Setsuo Mashimo

Infrequent involvement of p53 mutations and loss of heterozygosity of 17p in the tumorigenesis of renal cell carcinoma

Restriction fragment length polymorphism (RFLP) analysis and the polymerase chain reaction of the single-strand conformation polymorphism (PCR-SSCP) method were conducted to assess the loss of heterozygosity of chromosome 17p and mutations of the p53 gene in 30 surgical specimens of human renal cell carcinoma. Six of 29 tumors (20.6%) showed loss of heterozygosity on chromosome 17p in RFLP analysis, and in none of 21 tumors could a mutation be found on exons 5 to 8 of the p53 gene in PCR-SSCP analysis. We conclude that the p53 gene mutation does not play a role in the development of the majority of cases of renal cell carcinoma and that there may be another tumor suppressor gene on 17p.

Emphysematous Pyelonephritis, Ureteritis, and Cystitis in a Diabetic Patient

This paper presents a case of gas-forming infection of the urinary tract in a diabetic patient. Plain film and computed tomography scans of the abdomen greatly facilitated clarification of the entire inflammatory process. The patient was cured by early nephrectomy conducted following unsuccessful treatment by percutaneous drainage.

Use of Polaroid Film in Intraoperative Renal Radiography: A New Technique

A new intraoperative renal radiography technique using Polaroid film is presented. The quality of the Polaroid radiograph is satisfactory enough to visualize radiopaque calculi and provides good information on the localization of intrarenal calculi in a short time. The time required for photographic development is 15 seconds and a dark room is not necessary.

Clinical Evaluation of Bone Metabolism after Renal Transplantation to Support the Theory to Perform 1,25(OH)2D3 Pulse Therapy before Transplantation

Dr. Torn Hyodo, Department of Urology, Kitasato University, School of Medicine, 1-15-1 Kitasato Sagamihara, Kanagawa 228 (Japan) Dear Sir, The loss of bone mineral density after renal transplantation has been reported [1-3]. One of the risk factors seems to be hyper-parathyroidism which persists even after successful renal transplantation. New trials to prevent bone loss are urgently needed to develop rational and effective therapeutic strategies in kidney transplant patients [2, 3]. This study was done to confirm theoretical evidence to perform l,25(OH)2D3 pulse therapy before renal transplantation as a new therapeutic strategy. Twenty-one patients who had a serum creatinine level of less than 2.0 mg/dl were selected. All patients had a more than 1-year history after operation. Mean age: 28.5 ± 11.9 (mean ± SD) years old. Mean dialysis history before transplantation: 55.0 ± 59.4 months. Mean duration after operation: 71.9 ± 60.2 months. To these patients, serum Ca, P, ALP, l,25(OH)2D3, HS-PTH, %TRP, Singh score, osteoporosis score of vertebral bone and bone mineral content by digital image processing (DIP) method (ΣGS/D by DIP method) were measured and analyzed. Correlation between Singh score and duration after operation was r = -0.943 and the osteoporosis score of vertebral bone showed the same strong negative result. Concerning % ΣGS/D to normal control, 75% of transplanted patients showed less than 80%. Only 14% of all 21 patients had less than -1 SD level of serum l,25(OH)2D3 of normal control. Only 16% showed normal HS-PTH and the other 84% had a higher level than the normal range. %TRP was less than the normal limit in 71 % of all 21 patients. Serum P was normal in 95%. Phosphate (900-2,000 mg/day) was administered to 3 male patients with living related renal transplantation during 1-4 months from just after operation and %TRP, serum HS-PTH and P were measured. Mean %TRP was 20%. HS-PTH had a higher level and serum P a lower level than the normal range.

Visual laser Ablation of the Prostate and Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia

For the past 50 years, transurethral resection of the prostate (TURP) has been the most common treatment for benign prostatic hyperplasia (BPH). The authors have conducted visual laser ablation of the prostate (VLAP) for BPH as a minimum invasive surgery. The results were compared with those of VLAP, VLAP+transurethral incision of the prostate (TUIP), and TURP as other treatments for BPH. In the VLAP group, 50 of 52 (96.2%), 36 of 40 (90.0%) and 31 of 36 (86.1%) were categorized as having more than a Fair Response (FR) at 3, 6 and 12 months, postoperatively. In the VLAP+TUIP group, 24 of 29 (82.8%), 19 of 22 (86.4%) and 9 of 11 (81.8%) were classed as having more than a FR at 3, 6 and 1 2 months, postoperatively. Forty–one of 42 (97.6%), 1 7 of 1 7 (100.0%) and 6 of 6 (100.0%) patients reaction to TURP was more than FR in overall response at 3, 6 and 12 months, postoperatively. The need for a blood transfusion, perforation of the prostate capsule and transit incontinence persisting for more than 1 month occurred in 1 of 45 (2.2%), 1 (2.2%) and 4 (8.9%) patients in the TURP group. Bladder neck contracture was seen in 4 of 52 (7.7%) in the VLAP group. Average postoperative catheter duration was shorter in the VLAP+TUIP (5.7 ± 8.4 days) than in the VLAP group (10.3 ± 10.4 days). Although TURP remains the standard treatment for BPH, VLAP results in less morbidity compared to TURP. VLAP with TUIP appears to lessen the risk of postoperative urinary retention and provide better results in longer follow–up studies.

CLINICAL EXPERIENCE WITH THE ARTIFICIAL URINARY SPHINCTER AMS 800 FOR MALE INCONTINENCE

BACKGROUND The aim of this study is to evaluate the therapeutic efficacy of artificial urinary sphincter AMS 800 implants for male patients with urinary incontinence. METHODS Eleven male patients with urinary incontinence were treated by implantation of the artificial urinary sphincter AMS 800 between 1988 and 1992. Patient age at the surgery ranged from 14 to 79 years, with a mean age of 58 years. At presentation, 9 patients (82%) had true incontinence and 2 had overflow incontinence, and medical treatments and/or surgical procedures (Teflon injections in 2 and Sling procedure in 1) had been attempted previously elsewhere in all patients. The etiologies of incontinence were post-prostatectomy (transurethral resection in 4 and radical retropubic prostatectomy in 4) in 8 patients (73%) and myelomeningocele, spinal cord injury, pelvic trauma in one each. There were 5 patients with abnormal cystometrogram, and 2 of them were performing intermittent self catheterization. Vesicoureteral reflux was determined in 2 patients preoperatively, which were surgically corrected one year before AMS800 implant in a patient and simultaneously in another patient. The cuff was placed around the bulbous urethra (9), pendulous urethra (1) or bladder neck (1). The device was activated 6 weeks post implantation, and the assessment of therapeutic effects was started 2 weeks after activation. RESULTS Follow up ranged from 3 weeks to 75 months, with a mean of 56 months, if 3 cases done explantation due to periprosthetic infections were excluded. After AMS 800 implantation 5 patients (45%) were completely continent, 4(36%) required the use of not more than 1 pad per day, while a patient was not satisfied with the results and another patient was not definitive because of early explantation before device activation. Hence complete or near complete continence was achieved in 9 patients (81%). A patient is performing intermittent self catheterization in conjunction with the AMS 800 without any complications up until now. There were 3 periprosthetic infections (27%) associated with 2 cuff erosions, that consequently required explantation. Besides periprosthetic infection, neither complications nor mechanical device failures was experienced. CONCLUSION In conclusion, the AMS 800 artificial urinary sphincter was safe with reasonable mechanical reliability and offered acceptable and satisfactory urinary control to the selected patients with incontinence.