Katsushi Nagahama

Differences between proximal and distal portions of the male rabbit posterior urethra in the physiological role of muscarinic cholinergic receptors

1 The aim of the present study was to elucidate functional differences between embryologically different portions of the posterior urethra of male rabbits in response to muscarinic acetylcholine receptor (mAChR) stimulation using in vitro isometric tension experiments and radioligand binding studies. 2 In the in vitro isometric tension experiments, carbachol, produced a dose‐dependent contraction of the proximal portion under the resting state, but did not change the basal tone of the distal portion. Contraction of the proximal portion by 10−5 m noradrenaline (NA) was dose‐dependently enhanced by carbachol either in the presence or absence of NG‐nitro‐l‐arginine (NOARG). In contrast, carbachol induced relaxation of the distal portion contracted by 10−5 m NA, which was reversed to dose‐dependent contraction in the presence of NOARG. 3 Both portions of the urethra had a similar number of [3H]‐quinuclidinyl benzilate ([3H]‐QNB) binding sites (195.3±74.1 fmols mg−1 protein for the proximal portion and 146.5±8.5 fmols mg−1 protein for the distal portion) with similar affinities (115.0±45.4 pM for the proximal portion and 79.9± 2.9 pM for the distal portion). 4 The concentration‐response curves to carbachol in both portions were shifted to the right in a parallel manner in the presence of pirenzepine (an M1 antagonist), 11‐[[2‐[(diethylamino)methyl]‐1‐piperidinyl] acetyl]‐5, 11‐dihydro‐6H‐pyrido‐2,3‐b)‐(1,4)‐benzodiazepin‐6‐one (AFDX‐116, an M2 antgonist) and 4‐diphenyl‐acetoxy‐n‐methyl‐piperidine (4‐DAMP, an M1/M3 antagonist). The pA2 values for pirenzepine, AFDX‐116 and 4‐DAMP were 7.5±0.1, 7.2±0.02 and 9.3±0.1 respectively for the contraction of the proximal portion, and 7.2±0.1, 7.1±0.2 and 9.1±0.2, respectively for the relaxation of the distal portion. 5 In conclusion mAChR subtypes distribute in a similar fashion throughout the length of the male rabbit posterior urethra with the discrepant responses to carbachol attributable to the differential involvement of the NO pathway in mAChR‐generated reactions.

Actinomycosis of Urachal Remnants

We report a case of urachal actinomycosis. The patient presented with complaints of micturition pain and a lower abdominal mass. Computerized tomography and an echogram showed the mass extending from the dome of the bladder to just beneath the rectus muscle. Exploration revealed a hard mass in the urachal cord, which was near the dome of the bladder and extended to the umbilicus. The mass and urachal cord were resected, and histopathological examination revealed actinomycosis of the urachal remnants.

Equivalent survival and improved preservation of renal function after distal ureterectomy compared with nephroureterectomy in patients with urothelial carcinoma of the distal ureter: A propensity score-matched multicenter study

To investigate the oncological and functional outcome of distal ureterectomy compared with nephroureterectomy in the management of distal ureteral urothelial carcinoma.

MP72-14 IMPACT OF CHRONIC KIDNEY DISEASE AND HYPERTENSION ON DECLINE IN REMAINING KIDNEY FUNCTION AFTER RADICAL NEPHRECTOMY

1 versus>1). Recommended surveillance schedules balance estimated riskof non-cancerdeathwith recurrence riskwhereallowable recurrence is up to the risk of non-cancer death. Surveillance intervals were calculated based on each 1%, 3%, and 5% recurrence risk increase to amaximum10 years. Intervals shorter than 3 months were not allowed, with the next risk increase calculated from the date of the adjusted interval. RESULTS: AFT models for recurrence and death for stage, age, and comorbidity risk groups were generated (tables). Recommended interval schedules (e.g. 1%, 3%, or 5%) are based on the predicted risk of non-cancer death for a given age and CCI group. For example, patients <70 years with a CCI score 1 would be followed on a 1% risk of recurrence schedule for the duration of 10 years of followup regardless of stage. Conversely, patients 60-69 years old with a CCI >1, would follow a 1% interval for the first year only, then switch to 3% interval until year 6, at which point they would follow a 5% schedule. CONCLUSIONS: Using an AFT model for estimating risk of recurrence and risk of death we were able to generate risk-adapted screening intervals for surgical managed patients with RCC.

687 BIMODAL PATTERN OF THE IMPACT OF BODY MASS INDEX ON CANCER-SPECIFIC SURVIVAL OF UPPER URINARY TRACT UROTHELIAL CARCINOMA PATIENTS: MULTI-CENTER STUDY IN A 1114-CASE TOKYO METROPOLITAN DATABASE OF UROLOGIC DISEASE (TMDU) COHORT

UTUC database and the UTUC collaboration (n 4137). After excluding the nine patients who we previously reported on [5], 28 patients (0.7%) with pT0 tumor were included in this report. All patients had undergone cystoscopy, urine cytology, intravenous urography and/or abdominalpelvic CT-scans, and diagnostic ureteroscopy prior to RNU. None of the patients underwent preoperative radiotherapy and none of the patients had metastasis at time of RNU. Due to the low number of patients, only descriptive results are shown. RESULTS: The median age at diagnosis was 68 years (IQR: 57-74) and the male-to-female ratio was 2:1. Six patients had evidence of non-organ confined UTUC on pre-RNU imaging and received neoadjuvant cisplatin-based combination chemotherapy. Regional lymphadenectomy was performed in the six patients who had received neoadjuvant chemotherapy (median: 10 lymph nodes, IQR 6-14). On final pathology, all patients had pT0N0 except one patient who had two positive renal hilar lymph nodes (pT0 N1). Overall, 4 patients experienced disease recurrence (median time to recurrence : 38 months, IQR: 24-48). Three of these patients developed metastatic disease and one had a relapse in the operative field. The three patients with metastasis died from UTUC within a median time of 10 months from their disease recurrence. Within a median follow-up of 40 months (IQR: 22-64), nine patients developped intravesical recurrence (median time: 35 months, IQR: 14-54). The 5-year recurrence-free and cancer-specific survival rates were 77% (95% CI, 72-81.3) and 78% (95% CI, 69-83.8), respectively. CONCLUSIONS: pT0 UTUC may be the result from effective neoadjuvant chemotherapy, complete endoscopic treatment, misinterpretation of the pathologic specimen (i.e, false pT0), or overtreatment. Our limited data shows that post-RNU prognosis of pT0 patients is highly variable as some patients experience disease progression needing more stringent follow-up.

USE OF ULTRASONOGRAPHY IN THE BLADDER NECK SUSPENSION

From 1988 to 1992, 78 patients with genuine stress urinary incontinence underwent bladder neck suspension under ultrasonic monitoring. Tightness of suspension was adjusted by setting posterior urethrovesical angle to approximately 90 degree by transrectal ultrasonography during operation. Urinary continence was achieved in 68 of 78 patients. In the remaining 10 patients, slight incontinence recurred within 6 months after operation. In 60 patients undergoing postoperative chain cystourethrogram, the posterior urethrovesical angles set during operation were about the same as those after operation. In 39 patients undergoing uroflowmetry under the condition that micturition volume was 200 ml or more, urinary flow rate did not decrease after operation. In 20 patients whose posterior urethrovesical angles were measured by transperineal and transabdominal as well as transrectal ultrasonography, angles measured by each ultrasonography were almost identical and neither manipulation could change the configuration of the bladder neck. The posterior urethrovesical angles set during operation were kept postoperatively and provided proper tightness of the suspension suture to achieve urinary continence without any difficulty of urination. Therefore, a posterior urethrovesical angle can be set by transperineal and transabdominal ultrasonography as well as transrectal ultrasonography. While transrectal approach provides the clearest image among the three approaches, transperineal and transabdominal approach carried out with a transabdominal convex or sectorial probe are more convenient than transrectal approach which needed a special probe.