Risk factors for overactive bladder in the elderly population: a community-based study with face-to-face interview.

OBJECTIVES: The aim of this study was to measure the prevalence of and risk factors for overactive bladder (OAB) in the elderly. METHODS: A cross-sectional study of elderly subjects was conducted by analyzing data from a community-based Comprehensive Geriatric Assessment on people aged 70 years or older. Trained interviewers performed face-to-face interviews for the assessment of urological symptoms. OAB definition was based on urgency and eight or more episodes of urination per day. The subjects completed a self-administered questionnaire including lifestyle evaluation, Geriatric Depression Scale, Mini-Mental Status Examination and medical history. Brachial-ankle pulse wave velocity was recorded to assess atherosclerotic disease. The analysis included 833 subjects, after the exclusion of 115 subjects who provided insufficient information. RESULTS: Based on the definition of OAB, 153 subjects (18.4%) were identified as having OAB. Univariate analysis showed a significant association between OAB and depressive symptoms. Multivariate analysis showed that the risk of having OAB was significantly higher in subjects with depressive symptoms, current drinkers, and overweight subjects with odds ratios of 2.37 (1.60-3.52, 95% confidence interval), 1.65 (1.04-2.62), and 1.51 (1.02-2.24), respectively. CONCLUSIONS: This is the first report to show an association between OAB and depressive symptoms and alcohol intake in an epidemiological study of elderly people. The reasons for these correlations remain unclear, but should be the foci of future OAB studies.

Fresh testicular sperm retrieved from men with spinal cord injury retains equal fecundity to that from men with obstructive azoospermia via intracytoplasmic sperm injection.

OBJECTIVE: To examine the outcomes of intracytoplasmic sperm injection (ICSI) with testicular sperm retrieved from men with spinal cord injury. DESIGN: Retrospective study. SETTING: Private hospital-based infertility research laboratory. PATIENT(S): Twenty-two couples of whom one partner was a man with spinal cord injury (SCI). INTERVENTION(S): Reviewing the outcomes of testicular sperm extraction (TESE)-ICSI. MAIN OUTCOME MEASURE(S): Testicular sperm retrieval rate, fertilization rate, pregnancy rate, comparison with patients with obstructive azoospermia. RESULT(S): Testicular sperm were retrieved from 19 of 22 (86%) patients with SCI. Intracytoplasmic sperm injection resulted in a fertilization rate of 236 of 364 (65%). Of 19 couples, 14 couples achieved 18 pregnancies, and 22 infants (14 singleton and 4 twin) were born. (Pregnancy per couple was 74% and that per ICSI was 54%). There was no significant difference in pregnancy rate at the first ICSI between SCI couples and obstructive azoospermia couples (68% SCI, 68% obstructive azoospermia). However, pregnancy rate per fresh testicular sperm-ICSI was significantly higher than that per frozen-thawed sperm-ICSI in SCI couples (64% SCI fresh, 25% SCI frozen-thawed) although no significant difference was seen in obstructive azoospermia couples (76% obstructive azoospermia fresh, 63% obstructive azoospermia frozen-thawed). There was no significant difference in pregnancy rate between fresh ET cycle and frozen-thawed ET cycle in SCI couples. CONCLUSION(S): Testicular sperm in men with SCI may possess disadvantages in freezing and thawing compared with that in men with obstructive azoospermia. Fresh testicular sperm-ICSI may offer optimum outcome for SCI couples desirous of pregnancy.

[Pulmonary and lymph node metastases of renal cell carcinoma which completely responded to oral administration of UFT--a case report].

In April 2003, a 59-year-old woman suffering from renal cell carcinoma (RCC) underwent radical nephrectomy (Stage I). In October 2004, bilateral lower lobe lung tumors were resected with thoracoscopic assistance. Histologically, resected specimens were diagnosed as metastases from RCC. However, 2 months later,lung and abdominal lymph node metastases were detected by CT. Chemotherapy with interferon-alpha (IFN-alpha) 6,000,000 units every day was performed, but was discontinued after 3 months due to fatigue and depression. Because the tumor marker (IAP) level and the size of the metastatic tumors increased, second-line chemotherapy with oral administration of tegafur/uracil (UFT-E 600 mg/day) was started. Six months after UFT administration, there was a significant decrease of tumor markers and the metastatic tumors were disappeared, therefore we were judged as complete response (CR). No grade 3 or more severs adverse reactions have been observed. Some cases may be effectively treated by UFT after treatment failure of IFN-alpha therapy. This UFT therapy is simple and possible to continue safely on an outpatient chemotherapy while maintaining quality of life.

Spontaneous rupture of adrenal pheochromocytoma with capsular invasion.

A 67-year-old Japanese man developed a sudden onset of severe right-side upper abdominal pain, nausea and vomiting. On hospitalization, physical examination revealed sweating, tachycardia, hypertension and the appearance of peripheral vasoconstriction. An urgent computed tomography scan with contrast demonstrated a large hematoma in the right retroperitoneal space. A phentolamine test and an 131iodine metaiodobenzylguanidine scan suggested pheochromocytoma. An elective right adrenalectomy was successfully performed after pretreatment for sufficient volume replacement with continuous administration of alpha- and beta-adrenergic blocking agents. Pathological diagnosis was an adrenal pheochromocytoma 9.0 x 6.5 cm in diameter with evidence of capsular invasion, which could be associated with a tear in the capsule.

Health-related quality of life after radical prostatectomy in Japanese men with localized prostate cancer.

PURPOSE: We evaluated retrospectively health-related quality of life (HRQOL) after radical prostatectomy (RP) in Japanese men with localized prostate cancer. METHODS: The study was based on self-reported HRQOL of 280 patients. Patients were divided into seven groups: time 0 (T0), baseline before operation; T1, 1-3 months after RP; T2, 4-6 months after RP; T3, 7-12 months after RP; T4, 13-24 months after RP; T5, 25-36 months after RP; and T6, more than 36 months after RP. We measured the general and disease-specific HRQOL using the RAND 36-item Health Survey 1.0 (SF-36) and the University of California, Los Angeles Prostate Cancer Index (UCLA PCI). RESULTS: The general HRQOL of the postoperative groups was assessed by SF-36. The postoperative groups showed almost the same or higher scores than those of the baseline group. Urinary function scores decreased substantially after surgery. In contrast, there was no difference in urinary bother between the baseline and postoperative groups. Sexual function deteriorated substantially in all postoperative groups. Similarly, the sexual bother score significantly deteriorated after RP. The sexual bother score of men aged 65-years or younger was significantly worse than that of their counterparts in the T1-2 groups. CONCLUSION: Despite reports of problems with sexual activity and urinary continence, general HRQOL was mostly unaffected by RP. Although there was a substantial decrease in urinary function, recovery from urinary bother was rapid. Since the deterioration of sexual function was marked through the postoperative period, careful attention should be paid to this issue during preoperative counseling, especially for younger patients.

Acute eosinophilic pneumonia associated with intravesical bacillus Calmette-Guérin therapy of carcinoma in situ of the bladder.

A 71-year-old man with a history of rheumatoid arthritis was treated with intravesical bacillus Calmette-Guérin (BCG) instillation of 80 mg once-a-week for carcinoma in situ. He developed low-grade fever followed by dyspnea and severe hypoxemia. Radiological and laboratory studies revealed bilateral diffuse reticulonodular infiltrates and hypereosinophilia. A lymphocyte stimulation test for BCG was strongly positive. From these findings, a pulmonary hypersensitivity reaction to immunotherapy was suspected, and therefore, methylprednisolone (500 mg per day) was started. After that, the fever and dyspnea disappeared, the hypereosinophilia was normalised and chest radiography results were clear. The present case is the first reported case of eosinophilic pneumonia following intravesical BCG therapy.