Ryoei Hara

Optimal Approach for Prostate Cancer Detection as Initial Biopsy: Prospective Randomized Study Comparing Transperineal Versus Transrectal Systematic 12-Core Biopsy

OBJECTIVES Transperineal and transrectal prostate biopsy are both used for prostate cancer detection. However, which approach is superior remains unknown. In this study, we performed a prospective randomized study to compare the efficacy of transperineal versus transrectal 12-core initial prostate biopsy. METHODS From May 2003 to October 2005, a prospective randomized study of transperineal versus transrectal 12-core biopsy (126 and 120 patients, respectively) was conducted in 246 patients with a prostate-specific antigen level of 4.0 to 20.0 ng/mL. All procedures were performed with the patient in the lithotomy position, with the transperineal and transrectal approach performed with spinal anesthesia (0.5% bupivacaine) or a caudal block (1% lidocaine), respectively. With both approaches, eight biopsy specimens were obtained systematically from the peripheral zone, including the apex, and four from the transition zone. RESULTS The cancer detection rate was 42.1% (53 of 126 patients) with the transperineal approach and 48.3% (58 of 120 patients) with the transrectal approach (P = 0.323). For all patients undergoing transperineal and transrectal biopsy, the cancer core rate (cancer core number/biopsy core number) was 13.7% (207 of 1512 cores) and 14.4% (208 of 1440 cores), respectively (P = 0.566). Apart from headache, presumably related to the spinal anesthesia, no significant differences were found in the complications between the two groups. CONCLUSIONS No significant differences were found in the cancer detection rate, cancer core rate, or complications between the two approaches. We believe that the preferred approach as an initial prostate biopsy is the transrectal approach, which does not require spinal anesthesia or another burdensome process.

A novel technique for approaching the endopelvic fascia in retropubic radical prostatectomy, based on an anatomical study of fixed and fresh cadavers

To present the anatomical basis and details of a technique for an approach to the endopelvic fascia devised to preserve urinary continence.

A prospective randomized comparison of diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy.

The aim of this study is to elucidate the diagnostic efficacy between transperineal and transrectal 12-core prostate biopsy for prostate cancer. We prospectively randomized 200 consecutive men into two groups to undergo systematic prostate biopsy. Overall positivity for cancer was similar (47% by transperineal and 53% by transrectal; P=0.480). However, in case with ‘gray zone’ PSA (from 4.1 to 10.0 ng/ml), significantly more cores were positive when approach was transperineal, especially among transition zone cores. Therefore, urologist preferences are sufficient for choosing an approach, except for a possible small advantage of transperineal biopsy when PSA is in gray zone.

Effects of three types of alpha‐1 adrenoceptor blocker on lower urinary tract symptoms and sexual function in males with benign prostatic hyperplasia

Objectives:  The aim of the present study was to explore the effects of three different types of alpha‐1 adrenoceptor blockers (α1‐blocker) on lower urinary tract symptoms (LUTS), erectile dysfunction (ED) and ejaculatory dysfunction (EjD) in patients with benign prostatic hyperplasia.

Salvage high-dose-rate brachytherapy for local prostate cancer recurrence after radiotherapy – preliminary results

Study Type – Prognostic (case series)

Ejaculatory dysfunction caused by the new α1‐blocker silodosin: A preliminary study to analyze human ejaculation using color Doppler ultrasonography

Objectives:  In order to clinically investigate the mechanism of ejaculatory dysfunction attributable to the α1‐blocker silodosin, a real‐time observation of ejaculation by healthy males was performed.

Long-term safety and efficacy of two different antimuscarinics, imidafenacin and solifenacin, for treatment of overactive bladder: a prospective randomized controlled study.

Objective: The aim of this study was to assess the efficacy and safety of long-term treatment with two different antimuscarinics, imidafenacin and solifenacin, in patients with overactive bladder (OAB). Patients and Methods: Male or female patients 20 years of age or older who had urgency (more than 1 episode in 24 h) were randomized into two groups: group I, imidafenacin (0.1 mg twice daily), and group S, solifenacin (5 mg once daily) for a 12-month treatment regimen. Subjective and objective symptoms were assessed before, and 1, 3, 6 and 12 months after treatment. Results: A total of 109 patients, including 55 (mean age: 72.0 years) in group I and 54 (mean age: 70.4 years) in group S, were treated. Subjective symptoms were significantly improved in group I and S after treatment. Dry mouth significantly worsened in both groups. However, the duration of dry mouth in group I was significantly shorter than that in group S. Three (5.8%) and 7 (13.5%) patients discontinued treatment due to adverse events in group I and group S, respectively. Conclusions: Imidafenacin and solifenacin were efficacious, safe, and well-tolerated treatments for OAB. As for adverse events, group I had fewer than group S.

Tadalafil for male lower urinary tract symptoms improves endothelial function

To investigate the effects of tadalafil on vascular endothelial function and cardiovascular risk in patients with prostatic hyperplasia.

Comparison of Two Different α1-Adrenoceptor Antagonists, Tamsulosin and Silodosin, in the Treatment of Male Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: A Prospective Randomized Crossover Study.

Objectives: We assessed the efficacy and safety of two α1‐adrenoceptor antagonists, tamsulosin and silodosin, in the treatment of male lower urinary tract symptoms.

Practical application of color Doppler ultrasonography in patients with ejaculatory dysfunction.

We describe two cases in which dynamic analysis of ejaculation using color Doppler ultrasonography was useful in diagnosis of ejaculatory dysfunction and planning of therapy. The first patient was a 32‐year‐old man with a diagnosis of retrograde ejaculation. A bladder neck collagen injection was carried out, as the main cause was thought to be the bladder neck remaining open during ejaculation. The patient had antegrade ejaculation 1 week later. The second patient was a 48‐year‐old man with a diagnosis of anorgasmia accompanied by decreased seminal emission and insufficient function of the rhythmic pelvic striated muscles. The patient was prescribed etilefrine hydrochloride 15 mg/day. The symptom improved 2 weeks after starting this drug. These cases suggest that the use of color Doppler ultrasonography during ejaculation can improve the understanding of ejaculatory dysfunction and therapy for this condition.