(Purpose) The incidence of testicular cancer is rare. However, it is a significant cancer in that it develops not only in old age but also in children and younger age. We investigated the epidemiological characteristics of testicular cancer in Japan, in order to elucidate its features and problems. (Patients and methods) We surveyed hospitals and clinics in and around Gunma prefecture that treated patients with urologic diseases and reviewed the pathology records from 1985 to 1994, and calculated the annual age-adjusted incidence rates of testicular cancer. Incidence rates in Japan were taken from the estimates made by ‘The Research Group for Population-based Cancer Registration in Japan’. The annual number of deaths, annual age-adjusted death rates from 1947 and 1998, the age-specific death rates and decrease rate of them, and the prefectural standardized mortality ratio (SMR) from 1973 and 1998 was calculated from the data reported by Ohno et al. and statistical tables kept in ‘Statistics and Information Department, Minister' s Secretariat, Ministry of Health and Welfare’. (Results) In Gunma Prefecture, the annual age-adjusted incidence rates tended to increase. In estimated data of national survey, it slightly increased from 1975-79 to 1980-84, and remained stable thereafter. The annual number of deaths and age-adjusted death rates tended to decrease from around 1980. The peak of age-specific death rates was seen in infants, age 20 to 40 and old age. The decrease in the age-specific death rate was prominent for age under 20 and old age, but not significant for age 25 to 34. Prefectures in which SMR was high (≥120) were distributed all over Japan, but prefectures in which SMR was low (≤80) were concentrated in western Japan. (Conclusions) The annual number of deaths and age-adjusted death rates began to decrease from around 1980, which coincided with the time the clinical trial of cis-platinum began. More than 100 deaths of testicular cancer are reported even now, early diagnosis, early treatment, and improvement of treatment strategy to far-advanced cases are necessary.
(Purpose) In reference to the cases in which radical prostatectomy was performed after storage of autologous blood, we retrospectively study the usefulness of this procedure and proper amount of blood stored. (Patients and Methods) The subjects included 62 cases in which radical prostatectomy was performed after storage of autologous blood from October, 1997 to March, 2000. As the amount of blood to be stored, either 800ml or 1, 200ml was selected optionally as the amount of blood to be stored, and blood was stored at a rate of 400ml once a week. Erythropoietin, 24, 000 units was injected subcutaneously after storage of blood, and an iron preparation 200mg/day was administered orally throughout the period. (Results) Homologous blood transfusion could be avoided in 58 out of 62 cases, the avoidance rate being 93.5%. With 200ml of autologous blood as 1 unit, 104 units out of 330 units were discarded, the disposal rate being 31.5%. To lower the disposal rate, we studied whether there is any parameter that can predict the loss of blood preoperativey. As a result, we found a significant difference in the loss of blood between the body mass index of less than 24 and that of more than 24. Blood storage and transfusion produced no side-effects. (Conclusion) Storing autologous blood in radical prostatectomy is considered useful since homologous blood trasfusion can be avoided at a high percentage and no side-effects are produced. The body mass index is useful for predicting the loss of blood and determining a proper amount of blood to be stored.
(Purpose) Enterovesical fistula in patients with Crohn's disease is intractable. Although there are some reports that the enterovesical fistula were successfully treated conservatively, closure of the fistula cannot always be achieved and surgical intervention may required for those patients. Since surgical closure of entero-entero fistula has a high risk of relapse, the strategy for treating enterovesical fistula has not been established. We evaluated the clinical findings especially in management of enterovesical fistula in Crohn's disease. (Patients and methods) Two hundred two patients (mean age was 28.4 year old, range 12-69; 152 men and 50 women) were diagnosed as Crohn's disease during a period of 15 years between 1986 and 2000 in our institute. The incidence and the clinical results regarding the diagnosis and the treatment of enterovesical fistula in these patients were retrospectively evaluated. (Results) Seven in 202 patients were diagnosed to have an enterovesical fistula (3.5%, 6 men and 1 woman). The period from the initial diagnosis of Crohn's disease to the recognition of the enterovesical fistula was 11 to 204 months (mean 92.1 months). Enterovesical fistula was revealed and/or visualized by radiological enterography in 6, cystography in 2, cystoscopy in 6, and CT in 4 patients. Surgical interventions were finally conducted in all 7 patients after the failure of conservative treatment for 10 to 146 days (mean 68.2 days). Surgical procedures performed for closing the enterovesical fistula were partial cystectomy with fistulectomy in 5, fistulectomy with bladder wall overlay-suture in 2, and bladder wall overlay-suture alone in 1. No relapse of enterovesical fistula was recognized in any patient in the average observation of 41.6 months. (Conclusion) Although the treatment of Crohn's disease has been advanced, enterovesical fistula is shown to be resistant to conservative treatment options and it makes patients in unfavorable status for relatively long duration. Our evaluation shown here demonstrated the sufficient surgical results on the closure of enterovesical fistula without any relapse, and was different from the high relapse rate after the surgical management of entero-entero fistula in similar observation period. Surgical interventions of enterovesical fistula caused by Crohn's disease might have an advantage to make diseased patients improved in shorter duration.
(Purpose) We studied how transition zone index (TZ index) influenced the therapeutic efficacy of benign prostatic hyperplasia (BPH). In addition, we retrospectively investigated the availability of TZ index in selection of the more effective therapeutic method for BPH. (Method) One hundred twenty-five patients with symptomatic BPH whose prostate volume (PV) was more than 15ml by transrectal ultrasonography were investigated. Sisty-nine men underwent transurethral resection of the prostate (TURP) whereas 56 were treated with α1-blocker, Tamsulosin hydrochloride. These patients were evaluated based on TZ index as well as oridinary parameters of BPH; international prostatic symptom score, QOL score, peak flow rate and PV. (Results) The patients with TZ index≥0.5 showed good therapeutic results in the TURP group. On the other hand, the patients with TZ index<0.5 showed favorable response in α1-blocker group. Multivariate analysis revealed that TZ index affected the therapeutic efficacy more strongly than the other parameters. (Conclusion) TZ index had strong influence on therapeutic efficacy of TURP or α1-blocker and seemed to be a useful tool for the selection of BPH therapy.
(Purpose) Transurethral removal of the ureter in nephroureterectomy has been reported by several centers as being a useful procedure. We also have employed this procedure in selective cases, but we had several problems in this procedure. So we tried the modified pluck nephroureterectomy technique (En bloc removal of kidney and ureter) to improve the procedure. (Materials and Methods) Since October 1999 to September 2000, we employed this technique in 9 cases with renal pelvic or ureteral tumor, 2 with renal cell carcinoma and 3 with benign diseases. Standard nephrectomy is performed. After transurethral resection of the ureteral meatus, the distal ureter is freed by blind retroperitoneal dissection and plucked out of the bladder in continuity with the kidney. The bladder is drainaged for 6-1o days after surgery. (Results) The average time and blood loss during the operation were 247 minutes and 287ml. No appreciable complications such as retroperitoneal urine leakage or hemorrhage during or after the procedure were observed. (Conclusions) The modified pluck technique is useful because of its easiness and minimal invasiveness.
(Purpose) Ischemia/reperfusion injury associated with organ transplantation affects early graft function and acute rejection. Recently, it has been suggested that ischemic insult increases the immunogenicity of the organ. The purpose of this study was to determine the expression of a cell adhesion molecule, CD80, which plays an important role in the costimulatory pathway for full T-cell activation in organ transplantation. (Materials and Methods) Wistar male rats weighing 150-180g were divided into control group and ischemia groups with temporary clamping of the left renal artery for 30, 60 and 180 minutes. The left kidneys obtained at 1 hour, 1, 3, 7 and 14 days after reperfusion were subjected to total RNA extraction followed by reverse transcriptase-PCR (RT-PCR), fluorescence immunostaining and histological staining. (Result) The expression of CD80 by RT-PCR was not observed in the control group, but was observed in the ischemia groups from 1 to 14 days after reperfusion. Fluorescence immunostaining of CD80 was positive in the ischemia groups, but not in the control group. CD80 expression was detected mainly in the endothelium of the glomeruli and the peritubular vessels. (Conclusion) These results indicate that CD80 is upregulated by ischemic insult, and that the costimulatory pathway may be enhanced by ischemia/reperfusion injury without alloantigens.
We report 2 cases of women who became pregnant and experienced vaginal delivery after augmentation cystoplasty. Case 1: A 23-year-old woman with spina bifida became pregnant 3 years after augmentation sigmoidocystoplasty which had been performed to treat intractable urinary tract infection and urinary incontinence. During pregnancy, she developed febrile urinary tract infection twice which required antibiotics together with tight adherence to clean intermittent catheterization. At 36 weeks of gestation, she was safely delivered of a healthy baby. No deterioration of urinary continence level and renal function was observed after the delivery. Case 2: A 32-year-old woman bacame pregnant 23 years after augmentation ileocecocystoplasty which had been performed to reconstruct diverted urinary tract due to a congenital hour-glass bladder. At 19 weeks of gestation, she developed acute pyelonephritis and hydronephrosis at right kidney which required antibiotics and indwelling urethral catheter. At 21 weeks of gestation, a drip infusion of ritodorine hydrochloride was started and maintained until 34 weeks of gestation to inhibit premature uterine contraction. At 29 weeks of gestation, she developed acute pyelonephritis and progressive hydronephrosis at left kidney, for which percutaneous nephrostomy drainage was deemed to be mandatory. She was delivered of a healthy baby at 36 weeks of gestation. Ten days after the delivery, both nephrostomy tube and indwelling urethral catheter were removed and clean intermittent catheterization was resumed. Total renal function was maintained during and after the pregnancy, and no deterioration of urinary continence was observed after the delivery. Since urinary tract infection is extremely common during pregnacy after augmentation cystoplasty, prevention and prompt intervention for urinary tract infection should be mandatory. Significant upper tract obstuction, if developed, should be treated by an effective urinary drainage. Thus, urological as well as obstetrical appropriate management is mandatory for the safe accomplishment of pregnancy and delivery after augmentation cystoplasty.
A 55-year-old man with prostate cancer received a total prostatectomy. Two days after the operation, he suffered from high fever and shaking chilliness, followed by skin eruption, hypotension, diarrhea and chest pain. The results of blood bacterial culture and endotoxin were negative. Toxic shock syndrome was suspected, and the administration of vancomycin (VCM) and continuous hemodialysis-filtration (CHDF) were perfomed. The steroid pulse therapy for adult respiratory distress syndrome (ARDS) and the treatments for DIC were also done, and they were effecive. The desquamation of the extremity was observed on 10 days after the operation. MRSA was finally identified from pus discharge of the operation wound 13 days after the operation. The prevention and treatments for toxic shock syndrome were discussed.
A case of renal angiomyolipoma rapidly growing during pregnancy with tumor thrombus into the inferior vena cava is reported. Angiomyolipoma in a 31-year-old woman was incidentally found by ultrasonography. CT scan revealed a fat-containing tumor in the right kidney with 4cm in diameter. The patient was followed at outpatient clinic without any treatment. Fifteen months later, the post-delivery follw-up CT scan showed that tumor size had grown up to 11cm in diameter. Although laparoscopic right nephrectomy was tried, open transperitoneal right nephrectomy was performed because the tumor thrombus extending into the inferior vena cava was found during the laparoscopic procedure. Pathological diagnosis was angiomyolipoma of the kidney. There are several reports that indicate angiomyolipoma grows rapidly during pregnancy. Our case demonstrates that careful followup is required for angiomyolipoma in women with possible conception and delivery.
Prostatic phyllodes tumor is an unusual lesion for which there are only occasional reports in the literature. We encountered a phyllodes tumor of the prostate in a 36-year-old man who had complained of urinary frequency and dysuria for one month. In October 1998, he visited our hospital and had a transurethral resection of the prostate (TUR-P) for obstructive symptoms. He experienced recurrent same symptoms in September 1999 and underwentanother TUR-P. The pathologic examination at this time revealed phyllodes tumor. In the tumor, despite its regular alternating growth of ducts and stroma, the stromal element appeared histologically malignant, showing marked atypia and rhabdomyosarcoma-like components. Consequently, in December 1999, the patient underwent radical prostatectomy with lymph node dissection. The resection margins and pelvic lymph nodes were free of tumor. The patient remains alive and well after 14 months.
A 63-year-old man was admitted to our hospital complaining of painful urination. Urinalysis demonstrated pyuria and microscopic hematuria. Cystoscopy revealed the bladder tumor and the reddish mucosa. Transurethral biopsy was performed and the pathological examination showed transitional cell carcinoma in the bladder tumor and epithelioid granuloma in the reddish mucosa. Acid-fast bacilli smeas of urine sample and urine culture of Mycobacterium tuberculosis were positive. Therefore the treatment of urinary tuberculosis was started and the patient recieved intra-arterial chemotherapy combined with radiation. After the therapy, radical cystectomy and bilateral cutaneous ureterostomies were performed. Pathological study revealed transitional cell carcinoma and epithelioid granuloma in the removed bladder. The reports of urinary epithelial carcinoma with urinary tract tuberculosis were rare and, including our case, the 10 cases in Japanese literature are reviewed.
We report a case and surgical technique of successful sling suspension of insufficient efferent limb of continent urinary reservoir, which has occurred urinary incontinence. A 64-year old male, who received radical cystectomy with continent urinary reservoir, had been suffered urinary incontinence from the reservoir about one year after surgery. Various procedures, such as the repair of the efferent limb of the reservoir, addition of the ileal patch, instillation of scopolamine, oxybutinine into the reservoir and an injection of GAX collagen in the efferent limb, were not effective for his urinary incontinence. Finally, anti-incontinence procedure of sling at an efferent limb using abdominal rectus muscle fascia was employed and obtained a continence for 2 years after operation. The principle of this surgery is same with that of sling suspension for female stress incontinence. It is advisable for the incontinent urinary reservoir when it has an enough length of efferent limb.