[Show abstract][Hide abstract] ABSTRACT: Since distigmine can cause the serious side effect of cholinergic crisis, its dosage regimen has been reduced to 5 mg/day for patients with difficulty in urination due to detrusor underactivity. Therefore, the efficacy and safety of add-on therapy with distigmine at 5 mg daily were examined in patients with persistent urination problems due to detrusor underactivity despite administration of alpha1-blockers.
The subjects were 39 patients with underactive bladder (18 men and 21 women with an average age of 75 years) who showed no improvement of difficulty in urination or had a residual urine volume > or = 50 ml despite the administration of alpha1-blockers for more than 4 weeks. They received treatment with distigmine (5 mg daily after breakfast) in addition to their alpha1-blockers for 8 weeks. The international prostate symptom score (IPSS), quality-of-life (QOL) score, residual urine volume, blood pressure, and biochemistry tests were investigated before and after addition of distigmine.
After four and eight weeks of distigmine administration, all items of the IPSS and QOL score, as well as the residual urine volume, showed a significant decrease. In contrast, the pressure and pulse rate were unchanged. Serum creatinine showed a slight but significant decreased. As adverse events, frequent defecation, fecal incontinence, diarrhea, frequent urination and poor physical condition were recognized in 4 patients, but there was no serious event.
For difficulty in urination due to detrusor underactivity, the combination of an alpha1-blocker with distigmine at 5 mg daily showed early efficacy and good safety.
Preview · Article · Mar 2014 · Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology
[Show abstract][Hide abstract] ABSTRACT: We investigated whether the improvement of lower urinary tract symptoms (LUTS) and urinary adenosine triphosphate (ATP) level were related. Fifty-seven patients and 13 normal controls were enrolled in this study. All of the male patients had benign prostatic hyperplasia (BPH), and all of the female patients had overactive bladder (OAB). We administered an alpha-1 adrenergic receptor antagonist (tamsulosin hydrochloride) for BPH, while OAB patients received an anti-muscarinic agent (propiverine hydrochloride). Before and after treatment, we examined LUTS and urinary ATP/creatinine ratio. The urinary ATP/creatinine ratio was lower in males than females in both controls and patients. In the BPH patients, administration of the alpha-1 receptor antagonist decreased LUTS and urinary ATP/creatinine ratio, and improvement of LUTS was greater in patients with a high baseline urinary ATP level. In the OAB patients, administration of the anti-muscarinic agent decreased LUTS and urinary ATP/creatinine ratio, and improvement of LUTS was greater in patients with a high baseline urinary ATP level. Improvement of LUTS by treatment with the alpha-1 receptor antagonist or the anti-muscarinic agent was related to the decrease of urinary ATP/creatinine ratio in patients with BPH or OAB. Measurement of urinary ATP can be used as a marker of pathologic bladder function.
No preview · Article · Oct 2009 · Biomedical Research
[Show abstract][Hide abstract] ABSTRACT: Many patients with stress urinary incontinence do not have enough motivation to continue pelvic floor muscle training (PFMT) by themselves. Therefore, a device was created to support PFMT, and its effect was examined.
Forty-six women with stress urinary incontinence were assigned to a control group or a device group in order of presentation. A pamphlet on PFMT was given to control patients, while the same pamphlet plus the device and instructions on its use were given to patients in the device group. The device had a chime that was set to sound three times a day when exercise sessions were scheduled. PFMT consisted of fast and slow pelvic floor muscle contraction exercises that were performed for 2 min and followed a rhythm set by the device.
After 8 weeks, 20 patients from the control group and 21 patients from the device group could be evaluated. In the control group, only the quality of life (QOL) index improved significantly. In the device group, however, the daily number of incontinence episodes, the number of pads used daily, the QOL index, and the pad weight in the pad test improved significantly. Patients in the device group said that they felt obligated to perform PFMT when the chime sounded. Forty-eight percent of patients from the device group were satisfied with the outcome of PFMT, while only 15% were satisfied in the control group.
This device may be useful to support the management of stress urinary incontinence.
Full-text · Article · Sep 2003 · International Journal of Urology
[Show abstract][Hide abstract] ABSTRACT: In this study, we studied the immune response against to human renal cell carcinoma and its antigensity.
Mixed lymphocyte tumor culture test was performed using tumor cells as stimulator cells, peripheral blood lymphocytes from tumor patient (autologous) or healthy volunteer (allogeneic) as responder cells, and tumor cells or peripheral blood lymphocytes from tumor patient as target cells. The cytotoxic activity of mixed lymphocyte tumor culture test was assayed by 51Cr-relase test, and cell surface antigens presented on tumor cells or peripheral blood lymphocytes were assayed by antibody block test.
The cytotoxic activity against to tumor cells was induced from allogeneic peripheral blood lymphocytes by mixed lymphocyte tumor culture test. Its cytotoxic activity was inhibited by anti-CD8 antibody treatment of peripheral blood lymphocytes and anti-HLA class II antibody treatment of tumor cells. Furthermore, allogeneic peripheral blood lymphocytes induced to tumor cells did not damage peripheral blood lymphocyte of the tumor patient derivation.
Renal cell carcinoma may express tumor specific antigen restricted to HLA class II antigens that could be recognized by allogeneic CD8 positive T lymphocytes.
Preview · Article · Apr 2002 · Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology
[Show abstract][Hide abstract] ABSTRACT: A total of 163 patients with localized prostate cancer underwent retropubic radical prostatectomy and pelvic lymphadenectomy at a single hospital from 1989 to 1998. We reviewed the patients in terms of their prognostic factors and survival. The patients without advanced diseases were diagnosed as having prostate carcinoma, using either biopsies or transurethral resection of the prostate. The carcinomas were categorized into localized prostate carcinomas (stage A, B or C) as a result of digital rectal examinations, computed tomography scans and bone scans. The patients were informed of the risk of surgery and, if they agreed to sign the consent form, underwent radical prostatectomy under general and epidural anesthesia usually 2 months after a positive biopsy. The surgical specimens were sent for pathology and were graded according to classifications of well-, moderately and poorly differentiated adenocarcinoma. The patients were usually discharged from the hospital 2-3 weeks postoperatively and had regular follow-up treatment. The mean age (+/- SD) was 68.75 (+/- 5.59) years and the mean follow-up period was 47.2 months. There was a significant difference (34.4%) in pathologic grades between biopsy and surgical specimen. In a quarter of the patients (approximately 26.4%) upgrading of the surgical report occurred despite neoadjuvant therapy. Three-year, 5-year and 7-year actuarial survival rates were 91.8%, 79.9% and 71.9%, respectively. Patients with organ-confined prostate cancer underwent radical prostatectomy and survived a fairly good period of time. Histologic upgrading was frequently observed within a short period of time (2 months).
Full-text · Article · Sep 2001 · International Journal of Urology
[Show abstract][Hide abstract] ABSTRACT: We report a case of vesicorectal fistula caused by a pelvic foreign body. An 84-year-old woman presented with urinary tract infection and bladder stone. During transurethral lithotripsy, a foreign body was observed in the stone. CT and colonoscopy revealed a vesicorectal fistula due to a foreign body. After continuous bladder washout over a period of one month, resection of the foreign body, fistulectomy, and sigmoidostomy were performed. The foreign body was suspected to be a medical mesh from a sling operation. After the surgery, the patient's course was uneventful. This is the second patient with vesicointestinal fistula due to a foreign body in the Japanese literature.
No preview · Article · Mar 2001 · Hinyokika kiyo. Acta urologica Japonica
[Show abstract][Hide abstract] ABSTRACT: A 12-year-old boy presented to the Naha Municipal Hospital complaining of back pain. After intravenous pyelography, computed tomography, magnetic resonance imaging, ultrasonography and biopsy, he was suspected to have sarcoma of the prostate and was referred to the University of the Ryukyus Hospital. Acute renal failure of the post renal type was evident, accompanied by minimal hydronephrosis. Emergency hemodialysis and right ureterostomy were performed, as was a transurethral prostate biopsy. The specimen showed a poorly differentiated sarcoma not otherwise classifiable. After recovery from surgery, chemotherapy was attempted over 2 months, but the patient died of tumor 250 days after admission.
Full-text · Article · Dec 1999 · International Journal of Urology
[Show abstract][Hide abstract] ABSTRACT: A 69-year-old male was referred to our hospital because of suspicion of right renal tumor, invasion of the right renal vein and the inferior vena cava, and left adrenal tumor. At first, von Hippel-Lindau disease was suspected, but after hospitalization, a computerized tomographic scan, magnetic resonance imaging, venography, selective venous blood sampling, left adrenalectomy and right partial nephrectomy revealed left adrenal hemorrhage, bilateral multiple renal cysts and Budd-Chiari syndrome.
[Show abstract][Hide abstract] ABSTRACT: Two patients, one with and one without a history of nephrectomy for renal cell carcinoma, presented with lower abdominal pain. One of them, a 49-year-old man, had tumors in the right kidney and the right ischiadic bone. He underwent nephrectomy and pathologic findings showed renal cell carcinoma (tubular type, granular cell subtype, INF-gamma, G2). The other patient, a 33-year-old man with a previous history of left nephrectomy for renal cell carcinoma (tubular type, granular cell subtype, INF-alpha, G2), was found to have a large tumor in the pelvis, extending from the pubic and iliac bones to the hip joint. Both patients underwent embolization of the hypervascular mass using a vascular coil followed by hemipelvectomy under general anesthesia. The pathology reports confirmed bone metastases from renal cell carcinoma. Both patients survived surgery and their postoperative courses were uneventful without urinary or bowel incontinence. However, impaired potency was noted in the latter case. Immunotherapy with INF-alpha was resumed immediately after surgery.
No preview · Article · Aug 1999 · Hinyokika kiyo. Acta urologica Japonica
[Show abstract][Hide abstract] ABSTRACT: Bladder neck hypermobility causes cystocele in middle to old elderly women. We developed an easy and useful surgical technique for cystocele.
Thirteen patients with cystocele (grade 2-4) were operated by fornix of the vagina suspension. Patients were placed on lithotomy position under general or spinal anesthesia. Lower midline or lower abdominal transverse incision was made to open the peritoneum and denuded vesicouterine pouch. Several nylon sutures were placed on the lateral side of exposed fornix of the vagina. These sutures were suspended to anterior layer of the rectus sheath. Fornix of the vagina was fixed to the rectus muscle, so the prolapsed bladder wall was pulled up in normal position.
Operating time ranged from 15-110 minutes (average 73 minutes). Ten patients of thirteen were successful up to 2-43 months postoperatively. Cystocele recurred in three patients of thirteen. Two patients was re-operated by the same method, but one of them recurred. Two of three recurrent patients had grade 4 cystocele.
Fornix of the vagina suspension for cystocele seems useful and promising because of easy procedure without serious morbidity, especially in elderly high-risk patients.
Preview · Article · Jul 1999 · Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology
[Show abstract][Hide abstract] ABSTRACT: We performed 24 cadaveric renal transplantations between 1991 and 1998 in our institute. The recipients' characteristics comprised the following: 15 males and 9 females; patients; 37.2±9.9(16~56) years on average; hemodialysis period of 78.5±59.8 (2~182) months on average before the operation; and chronic glomerulonephritis (CGN) in 18 patients, focal glomerular sclerosis (FGS) in 2, nephrosclerosis in 1, Goodpasture syndrome in 1, systemic lupus erythematodes (SLE) in 1 and diabetic nephropathy in 1 as the original disease leading to chronic renal failure. The donors' characteristics comprised the following: 17 males and 7 females; 40.9±18.5 (15~66) years old on average; cerebrovascular disease in 13, brain trauma in 8 and asphyxia in 3 as the causes of death; 6.0±14.3 (0~54) minutes of warm ischemic time; and 20 hours 47 minutes ± 6hr05min (8hr30min~29hr03min) of total ischemic time. As for histocompatibility, ABO blood type showed compatibility and identical matching in 22 cases, and compatibility but not identical matching 2 cases: numbers of HLA mismatch were 2.05±0.98 in class I and 0.55±0.75 in class II: direct crossmatch revealed 2 cases of B(w) (+) but no cases of T (+) or Bc (+). The regimen of immunosuppressive drugs consisted of cyclosporine A or tacrolimus, methylprednisolone, antilymphocyte globulin (ALG), azathioprine and mizoribine. One patient achieved immediate renal function, but 23 patients needed hemodialysis after the renal transplantation. The average period of hemodialysis was 17.3±6.8 (6 ~30) days except in 2 patients with primary non function. Of 24 recipients, 19 have a currently functioning graft, 4 have lost the function of their graft, and 1 has died of fulminant hepatitis C with good function of the transplanted kidney. Out of 4 patients who have begun to receive regular hemodialysis again, graft loss was caused by primary non-function in 2, acute rejection in 1 and so called 'chronic rejection' in 1. The average level of creatinine in 19 recipients with current graft function was 1.53±0.63 (0.74~3.27) mg/dl, and 5 patients (20.8%) experienced acute rejection. The overall graft survival rate was 81.8%, 75.5% and 75.5% at 1, 3 and 5 years, respectively. Our study demonstrated that renal graft function was lost during the early period of the postoperative course, and therefore, to enhance graft survival, a more suitable graft should be procured without generating any serious disadvantage to the donors or to their families.
No preview · Article · Jun 1999 · Nishinihon Journal of Urology
[Show abstract][Hide abstract] ABSTRACT: A 57-year-old man was referred to our hospital complaining of painful urination. He had been aware of a perineal solid mass since 20 years earlier. Gradually, the mass had been increasing in size and hardness. We think it may have been present within a diverticulum of the urethra for an extended period without producing any symptoms. We removed the mass via the perineal route. X-ray diffraction analysis of the stone revealed it to be composed of calcium phosphate and ammonium magnesium phosphate.
[Show abstract][Hide abstract] ABSTRACT: We report 3 cases of hypogonadotropic hypogonadism and the effects of human chorionic gonadotropin (HCG) monotherapy on plasma testosterone levels, which were related to clinical results. The patients were males 29, 21 and 14 years old. Each received 5,000 units of HCG subcutaneously or intramuscularly twice or three times a week for 16 to 40 months. Genital effects, including an increase in testicular volume were seen in all patients after 2 or 3 months. The increase in plasma testosterone level after HCG therapy was significantly correlated with the genital effects similarly to other treatments. Moreover, spermatozoa appeared in one case.
[Show abstract][Hide abstract] ABSTRACT: A rusty sharp stick severed the urethra of a three-year-old boy. He later developed urinary retension and a swelling of scrotum. Ultrasonography and MRI demonstrated hematoma in the bladder and scrotum. Urethrography showed minor leakage at the pars membranacea. The treatment included a replacement of the Forey catheter and the administration of antibiotics. To the best of our knowledge this type of pediatric urethral injury is the first report of its kind in the Japanese literature.
No preview · Article · Mar 1998 · Nishinihon Journal of Urology
[Show abstract][Hide abstract] ABSTRACT: Between 1988 and 1996, we treated five patients with primary carcinoma of the female urethra between 65 and 79 years of age. Presenting symptoms included a urethral mass in 2 patients, hematuria in 1, dysuria in 1 and urethral bleeding in 1. Histopathology revealed squamous cell carcinoma in 4 cases and transitional cell carcinoma in 1. Clinical stage according to Grabstald's classification comprised Stage A in two cases, Stages B, C and D in one each. The modes of treatment were surgical resection alone in two, radiation therapy alone in two, and surgery with adjuvant chemotherapy in one case. Three patients without disease and two with disease are olive from 5 to 87 months after diagnosis.
No preview · Article · May 1997 · Hinyokika kiyo. Acta urologica Japonica
[Show abstract][Hide abstract] ABSTRACT: An 8 month old boy with a history of left hydronephrosis discovered prior to birth was referred for further evaluation. Imaging studies demonstrated a thin cortical structure with diffuse cystic renal change, and marked hydronephrosis with a torturous hydroureter. Radioisotope renoscintigraphy was not conclusive in guaranteeing the reversibility of the left renal function. Therefore, we attempted to establish a nephrostomy to the left kidney in order to determine whether or not the function was reversible. Unexpectedly, an inadequate urinary output necessitated the removal of the left kidney. The ureterovesical junction was identified as stenotic, and was implicated in the genesis of giant hydroureter. The hydronephrotic kidney which was removed consisted histologically of immature nephrons and dilated tubules, compatible with Potter type IV cystic kidney.
No preview · Article · Mar 1997 · Nishinihon Journal of Urology
[Show abstract][Hide abstract] ABSTRACT: The patient was a 57-year-old man whose chief complaint was left-flank pain. The findings obtained by CT, MRI and angiography were not compatible with renal cancer. The tentative diagnosis was inflammatory disease or soft-tissue tumor. We performed left radical nephrectomy, adrenectomy, splenectomy, partial colectomy and partial pancreatectomy. An immunohistochemical surface marker study revealed that the tumor was a B-cell lymphoma, and a genetic study revealed that the Y-chromosome was missing. After surgery, the patient recieved additional combination chemotherapy (CHOP) and is followed for 12 months without any evidence of recurrence.
No preview · Article · Jan 1997 · Japanese Journal of Clinical Urology
[Show abstract][Hide abstract] ABSTRACT: A 65 year old man had had a low fever, lumbar pain, and muscle weakness in his right leg for one month. The high fever and intractable right lumbar pain brought him to the hospital. Imaging studies including CT scan and MRI revealed some fluid collection the retrosperitoneum and swelling of the right psoas muscle. In addition, the patient was diagnosed as having mild hydronephrosis in his right kidney with negative urinalysis, and so he was referred to us. Exploratory laparotomy identified a purulent fluid collection around the psoas muscle and an infected hematoma in the psoas muscle. CT scan 1.5 months after surgery showed that the patient's right psoas muscle was normal without any swelling or fluid accumulation. The drainage catheter was removed 67 days after surgery, and he was then discharged from the hospital.
No preview · Article · Jan 1996 · Nishinihon Journal of Urology