(Purpose) We determined whether patients with bladder cancers accompanied by carcinoma in situ (CIS) or epithelial dysplasia carry a poor prognosis. (Materials and Methods) The resected bladders from 57 patients with a bladder cancer were step-sectioned. The stained specimens underwent microscopic examination and the extent of CIS and epithelial dysplasia was mapped out. The 57 patients were followed up for 5 to 10 years and the cumulative survival rates were calculated. (Results) Gross tumors were accompanied by CIS in 29 (51%) patients and by epithelial dysplasia in 52 (91%) patients. The survival rates did not differ significantly between the presence and absence of the accompanying mucosal lesions. However, the cancer specific survival rates were higher in patients with accompanying CIS located away from the gross tumor than in patietns with CIS located adjacent to the gross tumor (p=0.04). In patients with a non-papillary bladder cancer the survival rates tended to be higher when accompanying epithelial dysplasia accounted for over 3% of the whole mucasal area than when it accounted for less than 3% (p=0.09). (Conclusions) These results suggest that the presence of accompanying CIS or Epithelial dysplasia does not indicated a poor prognosis, and may indicate a favorable prognosis in patients with a non-papillary bladder cancer.
(Background) The objective of this study is to evaluate the sclerosing agents for simple renal cysts. (Methods) Thirty-three renal cysts of 30 patients were treated by injection of sclerosing agents with the guidance of ultrasonography. Among them, 22 were treated with ethanol, and 11 with minocycline-hydrochloride (MINO). (Results) Clinical efficacy rates and volume reduction rates in each treatment group of ethenol or MINO, were 100% and 90.9%, and 91.2±13.1% (mean±SD) and 83.2±28.5%, respectively. Although several complications including pain and intoxication were observed in ethanol (47.4%), no complications were observed in MINO. (Conclusion) The instillation of MINO into renal cysts is an effective, safe and simple treatment. It is thought that it can be the first choice of treatment for simple renal cysts.
(Background) The object of this study is to evaluate the usefulness of the ATP sensitivity assay for appropriate selection of anticancer drugs for prophylactic bladder instillation therapy in patients with superficial bladder cancer. (Methods) The ATP assay was performed using the method reported previously. The anticancer drugs examined were ADM, MMC, THP-ADM and EPI. The 5-year rate of non-recurrence in group A (32 cases) which had been treated using the results of ATP assay, was compared with that of group B (37 cases), for which the ATP assay was not performed. (Resuls) The most sensitive anticancer drug was THP-ADM. The 5-year rate of non-recurrence in group A (80.9%) was significantly higher than that in group B (39.4%) (p<0.001). Tumor recurrences in group A was observed within 2 years post-operatively in all cases. When the ATP assay was re-performed in 3 cases with recurrent disease, altered antitumor sensitivity was observed. (Conclusion) These findings suggested that ATP assay was useful for choosing effective anti-cancer drugs for prophylactic instillation, especially for patients with primary or solitary tumor, grade 2 disease or tumor of a certain size (≥1cm). It also appeared that the ATP assay should be performed for patients with primary superficial bladder cancer as a screening test for the selection of drugs for prophylactic instillation therapy.
(Objective) The results of genitoplasty performed at our clinic for 41 female patients with congenital adrenal hyperplasia (CAH) were reviewed. (Patients) Among 57 females with CAH (56 with 21-hydroxylase deficiency and 1 with 11β-hydroxylase deficiency) diagnosed between 1961 and 1995, 41 underwent genitoplasty. For the rest of 16 patients, 1 received already clitorectomy, 11 (19%) needed no surgical reconstruction, 2 died before surgery, and 2 are in a waiting list for surgery. (Results) According to Prader's classification of virilized genitalia, 41 patients who received surgery included 8 of type I, 10 of type II, 17 of type III, and 4 of type IV. There was no patients of type V, and 2 were not classified because of previous surgery. Four patients underwent genitoplasty 7 times in total before visting us. The age receiving initial genitoplasty at our clinic ranged from one year and 9 months to 20 years (median: 4 years and 5 months). Follow-up period averaged 17 years with the range of 2 months to 33 years. For enlarged clitoris, clitorectomy (amptation of clitoris) was carried out for 22 patients before 1975 and corporal resection for 17 after 1975. Two patients manifested recurrence of clitoromegaly after the surgery because of either incomplete resection of the clitoris or patient's ignorance of taking glucocorticoid regularly. Thirty-six patients needed labiovaginoplalsty. Simple midline cutback was performed for 6 patients and Y-V plasty (skin flap labiointroitoplasty) for 30. Vaginal orifice was not identified in 5 patients at the initial surgery. Two patients received successful second introitoplasty at the older age than 10. Post-operative stenosis of vaginal orifice was confirmed in 6 patients and 3 underwent second introitoplasty. Among 23 patients older than 25 years at present, 7 got married and 4 raised 6 children with assistance of Caesarian section. (Conclusions) Most of female patients with CAH needed genital plastic surgery including clitoroplasty and labiovaginoplasty. Corporal resection for enlarged critoris with sufficient hormone therapy brought a satisfactory result. Y-V plasty for labiovaginoplasty proved to be an excellent method, especially from cosmetic viewpoint, but remained some problems as one stage operation including difficult identification of vaginal orifice and post-operative stenosis of introitus in some patients.
(Objective) A scanty evidence previously reported regarding renal cell carcinoams occurring in association with renal cystic diseases prompted us to conduct a nationwide survery in July 1991. (Methods) A total of 507 hopitals responded to the questionnaire inquiring the clinical and pathological characteristics of renal cell carcinoma associated with renal cystic diseases over the previous 2 years. (Results) Renal cystic diseases were identified in 223 (3.9%) of 5, 721 patients with renal cell carcinoma. The patients consisted of 181 men and 42 women who had a mean age of 55.2±12.5 years (SD). The renal cystic diseases comprised simple renal cysts in 72 patients (32%), acquired cystic diseases of the kindey (ACDK) in 62 (28%), cystic renal cell carcinoma in 56 (25%), multilocular renal cysts in 20 (9%), polycystic kindey in 3 (1.3%), miscellaneous cysts in 9 (4.0%), and unspecified cysts in 1 (0.4%). Simple renal cysts were more common in older patients, while ACDK and multilocular cysts were more predominant in younger patients. They included 71 dialysis patients (32%), of whom 62 (87%) had ACDK. Renal cell carcinoma occurred bilaterally in 12 patients (17%) on dilaysis. Young male patients over a longer dialysis period were more susceptible to renal cell carcinoma. Low stage tumor, papillary type and granular cell subtype were more common in those on dialysis than in those without dialysis. In consideration of the Japanese general and dialysis population, we confirmed that dialysis patients with ACDK are more susceptible to renal cell carcinoma and those with polycystic kidney are less so. (Conclusion) Renal cystic diseases may be associated with about 4% of renal carcinoma. Young male patients over a longer dialysis period who are diagnosed to have renal cysts should be regularly and closely followed by imaging study.
(Background) Risk factors to induce graft dysfuntion during pregnancy in kidney transplant recipients were studied. (Methods) A total of 28 deliveries from 21 female kidney transplant recipients were analyzed. (Results) All recipients were maintained on either azathiopurine-based (n=17) or cyclosporine-based (n=11) immunosuppressive regimens. Graft dysfunction (creatinine clearance <40ml/min) occurred in 8 cases (8 patients) during pregnancy. No acute rejection, however, could be observed. In a case-controlled study comparing a group with graft dysfunction vs. a group with good graft function, there were significantly differences in the incidence of the cases with pre-existing hypertension (62.5% vs. 10.0%), the age of the grafted kidney (58.1 vs 47.6 year), the maternal anemia (Hb:10.3 vs. 11.8g/dl) and the creatinine level (1.4 vs. 1.0mg/dl) at the first trimester. These findings suggested that poorer graft function had been underlying before pregnancy and that additional loading of the pregnancy reduced further graft function, while the deterioration would be recovered after delivery in all cases except one case. (Conclusion) Risk factors to induce graft dysfunction during pregnancy are as follows. 1) high age of the grafted kidney (>50 year), 2) pre-existing hypertension, 3) maternal anemia (Hb:<11g/dl) and 4) high creatinine level (>1.3mg/dl) at the first trimester.
(Purpose) We investigated the changing patterns of urogenital cancer deaths during the past 22 years in Japan. (Methods) We analyzed patients that died from cancer of the prostate, bladder and kidney between 1973-1994. Age-adjusted death rates (adjusted to the world population), standardized mortality ratios (SMR) according to each prefectures and age-specific death rates for each types of cancer were calculated and changes in these patterns were analyzed. (Results) Age-adjusted death rates for cancer of the prostate increased from 2.29 in 1973 to 4.36 in 1994, a 1.9-fold increase. Death rates for cancer of the bladder were stable in males and declined in females. Death rates for cancer of the kidney (15 years or older) increased from 1.45 in 1973 to 2.72 in 1994, a 1.9-fold increase in males, and tended to increase in females as well. In the SMR analysis by prefecture, distribution in 1973-84 (former period) and that in 1985-94 (later period) were similar, and characteristic features were observed for each type of cancer. Age-specific death rates for cancer of the prostate and bladder rose by an index power of age, but that for cancer of the kidney reached a plateau or decreased after an index power increase to a certain age. The rate of increase in age-specific deah rates (later period/former period) rose according to age, especially 70 years or older, in cacner of the prostate and kidney in both males and females. However, age-specific death rates in the later period from cancer of the bladder was higher only in patients 85 years or older, but was lower in other age groups. (Conclusions) Death rates for cancer of the prostate and kidney (15 years or older) tended to increase, while that of the bladder remained stable or decreased. It is expected that detection and treatment of these disease can be improved by utilizing these epidemiologic information.
(Purpose and Methods) Diagnostic values and limitation of conventional urodynamic study (UDS) were assessed in 380 patients with benign prostatic hypertrophy (BPH), in terms of uroflowmetry, measurement of postvoid residual urine and cystometry. (Results) Maximum and average flow rate on uroflowmetry improved with increasing voided volume. Neither maximum nor average flow rate correlated with size of the prostate, subjective symptom (International Prostate Symptom Score) and bothersomeness for prostatism. Pre-TUR maximum flow rate did not predict outcomes on postoperative flow rate and surgical treatment failures. Uroflowmetry did not differentiate between obstruction and weakness of detrusor contraction. The intraindividual variation of postvoid residual urine was great and the volume of residual urine correlated poorly with subjective symptom, size of the prostate, maximum and average flow rate. On filling cystometry, although uninhibited detrusor contraction was much more frequently observed in patients with urege incontinence as compared with continent patients, there was no significant difference in other parameters between the two groups. Every parameter on cystometry did not correlate with nocturnal frequency. Postoperative persisitence of urge incontinence did not correlate with the bladder volume at the first desire to void or at the maximum desire to void, an amplitude of uninhibited detrusor contractions, or bladder compliance. In some cases, evaluation of the intravesical pressure on voiding phase and uroflowmetry was diagnostic of apparent obstruction. (Conclusions) In diagnosis of BPH, conventional UDS has limitation for certain and some caution showed be taken in interpretation of the data. However, since conventioanl UDS provides important and objective information on obstruction and dertrusor function, which are independent of subjective symptom and prostate size, these should be necessary in diagnosis, determination of treatment options and evaluation of treatment outcomes in BPH.
We report a case of congenital ejaculatory duct obstruction treated successfully by transurethral incision. A 33-year-old man was referred for evaluation of primary infertility. His semen analysis showed volumes of 1.7ml at average and azoospermia. Clinical examinations revealed right undescended testicle, absence of the left kidney and axial rotation of right kidney. Left vasogram showed dilated but intact seminal vesicle with no contrast material visible in the bladder. Following removal of right undescended testicle, transurethral incision of the left side of the prostatic urethral floor near the vermontanum was performed. Transurethral vesiculogram showed dilated but not cystic ejaculatory duct. Eight months postoperatively semen analysis showed a volume of 3.5ml, a concentration of 61.3×106/ml and motility rate of 51.8%. However, semen analysis 18 months postoperatively showed azoospermia again. After retransurethral incision, his sperm concentration increased to 15.2×106/ml. However, his wife didn't become pregnant yet.