(Objectives) Overactive bladder (OAB) is characterized by involuntary contractions of the detrusor muscles of the bladder. The primary symptoms of OAB include urinary urgency and frequency, with or without urge incontinence. Despite the growing awareness of OAB as a chronic medical condition, little is known about the disease's economic burden. Therefore, in the present study, the costs associated with the management of OAB symptoms in Japan were estimated, and the potential cost saving by increasing the rate of physician visits in OAB population was analyzed. (Methods) To estimate the costs of OAB symptoms in Japan, we collected a variety of epidemiologic and economic literatures about OAB or urinary incontinence published by June, 2007. Three types of costs were considered in this estimation: 1. OAB treatment cost (pharmacological treatment cost, diagnostic cost and cost for physician visits), 2, direct cost (OAB-related cost [urinary tract infections, skin infections and fractures] and incontinence care cost [costs of pads, diapers and cleaning] ), and 3. indirect cost (work loss due to absence from work and decrease in productivity). The analysis was conducted on community dwelling Japanese persons aged ≥40 years, and assumed that OAB patients visited a hospital or a clinic once every four weeks. For the estimation of pharmacological treatment cost, four anticholinergic drugs (immediate-release oxybutynin (Pollakisu®), propiverine (BUP-4®), extended-release tolterodine (Detrusitol®) and solifenacin (Vesicare®)) were referred. Potential cost saving was estimated on the assumption that the hospital visit rate would increase from the current 22.7% to 35% and 50%, respectively. (Results) The number of persons with OAB symptoms and OAB patients was estimated at 8.6 million (4.6 million men, 4.0 million women) and 2.0 million (1.7 million men, 0.3 million women), respectively. The annual cost for OAB was estimated to be 956.2 billion yen (112, 000 yen per one person with OAB symptoms). This cost included 180.9 billion yen (19%) for OAB treatment cost (including medication of 159.1 billion yen), 62 billion yen (6%) for OAB-related cost, 28.7 billion yen (3%) for incontinence care cost and 684.6 billion yen (72%) for work loss. Therefore, the cost for work loss accounted for the majority of OAB cost. The potential annual cost saving was estimated at 92.7 billion yen and 205.8 billion yen for the assumed hospital visit rate of 35% and 50%, respectively, and 88, 000 yen per newly visiting OAB patient. (Conclusion) It was revealed that the economic impact imposed by OAB was enormous. It might be possible to reduce the cost for OAB by appropriate treatment for OAB population.
(Objectives) At present, there are almost no report concerning post micturition dribble (PMD) in lower urinary tract symptoms (LUIS). PMD may have a negative effect on the quality of life (QOL) of afflicted patients. However, question concerning PMD are not included in the International Prostate Symptom Score (IPSS) questionnaire, and a number of questions about PMD remain to be addressed, such as the correlation between PMD and QOL. Therefore, we investigated PMD using an original question form (IPSS added PMD) we created. (Methods) Between June 2006 and March 2007, the self-administered modified IPSS (IPSS with new questions included concerning PMD) was 5 obtained from 621 outpatients (394 men and 227 women) visiting our hospital. (Results) The PMD scores were 1.2±1.7 in men, and 0.6±1.2 in women, and thus we see that the men had a significantly higher than the women. Men's PMD scores rise from age 50 and reach a peak in the 70's. On the other hand, there is no significant change for women from the 20s and thereafter. Those with higher PMD scores were male patients with benign prostatic hyperplasia (BPH) and females with stress urinary incontinence. In BPH group, the average PMD score was higher than patients with another urological disease. The PMD scores were appreciably high at 1.59±1.90 for the LUTS group, and had the lower value of 0.36±0.90 for the non-LUTS group. Therefore, the LUTS group was found to have a significantly higher PMD score. Men in the LUTS group (especially those with BPH) had a positive correlation between their QOL scores and PMD scores. (Conclusion) The following points may be revealed from the present study. —In patients with LUTS (especially BPH), PMD score is higher and may impair their QOL. -Even women and youth may experience PMD. A more detailed evidence concerning PMD will be needed.
A 32-year-old man complained about a reduction of testicular volume and loss of libido. He had been abusing androgenic anabolic steroids (AAS) for 7 years. Genital examination revealed that both testicular volumes were reduced to 13ml. Endocrinological investigations showed luteinizing hormone, follicle-stimulating hormone and total testosterone (Total T) levels to be low. The level of free testosterone (Free T) was documented to be high. Later, sex hormone-binding globulin (SHBG) and calculated bioavailable testosterone (cBAT) levels were found to be low. Based on these features, we diagnosed his condition as hypogonadotrophic hypogonadism caused by AAS abuse. We first forbade him to use AAS, but the symptoms and endocrinological features were not improved. Then treatment with injections of human chorionic gonadotropin (hCG) was started. About one month after treatment with hCG started, his symptoms and endocrinological features were not improved. It is well known that AAS abuse induces hypogonadotrophic hypogonadism. It is also reported that normal hormonal function usually recovers after AAS are discontinued, but sometimes the condition is not reversible. In such cases, we should carefully observe the endocrinological features of the patient, and whether the early treatment with hCG injection leads to early recovery of testicular function. It was useful to examine cBAT in this case to understand his endocrinological condition. There are many severe side effects of abusing AAS and thus education about the severe side effects of AAS abuse is necessary.
A 58-year-old man visited our hospital with a complaint of asymptomatic gross hematuria for three weeks. The urine cytology at another clinic had indicated Papanicolaou class V. A physical examination revealed soft abdominal distention in lower abdomen. Ultrasonography demonstrated an extremely dilated left pelvis, calyx and ureter in which a round mass was detected. Enhancement CT showed a mass 2cm in diameter in the middle part of the dilated left ureter. These findings suggested the diagnosis of left ureteral cancer having developed in the megaureter. Neither VUR nor UVJ stenosis were identified by VCG and RP. MR-urography showed a severely dilated left pelvis and tortuous megaureter. On the diagnosis of left ureteral cancer left nephroureterectomy with cuff of bladder was performed. Gross findings showed a 2cm sized papillary tumor in the extremely dilated ureter, and pathological findings showed grade 2, papillary transitional cell carcinoma and non-specific ureteritis in the dilated ureter. Postoperative course was non-eventful. Postoperative 3 months later multiple bladder tumors were detected all over the bladder, and so TUR-Bt and intravesical instillation therapy with pirarubisin was performed. However multiple bladder tumors had been relapsed and so finally radical cystectomy and right cutaneous ureterostomy were undergone postoperative 6 months later. He has been well 48 months postoperatively.
Diffusion-weighted MRI (DW-MRI) is a functional imaging to assess molecular diffusion. We report a case in which treatment response to lymph node metastatic bladder cancer was monitored by DW-MRI. A 67-year-old man had paraaortic lymph node metastasis from bladder cancer; the paraaortic lymph node showed high signal intensity on DW-MRI. After four course treatment of gemcitabine and cisplatin, the lesion showed reduction of signal intensity on DW-MRI and increase of the apparent diffusion coefficient value. These signal changes were consistent with the change of morphological images (CT, MRI (T1-W, T2-W)), 18F-FDG PET and tumor markers. This case suggests that DW-MRI is useful in monitoring treatment response of metastatic bladder cancer.