ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00548.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Continent urinary diversion (CUD) is performed on patients after total cystourethrectomy due to invasive bladder cancer or other diseases requiring urinary diversion. Since 1984, we have performed CUD using either the Kock pouch procedure or a modified Indiana pouch method. During the long‐term follow‐up, increasing numbers of late complications occurred, especially after the Kock pouch procedure. We summarized the frequency of postoperative complications, their management, and outcome of CUD using these 2 methods.Methods: Between 1984 and 1995, CUD using the Kock pouch method was performed on 102 patients, and on 61 patients using the Indiana pouch method, with a mean follow‐up period of 83 and 50 months, respectively. The patients were between 24 and 82 years old, with a mean age of 59 years. In most patients, the Kock pouch was constructed according to the original method, except for the use of a Dacron fabric collar, and the Indiana pouch was made using the ileal patch method.Results: Of 95 patients followed up for more than 3 months after CUD using the Kock pouch method, efferent and afferent nipple valve malfunction occurred in 21 (22%) and 26 (27%) patients, respectively. Efferent complications occurred during the first year after surgery, whereas afferent complications occurred several years after surgery. Open repair surgery (excluding ileus) was necessary for 36 (38%) patients. Of 59 patients followed for more than 3 months after CUD using the Indiana pouch method, 7 patients with stomal stenosis, 2 patients with stomal prolapse, and 1 patient with stricture at the ureterocolonic anastomosis were treated surgically. An hourglass‐like deformity of the pouch was seen in 2 patients, on whom the original Indiana pouch method was performed. As a whole, 13 patients (22%) were retreated with open surgery. Urinary calculi occurred in 42 (44%) patients after CUD using the Kock pouch method and in 11 patients (19%) using the Indiana pouch method. The outcome was excellent, good, fair, and poor in 31, 37, 24, and 8% of the patients after CUD using the Kock pouch method, and in 36, 17, 42, and 5% of the patients after CUD using the Indiana pouch method.Conclusions: We performed CUD using either the Kock pouch or the Indiana pouch method with a success rate of approximately 90%. The rates of revision, reoperation and stone formation were higher with the Kock pouch procedure than with the Indiana pouch procedure, while varying degrees of incomplete incontinence and difficulty in catheterization were seen more often in the

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00549.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Endourology, extracorporeal shock wave lithotripsy (ESWL), and laparoscopic surgery are considered minimally invasive procedures; however, estimation of operative invasiveness has not been fully accomplished. We measured serum interleukin‐6 (IL‐6) levels, as an indicator for systemic reaction, to examine operative invasiveness of these operations in comparison with open surgery. Method: Serum IL‐6 levels were measured in 119 patients undergoing open surgery, laparoscopic surgery, endourology, and ESWL.Results: The median IL‐6 levels on day 1 after the operation varied according to operative procedures: 83.5 pg/mL (range, 15–340 pg/mL) for open surgery, 24.8 pg/mL (range, 12–42 pg/mL) for laparoscopic surgery, and 10.8 pg/mL (range, 0–85 pg/mL) for endourology and ESWL. The extent of tissue injury and blood loss were found to be 2 major factors responsible for the serum IL‐6 elevation.Conclusion: The minimally invasive character of endourology, ESWL, and laparoscopic surgery is attributable to low levels of tissue injury and blood loss, regardless of

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00550.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Many attempts have been made to reduce the nephrotoxicity of the anticancer agent cisplatin but the number of clinically useful modalities is very limited. Our previous experiments demonstrated that in rats methylprednisolone significantly reduces the nephrotoxicity caused by cisplatin. The present clinical study was conducted to confirm the protective effects of methylprednisolone against cisplatin nephrotoxicity.Methods: Fourteen patients with urothelial tumors were injected with cisplatin according to the methotrexate, vinblastine, adriamycin, cisplatin (MVAC) therapy. Methylprednisolone was not administered during the first course of chemotherapy to provide a control, but was given in a dose of 2000 mg 2–3 hours before cisplatin during the second course of chemotherapy (treatment period) in each patient. Urinary excretion of N‐acetyl‐β‐D‐glucosarninidase (NAG) and γ‐glutamyltranspeptidase (CGTP), serum creatinine, and creatinine clearance (Ccr) were determined as indicators of the nephrotoxicity of cisplatin. Results were statistically analyzed by a pairedttest to compare the nephrotoxic effects of cisplatin during the first course of chemotherapy (control period) with those during the second course of chemotherapy (treatment period).Results: Methylprednisolone did not significantly inhibit the elevation in urinary enzyme excretion or serum creatinine levels following the cisplatin injection. However, the Ccrlevel after cisplatin infusion in the treatment period was significantly highter than that observed in the control period.Conclusion: The protective effects of methylprednisolone against cisplatin nephrotoxicity were indicated in this prospective c

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00551.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: Dilatation of the upper urinary tract is the most common congenital urogenital anomaly. Pyeloplasty is the therapy of choice in those patients with significant obstruction of the ureteropelvic junction. There are not many reports concerning the operative long‐term results from a morphologic point of view. Furthermore, little information is available about children with giant hydronephrosis treated without resection of the dilated renal pelvis.Methods: Between 1973 and 1993, 231 children with 262 renal units (kidney, renal pelvis, ureter) were treated at our institution. Giant hydronephrosis was observed in 52 renal units. The clinical and follow‐up data were obtained from the patients' records. The dilatation of the upper urinary tract, confirmed by means of intravenous pyelogram, was divided into 5 grades.Results: In 215 renal units, reconstructive surgery was performed without reduction of the renal pelvis. Revision of the pyeloplasty was necessary in 5 of the 215 renal units. The dilatation of the upper urinary tract improved or remained stable in 99.4% of the renal units during the follow‐up period of 4.8 years (range, 1 month to 21 years).Conclusion: Surgical reconstruction of the ureteropelvic junction obstruction is a safe and successful procedure. The excision of the dilated pelvis does not seem to be necessary, even in patients with giant hydroneph

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00552.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: We studied the effect of potential risk factors of urinary calcium oxalate saturation on calcium oxalate stone formation.Methods: Using the Equil2 program, the DG values of calcium oxalate in 390 clinical urine specimens were estimated in 5 healthy male individuals with and without citrate therapy.Results: Critical calcium‐oxalate supersaturation (DG value,>2.8) was noted in 15 out of 390 urine specimens. Of the 15, 14 late night or morning specimens had critical calcium oxalate supersaturation, while only 1 afternoon specimen was supersaturated. Critical calcium oxalate supersaturation was often associated with hyperoxaluria and hypercalciuria, while undersaturation was often associated with hypomagnesiuria, a high Ca/Mg ratio, and hypocitraturia.Conclusions: Hypomagnesiuria, hypocitraturia, and a high Ca/Mg ratio appear to be poor indicators of calcium‐oxalate supersaturation, and it is hard to predict the level of calcium‐oxalate saturation using single param

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00553.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The aim of the present study was to determine whether the indices of transrectal ultrasonography (TRUS) are related to the clinical response to tamsulosin, a long‐acting selectiveα1‐blocker.Methods: Sixty patients with symptomatic benign prostatic hypertrophy (BPH) were treated with tamsulosin hydrochloride (0.2mg/day) for 2 months. The findings on TRUS and uroflowmetry and the AUA symptom score before treatment were compared with those obtained at the end of the 2 month treatment period. For the indices of TRUS, transition zone (TZ) volume, transition zone ratio (TZ ratio = TZ volume/total prostate volume), total prostate volume, and prostate specific antigen density (PSAD) were calculated.Results: There was a significant correlation between the pretreatment TZ ratio and the residual urine volume (r= 0.421,P= 0.0005). Patients with a lower TZ ratio and/or PSAD responded well to the treatment. The correlation between the PSAD value and the percent change in peak urinary flow rate was statistically significant (r= ‐0.432,P =0.0009).Conclusion: TRUS provides simple parameters of PSAD that can be used to predict the response of patients to tamsulosin hydroch

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00554.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: The aim of the present study was to improve the accuracy of the prostate‐specific antigen (PSA) density for detecting prostate cancer by using the transition zone (TZ) volume instead of the total prostate volume.Methods: From April 1994 to October 1995, we examined 164 consecutive patients (52–88 years old), with an elevated PSA and/or abnormal digital rectal examination. All patients underwent a transrectal ultrasound‐guided biopsy. The PSA density for total prostate volume (PSAD) and for TZ volume (PSAT) were calculated from the transrectal ultrasound measurements.Results: Forty‐four of the 162 patients (27.2%) had histological confirmation of prostate cancer on biopsy. The area under the receiver‐operator characteristic curve was 0.667 for. PSA, 0.663 for PSAD, and 0.826 for PSAT. These areas were not significantly different for PSA and PSAD. However, PSAT was significantly superior to PSAD in differentiating benign hyperplasia from prostate cancer (P<0.01).Conclusion: The TZ volume‐adjusted PSA density (PSAT) is useful for selecting patients for prostate biopsy from those with suspected pros

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00555.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: This study was performed to evaluate the frequency of local tumor extension and its effect on disease progression after radical prostatectomy.Methods: The study consisted of 66 consecutive men who underwent radical prostatectomy for clinically localized prostate cancer without any prior hormonal therapy. Cases were stratified according to pathologic findings. Sites of capsular penetration were also evaluated.Results: The overall incidences of lymph node metastases, seminal vesicle invasion, capsular penetration, and positive surgical margin were, respectively, 23%, 32%, 55% and 35%. The disease progression rate in patients with positive lymph nodes differed significantly from that in those without nodal metastases (P<0.0001). Although seminal vesicle invasion, capsular penetration, or positive surgical margin had an adverse effect on prognosis, the difference in progression missed statistical significance, when patients with positive lymph node metastases were excluded. The most common site of capsular penetration was posterolateral, in the area of the neurovascular bundle.Conclusions: Extraglandular tumor extension and positive surgical margins are common features of radical prostatectomy specimens. A nerve‐sparing operation should be performed selectively and with great caution. The markedly adverse effect of lymph node involvement on progression must be accounted for when evaluating other variables relating to progressio

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00556.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

Background: A new tactile sensor was developed for detecting hardness of living tissue by Omata et al. in 1992. This paper reports applicability of the sensor for evaluation of penile rigidity.Methods: Nine patients from a group of 12 patients with penile erectile dysfunction were selected as subjects of this study. All patients agreed to artificial erection and monitoring of penile rigidity by a new tactile sensor and the Rigiscan system. The 9 patients selected all developed more than 1 cm circumferential expansion of the penis after an injection of smooth muscle relaxant into the corpus cavernosum.The sensor equipment consisted of a piezoelectric element that vibrated, and a pickup that detected vibration frequency. When the end of the sensor was pressed against a surface of the penis, the resonance frequency of the sensor changed and indicated rigidity of the organ. Rigidity of the penile shaft was simultaneously monitored with the sensor and the Rigiscan system before and after an injection of 40mg papaverine or 20μg prostaglandin E1. The sensor's measurements of rigidity were compared with those of Rigiscan.Results: Reproducibility of rigidity measured with the tactile sensor was satisfactory. Statistical analysis was made on 85 simultaneous pairs of rigidity values from the tactile sensor and Rigiscan. The analysis indicated significant correlation between the values.Conclusion: The tactile sensor as well as Rigiscan will be of use for evaluating rigidity of the penis

ISSN:0919-8172    

DOI:10.1111/j.1442-2042.1996.tb00557.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY