[A case of laparoscopic nephrectomy for ectopic vaginal ureter in a child].

An 11-year-old girl presented with continuous incontinence since infancy. Neither intravenous pyelography nor renal scintigraphy demonstrated the left upper urinary tract, but a very small left kidney was detected close to the 3rd lumbar vertebrae on computed tomography (CT). After cystoscopy, the patient was diagnosed with ectopic vaginal ureter and hypoplastic kidney. Laparoscopic nephrectomy was performed. Before surgery, a ureteral occlusion catheter was inserted through the meatus which opened in the vagina. The catheter was very useful for locating the small kidney during surgery. The procedure was successful and the surgical duration was short (123 min.) with only slight hemorrhage (15 ml). The patient was able to attend school on the seventh postoperative day. We recommend laparoscopic surgery for the treatment of ectopic ureter.

Lysosomal cysteine and aspartic proteinases and ubiquitin in rat and human urinary bladder epithelium.

To examine localization of cysteine and aspartic proteinases, and ubiquitin in rat and human urinary bladders, immunocytochemistry was applied to the tissues. In semi-thin sections, immunoreactivity for cathepsins B and D was densely localized throughout epithelial layers of rats and humans, while that for cathepsins H and L was mainly localized in rat superficial and human intermediate cells. Immunoreactivity for cathepsin C was relatively high in rat and human epithelia, especially in humans. Immunoreactivity for ubiquitin was detected in rat and human epithelial cells. By electron microscopy, vesicular or heterogeneously dense lysosomes labeled with immunogold particles indicating cathepsin B were seen in rat and human epithelial cells; particularly, they often appeared near fusiform vesicles in rat superficial cells and in human intermediate and superficial cells. By double immunostaining, lysosomes with or without vesicular structures were co-labeled with immunogold particles showing both cathepsin B and ubiquitin. The results suggest that cathepsins B, C, H, and L, and cathepsin D are involved in the lysosomal system of rat and human bladder epithelia. Moreover, considering that ubiquitin is a cofactor in the soluble ATP-dependent proteolysis, the results may also indicate that epithelial cells actively form autophagolysosomes.

[Rupture of an external iliac artery aneurysm into the bladder: a case report and review of the literature].

A case of fatal hemorrhage caused by rupture of the external iliac artery aneurysm into the urinary bladder is presented. The patient, a 58-year-old Japanese female, had undergone total hysterectomy, and post-operative therapeutic radiation, for uterine cancer in 1974. A vesicocecal fistula was observed, and surgical intervention for closure was performed in May, 1992. On July, 13, 1992, she presented with pulsating hemorrhage from the urinary bladder. Angiography was consistent with rupture into the bladder of an iliac artery aneurysm. Surgical intervention for closure of the aneurysm was performed but the aneurysm could not be resected. She had relapse of the fistula which became infected with methicillin-resistant Staphylococcus aureus (MR-SA), and died 3 months postoperatively. To the best of our knowledge, there have been only 3 cases in which an iliac artery aneurysm ruptured directly into the urinary bladder. This case indicates that resection of the aneurysm for therapy is a vital requirement.

A foreign body of the corpus cavernosum in a patient with cleft glans penis: a case report.

We had an opportunity to treat a rare case of foreign body in the corpus cavernosum in a patient with cleft glans penis. The foreign body was a 13 cm wire, which was inserted by the patient himself for masturbation, and was removed surgically. To our knowledge, such a case has never been reported in the literature.

[Renal metastasis from osteogenic sarcoma: report of a case].

Renal metastases of osteogenic sarcoma are unusual clinical occurrence and cases of osteogenic sarcoma treated by nephrectomy for renal metastases have been rarely reported. We report a 19-year-old male who was successfully treated by left nephrectomy for a metastatic tumor of osteogenic sarcoma from the right femur. In 1989 above-knee amputation was performed and the initial relapse with right pulmonary metastasis was treated by right upper lobectomy in 1991. In February 1992 he developed left renal and left pulmonary metastasis, hence left nephrectomy and left upper lobectomy were performed. Metastases of osteogenic sarcoma to the organs other than the lung and bone will increase because of the improvement of diagnostic modalities. Our study suggests that a bone scan is useful for routine follow-up of patients with osteogenic sarcoma and that resection of the metastatic lesion can improve these patients' quality of life.

Effects of hypogastric nerve and sympathetic chain stimulation on the pelvic nerve induced penile erection in the dog.

The effects of electrical stimulation of hypogastric nerve and sympathetic chain on 'electroerection' (penile erection induced by electrical stimulation of the pelvic nerve) were studied in dogs to clarify the physiological roles that these neural inputs may play in producing and/or maintaining penile erection. As an objective parameter of hemodynamics of the penile circulation, the pressure in the corpus cavernosum of the penis was measured. Hypogastric nerve electrostimulation was performed in 24 dogs who had received pelvic nerve stimulation and, therefore, had 'electroerection'. Ten dogs responded to this procedure with an augmentation of 'electroerection', 10 with an attenuation of 'electroerection', and 4 with no appreciable changes. 4 out of the 10 animals who exhibited an attenuation response were then given an alpha 1-adrenergic blocker (prazosin hydrochloride) prior to the electrical stimulation to evaluate the specificity of the effects of the hypogastric nerve stimulation. In 3 of the 4 dogs the attenuation effect was abolished by this treatment and instead an augmentation effect became evident. Sympathetic chain electrostimulation was performed in 6 dogs with 'electroerection'. When applied to the L4-5 interganglionic segment, it produced a biphasic response which consisted of an initial increase followed by a decrease of the intracorporeal pressure. In contrast, stimulation of the L2-3 interganglionic segment produced a monophasic response consisting of only augmentation of the intracorporeal pressure. These data suggested that there might be two groups of fibers in the hypogastric nerve and sympathetic chain which are functioning antagonistically, and that the anti-erectile neural inputs are mediated primarily by the alpha 1-adrenergic system. To examine the sites of penile vasculature where the innervating hypogastric nerve exerts its effects, electrical pelvic/hypogastric nerve stimulations were performed in dogs in whom the inflow blood circulation to the corpora cavernosa was disrupted by arterial ligation and replaced by a constant saline infusion. It appears that the stimulatory input via the hypogastric nerve caused an increased blood flow into the cavernous space due to vasodilation of the inflow blood vessels, and the inhibitory effect occurred mainly due to relaxation of the draining blood vessels with a resultant increase of the blood outflow from the cavernous space.

Two circulatory routes within the human corpus cavernosum penis: a scanning electron microscopic study of corrosion casts.

The microvascular architecture of the human corpus cavernosum penis was studied by scanning electron microscopy of vascular corrosion casts. The corpus cavernosum was supplied by the penile deep artery. It gave off branches to become either arteries distributed within the corpus cavernosum or those directly supplying the corpus spongiosum urethrae. The former arteries further divided into small arteries which fell into two categories: 1) arteries breaking up into capillaries, and 2) arteries draining directly into the cavernous sinuses. The capillaries were collected into venular networks just beneath the tunica albuginea (the subalbugineal venular plexus), while the cavernous sinuses were collected into venules at the periphery of the corpus cavernosum. These postcavernous venules also received venules from the subalbugineal venular plexus, and left the corpus cavernosum. Thus, two circulatory routes are evident within the corpus cavernosum. These findings suggested that the penile erectile cycle is controlled by hemodynamic changes between these two routes within the corpus cavernosum.

[A case of emphysematous pyelonephritis with septic shock recovered by transurethral drainage of pelvis].

A case of emphysematous pyelonephritis with septic shock was present in a 58-year-old diabetic woman. The spontaneous production of gas was present within the right renal pelvis in kidney-ureter-bladder X-ray. The patient's condition deteriorated rapidly after admission, became complicated with acute renal failure, disseminated intravascular coagulation and acute respiratory failure. Transurethral drainage of the pelvis using a 6 Fr. UPJ occlusion balloon catheter and endotracheal intubation with respiratory assistance were performed as a life-saving procedure. The optimal therapy with surgical or conservative approach for such a severe condition is discussed. The use of transurethral drainage of pelvis as a non-invasive treatment is suggested.

Quantitative analysis of outflow pathway of corpora cavernosa by pressure flow technique.

Using a pressure flow technique, quantitative analysis of the physiological characteristics of the outflow pathway of the corpus cavernosum was carried out in 19 male dogs weighing 7.5 to 23.0 kg. Pressure flow curves were made on dogs whose pelvic nerve was stimulated electrically and on dogs left unstimulated. When a cyclical change in saline perfusion rate was applied without nerve stimulation, the variable of the intracorporeal pressure showed a large hysteretic loop, indicating that the resistance of the outflow canals to flow was altered by the distension of the sinusoidal space. In dogs whose pelvic nerve was stimulated, the pressure flow curves shifted to the left side in comparison with the outward phase of the pressure flow curve of animals without pelvic nerve stimulation, and this curve piled on the returning phase. No hysteretic relation was observed between the outward and returning phase of the pressure flow curve with pelvic nerve stimulation, but in the detailed analysis, in which the % flow rate was used instead of actual flow rate of saline perfusion, a small hysteretic loop based on the difference of the elasticity of the outlet canals was found. The distension of the corpora cavernosa and the pelvic nerve electrostimulation probably act as the triggers of the same occlusive mechanism in the outflow pathway. The percentage decrease in the blood flow in the outflow canal of the corpus cavernosum induced by the distension of the sinusoidal space or by the pelvic nerve electrostimulation was 69.6 +/- 14.4% (mean +/- SD).

[The efficacy of recombinant interleukin 2 in local treatment of superficial bladder tumors].

The present study was undertaken to assess the efficacy of recombinant Interleukin 2 (rIL-2: S-6820) in treatment of superficial bladder tumors. Three intratumor injections at a dose of 5 x 10(5) units/day via urethra, were performed every other day under endoscopic control in 12 patients with superficial bladder cancer. On the 15th day after completion of the series of injections, the tumor had disappeared in one patient and 50% regression over was observed in two other patients. Therefore, the response rate to the rIL-2 treatment in our study was 25.0%. Each tumor which responded to the therapy, was single, small and low grade. In the peripheral blood of the 12 patients, an increase in IL-2 receptor-positive lymphocytes and augmentation of natural killer activity were detected after the rIL-2 intratumor injection. There were no serious side effects except for moderate fever in our study.

[Effect of selective intra-arterial infusion of OK-432 against renal cell cancers].

In 8 cases of operable renal cancer, selective intraarterial infusion of the streptococcal preparation, OK-432 was performed and its cytocidal effects on the surgical specimens, which were removed on the 8th day after infusion, were investigated histopathologically with immunological parameters of the peripheral blood. The histopathological study revealed a high grade of sinus histiocytosis of the renal pedicle lymph nodes, but the anti-tumor effect on renal tumors was not so marked in any of the 8 cases. OK-Ia-positive lymphoid cells of peripheral blood were increased significantly and Con-A stimulation index of blastogenesis was lowered without any change in the PHA stimulation index after the OK-432 infusion. No serious complications of the selective intraarterial infusion were experienced except for high fever (less than 38 degrees C). In conclusion, OK-432 selective intraarterial infusion was an effective method for improving regional and systemic immunoactivity, but the cytocidal effect against tumor cells could not be confirmed histopathologically.

[Clinical experience with cefbuperazone in complicated urinary tract infection].

Cefbuperazone (CBPZ) was administered to inpatients with complicated urinary tract infections (UTI) at our department. Clinical efficacy and safety were evaluated in 22 chronic cases by the criteria for evaluation of clinical of antimicrobial agents on urinary tract infection. Overall clinical efficacy was excellent in 8 cases, moderate in 9 cases and poor in 5 cases with an effectiveness rate of 77%. Twenty-four of the 34 strains isolated from the patients were eradicated and eradication rate was 71%. Neither subjective nor objective adverse reactions were observed. Abnormal changes in laboratory tests were found in 9 patients, but were probably not related to CBPZ administration. Judging from these results, CBPZ is considered to be an effective and safe antibacterial for the treatment of complicated UTI.

Human penile hemodynamics studied by a polarographic method.

Observations of the tissue oxygen tension alteration were made using an open tip type oxygen electrode polarographic method as an index of blood flow change in the penile skin, corpus cavernosum and thigh skin of 16 males aged 20-26 years (average age: 20.5 years). In another five males aged 18-21 (average age: 19.8 years) the relationship between corpus cavernosum tissue oxygen tension alteration and penile circumference change in the erection process was observed. This relation was obtained in the penile circulation model, and penile hemodynamics were ascertained. In the flaccid penis the corpus cavernosum contains low-oxygen blood and there is a blockade at the vascular tree in the corpus cavernosum. In the tumescence phase the blood flow of the corpus cavernosum increased suddenly by the relief of cavernosum vascular blockade. During the penile tumescence phase the increased inflow and outflow persisted in corpus cavernosum, and in penile skin the blood also increased initially, but gradually decreased as penile circumference increased. After erection was attained it is thought that resistance to inflow occurred by outflow pathway contraction. In the detumescence phase, a decrease of inflow and a concomitant increase of outflow occurred and the reopening of outflow is thought to be necessary for prompt penile detumescence.

[A case of primary ureteral carcinoma in the duplicated renal pelvis and ureter diagnosed by transurethral uretero-renoscopy].

We present a case of primary ureteral carcinoma in the duplicated renal pelvis and ureter diagnosed by transurethral uretero-renoscopy. The case was of a 78-year-old man with the complaint of sudden asymptomatic macrohematuria. An excretory urogram strongly suggested the presence of duplication of the right collecting system, and cystoscopy revealed a gross hematuria from the right ureteral orifice. A retrograde ureteropyelogram revealed incomplete duplication of the right renal pelvis and ureter fused at about the ureter crossing over the iliac vessels, and a polyp-like filling defect in the lower segment of duplicated ureter at about 4 cm from the fusion of the ureters. Transurethral uretero-renoscopy was employed to investigate the filling defect, and a papillary tumor extended into the lower segment of duplicated ureter was revealed. Tumor was resected by a rigid operating instrument under transurethral uretero-renoscopy. The pathological diagnosis was grade I-transitional cell carcinoma of the ureter, so that right total nephroureterectomy with partial cystectomy was carried out subsequently. Surgical specimen after right total nephroureterectomy with partial cystectomy showed no other tumor in the pelvis or ureter macroscopically, and histopathological studies of surgical specimens were no evidence of malignancy. We believe that transurethral uretero-renoscopy significantly increases the diagnostic accuracy in determining the nature of upper urinary tract lesions, and this procedure is indispensable in the diagnosis of ureteral tumors. The present case was the 7th case of primary ureteral carcinoma in the duplicated renal pelvis and ureter in the Japanese literature.

[Emphysematous pyelonephritis: report of a case].

A case of emphysematous pyelonephritis is presented. A 49-year-old male with diabetes mellitus complaining of high grade fever attack and right flank pain was referred from internal medicine. KUB demonstrated that the right ureter, pelvis and calyces were filled with gas. Anti-bioticus was given intensively and the abnormal gas shadow on plain film disappeared before RP was done, but high grade fever attack persisted and right nephrectomy was undergone. After this operation, the fever was relieved and the patient was discharged at the 30th day post-operatively. A search of available literature in Japan has disclosed only 17 reported cases. Diagnostic methods, treatment, complication and etiology are discussed.

[Clinical experience of norfloxacin in urinary tract infection].

Norfloxacin (NFLX) was administered to outpatients and inpatients with urinary tract infections at our department. Clinical efficacy and safety were evaluated in 50 patients by the criteria for evaluation of clinical efficacy of antimicrobial agents on urinary tract infection. Overall clinical efficacy for 17 cases with acute simple cystitis was excellent in 13 cases, moderate in 4 cases with an effectiveness rate of 100%. The overall clinical efficacy for 33 cases with chronic complicated UTI was excellent in 18 cases, moderate in 6 cases and poor in 9 cases with an effectiveness rate of 73%. The eradication rate of 21 strains from acute simple cystitis patients was 100%. Forty four out of 60 strains from chronic complicated UTI patients were eradicated and the eradication rate was 73%. Neither subjective nor objective adverse reactions were observed in 50 patients. Abnormal changes in laboratory tests were found in 8 patients, but were probably not related to NFLX administration. Judging from these results, NFLX is considered to be an effective and safe antibacterial for the treatment of UTI.

[Implant operation of penile inflatable prosthesis for a patient with erectile impotence due to radical cystectomy: a case report].

The hydraulically inflatable penile prosthesis consists of an inflate-deflate pump, a storage reservoir and paired cylinders and it is able to provided a more physiologically functional penis. We report our surgical experience of implant of an inflatable penile prosthesis for postoperative impotence. The patient was a 51-year-old male with impotence, who had received radical cystectomy and ilial conduit formation for transitional cell carcinoma of the bladder (G3, pT3NoMo.) 9 months earlier. There was nothing particular except for the postoperative status on physical, laboratory and X-ray examinations. He was diagnosed to have organic impotence (vasculogenic) by sexual functional tests. Auto-injection of the corpus cavernosum with papaverine HCl was attempted but an erection was not induced by the injection. So, implant operation of an inflatable penile prosthesis was performed by the lower abdominal approach. His postoperative course was uneventable and practice to deflate and inflate the cylinders was started at 2 weeks after the operation and he was able to have sexual intercourse at 5 weeks after the surgery. Now (3 months after the operation), he can have sexual intercourse with an orgasm but without ejaculation and he and his wife are both satisfied with the postoperative status.