Changes in prostate volume in Japanese patients with benign prostatic hyperplasia: Association with other urological measures and risk of surgical intervention

Objectives:   To evaluate changes in prostate volume (PV) and its association with selected urological measures and risk of surgical intervention in Japanese men with benign prostatic hyperplasia (BPH).
Methods:   The medical records of all consecutive urologist-diagnosed BPH patients of ≥40 years old who attended any of four urology clinics in Japan during January 2004–June 2006 were reviewed. Both cross-sectional and longitudinal data were captured to analyze baseline correlations among urological measures, to evaluate the longitudinal changes in PV and selected urological measures, and to examine the predictors of surgical intervention.
Results:   The follow-up period was 2.8 years. Mean PV and mean prostate-specific antigen (PSA) of 1331 eligible patients were 34.0 mL and 4.0 ng/mL, respectively. Both measures increased directly with age. Baseline PV correlated with residual urine volume (r = 0.18, P  < 0.05) and PSA (r = 0.41, P  < 0.001). Among 319 patients who had more than one PV measurement, PV increased in 51% of patients, remained the same in 28% and decreased in 21%. Use of α-blockers at baseline and during follow up was not associated with PV change. Patients who had a PV ≥30 mL, a severe International Prostate Symptom Score and a PSA level ≥1.5 ng/mL at baseline, were more likely to have surgical intervention during the follow-up period.
Conclusions:   Predictors generated in this study may help to identify a subset of BPH patients at high risk of surgical intervention.     

The aging males' symptoms scale for Japanese men: reliability and applicability of the Japanese version

We aimed to confirm the reliability of the Japanese version of the Aging Males' Symptoms rating scale (JPN-AMS) and its applicability in patients with testosterone deficiency syndrome (TDS)-like symptoms, comparing it for young, middle-aged and elderly Japanese men. The study included 93 patients with TDS-like symptoms, 39 men younger than 30 years old, and 125 normal men 40 years old and older, who agreed to respond to a self-administered questionnaire using the JPN-AMS. Testing-retesting was done to confirm the reliability of the questionnaire, with a 2-week interval between tests. The total AMS score and three domain scores were clearly higher in patients with TDS-like symptoms than in young men and in normal males, respectively. The test-retest analysis showed good reliability and internal consistency for the JPN-AMS. The JPN-AMS can be reliably used for measuring health-related quality of life of aging Japanese males.     

Surgical site infection by bacillus Calmette-Guerin (BCG) after radical cystectomy, occurring after intravesical bcg therapy: a case report

A 51-year-old man received 2 courses of intravesical bacillus Calmette-Guerin (BCG) therapy for carcinoma in situ of the bladder. Two years after the therapy, he underwent left radical nephroureterectomy, cystectomy, urethrectomy and construction of an ileal conduit because of left renal pelvic cancer and severe atrophic bladder. The histopathological diagnosis was carcinoma in situ of the left pelvis and ureter, and epithelioid cell granuloma of left kidney, prostate and bladder. After the operation, he developed extensive surgical site infection (SSI) by BCG, the diagnosis of which was delayed. He recovered from the SSI soon after anti-tuberculosis chemotherapy was begun. We discuss the requirements for more prompt diagnosis of SSI by BCG by analysis of this case.     

A case of neuroleptic malignant syndrome in a patient with hemodialysis

A 63-year-old man with chronic renal failure who had received hemodialysis three times per week for 4 years developed neuroleptic malignant syndrome 10 days after taking amoxapine. His condition was characterized by muscle rigidity, elevation of body temperature and altered consciousness. Although he was treated with dantrolen and supportive care as well as discontinuation of amoxapine, his condition rapidly deteriorated, resulting in death. Because the pharmacokinetics of drugs, especially those such as antidepressants, in patients with chronic renal failure has not been fully clarified, one should be careful about giving such patients these drugs.     

Minimally invasive transanal surgery for localized rectal carcinoid tumors

Local excision is often fully justified for rectal carcinoid tumors. However insufficient surgical field and difficult access to proximal tumors have been drawbacks in performing pre-existing local excision procedures. A novel local excisional technique called minimally invasive transanal surgery (MITAS) has been experimented for local removal of carcinoid tumors in the rectum. A specially designed anal retractor connected to the Octopus retractor holder was used and an ENDO-stapler allowed the simultaneous excision and anastomosis to be performed. Eight patients with carcinoid tumors in the rectum (4 tumors in the upper rectum) underwent MITAS. Median distance from anal verge to proximal tumor was 6.5 cm (range, 5–12 cm). The median diameter of the tumor was 9 mm. Median operative time was 18.5 minutes and blood loss was minimal. No analgesics were needed postoperatively, and there was no morbidity or mortality. Full-thickness excision of the rectum was accomplished and the tumors confined in the submucosa were demonstrated histologically to be with free surgical margins. No recurrences have been observed with a median follow-up period of 39 months. The technique facilitates total excisional biopsy for rectal carcinoid tumors and reduces operative time, blood loss and complications. Received: 10 January 2002 / Accepted in revised form: 28 January 2002     

Premalignancy of the mucosal polyp in the large intestine: II. Estimation of the periods required for malignant transformation of mucosal polyps

Conclusion The relationship between age of the patient and the histologic gradation of mucosal polyps (total 331 cases) and invasive carcinoma of the large intestine was studied in a surgical series (261 cases) as well as in an autopsy series (3,178 cases). The average ages of the patients increased steadily with the advance of histologic atypism from 40.7 years with grade I polyps to 58.7 years with invasive carcinoma in the autopsy series. From the differences in average ages of the patients, a provisional estimation of the periods which might be required for polyps of each grade to become malignant and to kill patients was attempted. The following figures were suggested; 3.6 years for polyps of grade V pseudostratification, 8.3 years for grade IV, 11.4 years for grade III, 13.1 years for grade II, and 18.0 years for grade I.