Shinya Maekawa

IMPACT OF INTERVENTIONAL THERAPY FOR BENIGN PROSTATIC HYPERPLASIA ON QUALITY OF LIFE AND SEXUAL FUNCTION: A PROSPECTIVE STUDY

PURPOSE Treatment for benign prostatic hyperplasia (BPH), including minimally invasive therapy, can impair the quality of life. We prospectively determined the impact of 4 different interventional therapies on quality of life and sexual function. MATERIALS AND METHODS A total of 173 patients were prospectively evaluated between February 1995 and August 1997. Treatment modalities consisted of standard transurethral resection of the prostate in 55 cases, transurethral microwave thermotherapy in 34, interstitial laser coagulation of the prostate in 42 and transurethral needle ablation in 42. Disease specific quality of life was assessed using the International Prostate Symptom Score quality of life assessment index and BPH impact index. In addition, a self-reporting questionnaire was completed before and 3 months after treatment to determine the impact on sexual function. RESULTS All 4 treatment groups showed significant improvement in the symptom score, International Prostate Symptom Score quality of life assessment score and BPH impact index score. Satisfaction with treatment was highest in patients treated with transurethral resection or laser coagulation. A mild to moderate decrease in erectile function was noted in 26.5%, 18.2%, 18.4% and 20.0% of the transurethral resection, microwave thermotherapy, laser coagulation and needle ablation groups, respectively, but there was no significant difference of mean pretreatment and posttreatment erectile function or libido scores in any group. Ejaculation loss or severe decrease in ejaculate volume was reported by 48.6%, 28.1%, 21.6% and 24.3% of the patients, respectively. Interestingly, 20 of the 44 patients (45. 5%) with loss of ejaculation or severe decrease in ejaculate reported deterioration of the sex life, while only 2 (3.6%) of the 56 without any change in ejaculate volume reported such deterioration. The association of ejaculatory dysfunction with an adverse impact on sexual activity was highly significant (p <0.0001). CONCLUSIONS Significant improvement in quality of life could be achieved with the present assessed interventional therapies. There was no significant change in sexual desire or erectile function with these therapies. Posttreatment sexual dysfunction appears to be mainly related to impaired ejaculatory function. Urologists should provide proper counseling regarding the possibility of this complication even in patients receiving minimally invasive treatment.

Patient-reported quality of life after radical prostatectomy for prostate cancer

Background: Increasingly, quality of life (QOL) assessments are receiving greater attention in the management of malignancies, including prostate cancer. We evaluated the impact of radical prostatectomy on patient QOL 12 months or longer after surgery.

Complexed prostate-specific antigen and its volume indexes in the detection of prostate cancer

OBJECTIVES To evaluate complexed prostate-specific antigen (cPSA), cPSA density (cPSAD), and cPSA adjusted for the transition zone volume (cPSA-TZ) in comparison with the free-to-total PSA ratio (F/T PSA) and free-to-complexed PSA ratio (F/C PSA) as a means of diagnosing prostate cancer. METHODS Transition zone volume was determined in 137 of 142 men who underwent systematic sextant biopsies and had total PSA (tPSA) values between 4.1 and 10.0 ng/mL. cPSAD and cPSA-TZ were calculated by dividing the cPSA value by the whole prostate volume and the transition zone volume, respectively. RESULTS Of the 137 men, 23 (16.8%) had prostate cancer. cPSA predicted the biopsy outcome better than tPSA, F/T PSA, or F/C PSA, although the difference was not significant. A cutoff value of 4.1 ng/mL for cPSA provided a specificity of 42% and a sensitivity of 87%. A combination of cPSA and F/C PSA maintained a sensitivity of 83% and gave an increased specificity of 54%. In a subgroup of 65 patients with smaller prostate volumes (less than 45 mL), the diagnostic value of cPSA-TZ was remarkably increased. A cutoff value of 0.31 for cPSA-TZ provided a sensitivity of 93% and a high specificity of 72%. CONCLUSIONS cPSA was more specific than tPSA and F/T PSA. As a component of F/C PSA, free PSA could provide additional value to cPSA. cPSA-TZ and cPSAD could be better indicators for prostate cancer than cPSA.

Tubeless cutaneous ureterostomy: the Toyoda method revisited.

PURPOSE Cutaneous ureterostomy is a less invasive method of urinary diversion and an attractive option especially in patients at high risk. We retrospectively examined the long-term outcome of the method introduced by Toyoda. MATERIALS AND METHODS Since 1983 the Toyoda cutaneous ureterostomy has been performed in 61 patients (103 renal units) with a minimum of 3 months of followup. The ureteral patency rate was reviewed. RESULTS Of the 92 renal units (89%) that achieved a tubeless condition 53 (51%) had no hydronephrosis, 23 (22%) had mild to moderate hydronephrosis without the need for treatment, 14 (14%) were not evaluated during followup and 2 (2%) were removed due to subsequent renal pelvic and/or ureteral carcinoma. CONCLUSIONS A high ureteral patency rate was achieved with the Toyoda cutaneous ureterostomy. This procedure is a reasonable alternative to other forms of urinary diversion.

Acute normovolemic hemodilution for radical prostatectomy: Can it replace preoperative autologous blood transfusion?

Abstract Background: Although preoperative autologous blood donation (PAD) is accepted as a standard of care for radical prostatectomy, it is costly, time‐consuming and has risks associated with blood storage. Acute normovolemic hemodilution (ANH) is reported to be less expensive and to preserve blood components more effectively than PAD. In the present study, the efficacy and safety of these two autologous blood‐collection techniques were compared.

Changes in resistive index following extracorporeal shock wave lithotripsy.

Abstract Background : Extracorporeal shock wave lithotripsy (ESWL) has replaced most surgical and endourologic forms of therapy for upper urinary tract stone disease. Despite its proved safety and efficacy, its adverse effects on renal function are still to be identified. A newer diagnostic technique, color Doppler ultrasonography, has brought a new insight into renal function. It enables precise evaluation of the renal vascular supply. Changes in intrarenal vascular resistance after ESWL were studied with Doppler ultrasound techniques.

Interstitial laser coagulation for management of benign prostatic hyperplasia: a Japanese experience.

PURPOSE The principle of interstitial laser coagulation is to shrink the prostate by generating intraprostatic necrosis without damaging the urethra or causing tissue sloughing. The clinical efficacy and durability of interstitial laser coagulation in the treatment of benign prostatic hyperplasia (BPH) were evaluated. MATERIALS AND METHODS From December 1993 to June 1996, 76 patients with symptomatic BPH were treated with interstitial laser coagulation. A neodymium:YAG laser was used in combination with a specially designed interstitial thermotherapy light guide. The tip of the light guide was inserted into each lobe of the prostate transurethrally under direct vision. All evaluations were made at baseline and then 1, 3, 6 and 12 months after therapy. Treatment outcome was evaluated by International Prostate Symptom Score (I-PSS), flow rate and post-void residual urine volume. Disease specific quality of life was assessed via a quality of life assessment score and a BPH impact index. Independent of symptom assessment, a self-reporting questionnaire was prepared at 3 months postoperatively regarding satisfaction with treatment and sexual function. RESULTS Among 44 patients followed to 12 months the mean I-PSS significantly decreased from 20.4 at baseline to 7.4, representing 64% improvement (p <0.001). Peak flow rate increased by 50% from a preoperative average of 7.4 to 11.1 ml. per second at 12 months in 42 patients (p <0.001). The post-void residual volume decreased by 57% from 102 to 44 ml. at 12 months in 40 cases (p <0.001). Steady and progressive improvement was observed on quality of life assessment and BPH impact index scores at 3, 6 and 12 months. No patients reported new onset of erectile dysfunction. No serious side effects were observed, except for loss of ejaculation in 3 cases and seminal vesicle abscess in 1. Only 6 patients (8%) required re-treatment for persisting obstructive symptoms during 12 months of followup. A recent change in methods towards more aggressive treatment plausibly influenced the outcomes to require less repeat treatment. CONCLUSIONS After the interstitial laser coagulation procedure satisfactory results were obtained and improvement lasted through 12 months. Although the optimal number of fiber placements for each prostate is not known, more aggressive treatment appears to provide better outcomes.

Value of Systematic Transition Zone Biopsy in the Detection of Prostate Cancer

Background:

Ultrasensitive Assay of Prostate-Specific Antigen for Early Detection of Residual Cancer after Radical Prostatectomy

Objectives: Perhaps the greatest value of PSA determination in the treatment of prostate cancer is in determining persistent disease after a radical prostatectomy. We investigated the ability of an ultrasensitive PSA assay to detect residual prostate cancer in men at risk for recurrence after a radical prostatectomy.

Urinary undiversion for pelvic actinomycosis: a long-term follow up.

Background: A 43‐year‐old woman who had been using intrauterine contraceptive devices for the past 10 years underwent an emergency operation for bowel and urinary obstruction.