Results of extracorporeal shock wave lithotripsy for the treatment of upper urinary tract stones.

The treatment results of 697 renal units in 687 patients treated for upper urinary tract stones using a Piezolith 2500 at the Ageo Central General Hospital during the 5-year period between August 1999 and July 2004 were analyzed. The stone-free rate and the success rate were calculated according to the stone size and location. Univariate and multivariate logistic regression analyses were performed to estimate the effect of the patient age, sex, affected side, stone location and stone size on the stone-free rate and the success rate. Overall, the stone-free rate and the success rate at 3 months after treatment were 82.6% and 91.9%, respectively. The stone-free rates in renal and ureteral stones were 60.5% and 88.7%, respectively. The success rates for renal and ureteral stones were 93.6% and 91.6%, respectively. In a univariate logistic regression analysis, patient age and stone size were significant negative factors for both the stone-free rate and the success rate and the stone location in ureter was a significant positive factor only for the stone-free rate. In a multivariate analysis, stone location in the ureter had a positive effect on the stone-free rate, although a negative effect on the success rate. Extracorporeal shock wave lithotripsy for upper urinary tract stones was an effective and safe treatment modality. However, if pre-treatment factors indicate unfavorable outcome, the other treatment options should be considered for the first line therapy.

[Clinico-statistical analysis of renal cell carcinomas in patients on hemodialysis].

Eleven patients on hemodialysis that were surgically treated for renal cell carcinomas during the recent 10 years at our institutes were clinically analyzed. Patients' ages at presentation ranged from 35 to 70 years with an average of 54.8 years. Nine of the 11 patients were males and 2 were females. Periods between the introduction of hemodialysis and the presentation ranged from 1 to 21 years with an average of 11.7 years. The most frequent cause of hemodialysis was chronic glomerulonephritis. Five patients presented with macroscopic hematuria, which was the most frequent clinical manifestation. Transperitoneal nephrectomy through a lumbar oblique incision was performed in 9 of 12 surgical procedures. Transperitoneal resection and retroperitoneal endoscopic resection were performed on 2 patients and 1 patient, respectively. Blood transfusion was performed on 2 patients with retroperitoneal hemorrhage before or after operation and 2 patients with pre-existing renal anemia. Pathologically, 9 patients had pT1a disease. Patients were followed up for up to 7 years and 11 months. One patient died of the disease and 2 patients died of unknown causes. In conclusion, surgical removal of renal cell carcinomas was well tolerated, safe and effective treatment in patients under hemodialysis.

[A case of leiomyosarcoma of the spermatic cord].

A 44-year-old male was referred to our hospital for further treatment of lung and adrenal metastases from leiomyosarcoma occurring in the left spermatic cord. He had undergone high orchiectomy 5 months before, but no adjuvant therapy was done. Although systemic CYVADIC therapy (cyclophosphamide, vincristine, doxorubicin hydrochloride, dacarbazine) was performed in our hospital, he died of metastatic disease 10 months after the initial therapy. Leiomyosarcoma arising in the spermatic cord is a rare entity. We present a case of leiomyosarcoma of the spermatic cord, and to our knowledge, this is the 23rd case reported in Japan.

Thymidine phosphorylase and dihydropyrimidine dehydrogenase in bladder cancer.

Thymidine phosphorylase (TP) and dihydropyrimidine dehydrogenase (DPD) levels in transitional cell carcinoma of the bladder resected from 38 patients were examined by ELISA. TP levels in high-grade and invasive cancer were significantly higher than those in low-grade and superficial cancer, respectively. No significant differences in the DPD levels were observed among grades and stages, but the DPD/TP ratio was significantly lower in grade 3 tumor than in grade 1. These results demonstrated that 5'-deoxy-5-fluorouridine seemed to be useful for managing patients with grade 3 cancer. The present study also suggested that we might be able to exclude cases of bladder cancer in which 5-fluorouracil group medicines would be inappropriate candidates in treatment options by measuring both TP and DPD levels in the tumor.