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Biomedical subjects

Akito Terai

Publications and source records attributed to Akito Terai.

At least 37 records · Page 2Linked to original sources
PubMed2005

Risk stratification after radical prostatectomy in men with pathologically organ-confined prostate cancer using volume-weighted mean nuclear volume.

OBJECTIVE: We examined the impact of volume-weighted mean nuclear volume (MNV) on biochemical failure after radical prostatectomy (RP) in pathologically organ-confined prostate cancer (PC) and developed a prognostic factor-based stratification model for these patients. PATIENTS AND METHODS: We analyzed 141 patients with pathologically organ-confined PC treated solely with RP. Unbiased estimates of MNV were calculated from biopsy specimens based on a stereological method, and compared with other clinical and pathologic findings including patient age, pre-treatment PSA, biopsy and RP specimen Gleason score, pathologic stage, total cancer volume, index cancer volume, tumor differentiation, number of tumor foci, main tumor location, and surgical margin status, with regard to prediction of disease outcome after RP using Cox proportional hazard models. RESULTS: The median follow-up was 38.6 months (range 4--119 months). Twenty patients (14.2%) experienced biochemical failure. On multivariate analysis, MNV was demonstrated to be an independent prognostic factor, along with pre-treatment PSA and total cancer volume (P=0.0004, 0.0184, and 0.0285, respectively). All patients were stratified into three groups according to their prognostic scores developed on the basis of multivariate analysis, with statistically significant prognostic differences revealed for each of the between-group comparisons. CONCLUSION: The results demonstrated that estimates of MNV contribute most significantly to the prediction of biochemical control of pathologically organ-confined PC. The combination of MNV with other independent predictors such as pre-treatment PSA and total cancer volume provided a statistically verifiable basis for risk stratification, facilitating more accurate prediction of disease outcome.

Aged↗
PubMed2005

Use of complementary and alternative medicine by patients with urologic cancer: a prospective study at a single Japanese institution.

OBJECTIVES: We prospectively evaluated the prevalence and predictors of complementary medicine (CAM) use among Japanese patients with urologic cancer 1 year after diagnosis. PATIENTS AND METHODS: A total of 349 patients with newly diagnosed urologic cancer answered a self-administered questionnaire on CAM use 1 year after diagnosis. General-health-related quality of life (GHQL) of the patients was also assessed at diagnosis and 1 year after diagnosis using the Medical Outcome Study Short Form-36 (SF-36). The overall prevalence, types of CAM used, and costs of CAM were assessed. The effects of several variables including GHQL at baseline and 1 year after treatment on the prevalence of use of CAM were evaluated. RESULTS: A total of 164 respondents (47%) admitted using some type of CAM, of which 73 (45%) had used multiple types. "Health food," in particular extract from Agaricus blazei, was the most common type of CAM used. CAM users had significantly lower scores for social function, general health perception, and vitality domains than CAM non-users 1 year after diagnosis. This tendency was more marked in users of multiple types of CAM. CONCLUSIONS: "Health food," including extract from A. blazei, was the most commonly used CAM in Japan. The prevalence of CAM use did not differ between patients with prostate cancer and those with urologic cancer other than prostate cancer. CAM users, especially those who used multiple types of CAM, had lower GHQL scores than non-users of CAM.

Adult↗
PubMed2005

Paracentric inversion of chromosome 7(q22-31) associated with nonobstructive azoospermia.

OBJECTIVE: To examine an unusual paracentric inversion of chromosome 7 found in an azoospermic man. DESIGN: Case report. SETTING: Infertility clinic at a private hospital. PATIENT(S): An azoospermic but otherwise apparently healthy man. INTERVENTION(S): Karyotyping with peripheral blood lymphocytes, microdissection testicular sperm extraction (TESE), and intracytoplasmic sperm injection (ICSI). MAIN OUTCOME MEASURE(S): Sperm count and GBG banding. RESULTS: A karyogram revealed paracentric inversion of chromosome 7 with breakpoints at 7q22 and 7q31. Testicular histopathology confirmed the Sertoli cell-only syndrome. Successful pregnancy and delivery were achieved with microdissection TESE and ICSI. CONCLUSION(S): Paracentric inversion of chromosome 7(q22-31) associated with nonobstructive azoospermia is rare. Chromosome 7q22-31 may be responsible for impaired spermatogenesis.

Adult↗
PubMed2005

Risk factors for subsequent development of bladder cancer after primary transitional cell carcinoma of the upper urinary tract.

OBJECTIVES: To determine the independent risk factors for intravesical tumor recurrence in patients with primary transitional cell carcinoma of the upper urinary tract, and to develop a risk-stratification model to allow more accurate prediction of recurrence risk. METHODS: Of 141 patients who underwent total nephroureterectomy for clinically localized transitional cell carcinoma of the upper urinary tract, the data from 89 patients were retrospectively reviewed. Patients with a previous history or concomitance of bladder cancer and/or a follow-up period of less than 1 year were excluded from this study. Multivariate analysis by Cox's proportional hazards model was used to determine independent risk factors for intravesical tumor recurrence. RESULTS: Of 89 patients, 37 (41.6%) experienced subsequent intravesical tumor recurrence during a median follow-up period of 39.7 months (range 12.0 to 186.6). On multivariate analysis, tumor multiplicity, pathologic stage, tumor size, and surgical modality had a statistically significant impact on the risk of intravesical tumor recurrence (P = 0.0075, P = 0.0221, P = 0.0377, and P = 0.0413, respectively). Pathologic stage and tumor size were inversely correlated to the risk. A scoring system for the risk of intravesical recurrence was developed from the proposed prognostic factors, and the patients were stratified into three groups according to their scores, with statistically significant prognostic differences between them (P = 0.0018). CONCLUSIONS: Tumor multiplicity, pathologic stage, tumor size, and surgical modality all had a significant impact on the incidence of intravesical tumor recurrence. A risk stratification model constructed from tumor biologic factors may be useful in the follow-up of patients with transitional cell carcinoma of the upper urinary tract.

Aged↗
PubMed2005

Impact of superficial bladder cancer and transurethral resection on general health-related quality of life: an SF-36 survey.

OBJECTIVES: To assess the general health-related quality of life (GHQOL) of patients with superficial bladder cancer who underwent transurethral resection (TUR). METHODS: We assessed the GHQOL a total of 178 times for 133 patients with superficial bladder cancer before multiple TURs. The GHQOL was assessed using the Medical Outcome Study Short-Form 36-item survey (SF-36). Ninety-three patients answered the questionnaire at the first TUR, 34 at the second TUR, 17 at the third TUR, and 34 at the fourth or later TUR. RESULTS: Compared with age-matched and sex-matched Japanese norms, the general health perception was severely impaired in patients with superficial bladder cancer. Their mental health was also severely impaired at the first TUR, but gradually returned to normal as TUR was repeated. The scores of physical functioning, social functioning, and role-emotional demonstrated a nadir at the second or third TUR, and increased thereafter if TUR was repeated four or more times. Intravesical treatment for prevention of recurrence increased the score of bodily pain. CONCLUSIONS: Although superficial bladder cancer is not frequently lethal, patients with this disease believed their general health was much impaired. Only two domains of bodily pain and vitality had no negative impact from this disease. As urologists, we should notice the considerable affect of superficial bladder cancer on the GHQOL of patients.

Aged↗
PubMed2005

Recovery of quality of life in year after laparoscopic or retropubic radical prostatectomy: a multi-institutional longitudinal study.

OBJECTIVES: To compare the general and disease-specific health-related quality of life (HRQOL) after laparoscopic radical prostatectomy (LRP) with that after retropubic radical prostatectomy (RRP). METHODS: A total of 45 patients who underwent LRP alone and 121 who underwent RRP alone were prospectively enrolled in an HRQOL survey. We measured the general and disease-specific HRQOL with the Medical Outcomes Study 36-Item Short Form and University of California, Los Angeles, Prostate Cancer Index, respectively. The participants were asked to complete the questionnaires before and 1, 3, 6, and 12 months after surgery. RESULTS: No significant differences were found in the preoperative characteristics of the two groups. Repeated measures of analyses of variance revealed significantly different patterns of alteration in the several general HRQOL domains between the RRP and LRP groups. The LRP group tended to have a more delayed recovery than the RRP group in the domain of urinary function and bother. The sexual function and bother of both groups showed a substantially lower score throughout the postoperative period. When the LRP group was divided into two groups according to the surgical period, an apparent improvement in HRQOL was observed in the most recent LRP series. CONCLUSIONS: The two approaches showed different patterns of alteration regarding general HRQOL for 1 year after surgery. The LRP group reported delayed recovery of urinary and sexual function, which seemed to affect their general HRQOL. LRP appears to be still an evolving procedure.

Aged↗
PubMed2005

Use of acute normovolemic hemodilution in patients undergoing radical prostatectomy.

OBJECTIVES: To evaluate the efficacy and safety of acute normovolemic hemodilution (ANH) in patients undergoing radical prostatectomy. Preoperative autologous blood donation (PAD) is widely accepted as a means of reducing the need for allogeneic blood transfusion in radical prostatectomy. ANH is an alternative method for obtaining autologous blood. METHODS: On the basis of our previous report that showed the equivalence of PAD and ANH, we prospectively replaced PAD with ANH as a standard practice for radical prostatectomy after September 1999. Of 174 radical prostatectomy patients between September 1999 and June 2004, 153 underwent ANH alone, 15 chose to receive both PAD and ANH, and ANH was contraindicated in 15 because of comorbidities. RESULTS: For the 153 patients undergoing ANH alone, 1032 +/- 201 mL of autologous blood was collected. With an intraoperative blood loss of 1602 +/- 926 mL, 14 patients (9.2%) received allogeneic blood transfusion. The preoperative, intraoperative nadir, and postoperative hematocrit value was 43.6% +/- 3.4%, 25.8% +/- 3.8%, and 31.9% +/- 4.3%, respectively. No patient experienced a perioperative adverse event related to hemodilution or blood transfusion. CONCLUSIONS: Our continued experience has shown that ANH is a safe and effective means of autologous blood procurement. Given its advantages, including lower cost, lower risk, and simplicity, we conclude that ANH can replace conventional PAD for use in radical prostatectomy, although the true value of ANH should be determined by future randomized studies including a no-treatment control group.

Aged↗
PubMed2005

Adverse effect of radical prostatectomy on nocturia and voiding frequency symptoms.

OBJECTIVES: To evaluate the impact of retropubic radical prostatectomy (RP) on urinary incontinence and obstructive/irritative urinary symptoms, according to global self-assessment instruments. METHODS: Self-report assessments were provided by 120 patients who underwent RP alone. The University of California, Los Angeles Prostate Cancer Index (UCLA PCI), the International Prostate Symptom Score (IPSS), and the IPSS quality of life (QOL) score were administered before and 12 months after RP. RESULTS: Overall mean total IPSS and IPSS QOL scores showed statistically significant improvement (both P < 0.001). There were no differences between baseline and postoperative scores in "Voiding frequency" or "Nocturia" related to irritative symptoms. Moreover, RP had adverse effects on the nocturia and voiding frequency composites score when the analysis was limited to those men who reported scores of 0 or 1 for each symptom preoperatively (P < 0.001 and P = 0.001, respectively). The urinary function score according to the UCLA PCI had substantially declined at 12 months compared with baseline (P < 0.001); however, no significant differences were observed in urinary bother between the baseline and postoperative scores. CONCLUSIONS: Although a significant proportion of men complained of urinary incontinence, RP significantly improved IPSS and IPSS QOL scores in men with moderate or severe urinary symptoms. However, RP seems to have a deleterious effect on nocturia and voiding frequency for some men with only mild symptoms.

Aged↗
PubMed2005

Lymphoepithelioma-like carcinoma of the ureter.

Lymphoepithelioma-like carcinoma is an undifferentiated epithelial tumor with a prominent lymphocytic infiltrate and is rarely seen in the upper urinary tract. Only 3 and 2 cases involving the ureter and renal pelvis, respectively, have been reported. We report the fourth documented case of lymphoepithelioma-like carcinoma of the ureter. Tumor cells were immunoreactive to cytokeratin and negative for Epstein-Barr virus. Our patient was disease free 30 months after nephroureterectomy. The prognosis is favorable for pure lymphoepithelioma-like carcinoma of the upper urinary tract.

Aged↗
PubMed2005

Emergency drainage for urosepsis associated with upper urinary tract calculi.

PURPOSE: We examined the characteristics of patients with urosepsis associated with upper urinary tract calculi requiring emergency drainage. MATERIALS AND METHODS: From January 1994 to December 2003, 424 patients were admitted to our urological department a total of 473 times for treatment of upper urinary tract calculi, of whom 53 required a total of 59 emergency drainage procedures for urosepsis. We summarized the characteristics of these patients and events, and determined risk factors for emergency drainage using logistic regression analysis. RESULTS: In 14 events (24%) intensive management, such as the use of vasopressors and anticoagulants, was performed. Transient thrombocytopenia less than 100,000/mm occurred in 18 events (31%). Hyperbilirubinemia occurred in 8 of 38 events (16%) without prior antibiotic therapy. One patient (2%) died of urosepsis. Patients with calculi who underwent emergency drainage required a longer hospital stay than those without emergency drainage (25.2 vs 14.8 days, p <0.001). Of the variables analyzed poor performance status (Karnofsky performance status 70% or less, OR 2.9, p = 0.003), age 75 years or older (OR 2.1, p = 0.038) and female sex (OR 1.8, p = 0.046) were risk factors on multivariate analysis. CONCLUSIONS: Our findings suggest that the frequency of emergency drainage in elderly patients with poor performance status has increased in recent years, at least in our rural area of Japan. Preventing calculous formation and urinary tract infection in individuals with poor performance status will be of considerable importance in the future.

Aged↗
PubMed2005

Intraoperative electrophysiological confirmation of urinary continence after radical prostatectomy.

PURPOSE: To determine the actual effect of nerve sparing radical retropubic prostatectomy (RP) on postoperative urinary continence we used intraoperative electrophysiological testing to confirm functional preservation of the neurovascular bundle (NVB). MATERIALS AND METHODS: A total of 85 patients undergoing RP for localized prostate cancer were studied. During RP NVB preservation was assessed macroanatomically. Electrophysiological testing was then performed to confirm NVB preservation. The NVB was electrostimulated and responses were observed by monitoring intracavernous or intraurethral pressure changes. All patients were classified into 3 groups according to the degree of nerve sparing, that is a bilateral nerve sparing group, a unilateral nerve sparing group and a nonnerve sparing group, based on macroanatomical assessment as well as on electrophysiological assessment. Postoperative continence in each group was then determined. Urinary continence at baseline, and 3 and 6 months postoperatively was studied using a self-administered questionnaire. RESULTS: With electrophysiological assessment 20.6% of macroanatomically determined NVB preservations were reclassified. Analysis of the data on groups classified accurately by electrophysiological testing showed that the bilateral nerve sparing group maintained postoperative urinary function significantly more than the unilateral nerve sparing and nonnerve sparing groups. However, when only macroanatomical assessment was considered, no significant difference among the groups was found in urinary function. CONCLUSIONS: Electrophysiological assessment revealed that bilateral NVB preservation contributes to early recovery of urinary continence after RP. Thus, intraoperative electrophysiological assessment is useful for predicting postoperative quality of life.

Aged↗
PubMed2005

Renal scarring is associated with nonsecretion of blood type antigen in children with primary vesicoureteral reflux.

PURPOSE: Nonsecretor status of blood type antigen has been associated with higher risk of urinary tract infection (UTI) in women. However its implication in the modern management for pediatric UTI remains unclear. We evaluate the impact of secretor status on clinical course in children with primary vesicoureteral reflux (VUR). MATERIALS AND METHODS: From 1998 to 2002, 382 cases of primary VUR presented to our institute and were treated either surgically or nonoperatively in accordance with the American Urological Association guideline. Of these potential candidates 128 patients and their guardians volunteered to be entered into the study. Antiseptic swabs to collect saliva were sent to them. The secretor status was determined using the hemagglutination inhibition assay from the eluted saliva on the swabs and medical records of responders were evaluated retrospectively. RESULTS: Secretor status was not associated with gender, VUR grade, presentation, history of breakthrough UTI, laterality of VUR and conservative vs surgical treatment. However, nonsecretor status weakly correlated with decreased split renal function and significantly correlated with the presence of focal renal scarring (40.9% vs 21.7% for children with and without scarring, respectively) as determined by technetium dimercapto-succinic acid renal scan. CONCLUSIONS: These results demonstrate that secretor status represents unrecognized host disposition that affects the clinical course of primary VUR. Further study is needed to determine the significance of secretor status for clinical management and pathophysiology of VUR.

Blood Group Antigens↗
PubMed2005

Impact of hormonal therapy prior to radical prostatectomy on the recovery of quality of life.

BACKGROUND: We investigated the changes in health-related quality of life (HRQOL) in patients who underwent prostatectomy (RP) with or without neoadjuvant hormonal therapy (NHT). METHODS: A total of 72 patients undergoing direct RP (DRP group) and 26 patients receiving neoadjuvant hormonal therapy (NHT group) were enrolled in the present study. The baseline interview was conducted before RP (not initiation of therapy). Follow-up interviews were conducted in person at scheduled study visits of 3, 6, and 12 months after surgery. We measured general and disease specific HRQOL with the Medical Outcomes Study 36-Item Short Form and University of California, Los Angeles Prostate Cancer Index, respectively. RESULTS: At baseline, the NHT group scored statistically lower for not only sexual function (P < 0.001), but also the general HRQOL, such as role limitations due to physical problems (P = 0.007), social function (P = 0.045) and mental health (P = 0.034), than the DRP group. The NHT group reported lower scores in social function and mental health at 3 months (P = 0.040 and 0.006, respectively). Patients who received NHT for more than 3 months continued to show significantly lower scores for some HRQOL domains 12 months later. CONCLUSION: Neoadjuvant hormonal therapy may decrease not only sexual function, but also general HRQOL before surgery. The recovery of HRQOL appeared to be further prolonged in patients who received long-term NHT.

Aged↗
PubMed2005

Fluctuation of night time frequency in patients with symptomatic nocturia.

BACKGROUND: We examined the fluctuation and causes of voiding frequency during the night in patients with symptomatic nocturia. MATERIALS AND METHODS: Actual night time frequency was recorded by 72 patients for a total of 769 nights (mean 10.7 nights per patient) and was compared with the 'nocturia score' of the International Prostate Symptom Scores (I-PSS). If a patient experienced nocturnal frequency higher or lower than usual, he or she checked the items on a questionnaire considered reasons for the changes. RESULTS: For 471 nights of 769 (61%), actual voiding frequency did not correspond with nocturia score. Patient-by-patient fluctuation in actual voiding frequency during the night was marked. The most prevalent patient-reported reason for fluctuation was amount of fluid intake, followed by duration of time in bed, feeling colder or warmer during time in bed and increased difficulty going to sleep. Fatigue, difficulty going to sleep and salt intake could affect night time frequency positively or negatively. When nocturia score and total score of the I-PSS were high, the differences between actual nocturnal frequency and nocturia score were significantly larger (3 or less, 0.71; 3-4 or more, 1.05, P<0.0001 and 13 or less, 0.78; 14 or more, 0.97; P=0.0030, respectively). Female patients tended to have nocturia scores differing from actual frequency of urination (1.03 versus male patients 0.84, P=0.0673). CONCLUSIONS: There is considerable discrepancy between the nocturia score of the I-PSS and actual voiding frequency, in addition to marked fluctuation of actual voiding frequency in symptomatic patients. Patient perception of fluctuation of night time frequency can provide clues to useful clinical education of patients regarding nocturia.

Adult↗
PubMed2005

Alteration of body configuration after retroperitoneoscopic nephrectomy and nephroureterectomy.

OBJECTIVE: To evaluate objective alterations of body configuration in patients who treated with retroperitoneoscopic nephrectomy (RN) and retroperitoneoscopy-assisted nephroureterectomy (RAN). PATIENTS AND METHODS: Twenty-six patients who had RN and 23 RAN were eligible for the study. Abdominal computed tomography films before and after surgery were evaluated. The intra-abdominal content surrounded by the vertebral bones and the muscles forming the trunk of the body were divided into four subspaces. The areas of these four portions were measured, and the ratio of occupation of each portion calculated before compared with that obtained after surgery. RESULTS: While RAN had little impact on body configuration, RN significantly affected it; after RN the total area and area of ventral subspaces decreased homogeneously throughout the L2-L4 levels. The ipsilatero-dorsal subspace had a marked cranial decrease in area and no caudal alteration. CONCLUSIONS: While RAN has little effect on body configuration, RN has a significant effect, as measured objectively. Continuing the skin incision between ports and muscle splitting to extract the specimen is probably responsible for the difference between the findings of RAN and RN.

Abdomen↗
PubMed2005

Classification and distribution of symptomatic nocturia with special attention to duration of time in bed: a patient-based study.

OBJECTIVE: To classify the night-time urinary frequency of patients with symptomatic nocturia by urine volume produced, nocturnal bladder capacity and time spent in bed. PATIENTS, SUBJECTS AND METHODS: In all, 110 patients whose principal complaint was nocturia were enrolled in the study; 32 age- and gender-matched subjects were recruited as controls. From studies of the controls, 190 mL and 510 min were identified as the normal limits for mean nocturnal urine voided volume and time spent in bed. The 110 patients were classified into eight categories based on urine volume, nocturnal bladder capacity and time spent in bed. RESULTS: There were abnormalities of urine volume produced, bladder capacity and time spent in bed in 72%, 50% and 54% of the patients, respectively. Patients with severe nocturia (> or =4 voids/night) tended to have more complex pathophysiology than those with mild nocturia (< or =3 voids/night). CONCLUSION: Time spent in bed, urine volume produced and bladder capacity should be used to assess patients with symptomatic nocturia.

Aged↗
PubMed2005

Salvage radiotherapy for biochemical recurrence after radical prostatectomy.

OBJECTIVE: To evaluate the clinical outcome of salvage radiotherapy (RT) for biochemical recurrence after radical prostatectomy (RP) at our institution. PATIENTS AND METHODS: Between March 1999 and January 2004, 37 patients had salvage RT for prostate-specific antigen (PSA) failure after RP, including eight who had had neoadjuvant hormone therapy. After surgery, PSA was measured with ultrasensitive immunoassays. In all patients RT was delivered to the prostatic bed at a total dose of 60 Gy with a four-field box technique. RESULTS: The median (range) PSA level before salvage RT was 0.146 (0.06-3.216) ng/mL and RT was started at a PSA level of <0.5 ng/mL in 34 of the 37 patients (92%). With a median follow-up of 31.9 (0-69.8), months, 11 patients (30%) had disease progression after RT and the 3- and 5-year progression-free probability was 74% and 54%, respectively. Univariate analysis showed that clinical and pathological tumour stages and PSA level before RT (>0.15 vs < or = 0.15 ng/mL) were significant predictors of disease progression. There were no late adverse events related to RT. CONCLUSION: Salvage RT for biochemical failure after RP at a low PSA level, using ultrasensitive immunoassays for monitoring, is a reasonably effective treatment. A relatively low radiation dose (60 Gy) seems to be effective.

Adenocarcinoma↗