Toshikazu Otani

Foods and nutrients in relation to bladder cancer risk : A case-control study in Aichi Prefecture, Central Japan

To elucidate the role of diet in the etiology of bladder cancer, we conducted a case-control study from 1996 to 1999 in Aichi Prefecture, Central Japan. Cases were patients newly diagnosed with bladder cancer, and one hospital control was selected for each case, matching gender, age, and hospital. A well-validated food frequency questionnaire was adopted to estimate intakes of nutrients and food groups. Odds ratios (ORs) adjusted for smoking and occupational history were computed using conditional logistic models. The analyses based on 297 cases and 295 controls revealed the following. 1) The more the intake of milk and dairy products, the lower the OR; the ORs across quartiles in all subjects were 1.02, 0.73, and 0.52. Fruit intake was negatively associated with the risk, particularly in men (ORs across quartiles = 0.76, 0.77, and 0.52). Green-yellow vegetables were associated with a decreased risk in the highest quartile of consumption in men (OR = 0.57). 2) Dietary intakes of retinol and saturated fatty acids were related to a reduced risk in all subjects (ORs across quartiles = 0.75, 0.54, and 0.66 and 0.55, 0.54, and 0.60, respectively). Monounsaturated fatty acids had an inverse association with bladder cancer risk in men.

A Randomized Study of Short-v ersus Long-Term Intravesical Epirubicin Instillation for Superficial Bladder Cancer

Objective: A prospective randomized study was undertaken to determine whether prophylactic maintenance instillation of epirubicin following induction treatment is beneficial in patients with superficial bladder cancer. Patients and Methods: One hundred and forty-eight patients with resectable superficial bladder cancer (Ta-1, single, multiple, primary or recurrent with, however, no recurrence during the last year) were enrolled in this study. In both arms, epirubicin (40 mg/ml in normal saline) was administered six times within 4 weeks after a transurethral resection of the bladder tumor(s). In arm A, the patients received 11 additional monthly instillations of epirubicin. Results: Of the 148 patients, 138 (93.2%) were eligible and followed for an average of 29.6 months. 93 (67.4%) had a solitary tumor. No significant difference in the recurrence-free curve was observed between the two arms (p = 0.62). The recurrence rate per year was 0.16 in arm A and 0.17 in arm B. Toxicity included vesical irritability in 10 (7.2%) and hematuria in 1 patient. No significant difference in the frequency or degree of toxicity was observed between the two arms. Conclusion: These data suggest that maintenance instillation of epirubicin does not reduce superficial bladder cancer recurrence.

Children With Unstable Bladder: Clinical and Urodynamic Observation

A clinical analysis was done on 303 patients diagnosed by urodynamic study as having an unstable bladder, which was characterized by uninhibited contraction of the detrusor without any overt neurogenic lesions. An age distribution histogram demonstrated 2 peaks: children less than 10 years old and patients between 60 and 80 years old. Sex was not significant in the children but men predominated in the adults. There were 68 children less than 15 years old with the chief complaints of enuresis (54 per cent), urge incontinence (41 per cent) and fever (25 per cent). The objective findings were vesicoureteral reflux in 29 children, urinary tract infection in 20 and distal urethral stenosis in 8. An unstable bladder type I, the occurrence of uninhibited contractions during the filling phase of cystometry, was found in 53 children (78 per cent). We noted several postures that the children characteristically used to resist unheralded urgency and to prevent urine from leaking. The main therapeutic regimen consisted of anticholinergics with or without antimicrobials. Several children underwent surgical intervention. Once the antireflux operation was performed followup with anticholinergics was of primary importance. The unstable bladders of 63 of the 68 children (93 per cent) have been controlled satisfactorily. The etiology of bladder instability is discussed for both groups of patients.

A paraplegic fathering a child after an intrathecal injection of neostigmine: case report

This paper reports a 33-year-old male paraplegic (T6) who fathered a child by artificial insemination following an intrathecal injection of neostigmine. His wife was healthy and pregnancy was achieved after the 10th insemination. She delivered a mature female child weighing 3,100 g in August 1984. To our knowledge this is only the fourth successful case in the world following neostigmine injection.

Urinary Retention Caused by Impaction of Enlarged Uterus

2 cases of urinary retention were reported which was caused by retroverted gravid uterus and a large fibroid uterus, respectively. A chain cystourethrography and an endoscopic examination were the most informative to disclose the pathogenesis of urinary retention. Urodynamically, bladder compliance was normal without any pathological contraction. Urethral function was characterized by a shortened functional profile length.

Holding postures characteristic of unstable bladder.

Holding postures to resist uninhibited detrusor contractions are illustrated and discussed. These postures were observed in children with urodynamically proved unstable bladders. The majority of the holding postures involved compressing the urethral meatus or the perineum in girls, or contracting all of the skeletal muscles or squeezing the glans penis in boys. The holding posture required the child to remain still. Younger children used straightforward holding postures, while older children adopted more sophisticated and less recognizable positions. These clinical observations seem to suggest that a physician should probably suspect an unstable bladder in any child who often demonstrates any of these postures.

Silodosin versus naftopidil in the treatment of premature ejaculation: A prospective multicenter trial

To determine the efficacy of two α1‐adrenoceptor antagonists with different affinities for α1‐adrenoceptor subtypes, silodosin and naftopidil, in the treatment of premature ejaculation.

Ureteral crossover method for bilateral antireflux operation modification of Cohen Technique

Abstract A ureteral crossover method has been devised for the bilateral antireflux operation. Our modification of Cohens procedure makes the formation of new ureteral orifices easier and the length of submucosal tunnels longer especially in children with small bladders.

Ejaculation obtained by intracavernous papaverine in a cervical spinal cord injury patient resulting in pregnancy and childbirth. Case report

A 28 year old male sustained a cervical spinal cord injury (C5, complete) from a traffic accident and was impotent. He started intracavernous injection therapy, by his partner, of papaverine hydrochloride for impotence, restoring ejaculation. His partner had a successful pregnancy after normal sexual intercourse, and delivered a mature female child weighing 3330 g. To our knowledge this is a rare case of a patient with a complete spinal cord injury fathering a child by the above technique.

Ureteral crossover method: Animal experiment for correction of reflux

The ureteral crossover method for the correction of bilateral vesicoureteral reflux, characterized by ureteral overlapping in the submucosal space and directing the submucosal tunnels toward a point other than the bladder neck, has been tested in 10 dogs. The operation was successful in 18 of 20 ureters (90%). This technique has two merits: (1) availability of a sufficient length of submucosal ureter without altering the original ureteral entrance bilaterally; and (2) easy ligation of the new orifices in the middle of the operative field. It is concluded that ureteral overlapping does not harm the ureteral physiology and that the surgical validity of this method has been verified.