(Background) The long-term effects of preoperative high-dose short-course radiotherapy for bladder cancer are controversial. (Methods) We reviewed 144 patients with an invasive or grade 3 bladder cancer who underwent radical cystectomy with or without preoperative radiotherapy between 1978 and 1990. Preoperatively, short-curse radiation (16Gy) was given to 100 patients, conventional pelvic radiation (median 31Gy) to 12 patients and no radiation to 32 patients. The median follow-up period was 7 years 11 months. One patient was lost to follow-up. (Results) The overall survival rates did not differ among the short-course, conventional and no-radiation groups. However, if limited to the patients with stage pT2 or higher, or with grade 2 or 3, the survival rates were significantly higher in the short-course radiation group than in the other groups. Although preoperative short-course radiation tended to lower the pathological stage, the presence or absence of down-staging did not influence the survival rates. (Conclusion) Preoperative short-course radiotherapy may possibly improve the prognosis of cystectomized patients with clinical stage T2 or T3, or squamous cell cancer.
(Background) The penetration of Tamsulosin hydrochloride into the blood and the prostatic tissue was examined. (Methods) Fifty-two patients with benign prostatic hyperplasia treated with transurethral resection of the prostate were entered in this study. This drug was administered orally in a dose of 2.0mg once a day for 7 to 179 days preoperatively. The blood samples were taken simultaneously at the time of the prostatic tissue sampling. (Results) 1. The correlation coefficient was hardly significant between aging and concentration of the drug in the blood or in the prostatic tissue. 2. The correlation coefficient was hardly significant between the duration of the drug administration and concentration of the drug in the blood or the prostatic tissue. 3. The correlation coefficient was significant between the concentration of the drug in the blood and the prostatic tissue. 4. The fifty-two patients showed no significant adverse reactions during administration of the drug. (Conclusion) These results suggest that the drug can be administered safely to the aged even in a long term and can be penetrated into the blood and the prostatic tissue with a positive correlation.
(Background) To clarify various conditions in the transplanted kidney, invasive biopsy must be performed in most cases. In this study, we measured blood flow in the transplanted kidney by color Doppler tomography to examine the usefulness of measuring renal blood flow in clarifying various conditions. (Method) Blood flow in the transplanted kidney was measured using peak flow velocity (PFV) and an index of resistance, the pulsatility index (PI), as parameters. (Result) In acute cellular rejection, there were no changes in blood flow in the segmental arteries, while there was a significant decrease in the blood flow in the interlobar artery. In acute vascular rejection, it was difficult to measure blood flow in the interlobar artery. The values of parameters were low even in the segmental arteries, suggesting markedly decreased blood flow. In chronic rejection, the values of the parameters were low in proportion to transplanted kidney function. In addition, parameters were examined with respect to vascular stenosis, fibrous stroma and edema in the histopathology of the transplanted kidney. As a result, vascular stenosis and fibrous stroma affected the segmental and interlobar arteries, severely reducing blood flow. It was also shown that interstitial edema reduced blood flow in the interlobar artery. (Conclusion) Color Doppler tomography may facilitate diagnosis of certain conditions in the transplanted kidney biopsy.
(Purpose) Androgens are required for the development of normal prostate and prostate cancer, through their action via the androgen receptor (AR). Although prostate cancer is potentially curable in the early stages by radical prostatectomy, androgen ablation is standard treatment for metastatic prostate cancer. Metastatic prostate cancer is incuarable despite temporary remission commonly achieved by androgen ablation therapy. To investigate the mechanism for the development of human prostate cancer, examination was made of AR gene mutations. (Materials and Methods) Thirty-two samples including 29 primary prostate cancers and 3 metastatic lymph nodes were examined from exons B to H of the AR gene by polymerase chain reaction of single-strand conformation polymorphism (PCR-SSCP) and direct-sequencing analysis. Three metastatic lymph nodes were removed from non-hopmone treated stage D1 patients by radical prostatectomy: Six of 11 stage D2 patients were hormone-independent stage following androgen ablation therapy. (Results) One of 29 (3.4%) primary prostate cancers and 1 of 6 (16.7%) hermone-independent stage D2 patients showed the AR mutation. This AR mutation is a G to A transition at nucleotide 2677 that leads to substitution of glutamine (CAG) for the wild type arginine (CGG) at colon 629. The serum prostate specific antigen level of the patients increased to 480ng/ml. Drugs for hormone therapy and duration of treatment had the same effects on the remaining 5 hormone-independent patients. No mutation was found in the other 28 primary prostate cancer or 3 metastatic lymph node samples. (Conclusions) The AR mutation may possibly be involved in the development of prostate cancer from the androgen-dependent to -independent stage during androgen ablation therapy.
(Background) We previously estimated the turning point of reflux nephropathy irreversibly deteriorating to end stage renal disease, mainly based on findings in renal biopsy (Eur. Urol., 26: 153-159, 1994). In this study, we aim to evaluate clinical parameters which may be closely associated with progression of reflux nephropathy to end stage renal disease. (Subjects and Methods) Ninety five patients (84 children and 11 adults; 41 men and 54 women) with renal scar and/or reflux (>/=grade 3), mean aged 9.4±9.1 years (3 months-53 years) were followed up for 3.7 years±2.7 (6 months-18 years). Vesicoureteral reflux was bilateral in 64 and unilateral in 31; primary in 85 and secondary in 10 patients. Clinical parameters including body weight, height, blood pressure, 24 hour urinary protein excretion, serum creatinine, 99mTc-DTPA GFR and 99mTc-DMSA uptake were monitored over time. All patients underwent antireflux surgery (with or without other reconstructive surgery) and open renal biopsy. Three patients progressing to end stage renal disease underwent subsequent biopsy. (Results) Over-5 year observation preiod, the prevalence of new scar formation and further extension in scar was significantly higher in the group of renal functional deterioration (35%) than in the group of stable renal function (6.0%). Over the same period DMSA uptake decreased significantly (<0.05) in the group of scar b (Smellie's classification), suggesting most kidneys of scar b eventually resulting in atrophic kidney (scar c). Proteinuria more than 100mg/day appeared to be a critical level for predicting irreversible deterioration in renal function. Glomerular hypertrophy was closely related to the increase in urinary protein excretion and serum creatinin, contrary to the decrease in DTPA-GFR. In addition, bilateral renal scar b, glomerular hypertrophy (>2SD), proteinuria (>300mg/day), low GFR (mean: 49ml/min), and diastolic hypertension seemed to be implicated in the genesis of ESRD. (Conclusion) Glomerular damage due to either reflux nephropathy or dysplasia may cause proteinuria. Proteinuria of 100mg/day was significantly (p<0.01) associated with 2 SD of glomerular hypertrophy on histology and clinical observation (suggesting hyperfiltration). Thereafter, a rapid increase in proteinuria followed by diastolic hypertension appears be significant for predicting ESRD.
This retrospective study describes the experience of arterial reconstruction of donor kidney in our institute since 1982. (Materials and Methods) Of total 56 living related kidney transplantations 15 required renal arterial reconstruction or ligation of donor kidneys. Renal arterial reconstruction was employed for 11 cases (end to side anastomosis [4 cases], conjoined anastomosis , hypogastric artery graft interposition , other ), while simple ligation was employed for 4. Bench surgery with microsurgical techniques was employed for the repair. Elective surgery was done for preoperatively defined multiple renal arteries  and aneurysm , while imperative surgery for intraoperatively detected accessory arteries  and surgical injuries . Postoperative patency of arteries and renal function (GFR) was evaluated by 99mTc-DTPA renoscintigraphy. (Results) The mean total ischemic time of reconstructed cases was 135min., while that of ligated ones was 67min. None of them required hemodialysis due to acute tubular necrosis. Postoperative graft arterial patency was impaired in 2 of 11 reconstructed cases (18%), while it was impaired in 3 of 4 ligated cases (75%). Two failure attempts of arterial reconstruction cases were all imperative ones. Postoperative GFR of the graft was well preserved in all cases. (Conclusion) We conclude that (1) Ligation and imperative surgery tend to be associated with renal infarction, although it does not affect GFR. (2) Renal artery reconstruction was highly successful in preserving renal mass (or normal cortical image), albeit longer ischemic time than simple ligation. (3) Considering importance of preserved nephron mass in clinical renal transplantation every attempt should be made to repair the donor arterial anomalies when expected (elective) or found (imperative). (4) Thorough preoperative evaluation of donor renal arteries is mandatory.
(Background) To evaluate the natural history of Peyronie's disease and to determine the suitable time for surgical treatment, we investigated changes of clinical findings of the disease over time. (Patients and Methods) We evaluated changes of plaque size, penile curvature and erectile dysfunction in 10 patients with Peyronie's disease. The mean follow-up period was 36.8 months. (Results) At the first examination, the mean plaque size of patients with erectile dysfunction was larger than that of those without erectile dysfunction, suggesting a positive association between size and erectile function. There was no significant relationship between plaque size and penile pain or penile curvature. The mean size of plaques decreased significantly compared with that at the first examination (p<0.05). However, penile curvature, pain and erectile dysfunction perisisted during the follow-up peirod in all but one patient, who showed improvement of penile curvature. (Conclusion) These results suggest that we may recommend a shorter observation period until surgery than we have done for some patients who want to be surgically treated.
(Background) Porocarcinoma is a rare eccrine sweat gland tumor, and a valied treatment is not yet determined for metastatic disease because of the chemo-resistant and radio-resistant nature of this tumor. (Case) This report describes a case of porocarcinoma arising on the penile shaft of 83-year-old man with extensive lymph node metastases. He was treated with emasculation and bilateral ilio-inguinal lymph node dissection. Histological examination of the resected tumor showed a homogeneous round cells with duct-like formation in some part and Pagetoid infiltration was also noted in the dermis. Immuno-histochemical examination demonstrated a positive CEA and negative S-100 staining and this result was consistent with the pathological diagnosis of porocarcinoma. One course of chemotherapy which consisted of methotrexate, cisplatin, adriamycin, and bleomycin was given to the patient following the surgery for the treatment of residual lymph nodes in the paraaortic area. Abdominal CT scan revealed partial response, about -94% shirnkage, after one course of chemotherapy. The duration of the response lasted for 4 months. He died of pneumonia caused by MRSA after 4 months and the autopsy revealed multiple liver metastases and a massive infiltration of tumor cells in the bone marrow of lumbar vertebra. (Conclusions) There is no diffinite treatment modality available for metastatic porocarcinoma. Because of the patient's age, only one course of chemotherapy was given, however, a fairly good response against this rate tumor suggested that this new regimen might be effective against porocarcinoma.
The hot water spary on perineum restored voiding function in a 77-year-old male patient with the poorly contractile bladder. He noticed the gradual decrease of bladder sensation and voiding stream, and needed clean intermittent catheterization to empty bladder even after TUR-P. Neurological examination revealed only weakened anal and bulbocavernosus reflex and impaired skin sensation of foot plate and perineum. Simple cystometry showed impaired perception of bladder filling and underactive bladder. Electromyography of the pelvic floor displayed decreased responses to bladder filling and voluntary shpincter contraction. Spine-X-ray examination and computed tomography of brain and spinal cord did not reveal any neurological lesions except for the silent small infarction of subcortex. Trial of drug therapy with Distigmine bromide, Cernilton and Prazosin did not restore voiding function. By accident, fowever, patient himself found spontaneous voiding could be induced by hot water spray on perineum and/or scrotum during bidet using. Since then, he has been continuing this stimulation daily for 4 years, with which almost complete voiding is possible without catheterization, though bladder sensation remains impaired. The pathophysiology and affecting factors on micturition reflex in this case were discussed.