Yoshio Naya

Ultrasonic estimation of bladder weight as a measure of bladder hypertrophy in men with infravesical obstruction: A preliminary report

The aim of the present study was to evaluate the usefulness of ultrasonic estimation of bladder weight as a measure of bladder hypertrophy using transabdominal ultrasonography in men with infravesical obstruction. Ultrasonically estimated bladder weight (UEBW) was calculated from the thickness of the bladder wall measured ultrasonically and the intravesical volume at the ultrasonic measurement, assuming a spheric bladder. There was a statistically significant correlation (r = 0.970, P <0.001) between the actual bladder weight of cadaver bladders and the UEBW. The UEBW did not change with bladder filling. The UEBW in the obstructed group (group O, 49.7 +/- 19.5 g, mean +/- SD) was significantly greater than that in the normal control group (group NC, 25.6 +/- 5.7 g; P <0.001) or the nonobstructed group (group NO, 28.4 +/- 4.2 g; P <0.001). The greatest UEBW was 34.8 g in group NC and 35.2 g in group NO, whereas 94% (45 of 48) of group O had a UEBW greater than 35.0 g. In all 5 patients with benign prostatic hyperplasia (BPH), the increased UEBW decreased to a normal control level at 3 months after treatment of BPH. This new noninvasive method may be useful in investigation of bladder hypertrophy.

Noninvasive Quantitative Estimation of Infravesical Obstruction Using Ultrasonic Measurement of Bladder Weight

PURPOSE Ultrasound estimated bladder weight was compared to pressure-flow studies to test the ability of ultrasound estimated bladder weight to predict infravesical obstruction. MATERIALS AND METHODS A total of 65 men with urinary symptoms underwent ultrasonic measurement of bladder weight and pressure-flow studies. Assuming the bladder is a sphere, ultrasound estimated bladder weight was calculated from bladder wall thickness measured ultrasonically and intravesical volume. RESULTS Ultrasound estimated bladder weight correlated significantly (p < 0.0001) with the Abrams-Griffiths number, urethral resistance factor and the Schäfer grade of obstruction. A cutoff value of 35 gm. for ultrasound estimated bladder weight revealed a diagnostic accuracy of 86.2% (56 of 65 cases) for infravesical obstruction with 12.1 (4 of 33) and 15.6% (5 of 32) false-positive and false-negative rates, respectively. CONCLUSIONS Ultrasound estimated bladder weight can be measured noninvasively at the bedside and it is promising as a reliable predictor of infravesical obstruction.

Correlation of histological inflammation in needle biopsy specimens with serum prostate- specific antigen levels in men with negative biopsy for prostate cancer

OBJECTIVES To reveal the possible contribution of histological inflammation within the prostate to the abnormal elevation of serum prostate-specific antigen (PSA) levels in patients with needle biopsy negative for prostate cancer. METHODS We reviewed negative needle biopsy specimens obtained in 93 patients. The degree of acute and chronic inflammation as evaluated histologically was compared with serum PSA levels in conjunction with age and prostate volume. RESULTS Both age (P <0.01) and prostate volume (P <0.0001) correlated significantly with serum PSA levels and were significantly greater in patients with abnormal serum PSA levels (greater than 4.0 ng/mL) than in those with normal serum PSA levels (4.0 ng/mL or less) (P <0.01). The presence of histological inflammation within the prostate also correlated significantly with serum PSA levels. Multiple regression analysis demonstrated prostate volume to be the only independent determinant of serum PSA levels (P <0.01). In patients with a prostate volume larger than 25 mL, only prostate volume correlated significantly with serum PSA levels (P <0. 05). On the other hand, the degree of acute inflammation as represented by polymorphonuclear leukocyte infiltration was the only parameter correlating significantly with serum PSA levels (P <0.05) in patients with a prostate volume smaller than 25 mL. CONCLUSIONS Histologically defined acute inflammation within the prostate is a significant contributor to elevated serum PSA levels, especially in patients with small prostates. In the assessment of needle biopsy results negative for prostate cancer, it might be helpful to evaluate the degree of histological inflammation, especially in terms of the necessity of subsequent repeated biopsies.

Reversible Change of Bladder Hypertrophy Due to Benign Prostatic Hyperplasia After Surgical Relief of Obstruction

PURPOSE Ultrasound estimated bladder weight was compared before and after surgery for benign prostatic hyperplasia (BPH) to reveal a possible reversible change in bladder hypertrophy. MATERIALS AND METHODS Ultrasound estimated bladder weight was measured before and after subcapsular (17) or transurethral (16) prostatectomy in 33 male patients with BPH. Sequential changes in the American Urological Association symptom score and urinary flow rate were also examined. RESULTS Along with a significant improvement in the American Urological Association symptom scores and maximum flow rate, ultrasound estimated bladder weight decreased from 52.9 +/- 22.6 to 31.6 +/- 15.8 gm. in 12 weeks after treatment. In all but 4 patients (29 of 33, or 87.9%) ultrasound estimated bladder weight decreased to less than 35.0 gm. in 12 weeks after treatment. Interestingly, in all patients with an initial ultrasound estimated bladder weight of greater than 80 gm. the bladder weight still remained at an abnormally high level 12 weeks after treatment. CONCLUSIONS Bladder hypertrophy was completely reversible after the surgical treatment of the obstruction in the majority of patients with BPH. The measurement of ultrasound estimated bladder weight was of value in monitoring therapeutic effects in BPH patients. An extraordinarily high ultrasound estimated bladder weight of 80 gm. or more might suggest degenerative and irreversible pathological changes in the bladder detrusor.

Preliminary results of power Doppler imaging in benign prostatic hyperplasia

Power Doppler imaging was performed in 77 patients with lower urinary tract symptoms to characterize Doppler blood-flow signals in benign prostatic hyperplasia (BPH). Pulsatile blood flows were detected in all patients, demonstrating a significant increase of the resistive index (RI) in BPH cases (n = 40, 0.72 +/- 0.05, p < 0.0001), compared to those with a healthy prostate (n = 37, 0.64 +/- 0.04). Of 40 patients with BPH, 28 (70%) had an RI of 0.70 or higher; all but 1 patient with a healthy prostate (1 of 37, 3%) had an RI lower than 0.70 (p < 0.0001). In all 10 patients with BPH, the elevated RI decreased significantly to a normal control level after surgical treatment (0.72 +/- 0.02 vs. 0.64 +/- 0.05, p < 0.001). In conclusion, Doppler RI might be useful as a new urodynamic parameter in BPH.

Doppler resistive index in benign prostatic hyperplasia : Correlation with ultrasonic appearance of the prostate and infravesical obstruction

Objective: This study was designed to characterize the resistive index (RI) of prostatic blood flows obtained by transrectal power Doppler sonography (TRPDS) in benign prostatic hyperplasia (BPH).Method: In 140 patients with lower urinary tract symptoms, the RI was measured using TRPDS and compared with age and planimetric parameters of the prostate obtained by conventional transrectal sonography. In addition, the RI was related with pressure flow studies.Results: The RI was significantly higher in patients with BPH (0.72±0.06, p<0.0001) than those with a normal prostate (0.64±0.04). Although the RI correlated significantly with age and all prostatic planimetric parameters, multiple regression analysis revealed that age and presumed circle area ratio were independent predictors for RI. The RI was also higher in patients with infravesical obstruction than those without (0.74±0.06 vs. 0.70±0.05, p<0.005). There was a significant correlation between RI and urodynamic parameters obtained in pressure flow studies. Out of 33 patients with obstruction, 28 (85%) had an RI of 0.7 or more, while 11 out of 24 patients (46%) without obstruction had an RI less than 0.7.Conclusion: The RI is promising as a new parameter to estimate the intraprostatic pressure to investigate BPH. Its value to represent urodynamic information during voiding remains to be studied.

Comparative morphometric study of bladder detrusor between patients with benign prostatic hyperplasia and controls

PURPOSE We determined the change in the amount of connective tissue of the detrusor in patients with benign prostatic hyperplasia (BPH) in relation to the degree of bladder hypertrophy by ultrasound estimated bladder weight. The ratio of connective tissue-to-smooth muscle between controls and BPH cases was compared. MATERIALS AND METHODS For normal controls we used cadaver bladders excised at autopsy from 13 men with no urinary tract diseases. Bladder wall samples were also obtained at subcapsular prostatectomy for BPH in 26 patients. On thin sections stained with Masson trichrome, the ratio of connective tissue-to-smooth muscle was measured using a computer assisted color image analysis. This ratio was compared in BPH cases with estimated bladder weight, which was measured preoperatively using transabdominal ultrasonography. RESULTS A connective tissue-to-smooth muscle ratio ranged from 19.8 to 28.2% (mean plus or minus standard deviation 24.7+/-2.4) and from 12.9 to 53.3% (27.3+/-9.9) in control and BPH cases, respectively. In BPH cases a significant correlation was noted between estimated bladder weight and connective tissue-to-smooth muscle ratio (r=0.788, p <0.0001). Interestingly, in BPH cases with an estimated bladder weight of less than 60 gm. the ratio ranged from 12.9 to 30.4% (22.8+/-4.9), which was not significantly different compared to control cases. In contrast, in all BPH cases with an estimated bladder weight of 60 gm. or more connective tissue-to-smooth muscle ratio increased significantly to more than 30% (range 33.4 to 53.3%, mean 42.2+/-13.6%). CONCLUSIONS These results suggest that abnormal increase of connective tissue in addition to smooth muscle hypertrophy and/or hyperplasia could contribute to advanced bladder hypertrophy caused by infravesical obstruction.

Correlation of presumed circle area ratio with infravesical obstruction in men with lower urinary tract symptoms.

OBJECTIVES To examine the predictive value of ultrasonic measurements obtained by transrectal ultrasonography for infravesical obstruction as evaluated by pressure flow studies. METHODS In 85 men with moderate to severe lower urinary tract symptoms, ultrasonic measurements including prostatic volume, transition zone volume, transition zone index (transition zone volume/prostatic volume), and presumed circle area ratio (PCAR) were compared with urodynamic parameters obtained by pressure flow studies. RESULTS There were significant interrelationships between these ultrasonic measurements, which were all significantly greater in the obstructed patients than in the unobstructed patients. A simple regression analysis demonstrated that prostatic volume (r = 0.362, P < 0.001), transition zone volume (r = 0.373, P < 0.0005), transition zone index (r = 0.331, P < 0.005), and PCAR (r = 0.487, P < 0.0001) correlated significantly with the Abrams-Griffiths number. More importantly, a multiple regression analysis demonstrated PCAR to be the only independent determinant of the Abrams-Griffiths number. A receiver operator characteristics curve analysis showed that 0.8 was the most suitable cutoff value of PCAR for the prediction of infravesical obstruction with a diagnostic accuracy of 76.5%. CONCLUSIONS PCAR is useful as a transrectal ultrasonic measurement in assessing the severity of infravesical obstruction in men with lower urinary tract symptoms.

Acupuncture on clinical symptoms and urodynamic measurements in spinal-cord-injured patients with detrusor hyperreflexia.

Objectives: We investigated the possible use of acupuncture for the treatment of urinary incontinence caused by detrusor hyperreflexia in patients with chronic spinal cord injuries. Methods: A total of 13 patients (11 males, 2 females) suffering from urinary incontinence due to spinal cord injuries were treated by acupuncture, which was carried out with disposable stainless steel needles inserted into the bilateral BL-33 (Zhongliao) points on the skin of the third posterior sacral foramina. Urodynamic studies were also performed before acupuncture, immediately after the 1st acupuncture and 1 week after the 4th acupuncture. In 6 patients, these urodynamic studies were performed again 1 month after the 4th acupuncture. Results: No side effects were recognized throughout the treatment period. Of the 13 patients, incontinence disappeared in 2 (15%) and decreased to 50% or less compared to baseline in a further 6 (46%). Maximum cystometric bladder capacity increased significantly from 76.2 ± 62.3 to 148.1 ± 81.5 ml 1 week after the 4th acupuncture (p < 0.01). In the 6 patients in whom cystometry was repeated 1 month after the 4th acupuncture, bladder capacity decreased from 187.5 ± 90.4 ml 1 week after the 4th acupuncture to 128.3 ± 93.4 ml. Conclusion: In spinal cord injury patients acupuncture could represent another valuable therapeutic alternative to the treatment of urinary incontinence caused by detrusor hyperreflexia.

Preliminary report of association of chronic diseases and erectile dysfunction in middle-aged men in Japan

OBJECTIVES To investigate the effect of chronic diseases on erectile dysfunction (ED) in Japanese middle-aged men using the International Index of Erectile Function, 5-item version (IIEF-5). METHODS The subjects consisted of 640 healthy men and 396 men with chronic disease who responded to the IIEF-5 questionnaire (mean age 43.6 +/- 8.3 years, range 30 to 59). The incidence and severity of ED were calculated in three age groups (30 to 39, 40 to 49, and 50 to 59 years). RESULTS The incidence of hypertension, cardiac disease, diabetes mellitus, and chronic renal failure was associated with the incidence and severity of ED, as was age. In stepwise multivariate logistic regression analysis, cardiac disease was the strongest independent risk factor (odds ratio [OR] 6.5), followed by diabetes mellitus (OR 5.9), chronic renal failure (OR 3.9), hypertension (OR 2.0), and age (OR 1.8). CONCLUSIONS The results of this study demonstrated that the risk of ED increases with the presence of cardiac disease, diabetes mellitus, chronic renal failure, and hypertension in middle-aged men in Japan.