Yasukuni Yoshimura

Calcium Independent Contraction of Bladder Smooth Muscle

Background Recently, it has been suggested that in vascular smooth muscle a Ca2+‐independent mechanism or Ca2+‐sensitization of contractile elements may participate in smooth muscle contraction. In this study, we evaluate this mechanism in detrusor muscle.

Clinical Guideline for Female Lower Urinary Tract Symptoms.

The “Japanese Clinical Guideline for Female Lower Urinary Tract Symptoms,” published in Japan in November 2013, contains two algorithms (a primary and a specialized treatment algorithm) that are novel worldwide as they cover female lower urinary tract symptoms other than urinary incontinence. For primary treatment, necessary types of evaluation include querying the patient regarding symptoms and medical history, examining physical findings, and performing urinalysis. The types of evaluations that should be performed for select cases include evaluation with symptom/quality of life (QOL) questionnaires, urination records, residual urine measurement, urine cytology, urine culture, serum creatinine measurement, and ultrasonography. If the main symptoms are voiding/post‐voiding, specialized treatment should be considered because multiple conditions may be involved. When storage difficulties are the main symptoms, the patient should be assessed using the primary algorithm. When conditions such as overactive bladder or stress incontinence are diagnosed and treatment is administered, but sufficient improvement is not achieved, the specialized algorithm should be considered. In case of specialized treatment, physiological re‐evaluation, urinary tract/pelvic imaging evaluation, and urodynamic testing are conducted for conditions such as refractory overactive bladder and stress incontinence. There are two causes of voiding/post‐voiding symptoms: lower urinary tract obstruction and detrusor underactivity. Lower urinary tract obstruction caused by pelvic organ prolapse may be improved by surgery.

Long-term Persistence with Mirabegron versus Solifenacin in Women with Overactive Bladder: Prospective, Randomized Trial

To compare persistence with medication and the reasons for discontinuation of mirabegron or solifenacin therapy up to12 months in women with overactive bladder (OAB).

Core lower urinary tract symptom score (CLSS) for the assessment of female lower urinary tract symptoms: A comparative study

Objective:  We have recently developed the core lower urinary tract symptom score (CLSS) questionnaire to readily address 10 important lower urinary tract symptoms (LUTS). The aim of the present study was to evaluate the performance of the CLSS in women compared with the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS).

Surgical treatment of female stress urinary incontinence with a transobturator tape (Monarc): Short‐term results of a prospective multicenter study

Aim:  Transobturator tape (TOT) kits approved as medical instruments are still not available in Japan. This study aimed to: (1) assess the outcomes of TOT using Monarc (American Medical Systems; AMS Inc, Minnetonka, MN, USA) in women with stress urinary incontinence (SUI); (2) evaluate possible different surgical outcomes in women with urethral hypermobility (UH) and/or intrinsic urethral deficiency (ISD); and (3) evaluate the possibility of improvement of preoperative urgency and urge urinary incontinence after TOT in mixed urinary incontinence (MUI).

Prototype of a reflux-preventing ureteral stent and its clinical use.

We have experimentally produced a ureteral stent which prevents vesicorenal reflux. This stent has a thin silicon sleeve at its distal end (intravesical portion). In a model experiment the sleeve demonstrated an excellent capability to prevent reflux. The sleeve allowed flow of fluid with minimal pressure rise. A patient with bilateral ureteral obstruction was managed with endoscopic insertion of a sleeved stent in the right ureter and a usual pigtail stent in left ureter. During cystography vesicorenal reflux was not observed on the right side while reflux occurred on the left side. Excretory urography forty days after stent placement demonstrated recovery of renal function and maintenance of drainage in both renal units. Thus, the drainage characteristic of this stent appears to be approximately the same as that of usual stent.

Female urology: What method will you select?

When I was a resident, my leader taught me that the gold standard forpatients with stress incontinence is the Marshall–Marchetti–Krantz(MMK) procedure. But a few years later, urologists who could performadvanced techniques showed me needle suspension as the best methodat a urological meeting. Fortunately my boss gave me a chance for ahand-to-hand lesson of the stamay procedure by the specialist. Sincethen, I have been selecting this procedure for a few years. Withoutdoubt, this needle suspension was the gold standard at that time.But now most urologists do not select this technique because of badresults. After I had mastered the technique of tension-free vaginal tape(TVT), I could see the smiling faces of patients after the operation. Atthat time I believed that TVT would be the gold standard for thiscondition. But the present status is what you know.Recently most specialists, including myself, believe that using‘mesh’ is the best operation for patients with pelvic organ prolapse. Isthis tendency good for the patients in the long run? No one can predictthe results of this procedure more than ten years from now.God knows what procedure will be the gold standard in the future.Assistant Professor Yasuyuki Suzuki

Sexual activity and quality of life in Japanese pelvic organ prolapse patients after transvaginal mesh surgery

This study aimed to evaluate sexual activity and quality of life (QOL) after transvaginal mesh (TVM) surgery in Japanese patients with pelvic organ prolapse (POP). The objective cure rate and associated complications were also investigated.

Clinical study of fungal peritonitis in continuous ambulatory peritoneal dialysis patients.

1982年10月から1991年9月までの約9年間に当科および関連3施設でCAPD患者47例中6例に真菌性腹膜炎を認めた. これら症例の臨床的検討を行い次のような結果を得た.1. 真菌性腹膜炎の発生頻度は, 1回/281.7患者・月であった. 2. 原因菌はCandida albicans 5例, Candida globrata 1例であった. 3. 細菌性腹膜炎と比べ特徴的な臨床症状は認めないが, 発症前に全例で抗生剤または免疫抑制剤の投与が行われていた. 4. 末梢血中好酸球数が増加したのは, 5例中1例のみであった. 5. 治療方針はまず抗真菌剤を投与し, 反応の悪い場合にカテーテル抜去を行うこととした. これは腹膜の癒着の頻度が低く, CAPDの継続を考えた場合, 支持されるべき方法と思われた. また, 反応の悪い場合のカテーテル抜去は, 発症後1週間位で行うべきと思われた. 6. 薬剤の選択では, Candida albicansに対しfluconazoleが有効に作用した1例を認めた. 7. カテーテルは抜去後約2か月で再留置したが, その際真菌の検出された例や, 再発をみた例はなかった. しかし, 腹膜の癒着防止を考えた場合, 適切な再留置の時期は未だ定まっていないように思われた.