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Mamoru Hashimoto,1 Nobutaka Shimizu,1 Mitsuhisa Nishimoto,1 Takafumi Minami,1 Kazutoshi Fujita,1 Kazuhiro Yoshimura,1 Akihide Hirayama,2 Hirotsugu Uemura1 1Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan; 2Department of Urology, Kindai Nara Hospital, Osaka-Sayama, JapanCorrespondence: Nobutaka ShimizuDepartment of Urology, Kindai University Faculty of Medicine, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, JapanTel +81-72-366-0221Fax +81-72-365-6273Email shimizun@med.kindai.ac.jpPurpose: This study aimed to elucidate the relationship of psoas muscle atrophy and visceral obesity with lower urinary tract symptoms in geriatric female patients.Patients and Methods: We retrospectively reviewed the medical records of female patients aged ≥ 65 years. The psoas muscle index was defined, using computed tomography, as the cross-sectional area of the psoas muscle at the third lumbar vertebral level divided by the body surface area. We also measured visceral fat area at the umbilical level using computed tomography. We used logistic regression analysis to examine the relationships between the International Prostate Symptom Score (total score, voiding subscore, and storage subscore) and variables, such as age, body mass index, psoas muscle index, and visceral fat area. The International Prostate Symptom Score was categorized as mild, moderate, or severe.Results: One hundred thirty-nine patients were included in our study. In the logistic regression analysis, we found statistically significant relationships between severe (versus mild-to-moderate) International Prostate Symptom Score storage subscore and variables, including low and high levels of psoas muscle index and visceral fat area, respectively. We could not find any significant relationships between the International Prostate Symptom Score total score and voiding subscore and the variables.Conclusion: Psoas muscle atrophy and visceral fat accumulation are potential risk factors for severe storage symptoms in female patients aged ≥ 65 years.Keywords: female, International Prostate Symptom Score, overactive bladder symptom, psoas muscle, visceral fat

Keisuke Kiba,1 Yasunori Akashi,1 Motokiyo Yoshikawa,1 Yutaka Yamamoto,1 Akihide Hirayama,1 Kiyohide Fujimoto,2 Hirotsugu Uemura3 1Department of Urology, Kindai University Nara Hospital, Ikoma-City, Nara, Japan; 2Department of Urology, Nara Medical University, Kashihara-City, Nara, Japan; 3Department of Urology, Kindai University Faculty of Medicine, Sayama-City, Osaka, JapanCorrespondence: Keisuke KibaDepartment of Urology, Kindai University Nara Hospital, 1248-1 Otoda-cho, Ikoma-City, Nara, JapanTel +81-743-77-0880Fax +81-743-77-0890Email kiba_uma@yahoo.co.jpPurpose: The aim of this study was to compare the safety and efficacy of photoselective vaporization of the prostate (PVP) and transurethral enucleation with a bipolar system (TUEB).Patients and Methods: Patients who underwent PVP or TUEB surgery for lower urinary tract symptoms due to bladder outlet obstruction at our institution from September 2015 to May 2019 were retrospectively reviewed. A total of 83 patients (PVP: n=45, TUEB: n=38) who were available for follow-up at least 12 months after surgery were included. Preoperative characteristics, perioperative parameters, and postoperative outcomes—such as International Prostate Symptom Score (IPSS), quality of life (QoL), maximum urinary flow rate (Qmax), post-void residual urine volume (PVR), and complications―at 3, 6, and 12 months after surgery were compared between the two groups.Results: Although differences in age, IPSS, and QoL were not significant, a significantly greater prostate volume, lower Qmax, and greater PVR were noted in the TUEB group. In perioperative parameters, a significantly shorter operation time, less change in serum hemoglobin, fewer days of catheterization, and shorter length of stay were observed in the PVP group. As for postoperative outcomes, the IPSS storage subscore and PVR were significantly improved in the TUEB group. As complications, stress urinary incontinence was more frequently observed in the TUEB group, and urethral stricture was more common in the PVP group.Conclusion: The present data suggest that PVP and TUEB are efficient and safe surgical treatment options. Management of patients undergoing PVP in the perioperative period appears easy. Improvements of subjective and objective parameters were superior after TUEB than after PVP.Keywords: prostate, prostatic hyperplasia, transurethral resection of prostate, laser therapy

Yutaka Yamamoto,1 Keisuke Kiba,1 Motokiyo Yoshikawa,1 Akihide Hirayama,1 Seiji Kunikata,1 Hirotsugu Uemura2 1Department of Urology, Nara Hospital, Kindai University Faculty of Medicine, Ikoma, 2Department of Urology, Kindai University Faculty of Medicine, Osakasayama, Japan Objective: The aim of this study was to evaluate the biochemical recurrence (BCR) in patients with high-risk prostate cancer (PCa) treated with radical prostatectomy (RP) or radiotherapy (RT) plus androgen deprivation therapy (ADT).Methods: Subjects were patients with National Comprehensive Cancer Network-defined high-risk PCa treated with either RP or RT plus ADT. We calculated BCR-free survival in patients with those treatments and evaluated risk factor against BCR.Results: A total of 114 patients, 71 RP and 43 RT plus ADT, were evaluated. A total of 59 and 20.9% of patients experienced BCR in the RP and RT treatment groups, respectively. The 5-year BCR-free survival probabilities improved significantly for patients who received RT compared to those who received RP (81.3 vs 37.3%, P

Koichi Sugimoto,1,2 Takahiro Akiyama,2 Nobutaka Shimizu,1 Naoki Matsumura,1,2 Mamoru Hashimoto,1 Takafumi Minami,1 Kazuhiro Nose,1 Masahiro Nozawa,1 Kazuhiro Yoshimura,1 Hirotsugu Uemura1 1Department of Urology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan; 2Department of Urology, Sakai-Onshinkai Hospital, Sakai, Osaka, Japan Abstract: Acute urinary retention is the most common urological emergency. To resolve this emergency, urethral catheterization is performed. If the procedure fails and permanent transurethral catheterization is required, the patient’s quality of life is significantly affected. Therefore, catheter-free treatment is the ideal goal of therapy for patients with acute urinary retention. Especially, for women, placement of a catheter poses a cosmetic problem. Therefore, the aim of this study was to treat female patients who had already received urapidil/distigmine bromide with acotiamide. Acotiamide was administered at a dose of 100 mg three times daily for 2 weeks, and the outcome of trial without catheter was evaluated. Only female patients were enrolled for this study. Treatment proved successful and all patients become catheter free. Keywords: female, acute urinary retention, acotiamide hydrochloride hydrate

Koichi Sugimoto,1 Takahiro Akiyama,2 Nobutaka Shimizu,3 Naoki Matsumura,1 Taiji Hayashi,1 Tsukasa Nishioka,1 Hirotsugu Uemura3 1Department of Urology, Sakai Hospital, Kinki University Faculty of Medicine, Sakai, Osaka, Japan; 2Department of Urology, Sakai-Onshinkai Hospital, Sakai, Osaka, Japan; 3Department of Urology, Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan Aim: To investigate the clinical efficacy of acotiamide hydrochloride hydrate in patients with detrusor underactivity. Methods: We measured the post-void residual urinary volume in 19 patients with underactive bladders. All these patients had been under treatment with distigmine bromide and were prescribed acotiamide hydrochloride hydrate at a dose of 100 mg three times daily for 2 weeks. Results: Compared with the post-void residual urinary volume value at baseline (161.4±90.0 mL) a statistically significant reduction was observed at the end of treatment (116.3±63.1 mL) (P=0.006). The drug was generally well tolerated by the majority of patients. Conclusion: Maybe, acotiamide hydrochloride hydrate showed clinical efficacy in patients with underactive bladders and may, therefore, be used alternatively in patients who do not respond sufficiently to distigmine bromide. Keywords: acotiamide hydrochloride hydrate, distigmine bromide, underactive bladder, detrusor underactive

Akiko Sato,1 Naoki Itcho,1 Hitoshi Ishiguro,2,3 Daiki Okamoto,1 Naohito Kobayashi,4 Kazuaki Kawai,5 Hiroshi Kasai,5 Daisuke Kurioka,1 Hiroji Uemura,2 Yoshinobu Kubota,2 Masatoshi Watanabe11Laboratory for Medical Engineering, Division of Materials Science and Chemical Engineering, Graduate School of Engineering, Yokohama National University, Yokohama, Japan; 2Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan; 3Photocatalyst Group, Kanagawa Academy of Science and Technology, Kawasaki, Japan; 4Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, Yokohama, Japan; 5Department of Environmental Oncology, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Kitakyushu, JapanAbstract: Docetaxel (DTX) is one of the most important anticancer drugs; however, the severity of its adverse effects detracts from its practical use in the clinic. Magnetic nanoparticles of Fe3O4 (MgNPs-Fe3O4) can enhance the delivery and efficacy of anticancer drugs. We investigated the effects of MgNPs-Fe3O4 or DTX alone, and in combination with prostate cancer cell growth in vitro, as well as with the mechanism underlying the cytotoxic effects. MgNPs-Fe3O4 caused dose-dependent increases in reactive oxygen species levels in DU145, PC-3, and LNCaP cells; 8-hydroxydeoxyguanosine levels were also elevated. MgNPs-Fe3O4 alone reduced the viability of LNCaP and PC-3 cells; however, MgNPs-Fe3O4 enhanced the cytotoxic effect of a low dose of DTX in all three cell lines. MgNPs-Fe3O4 also augmented the percentage of DU145 cells undergoing apoptosis following treatment with low dose DTX. Expression of nuclear transcription factor κB in DU145 was not affected by MgNPs-Fe3O4 or DTX alone; however, combined treatment suppressed nuclear transcription factor κB expression. These findings offer the possibility that MgNPs-Fe3O4–low dose DTX combination therapy may be effective in treating prostate cancer with limited adverse effects.Keywords: prostate cancer, magnetic nanoparticles, docetaxel, reactive oxidative species

Koichi Sugimoto,1,2 Nobutaka Shimizu,1 Naoki Matsumura,2 Takashi Oki,2 Kazuhiro Nose,2 Tsukasa Nishioka,2 Hirotsugu Uemura11Department of Urology, Kinki University Faculty of Medicine, Osaka-Sayama, 2Department of Urology, Sakai Hospital, Kinki University Faculty of Medicine, Sakai, Osaka, JapanBackground: Because the use of procalcitonin has been advocated as a marker of bacterial infection, this study was carried out to determine the usefulness of serum PCT as an early marker to decide upon intervention for urinary tract infection.Methods: The subjects were 68 patients with urinary tract infection (UTI) in whom we measured serum procalcitonin concentration at the start of treatment.Results: There were 47 patients with nonobstructed UTI and 21 with obstructed UTI. All patients with obstructed UTI were subjected to intervention. There were significant differences in procalcitonin, white blood cells, and creatinine levels between patients with nonobstructed and obstructed UTI (P < 0.05).Conclusion: Although this retrospective study comprised a small number of patients, we found that procalcitonin was a useful marker to decide upon urinary intervention.Keywords: procalcitonin, intervention, urinary tract infection, urology

Koichi Sugimoto,1,2 Nobutaka Shimizu,1 Takashi Oki,2 Kazuhiro Nose,2 Tsukasa Nishioka,2 Shogo Adomi,3 Takayuki Ohzeki,3 Atsunobu Esa,3 Hirotsugu Uemura11Department of Urology, Kinki University Faculty of Medicine, Osaka-Sayama, Osaka, Japan; 2Department of Urology, Sakai Hospital Kinki University Faculty of Medicine, Sakai, Osaka, Japan; 3Department of Urology, NTT West Osaka Hospital, Osaka, Osaka, JapanBackground: This study was undertaken to investigate the growth rate and clinical outcome of patients with a small renal mass (SRM) after delayed surgery.Methods: We reviewed the clinical records of 34 patients with SRMs ≦ 4 cm at diagnosis, who underwent delayed surgical intervention during surveillance from January 2000 to December 2011. Radiographic evaluations using computed tomography (CT) scan and magnetic resonance imaging (MRI) were performed at least every 6 months, and the tumor size was determined at least twice.Results: The mean follow-up time was 26.6 ± 18.6 months and mean tumor doubling time was 23.4 ± 16.0 months. Histopathological analysis revealed that 32 of the 34 patients were malignant in pT1aN0M0. Only one patient showed tumor recurrence, who subsequently died due to tumor progression.Conclusion: The growth rate of the small renal mass was slow in the majority of our patients. Delayed intervention does not have a detrimental effect on cancer-specific outcomes.Keywords: renal cell carcinoma, small renal mass, natural history, growth rate, delayed intervention

Nobutaka Shimizu,1 Masahiro Nozawa,1 Koichi Sugimoto,2 Yutaka Yamamoto,1 Takafumi Minami,1 Taiji Hayashi,1 Kazuhiro Yoshimura,1 Tokumi Ishii,1 Hirotsugu Uemura11Department of Urology, Faculty of Medicine, Kinki University, Osaka, 2Department of Urology, Sakai Hospital, Faculty of Medicine, Kinki University, Osaka, JapanObjectives: This study was conducted to examine the therapeutic efficacy and anti-inflammatory effect of ramelteon in elderly patients with insomnia associated with lower urinary tract symptoms (LUTS), who visited our urology department.Methods: The study included 115 patients (102 men, 13 women) who scored ≥4 on the Athens Insomnia Scale and who wished to receive treatment. The assessment scales for therapeutic efficacy included the International Prostate Symptom Score (IPSS) for LUTS and the Insomnia Severity Index (ISI) for sleep disorders. The high-sensitivity C-reactive protein (hs-CRP) test was used to an objective assessment. The patients were treated with ramelteon (8 mg/day) for an average of 10 weeks and were then reexamined using the questionnaires and hs-CRP test to evaluate therapeutic efficacy.Results: IPSS total scores declined significantly from 11.39 ± 8.78 to 9.4 ± 7.72. ISI total scores improved significantly from 11.6 ± 5.2 to 9.2 ± 5.3 (P < 0.0001). The levels of hs-CRP decreased significantly from 0.082 (standard deviation [SD] upper limit, 0.222; SD lower limit, −0.059) to 0.06 (SD upper limit, 0.152; SD lower limit, −0.032). The ISI scores ≥ 10 (n = 51) showed a weak correlation with the hs-CRP levels.Conclusion: Ramelteon had a systemic anti-inflammatory effect and improved sleep disorders and LUTS, suggesting that it may be a useful treatment for patients with LUTS-associated insomnia.Keywords: sleep disorders, inflammation, lower urinary tract symptoms, ramelteon

Nobutaka Shimizu,1 Yasuharu Nagai,1 Yutaka Yamamoto,1 Takafumi Minami,1 Taiji Hayashi,1 Hidenori Tsuji,1 Masahiro Nozawa,1 Kazuhiro Yoshimura,1 Tokumi Ishii,1 Hirotsugu Uemura,1 Takashi Oki,2 Koichi Sugimoto,2 Kazuhiro Nose,2 Tsukasa Nishioka21Department of Urology, Kinki University Faculty of Medicine, Osaka, Japan; 2Department of Urology, Sakai Hospital, Kinki University Faculty of Medicine, Osaka, JapanObjectives: This study examined the association between sleep disorders and lower urinary tract symptoms in patients who had visited urology departments.Methods: This was an independent cross-sectional, observational study. Outpatients who had visited the urology departments at the Kinki University School of Medicine or the Sakai Hospital, Kinki University School of Medicine, between August 2011 and January 2012 were assessed using the Athens Insomnia Scale and the International Prostate Symptom Score.Results: In total, 1174 patients (mean age, 65.7 ± 13.7 years), with 895 men (67.1 ± 13.2 years old) and 279 women (61.4 ± 14.6 years old), were included in the study. Approximately half of these patients were suspected of having a sleep disorder. With regard to the International Prostate Symptom Score subscores, a significant increase in the risk for suspected sleep disorders was observed among patients with a post-micturition symptom (the feeling of incomplete emptying) subscore of ≥1 (a 2.3-fold increase), a storage symptom (daytime frequency + urgency + nocturia) subscore of ≥5 (a 2.7-fold increase), a voiding symptom (intermittency + slow stream + hesitancy) subscore of ≥2 (a 2.6-fold increase), and a nocturia subscore of ≥2 (a 1.9-fold increase).Conclusion: The results demonstrated that the risk factors for sleep disorders could also include voiding, post-micturition, and storage symptoms, in addition to nocturia.Keywords: lower urinary tract symptoms, sleep disturbance, urological disease