(Objective) To assess the safety and efficacy of photoselective vaporization of the prostate (PVP) using 80 watt high power potassium-titanyl-phosphate (KTP) laser for benign prostatic hyperplasia (BPH). (Methods) Fifty-seven patients with lower urinary tract symptoms secondary to benign prostatic hyperplasia underwent 80W KTP laser vaporization of the prostate. According to their International Prostate Symptom Score Index (IPSS) and Quality of life (QOL) score as well as measurements of their peak flow rate and postvoiding residual urine volume (RUV), they fulfilled the diagnostic criteria of BPH. Vaporization was performed with the GreenLight PV® ADDStat™ fiber, which was inserted through a 22.5Fr. continuous flow laser cystoscope, and a saline solution was used for irrigation. KTP laser energy was generated by a GreenLight PV® (Minnetonka, Minnesota) generator. The end point of the procedure was to create a cavity like in TURP. Once vaporization was completed, an 18Fr Foley catheter was inserted and was removed the next morning, as a rule. Patients were evaluated preoperatively, and at 2 weeks and 1, 3 and 6 months postoperatively. (Results) The procedure could be performed without any intraoperative complication. None of the patients required continuous bladder irrigation or blood transfusion postoperatively. The mean age was 71.0±8.3 years (range 52 to 86). The preoperative prostate volume was 41.0±24.9 (mean±SD, range 6.7 to 107.2) and the preoperative serum PSA was 4.5±4.1ng/ml. Preoperative and immediate postoperative serum sodium concentration was 141.9±1.8mEq/L and 142.2±1.8mEq/L, respectively (p=0.23). The hemoglobin value changed from 14.0±1.4mg/dl preoperatively to 13.4±1.4mg/dl postoperatively. The operating time was 68.3±35.0 minutes (range 21 to 170) and total laser energy was 171.1±80.3kJ (range 18.1 to 484.8). The catheter indwelling time was 18.6±3.3hrs (range 15 to 48). At 2 weeks and 1, 3 and 6 months the International Prostate Symptom Score decreased from 20.2±8.9 to 11.4±7.8, 9.3±6.0, 6.6±5.0 and 6.1±5.0, respectively. The maximum urinary flow increased from 7.2±2.9mL/s to 13.6±7.6, 12.2±6.1, 15.3±7.4, and 15.3±7.5mL/s, respectively. (Conclusions) Photoselective vaporization of the prostate (PVP) using the high power (80W) potassium-titanyl-phosphate laser for benign prostatic hyperplasia (BPH) proved to be an effective and safe procedure for our patients.
(Purpose) Little is known regarding factors for decision-making on treatment by localized prostate cancer patients. We therefore conducted a survey series of cases for influence on treatment decision making, and also satisfaction after therapy. (Materials and methods) A total of 51 patients with localized prostate cancer treated with radical prostatectomy (RP) or external beam radiation therapy (EBRT) were mailed original questionnaires about their treatment decision-making factors and satisfaction and the results compared between the two groups. (Result) Some 48 (94.1%) patients responded to the questionnaire, 38 (79.2%) and 10 (20.8%) after RP and EBRT, respectively. The major factor determining the decision as to treatment approach was the physician in both groups (more than 90%). Excluding physicians, family or others were more important in the RP group than the EBRT group (p=0.023). RP group patients desired removal of their prostate for cancer control, while, EBRT group patients favored the less invasive approach in consideration of side effects. Over 80% patients indicated they would definitely or probably choose the same treatment again, although some of the RP group would switch to watchfulwaiting because of sexual dysfunction, urinary incontinence and the invasive nature of the procedure. (Conclusion) Physicians are in a most important position to help patients understand prostate cancer and treatment, outcomes, and need to help them make their best choice, with appropriate follow up including mental care.
(Objectives) We investigated perioperative management for transurethral resection of the prostate (TURP) in Japan. (Methods) The questionnaire survey was conducted in 1, 213 educational institutions for urology. (Results) The questionnaires were returned from 722 (60%) institutions. Admission to hospital was most frequently scheduled on preoperative day 1; termination of continuous drip infusion, starting meal intake and walking on postoperative day 1; intravenous antibiotics for three days; removal of Foley catheter on postoperative day 4; oral antibiotics for 7 days; and discharge from hospital on postoperative day 7. (Conclusion) Although hospitalization was 14 days or less at most institutions, several procedures, especially the administration of prophylactic antibiotics, were fairly varied. Discussions from various perspectives might be needed to standardize the perioperative management of TURP in Japan.
(Objective) Enlarged prostate often causes pubic arch interference during needle insertion on transperineal interstitial permanent prostate brachytherapy. Pre-treatment hormonal therapy is necessary for downsizing the prostate gland in such cases. The degree of prostate downsizing with antiandrogen treatment before iodine 125 permanent seed implant brachytherapy and its relation to clinical as well as pathological parameters were assessed. (Methods) From September 2003 to March 2005, 110 patients underwent permanent seed implantation and 86 patients of all received antiandrogen depriviation prior to the treatment at our institute. Prostate volume was measured using transrectal ultrasound at the time of cancer diagnosis and before the seed implant. Correlations between prostate downsizing and clinical as well as pathological parameters were evaluated. (Results) Mean percent volume of the prostate after the size reduction with average of 6.0 months antiandrogen monotherapy, 7.7 months LHRH agoniott and 8.2 months maximum androgen blockage (MAB) was 83%, 63%, and 60%, respectively. Mann-Whitney U test revealed that the degree of prostate downsizing is significantly correlated with the prostate volume in patients with prostate cancer utilizing LHRH agonists. (Conclusions) Antiandrogen monotherapy can be an alternative for prostate downsizing before interstitial brachytherapy. Utilizing LHRH agonists or MAB is recommended for cases with larger gland volume.
(Purpose) Clinical study of acute urinary retention seen by this department. (Materials and Methods) Subjects were 206 cases seen during office hours and during after-hours emergency care by the department of Urology at the Kinki University Hospital for acute urinary retention for the 12-year-period from April 1993 to April 2005. (Results) By gender, the 206 cases of acute urinary retention included 175 men (85%) and 31 women (15%). The ratio of men to women was 5.6:1, with a markedly larger number of male cases. Ages of the 206 cases overall were distributed from 6 to 93 years old and the mean age was 66 years old. In male cases, the mean age was 69.6 years old while in female cases it was 46.3 years old. With regard to the cause, bladder outlet obstruction (BOO) accounted for 123 (70.3%) of the 175 male cases; benign prostatic hyperplasia (BPH) was noted in 92 cases and accounted for 52.6%of the total. Detrusor Weakness (DW) was noted in 35 cases (20%). DW was most prevalent in women, being noted in 20 cases (64.5%). With regard to treatment, in male cases surgery was performed for BOO in 69 (56%) of 123 cases; surgery was performed for BPH in 56 (60.8%) of 92 cases, drug therapy was used in 19 cases, and 3 cases were observed. In female cases, 10 cases were able to urinate on their own through treatment of the causative disorder. With regard to outcome, ultimately a total of 139 cases (67.5%), 125 men and 14 women, were able to urinate on their own. (Conclusions) 1.85% of acute urinary retention cases were men. Of these, 70% were caused by some form of BOO. DW due to a cause other than obstruction accounted for about 70% of the remaining 30%. 2. Overall, 70% of cases were able to urinate on their own after treatment while 30% required catheterization. 3. After the cause of BOO was eliminated, cases were likely to be able to urinate on their own; CIC (clean intermittent catheterization) was frequently used in treatment of causes other than BOO. 4.15 % of acute urinary retention cases were women.
A 47-year-old woman with previous history of transvaginal uterectomy 4 years before, presented to another hospital complaining of pollakisuria and pain during micturition. She was treated with antibiotics, but symptoms failed to resolve. So she referred to our department for investigations and treatments. On cystoscopy, there was a large mass with edematous mucosa in the anterior wall of bladder. Magnetic resonance image demonstrated an 8cm irregularly-formed cystic mass which occupied dome of bladder. Resection of the mass including partial cystectomy was performed. This cystic mass contained retained 3 silk sutures surrounded by green color pus. Microscopic examination revealed inflammatory granulations without any malignancy. Because of the previous history, she was diagnosed as paravesical suture abscess due to infected silk materials at transvaginal uterectomy. Paravesical suture abscess is very rare complication of inguinal herniorrhaphy and mimics bladder or urachal neoplasm. In review of previously reported cases, the symotoms were predominantly urological. For avoiding unnecessary examinations and treatments, it is important to consider paravesical suture abscess in cases with histories of inguinal herniorrhaphy or other intra-pelvic operations. To our knowledge, there is no case report of paravesical abscess formation associated with transvaginal uterectomy and the present case is the first one for report.
A 62-year-old man was admitted to our hospital complaining of lower abdominal mass and weight loss. Computed tomography and magnetic resonance imaging studies revealed a large tumor occupying the pelvis and expanding into inferior vena cava, which reached to the renal pedicle. Open biopsy was undergone under general anesthesia. Histopathological diagnosis was inflammatory fibrosarcoma. Five courses of chemotherapy including vincristine, actinomycin-D and cyclophosphamide (VAC) resulted in 35% reduction of the tumor volume in one direction, indicating that VAC could be an alternative effective therapy for inoperable inflammatory fibrosarcoma.
A 54-year-old man with general fatigue and lumbago was admitted for further examination of hypercalcemia and leukocytosis. CT showed a huge renal tumor and extension of the tumor thrombus to the inferior vena cava (IVC). Moreover, the serum granulocyte colony-stimulating factor (G-CSF) and the C-terminal of parathyroid hormone-related protein (PTHrP) were elevated. Under the diagnosis of advanced renal tumor, we performed nephro-ureterectomy and throbectomy. Pathological examination revealed squamous cell carcinoma of the renal pelvis. To our knowledge, this is the first case in Japan that of the simultaneous production of G-CSF and PTHrP in squamous cell carcinoma of the renal pelvis accompanied with IVC thrombus.