Fumihiko Ikoma

Developmental Anomalies Associated With Hypospadias

We reviewed 272 patients with hypospadias who were treated surgically to survey the complicated anomalies in these patients. Urogenital anomalies were recognized in 40 per cent of the 272 cases and extra-urogenital anomalies were noted in 9.2 per cent. Undescended testis was the most frequently seen anomaly, having been noted in 13.2 per cent of the 272 cases. The incidence of male vagina or utriculus masculinus was 11.8 per cent, prepenile scrotum 7.7 per cent and hypoplasia of the testis 6.6 per cent. Each of these 4 anomalies associated with hypospadias increased in incidence in proportion to the severity of the penile deformity. The necessity of systemic urological and hormonal examinations was emphasized, especially in cases of severe hypospadias.

INTRA‐ AND INTERINDIVIDUAL VARIATION IN THE PHARMACOKINETICS OF TACROLIMUS (FK506) IN KIDNEY TRANSPLANT RECIPIENTS—IMPORTANCE OF TROUGH LEVEL AS A PRACTICAL INDICATOR

Background:Tacrolimus (FK506) is currently used as the primary immunosuppressant in clinical kidney transplantation in some centers. The purpose of this study was to evaluate the pharmacokinetics of this drug and to see if trough level, which has been used widely in therapeutic drug monitoring, can be used as an appropriate substitute for other pharmacokinetic measurement tests.

Gonadotropin and Testosterone Response in Prepubertal Boys with Hypospadias

Serum levels of luteinizing hormone and follicle-stimulating hormone before and after luteinizing hormone-releasing hormone stimulation, and levels of testosterone before and after 3 days of treatment with human chorionic gonadotropin were determined by radioimmunoassay in 98 boys with hypospadias (2 to 8 years old). The doses of luteinizing hormone-releasing hormone and human chorionic gonadotropin were calculated for body surface. The basal and peak levels of serum luteinizing hormone, follicle-stimulating hormone and testosterone in patients with hypospadias were compared with 9 endocrinologically normal boys of the same age without hypospadias. Luteinizing hormone response to luteinizing hormone-releasing hormone stimulation was significantly impaired in boys with hypospadias and also simple hypospadias (no associated anomaly). Basal levels of luteinizing hormone in boys with simple hypospadias and levels of follicle-stimulating hormone in patients with hypospadias were significantly low. The maximum testosterone response to human chorionic gonadotropin stimulation was significantly decreased in boys with severe hypospadias in direct proportion to the degree of hypospadias.

Ultrasonographically demonstrated nutcracker phenomenon: alternative to angiography.

We report on a child with nutcracker phenomenon, which is a possible cause of intermittent gross haematuria of unknown origin. Early serial ultrasound examinations can demonstraste the lesions.The merits and demerits of conventional angiographic imaging are also discussed.

Renal Growth and Progression of Reflux Nephropathy in Children with Vesicoureteral Reflux

We analyzed renal growth and development of renal scars in 754 children with primary and 169 with secondary vesicoureteral reflux. The incidence of a small kidney was 15.5 per cent in the primary and 24.1 per cent in the secondary groups. About three-fourths of the small kidneys remained small from the first examination through followup. Catch-up renal growth was only exceptional. New scars or progression of previous scarring was observed in 7.4 and 30 per cent of the primary and secondary groups, respectively. Factors that promote formation of new scars are high grade vesicoureteral reflux, recurrent urinary tract infections and abnormal bladder function that results in high pressure reflux. We emphasized the importance of precise examination of the lower urinary tract. An early antireflux operation should be performed on children with severe reflux or recurrent urinary tract infections.

Surgical correction of incomplete penoscrotal transposition associated with hypospadias

A surgical technique for correction of incomplete penoscrotal transposition associated with hypospadias is presented. An inverted omega skin incision is made around the scrotal skin, and the base of the penis and scrotal flaps are brought beneath the penis. The operation is performed after the completion of hypospadiac repair. This technique was applied to 20 cases and cosmetic results were satisfactory.

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.

Pyeloplasty in Hydronephrosis: Examination of Surgical Results from a Morphologic Point of View

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.

Ocular complications after renal transplantation

Seventy-two post-renal transplant patients were studied for ocular complications. Of 72 patients, 56 (77.8%) showed some ocular abnormality. Steroid cataract was the most common complication, occurring in 45 patients (62.5%). Eleven patients (18 eyes) had undergone operations for cataract. The average of their ages was 39.7 years and the period from renal transplantation to cataract operation was 3.3 years. Postoperative visual acuity was over 20/20 in most cases. Increased intraocular pressure was encountered in 9 patients (12.5%), cytomegalovirus ocular infection in 2 (2.8%), hypertensive retinopathy in 2 (2.8%), branch retinal vein occlusion in 1 (1.4%), and subconjunctival hemorrhage in 15 (20.8%). A new immunosuppressant, cyclosporine, increased renal graft survival more than azathioprine. However, ocular complications such as steroid cataract occurred frequently in spite of the use of cyclosporine, as in the azathioprine era. In conclusion, it is necessary for renal transplant patients to receive a periodical ophthalmological check-up.

Vesicoureteral reflux in infants under one year old Follow-up study and consideration on development of renal scarring

In an attempt to clarify reflux nephropathy (RN), 67 infants aged under one year with vesicoureteral reflux (VUR) were retrospectively classified into two groups, non-surgical and surgical. They were evaluated on VUR grading, VUR spontaneous cessation rate, and incidence of scarring. As a whole, spontaneous cessation rate was 61 percent. The cessation rate was higher for infants with lower VUR grading. The average age at cessation was 2.5 years. Some patients showed no scarring at presentation despite severe VUR. However, most cases of renal scarrings at the time of presentation belonged to grade IV or V. Scarring advanced in 3 kidneys of the non-surgical group and in 13 kidneys of the surgical group. Of these 16 kidneys, 7 were rated as grade IV and 9 as grade V. An association between development of scarring and recurrent urinary tract infections was suggested.