K Okamura

National Center for Geriatrics and Gerontology, Ōbu, Aichi-ken, Japan

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Publications (92)110.04 Total impact

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    ABSTRACT: Objective: The aim of the present study was to assess the effects of onabotulinumtoxinA injection for refractory non-neurogenic overactive bladder (OAB) for 12 months. Methods: For patients with persistent urgency urinary incontinence (UUI) more than once a week despite taking anti-cholinergic agents or incapability to continue the agents because of adverse effects, 100 units of onabotulinumtoxinA was injected at 30 sites in the sub-epithelial bladder wall. Efficacy was assessed every month up to 12 months after injection, using a three-day frequency-volume chart (FVC) and postvoid residual urine (PVR), three questionnaires, and a simple score of Global Response Assessment (GRA). Failure was defined as when GRA was negative and additional treatment was administered. Results: Nine men and eight women aged 67 ± 12 years were included. On FVC, frequencies of urgency, UUI and daytime urination significantly decreased up to the 11th month. PVR significantly increased at the first and second months but no patient required catheterization. The total scores of Overactive Bladder Symptom Score and International Consultation on Incontinence Questionnaire Short Form were significantly decreased for 10 and eight months, respectively. The score of GRA was significantly improved for eight months. The median time to failure was 11.0 months. Conclusion: This study suggests that onabotulinumtoxinA submucosal injection is promising for refractory non-neurogenic OAB. It is anticipated that the treatment is effective for eight to nine months and approximately 40% of the patients do not require anticholinergics at the 12th month postoperatively.
    Lower urinary tract symptoms 05/2013; 5(2). · 0.33 Impact Factor
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    ABSTRACT: AIMS: To estimate the prevalence of lower urinary tract symptoms (LUTS) in Japanese people, and the relationships to aging and sex, we carried out the present population-based study. METHODS: The present study included 1198 men aged 60.7 ± 12.5 years and 1218 women aged 60.8 ± 12.7 years who participated in a study of aging carried out at the National Center for Geriatrics and Gerontology between 2006 and 2008, using linguistically validated versions of the International Prostate Symptom Score (I-PSS) and International Consultation on Incontinence Questionnaire Short-form (ICIQ-SF). RESULTS: The prevalence of I-PSS ≥8 was 25.2% in men and 11.8% in women, that of two or more a week urinary incontinence was 3.3% and 6.6%, respectively, and that of I-PSS ≥8 and/or two or more a week urinary incontinence was 25.8% and 16.0%, respectively. The prevalence of the seven symptoms in I-PSS increased with aging. Just 9.1% of men and 4.6% of women who reported LUTS were medicated for LUTS. CONCLUSIONS: The results showed that the severity of LUTS in Japan was related to aging. The prevalence of LUTS with I-PSS ≥8 in Japan is similar to that in other countries. Geriatr Gerontol Int 2013; ●●: ●●-●●.
    Geriatrics & Gerontology International 03/2013;
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    ABSTRACT: OBJECTIVES: To improve the perioperative care for radical prostatectomy patients at a multi-institutional level and practice. METHODS: A prospective multi-institutional study involving 50 hospitals was carried out in cooperation with the Japanese Society of Endourology. As the first step, a consensus meeting was held to establish a standardized perioperative care plan. Second, the clinical pathways were individually developed and revised according to the standardized care plan in each of the participating hospitals. Patterns of perioperative care, including preoperative hospital stay, resuming meals and ambulation, removal of pelvic drain and urethral catheter, antimicrobial administration, and postoperative hospital stay, were compared before (2007) and after developing/revising pathways (2009). Furthermore, actual practice and complications before and after implementing the pathways were investigated. RESULTS: Except for resuming ambulation, all perioperative pathways were significantly shortened with the adoption of the newly defined clinical pathway (P < 0.001). Furthermore, all settings except for postoperative hospital stay significantly decreased in terms of variance (P < 0.002). In 2009, the overall complication rate significantly decreased (P < 0.001), and all of the outcomes except urethral catheter removal were also significantly shortened (P ≤ 0.008) and decreased in variance after implementation of the new pathways (P ≤ 0.006). In multivariate analyses, implementation of the refined clinical pathways was an important factor to improve perioperative care. CONCLUSIONS: When standardized goals in perioperative care are recommended to hospitals and care plans are developed/revised in individual hospitals, both settings and practice are significantly improved. It is to be investigated whether a similar intervention could be useful to achieve a standardization of surgical pathway for other diseases.
    International Journal of Urology 10/2012; · 1.73 Impact Factor
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    ABSTRACT: PURPOSE: We investigated the relationships between hospital surgical volume, surgical outcome, care plans indicated in critical pathways and actual perioperative care using data from a nationwide survey for radical prostatectomy. MATERIALS AND METHODS: In this study, urologists from 155 hospitals in Japan cooperated in submitting the data of 4,029 patients who underwent radical prostatectomy in 2007, and the perioperative care plan in critical pathways. Of these, we analyzed data of 3,499 patients undergoing open radical prostatectomy and minimum incision endoscopic radical prostatectomy. RESULTS: Increasing hospital volume was associated with decreased proportion of open radical prostatectomy (p < 0.001). As the hospital volume increased, surgical duration was significantly shorter (p < 0.001) and bleeding volume decreased (p < 0.004). Analyses of perioperative care suggested that low-volume hospitals (<15 patients annually) were likely to have longer care than medium-volume (15-29 patients per year) or high-volume (≥30 patients per year) hospitals, and the length of actual care was prolonged in the low-volume hospitals. Multivariate logistic regression analysis suggested that the occurrence of postoperative complications was significantly associated with surgeon's volume (p = 0.004), patient age (p = 0.001), preoperative anticoagulant therapy (p = 0.045), coexistent diabetes mellitus (p = 0.009), surgical duration (p = 0.002) and bleeding volume (p < 0.001), but not hospital volume. CONCLUSIONS: Urologists in high-volume hospitals appeared to attempt new types of surgery. Hospital surgical volume was strongly associated with the surgical duration, bleeding volume and planned and actual perioperative care; however, it was not associated with postoperative complications.
    International Journal of Clinical Oncology 08/2012; · 1.41 Impact Factor
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    ABSTRACT: Recently, various types of radical surgery have been performed in Japan. To elucidate the surgical consequences, morbidity and mortality, and perioperative care, we conducted a nationwide survey. Assisted by the Japanese Society of Endourology, perioperative data from 156 hospitals participating in this survey in 2007 were analyzed. Using a spreadsheet database, data were collected from each institution. Open radical prostatectomy was performed in 3,138 patients at 143 hospitals, minimum incision endourological radical prostatectomy in 361 at 15 hospitals, laparoscopic radical prostatectomy via transperitoneal approach in 143 at 11 hospitals and laparoscopic radical prostatectomy via extraperitoneal approach in 337 at 13 hospitals. For open and minimum incision endourological radical prostatectomy, the surgical duration was shorter but the bleeding volume was greater than that in laparoscopic radical prostatectomy via both approaches. As a whole, perioperatvie mortality rate was 0.05% and morbidity rate was 23.4%. Rectal injury was similarly infrequent among the four types of surgery. Superficial surgical site infection was most frequent in open radical prostatectomy. Perioperative management significantly varied among the four types of surgery. In laparoscopic radical prostatectomy via extraperitoneal approach, urethral catheter was removed earlier but acute urinary retention frequently occurred. In Japan, open radical prostatectomy was the most frequently performed surgery for prostate cancer. Surgical volume per hospital was small, however, mortality was low and morbidity was acceptable. Comparisons of complications and outcomes among the types of currently performed surgery should be useful to promote standardization of the perioperative care.
    Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 11/2011; 102(6):713-20.
  • Kikuo Okamura, Yoshikatsu Nojiri
    International Journal of Urology 08/2011; · 1.73 Impact Factor
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    ABSTRACT: The objective of the present study was to assess the short-term effects of botulinum toxin A (BTX-A) injection for refractory non-neurogenic overactive bladder (OAB) in the setting of a prospective multicenter clinical trial. Refractory OAB was defined as persistent urgency urinary incontinence (UUI) ≥ once a week despite taking anticholinergic agents, or the incapability to continue the agents because of the adverse effects. A total of 100 U of BTX-A were reconstituted in 15 mL of normal saline and an aliquot of 0.5 mL was injected at 30 submucosal sites of the bladder wall. Nine men and eight women aged 67 ± 12 years were included. Subjective daytime frequency, urgency and UUI significantly decreased after treatment. On a 3-day frequency-volume chart, the daytime and night-time frequency of UUI significantly decreased from 5.5 and 0.5 pre-injection to 2.0 and 0.3 postinjection, respectively. Daytime urinary incontinence completely disappeared in six subjects. A urodynamic study showed the disappearance of detrusor overactivity in eight patients and a decrease in five patients. Maximum bladder capacity significantly increased from 179.9 to 267.3 mL. Difficulty on micturition or feeling of incomplete emptying was reported by 23.5% and 43.8% of patients at weeks 2 and 4, respectively. Postvoid residual urine increased to >100 mL in seven patients and >200 mL in one patient after injection; however, none of the patients required clean intermittent catheterization. These findings suggest promising efficacy of BTX-A in Japanese OAB patients.
    International Journal of Urology 06/2011; 18(6):483-7. · 1.73 Impact Factor
  • Geriatrics & Gerontology International 01/2011; 11(1):131-2.
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    ABSTRACT: Objectives:  Various types of minimally invasive surgical treatments, including transurethral resection of prostate (TURP), are being carried out in Japan for patients with benign prostatic hyperplasia (BPH). The aim of the present study was to elucidate the current status of perioperative care for these treatments by carrying out a nationwide survey. Methods:  Assisted by the Japanese Endourology and ESWL Association, perioperative data from 157 institutions participating in this survey were collected and analyzed. Results:  This survey included 3918 patients undergoing TURP, 242 TUR in saline (TURis), 638 holmium laser enucleation of the prostate (HoLEP), 90 holmium laser ablation (HoLAP) and 241 photoselective vaporization (PVP). Mean operative time was shorter in TURP (71 min) and longer in HoLEP (127). Although no transfusions were required in cases undergoing HoLAP or PVP, blood was frequently transfused in those undergoing TURis (25.6%), TURP (10.2%) and HoLEP (7.8%), and the difference was significant. During the hospital stay, the incidence of TUR-syndrome, postoperative bleeding requiring bladder irrigation, acute urinary retention/difficulty on micturition and pad use at discharge was highest in TURP (2.3%), TURis (7.9%), HoLAP (16.7%) and HoLEP (15.1%), respectively. Two patients undergoing TURP died (0.05%). The shortest mean postoperative hospital stay was for PVP (1.6 days, even if the readmission rate within 90 days was the highest in this same group; 6.2%). Perioperative care during hospital stay varied among the five types of procedures. Conclusions:  This survey provides useful documentation on the current status of minimally invasive treatments for BPH in Japan. Complication rates for TURP are not significantly higher as compared with other procedures. Thus, TURP can still be considered as the gold standard for BPH treatment.
    International Journal of Urology 01/2011; · 1.73 Impact Factor
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    ABSTRACT: Our previous study indicated that there was a great variety in the perioperative management of radical prostatectomy among hospitals. Therefore we conducted a multiinstitutional study in order to standardize the perioperative management using clinical pathways. The perioperative data on radical prostatectomy were collected between January and December 2004 (Period 1) from eight hospitals. These outcomes were discussed by researchers and the clinical pathway used at each hospital was constructed or revised. The outcomes using these pathways in Period 2 (January 2005 to March 2006) were compared with those in Period 1. Three hundred seventy-eight men in Period 1 and 360 in Period 2 were enrolled in this study. The settings of perioperative management using the new pathways were relatively similar among hospitals. A majority of perioperative management procedures in Period 2 were conducted as described in the new clinical pathways, judging from the median days. The day of initiating the resumption of fluid intake, meals and removing the epidural anesthetic catheter and drain changed from 1.2 +/- 0.7 to 1.3 +/- 1.4 postoperative day, 1.9 +/- 1.2 to 1.8 +/- 1.7, 2.4 +/- 0.7 to 2.5 +/- 0.6, 3.8 +/- 2.5 to 3.8 +/- 2.8, respectively, without a significant difference. The postoperative day of initiating the walking and discontinuing continuous drip infusion and intravenous antibiotics were shortened from 1.9 +/- 0.9 to 1.5 +/- 0.6, 3.7 +/- 2.1 to 3.1 +/- 2.2 and 3.6 +/- 2.0 to 2.5 +/- 2.2, respectively, which did show a significant difference. The day of removing the urethral catheter was changed 9.1 +/- 4.9 to 8.6 +/- 5.4 without significant difference. But the durations of preoperative hospitalization, hospitalization after removing the urethral catheter and postoperative hospitalization were significantly shortened from 3.4 +/- 2.1 to 2.5 +/- 1.0 days, 8.9 +/- 10.1 to 5.6 +/- 3.8, and 17.9 +/- 10.9 to 14.4 +/- 9.1, respectively. The clinical pathways established or revised at these hospitals after discussing the perioperative management in multiple hospitals were similar, and using such pathways advanced the standardization of peri-operative management after radical prostatectomy.
    Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 08/2009; 100(5):563-9.
  • Kikuo Okamura, Junji Terada, Hajime Kato
    International Journal of Urology 07/2009; 16(6):590-1. · 1.73 Impact Factor
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    ABSTRACT: Although the International Prostate Symptom Score (IPSS) has often been used for female lower urinary tract symptoms (FLUTS), the psychometric properties of IPSS for FLUTS have not been studied. We investigated the reliability and validity of IPSS for FLUTS. Two samples were prepared. Sample A consisted of 227 women and 455 men who consulted a hospital doctor and sample B consisted of 519 women and 419 men who consulted a general practitioner. Eighty-nine percent of participants completed all IPSS items and quality of life index. Cronbach's alpha coefficients and Spearman's rho were calculated for reliability and validity assessment, respectively. A factor analysis was also conducted to explore the underlying structure. Significant differences were found in age and each IPSS item score between the 2 samples. Cronbach's alpha of IPSS in women was approximately 0.8 in both samples, comparable to that in men. The relatively high Spearman's rho among most of IPSS voiding items and among most storage items and low Spearman's rho among most of the different categories described indicated good convergent and discriminant validity. The factor analysis showed 2 components in IPSS for FLUTES. The first was consistently related to IPSS items 1, 3, 5, and 6 and the second was related to IPSS items 2, 4, and 7. In men, however, IPSS item 4 comprised different components between samples A and B. Although the subject background somewhat affects the psychometric properties, the IPSS can be relevant when used to examine women, as well as men.
    Urology 05/2009; 73(6):1199-202. · 2.42 Impact Factor
  • Kikuo Okamura, Yoshikatsu Nojiri, Yoko Osuga
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    ABSTRACT: To investigate the reliability and validity of the King's Health Questionnaire (KHQ) in both genders, which was originally developed as a health-related quality of life (HRQoL) questionnaire for female urinary incontinence for general lower urinary tract symptoms (LUTS). Data from the International Prostate Symptom Score (IPSS) and KHQ obtained from 179 men and 75 women consulting urologists (Sample A) were analysed. Cronbach's alpha coefficient and inter-domain correlation were calculated for reliability and validity assessment, respectively. Factor analysis was used to explore the underlying factor structure of the KHQ. KHQ scores of sample A were compared with those of 330 men and 418 women consulting general practitioners (Sample B). Internal consistency of KHQ was acceptable with a Crohnbach's alpha of 0.721-0.915 in the total population of sample A. Correlation analysis showed convergent validity among 'Physical Limitations', 'Role Limitation' and 'Social Limitations' and discriminant validity among 'Personal Relationship', 'Emotion's and 'Sleep/Energy'. Factor analysis showed three underlying components to explain convergent and discriminant validity. In both sample A and sample B, HRQoL was impaired in the eight domains according to IPSS severity. KHQ scores of domains other than 'General Health Perception' in sample B were lower than those in sample A. The KHQ can be used as a HRQoL questionnaire for LUTS in both genders. In the future, it is expected that the KHQ could be used in clinical studies for benign prostate hyperplasia and other conditions.
    BJU International 02/2009; 103(12):1673-8. · 3.05 Impact Factor
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    ABSTRACT: In Japan, only the following two guidelines are available: 'Guidelines on Urinary Incontinence in the Elderly' based on research funded by the Longevity Sciences Research Grant (chief investigator: Kikuo Okamura) and 'Guidelines on Urinary Incontinence in Women' based on 'Research on Treatment Standardization in the Urological Field' funded by the Health Sciences Research Grant (group leader: Osamu Nishizawa). This paper is an English translation of these two guidelines originally published in Japanese.
    International Journal of Urology 11/2008; 15(10):857-74. · 1.73 Impact Factor
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    ABSTRACT: We investigated the diagnosis and treatment of lower urinary tract symptoms (LUTS) by general practitioners (GPs) according to the Practical Manual for LUTS Evaluation and Treatment in the Elderly For GPs. Using the manual, 14 GPs determined LUTS severity using the International Prostate Symptom Score, Quality of Life Index, post-void residual urine volume and the International Consultation on Incontinence Questionnaire-Short Form, then evaluated utilization of the frequency volume charts and other examinations to treat LUTS and assessed treatment effectiveness. This study included 52 men (aged 71 +/- 9 years) and 37 women (73 +/- 9). Voiding symptoms were more frequent in men but storage symptoms occurred similarly in both sexes. The overall severities of LUTS were similar between sexes. Of 36 men and 27 women who were treated, water restriction for polyuria and nocturnal polyuria was recommended for 17 men and 14 women, bladder training for six women, and pelvic floor exercise for three men and 16 women as behavioral therapy. Of 27 men and 25 women whose treatment effectiveness was assessed by GPs, effectiveness was judged as "fairly good" or greater in 20 men (74%) and 23 women (92%). Eleven men (40%) and 20 women (80%) were satisfied with their treatment. It is suggested that GPs can provide high-quality LUTS practice when they follow the manual and use the recommended tools for evaluation and monitoring.
    Geriatrics & Gerontology International 07/2008; 8(2):119-25.
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    ABSTRACT: We investigated whether continuous bladder irrigation after Transurethral Resection of the Prostate (TURP) would prevent catheter obstruction by the clot. We analyzed data from 761 patients registered in "a multi-institutional study of TURP clinical pathway" sponsored by the Ministry of Health, Labor and Welfare between 2001 and 2003. The difference of clinical backgrounds of the cases, resected weight, operating time, risk of being feverish, risk of catheter obstruction and chance of postoperative Transurethral Fulguration (TUF) between each institution were investigated. The risk factor of catheter obstruction is characterized and the significance of continuous bladder irrigation is discussed. The incidence of catheter obstruction in the four institutions, in which 90% or more of patients underwent continuous bladder irrigation, was significantly lower than that in the three institutions, in which continuous bladder irrigation was performed in selected patients whose hematuria was severe (4.4% VS 12.9%, p<0.001). There was no difference in the frequency of either pyrexia or postoperative TUF. Logistic regression analysis showed that significant factors for catheter obstruction are continuous bladder irrigation, resected tissue weight and preoperative urinary infection. Routine continuous bladder irrigation achieved a lower incidence of catheter obstruction. However, we recommend that urologists should decide whether to perform routine continuous irrigation, considering the frequency of catheter obstruction, safety, labor and cost.
    Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 09/2007; 98(6):770-5.
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    ABSTRACT: The perioperative management of radical prostatectomy in Japan has not been investigated previously. It would be significant to document present management practices. A questionnaire survey of 1,213 educational institutions of Japanese urological association was conducted by mail. Questionnaires were returned from 722 (60%) institutions and responses indicated that radical prostatectomy was performed in 657 of these institutions (91%). Admission to hospital was most frequently scheduled on preoperative day 2; walking was most frequently planned to be initiated on postoperative day (POD) 1; beginning of food intake on POD 2; termination of continuous drip infusion and drain removal on POD 3, removal of the Foley catheter on POD 7; intravenous antibiotics for three days; oral antibiotics for 7 days; and discharge from hospital on POD 14. However, the duration of the indwelling drain and Foley catheter, antibiotic administration and hospitalization varied widely. There was great variety in the perioperative management of radical prostatectomy among hospitals. We need to obtain consensus on 1) the timing of drain removal, 2) duration of antibiotics, and 3) the timing of catheter removal, in order to uniformly provide medical care of good quality in Japan.
    Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 06/2007; 98(4):595-603.
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    ABSTRACT: The incidence of lower urinary tract symptoms (LUTS) in people consulting general practitioners (GPs) was investigated. We used a questionnaire including seven questions regarding LUTS and one question regarding bothersomeness based on the International Prostate Symptom Score (I-PSS), three questions on the Overactive Bladder Symptom Score (OABSS) and four questions on the International Consultation on Incontinence Questionnaire Short-Form (ICIQ-SF), and conducted the survey among 1120 people aged 50 or older who consulted 17 GP clinics. Of 958 persons (86%) who responded the questionnaires, we analyzed the data from 822 (73%) who completed all the above questions. There were 364 men (mean age, 67 years) and 458 women (mean age, 68 years). Moderate or severe grades in I-PSS and OABSS were indicated in 99 (27%) and 43 (12%), for men, respectively, and 55 (12%) and 39 (9%) for women, respectively. I-PSS correlated with age in men and OABSS did in both genders. Most people with moderate or severe I-PSS experienced moderate or severe bothersomeness. Fifty-five (15%) men and 185 (40%) women indicated that they had some type of urinary incontinence. There were 138 (38%) men and 165 (36%) women showing both moderate or severe I-PSS, and moderate or severe bothersomeness, and/or with an ICIQ-SF score of 1 or greater. Approximately one-third of men and women aged 50 or older consulting GPs have bothersome LUTS, including urinary incontinence. We believe that they should be carefully assessed to determine whether they need treatment.
    Geriatrics & Gerontology International 05/2007; 7(2):147 - 153.
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    ABSTRACT: Improvement of perioperative management for transurethral resection of the prostate (TURP) by revising the common clinical path was investigated in multiple hospitals. We discussed perioperative outcomes using the common path in 2002 and revised it for 2003. Changes in perioperative outcomes between 2002 and 2003 and differences among hospitals were compared. There were no statistically significant differences in age, proportion of patients with mildly impaired activity of daily living and/or impaired cognition, general anesthesia, operating duration, resected weight, incidence of intraoperative complications and blood transfusion between 2002 and 2003. Although there were no differences in preoperative hospital stay, re-hospitalization rate and charges for surgery and anesthesia, Foley catheter was removed significantly earlier from postoperative day 2.9 to 2.3 and total medical charge significantly decreased from 43,703 to 39,661 units (1 unit = 10 yen). The incidence of postoperative pyrexia increased from 2.4% to 11.2% in 2003, however, the incidences of epididymitis, postoperative bleeding and postoperative difficulty on micturition remained stable. The average and standard deviation of postoperative hospital stay and total medical charge at each hospital decreased, however, differences among hospitals found in 2002 remained in 2003. We found that standardization can be accomplished by discussing perioperative management using a common path in multiple hospitals and revising the path as needed. Common clinical path should be a valid method of advancing standardization in Japan.
    Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 02/2007; 98(1):3-8.
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    ABSTRACT: We investigated perioperative management for transurethral resection of the prostate (TURP) in Japan. The questionnaire survey was conducted in 1,213 educational institutions for urology. The questionnaires were returned from 722 (60%) institutions. Admission to hospital was most frequently scheduled on preoperative day 1; termination of continuous drip infusion, starting meal intake and walking on postoperative day 1; intravenous antibiotics for three days; removal of Foley catheter on postoperative day 4; oral antibiotics for 7 days; and discharge from hospital on postoperative day 7. Although hospitalization was 14 days or less at most institutions, several procedures, especially the administration of prophylactic antibiotics, were fairly varied. Discussions from various perspectives might be needed to standardize the perioperative management of TURP in Japan.
    Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 12/2006; 97(7):830-4.

Publication Stats

340 Citations
110.04 Total Impact Points

Institutions

  • 2004–2012
    • National Center for Geriatrics and Gerontology
      • Department of Urology
      Ōbu, Aichi-ken, Japan
  • 2003
    • Social Insurance Chukyo Hospital
      Nagoya, Aichi, Japan
  • 1996–2001
    • Komaki City Hospital
      Комаки, Aichi, Japan
  • 1999
    • Osaka Gas Co., Ltd.
      Ōsaka, Ōsaka, Japan
  • 1994–1995
    • Nagoya University
      • Division of Urology
      Nagoya-shi, Aichi-ken, Japan