Identification and characterization of a novel aac(6')-Iag associated with the blaIMP-1-integron in a multidrug-resistant Pseudomonas aeruginosa.

In a continuing study from Dec 2006 to Apr 2008, we characterized nine multi-drug resistant Pseudomonas aeruginosa strains isolated from four patients in a ward at the Hiroshima University Hospital, Japan. Pulsed-field gel electrophoresis of SpeI-digested genomic DNAs from the isolates suggested the clonal expansion of a single strain; however, only one strain, NK0009, was found to produce metallo-ß-lactamase. PCR and subsequent sequencing analysis indicated NK0009 possessed a novel class 1 integron, designated as In124, that carries an array of four gene cassettes: a novel aminoglycoside (AG) resistance gene, aac(6')-Iag, blaIMP-1, a truncated form of blaIMP-1, and a truncated form of aac(6')-Iag. The aac(6')-Iag encoded a 167-amino-acid protein that shows 40% identity with AAC(6')-Iz. Recombinant AAC(6')-Iag protein showed aminoglycoside 6'-N-acetyltransferase activity using thin-layer chromatography (TLC) and MS spectrometric analysis. Escherichia coli carrying aac(6')-Iag showed resistance to amikacin, arbekacin, dibekacin, isepamicin, kanamycin, sisomicin, and tobramycin; but not to gentamicin. A conjugation experiment and subsequent Southern hybridization with the gene probes for blaIMP-1 and aac(6')-Ig strongly suggested In124 is on a conjugal plasmid. Transconjugants acquired resistance to gentamicin and were resistant to virtually all AGs, suggesting that the In124 conjugal plasmid also possesses a gene conferring resistance to gentamicin.

Five-year longitudinal effect of radical perineal prostatectomy on health-related quality of life in Japanese men, using general and disease-specific measures.

OBJECTIVE: To investigate the longitudinal alteration of health-related quality of life (HRQL) up to 5 years after radical perineal prostatectomy (RPP) among Japanese patients with localized prostate cancer. PATIENTS AND METHODS: In all, 194 patients who had RPP were included in this longitudinal survey. The validated RAND 36-Item Health Survey (SF-36) and the University of California, Los Angeles Prostate Cancer Index (UCLA-PCI) were used to evaluate the HRQL. RESULTS: Among the UCLA-PCI urinary domains, urinary function scores decreased at 3 months after RPP, but they increased 6 months after RPP. Likewise, urinary bother showed a transient decrease at 3 months, but had returned to the baseline level 6 months after RPP. Sexual function (SF) was drastically decreased at 3 months after RPP, but had slightly increased 1 year after RPP. Patients who had a nerve-sparing (NS) RPP showed better SF-related HRQL than those who did not at 6 months after RPP. This favourable alteration involving SF-related HRQL was closely associated with the NS procedure, but not with the patient age. Multivariate analysis showed that later recovery of SF was essentially related to the use of NS RPP, while early recovery of sexual bother was closely related to the patient age. CONCLUSIONS: Our results confirmed the positive effect of RPP on the long-term HRQL in Japanese patients. Although NS surgery conferred the benefit of the recovery of SF, older Japanese patients were not greatly concerned about their decreased SF-related HRQL. The current results provide primary evidence for predicting the alteration of HRQL and understanding the effect of patient age and NS surgery on HRQL after RPP.

Increased prevalence and clonal dissemination of multidrug-resistant Pseudomonas aeruginosa with the blaIMP-1 gene cassette in Hiroshima.

OBJECTIVES: The aim of this study was to evaluate the dissemination of metallo-beta-lactamase (MBL)-encoding genes among multidrug-resistant (MDR) Pseudomonas aeruginosa isolates recovered from major hospitals in the Hiroshima region. METHODS: During July to December from 2004 to 2006, a surveillance of eight major hospitals in the Hiroshima region identified 387 non-duplicate isolates resistant to imipenem (MIC >or= 16 mg/L). They were screened for resistance to amikacin (MIC >or= 64 mg/L) and ciprofloxacin (MIC >or= 4 mg/L) and MBL-encoding genes. The structure of the variable regions of the integrons was determined using PCR mapping. Clonality was assessed using PFGE and multilocus sequence typing (MLST). RESULTS: The frequency of MBL-positive isolates in MDR P. aeruginosa isolates significantly increased from 42.3% in 2004 to 81.4% in 2006. Most of the MBL-positive isolates produced IMP-1 followed by VIM-2. The bla(IMP-1) and bla(VIM-2) genes were present in class 1 integrons. Characterization of the variable regions of the integron showed the presence of six different gene cassette arrays in bla(IMP-1) cassettes and a single array in bla(VIM-2) cassettes. The IMP-1 producers belonged to two clonal lineages using PFGE and MLST analyses and the integron variations correlated well with the clonal complexes. Among them, strains positive for a newly identified In113-derived bla(IMP-1) gene cassette array were most widely distributed in Hiroshima. CONCLUSIONS: This study shows a dramatic increase in MBL genes, primarily bla(IMP-1), in MDR P. aeruginosa isolates in Hiroshima during these 3 years. In addition, MDR P. aeruginosa with the newly discovered In113-derived bla(IMP-1) gene cassette array appears to be clonally expanding.

Prevalence of painful bladder syndrome (PBS) symptoms in adult women in the general population in Japan.

AIMS: The aim of this study was to clarify the prevalence of painful bladder syndrome (PBS) symptoms in adult women in the general population in Japan. METHODS: Web-based survey through an internet-based market research company that enrolled 561,631 men and women in Japan was conducted from January 9 to January 11, 2007. After the women allocated to four age groups; 20s, 30s, 40s, and 50s or older, a total of 80,367 women, comprising an almost equal number from each age group, were then randomly invited to participate. The O'Leary and Sant symptom index was used as the questionnaire. The following classification was defined on the basis of the total points score: 0 to 3 points for negligible PBS symptoms, 4 to 6 points for mild symptoms, 7 to 11 points for moderate symptoms, and 12 to 20 points for severe symptoms. A category of possible cases of PBS was defined as severe PBS symptoms including nocturia (twice or more) and pain (2 points or more). RESULTS: A total of 32,074 women ranging in age from 20 to 88 years participated. 76.6% of respondents had negligible PBS symptoms, 17.3% had mild symptoms, 5.6% had moderate symptoms, and 0.5% had severe symptoms, respectively. The incidence rate of women with possible cases of PBS was 0.265% (85/32,074). CONCLUSIONS: Comparison with previous reports revealed no difference in the prevalence of PBS symptom in adult women in the general population between Japan and Western countries.

Development of the human retroperitoneal fasciae.

INTRODUCTION: Although the renal fascia (RF), ureteral sheath, lateroconal fascia (LF) and hypogastric nerve are critical landmarks for retroperitoneal surgery, their laminar relationships require clarification. MATERIALS AND METHODS: Horizontal sections (hematoxylin-eosin staining) of human fetuses at two different developmental stages [9-12 (3 fetuses, crown-rump length, CRL 40-65 mm) and 20-25 weeks of gestation (9 fetuses, CRL 152-220 mm)] were compared. RESULTS: In the early-stage group, the pararenal space had already formed between the posterior RF and the transversalis fascia (TF). The anterior RF extended along the peritoneum and often fused with the latter. In the late-stage group, the posterior RF extended inferomedially toward the anterior aspect of the aorta and inferior vena cava. However, at the level of the renal hilus, the posterior RF was connected with vascular sheaths of the great vessels. The LF was seen developing as a fasciculation of the multilaminar structure in the pararenal space. However, on the posterolateral side of the colon after retroperitoneal fixation, the fusion fascia of the peritoneum could also be identified as LF. CONCLUSIONS: A common sheath for ureters and hypogastric nerves appeared to be likely on the inferior side of the kidney. The LF did not appear to be a primary structure such as the RF, but a result of secondary mechanical stress due to fatty tissue developing earlier along the TF than in the perirenal space. However, the suggested similarity between LF and fusion fascia in the plane occupied was a likely cause for misinterpreting the laminar configurations during surgery.

Decrease of renal function due to warm ischemia after laparoscopic partial nephrectomy: evaluation using 99mTc-DMSA renal scintigraphy.

INTRODUCTION: The purpose of this study is, using technetium-99m-dimercaptosuccinic acid ((99m)Tc-DMSA), to evaluate the decrease of renal function caused by warm ischemia. PATIENTS AND METHODS: The (99m)Tc-DMSA scan was performed before and 1, 3 and 6 months after the operation for 19 consecutive patients. The patients were divided into three groups by warm ischemic time (group A: 40 min intersection 60 min). Renal function of the unresected part was defined as the uptake to unresected part relative to the uptake to the contralateral kidney. The reduction of renal function was expressed as a ratio of the function after the surgery divided by function before the surgery and was compared between the three groups. RESULTS: The reduction in group C after 1 and 3 months tended to be greater than that in group A or B, although not reaching statistical significance (one-way ANOVA test, 1 month: p = 0.15 and 3 months: p = 0.13). There was a significant difference in reduction of renal function between the three groups after 6 months (one-way ANOVA test, p = 0.02). The Scheffé test showed a statistical significance between groups A and C (p < 0.05). CONCLUSION: Renal function calculated by (99m)Tc-DMSA shows that prolonged ischemic time causes significant damage to the kidney.

Immunohistochemical analysis of Reg IV in urogenital organs: Frequent expression of Reg IV in prostate cancer and potential utility as serum tumor marker.

Regenerating islet-derived family, member 4 (Reg IV) is a candidate marker for cancer and inflammatory bowel disease and is associated with neuroendocrine and intestinal differentiation. We have reported that 14% of prostate cancer (PCa) cases are positive for Reg IV by immunohistochemistry. In the present study, we performed immunohistochemical analysis of Reg IV in other major urological cancers, including 101 renal cell carcinoma (RCC), and 95 urothelial carcinoma (UC) of urinary bladder by immunohistochemistry. We also investigated neuroendocrine differentiation by chromogranin A and synaptophysin staining along with intestinal differentiation by MUC2 staining. Immunohistochemical analysis of Reg IV revealed no expression of Reg IV in RCC, and only one case (1%) of UC expressed Reg IV. Neither neuroendocrine nor intestinal differentiation was found in RCC. Among 95 UC cases, neuroendocrine differentiation was detected in 13 cases (14%), and intestinal differentiation was observed in 33 cases (35%). In one Reg IV-positive UC case, MUC2 staining was observed. Since Reg IV expression was frequently found in PCa, we also measured Reg IV levels in sera from patients with PCa by enzyme-linked immunosorbent assay. The serum Reg IV concentration in PCa patients (n=38, mean +/- SE, 1.69+/-0.16 ng/ml) was significantly higher than that in control individuals (n=40, 1.28+/-0.11 ng/ml, P=0.0199, Mann-Whitney U test). The sensitivity and specificity for detection of PCa were 34% (13/38) and 90% (36/40), respectively. These results suggest that among major urologic cancers, Reg IV is expressed frequently in PCa, and that serum Reg IV represents a novel biomarker for PCa.

Lack of information underlies women's perceptions of erectile dysfunction (ED) drugs in Japan.

INTRODUCTION: Some Japanese women are known to have negative attitudes toward erectile dysfunction (ED) drugs, but the environment underlying these perceptions is unclear. AIM: To reveal the underlying environment that shapes women's perceptions of ED drugs in Japan. METHODS: A web-based questionnaire was conducted through an Internet-based market research company. A total of 2,593 women in five age groups (20s, 30s, 40s, 50s, and 60s or older) were randomly invited to participate in this study, with an almost equal number in each age group. The questionnaire contained 30 items related to individual background and sexual information, concerns about the image of ED drugs, ED drug-related perceptions, and attitude toward sexual information media. MAIN OUTCOME MEASURES: The women's attitude and the independent predictors that affect their partner's use of ED drugs were clarified. RESULTS: Answers were obtained from 1,077 women, of whom 35.4% (n=381) had a negative image of ED drugs. Although 69.5% (n=749) agreed that a sexual relationship with a male partner was important, only 26.7% (n=288) agreed that this remained important if ED drugs were used. However, 56.7% (n=611) and 57.7% (n=621) of respondents, respectively, answered that they would allow their partner's use of ED drugs if they imagined that they understood the safety and effectiveness of ED drugs and that their quality of life was improved by their partner's use of the drugs. Lack of information about ED drugs was a significant predictor for acceptance of a partner's use of ED drugs among women with a negative image of ED drugs, since they were more likely to accept the use of these drugs if they were convinced about their safety and effectiveness or positive effect on quality of life. CONCLUSION: Lack of information about ED drugs may influence the perception of women in Japan regarding these drugs.

Female perineal membrane: a study using pelvic floor semiserial sections from elderly nulliparous and multiparous women.

To describe the architecture and topohistology of the female perineal structures, especially the perineal membrane (PM), we examined frontal sections (one side) and horizontal or transverse sections (another side) of 15 bisectioned pelvic floors. The PM, notably comprising elastic fibers, extended mediolaterally or transversely on the immediately inferior side of the rhabdosphincter area. More posteriorly, the elastic fibers more tilted along the long axis of the vagina and became lining the lateral vaginal wall as a fibrous skeleton. The compressor urethrae and urethrovaginal sphincter were embedded in and interdigitated with the PM. The elastic fiber architecture of the PM was similar to the rectovaginal septum. We hypothesize that the PM plays a role of a shock-absorber at the interface between the levator ani and distalmost vagina. A standard diagram of the female perineal structures is necessary to be revised.

Reg IV is an independent prognostic factor for relapse in patients with clinically localized prostate cancer.

Regenerating islet-derived family, member 4 (REG4, which encodes Reg IV) is a candidate marker for cancer and inflammatory bowel disease. We investigated the potential prognostic role of Reg IV immunostaining in clinically localized prostate cancer (PCa) after radical prostatectomy. Immunohistochemical staining of Reg IV was performed in 98 clinically localized PCa tumors obtained during curative radical prostatectomy. Intestinal and neuroendocrine differentiation was investigated by MUC2 and chromogranin A immunostaining, respectively. The prognostic significance of immunohistochemical staining for these factors on prostate-specific antigen (PSA)-associated recurrence was assessed by Kaplan-Meier analysis and a Cox regression model. Phosphorylation of the epidermal growth factor receptor (EGFR) by Reg IV was analyzed by Western blot. In total, 14 (14%) of the 98 PCa cases were positive for Reg IV staining. Reg IV positivity was observed frequently in association with MUC2 (P = 0.0182) and chromogranin A positivity (P = 0.0012). Univariate analysis revealed that Reg IV staining (P = 0.0004), chromogranin A staining (P = 0.0494), Gleason score (P < 0.0001) and preoperative PSA concentration (P = 0.0167) were significant prognostic factors for relapse-free survival. Multivariate analysis indicated that Reg IV staining (P = 0.0312), Gleason score (P = 0.0014) and preoperative PSA concentration (P = 0.0357) were independent predictors of relapse-free survival. In the LNCaP cell line, EGFR phosphorylation was induced by the addition of Reg IV-conditioned medium. These results suggest that Reg IV expression is an independent prognostic indicator of relapse after radical prostatectomy.

Restoration of FGF receptor type 2 enhances radiosensitivity of hormone-refractory human prostate carcinoma PC-3 cells.

BACKGROUND: This study was undertaken to investigate the radiosensitizing effects of fibroblast growth factor receptor 2IIIb (FGFR2IIIb) in androgen-independent human prostate carcinoma PC-3 cells devoid of normally resident epithelial cell FGFR2IIIb. MATERIALS AND METHODS: A clonal line of PC-3 cells expressing FGFR2IIIb was established by stable transfection. Clonogenic cell survival, apoptosis and cell cycle distribution with and without gamma-irradiation were then compared between FGFR2IIIb-expressing PC-3 cells and control cells mock-transfected with vector alone. RESULTS: Gamma-irradiation resulted in an increase of clonogenic cell death concurrent with enhanced apoptosis and cell cycle arrest in the G2/M-phase in both transfected and untransfected cells. A quantitative analysis of all three parameters indicated that cells expressing FGFR2IIIb were significantly more sensitive to irradiation than control cells. CONCLUSION: These results indicate that restoration of FGFR2IIIb to PC-3 cells enhances their sensitivity to irradiation through acceleration of apoptosis and cell cycle arrest.

Alternative nonsteroidal antiandrogen therapy for advanced prostate cancer that relapsed after initial maximum androgen blockade.

PURPOSE: Large meta-analyses have documented that maximum androgen blockade with nonsteroidal antiandrogens for advanced prostate cancer confers survival benefits, although it remains controversial. Also, we and others have reported the effectiveness of second line hormonal therapy for prostate cancer that relapses after initial hormone therapy. However, there is little clinical evidence of the effectiveness of the latter treatment strategy. Therefore, in this multicenter trial in Japan we analyzed clinical outcomes following alternative changing from 1 nonsteroidal antiandrogen to another, ie bicalutamide to flutamide and flutamide to bicalutamide, for advanced prostate cancer that relapsed after initial maximum androgen blockade. MATERIALS AND METHODS: The study included 232 patients with advanced prostate cancer who were initially treated with maximum androgen blockade, including surgical or medical castration combined with nonsteroidal antiandrogens. If a patient relapsed while on first line therapy, we discontinued antiandrogen and evaluated the patient for antiandrogen withdrawal syndrome. We then administered an alternative antiandrogen and evaluated its effect. RESULTS: The incidence of antiandrogen withdrawal syndrome after initial maximum androgen blockade was 15.5% for bicalutamide and 12.8% for flutamide. A prostate specific antigen decrease after antiandrogen withdrawal was a prognostic factor. Nonsteroidal antiandrogens as alternative therapy in patients with relapse after the initial maximum androgen blockade were effective (prostate specific antigen decrease greater than 50%) as second line maximum androgen blockade. Of 232 patients 142 (61.2%) showed a prostate specific antigen decrease in response to an alternative antiandrogen. These responders had significantly better survival than nonresponders, suggesting that responsiveness to second line therapy predicts increased survival. CONCLUSIONS: Following maximum androgen blockade with an alternative nonsteroidal antiandrogen is effective for advanced prostate cancer that has relapsed after initial maximum androgen blockade. Even a partial response to second line maximum androgen blockade was associated with improved survival. Our data support the notion that responders to second line regimens are androgen independent but still hormonally sensitive.

Deep hypothermic circulatory arrest for resection of renal tumor in the inferior vena cava: beneficial or deleterious?

BACKGROUND: The use of deep hypothermic circulatory arrest (CA) during resection of renal tumors with caval extension is limited in many institutes because of possible adverse effects on immune or platelet function. The present study examined whether routine use of CA implied a negative impact on prognosis. METHODS AND RESULTS: Thirty-six cases of renal tumor with caval extension were retrospectively reviewed (age range, 40-82 years; follow-up, 5 months to 23 years). The mean extension level (Novick classification) in the single clamp (SC) group (n=13), partial bypass (PB) group (n=8), and CA group (n=15) was 1.4, 1.8, and 3.0, respectively. There was 1 operative death (intraoperative pulmonary embolism: PB group) and 1 hospital death (pulmonary embolism of residual tumor: SC group). Volumes of bleeding and transfusion were comparable in the PB and CA groups. Although the level of tumor extension was significantly higher and operation time significantly longer in the CA group than in the other 2 groups (p<0.0001 and p=0.0003), the rate of local recurrence and 5-year survival were comparable among the 3 groups (overall 5-year survival rate 53.1%). CONCLUSIONS: The benefits and safety of tumor resection under CA might exceed its disadvantages.

Overactive bladder in children should be strictly differentiated from monosymptomatic nocturnal enuresis.

INTRODUCTION: To elucidate the prevalence of concomitant overactive bladder in children with a chief compliant of primary enuresis, and to evaluate the pathogenetic difference between monosymptomatic and non-monosymptomatic enuresis. MATERIALS AND METHODS: All patients had evidence of primary enuresis. Neurogenic bladder was excluded. Urinary symptoms were evaluated by taking a history from the affected children and parents, and using a questionnaire and bladder diary. Voiding cystourethrography was performed for non-responders to exclude urinary abnormalities. RESULTS: Eighty-eight patients (9.8 +/- 3.1 years old) were enrolled. Initial assessment demonstrated that 24% had undervalued overactive bladders and 9% had constipation. Voiding cystourethrography was performed in 25%, demonstrating mechanical urethral obstructions in 8% and vesicoureteral reflux in 4.5%. Constipation, a history of urinary tract infections, mechanical obstructions and vesicoureteral reflux were strongly associated with non-monosymptomatic enuresis. CONCLUSIONS: Patients with non-monosymptomatic enuresis had a different clinical background, therapeutic response and pathogenetic abnormalities. In children an overactive bladder should be strictly differentiated from monosymptomatic enuresis.

Inguinal hernia after radical perineal prostatectomy: comparison with the retropubic approach.

OBJECTIVES: To clarify the characteristics of inguinal hernia (IH) after radical perineal prostatectomy (RPP) compared with that after radical retropubic prostatectomy (RRP). METHODS: We retrospectively reviewed 285 and 311 men who underwent RPP and RRP, respectively, for clinically localized prostate cancer between August 2000 and June 2006, using medical records and a telephone survey. RESULTS: The incidence of postoperative IH after RPP was 1.8% (5 of 285) with a median follow-up time of 43 months; that after RRP was 10.3% (32 of 311) with a median follow-up of 36 months (P <0.0001). The cumulative IH-free rate was significantly higher after RPP than after RRP (P <0.0001, log-rank test). Three of the five RPP patients (60%) developed IH more than 24 months after surgery, whereas 25 of 32 (78%) of the RRP group did so within 24 months (P = 0.0742). The incidence rate of post-RPP IH did not differ between the standard (4 of 194 = 2.1%) and modified (1 of 91 = 1.1%) RPP procedures, where the endopelvic fascia was left intact and opened, respectively (P = 0.5638). CONCLUSIONS: The incidence of IH after RPP appears to be sporadic and about the same as that (2.0-2.4%) reported previously in men with prostate cancer treated nonsurgically. Although some kinds of procedures during RRP are speculated to affect the internal inguinal ring, prostatectomy with or without opening of the endopelvic fascia seems to be less implicated in the development of IH after RRP because it was not a significant variable in IH development after different techniques had been used in RPP.

First isolation of blaIMP-7 in a Pseudomonas aeruginosa in Japan.

We report here the first isolation in Japan of a carbapenem-resistant Pseudomonas aeruginosa strain that carries the metallo-beta-lactamase gene bla(IMP-7). This isolate revealed high-level resistance to all of the tested antibiotics except for piperacillin, showing a multidrug-resistant phenotype.

Lower urinary tract symptoms after radical perineal prostatectomy.

OBJECTIVE: To clarify the impact of radical perineal prostatectomy (RPP) on lower urinary tract symptoms (LUTS) in patients with clinically localized prostate cancer. METHODS: A total of 117 patients with a median age of 69 years who underwent RPP alone between August 2002 and August 2005 were included in the study. We measured LUTS on the basis of the International Prostate Symptom Score (IPSS) and IPSS quality of life (QOL) questionnaire before, and 3, 6 and 12 months after surgery. RESULTS: The overall mean total IPSS and IPSS QOL score decreased over time after RPP and was significantly reduced at 12 months after surgery. The decrease of the score was more prominent and rapid in patients with moderate to severe symptoms (IPSS > or = 8), whereas in those with no or only mild symptoms (IPSS < or = 7), the score did not change significantly after RPP. When the patients were divided into groups with baseline scores of 0-1 and 2-5 for each of the seven composites of the IPSS, scores for the 2-5 group improved significantly after RPP in all composites, whereas the 0-1 group had significantly worse scores for voiding frequency and nocturia. No significant change was noted in any of the other five composites. CONCLUSION: This longitudinal study shows that RPP is significantly beneficial for moderate to severe LUTS, but also has adverse effects on voiding frequency and nocturia in some men with no or mild symptoms. This information is important when counseling patients about treatment options for localized prostate cancer.

Risk factors for intravesical recurrence following urothelial carcinoma of the upper urinary tract: no relationship to the mode of surgery.

OBJECTIVE: The aim of this study was to clarify whether intravesical recurrence of upper urinary tract cancer after treatment is related to the mode of surgery or other oncological factors. METHODS: We evaluated 106 patients (mean age 70.4 years; mean follow-up 24.0 months) who underwent surgery for the upper urinary tract cancer at Hiroshima University and its affiliated hospitals between January 1995 and August 2005. Seventy-nine of the patients underwent retroperitoneoscopy-assisted radical nephroureterectomy (RN) and 27 underwent nephroureterectomy by open surgery (OS). Fifty-two patients had renal pelvic tumors, 48 had ureteral tumors, and six had both renal pelvic and ureteral tumors. Twenty-eight (26%) of the 106 patients had a pre-operative history of bladder cancer. We identified the risk factors predicting intravesical recurrence of upper urinary tract cancer according to the type of previous surgery using the Kaplan-Meier method, log-rank test, and univariate and multivariate analysis using the Cox proportional hazards model. RESULTS: Thirty-one (29%) of the 106 patients developed bladder tumors post-operatively. The 2-year intravesical recurrence-free rate was 55% in the RN group and 60% in the OS group. There was no significant difference (P = 0.51, log-rank test) in the rate of intravesical recurrence between the two groups. Multivariate analysis identified only a history of pre-operative bladder tumor (HR = 3.25, P = 0.003) as a predictor of post-operative intravesical recurrence. CONCLUSIONS: Intravesical recurrence after surgery for upper urinary tract cancer is not related to the mode of surgery (i.e. laparoscopy-assisted or open surgery) employed. The only risk factor for intravesical recurrence is a history of bladder cancer.

Anterior urethral valves in children: a possible association between anterior urethral valves and Cowper's duct cyst.

To elucidate the pathophysiology of congenital obstruction of the anterior urethra and to investigate the association between anterior urethral valves and syringocele. Three boys with congenital obstruction of the anterior urethra diagnosed at our department between 1997 and 2004 were analyzed retrospectively. All three boys had congenital obstruction in the bulbar urethra. The presenting symptoms and age of each patient were varied. Whereas continuity between Cowper's duct and the diverticulum was not demonstrated radiographically in all of the boys, it was speculated endoscopically in all. Our series has suggested a possible association between anterior urethral valves (diverticulum) and syringocele. These congenital anomalies of the anterior urethra should be considered in the differential diagnosis of obstructive lesions of the urinary tract.

Women's perception of male erectile dysfunction drugs in the general population.

OBJECTIVE: The aim of this study is to investigate trends in women's perception of male erectile dysfunction (ED) drugs in the general population. METHODS: We designed an online questionnaire survey and randomly invited an initial total of 2370 women to respond to it from a database population that included 450,000 men and women recruited through an Internet-based market research company. The 17 items of the questionnaire comprised 9 items related to socio-cultural background and 8 items related to the perception of ED drugs, ED itself, and sexual relations. RESULTS: A total of 1262 women (53.2% of those initially invited), ranging in age from 20 to 77 years, participated. Among the participants, 83.3% were aware of the existence of ED drugs, but only 12.0% showed some interest in them, 46.4% and 43.2% of the participants claimed to have an unfavorable image of ED drugs, and of men using ED drugs, respectively. Among the participants, 45.2% stated that if their partners suffered from ED at present or in the future, they would not desire their partners to use ED drugs, and 25.5% stated that they would not accept it. Multiple logistic regression analysis revealed that higher age had a negative impact on knowledge, interest and image of ED drugs, the image of men using ED drugs, and the importance of sexual relations. CONCLUSIONS: Our findings reveal that a high proportion of women have a negative perception of ED drugs and associated issues in Japan.