Mitsuru Kajiwara

Nocturnal enuresis and overactive bladder in children: An epidemiological study

Aims:  To investigate the prevalence and characteristics of nocturnal enuresis (NE) and to examine the prevalence of overactive bladder (OAB) symptoms in primary schoolchildren.

Impact of radical perineal prostatectomy on urinary continence and quality of life: A longitudinal study of Japanese patients

Aim: We used self‐completed questionnaires to obtain a longitudinal assessment of urinary continence and urinary, bowel, and sexual domain‐related quality of life (QOL) in Japanese patients undergoing radical perineal prostatectomy (RPP).

Prognostic significance of C-reactive protein in patients with intermediate-risk metastatic renal cell carcinoma treated with molecular targeted therapy

The present study aimed to investigate the impact of pre-treatment C-reactive protein (CRP) levels on the prediction of prognosis in patients with metastatic renal cell carcinoma (mRCC), who were classified as intermediate-risk patients using the Memorial Sloan Kettering Cancer Center (MSKCC) risk classification and who received molecular targeted therapy. The oncological outcome of 140 patients with mRCC who underwent molecular targeted therapy was analyzed. Patients were divided into favorable-, intermediate- and poor-risk groups (groups F, I and P, respectively) based on the MSKCC risk classification. The patients in group I were then further classified into two groups based on pre-treatment serum CRP levels. The overall survival (OS) rates of the patients in these groups were then assessed. The OS rate of the patients in group I with normal pre-treatment CRP levels was found to be significantly increased compared with that of patients with high pre-treatment CRP levels (P<0.0001), while there was no significant difference in the OS rate in the patients with normal pre-treatment CRP levels in group I compared with those in group F. Multivariate analyses revealed that high pre-treatment CRP levels were an independent prognostic factor for OS in the patients in group I (P<0.0001; hazard ratio, 3.898). Thus, pre-treatment CRP levels may be a candidate predictor for OS in patients with intermediate-risk mRCC.

Comparison of Renal Function after Partial Nephrectomy and Radical Nephrectomy for Renal Cell Carcinoma

Objective: To investigate the time-dependent changes of estimated glomerular filtration rate (eGFR) after radical nephrectomy (RN) and partial nephrectomy (PN) for renal cell carcinoma (RCC) and to determine the risk factors for the new onset of a postoperative eGFR <60 ml/min/1.73 m2. Patients and Methods: We assessed the renal function of 253 RCC patients by using the eGFR, and investigated the time-dependent changes of the eGFR after the operation. Regression models were used to determine risk factors for the new onset of an eGFR of <60 ml/min/1.73 m2 in 211 patients who had at least one month of postoperative follow-up. Results: From the first postoperative day to the 60th postoperative month the eGFR in the RN group was significantly lower than that in the PN group. For patients who had at least 1 month of postoperative follow-up, multivariable analysis revealed that RN (p < 0.001), age (p = 0.028), and maleness (p = 0.013) were risk factors for the postoperative onset of an eGFR <60 ml/min/1.73 m2. Conclusions: Renal function after PN was better than that after RN, and RN was a greater risk factor for the postoperative onset of an eGFR <60 ml/min/ 1.73 m2.

Lack of the complete circular rhabdosphincter and a distinct circular smooth muscle layer around the proximal urethra in elderly Japanese women: an anatomical study

Histological observations of semiserial sections obtained from the cadavers of 30 elderly Japanese women (aged 61–93 years) found that the urethral rhabdosphincter (URS) usually occurred as a ventrally localized structure instead of exhibiting the normal completely circular configuration. The superoinferior length, thickness and muscle fiber density of the URS area showed significant interindividual variation. A thick fascicle, extending posterolaterally from the URS and radiating to the lateral vaginal wall and other perineal tissues, was usually observed. A circular smooth muscle layer, which immediately surrounded the longitudinal smooth muscle layer, was consistently present in the proximal urethral but not in the bladder neck. These findings suggest that voluntary sphincteric action is weak or incomplete in elderly Japanese women. We therefore hypothesize that upward retraction of the midurethra by the URS, compression of the distal urethra by its posterolateral extensions, and tonus provided by the outer circular smooth muscle layer all contribute to maintaining continence in these women.

Overactive bladder in children should be strictly differentiated from monosymptomatic nocturnal enuresis.

Introduction: To elucidate the prevalence of concomitant overactive bladder in children with a chief compliant of primary enuresis, and to evaluate the pathogenetic difference between monosymptomatic and non-monosymptomatic enuresis. Materials and Methods: All patients had evidence of primary enuresis. Neurogenic bladder was excluded. Urinary symptoms were evaluated by taking a history from the affected children and parents, and using a questionnaire and bladder diary. Voiding cystourethrography was performed for non-responders to exclude urinary abnormalities. Results: Eighty-eight patients (9.8 ± 3.1 years old) were enrolled. Initial assessment demonstrated that 24% had undervalued overactive bladders and 9% had constipation. Voiding cystourethrography was performed in 25%, demonstrating mechanical urethral obstructions in 8% and vesicoureteral reflux in 4.5%. Constipation, a history of urinary tract infections, mechanical obstructions and vesicoureteral reflux were strongly associated with non-monosymptomatic enuresis. Conclusions: Patients with non-monosymptomatic enuresis had a different clinical background, therapeutic response and pathogenetic abnormalities. In children an overactive bladder should be strictly differentiated from monosymptomatic enuresis.

Patient-reported satisfaction and cosmesis outcomes following laparoscopic adrenalectomy: Laparoendoscopic single-site adrenalectomy vs. conventional laparoscopic adrenalectomy.

INTRODUCTION We evaluate patient-reported satisfaction and cosmesis of laparoendoscopic single-site adrenalectomy (LESS-A) in comparison with that of conventional laparoscopic adrenalectomy (CLA). METHODS A total of 19 and 104 patients who respectively underwent LESS-A and CLA between May 1996 and June 2011 were included in the study. Questionnaires inquiring about scar pain (0: not painful, 10: very painful), satisfaction (0: not satisfied, 10: very satisfied) and cosmesis (0: very unsightly, 10: very beautiful) on the basis of a visual analogue scale were sent to patients postoperatively. RESULTS The respondents consisted of 11 and 54 patients who underwent LESS-A and CLA, respectively. There was no significant inter-group difference in age, sex, affected side or body mass index. No significant differences were observed in operative time or estimated blood loss. There were also no significant differences in pain (0.67 vs. 0.57, p = 0.393), satisfaction (8.92 vs. 8.46, p = 0.453), or cosmesis score (8.58 vs. 8.00, p = 0.487) between the LESS-A and CLA groups overall. In female patients, the satisfaction score was significantly higher in the LESS-A group than in the CLA group (10.0 vs. 8.72, p = 0.049). In young patients (<50 years old), the satisfaction score was also significantly higher in the LESS-A group than in the CLA group (9.17 vs. 6.38, p = 0.036). CONCLUSIONS Young patients and female patients who had received LESS-A adrenal surgery were more satisfied with the scar outcomes than were the young patients and female patients who had received CLA. We suggest that this patient subset most values the cosmetic benefits of LESS-A.

Impact of laparoscopic experience on the proficiency gain of urologic surgeons in robot-assisted surgery.

PURPOSE The aim of our study is to assess the impact of skill in laparoscopic surgery on the learning of robot-assisted surgery by urologic surgeons using the Mimic dV-trainer (MdVT). MATERIALS AND METHODS Twenty-three urologic surgeons using the MdVT were assessed. Ten of them were laparoscopic surgeons certified by the Japanese Society of Endourology. Each of the subjects completed four trials of a program consisting of four EndoWrist modules and two needle-driving modules. The performances of all subjects were recorded using a built-in scoring algorithm. RESULTS In only one of the needle-driving tasks, Suture Sponge (that all subjects felt was the most difficult task), the scores of the certified laparoscopic surgeons became significantly better than those of the other subjects at the 2nd and the 3rd trials (p=0.0236 and p=0.0043 at the 2nd and 3rd trials, respectively). At the 4th trial there was no significant difference between the two groups with regard to the overall scores of any tasks. CONCLUSIONS Our data indicate that familiarity with laparoscopic surgery is not associated with any advantage in learning the most fundamental techniques of robot-assisted surgery.

Therapeutic efficacy of narrow band imaging-assisted transurethral electrocoagulation for ulcer-type interstitial cystitis/painful bladder syndrome.

Narrow band imaging cystoscopy can increase the visualization and detection of Hunners lesions. A single‐center, prospective clinical trial was carried out aiming to show the effectiveness of narrow band imaging‐assisted transurethral electrocoagulation for ulcer‐type interstitial cystitis/painful bladder syndrome.

Anterior urethral valves in children : A possible association between anterior urethral valves and Cowper's duct cyst

Abstract:  To elucidate the pathophysiology of congenital obstruction of the anterior urethra and to investigate the association between anterior urethral valves and syringocele. Three boys with congenital obstruction of the anterior urethra diagnosed at our department between 1997 and 2004 were analyzed retrospectively. All three boys had congenital obstruction in the bulbar urethra. The presenting symptoms and age of each patient were varied. Whereas continuity between Cowper’s duct and the diverticulum was not demonstrated radiographically in all of the boys, it was speculated endoscopically in all. Our series has suggested a possible association between anterior urethral valves (diverticulum) and syringocele. These congenital anomalies of the anterior urethra should be considered in the differential diagnosis of obstructive lesions of the urinary tract.