The Japanese Journal of Urology
Online ISSN : 1884-7110
Print ISSN : 0021-5287
ISSN-L : 0021-5287
Volume 86 , Issue 4
Showing 1-17 articles out of 17 articles from the selected issue
  • Hidehiro Kakizaki, Tomohiko Koyanagi
    1995 Volume 86 Issue 4 Pages 833-852
    Published: April 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
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  • Toshikazu Nakamura, Susumu Akimoto, Jun Shimazaki
    1995 Volume 86 Issue 4 Pages 853-859
    Published: April 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The efficacy of aspiration cytology, using Franzen method and echo-guided aspiration for prostate cancer was examined to 102 patients under saddle-block anesthesia in urological clinic of Chiba University Hospital.
    Between 1990 and 1993, 77 cases out of 102 patients were diagnosed histologically as prostate cancer by needle biopsy and 90% of them were coincidental with findings of aspiration cytology.
    Looking at histological grades, well defferenciated cancer was shown to yield low positivity compared with moderately and poorly defferentiated cancer. Positive rate showed similar when grade of specimens from needle biopsy was classified with Gleason pattern. Neither T category nor method of aspiration between Franzen and echo-guided methods influenced positive rate of aspiration cytology. On aspiration cytology, its grading revealed 60% of coincidence with that obtained by histological method. When counting more than 300 scattered cells, 90% of coincidence was achieved with histological grading.
    It is concluded that aspiration cytology is efficient for diagnosis of prostate cancer.
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  • Taketoshi Kakuta
    1995 Volume 86 Issue 4 Pages 860-869
    Published: April 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    In calculation of an uptake coefficient (UC), proportional to the glomerular filtration rate for renal dynamic images with 99mTc diethyl triamine pentaacetate (DTPA), by the graphic method proposed by Rutaland. We developed a new method of estimating input and output functions, by applying a factor analysis method to the renal dynamic images. The puropses of this paper are to describe the results obtained through phantom experiments and its clinical application.
    In the phantom experiments, a hemofilter was used as a method for real kidney and the filtration rate was changed to estimate the reproducibility of UCs. the UCs were estimated by trying different input functions; abdominal aorta curve, renal artery curve and intrarenal artery curve. The UCs estimated by using the intrarenal artery curve as an input function showed the best correlation with the pre-determined filtration rate. In clinical applications 8 normal subjects, 3 patients with acute renal failure, 11 donors and 22 recipients were studied. The USs obtained were compared with clinical data of renal function. A group of subjects having with both kidneys in the normal body space were classified as Cluster 1, another group of transplant recipients were classified as Cluster 2. In Cluster 1 the UCs showed a good correlation with Ccr (r=0.909), and effective renal plasma flow (r=0.798), and an inverse correlation between UCs and serum creatinine values (r=0.747). The median value of UCs in 11 donors at pretransplantation were 0.30, which increased to 0.46 at 3 weeks after transplantation. Cluster 2 has many risk factors (to be abnormal space, rejection, toxicity of Cyclosporin and immuno suppression) compared to Cluster 1, but in Cluster 2 the UCs showed a good correlation with Ccr (r=0.955), and effective renal plasma flow (r=0.653), and an inverse correlation between UCs and serum creatinine values (r=0.857). Cluster 1 and Cluster 2 showed the same correlations with Ccr and UCs. But Cluster 1 is a different group from Cluster 2.
    The results of the study showed that the modified Rutland's analy analytical method can estimate the renal filtration rate accurately, evaluate the residual renal function in donors quantitatively and be a useful parameter for monitoring renal graft function.
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  • Momokuni Fukuda
    1995 Volume 86 Issue 4 Pages 870-877
    Published: April 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The purpose of this study is clarify the changes in histological grade between primary and metastatic lesions in renal cell carcinoma.
    A tota of 100 cases of renal cell carcinoma and their metastases were compared respectively.
    In 31 (31%) of the cases observed, metastatic lesions were observed to have higher grade of malignancy when compared to primary lesions. In 59 (59%) of the cases, metastatic lesions had the same grade of malignancy and in 10 (10%) of the cases, metastatic lesions had a lower grade of malignancy when compared to primary lesions.
    The frequency of upgrading cases in young patients (i. e. less than 40 years old) occurred with less frequency when compared to elderly patients.
    Additionally, the frequency of upgrading cases invloving female patients was lower when compared to male patients.
    The one year survival rates in patients, who received nephrectomy, having grade 1 to 4 lesions following metastases were 100%, 65%, 71%, and 27% respectively. From these percentages, a stastically significant difference exists in one year survival rates between patients with grade 2 and 4 metastatic lesions (p<0.005), and grade 3 and 4 metastatic lesions (p<0.01).
    Histological grade of metastatic lesions is an important prognostic indicator for determining the outcome of renal cell carcinoma following metastases. Thus it is important that the prognosis of renal cell carcinoma be based on the histological grade of metastatic lesions as well as primary lesions.
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  • Koji Okihara
    1995 Volume 86 Issue 4 Pages 878-887
    Published: April 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The change of both prostatic volume and bone metastasis was observed from the period of castration to death in 23 cases of prostatic cancer. As for the change of prostatic volume, they were classified into two groups. One group was called “local progressive type”. In this group, prostatic volume reduced exponentially after the treatment of castration, then increased exponentially after a transient period. Another group was called “metastatic progressive type”. In this group, prostatic volume did not change after the treatment of castration although the degree of bone metastasis advanced severely. The regression speed after castration (τ) was faster in local progressive type than in metastatic progressive type. This τ had a close relationship to the prognosis of each case. In local progressive type, doubling time (DT) during relapsed period was calculated in 13 cases. An inverse correlation was found between τ and DT. This correlation might be able to lead the conclusion that the ratio between residual androgen sensitive cancerous tissue and residual androgen insensitive cancerous tissue related to the local progression in relapsed prostatic cancer.
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  • Yoshinari Ono, Shinichi Ohshima, Norio Katoh, Masafumi Sahashi, Tsuneo ...
    1995 Volume 86 Issue 4 Pages 888-893
    Published: April 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    To evaluate the efficacy of endopyeloureterotomy via a transpelvic extraureteral approach for the treatment of ureteropelvic junction obstruction or upper ureteric stenosis, we analysed the results of 85 patients treated with this procedure between Aug. 1988 and June 1993.
    Eighty-five patients underwent 87 procedures. Each patient has been followed-up more than 6 months postoperatively. Of 87 procedures, 71 were performed in patients with ureteropelvic junction obstruction and 16 were in patients with stenosis of the upper third ureter. Primary disease was 59 and secondary disease was 28. Twenty-one procedures were performed in patients with the stenotic segment over 2cm.
    The operative procedure was performed by first incising with a 22 Fr. urethrotome (ACMI Co.); the dilated renal pelvic or ureteral wall posterolaterally as long as 1-1.5cm junction from the stenotic segment toward ureteropelvic junction, then bringing the urethrotome out retroperitoneally through the incision and finally incising the stenotic segment with the cold knife under direct vision. A 12-16 Fr. PTCS tube (Sumitomo Behkuraito Co.) was left in place for 3 weeks as a stent.
    Mean operative time was 101min and average length of incised segment was 3.7cm. Complication included pneumothorax (1 case), pseudo ureter (1 case) and renal arterial anexryma (1 case).
    Followed-up period ranged from 6 to 64 months with the average being 26 moths. Of 87 procedures, 80 (92%) achieved a disappearance or improvement of the obstructive change and 7 failed. The success rate was 95% in the cases with the congenital disease and 86% in those with the secondary disease. It was 92% in the cases with ureteropelvic junction obstruction and 94% in the upper ureteric stenosis. It was also 91% in the cases with >2cm length of stenotic segment.
    These results indicate as follows; (1) this procedure is available for the upper ureteric stenosis as well as ureteropelvic junction obstruction. (2) it is feasible for treatment of the case with a long (>2cm) stenotic segment.
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  • Hitomi Kanno, Yuzo Kinoshita, Kazuo Saito, Yasushi Kawakami, Kazuhiko ...
    1995 Volume 86 Issue 4 Pages 894-900
    Published: April 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    The effect of caffeine (C) and pentoxifylline (P) on the sperm motility was examined after a 3°C storage in a TEST yolk buffer for one week. Thus stored 24 semen samples from infertile patients were incubated with or without C or P at 37°C. The motility was analysed for up to 240 minutes. The poststorage addition of C (1mM) and P (1mM) significantly increased the serum motility rate (p<0.01). The stimulant effect of C and P was rather transient lasting no more than 2 hours. The prestorage addition of C and P in a preservant TEST yolk buffer was less effective than the poststorage administration. According to the time-related profiles of the sperm motility, 24 cases were divided into three groups. In group A (11 cases), the sperm motility rate increased from 30 to 90 minutes even without C or P. This group was responder of C and P. In group B (8 cases), the motility rate increased only in response to C and P and, in group C (5 cases), no such responses were obserbed. The prestorage semen qualities in terms of the sperm concentration, the motility rate, the velocity, the linearity, and the amplitude of the lateral head displacement were compared in these three groups. There was a significant difference between these 3 groups (p<0.05) on the parameters in terms of the sperm concentration, motility rate and velocity. It was suggested that these prestorage parameters predict the sperm activity in response to C and P after a one week 3°C storage.
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  • Kazuo Saito, Gaku Arai, Akihiro Nagamoto, Makoto Hirokawa, Haruo Ito, ...
    1995 Volume 86 Issue 4 Pages 901-905
    Published: April 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We followed 135 primary bladder carcinoma patients for at least 3 years. Subsequent carcinomas of the upper urinary tract were found in 5 patients (3.7 per cent) an average of 67 months after an initial treatment of the bladder tumors. Two patients underwent radical cystectomy and the remaining 3 patients received transurethral resections or partial cystectomy five to seven times for bladder lesions. Primary bladder tumor was multiple in all and one of them was accompanied by carcinoma in situ in the bladder and urethra. Except for one patient who presented with gross hematuria, four patients had no symptoms referable to the upper urinary tract tumor. However two of them had high stage disease. Positive urinary cytology was observed in only one patient. All patients underwent nephroureterectomy and the four got well but one died of acute heart failure.
    Regular urinary cytology and IVP should be done for an extended period of time for early detection of renal pelvic and ureter cancers in patients who had multiple and recurrent bladder cancers.
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  • Yasushi Saiko, Isao Saito
    1995 Volume 86 Issue 4 Pages 906-911
    Published: April 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Transurethral radiofrequency thermotherapy was performed in 38 patients with benign prostatic hyperplasia using Thermex II (Direx) between December 1992 and June 1993, and its clinical efficacy was evaluated by analysing the subjective and objective responses following the treatment. Each patient was treated with an indwelling 16 Fr balloon catheter with electrode, in a single session of 90 minutes at 47-47.5°C. The clinical efficiency was evaluated by total of AUA symptom score and objective findings in terms of maximum flow rate 12 weeks after treatment. The symptom score improved from 15.4±4.9 (mean±SD) to 7.3±5.2. 25% or more improvement was found in 80% (20/25) of patients. No significant change was found in average of maximum flow rate before and after treatment, which were 8.9±4.1 (ml/sec) and 9.2±3.3, respectively. During the treatment no severe adverse effect except sense of heat and urgency was detected. Posttreatment urinary retension was found in 9 patients and catheters were indwelled in eight of them for a few days and prostatectomy was performed in one patients ater 8 weeks of treatment. In four patients prostatectomy was performed between one day and 8 weeks after thermotherapy and histrogical effect on the resected specimen was examined. In the prostatic urethra, hemorrhage and inflammatory change were observed. However, in the prostatic tissue there was no necrotic region.
    Transurethral radiofrequency thermotherapy is safe and easy and it may be one of the useful treatments for benign prostatic hyperplasia.
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  • Morimasa Kuwahara, Norito Takagi, Masaaki Nishitani, Kazuhiro Matsushi ...
    1995 Volume 86 Issue 4 Pages 912-918
    Published: April 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Recombinant human erythropoietin (rHuEPO) was administered to males undergoing hemodialysis, and its effects on penile erection and hypothalamus-pituitary-gonadal hormone levels were studied.
    The subject consisted of 18 males undergoing hemodialysis ranging in age from 22 to 58 years (mean 45.3 years). Chronic glomerulonephritis was present in 16, and diabetic nephropathy in 2, as underlying disease.
    rHuEPO was administered intravenously at 1, 500U 3 times a week with a target to increase the Ht value to 25% or above. Penile erection was evaluated subjectively by a questionaire based on a visual analogue scale and objectively by semi quantitative mesurement of nocturnal penile tumescence (NPT) using an erectometer.
    Of the 18 patients, subjective improvements in penile erection were observed in 13 (72%), and objective improvements in NPT were observed in 10 (56%).
    The administration of rHuEPO may alleviate hyperprolactinemia but was found to have no effect on the FSH, LH, Zn, or HS-PTH level.
    rHuEPO was suggested to be fairly effective for the treatment of sexual disorders.
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  • Osamu Kuriki, Yoshinari Ono, Norio Katoh, Masafumi Sahashi, Tsuneo Kin ...
    1995 Volume 86 Issue 4 Pages 919-926
    Published: April 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Between 1984 and 1992, 131 patients with bladder cancer underwent radical cystectomy and pelvic lymph node dissection with urinary diversion. There were 110 male and 21 female patients, aged between 35 and 86 with a mean of 64 years. The follow-up period ranged from 1 month to 113 months, with a median of 34 months. The five-year survival estimated by the Kaplan-Meier method wals 66.9% over all 131 patients. The five-year survival rates were 83.3% for stage pTis patients, 66.7% for stage pTa, 97.0% for pT1, 70.7% for pT2, 47.9% for pT3a, 26.2% for pT3b, and four-year survival was 25% for pT4 disease. Under the grading system, the five-year survival was 80.0% for cases of grade 2 disease and 63.6% for grade 3. There were two grade 1 patients who died of other diseases 15 and 16 months after surgery. Of all 131 patients, 22 (16.8%) had lymph node involvement. The five-year survival was 34.5% for patients with positive lymph nodes in comparison with 73.8% for those without lymph node involvement. The frequency of lymph node involvement was 26.1% in the non TCC group and 14.8% in the TCC group including 23.7% of the grade 3 and 4.3% of the grade 2 cases. Pathologically, the patients with higher stages had a higher frequency of lymph node involvement, and there was a significant difference in the frequency between pT3a (14.3%) and pT3b (47.8%) disease. The five-year survival of patients with positive lymph nodes was 40.0% for pN1, 32.1% for pN2 disease. The frequency of lymph node involvement by each nodal group was highest for the obturator node (68.2%), followed by the external iliac node (54.5%), and the internal iliac node (40.9%). Analyses revealed that the presence of pelvic lymph node involvement is an important prognostic factor and that the incidence of pelvic lymph node metastasis increased with tumor grade and pathological stage, with an especially significant difference between stage 3a and stage 3b disease.
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  • Yukiko Nishijima, Kenkichi Koiso, Ryosuke Nemoto
    1995 Volume 86 Issue 4 Pages 927-932
    Published: April 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A total of 75 prostate cancer and 67 lung cancer patients with positive bone scintigrams were studied. The patterns of spread of tumors to various bones were different between the 2 groups. The differences in the distribution of bony metastases between the prostate and lung are explained by the role of Batson's vertebral venous plexus.
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  • Yasushi Nagase, Nobuo Moriyama, Shigeharu Kurimoto, Yoshinori Tanaka, ...
    1995 Volume 86 Issue 4 Pages 933-939
    Published: April 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Ninety-two cases of advanced bladder tumor treated at the University of Tokyo and branch hospital from January 1977 to December 1992 were analyzed. The advanced bladder tumor was defined as that of higher than pT2 (according to the General Rule for Clinical and Pathological Studies on Bladder Cancer) or that with distant metastases. The following variants were evaluated, the therapeutic methods, the histological type, grade, stage, type of infiltration. The evidence of lymphatic infiltration, vessel infiltration, and lymph node metastases were also reviewed. The survival rate was calculated using Kaplan-Meier's method. In the cases with lymph node metastases, the survival rate was significantly lower than in the cases without metastases (p<0.01), while no other factors affected the survival rate.
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  • Takaharu Ichikawa
    1995 Volume 86 Issue 4 Pages 940-948
    Published: April 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We report here the influence of intratesticular aromatase activity and intratesticular estrogen concentration on spermatogenesis. In the present study, we measured the levels of aromatase activity and the concentrations of intratesticular testosterone (T) and estradiol (E2) in 21 testicular tissues from biopsy of 20 idiopathic male infertility patients, 5 testicular tissues from castration of 4 prostatic cancer patients and a testicular tissue from an autopsy. Serum T, Free T, E2, LH and FSH were also measured if possible. Aromatase activity in the testis were assayed by measuring the amount of 3H2O formed during the conversion of [1β-3H] androstenedione to estrogen. Histological evaluation of the testes were performed using the Johnsen's score count (JSC) method.
    The rate of aromatase activity was linear in regard to time and amount of tissue. The production of 3H2O was inhibited by 4-hydroxyandrostenedione. The apparent Km (Michaelis constant) of the reaction was 23.2nM. The rate of aromatase activity increased linearly as JSC level decreased (r=-0.67). Also, it significantly correlated with intratesticular T (r=0.69), E2 (r=0.88) and T/E2 ratio (r=-0.85), whereas it was not correlated with serum T, free T, E2, T/E2 ratio and free T/E2 ratio. Therefore, our results suggest the possibility that the increase in the rate of aromatase activity and the concentration of E2 may influence spermatogenesis.
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  • Takaji Tsukamoto, Toshio Fujioka, Yasuhiko Tsukiashi, Kiyohito Ishikaw ...
    1995 Volume 86 Issue 4 Pages 949-952
    Published: April 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We present a case of a uretero-aortic fistula assumed to be caused by an indwelling ureteral catheter.
    A 65-year-old male who underwent cystectomy and ureterocutaneostomy with bilateral ureteral stents had been well until gross hematuria from the left catheter developed. In spite of a through radiological examination of the left kidney, no abnormal findings were noted. However, massive hemorrhage was encountered on catheter exchange, prompting us to suspect a formation of a uretero-arterial fistula. CT scan was performed again, demonstrating severe adhesion between the left ureter and the aorta at the crossing point.
    At exploration, a fistula of about 7mm between the left ureter and anterior surface of the aorta was recognized. Left nephro-ureterectomy and closure of the aortic fistula with a rectus muscle fascia wrapping was successfully performed. His postoperative course was uneventful.
    Because the continued increase in the utilization of ureteral catherers could cause frequent occurrence of this condition, urologists should be aware of a uretero-arterial fistula as possible serious complication of indweling ureteral catheters.
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  • Jun-ichi Matsuzaki, Kimio Chiba, Akira Iwasaki, Eiichi Ishizuka, Hirok ...
    1995 Volume 86 Issue 4 Pages 953-956
    Published: April 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A new method for reconstruction of the urinary bladder was introduced by Taguchi in 1977. It consisted of two components; making of pseudo-urethra and the reconstruction of urinary reservoir in the pelvis. The latter was made of the ileum and the peritoneum with temporary use of Japanese paper. This operative method was applied to a 28-year-old female patient when she had cystectomy and bilateral ureterostomy. Thereafter she had has no trouble for 13 years. However, her recent rentogenogram showed urinary tract calculi in the reservoir. Endoscopic treatment was not indicated because of the deformed reservoir and the inflexible pseudourethra. Thus, extracorporeal shock wave lithotripsy (ESWL) was applied to the case with successful results.
    We herrin reported the case and discussed the usefulness of ESWL for urinali calculi in the ileal reservoir.
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  • Hiroshi Furuse, Hirotoshi Watase, Hiroyuki Ihara, Yutaka Kurita, Shinj ...
    1995 Volume 86 Issue 4 Pages 957-960
    Published: April 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A 39-year-old male presented with gross hematuria and left lower abdominal discomfort. Excretory urography showed a left ureteral stone and hydronephrosis. CT scans and magnetic resonance imaging showed a solid mass at the upper pole of the left kidney. Angiography revealed a hypervascular lesion at this area.
    The laboratory data showed a slightly decreased serum potassium level. In the endocrinological study, the serum deoxycorticosterone (DOC) level was markedly elevated. There was, however, no evidence of hypertension.
    The operation was performed on November 13, 1992. The tumor was almost separated from the left kidney, but an aberrant artery which divided from the renal artery and penetrated the renal parenchyma was found. Therefore, we had to carry out en bloc removal of the tumor together with the left kidney and the ureter which contained the ureteral stone. Pathological diagnosis was adrenocortical carcinoma. After the operation, hypokalemia and the serum concentration of DOC returned to normal range. Therefore, the tumor was diagnosed as DOC producing adrenocortical carcinoma. The patient was discharged 30 days after the operation with uneventful postoperative course. He received 2.5g of op'-DDD a day. There was no evidence of distant metastasis or local recurrence 12 months after the operation.
    Nineteen cases of DOC producing adrenocortical tumor have been reported in the world literature. A case and a review of the literature are herein reported.
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