Akihide Hirayama

Positive response to ice water test associated with high-grade bladder outlet obstruction in patients with benign prostatic hyperplasia

OBJECTIVES To elucidate the clinical significance of detrusor overactivity (DO) that is probably due to C-fiber activation caused by bladder outlet obstruction (BOO), we examined the responses to the ice water test (IWT) in patients with benign prostatic hyperplasia (BPH) and assessed the results with reference to the clinical manifestations and urodynamic findings. METHODS A total of 127 patients without neurologic disease, who were older than 50 years of age, with an International Prostate Symptom Score of 8 points or greater and a quality of life index of 2 or more points, were enrolled in this study. We tested the response to ice water instillation by monitoring the intravesical pressure in all cases and assessed the results with reference to the findings of International Prostate Symptom Score and quality of life index questionnaires, BOO indexes, 48-hour frequency volume charts, prostate volume, and data from free-flowmetry and pressure flow studies for detecting DO. Twenty patients with neurogenic bladder dysfunction underwent IWT as a control group. RESULTS The responders to the IWT accounted for 14 (70%) of the 20 patients with neurogenic bladder dysfunction and 35 (27%) of the 127 patients without neurologic disease. All of these responders showed DO on the pressure flow studies. The patients without neurologic disease who responded to the IWT had higher BOO indexes than did the nonresponders and had a smaller volume at a maximal desire to void on the urodynamic studies. The largest single-voided volume recorded from the 48-hour frequency volume charts was also smaller for the responders than for the nonresponders. CONCLUSIONS The patients with BPH clearly showed that DO was mainly due to active C-fibers stimulated by high-grade BOO and that DO was a cause of urgency and frequency-related symptoms with decreased bladder capacity. It will be necessary to assess the inhibitory effect of capsaicin on DO caused by activation of C-fibers and the reversibility of C-fiber activation after surgical treatment for BPH, so that the criteria for decision-making for the treatment of BPH may be clarified with the aid of the IWT.

Aggressive angiomyxoma in the scrotum expressing androgen and progesterone receptors

Abstract  Aggressive angiomyxoma is a rare benign mesenchymal myxoid tumor that arises from the pelvic soft tissues and perineum in relatively young females. This tumor has the ability to infiltrate locally and has a high risk of local recurrence after extirpation, but no potential to metastasize. We report here a rare case of aggressive angiomyxoma that developed in the scrotum of a 47‐year‐old male. Immunostaining of the resected specimen revealed that the tumor cell nuclei stained strongly and diffusely for androgen receptors (80% of the tumor cells), and moderately and partly for progesterone receptors (20% of the tumor cells). However, staining was negative for estrogen receptors. It is highly suggested that the growth of aggressive angiomyxoma in males may depend on androgen manipulation, contrary to its frequent and close association with estrogen receptor expression, which has been reported in females.

Inhibition of COX-2 expression by topical diclofenac enhanced radiation sensitivity via enhancement of TRAIL in human prostate adenocarcinoma xenograft model

BackgroundCOX-2 inhibitors have an antitumor potential and have been verified by many researchers. Treatment of cancer cells with external stressors such as irradiation can stimulate the over-expression of COX-2 and possibly confer radiation resistance. In this study, we tested if topical diclofenac, which inhibits both COX-1 and COX-2, administration rendered prostate tumor cells sensitize to the effects of radiation.MethodsLNCaP-COX-2 and LNCaP-Neo cells were treated with 0 to 1000 μM diclofenac. Next, a clonogenic assay was performed in which cells were subjected to irradiation (0 to 4 Gy) with or without diclofenac. COX-2 expression and other relevant molecules were measured by real-time PCR and immunohistochemistry after irradiation and diclofenac treatment. In addition, we assessed the tumor volumes of xenograft LNCaP-COX-2 cells treated with topical diclofenac with or without radiation therapy (RT).ResultsLNCaP-COX-2 and LNCaP-Neo cell lines experienced cytotoxic effects of diclofenac in a dose related manner. Clonogenic assays demonstrated that LNCaP-COX-2 cells were significantly more resistant to RT than LNCaP-Neo cells. Furthermore, the addition of diclofenac sensitized LNCaP-COX-2 not but LNCaP-Neo cells to the cytocidal effects of radiation. In LNCaP-COX-2 cells, diclofenac enhanced radiation-induced apoptosis compared with RT alone. This phenomenon might be attributed to enhancement of RT-induced TRAIL expression as demonstrated by real-time PCR analysis. Lastly, tumor volumes of LNCaP-COX-2 cells xenograft treated with diclofenac or RT alone was >4-fold higher than in mice treated with combined diclofenac and radiation (p<0.05).ConclusionsThese in vitro and in vivo findings suggest that conventional COX inhibitor, diclofenac enhances the effect of RT on prostate cancer cells that express COX-2. Thus, diclofenac may have potential as radiosensitizer for treatment of prostate cancer.

The Relationship Between Nocturnal Polyuria and the Distribution of Body Fluid: Assessment by Bioelectric Impedance Analysis

PURPOSE Increased nocturnal urinary volume is closely associated with nocturia. We investigated the relationship between nocturnal polyuria and the variation of body fluid distribution during the daytime using bioelectric impedance analysis. MATERIALS AND METHODS A total of 34 men older than 60 years were enrolled in this study. A frequency volume chart was recorded. Nocturnal polyuria was defined as a nocturnal urine volume per 24-hour production of greater than 0.35 (the nocturnal polyuria index). Bioelectric impedance analysis was performed 4 times daily at 8 and 11 a.m., and 5 and 9 p.m. using an InBody S20 body composition analyzer (BioSpace, Seoul, Korea). RESULTS A significant difference was found in mean +/- SEM 24-hour urine production per fat-free mass between the groups with and without nocturnal polyuria (17.8 +/- 1.4 vs 7.7 +/- 0.9 ml/kg). The increase in fluid in the legs compared with the volume at 8 a.m. was significantly larger at 5 p.m., while there was no difference in the arms or trunk. Nocturnal urine volume significantly correlated with the difference in fluid volume in the legs (r = 0.527, p = 0.0019) and extracellular fluid volume (r = 0.3844, p = 0.0248) between the volumes at 8 a.m. and 9 p.m. CONCLUSIONS Overproduction of urine per fat-free mass leads to nocturnal polyuria. Extracellular fluid accumulates as edema in the legs during the day in patients with nocturnal polyuria. The volume of accumulated extracellular fluid correlates with nocturnal urine volume. We suggest that leg edema is the source of nocturnal urine volume and decreasing edema may cure nocturnal polyuria.

Risk Factors for New-onset Overactive Bladder in Older Subjects: Results of the Fujiwara-Kyo Study

OBJECTIVE To evaluate the risk factors for new-onset overactive bladder (OAB) in older subjects. METHODS The present study enrolled 4427 subjects aged ≥ 65 years who had participated in the Fujiwara-kyo study. The prevalence of OAB at baseline and 1 year later was evaluated using the OAB symptom score questionnaire. The incidence and remission rate of OAB were calculated. We identified the risk factors for OAB by evaluating the difference in characteristics (including sex, age, body mass index, life style, comorbidities, depressive status, metabolic syndrome, and sum of voiding symptoms) between those with and without new-onset OAB. In addition, the independent risk factors were determined by multivariate analysis. RESULTS Of the 4427 subjects, 3685 completely replied to the self-administrated questionnaires at baseline and 1 year later. The incidence and remission rate of OAB was 11.9% and 29.8%, respectively. The male/female ratio, sum of voiding symptoms, alcohol consumption and smoking, hypertension, and depressive status in subjects with new-onset OAB, were significantly greater than those in subjects without new-onset OAB. A multivariate analysis, including sex (odds ratio 2.0, P < .0001), sum of voiding symptoms (odds ratio 1.1, P < .0001), and depressive status (odds ratio 1.8, P < .0001) were independent factors for new-onset OAB in older subjects. CONCLUSION The results of the present study have demonstrated that male sex, the sum of voiding symptoms, and depression were independent factors for new-onset OAB. It is necessary to determine whether the treatment of patients with voiding symptoms or depression controls for new-onset OAB.

Hydrodistension under local anesthesia for patients with suspected painful bladder syndrome/interstitial cystitis: safety, diagnostic potential and therapeutic efficacy.

Objectives:  To evaluate the safety, diagnostic potential and therapeutic efficacy of cystoscopy with hydrodistension under local anesthesia in patients with suspected painful bladder syndrome/interstitial cystitis (PBS/IC).

Trends of the primary therapy for patients with prostate cancer in Nara uro-oncological research group (NUORG): a comparison between the CaPSURE data and the NUORG data.

OBJECTIVE We assessed the variations in stage, prostate specific antigen at diagnosis, Gleason score, risk classification and primary therapy in Japanese prostate cancer patients, and compared with those of the US patients. METHODS Between 2004 and 2006, the distribution of primary therapy and clinical characteristics of 2303 newly diagnosed patients at Nara Medical University and its 23 affiliated hospitals were assessed to compare with those of the Cancer of the Prostate Strategic Urological Research Endeavor data and to clarify the differences in data between the USA and Japan. RESULTS The proportions of clinical T stage of 3-4, prostate specific antigen at diagnosis >20 ng/ml, Gleason score of 8-10 and high-risk group were greater in our study than those of the Cancer of the Prostate Strategic Urological Research Endeavor data (T3-4, 26.2 vs. 3.5-11.8%; prostate-specific antigen, 34.1 vs. 8.1-27.0%; Gleason score, 29.3 vs. 9.7-12.1%). Regarding the primary treatments, 51% of patients received primary androgen deprivation therapy, 30% underwent radical prostatectomy, 14% received radiation therapy and 2% had watchful waiting in our study, while the corresponding figures in the Cancer of the Prostate Strategic Urological Research Endeavor data were: radical prostatectomy, 44%; radiation therapy, 23%; primary androgen deprivation therapy 20% and watchful waiting 10%. CONCLUSIONS The Japanese prostate cancer patients still have higher prostate-specific antigen at diagnosis, higher Gleason score and higher clinical stage than the US patients. The trends of primary therapy for prostate cancer were different from those in the USA. The higher rate of primary androgen deprivation therapy is characteristic for the Japanese patients.

Sexuality and seeking medical help for erectile dysfunction in young adults with spina bifida

Objectives: The objectives of this study were to evaluate the correlation between the sexual function of spina bifida (SB) patients and Sharrard classification, touch sensation on the penis, to examine if SB patients who are sexually active have erectile dysfunction (ED) on the International Index of Erectile Function‐5 (IIEF5), and to clarify if they seek medical treatment for ED.

Relationship Between Nocturnal Urine Volume, Leg Edema, and Urinary Antidiuretic Hormone in Older Men

OBJECTIVE To evaluate the relationship between leg edema, nocturnal urine volume (NUV), and the secretion of antidiuretic hormone (ADH) during the night, and to investigate the principal factors affecting nocturnal polyuria in older men. METHOD A total of 74 male inpatients more than 50 years of age were enrolled in this study. Blood count, standard chemistry panel, brain natriuretic peptide (BNP), urinary ADH (u-ADH), urinary creatinine (u-Cre), and urinary osmolarity were measured at 6:00 am. Keeping a frequency volume chart, bioelectric impedance analysis was performed at 5 pm. Leg edema was measured as an edema ratio, using the following formula: extracellular water [L)/(extracellular water [L) + intracellular water [L)) in legs. RESULTS A total of 66 patients were evaluated. NUV had a significant positive correlation with leg edema (r = 0.32, P = .008), negative correlation with u-ADH/u-Cre (r = -0.37, P = .003) but not BNP. Leg edema had a significant positive correlation with the level of BNP (r = 0.33, P = .012) and negative correlation with u-ADH/u-Cre (r = -0.4, P = .001). However a partial correlation showed that there was no significant correlation between NUV and leg edema. A multivariate logistic model showed that only u-ADH/u-Cre was an independent predictive variable of nocturnal polyuria. CONCLUSIONS This study suggested that leg edema influenced nocturnal urine volume with an associated decrease in ADH secretion but not directly. ADH secretion during the night was the principal factor affecting NP in older men.

The Effects of Androgen Deprivation Therapy on Lipid Metabolism and Body Composition in Japanese Patients with Prostate Cancer

OBJECTIVE In Japan, androgen deprivation therapy is employed as the primary therapy for prostate cancer in more than 50% of patients, which is a percentage larger than that in the USA. The adverse effects of androgen deprivation therapy on body composition and lipid profile associated with metabolic syndrome have been reported mainly in Caucasian populations, and few studies have been performed in East Asian populations, including Japanese. METHODS This study enrolled 39 Japanese patients who were starting to receive androgen deprivation therapy for prostate cancer. Subjects were evaluated at baseline and at 3, 6, 9 and 12 months. Body composition and lipid profiles were measured by bioelectrical impedance analysis and using blood samples, respectively. RESULTS The volume of fat and visceral fat was significantly increased 6 months after the treatment and continued to increase until 12 months. On the other hand, skeletal muscle was significantly decreased during the same period. The serum concentration of total cholesterol and low-density lipoprotein cholesterol increased significantly over the same period. CONCLUSIONS Androgen deprivation therapy changed the body composition and lipid profile of men with prostate cancer. It was demonstrated that even Japanese patients with prostate cancer who are treated with androgen deprivation therapy have the risk of developing metabolic syndrome.