Influence of body mass index and total testosterone level on biochemical recurrence following radical prostatectomy.

OBJECTIVE: A high body mass index (BMI) and a low testosterone level were recently reported to be prognostic factors for prostate-specific antigen (PSA) recurrence following radical prostatectomy (RP). The goal of this study was to clarify their relationship and influences on biochemical recurrence after RP. METHODS: We analysed 126 patients whose data, including the pre-operative BMI and pre-operative serum total testosterone level, were available. All patients underwent RP at our institution between March 1998 and April 2006 without any adjuvant therapy or pelvic lymph node metastasis. The Cox proportional hazards model was used for the multivariate analysis regarding PSA recurrence for the variables of age, operation period, BMI, clinical stage, PSA, Gleason's sum, pre-operative serum total testosterone level and margin status. RESULTS: There were no internal correlations among the parameters we used, even between BMI and the total testosterone level. The total testosterone level was not different between two BMI groups (BMI <26.4 and >/=26.4 kg/m(2): the cut-off is the mean + 1 SD). BMI, PSA and Gleason's sum were found to be independent predictors for PSA recurrence through the multivariate analysis. PSA recurrence-free survival rates at 2 years were 77% for BMI <26.4 kg/m(2), and 31% for BMI >/=26.4 kg/m(2) (P = 0.002, log-rank test, 95% CI: 1.489-7.726). CONCLUSIONS: The current study suggests that high BMI independently contributes to PSA recurrence but that the total testosterone level does not. Although the mechanism by which obesity promotes PSA recurrence in RP patients has not been established, careful observation is needed for patients with high BMI.

[Urinary retention caused by female urethral diverticulum].

We report a 49-year-old female who had circumferential urethral diverticulum. She was admitted to our department for urinary retention. A cystic lesion surrounding the urethra had been detected by magnetic resonance imaging. We diagnosed the lesion as a urethral diverticulum after injecting dye to the cystic mass from vagina and confirming its discharge from the urethra at the pubic side by urethroscopy. Transvaginal resection of the diverticulum was peformed. In general, 4% of female urethral diverticula cause urinary retention. On the other hand, 1% of female bladder outlet obstruction is caused by urethral diverticula. It is neccessary for us to keep in mind urethral diverticulum when we evaluate female patients with urinary retention.

Preoperative computed tomography finding predicts for postoperative inguinal hernia: new perspective for radical prostatectomy-related inguinal hernia.

OBJECTIVES: To investigate the incidence of radical prostatectomy-related inguinal hernia (RPRIH) and the predictive factors for RPRIH. METHODS: We reviewed the medical charts of patients who had undergone retropubic radical prostatectomy (RRP) at our institution from January 2002 to December 2004 and had a median follow-up of 17 months (range 3 to 42). All patients were examined for RPRIH every 3 months. We also reviewed the computed tomography results in a blinded manner and investigated the predictive factors for RPRIH with multivariate analysis using the Cox proportional hazards model. RESULTS: Of 98 patients analyzed, 17 were diagnosed with RPRIH after RRP (17.3%) at the median of 7 months (range 3 to 12). Preoperative computed tomography results were available for all patients, and subclinical inguinal hernia was identified in 20 (20.4%) of the 98 patients. Multivariate analysis showed that a subclinical inguinal hernia was the single predictive factor for RPRIH. The estimated rate of RPRIH was 60.6% in the subclinical inguinal hernia group and 9.5% in the normal group at 12 months (log-rank test, P <0.001). CONCLUSIONS: The results of the present study have indicated that a preoperative computed tomography finding of a subclinical inguinal hernia predicts for postoperative inguinal hernia formation after RRP. RRP might only advance the time at which the inguinal hernia would develop with or without surgery. Thus, all patients with a subclinical inguinal hernia finding should be informed about the possibility of the development of RPRIH within 12 months after RRP and recommended to undergo surgical repair at RRP.

Clinical course in patients with percutaneous nephrostomy for hydronephrosis associated with advanced cancer.

We investigated the clinical courses of 33 patients with advanced malignancies who has undergone percutaneous nephrostomy (PNS) to clarify the efficacy and validity of PNS and evaluated the results according to the type of catheter. The pigtail, Malecot and balloon catheters were used. All the catheters were exchanged every 4 weeks, if necessary for larger ones. The site of the primary disease, preoperative performance status, duration of time spent at home after PNS construction, number of times the catheter was changed, type and size of the catheter and complications associated with PNS were compiled. The median overall survival was 3.0 months. Twenty-three patients (69.7%) were never discharged from hospital. Thirty patients died of their primary diseases. The median overall survival of patients with cancers of the upper gastrointestinal system, large bowel, urological organs and gynecologic organs were 1.5, 5.5, 3.0 and 3.0 months, respectively (p=0.0116). Eighteen patients (54.5%) experienced complications such as pyelonephritis, obstruction, dislodgement and so on. PNS is an appropriate urinary diversion for patients with hydronephrosis with advanced cancer and unilateral construction is effective for treating end-stage obstructive renal failure. However, PNS rarely improves the patient's quality of life and the risk of complications is unavoidable regardless of the type of catheter used.

Erectile function following external beam radiotherapy for clinically organ-confined or locally advanced prostate cancer.

BACKGROUND: External beam radiotherapy (XRT) has been a standard treatment for clinically localized prostate cancer. However, preservation of erectile function following XRT is controversial. In this study, the influence of XRT on erectile function of patients with clinically organ-confined or locally advanced prostate cancer was retrospectively evaluated. METHODS: The study included 34 of 84 patients with organ-confined or locally advanced prostate cancer who underwent XRT between 1995 and 2002. Erectile function following radiotherapy was assessed by a simple mailed questionnaire that was constructed for the study. To determine the predictive factors for erectile dysfunction following radiotherapy, data were analyzed by multivariate analysis with the Cox proportional hazards model. RESULTS: The modality of XRT was the only factor to independently predict erectile dysfunction following XRT. The maintenance rates of erectile function were 47.6% at 1 year and 19% at 3 years in patients who received the 3-dimensional conformal radiotherapy, which were significantly higher than in those who received conventional radiotherapy (P = 0.026). CONCLUSIONS: XRT significantly reduced the maintenance rate of erectile function during the follow-up period, with the rate being 19% at 3 years in patients who received 3-dimensional conformal radiation. The XRT modality was involved in the reduction of erectile function. These results suggest that erectile dysfunction is a possible adverse event following XRT.

External beam radiation monotherapy for localized or locally advanced prostate cancer.

PURPOSE: We report the treatment results and complications of external beam radiation monotherapy for localized or locally advanced prostate cancer patients. METHODS: Fifty-four patients with T(1b-3a)N(0)(pN(0))M(0) prostate cancer were treated with external beam radiation monotherapy between 1989 and 2001 at four institutes. RESULTS: During the 4-122 month follow-up period (median: 25 months), 11 (20%) patients experienced biochemical failure, including one with simultaneous local recurrence. The 2-year actuarial biochemical control rate was 85%. Univariate analysis showed that the clinical T classification (P = 0.01), Gleason score (P = 0.006), pretreatment PSA (P = 0.02) and PSA nadir value (P = 0.01) were associated with a higher probability of biochemical failure. Multivariate analysis using the Cox proportional hazards model demonstrated that only the PSA nadir value was a strong predictor of PSA recurrence (P < 0.01). Adverse events were mild and tolerable. No severe urinary or bowel complications were observed. CONCLUSIONS: External beam radiation monotherapy is effective for clinically organ-confined prostate cancer with a low incidence of severe complications in a mean follow-up period of 2 years.

National institutes of Health Chronic Prostatitis Symptom Index for Japanese men.

OBJECTIVES: To establish a Japanese version of the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and to determine its validity and applicability in patients with chronic prostatitis, comparing the results with those from patients with benign prostatic hyperplasia (BPH) and normal men. METHODS: The study included 103 patients with chronic prostatitis, 60 with BPH, and 87 normal men who agreed to respond to a self-administered questionnaire of the Japanese version of the NIH-CPSI (JPN-NIH-CPSI). Testing-retesting was done to confirm the reliability of the index in 23 patients with chronic prostatitis, with a 2-week interval between tests. RESULTS: Pain or discomfort was more prominent in the prostatitis group than in the BPH and normal groups. Overall, quality of life in the prostatitis group was impaired more severely than that in the other two groups. The scores of three domains (pain, urinary symptoms, and quality-of-life impact) in the prostatitis group were clearly higher than those in the BPH and normal groups, except for those of urinary symptoms in the BPH group. The test-retest analysis showed good reliability and internal consistency for the JPN-NIH-CPSI, with a Cronbach's alpha coefficient of more than 0.8. CONCLUSIONS: The JPN-NIH-CPSI can be reliably used for evaluation of Japanese patients with prostatitis, as is the NIH-CPSI for English-speaking men.