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A Clinical statistic survey was carried out on the patients, diseases, and the treatments undertaken at the Ward of Department of Urology, Kyoto University Hospital during the years of 1985 to 1988.

A recent four year statistic survey carried out on the patients in the Urological Outpatients Clinic of Kyoto University Hospital is reported.

Neurological disorders associated with a malignant neoplasm, which is not caused by a direct effect such as metastasis, infiltration or compression, is called carcinomatous neuromyopathy. Subacute cerebellar degeneration recognized in this category is characterized by acutely or subacutely progressive cerebellar ataxia and widespread loss of Purkinje cells. There have been several reports of subacute cerebellar degeneration in lung carcinoma, ovarian carcinoma and Hodgkin's disease, but rare in urogenital malignancies. We present a patient with neurological disorder considered subacute cerebellar degeneration associated with HCG-beta positive seminoma. A 29-year-old man noticed a left intrascrotal mass in the summer of 1984. The mass began to grow in April, 1985 and diplopia, gait disturbance and dysarthria appeared late in May. He consulted our hospital on July 20, 1985. Serum human chorionic gonadotropin (HCG)-beta was elevated to 200 ng/ml but alpha-fetoprotein and carcinoembryonic antigen were normal. Left high orchiectomy was performed and the tumor was diagnosed histologically as typical seminoma. Bulky metastatic tumor was recognized in retroperitoneum on abdominal CT but brain CT was normal. VAB VI chemotherapy was performed. The retroperitoneal metastatic tumor disappeared and HCG-beta was normalized and complete remission achieved, but cerebellar symptoms still remain 14 months after remission. This case is considered to be subacute cerebellar degeneration associated with seminoma and is the second case with testicular carcinoma reported.

前回の入院患者臨床統計に引き続き1983年1月から1984年12月までの臨床統計を行なった.入院患者予算ベッド数は60で, 占拠率は常時ほぼ80%以上であった.患者数は825名, 性別男子670名, 女子155名で, 男子の比率が増加しているが, 主に前立腺肥大症を含む, 尿路性器腫瘍の増加による.50歳以上の入院が1983年54.1%, 1984年55.8%であった.頻度の高い腫瘍, 結石, 尿路性器奇型の頻度は, 1983年度でそれぞれ47.5, 21.4, 22.6%であり, 1984年には45.2, 25.1, 16.2の割合であった.腫瘍のうちでは前立腺腫瘍, 膀胱腫瘍が大半を占めた.結石では上部尿路結石症が著増を示し, 尿路性器奇形では腎嚢胞をこの項に含めた.尿路性器腫瘍患者の割合は, 1979年以後は1981年を除き常に40%を越えている.死亡46名, 剖検率80.4%であった.年間の手術件数は手術の対象となった臓器の組み合わせで分類した, A clinical statistic survey was carried out on the patients, diseases, and the treatments undertaken at the Ward of Department of Urology, Kyoto University Hospital during the years of 1983 to 1984.

1)外来新患総数は50, 443人であり, 新患数は着実に増加し最近では年間4, 000人に近付いた.外来総手術件数は1, 412件であり, 包皮背面切開術, 環状包皮切除術が最も多く, 以下, 精管結紮術, 内シャント術の順であった.2)入院患者総数は, 男2, 561名, 女861名であり, 専門病棟開設後顕著に増加した.高齢者の増加が特に男性でより著明であった.腫瘍患者の絶対数, 割合が著しく増加し, なかでも前立腺肥大症, 膀胱腫瘍, 前立腺癌の3者が多かった.3)入院総手術件数は2, 908件であり, TUR-P, TUR-Btの増加が著しかった.尿路結石に対しPNL, TUULが1985年より導入され, これらの内視鏡的泌尿器科手術の割合が増加した, A clinical statistic survey was carried out on the patients, diseases and operations experienced at our department between 1968 and 1986. In 1968, the urological department became independent from the dermato-urological department, and in 1981 the urological ward was established. The 19 years are divided in three periods; first period: 1968-1974 (7 years), second period: 1975-1981 (7 years), and third period: 1982-1986 (5 years). The total number of new outpatients during the 19 years was 50, 443. They have gradually but steadily increased and have reached recently about 4, 000 per year. The total number of inpatients was 3, 422 (male: 2, 561, female: 861). The proportion of the elderly patients, especially male, has remarkably increased and that of patients more than 60 years old was 44.9% of all inpatients in the third period. Among the major diseases of the inpatients, tumors has got most remarkable increase of its number and proportion. And among tumors, increases of benign prostatic hyperplasia, bladder cancer, prostatic cancer were prominent and at the third period the proportion of those three has reached 81.3% of all tumors. Percutaneous nephrolithotripsy (PNL) and transurethral ureterolithotripsy (TUUL) were introduced in 1985. Recently endoscopical operations such as transurethral resection (TUR), PNL, TUUL and so forth have become a large part of the urological operations.

1983, 1984年の2年間の当科外来患者臨床統計を行なった.1983年は男性3070人, 女性1715人で合計4821人, 1984年は男性3152人, 女性1703人の合計4855人で男女比はほゞ2:1であった.年齢階層別には1983年と比べ1984年には70歳以上が5倍弱の増加を示した.疾患別患者数では尿石症は下部尿路結石の割合が依然として低く, 全尿石症の2～3%に過ぎなかった.腎盂腎炎の頻度は前回調査と同じで女性が男性の2倍を占めた.STDの明らかな増加は見られなかった.尿性器結核も前回とほゞ同じ傾向であった.尿性器腫瘍も前回と比べ著しい変化を示したものはなく, その他の上・下部尿路疾患もほゞ同様であったが, 原因不明熱で来院する患者の増加が予測された.内視鏡検査は1983年には延べ1157件, 1984年には970件, IVPやDIPは年間約2400件行なわれた, The statistics of the patients seen at our Urological Outpatients Clinic during 1983 and 1984 are reviewed.

Herein we describe a 59-year-old man with left renal artery emboli treated with selective intra-arterial infusion followed by systemic intravenous infusion of urokinase. Total dose of infused urokinase was 2, 712, 000 units. Although the function of the affected kidney was not recovered, we have demonstrated successful clot lysis and no complication. Selective or systemic thrombolytic therapy is extremely promising as a method of treatment of renal artery embolism, especially in the poor operative candidate. The availability of this potentially efficacious therapy suggests that aggressive diagnostic studies be performed early in patients suspected of having renal artery embolism.

We report a case of stone-containing pyelocaliceal diverticulum which was successfully managed by a percutaneous technique. Percutaneous management of pyelocaliceal diverticulum is discussed and four important points are stressed: 1) direct puncture is best, 2) the operation should be done carefully because a safety wire cannot be placed in most cases, 3) augmentation and stenting of the ostium are necessary and 4) shrinkage may be facilitated by the use of electrofulguration.

Multiple primary cancers form 1 to 10% of all malignancies, but only a few cases of quadruple cancers are reported a year in Japan. We report a case of quadruple cancers--gastric adenocarcinoma, transitional cell carcinoma of bladder, multiple myeloma and leiomyosarcoma of bladder.

The Mayer-Rokitansky syndrome has been generally defined as a congenital absence of the vagina in genotypic and phenotypic female subjects with normal endocrine status. Many authors have reported that urological anomalies associate commonly with this syndrome, but recently a new concept of this syndrome was proposed by Tarry and associates. They considered the embryogenesis of the Mullerian system and recognized a spectrum of Mullerian anomalies without total vaginal agenesis as this syndrome. They also proposed a new classification of this syndrome (Mullerian grade) considering grade of Mullerian anomaly. We experienced a 14-year-old girl who had uterus didelphys, left hematocolpos due to ipsilateral vaginal agenesis and agenesis of the left kidney, and herein report this case as Mayer-Rokitansky syndrome. In addition to Tarry's classification, we propose another embryologic classification for Mullerian anomalies considering the period of faulty differentiation in this syndrome: type A-faulty differentiation of the mesonephros (before week 4), type B-faulty differentiation of the mesonephric duct (week 4 to 5), type C- faulty differentiation of the paramesonephric duct only (after week 6).