Kimihiko Yoneda

Bladder capacity at the time of enuresis

OBJECTIVES To evaluate bladder capacity at the time of enuresis and compare the daytime capacity of enuretics with that of controls. METHODS The functional bladder capacity (FBC), which was the maximal endurable capacity in the daytime, the ordinary bladder capacity (OBC), which was the capacity at ordinary urinary sensation in the daytime, and the enuretic bladder capacity (EBC), which was the capacity at the time of enuresis, were measured in 67 patients with monosymptomatic nocturnal enuresis. The EBC was measured using a diaper and enuresis alarm. The FBC, OBC, and nocturnal bladder capacity, which was the maximal voided volume in the nighttime, were also measured in 67 controls. RESULTS The FBC was not significantly different between enuretics and controls. The EBC in enuretics was significantly smaller than the nocturnal bladder capacity in controls. In enuretics, the EBC was significantly smaller than the FBC and was similar to the OBC. In controls, no statistically significant differences were found between the FBC and the nocturnal bladder capacity. CONCLUSIONS In enuretics, the bladder capacity during sleep was significantly smaller than the daytime functional capacity. In controls, on the other hand, the bladder capacity during sleep did not differ from the daytime functional capacity. Our understanding of the bladder capacity in enuretics may need to change in view of this result. The inability to hold urine during sleep may be an important cause of nocturnal enuresis.

A Comparison of Cooling Methods for Laparoscopic Partial Nephrectomy

OBJECTIVES To evaluate appropriate cooling methods in laparoscopic partial nephrectomy. METHODS Under general anesthesia, 21 porcine kidneys were exposed retroperitoneoscopically. Ice slush (500 g) was put into the retroperitoneal cavity after renal vascular clamping. Renal parenchymal temperature was measured by a thermometer. Seven kidneys were cooled only by ice slush (group I). In seven kidneys, 200 mL of 4 degrees C saline was infused around the kidney 45 minutes after vascular clamping (group II). In seven kidneys, 4 degrees C saline was irrigated continuously through a 5F ureteral catheter, which was inserted into the ureter (group III). RESULTS In group I, 21 minutes after vascular clamping, the lowest temperature achieved was 13.2 degrees C, and at 47 minutes the temperature exceeded 20 degrees C. In group II, the lowest temperature achieved was 13.0 degrees C 23 minutes after vascular clamping, and at 59 minutes the temperature exceeded 20 degrees C. In group III, the lowest temperature of 10.6 degrees C was achieved at 27 minutes, and at 79 minutes the temperature exceeded 20 degrees C. CONCLUSIONS In complicated cases of laparoscopic partial nephrectomy, cooling with both ice slush and ureteral catheter irrigation was thought to be effective. When the renal collecting system is opened, an additional infusion of cooled water may also be effective.

Retroperitoneoscopic heminephroureterectomy for children with duplex anomaly: Initial experience

Abstract Objectives:  To evaluate the feasibility of retroperitoneoscopic heminephroureterectomy for children with duplex anomaly.

Learning curve of hand-assisted retroperitoneoscopic nephrectomy in less-experienced laparoscopic surgeons

Abstract Aim:  To evaluate the learning curve of hand‐assisted retroperitoneoscopic nephrectomy (HALS) performed by less‐experienced surgeons.

Preoperative administration of chlormadinone acetate reduces blood loss associated with transurethral resection of the prostate: a prospective randomized study

To assess the effects of giving chlormadinone acetate (CMA) before surgery on blood loss associated with transurethral resection of the prostate (TURP), in a prospective randomized controlled study.

Vesicoureteral Reflux Detected among Patients with Nocturnal Enuresis

OBJECTIVES To clarify the characteristics of vesicoureteral reflux detected in patients with nocturnal enuresis. METHODS Voiding cystourethrography (VCUG) was applied in 1,088 patients who visited our outpatient clinic with the chief complaint of nocturnal enuresis. The clinical features of reflux were evaluated and the prognosis of reflux and nocturnal enuresis was analyzed. RESULTS Reflux was detected in 86 ureters in 70 patients (6.4%) out of the 1,088 patients. The grade of reflux was 3 or less in all cases. The incidence of pyuria was 5 (7%) and that of renal scar during first examination was 1 (1%). The incidence of unstable bladder was 30 (75%) in 40 patients. The resolution rate of reflux in the cases which were followed-up for 2 years or more by conservative treatment was 50-66% for each grade of reflux. The percentage of patients who had siblings with a positive history of nocturnal enuresis and the incidence of frequency differed significantly between the enuretics with reflux and the 507 enuretics without urological abnormalities. CONCLUSIONS Our data suggest that the incidence of reflux in patients with nocturnal enuresis was rather low in comparison with the past literature, the severity was mild and the resolution rate by conservative treatment was rather high.

Hand-Assisted Retroperitoneoscopic Nephroureterectomy

In laparoscopic operations for upper urinary tract transitional cell carcinoma (TCC), three kinds of approach, the transperitoneal, retroperitoneal, and hand-assisted transperitoneal, have been reported. We have performed hand-assisted retroperitoneoscopic nephroureterectomy (HALS) since 2000. The surgical techniques and the operative results of 61 cases of HALS are described and analyzed. These procedures were effective and safe for upper urinary tract TCC.

Sniffer mice discriminate urine odours of patients with bladder cancer: A proof-of-principle study for non-invasive diagnosis of cancer-induced odours

Similar to fingerprints, humans have unique, genetically determined body odours. In case of urine, the odour can change due to variations in diet as well as upon infection or tumour formation. We investigated the use of mice in a manner similar to “sniffer dogs” to detect changes in urine odour in patients with bladder cancer. We measured the odour discrimination thresholds of mice in a Y-maze, using urine mixtures from patients with bladder cancer (Stage I) and healthy volunteers (dietary variations) as well as occult blood- or antibiotic drug metabolite-modulated samples. Threshold difference indicated that intensities of urinary olfactory cues increase in the following order: dietary variation < bladder cancer < occult blood < antibiotic drug metabolites. After training with patient urine mixtures, sniffer mice discriminated between urine odours of pre- and post-transurethral resection in individual patients with bladder cancer in an equal-occult blood diluted condition below the detection level of dietary variations, achieving a success rate of 100% (11/11). Furthermore, genetic ablation of all dorsal olfactory receptors elevated the discrimination thresholds of mice by ≥ 105-fold. The marked reduction in discrimination sensitivity indicates an essential role of the dorsal olfactory receptors in the recognition of urinary body odours in mice.