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Background and Objectives: The holmium laser has a short absorption depth in tissue and possesses excellent properties both in ablation and hemostasis. We have performed endoscopic incision for ureteral stricture using the holmium laser through a small-caliber ureteroscope. Methods: This method was used on five patients and seven ureters. The etiology of the stricture was stone scar in two patients, ureteroenteroanastomosis of Indiana urinary pouch in two, and primary in one. We used an 8F semi-rigid or 6.9F flexible ureteroscope. No prior procedures, such as balloon dilation, were necessary in any of the cases. The stricture was incised with the holmium laser using a 365-μm fiber through the working channel of the ureteroscope. The holmium laser operated at a wavelength of 2100 nm, with an output of 1.0J/pulse at a rate of 10 Hz. After completion of the incision, a 12F Double-J catheter was left in for six weeks. Results: The mean operative time was 89 minutes. The stricture resolved completely in all cases at an average follow-up of 8.6 months. Conclusions: The holmium laser incision for ureteral stricture using a small-caliber ureteroscope is an easy-to-perform, safe and effective procedure.

1981年から1995年迄の間に膀胱全摘除術が行われた原発性膀胱移行上皮癌77例を対象にした.77例中27例に再発が認められ, 1, 2, 3年非再発率はおのおの75.3, 64.9, 63.3%であった.手術後再発迄の期間は平均12.1ヵ月で, 27例中25例が2年以内に再発した.初回再発部位として27例中, 骨髄内再発のみ6例, 遠隔転移のみ18例, 骨盤内再発及び遠隔転移1例尿道再発2例であった.遠隔臓器転移の部位としては骨が最も多く, ついで肺の順であった.全体の原因特異的生存率は1年84.7%, 3年71.1%, 5年65.6%であり, 27例中25例が膀胱癌死した.再発及び予後との関係について単変量及びCoxの比例ハザードモデルを用いた多変量解析を行った.深達度, リンパ管侵襲, 静脈侵襲, 浸潤増殖様式, 所属リンパ節転移は, 単変量解析では有意な再発危険因子及び予後因子であったが, 多変量解析ではリンパ管侵襲のみが有意な再発及び予後に対する危険因子であった, A clinico-pathological study was performed retrospectively for 77 patients undergoing total cystectomy for primary transitional cell carcinoma of the urinary bladder between 1981 and 1995 to clarify the mode of recurrence, the risk factors which may affect recurrence following cystectomy and prognostic factors. Postoperative recurrence was recognized in 27 (35.1%) out of 77 patients and the one-, two- and three-year non-recurrent rates by the Kaplan-Meier method were 75.3, 64.9% and 63.3%, respectively. The duration from cystectomy to recurrence was 1 to 102 months with a mean of 12.1 months, and approximately 92.6% of recurrence occurred within two years. Among 27 patients with recurrence, pelvic recurrence, distant metastasis, both of them and urethral recurrence were recognized in 6 (22.2%), 18 (66.7%), 1 (3.7%) and 2 (7.4%), respectively as the first site of recurrence. The overall one-, three- and five-year cause-specific survival rates of the 77 patients were 84.7, 71.1% and 65.6%, respectively. Of the 27 patients with recurrence, 25 (92.6%) died of bladder cancer. Of the factors related to recurrence or prognosis, pathological stage, lymphatic invasion, venous invasion, type of infiltration and lymph node metastasis but not pathological grade or adjunctive chemotherapy were significant risk factors for recurrence and prognostic factors in univariate analysis. However, lymphatic invasion was the only significant risk factor for recurrence and prognosis in multivariate analysis using Cox's proportional hazard model.

We report here two cases of priapism. One of these cases was suspected to be drug induced and high and low flow mixed type. The patient had taken the drugs, alpha-blocker for hypertension and dysuria by BPH for a long time. He was treated by a caveno-glandular shunt. After surgery, detumescence was obtained for some time, but erection appeared again soon. Transcatheter embolization of the internal pudendal arteries was then performed, and detumescence became permanent. The other case was an idiopathic and high flow type. Detumescence was achieved soon by transcatheter embolization of the internal pudendal arteries only, then he experienced morning erection imperfectly on the 9th day after this treatment. The management of priapism as reported to date is also reviewed.

1)TUR-P患者においてCDZMは, 静脈内投与で速やかな前立腺内組織移行性を示した。2)CDZM 1gと2g投与間にdose responseが認められた。3)CDZMは, 泌尿器科領域感染症の起炎菌に対するMICに比して, 十分な組織移行性を示した。細菌性前立腺炎および前立腺疾患術後の感染予防に対し, CDZMは, 有効な薬剤である, Twenty-four patients suffering from prostate hyperplasia were given venous injections of CDZM of either 1 or 2 g at specific intervals (30 min, 1, 2 and 4 hr) before surgery. Blood samples from the injected vein and tissue samples from the prostate were subsequently taken. In this study, the concentrations of CDZM in the prostate tissue (P) and in serum (S), as well as the ratio of the tissue to serum concentrations (P/S) were determined. In patients given 1 g injections, P ranged from 5.26-48.10 micrograms/g, while S ranged from 25.40-130.00 micrograms/ml and P/S ranged from 12.6-37.0%. In the patients given 2 g injections, P ranged from 9.40-49.20 micrograms/g, S ranged from 62.30-234.00 micrograms/ml and P/S ranged from 9.3-29.1%. CDZM exhibited excellent transmigration to the prostate tissue. Inflammatory bacteria present in prostatitis and urinary tract infections are generally those of E. coli, Proteus sp., but because the P range was much higher than the ratio of MIC, CDZM is expected to be useful against infections in the field of urology.

MFL-5000で治療し, 3ヵ月経過観察した40例について, 1)40例の尿路結石症に対し, 1ヵ月後の, 排石率は67.5%27例に完全排石を認め, 3ヵ月後には, 85.0% 34例に排石率は上昇した。2)40例に対し1例のみ硬膜外麻酔を行い, 無麻酔症例において疼痛を訴えた症例に対しては, 鎮痛剤の投与のみにて対処し, 十分に除痛効果をえられた。3)治療を必要とした重篤な副作用は認めなかった, Our hospital recently installed one of the newest types of extracorporeal shock wave lithotripters, a Dornier MFL 5000-(U). We conducted preliminary clinical trials with the apparatus from April to June 1991. In this report we discuss our experience with the first 40 patients (52 stones) treated in a total of 52 extracorporeal shock wave lithotripsy (ESWL) sessions. Follow up observation was conducted for three months. Except in one case, invasive anesthesia was not used. A double J-catheter was inserted in 13 cases, a ureteral catheter in 7 cases, and percutaneous nephrolithotripsy (PNL) was used after ESWL in one case. After one month of follow-up, 27 patients (67.5%) were completely free from stone fragments, while at 3 months after treatment, 34 patients (85.0%) were free from stone fragments. No serious complications were observed after ESWL. We concluded that the Dornier MFL-5000-(U) apparatus is effective for renal and ureteral stones and generates no serious complications.

'88年1月より'91年12月までの4年間に尿路感染(UTI)と診断された患者からの尿中分離菌を集計し, 菌頻度の年次的変遷とニューキノロン系を中心とした感受性を検討した。外来単純性UTIからの分離菌総数は352株でE. coliが毎年約90%を占めた。外来複雑性の671株ではEnterococcus sp, fungi, other GNRおよび前記後二者が多く, やはり後二者が増加傾向である。E. coliはABPC, preoteus spはMINO, 以外には感受性を示す。P aeruginosaはG.M.以外の薬剤には耐性株が多く, S. aureusはMINO以外に耐性株が多い。一般に入院複雑性UTIではNFLXの感受性の有意の低下がある。ニューキノロン系薬剤では各菌種に対しTFLXが最も良好な抗菌力を示し, ついでCPFXで他の薬剤より1～2管程度低いMIC80値を示した, Statistical analyses were conducted on bacterial strains isolated from the urine of patients with urinary tract infections (UTI) in the Department of Urology at Aichi Medical University from January 1988 through December 1991. The drug sensitivity of the bacterial strains isolated from patients with complicated UTI between 1988 and 1991 was analyzed and compared. Among the outpatients with uncomplicated UTI, a total of 352 strains were isolated. E. coli was isolated the most frequently (90.1%). Among the outpatients with complicated UTI, a total of 829 strains were isolated. Enterococcus sp. was isolated the most frequently (21.2%). P. aeruginosa and S. aureus showed a tendency to increase. Among the inpatients with complicated UTI, a total of 671 strains were isolated. Enterococcus sp. was isolated the most frequently (22.5%). P. aeruginosa and S. aureus showed a tendency to increase, while E. coli and Enterobacter sp. showed a tendency to decrease. E. coli was highly sensitive to all drugs except ampicillin (ABPC). Proteus sp. and Klebsiella sp. were highly sensitive to norfloxacin (NFLX). P. aeruginosa was highly sensitive to gentamicin (GM). The frequency of NFLX-sensitive P. aeruginosa significantly dropped from 84.6% to 40.9% among the outpatients (P < 0.01), and from 75.0% to 44.4% among inpatients (P < 0.05). S. aureus was highly sensitive only to minocycline (MINO). The frequency of NFLX-sensitive S. aureus significantly dropped from 66.6% to 23.3% among inpatients (P < 0.05). Enterococcus sp. was highly sensitive to ABPC and MINO. Of the new quinolones, tosufloxacin (TFLX) had the strongest antimicrobial activity followed by (ciprofloxacin) CPFX on all the bacterial strains tested.

We report here two cases of priapism. One of these cases was suspected to be drug induced and high and low flow mixed type. The patient had taken the drugs, alpha-blocker for hypertension and dysuria by BPH for a long time. He was treated by a caveno-glandular shunt. After surgery, detumescence was obtained for some time, but erection appeared again soon. Transcatheter embolization of the internal pudendal arteries was then performed, and detumescence became permanent. The other case was an idiopathic and high flow type. Detumescence was achieved soon by transcatheter embolization of the internal pudendal arteries only, then he experienced morning erection imperfectly on the 9th day after this treatment. The management of priapism as reported to date is also reviewed.

Twenty-four patients suffering from prostate hyperplasia were given venous injections of CDZM of either 1 or 2 g at specific intervals (30 min, 1, 2 and 4 hr) before surgery. Blood samples from the injected vein and tissue samples from the prostate were subsequently taken. In this study, the concentrations of CDZM in the prostate tissue (P) and in serum (S), as well as the ratio of the tissue to serum concentrations (P/S) were determined. In patients given 1 g injections, P ranged from 5.26-48.10 micrograms/g, while S ranged from 25.40-130.00 micrograms/ml and P/S ranged from 12.6-37.0%. In the patients given 2 g injections, P ranged from 9.40-49.20 micrograms/g, S ranged from 62.30-234.00 micrograms/ml and P/S ranged from 9.3-29.1%. CDZM exhibited excellent transmigration to the prostate tissue. Inflammatory bacteria present in prostatitis and urinary tract infections are generally those of E. coli, Proteus sp., but because the P range was much higher than the ratio of MIC, CDZM is expected to be useful against infections in the field of urology.

Our hospital recently installed one of the newest types of extracorporeal shock wave lithotripters, a Dornier MFL 5000-(U). We conducted preliminary clinical trials with the apparatus from April to June 1991. In this report we discuss our experience with the first 40 patients (52 stones) treated in a total of 52 extracorporeal shock wave lithotripsy (ESWL) sessions. Follow up observation was conducted for three months. Except in one case, invasive anesthesia was not used. A double J-catheter was inserted in 13 cases, a ureteral catheter in 7 cases, and percutaneous nephrolithotripsy (PNL) was used after ESWL in one case. After one month of follow-up, 27 patients (67.5%) were completely free from stone fragments, while at 3 months after treatment, 34 patients (85.0%) were free from stone fragments. No serious complications were observed after ESWL. We concluded that the Dornier MFL-5000-(U) apparatus is effective for renal and ureteral stones and generates no serious complications.

Statistical analyses were conducted on bacterial strains isolated from the urine of patients with urinary tract infections (UTI) in the Department of Urology at Aichi Medical University from January 1988 through December 1991. The drug sensitivity of the bacterial strains isolated from patients with complicated UTI between 1988 and 1991 was analyzed and compared. Among the outpatients with uncomplicated UTI, a total of 352 strains were isolated. E. coli was isolated the most frequently (90.1%). Among the outpatients with complicated UTI, a total of 829 strains were isolated. Enterococcus sp. was isolated the most frequently (21.2%). P. aeruginosa and S. aureus showed a tendency to increase. Among the inpatients with complicated UTI, a total of 671 strains were isolated. Enterococcus sp. was isolated the most frequently (22.5%). P. aeruginosa and S. aureus showed a tendency to increase, while E. coli and Enterobacter sp. showed a tendency to decrease. E. coli was highly sensitive to all drugs except ampicillin (ABPC). Proteus sp. and Klebsiella sp. were highly sensitive to norfloxacin (NFLX). P. aeruginosa was highly sensitive to gentamicin (GM). The frequency of NFLX-sensitive P. aeruginosa significantly dropped from 84.6% to 40.9% among the outpatients (P < 0.01), and from 75.0% to 44.4% among inpatients (P < 0.05). S. aureus was highly sensitive only to minocycline (MINO). The frequency of NFLX-sensitive S. aureus significantly dropped from 66.6% to 23.3% among inpatients (P < 0.05). Enterococcus sp. was highly sensitive to ABPC and MINO. Of the new quinolones, tosufloxacin (TFLX) had the strongest antimicrobial activity followed by (ciprofloxacin) CPFX on all the bacterial strains tested.