Postoperative urinary incontinence is a major impairment to patients' quality of life after prostatectomy, and is not limited to laparoscopic total prostatectomy. Improvements in devices and techniques of laparoscopic surgery have facilitated reliable cancer control, and in this situation there will now be increasing focus on postoperative quality of life (QOL), particularly urinary incontinence. Between July 2007 and March 2009, we have performed laparoscopic total prostatectomy for 53 patients, focusing on techniques to reduce urinary incontinence. Here we report the details of six key points of operative skill for achieving better urinary continence. These include 1) minimal distal incision of the endopelvic fascia; 2) preservation of the bladder neck; 3) bilateral nerve-sparing surgery; 4) preservation of the puboprostatic ligament and its refixation to the anterior aspect of the bladder neck (bladder neck sling suspension); 5) preservation of the posterior (membranous) urethra; 6) suturing of the posterior aspect of the rhabdosphincter, the remaining portion of the Denonvilliers fascia, and the bladder neck (restoration of the Denonvilliers fascia). Moreover, we separated the 53 patients into two groups: those who were not treated using the above six key points, and those who were. We then compared the data for the two groups with regard to the time taken for continence recovery, operative parameters (operation time and bleeding), and postoperative pathological findings.
(Objectives) We retrospectively evaluated patients who received silodosin for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH/LUTS) in our hospital, to investigate its efficacy, adverse events and continuance rate. (Methods) From the release of silodosin (July 2006) through October 2008, 256 patients received silodosin for BPH/LUTS in our hospital. Of these 256, we evaluated 195, as 61 were excluded due to conditions such as prostate cancer. We evaluated the International Prostate Symptom Score (IPSS), quality of life (QOL) index, uroflowmetry and postvoid residual urine volume before and after medication. We calculated the continuance rate of the drug by the Kaplan-Meier method. (Results) The patients' mean age was 68.1 years and the mean medicated period was 3.1 months. Overall severity at baseline estimated by the criteria for severity of BPH was mild in 0%, moderate in 69%, and severe in 31%. Silodosin significantly improved the IPSS, QOL index, maximum urinary flow rate and postvoid residual urine volume in 90 patients whose data were available for analysis of the efficacy. Improvements were observed both in voiding symptoms and in storage symptoms. However, 45.6% of the overall efficacy was insufficient. Adverse events were observed in 56 of the 195 cases (28.7%). The most common adverse event was abnormal ejaculation (10.8%). The patients who reported adverse events were significantly younger in age and had lower IPSS and QOL index values after treatment than those without adverse events (mean age: 65.4 vs. 69.2 years old; mean IPSS: 7.7 vs. 13.1, mean QOL index: 2.9 vs. 3.6). The continuance rate for the drug was 12.0% at 1 year on the Kaplan-Meier curve. The development of adverse events was involved in the low continuance rate of silodosin. (Conclusions) Modification of treatment such as dose reduction is necessary to continue silodosin.
(Purpose) The usefulness of the screening for prostate cancer with prostate specific antigen (PSA) in the medical checkup ("Human Dock") at Onomichi Municipal Hospital was evaluated. (Methods) From April 1997 to December 2007, serum PSA of 1,234 male (median age: 59) was measured in the medical checkup and each parameter of screening was evaluated. In addition, for the cases with prostate cancer, results of treatment and clinical significance were assessed. (Results) PSA was elevated in 82 cases (6.6%), aged 42-87 (median 64), in which PSA varied 3.1-66.5ng/ml (median 5.4). Trans-rectal biopsy was performed in 35 cases and prostate cancer was detected in 15 (42.9% of biopsied cases and 1.2% of whole group), aged 58-81 (median 70), with PSA value 4.2-66.5ng/ml (median 10.3). Clinical stage of these cases was cT1cN0M0 in 12 and cT2aN0M0 or more in 3, Gleason score was 3+3 in 4 and 3+4 or more in 11. Initial treatment was radical prostatectomy in 12, androgen-deprivation therapy in 2 and external beam irradiation in 1. During the follow-up for 8-107 months (median 60), 14 were alive with good control and 1 was alive with relapse. Only one case was "clinically insignificant" cancer (impalpable and localized and tumor volume less than 0.5ml and Gleason score 3+3 or less). (Conclusions) Most of the prostate cancers detected in the medical checkup were clinically significant, therefore, PSA screening doesn't result in overtreatment and it is meaningful to perform PSA screening in the medical checkup.
(Objective) A specific screening test system for detection of Metabolic Syndrome was started in April 2008. This test includes urine protein but omits serum creatinine. This test system assumes this position based on the view that health guidance or recommendation of health examination in subjects diagnosed with hypertension or diabetes mellitus will help detect otherwise overlooked renal dysfunction. I conducted an investigation to obtain evidence that the specific screening test system can detect CKD. (Materials and methods) The investigation was conducted in 931 subjects who had been examined for urine protein, blood pressure, blood glucose, and serum creatinine. This investigation was invested with an aim to determine the frequency of renal dysfunction among the subjects in whom CKD is ruled out in the specific screening test because they test negative for urine protein. (Results) Of the 931 subjects, 169 developed a positive test for urine protein. Of 762 subjects testing negative for urine protein, 226 had renal dysfunction with eGFR<60ml/min/1.73m2. The urine protein test alone let 57.2% (226/395) of subjects escape the detection of CKD. Of the 226 subjects, 156 had hypertension and/or diabetes mellitus and were found to have renal dysfunction when their serum creatinine concentration was determined. As a result, the rate of CKD overlooking was reduced to 17.7% (70/395), but the sensitivity and specificity of this test system were 69.0% and 43.7%, respectively. It is still insufficient in these respects. (Conclusion) The specific screening test system let 226 of 395 subjects (57.2%) escape the detection of CKD. This result suggests that the test system should include the measurement of serum creatinine concentration.
We report on 2 infants with acute renal failure caused by bilateral obstructive ureteral stones associated with rotavirus gastroenteritis. A 28-month boy and a 13-month boy with several days history of watery diarrhea and vomiting were referred to our hospital because of anuria. They were diagnosed acute post-renal failure due to obstructive bilateral ureteral stones based on the findings of ultrasound scan and computed tomography. Immediately, percutaneous nephrostomy tubes were inserted for urinary drainage, serum levels of creatinine and uric acid returned to normal within several days. Sandy stones were excreted through the nephrostomy tubes with urine after urinary alkalization, which were proved to be mainly ammonium acid urate. Ammonium acid urate is rare in developed countries, but some cases of bilateral urolithiasis causing acute renal failure in infants with rotavirus gastroenteritis were reported in recent years. It has been known that the cause of acute renal failure is renal azotemia resulting from sustained hypovolemia, but post-renal causes due to ammonium acid urate stones should be taken into consideration.
The malignant tumor patient tends to develop various neuropathy by direct invasion, metastasis, secondary infectious disease of tumor, metabolic disorders, vascular damage and adverse drug reactions with a treatment, and, however, it rarely appear by mechanism of autoimmunization.Tumor tissue with paraneoplastic neurological syndrome (PNS) produces an antigen attacking nerve tissue by it's cross reaction, and many studies indicates that there are a few kinds of antineuritic antibodies occurred by the charactor of malignant diseases or the patterns of progression.There is no relationship between the symptoms and the progression of disease. We report a case of malignant testicular tumor presented the paraneoplastic limbic encephalitis which is one of paraneoplastic neurological syndrome.