[Peripelvic extravasation after extracorporeal shock wave lithotripsy: a case report].

We experienced a case of peripelvic extravasation after extracorporeal shock wave lithotripsy (ESWL) treatment. A 62-year-old man was admitted to our hospital with a complaint of macroscopic hematuria. The patient was diagnosed as having a radiolucent stone in the right kidney and ESWL treatment was performed to focus the stone by using drip infusion pyelography (DIP) under epidural anesthesia. The patient had right flank pain two weeks after ESWL treatment. DIP and computerized tomography (CT) showed peripelvic extravasation of contrast medium. Right pain improved after a double-J catheter was placed for decreasing intra-pelvic pressure. As a result, the disappearance of peripelvic extravasation was recognized by DIP and CT. We reviewed four cases of peripelvic extravasation after ESWL treatment including our case in the Japanese literatures and discussed the cause of peripelvic extravasation after ESWL treatment.

[Subcapsular orchiectomy using the ultrasonic surgical aspirator in patients with advanced prostatic cancer].

We report a technique for performing subcapsular orchiectomy using the ultrasonic surgical aspirator (USA). The procedure was simple and safe, and was completed within one hour in 2 patients on whom it was carried out. Operative complications such as bleeding, postoperative pain and wound swelling were minimal, and compression dressings were not necessary. Postoperatively, the serum testosterone value was lowered to the castrate level. We conclude that subcapsular orchiectomy using USA is superior to conventional bilateral scrotal orchiectomy, and will be a useful option.

[A case of male pseudohermaphroditism with incomplete testicular feminization syndrome].

A 19-year-old female visited our hospital because of primary amenorrhea. She was genetically (46XY) male. Her breasts were poorly developed. She had no pubic or axillary hair. The phenotype was female, and the vagina had a short and closed end. Plasma testosterone (T) and 5-alpha dihydrotestosterone (DTH) were low. However, DHT was elevated by ex vivo T load. The testis, which was atropic, epididymis and vas deferens, which were well developed, were found and resected by operation. The amount of androgen receptors of the skin tissue of the external genitalia was normal. These findings suggested that male pseudohermaphroditism with incomplete testicular feminization syndrome may have been caused by androgen resistance syndrome due to the disorder of androgen receptor complex, genetic information or post receptor.

[Experience of extracorporeal shock-wave lithotripsy for the urolithiasis in horseshoe kidney].

At Osaka City University, 1,987 patients with urolithiasis have been treated by extra-corporeal shockwave lithotripsy (ESWL) during a four-year period. We treated 5 patients with horseshoe kidney and the obtained results were analyzed retrospectively. Three of these patients, who had a solitary stone could successfully be treated by ESWL as monotherapy. One who had multiple stones required transurethral lithotripsy after ESWL due to stone-street. The remaining 1 patient who had undergone heminephrectomy developed perirenal hematoma after ESWL, which spontaneously disappeared without any specific treatment. We discuss the special care related to the use of ESWL in the horseshoe kidney.

[Evaluation of the results of extracorporeal shock-wave lithotripsy (ESWL) for solitary upper urinary tract stone].

We performed extracorporeal shock-wave lithotripsy (ESWL) on 1,701 patients in a total of 2,438 sessions using the Dornier kidney lithotriptor Model HM III from July 1985 to the end of June 1990. Among the patients with a solitary stone, 1,200 cases were available for the follow-up study in which the results of ESWL were analyzed according to the location and size of the stone. ESWL performed against stones at pelvis and calyces gave the best results. The results obtained on stones less than 20 mm in diameter were especially favorable with a success rate of 84%. ESWL performed against ureter stones showed poor results with a success rate of 62% for the stones smaller than 20 mm in diameter. We further studied the results of ESWL performed against ureter stones by dividing the patients into three groups: the patients treated in situ, the patients with ureteral stents and the patients with D-J stents. The results for stones larger than 10 mm in diameter were significantly better in the patients with D-J stents than in the patients treated in situ or the patients with ureteral stents. Among the patients treated in situ, the results were significantly worse for impacted stones than for non-impacted stones when the stone size was 10-20 mm in diameter.

[Extracorporeal shock wave lithotripsy for ureteral stones and cystine stones].

We report our experience with extracorporeal shock wave lithotripsy (ESWL) in the treatment of ureteral and cystine stones, which are known to be difficult to treat by this method. First, in order to determine the effectiveness of the ureteral catheter in the destruction of ureteral stones, we compared the clinical results of 121 patients treated without the catheter and 141 patients inserted with the catheter. There was no significant difference in the success rate between the two groups regardless of stone size, which indicates that the use of the ureteral catheter had no effect on the outcome of treatment. We then studied the clinical results of impacted ureteral stones which are especially difficult to destroy. Excretory urography was performed to non-invasively diagnose these stones, and those without visualization in the ureter below the stone were diagnosed as impacted stones and treated by ESWL without the ureteral catheter. Among the stones with a diameter of 1 to 2 cm, the success rate was significantly lower in impacted stones compared to non-impacted stone. These findings suggest that ESWL treatment without the ureteral catheter may be effective for ureteral stones with a diameter of less than 1 cm and non-impacted stones with a diameter of 1 to 2 cm, while combination therapy with other methods such as TUL may be better for other stones. We also performed ESWL on 6 patients with renal stones and 2 patients with ureteral stones which were cystine stones. Renal stones required an average 4.1 treatment with an average of 1,875 shocks per treatment, and ureteral stones required 1.5 treatment with an average of 1,833 shocks.(ABSTRACT TRUNCATED AT 250 WORDS)

[Hyperthermic treatment in patients with benign prostatic hypertrophy].

Hyperthermic treatment was performed in 31 patients with benign prostatic hypertrophy (BPH). Eight patients of them had a urethral catheter because of urinary retention. The prostate was heated trans-rectally to 43-45 degrees C. The treatment consisted of 10 sessions of 60 min. each. To evaluate this treatment, the following parameters were determined before, during and one week after the last hyperthermia session: subjective symptoms score, and residual urine volume, uroflowmetry and transrectal ultrasound of the prostate as objective data. Symptoms score improve in all patients. Of 8 patients with a catheter, the catheter could be removed from 4 patients. There was no significant change in prostate volume, but significant decreases of residual urine volume, and increases of maximum flow rate and mean flow rate were observed. No adverse reactions were seen. Judging from the above results, this treatment is considered to be useful for patients with BPH.

Examination of aggravating factors of urinary excretion of N-acetyl-beta-D-glucosaminidase after extracorporeal shock wave lithotripsy.

We measured urinary N-acetyl-beta-D-glucosaminidase (NAG) excretion before and after extracorporeal shock wave lithotripsy (ESWL) with a view to study the underlying factors which aggravate renal impairment immediately after ESWL. The factors associated with the significant elevation of urinary NAG after ESWL included female sex, a previous history of ESWL, and urinary tract infection (UTI). By studying the backgrounds of these factors, we found that both the female group and the group with a previous history of ESWL contained significantly more patients with UTI. These findings indicate that UTI may be one of the risk factors which aggravate renal damage immediately after ESWL, and that careful management is necessary in the ESWL treatment of urinary tract stones with UTI.

[Evaluation of the results of extracorporeal shock-wave lithotripsy (ESWL) for solitary upper urinary tract stone].

At Osaka City University Hospital, we performed extracorporeal shock-wave lithotripsy (ESWL) for 1277 patients in a total of 1788 sessions using Dornier kidney lithotripter Model HM III from July, 1985 to the end of December, 1988. Among the patients with a solitary stone, 911 cases were available for the follow-up study and we have compared the results among these cases in respect to the stone location and size. The results obtained were as follows: the ratio of kidney stone to ureter stone was found to be 2.2:1 in male, and 3.8:1 in female patients. This indicates that ureter stones are more frequently found in male than in female patients. In addition, we compared the size of kidney stones found in the patients including 415 male and 243 female patients. Stones larger than 20 mm were more frequently found in female than in male patients. Moreover, a stone composition study of these patients showed that the contents of both phosphate calcium and magnesium ammonium phosphate were higher in female than in male patients. ESWL performed against stones at pelvis and calyces exhibited the best results. The results obtained with the stones less than 20 mm in diameter were especially favorable with a success rate of 100% for the stones less than 10 mm and 83% for the stones 10-20 mm, in diameter, while the results with the stones larger than 20 mm in diameter were rather poor with a success rate of 31%. ESWL performed against ureter stones showed poor results with a success rate of 63% for the stones smaller than 20 mm in diameter.

[A case report of emphysematous pyelonephritis].

A 51-year-old male patient with diabetes mellitus consulted his home doctor because of high fever and right flank pain. Urinalysis showed marked pyuria. Treatment with antibiotics was not completely effective, and he was referred to our hospital for further examination and treatment. CT scan showed an abnormal gas shadow in right renal parenchyma. He was diagnosed with emphysematous pyelonephritis and right subcapsular nephrectomy was done after the control of diabetes mellitus. We reviewed 57 cases of emphysematous pyelonephritis including our case in the Japanese literature, and we discussed about its etiology, symptomatology, choice of treatment and prognosis.