Seiji Furuya

Alpha-adrenergic activity and urethral pressure in prostatic zone in benign prostatic hypertrophy.

In order to examine to what extent adrenergic mechanism contributes to the urethral pressure in patients with benign prostatic hypertrophy, changes in the intraurethral pressure in the prostatic zone were measured in vivo by both the urethral pressure profile technique and the balloon method before and after administration of alpha-adrenergic stimulants and an alpha-adrenergic blocker. The effect of spinal anesthesia on the urethral pressure was also investigated. It is suggested that 40 per cent of the total urethral pressure in patients with benign prostatic hypertrophy is due to alpha-adrenergic tone, and the remaining 53 per cent is due to static pressure resulting from the hypertrophied prostatic bulk. The in vitro study indicates that the increase in urethral pressure and contraction of the prostate, prostatic capsule and prostatic urethra.

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.

Is the short-term outcome of transurethral resection of the prostate affected by preoperative degree of bladder outlet obstruction, status of detrusor contractility or detrusor overactivity?

Aim: The aim of this study was to investigate whether the preoperative degree of bladder outlet obstruction (BOO), detrusor underactivity (DUA) or detrusor overactivity (DO) affected the short‐term outcome of transurethral resection of the prostate (TURP) for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH).

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

Symptomatic and urodynamic improvement by oral distigmine bromide in poor voiders after transurethral resection of the prostate.

UNLABELLED OBJECTIVESz: To study the clinical and urodynamic effects of oral distigmine bromide (distigmine) by using pressure-flow studies in patients who were persistently poor voiders after transurethral resection of the prostate. METHODS The study included 14 poor voiders after transurethral resection of the prostate who were 50 years old or older. Their poor voiding conditions were characterized by a mean International Prostate Symptom Score of 18.9 or a mean quality-of-life index of 4.6 and a mean maximum flow rate of 8.9 mL/s. All patients underwent symptomatic and urodynamic investigations before and after 4 weeks of daily treatment with 15 mg oral distigmine. RESULTS In the baseline pressure-flow studies, all patients had weak detrusor contractility as demonstrated by Schäfers diagram and the maximum Watts factor but did not have bladder outlet obstruction. They had symptomatic improvements after oral distigmine treatment, with the International Prostate Symptom Score reduced to a mean of less than 10 and the quality-of-life index reduced to a mean of less than 3. In the urodynamic investigations, the maximum flow rate improved significantly to a mean of more than 12 mL/s in parallel with a significant increase in the maximum Watts factor. Detrusor contractility according to Schäfers diagram also tended to improve after oral distigmine treatment. However, no significant changes were found in any of the parameters of bladder outlet obstruction. CONCLUSIONS Poor voiders after transurethral resection of the prostate who have weak detrusor contractility without bladder outlet obstruction may benefit clinically from treatment with distigmine because of its efficacy in increasing detrusor contractility without enhancing bladder outlet obstruction.

National institutes of Health Chronic Prostatitis Symptom Index for Japanese men.

OBJECTIVES To establish a Japanese version of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and to determine its validity and applicability in patients with chronic prostatitis, comparing the results with those from patients with benign prostatic hyperplasia (BPH) and normal men. METHODS The study included 103 patients with chronic prostatitis, 60 with BPH, and 87 normal men who agreed to respond to a self-administered questionnaire of the Japanese version of the NIH-CPSI (JPN-NIH-CPSI). Testing-retesting was done to confirm the reliability of the index in 23 patients with chronic prostatitis, with a 2-week interval between tests. RESULTS Pain or discomfort was more prominent in the prostatitis group than in the BPH and normal groups. Overall, quality of life in the prostatitis group was impaired more severely than that in the other two groups. The scores of three domains (pain, urinary symptoms, and quality-of-life impact) in the prostatitis group were clearly higher than those in the BPH and normal groups, except for those of urinary symptoms in the BPH group. The test-retest analysis showed good reliability and internal consistency for the JPN-NIH-CPSI, with a Cronbachs alpha coefficient of more than 0.8. CONCLUSIONS The JPN-NIH-CPSI can be reliably used for evaluation of Japanese patients with prostatitis, as is the NIH-CPSI for English-speaking men.

HEMATOSPERMIA : AN INVESTIGATION OF THE BLEEDING SITE AND UNDERLYING LESIONS

Background : The site of hemorrhage and causative lesions in patients with hematospermia were evaluated using the puncture technique for seminal vesicles and/or müllerian duct cysts under ultrasound guidance.

Urodynamic Effects of Terazosin Treatment for Japanese Patients With Symptomatic Benign Prostatic Hyperplasia

PURPOSE For treating benign prostatic hyperplasia (BPH) 5 or 10 mg. terazosin hydrochloride daily has been routinely used in North America and Europe. We investigated the urodynamic effects of 2 mg. terazosin daily on Japanese patients with symptomatic BPH using pressure flow study. MATERIALS AND METHODS A total of 20 Japanese patients 50 years old or older with symptomatic BPH underwent symptomatic and urodynamic evaluations, including pressure flow study, before and after terazosin treatment. Patients were given 1 mg. terazosin once daily for the first 7 days and they continued to receive 1 mg. terazosin twice daily for the following 3 weeks. RESULTS At 4 weeks after terazosin treatment the International Prostate Symptom Score, quality of life index and maximum and average flow rates were significantly improved. Pressure flow study demonstrated decreased detrusor pressure at maximum flow, and minimum detrusor pressure during voiding and urethral resistance factor after terazosin treatment. Of the 20 patients 13 (65%) showed improvement in the linear passive urethral resistance relation. There was no significant difference in the maximum W. factor before and after terazosin treatment. CONCLUSIONS Terazosin treatment, even 2 mg. daily, urodynamically relieved bladder outlet obstruction in Japanese patients with symptomatic BPH without any changes in detrusor contractility.

Anatomical and histological studies of so-called Müllerian duct cyst

Abstract  Background: We examined so‐called Müllerian duct cysts both histologically and immunohistochemically with anatomical observation to investigate the etiology of the ‘Müllerian duct cyst’.

Lower urinary tract symptoms of men seeking medical care-comparison of symptoms found in the clinical setting and in a community study

OBJECTIVES To investigate which lower urinary tract symptoms were most influential in causing men to seek medical care. METHODS We evaluated the International Prostate Symptom Score (IPSS) and quality-of-life (QOL) score of 235 outpatients having lower urinary tract symptoms and 242 participants in a community-based study of Japanese men aged 50 to 79 years old. RESULTS Although the proportion of outpatients in the severe IPSS category (IPSS 20 to 35) was greater than that in the participants of the community-based study in each age decade, the proportion in the moderate IPSS category (IPSS 8 to 19) in both groups overlapped each other. On the other hand, the distribution of QOL scores was considerably different, with only a small portion of overlap in each age decade. Although scores for both voiding symptoms (incomplete emptying, intermittency, weak stream, and hesitancy) and storage symptoms (increased frequency, urgency, and nocturia) were significantly greater in outpatients than in study participants in each age decade, the difference was more obvious for voiding symptoms than for storage symptoms. CONCLUSIONS The QOL score appeared to show more pronounced differences between men in a clinic setting and those in a community setting than the IPSS category. Voiding symptoms may affect medical care-seeking behavior through QOL impairment in Japanese men.