Faculty Profiles - WATANABE Toyohiko

Papers - WATANABE Toyohiko

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Development of noninvasive velocity flow video urodynamics using Doppler sonography - Part I: Experimental urethra Reviewed

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

JOURNAL OF UROLOGY 160 ( 5 ) 1787 - 1791 1998.11

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

Purpose: We believed that a totally noninvasive video urodynamic system could be invented based on the concept of Doppler ultrasonography. To develop this system we measured flow velocity in an experimental urethra using 4 materials, including natural urine.
Materials and Methods: A cellulose tube was inserted into a standoff pad as an experimental urethra. Degassed water, distilled water, urine and liposome (multi-lamellar particles) solution comprised the 4 materials used to compare signal intensity and flow velocity at various flow rates. The flow rate from the tube was measured with a uroflowmeter. The Doppler image and digital uroflow signal data were processed by a computer.
Results: Doppler signals and flow velocity curves could be sufficiently obtained using distilled water, urine and liposome solution, while degassed water showed no Doppler signals at any flow rate. Minimum flow rate at which clear Doppler signals were continuously detected from the angle in the frontal plane was greater than 3.0 ml. per second for distilled water, greater than 1.5 for urine and greater than 0.3 for liposome solution. Maximum flow velocities were identical in these 3 materials at a flow rate of greater than 2.0 ml. per second. The functional cross-sectional area of the tube showed a constant value irrelevant to the initial flow rate.
Conclusions: Flow velocity could be measured by Doppler ultrasound above a certain minimal flow rate. Dissolved gasses have an important role in creating Doppler signals. Flow velocity, velocity related parameters and functional cross-sectional area can diagnose and localize the area of bladder outlet obstruction. Liposome solution may be helpful in detecting velocity in low flow states in future systems.

Ice-water test in the urodynamic evaluation of spinal cord injured patients. Reviewed

Toyohiko Watanabe

Techniques in urology 4 ( 2 ) 87 - 91 1998.6

Publishing type：Research paper (scientific journal)

The purpose of this study was to determine the clinical utility of the ice-water test (IWT) during urodynamic evaluation in spinal cord injured (SCI) patients. Thirty-two suprasacral SCI patients with documented detrusor hyperreflexia (DH) underwent urodynamic study and IWT. Fifteen patients had repeated testing 2 weeks later. The IWT was performed with the patient in the supine position; 100 mL of sterile saline water at 4-8 degrees C was injected manually. If cystometric capacity was <200 mL, a volume of about 50% of the individual cystometric bladder capacity was used. The cold fluid was left within the bladder for 3 minutes. The test was considered positive if an involuntary bladder contraction > or =15 cm H2O was registered. All patients with cervical or thoracic level SCI had DH, which had 100% test-retest reproducibility on urodynamics. Seventy-two percent of patients with DH had a positive IWT and 28% had a negative IWT. IWT (same volume, 2 weeks later) in 4 (27%) of the 15 repeated tests gave different responses. Autonomic hyperreflexia, manifested as systolic blood pressure increase > or =50 mm Hg within 3 minutes of ice-water instillation, occurred in 16 (57%) of 28 patients with lesions above T7. In SCI patients, the IWT did not contribute to their management because of the insensitivity and nonspecificity. Autonomic hyperreflexia can occur during evaluation. The IWT did not influence clinical management in this group of SCI patients.

Inguinal cystoceles: A previously overlooked etiology of prostatism in men without bladder outlet obstruction Reviewed

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

JOURNAL OF UROLOGY 159 ( 3 ) 766 - 771 1998.3

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

Purpose: We determine whether inguinal cystoceles, a type of extraperitoneal herniation of the bladder, are responsible for symptoms consistent with prostatism in men without bladder outlet obstruction.
Materials and Methods: From January 1996 to February 1997 inguinal cystoceles were treated with surgical repair of the floor of the inguinal canal in 8 men with a relatively long history of symptoms consistent with prostatism. The diagnosis of inguinal cystoceles was based on the filling phase of video urodynamic studies done with the patient standing. The clinical outcome of surgery was assessed using the International Prostate Symptom Score and urodynamic findings.
Results: All inguinal cystoceles studied were physically occult but clearly detected as wide-mouthed, mild protrusions of the bladder wall in the inguinal region on cystograms obtained with the patient standing. Although clear cystoceles were present on radiography on the right side in 1 case, the left side in 2 and bilaterally in 5, apparent bilateral weakness in Hesselbach's triangle was noted in all at surgery. High detrusor opening pressure and a relatively long opening time mere regarded as urodynamic parameters characteristic of this condition. These parameters and subjective symptoms dramatically improved after bilateral surgical repair of the floor of the inguinal canal.
Conclusions: Inguinal cystoceles negatively affect voiding dynamics by increasing opening pressure and opening time, indicating that they should be considered in the differential diagnosis of men with symptoms consistent with prostatism. Video urodynamics is mandatory to detect this condition, which to our knowledge has been previously overlooked on radiography and urodynamics.

DOI： 10.1016/s0022-5347(01)63724-8

Early predictors of bladder recovery and urodynamics after spinal cord injury Reviewed

PJ Shenot, DA Rivas, T Watanabe, MB Chancellor

NEUROUROLOGY AND URODYNAMICS 17 ( 1 ) 25 - 29 1998

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

Our purpose was to determine if intact perianal (S4-5) pin sensation (PPS) and bulbocavernosus (S2-4) reflex (BCR) shortly after spinal cord injury (SCT) are predictive of bladder function recovery. Twenty-eight SCI patients (aged 18-68 years, Frankel Classification A-D, spinal injury level C4-T12), admitted within 72 hours of injury, underwent evaluation of initial PPS and BCR. The presence of intact PPS and BCR were correlated with the patient's voiding function and urodynamic evaluation results 1 year postinjury. Of the 28 patients within 72 hours of SCI, PPS was intact in 17 (60%) and absent in 11 (40%), while 15 patients (54%) demonstrated a positive BCR and 13 (46%) did not. One year after SCI, no patient with absent PPS voided unassisted, while of the 17 patients with preserved PPS, 11 (65%) were voiding spontaneously. Of these 11 patients, urodynamic evaluation revealed detrusor areflexia in 1 (9%), normal detrusor function in 2 (18%), and detrusor hyperreflexia in 8 (73%), with 3 of these 8 patients (38%) also demonstrating detrusor-sphincter dyssynergia. At 1 year postinjury, only 2 of 13 patients (15%) with an absent BCR voided spontaneously, while 9 of 15 patients (60%) with an intact BCR were able to void. Although PPS and BCR are moderately sensitive in predicting the return of spontaneous voiding, they cannot predict detrusor hyperreflexia and sphincter dyssynergia. Therefore, urodynamic study remains an essential component of initial urologic evaluation after SCI. (C) 1998 Wiley-Liss, Inc.

DOI： 10.1002/(sici)1520-6777(1998)17:1<25::aid-nau5>3.0.co;2-f

Gracilis urethral myoplasty: Preliminary experience using an autologous urinary sphincter for post-prostatectomy incontinence Reviewed

MB Chancellor, T Watanabe, DA Rivas, RD Hong, H Kumon, H Ozawa, Bourgeois, I

JOURNAL OF UROLOGY 158 ( 4 ) 1372 - 1375 1997.10

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

Purpose: We investigated the effect of a neurovascular intact gracilis muscle urethral wrap to restore urinary continence in men with severe stress urinary incontinence after radical retropubic prostatectomy.
Materials and Methods: Three men with stress incontinence after radical retropubic prostatectomy and external beam radiation therapy for adenocarcinoma of the prostate underwent gracilis urethral myoplasty. Video urodynamic evaluation and cystourethroscopy revealed Valsalva leak point pressure of less than 40 cm, water and a damaged urinary sphincter mechanism in all 3 patients, One man underwent concomitant ileocystoplasty.
Results: At 6 to 24-month followup all patients reported improved continence. Mean Valsalva leak point pressure increased from 26.3 +/- 3.2 cm. water before to 83.0 +/- 32.1 cm, water after surgery, The gracilis muscle urethral wrap did not have a deleterious effect on erectile function or ambulation, Complications included 1 wound infection.
Conclusions: An autologous gracilis muscle urinary neosphincter can be constructed in the bulbous urethra in a fashion similar to that of the artificial urinary sphincter with encouraging results in this preliminary series, The gracilis neosphincter may be an alternative to the artificial sphincter, especially in patients at higher risk for complications, such as after radiation and cryotherapy.

DOI： 10.1016/s0022-5347(01)64218-6

Fully hydrated images of Pseudomonas aeruginosa biofilm on the surface of catheter material. Reviewed

Toyohiko Watanabe

The Canadian journal of urology 4 ( 3 ) 416 - 421 1997.9

Publishing type：Research paper (scientific journal)

We examined the applicability of environmental scanning electron microscopy (ESEM) and confocal laser scanning microscopy (CLSM) for non-invasive imaging of intact bacterial biofilms. Fully hydrated images of Pseudomonas aeruginosa biofilms developing on the silicon disks in an in vitro experimental model were detected simply but clearly by ESEM and CLSM. Three-dimensional spatial images of the bioflims were obtained by ESEM using specimens with neither drying nor conductive coating. Horizontal and vertical sectioning images of the biofilms were obtained by using CLSM in conjunction with positive fluorescence staining techniques; acridine orange and sufranin were successfully used for detection of bacterial cells in the biofilms, while extracellular polymeric substances were obtained selectively with FITC-concanavalin A. The new technology reported here is applicable to diagnostic study as well as fundamental study of biofilm-associated infections in the urinary tract.

Gracilis urethromyoplasty - an autologous urinary sphincter for neurologically impaired patients with stress incontinence Reviewed

MB Chancellor, RD Hong, DA Rivas, T Watanabe, JA Crewalk, Bourgeois, I

SPINAL CORD 35 ( 8 ) 546 - 549 1997.8

Language：English Publishing type：Research paper (scientific journal) Publisher：STOCKTON PRESS

Purpose: To investigate the effect of a neurovascularly intact gracilis muscle urethral wrap, to be used to restore urinary continence as a transposed urinary sphincter graft. in patients with neurogenic lower urinary tract dysfunction. Methods: Five neurologically impaired men with a denervated and damaged urinary sphincter mechanisms were treated. The etiology of sphincteric insufficiency included sphincter denervation in three patients. external sphincterotomy in one, and urethral trauma due to a chronic indwelling catheter in one, All patients underwent gracilis urethromyoplasty sphincter reconstruction. Two patients also underwent concomitant ileocystoplasty and one patient ileocystostomy because of poor bladder compliance and a bladder capacity of <200 ml. Results: The gracilis urethromyoplasty functioned as a new autologous sphincter with follow-ups ranging from 6-35 months. The surgery was successful in four patients. Three of the four patients were managed with intermittent catheterization, and one managed by ileocystostomy. The fifth patient continued to require an indwelling urethral catheter. Conclusion: Gracilis urethromyoplasty achieves compression of the urethra using a neurovascularly intact muscle graft, The functional urethral closure, obtained from the gracilis muscle wrap, assures dryness, and permits intermittent self-catheterization. It also avoids the risks of infection, erosion. or malfunction associated with the artificical urinary sphincter. The potential exists for electrical stimulation of this muscle graft to allow volitional control of the neo-sphincter mechanism, and voluntary voiding.

DOI： 10.1038/sj.sc.3100444

Rectus urethromyoplasty of radical prostatectomy anastomosis decreases postoperative incontinence and anastomotic stricture; Technique and preliminary results Reviewed

MB Chancellor, S Strup, DA Rivas, T Watanabe, LG Gomella

JOURNAL OF UROLOGY 157 ( 1 ) 371 - 375 1997.1

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

Purpose: To investigate the effect of rectus urethromyoplasty on vesicourethral anastomosis healing during radical retropubic prostatectomy (RRP) and in an animal model.
Materials and Methods: Three groups of 10 female rats were studied. After complete urethral transection, group A animals underwent a primary urethral anastomosis, while rectus urethromyoplasty was used to reinforce the anastomosis of the animals in group B. Group C animals served as controls. All animals underwent urodynamic evaluation one month postoperatively, then were sacrificed for histological analysis. In 3 clinical subjects at the time of RRP, a 2-3 cm x 6-8 cm. strip of rectus muscle was isolated with its blood supply intact, emanating from an inferior epigastric artery pedicle. This muscular band was used to encircle the vesico-urethral anastomosis, suspending it slightly but without tension, and securing it to the pubic symphysis.
Results: The micturition pattern, bladder capacity, and leak point pressure of the 3 groups of animals were not significantly different. Histological examination of the rectus sling revealed viable muscle with histofibroblast, collagen, and blood vessel ingrowth from the vascular rectus muscle into the urethra. Three successful clinical rectus urethromyoplasty cases were performed with over 12 months of follow-up.
Conclusions: Reinforcement of the vesico-urethral anastomosis using rectus urethromyoplasty at the time of radical prostatectomy may improve continence by increasing urethral support and mucosal coaptation. This technique may decrease the incidence of stricture formation by augmenting blood supply available for healing of the anastomosis. Rectus urethromyoplasty may be especially beneficial to patients with an increased risk of requiring adjuvant radiation therapy post-prostatectomy.

In-vivo whole bladder response to anticholinergic and musculotropic agents in spinal cord injured rats Reviewed

Patrick J. Shenot, Michael B. Chancellor, David A. Rivas, Toyohiko Watanabe, Hiromi Kumon, T. Ernesto Figueroa

Journal of Spinal Cord Medicine 20 ( 1 ) 31 - 35 1997

Language：English Publishing type：Research paper (scientific journal) Publisher：American Paraplegia Society

The purpose of this study was to compare the effect on urodynamic parameters of anticholinergic and musculotropic agents in sham injured and spinal cord injured (SCI) rats. A standard rat SCI model induced by impact trauma was employed. Cystometrograms were performed under urethane anesthesia four weeks after SCI. Bladder capacity and voiding pressure were determined at the point of micturition monitored urodynamically and visually. The effect of oxybutynin chloride (0.01 - 0.1 mg/kg), propantheline bromide (0.05 - 0.5 mg/kg) and flavoxate hydrochloride (0.1 - 1.0 mg/kg) were assessed independently in sham injured and SCI rats (n=10 in each group). Bladder capacities were 0.6±0.2 and 7.1±1.6 ml in sham and SCI rats (p&lt
0.01), respectively. Maximal filling pressure was 17.5±5 mmHg in sham and 25±5 mmHg in SCI rats (p&lt
0.05). Bladder capacity increased with all three medications. Administration of oxybutynin, propantheline and flavoxate in sham rats resulted in bladder capacities of 0.88±0.3,0.71±0.3 and 0.8±0.2 ml, respectively (p&lt
0.01 ). In SCI rats, these drugs resulted in bladder capacities of 9.8±1.1,7.9±1.3 and 8.8±2.0 ml, respectively (p&lt
0.01). No significant change in maximum filling pressure occurred. We conclude that anticholinergic and musculotropic agents caused a similar increase in bladder capacity in both sham and SCI rats. Oxybutynin enhanced bladder capacity more than propantheline or flavoxate.

DOI： 10.1080/10790268.1997.11719389

The effect of urinary tract reconstruction on neurologically impaired women previously treated with an indwelling urethral catheter Reviewed

T Watanabe, DA Rivas, R Smith, WE Staas, MB Chancellor

JOURNAL OF UROLOGY 156 ( 6 ) 1926 - 1928 1996.12

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

Purpose: We investigated the changes in sexuality and quality of life that evolve after lower urinary tract reconstruction in neurologically impaired women previously treated with an indwelling urethral catheter.
Materials and Methods: A total of 18 neurologically impaired women treated with an indwelling urethral catheter underwent bladder reconstruction. Pubovaginal sling urethral compression was required to restore perineal dryness in 13 patients and was the only operation required in conjunction with intermittent catheterization in 3. Eight patients underwent ileocystostomy, that is creation of a ''bladder chimney,'' and 4 underwent augmentation cystoplasty with creation of a continent catheterizable stoma. In 3 patients ileocystoplasty alone with intermittent urethral catheterization was performed. All patients were followed 6 to 40 months (mean 18) after reconstructive surgery using a 9-part questionnaire to score numerically the effect of surgical reconstruction on sexuality and quality of life issues.
Results: On a scale of 0 (worst) to 5 (best) mean scores for self-esteem improved from 1 preoperatively to 4 postoperatively, self-image from 1 to 4, sexual desire from 2 to 4 and ability to cope with disability from 1 to 4, respectively. In 4 of the 15 women who were sexually active preoperatively the frequency of sexual intercourse doubled from a mean of 3 to 6 times per month, respectively, and all 4 women reported improved sexual satisfaction. All 13 patients with pelvic pain and 5 with symptoms of autonomic dysreflexia noticed significant improvement if not complete resolution of the symptoms.
Conclusions: Neurogenic lower urinary tract dysfunction treated with an indwelling urethral catheter is detrimental to sexuality and quality of life in neurologically impaired women. Urinary tract reconstruction restores not only quality of life but also sexuality by improving self-image, self-esteem and the ability to cope. Indwelling catheterization as a method of long-term urinary treatment should be avoided in women.

Gracilis muscle dynamic urethral sphincter myoplasty: Rat model experience Reviewed

T Watanabe, DA Rivas, B Huang, AW Epple, TE Figueroa, MB Chancellor

JOURNAL OF UROLOGY 156 ( 4 ) 1507 - 1510 1996.10

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

Purpose: Dynamic urethral sphincter myoplasty (skeletal muscle urinary sphincter reconstruction) using a neurovascularly intact gracilis muscle was investigated in a rat model.
Materials and Methods: In female Sprague-Dawley rats, a unilateral gracilis anticus muscle flap was dissected from the medial thigh, preserving the medial muscular insertion, vascular flow, and innervation This muscle graft was used to completely encircle the urethra and was fixed in position. Urodynamic leak point pressure (LPP) and bladder volume at leakage were measured with cystometry after 1 month, using an 18 gauge catheter placed through the bladder dome with a constant infusion rate of 0.2 mi. per minute. In addition, the effect of electrical stimulation of the gracilis myoplasty (current parameters: 1 to 10 mA, 1 to 60 Hz, 0.05 to 1 msec. duration) on intravesical leak point pressure was noted during cystometry.
Results: The gracilis muscle measured 3.8 +/- 0.3 cm. in length, 0.5 +/- 0.1 cm. in width and 0.2 +/- 0.1 cm. in thickness. Blood flow rates to the grafted and contralateral gracilis myoplasty were similar at 43 +/- 26 and 51 +/- 30 g.cm.(3), respectively (p = 0.46). The leak point pressure (LPP) of control, unstimulated gracilis myoplasty and gracilis myoplasty with electrical stimulation were 28 +/- 8, 32 +/- 12, and 85 +/- 27 mm.Hg (p < 0.01). Bladder volumes at LPP in the 3 respective groups were 0.5 +/- 0.2, 0.6 +/- 0.3 and 1.2 +/- 0.6 mi (p < 0.01).
Conclusions: Gracilis myoplasty is not obstructive, as substantiated by unchanged leak point pressure and leak point capacity. Myoplasty with low current stimulation, however, significantly increased LPP and leak point capacity.

Urodynamics of spinal cord injury Reviewed

T Watanabe, DA Rivas, MB Chancellor

UROLOGIC CLINICS OF NORTH AMERICA 23 ( 3 ) 459 - & 1996.8

Language：English Publishing type：Research paper (scientific journal) Publisher：W B SAUNDERS CO

Historically, urologic complications have been the major source of morbidity and mortality among spinal cord injured (SCI) patients. All SCI patients should undergo urodynamic evaluation, with the initial urodynamics study done after the patient is beyond the spinal-shock phase. Management of the urinary tract in SCI individuals should be based on urodynamic principles and findings rather than on the neurologic history.

DOI： 10.1016/s0094-0143(05)70325-6

Epidemiology of current treatment for sexual dysfunction in spinal cord injured men in the USA model spinal cord injury centers. Reviewed

Toyohiko Watanabe

The journal of spinal cord medicine 19 ( 3 ) 186 - 189 1996.7

Publishing type：Research paper (scientific journal)

This study is a prospective multicenter cooperative survey of the evaluation and treatment of erectile dysfunction in men with spinal cord injury (SCI). Uniform database questionnaires were completed prospectively by patients seeking therapy for erectile dysfunction. Eighty-five SCI men aged 17-68 years (mean age = 26 +/- 17) were enrolled. Mean duration of traumatic SCI was 3 +/- 3.2 years (Range = 0.3-18 years). The level of injury was cervical in 20 patients, thoracic in 31, lumbar in 29 and sacral in five. Patients were fully evaluated and then counseled as to their therapeutic options. Twenty-eight chose to use a vacuum erection device (VED), 26 preferred pharmacological penile injection and five used both intracorporeal therapy and VED. The remainder were managed with marriage and sexual counseling in 10 patients, three underwent penile prosthesis placement and two used topical pharmacotherapy. Four patients used other forms of treatment and in nine no therapy was recommended. Of the patients that used pharmacologic injection only, 74 percent used papaverine as a single agent, 20 percent used papaverine with phentolamine, five percent used prostaglandin E (PGE1) alone and one percent used a mixture. Patients using injection therapy report sexual intercourse a mean of 3 +/- 3.4 times per month as compared with 5 +/- 3.2 times per month in those using VED. Five intracorporeal injection patients developed priapism while two patients using the VED developed subcutaneous bleeding and one developed penile ischemia. We conclude that although a spectrum of erectile dysfunction treatment is present among SCI centers, VED and pharmacological penile injection are by far the two most popular methods of treatment and papaverine is the most common drug. The incidence of complications is small in the model centers.

DOI： 10.1080/10790268.1996.11719430

Fascial sling correction of kinked efferent limb in patients with continent diversion and catheterization difficulty Reviewed

MB Chancellor, PJ Shenot, RD Hong, T Watanabe, DA Rivas

JOURNAL OF UROLOGY 156 ( 1 ) 162 - 163 1996.7

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

Purpose: We determined the efficacy of-using a rectus fascial sling to revise an angulated efferent limb in patients with continent urinary diversion and difficulty with intermittent catheterization.
Materials and Methods: Two spinal cord injured women who underwent modified Indiana pouch urinary diversion required revision of each efferent limb because of difficulty with catheterizatian. A strip section of anterior rectus sheath was harvested and used to fix the efferent limb in position, assuring freedom from angulation and facilitating catheterization.
Results: Both patients remained continent fell more than 2 years postoperatively and neither had further difficulties with catheterization or required additional surgery.
Conclusions: Use of the rectus fascial sling in continent urinary diversion enables fixation of the efferent limb to facilitate catheterization and enhance continence.

Intravesical capsaicin in neurologic impaired patients with detrusor hyperreflexia. Reviewed

Das A, Chancellor MB, Watanabe T, Sedor J, Rivas DA

The journal of spinal cord medicine 19 ( 3 ) 190 - 193 1996.7

Total incontinence secondary to sphincter destruction after prostate cryotherapy for recurrent prostatic carcinoma. Reviewed

Watanabe T, Rivas DA, Miettinen M, Gomella L, Chancellor MB

International journal of urology : official journal of the Japanese Urological Association 3 ( 4 ) 324 - 325 1996.7

Reversible clinical outcome after sphincter stent removal Reviewed

MB Chancellor, DA Rivas, T Watanabe, JK Bennett, JE Foote, BG Green, EW Killorin, R MacMillan

JOURNAL OF UROLOGY 155 ( 6 ) 1992 - 1994 1996.6

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

Purpose: We determined whether the self-expanding sphincter stent, a potential alternative to conventional external sphincterotomy for the treatment of detrusor external sphincter dyssynergia, causes a permanent effect on the lower urinary tract.
Materials and Methods: Four spinal cord injured men with voiding symptoms of detrusor external sphincter dyssynergia as noted by complete urological evaluation, including a video urodynamic study, were treated with the self-expanding sphincter stent. However, the device was explanted 6 months or longer after insertion in all 4 cases due to stent migration (3) and difficulty with condom catheter urinary drainage (1).
Results: All stents were removed completely without damage to the urethra. Mean voiding pressure decreased from 62.5 +/- 39.4 to 20.7 +/- 6.5 cm. water after sphincter stent placement. One year after stent explantation mean voiding pressure remained unchanged from preoperative values of 58.5 +/- 21.5 cm. water. No patient had stress urinary incontinence or endoscopically apparent urethral strictures.
Conclusions: The stent can be removed even after complete epithelialization and an extended interval without damage to external sphincter function or urethral stricture formation. The urinary sphincter stent is an effective, reversible treatment for patients with detrusor external sphincter dyssynergia.

岡山大学泌尿器科における術後感染症の年次変遷 Reviewed

渡辺豊彦, 妹尾孝司, 井上高明

西日本泌尿器科 57 ( 3 ) 240 - 243 1995.3

Language：Japanese Publisher：西日本泌尿器科学会

1991年12月までの13年間に手術を行った3926例を対象とし,術後3週間以内の有熱性感染症,ならびに創感染を中心に集計し,年次的に検討を加え,入院患者における使用抗菌薬の変遷についても検討した。1)術後有熱性合併症としての感染症は,年次的に減少しており,特に前立腺術後有熱性感染症の減少が顕著であった。2)抗菌薬総使用量の年次的推移では,第3世代セフェム,ニューキノロン薬の使用量は1987年にピークに達し,最近ではむしろ減少していた。3)術後上部尿路感染症例よりのSerratiaの分離頻度は著明に減少したが,Pseudomonasにaeruginosaについては減少傾向は認められなかった

Observation of Pseudornonas aeruginosa Biofilm with Confocal Laser Scanning Microscope Reviewed

WATANABE Toyohiko

69 ( 1 ) 114 - 122 1995.1

緑膿菌性複雑性尿路感染症に対するcarindacillin(CIPC)の再評価 Reviewed

渡辺豊彦, 竹中皇, 門田晃一

日本化学療法学会雑誌 43 ( 1 ) 89 - 95 1995.1

Language：Japanese Publisher：(公社)日本化学療法学会

CIPCはCarbenicillin (CBPC)の誘導体である。CBPCの尿路感染症由来緑膿菌235株に対するMIC70は400μg/mlと,NFLX, OFLXの100μg/mlに比しかなりの高値を示したが,CBPCでは耐性化の傾向は認められなかった。NFLX, OFLXでは,尿中での抗菌力の明らかな低下がみられるのに対し,CBPCでは尿中での抗菌力の低下は軽度であった。臨床的検討における解析対象例は21例であり,UTI判定では著効5例,有効8例,無効8例,総合有効率は61.9%であった。細菌学的効果では,投与前分離緑膿菌21株のうち12株が除菌された。投与前分離緑膿菌に対する本剤のMICは6.25〜>1,600μg/mlの間に分布し,OFLXに比し高値を示した

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