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To increase the management of self-catheterization in children of school age, a catheter kit consisting of hydrophilic catheter and a packet containing sterilized water was developed. We evaluated the lubricating characteristic and clinical efficacy of this new catheter kit.The catheter kit used in the study was a pocket-size plastic container in which a polyurethane catheter coated with hydrophilic polymer and a packet containing sterilized water were packed in combination. The lubricating characteristic of catheter was assessed by the measurement of friction value. For clinical assessment, male children aged over 6 years old who were doing self-catheterization at 17 medical institutions nationwide were selected as the subjects. The 32 children who had given informed consent (mean age: 11.6 years old) were asked to use the catheter kit continuously for 1 week. The results were investigated by a questionnaire survey in which the assessment before and after the use was expressed in scores. At the same time, urinalysis and urine culture were examined.The friction value of hydrophilic catheter was equivalent to or less than that observed by applying a lubricant to the conventional catheter. The comparison of conventional catheter with the kit indicated significantly higher scores (assessment in 5 grades expressed in scores) for the portability and operability of the kit. Though there was no significant difference in the ease of insertion between the two catheters, there were several comments that the kit got stuck in the urethra when it was withdrawn. The global assessment gave a significantly higher score to the kit and 30 (94%) of the 32 children wanted to use the kit continuously. No increase in hematuria which caused a clinical problem or no new apparent urinary tract infection occurred after the use of the kit.Compared with the conventional catheter, the hydrophilic catheter kit highly satisfied a large number of children at the time of self-catheterization. Depending on the condition of children, the kit is considered useful for continued self-catheterization for a long term.

From January 1993 to June 1998, 319 cases were histopathologically diagnosed as prostatic cancer. In 7 of the 319 cases (2.2%) transurethral resection of the prostate (TUR-P) had been performed and a diagnosis of benign prostatic hyperplasia had been made with the resected specimens. The interval between TUR-P and the diagnosis of prostatic cancer ranged from 22 months to 15 years. All the cases showed an elevation of the prostate specific antigen (PSA) value (6.4-399 ng/ml, Tandem-R: RIA) at the time of cancer diagnosis. In 2 cases, PSA was measured in cancer screening. The clinical stage was stage B1 in 2 cases, stage B2 in 2 and D2 in 3. Only one case had been regularly followed-up after TUR-P, in which cancer was diagnosed by needle biopsy 22 months after TUR-P, because of the sustained high PSA values. Since most of such patients have an advanced stage of prostate cancer, it is of importance to have periodical follow-up examinations after TUR-P. The measurement of PSA appears the most reliable means in this way.

Pressure-flow study (PFS) is an excellent method for detecting the bladder outlet obstruction. However, PFS with the transurethral catheter has the disadvantage of unphysiological urination during testing. In the present study, we compared the urination in PFS with that in uroflowmetry (UFM) and analyzed the effect of the transurethral catheter.The subjects were 43 men who underwent PFS at Yamato Takada Municipal Hospital. PFS and UFM were compared with respect to four parameters, i.e., Qmax, the residual urine volume, the region on Liverpool nomogram, and the flow curve pattern (Jørgensen's classification).For PFS using a transurethral catheter, (1) Qmax was decreased by a mean of 2.6 ml/s and the residual urine volume was increased by a mean of 26.3 ml compared with UFM, and (2) the Liverpool nomogram and the flow curve pattern showed more impairment of urination with PFS than UFM.It is suggested that PFS using a transurethral catheter may not reflect physiological urination.

The present investigation was conducted to examine the effects of intra-arterial chemotherapy (IAC) for patients with invasive bladder cancer. A total of 37 patients were treated with IAC at Nara Medical University and its affiliated hospitals between January, 1993 and August, 1997. There were 27 patients in the poor risk group. The remaining 10 patients underwent anti-tumor IAC. Thirty of the 37 patients received chemotherapeutic agents via a reservoir, and the remaining 7 patients received a one-shot injection of agents followed by transcatheter arterial embolization (TAE). In the reservoir group, there were 18 patients who received IAC in combination with radiation therapy. As a result, reduction of tumor size was noted in 53%, and the 3-year cause-specific survival rate was 54% in all cases. There was a significant difference in the 3-year survival rate between the radiation-treated group and the group without radiation. The adverse events included anemia, leukopenia, thrombocytopenia and gastrointestinal symptoms, but none of them were severe. The results of the present study indicate that IAC is useful in the treatment of invasive bladder cancer for poor risk patients.

Retrospective analyses were performed to elucidate the clinical significance between Credé voiding (n = 56) and Valsalva voiding (n = 22) in the urological management of spina bifida patients who do not match the indication of clean intermittent catheterization. The age at initiating the urological management ranged from 0 to 31 years old (mean 2.1) in the Credé voiding and from 0 to 20 years old (mean 4.5) in the Valsalva voiding group. Seventeen patients in the Credé voiding group and 13 in the Valsalva voiding group were followed up for more than 10 years with a mean follow-up period of 14.6 and 13.7 years, respectively. Three patients in the Credé voiding group and one in the Valsalva voiding group showed progression of bladder deformity. In one patient in the latter group, vesicoureteral reflux newly appeared. In the Valsalva voiding group, disappearance or improvement of hydronephrosis was seen in three patients and that of hydroureter in three, bladder deformity in one, and vesicoureteral reflux in one. On the contrary, no patients in the Credé voiding group showed favorable changes in these pathological conditions except for disappearance of vesicoureteral reflux in one patient. Although these findings suggest possible superiority of Valsalva voiding over Credé voiding in the preservation of urinary tract, the differences between the two groups were not statistically significant. The clinical significance of Valsalva voiding remains to be elucidated through further study in neurogenic bladder patients.

Clinical symptoms, urodynamic findings, and urological treatment of 35 patients with neurogenic bladder dysfunction caused by Parkinson's disease (11 patients), multiple sclerosis (10 patients), and spinocerebellar degeneration (14 patients) were reviewed retrospectively. Most of the patients had a relatively low stage of disease, when they were first seen by their urologists. Chief urological complaints were of irritation in 63.6% of Parkinson's disease and 64.3% of spinocerebellar degeneration cases, compared with obstruction in 80.0% of multiple sclerosis cases. Cystometry revealed underactive detrusor function in 69.2% of the patients with spinocerebellar degeneration but no abnormalities in the patients with Parkinson's disease or multiple sclerosis. Of 34 patients, excluding one patient lost to follow-up, the period of urological management ranged from one to 44 weeks with a mean of 11.0. The final methods of urinary drainage in 34 patients consisted of voluntary voiding in 20, clean intermittent catheterization in 11 including eight by self catheterization, incontinence into diaper in two, and indwelling catheter in one. Five patients were compelled to change urinary drainage method from voluntary voiding to clean intermittent catheterization because of increasing residual volume in four and progressing bladder deformity in one. However, none of them showed the clinical signs of primary disease progression. These findings indicate that in patients with Parkinson's disease, multiple sclerosis, and spinocerebellar degeneration, the urological symptoms can appear even in the early stage of disease. In addition, close follow-up is important in the urological management of neurogenic bladder patients with these diseases, because the disorders of the lower urinary tract may progress regardless of the status of the primary disease.

The objective of this report is to evaluate the upper urinary tract changes of the patients with spina bifida who have been followed up for more than 10 years.We analyzed 228 patients (97 males and 131 females) of spina bifida. Mean patient age was 18.7 years (10 to 51 years) and follow up period ranged from 10 to 27 years (mean 13.4 years). Upper urinary tract deterioration (Hydroureter and/or hydronephrosis), vesicoureteral reflux (VUR) and bladder deformity were investigated by excretory urography and voiding cystourethrography. We compared these 3 parameters in the initial and final examinations.In the initial examinations, upper urinary tract deterioration, VUR and bladder deformity were observed in 32.9%, 33.3% and 40.0%, respectively. During the follow up period, upper urinary tract was improved in 47.3% and VUR in 80.0%. Bladder deformity was disappeared in 14.4%. On the other hand, upper urinary tract was deteriorated in 9.3%. VUR and bladder deformity was newly developed or progressed in 8.0% and 29.3%, respectively. Finally, upper urinary tract deterioration, VUR and bladder deformity were observed in 31.3%, 18.2% and 52.0%, respectively.These results revealed that upper urinary tract and VUR were relatively controlled, however, bladder deformity was increased in its frequency. To prevent upper urinary tract deterioration, further analysis of sequential changes of urinary tract conditions should be demanded.

The present investigation was conducted to examine the effects of granisetron alone and a combination of granisetron plus steroids on CDDP-based combination chemotherapy-induced emesis by multi-institutional randomized comparative trial using a central registration method. A total of 62 patients with urological cancer enrolled this study were randomized into two groups: granisetron (40 micrograms/kg) only group and granisetron (40 micrograms/kg) plus steroids (500 mg of methylprednisolone or 8 mg of dexamethasone) group. There were 31 patients eligible in the granisetron only group and 28 in the combination group. The same anti-emetic treatments were given in the recycling courses of chemotherapeutic regimens. Therefore, eligible patients of the second and the third cycle numbered 31 (17 in the granisetron only group, 14 in the combination group) and 21 (11 in the granisetron only group and 10 in the combination group). Significant inhibition of acute emesis in combination group was observed when compared with the granisetron only group in each cycle. Delayed emesis was also significantly inhibited in the combination group on Day 2 and 3 of the first cycle and on Day 2 of the second and third cycle. In addition, appetite loss was significantly reduced in the combination group on Day 2 and 3 of the first and second cycle. No adverse events were seen in either group. These results suggested that a combination of granisetron and steroids was useful for preventing CDDP-based combination chemotherapy-induced emesis.

Since April 1986, a prospective clinical trial for testicular cancer has been underway by our Nara Uro-Oncology Research Group. One hundred and forty-eight cases of germ cell tumor were entered into this study between April, 1986 and August, 1995. They included 99 cases (66.9%) of seminoma and 49 cases (33.1%) of non-seminomatous germ cell tumor (NSGCT). The mean age of seminoma cases (39.7 yrs) was higher than that (30.2 yrs) of NSGCT cases. One hundred and twenty-three cases were treated according to our protocol. In the treatment group, one patient with stage I seminoma died of other diseases and one patient each with stage II and stage III seminoma died of cancer. Three patients with stage III NSGCT died of cancer. The 5-year survival rate was 100% for stage I seminoma, and stage I and stage II NSGCT, 75.0% for stage II seminoma, 0% for stage III seminoma and 66.7% for stage III NSGCT. These findings suggest that new treatment modalities should be introduced into our protocol in the future.

The number of cases of prostate carcinoma (PCA) is steadily inceasing in Japan. The clinical application of a reliable tumor marker, prostate specific antigen (PSA) for the diagnosis, as well as the increasing elderly population in Japan may account for this increase. The subjects were patients at the Nara Medical University and its affiliated hospitals; 1) 687 cases without PCA were evaluated for age-specific PSA and the incidence of abnormal PSA following urological manipulations, 2) 135 cases with histological proven BPH by transurethral resection of prostate (TUR-P) were examined for PSA density (PSAD) and positive PSA rate in BPH, 3) 135 cases receiving a needle biopsy with suspicion of PCA were examined for the efficacy of PSA and PSAD and other parameters, and 4) 459 PCA cases treated between 1988 and 1994, were examined for specific PSA and PSAD values by stage and degree of cell differentiation. The PSA assay used in this study was MARKIT-M PA (normal rangeor = 3.6 ng/ml). The PSA was decreased gradually with age in non-PCA patients, and abnormal PSA was found in 5.5% of these patients following manipulations. The average PSA was 2.95 +/- 2.03 ng/ml in 130 BPH patients (mean age: 71.1 +/- 7.0 years old. and average prostate volume: 32.9 +/- 16.1 ml). And abnormal PSA level (more than 3.61 ng/ml) was found in 22.3%. The mean PSAD was 0.1.0 +/- 0.06, and PSAD was below 0.15 in 86.1% of these BPH cases. Among the 135 cases receiving a needle biopsy, 33 cases had PSA values between 3.61 and 10.0 ng/ml. Of these cases, PCA was found in 18.5% of the 27 cases with a PSAD below 1.5, and in 33.3% of the 6 cases with a PSAD over 1.5. PSA and PSAD were proportionally increased with stage, and a significant difference in the PSA value was observed between stage B1 and B2, and stage C and D (P0.05). However, PSA and PSAD values were not significantly correlated with the cell differentiation in PCA stage A2-C. In total, PSA was 18.1 ng/ml in well, 23.9 ng/ml in moderately and 35.9 ng/ml in poorly differentiated type PCA. The positive rate of PSA was 22.3, 65.4 and 83.5%, that of prostate acid phosphatase (PAP) was 10.0, 17.8 and 45.8%, and that of GSM was 25.0, 14.7 and 68.4%, in BPH, stage A PCA and stage BPCA, respectively. In conclusion, PSA is the most reliable tool in the diagnosis of localized PCA. However, the differential diagnosis of BPH and localized PCA is difficult when the PSA value is between 3.61 and 10.0 ng/ml, and accurate staging of localized PCA is difficult with PSA or PSAD alone. At present, it is necessary to use all possible tools for the early detection of localized PCA, and to perform the needle biopsy in all PCA-suspicious cases.

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.

A series of 180 patients treated with ileal conduit urinary diversion at Nara Medical University and its affiliated hospitals were reviewed. The patients ages at the time of operation ranged from 21 to 79 years old with an average of 60.9 years old and the average postoperative follow-up period was 44.2 months. Early complications occurred in 60 patients (33.3%) and 9 (5.0%) of them resulted in post-operative deaths. Late complications were noticed in 54 (31.6%) of the 171 patients. Frequent late complications included peristomal dermatitis (37.3%), ureteroileal stenosis (17.9%) and urolithiasis (11.9%), for the latter two of which endourological treatments seemed to be effective. To be emphasized is that more attentive care should be paid to the condition of the peristomal skin during follow-up.

The preliminary results of a multi-institutional prospective randomized study of the prophylaxis of superficial bladder cancer using epirubicin (protocol NUORG SBT-003) are reported. The subjects were 129 patients with untreated superficial bladder cancer (or = T1b,or = G2) who were randomized into 2 groups: a transurethral resection (TUR)-alone group (63 patients) and a TUR + intravesical epirubicin (20 mg/40 ml, 30 times/2 years) group (66 patients). The nonrecurrence rate observed in the epirubicin group was significantly higher than that seen in the control group. To unify the pathological diagnosis, a central pathology laboratory (CPL) was set up for extramural review. The correspondence of the pathological diagnosis of TUR-Bt specimens between the CPL and the local pathology laboratory (LPL) was 70.5% in grading and 51.9% in staging. There was a tendency for overdiagnosis by the LPL for both the grade and the stage of tumors. However, differing interpretations by pathologists seem to exert little influence on the nonrecurrence rate at interim analysis. Further observation will be necessary to clarify the prophylactic efficacy of low-dose, long-term periodic intravesical epirubicin instillation and the influence of the disagreement in pathological findings between the CPL and the LPL on the analysis of the results.

Rhodamine 123 (Rh123) is a red fluorescence dye, which is accumulated more and retained longer in the mitochondria of malignant transformed cells. In this study, the suppressive effects on the growth of cultured urogenital carcinoma cells (PC-3 and LNCaP from prostate carcinoma, T-24 from bladder cancer, and SV-HUC-1 human ureteral transitional cell transformed by SV virus in vitro, ACHN, YCR-1 and RCF213 from renal cell carcinoma) were examined. The cell growth of PC-3, LNCaP, T-24 and SV-HUC-1 was suppressed significantly in a dose dependent manner, but that of cells derived from renal cell carcinoma was not suppressed. The uptake and elimination of Rh123 in PC-3, ACHN and YCR-1 were not significantly different. When administered with verapamil and buthionine sulfoximine, which are reported to be chemical modulators of anticancer agents, Rh123 suppressed the growth of ACHN and YCR-1 significantly. Rh123 seems to have an anticancer effect against the urogenital carcinomas, and the role of Rh123 with hyperthermia, photodynamic therapy and chemotherapy requires further investigation.

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.

Augmentation cystoplasty is evolving into a common method of surgical treatment for a low capacity and/or low compliance neurogenic bladder. Although an increasing number of successful results have been recently reported, the operative indication of augmentation cystoplasty is yet to be established. Herein, we report two cases of neurogenic bladder due to spina bifida which required abandonment of augmentation cystoplasty. The first case was in a 23-year-old female with a severely deformed bladder and right vesicoureteral reflux (VUR). She refused to undergo ileocystoplasty because we could not assure her of postoperative conception which she eagerly anticipated. The second case was in a 19-year-old male with a severely deformed bladder and right VUR. He experienced recurrent episodes of ventriculoperitoneal shunt (V-P shunt) difficulty which required exchanging the shunt tube each time, and each exchange proved to be very difficult or nearly impossible. Based on lengthy neurosurgical consultation, we came to the conclusion that ileocystoplasty was not a preferable treatment of choice for the correction of his disease due to the possibility of V-P shunt infection, which could be fatal. Alternatively, both cases were treated with Cohen's ureteral reimplantation, which resulted in the recurrence of VUR. These cases presented still unresolved issues concerning the operative indication of augmentation cystoplasty in spina bifida patients.

Chronic urinary tract infection is an important risk factor for the development of carcinoma in the human urinary bladder. To test the effect of chronic persistent inflammation on bladder carcinogenesis, we instilled heat-killed Escherichia coli (1 x 10(8) cells suspended in 0.5 ml of phosphate-buffered 2.1% NaCl solution) twice a week into the heterotopically transplanted rat urinary bladders in which carcinogenesis was initiated by a single dose (0.25 mg) of N-methyl-N-nitrosourea. When compared with the control animals, the rats treated with killed E. coli showed significantly enhanced bladder tumorigenesis, as reflected by an increase in the incidence of tumor (P = 0.05) and a 6- to 40-fold increase in the number of tumors per bladder (P less than 0.0001). The tumors were characterized by intraepithelial clusterings of neutrophils and by chronic inflammation and marked capillary proliferation in the tumor stroma. All of these features were rare in tumors in the control groups. The accelerated cell proliferation induced by killed E. coli treatment appears to play a significant role in the enhancement of tumorigenesis.

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.

We previously demonstrated that the specific component of rat urine designated as Fraction I (Fr.I), which has been known to enhance carcinogenesis in the rat urinary bladder, contains epidermal growth factor (EGF) and transferrin (TF). The present study was designed to determine whether EGF or TF is responsible for the tumor-enhancing effect of Fr.I. The heterotopically transplanted rat urinary bladder (HTB), which has been developed in our laboratory, was used for the study. Fr.I was prepared from normal rat urine by a method published previously. Fr.I deficient in EGF or TF was prepared by passing this fraction through an Affi-Gel Hz column coupled with anti-rat EGF or TF antibodies, respectively. EGF and TF eluted from the column (designated as eluted EGF and eluted TF) were also tested for tumor-enhancing activity. Fr.I passed through the column coupled with nonimmune rabbit IgG served as control (Fr.I column control). After initiation of carcinogenesis in HTBs by instillation of a single dose of 0.25 mg of N-methyl-N-nitrosourea, test materials were administered into these HTBs once a week for 30 weeks. The results showed that removal of EGF significantly reduced the tumor-enhancing effect of Fr.I (P less than 0.001 as compared to that of the Fr.I column control) and that eluted EGF by itself significantly enhanced the carcinogenesis as compared to that of the vehicle control (P less than 0.006). Removal of TF from Fr.I also reduced the tumor-enhancing effect of Fr.I (P less than 0.01). However, removal of both EGF and TF from Fr.I did not enhance the inhibitory effect demonstrated by the Fr.I which was deficient in EGF. Likewise, combined use of TF and EGF did not exceed the tumor-promoting effect of EGF. The results indicate that EGF in Fr.I may play a significant role in the promotion of bladder carcinogenesis by urine.

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.

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.

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.

Twenty-one intracavernous injections of 40 or 60 mg papaverine hydrochloride were given to ten male paraplegics. Erection sufficient for coitus was achieved within a few minutes after 15 of the injections (71.4%). Tumescence of the penis lasted from 18 minutes to 48 hours and the penile tumescence of the patients who had reflective erection usually lasted longer than that of the patients who did not. The trial that lasted for 48 hours resulted in the fracture of the penis that was presumed to have occurred during coitus and it was treated operatively. Intracavernous injection of papaverine hydrochloride is available for the impotence of male paralegics, but both doctor and patient must be careful about the sensory disturbance of the penis to avoid penile injury during erection. Further studies are needed to establish safety and long-term efficacy, as well as to determine if histological change of cavernous body occurs by repeated injection.

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.

After monoassociation of Bifidobacterium longum with germ-free BALB/c mice (nu/+, heterozygous to nu gene), B. longum was recovered (10(2)-10(4) viable units per organ) from the mesenteric lymph nodes, liver and kidneys for 2 weeks post intragastric inoculation, but not after 4 weeks and later. Cessation of bacterial translocation was not observed in monoassociated nude (nu/nu) mice. Anti-B. longum IgA antibody was detected by ELISA using B. longum cell wall antigen in bile from Week 1 and in ileac wall extract from Week 8 post-association in both nu/+ and nu/nu mice. Total IgA levels in bile, ileac wall extract and caecal contents were also elevated in both mice after monoassociation. Cell-mediated immunity measured by the footpad test and macrophage migration inhibition test using B. longum protein fraction was detected in nu/+ mice in Week 4 and later, but not in nu/nu mice. Nu/nu mice reconstituted 4 weeks prior to monoassociation with lymphocytes from flora bearing nu/+ mice developed delayed footpad reactivity and bacterial translocation stopped after 4 weeks. Cell-mediated immunity rather than IgA antibody correlated well with the cessation of translocation.

The chemotherapeutic agents were evaluated using the experimental urinary bladder tumor rat model induced by N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN). Nine hundred and fourteen male rats received 0.05% BBN in drinking water for 8 weeks, and were divided into 35 groups to follow the regimens of chemotherapeutic agents. Thirty one groups received the agents after BBN treatment, and 4 groups were given the oral agents starting simultaneously with BBN treatment. All rats were killed at 20 weeks and incidence of the urinary bladder was examined histopathologically. The following 13 agents were evaluated; adriamycin (ADM), mitomycin-C (MMC), cyclophosphamide (CPM), 5-fluoro-uracil (5-Fu), N-(2-tetrahydrofuryl)-5-fluorouracil (FT-207), neocarcinostatine (NCS), carbazil quinone (CQ), bleomycin (BLM), vincristine (VCR) and cis-diammine-dichloroplatinum (CDDP) were dosed intraperitoneally, and N-(2-tetrahydrofuryl)-5-fluorouracil (FT-207), 1: 4 mixture of FT-207 and uracil (UFT) and 1-Hexylcarbamoyl-5-fluorouracil (HCFU) were dosed orally. Among these agents, 5-Fu, FT-207, CQ, VCR, CDDP, UFT and HCFU were effective in inhibiting the incidence of urinary bladder tumor induced by BBN. In conclusion, the experimental bladder tumor rat model induced by BBN seems to be useful in evaluating the effective chemotherapeutic agents for a superficial bladder cancer. The importance of the experimental animal model for the evaluation of chemotherapeutic agents is discussed.

A clinical survey was performed on 80 cases of renal pelvic and ureteral transitional cell carcinomas we treated between January, 1963 and December, 1986. The cases included 30 of renal pelvic tumors, 17 of ureteral tumors, 3 of renal pelvic and ureteral tumors, 7 of renal pelvic and ureteral and bladder tumors, 16 of ureteral and bladder tumors and 7 of renal pelvic or ureteral tumors after treatment for bladder tumors. There were 37 cases of bladder tumors: 7 cases with preceding bladder tumors, 23 cases of synchronous bladder tumors, and 13 cases of subsequent bladder tumors. The 5-year survival for all cases was 60.2%. The 5-year survival for 43 cases unrelated with bladder tumors was 80.5% and that for 37 cases of bladder tumor was 41.6%. Therefore, there was a significant difference between these 2 groups (p less than 0.005). The 5-year survival for 50 cases without synchronous bladder tumors at first diagnosis was significantly higher than that for 23 cases with synchronous bladder tumors (p less than 0.001). Subsequent bladder tumors occurred after 2 to 48 months (mean 10 months) of the initial treatment for renal pelvic and ureteral tumors. Six of the 7 cases of preceeding bladder tumors were superficial tumors of pTa and pT1 and 3 cases had vesicoureteral reflux.

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.

A total of 22 patients with locally invasive transitional cell carcinoma of the urinary bladder were treated with neoadjuvant cis-diamminedichloroplatinum (CDDP), vincristine, peplomycin (PVB) or cyclophosphamide, doxorubicin, CDDP (CAP) combined with radiation therapy in our institutes between June, 1982 and May, 1988. Twelve patients were entered into the PVB regimen and the remaining 10 patients into the CAP regimen. In the PVB treated group, clinical response was obtained in 2 complete response (CR) and 6 partial response (PR), 8 out of 12 patients (66.7%). Downstaging was noted in 8 out of 12 patients (66.7%). In the CAP treated group, a clinical response was obtained in 1 of CR and in 2 of PR out of the 9 patients with evaluable lesions (33.3%). Downstaging was noted in 6 out of 9 patients (66.7%). There were no significant side effects in either the PVB or CAP treated groups, and these neoadjuvant therapies were well-tolerated. These results indicated that neoadjuvant PVB or CAP combined with radiation therapy would be useful in the management of invasive bladder cancer.