The Japanese Journal of Urology
Online ISSN : 1884-7110
Print ISSN : 0021-5287
ISSN-L : 0021-5287
Volume 86 , Issue 5
Showing 1-16 articles out of 16 articles from the selected issue
  • Susumu Kagawa
    1995 Volume 86 Issue 5 Pages 963-978
    Published: May 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
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  • Teruaki Iwamoto, Shojirou Kohno, Michitaka Yajima, Takao Osada
    1995 Volume 86 Issue 5 Pages 979-984
    Published: May 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Generally it is believed that mammalian sperm mature during their transit through the whole epididymas. However spermatozoa aspirated from the epididymal duct or vasa efferentia have been recently reported to move actively in azoospermic patients with seminal tract obstruction. We examined whether the testicular sperm move which would provide useful information in the diagnosis of male infertility.
    Testicular biopsy materials were obtained from 38 testes of 37 patients as follows; 19 cases with azoospermia, 11 with oligozoospermia, and 8 orchiectomized for prostatic cancer (3), testicular cancer (2), epididymal abscess (1), and cryptorchid (2). All materials were obtained from either open biopsy or from the normal portion of the orchiectomized testis. The material was minced with a sharp knife or scissors in an Eppendorf tube containing Ham's F12 solution. Then a couple of drops of sperm suspension were placed on a warmed (37°C) slide glass which was then covered with a coverglass. The prepared slide was immediately examined by phase-contrast microscopy. Anogher part was used for preparing a touch smear for confirming the presence of testicular sperm and then was fixed in Bouin's solution and stained with H-E. Spermatogenesis was evaluated by Johnsen's mean score (JMS).
    Eleven of the 19 azoospermic cases revealed the presence of testicular sperm, and ten of them demonstrated the presence of motile sperm. The mean JMS in these cases was 8.8 (normal spermatogenesis). After surgical exploration or vasography, these patietns were diagnosed with obstructive azoospermia {post-vasectomy (4 cases), congenital absence of vas def erens (2 cases), secondary epididymal duct obstruction (4 cases)}. One case of immotile testicular sperm demonstrated severe hypospermatogenesis (JMS 5.5). In another 8 cases of azoospermia, no sperm were observed. Seven of them were diagnosed with Sertoli cell only syndrome (JMS 2) and one case was diagnosed as hypogonadotropic hypogonadism. In the eleven oligozoospermic cases, testicular sperm were demonstrated in 8 cases and motile sperm in 6 of them. They demonstrated a higher JMS (Mean 7.2) than the 3 cases (Mean 5.5) in which testicular sperm were not observed. In six orchiectomized cases for prostatic cancer, testicular cancer and epididymal abscess, the presence of testicular sperm was demonstrated and in 5 (JMS 7.6) of them motile sperm were observed. Two orchiectomized cases for cryptorchid showed almost sertoli's cells in the seminiferous tubules (JMS 2.0).
    These finding demonstrated the presence of motile sperm in the testis. Furthermore, the status of azoospermic patient was clarified. By confirming the presence of motile testicular sperm at testicular biopsy obstructive azoospermia can be diagnosed immediately. In conclusion, the examination of motile testicular sperm provides useful information for the diagnosis of seminal tract obstruction.
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  • Yasushi Nagase, Nobuo Moriyama, Shigeharu Kurimoto, Atsushi Tajima, Ei ...
    1995 Volume 86 Issue 5 Pages 985-990
    Published: May 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We examined whether the staining of proliferating cell nuclear antigen (PCNA) could be useful as a marker of chemotherapeutic effectiveness in nine patients with invasive bladder cancer treated by bilateral internal iliac artery infusion of cisplatin (CDDP). Two types of monoclonal antibodies PC-10, 19A2 were used for immunohistochemical staining in formalin-fixed, paraffin-embedded tissue sections. There was no difference between positive rates of PC-10 and 19A2.
    The mean positive rates between pre-chemotherapeutic specimens (15.4±6.7%) and post-chemotherapeutic specimens (4.2±3.1%) showed statistically significant difference (p<001). The immunohistochemical evaluation of PCNA has balue for investigation of cell's turnover. Therefore, the changes of PCNA-positive rate could be a historagical parameter for the evaluation of chemotherapeutic effects.
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  • Masahisa Ikegami, Tetsuro Nagano, Yasushi Hara, Masashi Negita, Masaak ...
    1995 Volume 86 Issue 5 Pages 991-995
    Published: May 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We have studied the involment of fibrinolysis in acute rejection after kidney transplantation by analyzing changes in urinary levels of substances such as FDP, D-dimer, tissue plasminogen activator (t-PA) and plasminogen activator inhibitor (PAT). Fibrinolytic activity was found to be low (that is, PAT is dominant) during acute rejection, and it was elevated (that is, PA became dominant) as acute rejection subsided. It appears that the dominance of PA laeds to an increase in the products of fibrinolysis and an elevation in the D-dimer/FDP ratio, resulting in disappearance of the acute rejection. Based on these findings, we thought it necessary to administer t-PA to kidney recipients so that PA becomes dominant earlier and the acute rejection can be reduced. It is necessary for us to directly study the phenomena within the kidneys. Therefore, we recently conducted a histochemical study of the distribution of t-PA, Urokinase type PA (u-PA) and PAT in transplanted kidneys. Transplanted kidney, which functioned well or showed signs of acute or chronic rejection, were biopsied. These renal samples as well as control samples (biopsied from normal nongrafted kidney) were examined as to distribution of t-PA, u-PA and PAI by the indirect enzyme complement method. In conclusion, t-PA, u-PA and PAI were detected in the glomeruli, arterioles, tubule and interstices of the control kidneys, well functioning grafts, acultely rejected grafts chronically rejected grafts. All samples showed intense chromatic responses in the arterioles and part of the tubules. On the whole, the chromatic response tended to be more intense in the acute rejection group than in the other group.
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  • Hiroaki Shiozawa, Keiichiro Ishibashi, Fumihiko Hokoishi, Jian Wei Hon ...
    1995 Volume 86 Issue 5 Pages 996-999
    Published: May 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Laparoscopic nephrectomy has been performed widely for minimally invasive therapy. However, the procedure of insertion of needles and trocars can cause vascular and intestinal injuries. In addition, pneumoperitoneum using high pressure CO2 gas can cause circulatory and respiratory problems. In order to avoid these problems, we tried retroperitoneoscopic nephrectomy without CO2 gas in 8 kidneys of 4 pigs.
    A 1.5cm skin incision was made just below the lowest rib and a small retroperitoneal space was made with the forefinger. The sheath of a 27 Fr rigid nephroscope was covered with a condom balloon and inserted into the retroperitoneal space. Under observing through the nephroscope, the condom was filled with 150-200ml saline to make a space for the operation. After removing the nephroscope with condom, a scope and trocars were inserted into the space and retroperitoneoscopic nephrectomy was performed.
    Making the space with condom balloon in the retroperitoneal space was very efficient. The procedures succeeded in 8 and average procedure time was 3 hours. Retroperitoneoscopic nephrectomy without gas is a very attractive minimally invasive technique.
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  • Katsuyuki Tanaka, Sumio Noguchi, Mitsumasa Takeda, Toshio Sakuramoto, ...
    1995 Volume 86 Issue 5 Pages 1000-1007
    Published: May 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Forty cases of primary aldosteronism after adrenalectomy were observed from 1975 to 1993 at Yokohama City University hospital. All of them had adrenocortical adenoma producing aldosterone. These cases are evaluated retrospectively on localizatin, surgical approach and long term follow up blood pressure.
    These patients were from 26 to 65 years old (averagbe 46.6), and consisted of 11 males and 29 females. Fourteen adenomas were located on the right adrenal gland, 25 on left, and one case had adenomas on bilateral adrenal glands.
    On localization study, 39 cases had been correctly diagnosed by combined diagnostic method of selective adrenal venous sampling, selective adrenal venography, adrenal scintigraphy, X-ray CT, and MRI, with each diagnostic values being 65.8%, 69.0%, 72.5%, 96.9%, 100% respectively. This analysis suggests that, in almost cases, it is enough to diagnose the laterality by adrenal scintigraphy, X-ray CT and MRI. Selective venous catheterization is not always necessary to know the laterality of the tumor.
    For surgical approach to the adrenal gland, 16 adenomas were removed through anterior subcostal incision (transabdominal approach) from 1975 to 1988, and 24 cases through lumbar oblique incision or dorsal incision (extra peritoneal approach) from 1986 to 1993. This analysis reveals that lumbar oblique and dorsal incision provided us superior surgical approach to the adrenal gland.
    Thirty-eight cases had been followed after adrenalectomy for more than one year (average 57.6 months). Blood pressure had been normalized in 28 cases, but 10 cases had remained hypertensive. As suspectable related factors for duration of hypertension after adrenalectomy, age on adrenalectomy, duration of hypertension before adrenalectomy, size of adenoma, and hypertensive change of fundus of the eye are evaluated. Statistical analysis shows that only the changes of fundus of the eye could predict the duration of hypertension after adrenalectomy.
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  • Jun Taniguchi, Nobuo Moriyama, Yasushi Nagase, Shigeharu Kurimoto, Kaz ...
    1995 Volume 86 Issue 5 Pages 1008-1015
    Published: May 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We examined the staining pattern of various lectins in the malignant and benign prostatic tissues to clarify the difference of sugar residues of mucosubstances between them. The binding of different lectins (Concanavalia ensiformis [Con A], Triticum vulgaris [WAG], Ricinus communis [RCA-I], Arachis hypogaea [PNA], Ulex europaeus [UEA-I], Glycine max [SBA], and Gliff onia simplicifolia II [GSA-II]) to cells of benign prostatic tissues (17 cases) and adenocarcinoma (54 cases) was evaluated immunohistochemically. SBA which was negative in benign epithelial cells, showed tendency to the binding to prostatic carcinoma (42.6%). UEA-I was significantly bound to the adenocarcinoma (68.5%) compared to the benign prostatic tissue (35.3%). We also examined histochemically 25 pairs of tissues obtained from prostatic adenocarcinoma before and after the various therapies with various lectins. The histological responsiveness on the post-therapeutic specimens showed a significant correlation to the clinical responsiveness to therapy. But the staining pattern of these 7 lectins on the pre-therapeutic specimens did not show a significant correlation to the clinical responsiveness to therapy.
    In summary, the staining pattern of some lectins in the prostatic cancers is different from that in the benign prostatic tissues.
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  • Masaaki Tachibana, Ayako Miyakawa, Jun Nakashima, Kaoru Nakamura, Nobu ...
    1995 Volume 86 Issue 5 Pages 1016-1021
    Published: May 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Determined were long-term results of methotrexate, vinblastine, doxorubicin and cisplatin (M-VAC) adjuvant chemotherapy following radical surgery for locally invasive urothelial cancers. All cases at least histologically exhibited one of the following findings, a stage beyond pT3b (bladder cancer) or pT3 (upper tract urothelial cancer), lymphduct tumor involvement (1y +), venous involvement (V +), and/or regional lymphnode involvement (N1) without any evidence of distant metastasis and/or residual tumors. Two cycles of M-VAC chemotherapy were given after radical surgery for each case. A total of 33 cases comprising 21 bladder cancers and 12 upper tract urothelial cancers following cystectomy and/or nephroureterectomy with partial cystectomy who had a mean follow-up period of 56.7±9.2 months could be analyzed. Overall actuarial suvival rates of three- and five-years estimated by Kaplan-Meier method were respectively 41.9% and 31.6%. These results indicate that the postoperative outcome was extremely poor in patients with locally advanced urothelial cancer even after extensive adjuvant chemotherapy. Therefore, more effective modalities including optimal dose and scheduling of chemotherapy are needed to assure therapeutic improvement of locally invasive urothelial cancers.
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  • Makoto Morozumi, Yoshihide Ogawa
    1995 Volume 86 Issue 5 Pages 1022-1027
    Published: May 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Glycolate and glyoxylate, documented lithogenic precursors of oxalate, were administered acutely and chronically to Wistar-strain rats in order to study their effects on oxalate excretion and subsequent stone formation. Urinary oxalate increased significantly within 4 hours, with a maximum being reached between 4-8 hours after a single administration of glycolic acid (200mg) or glyoxylic acid (200mg). The 24-hour increase in urinary oxalate was about 3% of each amount given. Hyperoxaluria developed immediately and persisted throughout the experimental period in all the rats, which were fed on a diet containing glycolic acid or glyoxylic acid at a 3% level. Microscopically amorphous substances accumulated in the renal tubules at one week. Significant crystal formation appeared in the tubules after two weeks in both experimental groups and consistently increased both in number and in volume until the 4th week.
    Therefore, the oral administration of either glycolate or glyoxylate increased urinary oxalate comparably much within a few hours, but a few weeks of hyperoxaluria may be necessary to develop crystals in the convoluted tubules.
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  • Ichiro Satake, Kiyonobu Tari, Kouji Chiba, Kazuaki Nakagomi, Kazunori ...
    1995 Volume 86 Issue 5 Pages 1028-1033
    Published: May 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Single-stomal ureterostomy such as double barreled ureterocutaneostomy and cutaneous transureteroureterostomy have usually been performed by transperitioneal approach. However, extraperitoneal method is preferable since the patients for whom ureterocutaneostomy is indicated usually have a deteriorating general condition. We have reported single-stomal ureterocutaneostomy which can be done extraperitoneally.
    A total of thirteen patients, one man and twelve women, for whom permanent urinary diversion was indicated, have undergone this extraperitoneal ureterocutaneostomy for February 1988 to June 1994. Those with retroperitoneal lesions or with a history of paraaortic radiotherapy were excluded. The mean age was 61.7 (range: 42-76). The reasons for urinary diversion were vesicovaginal fistula in seven, obstructive nephropathy in four, rectovesical fistula in one and postoperative urine leak from the bladder in one. All patients had been treated for malignant diseases and had undergone transperitoneal surgery. Six patients had colostomy and ten had clinically evident recurrent diseases.
    In the operation, left ureter was dissected and severed extraperitoneally through left paramedian incision or left lumbotomy. The ureteral end was pushed to the right in a retroperitoneal tunnel created by blunt dissection. Then the ureter was picked up through the contralateral retroperitoneal approach. After both ureters were exposed, ureterocutaneostomy was made in right hypogastrium. Transureteroureterstomy with end-cutaneous ureterostomy, double barreled ureterocutaneostomy and ureteroureterostomy with loop ureterostomy were done in six, four and three patients, respectively. The mean operative time was 119 (range: 75-175) minutes and the mean intraoperative blood loss was 210 (range: 48-682) grams. Arrhythmia developed during retroperitoneal manipulation in one patient for whom the operation was done under spinal anesthesia. Retroperitoneal hemorrhage was seen in another one. Postoperative urine leak and late stomal trouble were seen in one and three patients, respectively. No other complications associated with the operative procedure were observed with follow-up periods of 1-19 months. Food intake was commenced within four operative days in nine of the patients.
    This extraperitoneal ureterocutaneostomy we have reported have two disadvantages: First, two separate incisions are necessary. Second, it is sometimes difficult to form a retroperitoneal tunnel through which a ureter is pushed toward the opposite side. In spite of these, this method enables without opening peritoneum the single-stomal ureterostomy which is highly advantageous in terms of quality of life over bilateral ureterostomy. In conclusion, we believe that this method of ureterocutaneostomy is worthwhile for those who have an expected survival of three months or more and have intraabdominal lesions or a history of abdominal surgery.
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  • Akio Matsubara
    1995 Volume 86 Issue 5 Pages 1034-1043
    Published: May 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Stromal-epithelial cell interaction is very important for the development of human benign prostatic hyperplasia (BPH). Growth factors and their receptors in the prostate are thought to mediate the cell communication and play some roles in the development of BPH. Among many growth factors, fibroblast growth factor (FGF) family members have received the most intensive study, and mRNAs for acidic FGF (aFGF), basic FGF (bFGF) and keratinocyte growth factor (KGF) have been identified in rat or human prostate. However, synthesis sites and roles of them in stromal-epithelial cell interaction remain to be undefined.
    In the present study, to define the mechanisms for the regulation of prostatic cell growth by stromal cells in human BPH, we established the method for isolation and culture of epithelial cells as well as stromal cells from human BPH tissue. Using these primary cultured prostatic cells, we evaluated the effects of stromal cell conditioned medium (SCM) and stromal cell extract (SCE) on the growth of stromal cells and epithelial cells by [3H]-thymidine incorporation assay. We also examined the expression of mRNAs for aFGF, bFGF, KGF, FGF receptor 1 (FGFR1) and FGFR2 in epithelial and stromal cells using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) analysis.
    As the results, both SCM and SCE stimulated the growth of stromal cells, and the growth promoting effects of them to stromal cells were completely suppressed by anti-bFGF neutralizing antibody, but not by anti-aFGF neutralizing antibody at all. SCM also stimulated the growth of epithelial cells. The growth promoting effect of it to epithelial cells was not completely suppressed by anti-bFGF neutralizing antibody, and not by anti-aFGF neutralizing antibody at all. Furthermore, RT-PCR analysis demonstrated the expression of mRNAs for bFGF, KGF and FGFR1 in stromal cells and that of FGFR2 in epithelial cells.
    These findings suggest that bFGF produced by stromal cells acts on stromal cells through FGFR1 by an autocrine mechanism, KGF produced by stromal cells acts on epithelial cells through FGFR2 by a paracrine manner in human BPH. These mechanisms for the regulation of cell growth by stromal cells were thought to contribute to the development of human BPH.
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  • Hiroki Horita, Yoshiaki Kumamoto, Yoshikazu Satoh, Nobukazu Suzuki, Hi ...
    1995 Volume 86 Issue 5 Pages 1044-1050
    Published: May 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    Anti-androgenergic agents are usually used for patients with benign prostatic hypertrophy (BPH). However steroidal anti-androgenergic agents tend to suppress the sexual function. This side effect is very significant in middle-aged men. Therefore we studied the preventive effect of indeloxazine hydrochloride (INDX), which induces an increase of the dopamine level in the brain, on the sexual dysfunction induced by an anti-androgenergic agent (allylestrenol: ALE). Thirty-six patients with BPH were classified into two groups, one used ALE only, and the other ALE with INDX.
    For the subjective evaluation of the sexual function, a self assessment questionnaire method was employed before and after administration. We especially studied 3 questions, “morning erection”, “erectile capacity” and “frequency of sex”. For the objective evaluation of the sexual function, nocturnal penile tumescence (NPT) was measured using an erectometer. NPT occurs in healthy males as a physiological phenomenon and it shows the erectile capacity objectively. The levels of LH, total testosterone and free testosterone were also determined.
    In the ALE only group, sexual dysfunction was found subjectively and objectively, but in the ALE with INDX group, it was not found. Levels of LH, total testosterone and free testosterone were decreased in the both groups. There was no significant difference between the two groups.
    We hypothesized that the sexual dysfunction due to ALE is related with not only to the decrease of androgen, but also to suppression of the central nervous system; for example, the suppression of the area of the brain mediating sexual behavior. These results indicate that INDX, which activates the doperminergic neuron system in the brain, has a preventive effect against sexual dysfunction caused by ALE.
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  • Masahiro Narushima, Atso Kondo
    1995 Volume 86 Issue 5 Pages 1051-1059
    Published: May 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We have investigated surgical results of quantitative suspension of the bladder neck for stress urinary incontinence. Three hundred ninety-four female patients suffering from stress incontinence have been operated on with Stamey's or Gittes' procedures during the past 8 years. While the bladder neck was elevated by quantifying tension of nylon threads in 84 patients, 310 patients subsequently were operated on by quantifying both tension and length of nylon loops. A follow-up period averaged 51 months for a group of the Stamey's and 19 months for a group of Gittes' procedures. Postoperative continence rate was defined by patients' subjective evaluation. Those whose nylon loops were quantified as from 130 to 149mm attained the highest continence rate, which was not related to age or severity of incontinence. Postoperative difficulty in urination was less in those who had nylon loops of 130 to 149mm, and was more in those over 60 years of age. Eighty-eight percent of the patients stated very much satisfied or satisfied with the surgery they had undergone. Continence rate was 78% for those operated on with the Stamey's (51 months later) and 69% with the Gittes' procedures (19 months later). The 7-year continence rate was 77% for the former and the 3-year continence rate was 38% for the latter, indicating that the Stamey's procedure was significantly more useful than the Gittes' procedure. Postoperative complications were encountered with 17% of the patients. We conclude that quantitative suspension of the bladder neck is of value to obtain the high success rate of the needle suspension procedure.
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  • Gaku Kawabata, Hiroyoshi Shimogaki, Nozomu Yamanaka
    1995 Volume 86 Issue 5 Pages 1060-1063
    Published: May 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A 49-year-old male patient underwent an exploratory laparoscopy for a lumbosacral prevertebral mass which caused right hydronephrosis by extrinsic ureteral stricture. The diagnosis of idiopathic retroperitoneal fibrosis (IRPF) was made by the laparoscopic biopsy.
    We then proceeded to perform successfully laparoscopic ureterolysis and intraperitonealization of the ureter on the patient.
    Laparoscopic approach provides a less invasive alternative in diagnosis and treatment of the patient with IRPF.
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  • Ryusei Sasaki, Yutaka Tachiki, Taisei Tsukada, Kunio Miura, Tetsuro Ka ...
    1995 Volume 86 Issue 5 Pages 1064-1067
    Published: May 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    A 62-year-old male with slight fever, anorexia and easy fatigability was found to have a tumor in the left adrenal gland by computed tomogram of abdomen. Further study of angiogram suggesting neoplasm of the left adrenal gland, eventually he was undewent surgical extirpation. Histological study, combined with immunohistochemical staining, revealed that the tumor measuring 8×4×6cm was an angiosarcoma. The patient died of pulmonary dysfunction 42 days after the operation. Autopsy was not done. In the literature, 7 cases of adrenal angiosarcoma have been reported; ours is the 8th case.
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  • Kaoru Miyazaki, Yasuhisa Ichigi, Zenjiro Masaki, Kazushige Nanri
    1995 Volume 86 Issue 5 Pages 1068-1071
    Published: May 20, 1995
    Released: July 23, 2010
    JOURNALS FREE ACCESS
    We report a case of 73 years old male with recto-urethral fistula developing after transrectal hyperthermia for prostatic hypertrophy. This is the first case report of recto-urethral fistula probably caused by transrectal hyperthermia. Anterior anorectotomy approach for fistula closure provided a wide operative field and lead to a successful result.
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