Search

Objective The aim of this study was to investigate the efficacy and safety of tadalafil add-on therapy with α1 -adrenoceptor antagonists. Methods Patients with persistent storage symptoms refractory to α1 -adrenoceptor antagonists for benign prostatic hyperplasia were enrolled in the study. Patients were randomly assigned to either a 5 mg tadalafil or 5 mg solifenacin treatment group for 12 weeks. International Prostate Symptom Score, Overactive Bladder Symptom Score, urinary flow rates, residual urine volume, and blood pressure were measured prospectively before treatment and after 4 and 12 weeks of treatment. Changes from baseline were compared between groups. The rate of treatment discontinuation due to adverse effects was evaluated. Results Of the 75 patients recruited to the study, 38 and 37 were assigned to the tadalafil and solifenacin groups, respectively. There were no significant difference in baseline characteristics between the two groups. The change in the amount of residual urine volume was significantly larger in the solifenacin- than tadalafil-treated group; other parameters, including lower urinary tract symptoms and uroflowmetry measures, did not differ significantly between the two groups. Seven (18%) and 12 (32%) patients in the tadalafil and solifenacin groups, respectively, discontinued treatment because of adverse events. The main reasons for discontinuation in the tadalafil group were stomach discomfort or nausea and dizziness or vertigo; voiding difficulty and constipation were the main reasons for discontinuation in the solifenacin group. There was no significant difference in blood pressure fluctuations from baseline between the two groups. Conclusions Tadalafil add-on therapy was not inferior to solifenacin add-on therapy in terms of effect and safety. Therefore, tadalafil could be an alternative add-on drug for patients with persistent lower urinary tract symptoms refractory to α1 -adrenoceptor antagonists.

The aim of this study was to investigate the efficacy and safety of tadalafil add-on therapy with αPatients with persistent storage symptoms refractory to αOf the 75 patients recruited to the study, 38 and 37 were assigned to the tadalafil and solifenacin groups, respectively. There were no significant difference in baseline characteristics between the two groups. The change in the amount of residual urine volume was significantly larger in the solifenacin- than tadalafil-treated group; other parameters, including lower urinary tract symptoms and uroflowmetry measures, did not differ significantly between the two groups. Seven (18%) and 12 (32%) patients in the tadalafil and solifenacin groups, respectively, discontinued treatment because of adverse events. The main reasons for discontinuation in the tadalafil group were stomach discomfort or nausea and dizziness or vertigo; voiding difficulty and constipation were the main reasons for discontinuation in the solifenacin group. There was no significant difference in blood pressure fluctuations from baseline between the two groups.Tadalafil add-on therapy was not inferior to solifenacin add-on therapy in terms of effect and safety. Therefore, tadalafil could be an alternative add-on drug for patients with persistent lower urinary tract symptoms refractory to α

INTRODUCTION AND OBJECTIVES: Efficacy in the prostate cancer detection of real-time tissue elastogarpahy (RTE) has been reported. But RTE has a major problem that RTE is highly operator dependent procedure. We hypothesized that the pressure device might decrease the operator dependency and increase the prostate cancer detection rate of RTE. The pressure device run with water pressure was developed for this study, called this procedure real-time balloon inflation elastography (RBIE). The results of targeted prostate biopsy with RBIE was studied for detection of prostate cancer. METHODS: 233 patients and 1978 were enrolled in this study with abnormal findings of digital rectal examination (DRE), PSA and/ or TRUS. Median age was 73 year-old (range 54e89), median PSA was 7.6 ng/mL (range 0.8-2606.0), and median number of biopsy cores taken on each patient was 8 (range 8e10). All of 233 patients were examined with MRI prior to prostate needle biopsy. A total of 1978 specimens obtained by systemic biopsy were studied. The findings of RBIE, RTE, TRUS, PDUS and MRI (T2WI, dynamic contrast enhanced images (DCEI) and diffusion weighted image (DWI)) were compared to the histopathological findings of biopsy specimens. RESULTS: The prostate cancer was detected in 113 of 233 patients (48.5%), and 412 of 1978 specimens (20.8%). Gleason score of 5 to 6, 7 and 8 to 10 tumors was 110, 166 and 138 specimens respectively. Clinical stages of T1c, T2a-c, T3a-b, and T4 were 20, 60, 22 and 11 cases. The sensitivity of RBIE, RTE, TRUS, PDUS, T2WI, DCEI and DWI were 72.1%, 72.1%, 74.5%, 72.8%, 78.2%, 77.2% and 77.2%, the specificity were 94.3%, 93.6%, 85.4% 90.5%, 92.0%, 93.7% and 92.6%, respectively. Both of the sensitivity and the specificity of RBIE were not significantly inferior to those of MRI. The results of targeted biopsy (PPV) of RBIE, RTE, TRUS, PDUS, T2WI, DCEI and DWI were 76.7%, 74.8%, 57.4%, 67.0%, 72.0%, 76.4% and 73.3%. PPV of RBIE was also comparable to those of MRI. CONCLUSIONS: RBIE was low cost and low invasive procedure. The prostate cancer detection capability of RBIE might be not inferior to that of MRI, expensive and time consuming procedure. Furthermore, RBIE reveals prostate in real-time, so RBIE could enhance the prostate cancer detection as a biopsy guidance image.

In kidney transplant recipients, acute renal failure resulting from a ureteral obstruction by fungus balls is uncommon. We report a 60-year-old man diagnosed with ureteral obstruction caused by Candida albicans fungus balls early after transplant. Diagnosis was made by a T2-weighted magnetic resonance image, which demonstrated fungus balls as a low-intensity mass in the pelvis and microscopic examination findings in the urine. The patient was treated successfully with an antifungal agent and direct irrigation. It should be noted that fungus balls may cause ureteral obstruction of transplanted kidneys, possibly resulting in graft failure. Imaging of the kidneys and collecting system and aggressive debridement that adds to systemic therapy are necessary for early diagnosis and are central to a successful outcome.

protein (BMP)-2, a member of the transforming growth factor b superfamily, has been shown to act as a tumor suppressor in several cancers by activating signaling cascades that cause cell cycle arrest. In addition, the expression level of BMP-2 is downregulated because of promoter CpG hypermethylation. We hypothesized that impaired regulation of BMP-2 through epigenetic pathways is associated with the pathogenesis of renal cell carcinoma. METHODS: To test this hypothesis, CpG methylation of the BMP-2 gene was analyzed in 3 renal tumor cell lines and 96 renal tumor and matched normal renal tissue. Promoter CpG methylation was analyzed by methylation specific PCR using bisulfite-modified DNA as template. BMP-2 expression was measured by quantitative RT-PCR. RESULTS: BMP-2 mRNA expression was significantly enhanced after 5-aza-2€ treatment in renal tumor cell lines. The prevalence of BMP-2 promoter methylation was significantly higher and BMP-2 mRNA expression was significantly lower in renal tumor samples than in normal kidney samples (p

Objectives: To validate the feasibility and implications of a hybrid procedure using perineal and abdominal approaches for a radical prostatocystectomy. Methods: Between March 2007 and May 2012, we performed 16 prostatocystectomy and simultaneous urethrectomy under a hybrid procedure using perineal and abdominal approach for advanced bladder cancer. The hybrid procedure was selected in each case, because of prostatic urethra involvement in 13 and prior treatment in 3 (irradiation, radical retropubic prostatectomy, and sigmoidectomy, respectively). Two surgical teams, one responsible for the perineal approach and the other for the abdominal portion, performed the operation. Results: The median operation time for the prostatocystectomy procedure was 207 minutes and median intraoperative blood loss was 1665 ml. The en bloc removal of the specimen was perfectly performed and no intraoperative difficulties and intraoperative complications such as rectal injury were recognized in all cases. As for postoperative complications associated with the exaggerated lithotomy position, neurologic complications and rhabdomyolysis which could be treated conservately were found in 1 case. Although 5 patients died from distant metastasis, local recurrence was not seen in any of the 16 patients during the follow-up period. Conclusion: The hybrid procedure using perineal and abdominal approach for radical prostatocystectomy is a well-organized procedure that can provide good visualization of the surgical structure around the prostate, leading to a reduction in or prevention of local recurrence and surgical complications even in the selected patient.