Akifumi Yokoo

VOIDING DYSFUNCTION IN ILEAL NEOBLADDER

PURPOSE We attempt to understand better the voiding mechanism and determine the causes of voiding dysfunction in ileal neobladder patients. MATERIALS AND METHODS The voiding condition in 12 bladder cancer patients who had undergone neobladder construction after radical cystectomy was examined by pressure-flow study and voiding cystourethrography. The patients were classified into 2 groups based on the maximum flow rate in a pressure-flow study: fine voiders (6), with a maximum flow rate of 15 ml. per second or more, and poor voiders (4), with a maximum flow rate of less than 15 ml. per second. RESULTS Maximum flow rate in the fine voiders was 26.2 +/- 8.7 ml. per second (mean plus or minus standard deviation) compared with 9.4 +/- 0.9 ml. per second in the poor voiders. The fine voiders strained 1.5 +/- 0.9 times to void 100 ml. of urine, whereas the poor voiders strained 7.0 +/- 6.3 times. The bladder capacity, vesical opening pressure and vesical pressure at the maximum flow rate were similar in both groups. Pelvic floor electrical activity was amplified when the neobladder was either full or close to its capacity, and it was relaxed in coordination with abdominal straining in all patients. Voiding cystourethrography revealed that, in fine voiders, the neobladder outlet was funnel-shaped when the bladder was full and opened wider when the patient strained to void. However, in poor voiders, the neobladder outlet did not funnel even on abdominal straining. CONCLUSIONS Neobladder patients void by abdominal straining and relaxing the pelvic floor musculature. To obtain smooth voiding in such patients, it is crucial to locate the neobladder opening at the most caudal portion and preserve neobladder outlet elasticity.

Ileal Neobladder for Bladder Substitution after Radical Cystectomy

Background: Studers ileal neobladder is technically simple, and favorable clinical results have been reported. However, there have been only a few follow‐up studies on this type of ileal neobladder. We reviewed the clinical outcomes of patients who received Studers ileal neobladder, with a minor modification, in our institution.

EXPRESSION OF INTERCELLULAR ADHESION MOLECULE-1 IN MICE WITH PSEUDOMONAS-INDUCED PYELONEPHRITIS

PURPOSE To investigate the role of intercellular adhesion molecule-1 (ICAM-1) in the renal inflammatory process, we studied the time-course fluctuation of ICAM-1 expression on inflammatory lesions in mice with experimentally induced bacterial pyelonephritis and the effect of in vivo administration of an anti-ICAM-1 monoclonal antibody (mAb) on leukocytic migration. MATERIALS AND METHODS Ascending pyelonephritis was induced by transurethral instillation of Pseudomonas aeruginosa, and the expression of ICAM-1 in the pyelonephritic lesions was studied by immunohistochemical methods. RESULTS The expression of ICAM-1 on the pyelonephritic lesions closely paralleled the degree of infiltration of neutrophils and macrophages until 3 days after infection. At 7 days after infection, though the degree of infiltration of these cells was quite high, expression of ICAM-1 was reduced. Treatment with the anti-ICAM-1 mAb in mice with bacterial pyelonephritis resulted in suppression of influx of neutrophils and macrophages in the infected sites until 3 days after infection. However, at 7 days after infection inhibition of the influx of these cells was not seen. CONCLUSIONS These results suggest that ICAM-1 expression is transient and plays a key role in the influx of neutrophils and macrophages associated with the early-phase response, and that in the late phase ICAM-1 independent adhesion molecules may be more predominant.

Gatifloxacin treatment for chronic prostatitis: a prospective multicenter clinical trial

Antimicrobial treatment is usually used for chronic prostatitis. However, the efficacy of such treatment has not been fully evaluated. We conducted a study to evaluate the efficacy of gatifloxacin for patients with chronic prostatitis using the Japanese version of the National Institutes of Health Chronic Prostatitis Symptom Index (JPN-NIH CPSI). The study included 46 patients for final analysis. Patients who were younger than 65 years of age were treated with 200 mg gatifloxacin twice daily, and those who were 65 years and older were treated with 100 mg gatifloxacin twice daily, for 4–8 weeks. The study consisted of 10 patients in category II, 13 in category IIIA, 11 in category IIIB, and 12 who were unclassified. The gatifloxacin treatment resulted in significant reductions in the scores on the JPN-NIH CPSI. Of the total number of patients, 58.1% and 27.9% were 25% and 50% responders, respectively, 4 weeks after treatment, and these figures improved to 66.7% and 33.3%, respectively, 8 weeks after treatment. No significant difference was found in the changes in symptom scores between Category II and Category IIIA/IIIB groups. In conclusion, gatifloxacin treatment improved the symptoms in patients with chronic bacterial and nonbacterial prostatitis. This study is the first in this country to evaluate the efficacy of antimicrobial treatment for chronic prostatitis by using the NIH CPSI.

Acquired pure red cell aplasia in a hemodialyzed patient.

Abstract A 68‐year‐old male had end‐stage renal disease secondary to hypertension. He was placed on chronic dialytic therapy and was given recombinant human erythropoietin (epoetin) for renal anemia. One month later, rapidly progressing anemia was noted. The anemia was unresponsive to maximal doses of epoetin and the patient soon became transfusion‐dependent. Erythroid hypoplasia was demonstrated by bone marrow biopsy. A detailed search for the cause of the erythroblastopenia revealed nothing. A diagnosis of acquired pure red cell aplasia was made. The use of immunosuppressive agents improved the patients symptoms and laboratory data. Antibodies for erythropoietin (EPO) were negative after the treatment. It is suggested that patients with EPO‐resistant anemia with no obvious etiology should be examined for underlying hematologic disorders.

Ectopic Ureterocele with a Horseshoe Kidney in an Adult

A rare adult case of a left ectopic ureterocele associated with a duplex horseshoe kidney is reported. To the best of our knowledge, only one pediatric case of horseshoe kidney with an ectopic ureterocele has been reported. The present case was successfully treated by ureteropyelostomy, upper ureterectomy and unroofing of the ureterocele. The patient is currently followed with excretory urograms and renograms.

Molecular Cascade of Local Immune Response in Mice with Escherichia coli-Induced Ascending Pyelonephritis

We investigated the time course of gene expression of cytokines in mice with bacterial pyelonephritis. Murine kidneys were harvested at 2 and 6 hours, and 1, 3, 7, and 14 days after infection. Transcripts for murine cytokines (tumor necrosis factor (TNF)-α, interferon (IFN)-γ, interleukin (IL)-1α, and IL-6) were measured in kidney homogenates by cDNA-equalized reverse transcription polymerase chain reaction (RT-PCR). There was no signal seen for any, cytokines in the non-infected kidney. We found mRNA for TNF-α and IFN-γ in infected kidneys at 2 hours after infection, though no infiltrating immune-response cells were observed. It is possible that TNF-α and IFN-γ were produced by intraepithelial lymphocytes in mucosa-associated lymphoid tissue in the urinary tract. IL-6 mRNA was detected at 6 hours after infection, concomitantly with infiltration of IgA-positive B cells. As seen in the intestinal mucosa, IL-6 may stimulate the maturation of IgA-positive B cells in the urinary mucosa. IL-1α mRNA was detectable at 1 day after infection. IL-1 may help direct the neutrophils to the site of infection by inducing expression of intercellular adhesion molecule-1 expression. Our observations suggested that the inflammatory cytokines were of local origin and that urinary mucosa was activated directly by bacteria to produce cytokines.