[Patient Background Factors Affecting Prescription Drugs for Male Lower Urinary Tract Symptoms: The Multicenter Study of Miyazaki Urological-Network Group].

The present multicenter study performed by the MIYAZAKI UROLOGICAL-NETWORK GROUP involving patients from 32 hospitals in Miyazaki Prefecture demonstrates that an association exists between the use of prescription drugs for male lower urinary tract symptoms (MLUTS) and patient characteristics. Men aged ≥40 years who were prescribed at least one drug for MLUTS between April 1, 2014 and March 31, 2015 were prospectively recruited. In total, 2,295 patients with a median age of 72 years were enrolled. The median prostate volume was 33 ml, the median International Prostate Symptom Score (IPSS) was 15, and the median quality-of-life score was 5. Prescribed drugs were α1-blockers alone in 1,661 patients, tamsulosin hydrochloride in 702, silodosin in 481, and naftopidil in 477. Multivariate analysis of the associations between use of α1-blockers and patient characteristics revealed use of tamsulosin hydrochloride to be more significantly associated with higher age (P=0.02), higher prostate volume (P=0.048), and higher IPSS score (P=0. 01) than silodosin. No significant associations between patient characteristics and naftopidil or tamsulosin hydrochloride ware revealed. We found that 369 patients received drug therapy for MLUTS plus overactive bladder (OAB). Multivariate analysis of the associations between patient characteristics and use of drugs for MLUTS or MLUTS plus OAB revealed higher age (P=0.001) and lower PSA value (P=0.04), lower prostate volume (P=0.01), and higher storage symptom score of IPSS (P< 0.001) to be more strongly associated with use of drugs for MLUTS plus OAB than drugs for MLUTS alone.

[The Safety of Laparoscopic Radical Cystectomy during Initial Phases in a Japanese Multicenter Cohort].

We evaluated the safety of laparoscopic radical cystectomy (LRC) during initial phases and its learning curve in a Japanese multicenter cohort by studying 436 patients who underwent LRC with no robot assistance at 10 institutions in Japan. We divided the patients into three groups according to cumulative surgical volume at each institution (first 10 cases, 11-30 cases, after 31 cases in each institution), and compared perioperative and pathologic variables among the three groups. The first, second, and third groups included 100, 166, 170 patients, respectively. The preoperative variables were similar in the three groups except for the rate of neoadjuvant chemotherapy. The methods of LRC procedure, such as urinary diversion, the extent of lymph node dissection, and concomitant urethrectomy or nephroureterectomy, were similar in the three groups. Mean operative time was 629, 562 and 531 minutes, respectively, and mean blood loss was 755, 650 and 435 ml, respectively. Both values decreased over time with the institution's experience. There was no significant difference among the three groups in the rate of positive surgical margin, the number of retrieved lymph nodes, and the rate of intra- and postoperative complications. LRC was safely performed during initial phases with an acceptable complication rate and without compromising oncological results, although operative time was longer and blood loss increased.

[Effectiveness of acupuncture and moxibustion therapy for the treatment of refractory interstitial cystitis].

The efficacy of acupuncture and moxibustion treatment was examined on eight female patients with refractory interstitial cystitis (IC) who had been treated conservatively with hydrodistension, intravesical instillation of dimethyl sulfoxide, or oral medication. These patients had received hydrodistension on an average of 2.3±1.8 times. Moxa needles were applied to Ciliao in bladder meridian 32 and Xialiao in bladder meridian 34, and electroacupuncture was performed on Zhongliao in bladder meridian 33 at 3 Hz for 20 min once a week. The bladder condition was assessed by the visual analogue scale (VAS) score, the O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI), the Interstitial Cystitis Problem Index (ICPI), and the maximum voided volume (MVV). After 3 months, patients who showed a reduction of >2 in their VAS score, reduction of <30% of ICSI and ICPI, and increase of >100 ml MVV were considered responders. There were three responders, and after repeated therapy to maintain these effects, they no longer required hydrodistension. Two responders had no recurrence for 48 months or more. Acupuncture and moxibustion resulted in improvement in 38% of the patients (3/8) with refractory IC, and repeated therapy maintained the therapeutic effects. This therapy is traditional and relatively noninvasive. Although its precise mechanism of action is unclear, this study suggests that acupuncture and moxibustion treatment may be a complementary and alternative therapeutic option for refractory IC.

Retroperitoneoscopic treatment of caliceal diverticular calculi: report of two cases and review of the literature.

Two women with symptomatic stone-filled caliceal diverticula were treated by a retroperitoneoscopic approach. With a three-port technique, the diverticulum was marsupialized, the calculi removed, the cavity fulgurated, and perirenal fat inserted. The patients had no morbidity and remain stone and symptom free. They represent the 17th and 18th reported cases of this condition. We also review the clinical results in the literature.

[Clinical results of immunosuppressive triple therapies in living-related renal transplantation--a single center experience].

We reviewed the outcome of three methods employed for living-related renal transplantation (RTx) in our institution to assess triple immunosuppressive regimens. Between January 1989 and July 2003, a total of 35 living-related RTxs were performed at our institution. The immunosuppressive regimen given to 16 patients (group A) was cyclosporine (CsA), steroid and azathoprine (AZ) that given to 9 patients (group B) was tacrolimus (TAC), steroid and AZ and that given 9 patients (group C) was TAC, steroid and mycophenolate mofetil (MMF). Graft survival rate, serum creatinine, proteinuria, acute rejection, chronic allograft nephropathy (CAN), cytomegalovirus (CMV) infection and drug-induced nephropathy were investigated. There was no significant difference in graft survival rate among the three groups. Although serum creatinine levels (mg/dl) at 3 months post-transplant were 1.22+/-0.37 in group A, 1.43+/-0.14 in group B, 1.30+/-0.34 in group C, respectively (p<0.05; A vs. B), there was no significant difference at 1 year post-transplant. Frequency of proteinuria in groups A, B and C was 75.0, 50.0, 25.0%, respectively (p<0.05; A vs. C). The incidences of acute rejection and CAN within 1 year post-transplant were, respectively, 56.3% and 43.8% in group A, 37.5% and 37.5% in group B; and, 25.0% and 12.5% in group C (NS). The incidence of drug-induced nephrotoxicity was 12.5, 50.0% and 37.5% in groups A, B and C, respectively (p<0.05; A vs. B). The triple immunosuppressive therapy including calcineurin inhibitors, especially the regime of TAC, MMF, and steroids decreased the frequencies of proteinuria and rejections, which deteriorated the long-term outcome in living-related RTxs.

Living related renal transplantation for end-stage renal disease after liver transplantation from a brain-dead donor.

We report a case in which a living related renal transplantation was successfully performed for end-stage renal disease that had progressed after a liver transplantation from a brain-dead donor for liver cirrhosis associated with type C hepatitis. Because the transplanted liver function had been excellent with the use of tacrolimus and mycophenolate mofetil, the same immunosuppressive agents with prednisolone were employed for the renal transplantation. Both grafts are functioning well without recurrence of hepatitis at 10 months after the renal transplantation. From our experience, renal transplantation should not be contraindicated even if the patient has undergone liver transplantation or has hepatitis C viral infection.