bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship between Grade of Varicocele and the Response to Varicocelectomy
Authors: Takahara Masanobu , Ichikawa Tomohiko , Shiseki Yoshio , Nakamura Takeshi , Shimazaki Jun 
Published: July 2007

Background: Although several studies indicate that larger varicoceles are associated with greater impairment of spermatogenesis, others suggest that the response to surgery is independent of varicocele size. In order to elucidate these seeming contradictions, correlations between the preoperative evaluation of varicoceles and improvement in semen quality after varicocelectomy were investigated.Methods: Forty men with left unilateral varicocele, followed for at least 6 months after varicocelectomy, were included in this study. The relationships between the grade of varicocele by palpation, Doppler examination, ultrasound, or scintigraphy were correlated with a postoperative improvement in sperm density or sperm motility.Results: Greater improvement in sperm density was observed in the patients with a large varicocele graded by palpation or measured by ultrasound, and greater improvement in sperm motility was observed in the patients with high uptake of radioactivity in the left side by scrotal scintigraphy.Conclusion: An improvement in semen quality after varicocelectomy is greater in patients with a large varicocele than in the patients with a small one. The significance of surgical repair of a small varicocele should be reconsidered.
Metenkephalin in Seminal Plasma of Infertile Men
Authors: Fujisawa Masato , Kanzaki Masanori , Okada Hiroshi , Arakawa Soichi , Kamidono Sadao 
Published: July 2007

Background: Enkephalin is one of the opioids, which is expressed widely in reproductive organs. However, the function of enkephalin in male reproduction is not completely understood. The effect of metenkephalin on sperm motility remains especially controversial. In this study we examined the level of metenkephalin in seminal plasma from men with normal sperm production and patients with asthenospermia, oligospermia, and azoospermia to investigate the role of metenkephalin in seminal plasma on sperm function. We also investigated the effect of metenkephalin on sperm motility in vitro.Methods: Sixty nine infertile patients (31 oligospermic, 21 asthenospermic, and 17 azoospermic) were included in this study. The level of metenkephalin in seminal plasma of these men was measured and the effect of the peptide on the motility of human sperm was examined in vitro. Seventeen men with normal seminograms were a control group.Results: The level of metenkephalin in the seminal plasma of semen from asthenospermic men was significantly lower than that from the controls (P< 0.05). No significant correlations between the level of metenkephalin and the mean pathing or progressive velocity of sperm, or serum hormone levels were observed. In the in vitro study, which used semen from the controls, treatment of sperm with metenkephalin (50–200 pg/mL) maintained sperm motility for 4 hours. On the other hand, motility of sperm incubated without metenkephalin began to decrease at 3 hours. Metenkephalin levels of 50 pg/mL in seminal plasma is considered to be necessary for maintaining sperm motility.Conclusion: These results suggest that metenkephalin in seminal plasma is an important clue in the investigation of decreased sperm motility.
The Protective Effect of Methylprednisolone against Cisplatin‐Induced Nephrotoxicity in Patients with Urothelial Tumors
Authors: Uozumi Jiro , Koikawa Yasuhiro , Yasumasu Tetsuo , Tokuda Noriaki , Kumazawa Joichi 
Published: July 2007

Background: Many attempts have been made to reduce the nephrotoxicity of the anticancer agent cisplatin but the number of clinically useful modalities is very limited. Our previous experiments demonstrated that in rats methylprednisolone significantly reduces the nephrotoxicity caused by cisplatin. The present clinical study was conducted to confirm the protective effects of methylprednisolone against cisplatin nephrotoxicity.Methods: Fourteen patients with urothelial tumors were injected with cisplatin according to the methotrexate, vinblastine, adriamycin, cisplatin (MVAC) therapy. Methylprednisolone was not administered during the first course of chemotherapy to provide a control, but was given in a dose of 2000 mg 2–3 hours before cisplatin during the second course of chemotherapy (treatment period) in each patient. Urinary excretion of N‐acetyl‐β‐D‐glucosarninidase (NAG) and γ‐glutamyltranspeptidase (CGTP), serum creatinine, and creatinine clearance (Ccr) were determined as indicators of the nephrotoxicity of cisplatin. Results were statistically analyzed by a paired t test to compare the nephrotoxic effects of cisplatin during the first course of chemotherapy (control period) with those during the second course of chemotherapy (treatment period).Results: Methylprednisolone did not significantly inhibit the elevation in urinary enzyme excretion or serum creatinine levels following the cisplatin injection. However, the Ccr level after cisplatin infusion in the treatment period was significantly highter than that observed in the control period.Conclusion: The protective effects of methylprednisolone against cisplatin nephrotoxicity were indicated in this prospective clinical study.
Transition Zone Ratio and Prostate‐Specific Antigen Density: The Index of Response of Benign Prostatic Hypertrophy to an Alpha Blocker
Authors: Kurita Yutaka , Ushiyama Tomomi , Suzuki Kazuo , Fujita Kimio , Kawabe Kazuki 
Published: July 2007

Background: The aim of the present study was to determine whether the indices of transrectal ultrasonography (TRUS) are related to the clinical response to tamsulosin, a long‐acting selectiveα1‐blocker.Methods: Sixty patients with symptomatic benign prostatic hypertrophy (BPH) were treated with tamsulosin hydrochloride (0.2mg/day) for 2 months. The findings on TRUS and uroflowmetry and the AUA symptom score before treatment were compared with those obtained at the end of the 2 month treatment period. For the indices of TRUS, transition zone (TZ) volume, transition zone ratio (TZ ratio = TZ volume/total prostate volume), total prostate volume, and prostate specific antigen density (PSAD) were calculated.Results: There was a significant correlation between the pretreatment TZ ratio and the residual urine volume (r= 0.421, P= 0.0005). Patients with a lower TZ ratio and/or PSAD responded well to the treatment. The correlation between the PSAD value and the percent change in peak urinary flow rate was statistically significant (r= ‐0.432, P = 0.0009).Conclusion: TRUS provides simple parameters of PSAD that can be used to predict the response of patients to tamsulosin hydrochloride.
Clinical Applicability of a New Tactile Sensor for Evaluating Rigidity of the Penis: A Comparative Study with Rigiscan
Authors: Kaneko Shigeo , Mizunaga Mitsuhiro , Yachiku Sunao , Yamaguchi Osamu , Omata Sadao 
Published: July 2007

Background: A new tactile sensor was developed for detecting hardness of living tissue by Omata et al. in 1992. This paper reports applicability of the sensor for evaluation of penile rigidity.Methods: Nine patients from a group of 12 patients with penile erectile dysfunction were selected as subjects of this study. All patients agreed to artificial erection and monitoring of penile rigidity by a new tactile sensor and the Rigiscan system. The 9 patients selected all developed more than 1 cm circumferential expansion of the penis after an injection of smooth muscle relaxant into the corpus cavernosum.The sensor equipment consisted of a piezoelectric element that vibrated, and a pickup that detected vibration frequency. When the end of the sensor was pressed against a surface of the penis, the resonance frequency of the sensor changed and indicated rigidity of the organ. Rigidity of the penile shaft was simultaneously monitored with the sensor and the Rigiscan system before and after an injection of 40mg papaverine or 20μg prostaglandin E1. The sensor's measurements of rigidity were compared with those of Rigiscan.Results: Reproducibility of rigidity measured with the tactile sensor was satisfactory. Statistical analysis was made on 85 simultaneous pairs of rigidity values from the tactile sensor and Rigiscan. The analysis indicated significant correlation between the values.Conclusion: The tactile sensor as well as Rigiscan will be of use for evaluating rigidity of the penis.
Comparison of the Equil2 Program and Other Methods for Estimating the Ion‐Activity Product of Urinary Calcium Oxalate: A New Simplified Method Is Proposed
Authors: Ogawa Yoshihide , Hatano Tadashi 
Published: July 2007

Background: We aimed to develop a new simplified method to determine the urinary calcium‐oxalate saturation.Methods: The ion‐activity product (AP) of urinary calcium oxalate was estimated in 345 clinical urine specimens (all 2.5 hour collections) using the Equil2 computer program and several other methods, and the results were compared. A new index using 4 parameters was created using multiple regression analysis.Results: Our new simplified method (the AP(CaOx) index EQ2) provided a better approximation to the Equil2 method (r= 0.9897) than other conventional methods.Conclusion: This new method requiring 4 factors (urinary calcium, magnesium, oxalate, and citrate concentrations) is simple and clinically usable.
Effect of Surgical Stress on Immune Function in Patients with Urologic Cancer
Authors: Mizutani Youichi , Terachi Toshiro , Okada Yusaku , Yoshida Osamu 
Published: July 2007

Background: To determine the immunosuppressive effect of surgery for urologic cancers, multiple variables of immune function were measured serially before and after operation in patients with urologic cancer. Methods: Peripheral blood was obtained before operation and at postoperative day 7 and 14 from 20 patients with bladder cancer, renal pelvic, or ureteral cancer, or renal cell carcinoma. Results: In patients with bladder cancer who were undergoing radical cystectomy with use of intestine for urinary diversion, the serum level of immunosuppressive acidic protein (IAP) increased, and serum levels of immunoglobulin (Ig)A, IgG, and IgM decreased after operation. In contrast, the number of CD25+ lymphocytes significantly increased. Transurethral resection of bladder cancer also resulted in an increase in serum IAP level, however, the number of CD4+ and human leukocyte‐associated HLA‐DR+ lymphocytes increased. In patients with renal pelvic or ureteral cancer undergoing nephroureterectomy with cuff, the level of serum IAP increased and serum IgG level decreased after operation. By contrast, the number of CD3+ lymphocytes increased. In patients with renal cell carcinoma, radical nephrectomy led to a significant increase in the number of CD8+ lymphocytes. Conclusions: These findings suggest that surgical stress in patients with urologic cancer may result in both suppression and stimulation of host immunity.
Bladder Dysfunction in Patients with Benign Prostatic Hyperplasia: Relevance of Cystometry as Prognostic Indicator of the Outcome after Prostatectomy
Authors: Akino Hironobu , Gobara Masaru , Okada Kenichiro 
Published: July 2007

Background: We correlated cystometric findings to the clinical features of benign prostatic hyperplasia (BPH) and compared them in terms of outcome after prostatectomy. Methods: Cystometric findings obtained from 78 patients who underwent prostatectomy were correlated with clinical features in BPH patients. In 41 consecutive patients of this group, prospective periodical cystometry was also performed. Results: Low bladder compliance correlated significantly with an increase in age and prostate volume, detrusor instability and impaired contractility. Low compliance also correlated with irritative symptoms, decreased maximum flow rate, increased post‐void residual urine and an increase in the American Urological Association symptom score. Postoperative persistent incontinence was associated with low bladder compliance and detrusor instability. In a prospective study, bladder dysfunction was not completely restored in 53% of patients examined at a mean interval of 7.7 months after prostatectomy. Conclusions: Among the cystometric parameters investigated, low compliance was the most relevant to the clinical features of BPH and had some predictive value for the outcome after prostatectomy. In about half of the BPH patients with bladder dysfunction preoperatively, this condition was irreversible for a significant period of time after prostatectomy, in spite of surgical relief of the infravesical obstruction.
Recommended Dose of Flutamide with LH‐RH Agonist Therapy in Patients with Advanced Prostate Cancer
Authors: Akaza Hideyuki , Isaka Shigeo , Usami Michiyuki , Kanetake Hiroshi , Kotake Toshihiko , Koiso Kenkichi , Aso Yoshio 
Published: July 2007

Background: In a recent study by the Casodex Combination Study Group, USA, patients in a flutamide (750mg/day) plus LH‐RH agonist group showed a high treatment failure rate, mainly due to flutamide‐induced diarrhea and hepatotoxicity. Our current study was conducted to determine the optimal dose of flutamide for use in this type of Combination therapy. Methods: In a randomized, multicenter study, 30 patients (hormone untreated; stage C or D) were divided into 2 groups: flutamide 250mg (125mg × 2; 14 patients) and flutamide 375mg (125mg × 3; 16 patients), and each dose combined with either goserelin acetate (3.6 mg every 4 weeks) or leuprolide acetate (3.75 mg every 4 weeks). Goserelin and leuprolide were administered to patients in a 1:1 ratio. Flutamide monotherapy at a daily dose of 375 mg was determined to be the optimal dose in Japan in our previous phase II study. The endpoints of this pilot study were the objective response and adverse events during the 12‐week treatment. Results: The objective response rate was 83.3% in the flutamide 250mg group and 85.7% in the flutamide 375 mg group according to the Japanese response criteria for prostate cancer. Elevated PSA levels fell to within the normal range in 83.3% of the patients in the former group and in 93.3% of the patients in the latter group. One patient administered 250 mg of flutamide experienced diarrhea, while the serum GOT and/or GPT were elevated in 3 patients administered 250 mg of flutamide and 4 patients administered 375 mg of flutamide. Conclusions: Based on the findings of this pilot study of maximal androgen‐depletion therapy for advanced prostate cancer, 375mg/day of flutamide is recommended in combination with an LH‐RH agonist. Assessment of the effects of our recommended regimen on longer term survival, quality of life and antiandrogen withdrawal syndrome of patients treated requires additional patients and time for foIIow‐up.
Urinary Reconstruction Using Appendix as a Urinary and Catheterizable Conduit in 12 Patients
Authors: Okada Yusaku , Ogura Keiji , Ueda Tomohiro , Kakehi Yoshiyuki , Terachi Toshiro , Arai Yoichi , Takeuchi Hideo , Yoshida Osamu 
Published: July 2007

Background The appendix vermiformis can. provide an excellent urinary conduit or a catheterizable outlet in continent urinary reservoirs in selected cases. We report our clinical experience using the appendix in urinary reconstruction in adult patients. Methods A total of 12 patients underwent urinary reconstruction using the appendix. The indications were pelvic malignancies except for 1 patient with neurogenic bladder and difficulty in self‐catheterization via urethra. The appendix was used as a catheterizable conduit in 8 patients, and as a urinary conduit in 4 patients. The in situ submucosally embedded method was used in 6 patients and the Mitrofanoff method was used in 2 patients. Follow‐up ranged from 3 to 41 months (mean, 22). Results Early complications occurred in 3 patients (wound infection, false passage and intestinal anasotomotic leak). Late complications occurred in 3 (slight hydronephrosis, ileus, stomal stenosis). Emergent colostomy and pouchstomy with resection of the appendix was performed in the patient with anastomotic leak. The isoperistaltic Kock nipple valve was reconstructed for continence in this case. Prolonged ileus in 1 patient was treated by open surgery. Other complications were managed conservatively. End results were excellent in 8 patients, good in 3, and poor in 1. Conclusions The appendix can be used advantageously as an outlet of continent urinary reservoirs or for a urinary conduit when the ureter is too short to reach the skin. Complete continence and easy catheterization can be obtained, and the appendix construction can be used as a urinary conduit instead of the ileal conduit in poor risk patients.
Vitamin B12 Deficiency in Patients with Urinary Intestinal Diversion
Authors: Terai Akito , Okada Yusaku , Shichiri Yasumasa , Kakehi Yoshiyuki , Terachi Toshiro , Arai Yoichi , Yoshida Osamu 
Published: July 2007

Background Because vitamin B12 is absorbed exclusively by the terminal ileum, we investigated vitamin B12 deficiency as a potential metabolic complication after urinary intestinal diversion. Methods We measured serum levels in patients with Kock pouches (n = 35); Indiana pouches (n = 27); and ileal conduits (n = 25). Serial determinations of serum B12 levels were obtained in 1 9 patients with Kock pouches and 14 patients with Indiana pouches. The dual‐isotope Schilling test was performed in 9 patients with Kock pouches and 6 patients with Indiana pouches. Results No patient had an abnormally low serum B12 level (< 200 pg/mL). Mean (+ SD) serum B12 levels in patients with the Kock pouch (506 ± 202pg/mL) and the Indiana pouch (536 + 249pg/mL) were lower than that in patients with the ileal conduit (727 + 391 pg/mL). The mean serum B,2 level was not significantly different between patients with and without preoperative irradiation. Serial determinations showed that serum B12 levels in some patients with continent urinary reservoirs were persistently near the lower normal limit, or became progressively lower. Three of the 9 patients (33%) with Kock pouches and 4 of the 6 patients (67%) with Indiana pouches were B12 malabsorbers, although no patients had megaloblastic anemia or neurologic symptoms. Conclusions Some patients with continent urinary reservoirs are at risk for vitamin B12 deficiency due to malabsorption. Routine evaluation of serum B12 levels is recommended for all patients with continent urinary reservoirs, and a Schilling test for those with subnormal serum B12 levels.
Quality of Life Survey of Urinary Diversion Patients: Comparison of Continent Urinary Diversion Versus Ileal Conduit
Authors: Okada Yusaku , Oishi Kenji , Shichiri Yasumasa , Kakehi Yoshiyuki , Hamaguchi Akikazu , Tomoyoshi Tadao , Yoshida Osamu 
Published: July 2007

Background Continent urinary reservoirs (CUR) have become one of the major options for patients requiring urinary diversion to improve their quality of life (QOL). To assess whether CUR enhanced postoperative QOL, we surveyed patients with CUR and ileal conduit (IC) using a questionnaire sent by mail. Patients and Methods The questionnaire consisted of 133 questions that covered physical and mental status, social life, sexual habits and symptoms related to urinary diversions. A total of 1 72 questionnaires were sent out, and 137 (80%) patients (74 CUR and 63 IC patients) responded. Results Basic physical conditions were similar in the 2 groups, except for sleeping habits. Regarding social life, however, the CUR group showed better scores in bathing habits and frequency of overnight travel. Parasternal dermatitis was more frequent in the IC group and the patients were more hesitant to show their stoma to others. On the other hand, about half of the patients in the CUR group complained of troublesomeness in self‐catheterization, especially at night. Overall, 74% and 41% of the patients in the CUR and IC group were satisfied with their urinary diversion. When the Kock pouch and Indiana pouch were compared, no statistically significant differences were found in average capacity, maximum capacity, or frequency of self‐catheterization. Conclusions CUR recipients have enhanced QOL regarding the stoma, travel and sleeping habits as compared to ileal conduit. However, troublesomeness of night time self‐catheterization was noted in the CUR group. Individualized selection of the type of urinary diversion with informed consent is essential.
Feasibility of Urodynamic Study (Combined Cystometry and Electromyography of the External Urethral Sphincter) under General Anesthesia in Children
Authors: Ameda Kaname , Kakizaki Hidehiro , Yamashita Tetsufumi , Nonomura Katsuya , Shinno Yuichiro , Kemmotsu Osamu , Koyanagi Tomohiko 
Published: July 2007

Background To assess the feasibility of urodynamic study under general anesthesia (GA) we performed electromyography of the external urethral sphincter (EUS‐EMG) on 73 children and cystometry (CM) alone on 10 children. Methods Subjects were divided into 3 groups. Those in groups I and II were suspected of having voiding dysfunction with (group I) or without (group II) overt neurospinal defects, while those in group III were thought to be functionally normal. EUS‐EMG was performed under light anesthesia following cystourethroscopy to examine structural abnormalities. Atropine sulfate premedication was not used for the anesthetic procedure; muscle relaxants were used only for tracheal intubation. Results Voiding was observed in 83% of the patients. Among patients who voided, detrusor‐external sphincter dyssynergia (DSD) was noted in 7 (38%) group I patients and 6 (19%) group II patients; in group III, voiding was synergic in all patients. In 10 cases, CM alone was carried out both under anesthesia and in the waking state; anesthesia suppressed detrusor hyperreflexia (DH) in all 9 patients but produced no change in bladder compliance. Conclusions In children with urinary disorders, urodynamic study under GA following cystourethroscopy is a feasible method for assessing EUS function and documenting DSD; DH is not evaluable, however. Stratifying urinary management on the basis of these examinations resulted in satisfactory clinical outcomes.
Cisplatin, Vincristine, Methotrexate, Peplomycin, Etoposide (COMPE) Therapy for Disseminated Germ Cell Testicular Tumors
Authors: Yoshimura Koji , Yamauchi Tamio , Maeda Hiroshi 
Published: July 2007

Background The advent of cisplatin rendered disseminated testicular germ cell tumor an often curable malignant disease. Patients with a heavy metastatic burden, however, remain poor risks; furthermore, many patients experience nausea or other adverse events. This paper reports a trial of a cisplatin‐based (COMPE) combination chemotherapy regimen based on synchronization theory. Methods Twenty patients with disseminated germ cell testicular tumors were treated with COMPE; any residual tumor mass was surgically resected. Results Seventeen patients (85%) achieved complete remission by chemotherapy. The actuarial overall and cause‐specific 3‐year survival rates were 89% and 94%, respectively. In the subset of 16 “good‐risk” patients, all remain alive after a median follow‐up of 43 months. Complications were quite tolerable, with nephrotoxicity in particular being extremely mild. Conclusion COMPE is an effective chemotherapy regimen in patients with disseminated germ cell testicular tumors. Complications arising from this therapy are mild.