The change of sacral reflex activity of the striated urethral sphincter in the urine storage phas... more The change of sacral reflex activity of the striated urethral sphincter in the urine storage phase is investigated using evoked potential reaction of the bulbocavernosus reflex (BCR). (Methods) Eleven normal male subjects and 13 male patients with neurogenic bladder due to suprasacral (C3-C7) spinal cord injury (SCI patients) were investigated. Within the SCI patients, five were complete SCI and 8 were incomplete SCI. BCR was elicited by electrical stimulation of dorsal nerve of the penis, and the evoked potential of the BCR was recorded with a concentric needle electrode from the periurethral striated muscle. BCR was performed both at empty and at filled bladder respectively, and changes of the amplitudes (AMP) were examined. Moreover, the changes of AMP affected by bladder filling were compared between the normal subjects and the SCI patients. (Results) In both the normal subjects and the SCI patients, AMP increased at the filled bladder as compared with that of the empty bladder. In addition, the change of AMP was statistically bigger in the SCI patients (a ratio of amplitude at filled bladder/amplitude at empty bladder : 4. 73+3. 90) than in the normal subjects (the ratio: 1. 32+0. 44). (Conclusion) Sacral reflex activity was accelerated by bladder filling in both the normal subjects and SCI patients. And the acceleration in the SCI patients was more remarkable than that in the normal subjects. In addition to the conventional evaluation of the integrity of sacral reflex arc by BCR examination, the observation of changes of BCR affected by bladder filling may provide the information for the continuity of sacral segment and supraspinal micturition center.
The aim of this study is to localize the primary sensory cortex of urogenital organs in the human... more The aim of this study is to localize the primary sensory cortex of urogenital organs in the human brain. Using a newly developed MRIlinked magnetoencephalography system, we measured somatosensory evoked magnetic fields (SEFs) for unilateral stimuli on the dorsal penile nerve (DPN), posterior tibial nerve (PTN) and median nerve (MN). In five healthy male subjects, SEFs were clearly observed. Peak latencty of the first cortical components were 63.8 ± 9.2 ms for DPN, 39.8 ± 3.0 ms for PTN and 20.7 ± 0.7 ms for MN stimuli. Peak amplitude of the first cortical components were 63.1 ± 10.8 fT for DPN, 160.2 ± 50.1 fT for PTN and 335.2 ± 70.3 fT for MN stimuli. Isofield map for the peak latencies indicated a single dipolar pattern for DPN as well as for PTN and MN stimuli. Using a single current dipole model, all SEF sources were localized on the contralateral central sulcus to the stimuli, indicating the primary sensory cortex. The DPN sources were localized on the interhemispheric surfaces, corresponding to previous speculations by direct cerebral stimulation. This non-invasive SEF technique promises further brain functional mapping for the urogenital organs.
To explore the brain response to sacral surface therapeutic electrical stimulation (SSTES) for th... more To explore the brain response to sacral surface therapeutic electrical stimulation (SSTES) for the treatment of refractory urinary incontinence and frequent micturition, evoked magnetic fields were measured in six healthy males. Electrical stimuli were applied between bilateral surface electrodes over the second through fourth posterior sacral foramens with intensity just below the pain threshold. Somatosensory evoked magnetic fields (SEFs) for the bilateral median (MN) and posterior tibial nerves (PTN) were also measured for the comparison. Sources of the early SEF peaks were superimposed on individual magnetic resonance images. The first peak latency for sacral stimuli, M30, occurred at 30.2 ± 0.8 ms (mean ± standard deviation, N = 6), with shorter latency than those for PTN stimulus (39.3 ± 1.4 ms, N = 12) and longer latency than those for MN stimulus (21.0 ± 0.9 ms, N = 12). The second peak latency for sacral stimuli, M50, occurred at 47.2 ± 2.9 ms (N = 6). Both M30 and M50 peaks showed a single dipole pattern over the vertex in the isofield maps. The equivalent current dipoles of M30 and M50 were both estimated near the medial end of the central sulcus with approximately posterior current direction. These results suggest that the sacral M30 and M50 are responses from the primary somatosensory cortex. The relatively long time lag between the onset and peak of M30 suggests that SSTES directly affects both the cauda equina and cutaneous nerve of the sacral surface.
Hypothesis / aims of study The aim of this study was to investigate the primary somatosensory cor... more Hypothesis / aims of study The aim of this study was to investigate the primary somatosensory cortex of the penis in the human brain using magnetoencephalography (MEG). MEG, the magnetic counterpart of electroencephalography (EEG), has similar high time resolution and higher spatial resolution than EEG because of the negligible effect of the inhomogeneous head conductivity. Somatosensory evoked magnetic fields (SEFs) are the MEG responses to various types of stimulation of the peripheral nerves and skin.
1514 Cerebral Infarction Fails to Enhance the Sneeze-Induced Continence Reflex After Duloxetine, a Norepinephrine and Serotonin Reuptake Inhibitor, in Rats
Hypothesis / aims of study Uroflowmetry is a noninvasive and relatively inexpensive method for ur... more Hypothesis / aims of study Uroflowmetry is a noninvasive and relatively inexpensive method for urodynamic measurement. Therefore, it is an indispensable, first-line screening test for most patients with suspected lower urinary tract dysfunction 1) . On the other hand, since patients feel the strain when they undergo examination in conventional uroflowmeter those measurement environment is different from the toilets they use in their daily lives, it is possible that this strain influences the examination results. In 2008,the novel uroflowmeter (UM-100; TOTO Ltd., Fukuoka Japan) was developed, which is toilet-shaped and allows the patients to perform uroflowmetry just by urinating in the toilet as usual and can reduce the patients’ strain. The aim of this study was to elucidate the differences in the uroflow parameters between the novel toilet-shaped and conventional uroflowmeters in urologically normal female patients.
Hypothesis / aims of study Urinary incontinence and erectile dysfunction are major complications ... more Hypothesis / aims of study Urinary incontinence and erectile dysfunction are major complications after radical prostatectomy (RP). To promote recovery of erectile function after RP, penile rehabilitations have recently attracted attention. There have been some reports describing the efficacy of oral phosphodiesterase type-5 inhibitors (PDE5i) for penile rehabilitation in patients with postoperative erectile dysfunction. On the other hand, the efficacy of PDE5i on recovery for urinary continence after RP has not yet been well elucidated. So, we retrospectively evaluated the effects of PDE5i on the recovery of the urinary continence.
intraoperative wound cultures, perioperative antibiotics, inpatient notes, consult notes, and fol... more intraoperative wound cultures, perioperative antibiotics, inpatient notes, consult notes, and follow-up visits. Twenty patients with fungal infections were identified and additional information was requested. RESULTS: Fourteen patients underwent primary IPP implantation, the other 6 had previously undergone an average of 1.5 IPPrelated surgeries (range 1-3, median 1). Average age at implantation was 58 (range 31-72, median 60). Thirteen of the 20 fungal infection patients were diabetic (65%), the rest were not. Of the diabetic patients mean HgbA1c was 8.7 (range 6.5-13.3, median 8.3). Mean BMI for all patients was 30.9 kg/m2 (range 23.7-45 kg/m2, median 31 kg/m2). Mean BMI for diabetic patients was 31.8 kg/m2 (range 24.1-45 kg/m2, median 32 kg/m2). Ninety percent of implants were placed with IV antibiotics consistent with current AUA guidelines. In seven of these cases, fungi and bacteria were found in culture together. Eight devices were explanted, 8 underwent malleable implant salvage (MIST), and 4 were salvaged in the classic Mulcahy technique. Of the 8 patients who underwent explant, 5 later had successful reimplantation with either a malleable prosthesis or an inflatable prosthesis. The other three remain without an implant at last follow-up. Two of the 20 fungal infection patients were incontinent at IPP implantation. One of these patients underwent simultaneous Virtue sling implantation. No patient had concomitant immunosuppressive disease aside from DM at IPP implantation. No patient had evidence of recent antibiotic exposures prior to IPP implantation. CONCLUSIONS: To our knowledge these data represent the first in-depth exploration of IPP patients presenting with fungal infections. Approximately two-thirds of the patients were diabetic, suggesting that additional prophylaxis may be appropriate for diabetic patients. Further investigation is needed to confirm our results.
357 Estimated minimal residual membranous urethral length on preoperative MRI can be an independent predictor for continence after radical prostatectomy
Ductal adenocarcinoma is an unusual variant of adenocarcinoma of the prostate with a poorly under... more Ductal adenocarcinoma is an unusual variant of adenocarcinoma of the prostate with a poorly understood natural history, and its treatment is not well defined. Ductal adenocarcinoma is often diagnosed at an advanced stage, because no specific tumor markers are known. Docetaxel has been used for acinar adenocarcinoma of the prostate, a common type of prostate cancer, but it is largely ineffective for ductal adenocarcinoma. Earlier studies suggested that the chemotherapy with gemcitabine and cisplatin might be effective for ductal adenocarcinoma. Here we report two patients with ductal adenocarcinoma of the prostate that did not respond to docetaxel, but responded to the gemcitabine/cisplatin chemotherapy. Patient 1 was a 59-year-old man who had lung metastasis despite androgen deprivation therapy with undetectable levels of prostate-specific antigen and who presented with brain metastasis during docetaxel chemotherapy. Pathological examination of the resected brain tumor revealed duct...
MP2-19 High Risk Upper Urinary Tract Urothelial Carcinoma Patients with Lymphovascular Invasion Have the Advantage of Adjuvant Chemotherapy
The Journal of Urology, 2015
of postoperative renal dysfunction, and NACT was recommended for those patients. In selecting eli... more of postoperative renal dysfunction, and NACT was recommended for those patients. In selecting eligible NACT patients, this algorithm has a prediction ability with 76% (25/33) sensitivity and 77% (358/467) specificity. CONCLUSIONS: We developed a preoperative selection algorithm for the eligible NACT patients in UTUC. This algorithm might contribute to effective decision making in regard to providing NACT.
Low-dose maintenance gemcitabine-carboplatin chemotherapy could be an alternative to continuous standard chemotherapy for patients with metastatic urothelial carcinoma
International Journal of Urology, 2014
To examine whether low-dose maintenance gemcitabine-carboplatin chemotherapy is beneficial for pa... more To examine whether low-dose maintenance gemcitabine-carboplatin chemotherapy is beneficial for patients with metastatic urothelial carcinoma. We retrospectively reviewed the records of 36 patients with metastatic urothelial carcinoma who received first-line chemotherapy (gemcitabine/cisplatin, gemcitabine/carboplatin, or methotrexate/vinblastine/adriamycin/cisplatin) between 2006 and 2012. Those who had responded, but were unable to tolerate ongoing first-line chemotherapy, had been switched to low-dose maintenance chemotherapy consisting of 1 g/m(2) of gemcitabine and area under the curve 2-4 of carboplatin given on day 1 of a 6-week cycle, and were continued unless disease progression was seen. After a median of three cycles of first-line chemotherapy, 17 patients had been switched to low-dose maintenance chemotherapy. The median age was 70 years (range 56-79 years), and 12 patients (70.6%) had renal dysfunction (creatinine clearance <60 mL/min). The median number of cycles of low-dose maintenance chemotherapy was six (range 2-22), and the median survival time from initiation of first-line chemotherapy was 12 months (range 4-32 months). Adverse events requiring hospitalization were seen in three patients, but all of them recovered within a few days with conservative treatment. Seven patients discontinued within 9 months, whereas 10 patients continued on low-dose maintenance chemotherapy for ≥9 months. Patients with only lymph node metastases or who had a good response to previous first-line chemotherapy were likely to be able to continue low-dose maintenance chemotherapy. Low-dose maintenance gemcitabine-carboplatin chemotherapy might represent an alternative for patients with metastatic urothelial carcinoma not tolerating continuous first-line standard chemotherapy regimens.
47 Clinical Outcome of Patients with Cushing's and Subclinical Cushing's Syndrome After Laparoscopic Adrenalectomy: A Single Center Experience
The Journal of Urology, 2012
hypertension. Hardy-Weinberg equilibrium (HWE) and genotype frequencies of each polymorphism locu... more hypertension. Hardy-Weinberg equilibrium (HWE) and genotype frequencies of each polymorphism locus were determined by SNPassoc in R statistics program 2.7.0 software package. A P value 0.05 or odds ratio (OR) 1.00 is not in the range of 95% CI implicating statistical significant. RESULTS: Total of 128 APA patients have been followed up including 72 patients with idea control postoperative BP and 56 with persist postoperative hypertension. The distribution of genotypes of each locus was in accordance with Hardy-Weinberg Equilibrium (HWE) in the above two groups (P 0.05). Of the 4 SNPs, only rs1403543 locus in AT2R gene was found associated with persist postoperative hypertension of APA patients. APA patients with homozygotic genotype GG had an increased risk of persist postoperative hypertension compared to patients with AA or GA genotype (OR 5.00, 95% CI 1.3119.15, P 0.01). CONCLUSIONS: Polymorphisms at Rs1403543 locus in AT2R gene may be a predictor for postoperative BP recovery of APA patients.
Individualized Radical Hysterectomy Procedure Using Intraoperative Electrical Stimulation for Patients With Cervical Cancer
International Journal of Gynecological Cancer, 2012
In this study, by monitoring the varied distributions of nerve fascicles using intraoperative ele... more In this study, by monitoring the varied distributions of nerve fascicles using intraoperative electrical stimulation (IES), we sought to establish an individualized operation based on the patient's unique nerve distribution pattern, and to determine whether this technique would result in a higher preservation rate. Radical hysterectomy was performed from 2002 to 2010. Patients in group A are the 48 cases from 2002 to 2007 in which nerve-sparing radical hysterectomy using IES as our previous report was performed. Patients in group B are the 38 cases from 2008 to 2010 in which we used our new method, which was individualized to each patient. Urodynamic study (UDS) was used to confirm nerve preservation. Nerve preservation was defined as confirming distinct detrusor contraction during urinary voiding. In group B, nerve preservation rate was higher than in group A (75% vs 9 0%, P = 0.067). We classified the case-by-case nerve anatomy as whether the nerve fascicle was mainly on the medial side or on the lateral side of the deep uterine vein. The lateral type anatomy was observed unilaterally in 6 cases and bilaterally in 1 case. In summary, the lateral type anatomy was observed in 8 (29%) of 28 sides. In the cases evaluated by UDS, the positive predictive value of IES was 95% in group A and 100% in group B. Our method of IES showed a high positive predictive value of nerve preservation as confirmed by UDS. By delineating the nerve tract in detail using IES, it is possible to individualize the operation based on each patient's anatomy, with an improved nerve preservation rate.
Magnetoencephalography (MEG) was used to measure the somatosensory evoked fields in six healthy m... more Magnetoencephalography (MEG) was used to measure the somatosensory evoked fields in six healthy males undergoing sacral surface therapeutic electrical stimulation, a recently introduced treatment for chronic urinary dysfunction. This study was performed to investigate the utility of MEG to optimize the stimulation parameters. Strong or weak electrical stimuli were applied to small or large surface electrodes placed over the bilateral sacral surfaces. The peak latency and strength of the equivalent current dipole were evaluated at the first peak originating from the primary somatosensory cortex (M30). There was no difference in M30 latency in response to stimulation intensity or electrode size. However, a larger equivalent current dipole strength was obtained in response to higher stimulus intensities, which indicated a more effective stimulus on the sacral surface. The present MEG study shows that stronger stimuli given through large electrodes evoke larger responses than small stimuli through small electrodes. The study also suggests that MEG can be used as an objective tool to monitor whether therapeutic stimulation parameters are appropriate.
To explore the brain response to sacral surface therapeutic electrical stimulation (SSTES) for th... more To explore the brain response to sacral surface therapeutic electrical stimulation (SSTES) for the treatment of refractory urinary incontinence and frequent micturition, evoked magnetic fields were measured in six healthy males. Electrical stimuli were applied between bilateral surface electrodes over the second through fourth posterior sacral foramens with intensity just below the pain threshold. Somatosensory evoked magnetic fields (SEFs) for the bilateral median (MN) and posterior tibial nerves (PTN) were also measured for the comparison. Sources of the early SEF peaks were superimposed on individual magnetic resonance images. The first peak latency for sacral stimuli, M30, occurred at 30.2 ± 0.8 ms (mean ± standard deviation, N = 6), with shorter latency than those for PTN stimulus (39.3 ± 1.4 ms, N = 12) and longer latency than those for MN stimulus (21.0 ± 0.9 ms, N = 12). The second peak latency for sacral stimuli, M50, occurred at 47.2 ± 2.9 ms (N = 6). Both M30 and M50 peaks showed a single dipole pattern over the vertex in the isofield maps. The equivalent current dipoles of M30 and M50 were both estimated near the medial end of the central sulcus with approximately posterior current direction. These results suggest that the sacral M30 and M50 are responses from the primary somatosensory cortex. The relatively long time lag between the onset and peak of M30 suggests that SSTES directly affects both the cauda equina and cutaneous nerve of the sacral surface.
Haptoglobin‐β chain defined by monoclonal antibody RM2 as a novel serum marker for prostate cancer
Saito, S., Murayama, Y., Pan, Y., Taima, T., Fujimura, T., Murayama, K., Sadilek, M., Egawa, S., ... more Saito, S., Murayama, Y., Pan, Y., Taima, T., Fujimura, T., Murayama, K., Sadilek, M., Egawa, S., Ueno, S., Ito, A., Ishidoya, S., Nakagawa, H., Kato, M., Satoh, M., Endoh, M. and Arai, Y.(2008), Haptoglobin-β chain defined by monoclonal antibody RM2 as a novel serum ...
Purpose: To investigate a modified laparoscopic retroperitoneal lymph node dissection technique u... more Purpose: To investigate a modified laparoscopic retroperitoneal lymph node dissection technique using an extraperitoneal approach and to evaluate its feasibility. Patients and Methods: A group of consecutive patients from a single institution underwent extraperitoneal laparoscopic retroperitoneal lymph node dissection (EL-RLND) at weeks after orchiectomy for primary testicular nonseminomatous germ cell tumors (NSGCT). All patients were placed in the supine position and tilted up 15 degrees on the affected side. Four trocars were introduced. The templates of lymph node dissection conformed to those of Weissbach and Boedefeld. Results: EL-RLND was successfully performed in 15 patients (left, 6 patients; right, 9 patients). The mean total operative time for the entire series was 164-49 minutes. The mean blood loss was 118-74 mL. One intraoperative complication was injury of the vena cava, which occurred in one patient. Ureteral obstruction occurred in another patient. The mean postoperative intestinal function recovery time was 2 days. The mean postoperative hospitalization was 5.5-1.1 days. Normal antegrade ejaculation was preserved in all patients. Pathologic studies revealed positive lymph nodes in three (20%) patients. No recurrence or distant metastasis occurred during 2 to 32 months of follow-up. Conclusions: EL-RLND is a safe and feasible procedure using an improved extraperitoneal approach that provides minimal invasion and rapid recovery of patients.
A 32-year-old female visited our clinic with the chief complaints of macroscopic hematuria and po... more A 32-year-old female visited our clinic with the chief complaints of macroscopic hematuria and pollakisuria in February 18, 1987. Cystoscopic examination revealed findings of cystitis but bleeding from the ureteral orifice was not observed. IVP showed right non visualized kidney and retrograde pyelography demonstrated right ureteral stenosis on the lower ureter and right hydronephrosis. Total hysterectomy, right oophorectomy and right ureterolysis were carried out in March 5. Right lower ureter was buried in the fibrous tissue approximately over 2 cm above the crossing with iliac vessels. Dark reddish colored small tumor was noticed in the stenosed ureter and resected. The histological diagnosis confirmed endometriosis. A total of 37 cases of ureteral endometriosis in the Japanese literature was reviewed.
The change of sacral reflex activity of the striated urethral sphincter in the urine storage phas... more The change of sacral reflex activity of the striated urethral sphincter in the urine storage phase is investigated using evoked potential reaction of the bulbocavernosus reflex (BCR). (Methods) Eleven normal male subjects and 13 male patients with neurogenic bladder due to suprasacral (C3-C7) spinal cord injury (SCI patients) were investigated. Within the SCI patients, five were complete SCI and 8 were incomplete SCI. BCR was elicited by electrical stimulation of dorsal nerve of the penis, and the evoked potential of the BCR was recorded with a concentric needle electrode from the periurethral striated muscle. BCR was performed both at empty and at filled bladder respectively, and changes of the amplitudes (AMP) were examined. Moreover, the changes of AMP affected by bladder filling were compared between the normal subjects and the SCI patients. (Results) In both the normal subjects and the SCI patients, AMP increased at the filled bladder as compared with that of the empty bladder. In addition, the change of AMP was statistically bigger in the SCI patients (a ratio of amplitude at filled bladder/amplitude at empty bladder : 4. 73+3. 90) than in the normal subjects (the ratio: 1. 32+0. 44). (Conclusion) Sacral reflex activity was accelerated by bladder filling in both the normal subjects and SCI patients. And the acceleration in the SCI patients was more remarkable than that in the normal subjects. In addition to the conventional evaluation of the integrity of sacral reflex arc by BCR examination, the observation of changes of BCR affected by bladder filling may provide the information for the continuity of sacral segment and supraspinal micturition center.
The aim of this study is to localize the primary sensory cortex of urogenital organs in the human... more The aim of this study is to localize the primary sensory cortex of urogenital organs in the human brain. Using a newly developed MRIlinked magnetoencephalography system, we measured somatosensory evoked magnetic fields (SEFs) for unilateral stimuli on the dorsal penile nerve (DPN), posterior tibial nerve (PTN) and median nerve (MN). In five healthy male subjects, SEFs were clearly observed. Peak latencty of the first cortical components were 63.8 ± 9.2 ms for DPN, 39.8 ± 3.0 ms for PTN and 20.7 ± 0.7 ms for MN stimuli. Peak amplitude of the first cortical components were 63.1 ± 10.8 fT for DPN, 160.2 ± 50.1 fT for PTN and 335.2 ± 70.3 fT for MN stimuli. Isofield map for the peak latencies indicated a single dipolar pattern for DPN as well as for PTN and MN stimuli. Using a single current dipole model, all SEF sources were localized on the contralateral central sulcus to the stimuli, indicating the primary sensory cortex. The DPN sources were localized on the interhemispheric surfaces, corresponding to previous speculations by direct cerebral stimulation. This non-invasive SEF technique promises further brain functional mapping for the urogenital organs.
To explore the brain response to sacral surface therapeutic electrical stimulation (SSTES) for th... more To explore the brain response to sacral surface therapeutic electrical stimulation (SSTES) for the treatment of refractory urinary incontinence and frequent micturition, evoked magnetic fields were measured in six healthy males. Electrical stimuli were applied between bilateral surface electrodes over the second through fourth posterior sacral foramens with intensity just below the pain threshold. Somatosensory evoked magnetic fields (SEFs) for the bilateral median (MN) and posterior tibial nerves (PTN) were also measured for the comparison. Sources of the early SEF peaks were superimposed on individual magnetic resonance images. The first peak latency for sacral stimuli, M30, occurred at 30.2 ± 0.8 ms (mean ± standard deviation, N = 6), with shorter latency than those for PTN stimulus (39.3 ± 1.4 ms, N = 12) and longer latency than those for MN stimulus (21.0 ± 0.9 ms, N = 12). The second peak latency for sacral stimuli, M50, occurred at 47.2 ± 2.9 ms (N = 6). Both M30 and M50 peaks showed a single dipole pattern over the vertex in the isofield maps. The equivalent current dipoles of M30 and M50 were both estimated near the medial end of the central sulcus with approximately posterior current direction. These results suggest that the sacral M30 and M50 are responses from the primary somatosensory cortex. The relatively long time lag between the onset and peak of M30 suggests that SSTES directly affects both the cauda equina and cutaneous nerve of the sacral surface.
Hypothesis / aims of study The aim of this study was to investigate the primary somatosensory cor... more Hypothesis / aims of study The aim of this study was to investigate the primary somatosensory cortex of the penis in the human brain using magnetoencephalography (MEG). MEG, the magnetic counterpart of electroencephalography (EEG), has similar high time resolution and higher spatial resolution than EEG because of the negligible effect of the inhomogeneous head conductivity. Somatosensory evoked magnetic fields (SEFs) are the MEG responses to various types of stimulation of the peripheral nerves and skin.
1514 Cerebral Infarction Fails to Enhance the Sneeze-Induced Continence Reflex After Duloxetine, a Norepinephrine and Serotonin Reuptake Inhibitor, in Rats
Hypothesis / aims of study Uroflowmetry is a noninvasive and relatively inexpensive method for ur... more Hypothesis / aims of study Uroflowmetry is a noninvasive and relatively inexpensive method for urodynamic measurement. Therefore, it is an indispensable, first-line screening test for most patients with suspected lower urinary tract dysfunction 1) . On the other hand, since patients feel the strain when they undergo examination in conventional uroflowmeter those measurement environment is different from the toilets they use in their daily lives, it is possible that this strain influences the examination results. In 2008,the novel uroflowmeter (UM-100; TOTO Ltd., Fukuoka Japan) was developed, which is toilet-shaped and allows the patients to perform uroflowmetry just by urinating in the toilet as usual and can reduce the patients’ strain. The aim of this study was to elucidate the differences in the uroflow parameters between the novel toilet-shaped and conventional uroflowmeters in urologically normal female patients.
Hypothesis / aims of study Urinary incontinence and erectile dysfunction are major complications ... more Hypothesis / aims of study Urinary incontinence and erectile dysfunction are major complications after radical prostatectomy (RP). To promote recovery of erectile function after RP, penile rehabilitations have recently attracted attention. There have been some reports describing the efficacy of oral phosphodiesterase type-5 inhibitors (PDE5i) for penile rehabilitation in patients with postoperative erectile dysfunction. On the other hand, the efficacy of PDE5i on recovery for urinary continence after RP has not yet been well elucidated. So, we retrospectively evaluated the effects of PDE5i on the recovery of the urinary continence.
intraoperative wound cultures, perioperative antibiotics, inpatient notes, consult notes, and fol... more intraoperative wound cultures, perioperative antibiotics, inpatient notes, consult notes, and follow-up visits. Twenty patients with fungal infections were identified and additional information was requested. RESULTS: Fourteen patients underwent primary IPP implantation, the other 6 had previously undergone an average of 1.5 IPPrelated surgeries (range 1-3, median 1). Average age at implantation was 58 (range 31-72, median 60). Thirteen of the 20 fungal infection patients were diabetic (65%), the rest were not. Of the diabetic patients mean HgbA1c was 8.7 (range 6.5-13.3, median 8.3). Mean BMI for all patients was 30.9 kg/m2 (range 23.7-45 kg/m2, median 31 kg/m2). Mean BMI for diabetic patients was 31.8 kg/m2 (range 24.1-45 kg/m2, median 32 kg/m2). Ninety percent of implants were placed with IV antibiotics consistent with current AUA guidelines. In seven of these cases, fungi and bacteria were found in culture together. Eight devices were explanted, 8 underwent malleable implant salvage (MIST), and 4 were salvaged in the classic Mulcahy technique. Of the 8 patients who underwent explant, 5 later had successful reimplantation with either a malleable prosthesis or an inflatable prosthesis. The other three remain without an implant at last follow-up. Two of the 20 fungal infection patients were incontinent at IPP implantation. One of these patients underwent simultaneous Virtue sling implantation. No patient had concomitant immunosuppressive disease aside from DM at IPP implantation. No patient had evidence of recent antibiotic exposures prior to IPP implantation. CONCLUSIONS: To our knowledge these data represent the first in-depth exploration of IPP patients presenting with fungal infections. Approximately two-thirds of the patients were diabetic, suggesting that additional prophylaxis may be appropriate for diabetic patients. Further investigation is needed to confirm our results.
357 Estimated minimal residual membranous urethral length on preoperative MRI can be an independent predictor for continence after radical prostatectomy
Ductal adenocarcinoma is an unusual variant of adenocarcinoma of the prostate with a poorly under... more Ductal adenocarcinoma is an unusual variant of adenocarcinoma of the prostate with a poorly understood natural history, and its treatment is not well defined. Ductal adenocarcinoma is often diagnosed at an advanced stage, because no specific tumor markers are known. Docetaxel has been used for acinar adenocarcinoma of the prostate, a common type of prostate cancer, but it is largely ineffective for ductal adenocarcinoma. Earlier studies suggested that the chemotherapy with gemcitabine and cisplatin might be effective for ductal adenocarcinoma. Here we report two patients with ductal adenocarcinoma of the prostate that did not respond to docetaxel, but responded to the gemcitabine/cisplatin chemotherapy. Patient 1 was a 59-year-old man who had lung metastasis despite androgen deprivation therapy with undetectable levels of prostate-specific antigen and who presented with brain metastasis during docetaxel chemotherapy. Pathological examination of the resected brain tumor revealed duct...
MP2-19 High Risk Upper Urinary Tract Urothelial Carcinoma Patients with Lymphovascular Invasion Have the Advantage of Adjuvant Chemotherapy
The Journal of Urology, 2015
of postoperative renal dysfunction, and NACT was recommended for those patients. In selecting eli... more of postoperative renal dysfunction, and NACT was recommended for those patients. In selecting eligible NACT patients, this algorithm has a prediction ability with 76% (25/33) sensitivity and 77% (358/467) specificity. CONCLUSIONS: We developed a preoperative selection algorithm for the eligible NACT patients in UTUC. This algorithm might contribute to effective decision making in regard to providing NACT.
Low-dose maintenance gemcitabine-carboplatin chemotherapy could be an alternative to continuous standard chemotherapy for patients with metastatic urothelial carcinoma
International Journal of Urology, 2014
To examine whether low-dose maintenance gemcitabine-carboplatin chemotherapy is beneficial for pa... more To examine whether low-dose maintenance gemcitabine-carboplatin chemotherapy is beneficial for patients with metastatic urothelial carcinoma. We retrospectively reviewed the records of 36 patients with metastatic urothelial carcinoma who received first-line chemotherapy (gemcitabine/cisplatin, gemcitabine/carboplatin, or methotrexate/vinblastine/adriamycin/cisplatin) between 2006 and 2012. Those who had responded, but were unable to tolerate ongoing first-line chemotherapy, had been switched to low-dose maintenance chemotherapy consisting of 1 g/m(2) of gemcitabine and area under the curve 2-4 of carboplatin given on day 1 of a 6-week cycle, and were continued unless disease progression was seen. After a median of three cycles of first-line chemotherapy, 17 patients had been switched to low-dose maintenance chemotherapy. The median age was 70 years (range 56-79 years), and 12 patients (70.6%) had renal dysfunction (creatinine clearance <60 mL/min). The median number of cycles of low-dose maintenance chemotherapy was six (range 2-22), and the median survival time from initiation of first-line chemotherapy was 12 months (range 4-32 months). Adverse events requiring hospitalization were seen in three patients, but all of them recovered within a few days with conservative treatment. Seven patients discontinued within 9 months, whereas 10 patients continued on low-dose maintenance chemotherapy for ≥9 months. Patients with only lymph node metastases or who had a good response to previous first-line chemotherapy were likely to be able to continue low-dose maintenance chemotherapy. Low-dose maintenance gemcitabine-carboplatin chemotherapy might represent an alternative for patients with metastatic urothelial carcinoma not tolerating continuous first-line standard chemotherapy regimens.
47 Clinical Outcome of Patients with Cushing's and Subclinical Cushing's Syndrome After Laparoscopic Adrenalectomy: A Single Center Experience
The Journal of Urology, 2012
hypertension. Hardy-Weinberg equilibrium (HWE) and genotype frequencies of each polymorphism locu... more hypertension. Hardy-Weinberg equilibrium (HWE) and genotype frequencies of each polymorphism locus were determined by SNPassoc in R statistics program 2.7.0 software package. A P value 0.05 or odds ratio (OR) 1.00 is not in the range of 95% CI implicating statistical significant. RESULTS: Total of 128 APA patients have been followed up including 72 patients with idea control postoperative BP and 56 with persist postoperative hypertension. The distribution of genotypes of each locus was in accordance with Hardy-Weinberg Equilibrium (HWE) in the above two groups (P 0.05). Of the 4 SNPs, only rs1403543 locus in AT2R gene was found associated with persist postoperative hypertension of APA patients. APA patients with homozygotic genotype GG had an increased risk of persist postoperative hypertension compared to patients with AA or GA genotype (OR 5.00, 95% CI 1.3119.15, P 0.01). CONCLUSIONS: Polymorphisms at Rs1403543 locus in AT2R gene may be a predictor for postoperative BP recovery of APA patients.
Individualized Radical Hysterectomy Procedure Using Intraoperative Electrical Stimulation for Patients With Cervical Cancer
International Journal of Gynecological Cancer, 2012
In this study, by monitoring the varied distributions of nerve fascicles using intraoperative ele... more In this study, by monitoring the varied distributions of nerve fascicles using intraoperative electrical stimulation (IES), we sought to establish an individualized operation based on the patient's unique nerve distribution pattern, and to determine whether this technique would result in a higher preservation rate. Radical hysterectomy was performed from 2002 to 2010. Patients in group A are the 48 cases from 2002 to 2007 in which nerve-sparing radical hysterectomy using IES as our previous report was performed. Patients in group B are the 38 cases from 2008 to 2010 in which we used our new method, which was individualized to each patient. Urodynamic study (UDS) was used to confirm nerve preservation. Nerve preservation was defined as confirming distinct detrusor contraction during urinary voiding. In group B, nerve preservation rate was higher than in group A (75% vs 9 0%, P = 0.067). We classified the case-by-case nerve anatomy as whether the nerve fascicle was mainly on the medial side or on the lateral side of the deep uterine vein. The lateral type anatomy was observed unilaterally in 6 cases and bilaterally in 1 case. In summary, the lateral type anatomy was observed in 8 (29%) of 28 sides. In the cases evaluated by UDS, the positive predictive value of IES was 95% in group A and 100% in group B. Our method of IES showed a high positive predictive value of nerve preservation as confirmed by UDS. By delineating the nerve tract in detail using IES, it is possible to individualize the operation based on each patient's anatomy, with an improved nerve preservation rate.
Magnetoencephalography (MEG) was used to measure the somatosensory evoked fields in six healthy m... more Magnetoencephalography (MEG) was used to measure the somatosensory evoked fields in six healthy males undergoing sacral surface therapeutic electrical stimulation, a recently introduced treatment for chronic urinary dysfunction. This study was performed to investigate the utility of MEG to optimize the stimulation parameters. Strong or weak electrical stimuli were applied to small or large surface electrodes placed over the bilateral sacral surfaces. The peak latency and strength of the equivalent current dipole were evaluated at the first peak originating from the primary somatosensory cortex (M30). There was no difference in M30 latency in response to stimulation intensity or electrode size. However, a larger equivalent current dipole strength was obtained in response to higher stimulus intensities, which indicated a more effective stimulus on the sacral surface. The present MEG study shows that stronger stimuli given through large electrodes evoke larger responses than small stimuli through small electrodes. The study also suggests that MEG can be used as an objective tool to monitor whether therapeutic stimulation parameters are appropriate.
To explore the brain response to sacral surface therapeutic electrical stimulation (SSTES) for th... more To explore the brain response to sacral surface therapeutic electrical stimulation (SSTES) for the treatment of refractory urinary incontinence and frequent micturition, evoked magnetic fields were measured in six healthy males. Electrical stimuli were applied between bilateral surface electrodes over the second through fourth posterior sacral foramens with intensity just below the pain threshold. Somatosensory evoked magnetic fields (SEFs) for the bilateral median (MN) and posterior tibial nerves (PTN) were also measured for the comparison. Sources of the early SEF peaks were superimposed on individual magnetic resonance images. The first peak latency for sacral stimuli, M30, occurred at 30.2 ± 0.8 ms (mean ± standard deviation, N = 6), with shorter latency than those for PTN stimulus (39.3 ± 1.4 ms, N = 12) and longer latency than those for MN stimulus (21.0 ± 0.9 ms, N = 12). The second peak latency for sacral stimuli, M50, occurred at 47.2 ± 2.9 ms (N = 6). Both M30 and M50 peaks showed a single dipole pattern over the vertex in the isofield maps. The equivalent current dipoles of M30 and M50 were both estimated near the medial end of the central sulcus with approximately posterior current direction. These results suggest that the sacral M30 and M50 are responses from the primary somatosensory cortex. The relatively long time lag between the onset and peak of M30 suggests that SSTES directly affects both the cauda equina and cutaneous nerve of the sacral surface.
Haptoglobin‐β chain defined by monoclonal antibody RM2 as a novel serum marker for prostate cancer
Saito, S., Murayama, Y., Pan, Y., Taima, T., Fujimura, T., Murayama, K., Sadilek, M., Egawa, S., ... more Saito, S., Murayama, Y., Pan, Y., Taima, T., Fujimura, T., Murayama, K., Sadilek, M., Egawa, S., Ueno, S., Ito, A., Ishidoya, S., Nakagawa, H., Kato, M., Satoh, M., Endoh, M. and Arai, Y.(2008), Haptoglobin-β chain defined by monoclonal antibody RM2 as a novel serum ...
Purpose: To investigate a modified laparoscopic retroperitoneal lymph node dissection technique u... more Purpose: To investigate a modified laparoscopic retroperitoneal lymph node dissection technique using an extraperitoneal approach and to evaluate its feasibility. Patients and Methods: A group of consecutive patients from a single institution underwent extraperitoneal laparoscopic retroperitoneal lymph node dissection (EL-RLND) at weeks after orchiectomy for primary testicular nonseminomatous germ cell tumors (NSGCT). All patients were placed in the supine position and tilted up 15 degrees on the affected side. Four trocars were introduced. The templates of lymph node dissection conformed to those of Weissbach and Boedefeld. Results: EL-RLND was successfully performed in 15 patients (left, 6 patients; right, 9 patients). The mean total operative time for the entire series was 164-49 minutes. The mean blood loss was 118-74 mL. One intraoperative complication was injury of the vena cava, which occurred in one patient. Ureteral obstruction occurred in another patient. The mean postoperative intestinal function recovery time was 2 days. The mean postoperative hospitalization was 5.5-1.1 days. Normal antegrade ejaculation was preserved in all patients. Pathologic studies revealed positive lymph nodes in three (20%) patients. No recurrence or distant metastasis occurred during 2 to 32 months of follow-up. Conclusions: EL-RLND is a safe and feasible procedure using an improved extraperitoneal approach that provides minimal invasion and rapid recovery of patients.
A 32-year-old female visited our clinic with the chief complaints of macroscopic hematuria and po... more A 32-year-old female visited our clinic with the chief complaints of macroscopic hematuria and pollakisuria in February 18, 1987. Cystoscopic examination revealed findings of cystitis but bleeding from the ureteral orifice was not observed. IVP showed right non visualized kidney and retrograde pyelography demonstrated right ureteral stenosis on the lower ureter and right hydronephrosis. Total hysterectomy, right oophorectomy and right ureterolysis were carried out in March 5. Right lower ureter was buried in the fibrous tissue approximately over 2 cm above the crossing with iliac vessels. Dark reddish colored small tumor was noticed in the stenosed ureter and resected. The histological diagnosis confirmed endometriosis. A total of 37 cases of ureteral endometriosis in the Japanese literature was reviewed.
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Papers by Haruo Nakagawa