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The rate of residual stones and that of recurrent lithiasis were investigated in 183 patients who had undergone extracorporeal shock wave lithotripsy (ESWL) between July, 1986 and December, 1988. The investigation was done by questionnaire survey at 22 institutions including our hospital on patients who were followed up after ESWL. The 183 patients included 126 male and 57 female patients between 9 and 77 years old (the mean 43.6 years). The greater part of patients had lithiasis of the lower renal calyx and upper ureter. The rate of residual stones 3 months after ESWL was 33.3% (61 patients) and the success rate was 72.2%. Chemical analysis of stones disclosed calcium oxalate-containing stones in 61% and calcium phosphate-containing ones in 10.8%. Recurrence of lithiasis was observed in 18 of the 131 patients (13.7%) who could be followed up for 6 months or more. These results were compared with those obtained after endoscopic treatment at Kinki University.

A case of right ureteral stricture due to endometriosis in the pouch of Douglas was presented. A 46-year-old housewife was referred to our clinic with asymptomatic macroscopic hematuria on August 22, 1985. Intravenous pyelography (IVP) and abdominal computed tomographic scanning revealed right hydronephrosis and retrograde pyelography showed that ureteral stenosis existed at the lower portion of the right ureter. Right stenotic ureter was removed in 5 cm and ureterovesiconeostomy with psoas hitch method was performed following hysterectomy, left adenexotomy, right salpingectomy on November 28, 1985. Pathological specimen of the ureter revealed that endometriosis existed around the ureteral mucosa. Medication with Danazol was started from the third operative day. Two months later, IVP revealed decreasing right hydronephrosis and she was quite healthy without complaints.

Combined measurement of serum prostate-specific antigen (PA) and prostatic acid phosphatase (PAP) was performed in 235 patients with various urologic diseases including 55 patients with prostatic cancer. A PA level of over 24.7 ng/ml and a PAP level of over 3.1 ng/ml were considered to be positive. The positive rate of PA was 57% in the patients with untreated prostatic cancer and 3% in the patients without prostatic cancer. The positive rate of PAP was 52% in the patients with untreated prostatic cancer and 1% in the patients without prostatic cancer. PA and PAP were considered to be equally sensitive and specific serum markers of prostatic cancer. However, the positive rate increased to 65% without increasing the false positive rate when the PA and PAP were both measured simultaneously. The combined assay of PA and PAP is recommended for screening prostatic cancer. The cross-over titer of PA and gamma-Sm using standard samples in each kit revealed linearity, which suggested that PA and gamma-Sm possess the same antigenicity.

The clinical effectiveness and safety of Aztreonam (AZT) were studied in 55 patients with complicated urinary tract infections. AZT was administered at a dose of 4 g/day for 5 days. The results as evaluated by the UTI criteria were excellent in 8 cases, moderate in 26 and poor in 21. The overall effectiveness rate was 61.8%. Out of 64 strains of bacteria isolated before treatment, 50 strains (78.0%) were eradicated by the treatment. Bacteriological eradication rates for gram negative rods and gram positive cocci were 79.6% and 66.7%, respectively. There were no obvious side effects, except for a temporary elevation of glutamic oxaloacetic transaminase, glutamic pyruvic transaminase alkalinephosphatase, and total bilirubin in some patients. The results indicate that AZT tablets are useful and safe for the treatment of complicated urinary tract infections.

Two cases of paratesticular rhabdomyosarcoma are reported. A 15-year-old boy was admitted in July, 1983, with a 3-week history of gradually increasing painless scrotal swelling on the right side. With the suspicion of testicular cancer, right radical orchiectomy was performed and pathological examination revealed an embryonal rhabdomyosarcoma of the paratesticular region. Chemotherapy and retroperitoneal lymphadenectomy were performed, and the latter revealed lymph node metastasis at the bifurcation of the aorta. Radiotherapy was not done because of adherent ileus. About 8 months after the orchiectomy, he died of recurrence at pelvic cavity and brain metastasis. A 6-year-old boy presented in March, 1985, with a complaint of right scrotal swelling that was painless and gradually increasing for about a month. Transinguinal exploration revealed a paratesticular neoplastic lesion and right radical orchiectomy was performed. Pathological diagnosis was paratesticular embryonal rhabdomyosarcoma. No evidence of metastasis was found by chest X-ray, excretory urogram, abdominal CT-scan or lymphangiography. As post-operative treatment, only chemotherapy was performed, and 9 months after the orchiectomy, the patient was asymptomatic. Ninety four cases of paratesticular rhabdomyosarcoma found in the Japanese literature are reviewed and mainly the policy of treatment is discussed.

The clinical value of local irrigation of thrombin was studied in 30 patients with urethral bleeding following transurethral prostatic resection. A thrombin solution consisting of 25,000 units of thrombin in 500 ml of saline was irrigated in 20 patients through the especially designed three-way balloon catheter at a speed of 8.3 ml/min for five hours after the operation while sterile saline was irrigated in the same manner in 10 patients as a control. The hemostatic effect of thrombin solution was evaluated as excellent in 2 patients (10%), good in 5 (25%), moderate in 6 (30%), and poor in 2 (10%) with 5 drop outs (25%) in the thrombin irrigating group. In the control group, the effect of irrigation was evaluated as good in 1 patient (10%), moderate in 4 (40%), poor in 2 (20%), and unable to be estimated in 2 (20%) with 1 drop out (10%). Therefore the rate of overall effectiveness was 65% in the thrombin irrigating group and 50% in the control group and volume of postoperative blood loss was 0.58 ml/g X hour and 0.62 ml/g X hour, respectively. Though almost all of the patients in both groups showed a moderate elevation of fibrinogen in serum, there was no adverse effect considered to be caused by thrombin irrigation. The local irrigation of the thrombin solution is a useful method and safe in the management of bleeding following transurethral prostatic resection.

A statistic survey was made on the patients undergoing operations between January, 1984 and December, 1986.

A case of syphilitic orchitis with aortic aneurysm is presented. The patient was a 72-year-old man who was diagnosed as having aortic aneurysm of thorax and abdomen by angiography. He visited our clinic with the complaint of swelling of the scrotal contents with tenderness after aneurysmectomy. Antibiotics were not effective against the swelling or tenderness, and right orchiectomy was performed. Histological diagnosis was syphilitic orchitis and aortitis.

A case of transverse ectopia of the right testicle and the left testicular tumor with the immature uterus and the fallopian tubes is reported. The patient, a 27-year-old married man, was admitted to our hospital with the suspicion of left testicular tumor and right undescended testicle. In his left scrotum, a double hen-egg-sized tumor was palpable and the right scrotum was empty. Exploration of the left inguinal canal disclosed double testicles with hernia uteri inguinalis. The right testicle showed transverse ectopia, and the histological finding of the left testicle was choriocarcinoma. In our review of the Japanese literature, we discovered 67 reported cases of transverse testicular ectopia. 33 (49.3%) out of 67 cases had a uterus and 9 cases (13.4%) had testicular tumor.

A case of non-specific inflammatory granuloma of the bladder with marked eosinophilic infiltration is reported. A 54-year-old woman was admitted to our hospital on March 9, 1983, with the suspicion of bladder cancer. Her primary complaints were miction pain, frequency and gross hematuria. Cystoscopic examination revealed a hemi-sphere-shaped tumor at the dome of the bladder. Biopsy revealed no malignancy and marked eosinophilic and macrophagocytic infiltration of the submucosa. The patient was treated with antiallergic drugs and antibiotics with excellent relief of symptoms and objective remission of bladder findings on repeated cystoscopy and computed tomography.