[Congenital pelvi-ureteric stenosis in children: clinical study of 70 kidneys].
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Biomedical subjects
Publications and source records attributed to F Ikoma.
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A statistic survey was carried out on the histology of the 465 malignant tumors at our urological department during the last 10 years. The most frequent tumors were bladder tumor (50%), prostatic tumor (17%) and renal tumor (15%). Histological typing and grading were tabulated for each tumors.
This meeting was first established in 1972 for the purpose to make free discussion between the urologists and pediatric surgeons on pediatric urology. Several themes, such as undescended testis, hydronephrosis, intersex and stone disease, have been talked over. Ano-rectal malformation was one of the main themes, and many different opinions from both urological and surgical sides have been presented for the prevention of the complications of pelvic surgery. Pediatric urology has undergone a remarkable progress in the past 30 years. The main contribution has been brought about through the better understanding of the diseases in this field. Newer diagnostic methods and operative techniques have also influenced the development. What is left for the future in pediatric urology is how to preserve the renal function. It is not rare that the diseased child goes on to the end-stage renal failure, in spite of the successful intervention of urinary tracts. Hypodysplasia of the kidney is still incurable in the modern medicine. The best alternative may be renal transplantation. Pediatric urology is one member of a team of specialists to whom cases are referred by pediatricians and obstetricians. Earlier diagnosis, for example by the echogram of the fetus, and higher operative techniques are the themes in the future.
A case of fracture of the penis was presented. A 44-year-old man in the state of morning erection, suddenly heard an abnormal cracking sound while he rolled over in bed. He immediately felt pain of the swelling penis. Surgery was carried out soon after he was admitted. Postoperative course was uneventful, except for slight pain on erection. The Japanese literature was reviewed, and the clinical statistics on 208 patients were summarized.
Five children with ectopic ureters and hypoplastic kidneys are reported. Hypoplastic kidneys in these cases could not be detected by excretory urography, renal scintigraphy or other routine examinations. Finally, in three cases we could diagnose the localization of hypoplastic kidney by enhanced computed tomography. Enhanced computed tomography is very valuable for diagnosis of localization of hypoplastic kidney.
Urinary schistosomiasis is an endemic disease mainly distributed in most of Africa and Southwest Asia, and caused by infestation with Schistosoma haematobium. The case presented here was a 33-year-old Japanese male who had suffered from schistosomal infestation in the endemic area, and diagnosed as urinary schistosomiasis by detection of Schistosoma haematobium ova in urine and specimens obtained by mucosal biopsy of the bladder. Radiographic and endoscopic examinations revealed neither obstructive uropathy nor urothelial malignancy. The patient underwent treatment with antimonyl sodium tartrate (Stibnal), and the disease is under good control.
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We have reported [1,2] in immature golden hamster testis that 5 beta-reductase is localized in the seminiferous tubules, while 5a-reductase is present in the interstitial tissue and that the 17 beta-ol-dehydrogenase activity is found predominantly in the seminiferous tubules. In the present study, we show the intratubular localization of these enzymes. The left testis of golden hamster was irradiated with 2000R or 8000R of X-rays at 22 days of age. The hamsters were killed at 28 days of age. Homogenates of the left irradiated and right intact testes were incubated with [14C]-4-androstone-3,17-dione and NADPH, and enzyme activity was estimated. Both testes were also examined histologically. The X-irradiation of the testis resulted in an almost complete disappearance of germ cells with a significant decrease in testis weight, but the interstitial tissue and tubular nongerm cells including Sertoli cells remained almost unchanged. However, the activities of 5 beta-reductase and 17 beta-ol-dehydrogenase expressed as nmol formed/testis/h did not decrease at all. These results show that 5 beta-reductase is localized in the tubular nongerm cells including the Sertoli cells and 17 beta-ol-dehydrogenase is present in the tubular nongerm cells and interstitial tissue in immature golden hamster testis.
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Our surgical technique of scrotoplasty for repair of prepenile scrotum performed at our Department is described. Inverted omega skin incision was made around the scrotal skin and base of the penis. Scrotal flaps were prepared and these were brought beneath the penis. These scrotal flaps were sutured in two layers, subcutaneous tissue with 3-0 or 2-0 chromic catgut and skin with 4-0 or 3-0 prolene. Twenty four patients with prepenile scrotum were operated on with this technique and cosmetic results were excellent. When complicated with hypospadias, scrotoplasty was performed as the third stage operation, following chordectomy and urethroplasty.
Statistical studies on 2,040 new outpatients, 575 inpatients and 570 operative procedures at our department in 1982 revealed the following. The most frequent diseases among the outpatients were urogenital infections followed by anomalies and tumors. Over half of the inpatients were pediatric patients and the major diseases among inpatients were hypospadias, vesicoureteral reflux, urolithiasis, congenital urethral stenosis and undescended testis. A total of 570 operations were performed on 531 patients, and the major five operations were hypospadias repair (79), optic internal urethrotomy (71), TUR-P (49), ureterocystoneostomy (33) and orchidopexy (32).
The urethral closure pressure profile (UPP) examination was performed routinely together with the administration of alpha-blockers. By the measurement of UPP, we can understand whether the organic changes at the bladder neck have already occurred or not. Further, by calculating the decreasing rate of the pressure at the bladder neck (BNP) and the maximum urethral closure pressure (MP), we can determine which nerve component is affected. Particularly, when we want to detect the affected nerve component in a mild disorder of vesico-urethral function, the measurement of UPP is quite useful as one of the screening urodynamic tests.
UNLABELLED: We analyzed the radiographic renal size of 180 children with vesico-ureteral reflux as compared with that of 159 normal children. We measured on urogram the vertebral length, renal length and thickness of the renal cortex. Further, the ratio of the renal length to the vertebral length and the cortical thickness to the renal length were computed. The latter was named the cortical ratio. IN CONCLUSION: 1. The cortical ratio is the most useful parameter in analysis of the renal size. 2. Cortical damage due to VUR is noted already in newborns. This result suggests that vesico-ureteral reflux must be detected and treated in early childhood.
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We reviewed 272 patients with hypospadias who were treated surgically to survey the complicated anomalies in these patients. Urogenital anomalies were recognized in 40 per cent of the 272 cases and extra-urogenital anomalies were noted in 9.2 per cent. Undescended testis was the most frequently seen anomaly, having been noted in 13.2 per cent of the 272 cases. The incidence of male vagina or utriculus masculinus was 11.8 per cent, prepenile scrotum 7.7 per cent and hypoplasia of the testis 6.6 per cent. Each of these 4 anomalies associated with hypospadias increased in incidence in proportion to the severity of the penile deformity. The necessity of systemic urological and hormonal examinations was emphasized, especially in cases of severe hypospadias.
While applying direct electrical stimulation to the pudendal nerve and recording of electromyographic reactions of bulbocavernosus muscle and/or transverse perineal muscle, pudendal nerve block by phenol was performed for the treatment of dysuria due to detrusor-sphincter dyssynergia, resulting in a favourable response. The technique and the cases treated with this nerve block are presented.