[Laparoscopic radical prostatectomy: initial 17 case report].

PURPOSE: We report our early experience of laparoscopic radical prostatectomy for clinically localized prostatic cancer. MATERIAL AND METHOD: Between April and December 2000, 17 patients with clinical stage T1c to T2b prostatic cancer underwent laparoscopic radical prostatectomy. The median age was 70.9 year old, the median preoperative PSA and the median Gleason score of biopsy specimens was 7.1 ng/ml, 6, respectively. We followed the operation technique from the "Montsouris technique". Briefly, we used five trocars (two 10-mm and three 5-mm trocars) and the operation was performed transperitoneally. Pelvic lymph node dissection was performed in only one patient (case 3). Urethrovesical anastomosis was performed with 6 to 9 interrupted 3-0 absorbable sutures. RESULTS: No conversion to open surgery or reoperation was required in all cases. Median operation time was 450 minutes (range 290 to 750) and median intraoperative bleeding (including urine) was 600 ml (range 100 to 3,135). Only one case (case 3) needed homologous blood transfusion. Median postoperative Foley catheterization period was 9 days (range 5 to 19). Intraoperative complications related to operation procedure were one rectal injury and three vesical injuries, which were treated by absorbable suturing laparoscopically. Major complication was one complete A-V block (case 3) who was required a transient discontinuance of the procedure. Surgical margins were negative in 13 cases. Postoperative pathological evaluation was one pT0, five pT2a, seven pT2b and four pT3a. PSA value decreased less than 0.2 ng/ml after surgery in all patients. Although six months have passed after the surgery in only 4 patients, all of them were fully continent. CONCLUSION: Although the operation time is still longer than that of conventional open procedures, intraoperative magnified vision allows a more precise and safer dissection, especially for apical dissection. We believe that operative time will decrease with more experience. These results show that laparoscopic radical prostatectomy can be an acceptable treatment option for localized prostatic cancer.

[Syphilitic orchitis: a case report].

Syphilitic orchitis is recently a rare disease in Japan. A 75-year-old man was referred to our hospital with the complaint of persistent swelling of the left scrotal contents in spite of prior antibiotic therapy. We suspected a testicular tumor because of lack of pain, and performed high orchiectomy. The specimen showed wide-ranged necrosis with a non-specific inflammatory change of the testis on hematoxylin-eosin stain. After performing analysis using a polymerase chain reaction method, we reached the final diagnosis of syphilitic orchitis.

Lower urinary tract problems in patients with enuresis.

OBJECTIVE(S): Two hundred and thirty-eight children (170 males, and 68 females) with nocturnal enuresis were retrospectively studied for lower urinary tract problems. Surgical correction of subclinical organic obstruction in the lower urinary tract was evaluated for the improvement of bed-wetting. METHODS: One hundred and fifty-five micturating cystourethrography (MCU), and 89 urodynamic studies were performed. Optic internal urethrotomy was done in a boy, and meatoplasty in a girl for urethral 'ring' stenosis (URS). RESULTS: Nocturnal enuresis was found in 153 cases and nocturnal enuresis associated with daytime enuresis in 67 cases. Vesicoureteral reflux was found in 30, URS in 42, and posterior urethral valve in 3 cases on MCU. Detrusor instability was recognized in 39.4% of 38 cases of nocturnal enuresis associated with daytime enuresis and in 25.0% of 51 cases of nocturnal enuresis. Surgery brought 73.8% improvement of bed-wetting in 42 cases. CONCLUSIONS: Surgical correction of subclinical obstruction in the lower urinary tract might contribute to the earlier resolution of bed-wetting in children with nocturnal and/or diurnal enuresis.

[Vesicouterine fistula: a case report].

A 25-year-old woman suffered a vesicouterine fistula following cesarean section. Cystoscopic fulguration of the fistula was attempted, resulting in disappearance of incontinence. Two months later, incontinence recurred and open surgical repair was performed transabdominally. After resection and closure of the fistula with the help of peritoneal flap interposition, the patient became free from incontinence.

[A case of renal cell carcinoma with an extremely high serum carcinoembryonic antigen level].

A case of renal cell carcinoma with extremely high serum carcinoembryonic antigen (CEA) levels is presented. A 57-year-old female complained of left flank pain. Computerized tomographic (CT) scan revealed left renal tumor and laboratory examination revealed an extremely high serum level of CEA (815 ng/ml). No abnormal findings were recognized in gastrointestinal or genital systems. Radical nephrectomy was done. The histology was renal cell carcinoma (RCC, intermediate type, mixed type, pleomorphic cell type, G3 > G2, INF gamma, pT2, pV0). Tumor cells were positive for CEA by ABC-peroxidase staining. Levels of tumor markers decreased after operation. However, CEA levels rose again and lymph node metastases appeared. She died 6 months after operation.

[Tuberculous spondylitis after intravesical BCG instillation: a case report].

We report a case of tuberculous spondylitis after intravesical bacillus Calmette-Guerin (BCG) instillation. A 71-year-old man was administered BCG (80 mg per week) for 8 weeks for prophylactic treatment of bladder cancer. After the first instillation he experienced miction pain, pollakisuria, and febrile episodes. Two months after the completion of BCG instillation, he complained to back pain and spinal X-ray showed a lytic lesion of Th7 vertebra. Diagnosis of metastatic transitional cell carcinoma was made based on MRI and bone scan. But pathological findings at laminectomy revealed tuberculous spondylitis. Antituberculous therapy (SM, RFP, and INH) was instituted and anterior supine fusion was performed. Now he is free from bladder cancer and tuberculous infection. Intravesical BCG instillation is effective for superficial bladder cancer, but it should be kept in mind that complications related to this treatment could occur and the adequate antituberculosis treatment has to be insisted if indicated.

[Bacteremia of in-patients of the department of urology].

Thirty cases of bacteremia out of 1512 patients who had been admitted to our Department between February 1988 and June 1991 were reviewed. They consisted of 22 males and 8 females and their age ranged from 32 to 88 years (mean 62.7). 25 of the patients (83.3%) had malignant diseases of which bladder cancer (15 cases) was predominant and 5 had benign diseases. Gram positive bacteria were isolated in 18 cases (56.2%) and fungi in 4 cases (12.5%) from blood culture. Of these MRSA was most prevalent: 6 cases (18.8%), followed by S. epidermidis: 4 cases (12.5%), P. aeruginosa: 3 cases: E. faecalis: 3 cases and Corynebacterium: 3 cases (9.4%). Analysing the onset of bacteremia for each case, in three cases urinary tract infections, in one case a surgical wound infection and in one case a skin infection were prominent before the diagnosis of bacteremia. From their background, 23 cases (76.7%) were so-called compromised hosts. A total of 7 cases had died, 6 cases of bladder cancer and one case of testicular cancer, five of them were on systemic anti-cancer chemotherapy. Of those cases who expired, P. aeruginosa was isolated in two cases, Candida in two cases, MRSA in one case and E. faecium in one case, Corynebacterium in one case. It was noteworthy that in two cases where blood cultures were positive for P. aeruginosa and one case where the blood culture proved positive for Candida, drastic decrease of the peripheral leukocyte number during anti-cancer chemotherapy was seen.(ABSTRACT TRUNCATED AT 250 WORDS)

[Statistics on operations at Hara Genitourinary Hospital (1971-1991)].

The statistical analysis of the inpatients and operations in our department from April, 1971 to March, 1991 revealed a total of 9,170 operations. One of the biggest changes in treatment is a marked increase in closed surgery. This includes endourological surgeries; transurethral resections of prostate and bladder tumor (TUR-P, TUR-Bt), percutaneous nephrolithotripsy (PNL), transurethral uretero-lithotripsy (TUL) and extracorporeal shock-wave lithotripsy (ESWL). From 1976 to 1980 there were 721 open surgical procedures (71.0% of cases) and 295 closed procedures (21.0% of cases). This ratio has now been reversed completely. From 1986-1991, there were 342 open procedures (8.2% of cases) and 3808 closed procedures (91.8% of cases). The main reason for this change was the introduction of the new techniques PNL, TUL and ESWL. Other important observations include: The incidence of emergency operations was higher in this private institution than that seen in non-private hospitals. From 1986, there was an increase in the use of PNL and TUL for the management of urinary calculi, and from 1988, ESWL has overtaken PNL and TUL in the treatment of this condition. Recently the limitations of ESWL have been appreciated and the value of a combined approach to therapy, for selected cases, is being recognized. A total of 238 ileal or ileocecal conduits were created with good results. A low complication rate has been observed with preservation of renal function.