Case 1 reported in “A Study on Cystoplasty by Regeneration of Contracted Bladder Using Novectane (Liquid Synthetic Resin)-sprayed Thin Paper (I)” showed the simplest symptoms of tuberculous contracted bladder.
Cystoplasty was conducted for a certain period on this case by means of an artificial material prepared by spraying Novectane on a core of thin Japanese paper, with a successful result of increasing the bladder capacity from 50-60 to 400cc. This case has been under postoperative clinical observation for more than four years.
Case 2, one of the two cases reported in the same “series (2)”, had a bladder capacity of 20cc with vesico-ureteral refiux. Another case, Case 3, who had been urinating through nephrostomy for more than a year because of complete stricture at the lower end of ureter, had a bladder capacity of approximately 50cc. Both cases underwent cystoplasty and ureterovesicostomy simultaneously, which succeeded in increasing the single urination volume up to 300-400cc. These cases have been under postoperative clinical observation for more than three years.
Case 4 in the present report is a 34 years old male. To his left residual kidney is inserted a Nelaton's catheter through which he urinated for more than three years. The presence of calculus was confirmed in the upper ureter. Fig. 1 is a radiophotogram of the calculus as indicated by an arrow. The bladder and urethra show conspicuous pathological states with the bladder capacity of less than 3 cc and extensive tuberculous stricture in the urethra. Fig. 2 shows a state of contracted bladder and urethrostenosis. A Nelaton's catheter is inserted into the lowest part of the pelvis renalis and the calculus and the extensive complete stricture are present at the upper and lower parts of the ureter, respectively. Fig. 3-(1) gives patterns of the pelvis renalis, ureter, and bladder. The state of Case 4 may be expressed by (1) left renal fistula, (2) ureteral calculus, (3) extensitive complete ureteral stricture, (4) contracted bladder with a capacity below 3 cc and (5) urethra stricture. This is the most serious state in urinary tuberculosis as shown in Fig. 4-(A).
The treatment was commenced with urethral divulsion using a filiform bougie or a metal bougie. The enlargement was attained to 30 Foff the metal bougie. Ureterolithotomy was conducted, followed by the primary cystoplasty. The contracted bladder, that was almost a walnut in size, was subjected to crucial incision to remove hard cicatricial wall of the bladder. A3×2.5cm membrane wall of the bladder obtained was sutured with an artificial bladder using 00 cutgut. The fallen artificial material was removed transurethrally one month later. Figs. 5 and 6 show the state at the primary cystoplasty. The muscle as shown in Fig. 7 was obtained from the bladder wall at that time.
Since one month after the primary cystoplasty, 0.1% Urocydal solution was introduced into the regenerated bladder until the patient had a desire to urinate, to make him forbear urinating for 30 to 60 minutes. This treatment was repeated till the previous day of the second cystoplasty. As shown in Fig. 3-(2) and Fig. 4-(B), the contracted bladder of about 3 cc was enlarged to a regenerated one of 90 cc.
The secondary cystoplasty consisted of anastomosing the ureter and the ileum, and subsequently ileum and the regenerated bladder to reconstruct the whole urinary pathway. The bladder regenerated to 90 cc was fist-sized, protruding into the pelvic cavity. The bladder wall was found 0.5 to 0.8cm in thickness when subjected to crucial incision. Figs. 8 and 9 show the regenerated bladder. As Shown in Fig. 10, occurrence of the muscle was proved in the regenerated bladder wall. The regenerated bladder subjected to crucial incision was anastomosed to the ileum which had been anastomosed to the ureter. Fig. 11 shows the state after completion of the anastomosis. Fig. 4-(C) show

抄録全体を表示

Transitional cell carcinomas were produced in the urinary bladder of ACI/N rats by oral administration of N-butyl-N-butanol (4) nitrosamine (BBN). The cells of these carcinomas can multiply in vitro and are iso-transplantable into the urinary bladder. The effect of carcinostatic agents such as mitomycin-C (MMC), triethylen thiophosphoramide (Thio-TEPA), bleomycin (BLM) and cytosine-arabinocide (CA) were tested against these cancer cells in vivo and in vitro.
1. In vivo study
From the 4th day after inoculation of cells into the bladder wail of rats, 0.2 or 0.05mg of MMC, 1.0 or 0.1mg of Thio-TEPA, 1.5mg of BLM, 0.5mg of CA and 0.05mg of MMC combined with 0.5mg of CA were injected intravenously 4 times at 2 day-intervals. Rats were killed on the 12th day from the last inoculation and carcinomas of bladder were weighted and examined histologically. Rats given 1.0mg of Thio-TEPA died from side effects prior to the last injection. Some inhibitory effects were seen in all carcinostatic agents except BLM, but complete inhibition of development of carcinomas of the bladder was seen in none of them. Combined therapy of MMC and CA showed synergistic effect.
2. In vitro study
Mitomycin-C was the most effective and the next was Thio-TEPA. They showed a complete inhibition. However, no complete inhibition was seen in BLM or CA even at a high concentration. Synergistic effect of combination of MMC and CA was obserbed as in vivo.

抄録全体を表示

Forty-one patients with rectal bladder combined with intrasphincteric perineal colostomy have been reviewed in an attempt to know how many of them suffered from postoperative acute pyelonephritis and to discuss the possible causes of this lesion.
The symptom appeared in 34.1% of the cases within one month after the operation. In the period from the 1st month to 12th month after the operation, the cases which occurred in a sporadic way (the symptom appeared once or twice) amounted to 27.0%, the cases which occurred frequently (the symptom appeared more than 3 times) Here 18.9%. In the period after the 12th month following the operation, the cases with sporadic symptom were at the rate of 22.2% and the cases with frequent symptom at 14.8%.
Analysis was conducted on the possible causes of the crisis, including the age of patients, history of preoperative acute pyelonephritis, postoperative findings of the upper urinary tract, reflux at the site of urtero-intestinal anastomosis, etc.
It was emphasized that the intestinoureteral reflux is related to the occurrence of the acute pyelonephritis in the period within 12 months, and that, in the period after the 12th month, postoperative condition of the upper urinary tract has an important role on the occurrence of acute pyelonephritis.
It was pointed out that the urine from the rectal bladder often contained white blood cells even when the patient appeared in good condition. Therefore, careful observation was required thereafter.

抄録全体を表示

Since the urinary bladder has large regenerative ability, supplementation for the purpose of enlargement is required only until a sufficient regeneration of the bladder tissue is accomplished. This study was aiming to develop a biodegradable material for use in reconstruction of the bladder to serve a temporary function until normal regrowth of the host's tissue is completed. The biodegradable material can serve as a base over which the new bladder can regenerate. At the conclusion of the regrowth of the new tissue, the temporary material could be consumed by the body tissue and therefore not have to be removed. Bovine pericardium treated with 70% acetic anhydride was found being digested and dissolved in 4 weeks when implanted subcutaneously in dogs. Based upon this, supplementation of the bladder using this material was performed on 5 dogs. One dog showed urinary leakage and was sacrificed after one week. In 3 dogs examined for 4, 6 and 48 weeks after implantation, respectedly, the implanted material had been dissloved. In one animal autopsied after ten and a half months, a small remnant of the material still remained. Postoperative observation of the animals, excretory pyelocystograms and cystometry confirmed that the material applied was useful for experimental urinary bladder supplementation.

抄録全体を表示

A case of primary intrascrotal mucinous cystoadenocarcinoma was experienced. The patient was a 57-year-old male who visited the hospital with the chief complaints of intrascrotal masses and dysuria. The mass in the left scrotum was enlarged to the size of an infant head and the one in the right scrotum to the size of an adult fist. The scrotal skin showed several fissures and fistules. The tumor was diagnosed histologically as mucinous cystoadenocarcinoma. For complete cure, the intrascrotal tumors, scrotal contents, perineal and femoral tumors, rectum and anus, and part of urethra were excised and artificial anus was provided. No evidence of histological changes were recognized in testes, testis capsules, epididymides and spermatic cords. The surgery was followed by the irradiation of betatrone 8800 rad. Two years and five months after the operation, the patient is still in good health without any sign of recurrence.
Detailed discussion was attempted from the point of view of clinical symptoms, laboratory findings and histological findings with respect to the discrimination of mucinous cystoadenocarcinoma and Cowper's adenocarcinoma among mucinous adenocarcinomas primarily occurring in urogenital organ.
This report is made since this patient is believed to be the first case of primary intrascrotal mucinous cystoadenocarcinoma in Japan.

抄録全体を表示