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Purpose: We examined whether there would be any inhibitive effect to the crystal formation in ethylene glycol treated rat kidney by angiotensin II type I receptor blocker (candesartan)., Methods: We divided 10-weeks-old male Sprague-Dawley rats into 4 groups. In these groups, rats were given tap water (group A), 1.0% ethylene glycol (group B), 1.0% ethylene glycol and 20 microg/ml candesartan (group C), 20 microg/ml candesartan (group D) for 4 weeks. Immunohistochemical studies of a renal tissue was performed by ED1 antibody and the osteopontin antibody, the transcription of renin, angiotensin converting enzyme, angiotensin II and osteopontin mRNA in whole kidney was determined using real time PCR and malondialdehyde level was measured. Renal tissue was evaluated using H.E. stain for counting the calcium deposit in the renal tubules. Calcium concentrations in whole kidney were measured with an atomic absorption spectrophotometer., Results: Although there is no significant difference urinary oxalate and calcium levels compared with group B and C, group C showed fewer the numbers of calcium deposit in the tubules and decreased the amount of calcium contained in the whole kidney, ED1 positive cells, osteopontine mRNA expression and malondialdehyde level., Conclusion: These results suggest that candesartan inhibited superfluously induced osteopontin in the whole kidney by ethylene glycol and crystal formation was also related decreased.

Background: This study investigated the feasibility and long term results of retrograde endopyelotomy with the Acucise ureteral cutting balloon device in the management of ureteropelvic junction (UPJ) obstruction., Methods: Thirteen patients (primary: 12, secondary: 1, male: 7, female: 6, mean age: 36) with UPJ obstruction were treated by the Acucise under fluoroscopic guidance. After cutting the stenotic area electrically using cutting wire and dilatation by the balloon, ureteral catheter (7-14 Fr) was inserted for 6-8 weeks., Results: The mean operative time was 43 minutes, the median postoperative hospital stay was 4 days. The subjective success rate (disappearance of the abdominal pain) was 92% (11/12) and the objective success rate evaluated by radiographic studies was 62% (8/13). One patient needed a transfusion but no other major complication occurred in the treatment. The failure 5 patients were now under conservative follow up., Conclusion: Our limited data suggest that endopyelotomy with the Acucise device offer lower morbidity with slightly lower success rate compared other endopyelotomies. We believe that Acucise endopyelotomy can be an appropriate one of the first-line therapy for UPJO.

Purpose: The aim of the present study was to compare sialic acid concentrations of serum and urine specimens in both calcium (Ca)-containing urinary stone formers and non-stone formers. Moreover, we studied inhibitory activity of sialic acid upon the calcium oxalate (CaOx) crystal aggregation and growth., Materials and Methods: Sialic acid determinations were done on fresh serum and urine samples of 35 Ca-containing urinary stone formers (stone formers group) and 20 non-stone formers (patient controls group). Inhibitory activity of sialic acid upon the CaOx crystal aggregation and growth was studied by using in vitro assay method of seed crystal system., Results: Serum sialic acid concentrations were found to be similar in the two groups. Urinary sialic acid concentrations were significantly lower in the urine specimens of stone formers than in their patient controls. Sialic acid showed a dose dependent inhibitory activity upon the CaOx crystal aggregation and growth into seed crystal method., Conclusion: It is suggested that urinary sialic acid may play some role during the phase of stone formation from the results of the present study, because sialic acid shows marked inhibitory activity upon the CaOx crystal aggregation and growth at concentrations higher than 100 mg/dl.

Background: This study investigated the feasibility of retrograde endopyelotomy with the Acucise ureteral cutting balloon device in the management of ureteropelvic junction (UPJ) obstruction., Methods: Six patients (male: 3, female: 3, age: 6-18) with UPJ obstruction and abdominal pain as the chief complaint, were treated by the Acucise ureteral cutting balloon device (flexible ureteral catheter, 7 Fr) under epidural or general anesthesia (for the 6-year-old girl only). After cutting the stenotic area electrically and posteriolaterally using a 3 cm cutting wire and dilation by the balloon to a maximum of 24 Fr for 10 seconds, a 6/10 Fr (for children) or 7/14 Fr (for adults) endopyelotomy ureteral catheter was left in situ for 8 weeks after the operation. After removing the ureteral catheter transurethrally, the results, including the patency of the UPJ, of this procedure were evaluated by intravenous pyelography and the disappearance of the chief complaint, abdominal pain, 12 weeks after removing the ureteral catheter., Results: Mean operative time was 47 (25-90) minutes and the hospital stay after the operation was 5.3 (3-14, median: 4) days. There was no transfusion or emergent open operation for uncontrolled bleeding in this series. The results 20 months after the operation: improvement of hydronephrosis was shown in 4 patients (66.7%) on intravenous pyelography and abdominal pain disappeared in all patients., Conclusion: UPJ obstruction may be easily and safely treated by retrograde endopyelotomy with the Acucise ureteral cutting balloon device. The principal potential advantage of this procedure is reduced morbidity compared to that with antegrade or retrograde endopyelotomy by endoscopy.

Background: The indications and suitable operative time of parathyroidectomy for secondary hyperparathyroidism were discussed., Methods: From October 1978 to September 1994 parathyroidectomy was performed for 71 patients who had bone and/or joint pain due to secondary hyperparathyroidism. There were 37 men and 34 women (mean age 48.4 years). The duration of dialysis treatment before parathyroidectomy was 0.8 to 19 years, with a mean of 10.9 years., Results: Postoperative subjective improvement was noted in 69% of the patients. No significant difference was observed between the improved and non-improved groups regarding age and the duration of dialysis treatment. But the improvement rate in female patients was significantly lower than that in male patients., Conclusion: Patients with high carboxyl-terminal PTH level and generalized fibrous osteitis were good suitable objects for parathyroidectomy. But, those with high serum aluminum level were unsuitable objects for it. Furthermore, 99mTc-Pyrophosphate bone scintigraphy and bone mineral determination using dual photon absorptiometry (DPA) or dual energy X-ray absorptiometry (DEXA) were proved to be valuable for patient selection for parathyroidectomy.

We observed a patient with 48 XXYY Klinefelter syndrome who visited our hospital because of a short penis as chief complaint. The patient was a 21-year-old, tall and obese man. He had gynecomastia. The penis was short and bilateral testes were underdeveloped. Endocrinologically the LH and FSH showed high level and the testosterone was low. A diagnosis of very rare 48 XXYY Klinefelter was made based of the chromosomal analysis.

Since the opening of our clinic 117 years before, we have treated 62 cases of primary hyperparathyroidism (PHPT), among which there were 6 cases (1 male, 5 females) whose calcium levels fell within the normal range. However, in all these cases the serum ionized calcium (Ca++) levels and the serum ionized calcium/calcium ratio (Ca++/Ca ratio) were high. Moreover, in comparing them with hypercalcemic patients (56 cases), the serum Ca++ levels were significantly lower, but the (Ca++/Ca ratio) was significantly higher. Also, the excised weight of 606.1 +/- 520.3 mg was significantly smaller than that of hypercalcemic patients, which was 1,967.9 +/- 2,086.3 mg. Preoperative locations showed significantly lower levels in comparison with hypercalcemic patients by all methods including computed tomography (CT), ultrasonography, scintigraphy, and magnetic resonance imaging (MRI). In normocalcemic patients following parathyroidectomy, although the decrease in serum calcium levels was not significant, the serum Ca++ levels and the Ca++/Ca ratio decreased significantly, so that not only are they useful parameters for preoperative diagnosis of PHPT, but they are also considered necessary and indispensable for observation of the post-operative course and judging therapeutic effects including the operation. Based on our study we concluded that in multiple and recurrent stone formers with normal range of serum Ca levels, regardless of the presence or absence of local diagnosis, if the serum Ca++ level and Ca++/Ca ratio are high, existence of primary hyperparathyroidism must be suspected, and adequate treatments should be instituted promptly.

Renal damages after ESWL treatment were examined by Gd-DTPA enhanced dynamic MRI. Gd-DTPA was used as the contrast medium and fast magnetic resonance imaging with suspended respiration using the flip angle of 20 degrees and gradient echo technique at 0.5 Tesla was used for photographing. In normal kidneys, a low intensity band was observed with the passage of Gd-DTPA through the kidney from 1 to 2 minutes after the injection. In patients who underwent ESWL treatment, however, the low intensity band which was observed before ESWL treatment became partly obscure after ESWL treatment. Furthermore, these find changes in the renal parenchyma could not be fully detected by usual MRI which does not use Gd-DTPA. Gd-DTPA enhanced dynamic MRI was considered to be effective for finding the limited dose of shock waves for ESWL treatment.

The in vivo anticancer effects of high energy shock waves (HESW), on bladder cancer induced by N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN), were studied in the rat using the Siemens lithotriptor (Lithostar). There was no significant difference in the anticancer effects in delaying tumor growth, measured as the whole bladder weight including the weight of the cancer, between the groups with and without exposure to HESW. However, light microscopic examination revealed extensive submucosal bleeding and exfoliation of mucosa, and electron microscopic examination revealed degeneration of pleomorphic microvilli, swelling of mitochondria, and destruction of mitochondrial cristae in the cancer cells in bladders exposed to HESW. Flow cytometric determination of DNA content in the cancer cells exposed to HESW indicated a selective diminution of cells in the G2 and M phases and an increase of cells in the G0 and G1 phases of the cell cycle. While the mechanism of HESW-induced anticancer effect could not be determined on the basis of this study, these changes in the morphology and the cell cycle of cancer cells induced by HESW exposure suggest some kind of biological effects following exposure to HESW. It is expected that HESW be an effective method for the treatment of human cancer in combination with chemotherapy and radiation.

Because human urine contains various substances which can affect each other, it is quite difficult to clarify the mechanism of formation of calcium oxalate (CaOx) crystal in urine. The authors recently determined CaOx crystalline content and the concentrations of other substances in urine specimens from patients with urolithiasis and healthy volunteers, and subjected the data to multi-regressive analysis for the purpose of assessing the effect of these urinary substances on CaOx crystal formation. 1. In analysis of urine from patients with urolithiasis, the partial correlation coefficients of CaOx crystal formation with oxalic acid, sodium, calcium, uric acid magnesium were 0.67, 0.28, 0.18, and -0.10, respectively. The formula of regression was as follows: Amount of CaOx crystal (X 10(6) microns3/ml) = 3.59 X 10(-2) Ox (mM/L) + 4.72 X 10(-3) Ca (mM/L) + 4.52 X 10(-3) Na (mM/L) + 2.51 X 10(-4) UA (mM/L) -2.39 X 10(-2) Mg (mM/L) -1.65. The multiple correlation coefficient was 0.759. Thus, in patients with urolithiasis, urinary crystal formation was most dependent on the oxalic acid level, sodium, calcium, and uric acid were found to promote crystal formation, while magnesium to suppress it. 2. In analysis of urine from healthy volunteers, the partial correlation coefficients of CaOx crystal formation with oxalic acid and inorganic phosphorus were 0.51 and -0.24, respectively. The formula of regression was as follows: Amount of CaOx crystal (X 10(6) microns3/ml) = 1.91 X 10(-2) Ox (mM/L) -3.43 X 10(-4) P (mM/L) +0.29 The multiple correlation coefficient was 0.525.(ABSTRACT TRUNCATED AT 250 WORDS)

With the development of extracorporeal shock wave lithotripsy treatment, the duration of hospitalization for stone patients fortunately has become shorter. However, a detailed analysis of lithogenesis is not possible during such patients' short hospital stays. We prepared a standard diet to be eaten at home for investigation of lithogenesis at the out-patient clinic. This diet was nutritionally well-balanced and contained the following: energy: 2000 Kcal, total protein: 70-75 g, animal protein: 30-35 g, carbohydrate: 510 g, fat and oil: 50-60 g, calcium: 600-630 mg and magnesium: 320 mg. The urine of 24 male patients with stones on a free diet and the same patients after 3 days on the standard diet was analyzed for urea-nitrogen, uric acid, sodium, calcium, phosphorus, magnesium, citric acid and oxalic acid. The results were compared with those in 17 healthy male subjects who were eating the standard diet (controls). It was found that 66% of hypercalciuria (greater than = 300 mg/day) on a free diet became normocalciuria on the standard diet. The hypercalciuria was therefore thought to be of dietary origin. Moreover, urinary excretion of urea nitrogen, uric acid, sodium and phosphorus by patients remarkably decreased after 3 days on the standard diet, which was not different from that of controls. These results suggest that the standard diet at home is useful in the screening of hypercalciuria and also quite adequate for patients with stones.

A patient with testicular cancer (non-seminoma, stage IIB) who had undergone resection for primary disease and retroperitoneal lymph node dissection as well as chemotherapy and radiotherapy 6 years before developed iatrogenic retrograde ejaculation. The infertility was treated by oral medications, including herbal medicine and injections of a hormone preparation as well as artificial insemination of husband (AIH). After 24 sessions of AIH for 4 years, his spouse gave birth to a healthy baby girl. We believe that for patients with iatrogenic retrograde ejaculation AIH is an effective method of increasing fertility to be employed more often.

We retrospectively studied the effects and side effects of placing indwelling ureteral stents in 196 cases who underwent extracorporeal shock wave lithotripsy with a ureteral stent. The average period of ureteral stenting was approximately 22 days. Placing ureteral stents was mainly for large renal stones (79.3%), single kidney etc. There were no significant differences between the stunted and non-stunted patients with approximately 2 cm sized single renal stone with respect to the stone free rate, stone free period, and symptoms during stenting, which suggested that ureteral stenting might be unnecessary in those patients. High fever was highest in incidence of the symptoms and complications during stenting (17.2%). It occurred frequently in patients with infected stones or cystine stones. The percentages of pyrexia and stone street in patients using Towers type's stents were higher than those using the others. It was also shown that the bladder portions of the stents in patients using Towers peripheral ureteral stents were densely encased in calculous material and were very brittle. Fortunately the ureteral portions were removed intact. This study suggests that use of an indwelling ureteral stent may not contribute to the higher rate of being free of stones after the treatment of small to medium sized renal calculi, and that stents should be removed or changed early.

We evaluated 32 patients with urinary calculi under 16 years of age over the past 14 years since the founding of the Department of Urology, Kinki University School of Medicine. They comprised 0.8% of the total urolithiasis patients. They consisted of 18 boys and 14 girls with a male-to-female ratio of 1.29. The average age was 8.7 years for boys and 10.4 years for girls without any marked peak. The most frequently chief complaint was hematuria which was present in 15 cases (47%). Although pyuria was seen in seven cases (22%), urinary bacterial culture was positive only in 5. The underlying diseases could be diagnosed in 13 cases (41%), of which eight cases (62%) developed metabolic disorder. The sites of calculi were determined in 29 cases (91%), of which 28 had stones in the upper urinary tract. Surgical treatment was performed on 16 cases in 17 sessions. Ureterolithotomy was done in as many as five cases, followed by pyeloplasty in four cases. Nephrectomy was performed in only one case. There was only one case which had been treated with extracorporeal shock-wave lithotripsy (ESWL). The composition of calculi was found in 21 cases (66%), the majority or 13 cases (57%) of which had calcium-containing stones. Nevertheless, there was no case of hypercalciuria. When compared to the previous reports in Japan, it was worthy of note that calculi in the upper urinary tract and calcium-containing stones had higher incidences. It is expected that more patients will be treated with ESWL in the future.(ABSTRACT TRUNCATED AT 250 WORDS)

We encountered 4 patients with urolithiasis due to renal tubular acidosis (RTA) associated with Sjögren's syndrome. Laboratory results about RTA in 4 patients with Sjögrenhs syndrome were not significantly different from those in patients who suffered from urolithiasis due to RTA without Sjögren's syndrome. The incidence of urolitiasis in these cases was suspected to be higher than that in RTA patients without Sjögren's syndrome, because all 4 patients in this study had urolithiasis. When we examine patients with bilateral and multiple urolithiasis, particularly in middle-aged women, we should bear in mind that RTA and Sjögren's syndrome may exist in the background.

Bone mineral contents of calcium urolithiasis patients (105 males and 52 females) were measured by the microdensitometry (MD) method, and the patients were divided into the MD normal group and the MD abnormal group. The patients were also divided into the group (21 males and 3 females) treated with thiazides for 1 year or more and the nontreated group to examine various factors in blood and urine. [Nontreated group] The rate of MD abnormality was higher in younger males. The rate tended to increase with age in females. Alkaline phosphatase values were significantly higher in MD abnormal group males than in MD normal group males. Urinary calcium excretion and PTH values were significantly higher in MD abnormal group females than in MD normal group females. Comparison of hypercalciuria and normocalciuria revealed no significant difference between the MD normal rate and the MD abnormal rate. Comparison of single of stone formers and recurrent stone formers also revealed no significant difference between the MD normal rate and the MD abnormal rate. [Treated group] PTH and alkaline phosphatase values were significantly higher in the treated group than in the nontreated group. Alkaline phosphatase values were significantly higher in the MD abnormal group. From the viewpoint of stone recurrence prevention, the monitoring of bones where the majority of calcium in the body is present is considered important besides behavior of calcium in blood and urine.

The relationship between the interval from dinner until retiring and the concentration of various substances secreted into the urine during sleep was studied in 69 healthy men who had eaten the same meal. The specific gravity and the concentrations of creatinine, uric acid and magnesium in the morning spot urine were highest in subjects who had retired within 2 hours after dinner. The concentrations of calcium and oxalate in the morning spot urine were highest in those who had retired between 2 and 4 hours. The specific gravity and urinary concentrations of creatinine, uric acid and oxalate were markedly higher in those with the interval less than 4 hours than in those 4 hours or longer. The concentrations of calcium, magnesium and citrate were not significantly different between the two groups. From these results, we recommend that the interval from dinner until retiring be prolonged and fluid be drunk before going to bed to decrease the concentration of lithogenic substances during sleep.