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Michel MC, Cardozo L, Chermansky CJ, Cruz F, Igawa Y, Lee KS, Sahai A, Wein AJ, Andersson KE. Current and emerging pharmacological targets and treatments of urinary incontinence and related disorders. Pharmacol Rev 2023:pharmrev.121.000523. [PMID: 36918261 DOI: 10.1124/pharmrev.121.000523] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/16/2023] Open
Abstract
The overactive bladder syndrome with and without urinary incontinence and related conditions, signs, and disorders such as detrusor overactivity, neurogenic voiding dysfunction, underactive bladder, stress urinary incontinence, and nocturia are common in the general population and have a major impact on the quality of life of the affected patients and their partners. Based on the deliberations of the subcommittee on pharmacological treatments of the 7th International Consultation on Incontinence, we present a comprehensive review of established drug targets in the treatment of overactive bladder syndrome and the above-mentioned related conditions and the approved drugs used in its treatment. Investigational drug targets and compounds are also reviewed. We conclude that despite a range of available medical treatment options, a considerable medical need continues to exist. This is largely because the existing treatments are symptomatic and have limited efficacy and/or tolerability, which leads to poor long-term adherence. Significance Statement Urinary incontinence and related disorders are prevalent in the general population. While many treatments have been approved, few patients stay on long-term treatment despite none of them being curative. This manuscript provides a comprehensive discussion of existing and emerging treatment options for various types of incontinence and related disorders.
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Affiliation(s)
| | - Linda Cardozo
- Urogynaecology, King's College Hospital, United Kingdom
| | | | | | | | - Kyu-Sung Lee
- Urology, Sungkyunkwan University, Korea, Republic of
| | | | - Alan J Wein
- Urology, University of Pennsylvania, United States
| | - Karl-Erik Andersson
- Institute for Regenerative Medicine, Wake Forest University Medical School, United States
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Matsunaga A, Yoshida M, Shinoda Y, Sato Y, Kamei J, Niimi A, Fujimura T, Kume H, Igawa Y. Effectiveness of ultrasound-guided pelvic floor muscle training in improving prolonged urinary incontinence after robot-assisted radical prostatectomy. Drug Discov Ther 2022; 16:37-42. [PMID: 35264473 DOI: 10.5582/ddt.2022.01004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Persistence of urinary incontinence (UI) after robot-assisted radical prostatectomy (RARP) is a bothersome problem because of its negative effect on the patient's quality of life (QOL). This study aimed to evaluate the effect of transperineal ultrasound (TPUS)-guided pelvic floor muscle training (PFMT) on prolonged UI after RARP. Thirty men with stress UI persisting for > 1 year after RARP underwent biofeedback PFMT using TPUS once every 2-3 weeks for 3 months. The frequency and duration of sustaining pelvic floor muscle (PFM) contractions were assessed using ultrasound imaging. The severity of UI and UI-related QOL were evaluated using a 24-hour pad test and the incontinence quality of life (I-QOL) questionnaire. Twenty-four men (mean age, 72.2 years) completed the TPUS-guided PFMT. The mean duration from RARP to PFMT was 1,228.9 days. The mean cumulative session and the total duration of TPUS-guided PFMT were 4.6 times and 73.3 days, respectively. Compared with the data before TPUS-guided PFMT, the frequency of PFM contractions and duration of sustaining contraction significantly improved after TPUS-guided PFMT (p < 0.05). Additionally, the total amount of urinary leakage after TPUS-guided PFMT was reduced significantly (248.6 ± 280.6 g vs. 397.0 ± 427.0 g, p = 0.024). The I-QOL score was significantly increased after TPUS-guided PFMT (72.1 ± 16.8 vs. 61.0 ± 19.0, p < 0.001). TPUS-guided PFMT may be effective in improving prolonged UI occurring > 1 year after RARP.
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Affiliation(s)
- Akiko Matsunaga
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Mikako Yoshida
- Department of Women's Health Nursing & Midwifery, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Yusuke Shinoda
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan.,Department of Rehabilitation Medicine, Saitama Medical University Hospital, Saitama, Japan
| | - Yusuke Sato
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Jun Kamei
- Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Aya Niimi
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Urology, New Tokyo Hospital, Chiba, Japan
| | | | - Haruki Kume
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Urology, Nagano Prefectural Shinshu Medical Center, Nagano, Japan
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Akiyama Y, Niimi A, Igawa Y, Nomiya A, Yamada Y, Sato Y, Kawai T, Yamada D, Kume H, Homma Y. Cystectomy for patients with Hunner-type interstitial cystitis at a tertiary referral center in Japan. Low Urin Tract Symptoms 2021; 14:102-108. [PMID: 34704374 DOI: 10.1111/luts.12416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/28/2021] [Accepted: 10/14/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the outcomes of partial and total cystectomy in patients with refractory Hunner-type interstitial cystitis (HIC). METHODS Patients with end-stage HIC who underwent supratrigonal partial cystectomy with augmentation ileocystoplasty (PC-CP) or total cystectomy with ileal conduit (TC-IC) were identified retrospectively. Changes in the 11-point numerical rating scale of bladder pain and in 7-grade quality of life (QOL) scores were evaluated. Changes in the O'Leary and Sant's Symptom Index (OSSI) and O'Leary and Sant's Problem Index (OSPI) were analyzed in patients with PC-CP. Peri- and postoperative complications and patient satisfaction with overall outcomes were examined. RESULTS Four patients (one female) underwent PC-CP and 13 (nine females) underwent TC-IC. Bladder pain persisted in three PC-CP patients, but resolved completely in all TC-IC patients. Pain scale and QOL scores improved significantly in patients with TC-IC (P < .01), but not in those with PC-CP. OSSI/OSPI scores did not improve significantly in patients with PC-CP. Three PC-CP patients required clean intermittent catheterization due to voiding dysfunction or persistent pain. Two TC-IC patients developed stricture of the ureteroileal anastomosis, resulting in permanent placement of a ureteral stent in one case and nephrostomy in the other. Satisfaction rate was higher in the TC-IC than in the PC-CP group (76.9% vs 25.0%, P < .05). CONCLUSIONS TC-IC provided reliable pain relief and improved QOL in patients with end-stage HIC, but the small case number and limited methodology restrict interpretation of the results. Further studies are needed to identify appropriate candidates and optimal surgical procedures.
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Affiliation(s)
- Yoshiyuki Akiyama
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aya Niimi
- Department of Urology, New Tokyo Hospital, Matsudo, Japan
| | - Yasuhiko Igawa
- Department of Urology, Nagano Prefectural Shinshu Medical Center, Suzaka, Japan
| | - Akira Nomiya
- Department of Urology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Sato
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Japanese Red Cross Medical Center, Tokyo, Japan
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Matsumoto M, Tamai N, Miura Y, Okawa Y, Yoshida M, Igawa Y, Nakagami G, Sanada H. Evaluation of a Point-of-Care Ultrasound Educational Program for Nurse Educators. J Contin Educ Nurs 2021; 52:375-381. [PMID: 34324378 DOI: 10.3928/00220124-20210714-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The effectiveness of point-of-care ultrasound (POCUS) for nurses has been demonstrated; however, only a limited number of nurses have been trained to perform POCUS. This article reports on a POCUS train-the-trainer program for nurse educators that targets lower urinary track dysfunction. METHOD Nurse educators (n = 38) were invited to participate in a POCUS train-the-trainer program, which comprised an e-learning module and a hands-on seminar. Acquisition of knowledge and skills were assessed after the module and seminar, respectively. RESULTS Questions from the "Basic Knowledge of Ultrasonography" test were answered correctly at a rate of 93.0% (SD, 8.5%). Measured values of bladder urinary volume using ultrasonography were in close agreement with actual values. All of the participants indicated that the program covered the content necessary to use in practice. CONCLUSION The POCUS train-the-trainer program equips nurse educators with the knowledge and skills needed for training nurses at their institutions. [J Contin Educ Nurs. 2021;52(8):375-381.].
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Nakamura M, Hakozaki Y, Iwata S, Sato Y, Makino K, Kawai T, Yamada Y, Yamada D, Suzuki M, Omatsu J, Abe M, Hoshi K, Kume H, Igawa Y. Novel operative technique of advancement urethral meatoplasty utilizing buccal mucosa for Vulvar Paget's disease with urethral invasion: two case reports. J Med Case Rep 2021; 15:136. [PMID: 33773597 PMCID: PMC8005229 DOI: 10.1186/s13256-021-02729-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vulvar Paget's disease (VPD) is a rare malignant disorder originating in the external genitalia. It occasionally invades into urethral or vaginal mucosa of female, making surgical treatment more complicating. In case of urethral invasion of Paget's cells, systematic mapping biopsy of urethral mucosa is the standard of care to determine the range of surgical resection. Resection of urethral mucosa and simple skin grafting often result in urethral stricture after surgery, which severely deteriorates patient's quality of life. CASE PRESENTATION We applied a new technique of advancement urethral meatoplasty using buccal mucosa, in two Japanese cases of VPD with urethral invasion. After broad resection of vulvar skin together with the urethral mucosa, buccal mucosa was implanted between advanced urethral mucosa and skin graft. In both cases, we could prevent urethral stricture one year and two years after surgery, respectively. CONCLUSION This technique prevented urethral stricture after surgery and could be a useful technique as part of urethroplasty for VPD.
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Affiliation(s)
- Masaki Nakamura
- Department of Urology, The Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Yuji Hakozaki
- Department of Urology, The Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shohei Iwata
- Department of Urology, The Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Sato
- Department of Urology, The Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Katsuhiro Makino
- Department of Urology, The Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, The Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yuta Yamada
- Department of Urology, The Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Yamada
- Department of Urology, The Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Motofumi Suzuki
- Department of Urology, The Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Jun Omatsu
- Department of Dermatology, The Graduate school of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masanobu Abe
- Department of Oral-maxillofacial surgery, The Graduate school of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuto Hoshi
- Department of Oral-maxillofacial surgery, The Graduate school of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, The Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Urology, The Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Continence Medicine, The Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Kamei J, Aizawa N, Nakagawa T, Kaneko S, Fujimura T, Homma Y, Kume H, Igawa Y. Lacking transient receptor potential melastatin 2 attenuates lipopolysaccharide-induced bladder inflammation and its associated hypersensitivity in mice. Int J Urol 2020; 28:107-114. [PMID: 33026125 DOI: 10.1111/iju.14389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/02/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To study the role of transient receptor potential melastatin 2 in bladder function and inflammation-associated hypersensitivity. METHODS We evaluated physiological function of the bladder and intravesical lipopolysaccharide-induced inflammatory nociceptive responses in female wild-type and transient receptor potential melastatin 2-knockout mice. In vivo frequency/volume and decerebrated unanesthetized cystometry measurements, as well as in vitro detrusor strip functional studies, were carried out to evaluate bladder function. Mice received intravesical lipopolysaccharide (2.0 mg/mL) or saline instillation to evaluate responses to bladder inflammation. Voiding and bladder pain-like behaviors, cystometry measurements and histological evaluation were carried out before and after intravesical lipopolysaccharide instillation. RESULTS Few phenotypic differences in in vivo and in vitro physiological function were found between the two genotypes. Comparison of measurements taken before and 24-48 h after intravesical lipopolysaccharide instillation showed that voiding parameters did not change in transient receptor potential melastatin 2-knockout mice, whereas an increased voiding frequency was observed in wild-type mice. At 24 h after intravesical lipopolysaccharide instillation, the numbers of bladder pain-like behaviors and of infiltrated inflammatory cells in the bladder submucosal layer were significantly increased, and the voided volume and the intercontraction interval were significantly decreased on cystometry measurements in wild-type mice compared with those in both transient receptor potential melastatin 2-knockout mice and in wild-type mice treated with saline instillation. CONCLUSIONS Although the physiological roles of transient receptor potential melastatin 2 channels in the bladder might be limited, inflammation and associated hypersensitivity of the bladder caused by intravesical lipopolysaccharide instillation are attenuated in transient receptor potential melastatin 2-knockout mice, suggesting pathophysiological roles of transient receptor potential melastatin 2 channels in these processes.
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Affiliation(s)
- Jun Kamei
- Department of Urology, Jichi Medical University, Tochigi, Japan.,Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Naoki Aizawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Pharmacology and Toxicology, Dokkyo Medical University, Tochigi, Japan
| | - Takayuki Nakagawa
- Clinical Pharmacology and Therapeutics, Kyoto University Hospital, Kyoto, Japan.,Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan
| | - Shuji Kaneko
- Department of Molecular Pharmacology, Graduate School of Pharmaceutical Sciences, Kyoto University, Kyoto, Japan
| | | | - Yukio Homma
- Department of Urology, Japan Red Cross Hospital, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Urology, Nagano Prefectural Medical Center, Suzaka, Japan
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Watanabe D, Akiyama Y, Niimi A, Nomiya A, Yamada Y, Sato Y, Nakamura M, Kawai T, Yamada D, Suzuki M, Igawa Y, Kume H, Homma Y. Clinical characterization of interstitial cystitis/bladder pain syndrome in women based on the presence or absence of Hunner lesions and glomerulations. Low Urin Tract Symptoms 2020; 13:139-143. [PMID: 32830459 DOI: 10.1111/luts.12344] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To compare the clinical characteristics of three groups of female patients with interstitial cystitis/bladder pain syndrome (IC/BPS) classified according to the presence or absence of Hunner lesions (HL) and glomerulations. METHODS The clinical records of 100 female patients with IC/BPS who underwent their first bladder hydrodistension at our institution were retrospectively reviewed. They were divided into patients having (HL-IC; n = 57) or lacking (BPS; n = 43) HL. BPS patients were further classified as those with (29) and without (14) glomerulations. Among these three subtypes, demographics, comorbidities, symptom parameters including a visual analog scale for pain scores, O'Leary and Sant Symptom and Problem (OSSI/OSPI) Indices, frequency volume chart variables, and bladder capacity at hydrodistension were compared. RESULTS HL-IC patients were older and had higher OSSI/OSPI scores, greater daytime frequency and nocturia, reduced maximum and average voided volumes, and smaller bladder capacity at hydrodistension compared with BPS patients. Pain intensity and illness duration were comparable among the three groups. HL-IC patients had autoimmune disorders as comorbidities more often, but had psychiatric disorders and irritable bowel syndrome less often compared with BPS patients. No discernible differences in clinical characteristics of symptom severity and comorbid disorders were evident between BPS patients with and without glomerulations. CONCLUSIONS The presence of HL is associated with distinctive clinical characteristics, while glomerulations are not in female patients with IC/BPS. The presence of HL, but not glomerulations, is a robust phenotypic feature of IC/BPS in women.
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Affiliation(s)
- Daiji Watanabe
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshiyuki Akiyama
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aya Niimi
- Department of Urology, New Tokyo Hospital, Matsudo, Tokyo, Japan
| | - Akira Nomiya
- Department of Urology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yusuke Sato
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaki Nakamura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daisuke Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Motofumi Suzuki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Urology, Nagano Prefectural Shinshu Medical Center, Suzaka, Nagano, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Japanese Red Cross Medical Center, Tokyo, Japan
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Nakanishi O, Fujimori Y, Aizawa N, Hayashi T, Matsuzawa A, Kobayashi JI, Hirasawa H, Mutai Y, Tanada F, Igawa Y. KPR-5714, a Novel Transient Receptor Potential Melastatin 8 Antagonist, Improves Overactive Bladder via Inhibition of Bladder Afferent Hyperactivity in Rats. J Pharmacol Exp Ther 2020; 373:239-247. [DOI: 10.1124/jpet.119.263616] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/24/2020] [Indexed: 12/17/2022] Open
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Sekido N, Igawa Y, Kakizaki H, Kitta T, Sengoku A, Takahashi S, Takahashi R, Tanaka K, Namima T, Honda M, Mitsui T, Yamanishi T, Watanabe T. Clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury. Int J Urol 2020; 27:276-288. [PMID: 32077161 DOI: 10.1111/iju.14186] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/23/2019] [Indexed: 12/16/2022]
Abstract
The present article is an abridged English translation of the Japanese clinical guidelines for the diagnosis and treatment of lower urinary tract dysfunction in patients with spinal cord injury updated as of July 2019. The patients are adult spinal cord injured patients with lower urinary tract dysfunction; special consideration of pediatric and elderly populations is presented separately. The target audience is healthcare providers who are engaged in the medical care of patients with spinal cord injury. The mandatory assessment includes medical history, physical examination, frequency-volume chart, urinalysis, blood chemistry, transabdominal ultrasonography, measurement of post-void residual urine, uroflowmetry and video-urodynamic study. Optional assessments include questionnaires on the quality of life, renal scintigraphy and cystourethroscopy. The presence or absence of risk factors for renal damage and symptomatic urinary tract infection affects urinary management, as well as pharmacological treatments. Further treatment is recommended if the maximum conservative treatment fails to improve or prevent renal damage and symptomatic urinary tract infection. In addition, management of urinary incontinence should be considered individually in patients with risk factors for urinary incontinence and decreased quality of life.
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Affiliation(s)
- Noritoshi Sekido
- Department of Urology, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Urology, Nagano Prefectural Shinshu Medical Center, Suzaka, Nagano, Japan
| | - Hidehiro Kakizaki
- Department of Renal and Urologic Surgery, Asahikawa Medical University, Asahikawa, Hokkaido, Japan
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Graduate School of Medical Science, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Atsushi Sengoku
- Department of Urology, Hyogo Prefectural Rehabilitation Central Hospital, Kobe, Hyogo, Japan
| | - Satoru Takahashi
- Department of Urology, Nihon University School of Medicine, Tokyo, Japan
| | - Ryosuke Takahashi
- Department of Urology, Spinal Injuries Center, Iizuka, Fukuoka, Japan
| | - Katsuyuki Tanaka
- Department of Urology, Kanagawa Rehabilitation Hospital, Atsugi, Kanagawa, Japan
| | - Takashige Namima
- Department of Urology, Tohoku Rosai Hospital, Sendai, Miyagi, Japan
| | - Masashi Honda
- Division of Urology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan
| | - Takahiko Mitsui
- Department of Urology, University of Yamanashi Graduate School of Medical Sciences, Chuo, Yamanashi, Japan
| | - Tomonori Yamanishi
- Department of Urology, Continence Center, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Toyohiko Watanabe
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Homma Y, Akiyama Y, Niimi A, Nomiya A, Igawa Y. Classification, Characterization, and Sub-Grouping of Interstitial Cystitis. Curr Bladder Dysfunct Rep 2019. [DOI: 10.1007/s11884-019-00542-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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11
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Katoh T, Igawa Y, Yamaguchi O, Kato D, Hamada T, Kuroishi K. Cardiovascular safety of antimuscarinic add-on therapy in patients with overactive bladder who had a suboptimal response to mirabegron monotherapy: A post hoc analysis from the Japanese MILAI II study. Low Urin Tract Symptoms 2019; 12:68-80. [PMID: 31571403 PMCID: PMC7004007 DOI: 10.1111/luts.12286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 07/27/2019] [Indexed: 12/28/2022]
Abstract
Objective This analysis was conducted to investigate the cardiovascular (CV) safety outcomes from the MILAI II study. MILAI II was conducted to evaluate the long‐term safety and efficacy of antimuscarinic add‐on therapy to mirabegron over 52 weeks in patients with overactive bladder (OAB) symptoms. Methods MILAI II consisted of a 2‐week screening period (patients received mirabegron 50 mg once daily) plus a 52‐week treatment period (patients were randomized to receive a combination of mirabegron 50 mg/d plus solifenacin 5 mg/d, propiverine 20 mg/d, imidafenacin 0.2 mg/d, or tolterodine 4 mg/d). CV safety was assessed using treatment‐emergent adverse events (TEAEs), vital signs, and 12‐lead electrocardiograms (ECGs). Vital signs and ECG data were evaluated for each patient using worst post‐baseline values reported. Results Of 647 patients, 570 (88.1%) were female with a mean age of 65 years. CV history at baseline and CV‐related concomitant medication use throughout the study were balanced between groups. The incidences of overall and drug‐related CV TEAEs were ≤8.1% and ≤6.2%, respectively, for all groups. The most common TEAEs were ECG T wave amplitude decreased, ECG QT prolonged, and ventricular extrasystoles. Overall, 36 TEAEs of interest related to the CV system that were possibly/probably related to treatment were reported with similar incidences for each group. For the worst post‐baseline vital signs and ECGs, no relationships were noted in terms of either timing or treatment group. Conclusion A favorable CV safety profile was observed following long‐term combination treatment with mirabegron and an antimuscarinic in patients with OAB symptoms.
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Affiliation(s)
- Takao Katoh
- Cardiovascular Center, Mita Hospital, International University of Health and Welfare, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Osamu Yamaguchi
- Department of Chemical Biology and Applied Chemistry, Nihon University School of Engineering, Koriyama, Japan
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Kawai T, Sato Y, Makino K, Yamada Y, Nomiya A, Nakamura M, Yamada D, Suzuki M, Igawa Y, Kume H. Immune-related adverse events predict the therapeutic efficacy of pembrolizumab in urothelial cancer patients. Eur J Cancer 2019; 116:114-115. [DOI: 10.1016/j.ejca.2019.05.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 05/09/2019] [Indexed: 11/15/2022]
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13
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Igawa Y, Aizawa N, Michel MC. β 3 -Adrenoceptors in the normal and diseased urinary bladder-What are the open questions? Br J Pharmacol 2019; 176:2525-2538. [PMID: 30868554 DOI: 10.1111/bph.14658] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/31/2018] [Accepted: 01/29/2019] [Indexed: 12/13/2022] Open
Abstract
β3 -Adrenoceptor agonists are used in the treatment of overactive bladder syndrome. Although the relaxant response to adrenergic stimulation in human detrusor smooth muscle cells is mediated mainly via β3 -adrenoceptors, the plasma concentrations of the therapeutic dose of mirabegron, the only clinically approved β3 -adrenoceptor agonist, are considerably lower than the EC50 for causing direct relaxation of human detrusor, suggesting a mechanism of action other than direct relaxation of detrusor smooth muscle. However, the site and mechanism of action of β3 -adrenoceptor agonists in the bladder have not been firmly established. Postulated mechanisms include prejunctional suppression of ACh release from the parasympathetic nerves during the storage phase and inhibition of micro-contractions through β3 -adrenoceptors on detrusor smooth muscle cells or suburothelial interstitial cells. Implications of possible desensitization of β3 -adrenoceptors in the bladder upon prolonged agonist exposure and possible causes of rarely observed cardiovascular effects of mirabegron are also discussed. LINKED ARTICLES: This article is part of a themed section on Adrenoceptors-New Roles for Old Players. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.14/issuetoc.
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Affiliation(s)
- Yasuhiko Igawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Naoki Aizawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Martin C Michel
- Department of Pharmacology, Johannes Gutenberg University, Mainz, Germany
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14
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Fujimura T, Igawa Y, Aizawa N, Niimi A, Yamada Y, Sugihara T, Kamei J, Sato Y, Matsunaga A, Yoshida M, Shinoda Y, Fukuhara H, Nakagawa T, Homma Y, Kume H. Longitudinal change of comprehensive lower urinary tract symptoms and various types of urinary incontinence during robot-assisted radical prostatectomy. Neurourol Urodyn 2019; 38:1067-1075. [PMID: 30995359 DOI: 10.1002/nau.23952] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 11/17/2018] [Accepted: 01/28/2019] [Indexed: 11/10/2022]
Abstract
AIMS To clarify longitudinal change of lower urinary tract symptoms (LUTS) and various types of urinary incontinence following robot-assisted radical prostatectomy (RARP) using validated questionnaires. MATERIALS AND METHODS The core lower urinary tract symptom score (CLSS) and the International Consultation on Incontinence Questionnaire (ICIQ)-Short Form (SF) questionnaires were administered to 607 consecutive, treatment-naïve men receiving RARP before and after surgery. The time course of comprehensive LUTS and various types of urinary incontinence, including stress-, urgency-, and urinary incontinence with no obvious reason, were evaluated. Continence recovery rates were compared for the different types of incontinence using Cox hazard regression analysis. RESULTS After surgery, stress urinary incontinence (SUI) was reported most frequently (32% of cases) as the chief complaint with the most impact on daily life, as assessed by the CLSS questionnaire, followed by urgency urinary incontinence (UUI; 27% of cases). The rates of continence recovery differed among the different types of urinary incontinence, such as after urinating, when dressed, when asleep, when physically active or exercising, when coughing or sneezing, before reaching the toilet, and for no obvious reason. Incontinence for no obvious reason at 1 month after RARP was a strongest prognostic factor of delayed continence recovery (hazard ratio, 0.61; P < 0.0001), whereas patients reporting SUI and UUI gradually regained continence. CONCLUSIONS Further time course on continent recovery after RARP would be more precisely predictable based on the incontinence status at one month postoperatively. Especially, incontinence with no obvious reason would be a significant factor for delayed recovery.
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Affiliation(s)
- Tetsuya Fujimura
- Department of Urology, Jichi Medical University, Yakushiji, Simotsuke-shi, Tochigi, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Naoki Aizawa
- Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Japan
| | - Aya Niimi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Toru Sugihara
- Department of Urology, Jichi Medical University, Yakushiji, Simotsuke-shi, Tochigi, Japan
| | - Jun Kamei
- Department of Urology, Jichi Medical University, Yakushiji, Simotsuke-shi, Tochigi, Japan
| | - Yusuke Sato
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Akiko Matsunaga
- Department of Rehabilitation, Graduate School of Medicine, The University of Tokyo, Japan
| | - Mikako Yoshida
- Department of Gerontological Nursing/ Wound Care Management, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yusuke Shinoda
- Department of Rehabilitation, Graduate School of Medicine, The University of Tokyo, Japan
| | | | - Tohru Nakagawa
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
| | - Yukio Homma
- President Japanese Red Cross Medical Center, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Japan
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15
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Kamei J, Watanabe D, Homma Y, Kume H, Igawa Y. Feasibility of approximate measurement of bladder volume in male patients using the Lilium α-200 portable ultrasound bladder scanner. Low Urin Tract Symptoms 2019; 11:169-173. [PMID: 30854772 DOI: 10.1111/luts.12258] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/02/2019] [Accepted: 01/21/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examined the accuracy of a new portable ultrasound bladder scanner, the Lilium α-200 (Lilium Otsuka, Kanagawa, Japan), by evaluating the correlation between bladder volumes periodically measured by the Lilium α-200 and instilled volume during video-urodynamic studies (V-UDS). METHODS Using the Lilium α-200, fluid volume was measured prospectively in the bladders of patients with lower urinary tract dysfunction during V-UDS. This was done both immediately after micturition (for assessment of post-void residual [PVR] volume) and at 1-minute intervals during filling cystometry with patients in the supine position. These measurements were then compared with the PVR volume obtained directly by catheter drainage and instilled volume during cystometry using paired t tests and Spearman's rank correlation. RESULTS Fifteen male patients (median age 70.5 years; range 18-84 years) were included in the study. The PVR volume measured by the Lilium α-200 was strongly correlated with that obtained by catheter drainage (r = 0.94; P < 0.0001). There was a strong correlation between instilled and bladder volumes measured by the Lilium α-200 at every minute during and at the end of instillation (281 measurements in 15 patients; r = 0.86; P < 0.0001). However, the relative error of bladder volumes measured by the Lilium α-200 during cystometry showed considerable variation (mean [± SD] 5.6 ± 62.9%). CONCLUSIONS Bladder volumes measured periodically by the Lilium α-200 during cystometry were strongly correlated with actual PVR or instilled volumes. However, they showed considerable variation and may not predict actual volume accurately. The Lilium α-200 is feasible for obtaining an approximate measure of bladder volume.
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Affiliation(s)
- Jun Kamei
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Urology, Jichi Medical University, Tochigi, Japan
| | - Daiji Watanabe
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, Japan Red Cross Medical Center, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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16
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Aizawa N, Ohshiro H, Watanabe S, Kume H, Homma Y, Igawa Y. RQ-00434739, a novel TRPM8 antagonist, inhibits prostaglandin E2-induced hyperactivity of the primary bladder afferent nerves in rats. Life Sci 2019; 218:89-95. [DOI: 10.1016/j.lfs.2018.12.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 10/27/2022]
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17
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Suzuki M, Miyazaki H, Kamei J, Yoshida M, Taniguchi T, Nishimura K, Igawa Y, Sanada H, Homma Y. Ultrasound-assisted prompted voiding care for managing urinary incontinence in nursing homes: A randomized clinical trial. Neurourol Urodyn 2019; 38:757-763. [PMID: 30620134 PMCID: PMC6849834 DOI: 10.1002/nau.23913] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/21/2018] [Indexed: 01/09/2023]
Abstract
Aims To determine whether ultrasound‐assisted prompted voiding (USAPV) care is more efficacious than conventional prompted voiding (CPV) care for managing urinary incontinence in nursing homes. Methods Thirteen participating nursing homes in Japan were randomized to CPV (n = 7) or USAPV care group (n = 6). Residents of the allocated nursing homes received CPV (n = 35) or USAPV (n = 45) care for 8 weeks. In the CPV group, caregivers asked the elderly every 2‐3 h whether they had a desire to void and prompted them to void when the response was yes. In the USAPV group, caregivers regularly monitored bladder urine volume by an ultrasound device and prompted them to void when the volume reached close to the individually optimized bladder capacity. Frequency‐volume chart was recorded at the baseline and after the 8‐week intervention to measure the daytime urine loss. Results The change in daytime urine loss was statistically greater in the USAPV (median, −80.0 g) than in the CPV (median, −9.0 g; P = .018) group. The proportion of elderly individuals whose daytime urine loss decreased by >25% was 51% and 26% in the USAPV and CPV group, respectively (P = .020). Quality‐of‐life measures of elderly participants showed no significant changes in both groups. The care burden scale score of caregivers was unchanged in the USAPV group (P = .59) but significantly worsened in the CPV group (P = .010) after the intervention. Conclusions USAPV is efficacious and feasible for managing urinary incontinence in nursing homes.
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Affiliation(s)
- Motofumi Suzuki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hideyo Miyazaki
- Department of Urology, Center Hospital of the National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | - Jun Kamei
- Department of Urology, Graduate School of Medicine, Jichi Medical University, Shimotsuke-city, Tochigi, Japan
| | - Mikako Yoshida
- Department of Imaging Nursing Science, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Tamami Taniguchi
- Graduate Faculty of Medicine, Department of Health and Life Support Nursing Science, University of Yamanashi, Chuo-city, Yamanashi, Japan
| | | | - Yasuhiko Igawa
- Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yukio Homma
- Japanese Red Cross Medical Center, Shibuya-ku, Tokyo, Japan
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18
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Yamaguchi O, Kakizaki H, Homma Y, Igawa Y, Takeda M, Nishizawa O, Gotoh M, Yoshida M, Yokoyama O, Seki N, Okitsu A, Hamada T, Kobayashi A, Kuroishi K. Long-term safety and efficacy of antimuscarinic add-on therapy in patients with overactive bladder who had a suboptimal response to mirabegron monotherapy: A multicenter, randomized study in Japan (MILAI II study). Int J Urol 2018; 26:342-352. [PMID: 30548692 PMCID: PMC7379522 DOI: 10.1111/iju.13868] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 10/15/2018] [Indexed: 11/30/2022]
Abstract
Objectives To evaluate the long‐term safety (primary objective) and efficacy (secondary objective) of antimuscarinic add‐on therapy in patients receiving mirabegron. Methods During a 2‐week screening period, patients (aged ≥20 years, mirabegron treatment for ≥6 weeks, residual overactive bladder symptoms) received mirabegron 50 mg once daily. These patients were subsequently randomized to 52 weeks’ treatment with mirabegron 50 mg/day plus an antimuscarinic (solifenacin 5 mg, propiverine 20 mg, imidafenacin 0.2 mg, or tolterodine 4 mg) with the potential to double the antimuscarinic dose (except for tolterodine) at week 8. Safety assessments included treatment‐emergent adverse events, vital signs, 12‐lead electrocardiograms, post‐void residual volume, and laboratory evaluations. Efficacy was assessed using changes from baseline in overactive bladder symptom score total score; overactive bladder questionnaire short form score; micturitions, urgency episodes, urinary incontinence episodes, and urgency urinary incontinence episodes/24 h; mean volume voided per micturition; and number of night‐time micturitions. Results Overall, 80.2% of patients (88.1% women, mean age 65 years) experienced at least one treatment‐emergent adverse event, with similar rates for all treatments. The adverse events most commonly reported were dry mouth, nasopharyngitis, and constipation. No marked change was observed in systolic or diastolic blood pressure for any treatment, although pulse rate increased slightly in the mirabegron and propiverine, and mirabegron and tolterodine groups. For all treatments, significant improvements were observed in all efficacy parameters, including overactive bladder symptom score total and questionnaire short form scores. Conclusions Antimuscarinic add‐on therapy is well tolerated and effective after initial treatment with mirabegron in patients with overactive bladder symptoms.
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Affiliation(s)
- Osamu Yamaguchi
- Department of Chemical Biology and Applied Chemistry, Nihon University School of Engineering, Koriyama, Japan
| | - Hidehiro Kakizaki
- Department of Urology, Asahikawa Medical University, Asahikawa, Japan
| | - Yukio Homma
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masayuki Takeda
- Department of Urology, Graduate Faculty of Interdisciplinary Research, University of Yamanashi, Chuo, Japan
| | - Osamu Nishizawa
- Department of Urology, North Alps Medical Center, Azumi Hospital, Nagano, Japan
| | - Momokazu Gotoh
- Department of Urology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Yoshida
- Department of Urology, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Osamu Yokoyama
- Department of Urology, University of Fukui Faculty of Medical Sciences, Fukui, Japan
| | - Narihito Seki
- Department of Urology, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
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19
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Yoshida M, Matsunaga A, Igawa Y, Fujimura T, Shinoda Y, Aizawa N, Sato Y, Kume H, Homma Y, Haga N, Sanada H. May perioperative ultrasound-guided pelvic floor muscle training promote early recovery of urinary continence after robot-assisted radical prostatectomy? Neurourol Urodyn 2018; 38:158-164. [PMID: 30375062 DOI: 10.1002/nau.23811] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/02/2018] [Indexed: 11/11/2022]
Abstract
AIMS The efficacy of perioperative pelvic floor muscle training (PFMT) for continence recovery after robot-assisted radical prostatectomy (RARP) remains unclear. Visualization of the bladder neck and urethra using transperineal ultrasound (US) may promote self-recognition of urethral closure during PFM contraction. This study aimed to examine whether transperineal US-guided PFMT promotes early recovery of post-RARP incontinence. METHODS This prospective cohort study included 116 men undergoing RARP. All men were offered to undergo transperineal US-guided PFMT, and 36 men agreed. The protocol consisted of biofeedback PFMT using transperineal US before RARP and 1-month after RARP with verbal instruction of PFMT immediately after urethral catheter removal. The remaining 80 patients received verbal instruction for PFMT alone. Continence recovery was defined as the number of days requiring a small pad (20 g) per day by self-report. RESULTS No differences were observed in demographic or peri-operative parameters between the two groups except the longer operative time in the US-guided PFMT group. The mean time until continence recovery was significantly shorter in the US-guided PFMT group (75.6 ± 100.0 days) than in the verbal-PFMT group (121.8 ± 132.0 days, P = 0.037). Continence recovery rates within 30 days were 52.8% (19/36) and 35.4% (28/80) in the US-guided PFMT and verbal-PFMT groups, respectively (P = 0.081). US-guided PFMT was associated with better postoperative continence status (adjusted hazard ratio [95% confidence interval]: 0.550 [0.336-0.900], P = 0.017). CONCLUSIONS The results showed that transperineal US-guided PFMT perioperatively was associated with early recovery of urinary continence after RARP.
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Affiliation(s)
- Mikako Yoshida
- Department of Imaging Nursing Science, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Global Nursing Research Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Akiko Matsunaga
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yusuke Shinoda
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Naoki Aizawa
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yusuke Sato
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Haruki Kume
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yukio Homma
- Japanese Red Cross Medical Center, Tokyo, Japan
| | - Nobuhiko Haga
- Department of Rehabilitation Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiromi Sanada
- Global Nursing Research Center, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Gerongtological Nursing, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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20
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Krassioukov A, Igawa Y, Averbeck MA, Madersbacher H, Lloyd AJ, Bøgelund M, Thiruchelvam N. Gains in health utility associated with urinary catheter innovations. Med Devices (Auckl) 2018; 11:345-351. [PMID: 30319291 PMCID: PMC6171519 DOI: 10.2147/mder.s165778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To estimate gains in health utility for two different catheter features and a support service related to urinary catheters used for intermittent catheterization. Patients and methods Two internet-based time trade-off (TTO) surveys were undertaken to value vignettes describing two innovative catheter features and a support service. The first TTO survey “Size and Service” included catheters with compact design and the availability of a support service for users; the second TTO survey “Phthalates” included avoidance of potentially harmful phthalates in the material of the catheters. All participants were from the UK; they traded health states against a time horizon that matched their total life expectancy. Sensitivity analyses were done to estimate the impact of extreme values on disutilities. Results The participants (n=890) estimated the incremental value of 0.031 (95% CI: 0.024–0.039), 0.009 (95% CI: 0.003–0.015), and 0.037 (95% CI: 0.027–0.046), respectively, for catheters with compact design, availability of support service, and catheters not containing phthalates. Conclusions Participants valued all three improvements in catheter design. To capture the impact of such design improvements on quality of life and utilities, vignette-based approaches can be a useful supplement to the conventional, generic tools.
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Affiliation(s)
- Andrei Krassioukov
- University of British Columbia, International Collaboration On Repair Discoveries (ICORD), Vancouver, British Columbia, Canada, .,Division of Physical Medicine and Rehabilitation, Department of Medicine, G.F. Strong Rehabilitation Centre, Vancouver, British Columbia, Canada,
| | - Yasuhiko Igawa
- Department of Continence Medicine, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | | | | | | | | | - Nikesh Thiruchelvam
- Department of Urology, Cambridge University Hospitals NHS Trust, Cambridge, UK
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21
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Averbeck MA, Krassioukov A, Thiruchelvam N, Madersbacher H, Bøgelund M, Igawa Y. The impact of different scenarios for intermittent bladder catheterization on health state utilities: results from an internet-based time trade-off survey. J Med Econ 2018; 21:945-952. [PMID: 29882712 DOI: 10.1080/13696998.2018.1486846] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
AIMS Intermittent catheterization (IC) is the gold standard for bladder management in patients with chronic urinary retention. Despite its medical benefits, IC users experience a negative impact on their quality of life (QoL). For health economics based decision making, this impact is normally measured using generic QoL measures (such as EQ-5D) that estimate a single utility score which can be used to calculate quality-adjusted life years (QALYs). But these generic measures may not be sensitive to all relevant aspects of QoL affected by intermittent catheters. This study used alternative methods to estimate the health state utilities associated with different scenarios: using a multiple-use catheter, one-time-use catheter, pre-lubricated one-time-use catheter and pre-lubricated one-time-use catheter with one less urinary tract infection (UTI) per year. METHODS Health state utilities were elicited through an internet-based time trade-off (TTO) survey in adult volunteers representing the general population in Canada and the UK. Health states were developed to represent the catheters based on the following four attributes: steps and time needed for IC process, pain and the frequency of UTIs. RESULTS The survey was completed by 956 respondents. One-time-use catheters, pre-lubricated one-time-use catheters and ready-to-use catheters were preferred to multiple-use catheters. The utility gains were associated with the following features: one time use (Canada: +0.013, UK: +0.021), ready to use (all: +0.017) and one less UTI/year (all: +0.011). LIMITATIONS Internet-based survey responders may have valued health states differently from the rest of the population: this might be a source of bias. CONCLUSION Steps and time needed for the IC process, pain related to IC and the frequency of UTIs have a significant impact on IC related utilities. These values could be incorporated into a cost utility analysis.
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Affiliation(s)
| | - Andrei Krassioukov
- b International Collaboration On Repair Discoveries (ICORD), Department of Medicine , University of British Columbia and G.F. Strong Rehabilitation Centre , Vancouver , BC , Canada
| | - Nikesh Thiruchelvam
- c Department of Urology, Cambridge University Hospitals NHS Trust , Cambridge , UK
| | - Helmut Madersbacher
- d Department of Neurology , Medical University Innsbruck , Innsbruck , Austria
| | | | - Yasuhiko Igawa
- f Department of Continence Medicine , The University of Tokyo , Graduate school of Medicine , Tokyo , Japan
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22
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Otsuka M, Taguchi S, Nakagawa T, Morikawa T, Maekawa S, Miyakawa J, Matsumoto A, Miyazaki H, Fujimura T, Fukuhara H, Kume H, Igawa Y, Homma Y. Clinical significance of random bladder biopsy in primary T1 bladder cancer. Mol Clin Oncol 2018; 8:665-670. [PMID: 29725532 DOI: 10.3892/mco.2018.1587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 02/27/2018] [Indexed: 11/06/2022] Open
Abstract
The clinical significance of random bladder biopsies in primary non-muscle-invasive bladder cancer is unclear. The present study investigated the significance of positive random bladder biopsies in primary T1 NMIBC. The present study retrospectively reviewed the records of 71 patients with primary pT1N0M0 bladder cancer who underwent transurethral resection of the bladder tumor (TURBT) and concomitant random bladder biopsy. A total of 12 patients who received cystectomy immediately following the TURBT were excluded, and the remaining 59 patients were included in the analysis. Random bladder biopsy was defined as a cold-cup biopsy of pre-specified normal-looking areas in the bladder. The association of clinicopathological factors, including random biopsy results, with intravesical recurrence were assessed by univariate and multivariate Cox proportional hazards analyses. Of the 59 patients, 15 (25%) demonstrated carcinoma in situ (CIS) lesions on random bladder biopsy: Five (33%) in biopsy specimens alone and the remaining 10 (67%) in biopsy and TUR specimens. Positive random biopsy was associated with preoperative positive urine cytology (P=0.011) and small size of the main tumor (P=0.008). Multivariate analysis demonstrated positive random biopsy as the sole independent poor prognostic factor for intravesical recurrence (hazard ratio: 4.69, P=0.014). The five patients who had CIS detected in biopsy specimens alone had worse, although non-significantly worse, recurrence-free survival compared with those with CIS detected in biopsy and TUR specimens (P=0.100). In conclusion, positive bladder random biopsy, equivalent to the presence of CIS, was an independent predictor of recurrence in primary T1 bladder cancer. Given that one-third of CIS lesions could not have been detected without biopsy, random bladder biopsy should be considered for patients with T1 tumors.
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Affiliation(s)
- Masafumi Otsuka
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Satoru Taguchi
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Teppei Morikawa
- Department of Pathology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Shigekatsu Maekawa
- Department of Pathology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Jimpei Miyakawa
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Akihiko Matsumoto
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Hideyo Miyazaki
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo 113-8655, Japan
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Aizawa N, Watanabe D, Fukuhara H, Fujimura T, Kume H, Homma Y, Igawa Y. Inhibitory effects of silodosin on the bladder mechanosensitive afferent activities and their relation with bladder myogenic contractions in male rats with bladder outlet obstruction. Neurourol Urodyn 2018; 37:1897-1903. [DOI: 10.1002/nau.23547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/06/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Naoki Aizawa
- Department of Continence Medicine; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Daiji Watanabe
- Department of Continence Medicine; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Hiroshi Fukuhara
- Department of Urology; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Tetsuya Fujimura
- Department of Urology; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Haruki Kume
- Department of Urology; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Yukio Homma
- Department of Urology; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine; The University of Tokyo Graduate School of Medicine; Tokyo Japan
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24
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Aizawa N, Fujimori Y, Kobayashi JI, Nakanishi O, Hirasawa H, Kume H, Homma Y, Igawa Y. KPR-2579, a novel TRPM8 antagonist, inhibits acetic acid-induced bladder afferent hyperactivity in rats. Neurourol Urodyn 2018; 37:1633-1640. [DOI: 10.1002/nau.23532] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 01/27/2018] [Indexed: 01/25/2023]
Affiliation(s)
- Naoki Aizawa
- Department of Continence Medicine; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | | | | | - Osamu Nakanishi
- Discovery Research R&D; Kissei Pharmaceutical Co., Ltd.; Azumino Japan
| | - Hideaki Hirasawa
- Discovery Research R&D; Kissei Pharmaceutical Co., Ltd.; Azumino Japan
| | - Haruki Kume
- Department of Urology; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Yukio Homma
- Department of Urology; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine; The University of Tokyo Graduate School of Medicine; Tokyo Japan
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Abstract
Underactive bladder (UAB), which has been described as a symptom complex suggestive of detrusor underactivity, is usually characterized by prolonged urination time with or without a sensation of incomplete bladder emptying, usually with hesitancy, reduced sensation on filling, and slow stream often with storage symptoms. Several causes such as aging, bladder outlet obstruction, diabetes mellitus, neurologic disorders, and nervous injury to the spinal cord, cauda equine, and peripheral pelvic nerve have been assumed to be responsible for the development of UAB. Several contributing factors have been suggested in the pathophysiology of UAB, including myogenic failure, efferent and/or afferent dysfunctions, and central nervous system dysfunction. In this review article, we have described relationships between individual contributing factors and the pathophysiology of UAB based on previous reports. However, many pathophysiological uncertainties still remain, which require more investigations using appropriate animal models.
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Affiliation(s)
- Naoki Aizawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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26
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Akiyama Y, Maeda D, Morikawa T, Niimi A, Nomiya A, Yamada Y, Igawa Y, Goto A, Fukayama M, Homma Y. Digital quantitative analysis of mast cell infiltration in interstitial cystitis. Neurourol Urodyn 2017; 37:650-657. [PMID: 29065222 DOI: 10.1002/nau.23365] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 07/05/2017] [Indexed: 12/19/2022]
Abstract
AIMS To evaluate the significance of mast cell infiltration in interstitial cystitis (IC) by comparison with equally inflamed controls using a digital quantification technique. METHODS Bladder biopsy specimens from 31 patients with Hunner type IC and 38 patients with non-Hunner type IC were analyzed. Bladder biopsy specimens from 37 patients without IC, including 19 non-specific chronic cystitis ("non-IC cystitis") specimens and 18 non-inflamed bladder ("normal bladder") specimens, were used as controls. Mast cell tryptase-, CD3-, CD20-, and CD138-immunoreactive cells were quantified using digital image analysis software to evaluate both mast cell and lymphoplasmacytic cell densities. Mast cell and lymphoplasmacytic cell densities were counted independently in the entire lamina propria and detrusor areas and compared among the four groups. RESULTS In the lamina propria, there were no significant differences in mast cell and lymphoplasmacytic cell densities between Hunner type IC and non-IC cystitis or between non-Hunner type IC and normal bladder specimens. In the detrusor, the mast cell densities were not significantly different among the four groups. Mast cell density was correlated with lymphoplasmacytic cell density, but not with clinical parameters. CONCLUSIONS Mast cell density is not significantly different between IC specimens and non-IC control specimens with a similar degree of background inflammation. The intensity of mast cell infiltration generally correlated with that of lymphoplasmacytic cells. We conclude that mast cell count is of no value in the differential diagnosis between IC and other etiologies.
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Affiliation(s)
- Yoshiyuki Akiyama
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daichi Maeda
- Department of Cellular and Organ Pathology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Teppei Morikawa
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aya Niimi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Nomiya
- Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yukio Yamada
- Department of Urology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akiteru Goto
- Department of Cellular and Organ Pathology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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27
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Niimi A, Igawa Y, Aizawa N, Honma T, Nomiya A, Akiyama Y, Kamei J, Fujimura T, Fukuhara H, Homma Y. Diagnostic value of urinary CXCL10 as a biomarker for predicting Hunner type interstitial cystitis. Neurourol Urodyn 2017; 37:1113-1119. [PMID: 29048741 DOI: 10.1002/nau.23431] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/16/2017] [Indexed: 02/05/2023]
Abstract
AIM To investigate the feasibility of chemokines and cytokines potentially elevated in the bladder tissue of Hunner type interstitial cystitis (HIC) as urinary markers for distinguishing HIC from non-Hunner type interstitial cystitis (NHIC) METHODS: Urine specimens were collected from 41 HIC patients, 25 NHIC patients, and 31 healthy volunteers (control). The supernatants of urine specimens were subjected to ELISA kits for measurements of 10 cytokines and chemokines, whose gene expression was known to be elevated in HIC bladder tissue. Urinary levels normalized by urinary creatinine (Cr) concentration were compared among three groups. Efficiency in differentiating IC and IC subtypes was explored by ROC analysis. The correlation of marker levels with symptom severity, assessed by O'Leary-Sant's symptom index (OSSI) and problem index (OSPI), was examined. RESULTS The urinary levels of CXCL10 and NGF were significantly higher in HIC than NHIC. CXCL10 and NGF differentiated HIC against NHIC with AUC of 0.78 and 0.68, respectively. Combination of CXCL10 and NGF levels yielded an AUS of 0.81. The CXCL10 cut-off of 53.2 pg/mg Cr had sensitivity of 46.1%, specificity of 93.7%, positive predictive value of 97.7%, and negative predictive value of 60.0%. The urinary level of other cytokines showed no significant difference between HIC and NHIC. Significant correlation with symptoms was detected for CXCL10 alone. CONCLUSION The results suggested that increased urinary level of CXCL10 combined with or without high NGF level could be a promising supplementary biomarker for differentiating HIC from NHIC with modest sensitivity and high specificity.
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Affiliation(s)
- Aya Niimi
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Naoki Aizawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Toshiki Honma
- Discovery Research, D & R, Kissei Pharmaceutical Co., Ltd, Nagano, Japan
| | - Akira Nomiya
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yoshiyuki Akiyama
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Jun Kamei
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.,Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Fukuhara
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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28
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Aruga S, Kuwana N, Shiroki Y, Takahashi S, Samejima N, Watanabe A, Seki Y, Igawa Y, Homma Y. Effect of cerebrospinal fluid shunt surgery on lower urinary tract dysfunction in idiopathic normal pressure hydrocephalus. Neurourol Urodyn 2017; 37:1053-1059. [PMID: 28892272 DOI: 10.1002/nau.23399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/28/2017] [Indexed: 11/07/2022]
Abstract
AIMS To examine the outcomes of lower urinary tract symptoms (LUTS) and urodynamic test results after cerebrospinal fluid (CSF) shunt surgery in idiopathic normal pressure hydrocephalus (iNPH). METHODS Records of 48 patients (33 men; 15 women), who met the definite iNPH criteria and underwent CSF shunt surgery, were retrospectively analyzed. LUTS and their impact on quality of life (QOL) were evaluated using an all-or-none questionnaire targeting four symptoms, the Overactive Bladder Symptoms Score (OABSS), and the QOL index. Urodynamic investigations included filling cystometry and pressure-flow studies performed before and after surgery. RESULTS Forty-seven (98%) patients complained of LUTS, 41 (87%) patients of whom experienced LUTS improvement after surgery. The OABSS and QOL index, which before surgery were 6.8 ± 0.7 and 4.1 ± 0.4, respectively, significantly decreased to 4.6 ± 0.6 and 3.2 ± 0.3, respectively, after surgery. The maximum cystometric capacity (174.9 ± 13.3 mL to 222.4 ± 14.7 mL) and bladder compliance (35.8 ± 4.4 ml/cmH2 O to 52.1 ± 5.4 ml/cmH2 O) significantly increased after surgery. Detrusor overactivity, which was observed in 37 (77%) patients preoperatively, became undetectable in 7 patients postoperatively. Voiding dysfunction (defined as maximum flow rate <10 mL/s or post-void residual >100 mL) was observed in 29 (60%) patients, 22 (75%) of whom had detrusor underactivity before surgery. None of the voiding urodynamic parameters significantly improved postoperatively. CONCLUSIONS iNPH is often associated with LUTS and both storage and voiding dysfunctions. CSF shunt surgery improved LUTS and storage dysfunction, with limited effects on voiding dysfunction.
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Affiliation(s)
- Seiji Aruga
- Department of Urology, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | - Nobumasa Kuwana
- Department of Neurosurgery, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | | | | | - Naoyuki Samejima
- Department of Neurosurgery, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | - Akira Watanabe
- Department of Neurosurgery, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | - Yojiro Seki
- Department of Neurosurgery, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, University of Tokyo Graduate school of Medicine, Bunkyo-ku, Japan
| | - Yukio Homma
- Japanese Red Cross Medical Center, Shibuya-ku, Tokyo
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29
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Yamada Y, Fujimura T, Fukuhara H, Sugihara T, Nakagawa T, Kume H, Igawa Y, Homma Y. Predictors of Early Continence after Robot-assisted Radical Prostatectomy. Low Urin Tract Symptoms 2017; 10:287-291. [PMID: 28699263 DOI: 10.1111/luts.12181] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/03/2017] [Accepted: 03/27/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Our objective was to investigate predictors of early continence outcome after robot-assisted radical prostatectomy (RARP). METHODS Clinical records were prospectively collected in 272 patients who underwent RARP. Clinical parameters, continence rates, and time to achieve continence were investigated and analyzed. Recovery of continence was defined as achieving complete continence (pad-free). RESULTS In the univariate analysis, young age (≤67 years) and low pT stage (≤pT2) were significantly associated with continence achieved within 2 weeks after RARP (P = 0.0343 and P = 0.0406, respectively). Low prostate weight was the only factor associated with recovery of continence within 1 month (P = 0.0461). Multivariate analysis revealed that young age (≤67 years) and low pT stage (≤pT2) were statistically significant predictors of continence within 2 weeks after RARP (P = 0.040 and P = 0.015, respectively). CONCLUSION Young age and low pT stage were independent predictors of early continence.
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Affiliation(s)
- Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toru Sugihara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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30
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Yamada Y, Fujimura T, Fukuhara H, Sugihara T, Miyazaki H, Nakagawa T, Kume H, Igawa Y, Homma Y. Overactive bladder is a negative predictor of achieving continence after robot-assisted radical prostatectomy. Int J Urol 2017; 24:749-756. [PMID: 28697538 DOI: 10.1111/iju.13411] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 06/01/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate predictors of continence outcomes after robot-assisted radical prostatectomy. METHODS Clinical records of 272 patients who underwent robot-assisted radical prostatectomy were investigated. Preoperative Overactive Bladder Symptom Score, International Prostate Symptom Score and clinicopathological factors were investigated, and relationships between factors and recovery of continence after robot-assisted radical prostatectomy were assessed. The presence of overactive bladder was defined as having urgency for more than once a week and having ≥3 points according to the Overactive Bladder Symptom Score. RESULTS Age (≤66 years) was significantly associated with continence within 6 months after robot-assisted radical prostatectomy (P = 0.033). The absence of overactive bladder and lower Overactive Bladder Symptom Score (<3) were significantly associated with recovery of continence within 12 months after surgery (both variables P = 0.009). In terms of achieving recovery of continence after robot-assisted radical prostatectomy, Kaplan-Meier curves showed earlier recovery in "age ≤66 years," "prostate weight ≤40 g" and "overactive bladder symptom score <3" (P = 0.0072, 0.0172 and 0.0140, respectively). Multivariate analysis showed that the presence of overactive bladder was an independent negative predictor for recovery of continence within 12 months after surgery (P = 0.019). CONCLUSIONS The presence of baseline overactive bladder seems to represent an independent negative predictor for recovery of continence at 12 months after robot-assisted radical prostatectomy.
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Affiliation(s)
- Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toru Sugihara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hideyo Miyazaki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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31
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Nakagawa T, Taguchi S, Kanatani A, Kawai T, Ikeda M, Urakami S, Matsumoto A, Komemushi Y, Miyakawa J, Yamada D, Suzuki M, Enomoto Y, Nishimatsu H, Kondo Y, Nagase Y, Hirano Y, Okaneya T, Tanaka Y, Miyazaki H, Fujimura T, Fukuhara H, Kume H, Igawa Y, Homma Y. Oncologic Outcome of Metastasectomy for Urothelial Carcinoma: Who Is the Best Candidate? Ann Surg Oncol 2017; 24:2794-2800. [PMID: 28687875 DOI: 10.1245/s10434-017-5970-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Resection of metastatic lesions (metastasectomy) is performed for highly selected patients with metastatic urothelial carcinoma (mUC). This study aimed to identify the clinicopathologic factors associated with oncologic outcome for patients who underwent metastasectomy for mUC. METHODS This analysis included 37 UC patients who underwent metastasectomy with curative intent at nine Japanese hospitals. The primary end point was cancer-specific survival. The Kaplan-Meier method with the log-rank test and the multivariable Cox proportional hazards model addressed the relationship between clinical characteristics and survival. RESULTS Metastasectomy was performed for pulmonary (n = 23), nodal (n = 7), and other (n = 7) metastases. The median survival time was 35.4 months (interquartile range [IQR] 15.5, not reached) from the detection of metastasis and 34.3 months (IQR 13.1, not reached) from metastasectomy. The 5-year cancer-specific survival rate after detection of metastasis was 39.7%. In the multivariate analysis, the time from primary surgery to detection of metastasis (time-to-recurrence [TTR]) of 15 months or longer (hazard ratio [HR] 0.23; p = 0.0063), no symptoms of recurrence (HR 0.23; p = 0.0126), and serum C-reactive protein (CRP) levels lower than than 0.5 mg/dl (HR 0.24; p = 0.0052) were significantly associated with better survival. CONCLUSIONS Long-term survival could be achieved for some patients with mUC who underwent metastasectomy. Lung and lymph nodes were predominant sites for metastasectomy. Symptoms, TTR, and CRP value were identified as associated with survival and should be taken into account when metastasectomy is considered.
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Affiliation(s)
- Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan.,Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Atsushi Kanatani
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Masaomi Ikeda
- Department of Urology, Toranomon Hospital, Tokyo, Japan
| | | | - Akihiko Matsumoto
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | | | | | - Daisuke Yamada
- Department of Urology, National Center for Global Health and Medicine Center Hospital, Tokyo, Japan
| | | | - Yutaka Enomoto
- Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | | | - Yasushi Kondo
- Department of Urology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yasushi Nagase
- Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yoshikazu Hirano
- Department of Urology, The Fraternity Memorial Hospital, Tokyo, Japan
| | | | - Yoshinori Tanaka
- Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Hideyo Miyazaki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Urology, National Center for Global Health and Medicine Center Hospital, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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32
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Fujimura T, Fukuhara H, Taguchi S, Yamada Y, Sugihara T, Nakagawa T, Niimi A, Kume H, Igawa Y, Homma Y. Robot-assisted radical prostatectomy significantly reduced biochemical recurrence compared to retro pubic radical prostatectomy. BMC Cancer 2017; 17:454. [PMID: 28662644 PMCID: PMC5492400 DOI: 10.1186/s12885-017-3439-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 06/21/2017] [Indexed: 11/10/2022] Open
Abstract
Background The pathological and oncological outcomes of retro-pubic radical prostatectomy (RRP) and robot-assisted radical prostatectomy (RARP) have not been sufficiently investigated. Methods Treatment-naïve patients with localized prostate cancer (PC) (n = 908; RRP, n = 490; and RARP, n = 418) were enrolled in the study. The clinicopathological outcomes, rate and localization of the positive surgical margin (PSM), localization of PSM, and biochemical recurrence (BCR)-free survival groups were compared between RRP and RARP. Results The median patient age and serum PSA level (ng/mL) at diagnosis were 67 years and 7.9 ng/ml, respectively, for RRP, and 67 years and 7.6 ng/ml, respectively, for RARP. The overall PSM rate with RARP was 21%, which was 11% for pT2a, 12% for pT2b, 9.8% for pT2c, 43% for pT3a, 55% for pT3b, and 0% for pT4. The overall PSM rate with RRP was 44%, which was 12% for pT2a, 18% for pT2b, 43% for pT2c, 78% for pT3a, 50% for pT3b, and 40% for pT4. The PSM rate was significantly lower for RARP in men with pT2c and pT3a (p < 0.0001 for both). Multivariate analysis showed that RARP reduced the risk of BCR (hazard ratio; 0.6, p = 0.009). Conclusions RARP versus RRP is associated with an improved PSM rate and BCR. To examine the cancer-specific survival, further investigations are needed.
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Affiliation(s)
- Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toru Sugihara
- Department of Urology, Japan Red Cross Hospital, 4-1-22 Hiroo, Shibuya-ku, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Aya Niimi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasuhiko Igawa
- Department of Urology, Japan Red Cross Hospital, 4-1-22 Hiroo, Shibuya-ku, Tokyo, Japan.,Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yukio Homma
- Department of Urology, Japan Red Cross Hospital, 4-1-22 Hiroo, Shibuya-ku, Tokyo, Japan
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33
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Affiliation(s)
- Yasuhiko Igawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Naoki Aizawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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34
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Yamada Y, Fujimura T, Fukuhara H, Sugihara T, Takemura K, Kakutani S, Suzuki M, Nakagawa T, Kume H, Igawa Y, Homma Y. Incidence and risk factors of inguinal hernia after robot-assisted radical prostatectomy. World J Surg Oncol 2017; 15:61. [PMID: 28302122 PMCID: PMC5353804 DOI: 10.1186/s12957-017-1126-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 03/06/2017] [Indexed: 12/03/2022] Open
Abstract
Background Robot-assisted radical prostatectomy (RARP) has now become a gold standard approach in radical prostatectomy. The aim of this study was to investigate incidence and risk factors of inguinal hernia (IH) after RARP. Methods This study included 307 consecutive men who underwent RARP for the treatment of prostate cancer from January 2011 to August 2015. The incidence of IH after RARP was investigated. Clinical and pathological factors were also investigated to assess relationship with development of postoperative IH. Results Median follow-ups were 380 days, and median age of patients was 67 years. Incidence of IH was 11.3, 14.0, and 15.4% at 1, 2, and 3 years after RARP, respectively. Postoperative IH occurrence was significantly associated with low surgeon experience and postoperative incontinence at 3 or 6 months after surgery (P = 0.019, P = 0.002, and P = 0.016, respectively). Conclusions Most of the IH occurred within the first 2 years with a rate of 14%. Incidence of IH after RARP was significantly associated with surgical experience and incontinence outcomes.
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Affiliation(s)
- Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-ku, Tokyo, Japan.
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Toru Sugihara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Kotaro Takemura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Shigenori Kakutani
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Motofumi Suzuki
- Department of Urology, Tokyo Teishin Hospital, Chiyoda-ku, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-ku, Tokyo, Japan
| | - Yasuhiko Igawa
- Continence Medicine, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Hongo7-3-1, Bunkyo-ku, Tokyo, Japan
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Ito H, Pickering AE, Igawa Y, Kanai AJ, Fry CH, Drake MJ. Muro-Neuro-Urodynamics; a Review of the Functional Assessment of Mouse Lower Urinary Tract Function. Front Physiol 2017; 8:49. [PMID: 28220079 PMCID: PMC5292568 DOI: 10.3389/fphys.2017.00049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 01/18/2017] [Indexed: 12/17/2022] Open
Abstract
Background: Mouse urodynamic tests are fundamental to understanding normal lower urinary tract (LUT) function. These experiments also contribute to our understanding of neurological dysfunction, pathophysiological processes, and potential mechanisms of therapy. Objectives: Systematic assessment of published evidence on urodynamics, advantages and limitations of different urodynamic measurements in mice, and consideration of potential implications for the clinical field. Methods: A search using specific search-terms for urodynamic studies and mice was conducted on PubMed (from inception to 1 July 2016). Results: We identified 55 studies examining or describing mouse neuro-urodynamics. We summarize reported features of mouse urodynamic function deriving from frequency-volume chart (FVC) measurements, voiding spot assays, filling cystometry, and pressure-flow studies. Similarly, an influence of the diurnal cycle on voiding is observed in mice and should be considered when interpreting rodent urodynamic studies, especially FVC measurements and voiding spot assays. Anaesthesia, restraint conditions, or filling rate influence mouse neuro-urodynamics. Mouse cystometric studies have observed intravesical pressure oscillations that accompany urine flow, attributed to high frequency opening and closing of the urethra. This characterization is not seen in other species, except rats. In contrast to human clinical urodynamics, the terminology of these examinations has not been standardized although many rodent urodynamic studies have been described. Conclusion: Mice have many anatomical and physiological similarities to humans and they are generally cost effective, and allow investigation of the effects of aging because of their short lifespan. There are some differences between mouse and human urodynamics. These must be considered when interpreting LUT function in mice, and translational value of murine disease models.
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Affiliation(s)
- Hiroki Ito
- Department of Physiology, Pharmacology and Neuroscience, University of Bristol Bristol, UK
| | - Anthony E Pickering
- Department of Physiology, Pharmacology and Neuroscience, University of Bristol Bristol, UK
| | - Yasuhiko Igawa
- Department of Continence Medicine, University of Tokyo Graduate School of Medicine Tokyo, Japan
| | - Anthony J Kanai
- Department of Pharmacology and Chemical Biology, University of Pittsburgh Pennsylvania, PA, USA
| | - Christopher H Fry
- Department of Physiology, Pharmacology and Neuroscience, University of Bristol Bristol, UK
| | - Marcus J Drake
- Department of Physiology, Pharmacology and Neuroscience, University of Bristol Bristol, UK
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Nakagawa T, Taguchi S, Uemura Y, Kanatani A, Ikeda M, Matsumoto A, Yoshida K, Kawai T, Nagata M, Yamada D, Komemushi Y, Suzuki M, Enomoto Y, Nishimatsu H, Ishikawa A, Nagase Y, Kondo Y, Tanaka Y, Okaneya T, Hirano Y, Shinohara M, Miyazaki H, Fujimura T, Fukuhara H, Kume H, Igawa Y, Homma Y. Nomogram for predicting survival of postcystectomy recurrent urothelial carcinoma of the bladder. Urol Oncol 2017; 35:457.e15-457.e21. [PMID: 28110856 DOI: 10.1016/j.urolonc.2016.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 12/13/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE We aimed to identify prognostic clinicopathological factors and to create a nomogram able to predict overall survival (OS) in recurrent urothelial carcinoma of the bladder (UCB) after radical cystectomy (RC). MATERIALS AND METHODS Among 1,087 patients with UCB who had undergone RC at our 11 institutions between 1990 and 2010, 306 patients who subsequently developed distant metastasis or local recurrence or both were identified. Clinical data were collected with medical record review. Univariate and multivariate Cox regression models addressed OS after recurrence. A nomogram predicting postrecurrence OS was constructed based on Cox proportional hazards model, without using postrecurrence factors (systemic chemotherapy and resection of metastasis). The performance of the nomogram was internally validated by assessing concordance index and calibration plots. RESULTS Of the 306 patients, 268 died during follow-up with a median survival of 7 months (95% CI: 5.8-8.5). Postrecurrence chemotherapy was administered in 119 patients (38.9%). Multivariable analysis identified 9 independent predictors for OS; period of time from RC to recurrence (time-to-recurrence), symptomatic recurrence, liver metastasis, hemoglobin level, serum alkaline phosphatase level, serum lactate dehydrogenase level, serum C-reactive protein level, postrecurrence chemotherapy, and resection of metastasis. A nomogram was formed with the following 5 variables to predict OS: time-to-recurrence, symptomatic recurrence, liver metastasis, albumin level, and alkaline phosphatase level. Concordance index rate was 0.75 (95% CI: 0.72-0.78) by internal validation using Bootstraps with 1,000 resamples. Calibration plots showed that the nomogram fitted well. CONCLUSIONS We identified 9 clinicopathological factors as independent OS predictors in postcystectomy recurrence of UCB. We also created a validated nomogram with 5 variables that efficiently stratified those patients regardless of eligibility for chemotherapy. The nomogram would be useful for acquiring relevant prognostic information and for stratifying patients for clinical trials.
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Affiliation(s)
- Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Satoru Taguchi
- Department of Urology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Yukari Uemura
- Biostatistics Division, Central Coordinating Unit, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Atsushi Kanatani
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaomi Ikeda
- Department of Urology, Toranomon Hospital, Tokyo, Japan
| | - Akihiko Matsumoto
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan; Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kanae Yoshida
- Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Taketo Kawai
- Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan
| | - Masayoshi Nagata
- Department of Urology, National Center for Global Health and Medicine Center Hosptial, Tokyo, Japan
| | - Daisuke Yamada
- Department of Urology, National Center for Global Health and Medicine Center Hosptial, Tokyo, Japan
| | | | | | - Yutaka Enomoto
- Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | | | - Akira Ishikawa
- Department of Urology, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yasushi Nagase
- Department of Urology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yasushi Kondo
- Department of Urology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Yoshinori Tanaka
- Department of Urology, Musashino Red Cross Hospital, Tokyo, Japan
| | | | - Yoshikazu Hirano
- Department of Urology, The Fraternity Memorial Hospital, Tokyo, Japan
| | - Mitsuru Shinohara
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hideyo Miyazaki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Urology, National Center for Global Health and Medicine Center Hosptial, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Matos R, Cordeiro JM, Coelho A, Ferreira S, Silva C, Igawa Y, Cruz F, Charrua A. Bladder pain induced by prolonged peripheral alpha 1A adrenoceptor stimulation involves the enhancement of transient receptor potential vanilloid 1 activity and an increase of urothelial adenosine triphosphate release. Acta Physiol (Oxf) 2016; 218:265-275. [PMID: 27370818 DOI: 10.1111/apha.12744] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 03/22/2016] [Accepted: 06/28/2016] [Indexed: 12/24/2022]
Abstract
AIM Pathophysiological mechanisms of chronic visceral pain (CVP) are unknown. This study explores the association between the sympathetic system and bladder nociceptors activity by testing the effect of a prolonged adrenergic stimulation on transient receptor potential vanilloid 1 (TRPV1) activity and on urothelial adenosine triphosphate (ATP) release. METHODS Female Wistar rats received saline, phenylephrine (PHE), PHE + silodosin, PHE + naftopidil or PHE + prazosin. TRPV1 knockout and wild-type mice received saline or PHE. Visceral pain behaviour tests were performed before and after treatment. Cystometry was performed, during saline and capsaicin infusion. Fos immunoreactivity was assessed in L6 spinal cord segment. Human urothelial ATP release induced by mechanical and thermal stimulation was evaluated. RESULTS Subcutaneous, but not intrathecal, PHE administration induced pain, which was reversed by silodosin, a selective alpha 1A adrenoceptor antagonist, but not by naftopidil, a relatively selective antagonist for alpha 1D adrenoceptor. Silodosin also reversed PHE-induced bladder hyperactivity and L6 spinal cord Fos expression. Thus, in subsequent experiments, only silodosin was used. Wild-type, but not TRPV1 knockout, mice exhibited phenylephrine-induced pain. Capsaicin induced a greater increase in voiding contractions in PHE-treated rats than in control animals, and silodosin reversed this effect. When treated with PHE, ATP release from human urothelial cells was enhanced either by mechanical stimulation or by lowering the thermal threshold of urothelial TRPV1, which becomes abnormally responsive at body temperature. CONCLUSION This study suggests that the activation of peripheral alpha 1A adrenoceptors induces CVP, probably through its interaction with TRPV1 and ATP release.
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Affiliation(s)
- R. Matos
- i3S - Instituto de Investigação e Inovação em Saúde; Universidade do Porto; Porto Portugal
- IBMC - Instituto de Biologia Molecular e Celular; University of Porto; Porto Portugal
- Department of Experimental Biology; Faculty of Medicine of University of Porto; Porto Portugal
| | - J. M. Cordeiro
- CIMAR/CIIMAR-Interdisciplinary Centre of Marine and Environmental Research; University of Porto; Porto Portugal
| | - A. Coelho
- i3S - Instituto de Investigação e Inovação em Saúde; Universidade do Porto; Porto Portugal
- IBMC - Instituto de Biologia Molecular e Celular; University of Porto; Porto Portugal
- Department of Experimental Biology; Faculty of Medicine of University of Porto; Porto Portugal
- Department of Renal, Urologic and Infectious diseases; Faculty of Medicine of University of Porto; Porto Portugal
| | - S. Ferreira
- Department of Experimental Biology; Faculty of Medicine of University of Porto; Porto Portugal
| | - C. Silva
- i3S - Instituto de Investigação e Inovação em Saúde; Universidade do Porto; Porto Portugal
- IBMC - Instituto de Biologia Molecular e Celular; University of Porto; Porto Portugal
- Department of Renal, Urologic and Infectious diseases; Faculty of Medicine of University of Porto; Porto Portugal
- Department of Urology; Hospital S. João; Porto Portugal
| | - Y. Igawa
- Department of Continence Medicine; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - F. Cruz
- i3S - Instituto de Investigação e Inovação em Saúde; Universidade do Porto; Porto Portugal
- IBMC - Instituto de Biologia Molecular e Celular; University of Porto; Porto Portugal
- Department of Renal, Urologic and Infectious diseases; Faculty of Medicine of University of Porto; Porto Portugal
- Department of Urology; Hospital S. João; Porto Portugal
| | - A. Charrua
- i3S - Instituto de Investigação e Inovação em Saúde; Universidade do Porto; Porto Portugal
- IBMC - Instituto de Biologia Molecular e Celular; University of Porto; Porto Portugal
- Department of Experimental Biology; Faculty of Medicine of University of Porto; Porto Portugal
- Department of Renal, Urologic and Infectious diseases; Faculty of Medicine of University of Porto; Porto Portugal
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Yoshida M, Igawa Y, Higashimura S, Suzuki M, Niimi A, Sanada H. Translation and reliability and validity testing of a Japanese version of the Intermittent Self-Catheterization Questionnaire among disposable and reusable catheter users. Neurourol Urodyn 2016; 36:1356-1362. [PMID: 27701766 DOI: 10.1002/nau.23111] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 08/10/2016] [Indexed: 11/12/2022]
Abstract
AIMS Quality of life in the context of intermittent self-catheterization varies depending on the type of catheter used. This study translated into Japanese, evaluated the feasibility, reliability, and validity of the Intermittent Self-Catheterization Questionnaire (ISC-Q) among users of both reusable and disposable catheters, and examined the differences of it between them. METHODS Seventy patients (age mean ± SD: 62.8 ± 17.7 years) completed the Japanese version of the ISC-Q (J-ISC-Q) at baseline and 4 weeks later. Spearman's correlation coefficients between the J-ISC-Q, and Qualiveen® and the SF-12 were used for the translated scale's discriminant and convergent validity. Reliability was evaluated by intraclass correlation coefficients (ICC), the Bland-Altman method, and Cronbach's alpha. RESULTS Participants answered all questionnaire items with no difficulties. Scores on the convenience domain were significantly higher among reusable compared to disposable catheter users (P = 0.039). The J-ISC-Q had significantly strong correlations with the Qualiveen® total scale (ρ = -0.712 to -0.237), but weak correlations with the SF-12 total scale (ρ = -0.231 to 0.474). Internal consistency was good (Cronbach's alphas > 0.706), and test-retest reliability was acceptable (ICC > 0.6) for the total scale and the four J-ISC-Q domains. The Bland-Altman analysis showed no systematic error between scores at baseline and 4 weeks later for the total scale and four domains of the J-ISC-Q. CONCLUSIONS The J-ISC-Q has acceptable reliability and validity for assessing both reusable and disposable catheter users, and can be used to promote tailored individualized interventions based on the impact of catheter use.
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Affiliation(s)
- Mikako Yoshida
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shiho Higashimura
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Aya Niimi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Taguchi S, Fukuhara H, Morikawa T, Matsumoto A, Miyazaki H, Nakagawa T, Fujimura T, Kume H, Igawa Y, Homma Y. Cessation of long-term adjuvant androgen deprivation therapy after radical prostatectomy: is it feasible? Jpn J Clin Oncol 2016; 46:1143-1147. [PMID: 27620729 DOI: 10.1093/jjco/hyw136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 08/26/2016] [Accepted: 08/30/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Adjuvant androgen deprivation therapy is a common treatment option for prostate cancer after radical prostatectomy, especially in Asia. However, no study has investigated the oncological outcome after cessation of long-term adjuvant androgen deprivation therapy with favorable prostate-specific antigen control. METHODS Among 855 patients undergoing radical prostatectomy at our institution between 2000 and 2012, we identified 56 men with pT2-4N0-1M0 prostate cancer who had received long-term (>2 years) adjuvant androgen deprivation therapy after radical prostatectomy and subsequently stopped it under a condition of continued prostate-specific antigen values <0.1 ng/mL. The oncological outcome was evaluated using biochemical recurrence, defined as two consecutive prostate-specific antigen values ≥0.2 ng/mL, as the primary endpoint. Cox proportional hazards model was used for multivariate analysis. Age at androgen deprivation therapy cessation was dichotomized as <68 years and ≥68 years, based on the most discriminatory cutoff. RESULTS Median duration of adjuvant androgen deprivation therapy was 70 months. Overall, 13 of 56 (23%) patients developed biochemical recurrence with a median follow-up period of 41 months after androgen deprivation therapy cessation. Multivariate analysis identified age at androgen deprivation therapy cessation <68 years and pN1 as independent predictors of biochemical recurrence. Predisposition of younger age to poorer survival may be related to more frequent testosterone recovery in younger men (73 vs 33%, P = 0.0299). One patient had evidence of clinical metastasis and no one died of prostate cancer. CONCLUSIONS Androgen deprivation therapy cessation would be feasible in most men who received long-term adjuvant androgen deprivation therapy after radical prostatectomy with favorable prostate-specific antigen control. Risk factors of biochemical recurrence after androgen deprivation therapy cessation included younger age at androgen deprivation therapy cessation and pN1.
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Affiliation(s)
- Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Teppei Morikawa
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akihiko Matsumoto
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Hideyo Miyazaki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Yasuhiko Igawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo
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Aizawa N, Fukuhara H, Fujimura T, Homma Y, Igawa Y. Direct influence of systemic desensitization by resiniferatoxin on the activities of Aδ- and C-fibers in the rat primary bladder mechanosensitive afferent nerves. Int J Urol 2016; 23:952-956. [DOI: 10.1111/iju.13181] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 07/06/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Naoki Aizawa
- Department of Continence Medicine; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Hiroshi Fukuhara
- Department of Urology; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Tetsuya Fujimura
- Department of Urology; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Yukio Homma
- Department of Urology; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine; The University of Tokyo Graduate School of Medicine; Tokyo Japan
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Suzuki M, Iguchi Y, Igawa Y, Yoshida M, Sanada H, Miyazaki H, Homma Y. Ultrasound‐assisted prompted voiding for management of urinary incontinence of nursing home residents: Efficacy and feasibility. Int J Urol 2016; 23:786-90. [DOI: 10.1111/iju.13156] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 05/31/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Motofumi Suzuki
- Department of Urology Tokyo Teishin Hospital Tokyo Japan
- Department of Urology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Yasuhiro Iguchi
- Megumi Long‐Term Care Health Facility Departments of Continence Medicine Tokyo Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Mikako Yoshida
- Life Support Technology (Molten) Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Hiromi Sanada
- Gerontological Nursing/Wound Care Management Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Hideyo Miyazaki
- Department of Urology Graduate School of Medicine The University of Tokyo Tokyo Japan
| | - Yukio Homma
- Department of Urology Graduate School of Medicine The University of Tokyo Tokyo Japan
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Akiyama Y, Morikawa T, Maeda D, Shintani Y, Niimi A, Nomiya A, Nakayama A, Igawa Y, Fukayama M, Homma Y. Increased CXCR3 Expression of Infiltrating Plasma Cells in Hunner Type Interstitial Cystitis. Sci Rep 2016; 6:28652. [PMID: 27339056 PMCID: PMC4919639 DOI: 10.1038/srep28652] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/07/2016] [Indexed: 11/09/2022] Open
Abstract
An up-regulated CXCR3 pathway and affluent plasma cell infiltration are characteristic features of Hunner type interstitial cystitis (HIC). We further examined these two features using bladder biopsy samples taken from 27 patients with HIC and 15 patients with non-IC cystitis as a control. The number of CD3-positive T lymphocytes, CD20-positive B lymphocytes, CD138-positive plasma cells, and CXCR3-positive cells was quantified by digital image analysis. Double-immunofluorescence for CXCR3 and CD138 was used to detect CXCR3 expression in plasma cells. Correlations between CXCR3 positivity and lymphocytic and plasma cell numbers and clinical parameters were explored. The density of CXCR3-positive cells showed no significant differences between HIC and non-IC cystitis specimens. However, distribution of CXCR3-positivity in plasma cells indicated co-localization of CXCR3 with CD138 in HIC specimens, but not in non-IC cystitis specimens. The number of CXCR3-positive cells correlated with plasma cells in HIC specimens alone. Infiltration of CXCR3-positive cells was unrelated to clinical parameters of patients with HIC. These results suggest that infiltration of CXCR3-positive plasma cells is a characteristic feature of HIC. The CXCR3 pathway and specific immune responses may be involved in accumulation/retention of plasma cells and pathophysiology of the HIC bladder.
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Affiliation(s)
- Yoshiyuki Akiyama
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Teppei Morikawa
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Daichi Maeda
- Department of Cellular and Organ Pathology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Yukako Shintani
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Aya Niimi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Nomiya
- Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Atsuhito Nakayama
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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43
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Niimi A, Suzuki M, Yamaguchi Y, Ishii M, Fujimura T, Nakagawa T, Fukuhara H, Kume H, Igawa Y, Akishita M, Homma Y. Sleep Apnea and Circadian Extracellular Fluid Change as Independent Factors for Nocturnal Polyuria. J Urol 2016; 196:1183-9. [PMID: 27105762 DOI: 10.1016/j.juro.2016.04.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE We investigated the relationships among nocturnal polyuria, sleep apnea and body fluid volume to elucidate the pathophysiology of nocturia in sleep apnea syndrome. MATERIALS AND METHODS We enrolled 104 consecutive patients who underwent polysomnography for suspected sleep apnea syndrome. Self-assessed symptom questionnaires were administered to evaluate sleep disorder and lower urinary tract symptoms, including nocturia. Voiding frequency and voided volume were recorded using a 24-hour frequency-volume chart. Body fluid composition was estimated in the morning and at night using bioelectric impedance analysis. Frequency-volume chart data were analyzed in 22 patients after continuous positive airway pressure therapy. RESULTS Patients with nocturnal polyuria showed a higher apnea-hypopnea index (33.9 vs 24.2, p = 0.03) and a larger circadian change in extracellular fluid adjusted to lean body mass (0.22 vs -0.19, p = 0.019) than those without nocturnal polyuria. These relations were more evident in patients 65 years old or older than in those 64 years or younger. A multivariate linear regression model showed an independent relationship of nocturnal polyuria with the apnea-hypopnea index and the circadian change in extracellular fluid adjusted to lean body mass (p = 0.0012 and 0.022, respectively). Continuous positive airway pressure therapy significantly improved nocturnal polyuria and nocturia only in patients with nocturnal polyuria. CONCLUSIONS This study identified sleep apnea and the circadian change in extracellular fluid as independent factors for nocturnal polyuria.
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Affiliation(s)
- Aya Niimi
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | | | - Yasuhiro Yamaguchi
- Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
| | - Masaki Ishii
- Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Akiyama Y, Maeda D, Morikawa T, Niimi A, Nomiya A, Yamada Y, Kamei J, Aizawa N, Igawa Y, Fukayama M, Homma Y. MP72-02 FREQUENT EXPANSION OF CLONAL B-CELLS SUGGESTIVE OF SPECIFIC IMMUNE RESPONSES IN HUNNER TYPE INTERSTITIAL CYSTITIS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
Background To explore the real-life practice of clinical management of interstitial cystitis (IC) in Japan. Methods A questionnaire on the number of IC patients, cystoscopic findings, diagnostic methods, and the treatment modalities was sent via e-mail to 114 medical institutions belonging to the Society of Interstitial Cystitis of Japan (SICJ). Results Completed questionnaires were returned from 62 institutions (20 university hospitals, 26 general hospitals and 16 clinics), with a response rate of 54%. The median of patient number per institution was 20 and the national number of IC patients was counted as 4,531 in Japan. The number of new patients in 2013 was 7 (median) per institution and calculated as 1,214 in total. The case volume per institution distributed broadly and skewed to a lower volume. The patients were categorized according to cystoscopic findings as either Hunner type IC with Hunner lesions (n=2,066, 45%), non-Hunner type IC with glomerulations on hydrodistension (n=1,720, 38%) or hypersensitive bladder without endoscopic abnormalities (n=304, 7%), excluding unknown (n=441, 10%). The proportion of Hunner type IC was highly variable among the institutions, ranging from 0% to 100% with a median of 29%. As for evaluation, symptom and quality of life (QOL) assessment by questionnaires, frequency volume chart, urinalysis, urine cytology, urine culture, post-void residual measurement, uroflowmetry, ultrasound and cystoscopy were widely adapted. Administration of oral medicines and intravesical instillation therapy were undertaken at 98% and 63% of institutions, respectively. Hydrodistension was commonly performed, totaling in 812 procedures at 53 institutions, while only five cystectomies were reported from four institutions. Conclusions The survey estimated about 4,500 IC patients and 2,000 Hunner type IC patients in Japan. It also revealed a wide range of case volume, acceptable adherence to clinical guidelines, and high variability in the proportion of Hunner type IC. The variable proportions of Hunner type IC despite a high performing rate of endoscopy suggest inconsistency in diagnostic criteria for the Hunner lesion.
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Affiliation(s)
- Yukio Yamada
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Akira Nomiya
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Aya Niimi
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Yasuhiko Igawa
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Takaaki Ito
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Hikaru Tomoe
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Mineo Takei
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Tomohiro Ueda
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
| | - Yukio Homma
- 1 Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 2 Department of Urology, Mitsui Memorial Hospital, Tokyo, Japan ; 3 Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan ; 4 Department of Urology, Tamura Clinic, Tokyo, Japan ; 5 Department of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Tokyo, Japan ; 6 Department of Urology, Harasanshin Hospital, Fukuoka, Japan ; 7 Department of Urology, Ueda Clinic, Kyoto, Japan
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Taguchi S, Kume H, Fukuhara H, Morikawa T, Kakutani S, Takeshima Y, Miyazaki H, Suzuki M, Fujimura T, Nakagawa T, Ishikawa A, Igawa Y, Homma Y. Symptoms at diagnosis as independent prognostic factors in retroperitoneal liposarcoma. Mol Clin Oncol 2015; 4:255-260. [PMID: 26893871 DOI: 10.3892/mco.2015.701] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 12/07/2015] [Indexed: 01/27/2023] Open
Abstract
The prognostic factors of retroperitoneal liposarcoma have yet to be clearly determined due to its rarity, whereas the prognostic value of symptoms at diagnosis has never been evaluated to date. In this context, we reviewed 24 consecutive patients with primary retroperitoneal liposarcoma who underwent surgical resection with curative intent at our institution. The Kaplan-Meier analysis and the log-rank test were used to estimate progression-free survival (PFS; primary endpoint) and sarcoma-specific survival (SSS; secondary endpoint). The effect of various clinicopathological factors, including symptoms at diagnosis, on these two endpoints was assessed with a Cox proportional hazards model. During the study period, 11 patients (45.8%) developed recurrence after the initial surgery and 8 (33.3%) succumbed to retroperitoneal liposarcoma, with a median follow-up of 64 months. A total of 16 patients (66.7%) had symptoms at diagnosis, while the remaining 8 (33.3%) were diagnosed incidentally. The symptoms were palpability of the tumor (n=8); abdominal pain/fullness (n=3); flank pain/fullness (n=2); lower extremity pain (n=1); testicular pain due to varicocele (n=1); and discomfort on urination (n=1). Patients with symptoms at diagnosis were significantly more likely to develop recurrence (log-rank test, P=0.0196) and were also more likely to succumb to sarcoma (P=0.0778) compared with asymptomatic patients. On the multivariate analysis, symptoms at diagnosis and dedifferentiated components were independent predictors of poor PFS, while positive surgical margins were predictors of poor SSS. Given that symptoms at diagnosis are easily accessible for physicians, they may prove to be useful additional prognostic factors for primary retroperitoneal liposarcoma.
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Affiliation(s)
- Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Teppei Morikawa
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Shigenori Kakutani
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Yuta Takeshima
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hideyo Miyazaki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Motofumi Suzuki
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Tohru Nakagawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Akira Ishikawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Yasuhiko Igawa
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8655, Japan
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Maeda D, Akiyama Y, Morikawa T, Kunita A, Ota Y, Katoh H, Niimi A, Nomiya A, Ishikawa S, Goto A, Igawa Y, Fukayama M, Homma Y. Hunner-Type (Classic) Interstitial Cystitis: A Distinct Inflammatory Disorder Characterized by Pancystitis, with Frequent Expansion of Clonal B-Cells and Epithelial Denudation. PLoS One 2015; 10:e0143316. [PMID: 26587589 PMCID: PMC4654580 DOI: 10.1371/journal.pone.0143316] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 11/03/2015] [Indexed: 01/12/2023] Open
Abstract
Interstitial cystitis (IC) is a chronic bladder disease with urinary frequency, bladder discomfort or bladder pain of unknown etiology. Based on cystoscopic findings, patients with IC are classified as either Hunner-type/classic IC (HIC), presenting with a specific Hunner lesion, or non-Hunner-type IC (NHIC), presenting with no Hunner lesion, but post-hydrodistension mucosal bleeding. Inflammatory cell infiltration, composed predominantly of lymphocytes, plasma cells and epithelial denudation, has in the past been documented as a major pathological IC finding. However, the significance of the pathological evaluation of IC, especially with regard to the difference between HIC and NHIC, has been downplayed in recent years. In this study, we performed immunohistochemical quantification of infiltrating T-lymphocytes, B-lymphocytes and plasma cells, and measured the amount of residual epithelium in urinary bladder biopsy specimens taken from patients with HIC and NHIC, and those with no IC, using image analysis software. In addition, in situ hybridization of the light chains was performed to examine clonal B-cell expansion. Lymphoplasmacytic infiltration was significantly more severe in HIC specimens than in NHIC specimens (P <0.0001). Substantial lymphoplasmacytic inflammation (≥200 cells/mm2) was observed in 93% of HIC specimens, whereas only 8% of NHIC specimens were inflamed. Plasmacytic infiltration was more prominent in HIC specimens compared with NHIC and non-IC cystitis specimens (P <0.005). Furthermore, expansion of light-chain-restricted B-cells was observed in 31% of cases of HIC. The amount of residual epithelium was decreased in HIC specimens compared with NHIC specimens and non-IC cystitis specimens (P <0.0001). These results suggest that NHIC and HIC are distinct pathological entities, with the latter characterized by pancystitis, frequent clonal B-cell expansion and epithelial denudation. An abnormality in the B-cell population may be involved in the pathogenesis of HIC.
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Affiliation(s)
- Daichi Maeda
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Cellular and Organ Pathology, Graduate School of Medicine, Akita University, Akita, Japan
- * E-mail:
| | - Yoshiyuki Akiyama
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Teppei Morikawa
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akiko Kunita
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasunori Ota
- Department of Pathology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
| | - Hiroto Katoh
- Department of Genomic Pathology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Aya Niimi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akira Nomiya
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shumpei Ishikawa
- Department of Genomic Pathology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Akiteru Goto
- Department of Cellular and Organ Pathology, Graduate School of Medicine, Akita University, Akita, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukio Homma
- Department of Urology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Aizawa N, Wakamatsu D, Kida J, Otsuki T, Saito Y, Matsuya H, Homma Y, Igawa Y. Inhibitory effects of retigabine, a Kv7 channel activator, on mechanosensitive primary bladder afferent activities and nociceptive behaviors in rats. Neurourol Urodyn 2015; 36:280-285. [DOI: 10.1002/nau.22920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/13/2015] [Indexed: 01/25/2023]
Affiliation(s)
- Naoki Aizawa
- Department of Continence Medicine; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Daisuke Wakamatsu
- Discovery Research Laboratories 4; Department of Biology & Pharmacology; ONO Pharmaceutical Co., Ltd.; Osaka Japan
| | - Jun Kida
- Discovery Research Laboratories 4; Department of Biology & Pharmacology; ONO Pharmaceutical Co., Ltd.; Osaka Japan
| | - Takeya Otsuki
- Discovery Research Laboratories 4; Department of Biology & Pharmacology; ONO Pharmaceutical Co., Ltd.; Osaka Japan
| | - Yasuho Saito
- Department of Urology; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Hidekazu Matsuya
- Discovery Research Laboratories 4; Department of Biology & Pharmacology; ONO Pharmaceutical Co., Ltd.; Osaka Japan
| | - Yukio Homma
- Department of Urology; The University of Tokyo Graduate School of Medicine; Tokyo Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine; The University of Tokyo Graduate School of Medicine; Tokyo Japan
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Fujimura T, Menon M, Fukuhara H, Kume H, Suzuki M, Yamada Y, Niimi A, Nakagawa T, Igawa Y, Homma Y. Validation of an educational program balancing surgeon training and surgical quality control during robot-assisted radical prostatectomy. Int J Urol 2015; 23:160-6. [DOI: 10.1111/iju.12993] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/13/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Tetsuya Fujimura
- Department of Urology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Mani Menon
- Vattikuti Urology Institute; Henry Ford Hospital; Detroit Michigan USA
| | - Hiroshi Fukuhara
- Department of Urology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Haruki Kume
- Department of Urology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Motofumi Suzuki
- Department of Urology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Yuta Yamada
- Department of Urology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Aya Niimi
- Department of Urology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Tohru Nakagawa
- Department of Urology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
| | - Yukio Homma
- Department of Urology; Graduate School of Medicine; The University of Tokyo; Tokyo Japan
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Yokoyama O, Igawa Y, Takeda M, Yamaguchi T, Murakami M, Viktrup L. Tadalafil for lower urinary tract symptoms secondary to benign prostatic hyperplasia: a review of clinical data in Asian men and an update on the mechanism of action. Ther Adv Urol 2015; 7:249-64. [PMID: 26425140 DOI: 10.1177/1756287215589238] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Tadalafil, a phosphodiesterase type 5 (PDE5) inhibitor, is approved worldwide for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH-LUTS). The purpose of this narrative review is to summarize the clinical data on tadalafil 5 mg once-daily, primarily focusing on Asian men with BPH-LUTS, and to update the current understanding of the mechanism of action underlying PDE5 inhibition. Findings from studies have demonstrated that PDE5 is highly expressed in the lower urinary tract and supporting vasculature, and that PDE5 inhibition potentially decreases smooth muscle cell proliferation in the prostate, relaxes smooth muscle in the prostate, bladder neck and supporting vasculature, increases blood perfusion to the lower urinary tract, and modulates bladder afferent nerve activity. A total of 11 larger, 12-week, double-blind, randomized, placebo-controlled studies of tadalafil, including four Asian studies, have been conducted globally, enrolling >3000 men with BPH-LUTS. In addition, two long-term (42- and 52-week) studies enrolled 394 Japanese and 428 North American men, respectively, with BPH-LUTS. Overall, tadalafil 5 mg once-daily resulted in significant improvements in the change from baseline to endpoint in total International Prostate Symptom Scores (IPSS), IPSS storage and voiding subscores, and IPSS quality of life index compared with placebo. Tadalafil was well tolerated and had a favorable safety profile. These findings support tadalafil 5 mg once-daily for treating men, including Asian men, with BPH-LUTS.
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Affiliation(s)
- Osamu Yokoyama
- Department of Urology, Faculty of Medical Science, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
| | - Yasuhiko Igawa
- Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Masayuki Takeda
- Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi, Yamanashi, Japan
| | | | - Masahiro Murakami
- Lilly Research Laboratories Japan, Eli Lilly Japan K.K., Hyogo, Japan
| | - Lars Viktrup
- Lilly Research Laboratories, Eli Lilly and Co., Indianapolis, Indiana, USA
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