Laparoscopic radical nephrectomy for renal cell carcinoma.

PURPOSE: To estimate the efficacy of the laparoscopic radical nephrectomy we analyzed the clinical data of our series. PATIENTS AND METHODS: One hundred eighty five patients were enrolled in our laparoscopic radical nephrectomy program between July, 1992 and July, 2001. Of the 185 patients, 146 had small renal tumors (smaller than 5 cm in diameter) and 39 had large tumors (equal to or more than, 5 cm in diameter). Under a laparoscope the kidney, adrenal gland, and perirenal fatty tissue were dissected in an en bloc fashion. In case of taking out a small tumor, the specimen was fractionated within the sack to avoid an additional skin incision after entrapping in the laparoscopy sack in the working space. In case of a large tumor, regional lymph nodes dissection was done and the specimen was taken out intact in the sack through an enlarged incision. RESULTS: Our laparoscopic procedure was successful in 171 of the 185 cases; 14 patients required open surgery because of bleeding from an injured vessels or treatment for other injured organs. The mean operative time was 4.7 hours for both small and large tumors. Estimated blood loss was between 237 and 380 ml on average for small and large tumors, respectively. Full convalescence was achieved around 3 weeks after operation in both groups. Only one patient who had large tumor was found to have micrometastasis in 1 of 5 regional lymph nodes. Recurrences were observed in 4 cases of the small tumor group and in 2 cases of the large tumor group during 1 to 108 months of follow-up. CONCLUSION: Laparoscopic radical nephrectomy is a very useful and safe surgical procedure for renal cell carcinoma.

[Bilateral synchronous testicular seminomas: a case report and review of the Japanese literature].

A 39-year-old man was referred to our hospital with right testicular swelling. Ultrasonography and magnetic resonance imaging revealed bilateral, synchronous testicular tumors. Bilateral high inguinal orchiectomy was performed. Histological examination revealed anaplastic seminomas. Prophylactic radiation therapy was performed in the para-aortic and pelvic regions postoperatively, and no signs of metastasis have been found during the follow-up period of more than 5 months. Including the present case, 186 cases of bilateral testicular tumors reported in Japan are reviewed.

[Pelvic lymph node involvement in primary bladder cancer. A clinicopathological study of radical cystectomies].

Between 1984 and 1992, 131 patients with bladder cancer underwent radical cystectomy and pelvic lymph node dissection with urinary diversion. There were 110 male and 21 female patients, aged between 35 and 86 with a mean of 64 years. The follow-up period ranged from 1 month to 113 months, with a median of 34 months. The five-year survival estimated by the Kaplan-Meier method was 66.9% over all 131 patients. The five-year survival rates were 83.3% for stage pTis patients, 66.7% for stage pTa, 97.0% for pT1, 70.7% for pT2, 47.9% for pT3a, 26.2% for pT3b, and four-year survival was 25% for pT4 disease. Under the grading system, the five-year survival was 80.0% for cases of grade 2 disease and 63.6% for grade 3. There were two grade 1 patients who died of other diseases 15 and 16 months after surgery. Of all 131 patients, 22 (16.8%) had lymph node involvement. The five-year survival was 34.5% for patients with positive lymph nodes in comparison with 73.8% for those without lymph node involvement. The frequency of lymph node involvement was 26.1% in the non TCC group and 14.8% in the TCC group including 23.7% of the grade 3 and 4.3% of the grade 2 cases. Pathologically, the patients with higher stages had a higher frequency of lymph node involvement, and there was a significant difference in the frequency between pT3a (14.3%) and pT3b (47.8%) disease. The five-year survival of patients with positive lymph nodes was 40.0% for pN1, 32.1% for pN2 disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Extracorporeal shock wave lithotripsy using the Dornier MPL 9000 lithotriptor.

336 patients with urinary calculi were treated between June 1988 and October 1991 with extracorporeal shock wave lithotripsy using the Dornier MPL 9000 lithotriptor. Of 352 renal units (a kidney and its ureter), 286 had renal stones, 62 had ureteral stones and 10 had both. There were radiolucent stones in 6 units. The complete disintegration rate was 94%. The mean number of shock waves was 2,973, the range being from 300 to 16,131. In 310 of 447 (64%) sessions, treatment was done without any anesthesia. The rate of complete removal was 67.3% 3 months after the last treatment. Only 11 patients required supplementary treatment consisting of percutaneous nephrolithotripsy and transurethral lithotripsy. There were no severe complications except subcapsular hematomas observed in 2 patients. The Dornier MPL 9000 is a useful lithotriptor for the treatment of urinary calculi, except staghorn calculi.

Minocycline instillation for lymphorrhea after extraperitoneal pelvic lymphadenectomy. OFF.

We managed four cases of lymphorrhea after extraperitoneal pelvic lymphadenectomy by means of minocycline instillation into the cavity around the drainage tube. Two patients had concomitantly undergone cystectomy and one prostatectomy via the extraperitoneal approach. In all four cases, the lymphorrhea markedly subsided, which dramatically shortened the duration of drainage. No side effects occurred. These findings indicate that minocycline instillation is an efficacious treatment for lymphorrhea.

Small hyperechoic renal tumors displaying no fat content on CT.

We report two cases of small renal adenocarcinoma and one case of small angiomyolipoma, which were identified as hyperechoic tumors by ultrasonography. None of the three tumors displayed fat content on plain CT. Since CT cannot reliably identify the intratumoral structure of small hyperechoic renal tumors, we recommend intraoperative pathological examination when CT findings do not correspond with the results of ultrasonography.

[An analysis of 30 patients with renal trauma: diagnostic value of radiographic examinations].

To evaluate the diagnostic value of radiographic examinations in renal trauma, 30 patients treated between April, 1985 and March, 1988 were examined. The 25 male and 5 female patients ranged in age from 10 to 74 years, with 17 (57%) less than 30 years of age. Causes of injuries were traffic accidents in 19 patients (63%), falls in 5 (17%), sports in 2 (7%), and others in 4 (13%). Twenty-nine patients (97%) had hematuria and 3 (10%) had shock due to renal injury. The presence of shock indicated severe renal injury, but the degree of hematuria did not correlate to severity of injury. Of the 30 patients, 18 (60%) had renal contusions, 7 (23%) had minor lacerations, 4 (13%) had major lacerations and one had vascular injury. One patient had penetrating trauma and the other 29 had blunt trauma. Two patients (7%) had pre-existing renal anomalies. Associated injuries were present in 16 patients (53%). The presence of associated injuries had no relation to the severity of the renal injury. Computerized tomography (CT) with contrast medium was more sensitive to abnormal findings, especially subcapsular and perirenal hematoma, than excretory pyelography. Findings of renal angiography provided additional anatomical information for deciding immediate surgical treatment and for selecting operative methods for salvage of the kidney.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of herniation of the bladder].

A 34-year-old man was admitted with pain on urination, pollakisuria and left inguinal hernia. He had undergone a surgery for the left inguinal hernia 3 times, about 30 years, 28 years and 14 years earlier. Physical examination revealed that there was an elastic soft mass in the left inguinal region. Cystoscopy and cystography showed the bladder herniation and left vesicoureteral reflux (Grade 1). Radical surgery for the hernia of bladder was not performed. The literature on the hernia of the bladder in Japan were collected and discussed.