(Background) Surgical therapy for Benign Prostatic Hypertrophy (B. P. H.) has mainly depended upon Transurethral Resection of the Prostate (TUR-P) using a cutting loop electrode. Recently, a new tecnique TVP was reported using the VaporTrode® apparatus. We assessed the safety and efficacy of the VaporTrode® in a preliminary study. (Methods) Histological changes of the muscle and liver of pigs were examined after vaporization using the VaporTrode® and a cutting loop electrode. First, histological changes were investigated following vaporization after one stroke at a slow hand speed. Next, histological changes were assessed following vaporization at fixed stroke speed in an experimental model. (Results) At an electrical output of less than 275W, the depth of the vaporized layer increased as the stroke speed became slower (4.0cm/s-2.5cm/s). When the electrical output was 300W, the depth of vaporized layer increased even at a faster stroke speed (2.5cm/s-3.0cm/s.) The depth of the desiccated layer increased as the stroke speed became slower at any electrical output. However, when the stroke speed was 4.0cm/s, the depth of this layer was less than 2.0mm. With the cutting loop electrode, the depth of the desiccated layer increased at a higher electrical power, but the change was very small. (Conclusion) To achieve deep enough vaporized and desiccated layers safely, the VaporTrode® should be used at a stroke speed slower than 3.0cm/s and a high electrical power of about 275W.
(Background) In order to study the influence of testicular estrogen concentration on spermatogenesis, we conducted the following experiments. (Methods) Eight-week-old male Sprague-Dawley rats were used and two kinds of experiments were prepared. In experiment one (intraperitoneal injection), five groups were set up: control (saline solution), estradiol (E2), human chorionic gonadotropin (hCG), aromatase inhibitor (A. I.) and hCG+A. I. group. In experiment two (intratesticular injection), two groups were set up: control (saline solution) and E2 microcrystal suspension (Emcs) group. The experimental period was 28 days. At sacrifice, we evaluated the concentrations of serum testosterone (T) and E2, testicular T and E2, testicular aromatase activity and the seminiferous tubular diameter. (Results) Exp. 1: In the hCG group, the rate of testicular aromatase activity and testicular E2 level were higher and the diameter of seminiferous tubules was smaller than in the control group. However, these changes were not observed in the hCG+A. I. group. Exp. 2: In the Emcs group, testicular E2 level showed an increase without elevation of serum E2 level, and the diameter of seminiferous tubules was atrophic. (Conclusion) It was suggested that the increase of the rate of testicular aromatase activity and the following elevation of testicular E2 level is possibly one of the causes of male infertility.
(Background) Polyamine are recognized as cell growth factors. We studied in order to determine whether alterations in the levels of tissue and blood polyamines were useful biochemical markers for bladder tumor. (Methods) The concentrations of three polyamines, diamine, spermidine and spermine, in urinary bladder and blood were determined during N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN)-induced bladder carcinogeneses in male F344 rats. At 5 weeks of age, rats were given 0.05% BBN in the drinking water for 20 weeks. (Results) BBN induced bladder hyperplasia in 4 of 5 rats at 8 weeks, papillomas in 2 of 5 rats at 12 weeks, and transitional cell carcinoma in all the rats by 20 weeks. The levels of total polyamine in both bladder and blood of the rats during 12-20 weeks were significantly higher than those of the control animals given water alone. The elevation of total polyamine was mainly due to the increase of spermidine of the three polyamines, which was coincident with the incidence of bladder tumors. (Conclusion) The results indicated that the polyamines are exellent biochemical markers for bladder tumors.
(Purposes) The condition in infants showing the characteristic facial abnormalities, limb deformities, and pulmonary hypoplasia induced by oligohydramnios is termed Potter sequence (PS). In addition to bilateral renal agenesis, Potter sequence could be caused by other urological abnormalities such as cystic dysplasia and obstructive uropathy. Although lethal in most of the patients with PS, some exceptional infants were reported to survive in spite of the antenatal demonstration of oligohydramnios from renal abnormalities. These surviving patients put new questions to us regarding the management of both respiratory and renal failure starting from the newborn periods. The diversity of clinical courses in patients with antenatally detected PS may imply that this entity has a spectrum of severity. Our study of infants autopsied on the diagnosis of PS was undertaken to determine various histological grade of the kidneys and the lungs. (Materials and Methods) Thirty-two autopsy cases of PS (19 males and 13 females) diagnosed by the presence of the characteristic stigmata, oligohydramnios, and renal or urological abnormalities were studied retrospectively. Patients were divided according to the urological abnormalities into 3 groups; renal hypodysplasia, urinary obstruction, and polycystic kidney disease (PCKD). Renal histology was evaluated by two parameters; renal glomerular count (RGC), and dysplastic grade. Developmental aspects of the lung were judged by lung/body-weight ratio (L/B ratio) and radial alveolar count (RAC) proposed by Emery. (Results) The underlying urological disorders included renal hypodysplasia in 22 patients, obstruction in 7, and polycystic kidney disease in 3. Dysplastic grade of 29 patients with hypodysplasia and obstruction consisted of grade 4 in 12 patient, grade 3 in 9, and grade 2 in 8. In 10 kidneys from 8 patients with grade 2-dysplasia, RGC was significantly fewer than that of normal fetuses for the gestational age. The term patient with PS showed the glomerular count equivalent to normal fetus of around 25 weeks of gestation. L/B ratio indicated definite pulmonary hypoplasia in 25 of 29 patients. The ratio was much smaller than normal in another 4 patients. RAC was calculated in 24 patients; of these only 2 had normal count for gestational age. In another 22, the number of air space stopped to increase at about 20 to 25 weeks of gestation. There was a tendency for L/B ratio to decrease according to dysplastic grade (1.3% for grade 2 vs. 0.9% for grade 3 and 4). (Conclusion) The primary urological abnormalities leading to PS included bilateral renal hypodysplasia, obstructive uropathy, and PCKD. Histological study of the kidneys indicates that PS is the spectrum disease with various degree of nephron formation. The development of the lung depends, in part, on the grade of renal dysplasia.
(Background) We studied the clinical efficacy of transurethral microwave thermotherapy (TUMT) using Endotherm UMW™ system (OLYMPUS). (Methods) TUMT was performed in 28 patients with benign prostatic hyperplasia (BPH). Three patients of them were catheterized because of urinary retention. The treatment was performed in a single session for an hour. The urethral surface temparature was set at 39°C, and the coolant flow of the urethral applicator (21 Fr balloon catheter) was set at 30ml/min, to heat up the broad area of the prostate up to 45°C. The clinical efficacy was evaluated by analyzing subjective responses, using the International Prostate Symptom Score (I-PSS) scale (S) and QOL score (L), and objective respnses, using peak urinary flow rate (Qmax), average flow rate (Qave), residual urine volume and prostate volume following the treatment. (Results) At 24 weeks after the treatment, significant improvement were observed in S score (41%), L score (37%), Qmax (53%) and Qave (62%). Although there was no significant decrease in residual urine and prostate volume. The three patients, with a catherer indwelled because of urinary retention, were all free of the catheter within 4 weeks after the treatment. During and after the treatment, no severe adverse effects, including transient urinary retention needed for indwelling a catheter, was detected. (Conclusion) A single session of TUMT by Endotherm UMW™ considered to be safe and useful for symptomatic BPH patients, even who are not indicated for transurethral resection of the prostate (TUR-P) because of underlying disorders.
(Background) The histological pattern of prostatic involvement by transitional cell carcinoma is still unclear. The present study was carried out in bladder carcinoma with prostatic involvement to clarify the histological invasion pattern and its association with primary lesions. (Methods) In the past 10 years, 83 cases of total cystectomy including prostatectomy underwent pathological diagnosis in our department. This study included 81 cases of transitional cell carcinoma (TCC), of which 11 showed prostatic involvement of bladder carcinoma. In these cases, the histological patterns of invasion were classified in relation to prostatic urethra, prostatic duct, stroma, lymphatic duct, capsule, vein and perineural invasion. Seventy cases without prostatic involvement were controls. The location, pathological grade, stage and lymphatic involvement of primary bladder carcinoma were compared in terms of prostatic involvement cases with control cases. (Results) Among those 11 cases, there were 3 cases in which only the prostatic duct was involved, 2 cases with invasion to only lymphatic duct, and involvement of both in 6 cases. One case of the prostatic duct involvement showed non-continuous invasion in the prostatic duct without prostatic urethra invasion, suggesting the possibility that non-continuous invasion could occur as a type of multicentric growth of TCC. (Conclusions) Suspected routes of invasion of bladder carcinoma into the prostate were; 1 continuous transductal, 2 trans-lymphatic ductal, 3a combination of the two. It appears necessary to consider the possibility of TCC occurring in the prostate simultaneously with bladder carcinoma as a part of multicentric growth. There was a tendency of prostatic involvement cases include the bladder neck and trigone, and show lymphatic duct involvement more than nonprostatic involvement cases.
(Background) The objective of this study is the prevention of unexpected hypotension during hemodialysis caused by unsuitable filtration rate. (Methods) The plasma colloidal osmotic pressure (COP) was measured continuously during ultra-filtration, and relative plasma volume (%PV) and plasma refilling rate (PRR) were calculated during 12 ECUMs and one dialysis on twelve patients in early stage of chronic renal failure. Values of %PV and PRR calculated from COP were drawn in graphic curves, and analysed to obtain characteristic pattern. Minimum value of %PV (%PVmin), maximum value of PRR (PRRmax) and time for PRR to decrease to 95% (95%PVt) on the curves were documented simultaniously. (Results) At the initial stage of %PV curve, obvious fall was observed on 6 of 13 estimation (initial fall of %PV). On the contrary at the initial stage of PRR curve, obvious rise was observed on 5 estimation (initial rise of PRR). A close relationship was indicated between the two phenomenons. In 6 cases with initial fall of %PV and in 5 cases with initial rise of PRR body weight, PRRmax and 95%PVt were lower than another cases without it. The ultra-infiltration velocity was estimated to be relatively high in these groups. In these 8 cases, filtrated water volume was judged as adequate clinically. In 4 of 5 cases without final fall of PRR, it was judged as inadequate and needed to evacuate more 0.9 to 3.0kg (average of 1.8±1.07) of water from the patients. (Conclusions) From the above, we concluded that our method is useful for deciding suitable velocity of ultrafiltration and dry weight in hemodialysis therapy.
Luteinizing hormone-releasing hormone analogue, 3.6mg goserelin acetate and flutamide, 375mg per day were used to treat metastatic prostate cancer in a 66-year-old male. Marked increase in serum aminotransferases and total bilirubin levels was noted after 7 weeks of treatment. The enzyme levels returned to normal at 2 months following discontinuation of the treatment. Though incidences of severe hepatotoxicity are rare (0.003-0.18%), cases of fultamideinduced death have been reported. Careful monitoring of patients is mandatory while administering flutamide.