(Purpose) The aim of this study was to investigate the sacral reflex activity at the striated urethral sphincter relaxation by evoking the potential of the bulbocavernosus reflex (BCR). (Methods) 17 normal male subjects were investigated. BCR was elicited by electrical stimulation of dorsal nerve of the penis, and the evoked potential of the BCR (BCR-EP) was recorded by a concentric needle electrode at the periurethral striated muscle. In normal subjects BCR was performed at rest and during voluntary voiding. In 8 of the normal subjects. electrical stimulation was increased gradually during voluntary voiding, and changes of BCR-EP were studied. 3 male patients with neurogenic bladder suffering from urinary incontinence caused by involuntary sphincter relaxation (IVSR) were also investigated. In these patients with neurogenic bladder, BCR was performed at rest and during voluntary voiding as well as during involuntary voiding. (Results) In the normal subjects stable BCR-EP was elicited at rest, and disappeared during voluntary voiding. But a gradually increased larger stimulation clearly demonstrated BCR-EP during voluntary voiding. In 3 patients with neurogenic bladder, stable ECR-EP was elicited at rest. During involuntary voiding caused by IVSR obvious BCR-EP was also elicited, but its amplitude was slightly less than the amplitude of BCR-EP at rest. During voluntary voiding, in 2 of the 3 patients BCR-EP was recognized but the amplitude was much less, and in the third patient BCR-EP could not be recognized. (Conclusion) BCR-EP was suppressed during voluntary voiding in normal subjects, but insufficiently suppressed in the patients with neurogenic bladder. In these patients BCR-EP during voluntary voiding was suppressed more distinctly than BCR-EP during involuntary voiding due to IVSR. In urodynamic study, the detrusor contraction and the sphincter relaxation were common phenomenon in both voluntary voiding and involuntary voiding, but the difference in the degree of the BCR suppression depended on whether micturition was voluntary or involuntary. It was suggested that the measurement of BCR-EP could distinguish involuntary voiding caused by pathological uretheral sphincter relaxation from voluntary voiding.
(Purpose) We investigated the effects of intravesical BCG instillations for carcinoma in situ (CIS) of the urinary bladder. And we have retrospectively analyzed the prediction of effects by fresh urinary cytologic examinations before instillation. (Material and methods) 33 patients were treated for bladder CIS (1991-1997) with a median follow-up of 30 months (range from 9 to 90 months). The patients (27 males and 6 females) ranged in age from 46 to 91 (average 71 years) and received 6 to 12 weekly BCG Tokyo 172 strain 80mg instillations. They were divided into 3 groups based on tumor history: primary (9), secondary (15), concurrent (9). The prediction of effects were analized by scoring fresh urinary cytologic examinations before instillation. (Results) 22 cases (67%) were responded and they have remained free of disease for follow-up period. The statistic evaluation proved to show the significance between the effects of treatment and the sum of scoring (cellular appearance and existence of large nuclear cells). (Conclusion) We confirmed the effects of this treatment. The prediction of effect of this treatment seemed to be indicative by fresh urinary cytologic examinations before instillation, especially cellular appearance and existence of large nuclear cells.
(Purpose) To evaluate the usefulness of transperitoneal anterior approach in laparoscopic radical nephrectomy for patients with renal cell carcinoma. (Material) Ten patients (Eight males and two females) with small renal cell carcinoma less than 7cm in diameter were treated with laparoscopic radical nephrectomy between June 1997 and May 1999. Clinical stage was T1aN0M0 in 6 cases and T1bN0M0 in 4 cases. (Method) Of the 10 patients, the initial four received preoperative embolization of the renal artery. Under general anesthesia laparoscopic radical nephrectomy via transperitoneal anterior approach was performed in all patients. This procedure facilitates initiated early access to the renal vessels as does open radical nephrectomy. The kidney was dissected en bloc with Gerota's fascia and delivered from the small skin incision without morcellation. (Result) Two patients needed conversion to open surgery. The mean operating time of eight patients except for conversion cases was 247 minutes and the mean blood loss was 258ml. There was no major complication associated with laparoscopic procedure. (conclusion) Transperitoneal anterior approach in laparoscopic radical nephrectomy is a suitable and useful procedure for the treatment of small ranal cell carcinoma because it enables us to avoid possible tumor manipulation by early access to the renal vessels as open radical nephrectomy.
(Purpose) Many epidemiological factors contribute to erectile dysfunction (ED). The objective of the present research was to investigate the risk factors of ED and the influence of aging on male sexual function, to obtain some insight into prevention of ED. (Methods) The study sample consisted of employees, aged from 22 to 59 years old of ten companies in Japan, who responded to the International Index of Erectile Function (IIEF) questionnaire and a survey of health status and related variables. The IIEF sexual activity questionnaire includes 15 items related to male sexual activity organized into five domains (that is erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall satisfaction) to which 967 of the 1, 020 subjects (94.8%) provided complete responses. These 967 men constitute the present study sample. For statistical analysis, ANOVA with Scheffé's (post hoc) test was conducted, and statistical significance was set at p<0.05. (Results) Presence of hypertension, heart disease, diabetes and hyperlipidemia was associated with a significantly decreased score for erectile function in subjects in their fifties (p<0.05), however, it was not significant in the other age groups. In subjects, who were free from risk factors for sexual function, there was significant correlation between age and the scores for erectile function, orgasmic function, sexual desire and intercourse satisfaction. (Conclusions) Aging and chronic disorders that have been considered to be putative risk factors for ED, therefore affect male sexual function in the elderly. The IIEF was suggested to be suited for use in studies assessing epidemiology of ED.
A 32-year-old man consulted Osaka National hospital with chief complaints of dysuria and macrohematuria. DIP and CT revealed that the right kidney deviated to the lower pole of the left kidney and they fused together. The right ureter crossed over the supine. The calcified shadow existed in the lower end of the left ureter with cobra head image. He had no external anomalies. Under diagnosing crossed fused kidney (inverted L shaped) complicated the left ureterocele with a stone, transurethral incision of ureterocele (TUI) was perfomed. We made transverse incision and extracted stone, 7mm in size (calcium oxalate 96% and calcium phosphate 4%). Three months later after the operation, IVP, CG and VCG revealed the down-sized ureterocele and no VUR. Crossed renal ectopia complicated many anomalies about 50%. Among them anomalies of the urinary tract was most frequent about 30%. But crossed renal ectopia with ureterocele wasn't reported so far in Japanese literature.
We report a case in which the completely obstructed ureter was successfully treated by endourological procedure. The patient was a 66-year-old male who had been admitted for panperitonitis caused by diverticulitis perforation of the sigmoid colon. About one month later, leakage of both stool and urine and left hydronephrosis were observed. Therefore, left percutaneous nephrostomy was performed and the artificial anus was created. Radiographic examination showed about 1cm defect on the lower one-third of the left ureter. ‹1st Opertion› A 9.5 Fr. rigid ureteroscope was inserted into the left ureter transurethrally and a 7.5 Fr. flexible ureteroscope was inserted percutaneously. Antegrade puncture using a stiff end of a 0.038-inch guidewire into the obstructed segment was failed. Then, we bit off the obliterated tissue with a biopsy forceps transurethrally towards the light from the flexible scope, and a 12 Fr. double-J stent was indwelt. ‹2nd Operation› Eight weeks after the first operation, a 12 Fr. ureteroresectoscope was inserted transurethrally. Full-thickness coldknife insicion of the re-established ureter was failed, however. ‹3rd Operation› Two weeks after the second operation, a 12.5 Fr. ureteroscope was inserted transurethrally, and a full-thickness insicion in the lateral position of the re-established ureter was successfully made by KTP-laser. Then, a 12 Fr. endopyelotomy stent was placed. ‹Result› Six weeks after the third operation, the stent was removed and DIP revealed the improvement in hydronephrosis. The patient presented no reccurence at 2-year follow up.
An 81-year-old man was referred to our hospital with a chief complaint of asymptomatic macrohematuria. Cystoscopy revealed bleeding from the right ureteral orifice. Various examimations, including ureteroscopy, failed to find any abnormalities. As gingival bleeding followed the macrohematuria, further examinations of blood coagulatory function were undertaken. Decreased factor VIII coagulant activity accompanied by the presence of factor VIII inhibitor was revealed, leading to a final diagnosis of acquired hemophilia A. Macrohematuria and gingival bleeding immediately disappeared with oral administration of prednisolone at 30mg per day, and the titer of factor VIII inhibitor decreased to an undetectable level by the 45th day of treatment. We emphasized the importance of blood coagulation testing in the examination of patients with macrohematuria.