High-energy transurethral microwave thermotherapy in patients with benign prostatic hyperplasia: comparative study between 30-and 60-minute single treatments.

We retrospectively evaluated the subjective and objective treatment results of transurethral microwave thermotherapy (TUMT) for benign prostatic hyperplasia (BPH) and explored the difference in effectiveness between 30- and 60-min single treatments. From June 1997 through March 2003, 58 men with BPH underwent TUMT using the Targis device. Twenty-seven and 31 patients each received a single treatment of 60 or 30 min, respectively. Evaluations after treatment included a clinical determination of the International Prostate Symptom Score, urodynamic assessments by peak flow rate, and magnetic resonance imaging (MRI). In the 60-min treatment, the symptom score improved significantly, from 17.9 to 9.5 after 2 months. Similarly, there was a significant improvement in peak flow rate, from 6.7 to 11.2 ml/sec after 2 months. In the 30-min treatment, the symptom score also improved significantly, from 18.4 to 13.4 after 2 weeks. Similarly, there was a significant improvement in the peak flow rate, from 6.4 to 11.7 ml/sec after 1 month. MRI imaging showed necrosis of the prostate gland 2 weeks after either treatment. These results demonstrated that both the 60-min and the 30-min treatments were effective for patients with BPH. Moreover, the 30-min treatment led to quicker improvement than the 60-min treatment. Thus, a 30-min TUMT protocol is considered recommendable for this treatment.</p

Laparoscopic radical prostatectomy: initial cases at Okayama University Hospital.

We performed laparoscopic prostatectomy in seven cases with organ-confined prostate cancer. In 6 cases, the surgery was completed successfully and the mean operative time was 424 min. Volume of blood loss was 200 to 3,200 ml and catheterization lasted 6 to 37 days. No major complications were observed in 6 of the cases. In one case, open surgical conversion was necessary mainly due to a bladder injury. Although these were the first cases of laparoscopic prostatectomy in our institution, the technical difficulty and complexity of the surgery were moderate. We believe that laparoscopic radical prostatectomy will become a standard option for the treatment of organ-confined prostate cancer.</p

Ureteroscopic Management of Chronic Unilateral Hematuria: A Single-Center Experience over 22 Years

OBJECTIVE: To analyze the short and long term safety and efficacy of ureteroscopic evaluation and management of chronic unilateral hematuria. METHODS: We retrospectively reviewed patients with chronic unilateral hematuria from 1987 to 2008. The distal to middle ureter was evaluated with a semi-rigid ureteroscope without a guidewire. Subsequently, the flexible ureteroscope was advanced into the upper ureter to the renal pelvis using a low-pressure automated irrigant system (Uromat™). Lesions identified ureteroscopically were treated with diathermy fulguration. RESULTS: One hundred and four (56 male, 48 female) patients were identified, with a median age of 37 (14-80) years and median follow-up of 139 (34-277) months. The median preoperative duration of gross hematuria was 5 (1-144) months. Endoscopic findings included 61 (56%) minute venous rupture (MVR; a venous bleeding without clear abnormalities), 21 (20%) hemangioma (vascular tumor-like structure), 3 (3%) varix (tortuous vein), 1 (1%) calculus and 18 (17%) no lesions. The incidence of "no lesions" was less in the recent 12 years (9%) than the first 10 years (27%), while the incidence of MVR increased from 40 to 66% (p<0.05). All patients were treated endoscopically. Immediate success rate was 96% (100% in the recent 12 years). Long-term recurrent gross hematuria rate was 7%. Six resolved spontaneously and only 1 required ureteroscopy, revealing a different bleeding site. CONCLUSION: Ureteroscopy and diathermy fulguration is highly useful for evaluation and treatment of chronic unilateral hematuria. Sophisticated technique and improved instrumentation contributes to a better outcome

Prostatic malacoplakia: a case report with a review of 49 cases of malacoplakia of various sites in Japan.

We reported a 62-year-old man with malacoplakia of the prostate, and reviewed 49 cases of malacoplakia hitherto observed in Japan in which the lesions originated from the urogenital tract, except for one gastric case. E. Coli was emphasized as a possible causative agent for malacoplakia especially in the urogenital tract. The possible histiocytic origin of von Hansemann cells was stressed by demonstrating cytoplasmic processes and desmosomes in our prostatic case. An adjuvant use of cholinergic agents and ascorbic acid with chemotherapeutic agents was recommended for treating malacoplakia.</p

A Clinical Trial Evaluating the Usefulness of Tailored Antimicrobial Prophylaxis Using Rectal-culture Screening Media Prior to Transrectal Prostate Biopsy: A Multicenter, Randomized Controlled Trial

The aim of this report is to introduce an on-going, multicenter, randomized controlled trial to evaluate whether tailored antimicrobial prophylaxis guided by rectal culture screening prevents acute bacterial prostatitis following transrectal prostate biopsy (TRPB). Patients will be randomized into an intervention or non-intervention group; tazobactam-piperacillin or levofloxacin will be prophylactically administered according to the results of rectal culture prior to TRPB in the intervention group whereas levofloxacin will be routinely given in the non-intervention group. The primary endpoint is the occurrence rate of acute bacterial prostatitis after TRPB. Recruitment begins in April, 2021 and the target total sample size is 5,100 participants

A clinical study on urolithiasis Ⅱ. The relationship of urinary tract infection to urolithiasis.

The relationship of urinary tract infection (UTI) to urolithiasis was studied in 1069 patients who were treated in the Department of Urology, Okayama University Hospital. Of 211 cases with known causative factors, 58 (27.5%) had UTI. The incidence of cloudy urine became higher with increasing age and was significantly higher in females with renal calculi than in males with renal calculi. The main organisms isolated from the urine were Pseudomonas, Staphylococcus, E. coli and Proteus. UTI, caluculi containing struvite, and proteus in the urine were fonud significantly more often in cases of stghorn caluculi than in cases of other renal calculi

A clinical study on urolithiasis I. Recent cases in the department of Urology, Okayama University Hospital.

During the 9-year period from 1972 to 1980, 1069 cases of urolithiasis were seen in the Department of Urology, Okayama University Hospital. The ratio of males to females was 2.1 to 1. The maximum incidence of urolithiasis occurred from the third to fifth decade. The overall recurrence rate was 26.7% , and most recurrence (62.1%) occurred 1-3 years following the removal of initial calculi. Concerning renal calculi, the incidence of residual calculi and postoperative recurrence was dependent on the shape and number of calculi rather than operative methods. Mixed calcium oxalate and phosphate calculi were found most frequently, and calculi containing struvite also were found frequently in females. The components of recurrent calculi were identical to those of initial calculi in most cases (72.8%)