Hisanori Taniguchi

Microscopic visualization of testosterone in mouse testis by use of imaging mass spectrometry.

AbstractTestosterone is one of the androgens synthesized from cholesterol as a precursor in the Leydig cells of testes. Since the ionization efficiency of testosterone in matrix-assisted laser desorption ionization (MALDI) is quite low, visualization of testosterone by using MALDI-imaging mass spectrometry (MALDI-IMS) has been considered difficult. To overcome this problem, we used two types of on-tissue derivatization techniques, which were achieved by pyridine sulfur trioxide and Girard’s T (GT) reagent, to introduce a polar group into testosterone molecule with the aim to increase the sensitivity. Derivatization by use of GT reagent provided excellent results, superior to those obtained with pyridine sulfur trioxide, in terms of ionization efficiency, molecular specificity, and tissue damage. In GT derivatized testis tissues of mice treated with human chorionic gonadotropin (hCG), testosterone was broadly observed both inside and outside the seminiferous tubules by using an iMScope. To evaluate our imaging results, we performed quantification experiments of underivatized testosterone extracted from hCG-treated testes and control testes using LC-MS/MS. We confirmed the 256-fold concentration change between hCG-treated tissues and control tissues. We also confirmed the 228-fold change in detected peak intensities between hCG-treated tissue sections and control tissue sections in imaging results. We consider our tissue preparation methods for IMS provide high sensitivity with high precision. In addition, high-spatial definition IMS was also available, and we confirmed testosterone had mainly accumulated on the surface of the Leydig cells. Graphical abstractGirard’s T-testosterone (GT-Ts) provides the fragment ion at m/z 343.24. Clear GT-Ts signal was detected in hCG treated mouse testis not only as spectra but also as a mass image

Intravesical Prostatic Protrusion as a Predicting Factor for the Adverse Clinical Outcome in Patients With Symptomatic Benign Prostatic Enlargement Treated With Dutasteride

OBJECTIVE To evaluate the role of intravesical prostatic protrusion (IPP) as a predictive factor for adverse clinical outcomes in patients treated with dutasteride for lower urinary tract symptoms secondary to benign prostatic enlargement (BPE). METHODS In total, 111 patients treated with dutasteride for symptomatic BPE were analyzed. Stepwise multivariate logistic regression was applied to evaluate predictors for acute urinary retention (AUR) or benign prostatic hyperplasia (BPH)-related surgery. We applied an IPP cutoff value of 10 mm. The clinical variables were assessed using univariate analysis. RESULTS Of 111 patients, 27 (24.3%) developed AUR or required surgical intervention. On multivariate analysis, IPP remained as the independent predictor for AUR and need for BPH-related surgery (odds ratio, 1.27; P < .001). Both international prostate symptom score and maximum urinary flow rate significantly improved in patients with low IPP (P  =  .03 and P  <  .001, respectively), but not in those with high IPP. No significant reduction was found in the degree of IPP despite the significant reduction in prostate volume after dutasteride treatment (P  =  .84 and P  <  .001, respectively). The 3-year cumulative incidence of AUR or BPH-related surgery in the low IPP group vs the high IPP group was 9.9% vs 71.5%, respectively (P  <  .001). CONCLUSION High IPP is associated with a higher risk of treatment resistance, AUR, or the need for prostatic surgery in patients receiving dutasteride treatment for symptomatic BPE. Dutasteride might not be effective for IPP reduction.

Recovery of Erectile Function after Nerve-Sparing Laparoscopic Radical Prostatectomy in Japanese Patients Undergoing Both Subjective and Objective Assessments

INTRODUCTION The sexual potency rate following a radical prostatectomy can vary. In Japanese patients, sexual activity after nerve-sparing prostatectomy seems especially unfavorable. Most studies have assessed potency status subjectively using questionnaires. AIMS The aim of this study is to evaluate the recovery of potency in Japanese patients after nerve-sparing laparoscopic prostatectomy (nsLRP) both subjectively and objectively. METHODS Twenty-seven patients operated on with nsLRP (bilateral sparing in four patients, unilateral in 23 patients) were enrolled. The mean age of the patients was 60.1 years. Seventeen of 27 patients used type 5 phosphodiesterase inhibitors on demand at least 3 months after surgery. MAIN OUTCOME MEASURES Subjective erectile function was examined by the international index of erectile function (IIEF)-15 and by the erection hardness score (EHS) questionnaires before and at 3, 6, and 12 months after surgery. Objective erectile function, with measurement of rigidity and tumescence of the penis, was evaluated by RigiScan-Plus as the erectile response to audio-visual stimulation. RESULTS IIEF erectile function domain, IIEF-total, and EHS scores decreased significantly after surgery; they were almost half of pretreatment levels at 12 months after surgery. On the other hand, penile rigidity and tumescence measured by RigiScan also decreased significantly 3 months after surgery. However, these values gradually improved, and head nearly recovered at 12 months after surgery. At 12 months after surgery, recovery rates of penile rigidity and tumescence from baseline were rigidity 92.6% at tip and 96.3% at base, with tumescence of 87% at tip and 76% at base. CONCLUSIONS Discrepancies were found between results of subjective and objective assessments of erectile function. From an objective viewpoint, the recovery of erectile function in Japanese patients after nsLRP was not bad.

Symptomatic change in Japanese hypogonadal patients several years after androgen replacement therapy

Objective. There are few reports on the prognosis of patients receiving androgen replacement therapy (ART). In this study, we evaluated the subsequent symptoms of Japanese hypogonadal patients who had received ART, within several years previously by mail-in survey. Methods. Thirty-three aged men with symptoms of hypogonadism and testosterone deficiency who had received ART for 6 months responded to this survey. The survey consisted of questions associated with present physical and mental status and desire to resume ART. The Aging male’s symptoms (AMS) scale, IIEF-5 and SF-36 were also evaluated at pre-initiation, termination of ART and the time of the survey. Results. The mean duration from the last treatment was 55 months. Compared with the treatment period, more than half of patients (57.5%) answered that their present condition was better. Scores on the AMS scale, IIEF and SF-36 were all improved significantly in the early stages of treatment and not worsened a long period of time after ART was discontinued. Conclusions. For symptomatic Japanese hypogonadal patients, subjective effects of treatment were observed during the early treatment period and remained unchanged after discontinuation of ART. A short treatment period may thus be adequate in Japanese hypogonadal patients as regards symptomatic changes.

Introduction of an Enhanced Recovery after Surgery Protocol for Robot-Assisted Laparoscopic Radical Prostatectomy.

Introduction: No studies have shown whether the enhanced recovery after surgery (ERAS) protocol is superior to the conventional protocol after robot-assisted laparoscopic radical prostatectomy (RALP). We compared intestinal function and perioperative parameters of patients with prostate cancer after the ERAS and conventional protocols to determine the superior protocol for recovery of intestinal function. Material and Methods: A retrospective analysis of 198 consecutive patients who underwent RALP between August 2013 and June 2015 was conducted. Our study design included 2 cohorts. Patients underwent conventional care in one group (n = 123) and the ERAS protocol in the other group (n = 75). The primary outcome was the time to first defecation. Secondary outcomes were perioperative parameters and the complication rate. Results: The ERAS group showed a significantly shorter time to first defecation than did the conventional group (p = 0.006). Multivariate analysis showed that selection of the ERAS protocol was significantly associated with the number of days for first time to defecation. Conclusions: Successful application of an ERAS protocol was applied to our patients who underwent RALP and did not have major complications. The ERAS protocol included enhanced intestinal recovery. The ERAS group showed a significantly shorter time to first defecation than did the conventional group.

Contemporary outcomes of seminal tract re-anastomoses for obstructive azoospermia: a nationwide Japanese survey.

To evaluate current outcomes of seminal tract re‐anastomoses in Japan, and to compare them with historical data.

Preoperative sexual status of Japanese localized prostate cancer patients: comparison of sexual activity and EPIC scores

Abstract Objective: This study aimed to evaluate the relationship between sexual activity and sexual function using questionnaires distributed to middle-aged Japanese patients with localized prostate cancer. Methods: A total of 145 patients who underwent radical prostatectomy were enrolled in the survey reported on herein. Sexual activity and sexual function were investigated via the Expanded Prostate Cancer Index Composite (EPIC) and an original self-reported questionnaire. Results: Of participants, 24.1% and 20.7% had sexual activity within a month period as investigated via the EPIC and original questionnaire, respectively. However, 29.7% of all those who reported sexual activity rate reported “about once every 2 months to a year,” as shown in the original questionnaire. Regarding sexual function as addressed through EPIC, no results within that questionnaire’s measure of sexual function showed significant differences among patients with a rate of actual sexual activity. Conclusions: The present survey showed that more than quarter of preoperative middle-aged Japanese prostate cancer patients surveyed had actual sexual activity, though not within the preceding 4 weeks. To precisely evaluate sexual function of middle-aged Japanese patients, it is necessary to consider actual sexual activity.

Novel ureteroscopic navigation system with a magnetic tracking device: a preliminary ex vivo evaluation.

PURPOSE Examination of the pyelocaliceal system using a flexible ureteroscope necessitates accurate orientation of the tip of the instrument. This study assessed the use of a novel real-time ureteroscopic navigation system in a pyelocaliceal phantom. MATERIALS AND METHODS The navigation system used a magnetic tracking device to determine the position of the ureteroscope in a pyelocaliceal phantom and displayed the position of the endoscope on a three-dimensional image that could be rotated. Twenty-eight urologists were divided into group A and group B (seven novice surgeons and seven experienced surgeons in each group). All participants were asked to examine the phantom and identify the positions of three designated calices, without the navigation system (Task 1) and with the navigation system (Task 2). In group A, participants performed Task 1 followed by Task 2. In group B, participants performed Task 2 followed by Task 1. The accuracy rate (AR) of identifying the calices, migration length (ML) of the tip of the ureteroscope, and time (T) taken to complete the task were recorded. The results were compared between Task 1 and Task 2, and between novice and experienced surgeons. RESULTS The AR for Task 2 was 100% in both group A and group B. The AR was significantly lower in Task 1 than in Task 2 for both novice and experienced surgeons in both groups (group A: novice P=0.016, experienced P=0.034; group B: novice P=0.015, experienced P=0.015; Wilcoxon test). In Group A, T was significantly longer in Task 1 than in Task 2 for experienced surgeons. There were no significant differences in ML or T between novice and experienced surgeons. CONCLUSIONS Our novel ureteroscopic navigation system improved the accuracy of ureteroscopic maneuvers. Further development of this system for use in clinical ureteroscopic procedures is planned.

Nationwide survey of urological specialists regarding male infertility: results from a 2015 questionnaire in Japan

To investigate the incidence, etiology, treatment indications, and outcomes regarding infertile male patients in Japan.

Influence of scars on body image consciousness with respect to gender following laparoendoscopic single-site versus conventional laparoscopic surgery

Abstract Objective: The aim of this study was to evaluate and compare the cosmetic outcomes of laparoscopic single-site surgery (LESS) and conventional laparoscopy (CL) in the treatment of ureteropelvic junction obstruction (UPJO) and urachal remnant removal. LESS is thought to produce better cosmetic results than CL; however, patients’ perception of their scars has not been assessed. This study compared the subjective body image and cosmesis ratings of patients who had undergone LESS or CL for UPJO and urachal remnant removal. Materials and methods: Fifty patients who underwent LESS or CL for UPJO or urachal remnant removal between June 2008 and June 2015 were included. Cosmetic outcomes were evaluated using the Body Image Questionnaire (BIQ) and Photo-Series Questionnaire (PSQ). Results: The body image and cosmetic scores were significantly higher for patients who underwent LESS than for those who underwent CL, for both pyeloplasty and urachal remnant removal (p < .05 each). When performed for either a pyeloplasty or urachal remnant removal, significantly greater BIQ and PSQ scores were observed in females after LESS compared to CL, but not in males. Conclusion: LESS for UPJO and urachal remnant removal has better self-reported body image and cosmesis ratings than CL. This trend is particularly strong in female patients.