(Background) We evaluated blood loss in operation and postoperative urinary incontinence to total prostatectomy using the DDV-L.
(Methods) We performed total retropubic prostatectomy for 38 patients from May 1979 to May 1995. In 14 patients from October 1994 to May 1995 the DDV-L was used.
The DDV-L is used in transurethral approach, disposable device to ligate the deep dorsal vein complex by delivering the needle to lateral of deep dorsal vein complex.
(Recults) We composed the 14 patients which was used the DDV-L with the 14 patients which was from April 1990 to July 1994 was not used that. The mean operating time of 14 patients which was used the DDV-L was 178.5min, 14 patients which was not used that was 188.0min. The mean blood loss of 14 patients which was used th DDV-L was 735.7ml, 14 patients which was not used that was 1250.2ml. We transfused blood into 2 of 14 patients which was used the DDV-L (14.0%), 10 of 14 patients which was not used that (71.4%). The one of 14 patients which was used the DDV-L (7.5%) and 5 of 14 patients which was not used that (35.7%) had postoperative urinary incontinence needing pad.
(Conclusion) Acordingly the operating results of 14 patients which was used the DDV-L was undoubetely better that of 14 patients which was as regards blood loss in operation, postoperative urinary incontinence. We can perform easyly the management of deep dorsal vein complex by DDV-L, so we can cut of urethra without excess hemostasis and electronic coaglation, and leave enough long menbranous urethra. We consider the DDV-L is helpful to total prostatectomy.

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(Background) The insufficent circulatin of the internal pudendal vein is a characteristic sign observed in the patient with intrapelvic venous congestion syndrome (IVCS). The present study was designed to reveal the pathophysiological significance of it in IVCS.
(Methods) Twenty-seven men with IVCS and nine men without IVCS were used in this study. The circulatory status in the internal pudendal vein was evaluated by three dimensional magentic resonance venography (3D-MRV). From the coronal MRI (the original image of 3D-MRV) on the slice of the ischiorectal fossa, the thickness of the obturator internus muscle and the pararectal fatty tissue was measured. The interval between the ischial supine, locating at the bottom of the pelvis, was also measured. Using eleven cadavers, the pelvic cavity was examined carefully in terms of the course of the internal pudendal vein.
(Results) The finding of interruption in the internal pudendal vein by 3D-MRV was observed at the ascending portion in all cases with IVCS. Although the thickness of the obturator internus muscle was not significantly different between two groups, the thickness of the pararectal fatty tissue in IVCS group was significantly thinner as compared to control group (3.0±0.4 vs 3.6±0.1cm, p<0.01). The interval between the ischial supine in IVCS group was significantly narrower as compared to control group (7.9±1.1 vs 9.4±0.5cm, p<0.01).
In cadavers, it was confirmed anatomically that the ascending portion of the internal pudendal vein passed through the pudendal canal (the Alcock's canal) accompanied by the internal pudendal artery and the pudendal nerve.
(Conclusions) It was suggested that anatomical factors, such as the thinner pararectal fatty tissue or the narrower interval between the ischial supine, might cause the development of IVCS, according to the compression of the Alcock's canal.

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(Background) Although clinical reports concerning voiding dysfunction after cerebrovascular disease are observed, no experimental studies have been carried out using an animal model. This study was performed to establish an animal model to evaluate neurogenic voding dysfunction associated with cerebral infarctions.
(Methods) Male Sprague-Dawley (S-D) rats weighing between 250 to 350g were used. To induce regional cerebral infarction in rats, 4-0 monofilament nylon thread was introduced through the left internal carotid artery into the origin of the left middle cerebral artery. Cystometric examination was performed in conscious rats through a catheter chronically implanted into the bladder dome. Changes in body weight and bladder capacity were studied. The effects of intravenous oxybutynin hydrochloride, atropine and nifedipine on the conscious rat bladder were examined. By measuring the contractile response to field stimulation with added atropine and α, β-methylene-ATP, the proportion of muscarinergic and purinergic innervation was compared between them.
(Results) Bladder capacity in cerebral infarcted rats was significantly decreased just after middle cerebral artery occlusion, and 14, 21 and 28 days after occlusion reached less than half that in sham operated and untreated rats. Bladder capacity correlated with the area of infarcted lesion determined by triphenyltetrazolium chloride staining. In the cerebral infarcted rats, bladder capacity significantly increased at low concentrations of oxybutynin hydrochloride, while in the sham operated rats bladder capacity did not increase. Although an increase in bladder capacity was observed after administration of atropine both in cerebral infarcted and sham operated rats, a significant increase of residual urine was found and considered to be caused by decreased detrusor contraction pressure. Nifedipine increased bladder capacity in the cerebral infarcted rats without increasing residual urine. There was no significant difference in the proportion of muscarinergic and purinergic innervation between the cerebral infarcted and sham operated rats.
(Conclusion) These results indicate that calcium channel blocking agents may operate especially on the central nervous system rather than peripheral neuromuscular system, resulting in augmentation of the bladder capacity in the cerebral infarcted rats. Hitherto, the action of oxybutynin hydrochloride on the peripheral neuromuscular system is considered to be the most important, but in the cerebral infarcted rats its action on the central nervous system should also be considered. This type of animal model is believed to be useful to study neurogenic voiding dysfunction of human subjects with cerebrovascular disease.

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(Background) Pharmaco-dynamic infusion cavernosometry and cavernosography (pharmaco-DICC) is essential for diagnosis of venogenic impotence, however it is so invasive. On the other hand, color Doppler ultrasonography is non-invasive and has become one of the useful diagnostic methods for arteriogenic impotence. And there are some reports evaluating whether venogenic impotence can be diagnosed using color Doppler ultrasonography. In this study, we investigated whether the resistance index (RI) could be useful for screening for venogenic impotence.
(Methods) We performed color Doppler ultrasonography in 49 patients who had shown negative responses to an intracavernous injection of 20mcg of prostaglandin E1 (PGE1). They previously underwent pharmaco-DICC and were diagnosed venogenic impotent when the maintenance flow rate was equal to or more than 20ml/min. In 49 patients, 17 patients had DICC normality, while 32 patients had corporal leakages. After an intracavernous injection of 20mcg of PGE1, we performed color Doppler ultrasonography, and measured peak systolic velocity (PSV) and end diastolic velocity (EDV) in the cavernous artery. RI was calculated as follows.
RI=(PSV-EDV)/PSV
We adopted the RI value near to 1 as the case's RI from two RI values of bilateral cavernous arteries, and compared RI values with the results of pharmaco-DICC.
(Results) RI range in patients with normal DICC results was 0.895±0.092 (0.70-1.00), while RI range in patients with corporal leakages was 0.742±0.095 (0.55-0.97). RI values in patients with corporal leakages were significantly lower than those in patients with normal DICC results although there was some overlap in each group. From receiver-operating-characteristic curve (ROC curve) of the correlation between sensitivity and specificity at various RI values compared with DICC results, the RI cut off values were set up at 0.75 and 0.90, and classified the patients into 3 grousp according to their RI cut off values. In 10 patients with 0.9<RI, 9 patients (90%) had DICC normality. In 17 patients with 0.75<RI≤0.9, 7 patients had DICC normality while 10 patients had corporal leakages. In 22 patients with RI≤0.75, 21 patients (95.5%) had corporal leakages.
(Conclusion) We consider without carrying out pharmaco-DICC that patients with 0.9<RI were not venogenic impotent, while patients with RI≤0.75 had corporal leakages. Pharmaco-DICC will remain essential only in patients with 0.75<RI≤0.9.

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(Background) Although reflux nephropathy (RN) is one of the most important causes of renal failure in adolescence and young adulthood, we have no appropriate markers to know the future course of children with RN. In order to find out useful marker to predict the prognosis of these children, we analyzed the result of over ten years follow-up of children with RN.
(Methods) We evaluated renal function in 25 patients (aged between 11 years and 23 years, 14 males and 11 females) with RN using urinary α1-microglobulin (α1m), urinary albumin and ^99mTc-dimercaptosuccinic acid (DMSA) renal scan. All patients were followed up more than 10 years after disappearance of vesicoureteral reflux.
(Results) Of 25 patients, 13 showed high levels of urinary α1m (>4.4mg/gCr=upper normal limit) during follow-up period. Among them, renal dysfunction developed in 9 on DMSA renal scan and/or serum creatinin (Cr) level. Before puberty, all patients, even children with renal dysfunction (serum Cr>1.0mg/dl), remained in normal or slight high urinary albumin levels. Five cases, showed high levels of urinary α1m before puberty, demonstrated a remarkable increase of urinary albumin levels after puberty.
(Conclusion) From these results, it was suggested that urinary levels of α1m could be utilized as a marker to predict the prognosis of children with RN.

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(Purpose) The purpose of this study is to confirm the definite indication for surgery of pediatric testicular and funicular hydroceles in view of natural course.
(Methods) During the period from 1978 to 1994, we encountered 160 hydroceles in 149 pediatric patients. Patients ages ranged from 5 days after birth to 13 years and the mean follow-up periods was 4.7 years. We investigated the indication for surgery of pediatric hydroceles in six points of view: value of an aspiration of hydroceles, of what testicular or funicular or both, communication, size, age and testicular development.
(Results) Nevertheless, of 160 hydroceles, 66 (41%) were performed an aspiration of hydroceles, the aspiration of hydrocele was ineffective in the majority of patients. Common hydroceles in neonates and infants required no specific treatment, as the majority of hydrocele resolve spontaneously, however surgical treatment was required for a communicating large hydrocele that had been often attacked by aspiration and appeared at older age. Funicular hydroceles were more difficult to spontaneous healing. Ipsilateral testis manifests a well developed comparing control material.
(Conclusion) The indication for surgery of pediatric hydroceles were as follows: 1) hydroceles complicated by a inguinal hernia or cryptorchidism, 2) hydroceles appeared at older age and not resolved during 2-3 years over, 3) giant communicating funicular and testicular hydroceles present with an hindrance for daily life.

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(Background) Sixteen patients with invasive bladder cancer were received neoadjuvant methotrexate, vinblastine, pirarubicin and cisplatin chemotherapy on our planning protocol.
(Methods) The tumor was evaluated after 1 course of chemotherapy by radiographic examination, urine cytology, cystoscopy and random biopsy. If the response is CR or PR, one more course of chemotherapy was performed, and cystectomy was carried out. If the response is NC or PD, cystectomy was immediately carried out. Twelve of them were underwent cystectomy and four were preserved bladder. Clinical response was evaluated by echo, CT, MRI, urinary cytology, cystoscopy and random biopsy.
(Results) Clinical CR was observed in 25% and PR was 37.5%. Pathological CR was observed in 31.3% and PR was 37.5%. The different rate between clinical and pathological evaluations was 31.3% and the result suggests that we should find the method of more accurate staging evaluation. Four patients who were evaluated clinical CR were selected bladder-preserving. However, two of them (50%) had recurred; one had grade 3 tumor was treated by total cystectomy and the other had multiple tumors was treated by one course of M-VAC and TUR-Bt.
(Conclusion) We should consider which cases are possible to preserve bladder by investigating the tumor characteristics.

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A 71-year-old male with hyperglycemia was incidentally found to have a right renal tumor. Hyperglycemia had been controlled by administration of 34 units of insulin. Immediately after radical nephrectomy, hyperglycemia was improved to be able to stop insulin. His fasting blood glucose level remained within normal limits without any treatment. Laboratory studies, however, failed to reveal any endocrinopathy derived from renal cell carcinoma responsible for the diabetic state.

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A case of primary malignant mesothelioma grew from retroperitoneal space is reported. A 39-year-old man was admitted to our hospital with the right non-functioning kidney on April, 1993. He had felt the right lumbal dull pain and scrotal pain about 6 month ago, the pain became stronger gradually. He consulted the other clinic, and there, he was pointed out of the loss of function of his right Kidney by the IVP. Examination of cystocopy, retrograde pyelography, percutaneous antegrade pyelography, CT scan and ultrasonography suggested retroperitoneal tumor with unknown origin. His right ureter was totally obstructed by this tumor, and the right kidney had lost the function. The right nephrectomy and partial ureterectomy were done but this tumor was hard to be resected because of its sever invasion to the surrounding musles and bones. The pathology of this tumor resulted in a Malignant Mesothelioma. After the operation several chemotherapy was done but any effectiveness was not gained. The tumor made rapid progress and he died of multiple organ failure in 8 months after the first operation. Malignant Mesothelioma generally arises from serous membrane, so almost of this tumor are found in the peritoneum and pleura. But in this case, the tumor developped in the retroperitoneum. I have given this case a great deal of consideration and due to its unusual nature I make this report.

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