(Purpose) To translate the UCLA Prostate Cancer Index (UCLA PCI), which is designed to measure Quality of Life (QOL) of patients with prostate cancer, and to adapt it as needed for use in Japan. (Methods) We translated the original English version into a preliminary Japanese version in a multi-stage procedure according to established guidelines. Then, we tested the preliminary Japanese version on 6 patients with prostate cancer, and we revised the Japanese version based on the findings of the pilot test. (Results) The backtranslation of the preliminary Japanese version was reviewed by its original developer, and some wordings were revised. In the pilot testing, the average time required to complete the questionnaire was 5.5 minutes. Four of the 20 items frequently had missing data (>15%). This is believed to have been due to inappropriate wording of the response choices, which were revised accordingly. (Conclusion) We conducted translation and cross-cultural adaptation of the Japanese version of UCLA PCI. Pilot testing proved to be useful in refining items and response choices.
(Purpose) To evaluate linguistic validity of the Japanese version of International Prostate Symptom Score (IPSS) and BPH Impact Index (BII). (Methods) The translation was performed through multi-step procedure. Forward translation was created through the discussion by 5 urologists, 2 Japanese translators and 1 nurse on independent translations of the discussants and the translation published in the Guideline in Japan. Back translation was made by 2 native speakers of American English, and negotiated with the original developers. A person-to-person in-depth interview was carried out on 20 patients with benign prostatic hyperplasia. (Results) The developers generally approved our translation, but had 2 major concerns in the Japanese version; 1) “how often” in every sentence of English version was not translated into Japanese, and 2) the Japanese expression in the response choices of QOL index should be more emotional. The former concern was compromised by placing a sentence at the beginning of the questionnaire explaining that the response should be considered in frequency. The latter concern was examined in a pre-test involving additional 88 patients and compromised by making the translation of some response choices more emotional. (Conclusion) We evaluated linguistic validity of Japanese translations of IPSS and BII, and proposed a valid Japanese version of these questionnaires.
(Purpose) Applying the systemic inflammatory response syndrome (SIRS), we investigated the surgical invasiveness of augmentation ileocystoplasty in patients with spina bifida. (Materials and Methods) A total of 23 patients with spina bifida underwent augmentation ileocystoplasty. We diagnosed the cases as SIRS when they fulfilled at least 2 of the 4 SIRS criteria. We developed SIRS score, the sum of the number of positive items for the duration of SIRS, as a parameter of surgical invasiveness. We investigated the relationships between SIRS score and various factors and compared SIRS scores of augmentation with those of other urological operations as a control, which consisted of radical prostatectomy (25 patients) and radical nephrectomy (20 patients). (Results) We found a positive relationship between SIRS score and the operation time of augmentation. SIRS scores were significantly higher in the patients who underwent operations diverting ventriculoperitoneal shunt to ventriculoatrial shunt concurrently with augmentation. However, the operation times were not significantly different between the cases with and without shunt operations. SIRS scores in cases of augmentation were significantly higher than those of the major urological operations compared. (Conclusion) When evaluated by the SIRS score, the factors related to the surgical invasiveness of augmentation ileocystoplasty were a longer operating time and concurrent shunt diversion. The higher invasiveness of this operation compared with major urological operations was also revealed. These facts should be considered carefully when the indications for augmentation ileocystoplasty are determined.
(Purpose) Prostate cancer is generally controlled by endocrine therapy even in an advanced state, but relapse may occur in many cases. Generally, the prognosis of a relapsed case is poor, but the prognosis differs case by case. We experienced 74 cases of prostate cancer relapsed after effective endocrine therapy, and investigated the relationship between the PSA-related parameters, clinical stage and prognosis. (Patients and methods) We investigated 74 prostate cancer patients whose PSA declined 10ng/ml or lower by the treatment consisting of endocrine therapy, but relapsed later. Pre-treatment PSA, the value of PSA nadir, the period from the start of treatment to PSA nadir, the period from the start of treatment to relapse, PSA doubling time (PSA-DT) at relapse and PSA response to the second line therapy at relapse were calculated, and compared with the clinical stage and prognosis. The relationship between each PSA parameter and clinical stage was tested using the Kruskal-Wallis test and χ2 test. Cancer-specific survival after relapse in stage D patients was calculated by the Kaplan-Meier method and differences in prognosis were tested using the Logrank test. (Results) Pre-treatment PSA was significantly (p<0.01) high, while the period from the start of treatment to relapse (p<0.05) and PSA-DT at relapse (p<0.01) was significantly short as the stage progressed. According to PSA response to the second line therapy at relapse, the rate of CR+PR was significantly (p<0.05) high in clinical stage B+C group compared to clinical stage D group. The prognosis after relapse was significantly poorer in patients with relapse within 10 months after start of treatment than in those with relapse later, and in patients whose PSA-DT at relapse was shorter than 2 months than in those with a longer PSA-DT. (Conclusions) The period from the start of treatment to relapse, and PSA-DT at relapse were useful PSA-related parameters for predicting prognosis after relapse, and for determining the strategy of cancer therapy atter relapse. Using these data, the physician can inform the family and the patient of the prognosis more accurately, so that they can adjust future plans.
(Purpose) We retrospectively evaluated the outcome of Hautmann neobladder reconstruction in terms of complications, lower urinary tract symptoms, and sexual function in a large group of patients who underwent radical cystectomy. (Methods) We reviewed the medical records of 118 patients (105 men and 13 women) who underwent radical cystectomy and Hautmann neobladder construction at the Gifu University Hospital or one of its affiliate hospitals between Jan 1993 and Dec 1999. The 118 patients were asked to complete a questionnaire regarding lower urinary tract symptoms and sexual activity, and the data was compiled. (Results) The mean follow-up period was 50.4 months (range, 6.8-88.2). Early complications comprised wound infection (in 17.8% of patients) and ileus (in 10.1% of patients). Late complications comprised ileus, pyelonephritis, stone, and stricture of the pouch-urethral anastomosis, each of which occurred in 3.4% of patients. Eighty-one (73 men and 8 women, 72.9%) of 90 surviving patients replied to the questionnaire. Seventy-seven (95.1%) of these patients reported spontaneous micturition, whereas 4 (4.9%) patients required intermittent self-catheterization. The mean total I-PSS was 11.6 points. Twenty-five percent of patients experienced interrupted voiding almost always; 38% of patients did not experience this at all. Approximately 26% of patients experienced weak urinary streams; 36% did not. Daytime continence was achieved in 97.3% of patients; nighttime incontinence was present in 61.3%. Preoperatively, 79.7% of the men were capable of sexual intercourse. Postoperatively, 63.6% of men who underwent radical cystectomy with the nerve-sparing procedure were capable of sexual intercourse, whereas only 14.8% of men who underwent radical cystectomy without the nerve-sparing procedure were. (Conclusions) Morbidity rates were acceptable and functional outcome was excellent in this rather large group of patients who underwent Hautmann neobladder construction. Some problems have not been fully overcome, however, i. e., nocturnal incontinence and sexual dysfunction.
(Purpose) The long-term results were studied in patients who underwent transcatheter arterial embolization (TAE) for the spontaneous rupture of renal angiomyolipoma (AML). (Materal and Methods) Five cases (1male, 4 females) who underwent TAE for spontaneous AML rupture between November, 1996 and February 2000 were studied. Spontaneous rupture of AML was diagnosed with CT. TAE were carried out by injection of ethanol and lipiodol and application of either a metal coil or gelform. (Result) In 4 cases, after performing TAE only one time, the tumor size was reduced and there has been no re-rupture or re-bleeding during the ongoing follow-up. In the other case, an enucleation operation was carried out 11 days after TAE in accordance with the patient's request. (Discussion) Recently, there have been a few reports on the long-term effectiveness of TAE, a conservative treatment for renal AML rupture. Our study indicated that TAE might be recommended for patients with renal AML rupture not only for stanching and pre-operative treatment but also for a conservative treatment with regular follow-up.
We report here the 21st case of polyorchidism in Japan. A 3-year-old boy with left undiscending testis was refered to our hospital for orchiopexy. At surgery, the undiscending testis was identified as two testes. We performed left orchiopexy, because these testes had no malignancy.
A 38-year-old man who had been followed with diagnosis of dilated cardiomyopathy and retinal angioma was referred to our hospital because of incidentally detected bilateral adrenal masses. Although he was normotensive, levels of catecholamine in urine were elevated and I131-MIBG scintigraphy showed accumulation in bilateral adrenal glands. Screening of central nervous system by MRI revealed cerebellar hemangioblastoma. Right adrenalectomy and left partial adrenalectomy were performed, both of which tumors pathologically diagnosed as pheochromocytoma, followed by resection of the cerebellar hemangioblastoma. Five months later, abdominal CT revealed a left renal tumor and underwent left partial nephrectomy, being diagnosed as renal cell carcinoma. A right renal tumor was detected on follow up CT at 1 year after the partial nephrectomy. Since cardiac function was deteriorated, we have followed with careful observation. This is the second documented case of bilateral renal cell carcinomas and bilateral pheochromocytomas with VHL in Japan.
A patient with non-seminomatous germ cell tumor of testis underwent operations for metastases in the lung and mediastinum three times, when the serum AFP level remained remarkably high despite of intensive chemotherapy, and has been disease-free for three years after the last treatment. Our experience illustrates that the salvage surgery even under high serum marker levels may provide a beneficial outcome for selected cases of chemotherapy-resistant germ cell tumors.