札幌医誌 4（5），344～354 （1953） Pelvioprostatic Venography and Method of Estimating Size of Prostate Gland By IwArrARo TozuKA， KAzuHiDE KuRoDA and KENzo ［1］oi｛iMorro DepaTtment of DeTmatoJogy and UTogogy， 串卿oγoUniver吻（ゾMθ♂乞卿θ Total exst・irpation of the organs is commonly perior iliac spine， exposure factors are 60 KV performed today upon the malignant tumors peqk， 40 milliamp．， 3”， 91 cm． of bladder and prostate・ lt is very important In something over half of all cases cystogra－ to know the grades of its invasion to thei’c phies were made． at the same time with 100 to adjascent tissues for adequate performances． 150 cc air inflation or injection of 20 cc of 10 In discussing this problem， some authors such per cent sodium jodati solution， and in some as De ．la Panai）， Ceccarelli2）， Abeshouse ＆ Ru－ cases Takahashi－Okoshi’s method of cystography ben3）， Fit4patrick and Or：c4，） and some others ’was also employed simultaneously・ After the have tried a procedure roentgenologically to exposure the incision is closed with two or three deエnonstrate the pelvic veins， injecting opaque silk sutures．一・ media into the v． dorsalis penis profunda． t t These studies have dealt， however， only with Interpretation of the Findings some cases of hypertrophy or malignant tumors of prostate and indicate lack of systematical By the technique above described pelviopro－ examinations． The present writers undertook static venog’ra’ Phy was performed of 17 cases to get some patte’cns of this venography， and with normal prostate， 7 with prostatic cancer， ca’rried through this procedure on fifty－one cases 2 with prostatic calculi， 8 with tuberculous and with such prostate as normal and insane， corning nontuberculous prostati’ti’s， 3 cases of bladder to some conclusions． The－aim of this report is tumors （cancer ］， papillom 2．）， and 2 ・other mis－ to describe their new obseTvations about cancer ’ cellaneous cases， 5’1 cases in all． The conclusive and other pathological conditions of the pro＄tate．． findings from them， disregarding some dQubtful matters， are as follows ： Techtmique 1） ’ln eases with nornial prostates， the veno・一 grams are as shown in Figs． 1， 2， ＆ 3． The Patients are positioned on the roentgen table opaque media injected into the v． dorsalis penis with the grid of Potter－Bucky． A slight incj，sion p：rodunda comes together into the plexus pu－ is made on the dorsal surface of penis， and the dendalis which is situated at the lower part of needle is inserted into the exposed vena dorsalis the pubic arch， then leaves in two ways， strea－ penis ptofunda， then 15 to 30 cc of 35 pei’ cen’t ming above into the plexus vesicalis and below Sugiuron or 70 per cent Pyraceton is rapidly into the v， pudenda interna ； the lattet two uni’te injected． During the i’n’ jectl’on of the ］ast 3 cc together in the v． hypogastrica， coni municating antero－posterior exposures are made． Center commonly vsTith v・ iliaca communis， and rarely is in the mid－line， at the level of the anterior－su一 with v． iliaca externa． Halfway within these 1） De la Pena， A．： Z． f． Urol． 44， 516 （1951）， 640 （1952）． 2） Ceecarelli， G．： Urologiea 17， 377 （1950）． 4） Fitzpatriek， R． J． ＆Orr， M．： J． Urol．， 68， 640 C 1952）． 3） Abeshouse， B． S． ＆ Ruben， M． E．： J． Urol． 68， 344 4巻5号 ’Tdzuka．Kuroda．Torimbto Pelvioprostatie Venogtaphy 345 eourSes， v． pudenda interna cornmunicates with Among our seven tumor cases， the lack of vesical v． obturatoria，” plexus vesicalis with v． hemor－ plexus was seen in both sides （1 case） asig．11）， rhoidalis． Venae ileolumbales and v． glutae in one side （3 cases） （Figs．12，8）． ln the case are at times to be discerned・ These venographic which showed the lack of plexus vesicalis of patterns are symmetrical in both sides； the both sides， plexus pudendalis was als6 lacking venous passages can be recognized more stri－ and direct anastomosis of deep dorsal vein of kingly when films are viewed in stereo． penis to inner pudendal vein was seen （Fig． 11）． Plexus pudendalis is a round， oval or irregular The angle made by veins of． plexus vesicalis network of veins and plexus vesicalis also con一’ of both sides was very great； that is within sisted of several strips of veins but the latter 100－1500． takes the form of a single vein before emptying 3） Prostatic hypertrophy： Vascularity of both into the v．．hypogastrica・ pudendal and vesical plexuses are more ＄canty The angle whieh is made by the veins of the and more slender than normal （Figs． 13， 14）． plexus vesicalis of the two sides is in general But the irregularity of vascularisation of plexus less than 90C， 700 ・is rnost common （Fig・ 4）， but vesicalis as shown in cases of prostatic cancer， in some exceptional c，ases？ the angles are wider， the so－called “thrombosis of veins” of Abeshouse－ coming up to 1000 or more， （Fjg． 5） （Table 1）． Ruben， was． rarely observed and also complete Yet there are some variations in the case of absence of this plexus was seen in only a few normal prostate， viz．， the smallness of plexus cases． This is probably because of the lack of pudendalis because oE to its seanty vascularity infiltration into the neighbouring tissues as seen （3 cases） （Fig． 6）， or entire absence of venogram in the cases of cancer． ln our experiences， only of one side （frequently seen in the left， 2 cases） one case out of ten did not demonstrate the （Fig． 7）． lf the opaque madia is injected erro－ vesical plexus and it was in one side only・ neously into the superficial dorsal vein of penis， The angles made by the veins plexus of both pelvioprostatic venogram． connot be taken but sides were more wide than normal in the cases the dye will demonstrate v． pudenda externa of prostatic hypertrophy as in the cases of the and communicating v． femoralis （Fig． 19）． cancer， but narrower than in the cases of true 2） ’ ln cases of prostatic cancer in coMparison・ cancer， viz．， they were between 900 and 1000， with cases of normal prostate， plexus pudendalis 90G in seven cases， 100” in 3， ten ca’ 唐?ｓ in all・ is scantier of vessels and smaller in size； its 4） Prostatic abscess． ln two caseS of this dis－ connecting plexus vesicalis shows fewer bran－ ease， where prostate glands attained the size of ches， is irregular in its distribution and commonly goose－eggs， the pudendal plexus got smaller and thin． ’the vesicalis were narrow and partially deficient When the tuエnor is small， the changes above in their vessels， but thrombosis of the veins as described are very slight and it is difficult to in prostatic cancer was not recognized in them find out the differences from the normal・ But （Flg・ 15）． The angle of vesical plexus was as when the tumor is extremely great， plexus a matter of course wide， ranging 100－1300． vesicalis on one or both sides （rarely plexu’s 5） Prostatic falc’uli・ Almost similar’ finding＄ pudendalis too）， can not be delineated， but direct as in prostatic hypertrophy were made ；． it was anastomosis of the deep dorsal vein of penis to definitely observed that the shadow of the cal－ internal pudenda1 vein would be observed， as culi lay between the vesical plexus of the twb a result of tumor exphnsion and invasion to sides and surrounding the shadow of the calculi the surrounding tissues． The relative paucity ran the vessels of the vesical plexus asig． 16）． of vessels， the lack of distention and areas of 6） Prostatitis of tuberculosi’sor of other nattire． irregular filling are very stTiking in the ca＄es Quite the same conditions were fourid in these of carcinoma of prostate （Figs． 8－12）． These find－ cases as in the normal． Nothing characteristic ings have also been observed by Ceccarelli and was seen． Abeshouse－Ruben． Abeshouse－Ruben thought 7）， 7esical ，teoplasmct．s． ln a case of vesical this phenomenon to be attributable to the throm－ papilloma with prostatic hypertrophy． ， defect of bosis of“veins and very suggestive of malignancy． the shadow of left vesical plekus was demon一 346 Tozuka．Kuroda．TQrimoto 一Pelvioprostati’c Venogiraphy オ：L砲晃医誌 1953 strated ： other ・cases of this disease have no char一 ’ the cystographic method of lchikawa－Okoshi－ acteristic venogram even in a case of cancer Kuroda （1952）｛i）， the cystourethrogram method situated over the most part of the b］adder wall of Thumann （1951）7） and of Boone （1952）S） these and infiltrating into all its layers （Fig． 17）． are examples． Except for the relatively perfect 8） Other rniscellaneous diseases． （i） ln a caSe of method of lchikawa－Okoshi－Kuroda， every meth－ sem｛noma which resulted in anuria because of od above－mentioned has its o wn deficiency in its retroperitoneal lymphatic metastases CFig・ 18）， fulfiiling our need． it was demonstrated that a round or oval dense The writers， therefore， adopted the above networks of Shadows we．re multiplied in the descエibed pelvioprostatic venography．in ordef minor p’ elvis・ This may be attributable ．to the to－estimate the size and weight of prostate as new vascularization roun．d the metastatic lym－ accurately as possible．一 The p：ostatic vertical， phnodes． （ii） A case of peni］e cahcer with the diarneter is anatomically the d．istance from the metastases to the ．inguinal and fetnoral lymphatic upper rim of pudendal venous plexus to the nodes． ln this case the pelviopttostatic venogram ． base of the bladder， and’ when the p， r6state iS did not belong to any particuJar pattern， but the neoplastic， the distance to its most projected ipjection of ．opaque media into the subcutaneous point into the bladder． Venographically by our dorsal vein． of penis revealed multiple branched method， in combination with pneumocystography fine network of veins i．n the left femQral