Transvaginal mesh surgery for pelvic organ prolapse without blind maneuver.

AIM: To present the techniques of transvaginal mesh surgery for pelvic organ prolapse without the blind maneuver and elucidate its safety and efficacy. METHODS: This retrospective study included 45 women with a mean age of 77.9 years old. We investigated surgical outcomes including complications, anatomical recurrence rates, and changes in both subjective symptoms and quality of life. RESULTS: The surgery required 111 ± 18 min and blood loss was 40 ± 24 g. Minor injuries of the bladder and rectum occurred in two and one patient, respectively. The urethral catheter was removed on postoperative day 1.1 and patients were discharged on postoperative day 4.4. No one experienced voiding dysfunction requiring catheterization. Wound infections occurred in two patients but they subsided with only antibiotics administered. Five patients had anatomical recurrence during a median follow-up of 17 months. Of these, two underwent reoperation and the remaining three were solely followed-up because there were no or few associated problems. Chronic pain, mesh erosion, and exposure were absent in all cases. Subjective symptoms and quality of life significantly improved after surgery at 12 months postoperatively. CONCLUSION: It is considered that transvaginal mesh surgery without the blind maneuver is a safe and effective way to treat women with pelvic organ prolapse.

Two cases of pelvic schwannomas simultaneously resected with the prostate by robot-assisted surgery.

INTRODUCTION: Schwannoma is a rare benign tumor of peripheral nerves arising from Schwann cells of the ubiquitous nerve sheath. The operative steps and technical aspects of robotic resection of pelvic schwannoma are described herein. CASE PRESENTATION: We describe two patients with pelvic tumors simultaneously resected with the prostate by robot-assisted surgery: a 69-year-old man with schwannoma of the right side of the pelvic floor and a 68-year-old man with schwannoma in the left pelvis. As metastasis of prostate cancer could not be ruled out, tumorectomy was performed using robotic-associated prostatectomy. Malignancy was absent in the two pelvic tumors, and the patients were diagnosed with schwannoma. CONCLUSION: For surgery in a narrow deep pelvis, robot-assisted surgery is minimally invasive, offers excellent mobility of robotic instruments and visibility of three-dimensional view, and is a useful approach.

Interleukin-1beta (IL-1ß)-induced Notch ligand Jagged1 suppresses mitogenic action of IL-1ß on human dystrophic myogenic cells.

Duchenne muscular dystrophy (DMD) is a severe X-linked recessive muscle disorder caused by mutations in the dystrophin gene. Nonetheless, secondary processes involving perturbation of muscle regeneration probably exacerbate disease progression, resulting in the fatal loss of muscle in DMD patients. A dysfunction of undifferentiated myogenic cells is the most likely cause for the reduction of regenerative capacity of muscle. To clarify molecular mechanisms in perturbation of the regenerative capacity of DMD muscle, we have established several NCAM (CD56)-positive immortalized human dystrophic and non-dystrophic myogenic cell lines from DMD and healthy muscles. A pro-inflammatory cytokine, IL-1ß, promoted cell cycle progression of non-dystrophic myogenic cells but not DMD myogenic cells. In contrast, IL-1ß upregulated the Notch ligand Jagged1 gene in DMD myogenic cells but not in non-dystrophic myogenic cells. Knockdown of Jagged1 in DMD myogenic cells restored the IL-1ß-promoted cell cycle progression. Conversely, enforced expression of Jagged1-blocked IL-1ß promoted proliferation of non-dystrophic myogenic cells. In addition, IL-1ß prevented myogenic differentiation of DMD myogenic cells depending on Jagged1 but not of non-dystrophic myogenic cells. These results demonstrate that Jagged1 induced by IL-1ß in DMD myogenic cells modified the action of IL-1ß and reduced the ability to proliferate and differentiate. IL-1ß induced Jagged1 gene expression may be a feedback response to excess stimulation with this cytokine because high IL-1ß (200-1000 pg/ml) induced Jagged1 gene expression even in non-dystrophic myogenic cells. DMD myogenic cells are likely to acquire the susceptibility of the Jagged1 gene to IL-1ß under the microcircumstances in DMD muscles. The present results suggest that Jagged1 induced by IL-1ß plays a crucial role in the loss of muscle regeneration capacity of DMD muscles. The IL-1ß/Jagged1 pathway may be a new therapeutic target to ameliorate exacerbation of muscular dystrophy in a dystrophin-independent manner.

Systematic Review and Individual Patient Data Meta-analysis of Randomized Trials Comparing a Single Immediate Instillation of Chemotherapy After Transurethral Resection with Transurethral Resection Alone in Patients with Stage pTa-pT1 Urothelial Carcinoma of the Bladder: Which Patients Benefit from the Instillation?

CONTEXT: The European Association of Urology non-muscle-invasive bladder cancer (NMIBC) guidelines recommend that all low- and intermediate-risk patients receive a single immediate instillation of chemotherapy after transurethral resection of the bladder (TURB), but its use remains controversial. OBJECTIVE: To identify which NMIBC patients benefit from a single immediate instillation. EVIDENCE ACQUISITION: A systematic review and individual patient data (IPD) meta-analysis of randomized trials comparing the efficacy of a single instillation after TURB with TURB alone in NMIBC patients was carried out. EVIDENCE SYNTHESIS: A total of 13 eligible studies were identified. IPD were obtained for 11 studies randomizing 2278 eligible patients, 1161 to TURB and 1117 to a single instillation of epirubicin, mitomycin C, pirarubicin, or thiotepa. A total of 1128 recurrences, 108 progressions, and 460 deaths (59 due to bladder cancer [BCa]) occurred. A single instillation reduced the risk of recurrence by 35% (hazard ratio [HR]: 0.65; 95% confidence interval [CI], 0.58-0.74; p<0.001) and the 5-yr recurrence rate from 58.8% to 44.8%. The instillation did not reduce recurrences in patients with a prior recurrence rate of more than one recurrence per year or in patients with an European Organization for Research and Treatment of Cancer (EORTC) recurrence score ≥5. The instillation did not prolong either the time to progression or death from BCa, but it resulted in an increase in the overall risk of death (HR: 1.26; 95% CI, 1.05-1.51; p=0.015; 5-yr death rates 12.0% vs 11.2%), with the difference appearing in patients with an EORTC recurrence score ≥5. CONCLUSIONS: A single immediate instillation reduced the risk of recurrence, except in patients with a prior recurrence rate of more than one recurrence per year or an EORTC recurrence score ≥5. It does not prolong either time to progression or death from BCa. The instillation may be associated with an increase in the risk of death in patients at high risk of recurrence in whom the instillation is not effective or recommended. PATIENT SUMMARY: A single instillation of chemotherapy immediately after resection reduces the risk of recurrence in non-muscle-invasive bladder cancer; however, it should not be given to patients at high risk of recurrence due to its lack of efficacy in this subgroup.

Botulinum toxin A injection for the treatment of neurogenic detrusor overactivity secondary to spinal cord injury: multi-institutional experience in Japan.

OBJECTIVES: To examine the efficacy and safety of onabotulinumtoxinA (Botox) injection into the bladder wall for the treatment of neurogenic detrusor overactivity secondary to spinal cord injury in Japanese patients. METHODS: We enrolled Japanese spinal cord injury patients with cystometrically confirmed neurogenic detrusor overactivity who experienced urinary incontinence at least once a week either because they were refractory to anticholinergics or had to discontinue treatment because of adverse events. Patients received 200 units of onabotulinumtoxinA injected into the bladder wall after a 2-week washout of anticholinergics, and urodynamic variables were assessed before and 1 month after injection. Catheterization and urinary incontinence data, as well as International Consultation on Incontinence Questionnaire-Short Form scores, were assessed before injection and every month thereafter until the cessation of treatment effects. RESULTS: The study enrolled 19 patients (13 men, six women, age range 22-67 years). One month after injection, the mean number of urinary incontinence episodes decreased from 4.3 to 1.5 times/day (P = 0.004), and the maximum cystometric capacity increased from 100 mL to 296 mL (P = 0.0004). The rate of effective cases whose daily urinary incontinence frequency was decreased to less than 50% was 74%. The duration of efficacy without anticholinergic medication ranged from 3 to 12 months (median 8.5 months). Clinically significant adverse events were not observed. CONCLUSIONS: The present findings show the efficacy and tolerability of onabotulinumtoxinA injection for the treatment of neurogenic detrusor overactivity in Japanese spinal cord injury patients.

Core lower urinary tract symptom score questionnaire: a psychometric analysis.

OBJECTIVES: To analyze the reliability and validity of the Japanese version of the core lower urinary symptom score questionnaire with psychometric methods. METHOD: The present study included 140 women and 125 men who filled in a core lower urinary symptom score questionnaire while attending two lectures on lower urinary tract symptoms. Missing response rates to individual questions were 1.5-5.3%. After the descriptive analyses including box plot, Cronbach's α coefficients and Spearman's ρ were calculated for reliability and validity assessment, respectively. Factor analysis was also carried out to explore the underlying structure. RESULTS: Of the scores for 10 core symptoms, the interquartile range for pain in the bladder and urethra was 0 in both sexes, and that for stress incontinence was 0 in men. Cronbach's α of the core lower urinary symptom score was 0.733 in women and 0.721 in men. Questions regarding daytime frequency, nocturia, urgency and urgency urinary incontinence, and those on slow stream, straining and feeling of incomplete emptying were significantly correlated with each other in both sexes. Pain in the urethra and bladder showed more extensive associations in women than in men. Factor analysis showed four components in both sexes: the first was storage symptoms, second was voiding symptoms, third was pain and the fourth was urinary incontinence. CONCLUSIONS: The core lower urinary symptom score questionnaire shows good reliability and validity for both sexes, and it could be used as screening tool for lower urinary tract symptoms in any clinical setting or epidemiological investigation.

Prevalence of lower urinary tract symptoms in middle-aged and elderly Japanese.

AIMS: To estimate the prevalence of lower urinary tract symptoms (LUTS) in Japanese people, and the relationships to aging and sex, we carried out the present population-based study. METHODS: The present study included 1198 men aged 60.7 ± 12.5 years and 1218 women aged 60.8 ± 12.7 years who participated in a study of aging carried out at the National Center for Geriatrics and Gerontology between 2006 and 2008, using linguistically validated versions of the International Prostate Symptom Score (I-PSS) and International Consultation on Incontinence Questionnaire Short-form (ICIQ-SF). RESULTS: The prevalence of I-PSS ≥ 8 was 25.2% in men and 11.8% in women, that of two or more a week urinary incontinence was 3.3% and 6.6%, respectively, and that of I-PSS ≥ 8 and/or two or more a week urinary incontinence was 25.8% and 16.0%, respectively. The prevalence of the seven symptoms in I-PSS increased with aging. Just 9.1% of men and 4.6% of women who reported LUTS were medicated for LUTS. CONCLUSIONS: The results showed that the severity of LUTS in Japan was related to aging. The prevalence of LUTS with I-PSS ≥ 8 in Japan is similar to that in other countries.

Influence of hospital surgical volume of radical prostatectomy on quality of perioperative care.

PURPOSE: We investigated the relationships between hospital surgical volume, surgical outcome, care plans indicated in critical pathways and actual perioperative care using data from a nationwide survey for radical prostatectomy. MATERIALS AND METHODS: In this study, urologists from 155 hospitals in Japan cooperated in submitting the data of 4,029 patients who underwent radical prostatectomy in 2007, and the perioperative care plan in critical pathways. Of these, we analyzed data of 3,499 patients undergoing open radical prostatectomy and minimum incision endoscopic radical prostatectomy. RESULTS: Increasing hospital volume was associated with decreased proportion of open radical prostatectomy (p < 0.001). As the hospital volume increased, surgical duration was significantly shorter (p < 0.001) and bleeding volume decreased (p < 0.004). Analyses of perioperative care suggested that low-volume hospitals (<15 patients annually) were likely to have longer care than medium-volume (15-29 patients per year) or high-volume (≥30 patients per year) hospitals, and the length of actual care was prolonged in the low-volume hospitals. Multivariate logistic regression analysis suggested that the occurrence of postoperative complications was significantly associated with surgeon's volume (p = 0.004), patient age (p = 0.001), preoperative anticoagulant therapy (p = 0.045), coexistent diabetes mellitus (p = 0.009), surgical duration (p = 0.002) and bleeding volume (p < 0.001), but not hospital volume. CONCLUSIONS: Urologists in high-volume hospitals appeared to attempt new types of surgery. Hospital surgical volume was strongly associated with the surgical duration, bleeding volume and planned and actual perioperative care; however, it was not associated with postoperative complications.

Changes in perioperative management of radical prostatectomy using clinical pathways according to a standardized care plan: a multi-institutional study.

OBJECTIVES: To improve the perioperative care for radical prostatectomy patients at a multi-institutional level and practice. METHODS: A prospective multi-institutional study involving 50 hospitals was carried out in cooperation with the Japanese Society of Endourology. As the first step, a consensus meeting was held to establish a standardized perioperative care plan. Second, the clinical pathways were individually developed and revised according to the standardized care plan in each of the participating hospitals. Patterns of perioperative care, including preoperative hospital stay, resuming meals and ambulation, removal of pelvic drain and urethral catheter, antimicrobial administration, and postoperative hospital stay, were compared before (2007) and after developing/revising pathways (2009). Furthermore, actual practice and complications before and after implementing the pathways were investigated. RESULTS: Except for resuming ambulation, all perioperative pathways were significantly shortened with the adoption of the newly defined clinical pathway (P < 0.001). Furthermore, all settings except for postoperative hospital stay significantly decreased in terms of variance (P < 0.002). In 2009, the overall complication rate significantly decreased (P < 0.001), and all of the outcomes except urethral catheter removal were also significantly shortened (P ≤ 0.008) and decreased in variance after implementation of the new pathways (P ≤ 0.006). In multivariate analyses, implementation of the refined clinical pathways was an important factor to improve perioperative care. CONCLUSIONS: When standardized goals in perioperative care are recommended to hospitals and care plans are developed/revised in individual hospitals, both settings and practice are significantly improved. It is to be investigated whether a similar intervention could be useful to achieve a standardization of surgical pathway for other diseases.

Twelve Months Follow-up of Injection of OnabotulinumtoxinA into Vesical Submucosa for Refractory Non-neurogenic Overactive Bladder.

OBJECTIVE: The aim of the present study was to assess the effects of onabotulinumtoxinA injection for refractory non-neurogenic overactive bladder (OAB) for 12 months. METHODS: For patients with persistent urgency urinary incontinence (UUI) more than once a week despite taking anti-cholinergic agents or incapability to continue the agents because of adverse effects, 100 units of onabotulinumtoxinA was injected at 30 sites in the sub-epithelial bladder wall. Efficacy was assessed every month up to 12 months after injection, using a three-day frequency-volume chart (FVC) and postvoid residual urine (PVR), three questionnaires, and a simple score of Global Response Assessment (GRA). Failure was defined as when GRA was negative and additional treatment was administered. RESULTS: Nine men and eight women aged 67 ± 12 years were included. On FVC, frequencies of urgency, UUI and daytime urination significantly decreased up to the 11th month. PVR significantly increased at the first and second months but no patient required catheterization. The total scores of Overactive Bladder Symptom Score and International Consultation on Incontinence Questionnaire Short Form were significantly decreased for 10 and eight months, respectively. The score of GRA was significantly improved for eight months. The median time to failure was 11.0 months. CONCLUSION: This study suggests that onabotulinumtoxinA submucosal injection is promising for refractory non-neurogenic OAB. It is anticipated that the treatment is effective for eight to nine months and approximately 40% of the patients do not require anticholinergics at the 12th month postoperatively.

Botulinum toxin A submucosal injection for refractory non-neurogenic overactive bladder: early outcomes.

The objective of the present study was to assess the short-term effects of botulinum toxin A (BTX-A) injection for refractory non-neurogenic overactive bladder (OAB) in the setting of a prospective multicenter clinical trial. Refractory OAB was defined as persistent urgency urinary incontinence (UUI) ≥ once a week despite taking anticholinergic agents, or the incapability to continue the agents because of the adverse effects. A total of 100 U of BTX-A were reconstituted in 15 mL of normal saline and an aliquot of 0.5 mL was injected at 30 submucosal sites of the bladder wall. Nine men and eight women aged 67 ± 12 years were included. Subjective daytime frequency, urgency and UUI significantly decreased after treatment. On a 3-day frequency-volume chart, the daytime and night-time frequency of UUI significantly decreased from 5.5 and 0.5 pre-injection to 2.0 and 0.3 postinjection, respectively. Daytime urinary incontinence completely disappeared in six subjects. A urodynamic study showed the disappearance of detrusor overactivity in eight patients and a decrease in five patients. Maximum bladder capacity significantly increased from 179.9 to 267.3 mL. Difficulty on micturition or feeling of incomplete emptying was reported by 23.5% and 43.8% of patients at weeks 2 and 4, respectively. Postvoid residual urine increased to >100 mL in seven patients and >200 mL in one patient after injection; however, none of the patients required clean intermittent catheterization. These findings suggest promising efficacy of BTX-A in Japanese OAB patients.

Perioperative management of transurethral surgery for benign prostatic hyperplasia: a nationwide survey in Japan.

OBJECTIVES: Various types of minimally invasive surgical treatments, including transurethral resection of prostate (TURP), are being carried out in Japan for patients with benign prostatic hyperplasia (BPH). The aim of the present study was to elucidate the current status of perioperative care for these treatments by carrying out a nationwide survey. METHODS: Assisted by the Japanese Endourology and ESWL Association, perioperative data from 157 institutions participating in this survey were collected and analyzed. RESULTS: This survey included 3918 patients undergoing TURP, 242 TUR in saline (TURis), 638 holmium laser enucleation of the prostate (HoLEP), 90 holmium laser ablation (HoLAP) and 241 photoselective vaporization (PVP). Mean operative time was shorter in TURP (71 min) and longer in HoLEP (127). Although no transfusions were required in cases undergoing HoLAP or PVP, blood was frequently transfused in those undergoing TURis (25.6%), TURP (10.2%) and HoLEP (7.8%), and the difference was significant. During the hospital stay, the incidence of TUR-syndrome, postoperative bleeding requiring bladder irrigation, acute urinary retention/difficulty on micturition and pad use at discharge was highest in TURP (2.3%), TURis (7.9%), HoLAP (16.7%) and HoLEP (15.1%), respectively. Two patients undergoing TURP died (0.05%). The shortest mean postoperative hospital stay was for PVP (1.6 days, even if the readmission rate within 90 days was the highest in this same group; 6.2%). Perioperative care during hospital stay varied among the five types of procedures. CONCLUSIONS: This survey provides useful documentation on the current status of minimally invasive treatments for BPH in Japan. Complication rates for TURP are not significantly higher as compared with other procedures. Thus, TURP can still be considered as the gold standard for BPH treatment.

[Perioperative management of radical prostatectomy: a nationwide survey in Japan].

PURPOSE: Recently, various types of radical surgery have been performed in Japan. To elucidate the surgical consequences, morbidity and mortality, and perioperative care, we conducted a nationwide survey. MATERIALS AND METHODS: Assisted by the Japanese Society of Endourology, perioperative data from 156 hospitals participating in this survey in 2007 were analyzed. Using a spreadsheet database, data were collected from each institution. RESULTS: Open radical prostatectomy was performed in 3,138 patients at 143 hospitals, minimum incision endourological radical prostatectomy in 361 at 15 hospitals, laparoscopic radical prostatectomy via transperitoneal approach in 143 at 11 hospitals and laparoscopic radical prostatectomy via extraperitoneal approach in 337 at 13 hospitals. For open and minimum incision endourological radical prostatectomy, the surgical duration was shorter but the bleeding volume was greater than that in laparoscopic radical prostatectomy via both approaches. As a whole, perioperatvie mortality rate was 0.05% and morbidity rate was 23.4%. Rectal injury was similarly infrequent among the four types of surgery. Superficial surgical site infection was most frequent in open radical prostatectomy. Perioperative management significantly varied among the four types of surgery. In laparoscopic radical prostatectomy via extraperitoneal approach, urethral catheter was removed earlier but acute urinary retention frequently occurred. CONCLUSIONS: In Japan, open radical prostatectomy was the most frequently performed surgery for prostate cancer. Surgical volume per hospital was small, however, mortality was low and morbidity was acceptable. Comparisons of complications and outcomes among the types of currently performed surgery should be useful to promote standardization of the perioperative care.

[Multi-center study for standardisation of perioperative management of radical prostatectomy using clinical pathways].

PURPOSE: Our previous study indicated that there was a great variety in the perioperative management of radical prostatectomy among hospitals. Therefore we conducted a multiinstitutional study in order to standardize the perioperative management using clinical pathways. MATERIALS AND METHODS: The perioperative data on radical prostatectomy were collected between January and December 2004 (Period 1) from eight hospitals. These outcomes were discussed by researchers and the clinical pathway used at each hospital was constructed or revised. The outcomes using these pathways in Period 2 (January 2005 to March 2006) were compared with those in Period 1. RESULTS: Three hundred seventy-eight men in Period 1 and 360 in Period 2 were enrolled in this study. The settings of perioperative management using the new pathways were relatively similar among hospitals. A majority of perioperative management procedures in Period 2 were conducted as described in the new clinical pathways, judging from the median days. The day of initiating the resumption of fluid intake, meals and removing the epidural anesthetic catheter and drain changed from 1.2 +/- 0.7 to 1.3 +/- 1.4 postoperative day, 1.9 +/- 1.2 to 1.8 +/- 1.7, 2.4 +/- 0.7 to 2.5 +/- 0.6, 3.8 +/- 2.5 to 3.8 +/- 2.8, respectively, without a significant difference. The postoperative day of initiating the walking and discontinuing continuous drip infusion and intravenous antibiotics were shortened from 1.9 +/- 0.9 to 1.5 +/- 0.6, 3.7 +/- 2.1 to 3.1 +/- 2.2 and 3.6 +/- 2.0 to 2.5 +/- 2.2, respectively, which did show a significant difference. The day of removing the urethral catheter was changed 9.1 +/- 4.9 to 8.6 +/- 5.4 without significant difference. But the durations of preoperative hospitalization, hospitalization after removing the urethral catheter and postoperative hospitalization were significantly shortened from 3.4 +/- 2.1 to 2.5 +/- 1.0 days, 8.9 +/- 10.1 to 5.6 +/- 3.8, and 17.9 +/- 10.9 to 14.4 +/- 9.1, respectively. CONCLUSIONS: The clinical pathways established or revised at these hospitals after discussing the perioperative management in multiple hospitals were similar, and using such pathways advanced the standardization of peri-operative management after radical prostatectomy.

Psychometric analysis of international prostate symptom score for female lower urinary tract symptoms.

OBJECTIVES: Although the International Prostate Symptom Score (IPSS) has often been used for female lower urinary tract symptoms (FLUTS), the psychometric properties of IPSS for FLUTS have not been studied. We investigated the reliability and validity of IPSS for FLUTS. METHODS: Two samples were prepared. Sample A consisted of 227 women and 455 men who consulted a hospital doctor and sample B consisted of 519 women and 419 men who consulted a general practitioner. Eighty-nine percent of participants completed all IPSS items and quality of life index. Cronbach's alpha coefficients and Spearman's rho were calculated for reliability and validity assessment, respectively. A factor analysis was also conducted to explore the underlying structure. RESULTS: Significant differences were found in age and each IPSS item score between the 2 samples. Cronbach's alpha of IPSS in women was approximately 0.8 in both samples, comparable to that in men. The relatively high Spearman's rho among most of IPSS voiding items and among most storage items and low Spearman's rho among most of the different categories described indicated good convergent and discriminant validity. The factor analysis showed 2 components in IPSS for FLUTES. The first was consistently related to IPSS items 1, 3, 5, and 6 and the second was related to IPSS items 2, 4, and 7. In men, however, IPSS item 4 comprised different components between samples A and B. CONCLUSIONS: Although the subject background somewhat affects the psychometric properties, the IPSS can be relevant when used to examine women, as well as men.

Effects of purified newly developed botulinum neurotoxin type A in rat prostate.

OBJECTIVES: To investigate the efficacy of a newly purified neurotoxin (NTX) in male rat prostates. Several reports have suggested that intraprostatic injection of botulinum toxin type A has demonstrated efficacy against symptomatic benign prostatic hyperplasia. NTXs associate with nontoxic components and form large complexes designated "progenitor toxins." In general, progenitor toxins are used, because they are easily obtained and are more stable than NTXs. However, they have side effects for some patients in whom anti-progenitor toxins, including anti-NTX antibodies, are produced after several injections. We purified NTXs without their nontoxic components using a simple procedure. METHODS: Adult male Sprague-Dawley rats were injected with 5 U of NTX or saline into their prostates, which were harvested and weighed after 1 or 4 weeks. The effects of the NTX on the prostate were histologically and immunohistochemically studied using hematoxylin-eosin, synaptophysin, and terminal deoxynucleotidyl-mediated deoxyuridine triphosphate nick end labeling staining. RESULTS: In the NTX-treated rats, the prostate weight was reduced and atrophy and diffuse apoptosis were observed. Moreover, synaptophysin-positive cells in the epithelium were decreased after NTX injection. CONCLUSIONS: Intraprostatic NTX injection induces prostate apoptosis and atrophic change in the rat prostate. These results suggest that NTX injection might be a promising material for treatment of patients with benign prostatic hyperplasia.

Reliability and validity of the King's Health Questionnaire for lower urinary tract symptoms in both genders.

OBJECTIVE: To investigate the reliability and validity of the King's Health Questionnaire (KHQ) in both genders, which was originally developed as a health-related quality of life (HRQoL) questionnaire for female urinary incontinence for general lower urinary tract symptoms (LUTS). SUBJECTS AND METHODS: Data from the International Prostate Symptom Score (IPSS) and KHQ obtained from 179 men and 75 women consulting urologists (Sample A) were analysed. Cronbach's alpha coefficient and inter-domain correlation were calculated for reliability and validity assessment, respectively. Factor analysis was used to explore the underlying factor structure of the KHQ. KHQ scores of sample A were compared with those of 330 men and 418 women consulting general practitioners (Sample B). RESULTS: Internal consistency of KHQ was acceptable with a Crohnbach's alpha of 0.721-0.915 in the total population of sample A. Correlation analysis showed convergent validity among 'Physical Limitations', 'Role Limitation' and 'Social Limitations' and discriminant validity among 'Personal Relationship', 'Emotion's and 'Sleep/Energy'. Factor analysis showed three underlying components to explain convergent and discriminant validity. In both sample A and sample B, HRQoL was impaired in the eight domains according to IPSS severity. KHQ scores of domains other than 'General Health Perception' in sample B were lower than those in sample A. CONCLUSION: The KHQ can be used as a HRQoL questionnaire for LUTS in both genders. In the future, it is expected that the KHQ could be used in clinical studies for benign prostate hyperplasia and other conditions.