Two patients with nonfunctioning kidney were treated with retroperitoneal laparoscopic nephrectomy. The working space in the retroperitoneum was created by balloon dissector consisted of surgical glove and rigid nephroscope. The balloon dissector inserted to retroperitoneal space was inflated with 500-600ml normal saline. After removal of the balloon dissector, 4 trocars were inserted to the retroperitoneal space. In these two cases, the kidney were removed successfully without any complication. The operating time was 165min and 219min, respectively.
(Background) Diabetic lower urinary tract disfunction is well known, however, precise mechanism of the lower urinary tract disfunction remains to be solved. The present study is to clarify the lower urinary tract disfunction of diabetic rats by simultaneously measuring bladder and urethral pressures. (Methods) Female wistar rats were administered with streptozotocin (STZ 65mg/kg, i. p.) to induce diabetes mellitus. Bladder and urethral pressures during rhythmic bladder contractions were compared under urethane anesthesia (1.0g/kg, i. v.) between the control rats, diabetic rats, nd diuretic rats. (Results) The bladder contraction pressures of diabetic rats were decreased initially, but returned to the control values at 8 weeks. Atropine (2.5mg/kg, i. a.) produced a marked reduction of bladder contraction pressure in the 8 weeks diabetic rats. The diabetic rats showed an increase of urethral pressure simultaneously with an increase of bladder pressure in the initial phase of rhythmic bladder contraction which is totally blocked by striated muscle relaxant. This phenome non was not observed in the control or diuretic rats. Both group showed an initial decrease of urethral pressure followed by bladder contraction and rhythmic contractions of the urethra. (Conclusion) Our results suggest that bladder muscarinic receptors of the 8 weeks diabetic rats are more dominant than those of the other groups, and Mahoney's 4th reflex (urethrosphincteric guarding reflex) is facilitated but Mahoney's 6th reflex (detruthodetrusor facilitative reflex) is suppresed in the diabetic rats. We think that in the diabetic rats, sensory inputs by bladder distension were weak and could not induce Mahoney's 6th reflex until certain threshold values. Diabetic rats might develope changes in the mode of spinal neuronal transmission.
(Background) We reviewed our experience with bladder conservative treatment for invasive bladder cancer in 20 patients to investigate which type of tumor was suitable for organ conservation. (Methods) We performed radical transurethral resection with dissection to deep layer of the muscle plus intra-arterial chemoinfusion of the cis-platinum at a dose of 80-100mg/body twice at least, and the recurrent tumor was treated by the same procedure. There were 13 cases of stage T2 and 7 cases of stage T3a. All patients were pathologicallydiagnosed transitional cell carcinoma with 9 cases of grade 2 and 11 cases of grade 3. (Results) With a follow-up of 36 months (range 18 to 82), 15 (75%) of 20 patients were survived and 10 (50%) of 20 patients were free of tumor. Of 5 patients with residual or recurrent tumor, 2 patient underwent cystectomy and the others were required transurethral resection. Of 5 patients died, 4 patients died of cancer all with distant metastasis (lung meta: 2 cases, liver meta: 2 cases). In reference to tumor characteristics, all 4 patients had over 3cm diameter tumors withnon-papillary surface and 3 of 4 patients had invasive tumors extended to bladder neck andprostatic urethra. of 15 patients alive, 7 (47%) patients had non-papillary tumors, 9 (60%) had grade 3 tumors, 5 (33%) had T3a tumors, but invasion of the prostate urethra was recognized in only 3 patients (20%). (Conclusion) We had possibility of doing organ prevention therapy for the patients with invasive bladder cancer, even though it was non-papillary or grade 3 tumor. On the other hand, it was thought that a conservative approach should not be considered in patients with large non-papillary tumors that extended to bladder neck and prostatic urethra.
(Background) The prognosis of patients with testis cancer classified as being in the advanced extent according to the Indiana University staging system is still poor even when treated with cisplatin based chemotherapy. (Methods) Attempting to increase the efficacy of chemotherapy in this high risk group, we have adopted PVeBV chemotherapy (high dose CDDP+VBL+VP-16+BLM) for recent 8 patients with such advanced conditions. In this study, we analized the treatment outcome of those patients retrospectively. (Results) Two patients died during the first course of PVeBV chemotherapy due to cancer progression, while 6 patients treated with 3 to 4 cycles of PVeBv were eligible and assessable for response, survival, and toxicity. Five of those 6 achieved pathological CR (pCR) following surgical resection of residual masses after 3 cycles of PVeBV. The other case was saved by salvage chemotherapy with autologous BMT. All 6 patients were long-term disease free survivors in median follow up of 46 months. With the rG-CSF application and vigorous hydration, acute phase toxic effects (myelosuppression, pulmonary fibrosis and nephrotoxicity) were manageable in this intensive regimen. Long term toxic effects such as peripheral neuropathy and ototoxicity were also tolerable and quality of life in such advanced cancer patients was preserved well. (Conclusion) To improve a cure rate of high risk testis cancer, the dose escalation of induction chemotherapy should be considered.
(Background) The effects of cyclosporin (Cs), azathioprine (AZP) and mizoribine (MZR) on male reproduction in rats were examined. (Methods) Each drug was orally administered every day for 14 days at the following doses; Cs, 10, 20, 40, or 80mg/kg body weight; AZP, 5, 10, or 20mg; and MZR, 2.5, 5, 10, or 20mg. (Results) In the sperm count in the cauda epididymis, two weeks after the discontinuation of administration, a significant decrease was observed only in the 80mg/kg dose group among the Cs-treated groups and in the 5mg/kg and 20mg/kg dose groups among the AZP-treated groups. At the end of the administration, a significant dose-dependent decrease was observed in the MZR-treated groups. The degree of the decrease was smaller after Cs administration compared with the other 2 drugs. Sperm motility was significantly decreased in each Cs-treated group immediately after the oral administration of Cs and improved gradually, but was not changed in AZP- and MZR-treated groups. Significant dose-dependent damage of the seminiferous tubules was noted 6 weeks after administration of Cs, AZP and MZR. The serum levels of luteinizing hormone and follicle-stimulating hormone remained the same throughout the experiment. The serum level of testosterone was significantly low immediately after the oral administration of AZP, but was not changed by that of Cs and MZR. (Conclusion) Cs, AZP and MZR injured the spermatogenesis in rat. However, changes in the sperm count in the cauda epididymis suggested that the degree of impairment by Cs is relatively small, but only Cs injured epididymal function as well.
(Background) The clinical study of pediatric kidney transplantation in Kansai area is reported in this paper. (Methods) Seventy six children, 0-15 years old, received renal transplants at 8 transplant centers of Kansai area up to December, 1993. Clinical study was carried out about the etiology of renal failure causes, the graft survival and the complications. (Results) End-stage renal failure was due to a variety of diseases. The 3 most common csauses were chronic glomerulonephritis, chronic pyelonephritis including of reflux nephropathy and focal segmental glomerulosclerosis (FSGS). The graft rates at 3, 5 and 8 years were 75%, 71% and 53% for children receiving azathioprine (AZ), compared to 77%, 59% and 52% for ones receiving ciclosporin (Cs). Cs has led no improvement of the graft survival. Adult had the better graft survival rate than children in Cs immunosuppressive protocol. In 12 children transplanted kidneys for FSGS, only 3 cases had recurrent FSGS. Neoplasia was found in two case. They were acute leukemia and liposarcoma. (Conclusion) Kidney transplantation is recommended as the treatment for end-stage FSGS. Even the children should be carefully followed up after transplantation for malignant tumors.
(Background) We previously performed one-stage urethroplasy with OUPF IV in 17 patients with proximal hypospadias and experienced meatal stenosis in 3 and meatal regression in 2. (Methods) Because these complications seemed to be caused by diminished vascularity, we modified the technique to preserve the vascularity to the peripheral site of the neourethra. The modified OUPF IV (Koyanagi) was used to treat 6 patients with proximal hypospadias during the last 3 months. (Results) Urethrocutaneous fistulas developed in 2 patients but meatal stenosis and meatal regression did not occur. (Conclusion) We think this modification is suitable for severe proximal hypospadias.
(Background) We studied the relationship between the recurrence rate of primary superficial bladder cancer and random biopsy. (Methods) We performed transurethral resection of primary superficial bladder cancer in 144 patients, and in 55 of those cases a random biopsy was also performed. The non-recurrence rate was examined in many recurrence facters. (Results) The non-recurrence rate in the group with random biopsy was not significantly different from that observed in the group (100 patients) without random biopsy (x2 test, Generalized Wilcoxon test and multivariate analysis). Because the intravesical instillation therapy is an important inhibition factor in the recurrence rate of the primary superficial bladder cancer, we further analysed the recurrence rate in two non treated groups with or without random biopsy (13 and 35 patients respectively). No significant difference in the rate of recurrence between the two groups was observed. However, we noted recurrence of bladder cancer at biopsy positions in 8/13 patients. (Conclusion) It appears that random biopsy may have an effect on the recurrence or the implantation of tumor cells. Further studies are needed to clarify whether random biopsy is a risk factor in the recurrence rate of primary superficial bladder cancer.
(Background) The indications and suitable operative time of parathyroidectomy for secondary hyperparathyroidism were discussed. (Methods) From October 1978 to September 1994 parathyroidectomy was performed for 71 patients who had bone and/or joint pain due to secondary hyperparathyroidism. There were 37 men and 34 women (mean age 48.4 years). The duration of dialysis treatment before parathyroidectomy was 0.8 to 19 years, with a mean of 10.9 years. (Results) Postoperative subjective improvement was noted in 69% of the patients. No significant difference was observed between the improved and non-improved groups regarding age and the duration of dialysis treatment. But the improvement rate in female patients was significantly lower than that in male patients. (Conclusion) Patients with high carboxyl-terminal PTH level and generalized fibrous osteitis were good suitable objects for parathyroidectomy. But, those with high serum aluminum level were unsuitable objects for it. Furthermore, 99mTc-Pyrophosphate bone scintigraphy and bone mineral determination using dual photon absorptiometry (DPA) or dual energy X-ray absorptiometry (DEXA) were proved to be valuable for patient selection for parathyroidectomy.
We experienced a case of renal leiomyoma. A 51-year-old woman was refered to the Department of Urology, Tochigi Cancer Center with a complaint of right renal incidentaloma pointed out on CT scan. The renal mass was removed by enucleation. Histological examination revealed the tumor composed of monotonous proliferation of spindle shaped cells without atypia. Thus, the diagnosis of leiomyoma was comfirmed. DNA flow cytometric analysis of this tumor was performed and diploid pattern was shown.
We experienced a case of mucin producing prostate carcinoma, which occurred 46-year-old male patient. Serum tumor markers of prostate carcinoma were all in normal levels, and physical findings were similer to those of benign prostate hypertrophy. Histopathological study showed poorly differentiated mucinous adenocarcinoma occupying more than 30% of specimen. In literatures there seemed two types of mucin producing prostate carcinoma, the one is different from usual prostate carcinoma as our case and the other is a subtype of usual one, and so it was suggested that we must respect to this point on diagnosis and therapy of it.