological findings of the surgical specimen showed transitional cell carcinoma, grade 2, pTaN0M0.
    This case shows the need for periodic examinations of the defunctionalized bladder, because renal pelvic and ureteral carcinoma tends to recur in the bladder within two years after operation and because tumors rarely develope in the defunctionalized bladder.
    Download PDF (2997K)
  • A Report of 2 Cases
    Masao Nakahara, [in Japanese], [in Japanese], [in Japanese]
    1992 Volume 83 Issue 4 Pages 546-549
    Published: April 20, 1992
    Released on J-STAGE: July 23, 2010
    JOURNAL FREE ACCESS
    We experienced two cases of renal cell carcinoma with renal artery aneurysm in the contralateral kidney. These cases have not been reported in the literatures which we have so far explored. In our cases, firstly tumor was resected, and then extracorporeal surgery and autotransplantation were performed on the renal artery aneurysm of the opposite side.
    Their postoperative courses were uneventful.
    Only a few instances of extracorporeal surgery and autotransplantation for renal artery aneurysm in a solitary kidney have been reported in the literature.
    However, no report of a case treated by extracorporeal surgery and autotransplantation for renal artery aneurysm in the contralateral kidney after surgical treatment of renal cell carcinoma has been made. Regarding the treatment of renal artery aneurysm, extracorporeal surgery and autotransplantation appeared satisfactory in our experience. It was a safe and assured surgical procedure.
    We recommend extracorporeal surgery and autotransplantation for renal artery aneurysm when management in situ is considered difficult.
    Download PDF (4588K)
feedback
Top