Masaya Tsugawa

Endoscopic diagnosis and treatment of chronic unilateral hematuria of uncertain etiology

We evaluated 12 patients with unilateral unexplained gross hematuria by flexible ureteropyeloscopy and percutaneous pyeloscopy. All patients had localized bleeding except for 1 with diffuse bleeding caused by the nutcracker phenomenon, and 2 in whom no hematuria appeared upon examination and no gross lesions were observed. Among the 9 patients with localized bleeding transitional cell carcinoma was found in 1, hemangioma in 4 and minute venous rupture in 4. These 9 patients were treated endoscopically and no recurrences were observed during a follow-up of 6 to 21 months (average 10.3 months). Our results underscore the importance and efficacy of flexible ureteropyeloscopy in the evaluation and management of chronic unilateral hematuria.

RETROPERITONEOSCOPIC PYELOTOMY COMBINED WITH THE TRANSPOSITION OF CROSSING VESSELS FOR URETEROPELVIC JUNCTION OBSTRUCTION

PURPOSE We developed a new approach of retroperitoneoscopic pyelotomy combined with the transposition of crossing vessels for ureteropelvic junction obstruction as an alternative to conventional antegrade or retrograde endopyelotomy. MATERIALS AND METHODS From February 1997 to August 1999 we treated 5 cases of ureteropelvic junction obstruction due to crossing vessels that were diagnosed by helical computerized tomography. Ureterovascular hydronephrosis characterized by a malrotated renal pelvis with anterior crossing vessels was observed in 4 cases and ureteropelvic junction obstruction with a posterior crossing artery was present in 1. After endoureterotomy stent insertion under cystoscopic guidance we performed retroperitoneoscopic endopyelotomy with the kidney in standard position. Crossing vessels were transposed to a higher position to remove obstruction and fixed with peripelvic tissue via retroperitoneoscopy. In all cases a longitudinal incision approximately 1.5 cm. long was made with a potassium titanyl phosphate laser. RESULTS Convalescence was uneventful in all patients and the endoureterotomy stent was removed 4 to 8 weeks after surgery. Postoperatively helical computerized tomography showed the successful transposition of crossing vessels and significant hydronephrosis resolution in all cases. All patients were asymptomatic during followup of 17 to 28 months. CONCLUSIONS Despite our small number of patients our results are sufficient to conclude that retroperitoneoscopic pyelotomy combined with the transposition of crossing vessels is a simple and reliable method for treating ureterovascular hydronephrosis and associated conditions.

Prospective Randomized Comparative Study of Antibiotic Prophylaxis in Urethrocystoscopy and Urethrocystography

Background: There has been a great deal of discussion regarding the necessity of the prophylactic use of antibiotics in transurethral procedures. In order to clarify this complicated issue, a randomized prospective study was performed for patients undergoing urethrocystoscopy or urethrocystography.

Impact of 3-dimensional helical computerized tomography on selection of operative methods for ureteropelvic junction obstruction

PURPOSE We studied the feasibility of imaging the direct correlation between crossing vessels and obstructed ureteropelvic junction with helical (spiral) computerized tomography (CT) for selecting surgical repair of symptomatic ureteropelvic junction obstruction. MATERIALS AND METHODS From July 1995 to December 1995, 4 select patients with symptomatic ureteropelvic junction obstruction underwent contrast enhanced helical CT. In addition to transaxial images, 3-dimensional reformatted images were used for evaluation. RESULTS We identified 2 cases of ureteropelvic junction obstruction due to crossing vessels regarded as ureterovascular hydronephrosis, which is characterized by the spatial relationship between malrotated renal pelvis and anterior crossing vessels. Laparoscopic or open repair was performed in these 2 patients and operative findings were in agreement with prospective helical CT interpretation. Antegrade endopyelotomy was performed successfully for the remaining 2 patients. CONCLUSIONS The 3-dimensional helical CT is reliable in detecting ureterovascular hydronephrosis preoperatively and in presenting better operative methods for ureteropelvic junction obstruction.

Primary non-Hodgkin lymphoma of the ureter

A 41-year-old woman presented with right flank pain. Excretory urography showed moderate hydronephrosis; retrograde pyelography and CT detected narrowing of the proximal third of the right ureter, caused by a softtissue mass of the ureteric wall with a maximum diameter of 2.5 cm and #6 cm long (Fig. 1). No other abnormality was found; most notably, there was no adenopathy. Right ureteroscopy revealed partial obstruction encircled by bulging lesions with a slightly uneven surface but intact mucosa. A ureteroscopic biopsy was taken with 5 F cup forceps; the histological examination showed non-Hodgkin lymphoma of the diCuse large Fig. 2. Histology shows submucosal infiltrating lymphoma cells, B-cell type (Fig. 2). A bone marrow specimen was mainly large-cell type. Haematoxylin and eosin, reduced from normal, establishing stage 1E of the Ann Arbor classifi×100. cation. The entire soft-tissue mass surrounding the ureter, detected by CT, completely disappeared after four tissue masses of the ureteric wall commonly represent courses of systemic chemotherapy followed by radioprimary neoplasms of the ureter or metastases to the therapy. A subsequent ureteroscopy and biopsy yielded ureter. In diCerentiating such lesions ureteroscopy prono positive findings. vides more definitive findings than radiography. To our knowledge, this is the first case in which malignant Comment lymphoma was diagnosed by ureteroscopic biopsy and the kidney was preserved successfully by chemotherapy Although detection of extranodal non-Hodgkin lymcombined with radiotherapy. phoma has been improved with the use of CT, primary lymphoma involving the ureteric wall without contiguous lymphadenopathy is an unusual occurrence. Only four other such cases have been reported [1–4]. Soft-

Analysis of retrograde ejaculation using color Doppler ultrasonography before and after transurethral collagen injection

Transurethral bladder neck collagen injection therapy was performed in a patient with retrograde ejaculation. The phenomenon of retrograde ejaculation and its correction after the therapy were clearly demonstrated by color Doppler ultrasonography. To our knowledge this is the first report showing successful observation of retrograde ejaculation using color Doppler ultrasonography.

Endoscopic correction of vesicoureteral reflux by subureteric Teflon (polytetrafluoroethylene) injection: review of 6-year experience.

Background:

Ureteroscopic management of chronic unilateral hematuria: a single-center experience over 22 years.

Objective To analyze the short and long term safety and efficacy of ureteroscopic evaluation and management of chronic unilateral hematuria. Methods We retrospectively reviewed patients with chronic unilateral hematuria from 1987 to 2008. The distal to middle ureter was evaluated with a semi-rigid ureteroscope without a guidewire. Subsequently, the flexible ureteroscope was advanced into the upper ureter to the renal pelvis using a low-pressure automated irrigant system (Uromat™). Lesions identified ureteroscopically were treated with diathermy fulguration. Results One hundred and four (56 male, 48 female) patients were identified, with a median age of 37 (14–80) years and median follow-up of 139 (34–277) months. The median preoperative duration of gross hematuria was 5 (1–144) months. Endoscopic findings included 61 (56%) minute venous rupture (MVR; a venous bleeding without clear abnormalities), 21 (20%) hemangioma (vascular tumor-like structure), 3 (3%) varix (tortuous vein), 1 (1%) calculus and 18 (17%) no lesions. The incidence of “no lesions” was less in the recent 12 years (9%) than the first 10 years (27%), while the incidence of MVR increased from 40 to 66% (p<0.05). All patients were treated endoscopically. Immediate success rate was 96% (100% in the recent 12 years). Long-term recurrent gross hematuria rate was 7%. Six resolved spontaneously and only 1 required ureteroscopy, revealing a different bleeding site. Conclusion Ureteroscopy and diathermy fulguration is highly useful for evaluation and treatment of chronic unilateral hematuria. Sophisticated technique and improved instrumentation contributes to a better outcome.

Impact of selective media for detecting fluoroquinolone-insusceptible/extended-spectrum beta-lactamase-producing Escherichia coli before transrectal prostate biopsy

To investigate the prevalence of fluoroquinolone‐insusceptible and/or extended‐spectrum beta‐lactamase‐producing Escherichia coli colonizing in the male rectum before transrectal prostate biopsy.