Akimi Ogawa

Urinary Tract Dysfunctions in Tethered Spinal Cord Syndrome: Improvement After Surgical Untethering

We reviewed 55 patients with urinary tract dysfunction owing to the tethered spinal cord syndrome, a form of spina bifida occulta with or without mild myelodysplasia, to evaluate the effects of neurosurgical treatment. Of the patients 24 underwent laminectomy with release of a tethered spinal cord and 31 were followed without the operation. Median followup was approximately 5 years. Urological findings at the most recent examination were compared between the 2 groups. In the operated group 5 patients, including 2 with myelodysplasia, apparently were cured of urinary tract dysfunction and 6, including 2 with myelodysplasia, had somewhat satisfactory results, whereas in the unoperated group only 4 patients had satisfactory results and the remainder were unaffected. Urinary tract dysfunction in some patients with spina bifida occulta may be relieved by surgical release of a tethered spinal cord.

Inappropriate Elevation of the Aldosterone/Plasma Renin Activity Ratio in Hypertensive Patients with Increases of 11-Deoxycorticosterone and 18-Hydroxy-ll-Deoxycorticosterone: A Subtype of Essential Hypertension?

Among 436 patients with hypertension unrelated to any renal lesion, renovascular damage, pheochromocytoma, Cushings syndrome or hyperthyroidism, 15 patients had low plasma renin activity (PRA) and elevated plasma aldosterone concentrations in the upright position and resultant high aldosterone/PRA ratios: 8 with aldosterone-producing adenoma (APA; group 1) and 7 with idiopathic hyperaldosteronism (IHA; group 2). Thirty-nine patients had suppressed PRA in the presence of normal plasma aldosterone levels and moderately elevated aldosterone/PRA ratios (group 3). Thirty of them had elevated plasma 11-deoxycorticosterone (DOC) and 18-hydroxy-11-deoxycorticosterone (18-OH-DOC) concentrations (group 3a) and 9 of them had normal levels of those mineralocorticoids (group 3b). The rest of them (382 patients) had low aldosterone/PRA ratios (group 4). Adrenal scintigraphy with dexamethasone pretreatment revealed [13I]-cholesterol accumulation not only in patients with APA (unilateral) or IHA (bilateral), but also in patients of group 3a (bilateral). In patients in groups 3a and 3b adrenal size (especially thickness), as measured by computed tomography (CT scan), was enlarged, as in patients with IHA (group 2), and was significantly greater than in patients of group 4 (p less than 0.001). Spironolactone reduced blood pressure in all tested patients of group 3a, and the removal of adrenal tumor or hyperplastic tissue normalized blood pressure in patients of groups 1, 2 and 3a. Excised adrenal glands exhibited cortical hyperplasia with or without nodular hyperplasia in patients of group 3a. Good agreement was found between the actual size of the excised tissue and the measurement obtained by CT scan. Since beta-endorphin and beta-lipotropin were depressed in patients of group 3a, it is suggested that an unknown pituitary substance stimulates the adrenal cortex to release too large amounts of DOC and 18-OH-DOC and inappropriate secretion of aldosterone.

Reconstruction of the urethral meatus with a buccal mucosa graft.

A buccal mucosa graft from the lower lip was used for meatal reconstruction in 3 patients. The buccal mucosa graft was combined with a bladder mucosa graft for urethral substitution in 1 adult and 1 child, and was anastomosed to a skin tube for creating a glanular urethra in 1 child. The buccal mucosa graft obtained was approximately twice as wide as the desired urethra. Postoperatively the buccal mucosa graft became shrunken at the proximal anastomosis and urethral stricture developed in 2 children. The graft did not shrink at the meatus, but the meatus became widened in 2 patients. These results suggest that a buccal mucosa graft is useful for meatal reconstruction, but further technical improvement is necessary to avoid postoperative complications.

Renal xanthine stone in Lesch-Nyhan syndrome treated with allopurinol.

A rare case of renal xanthine stone in association with the Lesch-Nyhan syndrome is presented. The xanthine stone is thought to be a complication of allopurinol therapy.

Treatment of Bladder Carcinoma in Patients More than 80 Years Old

We reviewed 26 patients more than 80 years old with bladder carcinoma to determine if an active surgical policy is justified. Ten patients with superficial carcinoma were treated with transurethral resection; none died of cancer and half have survived 5 years. Of 16 patients with invasive carcinoma 9 underwent total cystectomy with urinary diversion and 2 underwent partial cystectomy. There was no operative mortality. Postoperative complications were not serious. Five of the 9 patients who underwent total cystectomy are alive, with a mean survival of 35 months. The 4-year crude survival rate was 50 per cent. Both patients who underwent partial cystectomy died within 2 years. One patient treated with radiotherapy alone and 1 without any treatment have survived 2 years. These results suggest that contrary to the general tendency towards conservative treatment, a curative operation is worth attempting in elderly patients with bladder carcinoma.

Gastrocystoplasty in dogs : an ulcerating effect of acid urine

Six dogs underwent bladder augmentation using an isolated flap of the body of the stomach after a supratrigonal cystectomy. Each dog was followed for six months with periodic determinations of urine pH, blood chemistry, cystometry and cystography. Postoperatively, urine pH decreased markedly after a meal in most dogs. No persistent hypergastrinemia was found. Autopsy showed that histological erosions developed in the bladder remnant in five dogs, and an ulcer in the bladder remnant in one dog. These results indicate that when an isolated, vagally denervated gastric segment is incorporated into the bladder, acid secretion from the segment may ulcerate the bladder.

Solitary Urethral Recurrence of Sigmoid Colon Carcinoma

We report a rare case of a solitary urethral recurrence of sigmoid colon cancer. The recurrence developed 2 years after a radical resection of sigmoid colon cancer invading the bladder. The involved portion of the urethra was resected and an end-to-end anastomosis was made. The patient has been able to urinate per urethram and has remained free of recurrence for 7 years after the urethral resection.

Ultrasound in penile cancer

Ultrasonography clearly visualized the extent of primary tumor and the presence or absence of inguinal node metastases in two patients with penile cancer. These findings enabled us to decide an appropriate level for penile amputation and the indication for lymphadenectomy.

Total Replacement of Urethral Mucosa with Oral Mucosa in Dogs

PURPOSEnIf the urethral mucosa is replaced by another mucosa, urethral recurrence might decrease in patients who undergo neobladder construction for bladder cancer. We determined whether such replacement is possible.nnnMATERIALS AND METHODSnSix dogs underwent an operation consisting of a longitudinal urethral incision at its full length and immediate closure. In 6 other dogs, after the urethral mucosa was totally removed, a tubularized sublingual mucosa was closely set inside the urethral lumen. Postoperatively, the urinary stream and external meatus were observed every day. To measure urine leakage, a 10-minute pad test was performed once a month. All dogs were sacrificed 3 to 12 weeks after the operation for histological examination of the urethra. The excised urethras were examined with a 12F catheter for urethral patency.nnnRESULTSnAll dogs were continent postoperatively. The results of the 10-minute pad test showed no significant difference in the weight increase of the pad among the control, sham-operated and mucosa-replaced dogs. Urethral stricture developed in 1 mucosa-replaced dog. Histological examination revealed that all of the grafted oral mucosa survived in the urethra.nnnCONCLUSIONnThese results indicate that the urethral mucosa can be replaced by oral mucosa without damaging the continence mechanism in female dogs.

Genitourinary Neurofibromatosis in a Child Presenting with an Enlarged Penis and Scrotum

We report on a boy with genitourinary neurofibromatosis. The patient presented with bilateral hydronephrosis, and a markedly enlarged penis and scrotum. Laparotomy showed a mass occupying the small pelvic cavity. Histologically, the mass was a plexiform neurofibroma. The enlarged genitalia seemed to be caused by involvement of neurofibromatosis. The patient underwent a successful ileal conduit diversion.