Kazufumi Nakashima

Liquid-Based Urine Cytology as a Tool for Detection of Human Papillomavirus, Mycoplasma spp., and Ureaplasma spp. in Men

ABSTRACT Liquid-based urine cytology (LB-URC) was evaluated for cytological diagnosis and detection of human papillomavirus (HPV), Mycoplasma, and Ureaplasma. Midstream urine samples were collected from 141 male patients with urethritis and 154 controls without urethritis, and sediment cells were preserved in liquid-based cytology solution. Urethral swabs from urethritis patients were tested for the presence of Neisseria gonorrhoeae and Chlamydia trachomatis. Papanicolaou tests were performed for cytological evaluation. HPV, Mycoplasma, and Ureaplasma genomes were determined by PCR-based methods, and localization of HPV DNA in urothelial cells was examined by in situ hybridization (ISH). The β-globin gene was positive in 97.9% of LB-URC samples from urethritis patients and in 97.4% of control samples, suggesting that high-quality cellular DNA was obtained from the LB-URC samples. HPV DNA was detected in 29 (21.0%) urethritis cases and in five (3.3%) controls (P < 0.05). HPV type 16 (HPV 16) was most commonly found in urethritis patients. Cytological evaluations could be performed for 92.1% of urethritis patients and 64.3% of controls. Morphological changes suggestive of HPV infection were seen in 20.7% of the HPV-positive samples, and ISH demonstrated the presence of HPV DNA in both squamous and urothelial cells in HPV-positive samples. Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum, and Ureaplasma urealyticum were detected in 14.5%, 10.9%, 6.5%, and 12.3% of urethritis patients, respectively. The prevalence rates of these microorganisms (except Ureaplasma parvum) were significantly higher in urethritis cases than controls (P < 0.05). LB-URC is applicable for detection of HPV, Mycoplasma, and Ureaplasma. HPV infection occurs in urothelial cells, especially in gonococcal urethritis.

Japan Cancer of the Prostate Risk Assessment for combined androgen blockade including bicalutamide: Clinical application and validation

The Japan Cancer of the Prostate Risk Assessment was developed as a risk stratification instrument for patients undergoing primary androgen deprivation therapy. However, there have been no studies to validate the accuracy of the Japan Cancer of the Prostate Risk Assessment in predicting clinical outcomes. We examined whether the clinical outcomes of patients treated with combined androgen blockade could be stratified using the Japan Cancer of the Prostate Risk Assessment.

Use of preoperative factors including urodynamic evaluations and nerve-sparing status for predicting urinary continence recovery after robot-assisted radical prostatectomy: Nerve-sparing technique contributes to the reduction of postprostatectomy incontinence

To examine which preoperative factors, including urodynamic evaluations, and operative procedures could predict continence status after robot‐assisted radical prostatectomy (RARP) in this study.

Etiological correlation of human papillomavirus infection in the development of female bladder tumor

The critical factors and etiological role of human papillomavirus (HPV) infection in the development of female bladder tumor were examined. Eighty‐four female patients with primary bladder tumor were studied. After DNA extraction from each paraffin‐embedded tissue, HPV‐DNA and genotype were checked. In cases of all HPV‐positive cases and some HPV‐negative cases, in situ hybridization (ISH) for high‐risk HPV‐DNA, and immunohistochemical analysis for p16‐INK4a were performed. HPV‐DNA was detected in 5 (6.0%) of 84 eligible patients, and HPV16 was detected in 3 patients, and HPV6 and HPV52 was detected in one case, respectively. HPV‐DNA was detected frequently in younger patients and in patients with a history of cervical cancer. In four high‐risk HPV‐positive cases, high‐risk HPV‐DNA was present in tumor tissues, and p16‐INK4a was expressed moderately or strongly. Two cases had a past history of cervical cancer. In these 2 cases, the same HPV type (HPV16) was detected from bladder tumor and cervical cancer. High‐risk HPV‐DNA ISH signals and p16‐INK4A expression were also detected widely in these cervical cancer tissues. HPV infection is likely to play an important role in the development of female bladder tumor at younger cases with a past history of cervical cancer.

Effects of testosterone replacement therapy on hypogonadal men with osteopenia or osteoporosis: a subanalysis of a prospective randomized controlled study in Japan (EARTH study)

Abstract Objective: We investigated the effects of testosterone replacement therapy (TRT) on bone mineral density (BMD) among hypogonadal men with osteopenia/osteoporosis. Methods: From our previous EARTH study population, 74 patients with a clinical diagnosis of osteopenia or osteoporosis and hypogonadism were included in this study, as the TRT (n = 35) and control (n = 34) groups. The TRT group was administered 250 mg of testosterone enanthate injection every 4 weeks for 12 months. The BMD, waist circumference, body mass index, body fat percentage, and muscle volume were measured at baseline and at 12 months. Blood biochemical data, including total cholesterol, triglycerides, HDL-cholesterol, hemoglobin A1c, and adiponectin values were also evaluated. Results: At the 12-month visit, BMD significantly increased in both groups. However, comparisons on changes of parameter values from baseline to the 12-month visit between the TRT and control groups were significantly different in BMD (5.0 ± 5.0 vs. 3.0 ± 3.2; p = .0434) and in adiponectin value (−0.90 ± 3.33 vs. 0.10 ± 2.04; p = .0192). There were no significant changes in other parameters. Conclusions: TRT for 12 months could improve BMD with a decrease in adiponectin levels among hypogonadal men with osteopenia/osteoporosis.

Changes in penile length after radical prostatectomy: Investigation of the underlying anatomical mechanism

To measure changes in penile length (PL) over time before and after radical prostatectomy (RP), and to investigate the underlying mechanisms for these changes.

Decreasing trend in prostate cancer with high serum prostate-specific antigen levels detected at first prostate-specific antigen-based population screening in Japan

To clarify the recent trends in prostate-specific antigen (PSA) distribution in men in Japan, we analyzed the PSA distributions of men undergoing PSA-based population screening. We summarized the annual individual data of PSA-based population screening in Kanazawa, Japan, from 2000 to 2011, and analyzed baseline serum PSA values of the participants at the first population screening. Serum PSA distributions were estimated in all participants and those excluding prostate cancer patients according to age. From 2000 to 2011, 19 620 men participated aged 54–69 years old in this screening program. Mean baseline serum PSA level of all participants at the first screening was 2.64 ng ml−1 in 2000, and gradually decreased to approximately 1.30 ng ml−1 in 2006. That of participants excluding prostate cancer patients was 1.46 ng ml−1 in 2000, and there was no remarkable change during the study period. The 95th percentiles in the participants excluding prostate cancer patients detected at the first population screening of men aged 54–59, 60–64, and 65–69 years old were 2.90, 3.60, and 4.50 ng ml−1, respectively. After the commencement of population screening, the proportion of prostate cancer patients with high serum PSA levels decreased. However, there were no changes in serum PSA levels in men without prostate cancer. Age-specific PSA reference level of men without prostate cancer in Japan was similar to that in China and Korea.

Effect of testosterone replacement therapy on sexual function and glycemic control among hypogonadal men with type 2 diabetes mellitus

We investigated the effect of testosterone replacement therapy (TRT) on glycemic control and sexual function among hypogonadal men with type 2 diabetes mellitus (T2DM). From the EARTH study, 86 patients (47 in the TRT and 39 in the non-TRT groups) with a diagnosis of T2DM were extracted. We collected data on waist circumference, body mass index, body fat volume, free testosterone, hemoglobin (Hb), fasting blood sugar, and hemoglobin A1c (HbA1c) at baseline and after 12 months. Aging Male Symptoms (AMS) score and International Prostate Symptom Score were obtained. Sexual function was assessed by questions 15 (sexual ability), 16 (morning erections), and 17 (sexual desire) of AMS subscores. The TRT group received intramuscular testosterone enanthate (250 mg) injections every 4 weeks for 12 months. Body fat percentage, Hb, and HbA1c were significantly improved in the TRT group. In addition, sexual ability and frequency, and sexual desire showed a significant improvement in the TRT group after 1 year TRT. On the other hand, any parameters including glycemic control and sexual functions were not significantly improved in non-TRT groups. One-year TRT can improve sexual function and glycemic control among hypogonadal men with T2DM.

Investigating the mechanism underlying urinary continence recovery after radical prostatectomy: effectiveness of a longer urethral stump to prevent urinary incontinence

To assess the chronological changes in urinary incontinence and urethral function before and after radical prostatectomy (RP), and to compare the findings of pelvic magnetic resonance imaging (MRI) before and after RP to evaluate the anatomical changes.

PD49-10 CHANGES IN PENILE LENGTH AFTER RADICAL PROSTATECTOMY: INVESTIGATION OF ANATOMICAL MECHANISM

INTRODUCTION AND OBJECTIVES: Intraoperative frozen section analysis (FSA) of biopsy or resection specimens often provides critical information for appropriate surgical management. However, to the best of our knowledge, there are no recent studies focusing on assessing the role of FSA in the status of surgical margins (SMs) relating to the outcomes of penectomy cases. Instead, a few review articles discourage its use in the intraoperative assessment of SMs during penectomy, mainly because lesions often show well differentiated squamous proliferation that can mimic nonneoplastic conditions. The current study aims to investigate the utility of routine FSA of the SMs in men undergoing penectomy for squamous cell carcinoma. METHODS: A retrospective review identified consecutive patients (n1⁄438) who underwent partial (n1⁄426) or total (n1⁄412) penectomy for squamous cell carcinoma at our institution from 2004 to 2015. FSA findings were correlated with the diagnosis of the frozen section control, the status of final SM, and patient outcomes. RESULTS: FSA of the SMs was performed in 20 (77%) partial penectomies and 9 (75%) total penectomies, while no FSA was done for SMs in other cases. FSAs were reported as positive (n1⁄43, 10%), negative (n1⁄424, 83%), and atypical (n1⁄42, 7%). All of the positive or negative FSA diagnoses, including those in 7 cases of well differentiated carcinoma, were confirmed accurate on the frozen section controls, whereas the 2 cases with atypical FSA had non-malignant and carcinoma cells, respectively, on the controls. Final SMs were positive in 5 (13%) penectomies (2 partial and 3 total), including 3 (10%) FSA cases versus 2 (22%) non-FSA cases (P1⁄40.574). Furthermore, 2 initially FSA-positive/atypical cases achieved negative conversion by excision of additional tissue sent for FSA. In contrast, 2 FSA-negative cases showed carcinoma at the final SM where FSA was not submitted. During follow-up (mean: 41.2; median: 42; range: 1-136 months), 3 patients (non-FSA/final SM-negative, non-FSA/final SM-positive, FSAnegative/final SM-negative) developed tumor recurrence, and one of them (non-FSA/SM-positive) died of cancer. Kaplan-Meier analysis revealed that the number or diagnosis of FSA was not significantly associated with disease progression. CONCLUSIONS: Overall, performing FSA during penectomy does not appear to have any significant impact on final SM status nor long-term oncologic outcomes. However, as seen in at least 2 cases, select patients may benefit from the routine FSA. Meanwhile, diagnostic accuracy of FSA of the SMs was found to be quite high.