(Objective) A prospective trial was performed to propose a suitable antimicrobial prophylaxis in patients undergoing transurethral resection of the prostate (TUR-P). (Subjects and Methods) Patients who underwent TUR-P due to symptomatic prostatic hyperplasia between April 1995 and February 1996 were included. Based on the results of urinalysis obtained within preoperative 3 days, the patients were classified into Group I (less than 5WBC/hpf and bacterial count of less than 104CFU/ml in urine specimen), and Group II (5 or more WBC/hpf or bacterial count of 104 or more CFU/ml in urine specimen). Furthermore, each group was randomly subdivided into Group A and Group B according to the period of antimicrobial administration. As prophylactic antimicrobials, cefazolin (CEZ) was used in Group I and CEZ or cef otiam (CTM) in Group II. The antimicrobial was administered only on the day of operation in Group IA (n=92), for 3 days in Group TB (n=96), 2 days in Group IIA (n=37), and 4 days in Group IIB (n=30). On the day of operation, the antimicrobial was infused immediately before the operation. The presence or absence of pyuria, bacteriuria and febrile infection, and the period required for normalization of the urinalysis were the major points evaluated here. (Results) No significant differences were observed in any parameters with respect to the period of administration of antimicrobial between the groups, but in both Group I and Group II, the incidence of febrile infection was higher in the groups with shorter antimicrobial administration periods. The mean period for normalization of the urinalysis required 68.4, 68.6, 65.2 and 58.2 days in Group IA, Group IB, Group IIA and Group IIB, respectively. (Conclusion) It is concluded that 3 or 4-day administration of first or second generation parenteral cephems is generally acceptable regimen for antimicrobial prophylaxis in patients undergoing TUR-P.
(Background) We evaluated the intrarenal distribution of prostaglandin E2 (PGE2) and thromboxane B2 (TxB2) on the rats that underwent unilateral ureteral obstruction (UUO), unilateral nephrectomy (UNX) or sham operation. (Methods) Male Sprague-Dawley rats were divided into three groups; left ureteral obstruction (UUO), left nephrectomy (UNX) and sham-operation (Control). They were sacrificed at 1, 3, 6, 12, 24 hours and Day 2, Day 3, Day 5, Day 7 and Day 9 after surgery. Intrarenal distribution of eicosanoids were immunohistochemically detected on both kidneys of UUO rats, and on right kidneys of UNX and Control rats. (Results) PGE2: In the obstructed kidneys, immunostained PGE2 increased in medullary interstitium at one hour to 6 hours, and in glomeruli and cortical interstitium at 6 hours. An increase of immunostained PGE2 was observed again in cortical interstitium at Day 3 to 5, and in medullary interstitium at Day 2 to 5. In the intact opposite kidneys, expression of immunostained PGE2 increased in glomeruli at Day 5 to 7, and in medullary interstitium at Day 3 to 5. In UNX, immunostained PGE2 increased in the medullary inetrstitium of the remnant kidneys at 3 hours and Day 3 to 7. On the other hand, an increase of immunostained PGE2 observed in glomeruli and cortical interstitium of these kidneys at Day 5 to 7. TxB2: In the obstructed kidneys, immunostained TxB2 increased in glomeruli and cortical interstitium at 6 hours, and in medullary interstitium at 3 to 12 hours. Predominant expression of TxB2 was observed in medullary interstitium at 3 hours compared to PGE2. We also observed an increase of immunostained TxB2 in cortical interstitium at Day 3 to 5, and in medullary interstitium at Day 2 to 5. In the intact opposite kidneys, immunostained TxB2 increased in medullary interstitium at 3 hours and Day 3. In the remnant kidneys of UNX, an increase of immunostained TxB2 was demonstrated in glomeruli at 6 hours and Day 7, and in medullary interstitium at 3 to 6 hours and Day 3 to 7. (Conclusion) In the obstructed kidneys, imbalance between PGE2 and TxA2 may contribute to the progression of renal injuries. The fact that expression patterns of these eicosanoids in the opposite kidneys of UUO different from that of the remnant kidneys of UNK, even though both were similarly associated with functional loss of contralateral kidneys, suggested that the opposite kidneys of UUO were affected by any additional factors different from that responsible for the remnant kidneys of UNK.
(Background and Methods) we performed renal ultrasonographic screening on 3799 healthy 3-month-old infants, who showed up for the routine health check up in Nobeoka City, for congenital malformations of the urinary tract. (Results) Urinary tract disorders were suspected in 139 (3.7%). Almost all ultrasonographic abnormalities of these were dissociation of CEC (Central Echo Complex). Thirty-three (24.4%) of the 135, which was 0.9% of the original 3799, were diagnosed as having significant congenital anomalies in urinary tract, such as vesicoureteral reflux (VUR) in 17, hydronephrosis in 10, unilateral renal agenesis in 2, unilateral small kidney in 2 and each case of horseshoe kidney, simple ureterocele, ectopic ureterocele, megaureter and mild dilated ureter. Minor or mild renal pelvis enlargement without the dilatation of calyx was found in 78 cases. Fiftythree of the 78 were followed more than 3 months, and complete or partial reduction of the pelvic enlargement was noted in 39 (74%), while enlarged pelvis remained unchanged in 14. There was no progressive hydronephrosis among these patients during the follow-up. Urinary tract infections were found in 6 cases (5 in VUR and 1 in ectopic ureterocele). Eleven ureters in 9 children of VUR (44%) were cured spontaneously (follow-up period: 3 months-6 months and 2 years). Surgical correction was required in 6 cases, antireflux surgery for VUR in 4, heminephroureterectomy for ectopic ureterocele in 1 and endoscopic incision of ureterocele for simple ureterocele in 1. (Conclusion) Our result indicate that infant ultrasonographic screening is a useful and valuable method of detecting urinary tract malformations.
(Backgrourd) In the present study, urease induced crystallization in synthetic urine was studied by an aggregometer technique. (Materials and Methods) The synthetic urine was made by the method by Griffith et al (1976). The synthetic urine of 200μl portions were stirred constantly at 37°C, and then 10μl of urease solution (1000 U/ml) was added. An aggregometer were recorded as turbidity curves on a chart during the incubation for the crystallization simultaneously. (Results) A two-phase turbidity curve was obtained from the reaction of synthetic urine and urease. Firstly the mild turbidity appeared gradually up untill to approximately 13min, and then the turbidity increased rapidly. The mild turbidity was called “early crystallization” and the rapid turbidity was called “late crystallization”. The early crystallization appeared gradually at pH 7.3 and 0.05M of anmmonia concentration, and this amount was completely depended on the concentration of calcium in the synthetic urine. The late crystallization occurred rapidly at pH 8.5 and 0.06-0.08M of anmmonia concentration and this amount was completely depended on the concentration of magnesium in the synthetic urine. We confirmed the early crystallization as calcium phosphate and the late crystallization as magnesium ammonium phosphate by the observations of polarized light microscopy as well as the estimations using an infrared spectrometer. (Conclusion) Urease induced crystallizations in the synthetic urine had a two-phase turbidity. Firstly the mild turbidity of calcium phosphate appeared gradually, and then rapid turbidity of magnesium ammonium phosphate occurred. Therefore, it is suggested that various crystallizations may be developed in the infected human urine according to the constituents of calcium and magnesium.
(Background) To investigate if serum levels of carboxyterminal propeptide of type I procollagen (PICP), cross-linked carboxyterminal telopeptide of type I collagen (ICTP) and urinary levels of deoxypyridinoline (D-Pyr) are useful markers of bone metastasis in patients with prostate carcinoma, we measured these markers in patients with untreated benign prostatic hyperplasia (BPH) and untreated prostate carcinoma (PCA). (Methods) Serum PICP, ICTP and urinary D-Pyr levels were determined in 53 patients; 16 patients with BPH, 15 patients with PCA without bone metastasis (stage A, B, C and D1) and 22 patients with PCA with bone metastasis (stage D2). At the same time correlations among these markers and serum total alkaline phosphatase (ALP) activity were studied. (Results) Serum PICP, ICTP and urinary D-Pyr levels in the PCA patients with bone metastasis were significantly higher than those of BPH. The serum levels of PICP in patients with PCA with bone metastasis group were significantly higher than those of without bone metastasis group. The serum levels of ICTP in patients with PCA without bone metastasis group were significantly higher than those of BPH group, while no significant difference was observed between PCA group with and without bone metastasis. In the PCA patients with bone metastasis, serum PICP and serum total alkaline phosphatase (ALP) activity were significantly correlated (r=0.80). In these patiens, serum ICTP and urinary D-Pyr levels were also significantly correlated (r=0.70). (Conclusion) These results suggest that serum PIPC, ICTP and urinary D-Pyr are the useful markers to quantitate bone metastasis in the patients with PCA. Moreover, the determination of srum ICTP levels may be significant for detecting occult bone metastasis in the patients with PCA.
(Background) The SV40-transformed stromal cell line (PSSVH) was established from rat dorsolateral prostate. To clarify the usefulness, PSSVH was studied on the immunohistochemical characteristics and the mRNA expression of growth factors and their receptors. (Method) Immunohistochemical method was used to detect cytokeratin, vimentin and large T antigen in the PSSVH cells. Chromosomal analyses were carried out by the Giemsa-banding technique. [3H]-thymidine uptake method was used to examine the influence for cell proliferation of androgens. To examine the expression of mRNA for epidermal growth factor (EGF), basic fibroblast growth factor (bFGF), keratinocyte growth factor (KGF), transforming growth factor (TGF)-α, TGF-β1 and their receptors, poly (A) RNA was extracted from PSSVH cells and Northern blot analysis was done. (Result) Immunohistochemically, PSSVH was positive for large T antigen, and the cell had a character of stromal cell which included a negative result for cytokeratin and a positive for vimentin. The cell had a karyotype of aneuploid, whereas it had not a common marker chromosome. The addition of testosterone (T: 10-10-10-6M) and 5α-dihydrotestosterone (DHT: 10-10-10-6M) did not influence on the DNA synthesis of PSSVH cells. Northern blot analysis showed expression of mRNA for KGF, TGF-α, TGF-β1, EGF receptor and TGF-β receptor (type II) in PSSVH cells. These expressions were not influenced by the addition of androgens. (Conclusion) PSSVH is the androgen-independent stromal cell from rat dorsolateral prostate and may be useful for the fundamental study of the prostate.
We herein report a case of pyelitis cystica in 65-year-old woman. She was referred to our hospital in order to have a treatment for a stone in the ureter on left side. Excretory urogram showed hydronephrosis on left, and multiple, small, smooth and round filling defects in the renal pelvis on right side. ESWL was performed to the ureteral stone, and the stone was discharged completely in 4 days. Then further examinations were made for the filling defects of right renal pelvis. Nonopaque calculi were ruled out on retrograde pyelogram and CT scan. Urinary cytology from the renal pelvis was class I. Our impression was pyelitis cystica of right kidney. Under spinal anesthesia, ureterofiberscopy was performed. Multiple small cysts were observed in the pelvis and calyx, as well as cystitis cystica. Cold cup biopsy was also done and histopathological finding ws pyelitis cystica, without malignancy. We compared endoscopic findings with radiographic findings in 18 cases of pyloureteritis cystica from the Japanese literature. The radiographic findings were multiple small, in a uniform size, and round filling defects with regular contour, and the endoscopic findings were multiple white or ocher colored, half sphere or sphere sphaped, and small cyst with smooth surface in 15 of 18 cases. We thought these findings were characteristic ones in pyloureteritis cystica. Endoscopy and biopsy are mandatory for diagnosis of pyeloureteritis cystica.
Benign tumors of the renal pelvis are relatively rare, and only a few reports have been published so far. Recently we experienced a case of a 50-year-old woman with a fibroepithelial polyp in the left pelvis. Drip infusion pyelography and abdominal CT revealed a filling defect and tiny renal stones in the left pelvis under the study of her urinary blood occult. A transitional cell carcinoma of the renal pelvis was suspected, so a left total nephroureterectomy was done. The pathological diagnosis of this tumor was fibroepithelial polyp. As it is said that preoperative diagnosis of such a polyp is difficult, preoperative ureteroscopy or perioperative pathological diagnosis by frozen sections should be attempted. But it is difficult to avoid a nephroureterectomy because low incidence of the disease.
The simultaneous occurrence of germ cell tumors and stromal tumor in the unilateral testis is extremely rare. We report a case of Leydig cell tumor and combined germ cell tumor in the right testis on a 24-year-old man. Histopathology revealed seminoma, embryonal carcinoma, choriocarcinoma and Leydig cell tumor.