Toshikazu Nitta

Shock Wave Lithotripsy for Renal Stones Is Not Associated with Hypertension and Diabetes Mellitus

OBJECTIVES To clarify the influences of shock wave lithotripsy (SWL) treatments for renal and ureteropelvic junction stones on new onsets of hypertension and diabetes mellitus (DM). METHODS We compared the new onsets of hypertension and DM after SWL in renal and ureteral stone groups. The renal stone group consisted of 772 patients treated with SWL, who had a possibility of renal and pancreatic shock wave damage. The ureteral stone group consisted of 505 patients treated with SWL, who were unlikely to have suffered SWL damage in the kidney and pancreas areas. Both treatment groups received SWL between 1984 and 1994. RESULTS The rates of new onset of hypertension in the renal stone and ureteral stone groups were 22.8% and 20.0% in men and 23.1% and 20.5% in women, respectively. The rates of new onset of DM in the renal stone and ureteral stone groups were 7.4% and 11.0% in men and 8.7% and 8.7% in women, respectively. There was no significant difference in the new onsets of hypertension and DM between renal and ureteral stone groups depending on each age decade or sex. Treatment for renal stone was not a significant risk factor for new onsets of hypertension and DM by logistic regression analysis. CONCLUSIONS Our findings suggest that SWL treatment for renal and UPJ stones might not be associated with new onset of hypertension or DM.

Silodosin and its potential for treating premature ejaculation: A preliminary report

Premature ejaculation is a common sexual problem, as is erectile dysfunction. We evaluated silodosin, a highly selective α1A‐adrenoceptor antagonist, as a new treatment option for premature ejaculation. α1‐Adrenoceptor antagonists are widely used for lower urinary tract symptoms, and clinical studies on silodosin have shown excellent clinical efficacy for lower urinary tract symptoms. However, compared with other α1‐adrenoceptor antagonists, silodosin appeared to suppress ejaculation in a relatively higher percent of trial participants. This suppression of ejaculation by silodosin suggested its potential for treating premature ejaculation. Consequently, we evaluated the feasibility of off‐label silodosin as a new treatment option for premature ejaculation. Eight patients suffering premature ejaculation were treated with silodosin. Silodosin (4 mg) was given 2 h before sexual intercourse. Intravaginal ejaculatory latency time, premature ejaculation profile item, clinical global impression change in premature ejaculation and systemic adverse events were recorded. Intravaginal ejaculatory latency time was significantly prolonged (from 3.4 min to 10.1 min, P = 0.003). All patients answered better (much better) or slightly better for their own premature ejaculation problem compared with pretreatment condition in the clinical global impression change. Premature ejaculation profile also significantly improved. Two (25%), three (37.5%) and seven patients (87.5%) experienced anejaculation, reduced semen volume and discomfort during orgasm, respectively. However, these problems were not of major concern for the participants. No systemic adverse effects were reported. The current results support the possible use of silodosin as a new treatment option for premature ejaculation, and suggest that a placebo controlled study assessing its clinical usefulness would be worthwhile.

How long do patients with erectile dysfunction continue to use sildenafil citrate? Dropout rate from treatment course as outcome in real life

Objectives:  To study the dropout rate for use of sildenafil after initial prescription and during successful treatment to clarify their risk factors.

Characteristics of patients with staghorn calculi in our experience

Purpose: To elucidate the factors contributing to staghorn stone formation in patients.

Recurrence pattern for superficial bladder cancer

Aim:  Patients with superficial bladder tumors sometimes have long recurrence‐free intervals. We evaluated whether patients with long recurrence‐free periods had subsequent recurrences. We also clarified how these patients should be followed.

Signet-ring cell carcinoma of the prostate effectively treated with maximal androgen blockade

Abstract Primary signet‐ring cell carcinoma (SRCC) of the prostate is very rare and has a poor prognosis, even when treated with aggressive therapy. We report herein a case of a 72‐year‐old man with prostatic SRCC. The patient had a tumor that extended directly to the rectum. Maximal androgen blockade was started and 20 months later, the patient was alive without evidence of recurrence. The present case of prostatic SRCC responded well to medical therapy, however, tumors can recur after a long period of time. Therefore, adjuvant therapy is recommended.

Dissociation between patients and their partners in expectations for sexual life after radical prostatectomy

To analyze expectations for sexual life after radical prostatectomy in patients and their partners, and its influence on sexual motivation and bothers in the postoperative period.

Simple and reliable predictor of urinary continence after radical prostatectomy: serial measurement of urine loss ratio after catheter removal.

To evaluate urine loss ratio after catheter removal as a predictive factor of urinary continence after radical prostatectomy.

Serum testosterone levels using the radioimmunoassay method in healthy Japanese male volunteers

AimThe objective of the present study was to measure serum free and total testosterone values using the radioimmunoassay (RIA) method in healthy Japanese male volunteers with no current diseases.MethodsTwo hundred and fifty-one healthy men who had no medical illness and received no current medical treatment were selected from 405 male volunteers. Free and total testosterone were measured in blood samples using the RIA method.ResultsFree but not total testosterone significantly decreased with age. Mean free testosterone values from morning blood samples for each age decade from the 20s to the 70s were 17.0, 14.6, 12.5, 10.6, 8.9 and 8.5 pg/mL, respectively. Mean total testosterone values from morning blood samples for each age decade from the 20s to the 70s were 4.7, 4.2, 4.4, 4.2, 4.2, 4.0 and 4.0 ng/mL, respectively. The rates of healthy volunteers that fell within the standard reference ranges for free and total testosterone were 97% and 97%, respectively. However, 19% of the total testosterone values were considered to indicate hypogonadism according to the International Society for the Study of the Aging Male (ISSAM) criteria (< 3.17 ng/mL).ConclusionsOur data corresponded to the standard reference ranges of Japanese men but not the ISSAM criteria. It may be more appropriate to establish a standard reference range for serum testosterone for individual countries.

MP62-13 COMPARISON OF PATIENT SATISFACTION FOR TREATMENT EFFICACY AND ASSOCIATED FACTORS BETWEEN SWL AND URS FOR URINARY STONE: ANALYSIS FROM PATIENTS' VIEW

INTRODUCTION AND OBJECTIVES: Goals of this study were to compare satisfaction for treatment efficacy and associated factors in treatment for upper urinary stone with shock wave lithotripsy (SWL) and ureteroscopic surgery (URS) and to clarify significant factors for desirable treatment from patients view. METHODS: In current study, 294 consecutive patients who underwent SWL (n1⁄4194) or URS (n1⁄471) and both surgical procedures (n1⁄429) for upper urinary stone in one treatment period were enrolled. We evaluated satisfaction for treatment outcomes and significant factors for desirable treatment used a self-administered ad-hock questionnaire. Satisfaction for treatment were analyzed in five domains (overall satisfaction, pain during treatment and after treatment, voiding symptom, and overall difficulty) using a visual analog scale. RESULTS: There is no significant differences in age and sex distribution between the SWL and URS group (a mean age of 50.7years, range 21-76). There were no significant difference in overall satisfaction values between both groups. However, other objective outcomes from patients’ view (pain during treatment and after treatment, voiding symptom, and overall difficulty) were significantly better in the SWL group compared to those in the URS group. The patients considered many factors to decide for counseling treatment options, such as efficacy of treatment, cost, safety, hospitalization, kind of anesthesia, pain associated with treatment. Rate of patients who selected SWL as a next desirable treatment in the SWL group, the URS group and both treatment group were 61.5, 81.0, and 93.5%, respectively. CONCLUSIONS: Overall satisfaction were not significantly different between SWL and URS. However, pain and convenience associated treatment around operative period are better in SWL than TUL. The patients considered many factors to decide for counseling treatment options in addition to treatment efficacy. Consequently, significantly higher percentage of patients selected SWL treatment as a desirable treatment option.