[Clinical treatment of urinary tract stones with Alexandrite laser].

Clinical treatment of urolithiasis with Alexandrite-laser which is a solid pulse laser system developed in Switzerland is reported. Two cases of renal stones, 3 cases of vesical stones, and 35 renal units in 34 cases of ureteral stones were treated. The approach to the aimed stone was, percutaneous to the renal stones, and transurethral to the vesical and ureteral stones. The clinical success rate was 92.5% (37/40), when we defined success as the endoscopically observed fragmentation. The uric acid stone in the bladder was not disintegrated even when the plasma occurred, but the ureteral uric acid stone was easily fragmented. The difference was thought to be attributed to the condition of the surface. The Alexandrite-laser system generates a 750 nm wavelength, and this wavelength is neither absorbed in water nor hemoglobin, so is thought to be harmless to the tissue. Actually, if misirradiation to the ureteral mucosa during lithotripsy was done, neither plasma formation nor perforation occurred. In conclusion, the Alexandrite-laser is thought to be safe and effective equipment for the treatment of urolithiasis.

[Clinical application of transrectal ultrasonic therapy to nonbacterial prostatitis and prostatodynia cases which were resistant to conventional drug therapy].

A total of 25 patients with nonbacterial prostatitis and prostatodynia which were resistant to conventional drug therapy underwent 5 minutes course of transrectal ultrasonic therapy in association with application of 1% hydrocortisone acetate cream to the anterior rectal wall for consecutive 8 days. The efficacy of the treatment was evaluated only by comparison of symptom scores for subjective symptoms obtained before and after treatment. Excellent results, which were defined as more than 70% reduction of symptom scores after treatment, were obtained in 5 (27.8%) among 18 evaluable cases in which symptom scores before treatment were more than 4, good (40-69% reduction of scores) in 4 (22.2%), fair (10-39% reduction of scores) in 4 (22.2%) and poor (less than 10% reduction of scores) in 5 (27.8%). Because of good clinical efficacy and the absence of complication, transrectal ultrasonic therapy combined with hydrocortisone acetate cream application was thought to be useful for the treatment of nonbacterial prostatitis and prostatodynia cases which responded poorly to the conventional therapy.

[Operation of female stress incontinence--comparison between Raz procedure and Gittes procedure].

We performed Raz procedure and Gittes procedure for female stress incontinence since October 1986. Raz procedure was performed on 19 patients between October 1986 and February 1990, and Gittes procedure was performed on 18 patients between June 1990 and May 1991. We followed up 17 patients who underwent Raz procedure and all the patients who underwent Gittes procedure at the time August 1991. Disappearance or marked improvement of incontinence was confirmed in 12 patients by Raz procedure, and 16 patients by Gittes Procedure. No serious complications were recognized. The reason why the result of Raz procedure was not sufficient was due to our immature operative technique and incorrect patient selection in our early experience. From this experience, we believe that both procedures can be very useful and minimal invasive operation for female stress incontinence.

[Clinical studies on Kock continent urinary reservoir and Indiana continent urinary reservoir].

Recently, the continent urinary reservoir which provides the patient with a better quality of life has become popular. Many types of reservoirs have been reported, but the optimal procedure remains to be established. From July 1987 through November 1988, we performed Kock pouch construction on 11 patients (ages 39 to 76 years). Between July 1989 and March 1991, 9 patients (ages 44 to 66 years) underwent Indiana pouch operation. The first 4 patients underwent ileal patch type, and the subsequent 5 underwent Heineke-Mikulicz type procedure. A one-stage radical cystectomy and continent urinary reservoir construction was performed on 19 patients, and bilateral cutaneous ureterostomy was converted to Kock pouch in one patient. There were no perioperative deaths, but reoperation was required for urinary leakage from the reservoir on one patient in each group. As the late complications in the Kock pouch group, one patient required revisional operation of the continent valve mechanism, 2 patients experienced intermittent prolapse of the nipple valve of the efferent limb, and 2 had malfunction of the afferent nipple valve. In the Indiana pouch group unilateral hydronephrosis was noticed in one patient, and 4 had mild difficulty of catheterization. Although 3 patients in both groups had mild urinary leakage, all patients had good quality of life with capacity of reservoir over 500 ml and with good renal function. We changed the type of operative procedure from Kock pouch to Indiana pouch because of the high complication ratio in the former.(ABSTRACT TRUNCATED AT 250 WORDS)

[243 cases of percutaneous nephrolithotomy--result of 5 years].

Between May, 1982 and April, 1987, upper urolithiasis of 247 kidneys of 243 patients, 174 male and 69 female, were treated by percutaneous nephrolithotomy (PNL). The main stone was successfully removed from 236 kidneys (about 95.5%). Seven cases of ureteral stone could not be removed by PNL, and were treated by traditional ureterolithotomy. In 3 cases of pelvic stone, the stone descended to the ureter during the PNL procedure, and was also removed by ureterolithotomy. In one case of pelvic stone, complete obstruction of uretero-pelvic junction after PNL occurred, and pyeloplasty was needed. One pelvic stone patient who had basical hypertension and arrhythmia died soon after PNL, because of acute myocardial infarction. Blood transfusion was needed in 31 cases (12.8%). The residual stones over 5 mm were noticed in 48 cases (20.3%). The most important point to succeed in PNL is to make a nephrostomy through the most suitable calyx to the stone. The easiest way to identify the location and connection of the aimed calyx with the stone in three dimensional position, is to take X-ray films in intravenous pyelograms not only from postero-anterior but also oblique positions. Additional transureteral lithotripsy (TUL) for the fragment descending to the ureter after PNL produces a much better result.

[The influence of percutaneous nephrolithotomy on renal function evaluated by 99m-Tc-DTPA renoscintigram].

The influence of percutaneous nephrolithotomy (PNL) on renal function was evaluated by 99m-Tc-DTPA renoscintigraphy. The renoscintigram was recorded and regions of interest of both kidneys (R) and background (BKG) were settled. Renal uptake ratio was calculated by the following formula. Renal uptake ratio = (formula; see text). The renal uptake ratio of 50 patients were compared before and up to 6 months after PNL. Most cases showed an increase or no change in post-PNL renal uptake ratio in operated kidney. Five cases (10%) showed decreased renal uptake ratio of post-PNL. No risk factors for the renal damage caused by PNL such as age, sex, stone size, number of nephrostomy and course of PNL were detected when compared with increased or no change groups. In cases of complete staghorn calculi in the decreased renal uptake ratio group, compensatory hypertrophy of contralateral kidney PNL course might occur, and the function of the operated kidney might not have recovered. More during cases and longer follow-up is necessary for the recovery of renal function.

[Chemotherapy of disseminated germ cell testicular tumors with cis-diamminedichloroplatinum and other drugs].

The effect of single CDDP therapy and PVB therapy was examined in 7 cases of stage III germ cell testicular tumors with measurable metastases. The mean age of the patients was 30.6 years old, and their histological types of primary sites were seminoma in 3 cases, embryonal carcinoma in 2, immature teratoma in 1 case and embryonal carcinoma + teratoma in 1 case. In 1 case of seminoma, 375 mg of CDDP was administered. In 1 case of embryonal carcinoma + teratoma, 100 mg of CDDP and then 2 courses of PVB therapy were performed, and 3 courses of PVB therapy were given in all other cases. Three cases showed complete response, 2 cases partial response and 2 cases no change. Pulmonary metastatic nodules were extirpated after the PVB therapy in 1 of the cases showing no change, and the histological examination of these nodules was found to be mature teratoma. As a result, the effectiveness of the chemotherapy alone was 71.4%, and that of chemotherapy + surgical operation was 85.7%. Significance of intensive chemotherapy and necessity of extirpation of residual metastatic nodules after intensive chemotherapy in the management of advanced germ cell testicular tumors are stressed.

[Case of immature teratoma of the testicle metastasizing as completely mature teratoma].

A case of immature teratoma of the testicle metastasizing as completely mature teratoma is presented. A 23-year-old man underwent right inguinal orchiectomy for an immature teratoma of the testicle on September 14, 1982. At retroperitoneal lymph node dissection, 12 lymph nodes were removed, all of which were negative for cancer. He was well until March 1983, when bloody sputum and left chest pain occurred. Since full lung tomography revealed two pulmonary nodules, he was treated with a course of VP-16 and three courses of vinblastine, bleomycin and CDDP. In September 1983, after completion of the combination chemo-therapy, the two pulmonary nodules were noticed to be slightly enlarging. A thoracotomy was scheduled to remove these nodules, since they were believed to be his only remaining tumors. Pathologic examination of the extirpated nodules disclosed completely benign teratoma. Mediastinal lymph nodes had no metastatic involvement histologically. It is our intention in this paper to emphasize, by means of several case reports, the frequently benign nature of these residual lesions and also to emphasize a recently recognized phenomenon--the apparent induction of benign teratomas by this intensive chemotherapy.

[A case of a congenital unilateral multicystic kidney and a review of 126 cases in Japan].

A 3-year-old boy was admitted to our hospital with complaints of left flank mass and growth retardation. Examinations with IVP (Fig. 1), retrograde pyelography (Fig. 4) and cystoscopic examination (Fig. 3) showed a left nonopacified kidney, and right hydroureteronephrosis due to stenosis of the midureter. Two large cystic patterns were found in the left kidney by ultrasonic scanning tomography (Fig. 2); and, the left kidney was found to be occupied by a round and homogeneously low density mass by CT scanning (Fig. 6). The left renal artery was not demonstrated on the aortogram (Fig. 5). The patient was diagnosed to have a left congenital unilateral multicystic kidney, and laparotomy was performed. The left kidney was easily removed, and the part with stenosis in the right ureter was removed, then end-to-end anastomosis was performed. Grossly, two large cysts (upper and lower part) and connective tissues were found in the left kidney (Fig. 7), and the vessels of the renal pedicle were filiform. No luminal formation of the renal pelvis or ureter was found. The epithelium of the cyst wall (Fig. 8) was deciduated leaving the connective tissue and smooth muscle, as shown by the histological examination. Histological examination of the parenchymal tissue (Fig. 9) between the two cysts showed primitive glomeruli and renal tubules among abundant connective tissue, but no cartilage tissue. Statistic examination and discussion have been made of 126 cases of congenital multicystic kidney reported in Japan.