Endourological Evaluation and Management of Leukoplakia of the Renal Pelvis

Since August 1989, we have seen 4 patients with leukoplakia of the renal pelvis associated with a longstanding renal stone. In 2 of them, excretory or retrograde pyelography revealed multiple filling defects in the left renal pelvis as well as a renal stone, although urine cytological examination was negative. One of the other 2 patients underwent extracorporeal shock wave lithotripsy (ESWL) for the renal stone, but this was not followed by the passage of stone fragments. The renal stone in the remaining patient was associated with staghorn calculi. For stone extraction as well as endoscopic evaluation of the intrapelvic lesion, percutaneous nephroscopy was performed. A small to large amount of tissue-like white debris in sheets characteristic of leukoplakia was found in the renal pelvis with stones embedded in it and was removed directly by forceps or suction and then by irrigating with saline. We propose that 1) the endourological approach should be recommended for patients with renal pelvic lesions associated with longstanding renal stones or for patients who show difficulty in passing stone fragments after ESWL and 2) this entity of leukoplakia should be kept in mind for the differential diagnosis of renal pelvic lesions associated with renal stones

Laparoscopic Evaluation and the Management of the Nonpalpable Testis

From June 1992 to December 1996, we performed laparoscopic evaluation for 28 nonpalpable testes in 22 patients (1–21, median 3 years old)

外科的治療を施行した転移性副腎腫瘍の検討

The indications for adrenalectomy in cases of metastatic adrenal tumor remain controversial. To clarify indications and outcomes of adrenalectomy for adrenal metastasis, we performed a retrospective review of all 8 patients who underwent adrenalectomy for adrenal metastasis between 1990 and 2006 in Asahikawa Medical College Hospital. The Primary tumor was renal cell carcinoma in 2 cases, and eccrine poro carcinoma, rectal cancer, lung cancer, melanoma, bladder cancer and cancer of unknown origin in 1 case each. Open adrenalectomy was performed in all cases, including 1 case that was converted from laparoscopic adrenalectomy. Of the 4 patients with solitary adrenal metastasis, 3 were considered tumor-free after adrenalectomy, while the remaining patient was not due to unresectable primary tumor. Of the 3 patients with complete resection, one remained alive as of 88 months after adrenalectomy but was then lost to follow-up, and the other 2 patients remain alive 12 and 7 months after adrenalectomy. Of the 2 patients with other resectable metastasis who were tumor-free after removal of all metastases, one was alive 31 months postoperatively and the other died 23 months after operation. The remaining 2 cases with other unresectable metastasis died within 6 months after adrenalectomy. At least in cases of solitary adrenal metastasis, adrenalectomy can be effective if other valid methods are unavailable.転移性副腎腫瘍に対する副腎摘除術の適応に関してはまだ統一された見解はない。そこでその適応と治療効果を明らかにするために, 1990年から2006年までの間に当院において転移性副腎腫瘍に対し副腎摘除術を施行した8症例についてretrospectiveに検討した。全例開腹にて副腎摘除を施行しており, 1例は腹腔鏡下摘出術からの移行であった。孤立性副腎転移は4例に認められ, 3例が術後tumor freeとなり得た。これら3例の観察期間はそれぞれ88, 12, 7ヵ月であった。副腎以外にも転移を認めたが, 副腎も含めてすべて外科的切除が可能であった2例はそれぞれ31, 23ヵ月の観察期間であった。副腎以外に切除不能な転移を認めた2例は6ヵ月以内に死亡した。他に有効な治療がない場合, 少なくとも孤立性副腎転移に関しては副腎摘除が有効な治療となる可能性があると思われた。(著者抄録

Causative significance of bladder blood flow in lower urinary tract symptoms

Blackwell Publishing Seiji Matsumoto,Hidehiro Kakizaki International Journal of Urology、19(1)、2012、20〜25 AuthorThe association between metabolic syndrome and lower urinary tract symptoms has been attracting enormous interest and attention. This enthusiasm is based on the presence of many common risk factors being involved in both metabolic syndrome and lower urinary tract symptoms, as shown by various epidemiological studies. Metabolic syndrome and lower urinary tract symptoms have many pathophysiological features in common, particularly overactive bladder. Herein, we analyze the pathophysiological relationship between metabolic syndrome and lower urinary tract symptoms with a special emphasis on bladder blood flow. We also propose a new treatment strategy for treating lower urinary tract symptoms from the viewpoint of bladder blood flow

Clinical experience in lower urinary tract symptoms

The definitive version is available at www.blackwell-synergy.com autho

本学教員執筆書籍の紹介 小児泌尿器科手術（柿崎秀宏 編集）

雑誌掲載

腎細胞癌の卵巣転移の1例

A 52-year-old woman had a pathological fracture of the right femur. On histopathological examination bone metastasis from renal cell carcinoma was suspected. Abdominal computed tomography showed a heterogeneous mass (9.1 x 7.8 x 6.5 cm) in the left kidney and a cystic multilocular mass (12 x 10 cm) in the pelvis. Bone scintigraphy revealed an abnormal uptake in the left coracoid process, right third rib, and right distal femur and proximal tibia. Clinical diagnosis was left renal cancer with multiple bone metastases (cT2NOM1, stage IV) and a right ovarian tumor. We performed left radical nephrectomy and resection of right ovarian tumor by bilateral adnexectomy. On histopathological examination, the left kidney tumor was diagnosed as renal cell carcinoma (clear cell carcinoma with chromophobe component, G2 > G1). The ovarian tumor consisted of carcinoma of clear cell type (G2) that resembled components of left renal cell carcinoma, confirming the diagnosis of metastatic renal clear cell carcinoma to the ovary. Although she underwent immunotherapy with interferon, she died 10 months after nephrectomy. Metastasis to the ovary from renal clear cell carcinoma is very rare and only 18 cases have been reported in the literature. This rarity may be related to the difficulty of differential diagnosis between metastatic renal cell carcinoma to the ovary and primary ovarian clear cell carcinoma. Elaborate analysis of microscopic features and immunohistochemical profiles may help in the distinction of this metastatic lesion.患者は52歳、女性。右大腿骨の病的骨折をきたし、骨折片の病理学組織学的検索で腎細胞癌(淡明細胞癌、G2)を疑われた。CT検査で左腎腫瘍(9.1×7.8×6.5cm)および多房嚢胞性の右卵巣腫瘍(12×10cm)を認めた。腎癌cT2N0M1, stageIVと診断し、卵巣腫瘍は悪性腫瘍を強く疑ったが原発性か転移性かの鑑別は困難であった。経腹的根治的左腎摘除、右卵巣腫瘍摘出および両側付属器切除術を施行し、病理組織学的には腎は一部に嫌色素細胞癌を伴う淡明細胞癌(G2>G1)であった。卵巣は腎で認めたG2の淡明細胞癌と類似した組織型であり、大腿骨の転移巣と同じ組織型を呈していたことから、腎癌の卵巣転移と診断した。術後インターフェロンによる後療法を施行したが、10ヵ月後、肺転移の出現と骨転移巣の増大のため死亡した。腎細胞癌の卵巣転移はきわめて稀であり、文献上18例の報告しかない。(著者抄録

中枢における排尿制御機構

著者最終原稿版PETやfMRIという機能的脳画像を用いることで、ヒトの膀胱機能を調節する脳の仕組みが理解できるようになってきた。蓄尿時に活動が活発となる脳の部位は、島(とう)、視床、前帯状回、被殻、中脳中心灰白質、橋、小脳などであり、これらの部位が蓄尿に重要な中枢と考えられる。下部尿路機能障害を有する患者と健常者との間で、機能的脳画像の情報を比較することにより、下部尿路機能障害の病態解明や新しい治療法の確立につながる可能性が期待される

国際尿失禁会議からの報告 男性の尿失禁に対する手術

著者