(Backgraund) Conventional transurethral Nd:YAG laser ablation of the prostate does not significantly reduce the volume of prostate and patients frequently experience post-operative urinary retention. Thus in the present study, prostatic tissue was extensively vaporized with laser fiber to produce a definite cavity during the operation. (Methods) Between August 1993 and April 1995, laser prostatectomy utilizing Ultraline™ was carried out on 91 patients with BPH, 38 of these patients had histories of urinary retention. The size and form of the prostate were examined by transurethral ultrasonography (TUUS) prior to surgery and ablation was conducted based on the findings. The results were checked by TUUS a second time. (Results) Operating time was 84.1 minutes on the average including the time for systematic needle biopsy and cystostomy for irrigation. Total irradiation dose was 132, 035J on the average. The catheter was removed at an aerage 5.8 days postoperatively. I-PSS was noted to improve from 15.3 to 5.6, maximum flow rate, 9.3 to 15.8ml/s, average flow rate, 4.6 to 9.2ml/s and residual urine, 76.0 to 15.9ml. The volume of the prostate was reduced by 31.5% (39.3 to 26.6ml) and the patients could urinate for more than a year without discomfort. No serious complications were encountered though epididymitis was noted in 5 and urethral stricture in 10 patients. (Conclusion) The present laser prostatectomy is less invasive than TUR-P and the results might be equal to it.
(Background) The anti-androgen therapy usually used to manage prostatic cancer is effective because the growth of adenocarcinoma of the prostate is influenced by androgens. However, some prostatic cancers do not respound to hormone therapy. Many studies have been conducted with the objective being to assess the responsiveness of prostatic cancer tissues by measuring the amount of androgen receptors (AR). The present study investigates the expression of AR in adenocarcinoma and in benign adenoma of the human prostate. (Methods) Formaline fixed paraffin sections of adenocarcinoma were prepared using 86 patients with primary prostatic cancer, seven patients with relapsed prostatic cancer, and 26 patients with BPH (as the control). Specimens were obtained by needle biopsy and immunohistochemical staining was performed. (Results) The benign adenoma AR were stained in the nuclei of the glandular epithelial cells. The receptor-positive and receptor-negative cells were intermingled with the malignant prostatic cells. The labelling indexes (LI) of the androgen receptor stain values in adenocarcinoma of the prostate (57.8±14.5%) in 86 patients were significantly lower than benign adenoma (86.4±6.3%) (p=0.0001). And the LI were decreased with the progress of grades in malignancy: 72.8±7.5% in well defferanciated; 58.7±7.3% in moderately differanciated; and 41.4±8.2% in poorly differanciated adenocarcinoma (p=0.0001). Moreover, LI in relapsed case, all of which were poorly differanciated (22.9±13.6%), were significantly lower than the LI values of the primary cancer cases with poorly differanciated adenocarcinoma (p=0.0004). Responders to anti-androgen therapy had high AR positive rate (p=0.0001) and weakly stained cases had a lower survival rate than strongly stained cases (p=0.03). (Conclusion) These results suggest that the detection of AR with immunohistochemical study is useful for estimating the prognosis of the patients undergone anti-androgen therapy. And prostatic cancer cells are heterogenously composed of clones of both androgen dependent and independent cancer cells before hormonal therapy is begun. And one reason why these tumors easily relapse with the progress of grades in hormonal therapy.
(Background) The objective of this study is to report the outcome of various treatments in patients who were newly diagnosed prostate cancer from May 1984 to Descember 1994, at a single institution. (Methods) A retrospective study was carried out in the 142 patients. (Results) Total retropubic prostatectomy were performed in 52 patients (37%). The 5-year survival rates (Kaplan-Meier) in the patients with total prostatectomy were 89% in stage B (24), 86% in stage C (7), and 87% in stage D1 (17), respectively. Endocrine therapies (33) or endocrine therapies in combination with chemotherapies (37) as a initial therapy for stage D2 were performed. Among these therapies, endocrine therapy in combination with cyclophosphamide (700mg/m2/4 weeks, iv) was superior to any of the other treatments in stage D2. The response rate, median response duration and median survial time in this combination therapy were 83%, 29 months and 49 months. The overall 3, 5, and 10-year survival rate in the 142 patients were 67%, 51% and 26%, respectively. The 5-year survival rates according to grade were 73% in grade 1, 45% in grade 2, 42% in grade 3, respectively. (Conculusion) The 5-year survival rates in pathological stage C and D1 patients who recieved adjuvant hormone and radiation therapy after radical prostatectomy were 86% and 87%. The most effective therapy for stage D2 was hormone in combination with cyclophosphamide. The response rate and median response duration were 83% and 29 months.
(Purpose) We have clarified the usefulness of extracorporeal shock wave lithotripsy for patients with ureteral stone in an outpatient clinic. (Patients and Method) One hundred ten patients with ureteral stone were treated using a small focused piezoelectric lithotriptor (Toshiba ESL-500A). No anesthesia and no associated therapy was applied to all patients. (Results) Ninety eight patients (89.1%) were successfully treated in our outpatient clinic. Twelve patients (10.1%) were treated after admission becase of several reasons such as colicky attack. In 107 patients (97.3%) no remaining stone was observed. We judged our treatment was effective in 109 patients (99.1%) including 2 cases with very small remaining fragment. No serious complication was encountered. In 83 cases with ureteral stone smaller than 10mm in longer diameter, mean treatment sessions was 1.24 and mean total shots was 3, 227. In contrast, in 27 cases with ureteral stone bigger than 10mm, mean 2.67 sessions and 11, 715 shots was needed. Although some patients with bigger stone underwent several sessions up to 9 times, all of them had no problem before completion of treatment. (Conclusion) These results indicated that most of patients with ureteral stone can be simply treated in an outpatient clinic using a small focused piezoelectric lithotriptor.
(Background) The objective of this study is to investigate the pathological changes which occured in prostatic cancer shortly after the commencement of endocrine therapy. (Methods) Fourty-three patients underwent radical prostatectomy immediately after the short term endocrine therapy (treatment period was within one month) and the histological pictures of operative specimens were compared to those obtaind from the pretreatment biopsy specimens. (Results) Degenerative changes of cancer cells, such as nuclear and cytoplasmic vacuole, collapse of the cytoplasm and the appearance of naked hyperchromatic nucleus were noticed after the short term endocrine therapy. Especially in the cases which were histologically evaluated to be poorly differenciated in the biopsy specimens, not only degenerative changes but also destruction of cancer nests caused by cell death were observed. The histological effects affected by short term endocrine treatment had no relation to the prognosis, but in the cases of stage D2, the pathological grade judged by posttherapeutic specimens were found to be useful for the perdiction of prognosis. (Conclusion) Endocrine therapy induces remarkable pathological changes in prostatic cancer within a very short time after biginning treatment.
In order to evaluate the utility of laparoscopic adrenalectomy for Cushing's syndrome, the results of 6 laparoscopic adrenalectomies for Cushing's syndrome were compared with those of 34 other laparoscopic adrenalectomies, consisting of 7 pre-Cushing's syndromes, 13 primary aldosteronisms, and 14 non-functioning adrenal tumors. The results were also compared with 5 open adrenalectomies for Cushing's syndrome. The results of the laparoscopic adrenalectomies for Cushing's syndrome were as follows: the mean operating time was 216±46min, and the mean estimated blood loss was 180±194ml. From the third patient, an ultrasonic surgical system was used and the estimated blood loss decreased significantly. The ultrasonic surgical system, together with a more experienced surgical technique, also cut down the operating times. During surgical intervention, 2 complications occurred; a hemorrhage of more than 500ml in one patient, and splenic injury in another, which was treated by compression. Postoperative complications occurred in 2 patients; paralytic ileus in one, and abdominal pain due to the pneumoperitoneum in the other. All patients except 2 patients with vertebral fracture began oral intake and ambulation 1 to 4 days postoperatively, and resumed normal daily activity on postoperative day 5 to 7. Compared with the laparoscopic adrenalectomies for the other adrenal tumors, the operating time and estimated blood loss in the Cushing's syndrome patients was not substantially different, though postoperative recovery was slightly longer. When compared with the open adrenalectomies, the operating time was longer, but the postoperative recovery period was significantly shorter. We conclude that with careful surgical intervention, experience of thechnique, and the introduction of proper equipment, a laparoscopic adrenalectomy for Cushing's syndrome can be performed as less-invasively as a laparoscopic adrenalectomy is for the other adrenal tumors. Furthermore, our findings suggest that laparoscopic adrenalectomy for Cushing's syndrome is likelier to have better postoperative results than conventional procedures, including a more rapid recovery to normal daily activity.
(Background) The frequency of hematuria and proteinuria was assessed in terms of the existence of glomerular disorders. (Methods) Fifty-five patients with asymptomatic microscopic hematuria, in whom no urological disorders were recognized, were used in this study. The frequency of hematuria and proteinuria was assessed by self-test of the first voided urine in the morning with urinary dipsticks for 7 consecutive days. Hematuria (proteinuria) was judged positive when reaction for hematuria (proteinuria) on a dipstick was 1+ or more, and negative when reaction was - or ±. On the basis of self-test, the frequency of hematuria (proteinuria) was classified into 3 types as follows: Type C, positive hematuria (proteinuria) recognized continuously throughout 7 days; Type S, positive and negative hematuria (proteinuria) recognized sporadically; Type N, negative hematuria (proteinuria) recognized throughout 7 days. The results were evaluated in terms of the existence of glomerular disorders, as revealed by renal biopsy. (Results) Self-tests were completed successfully in 53 (96%) out of 55 patients at the first attempt. Of these 55 patients 32 (58%) were Type C hematuria, 14 (26%) were Type S hematuria and 9 (16%) were Type N hematuria. The incidence of glomerular disorders was significantly higher in patients with Type C (81%, p<0.0001) and Type S (71% p<0.01) hematuria than those with Type N (0%) hematuria. (Conclusion) The presence of hematuria confirmed by self-test used in the present study was suggestive of glomerular disorders.
(Background) The objective of this study is to evaluate the relationship between PSA value and prognosis of the patients with stage D2 prostate carcinoma. (Methods) Serum prostate specific antigen was analyzed in 61 patients with stage D2 prostate carcinoma submitted to hormone therapy. (Results) The median values of PSA parameters were 77.6ng/ml for the initial PSA, 91.8% for the maximal decrease, 2.7ng/ml for the nadir, 1.1 months for the half-life time, 3.0 months for the time to nadia, 3.2 months for the doubling time after progression and 0.39 for the ratio of antemortem versus initial PSA. The median biochemical progression-free time was 15.0 months and the median actuarial survival after progression was 24.9 months. The progression-free time was significantly correlated with the normalization of PSA (p<0.001) and the initial PSA of less than 100ng/ml (p<0.05), and the survival time after progression was significantly correlated with the doubling time (p<0.05). The normalization of PSA was affected by initial value, maximal decrease rate and and half-life time of PSA respectively, but not by the histological grade of the primary tumors. The doubling time was not correlated with these factors nor with the progression-free time. (Conclusion) The results show that the initial value, nadir level and doubling time of PSA can be used as prognostic parameters for prostatic carcinoma. Both the low ratio of premortem versus initial PSA, which may reflect an increase of stem cell fraction, and the PSA doubling time after relapse, which seems similar to or shorter than that of untreated cases, will indicate an aggressive potential of hormone-refractory tumors.
A case of testicular torsion in the newborn is presented. A 8-day-old infant with bilateral intrascrotal swelling since birth was referred to us. Bilateral testicular torsion was suspected and operation was carried out at the same day. We operatively found extravaginal torsion of the bilateral spermatic cord. The bilateral testis appeared extensively necrotic, but we repaired the torsion and performed bilateral orchiopexy because of bilateral torsion. We could not palpate well the bilateral testis in one year, probably due to an atrophy. Sixty-nine cases of testicular torsion in the newborn including our case from Japanese literatures were reviewed and discussed. Especially forty-seven cases were presented at birth.