Mineo Takei

Japanese guideline for diagnosis and treatment of interstitial cystitis

Interstitial cystitis (IC) is a disease of the urinary bladder with lower urinary tract symptoms such as urinary frequency, bladder hypersensitivity and/or bladder pain and resultant serious impairment of quality of life. In Japan, assuming that IC is very rare, research activity and medical care of IC have been sparse until 2001, when the Society of Interstitial Cystitis of Japan (SICJ) and a patient support group were founded. 1,2 Subsequently the International Consultation on Interstitial Cystitis Japan (ICICJ) was held in Kyoto in 2003. 3 On the other hand, the etiology of IC has not been well clarified, which complicates its diagnosis and treatment at clinical settings. We have thus developed the Japanese Clinical Guideline, 4 which is targeted at healthcare professionals including specialists in urology and womens health care who may engage in the diagnosis and treatment of IC. This article is the English translation of a shortened version of the Guideline for convenience of readers worldwide.

Analysis of the prognostic factors for overactive bladder symptoms following surgical treatment in patients with benign prostatic obstruction

To identify the prognostic variables concerning the improvement of overactive bladder syndrome (OAB) related symptoms following a transurethral resection of the prostate (TURP) in patients with benign prostatic obstruction (BPO).

Recent trends in patient characteristics and therapeutic choices for interstitial cystitis: Analysis of 282 Japanese patients

Objectives:  We investigated the characteristics of recent male and female patients diagnosed with interstitial cystitis (IC), then investigated which therapy was chosen by the attending urologist.

Quality of life assessments in women operated on by tension-free vaginal tape (TVT)

The aim of the study was to evaluate quality of life (QOL) prospectively in women who undergo tension-free vaginal tape (TVT) operation for stress urinary incontinence. Sixty-six women who completed QOL questionnaires and a 2-year follow-up examination were included. Improvement of health-related QOL was assessed by the Incontinence Impact Questionnaire-7 (IIQ-7), the Urogenital Distress Inventory-6 (UDI-6), and two questions regarding patient satisfaction and de novo urge incontinence. Prior to surgery, patients complained most of stress symptoms followed by physical activities and emotional health. Postoperatively IIQ-7 and UDI-6 as a whole and all seven domains improved significantly (p<0.001). Scores of IIQ-7, UDI-6, and seven domains did not differ between the adult and the elderly groups. Of the patients 88% were much satisfied or satisfied with surgical outcomes. Incidence of de novo urge incontinence was 12%. It is concluded that the TVT procedure significantly improved health-related quality of life.

Long‐term safety, tolerability and efficacy of extended‐release tolterodine in the treatment of overactive bladder in Japanese patients

Abstract  Aim: To evaluate the long‐term safety, tolerability and efficacy of extended‐release (ER) tolterodine in Japanese patients completing 12‐week treatment in a randomized, double‐blind trial comparing tolterodine ER 4 mg once daily, oxybutynin 3 mg three times daily or placebo in patients with overactive bladder.

Tension-free vaginal tape surgery for stress urinary incontinencne: A prospective multicentered study in Japan

Aim:  To report the prospective multicentered study of the tension‐free vaginal tape (TVT) procedure for stress urinary incontinence.

Familial amyloidotic polyneuropathy (ATTR Ser50Ile): the first autopsy case report

Abstract We report an autopsy case of a pedigree of familial amyloidotic polyneuropathy (FAP) with a mutation of isoleucine-50 transthyretin (ATTR Ser50Ile). A 47-year-old man started developing severe diarrhea and weight loss at age 41 years, followed by urinary incontinence, autonomic-nervous-system abnormalities and serious heart failure; the diagnosis of FAP (ATTR Ser50Ile) was made on the basis of genetic, histochemical and immunohistochemical analysis. Six years after the initial symptoms, he died of septic shock. Autopsy revealed suppurative peritonitis, perforation of the sigmoid colon and marked systemic amyloid deposition. The total amount of amyloid deposited in the heart was greatly increased and was much lower in the thyroid gland and kidneys compared with amyloid deposits in ordinary FAP (ATTR Val30Met). Amyloid deposition in peripheral vessel walls was prominent, particularly in lymphatics and veins. His elder sister, 54 years old, started to develop orthostatic hypotension at age 49 years, followed by dysesthesia, diarrhea and severe congestive heart failure. Endomyocardial biopsy revealed severe TTR–amyloid deposition; ultrastructural examination demonstrated that amyloid fibrils were deposited disproportionately and extended radially around microvessels. These characteristic patterns of systemic amyloid deposition and distinct clinical manifestations, especially in the cardiovascular system, are considered to be a characteristic feature of ATTR Ser50Ile amyloidosis.

Summary of the Urodynamics Workshops on IC Kyoto, Japan

Urodynamics has traditionally played a valuable role in the diagnostic evaluation of patients with irritative bladder symptoms. The investigation allows the clinician to distinguish the oversensitive bladder (interstitial cystitis) from the overactive bladder (detrusor overactivity or instability). The importance of urodynamics was exemplified by the NIDDK consensus committee on interstitial cystitis (IC) who included cystometry as an essential diagnostic tool in selecting patients for clinical trials related to IC. 1 However, since then, as a wider choice of more effective medical therapies for urgency, frequency, and even urge incontinence have become available, there has been a shift away from urodynamics as a firstline investigation of these patients and a move towards empiral treatment on the basis of symptoms alone. This appears to be the case in interstitial cystitis (IC) also. 2

Predictability of conventional tests for the assessment of bladder outlet obstruction in benign prostatic hyperplasia.

Background The degree of bladder outlet obstruction (BOO) in benign prostatic hyperplasia (BPH) is most accurately quantified by pressure flow studies (PFS), although these studies are more invasive and complicated than conventional tests. We examined how precisely conventional tests predicted the PFS‐assessed degree of BOO.

Clinical Guideline for Female Lower Urinary Tract Symptoms.

The “Japanese Clinical Guideline for Female Lower Urinary Tract Symptoms,” published in Japan in November 2013, contains two algorithms (a primary and a specialized treatment algorithm) that are novel worldwide as they cover female lower urinary tract symptoms other than urinary incontinence. For primary treatment, necessary types of evaluation include querying the patient regarding symptoms and medical history, examining physical findings, and performing urinalysis. The types of evaluations that should be performed for select cases include evaluation with symptom/quality of life (QOL) questionnaires, urination records, residual urine measurement, urine cytology, urine culture, serum creatinine measurement, and ultrasonography. If the main symptoms are voiding/post‐voiding, specialized treatment should be considered because multiple conditions may be involved. When storage difficulties are the main symptoms, the patient should be assessed using the primary algorithm. When conditions such as overactive bladder or stress incontinence are diagnosed and treatment is administered, but sufficient improvement is not achieved, the specialized algorithm should be considered. In case of specialized treatment, physiological re‐evaluation, urinary tract/pelvic imaging evaluation, and urodynamic testing are conducted for conditions such as refractory overactive bladder and stress incontinence. There are two causes of voiding/post‐voiding symptoms: lower urinary tract obstruction and detrusor underactivity. Lower urinary tract obstruction caused by pelvic organ prolapse may be improved by surgery.