Search

Using a Dornier HM3 lithotripter, we treated 1, 000 patients with renal and ureteral stones from April, 1986 to July, 1989. They consisted of 612 solitary stones (pelvic stones, 152; calyceal stones, 167; ureteral stones, 293), 265 multiple stones and 123 staghorn calculi (complete, 48; partial, 75). The overall rate of the auxiliary procedure was 59.3% (pre-operative, 47.9%; post-operative, 11.4%). Pre-operative procedure included 430 catheterizations, 26 percutaneous nephrostomies (PNSs) and 23 pyelograms . Post-operative procedure included 69 transurethral lithotripsy , 21 PNSs, 26 percutaneous nephrolithotripsy (PNLs), 6 meatotomy , 5 chemolysis and 1 open surgery. 484 (68.3%) in 709 good follow-up cases were stone-free at the time of 3 months since the first extracorporeal shock-wave lithotripsy (ESWL). Complications were pain (34.8%), fever (4.3%), pain & fever (8.5%), subcapsular hematoma (0.1%) and ureteral obstruction (0.1%). Thus, ESWL is considered to be a useful means for renal and ureteral stones and in the case of large stone the combination therapy with PNL is more effective than ESWL-monotherapy.

A 22-year-old female visited our hospital with complaints of pollakisuria and dysuria on July 3, 1987. Cystoscopy revealed a tumorous lesion in the urinary bladder. On July 8, 1987, she had urinary retention because of relapse of the tumor from the external urethral orifice. Under the diagnosis of urinary bladder tumor, tumorectomy was performed. The resected tumor had a steel, smooth surface, was elastic soft, red-purple and 7 g in weight. Pathological examination demonstrated the tumor to be composed of spindle-like cells, which showed no mitotic figures. Therefore, the tumor was diagnosed as leiomyoma of urinary bladder. In the literature, 67 cases of leiomyoma of the urinary bladder have been reported so far in Japan. The patients ages ranged from the 2nd to 8th decade, the peak age being the 4th decade. The sex ratio was 5 to 2, females being predominant. Chief complaints were hematuria, pollakisuria and dysuria, but prolapse of the tumor from the external urethral orifice was rare, only 3 cases including our case being reported thus far. Tumorectomy (34 cases, 27%) or partial cystectomy (16 cases, 27%) was performed in many cases, because it was benign. The prognosis was good, and there have been no reports stating that it become malignant.

A case of pure choriocarcinoma of the testis in a 62-year-old male is reported. The patient consulted his family physician with an enlarged but painless right scrotal containment in November, 1980. Initial diagnosis was right hydrocele testis and chronic epididymitis, and he was treated with antibiotics. However, the tumor continued to enlarge. Right high orchiectomy was performed on March, 15, 1981 under the diagnosis of suspected right testicular tumor. The resected specimen was 10 X 7 X 6 cm and elastic hard. The cut surface was dark reddish with hemorrhagic foci. Serial sections of the entire testis were made and their histopathological examinations revealed the tumor to be a classical pure choriocarcinoma of the testis. The plasma beta-HCG level was remarkably elevated, but the alpha-fetoprotein level was normal. Anticancer chemotherapy (CDDP 125 mg, MTX 20 mg, ADM 50 mg, and EDX 500 mg) was performed in eight courses after the operation. Multiple metastatic foci were present in both lungs during the treatment, and his condition gradually deteriorated. Therefore, he was transferred to our hospital. Aggressive anticancer treatment could not be given because of his poor general condition, and he died on May, 16, 1982 of carcinomatosis. The autopsy revealed multiple nodular metastasis of the tumor to bilateral lungs, bilateral adrenal glands and right kidney. There was no metastasis to the lymph nodes. The metastatic lesions, macrospically dark reddish with hemorrhagic foci, were histopathologically pure choriocarcinoma.

We report two cases of heterotopic bone formation in the kidney. One patient was a 54-year-old man who consulted his family physician with the complaint of fever-up and nocturia. X-ray examination revealed a calcification in the left kidney and location of the pelvis for outside. Therefore, abdominal CT scan and selective renal angiography were performed. As a malignant renal tumor with hypovascularity could not be neglected, left nephrectomy was performed on August 18, 1980. Grossly, the resected kidney was 230 g in weight and had a 8 X 3 cm mass with a white cut surface and bone-like tendency. Histopathologically, a well-developed bone with erythropoietic bone marrow was found outside of the renal capsule. The other patient was a 52-year-old man with the complaint of painful swelling of left scrotum and lumbago. X-ray examination revealed bilateral renal stones and left ureteral stone. Bilateral nephrolithotomy and left ureterolithotomy were performed, and some stones and a part of bilateral renal pelvis which was bony hard and white in color were resected. Histopathologically, there were well-developed bone formation and infiltration of inflammatory cells in renal pelvic membrane. Among 36 reported cases in Japan, 16 cases were in male and 20 cases in female patients. Our second case was the first cases of bilateral renal heterotopic bone formation complicated with bilateral renal stones in 5 reported cases with renal stones. Including our first case, 5 cases which had heterotopic bone formation in renal capsule have been reported.

A case of right ureteral obstruction secondary to right common iliac aneurysm presenting as right hydronephrosis is reported and the literature is reviewed. A 66-year-old man was admitted to our hospital with lower abdominal pain and was treated by bypass operation with artificial vessel and uretero-ureterostomy of right ureter under the diagnosis of right ureteral stenosis secondary to right iliac aneurysm. Histological examination showed arteriosclerotic aneurysm and a fibrillary inflammatory change in peri-ureteral tissue without any hemosiderin-laden macrophages. Intravenous pyelography showed improvement of right hydronephrosis 45 days after operation. To date 11 cases including our case have been reported in Japan, 10 in males and the other in a female. Initial symptoms were either lumbago or an abdominal mass with palpitation in many cases. The treatment was by resection of aneurysm with bypass grafting or ureterolysis.

A case of prostatic papillary adenocarcinoma is reported. A 70-year-old male was admitted with the complaint of urinary retention. Suprapubic prostatectomy was performed on July 17, 1984 under the diagnosis of benign prostatic hypertrophy. The bilobes of prostate were 4 X 3 X 3 cm in size and 60 gm in weight. They were very soft and yellow-red. The histopathological examination revealed papillary adenocarcinoma of prostate. Glands were lined by a single or two layers of cuboidal cells with dark cytoplasm and a clear nucleolus. It seemed to arise from the prostatic duct, since serum level of prostatic acid phosphatase was elevated. But it was thought that prostatic carcinoma of acini grew in the papillary pattern, too. Therefore, it was difficult to identify the origin. Only hormone therapy (Honvan) was performed as postoperative anticancer therapy. During the follow up at the clinic, there have been no abnormal findings.

A case of primary right ureteral squamous cell carcinoma with intraperitoneal invasion was studied. The patient was a 38-year-old male with chief complaints of right lumbago and gross hematuria. He was admitted to our clinic suspected of having calculi. However, the radiogram was negative. As the patient was suffering from severe hypogastric pain, indicating acute abdomen, an investigative celiotomy was performed. The tumor that was subsequently revealed formed a mass engulfing the furcation of the right internal and external iliac arteries, ureter, ileum and sigmoid colon. As a radical resection was considered impossible, as much of the tumor as possible was excised and a colostomy was performed. After the operation, a regimen of polypharmacy, including bleomycin, was administered against the residual tumor. This therapy has proved to be remarkably effective. At present, the patient is under regular medical observation, and the postoperative course has been favorable.

A case of primary leiomyosarcoma of the inferior vena cava was reported. The patient, a 74-year-old man, consulted our hospital with complaints of back pain and abdominal mass in right flank. Probe laparotomy revealed a tumor situated in the retroperitoneum and multiple metastatic nodules in the liver. Biopsy was performed and diagnosed as leiomyosarcoma. He was intensively treated with antineoplastic chemotherapy, but his condition gradually aggravated. He died 4 months after admission. The autopsy revealed a right retroperitoneal mass (17 X 12 X 18 cm in size, 1, 340 g in weight) that showed a yellowish appearance. There was also a thumb-tip sized tumor with a stalk in the lumen of inferior vena cava. Both tumors grew in continuity with each other through the wall of inferior vena cava. The tumors were diagnosed as leiomyosarcoma, which derived from inferior vena cava.

7例の膀胱癌患者と, 1例の直腸癌患者に尿路再建術としてColon bladder replacementを行った.1)全例, 尿道からの排尿が可能であるが, 1例のみself catheterizationが必要であった.2)尿流量測定では, 平均最大尿流量は16 ml/secと良好で, 残尿は認められなかった.3) 8例中5例は完全な尿禁制を得たが, 3例には週1～2回の軽度の夜間遺尿があった.4)全例, VURや上部尿路の拡張などの異常所見を認めなかった, Although ileal conduit diversion is widely accepted in the treatment of the patients undergoing radical cystectomy, many patients would prefer other alternatives which allow continence. and urination through the urethra. We describe a new procedure in which a segment of detuburalized right colon is used as a continent reservoir. Eight patients, 7 after radical cystectomy for bladder cancer and one after total exenteration for rectal cancer, have undergone colon bladder replacement. New created bladder had a capacity of 300 to 600 ml. All patients could pass urine through the urethra but one is on self-catheterization. Five of the 8 patients had no residual urine. Three months after operations 4 were totally continent and 3 were satisfactorily dry during daytime but slightly enuretic. Excretory urography showed no abnormalities in their upper urinary tract. Considering the "quality of life' of a patient, this procedure can be an ideal option for selected patients.

This paper presents an autopsy case of primary malignant lymphoma of the urinary bladder. The patient, a 63-year-old man, consulted us because of macroscopic hematuria. Cystoscopy revealed a bladder tumor, which was diagnosed as an anaplastic cell carcinoma by transurethral punch biopsy. The tumor progressively increased in size, despite treatment with preoperative antineoplastic chemotherapy consisting of CDDP. Only ureterocutaneostomy and biopsy were performed at the operation although total cystectomy and ileal conduit had been planned, because the tumor had invaded into the perivesicular tissue. Biopsy revealed B cell lymphoma, which was characterized by specific staining with IgG by the PAP method. Although antineoplastic chemotherapy was performed again after operation, the patient gradually weakened and died 5 months after admission. At autopsy, a hen-egg sized, non-papillary tumor which invading into the perivesicular tissue was found at the anterior wall of the urinary bladder. There were many metastatic nodules in the thraco-lumbar vertebral columns, para-aortic lymphnodes and mesenteric lymphnodes. Lungs and liver were free from metastatic tumors.

Two autopsy cases of prune belly syndrome are reported. In Japan, 111 cases have been reported. Abdominal muscle deficiency or hypoplasia, urinary tract abnormalities and cryptorchidism are usually recognized. Case 1 was a female stillborn at 33 weeks' gestation and case 2 was a male stillborn at 21 weeks' gestation. Both cases had anomalies of genitourinary and digestive system. There was anatomic obstruction of external urethral orifice in case 1 and overriding urethra in case 2 which meant functional obstruction. In relation to the pathogenesis, we propose the important role of the urethral obstruction, whatever anatomic or functional. Further examination of the lower urinary tract including serial section analysis might be necessary to identify the pathogenesis of prune belly syndrome.

Leiomyosarcoma of the left kidney seen in a 58-year-old man is reported. On April 10, 1982, he complained of left flank pain. He visited our hospital and left solitary renal cyst was suspected. He had been treated as an outpatient, but left flank pain became exacervated. On May 18, he was admitted to our hospital. On June 7, radical nephrectomy was done under the diagnosis of left renal cell carcinoma. At operation, the tumor invased directory to the psoas muscle and abdominal wall, and could not be completely resected. Pathological diagnosis was renal cell carcinoma with sarcomatoid change. On July 1, he was discharged from the hospital. In December, left flank distention appeared and back pain became exacervated. On February 8, 1983, he was readmitted to our hospital. Low density area was found in left psoas muscle by CT scanning and recurrence of renal cell carcinoma was suspected. alpha-Interferon therapy had been done, but tumor increased remarkably and caused ileus. He died on June 14, 1983. The autopsy revealed a child head-sized cystic tumor in the upper retroperitoneal space, a 5 X 5 X 5 cm metastasis of the left lobe of the liver, a 3 X 3 X 4 cm tumor to the left upper lobe with cavity formation and direct invasion into the spleen, diaphragma and gastric serosa. These metastatic lesions were leiomyosarcoma. Retrospectively, the primary tumor of kidney revealed primary leiomyosarcoma of kidney.