Background Healthcare costs are rising, and a substantial proportion of medical care is of little... more Background Healthcare costs are rising, and a substantial proportion of medical care is of little value. De-implementation of low-value practices is important for improving overall health outcomes and reducing costs. We aimed to identify and synthesize randomized controlled trials (RCTs) on de-implementation interventions and to provide guidance to improve future research. Methods MEDLINE and Scopus up to May 24, 2021, for individual and cluster RCTs comparing de-implementation interventions to usual care, another intervention, or placebo. We applied independent duplicate assessment of eligibility, study characteristics, outcomes, intervention categories, implementation theories, and risk of bias. Results Of the 227 eligible trials, 145 (64%) were cluster randomized trials (median 24 clusters; median follow-up time 305 days), and 82 (36%) were individually randomized trials (median follow-up time 274 days). Of the trials, 118 (52%) were published after 2010, 149 (66%) were conducted...
Study design, materials and methods We collected data on 5,701 individuals who participated in a ... more Study design, materials and methods We collected data on 5,701 individuals who participated in a multiphasic health screening in Fukui, Japan, in 2003 (baseline) and 2007, and were ≤65 years at baseline. After excluding participants with MetS at baseline, data from 5,234 participants (1,173 men and 4,061 women) were subjected to analysis. MetS diagnoses were made using the modified Japanese criteria, in which MetS was diagnosed when obesity plus two or more of following criteria were present: HDL cholesterol <40 mg/dL or triglycerides ≥150 mg/dL; systolic blood pressure ≥130 mmHg, diastolic blood pressure ≥85 mmHg, or on therapy; and fasting plasma glucose ≥110 mg/dL, or in therapy. Obesity was defined as a body mass index ≥25.0 kg/m 2 . Waist circumference was not included in the definition of obesity because this measurement was not available in this study. Subjects were considered to have MetS if they were taking medication for hypertension, hypercholesterolemia, hypertriglyce...
Tahtinen R M, Cartwright R, Tsui J F, Aaltonen R L, Aoki Y, Joronen K M, Mirza E, Oksjoki S M, Pe... more Tahtinen R M, Cartwright R, Tsui J F, Aaltonen R L, Aoki Y, Joronen K M, Mirza E, Oksjoki S M, Pesonen J S, Heels-Ansdell D, Guyatt G H, Tikkinen K A O 1. Dept. of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland, 2. Dept. of Epidemiology and Biostatistics, and Dept. of Urogynaecology, Imperial College London, UK, 3. Department of Urology, North ShoreLIJ Lenox Hill Hospital, New York City, New York, United States of America, 4. Dept. of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland, 5. Dept. of Urology, University of Fukui Faculty of Medical Sciences, Fukui, Japan, 6. Dept. of Obstetrics and Gynaecology, St Marys Hospital, London, UK, 7. Dept. of Urology, Tampere University Hospital, Tampere, Finland, 8. Dept. of Clinical Epidemiology and Biostatistics, Hamilton, ON, Canada, 9. Depts. of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Purpose: Although nocturia is associated with various comorbidities, its impact on falls and frac... more Purpose: Although nocturia is associated with various comorbidities, its impact on falls and fractures remains unclear. We performed a systematic review and meta-analysis to evaluate the association between nocturia and falls and fractures as a prognostic and as a causal risk factor. Materials and Methods: We searched PubMedÒ, ScopusÒ, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and abstracts of major urological meetings up to December 31, 2018. We conducted random effects meta-analyses of adjusted relative risks of falls and fractures. We applied the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach to rate the quality of evidence for nocturia as a prognostic and causal factor of falls and fractures. Results: Among 5,230 potential reports 9 observational longitudinal studies provided data on the association between nocturia and falls or fractures (1 for both, 4 for falls, 4 for fractures). Pooled estimates demonstrated a risk ratio of 1.20 (95% CI
The impact of delivery mode and number of deliveries on urinary incontinence (UI) has been debate... more The impact of delivery mode and number of deliveries on urinary incontinence (UI) has been debated, and vaginal delivery has been suggested as a risk factor for female UI. Other potential factors include age, body mass index (BMI), parity, smoking, diabetes mellitus, and hysterectomy. We investigated whether delivery mode and number of deliveries is associated with UI among Japanese women. METHODS: We investigated 514 women recruited from outpatient departments (except the departments of pediatrics, psychiatry and ophthalmology) at our university hospital, regardless of the reason for visiting, during a 2-week period (from August 6 to August 17, 2007). All participants were asked to answer a standardized self-reported questionnaire. Using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), overactive bladder symptom score (OABSS), and an original questionnaire, we evaluated urinary symptoms and delivery mode history. We analyzed the impact of mode and number of deliveries on UI. The chi-square test and logistic regression modeling were used for statistical analyses. Values of P<0.05 were considered statistically significant. RESULTS: A total of 429 individuals completed the questionnaire (response rate, 83.5%). The mean age of respondents was 51.3 years (range, 23-83 years). The prevalence of each disorder was as follows: stress UI (SUI), 38.5%; urgency UI (UUI), 23.5%. The prevalence of UI tended to increase with age. The mean number of deliveries was 2 (range, 0-6). The prevalence of delivery mode was as follows: vaginal, 76%; caesarean (and/or vaginal), 12%; and no deliveries, 12%. Univariate analysis revealed a significant association between number of deliveries and SUI. Age and BMI were also associated with SUI and UUI. In multivariate analysis, the independent risk factors for SUI were age, BMI and number of deliveries (odds ratios (ORs), 1.03, 1.06, and 1.40, respectively). On the other hand, type of delivery was not a risk factor for SUI (Table). For UUI, only age was identified as an independent risk factor (OR, 1.05; p<0.05). CONCLUSIONS: This study revealed the number of deliveries as an independent risk factor for SUI, but showed no significant relationship between UI and delivery mode among Japanese women.
is unclear. This study aims to investigate the direct effects of BoNT/A on sensory afferent firin... more is unclear. This study aims to investigate the direct effects of BoNT/A on sensory afferent firing in an ex vivo mouse bladder preparation. METHODS: Adult male mice were sacrificed humanely according to UK legislation. The whole pelvic region was dissected out and placed in a recording chamber superfused with oxygenated Krebs-bicarbonate solution (95% O2, 5% CO2) at 35°C. The urethra and dome were catheterised. Recording of afferent nerve firing was performed by placing a pelvic sensory nerve bundle into a suction electrode, as previously described (Daly et al, 2007). This preparation enabled simultaneous sampling of intravesical pressure and multiunit afferent nerve firing. Ramp distension (100μl.min-1) of the bladder with saline (NaCl, 0.9%) up to 40 mmHg was repeated at 10 minute intervals. To determine the effect of BoNT/A, 2U (BOTOX®) was applied to the bladder lumen during distension, preceded and followed by the control (saline) distension protocol. The effects of BoNT/A was monitored for over 2 hours post application. Data are presented as normalised to the response prior to application of BoNT/A and presented as mean ± S.E.M. Statistical analysis was carried out using either a 2-way ANOVA followed by a Bonferroni post test or paired Students t-test. RESULTS: Ramp distension of the bladder evoked a graded increase in afferent firing with increasing intravesical pressure, which was reproducible following repeated distensions with saline. Following addition of BoNT/A, the afferent response was significantly attenuated after 1 hour. At 2 hours, the maximum afferent firing at 40 mmHg was reduced by 75.9 ± 12.2% (control: 116 ± 13.6 vs. BoNT/A: 24.1 ± 12.2, P=0.0016, n=5). A 2-way ANOVA revealed statistically different afferent responses > 15 mmHg. Interestingly, bladder compliance was not affected after application of BoNT/A (P=0.38). CONCLUSIONS: These results indicate that intravesical BoNT/A directly attenuated distension evoked sensory afferent nerve firing in vitro. BoNT/A application did not affect bladder compliance. Further studies are required to determine how BoNT/A affects mechano-sensory pathways in the bladder. Daly D et al. J Physiol 2007 Sep;583(2):663-674
THE JOURNAL OF UROLOGY ® 339 significantly different among these three subgroups. Patients with l... more THE JOURNAL OF UROLOGY ® 339 significantly different among these three subgroups. Patients with level C impairment (1.97±1.93) had a significantly higher urinary NGF/Cr level than patients with level B (0.66±0.94, p=0.002) and level A (0.012±0.04, p<0.001). (Fig. 1) Conclusions: This study found that urinary NGF levels were elevated in patients with CVA. The elevated urinary NGF levels were not correlated with lesion sites, duration of stroke, or clinical urinary symptoms, but were correlated with the severity of neurological impairment. This result implies that urinary NGF levels could be used as a biomarker for the severity of brain damage after stroke.
Background : To assess the prognostic usefulness of the nuclear area index (NAI), a new nuclear m... more Background : To assess the prognostic usefulness of the nuclear area index (NAI), a new nuclear morphometric parameter expressed as the mean nuclear area (MNA) ratio of cancer to normal transitional cells in patients with bladder cancer, who have undergone radical cystectomy. Methods : Measurements of the nuclear areas of cancer and normal transitional cells were carried out on the histological slides of 73 patients with bladder cancer. The clinical usefulness of MNA, NAI, grade, and TNM categories for the prediction of the cause-specific survival of the patients was examined. Results : The median values of MNA and NAI in the 73 patients were 39 m m 2 and 1.2, respectively. Cause-specific survival rates of the patients were calculated according to stage (T1-2 vs T3-4), grade (grade 2 vs grade 3), MNA (< 39 m m 2 vs ≥ 39 m m 2) and NAI value (< 1.2 vs ≥ 1.2). Using univariate analysis, all these parameters were statistically significant prognostic factors. However, by multivariate analysis, NAI was the only independent variable for the survival of the patients (P < 0.01). Causespecific survival rates of patients with NAI values of less than 1.2 were significantly higher than those with NAI values of 1.2 or more, in both grade 2 and grade 3 tumors. Conclusions : These results suggest that NAI could provide improved prognostic information for patients with bladder cancer.
Background: Increasingly, quality of life (QOL) assessments are receiving greater attention in th... more Background: Increasingly, quality of life (QOL) assessments are receiving greater attention in the management of malignancies, including prostate cancer. We evaluated the impact of radical prostatectomy on patient QOL 12 months or longer after surgery.Patients and Methods: We evaluated the impact of radical prostatectomy on QOL in 60 patients with prostate cancer. The patients comprised two groups: the first group (n = 32) was evaluated 12 months or longer after radical prostatectomy; the second group (n = 28) was evaluated while awaiting radical prostatectomy. General health‐related QOL was measured with the European Organization for Research and Treatment of Cancer Prostate Cancer QOL Questionnaire. Sexual function was assessed with the Sapporo Medical University Sexual Function Questionnaire. A newly developed instrument assessing urinary function was prepared only for the postoperative group.Results: No differences between the two groups were seen in comparisons of general healt...
Hypothesis / aims of study The bladder epithelium acts as a sensory organ that responds to mechan... more Hypothesis / aims of study The bladder epithelium acts as a sensory organ that responds to mechanical and chemical stimulation by releasing neurotransmitters, such as acetylcholine, ATP, and prostaglandins (PGs). Researchers have hypothesized that these mediators can act on suburothelial afferent nerves and interstitial cells to modulate bladder activity during the storage phase. They have further suggested that detrusor overactivity caused by bladder outlet obstruction (BOO) may be initiated from the bladder outlet region rather than from the bladder itself (1). Pharmacological activation of urethral afferent nerves by intraurethral PGE2 elicited an excitatory effect on micturition reflex (2). Furthermore, immunohistochemical data have indicated the presence of capsaicinsensitive primary afferent fibers in the rat proximal urethra (3). Considering these findings, stretch-induced release of some mediators from the urethral epithelium may play an important role in the induction of de...
Xeroderma pigmentosum (XP) is a rare autosomal recessive disease caused by a defect in deoxyribon... more Xeroderma pigmentosum (XP) is a rare autosomal recessive disease caused by a defect in deoxyribonucleic acid repair. Along with cutaneous symptoms, neurological symptoms are important clinical features of XP. However, information on neurogenic bladder occurrence among XP cases is rare. Herein, we describe a case of neurogenic bladder in a patient with XP type A (XPA). In this case, low bladder compliance, impaired bladder emptying, and urethral sphincter discoordination were significant cystometric findings, and frequent febrile urinary tract infection was a clinical problem. XPA patients often cannot express their symptoms because of cognitive dysfunction. Close follow-up and assessments are necessary.
A 27-year-old Japanese man visited our urological department due to urinary frequency, and we det... more A 27-year-old Japanese man visited our urological department due to urinary frequency, and we detected a ureterocele by cystoscopy. The treatment consisted of an endoscopic-laser incision of the ureterocele. After the operation, the patient's symptoms subsided, and the vesicoureteral reflux and urinary infection disappeared. With the advances in image diagnostic technology, a ureterocele is easily diagnosed during childhood. In the present case, the ureterocele may have increased in volume over a period of decades, causing the urinary frequency. An endoscopic incision is the standard treatment for ureterocele, but there are concerns about vesicoureteric reflux after the endoscopic-laser incision, the patient is still doing well. The present case indicates that endoscopic-laser incision is an effective treatment for a ureterocele, at least in adult patients.
Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on heal... more Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions c...
Female lower urinary tract symptoms (LUTS) affect quality of life and sexual activity. This study... more Female lower urinary tract symptoms (LUTS) affect quality of life and sexual activity. This study aimed to evaluate the influences of LUTS on sexual well-being in Japanese women, as little is known on this topic. METHODS: We investigated 514 women recruited between August 6 and August 17, 2007, from the outpatient departments (except the departments of pediatrics, psychiatry and ophthalmology) at our hospital, regardless of the reason for visiting. All participants were asked to answer a standardized self-reported questionnaire. Using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the overactive bladder symptom score (OABSS), we evaluated urinary symptoms, including stress urinary incontinence, urgency, day time frequency, and nocturia. To assess satisfaction with sexual function, we asked the question "If you were to spend the rest of your life with your sexual function the way it is today, how would you feel about this?", with answer choices of "very satisfied", "somewhat satisfied", "neither satisfied nor dissatisfied", "somewhat dissatisfied" and "very dissatisfied", from part of a questionnaire from the Global Study of Sexual Attitudes and Behaviors (GSSAB) study. The top two categories for each aspect were collapsed to identify positive answers as being very or somewhat satisfied with the level of sexual function. We analyzed relationships between dissatisfaction with sexual function and other variables, including age, stress urinary incontinence, urgency (¼ once a day), daytime frequency (!8 times/day), and nocturia (¼ once a night). The chi-square test and logistic regression models were used for statistical analyses. Values of P<0.05 were considered statistically significant. RESULTS: A total of 360 individuals completed the questionnaire (response rate, 70.0%). The mean (AEstandard deviation) age of respondents was 48.3 AE 13.2 years. Prevalences of stress urinary incontinence, urgency, daytime frequency, and nocturia were 35.4%, 3.1%, 39.6%, and 55.0%, respectively. Overall, the prevalence of dissatisfaction with sexual function was 55.4%. In univariate analysis, age, urgency, and nocturia were associated with dissatisfaction with sexual function. In multivariate analysis, a significant correlation was found between dissatisfaction with sexual function and both age (odds ratio (OR), 1.05; p<0.001) and urgency (OR, 9.19; p¼0.047). CONCLUSIONS: Our study confirmed age and urgency as independent risk factors for dissatisfaction with sexual function. These results suggest that urgency can offer a predictor of sexual dysfunction among Japanese women.
Background. Chronic radiation proctopathy (CRP) is late toxicity and associated with morbidity. A... more Background. Chronic radiation proctopathy (CRP) is late toxicity and associated with morbidity. Aim. To investigate the predictors of prognosis in patients with CRP after brachytherapy (BT). Methods. One hundred four patients with prostate cancer were treated with BT or BT followed by external-beam radiotherapy (BT + EBRT). We retrospectively investigated the 5-year incidence of rectal bleeding and endoscopic findings of CRP using the Vienna Rectoscopy Score (VRS). Twenty patients with VRS ≥ 1 were divided into the improved VRS group without treatment, unchanged VRS group, and treated group. The parameters associated with alteration of VRS were analyzed. Results. The incidence of rectal bleeding was 24%. The risk of rectal bleeding was higher in patients treated with BT + EBRT compared to those treated with BT (p < 0.0001). The incidence of superficial microulceration was higher in the improved VRS group than in the unchanged VRS group (p < 0.05). The incidence of multiple con...
Background Healthcare costs are rising, and a substantial proportion of medical care is of little... more Background Healthcare costs are rising, and a substantial proportion of medical care is of little value. De-implementation of low-value practices is important for improving overall health outcomes and reducing costs. We aimed to identify and synthesize randomized controlled trials (RCTs) on de-implementation interventions and to provide guidance to improve future research. Methods MEDLINE and Scopus up to May 24, 2021, for individual and cluster RCTs comparing de-implementation interventions to usual care, another intervention, or placebo. We applied independent duplicate assessment of eligibility, study characteristics, outcomes, intervention categories, implementation theories, and risk of bias. Results Of the 227 eligible trials, 145 (64%) were cluster randomized trials (median 24 clusters; median follow-up time 305 days), and 82 (36%) were individually randomized trials (median follow-up time 274 days). Of the trials, 118 (52%) were published after 2010, 149 (66%) were conducted...
Study design, materials and methods We collected data on 5,701 individuals who participated in a ... more Study design, materials and methods We collected data on 5,701 individuals who participated in a multiphasic health screening in Fukui, Japan, in 2003 (baseline) and 2007, and were ≤65 years at baseline. After excluding participants with MetS at baseline, data from 5,234 participants (1,173 men and 4,061 women) were subjected to analysis. MetS diagnoses were made using the modified Japanese criteria, in which MetS was diagnosed when obesity plus two or more of following criteria were present: HDL cholesterol <40 mg/dL or triglycerides ≥150 mg/dL; systolic blood pressure ≥130 mmHg, diastolic blood pressure ≥85 mmHg, or on therapy; and fasting plasma glucose ≥110 mg/dL, or in therapy. Obesity was defined as a body mass index ≥25.0 kg/m 2 . Waist circumference was not included in the definition of obesity because this measurement was not available in this study. Subjects were considered to have MetS if they were taking medication for hypertension, hypercholesterolemia, hypertriglyce...
Tahtinen R M, Cartwright R, Tsui J F, Aaltonen R L, Aoki Y, Joronen K M, Mirza E, Oksjoki S M, Pe... more Tahtinen R M, Cartwright R, Tsui J F, Aaltonen R L, Aoki Y, Joronen K M, Mirza E, Oksjoki S M, Pesonen J S, Heels-Ansdell D, Guyatt G H, Tikkinen K A O 1. Dept. of Obstetrics and Gynecology, Kuopio University Hospital, Kuopio, Finland, 2. Dept. of Epidemiology and Biostatistics, and Dept. of Urogynaecology, Imperial College London, UK, 3. Department of Urology, North ShoreLIJ Lenox Hill Hospital, New York City, New York, United States of America, 4. Dept. of Obstetrics and Gynecology, University of Turku and Turku University Hospital, Turku, Finland, 5. Dept. of Urology, University of Fukui Faculty of Medical Sciences, Fukui, Japan, 6. Dept. of Obstetrics and Gynaecology, St Marys Hospital, London, UK, 7. Dept. of Urology, Tampere University Hospital, Tampere, Finland, 8. Dept. of Clinical Epidemiology and Biostatistics, Hamilton, ON, Canada, 9. Depts. of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
Purpose: Although nocturia is associated with various comorbidities, its impact on falls and frac... more Purpose: Although nocturia is associated with various comorbidities, its impact on falls and fractures remains unclear. We performed a systematic review and meta-analysis to evaluate the association between nocturia and falls and fractures as a prognostic and as a causal risk factor. Materials and Methods: We searched PubMedÒ, ScopusÒ, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and abstracts of major urological meetings up to December 31, 2018. We conducted random effects meta-analyses of adjusted relative risks of falls and fractures. We applied the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach to rate the quality of evidence for nocturia as a prognostic and causal factor of falls and fractures. Results: Among 5,230 potential reports 9 observational longitudinal studies provided data on the association between nocturia and falls or fractures (1 for both, 4 for falls, 4 for fractures). Pooled estimates demonstrated a risk ratio of 1.20 (95% CI
The impact of delivery mode and number of deliveries on urinary incontinence (UI) has been debate... more The impact of delivery mode and number of deliveries on urinary incontinence (UI) has been debated, and vaginal delivery has been suggested as a risk factor for female UI. Other potential factors include age, body mass index (BMI), parity, smoking, diabetes mellitus, and hysterectomy. We investigated whether delivery mode and number of deliveries is associated with UI among Japanese women. METHODS: We investigated 514 women recruited from outpatient departments (except the departments of pediatrics, psychiatry and ophthalmology) at our university hospital, regardless of the reason for visiting, during a 2-week period (from August 6 to August 17, 2007). All participants were asked to answer a standardized self-reported questionnaire. Using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), overactive bladder symptom score (OABSS), and an original questionnaire, we evaluated urinary symptoms and delivery mode history. We analyzed the impact of mode and number of deliveries on UI. The chi-square test and logistic regression modeling were used for statistical analyses. Values of P<0.05 were considered statistically significant. RESULTS: A total of 429 individuals completed the questionnaire (response rate, 83.5%). The mean age of respondents was 51.3 years (range, 23-83 years). The prevalence of each disorder was as follows: stress UI (SUI), 38.5%; urgency UI (UUI), 23.5%. The prevalence of UI tended to increase with age. The mean number of deliveries was 2 (range, 0-6). The prevalence of delivery mode was as follows: vaginal, 76%; caesarean (and/or vaginal), 12%; and no deliveries, 12%. Univariate analysis revealed a significant association between number of deliveries and SUI. Age and BMI were also associated with SUI and UUI. In multivariate analysis, the independent risk factors for SUI were age, BMI and number of deliveries (odds ratios (ORs), 1.03, 1.06, and 1.40, respectively). On the other hand, type of delivery was not a risk factor for SUI (Table). For UUI, only age was identified as an independent risk factor (OR, 1.05; p<0.05). CONCLUSIONS: This study revealed the number of deliveries as an independent risk factor for SUI, but showed no significant relationship between UI and delivery mode among Japanese women.
is unclear. This study aims to investigate the direct effects of BoNT/A on sensory afferent firin... more is unclear. This study aims to investigate the direct effects of BoNT/A on sensory afferent firing in an ex vivo mouse bladder preparation. METHODS: Adult male mice were sacrificed humanely according to UK legislation. The whole pelvic region was dissected out and placed in a recording chamber superfused with oxygenated Krebs-bicarbonate solution (95% O2, 5% CO2) at 35°C. The urethra and dome were catheterised. Recording of afferent nerve firing was performed by placing a pelvic sensory nerve bundle into a suction electrode, as previously described (Daly et al, 2007). This preparation enabled simultaneous sampling of intravesical pressure and multiunit afferent nerve firing. Ramp distension (100μl.min-1) of the bladder with saline (NaCl, 0.9%) up to 40 mmHg was repeated at 10 minute intervals. To determine the effect of BoNT/A, 2U (BOTOX®) was applied to the bladder lumen during distension, preceded and followed by the control (saline) distension protocol. The effects of BoNT/A was monitored for over 2 hours post application. Data are presented as normalised to the response prior to application of BoNT/A and presented as mean ± S.E.M. Statistical analysis was carried out using either a 2-way ANOVA followed by a Bonferroni post test or paired Students t-test. RESULTS: Ramp distension of the bladder evoked a graded increase in afferent firing with increasing intravesical pressure, which was reproducible following repeated distensions with saline. Following addition of BoNT/A, the afferent response was significantly attenuated after 1 hour. At 2 hours, the maximum afferent firing at 40 mmHg was reduced by 75.9 ± 12.2% (control: 116 ± 13.6 vs. BoNT/A: 24.1 ± 12.2, P=0.0016, n=5). A 2-way ANOVA revealed statistically different afferent responses > 15 mmHg. Interestingly, bladder compliance was not affected after application of BoNT/A (P=0.38). CONCLUSIONS: These results indicate that intravesical BoNT/A directly attenuated distension evoked sensory afferent nerve firing in vitro. BoNT/A application did not affect bladder compliance. Further studies are required to determine how BoNT/A affects mechano-sensory pathways in the bladder. Daly D et al. J Physiol 2007 Sep;583(2):663-674
THE JOURNAL OF UROLOGY ® 339 significantly different among these three subgroups. Patients with l... more THE JOURNAL OF UROLOGY ® 339 significantly different among these three subgroups. Patients with level C impairment (1.97±1.93) had a significantly higher urinary NGF/Cr level than patients with level B (0.66±0.94, p=0.002) and level A (0.012±0.04, p<0.001). (Fig. 1) Conclusions: This study found that urinary NGF levels were elevated in patients with CVA. The elevated urinary NGF levels were not correlated with lesion sites, duration of stroke, or clinical urinary symptoms, but were correlated with the severity of neurological impairment. This result implies that urinary NGF levels could be used as a biomarker for the severity of brain damage after stroke.
Background : To assess the prognostic usefulness of the nuclear area index (NAI), a new nuclear m... more Background : To assess the prognostic usefulness of the nuclear area index (NAI), a new nuclear morphometric parameter expressed as the mean nuclear area (MNA) ratio of cancer to normal transitional cells in patients with bladder cancer, who have undergone radical cystectomy. Methods : Measurements of the nuclear areas of cancer and normal transitional cells were carried out on the histological slides of 73 patients with bladder cancer. The clinical usefulness of MNA, NAI, grade, and TNM categories for the prediction of the cause-specific survival of the patients was examined. Results : The median values of MNA and NAI in the 73 patients were 39 m m 2 and 1.2, respectively. Cause-specific survival rates of the patients were calculated according to stage (T1-2 vs T3-4), grade (grade 2 vs grade 3), MNA (< 39 m m 2 vs ≥ 39 m m 2) and NAI value (< 1.2 vs ≥ 1.2). Using univariate analysis, all these parameters were statistically significant prognostic factors. However, by multivariate analysis, NAI was the only independent variable for the survival of the patients (P < 0.01). Causespecific survival rates of patients with NAI values of less than 1.2 were significantly higher than those with NAI values of 1.2 or more, in both grade 2 and grade 3 tumors. Conclusions : These results suggest that NAI could provide improved prognostic information for patients with bladder cancer.
Background: Increasingly, quality of life (QOL) assessments are receiving greater attention in th... more Background: Increasingly, quality of life (QOL) assessments are receiving greater attention in the management of malignancies, including prostate cancer. We evaluated the impact of radical prostatectomy on patient QOL 12 months or longer after surgery.Patients and Methods: We evaluated the impact of radical prostatectomy on QOL in 60 patients with prostate cancer. The patients comprised two groups: the first group (n = 32) was evaluated 12 months or longer after radical prostatectomy; the second group (n = 28) was evaluated while awaiting radical prostatectomy. General health‐related QOL was measured with the European Organization for Research and Treatment of Cancer Prostate Cancer QOL Questionnaire. Sexual function was assessed with the Sapporo Medical University Sexual Function Questionnaire. A newly developed instrument assessing urinary function was prepared only for the postoperative group.Results: No differences between the two groups were seen in comparisons of general healt...
Hypothesis / aims of study The bladder epithelium acts as a sensory organ that responds to mechan... more Hypothesis / aims of study The bladder epithelium acts as a sensory organ that responds to mechanical and chemical stimulation by releasing neurotransmitters, such as acetylcholine, ATP, and prostaglandins (PGs). Researchers have hypothesized that these mediators can act on suburothelial afferent nerves and interstitial cells to modulate bladder activity during the storage phase. They have further suggested that detrusor overactivity caused by bladder outlet obstruction (BOO) may be initiated from the bladder outlet region rather than from the bladder itself (1). Pharmacological activation of urethral afferent nerves by intraurethral PGE2 elicited an excitatory effect on micturition reflex (2). Furthermore, immunohistochemical data have indicated the presence of capsaicinsensitive primary afferent fibers in the rat proximal urethra (3). Considering these findings, stretch-induced release of some mediators from the urethral epithelium may play an important role in the induction of de...
Xeroderma pigmentosum (XP) is a rare autosomal recessive disease caused by a defect in deoxyribon... more Xeroderma pigmentosum (XP) is a rare autosomal recessive disease caused by a defect in deoxyribonucleic acid repair. Along with cutaneous symptoms, neurological symptoms are important clinical features of XP. However, information on neurogenic bladder occurrence among XP cases is rare. Herein, we describe a case of neurogenic bladder in a patient with XP type A (XPA). In this case, low bladder compliance, impaired bladder emptying, and urethral sphincter discoordination were significant cystometric findings, and frequent febrile urinary tract infection was a clinical problem. XPA patients often cannot express their symptoms because of cognitive dysfunction. Close follow-up and assessments are necessary.
A 27-year-old Japanese man visited our urological department due to urinary frequency, and we det... more A 27-year-old Japanese man visited our urological department due to urinary frequency, and we detected a ureterocele by cystoscopy. The treatment consisted of an endoscopic-laser incision of the ureterocele. After the operation, the patient's symptoms subsided, and the vesicoureteral reflux and urinary infection disappeared. With the advances in image diagnostic technology, a ureterocele is easily diagnosed during childhood. In the present case, the ureterocele may have increased in volume over a period of decades, causing the urinary frequency. An endoscopic incision is the standard treatment for ureterocele, but there are concerns about vesicoureteric reflux after the endoscopic-laser incision, the patient is still doing well. The present case indicates that endoscopic-laser incision is an effective treatment for a ureterocele, at least in adult patients.
Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on heal... more Urinary incontinence symptoms are highly prevalent among women, have a substantial effect on health-related quality of life and are associated with considerable personal and societal expenditure. Two main types are described: stress urinary incontinence, in which urine leaks in association with physical exertion, and urgency urinary incontinence, in which urine leaks in association with a sudden compelling desire to void. Women who experience both symptoms are considered as having mixed urinary incontinence. Research has revealed overlapping potential causes of incontinence, including dysfunction of the detrusor muscle or muscles of the pelvic floor, dysfunction of the neural controls of storage and voiding, and perturbation of the local environment within the bladder. A full diagnostic evaluation of urinary incontinence requires a medical history, physical examination, urinalysis, assessment of quality of life and, when initial treatments fail, invasive urodynamics. Interventions c...
Female lower urinary tract symptoms (LUTS) affect quality of life and sexual activity. This study... more Female lower urinary tract symptoms (LUTS) affect quality of life and sexual activity. This study aimed to evaluate the influences of LUTS on sexual well-being in Japanese women, as little is known on this topic. METHODS: We investigated 514 women recruited between August 6 and August 17, 2007, from the outpatient departments (except the departments of pediatrics, psychiatry and ophthalmology) at our hospital, regardless of the reason for visiting. All participants were asked to answer a standardized self-reported questionnaire. Using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and the overactive bladder symptom score (OABSS), we evaluated urinary symptoms, including stress urinary incontinence, urgency, day time frequency, and nocturia. To assess satisfaction with sexual function, we asked the question "If you were to spend the rest of your life with your sexual function the way it is today, how would you feel about this?", with answer choices of "very satisfied", "somewhat satisfied", "neither satisfied nor dissatisfied", "somewhat dissatisfied" and "very dissatisfied", from part of a questionnaire from the Global Study of Sexual Attitudes and Behaviors (GSSAB) study. The top two categories for each aspect were collapsed to identify positive answers as being very or somewhat satisfied with the level of sexual function. We analyzed relationships between dissatisfaction with sexual function and other variables, including age, stress urinary incontinence, urgency (¼ once a day), daytime frequency (!8 times/day), and nocturia (¼ once a night). The chi-square test and logistic regression models were used for statistical analyses. Values of P<0.05 were considered statistically significant. RESULTS: A total of 360 individuals completed the questionnaire (response rate, 70.0%). The mean (AEstandard deviation) age of respondents was 48.3 AE 13.2 years. Prevalences of stress urinary incontinence, urgency, daytime frequency, and nocturia were 35.4%, 3.1%, 39.6%, and 55.0%, respectively. Overall, the prevalence of dissatisfaction with sexual function was 55.4%. In univariate analysis, age, urgency, and nocturia were associated with dissatisfaction with sexual function. In multivariate analysis, a significant correlation was found between dissatisfaction with sexual function and both age (odds ratio (OR), 1.05; p<0.001) and urgency (OR, 9.19; p¼0.047). CONCLUSIONS: Our study confirmed age and urgency as independent risk factors for dissatisfaction with sexual function. These results suggest that urgency can offer a predictor of sexual dysfunction among Japanese women.
Background. Chronic radiation proctopathy (CRP) is late toxicity and associated with morbidity. A... more Background. Chronic radiation proctopathy (CRP) is late toxicity and associated with morbidity. Aim. To investigate the predictors of prognosis in patients with CRP after brachytherapy (BT). Methods. One hundred four patients with prostate cancer were treated with BT or BT followed by external-beam radiotherapy (BT + EBRT). We retrospectively investigated the 5-year incidence of rectal bleeding and endoscopic findings of CRP using the Vienna Rectoscopy Score (VRS). Twenty patients with VRS ≥ 1 were divided into the improved VRS group without treatment, unchanged VRS group, and treated group. The parameters associated with alteration of VRS were analyzed. Results. The incidence of rectal bleeding was 24%. The risk of rectal bleeding was higher in patients treated with BT + EBRT compared to those treated with BT (p < 0.0001). The incidence of superficial microulceration was higher in the improved VRS group than in the unchanged VRS group (p < 0.05). The incidence of multiple con...
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Papers by Yoshitaka Aoki