bluuebunny/crossref_metadata_2025 huggingface dataset:
Urinary Reconstruction Using Appendix as a Urinary and Catheterizable Conduit in 12 Patients
Authors: Okada Yusaku , Ogura Keiji , Ueda Tomohiro , Kakehi Yoshiyuki , Terachi Toshiro , Arai Yoichi , Takeuchi Hideo , Yoshida Osamu
Published: July 2007

Background The appendix vermiformis can. provide an excellent urinary conduit or a catheterizable outlet in continent urinary reservoirs in selected cases. We report our clinical experience using the appendix in urinary reconstruction in adult patients.

Methods A total of 12 patients underwent urinary reconstruction using the appendix. The indications were pelvic malignancies except for 1 patient with neurogenic bladder and difficulty in self‐catheterization via urethra. The appendix was used as a catheterizable conduit in 8 patients, and as a urinary conduit in 4 patients. The in situ submucosally embedded method was used in 6 patients and the Mitrofanoff method was used in 2 patients. Follow‐up ranged from 3 to 41 months (mean, 22).

Results Early complications occurred in 3 patients (wound infection, false passage and intestinal anasotomotic leak). Late complications occurred in 3 (slight hydronephrosis, ileus, stomal stenosis). Emergent colostomy and pouchstomy with resection of the appendix was performed in the patient with anastomotic leak. The isoperistaltic Kock nipple valve was reconstructed for continence in this case. Prolonged ileus in 1 patient was treated by open surgery. Other complications were managed conservatively. End results were excellent in 8 patients, good in 3, and poor in 1.

Conclusions The appendix can be used advantageously as an outlet of continent urinary reservoirs or for a urinary conduit when the ureter is too short to reach the skin. Complete continence and easy catheterization can be obtained, and the appendix construction can be used as a urinary conduit instead of the ileal conduit in poor risk patients.
Vitamin B12 Deficiency in Patients with Urinary Intestinal Diversion
Authors: Terai Akito , Okada Yusaku , Shichiri Yasumasa , Kakehi Yoshiyuki , Terachi Toshiro , Arai Yoichi , Yoshida Osamu
Published: July 2007

Background Because vitamin B12 is absorbed exclusively by the terminal ileum, we investigated vitamin B12 deficiency as a potential metabolic complication after urinary intestinal diversion.

Methods We measured serum levels in patients with Kock pouches (n = 35); Indiana pouches (n = 27); and ileal conduits (n = 25). Serial determinations of serum B12 levels were obtained in 1 9 patients with Kock pouches and 14 patients with Indiana pouches. The dual‐isotope Schilling test was performed in 9 patients with Kock pouches and 6 patients with Indiana pouches.

Results No patient had an abnormally low serum B12 level (< 200 pg/mL). Mean (+ SD) serum B12 levels in patients with the Kock pouch (506 ± 202pg/mL) and the Indiana pouch (536 + 249pg/mL) were lower than that in patients with the ileal conduit (727 + 391 pg/mL). The mean serum B,2 level was not significantly different between patients with and without preoperative irradiation. Serial determinations showed that serum B12 levels in some patients with continent urinary reservoirs were persistently near the lower normal limit, or became progressively lower. Three of the 9 patients (33%) with Kock pouches and 4 of the 6 patients (67%) with Indiana pouches were B12 malabsorbers, although no patients had megaloblastic anemia or neurologic symptoms.

Conclusions Some patients with continent urinary reservoirs are at risk for vitamin B12 deficiency due to malabsorption. Routine evaluation of serum B12 levels is recommended for all patients with continent urinary reservoirs, and a Schilling test for those with subnormal serum B12 levels.
Quality of Life Survey of Urinary Diversion Patients: Comparison of Continent Urinary Diversion Versus Ileal Conduit
Authors: Okada Yusaku , Oishi Kenji , Shichiri Yasumasa , Kakehi Yoshiyuki , Hamaguchi Akikazu , Tomoyoshi Tadao , Yoshida Osamu
Published: July 2007

Background Continent urinary reservoirs (CUR) have become one of the major options for patients requiring urinary diversion to improve their quality of life (QOL). To assess whether CUR enhanced postoperative QOL, we surveyed patients with CUR and ileal conduit (IC) using a questionnaire sent by mail.

Patients and Methods The questionnaire consisted of 133 questions that covered physical and mental status, social life, sexual habits and symptoms related to urinary diversions. A total of 1 72 questionnaires were sent out, and 137 (80%) patients (74 CUR and 63 IC patients) responded.

Results Basic physical conditions were similar in the 2 groups, except for sleeping habits. Regarding social life, however, the CUR group showed better scores in bathing habits and frequency of overnight travel. Parasternal dermatitis was more frequent in the IC group and the patients were more hesitant to show their stoma to others. On the other hand, about half of the patients in the CUR group complained of troublesomeness in self‐catheterization, especially at night. Overall, 74% and 41% of the patients in the CUR and IC group were satisfied with their urinary diversion. When the Kock pouch and Indiana pouch were compared, no statistically significant differences were found in average capacity, maximum capacity, or frequency of self‐catheterization.

Conclusions CUR recipients have enhanced QOL regarding the stoma, travel and sleeping habits as compared to ileal conduit. However, troublesomeness of night time self‐catheterization was noted in the CUR group. Individualized selection of the type of urinary diversion with informed consent is essential.
Feasibility of Urodynamic Study (Combined Cystometry and Electromyography of the External Urethral Sphincter) under General Anesthesia in Children
Authors: Ameda Kaname , Kakizaki Hidehiro , Yamashita Tetsufumi , Nonomura Katsuya , Shinno Yuichiro , Kemmotsu Osamu , Koyanagi Tomohiko
Published: July 2007

Background To assess the feasibility of urodynamic study under general anesthesia (GA) we performed electromyography of the external urethral sphincter (EUS‐EMG) on 73 children and cystometry (CM) alone on 10 children.

Methods Subjects were divided into 3 groups. Those in groups I and II were suspected of having voiding dysfunction with (group I) or without (group II) overt neurospinal defects, while those in group III were thought to be functionally normal. EUS‐EMG was performed under light anesthesia following cystourethroscopy to examine structural abnormalities. Atropine sulfate premedication was not used for the anesthetic procedure; muscle relaxants were used only for tracheal intubation.

Results Voiding was observed in 83% of the patients. Among patients who voided, detrusor‐external sphincter dyssynergia (DSD) was noted in 7 (38%) group I patients and 6 (19%) group II patients; in group III, voiding was synergic in all patients. In 10 cases, CM alone was carried out both under anesthesia and in the waking state; anesthesia suppressed detrusor hyperreflexia (DH) in all 9 patients but produced no change in bladder compliance.

Conclusions In children with urinary disorders, urodynamic study under GA following cystourethroscopy is a feasible method for assessing EUS function and documenting DSD; DH is not evaluable, however. Stratifying urinary management on the basis of these examinations resulted in satisfactory clinical outcomes.
Cisplatin, Vincristine, Methotrexate, Peplomycin, Etoposide (COMPE) Therapy for Disseminated Germ Cell Testicular Tumors
Authors: Yoshimura Koji , Yamauchi Tamio , Maeda Hiroshi
Published: July 2007

Background The advent of cisplatin rendered disseminated testicular germ cell tumor an often curable malignant disease. Patients with a heavy metastatic burden, however, remain poor risks; furthermore, many patients experience nausea or other adverse events. This paper reports a trial of a cisplatin‐based (COMPE) combination chemotherapy regimen based on synchronization theory.

Methods Twenty patients with disseminated germ cell testicular tumors were treated with COMPE; any residual tumor mass was surgically resected.

Results Seventeen patients (85%) achieved complete remission by chemotherapy. The actuarial overall and cause‐specific 3‐year survival rates were 89% and 94%, respectively. In the subset of 16 “good‐risk” patients, all remain alive after a median follow‐up of 43 months. Complications were quite tolerable, with nephrotoxicity in particular being extremely mild.

Conclusion COMPE is an effective chemotherapy regimen in patients with disseminated germ cell testicular tumors. Complications arising from this therapy are mild.
Application of the Interferon Minipellet to Human Renal Cell Carcinoma in Nude Mice
Authors: Marumo Ken , Oya Mototsugu , Murai Masaru
Published: July 2007

Background The interferon (IFN) minipellet is a sustained‐release formulation of human lymphoblastoid IFN, with atelocollagen used as the carrier material. We evaluated the antitumor effect of the IFN minipellet on an established human renal cell carcinoma cell line (KU‐2) transplanted in nude mice.

Methods The treatment was started when tumor nodules had grown to 6 to 8mm in diameter. The IFN minipellet, or an aqueous solution of IFN, was given by subcutaneous injection, or peritumor injection, on days 1 and 10. Antitumor effects were evaluated according to tumor weights calculated as (long diameter) × (short diameter)2/2 in 7 groups consisting of 6 mice each.

Results IFN levels remained detectable in both tumor tissue and serum up to 10 days after peritumor injection of the IFN minipellet. Administered by the peritumor route, the IFN minipellet inhibited growth of the tumor significantly as compared with tumor growth in the untreated mice. The IFN minipellet showed greater inhibition of tumor growth by peritumor injection compared to subcutaneous injection. The aqueous solution of IFN was not effective either by subcutaneous or by peritumoral injection.

Conclusion Results indicate that the IFN minipellet is useful in the treatment of renal cell carcinoma.
Immunohistochemical Study of Tumor‐Infiltrating Lymphocytes Before and After Intravesical Bacillus Calmette‐Guérin Treatment for Superficial Bladder Cancer
Authors: Honda Shin‐ichi , Sakamoto Yoshiro , Fujime Makoto , Kitagawa Ryuichi
Published: July 2007

1Department of Urology, Juntendo University School of Medicine, Tokyo Japan

Background This study investigated changes in the phenotypic characteristics of tumor‐infiltrating lymphocytes during intravesical bacillus Calmette‐Guérin (BCC) treatment using an immunohistochemical technique.

Methods A total of 16 patients with superficial bladder cancer underwent intravesical BCG treatment for therapeutic purposes. Tissue specimens were obtained from these patients before and after BCG treatment by cold cup biopsies.

Results The numbers of CD3+ cells, CD4+ cells, CD8+ cells, and CD19+ cells significantly increased after treatment compared with numbers before treatment (P <0.01). Although γ/δT cells were not observed before treatment, they appeared after treatment in 6 patients‐ In all these patients, the tumors disappeared or their size was reduced by more than 50%, and none of the tumors recurred. The induction of CD25+ cells after treatment was seen in 11 of the 16 patients.

Conclusionsγ/δT cells may play an important role in the immune response of the host to the tumor in intravesical BCG treatment (although this correlation was statistically insignificant).
Aldosterone‐Producing Adrenocortical Carcinoma Metastases Found Seven Years After Adrenalectomy
Authors: Sakai Naoki , Yamada Tetsuo , Asao Takeshi , Murayama Tetsuo
Published: July 2007

We report a case of metastatic adrenocortical carcinoma detected 7 years after adrenalectomy. A 52‐year‐old woman, who. had undergone adrenalectomy for an aldosterone‐producing adrenocortical carcinoma at age 45, was found on examination by computerized tomography to have enlarged paraaortic lymph nodes. These nodes were surgically resected, and the histological diagnosis from the resected tissue was metastatic adrenocortical carcinoma. The patient has now survived for more than 9 years following the original adrenalectomy. Evidence suggests that this was a slow‐growing tumor, because the primary tumor was sharply demarcated and the metastases were found 7 years after the original operation. We believe that aggressive surgical resection of metastatic lesions could lead to prolonged survival in patients with adrenocortical carcinomas of this type.
Idiopathic and Spontaneously Regressing Thrombus in Right Renal Vein and Inferior Vena Cava
Authors: Chikaraishi Tatsuya , Kobayashi Shinya , Harada Hiroshi , Komaki Tohru , Koyanagi Tomohiko
Published: July 2007

We present the case of a 57‐year‐old woman with a thrombus in the right renal vein and the inferior vena cava that disappeared spontaneously during 6 months of observation. She had no thrombus‐related disease such as kidney cancer, dehydration, multiple myeloma, nephrotic syndrome, or abnormal coagulability. While various examinations were being performed over a 2 month period the thrombus regressed spontaneously. After 6 months of follow‐up the thrombus could not be seen on abdominal computerized tomography scan. Twenty months after disappearance of the thrombus the patient is doing well and has no recurrence of thrombus.
Bilateral Chromophobe Cell Renal Carcinoma in Tuberous Sclerosis Comple
Authors: Hidai Hideo , Chiba Tetsuo , Takagi Yutaka , Taki Atsuko , Nagashima Yoji , Kuroko Kouichi
Published: July 2007

We report on a patient with tuberous sclerosis complex and polycystic kidney disease who developed bilateral chromophobe cell renal carcinoma. We discuss the tuberous sclerosis complex, associated bilateral renal cell carcinoma, polycystic kidney disease and chromophobe cell renal carcinoma; a recently established subtype with a rather favorable prognosis.

In a patient with tuberous sclerosis complex and multiple space‐occupying lesions, a diagnosis of angiomyolipoma should be considered first but bilateral and/or multifocal renal cell carcinoma is a likely diagnosis.
Neurogenic Bladder May be a Side Effect of Focus Resection in an Epileptic Patient
Authors: Sekido Noritoshi , Akaza Hideyuki
Published: July 2007

A 34‐year‐old man with intractable epilepsy was treated by focus resection. The resected volume of neocortex in the left supracallosal part of the medial frontal gyrus was 7 times 1×2.5 cm. The treatment was effective and epileptic attacks completely disappeared. However, the patient developed urinary incontinence postoperatively without any other new neurological abnormalities. Urodynamic study revealed loss of bladder sensation, increased bladder capacity, involuntary detrusor contraction, and synergic external sphincter. The supracallosal part of the medial frontal gyrus has been reported to include 1 of the suprapontine micturition centers. In this case, resection of this area significantly affected bladder function. Loss of bladder sensation and increased threshold volume on micturition are characteristic signs of deficit in this area.
Urethral Recurrence of an Urachal Carcinoma: A Case Report
Authors: Yasui Takahiro , Okamura Takehiko , Akita Hidetoshi , Kojima Mihoko , Kohri Kenjiro
Published: July 2007

A 68‐year‐old man presented with microscopic hematuria. Cystoscopy revealed a papillary and pedunculated tumor in the bladder dome which, on punch biopsy, proved to be adenocarcinoma. Partial cystectomy and urachal remnant resection were performed. Histopathologically, the tumor was diagnosed as an urachal tumor. Four months after surgery, multiple posterior urethral tumors were found; punch biopsy revealed adenocarcinoma, which was quite similar to the previous tumor. Based on the histopathological examination of the transurethrally resected tissue, the urethral tumor was diagnosed as a recurrence of the urachal carcinoma. No evidence of either tumor recurrence or metastasis was found within the 15 months following the second surgery.
Recurrence of Primary Superficial Bladder Cancer Treated with Prophylactic Intravesical Tokyo 172 Bacillus Calmette‐Guerin: A Long‐Term Follow‐up
Authors: Shinka Toshiaki , Matsumoto Miyo , Ogura Hideaki , Hirano Atsuyuki , Ohkawa Tadashi
Published: July 2007

Background Long‐term results after transurethral resection (TUR) and prophylactic intravesical Tokyo 172 bacillus Calmette‐Guerin (BCG) therapy for primary superficial bladder cancer were analyzed by multivariate analysis, and factors affecting the recurrence of bladder tumors after this therapy were examined.

Methods One‐hundred and forty‐one consecutive patients with primary superficial bladder cancer who consulted the Department of Urology at Wakayama Medical College and affiliated hospitals between May 1985 and May 1990 were studied. Tokyo strain BCG was given intravesically (80 mg in 40mL saline) weekly for 6 weeks.

Results The 5‐year cumulative recurrence‐free rate by the Kaplan‐Meier method was 0.702 in 141 patients with primary superficial bladder cancer. The 5‐year recurrence‐free function using the proportional hazard model was 0.743. Using the Cox proportional hazard model, variables that significantly contributed to recurrence after intravesical BCG included female sex, tumor size less than 1 cm in diameter, and T1 tumor stage. Patient age, tumor type, multiplicity, tumor grade, and concomitant carcinoma in situ did not contribute to recurrence.

Conclusion Long‐term results showed that prophylactic intravesical Tokyo strain BCG after TUR for primary superficial bladder cancer is also effective in preventing the recurrence of bladder cancer, and the biologic behavior of superficial bladder cancer other than stage T1 tumor may be altered after intravesical BCG.
Preoperative Endocrine Therapy for Clinical Stage A2, B, and C Prostate Cancer: An Interim Report on Short‐Term Effects
Authors: Homma Yukio , Akaza Hideyuki , Okada Kiyoki , Yokoyama Masao , Moriyama Nobuo , Usami Michiyuki , Hirao Yoshihiko , Tsushima Tomoyasu , Sakamoto Atsuhiko , Ohashi Yasuo , Aso Yoshio
Published: July 2007

Background Preoperative endocrine therapy has been suggested to improve surgical radicality and/or patient prognosis in prostate cancer.

Methods Patients with clinical stage A2, B, and C prostate cancer were randomized to either group I (n = 113) or group II (n = 111). Croup I patients were to receive preoperative endocrine therapy consisting of leuprolide and chlormadinone for 3 months, followed by radical prostatectomy with lymph node dissection. Group II patients were to undergo the surgery before endocrine therapy. Results: Group I patients showed a remarkable decrease in prostate‐specific antigen (PSA) (mean ± SE: 41.8 ± 8.6ng/mL to 2.7 ± 0.7 ng/mt) and prostate volume (29.8 ± 1.7 mL to 21.2 ± 1.6 mL) during the preoperative therapy. Histopathologic analysis showed a significant difference in the rates of down‐staging (19.1 % in group I versus 3.3% in group II), positive surgical margins (63.8% versus 81.3%) and positive lymph node metastasis (20.7% versus 36.5%). No significant difference was detected in operating features. Subgroup analyses indicated that beneficial effects were correlated positively with degree of histologic differentiation and negatively with the basal PSA level.

Conclusions Preoperative endocrine therapy reduced local extention of prostate cancer, and the effects depended on histologic differentiation and PSA level. Long‐term follow‐up data are needed to determine the effects on the patient prognosis.
Biplane Planimetry as a New Method for Prostatic Volume Calculation in Transrectal
Authors: Kimura Akira , Kurooka Yuji , Kitamura Tadaichi , Kawabe Kazuki
Published: July 2007

Background We developed a new prostatic volume calculation method using the full information obtained from biplane transrectal ultrasonogram.

Methods Based on the cross and sagittal contours, a model composed of sequentially arranged copies of the cross sections, which are reduced so that the anteroposterior diameters of the copies fit the contour of the sagittal section, was created. The volume of this model was the sum of the square of the reduced rates of the height multiplied by the area of the maximum cross section and by slice thickness. Sonograms of 150 patients who underwent ultrasonography with a transrectal chair‐type probe were used for the comparison of this method with the ellipsoid volume calculation and the prolate ellipse volume calculation methods. The step‐section planimetric volume calculation method was used as the gold standard.

Results This new method showed the least difference from the step‐section planimetry among the 3 calculation methods evaluated.

Conclusion The formula of the new method is very simple, so it is easy for it to be incorporated in ultrasonic consoles that are capable of measuring distance and area.
Absence of RET Proto‐Oncogene Mutations in a Father and Son with Pheochromocytoma and Pancreatic Islet Cell Tumor
Authors: Kawasaki Takashi , Tomita Yoshihiko , Takahashi Hitoshi , Takeda Masayuki , Tanaka Hajime , Tamiya Yoichi , Takahashi Kota
Published: July 2007

Background We describe a father and son with a combination of pheochromocytoma and pancreatic islet cell tumor. Although its familial occurrence is rare, this syndrome could be called overlapping‐type multiple endocrine neoplasia (MEN), since it fulfills the criteria for both type 1 and type 2 MEN. Recently, germ line mutations of the RET proto‐oncogene (RET) were found to be related to tumorigenesis and disease phenotypes in type 2 MEN.

Methods Using polymerase chain reaction‐single strand conformation polymorphism (PCR‐SSCP) analysis, we looked for germ line mutations of RET in 8 members of this family, including the 2 patients.

Results Analysis of RET exons 10, 11 and 16, which contain the hot‐spot codons for MEN type 2, revealed no mutations in any individual examined.

Conclusion These findings suggest that these 3 exons in RET are not related to tumorigenesis in overlapping‐type MEN.
Y Chromosome (Yq11) Microdeletions in Idiopathic Azoospermia
Authors: Shirakawa Toshiro , Fujisawa Masato , Kanzaki Masanori , Okada Hiroshi , Arakawa Soichi , Kamidono Sadao
Published: July 2007

Background Cytogenetic anomalies and molecular deletions of the Y chromosome in idiopathically sterile men suggest that genetic factor(s) controlling spermatogenesis are located in the distal portion of Yq11. We studied Y chromosome microdeletions in the Yq11.23 region in idiopathic azoospermia.

Methods We studied 25 azoospermic male patients with a cytogenetically normal 46XY karyotype; 1 3 exhibited Sertoli‐cell‐only syndrome and 12 exhibited maturation arrest. Microdeletions in the Yql 1 region were examined using the PCR technique with 4 pairs of primers from DNA loci in Yq11.23.

Results Microdeletions in Yq11.23 were detected in 4 of the 25 azoospermic men. The most common deletion was of the Y6HP52pr sequence, which was detected in 3 of 13 men with Sertoli‐cell‐only syndrome but in only 1 of 12 with maturation arrest.

Conclusion Detection of microdeletions within the Yq11 sequence is an important clue to the genetic factor(s) underlying azoospermia.
Malignant Mesenchymoma of the Spermatic Cord with a Brief Review of the Literature
Authors: Inagaki Takeshi , Ebisuno Shoichi , Nagareda Tomofumi
Published: July 2007

Sarcomas of the spermatic cord are rare, and malignant mesenchymomas are particularly rare. Only 8 cases of paratesticular mesenchymoma have been described previously. We report here the ninth case of malignant mesenchymoma of the spermatic cord, in which there was a local recurrence. We also briefly review the previously reported cases.
Lower Urinary Tract Dysfunction as Persistent Complication of Radical Hysterectomy
Authors: Sekido Noritoshi , Kawai Koji , Akaza Hideyuki
Published: July 2007

Background This study was performed to evaluate late effects on the lower urinary tract after radical hysterectomy.

Methods We studied 9 women treated with radical hysterectomy for cervical cancer. All patients underwent surgery more than 10 years ago (range, 14 to 36 years). Six patients had urologic complications associated with lower urinary tract dysfunction. The remaining 3 were referred for urinary tract abnormalities detected by radiologic examinations. Lower urinary tract function was evaluated with thorough history taking, laboratory examinations, intravenous urography, and conventional urodynamic studies.

Results Obstructive voiding symptoms and/or urinary incontinence were observed in 7 patients. Uroflowmetry, which was assessable in 7 patients, revealed intermittent flow and a significant amount of residual urine in all patients. Cystometry revealed impaired bladder sensation, detrusor areflexia, straining on voiding, and probable impaired relaxation of the sphincter in all assessable patients. In addition, decreased bladder compliance was observed in 5 patients.

Conclusion All of the examined patients had severe and complicated urinary tract dysfunctions, even at more than 10 years after surgery. Careful follow‐up may be mandatory for patients after radical hysterectomy, because compensating factors tend to mask their urologic symptoms.
Prostate‐Specific Antigen Levels from a Mass Screening Program Using Highly Sensitive RIA Kits
Authors: Akimoto Susumu , Ichikawa Tomohiko , Akakura Koichiro , Shimazaki Jun
Published: July 2007

Background This study was designed to evaluate the distribution of prostate‐specific antigen (PSA) levels of men in a mass screening program for prostatic disease.

Methods A total of 763 men over 40 years of age underwent mass screening for prostatic disease in a Japanese prefecture using the highly sensitive Eiken kit and the Hybritech (Tandem‐R) kit. The screening tests consisted of serum PSA determination, digital rectal examination, a questionnaire on symptoms, evaluation of prostate volume, and determination of the obesity rate.

Results Serum PSA levels of all subjects were measured with both kits. The correlation between the values obtained by the Eiken kit and those of the Tandem‐R kit was high (r = 0.990), but the values of the former were slightly higher than those of the latter. Serum PSA weakly correlated with age, however, when estimated within decade age brackets, the levels of PSA showed significant differences among only 1 pair of groups stratified by age. In contrast, the levels of PSA showed significant differences among 9 pairs of groups stratified by prostate volume.

Conclusion A highly sensitive assay kit is useful to evaluate both the distribution of PSA levels and the relationship of PSA values to age and prostate volume of men in mass screening programs for prostatic disease, since approximately 40% of the subjects who underwent the present mass screening showed PSA values under 1 .Ong/mL, which have been the the lower limit of detection of many PSA kits.
Spontaneous Loss of Antibiotic‐Resistant Plasmids Transferred to Escherichia coli in Experimental Chronic Bladder Infection
Authors: Inoue Yoshihiro
Published: July 2007

Background We investigated whether Escherichia coli that has been transformed with antibiotic‐resistant plasmids spontaneously loses the plasmids while infecting the rat bladder.

Methods A nontransmissible antibiotic‐resistant plasmid was transferred to a clinically isolated strain of E. coli. A knotted thread holding the strain was implanted into the bladder of male Wistar rats. One or 4 weeks later, the total number of bacteria and that of plasmid‐carrying bacteria were measured in the bladder.

Results When plasmid‐carrying E. coli alone was inoculated, most of the plasmid‐carrying E. coli were replaced with plasmid‐free E. coli. When plasmid‐carrying and plasmid‐free E. coli were simultaneously inoculated, this replacement was accelerated.

Conclusion These results suggest that E. coli carrying antibiotic‐resistant plasmids spontaneously lose the plasmids as time passes, and thus become sensitive to antibiotics.

Int J Urol 1997;4:285‐288
Escherichia coli Virulence Factors and Serotypes in Acute Bacterial Prostatitis
Authors: Terai Akito , Yamamoto Shingo , Mitsumori Kenji , Okada Yusaku , Kurazono Hisao , Takeda Yoshifumi , Yoshida Osamu
Published: July 2007

Background
Escherichia coli is the most frequent pathogen in both acute bacterial prostatitis and acute uncomplicated urinary infections. To assess the virulence profiles of E. coli in acute prostatitis, the serotypes and virulence factor (VF) genotypes were determined.

Methods We studied 107 E. coli isolates from cases of acute bacterial prostatitis, 76 isolates from acute pyelonephritis, 194 isolates from acute cystitis and 80 fecal isolates from healthy people. All pyelonephritis and cystitis isolates were from women. Seven urovirulence determinants were analyzed by DNA colony hybridization, including the genes for type 1 fimbria (pil), P fimbria (pap), S fimbria (sfa), afimbrial adhesin AFA‐I (afal), α‐hemolysin (hly), cytotoxic necrotizing factor 1 (cnfl) and aerobactin (aer). 0:H:K serotypes were also determined.

Results With the exception of pil and afal, all VFs were significantly more often associated with prostatitis, pyelonephritis and cystitis isolates than with the fecal isolates. The prevalence of sfa, hly and cnfl was higher in prostatitis isolates than in pyelonephritis and cystitis isolates, and the pap+sfa+hly+cnf+ genotype was dominant among prostatitis isolates (48.8%). Nine O serotypes(01, 02, 04, 06, 01 6, Ol 8, 022, 025 and 075) accounted for 79.4%, 73.7% and 78.4% of the prostatitis, pyelonephritis and cystitis strains, respectively. There was an apparent correlation between serotype and genotype in uropathogenic E. coli.

Conclusion The predominance of O serotypes in female urinary tract infections and a high percentage of multiple VFs among the prostatitis isolates suggested that VFs play important roles in the pathogenesis of acute bacterial prostatitis.
Effects of Ethanol on Responses of Isolated Rabbit Urinary Bladder and Urethra
Authors: Ohmura Masaharu , Kondo Atsuo , Saito Masahiko
Published: July 2007

Background Acute ethanol ingestion increases the risk of urinary retention in patients with benign prostatic hyperplasia (BPH). To elucidate the mechanism of this effect, we investigated the in vitro effects of ethanol on lower urinary tract function in rabbits.

Methods The responses to various stimuli of muscle strips isolated from male rabbit bladder and urethra were determined in the presence of 0%, 0.5%, 1.0%, and 3.0% ethanol.

Results Basal tension of tissue strips taken from the bladder and the urethra was reduced by ethanol in a dose‐dependent manner, as were bladder contractions induced by field stimulation, bethanechol, and ATP. Ethanol also reduced phenylephrine‐induced contractions of the prostatic urethra. A high (3%) concentration of ethanol significantly reduced KCI‐induced contraction of both the bladder and urethra, as well as urethral relaxation induced by field stimulation following contraction with 200μol/L phenylephrine.

Conclusion Responsiveness of the rabbit lower urinary tract was significantly reduced by exposure to ethanol. A similar decrease in tonus and contractility of the detrusor and inhibition of relaxation in the prostatic urethra may lead to urinary retention in men following acute ingestion of ethanol.
Laparoscopic Adrenalectomy for Bilateral Pheochromocytoma: A Case Report
Authors: Terai Akito , Terachi Toshiro , Inoue Takahiro , Ogawa Osamu , Kakehi Yoshiyuki , Okada Yusaku , Yoshida Osamu
Published: July 2007

We report a case of bilateral (2.4‐cm left and 6.5‐cm right) adrenal pheochromocytoma in a 27‐year‐old man that was treated by laparoscopic adrenalectomy. The patient had no evidence of multiple endocrine neoplasia, type II. The left adrenalectomy was performed first, with the patient in a semilateral position, and then the patient was turned before the procedure was begun on the right side. His postoperative convalescence was uneventful, and he continues corticosteroid replacement therapy. Transperitoneal laparoscopic adrenalectomy can be a safe procedure for bilateral pheochromocytoma, if the patients are carefully selected and the procedures are performed by experienced laparoscopists.
Family Study of 2,8‐Dihydroxyadenine Stone Formation: Report of Two Cases of a Compound Heterozygote for Adenine Phosphoribosyltransferase Deficiency (APRT*J/APRT*QO)
Authors: Suzuki Koji , Kobayashi Shigeyuki , Kawamura Kenji , Kuhara Tomiko , Tsugawa Ryuzo
Published: July 2007

The family members of 2 formers of 2,8‐dihydroxyadenine stones were examined for history, adenine phosphoribosyltransferase (APRT) activity, genotype, urinary sediment, and urinary constituents. The patients' father showed a genotype of APRT*1/APRT*Q0, and their mother showed APRT*1/APRT*J. Patients 1 and 2 were compound heterozygotes for adenine phosphoribosyltransferase deficiency (APRT*J/APRT*QO), and APRT activities were 4.5% and 4.0% of normal, respectively. 2,8‐Dihydroxyadenine crystals could be seen in the urinary sediment. Treatment with allopurinol completely stopped new stone formation for 5 years in patient 1.
Transitional Cell Carcinoma of the Renal Pelvis with Vena Caval Tumor Thrombus
Authors: Oba Kazuo , Suga Akinobu , Shimizu Yoshiyuki , Takahashi Mutsuo , Hoshii Yoshinobu , Naito Katsusuke
Published: July 2007

We report a case of transitional cell carcinoma of the renal pelvis with vena caval tumor thrombus. To our knowledge only 14 cases of transitional cell carcinoma of the renal pelvis protruding into the vena cava have been reported. The literature regarding these cases is reviewed, and the differential diagnosis of this tumor from renal cell carcinoma is discussed.
Perirenal Pseudolymphoma: A Case Report
Authors: Kitsukawa Shin‐ichi , Shiozawa Hiroaki , Ogawa Masashi , Noda Kenjiro , Shishido Toshihide , Miki Makoto , Serizawa Hiromi
Published: July 2007

A right nephrectomy was performed on a 51 year‐old female with a tumor surrounding the right kidney since the possibility of malignant lymphoma could not be excluded based on radiography or a needle biopsy. An immunohistological examination of the surgically‐resected specimen confirmed a diagnosis of pseudolymphoma. A pseudolymphoma involving the urinary tract is rare, and this is only the second reported case of pseudolymphoma in the perirenal space.
Diagnostic Magnetic Resonance‐Urography in an Infant Girl with an Ectopic Ureter Associated with a Poorly Functioning Segment of a Duplicated Collecting System
Authors: Yanagisawa Naoko , Yajima Michitaka , Takahara Taro , Nosaka Shunsuke , Iwamoto Teruaki
Published: July 2007

We report on a case of an ectopic ureter associated with a duplicated collecting system in a 6‐month‐old girl. Results of conventional imaging and endoscopic studies, including intravenous pyelography, ultrasonography of the kidneys, cystoscopy, vaginoscopy, and vaginogram, were unremarkable. An ectopic ureter, extending from a poorly functioning upper pole of the ipsilateral duplicated kidney to its vaginal opening, was visible on the magnetic resonance‐urogram. The imaging time was not extensive, and the need for patient sedation was minimal. Respiratory motion and intestinal gas did not interfere with the quality of the images. Magnetic resonance‐urography may possibly be used as a primary diagnostic method for this anomaly when it is not detected by standard imaging techniques, or as a noninvasive substitute for some interventional studies in infants.
Small Cell Carcinoma of the Prostate: A Case Report
Authors: Sano Katsuyuki , Miyai Keikoku , Yoshida Sachiko
Published: July 2007

A case of small cell carcinoma of the prostate without a primary lesion in the lung was reported. The cancer was diagnosed after the patient complained of lumbago caused by bone metastasis. The tumor was 5.9 times 5.0 times 4.6cm. The patient was treated with 4 courses of chemotherapy using cisplatin and etoposide. The tumor diminished to 4.0 times 4.0 times 3.5 cm after completion of the 4 courses of treatment. Prostatic antigen levels were less than 1.0ng/mL during the therapy. Neuron‐specific enolase levels were 35.9ng/mL at the beginning of therapy, and decreased to 7.4 ng/mL after completion of 4 courses of treatment. The patient died 3 months after the completion of treatment. This regimen had some value for inhibiting the growth of small cell carcinoma.
Accessory Scrotum with Penoscrotal Transposition and Retrocerebellar Arachnoid Cyst: A Case Report
Authors: Kawa Gen , Kawakita Shigenari , Ohara Takashi , Matsuda Tadashi
Published: July 2007

A 2‐year‐old boy presented with an accessory scrotum associated with penoscrotal transposition and a perineal lipoma. He also had a retrocerebellar arachnoid cyst. The accessory scrotum was resected with concurrent scrotoplasty. The retrocerebellar arachnoid cyst was seen on a subsequent brain computed tomography scan and was left untreated because there was no evidence that the volume was increasing.
Bone‐Turnover Metabolites as Clinical Markers of Bone Metastasis in Patients with Prostatic Carcinoma
Authors: Takeuchi Shin‐ichi , Saitoh Hiroshi
Published: July 2007

Background: Candidate markers of prostatic metastases to bone, urinary deoxypyridinoline, serum carboxy‐terminal propeptide of type 1 procollagen (P1CP), and pyridinoline cross‐linked carboxy‐terminal telopeptide of type 1 collagen (1CTP), were measured to evaluate their prognostic efficacy.

Methods: Urinary levels (mean ± SD) of deoxypyridinoline were measured by a competitive immunoassay, and serum levels of P1CP and 1CTP were measured by radioimmunoassay in 30 patients with benign prostatic hyperplasia, 18 patients with prostatic carcinoma without bone metastases, and 27 patients with prostatic carcinoma and bone metastases.

Results: Urinary concentrations of deoxypyridinoline (pmol/μmol creatinine) in patients with prostatic carcinoma and bone metastases (10.4 ± 7.7) were significantly higher than those in similar patients without bone metastases (4.3 ± 1.3) and those in patients with benign prostatic hyperplasia (3.8 ± 1.2). Serum levels of P1CP and 1CTP (ng/mL) in patients with prostatic carcinoma and bone metastases (262.6 ± 188.7 and 10.3 ± 9.5, respectively) were significantly higher than those in similar patients without bone metastases (118.1 ± 30.2 and 4.3 ± 1.4, respectively) and those in patients with benign prostatic hyperplasia (93.9 + 25.1 and 3.3 ± 1.1, respectively). Serial measurements of urinary deoxypyridinoline and serum P1CP and 1CTP were correlated with a positive response to treatment (reduced measurements) and with the clinical progression of disease (increased measurements) before detection of new bone lesions by bone scintigram.

Conclusion:Urinary deoxypyridinoline, serum P1CP, and serum 1CTP should be useful markers in confirming and monitoring prostatic carcinoma metastases to bone.
Activity of Keratinocyte Growth Factor‐Like Substance Extracted from Rabbit Liver on Renal Tubular Cell Growth during Compensatory Renal Hyperplasia
Authors: Kanda Shigeru , Igawa Tsukasa , Kanetake Hiroshi , Saito Yutaka
Published: July 2007

Background: In response to unilateral nephrectomy, the rabbit liver transiently produces 2 growth regulators for cultured renal cortical tubular cells: a tubular cell growth factor and a growth inhibitor. We report on the effects of the tubular cell growth factor on a variety of cell lines.

Methods: The tubular cell growth factor activity was partially purified from the rabbit liver by using gel filtration and ion‐exchange chromatography. The activity was monitored by the incorporation of iododeoxyuridine into DNA of cultured cells. Expression of the fibroblast growth factor receptor‐2 in the rabbit kidney was determined by the immunoblot analysis.

Results: This growth factor stimulated the DNA synthesis in LLC‐PK, cells, LLC‐RK, cells, and human keratinocytes. It did not affect the growth of BS‐C‐1 cells, MDCK cells, BALB/c 3T3 fibroblasts, or rat parenchymal hepatocytes. The additive effect of this factor on the DNA synthesis of cultured tubular cells maximally was stimulated by insulin‐like growth factor‐l, basic fibroblast growth factor, and epidermal growth factor, but was not stimulated by keratinocyte growth factor. The amount of this activity also increased in the liver after sham operation. In the days after surgery, expression of fibroblast growth factor receptor‐2, which includes the keratinocyte growth factor receptor, was down‐regulated in the kidneys of both uninephrectomized and sham‐operated rabbits.

Conclusion: These findings indicate that tubular cell growth factor in the liver seems to be a keratinocyte growth factor, and acts in an endocrine manner in renal tubular hyperplasia.
Role of Platelet‐Activating Factor in Two‐Kidney, One‐Clip Hypertension
Authors: Takahashi Shinichi , Imagawa Masaharu , Mimata Hiromitsu , Nakagawa Masayuki , Ogata Jiro , Nomura Yoshio
Published: July 2007

Background: Platelet‐activating factor (PAF) is a bioactive phospholipid which is a potent hypotensive agent. To investigate the role of PAF in renovascular hypertension, we determined the PAF concentration and its production level assessed by the activity of cholinephosphotransferase (CPT) in renal tissue and examined the effect of a PAF antagonist on the mean arterial pressure (MAP) in control and two‐kidney with one clipped (2K1C) hypertensive rats.

Materials and Methods: The concentration of PAF and CPT in the renal medulla and cortex were determined by radioassay. Also, the effect of a PAF antagonist, CV‐6209, on MAP was also examined in both 2K1C hypertensive and normal control rats.

Results: The PAF concentration and CPT activity were significantly higher in the medulla than in the cortex in both 2K1C hypertensive and normal control rats, and both values in the medulla were also significantly higher in the clipped kidney than in the contralateral undipped kidney or in control rat kidneys. We also observed a significant negative correlation between the PAF concentration in the medulla, and the medulla weight in the clipped kidney of 2K1C hypertensive rats. Infusion of the PAF antagonist, CV‐6209, did not affect MAP in 2K1C hypertensive rats, but was significantly increased (P< 0.05) in control rats.

Conclusions: These findings suggest that PAF, whose production is induced by renal ischemia due to renal artery stenosis, plays an important role in the renomedullary vasodepressor system, but the effect of PAF as a vasodilator in the peripheral vessels is limited in 2K1C hypertension.
Effect of NS‐21, an Anticholinergic Drug with Calcium Antagonistic Activity, on Lower Urinary Tract Function in a Rat Model of Urinary Frequency
Authors: Sasaki Yasuo , Hamada Kozo , Yamazaki Chiemi , Seto Toshie , Kimura Yutaka , Ukai Yojiro , Yoshikuni Yoshiaki , Kimura Kiyoshi
Published: July 2007

Background: NS‐21 is under development for the treatment of urinary frequency and urinary incontinence. The purpose of this study was to investigate the effects of NS‐21 and its active metabolite, RCC‐36, on lower urinary tract function in an experimental rat model of urinary frequency.

Methods: Cystometrograms were recorded in anesthetized rats with bilaterally transected hypogastric nerves. All drugs were administered intraduodenally.

Results: In sham‐operated rats, NS‐21 (≥ 50mg/kg) significantly increased the bladder capacity without significantly decreasing micturition pressure, while RCC‐36 (100mg/kg) significantly increased bladder capacity, and at a dose of a 30mg/kg, also caused a decrease in micturition pressure. This increase in bladder capacity appeared at lower doses of both NS‐21 and RCC‐36 in the hypogastric nerve‐transected rats. Propiverine (100mg/kg) increased bladder capacity and at a 30mg/kg, decreased micturition pressure in both sham‐operated and nerve‐transected rats. Oxybutynin (100mg/kg) and atropine (30mg/kg) decreased the micturition pressure in both sham‐operated and nerve‐transected rats without increasing the bladder capacity, while a similar anticholinergic calcium antagonist, terodiline (100mg/kg) had no effect on bladder capacity in either sham‐operated or nerve‐transected rats. Flavoxate (500mg/kg) significantly increased bladder capacity without significantly decreasing micturition pressure in both sham‐operated and nerve‐transected rats, while 50mg/kg of verapamil significantly increased bladder capacity without significantly decreasing the micturition pressure in nerve‐transected rats.

Conclusions: NS‐21 and RCC‐36 increased bladder capacity at lower doses in hypogastric nerve‐transected rats than in sham‐operated rats. Furthermore, NS‐21 increased the bladder capacity without suppressing micturition pressure, suggesting that NS‐21 may be a more effective therapeutic drug than propiverine, oxybutynin or flavoxate for the treatment of urinary frequency and urinary incontinence.
Potentiating Effect of Buserelin Acetate, an LHRH Agonist, on the Proliferation of Ventral Prostatic Epithelial Cells in Testosterone‐Treated Castrated Rats
Authors: Maezawa Hiroaki , Komatsu Hideki , Kawaoi Akira , Ueno Akira
Published: July 2007

Background: We used buserelin acetate ([D‐Ser(But)6] LHRH), an LHRH agonist and strong blocker of LH secretion, as a treatment for prostatic cancer. It is possible that this LHRH agonist has a proliferative effect on the prostate in addition to suppressing LH secretion. The purpose of this study was to examine the proliferative effect of LHRH agonist on rat prostatic epithelial cells.

Methods: We determined the optimal dose of testosterone necessary to maintain a positive level of proliferating cell nuclear antigen (PCNA) in the ventral prostatic epithelial cells of castrated Wistar rats. Testosterone‐treated rats then received various doses of buserelin acetate. Castrated rats without exogenous testosterone also received buserelin acetate. The PCNA positivity was determined by immunohistochemistry with anti‐PCNA monoclonal antibody.

Results: The optimal dose of testosterone enanthate was 4mg at 0 and 28 days after castration. Administration of buserelin acetate on day 0 and 28 in doses of 0.1 6mg to 1.28mg significantly increased PCNA positivity in a dose‐dependent manner. Administration of buserelin acetate to castrated rats without testosterone also increased PCNA positivity but there was no statistical significance. Conclusions: Buserelin acetate has a potentiating effect on the proliferation of ventral prostatic epithelial cells of castrated rat in the presence of a physiological level of exogenous testosterone. This effect may slightly influence the result of hormonal therapy by LHRH agonist.
Extracorporeal Shock Wave Lithotripsy‐Induced Renal Laceration
Authors: Fukumori Tomoharu , Yamamoto Akihiro , Ashida Shingo , Komatsu Fumito , Matsumoto Shigeru , Yuasa Kenji , Terao Naotami
Published: July 2007

After extracorporeal shock wave lithotripsy (ESWL), perinephric hematomas, while uncommon, are a serious complication involving the risk of blood transfusion and subsequent impairment of renal function. We report a rare case of ESWL‐induced renal laceration in which an expanding retroperitoneal hematoma required blood transfusion but was treated successfully without surgical intervention.
Incontinent Ileal Tube Repaired by Infolding with the Ileal Pouch Wall
Authors: Kato Haruaki , Igawa Yasuhiko , Ogawa Akimi
Published: July 2007

In a patient who had undergone construction of a continent ileal pouch we successfully repaired an incontinent ileal tube by infolding it in an imbricated portion of the ileal pouch wall. For 2 years postoperatively the patient has been urine continent and has catheterized the pouch easily. We believe this infolding technique is useful for reconstructing the continent mechanism in patients with incompetent ileal valves.