Successful closure of neovesicocutaneous fistula with fibrin glue

We report a case of neovesicocutaneous fistula following radical cystectomy with urinary diversion via an ileal neobladder. The fistula was closed with fibrin glue. The present case suggests that occlusion therapy with fibrin glue is useful as a treatment option to facilitate the closure of a fistulous tract in the case of prolonged urine leakage from the ileal neobladder.

Leiomyoma of the ureter

We report a case of leiomyoma of the ureter, and the patient underwent partial ureteral resection. This is the 8th case reported after 1955, and the clinical features of ureteral leiomyomas of these 8 cases are discussed.

[The vanishing testis: diagnosis and histological findings]

PURPOSE

Controversy exists on how to diagnose the vanishing testis and the degree of investigation required. In this series, we reviewed anatomical and histological findings in vanishing testes and investigated the effectiveness of diagnostic laparoscopy and imaging studies.

MATERIALS AND METHODS

Between 1974 and March 1999, 107 boys with nonpalpable testis underwent surgery. Of the total, 52 had spermatic vessels, vas deferens, and/or nubbin, and as a result the diagnosis of vanishing testis was made.

RESULTS

The affected side of vanishing testis was left 41, right 9 and bilateral 2.35 nubbins were found and the lengths of 24 nubbins were 5 mm or less. Histological examinations were performed in 43 cases including 27 nubbins. From that total, 31 had vas deferens and 11 had epididymis. Only two nubbins had seminiferous tubules but they included no germ cells. The two nubbins were greater than 5 mm long. Laparoscopic surgery was undertaken in 12 separate cases of the vanishing testis and as a result hypoplastic spermatic vessels were present in 7 of the 12 cases.

CONCLUSION

The incidence of viable testicular tissue in vanishing testes was 4.7% in our series and it ranges from 0-16% in other series. We submit that one can diagnose the inguinal vanishing testis with preoperative imaging and laparoscopy, and that the nubbin seldom contains testicular tissue. Our results do not support the necessity to remove nubbins.

Altered synaptic transmission in the hippocampus of the castrated male mouse is reversed by testosterone replacement

PURPOSE

To determine the effect of castration on hippocampal function, we have investigated synaptic transmission in the castrated male mouse in vivo. We also examined whether administering testosterone can reverse the changes.

MATERIALS AND METHODS

Male 12 weeks-old C57BL/6J mice were divided into three experimental groups; sham-castration (Control), the castration group (Cast), and the castration plus testosterone propionate group (Cast+TP). Field excitatory postsynaptic potentials (fEPSP) were evoked in the CA1 area of the hippocampus by stimulating the commissural fibers of the contralateral hippocampus. Field EPSPs were evoked in the granular cells of the dentate gyrus (DG) by stimulating the ipsilateral perforant path fibers.

RESULTS

Laminar analysis of the fEPSPs in the hippocampal CA1 pyramidal cell layer did not differ significantly between the three experimental groups. However, paired pulse facilitation (PPF) of the fEPSP with short inter-stimulus intervals (30 to 100 msec) was significantly suppressed in Cast group. This suppression was reversed by testosterone injection (Cast+TP). Longterm potentiation (LTP) in the CA1 pyramidal neurons by high frequency stimulation (HFS) did not differ significantly between the three experimental groups, whereas potentiation evoked by primed burst stimulation (PBS) was much weaker in the Cast group compared with the Control group. Testosterone injection restored the PBS-induced potentiation to the control level. Synaptic transmission between perforant pathway and the granule cells in the dentate gyrus (DG) did not differ significantly among the three experimental groups.

CONCLUSIONS

Suppression of PPF and impairment of the potentiation by PBS in CA1 hippocampal neurons was observed in castrated male mice and these changes were reversed by testosterone injection. These findings suggest that altered synaptic transmission in the castrated male mouse is caused by disturbance of inhibitory neuronal networks that are influenced by testosterone.

[Stage pT1 signet ring cell carcinoma of the urinary bladder: a case report]

A case of primary signet ring cell carcinoma of the urinary bladder is described. A 59-year-old man presented with microscopic hematuria, and cystoscopy revealed a white nonpapillary tumor. Histopathological examination of the resected tumor revealed signet ring cell carcinoma and transitional cell carcinoma. Histological depth of invasion was pT1. No adjuvant therapy was performed. Primary signet ring cell of the urinary bladder is a rare tumor with 37 cases reported to date in Japan. We investigated previously reported cases and discussed adjuvant therapies of superficial signet ring cell carcinoma of the urinary bladder.

Serum anti-p53 antibodies and p53 protein status in the sera and tumors from bladder cancer patients

OBJECTIVES

The purpose of this study was to evaluate the association between the serum anti-p53 antibodies (Abs) status and the p53 protein status in the sera and tumors as well as clinical or pathological parameters in bladder cancer patients retrospectively.

METHODS

Serum samples from 100 patients with bladder cancer were assayed for anti-p53 Abs and p53 protein by enzyme-linked immunosorbent assay (ELISA). A monoclonal antibody DO7 was used for immunohistochemical staining of tumor p53 protein.

RESULTS

Prevalences of serum anti-p53 Abs, serum p53 protein and tumor p53 protein were 12, 1 and 63%, respectively. There was a significant correlation between serum anti-p53 Abs status and factors including tumor stage, tumor grade, and tumor p53 protein status. In the univariate analysis, tumor stage, tumor grade, serum anti-p53 Abs status, and tumor p53 protein status were significantly associated with an increased risk of death. Multivariate analysis showed that tumor stage was the only independent prognostic factor among the factors examined.

CONCLUSIONS

The present study suggests that serum anti-p53 Abs had a limited value as a tumor marker in bladder cancer patients. Further studies to elucidate the mechanism of anti-p53 Abs production will be necessary for a better understanding of the immune status in bladder cancer patients.

[Intra-arterial infusion chemotherapy for superficial bladder cancer]

Intra-arterial infusion chemotherapy (AI) is widely used in the treatment of invasive bladder cancer, but few studies have been reported on its efficacy for superficial bladder cancer. We retrospectively examined the anti-tumor effect and prophylactic effect of AI in 18 cases which were either a case with multiple or extensive tumors which could not be controlled completely by transurethral resection (TUR), a case with grade 3 tumors or a recurrent case after TUR and/or intravesical chemotherapy. Fifty mg of adriamycin and 100 mg of cisplatin were administered into bilateral internal iliac arterys. This treatment was repeated 1-3 times every three weeks. Concerning the anti-tumor effect, 8 showed a complete response, 5 showed partial response and 5 showed no change; the overall response rate (CR + PR) was 72%. Concerning the prophylactic effect, 1-, 2- and 3-year recurrence-free rates were 58.8%, 41.1% and 32.9%, respectively. This study demonstrated the efficacy of AI in the anti-tumor treatment, but not in the prophylactic treatment of superficial bladder cancer.

[A case of pulmonary metastasis from renal cell carcinoma with complete response to interferon-alpha and tegafur/uracil (UFT) but possibly UFT-induced liver dysfunction and leukoencephalopathy-like symptoms]

A 61-year-old man presented with gross hematuria. He underwent left radical nephrectomy under a diagnosis of left renal cell carcinoma without distant metastasis, but bilateral multiple pulmonary metastases appeared 2.5 months after the operation. Though the metastases responded well to combination therapy of interferon-alpha and a 1:4 mixture of tegafur and uracil (UFT), the side effects of liver dysfunction and leukoencephalopathy-like symptoms due to UFT appeared 7 months after the beginning of the chemotherapy. These side effects were improved after the cessation of UFT administration.

Biomodulation of 5-fluorouracil by interferon-alpha in human renal carcinoma cells: relationship to the expression of thymidine phosphorylase

PURPOSE

To provide the basis for improved therapeutic benefit in combination chemotherapy with interferon (IFN) and 5-fluorouracil (5-FU), we investigated the modulatory actions of human recombinant IFN alfa-2a on 5-FU in five renal cell carcinoma (RCC) cell lines in vitro, in particular focusing on thymidine phosphorylase (TP) expression.

METHODS

The sensitivity of RCC cell lines to the drugs was evaluated using an AlamarBlue assay. An enzyme-linked immunosorbent assay (ELISA) was used to determine TP expression.

RESULTS

IFN-alpha enhanced the sensitivity of three of five RCC cell lines to 5-FU in a dose- and schedule-dependent manner. When IFN-alpha was given prior to 5-FU, sensitivity to 5-FU was significantly higher than when IFN-alpha was given simultaneously (P < 0.05). IFN-alpha enhanced TP expression in a dose-dependent manner in three of five RCC cell lines (P < 0.05). The relative IFN-alpha-induced increase in sensitivity to 5-FU correlated with the relative IFN-alpha-induced increase in TP expression (P < 0.05). In addition, two of three RCC cell lines with more than a twofold increase in sensitivity to 5-FU induced by IFN-alpha showed a higher TP expression without IFN-alpha stimulation.

CONCLUSIONS

These results suggest that IFN-alpha upregulates TP expression and modulates 5-FU anabolism thus enhancing 5-FU cytotoxicity in a dose- and schedule-dependent manner in some RCC cells. The results imply that TP expression measurement in RCC could identify subgroups of metastatic RCC that may respond to IFN-alpha/5-FU combination therapy, and sequential administration of IFN-alpha followed by 5-FU may be beneficial in such cases.

[A case of giant transitional cell carcinoma of the prostate]

A 69-year-old man presented with a complaint of pollakisuria, dysuria and anal pain. Digital rectal examination, transrectal ultrasonography and tumor marker of the prostate indicated a giant benign prostate hypertrophy (BPH), but urethrocystogram and magnetic resonance imaging (MRI) of the prostate was not typical of BPH. A diagnosis of giant BPH was made by transrectal needle biopsy of the prostate. However, symptoms of dysuria and anal pain became severe and then a catheter was indwelt into his bladder. A biopsy performed, 3 months later revealed transitional cell carcinoma in the specimens, but he suddenly died of pulmonary infarction.

[Intravesical instillation of epirubicin in the prophylactic treatment of recurrent superficial bladder cancer]

A retrospective study was performed to determine the efficacy of intravesical instillation of epirubicin in the prophylactic treatment for recurrent superficial bladder cancer when compared with no treatment controls. Seventeen patients with recurrent superficial bladder cancer received epirubicin (30 mg/40 ml in normal saline) seventeen times after transurethral resection (TUR). Historical controls consist of sixteen patients with recurrent superficial bladder cancer who received no adjuvant treatment after TUR. In the epirubicin group, 1-, 2- and 3-year recurrence free rates were 64.7%, 41.2% and 5.9%, respectively. In controls all of them recurred and 1- and 2-year recurrence free rates were 17.6% and 0%, respectively. The recurrence-free rate was significantly higher in the epirubicin group than in the controls (p < 0.05). We investigated whether intravesical instillation of epirubicin prolonged recurrence-free intervals when compared with recurrence-free intervals without adjuvant treatment after TUR in each patient. The 1- and 2-year recurrence free rates after initial TUR were 25% and 12.5%, respectively, and those with epirubicin treatment after TUR were 62.5% and 37.5%, respectively. Recurrence-free intervals were significantly prolonged by intravesical instillation of epirubicin as compared with those without adjuvant treatment in each patient. This study demonstrated the efficacy of intravesical instillation of epirubicin in the prophylactic treatment for superficial recurrent bladder cancer.

[Clinical effects of beta-sitosterol (phytosterol) on benign prostatic hyperplasia: preliminary study]

Phytosterol derived from plants has long been used for the medical treatment of benign prostatic hyperplasia (BPH) in Europe but not in Japan. The efficacy of phytosterol was evaluated in patients with manifestations of urinary outlet obstruction caused by BPH. Phytosterol containing 180 mg of sitosterol per day was given to 12 patients with BPH in two or three divided doses for three months. The symptoms were assessed monthly using the International Prostate Symptom Score (IPSS) and quality-of-life (QOL) score while the objective findings including the urinary flow, prostatic volume, and residual urine volume were assessed after three months of treatment of BPH. The IPSS and QOL scores showed significant improvement (p < 0.05), and the peak flow rate and residual urine volume showed slight but not significant improvement.

Gastrocystoplasty in a woman with radiation-induced ureteral obstruction and low-compliance bladder

A 56-year-old woman presented with bilateral hydronephrosis and moderate renal insufficiency. A diagnosis of bilateral ureteral obstruction and low-compliance bladder following pelvic irradiation was made by urological examinations. She underwent gastrocystoplasty to facilitate bilateral ureteral reimplantation with an uneventful postoperative course. We consider that the use of the stomach to reconstruct the urinary tract injured by pelvic irradiation is valuable to avoid an abdominal urinary stoma.

[Appropriate intravesical retention time of pirarubicin concentration based on its level in tumor tissue, anti-tumor effect and side effect in intravesical instillation therapy for bladder tumor]

The present study was designed to investigate the appropriate intravesical retention time of pirarubicin (THP) for the treatment of bladder tumor in terms of its anti-tumor effect and side effect. We administered THP to 22 patients with superficial bladder tumor intravesically and measured the THP concentration in the tumor tissues. Patients were divided into 3 groups by retention time; 8 for 30 minutes, 8 for 1 hour and 7 for 2 hours. Tumor tissues were obtained by transurethral resection 30 min., 1 or 2 hours after the intravesical instillation of THP at the fixed concentrations of 30 mg/30 ml. There was no significant difference in THP concentration between 3 groups. This indicates that the anti-tumor effect of intravesical instillation of the THP would be expected by only 30 min. of intravesical retention time at the THP concentration of 30 mg/30 ml. Then, we administered 30 mg/30 ml of THP solution for 30 min. to 10 patients intravesically 6 times every 48 hours to investigate its clinical anti-tumor effect and side effect. There were 2 complete responses, 3 partial responses and 5 cases with no changes for a total response rate of 50%. No side effect was observed. It is considered that 30 min. of intravesical retention time at the THP concentration of 30 mg/30 ml would be appropriate in terms of its anti-tumor effect and side effect.

[Clinical usefulness of blood PICP, PINP and ICTP concentrations as bone metastasis markers in prostate cancer patients]

PICP and PINP are considered markers of bone formation, and ICTP is considered to be a marker of bone resorption. We measured these three markers as indicators of bone metastasis of prostatic cancer, and assessed their clinical usefulness. Serum PICP, PINP and ICTP were significant higher in patients with bone metastasis than localized cancer or controlled bone metastasis. Serum PSA increased initially with the LH-RH agonist during the course of bone metastasis. All these markers were subsequently observed to increase. Change in PICP of patients with bone metastasis was slight compared to PINP during endocrine treatment. Serum PICP, PINP and ICTP reflect the extent of metastasis in bone and are useful for monitoring the response of this condition to therapy.

[Gastrocystoplasty for severely contracted bladder following high dose pelvic irradiation: a case report]

A 24-year-old female who had received hysterectomy and adnexectomy of bilateral appendages for yolk sac tumor at the age of 12 years, followed by repeated surgery and pelvic irradiation over a total of 100 Gy for relapse of tumor, suffered from a severely contracted bladder and renal dysfunction of serum creatinine level over 2.0 mg/dl. The diagnosis was radiation-induced contracted bladder with renal dysfunction due to vesicoureteral reflux. Since the small intestine was not considered suitable after high dose irradiation, the stomach was used to reconstruct the bladder. The vesical pressure, which was 70 cmH2O at the capacity of 30 ml, was decreased to 22 cmH2O at the capacity of 100 ml, 5 weeks after surgery. The renal function was stable with a serum creatinine level below 1.4 mg/dl and the bladder capacity was 200 ml, 15 months after surgery. This method using the stomach was considered valuable for bladder reconstruction after large dose pelvic irradiation.

[A case of colo-vesico-vaginal fistula caused by sigmoid colon diverticulitis]

A 74-year-old woman was referred to our hospital with the chief complaints of pneumaturia, fecaluria and discharge of feces and urine from vagina. Fistulography on the vaginal side showed the presence of contrast medium both in the sigmoid colon and bladder. Colonoscopy revealed multiple diverticulosis of the sigmoid colon. Under diagnosis of colo-vesico-vaginal fistula due to sigmoid colon diverticulitis, a one-stage operation removing sigmoid colon, uterus-vaginal wall and urinary bladder wall including the fistula and careful reconstruction was performed. Postoperatively, urinary leakage from vagina in large amounts continued due to the recurrence of vesico-vaginal fistula. An attempt to use human fibrin glue in the recurrent fistula was successful, and the patient was asymptomatic at 21 months of follow-up. Colovesical fistula has been reported in about 10-20% of patients undergoing surgery for complicated diverticulitis, but a combined fistula is a rare condition. Furthermore, we recommend the use of human fibrin glue for a recurrent fistula.

Effect of citrate and pyrophosphate on the stability of calcium oxalate dihydrate

The effect of citrate and pyrophosphate on the stability of calcium oxalate dihydrate (COD) was studied in an aqueous solution over 7 days. COD was precipitated from 1.0 x 10(-2) mol/l calcium oxalate solution with the addition of citrate and/or pyrophosphate and separated by centrifugation immediately, 48 h and 7 days after the precipitation. The percentage of COD in the precipitate, determined by X-ray diffraction, increased with a rise in citrate or pyrophosphate concentration and reached > or =90% at a citrate concentration of 1.0 x 10(-3) mol/l or a pyrophosphate concentration of 2.0 x 10(-4) mol/l. The resulting COD was completely transformed into calcium oxalate monohydrate within 48 h when the precipitate was composed of <90% COD. Nearly pure COD produced with pyrophosphate was stable over 7 days while that with citrate underwent partial transformation within 48 h. An additive effect of citrate and pyrophosphate was found on the stability of COD. It was concluded that a pyrophosphate concentration above a critical point was sufficient to prevent solution-mediated transformation of COD, and this critical point might be lowered to the physiological range with the presence of citrate.

Use of a sponge stopper for placement of urethrovesical anastomotic sutures after radical prostatectomy or enterocystoplasty

Vesicourethral anastomosis during radical retropubic prostatectomy or enterocystoplasty is often difficult because of poor visualization and collapse of the urethral stump. We have attempted to use a sponge stopper to facilitate urethral suture placement for vesicourethral anastomosis. The technique for use of a sponge stopper is described.