Junji Hirano

Serum Prostatic Acid Phosphatase, Gamma-Seminoprotein and Prostatic Specific Antigen in Hemodialysis Patients

Serum concentrations of prostatic acid phosphatase (PAP), gamma-seminoprotein (gamma-Sm) and prostatic specific antigen (PSA) were measured in 31 hemodialysis patients without clinical signs of malignant disease. PAP, gamma-Sm and PSA levels in serum were not significantly different between control and hemodialysis groups. A significant reduction in these tumor markers was not found after dialysis treatment. This indicates that the measurement of PAP, gamma-Sm and PSA in serum is useful for the detection of prostatic cancer in patients undergoing hemodialysis.

Transurethral treatment of bladder diverticula

We performed transurethral fulguration of the diverticular mucosa and incision of the diverticular neck in combination with transurethral prostatectomy or bladder neck resection to treat all aspects of diverticula in 9 patients. Eight cases with bladder outlet obstruction, involving 2 cases of large diverticula, have been successfully treated. A case with neurogenic bladder has failed. We found the transurethral procedure to be equally effective as open operation.

Crossed Ectopia of Left Vas Deferens, Leaving Ipsilateral Seminal Vesicle in Normal Position

A 19-year-old man with crossed ectopia of the vas deferens was investigated with special reference to right hydronephrosis and renal dysfunction. There was no vesicoureteral reflux. The left kidney was hypoplastic or dysplastic and the left ureter emptied into the left seminal vesicle. The right malrotated hydronephrotic kidney was in the lumbar position. The right lower ureter communicated with either the right seminal vesicle or the ampullary portion of the left vas deferens and drained into the bladder at the normal site. The end of the right vas deferens was dilated. The left vas deferens crossed the midline and opened into the right seminal vesicle, leaving the ipsilateral seminal vesicle in the normal position. A search of the literature failed to reveal any similar anomalies.

Successful Repair of Huge Bladder Diverticulum with a Transurethral Fulguration

We present a 68-year-old man with a huge bladder diverticulum associated with benign prostate hypertrophy treated with transurethral fulguration of the diverticular mucosa in combination with transurethral resection of the prostate. The procedure was well tolerated by the patient and unfavorable symptoms faded after this procedure. Follow-up cystogram demonstrated remarkable reduction of the diverticulum.

[Conservative surgery of renal cell carcinoma associated with renal (artery) aneurysm in solitary kidney--a case report].

A rare case of renal cell carcinoma associated with renal artery aneurysm in solitary kidney is reported. The patient is a 63-year-old woman with asymptomatic macrohematuria as CC, who previously received left nephrectomy (for which underlying disease is unknown). Excretory pyelography, abdominal CT and right renoarteriography revealed a 6 X 6 cm-tumor at the center of the right kidney, comprising the middle calices and a 16 X 18 mm-saccular aneurysm at the first bifurcation of the renal artery. No remote metastasis was revealed. Aneurysmectomy and partial nephrectomy (three-quarter of right middle and lower calices) were simultaneously performed in situ. The renal cell carcinoma was pT2b, of clear cell subtype and grade 1, and no calcification of the aneurysmal wall was observed. Anuria lasted for 21 postoperative days, but thereafter diuresis appeared. Renal function after 3 post-operative months remains kept as follows: BUN, 26 +/- 7 mg/dl; serum creatinine, 26 +/- 0.6 mg/dl; creatinine clearance, 20.1 ml/min. Now, after 18 postoperative months, the patient is already returning to work, with neither relapse nor need of dialysis.