Six patients with synchronous bilateral renal cell carcinoma were treated surgically over a 7-year period in our department. They were all males and the mean age was 60.3 years. They comprised 7.1% of all patients with renal cell carcinoma encountered during the same period. In four out of the six cases, radical nephrectomy for the larger tumor plus partial nephrectomy for contralateral kidney was performed simultaneously. In the remaining two cases, bilateral partial nephrectomy was performed simultaneously or as separate procedures. Two patients required chronic hemodialysis and died of cardio-pulmonary insufficiency on the 70th and 75th day. One patient, who underwent bilateral partial nephrectomy with incomplete tumor removal, subsequently died of metastatic disease at 27 months. Although one of them required transient hemodialysis, the remaining three patients were alive and disease-free 84, 42, and 17 months after operation, without evidence of tumor. This series suggests that partial nephrectomy is an appropriate option in the management of selected cases of bilateral renal cell carcinoma.

In 33 adult mongrel dogs, the function of the intramural ureter was investigated. (A) Bipolar electrodes were placed in both the extravesical ureter and the intramural ureter. Then, an electromyogram (EMG) was recorded from two leads. (B) Cystotomy was performed, needle-type electrodes were inserted into the wall of the ureteral orifice and the extravesical ureter, and the EMG was recorded. (C) A special needle which could record EMG and measure pressure simultaneously was prepared. Then EMG and pressure measurements were recorded from the wall of the intramural ureter. In each experiment, action potentials were recorded from the intramural ureter that were similar to those from the extravesical ureter. The pressure in the wall of the intramural ureter showed variations matching the action potentials. From these results, it was evident that active muscle contraction occurred due to the action potential transmitted from the extravesical ureter even in the intramural ureter.

No abstract

The relationship between bladder movements and the intramural ureter was studied in the dog by recording electromyograms of the intramural and extravesical ureters recorded during bladder filling and contraction. Bladder filling was achieved by instilling physiological saline at a rate of 10 ml/min to a volume of 5 ml/kg, while bladder contraction was induced by electrical stimulation. For electromyography, an electrode was inserted transperitoneal into both the extravesical ureter and the intramural ureter after it had been separated from the extravesical ureter. A cystostomy for the instillation of water and another cystostomy for the measurement of intravesical pressure were also made in the bladder. During bladder filling at an intravesical pressure of about 10 cmH2O, the frequency of the action potentials in the intramural ureter showed no significant difference to those in the extravesical ureter. In addition, during bladder contraction at a greatly increased intravesical pressure of about 5 times the precontraction level, the frequency of the action potentials in the intramural ureter was not significant by different from those in the extravesical ureter, and also from its own precontraction value. The above findings suggest that action potentials in the intramural ureter are not affected by bladder movements such as filling or contraction, and that the ureter continues to actively transport urine to the bladder during such movements.