Differences in motor learning of pelvic floor muscle contraction between women with and without stress urinary incontinence: Evaluation by transabdominal ultrasonography.

AIMS: To evaluate differences in motor learning of pelvic floor muscle (PFM) contraction between women with and without stress urinary incontinence (SUI) under transabdominal ultrasonography (TAUS)-guided PFM training. METHODS: Postpartum women received an intensive 3-month PFM training program from 3 to 6 months postpartum. The program consisted of home exercises and weekly group sessions with individual TAUS-guided training. Motor learning progress of PFM contraction was evaluated with TAUS at each weekly session. We regarded a woman who contracted her PFM correctly more than 9 times out of the 10 repetitions as having achieved the associative stage of motor learning. Women were evaluated before and after a 12-week intervention for PFM and SUI by using transperineal ultrasonography and questionnaire, respectively. RESULTS: Seventy-three women were included: 44 primiparous women (60.3%) and 64 vaginal deliveries (87.7%). Of 73 women, 22 (30.1%) were classified as the SUI group. By the fifth session, the proportion of women who could correctly contract their PFM > 9 out of the 10 repetitions had increased significantly more in the non-SUI group than in the SUI group (90.0% vs. 58.8%, P = 0.011). The proportion of women achieving the associative stage of correct PFM contraction was not different between the two groups after the sixth session. PF morphology and SUI were improved after intervention (P < 0.05). CONCLUSIONS: The proportion of women achieving the associative stage in women with SUI was less than that in women without SUI in the early phase of the combination of group and home PFM training with TAUS-guided training. Neurourol. Urodynam. 36:98-103, 2017. © 2015 Wiley Periodicals, Inc.

Multivariate Analysis of the Factors Associated With Sexual Intercourse, Marriage, and Paternity of Hypospadias Patients.

INTRODUCTION: Patients with hypospadias are treated surgically during childhood, which has the intention of enabling a satisfactory sexual life in adulthood. However, it is unclear whether patients with corrected hypospadias can lead a satisfactory sexual life and sustain a marital relationship and produce offspring. AIM: To evaluate factors associated with achievement of sexual intercourse, marriage, and paternity in patients with hypospadias who have reached adulthood. METHODS: Self-completion questionnaires were mailed in April 2012 to patients with hypospadias at least 18 years old who had been treated at our institution during childhood from 1973 through 1998 by a single surgeon and the same surgical policy. Assessments included the International Prostate Symptom Score, the International Index for Erectile Function-5, and non-validated questions related to current social and physical status and sexual, marital, and paternity experiences. Candidate factors were extracted from patients' neonatal data, surgical findings and results, and current physical and social status obtained by the questionnaires. MAIN OUTCOME MEASURES: Candidate factors associated with heterosexual intercourse, marriage, and paternity experiences were analyzed using univariate and multivariate proportional hazard models and log-rank test of Kaplan-Meier curves. RESULTS: Of the 518 patients contacted, 108 (age = 18-50 years, median = 28 years) met the inclusion criteria. Two- and one-stage repairs were performed as the initial treatment in 79 and 12, respectively, and 17 of the analyzed cases were reoperations for patients initially treated elsewhere. Fifty-seven patients had the milder type (31 glandular, 26 penile), 36 had the proximal type (13 penoscrotal, 23 scrotal-perineal), and 15 had an unknown type. Multivariate analyses by Cox proportional hazard model and log-rank tests confirmed that experience of sexual intercourse was associated with the milder type of hypospadias (P = .025 and .0076 respectively), marriage was associated with stable employment (P = .020 and .026, respectively), and paternity was associated with the absence of additional surgery after completion of the initial repair (P = .013 by multivariate analysis). CONCLUSION: There was scant overlap of factors associated with the three events. The present findings provide reference information for surgeons and parents regarding future sexual and marriage experiences of children treated for hypospadias.

[An Adult Case of Transperineal Repair of Congenital Rectourethral Fistula Using Gracilis Muscle Flap Interposition].

A man in his 50s was referred to our hospital after recurrent severe urinary tract infection. He had undergone anoplasty for anorectal malformation during early infancy. He noticed urinary leakage from the anus for a long time. Under diagnosis of congenital rectourethral fistula, we performed fistula closure. The fistula was transsected via transperineal incision and each stump was closed. A gracilis muscle flap approximately 30 cm long was harvested from the left thigh, brought into the deepest part between the separated rectum and urethra through a subcutaneous tunnel and fixed there. The urinary leakage from the anus disappeared, and the infection resolved. Application of gracilis muscle flap for congenital diseases is rare, but was useful in the present case.

[A Case of Retroperitoneal Serous Cyst Treated by Open Fenestration : A Case Report].

A 47-year-old woman came to our hospital with left lower abdominal pain in April 2013. An abdominal computed tomographic (CT) examination revealed left hydronephrosis secondary to a 7 cm retroperitoneal cyst near the left common iliac artery and ureter. Serum tumor markers including CEA, CA19-9, and CA125 were negative. Although CT guided needle aspiration of the cyst successfully relieved severe left flank pain, the cyst again increased in size, causing left hydronephrosis, though examinations for fluid tumor markers and cytology were negative. Two months later, the patient underwent open fenestration. The final pathological results demonstrated a mesothelial cyst without malignant findings. Six months after the operation, the patient was doing well without recurrence of symptoms.

[The safety and efficacy of sunitinib using a modified regimen (2 weeks on/1 week off) for treatment of metastatic renal cell carcinoma].

We prospectively investigated the safety and efficacy of sunitinib using a modified regimen (2 weeks on/1 week off) in 24 patients (22 males, 2 females ; age range 39-86 years, median 64 years) with metastatic renal cell carcinoma (RCC). During the observation period (3-62 weeks, median 21 weeks), thrombocytopenia was seen in 13 (54.2%), leukopenia in 11 (45.8%), hand-foot syndrome in 5 (20.8%), hypertension in 4 (16.7%), and hypothyroidism in 3 (12.5%) patients, while grade 3 or higher adverse events were found in 4 (16.7%), 1 (4.2%), 1 (4.2%), 2 (8.3%), and 0 patients, respectively. Of the 21 patients evaluable for response, 5 (23. 8%) showed partial response, 8 (38.1%) stable disease, and 8 (38.1%) progressive disease. This new modified regimen may lead to a reduction in adverse events for treatment of patients with metastatic RCC as a substitute for the standard dosing regimen of sunitinib.

[Leiomyosarcoma of the inferior vena cava: a case report and review].

A 37-year-old woman with an incidentally found abdominal mass was referred to our hospital. A fixed, non-tender mass was palpated in the right upper quadrum of her abdomen. There was no elevation of tumor markers. Computed tomography revealed a mass extending from the hepatic vein level to renal hilar level. The tumor completely obstructed the inferior vena cava (IVC). T1-weighted magnetic resonance imaging (MRI) showed that the mass was isointense with muscles. T2-weighted MRI image with contrast medium demonstrated collateral circulation. Upon diagnosis of the IVC tumor, we removed the right kidney and the tumor en bloc without reconstructing IVC. The tumor diameter was 11.6 × 5.5 × 4.7 cm. Pathological examination established a diagnosis of IVC leiomyosarcoma. She is alive without sign of recurrence after operation for seven months. There were 143 reports of IVC leiomyosarcoma in Japan. In 31% of them, IVC was not reconstructed.

[Impacted ureteral stents with cystine encrustation in cystinuric patients : report of two cases].

A 23-year-old man and a 62-year-old man suffering from cystinuria underwent extracorporeal shock wave lithotripsy (ESWL) for right renal stone and left ureteral stone, respectively. They had double-J stents placed before ESWL, but since attempts to retrieve the stents were unsuccessful due to encrustation, they were referred to our clinic. Multimodal endourologic and open approaches including ESWL, transurethral ureterolithotripsy, and pyelolithotomy were required to render them stent- and stone-free. The guidelines do not recommend routine stenting before ESWL ; therefore, the indication and duration of indwelling stents should be minimized. Multimodal options including not only ESWL and endoscopic surgery but also open surgery, should be attempted for the management of encrusted stents. Close monitoring and follow up are important to the prevent complications of ureteral stents.

[Renal metastasis originating from colon cancer : a case report].

In 2008, a 65-year-old woman was referred to our department because of a right renal tumor detected by computed tomography (CT) that was associated with macroscopic hematuria. She underwent right hemicolectomy for ascending colon cancer in 2003, and right lower lobectomy for lung metastasis of colon cancer in 2004. CT, magnetic resonance imaging, fluorodeoxyglucose positron emission tomography computed tomography and bone scintigraphy did not indicate any other metastatic lesion except the right renal mass ; therefore, open right nephrectomy was performed. Results of the histopathologic examination demonstrated renal metastasis of colon cancer. Although administration of chemotherapy was continued, the patient died of multiple metastases 8 months after the right nephrectomy.

[Assessment of oral health using the general oral health assessment index in patients with overactive bladder].

Patients administered anti-cholinergic agents, as first-line therapy for an overactive bladder (OAB) are often unable to continue medical treatment because of dry mouth. We assessed oral health in patients with OAB using the General Oral Health Assessment Index (GOHAI), an oral health-related quality of life questionnaire. We investigated 75 patients with OAB who were receiving continuous administration of anti-cholinergic agents. The OAB symptom score, as well as GOHAI and our original dry mouse score were determined by self-administered questionnaires. The mean age of the subjects was 70.9±10.2 years, the median period of anti-cholinergic agent use was 20 (1-116) months and the mean OAB symptom score was 6.3±3.1. The GOHAI score for all patients was 51.9±8.4 and not significantly different from the national normal value (p＝0.22). On the other hand, the score in patients with a severely dry mouth was 49.2±8.6, which was worse than the national normal value (p＝0.04). The psychosocial functioning score in patients with a severely dry mouth was significantly lower than in those with a slightly dry mouth (p＝0.02). Our results indicate that dry mouth in patients with OAB is significantly associated with worsening of oral health. GOHAI is useful as a screening test to assess the quality of life in patients with OAB.

A multi-center study of pediatric uroflowmetry data using patterning software.

OBJECTIVE: We created software for patterning uroflowmetry (UFM) curves, and validated its utility. PATIENTS AND METHODS: The software patterns a given UFM curve upon four parameters: sex, voided volume, maximal flow rate, and amplitude of fluctuation. Using the software, 6 urologists from 4 institutes assessed 30 test curves. Further, 329 UFM curves obtained from children presenting to 3 institutes for daytime and/or nighttime wetting were assessed. Clinical presentation was divided into 3 groups: group A, daytime incontinence; group B, non-monosymptomatic nocturnal enuresis without daytime wetting; and group C, monosymptomatic nocturnal enuresis. RESULTS: Using the software, inter-rater agreement ranged from 0.85 to 1.00 (mean, 0.93 ± 0.04). It could pattern 310 out of 329 clinical curves. In each institute, the tower pattern was prevalent according to severity of daytime symptoms, although not significantly. The merged data showed that the percent tower pattern significantly correlated with presence of daytime symptoms (groups A, B, and C, 29.7%, 27.0%, and 16.3%, respectively; p < 0.05). No correlation with daytime symptoms was noted for fluctuated (staccato and interrupted) and plateau patterns. CONCLUSION: The software creates a common platform for evaluating pediatric UFM, enabling extraction of common and biased features of different cohorts, and their integration into one single cohort.

[Unclassified renal cell carcinoma accompanying pyonephrosis: a case report].

A 73-year-old male, admitted to a local hospital because of fever and consciousness disturbance, was referred to our institute. He had a history of long-term steroid administration and diabetes mellitus. Under diagnosis of severe right pyonephrosis associated with severe inflammatory response syndrome as well as disseminated intravascular coagulopathy, he was transferred to our hospital. Computed tomography and magnetic resonance imaging showed a mass 5 cm in diameter at the right ureteropelvic junction and lymph node swelling at the renal hilum, suggesting obstructive pyonephrosis by a malignant tumor such as renal pelvic cancer. Since the patient failed to respond to conservative medical treatment including polymyxin B hemoperfusion, hemodialysis, and antimicrobials, we performed right nephrectomy. Histopathological examination demonstrated that the tumor obstructing the pelvis arose from the parenchyme under the muscle layer, and was diagnosed as unclassified renal cell carcinoma while the renal pelvic epithelium was normal. Although his general condition and laboratory data transiently improved after nephrectomy, he died of carcinomatous peritonitis 30 days postoperatively. We advocate that, in the case of pyonephrosis with a lesion highly suspected to be an infiltrating neoplasm, nephrectomy is justified as first choice to control the septic condition.

[Metachronous urothelial cancer in bilateral upper urinary tracts and bladder associated with hereditary nonpolyposis colorectal cancer].

A 40-year-old man had undergone right hemicolectomy and sigmoidectomy under the diagnosis of ascending and sigmoid colon cancer and right nephroureterectomy under the diagnosis of right ureteral cancer, in 1997 and in 2002, respectively. In 2007, He visited our hospital with a complaint of bloody stool and hematuria. Colon fiberscopy, ureteropelvicscopy and cystoscopy demonstrated colon cancer, left renal pelvis cancer and bladder cancer, respectively, as diagnosed by biopsies, followed by restative colectomy, left nephroureterectomy and cystectomy. The final histopathological examination showed well differentiated adenocarcinoma (pSM) in the colon, and urothelial carcinoma in the left renal pelvis (pT2) and the bladder (pT1). Since his uncle and elder brother had suffered from stomach cancer and colon cancer, respectively, he was diagnosed with hereditary nonpolyposis colorectal cancer (HNPCC : Lynch syndrome). He has been well doing without recurrence for 3 years after the surgery.

[A case of primary urothelial carcinoma of the prostate responsive to MVAC intra-arterial chemotherapy: a case report].

A 70-year-old man visited a urological clinic on May 2008 complaining of dysuria and nocturia since 2 years prior. He was diagnosed as having gross benign prostatic hypertrophy, and was referred to a nearby hospital for transurethral resection of prostate (TURP). During TURP, a papillary tumor was found in the prostatic urethra on the left side and a biopsy was performed. A pathological examination revealed urothelial carcinoma G3. Cystoprostatectomy was planned, but the patient refused the procedure. Therefore, he underwent three courses of MVAC intra-arterial chemotherapy (methotrexate, vinblastin, doxorubicin, cisplatinum) at our hospital. After chemotherapy, no tumor was found in the prostatic urethra and a pathological report of repeat TUR showed no tumor. Currently, the patient is alive and there has been no evidence of recurrence for 1 year and 10 month.

A single-dose regimen for antimicrobial prophylaxis to prevent perioperative infection in urological clean and clean-contaminated surgery.

A single dose of antimicrobial prophylaxis (AMP) was administered parenterally for the prevention of perioperative infection in a total of 788 patients undergoing urological surgery, including 380 endoscopic-instrumental, 328 clean, and 80 clean-contaminated operations performed at our institute between January 2007 and December 2009. Surgical site infections (SSIs), urinary tract infections (UTIs), and remote infections (RIs) were prospectively surveyed. The definition for a single dose of AMP allowed for the administration of an additional dose of an antimicrobial during surgery if the procedure was longer than 3 h, but not for the parenteral or oral administration at the end of the procedure in the recovery room, or at a later time over a period of more than 24 h. UTI was observed in 12 (3.2%) patients after endoscopic-instrumental operation, 1 (0.3%) after clean operation, and 1 (0.9%) after clean-contaminated operation. SSI was observed in 2 (0.6%) patients after clean operation but in none after clean-contaminated operations. RI was observed in 1 (0.3%) patient after endoscopic-instrumental operation, 3 (0.9%) after clean operation, and none after clean-contaminated operations. A single-dose regimen of AMP was effective and feasible for the prevention of perioperative infections, including SSIs, UTIs, and RIs, in endoscopic-instrumental, clean, and clean-contaminated urological surgical procedures.

The nationwide study of bacterial pathogens associated with urinary tract infections conducted by the Japanese Society of Chemotherapy.

This study was conducted by the Japanese Society of Chemotherapy and is the first nationwide study on bacterial pathogens isolated from patients with urinary tract infections at 28 hospitals throughout Japan between January 2008 and June 2008. A total of 688 bacterial strains were isolated from adult patients with urinary tract infections. The strains investigated in this study are as follows: Enterococcus faecalis (n = 140), Escherichia coli (n = 255), Klebsiella pneumoniae (n = 93), Proteus mirabilis (n = 42), Serratia marcescens (n = 44), and Pseudomonas aeruginosa (n = 114). The minimum inhibitory concentrations of 39 antibacterial agents used for these strains were determined according to the Clinical and Laboratory Standards Institute (CLSI) manual. All Enterococcus faecalis strains were susceptible to ampicillin and vancomycin. Although a majority of the E. faecalis strains were susceptible to linezolid, 11 strains (7.8%) were found to be intermediately resistant. The proportions of fluoroquinolone-resistant Enterococcus faecalis, Escherichia coli, Proteus mirabilis, and S. marcescens strains were 35.7%, 29.3%, 18.3%, and 15.2%, respectively. The proportions of E. coli, P. mirabilis, K. pneumoniae, and S. marcescens strains producing extended-spectrum ß-lactamase were 5.1%, 11.9%, 0%, and 0%, respectively. The proportions of Pseudomonas aeruginosa strains resistant to carbapenems, aminoglycosides, and fluoroquinolones were 9.2%, 4.4%, and 34.8%, respectively, and among them, 2 strains (1.8%) were found to be multidrug resistant. These data present important information for the proper treatment of urinary tract infections and will serve as a useful reference for periodic surveillance studies in the future.

Double short-time exposure to pirarubicin produces higher cytotoxicity against T24 bladder cancer cells.

This study was designed to determine the ideal manner (schedule and duration) of intravesical chemotherapy using pirarubicin (THP). At first, T-24 cancer cells were treated with 50, 100, 150, and 200 µg/ml THP for 10, 30 and 60 min. Following the first exposure, at various intervals (3, 6, 12, and 24 h), a second exposure to THP was performed under the same condition in vitro. The cell viability was measured by XTT assay. Further, the cells were scanned with a laser scanning cytometer (LSC) and DNA histograms were analyzed to evaluate the cell-cycle components. A single exposure of T-24 cells to THP resulted in significantly higher inhibition of cell growth for 30 min with 100 µg/ml and higher concentrations of THP; for example, the cell viability was reduced to 15, 2, and 0% by incubating cells with 100, 150, and 200 µg/ml of THP, respectively, whereas it was 49% with 50 µg/ml THP. Double exposure of T-24 cells to THP resulted in significantly higher inhibition of cell growth than single treatment at all intervals. LSC assay demonstrated a higher sub-G(1) peak after double treatment with THP when compared with that after a single treatment. Similar cytotoxic effects following double treatment with THP were observed on other bladder cancer cell lines (UMUC3, TCCSUP, 5637, and 253J cells) in vitro. In conclusion, the double short-term exposure to bladder cancer cells by THP has more remarkable cytotoxic effects than the single exposure in vitro.

[A case of lymphangioma of the intrascrotum in an adult].

We reported a rare case of intrascrotal lymphangioma in an adult. A 31-year-old man visited a urological clinic with a chief complaint of left scrotal swelling since a few days ago, and was pointed out to have a left intrascrotal cystic mass. The patient was sent to our hospital for further examination in 23 April 2008. The left scrotal mass was palpated elastic hard below the left testis and its surface was irregular. Light transillumination test showed positive. Ultrasonography revealed a cystic mass 7.0 x 4.4 x 4.5 cm with multiseptate accumulation at the lower pole of the left testis. Magnetic resonance imaging showed low intensity by T1WI and high intensity by T2WI, suggesting a protein-rich component. We suspected left intrascrotal lymphangioma and extirpated the scrotal mass under lumbar anesthesia. Pathological examination demonstrated lymphangioma. The patient had no evidence of recurrence after 1 year.

Current therapy of acute uncomplicated cystitis.

Acute uncomplicated cystitis (AUC) is one of the most common bacterial urinary tract infections. AUC frequently occurs in young sexually active, as well as postmenopausal, women. According to the guidelines published by the Infectious Diseases Society of America in 1999, the standard antimicrobial regimen for treatment of AUC is 3 days with trimethoprim-sulfamethoxazole (TMP/SMX); however, today the most popular antibiotics are the fluoroquinolones because of the emergence of uropathogens that are resistant to TMP/SMX. Fluoroquinolone resistance is also increasing worldwide, although the resistance rates have not been as high as those for TMP/SMX. Extended-spectrum beta-lactamase (ESBL)-producing strains are another problem because most nosocomial ESBL producers are also resistant to non-beta-lactams, such as the fluoroquinolones. Under such circumstances, 3 days of therapy with fluoroquinolones or 7 days with beta-lactams is recommended for empirical therapy, although these regimens should be re-evaluated in the next decade. Low-dose fluoroquinolones should no longer be used because of the potential for emergence of resistance.

[A case of primary testicular malignant lymphoma associated with contralateral testicular recurrence after a nine-year interval: a case report].

A 69-year-old man visited our hospital in February 1996 with a chief complain of left scrotal swelling. The left scrotal content was hard by palpation and ultrasonography showed a hypo-echoic lesion. Left high orchiectomy was performed with suspicion of a testicular tumor. Pathological examination demonstrated a diffuse large B-cell lymphoma (DLBCL) originating from the left testis, and then he underwent 5 courses of chemotherapy consisting of THP-COP (THP-adriamycin, cyclophosphamide, vincristin, predonisone). Following the treatment for five years, he had no evidence of recurrence. Nine years later, in October 2005, he noticed right scrotal swelling. He underwent right high orchiectmy with suspicion of a contralateral testicular malignant lymphoma. Pathological examination revealed DLBCL. He underwent chemotherapy (rituximab-THP-COP) and achieved complete remission again. He is doing well without recurrence of disease for three years after the last treatment.

[Results of microsurgical varicocelectomy in the adolescent].

PURPOSE: Microsurgical varicocelectomy procedures are known to have high rates of success and minimal incidence of postoperative hydrocele occurrences in adults. Herein, we report our initial experience with microsurgical inguinal and subinguinal techniques for the treatment of varicoceles in adolescent patients. PATIENTS AND METHODS: A total of 9 boys (averaged age 12.7 years each younger than 15 at the time of the operation) with a left varicocele underwent microsurgical inguinal or subinguinal repair, and were included in this study. RESULTS: The microsurgical varicocelectomy procedures including meticulous dissection required a mean 170.4 +/- 45.6 minutes (range, 105-240 minutes) and the testicular arteries were preserved in all patients. Catch-up growth was seen in one of two patients whose testicular volumes were determined by ultrasonography both pre and post operatively. None of the patients has developed a recurrent varicocele or postoperative hydrocele after a mean follow-up of 24.6 months. CONCLUSION: As with adults, microsurgical subinguinal and inguinal varicocelectomy procedures are safe and effective, and can be considered one of feasible treatment for varicoceles in adolescents.