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We have been engaged in the treatment of urinary tract calculi using extracorporeal shockwave lithotripsy (ESWL) and endourology techniques for more than 8 years. In the treatment of thin staghorn calculi, ESWL monotherapy is the first choice. On the other hand, combination of percutaneous nephrolithotomy (PNL) and ESWL is important for the treatment of thick staghorn calculi in order to avoid the stone street and side effects of shock waves. When the stone is made of hard components such as calcium oxalate monohydrate and cystine, combination of both methods is also useful. In the case of complicated staghorn calculi with isolated branches, open surgery such as nephrolithotomy or partial nephrectomy might be the choice.

1) 55例のTULを術前にD-J catheterを留置した27例, D-J catheterを留置しなかった28例に分類した.2) D-J catheter留置により尿管の拡張がえられ, 尿管ブジーを要さずに容易に尿管鏡の挿入が行える.3)尿管鏡操作が容易なために手術時間の短縮ができる.4)尿管の拡張は3日間のD-J catheterの留置で充分であった.5)膀胱刺激症状を与えた症例もあるが, 症状に耐えられず抜去することはなかった.6) D-J catheter留置の有無にかかわらず術後の経過に差異はなく, 経過観察期間にはTULによる尿管狭窄は認められなかった, Transurethral lithotripsy (TUL) was performed in the cases in which the ureteral calculi were not destroyed by the extracorporeal shock-wave lithotriptor (Dornier HM-3, EDAP LT 01). Preoperative placement of double-J ureteral catheter (D-J catheter) caused ureteral dilation, allowing smooth insertion of the ureteroscope. We divided the 55 TUL cases into two groups, those with (27) or without (28) a D-J catheter placed preoperatively, and compared requirement of ureteral bougination, difficulty of ureteroscope insertion and duration of operation between the two groups. In all cases with a D-J catheter, ureteral bougination was not necessary, the insertion of ureteroscope was easier and the duration of operation was shorter than the cases without a D-J catheter. Bladder irritable symptoms were seen in some cases with a D-J catheter but did not require removal of the D-J catheter. On the follow-up term after TUL, there was no difference in the incidence of postoperative fever or postoperative ureteral stenosis, between the cases with and those without a D-J catheter.

今日ESWLが腎尿管結石治療の中心的役割を果すようになった要因として, 第二・第三世代の装置の開発と, endourologyのバックアップにより, 治療適応の範囲が拡大されたこと, さらに衝撃波を節約して合併症を極力おさえ, 術後のstone streetへの対処がスムーズに行えるようになったことが考えられる, The pitfall of extracorporeal shock-wave lithotripsy (ESWL), such as complications of ESWL, problems of focus and results of stone disintegration are discussed. The progress of ESWL today is mainly due to the development of new generation lithotripters and endourological support, which has broadened the indications of ESWL. The necessary shock-waves have been selected, and complications have been reduced. Post ESWL stone street is now easier to treat. We expect more improved lithotripters such as by incorporation of X-ray and echo focusing systems. Endourological techniques including laser lithotripsy also should be improved.

A Clinical statistic survey was carried out on the patients, diseases, and the treatments undertaken at the Ward of Department of Urology, Kyoto University Hospital during the years of 1985 to 1988.

We have been engaged in the treatment of urinary tract calculi using extracorporeal shockwave lithotripsy (ESWL) and endourology techniques for more than 8 years. In the treatment of thin staghorn calculi, ESWL monotherapy is the first choice. On the other hand, combination of percutaneous nephrolithotomy (PNL) and ESWL is important for the treatment of thick staghorn calculi in order to avoid the stone street and side effects of shock waves. When the stone is made of hard components such as calcium oxalate monohydrate and cystine, combination of both methods is also useful. In the case of complicated staghorn calculi with isolated branches, open surgery such as nephrolithotomy or partial nephrectomy might be the choice.

Transurethral lithotripsy (TUL) was performed in the cases in which the ureteral calculi were not destroyed by the extracorporeal shock-wave lithotriptor (Dornier HM-3, EDAP LT 01). Preoperative placement of double-J ureteral catheter (D-J catheter) caused ureteral dilation, allowing smooth insertion of the ureteroscope. We divided the 55 TUL cases into two groups, those with (27) or without (28) a D-J catheter placed preoperatively, and compared requirement of ureteral bougination, difficulty of ureteroscope insertion and duration of operation between the two groups. In all cases with a D-J catheter, ureteral bougination was not necessary, the insertion of ureteroscope was easier and the duration of operation was shorter than the cases without a D-J catheter. Bladder irritable symptoms were seen in some cases with a D-J catheter but did not require removal of the D-J catheter. On the follow-up term after TUL, there was no difference in the incidence of postoperative fever or postoperative ureteral stenosis, between the cases with and those without a D-J catheter.

The pitfall of extracorporeal shock-wave lithotripsy (ESWL), such as complications of ESWL, problems of focus and results of stone disintegration are discussed. The progress of ESWL today is mainly due to the development of new generation lithotripters and endourological support, which has broadened the indications of ESWL. The necessary shock-waves have been selected, and complications have been reduced. Post ESWL stone street is now easier to treat. We expect more improved lithotripters such as by incorporation of X-ray and echo focusing systems. Endourological techniques including laser lithotripsy also should be improved.

A Clinical statistic survey was carried out on the patients, diseases, and the treatments undertaken at the Ward of Department of Urology, Kyoto University Hospital during the years of 1985 to 1988.

A recent four year statistic survey carried out on the patients in the Urological Outpatients Clinic of Kyoto University Hospital is reported.

前立腺癌23例に対し, MRIを施行した.内6例に全摘術を施行したが, stagingはMRIがperiprostatic plexusの描出や精嚢浸潤の判断の容易さなどにより最も正確であった.また限局した癌は, MRIではT2-WI上high intensityを示すべき外腺内のlow intensity areaとして描出され, USでは, hypoechoic areaとして描出された.広範な癌ではMRIでは内外腺の境界線の一部または全部の消失として判断できたが, USでは全体にheterogenousなエコーを示した.CTは限局性の癌に対してほとんど不用であった, Twenty-three pathologically revealed prostatic cancer patients were examined by magnetic resonance imaging (MRI), computed tomography (CT) and transrectal ultrasonography, (US) and 6 of them underwent radical prostatectomy. A localized prostatic cancer was identified as a low intensity area in the outer zone with high intensity or showed a partial or total destruction of the border line between the internal and the outer zone when cancer invaded into the internal zone from the outer zone, on T2 weighted image of MRI, as we have already reported. On US, a localized prostatic cancer was identified as a hypoehoic area in the outer zone, and showed a heterogeneous image when cancer enlarged. On CT, a localized cancer could not be identified. A diagnostic criteria for local staging by MRI was made and preoperative staging were done in 6 total prostatectomy cases. The accuracy of preoperative staging of cancer seemed to be the highest by MRI, because it was more accurate in diagnosing the extracapsular invasion, seminal vesicle invasion and bladder neck invasion of the tumor than by CT and US.

前回の入院患者臨床統計に引き続き1983年1月から1984年12月までの臨床統計を行なった.入院患者予算ベッド数は60で, 占拠率は常時ほぼ80%以上であった.患者数は825名, 性別男子670名, 女子155名で, 男子の比率が増加しているが, 主に前立腺肥大症を含む, 尿路性器腫瘍の増加による.50歳以上の入院が1983年54.1%, 1984年55.8%であった.頻度の高い腫瘍, 結石, 尿路性器奇型の頻度は, 1983年度でそれぞれ47.5, 21.4, 22.6%であり, 1984年には45.2, 25.1, 16.2の割合であった.腫瘍のうちでは前立腺腫瘍, 膀胱腫瘍が大半を占めた.結石では上部尿路結石症が著増を示し, 尿路性器奇形では腎嚢胞をこの項に含めた.尿路性器腫瘍患者の割合は, 1979年以後は1981年を除き常に40%を越えている.死亡46名, 剖検率80.4%であった.年間の手術件数は手術の対象となった臓器の組み合わせで分類した, A clinical statistic survey was carried out on the patients, diseases, and the treatments undertaken at the Ward of Department of Urology, Kyoto University Hospital during the years of 1983 to 1984.

1983, 1984年の2年間の当科外来患者臨床統計を行なった.1983年は男性3070人, 女性1715人で合計4821人, 1984年は男性3152人, 女性1703人の合計4855人で男女比はほゞ2:1であった.年齢階層別には1983年と比べ1984年には70歳以上が5倍弱の増加を示した.疾患別患者数では尿石症は下部尿路結石の割合が依然として低く, 全尿石症の2～3%に過ぎなかった.腎盂腎炎の頻度は前回調査と同じで女性が男性の2倍を占めた.STDの明らかな増加は見られなかった.尿性器結核も前回とほゞ同じ傾向であった.尿性器腫瘍も前回と比べ著しい変化を示したものはなく, その他の上・下部尿路疾患もほゞ同様であったが, 原因不明熱で来院する患者の増加が予測された.内視鏡検査は1983年には延べ1157件, 1984年には970件, IVPやDIPは年間約2400件行なわれた, The statistics of the patients seen at our Urological Outpatients Clinic during 1983 and 1984 are reviewed.

21症例22腎嚢胞に対して, 超音波ガイドによる経皮的な腎嚢胞穿刺と嚢胞再発防止のための95%エタノール注入をおこなった.1)エタノール注入後3ヵ月～2年4ヵ月(平均12ヵ月)のfollow-upで, 超音波断層検査上, 嚢胞性病変は全例に消失し, CT上, 嚢胞の著明な縮小と嚢胞壁の肥厚を認めた.2) IVPと99mTc-DMSA腎シンチグラム上, 穿刺側で形態的には著明な改善を認め, 機能的にも僅かではあるが, 有意にDMSA腎摂取率の増加を認めた.3)副作用として, 穿刺注入操作にともなって, 1例にカテーテル先端の断裂, 残存を認めたが, 他には重篤なものはなかった.注入エタノールによる局所刺戟症状を全例に, 約半数に熱感～酒酔い感を訴えたが, いずれも一過性であった.1例にエタノール注入後Cephem系抗生物質の使用によりアンタビュース様作用が出現した, Ultrasound-guided renal cyst puncture was performed on 22 cysts which were then 95% ethanol instilled to prevent recurrence of cystic fluid. Cystic lesions disappeared on the ultrasonogram in the follow-up period of 3 to 28 months. On CT, cystic lesions became smaller size but did not disappear. Average CT numbers of the cyst were 8.75 +/- 3.83 before and 12.96 +/- 3.27 after ethanol instillation. The cystic wall became thicker. Caliceal distortion and/or pelvis compression by cystic lesions improved on IVP 2 to 3 days after ethanol instillation. The renal image on Tc-99m-DMSA scintigram showed morphological improvement and DMSA renal uptake rate increased slightly but significantly 2 to 4 weeks after ethanol instillation. There were no major complications with this procedure except for one case in which the tip of the catheter became stuck in the cyst and broke off when the catheter was removed. A slight local irritable pain was noticed in all cases. Half of the patients had hot flushes and/or somewhat drunken sense but these symptoms were only temporary. Antabuse phenomenon appeared in one case with concomitant use of a cephem antibiotics after ethanol instillation. This method of therapy is a safe non-surgical approach to treat renal cysts. 95% ethanol instillation in the cyst seems to prevent recurrence of cystic fluid.

A case of von Recklinghausen's disease localized to the lower abdominal and the external genital region is reported. The patient was a 14-year-old male who complained of an abnormality of the external genitalia. There was a subcutaneous mass with the skin pigmentation, which surrounded the penis, so that the foreskin appeared like a cyst. Excision of the subcutaneous mass and plastic operation of the penis were performed. Histological examination showed it to be diffuse neurofibroma. There has been no recurrence two years after the operation. This type of von Recklinghausen's disease has not been reported in Japan.

A statistic survey was carried out on the patients, diseases, and operations experienced at the urological ward of Kyoto University Hospital during the years of 1977 to 1982.

A case of renal call carcinoma associated with horseshoe kidney is reported. The patient was a 59-year-old woman complaining of right flank mass. Radiological examination showed right renal tumor and horseshoe kidney, and right nephrectomy was performed. Histological examination showed it to be clear cell type renal cell carcinoma. Only 17 cases of horseshoe kidney with renal cell carcinoma have been reported in Japan. We report the 18th case with a review of the literature.

A clinical statistic survey was carried out on the patients, diseases, and the treatments undertaken at the Ward of Department of Urology, Kyoto University Hospital during the years of 1983 to 1984.

A statistic survey was carried out on the patients, diseases, and operations experienced at the urological ward of Kyoto University Hospital during the years of 1977 to 1982.

A recent six year statistic survey was carried out on the patients in the Urological Outpatients Clinic of Kyoto University Hospital.

Twenty-three pathologically revealed prostatic cancer patients were examined by magnetic resonance imaging (MRI), computed tomography (CT) and transrectal ultrasonography, (US) and 6 of them underwent radical prostatectomy. A localized prostatic cancer was identified as a low intensity area in the outer zone with high intensity or showed a partial or total destruction of the border line between the internal and the outer zone when cancer invaded into the internal zone from the outer zone, on T2 weighted image of MRI, as we have already reported. On US, a localized prostatic cancer was identified as a hypoehoic area in the outer zone, and showed a heterogeneous image when cancer enlarged. On CT, a localized cancer could not be identified. A diagnostic criteria for local staging by MRI was made and preoperative staging were done in 6 total prostatectomy cases. The accuracy of preoperative staging of cancer seemed to be the highest by MRI, because it was more accurate in diagnosing the extracapsular invasion, seminal vesicle invasion and bladder neck invasion of the tumor than by CT and US.

A case of von Recklinghausen's disease localized to the lower abdominal and the external genital region is reported. The patient was a 14-year-old male who complained of an abnormality of the external genitalia. There was a subcutaneous mass with the skin pigmentation, which surrounded the penis, so that the foreskin appeared like a cyst. Excision of the subcutaneous mass and plastic operation of the penis were performed. Histological examination showed it to be diffuse neurofibroma. There has been no recurrence two years after the operation. This type of von Recklinghausen's disease has not been reported in Japan.

The statistics of the patients seen at our Urological Outpatients Clinic during 1983 and 1984 are reviewed.

Ultrasound-guided renal cyst puncture was performed on 22 cysts which were then 95% ethanol instilled to prevent recurrence of cystic fluid. Cystic lesions disappeared on the ultrasonogram in the follow-up period of 3 to 28 months. On CT, cystic lesions became smaller size but did not disappear. Average CT numbers of the cyst were 8.75 +/- 3.83 before and 12.96 +/- 3.27 after ethanol instillation. The cystic wall became thicker. Caliceal distortion and/or pelvis compression by cystic lesions improved on IVP 2 to 3 days after ethanol instillation. The renal image on Tc-99m-DMSA scintigram showed morphological improvement and DMSA renal uptake rate increased slightly but significantly 2 to 4 weeks after ethanol instillation. There were no major complications with this procedure except for one case in which the tip of the catheter became stuck in the cyst and broke off when the catheter was removed. A slight local irritable pain was noticed in all cases. Half of the patients had hot flushes and/or somewhat drunken sense but these symptoms were only temporary. Antabuse phenomenon appeared in one case with concomitant use of a cephem antibiotics after ethanol instillation. This method of therapy is a safe non-surgical approach to treat renal cysts. 95% ethanol instillation in the cyst seems to prevent recurrence of cystic fluid.

A case of renal call carcinoma associated with horseshoe kidney is reported. The patient was a 59-year-old woman complaining of right flank mass. Radiological examination showed right renal tumor and horseshoe kidney, and right nephrectomy was performed. Histological examination showed it to be clear cell type renal cell carcinoma. Only 17 cases of horseshoe kidney with renal cell carcinoma have been reported in Japan. We report the 18th case with a review of the literature.