女性過活動膀胱に対する牛車腎気丸の安全性と治療効果

過活動膀胱の日本人女性に対する牛車腎気丸の安全性, 効果を, 西洋医学的アプローチでプロスペクティブに評価することを目的とした。44例(平均68歳)に牛車腎気丸を8週間投与し, 排尿回数, IPSS, IPSS-QOL, 残尿を評価。昼間排尿回数は有意に減少し, IPSSも有意に低下した。IPSS-QOLによる効果判定では著効, 有効, 不変, 悪化が7, 46, 41, 7%であった。副作用は9%であった。牛車腎気丸は安全で有用な治療オプションの1つとなりうることが期待される。(著者抄録)The efficacy and tolerability of a single-agent treatment with 7.5 g/day Gosha-jinki-gan in Japanese females with overactive bladder were analyzed objectively with linguistically validated questionnaires. A total of 44 Japanese females diagnosed as having overactive bladder were enrolled. Before and after the treatment, urinary frequency during the daytime and sleep was counted for two days, and the International Prostate Symptom Score index scores and quality of life index scores were examined. The efficacy assessment was done by comparing the quality of life index scores. The total scores of International Prostate Symptom Score, quality of life index scores and urinary frequency during the daytime and sleep were significantly decreased, respectively. Objective evaluation with the quality of life questionnaire yielded a result of excellent in 7%, improved in 46%, unchanged in 41% and worsened in 7%. Adverse reactions were observed in 9%. Gosha-jinki-gan could be a safe and effective potential therapeutic alternative in females with overactive bladder

本邦中学生の過活動膀胱, 夜尿症に関する疫学調査

広島県内の2つの中学校に在籍する全生徒624名を対象に, 排尿症状に関する匿名アンケート調査を施行した.質問事項は年齢, 性別, 既往歴, 排尿症状および排便症状で, 過活動膀胱(OAB)は頻尿(昼間8回以上)または切迫性尿失禁(月1回以上)と定義した.その結果, 1)回答率は32.4%で, 平均昼間排尿回数5.0±2.2回(2～14回), 頻尿10.4%, 夜間頻尿4.0%であった. 2)OAB, 夜尿症の罹患率は各々15.3%(95%信頼区間10.4～20.3%), 3.0%(95%信頼区間0.65～5.4%)でいずれも年齢とともに減少していた. 3)OABの19.4%に夜間頻尿を認めたTo assess the prevalence of overactive bladder (OAB) and nocturnal enuresis (NE) in early adolescents, we distributed an anonymous questionnaire about urinary symptoms to 624 middle school students aged 13 and 15 years. The questionnaire included items regarding age, gender, past and present diseases, urinary symptoms and bowel habits. OAB was defined as symptoms of increased daytime frequency occurring more than eight times during the daytime and/or urge incontinence occurring at least once a month. The overall response rate to the questionnaire was 32.4%, and the mean age +/- SD of all respondents was 13.9 +/- 0.89 years. The prevalence of OAB was 15.3% of all respondents (95% CI, 10.4-20.3%; 4.2-16.1% of boys and 12.5-28.3% of girls). The prevalence of OAB decreased with age from 17.6% of respondents aged 13-year-olds to 11.8% of 15-year-olds. The mean daytime frequency was 5.0 +/- 2.2 times. Increased daytime frequency was found in 10.4% (95% CI, 6.2-14.6%; 2.7-13.5% of boys and 6.1-19.0% of girls) and nocturia in 4.0% (95% CI, 1.3-6.7%). The prevalence of NE was 3.0% (95% CI, 0.65-5.4%; three boys and three girls). The results of this study demonstrate that some early adolescents had OAB or NE. Further large-scale studies would be required to investigate the prevalence and natural history of OAB and NE

Needlescopic-assisted laparoendoscopic single-site adrenalectomy

Our objective was to compare the perioperative parameters of needle-assisted and conventional laparoendoscopic single-site adrenalectomy (LESS-A). We compared 23 patients undergoing needle-assisted LESS-A with 29 patients undergoing conventional LESS-A at Hiroshima University Hospital between November 2009 and February 2014. Needle-assisted LESS-A was performed using a MiniLap instrument (Stryker, San Jose, CA, USA). We used this instrument to protectively retract the liver at the right side of the tumor and the spleen at the left side by grasping with a Securea endoscopic surgical spacer (Hogy Medical Co., Ltd., Tokyo, Japan). Various parameters including insufflation time, estimated blood loss, pain scale, resumption of oral intake, transfusion rate, and complications were analyzed using the Mann–Whitney U test. In all cases, LESS-A was completed successfully with no major intraoperative complications. Patients in both treatment groups had similar age, body mass index, sex, and laterality. Significantly, needle-assisted LESS-A was performed using the transumbilical approach rather than the subcostal approach. The insufflation time of the needle-assisted LESS-A was shorter than that of the conventional LESS-A (p = 0.0335). No patients required intraoperative or postoperative blood transfusions. Retrospective design and the small sample size are main limitations of this study. Needle-assisted LESS-A was performed safely and in a manner that mitigated many of the difficulties of LESS surgery

Needlescopic-assisted laparoendoscopic single-site adrenalectomy

Objective: Our objective was to compare the perioperative parameters of needle-assisted and conventional laparoendoscopic single-site adrenalectomy (LESS-A). Methods: We compared 23 patients undergoing needle-assisted LESS-A with 29 patients undergoing conventional LESS-A at Hiroshima University Hospital between November 2009 and February 2014. Needle-assisted LESS-A was performed using a MiniLap instrument (Stryker, San Jose, CA, USA). We used this instrument to protectively retract the liver at the right side of the tumor and the spleen at the left side by grasping with a Securea endoscopic surgical spacer (Hogy Medical Co., Ltd., Tokyo, Japan). Various parameters including insufflation time, estimated blood loss, pain scale, resumption of oral intake, transfusion rate, and complications were analyzed using the Mann–Whitney U test. Results: In all cases, LESS-A was completed successfully with no major intraoperative complications. Patients in both treatment groups had similar age, body mass index, sex, and laterality. Significantly, needle-assisted LESS-A was performed using the transumbilical approach rather than the subcostal approach. The insufflation time of the needle-assisted LESS-A was shorter than that of the conventional LESS-A (p = 0.0335). No patients required intraoperative or postoperative blood transfusions. Retrospective design and the small sample size are main limitations of this study. Conclusion: Needle-assisted LESS-A was performed safely and in a manner that mitigated many of the difficulties of LESS surgery

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

Aims: To elucidate the pathophysiology of congenital obstruction of the anterior urethra and to investigate the association between anterior urethral valves and syringocele. Methods: Three boys with congenital obstruction of the anterior urethra diagnosed at our department between 1997 and 2004 were analyzed retrospectively. Results: All of the three boys had congenital obstruction in bulbar urethra. The presenting symptom and age of each patient were varied. Whereas continuity between Cowper's duct and the diverticulum was not demonstrated radiographically in all boys, it was speculated endoscopically in all. Conclusion: 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