Yoshinori Okano

Ureteropyeloscopy in the diagnosis of patients with upper tract hematuria: An initial clinical study

Background: To study the usefulness and safety of ureteropyeloscopy in the diagnosis of upper tract hematuria of unknown etiology by standard diagnostic methods.

Immunohistochemical Studies of Proliferating Cell Nuclear Antigen and Cathepsin D in Transitional Cell Carcinoma of the Urinary Bladder

Immunohistochemical staining for proliferating cell nuclear antigen (PCNA) and cathepsin D was performed on 60 transitional cell carcinoma (TCC) specimens from 60 patients with bladder cancer. The percentage of PCNA-positive cells (PCNA-labelling index) was determined by counting 500 or 1,000 cells, and cathepsin D expression was graded according to the extent of immunoreactivity to anti-cathepsin D antibody. The PCNA-labelling index was significantly higher in high-grade and high-stage tumors compared to that in low-grade and low-stage tumors. Cathepsin D was highly positive in grade-1 tumors. In contrast, 82% of grade-3 tumors and 76% of advanced tumors showed negative or low reactivity to anti-cathepsin D. Groups of high PCNA-labelling index and negative cathepsin D had significantly poorer prognoses compared to those of the low PCNA group and cathepsin D highly positive group, respectively, in univariate analyses. However, neither of these two factors were independent prognostic factors in multivariate analyses. These results suggest that the PCNA-labelling index and cathepsin D expression may indicate the malignant potential of TCC and may be able to provide additional information for predicting survival when stratifying for grade of bladder cancer.

Gonadal Function in Patients with Testicular Germ Cell Tumors

The gonadal function of 18 patients with testicular germ cell tumors was evaluated. Seminal parameters after orchiectomy were examined in 15 patients. Six of them were available for follow-up observation after 2 or 3 courses of adjuvant chemotherapy. Serum gonadal hormones before and after orchiectomy were evaluated in 7 patients (testosterone and PRL were not examined in one patient). Five of 15 (33.3%), 8 of 15 (53.3%), 13 of 15 (86.7%), 7 of 13 (53.8%), and 9 of 12 (75.0%) had abnormal values in seminal volume, sperm concentration, motility, morphology, and vitality, respectively. The sperm concentration gradually improved after chemotherapy following orchiectomy in 5 of 6 (83.3%) patients. In all the patients examined, serum levels of follicular stimulating hormone (FSH), luteinizing hormone (LH), and prolactin (PRL) increased after orchiectomy. Serum levels of testosterone increased in 4 patients, but decreased in 2 after orchiectomy. These findings suggest that several factors, including preexisting intrinsic defect and disturbance of the hypothalamus-pituitary-gonadal axis, are involved in the deterioration of gonadal function in patients with testicular germ cell tumors.

Sling operation for male urinary incontinence after ileal neobladder reconstruction: a case report.

In July 1992. sling surgery was performed on a 62‐year‐old male patient with urinary incontinence following ileal neobladder reconstruction. Incontinence ceased immediately after this procedure which was conducted using five nylon sutures and two dacron tubes to protect the posterior urethra.

Multidisciplinary Treatment of Advanced Testicular Tumor with Bulky Liver Metastasis

A 21-year-old man with far-advanced nonseminomatous germ cell tumor of the left testis is presented. He had multiple bulky metastases in the liver and retroperitoneum with an extraordinarily elevated serum α-fetoprotein (23,500 ng/ml). He received multidisciplinary treatment consisting of systemic chemotherapy, cytoreductive left hepatic lobectomy, percutaneous ablation therapy, transarterial chemoembolization, and external beam irradiation for median segments of the liver. The efficient combination treatment normalized the tumor markers within 6 months and has maintained complete serological remission for 4.7 years.

Removal of the entire urinary tract following recurrent urothelial cancer in a patient with chronic renal failure.

透析患者の予後の改善に伴って悪性腫瘍の合併も増加している. しかし尿路に広範な腫瘍が繰り返し出現し, 全尿路摘除に至ったという症例報告は少ない. 我々は繰り返す尿路上皮癌の発生により全尿路摘除術を行った症例を経験したのでここに報告する.症例は66歳, 女性. 主訴, 肉眼的血尿. SLEによる腎不全のために紹介病院で血液透析を行っていた. 1989年5月より血尿が持続するため腎CTを行ったところ右腎盂腫瘍と診断され右腎摘除術を行った. 病理組織診断はgrade 2, 移行上皮癌 (TCC) であった. 経過観察中1990年11月再び肉眼的血尿が出現. 右尿管口と膀胱左側壁に腫瘍がみられ, 経尿道的膀胱腫瘍切除術 (TUR-Bt) を行った. 病理組織診断はgrade 1, TCCであった. その後, 1991年1月右残存尿管, 膀胱, 左尿管にも腫瘍発生が疑われたため1991年2月全尿路摘除を行った. 術後約2年経った現在再発もなく患者は定期的に経過観察されている.