Osamu Yokoyama

University of Fukui, Hukui, Fukui, Japan

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Publications (191)436.05 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To investigate the efficacy of a once-daily oxybutynin patch for nocturia, and its influence on sleep quality in patients with overactive bladder. We carried out post-hoc analysis of a phase III, randomized, double-blind, comparative study in which an oxybutynin patch was administered once daily for 12 weeks to Japanese patients with overactive bladder. Patients with a baseline mean of one or more episodes of nocturia per night (data from voiding diaries) were analyzed. The mean number of micturitions, mean voided volume per micturition, mean first voided volume at night, mean sleep duration, and hours of undisturbed sleep were compared between the once-daily oxybutynin patch group and the placebo group. All parameters were expressed as the least squares mean values. The analysis included 576 patients. The number of nocturia episodes decreased by 0.66 in the oxybutynin patch group versus 0.51 in the placebo group (P = 0.0249). Also, the voided volume per nocturnal micturition and the first voided volume at night showed a significant increase in the oxybutynin patch group compared with the placebo group (P = 0.0073 and P = 0.0005, respectively). The hours of undisturbed sleep showed significant prolongation by 76.14 min in the oxybutynin patch group versus 56.07 min in the placebo group (P = 0.0257). Oxybutynin patch treatment reduces the number of nocturia episodes and prolongs the hours of undisturbed sleep, thus improving sleep quality and sleep-related quality of life in patients with overactive bladder. © 2015 The Japanese Urological Association.
    International Journal of Urology 03/2015; DOI:10.1111/iju.12755 · 1.80 Impact Factor
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    ABSTRACT: To clarify the possible interference of the 5α-reductase inhibitor dutasteride with α-adrenergic blockers, whose action is mainly mediated by α1A-adrenergic receptor. Male rats were divided into dutasteride and vehicle-treated groups. The drug treatment group was treated with oral dutasteride 0.5 mg/kg/d, and the control group received vehicle only for 2 months. After the 2-month treatment, the rats' ventral prostate weight changes and the testosterone and dihydrotestosterone levels in the serum were measured. In vitro organ-bath studies, real-time polymerase chain reaction, and tissue-segment binding were performed to determine the expression of α1A-adrenergic receptors and its mediated contractility. Dutasteride treatment significantly decreased the rats' ventral prostate weight, increased their testosterone levels, and decreased the dihydrotestosterone levels in their serum. There were no marked changes in the α1A-adrenergic receptor messenger ribonucleic acid expression, relative phenylephrine-induced contractility, or nerve-mediated contractility between the groups. Dutasteride treatment caused no marked changes in the relative binding capacity of α1A-adrenergic receptor, whereas it greatly decreased the total protein expression of this subtype and its mediated maximal contraction in the whole ventral prostate. These results suggest that dutasteride does not interfere with α-adrenergic blockers but otherwise has beneficial effects on their actions. Therefore, the long-term administration of the combination of dutasteride with an α-adrenergic blocker might be a better choice for the treatment of lower urinary tract symptoms due to benign prostatic hyperplasia. Copyright © 2015 Elsevier Inc. All rights reserved.
    Urology 03/2015; 85(3):704.e9-704.e14. DOI:10.1016/j.urology.2014.12.002 · 2.13 Impact Factor
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    ABSTRACT: Assess the efficacy and safety of tadalafil 5 mg once-daily in Asian men with lower urinary tract symptoms by pooling data from three clinical studies. Data on 1199 Japanese, Korean, and Taiwanese men given tadalafil 5 mg (n = 601) or placebo (n = 598) were pooled from three double-blind, placebo-controlled, 12-week studies. Efficacy measures included International Prostate Symptom Score, and Patient and Clinician Global Impressions of Improvement. These measures were also assessed for patient subgroups (age categories, baseline disease severity and/or prostate volume, prior alpha-blocker treatment). Safety measures included adverse events, including those in selected body systems. Efficacy measure changes throughout treatment were assessed by mixed-effect model repeated-measures analysis; baseline to end-point changes for the total population and subgroups were evaluated by analysis of covariance. Tadalafil 5 mg led to significant improvement (vs placebo) in all International Prostate Symptom Scores at all time-points (week 4 P ≤ 0.013 for all measures; week 8 P ≤ 0.005, week 12 P < 0.001). End-point results for both global impressions scales also favored tadalafil (both P < 0.001 vs placebo). Tadalafil efficacy was similar between patient subgroups of varied disease severity (interaction P = 0.097), prior alpha-blocker use (P = 0.580), and prostate volume (P = 0.921). The drug was slightly less effective in older men (interaction P = 0.042). No unexpected adverse events were reported, and no meaningful adverse effects were observed in visual, auditory, or cardiovascular systems. Tadalafil 5 mg once-daily for 12 weeks is efficacious and safe in Asian men with lower urinary tract symptoms. Tadalafil is also effective in men of different ages, disease severity, prior alpha-blocker exposure, and prostate volumes. © 2015 The Japanese Urological Association.
    International Journal of Urology 02/2015; 22(4). DOI:10.1111/iju.12699 · 1.80 Impact Factor
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    ABSTRACT: Objective To examine the safety and efficacy of mirabegron as add-on therapy to solifenacin in patients with OAB.Patients and Methods This multicenter, open-label, Phase IV study enrolled patients ≥20 years old with OAB, as determined by an overactive bladder symptom score (OABSS) total score of ≥3 points and a Question 3 OABSS of ≥2 points, who were being treated with solifenacin at a stable dose of 2.5 or 5 mg once daily for at least 4 weeks.Study duration was 18 weeks, comprising a 2-week screening period and a 16-week treatment period. Patients meeting eligibility criteria continued to receive solifenacin (2.5 or 5 mg once daily), and additional mirabegron (25 mg once daily) for 16 weeks. After 8 weeks of treatment, the mirabegron dose could be increased to 50 mg if the patient's symptom improvement was not sufficient, he/she was agreeable to the dose increase, and the investigator judged that there were no safety concerns.Safety assessments included adverse events (AEs), laboratory tests, vital signs, 12-lead electrocardiogram (ECG), QT corrected for heart rate using Fridericia's correction (QTcF) interval and post-void residual (PVR) volume.Efficacy endpoints were changes from baseline in OABSS total score, overactive bladder questionnaire short form (OAB-q SF) score (symptom bother and total health-related quality of life [HRQL] score), mean number of micturitions/24 h, mean number of urgency episodes/24 h, mean number of incontinence episodes/24 h, mean number of urgency incontinence episodes/24 h, mean volume voided/micturition, and mean number of nocturia episodes/night. Patients were instructed to complete the OABSS sheets at week –2, 0, 8 and 16 (or at discontinuation), OAB-q SF sheets at week 0, 8 and 16 (or at discontinuation), and patient micturition diaries at week 0, 4,8,12 and 16 (or at discontinuation).ResultsOverall incidence of drug-related TEAEs was 23.3%. Almost all TEAEs were mild or moderate. The most common TEAE was constipation, with similar incidence in the groups receiving a dose increase to that observed in the groups maintained on the original dose.Changes in post-void residual volume, QTcF interval, pulse rate, and blood pressure were not considered to be clinically significant and there were no reports of urinary retention.Significant improvement was seen for changes in efficacy endpoints from baseline to end of treatment (EOT) in all groups (patients receiving solifenacin 2.5 or 5 mg + mirabegron 25 or 50 mg).Conclusions Add-on therapy with mirabegron 25 mg once daily for 16 weeks, with an optional dose increase to 50 mg at week 8, was well tolerated in patients with OAB treated with solifenacin 2.5 mg or 5 mg once daily.Significant improvements from baseline to EOT in OAB symptoms were observed with combination therapy with mirabegron and solifenacin.Add-on therapy with mirabgron and an antimuscarinic agent such as solifenacin may provide an attractive therapeutic option.
    BJU International 01/2015; DOI:10.1111/bju.13068 · 3.13 Impact Factor
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    ABSTRACT: To evaluate the efficacy and safety of imidafenacin (IM), a novel short half-life anticholinergic, as add-on therapy for male LUTS with nocturia and nocturnal polyuria.
    World Journal of Urology 09/2014; DOI:10.1007/s00345-014-1399-x · 3.42 Impact Factor
  • The Journal of Urology 04/2014; 191(4):e309. DOI:10.1016/j.juro.2014.02.754 · 3.75 Impact Factor
  • The Journal of Urology 04/2014; 191(4):e43. DOI:10.1016/j.juro.2014.02.204 · 3.75 Impact Factor
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    ABSTRACT: Objective To investigate the efficacy of fesoterodine vs placebo on nocturia, sleep disturbance, and sleep-related quality of life (QoL) in patients with overactive bladder and nocturia. Methods This posthoc analysis used data from a 12-week, randomized, placebo-controlled trial of fesoterodine 4 and 8 mg per day in Asian adults reporting ≥8 micturitions and ≥1 urgency urinary incontinence episodes per 24 hours at baseline. Patients who reported ≥1 nocturnal micturition/24 h were included in this analysis. Efficacy variables included change from baseline to week 12/end of treatment in nocturnal micturitions/24 h, nocturnal voided volume/micturition, and hours of undisturbed sleep. Sleep-related QoL was assessed using King's Health Questionnaire Sleep/Energy domain. Treatment comparisons were made using analysis of covariance. Results Among 555 patients, reductions in nocturnal micturitions with fesoterodine 4 mg (−0.63) and 8 mg (−0.77) were numerically greater vs placebo (−0.56), but differences were not significant (P >.05). When patients with a nocturnal polyuria index >33% were excluded, the decrease in nocturnal micturitions was significantly greater with fesoterodine 8 mg vs placebo (−0.24; P = .031). Increases in nocturnal voided volume/micturition were significantly greater with fesoterodine 4 (38.07 mL; P = .013) and 8 mg (42.05 mL; P <.001) vs placebo (14.89 mL). Hours of undisturbed sleep was significantly longer with fesoterodine 4 mg vs placebo (80 vs 54 minutes; P = .032); improvement in King's Health Questionnaire Sleep/Energy scores was significantly greater with fesoterodine 4 (P = .034) and 8 mg (P = .019) vs placebo. Conclusion These results suggest that fesoterodine may reduce nocturnal micturitions and improve sleep quality and QoL in overactive bladder patients with nocturia.
    Urology 04/2014; 83(4). DOI:10.1016/j.urology.2013.12.008 · 2.13 Impact Factor
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    ABSTRACT: The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) is the standard questionnaire that determines the degree of symptoms and efficacy of treatment in patients with chronic prostatitis/chronic pelvic pain syndrome. Because there was no officially approved Japanese version of the NIH-CPSI, the Japanese Urological Association (JUA) formed a committee to develop one chaired by Dr. Masayuki Takeda, who also chairs the special field of voiding function and neurourology in the JUA. Consequently, the committee produced a Japanese version, referring to previous proposals and the Japanese version of the International Prostate Symptom Score. The committee strongly expects that the Japanese version of the NIH-CPSI will be taken full advantage of in future clinical research.
  • The Journal of Urology 04/2014; 191(4):e6. DOI:10.1016/j.juro.2014.02.112 · 3.75 Impact Factor
  • The Journal of Urology 04/2014; 191(4):e48. DOI:10.1016/j.juro.2014.02.214 · 3.75 Impact Factor
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    ABSTRACT: To gain further evidence on the efficacy, safety and tolerability of tadalafil 5 mg once-daily in Asian men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Japanese and Korean men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia were randomized to once-daily tadalafil 5 mg (n = 306) or placebo (n = 304) for 12 weeks. A significantly greater improvement (P < 0.001) in total International Prostate Symptom Score for the change from baseline (week 0) to study end-point (week 12) was observed for tadalafil (-6.0) versus placebo (-4.5). Significantly greater improvements (P < 0.01) in total International Prostate Symptom Score for the change from baseline to weeks 4 and 8 were observed for tadalafil versus placebo. Significantly greater improvements (P < 0.05) in International Prostate Symptom Score voiding and storage subscores, and International Prostate Symptom Score Quality of Life Index were observed for the change from baseline to end-point for tadalafil versus placebo. Significantly greater improvements (P < 0.001) in urinary symptoms were observed for tadalafil versus placebo for both Patient and Clinician Global Impressions of Improvement. No new safety concerns were identified. These findings confirm the efficacy and safety profile of tadalafil 5 mg once-daily in Asian men with lower urinary tract symptoms suggestive of benign prostatic hyperplasia.
    International Journal of Urology 02/2014; 21(7). DOI:10.1111/iju.12410 · 1.80 Impact Factor
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    ABSTRACT: To evaluate the efficacy and safety of the β3 -adrenoceptor agonist, mirabegron, in a Japanese population with overactive bladder (OAB). This randomized, double-blind, placebo-controlled Phase III study enrolled adult patients experiencing OAB symptoms for ≥24 weeks. Patients with ≥8 micturitions/24 h and ≥1 urgency episode/24 h or ≥1 urgency incontinence episode/24 h were randomized to once-daily placebo, mirabegron 50 mg, or tolterodine 4 mg (as an active comparator, without testing for non-inferiority of efficacy and safety) for 12 weeks. Primary endpoint was change from baseline to final assessment in mean number of micturitions/24 h. Secondary endpoints included micturition variables related to urgency and/or incontinence and quality of life (QOL) domain scores on the King's Health Questionnaire (KHQ). Safety assessments included adverse events (AEs), post-void residual volume, laboratory parameters, vital signs, and 12-lead electrocardiogram (ECG). Registered at clinical trials.gov (NCT00966004). A total of 1139 patients were randomized to receive placebo (n = 381), mirabegron 50 mg (n = 380), or tolterodine 4 mg (n = 378). Demographic and baseline characteristics were similar across groups. At final assessment, mirabegron showed significant improvements vs placebo in mean [SD] change from baseline in number of micturitions/24 h (-1.67 [2.212] vs -0.86 [2.354]; P < 0.001) and in the secondary endpoints: number of urgency episodes/24 h (-1.85 [2.555] vs -1.37 [3.191]; P = 0.025), incontinence episodes/24 h (-1.12 [1.475] vs -0.66 [1.861]; P = 0.003), urgency incontinence episodes/24 h (-1.01 [1.338] vs -0.60 [1.745]; P = 0.008), volume voided/micturition (24.300 [35.4767] mL vs 9.715 [29.0864] mL; P < 0.001). The incidence of AEs in the mirabegron group was similar to placebo; most AEs were mild and none were severe. Mirabegron 50 mg once-daily is an effective treatment for OAB symptoms, with a low occurrence of side effects, in a Japanese population.
    BJU International 01/2014; 113(6). DOI:10.1111/bju.12649 · 3.13 Impact Factor
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    ABSTRACT: Purpose. To assess changes in lower urinary tract symptoms (LUTS) within 1 year after brachytherapy in patients receiving alpha 1-adrenoceptor antagonists. Methods. We retrospectively evaluated 116 patients who underwent (125)I prostate brachytherapy in our institute. Seventy-one patients were treated with a combination of external beam radiation therapy and brachytherapy. Alpha 1-adrenoceptor antagonists were prescribed to all patients after brachytherapy. International Prostate Symptom Score (IPSS) forms and postvoid residual urine volume were recorded at all follow-up visits. Results. Forty-nine patients were given tamsulosin hydrochloride, 32 were given silodosin hydrochloride, and 35 were given naftopidil for up to 6 months after seed implantation. Patients given tamsulosin or naftopidil tended to show a higher peak IPSS and slower recovery to baseline values than those given silodosin. The patients given naftopidil showed an insufficient recovery in storage symptoms in naftopidil group in comparison with tamsulosin group at 3 months and with silodosin group at 6 and 9 months. Conclusions. In the management of LUT after brachytherapy, silodosin may provide a more favorable improvement. Silodosin and tamsulosin may have an advantage in improving not only voiding but also storage lower urinary tract symptoms after brachytherapy.
    01/2014; 2014:140654. DOI:10.1155/2014/140654
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    ABSTRACT: We report a rare case of a solitary adrenal metastasis from small cell carcinoma of the urinary bladder that was successfully treated with surgical resection. A 71-year-old man was suffering from bladder tamponade for hematuria. Computed tomography (CT) revealed a bladder tumor at the left wall. The patients underwent radical cystectomy. Histopathological results were obtained in small cell carcinoma of the bladder with muscle invasion. Thus, he received two courses of adjuvant etoposide and cisplatin chemotherapy, followed by the regimen for small cell lung cancer. Seven months after surgery, follow-up CT showed a gradually enlarged mass enhanced heterogeneously in the right adrenal gland. There was a solitary adrenal metastasis without any other metastasis; therefore, we performed right laparoscopic adrenalectomy. The patient has remained uneventful for four years after the adrenal gland surgery. For patients who have a solitary adrenal metastasis, adrenalectomy may provide a survival benefit.
    12/2013; 2013:982787. DOI:10.1155/2013/982787
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    ABSTRACT: The study aims to assess the usefulness of PET with C-acetate and F-FDG to differentiate renal cell carcinoma (RCC) from complicated renal cysts. Thirty-one patients were enrolled, 14 patients with complicated renal cysts (12 with Bosniak III and 2 with Bosniak IV) and 17 patients with 19 solid renal tumors. The patients underwent both C-acetate PET and FDG PET. Nephrectomy or partial nephrectomy was performed after the PET scans. In 29 patients, 32 renal lesions were diagnosed as RCC. Twenty-three of the 32 RCCs (72%) had positive C-acetate PET findings, whereas only 7 FDG PET studies were positive (22%). Considering the relationship between tumor size measured by macroscopic appearance of resected tumors and PET results, 22 of 25 (88%) tumors more than 1.5 cm showed positive C-acetate PET findings. In 12 patients with Bosniak III renal cysts, 10 renal lesions were diagnosed as RCC. In this subgroup, 5 of the 10 RCCs (50%) had positive C-acetate PET findings, whereas 2 RCCs (20%) had positive FDG PET findings. None of the cases with benign findings had positive C-acetate PET or FDG PET scans. C-acetate PET demonstrates a pronounced increase in tracer uptake in RCC, especially in renal tumors more than 1.5 cm, and displays a higher sensitivity than FDG PET. These preliminary data show that C-acetate may be a useful PET tracer to exclude RCC in complex renal cysts.
    Clinical nuclear medicine 11/2013; DOI:10.1097/RLU.0000000000000287 · 2.86 Impact Factor
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    ABSTRACT: Two cases of epithelioid angiomyolipoma of the kidney are reported. A 62-year-old female with incidental left renal tumor underwent laparoscopic leftpartial nephrectomy under a diagnosis of renal cell carcinoma. A pathological examination revealed epithelioid angiomyolipoma. The second case was that of a 35-year-old female with back pain. A laparoscopic right nephrectomy revealed epithelioid angiomyolipoma. This recently identified variant of angiomyolipoma is sometimes associated with aggressive clinical behavior including local recurrence and metastasis.
    Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology 11/2013; 104(6):712-5. DOI:10.5980/jpnjurol.104.712
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    ABSTRACT: To evaluate the efficacy and safety of magnetic stimulation for the treatment of urinary incontinence in women with overactive bladder. A total of 151 women with urgency incontinence were randomized to the active stimulation group or the sham stimulation group in a 2:1 order. An armchair type magnetic stimulator was used for 25-min magnetic stimulation twice a week, with the maximum magnetic flux density of 560 mT peak at 10 Hz. The sham device was set to deliver in a 5-s "on"-5-s "off" pulsing manner with the maximum intensity of 20.4% of active stimulation at 1 Hz. The study consisted of a baseline period for 1 week, and a treatment period for 6 weeks. The primary end-point was the number of leaks/week from the bladder diary. The secondary end-points were the number of voids and urgency/24 h, mean and maximum voided volume, and the quality of life assessment. Changes from baseline in the active and sham group, respectively, were -13.08 ± 11.00 and -8.68 ± 13.49 in leaks/week (P = 0.038), -2.65 ± 2.52 and -1.53 ± 2.39 in number of urgency/24 h (P = 0.011), and 14.03 ± 34.53 mL and -4.15 ± 40.60 mL in mean voided volume (P = 0.0056). As for safety, except for diarrhea and constipation, no patients experienced any device-related adverse event. Magnetic stimulation is effective for the treatment of urgency incontinence in female patients with overactive bladder.
    International Journal of Urology 10/2013; 21(4). DOI:10.1111/iju.12289 · 1.80 Impact Factor
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    ABSTRACT: To investigate patient satisfaction with antimuscarinic treatment of overactive bladder syndrome, and to identify factors having a significant influence on satisfaction. A cross-sectional questionnaire survey was carried out to assess treatment satisfaction among male and female patients with overactive bladder (age ≥20 years) in the Hokuriku district of Japan. The overactive bladder symptom scores, treatment efficacies, adverse events (dry mouth and constipation), and patient satisfaction scores were investigated and compared among patients using different antimuscarinic therapeutics. In total, 977 survey respondents (52.6% men; mean age 73.6 years) received antimuscarinic treatment. The mean overactive bladder symptom score of these patients was 6.17; in addition, 32.3% patients were satisfied with their treatment, but 33.1% were dissatisfied. Factors having a significant influence on treatment satisfaction were sex (men were less satisfied), efficacy, adverse events and the overactive bladder symptom score. Constipation negatively influenced patient satisfaction to a greater extent than did dry mouth. Patient satisfaction varied according to the drug used. Constipation was less severe with the immediate-release-type agents (imidafenacin and oxybutynin) than with the extended-release-type (propiverine, solifenacin or tolterodine). Just one-third of Japanese Hokuriku patients with overactive bladder seem to be satisfied with their antimuscarinic treatment. Patient satisfaction is impaired by poor efficacy and the presence of adverse events; furthermore, constipation should be recognized as an adverse event that negatively influences patient satisfaction to a greater extent than dry mouth. Patient satisfaction differs according to the antimuscarinic agent used, with higher patient satisfaction being associated with less severe constipation.
    International Journal of Urology 10/2013; 21(4). DOI:10.1111/iju.12298 · 1.80 Impact Factor
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    ABSTRACT: Two distinct α1 -adrenoceptor phenotypes (α1A and α1L ) have been recently demonstrated to originate from a single α1A -adrenoceptor gene. Here, we examined the agonist profiles of recombinant α1A and α1L phenotypes and of lower urinary tract (LUT) α1 -adrenoceptors. Recombinant α1A - and α1L -adrenoceptor phenotypes were stimulated with various drugs, and the potency and intrinsic activity were estimated from the evoked Ca2+ responses. Agonist-induced contractions were also examined in LUT tissues of rats and humans and in the human mesenteric artery and rat tail artery. A series of drugs (A61603, Ro 115-1240, NS-49, MK017, and ESR1150) that had been developed for stress urinary incontinence (SUI) therapy showed high agonist activity for the α1A -adrenoceptor phenotype compared to the α1L -adrenoceptor phenotype. Among them, Ro 115-1240 was an α1A -specific partial agonist that produced partial contractions through α1A -adrenoceptors in rat prostate and tail artery but not in the other LUT tissues and human mesenteric artery. On the other hand, P-come 102 showed full agonist activity at α1A - and α1L -adrenoceptors and was less selective than noradrenaline for the α1A -adrenoceptors. P-come 102 induced contraction all of the tested LUT tissues with high potency, like noradrenaline. However, the potency and intrinsic activity of P-come 102 were significantly lower than those of noradrenaline in human mesenteric artery. Distinct agonist profiles were observed between α1A - and α1L -adrenoceptor phenotypes and LUT α1 -adrenoceptors. As adrenergic contractions in LUT are predominantly mediated through α1L -adrenoceptors, the development of α1L -selective agonists may prove useful for SUI therapy.
    British Journal of Pharmacology 09/2013; 170(6). DOI:10.1111/bph.12403 · 4.99 Impact Factor

Publication Stats

2k Citations
436.05 Total Impact Points

Institutions

  • 2004–2015
    • University of Fukui
      • Division of Urology
      Hukui, Fukui, Japan
  • 2013
    • National Institute of Radiological Sciences
      • Molecular Imagining Center
      Tiba, Chiba, Japan
  • 2011
    • Nagoya City University
      Nagoya, Aichi, Japan
    • Fukushima Medical University
      • Department of Urology
      Hukusima, Fukushima, Japan
    • Nagoya University
      • Division of Urology
      Nagoya-shi, Aichi-ken, Japan
  • 2010
    • Shinshu University
      Shonai, Nagano, Japan
  • 2003–2006
    • Fukui University
      Hukui, Fukui, Japan
    • Fukui General Hospital
      Hukui, Fukui, Japan
  • 2000–2006
    • Kanazawa Medical University
      • Department of Urology
      Kanazawa-shi, Ishikawa-ken, Japan
  • 1988–2006
    • Kanazawa University
      • • Department of Urology
      • • School of Medicine
      Kanazawa, Ishikawa, Japan
  • 2000–2003
    • University of Pittsburgh
      • School of Medicine
      Pittsburgh, Pennsylvania, United States