Kazutaka Horiuchi

Association Between Metabolic Syndrome and Male Lower Urinary Tract Symptoms in Japanese Subjects Using Three Sets of Criteria for Metabolic Syndrome and International Prostate Symptom Score

OBJECTIVES To investigate whether the metabolic syndrome is a risk factor for lower urinary tract symptoms (LUTS), as defined by the International Prostate Symptom Score (IPSS). METHODS A total of 900 men underwent digital rectal examination of the prostate and completed an IPSS questionnaire. These men had visited our hospital for metabolic screening from April 2008 to March 2009. The IPSS includes scores for 3 questions on voiding symptoms, 3 on storage symptoms, and 1 on postmicturition symptoms. The relationships of the LUTS (determined from the IPSS subscores) with the metabolic syndrome diagnosed using the Japan Society for the Study of Obesity, 2005 National Cholesterol Education Program-Adult Treatment Panel III, and 2005 International Diabetes Federation criteria were examined. The severity of LUTS was compared among the younger, middle-age, and older men (<50, 50-64, and ≥65 years old, respectively) with and without the metabolic syndrome. RESULTS A diagnosis of the metabolic syndrome was made in 16.7%, 16.6%, and 11.7% of the men using the Japan Society for the Study of Obesity, 2005 National Cholesterol Education Program-Adult Treatment Panel III, and 2005 International Diabetes Federation criteria, respectively. Regardless of the presence of the metabolic syndrome, aging was significantly associated with an increased rate of moderate or severe LUTS, except for postmicturition symptoms. In the middle-age men, the metabolic syndrome had a significant negative correlation with storage symptoms (odds ratio 0.258-0.426). In the younger and older men, LUTS was observed equally in those with and without the metabolic syndrome. CONCLUSIONS A relationship between age and LUTS was observed; however, the metabolic syndrome did not show a clear association with LUTS. Our results suggest that LUTS is associated with aging, regardless of the presence of the metabolic syndrome.

Association Between Metabolic Syndrome and Male Overactive Bladder in a Japanese Population Based on Three Different Sets of Criteria for Metabolic Syndrome and the Overactive Bladder Symptom Score

OBJECTIVE To investigate whether metabolic syndrome is a risk factor for overactive bladder (OAB) defined by the Overactive Bladder Symptom Score (OABSS). METHODS A digital rectal examination of the prostate and an OABSS questionnaire were conducted in 1031 men who visited our hospital for metabolic screening from April 2009 to March 2010. The OABSS includes scores for daytime frequency, nighttime frequency, urgency, and urgency incontinence. Relationships of OAB (defined as OABSS ≥3 with an urgency score ≥2) with metabolic syndrome diagnosed by Japan Society for the Study of Obesity (JASSO), National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III), and International Diabetes Federation (IDF) criteria were examined. The severity of OAB symptoms was compared among younger, middle-aged, and elderly men (<50, 50-64, and ≥65 years old, respectively) with and without metabolic syndrome. RESULTS Diagnoses of metabolic syndrome were made in 16.4%, 16.9%, and 12.0% of the men using JASSO, NCEP-ATP III, and IDF criteria, respectively. Regardless of the presence of metabolic syndrome, aging was significantly associated with increased rates of moderate or severe OABSS findings and OAB defined by the OABSS. In middle-aged men, metabolic syndrome had a significant negative association with OAB rate. In elderly men, metabolic syndrome had a significant negative association with the total OABSS. CONCLUSION A relationship between age and OAB was observed, but metabolic syndrome did not show a clear association with OAB. Our results suggest that OAB is associated with aging regardless of the presence of metabolic syndrome.

High-frequency endoluminal ultrasonography for staging transitional cell carcinoma of the bladder

OBJECTIVES To assess the feasibility and limitations of endoluminal ultrasound (ELUS) for clinical staging of bladder tumors. METHODS From 1998 to 1999, 32 patients with transitional cell carcinoma of the bladder were evaluated by high-frequency ELUS using miniature ultrasound transducers (20 MHz, 5.1F or 7.2F) before transurethral resection. Clinical staging using ELUS was compared with the results of pathologic staging. RESULTS Seventeen (94%) of the 18 patients with superficial tumors on ELUS were confirmed by pathologic examination to have Stage pTa (n = 12) or Stage pT1 (n = 5) disease, and 11 (63%) of the 14 patients with muscle-invasive tumors on ELUS were confirmed by pathologic evaluation to have Stage pT2a (n = 2) or Stage pT2b (n = 9) disease. In all of the misdiagnosed patients, the tumor lacked a well-defined base and was larger than 2 cm in size. It was difficult to distinguish between Stage Ta and Stage T1 tumors because of the limited resolution of ELUS and between Stage T2a and Stage T2b tumors because of its low penetration. CONCLUSIONS ELUS using a high-frequency (20 MHz), miniature ultrasound transducer is able to distinguish superficial tumors from those with muscle invasion. However, the lack of penetration of the sonographic beam places major limitations on the evaluation of the depth of the invasion in large (greater than 2 cm) tumors with a broad base.

Renal masses detected by general health checkup.

Abstract Background A total of 60 604 persons underwent a general health checkup at Toma Hospital, Saitama, Japan, between January 1993 and June 1997, and transabdominal ultrasonography (US) was performed on all persons. We investigated the usefulness of transabdominal US in detecting renal tumors during general health checkups.

Facilitation of expulsion of ureteral stones by addition of α1-blockers to conservative therapy.

Abstract Objective. An antispasmodic agent and a medicine that facilitates stone expulsion are given commonly as conservative therapy for ureteral stones in Japan. The goal of this study was to compare the efficacy of the addition of various α1-blockers to the conservative therapy for spontaneous passage of ureteral stones. Material and methods. The subjects were 132 patients with stones from the upper to the lower ureter who were randomly placed into one of four groups and followed for 1 month to assess spontaneous passage of stones. The control group received daily doses of 240 mg flopropione as an antispasmodic agent and 1350 mg extract of Quercus salicina Blume/Quercus stenophylla Makino as a medicine that facilitates stone expulsion. The other three groups received this therapy and daily doses of 30 mg urapidil, 0.2 mg tamsulosin or 50 mg naftopidil, respectively. The characteristics of the stones and stone expulsion were evaluated by urinalysis, a kidney, ureter and bladder (KUB) X-ray, ultrasound and computed tomography. Results. All patients completed the study and there were no major side-effects. There was no difference in age, stone position or stone size among the groups. Multivariate analysis using a Cox proportional hazards model indicated that the probability of stone expulsion for 1 month was increased 2.38 times (95% confidence interval 1.23–4.61) by naftopidil compared with control therapy alone (p = 0.01). Conclusion. Naftopidil in combination with an antispasmodic agent and a medicine that facilitates stone expulsion produces a significantly increased rate of ureteral stone expulsion.

Diagnosing the Location of Carcinoma in situ (CIS) of the Urinary Bladder Using Pirarubicin Hydrochloride

Introduction: No established technique for locating solitary carcinoma in situ (CIS) of the urinary bladder or CIS accompanying bladder cancer has been determined. Here we investigated whether the location of CIS of the urinary bladder can be macroscopically ascertained by instilling pirarubicin hydrochloride (THP) into the urinary bladder. Patients and Methods: We dissolved 50 mg of THP in 50 ml of distilled water, and instilled the resulting solution into the urinary bladder. After 5 min, the urinary bladder is examined using a cystoscope. The study group consisted of 30 subjects (23 men and 7 women). Results: THP uptake was seen in 19 flat (nontumorous) areas of the bladder mucosa in 13 patients. Of these, 11 lesions in 6 patients were confirmed to be CIS. THP uptake was also seen in flat malignant lesions such as bladder cancer invasion into the prostatic urethra, and in benign lesions such as chronic cystitis and urothelial hyperplasia. Conclusions: The present method can be useful to find easily and macroscopically the location of flat malignant lesions such as CIS.

Laparoscopic radical prostatectomy : initial 30-case experience

AbstractBackground. We carried out this study to clarify whether the operative methods of laparoscopic prostatectomy established in France could become standard therapy. The purpose was to evaluate the technical feasibility, oncological efficacy, and intraoperative and postoperative morbidity of laparoscopic prostatectomy performed by a general urologist. Methods. Between June 2000 and August 2002, 30 patients with clinically localized prostate cancer underwent laparoscopic radical prostatectomy performed as previously reported by Guillonneau and colleagues. Oncological data were assessed by pathological examination and by postoperative prostate-specific antigen (PSA) levels. All prostatectomy specimens were processed according to the Stanford protocol. Prostate features, including tumor weight; Gleason score; and the tumor status of the capsule, seminal vesicles, and surgical margins were studied. Results. Complete laparoscopic removal of the prostate and seminal vesicles was achieved in all 30 patients. Operating time averaged 325.5 min (range, 165 to 880 min). The transfusion rate for the patients in the series was 50%, using own-blood transfusion (800–1200 ml). No patient required an allogenic blood transfusion. Only 2 of the 30 patients had a positive surgical margin that involved the urethra. There were three complications: bladder injury, rectal injury, and ileus associated with a drainage tube. No vascular, nervous system, or urethral complications were found. Conclusion. These preliminary results demonstrated that radical prostatectomy can be performed laparoscopically by general urologists. Laparoscopy offered better luminosity and magnification than conventional procedures, permitting precise dissection. Thus, laparoscopic prostatectomy could be a standard operation for patients with clinically organ-confirmed prostate cancer.

Urothelial mucosal concentration of levofloxacin administered before transurethral resection: Is the mucosal concentration predictable?

Background: Although it is an established surgical technique, transurethral resection (TUR) is associated with a certain incidence of postoperative bacteriuria. Assessment was made whether the urothelial mucosal concentration of an antibiotic administered before TUR was high enough to decrease the incidence of urinary tract infection (UTI). Also investigated were factors predicting the organ concentration.