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ABSTRACT: We present a patient with a urachal cyst manifesting unique symptoms, which was successfully treated by laparoscopic excision and segmental resection of the bladder using a harmonic scalpel.
07/2009; 9(1):31-34.
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ABSTRACT: We assessed the impact of bother with urinary and bowel dysfunction on social activities among men in Japan and the United States following primary therapy for localized prostate cancer. In paired longitudinal outcomes studies, we measured general and disease-specific health-related quality of life in 400 Japanese and 427 American men who underwent radical prostatectomy or brachytherapy for localized prostate cancer. Outcomes included the social function domain of the Medical Outcomes Study Short Form-36 and the University of California, Los Angeles Prostate Cancer Index, all of which are scored 0-100. Participants completed the questionnaires before and 1, 12 and 24 months after treatment. Among men who reported any urinary bother, Japanese men had slightly better urinary function than American men (84 vs 77, P<0.01). Before brachytherapy, urinary bother was weakly correlated with social function in both the countries; after brachytherapy, urinary bother was strongly correlated with social function in American but not Japanese men. After brachytherapy, bowel dysfunction had a stronger correlation with social function in American than Japanese men (P<0.05). The bother associated with urinary and bowel dysfunction after surgery or brachytherapy for prostate cancer has a greater impact on social function in American men than in Japanese men.
Prostate cancer and prostatic diseases 04/2008; 12(1):67-71. · 2.10 Impact Factor
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ABSTRACT: We conducted a cross-cultural comparison of the recovery of sexual function and bother during the first 2 years after radical prostatectomy (RP) between American and Japanese men. A total of 275 Japanese and 283 American men who underwent RP alone were prospectively enrolled into longitudinal cohort studies of health-related quality of life outcomes. Sexual function and bother (distress) were estimated with English and validated Japanese versions of the UCLA Prostate Cancer Index before RP and 1, 2-3, 4-6, 12, 18 and 24 months after RP. Each subject served as his own control. Japanese men reported lower sexual function scores at baseline, even after adjusted for age, prostate-specific antigen (PSA) and comorbidity (38 vs 61, P<0.001). The two groups had similar baseline sexual bother (70 vs 69, P=0.84). Japanese men had a smaller improvement in sexual function (beta=0.8 vs beta=5.3) and bother (beta=0.2 vs beta=2.9) over time than did the American men postoperatively, after adjusting for baseline score, age, baseline PSA and nerve-sparing. American men were more likely than Japanese men to regain their baseline sexual function by 24 months after surgery (hazard ratio (HR)=1.60; 95% confidence interval (CI)=1.06-2.42). In contrast, American men were less likely than Japanese men to return to baseline sexual bother (HR=0.57; 95% CI=0.44-0.75). This study demonstrates that Japanese and American men experience different patterns of recovery of their sexual function and bother after RP. Ethnicity may be a contributing factor.
Prostate cancer and prostatic diseases 10/2007; 11(3):298-302. · 2.10 Impact Factor
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M Usami,
H Akaza, Y Arai,
Y Hirano,
S Kagawa,
H Kanetake,
S Naito,
Y Sumiyoshi,
Y Takimoto,
A Terai,
H Yoshida,
Y Ohashi
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ABSTRACT: To compare combination therapy with bicalutamide 80 mg and a luteinizing hormone-releasing hormone agonist (LHRH-A) versus LHRH-A alone in Japanese men with untreated advanced prostate cancer. A total of 205 patients with stage C/D prostate cancer were randomized to either LHRH-A+once-daily oral bicalutamide 80 mg or placebo. Primary study variables have been reported previously. Secondary variables included: time to achieve prostate-specific antigen < or = 4 ng/ml, time-to-treatment failure (TTTF), time-to-disease progression (TTP), overall survival (OS), adverse events and adverse drug reactions. Following combination therapy with bicalutamide 80 mg, there were significant (P<0.001) advantages over LHRH-A alone in terms of TTTF and TTP, but the difference in the interim OS was not statistically significant. First-line combination therapy with bicalutamide 80 mg in Japanese patients with advanced prostate cancer offers significant benefits over LHRH-A alone, with respect to TTTF and TTP. Follow-up for OS continues.
Prostate Cancer and Prostatic Diseases 02/2007; 10(2):194-201. · 2.42 Impact Factor
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ABSTRACT: We assessed the longitudinal alteration of the quality of life (QOL) of patients with localized prostate cancer after radical prostatectomy or hormonoradiotherapy during 3-y follow-up. In addition, we examined the impact on QOL of initiation of second treatment after failure of primary treatment. In all, 135 patients with localized prostate cancer who underwent radical retropubic prostatectomy (RP) (N=84) or external beam radiotherapy with neoadjuvant hormone (XRT) (N=51) at our institute and who had a minimum follow-up of 3 y were included in this study. Data were collected prospectively, at baseline, at 3 months after treatment, at 1 y, and annually thereafter. QOL, generic and disease-targeted was evaluated using the European Organization for Research and Treatment of Cancer Prostate Cancer QOL Questionnaire, the Sapporo Medical University Sexual Function Questionnaire, the International Prostate Symptom Index Quality of Life Score and similar questions regarding bowel function. Repeated-measures ANOVA revealed significantly different patterns of alteration in the domains of QOL, with the exception of several domains, between the RP and XRT groups. Rapid decline of sexual function and increase in sexual bothersomeness were followed by slight amelioration throughout follow-up in the RP group, and did not change thereafter in the XRT group. Overall satisfaction with urinary condition significantly improved after treatment and that with bowel condition was stable during follow-up in both of the groups. Failure of primary treatment and initiation of salvage treatment had no impact on QOL. This prospective study revealed longitudinal alteration of QOL status of patients undergoing treatment for localized prostate cancer, but did not yield any conclusions regarding effect of treatment failure and second treatment on QOL due to small sample size. It should be noted that different instruments for assessment of QOL can generate different outcomes.
Prostate Cancer and Prostatic Diseases 02/2004; 7(2):144-51. · 2.42 Impact Factor
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ABSTRACT: Background: The use of complementary/alternative medicine (CAM) has recently received considerable attention throughout the world. We
evaluated the prevalence and predictors of CAM use among Japanese patients with localized prostate cancer.
Methods: A total of 177 patients with localized prostate carcinoma underwent radical retropubic prostatecotomy or external beam radiation
therapy between January 1994 and January 2001. Of them, 138 (78%) answered a self-administered questionnaire on CAM use and
were eligible for this study. The overall prevalence, types of CAM used, and costs of CAM were assessed. The effects of age,
prostate-specific antigen (PSA) level, clinical stage, pretreatment Gleason score, patients' income, patients' final educational
status, and general health-related quality of life at baseline and 1 year after treatment, as estimated using the European
Organization for Research and Treatment of Cancer Prostate Cancer Quality of Life Questionnaire on the prevalence of CAM use,
were evaluated.
Results: Twenty-seven patients (20%) had once used or had been using some types of CAM. Herbal medicine and vitamins were the most
common types of CAM used. Preoperative Gleason score was significantly associated with CAM use, as determined by the χ2 test (P = 0.0198), and PSA level and posttreatment physical function domain were marginally associated with CAM use, as determined
by the Mann-Whitney U-test (P = 0.0734 and P = 0.0597, respectively). Patient age, income, and final educational status had no impact on CAM use.
Conclusion: A relatively small proportion of Japanese patients with localized prostate cancer have tried CAM compared with the proportions
of patients described in previous reports from Western countries.
International Journal of Clinical Oncology 01/2003; 8(1):0026-0030. · 1.41 Impact Factor
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ABSTRACT: Methods: The Japanese version (version 1.2) of the UCLA PCI was developed through a process of translation, back-translation, and
refinement after interviewing patients. Reliability and validity were examined for 125 Japanese patients with localized prostate
cancer. The patients simultaneously responded to the Japanese version of the RAND 36-Item Health Survey (SF-36) and five representative
questions from the International Index of Erectile Function (IIEF).
Results: Internal consistency reliability was very high for both urinary and sexual function scales, and lower for bowel function.
The test-retest reliability of the urinary and sexual function scales and the urinary bother scales was stable, while that
of the bowel function and bother scales was relatively unstable. Sexual function scores did not correlate highly with sexual
bother scores. Furthermore, poor sexual function and bother had little association with the SF-36 scores. Missing data as
to urinary and bowel function/bother scales were minimal (0.8%–2.4%), while those for sexual function and bother were relatively
high (4.8%–11.2%).
Conclusions: The results of this pilot study, together with the previous American study, suggest ethnic or cultural difference in how
impaired sexual function is integrated into overall QOL. A future cross-cultural comparative study using the UCLA PCI and
SF-36 will provide useful information about the influence of cultural or ethnic differences on health-related QOL in prostate
cancer patients.
International Journal of Clinical Oncology 09/2002; 7(5):0306-0311. · 1.41 Impact Factor
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BJU International 07/2002; 89(9):964-6. · 2.84 Impact Factor
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ABSTRACT: To investigate whether the volume-weighted mean nuclear volume (MNV, the only means by which unbiased estimates of three-dimensional variables can be obtained from a two-dimensional section by stereological methods) at diagnosis correlates with tumour biology and clinical behaviour in patients with prostate cancer treated by watchful waiting.
In a prognostic study, 64 patients with clinically localized prostate cancer were followed prospectively with initial expectant management. The median (mean, range) follow-up was 22 (27, 6.0-68) months. The prostate specific antigen (PSA) doubling time (PSADT) was calculated by linear regression. The MNV was estimated using biopsy specimens, based on a stereological method, and compared with PSADT and traditional clinicopathological variables.
PSADT was significantly associated with MNV, but not with other clinicopathological variables. The PSA 'rapid-riser' subset (PSADT<median value) had significantly larger MNVs than did the PSA 'slow-riser' (PSADT>or=median value) and PSA-stable subsets (P = 0.0017 and 0.004, respectively). On multivariate analysis using a stepwise Cox proportional hazards regression, only MNV remained independently significant as a predictor of clinical progression among the clinicopathological variables (P < 0.001).
These findings suggest that cancer cell nuclear volume is significantly associated with tumour biology and behaviour in patients with prostate cancer. Although further study with a larger patient population is needed to confirm the findings, estimates of MNV may be an important prognostic indicator in men treated with watchful waiting.
BJU International 12/2001; 88(9):909-14. · 2.84 Impact Factor
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ABSTRACT: To assess the long-term efficacy of intrarenal bacillus Calmette-Guérin (BCG) therapy for the treatment of cytologically diagnosed upper tract carcinoma in situ (CIS) and report the time course in cases of failure.
Fourteen renal units in 11 patients cytologically diagnosed as having upper urinary tract (UUT) CIS were treated with intrarenal BCG instillation. The BCG solution was administered by retrograde ureteric catheterization weekly for 6 weeks.
Seven units were radiologically and cytologically free of disease at a median follow-up of 60 months. Two units which showed an initial response had recurrence with ipsilateral UUT CIS. The remaining five units did not respond to BCG. Of seven units with an initial negative response or recurrent UUT CIS, nephroureterectomy was undertaken in one because of coincidental renal cell carcinoma. In four of the remaining six units, invasive pelvic tumour developed at a mean follow-up of 20.5 months after the final instillation. Computed tomography showed wall thickening of the renal pelvis in two and mass-forming tumour in the renal parenchyma mimicking renal cell carcinoma in two. In three of these four cases, retrograde pyelography did not show typical findings of renal pelvic tumour, e.g. filling defect, infundibular obstruction or stenosis.
Intrarenal BCG is effective in the treatment of UUT CIS in a long-term follow-up. In cases with a poor response or ipsilateral recurrence of CIS, there is a high risk of developing invasive tumour. Close follow-up using computed tomography is recommended because of the atypical radiographic findings of such tumours.
BJU International 10/2001; 88(4):343-7. · 2.84 Impact Factor
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ABSTRACT: Laparoscopic partial nephrectomy is a challenging procedure due to the risk of excessive bleeding. We evaluated the usefulness of a microwave tissue coagulator during laparoscopic partial nephrectomy for small renal tumor.
From January to July 2000, 6 patients with small renal tumors, from 11 to 25 mm. in diameter, underwent laparoscopic partial nephrectomy with a microwave tissue coagulator without renal pedicle clamping. There were 4 patients who underwent the transperitoneal and 2 who underwent the retroperitoneal approaches.
Mean operating time was 186 minutes (range 131 to 239), and blood loss was minimal. Complications were mild and tolerable, and there was no significant deterioration of renal function.
Laparoscopic partial nephrectomy with a microwave tissue coagulator is a useful and less invasive method for treatment of select small renal tumors. Long-term followup of patients is warranted to determine the potential for cancer control with this method.
The Journal of Urology 07/2001; 165(6 Pt 1):1893-6. · 3.75 Impact Factor
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ABSTRACT: To assess the staging accuracy and detection of neurovascular bundle involvement by dynamic subtraction contrast-enhanced endorectal magnetic resonance imaging (MRI) in patients with localized prostate cancer.
In 38 patients with biopsy-proven prostate cancer, endorectal MRI was performed on a 1.5-Tesla magnetic resonance system using the dynamic technique with gadolinium-diethylenetriaminepentaacetic acid bolus enhancement. Two radiologists prospectively assessed the tumor involvement, localization, capsular penetration, seminal vesicle invasion, and neurovascular bundle involvement. All patients subsequently underwent radical prostatectomy, and the MRI findings were correlated with the histopathologic results.
The overall accuracy of detecting cancer localization in the prostate was 72%. The detection of involvement in the peripheral zone had an 80% accuracy rate, but for lesions in the transition zone, the rate was 63%. The sensitivity and specificity of tumor detection was 81% and 79% for peripheral zone cancers and 37% and 97% for transition zone cancers, respectively. The accuracy rate, was 84%, 97%, and 97% for the detection of capsular penetration, seminal vesicle invasion, and neurovascular bundle involvement, respectively.
Prostatic MRI with an endorectal surface coil using the dynamic technique more accurately detected tumor localization, capsular penetration, seminal vesicle invasion, and neurovascular bundle involvement than previously reported methods. The detection of tumor localization was more accurate in the peripheral zone than in the transition zone. This technique may be useful for the selection of patients for radical prostatectomy and, particularly, for identifying candidates for nerve-sparing surgery.
Urology 05/2001; 57(4):721-6. · 2.43 Impact Factor
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ABSTRACT: Although preoperative autologous blood donation (PAD) is accepted as a standard of care for radical prostatectomy, it is costly, time-consuming and has risks associated with blood storage. Acute normovolemic hemodilution (ANH) is reported to be less expensive and to preserve blood components more effectively than PAD. In the present study, the efficacy and safety of these two autologous blood-collection techniques were compared.
The study included 16 consecutive patients scheduled for radical prostatectomy. The first eight patients underwent conventional preoperative autologous blood donation of 400 mL 1 week before the operation (PAD group) and the second eight patients underwent acute normovolemic hemodilution followed by immediate operation (ANH group). All blood collected was transfused in the perioperative period. Preoperative and postoperative hematocrit levels in these two groups were compared.
There were no differences in preoperative hematocrit, time of operation or operative blood loss between the two groups. In the ANH group, 1080 +/- 160 mL of blood were collected. The postoperative hematocrit level did not differ significantly between the groups. No patient in either group received allogeneic blood transfusion or experienced an adverse event directly related to blood transfusion.
The two blood-conservation strategies resulted in similar postoperative hematologic outcomes. Given its advantages, which include lower cost, lower risk and higher convenience, ANH is one of the procedures that may replace conventional PAD for use in radical prostatectomy.
International Journal of Urology 05/2001; 8(4):149-52. · 1.75 Impact Factor
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ABSTRACT: To evaluate the clinical efficacy and durability of transurethral microwave thermotherapy (TUMT) in the treatment of benign prostatic hyperplasia. The clinical variables useful in predicting outcome were identified.
From October 1996 to March 2000, 58 patients with symptomatic benign prostatic hyperplasia were treated with TUMT using the Urowave device. Treatment outcome was evaluated by the International Prostate Symptom Score (IPSS), quality-of-life assessment score, and urodynamic investigation. The patients were divided into those having a good and poor response on the basis of the degree of IPSS decrease at 3 months.
The mean IPSS significantly decreased from 19.2 at baseline to 13.3 at 3 months (P <0.0001). The mean quality-of-life score changed from 4.6 at baseline to 2.9 at 3 months (P <0.0001). No statistically significant differences in peak flow rate, postvoid residual volume, Schäfer's obstruction scale, or detrusor pressure at peak flow were noted before or after TUMT. The pretreatment IPSS of the good response group was significantly higher than that of the poor response group (P=0.017). A more significant difference was obtained for the obstructive score (P = 0.002), and no difference was observed in the irritative score (P = 0.631). The Schäfer grading scale score of the good response group was significantly smaller than that of the poor response group (P = 0.047).
TUMT with the Urowave was effective in eliminating symptoms associated with benign prostatic hyperplasia, but did not markedly improve the objective voiding parameters. Patients with urodynamically less obstructive symptoms but subjectively more obstructive symptoms are therefore probably good candidates for TUMT.
Urology 04/2001; 57(4):701-5; discussion 705-6. · 2.43 Impact Factor
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ABSTRACT: Cutaneous ureterostomy is a less invasive method of urinary diversion and an attractive option especially in patients at high risk. We retrospectively examined the long-term outcome of the method introduced by Toyoda.
Since 1983 the Toyoda cutaneous ureterostomy has been performed in 61 patients (103 renal units) with a minimum of 3 months of followup. The ureteral patency rate was reviewed.
Of the 92 renal units (89%) that achieved a tubeless condition 53 (51%) had no hydronephrosis, 23 (22%) had mild to moderate hydronephrosis without the need for treatment, 14 (14%) were not evaluated during followup and 2 (2%) were removed due to subsequent renal pelvic and/or ureteral carcinoma.
A high ureteral patency rate was achieved with the Toyoda cutaneous ureterostomy. This procedure is a reasonable alternative to other forms of urinary diversion.
The Journal of Urology 04/2001; 165(3):785-8. · 3.75 Impact Factor
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ABSTRACT: Estimates of volume-weighted mean nuclear volume (MNV) are the only means by which unbiased estimates of three-dimensional parameters can be obtained from a single two-dimensional section, with stereological methods. The present study was conducted to elucidate the role of MNV in predicting tumor biology for patients treated with radical prostatectomy.
A retrospective prognostic study of 71 patients with T1/T2 disease, treated with radical prostatectomy alone, was performed. MNV was estimated using biopsy specimens based on a stereological method, and was compared with other preoperative clinical variables. For patients with prostate-specific antigen (PSA) failure, we determined the correlation of MNV with PSA doubling time (PSA DT) which was calculated using PSA values obtained with an ultrasensitive assay.
Mean MNVs for pathologically organ-confined and non-organ-confined tumors were 198.9 and 236.3 microm3, respectively; this difference was significant (P = 0.0364). Univariate analysis showed that PSA, MNV, and Gleason score were significant predictors of prognosis (P = 0.0126, 0.0148, and 0.0375, respectively). Multivariate analysis revealed that MNV and preoperative PSA were powerful independent predictors of prognosis (P = 0.0160 and P = 0.0147, respectively), but the Gleason score was not correlated with prognosis (P = 0.4120). For patients with PSA failure, PSA DT was significantly correlated with MNV (r = -0.597, P = 0.0099). When these patients were classified using median PSA DT at 6 months into two groups, MNV was significantly greater in PSA rapid-riser group than in the slow-riser group (P = 0.0008), but no differences were observed between these groups in PSA, the Gleason score, or cancer volume.
The findings of the present study suggest that MNV is a powerful predictor of PSA failure for patients with clinically organ-confined disease treated with radical prostatectomy. More importantly, they suggest that MNV can be a useful new parameter for prediction of tumor biology for patients with PSA failure after radical prostatectomy.
The Prostate 03/2001; 46(2):134-41. · 3.48 Impact Factor
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Prostate cancer and prostatic diseases 01/2001; 3(S1):S4. · 2.10 Impact Factor
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Prostate cancer and prostatic diseases 01/2001; 3(S1):S11. · 2.10 Impact Factor
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ABSTRACT: The number of cases of stage T1c prostate cancer has dramatically been increasing since the introduction of PSA as a screening test. The patients with T1c prostate cancer are usually treated by radical prostatectomy. In this group, however, some cancers are of small tumor volume and with a Gleason score of less than 7. These cancers are considered to be good candidates for watchful waiting management. We have investigated 40 patients with T1c prostate cancer treated by radical prostatectomy between 1996 and 1998. All 9 patients harboring tumors of Gleason score 7 or greater had tumors larger than 0.5 cm3. We have investigated PSA-related parameters including total PSA (PSA), PSA density (PSAD), free PSA, and % free PSA in 31 patients with T1c cancers of Gleason score 6 or less in order to clarify good preoperative predictors of tumor volume. We compared the distribution of PSA, PSAD, free PSA, and % PSA between the larger and smaller tumor groups. There was no significant difference in PSA, PSAD, or free PSA value. The small tumor group had a greater mean % free PSA than the larger tumor group (23.27 versus 11.88, p = 0.007). Areas under receiver operating characteristic curves were 0.715, 0.794, 0.636, and 0.842 for PSA, PSAD, free PSA and % free PSA. In stage T1c prostate cancer of Gleason score 6 or less, % free PSA may be the most useful preoperative predictor for tumor volume of 0.5 cm3 or greater.
Hinyokika kiyo. Acta urologica Japonica 12/2000; 46(11):785-90.
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ABSTRACT: Treatment for benign prostatic hyperplasia (BPH), including minimally invasive therapy, can impair the quality of life. We prospectively determined the impact of 4 different interventional therapies on quality of life and sexual function.
A total of 173 patients were prospectively evaluated between February 1995 and August 1997. Treatment modalities consisted of standard transurethral resection of the prostate in 55 cases, transurethral microwave thermotherapy in 34, interstitial laser coagulation of the prostate in 42 and transurethral needle ablation in 42. Disease specific quality of life was assessed using the International Prostate Symptom Score quality of life assessment index and BPH impact index. In addition, a self-reporting questionnaire was completed before and 3 months after treatment to determine the impact on sexual function.
All 4 treatment groups showed significant improvement in the symptom score, International Prostate Symptom Score quality of life assessment score and BPH impact index score. Satisfaction with treatment was highest in patients treated with transurethral resection or laser coagulation. A mild to moderate decrease in erectile function was noted in 26.5%, 18.2%, 18.4% and 20.0% of the transurethral resection, microwave thermotherapy, laser coagulation and needle ablation groups, respectively, but there was no significant difference of mean pretreatment and posttreatment erectile function or libido scores in any group. Ejaculation loss or severe decrease in ejaculate volume was reported by 48.6%, 28.1%, 21.6% and 24.3% of the patients, respectively. Interestingly, 20 of the 44 patients (45. 5%) with loss of ejaculation or severe decrease in ejaculate reported deterioration of the sex life, while only 2 (3.6%) of the 56 without any change in ejaculate volume reported such deterioration. The association of ejaculatory dysfunction with an adverse impact on sexual activity was highly significant (p <0.0001).
Significant improvement in quality of life could be achieved with the present assessed interventional therapies. There was no significant change in sexual desire or erectile function with these therapies. Posttreatment sexual dysfunction appears to be mainly related to impaired ejaculatory function. Urologists should provide proper counseling regarding the possibility of this complication even in patients receiving minimally invasive treatment.
The Journal of Urology 10/2000; 164(4):1206-11. · 3.75 Impact Factor
