Toshiyuki Un-no

ENDOSCOPIC MANAGEMENT OF IMPACTED URETERAL STONES USING A SMALL CALIBER URETEROSCOPE AND A LASER LITHOTRIPTOR

PURPOSE We reviewed our experience with retrograde endoscopy using a small caliber ureteroscope and a laser lithotriptor in 104 consecutive patients with impacted ureteral stones and also analyzed the associated endoscopic findings. MATERIALS AND METHODS From July 1993 to October 1999 we performed retrograde endoscopic treatment in 104 patients with impacted ureteral stones. Average maximum stone diameter was 15.2 mm. (range 2 to 110), and 9 patients had stones larger than 3 cm. Mean duration of impaction was more than 14 months and the longest was 10 years. We used 6.9Fr rigid or 6.9 to 7.5Fr flexible ureteroscopes and a pulsed dye laser or holmium:YAG laser lithotriptor. RESULTS Of the 104 ureteral stones 100 (96.2%) were completely fragmented by a single endoscopic procedure. Although 1 uric acid stone could not be disintegrated by either the pulsed dye laser or electrohydraulic lithotripsy early in this series, it was discharged spontaneously 2 weeks after the procedure. Additional extracorporeal shock wave lithotripsy (ESWL*) was required in 3 patients who initially had stones larger than 3 cm. A month after treatment no patient had evidence of residual stones. Using adjuvant ESWL a 100% success rate was attained with minimal morbidity. Endoscopic observation revealed inflammatory polyps of the ureter in 22 patients (21.2%), and stricture adjacent to the stone in 16 (15. 4%). There were no significant complications. CONCLUSIONS Using a small caliber ureteroscope and a laser lithotriptor we could treat the target stone in all 104 patients with adjuvant ESWL in 3 cases. Endoscopic lithotripsy seems to be effective first line therapy for chronically impacted stones which are frequently associated with chronic inflammation, polyps and strictures, and avoids the futile repetition of ESWL and problems related to the prolonged passage of stone fragments.

Endoscopic management of upper urinary tract disease using a 200-μm holmium laser fiber: initial experience in japan

OBJECTIVES To study the clinical effectiveness of the 200-microm holmium laser fiber for endoscopic management of upper urinary tract lesions. METHODS From January 1997 to March 1998, we performed retrograde endoscopic treatment in 25 patients with urinary tract lesions using a 200-microm holmium laser fiber. Nineteen patients had 20 stones (16 ureteral, 3 lower calyx, and 1 middle calyx), 4 had bleeding lesions in the lower calyx, 1 had transitional cell carcinoma involving the renal pelvis and upper calyx, and 1 had a ureteral stricture associated with an impacted ureteral stone. We used a 7.5F flexible ureterorenoscope for renal and upper ureteral lesions, and a 6.9F rigid ureteroscope for mid and lower ureteral lesions. For treatment, we used a holmium:yttriumaluminum-garnet laser generator and a 200-microm flexible quartz fiber. RESULTS All stones were successfully fragmented, including three lower caliceal stones. Lower caliceal bleeding spots were successfully cauterized for hemostasis in all 4 patients, and the pelvic tumor was successfully vaporized and ablated. In 1 patient, we had previously failed to treat a ureteral stricture with a 365-microm fiber because of inadequate visualization, but it was successfully incised using the 200-microm fiber. There were no significant complications such as ureteral obstruction or stenosis. CONCLUSIONS The improved flexibility of the new 200-microm holmium laser fiber facilitates treatment of stones, tumors, strictures, and lesions in the lower calyx, where access is difficult when using the previously available 365-microm fiber.

Retroperitoneoscopic treatment of a retrocaval ureter

Background : Retroperitoneoscopic surgery was performed on a 41‐year‐old man with a retrocaval ureter.

Neonatal Exposure to Estrogen in the Wistar Rat Decreases Estrogen Receptor-Beta and Induces Epithelial Proliferation of the Prostate in the Adult

Background/Aims: The effects of environmental endocrine disruptors on the male reproductive system have received much attention. We attempted to assess the responsible reproduction period vulnerable to decrease in ERβ mRNA by exposing neonate rats to disruptors. Methods: Each of 64 male Wistar rats was given an injection of estradiol at a dose of 25 µg or oil on days 1, 3 and 5 after birth. These rats were sacrificed on days 80, 120, 160 and 180 and then subjected to measurements of both serum and tissue testosterone levels. Real-time quantitative polymerase chain reaction (PCR) was used to measure the levels of androgen receptor (AR) and estrogen receptor-β (ERβ) mRNA of the ventral prostate. Histological compositions were analyzed by quantitative morphometry. Immunohistochemical analysis of proliferating cell nuclear antigen (PCNA) was determined. Results: The incidence of epithelial components by histomorphometry and the expression of PCNA was significantly higher in the estrogen group in the mature adult (day 160). Levels of AR and ERβ mRNAs in the estrogen group were significantly lower in middle-aged rats (day 180). Conclusion: Estrogen exposure in the neonatal period to Wistar rats decreases the number of ERβ in the mature adult and accelerates cell proliferation.

Adrenocortical Adenoma Producing 18‐Hydroxycorticosterone

A 30‐year‐old man presented at our hospital with microscopic hematuria. Ultrasonography and computed tomography scanning revealed a right adrenal mass measuring 20 × 20mm. The tumor was asymptomatic, but there was obvious accumulation on the right side when scintigraphy was performed with radioactive iodine (131I)‐labeled adosterol. Endocrinology studies showed elevation of the plasma cortisol and renin concentrations, while the plasma aldosterone level was low. Right laparoscopic adrenalectomy was done on July 4, 1994. Histologic examination showed an adrenocortical adenoma. Serum levels of adrenocortical hormones were measured before and after surgery, and the tissue content for the same hormones was determined in the resected tumor. The hormonal studies showed that the tumor produced 1 8‐hydroxycorticosterone.