Biomedical subjects

Akito Terai

Publications and source records attributed to Akito Terai.

At least 19 recordsLinked to original sources

PubMed2006

Increased biofilm formation in Escherichia coli isolated from acute prostatitis.

Using crystal violet binding assay, we examined the potential for biofilm formation in 194, 76 and 107 isolates from urine of patients with uncomplicated acute cystitis, pyelonephritis and prostatitis, respectively. The prostatitis isolates showed significantly higher optical density (OD) values compared with cystitis and pyelonephritis isolates (OD(540): 0.82, 0.29 and 0.43, respectively, P<0.0001). Similarly, strains of serotypes O4 and O22, which were commonly isolated from prostatitis, exhibited significantly higher OD values than did other strains. Furthermore, when the 21 prostatitis isolates were examined for expression of curli fimbriae, eight of 12 strains with a high OD value, but only three of nine with a low OD value, expressed curli fimbriae (P=0.0195). These results suggest an association between acute bacterial prostatitis and biofilm formation.

Acute Disease↗

PubMed2006

Natural history of voiding function after radical retropubic prostatectomy.

OBJECTIVES: To report results from a 2-year longitudinal survey of lower urinary tract function and quality of life (QOL) in men after radical retropubic prostatectomy (RP) for localized prostate cancer. METHODS: Between November 2001 and September 2003, self-report assessments were provided to 225 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 QOL score were administered before and 3, 6, 12, 18, and 24 months after RP. RESULTS: The overall mean total IPSS and IPSS QOL score progressively improved with time. The mean scores of several components improved significantly postoperatively. No significant difference was observed in nocturia between the baseline assessment and any of the postoperative follow-up assessments. The IPSS of the younger patients continued to recover significantly more rapidly than that of the older patients after RP. According to the UCLA PCI scores, urinary function substantially declined just after RP and continued to recover but scored lower than the baseline. The mean total IPSS and IPSS QOL scores observed in men with a UCLA PCI urinary function score of 80 or more were significantly better than in men with scores less than 80 at 24 months postoperatively. CONCLUSIONS: Radical retropubic prostatectomy has a significant beneficial effect on lower urinary tract symptoms. The rate of improvement was lowest for nocturia among the seven symptoms of IPSS. Urinary continence after RP and age can affect the recovery of voiding function.

Aged↗

PubMed2006

Adult onset of declining spermatogenesis in a man with nonmosaic Klinefelter's syndrome.

OBJECTIVE: To examine an unusual case of Klinefelter's syndrome. DESIGN: Case report. SETTING: An infertility clinic at a private hospital. PATIENT(S): A patient with nonmosaic Klinefelter's syndrome who had had a child with his ex-wife without artificial reproductive technologies. INTERVENTION(S): Karyotyping with peripheral blood lymphocytes, microdissection testicular sperm extraction, and intracytoplasmic sperm injection (ICSI). MAIN OUTCOME MEASURE(S): Sperm count and testicular histopathology. RESULT(S): Semen analysis revealed severe oligoasthenozoospermia. Intracytoplasmic sperm injection using ejaculated spermatozoa was performed, and successful pregnancy and delivery were achieved. Two years later, multiple semen analyses revealed azoospermia. Microdissection testicular sperm extraction was performed, and motile sperm were successfully retrieved. Unfortunately, the first cycle of ICSI using testicular sperm failed. Testicular histopathology was compatible with decreased spermatogenesis. CONCLUSION(S): This is a case of a man with nonmosaic Klinefelter's syndrome who exhibited progressive decline of spermatogenesis. This case suggests the merit of early sperm retrieval and cryopreservation for future management of infertility in Klinefelter's syndrome.

Adult↗

PubMed2006

Health-related quality of life after intensity modulated radiation therapy for localized prostate cancer: comparison with conventional and conformal radiotherapy.

OBJECTIVE: No previous studies have reported the longitudinal health-related quality of life (HRQOL) for intensity modulated radiation therapy (IMRT). We compared HRQOL after IMRT with that after conventional and after conformal radiation therapy (XRT). METHODS: A total of 110 patients underwent XRT (34 patients underwent conventional radiation therapy and 76 underwent conformal radiation therapy) and 30 underwent IMRT for clinically localized prostate cancer between 2000 and 2002. We measured the general and disease-specific HRQOL using the Medical Outcomes Study 36-Item Health Survey and University of California, Los Angeles, Prostate Cancer Index, respectively. RESULTS: There were no significant differences in the preoperative characteristics and HRQOL scores of the two groups. Repeated measure analyses of variance revealed significantly different patterns of alteration in several general HRQOL domains between XRT and the IMRT groups. In the urinary domain, there was no difference in the alteration patterns between the two groups. The XRT group suffered worse bowel function at 3 and 6 months than the IMRT group (P < 0.05). In the XRT group, sexual function decreased at 3 months and remained substantially lower than the baseline level. However, the IMRT group showed no significant difference from the baseline level at any of the observation periods. At 18 months the XRT group showed worse sexual function than the IMRT group. CONCLUSION: The two approaches showed different longitudinal profiles regarding general and disease-specific HRQOL during the first 2 years after treatment. The IMRT approach produced little impairment in bowel and sexual function.

Aged↗

PubMed2006

Testosterone-induced priapism in Klinefelter syndrome.

We present the case of a patient with Klinefelter syndrome and priapism after testosterone administration. The patient underwent testicular sperm extraction for interventional fertilization, but no sperm were found. Because he had given up trying to father a child and his testosterone level had been low, testosterone replacement therapy was started with testosterone enanthate. After the third injection, he presented with low-flow priapism. Conservative management was successful, and no recurrence developed during the next 15 months. Testosterone replacement therapy carries some risk of priapism even for patients with Klinefelter syndrome.

Adult↗

PubMed2006

Aging Males' Symptoms scale in Japanese men attending a multiphasic health screening clinic.

OBJECTIVES: The Aging Males' Symptoms (AMS) scale is a health-related quality-of-life scale. The AMS scale has been used worldwide for the evaluation of andropause symptoms, but its standardized values have only been published for Germany. We sought to evaluate the prevalence of andropause symptoms in the male Japanese population using the AMS scale. METHODS: Of a consecutive series of 2833 men who underwent multiphasic health screening at Kurashiki Central Hospital, we analyzed the results for 2211 men who responded to all questions on the AMS scale. RESULTS: The severity of the total score and the sexual subscore of the AMS scale increased significantly with age, but no significant age relationships were observed in the psychological and somatic subscores. Approximately 50% of men in their 40s had moderate or severe symptoms in the sexual subscore. The total scores and all subscores for the Japanese population were significantly greater than those for the German population. CONCLUSIONS: A decline in sexual function with age was demonstrated in healthy Japanese men, but the somatic and psychological subscores were not influenced by age. The present study has provided standardized values for the AMS scale for the Japanese population.

Adult↗

PubMed2006

Changes in quality of life in first year after radical prostatectomy by retropubic, laparoscopic, and perineal approach: Multi-institutional longitudinal study in Japan.

OBJECTIVES: To investigate the health-related quality of life of patients who underwent radical prostatectomy performed using retropubic, laparoscopic, and perineal approaches. METHODS: A total of 218 men who underwent retropubic prostatectomy, 65 who underwent laparoscopic prostatectomy, and 66 who underwent perineal prostatectomy were enrolled in our survey. A baseline interview was conducted before treatment. Follow-up interviews were conducted in person at scheduled study visits 1, 3, 6, and 12 months after surgery. We measured two validated questionnaires that assessed the general and disease-specific health-related quality of life. RESULTS: The retropubic group reported substantial deterioration in physical limitations, emotional limitations, social function, and bodily pain at 1 month. The perineal group reported less bodily pain just after surgery than the retropubic and laparoscopic groups. After 6 months, however, no significant differences were found among the three groups. Postoperative urinary function remained substantially lower than the baseline level in every treatment group. Each approach with a nerve-sparing procedure showed a similar recovery profile of urinary function postoperatively. The perineal group reported no significant difference in bowel function compared with the other two groups. All of the groups continued to have decrements in sexual function. CONCLUSIONS: The results of this study have demonstrated that retropubic, laparoscopic, and perineal prostatectomy have differences in the recovery of general and disease-specific quality of life in the early postoperative period. When performed by an experienced surgeon, the retropubic, laparoscopic, and perineal approaches appear to be equivalent in terms of health-related quality of life.

Aged↗

PubMed2006

Dynamic contrast-enhanced subtraction magnetic resonance imaging in diagnostics of testicular torsion.

OBJECTIVES: To retrospectively correlate the magnetic resonance imaging (MRI) diagnosis with the surgical findings and/or clinical outcomes in patients presenting with an acute scrotum. METHODS: From January 1997 to June 2004, 39 selected patients presenting with an acute scrotum underwent dynamic contrast-enhanced subtraction MRI as a 24-hour stand-by examination. The MRI diagnosis was based solely on the presence or absence of testicular contrast enhancement, without respect to the clinical history or physical examination findings. RESULTS: Contrast enhancement of the affected and normal testes could be accurately compared in all cases. The MRI diagnosis was testicular torsion (no testicular contrast enhancement, n = 13), nonspecific (reduced to normal enhancement, n = 10), appendiceal torsion (n = 3), and epididymitis (n = 13). The surgical findings and/or subsequent clinical outcomes showed that MRI diagnosis of testicular torsion was accurate in all 13 cases. Furthermore, exploration revealed testicular torsion in 1 case with very little enhancement. The sensitivity and specificity of MRI in the diagnosis of testicular torsion was 93% (13 of 14) and 100% (25 of 25), respectively. Although MRI detected testicular perfusion, 5 of the 6 patients with clinical suspicion of intermittent torsion underwent surgical exploration. CONCLUSIONS: MRI is a highly accurate imaging modality for the diagnosis of testicular torsion. However, it could not be used to rule out intermittent torsion and the clinical use of negative findings for an MRI torsion test was less than 100% specificity. Because this was a preliminary retrospective study, the true clinical value of MRI should be evaluated by prospective studies.

Adolescent↗

PubMed2006

Obstructive azoospermia associated with chronic sinopulmonary infection and situs inversus totalis.

We describe 2 cases of obstructive azoospermia associated with situs inversus and sinopulmonary infection due to ciliary defects. Electron microscopy of testicular sperm flagella demonstrated normal morphology with nine peripheral doublets surrounding a central pair and complete sets of inner and outer dynein arms. Electron microscopy of the nasal mucosa revealed partial defects of the dynein arms of cilia, although the "9+2" morphology was preserved. Our cases were considered unique variants of Young's syndrome but also had characteristic features of Kartagener syndrome, and thus support the hypothesis that Young's syndrome has a genetic etiology similar to that of Kartagener syndrome.

Adult↗

PubMed2006

Subtyping of uropathogenic Escherichia coli according to the pathogenicity island encoding uropathogenic-specific protein: comparison with phylogenetic groups.

BACKGROUND: Phylogenetic analysis has been used widely to characterize extraintestinal pathogenic Escherichia coli in molecular epidemiological studies. We have recently reported a putative pathogenicity island (PAI), carrying uropathogenic-specific protein (usp) and a unique mosaic structure of small open reading frames following usp, providing four subtypes of PAIusp classified from their sequential patterns. METHODS: A total of 427 E. coli isolates from uncomplicated urinary tract infections (194 cystitis, 76 pyelonephritis, and 107 prostatitis) and 50 fecal isolates were examined for phylogenetic grouping and PAIusp subtyping as well as the prevalence of virulence factors (VF) and O serogroups. RESULTS: Both phylogenetic group B2 and usp-positive strains were equally predominant in cystitis, pyelonephritis and prostatitis (B2, 80.9%, 86.8%, and 86.9%; usp, 79.4%, 93.4%, and 88.8%, respectively). Furthermore, each PAIusp subtype was shown to be closely associated with several VF genes as well as several common O serogroups of uropathogenic E. coli. CONCLUSIONS: In molecular epidemiological studies, PAIusp subtyping will provide additional informative findings of E. coli strains belonging to phylogenetic group B2.

Escherichia coli↗

PubMed2006

Clinical outcome of tubeless cutaneous ureterostomy by the Toyoda method.

AIM: Cutaneous ureterostomy is the least invasive method of urinary diversion, but it carries a risk of stomal stenosis. We retrospectively examined the long-term outcome of tubeless cutaneous ureterostomy by the Toyoda method. METHODS: Since 1983, the Toyoda cutaneous ureterostomy has been performed in 97 patients (169 renal units) with a minimum follow up of 3 months. The ureteral patency rate was reviewed according to whether the stomal type was single (one ureter, one stoma) or double-barrel (two ureters, one stoma). RESULTS: After a median follow up of 23 months (range 3 to 169), a tubeless condition was achieved in 102 (82%) of 124 renal units associated with double-barrel stoma and in 35 (78%) of 45 renal units associated with single stoma. Although mild to moderate hydronephrosis was observed in 19% of patients, serum creatinine levels did not change after a minimum of 12 months after surgery (median 35). CONCLUSIONS: A high ureteral patency rate was achieved with cutaneous ureterostomy using the Toyoda method. This procedure, especially double-barrel stomal creation, is a reasonable alternative to other forms of urinary diversion in patients at high risk.

Adult↗

PubMed2006

Automatic switching and guidance system to facilitate unassisted uroflowmetry using commercial electronic devices.

To enable male patients to undergo uroflowmetry in a private condition without medical supervision, we devised an automatic switching and patient guidance system for the spinning disk uroflowmeter Urodyn 1000, using two commercial electronic devices (an infrared motion sensor tap and a memorizable vacuum fluorescent display). Instead of running the uroflowmeter continuously, which shortens the life of the spinning disk due to mechanical wear, an infrared motion sensor turns on the devices each time a patient enters the room. The patient urinates according to the timely instructions on the visible display and voided urine directly flows into a urinal. The devices are automatically turned off 5 min after the patient leaves the room. With the use of our system, men already acquainted with uroflowmetry could perform self-administered uroflowmetry any time in private. The system was considered useful for improving the quality of patient service.

Ambulatory Care↗

PubMed2006

Application of siphon principle to fluid drainage in transurethral surgery.

Transurethral resection is usually performed using an all-in-one drape with a fluid collection pouch, drainage port and hose. Gravity drainage of irrigation fluid through the hose is often hampered, resulting in fluid retention in the pouch. We applied a siphon principle to facilitate fluid drainage by making a U-shaped bend near the distal end of the hose, using an adhesive tape, and hooking the distal end of inverted U shape on the edge of bucket placed on the floor. When the hose is filled with irrigation fluid up to the crest of the siphon, fluid flow driven by atmospheric pressure continues until the pouch is evacuated. Repriming and restarting occur automatically throughout the operation. This simple device has virtually eliminated fluid retention in the pouch and proved to be especially useful in transurethral prostatectomy, which requires a large amount of irrigation fluid.

Drainage↗

PubMed2006

Antibiotic prophylaxis in radical prostatectomy: 1-day versus 4-day treatments.

OBJECTIVE: The standard protocol of antibiotic prophylaxis in radical prostatectomy remains to be established. We retrospectively compared the occurrence of perioperative infections following radical prostatectomy between two different protocols of antibiotic prophylaxis. METHODS: This study included 106 cases of radical retropubic prostatectomy managed on the clinical pathways. Two different protocols of antibiotic prophylaxis were used in otherwise identical pathways. Between January and December 2004, 50 patients received a second generation cephem, cefotiam, for 4 days, beginning 30 min before surgery (4-day group), whilst between December 2004 and July 2005, only two doses of cefotiam were given on the day of operation in 56 patients (1-day group). The incidence of surgical site infection (SSI) and remote infection (RI) was retrospectively investigated. RESULTS: Superficial incisional SSI occurred in one (1.8%) patient in the 1-day group, whereas no patient in the 4-day group developed SSI. No RI was observed in either the 1-day or 4-day group. Intravenous antibiotics were administered besides the pathway in a patient in the 1-day group because unexplained fever more than 38 degrees C continued postoperative day (POD) 2 through POD 4 without signs of SSI or RI. Excluding this case, postoperative more than 38 degrees C was rare and transient after POD 2. CONCLUSION: The incidence of SSI and RI was low and not significantly different between the 1-day and 4-day groups. Therefore, the 1-day protocol of prophylactic antibiotic treatment seems adequate for preventing perioperative infections in radical prostatectomy.

Aged↗

PubMed2006

[Questionnaire survey of peri-operative management of transurethral prostate resection in Japan].

OBJECTIVES: We investigated perioperative management for transurethral resection of the prostate (TURP) in Japan. METHODS: The questionnaire survey was conducted in 1,213 educational institutions for urology. RESULTS: The questionnaires were returned from 722 (60%) institutions. Admission to hospital was most frequently scheduled on preoperative day 1; termination of continuous drip infusion, starting meal intake and walking on postoperative day 1; intravenous antibiotics for three days; removal of Foley catheter on postoperative day 4; oral antibiotics for 7 days; and discharge from hospital on postoperative day 7. CONCLUSION: Although hospitalization was 14 days or less at most institutions, several procedures, especially the administration of prophylactic antibiotics, were fairly varied. Discussions from various perspectives might be needed to standardize the perioperative management of TURP in Japan.

Critical Pathways↗

PubMed2006

[The Aging Male's Symptoms (AMS) scale in Japanese men attending an infertility clinic].

There is a gradual decline in testosterone and free testosterone with age. Physical and psychological changes can occur due to this decline of androgens--a syndrome known as "partial androgen decline in the aging male" (PADAM). Male infertility and erectile dysfunction (ED) can also be caused by androgen deficiency. Thus, male infertility, ED and PADAM are interrelated. We evaluated the prevalence of PADAM symptoms in 215 infertile patients in an infertility clinic using the Aging Males Symptom (AMS) scale. Results of the evaluation of 301 men, (30-39 years old) using the same scale, who were part of a multiphasic health screening program, served as controls. The total score of the infertile patients was lower than that of the controls. Especially, the scores of the psychological and somatic subscales were significantly lower in infertile patients (P=0.009, P=0.012, respectively). Thirty three (15.3%) of the 215 infertile patients had ED. Although the score of sexual subscale was higher in the ED patients than in the controls, the scores of the psychological and somatic subscales were not significantly different from those in the controls. In conclusion, PADAM symptoms in Japanese infertile patients were not severe. Moreover, general function was better preserved in the infertile patients than in the controls. The psychological and somatic functions of ED patients were also well preserved.

Adult↗

PubMed2005

Intraoperative electrophysiological confirmation of neurovascular bundle preservation during radical prostatectomy: long-term assessment of urinary and sexual function.

OBJECTIVE: We investigated the longitudinal recovery of urinary and sexual function after radical retropubic prostatectomy (RP) using an intraoperative electrophysiological test to confirm the functional preservation of the neurovascular bundle (NVB). METHODS: A total of 70 patients who underwent RP for localized prostate cancer were prospectively enrolled in our survey. During RP, electrophysiological testing was performed to confirm the NVB preservation. The NVB was electrostimulated and the responses were observed by monitoring the intracavernous or intraurethral pressure changes. All patients were classified into three groups according to the degree of nerve-sparing [a bilateral nerve-sparing group (BNS), a unilateral nerve-sparing group (UNS) and a non-nerve-sparing group (NNS)] based on the macroanatomical as well as the electrophysiological assessment. Both urinary and sexual function were measured before and 3, 6, 12 and 24 months after RP by a self-administered questionnaire. RESULTS: The concordance rate of nerve-sparing or non-nerve-sparing between the electrophysiological and macroanatomical assessment was 80%. According to the electrophysiological data, the BNS maintained significantly better urinary function at 3 months after RP than the NNS and UNS. After 6 months, each group had almost recovered continence. When considering sexual function, the BNS showed better sexual function scores than the NNS throughout the post-operative periods and the UNS at 2 years. According to the macroanatomical assessment, however, these differences were significant. CONCLUSIONS: Nerve-sparing RP as confirmed by intraoperative electrophysiological test may contribute significantly to the early recovery of continence and greater rate of sexual function after RP.

Aged↗

PubMed2005

Quality of life after radical prostatectomy in Japanese men: 2 year longitudinal study.

OBJECTIVE: We performed a 2 year longitudinal survey of health-related quality of life (HRQOL) after radical retropubic prostatectomy (RP) in Japanese men with localized prostate cancer. PATIENTS AND METHODS: We measured 112 patients who underwent RP with SF-36 and University of California, Los Angeles Prostate Cancer Index before and 3, 6, 12, 18 and 24 months after surgery. RESULTS: Patients who underwent RP showed problems in some domains of general HRQOL, but these problems diminished over time. Mental health significantly improved throughout the follow-up period. The urinary function substantially declined at 3 months and continued to recover gradually but never returned to the baseline. Urinary bother at 3 months showed a significant decrease, but at 6 months it returned to baseline. The data of sexual function and bother showed a substantially lower score after RP. Patients lost their sexual desire significantly throughout the post-operative period. After 12 months, the nerve sparing group had significantly better improvement in sexual function than the non-nerve sparing group and this improvement continued up to 2 years after operation. CONCLUSION: Despite reports of problems with sexuality and urinary continence, general HRQOL was mostly unaffected by RP after 6 months. RP had a favorable impact on mental health. Although urinary function did not completely return to the baseline level even at 2 years after RP, recovery from urinary bother was rapid. RP had serious consequences on libido, erectile function and sexual activity. In the second year, the sexual function of those who underwent RP with bilateral nerve sparing procedure continued to improve.

Aged↗