Yasuhiko Igawa

The University of Tokyo | Todai · Department of Continence Medicine

Persistence of urinary incontinence (UI) after robot-assisted radical prostatectomy (RARP) is a bothersome problem because of its negative effect on the patient's quality of life (QOL). This study aimed to evaluate the effect of transperineal ultrasound (TPUS)-guided pelvic floor muscle training (PFMT) on prolonged UI after RARP. Thirty men with st...

Objectives: To evaluate the outcomes of partial and total cystectomy in patients with refractory Hunner-type interstitial cystitis (HIC). Methods: Patients with end-stage HIC who underwent supratrigonal partial cystectomy with augmentation ileocystoplasty (PC-CP) or total cystectomy with ileal conduit (TC-IC) were identified retrospectively. Cha...

Background: The effectiveness of point-of-care ultrasound (POCUS) for nurses has been demonstrated; however, only a limited number of nurses have been trained to perform POCUS. This article reports on a POCUS train-the-trainer program for nurse educators that targets lower urinary track dysfunction. Method: Nurse educators (n = 38) were invited...

Cystectomy is an ultimate treatment option for patients with end-stage Hunner-type interstitial cystitis (HIC). However, pertinent information regarding this procedure such as optimal candidate selection, surgical procedures, possible complications, and treatment prognosis, is limited owing to its extremely low prevalence. We report outcomes of 17...

Background Vulvar Paget’s disease (VPD) is a rare malignant disorder originating in the external genitalia. It occasionally invades into urethral or vaginal mucosa of female, making surgical treatment more complicating. In case of urethral invasion of Paget’s cells, systematic mapping biopsy of urethral mucosa is the standard of care to determine t...

Objective: To study the role of transient receptor potential melastatin 2 in bladder function and inflammation-associated hypersensitivity. Methods: We evaluated physiological function of the bladder and intravesical lipopolysaccharide-induced inflammatory nociceptive responses in female wild-type and transient receptor potential melastatin 2-kn...

Objectives To compare the clinical characteristics of three groups of female patients with interstitial cystitis/bladder pain syndrome (IC/BPS) classified according to the presence or absence of Hunner lesions (HL) and glomerulations. Methods The clinical records of 100 female patients with IC/BPS who underwent their first bladder hydrodistension...

We evaluated pathophysiological characteristics of the lower urinary tract dysfunction in a streptozotocin (STZ)-induced diabetic rat model. STZ (60 mg/kg) was injected intraperitoneally into male Wistar rats. In vitro bladder muscle strip experiments, in vivo cystometry, and simultaneous recordings of bladder pressure + urethral perfusion pressure...

Transient receptor potential melastatin 8 (TRPM8) is a temperature-sensing ion channel mainly expressed in primary sensory neurons (Aδ-fibers and C-fibers in the dorsal root ganglion). In this report, we characterized KPR-5714 (N-[(R)-3,3-difluoro-4-hydroxy-1-(2H-1,2,3-triazol-2-yl)butan-2-yl]-3-fluoro-2-[5-(4-fluorophenyl)-1H-pyrazol-3-yl]benzamid...

The present article is an abridged English translation of the Japanese clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury updated as of July 2019. The patients are adult spinal cord injured patients with lower urinary tract dysfunction; special consideration of pediatric and el...

Purpose of Review Interstitial cystitis (IC) and IC-related conditions such as painful bladder syndrome (PBS), bladder pain syndrome (BPS), and hypersensitive bladder (HSB) have a similar symptomatic profile but probably different etiologies. A reasonable classification of these diseases/conditions is mandatory for clinical and investigational prog...

Objective: This analysis was conducted to investigate the cardiovascular (CV) safety outcomes from the MILAI II study. MILAI II was conducted to evaluate the long-term safety and efficacy of antimuscarinic add-on therapy to mirabegron over 52 weeks in patients with overactive bladder (OAB) symptoms. Methods: MILAI II consisted of a 2-week screen...

Aims To clarify longitudinal change of lower urinary tract symptoms (LUTS) and various types of urinary incontinence following robot‐assisted radical prostatectomy (RARP) using validated questionnaires. Materials and methods The core lower urinary tract symptom score (CLSS) and the International Consultation on Incontinence Questionnaire (ICIQ)‐Sh...

Purpose: We systematically characterized gene expression, inflammation and neovascularization in patients with interstitial cystitis/bladder pain syndrome to obtain biological evidence supporting diagnosis and classification. Materials and methods: We sequenced RNA obtained from bladder mucosal biopsies of 33 patients with 3 subtypes of intersti...

Objective This study examined the accuracy of a new portable ultrasound bladder scanner, the Lilium α‐200 (Lilium Otsuka, Kanagawa, Japan), by evaluating the correlation between bladder volumes periodically measured by the Lilium α‐200 and instilled volume during video‐urodynamic studies (V‐UDS). Methods Using the Lilium α‐200, fluid volume was me...

β 3 ‐Adrenoceptor agonists are used in the treatment of overactive bladder syndrome. Although the relaxant response to adrenergic stimulation in human detrusor smooth muscle cells is mediated mainly via β 3 ‐adrenoceptors, the plasma concentrations of the therapeutic dose of mirabegron, the only clinically approved β 3 ‐adrenoceptor agonist, are co...

Aims To determine whether ultrasound‐assisted prompted voiding (USAPV) care is more efficacious than conventional prompted voiding (CPV) care for managing urinary incontinence in nursing homes. Methods Thirteen participating nursing homes in Japan were randomized to CPV (n = 7) or USAPV care group (n = 6). Residents of the allocated nursing homes...

Neurogenic lower urinary tract dysfunction (NLUTD) is a heterogeneous combination of symptoms and urodynamic findings that are the result of neurological injury to the bladder (Fig. 27.1) [1–4]. The patterns of bladder storage and voiding disturbances depend on the lesion of neurologic lesion (Fig. 27.2). Patients often have incontinence, urgency,...

Storage and elimination of urine are dependent upon the coordinated activity of two functional units in the lower urinary tract; the urinary bladder and its outlet, which are innervated by three sets of peripheral nerves: sacral parasympathetic (pelvic nerves), thoracolumbar sympathetic (hypogastric nerves and sympathetic chain) and sacral somatic...

Bladder afferent nerves are composed by myelinated Aδ- and unmyelinated C-fibers. During the storage phase of urine, distention of the bladder has long been considered to evoke afferent activity via Aδ-fibers connected in series with the smooth muscle fibers. In contrast, a previous study in cats revealed that more than 90% of C-fibers do not respo...

Objectives To evaluate the long‐term safety (primary objective) and efficacy (secondary objective) of antimuscarinic add‐on therapy in patients receiving mirabegron. Methods During a 2‐week screening period, patients (aged ≥20 years, mirabegron treatment for ≥6 weeks, residual overactive bladder symptoms) received mirabegron 50 mg once daily. Thes...

Aims To examine the effects of RQ-00434739, a novel selective TRPM8 antagonist, on deep body temperature (DBT) and normal bladder sensory function and overactivity and its associated facilitation of mechanosensitive primary bladder single-unit afferent activities (SAAs) induced by intravesical l-menthol or prostaglandin E2 (PGE2) instillation in ra...

Background/aim: The aim of this study was to demonstrate the clinical significance of latent Gleason pattern (GP) 5 occasionally found in prostatectomy specimens. Materials and methods: Patients (n=605) undergoing radical prostatectomy were classified into three groups according to the presence of GP5 in the biopsy or in the prostatectomy specim...

Aims The efficacy of perioperative pelvic floor muscle training (PFMT) for continence recovery after robot‐assisted radical prostatectomy (RARP) remains unclear. Visualization of the bladder neck and urethra using transperineal ultrasound (US) may promote self‐recognition of urethral closure during PFM contraction. This study aimed to examine wheth...

Transient receptor potential ankyrin 1 (TRPA1) channel expressed by urothelial cells and bladder sensory nerve fibers might act as a bladder mechanosensor and nociceptive transducer. To disclose the role of TRPA1 in bladder function and inflammation-associated hypersensitivity, we evaluated in vitro and in vivo bladder function and inflammatory mec...

The clinical significance of random bladder biopsies in primary non-muscle-invasive bladder cancer is unclear. The present study investigated the significance of positive random bladder biopsies in primary T1 NMIBC. The present study retrospectively reviewed the records of 71 patients with primary pT1N0M0 bladder cancer who underwent transurethral...

Aims: We investigated the effects of silodosin, an α1A-adrenoceptor (AR) antagonist, on bladder function, especially on non-voiding contractions (NVCs), in a male rat model of bladder outlet obstruction (BOO) by evaluating cystometry (CMG) findings and bladder mechanosensitive single-unit afferent activities (SAAs), related with microcontractions,...

Aims: Transient receptor potential melastatin 8 (TRPM8) is proposed to be a promising therapeutic target for hypersensitive bladder disorders. We examined the effects of KPR-2579, a novel selective TRPM8 antagonist, on body temperature and on mechanosensitive bladder single-unit afferent activities (SAAs) provoked by intravesical acetic acid (AA)...

Purpose: To evaluate the impact of preoperative chronic kidney disease (CKD) on oncological outcomes after radical cystectomy (RC) for bladder cancer. Methods: We reviewed the medical records of patients with urothelial bladder carcinoma who underwent RC with curative intent at seven hospitals between 1990 and 2013. After excluding patients with...

We investigated age-related changes in in vivo and in vitro functions and gene expression of the bladder of male and female mice. Mature and aged (12 and 27-30 month old) C57BL/6 mice of both sexes were used. Frequency volume, conscious free-moving cystometry and detrusor contractile and relaxant properties in in vitro organ bath were evaluated. mR...

Aims: To assess the clinical impact of Hunner lesions in patients with Hunner type interstitial cystitis (HIC). Methods: The clinical records of 94 HIC patients who underwent their first hydrodistension (with lesion fulguration) were retrospectively reviewed. At surgery, the extent of each lesion was classified in terms of the relative involveme...

We investigated the characteristics of bladder mechanosensitive single-unit afferent activities (SAAs) in rats with a bladder outlet obstruction (BOO) and their relationship with bladder microcontractions. Male Wistar rats were divided into Sham and BOO groups. Four or 10 days after the surgery, rats were anesthetized with urethane. The SAAs of Aδ-...

Underactive bladder (UAB), which has been described as a symptom complex suggestive of detrusor underactivity, is usually characterized by prolonged urination time with or without a sensation of incomplete bladder emptying, usually with hesitancy, reduced sensation on filling, and slow stream often with storage symptoms. Several causes such as agin...

Aims: To evaluate the significance of mast cell infiltration in interstitial cystitis (IC) by comparison with equally inflamed controls using a digital quantification technique. Methods: Bladder biopsy specimens from 31 patients with Hunner type IC and 38 patients with non-Hunner type IC were analyzed. Bladder biopsy specimens from 37 patients w...

PurposeTo evaluate the efficacy of adjuvant systemic chemotherapy for locally advanced (pT3-4pN0/xM0) upper tract urothelial carcinoma (UTUC). Materials and methodsWe retrospectively reviewed the medical records of 109 patients with pT3-4pN0/xM0 UTUC who had undergone radical nephroureterectomy between 1996 and 2013 at our four institutions. The pa...

Aim: To investigate the feasibility of chemokines and cytokines potentially elevated in the bladder tissue of Hunner type interstitial cystitis (HIC) as urinary markers for distinguishing HIC from non-Hunner type interstitial cystitis (NHIC) METHODS: Urine specimens were collected from 41 HIC patients, 25 NHIC patients, and 31 healthy volunteers (...

Objective: Our objective was to investigate predictors of early continence outcome after robot-assisted radical prostatectomy (RARP). Methods: Clinical records were prospectively collected in 272 patients who underwent RARP. Clinical parameters, continence rates, and time to achieve continence were investigated and analyzed. Recovery of continen...

Objectives: To investigate predictors of continence outcomes after robot-assisted radical prostatectomy. Methods: Clinical records of 272 patients who underwent robot-assisted radical prostatectomy were investigated. Preoperative Overactive Bladder Symptom Score, International Prostate Symptom Score and clinicopathological factors were investiga...

Background: Resection of metastatic lesions (metastasectomy) is performed for highly selected patients with metastatic urothelial carcinoma (mUC). This study aimed to identify the clinicopathologic factors associated with oncologic outcome for patients who underwent metastasectomy for mUC. Methods: This analysis included 37 UC patients who under...

Background The pathological and oncological outcomes of retro-pubic radical prostatectomy (RRP) and robot-assisted radical prostatectomy (RARP) have not been sufficiently investigated. Methods Treatment-naïve patients with localized prostate cancer (PC) (n = 908; RRP, n = 490; and RARP, n = 418) were enrolled in the study. The clinicopathological...

Toll-like receptor 7 (TLR7) is associated with the pathophysiology of systemic lupus erythematosus and Sjögren syndrome, well-known diseases accompanying interstitial cystitis (IC). We studied TLR7 expression in the bladder of patients with Hunner-type IC (HIC) and its functional roles in bladder inflammation and nociception using mice. Bladder bio...

Data from an immunohistochemical study reveal abundant expression of [beta]3-adrenoceptors on cholinergic nerves of the human urinary bladder. This finding suggests that the effects of [beta]3-adrenoceptor agonists on overactive bladder are not mediated simply through direct inhibition of bladder smooth muscle cell excitability, but might involve a...

Background Robot-assisted radical prostatectomy (RARP) has now become a gold standard approach in radical prostatectomy. The aim of this study was to investigate incidence and risk factors of inguinal hernia (IH) after RARP. Methods This study included 307 consecutive men who underwent RARP for the treatment of prostate cancer from January 2011 to...

Background The benefit of adjuvant immunotherapy after nephrectomy in renal cell carcinoma (RCC) is controversial. The present study aimed to examine the possible benefit of adjuvant immunotherapy in various clinical settings. Methods We retrospectively reviewed 436 patients with pT1-3N0-2M0 RCC who underwent radical or partial nephrectomy with cu...

The clinical and pathological data of all the subjects. (XLSX)

Kaplan—Meier curves depicting CSS in pT1a-2aN0, pT2b-3cN0, and pTanyN1-2 patients among (A) all patients, (B) adjuvant IFN-α group, and (C) control group, respectively (all P<0.0001, log-rank test). CSS in pT2b-3cN0 was similar to that in pT1a-2aN0 in the adjuvant IFN-α group, but significantly worse in the control group. (TIF)

Kaplan—Meier curves depicting OS in pT1a-2aN0, pT2b-3cN0, and pTanyN1-2 patients among (A) all patients, (B) adjuvant IFN-α group, and (C) control group, respectively (ditto with RFS). Similar trends to CSS were observed for both OS and RFS. (TIF)

Background: Mouse urodynamic tests are fundamental to understanding normal lower urinary tract (LUT) function. These experiments also contribute to our understanding of neurological dysfunction, pathophysiological processes, and potential mechanisms of therapy. Objectives: Systematic assessment of published evidence on urodynamics, advantages and l...

Background Adjuvant androgen deprivation therapy is a common treatment option for prostate cancer after radical prostatectomy, especially in Asia. However, no study has investigated the oncological outcome after cessation of long-term adjuvant androgen deprivation therapy with favorable prostate-specific antigen control. Methods Among 855 patients...

Aims: Quality of life in the context of intermittent self-catheterization varies depending on the type of catheter used. This study translated into Japanese, evaluated the feasibility, reliability, and validity of the Intermittent Self-Catheterization Questionnaire (ISC-Q) among users of both reusable and disposable catheters, and examined the dif...

Objectives: To examine whether systemic resiniferatoxin treatment can desensitize the single-unit afferent activities of Aδ- and C-fibers in rat primary bladder mechanosensitive afferent nerves. Methods: Female Sprague-Dawley rats were divided into two groups (resiniferatoxin-treated: n = 9, vehicle-treated: n = 9). Resiniferatoxin (0.3 mg/kg) o...

Objectives: To assess the efficacy and feasibility of ultrasound-assisted prompted voiding for the management of urinary incontinence in nursing homes. Methods: Nursing home residents who had received prompted voiding care for urinary incontinence were enrolled. The voided urinary volume and residual urinary volume were initially measured for a...

An up-regulated CXCR3 pathway and affluent plasma cell infiltration are characteristic features of Hunner type interstitial cystitis (HIC). We further examined these two features using bladder biopsy samples taken from 27 patients with HIC and 15 patients with non-IC cystitis as a control. The number of CD3-positive T lymphocytes, CD20-positive B l...

Purpose: We evaluated aging-related bladder dysfunctions and biological changes in the bladder and dorsal root ganglia (DRG) in rats, and investigated whether long-term caloric restriction (CR) may have preventive effects on these changes. Materials and methods: Male Fischer 344 rats were divided into young (6 months-old) fed ad libitum (Y), old...

Purpose: We investigated the relationship among nocturnal polyuria, sleep apnea, and body fluid volume to elucidate the pathophysiology of nocturia in sleep apnea syndrome. Materials and methods: We enrolled 104 consecutive patients who underwent polysomnography for suspected sleep apnea syndrome. Self-assessed symptom questionnaires were admini...

The patient is a 43-year-old male, presented with numbness of the left lower extremities. Imaging studies showed a pelvic tumor 20 cm in diameter, involving the left ureter, left common iliac vessels, left internal and external iliac vessels, and inferior mesenteric artery, which was deemed unresectable. Tumor biopsy confirmed liposarcoma. As chemo...

Background: To explore the real-life practice of clinical management of interstitial cystitis (IC) in Japan. Methods: A questionnaire on the number of IC patients, cystoscopic findings, diagnostic methods, and the treatment modalities was sent via e-mail to 114 medical institutions belonging to the Society of Interstitial Cystitis of Japan (SICJ...

The prognostic factors of retroperitoneal liposarcoma have yet to be clearly determined due to its rarity, whereas the prognostic value of symptoms at diagnosis has never been evaluated to date. In this context, we reviewed 24 consecutive patients with primary retroperitoneal liposarcoma who underwent surgical resection with curative intent at our...

Interstitial cystitis (IC) is a chronic bladder disease with urinary frequency, bladder discomfort or bladder pain of unknown etiology. Based on cystoscopic findings, patients with IC are classified as either Hunner-type/classic IC (HIC), presenting with a specific Hunner lesion, or non-Hunner-type IC (NHIC), presenting with no Hunner lesion, but p...