[Recent progress and problems in bladder-sparing operations in bladder tumors]

Retrospective analysis of the bladder tumor patients was performed to reveal the clinical results of partial cystectomy or transurethral resection (TUR). The observed 3-, 5-, 10-year survival rates after 143 partial cystectomies indicated for the first tumors were 66.2%, 57.1% and 41.5% respectively. To obtain satisfactory results, however, the operation should be indicated for pT2 or G0-G1. Some of the G2 tumors could also be the candidates for this procedure, but the stage of the disease must be below T2. At present, all these tumors could be well controlled by TUR, and this statement was confirmed by the study of clinical results obtained by TUR. The analysis also revealed a poor outcome in 6% of the low grade or low stage tumors and it increased to 25% in high grade and pT2. The complete cure of the high stage or high grade tumor is still difficult, but to improve the survival rate, radical surgery should be employed more positively instead of partial cystectomy. The reasons for this conclusion are also discussed.

Male urethral tumour (condyloma acuminatum): urethrographic and endoscopic appearances

Two cases of condyloma acuminatum of the male urethra were clearly demonstrated by retrograde urethrogram and endoscopy. Characteristic urethrographic and endoscopic appearances of these cases are presented.

[A case of renal cell carcinoma with contralateral adrenal metastasis]

A case of a 55-year-old man with renal cell carcinoma metastasized to the contralateral adrenal gland is reported. He was admitted to our hospital with the complaints of hematuria and weight-loss. CT and arteriography revealed left renal tumor and contralateral adrenal mass. We made the diagnosis of left renal cell carcinoma with right adrenal metastasis, and performed left total nephrectomy and right adrenalectomy. Histologically, the adrenal mass was clear cell carcinoma, and it was diagnosed as metastasis from the left renal cancer. We reviewed 9 cases of renal cell carcinoma metastasized to the contralateral adrenal gland in the Japanese literature and discussed the effectiveness of pre-operative CT evaluation.

Cavernous hemangioma of scrotum and penile shaft

We report a 13-year-old boy with two independently detected cavernous hemangiomas of the scrotum and the penile shaft. A right scrotal cavernous hemangioma was incidentally found at the age of 6 years by a histological examination of a right scrotal hematoma attributed to contusion. The patient noticed a soft tumor of the penile shaft at the age of 10 and gradual enlargement of the tumor during the next 3 years. He consulted our department at the age of 13. An ultrasonic echogram revealed a heterogeneous tumor, a hemangioma, having dimensions of 3.5 X 2.5 X 1.5 cm and no connection of the corpus cavernosum penis. The tumor was completely removed surgically by means of circumcision on March 30, 1984, and histological examination demonstrated a cavernous hemangioma.

Urinary tract stone disease in modern Japan. Stone incidence, composition and possible causes in Osaka district

2,969 stones, obtained from affiliated hospitals as well as the Osaka University Urologic Clinic were analyzed by infrared spectrophotometry. 2,724 of the 2,969 stones were obvious upper urinary tract stones, and the composition of these 2,724 stones is reported. The incidence and possible cause of stones in 750 patients with upper urinary tract calculi, managed in Osaka University Urologic Clinic, are discussed, as well as the recent figures on urinary tract stone disease in Osaka district. These figures are representative of stone disease in Japan.

State of systemic hemodynamics in a case of juxtaglomerular cell tumor

A renin-producing juxtaglomerular cell tumor was found in a 27 year-old woman. The infusion of angiotensin II analogue produced a marked decrease in arterial pressure. Oral administration of captopril also reduced her blood pressure. Although the renal vein renin did not indicate the laterality of the tumor, unilateral partial nephrectomy cured the disease. This is the first case report to describe measurement of several hemodynamic parameters before and after surgical removal of a juxtaglomerular cell tumor.

Reno-colic-cutaneous fistula

A case of reno-colic-cutaneous fistula is presented. Of several diagnostic methods, fistulography combined with computerized tomography was the most useful to locate the precise anatomical site of involvement. Total nephrectomy, resection of the descending colon and excision of the retroperitoneal abscess were successfully performed.

Masculinizing operation for a female patient with congenital adrenocortical hyperplasia due to 21-hydroxylase deficiency

A 25-year-old female with simple virilizing type of congenital adrenocortical hyperplasia due to 21-hydroxylase deficiency was treated surgically with masculinizing operations which consisted of two-stage procedures. The first procedure was chordectomy associated with excision of both gonads and female internal genitalia. Eleven months later, the second procedure consisting of urethroplasty and implantation of testicular prosthesis was performed. The postoperative course was successful in terms of urination and penile erection.

[Evaluation of renal intra-arterial digital subtraction angiography]

A total of 68 patients with renal abnormalities and potential donors were examined by intra-arterial digital subtraction angiography (IA-DSA). Compared with the conventional angiography, the advantages of IA-DSA are reduction of volume of contrast material and rate of injection. The image quality is superior to intravenous DSA. For the potential donors, IA-DSA has the same diagnostic value as conventional angiography to depict the number and position of renal arteries. IA-DSA is an effective method for screening hypertensive patients for renovascular disease. However, conventional angiography is necessary when evaluation of smaller intra-renal branch is desired. IA-DSA would be valuable for renal recipients because of good visibility by a smaller volume of contrast material. Another advantage of IA-DSA is the reduction of examination time. Embolization can also be done in a shorter time. Renal vein is easily detected by IA-DSA. Renal vein anomalies and obstruction are diagnosed in the left side without conventional venography. Renal IA-DSA can be replaced by conventional arteriography except when the delineation of tiny arterial change is desired.

[Operative methods and their problems in the surgical treatment of renal staghorn calculi]

Percutaneous nephrolithotripsy and extracorporeal shock wave lithotripsy are entering the stage of clinical use. Herein, all of the operative methods for renal staghorn calculi used today are reviewed and their problems discussed. Concerning extended pyelolithotomy, which is thought to be the most desirable operative approach to the staghorn calculi, restrictions of indication, such as shapes of calculus and pelviocalyceal system, thickness of renal parenchyma are presented. The literature on nephrolithotomy, not only on advances of protection for damage of renal parenchyma due to ischemia, incision and suture, but also on vascular damage due to pedicle clamping are discussed, and delayed bleeding after nephrolithotomy about its incidence and modern methods of conservative treatment, transcatheter embolization are reviewed.

Cytotoxic activity of peripheral blood lymphocytes grown with interleukin 2 against autologous cultured tumor cells in patients with renal cell carcinoma: preliminary report

To examine the use of interleukin 2 as a therapeutic agent for human renal cell carcinoma the peripheral blood lymphocytes derived from patients with renal cell carcinoma were grown in interleukin 2 and tested in a 4-hour 51chromium release cytotoxicity assay against autologous cultured tumor cells. Peripheral blood lymphocytes, which were cultured separately in medium alone, mitomycin C-treated tumor cells, 20 per cent interleukin 2 and tumor cells plus interleukin 2, were used as effector cells. In all patients neither peripheral blood lymphocytes in medium alone nor in mitomycin C-treated tumor cells could lyse their own tumor cells. However, in 5 of 7 patients peripheral blood lymphocytes grown in interleukin 2 regardless of the presence of mitomycin C-treated tumor cells were capable of causing 5.7, 9.4, 12.7, 36.1 and 52.5 per cent lysis at effector/target cell ratios of 25, 50, 50, 50 and 25, respectively. However, more significant cytotoxicity was not obtained by peripheral blood lymphocytes cultured with tumor cells and interleukin 2. These results suggest that interleukin 2 might become a useful agent for patients with renal cell carcinoma.

[Clinical observation on in situ carcinoma of the bladder and related conditions]

Clinical course and histological findings of 692 patients with bladder tumor were reviewed to reveal the statistics and clinical profile of carcinoma in situ and its related conditions in the urinary bladder. Primary papillary intraepithelial lesions were found in 83 cases (12.0%), whereas flat intraepithelial carcinoma was found in 16 cases (2.0%), 10 as primary and 6 as secondary tumors. In 35 cases (3.5%), the bladder lesion was flat and rather difficult to find by cystoscopy, and initially considered as chronic cystitis or flat carcinoma in situ. Post-operative histological diagnosis, however, revealed micro- or apparent invasion beyond the basement membrane. Thus they were tentatively classified as clinical carcinoma in situ. The result of the radical surgical treatments for the clinical carcinoma in situ was very poor with a rough 5-year survival of 19%. The management of primary or secondary flat intraepithelial carcinoma was carried out by radical surgery or bladder sparing operation followed by intravesical instillation of cytotoxic agents. The results of these procedures remain uncertain. Some confusion in terminology of carcinoma in situ is discussed and the term "flat carcinoma" was recommended to indicate carcinoma in situ and its related conditions.

Xanthine calculi in the patient with the Lesch-Nyhan syndrome associated with urinary tract infection

A Japanese boy with Lesch-Nyhan syndrome who passed xanthine calculi is reported. After pyelolithotomy for a left renal stone, made up of ammonium urate, associated with urinary tract infection, a high dose of allopurinol was given because of the persistence of pyuria. In the present case, the administration of a high dose of allopurinol, given for the prevention of ammonium urate stone formation in infected urine, induced xanthine calculi formation and we had difficulty in the management of this patient with Lesch-Nyhan syndrome associated with urinary tract infection. However, we believe it a basic necessity to cure our patient of his urinary tract infection and prevent recurrent ammonium urate stone formation because of the risk of renal deterioration.

[Indication and result of renal autotransplantation for renovascular hypertension]

Twenty patients with renovascular disease in 22 kidneys were treated surgically by the method of renal autotransplantation at our department during the 13 years from 1970 to 1982. Etiological disorders included 11 cases of fibromuscular dysplasia, 3 cases of atherosclerosis, 3 cases of aortitis syndrome, two cases of renal artery aneurysm and one case of renal artery thrombosis. Age distribution ranged from 13 to 64 years old (average 28.9 years), and male to female ratio was 1 to 3. Ex vivo surgery was carried out in 11 of these 20 cases. Angioplasty in 9 cases, endarterectomy and partial nephrectomy in one case each were performed extracorporeally. Reconstruction of the urinary tract was needed for 14 kidneys in 13 patients, 12 kidneys were treated by UCN, and PU anastomosis was performed in 2 kidneys in 2 patients. Outcome of renal autotransplantation was "cured" in 17 cases and "improved" in 3 cases during follow-up period from 8 months to 13 years. Revision was successful for the postoperative complication such as urine leakage, bladder tamponade, perirenal fluid collection and ileus.

[Clinical evaluation of ceftizoxime in the treatment of complicated urinary tract infections]

Ceftizoxime (CZX) was given clinically to 80 patients with urogenital tract infections, in which 34 cases of complicated UTI satisfied the criteria of the UTI committee. CZX was administered for at least five days at a daily dose of 1 to 4 g in two divided doses by intravenous drip infusion. The overall clinical efficacy of CZX in 34 cases of complicated UTI was 59%, estimated by the criteria of the UTI committee. The overall clinical efficacy rate according to group of infection was: 64% for the 11 patients in the 1st group, 56% for the 9 patients in the 2nd group, 100% for the 5 patients in the 3rd group, 50% for the 4 patients in the 4th group and 20% for the 5 patients in the 5th group. No serious side effects were observed in the clinical or laboratory findings except for slight elevation in GOT & GPT values in two cases (2.5%), which returned to normal after CZX treatment. It is therefore suggested that CZX is a clinically useful and safe drug in the treatment of complicated UTI.

[Anti-tumor effect of intravesical instillation of mitomycin C combined with cytosine arabinoside]

The anti-tumor effect of twice a week instillation of 30 mg mitomycin C combined with 200 mg cytosine arabinoside dissolved in 30 ml saline was studied in 37 bladder tumor patients. Endoscopic or histological disappearance of the tumor was observed in 19 cases, average instillation being 16.4 times. Small (less than 1 cm in diameter), low grade, low stage and villous-surfaced tumors were more sensitive to this therapy. Further more, in the cases showing a complete response, frequency of the intravesical tumor recurrence significantly decreased compared with the cases showing no response. The clinical results of this therapy are compared mainly with those of TUR performed at our hospital, and the usefulness and clinical limitation of this kind of management in the treatment of bladder tumors are discussed.

A risk of inaccuracy in biochemical analysis of urinary stone-forming salts

We investigated the occasional inaccuracy in the biochemical measurement of urine by comparing the values from untreated samples to those obtained following our experimental pre-treatment regimen, which prevents precipitation and dissolves visible crystals. Discrepancies were observed between some of the paired samples, especially with regard to calcium and uric acid (urate) concentrations. Moreover, considerable differences were recognized in fresh as well as stored urine specimens. Our findings demonstrate the need to develop accurate methods of processing urine for biochemical analysis with multichannel autoanalyzers.

Hormone receptor in renal cell carcinoma and correlation with clinical response to endocrine therapy

Analyses of hormone receptors in cytosols from 41 renal cell carcinoma specimens were performed by the dextran-coated charcoal technique, using estradiol, synthetic progestin R5020 and synthetic androgen R1881. Binding data were calculated according to the method of Scatchard. Of 41 renal cell carcinomas estradiol receptor was detected in 11, R5020 receptor in 11 and R1881 receptor in 13. No significant correlation between histopathological findings and hormone receptors was observed. Patients were classified into those positive and negative for receptors. The clinical response of endocrine therapy for 17 with advanced residual or metastatic lesions after nephrectomy was studied in regard to the survival rates. Although there was no complete or partial regression in tumor size, the survival rate of patients with 1 or more receptors was significantly higher than that of patients negative for receptors (p less than 0.01). In conclusion, hormonal manipulation in patients with renal cell carcinoma cannot induce an antitumor effect but seems to increase survival in patients with receptors.