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膀胱皮膚瘻で尿路管理中の女性頸髄損傷患者5例の長期成績について検討した.全例で, 上部尿路は正常に保たれており, 自律神経過反射は消失した.患者のQOLも改善し, 手術に対する満足度も高かった.女性頸髄損傷患者において, 膀胱皮膚瘻は有用な尿路管理法であると考えられた, Tetraplegic women who underwent a cutaneous vesicostomy in our institutions were studied to evaluate long-term urinary complications and their quality of life (QOL). A total of 5 patients (C4, C5 and C6 injuries in one patient each and C7 injury in 2) were followed for 98 to 125 months (mean 107 months). Autonomic hyperreflexia disappeared after surgery in all patients. None of the patients showed deterioration of the upper urinary tract. Urinary tract infections were noted in 3 of 5 patients, but not severe. Bladder stones developed in 2 patients and a stomal stricture in 1. A questionnaire survey showed the patients to be satisfied with the operation, which had improved their QOL. These findings suggest that a cutaneous vesicostomy is an excellent surgical procedure for tetraplegic women.

当科において平成5年7月より1年間の泌尿器科評価を行った18歳以上の二分脊椎症患者においてアンケートで性機能の評価を行った. 1)異性に対する興味, 性に対する興味, 性欲は男性で, 95%, 95%, 100%であり, 女性で83%, 75%, 75%であった. 2)男性において, 勃起は視聴覚刺激によるものが95%, 触覚刺激によるものは86%であり, 勃起高度に満足しているものは73%, 射精は77%可能であった.オーガスムを感じるものは67%であった. 3)女性において全体では月経の周期は96%が定期的にあり, 分泌は88%に認めたが, 陰部の快感は19%にしかなかった.これら項目についてSharrad分類, 排尿筋-括約筋の活動性, 年齢で比較したが有意な傾向はなかった, In the present study, sexual function in 46 patients (22 males and 24 females) with myelomeningocele was assessed by a questionnaire study. The mean age of the patients was 24.0 +/- 9.6 years (with an age range of 18 to 50) for male patients and 25.2 +/- 6.2 years (with an age range of 18 to 42) for female patients. Having interest in the opposite sex and sexual desire were evident in 95% and 100% of male patients, and 83% and 75% of female patients, respectively. In male patients, erection was achieved in 95% by visual stimulation and in 86% by tactile stimulation. However, only 27% of the patients with erectility were satisfied with penile rigidity. Ejaculation and orgasm was noted in 67%. Orgasm was frequently seen in patients whose external sphincter activity was maintained. The age and the degree of lower extremity paralysis according to Sharrard classification were not significantly correlated with sexual function. In female patients, menstruation was regular in 95%, vaginal secrete was adequate in 88%, but only 19% of the patients felt ecstacy around perineal lesion at coital movements. In female patients, sexual function was not correlated with the age, the degree of lower extremity paralysis and detrusor activity-sphincter activity. Although most patients had sexual desire, only 18% of the males, and 33% of the females, had sexual intercourse activities. It appears, therefore, that these patients need to be given appropriate advice.

二分脊椎患者32例に於いて, VUR(膀胱尿管逆流現象)を有する50尿管に対して逆流防止術を行った。1例を除き全例にCohen法の尿管膀胱新吻合術, 1例に両側Politano-Leadbetter法を行った。平均追跡期間42.5ヵ月に, 尿管の92.0%, 症例の87.5%で成功した。これらの成績は最近の文献のそれ等に匹敵した。3例ではVURが再発した。一側再植え込みを行った別の1例では対側尿管に新しく逆流が発生した。術後VURを防止する為には間欠導尿法を続ける事が重要である事を強調した, A series of 32 patients with spina bifida, representing 50 renal units with vesicoureteral reflux (VUR), was treated with antireflux operation. All but one patient underwent ureteral reimplantation with Cohen's technique. Another patient was treated with bilateral Politano-Leadbetter's technique. The overall success rates were 92.0% by renal unit and 87.5% by case, with a mean follow-up period of 42.5 months. These results were comparable to those in the recent literature. Failure included recurrence of VUR in 3 patients. Another patient who had undergone unilateral reimplantation developed new occurrence of reflux in the contralateral ureter. Possible masking of contralateral VUR should be taken into consideration in patients with unilateral high grade VUR. We also emphasize the importance of continuing clean intermittent catheterization in a proper manner to be free of VUR postoperatively.

1)保存的療法のみでは排尿障害の十分な改善がえられず, BPHやBNcによる下部尿路閉塞を認めた慢性期の初発脳卒中症例40例に対しTUR-Pを施行し, 術後の排尿自立について検討を行った.2)術後約6ヵ月後の評価では, 脳幹部梗塞再発作によりやむなく留置カテーテルとなった1例を除く39例のうち36例(92%)に排尿自立がえられ, 新たに尿失禁が出現した例はなかった.3)術後も介助, 集尿器を必要としたのは3例で, うち2例は移動能力あるいは下肢機能が低く, 1例は痴呆が高度な症例であった, We discuss the transurethral resection of the prostate (TUR-P) on 40 patients in the chronic stage of stroke, all of whom were refractory to conservative managements of urinary disturbance. All patients, between 35 and 89 years old (mean: 52.6 years), had only one episode of stroke and were diagnosed as benign prostatic hypertrophy or bladder neck contracture that appeared to cause urinary disturbance in these patients. At six months after TUR-P, all except for one patient, who needed an indwelling catheter due to a reinfarction, were catheter free. Of these cases 36 (92%) obtained independent micturition and did not develop urinary incontinence except transiently postoperatively. Two cases with impaired mobility and one case with progressive senile dementia required helpmates and/or a commode and so forth postoperatively. It is concluded that in chronic stroke patients TUR-P is recommended for those with benign prostatic hypertrophy or bladder neck contracture.

1)初発の慢性期脳卒中154例の尿路管理について検討した.2)いずれの病巣群においても膀胱利尿筋機能不全タイプの割合に局在性を認めなかった.大脳基底核群を除いた他の脳病巣では高活動型群と正常型群の間で排尿自立の割合に有意差を認めなかった.退院時には154例中113例が排尿自立例であった.3)脳病巣部位にかかわらずADLが排尿自立面での予後に最も関与していた.ADLが高いにもかかわらず, 家族の協力や理解がえられないといった社会的理由からカテーテル抜去が不可能であったり, 高度の痴呆のため排尿自立へ至らなかった, A total of 154 stroke patients, 96 males and 58 females, were analyzed to establish the micturitional modality according to the type of detrusor function and the level of activities of daily living (ADL). All patients had only one episode of stroke attack and were checked at least one month after the onset. Localization of cerebral lesion in each patient was evaluated by neurological findings and cerebral angiography in addition to computed tomography of the brain. In the patient groups classified according to the type of detrusor function, micturitional modality was established in 50% of the patients with the underactive type, 70% of those with the overactive type and in 88% of those with normal function. This suggests that the overactive and normal type of detrusor function may not affect establishment of micturitional modality. On the other hand, when classified according to the level of ADL, none established micturitional modality in patients with poor ADL. By contrast, in the patients on higher levels of ADL who were able to transfer themselves from or to a wheel-chair without any assistance it was established in 75%, and in those who were able to gait with or without a brace upon discharged from the hospital, in 91%. It is concluded that establishment of micturitional modality in stroke patients is closely related to the level of ADL or function of lower extremities, but not to localization of the brain lesion.

1)慢性期脳卒中患者213例に膀胱内圧測定を施行したところ, 71.9%が高活動型, 22.5%が正常型, 5.6%が低活動型を示した.2)片麻痺側と膀胱利尿筋機能のタイプあるいは排尿自立の割合とは, 明らかな関連性を示さなかった.3)排尿自立の割合はADLと相関し, 車椅子レベル以上の症例では有意に高かった.4)カテーテルフリーにしえない症例では, 両片麻痺や高度の痴呆に加え, 介護力に乏しいといった社会的因子にも負う点が示唆された, We managed 246 patients with bladder dysfunction due to the first stroke in our hospital between January, 1983 and December, 1988. Of these 221 were in the chronic stage of stroke. A total of 213 patients were evaluated for types of bladder dysfunction by cystometry. We examined the relation between hemiplegic side and type of dysfunction or micturition activity, but obtained no significant relationship. Establishment of voluntary voiding pattern was considered to depend on the improvement of daily life activities. The catheter-free rate was 89.4%, while 10.6% of the patients, who could not receive sufficient nursing care or had severe medical problems, were obliged to keep an indwelling catheter. We conclude that establishment of a bladder retraining program is necessary not only medically but socially for improvement of quality of life in stroke patients.

CICへの主な変更理由は, VUR (48/113例)および残尿(36/113例)によるものであった.対象症例の56.6%が低活動性利尿筋・活動性括約筋群に属する症例であり, 下肢麻痺についてはSharrard分類のGroup 1～3が29例, Group 4～6が84例であった.CICにより水腎・水尿管は37/71例に, VURは36/63例に, 尿路感染症は39/55例に, 尿失禁は72/87例に改善をみた.主な合併症としては腎盂腎炎が12例, 尿道痛が5例に認められた.膀胱機能障害を有し, 排尿障害を認める症例においてCrede法やValsalva法を採用した場合, 高圧排尿を余儀なくされる症例では, 初期の段階でCICを選択することが最も望ましい.一方, 低圧排尿が可能な症例については, Crede法, Valsalva法またはCICのいずれの方法を選択しても良い, One hundred and thirteen cases of spina bifida treated with clean intermittent catheterization (CIC) were reviewed. There were 42 males and 71 females, ranging from 4 months to 50 years. The major reasons for CIC from other voiding methods were vesicoureteral reflux (VUR) (48/113) old, and residual urine (36/113). The most common type of neurogenic bladder was hypoactive detrusor-active sphincter, in 56.6% of patients (64/113). The grade of paralytic disability of lower limb (Sharrard's classification) was low (group IV-VI) in 84 patients and high (group I-III) in 29 patients. Hydroureteronephrosis and VUR improved 52.1% (37/71) and 57.1% (36/63), urinary tract infection and urinary incontinence improved 70.9% (39/55) and 81.7% (72/87). Major complications were pyelonephritis (12 cases) and urethral pain (5 cases). We discussed the choice of voiding method in the management of spina bifida.

Three patients with contracted bladder caused by neurogenic bladder underwent ileocystoplasty. The primary diagnosis was meningomyelocele for all of them. The operative procedure adopted was Goodwin's Cup-patch method. All cases have obtained increased bladder capacity with improvement of bladder compliance and have been free from urinary incontinence. They were followed up by using clean intermittent self catheterization. Ileocystoplasty combined with clean intermittent self catheterization offers a successful method in patients with contracted bladder caused by neurogenic bladder.

CQの膀胱内注入療法による副作用の発生につきMMCを対照薬とし雌性Beagle犬を用いCQ 5mgと10mgの投与量で膀胱内注入実験をおこなった.(1)空置膀胱内へCQ 10mg/20ml PBSの48時間貯留実験で, CQによる膀胱壁全層に炎症性変化が発生したが, 全身的副作用の発生は認めなかった.溶解液PBSには局所的, 全身的副作用を認めなかった.(2) CQ 5mg/20ml PBSを週1回, 3週間3回膀胱内注入実験で, 注入終了後3週間の実験終了時には, 血液, 血液化学的諸検査結果に変化はみず, 膀胱局所は内視鏡的には回復傾向がいちじるしく, 粘膜下組織に軽度の炎症性細胞浸潤をみ, 3頭中2頭に筋層と漿膜層に浮腫と軽度の炎症性変化を認めたのみであった.膀胱粘膜上皮には再生過程と考えられる粘膜上皮過形成をみた.(3) MMC 10mg/20ml PBSを週1回, 3週間3回膀胱内注入群では, 3頭中2頭で, 注入終了後7日目に未梢血白血球数が若干減少したが, 実験終了時には正常値に回復していた.膀胱鏡所見は3頭中1頭は回復傾向をみたが, 他の2頭では, 膀胱鏡所見, 病理組織学的所見ともにいちじるしい炎症性変化を認めた, The effects of intravesical instillation of Carboquone at the clinically used doses of 5 and 10 mg on the normal mucosa of female beagle dogs was compared with that of 10 mg Mitomycin C used as the control drug. Intravesical instillation for 48 hours of 10 mg carboquone/20 ml phosphate buffer solution (PBS) after bilateral cutaneous uretrostomies produced severe inflammatory changes in all layers of the bladder wall. However, no secondary effects were observed in blood laboratory examinations or histological examinations of the whole organ after autopsy. Phosphate buffer solution produced no remarkable secondary effects in animals. Five milligrams carboquone per 20 ml PBS was instilled intravesically once a week for 3 weeks in normal animals. Cystoscopically , the bladder mucosa recovered normally. Blood laboratory examinations showed no abnormal results, but the bladder epithelium had regenerative epithelial hyperplasia and slightly inflammatory changes in the submucosal layers. Two of the three control animals given instillation of 10 mg of Mitomycin C/20 ml PBS had slight leucopenia at 7 days after the last intravesical instillation, but leucocyte count was normal at the end of the experiment. Cystoscopic and histological examination of the epithelium of the urinary bladder revealed severe inflammatory changes in 2 of the 3 animals.

A case of secondary VUR in neurogenic bladder with meningomyelocele treated successfully with urethral catheterization is reported. A 4-month-old girl was introduced to our clinic for the management of incontinence following the closure of the meningomyelocele (below S1 level). Anal sphincter and bulbocavernous reflex was almost normal. Since the IVP revealed right hydronephrosis, an urethral catheter was indwelt immediately in order to decompress the vesical pressure. Three weeks later, the right hydronephrosis improved, but the cystogram revealed right vesicoureteral reflux. The urethral catheter was left for the conservative management for 20 weeks. VUR had disappeared on the cystogram and right hydronephrosis returned to normal. Thereafter, the treatment was changed from indwelling catheter to clean intermittent catheterization by her mother. No urinary tract infection has occurred. The necessity of early management, especially decompression of the vesical pressure, for patients with neurogenic bladder associated with meningomyelocele is discussed.

We report a case of spontaneous rupture of a calyceal diverticulum in a perinatal woman who was treated with percutaneous procedure. A 28-year-old woman, who delivered a full-term healthy male infant 13 days prior to hospitalization, was admitted complaining of left progressive severe flank pain. Kidney-urethra-bladder X-ray showed a space-occupying lesion in the lower pole of the left kidney. Drip intravenous pyelography revealed the left renal pelvis and calyx to be pushed up. Renal computed tomographic scan demonstrated a cystic lesion in the lower pole of the left kidney with a perirenal hematoma. After percutaneous puncture followed by indwelling of 8 Fr. balloon catheter within the cystic lesion for drainage, the patient recovered dramatically. Retrograde and antegrade pyelography showed the cystic lesion communicating with an adjacent calyx in the lower pole of the left kidney. The physiological relationship to pregnancy is discussed as a possible etiological factor in the unique occurrence of this rare rupture, and the literature is reviewed.

1980年1月からの5年間に星ヶ丘厚生年金病院泌尿器科で尿路管理を行った女性脊髄損傷症例28症例について検討した.1)退院時排尿方法は, catheter free 11例(39.3%), 間欠的自己導尿法3例(10.7%), 介助者による間欠的導尿法1例(3.6%), 膀胱留置カテーテル13例(46.4%)であった.2)女性用の有効な集尿器や尿失禁防止器具のないことおよび下位胸髄損傷や腰髄損傷であってもADLレベルの低い症例が少なからず存在した.3)対麻痺患者においては, toilet activitiesが可能な症例に対して, 今後間欠的自己導尿法の適用が増加していくと思われる.4)頸髄損傷症例においては80%がやむなく膀胱留置カテーテルとなっていた, Most of the literature about the urological management of spinal cord injury patients is on male patients, and the method of the urological treatment for male spinal cord injury patients is often not useful for female patients. A clinical survey was done on 28 female neurogenic bladder patients after spinal cord injury treated at our Hospital between January, 1980 and January, 1985. At discharge, 11 patients (39.3%) were catheter free, 3 (10.7%) were managed by clean intermittent self catheterization, 1 (3.6%) was managed by clean intermittent catheterization by a helper, and 13 (46.4%) were on indwelling catheters. One of the main reasons that prevents female spinal cord injury patients from becoming catheter free is that there are no effective external collecting devices or devices to prevent urinary incontinence for female neurogenic bladder patients. Another reason is that some female patients can not obtain a high enough ADL level for toilet activities by rehabilitation in spite of lower thoracic or lumbar lesions.

The following tables show statistics on the inpatients, diseases and operations in our department during the period from January to December of 1978.

Effectiveness of regional renal hypothermia was determined from the change in serum and urinary enzyme activities in experimental renal ischemia and in clinical ischemia of patients with renal calculi. 1) Twenty-eight dogs were used for the experimental renal ischemia. All dogs had right nephrectomy 4 weeks before the renal ischemic experiment. The dogs were allocated into four groups according to duration of ischemia and with or without hypothermic renal perfusion. Serum and urinary lactic dehydrogenase (LDH) activities showed consistent elevation following renal ischemia in both the dogs that had received hypothermic renal perfusion and in those that had not. Serum LDH isozyme index was elevated in dogs that had not received hypothermic renal perfusion during renal ischemia. Serum and urinary alkaline phosphatase (AI-p) and glutamic oxaloacetic transaminase (GOT) activities were elevated immediately after ischemia and decreased day by day. However, serum and urinary leucine aminopeptidase (LAP) activities did not change after renal ischemia in the dogs that had received hypothermic renal perfusion or in those that had not. Histologically, severe degenerative changes of the renal parenchyma were observed in dogs when ischemia was prolonged long without hypothermic renal perfusion. 2) Thirty-six patients with renal calculi had nephrotomy. In situ hypothermic renal perfusion was performed in 9 of the cases and it was not used in the other cases. Serum and urinary enzyme activities were studied in these two groups of patients following renal ischemia. Serum LDH activity was elevated after operation in all the paients who had in situ hypothermic renal perfusion and those who had not. Urinary LDH activity was elevated after ischemia in patients who had had in situ hypothermic renal perfusion. Serum and urinary LDH isozyme indexes were elevated after ischemia in patients who did not have hypothermic renal perfusion. However, these LDH isozyme indexes did not elevate after ischemia in patients who had had in situ hypothermic renal perfusion. Urinary Al-p and LAP activities were elevated immediately after operation and decreased day by day in all patients. Serum and urinary LDH isozyme indexes were helpful for the evaluation on disturbance of the renal function after ischemia. Regional hyothermic renal perfusion is useful for preservation of renal function after an operation using renal ischemia.

Long-term therapeutic effect of Robaveron tablet (KN-7) was studied on 10 female patients of middle and old age with ptosis of urinary bladder and 9 patients with neurogenic bladder. The patients had mainly complained of such subjective symptoms as pollakisuria, difficulty of urination, sense of residual urine, lower abdominal discomfort and urinary incontinence. Robaveron tablet was administered at 2 tablets t.i.d. for 3-26 months. And the drug efficacy was evaluated by residual urine, cystometric findings and subjective symptoms. A significant decrease in the residual urine rate and a significant increase of pressure amplitude were obtained, and improvement of subjective symptoms was seen with an effective rate of about 70%. Overall effectiveness, rated slightly improved or better was 89.5%. No cases of side effects or abnormalities in laboratory tests were observed. Robaveron tablet is safe and effective for patients with urinary disturbance accompanied by ptosis of urinary bladder, as a myogenic disorder, as well as neurogenic bladder in the long-term therapy.

前立腺肥大症65症例でオキセンドロン(Prostetin(R)) 200 mg/週を12回投与した.自覚症状の改善は58.5%にみられ, 他覚所見の改善は35.0%にみられた.触診・尿流量測定, 経直腸的超音波断層法による検討を含め自・他覚所見の推移に相関はみられず, 本剤の前立腺腫縮小効果も明確にしえなかった, 65 patients with BPH were treated with 200 mg oxendolone (Prostetin®) given intramuscularly at the dose of 200 mg a week for 12 weeks. Subjective symptoms were improved in 58.8 % of these patients. Objective improvement was estimated by rectal palpation, uroflowme try, residual urine volume measurement, urethrocystography, transrectal ultrasonography and endoscopy. Improvement of objective findings were observed to some extent in 35.0% of the patients. But in almost all the patients no evaluable changes were noticed by uroflowmetry or ultrasonography. The changes in the subjective symptoms and objective findings in each case were compared, and a remarkable discrepancy was noticed between the two categories. It is suggested that the subjective improvement in these patients is not based on reduction of prostatic size.

1980年1月より3年6ヵ月間に, 入院した完全脊損患者180例に対して, catheter freeを目的として, 薬物療法, 手術療法および神経ブロック療法を施行し, 排尿訓練を指導した結果157例(87.2%)に対して, catheter freeとすることができた.1)神経因性膀胱の尿路管理に関して, 腎機能を保護し, 排尿効率のよい排尿方法を確立させることが最も大切であるが, 脊損患者の場合, 損傷レベル, 合併症の有無, ADLの状況, 介助者の有無などの社会的背景を考慮して, 排尿手段を考えていく必要がある.2)できるだけcatheter freeとすることが望ましいが, その目的のためには, TUR, 仙骨神経ブロック, 陰部神経ブロック, 閉鎖神経ブロック, 腰神経根ブロックなどを施行し, 緻密な排尿訓練を指導することが有用である, One hundred eighty patients with spinal cord injury were admitted to our hospital between January, 1980 and June, 1983. Eighty-five of them had cervical lesions, 54 had thoracic lesions and 41 had lumbar lesions. Most of the neurogenic bladders due to spinal cord injury treated in our clinic, could be classified into 3 major patterns: hypoactive detrusor-hypoactive sphincter, hypoactive detrusor-active sphincter, and hyperactive detrusor-hyperactive sphincter. To control the hyperactivity of the detrusor and the sphincter, we employed pharmacotherapy first and then we performed transurethral resection of the bladder neck and prostatectomy (TUR-Bn.P) and nerve block (sacral nerve block, pudendal nerve block, obturator nerve block and lumbar nerve block). In the case of a hypoactive detrusor, we employed TUR-Bn.P, open ileal flap fixation to the bladder and voiding training. Using these procedures, we could make 157 patients catheter-free.

逆流防止術を13例の患児に施行した.1) 1例2尿管にPolitano-Leadbetter法を施行し, 12例18尿管にCohen法を施行したが, 20尿管中17尿管の成功率であった.2) VURは低活動性利尿筋-活動性括約筋のパターンを有する症例に多く, それはdetrusor-sphincter dyssynergiaが大きな原因を占めているものと考えた.したがって, 低活動性利尿筋-活動性括約筋のパターンを有する症例の上部尿路変化については, VURの精査を十分にする必要がある.3) VURの治療に関して, 腎機能の保存のためには, 長期の保存的治療より, まず逆流防止術の適応となる症例に対しては積極的に施行する必要がある, Thirteen cases (20 ureters) of vesicoureteral reflux (VUR) associated with neurogenic bladder, treated with anti-reflux operation are reviewed. Twelve of the 13 cases had meningomyelocele and 1 had spina bifida occulta as an underlying disease. The type of neurogenic bladder was hypoactive detrusor-active sphincter in 11 patients and hypoactive detrusor-hypoactive sphincter in 2 patients. They were treated with an anti-reflux operation, 2 ureters by Politano-Leadbetter method and 18 ureters by Cohen method. The results were successful (success rate 85.0%). Therefore, we concluded that in neurogenic bladder patients especially with the hypoactive detrusor-active sphincter, the cause of their renal deterioration is mostly VUR. Thus we should examine such patients for VUR. On the other hand, when the renal deterioration of VUR patients cannot be improved by conservative treatment for example clean intermittent catheterization or indwelling catheter, we should perform an anti-reflux operation.

1963年から1981年までの過去19年間に当科で治療した原発性尿管腫瘍は計25例あり, 男性18例, 女性7例, 平均年齢は63.0歳であった.臨床症状は血尿が圧倒的に多く, 症状初発から受診までの期間は多数例が6ヵ月未満に受診していた.1VP所見は過半数で無機能腎を示した.尿細胞診は19例中12例(63.2%)と高率に陽性を示し, 尿管腫瘍の診断方法として重要である.手術は23例に施行し, うち21例に完全腎尿管全摘除術を施行した.病理組織は22例が移行上皮癌.1例が扁平上皮癌であった.移行上皮癌についてgradeとstageとの間には相関関係の存在が示唆された.他の尿路上皮性腫瘍の合併は, 膀胱腫瘍が13例認められ, 術後尿路上皮性腫瘍の発生は膀胱に3例, 尿道に1例であった.予後は5年実測生存率で39.4%であり, 予後に影響を及ぼす因子は腫瘍のgradeとstageが最も重要で, 術後補助療法はしない方が結果は良好であった, Twenty-five primary ureteral tumors treated at our University between 1963 and 1981, were reviewed retrospectively. The conclusions of this study are as follows. Sex and age distribution of the patients were 18 males and 7 females (2.6: 1), and average age was 63.04 years old. The major symptom was hematuria. The majority of the patients were admitted to our clinic within 6 months from manifestation of symptoms. The major finding of IVP was non-functioning kidney. The positive rate of urinary cytology was 63.2%. Total nephroureterectomy with bladder cuff was performed in 21 out of 23 cases. Histologically, 22 cases were transitional cell carcinoma and one case was squamous cell carcinoma. Simultaneous urothelial tumor was found in 13 cases in the bladder. Most of the ureteral tumors (63.6%) were found in the lower third segment of the ureter. Subsequent urothelial tumors were seen in 3 bladders and one urethra out of 22 cases receiving surgical treatment in the follow-up period. The 5-year survival rate by actuarial method was 39.4%. Among several factors, grade and stage of tumor were the most influencing factors for prognosis. An effective method of post-operative treatment could not be established.

1963～1981年までの19年間に当科で加療した原発性腎盂腫瘍は40例あり, 男性30例:女性10例, 平均60.5歳であった.臨床症状は血尿が圧倒的に多く, 初発症状から受診までの期間は多くは6ヵ月未満であった.1VPでは無機能腎と陰影欠損が同程度存在し, 尿細胞診の陽性率は46.7%と高率で, 本疾患の診断方法として重要である.手術は32例に行ない, うち20例に完全腎尿管摘除術を施行した.病理組織では, 29例が移行上皮癌, 4例が結石を伴なった扁平上皮癌であった.腫瘍のgradeとstageには相関関係が示唆された.併発尿路上皮性腫瘍は40例中尿管に3例, 膀胱に7例, 尿道に1例でうち重複発生を2例に認めた.術後尿路上皮性腫瘍の発生を残存尿管に1例, 膀胱に7例見た.予後は5年実測生存率で75.9%で, 予後に影響する因子では腫瘍のgradeとstageが最も重要であり, 術後補助療法に関しては現在のところ有効なものは認められなかった, Forty primary renal pelvic tumors treated at our University between 1963 and 1981, were reviewed retrospectively. The conclusions of this study are as follows. Sex and age distribution of the patients were 30 males and 10 females (3: 1), and average age was 60.5 years old. The major symptoms were hematuria and flank pain; however, palpable mass was rare. The majority of patients were admitted to our clinic within 6 months from manifestation of symptoms. The major findings of IVP were non-functioning kidney and filling defect. The positive rate of urinary cytology was 46.7%. Total nephroureterectomy with bladder cuff was performed in 20 out of 32 cases. Histologically, 29 cases were transitional cell carcinoma and 4 cases were squamous cell carcinoma with renal calculi. Simultaneous urothelial tumors were seen in 10 cases, 3 in the ureter and 7 in the bladder. A subsequent ureteral tumor was found in one out of 12 cases in which ureters were resected incompletely, and 7 subsequent bladder tumors were found out of 32 cases receiving surgical treatment in the follow-up period. The 5-year survival rate by the actuarial method was 75.9%. Among several factors, grade and stage of the tumor were the most influencing factors for prognosis. An effective method of post-operative treatment could not be established.

男性頸髄完全損傷症例16例を対象とし, 経尿道的外括約筋切除術(TUR-sph)施行前後での残尿率, 排尿時血圧, および排尿時血中ノルアドレナリン値の変化につき検討した結果, 男性頸髄完全損傷例の尿路管理におけるTUR-sphは, 排尿効率の改善をもたらすだけでなく, detrusor-sphincter dyssynergiaによるautonomic dysreflexiaに対するsafety valveとしての効果をもたらすものと考えられた, Transurethral electroresection of external urethral sphincter (TUR-sph) was performed in sixteen male tetraplegics to obtain good voiding efficiency and to prevent autonomic dysreflexia due to detrusor sphincter dyssynergia. Ratio of residual urine as a parameter of voiding efficiency and blood pressure and plasma noradrenaline level during voiding as parameters of the significance of autonomic dysreflexia were evaluated before and after TUR-sph, and all these parameters had significantly improved after TUR-sph. After discharge from the hospital, all patients urinated comfortably with the maneuver of suprapubic percussion by themselves and/or their helpmates, and no patients complained of any inconvenience due to urinary incontinence. Moreover, no patients had the episode of autonomic dysreflexia in daily life except for one patient who had it once with urinary tract infection. TUR-sph brings not only the improvement of voiding efficiency but also the effect as a safety valve against autonomic dysreflexia by means of preventing the occurrence of autonomic dysreflexia due to detrusor sphincter dyssynergia.

Twenty-seven patients with advanced urogenital cancer, 14 prostatic adenocarcinoma, 5 urinary bladder cancer, 3 non-seminomatous testicular cancer, 1 prostatic transitional cell carcinoma, 1 urethral squamous cell carcinoma, 1 vVilms' tumor, 1 renal cell carcinoma, 1 penile cancer were treated with cis-diamminedichloroplatinum (II) (CDDP). Of 14 prostatic adenocarcinoma, 7 cases were received CDDP single treatment and 7 cases were received CDDP combined treatment with bil. orchiectomy, diethylstilbestrol diphosphate, futraful and picibanyl. Complete response was not observed, but partial responses were observed in 4 cases in single treatment group and 3 cases in combined treatment group. Overall response rate was 50% in advanced prostatic cancers with CDDP treatment, and response rate was 57% with single treatment and 43% with combined treatment. Of 7 cases with CDDP single treatment, however, 5 cases had been received bil. orchiectomy previously, so that response rate was 58% in the patients group with bil. orchiectomy, and no objective response was observed in 2 patients without bil. orchiectomy. Non-seminomatous testicular cancers well responsed to Einhorn's PVB regimen, CDDP, vinblastine and bleomycin. Complete responses were achieved in 2 patients with retroperitoneallymphadnectomy followed by CDDP combined treatment, and partial response was observed in a patient whose multiple bulky lung metastasis regressed remarkably, by 2 courses of CDDP combined treatment. The patient died of cancer 13 months after the CDDP treatment. Urinary bladder cancers responsed to CDDP single treatment. Complete response was not observed, but partial response was in all 5 cases. Prostatic transitional cell carcinoma was achieved complete response with CDDP single treatment. Wilms' tumor with local recurrence, liver and lung metastasis also responsed to CDDP with vinblastine. However, penile cancer, urethral squamous cell carcinoma and renal cell carcinoma did not response to CDDP treatment. In a view of the toxicity, moderate to severe nausea, vomiting and anorexia were observed in all cases during CDDP treatment and following several days. Nephrotoxity was mild in 4 cases and moderate in a case. Anemia was observed in 19 cases (70%), and leucopenia was observed in 8 cases (

Between 1978 and 1985, 72 patients with urinary and defecatory dysfunction due to neurogenic bladder associated with myelodysplasia (57), spinal cord injury (11), and other causes (4) were treated with modified sero-muscular ileal flap fixation to the bladder (modified IFFB). They were followed from 1 to 88 months (mean: 36.3 months). This operative procedure was attempted to recover urinary and defecatory function. Sixty-four patients underwent urodynamic studies before and after the modified IFFB. On urodynamic evaluation, bladder capacity was not decreased, voiding time was diminished, and average urine flow rate was significantly improved after the modified IFFB. Patients who were followed at least 6 months after the modified IFFB showed the following results. Urinary substitute sensation appeared in 57 out of 59 patients (96.6%) and fecal substitute sensation in 34 (57.6%). Urinary incontinence improved in 38 out of 42 patients (90.5%), disappearing completely in 19 (45.2%). Constipation improved in 26 of 59 patients (44.1%). The upper urinary tract improved in 22 renal units, remained unchanged in 90 renal units, and deteriorated in 6 of the 118 renal units. Operative complications were encountered in 6 out of 72 patients (8.3%). The modified IFFB procedure does not appear to be suitable for the low compliance bladders with high grade VUR or for young women who desire pregnancy in the future.

A case of primary transitional cell carcinoma of the prostate was reported. The patient was a 64-year-old man who had complained of the pain in the right lower abdomen and the right leg. Initially it was confirmed that the patient had a metastatic adenocarcinoma of the ischial bone by its biopsy in the other clinic and he was sent to our hospital. The histological diagnosis was mixed type of transitional cell carcinoma with adenocarcinoma by needle biopsy and transurethral resection of the prostate. Nonneoplastic change of the bladder epithelium was found by random transurethral cold punch biopsy of the urinary bladder. Initially, the treatment consisted of orchiectomy and intravenous administration of diethylstilbestrol diphosphate. Oral administration of N1-(2-tetrahydrofuryl)-5-f1uorouracil and intramuscular injection of picibanil were added after the confirmation of histological diagnosis. About 2 months later, this treatment proved to be non-effective histologically despite of decrease in serum acid phosphatase and prostatic acid phosphatase. Accordingly doxorubicin hydrochloride was administered for the next treatment. Doxorubicin hydrochloride was effective on the primary lesion, but did not effect on the osseous metastatic lesions. Then finally he was treated with cis-diamminedichloroplatinum. The complete disappearance of primary and osseous metastatic lesions were shown by roentgenography and bone scanning. Cis-diamminedichloroplatinum appears to be the most effective drug for the treatment of advanced transitional cell carcinoma of the prostate.

Of 57 patients with renal cell carcinoma admitted to our hospital or a collaborating hospital from January 1966 through December 1980, 16 patients were diagnosed to have stage IV cancer. The therapeutic results of these 16 patients are presented in this paper. The patients were 4 females and 12 males, and ranged in age from 48 to 71 years, with an average of 59.9 years. Metastatic lesions were seen in the lungs in 6 patients, in the bones in 3 patients, in the liver in 3 patients, in both the lungs and bones in 2 patients, in the distant lymph nodes in 2 patients, and in the skin in 1 patient. Palliative nephrectomy was performed on 10 patients. Their survival rates were 50.0% at 6 months, 40.0% at 1 year and 28.6% at 2 years. Four out of 6 patients given Provera, Futraful and Picibanyl after the palliative nephrectomy survived longer than those given other treatments.

The following tables show the statistics on the diseases and operations of the inpatients seen at our department between January and December 1979.

The following tables show the statistics on the inpatients, diseases and operations at our department during the period from January through December of 1980.

The following tables show statistics on the inpatients, diseases and operations in our department during the period from January to December of 1973.

A case of the asymmetric horseshoe kidney was presented. A 38-year-old man was admitted with chief complaint of fever on 30th, September, 1974. Several urological studies, including IVP, PRP, angiography, renal scintigram and renogram, disclosed a findings interpreted as a reversed L-shaped asymmetric fused kidney and a right ureteral orifice could not be recognized in cystoscopic examination. Heminephrectomy was performed and the right renal mass was removed on 28th, January, 1975. The isthmus was confirmed to be located behind the caval vein and abdominal aorta and the right ureter could not be found. A post-operative course was uneventful and he was discharged from all the complications. We believe that this case comes within the category of asymmetric horseshoe kidney by the clinical and surgical findings. Nowaday, the reports of the symmetric horseshoe kidney are not so rare, but the asymmetric horseshoe kidney has been reported rarely. We can collect 12 cases of the asymmetric horseshoe kidney in Japanese literature up to date.

The following tables show statistics on inpatients, diseases and operations in our department during the period from January to December of 1976.

Tranexamic acid was administered to control hemorrhage during and following prostatectomy in prostatic hypertrophy, and its clinical effect was comparatively investigated with 10% saline as a control drug by means of a double blind method. The follwoing results were obtained. 1. Tranexamic acid was administered to 39 cases and placebo to 37 cases. No significant difference was noted between the two groups in various background factors. 2. The evaluation of clinical effect of each 'drug was decided according to the individual evaluation of the hemostatic effect on blood loss and abnormal bleeding (oozing) during operation and severity of postoperative hematuria. 3. The results were analyzed statiscally and significant difference was observed between these evaluations. Tranexamic acid group showed a highly significant reduction in bleeding during and following prostatectomy. The final clinical effect of tranexamic acid was excellent 51.3%, good 30.8% and poor 17.9%, while the effect of placebo was excellent 37.8%, good 10.8% and poor 51.4%. 4. As the side effect, only one case of tranexamic acid group showed slight nausea. 5. With the results obtained above, it was confirmed that tranexamic acid has marked hemostatic effect to control hemorrhage during and following prostatectomy in prostatic hypertrophy.