(Background) Clinically isolated Staphylococcus epidermidis KK3-75, Enterococcus faecalis SMU-14, and Escherichia coli TF6-27 were subjected to test for bladder lodgments. (Methods) Experimental cystitis on mice was investigated pathologically by light, confocal laser, and electron microscope after intravesical injection of cell suspensions of the strains. Bacterial affinities with bladder mucosal proteins and with extracellular components were detected by Western blot analysis. (Results) Pathological findings of experimental cystitis revealed prominent infiltration of neutrophils except for those that were challenged with Enterococcus faecalis SMU-14. Capsule-like structures were demonstrated for the other two strains. Each strain showed histological tropism within the tissue sections, which correlated with the capability to bind the respective extracellular matrix components tested. Type I collagen bound only to cellular extracts of Enterococcus faecalis SMU-14 and Escherichia coli TF6-27, whereas fibronectin and type IV collagen bound only to those of Staphylococcus epidermidis KK3-75 and Enterococcus faecalis SMU-14. Bladder mucosal proteins had a variety of ability to bind cell surface proteins of each strain. Bacterial cell surface binding of all except for two of the bladder mucosal proteins detected was inhibited by extracellular matrix components. (Conclusion) These experimental results suggest that the bacterial affinity of the bladder restricted by strain specific cell surface properties may be important for explanation in the difference of occurrence and progression of urinary tract infections caused by each strain.
(Background) No guideline exists on how to treat boy's phimosis. We examined if retraction of the foreskin of the newborn boy's penis could make true phimosis become false phimosis. (Methods) We taught the mother to retract the foreskin and keep inside the foreskin clean. Exposure degree of glans by retraction of foreskin was defined in 7 grades, 0(none)-III(middle)-VI(full). (Results) Of the 538 newborn examined, none had full exposure (VI). All of the 372 cases who continued the procedure, including 2 buried penis, gained full exposure (VI). Average time for full exposure according to the first degree of exposure was 2.94 months (0), 1.78 months (III), 1.22 months (V), 2.32 months average, respectively. No serious complications occurred. (Conclusion) Retraction of the foreskin from the newborn period made all the true phimosis to be false phimosis and operative procedures became unnecessary.
(Purpose) We investigated the female continence mechanisms by comparing directional differences of static and stress urethral pressure profiles (UPP) in urinary continent females with those in stress incontinent females. Also, the mechanisms of bladder neck suspension were investigated by comparing directional differences of UPP pre- and postoperatively. (Methods) UPP at rest and under stress were recorded by means of double lumens microtip transducer catheter in 21 females without urinary incontinence (normal group) and 38 females with stress urinary incontinence (SUI group). And UPP were recorded pre- and postoperatively in 19 females of SUI group who had surgical cure of SUI (ope group). These measurements were performed on the urethral directions (anterior-direction of symphysis pubis, lateral and posterior) to which the pressure sensor in the catheter were pointed. Pressure transmission ratios (PTR) were calculated in each quartile dividing functional urethral length (FUL) into four equal lengths. We compared the parameters (the maximum urethral closure pressure=MUCP, FUL and PTR) when the sensor lies at the anterior, lateral and posterior direction in each group. The parameters in normal group were compared with those in SUI group in each direction and those in ope group were compared pre- and postoperatively. (Results) In all groups, MUCP is always highest in the anterior direction but FUL shows no differences in the three directions. In all directions, MUCP and FUL are higher in the normal group than in the SUI group and there is no significant change in MUCP and FUL following successful bladder neck suspension. In the normal group, PTR of anterior, lateral and posterior urethra were approximately equal, but SUI group patients demonstratred significantly decreased PTR in the lateral and posterior urethra in comparison with PTR observed in the anterior urethra. Also, PTR of the anterior urethra in the SUI group approximates that in the normal group but PTR of the lateral and posterior urethra are lower in the SUI group than in the normal group. In the ope group, in the proximal three-quarters of the FUL, PTR in the lateral and posterior urethra approximated to those in the anterior urethra postoperatively. (Conclusion) These findings suggest that urethral support is destructed in the SUI group as mentioned in DeLancey's hammock hypothesis and lateral and posterior weakness were corrected by bladder neck suspension. Bladder neck suspension restored the continence by constructing posterior support of urethra as the substitution for destructed urethral support.
(Background) Pulmonary resection for metastatic renal cell carcinoma were studied to assess the indication of surgical management. (Methods) Between January, 1981 and December 1994, 17 consecutive patients (14 men and 3 women) underwent complete pulmonary resection for metastatic renal carcinoma. Median age was 61 years (range, 45 to 73 years). Eleven were appeared lung metastasis after resection of primary tumor. Median time between nephrectomy and pulmonary resection was 32 months (range, 0 to 127 months). (Results) There were no operative deaths. One patient had solitary metastasis, 4 had two, 2 had three, 2 had four, one had seven, one had eight and 6 had more than twenty-two. Segmental resection was performed in 12 patients, lobectomy in 2, lobectomy and segmentectomy in 3 and segmentectomy for total lobes in 3. Four patients had another site operation of renal metastasis, brain tumor resection, chest wall and ribs resection, contra-lateral adrenalectomy and contralateral partial nephrectomy. Median follow-up was 44 months (range, 10 to 129 months). The cause specific survival rate and disease free survival after pulmonary resection was 55 and 48 percent at 5 years and 27 and 14 percent at 10 years, respectively. (Conclusion) Pulmonary resection for metastatic renal cell carcinoma was considered effective in some selected slow-growing cases. Multiple and both lungs metastases is not contraindication and the patients under 10 metastatic focuses had good prognosis.
(Background) Neopterin is released from macrophages upon stimulation with γ-interferon, secreted by activated T cell. Therefore it has been recognized as a useful indicator of the activation of the T cell-macrophage system. Increased neopterin levels are observed in patients with acute graft rejections, viral infections, auto-immune diseases and several malignancies. Urinary neopterin concentrations were determined in patients with genitourinary tract malignancies to evaluate the usefulness of neopterin as a tumor marker. (Methods) Urinary neopterin concentrations were determined by high-performance liquid chromatography in 90 patients with genitourinary tract malignancies and 28 patients with benign urological tumors and 34 healthy subjects. (Results) Increased urinary neopterin levels were observed in 52% of the patients with genitourinary tract malignancies and 7% with benign urological tumors. The positivity rate in patients with renal cell carcinoma (RCC), renal pelvic and ureteral tumor, bladder tumor (BT), prostatic carcinoma (PC) and testicular tumor was 68%, 80%, 47% and 30%, respectively. The difference in the urinary neopterin levels between low and high stages was highly significant (p<0.0005) in patients with RCC (stage I-II vs. stage III-IV) and BT (Tis-1 vs. T2-4). The urinary neopterin levels were also correlated with the tumor grade in patients with RCC and PC. (Conclusion) Our study suggests that urinary neopterin levels may supplement laboratory examinations for patients with genitourinary tract malignancies, providing useful information in evaluating the tumor stage and follow-up of the disease.
We performed construction of continent urinary reservoir in an 8-year-old girl with cloacal exstrophy who had double stoma of ileostomy and colon conduit. Preoperative evaluation revealed non-functioning right kidney with severely dilated renal pelvis and calyxes in her pelvis. Urinary reservoir was constructed using detubularized colon segment which had been used as the urinary conduit and dilated renal pelvis of non-functioning pelvic kidney. Using Mitrofanoff's principle, continent catheterizable channel was also made of the anterior wall of the renal pelvis. Postoperative course was uneventful. Reservoir capacity increased to 350ml one and half year postoperatively and she is almost dry with clean intermittent catheterization 5 times a day. Dilated upper urinary tract is one of the ideal material for bladder enlargement that avoids the complication associated with the use of gastrointestinal tract.