Haruo Nakagawa

Impact of Nocturia on Bone Fracture and Mortality in Older Individuals: A Japanese Longitudinal Cohort Study

PURPOSE We evaluated the association of nocturia with fracture and death in a large, community based sample of Japanese individuals 70 years old or older. MATERIALS AND METHODS The baseline in this population based study was determined in 2003 by an extensive health interview with each participant. In this study we followed 784 individuals with a mean ± SD age of 76.0 ± 4.6 years (range 70 to 97). Information on mortality and fracture during the study period was provided by the National Health Insurance system and details on fractures were collected from medical records. We compared the risk of bone fracture and death with or without nocturia in a multivariate Cox proportional hazard model. RESULTS Nocturia (2 or greater voids per night) was present in 359 of the 784 participants (45.7%). Fracture was observed in 41 cases, including 32 fall related cases. For all fractures and fall related fractures with nocturia the HR was 2.01 (95% CI 1.04-3.87) and 2.20 (95% CI 1.04-4.68, each p = 0.04). Death occurred in 53 cases. The mortality rate in individuals with nocturia was significantly higher than in those without nocturia. For mortality in patients with nocturia the age-gender adjusted HR was 1.91 (95% CI 1.07-3.43, p = 0.03). Even when further adjusted for diabetes, smoking status, history of coronary disease, renal disease and stroke, tranquilizers, hypnotics and diuretics, the positive relationship was unchanged (HR 1.98, 95% CI 1.09-3.59, p = 0.03). CONCLUSIONS During a 5-year observation period elderly individuals with nocturia were at greater risk for fracture and death than those without nocturia.

Haptoglobin-β chain defined by monoclonal antibody RM2 as a novel serum marker for prostate cancer

In our previous study, monoclonal antibody RM2, established toward the glycosyl epitope, reflected grade of malignancy of prostate cancer cells whereas RM2 reactivity to benign glands was negative or weak. RM2 reactivity was also detected in stroma, suggesting the glycoprotein RM2 recognizes could be released into the bloodstream. Then, we explored RM2 reactivity to sera of early prostate cancer. We compared RM2 reactivity to sera between 62 patients with early prostate cancer and 43 subjects with benign prostatic disease, and examined RM2 reactivity before and after radical prostatectomy in 15 patients by Western blotting. We also examined RM2 reactivity to sera of the other urogenital cancers. RM2 reactivity was significantly enhanced on a serum glycoprotein with molecular mass ∼40 kDa, hereby termed GPX, in the patients with early prostate cancer when compared with those with benign prostatic disease (p < 0.0001). Setting an appropriate cutoff level, RM2 reactivity to GPX for detection of prostate cancer had sensitivity of 87% and specificity of 84%, respectively. Furthermore, the level of RM2 reactivity significantly decreased after radical prostatectomy (p = 0.006). However, increased RM2 reactivity to GPX was also observed in the other urogenital cancers. The proteomics approach identified GPX as haptoglobin‐β chain and RM2 showed preferential reactivity toward haptoglobin‐β chain derived from prostate cancer when compared with polyclonal anti‐haptoglobin antibody. Haptoglobin‐β chain defined by RM2 is a novel serum marker that may be useful for detection of early prostate cancer when coupled with prostate‐specific antigen because it is not specific to prostate cancer.

Risk factors for overactive bladder in the elderly population: A community-based study with face-to-face interview

Objectives:  The aim of this study was to measure the prevalence of and risk factors for overactive bladder (OAB) in the elderly.

Somatosensory evoked magnetic fields elicited by dorsal penile, posterior tibial and median nerve stimulation

The aim of this study is to localize the primary sensory cortex of urogenital organs in the human brain. Using a newly developed MRI-linked magnetoencephalography system, we measured somatosensory evoked magnetic fields (SEFs) for unilateral stimuli on the dorsal penile nerve (DPN), posterior tibial nerve (PTN) and median nerve (MN). In five healthy male subjects, SEFs were clearly observed. Peak latency of the first cortical components were 63.8 +/- 9.2 ms for DPN, 39.8 +/- 3.0 ms for PTN and 20.7 +/- 0.7 ms for MN stimuli. Peak amplitude of the first cortical components were 63.1 +/- 10.8 fT for DPN, 160.2 +/- 50.1 fT for PTN and 335.2 +/- 70.3 fT for MN stimuli. Isofield map for the peak latencies indicated a single dipolar pattern for DPN as well as for PTN and MN stimuli. Using a single current dipole model, all SEF sources were localized on the contralateral central sulcus to the stimuli, indicating the primary sensory cortex. The DPN sources were localized on the interhemispheric surfaces, corresponding to previous speculations by direct cerebral stimulation. This non-invasive SEF technique promises further brain functional mapping for the urogenital organs.

Acute renal failure as a result of bilateral ureteral obstruction by Candida albicans fungus balls

Abstract  A 73‐year‐old male with a history of diabetes mellitus was admitted to our hospital for acute renal failure. An ultrasonogram revealed bilateral hydronephrosis, which worsened despite insertion of a bladder catheter. Nephrostomy catheters were positioned bilaterally, and Candida albicans was found in the urine culture. The patient was successfully treated with intermittent direct irrigation and i.v. antifungal agent therapy. Since 1977, approximately 50 cases of fungus balls or fungal bezoars in the urinary tract have been reported, but the majority of these cases have been characterized by unilateral ureteral or bladder involvement. Herein, we report a case of acute renal failure as a result of bilateral ureteral obstruction by Candida albicans fungus balls.

Recovery of health related quality of life after radical prostatectomy in Japanese men: A longitudinal study

Abstract Background: We performed a longitudinal survey of health related quality of life (HRQOL) after radical retropubic prostatectomy (RP) in Japanese men with localized prostate cancer.

Laparoscopic simultaneous bilateral adrenalectomy: assessment of feasibility and potential indications.

Objective:  To report a single‐center experience with laparoscopic simultaneous bilateral adrenalectomy (LSBA) and to evaluate its safety, surgical outcomes, and potential indications of the procedure.

Effects and indications of sacral surface therapeutic electrical stimulation in refractory urinary incontinence

Objective: To describe the effects and indications of sacral surface therapeutic electrical stimulation (SS-TES) for refractory urinary incontinence. Design: Evaluation before and after therapy. Setting: On clinical site and at nursing home. Subjects: Seven neurogenic bladder, five unstable bladder and six nocturia cases were investigated. Twelve were outpatients and six were residents. Interventions: Surface electrodes were placed at the posterior sacral foramens of S2 and S4. Stimulation conditions were duration 0.3 ms, frequency 20 Hz and maximum intensity. The stimulation was continued for 15 min twice daily for over one month. Main outcome measures: Therapeutic effects were evaluated on the basis of voiding charts as subjective findings and urodynamic study as objective findings before and after therapy. Results: Subjective findings showed incontinence frequency significantly decreased from 2.39±1.4 times/day before therapy to 1.39±2.0 times/day after therapy (p≤0.01); 55.5% of patients were improved or greatly improved. Objective findings showed that maximum vesical capacity (MVC) significantly increased from 208.29±94.5 ml before therapy to 282.19±66.8 ml (p≤0.001). Uninhibited contraction significantly decreased from 40.4±31.4 cmH2O before therapy to 25.79±23.9 cmH2O (p≤0.01); 44% of patients were improved or greatly improved. This therapy was effective in particular for cases whose MVC was small before applying SS-TES. Conclusion: SS-TES was effective in some patients with refractory urinary incontinence.

Long-term quality of life after radical prostatectomy: 8-Year longitudinal study in Japan

To assess long‐term health‐related quality of life in patients undergoing radical prostatectomy.

The Relationships Between Preoperative Sexual Desire and Quality of Life Following Radical Prostatectomy: A 5‐Year Follow‐Up Study

INTRODUCTION There were few studies about the relationship between sexual desire (SD) and radical prostatectomy (RP). AIMS We assessed the relationships between RP and quality of life (QOL) according to the preoperative SD. MAIN OUTCOME MEASURE General QOL was measured with Short Form 36. Sexual function and bother were measured with the University of California, Los Angeles Prostate Cancer Index (PCI). Changes of postoperative SD were also evaluated using PCI. METHODS We analyzed data from 285 men who underwent RP and were prospectively enrolled into a longitudinal cohort study. Patients were divided into two groups according to whether they had SD at baseline, which is addressed in the PCI questionnaire: a low SD (LSD) group and a high SD (HSD) group. The assessments were completed before treatment and 3, 6, 12, 24, and 60 months after RP. RESULTS Of the 244 men, 52% had high or a fair level of SD before RP, whereas 48% reported that the level of their SD was low. The HSD group reported better sexual function and sexual bother scores than the LSD group at baseline (both P < 0.001). Fifty-one percent of the HSD group reported that SD at 3 months was poor or very poor, which did not return to the preoperative level at all postoperative time points. Nearly 20% of the LSD group regained higher SD after RP than the baseline level. The HSD group showed worse sexual bother scores than the baseline throughout the postoperative follow-up (P < 0.001). However, the LSD group demonstrated equivalent sexual bother scores after RP compared with the baseline. CONCLUSIONS RP adversely affected SD as well as sexual function and sexual bother. The patients who had HSD experienced greater distress concerning their sexual dysfunction postoperatively than those with LSD.