Dietary glycine improves urine storage symptoms in urology outpatients.

OBJECTIVES: Spinal glycinergic mechanisms inhibit the micturition reflex, and administration of glycine inhibits bladder activity in rats. Therefore, we examined whether dietary glycine would improve storage symptoms in urological outpatients. METHODS: We enrolled 20 participants (16 men and four women) with an overactive bladder symptom score (OABSS) ≥ 3. All participants took 3 g of glucose (placebo) twice a day for the first four weeks, then 3 g of glycine twice a day for the next four weeks. We evaluated blood pressure, international prostate symptom score (IPSS), nocturia quality of life (N-QOL) score, OABSS, frequency of urination, sleep latency, time to first nighttime void, bladder pain, global self-assessment (GSA) evaluated urinary symptom improvement, and adverse events. RESULTS: Glucose administered as a placebo improved urinary frequency, urine force on the IPSS, and five of the 13 items on the N-QOL. However, compared to the results before and after glucose administration, glycine treatment decreased the number of nocturnal voids, urgency, and total score for urine storage items on the IPSS. It also reduced blood pressure and improved IPSS-QOL. For the OABSS, improvements with glycine were noted in the number of nocturnal urinations, urinary urgency, urge incontinence, and total score. For the N-QOL, eight of 13 items, and the total score, improved. The actual number of nighttime urinations, sleep latency, latency to first nighttime urination, bladder pain, and GSA also improved. There were no adverse events. CONCLUSIONS: Glycine might improve urine storage symptoms, cardiovascular function, pain, and sleep.

Clinical Efficacy of 1-Year Intensive Systematic Dietary Manipulation as Complementary and Alternative Medicine Therapies on Female Patients With Interstitial Cystitis/Bladder Pain Syndrome.

OBJECTIVE: To evaluate the clinical efficacy of intensive systematic dietary manipulation (ISDM) for female patients with interstitial cystitis (IC)/bladder pain syndrome (BPS) in stable condition who were followed up in our hospital. MATERIALS AND METHODS: In cooperation with the nutrition control team, we created a basic IC/BPS diet menu for 1 month. Data regarding daily food intake and food-related symptoms were collected by conducting a detailed interview of each patient, and we set meal menu to control IC/BPS symptoms and advised the patients to reduce the intake of specific food items to the maximum possible extent. The following food items were removed from or restricted in the diet of patients: tomatoes, tomato products, soybean, tofu product, spices, excessive potassium, citrus, high-acidity-inducing substances, etc. We evaluated the following factors 3 months and 1 year after the start of the intervention: O'Leary-Sant symptom index, O'Leary-Sant problem index, urgency visual analogue scale score, bladder or pelvic pain visual analogue scale score, and numerical patient-reported quality of life index. RESULTS: All evaluated factors improved statistically significantly when the intensive group was compared with the nonintensive group (baseline to 3 months and 3 months to 1 year ISDM, P <.05, respectively). CONCLUSION: ISDM was found to alleviate the symptoms of IC/BPS in almost 3 months and continued clinical efficacy for at least 1 year. ISDM as one of the conservative treatment modality for IC/BPS should be attempted more strictly because of its noninvasiveness, without alterations to the other treatments.

[STUDY OF NEW ORAL QUINOLONES (LEVOFLOXACIN AND SITAFLOXACIN) AS PROPHYLACTIC ANTIMICROBIAL AGENTS IN TRANSRECTAL PROSTATE NEEDLE BIOPSY].

(Objective) A single prophylactic dose of new quinolones is recommended to prevent infection associated with transrectal prostate needle biopsy (TRPB), except in high-risk patients, and a single dose of levofloxacin (LVFX) 500 mg is often administered. We examined single administrations of LVFX and sitafloxacin (STFX), in relation to the frequency of febrile infection. (Patients and methods) The subjects were 411 patients deemed to be suitable candidates for TRPB and ranging in age from 52 to 84 years (median, 75 years). Their PSA values ranged from 3.89 to 2,450 ng/mL (median, 6.92 ng/mL). They were randomly assigned to receive LVFX (group A, 204 patients) or STFX (group B, 207 patients), and the two groups were compared for the incidence of infection with a temperature of 38°C or more within 48 hours after TRPB. (Results) Febrile infection was observed in 8 (3.92%) of the 204 patients in group A and 1 (0.48%) of the 207 patients in group B. Of the 9 patients with febrile infection, 8 had acute prostatitis. There was a significant difference in the incidences of febrile infection between the two groups (p = 0.041; odds ratio, 8.41; 95% confidence interval, 1.04-67.85). The pathogenic bacteria in the 9 patients were Escherichia coli in 7 (Extended-spectrum beta-lactamase [ESBL]-producing bacteria in 3, LVFX-resistant bacteria in 2), Klebsiella pneumoniae in one, and Enterococcus faecalis in one. (Discussion) Measures against quinolone-resistant bacteria, ESBL-producing bacteria, and gram-positive bacteria should be considered for the prevention of infections associated with TRPB. Based on our present observations, STFX is considered to have more favorable effects than LVFX.

CLINICAL EFFICACY OF DIETARY MANIPULATION AS COMPLEMENTARY AND ALTERNATIVE MEDICINE THERAPIES ON FEMALE INTERSTITIAL CYSTITIS PATIENTS.

(Objectives) We examined the clinical efficacy of dietary manipulation (DM) for female patients with interstitial cystitis (IC) in stable condition who were followed in our hospital. (Patients and methods) This study included 20 female patients with IC in rather stable condition who were followed at our hospital. In cooperation with the nutrition control team, we created a basic IC diet menu for 1 month (total daily calories, 1,500 kcal; protein, 65 g; fat, 40 g; carbohydrate, 220 g; water, 1,000 ml; salt, 7 g). Data regarding daily food intake and food-related symptoms were collected by detailed interview of each patient conducted by the doctors, nurses, and nutritionists at our hospital. In accordance with the abovementioned nutrition control, we set meal menu to control IC symptoms and advised the patients to reduce the intake of specific food items to the maximum possible extent.The following food items were removed from or restricted in the diet of patients: tomatoes, tomato products, soy, tofu product (seasoning was acceptable), spices (pepper, curry powder, mustard, horseradish, etc.), excessive potassium, citrus, high-acidity-inducing substances (caffeine, carbonate, and citric acid), etc. We evaluated the following factors to determine the efficacy of this diet menu 3 months after the start of the intervention: O'Leary-Sant symptom index (OSSI), O'Leary-Sant problem index (OSPI), urgency visual analogue scale (UVAS) score, (0, no urgency; 10, severe urgency), bladder or pelvic pain VAS (PVAS) score, (0, no pain; 10, worst possible pain), and numerical patient-reported quality of life (QOL) index (0, highly satisfied; 6, highly dissatisfied). (Results) OSSI and OSPI improved from 11.7 to 10.1 (p<0.0001), and from 10.7 to 8.8 (p=0.01), respectively. The UVAS score significantly reduced from 6.4 to 4.8, and the PVAS score significantly improved from 6.5 to 4.8 (p<0.0001). The patient-reported QOL index significantly improved from 5.1 to 3.9 (p<0.0001). (Conclusion) Although repeated notes were taken and patients who were followed up for a long term were consulted on the meal, as appropriate, at the time of visit, DM was found to alleviate the symptoms of IC. DM as a systematic treatment modality for IC should be attempted more aggressively because of its non-invasiveness, without alterations to the other IC treatments.

Effect of carbazochrome sodium sulfonate on refractory chronic prostatitis.

OBJECTIVES: To study the effect of carbazochrome sodium sulfonate, an agent that reduces capillary permeability, on refractory chronic prostatitis. METHODS: Patients with prostatitis refractory to at least 8 weeks of routine therapy and with urinalysis positive for microhematuria were considered for the present study. In addition to their prior therapy, the patients received carbazochrome at a dose of 30 mg three times a day. The severity of pain (score 0-10), daytime and night-time frequency, international prostate symptom score, global self-assessment, urine occult blood positivity, and adverse events were assessed after 4 and 8 weeks of treatment, and compared with baseline findings. RESULTS: A total of 50 patients (mean age 68.6 ± 8.5 years) were evaluable. The pain score decreased significantly from 3.2 ± 2.1 at baseline to 1.7 ± 1.4 after 4 weeks of treatment and to 1.1 ± 1.8 after 8 weeks. Daytime and night-time frequency, storage symptoms, post-micturition symptoms, and urine occult blood positivity also significantly improved. More than 36% of the patients gave a global self-assessment rating of "improved" or "better" after both 4 and 8 weeks of treatment. Mild adverse events occurred in three patients; one had nausea and two developed drug rash. CONCLUSIONS: Carbazochrome seems to effectively improve pain as well as storage and post-micturition symptoms in patients with refractory chronic prostatitis.

Efficacy of combined androgen blockade with zoledronic acid treatment in prostate cancer with bone metastasis: the ZABTON-PC (zoledronic acid/androgen blockade trial on prostate cancer) study.

AIM: Zoledronic acid (ZA) reduces the risk of skeletal-related events (SREs) in castration-resistant prostate cancer (CRPC) with bone metastasis and improves quality of life. It remains unclear when clinicians should initiate ZA treatment. PATIENTS AND METHODS: Hormone-naïve patients were randomized to a combined androgen blockade (CAB) group or CAB with ZA group (CAB-ZA) based on Gleason score (GS) or extent of disease. The primary end-point of the study was progression-free survival (PFS) and the secondary end-point was incidence of SREs and bone pain. RESULTS: Thirty-one and 29 patients among 60 enrolled patients were assigned to the CAB group and the CAB-ZA group, respectively. There was no significant difference in PFS between the two groups. Subgroup analyses revealed better PFS in the CAB-ZA group with GS ≥8 (p=0.021). Moreover, incidence of SREs, including bone pain, was lower in the CAB-ZA group (p=0.019). CONCLUSION: CAB-ZA treatment was found to improve PFS for patients with prostate cancer with high GS. CAB-ZA treatment could be recommended for treatment of patients with prostate cancer.

Usefulness of naftopidil for dysuria in benign prostatic hyperplasia and its optimal dose--comparison between 75 and 50 mg.

BACKGROUND/OBJECTIVES: The clinical usefulness and optimal dose of naftopidil were evaluated and discussed in 100 patients with benign prostatic hyperplasia without urinary retention. METHODS: Naftopidil was administered once in the morning in a dose of 75 mg for 6 weeks; following washout for 1 week, a reduced dose of 50 mg was administered for another 6 weeks. Subjective and objective symptoms were clinically evaluated. RESULTS: Significant improvements were observed in nocturia, IPSS, QOL index, Qmax, Qave, and % postvoid residual urine volume after administration of 75 mg as well as 50 mg. Comparison of the results obtained after administration of 75 and 50 mg revealed improvement only in bladder compliance. Among the items of the IPSS, 'nocturia', 'less than two hours urination', 'weak urinary stream' and 'sensation of not emptying bladder' improved, after administration of 75 as well as 50 mg. The bladder compliance aggravated to 13.6, from 22.1 ml/cm H(2)O after administration of 50 mg. CONCLUSIONS: Naftopidil could have superior effects in benign prostatic hyperplasia patients whose complaints are storage and voiding symptoms, especially nocturia of three times or more, as well as in patients with low compliance bladder and detrusor overactivity. The recommended dose seems to be 50 mg.

Effect of naftopidil on nocturia after failure of tamsulosin.

OBJECTIVES: The clinical usefulness of naftopidil was evaluated in 122 patients with benign prostatic hyperplasia for urinary tract symptoms and signs, focused in particular on nocturia. METHODS: A total of 122 patients with BPH whose symptoms did not improve after 6 weeks of tamsulosin administration were enrolled. After the treatment was followed by a washout period with placebo, patients were prescribed 75 mg of naftopidil to be taken after dinner for 6 weeks, and the efficacy was re-evaluated. All the drugs used were unidentified, and attention was given to not have the patients recognize the change in the drug given. The primary purpose of this study was the improvement of nocturia in patients with a poor response to tamsulosin. The clinical efficacy of naftopidil was defined as significant improvement in International Prostate Symptom Score, quality-of-life index, and maximal urinary flow rate. RESULTS: After 6 weeks of naftopidil administration, significant improvements in daytime and nighttime frequency, International Prostate Symptom Score, quality-of-life index, maximal flow rate, average flow rate, and bladder compliance were examined. On the International Prostate Symptom Score questionnaire, improvement in the sensation of the bladder not emptying and a reduction in nighttime frequency stood out. Moreover, detrusor overactivity was observed in 40 patients before the start of treatment and was eliminated in 31. The effective rate of this study was 69.7% (85/122). CONCLUSIONS: Naftopidil has novel effects in patients with BPH whose main complaints are storage and voiding symptoms, especially that of nocturia of >or=3 times, as well as in patients with a low compliance bladder and detrusor overactivity, who did not respond to tamsulosin.

Efficacy of interferential low frequency therapy for elderly wet overactive bladder patients.

OBJECTIVES: Examining the clinical efficacy on the interferential low frequency therapy (IF) for elderly nonneurogenic (idiopathic) overactive bladder patients with urgent urinary incontinence (wet OAB) prospectively, for whom anticholinergics were not effective. MATERIALS AND METHODS: Subjects are elderly 80 patients (69-78, median age 72.0) with urinary incontinence, who are clinically diagnosed with wet OAB without urodynamics (pressure/flow study). For 3 months, they were administered anticholinergics (propiverine hydrochloride 20 mg/once per day in the morning), but all their quality of life (QOL) score were 4 or over due to poor control of storage symptoms and urinary incontinence. We selected patients for whom anticholinergics were not effective (above-mentioned 80 patients) and they were provided with IF alone for 3 months with informed consent. Before and after IF, the followings were examined. (1) frequency of IF treatment required to show optimal effects, (2) average weekly frequency of incontinence, (3) 60-min pad test, (4) frequency and voided volume in the daytime and nighttime, (5) fluid intake volume, (6) International Prostate Symptom Score, quality of life score, (7) Uroflowmetry, (8) postvoid residual urine volume, (9) specific gravity of urine, (10) average hours spent outdoors, (11) average radius of action and activities of daily life score, (12) standing blood pressure (BP) and heart rate, (13) clinical laboratory findings, (14) adverse events, (15) plasma osmotic pressure (OP), and (16) Brain natriuretic peptide (BNP). RESULTS: (1) The patients showed improvements for eight treatments (median). Improvement was observed in the followings: (2), (3), (4) voiding frequency, (6), (7) voided volume, maximum and average flow rate, (10), (11), (12) BP, (15) OP, and (16). CONCLUSIONS: The IF has safe and better effects than anticholinergics on the elderly wet OAB patients.

[Efficacy on interferential low frequency therapy for elderly overactive bladder patients with urinary incontinence].

AIMS OF STUDY: Examining the clinical efficacy on the interferential low frequency therapy for elderly overactive bladder (OAB) patients with urinary incontinence prospectively, for whom anticholinergics were not effective. STUDY DESIGN, MATERIALS AND METHODS: Subjects are 80 patients over 65 years with urinary incontinence, who are clinically diagnosed with OAB. For over three months, they were administered anticholinergics (20mg/day propiverine hydrochloride), but in an interview after the administration period they responded that their QOL indexes were 4 (mostly dissatisfied) or over. After the anticholinergics had been washed out for over one week, the patients were provided with interferential low frequency therapy (IF) alone for three months using the Uromaster" (made by Nihon Medix Co.). Before and after IF, the following items were examined. 1) Frequency of IF treatment required to show optimal effects subjectively, 2) Average incontinence frequency in a week, 3) PAD test for 60 minutes, 4) Frequency and voided volume in the daytime and nighttime, 5) Fluid intake volume, 6) IPSS, QOL index, 7) UFM (voiding time, voided volume, Qmax, Qave), 8) PVR (postvoid residual urine), 9) Specific gravity of urine, 10) Average hours spent outside per day, 11) Average radius of action per day, ADL scale, 12) Blood pressure and pulse in the standing position, 13) Values of clinical examination, 14) Adverse events of IF., 15) Plasma osmotic pressure, 16) BNP (Brain natriuretic peptide). During the trial, no behavioral advice, including fluid intake advice, was provided to the patients. Before starting this study, all patients signed an informed consent agreement. RESULTS: 1) After a median of eight treatments of IF, the patients showed significant improvements subjectively and this effect continued. Improvement was observed in the following items. All these values showed [The mean value before IF]-->[The mean value after IF for three months], and statistically significant differences were identified between before and after IF in all these values (p< 0.0001 except nighttime voiding frequency [p = 0.0004]). 2) Incontinence frequency; 13.3-->3.6 times/week, 3) PAD test; 17.5-3.1gr., 4) daytime voiding frequency; 8.3-*7.0 times, nighttime voiding frequency; 1.8-->1.4 times, 6) IPSS; 12.1-->6.3, QOL index; 5.2-->2.4, 7) Voided volume; 170.2-->254.2ml, Qmax; 18.1 -->25.7ml/sec, Qave; 8.9-->12.1ml/sec, 10) Average hours spent outside; 1.5-->3.0hrs., 11) Average radius of action; 400-->1,200m, ADL scale; 8.0-->3.4, 12) Blood pressure in the standing position; 132.9/ 79.7-->127.1/74.7mmHg., 15) Plasma osmotic pressure; 295.1-->297.8 mOsm/1, 16) BNP; 41.3-->19.2 pg/ ml. Other items including clinical examination and pulse did not change much, while the adverse events of IF were not recognized. INTERPRETATION OF RESULTS: The results indicate the possibility that IF has safe and better effects than anticholinergics on the elderly OAB patients with urinary incontinence. It is clear that the OAB can significantly impair the QOL and reduce the ADL. By improving the urgent incontinence, the QOL will be improved and the physical activity may increase.

Study of low bladder volume measurement using 3-dimensional ultrasound scanning device: improvement in measurement accuracy through training when bladder volume is 150 ml or less.

PURPOSE: Using a Bladder Scan BVI6100 portable 3-dimensional ultrasound scanning device we examined measured values of bladder volume, especially focusing on volumes of 150 ml or less. MATERIALS AND METHODS: A total of 89 men and 71 women were enrolled in the study. We performed a comparison study between the measured value (the average of 3 bladder volume measurements after a trial in male and female modes) using the BVI6100 and the actual measured value determined by urethral catheterization in each patient. We examined factors that could increase the error rate and measuring techniques to decrease measurement errors. We also reviewed the training effects of measurement for a year. RESULTS: Actual measured values in all patients correlated well with the average value of 3 measurements after a trial of BVI6100 in male mode. The correlation coefficient was 0.941 (0.967 after a year), the mean +/- SD error rate was -2.0% +/- 22.0% (-2.0% +/- 13.8% after a year) and the average variation coefficient was 12.4 (7.6 after a year). It was found that measurement results using the BVI6100 were influenced by patient factors, including extracted edges between the bladder wall and urine, thickened bladder wall, irregular bladder wall, flattened bladder, mistaking the prostate for the bladder in male mode, mistaking the bladder for the uterus in female mode, etc, and examiner factors, including changes in the angle between the BVI6100 and the abdominal wall, compatibility between the abdominal wall and the ultrasound probe, controlling deflection while using the probe, etc. It was also found that measurement accuracy could be improved regarding patient and examiner factors by choosing appropriate patients and performing concise measurement procedures (training effects). CONCLUSIONS: When appropriate patients are chosen and proper measurement is performed, the BVI6100 provides significantly higher accuracy for determining lower bladder volume compared with existing abdominal ultrasound methods.

[Efficacy and problems of bladder volume measurement using portable three dimensional ultrasound scanning device--in particular, on measuring bladder volume lower than 100ml].

OBJECTIVES: Using a portable three dimensional ultrasound scanning device (The Bladder Scan BVI6100, Diagnostic Ultrasound Corporation), we examined measured values of bladder volume, especially focusing on volume lower than 100 ml. MATERIALS AND METHODS: A total of 100 patients (male: 66, female: 34) were enrolled in the study. We made a comparison study between the measured value (the average of three measurements of bladder urine volume after a trial in male and female modes) using BVI6100, and the actual measured value of the sample obtained by urethral catheterization in each patient. We examined the factors which could increase the error rate. We also introduced the effective techniques to reduce measurement errors. RESULTS: The actual measured values in all patients correlated well with the average value of three measurements after a trial in a male mode of the BVI6100. The correlation coefficient was 0.887, the error rate was--4.6 +/- 24.5%, and the average coefficient of variation was 15.2. It was observed that the measurement result using the BVI6100 is influenced by patient side factors (extracted edges between bladder wall and urine, thickened bladder wall, irregular bladder wall, flattened rate of bladder, mistaking prostate for bladder in male, mistaking bladder for uterus in a female mode, etc.) or examiner side factors (angle between BVI and abdominal wall, compatibility between abdominal wall and ultrasound probe, controlling deflection while using probe, etc). CONCLUSIONS: When appropriate patients are chosen and proper measurement is performed, BVI6100 provides significantly higher accuracy in determining bladder volume, compared with existing abdominal ultrasound methods. BVI6100 is a convenient and extremely effective device also for the measurement of bladder urine over 100 ml.

Usefulness of MR-seminography using Gd-DTPA in intermediate magnetic field MRI equipment.

T(2)-weighted fast advanced spin-echo imaging with gadolinium (hereinafter referred to as "MR-seminography") of the genital tract was evaluated for its usefulness in non-invasive investigation into the morphology of these organs. Twenty healthy male volunteers who are confirmed as free of genital tract obstruction were entered into the study. The genital tract was imaged using the 0.5 T MRI system by fast advanced spin echo (FASE) method. Based on quantitative evaluation, visibility evaluation, and the visualization of the genital tract in each subject, the contrast-enhanced images were assessed in comparison with those at pre-injection of the contrast agent by four specialists. Also examined were the morphology of the seminal vesicle according to age group using "Ishigami-Mori's classification," and the age angle of the main ducts. MR-seminography produced high contrast images and revealed a significantly decreased signal in the pelvic organs under investigation. In the analysis of individual subjects, the area from the proximal portion of the vas deferens to the ampulla and the seminal vesicles was on the whole well visualized except for the distal portion of the vas deferens and the ejaculatory duct. With regard to seminal vesicle morphology, type II was predominant. The age angle showed a trend toward widening with age. MR-seminography is non-invasive, useful, and therefore a highly recommended procedure for observation of the morphology in the area from the proximal portion of the vas deferens to the seminal vesicle.