Midori Ichino

Relation between expression of α1-adrenoceptor mRNAs in bladder mucosa and urodynamic findings in men with lower urinary tract symptoms

Abstract Objective. To investigate the possible relationship between the bladder mucosal expression of α1-adrenoceptor (AR) mRNAs, storage symptoms and urodynamic findings in patients with lower urinary symptoms (LUTS) and benign prostatic obstruction (BPO). Material and methods. Mucosa was obtained from the posterior bladder wall from 20 patients with a diagnosis of LUTS and BPO undergoing prostatectomy. α1-AR subtype mRNA was quantified using competitive real-time reverse transcription–polymerase chain reaction. A preoperative video urodynamic study measured volumes for first desire to void (FDV) and strong desire to void (SDV). Patients were divided into group 1, with volumes for FDV ≤ 200 ml or SDV ≤ 300 ml, and group 2, with volumes FDV ≥ 201 ml and SDV ≥ 301 ml. Preoperative and postoperative international prostate symptom score (IPSS) and Overactive Bladder Symptom Score (OABSS) were evaluated. Results. The group 1 FDV (141.0 ± 13.5 ml) was significantly lower than that of group 2 (299.0 ± 48.1 ml). Similarly, the SDV for group 1 (247.0 ± 21.9 ml) was also significantly lower than for group 2 (444.0 ± 32.5 ml). There were no significant differences between groups 1 and 2 with respect to mucosal α1a- and α1b-AR mRNA levels. However, group 1 patients had significantly more α1d-mRNA than those in group 2. No relationship between the expression of α1-AR mRNAs and preoperative or postoperative OABSS or IPSS was detected. Conclusion. There was a relationship between the expression of α1d-AR mRNA in the bladder mucosa and storage-phase urodynamics in LUTS/BPO patients, suggesting a role of α1D-ARs in bladder sensation.

Relationship between expression of β3-adrenoceptor mRNA in bladder mucosa and urodynamic findings in men with lower urinary tract symptoms.

To investigate the relationship between urinary bladder mucosal expression of β3‐adrenoceptor (AR) mRNA and urodynamic findings in patients with lower urinary tract symptoms and benign prostatic obstruction (BPO).

Liposome Encapsulated Doxorubicin Transfer to the Pelvic Lymph Nodes by Endoscopic Administration into the Bladder Wall: A Preliminary Report

PURPOSE Liposome encapsulated doxorubicin administered to the pelvic lymph nodes might be effective against pelvic node metastasis. We determined whether the drug can be delivered to the nodes via the bladder wall. MATERIALS AND METHODS Ten patients underwent endoscopic administration of 10 mg. liposomal doxorubicin into the bladder wall 3 days before cystectomy. The concentration of doxorubicin in the pelvic lymph nodes obtained at operation was measured. RESULTS No complication developed after drug administration. Almost all lymph nodes examined contained more than 100 ng./gm. doxorubicin (median 1,860). CONCLUSIONS Endoscopic administration of liposomal doxorubicin into the bladder wall may be an alternative method to deliver doxorubicin to the pelvic lymph nodes.

Videourodyanamic Examination and Tension-free Vaginal Mesh/Transobturator Tape Surgery.

Most pelvic organ prolapse (POP) patients have lower urinary tract symptoms (LUTS) before and after POP surgery. LUTS of POP patients consist of various storage and voiding symptoms from anatomical causes. Videourodynamic examination for POP patients provides accurate information about morphological findings of the bladder and urethra, and lower urinary tract (LUT) function. The leak point pressure (LPP) measurement at cough maneuver in the standing position is important to detect urodynamic stress urinary incontinences (UDS SUI). Prolapse reduction procedure is not perfect for the detection of SUI.

Analysis of the Pressure-Flow Study in Weak Detrusor Patients with Benign Prostatic Hypertrophy

Objective: Pressure‐flow study is a method used to evaluate the degree of bladder outlet obstruction and the strength of detrusor contractility during voiding. However, whether or not the operation for benign prostate hyperplasia should be avoided in detrusor underactivity patients remains controversial. To address this, we performed a retrospective analysis of our pressure‐flow study data for benign prostate hyperplasia patients. We especially focused on the backgrounds of patients with weak detrusor contractility.

Correlation Between Bladder Mucosal Alpha-1D/Alpha-1A Adrenoceptor mRNA Ratio and Lower Urinary Tract Function in Benign Prostatic Obstruction Patients

Objectives: Alpha‐1 adrenoceptor (AR) antagonists are commonly used as therapeutic agents for patients with benign prostatic obstruction (BPO). Our objective was to investigate the correlation between the ratio of bladder mucosal alpha‐1D/alpha‐1A adrenoceptor mRNA and lower urinary tract function in BPO patients.

Secondary Transobturator Tape Procedure after Combined Pelvic Organ Prolapse Repair.

A 66‐year‐old female who underwent a partial urethrectomy complained of severe incontinence due to intrinsic sphincter deficiency. Bone anchor surgical technique was performed, but in 3 years, serious pelvic organ prolapse had occurred. Consequently, anterior and posterior tension‐free vaginal mesh operation was planned. Preoperative urodynamic examination predicted postoperative stress incontinence, and concurrent transobturator tape (TOT) surgery was performed. After 3 months, stress incontinence reoccurred, and secondary TOT was performed. Relapse was probably caused by dislocation of the first TOT towards the bladder neck. Thus, the secondary TOT was placed distal to the initial tape towards the external urethral meatus, and proper tension was applied. After the operation, stress incontinence was cured. Thus, a second TOT procedure, with proper positioning and tensioning, can effectively cure stress incontinence that occurs after an initial TOT procedure.

A case of adult neuroblastoma arising in the retroperitoneal space

Neuroblastoma, common in children, rarely develops in adults. We recently treated a patient with adult neuroblastoma. A 34-year-old man complained of a swelling in right inguinal region. CT scan showed swelling of retroperitoneal and inguinal lymph nodes, and bone scintigram by 99mTc-HMDP showed an abnormal uptake in the swollen lymph nodes. Chemotherapy with CDDP (cisplatinum), VP-16 (etoposide), BLM (bleomycin), ADM (adriamycin) was not effective. Histopathological examination of a biopsy specimen revealed neuroblastoma. Another chemotherapy with CPM (cyclophosphamide), VCR (vincristine), ADM, DTIC (dacarbazine), CDDP, VP-16 was effective in decreasing the tumor size. Further high dose chemotherapy with CPM, ADM, CDDP, VP-16 combined with peripheral blood stem cell transplantation led to almost complete disappearance of the tumor and normalization of blood tumor markers (neuron specific enolase and immunosuppressive acidic protein). Retroperitoneal lymph node dissection demonstrated well-differentiated neuroblastoma in the excised tissue. Six months postoperatively, the tumor recurred in the pelvic cavity. Although chemotherapy and radiotherapy were given, he died of the disease 12 months postoperatively.