[Sexual precocity].
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Androgen Antagonists↗
Biomedical subjects
Yasuyuki Naitoh
Publications and source records attributed to Yasuyuki Naitoh.
Combination therapy with alarm and drugs for monosymptomatic nocturnal enuresis not superior to alarm monotherapy.
OBJECTIVES: To evaluate the effectiveness of alarm-based combination therapy using desmopressin and imipramine for primary monosymptomatic nocturnal enuresis. METHODS: Of the 105 patients, 37 were treated with alarm monotherapy (monotherapy group), 35 were treated with desmopressin combined with an alarm (desmopressin group), and 33 were treated with imipramine combined with an alarm (imipramine group). The therapeutic effects were evaluated at 3 and 6 months. The relapse rates and predictive factors of the therapies were also studied. RESULTS: No significant differences were found in the changes in the frequency of wet nights among the three groups, although the frequencies in all three groups decreased significantly with the therapeutic duration. Although the improvement rates at 3 months did not differ among the three groups, the improvement rate of 80% in the desmopressin group and 79% in the imipramine group at 6 months were greater than the 59% rate in the monotherapy group. After cure, no patients relapsed in the monotherapy group, and 3 (43%) each did so in the desmopressin and imipramine groups. In comparing the improved cases in each group, no significant differences were found in background factors. CONCLUSIONS: Desmopressin and imipramine combined with an alarm was no more effective than alarm monotherapy. As for alarm monotherapy, other therapeutic modalities should be considered if it has not proved effective after 3 months. In such a situation, combination therapy may be effective as a second choice. No predictive factors for the therapeutic effects in the three modalities were found.
Adolescent↗
Laparoscopic pyeloplasty and isthmectomy for hydronephrosis of horseshoe kidney: a pediatric case.
A 4-year-old boy suffering from hydronephrosis of a horseshoe kidney underwent laparoscopic pyeloplasty with isthmectomy. Pyeloplasty was performed by the transposition of crossing vessels and the Anderson-Hynes method. In isthmectomy, Ligasure was used for transection of the isthmus. The surgery time was 310 minutes, the estimated blood loss was 10 mL, and the patient required no analgesia postoperatively. Convalescence was complete within 14 days. The follow-up diuretic renal scan showed prompt emptying of the radioisotope from the left collecting system, with a T1/2 of 12 minutes.
Anastomosis, Surgical↗
Vesicoureteral reflux detected among patients with nocturnal enuresis.
OBJECTIVES: To clarify the characteristics of vesicoureteral reflux detected in patients with nocturnal enuresis. METHODS: Voiding cystourethrography (VCUG) was applied in 1,088 patients who visited our outpatient clinic with the chief complaint of nocturnal enuresis. The clinical features of reflux were evaluated and the prognosis of reflux and nocturnal enuresis was analyzed. RESULTS: Reflux was detected in 86 ureters in 70 patients (6.4%) out of the 1,088 patients. The grade of reflux was 3 or less in all cases. The incidence of pyuria was 5 (7%) and that of renal scar during first examination was 1 (1%). The incidence of unstable bladder was 30 (75%) in 40 patients. The resolution rate of reflux in the cases which were followed-up for 2 years or more by conservative treatment was 50-66% for each grade of reflux. The percentage of patients who had siblings with a positive history of nocturnal enuresis and the incidence of frequency differed significantly between the enuretics with reflux and the 507 enuretics without urological abnormalities. CONCLUSIONS: Our data suggest that the incidence of reflux in patients with nocturnal enuresis was rather low in comparison with the past literature, the severity was mild and the resolution rate by conservative treatment was rather high.
Child↗
Significant antitumor effect of intratumoral ethanol injection on renal cell carcinoma.
OBJECTIVE: The effects of intratumoral ethanol injection on renal cell carcinoma (RCC) heterotransplanted in nude rats were evaluated. MATERIALS AND METHODS: The OUR95AF human RCC cell line was inoculated subcutaneously into the backs of nude rats. Four weeks after transplantation, the size of tumors became 1.5-2.0 cm in maximal length, and 95% ethanol was injected intratumorally once a week for five weeks. The effectiveness of this treatment was evaluated by measurement of tumor volume, magnetic resonance (MR) imaging using Gadopentetate-diethylenetriaminepentaacetic acid (Gd-DTPA) and histological examinations. RESULTS: In the ethanol injected group, no increase in tumor volume was recognized. The growth of the tumors was significantly suppressed after the third injection. Non-enhanced parts in MR imaging were observed in the central region of the tumors at the second injection, and increased at the third injection. After the fifth injection, only small parts of non-enhanced regions remained. Degenerative necrosis was histologically found in the non-enhanced parts of the MR image. The signal to noise ratio (SNR) and the contrast to noise ratio (CNR) calculated from T1 weighted imaging using Gd-DTPA, and relative enhancement (RE) were thought to be good parameters for evaluating the effect of ethanol injections. CONCLUSION: Intratumoral ethanol injection was very effective against RCC. Five weekly injections of ethanol induced necrosis of the tumor. MR imaging using Gd-DTPA may be a useful method for evaluating the effect of ethanol injection.
Animals↗
Surgical management of urinary incontinence in children with anatomical bladder-outlet anomalies.
BACKGROUND: Pediatric urinary incontinence secondary to anatomical anomalies of the bladder outlet is relatively rare, and there is no consensus on its surgical treatment. We reviewed the clinical courses and surgical management of children with this pathology. METHODS: From 1991 to 2001, we performed bladder neck reconstruction on seven children (three boys and four girls). The mean age at the first intervention was 7 years (range 5-12 years). The underlying diagnosis was bladder exstrophy in two children, pseudoureterocele-type ectopic ureter in three, bladder neck incompetence from unknown etiology in one boy with hypospadias, and bilateral single ectopic ureter associated with cloacal malformations in one child. Lower urinary tract was evaluated through various imagings, endoscopy, and urodynamic studies. RESULTS: The methods used to reconstruct the bladder neck was the Young-Dees-Leadbetter procedure (performed on four children); the Kropp procedure (two children); and the Pippi-Salle procedure (one child). Bladder augmentation with intestinal segment was performed on four children; Mitrofanoff continent stoma was created in all patients. Urethral catheterization could not be routinely used in all patients, because of pain, stricture, or complicated urethral anatomy. All patients achieved urinary continence. CONCLUSION: The treatment of pediatric urinary incontinence from anatomical anomalies is technically challenging. Depending on the underlying disorders and anatomy, one needs to decide which method of reconstruction to perform. It would be safer to employ simultaneous augmentation and to create catheterizable continent stoma.
Child↗