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1.
Sci Rep ; 14(1): 5847, 2024 03 11.
Artigo em Inglês | MEDLINE | ID: mdl-38462660

RESUMO

This study aimed to assess the effects of thienopyridine-class antiplatelet agents (including ticlopidine, clopidogrel, and prasugrel) on bleeding complications in patients who underwent robot-assisted radical prostatectomy. This cohort study used a database for robot-assisted radical prostatectomy at 23 tertiary centers nationwide between 2011 and 2022. Patients who received thienopyridines (thienopyridine group) were compared with those who received aspirin monotherapy (aspirin group). The primary outcome was the incidence of bleeding complications. High-grade complications were defined as Clavien-Dindo grade III or higher. The risks of these outcomes were evaluated using inverse probability of treatment weighted regression models. The study results demonstrated that thienopyridine therapy was associated with a higher risk of overall bleeding complications (OR: 3.62, 95%CI 1.54-8.49). The increased risks of the thienopyridine group were detected for low-grade bleeding complications (OR: 3.20, 95%CI 1.23-8.30) but not for high-grade bleeding complications (OR: 5.23, 95%CI 0.78-34.9). The increased risk of bleeding complications was not observed when thienopyridine was discontinued (OR: 2.52, 95%CI 0.83-7.70); however, it became apparent when it was continued perioperatively (OR: 4.35, 95%CI 1.14-16.61). In conclusion, thienopyridine increased the incidence of bleeding complications, particularly low-grade bleeding complications, following robot-assisted radical prostatectomy. These bleeding effects emerged when thienopyridine was continued perioperatively.


Assuntos
Inibidores da Agregação Plaquetária , Piridinas , Robótica , Masculino , Humanos , Inibidores da Agregação Plaquetária/efeitos adversos , Estudos de Coortes , Hemorragia/induzido quimicamente , Aspirina/efeitos adversos , Tienopiridinas , Prostatectomia/efeitos adversos
2.
Int Urol Nephrol ; 56(3): 989-997, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37907707

RESUMO

PURPOSE: To determine baseline factors and surgical procedures associated with clinically meaningful improvement or deterioration of lower urinary tract symptoms (LUTS) after robot-assisted radical prostatectomy (RARP). METHODS: We retrospectively reviewed our RARP database and analyzed the changes in the International Prostate Symptom Score (IPSS) at baseline and 1, 3, 6, and 12 months postoperatively. Multivariable ordinal logistic regression analysis was performed to determine variables that predicted clinically meaningful improvement (∆IPSS ≤ -5) or deterioration (∆IPSS ≥ 5) in LUTS after RARP. RESULTS: A total of 172 patients were eligible for analysis. Patients aged ≥ 70 reported a higher IPSS before and after RARP (all p < 0.05). Patients with a prostate volume of > 30 mL or body mass index of < 24 kg/m2 had worse preoperative LUTS; however, the difference disappeared after RARP. While patients with or without nerve-sparing (NS) had a similar preoperative LUTS burden, the NS group reported significantly lower IPSS than the non-NS group at all postoperative time points (p < 0.05). Twelve months after RARP, LUTS improved in 27% and worsened in 6% of patients in the NS group, compared with 20% and 24% of those in the non-NS group, respectively (p = 0.018). Preoperative IPSS (OR, 0.84; 95% CI, 0.79-0.89) and NS (OR, 0.39; 95% CI, 0.18-0.83) were independently associated with clinically meaningful changes of LUTS at 12 months after RARP. CONCLUSION: Other than baseline LUTS severity, NS was the only independent factor associated with clinically meaningful changes in LUTS after RARP.


Assuntos
Sintomas do Trato Urinário Inferior , Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Robótica , Masculino , Humanos , Próstata/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/cirurgia , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Neoplasias da Próstata/cirurgia
3.
J Urol ; 208(2): 377-378, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35575713
4.
Neurourol Urodyn ; 41(5): 1165-1171, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35419862

RESUMO

AIM: To assess real-world treatment profiles, including utilization rate, time to and reasons for discontinuation of combination pharmacotherapy with ß3 -agonists and antimuscarinics for refractory overactive bladder (OAB) through a retrospective chart review. METHODS: We retrospectively reviewed the records of OAB patients who received ß3 -agonists or antimuscarinics at our hospital between 2012 and 2020 and analyzed the clinical course of patients who progressed to combination therapy. Data on age, sex, major complaints, OAB symptom score at the initiation of combination therapy, treatment persistence, and reasons for discontinuation were collected. Treatment persistence was assessed with respect to the median time to discontinuation and persistence rate at 12 months. RESULTS: Of the 2163 patients receiving ß3 -agonists or antimuscarinics, only 84 (3.8%) progressed to combination therapy with both drug classes. At therapy initiation, most (98%) of these patients had moderate to severe OAB symptoms. Median treatment duration and 12-month persistence rate for combination therapy were 595 days and 64.0%, respectively. The reasons for discontinuation were insufficient treatment efficacy followed by adverse effects including voiding impairment in nearly 10% of the patients. None of the baseline parameters was independently associated with persistence in the multivariate analysis. CONCLUSION: While underutilized among OAB patients refractory to monotherapy, combination pharmacotherapy showed a greater persistence rate than published mirabegron or antimuscarinic monotherapy when applied to patients with moderate to severe symptoms. Treatment-emergent voiding impairment is a concern associated with this mode of therapy. A small sample size at a single institution is the limitation of this study.


Assuntos
Bexiga Urinária Hiperativa , Agentes Urológicos , Acetanilidas/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 3/efeitos adversos , Quimioterapia Combinada , Humanos , Antagonistas Muscarínicos/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Bexiga Urinária Hiperativa/induzido quimicamente , Bexiga Urinária Hiperativa/tratamento farmacológico , Agentes Urológicos/efeitos adversos
5.
Neurourol Urodyn ; 39(8): 2527-2534, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32985716

RESUMO

AIM: To assess real-world treatment profiles, including the time to and reasons for discontinuation or drug switching, treatment reinitiation, and postdiscontinuation follow-up in patients receiving antimuscarinics or ß3-agonists for overactive bladder (OAB) through a retrospective chart review. METHODS: We retrospectively reviewed medical charts of 777 patients, aged ≥18 years, who underwent antimuscarinic or ß3-agonist therapy at our hospital. Data on patient's age, sex, chief complaint, and OAB symptom score at therapy initiation were collected. Treatment persistence was assessed with respect to the median time to discontinuation and the persistence rate at 12 months. RESULTS: Older patients, male patients, and those with more severe urgency symptoms were more likely to show treatment persistence with OAB medications. Treatment persistence with mirabegron was significantly longer than that with antimuscarinics when administered as either the first- or second-line medication. Multivariate analyses showed that urgency severity and use of mirabegron were independently associated with better persistence (p = .026 and p = .018, respectively). Out of 583 patients who discontinued medication, 344 continued with the visit schedule, and the reinitiation rate of the OAB medication was 19% at a median follow-up of 24 months. CONCLUSION: Although the persistence rates for OAB medications improved with the introduction of mirabegron, most patients still discontinued the medication therapy within 1 year. The treatment strategies for patients with mild symptoms and those who are resistant to medication can still be improved. Tailored individualized treatments that avoid excessive reliance on pharmacotherapy would be key to further improve treatment outcomes in OAB patients.


Assuntos
Acetanilidas/uso terapêutico , Antagonistas Muscarínicos/uso terapêutico , Tiazóis/uso terapêutico , Bexiga Urinária Hiperativa/tratamento farmacológico , Agentes Urológicos/uso terapêutico , Adulto , Idoso , Substituição de Medicamentos , Feminino , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Resultado do Tratamento
6.
BMC Nephrol ; 18(1): 312, 2017 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-29037159

RESUMO

BACKGROUND: Complications of peritoneal dialysis (PD) such as pain and catheter leakage are frequently reported. Delayed bowel perforation of a PD catheter is a rare adverse event but a serious complication associated with significant mortality. Bowel perforation of a PD catheter is difficult to differentiate from PD-related peritonitis and likely to result in a delay in diagnosis. Here, we report two cases of bowel perforation after PD catheter insertion by the stepwise initiation of PD using the Moncrief and Popovich technique (SMAP) and peritoneal wall anchor technique (PWAT). CASE PRESENTATION: The first case was a 53-year-old woman with end-stage renal disease (ESRD) due to diabetic nephropathy and a history of entero-adhesiolysis. She underwent PD catheter insertion by the SMAP with PWAT. Four months after PD catheter insertion, the catheter was found to perforate sigmoid colon. The second case was a 57-year-old woman with ESRD due to large polycystic kidney disease. She underwent the same procedure. After exteriorization of the catheter, she developed peritonitis due to perforation of the catheter tip into the bowel. Both patients were safely removed the catheter with uneventful recovery. CONCLUSION: We reported two cases of a rare complication of PD catheter. The SMAP method, PWAT, enlarged kidneys and migration of the lower cuff may be risk factors of bowel perforation of a PD catheter.


Assuntos
Cateteres de Demora/efeitos adversos , Perfuração Intestinal/etiologia , Diálise Peritoneal/efeitos adversos , Doenças do Colo Sigmoide/etiologia , Feminino , Humanos , Falência Renal Crônica/terapia , Pessoa de Meia-Idade
7.
Hinyokika Kiyo ; 62(5): 271-4, 2016 May.
Artigo em Japonês | MEDLINE | ID: mdl-27320120

RESUMO

A 27-year-old man visited our hospital with painless swelling of the left scrotum. Hematologic studies showed the following levels of lactate dehydrogenase, 3,171 IU/l ; alpha-fetoprotein, 2.2 ng/ml ; and ß- human chorionic gonadotropin, 0.4 ng/ml, and abdominal computed tomography revealed a mass of 10×8 ×4 cm in the left testis, and that of 3.5×3.0×5.0 cm in the left renal hilar lymph node, without any other metastasis. Left high inguinal orchiectomy was performed, and histopathological examination revealed mixed form with seminoma and teratoma. He was diagnosed to have a left germ cell tumor with left renal hilar lymph node metastases, pT1, N3, M0, stage II C, indicating poor prognosis with IGCCC. The patient received four cycles of chemotherapy, COMPE regimen (CDDP, VCR, MTX, PEP, VP-16 [etoposide]). After lactate dehydrogenase, alpha-fetoprotein, and ß -human chorionic gonadotropin all normalized, retroperitoneal lymph node dissection was performed. Histopathological examination revealed only a mature teratoma. Two and half years later, hematologic studies showed blast transformation. Bone marrow biopsy revealed acute myeloblastic lymphoma (M2). The patient received one cycle of AraC and daunorubicin, one cycle of high dose AraC, and three cycles of AraC and mitoxantrone. After chemotherapy, he has maintained a disease-free status for 11 years. In this case, etoposide, a topoisomerase II inhibitor, was the presumed cause of therapy-related acute myeloid leukemia. After administering chemotherapeutic agents especially etoposide, it is important to check blood count periodically for a long time.


Assuntos
Antineoplásicos Fitogênicos/efeitos adversos , Etoposídeo/efeitos adversos , Leucemia Mieloide Aguda/induzido quimicamente , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Testiculares/tratamento farmacológico , Adulto , Antineoplásicos Fitogênicos/administração & dosagem , Etoposídeo/administração & dosagem , Humanos , Leucemia Mieloide Aguda/patologia , Metástase Linfática , Masculino
8.
BMC Res Notes ; 8: 490, 2015 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-26415511

RESUMO

BACKGROUND: Although nocturia has been reported to increase mortality in elderly individuals, the particular risk factors that are associated with this event are unclear. Therefore, we evaluated risk factors for death in outpatients with nocturia. METHODS: Between October 2002 and December 2009, 250 consecutive patients with nocturia were enrolled in two general hospitals in Japan. Among them, 193 patients were able to be followed for at least 1 year and up to 9 years (median 4.8 years) if the patients did not die. Mortality rates and risk factors were evaluated in the nocturic outpatients. RESULTS: Two- and 5-year survival of the nocturic outpatients was 94.6% [95% confidence interval (CI) = 92.2-97.1] and 82.6% (95% CI = 75.4-87.8), respectively. Higher Charlson Comorbidity Score, lower body mass index (BMI) and lower Physical Component Summary of Short Form-36 item scores were significantly correlated with mortality (p < 0.0001, p < 0.005 and p < 0.05, respectively) in multivariate analysis. The International Prostate Symptom Score, Pittsburgh Sleep Quality Index, Mental or Role/Social Component Summary of Short Form-36 item scores and Nocturnal Polyuria index were not significantly correlated with mortality. The mortality rate was significantly higher in subjects with an underweight BMI (<18.50) compared with a normal range (18.50-24.99) or overweight (≥25.00) BMI [p < 0.00005, hazard ratio (HR) = 5.84, 95% CI = 2.03-16.8; p < 0.0005, HR = 5.92, 95% CI = 1.94-18.0]. CONCLUSIONS: Additional attention is required for nocturic outpatients with not only a high Charlson Comorbidity Score but also an underweight BMI because of their high mortality. Large prospective studies are warranted to validate this finding and extend more.


Assuntos
Noctúria/epidemiologia , Noctúria/mortalidade , Pacientes Ambulatoriais , Magreza/complicações , Idoso , Índice de Massa Corporal , Feminino , Humanos , Japão/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Modelos de Riscos Proporcionais , Fatores de Risco
9.
Hinyokika Kiyo ; 58(5): 223-6, 2012 May.
Artigo em Japonês | MEDLINE | ID: mdl-22767274

RESUMO

Anticoagulant and antiplatelet medications are commonly used for the treatment and prevention of cardiovascular diseases. We studied 84 patients who received heparin as a bridging anticoagulant and antiplatelet therapy during the perioperative period. Hospitalization was extended for adjusting anticoagulant and antiplatelet drugs and also bleeding complications in the perioperative period. There were 25 instances of bleeding complications (29.7%) in this study. These complications mainly occurred when anticoagulant and antiplatelet medications were restarted in the postoperative period. In transurethral surgery, patients taking warfarin and antiplatelet drugs (aspirin or ticlopidine) had a statistically significant increase in bleeding complications compared to patients taking warfarin alone. We compared 51 cases of transurethral resection of bladder tumor, transurethral resection of the prostate holium laser enucleation of the prostate, nephroureterectomy and percutaneous nephrolithotomy with heparinization were compared to 692 cases with no heparinization. The heparinization group had a statistically significant longer hospitalization period and an increase in bleeding complications. There was one instance of thromboembolism (1.2%) in our series. This involved stent thrombosis of a patient who had drug-eluting stent in the left anterior descending coronary artery. She died three days postoperatively. The number of patients taking anticoagulant and/or antiplatelet drugs is predicted to increase in the future due to aging of the population. Guidelines for the management of anticoagulant and antiplatelet therapy in the urological period are considered necessary.


Assuntos
Anticoagulantes/uso terapêutico , Heparina/uso terapêutico , Período Perioperatório , Inibidores da Agregação Plaquetária/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/tratamento farmacológico , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Urológicos
10.
Low Urin Tract Symptoms ; 4(2): 77-81, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-26676530

RESUMO

OBJECTIVES: To investigate the efficacy of two types of drugs, furosemide and gosha-jinki-gan (GJG), for treatment of nocturia with nocturnal polyuria using a randomized crossover method. METHODS: A total of 36 patients with nocturnal polyuria were recruited for this study. We assessed the International Prostate Symptom Score (I-PSS), Pittsburgh Sleep Quality Index (PSQI), frequency volume charts, blood pressure, urine chemistry, serum B-type natriuretic peptide (BNP) and body fluid compartments. RESULTS: Both furosemide and GJG significantly improved the nocturia score in the I-PSS, the I-PSS Quality of Life (QOL) score, actual nocturnal frequency and hours of undisturbed sleep compared with those at baseline. Nocturnal frequency and nocturnal urine volume were more significantly reduced by furosemide treatment than with GJG treatment. The I-PSS total score and nocturnal urine volume significantly improved only by furosemide treatment. CONCLUSION: Furosemide treatment definitively improved nocturia with nocturnal polyuria. GJG treatment may also induce mild improvement of nocturnal polyuria, although further study is required to confirm its efficacy.

11.
Hinyokika Kiyo ; 57(10): 551-4, 2011 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-22089152

RESUMO

We report a case of bilateral renal calculi in a 1-year-old female with adenine phosphoribosyl transferase (APRT) partial deficiency. She initially visited another institution with high fever as the major complaint. Computed tomography revealed a bilateral renal stone and left hydro nephrosis. In the urine, there were 2, 8-dihydroxyadenine (DHA) crystals. An analysis of the APRT gene revealed the APRT deficiency and the genotype to be APRT*J/APRT*Q0. We performed extracorporeal shock wave lithotripsy (ESWL) under general anesthesia, and as dissolution therapy we administered Meylon through the nephrostomy and citric acid orally. The stone disappeared from her kidney. The analysis of the stone fragments revealed 2,8- dihydroxyadenine (DHA) urolithiasis.


Assuntos
Adenina Fosforribosiltransferase/deficiência , Cálculos Renais/complicações , Adenina Fosforribosiltransferase/genética , Ácido Cítrico/administração & dosagem , Feminino , Humanos , Lactente , Cálculos Renais/terapia , Litotripsia
12.
Hinyokika Kiyo ; 57(7): 353-7, 2011 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-21832868

RESUMO

To assess appropriate treatment strategies for transitional cell carcinoma in situ (CIS) of the upper urinary tract (UUT), we evaluated the long-term outcome of Bacillus Calmette-Guérin (BCG) perfusion therapy for CIS of UUT. We retrospectively reviewed the medical records of 24 patients who underwent BCG perfusion therapy for CIS of UUT between August 1993 and August 2009. Patients received at least one course of BCG (once weekly for 6 weeks). The median follow-up period was 48.5 months (range 16-201 months). In 23 patients (96%), cytology became negative after one course of BCG perfusion and 12 patients (50%) remained disease-free for a median follow-up of 38. 5 months. In 11 patients positive cytology recurred, and in five of them nephroureterectomy was performed after radiologic studies showed the presence of a tumor in the UUT. Histopathology showed invasive tumor (pT3) in all cases, and three of them experienced distant metastases after surgery. In conclusion, BCG perfusion therapy is effective for the treatment of CIS of UUT with long-term follow-up. However, in cases with a poor response or recurrence of CIS, there is a high risk of developing invasive tumor. Surgical intervention should be immediately considered in such cases after the first course of BCG perfusion therapy.


Assuntos
Carcinoma in Situ/terapia , Carcinoma de Células de Transição/terapia , Mycobacterium bovis , Neoplasias Urológicas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma in Situ/cirurgia , Carcinoma de Células de Transição/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Perfusão , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias Urológicas/cirurgia
13.
J Med Case Rep ; 5: 234, 2011 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-21702973

RESUMO

INTRODUCTION: Iatrogenic damage to the seminal tract is one of the causes of obstructive azoospermia, which can be an indication for reconstruction surgery. We present a case of obstructive azoospermia as an unusual complication after neonatal herniorrhaphy of an omphalocele. CASE PRESENTATION: A 30-year-old Japanese man was diagnosed with obstructive azoospermia. He had undergone herniorrhaphy of an omphalocele immediately after birth. Reconstruction surgery of both seminal tracts was performed to pursue the possibility of naturally achieved pregnancy. Intra-operative findings demonstrated that both vasa deferentia were interrupted at the internal inguinal rings, although the abdominal end of the right vas leading to the seminal vesicle was found in the abdominal cavity. The discharge from the stump of the testicular end had no sperm, although the right epididymal tubules were dilated with motile sperm. Therefore, we performed right-sided vasovasostomy in the internal inguinal ring and ipsilateral epididymovasostomy simultaneously. CONCLUSION: To the best of our knowledge, this is the first report describing obstructive azoospermia as an unusual complication of herniorrhaphy of an omphalocele. It is important to pay attention to the existence of seminal tracts in such surgery as well as in inguinal herniorrhaphy.

14.
Hinyokika Kiyo ; 57(2): 77-9, 2011 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-21412039

RESUMO

Urolithiasis in pediatric patients is relatively rare. Extracorporeal shock wave lithotripsy and endoscopic procedures play a major role in treating pediatric urolithiasis. A 3-year-old girl presented with macroscopic hematuria and right back pain and was diagnosed with a right renal stone (15 mm). Obstruction of ureteropelvic junction was suspected on computed tomography-urography and therefore the patient underwent percutaneous nephrolithotripsy (PNL). The operation was performed using a 12 Fr miniature nephroscope and Ho : YAG laser without any complications. This patient achieved a stone-free status. The stone analysis revealed a mixture of calcium oxalate and ammonium acid urate. PNL with a miniature nephroscope is safe and effective treatment for pediatric urolithiasis.


Assuntos
Cálculos Renais/terapia , Litotripsia/métodos , Pré-Escolar , Feminino , Humanos , Cálculos Renais/diagnóstico por imagem , Ultrassonografia
15.
Nihon Hinyokika Gakkai Zasshi ; 102(6): 726-30, 2011 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-22390087

RESUMO

A 64-year-old woman presented with recto-cutaneous fistula after tension-free vaginal mesh reconstruction using polypropylene mesh for pelvic organ prolapse. Eleven months after the operation, an ulcerative lesion with stools smell secretion developed in the left hip. Magnetic resonance imaging and colonoscopy revealed a migration of the left arm of the mesh and a recto-cutaneous fistula. The patient underwent excision of the infected mesh and rectal wall closure together with transient colostomy. After 8 months, colonoscopy revealed a new migration of the mesh in the rectum, which was also removed. The colostomy was closed one year later and rectal erosion has not reccurred since then. The possibility of developing a rare but severe mesh-related complication as presented here should always be kept in mind.


Assuntos
Fístula Cutânea/etiologia , Migração de Corpo Estranho/complicações , Fístula Retal/etiologia , Telas Cirúrgicas/efeitos adversos , Colonoscopia , Colostomia , Fístula Cutânea/diagnóstico , Feminino , Migração de Corpo Estranho/diagnóstico , Migração de Corpo Estranho/patologia , Humanos , Pessoa de Meia-Idade , Prolapso de Órgão Pélvico/cirurgia , Polipropilenos , Fístula Retal/diagnóstico
16.
Hinyokika Kiyo ; 56(10): 559-63, 2010 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-21063159

RESUMO

An adequate protocol for antimicrobial prophylaxis (AMP) in radical prostatectomy (RP) has not been established. We retrospectively compared the occurrence of perioperative infection following RP between two different AMP protocols. This study included 340 cases with prostate cancer who underwent RP at our institution between January 2005 and December 2008. The 1-day group consisting of 93 cases received a second generation cephem, cefotiam, intravenously during and after the operation on the operative day. The single dose group consisting of 247 cases received cefotiam during the operation only. The incidence of surgical site infection (SSI) and remote infection (RI) was retrospectively investigated. There was no significant difference in the rate of SSI and RI occurrence between the 1-day group (2.2, 0%) and single dose group (3.6, 0.4%) (p = 0.52). The single dose protocol of AMP seems sufficient for prevention of perioperative infection in RP.


Assuntos
Infecções Bacterianas/prevenção & controle , Cefotiam/administração & dosagem , Prostatectomia , Idoso , Humanos , Masculino , Complicações Pós-Operatórias/prevenção & controle , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/prevenção & controle
17.
J Urol ; 184(3): 1000-4, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20643422

RESUMO

PURPOSE: Nocturia has a major impact on quality of life and affects numerous aspects of health. Lifestyle modifications are expected to be helpful in improving nocturia. However, the efficacy of this strategy has not been established. We tested the efficacy of nondrug lifestyle measures as a first step in treating nocturia and found factors predictive of the efficacy of the intervention. MATERIALS AND METHODS: We conducted a prospective evaluation of 56 patients treated at 3 hospitals between 2005 and 2009 for symptomatic nocturia. The patients were advised to modify their lifestyle to improve nocturia. Lifestyle modifications consisted of 4 directives of 1) restriction of fluid intake, 2) refraining from excess hours in bed, 3) moderate daily exercise and 4) keeping warm in bed. The frequency volume chart, International Prostate Symptom Score, and Pittsburgh Sleep Quality Index before and 4 weeks after the intervention were used to evaluate the efficacy of the therapy. RESULTS: Mean nocturnal voids and nocturnal urine volume decreased significantly from 3.6 to 2.7 (p <0.0001) and from 923 to 768 ml (p = 0.0005), respectively. Of the 56 patients 26 (53.1%) showed an improvement of more than 1 episode. This treatment was significantly more effective in patients with a larger 24-hour urine production. CONCLUSIONS: Nondrug lifestyle measures were effective in decreasing the number of nocturia episodes and improving patient quality of life. Patients with polyuria showed a better response to the treatment.


Assuntos
Terapia Comportamental , Estilo de Vida , Noctúria/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
18.
Hinyokika Kiyo ; 56(6): 319-21, 2010 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-20610924

RESUMO

A 46-year-old woman with gross hematuria was referred to our hospital with suspicion of bilateral renal cell carcinoma. Computed tomography (CT) showed multiple renal tumors with contrast enhancement and multiple lung nodules. Based on a diagnosis of bilateral multiple renal cell carcinoma with multiple lung metastases, a combination therapy with interferon-alpha (IFN-alpha) and 5-flurouracil (5-FU) was initiated. Six months later, all the renal and pulmonary lesions remained the same, and IFN-alpha alone was continued thereafter. One tumor in the right upper pole decreased in size during the next six years, while all the other lesions remained unchanged. Then the immunotherapy was discontinued on the basis of possibility that the tumors could be benign lesions. Three years later,the right upper renal tumor disappeared on CT, but, one of the left renal tumors showed progressive disease. The patient underwent left partial nephrectomy together with resection of neighboring small tumors. All the excised tumors were diagnosed as chromophobe renal cell carcinoma on histological examination. There has been no change with the remaining tumors for 1.5 years postoperatively.


Assuntos
Carcinoma de Células Renais/terapia , Neoplasias Renais/terapia , Carcinoma de Células Renais/patologia , Feminino , Humanos , Interferon-alfa/uso terapêutico , Neoplasias Renais/patologia , Pessoa de Meia-Idade , Nefrectomia
19.
Hinyokika Kiyo ; 55(11): 685-9, 2009 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-19946185

RESUMO

We aimed to investigate health-care seeking behavior related to lower urinary tract symptoms (LUTS) using a questionnaire-based survey. The questionnaire included questions related to 5 demographic issues, 9 past histories, 8 LUTS, and others about health-care seeking related to LUTS. We sent the questionnaire to 6,000 residents, 41 to 70 years old, in three Japanese communities (Tobetsu, in a subarctic zone, Kumiyama, in a temperate zone, and Sashiki, in a subtropical zone). Of the questionnaires, 36.5% were valid for analyses. The prevalence of desire for treatment for LUTS was 15.6% (still-treated health-care seeker : 4.5%, never-treated health-care seeker : 11.1%). This finding suggested that, among residents with a desire for treatment, only 29% actually had treatment for LUTS. Multivariate analyses revealed that incomplete emptying, weak stream, and straining for males, and urinary frequency, nocturia, and incontinence for females were independently significant factors associated with health-care seeking related toLUTS.


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde , Transtornos Urinários/psicologia , Adulto , Idoso , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Incontinência Urinária/psicologia
20.
Hinyokika Kiyo ; 55(10): 623-5, 2009 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-19926948

RESUMO

A 72-year-old man came to our clinic as a candidate of the donor of renal transplantation for his 44-year-old daughter. However, his serum PSA was found elevated, and he was diagnosed with stage C prostate cancer. He received neoadjuvant androgen deprivation therapy and subsequent IMRT as a definitive curative therapy. Since his PSA remained at a very low level after IMRT for three years, we performed systematic 16-site prostate biopsy, which revealed no viable prostate cancer cells. His renal function seemed to be normal and no functional difference was noted between the two kidneys. Then, his left kidney was harvested by hand-assisted retroperitoneal laparoscopic approach, and transplanted to his daughter successfully. The suitability of a donor with two potential problems-advanced age and a history of prostatic cancer-was discussed, together with a review of the literature.


Assuntos
Transplante de Rim , Doadores Vivos , Neoplasias da Próstata/radioterapia , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Antígeno Prostático Específico/sangue
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