[Development of a X-ray Exposure Dose Control Tool for CT Examination by Using Spreadsheet Software].

PURPOSE: We developed X-ray dose monitoring and optimization software for computed tomography (CT) by using a spreadsheet software. METHODS: The analysis was carried out on 1,212 patients using 2,128 CT examinations at our institution, in the period of April 2020 to April 2022. These cases were extracted in the limitation of patient's weight in the range of 50 to 70 kg. The individual radiation report, including CTDIvol and DLP, on the console displayed by a CT system was used and manually transferred to our software. The X-ray dose distribution was evaluated by using a boxplot chart and a scatter plot, and the data were referred to Japan DRLs 2020 (National Diagnostic Reference Levels in Japan 2020). RESULTS: Almost all patient's doses in our institution were distributed in the acceptable ranges in comparison with the Japan DRLs 2020. Neither extremely high nor low dose data were recorded. However, seven cases recorded outlier dose values. Three cases were caused by errors during manually inputting the data. Four from seven cases were explored the reason to record outlier dose values. CONCLUSION: Our software on a spreadsheet software worked well to explore the CT dose data, such as CTDIvol and DLP. Our software was able to find cases that were recorded as outlier dose values, but their values were not extremely high/low values. The cautionary notice of either high or low dose, as a function of our software, will be able to keep our patient's CT dose in the universal-standard "justification and optimization" level.

[A Case Report of Cancer Chemotherapy for Disseminated Carcinomatosis of the Bone Marrow Associated with Gastric Cancer Accompanied by Disseminated Intravascular Coagulation].

A 72-year-old woman was admitted to our hospital because of symptoms of bleeding diathesis such as hematuria and purpura. A blood test revealed disseminated intravascular coagulation(DIC). Upper gastrointestinal endoscopy showed advanced gastric cancer. Bone marrow aspiration cytology demonstrated diffuse hyperplasia of large atypical cells, and metastasis of the epithelial tumor was suspected on immunohistochemical examination. She was diagnosed with disseminated carcinomatosis of the bone marrow associated with gastric cancer accompanied by DIC. She was treated with weekly infusion of methotrexate 100 mg/m2 plus 5-fluorouracil 600 mg/m2 for 4 courses; and she completely recovered from DIC. She received oral tegafur/gimeracil/oteracil as an outpatient. However, DIC recurred 126 days after the initial chemotherapy, and 5-fluorouracil plus cisplatin was administered subsequently. After 1 course, she died 166 days after the initial chemotherapy. Although the prognosis of patients with disseminated carcinomatosis of the bone marrow associated with gastric cancer accompanied by DIC is extremely poor, this case shows that secession of DIC and prognostic improvement by chemotherapy could occur. Chemotherapy could be considered a potentially effective treatment in this case.

Natural history of hematospermia in 189 Japanese men.

OBJECTIVES: To prospectively investigate the natural history of hematospermia. METHODS: This study included 189 patients with hematospermia. All the patients underwent watchful waiting without any empirical treatment. RESULTS: The median observation period was 52 months. Hematospermia resolved spontaneously in 168 (88.9%) of the 189 patients, and the median disease duration was 1.5 months. Kaplan-Meier analysis showed that the persistence rates of hematospermia were 57.7% at 1 month, 34.2% at 3 months, 23.3% at 6 months, 12.5% at 1 year and 7.6% at 2 years. Hematospermia reoccurred in 20 (13.5%) of the 148 patients who had adequate follow up. The recurrence-free rates were 96.6% at 3 months, 89.0% at 1 year, 84.8% at 5 years and 78.2% at 10 years. Multivariate analysis showed that seminal vesicle hemorrhage and a midline cyst of the prostate were significant factors to predict the duration of hematospermia until spontaneous resolution. The nine patients with persisting hematospermia for more than 1 year were treated with transurethral endoscopic surgery (unroofing of the midline cyst in six, and transurethral resection of the ejaculatory duct in three), and hematospermia resolved postoperatively in all these patients. CONCLUSIONS: In patients with hematospermia without inflammation, infection or malignancy, it is important to provide information on the possibility that symptoms will resolve spontaneously and to implement measures to relieve their anxiety. Detection of seminal vesicle hemorrhage and a midline cyst of the prostate is important for prediction of the duration of hematospermia.

Novel insight for midline cyst formation in prostate: The involvement of decreased prenatal testosterone suggested by second-to-fourth digit ratio study.

OBJECTIVES: To clarify the relationship between midline cyst formation and second to fourth finger length ratio. METHODS: The present study included 95 benign prostatic hyperplasia patients and 61 healthy male college students. All midline cysts were identified by transrectal ultrasonography. In the benign prostatic hyperplasia group, 45 midline cyst (+) men (M(age) = 67.2 years) and age-matched 50 midline cyst (-) men (M(age) = 67.1 years) were included. In the university student group, 12 midline cyst (+) men (M(age) = 21.7 years) and age-matched 49 midline cyst (-) men (Mage = 21.1 years) were included. We took photocopies of the participants' bilateral hands, and measured the second and fourth finger length was measured by one examiner in a blind manner. RESULTS: Second to fourth finger length ratios in the benign prostatic hyperplasia group (right/left mean ± SD) were higher bilaterally in midline cyst (+) (0.95 ± 0.03/0.95 ± 0.03) than those in midline cyst (-) (0.92 ± 0.03/0.92 ± 0.03; P < 0.0001/P = 0.0010). Second to fourth finger length ratios in students were higher only in the right hand in midline cyst (+) (0.96 ± 0.03/0.94 ± 0.03) than those in midline cyst (-) (0.93 ± 0.03/0.94 ± 0.03; P = 0.0018/P = 0.9968). The second to fourth finger length ratio of midline cyst (+) men was significantly higher than that in midline cyst (-) men. CONCLUSIONS: The second to fourth finger length ratio is higher in subjects with midline cyst of the prostate. It can be speculated that the prostatic utricle dilates in cases less exposed to male hormones during fetal development.

Successful diagnosis of type II enteropathy-associated T-cell lymphoma using flow cytometry and the cell block technique of celomic fluid manifesting as massive pyoid ascites that could not be diagnosed via emergency laparotomy.

Enteropathy-associated T-cell lymphoma (EATL), an intestinal tumor of intraepithelial T lymphocytes, is a rare and highly aggressive disease. We herein describe a case of type II EATL with massive pyoid ascites in which a histological examination could not be performed despite emergency laparotomy that was successfully diagnosed using flow cytometry and the cell block technique to analyze the celomic fluid. This case suggests that EATL should be included in the differential diagnosis of pyoid ascites of unknown origin and that flow cytometry and the cell block technique of assessing celomic fluid are useful procedures for diagnosing EATL, especially in cases in which conducting a histological examination is impossible.

The efficacy and safety of propiverine hydrochloride in patients with overactive bladder symptoms who poorly responded to previous anticholinergic agents.

Objectives. To prospectively examine the efficacy and safety of propiverine hydrochloride in patients with overactive bladder (OAB) symptoms who poorly responded to previous treatment with solifenacin, tolterodine or imidafenacin. Methods. Patients aged ≥20 with persisting OAB symptoms (≥6 in OAB symptom score (OABSS)) even after at least 4-week treatment using solifenacin, tolterodine or imidafenacin were enrolled. Propiverine 20 mg/day was administered for 12 weeks to 70 patients who desired the further improvement of OAB symptoms and 3 who had intolerable adverse events of previous drugs. The OABSS and postvoid residual urine volume (PVR) were determined before and at 4 and 12 weeks of treatment. Results. Of 73 patients enrolled (29 males and 44 females, median age 71 years), 52 completed the protocol treatment. The OABSS was significantly improved by propiverine treatment (9.0 at baseline, 6.2 at 4 weeks, 6.3 at 12 weeks (P < 0.001)). The scores of OAB symptoms (nighttime frequency, urgency and urge incontinence) except daytime frequency also improved significantly. No increase in PVR was observed. The most frequent adverse event was dry mouth (13.7%), followed by constipation (6.8%). Conclusions. Propiverine is useful to improve OAB for patients who poorly respond to solifenacin, tolterodine or imidafenacin.

[Investigation of post micturition dribble in patients after transurethral resection of the prostate].

OBJECTIVES: We investigated the actual status of post micturition dribble (PMD) after transurethral resection of the prostate (TURP). PATIENTS AND METHODS: We surveyed 388 patients who underwent TURP to determine whether they experienced urinary incontinence one year after the procedure. If they reported it, its frequency, degree and the type of urinary incontinence (stress urinary incontinence, urge incontinence, PMD) were investigated using a questionnaire. RESULTS: Of the 270 patients who responded to the questionnaire, 78 (29%) reported urinary incontinence. Although most of them experienced incontinence infrequently (less than once or twice a week) with a mild degree (tiny spot on the underwear), a few reported frequent (every day) or severe (wet pants or need a pad) urinary incontinence. PMD was the most common type of urinary incontinence, and was found in 48 patients (62%). CONCLUSION: PMD occurred in half or more of the patients with urinary incontinence after TURP.

[Investigation of adverse events and the continuance rate of silodosin in all patients who received silodosin for lower urinary tract symptoms suggestive of benign prostatic hyperplasia].

OBJECTIVES: We retrospectively evaluated patients who received silodosin for lower urinary tract symptoms suggestive of benign prostatic hyperplasia (BPH/LUTS) in our hospital, to investigate its efficacy, adverse events and continuance rate. METHODS: From the release of silodosin (July 2006) through October 2008, 256 patients received silodosin for BPH/LUTS in our hospital. Of these 256, we evaluated 195, as 61 were excluded due to conditions such as prostate cancer. We evaluated the International Prostate Symptom Score (IPSS), quality of life (QOL) index, uroflowmetry and postvoid residual urine volume before and after medication. We calculated the continuance rate of the drug by the Kaplan-Meier method. RESULTS: The patients' mean age was 68.1 years and the mean medicated period was 3.1 months. Overall severity at baseline estimated by the criteria for severity of BPH was mild in 0%, moderate in 69%, and severe in 31%. Silodosin significantly improved the IPSS, QOL index, maximum urinary flow rate and postvoid residual urine volume in 90 patients whose data were available for analysis of the efficacy. Improvements were observed both in voiding symptoms and in storage symptoms. However, 45.6% of the overall efficacy was insufficient. Adverse events were observed in 56 of the 195 cases (28.7%). The most common adverse event was abnormal ejaculation (10.8%). The patients who reported adverse events were significantly younger in age and had lower IPSS and QOL index values after treatment than those without adverse events (mean age: 65.4 vs. 69.2 years old; mean IPSS: 7.7 vs. 13.1, mean QOL index: 2.9 vs. 3.6). The continuance rate for the drug was 12.0% at 1 year on the Kaplan-Meier curve. The development of adverse events was involved in the low continuance rate of silodosin. CONCLUSIONS: Modification of treatment such as dose reduction is necessary to continue silodosin.

The 12-year symptomatic outcome of transurethral resection of the prostate for patients with lower urinary tract symptoms suggestive of benign prostatic obstruction compared to the urodynamic findings before surgery.

OBJECTIVE: To investigate whether bladder outlet obstruction (BOO), detrusor underactivity (DUA) and detrusor overactivity (DO) affect the long-term outcome of transurethral resection of the prostate (TURP) for patients having lower urinary tract symptoms suggestive of benign prostatic obstruction. PATIENTS AND METHODS: Of 92 patients who had TURP after a urodynamic study between 1995 and 1997, 43 (47%) were alive at the time of the survey in February 2008. Nine patients were excluded because of prostate cancer, neurological diseases and the impossibility of symptomatic examination. The International Prostate Symptom Score (IPSS) and quality-of-life (QoL) index were determined at baseline, 3 months, 3, 7 and 12 years after surgery for 34 patients. RESULTS: Although the improved IPSS and QoL index at 3 months gradually deteriorated with time, patients at 12 years were still significantly better than those at baseline. The IPSS in patients without BOO deteriorated faster than in those with it, whereas neither DUA nor DO influenced the slope of change in IPSS. Regardless of the preoperative urodynamic findings, the QoL index remained improved for 12 years. Two-thirds of patients with DUA but not BOO were satisfied with their urinary condition at 12 years. CONCLUSION: The symptomatic improvement provided by TURP lasts for >10 years, although there is a gradual deterioration with time. The QoL index remained improved for 12 years regardless of the preoperative urodynamic findings.

Treatment strategy according to findings on pressure-flow study for women with decreased urinary flow rate.

PURPOSE: In women who reported a weak urinary stream, the efficacy of treatment chosen according to the urodynamic findings on pressure-flow study was prospectively evaluated. MATERIALS AND METHODS: Twelve female patients with maximum flow rates of 10 mL/sec or lower were analyzed in the present study. At baseline, all underwent pressure-flow study to determine the degree of bladder outlet obstruction (BOO) and status of detrusor contractility on Schäfer's diagram. Distigmine bromide, 10 mg/d, was given to the patients with detrusor underactivity (DUA) defined as weak/very weak contractility, whereas urethral dilatation was performed using a metal sound for those with BOO (linear passive urethral resistance relation 2-6). Treatment efficacy was evaluated using the International Prostate Symptom Score (IPSS), uroflowmetry, and measurement of postvoid residual urine volume. Some patients underwent pressure-flow study after treatment. RESULTS: Urethral dilatation was performed for six patients with BOO, while distigmine bromide was given to the remaining six showing DUA without BOO. IPSS, QOL index, and the urinary flow rate were significantly improved in both groups after treatment. All four of the patients with BOO and one of the three with DUA but no BOO who underwent pressure-flow study after treatment showed decreased degrees of BOO and increased detrusor contractility, respectively. CONCLUSIONS: Both BOO and DUA cause a decreased urinary flow rate in women. In the short-term, urethral dilatation and distigmine bromide are efficacious for female patients with BOO and those with DUA, respectively.

[Current status and issues of stroke care in the Hokumou Secondary Medical District: the activity of the Okhotsk Stroke Association].

To achieve good care for stroke patients in the Hokumou Secondary Medical District, we reaffirmed the current status of the services, discovered the keypoints and issues, and searched for solutions to the current problems. The population, its age composition and the number of beds occupied by stroke patients--stratified in acute, convalescent and maintenance stages-were surveyed. The number of patients suffering from stroke under the jurisdiction of this district was compiled, by using the "regional alliance path for stroke," and the severity and outcome of each case were evaluated by using the mRS (modified Rankin Scale). We held seminars for citizens' on the prevention and management of stroke and the attendees were asked to fill out questionnaires, and were organized: networks for medical care and nursing in the Okhotsk Sea area and people's voices were heard at the network meetings; and at the town meetings held at Kitami, Abashiri and Bihoro, the challenges and problems in each area were discussed. The findings obtained from these activities were compiled for the current study. The rate of release of the patients to their home environment was high in the acute stage but low in the convalescent stage. To substantiate the regional management of stroke patients, it is essential that one be familiar with the availability of the limited medical recourses for and dynamics of patients. And yet, there is a limit to the efforts that the medical profession alone can make for the acute and convalescent stages. It is necessary that the health services assist in solving the problems, with the cooperation of the citizens and the nursing network that is involved in homes and nursing facilities for the care of patients in the maintenance stage.

Is urethritis accompanied by seminal vesiculitis?

OBJECTIVE: To determine whether urethritis is accompanied by seminal vesiculitis using transrectal ultrasound (TRUS) imaging. METHODS: Fifty-six male patients (mean age 31.6 8.7 years) with urethritis were included in the study. As a control group,we also considered 34 healthy volunteers (mean age 21.3 1.8 years). The two groups were evaluated by the nucleic acid amplification test and imaging studies using TRUS. RESULTS: The nucleic acid amplification test could identify 15 patients (26.8%) with gonococcal urethritis (five had accompanying chlamydial urethritis), 32 (57.1%) with chlamydial urethritis, and nine (16.1%) with nongonococcal and nonchlamydial urethritis. The mean anteroposterior diameter of the bilateral seminal vesicles was significantly longer in the urethritis group than in the controls (12.9 3.3 mm vs 11.0 2.0 mm, P = 0.004). The incidence of dilatation or cystic changes of seminal vesicles was significantly higher in the urethritis group than in the controls (dilatation: 30% vs 9%, P = 0.019; cystic change: 39% vs 12%, P = 0.007). There was no significant difference in the incidence of dilatation or cystic changes of seminal vesicles between gonococcal urethritis and chlamydial urethritis. CONCLUSIONS: Patients with urethritis are likely to have accompanying seminal vesiculitis. This suggests a close interrelationship among urethritis, seminal vesiculitis and epididymitis.

Inflammatory myofibroblastic tumor causing ileoileal intussusception: an unusual cause of an unusual neoplasm in an adult, with a clinicopathological review of the literature.

An inflammatory myofibroblastic tumor (IMT) of the ileum is a very rare lesion of the gastrointestinal tract. A 36-year-old female presented with abdominal fullness and colicky pain of 5 days' duration. Plain abdominal radiography showed an intestinal obstruction with dilated jejunal loops. Abdominal computed tomography and ultrasonography demonstrated a well-defined intraluminal solid mass surrounded by the typical mural layers of an invaginated ileum. The patient then underwent an exploratory laparotomy under a clinical diagnosis of intussusception caused by a small bowel tumor. The surgical findings revealed a large mass leading to an ileoileal intussusception, with regional lymph node enlargement and a small bowel resection accompanied by lymph node dissection was performed. The definitive diagnosis of IMT was confirmed by both conventional histopathology and minute immunohistochemistry.

Magnetic resonance imaging is accurate to detect bleeding in the seminal vesicles in patients with hemospermia.

OBJECTIVE: To confirm the presence of hemorrhage in the seminal vesicles by aspiration in patients with findings suspicious for hemorrhage on magnetic resonance imaging (MRI); and to investigate the relationship between findings on MRI and the freshness of hemorrhage. METHODS: Twenty-six patients with hemospermia who showed high-intensity signals on T1-weighted images with or without low-intensity signals on T2-weighted images, suggesting seminal vesicle hemorrhage, were analyzed. Of the 26, 15 underwent transperineal aspiration of the seminal vesicles under transrectal ultrasound guidance to confirm the bleeding. RESULTS: Bloody fluid was aspirated from all seminal vesicles showing a pattern suggestive of bleeding on MRI. The morphologic analysis of red blood cells in the fluid indicated relatively fresh hemorrhage in the seminal vesicles showing high-intensity signals on T1-weighted images and low-intensity signals on T2-weighted images (group A), but old hemorrhage in those showing high-intensity signal on T1-weighted images as well as T2-weighted images (group B). In 3 patients of group A who did not receive aspiration, repeated MRI during the follow-up showed that the signal intensity changed from low to high on T2-weighted images. On the other hand, in 2 patients of group B who received aspiration, repeated MRI performed 12 and 7 days after aspiration showed low signal intensity on T2-weighted images. CONCLUSIONS: Hemorrhage is really present in the seminal vesicles if high signal intensity is observed on T1-weighted images. The patterns showing low and high signal intensities on T2-weighted images suggest relatively fresh and old bleeding, respectively.

New classification of midline cysts of the prostate in adults via a transrectal ultrasonography-guided opacification and dye-injection study.

OBJECTIVES: To reclassify midline cysts (MLCs) of the prostate according using the results from transrectal ultrasonography (TRUS)-guided opacification and dye injection. PATIENTS AND METHODS: Eighty-six patients (mean age 60.9 years) who had MLCs detected in the pelvis by TRUS were investigated. In all patients the size of the MLC was measured and they had transperineal aspiration under TRUS guidance. After aspiration of the MLC a mixture of water-soluble contrast medium and indigo carmine dye was injected to check for communication with the urethra or seminal tract by endoscopic and pelvic X-ray examination. RESULTS: We classified MLCs into four categories: (i) type 1 (nine cases), MLC with no communication into the urethra (traditional prostatic utricle cyst); (ii) type 2a (60 cases), MLC with communication into the urethra (cystic dilatation of the prostatic utricle, CDU); (iii) type 2b (14 cases), CDU which communicated with the seminal tract; (iv) type 3 (three cases), cystic dilation of the ejaculatory duct. The location, shape and volume of the MLC, and the prostate-specific antigen level of MLC fluid, did not influence the classification. CONCLUSIONS: The most common type of MLC was CDU. A new classification that depends on the communication with the urethra or seminal tract is proposed.

Fate of seminal vesicles and prostate after medical castration: how long is the optimal duration of neoadjuvant treatment for prostate cancer before radiation?

OBJECTIVES: To clarify the morphological alteration of prostate and seminal vesicles (SV) quantitatively after testosterone ablation, we investigated the prostate volume (PV) and the SV volume (SVV) using transrectal ultrasonography. METHODS: Between July 2002 and October 2004, we prospectively investigated 29 prostate cancer patients. The medical castration group included 21 patients (42 SV and 21 prostate; median Gleason sum, 74 years) who were diagnosed as having T1b to T3aN0M0 prostate cancer and underwent androgen ablation with a luteinizing hormone-releasing hormone (LH-RH) analogue and chlormadinone acetate. As normal controls, 8 patients (16 SV and 8 prostate; median age, 68.5 years) with T1aN0M0 prostate cancer without any other additional treatment were enrolled in this study. We measured both PV and SVV in these groups with transrectal ultrasonography. RESULTS: Both PV and SVV significantly decreased in the medical castration group (PV: 28.4 +/- 9.3 mL to 17.0 +/- 5.3 mL, SVV: 3.5 +/- 1.8 mL to 1.9 +/- 1.0 mL; median, 6 months), whereas those in the control group were maintained (PV: 16.6 +/- 5.7 mL to 16.5 +/- 5.3 mL, SVV: 2.5 +/- 1.0 mL to 2.6 +/- 1.6 mL; median, 12 months). In longitudinal assessment, mean PSA, PV, and SVV were significantly reduced gradually up to 12 months after medical castration. CONCLUSIONS: Not only PV but also SVV was significantly reduced after medical castration. Moreover, size reduction continued up to 12 months in SV, with especially marked reduction seen through the first 6 months. These results demonstrated that optimum duration for androgen ablation before radiotherapy is at least 6 months, and up to 12 months for the maximum effect.

A clinical investigation of the mechanism of loxoprofen, a non-steroidal anti-inflammatory drug, for patients with nocturia.

We previously reported the effectiveness of loxoprofen sodium (loxoprofen), a non-steroidal anti-inflammatory drug, for patients with lower urinary tract symptoms (LUTS) complaining of nocturia. In this study, we explored the mechanism of loxoprofen in the treatment of nocturia. Fifty-six patients complaining of nocturia were enrolled. They took a single 60-mg tablet of loxoprofen at bedtime for 14 days. The effects of this treatment were assessed by bladder diaries. Nocturia improved (nocturia decreased >or=1 void/night) in 40 patients (71.4%). Nocturnal urine volume was reduced in 31 of 40 (77.5%) without nocturnal single-void volume increase. Nocturnal single-void volume increased in 4 of 40 (10.0%) without nocturnal urine volume reduction. Two of 40 (5.0%) demonstrated both nocturnal urine volume reduction and nocturnal single-void volume increase. Three (7.5%) were exceptions to the above. In conclusion, the main mechanism of loxoprofen is the reduction of nocturnal urine volume for the treatment of nocturia and the second mechanism is the increased bladder capacity.

Glomerulation observed during transurethral resection of the prostate for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia is a common finding but no predictor of clinical outcome.

OBJECTIVES: Although glomerulation in the bladder mucosa when the bladder is overdistended is a finding suggestive of interstitial cystitis (IC), it is sometimes observed at transurethral resection of the prostate (TURP) for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). We prospectively investigated the incidence and clinical implications of glomerulation found at TURP. METHODS: From December 2003 to October 2005, 197 patients aged 50 years or older who were considered to be appropriate candidates to undergo TURP for LUTS/BPH were investigated in this study. Just before beginning resection under spinal anesthesia, the bladder was filled to a water pressure of 80 cm and the capacity was measured. After evacuation of the fluid, careful inspection was conducted for glomerulation during refilling. Before TURP, and 3 and 12 months after TURP, the International Prostate Symptom Score and O'Leary-Sant IC Symptom and Problem Index were determined, and uroflowmetry and measurement of residual urine volume were performed. RESULTS: Glomerulation was observed in 40 of the 197 patients (20.3%). There was no difference in bladder capacity between the glomerulation and nonglomerulation groups, although the glomerulation group was younger with lighter resected weight and a higher baseline IC problem index than the nonglomerulation group. There were no differences in other parameters before, 3, and 12 months after TURP between the 2 groups. CONCLUSIONS: Although glomerulation at TURP is a common finding, the clinical implications related to IC are unknown. Glomerulation itself may not be a predictor of the clinical outcome of TURP. Glomerulation observed during transurethral resection of the prostate for patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia is a common finding but no predictor of clinical outcome.

[Long-term results of lower urinary tract symptoms and urinary flow rate after transurethral resection of the prostate].

We investigated lower urinary tract symptoms (LUTS) and the urinary flow rates of patients who underwent transurethral resection of the prostate (TUR-P) for benign prostatic hyperplasia to determine the persistence of the efficacy of TUR-P. We mailed questionnaires for evaluation of LUTS to 1236 patients who had received TUR-P. In addition, we encouraged them to visit a clinic for uroflowmetry if possible. LUTS using the International Prostate Symptom Score (IPSS) and QOL index, and uroflowmetry were analyzed in 847 (68.5%) and 150 patients (12.1%), respectively. The IPSS of patients who had received TUR-P more than 5 years earlier was higher than that of patients who had received it in the preceding 5 years. However, more than 80% of the patients in both groups were satisfied with their urinary condition at evaluation. Although no obvious change in the maximum urinary flow rate was observed in the patients who had received TUR-P in the preceding 5 years, it was significantly decreased in the patients who had received it more than 5 years earlier. The tendency was marked in the patients when TUR-P was performed at 70 years of age and older. Although the change in detrusor function determined by the age at surgery and the postoperative period may cause LUTS and reduce the urinary flow rate in the long-term after TUR-P, the efficacy of TUR-P appears to last for long periods in terms of the maintenance of QOL.