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A 27-year-old Japanese man visited our urological department due to urinary frequency, and we detected a ureterocele by cystoscopy. The treatment consisted of an endoscopic-laser incision of the ureterocele. After the operation, the patient’s symptoms subsided, and the vesicoureteral reflux and urinary infection disappeared. With the advances in image diagnostic technology, a ureterocele is easily diagnosed during childhood. In the present case, the ureterocele may have increased in volume over a period of decades, causing the urinary frequency. An endoscopic incision is the standard treatment for ureterocele, but there are concerns about vesicoureteric reflux after the endoscopic-laser incision, the patient is still doing well. The present case indicates that endoscopic-laser incision is an effective treatment for a ureterocele, at least in adult patients.

A 60-year-old man was examined at a local clinic for difficulty in urinating, and was diagnosed with prostatic hypertrophy. He was referred to our department because his prostate-specific antigen (PSA) level was elevated (276 ng/ml). His Gleason score was 4＋3, there was one bone metastasis in the left ileac bone, and multiple lung metastases were present. The patient was accordingly diagnosed with stage D2 prostate cancer. Lutenizing hormone-releasing hormone (LH-RH) analogue treatment was initiated in April 1999, and 9 months later the PSA level had decreased to 4.3 ng/ml. Six years and 9 months after the start of hormone therapy, the cancer had developed into castration-resistant prostate cancer and the PSA level had risen to 43.8 ng/ml. Paclitaxel-carboplatin therapy was therefore initiated. Eight months after the start of chemotherapy, the PSA level had decreased to 25.9 ng/ml, but 6 years and 1 month later it had risen to 925 ng/ml, and the chemotherapy was discontinued. Docetaxel-predonine therapy was initiated in March 2012. Three months after the start of chemotherapy, the PSA level had decreased to 3.1 ng/ml, and the bone metastasis was reduced.

In this study we investigated the influences of decreased levels of activities of daily living (ADL), especially in bedridden patients, on lower urinary tract dysfunction and urinary management during hospital care. All 1, 106 non-urological inpatients (896 non-bedridden patients and 210 bedridden patients) with an indwelling urethral catheter treated at Noto General Hospital between April 2006 and October 2009 were retrospectively evaluated. Maximum bladder capacity and post-void residual urine volume (PVR) were evaluated with uroflowmetry or voiding cystourethrography at the time the catheter was removed. Clean intermittent catheterization (CIC) and drug administration were performed for patients who had a PVR of 100 ml or more. Bedridden patients required urinary interventions at a higher rate than did non-bedridden patients (bedridden : 29.0%, non-bedridden : 17.6%). Although indwelling urethral catheters were reinserted in 13 patients in the bedridden group and 16 patients in the non-bedridden group, many patients in both groups could be free from the catheter. Our results indicate that patients with low ADL are vulnerable to impaired bladder emptying, and early diagnosis of impaired bladder emptying and active urinary management are required to solve their urinary problems.

The pathophysiology in the development of overactive bladder syndrome (OAB) possibly due to benign prostatic hyperplasia (BPH) has not fully been understood. The clinical study in male outpatients aged over 50 years with lower urinary tract symptoms showed that the frequency of urgency was significantly associated with aging, bladder outlet obstruction (BOO) and benign prostatic enlargement (BPE). From the results of the experiments we did using rats, the mechanisms underlying the development of OAB were suggested as follows. The functional impairment of acetylcholine neuron in the central nervous system is induced by aging and decreases the bladder capacity. Non-voiding contractions of the bladder may have some bearing on OAB associated with BOO. The C-fiber in the urethra may be involved in the generation of the detrusor overactivity associated with BPE. These results showed that the pathophysiology of OAB related to BPH is quite complex, suggesting that a multidisciplinary approach is necessary for the treatment.

This chapter critically reviews the literature on surgery for stress urinary incontinence (SUI) and pelvic organ prolapse (POP), and medical treatment for overactive bladder in women. The midurethral polypropylene sling was reported to provide a durable option with significant improvement. The tension-free vaginal tape (TVT) procedure is based on a theory of pathophysiology of stress incontinence presented by Petros and Ulmsten. In their "integral theory" impairment of the pubourethral ligament is one of the primary cause of SUI. The transobturator sling was found to be effective in SUI patients with less incidence of perioperative complications and voiding difficulties. Prolapse of the uterus/vaginal apex and posterior vaginal wall may also be found in women with stress incontinence. There are many procedures for the correction of POP. Transvaginal repair of anterior and posterior compartment prolapse with polypropylene mesh has been developed in recent years. It is necessary to assess and compare the current quality of outcomes.

21歳の日本人男性がBMX競技中に会陰部を強打し, 会陰部疼痛, 肉眼的血尿, 陰嚢皮下出血を訴え受診した.逆行性尿道造影にて球部尿道に造影剤の溢流があり, 断裂が明らかとなった.陰嚢超音波検査では両側精巣内に複数の小石灰化が認められた.オフロード用自転車のサドルによる持続的な衝撃と振動のために生じた精巣の石灰化の1例を報告する(著者抄録), A 21-year-old Japanese man who was a professional bicycle motocross rider injured his perineum during a competition. Chief complaints were gross hematuria, perineal pain, and subcutaneous ecchymosis of the scrotum. Urethrocystography revealed a torn bulbar urethra and extravasation in the same region. Scrotal ultrasonography revealed small calcifications in the bilateral testes. Here, we report a case of bilateral testicular calcifications caused by the continuous shock and vibration of the saddle in an off-road bicycle rider.

The patient was a 72-year-old man with C4 incomplete tetraplegia incurred in a traffic accident in March, 2008. He managed his bladder with an indwelling Foley catheter. In August, 2009, the catheter obstruction induced autonomic dysreflexia (AD). Although distention of bladder disappeared immediately, cerebeller hemorrhage occurred due to AD. After an operation the patient was alive but left with disturbance of consciousness. AD is one of the most important complications of high-level spinal cord injury. The pathophysiology of AD is the disconnection of the spinal sympathetic centers from spuraspinal control, leading to unopposed, sustained sympathetic outflow below the spinal lesion. Clinically, it is characterized by an acute increase in blood pressure, headache, sweating, and facial flushing and is often triggered by nonspecific stimuli below the level of the spinal cord lesion. The main triggering factors are bladder overdistension and bowel distension. Most events subside after prompt recognition and removal of the triggering factors, but, it is a life threatening emergency that may lead to apoplexy. This life-threatening complication should be kept in mind in the patients with spinal cord injury.

The International Continence Society (ICS) recently derived a consensus symptomatic definition of overactive bladder (OAB) as urinary urgency, with or without urge incontinence, usually with frequency and nocturia. These symptom combinations are suggestive of urodynamically demonstrable detrusor overactivity. The etiology of OAB falls into two broad categories: neurogenic and nonneurogenic. It is not easy to confirm the etiology of OAB in patients with bladder outlet obstruction and neurological disease. This debate has attempted to examine the pathophysiology of OAB and to determine the optimal treatment strategy in a patient with two diseases possibly causing OAB. A 75-year-old man visited our hospital due to symptoms of OAB (urgency, nocturia, and urge incontinence) occurring after cerebrovascular accidents. Urge incontinence worsened concomitantly with the appearance of turbid urine. Urinary tract infection was accompanied by 84 ml of post-void residual. The prostate volume and PSA value were 28 ml and 1.2 ng/ml, respectively. The total International Prostate Symptom Score (IPSS) and Quality of Life (QOL) Index were 23 and 5, respectively. IPSS for storage symptoms was higher than that for obstructive symptoms. The maximum flow rate, measured after treatment for UTI, was 9.4 ml/s. Two debaters discuss the treament modality, TURP, or pharmacotherapy.

難治性の尿失禁を有する神経因性膀胱症例9例に対し塩酸オキシブチニンの膀胱内注入療法を施行した.注入1ヵ月後に最大膀胱容量は128mlから212mlへと増大したが, 有意差は認められなかった.過活動型膀胱には平均175%の膀胱容量の増加が認められたが, 低活動型では平均13%であった.又, 無効例では尿道閉鎖圧の低い症例が多かった.現在2例のみが膀胱内注入を継続している, Nine patients with persistent urinary incontinence due to neurogenic bladder and intolerable systemic side effects on oral anticholinergic agents were treated with intravesical instillation of oxybutynin hydrochloride. Two tablets (6 mg) dissolved in 10 ml of physiological saline or sterile water were instilled into the bladder two times daily via self intermittent catheterization. The mean bladder capacity increased from 128 to 212 ml 1 month after intravesical instillation of oxybutynin hydrochloride, although this difference was not significant. The bladder was augmented more efficaciously in patients with overactive detrusor than patients with an underactive detrusor. Subjective improvement was recognized in 4 patients. Among 5 patients who discontinued therapy due to ineffective results, maximum urethral closure pressure below 50 cmH2O was seen in 4. Intravesical instillation of oxybutynin hydrochloride was considered to be ineffective clinically in patients with underactive detrusor and low urethral closure pressure. Although no systemic side effects were observed, a decrease of bladder capacity was recognized in 2 patients.

We present a case of colovesical fistula due to sigmoid colon diverticulitis. A 63-year-old woman was referred to our department with the complaints of dysuria, turbid and foul smelling urine. She was treated twice for acute cystitis at the referral hospitals. A diagnosis of colovesical fistula was confirmed on barium enema. She underwent partial resection of sigmoid colon with primary anastomosis and partial cystectomy with repair of bladder wall and covered with omentum. Retrograde cytography taken on the 20th post-operative day revealed no leakage of contrast medium. She was asymptomatic at 3 months of follow-up.

25歳未婚男.左精巣腫瘍に高位精巣摘除術を施行され, 約3年後に右陰嚢内に腫瘤を認めた.超音波断層検査上右精巣内にlow echoic lesionを認め, MRIではT2強調画像で径2cmのlow intensityに強調される部位を認めた.CTでは後腹膜等にリンパ節転移は認めなかった.以上から右精巣腫瘍と診断し, 精巣機能の温存を強く希望されたため, 精液を冷凍保存した上で, 右精巣部分切除を施行した.摘出標本の病理結果はseminomaであり, 生検組織中にCarcinoma in situを認めなかった.術後の精液検査の結果は無精子症であったが, 術後1年6ヵ月経過で再発は認めず, 超音波断層検査上, 残存精巣は径3cmであった.testosterone値は術後1台後半から2台前半と低値であるが, 補充療法は必要ないと考えられる.なお, リビドーや勃起能・射精能に関しては術後も維持されている.本邦で部分切除術を施行した報告は調べ得た限りでは3症例のみで, 全例再発を認めておらず, 両側精巣腫瘍に対する温存手術は治療の選択肢の1つとして十分に考慮に値する治療法であると考えられた, A 25-year-old single man presented with a mass in the right testis. He had a history of left radical orchiectomy for testicular cancer. Magnetic resonance imaging (MRI) and ultrasonography demonstrated a tumor (2 cm in diameter) within the right tests. The patient underwent right partial orchiectomy. Histological examination revealed typical seminoma of the right testis. He is alive with no evidence of disease recurrence at 18 months after surgery, and did not need androgen substitution.

21歳女性.腎動静脈奇形(AVM)に対しn-Butyl 2-cyanoacrylate(NBCA)を用い塞栓術を行った1例を経験した.肉眼的血尿で他院にて膀胱鏡で右尿管口に凝血塊を認め紹介入院した.右腎動脈造影で右腎中極に造影早期に静脈にシャントするAVMを認め, steel coilを用いて塞栓術を施行してシャントは消失し, 翌日より血尿も消失した.その後, 再度の高度血尿をを認め, 右腎動脈造影で前回部位より上方に側副路が発達しシャントを認めた.無水エタノール注入も奏効せず, NBCAとリピオドールを1:4に溶かした溶液を注入した.AVMが鋳型に造影され, シャント消失が確認できた.血液所見が正常化し退院した.以後1年経過で肉眼的血尿は認めていない.NBCAは難治AVM症例に対して有効な手段の一つと考えられた, A 22-year-old woman presented with sudden onset gross hematuria. Drip infusion pyelography and enhanced computerized tomography yielded no unusual findings. Renal angiography demonstrated an arteriovenous malformation (AVM) in the central portion of the right kidney. Superselective transcatheter arterial embolization (TAE) of the AVM was performed with a steel coil, and hematuria disappeared after TAE. However, severe gross hematuria developed again six days later. Second renal arteriography revealed the formation of the collateral vessels. By using n-butyl 2-cyanoacrylate (NBCA), TAE for AVM was performed successfully. She has been free of hematuria during the one-year follow-up.

A 24-year-old female with neurogenic bladder due to spina bifida consulted our department for further evaluation and treatment of a left renal stone. She innately voided urine by Crede's method. At the age of 15 years, intermittent self-catheterization was started because left severe hydronephrosis was found. At the age of 19 years, cystostomy was performed because of low compliance bladder and an aggravation of hydronephrosis in spite of intermittent catheterization. Thereafter, she was referred to our department for further evaluation and treatment of a left renal stone since the stone was increasing in size. First, left percutaneous nephrolithotomy was performed successfully. Secondly, clam ileocystoplasty using the ileum was carried out, followed by 1) increase of the bladder capacity, 2) improvement of the bladder compliance, 3) adequate intermittent self-catheterization, and 4) disappearance of urinous odor resulting from removal of the cystostomy catheter. Thus, the clinical effects were thought to be significant.

雌性正常イヌをα-chloralose urethane麻酔下に肛門電気刺激を行った結果, 生理的食塩水の持続的注入時にみられる膀胱の周期的な反射性収縮を抑制するためには5～10 Hzの低周波数刺激が適当であるとの結果をえた.過活動型膀胱が認められる切迫性尿失禁患者18例を以下の刺激条件にて肛門電気刺激を行った.持続時間0.2 msec, 周波数5 Hz, 強度は患者の耐えうる最大強度(30～150 V), 30分間刺激を週5回の頻度で10回行った.18例中12例に尿失禁の消失がみられ, 肛門電気刺激前後の初発尿意量, 最大膀胱容量に有意の増加が認められたが, 最大尿道閉鎖圧, 残尿量に関しては, 有意の増減はみられなかった.症例を不安定膀胱群と神経因性膀胱群に分類して比較を行った場合, 自覚症状の改善率に関しては, 両群間に有意差はみられなかったが, 神経因性膀胱群では初発尿意量, 最大膀胱容量に有意の増加が認められた.塩酸terodilineなどの薬剤併用群と非併用群とに分類した場合(併用群は18例中11例), 尿失禁の改善率は併用群に有意に高かった, To determine the most effective parameter of functional electrical stimulation of the anal sphincter (FES), the present study was carried out in female mongrel dogs anesthetized with alpha-chloralose urethane. When spontaneous and rhythmic micturition contractions of the bladder were present, they were more effectively inhibited by the stimulation with low frequency (5 to 10 Hz). Based on the results of this experiment 18 patients with urge incontinence were treated by maximal electrical stimulation with the following parameters. The duration for each stimulus was 0.2 msec, frequency 5 Hz, amplitude 30 to 150 volts. Every patient received ten treatments for two weeks, each lasting for 30 minutes. A clinical cure for urge incontinence was noted in 12 patients. As for urodynamic studies, FES increased significantly the volumes of the first desire to void (FDV) and maximum desire to void (MDV); however, it did not increase significantly the maximum urethral closure pressure or residual urine volume. Eighteen patients were divided into two groups; an unstable bladder group and a neurogenic bladder group. In the latter, the increases in volumes of FDV and MDV were significant. Second, 18 patients were divided into two groups according to the administration of lack of anticholinergic agents. For subjective symptoms, the rate of improvement of urge incontinence was significantly higher in the group administered the agents. These findings suggested that FES was very useful for the treatment of urge incontinence, with its efficacy augmented by the administration of anticholinergic agents.

55歳男, 血液透析開始12年後および15年後にそれぞれ左腎, 右腎に多中心発生性の腎細胞癌を認めた.両腎ともに多嚢胞化萎縮腎の状態であり, 腎癌以外の組織内に過形成性変化もみられた.透析患者の長期生存が可能となるに従い発癌の頻度も高まるものと推測される, Bilateral renal cell carcinoma developing in a 55-year-old male receiving long-term dialysis is reported. The patient, who had undergone maintenance hemodialysis for 12 years, was admitted in July, 1986 for the purpose of extensive examination of a right renal mass. CT scan and ultrasonography demonstrated an enlarged bilateral kidney associated with multiple cysts, containing a solid mass in the right upper pole. The patients underwent right nephrectomy under the diagnosis of right renal tumor. The solid tumor 4 x 3 cm in size revealed a grade 1 to 2 renal cell carcinoma pathologically. Two small tumors were recognized in other portions of the kidney. Multiple cysts of varying sizes, the largest 2 cm in diameter, replaced the renal parenchyma. The cyst walls frequently contained hyperplastic changes. The patient has been subsequently followed up for 2 years and 9 months and underwent left nephrectomy for suspected left renal tumor. The surface of the left kidney was covered by numerous cysts. The result of pathological examination was renal cell carcinoma, which was recognized in a total of 7 regions of the left kidney. The patient remains well on hemodialysis, with no evidence of recurrence or metastasis.

透析中の患者167例をACDKの有無に従い2群に分類し, 各種検査成績を比較した.胃癌が疑われた12例とACDKの自然破裂により後腹膜腔に大出血をきたした1例の計13例に腎摘を施行し, 病理学的検討を行った.ACDKを認めた症例は63例, 平均透析期間は10.3年であり, ACDKを認めない群の平均透析期間5.0年との間に有意差が認められた.特に, 10年以上の症例では64.6%にACDKがみられた.ACDK群ではHt値, Hb値が有意に高かった.腎癌が疑われた12例中8例に組織学上腎細胞癌が, 1例に腺腫が認められた.後腹膜腔への出血をきたした症例に嚢胞上皮の過形成がみられた.8例の腎癌症例中5例にACDKが, 2例に組織学上嚢胞が認められ, うち1例はCAPD症例であり, また1例は両側腎癌症例であった.摘出腎に腎細胞癌以外の変化, すなわち嚢胞上皮に過形成あるいは腺腫が認められた症例は8例中5例であり, いずれも透析歴7.5年以上の症例であった.腎癌症例の発見時平均年齢は44.7歳で, 無症状患者の定期的スクリーニングによって発見された, Long-term dialysis patients frequently develop acquired cystic disease of the kidneys (ACDK). One hundred and sixty-seven dialysis patients were classified into two groups according to the presence or absence of ACDK, and the two groups were compared with regard to the dialysis period, laboratory findings, and so forth. Among the 167 dialysis patients, 37.7% showed ACDK and had an average dialysis duration of 10.3 years, which was significantly longer than the 5.0 years for patients without ACDK. The proportion of patients with ACDK rose with increasing duration of dialysis; 64.6% of the patients on dialysis for more than 10 years had ACDK. The values of hemoglobin and hematocrit of patients with ACDK were significantly higher than those without ACDK. Of 12 dialysis patients who were operated upon because of suspected renal tumor, pathological examination confirmed renal cell carcinoma in 8 and adenoma in one. One of these patients had been treated with chronic ambulatory peritoneal dialysis, and another had bilateral renal tumor. Among the 8 patients with renal cell carcinoma, ACDK was detected in 5 by means of CT and ultrasound tomography, and cystic changes were observed in two on light microscopic examination of the resected kidneys. Pathological examination of the non-tumorous renal tissues revealed hyperplastic or adenomatous changes in the cyst epithelium in 5 patients undergoing dialysis for more than 7.5 years. These changes were thought to be pre-neoplastic. The high incidence of ACDK and the development of renal tumors in long-term dialysis patients indicates the necessity of intensive monitoring.

A 42-year-old woman was admitted to our hospital complaining of dull left flank pain. Excretory urogram showed a downward compression above the left nephrogram. Computed tomographic scan and magnetic resonance imaging (MRI) revealed a left adrenal tumor with a non-homogenous inner density. The mass was hyperintense as compared to the liver on T2-weighted images of MRI. No endocrinological abnormalities were detected by laboratory examinations. We performed transperitoneal left adrenalectomy and nephrectomy under the diagnosis of non-functioning left adrenal tumor. The histological examination revealed adrenal cortical carcinoma without lymph node metastasis. The patient has been receiving 4.5g o, p'-DDD per day after the operation. There has been no evidence of recurrence or metastasis during the 7-month follow-up period.

12例のMSに対しurodynamic studyを施行した.overactive bladder (bl) 4例・normoactive bl 5例・underactive bl 3例であった.4例には排尿筋括約筋協調不全(DSD)を合併していた.重症例にはoveractive bl症例及びDSD合併例が多い傾向にあり, α-blocker・choline作動薬などの使用, 間歇導尿などが行われ, 良好な排尿管理が可能であった, During a period of 4.5 years, neurological and urodynamic evaluation was done on 12 patients with multiple sclerosis between 20 and 67 years old with an average age of 47.6 years. Pyramidal dysfunction (100%), sensory disturbance (100%) and brain stem dysfunction (60%) were common neurological signs. All patients were assessed by the Kurtzke's rating of neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Of the 12 cases 6 were diagnosed as severe multiple sclerosis (EDSS greater than or equal to 4.5) and the remainders were diagnosed as relatively mild (EDSS less than 4.5). Neurourologic evaluation was performed by rapid filling carbon dioxide cystometry and sphincter electromyography. Cystometry revealed overactive bladder in 4 (33%), underactive bladder in 3 (25%) and normoactive bladder in 5 (42%) of the 12 cases. Of the 6 severe cases of multiple sclerosis, 3 (50%) showed overactive bladder, while only 1 of the 6 (17%) mild cases showed overactive bladder. Detrusor sphincter dyssynergia (DSD) was observed in 4 of the 9 (67%) severe cases and none of the 6 mild cases. The presence of overactive bladder or DSD seems to correlate with the severity of multiple sclerosis.

The clinical effectiveness and safety of propiverine hydrochloride (P-4, 20 mg tablet) were studied on 29 patients with nervous pollakisuria, neurogenic bladder or unstable bladder, whose chief complaints were urinary frequency and/or urinary incontinence. The clinical efficacy was "good" or better in 62.1% and "fair" or better in 86.2%. Patients' impressions were "good" or better in 79.3%. There were a total of 4 cases (13.8%) of adverse reactions, namely, two cases of decreased urinary stream, one dry mouth, and one dizziness. These reactions disappeared rapidly after the completion or discontinuance of drug administration, and therefore, did not constitute significant safety problems. The clinical efficacy in the treatment of subjective symptoms was 74.1% for diurnal pollakisuria, 50.0% for nocturnal pollakisuria, 83.3% for urinary incontinence and 69.0% for urgent feeling of micturition. For objective symptoms, P-4 increased significantly the volume of maximum desire to void (MDV); however it did not increase significantly the residual urine volume. The results of this study suggest that propiverine hydrochloride is very useful for the treatment of urinary frequency and/or incontinence.

A 3-year-old girl with an extrarenal nephroblastoma arising from the right retroperitoneal space is described. She was admitted to our hospital with the chief complaint of abdominal pain. On physical examination, she was found to have a large (12 X 10 cm in size), firm and nontender mass in the right upper quadrant of the abdomen. The mass did not extend beyond the midsagital line. The physical examination did not reveal any particular findings or any congenital anomalies. Urinalysis and hematological data were within the normal limit. Radiological examinations including CT scan showed that the solid tumor was related to the right kidney. Under the diagnosis of right nephroblastoma, 15 micrograms/kg/day of actinomycin D was given intravenously for 5 days from October 18, 1982. The regression rate of the tumor was 78 percent on CT scan after chemotherapy. On November 22, 1982, transperitoneal nephrectomy was performed through a right paramedian incision. The tumor was found to adhere tightly to the upper pole of the kidney. The surgical specimen was 76 g in weight. A section of the surgical specimen showed an extrarenal tumor located completely outside the kidney and separated from the renal cortex by a thickened renal capsule. Histological diagnosis was extrarenal nephroblastoma showing renal capsular invasion by epithelial tumor cells. No teratomatous components were encountered in the tumor.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of inverted papilloma of the bladder with mild atypia in a 31-year-old male is reported. The patient was admitted complaining of macroscopic hematuria. An excretory urogram revealed a small filling defect in the center of the bladder. A 15 x 11 mm. exophytic lesion was noted at the center of the trigone by cystoscopy and ultrasonography. The patient underwent transurethral resection of the bladder tumor and selected-site mucosal biopsies. The result of a histopathological examination of the tumor was an inverted configuration with nuclear atypia, corresponding to transitional cell carcinoma, grade 1. No histopathological abnormalities in the normal-appearing bladder mucosa were observed. The patient has been subsequently followed up for 43 months and there was no evidence of recurrence.

A case of bilateral testicular seminomas with abdominal huge metastatic tumors is presented. The patient is a 23-year-old male. An abdominal huge mass was found incidentally by a physician. CT scan and ultrasonography revealed the presence of the tumor in the left retroperitoneal space and biopsy specimen of the abdominal tumor was diagnosed as seminoma. On March 7, 1985, he was referred to our clinic. Bilateral testicular tumors were detected on palpation and ultrasonography. Bilateral orchiectomy was performed. Histological diagnosis was pure seminoma. After four sessions of VAB-6 combined chemotherapy, the abdominal tumor, 14.1 x 12.3 cm in size, decreased to 5.7 x 4.4 cm ( a regression rate of 85.5%). Retroperitoneal lymph-node dissection was undertaken, but the abdominal tumor could not be resected completely. Histological examination of the resected tumor revealed complete necrosis of the tumor tissue. After the operation, one session of the chemotherapy and irradiation were added. A total of 109 cases of bilateral testicular germ cell tumors in Japan was reviewed.

We present three cases of benign prostatic hypertrophy associated with chronic renal failure for three years from 1982 to 1984. Endogenous 24-hour creatinine clearance (Ccr) on admission ranged from 8.7 to 29.4 ml/min. Temporary hemodialysis treatment was required in one patient at the beginning of hospitalization. Indwelling intraurethral catheterization for 3 months or more improved the renal function in one patient, but brought troublesome complications of gross hematuria, intractable urethral pain or recurrent pyelonephritis in the other patients. These complications might arise from strong uninhibited detrusor contractions triggered or accelerated by stimuli and/or urinary tract infection induced by urethra-indwelt catheters. Intermittent self catheterization reduced these complications in one patient. In two patients, Ccr increased beyond 30 ml/min as a desirable standard level for safe operations. Suprapubic prostatectomy was successfully performed in all the patients. However, severe gastric ulcer or fatal duodenal ulcer occurred in two patients. Hypoproteinemia and/or urinary tract infection was thought to be highly related to ulceration. In conclusion, we would like to emphasize that a Ccr of more than 30 ml/min is needed for safe operations concerning renal function in patients with benign prostatic hypertrophy associated with chronic renal failure.

雌性雑種成犬の膀胱に, 短時間(1時間), 長時間(48時間)の過伸展状態を作成し, 解除2週間後膀胱容量, 膀胱内圧の変化と利尿筋切片のAchに対する収縮反応の変化を調べた.膀胱容量, 膀胱内圧は感染の影響もあり一定の傾向は見出しえなかったが, 非感染群は7頭中6頭に膀胱容量の増加を, 感染群は5頭中4頭に膀胱容量の減少を認めた.感染は膀胱過伸展の両群で42%に認めた.Achに対する収縮反応は, 短時間群, 長時間群とも無処置群に比しあきらかに大きな収縮反応を示し, さらに長時間群では, Ach 10-8 g/ml以下の低濃度域でも収縮反応をみた, The influence of prolonged bladder overdistension on the detrusor muscle was studied in female mongrel dogs. Two overdistending methods were employed, namely, constantly elevated hydrostatic pressure for one hour and bladder neck ligation for 48 hours. The cystometrogram and urinalysis at 2 weeks after release of overdistension were compared with the preoperative estimations. Using the in vitro isometric technique, the contractility of the detrusor muscle strip to acetylcholine was evaluated in the untreated control group and the two overdistended groups. Prolonged bladder overdistension for one hour as well as 48 hours resulted in a high incidence of urinary tract infection. There was no correlation between the cystometric findings before and after overdistension . An increase in contraction response to acetylcholine was observed in both overdistended groups. Besides, a small contraction response to acetylcholine at a lower concentration was observed in the group overdistended for 48 hours. It is suggested that the observed contraction response increase was probably due to axonal degeneration caused by a decrease in the blood supply to the overdistended bladder wall.

膀胱過伸展のモデルとして雌性雑種成犬の膀胱頸部を糸付きシリコンリングにて結紮し, 48時間の完全尿閉状態を作成した.利尿筋切片のachに対する収縮は尿閉解除後2週群の反応が最大であり, 4週群は無処置群より低い反応を示した.筋層組織像は4週群で筋束への線維増生がみられた.また膀胱血流量を水素ガスクリアランス法を用いて測定し, 48時間尿閉解除直後では膀胱空虚時に比較して63%の血流減少を認めた, To investigate denervation supersensitivity of the detrusor muscle due to prolonged bladder overdistension, overdistended bladders were produced in female mongrel dogs by bladder neck obstruction for 48 hours and the dogs were sacrified 1, 2 and 4 weeks after overdistension. The sensitivity of the detrusor muscle to acetylcholine was measured using the isometric in vitro technique. The bladder wall tissues were examined with Masson's trichrome staining. The blood flow of the bladder wall was determined by the hydrogen gas clearance method. Sensitivity reached a maximum 2 weeks after overdistension, thereafter decreasing to a lower level 4 weeks after overdistension than that of the untreated detrusor muscle. A decrease of blood supply to the bladder wall, the rate being 63% immediately after overdistension, may result in a degeneration of the axon which is more fragile to ischemic changes. Subsequently axonal degeneration may be followed by denervation supersensitivity of the detrusor muscle. Remarkable fibrotic changes of the bladder wall 4 weeks after overdistension suggested a decrease of the detrusor muscle contraction to acetylcholine.

A case of benign retroperitoneal cystic teratoma in a 62-year-old female is reported. The patient was admitted to our hospital for the purpose of extensive examination of a left abdominal mass. Radiological examinations including CT scanning revealed a large retroperitoneal mass arising in the left upper quadrant superior to the left kidney, containing cystic areas. The mass was removed by the thoracoabdominal approach under the diagnosis of cystic teratoma or liposarcoma. The margin of the mass was well demarcated and completely separated from other adjacent structures. Histological examination confirmed the diagnosis of benign cystic teratoma. From the 6th postoperative day, the discharge from a drainage tube, placed in the left retroperitoneal space, increased gradually and the discharge fluid became lipemic. The amount of daily discharge had a peak of approximately 400 ml on the 15th postoperative day. Total parenteral hyperalimentation was started on the 17th postoperative day under a diagnosis of chylous ascites. The amount of the discharge decreased and the drainage tube was removed on the 21st postoperative day.

A combined treatment of alpha interferon (INF), 8 MHz radiofrequency (RF) hyperthermia using Thermotron-RF Model 8 and/or irradiation was performed on a patient with advanced renal cancer. The patient was a 52-year-old male, who had received arterial embolization with a gelatin sponge and 60 mg of adriamycin for the right renal tumor in January, 1985. He was referred to our clinic in April, 1985. Computed tomography showed a right renal tumor, 120 x 105 x 80 mm. Histological examination revealed clear cell carcinoma of the right kidney. The tumor was unresectable because of the huge tumor size, invasion into the right lobe of the liver, multiple pulmonary metastases and severe dysproteinemia. From the beginning of May, 1985, administration of 3 x 10(6) units interferon-alpha (INF) daily and radiofrequency (RF)hyperthermia for one hour twice a week were started. By June 11, 1985, 10 sessions of RF-hyperthermia were performed. Thereafter, hyperthermia for the renal tumor was maintained once a week until June, 1986. From the middle of June, 1985, a gradual improvement of dysproteinemia and appetite loss, and a decrease of the right renal tumor size as well as disappearance of febrile attacks were attained. In November, 1985, mediastinal lymph node swelling developed. A combined therapy of RF-hyperthermia twice a week and irradiation with 2.0 Gy daily 5 times a week was started. A total of 14 sessions of RF-hyperthermia and 30 Gy of irradiation were delivered until January, 1986. Intratumoral temperature of the renal tumor reached 44.0 degrees C during the heating.(ABSTRACT TRUNCATED AT 250 WORDS)