(Background) The objective of this study is to evalute the efficiency of a new method of transurethral balloon laser thermotherapy (TUBAL-T) using prostalase in patients with benign prostatic hyperplasia. (Methods) From September 1993 to March 1994, 21 men were treated with a single session of TUBAL-T for the relief of bladder outlet obstruction secondary to benign prostatic hyperplasia. Thirteen of them had hormonal therapy before TUBAL-T and have no mediation after treatment (group A). Eight men had no hormonal therapy before and after TUBAL-T (group B). The clinical efficacy of this modality was evaluated by analysing the subjective and objective responses following the treatment. The laser balloon, equipped with a cooling system for preservation of urethral mucosa, delivers a Nd: YAG laser into the prostate. Treatment was performed by using a laser power of 30 to 50 watts for 40 minutes. At 3 months after treatment, the clinical efficacy was evaluated by subjective symptom score, and residual urine volume, uroflowmetry and prostatic volume by transrectal ultrasound as objective data. (Results) In group A, subjective symptom scores decreased by an average of 72.8%, the average uroflow rates and the peak uroflow rates increased by an average of 44% and 45.9%, the post-void residual urine volume rates decreased by an average of 58.4% and ultrasonography showed that the prostatic volume decreased in 8 men but increased in 5 men. In group B, symptom score decreased by an average of 85.1%, the average uroflow rates and the peak uroflow rates increased by an average of 46.2%, the post-void residual urine volume rates decreased by average of 83.4% and ultrasonography showed that the prostatic volume decreased by an average of 35.6%. (Conclusion) During the treatment and follow-up period, no adverse effect was detected. These results suggest that TUBAL-T for the relief of bladder outlet obstruction secondary to BPH is a useful therapy.
(Background) To evaluate measurement of separate renal function with Doppler ultrasound, renal blood flow velocity of interlobar and segmental arteries was examined with color Doppler echography. (Methods) Maximum blood flow velocity, minimum blood flow velocity, mean blood flow velocity, acceleration, resistive index, and pulsatility index were used as parameters of blood flow. (Results) In 71 patients who had undergone unilateral nephrectomy (group 1), interlobar arterial minimal blood flow velocity correlated with creatinine clearance (r=0.59) and 15 min. PSP value (r=0.47). In 43 patients whose separate renal functions were different each other (group 2), the separate Ccr calculated from radioisotope renogram, correlated with interlobar arterial minimal blood flow velocity (r=0.75). As far as unilateral renal blood flow velocity showed the same value, Ccr in group 1 was larger than in one kidney of group 2. This would be account for the fact that the volume of unilateral renal parenchyma which was measured by CT scan was larger in group 1 than in one kidney of group 2. In addition, the left to right ratio of Ccr was similar to that of interlobar arterial minimal blood flow velocity. Interlobar arterial minimal blood flow velocity has been decreasing along with aging in cases with normal kidneys. (Conclusion) Color Doppler echography is a useful technique for estimating separate renal function.
(Purpose) To examine the efficacy of laparoscopic radical nephrectomy (LPRNX) for patients with small renal cell carcinoma, the clinical result of 10 patients treated with this procedure was analysed. (Materials) Ten patients with renal cell carcinoma measuring diameter less than 5cm were treated by LPRNX between July 1992 and October 1994. Four cases had T1N0M0 disease and 6 had T2N0M0 disease. Of the 10 patients, seven had right sided tumor and three had left sided tumor. (Method) Trans-abdominal approach was employed for the initial 8 cases. Retroperitoneal approach was applyed for the last 2 cases. Five trocars were placed through lateral abdominal wall. Intraperitoneal or retroperitoneal cavity was insffulated with CO2 at 12mmHg. A kidney was dissected endoscopically with Gerota's fascia, peri renal fatty tissue and adrenal gland as en bloc fashion. It was trapped into the laparoscopy sack and pulled out of the body through a 4 to 5cm incision without morcellation. (Results) Average operation time was 331 minutes and average bleeding was 380ml. All the kidneys were removed by endoscopic tehcnique. As major complications, we experienced a cases of splenic injury and a cases of adrenal injury. The bleeding of both cases was successfully managed by endoscopical procedure, howerver, transfusion was needed for the last case. Pathological examination of specimens revealed renal cell carcinoma in all ten cases. Average hospital stay after surgery was 10.6 days and average duration to the convalescence was 20 days. There was no episode of recurrence in all 10 patients for 2 to 29 months (Mean: 15.2 months) followed up period. (Conclusion) Although further technical progress was expected, LPRNX is a potential operative procedure that realizes minimally invasive therapy for the patients with small volume of renal cell carcinoma.
(Background) The objective of this study is to evaluate the diagnostic utility of digital rectal examination (DRE), prostate specific antigen (PSA) and transrectal ultrasonography (TRUS) for prostate cancer. (Methods) On 266 patients ultrasonography guided transrectal biopsies were performed using the automatic biopsy gun fitted with an 18 gauge biopsy needle. (Results) There was no major complication. Cancers were found in 52 patients (19.5%), and 16 of them were not identified by echography. Among 67 hypoechoic areas detected by echography, 36 (53.7%) were found to be cancer. The positive predictive value of DRE was 52.1%, and that of PSA and TRUS were 24.4% and 53.7%, especially the rate increased to 93.7% by combining of these three techniques. (Conclusion) These results suggest that the use of DRE, PSA in conjunction with TRUS enhances early detection of prostate cancer.
(Background) The objective of this study is to evaluate the efficacy of ureteroscopic lithotripsy as the treatment of ureteral stoens in the recent era by comparing the result using a semirigid ureteroscope with the result using a conventional ureteroscope. (Methods) Between 1991 and 1994, 136 patients with ureteral calculi underwent transurethral ureteroscopic lithotripsy in our hospital. From July 1991 to March 1993, 14F rigid ureteroscope with the rod lens system was used for 82 patients (group 1), whereas from April 1993 to July 1994 either a 9.5F or 7F semirigid fiberoptic ureteroscope was used for 54 patients (group 2). Insertion of ureteroscopes was performed under continuous irrigation of saline without mechanical dilation of the ureteral orifice in both groups. (Results) The rates of complete romoval of stone at the first trial were 56.1% in group 1 and 72.2% in group 2 with the overall complete removal rate of 62.5%. The complete removal rates of stones in the upper, middle and lower ureters were 18.2%, 54.8% and 72.4% in group 1 and 14. 3%, 72.7% and 88.0% in group 2, respectively. The major reason for unsuccessful treatments was upward migration of stones during the procedure. As intraoperative complications, ureteral disruption occurred in 1 case in group 1, and ureteral perforation in 5 patients in group 1 (6.1%) and 2 in group 2 (3.8%). Acute bacterial infection with prolonged fever was observed in 3 patients in group 1 and in none in group 2. (Conclusion) From these results, the new semirigid ureteroscope with fiberoptic imaging bundles made the transurethral lithotripsy a safer and more efficient procedure for the treatment of ureteral calculi especially those in the lower ureters.
(Background) The objective of this study is to evaluate the clinicopathological features of incidental renal cell carcinoma, compared with non-incidental carcinoma. (Methods) Between July 1st, 1984 and June 30, 1994, 87 renal cell carcinoma patients were treated at our hospital; 56 had non-incidental renal cell carcinoma and 31 had incidental carcinoma. The clinicopathological features were examined. (Results) The incidence of incidental cancer ranges from 0 to 66%, and the incidence has increased in recent years. The median value of maximal tumor size was 4.0cm (1.5-8.0cm) for incidental cancer, and 8.0cm (3.0-16cm) for non-incidental cancer; i. e., the incidental cancer was significantly smaller than the non-incidental one (p<0.001). The pathological stage of the resected non-incidental renal cell carcinoma (n=47) was pT1, pT2, pT3 and pT4 in 0, 23, 21 and 3 patients, respectively. For the resected incidental renal cell carcinoma (n=31) 3, 26, 2 and 0 patients showed pathological stages pT1, pT2, pT3 and pT4, respectively; the pathological stage of incidental renal cell carcinoma was significantly lower than that of non-incidental carcinoma (p<0.001). Eighteen and 29 resected non-incidental renal cell carcinoma were grades 1 and 2, respectively, whereas 17 and 14 resected incidental renal cell carcinomas were in grades 1 and 2, respectively. The grade of incidental carcinoma did not different from that of non-incidental cancer. Vascular invasion by tumor cells was shown in 31 (66.0%) and 8 (25.8%) patients with non-incidental and incidental renal cell carcinomas, respectively; the incidence of vascular invasion in incidental cancer being significantly lower than in non-incidental cancer (p<0.001). The performance status and general condition in patients with incidental renal cell carcinoma were superior to those in patients with the non-incidental cancer. The 1, 3 and 5-year survival rate of all 87 renal cell carcinoma patients was 81, 62 and 57%, respectively. These rates for patients with non-incidental renal cell carcinoma were 72, 48 and 41%, respectively, and those for incidental cancer patients were 100%. The survival of patients with incidental renal cell carcinoma was significantly better than that of non-incidental carcinoma patients (p<0.005). (Conclusion) Our results suggest that the detection of incidental renal cell carcinoma will increase, and that the prognosis for renal cell carcinoma will improve. However, even in incidental renal cell carcinoma, careful long-term follow up may be necessary, since some tumors are comparatively large and exhibit vascular invasion.
(Background) The associations of human atrial natriuretic peptide (hANP) and arginine vasopressin (AVP) with nocturia in two groups of elderly individuals were investigated. (Methods) Plasma hANP and AVP levels were detemined at 8:00, 14:00, 20:00, 2:00 and 8:00 (2nd day) in 15 healthy younger elderly individuals and 30 elderly individuals who showed no abnormal physical findings. Urine volume, urinary Na and K levels, and urinary osomotic pressure were also determined every 6 hours at the above-mentioned times. The maximum diameter of the inferior vena cava (IVC) in the inferior portion of the confluence of the hepatic veins was determined at 14:00, 20:00 and 2:00 in 11 younger elderly individuals and 17 elderly individuals. (Results) The mean hANP level was significantly higher in the elderly group than in the younger elderly group, and the mean AVP level was significantly higher in the younger elderly group than in the elderly group. There were no significant differences in diurnal variation in hANP between daytime and night among the younger elderly individuals, but the hANP level was significantly increased during the night in the elderly individuals. The AVP level was significantly higher at night than during the daytime in the younger elderly individuals, while it was significantly decreased at night in the elderly individuals. Although there was no marked diurnal variation in the IVC in any of the younger elderly individuals, IVC diameter was significantly increased at night in the elderly individuals. Urine volume was high during the daytime in the younger elderly group, and increased during the hight in the elderly group. (Conclusions) The increase in body fluid and elevation of hANP over the time between evening and night, and the decrease in AVP accompanying these increases were considered to lead to the increase in urine volume during the night, and this increase is considered to be a factor in nocturia.
(Background) In the adult male rat prostate, castration induces apoptosis of epithelial cells concomitant with the increase in transforming growth factor-beta 1 (TGF-β1). In the present study, we investigated the effects of castration on apoptosis and TGF-β1 mRNA in neonatal. mouse seminal vesicles. (Methods) 5-day-old BALB/c mice were castrated by Pfeifer's method. We estimated the weight, 3H-thymidine uptake by whole seminal vesicles, the amount of TGF-β1 mRNA by RT-PCR method, and the apoptotic index of both epithelium and mesenchyme. (Results) The castration of 5-day-old neonatal mice resulted in much less weight of seminal vesicles and DNA synthesis estimated by 3H-thymidine uptake by whole seminal vesicles compared to intact neonatal mice, indicating that the growth of neonatal mouse seminal vesicles depends on androgens secreted by the testis. The amount of TGF-β1 mRNA estimated by RT-PCR method increased 4 days after castration at 5 days of age. However, the castration did not induce apoptosis in the seminal vesicles. (Conclusion) The present study indicates that castration of neonatal mice does not induce apoptosis in the seminal vesicles, although it does a transient increase in TGF-β1 mRNA in the seminal vesicles.
(Purpose) In several previous reports, it has been suggested that the androgen system is related to bladder carcinogenesis. In this study, to understand the mechanism underlying this relationship, we administered a LH-RH agonist depot (Leuprolide depot), a pure-antiandrogen (flutamide) or a 5α-reductase inhibitor (finasteride) to the mice in the promotion state of bladder carcinogenesis by N-butul-N-(4-hydroxybutyl) nitrosamine (BBN). (Materials and Methods) 177 C3H/He male mice were divided into 7 groups. All mice were treated with 0.05% BBN for 10 weeks and were maintained over the subsequent 12 weeks with the following treatments. Group 1 was a control group; in group 2, castration was performed at the 11th week; in group 3, finasteride was administered starting the 11th week; in group 4, a LH-RH agonist depot was administered starting the 11th week; in group 5, flutamide was administered starting the 11th week; in group 6, both finasteride and a LB-RH agonist depot were administered simultaneously starting the 11th week; and in group 7, both flutamide and a LH-RH agonist depot were administered simultaneously starting the 11th week. (Results and Conclusions) (1) We confirmed that castration significantly suppressed bladder carcinogenesis. (2) Fnnasteride or flutamide administration as monotherapy had no effect on the results; however, the dosages of these drugs may have been too low, so we are planning a study with higher doses. (3) Conversely, the LB-RH agonist depot significantly promoted bladder carcinogenesis, we believe that the high levels of testosterone immediately after the administration were responsible for this promotion. (4) Simultaneous administration of flutamide suppressed this LB-RH induced promotion of carcinogenesis.
(Background) We evaluated the usefulness of 1H endorectal magnetic resonance spectroscopy to characterize prostate pathology. (Methods) With an endorectal surface coil we have studied 20 individuals with normal (1), benign hyperplastic (9) and malignant (10) prostates. (Results) The major findings of our studies were that the patients with cancer have a significantly lower citrate-to-choline ratio (cit/cho) and creatin-to-choline ratio (cre/cho) than the patients with BPH (p<0.05). There is well correlation between cit/cho and gland-to-stroma ratio of the BPH tissue as well as histological grade of the cancer tissue. 1H spectroscopy offers the advantages of differential diagnosis between benign and malignant prostates. We, however, failed to demonstrate cancer in 2 cases; the lesion was too small in one case, and out of the region of interest in the other. It is necessary that the foci in the prostate is at least 1.5×1.5×1.5cm3 of the volume in order to obtain genuine spectrogram of carcinoma. (Conclusion) Endorectal 1H magnetic resonance spectroscopy can characterize metabolic differences between the normal and malignant prostate.
A case of bladder cancer following spinal cord injury is reported. A 57-year-old male with Li incomplete paraplegia was referred to our hospital under the diagnosis of bladder tumor with gross hematuria in November, 1994. Radical cystectomy, rt nephroureterctomy (nonfunctioning kidney) and lt ureterocutaneostomy were carried. Histopathological study revealed squamous cell carcinoma (well differentiation) and transitional cell carcinoma (G3), stage pT3b. He has been doing well without reccurence for 4 months after operation. In this report we also review the referrences hitherto made to paraplegia bladder cancer.
We experienced a case of retroperitoneal dedifferentiated liposarcoma with tumor thrombus in the inferior vena cava. A 45-year-old man was pointed out a retroperitoneal mass on ultrasound exammination. He was refered to the Department of Urology, Tochigi Cancer Center for critical evaluation. Image diagnostic procedures showed a retroperitoneal mass surrounded by loose tissue and large thrombus in the inferior vena cava. The tumor was removed surgically with right lobe of the liver and segment of the inferior vena cava. Histological examination revealed the tumor composed of the peripheral well differentiated liposarcoma and the central dedifferentiated liposarcoma. Characteristic radiological findings of retroperitoneal liposarcoma with dedifferentiation could be pointed out.