Ryoji Furuya

Ejaculatory disorder caused by alpha‐1 adrenoceptor antagonists is not retrograde ejaculation but a loss of seminal emission

Aim: The etiology of the ejaculatory disorder induced by alpha‐1 blockers is still controversial, although it has been suggested to be retrograde ejaculation. The aim of this study was to investigate the distribution of alpha‐1 adrenoceptor subtype mRNA in human seminal vesicles, and to analyze the prevalence and etiology of the disorder in healthy men.

The 12-year symptomatic outcome of transurethral resection of the prostate for patients with lower urinary tract symptoms suggestive of benign prostatic obstruction compared to the urodynamic findings before surgery.

Study Type – Therapy (case series)
Level of Evidence 4

Detection of human Papillomavirus DNA on the external genitalia of healthy men and male patients with urethritis

Background Only a few studies have been done involving detection of human papillomavirus (HPV) DNA on the external genitalia of men without genital warts, although many have been done for women. We conducted HPV DNA detection among healthy male volunteers and men with urethritis, both having no visible lesions on their external genitalia. Goal The goal of the study was to determine the detection rate of HPV DNA in volunteers and patients with urethritis and to determine risk factor(s) for positive DNA. Study Design This was a prospective clinical study. Results HPV DNA was found in 1.3% of 75 volunteers and in 18.5% of 130 patients with urethritis. DNA of a high-intermediate oncogenic risk was more predominant than the low-risk type. Among various risk factors, only a history of STD was a significant factor for the positive detection of HPV DNA in multiple regression analysis. Conclusion HPV DNA was found in patients with urethritis more frequently than in volunteers, probably because the former had higher sexual activity.

Ejaculatory Disorders Caused by Alpha-1 Blockers for Patients with Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: Comparison of Naftopidil and Tamsulosin in a Randomized Multicenter Study

Introduction: To investigate the incidence of ejaculatory disorders caused by naftopidil and tamsulosin in patients with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH). Materials and Methods: Ninety-five patients with LUTS/BPH who had International Prostate Symptom Scores (IPSS) of 8 or more were randomly assigned to receive naftopidil (50 mg/day, n = 48) or tamsulosin (0.2 mg/day, n = 47). Before and 12 weeks after treatment, a questionnaire was used to evaluate ejaculation. Results: Among men who had sexual activity during the 12 weeks, the proportion who reported an abnormal feeling on ejaculation was higher in the tamsulosin group (16.7%) than in the naftopidil group (7.4%), although the difference was not significant (p = 0.402). The proportion of men who reported reduced ejaculatory volume after treatment was significantly higher in the tamsulosin group (96.0%) than in the naftopidil group (73.1%, p = 0.0496). On the other hand, the improvements in IPSS and the quality of life index were significantly higher in the tamsulosin group than in the naftopidil group. Conclusions: Tamsulosin may cause a higher incidence of ejaculatory disorders than naftopidil, although the efficacy of 0.2 mg tamsulosin may be better than that of 50 mg naftopidil.

Magnetic Resonance Imaging Is Accurate to Detect Bleeding in the Seminal Vesicles in Patients With Hemospermia

OBJECTIVE To confirm the presence of hemorrhage in the seminal vesicles by aspiration in patients with findings suspicious for hemorrhage on magnetic resonance imaging (MRI); and to investigate the relationship between findings on MRI and the freshness of hemorrhage. METHODS Twenty-six patients with hemospermia who showed high-intensity signals on T1-weighted images with or without low-intensity signals on T2-weighted images, suggesting seminal vesicle hemorrhage, were analyzed. Of the 26, 15 underwent transperineal aspiration of the seminal vesicles under transrectal ultrasound guidance to confirm the bleeding. RESULTS Bloody fluid was aspirated from all seminal vesicles showing a pattern suggestive of bleeding on MRI. The morphologic analysis of red blood cells in the fluid indicated relatively fresh hemorrhage in the seminal vesicles showing high-intensity signals on T1-weighted images and low-intensity signals on T2-weighted images (group A), but old hemorrhage in those showing high-intensity signal on T1-weighted images as well as T2-weighted images (group B). In 3 patients of group A who did not receive aspiration, repeated MRI during the follow-up showed that the signal intensity changed from low to high on T2-weighted images. On the other hand, in 2 patients of group B who received aspiration, repeated MRI performed 12 and 7 days after aspiration showed low signal intensity on T2-weighted images. CONCLUSIONS Hemorrhage is really present in the seminal vesicles if high signal intensity is observed on T1-weighted images. The patterns showing low and high signal intensities on T2-weighted images suggest relatively fresh and old bleeding, respectively.

Efficacy of treatment with carbapenems and third-generation cephalosporins for patients with febrile complicated pyelonephritis.

The purpose of this study was to clarify the clinical relevance of carbapenem and third-generation cephalosporin treatment for febrile complicated pyelonephritis, which often leads to urosepsis. Parenteral antimicrobial treatment with a carbapenem or third-generation cephalosporin was administered to febrile patients and the treatment was switched to oral antimicrobial agents after they became afebrile. In principle, the duration of the course of antimicrobial chemotherapy was limited to a total of 14 days. Clinically, the success rates were 97.3% in the carbapenem group and 96.0% in the third-generation cephalosporin group. For microbiological efficacy, the success rates were 89.2% in the carbapenem group and 92.0% in the third-generation cephalosporin group. There were no serious adverse events in the course of the study. The treatment regimen with a carbapenem or a third-generation cephalosporin was highly effective for patients with febrile complicated pyelonephritis and was well tolerated. Either of these regimens could become one of the standard treatments for patients with febrile complicated pyelonephritis.

New classification of midline cysts of the prostate in adults via a transrectal ultrasonography-guided opacification and dye-injection study

To reclassify midline cysts (MLCs) of the prostate according using the results from transrectal ultrasonography (TRUS)‐guided opacification and dye injection.

Chlamydial seminal vesiculitis without symptomatic urethritis and epididymitis

Abstract  We previously reported that seminal vesiculitis was associated with acute epididymitis, and that Chlamydia trachomatis was the major causative pathogen for infection of the seminal vesicle, suggesting that seminal vesiculitis was a discrete disease entity. In this paper, we report two patients with bacteriologically and cytologically proven seminal vesiculitis who had asymptomatic urethritis but not epididymitis. The clinical courses of these patients suggest that chlamydial seminal vesiculitis may be a cause of asymptomatic infection of the urethra or subsequent development of acute epididymitis.

Is urethritis accompanied by seminal vesiculitis

Objective:  To determine whether urethritis is accompanied by seminal vesiculitis using transrectal ultrasound (TRUS) imaging.

Treatment Strategy According to Findings on Pressure-Flow Study for Women with Decreased Urinary Flow Rate

Purpose. In women who reported a weak urinary stream, the efficacy of treatment chosen according to the urodynamic findings on pressure-flow study was prospectively evaluated. Materials and Methods. Twelve female patients with maximum flow rates of 10 mL/sec or lower were analyzed in the present study. At baseline, all underwent pressure-flow study to determine the degree of bladder outlet obstruction (BOO) and status of detrusor contractility on Schäfers diagram. Distigmine bromide, 10 mg/d, was given to the patients with detrusor underactivity (DUA) defined as weak/very weak contractility, whereas urethral dilatation was performed using a metal sound for those with BOO (linear passive urethral resistance relation 2–6). Treatment efficacy was evaluated using the International Prostate Symptom Score (IPSS), uroflowmetry, and measurement of postvoid residual urine volume. Some patients underwent pressure-flow study after treatment. Results. Urethral dilatation was performed for six patients with BOO, while distigmine bromide was given to the remaining six showing DUA without BOO. IPSS, QOL index, and the urinary flow rate were significantly improved in both groups after treatment. All four of the patients with BOO and one of the three with DUA but no BOO who underwent pressure-flow study after treatment showed decreased degrees of BOO and increased detrusor contractility, respectively. Conclusions. Both BOO and DUA cause a decreased urinary flow rate in women. In the short-term, urethral dilatation and distigmine bromide are efficacious for female patients with BOO and those with DUA, respectively.