Search

The patient was a 74-year-old man who was referred to our hospital with a complaint of left flank pain. Laboratory data were almost within normal limits and urine cytology was positive. X-ray examination revealed a calcification in the left kidney and abdominal CT scan confirmed the presence of a heterogenous renal pelvic mass which contained a calcification. Based on these examinations, a diagnosis of a renal pelvic cancer with heterotopic bone formation was made. Subsequently, left nephroureterectomy was performed. Grossly, the renal pelvis of the resected kidney was filled with a mass which had a white cut surface and bone-like tendency. Histopathologically, a poorly differentiated transitional cell carcinoma with massive bone formation was found. Fifty five cases of heterotopic bone formation in the kidney have been reported in Japan. Among the cases, 4 cases were complicated with renal pelvic tumor and our case was the second case of heterotopic bone formation complicated with a transitional cell carcinoma of the renal pelvis in Japan.

We report two cases of a nephrogenic adenoma in the bladder diverticulum. The first patient was an 81-year-old man with gross hematuria. Cystoscopy revealed bladder diverticulum and a papillary tumor within. Bladder diverticulectomy was performed and the histopathological diagnosis was a nephrogenic adenoma. The second patient was a 50-year-old man with gross hematuria and dysuria. Transabdominal ultrasound revealed bladder diverticulum. Transurethral coagulation of the bladder diverticulum was performed. Then three papillary tumors were detected, and were resected transurethrally. The histopathological diagnosis was a nephrogenic adenoma. These are the first and second cases of a nephrogenic adenoma in the bladder diverticulum reported in Japan.

We analyzed retrospectively the technical and clinical consequences of combined spinal-epidural anesthesia by needle-through-needle approach over the last two years. A Tuohy-type 18-gauge epidural needle (Perican; B. Braun Co.) and long pencil-pointed 27-gauge spinal needle (Whitacre; Becton-Dikinson Co.) were selected. Spinal anesthesia was administered with 0.5% tetracaine. A total of 485 anesthesia cases included 144 cases for lower abdominal, 193 cases for gynecological and 148 cases for orthopedic surgeries. The successful subarachnoid puncture with only one attempt was recorded in 89% of abdominal, 71% of gynecological and 72% of orthopedic cases. On the other hand, in three (0.6%) cases even with several attempts, the puncture was not possible. Inadvertent dural puncture and subarachnoid catheterization occurred in six (1.2%) and four (0.6%) cases, respectively. Inadequate spinal anesthesia was supplemented with epidural anesthesia in 13% of abdominal, 21% of gynecological and 7% of orthopedic cases. No serious complication occurred. We conclude that this needle-through-needle approach facilitates subarachnoid puncture with an ultra-fine spinal needle and subsequent epidural catheterization serves for supplemental and post-operative analgesia unless inappropriate subarachnoid indwelling occurs.

The treatment outcome was evaluated in 63 patients with bladder cancer more than 2 years after cystectomy. Cisplatin-based combination chemotherapies were given to 40 patients after the operation as an adjuvant therapy and two patients with T4 or N2 bladder cancer received chemotherapy before the operation as a neoadjuvant therapy. The extent of infiltration of the removed tumors was pTa in 5, pT1 in 18, pT2 in 8, pT3a in 6, pT3b in 17, and pT4 in 9 cases. Regional lymph node metastases were present in 10 cases (16%). Nineteen patients died of tumor recurrences. The 5-year acturial survival rates at each stage were 60% for stage pTa, 78% for stage pT1, 63% for stage pT2, 83% for stage pT3a, 33% for stage pT3b and 38% for stage pT4, respectively. A significant difference (p0.05) in survival curve was observed between pT3a and pT3b. The prognosis of patients with tumors extending beyond the bladder muscles is extremely unfavourable, with the exception of bladder cancers infiltrating the neighboring organ (pT4a), the removal of which may result in lasting survival in a part of the cases. Effective adjuvant treatment is required for patients with bladder tumors penetrating the bladder wall.

We reviewed 40 patients with renal pelvic and/or ureteral transitional cell carcinomas, consisting of 24 males and 16 females with a mean age of 65 years. The histopathological stage of surgically removed specimen was pTa in 6 patients, pT1 in 7, pT2 in 5, pT3 in 11 and pT4 in 6. Three patients with Tis and 2 with T3 did not undergo surgery. Of 35 patients pathologically examined, lymphatic and venous invasions were detected in 22 (63%) and 16 (46%), respectively, and were associated with pathological stage and grade. Overall the 5-year actuarial survival rate was 57.1%. Tumor staging and vascular invasion had a prognostic significance on the treatment outcome, but not metachronous or synchronous bladder cancer, identified in 55% of the patients. Adjuvant chemotherapy appeared to improve the survival of the patients with tumors pT2 or higher, grade 3 or vascular invasion without metastases.

Four patients with upper urinary tract transitional cell carcinoma were treated with bacillus Calmette-Guerin (BCG) via a percutaneous nephrostomy tube or a retrograde ureteral catheter. A 68-year-old female and an 80-year-old male had carcinoma in situ (CIS) in the left upper urinary tract (cases 1 and 2). A man aged 47 had CIS in the left upper urinary tract, bladder, and prostatic urethra (case 3). CIS in the left upper urinary tract was identified in a woman aged 63 with chronic renal insufficiency (case 4). Two patients (cases 1 and 2) responded to this therapy. In the other two patients nephrectomy was performed due to residual tumor. There were extensive tuberculous granulomas in the kidneys. In one resected kidney (case 4) carcinoma had invaded the renal parenchyma. The reviewed literature showed that BCG perfusion therapy was effective in 71% (27 of 38 renal units) for the upper urinary tract tumors and that there were 5 cases of severe complication, including sepsis in 2, high fever in 2, and ureteral stricture in 1. Based on the fact that the kidney receives a profuse blood supply and that the renal pelvis and ureter have a thin wall, careful management is mandatory to prevent severe adverse effects and insidious tumor progression.

A clinical statistic survey was carried out on the patients and disease experienced at the outpatient clinic of our Department of Urology, between 1983 and 1993. Although the number of newly diagnosed patients was rather constant, the total number of outpatients gradually increased every year, and the average and median age of newly diagnosed patients became higher. The major disease categories were infectious and neoplastic disorders.

99mTc-MAG3 (mercaptacetyl glycilglycilglycine) is a newly developed radiopharmaceutical for the functional imaging of kidneys. We evaluated the clinical usefulness of 99mTc-MAG3 in 12 cases (7 men and 5 women, aged from 18 to 57 years old) with transplanted kidney, and compared it with 123I-OIH (o-iodohippurate). Immediately after bolus injection of 300 MBq of 99mTc-MAG3, first pass images (1 frame/3 sec for 1 min) and dynamic renal images (1 frame/60 sec for 30 min) were recorded. In 10 of 12 cases, the same examination was carried out using 37 MBq of 123I-OIH within 2 weeks. Because of its larger dose and suitable gamma-ray energy, 99mTc-MAG3 provided much better images than 123I-OIH, particulary among first pass images. Effective renal plasma flow (ERPF) calculated from the clearance of 99mTc-MAG3 was less (about 70%) than that of 123I-OIH, however, a strong correlation (r = 0.98, p0.001) was observed between the ERPF values of the two radiotracers. No adverse effects were caused by 99mTc-MAG3. Our data suggested that 99mTc-MAG3 was a promising radiopharmaceutical with which to evaluate regional dynamic renal function.

The clinical usefulness of Combined Spinal-Epidural (CSE) needles, Portex Spinal/Epidural set (P needles) and Hakko Disposable Needles set type H (H needles) was compared on 30 patients undergoing elective orthopedic lower limb surgeries. Although the calibers of the epidural needles were a little different, both needles were introduced quite easily in the epidural space. The spinal needles were inserted successfully to the subarachnoid space in 27 out of 30 cases by the P needles and 23 out of 30 cases by the H needles. The average trial times for successful insertion of the spinal needles were 1.3 and 2.6 by the P needles and the H needles, respectively. this was statistically significant (P0.05). Adequate spinal anesthesia was established in 26 patients (87%) and 19 patients (63%) by the P needles and the H needles, respectively. One case of the accidental location of the epidural catheter in the subarachnoid space was observed in each group. As the CSE device, the P needles were more sophisticatedly designed for easier insertion to the subarachnoid space than the H needles.

The effect of the antispasmodic agent, SA-504 subtle granules, was studied. Ninety mg per day of timepidium bromide subtle granules was given orally to 17 patients with renal or ureteral calculi for no less than fourteen days. SA-504 subtle granules as well as the capsule showed good antispasmodic effect and stimulated spontaneous passage of ureteral calculi. No subjective or objective side effects were observed.

A 68-year-old female patient was admitted for the examination of duplication of right ureter and right hydronephrosis. Antegrade pyelography showed multiple, small, round defects in the ureter from the upper pole of right kidney. Ureteroureterostomy was performed under the diagnosis of ureteritis. Including our case, 25 cases of pyeloureteritis cystica have been reported in Japan.

The presence of bacteria at the renal pelvis and the methods of their detection were studied in 11 patients with catheter-free cutaneous ureterostomy (tubeless ureterocutaneostomy). These patients had had total radical cystectomy due to bladder carcinoma. Of these, 5 patients had single-sided stoma with 9 kidney-ureter units and 6 patients had bilateral stoma with 10 units, excluding 2 ureters because of indwelling catheters. The urine obtained both from the renal pelvis with a single lumen catheter and from the pouch were used in the bacterial culture test and urinalysis. The aseptic swab after touching the skin around the stoma was also cultured for bacteria. Of 19 kidney-ureter units, 9 (47%) were found to have bacteria in urine obtained from catheterization. However, only 2 units (11%) were observed to be accompanied with pyuria. In this method, the rate of bacterial appearance was higher in single-sided stomas than in bilateral ones. There was no statistical correlation between the presence of hydronephrosis and the rate of bacterial appearance. In conclusion, the method of single lumen catheterization might be of great use for analysis of urinary tract infections in patients with such conditions.

Results of operation were analyzed statistically in 123 patients who underwent suprapubic prostatectomy for benign prostatic hypertrophy from 1974 through 1981. Age of the patients ranged from 48 to 89 years and the mean age was 70.1 years. The average amount of blood loss during operation was 590 ml. Amount of blood loss in patients operated under epidural anesthesia was less than that in the patients operated under general anesthesia. Furthermore, significant correlation was observed between amount of blood loss and the weights of enucleated prostate glands. The average weight of enucleated prostate glands was 33.4 g and the weight increased as the patient's age increased. Histological examination of the enucleated specimens revealed occult carcinoma in 4.1% of the patients. Association of bladder neck sclerosis was observed in 27% of the patients whose prostate weighed less than 20 g. Significance of prophylactic vasectomy for the prevention of postoperative epididymitis was considered to be low. Incidence of postoperative bacteriuria was higher in patients who had bacteriuria preoperatively than those without preoperative bacteriuria. Therefore, eradication of preoperative bacteriuria seemed important in the prevention of postoperative bacteriuria. No significant correlation was observed between postoperative residual urine volume and the weight of the enucleated prostate glands.