Faculty Profiles - WATANABE Toyohiko

Papers - WATANABE Toyohiko

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Prevalence of pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae among heterosexual men in Japan Reviewed

Koichiro Wada, Shinya Uehara, Ritsuko Mitsuhata, Reiko Kariyama, Hiroyuki Nose, Shinichi Sako, Ayano Ishii, Toyohiko Watanabe, Akira Matsumoto, Koichi Monden, Satoru Uno, Tohru Araki, Hiromi Kumon

JOURNAL OF INFECTION AND CHEMOTHERAPY 18 ( 5 ) 729 - 733 2012.10

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER JAPAN KK

Pharyngeal chlamydial and gonococcal infections can occur as a consequence of oral sex, and they also can be transmitted from the pharynx to the genital tract of sex partners. There have been many reports on the prevalence of pharyngeal Chlamydia trachomatis and Neisseria gonorrhoeae in men who have sex with men; however, there have been few reports on the prevalence of these pathogens in the pharynges of heterosexual men. In this study, we determined the prevalence of pharyngeal C. trachomatis and N. gonorrhoeae in 42 heterosexual men diagnosed with urethritis. Pharyngeal swabs and first-voided urine specimens were tested using the Gen-Probe APTIMA Combo 2 transcription-mediated amplification assay. The prevalence of pharyngeal C. trachomatis and N. gonorrhoeae in patients with urethritis was 2.4 % (1/42) and 11.9 % (5/42), respectively. Among patients with either chlamydial or gonococcal urethritis, 9.1 % (1/11) and 25.0 % (5/20) had pharyngeal C. trachomatis or N. gonorrhoeae, respectively. Our results suggest that screening for pharyngeal colonization by N. gonorrhoeae and C. trachomatis using validated nucleic acid amplification tests should be performed in heterosexual men diagnosed with urethritis.

DOI： 10.1007/s10156-012-0410-y

Ureteroscopic Management of Chronic Unilateral Hematuria: A Single-Center Experience over 22 Years Reviewed

Motoo Araki, Shinya Uehara, Katsumi Sasaki, Koichi Monden, Masaya Tsugawa, Toyohiko Watanabe, Manoji Monga, Yasutomo Nasu, Hiromi Kumon

PLOS ONE 7 ( 6 ) e36729 2012.6

Language：English Publishing type：Research paper (scientific journal) Publisher：PUBLIC LIBRARY SCIENCE

Objective: To analyze the short and long term safety and efficacy of ureteroscopic evaluation and management of chronic unilateral hematuria.
Methods: We retrospectively reviewed patients with chronic unilateral hematuria from 1987 to 2008. The distal to middle ureter was evaluated with a semi-rigid ureteroscope without a guidewire. Subsequently, the flexible ureteroscope was advanced into the upper ureter to the renal pelvis using a low-pressure automated irrigant system (Uromat (TM)). Lesions identified ureteroscopically were treated with diathermy fulguration.
Results: One hundred and four (56 male, 48 female) patients were identified, with a median age of 37 (14-80) years and median follow-up of 139 (34-277) months. The median preoperative duration of gross hematuria was 5 (1-144) months. Endoscopic findings included 61 (56%) minute venous rupture (MVR; a venous bleeding without clear abnormalities), 21 (20%) hemangioma (vascular tumor-like structure), 3 (3%) varix (tortuous vein), 1 (1%) calculus and 18 (17%) no lesions. The incidence of "no lesions" was less in the recent 12 years (9%) than the first 10 years (27%), while the incidence of MVR increased from 40 to 66% (p<0.05). All patients were treated endoscopically. Immediate success rate was 96% (100% in the recent 12 years). Long-term recurrent gross hematuria rate was 7%. Six resolved spontaneously and only 1 required ureteroscopy, revealing a different bleeding site.
Conclusion: Ureteroscopy and diathermy fulguration is highly useful for evaluation and treatment of chronic unilateral hematuria. Sophisticated technique and improved instrumentation contributes to a better outcome.

DOI： 10.1371/journal.pone.0036729

【泌尿器科ベッドサイドマニュアル】ベッドサイドトラブル対処法創感染症,創離開

渡邉豊彦

臨床泌尿器科 66 ( 4 ) 108 - 112 2012.4

Laparoscopic-Assisted Tension-free Vaginal Mesh: An Innovative Approach to Placing Synthetic Mesh Transvaginally for Surgical Correction of Pelvic Organ Prolapse Reviewed

Toyohiko Watanabe, Miyabi Inoue, Ayano Ishii, Toyoko Yamato, Masumi Yamamoto, Katsumi Sasaki, Yasuyuki Kobayashi, Motoo Araki, Shinya Uehara, Takashi Saika, Hiromi Kumon

ACTA MEDICA OKAYAMA 66 ( 1 ) 23 - 29 2012.2

Language：English Publishing type：Research paper (scientific journal) Publisher：OKAYAMA UNIV MED SCHOOL

Polypropylene mesh implants for the correction of pelvic organ prolapse (POP) are now available in Japan. We developed an innovative approach for correcting POP by placing polypropylene mesh transvaginally with laparoscopic assistance. From June 2007 through March 2010, sixteen consecutive patients with symptomatic stage 2 or 3 pelvic organ prolapse underwent the laparoscopic-assisted tension-free vaginal mesh procedure at Okayama University Hospital. All patients were evaluated before and at 1, 3, 6, and 12 months after surgery. Female sexual function was also evaluated with the Female Sexual Function Index (FSFI). The procedure was performed successfully without significant complications. Fifteen of 16 patients were considered anatomically cured (93.8%) at 12 months postoperatively. One patient with a recurrent stage 3 vaginal vault prolapse required sacral colpopexy six months postoperatively. Total FSFI scores improved significantly from 10.3 +/- 1.3 at baseline to 18.0 +/- 1.2 at 12 months after surgery. The laparoscopic-assisted trans-vaginal mesh is a safe, effective, and simple procedure for POP repairs. The procedure not only restores anatomic relationships but also improves sexual function.

DOI： 10.18926/AMO/48078

Pelvic surgeons caught in the meshes of the law. Reviewed

Toyohiko Watanabe

Reviews in urology 14 ( 1-2 ) 35 - 36 2012.1

Nerve growth factor level in the prostatic fluid of patients with chronic prostatitis/chronic pelvic pain syndrome is correlated with symptom severity and response to treatment Reviewed

Toyohiko Watanabe, Miayabi Inoue, Katsumi Sasaki, Motoo Araki, Shinya Uehara, Koichi Monden, Takashi Saika, Yasutomo Nasu, Hiromi Kumon, Michael B. Chancellor

BJU INTERNATIONAL 108 ( 2 ) 248 - 251 2011.7

Language：English Publishing type：Research paper (scientific journal) Publisher：WILEY-BLACKWELL

OBJECTIVE
To explore whether levels of nerve growth factor (NGF) in expressed prostatic secretions (EPS) are correlated with symptom severity in chronic prostatitis (CP) and chronic pelvic pain syndrome (CPPS).
PATIENTS AND METHODS
All patients with CP/CPPS underwent a complete history and physical examination, and were scored according to the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI).
Expressed prostatic secretion samples from 20 patients with CP/CPPS and from four asymptomatic control patients were collected and frozen, and NGF levels in EPS were measured by enzyme-linked immunosorbent assay.
Patients were asked to complete NIH-CPSI questionnaires at baseline and 8 weeks after treatment and patients with at least a 25% decrease in total NIH-CPSI score from the baseline values were classified as responders to treatment.
RESULTS
The mean (+/-SD) NGF levels in EPS of patients with CP/CPPS and asymptomatic control patients were 7409 (+/-3788) pg/mL and 4174 (+/-1349) pg/mL, respectively. The NGF level in patients with CP/CPPS correlated directly with pain severity (P = 0.014, r = 0.541).
There were no significant differences between NGF levels in EPS before and after treatment. However, successful treatment significantly decreased NGF levels in responders (P = 0.001).
CONCLUSION
Nerve growth factor might contribute to the pathophysiology of CP/CPPS as changes in NGF level in EPS occurred in proportion to pain severity. Therefore, these results suggest that NGF could be used as a new biomarker to evaluate the symptoms of CP/CPPS and the effects of treatment.

DOI： 10.1111/j.1464-410X.2010.09716.x

Impact of overactive bladder and lower urinary tract symptoms on sexual health in Japanese women Reviewed

Tomoko Sako, Miyabi Inoue, Toyohiko Watanabe, Ayano Ishii, Teruhiko Yokoyama, Hiromi Kumon

INTERNATIONAL UROGYNECOLOGY JOURNAL 22 ( 2 ) 165 - 169 2011.2

Language：English Publishing type：Research paper (scientific journal) Publisher：SPRINGER LONDON LTD

This study aims to assess whether lower urinary tract symptoms (LUTS) affect sexual function in Japanese females.
A multi-component questionnaire was mailed to 576 female hospital workers. It contained the Female Sexual Function Index (FSFI) and a self-administered questionnaire pertaining to LUTS.
Of the 276 responses (overall response rate, 47.9%), 146 questionnaires were evaluable. LUTS had been experienced by 72 (49.3%) of the respondents, 17 (11.6%) had urge urinary incontinence, and 35 (24.0%) had stress urinary incontinence (SUI). The mean overall FSFI score was 22.4 +/- 9.0. The mean FSFI score was not significantly different between women with LUTS and women without LUTS (23.2 +/- 9.3 and 21.6 +/- 8.8, respectively; P = 0.057). However, the mean FSFI score of women with SUI was significantly lower than that of women without it (P = 0.04). No other symptoms showed significant differences in FSFI scores.
Our results suggest that sexual dysfunction is related to SUI.

DOI： 10.1007/s00192-010-1250-x

Cell-penetrating D-Isomer Peptides of p53 C-terminus: Long-term Inhibitory Effect on the Growth of Bladder Cancer Reviewed

Daiji Araki, Kentaro Takayama, Miyabi Inoue, Toyohiko Watanabe, Hiromi Kumon, Shiroh Futaki, Hideki Matsui, Kazuhito Tomizawa

UROLOGY 75 ( 4 ) 813 - 819 2010.4

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

OBJECTIVES To investigate whether a single application of the membrane-permeable D-isomer of the p53 C-terminus connected with a retro-inverso version of the NH(2)-terminal 20-amino acid peptide of the influenza virus hemagglutinin-2 protein (riHA2) inhibited the growth of bladder cancer cells. The transduction of p53 using poly-arginine is useful for targeting and suppressing the growth of bladder cancer cells. However, the protein's intracellular half-life is short, and repeated application is necessary to achieve an anti-tumor effect.
METHODS The p53 carboxyl-terminal peptides covalently coupled with cell-penetrating peptides were synthesized with D- or L-amino acids. Moreover, the peptides were connected with riHA2 by a disulfide bridge. Human bladder cancer cell lines were incubated with each peptide and cell viability was assessed with the WST assay. Apoptotic cells were confirmed by Hoechst and active capase-3 staining. The p53 peptides were injected into severe combined immunodeficiency disease mice transplanted with J82 cells to investigate their anti-tumor effect on bladder tumors. A survival curve was plotted using the Kaplan-Meier method.
RESULTS A single application of cell-penetrating D- isomer peptides of the p53 C-terminus connected with riHA2 (d11R-p53C'-riHA2 and dFHV-p53C'-riHA2) inhibited the growth and induced the apoptosis of bladder cancer cells. The tumor-bearing mice treated only with vehicle had a mean survival time of 12 days, whereas treatment with d11R-p53C'-riHA2 resulted in a long-term survival rate of 50%.
CONCLUSIONS Peptide transduction therapy using the D- isomer p53 C-terminal peptide with riHA2 may be an innovative method for the treatment of bladder cancer. UROLOGY 75: 813-819, 2010. (C) 2010 Elsevier Inc.

DOI： 10.1016/j.urology.2009.10.002

The future of urodynamics: Non-invasive ultrasound videourodynamics Reviewed

Hideo Ozawa, Tatsuo Igarashi, Katsutoshi Uematsu, Toyohiko Watanabe, Hiromi Kumon

INTERNATIONAL JOURNAL OF UROLOGY 17 ( 3 ) 241 - 249 2010.3

Language：English Publisher：WILEY-BLACKWELL PUBLISHING, INC

A totally non-invasive transperineal urodynamic technique using Doppler ultrasonography has been developed. Normal urine doesn't have blood cells so urine was thought not to produce Doppler effects. However, basic studies confirmed that the decrease of pressure at high velocity (Bernoulli effects) caused dissolved gas to form microbubbles, which are detected by Doppler ultrasonography. Subjects sat and a probe was advanced via remote control to achieve gentle contact with the perineal skin. The digital uroflow data signals and the color Doppler ultrasound video images were processed on a personal computer. This method was viable to diagnose the degree of bladder outlet obstruction. The advantage of being rapid, effective, and equipped with no special attachments allows it to surpass any other non-invasive urodynamic methods. The difference between the echocardiogram and the ultrasound urodynamic system is only the frequency of obtaining velocity information: more than 50 times per minute vs once every several hours, respectively. Although the ultrasound urodynamic system is more difficult to develop than the echocardiogram, one principle is shared by both methods. The patient can void freely without interruptions, there is no contact between the penis and the equipment and it is specifically directed toward non-invasive diagnosis. The development of non-invasive Doppler ultrasound videourodynamics will dramatically expand understanding of voiding function.

DOI： 10.1111/j.1442-2042.2010.02447.x

【Female Urology 新たなartとevidence】腹腔鏡を併用した新しいTVM手術

渡邉豊彦

Urology View 8 ( 1 ) 94 - 99 2010.2

【食中毒】ボツリヌス神経毒素を用いた尿失禁,尿排出障害の治療

渡辺豊彦, 公文裕巳

臨床検査 53 ( 6 ) 723 - 726 2009.6

Use of Doppler ultrasound for non-invasive urodynamic diagnosis Reviewed

Hideo Ozawa, Toyohiko Watanabe, Katsutoshi Uematsu, Katsumi Sasaki, Miyabi Inoue, Hiromi Kumon

Indian Journal of Urology 25 ( 1 ) 110 - 115 2009.1

Language：English Publishing type：Research paper (international conference proceedings)

Objectives: A totally non-invasive transperineal urodynamic technique using Doppler ultrasonography has been developed. Methods: Since normal urine does not have blood cells, urine was thought not to produce the Doppler effects. However, basic studies confirmed that the decrease of pressure at high velocity (Bernouilli effect) caused dissolved gas to form microbubbles, which are detected by Doppler ultrasonography. Subjects sat and the probe was advanced via remote control to achieve gentle contact with the perineal skin. The digital uroflow data signals and the color Doppler ultrasound video images were processed on a personal computer. The flow-velocity curves from two sites
the distal prostatic urethra just above the external sphincter (V1) and the sphincteric urethra (V2) were plotted against time. The parameters of both the pressure-flow studies and the Doppler ultrasound urodynamic studies were compared in men who had various degrees of obstruction. Results: Functional cross-sectional area at prostatic urethra (A1), calculated by Q max/V1, was lower in the group of bladder outlet obstruction (BOO) vs. control group. Velocity ratio (VR), which was calculated by V1/V2, was the parameter having the best correlation with BOO index, though A1 had a similar correlation. This method is viable to diagnose the degree of BOO. Conclusions: The development of non-invasive Doppler ultrasound videourodynamics (Doppler UDS) will dramatically expand the information on voiding function.

DOI： 10.4103/0970-1591.45548

Naftopidil and propiverine hydrochloride for treatment of male lower urinary tract symptoms suggestive of benign prostatic hyperplasia and concomitant overactive bladder: A prospective randomized controlled study Reviewed

Teruhiko Yokoyama, Katsutoshi Uematsu, Toyohiko Watanabe, Katsumi Sasaki, Hiromi Kumon, Atsushi Nagai

SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 43 ( 4 ) 307 - 314 2009

Language：English Publishing type：Research paper (scientific journal) Publisher：TAYLOR & FRANCIS AS

Objective. To assess the efficacy and safety of propiverine hydrochloride (antimuscarinic), naftopidil (1-adrenoceptor antagonist) or both in patients with male lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia and concomitant overactive bladder (OAB). Material and methods. Men aged at least 50 years who had a total International Prostate Symptom Score (IPSS) of 8 or higher and bladder dairy documenting micturition frequency (more than eight micturitions/24 h) and urgency (more than one episode/24 h), with or without urgency urinary incontinence were randomized into three groups: group N, naftopidil (50 mg once daily) only; group P, propiverine hydrochloride (20 mg once daily); and group NP, naftopidil (50 mg once daily) plus propiverine hydrochloride (20 mg once daily) for a 4-week treatment regimen. Results. A total of 66 men, including 20 in group N, 23 in group P and 23 in group NP, were treated and 58 (87.9%) completed the 4 weeks of treatment. IPSS improved significantly in groups N and NP. Urinary frequency improved significantly in groups P and NP. Postvoid residual urine volume increased significantly in groups P and NP. Significant improvements in urgency episodes were noted in each group. One patient in group P required catheterization owing to acute urinary retention and another stopped medication because of difficulty in voiding. Conclusion. These results suggest that each treatment showed effectiveness for male LUTS with OAB. However, there are some possibilities of adverse effects with propiverine hydrochloride monotherapy.

DOI： 10.1080/00365590902836740

慢性前立腺炎における新しいバイオマーカーとしてのNGFの有用性について Reviewed

渡辺豊彦, 上原慎也, 荒木大司, 井上雅, 門田晃一, 雑賀隆史, 那須保友, 公文裕巳, 横山光彦

西日本泌尿器科 69 ( 10 ) 578 - 583 2007.10

Language：Japanese Publisher：西日本泌尿器科学会

慢性前立腺炎/慢性骨盤痛症候群(CP/CPPS)16例を対象に前立腺圧出液(EPS)中の神経成長因子(NGF)を測定し、National Institutes of Health chronic prostatitis symptom index(NIH-CPSI)による臨床症状との相関を検討した。その結果、EPS中NGFはコントロール群に比べCP/CPPS群で高値を示した。CP/CPPS群では、治療後にEPS中NGF値が低下傾向を示し、NIH-CPSIにおいて特に痛みスコアの改善とEPS中NGFの低下率との間に相関を認めた。

Natural course of lower urinary tract symptoms following discontinuation of alpha-1-adrenergic blockers in patients with benign prostatic hyperplasia Reviewed

Teruhiko Yokoyama, Toyohiko Watanabe, Takashi Saika, Yasutomo Nasu, Hiromi Kumon, Yoshiyuki Miyaji, Atsushi Nagai

INTERNATIONAL JOURNAL OF UROLOGY 14 ( 7 ) 598 - 601 2007.7

Language：English Publishing type：Research paper (scientific journal) Publisher：BLACKWELL PUBLISHING

Objectives: alpha 1-adrenergic blockers (alpha b) remain the first-line therapy in men with lower urinary tract symptoms (LUTS). The current published work advocates continued use of alpha b for their effect to be maintained. However, some patients decide to discontinue use of the medication after their symptoms are relieved and can keep good conditions. In this study, we investigated the natural course of LUTS after the discontinuation of successful treatment of alpha b.
Methods: Among 75 patients with LUTS who stopped alpha b medication once their symptoms improved, 60 patients (age, 50-87 years; median, 70) who could be followed for at least 12 months after discontinuation of alpha b were analyzed in this study. Evaluations included a clinical determination of the International Prostate Symptom Score (IPSS), peak flow rate (Qmax) and postvoid residual urine volume (PVR). Upon patient request or in cases of PVR more than 100 mL, administration of alpha b was resumed.
Results: Eighteen out of the 60 patients (30%) asked for re-treatment within 12 months after discontinuation (re-treatment group). The other 42 patents were able to maintain good condition without medication (discontinuation group). The IPSS was 15.9, 8.7, 10.1, 10.2, 9.7, 8.8 and 9.0, on the first visit, just before discontinuation, and 1, 3, 6, 9 and 12 months after stopping treatment among the discontinuation group, respectively. Similarly, Qmax was 10.6, 14.8, 14.2, 14.3, 14.7, 13.2 and 13.6 mL/ s, respectively. Treatment periods, prostatic volume and peak flow rates just before discontinuation of medication differed significantly between the re-treatment and discontinuation group.
Conclusions: In spite of the short follow-up periods, these results suggest that selected patients with relatively small prostatic volume and good flow rates after therapy can discontinue alpha b medication after their symptoms improve.

DOI： 10.1111/j.1442-2042.2007.01784.x

Comparison of 25 and 75 mg/day naftopidil for lower urinary tract symptoms associated with benign prostatic hyperplasia: A prospective, randomized controlled study Reviewed

Teruhiko Yokoyama, Hiromi Kumon, Yoshitsugu Nasu, Hitoshi Takamoto, Toyohiko Watanabe

INTERNATIONAL JOURNAL OF UROLOGY 13 ( 7 ) 932 - 938 2006.7

Language：English Publishing type：Research paper (scientific journal) Publisher：BLACKWELL PUBLISHING

Background: The present study investigated the efficacy, safety, and utility of starting an alpha(1d)-selective antagonist, naftopidil, at 75 or 25 mg/day in patients with lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).
Methods: In this prospective comparative study, the subjects comprised 153 patients with LUTS associated with BPH. Patients were randomized to receive either 25 mg/day (Group LD) or 75 mg/day (Group HD) of naftopidil for 4 weeks. The lower urinary tract disease symptom score (LUTDSS), the International Prostate Symptom Score (IPSS), the Quality of life assessment index, the maximum flow rate (Q(max)), and the residual urine volume were compared between the groups.
Results: In both groups, the LUTDSS and the IPSS were significantly improved at the endpoint and no significant intergroup differences were identified. However, the improvement in the Q(max) was significantly better for Group HD than for Group LD. The overall efficacy did not differ significantly between the groups. The degree of improvement in voiding symptoms and LUTDSS among patients with moderate symptoms was significantly greater for Group HD than for Group LD. The frequency of adverse reactions did not differ significantly between the groups.
Conclusions: Starting administration at 75 mg/day rather than 25mg/day is helpful for LUTS associated with BPH for patients with moderate symptoms, particularly in improving voiding symptoms. The 75 mg/day administration was considered to be a recommendable therapeutic dose in some patients.

DOI： 10.1111/j.1442-2042.2006.01443.x

Intravesical resiniferatoxin for patients with neurogenic detrusor overactivity Reviewed

T Watanabe, T Yokoyama, K Sasaki, K Nozaki, H Ozawa, H Kumon

INTERNATIONAL JOURNAL OF UROLOGY 11 ( 4 ) 200 - 205 2004.4

Language：English Publishing type：Research paper (scientific journal) Publisher：BLACKWELL PUBLISHING ASIA

Background: Resiniferatoxin (RTX), a substance isolated from some species of Euphobia, is a specific C-fiber neurotoxin which produces desensitization rather than excitation. At first, we performed intravesical RTX therapy on eight patients with neurogenic detrusor overactivity. After we confirmed the safety and efficacy, a Japanese RTX study group was organized and a new protocol made. The multicenter trial was performed in Japan. However, the efficacy of the treatments was different among the institutions. Therefore, we have compared the results between the first protocol and the new one at our hospital.
Methods: The first and second protocol involved the RTX solution (30 mL of 500 nM, and 100 mL of 1 muM, respectively) being instillated in the bladder for 30 min by almost the same procedures. Effects on bladder function were evaluated during treatment and at follow up.
Results: For the first and second protocols, six out of eight patients noted symptomatic improvement while two patients did not notice any change in the degree of incontinence for one month. The mean urodynamic bladder capacity had significantly increased from 138.0 +/- 64.4 mL to 227.3 +/- 112.4 mL and 133.1 +/- 43.3 mL to 247.0 +/- 102.3 mL 1 month after RTX treatment for the first and second protocols, respectively (P < 0.05). No severe side-effects were seen in either group.
Conclusion: Intravesical RTX improved bladder capacity in patients with neurogenic detrusor overactivity in both protocols. The concentration of RTX did not exhibit any change in the effect and safety in our hospital. Intravesical RTX is a promising treatment for neurogenic detrusor overactivity.

DOI： 10.1111/j.1442-2042.2003.00782.x

Comparative study of effects of extracorporeal magnetic innervation versus electrical stimulation for urinary incontinence after radical prostatectomy Reviewed

T Yokoyama, J Nishiguchi, T Watanabe, H Nose, K Nozaki, O Fujita, M Inoue, H Kumon

UROLOGY 63 ( 2 ) 264 - 267 2004.2

Language：English Publishing type：Research paper (scientific journal) Publisher：ELSEVIER SCIENCE INC

Objectives. To perform a randomized comparative study to investigate the clinical effects of extracorporeal magnetic innervation (ExMI) and functional electrical stimulation (FES) on urinary incontinence after retropubic radical prostatectomy.
Methods. Thirty-six patients with urinary incontinence after radical prostatectomy were randomly assigned to three groups (12 patients each in the FES, ExMI, and control groups). For FES, an anal electrode was used. Pulses of 20-Hz square waves at a 300-mus pulse duration were used for 15 minutes twice daily for 1 month. For ExMI, the Neocontrol system was used. The treatment sessions were for 20 minutes, twice a week for 2 months. The frequency of the pulse field was 10 Hz for 10 minutes, followed by a second treatment at 50 Hz for 10 minutes. For the control group, only pelvic floor muscle exercises were performed. Objective measures included bladder diaries, 24-hour pad weight testing, and a quality-of-life survey, at 1, 2, and 4 weeks and 2, 3, 4, 5, and 6 months after removing the catheter.
Results. The leakage weight during the 24 hours after removing the catheter was 684, 698, and 664 g for the FES, ExMI, and control groups, respectively. At 1 month, it was 72, 83, and 175 g (FES versus control, P < 0.05) and at 2 months was 54, 18, and 92 g (ExMI versus control, P < 0.05) in the FES, ExMI, and control groups, respectively. Finally, 6 months later, the average 24-hour leakage weight was less than 10 g in all groups. Quality-of-life measures decreased after surgery, but gradually improved over time in all groups. No complications were noted in any of the groups.
Conclusions. ExMI and FES therapies offered earlier continence compared with the control group after radical prostatectomy. We consider ExMI and FES to be recommendable options for patients who want quick improvement of postoperative urinary incontinence.

DOI： 10.1016/j.urology.2003.09.024

移植腎機能廃絶後のacquired cystic disease of the kidney(ACDK)に発症した両側性固有腎細胞癌の1例 Reviewed

渡辺豊彦, 武田克治, 小林泰之, 朝日俊彦

西日本泌尿器科 65 ( 2 ) 65 - 68 2003.2

Language：Japanese Publisher：西日本泌尿器科学会

50歳男性.移植腎機能廃絶後のacquired cystic disease of the kidney(ACDK)に発症した両側性固有腎細胞癌の1例を経験した.移植腎機能廃絶で血液透析再導入中,血尿,下腹部痛を主訴に受診し,CTで左側固有腎に腫瘤を認め入院した.CTでは固有腎は両側ともACDKを呈し,左側固有腎下極に内部不均一な径6cm大の充実性腫瘤を認めたが,右側固有腎には明らかな腫瘤は認めなかった.ACDKに発生した左側固有腎細胞癌と診断し,経腹的両側固有腎摘除術と移植腎摘除術を施行した.摘出標本では,固有腎は左右とも多数の嚢胞が形成され,左固有腎下極の腫瘍の割面は黄白色充実性で,右固有腎上極にも割面が黄白色充実性腫瘍を認めた.移植腎は萎縮していたが,腫瘍性変化は認めなかった.病理所見は左右ともrenal cell carcinoma,clear cell carcinomaであった.術後6ヵ月で再発・転移は認めていない

Development of noninvasive velocity flow video urodynamics using Doppler sonography. Part II: Clinical application in bladder outlet obstruction Reviewed

H Ozawa, H Kumon, T Yokoyama, T Watanabe, MB Chancellor

JOURNAL OF UROLOGY 160 ( 5 ) 1792 - 1796 1998.11

Language：English Publishing type：Research paper (scientific journal) Publisher：LIPPINCOTT WILLIAMS & WILKINS

Objectives: We have developed a totally noninvasive urodynamic technique based on the concept of Doppler sonography, which was tested in men with and without bladder outlet obstruction.
Materials and Methods: An ultrasonic image directed Doppler system with a 3.75 MHz. micro-convex electro-probe was operated transperineally using a specially devised remote control robotic holder. Uroflow rates from the urethral meatus were also measured with a flowmeter. The color Doppler ultrasound image and digital now velocity data were processed by a personal computer. Color scale data were analyzed by customized software. Multiple rectangle sample volumes could be set in any size in any position, and the resulting color encoded data were averaged. Calculation was performed every 0.5 second and a flow velocity curve in the region of interest was obtained. A total of 12 men, 6 without (controls) and 6 with bladder outlet obstruction, were evaluated by conventional pressure flow study and the new Doppler ultrasound urodynamic system. Bladder outlet obstruction was determined using the nomogram of Abrams and Griffiths. The sample volume for a flow velocity curve was set only in the prostatic urethra and, thus, maximum flow velocity in and functional cross-sectional area of the prostatic urethra were determined.
Results: Urinary stream in the male urethra was clearly detected and flow velocity in the prostatic urethra could be measured in all cases. Maximum flow rate measured by a flowmeter was significantly lower in the bladder outlet obstruction group. Maximum flow velocity by Doppler study was almost the same in the obstructed and control groups. Functional cross-sectional area, which was calculated by dividing maximum flow rate by maximum flow velocity, was lower in the bladder outlet obstruction (mean plus or minus standard deviation 0.31 +/- 0.16 cm.(2)) than control group (0.78 +/- 0.23 cm.(2)) (p = 0.006). Velocity flow plots were possible in both groups.
Conclusions: The concept of noninvasive pressure flow-like urodynamic evaluation based on Doppler ultrasound is feasible. Parameters of flow velocity as well as functional cross-sectional area can be used in the diagnosis of bladder outlet obstruction and to localize the site of obstruction.

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