Osamu Ueki

The Influence of Prostatic Urethral Anesthesia in Overactive Detrusor in Patients with Benign Prostatic Hyperplasia

We examined the effects of prostatic urethral anesthesia on cystometrography in benign prostatic hyperplasia (BPH) patients with or without neurological disorders. Although cystometrography after anesthesia showed no disappearance of involuntary detrusor contraction, it did demonstrate significant increases in first sensation volume and maximum cystometric capacity in BPH patients without neurological diseases, as well as BPH patients with a history but no physical evidence of neurological disease. Furthermore, the bladder might be augmented more efficaciously in patients with involuntary detrusor contractions. No significant differences were found in first sensation volume or maximum cystometric capacity before and after anesthesia in patients without infravesical obstruction who had documented neurological disease with physical evidence. Our results demonstrated that prostatic urethral anesthesia can be used preoperatively in patients with infravesical obstruction to discriminate whether involuntary detrusor contractions are due to infravesical obstruction or to neurological disease.

CELLULAR BINDING OF HEMATOPORPHYRIN DERIVATIVE IN HUMAN BLADDER CANCER CELL LINES: KK‐47

Abstract— The fluorescence lifetime and degree of fluorescence polarization of hematoporphyrin derivative (HpD) have been investigated using different solutions: organic and micellar solutions. Hams F12 medium, and KK‐47 cell suspension. The lifetime and polarization degree in organic and micellar solutions did not change with increasing incubation time, but the polarization degree in the cell suspensions temporarily increased at the initial incubation time and then decreased 4 h after incubation. The lifetime in the cell suspensions exhibited a bi‐phasic exponential decay. The results obtained suggested that mainly dimeric HpD may bind weakly to the cell membrane, and then slowly be distributed throughout the cytoplasm. The polarity and viscosity of the intracellular loci containing HpD were evaluated from the fluorescence polarizations of HpD in MeOH‐H2O mixtures and ethylene glycol(EG)‐MeOH mixtures. The dielectric constant and viscosity of the loci containing HpD were 35 and 11 cp, respectively. Accordingly, the intracellular location of HpD were considered relatively hydrophilic loci of the cells.

Cellular uptake of hematoporphyrin derivative in KK-47 bladder cancer cells

SummaryThe fluorescence emission spectra and degree of fluorescence polarization of hematoporphyrin derivative (HpD) have been investigated using HpD-containing KK-47 cells, PBS and cetyl trimethyl ammonium chloride (CTAC) micellar solutions. The fluorescence emission bands in the HpD-containing cell suspension were red-shifted and broadened as compared to those in the PBS solution. The degree of the polarization in the PBS and CTAC micellar solutions did not change with increasing incubation time, but in the cell suspension it increased temporarily and then decreased 4 h after incubation. These results suggest that HpD monomers and dimers may bind weakly to the outer cell membrane, and then slowly distribute throughout the intracellular loci in strong-binding form. In addition, the cellular uptake and/or binding loci of HpD were considered to be the mitochondria and nuclear membrane by subcellular fractionation and fluorescence microscopic studies.

Case of leiomyosarcoma of the renal pelvis

Abstract  A 54‐year‐old man presented at the Mibayashi clinic with bowel discomfort. Ultrasonography showed a left renal mass and the patient was referred to Noto General Hospital for urological evaluation. Results of the physical examination were unremarkable, but computed tomography and magnetic resonance imaging demonstrated a large tumor in the middle of the left kidney. The patient underwent left nephrectomy. On hemisection of the kidney, a firm tumor, measuring 8 × 7.5 cm, was seen occupying the renal pelvis. The histological diagnosis was leiomyosarcoma arising from the right renal pelvis. No treatment was provided after surgery and no recurrence was observed 6 months postoperatively.

Inhibition of Cell Growth by Irradiation in Combination with Hyperthermia or Anticancer Drugs

Using a clonogenic assay and the human bladder cancer cell line T24, enhanced cytotoxicity by the combined use of irradiation and 43 degrees C hyperthermia or two anticancer drugs, bleomycin (BLM) and cis-dichlorodiammineplatinum (CDDP), has been investigated in vitro, as well as the size of colonies derived from single survivor cells after treatment. Irradiation combined with 43 degrees C hyperthermia showed greatly enhanced cytotoxicity and diminution in mean colony diameter and decreased distribution of colony size. BLM had almost the same effect as 43 degrees C hyperthermia in terms of cytotoxicity and colony size. While CDDP showed a certain degree of enhanced cytotoxicity in combination with irradiation, it produced no appreciable decrease in mean colony diameter. Hyperthermia may be beneficial in the management of radiation resistant cells surviving a large dose of radiation, and would seem to be a promising means for achieving eradication of cancer cells in combination with radiation therapy.

Methotrexate, vinblastine, doxorubicin, and cisplatin for advanced urothelial cancer

SummaryA series of 31 patients with advanced urothelial cancer were treated with combination chemotherapy consisting of 1–4 cycles of methotrexate, vinblastine, doxorubicin, and cisplatin (M-VAC). Of the 31 patients, 29 had measurable and evaluable lesions. A complete remission was achieved by 4 of these 29 patients (14%) for 1–46 months. A partial remission was observed in 14 of the 29 patients (48%) for 1–9 months. Whereas bony and hepatic metastatic lesions did not respond, some nodal (7/12), pulmonary (4/8), and pelvic lesions (2/3) as well as primary bladder tumors (4/6) and a tumor marker (1/2) responded. Complete tumor remission was observed in nodal (2/12) and pulmonary (1/8) metastatic lesions, in invasive lesions to the prostate and seminal vesicle (1/1), and in primary lesions in the bladder (2/6), ureter (1/1), and urethra (1/1). Two of three patients with non-transitional cell tumors attained a partial remission for 1–7 months. Complete remission of the pulmonary lesions was obtained in a case of squamous cell cancer of the bladder with pulmonary metastases. The toxicity of this regimen was generally tolerable and included moderate to severe myelosuppression, mild to moderate nausea and vomiting, renal toxicity, and mucositis. These results suggest that the M-VAC regimen holds promise for the treatment of advanced metastatic transitional cell cancer as well as nontransitional cell cancer of the urothelium.

V8-07 MODIFIED MILAN SLING TECHNIQUE DURING ROBOT-ASSISTED RADICAL PROSTATECTOMY FOR EARLY RECOVERY OF URINARY CONTINENCE WITHOUT NERVE-SPARING: A PILOT STUDY

patient’s giant duplicated kidney. This 2.96 mm instrument shaft was inserted through a small puncture and maintains the nearly scarless cosmesis of LESS surgery. The 5 mm grasping tip, which can be changed through any conventional laparoscopic port, was robust and allowed for the effective manipulation of this giant kidney. The estimated blood loss was 100 cc and the operative time was 310 min. The patient tolerated the procedure well without any perioperative complications. The patient was discharged home on POD 1 and required no narcotic pain medications. CONCLUSIONS: The addition of the PEAL instrument facilitated the completion of LESS nephrectomy in a patient with complicated anatomy. By using these externally assembled instruments, PEAL provides a functional, robust 5 mm tip and reestablishes instrument triangulation, thereby greatly simplifying LESS surgery. In addition the <3mm shaft maintains a nearly scarless cosmetic outcome. The PEAL instruments can be used to simplify LESS, reduce the invasiveness of conventional laparoscopic surgery or as stand-alone surgical paradigm. For these reasons we feel that the PEAL paradigm is a promising new surgical approach