Mutsuo Hayashi

Abnormalities of Renal Venous System and Unexplained Renal Hematuria

Since 1968, 152 patients with unexplained renal hematuria have been treated at our clinic. Renal angiography in 46 patients who did not respond to conservative therapy revealed 21 abnormalities of the vascular system. Of these 21 patients 10 had or were suspected to have renal pelvic and ureteral varices, and 8 had congenital anomalies of either the inferior vean cava or the renal vein. Therefore, it was confirmed that vascular abnormalities were associated with the unexplained renal hematuria in these cases. Since these congenital anomalies might easily induce congestion in the renal venous system they might be the predisposing condition of the renal hematuria. Epinephrine-assisted renal phlebography has been a useful technique to detect anomalies of the venous system.

Transrectal high-intensity focused ultrasound for treatment for patients with biochemical failure after radical prostatectomy

Abstract:  Four patients with biochemical prostate‐specific antigen (PSA) failure with suspected local recurrence at the vesico‐urethral anastomotic site after radical prostatectomy were treated using a high‐intensity focused ultrasound (HIFU) device (Sonablate 500) under caudal or spinal anesthesia. The pretreatment PSA levels ranged from 0.318 to 0.898 ng/mL and their Gleason scores ranged between 5 and 7. HIFU treatment was carried out six times in four patients. The median time of operation and follow‐up period were 30 min (range, 15–37) and 13 months (range, 7–18), respectively. In all patients, the median PSA levels decreased from 0.555 ng/mL (range, 0.318–0.898) to 0.137 ng/mL (range, 0.102–0.290). The median PSA nadir after each HIFU was 0.054 ng/mL (range, 0.008–0.097). No major complications were noted. HIFU may be useful for the therapy of vesicourethral anastomostic lesion in patients with PSA failure after prostatectomy.

A Clinical Study of Upper Urinary Tract Calculi Treated with Extracorporeal Shock Wave Lithotripsy: Association with Bacteriuria before Treatment

To study the characteristics of upper urinary tract calculi associated with bacteriuria, we determined the relationships between the frequency of bacteriuria and some clinical factors such as location and size of calculi. Nine hundred and fifty-eight patients, 596 with renal calculi and 362 with ureteral calculi, were subjects in the present study. Bacteriuria was found in 75 patients, 57 with renal calculi (10%) and 18 with ureteral calculi (5%). The frequency of bacteriuria was significantly higher in patients with renal calculi than in those with ureteral stones (p < 0.05). In the patients with renal calculi, bacteriuria was most frequently associated with stones having a diameter of > 30 mm (19%), and secondarily with stones of 20-30 mm (12%). In contrast, the presence of bacteriuria was not related to the size of ureteral calculi. In conclusion, patients with renal stones of > 20 mm diameter have an increased risk of bacteriuria.

Modified pluck method in en bloc nephroureterectomy with bladder cuff for upper urothelial cancer

Abstract  Aim:  To evaluate the surgical results of the en bloc removal of the kidney and ureter with a bladder cuff by using our modified pluck method.

Fever after extracorporeal shock wave lithotripsy for patients with upper urinary tract calculi associated with bacteriuria before treatment

The present study was carried out to determine the relationship between fever (> or = 38 degrees C) after extracorporeal shock wave lithotripsy (ESWL) and the history of bacteriuria before ESWL. The subjects of this study comprised 958 patients. Significant bacteriuria before ESWL was found in 75 patients. These patients were treated with antibiotics and underwent ESWL after bacteriuria disappeared. Despite treatment with antibiotics, the patients with bacteriuria before ESWL had a significantly higher incidence of fever after ESWL than those without bacteriuria. Among the 14 patients whose high fever persisted after ESWL, the patients with bacteriuria included 7 (50%) with stones > 20 mm in size. The patients with stones > 20 mm and bacteriuria before ESWL had a high risk of persistent high fever after ESWL.

A Case of Bilateral Metastatic Renal Tumor Originating in a Cervical Carcinoma

A rare case of metastatic renal tumor originating in a cervical carcinoma in a 59-year-old Japanese woman is presented and the clinical and autopsy features discussed.