[Effect of extracorporeal shock wave lithotripsy on renal function-an experience with the new type piezoelectric lithotripter, Therasonic]

Seventeen patients with renal stones and 17 patients with ureteral stones were treated using the newly developed piezoelectric shock wave lithotripter, THERASONIC. To determine the effect of shock wave on renal function, urinary N-acetyl-beta-D-glucosaminidase (NAG) activity, urinary beta 2 microglobulin (BMG) concentration, serum BMG concentration and creatinine clearance (Ccr) were measured. Urinary NAG activity and urinary BMG concentration in renal stone patients were significantly elevated immediately after the treatment and returned to the pretreatment value within 24 hours. Neither serum BMG nor Ccr showed significant change in any of the patients. Therefore, we conclude that the renal tubular damage, which is transient and subtle, is the effect of shock wave lithotripsy using THERASONIC machine.

[Treatment of urinary stones with Therasonic, the third generation piezoelectric shock wave lithotripter]

The THERASONIC lithotripsy treatment system, a newly developed piezoelectric lithotripter, uses both an X-ray and ultrasound system and enables stone localization effective. Treatment of urinary stones with THERASONIC was begun in June, 1989 and 57 treatments have already been performed on 38 patients. Successful treatment, defined as either stone free or with a residual stone less than 4 mm in diameter on flat X-ray film, was accomplished in 95% of the renal stones and over 50% of the ureteral stones. The overall success rate was 74%. Blood pressure and laboratory values did not show any significant change during or after the treatment. No major complication has been observed except for one perirenal hematoma which was resolved with conservative therapy.

[Studies of immunosuppressive substances in human seminal plasma]

Endogenous opioids, which have been shown to exhibit pharmacological and physiological activity on the immune system, have recently been reported to inhibit rosette formation between human T lymphocytes and sheep red blood cells. Because those opioids were found at a higher concentration in seminal plasma than in plasma, we studied whether seminal plasma could influence E rosette formation in 23 patients who complained of infertility. Seminal plasma significantly inhibited E rosette formation. With the dilution of seminal plasma, the percentage of E rosette formation increased. The incubation mixture of naloxone prevented the inhibition of E rosette formation produced by seminal plasma. The percentage of E rosette formation was significantly inhibited in azoospermia and oligozoospermia than in normozoospermia. In conclusion, these results suggest that opioids exert a suppressive effect on E rosette formation and may play a role in human spermatogenesis.

[A case of primary malignant neoplasms associated with penile cancer and prostatic cancer]

A case of a 79-year-old man with penile cancer and prostate cancer is reported. The pathological study of surgical specimens disclosed well-differentiated squamous cell carcinoma of the penis and poorly differentiated adenocarcinoma of the prostate. This is a rare case of multiple primary malignant neoplasms associated with penile cancer and prostate cancer.

[Stones of the seminal vesicles and ejaculatory duct in infant: report of a case]

A 7-year-old boy was brought to our clinic with the chief complaint of terminal pain on urination. Rectal examination revealed a prostate of almost normal size and consistency, but seminal vesicles were palpated to be hard and in a painful mass. Plain x-ray and urethrogram demonstrated several small stones in the posterior urethra and in seminal vesicles. In the first operation, the stones located in the posterior urethra were removed through the transvesical approach, and the seminal vesicular stones were extirpated in the next operation. The stones were found to consist of magnesium ammonium phosphate by infrared rays spectrum analysis. The histopathological findings of the partially resected seminal vesicles showed no inflammatory or tuberculous changes. Twenty cases of stones in seminal vesicle, in seminal canal, or in ejaculatory duct have been reported in the Japanese literature. Etiology, pathology, clinical problems and therapy of the stones of seminal tract are discussed in relation to the cases reported in Japan including the present case.

[Perineal testis: report of two cases]

Perineal testis is a very rare congenital anomaly. Since the first case of the disease reported by John Hunter in 1786, more than 113 cases have been reported in the English literature, and 13 cases have been reported in the Japanese literature. The 14th and 15th cases are presented herein. Case 1 was a 38-year-old man who came to our clinic with the chief complaint of discomfort of the perineum. Physical examination revealed emptiness of the left scrotal contents and there was a small hen's-egg growth mass corresponding to the normal testis at the left side of the perineum. Excretory urogram showed no abnormality. Orchiopexy to the left scrotum was performed. On surgical exploration the gubernaculum testis was found obviously fixed to the perineum. Histologic examination of the biopsied ectopic testis revealed mild hypospermatogenesis. Case 2 was a 2-year-old boy who was referred to our clinic with the chief complaint of emptiness of the right scrotal contents. Physical examination revealed a bean-sized mass corresponding to the normal testis at the right side of the perineum. Orchiopexy to the right scrotum was performed. On surgical exploration the gubernaculum testis was found to be fixed to the perineum.