(Objectives) In order to evaluate the immunological milieu in renal cell carcinoma (RCC), we investigated infiltration by mature dendritic cells (CD83 positive cells), cytotoxic-T cells (CD8 positive cells) and helper-T cells (CD4 positive cells) in RCCs, as well as in surrounding normal tissues and correlations between the cell types. (Materials and methods) Specimens from 33 surgically resected RCCs were embedded in paraffin and then stained for CD4, CD8, CD83. Each section contained three areas, tumor tissue, tumor margin and normal renal parenchyma. Cells positive for CD4, CD8 and CD83 were counted each area. (Result) Cells positive for CD4, CD8 and CD83 were observed predominantly in the tumor margins, rather than tumor tissue and normal renal parenchyma. The differences were significant in the number of immune positive cells between tumor margin and tumor tissue, and between tumor margin and normal renal parenchyma. A significant correlations was found between CD4 and CD83 positive cells (r=0.805, p<0.0001), and also between CD8 and CD83 positive cells (r=0.505, p<0.0001). (Conclusion) It has been reported that mature dendritic cells induces cytotoxic-T cell and helper-T cell responses. Infiltrating mature dendritic cells, cytotoxic-T cells and helper-T cells were present only in the tumor margin. This may reflect significant immune reaction around the tumor margin.
(purpose) We evaluated condition of urination and International Prostate Symptom Score (I-PSS) after radical prostatectomy. (patients and methods) Forty-three men with prostatic cancer underwent radical prostatectomy between October 1993 and October 2002. Mean patients age was 66 years (range 56 to 79) and clinical follow-up averaged 38.6 months (range 3 to 84). Urodynamics studies including urofloemetry, cystometry and evaluation of I-PSS were performed before and 1, 3, 6, 12 months after the operation. After 12 months these studies were performed every year. The status of postoperative urinary incontinence was based on patients' report. (results) First desire to void, maximum desire to void and maximal flow rate was decrease temporarily after radical prostatectomy. However most patients had normal uroflowmetorogram and normal cystometrogram at 6 months. I-PSS and QOL index was improved during postoperative 12 months. (conclusions) Postoperatively urodynamics studies was improved from 3 to 6 months, but evaluation of I-PSS and QOL index was improved from 6 to 12 months. The difference was formed to both.
(Background) Intravesical instillation of bacillus Calmette-Guerin (BCG) is efficient for prophylaxis of superficial bladder cancer and treatment for carcinoma in situ (CIS) of the upper urethelial cancer. However, the incidence of adverse effects is relatively high, and those include reactive arthritis. We retrospectively evaluated the incidence and the outcome of reactive arthritis following Intravesical BCG therapy for urothelial cancers. (Patients and Methods) Intravesical instillations of BCG were performed in 192 cases (218 courses) between January 1998 and January 2002. BCG was instilled for prophylaxis of superficial bladder cancer recurrence in 170 (195 courses), treatment for CIS in 7 (8 course), and treatment for CIS in 7 (8 courses), and treatment for CIS in upper urinary tract in 15 (15 courses). (Results) Arthritis was recognized in 8 cases (3.7%, 8/218 courses), and 7 of them were identical to reactive arthritis following BCG therapy. Remaining 1 patient was diagnosed as rheumatoid arthritis (RA), and the relation between arthritis and intravesical BCG instillation was unclear. Mean number of BCG instillation was 5.6 (3-8 times). All reactive arthritis were occurred within 4 weeks after the last BCG instillation, i. e., BCG induced urinary tract infection, and 6 of them were polyarthritis. Concurrence of conjunctivitis was seen in one patient. HLA-B27 was negative in 4 examined patients. A nonsteroidal anti-inflammatory drug (NSAID) was used in all 8 patients, anti-tuberculous agents were used in 3, and prednisolone was added in 3, Arthritis was improved within 2 months in patients received prednisolone, however, it persisted longer than 3 months in patients without prednisolone. (Conclusion) Arthritis was recognized in higher incidence than previous reports following intravesical instillation of BCG. All cases except one, diagnosed as RA, were diagnosed as reactive arthritis (Reiter's syndrome). However, correlation between HLA-B27 and arthritis was not clear in this study. Administration of steroidal drug was thought to improve arthritis in shorter duration.
(Objective) The Ministry of Health, Labour and Welfare announced that periconceptional consumption of folic acid will reduce risks of having babies afflicted with Neural Tube Defects (NTDs) in the year of 2000. We assessed awareness of the role of folic acid among urologists and a patient group, how urologists give advices on lifestyle to young women, and what lifestyle the patient group currently maintains. (Materials and Methods) A postal questionnaire survey was conducted involving 400 urologists randomly selected and a group of 250 female patients afflicted with NTDs and 250 mothers who had given birth to babies having NTDs during the past 7 years. Eighty-four percent of urologists aged 40 years and over and 76% of the patient group aged in their 20s and 30s. Response rates were 56% in the former and 52% in the later. (Results) Twenty-six percent of urologists and 92% of the patient group knew an important role folic acid played in prevention of neural tube defects. While 10% of urologists advised to consume multi-vitamins containing folic acid or folic acid supplements, 25% of myelodysplastics and the mothers took them. Sixty-eight percent of doctors advised to take well-balanced food and 82% of the patent group answered that they do. Over 80% of the doctors and the patient group believed that a folic acid campaign is to be organized to inform young women of childbearing age of possible reduction of the risk. (Conclusion) It is found that proportion of urologists who are aware of a role of periconceptional consumption of folic acid is significantly lower than that of the group of patients (p<0.0001). Urologists are expected to recognize specific benefits of folic acid in the prevention of NTDs, to advise young women of childbearing age to take well-balanced meals, and to recommend those who wish to be pregnant to consume 400 micrograms of folic acid supplements from 4 weeks before to 12 weeks after conception.
(Purpose) Retroperitoneoscopic radical nephrectomy (RRN) has been performed at Yokohama City University Medical Center since May 2002. Three surgeons have become skilled in performing RRN without major complications. We investigated the outcomes of the surgery and attempt to clarify whether the technique we adopted is suitable to perform this procedure safely. (Patients and Methods) Between May 2002 and June 2003, 14 patients suspected of renal cell carcinoma underwent retroperitoneoscopic radical nephrectomy at Yokohama City University Medical Center. The surgical procedure is shown below. In a lateral position, a lumbar oblique incision 6cm long is made to approach the retroperitoneal space. Under direct vision, the ureter is dissected and Gerota's fascia is dissected from the peritoneum and the psoas muscle to signalize the subsequent dissection line. After the dissection, hand port device was attached to the skin and three 12-mm trocars were placed. The subsequent procedures are performed by retroperitoneoscopic surgery with carbon dioxide insufflation. The isolated kidney was removed through the incision that was made initially. We investigated the outcomes of this procedure. (Results) The mean surgical duration was 244.4 minutes and mean blood loss was 217.9ml. Conversion to open surgery was required in one case due to bleeding and in one case due to incomplete management of a small artery. Blood transfusion was not required in any case. There were no major complications during the perioperative period. (Conclusions) The three operators have become skilled in performing RRN safely with this technique.
We report a case of primary malignant lymphoma of the urinary bladder. A 72-year old woman complaining of low abdominal pain was admitted to the Tone Central Hospital in February, 2001. Macrohematuria appeared, and the submucosal tumor was observed by cystoscopy, and A Transurethral bladder biopsy led to a histopathological diagnosis of non-Hodgkin' s malignant lymphoma (diffuse lymphoma, large-sized cell type, B-cell type). Clinical stage was IE, but as soon, she was get bilateral hydronephrosis and bladder-ileum fistula. The administration of 6-course CHOP chemotherapy had an excellent effect of disappearing the tomor, bilateral hydronephrosis, and bladder-ileum fistula. She remaind free of disease until now.
A 18-year-old male visited hospital with macroscopic hematuria. Computed tomography showed slightly enhanced left renal tumor that was uncharacteristic for clear cell carcinoma, and radical nephrectomy was performed. Operative specimen revealed primary small cell carcinoma of the kidney. 18 months after operation, bone metastases were diagnosed. Chemotherapy including cisplatinum, etoposide and bleomycin and external irradiation was performed. This intensive therapy was effective for metastatic lesion. He is still alive for 55 months after diagnosis, and is the best controlled case around the world. To our knowledge, this is the 14th case as primary renal small cell carcinoma in the world literature.
Paravesical granuloma is a rare complication after inguinal herniorrhaphy. We report a case of this rare disease and review 27 previously reported cases. A 70-year-old male presented with hematopyuria. He had undergone right inguinal herniorrhaphy five years earlier. On presentation, the right inguinal area was wet with exudate. Cystoscopy revealed edematous mucosa on the right side of the bladder dome, but transurethral bladder biopsy demonstrated no malignancy. CT identified a 2-cm diameter mass with heterogeneous appearance on the right side of the bladder dome. Treatment with antibiotics proved ineffective, and en bloc excision of the tumor with partial cystectomy was performed. Symptoms subsequently resolved completely. Histopathologically, the tumor represented inflammatory granuloma, and a mesh thought to be a remnant from the previous herniorrhaphy was found in the central portion of the tumor. Paravesical granuloma should be considered for patients with continuous hematopyuria and a history of inguinal herniorrhaphy.
A 62-year-old man consulted our hospital complaining of macroscopic hematuria. Intravenous urography showed a dilated terminal portion of the left ureter resembling a cobra head. Cystoscopy revealed multiple tumors on the ureterocele. There were no metastatic lesions on CT and MRI. Transurethral resection of the tumor and the ureterocele was performed and the pathological examination revealed transitional cell carcinoma on the ureterocele. This is the 4th case of urothelial cancer on a simple ureterocele reported in Japan.
A 6-year-old girl was referred to our department due to pyelonephritis. Voiding cystourethrogram (VCUG) revealed grade 4 vesicoureteral reflux (VUR) and urethral deformity (stenosis and lateral deviation). She had a history of sacrococcygeal teratoma resection in the newborn. Urodynamic study revealed a large-capacity hypotonic bladder and poor bladder emptying. Magnetic Resonance Imaging of the spine demonstrated no abnormal findings. Despite conservative therapy, there were no improvement of VUR. Then, urethral dilation and anti-reflux-surgery were performed. Six months after the operation, VCUG showed no VUR. However, she has persistent residual urine due to neurogenic voiding dysfunction, and is being treated with a regimen of frequent timed voiding to reduce urinary residual and urinary tract infection.