[Bladder substitution using ileal neobladder after total cystectomy: report of three cases].

We constructed an ileal neobladder in three patients using Hautmann's technique. The patients were men 51 and 67 years old with invasive bladder cancer and a 45-year-old woman with intractable hemorrhagic cystitis induced by cyclophosphamide. The urethral catheter was removed on the 21st postoperative day. At 2 to 5 months following operation, 3 patients had a vesical capacity of 270 to 500 ml and the maximum volume of urine excreted at one voiding was 130 ml to 400 ml. Voiding cystography disclosed no vesico-ureteral reflux. Two patients required abdominal straining at urination and another patient complained of a slight degree of nocturnal incontinence. Intravesical pressure was retained below 10 cm in hydrostatic height in two patients. On the other hand, it gradually increased as the neobladder was extended in another one. No uninhibited contraction was demonstrated by cystometric examination. The serum chloride level indicated almost the maximum normal value in all patients. Neither hydronephrosis nor residual urine was seen on drip infusion pyelography. The postoperative results indicate that the ileal neobladder using Hautmann's technique may become a very useful way to reconstruct the urinary tract.

[Clinical analysis of 169 patients with prostate cancer].

At Matsumoto National Hospital, 169 patients with prostate cancer were diagnosed between April 1986 and May 1994. The prostate cancer incidence was the highest in the latter half of the seventies, with an average age of 74.3 years. The clinical stage was defined as A1, A2, B, C, and D2 in 24 (14.2%), 38 (22.5%), 39 (23.1%), 23 (13.6%) and 45 (26.6%) patients, respectively. The clinical stage was not correlated with the patient's age. Incidental carcinoma was discovered in 5.8% of the patients who underwent prostatectomy for benign prostatic hypertrophy (BPH). At initial diagnosis, the tumor was well, moderately, and poorly differentiated adenocarcinoma in 71 (42.0%), 64 (37.9%), and 34 (20.1%) patients, respectively. The median follow-up period was 38.7 months. The over all five-year crude survival rate was 54.8%, while the cause-specific five-year survival rate was 80.0%. The five-year crude survival rate was 58.4, 82.0, 55.2, 42.5 and 37.4%, for patients with cancer at stage A1, A2, B, C, and D. The survival rate was higher for patients with cancer at clinical stage A and shorter for those with cancer at clinical stage D than in other stages. Prognosis was also worse in patients with moderately or poorly differentiated adenocarcinoma than in those with well-differentiated adenocarcinoma. The clinical stage and the pathological grade are important as prognostic factors, although the high incidence of death from other diseases shows that the patients' age should be considered to choose the modality of therapy. These findings indicate that intensive treatment of the patients in clinical stage A2, B and C prostate cancer in combination with screening for the men between 50 and 75 years old for early cancer detection is required.

[A clinical and pathological study of radical prostatectomy for prostate cancer].

BACKGROUND: Thirty-one patients with prostate cancer underwent radical prostatectomy and simultaneous pelvic lymphadenectomy at Matsumoto National Hospital between 1988 and 1994. Prognostic factors are discussed from their clincopathological findings. METHODS: The patients ranged from 54 to 80-year-old, with an average age of 69.9 years. The median follow-up period was 44 months. The diagnosis was confirmed by needle biopsy or transurethral resection of the prostate. All the patients received short-term endocrine therapy preoperatively, and only noncuratively resected patients underwent adjuvant therapy postoperatively. At initial diagnosis, the tumor grades were well, moderately, and poorly differentiated adenocarcinoma in 9, 12, and 10 patients, respectively. The clinical stage was defined as A2, B, C, D1, and D2 in 12, 4, 6, 3, and 6 patients, respectively. RESULTS: A difference of tumor grade was found between the initial diagnosis and the final diagnosis based on the resected prostate in 8 patients (26%), with 7 of them (88%) showing an increase in grade in the final diagnosis. Also revealed was that 11 of the 25 patients (44%) in stage A2, B, C, or D1 had been understaged preoperatively. The five-year actuarial survival rates were 100%, 92%, and 51% for patients with well, moderately, and poorly differentiated adenocarcinoma, respectively, with a significant difference noted between well and poorly differentiated adenocarcinoma (p = 0.03). Recurrence only developed in patients with pathological stage D tumors. However, the presence or absence of lymph node metastasis did not affect the crude 5-year survival rate. Several stage D patients were successfully treated by radical prostatectomy and adjuvant therapy, achieving long survival. CONCLUSION: These results indicate that patients in clinical stage C have tumors which exhibit differing biological behavior. These patients should be analyzed and classified more precisely so that the most appropriate therapy can be chosen.

Severe cyclophosphamide-induced hemorrhagic cystitis successfully treated by total cystectomy with ileal neobladder substitution: a case report.

A 45-year-old woman with intractable cyclophosphamide-induced hemorrhagic cystitis was successfully treated with total cystectomy and ileal neobladder substitution. To our knowledge this is the first reported reconstruction of the lower urinary tract in a patient with acute hemorrhagic cystitis using a neobladder. Neobladder substitution is contraindicated if the urethra or bladder neck is involved in the disease, although neither was involved in our patient. Whether these lesions are generally left intact has not been discussed previously. If a neobladder can be used, life threatening hemorrhagic cystitis should be treated with total cystectomy accompanied by immediate neobladder substitution.

Effects of intravesical capsaicin and resiniferatoxin on distension-induced bladder contraction in conscious rats with and without chronic spinal cord injury.

PURPOSE: To compare conscious, normal rats and rats with chronic spinal cord injury (CSI) in terms of the rhythmic bladder contractions (RBCs) induced by intravesical infusion of saline, and to determine how these contractions are influenced by intravesical capsaicin and resiniferatoxin. MATERIALS AND METHODS: Female Sprague-Dawley rats, normal or with spinal transection at the level of Th8-Th9, were investigated cystometrically under isovolumetric conditions before and after intravesical administration of capsaicin or resiniferatoxin. RESULTS: Spinal transection induced a significant increase in bladder weight. In both control and CSI animals, intravesical saline instillation induced reproducible RBCs that could be blocked by hexamethonium. Four weeks after the transection, the CSI animals had a significantly larger threshold volume than the controls, even after correction for bladder weight. The mean amplitude and duration of the RBCs did not differ between the two groups, but the frequency was significantly lower in CSI animals. Both capsaicin (0.1 and 1 mM) and resiniferatoxin (1 and 10 microM), instilled intravesically, were found to inhibit RBCs in both normal and CSI rats. There were no qualitative differences in the response to the drugs between the two groups. However, resiniferatoxin was approximately 100 times more potent than capsaicin. CONCLUSION: Capsaicin and resiniferatoxin inhibited RBCs in both normal and CSI rats, suggesting that activity in sensory fibers (C and Adelta), which are sensitive to the action of these drugs, is initiated by bladder filling in both types of rat.