(Purpose) We report our initial experiences of retroperitoneoscopic partial nephrectomy for renal cell carcinoma.
(Materials and Methods) From April 2002 to October 2003, we performed 11 retroperitoneoscopic partial nephrectomy for renal cell carcinoma. Our indication was T1N0M0 renal tumors which sizes were about 4cm or less and were exophytic and were not situated at the renal hilum. First we inserted single J catheter to the renal pelvis cystoscopically. under fluoroscopic guidance. Next 4 trocars were set at pneumoretroperitoneum and the renal artery and vein were clamped individually after cold saline was circulated from the single J catheter. Renal parenchyma was sharply cut with scissors and vessels were coagulated with bipolar coagulator. When renal collecting system was opened, cariceal suture repair was performed. We used the microwave tissue coagulator without clamping the renal pedicle when the tumor was 2cm or less in diameter and the distance from the tumor edge to the renal collecting system was more than 1cm.
(Results) In 9 cases renal pedicles were clamped and in 2 cases were not. Mean tumor size was 27.5±8.9mm and mean operative time was 350±92 minutes and mean estimated blood loss was 743±998ml, and mean warm ischemic time was 70±30 minutes. In one case bleeding from cut surface was uncontrollable, so open conversion was needed. In this case the renal artery and vein were clamed but another artery exited. The surgical margins were all negative, and no other complications were happened. Post operative serum creatinine raised soon after the operation but finally downed, and the mean up level was 0.07ng/ml only. But RI examination revealed the residual renal damages were in proportioned to the warm ischemic times. During a mean followup of 8 months no patients has had local recurrence or metastatic disease.
(Conclusions) Retroperitoneoscopic partial nephrectomy for renal cell carcinoma is effective for select patients. But better cooling method and earlier suture technique and more long follow-up periods will be necessary for establishment.

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(Objectives) We retrospectively reviewed our experience of augmentation ureterocystoplasty in children to evaluate its long-term results.
(Materials and Methods) From February 1996 to March 1999 four children (2 boys and 2 girls) with neurogenic bladder had augmentation cystoplasty using dilated ureter in our institute. After trans-uretero-ureterostomy the lower two thirds of the unilateral ureter was used to perform the augmentation cystoplasty. Follow-up varied between 59 and 96 months (mean 85).
(Results) In early post-operative period bladder volume and compliance increased from 96 (64-150) to 113 (40-220)ml and from 2.7 (1.3-5.8) to 4.5 (2.0-11.0)ml/H₂O respectively. Incontinence was improved in all children and two had dry interval of 3-hour catheterization. Although bladder volume and compliance kept increasing gradually (239 (237-241)ml, 11.5 (5.7-18.5)ml/H₂O respectively) over 5 years postoperatively, 2 elder patients had repeat augmentation cystoplasty using gastrointestinal tract because of hydronephrosis and deterioration of renal function.
(Conclusion) Our long-term result of ureterocystoplasty was no good. Ureter is not an ideal material to provide adequate bladder capacity and compliance for elder children unless their bladder becomes as large as that of adults early post-operatively.

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(Purpose) To evaluate the efficacy of combined lumbar spinal and epidural (CLSE) anesthesia in retropubic radical prostatectomy.
(Materials and methods) Twenty consecutive patients who underwent radical retropubic prostatectomy by a single surgeon (H. K.) under CLSE anesthesia from July of 2003 to February of 2004 were selected as subjects. They were compared with 20 consecutive patients who underwent radical retropubic prostatectomy performed by the same surgeon under combined general and epidural (CGE) anesthesia from April to December of 2002. Both periods were carefully selected to exclude radical prostatectomies with intraoperative complications to evaluate genuine effects of anesthesia. For lumbar spinal anesthesia, 0.5% hyperbaric bupivacaine hydrochloride or 0.5% hyperbaric tetracaine hydrochloride (dissolved in a 10% glucose solution) was used. An epidural tube was inserted for both lumbar spinal anesthesia and general anesthesia mainly for the purpose of controlling a pain after operation.
(Results) Intraoperative blood loss was significantly less in the CLSE anesthesia group compared with CGE anesthesia group (p=0.024). Postoperative water drinking was started at 0.4 days (average) for CLSE anesthesia and at 1.1 days (average) for CGE anesthesia (p<0.0001). Postoperative diet was begun at 0.7 days (average) for CLSE anesthesia and at 1.5 days (average) for CGE anesthesia (p<0.0001). Compared with the CLSE anesthesia group, the mean of the highest intraoperative mean blood pressure was significantly higher in the CGE anesthesia group (p=0.002).
(Conclusion) Intraoperative blood loss was less, intraoperative change in blood pressure was less and recovery of postoperative intestinal peristalsis was earlier in patients who underwent prostatectomy under CLSE anesthesia than in patients who underwent prostatectomy under CGE anesthesia. We believe that prostatectomy under CLSE anesthesia is more advantageous than prostatectomy under CGE anesthesia.

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We herein report a case of bilateral testicular germ cell tumor recurring 31years after right high inguinal orchiectomy. In 2003, a 62-year-old man presented with a mass in the left testis. Ultrasonography demonstrated three hypoechoic mass and microlithiasis of the left testis. Abdominal and breast computed tomography revealed no lymph adenopathy and any metastasis. The preoperative diagnosis was stage I testicular tumor and subsequently left high orchiectomy was performed. Histological examination revealed typical seminoma. At present, the patient is free from recurrence after the surgery. To our knowledge, 166 cases were reported in Japan. Approximately fifty percent of metachronal bilateral testicular tumors previously reported have been recurred after five years and more from the initial surgery. In the testicular cancer, long-term follow-up and self examination of the scrotum are of great importance. We review the metachronal bilateral testicular germ cell tumors previously reported in Japan.

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Late relapse of testicular tumor is rare. We report a case of recurrence of seminoma at left inguinal lymph node 18 years after initial treatment.
A 63-year-old man had a left orchiectomy for left testicular tumor (T1N0M0) in February 1985, with no past history of scrotal or inguinal surgery. Histological examination revealed seminoma (pT1), and prophylactic radiotherapy (34.2 Gy) to para-aortic and left hemi-pelvic regions was perfomed.
In November 2003, the patient presented with left inguinal swelling, and was referred to our hospital with suspicion of metastasis to left inguinal lymph nodes. Serum markers (AFP, hCG, hCGβ and LDH) were normal. Computerized tomography (CT) showed three masses in the left inguinal region, but no other abnormal mass was detected at chest, abdomen or pelvis. Lymphoidectomy of the left inguinal region was perfomed in January 2004, and the mass revealed to be metastasis of seminoma by histological examination.

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A 31-year-old man was presented with an asymptomatic repeated gross hematuria. A drip infusion pyelography (DIP) revealed a pouch with a stone in the left lower ureter. 29 months later, he was re-hospitalized for left flank pain. Urinalysis revealed 10 to 19 RBC and 20-29 WBC/HPF. A DIP demonstrated left mild hydronephrosis due to the ureteral stenosis just proximal to the stone filledureteral pouch. He underwent partial ureterectomy. Histologic examination revealed the true ureteral diverticulum with all the layers of a ureteral wall. True ureteral diverticulum is a rare congenital anomaly. To our knowledge, this is the 3^rd case in the Japanese literature.

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