Naoyuki Sakakibara

Pituitary and gonadal function in prepubertal boys with hypospadias.

Luteinizing hormone releasing hormone and human chorionic gonadotropin tests were performed to examine the pituitary gonadal axis in 31 prepubertal boys with hypospadias. Luteinizing hormone and follicle stimulating hormone responses to luteinizing hormone releasing hormone in these boys with hypospadias were significantly higher than those in prepubertal control subjects (luteinizing hormone, p less than 0.01). follicle stimulating hormone, p less than 0.05). Prepubertal boys with hypospadias had remarkably reduced testosterone responses to human chorionic gonadotropin stimulation compared to controls (p less than 0.01). Hormonal milieus were further analyzed in the subtypes of hypospadias depending on their severity (distal vs. proximal). Nine of the 31 boys with hypospadias were classified as the proximal type. Basal luteinizing hormone levels in the proximal type were significantly higher than in the distal type (p less than 0.05). Luteinizing hormone and follicle stimulating hormone responses to luteinizing hormone releasing hormone and responses of testosterone to human chorionic gonadotropin were not significantly different in the 2 types. Seven of the 31 boys with hypospadias had a history of maternal progestin ingestion. Basal luteinizing hormone levels and responses of luteinizing hormone and follicle stimulating hormone to luteinizing hormone releasing hormone were also significantly higher in these subjects than in controls (p less than 0.005), though basal levels and responses of testosterone to human chorionic gonadotropin were not different from those of controls. Tests conducted to determine luteinizing hormone and follicle stimulating hormone and testosterone levels using luteinizing hormone releasing hormone and human chorionic gonadotropin stimulation revealed no statistical differences between the boys with hypospadias who had a history of maternal progestin ingestion and those without such a history. The majority of prepubertal boys with hypospadias had varying degrees of deficient testicular activity. The testicular function of these patients should be evaluated longitudinally at puberty and thereafter in order to insure the completion of secondary sexual development.

Use of Testosterone Ointment before Hypospadias Repair

Fifteen children, aged between 2 and 9 years old, with hypospadias (4 penile; 6 penoscrotal; 3 scrotal; 1 perineal) were administered testosterone ointment before one-stage urethroplasty. Temporary penile growth and skin enlargement were obtained in all. Side effects were negligible. The plasma testosterone level was measured before, during and after testosterone administration. During testosterone stimulation, the plasma testosterone level ranged from 30 to 190 ng/dl, and returned to the normal range a week after administration had been stopped. Primary success of hypospadias repair was obtained in 10 of 15 children (66.7%).

Androgen binding activity in the spongy tissue of mammalian penis

The binding of [3H]R1881 to cytosol fractions was determined for the spongy tissues of horse, porcine and human penis. Binding of [3H]R1881 to cytosol fractions from these spongy tissues was found to be specific with high affinities (mean of Kd; 1.8 X 10(-10) M) but with equally low binding capacities (mean of 4.66 fmol/mg. protein). Saturation analysis revealed that the binding capacity was similar for both corpus cavernosum and corpus spongiosum of horse penis. We conclude that a trace amount of androgen receptor is present in spongy tissue of the penis and that there is no difference in cytosolic receptors between corpus cavernosum and corpus spongiosum in adult mammalian penis.

Benign fibrous histiocytoma of the kidney

A case of benign fibrous histiocytoma of the kidney in a 48-year-old man is reported. A 7-year followup has revealed no recurrence. To our knowledge there have been no previous reports of benign fibrous histiocytoma of the kidney.

Parturition in six renal allograft recipients.

Between 1983 and 1994, we studied renal function and neonatal conditions for eight pregnancies and births to six women who had received renal transplants in order to assess the effect of an allograft on pregnancy and its outcome. The gestation period was 34 to 39 weeks (mean 36 weeks and 4 days), and four pregnancies ended before term. All eight babies were delivered by cesarean section. Intrauterine growth retardation (IUGR) was found in both babies of one woman who had been treated with conventional (without cyclosporin) immunosuppression. The serum creatinine level did not change during gestation in any of the women but was elevated after delivery in four. Four mothers suffered from proteinuria (25–364 mg/dl) during gestation, but the proteinuria disappeared after delivery in all but one case. The one exception, persistent proteinuria of 100–200 mg/dl, was assumed to result from the recurrence of the original renal disease (IgA nephropathy). The reduction of creatinine clearance and hydronephrosis of one graft noted during gestation were later reversed. None of the eight babies (four females and four males) was congenitally malformed, and their Apgar scores were 6 to 9 (median 8). They are now 3 months to 11 years old, and seven of them are healthy and show good growth. One of the two IUGR babies has not grown well; her weight and height are more than 1 SD below the mean for her age, and she is mentally retarded and suffers from muscle weakness. Compared with dialysis patients, female renal allograft recipients have a better quality of life because they can safely deliver a child if they observe the criteria for pregnancy established for renal allograft recipients.

Papillary Adenoma of the Bladder in a Patient with Intermittent Self-Catheterization

We report a case of papillary adenoma of the bladder. The patient had had intermittent self-catheterization for the previous 3 years. The tumors developed multiply and were identified on the trigone and posterior wall of the bladder. Dysplasia of the urothelium was associated in nontumorous areas. Transurethral resection of the tumors was performed. The tumor recurred 3 times for 3 years, but no malignant changes were identified.

Gasless retroperitoneoscopic partial nephrectomy for a case with renal cell carcinoma.

A 53‐year‐old man with incidental renal cell carcinoma underwent gasless retroperitoneoscopic partial nephrectomy. Convalescence was uneventful. There remained no evidence of disease during the 58‐month follow up.

A new technique for skin closure in hypospadias: ipsilateral penoscrotal approximation for closure.

Sixteen patients, between 2 and 45 years old, with hypospadias underwent repair with our new skin closure procedure called ipsilateral penoscrotal approximation for closure (IPSAC). Complete functional success was obtained in all 6 patients with distal hypospadias and in 7 of 10 patients with proximal hypospadias. Meatal regression and urethrocutaneous fistula were complications in one-stage repair. Another urethrocutaneous fistula resulted from fifth-stage repair in the case of an adult hypospadias cripple. Cosmetically, there were two cases with unsightly thickening of the base of the penis in this early series. It was found that this IPSAC procedure had two major advantages: it provided (1) a tension-relieving skin closure, and (2) correction of scrotal deformity, especially in one-stage repair with the parameatal flap and in multi-staged repair with absolute penile skin deficiency.