Document 6430590

Transcription

Document 6430590

Dear Colleagues:
Welcome to Taiwan to participate 6th Pan-Pacific Continence Society
(PPCS) Meeting.
The 2-day meeting will begin with the Pre-PPCS symposium, Bob LevinAsia Connection, held on September 23rd in SweetMe Hot Spring Resort.
All PPCS participants are invited to attend the symposium. The symposium
is to commemorate the invaluable contribution of Dr. Levin for his teaching
on Asian MD scientists, who continue to make major discoveries in clinical
and basic researches in functional urology after they go back to their home
countries.
The main scientific meeting will be held on September 24th in Taipei
Veterans General Hospital. Distinguished international speakers will share
their expertise in functional urology. Excellent papers, including podium
presentation and posters, have been selected and will be presented in the
meeting. This year the meeting has an ample space for non-discussion
posters, allowing more authors to show their works which are not selected
for formal presentation due to time limitation.
Science and friendship are key values of PPCS. 6th PPCS meeting is
organized to promote these two values. The location of congress hotels are
in Beitou area in Taipei City, where is famous for its hot spring and leisure
atmosphere. The meeting reception and congress dinner are also held in
the hotels in Beitou, providing wonderful opportunities for renewing old
and making new friendship. The golf program on Sunday further provides
an excellent occasion for the friendship, in addition to for our own health.
We wish you will enjoy the meeting and your stay in Taiwan.
Alex TL Lin, M.D., Ph.D.
President of 6th PPCS
Professor of Division of Urology
National Yang Ming University
Taipei Veterans General Hospital
Hann-Chorng Kuo, M.D.
TCS President
Professor of Urology
Buddhist Tzu Chi University,
Hualien, Taiwan
GENERAL INFORMATION
Welcome Address
Organizing Committe
(Listed according to alphabetic order of country names)
China
Dongwen Wang, M.D., Shanxi Medical University
Limin Liao, M.D., China Rehabilitation Research Center (CRRC)
Japan
Osamu Yamaguchi, M.D., Fukushima Medical University
Osamu Nishizawa, M.D., Shinshu University
Masayuki Takeda, M.D., Yamanashi University
Tomonori Yamanishi, M.D., Dokkyo University
Momokazu Gotoh, M.D., Nagoya University
Osamu Yokoyama, M.D., Fukui University
Korea
Won Hee Park, M.D., Inha University
Jeong Gu Lee, M.D., Korea University
Myung Soo Choo, M.D., Ulsan University
Jeong Zoo Lee, M.D., Busan National University
Duk Yoon Kim, M.D., Catholic University
Kyu Sung Lee, M.D., Sungkyunkwan University
Taiwan
Alex T.L. Lin, M.D., National Yang Ming University
Hann-Chorng Kuo, M.D., Tzu Chi University
Hong-Jeng Yu, M.D., National Taiwan University
Henry Shing-Hwa Lu, M.D., National Yang Ming University
Day 1: 23 September, 2011
Registration
SweetMe Hot Spring Resort, Taipei (1F lobby)
The registration starts from 12:00 pm to 6:30 pm
Pre-PPCS Bob Levin-Asia Connection Symposium
SweetMe Hot Spring Resort, Taipei (2F)
The meeting commences at 1:00 pm and last session closes at 4:50 pm
Organizing Committee Meeting
SweetMe Hot Spring Resort, Taipei (B1 meeting room)
The organizing committee meeting at 5:00 pm to 5:30 pm
Pre-reception Symposium
The pre-reception symposium at 6:10 pm
Welcome Reception
The welcome reception at 7:00 pm
Day 2: 24 September, 2011 - I
Registration
Taipei Veterans General Hospital, Chi-Teh Medical Research Building (1F)
The registration starts from 8:00 am to 12:00 pm
PPCS Meeting
The meeting commences at 8:30 am and last session closes at 5:50 pm
Poster Exhibition
Posters display starts from 8:00 am to 5:30 pm
Time of poster removal: from 5:30 pm to 6:00 pm
GENERAL INFORMATION
Information for Participants
Day 2: 24 September, 2011- II
Luncheon Symposium
Su Hung Restaurant, Taipei (2F)
(Meeting staff will guide in the way to the restaurant)
Congress Dinner
Longbon Resort, Taipei (2F)
The congress dinner at 7:00 pm
Allocated Time for Paper Presentation for PPCS meeting on Sept. 24
Podium
7 minutes for presentation, 3 minutes for discussion
Moderated Poster
3 minutes for presentation, 2 minutes for discussion
From Hotel to Venue
Route 1: Leave at AM 7:30, from SweetMe Hot Spring Resort → Taipei Veterans
General Hospital, Chi-Teh Medical Research Building
Route 2: Leave at AM 7:20, From Royal Seasons Hotel, Beitou → LongBon Resort
→ Taipei Veterans General Hospital, Chi-Teh Medical Research Building
From Venue to Congress Dinner
Route 1: Leave at PM 6:00, From Taipei Veterans General Hospital, Chi-Teh
Medical Research Building → SweetMe Hot Spring Resort (wait for 10
minutes) → Longbon Resort
Medical Research Building → Royal Seasons Hotel, Beitou (wait for 10
minutes) → Longbon Resort
Medical Research Building → Longbon Resort
GENERAL INFORMATION
Information of Shuttle Bus (only 24th September)
Program
9/23 (Fri) Pre-PPCS Symposium: Bob Levin-Asia Connection
Program organized by: Eric Chieh-Lung Chou
13:00 ~ 13:10 Welcome and opening remarks
Alex TL Lin
Robert M. Levin
Co-chairs: Alex TL Lin; Kumiko Kato
13:10 ~ 13:20 What I have learned from Bob
Alex TL Lin
13:20 ~ 13:35 The effects of prolapse mesh operation on QoL and LUTS
Kumiko Kato
13:35 ~ 13:50 Research on LUTD associated with metabolic disorders
Yat-Ching Tong
13:50 ~ 14:05 The development of bionic interface technology to control
neural informationclose loop neuromodulation system
Jeong Gu Lee
14:05 ~ 14:20 Pathophysiological studies of overactive bladder and bladder
motor dysfunction in a rat model of metabolic syndrome
Hong-Jeng Yu
14:20 ~ 14:30 Effect of tamsulosin on bladder blood flow and bladder
function in a rat model of bladder overdistension/emptyinginduced bladder overactivity
Seiji Matsumoto
14:30 ~ 14:40 Discussion
14:40 ~ 15:00 Break
Co-chairs: Hong Jeng Yu; Jeong Gu Le
15:00 ~ 15:15 Androgen deficiency in Taiwanese males
Shih-Ping Liu
15:15 ~ 15:30 The relation between angiotensin II and bladder
pathophysiology
Ken Aikawa
15:30 ~ 15:45 Women urinate in the standing position: clinical and
urodynamics research
Eric Chieh-Lung
Chou
15:45 ~ 16:00 Healthcare research in urology: bike cycling causes urological
symptoms
Alpha DY Lin
16:00 ~ 16:15 Sex related differences in activities of bladder in response to
ischemia/reperfusion injury
Yung-Shun Juan
16:15 ~ 16:30 Bladder outlet obstruction: biomarkers and systemic oxidative
stress
Wei-Yu Li
16:30 ~ 16:40 Discussion
16:40 ~ 16:50 Closing remarks
Alex TL Lin
Robert M. Levin
9/24 (Sat) The 6th Pan-Pacific Continence Society Main Meeting
Program organized by: Henry Shing-Hwa Lu
08:00 ~ 08:30 Registration
08:30 ~ 08:40 Opening remarks
Alex TL Lin
Symposium 1 Co-chairs: Jeong Gu Lee; Stephen Shei-Dei Yang
Joint Symposium of PPCS and ICCS (International Children Continence Society) – managing special
situations of LUTS
08:40 ~ 08:55 (1) Optimal management of LUTS in bladder outlet obstruction Chih-Shou Chen
08:55 ~ 09:10 (2) Management of meningomyelocele: from children to
adulthood, including intravesical electrotherapy of MMC
Sang Won Han
09:10 ~ 09:25 (3) Overactive bladder – is there a gender difference in
diagnosis and management?
Hirotaka Asakura
09:25 ~ 09:40 (4) Innovations in childhood incontinence – neurogenic and
functional disorders
Stuart Bauer
09:40 ~ 09:55 (5) What we know and what we do not know about
dysfunctional voiding in adults
Yong-Gil Na
09:55 ~ 10:10 (6) Dysfunctional voiding – lessons learned from children
Stephen S. Yang
10:10 ~ 10:30 Coffee break and non – moderated poster visit
State-of-the-Art Lecture 1 Chair: Alex TL Lin
10:30 ~ 11:00 The effect of antioxidants on the response of the rabbit
urinary bladder to in vitro ischemia/reperfusion: effects on
fatty acid metabolism
Robert M. Levin
Podium Presentaion Co-chairs: Duk-Yoon Kim; Osamu Yokoyama
11:00 ~ 12:40 Podium presentation
Luncheon symposium Chair: Hann-Chorng Kuo
12:40 ~ 13:45 Male LUTS and adrenergic receptor mechanisms
Naoki Yoshimura
13:45 ~ 14:20 Non-moderated poster and booth visit
Symposium 2 Co-chairs: Hong Jeng Yu; Won Hee Park
Female Urinary Incontinence – management in Complicated Situation
14:20 ~ 14:35 (1) Salvage therapy for failed surgery for mixed urinary
incontinence in females
Chung-Hsin Yeh
GENERAL INFORMATION
Program
Program
14:35 ~ 14:50 (2) Management of stress urinary incontinence and pelvic
organ prolapse – concurrently or treat prolapse only?
Isao Araki
14:50 ~ 15:05 (3) Tricks and tips to avoid and manage complications in
female pelvic floor surgery
Jong Hyun Kim
State-of-the-Art Lecture 2 Chair: Osamu Nishizawa
15:05 ~ 15:30 Clinical challenges of male incontinence: post-prostatectomy
incontinence
Kyu-Sung Lee
15:30 ~ 15:45 Coffee break and non-moderated poster visit
Symposium 3 Co-chairs: Jeong Zoo Lee; Masayuki Takeda
Translational researches on lower urinary tract
15:45 ~ 16:00 (1) New aspects in Immunological mechanisms of bladder
pain syndrome/iInterstitial cystitis
Tomohiro Ueda
16:00 ~ 16:15 (2) Translating clinical and basic science findings into OAB
management
Yun Seob Song
16:15 ~ 16:30 (3) Stem cells and tissue engineering for urological
regeneration
Shing-Hwa Lu
Moderated Poster Presentaion Co-chairs: Yao-Chi Chuang; Tomonori Yamanishi
16:30 ~ 17:35 Moderated poster presentation
17:35 ~ 17:45 Welcome message from the chairman of the 7th PPCS meeting Momokazu Goto
in 2012 (Japan)
17:45 ~ 17:50 Closing remarks
Hann-Chorng Kuo
Pre-PPCS Symposium: Bob Levin - Asia
Connection


What I have learned from Bob
3

The effects of prolapse mesh
operation no QoL and LUTS
4
Alex TL Lin
Department of Urology, Taipei Veterans General
Hospital; National Yang Ming University, Taipei,
Taiwan

Research on LUTD associated with
metabolic disorders
6
Symposium 1
Pathophysiological studies of
overactive bladder and bladder
motor dysfunction in a rat model of
metabolic syndrome
7
Effect of tamsulosin on bladder
blood flow and bladder function
in a rat model of bladder
overdistension/emptying-induced
bladder overactivity
8

Androgen deficiency in Taiwanese
males

The relation between angiotensin
II and bladder pathophysiology

9
Healthcare research in urology:
bike cycling causes urological
symptoms
Alpha DY Lin
Department of Urology, Tseng's Hernia Hopsital,
Taichung, Taiwa
Management of myelomeningocele:
from children to adulthood,
including intravesical
electrotherapy of MMC
18
Overactive bladder – is there a
gender difference in diagnosis and
management?
19
Innovations in childhood
incontinence – neurogenic and
functional disorders
20
What we know and what we do not
know about dysfunctional voiding
in adults
21
Hirotaka Asakura
Department of Urology, Saitama Medical University
Faculty of Medicine
10

Ken Aikawa, Kei Ishibashi, Takio Sakai, Soichiro
Ogawa, Osamu Yamaguchi
Department of Urology, Fukushima Medical
University, Fukushima, Japan

17
Sang Won Han
Department of Pediatric Urology, Severance
Children’s Hospital, Yonsei University Health System
Shih-Ping Liu
Department of Urology, National Taiwan University
Hospital, Taipei, Taiwan

Optimal management of LUTS in
bladder outlet obstruction
Chih-Shou Chen
Department of Urology, Chuang Gung Medical
Foundation, Chiayi Hospital, Chiayi, Taiwan
Seiji Matsumoto
Department of Renal and Urologic Surgery,
Asahikawa Medical University

13
The 6th Pan-Pacific Continence Society
Meeting
Hong-Jeng Yu
Department of Urology, National Taiwan University

Bladder outlet obstruction:
biomarkers and systemic oxidative
stress
Wei-Yu Li
Department of Urology, Chuang Gung Medical
Foundation, Chiayi Hospital, Chiayi, Taiwan
Yat-Ching Tong
Department of Urology, National Cheng Kung
University, Tainan, Taiwan

12
Yung-Shun Juan1,2,3, Shu-Mien Chuang1, Robert M.
Levin4, Chun-Hsiung Huang2,3
1
Graduate Institute of Medicine, 2Department
of Urology, and College of Medicine, Kaohsiung
Medical University, Kaohsiung, Taiwan; 3Department
of Urology, Kaohsiung Medical University Hospital,
Kaohsiung, Taiwan; 4Albany College of Pharmacy,
Albany, New York, USA

Kumiko Kato, Shoji Suzuki, Shigeki Yamamoto,
Kenichi Furuhashi, Koichi Suzuki, Tatsuro Murase,
Momokazu Gotoh
Japanese Red Cross Nagoya First Hospital; Nagoya
University Graduate School of Medicine
Sex related differences in activities
of bladder in response to ischemia/
reperfusion injury
Stuart Bauer
Department of Urology, Children's Hospital Boston,
Harvard Medical School, Boston, Massachusetts
11

Yong-Gil Na
Department of Urology, Graduate School of
Medicine, Chungnam National University, Daejeon,
Korea
GENERAL INFORMATION
Table of Contents

Dysfunctional voiding: lessons
learned from children
22

Stephen S. Yang
Department of Urology, Medical College of
Buddhist Tzu Chi University, Hualien, Taiwan
The effect of antioxidants on the
response of the rabbit urinary
bladder to in vitro ischemia/
reperfusion: effects on fatty acid
metabolism
25

Robert M. Levin
Albany College of Pharmacy and Health Sciences,
New York, USA
Efficacy and safety of
augmentation ileocystoplasty for
the treatment of interstitial cystitis

29
Hyo Serk Lee1, Won Jin Cho2, Ha Na Lee3, Young-Suk
Lee4, Jeongyun Jeong1, Kyu-Sung Lee1
1
Samsung Medical Center, Sungkyunkwan
University School of Medicine, Seoul, Korea; 2Chosun
University Hospital, Chosun College of Medicine,
Gwangju, Korea; 3Iwha Women's University School
of Medicine, Seoul, Korea; 4Samsung Changwon
Hospital, Sungkyunkwan University School of
Medicine, Changwon, Korea


Increased expression of TRPA1,
TRPV2, ASIC1 and CXCL9 mRNA
in bladder tissue from patients
with ulcer-type interstitial cystitis
31
Bladder damage induced by
ketamine abuse in a rat animal
model
33
Yung-Shun Juan1,2,3, Shu-Mien Chuang1,4, Tzu Hui
Wu5, Cheng-Yu Long6,7, Keh-Min Liu4, Chun-Hsiung
Huang2,3
1
Graduate Institute of Medicine, 2Department of
Urology, 4Department of Anatomy , and 7Excellence
for Environmental Medicine, College of Medicine,
Kaohsiung Medical University; 3Department of
Urology, Kaohsiung Medical University Hospital,
Kaohsiung, Taiwan; 5Department of Biological
Science, National Sun Yat-Sen Univeraity, Kaohsiung,
Taiwan; 7Department of Obstetrics and Gynecology,
Kaohsiung Municipal Hsia-Kang Hospital,
Kaohsiung, Taiwan
35
Urinary bladder as one of the
target organs of desmopressin in
nocturnal enuresis
36
The impact of overactive bladder
on health-related quality of life,
sexual life and psychological health
in Korea
37
Increased urine nerve growth
factor associated with LUTS and
the serum NOx deficiency in the
men with bladder outlet obstruction
38
Chih-Shou Chen, Jia-Jen Shee, Ching-Fang Wu, WeiYu Lin, Dong-Ru Ho, Yun-Chin Huang, Pey-Jium
Chang, Meng-Hsin Chen
Division of Urology, Department of Surgery Chang
Gung Memorial Hospital, Chia-Yi, Taiwan; Graduate
Institute of Clinical Medical Sciences, Chang Gung
University, Taiwan; Department of Nursing, Chang
Gung Institute of Technology, Taiwan
Kang Jun Cho, Eun Sang Yoo1, Seung-June Oh2, Duk
Yoon Kim3, Joon Chul Kim
Department of Urology, School of Medicine,
The Catholic University of Korea, Seoul, Korea;
1
Kyungpook National University, Daegu, Korea;
2
Department of Urology, School of Medicine, Seoul
National University, Seoul, Korea; 3Department
of Urology, School of Medicine, Daegu Catholic
University, Daegu, Korea
Akira Nomiya1, Mitsuhiro Tagaya2, Tatsuya Oyama2,
Yuko Kawai2, Kazuchika Takagaki2, Hiroaki
Nisimatsu1, Naoki Aizawa3, Tetsuya Fujimura1,
Yasuhiko Igawa3, Yukio Homma1
1
University of Tokyo, Department of Urology;
2
Nippon Shinyaku Co., LTD; 3University of Tokyo,
Department of Continence Medicine

Evaluation of the usefulness of the
Japanese version of N-QoL through
a cross-sectional survey of nocturia
in Tochigi, Japan
Tomonori Yamanishi
Department of Urology, Dokkyo Medical University,
Tochgi, Japan
Podium Presentaion

34
Ji-Yeon Han1, Daeseon Yoo1, Kyung Hyun Moon2,
Myung-Soo Choo1
1
Department of Urology, Asan Medical Center,
University of Ulsan College of Medicine, Seoul,
Korea; 2Department of Urology, Ulsan University
Hospital, University of Ulsan College of Medicine,
Ulsan, Korea
State-of-the-Art Lecture 1

Next surgical management of
female stress urinary incontinence
after failed midurethral sling: tape
tightening or repeat sling?

Hisashi Honjo1,2, Masahiro Nakao3, Jun Ueyama4,
Takaaki Kondo4, Osamu Ukimura2, Akihiro
Kawauchi2, Hiroshi Kitakoji1, Nobuyuki Hamajima5,
Tsuneharu Miki2
1
Department of Clinical Acupuncture and
Moxibustion, Meiji University of Integrative
Medicine, Nantan, Japan; 2Department of Urology,
Kyoto Prefectural University of Medicine, Kyoto,
Japan; 3Department of Urology, Meiji University
of Integrative Medicine, Nantan, Japan; 4Program
in Radiological and Medical Laboratory Science,
Nagoya University Graduate School of Medicine,
Nagoya, Japan; 5Department of Preventive Medicine,
Nagoya University Graduate School of Medicine,
Nagoya, Japan

Involved extrinsic apoptotic
pathway from the bladder biopsy of
patients with interstitial cystitis
40
Jane-Dar Lee1,3, Ming-Huei Lee2,3
1
Division of Urology, Department of Surgery,
Taichung Armed Forces General Hospital;
2
Department of Urology, Taichung Hospital,
Department of Health; 3Central Taiwan University of
Science and Technology, Taiwan
PK01 Association between blood vessel
changes of bladder mucosa and
storage symptoms in female stress
urinary incontinence patients
Luncheon Symposium

Male LUTS and adrenergic receptor
mechanisms
43
herpes simplex virus vectors for
bladder pain and overactivity
Symposium 2
Salvage therapy for failed surgery
for mixed urinary incontinence in
females
47

Management of stress urinary
incontinence and pelvic organ
prolapse --- concurrently or treat
prolapse only?
urothelium dysfunction in patients
with overactive bladder syndrome
Tricks and tips to avoid and
manage complications in female
pelvic floor surgery
48
saponin on the bladder and
prostatic urethra: in vitro and in
vivo study
49
55
the lower urinary tract function
in patients with benign prostatic
hyperplasia according to prostate
size: prospective investigation
using pressure-flow study
PT02 Serum C-reactive protein levels are
Symposium 3
New aspects in immunological
mechanisms of bladder pain
syndrome/interstitial cystitis
Tomohiro Ueda
Department of Urology, Kyoto city Hospital, Kyoto
University
70
Yoshihisa Matsukawa, Ryohei Hattori, Tokunori
Yamamoto, Naoto Sassa, Yasushi Yoshino and
Momokazu Gotoh
Department of Urology, Nagoya University
Graduate School of Medicine, Nagoya,Japan
Kyu-Sung Lee
Department of Urology, Samsung Medical Center,
Sungkyunkwan University School of Medicine,
Seoul, Korea

68
Hoon Ah Jang1, Mi Mi Oh1, Khae Hawn Kim2, Jae
Hyun Bae1, Jeong Gu Lee1
1
Korea University Medical Ccenter, Department
of Urology, Seoul, Korea; 2Gil Medical Center,
Department of Urology, Gachon University of
Medicine and Science, Incheon, Korea
PJ02 Long-term efficacy of silodosin on
Clinical challenges of male
incontinence: post-prostatectomy
incontinence
Department of Urology, Buddhist Tzu Chi
General Hospital, Hualien, Taiwan
PK02 The relaxant effect of ginseng
Jong-Hyun Kim
Miz Medi Hospital Seoul Korea

66
Hsin-Tzu Liu, Hann-Chorng Kuo
Isao ARAKI
Department of Urology, Shiga University of Medical
Science, Otsu, Japan

64
Tomohiko Oguchi1,2, Hitoshi Yokoyama1,2, Osamu
Nishizawa2, William F Goins3, James R Goss3, Joseph
C Glorioso3, Naoki Yoshimura1
1
Department of Urology, University of Pittsburgh;
2
Department of Urology, Shinshu University;
3
Department of Molecular biology and Genetics,
University of Pittsburgh
PT01 Chronic inflammation but not
Chung-Hsi Yeh
Division of Urology, Department of Surgery, Shin
Kong Wo Ho Su Memorial Hospital, Taipei, Taiwan;
School of Medicine, Fu-Jen Catholic University,
Taipei, Taiwan
63
Duk-Yoon Kim1, Hyun Chan Chang1, Yoo Jun Park1,
Gong Hynk Jun1, Byung Hoon Kim2, Chaol Hee Park2
1
Department of Urology Catholic University of
Daegu, Daegu, Korea; 2Department of Urology,
Keimyung University, College of Medicine, Daegu,
Korea
PJ01 Interleukin-4 gene therapy using
Naoki Yoshimura
Department of Urology, University of Pittsburgh
School of Medicine

Moderated Poster Presentaion
59
associated with residual urgency
symptoms in patients with benign
prostatic hyperplasia after medical
treatment
Chun-Hou Liao1, Shiu-Dong Chung2, Hann-Chorng
Kuo3
1
Department of Urology, Cardinal Tien Hospital
and College of Medicine, Fu Jen Catholic University,
Taipei, Taiwan; 2Department of Urology, Far Eastern
Memorial Hospital, Taipei, Taiwan; 3Department of
Urology, Buddhist Tzu Chi General Hospital and Tzu
Chi University, Hualien, Taiwan
71
PK03 A comparative study of the
efficacy of solifenacin succinate
for frequency and frequency with
urgency patients
72
PK05 Influence factors for patient
Ji-Yeon Han1, Daeseon Yoo1, Kyung Hyun Moon2,
Myung-Soo Choo1
1
Department of Urology, Asan Medical Center,
University of Ulsan College of Medicine, Seoul,
Korea; 2Department of Urology, Ulsan University
Hospital, University of Ulsan College of Medicine,
Ulsan, Korea
PJ03 Implantation of bone marrow-
derived cells recovers radiation
injured urinary bladders in rats
satisfaction in after surgical
intervention with stress urinary
incontinence
73
bladder neck may predict a higher
recurrent rate of SUI
sensitive or insensitive?
and incontinence following
augmentation cystoplasty in
patients with neurogenic bladder
secondary to spinal cord lesion
PK07 Efficacy and safety of propiverine
75
M2 mediates Ca2+ sensitization via
indirect activation of Rho kinase
pathway in human detrusor smooth
muscle
77
as the prediction of overactive
bladder
Cheng-Yen Chiang, Yu-Hua Fan, Chih-Chieh Lin,
Alex T.L. Lin, Kuang-Kuo Chen
Division of Urology, Department of Surgery, Taipei
Veterans General Hospital, and School of Medicine,
National Yang-Ming University, Taipei, Taiwan
84
Dong-Gi Lee, Woo Jung Kim, Kwan Hyun Park1,
Minki Baek
Department of Urology, Samsung Medical Center,
Sungkyunkwan University, Seoul; 1Seoul Samsung
Urology Clinic/Gynecology Health Care Center,
Ulsan, Korea
surgery in elderly patients over
75 years old with female stress
urinary incontinence
85
Dong Hwan Lee1, Joon Chul Kim2, Hyun Woo Kim3,
Kwang Woo Lee4, Jong Bo Choi5
1
Department of Urology, Incheon St. Mary’s Hospital,
Incheon, Korea; 2Department of Urology, Bucheon
St. Mary’s Hospital, Bucheon, Korea; 3Department
of Urology, St. Paul’s Hospital, Seoul, Korea;
4
Department of Urology, Bucheon Soonchunhyang
Hospital, Bucheon, Korea; 5Deparment of Urology,
Ajou University Hospital, Suwon, Korea
78
PK09 Analysis of relative trends
with QoL score 3 in IPSS/QoL
questionnaire
85
Ha Wook Hwang, Hyeon Taek Choo, Hyeon Wook Cho,
Dae Kyung Kim
Department of Urology, Eulji University College of
Medicine, Daejeon, Korea
Shunichi Kajioka, Nouval Shahab, Maya Hayashi,
Takakazu Yunoki, Seiji Naito
Department of Urology, Kyushu University, Japan
PT04 First voided volume in the morning
in children with overactive bladder
PK08 The effect of midurethral sling
Sang Lim Lee, Jungbum Bae, Jin-Kyu Oh1, Minsoo
Choo, Seung-June Oh
Department of Urology, Seoul National University
Hospital, Seoul, Korea; 1Department of Urology,
Gachon University Gil Hospital, Incheon, Korea
PJ04 The musarinic receptor subtype of
83
Changho Lee, Hyungrae Jeong, Heejo Yang, Doosang
Kim, Yun Soo Jeon, Nam Kyu Lee
Department of Urology, Soonchunhyang University
Cheonan Hospital, Cheonan, Korea
Yuan-Hong Jiang1, Qian-Sheng Ke1, Chung-Cheng
Wang2, Hann-Chorng Kuo1
1
Department of Urology, Buddhist Tzu Chi General
Hospital, Hualien, Taiwan; 2Department of Urology,
En Chu Kong Hospital, Taipei, Taiwan
PK04 Change of urodynamics
83
Choal Hee Park, Byung Hoon Kim, Young Kee Kwon,
Duk-Yoon Kim1
Department of Urology, Keimyung University school
of Medicine, 1Department of Urology, Catholic
University of Daegu, Daegu, Korea
PK06 The bladder of older people:
Tetsuya Imamura1, Osamu Ishizuka1,2, Yoshiki
Kurizaki2, Wataru Noguchi2, Zhang Lei2, Haruaki
Kato2, Osamu Nishizawa1,2
1
Department of Lower Urinary Tract Medicine,
Shinshu University School of Medicine; 2
Department of Urology, Shinshu University School
of Medicine
PT03 Position of suburethral sling at the
Non-Discussion Poster
80
PK10 The outcome of TURP in BPH
patients with hypocontractile
bladder
86
Duk-Yoon Kim1, Hyeon Chan Jang1, Yoo Jun Park1,
Byung Hoon Kim2, Choal Hee Park2
1
Department of Urology Catholic University of
Daegu, Daegu, 2Department of Urology, Keimyung
University, College of Medicine, Daegu, Korea
PK11 Significance of spina bifida occulta
finding out by KUB in children
with nocturnal enuresis
Sang Hee Shin, Eun Kyoung Choi, Young Jae Im, Mi
Jung Lee, Myung Jun Kim, Chang Hee Hong, Sang
Won Han
Severance Children’s Hospital, Yonsei University
Health System, Seoul, Korea
87
PK12 Prognostic factors for persistent
storage symptoms following
surgical treatment in patients with
benign prostatic obstruction
87
lower urinary tract symptoms of
bicycle riding in men
89
Jong Min Kim1, Esther Shin2, Phil Hyun Song, Hee
Chang Jung1
1
Yeungnam university, 2Institute of Biomedical
engineering, Yeungnam University
PK14 Comparison between TVT SECUR
® and TOT : analysis of postoperative pain in patients with
stress urinary incontinence
cystectomy with the Ghoneim
pouch and the Mainz II pouch in
bladder cancer patients
89
triple therapy with gabapentin,
amitriptyline, and a nonsteroidal
anti-Inflammatory drug
1
90
tissue on surgical outcome after
transurethral resection of prostate
Hyoung Keun Park, Kyung Kyu Jun, Young Ik Lee,
Gwoan Youb Choo, Sung Hyun Paick, Yong Soo Lho,
Hyeong Gon Kim
Department of urology, Konkuk university medical
center
Hong Wook Kim, Myung Soo Kim, Ho Song Yu, Seung
Cheol Yang, Sung Jun Hong, Jang Hwan Kim
Department of Urology & Yonsei Urological Science
Institute, Yonsei University College of Medicine,
Seoul, Korea
readjustable urethral sling
procedure (Remeex System®) for
male stress urinary incontinence
combined with anticholinergic
on daytime frequency in female
patients with overactive bladder
PK23 Comparison of clinical results
between TOT outside-in
midurethral slings and single
incision sling
91
94
95
retention after Holmium laser
enucleation of the prostate
91
97
Jumgbum Bae, Minsoo Choo, Jin-Kyu Oh1, Jae-Seung
Paick, Seung-June Oh
Hospital, Seoul, Korea; 1Department of Urology,
Gachon University Gil Hospital, Incheon, Korea
PK25 Heart rate variability in the
assessment of autonomic
dysfunction in patients with
chronic prostatitis/chronic pelvic
pain syndrome
92
96
Hana Yoon1, Jae Yup Hong2
1
Department of urology, Ewha Womans University
School of Medicine, Seoul, 2Cha University School of
Medicine, Gyoungi-do, Korea
PK24 Factors affecting de novo urinary
Hyung Jong Nam, Dong Gil Shin, Suk Gun Jung,
Young Hoon Choi, Jeong Zoo Lee
Department of Urology, Pusan National University
School of Medicine, Busan, Korea
PK18 The effect of resected prostate
93
Hayoung Kim
Department Urology, Kangdong Sacred Heart
Hospital, Hallym University, Seoul, Korea
Hee Jong Jeong , Dong Yup Han1, Jun Hwa Rho
1
Wonkwang University Hospital, Iksan, Korea;
2
Chistian Hospital, Gwang Ju, Korea
of the tension-free vaginal tape
(TVT) procedure for treating female
complication of BPH?
PK22 The effect of desmopressin
2
PK17 Single surgeon's 10 years results
93
Hong Wook Kim, Myung Soo Kim, Koon Ho Rha,
Sung Jun Hong, Jang Hwan Kim
Department of Urology & Yonsei Urological Science
Institute, Yonsei University College of Medicine,
Seoul, Korea
Hoon Jang1, Kwan-Hee Shin2, Won-Tae Kim3, YongJune Kim3, Seok-Joong Yoon3, Sang-Cheol Lee3, WunJae Kim3
1
Department of Urology, Daejeon Veterans Hospital,
Daejeon, 2Department of urology, Gongju Medical
Center, Gongju, 3Department of Urology, Chungbuk
National University College of medicine, Cheongju,
South Korea
PK16 Bladder pain syndrome treated with
PK20 Acute urinary retention is fearful
PK21 New surgical approach of tension
Hui Dai Lee, Sehwan Park, Dae Gi Jo, Joong Shik
Lee, Ju Tae Seo
Department of Urology, Cheil General Hospital,
Kwandong University College of Medicine, Seoul,
Korea
PK15 Clinical results of radical
overactive bladder in community
based survey
Hong sang Moon, Shin ah Kim1, Bo youl Choi1, Yong
tae Kim
Department of Urology and 1Preventive Medicine,
College of Medicine, Hanyang University
Hoon Ah Jang, Mi Mi Oh, Jae Hyun Bae, Jeong Gu
Lee
Korea university medical center, department of
urology, Seoul, Korea
PK13 Impact on sexual function and
PK19 Analysis of risk factors for
97
Jong Bo Choi1, Hyun Woo Kim2, JoonChul Kim2, Dae
Sung Cho1, Young Soo Kim1
1
Department of Urology, College of Medicine, Ajou
University and 2Department of Urology, College of
Medicine, Catholic University, Korea
PK26 The relation between the severity
of lower urinary tract symptom
and detection of prostate cancer in
transrectal prostate biopsy
Jeong Kyun Yeo, Dae Yeon Cho, Min Gu Park, Sang
Hyun Park, Seok San Park
Department of Urology, College of Medicine, Inje
University, Pusan, Korea
98
PK27 Therapeutic efficacy of bipolar
radio frequency thermal treatment
for patients with chronic prostatitis
99
Joonhwa Noh1, Juyoung Lim1, Jusung Kim1, Donghoon
Yoo1, Myungki Kim2, Heejong Jeong3, Jongyeon Kim4,
Youngwoong Park4
1
Department of Urology, Kwangju Christian
Hospital, Chonnam University medical School
Gwangju, 2Chonbuk University medical School,
Chonju, 3Wonkwang University School of Medicine,
Iksan, 4Naju Urologic Clinic, Korea
PK28 The efficacy and safety of the
REMEEX system in female stress
urinary incontinence patients with
a VLPP less than 60cmH2O
on voiding symptoms but not on
sexual function
100
101
Seong Jin Jeong, Jeong Geun Lee, Hyeon June Kim,
Byung Ki Lee, Young Min Choo, Jong Jin Oh, Chang
Wook Jeong, Cheol Yong Yoon, Sung Kyu Hong, SeokSoo Byun, Sang Eun Lee
Bundang Hospital, Seongnam, Korea
105
Young Hoon Choi, Hyung Jong Nam, Dong Gil Shin,
Suk Gun Jung, Jeong Zoo Lee
The Department of Urology, Pusan National
University School of Medicine, Busan, Korea
diode photoselective vaporization
of protate for benign prostatic
hyperplasia according to
postoperative period
PK38 The efficacy of tamsulosin and
102
106
tolterodine combination therapy in
female OAB patients
107
Young Sam Cho, Kwan Joong Joo, Chil Hun Kwon,
Heung Jae Park
Department of Urology, Kangbuk Samsung Hosptial,
Sungkyunkwan University School of Medicine
PK39 Improvement of cystometric
parameters in obstructed rat
bladder outlet by transplantation of
mesenchymal stem cells
103
Sung Chul Kam, Jeong Seok Hwa, Jae Seog Hyun
Department of Urology, College of Medicine,
Gyeongsang National University, Jinju, Korea
incontinence symptoms assessed
by the initial standard evaluation
including measurement of postvoid residual volume and a stress
test: are urodynamic studies still
needed?
105
Youl Keun Seong, Dong Woo Kim1, Keun Soo Kong2
1
Department of Urology, Maryknoll medical center,
Bongseng Hospital, 2Bumin Hospital, Busan, Korea
Joonhwa Noh1, Juyoung Lim, Jusung Kim1, Donghoon
Yoo1, Myungki Kim2, Heejong Jeong3, Jongyeon Kim4,
Youngwoong Park4
1
Department of Urology, Kwangju Christian
Hospital, Chonnam University medical School
Gwangju, 2Chonbuk University medical School,
Chonju, 3Wonkwang University School of Medicine,
Iksan, 4Naju Urologic Clinic, Korea
PK33 Women with pure stress urinary
variables and holmium laser
PK37 Analysis of the efficacy of K2
Kwang Woo Lee, Young Ho Kim, Dong Hwan Lee1
College of Medicine, Bucheon, 1The Catholic
University of Korea College of Medicine, Incheon,
Korea
by tamsulosin and solifenacin
combination therapy on erectile
function
continence in patients with roboticassisted radical prostatectomy
PK36 Relationship between preoperative
of painful bladder syndrome: is it
meaningful?
PK32 Impact of LUTS/BPH treatment
PK35 Techniques for early recovery of
Tae Hyo Kim, Won Yeol Cho
Department of urology, college of medicine,
Dong-A university, Busan, Korea
PK30 Diagnostic cystoscopy in outpatient 101
radio frequency thermal treatment
for patients with benign prostate
hyperplasia
104
Seung-June Oh1, Wen Ji Li2, Jong Min Kim3
Hospital, Seoul, Korea; 2Department of Urology
and Andrology, Ninth People’s Hospital, School of
Medicine, Shanghai Jiaotong University, Shanghai,
China; 3Laboratory of Veterinary Surgery, College of
Veterinary Medicine, Chungbuk National University,
Cheongju, Korea
Kweonsik Min1, Jiyeon Jun1, Dongil Kang1, Jangho
Yoon1, Hyunwoo Kim2
1
Department of Urology, Pusan Paik Hospital, Inje
University and 2Daedong Hospital, Busan, Korea
PK31 Therapeutic efficacy of bipolar
on urodynamic procedure in female
cats
1
Jung Yoon Kang, Hee Joo Cho, Jeong Man Cho, Tak
Keun Yoo
Department of Urology, Eulji Hospital, Eulji
University School of Medicine, Seoul, Korea
PK29 Menopause impacts negatively
PK34 Effects of level of consciousness
Yun Seob Song1, Hong Jun Lee2, Seung Hwan Doo1,
Won Jae Yang1, Sun Ju Lee3, Seung U. Kim2
1
School of Medicine, 2Medical Research Institute,
Chung-Ang University College of Medicine,
3Department of Urology, Kyunghee University
School of Medicine Seoul, Korea
PK40 Transrectal ultrasound
103
107
measurement of bladder wall
thickness is associated with lower
urinary tract storage symptom in
men
Hong Sang Moon, Joong Soo Park, Yong Tae Kim
Department of Urology, College of Medicine,
Hanyang University, Seoul, Korea
108
PJ05 ATP release in urothelium upon
stimulation with stretch, especially
focusing on the accumulated ATP
in secretory vesicle via VNUT and
subsequent exocytosis
110
in patients with benign prostatic
obstruction (BPO) is correlated
with severity of symptoms and
response to medical treatment
PJ11 Antimuscarinic agents bind to rat
urothelial muscarinic receptors
with high affinity
activation on the primary bladder
afferent activities of the rat
111
periodontal disease
traumatic and iatrogenic posterior
urethral disruption
Haruaki Kato, Tomoaki Tanabe, Hitoshi Yokoyama,
Shinya Kobayashi, Hiroya Mizusawa, Osamu
Nishizawa
Department of urology, Shinshu University School
of Medicine, Matsumoto, Japan
115
116
Teruhiko Tsuru, Isao Araki, Shigehisa Kubota, Ryo
Ikari, Takuya Maezawa, Tetsuya Yoshida, Yusaku
Okada, Satoru Kira, Yaburu Haneda, Hideki
Kobayashi, Masayuki Takeda
Department of Urology, Shiga University of Medical
Science; Department of Urology, University of
Yamanashi Faculty of Medicine
PJ13 Effect of silodosin on detrusor
111
overactivity in the male
spontaneously hypertensive rat
112
hypertension-related detrusor
overactivity in the SHR
119
Motoaki Saito, Fumiya Ohmasa, Panagiota Tsounapi,
Seiya Inoue, Harunori Iwata, Yukako Kinoshita and
Keisuke Satoh
Division of Molecular Pharmacology, Tottori
University School of Medicine
PJ15 Comparative characterization
113
117
Seiya Inoue1, Motoaki Saito2, Panagiota Tsounapi1,2,
Fotios Dimitriadis1,2, Fumiya Ohmasa2, Yukako
Kinoshita2, Keisuke Satoh2 ,Atsushi Takenaka1
1
Division of Urology, Tottori University School of
Medicine, 36-1 Nishi-machi, Yonago, 683-8503,
Japan; 2Division of Molecular Pharmacology, Tottori
University School of Medicine, 86 Nishi-machi,
Yonago, 683-8503, Japan
PJ14 Nicorandil ameliorates
Seiji Matsumoto, Mitsuyoshi Matsuda1, Masaki
Watanabe, Naoki Wada, Masafumi Kita, Hidehiro
Kakizaki
Department of Renal and Urologic Surgery, and
the 1Department of Oral and Maxillofacial Surgery,
Asahikawa Medical University, Asahikawa, Hokkaido,
Japan
PJ09 Surgical reconstruction for
PJ12 Effects of concurrent prolapse
repair on TOT sling outcomes
Naoki Aizawa1, Jean-Jacques Wyndaele2, Yukio
Homma3, Yasuhiko Igawa1
1
Department of Continence Medicine, The
University of Tokyo Graduate School of Medicine,
Tokyo, Japan; 2Department of Urology, Faculty of
Medicine, University of Antwerp, Antwerp, Belgium;
3
Department of Urology, The University of Tokyo
Graduate School of Medicine, Tokyo, Japan
PJ08 Association of LUTS with chronic
114
Shizuo Yamada, Yusuke Fuchihata, Masaki Ogoda,
Akira Yoshida
1
Department of Pharmacokinetics and
Pharmacodynamics and Global Center of Excellence
(COE) Program, School of Pharmaceutical Sciences,
University of Shizuoka, Shizuoka, Japan
Katsumi Sasaki1, Toyohiko Watanabe1, Miyabi Inoue1,
Aayano Ishii1, Motoo Araki1, Shinya Uehara1, Hiromi
Kumon1, Teruhiko Yokoyama2, Atsushi Nagai2, Hitoshi
Takamoto3
1
Depatment of Urology, Okayama Univesity,
2
Kawasaki Medical University, 3Kurashiki Medical
Center, Okayama, Japan
PJ07 Effects of TRPV4 cation channel
in detrusor overactivity induced by
cold stress in ovariectomized rats
Wataru Noguchi1, Tetsuya Imamura1,2, Osamu
Ishizuka1,2, Yoshiki Kurizaki1, Zhong Lei1, Takahiro
Yamagishi1, Osamu Nishizawa1,2
1
Department of Urology, Shinshu University School
of Medicine, Matsumoto, Japan; 2Department of
Lower Urinary Tract Medicine, Shinshu University
School of Medicine, Matsumoto, Japan
Hiroshi Nakagomi1, Tsutomu Mochizuki1, Tatsuya
Miyamoto1, Satoru Kira1, Mitsuharu Yoshiyama1,
Isao Araki2, Yoshinori Moriyama3, Schuichi Koizumi4,
Masayuki Takeda1
1
Department of Urology, Interdisciplinary Graduate
School of Medicine and Engineering, University
of Yamanashi, Yamanashi, Japan; 2Department of
Urology, Shiga University of Medical Science, Shiga,
Japan; 3Department of Membrane Biochemistry,
Okayama University Graduate School of Medicine,
Density, and Pharmaceutical Science, Okayama,
Japan; 4Department of Neuropharmacology,
Interdisciplinary Graduate School of Medicine and
Engineering, University of Yamanashi, Yamanashi,
Japan
PJ06 Urinary nerve growth factor level
PJ10 Roles of alfa1-adrenergic receptors
of muscarinic receptor binding
activity of fesoterodine and its
active metabolite for treatment of
overactive bladder
Akira Yoshida, Yusuke Fuchihata, Masaki Ogoda,
Yoshihiko Ito and Shizuo Yamada
Department of Pharmacokinetics and
Pharmacodynamics and Global Center of Excellence
(COE) Program, School of Pharmaceutical Sciences,
University of Shizuoka, Shizuoka, Japan
120
PJ16 Excitatory effect of propiverine
hydrochloride on urethral activity
in rats
121
Katsumi Kadekawa1,2, Saori Nishijima1, Katsuhiro
Ashitomi1, Hideyuki Yamamoto3, Kimio Sugaya1
1
Southern Knights’ Laboratory LLP, Okinawa, Japan;
2
Department of Urology, Okinawa Kyodo Hospital,
Okinawa, Japan; 3Department of Biochemistry
Graduate School of Medicine, University of the
Ryukyus, Okinawa, Japan
PJ17 Dutasteride relieves obstruction
and suppresses urinary oxidative
stress in patients with LUTS/BPH
controlled study of two different
antimuscarinic agent, imidafenacin
and solifenacin, in Japanese
PJ23 Comparison of the efficacy of
123
factors including urodynamic
assessment for urinary morbidity
which occurred within 12 month
after permanent iodine-125
prostate brachytherapy
124
can have dry mouth and
constipation before treatment with
anticholinergic agents
124
study of the evaluation of voiding
condition before and after
transobturator tension-free vaginal
tape (TOT) procedure in female
Satoru Kira1, Araki Isao2, Yaburu Haneda1, Norifumi
Sawada1, Hideki Kobayashi1, Masayuki Takeda1
1
Department of Urology, University of Yamanashi
Faculty of Medicine; 2 Department of Urology, Shiga
University of Medical Science
PT05 The correlation between voiding
129
hyaluronic acid instillation with
different regimens for interstitial
cystitis/painful bladder syndrome
126
131
Wei-Chih Chen1, Ming-Huei Lee1,2, Chui-De Chiu3,
Yi-Chang Chen1, Huei-Ching Wu1,2
1
Department of Health, Taiwan; 2Central Taiwan
University of Science and Technology; 3National
Taiwan University of clinical psychology, Taipei,
Taiwan
PT06 Comparison of intravesical
132
Ming-Chih Lai1, Yuh-Chen Kuo2, Jia-Heng Shie3,
Qian-Sheng Ke3, Hann-Chorng Kuo3
1
Department of Urology, Taitung Christian Hospital,
Taitung, Taiwan; 2Department of Urology, Taipei City
Hospital, Taipei, Taiwan; 3Department of Urology,
Buddhist Tzu Chi General Hospital, Hualien, Taiwan
PT07 The alteration of glomerulation
and angiogenic molecules change
after botulinum toxin A therapy in
interstitial cystitis/painful bladder
syndrome
Hisae NISHII 1,2, Kayoko ITO 3, Makoto INOUE 4,
Kiyoko FUKAI 5, Tetsuro MATSUMOTO 1
1
Department of Urology, University of Occupational
and Environmental Health, Japan; 2Fukuoka Institute
of Occupational Health, Japan; 3Geriatric Dentistry,
Niigata University Medical and Dental Hospital;
4
Department of Oral Biological Science, Division
of Dysphagia Rehabilitation, Niigata University
Graduate School of Medical and Dental Sciences;
5
Graduate School of Health Sciences, Okayama
University
PJ21 A retrospective, single-center
medicines for urinary incontinence
in rats with stress urinary
incontinence
symptoms, urodynamic findings
and maximum bladder capacity in
patients with ketamine-induced
cystitis (KIC)
Yoshiyuki Ishiura1, Hiroshi Yaegashi1, Kiyoshi
Koshida1, Yasuo Saito2
1
Department of Urology and 2Radiology, NHO
Kanazawa Medical Center, Kanazawa, Japan
PJ20 Overactive bladder patients
128
Saori Nishijima1, Kimio Sugaya1, Katsumi
Kadekawa1, Katsuhiro Ashitomi1, Hideyuki
Yamamoto2
1
Southern Knights’ Laboratory, LLP; 2Department of
Chemistry, University of the Ryukyus
Yokoyama T1, Ohbatake A1, Fujii T1, Jo Y1, Miyaji Y1,
Nagai A1, Koide T2, Furukawa Y2
1
Department of Urology, Kawasaki Medical School,
Kurashiki, Japan, 2Kasaoka Daiichi Hospital, Kasaoka,
Japan
PJ19 The investigation of predictive
parallel study of the effectiveness
and safety of solifenacin versus
propiverine in the treatment of
overactive bladder
Tomonori Yamanishi
Department of Urology, Dokkyo Medical University,
Tochgi, Japan
Naoki Wada, Seiji Matsumoto, Masafumi Kita,
Masaki Watanabe, Hidehiro Kakizaki
Department of Renal and Urologic Surgery,
Asahikawa Medical University, Japan
PJ18 A prospective randomized
PJ22 A randomized, single-blind,
133
Jia-Heng Shie1, Hsin-Tzu Liu1, Yuh-Chen Kuo2,
Hann-Chorng Kuo1
1
Taipei City Hospital, Taipei, Taiwan
PT08 Serum C-reactive protein is
127
associated with storage but not
with empty symptoms in men with
lower urinarytract symptoms
Shiu-Dong Chung1, Victor C. Lin2, Jing-Ling Chen3,
Hann-Chorng Kuo3
1
Department of Urology, Far Eastern Memorial
E-DA Hospital, Kaohsiung, Taiwan; 3Department of
Urology, Buddhist Tzu Chi General Hospital, Hualien,
Taiwan
135
PT09 Sexual dysfunction in women with
ketamine cystitis - a case control
study
136
Yung-Shun Juan1,2,3, Mei-Yu Jang4, Cheng-Yu Long5,6,
Shu-Mien Chuang1, Chun-Hsiung Huang2,3, Wen-Jen
Wu2,4
1
Graduate Institute of Medicine, College of
Medicine, Kaohsiung Medical University, Kaohsiung,
Taiwan; 2Department of Urology, College of
Taiwan; 3Department of Urology, Kaohsiung
Medical University Hospital, Kaohsiung, Taiwan;
4
Department of Urology, Kaohsiung Municipal
Hsia-Kang Hospital, Kaohsiung, Taiwan; 5Center of
Excellence for Environmental Medicine, College of
Taiwan; 6Department of Obstetrics and Gynecology,
Kaohsiung Municipal Hsia-Kang Hospital,
Kaohsiung, Taiwan
PT10 The correlation of urinary bladder
weight and glomerulation in female
interstitial cystitis/painful bladder
syndrome
characteristics of adult women
with dysfunctional voiding
PT16 Traumatic experience and
subjective symptom scores in
women with interstitial cystitis/
painful bladder syndrome (IC/PBS)
in Taiwan
137
formation of interstitial cystitis
patients
1,3
significantly correlate with
nocturia in men aged 40–79 years
138
139
140
characteristics between female
patients with interstitial cystitis/
bladder pain syndrome and
overactive Bladder
Yu-Wen Huang, Yu-Hua Fan, Alex Tong-Long Lin,
Kuang-Kuo Chen
Veterans General Hospital, and Department of
Urology, School of Medicine, National Yang-Ming
University, Taipei, Taiwan
monotherapy is safe and effective
for men with predominant
international prostate symptom
score storage subscore based on
IPSS-voiding/storage ratio
PT19 Lower urinary tract symptoms
and quality of life in the patient
underwent radical cystectomy and
orthotopic neobladder
Josh Wei-Tang Kao1, Yu-Hua Fan1,2, Alex Tong-long
Lin1,2, Kuang-Kuo Chen1,2
1
Veterans General Hospital; 2Department of Urology,
School of Medicine, National Yang-Ming University,
Taipei, Taiwan.
PT14 The differences in urodynamic
144
145
Chun-Hou Liao1, Shiu-Dong Chung2, Victor C. Lin3,
Hann-Chorng Kuo4
1
Department of Urology, Cardinal Tien Hospital,
Memorial Hospital, Taipei, Taiwan; 3Department
of Urology, E-DA Hospital, Kaohsiung, Taiwan;
4
Hospital, Hualien, Taiwan
Jane-Dar Lee , Ming-Huei Lee
1
Taichung Armed Forces General Hospital;
2
Department of Health; 3Central Taiwan University of
Science and Technology, Taiwan
female urinary retention
143
Chun-Hou Liao1,2, Han-Sun Chiang1, Hong-Jeng Yu2
1
Cardinal Tien Hospital; College of Medicine, Fu Jen
Catholic University, Taipei, Taiwan; 2Department of
Urology, National Taiwan University Hospital and
College of Medicine, National Taiwan University,
Taipei, Taiwan
PT18 First-line antimuscarinic
2,3
PT13 Etiology and prognosis of acute
141
Wei-Chih Chen1, Ming-Huei Lee1,2, Chiu-De Chiu3,
Huei-Ching Wu1,2, Yi-Chang Chen1
1
University of Science and Technology; 3Department
of Psychology, National Taiwan University, Taipei,
Taiwan
PT17 Serum testosterone levels
Yih-Chou Chen1, Jing-Ling Chen2, Hann-Chorng
Kuo2
1
Department of Urology, Hualien Hospital, Hualien,
Taiwan; 2Department of Urology, Buddhist Tzu Chi
PT12 Hypoxia involved glomerulation
botulinum toxin A injections on
teatment of refractory interstitial
cystitis/painful bladder syndrome--preliminary results
Yuh-Chen Kuo1, Jia-Heng Shie2, Hsin-Tzu Liu2,
Hann-Chorng Kuo2
1
Department of Urology, Taipei City Hospital, Taipei,
Ming-Huei Lee1,2, Huei-Ching Wu1,2, Yi-Chang
Chen1, Wei-Chih Chen1, Yung-Fu Chen1,2
1
University of Science and Technology
PT11 Clinical and videourodynamic
PT15 Effect of repeated intravesical
146
Eric Chieh-Lung Chou, Hung-Chieh Chiu, ChaoHsiang Chang, Hsi-Chin Wu, Che-Rei Yang
Department of Urology, China Medical University
Hospital, Taichung, Taiwan
140
PT20 Urodynamic examination with
potassium chloride (KCL) test in
women with interstitial cystitis/
painful bladder syndrome (IC/PBS)
Wei-Chih Chen1, Ming-Huei Lee1,2, Yi-Chang Chen1,
Ya-Ling Chen1, Huei-Ching Wu1,2
1
University of Science and Technology
147
PT21 Differences in the subjective
symptoms, urodynamic
examination and cystoscopic
maximal bladder capacity of
Interstitial Cystitis/ Painful
Bladder Syndrome (IC/PBS) in
Women With or Without Sexual
pain
148
are elevated in type 2 diabetic
patients aged less than 45 years
old and correlated with erectile
dysfunction but not lower urinary
tract symptoms
PT27 The role of C-reactive protein in
the diagnosis of women with lower
urinary tract symptoms
149
and urinary incontinence and their
associated factors among middle
and elder people in Taiwan
hyaluronic acid for interstitial
cystitis/bladder pain syndrome
150
151
Yu-Hua Fan, Alex T.L, Lin, Kuan-Kuo Chen, Luke S
Chang
Veterans General Hospital, and School of Medicine,
National Yang-Ming University, Taipei, Taiwan
Chia-Min Yang, Alex TL Lin, Chih-Chieh Lin,
Kuang-Kuo Chen
Veterans General Hospital, and Department of
Urology, National Yang-Ming University, School of
Medicine, Taipei, Taiwan
Fei-Chi Chuang1, Kuan-Hui Huang1, Qian-Sheng
Ke2, Sheng-Mou Hsiao3, Hann-Chorng Kuo2
1
Department of Obstetrics and Gynecology, Chang
Gung Memorial Hospital, Kaohsiung, Taiwan;
2
Hospital, Hualien, Taiwan; 3Department of Obstetrics
and Gynecology, Far Eastern Memorial Hospital,
Taipei, Taiwan
PT30 Progression of lower urinary tract
symptoms after discontinuation
of one medication from twoyear combined alpha-blocker and
5-alpha-reductase inhibitor therapy
for benign prostatic hyperplasia in
men
Chun-Hou Liao1, Shiu-Dong Chung2, Chung-Cheng
Wang3, Victor C. Lin4, Hann-Chorng Kuo5
1
Department of Urology, Cardinal Tien Hospital,
of Urology, En Chu Kong Hospital, Taipei, Taiwan;
4
Department of Urology, E-DA Hospital, Kaohsiung,
bladder inflammation the
urothelium exhibits a loss of
inhibtory function on the detrusor
and an increased expression of
TRPV1
156
videourodynamic characteristics of
women with clinically unsuspected
bladder outlet obstruction
and antimuscarinics in male lower
urinary tract symptoms based on
international prostate symptom
Score (IPSS) subscore ratio
PT25 In lipopolysaccharide-induced
154
PT29 Lower urinary tract symptoms and 157
Aih-Fung Chiu1, Hung M2, Chun-Hou Liao3, HannChorng Kuo4
1
Institute of Medical Sciences, Tzu Chi University,
Hualien, Taiwan; 2Department of Nursing, Meiho
University, Pingtung, Taiwan; 3Department of
Urology, Cardinal Tien Hospital, Taipei, Taiwan;
4
PT24 Therapeutic effect of α-blockers
153
Sheng-Mou Hsiao1, Fei-Chi Chuang2, Hann-Chorng
Kuo3
1
Department of Obstetrics and Gynecology,
Far Eastern Memorial Hospital, Taipei, Taiwan;
2
Department of Obstetrics and Gynecology, Chang
Gung Memorial Hospital, Kaohsiung, Taiwan;
3
PT28 Extended course of intravesical
Chung-Cheng Wang1, Hsin-Tzu Liu2, Hann-Chorng
Kuo2
1
Department of Urology, En Chu Kong Hospital,
Taipei, Taiwan; 2Department of Urology, Buddhist
Tzu Chi General Hospital, Hualien, Taiwan
PT23 Prevalence of overactive bladder
laser prostatectomy: a randomized
prospective study by a single
surgeon
Chung-Cheng Wang
Department of Urology, En Chu Kong Hospital,
Taipei, Taiwan
Huei-Ching Wu1,2, Wei-Chih Chen1, Ming-Huei
Lee1,2, Chui-De Chiu3 ,Yi-Chang Chen1
1
University of Science and Technology; 3National
Taiwan University of clinical psychology, Taipei,
Taiwan
PT22 Urine nerve growth factor levels
PT26 Green light laser versus thulium
153
158
Victor C. Lin1, Shiu-Dong Chung2, Chun-Hou Liao3,
Hann-Chorng Kuo4
1
Taiwan; 2Department of Urology, Far Eastern
of Urology, Cardinal Tien Hospital, Taipei, Taiwan;
4
PT31 Urinary incontinence might not
improve the evaluation of benign
prostatic obstruction by american
urological association symptom
index
Chih-Cheng Lu1, Jin-Sheng Roan2
1
Department of Management in Medical Records
& Information, Chi Mei Medical Center, Liouying,
Tainan, Taiwan; 2National Chung Cheng University,
Chiayi, Taiwan
160
161
PT32 Maximal uroflowmetry and
transrectal evaluation of prostate
before prostatic biopsy—a local
experience
PT36 Pharmacotherapy for underactive
detrusor related to diabetes in
female
Wei-Che Wu1, Bin Chiu1, Shiu-Dong Chung1,2
1
Department of Surgery, Far Eastern Memorial
Hospital, Ban Ciao, Taipei, Taiwan; 2Department of
Urology, National Taiwan University Hospital, Taipei,
Taiwan
Chih-Cheng Lu, Chia-Ho Lin, Dennis Chian-Shiung
Lin, Wen-Chou Fan, Tse-Chou Cheng
Divisions of Urology, Department of Surgery, Chi
Mei Medical Center, Liouying, Tainan, Taiwan
161
PT33 Urinary storage symptoms in
patients with chronic heart failure
Aih-Fung Chiu1, Chun-Hou Liao2, Chung-Cheng
Wang3, Hann-Chorng Kuo4
1
Institute of Medical Sciences, Tzu Chi University,
Hualien, Taiwan; 2Department of Urology, Cardinal
Tien Hospital, Taipei, Taiwan; 3Department of
Urology, En Chu Kong Hospital, Taipei, Taiwan;
4
PT37 The role of non-adrenergic noncholinergic neurotransmission
in ketamine-induced bladder
dysfunction
PT38 Urethrovestibular reflux: an
163
score is not suitable for assessing
emptying lower urinary tract
dysfunction in women
unusual cause of daytime
incontinence in young girls – two
cases report and review of the
literature
Su Chia-Cheng1, Shang-Jen Chang2, Stephen Shei Dei
Yang2
1
Division of Urology, Department of Surgery, Chi Mei
Medical Center, Tainan, Taiwan; 2Buddhist Tzu Chi
General Hospital, Taipei Branch, New Taipei, Taiwan;
Scool of Medicine, Buddhist Tzu Chi University,
Hualien, Taiwan
Victor C. Lin1, Chun-Hou Liao2, Shiu-Dong Chung3,
Hann-Chorng Kuo4
1
Taiwan; 2Department of Urology, Cardinal Tien
4
PT35 International prostate symptom
166
E. Meng, T. L. Cha, G. H. Sun, D. S. Yu, S.Y. Chang
Division of Urology, Department of Surgery, TriService General Hospital, National Defense Medical
Center, Taipei, Taiwan
PT34 Benign prostate hyperplasia with
high prostate specific antigen
levels fares the same treatment
outcome of combined therapy with
5-alpha-reductase inhibitor and
alpha-blocker as low PSA level
166
164
Sheng-Mou Hsiao1, Qian-Sheng Ke2, Yih-Chou
Chen3, Hann-Chorng Kuo2
1
Department of Obstetrics and Gynecology,
2
Hualien Hospital, Hualien, Taiwan
6th PPCS Meeting Staff / Co-organizer / Sponsor
6th PPCS Meeting Staff
General secretary: Chih-Chieh Lin, M.D., Yao-Chi Chuang, M.D.
TCS staff: Ms. Mu-Jung Chung, Ms. Chia-Chen Hsu
Co-organizer
Department of Urology, Veterans General Hospital, Taipei
Sponsored by
National Science Council
167
The 6th Pan-Pacific
Continence Society Meeting
Pre-PPCS Symposium:
Bob Levin - Asia Connection
Pre-PPCS Symposium: Bob Levin-Asia Connection
What I have learned from Bob
Alex TL Lin
Department of Urology, Taipei Veterans General Hospital; National Yang Ming University, Taipei, Taiwan
First thing I learned from Bob is that a teacher can be kind and nice. It was in 1987 when I met Bob for the first
time in Philadelphia airport. I did not expect that my teacher would come to airport to pick up me. In Asia, teachers
typically are quite serious with authority that no one would imagine that teachers go to the airport to pick up their students.
Bob helped me to settle down in Philadelphia and invited me to his home once a while. With his kindness, my tension as
a foreigner working in a brand new environment was greatly eased. So I learn that kindness and patience to the students is
important for being a good teacher.
Another important thing I learned from Bob is how to do bladder research. I did not have training on basic science
research before I went USA. Bob taught me how to do cystometry on animals and how to do organ bath study. Quickly
I started my project on bladder ischemia and submitted an abstract to AUA annual meeting. I was quite happy to present
my first AUA paper in Boston in 1988. My subsequent works on subtotal cystectomy and detrusor glucose metabolism
further strengthened my research ability and knowledge. From Bob, I also learned how to write, submit and respond
to reviewers’ questions. Thanks to Bob’s teaching and his role model, now I can do what he did to me to my students:
teaching bladder research and scientific paper writing.
What most fruitful to me during my 1-year stay in Bob Lab is to establish self confidence and to broaden my
scope of functional urology. Bob always could pick up some good points from the data that I did not suppose to be
good to encourage me to work further. With his encouragement, my experiments were usually successfully done. After
1-year study with Bob, from an inexperienced one I became a trained scholar who can confidently give presentations in
international meetings and publish scientific papers in reputable journals. What I learned from Bob solidly helps me to
develop my career.
Thanks Bob!
The 6th Pan-Pacific Continence Society Meeting
The effects of prolapse mesh operation no QoL and LUTS
Kumiko Kato, Shoji Suzuki, Shigeki Yamamoto, Kenichi Furuhashi, Koichi Suzuki, Tatsuro Murase, Momokazu Gotoh
Japanese Red Cross Nagoya First Hospital; Nagoya University Graduate School of Medicine
Female pelvic floor dysfunction had been an underestimated medical field in Japan until recently. In 1986, Prof.
Atsuo Kondo and I opened the first female continence clinic in Japan at Nagoya University. Japanese urologists began
to use needle bladder neck suspension such as Stamey procedure in 1980's and have shifted to midurethral slings (TVT
and TOT) since 1999. I myself was suffered from stress urinary incontinence after late childbearing and underwent TVT
procedure by Prof. Momokazu Gotoh. I sometimes talk about this episode for continence promotion.
Regarding the treatment of pelvic organ prolapse (POP) in Japan, vaginal hysterectomy with colporraphy and
colpocleisis have been traditionally performed by gynecologists whereas anterior colporraphy has often been done by
urologists. In 2004, the tension-free vaginal mesh (TVM) procedure was published by a French group, and standardized
mesh prolapse kits are now commercially available worldwide. As no such kits have had governmental approval in Japan
yet, Prof. Makoto Shimada and Dr. Masami Takeyama have begun to cut soft polypropylene mesh into a similar shape
as Prolift with a paper pattern and to insert their arms through the obturator foramen and sacrospinous ligament using
custom-made needles. Prolapse mesh operation is now becoming popular among Japanese urologists and gynecologists by
its low-invasiveness, uterine preservation, easy applicability to post-hysterectomy cases.
In this Pre-PPCS Symposium (Bob Levin-Asia Connection), I would like to talk about 1) outcomes and quality of
life (QoL) of TVM repair in elderly women and 2) practice patterns of prolapse mesh operation in Japan.
Outcomes and QoL of TVM Repair in Elderly Women
As the aging population is rapidly increasing in many countries, urgent demands for the POP treatment of elderly
women have emerged. Transvaginal mesh repair is expected to be one surgical option suitable for the elderly due to its
less invasiveness though there is criticism on mesh-related complications.
Between 2006 and 2008, 505 consecutive women with POP quantification (POP-Q) stage III or IV underwent
TVM repair in our institution. Afterwards they were stratified into three age groups; young (≤64 years, n=197), youngold (65-74 years, n=213), and old-old (≥75 years, n=95) group. Concomitant anti-incontinence procedures were avoided,
and concomitant hysterectomy was restricted to 5 patients with cervical or ovarian pathology. POP-Q scale, prolapse-QoL
questionnaire (P-QoL), international consultation on incontinence questionnaires short form (ICIQ-SF), and overactive
bladder symptom score (OABSS) were assessed before and one year after operation in each age group.
The mean operative time was 52 minutes and mean intraoperative blood loss was 18 mL. Perioperative
complications included 17 cases (3.4%) of bladder injury, and 1 case each consisting of rectal injury, blood loss over 200
mL, and temporary hydronephrosis. Residual urine during hospitalization remained over 50 mL in 25 patients (5.0%),
but none required clean intermittent catheterization at home. Within one-year follow-up, 8 patients (1.6%) had vaginal
mesh exposure. These operative features and complications did not differ by age groups. When prolapse recurrence is
defined as POP-Q stage II or higher, 74 (37.6%) of ≤64 years group, 57 (26.8%) of 65-74 years group and 17 (17.9%) of ≥
75 years group were classified as recurrence; younger group had more recurrence. However, vast majority of them were
asymptomatic "point Aa failure" and only 5 cases (1.0%) necessitated re-intervention. Later dissection up to distal urethra
and increasing mesh fixation points were useful to prevent distal retraction of the mesh. A total of 36 patients required
a second-stage midurethral slings due to persistent or de novo stress incontinence. All age groups showed significant
postoperative improvements in QoL domains of P-QoL. Prolapse and urinary symptom scores of P-QoL except stress
urinary incontinence improved significantly in all age groups. ICIQ-SF and OABSS showed significant improvement
of urinary incontinence and OAB, respectively. Treatment of prolapse with TVM technique seems to be a feasible and
effective surgical option in the elderly population.
Practice Patterns of Prolapse Mesh Operation in Japan
We wanted to compare the practice patterns of prolapse surgery between gynecologists and urologists and estimate
the complication rates of mesh surgery in Japan. We handed out a questionnaire to the doctors attending a national
meeting about mesh prolapse surgery in 2010. A total of 118 (46% of members, 59% of attendants) responded the
questionnaire. The mean age of respondents was 44.0 +/- 9.1 years, and 46% of them were gynecologists and 54% were
urologists. As the preoperative evaluation of prolapse, gynecologists performed more transvaginal ultrasound, cervical
and endometrial cytology, while urologists performed more residual urine examination, urodynamics, and cystography.
All urologists and 78% of gynecologists were doing anti-incontinence surgery whether more gynecologists (93%) than
urologists (73%) were doing non-mesh surgery for prolapse. Considering the operative indications of prolapse, 98%
performed mesh surgery on patients including initial cases, and 2% restricted it to recurrent or post-hysterectomy cases. A
total of 11935 Prolift-type mesh prolapse surgery were done within 4 years and the complications included bladder injury
(1.6%), rectal injury (0.3%), ureteral injury (0.1%), fistula (0.03%), bleeding requiring blood transfusion (0.2%) or vascular
embolization (0.02%), mesh erosion (2.8%), and recurrence requiring reoperation (1.1%). Although complications did not
differ between specialty, bladder injury, blood transfusion and mesh erosion were less prevalent in surgeons with larger
experience of mesh surgery.
Research on LUTD associated with metabolic disorders
Yat-Ching Tong
Department of Urology, National Cheng Kung University, Tainan, Taiwan
This presentation recapitulates a series of laboratory research we performed in the study of the effects of metabolic
disorders on the lower urinary tract.
Bladder synaptosomes, or nerve ending particles, were first successfully isolated from the rat using the technique
of differential centrifugation in a discontinuous sucrose gradient. Measurement of the neurotransmitter concentrations
showed almost 4-fold increases of the acetylcholine, norepinephrine and epinephrine in the nerve endings of STZinduced diabetic rat bladder. This suggested a defective neurotransmitter release function in diabetic neuropathy. By
using Western and Northern blotting techniques, the bladder M2 and M3 muscarinic receptor protein and mRNA were
measured. It was found that in 2-week diabetic rats, the protein and m-RNA of both subtypes were significantly increased
in both bladder urothelium and muscle layer when compared with the controls. The up-regulation of M2 receptors is
interesting since it can theoretically related to bladder overactivity. The role of sorbitol, a product of glucose metabolism,
in the pathogenesis of diabetic cystopathy was also studied. Administration of sorbitol to rats could induce similar M2
muscarinic receptor up-regulation in the bladder. Treatment for 14 days with an aldose reductase inhibitor ONO-2235,
significantly alleviated the change in 2-week STZ-induced diabetic rats. Additional the drug also restored NGF expression
in 9-week diabetic rats. On the other hand, a traditional Chinese herbal preparation, Ba-Wei-Die-Huang-Wan was tested
effective in reversing the effect of diabetes on the rat bladder. Moreover, the effect of diabetes on the prostate was studied
in the 2-week STZ-induced rats. Increased in alpha-1A adrenoceptor expression was demonstrated, suggesting a state of
“diabetic prostatopathy”.
The effect of metabolic syndrome on the lower urinary tract is currently a hot topic. We showed in fructose-fed
obese rats, a rodent model of metabolic syndrome, increases in bladder muscarinic receptors, both M2 and M3 subtypes.
Functionally, the fructose rats also showed urodynamic evidence of detrusor overactivity. In the rat prostate, metabolic
syndrome induced glandular enlargement and hyperplasia associated with impaired perfusion. These new findings have
guided us to a new direction of understanding the pathogenesis leading to clinical BPH.
Pathophysiological studies of overactive bladder and bladder motor
dysfunction in a rat model of metabolic syndrome
Hong-Jeng Yu
Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
Purpose
We studied bladder motor dysfunction and searched for markers of neurogenic and myogenic alterations among
fructose fed rats with or without abnormal voiding behavior.
Materials AND Methods
Female Wistar rats were fed with a fructose rich diet (60%) or a normal diet for 6 months. Based on cystometry
and voiding behavior the fructose fed rats were divided into 3 groups, including a group with normal detrusor function
with normal micturition frequency, a group with detrusor overactivity with increased micturition frequency and a group
with acontractile detrusor with increased micturition frequency. Denuded bladder tissues were obtained to assess in vitro
detrusor contractility, postsynaptic receptors, smoothelin, nitrosative products and the intrinsic pathway of apoptosis.
Results
Fructose fed rats with abnormal voiding behavior had obvious neurogenic and myogenic alterations, including
increased expression of postsynaptic receptors, dysregulation of smoothelin and decreased expression of Bcl-2 with a
subsequent increase in apoptotic cells in the bladder stroma, causing decreased carbachol induced contractility. Rats with
detrusor overactivity were also insulted by nitrosative stress associated with nitrotyrosine up-regulation in the bladder
tissue. Up-regulation of M(2) and M(3)-muscarinic receptors, and P2X(1) receptors appeared to be generalized alterations
of fructose fed rats and not exclusive to those with detrusor overactivity.
Conclusions
Up-regulation of postsynaptic receptors and dysregulation of smoothelin contribute to overactive bladder symptoms
in rats with metabolic syndrome. Nitrosative stress and decreased Bcl-2 expression lead to bladder muscle cell loss via the
intrinsic pathway of apoptosis, which may further deteriorate bladder function.
Effect of tamsulosin on bladder blood flow and bladder function in a rat
model of bladder overdistension/emptying-induced bladder overactivity
Seiji Matsumoto
Department of Renal and Urologic Surgery, Asahikawa Medical University
Purpose
The decreases in bladder blood flow (BBF) have recently been studied as one of the pathophysiologic causes
of bladder overactivity. In this study, we developed a rat model of bladder overdistension/empting-induced bladder
overactivity and investigated the effect of tamsulosin, an α1-adrenoceptor antagonist, on BBF and bladder function in this
model.
Materials and Methods
The bladder was distended with 2 mL of saline under anesthesia for 2 h (overdistension) and then emptied (emptying).
BBF was measured using a perfusion imager. Micturition behavior and parameters were observed using a metabolic cage
and cystometry method, respectively, from 2 h after bladder emptying. After model establishment was confirmed the effect
of tamsulosin were investigated using metabolic cage in tamsulosin (1 μg/kg/h) pre-treated rats, respectively.
Results
Reduction in BBF was observed on overdistension, with partial recovery on emptying. Bladder overdistension/
emptying increased micturition frequency and decreased mean voided volume in the micturition recording study, and
decreased intercontraction interval and voided volume without affecting micturition pressure, threshold pressure and
residual volume in the cystometry study. One-week continuous treatment with tamsulosin increased BBF after bladder
emptying, resulting in the decrease in micturition frequency and the increase in voided volume.
Conclusions
We demonstrated that bladder overdistension/emptying induces BBF reduction/partial recovery and causes bladder
overactivity. In addition, findings in tamsulosin-treated rats confirmed the potencies of tamsulosin to increase BBF and
ameliorate bladder overactivity.
Keywords: bladder blood flow, overdistension, bladder overactivity, α1-adrenoceptor antagonist, rat
Androgen deficiency in Taiwanese males
Shih-Ping Liu
Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
The metabolic syndrome (MetS) has drawn world-wide attention due to its association with an increased risk of
cardiovascular disease. Low serum testosterone (T) is considered to be a risk factor of MetS in men.
A study is conducted in Taiwanese men older than 40 years who were recruited through media in 2008.
Anthropometric characteristics, including blood pressure, height, body weight and waist circumference were measured.
Biochemical measurements, including TT, hormone-binding globulin (SHBG), albumin, fasting blood sugar (FBS),
triglyceride (TG), cholesterol (CHO), were determined by blood sampling. Based on the recommendation of The
International Society for the Study of the Aging Male (ISSAM), a total T below 320 ng/dL (11 nmole/L) or a free T below
6.6 ng/dL (0.225 nmole/L) is considered as low value. The MetS is diagnosed by the Modified Asian AHA/NHLBI
criteria.
Among 1062 participants, 857 men were eligible for data analysis. Men with MetS were increased in higher age, and
low TT and calculated free T (C. FT) were increased as age increased. When the participants with MetS were analyzed
separately from the non-MetS within each age group, low TT was positively correlated to MetS in age group of 40’s rather
than other ages. The subjects with low TT in the age group of 40’s have higher prevalence of MetS than in other age
groups.
Low TT and low C. FT were increased in higher age, and men with MetS were increased odds with low TT.
Particularly in age group of 40’s, the correlation of low TT with MetS is tighter (O.R.=8.2) than in other age groups (total
O.R. = 4.0). Thus, low TT may provide an early warning sign of developing MetS for the middle-aged Taiwanese men.
10
The relation between angiotensin II and bladder pathophysiology
Ken Aikawa, Kei Ishibashi, Takio Sakai, Soichiro Ogawa, Osamu Yamaguchi
Department of Urology, Fukushima Medical University, Fukushima, Japan
Aims of study
Bladder hypertrophy is not only a compensatory response to bladder outlet obstruction (BOO), but it is also a major
risk factor for bladder dysfunction. An increase in bladder wall tension (mechanical stretch stress) is considered to be the
trigger that induces both the bladder remodeling and the dysfunction observed after BOO.
Repetitive stretch and relaxation applied to bladder smooth muscle cells (SMCs) in vitro has been used to model
the urodynamically overloaded detrusor muscle under conditions of BOO. Recent evidence indicates that angiotensin II
(AngII) is released from bladder SMCs in response to such repetitive stretch stimulus, which then activates angiotensin
II type 1 receptors (AT1s) in an autocrine fashion. This AT1 activation has been shown to mediate heparin-binding
epidermal growth factor-like growth factor (HB-EGF) gene expression and to increase the DNA synthesis rate of bladder
SMCs. These in vitro studies suggested that the local renin-angiotensin system (RAS) is activated by urodynamic overload,
and that AT1s have a crucial role in the development of load-induced bladder hypertrophy. However, it remains unclear
whether such a mechanism also works in vivo and affects bladder function.
Thus, the present study attempted to determine whether long-term administration of an AT1 antagonist improves
morphology and function in obstructed rat bladders.
A total of 48 male, 12-week-old, Sprague-Dawley rats were used. The rats underwent surgery to produce partial
bladder outlet obstruction (BOO-rats; N=32) or sham surgery (sham group; N=16). Two weeks after surgery, 16 BOOrats were administered the AT1 antagonist losartan subcutaneously at a rate of 3 mg/kg/day (losartan group), using an
osmotic pump for 4 weeks. The remaining BOO-rats were given vehicle (BOO group; N=16). Six weeks after surgery,
continuous cystometry was performed without anesthesia and restraint in 8 rats of each group. The urodynamic
parameters used were micturition interval (time between two voids), micturition pressure (maximum pressure during the
void), bladder contraction time (time from the onset of contraction to the end of void), and micturition volume. Residual
urine was drained and measured after a completed micturition cycle at the end of cystometric recording. The bladder was
removed from the remaining rats in each group (N=24). Bladder weight was measured, and each bladder was used for
analysis of muscle strip contraction, Elastica-Masson staining, and HB-EGF mRNA expression. With regard to muscle
strip contraction, the response to 0.1 μM AngII, EFS (2 to 40 Hz), 2 mM ATP, 20 μM carbachol and 80 mM KCl were
determined.
Results
Bladder weight was significantly increased in the BOO group (827±199 mg) compared to the sham group (280±
18 mg), and losartan treatment (519±37 mg) suppressed the increase. Micturition pressure was significantly higher in the
BOO group (71±4 cmH2O) than in the sham group (26±3), and losartan treatment had no effect on micturition pressure.
The shortened micturition interval (277±115 sec) and decreased micturition volume (0.6±0.2 mL) with BOO were
significantly prolonged (985±377 sec) and increased (2.4±0.5 mL) by losartan treatment. Residual urine was observed
with BOO (2.9±1.8 mL), but it was significantly decreased by losartan treatment (0.6±0.7 mL). Bladder contraction time
was significantly prolonged with BOO (51±8 sec) compared to the sham group (24±4 sec), and it was further prolonged
by losartan treatment (64±10 sec). On histological examination, the collagen fiber-to-smooth muscle ratio in the bladder’s
muscular layer was significantly increased with BOO (0.82±0.19) compared to the sham group (0.56±0.12); this increase
was suppressed by losartan treatment (0.45±0.11). HB-EGF mRNA relative expression significantly increased in obstructed
bladder compared to sham bladder. HB-EGF mRNA relative expression in obstructed bladders was significantly reduced
by losartan treatment. Losartan treatment increased the maximal contraction for all stimuli except for AngII compared
to the BOO group. The bladder contractile response for AngII was similar for the sham and BOO groups, while it
disappeared with losartan treatment.
Conclusions
AT1 antagonist administration prevented bladder hypertrophy, fibrosis, and dysfunction related to bladder
obstruction. These findings suggest that bladder AT1s exposed to outlet obstruction were activated, which might be
associated with the pathophysiology of bladder remodeling and dysfunction.
11
Healthcare research in urology: bike cycling causes urological
symptoms
Alpha DY Lin
Department of Urology, Tseng's Hernia Hopsital, Taichung, Taiwan
Object
Bike cycling was thought to be a good aerobic exercise to enhance cardiopulmonary function. However, urologic
complications have been evaluated in literatures. The current study was designed to investigate the influence of bike
cycling on lower urinary tract symptoms (LUTS) and urological symptoms and sexual function.
A total of 20 healthy middle-aged male (52±5.8 ) were enrolled in the study. Before and after 3 weeks of bike
cycling (30 minutes, twice a day, 60 rpm). Questionnaires including the International Prostate Symptom Score (IPSS), the
International Index of Erectile Function (IIEF), urological symptoms such as genital numbness, prostatitis were evaluated.
Results
There was no significant change in the IPSS after bike cycling (15.2±4.8 vs 16.9±3.1, p=0.594). However, IIEF scores
was showed significant change (20.2±3.2 vs 15.3±6.1, p=0.034). Prevalence of genital numbness and prostatitis were 8/20
and 2/20.
Conclusions
Bicycle riding seems to have measurable effect on sexual function. Though LUTS were not affected, urological
hazardous symptoms such as genital numbness were significantly occurred.
12
Sex related differences in activities of bladder in response to ischemia/
reperfusion injury
Yung-Shun Juan1,2,3, Shu-Mien Chuang1, Robert M. Levin4, Chun-Hsiung Huang2,3
1
Graduate Institute of Medicine, 2Department of Urology, and College of Medicine, Kaohsiung Medical University,
Kaohsiung, Taiwan; 3Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 4Albany
College of Pharmacy, Albany, New York, USA
Gender difference in myocardial ischemia/reperfusion (I/R) has been well established. Males are much more
susceptible to I/R induced cardiac injury with worsen myocardial function compared with females following I/R. The
increased I/R in males has been primarily attributed to a lack of estrogen protection. However, in some studies also
showed testosterone may play a negative role in the myocardial response to acute I/R in the males. Current studies have
demonstrated that ischemia and reperfusion, with the accompanying generation of free radicals, are major etiologic
factors in obstructive bladder dysfunction. It has been shown that during bladder emptying, the increased intra-wall
tension results in blood vessel compression, decreased blood flow and tissue hypoxia. Although this occurs in normal
bladders, this phenomenon is significantly exaggerated in the obstructed hypertrophied bladder. There have been few
reports on the effects of androgen on the bladder tissue and function. In our recent study, we showed in un-castrated male
rats, testosterone administration has little effect on bladder dysfunction following I/R, while orchiectomy has protective
effect on I/R induced bladder damage. Interestingly, testosterone administration following 2 weeks castration worsened
I/R induced bladder dysfunction in male rats. Estrogen supplementation has protective effects on I/R induced bladder
damages.
13
Bladder outlet obstruction: biomarkers and systemic oxidative stress
Wei-Yu Li
Department of Urology, Chuang Gung Medical Foundation, Chiayi Hospital, Chiayi, Taiwan
As men age the prostate enlarges which compresses the urethra making it difficult to urinate. Partial bladder outlet
obstruction (PBOO) occurring due to benign prostate hyperplasia (BPH) in men interferes with the ability of the bladder
to empty its contents. Various animal models of PBOO, in which the urethra is partially legated, have been developed
and showed changes in morphology and function similar to that in humans. Oxidative damages in bladder tissue have
been detected in animals with PBOO. Our result revealed that oxidative stress could be detected in the plasma and urine
of PBOO-treated rabbits for 4 and 8 weeks, not only from bladder tissue as previously reported. The significance of the
findings showed that there could be an easy and alternative way to evaluate rabbit bladder function by analysis of urine
and/or plasma. Besides, epidemiological studies have provided clear evidence that lower urinary tract syndrome (LUTS)
and erectile dysfunction (ED) are strongly linked with obstructive LUTS being a better predictor of ED than irritative
LUTS. However, it is still unclear in our current understanding of the pathophysiological mechanisms, which show the
relationship between LUTS and ED. Using the RT-PCR and Western blot analysis, a progressive increase of TGF-β1
in penis was found at 2, 4 and 8 weeks after obstruction. On the basis of our results, the increase TGF-β1 and elevated
systemic oxidative stress may play key roles to contribute to penile dysfunction after chronic PBOO. Furthermore,
following our first study about rabbits with chronic PBOO showing an increase in systemic oxidative stress, we found that
reversal of PBOO resulted in a progressive reduction in the levels of biomarkers of systemic oxidative stress. This finding
further suggests that reverse of PBOO will attenuate systemic oxidative stress.
The 6th Pan-Pacific
Symposium 1
Joint Symposium of PPCS and ICCS
(International Children Continence Society) -managing special situations of LUTS
Symposium 1
17
Optimal management of LUTS in bladder outlet obstruction
Chih-Shou Chen
Department of Urology, Chuang Gung Medical Foundation, Chiayi Hospital, Chiayi, Taiwan
The secondary response of bladder to the bladder outlet obstruction is well documented. This is the whole idea
of LUTS induced by bladder outlet obstruction. However, the receptors of prostate and bladder detrusor are different
on the impact of bladder outlet obstruction. This is also the main consideration of optimal treatment for LUTS/BOO.
Therefore, the sub-groups of α-blocker is important in the selection of adequate medical management. On the contrary,
the role of different receptors located within urothelial and submucosal area is also an important issue. The TRPV4 or β-3
agonist and even PDE5 inhibitors and other transmitters may have a promising role in the management of LUTS/BOO in
the future.
Nevertheless, the consideration of optimal management of LUTS/BOO should take overactive bladder (OAB)
and nocturia into the consideration for optimal treatment strategies. This is because, the treatments specific for OAB and
BPO are not specific for the symptoms of nocturnal polyuria which is the major cause of nocturia. On the other hand,
one could not expect the satisfaction only after the treatment of obstructive symptoms. In fact, the irritation symptoms are
usually the main bothersome symptoms which may attributed to the OAB.
That`s the reason why we need a more practical approaching and treatment guidelines for LUTS/BOO.
Taiwanese Continence Society (TCS) proposed a treatment guideline which covers the above important issues need to be
reconsidered.
In conclusion, bladder outlet obstruction is not a problem of obstruction only, it is a combination of different
problems such as obstruction, irritation and nocturia. That`s why we need a step by step approaching and consideration to
achieve optimal management for LUTS/BOO.
18
Management of myelomeningocele: from children to adulthood,
including intravesical electrotherapy of MMC
Sang Won Han
Department of Pediatric Urology, Severance Children’s Hospital, Yonsei University Health System
The most common cause of neurogenic bladder in children is spina bifida including myelomeningocele(MMC).
Although it can cause various problems such as bowel dysfunction, sexual dysfunction and infertility, renal function
deterioration and urinary incontinence have been focused on mainly.
Fortunately the world wide prevalence of MMC have gradually decreased with use of folic acid and promptly
managed in prenatal and neonatal period. The study and experience from MMC patients have offered the knowledge to
manage the patients with lipomeningmyelocele or tethered cord syndrome.
The goals of management of MMC are to reduce the storage pressure of bladder to preserve renal function and
to obtain or maintain urinary continence. Since Lapide era clean intermittent catheterization (CIC) is the mandatory to
preserve bladder and renal function. Also McGuire principle about the leak point pressure has been historical milestone
and made anticholinergics to be the first line treatment methods to fulfill the goals.
These two keys of CIC and anticholinergics to manage MMC should be applied from neonates if necessary.
Therefore the urodynamics is essential from neonate and VCU and ultrasonography is the best way to evaluate upper
urinary tract and bladder. The infants with MMC should be closely followed until 2 years old when bladder function
becomes stable. However since then continuous monitoring is recommended even though the bladder is not belonged to
high risk group because the cord tethering may occur in any age.
To preserve renal function, bladder augmentation has been known as the definitive treatment to increase of bladder
capacity and compliance. However it should be defer as far as possible because of high morbidity and irreversible
changes of body. The night time drainage, the maximum dose of anticholinergics and etc. would be recommended before
decision of bladder augmentation. The botulinum toxin widely used in adults is another option for increasing bladder
capacity and compliance, but it has short duration of effects and needs repeated general anesthesia in children. Various
neuromodulations have been tried for the goal of volitional voiding or increasing bladder capacity, but the former has
not been accomplished at all. Intravesical electrical therapy(IVES) has been reported as an effective method to increase
bladder capacity and sensation in MMC patients by a few institutes including our clinic. We have the data from animal
study and the clinical trial of IVES on bladder and bowel function in neurogenic bladder.
To obtain urinary continence, sling, bladder neck injection, bladder neck reconfiguration and continent urinary
diversion have been reported with the wide-ranging results. Artificial urinary sphincter implantation in children also
seems to be a good choice to get both of continence and urination, but has not been free from some issues like technical
problems and unwanted change of upper tracts.
From child to puberty, renal function, nutrition and growth rate should be curiously followed whatever the patients
had undergone enterocystoplasty or not. Hypertension is easily inattentive issue that may shorten life. There is no need
to emphasize the importance of the psychosocial support for child and adolescence. After puberty, sexual dysfunction
is variable according to the level of defect. It can be overcome by intracorporeal injection or sildenafil in male and by
adequate education in female. Fertility in females is thought to be normal. On the contrary, some males have possible
infertility associated with azoospermia and cannot be resolved by electro-ejaculation.
Keywords: spinal dysraphism, neurogenic bladder, child, adult, electric stimulation therapy
Symposium 1
19
Overactive bladder – is there a gender difference in diagnosis and
management?
Hirotaka Asakura
Department of Urology, Saitama Medical University Faculty of Medicine
OAB is the term used to describe the symptom complex of urgency with or without urgency incontinence, usually
with frequency and nocturia. The prevalence of OAB in both sexes is almost same and it increases with aging.
The human male and female each has a unique and different urogenital system. Therefore the underlying
pathophysiology of OAB and key points of diagnosis/management might be different between males and female patients.
There are some relationship between BPH and OAB. About 60% of patients with BPH are associated with OAB.
Medical management of LUTS due to BPH with α-blocker and/or 5α-reductase inhibitor is the first line treatment. In
patients with OAB anticholinergic medication with or without α-blocker may be the first line treatment. Recent review
showed that use of antimuscarinic agents for treatment BOO effectively improves patient quality of life. It seems that
antimuscarinic agents do not affect voiding pressures and the use of antimuscarinic agents for BOO seems safe. There still
remain some refractory cases that require surgical operation.
There is a causal relationship between OAB and POP. No evidence is found for a relationship between the
compartment or stage of the prolapse and the presence of OAB symptoms. All treatments for POP may result in an
improvement in OAB symptoms.
Pelvic organ prolapse in the female and prostatic obstruction in the male require uniquely different approaches to
lower urinary tract dysfunction.
In this presentation, I would like to overview gender difference for OAB treatment and management and add some
of our clinical investigation of OAB in pelvic organ prolpase.
20
Innovations in childhood incontinence – neurogenic and functional
disorders
Stuart Bauer
Department of Urology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
Exciting things are happening in the work-up and management of children with lower urinary tract dysfunction. This
lecture is designed to provide information about the latest research in the field of bladder dynamics in children. Knowing
what’s happening, what works and what doesn’t will streamline the clinician’s ability to present current and future ideas for
management of their patients.
Firstly, new anticholinergic medications that have greater affinity for M3 receptors, the principal receptor for
controlling detrusor contractions, are being tested to determine their safety and efficacy. I plan to discuss the latest
research regarding these drugs in patients with detrusor overactivity so when they become available you will have a better
appreciation for their use in non-neurogenic as well neurogenic conditions.
Secondly, percutaneous tibial nerve stimulation is beginning to play an increasingly important role in the
management of the overactive bladder. Recent advances in the needle characteristics have improved its tolerability and
thus efficacy of this relatively non-invasive technique. I plan to describe some of the latest responses as a result of this
improved technology.
Thirdly, I plan to present the latest applications for using robotic assisted surgeries thus making it easier to consider
and apply this exciting and promising technique as part of the surgeon’s armamentarium for management of lower urinary
tract function in children.
If time permits I will address the latest finding regarding nerve re-routing for the management of bladder dysfunction
in children with myelomeningocele and our findings regarding postnatal lower urinary tract function in myelodysplastic
children who were closed prenatally.
Symposium 1
21
What we know and what we do not know about dysfunctional voiding in
adults
Yong-Gil Na
Department of Urology, Graduate School of Medicine, Chungnam National University, Daejeon, Korea
Dysfunctional voiding is an abnormality of bladder emptying in neurologically normal individuals in whom there is
increased external sphincter and/or pelvic floor muscle activity during voluntary voiding. Dysfunctional voiding may result
in various lower urinary tract symptoms, including storage symptoms (frequency, urgency and urgency incontinence) and
emptying symptoms (decreased force of stream, hesitancy, need to strain and a feeling of incomplete bladder emptying). It
may also be responsible for recurrent urinary tract infections, acute or chronic urinary retention, and in severe cases upper
and lower urinary tract decompensation.
Dysfunctional voiding in children was originally thought to be a response to psychosocial problems. It is now
recognized that it may represent a developmental abnormality, in which the transitional phase persists between infantile
reflexogenic voiding and normal volitional voiding of adulthood. There are several theories of why dysfunctional voiding
occurs in adults. The most believable theory is that it represents learned behavior in response to an adverse event
or condition, such as inflammation, irritation, infection (cystitis, urethritis or vaginitis), urethral diverticulum, pelvic
inflammatory disease, anorectal disease or trauma.
While the prevalence of dysfunctional voiding in the general adult female population is not known, Groutz et al
observed that the incidence of dysfunctional voiding was 2% in a review of a database of 1,015 video urodynamic studies in
adults.
The diagnosis of dysfunctional voiding is made when there is increased external sphincter activity during a sustained
voluntary detrusor contraction. Typically this condition is noted as an increase in electromyography activity and/or a
dilated proximal urethra, often with intermittent sphincteric activity, on voiding cystourethrography and usually associated
with decreased or intermittent urinary flow. The clinical feature of dysfunctional voiding may be more benign in adults
than in children or milder disease may more readily diagnosed, since urodynamic testing is more commonly performed
in adults with long-standing symptoms than in children. Deindl et al noted 2 distinct types of dysfunctional patterns, that is
increased pelvic floor muscle activity in 73% of cases and increased external urethral sphincter activity in 27%.
The treatment of dysfunctional voiding has evolved during the years. As in children, biofeedback and behavioral
modification have become recommended treatment in women with dysfunctional voiding. Biofeedback has also been
proved to be successful in men. Neuromodulation has become an integral component in the treatment algorithms for
patients with dysfunctional voiding. The minimally invasive techniques currently employed provide a safe and effective
alternative for patients with dysfunctional voiding refractory to conservative treatments.
Neurological disease should be suspected in any patient with dysfunctional voiding, especially in younger patients
with detrusor instability and urge incontinence. Formal neurological evaluation should be done in these cases.
References
1. Carlson KV, Rome S, Nitti VW: Dysfunctoional voiding in women. J Urol 2001; 165:143-147.
2. Campbell WA 3rd: Functional abnormalities of the bladder in children: characteristics of chronic cystitis and chronic urethritis. J
Urol 1970; 104:926-929.
3. Allen TD, Bright TC 3rd: Urodynamic patterns in children with dysfunctional voiding problems. J Urol1978; 119:247-249.
4. Raz S, Smith RB: External sphincter spasticity syndrome in female patients. J Urol 1976; 115:443-446.
5. Groutz A, Blaivas JG, Pies C, Sassone AM: Learned voiding dysfunction (non-neurogenic, neurogenic bladder) among adults.
Neurourol Urodyn 2001; 20:259-268.
6. Deindl FM, Vodusek DB, Bischoff C, Hofmann R, Hartung R: Dysfunctional voiding in women: which muscles are responsible? Br
J Urol 1998; 82:814-819.
7. He W, Chen M, Zu X, Li Y, Ning K, Qi L: Chronic prostatitis presenting with dysfunctional voiding and effects of pelvic biofeedback
treatment. Br J Urol 2009; 105:975-977.
8. Murphy AM et al: An update on Neuromodulation for voiding dysfunction. Current Bladder Dysfunction Reports 2011/08/29.
22
Dysfunctional voiding: lessons learned from children
Stephen S. Yang
Department of Urology, Medical College of Buddhist Tzu Chi University, Hualien, Taiwan
Dysfunctional voiding (DV) means intermittent contraction or unrelaxed urinary sphincter during voiding phase. It
is a voiding disorder and can be associated with storage disorder. Dysfunctional voiding can be congenital because many
infants void in this dyscoordinated situation which usually resolves with time. Some children may acquire this abnormal
voiding behavior under stressful environment, abnormal voiding posture, or no apparent risk factor at all.
Dysfunctional voiding should be suspected in children with urinary tract infection (UTI), or lower urinary tract
symptoms (LUTS) such as urgency, daytime incontinence or nocturnal enuresis. DV can be diagnosed in cases with
repeated staccato flow pattern in free uroflowmetry. The addition of perineal patch electromyogram (EMG) adds
specificity on the diagnosis. Definite diagnosis can be demonstrated by videourodynamic study which reveals increased
sphincter EMG at voiding phase and/or intermittent sphincter contraction during voiding phase.
Dysfunctional voiding is frequently associated with constipation. Dysfunctional elimination syndrome describes the
combined problems of voiding and defecation. Successful treatment of constipation results in resolution of LUTS. Hence,
urologists should master in the diagnosis and treatment of constipation.
Dysfunctional voiding frequently results in high detrusor pressure which may induce vesicoureteral reflux (VUR).
Since DV is present in a subset of infants and may disappear after one year of age, operation may wait until that time.
Anitmuscurinics or Biofeedback relaxation of pelvic floor muscles can reduce detrusor pressure and should be applied to
appropriate children with high detrusor pressure.
There is a belief that DV may squeeze infected urine back to bladder and cause UTI. Biofeedback relaxation of
pelvic floor muscles did reduce the incidence of febrile UTI in chidren.
A bladder capacity >115% expected bladder capacity (EBC) or a voided volume >100% EBC can be defined as
bladder over distention (BOD). BOD frequently results in staccato flow pattern, which implies dysfunctional voiding.
Through modification of fluid intake and timed voiding we have reversed some cases of dysfunctional voiding associated
with BOD.
Implications to adult urologists
Dysfunctional voiding may be present in adults with refractory LUTS, incontinence, or UTI. Constipation is related
to DV and LUTS and UTI. DV can be an extension from childhood or recently acquired in the adulthood. Biofeedback
relaxation of pelvic floor reverses DV and improves urinary symptoms. Bladder over distention may be present in adults
with urgency +/- urgent incontinence.
The 6th Pan-Pacific
25
The effect of antioxidants on the response of the rabbit urinary bladder
to in vitro ischemia/reperfusion: effects on fatty acid metabolism
Robert M. Levin
Albany College of Pharmacy and Health Sciences, New York, USA
Objective
It has become evident that oxidative stress is a major factor in several lower urinary tract dysfunctions in both males
and females. The specific aim of these current studies was to evaluate the protective effects of two naturally occurring
antioxidants, alpha-lipoic acid and coenzyme Q10 on the response to in-vitro ischemia/reperfusion of the rabbit urinary
bladder. We measured the effects on free fatty acid (FFA) content, phospholipid (PL) content, malondialdehyde (MDA)
levels, and phospholipase A2 activity (PLA) of subcellular compartments. We chose to study in vitro ischemia/reperfusion
because we wanted to avoid the significant structural changes that occur in models of partial outlet obstruction (males) and
ovariectomy (in females).
Methods
Twenty New Zealand White male rabbits were separated into four groups of 5 rabbits each. The in vitro whole
bladders from Groups 1 and 2 received a3 hour incubation under normal oxygenated physiological conditions. The
bladders were stimulated by field stimulation at 1 and 3 hours. The bladders from groups 3 and 4 underwent 1 hour
incubation time under normal oxygenated physiological conditions. After 1 hour, the bladders were stimulated with
field stimulation. After a maximal pressure response was recorded, the stimulation was turned off and the bath medium
changed to one equilibrated with 95% nitrogen, 5% oxygen without glucose (ischemic medium) and incubated for 1 hour
with field stimulations occurring at 5 minute intervals during this time. At the end of this hour of ischemia with repetitive
stimulation, the bath was changed to an oxygenated medium with glucose for a 1 hour reperfusion period after which
the stimulation was repeated. The rabbits from groups 2 and 4 received á-Lipoic acid (10 mg/kg/day) + Coenzyme Q10
(3 mg/kg/day) by gavage for 4 weeks prior to the experiment. At the end of the experimental period, each bladder was
opened longitudinally and the muscle and mucosa separated by blunt dissection, frozen under liquid nitrogen, and stored
at -80°C for biochemical analyses. Each tissue was fractionated by differential centrifugation into nuclear, mitochondrial,
synaptosomal and cytosol (supernatant) components. PL, FFA, MDA, and PLA were analyzed using standard biochemical
techniques.
Results
Post-ischemic contractility only returned to 30% of control of the untreated group. However, post-ischemic
contractility of the treated group returned to approximately 70% of control. PL loss in the muscle mitochondria and
synaptosomes was prevented by antioxidant treatment, while the mucosal layer showed a significant drop in PL with
antioxidants treatment. Administration of CoQ+LA significantly decreased MDA levels in both control and ischemic
tissues in both the muscle and mucosal bladder layers, especially substantial in the microsomal and mitochondrial
components. Treatment had variable effects on PLA2 activity.
Conclusions
Treatment of bladder dysfunction with antioxidants daily can be beneficial in man to prevent or delay the onset
of progressive loss of bladder function especially that due to ischemic damage (Oxidative stress) to mitochondrial and
microsomal lipids. CoQ10+LA can provide similar protection of the bladder muscle and mucosa against lipid oxidative
stress as they have been shown to protect against protein oxidative damage.
The 6th Pan-Pacific
Podium Presentaion
Podium Presentaion
29
Efficacy and safety of augmentation ileocystoplasty for the treatment
of interstitial cystitis
Hyo Serk Lee1, Won Jin Cho2, Ha Na Lee3, Young-Suk Lee4, Jeongyun Jeong1, Kyu-Sung Lee1
1
Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; 2Chosun University Hospital,
Chosun College of Medicine, Gwangju, Korea; 3Iwha Women's University School of Medicine, Seoul, Korea; 4Samsung
Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
Aims of Study
Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronic condition that characterized by irritative bladder
symptoms and suprapubic pain. Although a number of nonsurgical treatment modalities have been used, some patients
have refractory conditions that do not respond at all to symptomatic treatment. Augmentation ileocystoplasty is one of
the last options for BPS/IC refractory to conservative treatments. Reported long-term success rates of ileocystoplasty
have varied from 25 to 90%. The aims of this study were to evaluate the long term efficacy and safety of augmentation
ileocystoplasty for severe symptomatic patients with BPS/IC.
Material and Methods
We prospectively evaluated 26 patients, who had undergone augmentation ileocystoplasty by single surgeon from
July 2006 to February 2010 for severe BPS/IC refractory to conservative treatments. We analyzed the patients by pain
visual analogue scale (VAS), 3-days micturition time chart, O’Leary-Sant IC Symptom (ICSI) and O’Leary-Sant IC
Problem (ICPI) Indexes before and after the operation. We performed voiding cystourethrography (V.C.U.G) at 3 months
follow-up and urodynamic study at 6 months follow-up of the operation. Patients were interviewed for the improvement
of symptoms by using global response assessment (GRA) and for interaction between the degree of symptoms and
limitation of activities by using patient global assessment (PGA) questionnaires. We evaluated the responsiveness of
the ICSI according to reference standards of mean change in the ICSI scores; 2.3 in those who worsened, -1.5 in stable
respondents, and -5.4 in those who improved.
Result
Twenty six (mean age 58.69±10.03 years, 25 women and 1 man) patients were evaluated. The follow-up range was
4 to 34 months. The mean symptom duration was 3.9±2.0 years. Pain VAS, voiding frequency, ICSI and ICPI have
improved significantly after the operation (p<0.05). Functional bladder capacity and maximal cystometric capacity have
increase significantly after treatment (Table). According to the responsiveness of the ICSI, 73% of patients were improved
and 19% were stable respondents. There was no patient who was worsened. Eighty-eight percents (24/26) of patients
improved their symptoms after treatment according to GRA questionnaires. With PGA questionnaire, 67% (17/26) of
patients had no limitation of normal activities and five patients noted that there was limitation of some normal activities.
Perioperatively, there was no complication such as gastrointestinal problem like ileus. Four patients showed vesicoureteral
reflux without upper urinary tract damage according to V.C.U.G. at 3 months after operation. Five patients had urinary
tract infection that had resolved with antibiotic treatment. One patient showed urothelial carcinoma. Four patients were
needed to perform clean intermittent self-catheterization. Of them, 3 patients had answered that their symptoms were
moderately improved by global response assessment. There was no severe complication with surgery at long-term followup.
Conclusion
Our results showed augmentation ileocystoplasty has good outcomes that pain and frequency had decreased and
bladder capacity has increased significantly. There’s no severe complication with surgery for short term and long term
follow up. The finding that in some clean intermittent self-catheterization is required after surgical reconstruction is in
accordance with previous experience. It had known that clean intermittent self-catheterization is well accepted by patients
because the overall situation is so markedly improved after surgery. We recommend augmentation ileocystoplasty is
effective and safe treatment method for severe symptomatic interstitial cystitis.
30
Table. The change of pain visual analogue scale, urodynamic parameters, and O’Leary-Sant IC symptom (ICSI) and
problem (ICPI) index before and after augmentation ileocystoplasty
Baseline
Post-op (6months)
p-value
Pain visual analogue scale
8.73±1.75
0.96±1.28
<0.05
Micturition frequency
21.55±2.05
10.74±5.35
<0.05
Maximum flow rate (mL/sec)
13.84±8.45
18.16±10.49
0.148
Maximum voided volume (cc)
130.53±27.10
283.16±63.43
<0.05
Maximal cystometric capacity (cc)
206.48±17.91
377.38±90.50
<0.05
Post voiding residual urine (cc)
31.88±30.51
150.06±190.27
0.004
O’Leary-Sant IC-Q questionnaires
IC-Symptom index (0-20)
17.36±2.84
8.56±5.41
<0.05
IC-Problem index (0-16)
15.00±1.52
6.12±4.40
<0.05
Podium Presentaion
31
Increased expression of TRPA1, TRPV2, ASIC1 and CXCL9 mRNA in
bladder tissue from patients with ulcer-type interstitial cystitis
Akira Nomiya1, Mitsuhiro Tagaya2, Tatsuya Oyama2, Yuko Kawai2, Kazuchika Takagaki2, Hiroaki Nisimatsu1, Naoki
Aizawa3, Tetsuya Fujimura1, Yasuhiko Igawa3, Yukio Homma1
1
University of Tokyo, Department of Urology; 2Nippon Shinyaku Co., LTD; 3University of Tokyo, Department of
Continence Medicine
Purpose
Interstitial cystitis (IC) is a chronic inflammatory disease of the bladder with unknown etiology (1). The quantitative
real-time polymerase chain reaction (qRT-PCR) approach offers the opportunity to discover differential gene expression
independently of any prior hypothesis of etiology, providing ideas for new therapeutic strategies. In the present study, we
assessed the differential expression of the human transient receptor potential (TRP) channel gene transcripts, acid sensing
ion channel (ASIC), nerve growth factor (NGF), uroplakin 3A (UPK3A) and chemokine (C-X-C motif) ligand 9 (CXCL9)
in bladder tissue in IC patients and controls.
Patients with IC scheduled for hydrodistension or with non-invasive bladder cancer (as controls) undergoing
transurethral resection were enrolled under informed consent. Diagnosis of IC was based on the clinical guidelines for
interstitial cystitis and hypersensitive bladder syndrome. Cystoscopy was performed with a rigid 9-mm cystoscope under
spinal anaesthesia and bladder specimens were obtained from 1) retrotrigonal portions in non-ulcer- type IC patients,
2) non-ulcerative retrotrigonal portions in ulcer-type IC patients, 3) ulcerative portions in ulcer-type IC patients, and
4) non-cancerous retrotrigonal portions in bladder cancer patients (non-IC bladder, BT) with cold-cup biopsy forceps,
and placed immediately in ice-cold RNA later and stored at -80°C. Total RNA was extracted from bladder samples, and
reverse transcribed into cDNA with reverse transcriptase. The mRNA expression levels of several TRP channels (TRPA1,
TRPV1, TRPV2, TRPV4, TRPM2, TRPM7 and TRPM8), ASIC1, NGF, UPK3A and CXCL9 were compared among
the three groups by qRT-PCR. The mRNA levels were expressed as the fold change in the average value for non-IC
bladder tissue. The protocol of the study was approved by our Institutional Review Board.
Results
After optimization of the protocol, a total of 43 specimens (non-ulcerative lesions and ulcerative lesions from ulcer
type, 14; non-ulcer type, 9; bladder cancer, 6) were analyzed between October 2009 and January 2011. The subjects’
background is shown in Table 1 and the qRT-PCR results are shown in Table 2.
Among the TRP channels, TRPA1 and TRPV2 showed significantly increased mRNA expression in non-ulcerative
portions of ulcer-type IC compared with controls. In the same portions, a significant increase in the mRNA expression of
ASIC1 and CXCL9 and a decrease in the mRNA expression of UPK3A were observed. Also, in ulcerative portions of
ulcer-type IC, a significant increase in TRPV2 and CXCL9 and a significant decrease in UPK3A were found as compared
with controls. However, no significant difference in any of these mRNA expressions was observed between non-ulcer-type
IC tissue and controls (Figure 1).
Conclusion
This study demonstrates increased expression of TRPA1, TRPV2, ASIC1 and CXCL9 mRNA and decreased
expression of UPK3A mRNA in ulcer-type IC but no significant changes in non-ulcer-type IC. These findings suggest that
there is a distinct difference in pathophysiology and disease entity between these two types of IC and also that TRPA1,
TRPV2, ASIC1 and CXCL9 may be potential targets to novel therapy for ulcer type IC.
Table 1. Subjects’ background
Variables
Number of patients
(male/ female)
Mean age (range)
BMI
BT (control)
6
(4/2)
74.0±9.63 (61–88)
22.4±2.89
Non-ulcer-type IC
9
(4/5)
52.3±20.5 (20–73)
23.5±4.43
Ulcer-type IC
14
(2/12)
70.4±12.2 (36–83)
22.0±2.26
32
Table 2. mRNA expression in the bladder tissue with interstitial cystitis (fold change of control)
Non-ulcer type IC
Ulcer type IC
Gene Symbol
Non-ulcerative lesion
Ulcerative lesion
Fold change
p-value (n=9) Fold change
p-value (n=14) Fold change
p-value (n=14)
ACTB
0.87
0.272
1.39
0.179
1.38
0.179
TRPA1
TRPV1
TRPV2
TRPV4
TRPM2
TRPM7
TRPM8
NGF
ASIC1
UPK3A
CXCL9
1.27
1.32
1.23
1.08
0.40
0.95
0.39
2.45
1.22
0.19
1.82
0.388
0.145
0.456
0.776
0.328
0.955
0.224
0.181
0.272
0.224
0.224
1.64
1.47
1.79
0.83
1.17
1.02
1.45
1.57
1.57
0.07
4.78
0.041*
0.076
0.005**
0.274
0.968
0.779
0.091
0.207
0.009**
0.009**
0.000**
1.34
0.61
1.86
0.79
1.02
0.96
1.51
0.61
0.91
0.08
3.78
0.353
0.779
0.009**
0.153
0.841
0.779
0.109
0.659
0.779
0.033**
0.006**
GAPDH mRNA levels were used as an internal normalization control.
The p-values were determined by the Wilcoxon rank-sum test. (*p<0.05, **p<0.01)
Figure 1. mRNA expression of TRPA1, TRPV2, CXCL9 and UPK3A in the bladder tissue.
BT: bladder tumor (control), nu: non-ulcer type IC, u/nu: non-ulcerative lesion of ulcer type IC, u/u: ulcerative lesion of ulcer type IC
Podium Presentaion
33
Bladder damage induced by ketamine abuse in a rat animal model
Yung-Shun Juan1,2,3, Shu-Mien Chuang1,4, Tzu Hui Wu5, Cheng-Yu Long6,7, Keh-Min Liu4, Chun-Hsiung Huang2,3
1
Graduate Institute of Medicine, 2Department of Urology, 4Department of Anatomy , and 7Excellence for
Environmental Medicine, College of Medicine, Kaohsiung Medical University; 3Department of Urology, Kaohsiung
Medical University Hospital, Kaohsiung, Taiwan; 5Department of Biological Science, National Sun Yat-Sen Univeraity,
Kaohsiung, Taiwan; 6Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsia-Kang Hospital, Kaohsiung,
Taiwan
Aims of Study
Clinically, ketamine abuse is associated with severe lower urinary tract dysfunction. Reduced bladder capacity and
hemorrhagic cystitis with irreversible pathological changes may develop in some cases of long-term drug abuse. Up to now,
the mechanisms that cause these severe side effects are still not clear. Herein, we will determine the pathological changes
and explore the pathological mechanisms of urinary bladders destruction in a novel ketamine addiction rat model.
Thirty-six rats were divided into three groups, including the control, 14 days and 28 days of ketamine injection.
Ketamine administration (25 mg/kg) was given as intra-peritoneal (IP) daily injection, while the controls were administered
of normal saline. In vivo isovolumetric cystometrography (CMG) studies were performed. The bladder tissues were then
collected for Western blotting and immunohistochemical studies.
Results
Ketamine treatment significantly increased micturition pressure, but decreased bladder capacity compared to control
rats, especially after 28 days ketamine injection. Ketamine treatment also markedly decreased bladder compliance and
increased the frequency of bladder non-voiding contraction. Immunofluorescence studies confirmed the neurotoxicity of
ketamine. Neurofilament staining was significantly decreased after 28 days ketamine treatment. TUNEL staining showed
multiple degenerated cells diffusely distributed in the urothelium, sub-urothelium, and smooth muscle layers in the
ketamine treated rats. Western blotting demonstrated ketamine injection increased bladder iNOS, eNOS and COX-2
expressions in protein level.
Conclusions
Chronic exposure to low, subanesthetic concentrations of ketamine could affect cell survival and impair neuronal
morphology. Impaired neuronal structure and increased inflammatory process might lead to neural networks dysfunction
and altered bladder micturation reflex.
34
Next surgical management of female stress urinary incontinence after
failed midurethral sling: tape tightening or repeat sling?
Ji-Yeon Han1, Daeseon Yoo1, Kyung Hyun Moon2, Myung-Soo Choo1
1
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; 2Department of
Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
Aim of Study
At present there are no guideline regarding the management of patients who fail sling procedures. We therefore
compared outcomes and factors associated with cure in patients with recurrent or persistent SUI after initial midurethral
sling (MUS) who undergo repeat MUS or shortening of pre-implanted tape.
We enrolled all patients who underwent repeat MUS or tape shortening as a second surgical procedure due to
recurrent or persistent SUI between January 2006 and June 2009. Persistent SUI was defined as leakage within 6 weeks
after initial MUS in response to stress events causing increased intra-abdominal pressure, and recurrent SUI was defined
as leakage occurring more than 6 weeks after initial successful MUS. The choice of treatment method was based on a joint
decision by the patient and the surgeon, and all patients were theoretically suitable for either approach. Of the total of 66
women, 36 underwent repeat MUS and 30 underwent tape shortening.
All patients were followed-up for at least 12 months after second surgery. Efficacy was measured by cure and success
rates on stress cough test. Safety was evaluated by assessing maximal urine flow rate (MFR), postvoid residual urine volume
(PVR) and procedure- related complications.
Cure of SUI was defined as the absence of any episodes of involuntary urine leakage during stressful activities and
by the results of the stress cough test. Improvement was defined as a significant decrease in urine leakage without further
treatment. Failure was defined as persistent SUI after surgery or recurrent SUI during postoperative follow-up. Cure or
improvement of SUI was regarded as surgical success.
Outcomes and cure rate were assessed relative to the reasons for the secondary procedure (i.e. persistent or
recurrent SUI) and ISD. We also assessed factors associated with cure, changes in uroflowmetry parameters and
procedure-related complications.
Results
There were no significant between-group differences in patients age at operation, body mass index (BMI), maximal
urinary flow rate (MFR), PVR and urodynamic parameters (valsalva leak point pressure (VLPP), maximal urethral closing
pressure (MUCP), and maximal detrusor pressure). In contrast, there were significant differences between the two groups
in SUI symptom grade, mean interval from initial surgery to secondary procedure, types of first MUS (retropubic or
transobturator approach) and the reason for secondary procedure (persistent/recurrent SUI).
Although the success rates of repeat MUS and tape shortening did not differ significantly (83.3% vs. 70.0%, p=0.198),
the cure rate was significantly higher in patients who underwent repeat MUS (72.2% vs. 46.7%, p=0.034). Among patients
with ISD, the cure rate was significantly higher in patients who underwent repeat MUS than tape shortening (76.5% vs.
40.0%, p=0.048). Among the patients who underwent repeat MUS, those who were cured had a significantly shorter
mean interval from initial surgery to secondary procedure than those who failed the secondary procedure (14.2±21.7 vs.
23.0±20.7 months, p=0.031). In patients who underwent tape shortening, only the presence of urgency incontinence was
associated with cure rate (p=0.032).
The MFR decreased significantly in the repeat MUS (from 27.1 mL/s to 19.0 mL/s) but not in tape shortening
(from 25.3 mL/s to 21.4 mL/s). The PVR increased significantly after repeat MUS (from 33 mL to 49.7 mL) but not after
tape shortening (from 25.1 mL to 17.5 mL). One patient who underwent repeat MUS required tape cutting and one who
underwent tape shortening experienced mesh erosion.
Conclusions
Repeat MUS has a higher cure rate than tape shortening in the surgical treatment of patient with persistent or
recurrent SUI, especially in patients with ISD.
Keywords: midurethral sling; reoperation; urinary incontinence, stress
Podium Presentaion
35
Evaluation of the usefulness of the Japanese version of N-QoL through
a cross-sectional survey of nocturia in Tochigi, Japan
Tomonori Yamanishi
Department of Urology, Dokkyo Medical University, Tochgi, Japan
Aim
To evaluate the usefulness of the Japanese version of Nocturia Quality-of-Life questionnaire (N-QoL) through a
cross-sectional survey of nocturia in Tochigi, Japan.
Methods
A joint urologic survey designed to investigate the epidemiologic aspects of nocturia. A prospective questionnaire
survey was conducted from October 2008 to June 2009 using outpatients in urology, orthopedics, internal medicine,
surgery, gynecology, etc. at 95 sites in Tochigi, Japan. Participants were surveyed with the Japanese version of N-QoL,
the overactive bladder symptom score (OABSS) and self-administered questionnaires about nighttime voiding including
nighttime awakening, nocturia, nighttime incontinence, falling. Since OAB is one of the main factors of nocturia, the
relationship between the Japanese version of N-QoL and the OABSS as an out-standard were evaluated by the correlation
coefficient (Spearman rank sum test). We considered that the absolute value of number was judged to be 0.400 or greater
validity. The Jonckheerre-Terpstra test was performed to evaluate the relationship between the N-QoL and the frequency
of nighttime voiding, falling, and nighttime incontinence.
Results
Overall, 2494 subjects (male:1154, female:1208; with a mean age of 63.2±15.1) joined this survey and the underlying
diseases were diabetes, hypertension, cardiovascular disease and BPH. N-QoL score was 86.8±16.9 at average in 2494
patients. Overall, 27% of subjects (625 out of 2494 patients) were diagnosed with an OAB. Overall score of N-QoL was
correlated with the OABSS (r=0.5966) and nighttime frequency score in OABSS(r=0.5389). Both Sleep/Energy domain
and Bother/Concern domain in N-QoL were also well correlated with OABSS (r=0.4898, r=0.5361, respectively) and
with nighttime frequency score in OABSS (r=0.4455, r=0.5361, respectively). N-QoL score was lower in the patients with
nighttime awakening compared to without nighttime awakening (p<0.0001). Moreover, the decreasing N-QoL overall
score correlate with the increasing nighttime frequency, nighttime incontinence and falling number respectively (p<0.0001).
Conclusions
The results of this study confirmed that the Japanese version of N-QoL was useful to evaluate nocturia. Moreover,
this study represents the first report that the decreasing N-QoL overall score correlate with the increasing falling number
associated with nocturnal episodes. Further interventional studies are needed for this tool.
36
Urinary bladder as one of the target organs of desmopressin in
nocturnal enuresis
Chih-Shou Chen, Jia-Jen Shee, Ching-Fang Wu, Wei-Yu Lin, Dong-Ru Ho, Yun-Chin Huang, Pey-Jium Chang, MengHsin Chen
Division of Urology, Department of Surgery Chang Gung Memorial Hospital, Chia-Yi, Taiwan; Graduate Institute
of Clinical Medical Sciences, Chang Gung University, Taiwan; Department of Nursing, Chang Gung Institute of
Technology, Taiwan
Background
Nocturnal enuresis had been successfully treated by pediatric specialists with desmopressin. However, recent studies
revealed that there decreasing urine amount may not be the only reason for PNE improvements. We evaluated a rat
model of additional desmopressin to evaluate if bladder is affected by the use of desmopressin.
Diurnal voiding patterns of rats were monitored with metabolic cages. Desmopressin were given in half of the rats to
monitor voiding pattern, cystometrography, and urine/serum biochemistry changes. Aquaporin 1, 2, and 3, along with Rho
kinase and Transient receptor potential cation channel subfamily V member 4 (TRPV4) mRNA expression in bladder
were evaluated for the effect of desmopressin on bladder. Urine nerve growth factor (NGF) was measured to correlate
with bladder function.
Results
Voiding interval was significant different between desmopressin treated rats and control. Detrusor contractility
significantly increased after desmopressin treatment, which is demonstrated in cystometrography and bladder muscle strips
contractility under electric field stimulation. The overall amount of bladder aquaporin 1, 2, and 3 generally increased in
experiment group at the end of the study. There were no difference in Rho kinase mRNA expression and urine NGF
between the two, but TRPV4 expression is increased in desmopressin rats.
Conclusions
Desmopressin may help increase bladder contractility and decrease voiding interval, and thus improve bladder
voiding efficacy. It may work through increase of aquaporin or TRPV4 expression, but may not be associated with NGF
or Rho kinase.
Podium Presentaion
37
The impact of overactive bladder on health-related quality of life, sexual
life and psychological health in Korea
Kang Jun Cho, Eun Sang Yoo1, Seung-June Oh2, Duk Yoon Kim3, Joon Chul Kim
Department of Urology, School of Medicine, The Catholic University of Korea, Seoul, Korea; 1Department of Urology,
School of Medicine, Kyungpook National University, Daegu, Korea; 2Department of Urology, School of Medicine, Seoul
National University, Seoul, Korea; 3Department of Urology, School of Medicine, Daegu Catholic University, Daegu,
Korea
Aims of Study
To estimate the prevalence of overactive bladder (OAB) in Korea, assess variation in prevalence by sex and age, and
measure impact of OAB on quality of life regarding role limitation, sexual life, and psychological aspects.
Population-based cross-sectional telephone survey was conducted between April and June 2010 using questionnaire
regarding prevalence of OAB, demographics and impact of OAB on quality of life. A geographically stratified random
sample of men and women more than 30 years old were selected. To analyze differences in the prevalence by gender and
age, subjects were stratified into 10 age categories, and a total of 2,000 subjects were targeted for the survey. Modified 2
items related to role limitations and personal relationships from The Korean version of the King’s Health Questionnaire
were used to survey the impact of OAB on job, daily life, and sexual life, and the Korean version of the Hospital Anxiety
and Depression Scale was used to evaluate the impact of OAB on psychological aspects such as anxiety and depression.
Results
The overall prevalence of OAB was 22.9% (458/2,000) with 19% among male and 26.8% among female in Korean,
more than 30 years old. The prevalence of OAB was more common in women than men in all ages, and increased with
age in men. More than 37% of participants with OAB reported moderate (31.4%) or severe (6.2%) bothersome on their
daily life due to OAB symptoms but about 5% of participants without OAB reported moderate (5.0%) or severe (0.6%)
bothersome (p<0.001). About 19.9% of participants with OAB reported that voiding symptoms affected their sexual life
but only 3.5% of participants without OAB reported about it. (p<0.001) And About 22.7% and 39.3% of participants with
OAB had anxiety and depression, but 9.7% and 22.8% of participants without OAB had those things. (p<0.001) Only
19.7% of participants with OAB consulted a doctor for their voiding symptoms and 50.7% of respondents with OAB had
willingness to visit hospital for the management of their OAB symptoms.
Conclusions
This study confirmed that OAB symptoms are highly prevalent in Korea, for which many sufferers appear to have
actively sought medical help. And OAB has severe effects on daily life and sexual life as well as psychological health in
Korea.
38
Increased urine nerve growth factor associated with LUTS and the
serum NOx deficiency in the men with bladder outlet obstruction
Hisashi Honjo1,2, Masahiro Nakao3, Jun Ueyama4, Takaaki Kondo4, Osamu Ukimura2, Akihiro Kawauchi2, Hiroshi
Kitakoji1, Nobuyuki Hamajima5, Tsuneharu Miki2
1
Department of Clinical Acupuncture and Moxibustion, Meiji University of Integrative Medicine, Nantan, Japan;
Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan; 3Department of Urology, Meiji
University of Integrative Medicine, Nantan, Japan; 4Program in Radiological and Medical Laboratory Science, Nagoya
University Graduate School of Medicine, Nagoya, Japan; 5Department of Preventive Medicine, Nagoya University
Graduate School of Medicine, Nagoya, Japan
2
Aims of Study
Urinary nerve growth factor (NGF) levels have been shown to increase in the patients with both bladder outlet
obstruction (BOO) and overactive bladder (OAB) or detrusor overactivity (DO) (Urology, 72(1): 104, 2008). Recently,
several clinical studies on the phosphodiesterase type 5 (PDE5) inhibitors for the treatment of lower urinary tract
symptoms (LUTS) in men with benign prostate hyperplasia (BPH) have reported significant symptom improvement. On
the other hand, we have revealed that the serum nitrite plus nitrate (NOx) in the women with OAB without urge urinary
incontinence (OAB-Dry) was significantly lower than any other groups (Eur Urol, Suppl 9(2): 251, 2010). Aims of this
study are to assess whether the levels of urine NGF are related to LUTS and the serum NOx levels in community-dwelling
men of 40 years or older in Japan.
All participants were recruited for the purpose of a mass-screening program of 2009 for general health in a
community-based study in Japan. A total of 217 men (mean 66.6 years old, range 42 to 89) were asked to complete 3-day
bladder diary and questionnaire to assess LUTS using International Prostate Symptom Score (IPSS). Bladder outlet
obstruction was confirmed by transrectal ultrasonography. Urinary NGF levels were assayed by using a commercial ELISA
kit (NGF Emax® ImmunoAssay System, Promega, Madison, WI, USA). All NGF values were standardized by urine
creatinine (NGF/Cr). Serum NOx levels were measured using a commercial EIA kit (Nitrate/Nitrite Colorimetric Assay
kit, Cayman Chemical, Ann Arbor, MI, USA).
Results
The urinary NGF/Cr levels of the men with BOO significantly increased more than those of the men without BOO
(0.14 vs. 0.056, p=0.005). On the other hand, the serum NOx levels of the men without BOO were greater than those of
the men with BOO, however, there were no significant differences between the two groups (62.7 vs. 57.4 μmol/l, p=0.61).
In subgroup of the men with LUTS (total IPSS≥8) the urinary NGF/Cr levels of the men with BOO significantly increased
when compared with those of the men without BOO (0.16 vs. 0.025, p=0.003). The serum NOx levels of the men without
BOO were greater than those of the men with BOO (80.7 vs. 58.0 μmol/l, p=0.20). On the contrary, in subgroup of the
men without LUTS (total IPSS<8) the urinary NGF/Cr levels did not change significantly between the men with and
without BOO (0.12 vs. 0.085, p=0.18). The serum NOx levels also did not change significantly between the men with
and without BOO (57.0 vs. 56.3 μmol/l, p=0.72). In linear regression analysis of all participants, a statistically significant
positive correlation was observed between age and IPSS (r=0.33, p<0.0001) as well as prostate volume (r=0.22, p=0.019).
The serum NOx levels also had a significant statistically positive correlation with age (r=0.17, p=0.013). Although, there
was not a significantly statistical correlation between the urinary NGF/Cr levels and age (r=-0.0056, p=0.93). In contrast,
a significant statistically negative correlation was observed between the urinary NGF/Cr levels and the serum NOx levels
(r=-0.20, p=0.004). In particular, in subgroup of the men without BOO a highly significant statistically negative correlation
was observed between the urinary NGF/Cr levels and the serum NOx levels (r=-0.65, p<0.0001), while there was no
significant statistical correlation between the two levels in subgroup of the men with BOO (r=-0.005, p=0.71). In multiple
regression analysis of all participants, the serum NOx levels were independently correlated with the urinary NGF/Cr
levels (F=21.1, p<0.0001, R2=0.19). Moreover, in the subgroup of the men without BOO the serum NOx levels were
independently correlated with the urinary NGF/Cr levels (F=27.3, p<0.0001, R2=0.54).
Conclusions
This study demonstrates that the increased urinary NGF/Cr levels of the men with BOO associate with LUTS and
the lower serum NOx levels. The results of this study suggest that the lower urinary NGF/Cr levels may be accompanied
Podium Presentaion
39
with the greater serum NOx levels in the men with BOO. It could provide important information on the clinical
significance of the PDE5 inhibitors for the treatment of LUTS in men with BPH. The serum NOx levels could also
contribute as a biomarker of BPH.
40
Involved extrinsic apoptotic pathway from the bladder biopsy of
patients with interstitial cystitis
1
Division of Urology, Department of Surgery, Taichung Armed Forces General Hospital; 2Department of Urology,
Taichung Hospital, Department of Health; 3Central Taiwan University of Science and Technology, Taiwan
Aim
Previous studies have reported that the apoptosis is increased in patients with interstitial cystitis (IC). However, the
real mechanism is not clear today. We studied the apoptosis-associated proteins by detecting Bcl-2/Bax ratio, cleaved
caspase-9, Fas, cleaved caspase-8, and cleaved caspase-3 expressions from the bladder biopsy of patients with IC, for
detecting the intrinsic or extrinsic pathway.
Methods and Materials
The study group consisted of 55 patients with IC, and the control group consisted of 8 volunteers. We obtained
bladder biopsies from both groups and studied the expression of apoptosis-associated proteins by immunoblotting. Data
were analyzed using the Mann-Whitney U test.
Results
Increased apoptotic protein (cleaved caspase-3) was found in the study group than in the control group (P<0.05).
The expression of Fas and cleaved caspase-8 were also increased in the study group. There is no statistical difference in
intrinsic apoptotic proteins including Bcl-2/Bax ratio and cleaved caspase-9 expression between the control and study
groups.
Conclusions
Our findings showed that increased apoptosis through extrinsic pathway in the bladder tissues of patients with IC.
The 6th Pan-Pacific
Luncheon Symposium
Luncheon Symposium
43
Male LUTS and adrenergic receptor mechanisms
Naoki Yoshimura
Department of Urology, University of Pittsburgh School of Medicine
Male lower urinary tract symptoms (LUTS) related to benign prostatic hyperplasia (BPH) are commonly seen
and consist of both storage (irritative) and voiding (obstructive) symptoms. α1-Adrenergic receptor blocking agents have
often been used as a first choice of therapy of BPH-related male LUTS. As the major subtype of α1-adrenergic receptors
in the prostate, urethra and bladder neck is the α1A-type, α1A-selective adrenergic receptor antagonists such as silodosin
have recently been shown to be effective for reducing LUTS in male patients with BPH. In the clinical studies using α1blockers, not only voiding symptoms, but also storage symptoms are reduced in male LUTS patients. The etiology of
storage symptoms of LUTS, which are overlapped with overactive bladder (OAB) symptoms, would be multifactorial, and
may include increased myogenic activity of the hypertrophied detrusor muscle, sensitization of afferent nerves from the
prostate and the bladder, or others. Based on the findings in animal studies, α1-blockers including silodosin can suppress
afferent activity originating from the urethra and the bladder. Another potential site of action of α1-blockers might be
in the central nervous system (CNS), especially in the spinal cord, since there is evidence that the spinal descending
adrenergic system originating from the brain stem has facilitately effects on the micturition reflex and that α1-blockers
including silodosin applied to the spinal cord can suppress bladder overactivity in animal models of OAB. Therefore,
these afferent and CNF effects of α1-blockers could also contribute to the improvement of storage symptoms of male
LUTS in addition to the relaxing effects on prostatic and urethral smooth muscle, which reduce voiding symptoms of
LUTS. Thus, in this lecture, I will discuss potential mechanisms of adrenergic receptors and α1-blockers for the treatment
of male LUTS related BPH.
The 6th Pan-Pacific
Symposium 2
Female urinary incontinence -management in complicated situation
Symposium 2
47
Salvage therapy for failed surgery for mixed urinary incontinence in
females
Chung-Hsi Yeh
Division of Urology, Department of Surgery, Shin Kong Wo Ho Su Memorial Hospital, Taipei, Taiwan; School of
Medicine, Fu-Jen Catholic University, Taipei, Taiwan
Mixed urinary incontinence (MUI) is defined as a combination of stress and urge symptoms. Chronically , it has
somehow been considered as a single disease entity, encompassing treatment options and etiology.
Selecting an optimal therapy for mixed incontinence is challenging, because a single-treatment modality may be
insufficient for alleviating both the stress and urge components.
Lifestyle modification and behavioral therapy should be considered first-line options for all women with MUI. The
add-on modality of pelvic floor muscle exercise may have an additional positive effect. It is effective to treat urge part with
antimuscarinics; however, the stress component is most likely to persist after medical therapy.
Anti-incontinence surgery may have a positive impact on both the stress and urge parts of MUI; nevertheless, females
with MUI probably may have lower cure rate as compared with women suffering from pure stress urinary incontinence.
Therefore, what if anti-incontinence surgery failed to treat women with MUI; What should we ponder to decide the next
treatment option which is the most appropriate and effective for the patient?
Before the so-called salvage therapy is applied, we should be able to pick up the best candidate for surgery and
reduce the probability of failure to much extent as well. Once facing the failed case, to decide which salvage therapy will
work depends on the individual’s clinical scenario and further study to elucidate the causative factors as completely as
possible.
In summary, The optimum management of females with MUI may often need multiple treatment modalities.
Although anti-incontinence surgery can resolve both components simultaneously for 50-75% of the patients, its routine
implementation should be made with caution and the patient should be highly selected and counseled preoperatively.
48
Management of stress urinary incontinence and pelvic organ prolapse --concurrently or treat prolapse only?
Isao ARAKI
Department of Urology, Shiga University of Medical Science, Otsu, Japan
Advanced pelvic organ prolapse (POP) is associated with stress urinary incontinence (SUI). The rate of POP patients
complaining of concomitant SUI has been reported to be 40 to 66%. Furthermore, a certain percentage of SUI is masked
preoperatively, since advanced POP may cause urethral kinking and external urethral compression. The reported rate of
occult or masked SUI in continence patients ranges from 27 to 68%.
To date, SUI prevention at the time of prolapse repair is still debatable, especially in preoperatively diagnosed occult
SUI. It has been reported that preoperative positive stress test with prolapse reduction is associated with a higher risk for
postoperative leakage. However, some of patients with positive stress test are still continence after POP surgical repair
without continence surgery. Further, when performing concurrent prolapse and continence surgeries, some reports suggest
the potential risks of developing the storage and voiding problems and increasing urinary tract injuries.
Using cough stress testing with prolapse reduction, we examined how precisely preoperative evaluation of occult SUI
can predict the development of SUI after POP surgery.
We reviewed retrospectively the records of all 119 women who underwent surgery for symptomatic POP. The
International Consultation on Incontinence Questionnaire Short Form for urinary incontinence (ICIQ-UI) was used
for evaluation of urinary incontinence (UI). Women were considered to have UI if they reported symptoms of UI
on the ICIQ-UI and required a pad usage during activities of daily living. POP repair was performed with the use of
polypropylene mesh (GyneMesh PSTM, Ethicon, USA) cut by the surgeon according to the Trans Vaginal Mesh (TVM)
technique described previously. Whenever the patients with symptomatic SUI and/or a positive stress test wished for
operative correction or prevention, the trans-obturator mid-urethral sling (TOT) procedure was performed concurrently.
A stress test with prolapse reduction was performed at a bladder volume of 300 mL or maximal bladder capacity,
whichever was less, in a 45˚ lithotomy position. During filling cystometry, it was confirmed that involuntary detrusor
contraction was not provoked by coughing. Occult SUI was defined as a positive stress test without history of SUI
symptoms. Postoperative SUI was determined by symptom assessment and a pad usage 6 months after surgery. SUI
symptoms were verified by stress testing.
In our study, 59% of patients diagnosed with occult SUI using stress testing developed symptomatic SUI after
POP surgery, if they did not undergo TOT concurrently. In contrast, of 73 patients with a negative stress test, only 5%
developed SUI postoperatively. Thus, cough stress test with prolapse reduction may be sufficient for diagnosis of occult
SUI. However, some of the patients with a positive stress test (41%) did not develop SUI postoperatively without the TOT
procedure. We think that a preventive effect of TVM on SUI is unlikely, since TVM leaves the bladder neck perfectly
free. The detection rate of occult SUI with a cough stress test varies by method of prolapse reduction and examiner.
It is thus possible that occult SUI is somewhat overdiagnosed and that false positive findings occur on stress testing, as
previously suggested.
Occult SUI diagnosed preoperatively may alter the surgical strategy. Thus, a cough stress test with simple filling is
essential for diagnosis of occult SUI. Our findings seem to support the usefulness of concurrent performance of anti-SUI
surgery with POP repair in patients with symptomatic and occult SUI, however the criterion for a positive stress test needs
the refinement (for example, the quantification/grading of test result).
Symposium 2
49
Tricks and tips to avoid and manage complications in female pelvic
floor surgery
Jong-Hyun Kim
Miz Medi Hospital Seoul Korea
Introductions
Pelvic organ prolapsed (POP) is due to attenuation & weakness of pelvic floor muscles, fasciae & ligaments due to
delivery, aging & chronic stress. It is classified as anterior (cystocele, cystourethrocele related with stress incontinence),
apical (uterine or vault prolapse, enterocele) and posterior compartment (rectocele). This is prevalent problem up to 50%
of parous women but only 11% of POP patients were undergone operation to correct SUI or POP. Of those who receive
surgery, an estimated 13% will require a repeat operation within 5 years and as many as 29% will undergo another surgery
for prolapse or a related condition at some point during their life. The need to improve the outcome of traditional surgical
treatment of SUI or POP has led to increased use of synthetic or biologic graft materials in pelvic floor surgery.
The use of synthetic mesh for inguinal and ventral hernia repair is well supported in the general surgery and is
currently considered the ‘gold standard’ approach. In the field of pelvic floor surgery, the use of synthetic mesh during
mid urethral sling operation and sacral colpopexy is well established. Recently there has been an increase in the use of
synthetic or biologic mesh to augment transvaginal POP surgery. This has largely been driven by the recent availability and
marketing of commercially made ‘mesh kits’ for transvaginal POP repair. Despite a paucity of consistent data, the use of
new synthetic materials including mesh kits is rapidly expanding.
In this chapter, I will summarize the potential benefits and risks associated with vaginal mesh and provide proper
approach for avoiding and managing postoperative complications in female pelvic floor surgery.
Benefits and Risks of Vaginal Mesh Use
The use of mesh or graft to correct SUI or augment vaginal prolapse surgery is associated with both potential
benefits and risks. The pelvic surgeon must carefully consider the balance of these benefits and risks when deciding the
use of mesh for transvaginal surgery. The aim of using mesh in pelvic reconstructive surgery is to get the result which is
safe, more effective and durable. It seems to be reasonable to use mesh tape in anti-incontinence surgery when benefits
and risks are evaluated. The longest FU result of TVT (11 years) shows objective cure 90%, subjective cure 77% and its
complication rate has not been high compared to its effectiveness. However there are some controversies to use mesh
or graft to improve the success in prolpase surgery. In 2008, the Society of Gynecologic Surgery(SGS) and in 2010, the
Cochrane Collaboration completed a systematic review and concluded that the use of mesh at the time of anterior vaginal
wall repair may reduce the risk of recurrent cystocele but the use of non absorbable synthetic mesh may be associated with
significant adverse effect, and there was insufficient evidence to make recommendations for posterior and apical repair.
Potential complications related to graft and mesh include voiding problems (obstructive and irritative symptoms, de
novo SUI), mesh erosion or extrusion, infection, chronic pain, dyspareunia, fistula.
In October 2008, the Food and Drug Administration (FDA) issued a public health notification and made
recommendations regarding the serious complications associated with transvaginal placement of surgical mesh for the
repair of POP and SUI in which they describe receiving 1000 reports of complications over 3 years. This counseling
includes informing patients about the following: (1) obtain specialized training for each mesh placement technique, (2)
implantation of surgical mesh is permanent, (3) some complications associated with the implanted mesh may require
additional surgery that may or may not correct the complication, and (4) there is the potential for serious complications
that may affect quality of life, including pain during sexual intercourse, scarring, and narrowing of the vaginal wall. This
illustrates the balance of benefits and risks that the surgeon and patient must keep in mind before deciding the use of
vaginal mesh or graft for the treatment of pelvic organ prolapse.
Complications of Female Pelvic Floor Surgery
Voiding Problems
The incidence of voiding difficulty after mid urethral sling operation was 2.8-8% and the mechanism is excessive
sling tension and/or migration of tape to proximal portion. The clinical manifestation is obstructive and/or irritative urinay
symptoms and there is clear temporal relationship of symptoms and operation. On physical examination, fixed and
hypersuspended urethral mobility was found.
50
De novo SUI appears in women who had anterior repair with mesh augmentation. The incidence was reported by
7-23%. This is more common in mesh augmented repair compared to traditional method. Hiltunen et al. reported de
novo stress urinary incontinence in 23% of patients who had mesh repair compared with 10% in patients who underwent
traditional anterior repair. Hung et al. reported de novo stress urinary incontinence in 16.7% of women after anterior
repair reinforced with mesh.
Mesh Erosion
Mesh erosion rate of mid urethral sling operation using macroporous monofilament polypropylene tape is 0.7-1.8%
but the incidence is higher in POP surgery. Erosion of mesh after transvaginal prolapse surgery varies widely from
2% to 25%, 3 to 24 months after placement with synthetic mesh. Multifilament mesh has a higher rate of erosion and
complications than wide pore monofilament mesh. The causes of mesh erosion are inadequate vaginal tissue coverage,
poor tissue vascularity, infection, and mesh contraction or folding. Clinical symptoms are vaginal discharge, bleeding,
chronic pain, dyspareunia and partner’s pain during intercourse but it can be asymptomatic in some patients.
Mesh-Related Infection
Vaginal surgery is a ‘clean–contaminated surgery’ since the vagina is naturally colonized by bacteria and is located
close to the anus. Bacterial contamination may occur during vaginal prepping or vaginal closure. The reported frequency
of infection after the use of polypropylene mesh for POP is 0-8%. It should be emphasized that clinically evident infection
is frequently associated with erosion while asymptomatic infection may be the cause of an additional proportion of cases
with erosion. Clinical symptoms include non-specific pelvic pain, persistent vaginal discharge or bleeding, dypareunia, and
urinary or faecal incontinence. Clinical examination can reveal vaginal induration, vaginal granulation tissue, draining sinus
tracts, and mesh erosion. A mesh-related infection can sometimes manifest as a pelvic abscess in the retropubic space,
pararectal abscess, ischio-rectal abscess, vesicovaginal fistula, recto-vaginal fistula, abdominal fistula, sigmoid bowel-vaginal
fistula, entero-cutaneous or enteroperineal fistulas, and osteomyelitis.
Chronic Pain & Dyspareunia
Persistent pain after 3 months is suspicious for nerve capture or injury. Vaginal examinations can provide substantial
information. In cases of obturator neuralgia, palpating the obturator foramen can provoke the electric pain. In cases of
pudendal neuralgia, the pain is provoked by palpating the ischial spine.
Mesh shrinkage caused by excessive fibrin reaction is a recently identified complication. It may lead to excessive
stiffness of the vaginal wall and cause secondary pain and dyspareunia. Dyspareunia rate of up to 38% has been reported
with vaginally introduced mesh for POP repair. Women may develop de novo dyspareunia without mesh erosion.
Regardless of the presence of mesh erosion, chronic pain and de novo dyspareunia related with mesh implantation were
the indication for removal of mesh.
Fistula
Risk Factors of Mesh Erosion and Contraindications of Mesh Use
Patients with significant urogenital atrophy who have thin vaginal walls may be at risk for mesh erosion or exposure
after mesh placement. Age, concomitant hysterectomy, smoking, active sexuality, chronic steroid use, pelvic radiation,
uncontrolled diabetes mellitus, or other causes of a compromised immune system may be also other risk factors to affect
wound healing and these conditions are relative contraindications to vaginal mesh placement.
In addition to a history of chronic pain, current and future sexual activity is another factor to consider when choosing
a transvaginal mesh procedure. Mesh does not have the same elasticity as the vaginal wall and therefore may alter the
functionality of the vagina. So some surgeons do not place permanent synthetic mesh in sexually active women because of
reported de novo dyspareunia and/or altered sexual function.
Perioperative Principles to Avoid Complications
1) The bladder should be drained with a transurethral catheter.
2) A well-estrogenized vaginal wall is preferred before surgery (intravaginal estrogen cream daily (0.5 to 1.0 g/d) for 2 to
3wk preoperatively).
3) A vaginal pessary should be removed 1 to 2 weeks before surgery to limit vaginal epithelium irritation.
4) The procedure should be initiated after antibiotic prophylaxis with a first or second generation cephalosporin 1 hour
before surgery.
Symposium 2
51
5) Avoid making inverted ‘‘T-shaped’’ incisions from a concurrent hysterectomy and colporrhaphy.
6) Exposure of the correct vesicovaginal and rectovaginal planes are performed with hydrodissection of 20 to 80 mL 0.5%
lidocaine with 1:200,000 epinephrine, dilute pitressin (20 units in 60 to 100 mL of saline), or normal saline.
7) Mesh should be placed underneath the vaginal muscularis. It is vital that the surgeon perform a full-thickness dissection
deep into the vesicovaginal and rectovaginal spaces to avoid erosion of the mesh postoperatively.
8) The mesh should be placed loosely. Loosely place the prosthesis because mesh can contract by up to 20-25% after
placement compromising vaginal length and caliber.
9) The mesh is placed flat and minimal tension and it will improve fibroblast growth and minimize complications of pain
or erosion.
10) The vaginal epithelium should not be trimmed. Trimming the vaginal epithelium can lead to discomfort and may also
contract.
11) The colpotomy incision is closed using a non-locking continuous absorbable suture.
12) Cystoscopy, digital rectal examination and, if necessary, protoscopy should be performed routinely after mesh
placement to identify potential visceral injury.
13) Macroporous monofilament, low weighted polypropylene mesh should be chosen.
Management of Mesh Complications
Voiding Difficulty
The incidence of voiding difficulty after mid urethral sling operation is 2.8-8%. This is relatively lower compared
to other anti-incontinence surgeries such as colposuspension or pubovaginal sling operation. To solve this problem, non
surgical or surgical treatment modalities can be used. Non surgical management include waiting with CIC, medication
(obstructive-diazepam, baclofen, alpha blocker, irritative- anticholinergics), physical therapy for pelvic floor control,
urethral dilation and downward traction. Surgical management is tape incision or release and formal urethrolysis. In
most cases, obstruction can be effectively treated with tape manipulation with incision or release. The success rate of tape
incision or release was 81-100% in obstructive symptom, 57-88% in irritative symptom and recurred SUI appeared 0-40%.
Under rare circumstances, when simple tape incision does not sufficiently alleviate the obstructive symptom, complete
transvaginal urethrolysis with lateral dissection and perforation of endopelvic fascia is required to achieve satisfactory
vesicourethral mobility.
The timing of tape incision or urethrolysis has been commonly recommended at minimum 3 months after operation
but the reports advocating earlier operation is growing. During sling revision, concomitant mid urethral sling operation has
not been recommended.
In summary, both obstructive & irritative symptoms due to urethral obstruction after mid urethral sling operation are
well controlled by simple tape incision or urethrolysis and the incidence of recurred SUI after sling revision is acceptable.
Mesh Erosion with or without Infection
Mesh or graft erosion is one of the most common postoperative complication and not always combined with
infection and pain. The simple exposition can be differentiated from infection or foreign-body rejection by simple pulling
on the mesh. In the former, tissue ingrowth is strong and the mesh is attached and in the latter, the mesh is loose without
tissue attachment on a part or the whole surface. If the mesh is loose, it must be totally removed or, at least, trimmed as far
as possible, up to a part with strong tissue ingrowth.
Treatment options consist of use with antibiotics and estrogen cream, partial simple excision and removal of the
maximum amount of mesh or graft. If the patient is asymptomatic, not sexually active, and the erosion is small (<1cm) we
initially advocate the use of vaginal estrogen. We will typically use 1 g of vaginal estrogen at night for 2 weeks and then 3
times weekly. If the erosion persists until 3 months after estrogen use we proceed to partial simple excision. Partial simple
excision is mostly done in case of a limited vaginal exposure with mild symptoms. The exposure site is circumcised and
the edges of the vaginal epithelium are mobilized approximately 1cm around the exposure. The extruded part of the mesh
is then removed and the edges of the vaginal epithelium trimmed and reapproximated.
In cases where partial mesh excision has failed, when the exposure area is large, when infection, foreign body
rejection, abscess, fistula, or chronic pain is present and when mesh erosion involving bladder or rectum is found, removal
of the majority of the mesh is considered. If the mesh was originally placed from a completely transvaginal approach,
then it may be possible to remove the mesh in its entirety. If trocars were used to place the mesh, as is the case with many
commercially available mesh kits, it is often not possible to remove the arms of the mesh because they pass through the
52
ischiorectal fossa and/or obturator space. In these cases, we advocate removal of as much of the mesh as possible through
a vaginal approach while leaving the mesh arms in place.
The possibility of recurrence of POP after excision of mesh was more common with complete or maximal excision
than with partial excision. If it is possible, partial excision should be preferred in most cases of mesh exposure with
relatively mild symptoms.
The 6th Pan-Pacific
State-of-the-art lecture 2
55
Clinical challenges of male incontinence: post-prostatectomy
incontinence
Kyu-Sung Lee
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Introduction
Despite improvements in surgical technique designed to preserve the functional integrity of the urethral sphincteric
mechanism, incontinence after radical prostatectomy still occurs in many patients. Most patients with post-prostatectomy
incontinence (PPI) have stress urinary incontinence (SUI) secondary to intrinsic sphincter deficiency (ISD). Patients with
bladder dysfunction should be diagnosed and treated prior to surgical intervention.
Management of post-prostatectomy incontinence
The primary management of sphincteric incompetence after radical prostatectomy is bulking agents, artificial urinary
sphincter and bulbourethral sling procedures. While pelvic floor exercise training and therapy instituted prior to radical
prostatectomy aids in the earlier achievement of urinary incontinence, the value of the various approaches to conservative
management of PPI generally remains uncertain [1].
Since its introduction in 1993, bovine glutaraldehyde cross-linked collagen (Contigen; CR Bard, Covington, GA)
has been used extensively as a bulking agent in the treatment of ISD in men. However, enthusiasm for this endoscopic
procedure has waned because of the low success rates and the need for multiple treatments. In short-term studies,
significant improvement or cure was achieved in approximately 20-62% of patients, but success rates declined dramatically
with longer-term follow-up [2]. Traditionally, collagen implant which is well tolerated and has low complication rate, has
been recommended for mild to moderate incontinence in male SUI.
Various types of male sling procedures have been introduced over the years. Unlike the artificial urinary sphincter
(AUS), the perineal male sling has the advantage of allowing spontaneous physiological voiding without need for
manipulation. Bone anchored male sling appears to be effective and safe in intermediate term follow up. Excellent cure
rates have been reported and they generally range between 70-90% depending on the method of evaluation and definition
of success [3-5]. Patient satisfaction rate of 70% with a mean follow-up of 24 months [5]. The sling failure correlated with
the type of material and severity of the incontinence.
AUS is the gold standard treatment for PPI offering patients the greatest chance of cure. In the largest study to date,
Elliott and Barrett reported 245 of 271 (90%) patients having a functioning AUS at mean follow-up of 5 years and 72%
required no revision [6]. Another study with 61 patients and a 10-year follow-up reported a 75% continence rate, with
80% of patients having had at least one revision procedure by 10 years [7]. In spite of new technology, AUS continues to
provide high patient satisfaction and cure rates.
Recently, various adjustable male slings have been introduced in Europe which can be adjusted according to patient
needs and recurrence of urinary incontinence, such as ProACT [8], Reemix [9] and Argus [10]. Recently, Rehder and
Gozzi reported the safety and efficacy of a transobturator sling suspension, which may offer further advantages, including
the avoidance of bone anchors, but data on outcomes are still pending [11].
Summary
Most patients with PPI have SUI secondary to ISD. Patients with bladder dysfunction should be diagnosed and
treated prior to surgical intervention. The AUS is the gold standard in treating patients with stress incontinence. Collagen
injection therapy plays a very limited role in the PPI patients. Various bulbourethral slings, especially bone-anchored male
sling and new devices provide an alternative therapy to the AUS.
References
1. Parekh AR, Feng MI, Kirages D, Bremner H, Kaswick J, Aboseif S: The role of pelvic floor exercises on post-prostatectomy
incontinence. J Urol 2003; 170:130-133.
2. Faerber GJ, Richardson TD: Long-term results of transurethral collagen injection in men with intrinsic sphincter deficiency. J
Endourol 1997; 11:273-277.
3. Madjar S, Jacoby K, Giberti C, et al: Bone anchored sling for the treatment of post-prostatectomy incontinence. J Urol 2001;
165:72-76.
56
4. Comiter CV: The male sling for stress urinary incontinence: a prospective study. J Urol 2002; 167:597-.601.
5. Rajpurkar AD, Onur R, Singla A: Patient satisfaction and clinical efficacy of the new perineal bone-anchored male sling. Eur Urol
2005; 47:237-242.
6. Elliott DS, Barrett DM: Mayo Clinic long-term analysis of the functional durability of the AMS 800 artificial urinary sphincter: a
review of 323 cases. J Urol 1998; 159:1206-1208.
7. Fulford SC, Sutton C, Bales G, Hickling M, Stephenson TP: The fate of the 'modern' artificial urinary sphincter with a follow-up of
more than 10 years. Br J Urol 1997; 79:713-716.
8. Hubner WA, Schlarp OM: Treatment of incontinence after prostatectomy using a new minimally invasive device: adjustable
continence therapy. BJU Int 2005; 96:587-594.
9. Sousa-Escandón A, Rodríguez Gómez JI, Uribarri González C, Marqués-Queimadelos A.: Externally readjustable sling for treatment
of male stress urinary incontinence: points of technique and preliminary results. J Endourol 2004; 18:113-118.
10. Moreno Sierra J, Victor Romano S, Galante Romo I, Barrera Ortega J, Salinas Casado J, Silmi Moyano A.: [New male sling "Argus"
for the treatment of stress urinary incontinence]. Arch Esp Urol 2006; 59:607-613.
11. Rehder P, Gozzi C: Transobturator sling suspension for male urinary incontinence including post-radical prostatectomy. Eur Urol
2007; 52:860-866.
The 6th Pan-Pacific
Symposium 3
Translational researches on lower urinary tract
Symposium 3
59
New aspects in immunological mechanisms of bladder pain syndrome/
interstitial cystitis
Tomohiro Ueda
Department of Urology, Kyoto city Hospital, Kyoto University
Objectives
Upon completion of this session, attendees will be presented with: up-to-date information regarding investigational
approaches, mechanistic concepts and therapeutic options about the immunological mechanisms of BPS/IC.
Overall Presentation
Bladder pain syndrome/interstitial cystitis (BPS/IC) is a chronically progressive syndrome affecting the urinary
bladder and is associated with symptoms of urgency, frequency and pain. This lecture will cover the current knowledge
regarding peripheral targets and mechanisms underlying BPS/IC as well as therapeutic strategies. I will present evidence
supporting a possible involvement of immune reactivity and the mechanisms that may be involved in triggering symptoms
in patients diagnosed with BPS/IC. Urothelial cells have been demonstrated to release an array of signaling factors in
response to mechanical and chemical stimuli. The targets for these signaling factors are thought to include afferent
nerve terminals and lamina propria interstitial cells, suggesting that the urothelium may be involved in regulating bladder
activity and sensory function. As no one pathological process has been identified in every patient with BPS/IC, a better
understanding of possible mechanisms will increase opportunities for the development of new therapeutics targets for the
treatment of this disorder.
The pathology of BPS/IC has been linked with a number of findings including an epithelial deficiency (alterations in
the GAG layer), increased mast cell number and activity and/or increased expression of angiogenic and neuroendocrine
factors. While there is no evidence for a direct causal role for autoimmune reactivity, there is increasing support for an
involvement of the immune system in this disorder. In this regard, a number of clinical associations have been reported
between BPS/IC and other autoimmune diseases such as lupus erythematosis, rheumatoid arthritis and ulcerative colitis.
In addition, recent reports have also linked stress responses (which also increase incidence of symptoms in PBS/IC
patients) and increased reactivity of the immune system. Both “defensive” agents (such as chondroitin sulfate, heparinoids
and/or pentosan polysulfate-used against bladder symptoms) as well as “offensive” symptoms and factors (chronic
inflammation, substances in urine) will be discussed. In addition, there is also evidence for auto-antibodies (which can
affect a number of receptors/ion channels at various sites within the bladder wall) in patients with BPS/IC and other
known autoimmune diseases. Narrow Band Imaging (NBI) and Neurometer could play an important role in clarifying the
immunological condition of urinary bladder.
Take Home Message
Immunological reactivity may be an important component in the pathogenesis of BPS/IC, exhibiting different stages
of host defense mechanisms depending upon the degree of various pathogenic factors in the bladder. The net result is a
hypersensitivity of the urinary bladder to physical and chemical stimulation.
The 6th Pan-Pacific
63
PK01 Association between blood vessel changes of bladder mucosa and
storage symptoms in female stress urinary incontinence patients
Duk-Yoon Kim1, Hyun Chan Chang1, Yoo Jun Park1, Gong Hynk Jun1, Byung Hoon Kim2, Chaol Hee Park2
1
Department of Urology Catholic University of Daegu, Daegu, Korea; 2Department of Urology, Keimyung University,
College of Medicine, Daegu, Korea
Aims of Study
Although midurethral sling (MUS) surgery is a very effective procedures to relieve stress urinary incontinence
(SUI) as well as mixed incontinence, urgency/frequency and urge incontinence remain in some patients post-operatively
and bother the patients. In this study, we investigated that the cystoscopic findings of blood vessel changes such as
neovascularization and telangiectasia in bladder mocosa associated with the development of storage symptoms in stress
urinary incontinence before and after operation.
60 patients who were admitted for MUS surgery included in our study. 20 patients were genuine stress incontinence
(group 1), 20 were SUI with urgency/frequency (group 2) and 20 were mixed incontinence (group 3). Average age was
53 year-old (range 38-70). Cystoscopic examination were done under anesthesia before midurethral sling procedure and
blood vessel changes was classified as neovascularization, telangiectasia. Association between blood vessel changes and
presence of storage symptoms was evaluated and storage symptoms was defined as documentation of urgency/frequency,
nocturia.
Results
There was no operation-related complications such as bladder perforation, mesh erosion and urethral injury. 4
cases in group 1, 16 cases in group 2, 18 cases in group 3 showed blood vessel changes. Persistent storage symptoms
observed in 1 case (group 1), 3 cases (group 2) and 4 cases (group 3) post-operatively (Table 1). There was no case of new
development of storage symptoms in which did not showed mucosal blood vessel changes pre-operatively. As storage
symptoms severe in stress urinary incontinence, the incidence of mucosal blood vessel changes increased. Persistence of
storage symptoms was limitedly observed in blood vessel changed patients.
Conclusions
The incidence and severity of storage symptoms were closely related with bladder mucosal vessel changes and this
finding suggest that storage symptoms in stress urinary incontinence may be associated with factors which provoke the
over-expression of mucosa blood vessel changes.
Figure 1. Telangiectasia in cystoscopic findings.
Table 1. Correlation between storage symptom and telangiectasia
Genuine stress incontinence Stress urinary incontinence
with urgency/frequency
Pre-op.
Post-op.
Pre-op.
Post-op.
Bladder mucosa Positive
4
1*
16
3*
3
13
vessel changes
Negative 16
0*
4
0*
16
4
Total
20
20
Mixed incontinence
Pre-op.
18
2
20
Post-op.
4*
14
0*
2
64
PJ01 Interleukin-4 gene therapy using herpes simplex virus vectors
for bladder pain and overactivity
Tomohiko Oguchi1,2, Hitoshi Yokoyama1,2, Osamu Nishizawa2, William F Goins3, James R Goss3, Joseph C Glorioso3, Naoki
Yoshimura1
1
Department of Urology, University of Pittsburgh; 2Department of Urology, Shinshu University; 3Department of
Molecular biology and Genetics, University of Pittsburgh
Aims of Study
Although the etiology bladder pain syndrome/interstitial cystitis (BPS/IC) is not fully understood, bladder
inflammation associated with production of inflammatory cytokines or chemokines have been proposed as potential
pathogenesis of the disease. The expression levels of interleukin (IL)-2, IL-6, TNFα or other chemokines in the bladder
of IC patients are significantly greater than controls, which might be used as a specific marker for IC. On the other
hands, IL-4 is a prototypical anti-inflammatory cytokine, which inhibits secretion of cytokines like IL-1β, TNFα and IL-6.
However, because of its pleiotropic effects on the immune system, it could not be used as systemic treatment of pain
in humans. We therefore examined the effects of localized and targeted gene therapy using replication-deficient HSV
vectors (S4IL4) expressing murine IL-4, on bladder overactivity and pain behavior induced by intravesical application of
resiniferatoxin (RTx) in rats.
Methods
Replication-deficient HSV vector S4IL4 expressing IL-4 (HSV-IL4) was produced using Cre-lox recombination of a
plasmid that contains ICP4 promoter driving the murine IL-4 gene in addition to the HCMV IE promoter-β-galactosidase
expression cassette and a lox combination site into the thymidine kinase (tk) locus of d120, which is a replication-defective
KOS strain HSV mutant, containing a deletion of both copies of the immediate-early ICP4 gene. As an isogenic control
vector, we employed the SHZ (HSV-lac Z) virus that has the HCMV IE promoter-β-galactosidase expression cassette
recombined into thymidine kinase (tk) locus of d120 by similar techniques. One or 2 weeks prior to experiments, 20
μl of viral suspension (4×109 pfu/mL S4IL4 or 5×108 pfu/mL SHZ) were injected to the bladder wall of female SD rats
with midline incision under pentobarbital anesthesia. (1) Virus infection was examined by immunohistochemistry using
β-galactosidase staining technique. (2) Murine IL-4 in L6 DRGs and the bladder of S4IL4 injected rats were quantified by
ELISA. (3) Cystometry was performed under urethane anesthesia (1.2 g/kg, s.c.). After 2 hours of saline infusion, 10nM
RTx was continuously infused into the bladder to induce bladder overactivity (n=9 each). Intercontraction intervals (ICI)
were compared before and after RTx administration. (4) A behavioral study was performed to evaluate the effects of IL4
gene delivery through the bladder on bladder pain induced by RTx. In a conscious condition, 3 μM RTx (0.3 mL, 1 min)
was injected to the bladder through a temporally indwelled urethral catheter to evaluate nociceptive behaviors such as
licking (lower abdominal licking) and freezing (motionless head-turning to the lower abdomen) were counted and recorded
every 5 sec for 15 min (n=7-8). Based on our previous observation, licking behavior represents urethral pain, which is
mainly mediated by activation of the pudendal nerve. On the other hands, freezing behavior is predominantly related
to bladder pain, which is mainly mediated by activation of the pelvic nerve. (5) HSV vector-treated rats were sacrificed
6 hours after 3 μM RTx application into the bladder (0.3 mL, 1min) to quantify IL-1β in the bladder using ELISA (n=4
each).
Results
(1) Lac Z-positive staining was identified in the bladder and L6 DRG neurons of SHZ injected rats. (2) Murine IL4
was detected in the bladder (5.6±1.6 pg/mg total protein [TP]) and L6 DRG (13.3±3.8 pg/mgTP) in S4IL4 injected rats. (3)
There were no significant difference in ICI between two groups during saline infusion (p=0.15). After RTx administration,
SHZ injected rats showed a significant reduction in ICI (p<0.05) while ICI did not change significantly (p=0.47) in S4IL4
injected rats. (4) RTx-induced freezing behavior was significantly less in S4IL4 injected rats by 47% than in SHZ rats (30
±5 vs. 57±6 times, p<0.05). (5) Bladder IL-1β after 3 μM RTx administration was significantly reduced in S4IL4 injected
rats compared to SHZ injected rats (42.1±8.0 vs. 84.4±9.6 pg/mgTP, p<0.05).
Cconclusions
The results of this study indicate that: (i) HSV vectors injected into the bladder wall are transported into L6 DRG
neurons via afferent nerves; (ii) significant increases of murine IL-4 were detected in the bladder and L6 DRG from S4IL4
vector-injected rats, (iii) in S4IL4-treated rats, the ICI was not reduced during RTx intravesical administration, which
65
induced bladder overactivity in SHZ-treated control rats; (iv) S4IL4-injected rats showed a reduction in freezing behavior;
and (v) increased expression of IL-1β elicited by RTx-induced bladder irritation was reduced in S4IL4-treated rats.
Therefore, IL-4 gene therapy using replication-deficient HSV vectors could be a new strategy for treating bladder
pain and/or urinary frequency in patients with BPS/IC.
66
PT01 Chronic inflammation but not urothelium dysfunction in patients
with overactive bladder syndrome
Hsin-Tzu Liu, Hann-Chorng Kuo
Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
Aims of Study
Recent investigations have linked overactive bladder syndrome (OAB) with chronic inflammation. Urinary nerve
growth factor, cytokines and serum C-reactive protein have been demonstrated to increase in patients with OAB and
interstitial cystitis/painful bladder syndrome (IC/PBS). Previous reports have suggested that IC/PBS is associated with
increased activated mast cell numbers in the bladder and disruption of the barrier function of the urothelium. However,
there is no study investigating the mast cell activation and urothelium barrier dysfunction in OAB. Since there are
similarities in the inflammatory protein expression between OAB and IC/PBS, therefore, in this study the Infiltration of
mast cells and the distribution of protein involved in barrier function were explored by immunohistochemical assessment
of E-cadherin and ZO-1 in the bladder tissue of patients with OAB and IC/PBS.
Bladder wall biopsies were performed in 27 patients with OAB, 18 patients with IC/PBS, and 19 patients with
stress urinary incontinence but without urgency frequency symptoms and served as controls. The expression of junction
protein E-cadherin, tight junction protein ZO-1 and activated mast cell in bladder wall from these patients were evaluated
quantitatively using immunofluorescence staining. The percentages of tryptase-positive mast cells were calculated from 5
consecutive high-power fields (X400) in the area with the highest dense infiltrate. Confocal microscopy was used to capture
ZO-1 image. Density of E-cadherin and ZO-1 expression were quantified with Image J software. Two to three sections
per sample from OAB or IC/PBS bladders and controls were examined. Statistical analysis was performed using one-way
ANOVA and p value small than 0.05 was considered as significance. This study was approved by the Institution Review
Board of the hospital.
Results
The OAB group consisted of 6 women and 21 men aged from 42 to 85 years old (mean 72). Patients with IC/PBS
were 16 women and 2 men aged 21 to 72 years old (mean 42). Control patients were 19 women aged 29 to 71 years
old (mean 54). All OAB patients presented with urgency and urgency incontinence (OAB wet) and the bladder tissue
were obtained during procedure of intravesical botulinum toxin injection. All patients with IC/PBS had been proven by
cystoscopic hydrodistention and had characteristic glomerulation. The bladder tissues of the controls were obtained during
anti-incontinence surgery. The number of mast cells in suburothelium and detrusor area was low in the control group (mean
± standard error 1.77±0.47, range 0.00-9.00). But a highly significant increase of the mast cells infiltration was observed in
the specimens from IC/PBS (4.64±0.72, range 1.00-10.00) and OAB patients (4.00±0.55, range 0.00-11.00) (p=0.008 and
p=0.024, respectively ). The expression level of E-cadherin and ZO-1 in the IC/PBS bladder (mean ± standard error 59.05
±9.48 and 7.45±0.99) were significantly down regulated compared with that in the control group ( 96.30±9.15 and 14.55±
2.08 ; p=0.009 and p=0.013). However, compare the density of E-cadherin and ZO-1 between control bladder and OAB
patients (79.41±6.90 and 13.46±1.32), there were no significant difference between the two group (p=0.334 and p=0.876).
(Table1, Figure 1) These results suggest that the pathophysiology of IC/PBS and OAB both might linked with chronic
inflammation. However, IC/PBS is associated with impairment of the barrier function of the urothelium but the bladder
urothelium barrier in OAB is not disrupted.
Interpretation of Results
In our study, patients with OAB and IC/PBS all had significantly greater number of mast cells in the bladder wall
compared with controls. The bladder biopsies from IC/PBS patients reported previously have confirmed the involvement
and presence of mast cells in the detrusor. Mast cells have been considered as crucial effector cells for the immune
response implicated in the pathogenesis of IC/PBS. Bladder mast cell activation has been reported as a characteristic
pathological finding in a subset of IC/PBS patients. Measurement of surrogate mast cell-related products in urine has been
previously studied to assess the disease extent in patients. Since patients with OAB and IC/PBS all had elevated mast cell
activities compared with that of the controls in this study, It is possible that a common pathway of chronic inflammation
exists in the pathogenesis between these two diseases.
67
Conclusion
The results of this study suggest that both IC/PBS and OAB are associated with chronic inflammation and the role of
bladder tissue mast cells in the pathogenesis and pathophysiology of OAB and IC/PBS is worthy of further investigation.
Table 1. Expression level of mast cell, E-cadherin and ZO-1 protein in bladder tissue of OAB and IC/PBS patients
Control
n=19
IC
n=18
OAB
n=27
Control vs IC
Control vs OAB
OAB vs IC
Age
53.63±11.88
29~71
41.78±13.48
21~72
71.63±10.77
42~85
Gender
F: 19
F: 16 M: 2
F: 6 M: 21
Mast cells
1.77±0.47
0.00~9.00
4.64±0.72
1.00~10.00
4.00±0.55
0.00~11.00
p=0.008**
p=0.026*
p=0.740
E-cadherin
96.30±9.15
44.83~166.24
59.05±9.48
7.5~155.56
79.41±6.90
17.50~150.25
p=0.009**
p=0.334
p=0.143
ZO-1
14.55±2.08
2.19~37.69
7.45±0.99
1.44~14.0
13.46±1.32
5.17~27.79
p=0.013*
p=0.876
p=0.024*
*: p<0.05; **: p< 0.01
Figure 1. Immunofluorescence staining of mast cell activity, E-cadherin and ZO-1 in OAB, IC/PBS and control
bladder.
68
PK02 The relaxant effect of ginseng saponin on the bladder and
prostatic urethra: in vitro and in vivo study
Hoon Ah Jang1, Mi Mi Oh1, Khae Hawn Kim2, Jae Hyun Bae1, Jeong Gu Lee1
1
Korea University Medical Ccenter, Department of Urology, Seoul, Korea; 2Gil Medical Center, Department of Urology,
Gachon University of Medicine and Science, Incheon, Korea
Aim of Study
We performed in vivo and in vitro analysis of ginseng saponin on the bladder and prostatic urethra to investigate its
relaxation effect.
Methods
In vitro study, prostatic urethra muscle strips were harvested from 18 male New Zealand rabbits. The strips were
mounted in organ baths and connected to force displacement transducers. After stabilization, maximal tissue contractions
were obtained by the addition of phenylepinephrine for urethra strips. When the contraction was stabilized, a doseresponse curve of ginseng saponin was constructed (10-6 to 10-2 mol/L). After pretreatment urethra strips with N-nitro-Larginine methyl ester (L-NAME), a dose-response curve of ginseng saponin was repeated. For the in vivo study using adult
male Sprague-Dawley rats composed of three groups (control, PBOO and saponin fed groups) intravesical pressure and
urethral perfusion pressure were monitored.
Results
The ginseng saponin induced significant relaxant effect on the prostatic urethra strips in a dose-dependent manner.
At 10–2 M, ginseng saponin induced a significant relaxation of the urethra strips by 50.2%. The relaxant effect was partially
inhibited with L-NAME pretreatment. In the in vivo study, the UPPΔ was significantly higher in the group III than group I
or II (p<0.001). And group III showed significant lower baseline vesical pressure than group II.
Conclusions
Significant relaxation effect of ginseng saponin on the bladder and prostatic urethra was shown in the in vitro and in
vivo studies. And this mechanism was thought to pass NO/NOS pathway.
Table 1. In vitro, organ bath study showed significant relaxation
And this effect was partially blocked after L-NAME pretreatment
% relaxation
Saponin concentration (logM)
10-6
10-5
Prostatic urethra
0.18±0.1
2.78±3.89
L-NAME pretreatment
0.20±0.13
0.20±0.37
p-value
0.189
0.102
effect of KRG saponin on prostatic urethra strips.
10-4
5.28±6.18
3.00±4.39
0.581
10-3
31.75±13.11
11.46±10.60
0.011
10-2
50.21±20.26
13.32±11.18
0.012
Wilcoxon signed ranks test
Figure 1. A. Dose-response curves of ginseng saponin in rabbit prostatic urethral strips relaxation. The relaxing effect
was partially inhibited with pretreatment of L-NAME. B. Dose-response relaxation tracing curves of ginseng saponin.
A
B
69
Table 2. Urodynamic parameters of three rat groups. (Group I: the control group, Group II: the group of partial
bladder outlet obstruction(PBOO) with standard diet, Group III: the group of PBOO with ginseng saponin
administration)
Group I
Group II
Group III
UPPbasal, cmH2O
0.91±0.01
0.89±0.01
0.91±0.019
UPPnadir, cmH2O
0.89±0.02
0.88±0.01
0.88±0.01
UPPΔ, cmH2O
-0.017±0.01
-0.008±0.01
-0.022±0.01
p=0.001*
Pves, cmH2O
0.080±0.01
0.114±0.04
0.086±0.02
p=0.026+
Ppves, cmH2O
0.10±0.01
0.13±0.04
0.11±0.01
Pvesgap, cmH2O
0.02±0.01
0.02±0.01
0.02±0.02
UPPbasal: baseline urethral perfusion pressure; UPPNadir: urethral perfusion pressure during relaxation; UPPΔ : difference between
UPPbasal and UPPNadir; Pves: baseline vesical pressure; Ppves: vesical pressure during bladder contraction; PvesΔ: vesical pressure change
between peak and baseline pressure; *Statistically significant among group 1, 2 and 3; +Statistically significant between group 2 and 3
70
PJ02 Long-term efficacy of silodosin on the lower urinary tract function
in patients with benign prostatic hyperplasia according to prostate
size: prospective investigation using pressure-flow study
Yoshihisa Matsukawa, Ryohei Hattori, Tokunori Yamamoto, Naoto Sassa, Yasushi Yoshino and Momokazu Gotoh
Department of Urology, Nagoya University Graduate School of Medicine, Nagoya,Japan
Aim of Study
Prostate size is an important factor in selecting treatment option and predicting therapeutic outcome in benign
prostatic hyeperplasia (BPH).
α1-adrenoceptor (AR) antagonists are widely used as the drug of first choice for LUTS with BPH. On the other
hand, the efficacy of single use for patients with large prostate is debatable. We prospectively investigated the long-term
effects of silodosin, a new 1-AR antagonist purely selective for the 1A-AR subtype, on the lower urinary tract function in
patients with BPH according to prostate size, using pressure-flow study (PFS).
This study is an open-labeled and prospective study in 140 men with lower urinary tract symptoms associated with
BPH. Silodosin was administered at 8 mg/day to these patients. The patients were classified into 2 groups according to
prostate size; small prostate (SP) group (prostate volume <35 mL) and large prostate (LP) group (≥35 mL).
Primary endpoints were changes in parameters of voiding and storage function as measured by PFS from baseline to
4 weeks and 1 year after administration. Secondary endpoints were changes in international prostate symptom score (IPSS),
IPSS-quality of life (QoL), overactive bladder symptom score (OABSS).
Results
Of the 140 patients, 8 discontinued treatment because of adverse reactions, 6 patients were performed TURP, and
6 patients did not undergo PFS after treatment. Accordingly, 120 patients were included in analysis. Mean age of the
analyzed patients was 69.2 years, ranging from 51 to 84. The prostate volume ranged from 20 to 84 mL, with mean of 43.9
mL. In the 63 case LP group, mean prostate volume was 52.5 mL and in the 57 case SP group , it was 30.2 mL.
At baseline, no significant difference was detected in IPSS or IPSS-QoL between LP group and SP group, but LP
group had a significantly higher OABSS (6.4 vs 5.0). On PFS, detrusor pressure at maximum flow rate (PdetQmax),
bladder outlet obstruction index, and incidence of detrusor overactivity were significantly higher in LP group. After
treatment, both groups showed significant improvement in IPSS, IPSS-QoL and OABSS at both 4weeks and 1 year. For
the long-term examination, SP group showed further improvement in both IPSS-total and QoL, while LP group reduced
the effectiveness of improvement in both parameters. PFS during the voiding phase at 4 weeks demonstrated a significant
improvement in Qmax, PVR, pdetQmax and BOOI, regardless of prostate size. However, although the improvement in
voiding parameters at 4 weeks was maintained to 1 year in SP group, these parameters changed for the worse compared
with that of 4weeks in LP group. In storage phase on PFS, both groups showed a significant increase in FDV and MCC at
4 weeks and further improvement at 1 year.
Conclusions
Silodosin quickly improves bladder storage function and relieves bladder outlet obstruction, regardless of prostate
size. However, in long-term administration, an improvement of bladder outlet obstruction may be reversed in patients with
large prostate, despite preservation of an improvement in storage function.
71
PT02 Serum C-reactive protein levels are associated with residual
urgency symptoms in patients with benign prostatic hyperplasia
after medical treatment
Chun-Hou Liao1, Shiu-Dong Chung2, Hann-Chorng Kuo3
1
Department of Urology, Cardinal Tien Hospital and College of Medicine, Fu Jen Catholic University, Taipei, Taiwan;
Department of Urology, Far Eastern Memorial Hospital, Taipei, Taiwan; 3Department of Urology, Buddhist Tzu Chi
General Hospital and Tzu Chi University, Hualien, Taiwan
2
Aim of Study
Urinary urgency is a common and bothersome symptom in patients with benign prostatic hyperplasia (BPH); this
symptom may persist even after medical treatment. Chronic inflammation has been reported to be associated with the
pathogenesis of BPH and lower urinary tract symptoms (LUTS). We investigate the association between serum C-reactive
protein (CRP) level and residual urgency symptoms in BPH patients after medical treatment.
A total of 205 men undergoing stable medical treatment for BPH, defined as a total prostate volume of ≥40 mL,
were enrolled. Patients with acute infection or those taking non-steroid anti-inflammatory drugs or aspirin were excluded.
Uroflowmetry, postvoid residual volume, transrectal ultrasound parameters, serum prostate specific antigen (PSA), and
CRP level were measured. A three-day void diary was recorded to identify the presence of urinary urgency.
Results
The mean serum CRP level was 0.24 mg/dL (range, 0.01–2.84), and residual urgency was identified in 90 patients
(43.9%). Patients with residual urgency were older and had significantly higher serum CRP levels (0.39±0.54 mg/dL) than
those without urgency (0.13±0.20, p<0.001). On multivariable logistic regression analysis, men with CRP levels of ≥0.3 mg/
dL were more likely to have urgency (odds ratio, 8.22; 95% confidence interval, 3.34–20.3) after adjusting for age, serum
PSA level, and antimuscarinic use. Patients with serum CRP levels ≥0.30 mg/dL had more urgency (82.1%) than those
with serum CRP levels <0.30 mg/dL (34.9%).
Conclusions
Serum CRP level is significantly associated with residual urgency in BPH patients after medical treatment. Chronic
inflammation may play a role in the occurrence of residual urgency in BPH patients.
72
PK03 A comparative study of the efficacy of solifenacin succinate for
frequency and frequency with urgency patients
Ji-Yeon Han1, Daeseon Yoo1, Kyung Hyun Moon2, Myung-Soo Choo1
1
Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; 2Department of
Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
Aim of Study
The overactive bladder (OAB) was defined as urgency with or without urge incontinence, usually with frequency and
nocturia. But several studies presented that patients reported that the most troublesome OAB symptom was frequency.
It is difficult to perception urgency and to distinguish between urgency and frequent desire to void. So we assumed that
antimuscarinic drug was effective for frequency without urgency as well as urgency. We compared of the efficacy of
solifenacin for frequency and frequency with urgency.
This study is a multi-center, 12-week, open label, comparative study and non-inferior study based on the hypothesis,
“The efficacy of solifenacin for frequency is non-inferior to the efficacy of solifenacin for frequency with urgency”.
We classified the patients with frequency of micturition >8 voids/day without urgency as Group 1 and the patients with
frequency of micturition >8 voids/day with urgency (urgency grade ≥3 (5 scales) & ≥2/day) as Group 2. The primary
efficacy variable was change of daily micturition frequencies from baseline and secondary efficacy variables included
change in PPBC (Patients’ Perception of Bladder Condition), OABSS (OAB Symptom Score) and BSW (Benefit,
Satisfaction, Willingness to continue) questionnaire at the end of treatment. Safety was evaluated by adverse events,
maximal urinary flow rate (MFR) and post-void residual (PVR).
Results
Of 286 patients enrolled, 240 (83.9%) were completed (Group 1: 115, Group 2: 125). The change of daily
micturition frequencies of Group 1 was -1.9±3.0 and Group 2 was -2.4±3.2, respectively (p=0.176). There was no
significantly difference between two groups. However, the lower limit of confidence interval set were -1.33 and -1.80,
respectively and didn’t met the predetermined non-inferiority limit (-0.8). There was no significant difference between
the portions of patients who improved in PPBC. The portion of patients who improved to mild grade from moderate
and severe grade in OABSS was higher in Group 1 than Group 2 (88% and 62.8%, respectively, p=0.016). There was
no significant difference in BSW questionnaire at the end of treatment. There were no significant difference in changes
of MFR and PVR from baseline between two groups (-1.4±11.3 vs -0.11±10.3 and 5.5±32.1 vs 9.3±44.1, respectively).
Treatment with solifenacin was well tolerated in Group 1 and Group 2.
Conclusions
We couldn’t verify that the efficacy of solifenacin for frequency without urgency was non-inferior to the efficacy
of solifenacin for OAB. However solifenacin was also effective in patients with frequency without urgency after 12 week
treatment.
73
PJ03 Implantation of bone marrow-derived cells recovers radiation
injured urinary bladders in rats
Tetsuya Imamura1, Osamu Ishizuka1,2, Yoshiki Kurizaki2, Wataru Noguchi2, Zhang Lei2, Haruaki Kato2, Osamu
Nishizawa1,2
1
Department of Lower Urinary Tract Medicine, Shinshu University School of Medicine; 2 Department of Urology,
Shinshu University School of Medicine
Aims of Study
We indicated that bone marrow-derived cells implanted into frozen-injured urinary bladders and urethral sphincters
differentiated into smooth or striated muscle cells, and then restored functional tissues (Imamura et al., Cell Trans., 2008;
Tissue Eng., 2011). In addition, the frozen-injured tissues had an ideal microenvironment to bring out the potentials of
bone marrow-derived cells (Imamura et al., Tissue Eng., 2009). Thus, we targeted irreversibly damaged, radiation-injured
urinary bladders. In this study, we investigated to determine if the implantation of bone marrow-derived cells could
recover the radiation-injured urinary bladders in rats.
This study used female 10-weeks old Sprague-Dawley (SD) rats, and male 17-weeks old Tg-SD (green) rats as
recipient and donor animals, respectively.
Thirty SD rats were anesthetized, and retained and protected with an iron board. The region including urinary
bladder within 1cm-diameter cycle bordering on pubis was exposed through the iron board. The region was radiated with
2Gy (wherein Gy is the absorbed energy of 1 J/kg). The radiation was performed every week, and repeated 5 times. After
the radiation, the rats were maintained with freely available food and water under a 12-hour alternating light-dark cycle for
2 weeks. After 14 days of radiation, the radiated rats (n=20) were separated into two groups: cell implantation group (n=10),
and cell-free injection control group (n=10). Other rats were used as pre-implantation group to estimate the radiationinjured urinary bladders (n=10). Six female SD rats received non-radiation treatments were used as sham group.
Six male green rats were anesthetized, and then their both femurs of each rat were harvested. We harvested bone
marrow cells from the femurs with culture medium. The cells were cultured in type I collagen-coated 10cm culture dishes
for 7 days. During culture, the medium was completely replaced every day, and non-attached cells were discarded. Seven
days after seeding, adherent proliferating cells were used as bone marrow-derived cell.
Seven weeks after the radiation, the urinary bladders of cell-implantation and cell-free injection control rats were
exposed. For the cell implantation group, the 2.0x106 bone marrow-derived cells were implanted into the bladder wall. For
the cell-free injection control group, 200 μl of cell-free culture medium was similarly injected.
At 4 weeks after implantation, cystometric investigations of the rats were performed, and then their urinary bladders
were analyzed by immunohistochemistry using GFP-antibody to detect implanted cells, and smooth muscle actin (SMA)-,
or S100-antibody, as a smooth muscle cell or nerve cell marker. In addition, the tissue sections were performed with
hematoxylin and eosin (HE) and masson trichrome stain. To estimated proportion of smooth muscle area, the masson
trichrome stain images were analyzed with image pro software. Results were expressed as means ± standard error of
the means. Statistical differences were determined by non-repeated measures ANOVA followed by the Scheffe’s test.
Differences with p<0.05 were considered significant.
Results
After 7 days after of culture, the adhered proliferating cells were positive for STRO1 (CD34)-antibody, which was a
mesenchymal cell marker, but not positive for smooth muscle and nerve cell differentiation marker antibodies.
Just prior to the cell-implantation, smooth muscle layers of the radiation-injured urinary bladders were disorganized
(Figure 1A). The proportion of smooth muscle area (0.08±0.01) was significantly decreased compared to the non-radiated
sham urinary bladders (0.21±0.01, P<0.01). At 4 weeks after, although the control urinary bladders injected with the cellfree solution had smooth muscle cells, the smooth muscle layers were similar to the pre-implantation radiation-injured
urinary bladders (Figure 1B). However, the cell-implanted urinary bladders had numerous smooth muscle cells that were
organized into distinct smooth muscle layers (Figure 1C). The proportion of the smooth muscle area of cell-implanted
urinary bladders (0.19±0.01) was significantly higher than that of the cell-free control ones (0.11±0.01, P<0.01).
74
The reconstructed smooth muscle layers had some GFP-positive cells that were positive for SMA-antibody appeared
to form contacts among themselves, creating smooth muscle layer structures. Similarly, other implanted GFP-labeled cells
were positive for S100-antibody.
The cystometric investigations showed that basal, threshold and micturition pressure, and micturition volume did
not have any statistical differences among four groups. The voiding interval (7.92 min) and residual volume (0.13 mL) of
radiation-injured urinary bladders tended to lengthen and increase compared to the sham non-radiated sham ones (6.18min
and 0.06 mL, respectively). These values of cell-free control urinary bladders (7.39 min and 0.15 mL, respectively) did
not alter compared to the radiation-injured ones. However, the voiding interval (5.46 min, P<0.05) and residual volume
(0.04 mL, P<0.01) of cell-implanted urinary bladders were significantly decreased compared to the cell-free control and
radiation-injured ones, and these values were as same as the non-radiation sham ones.
Conclusions
The radiation-injured urinary bladders showed disorganization of smooth muscle layers and dysuria including
lengthened voiding interval and increased residual volume. However, bone marrow-derived cells implanted into the
radiation-injured urinary bladders reconstructed smooth muscle layers, and improved the voiding interval and residual
volume. Therefore, implantation of bone marrow-derived cells may recovery the irreversibly damaged urinary bladders.
Figure 1. Smooth muscle layers were stained with masson trichrome. (A) Just prior to implantation, smooth muscle
layers of radiation-injured urinary bladders were disorganized. (B) After 4 weeks, the smooth muscle layers of
cell-free control injection did not alter. (C) After 4 weeks, the smooth muscle layers of cell-implantation were
reconstructed. Bar=100 μm.
75
PT03 Position of suburethral sling at the bladder neck may predict a
higher recurrent rate of SUI
Yuan-Hong Jiang1, Qian-Sheng Ke1, Chung-Cheng Wang2, Hann-Chorng Kuo1
1
Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan; 2Department of Urology, En Chu Kong
Aims of Study
Many surgical procedures for stress urinary incontinence (SUI) have been reported, and the best one remains
controversial. Most of the research focuses on the comparison of the effectiveness and safety among different surgical
techniques of suburethral sling. However, little data are available on the influence of the position of the suburethral sling
on the treatment outcomes of SUI. The aim of this study was to investigate the relationship between the position of the
suburethral sling and the outcomes of anti-incontinence surgery.
From 1998 to 2010, 154 women with SUI who received pubovaginal sling procedure using a polypropylene
suburethral sling were retrospectively reviewed. Patients with preoperatively urodynamic proven detrusor overactivity,
detrusor underactivity, neurogenic bladder dysfunction, high grade cystocele requiring concomitant colporrhaphy or pelvic
floor reconstruction were not included. All patients had been investigated preoperatively and postoperatively by transrectal
sonography of the bladder and urethra (TRUS-B). The BN incompetence at resting status and urethral incompetence
during straining were also examined in TRUS-B to identify the BN and urethral condition after sling procedure. The
suburethral sling positions in TRUS were classified as at the bladder neck (BN, 0-20% of the urethral length), proximal
urethral (PU, 21-40% of the urethral length), middle urethral (MU, 41-60% of the urethral length), and distal urethral
(DU, 61-80% of the urethral length). (Figure 1) Their post-operative continent status and the lower urinary tract symptoms
such as urgency/urgency urinary incontinence or difficult voiding were compared among different groups of patients with
different suburethral sling position.
Results
All patients received the pubovaginal sling procedures by the same urologist and the procedure was standardized as
previously published technique. The mean age was 60.7 years (ranged from 30 to 85 years), and the median follow-up was
48 months (from 6 to 124). Postoperatively, the sling was found to locate at BN in 18, PU in 82, MU in 45, and DU in 9
patients. The overall rate of recurrent SUI was 15.5% (24 patients). Among the 154 patients, there was a significant higher
recurrent rate of SUI in the group of BN (BN 38.9%, PU 8.5%, MU 17.8%, and DU 22.2%) (p=0.012) (Table1). The
occurrence of BN incompetence at the resting status in TRUS-B was significantly higher in the group of DU (BN 27.8%,
PU 40.2%, MU 71.1% and DU 88.9%) (p<0.001). The occurrence of incompetent urethra in TRUS-B was significantly
higher in the groups of BN and DU (BN 22.2%, PU 2.4%, MU 6.7%, and DU 22.2%) (p=0.007). De novo urge symptoms
occurred in 14.9% of overall patients, and de novo difficult voiding symptoms occurred in 18.2% of patients. There was no
significant difference among these four groups in either de novo urge symptoms (p=0.571) or voiding symptoms (p=0.934).
The patient group with sling at the BN had a higher recurrence rate of SUI, and the groups with sling at the PU
and MU had a better continence rate. When the suburethral sling was located at the more distal position, the BN
incompetence rate in TRUS-B was higher. In the groups of BN and DU, there was higher incidence rate of urethral
incompetence in TRUS-B. The data indicated that suburethral slings at the BN contributed more in the BN competence
during resting, but cannot assure a competent urethra during straining. On the other hand, the sling position at the PU
and MU gave more contribution in maintaining urethra competence and therefore, a higher continence rate in long-term
follow-up. Nevertheless, no significant difference was noted in the aspects of de novo urge or voiding symptoms among
different groups, suggesting the de novo urge might be from the bladder origin and difficult urination was result from sling
tension on the bladder outlet rather than the sling position.
Conclusion
Positioning of the suburethral sling at the BN may predict a higher recurrent rate of SUI. The position of the
suburethral sling played an important role in the effect of anti-incontinence surgery. Sling locating at the PU and MU had
the best continence rate, which implies a good hammock effect can be achieved when placing the suburethra sling at these
positions. The sling position has no effect on de novo urge or difficult voiding symptoms.
76
Figure 1. The sling position after pubvaginal sling procedure.
Table 1. Outcomes of pubovaginal sling procedure among groups with different sling positions
Bladder
Proximal Middle
Distal
neck
urethra
urethra
urethra
No. of patients
18
82
45
9
Recurrence of SUI
7 (38.9)
8 (8.5)
8 (17.8)
2 (22.2)
De novo urge symptoms
1 (5.6)
14 (17.1) 6 (13.3)
2 (22.2)
De novo voiding symptoms
3 (16.7)
15 (18.3) 9 (20.0)
1 (11.1)
BN incompetence in resting TRUS-B
5 (27.8)
33 (40.2) 32 (71.1) 8 (88.9)
Urethral incompetence in straining TRUS-B
4 (22.2)
2 (2.4)
3 (6.7)
2 (22.2)
( ): percentage
Total
p value
154
24 (15.6)
23 (14.9)
28 (18.2)
78 (50.6)
11 (7.1)
0.012
0.571
0.934
<0.001
0.007
77
PK04 Change of urodynamics and incontinence following
augmentation cystoplasty in patients with neurogenic bladder
secondary to spinal cord lesion
Sang Lim Lee, Jungbum Bae, Jin-Kyu Oh1, Minsoo Choo, Seung-June Oh
Department of Urology, Seoul National University Hospital, Seoul, Korea; 1Department of Urology, Gachon University
Gil Hospital, Incheon, Korea
Aims of Study
It is well known augmentation cystoplasty has a significant role in preventing upper urinary tract deterioration and
acquiring urinary continence in patients with neurogenic bladder refractory to conservative treatment. In this study, we
evaluate the alteration of urodynamic parameters and continent status in patients underwent augmentation cystoplasty due
to spinal cord lesion in Korean.
A retrospective study included patients who underwent augmentation enterocystoplasty from Jan 2006 to Sep 2010
in the Seoul National University Hospital. Preoperative and postoperative fluoroscopic urodynamic parameters and
incontinence questionnaires (ICI-Q Korean version) were analyzed.
Results
Thirty-six patients (21 males and 15 females) were analyzed. Fourteen patients had spinal cord injury, 17 congenital
myelodysplasia, and 5 acquired spinal disease (mean age 32.4±17 yr, SD). For enterocystoplasty, ileum was utilized in 29
cases, sigmoid in 7 cases. Postoperative urodynamics were performed at mean 9.6 months after surgery. Preoperatively
involuntary detrusor contractions (IDC) were found in 62.9% (22/35 cases), decreased bladder capacity in 65.7%
(23/35), poor compliance 77.1% (27/35), sphincteric incompetency demonstrated by fluoroscopy in 57.1% (20/35), and
vesicoureteral reflux (VUR) in 60.0% (21/35), including bilateral in 6, unilateral in 15. Postoperatively 89.5% (17/19),
87.5% (14/16) and 81.3% (13/16) of patients showed normalization in compliance, capacity and IDC respectively. In
13 patients (15 postoperatively investigated), VUR improved in 84.2% (16/19 ureters; disappeared in 14, down-graded
in 2). Out of 24 patients who complained preoperative subjective symptom, 29.2% (7/24) patients had small amount of
incontinence, 70.8% (17/24) did more than moderate preoperatively, whereas postoperatively 72.0% (18/25) patients
replied as dry. The incontinence-related bother score (visual analogue scale) declined from 8.3 (±2.3) preoperatively to 1.3
(±2.3) postoperatively (p<0 .001).
Conclusions
Both objective urodynamic parameters and subjective incontinence symptom improved significantly after
augmentation cystoplasty in patients with neurogenic bladder caused by spinal cord lesion.
Keywords: neurogenic bladder, urinary incontinence, urondynamics, augmentation cystoplasty
78
PJ04 The musarinic receptor subtype of M2 mediates Ca2+ sensitization
via indirect activation of Rho kinase pathway in human detrusor
smooth muscle
Shunichi Kajioka, Nouval Shahab, Maya Hayashi, Takakazu Yunoki, Seiji Naito
Department of Urology, Kyushu University, Japan
Aims of Study
In urinary bladder, carbachol (CCh) induces contraction through M2 and mainly M3 receptor subtypes. However,
the contribution of the muscarinic receptor subtypes to the Ca2+ sensitization, so called, rho-kinase (ROK) pathway and
protein kinase C (PKC) pathway are still unknown. In particular, there is absolutely no report regarding the contribution
of M2 receptor subtype on the Ca2+ sensitization. It is very likely and of our interest that the down-regulation of cyclic
adenosine monophosphate (cAMP) via M2 receptor subtype would an indirect influence on contraction since it has been
suggested that cAMP might antagonize ROK pathway. The aim of our present study is to clarify the role and signaling
cascades of these M2 and M3 receptor subtypes on Ca2+ sensitization using alpha-toxin permeabilized human detrusor
smooth muscle (DSM).
The DSM specimens were obtained from urinary bladder of human who underwent radical cystectomy due to
urinary bladder cancer.
Alpha-toxin permeabilized human DSM strips were prepared and mounted horizontally for isometric force
recording. The role and signalling cascade of M2 and M3 receptor subtypes in Ca2+ sensitization was studied using selective
antagonists of M2 (AF-DX116) and M3 (4-DAMP) receptor subtypes. The effects of a selective inhibitor of ROK, Y-27632,
and a selective inhibitor of PKC, GF-109203X were also studied in contraction induced by 10 μM CCh with 100 μM GTP
at fixed 1 μM [Ca2+]i after pre-application with 1 μM AF-DX 116 or with 1 μM 4-DAMP. The effect of a cAMP specific
phosphodiesterase (PDE IV) inhibitor Rolipram on Ca2+ sensitization was also investigated. All protocols were carried out
after pre-treatment with thapsigargin (1 μM) and with cyclopiazonic acid (CPA; 1 μM).
All data and graphs are expressed as the mean ± SEM of n (the number of samples) and N (the number of patients).
Student’s t-test was used for statistical analyses.
Results
As preliminary information, the small inhibitory effects by 5 μM Y-27632 (10.6±2.2%, n=4; N=4) and greater
inhibitory effect by 5 μM GF-109203X (39.7±1.5%, n=4; N=4) were observed the contraction induced by only 1 μM Ca2+.
After the increase of Ca2+ sensitization was observed by the application of 10 μM CCh with 100 μM GTP at the fixed
concentration of 1 μM Ca2+, 1 μM AF-DX116 and 1 μM 4-DAMP inhibited the contraction by 13.0±1.5 % and 41.4 ± 2.9
%, respectively (n=6; N=4, p<0.001). 5 μM Y-27632 attenuated the increase of Ca2+ sensitization by 10 μM CCh with 100
μM GTP at 1 μM Ca2+ for 54.7±6.0 % (n=6). Not only 1 μM 4-DAMP but also 1 μM AF-DX 116 remarkably inhibited
this attenuation effect of Y-27632 from 54.7±6.0% to 4.4±1.0% (n=6; N=4) and to 14.7±1.1% (n=6; N=4), respectively
although the inhibition by 1 μM 4-DAMP was significantly stronger than that by 1 μM AF-DX116 (p<0.001). Likewise, 5
μM GF-109203X attenuated the increase of Ca2+ sensitization by 10 μM CCh with 100 μM GTP at 1 μM Ca2+ for 70.7±
3.2% (n=6; N=4). Both 1 μM AF-DX 116 and 1 μM 4-DAMP inhibited this attenuation effect of GF-109203X from 70.7±
3.2% to 16.4±5.8% (n=6; N=4) and 35.9±2.7 % (n=6; N=4), respectively. The inhibition by 1 μM 4-DAMP was significantly
stronger than that by 1 μM AF-DX116 (p<0.001). The above result that M2 selective inhibitor AF-DX 116 (1 μM)
certainly inhibited the attenuation effect of Y-27632 was on the contrary to the probable effect of AF-DX 116 on the ROK
pathway. Therefore, the indirect effect of M2 receptor on Ca2+ sensitization via down regulation of cAMP was speculated.
Accordingly, the effect of PDE IV specific inhibitor Rolipram on the contraction was investigated. 5 μM Rolipram
attenuated the Ca2+ (1 μM) induced contraction by 35.1±1.0% (n=4, N=3). This attenuation by Rolipram was significantly
relatively decreased from 35.1±1.0% to 15.5±1.0% (n=4) in the condition where Ca2+ sensitization was activated by 10 μM
CCh with 100 μM GTP (p<0.001)
Conclusion
The inhibition by Y-27632 and GF-109203X on only Ca2+-induced contraction indicated that ROK and PKC
79
pathways have already been activated in Ca2+-induced contraction of permeabilized DSM. The inhibition by 1 μM 4-DAMP
was significantly stronger than that by 1 μM AF-DX116 on the Ca2+ sensitization by CCh with GTP indicating that the
predominant role of M3 receptor in Ca2+ sensitization of human DSM. Slightly AF-DX 116 but mainly 1μM 4-DAMP
inhibited the attenuation effect of GF-109203X on the Ca2+ sensitization by CCh with GTP indicating the coherent
understanding that M3 receptor plays a predominant role in PKC pathway. Regarding ROK pathway, from the fact that
M2 selective inhibitor AF-DX 116 certainly inhibited the attenuation effect of Y-27632 although AF-DX116 induced little
inhibition in Ca2+ sensitization activated by CCh with GTP, the indirect effect of M2 receptor was suggested. To support
this hypothesis, the attenuation by PDE IV inhibitor Rolipram on the contraction just by Ca2+ was relatively decreased
by the activation of Ca2+ sensitization by CCh with GTP. These results suggested that cAMP formation had already been
inhibited in advance by muscarinic stimulation via M2 receptor.
Our present study demonstrated the first evidence in human DSM that both M2 and M3 receptor subtypes mediate
Ca2+ sensitization. Our study also revealed the predominant role of M3 receptor subtypes to ROK and PKC pathways
with comparable contribution which induced Ca2+ sensitization. Further, interestingly, the contribution of M2 receptor
subtype is indirectly and preferably to ROK pathway via the down-regulation of cAMP but little to PKC pathway. These
findings might be important in the clinical application of highly selective antimuscarinic treatment for lower urinary tract
dysfunction.
80
PT04 First voided volume in the morning as the prediction of
overactive bladder
Cheng-Yen Chiang, Yu-Hua Fan, Chih-Chieh Lin, Alex T.L. Lin, Kuang-Kuo Chen
Division of Urology, Department of Surgery, Taipei Veterans General Hospital, and School of Medicine, National YangMing University, Taipei, Taiwan
Aims of Study
Frequency-volume chart (FVC) provides objective information on voiding parameters, serving as an important tool
in the evaluation and management of overactive bladder (OAB). However, many patients cannot record FVC well due to
a variety of reasons. We suspect that a simple and convenient measurement, such as the first morning void volume (FMV)
might be a useful alternative. The aim of the study is to determine the usefulness of measuring the first morning void
volume (FMV) in evaluating patients with OAB.
We prospectively recruited patients with OAB symptoms between January 2009 and April 2010. All patients
completed a 3-day FVC. Mean FMV was obtained by averaging 3-days’ FMV. Symptom severity was evaluated with
Overactive Bladder Symptom Score (OABSS) questionnaire proposed by Homma et al. We also defined small volume
bladder as the maximal bladder volume ≤300 mL recorded in the FVC. All patients underwent either conventional
pressure-flow urodynamic study or videourodynamic study. The correlation between FMV, urodynamic parameters and
symptoms severity was analyzed with Spearman correlation. We also compared the sensitivity and specificity in predicting
small volume bladder with FMV and CMG capacity.
Results
A total of 102 patients, including 43 men and 59 women, were recruited into the study. The mean age of the patients
was 66.8±14.0 years (range: 23-85). The mean FMV was 196.6±106.5 mL (range : 20-650 ). The FMV was the maximum
voided volume of the day in 24 patients (23.5%) and was significantly correlated with the all-day mean void volume (p
<0.001). FMV was negatively correlated with daytime frequency (p=0.013) and nighttime frequency (p<0.001). FMV
was significantly correlated with cystometric capacity (p=0.026), which was significantly correlated with the total score of
OABSS (p=0.031). Although there was no significant correlation between FVM and total score of OABSS, FMV was
negatively correlated with the sub-score for nighttime frequency of the OABSS (p=0.004). As in predicting small volume
bladder, FMV showed its superiority either in sensitivity or specificity compared to CMG capacity (100% v.s. 95.9%,
43.3% v.s. 15.1%, respectively).
Conclusions
In patients with OAB FMV might represent the severity of daytime and nighttime frequency and the cystometric
capacity. The FMV also is a better tool to predict if a OAB patient has small volume bladder comparing to CMG capacity.
A simple measurement of FMV seems to be helpful in evaluating OAB patients, especially for those with poor compliance
in recording FVC.
The 6th Pan-Pacific
83
Korea
PK05 Influence factors for patient satisfaction in after surgical
intervention with stress urinary incontinence
Choal Hee Park, Byung Hoon Kim, Young Kee Kwon, Duk-Yoon Kim1
Department of Urology, Keimyung University school of Medicine, 1Department of Urology, Catholic University of
Daegu, Daegu, Korea
Aim of Study
Aim of the study was to identify influence factors of patient satisfaction after transobturator tape (TOT) procedure.
During 3 years, 107 patients underwent TOT. We compared patient satisfaction at 3 months with medical factors;
age, body mass index (BMI), menopause & uterine status, parity, cystocele, rectocele, uroflowmetry, urge incontinence (UI),
pad test, voiding volume & postvoid residual volume (PVR) at postoperative 1 day and PVR after 1 month.
Results
After 3 months, 80 cases (75%) was satisfied. In satisfaction group, there are younger age (p<0.001), low BMI
(p<0.001), absence of UI (p<0.001), rectocele existence (p=0.02), high average flow rate(p=0.008), large leakage of pad test
(p=0.003), large voiding volume at postoperative 1 day (p=0.001) and small PVR after 1 month (p<0.001).
Conclusion
Younger age, low BMI and absence of UI are influence factors for patient satisfaction. Especially, the patients who
has rectocele are more satisfied.
PK06 The bladder of older people: sensitive or insensitive?
Changho Lee, Hyungrae Jeong, Heejo Yang, Doosang Kim, Yun Soo Jeon, Nam Kyu Lee
Department of Urology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
Aim of Study
Someone is getting old, and bladder is also getting old. The functional bladder capacity is known to be decreased
according to age. But, the change of bladder sensation according to age is vague. We tried to know sensory changes in
aging bladder using urodynamic data.
Materials and Method
We reviewed urodynamic data of females with lower urinary tract symptoms referred for performing urodynamic
study. The clinical diagnoses of referred patients were urinary incontinence and/or overactive bladder. Most of presenting
symptoms are incontinence, urgency, frequency, nocturia. We performed filling cystometry and then pressure flow
study according to ICS guideline by one provider. We analyzed urodynamic parameters. We excluded the patients who
taking medicine affecting bladder function, having disease such as diabetes, organ prolapsed, having previous history of
cerebrovascular accidents or cord injury, receiving previous anti-incontinence surgery. We defined bladder sensation as
first desire to void, the bladder capacity at which they first became aware of the desire to void during filling cystometry. We
also excluded the data those bladder capacities of first desire are below 50 cc.
84
Results
We classified urodynamic data according to age: Group 1; 41-50 yrs (21 cases), Group 2; 51-60 yrs (24 cases), and
Group 3; 61-70 yrs (18 cases). The bladder capacity at first desire to void of each groups were 115.1±47 cc (Gr. 1), 138.6±
60 cc (Gr.2), and 146±68 cc (Gr.3) (p<0.05), respectively. The compliance of each groups were 134.9±61 (Gr.1), 125.7±69
(Gr.2), and 111.0±46 (Gr.3) (p<0.05), respectively. The maximal capacity of each groups were 410.5±118 cc (Gr.1), 448.6
±131 cc (Gr.2), and 346.2±133 cc (Gr.3) (p>0.05), respectively. The bladder capacity at first desire increased progressively
and the compliance decreased progressively in association with age. The maximal bladder capacity fell in sexagenarians.
Conclusion
Grow older; the bladder capacity at first desire has grown. These results support the opinion that the bladder
sensation is decreased in association with age.
PK07 Efficacy and safety of propiverine in children with overactive
bladder
Dong-Gi Lee, Woo Jung Kim, Kwan Hyun Park1, Minki Baek
Department of Urology, Samsung Medical Center, Sungkyunkwan University, Seoul; 1Seoul Samsung Urology Clinic/
Gynecology Health Care Center, Ulsan, Korea
Aims of Study
Antimuscarinic therapy remains one of the common forms of therapy for overactive bladder in children. However,
few clinical studies about the outcome of antimuscarinics in children with overactive bladder were reported. Therefore
we evaluated the efficacy and safety of propiverine which was frequently prescribed for treatment of pediatric overactive
bladder.
We reviewed the medical records of children treated with propiverine for last 5 years in our hospital. The children
with urinary tract infection, neurogenic bladder or genitourinary tract anomaly were excluded. We evaluated the changes
of symptoms before and after treatment. The efficacy was classified into non-response, partial response, and full response.
Full response was defined as the complete disappearance of the symptoms of overactive bladder. Overall response was
defined as sum of full response and partial response. We also analyzed the cumulative response rate according to the
periods of treatment. Changes from baseline in the number of voids per day and functional bladder capacity were also
evaluated from bladder diary. Safety was assessed through records of adverse events.
Results
Total 100 children were treated with propiverine (58 boys, 48 girls; mean age 5.99±1.81 years). The mean treatment
duration was 21.5 weeks. Among 100 children 42 children appealed urge incontinence. The overall response rate was
77.0%. The full response, partial response and non-response were 14.0%, 63.0% and 23.0%, respectively. Among 42
children with urge incontinence, 9 children (21.4%) showed complete dryness (full response) and 26 children (6.19%)
presented partial response (overall response for urge incontinence 83.3%). Functional bladder capacity after treatment
was 169.3 mL, showing 19.8 mL (13.3%) increase compared to the mean value (149.5 mL) before treatment. The voiding
frequency per day decreased from 14.0 to 9.4 (mean change 4.72 (33.4%)).The cumulative efficacy rate of 4, 8, 12, 16,
20, 24, and over 24 weeks were 30.0%, 52.0%, 66.0%, 68.0%, 70.0%, 71.0%, and 77.0%, respectively. The cumulative
improvement rate of urge incontinence were 21.4%, 42.9%, 52.4%, 54.8%, 61.9%, 64.3%, and 83.3%, respectively. Side
effects were observed in only three children. Two children presented constipation and one child presented dry mouth.
But no serious adverse events were recorded.
Conclusions
Propiverine has good efficacy and tolerability for the treatment of children suffering from overactive bladder with or
without urinary incontinence.
85
PK08 The effect of midurethral sling surgery in elderly patients over
75 years old with female stress urinary incontinence
Dong Hwan Lee1, Joon Chul Kim2, Hyun Woo Kim3, Kwang Woo Lee4, Jong Bo Choi5
1
Department of Urology, Incheon St. Mary’s Hospital, Incheon, Korea; 2Department of Urology, Bucheon St. Mary’s
Hospital, Bucheon, Korea; 3Department of Urology, St. Paul’s Hospital, Seoul, Korea; 4Department of Urology, Bucheon
Soonchunhyang Hospital, Bucheon, Korea; 5Deparment of Urology, Ajou University Hospital, Suwon, Korea
Aims of Study
Aging is known to be one of risk factors of failure in midurethral sling (MUS) surgery for female stress urinary
incontinence (SUI). The aim of this study was to evaluate the effect of sling surgery in elderly SUI patients over 75 years
old.
872 patients with SUI underwent MUS surgery from 2002 to 2008. Among these patients, 29 were over 75
years old, but 6 were lost to follow up. Medical records and detailed telephone interview of 23 patients were reviewed
retrospectively to clarify whether MUS was effective in this age group. The primary end point was subjective symptom
improvement, and secondary endpoint was their satisfaction.
Results
Median age of patients were 78.3±1.6 ranging from 75 to 84, mean follow up periods were 11.4±3.5 (range: 6-27)
months and parity was 4.6±1.7 (range: 3-7). No. of mixed incontinence was 7 and ISD (VLPP<60 cmH2O) was 11 (47.8%).
Types of sling materials were TVT in 4 and TOT in 19. The objective success rate was 69.6% (16 patients: cured in 12
and improved in 4), and satisfaction rate was 60.9% (14 patients). De novo urgency was noted in 2 patients. Among 7
patients (30.4%) of failed MUS surgery, 5 were ISD and 2 were managed by additional adjustable sling (Remeex system)
Conclusions
Although failure rate of MUS surgery in patients over 75 was 30.4%, MUS surgery is still being used as a primary
choice because this is a minimally invasive surgery. As the population of elderly women is now increasing, MUS surgery
for these patients group should be reassessed as an initial choice. It looked like that ISD was a risk factor of failure in
elderly.
PK09 Analysis of relative trends with QoL score 3 in IPSS/QoL
questionnaire
Ha Wook Hwang, Hyeon Taek Choo, Hyeon Wook Cho, Dae Kyung Kim
Department of Urology, Eulji University College of Medicine, Daejeon, Korea
Aim of Study
Male lower urinary tract symptoms (LUTS) are often associated with a reduced disease specific quality of life (QoL),
and can be globally assessed by a QoL question of the International prostate symptom score (IPSS). The definition of
quality of life(QoL) score 3 in IPSS/QoL questionnaire is ‘Mixed about equally satisfied and unsatisfied’. In clinical
practice, many patients check in the box under QoL 3 because they feel their voiding status not ‘exactly’ but ‘about’ equally
satisfied and unsatisfied. If it is not exactly in the middle of the satisfaction scale, it may be located either somewhere in the
satisfied side or unsatisfied side. Although it depends upon individual conditions or preferences, a gross tendency would
exist. We tried to find the tendency using the statistical technique of homogeneous subset analysis.
During study periods all male patients (age>50) who visited our urology clinic for the first time were asked to fill up
IPSS/QoL questionnaires. Exclusion criteria were: (1) impaired cognitive function, (2) previous experience of answering
86
IPSS/QoL (3) urinary tract infection, and (4) painful conditions such as urolithiasis. All data were grouped by each QoL
score. Homogeneous subset analysis was done by the each IPSS score and compared according to QoL score group.
SPSS 11.0 software package was used for the statistical analysis.
Results
Overall, 156 patients were included in this study. The number of patients in each QoL group were 20 (QoL 1), 16
(QoL 2), 45 (QoL 3), 45 (QoL 4), and 30 (QoL 5). QoL 3 group had a homogeneity with QoL 2 group in incomplete
emptying, frequency, urgency and weak stream (Scheffe method, subset for alpha=0.05). QoL 3 group had a homogeneity
with QoL 4 group only in intermittency. In straining and nocturia, QoL 3 group had a homogeneity with both QoL 2 and
QoL 4 group. In total IPSS score, QoL 3 group had a homogeneity only with QoL 2 group.
Conclusions
In 4 out of 7 items of IPSS and total IPSS score, QoL score 3 has more homogeneous characteristics with QoL 2
than with QoL 4. So far as the voiding symptoms are concerned, we cautiously conclude that the position of QoL 3 in
satisfaction scale is located more or less to the satisfied side from the middle.
PK10 The outcome of TURP in BPH patients with hypocontractile
bladder
Duk-Yoon Kim1, Hyeon Chan Jang1, Yoo Jun Park1, Byung Hoon Kim2, Choal Hee Park2
1
Department of Urology Catholic University of Daegu, Daegu, 2Department of Urology, Keimyung University, College
of Medicine, Daegu, Korea
Aims of Study
The functional changes of bladder occur if BOO (bladder outlet obstruction) is present. Disorder of detrusor
muscle such as OAB (overactive bladder) and detrusor hypocontractality is related. The goal of this study is to evaluate the
post-TURP satisfaction in patients with lower urinary tract syndrome; LUTS (Lower urinary tract syndrome) with detrusor
hypocontractality
Among patients with lower urinary tract syndrome, 17 patients who showed detrusor hypocontractality at urodynamic
study between July 2007 and January were analyzed retrospectively. The mean age was 68.7 years old (57~85 years old).
Patients with history of neurogenic bladder, prostate cancer, or urethral stricture were excluded. BOO means it is included
in obstruction section at Schäfer nomogram. Detrusor underactivity is defined as the location of coordinate of voiding
pressure in weak+, weak-, and very weak section at max flow rate; Qmax. Preoperative and postoperative international
Prostate Symptom Score (IPSS), quality of life (QoL), and uroflow Qmax were researched and compared. Paired-T test
was used for statistic analysis and significance level a was 0.05.
Results
Preoperative mean prostatic volume of patients was 41 cc (32~68 cc). The max bladder capacity was 382 cc, and
PdetQmax was 46.7 cmH2O at urodynamic findings. There were significant improvement in IPSS, QoL, and Qmax after
the procedure (Table 1).
Conclusion
The outcome of TURP in patients with BPH and hypocontractile bladder was relatively satisfactory. The importance
of urodynamics in predicting the outcome of operation is emphasized.
87
Table 1. Change of the IPSS, QoL, Qmax after TURP (p<0.0001)
PParameters
IPSS(Total)
(Voiding)
(Storage)
QoL
Qmax
Pre-op.
27.1±1.4
15.7±1.1
11.4±1.5
4.5±0.9
8.5±1.2
Post-op.
10.3±1.2
5.7±0.7
4.6±0.7
2.1±0.6
15.3±0.9
PK11 Significance of spina bifida occulta finding out by KUB in
children with nocturnal enuresis
Sang Hee Shin, Eun Kyoung Choi, Young Jae Im, Mi Jung Lee, Myung Jun Kim, Chang Hee Hong, Sang Won Han
Severance Children’s Hospital, Yonsei University Health System, Seoul, Korea
Aims of Study
Some previous reports have suggested that the incidence of spina bifida occulta (SBO) in patients with nocturnal
enuresis (NE) is higher compared to the normal population. But, the effect of SBO in the response to treatment of NE
is controversial. The purpose of this study was to investigate correlation of the presence of SBO and the response to
treatment of NE.
Between 2006 and 2009, the records of 160 children with NE were reviewed. Children with other organic urological
disease or symptoms suggestive of spinal dysraphism were excluded. Plain X-ray films (KUB) were performed before the
start of treatment. We compared response to treatment of children with and without SBO.
Results
There were 53 girls out of 160 children and mean age was 7.8 years old (5-18). Mean duration of treatment was 8.8
month (1-51). SBO was detected in 43 (26.9%) children. Levels of SBO were L4 in 4, L5 in 12, S1 in 26 and S2 in 2.
There was a significant difference between both groups in outcome (p=0.013). A full response was more likely in children
without SBO (p=0.005). Also, although there was no significant difference, children with SBO didn’t show full response in
primary non-mono symptomatic NE.
Conclusions
In this study, the incidence of SBO in children with NE was 26.9%, higher than that of the normal population.
There was a significant correlation between the existence of SBO and clinical outcome of enuresis. The pathphysiology of
SBO in NE should be investigated.
Keywords: spina bifida occulta, KUB, enuresis
PK12 Prognostic factors for persistent storage symptoms following
surgical treatment in patients with benign prostatic obstruction
Hoon Ah Jang, Mi Mi Oh, Jae Hyun Bae, Jeong Gu Lee
Korea university medical center, department of urology, Seoul, Korea
Aims of Study
To identify the prognostic factors concerning the persistent storage symptoms following transurethral resection of the
prostate (TURP) in patients with benign prostate obstruction (BPO).
88
Methods
A retrospective study was conducted in 336 males with BPO who had undergone TURP. Patients who showed
pyuria pre or postoperatively were excluded. All patients had completed the preoperative evaluations including 3-day
bladder diary, International Prostate Symptom Score (IPSS) questionnaires, transrectal prostate ultrasonography and
urodynamic studies as well as postoperative symptomatic assessment. The storage symptoms were defined by IPSS (≥3
of IPSS storage symptom score (sum of 2, 4 and 7 stand) with ≥2 of urgency score (4 stand)). The patients were divided
into two groups according to postoperative IPSS storage symptom score. (Group 1: <3, group 2: ≥3) The changes in
IPSS scores and storage symptoms after TURP were observed and the association between the baseline variables and the
improvement in storage symptom score was analyzed statistically.
Results
Among 201 patients, 109 patients presented storage symptoms preoperatively. After TURP, 120 patients were cured
storage symptoms (group 1) and 82 complaint persistent storage symptoms (group 2). On univariate analysis, age, prostate
volume and maximum voided volume were statistically different between two groups (p<0.01) and preoperative IPSS
total score and voiding symptom score were statistically different between two groups (p=0.034, 0.003). In preoperative
urodynamic study, Pdet.max and Pdet.Qmax were significantly low in persistent storage symptoms group. No statistical
differences existed in storage symptoms, maximum flow rate and postvoid residual urine volume between two groups.
(p>0.05) A multivariate analysis suggested that preoperative detrusor contractility was associated with the improvement of
storage symptoms. (p<0.05, Odds ratio: 0.002) And the patient’s age (Odds ratio: 3.87) and the maximum voided volume
(Odds ratio: 0.91) influenced the improvement of OAB symptoms.
Conclusion
The positive correlation between the preoperative degree of detrusor contractility and the maximum voided volume
and the improvement in storage symptoms, suggests that good detrusor contractility and proper bladder capacity are
indispensable for the symptomatic benefits after the surgical relief of bladder outlet obstruction.
Table 1. Univariant analysis of two groups according to postoperative persistent storage symptoms
Number of patients
Age (years)
Prostate volume (mL)
Preoperative IPSS
Voiding symptoms
Storage symptoms
Total score
MVV (mL)
Free-Qmax (mL/sec)
PVR (mL)
Preoperative
Pdet.max (cmH2O)
Pdet.Qmax (cmH2O)
Schafer contractility grade
Very weak+weak
Normal
Strong
Postoperative
Voiding symptoms
Storage symptoms
Total score
Persistent storage symptoms group
81
78.5±6.6
48.5±24.2
Non storage symptoms group
120
67.47±5.1
65.3±22.2
p value
13.1±4.5
8.3±3.5
21.4±7.0
181.1±70.8
9.7±5.3
101.2±94.4
10.9±5.3
8.1±3.8
19.0±8.3
364.0±126.6
10.9±3.6
80.9±71.3
0.001
0.088
0.084
50.1±23.4
43.0±21.3
71.1±34.9
55.6±32.5
0.001
0.001
69
12
0
52
60
8
0.001
3.8±3.2
4.5±1.9
8.3±3.9
3.5±1.7
1.3±0.5
4.8±1.7
0.373
0.001
0.001
0.001
0.001
IPSS: international prostate symptom score; MVV: maximum voided volume; Qmax: maximum flow rate; PVR: post void residual;
QoL: quality of life
89
Table 2. Logistic regression analysis for persistent storage symptoms following TURP
Age
MVV
Schafer contractility grade
Very weak+weak/Normal
Strong
P value
0.029
0.011
0.043
Odd ratios
3.87
0.918
0.002
IPSS: international prostate symptom score; MVV: maximum voided volume
PK13 Impact on sexual function and lower urinary tract symptoms of
bicycle riding in men
Jong Min Kim1, Esther Shin2, Phil Hyun Song, Hee Chang Jung1
1
Department of Urology, School of Medicine, Yeungnam university, 2Institute of Biomedical engineering, Yeungnam
University
Aims of Study
Recently, reports in the mass media have implicated that bicycle riding increases the risk of erectile dysfunction and
prostatic diseases. So, we evaluate the impact of bicycle riding on erectile function and lower urinary tract symptoms (LUTS)
in healthy general men.
From 26 June 2010 to 20 July 2010, we investigate degree of LUTS (voiding and storage symptoms), using
International Continence Society-male Questionnaire (ICS-mQ) and erectile function using International Index of Erectile
Function-5 Questionnaire (IIEF-5) in 5 work places (personnel of public office, hospital, university, etc.) of which bicycle
riding club members were doing active club activities. Respondents, who participated in club activities for 6 months
and longer, were classified as the bicycle club(142 men, age: 44.02±8.56). Ones who do not ride bicycles were classified
as the control group(83 men, age: 42.13±7.85). People who were having the history of urological and other chronic
diseases(diabetes, vascular disease, heart disease, etc) were excluded from both groups.
Results
Bicycle club is not significantly associated with increased prevalence of LUTS (bicycle club; 2.1-57.7%, control;
4.8-73.5%) and erectile dysfunction (bicycle club; 46.1%, control; 55.4%). The total mean score (storage/voiding/erectile
function) of bicycle club (13.93±1.95/11.14±3.49/20.46±5.30) were not significantly different from control (14.35±
2.49/11.52±3.38/20.40±4.07) (p=0.190-0.968).
Conclusions
These results suggested that bicycle riding as exercise or hobby has no negative effect on LUTS and erectile function
in healthy general men, although this research data were limited to the questionnaire analysis.
PK14 Comparison between TVT SECUR® and TOT : analysis of postoperative pain in patients with stress urinary incontinence
Hui Dai Lee, Sehwan Park, Dae Gi Jo, Joong Shik Lee, Ju Tae Seo
Department of Urology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea
90
Aim of Study
The Tension-free vaginal tape (TVT) SECUR® procedure was introduced as a simple, minimally invasive, and less
painful alternative to tension-free transobturator tape (TOT) procedure. This study compares the postoperative pain
described by patients after TVT SECUR or TOT.
Postoperative pain was evaluated in patients who had TVT SECUR from April 2007 to March 2008 (group A,
n=33), and patients who had TOT from May 2010 to Augst 2010 (group B, n=33). The pain was described by patients on
the next day of the operation, using visual analogue scale (VAS). Inguinal and leg pain were stated by the number 0, as no
pain, to 10, as an intolerable pain.
Results
Patients in two groups had similar age, BMI, obstetric history, menopausal status, and days of hospital stay.
Postoperative pain was significantly lesser in group A compared to group B (0.76±0.86 vs. 1.81±2.04, p=0.024). Operation
using TVT SECUR took a shorter time compared to TOT. Hemoglobin change in two groups is statistically insignificant.
Conclusions
According to our study, TVT SECUR is one of the best alternative procedure for patients suffering from stress
urinary incontinence due to its simple, minimally invasive, and less painful characteristics.
Keywords: minimally invasive surgical procedures, stress urinary incontinence, pain
PK15 Clinical results of radical cystectomy with the Ghoneim pouch
and the Mainz II pouch in bladder cancer patients
Hoon Jang1, Kwan-Hee Shin2, Won-Tae Kim3, Yong-June Kim3, Seok-Joong Yoon3, Sang-Cheol Lee3, Wun-Jae Kim3
1
Department of Urology, Daejeon Veterans Hospital, Daejeon, 2Department of urology, Gongju Medical Center,
Gongju, 3Department of Urology, Chungbuk National University College of medicine, Cheongju, South Korea
Aim of Study
Many forms of orthotopic bladder substitutes have been described with use of various portionsof bowel. The aim
of this study was to compare the functional outcomes of two types of bladder substitution, the Ghoneim pouch and the
Mainz II pouch.
Radical cystectomy cases of 60 bladder cancer patients were enrolled in 1995 to 2009. In 40 patients surgery was
performed the Ghoneim pouch, other 20 patients was performed the Mainz II pouch. The laboratory finding, bladder
capacity and complication in hospitalization and outpatient follow-up period were investigated for the medical records.
Results
In the Ghoneim pouch group (A group) and the Mainz II pouch group (B group), the average age was 65.0 years
and 61.3 years (p=0.16), respectively. And the mean follow-up period was 26 months and 70 months, respectively. The
A and B group median duration of hospital stay was 28.5 days (14-60) and 28.5 days (18-47), respectively (p>0.05). The
A and B group mean operation time was 426 minutes and 483 minutes, respectively, group A was significantly less than
group B (p=0.001). The early and late bladder capacity of group A and B were 163 mL, 516 mL and 157 mL, 561 mL,
respectively (p>0.05). The early The disease-specific survival did not differ significantly in the two groups (p=0.217).
Conclusions
The Ghoneim pouch group had lesser operation time than the Mainz II pouch group. The clinical results and
complications between two types of operation had no significant difference.
91
PK16 Bladder pain syndrome treated with triple therapy with
gabapentin, amitriptyline, and a nonsteroidal anti-Inflammatory
drug
Hee Jong Jeong1, Dong Yup Han1, Jun Hwa Rho2
1
Wonkwang University Hospital, Iksan, Korea; 2Chistian Hospital, Gwang Ju, Korea
Aims of Study
Bladder pain syndrome is a chronic disease that manifests as bladder pain, frequency, nocturia, and urgency. Gabap
entin,amitriptyline, and nonsteroidal anti-inflammatory drugs are efficacious treatments for bladder pain syndrome. Here,
we assessed the effect of triple therapy with these drugs in women with bladder pain syndrome.
Between May 2007 and May 2010, we conducted a prospective nonrandomized study on 74 patients with bladder
pain syndrome. Of these patients, 38 (11 men and 27 women; mean age, 55.9 years; range, 25 to 77 years; mean followup, 12.6 months) were administered the interstitial cystitis (IC) symptom scales (O’Leary-Sant Symptom Index) and visual
analog scale (VAS) 1, 3, and 6 months after treatment to assess the efficacy of triple therapy.
Results
The pretreatment O’Leary-Sant IC symptom score was 11.7, and the post-treatment scores were 4.4, 3.8, and 4.0 at 1,
3, and 6 months, respectively; the pretreatment problem index score was 10.5, and the post-treatment scores were 3.7, 2.7,
and 2.9 at 1, 3, and 6 months, respectively. The pretreatment VAS score was 6.7, and the post-treatment scores were 1.8, 1.5,
and 1.7 at 1, 3, and 6 months, respectively.
The O’Leary-Sant IC symptom index and problem index and VAS scores improved considerably 1 month after
treatment (p<0.05). However, the results at 1, 3, and 6 months after treatment were not significantly different (p>0.05).
Conclusions
Triple therapy was sufficiently effective in patients with bladder pain syndrome and caused no significant adverse
effects. However, large-scale studies should be performed to verify our findings.
PK17 Single surgeon's 10 years results of the tension-free vaginal tape
(TVT) procedure for treating female stress urinary incontinence
Hyung Jong Nam, Dong Gil Shin, Suk Gun Jung, Young Hoon Choi, Jeong Zoo Lee
Department of Urology, Pusan National University School of Medicine, Busan, Korea
Aim of Study
The results of 10 years after the procedure of the tension-free vaginal tape (TVT) for treating female stress urinary
incontinence (SUI) were evaluated.
Of 110 women that underwent the TVT procedure between March 1999 and December 2000, for stress urinary
incontinence, 67 were followed up for at least 10 years following surgery. Preoperatively, the patients were evaluated
with history taking, physical examinations, one hour pad tests, urine analysis, urine cultures and complete multichannel
urodynamic studies. Long-term evaluations were performed via questionnaires on the durability of the surgical outcome
and the patients' satisfaction with the procedure. All the patients were asked about their voiding symptoms as well as any
recurrence by conducting detailed telephone interviews.
92
Results
The follow-up period was a mean of 131.6 months. Of the 67 patients who were followed up for at least 10 years,
the patients were classified according to their symptom grades; grade I (n=17, 25.4%), grade II (n=36, 53.7%) and grade III
(n=14, 22.4%). The TVT procedure remained successful in 79.1% (cured: 56.7%, improved: 22.6%). 32 patients (47.8%)
were very satisfied, 21 patients (31.3%) were satisfied with the TVT procedure. There were no serious or long-term
complications related to the procedure.
Conclusions
The TVT procedure showed a good long-term cure rate for treating female stress urinary incontinence. We consider
the TVT procedure to be an effective treatment for stress urinary incontinence, with long-term durability of continence
and minimal complications related to the surgery.
Table 1. Pre-operative urodynamic parameters of 67 patients
Parameter (mean±SD)
Voided volume (mL)
Maximal flow rate (mL/sec)
Residual volume (mL)
Maximal cystometric capacity (mL)
Maximal detrusor pressure (cmH2O)
n=67
245.9±174.9
29.4±13.4
12.2±16.0
468.5±94.9
27.5±14.3
PK18 The effect of resected prostate tissue on surgical outcome after
transurethral resection of prostate
Hyoung Keun Park, Kyung Kyu Jun, Young Ik Lee, Gwoan Youb Choo, Sung Hyun Paick, Yong Soo Lho, Hyeong Gon Kim
Department of urology, Konkuk university medical center
Aims of Study
Few studies exist correlating the extent of tissue resected with symptom improvement after transurethral resection
of prostate (TURP). This study evaluated the effect of the amount of resected tissue and the ratio of resected tissue in
comparison with the transitional zone volume (TZV) on improvement of voiding symptoms and flow rate.
A total of 50 patients with prostate size greater than 40 gm were included in this retrospective study, all of whom
underwent bipolar TURP and had at least six months of follow-up data. The evaluation before TURP included
international prostate symptom score (IPSS), quality of life (QoL) score, maximum urinary flow rate (Qmax), postvoid residual urine (PVR), PSA and transrectal ultrasonography. The operative time, weight of resected tissue and
complications were noted. After TURP, patients were reassessed for the IPSS, QoL, Qmax and PVR at 6 months. The
correlation analysis was performed between resected tissue weight, the ratio of resected tissue and surgical outcome.
Results
The mean age, prostate volume, transitional volume and PSA level were 67.0±6.1 years, 76.1±32.9 gm, 42.0±25.2 gm
and 6.4 ng/mL, respectively. Total IPSS score was increased by 13.8 points and QoL score was decreased by 2.3 points.
Qmax increased from 10.4 mL/sec to 20.4 mL/sec, PVR decreased from 121.8 mL to 32.9 mL. Total amount of resected
tissue was 25.9 gm and transition zone resection ratio was 61.3%. There were significant correlations between the total
amount of resected tissue and total IPSS and QoL score change (p=0.012 Pearson correlation 0.414, p=0.020 Pearson
correlation 0.385 respectively). However, the change of Qmax and PVR was not correlated with resected tissue weight.
There were no statistically significant difference between the transition zone resection ratio and all surgical parameters.
Conclusions
Resected tissue weight rather than resection ratio had an effect on post-TURP clinical symptom improvement. These
results suggest that complete prostate adenoma resection may not be essential.
93
PK19 Analysis of risk factors for overactive bladder in community
based survey
Hong sang Moon, Shin ah Kim1, Bo youl Choi1, Yong tae Kim
Department of Urology and 1Preventive Medicine, College of Medicine, Hanyang University
Aims of Study
This study evaluated the risk factors of overactive bladder (OAB) in population aged 40 year and older living in a
community.
From October to November 2010, we conducted a community based survey of overactive bladder using overactive
bladder symptom score (OABSS) in population aged 40 and older in Guri city and Yangpyeong county, in South Korea.
The response rate was 74.2% (940 responders out of 1,226) and we excluded 14 subjects because their questionnaires
were incomplete. The data from the remaining responders were analyzed. The survey was performed with demographic
characteristics of the responders included age, dwelling place (rural or urban area), marital status, educational status,
behavioral factors (smoking, drinking), self reported medical history (hypertension, stroke, myocardial infarction, angina,
hyperlipidemia, diabetes, osteoporosis, arthritis, tuberculosis, asthma, rhinitis, atopic dermatitis, cataract, hepatitis B,
depression). Categorical variables analyzed using chi-square test or Fisher's exact test and adjusted for age using the
Cochran-Mantel-Haenszel test. Statistical significance was verified at the level of alpha error 0.05. Statistical analysis was
performed with SAS 9.1 (SAS Institute, Cary, NC).
Results
The subjects diagnosed with OAB were 130/926 (14.1%). Male were 49/403 (12.2%) and female were 81/523
(15.5%). With increasing age, risk of OAB was increased in subjects (p<0.0001). We used age adjusted p-value and risk
factors with OAB detected in this study were educational status (p<0.0487), stroke (p<0.0414), osteoporosis (p<0.0208),
asthma (p<0.0091), rhinitis (p<0.0150) and cataract (p<0.0008). Other factors (dwelling place, marital status, smoking,
drinking, hypertension, diabetes, hyperlipidemia, myocardial infarction, angina, tuberculosis, atopic dermatitis, hepatitis B,
depression) were not associated with OAB.
Conclusions
The prevalence of OAB was 14.1% and risk factors with OAB were educational status, stroke, osteoporosis, asthma,
rhinitis, and cataract in this study.
PK20 Acute urinary retention is fearful complication of BPH?
Hong Wook Kim, Myung Soo Kim, Ho Song Yu, Seung Cheol Yang, Sung Jun Hong, Jang Hwan Kim
Department of Urology & Yonsei Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
Aim of Study
Benign prostatic hyperplasia (BPH) is a progressive disease. BPH patients were experienced lower urinary tract
symptoms and some complications as urinary tract infection, renal insufficiency, acute urinary retention (AUR). AUR is
one of the most common emergency situation in the urology and it is the result of progressive BPH. AUR patients were
distressed such as renal colic and distended bladder affected some damage. It is suspected the result of TURP due to
AUR would be worse than non-AUR. We compare the result of TURP between AUR patients and Non-AUR patients.
Between January 2010 and March 2011, 31 AUR patients and 64 non AUR patients were operated TURP(trauma,
postoperative period AUR, neurologic cause and prostate cancer were excluded.). Between two groups age, PSA, prostate
volume, Pre- and postoperative symptoms(IPSS), uroflowmetry and postvoid residual urine volume were evaluated.
94
Results
PSA and prostate volume of AUR group are higher than non-AUR group. Preoperative Quality of life, voided
volume and residual urine were significantly worse in the AUR group.
AUR group
Non-AUR group
Age (yr)
74.8±6.5
70.9±7.0
PSA (ng/mL)*
5.6±5.8
2.3±3.1
Prostate volume (mL)*
31.8±17.4
16.3±14.6
*: p<0.05
There is no statistically significant difference in the postoperative Symptoms score between two groups. Only voided
volume of AUR-group was lower than Non-AUR group.
1
AUR-Group
1.3±1.3
Non-AUR Group 1.4±1.4
AUR-TURP
Non-AUR TURP
2
2.2±1.0
1.9±1.3
3
1.6±1.2
1.6±1.5
Qmax (mL/sec)
13.9±5.6
13.5±6.5
4
1.7±1.3
1.7±1.4
5
2.1±1.4
1.9±1.6
Voided Vol. (mL) *
172.1±104.0
253.7±146.6
6
1.2±1.3
1.5±1.7
7
1.9±1.0
1.9±1.2
QoL
2.5±1.1
2.6±1.4
PVR (mL)
23.7±60.5
40.5±49.1
*: p<0.05
Conclusions
Because PSA and prostate volume were significant risk factor for AUR, it is higher in the AUR group. Many
urologists doctors believe easy to do the results are worse in the AUR group. But there are no significant difference in the
postoperative IPSS, Qmax and postoperative residual urine volume. Only Voided volume were was in the AUR-group.
AUR is a emergent urologic condition. But the effect of AUR for postoperative voiding symptoms and uroflowmetry
results were limited.
Keywords: AUR, BPH, IPSS, uroflowmetry
PK21 New surgical approach of tension readjustable urethral
sling procedure (Remeex System®) for male stress urinary
incontinence
Hong Wook Kim, Myung Soo Kim, Koon Ho Rha, Sung Jun Hong, Jang Hwan Kim
Department of Urology & Yonsei Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
Aim of Study
Stress urinary incontinence (SUI) can be a debilitating problem after surgery of the prostate. The treatment of
male incontinence are collagen injection, artificial urinary sphincter implantation and male sling operation. Previously we
reported male sling operation(The Remeex System®) result for the mesh placement in the posterior urethra. But the long
term follow up result of Remeex System® was satisfactory in only 36%. Recently new approach for the Remeex System®
was introduced for the mesh placement in the urethral bulb. We report our experience using the Remeex System® in male
SUI patients with new surgical approach.
Between September 2010 and June 2011, 12 male patients age 38 to 74 years (mean age 61.0±9.1) with SUI were
operated with a readjustable suburethral sling Remeex System® with new surgical approach. The interval between TURP
or radical prostatectomy (RP) or spinal cord injury and sling operation was 40.3±19.3 months (range 40.2-93months).
The postoperative course was evaluated. Success was defined as requiring no pad with the patient being satisfied with the
incontinence state.
95
Results
Ten patients had previously underwent RP, one TURP and one spinal cord injury. More than 1 month after surgery
in patients with possible follow-up 7 persons were analyzed. Six patients had previously underwent RP and one spinal
cord injury. All patients used for than 1 pad/day. Two case bladder puncture (RP) occurred. It was improved conservative
treatment. There was no other significant intraoperational complication. Mean follow-up duration is 4.7±2.7 (range 1-9)
months. Five patients were completely dry, two patients (one RP and one spinal cord injury) had intermittent urine leak
when strenuous exercise. One patient use a 1/2 pad a day and the other use safety liner. Every patient was readjusted
during early postoperative period. During follow up period, the 8 was readjusted an average of 1.1±0.4 (range 1-2) times.
There was not yet reported infection, erosion, malfunction of tensioning device.
Conclusions
New approach result of Remeex System® was satisfactory in 71% (5 of 7 patients). Also, other two persons were
satisfied in spite of intermittent leak. New approach need more advanced dissection on the perineal body and between
bulbous urethral and rectal space. So there is more chance for bleeding and tissue injury. But above mentioned
complication not yet occur. Bladder puncture was managed with conservative manner. The short term follow-up result for
new approach of Remeex System® is very hopeful for male SUI patients. It is needed more patient and long-term followup for the result about the new approach for Remeex System®.
Keywords: male incontinence, male sling operation, bulbous urethra
PK22 The effect of desmopressin combined with anticholinergic on
daytime frequency in female patients with overactive bladder
Hayoung Kim
Department Urology, Kangdong Sacred Heart Hospital, Hallym University, Seoul, Korea
Aims of Study
Traditionally, antimuscarinic drugs are widely used to treat overactive bladder (OAB). However, their effects are
known to be 60-70%. Recently, there were several clinical reports to improve nocturnal and daytime frequency in the
patient with OAB with desmopressin by decreasing renal urine production and increasing bladder filling-time. However
there is no report concerning the effect of desmopressin combined with antimuscarinics. Therefore we performed this
study to evaluate the effect of desmopressin combined with antimuscarinics on daytime frequency in female patients with
OAB.
We included 68 women patients with OAB, who had at-least four voids in the first 8-hr of the day after rising,
excluding the first morning voids. The patients were randomly assigned to receive 5mg of solifenacin (group I) and 5mg
of solifenacin and 0.2mg of desmopressin (group II) for 2weeks. The patients were instructed to take the tablets after first
morning void. By using pre/post-treatment 3-days voiding diary, Urinary Distress Inventory (UDI-6) and Incontinence
Impact Questionnaire(IIQ-7), changes in voiding symptoms and quality of life (QoL) were assessed and compared
between groups.
Results
Group I and II had 31 and 37 patients, respectively. Time to first void was 12-min later in group II (105 min vs
117 min) and this difference was not statistically significant. But time to the second, third voids (184 min vs 215 min,
267 min vs 305 min) and the first urgency episode (212 min vs 255 min) were significantly longer in group II. When
the improvement after treatment was defined as increase in time to first void more than 10% after 2 weeks of treatment,
desmopressin was more effective in patients with age of ≥65years and voided volume of ≥150 mL (Table 1). There
were also significant decreases in the numbers of voids (6.8 vs 5.4) and urgency episodes (2.6 vs 1.7) during the first 8-hr
following treatment in group II compared to group I. The patients in group II showed significant improvement in QoL
scores as measured by the UDI-6 and IIQ-7 compared with group I.
96
Conclusions
Desmopressin combined with anticholinergic was more effective than anticholinergic only in the treatment of
daytime frequency in female patients with OAB, especially in patients aged more than 65 years and with more than 150
mL of voided volume.
Table 1. Univariate logistic regression analysis of pretreatment parameters with respect to the improvement
Parameters
Age
No. of micturition
No. of urgency
Urge incontinence
Voided volume
Improvement in time to 1st micturition(>10%)
Odds ratio (95% CI)
1.00 (reference)
1.16 (1.00-1.38)
1.00 (reference)
0.98 (0.96-1.00)
1.00 (reference)
1.01 (0.98-1.05)
1.00 (reference)
2.12 (0.88-5.07)
1.00 (reference)
1.34 (1.13-1.59)
<65
≥65
≤5/1st 8-hr
>5/1st 8-hr
≤2/1st 8-hr
>2/1st 8-hr
+
<150 mL
≥150 mL
p-value
0.048
0.117
0.332
0.091
0.001
PK23 Comparison of clinical results between TOT outside-in
midurethral slings and single incision sling
Hana Yoon1, Jae Yup Hong2
1
Department of urology, Ewha Womans University School of Medicine, Seoul, 2Cha University School of Medicine,
Gyoungi-do, Korea
Aims of Study
Single incision TOT method is newly introduced method treating SUI without penetrating obturator membrane
but anchors to the muscular plane. In this study, we aimed to compare the treatment results between single incision sling
(Contasure-needless® sling, SIS) and TOT outside-in technique.
Materials and methods: One hundred and three women with SUI were enrolled to this study. They were
randomly divided into two groups according to their operative procedure (single incision sling, SIS 52, TOT outsidein 51). All operative procedures were conducted by single surgeon. Patients’ epidemiological information, three-day
frequency-volume chart, uroflow (UFR)with post void residual (PVR) volume, symptom questionnaire, operation related
complications, operative time, post-operative voiding symptoms were reviewed and analyzed.
Results
Mean age of patients were 52.90±9.97(SIS) 56.95±9.64 (TOT) (p=0.088). Pre-operative voiding characters were
not significantly different between two groups (p>0.05, Table 1). Mean operation time, post-operative 4 weeks follow-up
voiding characters were not significantly different (p>0.05, Table 1). There had been no significant complications in both
groups. There were three recurrence of incontinence (1 in TOT group, and 2 in SIS group) during the follow up period.
The types of incontinence of recurrent patients were mixture of stress and urge incontinence with dominant nature of urge
incontinence.
Age
(years old)
SIS
52.9±
9.97
TOT
56.95±
9.64
P value 0.088
Preop.
VV
254.3±
126.78
191.7±
208.37
0.38
Preop.
Qmx
19.7±
13.69
20.2±
14.35
0.401
Preop.
PVR
43.1±
25.08
63.7±
31.67
0.436
Postop.
VV
254.3±
180.76
191.7±
85.13
0.47
Postop.
Qmx
19.7±
12.31
20.2±
3.26
0.39
Postop.
PVR
43.1±
48.64
63.7±
54.17
0.298
Preop.
VLPP
95.9±
26.22
100.4±
17.08
0.058
Op. duration
(min)
29.3±
6.16
25.7± 18.48
0.167
VV: voiding volume (mL); Qmx: maximal flow rate (mL/sec); PVR: post-void residual urine volume (mL); VLPP: Valsalva leak point
pressure (cmH2O)
97
Conclusions
Single incision sling and TOT outside-in sling technique both provide similar outcomes in short-term followup. Although, longer-term data should followed, the single incision sling technique can also be considered as effective
operative method in selected group of stress incontinence patients.
PK24 Factors affecting de novo urinary retention after Holmium laser
Jumgbum Bae, Minsoo Choo, Jin-Kyu Oh1, Jae-Seung Paick, Seung-June Oh
Department of Urology, Seoul National University Hospital, Seoul, Korea; 1Department of Urology, Gachon University
Gil Hospital, Incheon, Korea
Aims of Study
Patients can experience urinary retention after Holmium laser enucleation of the prostate (HoLEP) where urinary
bladder is kept distended during both enucleation and morcellation procedures. The aim of this study was to evaluate
factors affecting urinary retention after HoLEP retrospectively.
Between July 2008 and August 2010, 336 patients underwent HoLEP for symptomatic benign prostatic hyperplasia
by two surgeons. Urinary retention was defined as the case which needed catheter indwelling secondary to failure to void
after catheter removal. Catheter was routinely removed one or two days after surgery in uneventful case. Demographic and
clinical parameters were compared between urinary retention (UR) and non-retention (non-UR) groups.
Results
Mean operative time was 75.5 (±37.4, SD) min and mean age was 68.3 (±6.6) years. Thirty-seven patients (11.0%)
experienced postoperative urinary retention. All UR patients voided catheter free emptying after mean 6.8 days after
urinary retention. With regard to cause of retention, clot retention was in 22 (6.5%) and non-clot retention 15 (4.5%).
There was no significant relation between the UR and non-UR groups with regarded to age (p = 0.11), history of diabetes
(p =0.653), symptom duration (p=0.68), prostate volume (p=0.62), preoperative PVR (p=0.35), operative time (p=0.51)
and hospital stay (p=0.19). As for non-clot retention, univariate analysis showed significantly correlated with postoperative
PVR (p=0.03) and morcellation efficiency (p=0.005). However, patient age (p=0.11), history of diabetes (p=0.77), prostate
volume (p=0.62), pre-operative PVR (p=0.35), bladder contractility index (p=0.29) and operative time (p=0.51) were not
significantly correlated with retention. In multivariate analysis there was no independent risk factor for urinary retention.
Learning curve did not affect the incidence of retention.
Conclusions
These results suggest that urinary retention after HoLEP was self-limiting and was not related with learning curve.
Also, patient age, history of diabetes and operative time did not increase the risk of postoperative urinary retention.
Keywords: urinary retention, benign prostatic hyperplasia, holmium, lasers, prostatectomy
PK25 Heart rate variability in the assessment of autonomic
dysfunction in patients with chronic prostatitis/chronic pelvic
pain syndrome
Jong Bo Choi1, Hyun Woo Kim2, JoonChul Kim2, Dae Sung Cho1, Young Soo Kim1
1
Department of Urology, College of Medicine, Ajou University and 2Department of Urology, College of Medicine,
Catholic University, Korea
98
Aims of Study
To determine and compare autonomic dysfunction in patients with chronic prostatitis/chronic pelvic pain syndrome
(CP/CPPS), we measured and compared parameters of heart rate variability (HRV) between CP/CPPS patients and
normal healthy men.
The ages of all participants were between 30 to 60 years old and they have no other disease such as diabetes,
hypertension and so on. Electrocardiographic signals were obtained from 59 patients with CP/CPPS (mean age, 46.5±7.02
years old) and 94 healthy control (mean age, 48.4±5.96 years old) in resting state.
Results
CPPS
Control
Sig.(t-test)
SDNN
31±10.6
39±13.2
<0.001
RMSSD
23±10.9
29±12.9
0.004
HR
72±10.1
67±9.8
0.003
TP
860±671.8
1287±998.7
0.004
VLF
477±424.0
691±549.8
0.012
LF
246±255.1
362±420.7
0.058
HF
137±110.1
235±213.3
<0.001
SDNN: the standard deviation of the N–N interval; RMSSD: the square root of the mean squared differences of successive N–N
intervals; HR: heart rate, TD: total power, VLF: very low frequency, LF: low frequency, HF: high frequency
Conclusions
It means that there is some difference of autonomic nervous system between CP/CPPS patients and normal healthy
men and it may be a clue that we should consider autonomic dysfunction is one of the causes which aggravate CP/CPPS.
PK26 The relation between the severity of lower urinary tract
symptom and detection of prostate cancer in transrectal prostate
biopsy
Jeong Kyun Yeo, Dae Yeon Cho, Min Gu Park, Sang Hyun Park, Seok San Park
Department of Urology, College of Medicine, Inje University, Pusan, Korea
Aims of Study
To know the relation between the severity of lower urinary tract symptom and detection of prostate cancer in
transrectal prostate biopsy (TRBx).
The data (international prostate symptom score (IPSS), prostate specific antigen (PSA), prostate volume measured
by transrectal ultrasonograpy) of 128 patients who took an ultrasono-guided TRBx for high PSA (> 4.0 ng/mL) and/or
positive DRE (on digital rectal examination) from January 2009 to April 2011 was investigated retrospectively. The patients
were divided into two groups according to the pathologic result of TRBx; group I (diagnosed as cancer, n=86) and group
II (not diagnose as cancer, n=42). Independent t-test and linear by linear association were used for statistical analysis and p
<0.05 was considered to be statistical significant.
Results
Mean age of each group was 63.78±12.42, 69.62±8.90 years (p=0.007) and mean PSA of each group was 7.19±8.22,
118.84±424.43 ng/mL (p=0.096). The mean prostate volume of each group was 53.49±25.61, 43.69±26.05 mL (p=0.051).
Total IPSS showed significant difference between two groups (13.74±9.15, 10.0±6.28, p= 0.008) and in compassion
according to each voiding and storage symptom of IPSS, there was significant difference between two groups (p=0.036,
p=0.005). The linear by linear association showed significant positive correlation between the severity of IPSS and
detection of prostate cancer (p=0.01) (Table 1).
99
Conclusions
The results showed that the severity of IPSS was correlated with the detection of prostate cancer in TRBx; the lower
the IPSS is, the higher the possibility of detection of prostate cancer is. However, the prospective randormized controlled
study is needed.
Keywords: IPSS, prostate cancer, biopsy
Table 1. The correlation between IPSS and cancer
Group I (cancer)
Group II (others)
IPSS
Mild (0-7)
N (%) 19 (45.2)
N (%) 28 (32.6)
Moderate (8-19)
21 (50.0)
34 (39.5)
Severe (20-35)
2 (4.8)
24 (27.9)
Total
42
86
Linear-by-Linear Association, Asymp. Sig. (2-sided): p=0.010
PK27 Therapeutic efficacy of bipolar radio frequency thermal
treatment for patients with chronic prostatitis
Joonhwa Noh1, Juyoung Lim1, Jusung Kim1, Donghoon Yoo1, Myungki Kim2, Heejong Jeong3, Jongyeon Kim4, Youngwoong
Park4
1
Department of Urology, Kwangju Christian Hospital, Chonnam University medical School Gwangju, 2Chonbuk
University medical School, Chonju, 3Wonkwang University School of Medicine, Iksan, 4Naju Urologic Clinic, Korea
Aim of Study
In regarding of cost, ease of use and efficacy, bipolar radio frequency thermal therapy (Tempro system from DirexInitia ) for patients with chronic prostatitis (CP) intractable to conventional medication shows effective improvement in
pain, voiding symptom and quality of life. We compared the clinical symptom and treatment result in order to evaluate
the therapeutic efficacy.
A prospective study of 26 patients diagnosed as CP (National Institutes of Health; NIH-category III) who were under
50 years old between october 2009 and september 2010 was performed. 20 patients were diagnosed as inflammatory CP
(NIH-category IIIa) and the rest were noninflammatory CP (NIH-category IIIb). We used the Tempro system with a
treatment protocol of 55 degree Celsius for 50 minutes, medium heating rate. All patients performed the NIH-chronic
prostatitis symptom index (CPSI) before and after treatment.
Results
In the patients with CP, the mean serum prostate specific antigen level was 0.9±0.3 ng/mL and the prostate volume
was 27.1±5.5 gm, and the average score for all 3 domains in NIH-CPSI significantly decreased. The total scores decreased
from 19.8±7.1 to 11.1±7.0, the pain domain decreased from 8.6±3.1 to 4.8±3.1, the voiding symptoms from 5.1±1.8 to 3.6
±1.8, and the effect on the quality of life from 6.1±2.2 to 3.4±2.2 (p<.001).
Conclusions
Tempro system for patients with chronic prostatitis intractable to conventional medication can provide significant
improvement in NIH-CPSI. Large, randomized controlled trials are needed to confirm the efficacy of these data.
Keywords: chronic prostatitis, bipolar radio frequency thermal therapy, tempro system
100
PK28 The efficacy and safety of the REMEEX system in female stress
urinary incontinence patients with a VLPP less than 60cmH2O
Jung Yoon Kang, Hee Joo Cho, Jeong Man Cho, Tak Keun Yoo
Department of Urology, Eulji Hospital, Eulji University School of Medicine, Seoul, Korea
Purpose
After performing surgery with the REMEEX system for treating female stress urinary incontinence, the tape tension
can be adjusted manually. We evaluated the efficacy and safety of the REMEEX procedure for SUI patients with a Valsava
leak point pressure (VLPP) less than 60 cmH2O.
From July 2008 to May 2010, we enrolled 28 female mixed urinary incontinence patients with a VLPP less than
60 cmH2O and who underwent surgery using the REMEEX system were enrolled. A preoperative medical history, a
physical examination and uroflowmetry and urodynamic study were performed and the International Prostate Symptom
score (IPSS), the King's health questionnaire (KHQ) and the postvoiding residual (PVR) volume were assessed. Until the
patients achieved comfortable uroflow and did not have urinary incontinence, we readjusted the REMEEX screw to a
suitable setting for 2 days after surgery. Six months following surgery, we estimated the IPSS, PVR volume, the success rate
and satisfaction and the patients underwent uroflowmetry and retook the KHQ questionnaire.
Result
The preoperative VLPP was 49.2±11.7 cmH 2O and the maximal bladder capacity was 410.9±86.0 mL on
urodynamic study. There were 22 patients who were cured (78.6%) and 4 patients who improved (14.3%). The success
rate of the REMEEX was 92.9% (26/28). There were 16 patients who were very satisfied (57.1%), 9 patients were satisfied
(32.2%) and 3 patients were dissatisfied (10.7%). The dissatisfied patients were 2 patients with bladder dysfunction and
1 patient with mixed urinary incontinence. The postoperative complications included 2 patient with abdominal wound
dehiscence (7.1%), 1 patient with a foreign body sensation (3.6%) and 1 patient with vaginal erosion (3.6%). There was no
de novo urgency.
Conclusion
The REMEEX system is useful in urinary incontinence patients with a VLPP of 60 cmH2O because it can handle (ED
note: adjust?) the tape tension after surgery. But the bladder dysfunction patients had no effect after surgery and so giving
sufficient explanation to these patients is need.
Table 1. Comparison the preoperative and postoperative results after REMEEX surgery
Qmax (mL/s)
Voided volume (mL)
PVR(mL)
IPSS total
IPSS frequency
IPSS urgency
IPSS nocturia
IPSS QoL
KHQ domain
General health perceptions
Impction on life
Role limitation
Physical/social limitation
Personal relationship
Emotions
Sleep/energy
Incontinence severity measure
Preoperative
22.5±12.2
264.6±104.5
12.2±10.6
16.6±8.1
3.4±1.4
3.0±2.0
2.0±1.2
3.7±1.5
Postoperative
19.9±11.3
245.2±112.7
22.1±15.9
9.7±9.5
1.6±1.2
1.4±1.9
1.5±0.9
2.1±1.2
p-value
0.457
0.601
0.173
0.010
0.023
0.058
0.131
0.016
3.3±1.1
2.9±1.1
3.9±2.4
8.0±4.4
3.6±3.7
5.5±3.5
2.5±2.2
9.7±4.6
3.2±0.9
2.6±1.4
1.4±0.7
2.0±1.0
0.7±0.3
1.7±0.7
1.0±0.4
3.0±1.4
0.730
0.459
0.020
0.014
0.028
0.006
0.020
0.005
101
PK29 Menopause impacts negatively on voiding symptoms but not on
sexual function
Kweonsik Min1, Jiyeon Jun1, Dongil Kang1, Jangho Yoon1, Hyunwoo Kim2
1
Department of Urology, Pusan Paik Hospital, Inje University and 2Daedong Hospital, Busan, Korea
Aims of Study
To investigate the impact of menopause on the quality of life (QoL) including general well-being, voiding symptoms
and the sexual functions in mid to old women.
Questionnaires were composed of voiding problem, women’s Health questionnaire (WHQ), female sexual distress
used as a tool for assessing quality of life. This questionnaire was self-administered by 1679 in Republic of Korea. Total
1262 women were available to analyze statistical significance premenopausal (n=307), perimenopausal (n=240) and
postmenopausal (n=715) group.
Results
Voiding discomforts increased significantly in postmenopausal and perimenopausal women compared to
premenopausal women (p<0.0001). General well-being was worsening by progression of menopause (p < 0.001).
Menopausal women with old age (p=0.014), hysterectomy state (p=0.005) and urinary incontinence (p=0.0001) showed
increased voiding symptoms. Hypertension (p=0.026), cardiac disease (p=0.013), arthritis (p=0.0001) resulted in
significantly decreased general–well beings. Women with hysterectomy state (p=0.017), arthritis (p=0.004) revealed low
sexual functions. Menopausal women group which with occupation expressed better general well-being than unemployed
group.
Conclusions
Menopause impacted negatively on QoL of mid to old women because of decreased general well-being and
increased voiding symptoms. General health, even in menopausal women, was important to retain better QoL. For
preserving QoL of women with menopause, control of menopause and their underlying diseases should be considered.
Keywords: postmenopause, quality of life, urination disorders, psychosexual dysfunction
PK30 Diagnostic cystoscopy in outpatient of painful bladder syndrome:
is it meaningful?
Kwang Woo Lee, Young Ho Kim, Dong Hwan Lee1
Department of Urology, Soonchunhyang University College of Medicine, Bucheon, 1The Catholic University of Korea
College of Medicine, Incheon, Korea
Aims of Study
Painful Bladder Syndrome (PBS) is a condition characterized by pelvic pain, pressure, or discomfort related to
the bladder, typically associated with persistent urge to void or urinary frequency, in the absence of infection or other
pathology. The most debating issues in PBS and Interstitial Cystitis (IC) is the definition and diagnostic techniques of it.
The diagnostic cystoscopy in outpatient of PBS is still a debating controversies because of the safety and the efficacy. We
studied the role of diagnostic cystoscopy in outpatient of PBS.
We performed a prospective study of efficacy and safety of diagnostic cystoscopy. A total of 210 women with
complaints of PBS visited urologic outpatient department from Feb. 2009 to Feb. 2010. At first visit, urine analysis, urine
culture, uroflowmetry, residual urine, urgency score were checked. At second visit, diagnostic cystoscopy was performed
102
among the 81 patient who do not had neurologic history, urinary tract infection and bladder outlet obstruction (more
than 50 cc of residual urine). Diagnostic cystoscopy was done with flexible cystoscope. Normal saline was instilled under
physiologic rate until pain complaints of patient or identification of bladder mucosa changes. The bladder is emptied and
then refilled to look for glomerulations or ulceration. We analyzed cystoscopic findings, glomerulation grade among the
81 patients.
Results
Diagnostic cystoscopy in outpatient of PBS was performed safely in all patients that the vital signs before and after
the procedure were normal. Bladder tumor was revealed in four patients (4.9%) and bladder stone in one patients.
Glomerulation was identified in 20 patients (24.6%) and classic ulcer was revealed in 14 patients (17.2%). After diagnostic
cystoscopy, 9 patients (11.1%) had complaints of gross hematuria but no further treatment was needed. Four patients had
complaints of aggravated pain.
Conclusions
Diagnostic cystoscopy in outpatient of PBS is safe and meaningful for exclusion of bladder tumor. Moreover,
glomerulation and classic ulcer which is characteristic cystoscopic features of IC could be identified rather simply than
traditional diagnostic cystoscopy done under general anesthesia.
PK31 Therapeutic efficacy of bipolar radio frequency thermal
treatment for patients with benign prostate hyperplasia
Joonhwa Noh1, Juyoung Lim, Jusung Kim1, Donghoon Yoo1, Myungki Kim2, Heejong Jeong3, Jongyeon Kim4, Youngwoong
Park4
1
Department of Urology, Kwangju Christian Hospital, Chonnam University medical School Gwangju, 2Chonbuk
University medical School, Chonju, 3Wonkwang University School of Medicine, Iksan, 4Naju Urologic Clinic, Korea
Aim of Study
In regarding of cost, ease of use and efficacy, bipolar radio frequency thermal therapy (Tempro system from DirexInitia ) for patients with benign prostate hyperplasia (BPH), especially dissatisfied with conventional medication and
unwilling to surgery, shows effective improvement in the voiding symptom and the quality of life. We compared the
clinical symptom and treatment result in order to evaluate the therapeutic efficacy.
A prospective study of 63 patients diagnosed as BPH who presented with a serum prostate specific antigen (s-PSA)
level lower than 4 ng/mL between october 2009 and september 2010 was performed. We used the Tempro system
with a treatment protocol of 55 degree Celsius for 50 minutes, medium heating rate. Patients with BPH performed the
uroflowmetry and the international prostate symptom score (IPSS) before and after treatment.
Results
In the patients with BPH, the average s-PSA level was 1.1±0.8 ng/mL and the prostate volume was 35.5±8.7 gm, and
the mean maximal flow rate (Qmax) was 11.9±4.3 mL/s before treatment and it was 13.9±5.9 mL/s after treatment (p<.05).
Also, the IPSS was significantly decreased from 19.6±5.7 to 13.6±6.1, and the effect on the quality of life from 3.3±0.9 to 2.3
±0.9 (p<.001).
Conclusions
Tempro system for patients with BPH can provide significant improvement in uroflowmetry, IPSS and the effect on
the quality of life. It will be alternative treatment option for patients with BPH dissatisfied with conventional medication
and unwilling to surgery but large, randomized controlled trials are needed to confirm the efficacy of these data.
Keywords: benign prostate hyperplasia, bipolar radio frequency thermal therapy, tempro system
103
PK32 Impact of LUTS/BPH treatment by tamsulosin and solifenacin
combination therapy on erectile function
Sung Chul Kam, Jeong Seok Hwa, Jae Seog Hyun
Department of Urology, College of Medicine, Gyeongsang National University, Jinju, Korea
Objectives
Some reports suggest that the improvement of LUTS leads to erectile dysfunction. The aim of this study was to
examine the effects of a concomitant treatment of alpha-blocker (tamsulosin) and antimuscarinic agent (solifenacin) on
erectile function in patients with LUTS/BPH.
Design and Methods
Fifty-seven male patients with LUTS/BPH were assessed for the degree of LUTS and erectile function using the
International Prostate Symptom Score (IPSS: total scores, storage symptoms (ST), voiding symptoms (VD), and quality of
life (QoL)) and a 5-item version of the International Index of Erectile Function (IIEF-5). Then, prostate-specific antigen
(PSA), trans-rectal ultrasonography (TRUS), urine flowmetry (UFM), and residual urine (RU) tests were conducted. In
group 1 (tamsulosin) and group 2 (tamsulosin and solifenacin), changes in IPSS (total, ST, and VD), IIEF-5, UFM, and
RU were measured following a 3-month treatment period. In both groups, it was determined whether treatment was
associated with changes in LUTS and erectile function pre- and post-treatment and whether the improvement in IPSS was
correlated with IIEF-5. Comparative analysis was also done to examine whether there is a relinear relationship between
improved IPSS scores and IIEF-5 scores before and after treatment of the two groups.
Results
A comparison of the degree of improvement in all the parameters before and after treatment indicated that both
groups showed significant improvement in total IPSS, IPSS-ST, IPSS-VD, and QoL (p<0.05). In group 1, as the IPSSST domain score improved, the IIEF-5 also significantly improved. However, in group 2, improvement of the IPSS-ST
domain score showed no significant association with IIEF-5.
Conclusions
In patients with LUTS/BPH, tamsulosin and solifenacin combination therapy was effective in LUTS, but erectile
function was not significantly improved. Therefore, although effective in improving LUTS, combination therapy using
alpha-blocker and antimuscarinic agent was not effective in improving erectile function.
PK33 Women with pure stress urinary incontinence symptoms
assessed by the initial standard evaluation including
measurement of post-void residual volume and a stress test: are
urodynamic studies still needed?
Seong Jin Jeong, Jeong Geun Lee, Hyeon June Kim, Byung Ki Lee, Young Min Choo, Jong Jin Oh, Chang Wook Jeong,
Cheol Yong Yoon, Sung Kyu Hong, Seok-Soo Byun, Sang Eun Lee
Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
Aims of Study
The significance of preoperative urodynamic studies in women with a “clinically-defined pure stress urinary
incontinence (SUI) symptom” has been debated in recent years. We evaluated changes of reliability of pure SUI
symptoms for prediction of pure urodynamic SUI (USUI) when the assessment of post-void residual (PVR) volume and
a stress test, designated as the initial standard evaluation in the NICE and AUA guidelines, were added to the process for
the diagnosis of pure SUI symptoms.
104
Methods
We reviewed records of 1,019 women aged 30 to 80 who underwent urodynamic study for incontinence. Criteria
for pure SUI symptoms were defined as absence of overactive bladder symptoms and voiding difficulties based on a
frequency-volume chart and AUA Symptom Index. We then added assessment of PVR volume and a stress test to the
process for clinical diagnosis.
Results
Of subjects, 211 (20.7%) could be classified as having a pure SUI symptom. Of these, only 167 (79.1%) had pure
USUI and 33 (15.7%) had detrusor overactivity. Eight (3.8%) had detrusor underactivity/bladder outlet obstruction.
Sensitivity and specificity of pure SUI symptoms for pure USUI were 28.6% and 89.9%. Addition of assessment of PVR
volume and a stress test resulted in an increase of predictive accuracy of only 3.6%.
Conclusions
As one-fifth of women with pure SUI symptoms exhibit the pathophysiologies that could affect the surgical outcomes
despite additional use of PVR assessment and a stress test in the clinical diagnostic process, urodynamic evaluation is
considered necessary before anti-incontinence surgery in this population.
PK34 Effects of level of consciousness on urodynamic procedure in
female cats
Seung-June Oh1, Wen Ji Li2, Jong Min Kim3
1
Department of Urology, Seoul National University Hospital, Seoul, Korea; 2Department of Urology and Andrology,
Ninth People’s Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; 3Laboratory of Veterinary
Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Korea
Aims of Study
Urodynamic evaluation is an invasive and uncomfortable procedure that can cause physical distress and is difficult
to perform in uncooperative patients. The aim of this study was to evaluate the effects of consciousness on urodynamic
evaluation in an animal model.
Repeated cystometry, electromyogram, and measurement of serum cortisol concentrations were performed in
female cats under conscious (CON), conscious sedation (CS) and deep anesthesia (DA) conditions.
Results
Urodynamic evaluation showed that there were no statistical differences in maximum detrusor pressure or bladder
capacity observed among the three conditions. Under the DA condition, but not the CON and CS conditions, bladder
contraction was accompanied by an un-relaxed anal sphincter. Residual urine volume significantly increased in the DA
condition compared to the CON and CS conditions. The levels of serum cortisol significantly increased after performing
urodynamic evaluation under the CON condition, whereas these levels were not significantly increased under the CS and
DA conditions.
Conclusions
This study showed that conscious sedation has no adverse effects on the urodynamic parameters, and that it
significantly reduces distress in cats undergoing the examination. These results may provide novel insights for performing
urodynamic studies in uncooperative patients.
Keywords: cats; conscious sedation; distress; urodynamic study
105
PK35 Techniques for early recovery of continence in patients with
robotic-assisted radical prostatectomy
Tae Hyo Kim, Won Yeol Cho
Department of urology, college of medicine, Dong-A university, Busan, Korea
Aim of Study
With the introduction of the da-Vinci system, many techniques have been reported to improve the quality of life
for patients undergoing robot-assisted radical prostatectomy (RARP). We would like to report our results from using the
posterior reconstruction and ultra-dissection technique.
From December 2007 to December 2009, we analyzed the postoperative data of 100 patients that had undergone
RARP. There were 32 patients in the A group where the posterior reconstruction and the ultra-dissection technique were
not performed. In group B of 32 patients, only the posterior reconstruction technique was performed. In Group C of
36 people where both techniques were utilized. We analyzed the recovery of continence in these 3 groups. We defined
'recovery of continence' as the usage of 1 pad or less within 24 hours.
Results
Mean age was similar among 3 groups (65.9 years in group A, 65.3 years in group B and 64.7 years in group C
(p=0.69). Preoperative mean PSA was 9.5 ng/mL, 10.4 ng/mL and 9.1 ng/mL (p=0.45) in each group. Mean BMI was
24.3 kg/m2 , 23.9 kg/m2 and 24.9 kg/m2 (p=0.43) and the mean prostate volume was 33.8 g, 39.2 g and 36.8 g (p=0.15) in
each group. Mean operative time was 237.6 min, 203 min and 168.5 min (p=0.23). Mean blood loss was 229.7 cc, 202.8
cc and 146.2 cc (p=0.03). Mean catheter duration was 8.7days, 6.4 days and 5.9 day in each group. In group A, there were
2 patients with urine leakage, while group B and C were none. Recovery rate of continence was 34.8% at 1 month, 34.8%
at 3 month, 31.8% at six month in group A. Group B was 57.2%, 32.1% and 7.1% at each interval. Group C was 80% at 1
month and 20% at 3 month. Overall at 6 month, the recovery rate of continence was 90.6% in group A, 96.4% in group B,
100% in group C. The positive surgical margin rate was 31.2% in group A, 21.4% in group B, 30% in group C.
Conclusion
In RARP, the posterior reconstruction and ultra-dissection techniques showed the decreased rate of urine leak
and increased early recovery of continence. But within the ultra-dissection cases, the rate of positive surgical margin has
increased. Therefore, efforts need to be directed to decrease the rate of positive surgical margin, while increasing the
quality of life for the patients.
Keywords: prostatic neoplasms, prostatectomy, laparoscopy, robotics
PK36 Relationship between preoperative variables and holmium laser
Young Hoon Choi, Hyung Jong Nam, Dong Gil Shin, Suk Gun Jung, Jeong Zoo Lee
The Department of Urology, Pusan National University School of Medicine, Busan, Korea
Aim of Study
Holmium laser enucleation of the prostate (HoLEP) is a recent step in enabling a true anatomical enucleation
of prostatic tissue. To our knowledge, there are no study that have analysed the influence of variables on the outcome
of HoLEP. In the present study we retrospectively analysed the influence of preoperative variables on the outcome of
HoLEP.
106
We retrospectively reviewed the records of 230 patients who had HoLEP at our institution from April 2009 to July
2010. Patients with associated neurogenic bladder or urethral stricture were excluded from the study. Demographic data
and perioperative variables were recorded and analysed.
Results
Mean age of patients, preoperative prostate-specific antigen level and body mass index was 67.8±6.9 years, 4.8±6.8
ng/mL and 23.7±2.6, repectively. The mean prostate and adenoma size was 55.4±30.7 and 28.5±18.0 mL. Mean duration
of begin prostate hyperplasia and rate of previous transurethral prostate surgery was 6.4±6.3 years and 15.3% (n=27). Mean
enucleation and morcellation time was 67.2±39.5 and 15.5±13.0 minutes. Intraoperative complications were 5 cases (2.8%)
which included capsular perforation with (n=3) or without (n=2) blood transfusion. Postoperative complications were 34
cases (19.3%) which were transient incontinence 15 (8.5%), foley re-catheterization 9 (5.1%), urethral stricture 6 (3.4%)
and retrograde ejaculation 4 cases (2.2%). The increase in postoperative maximal flow rate was 138.4±152.1% but was not
statistically significantly correlated to peoperative variables (p=0.067). Post-voiding residual volume dropped 103.7±145.1%
without statistical correlation to preoperative variables (p=0.472), but the larger adenoma was, the more post-voiding
residual volume dropped (p=0.053). The mean procedure efficiency was 0.2±0.2 g/min, which was statistically significantly
correlated to larger prostate and adenoma weight (p<0.001), but had the most statistical correlation to adenoma weight
(coefficient of correlation=0.938).
Conclusions
HoLEP is a safe and effective procedure for treating BPH independent of prostate size. Adenoma weight is the
most important preoperative factor associated with decrease in postvoiding residual volume and increases in procedure
efficiency.
PK37 Analysis of the efficacy of K2 diode photoselective vaporization
of protate for benign prostatic hyperplasia according to
postoperative period
Youl Keun Seong, Dong Woo Kim1, Keun Soo Kong2
1
Department of Urology, Maryknoll medical center, Bongseng Hospital, 2Bumin Hospital, Busan, Korea
Aim of Study
This study was conducted to investigate analysis of the efficacy of photoselective vaporization of prostate (PVP) using
K2 diode laser for benign prostatic hyperplasia (BPH) according to postoperative period.
From March 2010 to December 2010, 110 patients with symptomatic BPH who had treated with PVP using K2
diode laser of 980nm wavelength were analyzed retrospectively. The preoperative evaluation included urinalysis, prostatespecific antigen (PSA), prostate volume (PV), International Prostate Symptom Score (IPSS), Quality of life (QoL)
score, maximal flow rate (Qmax) and postvoid residual urine volume (PVR). Total operative time, used energy (Kj) and
postoperative foley catheter indwelling period were recorded afterward. The patients were evaluated at 1 week, 1, 3, and 6
months postoperatively by use of the urinalysis, IPSS, QoL, Qmax, and PVR.
Results
The mean prostate volume was 45±25 g, the mean operative time was 42±28 minutes, the total amount of energy
was 126±84 Kj and the foley catheter maintenance period after PVP was 24.8±15.6 hours. After 1 week, inflammation was
observed in all urinalysis and improvements were not seen in most of voiding parameters than before surgery. At 1 month,
significant improvements were noted in IPSS (11.5±6), QoL score (2±1.5), Qmax (16.5±8 mL/sec) and PVR (44±28 mL).
But inflammation was not subsided completely in a few patients. However, 3 months later, all follow-up parameters were
showed significant improvements and sustained throughout a period of 6 months after PVP.
107
Conclusions
After surgery, the symptoms were not improved prominently in early days. Therefore, supportive medication and
careful observation are needed for improvement of symptoms until 1 week at least.
PK38 The efficacy of tamsulosin and tolterodine combination therapy
in female OAB patients
Young Sam Cho, Kwan Joong Joo, Chil Hun Kwon, Heung Jae Park
Department of Urology, Kangbuk Samsung Hosptial, Sungkyunkwan University School of Medicine
Aim of Study
Although, first-line drug in medical treatment of female overactive bladder (OAB) is anti-muscarinic agents such as
tolterodine, addition of tamsulosin in empirical base is also used. So, we compared the efficacy of tolterodine (2 mg) and
tamsulosin (0.2 mg) combination therapy with tolterodine alone.
Between January 2009 and December 2009, a study was carried out on 80 female patients with newly diagnosed
OAB. Before and after 6 weeks of treatment, all patients were evaluated with 3 days of voiding diary, uroflowmetry (UFM)
including postvoiding residual urine volume (PVR) and QoL index in IPSS. The treatment efficacy was measured with
mean number of micturition, nocturia and urgency, mean voided volume, maximal flow rate (Qmax), PVR and QoL
index. Five patients who stopped medication due to side effect (two with dry mouth, three with orthostatic hypotension)
were excluded in this study.
Results
There were no statistical differences in evaluation factors between monotherapy group (Group I, n=38) and
combination therapy group (Group II, n=37) before treatment. After 6 weeks of treatment, mean number of micturition
and urgency, mean voided volume, and QoL index were improved in both groups. But there were no statistical differences
in improved factors after treatment between the two groups. The Qmax in Group II showed only significant increase when
compared to pretreatment Qmax in Group II and also compared to Group I.
Subgroup analysis was performed in some patients (n=14) with possibility of female voiding dysfunction (Qmax≤
12 mL/s). The combination therapy group with abnormal Qmax (n=8) showed much improvement in mean number of
micturition and increase in Qmax when compared to monotherapy group with abnormal Qmax (n=6).
Conclusions
Tamsulosin, the antagonist of α1A and α1D receptor, is thought to increase storage function of bladder and also used
in female OAB patients as empirical treatment. But, this study shows no comparative advantages in combination treatment
with tamsulosin when compared to tolterodine monotherapy except maximal flow rate. Further research including placebo
group and urodynamic study may provide more accurate result about the efficacy of tamsulosin in female OAB patients.
PK39 Improvement of cystometric parameters in obstructed rat
bladder outlet by transplantation of mesenchymal stem cells
Yun Seob Song1, Hong Jun Lee2, Seung Hwan Doo1, Won Jae Yang1, Sun Ju Lee3, Seung U. Kim2
1
Department of Urology, Soonchunhyang University School of Medicine, 2Medical Research Institute, Chung-Ang
University College of Medicine, 3Department of Urology, Kyunghee University School of Medicine Seoul, Korea
108
Aims of Study
Bladder overactivity is found in bladder outlet obstruction (BOO) that followed by collagen deposition. The present
study is to investigate if human mesenchymal stem cells (hMSCs) are capable of inhibiting collagen deposition and
improve cystometric parameters in bladder outlet obstruction in rats.
Forty 6-week old female SD rats were divided into 4 groups(group 1: control, group 2: sham operation, group 3:
BOO, group 4: BOO rats receiving hMSCs). Two weeks after the onset of BOO, hMSCs were injected into the bladder
wall. Four weeks after transplantation, cystometric parameters were evaluated. Histological examination and western blot
analysis were performed.
Results
hMSCs transplanted into the rat bladder survived 4 weeks post-transplantation. While weight of bladder and collagen
deposition increased after BOO, transplantation of hMSCs in BOO resulted in return to the original weights. The
expression of collagen and TGFβ protein increased after BOO. The expression of collagen and TGFβ protein returned to
the original levels after hMSC transplantation. Intercontraction interval decreased after BOO but it recovered after hMSC
engraftment. Maximal voiding pressure and residual urine volume increased after BOO, but it recovered after hMSCs
treatment.
Conclusions
Transplanted hMSCs inhibited the bladder fibrosis and mediated improvement of cystometric parameters in the rat
BOO model.
Keywords: bladder outlet obstruction, human mesenchymal stem cells, collagen
PK40 Transrectal ultrasound measurement of bladder wall thickness
is associated with lower urinary tract storage symptom in men
Hong Sang Moon, Joong Soo Park, Yong Tae Kim
Department of Urology, College of Medicine, Hanyang University, Seoul, Korea
Purpose
In the last decade interest has arisen in the use of ultrasound derived measurements of bladder wall thickness(BWT)
as potential diagnostic tools for detrusor overactivity in women and bladder outlet obstruction in men. However, to date
such measurements have not been adopted to detect overactive bladder symptoms in men. We investigated the correlation
between BWT and storage symptoms in male patients with lower urinary tract symptoms (LUTS).
Material and Method
From Jan, 2011 to Feb, 2011, Seventy four male patients who have LUTS were included. We investigated symptom
score (IPSS/QoL) and performed serum PSA, transrectal ultrasonography, uroflowmetry and residual urine. BWT was
measured in the mid-sagittal plane with bladder filling of 100 mL. BWT was measured at the thickest part of anterior,
trigone and dome and the thickest BWT was selected. Prostate volume, transition zone volume, and intravesical prostate
protrusion were also measured. We investigated correlation between BWT and clinical factors with multivariate regression
test.
Result
Mean age, prostate volume and PSA was 61.23±10.70 years old, 37.22±14.58 mL and 2.00±2.75 ng/mL, respectively.
Statistically, BWT was correlated with intravesical prostate protrusion, storage symptom score, maximal flow rate. But
there was no significant relation between voiding symptom score, prostate volume, post voided residual and BWT (Table
1). According to multivariated regression test, BWT has positive correlation with IPP and storage symptom score(r=0.491,
p=0.001, r=0.382, p=0.002). With maximal flow rate, BWT has negative coreelation(r=-0.31, p=0.032).
109
Conclusion
BWT was significantly correlated with storage symptom score , maximal flow rate and intravesical prostate
protrusion. BWT measurement could be a possible tool for assessing overactive bladder in men with LUTS.
Keywords: bladder wall thickness,transrectal ultrasonography, LUTS
Table 1. Correlation between BWT and clinical factors
Age
Voiding score
Storage score
QoL
PSA (ng/mL)
Prostate volume (mL)
T-zone volume (mL)
IPP (cm)a
Qmax (mL/sec)b
PVR (mL)c
Average
61.23
8.20
9.26
4.09
2.00
37.22
21.88
0.35
12.73
45.85
Standard deviation
±10.70
±4.34
±4.95
±1.15
±2.75
±14.58
±12.22
±0.43
±8.75
±48.61
a):Intravesical prostate protrusion; b): Maximal flow rate; c): Post-voided residu
p-value
0.734
0.162
0.002
0.355
0.888
0.400
0.266
0.001
0.032
0.907
110
JAPAN
PJ05 ATP release in urothelium upon stimulation with stretch,
especially focusing on the accumulated ATP in secretory vesicle
via VNUT and subsequent exocytosis
Hiroshi Nakagomi1, Tsutomu Mochizuki1, Tatsuya Miyamoto1, Satoru Kira1, Mitsuharu Yoshiyama1, Isao Araki2, Yoshinori
Moriyama3, Schuichi Koizumi4, Masayuki Takeda1
1
Department of Urology, Interdisciplinary Graduate School of Medicine and Engineering, University of Yamanashi,
Yamanashi, Japan; 2Department of Urology, Shiga University of Medical Science, Shiga, Japan; 3Department of
Membrane Biochemistry, Okayama University Graduate School of Medicine, Density, and Pharmaceutical Science,
Okayama, Japan; 4Department of Neuropharmacology, Interdisciplinary Graduate School of Medicine and
Engineering, University of Yamanashi, Yamanashi, Japan
Introduction and Objectives
Recent studies have indicated that bladder epithelium (urothelium) plays an important role in a sensor responding to
physical and chemical stimuli as well as a barrier against ions and infections. Several substances including ATP, ACh, NO,
PG and NGF, are released from urothelial cells following physical and chemical stimulation, among which ATP plays
a central role for afferent nerve stimulation. However, molecular mechanisms and pathways of ATP release are largely
unknown. We confirmed VNUT (Vesicular Nucleotide Transporter; PNAS 2008) localized in urothelial cell of mouse
bladder. VNUT plays an essential role in vesicular storage of ATP in the ATP-secreting cells. Here we have investigated
the accumulated ATP in secretory vesicle via VNUT and exocytotic release of ATP from urothelium upon stretch
stimulation in urothelial cells.
WT (C57BL/6Cr) 8-12 week-old male mice were used. The experiments were performed by mouse primary
urothelial cell culture from WT and VNUT RNA interference. VNUT siRNA was transfected to mouse primary
urothelial cell culture by a lipofection method. RT-PCR: Extracted m-RNA from mouse urothelial primary culture
cells and confirmed the expression of VNUT gene. Immunostaining: Expression of VNUT protein was confirmed
using an anti-VNUT antibody in mouse bladder specimen and urothelial primary culture cells. Quinacrine-labeling and
Visualization of dynamics: Used to locate intracellular stores of ATP bound to peptides, displaying a granular fluorescence.
Quinacrine-labeling vesicle of dynamics upon mechanical stimulation was visualized. Photon imaging of ATP release：
ATP release from the urothelial primary cultures upon mechanical stretch stimulation was investigated with a luciferinluciferase bioluminescence assay. ATP bioluminescence during stretch stimulation was detected and visualized with a VIM
camera.
Results
VNUT was highly expressed in the epithelium of mouse bladder tissue and primary urothelial cell culture in mRNA
and protein level. VNUT expressed in urothelial layer, from basal to apical cell layer. VNUT positive signals are identified
as vesicle form in cell culture. The exocytotic images of Quinacrine-labeling vesicle were visualized upon stimulation with
a pipet. VNUT mRNA and protein expression were suppressed most markedly at 72 hrs and 84 hrs after transfection,
respectively. Knockdown of VNUT in urothelial primary culture cells markedly reduced ATP release (approximately 55%
down) upon mechanical stretch stimulation.
Conclusion
VNUT existed in urothelial cell layer of mouse bladder. VNUT dependent vesicular exocytosis was involved in ATP
release pathway. Vesicular exocytosis of ATP appers to play a role in distension of the mouse bladder epithelium.
111
PJ06 Urinary nerve growth factor level in patients with benign
prostatic obstruction (BPO) is correlated with severity of
symptoms and response to medical treatment
Katsumi Sasaki1, Toyohiko Watanabe1, Miyabi Inoue1, Aayano Ishii1, Motoo Araki1, Shinya Uehara1, Hiromi Kumon1,
Teruhiko Yokoyama2, Atsushi Nagai2, Hitoshi Takamoto3
1
Depatment of Urology, Okayama Univesity, 2Kawasaki Medical University, 3Kurashiki Medical Center, Okayama, Japan
Aims of Study
Our previous study has shown that urinary NGF levels increase in patients with overactive bladder (OAB) (Yokoyama
T et al, Neurourol Urodynam 2008; 27:417-420). However, the urinary NGF levels in patients with OAB besides benign
prostatic obstruction (BPO) and the change of urinary NGF levels after relief of BPO, resulted in improvement of OAB
have not been fully investigated. Our aim is to measure the change of urinary NGF levels in patients with OAB due to
BPO and to determine whether urinary NGF can serve as a biomarker for OAB with BPO.
20 patients (66±17 yrs old) with OAB due to BPO were investigated as an open label multicenter trial. Eligibility
criteria include the following; patients with benign prostatic obstruction, total International Prostate Symptom Score
(IPSS) score was 8 pt or more, QoL score was 2 pt or more, the score of OAB symptom score (OABSS) question 3 was
2 pt or more, and OABSS total score was 3 pt or more. Patients were treated with tamsulosin 0.2 mg once daily for at
least 12 weeks. Urinary NGF levels were measured by enzyme-linked immunosorbent assay technique (ELISA) and the
results were normalized based on the urine creatinine (Cr) concentration. The urinary NGF/Cr levels, IPSS, QoL index,
OABSS at baseline were compared with those at 4 and 12 weeks after treatment with tamsulosin. In addition, the current
perception threshold of C and A delta fibers was measured by Neurometer (Neurotron, Inc, Baltimore, Maryland) before
and 12 weeks after treatment with tamsulosin to evaluate clinical significance.
Results
Average IPSS total score, OABSS, and Qmax were improved significantly from 17.4 pt, 8.4 pt, and 10.9 mL/sec. at
baseline to 11.3 pt, 4.5 pt, and 15.1 mL/sec, respectively, at 12 weeks after treatment with tamsulosin. The urinary NGF
levels were decreased from 10.7 pg/mL Cr at baseline to 7.7 pg/mL Cr at 4 weeks, and 4.8 pg/mL Cr at 12 weeks after
treatment with tamsulosin. Mean current perception threshold values of C fibers showed tendency of improved from 23.3
to 28.7, but this change was not statistically significant.
Conclusions
Changes in the urinary NGF levels were associated with the changes of the IPSS and OABSS, which resulted in
improvement of voiding symptoms after alpha 1-adrenergic antagonist treatment with tamsulosin. The urinary NGF level
could be a potential biomarker for evaluating therapeutic results of alpha-1 blackade therapy.
PJ07 Effects of TRPV4 cation channel activation on the primary
bladder afferent activities of the rat
Naoki Aizawa1, Jean-Jacques Wyndaele2, Yukio Homma3, Yasuhiko Igawa1
1
Department of Continence Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan;
Department of Urology, Faculty of Medicine, University of Antwerp, Antwerp, Belgium; 3Department of Urology, The
University of Tokyo Graduate School of Medicine, Tokyo, Japan
2
Aims of Study
It has been suggested that transient receptor potential vanilloid 4 (TRPV4) in the urothelium affects the afferent
pathways innervating the bladder. We investigated the effects of GSK1016790A (GSK) and RN1734, a TRPV4 agonist
and antagonist, respectively, and P2X-purinoceptor antagonists (TNP-ATP and PPADS) on cystometry (CMG), and the
112
effect of GSK on single afferent fiber activities (SAAs) of the rat bladder and its relationship with capsaicin (Cap)-sensitivity.
Female Sprague-Dawley rats were used in conscious and free-moving condition for CMG measurements. In SAAs
measurements, under urethane anesthesia, a single nerve fiber primarily originating from the bladder was identified
by electrical stimulation of the left pelvic nerve and by bladder distention, which were classified as Aδ- and C-fibers by
their conduction velocity. In CMG measurements, cystometric parameters were measured before and after intravesical
drug instillation. The SAAs measurements with saline instillation were served as the baseline observation before drug
instillation. Then, GSK was instilled intravesically 3 times, and finally Cap was instilled to investigate the relationship with
Cap-sensitivity.
Results
Intravesical GSK-instillation significantly decreased bladder capacity and voided volume at first, and then these
effects were attenuated with time and disappeared. These effects of GSK were counteracted by RN1734, TNP-ATP, and
PPADS. In SAA measurements, Aδ-fibers (n=7) were not affected by either GSK or Cap. Based on the Cap-sensitivity,
C-fibers could be divided into two subtypes: Cap-insensitive (n=14) and Cap-sensitive (n=8). In the Cap-insensitive C-fibers,
GSK significantly increased the SAAs during the first instillation, but the increase attenuated with time, whereas GSK did
not significantly affect the Cap-sensitive C-fibers.
Conclusions
The present results suggest that activation of TRPV4 in the bladder, probably urothelium, facilitates the micturition
reflex by P2X-purinoceptor-mediated activation of the mechanosensitive, Cap-insensitive C-fibers of the primary bladder
afferents in rats.
PJ08 Association of LUTS with chronic periodontal disease
Seiji Matsumoto, Mitsuyoshi Matsuda1, Masaki Watanabe, Naoki Wada, Masafumi Kita, Hidehiro Kakizaki
Department of Renal and Urologic Surgery, and the 1Department of Oral and Maxillofacial Surgery, Asahikawa
Medical University, Asahikawa, Hokkaido, Japan
Aims of Study
Recently the linkage between metabolic syndrome (MetS) and lower urinary tract symptoms (LUTS) has been
highlighted by many studies. MetS and LUTS are suggested to share common pathophysiological factors including
insulin-resistance, endothelial dysfunction and systemic inflammatory disease. It is also suggested that chronic periodontal
disease (CPD) is related to MetS. To our knowledge, the relationship between CPD and LUTS has never been studied.
Therefore the aim of this study was to examine the relationship between CPD and LUTS.
The interview sheet of the CPD self-checklist (CPD score) and LUTS (IPSS/QoL, OABSS) was distributed to
600 adult men and women (300 each) who received a comprehensive dental examination at our hospital and the dental
clinics in the city of Asahikawa, Japan. LUTS was defined as IPSS total score ≥8 and QoL index ≥2. Overactive bladder
symptom score (OABSS; Urology 68: 318, 2006) was used to diagnose overactive bladder (OAB) that was defined as
urinary urgency once a week or more (Question 2 of OABSS≥2) and OABSS total score ≥3. The relationship between
the CPD score and LUTS or OAB was examined. Statistical analyses were performed by the Spearman's rank correlation
coefficient and other methods. Statistical significance was accepted at the level of p<0.05.
Results
The interview sheet was collected from 88 men (response rate 29.3%, 50.9±16.6 years old) and 97 women (response
rate 32.3%, 51.1±15.5 years old). There was no statistically significant correlation between the CPD score and age, or the
CPD score and LUTS. However, there was a statistically significant correlation between the CPD score and some scores
of IPSS. In men, Urgency score (Q4 of IPSS) and Weak stream score (Q5 of IPSS) significantly correlated with the CPD
113
score, while in women Intermittency score (Q3 of IPSS), Urgency score (Q4 of IPSS), Weak stream score (Q5 of IPSS)
and Voiding symptom score (Q3+Q5+Q6 of IPSS) significantly correlated with the CPD score. There was a statistically
significant correlation between the CPD score and the presence of OAB in men but not in women.
Conclusions
The present study demonstrated for the first time that some storage and voiding symptoms are significantly
associated with CPD. Interestingly the significant correlation between the CPD score and OAB was only noted in men.
Thus, although CPD and LUTS seem to have common pathophysiological factors, the interrelationship between CPD
and LUTS is slightly different between men and women. This sex difference is worth further investigation.
PJ09 Surgical reconstruction for traumatic and iatrogenic posterior
urethral disruption
Haruaki Kato, Tomoaki Tanabe, Hitoshi Yokoyama, Shinya Kobayashi, Hiroya Mizusawa, Osamu Nishizawa
Department of urology, Shinshu University School of Medicine, Matsumoto, Japan
Aims of Study
Repair of a posterior urethral disruption associated with a pelvic fracture is a challenge for urologic surgeons. We
evaluate our results of surgical reconstruction for traumatic posterior urethral disruption associated with a pelvic fracture.
Furthermore, iatrogenic obliterated vesicourethral junction especially after radical prostatectomy is both complex and
devastating problem. Here, we report an innovative method using a mobilized bulbar urethra as a continent tube for these
patients.
Twenty-seven patients (age range 4 to 78 years) with a posterior urethral disruption underwent primary excision and
end-to-end anastomosis. Half of the patients had previously undergone multiple procedures. The length of the defect was
1-4 cm (mean 2.3 cm). The posterior urethroplasty was carried out only with applying a transperineal approach alone in
12 patients. In 9 patients, a transperineo-abdominal approach was applied and a transpubic approach was adapted for 5
patients. These approaches were selected and changed step-by-step according to the multiple factors such as dense scar,
deviation, narrow pelvis, or the state of the proximal bulbar urethra due to previous procedures (perineo-abdominal
progression approach).
Two patients (aged 60, 71 years) with obliterated vesico-urethral junction after radical prostatectomy and one patient
(aged 20 years) with fibrotic prostate by trauma underwent submucosal implantation of the fully mobilized bulbar urethra
into the anterior bladder wall with or without pubectomy. In this novel technique, the mobilized bulbar urethra was used
as a continent tube.
Results
All the patients with traumatic posterior urethral disruption regained satisfactory urination without urethral
instrumentation with a minimal follow-up of at least more than 12 months, except one who required internal urethrotomy
twice. Three patients with devastating vesico-urethral junction could easily catheterize from the external meatus without
incontinence.
Conclusions
Our results of posterior urethroplasty were satisfactory. We believe that the key to success is to complete a true
bulboprostatic mucosa-to-mucosa anastomosis and the perineoabdominal progression approach is versatile and can be
applied to any difficult case. Although the experienced surgeons in the world insist that the most defects can be repaired
by the perineal approach alone, we should keep in mind the possibility of its conversion to transperineo-abdominal or
transpubic approach since the perineal triangle is narrow and the pubic arch angle is acute in the Japanese population.
With regard to the patients with obliterated vesico-urethral junction, urinary management was achieved by selfcatheterization postoperatively, and they were satisfied with their status. This newly devised continent valve construction
using a bulbar urethra is effective for reconstruction of the obliterated vesico-urethral junction, which markedly improves
patients’ quality of life.
114
PJ10 Roles of alfa1-adrenergic receptors in detrusor overactivity
induced by cold stress in ovariectomized rats
Wataru Noguchi1, Tetsuya Imamura1,2, Osamu Ishizuka1,2, Yoshiki Kurizaki1, Zhong Lei1, Takahiro Yamagishi1, Osamu
Nishizawa1,2
1
Department of Urology, Shinshu University School of Medicine, Matsumoto, Japan; 2Department of Lower Urinary
Tract Medicine, Shinshu University School of Medicine, Matsumoto, Japan
Aims of Study
A sudden drop of temperature or serious cold sensation is empirically known to cause that lower urinary tract
symptoms (LUTS), including urgency, and urinary frequency. Our previous studies showed that cold stress significantly
decreased voiding interval, micturition volume, and bladder capacity in conscious rats (Imamura et al, Neurourol Urodyn
2008). RTX-sensitive neurological pathway, and transient receptor potential channel melastatin member 8 (TRPM8)
expressing on the skin partially mediated the responses in the micturition patterns (Shibata et al, Neuroreport 2010). In
addition, we indicated that alpha 1-adrenergic receptor antagonists prevented the decreases of voiding interval and bladder
capacity (Zhong et al, Neurourol Urodyn 2009).
In postmenopausal women, prevalence of LUTS is increased. Clinically, LUTS of the postmenopausal women are
often developed by the cold stress. However, the mechanisms are not well known. In this study, we investigated cold stressinduced detrusor overactivity in ovariectomized rats, and determined if alpha 1-adrenergic receptor antagonists suppress
the responses.
Female Sprague-Dawley (SD) rats at postnatal week 10 and 30 (Japan SLC Inc., Japan) were used for the
experiments. The both week rats were divided into two groups: sham operated control group (10-weeks rats; n=10,
30-weeks rats; n=7) and bilateral ovariectomy group (10-weeks rats; n=10, 30-weeks rats; n=7). Five weeks prior to
cystometric investigation, the rats in the ovariectomy group were received ovariectomy. The control rats were received
sham operations. The cystometric investigation was performed on unanesthetized and unrestricted rats. The rats
were placed in metabolic cages at room temperature (RT, 27±2°C) for 20 minutes. They were then quickly and gently
transferred in the metabolic cages to the cold room for low temperature exposure (LT, 4±2°C) for 20 minutes. The
following cystometric variables were measured: basal pressure (cmH2O), micturition pressure (cmH2O), voiding interval
(min), micturition volume (mL), and bladder capacity (mL). Bladder capacity was calculated by adding the micturition
volume and the difference between the saline infusion volume and micturition volume. These values were averaged for
each 20 minutes period.
Similarly, other 12 female 30-weeks SD rats were received ovariectomy operation as described above. Five minutes
prior to transferring low temperature, the one groups (n=6) were intravenously administrated with 1 mg/kg naftopidil,
another groups (n=6) were intravenously administrated with saline solution (placebo).
Results were expressed as means ± standard error of the means. Statistical differences were determined by nonrepeated measures ANOVA followed by the Scheffe’s test. Differences with p<0.05 were considered significant.
Results
The voiding interval and micturition volume of all rats under low temperature condition significantly decreased
compared to those values under room temperature condition. In the 10-weeks rats under room temperature condition,
the voiding interval (4.05±0.44 min, p<0.05) and micturition volume (0.69±0.14 mL, p<0.05) of the ovariectomized rats
were significantly lower than those of the sham-treated control ones, 4.80±1.20 min, and 0.86±0.21 mL, respectively.
Similarly, under low temperature condition, the voiding interval and micturition volume of the 10-weeks ovariectomized
rats significantly decreased to 2.08±0.46 min (p<0.01), and 0.44±0.12 mL (p<0.01) compared to the control rats, 3.81±1.52
min, and 0.68±0.21 mL, respectively. In the 30-weeks rats under room temperature, the voiding interval (3.46±2.68 min,
p<0.05) and micturition volume (0.59±0.55) mL, p<0.01) of the ovariectomized rats were significantly lower than those of
the sham-treated control ones, 5.56±4.4 min and 1.18±0.57 mL, respectively. Similarly, under low temperature condition,
the voiding interval and micturition volume of the 30-weeks ovariectomized rats significantly decreased to 1.98±1.60 min
(p<0.05), and 0.38±0.33 mL (p<0.01) compared to the control rats, 3.05±2.52 min, and 0.74±0.52 mL, respectively.
We investigated to determine if one of the alpha 1-adrenergic receptor antagonists, naftopidil improved the
decreased voiding interval and micturition volume of the 30-weeks non-treated ovariectomized rats transferred to low
115
temperature condition. The voiding interval (3.90±4.82 min) and micturition volume (0.67±0.84 mL) of the naftopidiltreated 30-weeks ovariectomized rats under low temperature condition did not alter compared to the room temperature.
The interval and volume of the naftopidil-treated rats were significantly larger than those of the non-treated placebo rats
(p<0.05).
Conclusion
In the ovariectomized rats (both 10 and 30-weeks), the voiding interval and micturition volume of the ovariectomized
rats significantly decreased compared sham-treated rats under room temperature condition. Also, under low temperature
condition, the voiding interval and micturition volume of the ovariectomized rats were lower than those of the sham-treated
ones. The administration of naftopidil improved the voiding interval and micturition volume under low temperature
condition. The cold stress-induced detrusor overactivity in postmenopausal women might be partially mediated by neural
pathway related with alpha1 receptor-mechanism. Further study will be needed to know the relationship between the level
of estrogen and alpha 1 adrenoceptors in this detrusor overactivity.
PJ11 Antimuscarinic agents bind to rat urothelial muscarinic receptors
with high affinity
Shizuo Yamada, Yusuke Fuchihata, Masaki Ogoda, Akira Yoshida
1
Department of Pharmacokinetics and Pharmacodynamics and Global Center of Excellence (COE) Program, School of
Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
Aims of Study
The bladder urothelium not only provides a barrier to diffusion but also serves a sensory function and releases
signalling molecules such as acetylcholine and ATP. Although the intrinsic ability of urothelium to make and release
acetylcholine remains unclear, it is suggested that muscarinic receptors are present on the mucosa (urothelium) as well as
detrusor muscle of the urinary bladder [1]. Therefore, mucosal muscarinic receptors may represent a novel site of action
of antimuscarinic agents for the treatment of bladder disorders. In this connection, Kim et al. [2] showed that intravesically
infused antimuscarinic agents suppressed carbachol-induced bladder overactivity, suggesting a blockage of muscarinic
receptors in bladder-afferent pathways. However, the pharmacologically relevant muscarinic receptors in the rat urothelium
have not been identified and characterized directly. The aim of the current study was to identify pharmacologically
relevant muscarinic receptors in the rat urothelium and to characterize binding properties of antimuscarinic agents to these
receptors, by using radioreceptor binding assay.
The urothelium and detrusor were dissected from the rat bladder, and homogenized for the preparation of
crude membranes. The muscarinic receptors in rat tissue homogenates were measured by a radioligand binding assay
using [N -methyl-3H]scopolamine methyl chloride ([3H]NMS), a selective radioligand of muscarinic receptors. For the
quantitative determination of muscarinic (M2, M3) receptor subtypes, the urothelium and detrusor of rats were treated
with N -(2-chloroethyl)-4-piperidinyl diphenylacetate (4-DAMP mustard), an irreversibly inactivating agent of M3 subtype,
as previously reported [3]. Also, the binding activity in the rat urothelial muscarinic receptors after the intravesical
injection of antimuscarinic agents was also examined. For experimental acute cystitis, rats received a single injection of
cyclophosphamide (150 mg/kg, i. p.) and bladder muscarinic receptors were measured at 3 days after the injection.
Results
Specific [3H]NMS binding in the rat urothelium was saturable and of high affinity. The density (maximal number
of binding sites: Bmax) and affinity (apparent dissociation constant: Kd) of [3H]NMS binding was not different between
the urothelium and detrusor tissues. Moreover, antimuscarinic agents such as imidafenacin, solifenacin, tolterodine,
darifenacin, propiverine, active metabolite of propiverine: DPr-P-4 (N→O) was shown to bind to muscarinic receptors in
the bladder urothelium with high affinity, and their binding affinities were quite similar to those in the detrusor muscle.
Moreover, the pretreatment with 4-DAMP mustard, an irreversible inactivation agent of M3 receptor subtype, caused
significant reduction (36% and 22%, respectively) of [3H]NMS binding sites in both urothelium and detrusor tissues of
rats, and the decrease in the density of M3 receptors was significantly greater in the urothelium than the detrusor muscle
116
of rats. Imidafenacin and DPr-P-4 (N→O) are known to be excreted at the pharmacologically significant amount in the
urine from patients who received clinical doses of imidafenacin and propivrine. The intravesical injection of these agents
in rats was shown to bind significantly to the urothelial muscarinic receptors. Furthermore, the density (Bmax) of specific
[3H]NMS binding sites was significantly decreased in the urothelium and detrusor muscle of cyclophosphamide-treated
rats compared with control rats.
Discussion and Conclusions
There are similar density of pharmacologically relevant muscarinic receptors in the rat bladder urothelium and
detrusor muscle. The density of M3 receptors was suggested to be higher in the former than the latter. The antimuscarinic
agents excreted into the urine may bind significantly to the urothelial muscarinic receptors. The bladder cystitis due to
the cyclophosphamide treatment may cause a down-regulation of bladder muscarinic receptors. Antimuscarinic agents
used currently to treat overactive bladder may bind to muscarinic receptors in the urothelium with high affinity in vivo,
suggesting that these receptors are the pharmacological targets for antimuscarinic agents.
References
1. Bschleipfer T, Schukowski K, Weidner W, et al: Expression and distribution of cholinergic receptors in the human urothelium. Life
Sci 2007; 80:2303-2307.
2. Kim Y, Yoshimura N, Masuda H, de Miguel F, Chancellor MB: Antimuscarinic agents exhibit local inhibitory effects on muscarinic
receptors in bladder-afferent pathways. Urology 2005; 65:238-242.
3. Thomas EA, Hsu HH, Griffin MT, Hunter AL, Luong T, Ehlert FJ: Conversion of N-(2-chloroethyl)-4-piperidinyl diphenylacetate
(4-DAMP mustard) to an aziridinium ion and its interaction with muscarinic receptors in various tissues. Mol Pharmacol 1992;
41:718-726.
PJ12 Effects of concurrent prolapse repair on TOT sling outcomes
Teruhiko Tsuru, Isao Araki, Shigehisa Kubota, Ryo Ikari, Takuya Maezawa, Tetsuya Yoshida, Yusaku Okada, Satoru Kira,
Yaburu Haneda, Hideki Kobayashi, Masayuki Takeda
Department of Urology, Shiga University of Medical Science; Department of Urology, University of Yamanashi Faculty
of Medicine
Aims of Study
The risk of surgery for pelvic organ prolapse (POP) or stress urinary incontinence (SUI) by age 80 is approximately
11.1% in women. POP and SUI frequently coexist with each other. When performing concurrent prolapse and
continence surgeries, however, some reports suggest the potential risks of developing the storage and voiding problems
and increasing urinary tract injuries. We examined whether concomitant prolapse surgery affects the short-term outcomes
of sling surgery.
After obtaining Institutional Review Board approval, we retrospectively reviewed the clinical records of 51 women
who underwent mid-urethral sling operation with trans-obturator tape (TOT) for SUI between October 2007 and January
2010. 27 women were treated with TOT alone (group 1), whereas 24 women were concurrently treated with prolapsed
repair at the time of TOT (group 2). In group 2, prolapse repair was performed with the use of polypropylene mesh
(GyneMesh PSTM) cut by the surgeon according to the Trans-Vaginal Mesh (TVM) technique under general anesthesia,
and the TOT was performed through a separate incision after the completion of TVM procedure. After having awoken
from anesthesia, the sling tension was adjusted by the use of a cough stress test in both groups. Treatment outcome,
surgical complications and postoperarive urinary problems were compared between groups 6 months after surgery.
Women were considered to have UI if they reported symptoms in ICIQ-UI short form and required a pad usage during
activities of daily living. SUI symptoms were verified by cough stress test.
Results
Age, body mass index, parity and histories of hysterectomy and pelvic floor reconstruction did not differ between
groups. SUI persisted in 1 patient of each group after surgery (Table 1). Urge UI (UUI) was found 10 patients (4 in
117
group 1 and 6 in group 2) preoperatively and persisted in only 1 of group 2 postoperatively. De novo UUI developed
in 4 patients (1 of group 1 and 3 of group 2), but all was improved until 6 months after surgery. In uroflowmetry (Table
2), the mean values of voided volume (mL), maximum flow rate (mL/s), average flow rate (mL/s) and post-void residual
urine volume (PVR: mL) were 321, 30.8, 16.0, 11.9 in group 1, and 360, 28.3, 13.1, 27.0 in group 2 preoperatively.
After surgery, these values were 310, 26.0, 12.5, 7.6 in group 1, and 290, 28.8, 13.2, 28.9 in group 2. Except voided
volume in group 2 (p=0.006), there were no significant differences in these parameters between before and after surgery
in each group. However, postoperative PVR was significantly different between groups (p=0.01). Two patients of group 2
developed PVR≥200 mL immediately after surgery. Pressure-flow study demonstrated weak detrusor contractility in these
two patients. PVR improved in 1 patient within 1 month, but persisted in 1 who had showed PVR≥200 mL preoperatively.
Surgical complications occurred in 2 patients of group 1, urethral injury and thigh pain in 1 and thigh pain in 1.
Conclusions
TOT was safe and its short-term outcomes were good in both groups. Concurrent performance of prolapse surgery
at the time of sling procedure did not increase the surgical complications and the postoperative urinary problems.
Table 1. Lower urinary tract dysfunction before and after surgery
Group 1 (n=27)
Group 2 (n=24)
SUI
Pre
27
14
UUI (de novo)
1M
6M
2
1
2
1
Pre
4
6
PVR≥100 mL
1M
6M
1 (1)
0
1 (3)
1
Pre
0
1
1M
0
2
6M
0
1
SUI: stress urinary incontinence; UUI: urge urinary incontinence; PVR: post-void residual urine volume; Pre: preoperative; 1M: 1
month after surgery; 6M: 6 months after surgery
Table 2. Surgical influence on uroflowmetric parameters
Group 1 (n=27)
Pre
Post
Group 2 (n=24)
Pre
Post
Vv (mL)
Qmax (mL/s)
Qave (mL/s)
PVR (mL)
321
310
30.8
26.0
16.0
12.5
11.9
7.6
360
290*
28.3
28.8
13.1
13.2
27.0
28.9**
Vv: voided volume; Qmax peak flow rate; Qave: average flow rate; PVR: post-void residual urine volume; Pre: preoperative; Post:
postoperative; Single asterisk: a significant difference between before and after surgery in the group; Double asterisk: a significant
difference between groups
PJ13 Effect of silodosin on detrusor overactivity in the male
spontaneously hypertensive rat
Seiya Inoue1, Motoaki Saito2, Panagiota Tsounapi1,2, Fotios Dimitriadis1,2, Fumiya Ohmasa2, Yukako Kinoshita2, Keisuke
Satoh2 ,Atsushi Takenaka1
1
Division of Urology, Tottori University School of Medicine, 36-1 Nishi-machi, Yonago, 683-8503, Japan; 2Division of
Molecular Pharmacology, Tottori University School of Medicine, Yonago, Japan
Aims of Study
Alpha 1-blockers are the first line therapy for lower urinary tract symptoms (LUTS) in benign prostatic hyperplasia
(BPH), and several α1 adrenoceptor antagonists have been developed. Silodosin is a new α1-blocker with high selectivity for
α1A receptor subtype, which statistically significantly improved storage and irritative scores compared to placebo. However,
the mechanism of improvement of silodosin on storage symptoms is not well investigated and unclear. Furthermore, the
mechanisms of action of silodosin in bladder ischemic animal models without any urinary obstructed disorders have not
been clarified yet. The aim of this study is to investigate the effect and possible mechanism of silodosin on hypertension-
118
related detrusor overactivities (DO) in male SHRs.
Twelve-week-old male SHRs received 6 weeks of treatment by vehicle or silodosin (100 μg/kg, perorally every day).
Wistar rats were used for normotensive controls. As the silodosin dose recommended by the FDA is 8mg orally once a
day, we used the doses of 100 and 300 μg/kg, perorally, 6 weeks every day for our preliminary experiments. The results
from these experiments showed that there were no significant differences of micturition frequency and some parameters
between SHRs treated with the two different doses of silodosin. Thus, in the subsequent experiments we decided to
use only one dose of 100 μg/kg per day. After 6 weeks of silodosin treatment, blood pressure was estimated by tale cuff
method, BBF was estimated by hydrogen clearance method, and the bladder functions were estimated by voiding behavior
studies and cytometric studies. Tissue levels of nerve growth factor (NGF) and calcitonin gene-related peptide (CGRP) in
the bladder were measured by ELISA method. Furthermore, the participation levels of α1 adrenoceptor subtypes in the
bladder tissue were investigated by real-time PCR method.
Results
SHRs showed significant increases in blood pressure, micturition frequency, tissue levels of NGF and CGRP in the
bladder. The mean blood pressure in the Wistar, SHR and Silodosin groups were 95.6±2.3, 167.7±4.2 and 156.3±3.5
mmHg, respectively. Moreover, there were significant decreases in bladder blood flow as well as single voided volume in
both metabolic cages and cystometrograms in the SHR compared to the Wistar rat. Treatment with silodosin significantly
ameliorated hypertension-related alterations of these parameters. The expression levels of α1 adrenoceptor subtype
mRNAs were similar and their rank order was α1A > α1D > α1B in all groups. However, there were no significant differences
of expression of α1A adrenoceptor subtype mRNAs between any groups except for those of α1D adrenoceptor mRNAs
between the SHR and Wistar groups.
The result of voiding behavior studies in the experimental rats
Group
Wistar
SHR
Silod 100
Urine output (mL/day)
17.2±1.0
12.3±2.0
10.7±1.2*
Micturition frequency ( /day)
10.4±0.9
19.5±0.7*
15.4±0.8*#
Single voided volume (mL)
1.50±0.11
0.55±0.05*
0.85±0.11*#
*) significantly different from the Wistar group (p<0.05). #) significantiy different from the SHR group (p<0.05).
The result of cystometric studies in the experimental rats
Group
Wistar
SHR
Silod 100
Pdet (cmH2O)
31.6±3.5
34.9±1.8
35.4±5.7
Single voided volume (mL)
0.765±0.063
0.245±0.038*
0.342±0.018*#
Post voiding residual urine (mL)
0.144±0.067
0.174±0.021
0.147±0.048
Pdet: maximum detrusor pressure; *) significantly different from the Wistar group (p<0.05); #) significantiy different from the SHR
group (p<0.05).
Blood flow in the bladder; *) significantly different from the other groups. Bladder NGF and CGRP levels; *) significantly different
from the other groups. p < 0.05 is the level of significance.
119
Expression of α1 adrenoceptor subtypes in the bladder; *) significantly different from the Wistar group. p<0.05 is the level of
significance.
In the present study, we demonstrated that silodosin prevented to develop DO in the SHR estimated by several
parameters. In addition, bladder NGF and CGRP levels are possible biomarkers of OAB. Treatment with silodosin
significantly normalized up-regulated bladder NGF and CGRP levels to the control levels. Moreover, in the present study,
the expressions of α1 adrenoceptor subtypes in the bladder are α1A > α1D > α1B in the all groups. It is reported that relative
subtype composition in the vesical artery was α1A >α1D > α1B in both control rats and tamsulosin mediated rats under the
use of bladder outlet obstruction rat models. This report is corrobrating to our present real-time PCR data in the bladder.
Therefore, it is possible that silodosin improves the decreased BBF in the SHR via α1A adrenoceptor subtype in the
bladder vessels.
Conclusion
Silodosin ameliorates hypertension-related DO in the SHR. One possible mechanism of the efficacy of silodosin to
the DO includes the improvement of the BBF in the bladder
PJ14 Nicorandil ameliorates hypertension-related detrusor overactivity
in the SHR
Motoaki Saito, Fumiya Ohmasa, Panagiota Tsounapi, Seiya Inoue, Harunori Iwata, Yukako Kinoshita and Keisuke Satoh
Division of Molecular Pharmacology, Tottori University School of Medicine
Aims of Study
The overactive bladder (OAB) syndrome is a common disorder. The etiology of OAB is complicated, and various
etiological factors have been suggested. Recently, several studies have suggested that the bladder ischemia causes detrusor
overactivity (DO). Yoshida and his associates demonstrated that Watanabe Heritable Hyperlipidemic rabbits showed
DO with decreased detrusor contraction due to chronic ischemia in the bladder (Neurourol Urodyn 2010; 29:1350-4).
Spontaneously hypertensive rats (SHRs) develop bladder hyperactivity with pelvis ischemia, and the SHR is considered
a valuable tool for exploring the pathogenesis of DO (Exp Physiol 1999; 84:137-47; Life Sci 2007; 81:218-22; J Recept
Signal Transduct Res 2008; 28:403-12). Nicorandil, a KATP channel opener and nitric oxide (NO) donor, is used in
the treatment of angina and acute heart failure in order to dilate coronary vessels (Am J Cardiol 1989; 63: 18-24). Our
hypothesis is that nicorandil could improve the hypertension-related DO via improvement of bladder blood flow. We
investigated the effect of nicorandil on hypertension-related DO in SHRs.
Twelve-week-old SHRs started to receive six-weeks treatment with nicorandil (0, 3, or 10 mg/kg, i.p. every day).
Wistar rats were used for normotensive controls (Neurourol Urodyn 2010; 29:1338-43). Six weeks after nicorandil
treatment, the bladder blood flow was estimated by hydrogen clearance method, and the bladder functions were estimated
by voiding behavior studies and organ bath studies with 100 mM KCl and carbachol. Tissue levels of nerve growth factor
(NGF) were measured by ELISA method. Furthermore, the participation levels of KATP channel pores were investigated
by real-time PCR.
120
Results
The SHRs showed significantly smaller weight gain by the age of 18 weeks, as well as significantly smaller bladder
weight compared to Wistar rats. Blood pressure in the SHR was significantly higher in comparison with the Wistar group
and treatment with nicorandil slightly but not significantly decreased blood pressure in the SHR. The bladder blood flow
in the SHR group was significantly lower compared with the Wistar group. Treatment with low dose of nicorandil slightly
recovered the bladder blood flow whereas high dose of nicorandil significantly recovered the bladder blood flow. The
micturition frequency and the single voided volume in the SHR group were significantly smaller compared to the Wistar
group. Daily treatment with 10 mg/kg of nicorandil significantly recovered these parameters compared to the SHR group.
The Each values obtained from contractile resp@onses to carbachol and 100 mM KCl were significantly larger compared
to the Wistar group. Hypercontractility to carbachol and 100 mM KCl in the SHR group was ameliorated by nicorandil
in a dose-dependent manner. However, when the Emax values to the carbachol were normalized by 100 mM KCl,
there were no significant differences of the Emax values between any groups. In addition, the EC50 values with respect
to carbachol were not significantly different among the four groups. Tissue levels of NGF in the SHR were significantly
higher than those in the Wistar, and treatment with nicorandil significantly ameliorated them in a dose dependent
manner. The expression levels of KIR6.1 mRNAs in the bladder were more than 100-fold of those of KIR6.2 mRNAs in
both Wistar and SHR groups. The expression levels of KIR6.1 mRNAs in the SHR group were significantly up-regulated
compared to Wistar group. However, the expression levels of KIR6.2 mRNAs in the SHR group were slightly but not
significantly up-regulated compared to Wistar group. Treatment with high dose of nicorandil significantly increased the
expressions of both KIR6.1 and KIR6.2 mRNAs.
In the present study, we clearly demonstrated that nicorandil prevented to develop OAB in the SHR in a dosedependent manner estimated by several parameters. In addition, urinary and tissue level of NGF is a possible maker of
OAB (LUTS 2011; 3:2-9). Treatment with nicorandil significantly normalized up-regulated bladder NGF levels to the
control levels. There are some reports indicated that nicorandil ameliorates DO in the bladder. Nicorandil is reported
to inhibit the contractile response to acetylcholine and KCl in the detrusor of the rat bladder (Eur J Pharmacol 1995;
273:153-9). Oral administration of 1 mg/kg of nicorandil significantly decreased partial bladder outlet obstruction
induced voided frequency in the rat (Biol Pharm Bull 2008; 31:2079-82). Studies in three OAB animal models including
C-fiber mediated bladder overactivity by infusion of a low concentration acetic acid into the bladder in female Wistar
rats; bladder outlet obstruction created by partial urethral obstruction in female Wistar rats; and neuronal NO synthase
knockout mice, suggest that nicorandil suppresses OAB which is caused by both neurogenic and myogenic causes
(BJU Int 2008; 101:360-5). In addition, Yu and de Groat reported that ZD6169, a KATP channel opener, influences the
bladder hyperactivity by suppressed firing of capsaicin-sensitive C-fiber bladder afferents, which are known to modulate
the micturition reflex (Brain Res 1998; 807:11-8). Two mechanisms of preventive effect of nicorandil on OAB have
been suggested; one mechanism is direct effect on bladder smooth muscle, and the other one is suppressing the firing of
capsaicin-sensitive C-fiber bladder afferents. From present data, we suggest the third mechanism of preventive effect of
nicorandil on OAB; nicorandil improves DO via improvement of chronic ischemia in the bladder. The expressions of
KIR6.1 or KIR6.2 were up-regulated in the SHRs, and treatment with nicorandil increased these up-regulated KIR6.1 and
KIR6.2. However, it is still unclear which type plays major role in the detrusor smooth muscle in this condition.
Conclusion
Our data indicated that nicorandil prevents hypertension-related DO in the SHR via possible mechanisms, direct
effect on detrusor smooth muscle, suppressing the firing of capsaicin-sensitive C-fiber bladder afferents and modulating
blood flow in the bladder.
PJ15 Comparative characterization of muscarinic receptor binding
activity of fesoterodine and its active metabolite for treatment of
overactive bladder
Akira Yoshida, Yusuke Fuchihata, Masaki Ogoda, Yoshihiko Ito and Shizuo Yamada
Department of Pharmacokinetics and Pharmacodynamics and Global Center of Excellence (COE) Program, School of
Pharmaceutical Sciences, University of Shizuoka, Shizuoka, Japan
121
Aims of Study
Fesoterodine is one of the most novel antimuscarinic agents approved for the treatment of overactive bladder.
Fesoterodine is rapidly and extensively converted by ubiquitous nonspecific esterase to its active metabolite,
5-hydroxymethyl tolterodine (5-HMT), which is also active metabolite of tolterodine [1]. Both agents may contribute
significantly to the pharmacological effects in the bladder after oral administration of fesoterodine. Fesoterodine displayed
about 20 times higher affinity to M2 and M5 subtype than M3 subtype in membranes prepared from CHO cells expressing
human M1 to M5 receptors [2]. However, the muscarinic receptor binding properties of fesoterodine and and 5-HMT
in the bladder and other tissues have not been comparatively examined. Thus, the current study was aimed to examine
comparratively the muscarinic receptor binding activity of fesoterodine, 5-HMT and tolterodine in nine different tissues
from rats, by using radioligand binding assay.
The tissues (bladder urothelium and detrusor, submaxillary gland, lung, heart, ileum, colon, prostate, brain) from
rats were dissected and homogenized for the preparation of crude membranes by suspension and centrifugation. The
muscarinic receptors in tissue homogenates were measured by a radioligand binding assay using [N -methyl-3H]scopolamine
methyl chloride ([3H]NMS), a selective radioligand of muscarinic receptors as previously desceibed [3]. The inhibition
constant (Ki) for the inhibitory effects of fesoterodine and 5-HMT in rat tissues was estimated.
Results
Fesoterodine (1 nM-10 nM) inhibited concentration-dependently specific [ 3H]NMS binding in the bladder
urothelium and detrusor, submaxillary gland, lung, heart, ileum, colon, prostate, and brain from rats. Similarly, 5-HMT
(0.1-30 nM) and tolterodine (1-100 nM) inhibited specific [3H]NMS binding in these tissues. Based on Ki values, the rank
order of binding affinity of each agent in rat tissues was 5-HMT > tolterodine > fesoterodine. Notably, the binding affinity
of 5-HMT was about 20 times higher than that of fesoterodine in tissues except the prostate and cerebral cortex which
showed about 140 and 350 times respectively, higher affinity. 5-HMT displayed about 2 times higher affinity to muscarinic
receptors in the bladder than the submaxillary gland. There was no significant difference among nine tissues of rats in
the muscarinic receptor binding affinity of tolterodine. The Hill coefficients for the inhibition of [3H]NMS binding by
fesoterodine and 5-HMT in each tissue were close to unity.
Discussion and Conclusions
Fesoterodine and 5-HMT bind to the muscarinic receptors in the bladder and other tissues, and the binding affinity
of 5-HMT is significantly higher than that of fesoterodine.
References
1. Malhotra B, Gandelman K, Sachse R, Wood N, Michel MC: The design and development of fesoterodine as a prodrug of
5-hydroxymethyl tolterodine (5-HMT), the active metabolite of tolterodine. Curr Med Chem 2009; 16:4481-4489.
2. Mansfield KJ, Chandran JJ, Vaux KJ, et al: Comparison of receptor binding characteristics of commonly used muscarinic antagonists
in human bladder detrusor and mucosa. J Pharmacol Exp Ther 2009; 328:893-899.
3. Oki T, Kageyama A, Takagi Y, Uchida S, Yamada S: Comparative evaluation of central muscarinic receptor binding activity by
oxybutynin, tolterodine and darifenacin used to treat overactive bladder. J Urol 2007; 177:766-770.
PJ16 Excitatory effect of propiverine hydrochloride on urethral activity
in rats
Katsumi Kadekawa1,2, Saori Nishijima1, Katsuhiro Ashitomi1, Hideyuki Yamamoto3, Kimio Sugaya1
1
Southern Knights’ Laboratory LLP, Okinawa, Japan; 2Department of Urology, Okinawa Kyodo Hospital, Okinawa,
Japan; 3Department of Biochemistry Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan.
Aims of Study
Propiverine hydrochloride is an antimuscarinic agent that is used for the treatment of urinary frequency and
overactive bladder. Propiverine is not only effective for urge incontinence, but is also useful for stress incontinence. The
mechanism by which propiverine improves stress incontinence has not yet been clarified. In a recent study of female rats,
122
we found that propiverine administration for 2 weeks increases the plasma noradrenaline level by 123% and the dopamine
level by 176% without changing the heart rate or blood pressure [Nishijima S et al. Biomed Res. 2009; 30: 107.].
Noradrenaline in the sympathetic pathways mediates excitatory inputs to the bladder neck and the proximal urethra, as
well as inhibitory inputs to the body of the bladder. Therefore, an increase of circulating catecholamines after propiverine
administration may activate smooth muscle in the bladder and the proximal urethra. Accordingly, we investigated the
influence of propiverine on bladder and urethral activity in rats.
Fifty-four female Sprague-Dawley rats were used. The study protocol was approved by the Animal Care and Use
Committee of the University of the Ryukyus. The rats were divided into three groups, which were a control group (n=18),
a propiverine group (n=30), and an imidafenacin group (n=6). Rats in these groups were respectively administered 1 mL
of distilled water (once a day), 0.5 mg/1 mL of propiverine dissolved in distilled water (once a day), or 0.01 mg/1 mL of
imidafenacin (an antimuscarinic agent) dissolved in distilled water (twice a day) by gavage using a fine catheter. The rats
were treated for 2 weeks. Then the animals in each group were anesthetized with urethane, and the following experiments
were performed. In 6 rats from each of the control, propiverine, and imidafenacin groups, a lower abdominal incision
was made and the bladder neck was ligated to produce an isovolumetric state. A catheter was inserted through the dome
of the bladder, and another catheter was inserted into the urethra through the external urethral meatus. Then the changes
of bladder and urethral activity were recorded. In rats from the control group and the propiverine group, prazosin
hydrochloride, a non-selective α1-adrenergic receptor antagonist (0.1-100 mg), was injected intravenously, and the changes
of bladder and urethral activity were recorded in the control group (n=6) and the propiverine group (n=6). In other rats of
the propiverine group, silodosin (an α1A-adrenergic receptor antagonist, 0.001-10 mg, n=6) or naftopidil (an α1D-adrenergic
receptor antagonist, 0.001-1 mg, n=6) was injected intravenously, and the changes of bladder and urethral activity were
recorded. Furthermore, in rats from the control group (n=6) and the propiverine group (n=6), the leak point pressure (LPP)
after electrical stimulation of abdominal wall muscles was measured in rats with vaginal distension from the control and
propiverine groups.
Results
Intravesical baseline pressure was significantly lower in the propiverine group (34% decrease, P=0.007) and
imidafenacin group (20% decrease, p=0.048) compared with the control group, while the urethral baseline pressure was
significantly higher in the propiverine group compared with the control group (28% increase, P=0.007) or imidafenacin
group (23% increase, p=0.035). Intravenous injection of prazosin significantly decreased the urethral baseline pressure
in both of the propiverine and control groups (control group: 10% decrease at 100 mg of prazosin, P=0.044; propiverine
group: 21% decrease at 100 mg of prazosin, p=0.022). Intravenous injection of silodosin and naftopidil significantly
decreased the maximum contraction pressure and the urethral baseline pressure in the propiverine group (naftopidil:
16% decrease at 1 mg of naftopidil, p=0.027; silodosin: 33% prolongation at 1 mg of naftopidil, P=0.022). The LPP of the
propiverine group was significantly higher than that of the control group (34.1±9.0 cmH2O vs 20.3±4.2 cmH2O).
Conclusion
Propiverine increased the urethral baseline pressure compared with that in the control group or imidafenacin group,
while this increment of urethral baseline pressure was reduced by administration of prazosin, silodosin, or naftopidil.
The increment of urethral baseline pressure may be due to an excitatory effect of propiverine on the smooth muscle
of the bladder neck and the proximal urethra, and/or an influence on the striated external urethral sphincter muscle.
Noradrenaline is the neurotransmitter that mediates excitatory sympathetic inputs to the bladder neck and the proximal
urethra via α1A- and α1D-adrenergic receptors. Dense noradrenaline-containing terminals and urethral rhabdosphincter
motor neurons are located in the motor nucleus of the urethral sphincter (Onuf’s nucleus) in the sacral spinal cord.
Therefore, an increase of catecholamines induced by administration of propiverine might activate both sympathetic
pathways and Onuf’s nucleus via α1A- and α1D-adrenergic receptors to increase the urethral baseline pressure. Some
authors have reported on the efficacy and safety of combining of α1-adrenergic receptor antagonists and antimuscarinic
agents including propiverine to treat benign prostatic hyperplasia. Therefore, even if propiverine increases urethral tone,
treatment with propiverine plus an α1-adrenergic receptor antagonist may be both safe and effective for storage symptoms
in men with symptomatic benign prostatic hyperplasia.
Propiverine increased the LPP of rats with vaginal distension compared with the control group, also indicating
that propiverine increases urethral tone. Rats with vaginal distension are an animal model of stress incontinence due to
simulated birth trauma. Active urethral closure during stress is mediated by activation of somatic nerves innervating striated
muscles of the urethra and pelvic floor. Therefore, one reason why propiverine is effective for stress incontinence may
123
be its activation of spinal motoneurons innervating urethral and pelvic floor striated muscle because propiverine increases
catecholamine levels.
PJ17 Dutasteride relieves obstruction and suppresses urinary oxidative
stress in patients with LUTS/BPH
Naoki Wada, Seiji Matsumoto, Masafumi Kita, Masaki Watanabe, Hidehiro Kakizaki
Department of Renal and Urologic Surgery, Asahikawa Medical University, Japan
Aims of Study
Lower urinary tract symptoms (LUTS) suggestive of bladder outlet obstruction (BOO) due to benign prostatic
hyperplasia (BPH), often called “LUTS/BPH”, are highly prevalent disorder in men. Large-scale study has shown that
dutasteride, a 5-alpha reductase inhibitor, could reduce prostatic volume (PV) and improve symptoms and flow rate in
men with LUTS/BPH. The relief of mechanical obstruction by reducing PV leads to significant improvement of not
only voiding symptoms but also storage symptoms (overactive bladder: OAB). Animal and clinical studies have suggested
that bladder ischemia plays an important pathophysiological role in the development of OAB associated with BOO.
Generation of free radicals by bladder ischemia and reperfusion injury induce oxidative stress and cause progressive
bladder dysfunction.
In the present study, we investigated whether dutasteride improves BOO and oxidative stress in patients with
LUTS/BPH.
A prospective study was conducted in 16 patients (mean age 75 years) with LUTS/BPH who had previously been
treated with any alpha adrenergic antagonist for more than 3 months without anticholinergic agent. Patients with PV≥30
mL and total IPSS score≥8 or QoL index≥3 were included in this study. At baseline and 24 weeks after administration
of dutasteride 0.5 mg per day as add-on with alpha adrenergic antagonist, IPSS and QoL index were obtained from
all patients, PV was measured by trans-abdominal ultrasonography and urodynamics including uroflowmetry, filling
cystometry and pressure-flow study were performed. Obstruction was determined by Schafer nomogram. Oxidative stress
was evaluated by urinary 8-hydroxy-2’-deoxyguanosine (8-OHdG) before and after dutasteride treatment.
Results
Total IPSS (from 21.6±7.6 to 16.4±6.8, p<0.01), voiding subscore of IPSS (from 9.1±4.3 to 7.2±4.0, p<0.05), storage
subscore of IPSS (from 9.8±4.5 to 7.3±3.1, p<0.01) and QoL index (from 4.7±1.0 to 3.8±1.4, p<0.01) were significantly
improved after 24 weeks administration of dutasteride. PV was significantly reduced from 62±27 to 46±27 mL (-26%,
p<0.001). Regarding urodynamics, there was no significant difference in Qmax (from 12.8±7.1 to 13.9±9.3 mL/sec), or
postvoid residual (from 88±56 to 120±121 mL). On Schafer nomogram, obstruction grade significantly decreased from 3.4
±1.4 to 2.6±1.4 (p<0.01). Urinary 8-OHdG significantly decreased after dutasteride treatment (from 9.2±5.1 to 6.1±3.5 ng/
mg creatinine, p<0.05). In 7 patients whose obstruction grade on Schafer nomogram was unchanged, urinary 8-OHdG did
not decrease significantly (from 8.4±5.1 to 6.2±5.3 ng/mg creatinine, p=0.40), while in other 9 patients whose obstruction
grade was improved, urinary 8-OHdG significantly decreased (from 9.8±5.4 to 6.0±1.5 ng/mg creatinine, p=0.03).
Conclusions
Dutasteride can reduce PV and relieve obstruction, leading to improvement of both voiding and storage symptoms.
Treatment with dutasteride resulted in a significant decrease in urinary 8-OHdG, especially in patients with reduced
obstruction. These results suggest that dutasteride can exert antioxidant effect through relieving obstruction. This ancillary
effect of dutasteride might be another factor contributing to improvement of symptoms in patients with LUTS/BPH.
124
PJ18 A prospective randomized controlled study of two different
antimuscarinic agent, imidafenacin and solifenacin, in Japanese
Yokoyama T1, Ohbatake A1, Fujii T1, Jo Y1, Miyaji Y1, Nagai A1, Koide T2, Furukawa Y2
1
Department of Urology, Kawasaki Medical School, Kurashiki, Japan, 2Kasaoka Daiichi Hospital, Kasaoka, Japan
Aims of Study
Overactive bladder (OAB) is a highly prevalent and has a profound effect on the ordinary quality of life. The current
mainstay of OAB pharmacotherapy is antimuscarinic agents. OAB is a chronic condition and many patients should
receive long-term medication. Therefore, there is a need for effective and well tolerated agents that achieve good long-term
compliance. We assess the efficacy and safety of two different antimuscarinics, imidafenacin and solifenacin in Japanese
patients with overactive bladder (OAB) for 12 months.
After approval of local institutional review board, 20 years or older male or female patients who had urgency (more
than 1 episode per 24 hours), with or without urgency urinary incontinence and post-void residual urine volume (PVR)≤
100 mL were randomized into 2 groups, group I- imidafenacin (0.1 mg twice a day), group S-solifenacin (5 mg once daily)
for a 12-month treatment regimen. Subjective symptoms were assessed using the International Prostate Symptom Score
(IPSS), QoL index, Overacitve Bladder Symptom Score (OABSS), the Urgency Perception Scale (UPS), visual analogue
scale (VAS) for the degree of dry mouth and constipation, and the PVR detected by ultrasonography before, 1, 3, 6, and
12 months after treatment. The duration time of dry mouth was also assessed at each time points.
Results
A total of 109 patients, including 55 (mean 72.0 years old, 32 females and 23 males) in group I and 54 (mean 70.4
years old, 36 females and 18 males) in group S were treated. The persistent rates were 94.5% and 96.3% at 1 month,
61.8% and 81.5% at 3 months, 38.2% and 46.3% at 6 months, and 29.1% and 35.2% at 12 months, respectively. In both
groups, IPSS, QoL index, OABSS, and UPS were significantly improved after treatment and no significant intergroup
differences were identified. PVR did not significantly increase in both groups. As to adverse events, VAS of dry mouth
significantly increased in both group I and S from 0.57 to 2.11, 0.65 to 2.26 before and after 1 month treatment,
respectively. VAS of constipation was from 0.82 to 1.06, 0.74 to 1.22 in group I and S before and after 1 month treatment,
respectively. That of VAS significantly increased in only group S after the treatment. The duration time of dry mouth was
significantly shorter in group I compared with in group S from 1.42 hr to 2.16 hr, 1.09 hr to 3.44 hr before and after 1
month treatment, respectively. No acute urinary retention was found in this study.
Conclusions
Imidafenacin and solifenacin were efficacious, safe, and well-tolerated medicine for the treatment of OAB. Profiles
and difference of each drug should be considered in making treatment choice.
PJ19 The investigation of predictive factors including urodynamic
assessment for urinary morbidity which occurred within 12
month after permanent iodine-125 prostate brachytherapy
Yoshiyuki Ishiura1, Hiroshi Yaegashi1, Kiyoshi Koshida1, Yasuo Saito2
1
Department of Urology and 2Radiology, NHO Kanazawa Medical Center, Kanazawa, Japan
Aims of Study
Permanent prostate brachytherapy using an iodine-125 seed source has become popular in the USA and Europe
since the 1990s. In Japan, the first iodine-125 prostate brachytherapy was performed in 2003 and this method is becoming
more popular. Urinary symptoms and urinary retention are more common after brachytherapy than after external beam
125
radiotherapy. Previous studies reported that I-PSS increases 3 months after brachytherapy, which mostly decreases
one year after brachytherapy. Some reports revealed that large prostate volume, hemorrhage or swelling following
brachytherapy, excess radiation dose and excess residual urine volume at baseline were thought to be predictive factors
of urinary retention or troublesome urinary symptoms after brachytherapy. However few report described urodynamic
assessment. The relation between urodynamic findings and bothersome urinary symptoms had not been described. The
purpose of this study was to investigate the predictive factors including urodynamic assessment for urinary morbidity which
occurred within 12 month after brachytherapy.
80 patients with localized prostate cancer were enrolled. The mean age was 69 years old and the average value of
PSA was 7.1 ng/ mL. At the consultation men qualifying for prostate brachytherapy are assessed with history and physical
examination, I-PSS questionnaire, uroflowmetry, urodynamic studies and trans-rectal ultra-sound to verify prostate
volume. Formal urodynamic studies were conducted in an unselected group of 64 patients, comprising filling cystometry
and a pressure-flow study. After brachytherapy, urethral catheter was inserted for about 40 hours and α-1 blockers were
prescribed for a minimum of 3 months or until bothersome symptoms resolved. Blood analysis was performed at post
operative day one and changes in hemoglobin between baseline and post brachytherapy was estimated. The post-implant
computed tomography which would produce post planning values, was performed 1 month after brachytherapy. The post
planning prostate D90 (minimal dose covering 90% of the entire prostate which means values of radiological effects for
prostate) and the post planning urethral D5 (minimal dose covering 5% of the entire prostate urethra which means values
of radiological toxicity for prostatic urethra) were also calculated. Post-implant I-PSS and uroflowmetry were evaluated in
the 3rd, 6th and 12nd month after brachytherapy. Urinary retention or great increases of I-PSS which means bothersome
urinary symptoms were indicated as clinically important urinary morbidity. Bothersome urinary symptoms were
categorized as an increase of I-PSS more than 10 points above baseline. Correlation between urinary morbidity (urinary
retention or great increases of I-PSS) and various predictive factors were investigated. Age, prostate volume, adjuvant
external beam radiotherapy, neo-adjuvant androgen-deprivation therapy, changes in hemoglobin between baseline and
post brachytherapy, the number of implanted seeds, the post planning prostate D90 and the post planning urethral
D5 were selected as predictive factors which were not associated with urodynamic studies. Involuntary contraction,
urodynamic obstruction, strength of voiding detrusor contraction, maximal flow rate and residual urine volume were
selected as predictive factors which were associated with urodynamic studies.
Results
Average prostate volume was 23.3 cc (range 9.7 to 44.5). Average number of implanted iodine-125 seeds were 66.3
(range 36 to 100). Average dose of post planning prostate D90 and urethral D5 were 156 gray (range 101 to 206) and 258
gray (range 144 to 584) respectively. Existences of urodynamic obstruction, detrusor weak and involuntary contraction
were revealed in 34 cases, 8 cases and 8 cases respectively. Urinary retention was observed in two patients, one was
transient and the other one needed intermitted catheterization for 9 month. Both patients had urodynamic obstruction
which could be a most characteristic factor. The mean IPSS at baseline was 10.1 and at 3rd, 6th and 12nd month after
brachytherapy was 15.3, 12.4 and 10.4 respectively. The mean QoL score at baseline was 2.7 and at 3rd, 6th and 12nd
month after brachytherapy was 3.6, 3.4 and 2.4 respectively. The mean Qmax at baseline was 14.4 mL/sec and at 3rd, 6th
and 12nd month after brachytherapy was 11.7 mL/sec, 11.8 mL/sec and 13.0 mL/sec respectively. The mean IPSS and
QoL score showed a significant increase at 3rd and 6th month after brachytherapy and returned to baseline 12 month
later. Bothersome urinary symptoms which were categorized as great increases of I-PSS in a period of 3rd, 6 th and 12 nd
month after brachytherapy were observed in 40 cases, 14 cases and 8 cases respectively. Thirty-five cases received high
level of urethral D5 (more than 250 gray). These patients suffered great increases of I-PSS significantly in a period of 3rd,
6th and 12nd month after brachytherapy (28 cases, 10 cases and 5 cases respectively). Urodynamic involuntary contraction
was recognized 8 cases. These patients suffered great increases of I-PSS significantly in a period of 3rd, 6th and 12nd
month (6 cases, 4 cases and 4 cases respectively). Three-fourths of patients with urodynamic abnormalities (involuntary
contraction, detrusor abnormalities or urodynamic obstruction) suffered great increases of I-PSS in a period of 3rd
month. Excess residual urine volume and poor maximal flow rate at baseline tended to occur bothersome symptoms.
Age, prostate volume, adjuvant external beam radiotherapy, neo-adjuvant androgen-deprivation therapy, changes in
hemoglobin, the number of implanted seeds and the post planning prostate D90 were not concerned with bothersome
symptoms.
Conclusions
This is the first report to evaluate the predictive factors including urodynamic assessment for urinary morbidity such
as troublesome urinary symptoms which occurred within 12 month after iodine-125 brachytherapy. Two patients with
126
urodinamic obstruction suffered from urinary retention. Great increases of I-PSS following brachytherapy were observed
in half of patients within 3 month after brachytherapy but decreased to 10% of patients 12 month later. Excessive radiation
dose to prostatic urethra and urodynamic abnormalities such as involuntary contraction before brachytherapy could be the
predictive factor for great increases of I-PSS which occurred within 12 month after brachytherapy.
PJ20 Overactive bladder patients can have dry mouth and constipation
before treatment with anticholinergic agents
Hisae NISHII 1,2, Kayoko ITO 3, Makoto INOUE 4, Kiyoko FUKAI 5, Tetsuro MATSUMOTO 1
1
Department of Urology, University of Occupational and Environmental Health, Japan; 2Fukuoka Institute of
Occupational Health, Japan; 3Geriatric Dentistry, Niigata University Medical and Dental Hospital; 4Department of Oral
Biological Science, Division of Dysphagia Rehabilitation, Niigata University Graduate School of Medical and Dental
Sciences; 5Graduate School of Health Sciences, Okayama University
Aim of Study
Overactive bladder (OAB) is a symptom syndrome characterized by urgency with or without urgent incontinence,
which affects 12.4% in population >/=40 years old in Japan. OAB is a bothersome condition affecting the quality of life
(QoL) of the patients. Recently, pharmacological treatment for OAB is centered on anticholinergic agents. However, it
is well known that anticholinergic agents can deteriorate the QoL of the OAB patients due to adverse effects such as dry
mouth and constipation. Unwillingness and inability of OAB patients to continue oral therapy with anticholinergic agents
due to these adverse effects have been the clinical problem especially in the long term therapy. In addition, the prevalence
of OAB increases with age, and dry mouth and constipation are to be caused by the age as well. Thus, clinicians need
more attention to the treatment with anticholinergic agents for OAB patients of advanced age. The aim of this study is to
evaluate the prevalence of dry mouth and constipation among the general population >/=40 years old whose are with or
without OAB symptoms.
An internet survey to evaluate the prevalence of OAB symptom, dry mouth and constipation among the general
Japanese population >/=40 years old (Male n=100, Female n=199) was performed by using overactive bladder symptom
score (OABSS), dry mouth score (DMS) and constipation assessment scale (CAS), respectively. The illnesses and
medications which they take were questioned in the survey. Patients were diagnosed as OAB if they scored 3 or more
points in the OABSS, and answered “more than once a week” regarding the sub-score of urgency in OABSS. The dry
mouth symptoms, accompanying symptoms and other symptoms were asked on the basis of face scale in DMS which
was validated. CAS, which was standardized as a Japanese version, includes 8 items to ask about the defecation status in
the past week. Patients answer on three points scale, 0 (none, rarely), 1(mild, sometimes), and 2 (never, always) in CAS.
For statistical analysis, Mann-Whitney U test, Pearson's product-moment coefficient of correlation and Spearman's rank
correlation coefficient were used and p value <0.05 was considered statistically significant.
Results
Average age of the responders was 66.9 +/- 10.8 years old (Male 65.6 +/- 11.0, Female 69.7+/- 9.8).
1) OABSS
The average score in OABSS of all responders was 2.36 +/- 2.26. Total OABSS, subscore in urgency and nocturia
significantly increased with age (p<0.05). There was no significant difference in OABSS between male and female
responders (2.66 +/-2.54 vs 2.21 +/- 2.10). The prevalence of OAB was 16.7% (50 of 199), whose average OABSS was 6.10
+/- 2.21. Only 14 % in OAB group were treated with medications.
2) DMS
The average score in DMS was 21.52 +/- 9.49. The average score in the dry mouth symptoms, accompanying
symptoms and other symptoms were 8.76 +/- 4.16, 6.63 +/- 3.42, and 6.13 +/- 3.10, respectively. There was no significant
difference in DMS between male and female responders (20.36 +/- 8.75 vs 22.10 +/- 9.81). The average score in total
DMS, dry mouth symptoms, accompanying symptoms and other symptoms in OAB group was significantly higher than
that in non-OAB group (27.07 +/- 10.24 vs 20.29 +/- 9.01, p<0.05) (Figure 1).
127
3) CAS
The average score in CAS was 3.35 +/- 2.55. There was no significant difference in CAS between male and female
responders (3.05 +/- 2.52 vs 3.50 +/- 2.56). The average CAS score in OAB group was significantly higher than that in nonOAB group (4.25 +/- 2.35 vs 3.17 +/- 2.58, p<0.05)
4) Correlation coefficient among OABSS, DMS and CAS
The correlation coefficients between OABSS and DMS, DMS and CAS, OABSS and CAS were 0.3766 (p<0.0001),
0.3850 (p<0.0001) and 0.2060(p=0.0003), respectively. There was positive correlation between DMS and OABSS (Figure
2).
Conclusions
The prevalence of OAB in this study was compatible with the previous report (Homma et al., 2005). There
was no difference in the prevalence of OAB between male and female as reported previously. As only 14 % of those
who met the diagnosis criteria of OAB had medical treatment, the treatment for OAB in not widely spread in Japan.
OAB group showed significantly higher scores in DMS and CAS. Positive correlation was observed between DMS and
OAB symptoms. Clinical attention should be paid to possibility that OAB patients can suffer from the dry mouth and
constipation before the prescription of anticholinergic agents.
Figure 1. The average score in total DMS, dry mouth symptoms, accompanying symptoms and other symptoms
between non overactive bladder group and overactive bladder group.
Figure 2. The correlation between DMS and OABSS.
Figure 1
Figure 2
PJ21 A retrospective, single-center study of the evaluation of voiding
condition before and after transobturator tension-free vaginal
tape (TOT) procedure in female stress urinary incontinence
Satoru Kira1, Araki Isao2, Yaburu Haneda1, Norifumi Sawada1, Hideki Kobayashi1, Masayuki Takeda1
1
Department of Urology, University of Yamanashi Faculty of Medicine; 2 Department of Urology, Shiga University of
Medical Science
Aims of Study
Stress urinary incontinence (SUI) affects about a third of adult women worldwide, and can lead to deterioration in
the quality of life. Delorme described the transobturator tension-free vaginal tape (TOT) procedure to reduce the potential
of complications associated with the retropubic approach of tension-free vaginal tape [1]. Since then, TOT appeared
to become almost the mainstay of the treatment of SUI. TOT has been reported to be safe and effective for SUI. [2]
However, one main issue of this technique remains the postoperative voiding symptoms in which underlying mechanism
128
is still unknown. In this study, we focused on the voiding condition before and after TOT to evaluate the postoperative
voiding symptoms.
Materials and Method
After obtaining Institutional Review Board approval, we reviewed the records of all 33 women who underwent
TOT procedure for symptomatic SUI during the 13-month period beginning October 2008. Preoperatively, symptom
assessment using questionnaires, a pad test, cough stress test and urodynamic testing, including free uroflowmetory with
ultrasound measurement of postvoid residuals (PVR), filling cystometory and pressure-flow study (PFS), were performed
in all patients. Postoperative evaluation at 1 month and 6 months included uroflowmetry with PVR, and symptom
assessment using questionnaires. Statistical analysis was made using the paired t test for comparison between before and
after values. A level of p<0.05 was considered to be statistically significant.
Results
In 33 patients, mean age, mean number of vaginal deliveries and body mass index were 66.1 (range 36–80), 2.3 (range
0–5) and 25.5 (range 19.2–30.4) respectively. 16 patients were undergone TOT procedure with Pelvic Organ Prolapse
(POP) surgery and 17 patients were undergone without POP surgery.
The overall subjective cure rates at 1 and 6 months after procedure were 88% and 93%. At 1 month after procedure,
de novo urgency and urge incontinence was observed in four patients and one patient respectively, but at 6 months
after procedure both was resolved spontaneously. Only one case of urinary retention observed postoperatively and was
introduced Clean Intermittent self-Catheterization (CIC). At 1 month after procedure, CIC was withdrawn when PVR was
decreased less than100 mL. No major complications, notably no injury of major vessels, neurological or gastrointenstinal
complications and no pulmonary embolism were reported. None of the cases suffered urethral injury or bladder
perforation and experienced postoperative thigh pain.
In the uroflowmetroy, preoperative mean Voiding Volume (VV), mean Qmax , mean Qave and mean PVR were not
significantly changed at 6 months after procedure respectively.《 VV: (pre 326 mL, vs post 287 mL; p=0.18), Qmax: (pre
29.2 mL/s, vs post 27.5 mL/s; p=0.58), Qave: (pre 15.5 mL/s, vs post 13 mL/s; p=0.14), PVR: (pre 17.5 mL, vs post 18.6
mL; p=0.99) 》In the PFS, according to Schafer’s nomogram, detrusor contractility was classified into six classes: strong
(ST), normal+ (N+), normal–(N-), weak+(W+), weak–(W-) and very weak (VW). In classes ST, N+ and N- (more than N-),
the parameters (mean VV, mean Qmax, mean Qave and mean PVR) in the uroflowmetory before and after procedure
were not changed significantly. In classes W+, W- and VW (less than W+), these were not changed significantly, too.
Between classes more than N- and classes less than W+, the parameters in the uroflowmetory after procedure were not
changed significantly.
Conclusions
Our data showed that TOT for female SUI was undergone with high cure rates and less postoperative complications.
TOT was useful for female SUI without change in the postoperative voiding condition, not only normal detrusor
contractility, but also the possibility of weak detrusor contractility in the UDS.
References
1. Delorme E: [Transobturator urethral suspension: mini-invasive procedure in the treatment of stress urinary incontinence in women].
Prog Urol 2001; 11:1306-1313.
2. Porena M, Costantini E, Frea B, et al: Tension-free vaginal tape versus transobturator tape as surgery for stress urinary incontinence:
results of a multicentre randomised trial. Eur Urol 2007; 52:1481-1490.
PJ22 A randomized, single-blind, parallel study of the effectiveness
and safety of solifenacin versus propiverine in the treatment of
overactive bladder
Tomonori Yamanishi
Department of Urology, Dokkyo Medical University, Tochgi, Japan
129
Aim
To compare the effectiveness and safety of solifenacin versus propiverine in the treatment of overactive bladder
(OAB), in a single-blind, randomized parallel study.
Methods
Sixty-six patients with OAB (14 men and 52 women) were randomly allocated to groups: solifenacin (5-10 mg/day)
or propiverine (20-40 mg/day) in the clinic (Feb 2007- Jul 2009) and treated for 8 weeks. The primary outcome variable
was mean change from baseline to end of treatment in urgency of the OAB symptom score (OABSS). Secondary
outcomes were change over 24 h in the mean number of voids (daytime and nighttime), episodes of micturition urgency
and incontinence, and mean volume voided, in the bladder diary. Patients also completed total OABSS and the King’s
Health questionnaires.
Results
Group backgrounds were comparable except for the male, female proportion; 11:22, solifenacin (n=33, mean age
73.8±12.0 years) vs. 3:33, propiverine (n=33, mean age 68.8±10.8 years). Adverse events (AE) were 6 of 29 (21%) for
solifenacin versus 14 of 26 (54%) for propiverine (p=0.017). Withdrawals for AEs were 1 dysuria for solifenacin, and 2
dysuria and 1 dry mouth for propiverine. In 51 patients (28, solifenacin; 23, propiverine), effectiveness to improve urgency
in OABSS (change in group mean ≥-1) with results of -2.3±1.4 for solifenacin versus -1.3±1.7 for propiverine (p=0.0372;
95% CI, -0.1, -1.9 ).
Conclusion
Although both solifenacin 5 mg and propiverine 20 mg were effective in the treatment of OAB, solifenacin appeared
to be more effective and tolerable.
PJ23 Comparison of the efficacy of medicines for urinary incontinence
in rats with stress urinary incontinence
Saori Nishijima1, Kimio Sugaya1, Katsumi Kadekawa1, Katsuhiro Ashitomi1, Hideyuki Yamamoto2
1
Southern Knights’ Laboratory, LLP; 2Department of Chemistry, University of the Ryukyus
Aims of Study
Clinically, pharmacologic therapy has been widely used, with varying success rates, for the treatment of stress
urinary incontinence in women. Anticholinergic agents and serotonin-noradrenaline reuptake inhibitors (SNRI) such
as tricyclic antidepressants are usually used for the treatment to stress urinary incontinence. However, the specific drug
which described clearly the stress urinary incontinence is not sold in Japan, so there is little examination that compared the
medical efficacy of these drugs for the stress urinary incontinence. In this study, therefore, we compared the efficacy of the
three medicines, propiverine (an anticholinergic agent), imipramine (a tricyclic antidepressant and SNRI), and duloxetine
(an antidepressant and SNRI) by using rats with stress urinary incontinence.
Eighteen female Sprague-Dawley rats were used. The study protocol was approved by the Animal Care and Use
Committee of the University of the Ryukyus. Under 2% isoflurane anesthesia, a modified 10 Fr. Foley balloon catheter
was inserted into the vagina, and the vaginal orifice was closed with suture (4-0). The balloon catheter was inflated with
4 mL water to distend the vagina for 3 hr. At 4 days after surgery, ureters and all nerves which flowed into the bladder
were cut bilaterally, and polyethylene catheter (PE-50) was inserted into the bladder through the dome for recording the
intravesical pressure to detect the leak point pressure. After the bladder was emptied, 0.2 mL of saline solution containing
Evans blue (100 µg/mL) was injected into the bladder. Then, stimulus electrodes were inserted into two sites of abdominal
muscles. The stimulus intensity was gradually increased step by step, and the lowest maximal intravesical pressure value
that induced the fluid leakage from the urethral orifice was defined as the baseline-leak point pressures (B-LPP). After
B-LPP was obtained, each medicine (0.1-3 mg/kg) was injected intravenously and abdominal muscles stimulation was
performed again to evaluate the efficacy of the medicine on the LPP.
130
Results
Before administration, the B-LPP was 24-30 cmH2O. Significant change of the LPP was not observed before
and after injection 0.1-1 mg/kg propiverine. However, the LPP after injection of 3 mg/kg propiverine was significantly
increased (44 cmH2O) compared to those before and 1 mg/kg injection. When the imipramine or duloxetine was injected
intravenously, the LPP significantly increased at 1 mg/kg of injection, and reached to 53 cmH2O and 45 cmH2O at 3 mg/
kg of injection, respectively.
Conclusion
Imipramine and duloxetine increased the LPP at same degree. Efficacy of propiverine to the stress urinary
incontinence was weaker than other 2 medicines, but high-dose administration increased the LPP same level with
duloxetine equally. It has been reported that duloxetine increases the activity of the external urethral sphincter muscles
at the spinal cord level. Dense noradrenaline-containing terminals and urethral rhabdosphincter motor neurons are
located in the motor nucleus of the urethral sphincter (Onuf’s nucleus) in the sacral spinal cord. Therefore, SNRI action
of imipramine and duloxetine is thought to activate the motoneurons in the Onuf’s nucleus, and increase the urethral
closing pressure. It has been also reported that propiverine increases the plasma catecholamine level. Noradrenaline in the
sympathetic pathways mediates excitatory inputs to the bladder neck and the proximal urethra. Therefore, an increase of
circulating catecholamines induced by administration of propiverine might also activate both urethral smooth muscles and
Onuf’s nucleus, and increase the urethral closing pressure.
131
Taiwan
PT05 The correlation between voiding symptoms, urodynamic findings
and maximum bladder capacity in patients with ketamineinduced cystitis (KIC)
Wei-Chih Chen1, Ming-Huei Lee1,2, Chui-De Chiu3, Yi-Chang Chen1, Huei-Ching Wu1,2
1
Department of Urology, Taichung Hospital, Department of Health, Taiwan; 2Central Taiwan University of Science and
Technology; 3National Taiwan University of clinical psychology, Taipei, Taiwan
Purpose
The symptoms of ketamine-induced cystitis (KIC) include a range of lower urinary tract symptoms (LUTS)
mainly irritative in nature and the patients will complain of intense urgency, extreme frequency and intractable dysuria.
Previous study reported urodynamic studies in KIC patients have been utilised with most values being <150 mL. This
study investigated objective data compared with interstitial cystitis/painful bladder syndrome (IC/PBS) patients and the
correlation between voiding symptoms and objective findings.
From 2007 to 2011, 23 patients who were admitted due to LUTS with recreational ketamine abuse history. Fifty
IC/PBS patients were included as control group. These two group patients were assessed by validated questionnaire
including O'Leary-Sant Symptom (ICSI) and Problem Index (ICPI) was used to objectify subjective symptoms. Pelvic
Pain and Urgency/Frequency (PUF) questionnaire was also completed. Standardized consecutive filling cystometry and
volume at first desire to void (FDV), normal desire to void (NDV), strong desire to void (SDV) and maximum cystometric
capacity (MCC) were performed. Cystoscopic anesthetic maximal bladder capacity (MBC) was measured. These data were
analyzed using t test and Pearson correlations between symptom scores, urodynamic cystometric capacity, and anesthetic
maximal bladder capacity.
Results
KIC patients with a mean age of 25.57±5.3 years were statistically significant younger than IC/PBS patients with a
mean age of 40.34±9.6 years (p<0.01). Patients with KIC had higher ICSI, ICPI, and PUF scores than those with IC/PBS
(13.76±3.5 v.s 11.81±4.7, 12.00±3.9 v.s 10.89±2.8, 22.41±7.2 v.s 19.02±5.3) showed statistically significant. The values for
FDV, NDV, SDV, and MCC in the patients with KIC were 49.60 mL (±40.1), 60.42 mL (±51.0), 72.33 mL (±56.1), 93.27
mL (±68.9) respectively compared to IC/PBS group as 94.44 (±50.3) mL, 121.63 (±58.4) mL, 188.86 (±96.9) mL, 247.48
(±106.2) mL. Similarly, the KIC group had statistically significant lower MBC than IC/PBS group (268.70±168.2 mL v.s
647.50±156.2 mL, p<0.01). No strong correlation between MCC, anesthetic MBC and symptom score as ICSI, ICPI and
PUF scores in patients with KIC could be indentified, except the negative correlation between PUF score and MBC (
p<0.05). MBC were also negatively correlated with pain score (p=0.01).
Conclusions
Our study showed that subjects with KIC have smaller MCC and anesthetic MBC compared to those with IC/PBS.
Hypersensitive bladder in patients with KIC seems more severe to those with IC/PBS. In addition, MBC have negative
correlation with pain score and PUF score, implying that MBC played an important role on pain perception including
sexual pain disorder rather than irritative symptoms and need to be further evaluated.
132
PT06 Comparison of intravesical hyaluronic acid instillation with
different regimens for interstitial cystitis/painful bladder
syndrome
Ming-Chih Lai1, Yuh-Chen Kuo2, Jia-Heng Shie3, Qian-Sheng Ke3, Hann-Chorng Kuo3
1
Department of Urology, Taitung Christian Hospital, Taitung, Taiwan; 2Department of Urology, Taipei City Hospital,
Taipei, Taiwan; 3Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
Aims of Study
Preliminary studies using intravesical hyaluronic acid instillation have been demonstrated to have benefit in the
treatment of interstitial cystitis/painful bladder syndrome (IC/PBS). A loading dose of four weekly instillation of 50 mL
(40 mg) hyaluronic acid followed by 5 monthly maintaining doses has been suggested. However, the optimal regimen has
not been defined yet. Patients might feel improved during the first month, but gradually failed in the maintenance period.
The aim of this study was to compare the clinical effectiveness of intravesical hyaluronic acid instillations with different
regimens in patients with IC/PBS.
In this prospective, randomized, parallel study, 60 patients (age 16-77 years) who were diagnosed to have IC/PBS,
were identified. All patients had undergone urine analysis, videourodynamic study, potassium chloride (KCL) test and
cystoscopic hydrodistention with biopsy. The final diagnosis of IC/PBS was made based on cystoscopic findings of
glomerulations and clinical symptoms. Thirty patients were assigned to receive intravesical instillation of 40 mg HA
weekly in the first month and then monthly in the following 5 months (HA-9 group). Another 30 patients received
intravesical instillation of 40 mg HA per 2 weeks for 24 weeks (HA-12 group). Symptom after HA treatments was
assessed using Interstitial Cystitis Symptom and Problem Index (ICSI/ICPI), pain visual analog scale (VAS), functional
bladder capacity(FBC), frequency, noturia, maximum flow rate (Qmax), voided volume, postvoid residual volume (PVR),
and quality of life index(QoL-I) at 1,3 and 6 months. Efficacy analysis compared responders (moderately or markedly
improved) according to the global response assessment (GRA) at 1,3 and 6 months, relative to overall baseline symptoms.
Results
All 60 patients were evaluable at 6 months. The ICSI/ICPI total score and QoL-I were significantly improved at
6 months in both groups (Table 1). The VAS, FBC and ICSI, ICPI score, however, were significantly improved only in
HA-12 group (Table 2). Endpoint analysis at month 1, 3 and 6 revealed with moderately and markedly improved was
similar in both groups. The measured variables all showed no significant change from baseline to 6 months between two
groups.
Interpretation of results
Intravesical hyaluronic acid instillation improved IC/PBS symptoms and improved quality of life. Treatment either
with initial four weekly loading doses plus maintaining five monthly doses or regular treatment biweekly for 12 times
provided similar results. However, patients in the HA-12 group had better improvement in pain and symptom after
treatment although the difference in treatment effect in this study was not statistically significant between two regimens.
Conclusions
No significant difference was noted in therapeutic effect between two regimens of HA instillation for IC/PBS
patients. Both groups showed significant improvement in symptom score and QoL index.
133
Table.1 The changes of variables from baseline to 6 months in HA-9 group
HA-9
ICSI+ICPI
ICSI
ICPI
VAS
FBC
Frequency
Nocturia
Qmax
Volume
PVR
QoL
Baseline
15.86±7.59
8.27±3.37
7.58±4.53
3.27±2.48
181.0±96.7
10.13±4.23
2.24±1.64
16.10±9.72
222.6±128.5
35.17±56.27
3.20±1.18
1M
12.17±7.27
6.89±3.17
5.27±4.33
1.93±2.14
216.2±105.
9.44±4.66
2.07±1.36
18.56±9.34
241.±151.9
36.89±54.9
2.24±0.83
3M
11.19±6.96
6.80±3.28
4.53±3.76
2.04±2.60
223.3±133.2
9.90±4.83
2.29±1.38
15.81±10.0
214.6±179.4
41.77±52.8
2.29±0.90
6M
11.13±7.50
6.69±3.52
4.44±4.10
1.94±2.14
219.36±135.8
10.19±4.49
2.31±1.49
20.18±12.53
278.1±200.1
22.80±21.0
2.44±1.03
p value
0.041
0.067
0.056
0.147
0.366
0.852
0.188
0.259
0.268
0.424
0.010
6M
11.69±6.84
6.54±3.07
5.15±3.87
2.33±2.06
226.9±123.5
7.92±2.06
2.31±1.18
19.58±7.61
268.5±143.8
32.39±39.69
2.15±0.98
p value
0.000
0.001
0.000
0.002
0.001
0.060
0.157
0.145
0.114
0.508
0.000
Table 2. The changes of variables from baseline to 6 months in HA-12 group
HA-12
ICSI+ICPI
ICSI
ICPI
VAS
FBC
Frequency
Nocturia
Qmax
Volume
PVR
QoL
Baseline
15.40±7.39
8.10±3.37
7.30±4.18
3.30±2.38
161.7±83.4
10.47±5.25
2.87±1.63
13.47±7.66
202.5±141.3
47.67±54.84
3.20±1.21
1M
13.77±6.16
7.40±2.97
6.37±3.41
2.53±1.83
183.33±73.0
9.13±2.85
2.63±1.56
14.28±8.20
208.3±105.4
22.63±21.72
2.40±0.72
3M
12.80±7.07
6.95±3.33
5.85±3.86
2.45±2.28
232.0±113.4
9.10±3.34
2.65±1.63
18.99±9.27
293.2±188.6
29.45±38.52
2.25±0.78
PT07 The alteration of glomerulation and angiogenic molecules change
after botulinum toxin A therapy in interstitial cystitis/painful
bladder syndrome
Jia-Heng Shie1, Hsin-Tzu Liu1, Yuh-Chen Kuo2, Hann-Chorng Kuo1
1
Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan; 2Department of Urology, Taipei City
Aims of Study
Glomerulation of bladder mucosa after cystoscopic hydrodistention (HD) has been regarded one of the requisite
criteria for the diagnosis of interstitial cystitis/painful bladder syndrome (IC/PBS). Previous studies found that botulinum
toxin A (BoNT-A) not only inhibit the release of acetylcholine and norepinephrine, but also resolved clinical symptoms
of IC/PBS. We have observed the HD induced glomerulation decreased in grade after repeated BoNT-A injection. This
study investigated the mechanism of action for IC/PBS patients having symptomatic and cystoscopic improvements after
intravesical BoNT-A injections, such as bladder glomerulation and inflammation.
Twenty-five women with characteristic symptoms of IC/PBS and glomerulation after cystoscopic HD were enrolled
in this study. Bladder biopsies at three sites were taken immediately after cystoscopic HD for the diagnosis of IC/PBS.
All patients were previously untreated for IC/PBS before the bladder procedure. The bladder specimens with grade 2 to
3 glomerulation without ulceration were used in this study. The bladder tissue specimens at baseline and after intravesical
134
BoNT-A injection were investigated by immunofluorescence, protein array, western blotting and ELISA for the mast cell
activity and angiogenic protein expression.
Results
The results of tryptase stain indicated that the inflammation was decreased in the bladder tissue after BoNT-A
injection. (Figure 1) We also found that several inflammatory molecules were decreased in the IC/PBS samples, including
interleukins and TNF-α signal-related molecule. Beside, the result of angiogenic protein array indicated that VEGF and
IL-8 of IC/PBS bladders were reduced after BoNT-A therapy. The alteration of these protein expressions were confirmed
by western blotting using bladder tissue specimens of baseline and after intravesical BoNT-A injection. About 92% of the
molecules of angiogenesis and vascular inflammation in the array membrane were suppressed after BoNT-A injection,
such as VEGF, platelet factor 4, IL-1β, IL-8, CXCL16, and TIMP-4. The tryptase and IL-8 were found c-localized in
IC/PBS bladder mucosa. (Figure 2) Moreover, we found that the decrease of angiogenic and inflammatory molecules
were consistent with the glomerulation improved in IC/PBS after BoNT-A therapy. To further prove these angiogenic
molecular alterations might be due to inflammatory stimulation, the primary endothelial cell treated with tryptase which
derived from human mast cell was analyzed.
Our results found that several signal transduction pathway were involved in the pathophysiology of IC/PBS and
provided valuable information and signal network of different pathway in IC/PBS, including inflammation, angiogenesis
and apoptosis. Our study indicated that glomerulation degree and angiogenic markers could be reduced due to the
inflammatory suppression after intravesical BoNT-A injection in a portion of IC/PBS patients. These results could provide
evidence for the existing pathophysiology of IC/PBS as well as the possible mechanism of action of BoNT-A in treating
IC/PBS.
Conclusions
Intravesical BoNT-A injections in IC/PBS bladders improved clinical symptoms and decreased glomerulation grade.
Protein analysis revealed decrease of inflammatory and angiogenic protein expressions in IC/PBS bladders. These findings
provides evidence that BoNT-A intravesical injection can decrease inflammation and improved bladder glomerulation in
patients with IC/PBS.
Figure 1. The number of mast cell was decreased after BoNT-A injection.
Figure 2. The co-localization of tryptase and IL-8 in IC/PBS bladder mucosa.
135
PT08 Serum C-reactive protein is associated with storage but not with
empty symptoms in men with lower urinarytract symptoms
Shiu-Dong Chung1, Victor C. Lin2, Jing-Ling Chen3, Hann-Chorng Kuo3
1
Department of Urology, Far Eastern Memorial Hospital, Taipei, Taiwan; 2Department of Urology, E-DA Hospital,
Kaohsiung, Taiwan; 3Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
Aims of Study
Chronic prostatic Inflammation had been hypothesized to be associated with the pathogenesis of benign prostatic
hyperplasia (BPH). However, the association between histological prostatic inflammation and lower urinary tract
symptoms (LUTS) were relatively weak. Serum C-reactive protein (CRP) level is a nonspecific biomarker of systemic
inflammation, but there were few reports discussing the association between serum CRP levels and BPH/LUTS. This
study investigated the association between serum CRP and storage or empty scores of the International Prostate Symptom
Score (IPSS) in men with LUTS.
We prospectively enrolled 446 consecutive male patients with LUTS. The LUTS were assessed by IPSS, which was
further categorized as storage (IPSS-S) and empty (IPSS-E) subscore. The prostate volume was estimated by transrectal
ultrasound of prostate (TRUS-P). Serum prostate specific antigen (PSA), serum C-reactive protein (CRP), voided volume,
peak uroflow rate (Qmax) and postvoid residual (PVR) were also recorded. These objective findings of symptoms,
prostate and uroflow measurements and serum level of CRP were analyzed.
Results
The mean patient age was 65.6 years (range 37 to 90). The mean CRP levels were significantly higher in patients with
total IPSS≥20 (0.66±1.36) than those with IPSS 8-19 (0.32±0.68, p=0.012) or IPSS<8 (0.34±0.68, p=0.03). Mean serum
CRP was positively associated with age (Pearson 0.190, p=0.000) (Fig.1), total IPSS (p=0.004), IPSS-S (p<0.001) but not
IPSS-E (p=0.250). Serum CRP level was also negatively associated with voided volume (p<0.001) and Qmax (p=0.005).
However, there was no significant association between serum CRP and PSA (p=0.163), total prostate volume (p=0.379),
or PVR (p=0.279)(Table 1). Among 129 patients with LUTS, the serum CRP was significantly decreased after medical
treatment for 3 months (p=0.037)(Table 2).
Serum CRP levels increased with age, associated with higher total IPSS, storage IPSS, small voided volume and
lower Qmax. These findings suggest chronic inflammation might be a causing factor for the storage symptoms in the
elderly. This finding is compatible with previous epidemiological study that a higher CRP levels can be found in the
elderly, which implies that chronic inflammation might contribute to increased LUTS. However, the CRP was not
associated with PSA, total prostate volume and empty IPSS, indicating that elevated serum CRP in men with LUTS is not
associated with prostatic enlargement or bladder outlet obstruction.
Conclusions
Based on these findings, the elevated serum CRP in men with LUTS should be attributed to the bladder dysfunction
and storage failure not bladder outlet obstruction.
Table 1. The correlation between serum CRP and prostate and urflow parameters
CRP
TPV
TZI
Qmax
Volume
PVR
n
446
440
438
430
429
439
mean±SD
0.42±0.92
42.9±26.2
0.33±0.13
12.2±7.00
225.2±156.4
45.7±55.2
Pearson
1.000
-0.043
-0.047
-0.136
-0.173
0.052
p-value
0.379
0.332
0.005
0.000
0.279
136
Table 2. The serum CRP and other parameters at baseline and 3 months after medical treatment for male LUTS
IPSS-Total
IPSS-E
IPSS-S
Qmax
PVR
Volume
TPV
TZI
PSA
CRP
Baseline
14.58±6.41
8.81±5.33
5.78±3.39
10.68±5.77
60.23±65.45
219.83±143.78
48.22±25.81
0.36±0.12
4.41±5.11
0.44±0.97
3 month
8.05±5.22
4.27±4.28
3.78±2.11
13.82±6.06
54.12±62.48
284.20±148.14
47.04±25.59
0.36±0.12
3.54±4.53
0.24±0.41
p-value
0.000
0.000
0.000
0.000
0.295
0.000
0.181
0.691
0.000
0.037
(N=129)
Figure 1. Positive correlation between serum CRP levels and age.
PT09 Sexual dysfunction in women with ketamine cystitis - a case
control study
Yung-Shun Juan1,2,3, Mei-Yu Jang4, Cheng-Yu Long5,6, Shu-Mien Chuang1, Chun-Hsiung Huang2,3, Wen-Jen Wu2,4
1
Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 2Department
of Urology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 3Department of Urology,
Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 4Department of Urology, Kaohsiung Municipal HsiaKang Hospital, Kaohsiung, Taiwan; 5Center of Excellence for Environmental Medicine, College of Medicine, Kaohsiung
Medical University, Kaohsiung, Taiwan; 6Department of Obstetrics and Gynecology, Kaohsiung Municipal Hsia-Kang
Hospital, Kaohsiung, Taiwan
Aim of the Study
Chronic pelvic/bladder pain and sexual dysfunction are common in women with urological disorders. Ketamine
cystitis (KC) is increasingly recognized as a sequel after ketamine abuse. Evaluating correlation between sexual dysfunction
and KC is important to delineate a better therapeutic strategy. The aim of the study is to conduct a case-control study for
evaluating clinical symptom severity and sexual dysfunction in women with KC.
Twenty-nine patients with KC and 27 controls completed the symptoms survey. Participants completed a
137
visual pelvic pain analogue scale, O’Leary-Sant Interstitial Cystitis Symptom Index (ICSI) and Problem Index (ICPI)
questionnaire, Female Sexual Function Index (FSFI), and a short form of Chinese Health Questionnaire (CHQ)-12.
Results
Both ICSI and ICPS score were significantly higher in the KC patients than in the controls (p<0.001). Prevalence of
sexual dysfunction was high in KC patients. There was difference on total adjusted FSFI scores between the patients with
KC and the controls (mean total FSFI score: KC cases 17.65±6.15 vs. controls 25.87±4.16; p<0.001). In terms of sexual
activity, 17.2% (5/29) KC cases and 3.7% (1/27) controls reported no sexual activity in the year before the study. Except
for sexual desire domain of female sexual dysfunction, the patients with KC scored lower on all domains than the controls.
There was no significant difference between KC patients and the controls in mental health evaluated by CHQ-12.
Conclusions
Sexual dysfunction and KC symptoms severely impacted the quality of life. Mental health had no significant
difference between KC patients and the controls.
PT10 The correlation of urinary bladder weight and glomerulation in
female interstitial cystitis/painful bladder syndrome
Ming-Huei Lee1,2, Huei-Ching Wu1,2, Yi-Chang Chen1, Wei-Chih Chen1, Yung-Fu Chen1,2
1
Technology
Purpose
The clinical diagnosis of interstitial cystitis (IC) is based on symptoms of pain in the bladder area, urgency, frequency
and glomerulation appearing under anesthetized cystoscopy. However, the anesthetized cystoscopy may have the
complication of bladder perforation. The goal is to discuss the correlation of glomerulation and urinary bladder weight by
using noninvasive, highly accurate and highly consistent three-dimensional (3D) ultrasound imaging.
The three-dimensional (3D) ultrasound imaging is measured on 30 IC and 30 non-IC female subjects to estimate
patients’ bladder wall thickness and bladder weight. Anesthetized cystoscopy was made on IC patients to record the
severity of glomerulation. T-test was used to delineate the difference between two groups, Person test was used to describe
the relation of bladder thickness, weight and the volume.
Results
Average age of experimental group and control group is 42±10.12 years and 44±0.86 years. The average bladder
thickness of experimental group and control group is 2.17±0.39 mm and 2.02±0.39 mm. The bladder thickness of
experimental group is thicker than control group, however no statistical differences was noted. Average weight of
experimental group and control group is 44.43±5.98 g, 40.56±9.83 g. The p-value 0.071 shows no statistic difference .The
bladder thickness of patients with serious glomerulation and patients with minor glomerulation is 2.21±0.37 mm, 2.06±0.43
mm, respectively, the increasing weight is shown in the bladder muscle thickness of patients with severe glomerulation,
but p-value is 0.353. No statistical difference could be also found. The variation of bladder capacity in 2 minutes and 15
minutes under anesthetized cystoscopy is not related to bladder muscle thickness and weight.
Conclusions
The thickness and weight of IC patients are higher than controls, but without statistic difference. No obvious
differences are found among of bladder thickness, weight and the severity of glomerulation in IC patients. The noninvasive
three-dimensional (3D) ultrasound imaging could not be used to estimate the severity of glomerulation in female interstitial
cystitis patient.
138
PT11 Clinical and videourodynamic characteristics of adult women
with dysfunctional voiding
Yih-Chou Chen1, Jing-Ling Chen2, Hann-Chorng Kuo2
1
Department of Urology, Hualien Hospital, Hualien, Taiwan; 2Department of Urology, Buddhist Tzu Chi General
Aims of Study
Dysfunctional voiding (DV) is an abnormality of bladder emptying in neurologically normal individuals where the
external sphincter activity increases during voiding. Although DV is common in children and can be detected early in
those with characteristic clinical presentations or recurrent urinary tract infection (UTI), the differential diagnosis between
DV and detrusor overactivity (DO) in adult women is difficult and can be inaccurate when based on LUTS alone. This
study investigated the clinical presentations and videourodynamic characteristics of adult women with dysfunctional voiding
Study Design
A retrospective analysis of the videourodynamic (VUD) study results in recent 14 years.
This study is a retrospective analysis and a total of 1605 consecutive women with lower urinary tract symptoms (LUTS)
were analyzed from 1997 to 2010. The medical record charts were reviewed, and the clinical LUTS, co-morbidity,
VUD characteristics, urodynamic parameters, and result of treatment were recorded in detail. Patients with pelvic organ
prolapse, genuine stress urinary incontinence, previous genitourinary surgery, history of genitourinary tract cancer,
neurogenic voiding dysfunction, established diagnosis of interstitial cystitis/painful bladder syndrome, or active UTI were
excluded. These female patients with LUTS received VUD study for diagnosis. The clinical symptoms of LUTS were
recorded in detail. The main symptom was defined as the most bothersome symptom that drove patients to seek help.
DV was diagnosed when high voiding detrusor pressure, intermittent or increased external sphincter EMG activity, and a
‘spinning top’ urethral appearance on cinefluoroscopy during voiding occurred together. If patients were found to have a
neurological disease, they were classified as having external-detrusor sphincter dyssynergia but not DV. The clinical urinary
symptoms and VUD characteristics were compared with normal controls. Antimuscarinic or alpha-blocker treatment,
with or without a skeletal muscle relaxant according to the chief complaint of storage or voiding symptoms, respectively,
was given to women with DV. Patients were treated for 1 to 3 months and the treatment results were recorded using the
validated 6-scale Patients Perception of Bladder Condition questionnaire.
Results
There were 168 women diagnosed with DV. DO occurred in 69% of women with DV. Patients with DV had
lower cystometric bladder capacity, higher detrusor pressure, lower maximum flow rate, and larger post-void residual
volume than the controls (Table 1). Among patients with DV, urinary frequency (n=69, 41.1%) was the most common
chief complaint, followed by dysuria (n=54, 32.1%), and urgency incontinence (n=26, 15.5%). A total of 114 (67.9%)
patients had storage symptoms and 54 (32.1%) had voiding symptoms as their chief complaints among those with DV.
The incidence of urgency incontinence and dysuria were significantly greater than that in the control group, however, the
incidence of frequency, urgency, or nocturia showed no significant difference between DV and control groups (Table 2).
Treatment results were similar for antimuscarinic (41.2%) and alpha-blocker therapies (52.9%).
The results of this study revealed that DV is highly prevalent in women with LUTS. The incidence of DO (69%)
and increased bladder sensation (17.9%) was also higher in DV group compared with the control group. In conjunction
with smaller CBC and the presentation of storage symptoms in all women, we postulated that DV might be a voiding
dysfunction originating from sensory urgency or DO. The urodynamic parameters in DV indicate that the vesicourethral
abnormalities of DV are not only BOO, but also exhibit sensory disorders. Although dysuria was also a chief complaint
in 32.1% of patients with DV, all these patients had storage LUTS as associated symptoms. These findings suggest
that sensory dysfunction, either primary or secondary to urethral sphincter dysfunction, plays an important role in the
pathophysiology of LUTS and the development of DV. Interestingly, all DV patients had storage symptoms and about
half of the patients with primary storage symptoms were successfully treated with antimuscarinics. These results suggest
that DO could be a primary etiology of DV in adult women. A longer treatment course might improve the success rate.
139
Conclusions
DO and storage LUTS commonly occurred in women with DV. Diagnosis of DV cannot be based on LUTS alone,
as VUD studies yielded a high diagnostic rate for DV in women with LUTS.
Table 1. Urodynamic parameters of DV and control patients
CBC (mL)
Pdet (cmH2O)
Qmax (mL/s)
PVR (mL)
Compliance (mL/cmH2O)
DO
IBS
DV (n=168)
286±160
49.1±17.4
11.3±7.56
77.4±113
63.0±82.1
116 (69%)
22 (13.1%)
Normal (n=272)
482±100
18.8±8.98
20.5±7.95
25.7±44.0
120±121
0
0
p value
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
CBC: cystometric bladder capacity; Pdet: detrusor pressure; Qmax: maximum flow rate; PVR: post-void residual; DO: detrusor
overactivity; IBS: increased bladder sensation
Table 2. Chief complaints of the DV and control patients
Frequency
Nocturia
Urgency
Urge incontinence
Dysuria
Urine retention
Residual sensation
Terminal dribbling
Bladder pain
Micturition pain
DV (n=168)
69 (41.1%)
3 (1.8%)
16 (9.5%)
26 (15.5%)
53 (32.1%)
1 (0.6%)
0
0
0
0
Normal (n=272)
100 (36.8%)
5 (1.8%)
15 (5.5%)
13 (4.8%)
54 (19.9%)
3 (1.1%)
3 (1.1%)
1 (0.4%)
49 (18.0%)
4 (1.5%)
p value
0.42
0.16
0.13
0.00
0.004
1.00
0.29
0.00
0.00
0.30
PT12 Hypoxia involved glomerulation formation of interstitial cystitis
patients
1
Division of Urology, Department of Surgery, Taichung Armed Forces General Hospital; 2Department of Urology,
Taichung Hospital, Department of Health; 3Central Taiwan University of Science and Technology, Taiwan
Aim
Previous studies have reported that bladder perfusion is decreased in patients with interstitial cystitis (IC). Hypoxia
induces overexpression of vascular endothelial growth factor (VEGF), which has been reported to be associated with the
formation of glomerulations in patients with IC. We examined the relationship between hypoxia-inducible factor-1α (HIF1α) and VEGF in IC patients.
Methods and Materials
The study group consisted of 32 patients with IC, and the control group consisted of 8 volunteers. We obtained
bladder biopsies from both groups and studied the expression of HIF-1α and VEGF proteins by immunoblotting, and
immunohistochemical and double immunofluorescent staining. Data were analyzed using the Mann-Whitney U test.
Results
Immunoblotting and immunostaining revealed the expression of HIF-1α and VEGF proteins was increased in the
140
study group compared to the control group. The relative intensities of HIF-1α and VEGF proteins were 60.60±7.81 and
43.60±5.37 in the study group and 26.20±4.72 and 20.25±1.45 in the control group, respectively. The overexpression of
VEGF in study group biopsies was particularly evident in umbrella cells examined by confocal microscopy.
Conclusions
Our findings identified increased expression of HIF-1α in bladder tissue and overexpression of VEGF in umbrella
cells from patients with IC. These events may be associated with glomerulation formation during hydrodistention in IC
bladders. Thus, these molecular findings could offer the therapeutic mechanism for hyperbaric oxygenation application to
patients with IC.
PT13 Etiology and prognosis of acute female urinary retention
Josh Wei-Tang Kao1, Yu-Hua Fan1,2, Alex Tong-long Lin1,2, Kuang-Kuo Chen1,2
1
Division of Urology, Department of Surgery, Taipei Veterans General Hospital; 2Department of Urology, School of
Medicine, National Yang-Ming University, Taipei, Taiwan.
Aims of Study
Acute urinary retention (AUR) in the female is an uncommon and poorly managed condition. Despite there being
several well-known etiological factors, the majority of the literature concentrates on “psychogenic” or hysterical causes. The
aim of the study was to determine the etiology of urinary retention in females, and identify the predictors of successful trial
without catheter (TWOC) following an episode of AUR.
We prospectively recruited female patients presented with acute urinary retention between June 2006 and December
2008. All patients were interviewed for detailed personal, medical and surgical history. All patients underwent routine
urine examination and cystometrogram (CMG). On the basis of these evaluations, the etiology of AUR was determined.
The outcome of TWOC was documented. We assessed for predictors of successful TWOC, which included: age, volume
drained at time of catheterization, cause of retention, co-morbidities, and CMG variables.
Results
A total of 147 female patients were recruited into the study. The mean age of the patients was 70.3±4.5 years
(range: 22-102). Mean bladder capacity on CMG was 147.2 mL. In our patient group, comorbidity with diabetes mellitus
was 36.7% (54/147), neurologic origin was 33.8%, urinary tract infection was 10.8%, post-general anesthesia was 8.8%.
Successful TWOC rate was 72.8%. Successful TWOC was more likely in CMG disclosed detrusor overactivity or normoreflexia (p=0.004), young age (p=0.003) and anesthesia-related acute urine retention (p=0.004).
Conclusions
Successful TWOC was more likely in CMG disclosed detrusor overactivity or normo-reflexia (p=0.004), young age
and anesthesia-related acute urine retention. Urinary tract infection during acute urine retention, although an important
cause of AUR, had no influence on TWOC outcome following UTI treatment TWOC. This observation needs further
investigation.
PT14 The differences in urodynamic characteristics between female
patients with interstitial cystitis/bladder pain syndrome and
overactive Bladder
Yu-Wen Huang, Yu-Hua Fan, Alex Tong-Long Lin, Kuang-Kuo Chen
Division of Urology, Department of Surgery, Taipei Veterans General Hospital, and Department of Urology, School of
Medicine, National Yang-Ming University, Taipei, Taiwan
141
Aims of Study
Interstitial cystitis/bladder pain syndrome (IC/BPS) and overactive bladder (OAB) share similar symptoms (urgency,
frequency and nocturia). However, typically IC/BPS patients do not have urgency incontinence, indicating that certain
differences in underlying pathophysiology exist between two conditions. In an attempt to uncover such differences, we
compare the urodynamic characteristics between patients with IC/BPS and OAB.
Sixty six consecutive female patients with IC/BPS and 105 female patients with OAB received either conventional
pressure-flow urodynamic study or videourodynamic study between January 2009 and August 2010. The urodynamic
parameters were analyzed and compared between two groups. The diagnosis of IC/BPS was based on National Institute
of Arthritis, Diabetes, Digestive and Kidney Diseases (NIDDK) criteria. All patients with OAB had urgency and urgency
incontinence. No OAB patients had bladder-related pain. And no IC/BPS patients had urgency incontinence. Both
groups received symptoms assessment with questionnaires, including International prostate symptom score (IPSS) and
overactive bladder symptom score (OABSS).
Results
Mean (±SD) age of patients with IC/BPS and OAB was 47.2 (±13.8) and 64 (±13.7) years, respectively. IC/BPS
patients were significantly older than OAB patients (p<0.001). IPSS and OABSS differed significantly between two
groups (p<0.001). Voiding sub-score of IPSS was significantly higher (p<0.001) in patients with IC/BPS. Maximum flow
rate obtained with free uroflowmetry was significantly slower (p=0.024) in patients with IC/BPS, as was mean flow rate
(p=0.002). Cystometric bladder capacity was significantly larger in patients with IC/BPS (233.2±108.4 vs 184.5±104.3 mL,
p=0.004). There was no significant difference in voiding detrusor pressure at maximum flow between 2 groups (12.0±5.1
vs 13.4±9.7 cmH2O, p=0.211). 66 IC/BPS patients and 46 OAB patients received videourodynamic study. The diagnosis
of dysfunctional voiding was more prevalent in patients with IC/BPS (63.6% v.s. 8.7%, p<0.001) but the prevalence of
bladder neck obstruction was similar (3% v.s. 4.3%, p=0.712).
Conclusion
This study showed that the urodynamic characteristics were significantly different between patients with IC/BPS and
OAB. IC/BPS patients usually are younger with more severe voiding symptoms, slower flow rate and a higher prevalence
rate of dysfunctional voiding. The findings of this study support the concept that underlying pathophysiology is different, at
least in part, between IC/BPS and OAB.
PT15 Effect of repeated intravesical botulinum toxin A injections
on teatment of refractory interstitial cystitis/painful bladder
syndrome--preliminary results
Yuh-Chen Kuo1, Jia-Heng Shie2, Hsin-Tzu Liu2, Hann-Chorng Kuo2
1
Department of Urology, Taipei City Hospital, Taipei, Taiwan; 2Department of Urology, Buddhist Tzu Chi General
Aims of Study
Interstitial cystitis/painful bladder syndrome (IC/PBS) is a debilitating chronic disease of unknown aetiology
characterized by urgency frequency and suprapubic pain at full bladder. Current treatments are usually unsuccessful in
completely eradicating bladder pain and increasing bladder capacity. Although botulinum toxin A (BoNT-A) injection
seems promising in treating symptoms of IC/PBS, long term results did not provide successful outcome. This study
valuated the effects of repeated intravesical BoNT-A injections plus hydrodistention on treatment of IC/PBS refractory to
conventional treatment.
A prospective study was performed in a urological referral centre. Patients with IC/PBS who have failed conventional
treatments have been enrolled. They received intravesical injection of 100 U of BoNT-A (onabotulinumtoxinA, Allergan,
142
Irvine, CA, USA) immediately followed by cystoscopic hydrodistention under intravenous general anesthesia. Repeated
BoNT-A injection and hydrodistention were performed at 6 months after the first treatment if they felt recurrence
of baseline symptoms and desired for further treatment. The BoNT-A injection plus hydrodistention was repeated
every 6 months up to 4 times or till patients declared their symptoms have relieved. In each time of therapy, O’LearySant symptom and problem indexes (ICSI and ICPI), bladder pain visual analogue scale (VAS), functional bladder
capacity (FBC), daily urinary frequency and nocturia were recorded at baseline, 3 months and 6 months after treatment.
Urodynamic parameters were measured at baseline and 6 months after treatment. Global response assessment (GRA) was
used to evaluate successful treatment response.
Results
From 2005 October till now, 6 men and 65 women aged 44.1±11.5 (31-57) and 47.9±12.6 (21-76) years respectively
were enrolled in this study. Among them, 71, 49, 32 and 19 patients completed one, two, three and four times of
intravesical BoNT-A injection respectively. As the number of treatment increased from one to four times, the IC/PBS
symptom score, pain VAS and daytime frequency significantly decreased. When BoNT-A injection was repeated up to
four times, FBC, volume at full sensation and cystometric bladder capacity significantly increased (Table 1). In addition,
a successful result (GRA≥2) at 6 months after the first, second, third and fourth BoNT-A injection was reported in 24
(44%), 15 (44%), 9 (53%) and 7 (54%) patients (Figure 1). The overall incidence of adverse effects including urinary tract
infection, dysuria, intermittent catheterization, acute urine retention and hematuria during first, second, third and fourth
treatment was 28%, 29%, 45% and 32% respectively (p=0.305).
Repeated intravesical BoNT-A injection plus hydrodistention might not only continue decreasing the clinical
symptoms (IC/PBS symptom score, pain VAS, daytime frequency and FBC) significantly but also continue improving the
urodynamic parameters (volume at full sensation and cystometric bladder capacity) significantly in patients with refractory
IC/PBS. Long-term successful result might be achieved. The adverse effects for repeated treatment did not increase
significantly than single treatment. The effects of repeated intravesical BoNT-A injections might involve not only inhibiting
release of acetylcholine in the neuromuscular junctions of the detrusor but also anti-inflammatory response.
Conclusion
The effect of repeated intravesical BoNT-A injection plus hydrodistention on treatment of refractory IC/PBS is
promising and durable with acceptable adverse effects.
Figure 1. The overall success rate during the therapy course.
143
Table 1. Changes of baseline parameters before each time injection of BoNT-A
Variable
N
Mean±SD
ICSI
ICPI
OSS
Pain VAS
FBC
Frequency
Nocturia
Urodynamics
FSF
FS
US
CBC
Pdet
Qmax
Volume
PVR
GRA
BTX-1
71
BTX-2
49
BTX-3
32
BTX-4
19
p value
12.37±3.13
11.14±2.95
23.51±5.84
5.41±2.32
130.14±75.72
15.04±7.47
4.48±3.89
9.27±4.57
8.45±4.51
17.71±8.74
3.94±2.44
172.24±88.42
10.82±5.35
3.10±1.81
9.47±3.99
8.53±4.44
18.00±8.21
3.91±2.37
206.88±100.4
11.50±5.83
3.31±2.29
9.05±4.31
7.21±4.87
16.21±9.08
3.11±2.28
224.2±127.86
11.0±5.44
3.68±3.30
0.000*
0.000*
0.000*
0.000*
0.000*
0.001*
0.082
111.13±50.97
158.63±69.43
203.54±89.81
257.18±110.52
20.14±10.10
13.05±4.75
241.60±108.95
15.20±35.55
0.39±0.84
131.83±52.31
188.00±52.31
238.93±72.80
306.2±119.46
18.54±9.73
12.90±6.59
269.4±133.1
30.43±57.62
1.18±1.24
134.76±65.88
207.71±91.94
241.70±79.69
344.62±139.1
19.04±12.36
14.16±6.11
317.31±137.19
32.00±55.80
1.25±1.11
143.1±69.19
218.29±93.8
238.60±88.85
327.4±175.48
19.87±11.60
12.58±6.24
393.7±169.78
31.76±47.07
1.42±1.39
0.057
0.005*
0.156
0.011*
0.887
0.792
0.066
0.217
0.000*
*p<0.05
PT16 Traumatic experience and subjective symptom scores in women
with interstitial cystitis/painful bladder syndrome (IC/PBS) in
Taiwan
Wei-Chih Chen1, Ming-Huei Lee1,2, Chiu-De Chiu3, Huei-Ching Wu1,2, Yi-Chang Chen1
1
Technology; 3Department of Psychology, National Taiwan University, Taipei, Taiwan
Purpose
IC/PBS is a chronic disease of uncertain etiology that is characterized by urgency, frequency, and suprapubic pain
related to bladder filling. Early stressful experience, such as childhood sexual maltreatment, has been considered as an
environment risk factor for IC/PBS. However, the definition and the scope of potentially traumatic experience vary in
studies. It is unclear to what an extent this experience prevails in patients with IC/PBS and links to its symptom profile.
It is therefore the intent of the present study to investigate the traumatic experiences prevalence in IC/PBS patients and
correlation between traumatic experience and subjective symptoms.
This was a prospective case control study. Fifty female patients who were compatible with the NIDDK criteria
were included and these patients were assessed by validated questionnaire including O'Leary-Sant Symptom (ICSI)
and Problem Index (ICPI) was used to objectify subjective symptoms. Pelvic Pain and Urgency/Frequency (PUF)
questionnaire was also completed and standardized self-report instruments, Chinese Brief Betrayal-Trauma Survey (BBTS)
questionnaire was used to measure the prevalence of diverse potentially traumatic experiences (natural disasters, traffic
accidents, physical and sexual assaults, emotional maltreatment, and witnessing other’s negative events) in childhood and
adulthood. Subjects were tested individually in two sessions, in order to avoid fatigue. Of 200 Taiwanese college students
who was selected randomly served as controls. These data were analysed using Pearson correlations.
144
Results
Patient demographics show the average age being 40.34 years (±9.6). The average ICSI, ICPI, and PUF
questionnaire were 11.81 (±3.5), 10.89 (±2.8), and 19.02 (±5.3) respectively. The prevalence of physical attack and
emotional maltreatment by someone close to the patients showed 14% and 27% compared to control groups, 9% and
12% respectively. Another prevalence of physical attack and sexual maltreatment by someone not so close to the patients
showed 8% and 6% compared to controls, 12% and 6% respectively. Our result showed that women with IC/PBS
endorsed higher incidences on various traumatic experiences except for sexual maltreatment in both childhood and
adulthood. Diverse life events prevail in patients with IC/PBS. Nevertheless, potentially traumatic experiences did not
reliably predict the symptom profiles of IC/PBS. Only sexual maltreatment by someone close to patients had negative
correlation with subjective symptoms, ICSI.
Conclusions
Our study showed that, the prevalence of interpersonal abuse, especially those inflicted by someone close to the
patients, was higher in patients with IC/PBS. However, potentially traumatic experiences did not reliably predict the
symptom profiles of IC/PBS.
PT17 Serum testosterone levels significantly correlate with nocturia in
men aged 40–79 years
Chun-Hou Liao1,2, Han-Sun Chiang1, Hong-Jeng Yu2
1
Division of Urology, Department of Surgery, Cardinal Tien Hospital; College of Medicine, Fu Jen Catholic University,
Taipei, Taiwan; 2Department of Urology, National Taiwan University Hospital and College of Medicine, National Taiwan
University, Taipei, Taiwan
Aim of Study
To investigate the association between serum sex hormone levels and lower urinary tract symptoms (LUTS) in men
aged 40-79 years.
Methods
A cross-sectional study was conducted in 509 men (mean age 58 years). Serum total testosterone (TT),
dihydrotestosterone (DHT), and estradiol (E 2) levels were measured. Total prostate volume (TPV) measured by
transrectal ultrasonography and International Prostate Symptom Score (IPSS) questionnaire were obtained. Correlations
were determined using univariate and multivariate regression analyses.
Results
Subjects with moderate to severe LUTS (total IPSS≥8) were elder, with higher incidence of hypertension and
diabetes, with larger prostate, and had lower serum TT levels. On univariate analyses, serum TT levels were negatively
associated with total IPSS, IPSS storage subscore, weak stream, and nocturia. After adjusting age, hypertension, diabetes,
and TPV only serum TT level significantly associated with nocturia (more than 2 times per night) (p=0.042), and men with
serum TT levels in the highest quartile had 44% reduced risk of nocturia than in the lowest quartile (p=0.037).
Conclusions
In our relative healthy male cohort, most IPSS items showed no significant association with serum sex hormone
levels except for nocturia, which showed a negative correlation with serum testosterone level.
145
PT18 First-line antimuscarinic monotherapy is safe and effective for
men with predominant international prostate symptom score
storage subscore based on IPSS-voiding/storage ratio
Chun-Hou Liao1, Shiu-Dong Chung2, Victor C. Lin3, Hann-Chorng Kuo4
1
Department of Urology, Cardinal Tien Hospital, Taipei, Taiwan; 2Department of Urology, Far Eastern Memorial
Hospital, Taipei, Taiwan; 3Department of Urology, E-DA Hospital, Kaohsiung, Taiwan; 4Department of Urology, Buddhist
Aims of Study
Most of the first-line treatments for male lower urinary tract symptoms (LUTS) focus on prostate and based on
alpha-blockers traditionally. Antimuscarinic therapy is always put in the second line as monotherapy or added to combine
with alpha-blockers when LUTS do not improve. Physicians usually concern that the inhibitory effect of antimuscarinics
might aggravate voiding difficulties or cause urinary retention. There is still controversy about which patients can be
beneficial from and who are at risk for first-line antimuscarinic monotherapy for LUTS. We conduct a prospective study
to investigate the safety and efficacy of first-line antimuscarinics monotherapy for men with predominant storage based
on the International Prostate Symptom Score (IPSS) voiding to storage subscore ratio (IPSS-V/S). This study was also
aimed to identify the risk factors of increased post-void residual (increased PVR by ≥50 mL) and aggravating IPSS voiding
subscore (increased IPSS-V by ≥4) after first-line tolterodine monotherapy for men with a IPSS-V/S≤1.
We conducted a prospective open-label study in men with total IPSS (IPSS-T) 8 or more. Total prostate volume
(TPV), transition zone index (TZI), maximum flow rate (Qmax), PVR, and voiding efficiency (VE) were also obtained.
The voiding (IPSS-V) and storage IPSS subscores (IPSS-S) were recorded separately. Men with a higher IPSS-S than
IPSS-V (IPSS-V/S≤1) received first-line tolterodine (4 mg QD) monotherapy regardless of their TPV, TZI, Qmax, PVR,
or PSA values. Men with active infection, abnormal digital rectal exam, PSA>4 ng/mL without prostate biopsy, or previous
transurethral surgery were excluded.
Results
One-hundred and twenty-five consecutive men (aged 31 to 90 years) received first-line tolterodine monotherapy for
1 month. The mean IPSS-T, IPSS-S decreased, and quality of life improved significantly (p<0.001). At 1 month, 73.2%
of patients reported a satisfactory result based on IPSS quality of life improvement. No patient developed acute urinary
retention, but significantly increased PVR (from 51.9 mL to 65.7 mL) was noted. Increased PVR (≥50 mL) and IPSS-V (≥4)
were found in 17 (13.6%) and 18 (14.4%) patients, respectively. Patients with increased PVR≥100 mL after treatment had
a baseline PVR (107.7±100.2 mL) greater than those with a PVR<100 mL (38.8±35.9 mL) at 1 month (p<0.05). However,
the baseline parameters including TPV, Qmax, PVR, VE, or severity of IPSS, were similar between patients with and
without increased PVR≥50 mL or IPSS-V after treatment.
The mean IPSS-T, IPSS-S, and quality of life decreased significantly after first-line tolterodine monotherapy for
1 month regardless the baseline prostate volume, Qmax, PVR, VE, or IPSS severity. Our patients have mean baseline
TPV≥40 mL and PSA>3 ng/dl, which implies that tolterodine monotherapy is safe and effective for patients with large
total prostate volume or high PSA. However, our conclusion cannot extend to patients with large PVR because the mean
baseline PVR was only 51.9 mL in our study. However, if men with LUTS had a baseline PVR greater than 100 mL, the
PVR tended to be greater than 100 mL after tolterodine treatment. In addition, we cannot identify risk factors of increased
PVR of ≥50 mL or aggravated IPSS-V of ≥4 after tolterodine monotherapy in this study.
Conclusions
First-line tolterodine monotherapy for men with IPSS-V/S≤1 is safe and effective with no increased risk of urinary
retention and only mildly increased PVR is noted. For these patients, it is difficult to identify risk factor of increased PVR
or IPSS-V using baseline parameters.
146
Table 1. Changes of parameters after antimuscarinic monotherapy for 1 month
IPSS-T
IPSS-V
IPSS-S
Qmax
PVR
Volume
QoL
Pre-Treatment
14.82±5.72
5.34±3.69
9.61±3.23
12.85±8.26
51.85±62.44
209.67±163.74
3.90±0.57
Post-Treatment
10.82±6.56
4.69±4.51
6.15±3.26
13.83±8.23
65.73±64.39
230.48±149.25
2.77±1.00
p value
0.000
0.156
0.000
0.116
0.034
0.121
0.000
Table 2. Comparisons of baseline parameters between patients with and without increased PVR or IPSS-V after
tolterodine monotherapy for 1 month
TPV<40 mL
TPV≥40 mL
Qmax<15
Qmax≥15
PVR<50
PVR≥50
V.E<90
V.E≥90
IPSS-T<20
IPSS-T≥20
PVR increased
<50 mL
43(79.6%)
28(82.4%)
44(77.2%)
25(86.2%)
44(78.6%)
28(84.8%)
43(82.7%)
26(76.5%)
21(70.0%)
51(86.4%)
≥50 mL
11(20.4%)
6(17.6%)
13(22.8%)
4(13.8%)
12(21.4%)
5(15.2%)
9(17.3%)
8(23.5%)
9(30.0%)
8(13.6%)
p value
0.490
0.244
0.332
0.330
0.059
IPSS-V increased
<4
≥4
47(79.7%)
12(20.3%)
30(83.3%)
6(16.7%)
46(76.7%)
14(23.3%)
26(86.7%)
4(13.3%)
49(83.1%)
10(16.9%)
26(76.5%)
8(23.5%)
43(78.2%)
12(21.8%)
29(82.9%)
6(17.1%)
26(81.3%)
6(18.8%)
49(80.3%)
12(19.7%)
p value
0.437
0.203
0.305
0.398
0.574
V.E: voiding efficiency
Table 3. Comparisons between patients with PVR≥100 mL and <100 mL after tolterodine monotherapy
Baseline data
Age
IPSS-T
IPSS-V
IPSS-S
IPSS-V/S
PSA (ng/dl)
TPV (mL)
Qmax (mL/s)
PVR (mL)
2 weeks after treatment
PVR≥100 mL (n=20)
72.6±10.5*
14.7±5.9
5.7±3.4
9.0±2.9
0.64±0.30
5.2±7.4
46.3±38.1
8.3±3.4*
106.5±99.2*
PVR<100 mL (n=75)
66.4±12.8*
14.9±5.9
5.8±4.0
9.1±3.3
0.72±0.62
4.0±5.2
37.7±18.2
13.5±8.7*
35.6±35.3*
1 month after treatment
PVR≥100 mL (n=17) PVR<100 mL (n=84)
74.1±12.1*
66.0±11.9
15.5±5.9
14.5±5.5
6.0±3.5
5.6±3.8
9.4±3.3
9.1±3.2
0.66±0.30
0.69±0.58
6.5±7.4
3.8±5.0
52.9±41.7
37.6±17.8
107.7±100.2*
38.8±35.9*
*p<0.05 by ranksum test; **p<0.05 by chi-square test between groups
PT19 Lower urinary tract symptoms and quality of life in the patient
underwent radical cystectomy and orthotopic neobladder
Eric Chieh-Lung Chou, Hung-Chieh Chiu, Chao-Hsiang Chang, Hsi-Chin Wu, Che-Rei Yang
Department of Urology, China Medical University Hospital, Taichung, Taiwan
Purpose
The incidence of urinary bladder cancer is increasing gradually in the past 20 years in Taiwan. For advanced bladder
147
cancer with muscle-layer invasion, radical cystectomy with orthotopic neobladder is one of treatment choices. There are
few studies aimed for post-operative voiding dysfunction and life quality evaluation. The aim of our study was to evaluate
low urinary tract symptoms and quality of life in the patient underwent radical cystectomy with orthotopic neobladder.
We had retrospectively reviewed all the patients underwent radical cystectomy with orthotopic neobladder in the
past 15 years in CMUH . American Urological association symptom score (AUASS), Urogenital Distress Inventory
(UDI), King’s health questionnaire (KHQ) were used for evaluation in telephone or appointment interview. Uroflometry
was arranged for further evaluation when patients returned to outpatient-department. .Based on AUASS , the cases were
divide into two groups : Group I: AUASS≤7 (mild symptoms) and Group II: AUASS>7(moderate to severe symptoms).
The difference between 2 groups was determined and statistically analyzed.
Results
A total of 19 cases who underwent radical cystectomy with orthotopic neobladder were included. Group I: n=7
(36.85%) and Group II: n=12 (63.15%) . Significant difference was noticed in obstructive symptoms (emptying problem,
intermittency, weak stream, straining) in AUASS (p<0.05) among two groups. Positive relationship was noted between in
emptying symptom of AUASS and residual urine amount in uroflowmetry. Urine leakage related to physical activity or
coughing and difficulty in urination revealed significant difference between two groups in UDI. Group I got significant
better life quality in the physical and emotional domains than Group II. The mean Qmax and average flow rate in
uroflowmetry were 14.5 mL/s and 6.6 mL/s in group I and 7.5 mL/s, 2.2 mL/s in group II (P<0.01 ) which showed
statistically significance.
Conclusions
Near two-thirds of our patients underwent radical cystectomy with orthotopic neobladder experienced moderate to
severe low urinary tract symptoms. Obstructive symptoms were the main voiding symptoms. The result in King’s health
questionnaire demonstrated the voiding symptoms affected their quality of life with respect to the physical and emotional
domains.
PT20 Urodynamic examination with potassium chloride (KCL) test in
women with interstitial cystitis/painful bladder syndrome (IC/
PBS)
Wei-Chih Chen1, Ming-Huei Lee1,2, Yi-Chang Chen1, Ya-Ling Chen1, Huei-Ching Wu1,2
1
Technology
Purpose
Recent research has suggested that in healthy volunteers, if cystometry is repeated with 0.9% NS during the same
session, the bladder volumes tend to increase by 30-50 mL, and it is the similar findings in the neurogenic bladder
patients. Other researchers have proposed that a comparative assessment of cystometric capacity using 0.9% NS and
0.2 M KCL suggesting that a decrease in maximum cystometric capacity of more than 30% with KCL compared to NS
is indicative of IC/PBS. The aim of our study is to explore differences of the IC/PBS patients in urodynamic findings
between consecutive 0.9% NS and 0.2 M KCL instillation.
This is a prospective study for all the urodynamic studies that were done for female patients with IC/PBS symptoms
in one center. IC/PBS patients who were compatible with the NIDDK criteria were included and the urodynamic findings
were reported by one physician. After thorough counseling, informed consent for consecutive cystometry with NS and
KCL was obtained.The patients are subdivided in to two groups. Group 1 consisted of 80 women that 2 consecutive
cystometries with NS and KCL were performed. Group 2 consisted of 22 women that performing 3 consecutive
cystometries with 0.9% NS for twice and 0.2 M KCL. On filling cystometry we recorded and examined variability between
148
volume at first desire to void (FDV), normal desire to void (NDV), strong desire to void (SDV) and maximum cystometric
capacity (MCC).
Results
Our study shows that the volumes in group 2 at FDV, NDV, SDV, and MCC increased significantly from the first
NS instillation to the second measurement, by 32.00 mL, 44.60 mL, 50.13 mL, and 45.52 mL respectively. In addition
the volumes in group 2 at NDV, SDV, and MCC decreased significantly from the second NS instillation to the KCL
measurement except FDV. However, the volumes in group 1 at MCC decreased significantly by 27.36 mL from NS to
KCL with no significant change at FDV, NDV, and SDV. The results indicate that in IC/BPS patients if filling cystometry
repeated during the consecutive NS instillation the bladder capacity tended to increase.
Conclusions
IC/PBS patients have increased bladder capacity around 32.00 mL to 50.13 mL during the consecutive cystometries
with NS from first to second, which was similar in normal volunteers. There existed a significant decrease with mean value
49 mL with 3 consecutive cystometry from second normal saline to 0.2 M KCL than dual cystometry. The difference
should be kept in mind while performing the urodynamic study especially with 0.2 M KCL.
PT21 Differences in the subjective symptoms, urodynamic examination
and cystoscopic maximal bladder capacity of Interstitial Cystitis/
Painful Bladder Syndrome (IC/PBS) in Women With or Without
Sexual pain
Huei-Ching Wu1,2, Wei-Chih Chen1, Ming-Huei Lee1,2, Chui-De Chiu3 ,Yi-Chang Chen1
1
Technology; 3National Taiwan University of clinical psychology, Taipei, Taiwan
Purpose
Previous study established a strong association between urinary tract symptoms and arousal disorders and sexual
pain disorders. Other sources suggested that IC/PBS patients had significantly more dyspareunia and more fear of pain,
compared with healthy controls. We investigated the differences in the subjective symptoms, urodynamic findings and
anesthetic bladder capacity of IC/PBS in women with or without sexual pain.
A total of 89 IC/PBS female patients were included in this study. All subjects were asked if they had a history of
sexual pain and were assessed by validated questionnaire including O'Leary-Sant Symptom (ICSI) and Problem Index
(ICPI). Pelvic Pain and Urgency/Frequency (PUF) questionnaire was also completed. Standardized consecutive filling
cystometry and volume at first desire to void (FDV), normal desire to void (NDV), strong desire to void (SDV) and
maximum cystometric capacity (MCC) were performed. Cystoscopic anesthetic maximal bladder capacity (MBC) was also
measured. We compared subjects with and without a history of sexual pain disorder using unpaired 2-tailed t tests.
Results
The occurrence of IC/PBS patients with sexual pain disorder was 65/89 (73%). Patient demographics with or without
sexual pain disorder showed the average age being 39.98 years (±11.8) and 41.17 years (±10.2), respectively. The ICSI
and ICPI scores were equivalent between the two groups but patients with sexual pain had a statistically significant higher
PUF scores than those without sexual pain (21.52± 5.4 v.s 16.21± 4.6, p< 0.01). In patients with sexual pain, the values for
FDV, NDV, SDV, and MCC were lower than those without sexual pain but were not statistically significant (67.89± 35.9
v.s 86.13±52.5 mL, 93.31±38.2 v.s 115.13±56.4 mL, 138.78±65.8 v.s 158.19±110.2 mL, 195.43±69.9 v.s 225.75±149.8
mL). Similarly, patients with sexual pain had lower anesthetic MBC than those without sexual pain, however no statistically
significant difference could be noted (596.15± 210.1 v.s 646.25±156.7 mL, p=0.2).
Conclusions
149
Women with IC/PBS symptoms experience around 73% occurrence rate of sexual pain in our study. MCC and
anesthetic MBC showed lower capacity in sexual pain group but without statistically significant difference between two
groups. PUF score was higher in patients with sexual pain disorder group but ICSI and ICPI did not show the difference.
This suggests that physicians should consider sexual pain disorder in the management of patients with IC/PBS and the
evaluation of subjective symptoms including sexual pain in IC/PBS patients, PUF score maybe better than ICSI and ICPI.
PT22 Urine nerve growth factor levels are elevated in type 2 diabetic
patients aged less than 45 years old and correlated with erectile
dysfunction but not lower urinary tract symptoms
Chung-Cheng Wang1, Hsin-Tzu Liu2, Hann-Chorng Kuo2
1
Department of Urology, En Chu Kong Hospital, Taipei, Taiwan; 2Department of Urology, Buddhist Tzu Chi General
Aims of Study
Urine nerve growth factor (NGF) levels have been considered as a novel biomarker for diagnosing overactive
bladder. Overactive bladder is a common clinical presentation in the early stage of diabetes. Erectile dysfunction is
associated with lower urinary tract symptoms. Taking together, we hypothesize that urine NGF levels is elevated in the
early stage of diabetes and correlated with the severity of lower urinary tract symptoms and erectile dysfunction. The aims
of study is to investigate urine NGF levels in type 2 diabetic men younger than 45 years old and to correlate the lower
urinary tract symptoms and erectile dysfunction.
Urinary NGF levels were measured in 72 diabetic patients and in 20 control subjects without lower urinary tract
symptoms or erectile dysfunction. The urinary NGF levels were measured by enzyme-linked immunosorbent assay. The
total urinary NGF levels were normalized to the concentration of the urinary creatinine (NGF/Cr) level. Participants
were evaluated using the International Prostate Symptom Score (IPSS), quality of life (IPSS-QoL), Overactive Bladder
Symptom Score (OABSS), the five-item version of the International Index of Erectile Function questionnaire (IIEF-5), the
patient perception of bladder condition (PPBC) questionnaire and measurement of flow rate and postvoid residual urine
volume. The Spearman correlation analyses were used to examine urinary NGF/Cr levels associated with IPSS, IIEF-5,
OABSS, PPBC and uroflowmetry.
Results
The mean (SD, range) age of the diabetic patients was 39.8 (6.1, 19-45) years and the mean duration of diabetes was
4.0 (4.0, 0.5-20) years. Diabetic patients had significantly higher urinary NGF/Cr levels compared to the controls (0.48 ± 1.2
versus 0.01±0.01, p=0.04). The urinary NGF/Cr levels were negatively correlated with IIEF-5 score (p=0.03, coefficient=
-0.26, -0.02~-0.47). The urinary NGF/Cr levels were not correlated with age (p=0.33), diabetic duration (p=0.75), body
mass index (p=0.30), IPSS score (p=0.69), OABSS score (p=0.70), voided volume (p=0.91), peak flowrate (p=0.54),
postvoid residuals (p=0.89). Forty-two patients with urinary NGF/Cr level <0.05 had higher IIEF-5 score than 30 patients
with urinary NGF/Cr level ≥0.05 (20.2±4.6 versus 16.9±6.7, p=0.03).
Previous study has been showed that type 2 diabetic patients aged less than 45 years old have more lower urinary
tract symptoms and erectile dysfunction. This study further demonstrated that compared with controls, diabetic patients
aged less than 45 years old have higher urine NGF levels, a biomarker of overactive bladder. However, the urine NGF
levels were not correlated with the severity of lower urinary tract symptoms or overactive bladder symptoms. Interestingly,
the urine NGF levels were correlated with the severity of erectile dysfunction.
Conclusions
Urinary NGF levels were elevated in type 2 diabetic male aged less than 45 years. Urinary NGF levels were
correlated with erectile dysfunction but not correlated with lower urinary tract symptoms, OAB symptoms or the
parameters of uroflowmetry in these patients.
150
PT23 Prevalence of overactive bladder and urinary incontinence
and their associated factors among middle and elder people in
Taiwan
Aih-Fung Chiu1, Hung M2, Chun-Hou Liao3, Hann-Chorng Kuo4
1
Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan; 2Department of Nursing, Meiho University,
Pingtung, Taiwan; 3Department of Urology, Cardinal Tien Hospital, Taipei, Taiwan; 4Department of Urology, Buddhist
Aims of Study
To explore the prevalence of overactive bladder (OAB) symptoms and urinary incontinence (UI) and associated
factors among the middle and elderly people in southern Taiwan.
A cross-sectional design using participant-reported questionnaires was adopted in this study. In Taiwan, the voluntary
health examinations free of charge for adults aged 40 years are regularly Implementation. A convenience sample visiting
the four public health centers for health examinations in Pingtung county, southern Taiwan were recruited during March
to July of 2010. The inclusion criteria were people who aged 40 years or older, and who were willing to participate in this
study. A total of 1190 participants were contacted, whereas 136 subjects without complete the survey and 44 subjects who
complained of the presence of urinary symptoms occurred in the past four weeks, which was suspected to be a current
urinary tract infection (UTI), were excluded from this study. Overall, 1010 participants (480 males and 530 females)
completed the survey of urinary symptoms. Each interview was approximately 15-20 minutes to complete. No urodynamic
studies or urinary diaries were performed. All of the participants in this survey voluntarily filled out the questionnaires and
were assured of retaining their anonymity.
Results
OAB were reported by 17.5% of participants (16.8% of females and 18.3% of male). UI was reported by 19.0%
of participants (22.6% of females and 25% of males). Age, heart diseases, stroke, chronic constipation and the history of
urinary tract infection in the past year were independent factors for OAB, while gender, age, diabetes, chronic constipation
and urinary tract infection were independent factors for UI. Most (67.4%) participants with 68.7% of females and 65.7%
of males perceived mild to sever symptom bother, however, only 34.1% of participants with OAB or/and UI have ever
sought a physician for your bladder symptoms.
Our study reported higher prevalence of OAB and UI compared with previous community-based epidemiological
surveys. This is understandable, different prevalence may be explained by differences in definition of OAB and UI, study
population or survey method (telephone, interview, or mail) and different sample group. The present study had less
restrictive definition of OAB (defined as urgency was one or more episodes/week and more than 3 points of the OABSS),
and survey sample come from the public health centers for free physical examination were more older individuals.
Anyway, the results of this study imply that a substantial burden of OAB and UI in the communities. In addition, the
chronic illnesses showed the complex link with OAB and UI. We cannot clarify whether the chronic illnesses may arouse
OAB or UI in this cross-sectional study, however, this study indicated that OAB and UI co-existed with several chronic
illnesses.
Conclusions
OAB and UI affect a substantial people in southern Taiwan. Excepting for females and elderly people, health
providers should increase the awareness that people with some specific comobit illnesses are susceptible groups for OAB
and UI, and thereby provide the appropriate continence prevention or management.
151
PT24 Therapeutic effect of α-blockers and antimuscarinics in male
lower urinary tract symptoms based on international prostate
symptom Score (IPSS) subscore ratio
Chun-Hou Liao1, Shiu-Dong Chung2, Chung-Cheng Wang3, Victor C. Lin4, Hann-Chorng Kuo5
1
Department of Urology, Cardinal Tien Hospital, Taipei, Taiwan; 2Department of Urology, Far Eastern Memorial
Hospital, Taipei, Taiwan; 3Department of Urology, En Chu Kong Hospital, Taipei, Taiwan; 4Department of Urology, E-DA
Hospital, Kaohsiung, Taiwan; 5Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
Aims of Study
Lower urinary tract symptoms (LUTS) include voiding, storage, and postmicturition symptoms. Although most initial
treatments for male LUTS focused on prostate and based on alpha-adrenoceptor antagonists traditionally, a subset of
men who receive treatment for prostate conditions may have persistent storage symptoms. Under such condition, additive
of antimuscarinics for residual storage symptoms is recommended. However, many primary care clinicians (PCPs) may
avoid using antimuscarinics in men because of safety concerns. We had reported that measuring International Prostate
Symptom Score (IPSS) subscores and calculating the IPSS voiding to storage subscore ratio (IPSS-V/S) is a simple and
useful method to differentiate failure to voiding and failure to storage lower urinary tract dysfunction in men with LUTS.
To further investigate if IPSS-V/S can help to guide the treatment for male LUTS, we conducted the prospective, nonrandomized and open-label study to investigate the therapeutic effect of α-blockers and antimuscarinics in male LUTS
based on IPSS-V/S.
Three hundred and seventy-one men aged 40 years or older with a total IPSS (IPSS-T) 8 or more were enrolled
from January 2010 to December 2010. The voiding (IPSS-V) and storage IPSS subscores (IPSS-S) were recorded
separately by patients themselves before any treatment, and the IPSS-V/S was calculated. Patients were divided into 2
groups according to IPSS-V/S. Doxazosin 4 mg and tolterodine 4 mg per day was given to patients with IPSS-V/S>1 and
IPSS-E/S≤1, respectively.
Results
There were no significant differences of baseline age, quality of life (QoL), total prostate volume (TPV), transition
zone index (TZI), prostate specific antigen (PSA), maximum flow rate (Qmax), voided volume, or postvoid residual
(PVR) between groups (Table 1). After medical treatment for 1 month, 100/139 (71.9%) patients receiving tolterodine and
170/209 (81.3%) patients receiving doxazosin reported an improved outcome (global response assessment, GRA≥1 point).
Total IPSS and IPSS-S were significantly decreased in both groups. But significant increased Qmax, voided volume and
decreased IPSS-V were noted only in patients receiving doxazosin. No patient treated with tolterodine developed urinary
retention, but significantly increased PVR (from 51.76 mL to 65.61 mL) was noted (Table 2). When comparing baseline
parameters between those with GRA≥1 and GRA<1, there were no significant differences in both groups (Table 3).
Our preliminary results showed satisfactory response using IPSS-V/S to guide the initial treatment for male LUTS.
Using tolterodine for patients with IPSS-V/S≤1 was safe and effective except mild increased PVR was noted. However, it’s
hard to identity who will report GRA≥1 using baseline parameter.
Conclusions
Initial treatment with tolterodine for patients with IPSS-V/S≤1 and doxazosin for patients with IPSS-V/S>1 is safe
and effective. Using IPSS-V/S ratio can help to guide the treatment of male LUTS, especially for the PCPs.
152
Table 1. Baseline parameters between IPSS-V/S>1 and IPSS-V/S≤1
Age (years)
IPSS-T
IPSS-V
IPSS-S
QoL
TPV (mL)
TZI
PSA (ng/mL)
Qmax (mL/s)
Volume (mL)
PVR (mL)
Total (n=371)
66.05±11.96
16.33±6.06
9.54±5.07
6.85±3.51
3.91±0.52
43.08±26.37
0.33±0.12
3.76±5.27
11.51±6.79
218.18±157.40
50.10±58.16
IPSS-V/S>1 (n=244)
65.44±11.18
17.33±6.14
11.84±4.19
5.53±2.93
3.93±0.51
42.91 ± 23.92
0.33 ± 0.12
3.66 ± 5.32
11.08 ± 6.18
229.43 ± 156.80
50.71 ± 58.53
IPSS-V/S≤1 (n=127)
67.20±13.31
14.40±5.43
5.13±3.44
9.38±3.15
3.87±0.53
43.40 ± 30.67
0.34 ± 0.13
3.97 ± 5.19
12.36 ± 7.81
196.33 ± 156.91
48.94 ± 57.68
p value
0.179
0.000
0.000
0.000
0.295
0.870
0.527
0.597
0.123
0.063
0.786
IPSS-T: IPSS total score; IPSS-V: IPSS voiding subscore; IPSS-S: IPSS storage subscore; IPSS-V/S: IPSS voiding to storage subscore
ratio; QoL: quality of life; TPV: total prostate volume; TZI: transition zone index; PSA: prostate specific antigen; Qmax: maximum flow
rate; PVR: postvoid residual
Table 2. Parameters changes after medical treatment for 1 month
IPSS-T
IPSS-V
IPSS-S
Qmax
Volume
PVR
IPSS-V/S>1 (n=200)
Doxazosin Tx
Pre-Tx
Post-Tx
17.24 ± 6.13
9.81 ± 5.56
11.87±4.25
5.70±4.65
5.43±2.95
4.11±2.42
10.43±5.62
13.16±6.92
228.55±154.30
265.05±158.88
53.08±59.92
46.81±54.19
P-value
0.000
0.000
0.000
0.000
0.001
0.166
IPSS-V/S≤1 (n=97)
Tolterodine Tx
Pre-Tx
14.78±5.71
5.34±3.67
9.58±3.23
13.07±8.45
213.45±166.34
51.76±62.09
Post-Tx
10.75±6.56
4.66±4.50
6.10±3.27
13.92±8.22
235.77±155.98
65.61±64.04
p value
0.000
0.138
0.000
0.177
0.094
0.032
Table 3. Comparisons of baseline parameters between GRA≥1 and GRA<1 at 1 month in both groups
Age
IPSS-T
IPSS-V
IPSS-S
TPV
TZI
Qmax
Volume
PVR
IPSS-V/S>1 (n=200)
Doxazosin Tx
GRA≥1 (n=163)
66.53±10.76
17.28±6.07
11.83±4.23
5.50±2.94
45.17±25.35
0.34±0.12
10.41±6.04
220.25±143.67
56.57±62.59
GRA<1 (n=37)
64.14±9.60
17.08±6.46
12.00±4.39
5.11±3.01
40.85±24.86
0.31±0.12
11.17±4.84
254.75±193.88
40.00±49.48
P value
0.215
0.862
0.831
0.471
0.356
0.135
0.499
0.248
0.155
IPSS-V/S≤1 (n=97)
Tolterodine Tx
GRA≥1 (n=71)
68.31±13.71
14.73±5.77
5.31±3.76
9.61±3.32
41.05±26.17
0.34±0.12
13.30±9.06
212.28±184.22
53.37±58.77
GRA<1 (n=26)
66.92±10.81
14.92±5.65
5.42±3.47
9.50±3.02
42.46±21.71
0.31±0.14
11.98±6.49
185.71±120.20
45.75±70.21
p value
0.606
0.885
0.894
0.887
0.808
0.496
0.516
0.513
0.604
153
PT25 In lipopolysaccharide-induced bladder inflammation the
urothelium exhibits a loss of inhibtory function on the detrusor
and an increased expression of TRPV1
Yu-Hua Fan, Alex T.L, Lin, Kuan-Kuo Chen, Luke S Chang
Division of Urology, Department of Surgery, Taipei Veterans General Hospital, and School of Medicine, National YangMing University, Taipei, Taiwan
Aims
Bladder overactivity might be due to an enhanced sensory activity of the urothelium and/or an increase of
contractility/excitability of the detrusor. This study investigated the underlying mechanisms for lipopolysaccharide (LPS)induced bladder overactivity.
We used male New Zealand rabbits for the study. Bladder inflammation was induced with intravesical instillation
of 5 mL E.Coli endotoxin lipopolysaccharide (750 μg/mL) for 90minutes (N=6). Before and 4 hours after LPS instillation
cystometry was performed. Control group (n=6) received normal saline instillation. Tissue strips from bladder body
were then obtained and the contractile responses to 120 mM KCl, field stimulation and bethanechol were tested on the
strips with (Uro+) and without (Uro-) urothelial layer in the tissue bath. The expression of nitrotyrosine and Rho kinase
II in the urothelium and detrusor was determined with western blotting. The expression of TRPV1 was assessed with
immunohistochemistry.
Results
LPS Instillation induced bladder inflammation with the inflammatory cells infiltrating in the urothelial layer.
Comparing with normal saline group, instillation of LPS induced bladder overactivity with a mean reduction of 43%
bladder capacity. In the control group the contractile response to KCL was not different between Uro+ and Uro- strips.
But the responses to field stimulation and bethanechol of Uro- strips were significantly greater than those of Uro+ strips.
Following LPS instillation the contractile responses of the Uro- detrusor strips to all types of stimulation were not different
from the control Uro- strips. However, in LPS group the contractile responses were not different between Uro- and Uro+
strips. The expression of nitrotyrosine and Rho Kinase II was not significantly changed following LPS instillation as shown
by the western blotting. Immunohistochemistry showed an increased expression of urothelial TRPV1 in the LPS-treated
bladders.
Conclusions
The loss of urothelial inhibitory action on the detrusor contraction and the increased TRPV1 expression of the
urothelium, but not an increase in Rho kinase expression of the detrusor, might contribute to the bladder overactivity in
LPS-induced inflammation.
PT26 Green light laser versus thulium laser prostatectomy: a
randomized prospective study by a single surgeon
Chung-Cheng Wang
Department of Urology, En Chu Kong Hospital, Taipei, Taiwan
Introduction and Objective
Various laser technologies have been applied to treat lower urinary tract symptoms secondary to benign prostatic
hyperplasia (BPH). A prospective randomized study to compare green light laser (GLL) and thulium laser prostatectomy
(TmL) for symptomatic BPH was reported.
154
100 consecutive BPH patients were randomized for surgical treatment with GLL (n=50) and TmL (n=50). All
patients were preoperatively assessed International Prostate Symptom Score (IPSS), PSA, uroflowmetry and transrectal
ultrasound of prostate. Preoperative and perioperative parameters at 1 and 6 months follow-up were also evaluated. All
complications were recorded.
Results
The mean patient age (70.3±6.7 versus 69.5±7.3, p=0.85), IPSS (22.9±5.8 versus 23.8±6.1, p=0.70), prostate size
(65.9±16.7 versus 63.5±17.3, p=0.51), PSA (3.5±1.7 versus 3.2±1.3, p=0.77) , voided volume (167±50 versus 187±67,
p=0.77), maximal urinary flowrate (7.9±2.7 versus 8.1±3.3, p=0.45) and residual urine (108±58 versus 117±73, p=0.46)
were comparable in GLL and TmL groups. GLL was significantly superior to TmL in terms of catheterization time (22±1
versus 34±2 hours, p<0.01) and hospital stay (34±5 versus 44±6, p<0.01). TmL was significantly superior to GLL in terms
of operative time (107±37 versus 75±23, p<0.01) and reduction in prostatic size (15±3 versus 26±5 g, p<0.01). Both groups
resulted in a significant improvement from baseline in terms of IPSS, uroflowmetry and residual urine. But no significant
difference was found between two groups. Late complications were limited and also comparable.
Conclusion
Both lasers are promising, safe and effective technologies to treat lower urinary tract symptoms in symptomatic BPH.
PT27 The role of C-reactive protein in the diagnosis of women with
lower urinary tract symptoms
Sheng-Mou Hsiao1, Fei-Chi Chuang2, Hann-Chorng Kuo3
1
Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Taipei, Taiwan; 2Department of Obstetrics
and Gynecology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 3Department of Urology, Buddhist Tzu Chi
Aims of Study
Lower urinary tract symptoms (LUTS) are symptoms reported by patients’ perception of bladder feeling. The real
pathophysiology for LUTS might be difficult to interpret based on symptoms alone. Some lower urinary tract dysfunctions
(LUTD) may have similar storage or voiding symptoms. Besides, chronic inflammation is cnsidered to be a possible
underlying mechanism for OAB and painful bladder syndrome, which are common subgroups of LUTD. The aim of this
study was to investigate the role of C-reactive protein (CRP), a marker of inflammation, in women with LUTS, especially
for discriminating LUTD subtypes.
Between March 2009 and January 2011, all consecutive women with LUTS who visited the outpatient clinics of
Department of Urology of a medical center for treatment were enrolled in this study. The enrolled women were also
questioned by overactive bladder symptom score (OABSS), urgency severity score (USS) questionnaires, and CRP levels.
The classification of female LUTD was based on the results of videourodynamic study.
Results
Two hundred and thirty two women were enrolled (Table 1). The mean CRP level was 0.22±0.60 mg/dL. Univariate
linear regression analysis revealed that age, body mass index and the presence of voiding dysfunction were associated
with CRP level. However, backward stepwise multivariate regression revealed that higher body mass index, lower voided
volume were independent predictors for higher CRP level, and the presence of increased bladder sensation (IBS) was an
independent predictor for lower CRP levels (Table 2). From receiver operating characteristic curve, we found that CRP
≥0.13 mg/dL was a cut-off point to detect non-IBS LUTS with an area of 0.59 (95% confidence interval = 0.51 to 0.67)
(Figure 1). The probability of having non-IBS LUTS in a female LUTS patient with CRP ≥0.13 mg/dL was 78.2%, and
the probability of having IBS with CRP <0.13 mg/dL was 39.5%.
155
Higher body mass index associated with higher CRP level had been reported [1,2]. Besides, the finding of lower
voided volume as a predictor for higher CRP level might mean that increased systemic inflammation might be associated
lower bladder capacity, echoed Kupelian et al.’s findings [3]. In addition, we had a novel finding that the presence of
increase bladder sensation was associated with a decrease of CRP level, and this meant that increase bladder sensation may
be indeed a different subtype to other female LUTS and associated with less inflammatory status. However, the predictive
value of CRP in detecting IBS is poor.
Conclusion
Body mass index, voided volume and the presence of increased bladder sensation (IBS) were independent
predictors for CRP level. However, CRP level is not suitable for discriminating female LUTD subtypes.
Table 1. Baseline demographic and clinical characteristics of female patients with lower urinary tract symptoms
Variables
Age (years)
BMI (kg/m2)
OABSS
USS
CRP (mg/dL)
Qmax (mL/s)
Voided volume (mL)
PVR (mL)
IBS (n)
OAB dry (n)
OAB wet (n)
Voiding dysfunction (n)
SUI (n)
NORM (n)
n=232
57.7±15.0
23.9±4.0
5.4±3.0
1.9±1.0
0.22±0.60
17.4±10.0
214.8±140.4
39.2±51.7
76 (31.7%)
59 (28.8%)
43 (20.1%)
37(17.3%)
13 (0.7%)
4 (1.4%)
BMI: body mass index; CRP: C-reactive protein; IBS: increased bladder sensation; NORM: normal control; OAB: overactive bladder;
OABSS: Overactive Bladder Symptom Score; PVR: post-void residual; Qmax: maximum flow rate; SUI: stress urinary incontinence;
USS: Urgency Severity Score; VD: voiding dysfunction
Table 2. Univariate and multivariate linear regression analyses of predictors for serum CRP levels among 232 women
with lower urinary tract symptoms
Variables
Age (years)
BMI (kg/m2)
OABSS
USS
Qmax (mL/s)
VV (mL)
PVR (mL)
IBS
OAB dry
OAB wet
SUI
VD
NORM
Abbreviation as Table 1
Univariate
Coefficient (95% CI)
0.01 (0.002, 0.01)
0.02 (0.01, 0.02)
-0.003 (-0.03, 0.02)
0.04 (-0.04, 0.12)
-0.01 (-0.02, 0.002)
-0.001 (-0.001, 0.000)
0.002 (-0.000, 0.003)
-0.10(-0.27, 0.07)
-0.12 (-0.31, 0.06)
0.19 (-0.10, 0.32)
-0.01 (-0.36, 0.34)
0.23 (-0.01, 0.44)
-0.09 (-0.68, 0.51)
p
0.01
<0.001
0.84
0.31
0.12
0.053
0.053
0.25
0.18
0.30
0.97
0.04
0.78
Multivariate
Coefficient (95% CI)
p
0.01 (0.01, 0.02)
<0.001
-0.0002 (-0.0004, -0.0000)
0.03
-0.05 (-0.10, -0.01)
0.03
156
Figure 3. The ROC curve for C-reactive protein level as a diagnostic test for non-increased bladder sensation (non-IBS)
subtypes.
Reference
1. Wee CC, Mukamal KJ, Huang A, Davis RB, McCarthy EP, Mittleman MA: Obesity and C-reactive protein levels among white,
black, and hispanic US adults. Obesity (Silver Spring) 2008;16:875-880.
2. Hwang JJ, Li HY, Shieh GJ, Chien YF, Hua CH, Lin JW: Illustrating the roles of C-reactive protein in the development of the
metabolic syndrome in women--a cross-racial validation. Nutr Metab Cardiovasc Dis 2008; 18:671-677.
3. Kupelian V, McVary KT, Barry MJ, Link CL, Rosen RC, Aiyer LP, Mollon P, McKinlay JB: Association of C-reactive protein and
lower urinary tract symptoms in men and women: results from Boston Area Community Health survey. Urology 2009; 73:950-957.
PT28 Extended course of intravesical hyaluronic acid for interstitial
cystitis/bladder pain syndrome
Chia-Min Yang, Alex TL Lin, Chih-Chieh Lin, Kuang-Kuo Chen
Division of Urology, Department of Surgery, Taipei Veterans General Hospital, and Department of Urology, National
Yang-Ming University, School of Medicine, Taipei, Taiwan
Aims of Study
Patients with interstitial cystitis/bladder pain syndrome (IC/BPS) might only get suboptimal benefit from a single
course of intravesical instillation of hyaluronic acid. We investigate whether an extended course of the treatment gives a
further benefit.
29 IC/BPS patients, who had suboptimal response to one course of intravesical instillation, received a second
course. One course of intravesical hyaluronic acid consists of 40 mg weekly for 4 weeks followed by monthly for 5 months.
Response to therapy was evaluated by Interstitial Cystitis Symptoms Index (ICSI), visual analogue scales(VAS) for pain
and urgency, maximum voided volume (MVV), mean daily voiding frequency, mean night-time frequency and Clinical
Global Impression of Improvement (CGI-I). These parameters were measured before and after the first course and after
the second course of intravesical hyaluronic acid.
Results
After one course of intravesical hyaluronic acid, there was a significant decrease in daily voiding frequency (mean:
17.4 vs 13.5, p<0.001) but without a significant improvement in VAS-urgency (mean: 4.43 vs 3.74, p=0.069). After the
second course, both VAS-urgency (mean 4.43 vs 2.4, p=0.009) and daily voiding frequency (mean 17.44 vs 12.4) were
significantly improved. There was no significant improvement in other subjective parameters, including ICSI (mean 8.65
vs 9.0 vs 10.6, p=0.159), VAS for pain (mean 4.1 vs 4.2 vs 5.2, p=0.238) , MVV ( mean 116 vs 127 vs 105, p=0.144) or
157
mean night-time frequency ( mean 2.14 vs 2.12 vs 2.86, p=0.094). Subjective satisfaction as evaluated by CGI-I showed that
after two courses of intravesical hyaluronic acid therapy, 87.0% patients had a much or very much improvement, which
was reported in only 70.6% patients after the first course.
Conclusions
Extended course of intravesical hyaluronic acid shows further subjective and objective benefits for some IC/BPS
patients.
PT29 Lower urinary tract symptoms and videourodynamic
characteristics of women with clinically unsuspected bladder
outlet obstruction
Fei-Chi Chuang1, Kuan-Hui Huang1, Qian-Sheng Ke2, Sheng-Mou Hsiao3, Hann-Chorng Kuo2
1
Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 2Department of
Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan; 3Department of Obstetrics and Gynecology, Far Eastern
Memorial Hospital, Taipei, Taiwan
Aims of Study
To analyze the lower urinary tract symptoms (LUTS) and video-urodynamic characteristics of women with clinically
unsuspected bladder outlet obstruction (BOO).
We reviewed the charts of 212 women diagnosed with BOO based on video-urodynamic criteria and 264 women
without abnormal findings. Women with BOO were categorized into dysfunctional voiding, bladder neck dysfunction,
and urethral stricture subgroups (Figure 1). LUTS and urodynamic parameters were compared between obstructed and
unobstructed cases and among the BOO subgroups.
Results
The mean ages of the BOO (58.2 years) and control groups (58.8 years) were similar. The mean values of detrusor
pressure at maximum urinary flow rate (PdetQmax)/maximum flow rate (Qmax) of the BOO and control groups were
51.83 cmH2O/10.22 mL/s versus 18.81 cmH2O/20.52 mL/s. In the BOO group, cine-fluoroscopy revealed dysfunctional
voiding in 168 patients (79.2%), urethral stricture in 17 (8.0%), bladder neck dysfunction in 27 (12.7%). The mean urethral
resistance relationship (PdetQmax/Qmax, URR) value in each subgroup was 8.04 in the dysfunctional voiding group,
16.87 in the urethral stricture group, and 13.17 in the bladder neck dysfunction group. The relationship of PdetQmax and
Qmax among the three subgroups is shown in the pressure-flow plots in Figure 2.Overall, 149 BOO patients (70.3%) had
detrusor overactivity, 35 (16.5%) had increased bladder sensation, 28 (13.2%) had stable detrusor conditions. Patients with
dysfunctional voiding had significantly lower urethral resistance compared with the other two BOO subgroups. Combined
storage and voiding symptoms were present in most BOO patients (53.8%), followed by isolated storage symptoms (30.2%).
Seventy-seven patients (37.3%) had dysuria and 79 patients (36.3%) had frequency as their main symptom.
In our study, we did not enroll patients with pelvic organ prolapse and anti-incontinence surgery-induced BOO,
which can be detected through pelvic examination and obtaining a complete medical history. There are distinct image
appearances on fluoroscopy among the three types of BOO. In this series of patients, we found that the urodynamic
parameter of PdetQmax was relatively lower and Qmax was relatively higher in the dysfunctional voiding group than
in the bladder neck dysfunction or urethral stricture groups. This finding suggested that the degree of obstruction was
relatively less serious in women with dysfunctional voiding. In other words, if we found higher urethral resistance with
higher PdetQmax and lower Qmax, we must have a high suspicion of bladder neck dysfunction or urethral stricture. This
finding provides an important hint to the physicians who have only the facilities of conventional urodynamic study without
imaging. Cystoscopy and voiding cystourethrography are necessary in cases of unusually high PdetQmax and low Qmax to
exclude bladder neck dysfunction or urethral stricture. There was no significant difference in the distribution of presenting
158
symptoms among the three BOO subgroups, suggesting that it is not possible to make an accurate diagnosis according to
presenting symptoms.
Conclusion
Women with BOO usually have nonspecific LUTS. Dysfunctional voiding was the most common form among
women with clinically unsuspected BOO, but the degree of obstruction was less severe than with primary bladder neck
obstruction and urethral stricture.
Figure 1. Voiding cystourethrography showing examples of the three subgroups of BOO in women.
(a) Dysfunctional voiding.
(b) Urethral stricture.
(c) Bladder neck dysfunction.
Figure 2. Pressure-flow plot.
The points represent schematically the values of maximum flow rate and detrusor pressure at maximum flow for different voids in the
three subgroups of BOO and in normal controls.
PT30 Progression of lower urinary tract symptoms after
discontinuation of one medication from two-year combined
alpha-blocker and 5-alpha-reductase inhibitor therapy for benign
prostatic hyperplasia in men
Victor C. Lin1, Shiu-Dong Chung2, Chun-Hou Liao3, Hann-Chorng Kuo4
1
Department of Urology, E-DA Hospital, Kaohsiung, Taiwan; 2Department of Urology, Far Eastern Memorial Hospital,
Taipei, Taiwan; 3Department of Urology, Cardinal Tien Hospital, Taipei, Taiwan; 4Department of Urology, Buddhist Tzu
Chi General Hospital, Hualien, Taiwan
159
Aims of Study
Benign prostatic hyperplasia (BPH) is highly prevalent in men. Combined alpha-blocker and 5-alpha-reductase
inhibitor (5ARI) (combination therapy) has been proven effective in reducing lower urinary tract symptoms (LUTS)
and decreasing total prostatic volume (TPV). However, there has been no data showing how long should a man take
combination therapy for LUTS. Whether the LUTS will relapse or transurethral resection of the prostate (TURP)
becomes necessary after discontinuing one or both medications? Can men with LUTS discontinue one medication from
combination therapy after a period of therapeutic duration without compromising LUTS and maintaining therapeutic
effect? This study was designed to investigate the above questions in a cohort of patients with BPH and LUTS who have
been treated with combination therapy for 2 years.
A total of 200 men aged more than 45 years, with TPV≥30 mL, maximum flow rate (Qmax)<15 mL/s, International
Prostatic Symptom Score (IPSS)≥8, and quality of life (QoL) index≥4 were prospectively enrolled in this open, unblinded,
randomized comparative study. All patients received combination therapy with 5-ARI (dutasteride 5 mg QD) and
alpha-blocker (doxazosin 4 mg QD) for their LUTS/BPH for 2 years. Then they were randomly assigned to the 5-ARI
discontinue group (DC-5ARI) or alpha-blocker discontinue group (DC-alpha-blocker). Each group remained taking one
single drug (monotherapy) and followed up for 12 months more. The primary end-point was progression of LUTS from
discontinuation baseline to 12 months. The definitions of LUTS progression were: IPSS increase≥4, Qmax decrease≥
2 mL/s, TPV increase≥20%, postvoid residual (PVR) increase≥50% compared to baseline values, and the occurrence
of acute urinary retention (AUR) and the need for TURP. Secondary end-points were the net change of the following
parameters from discontinuation baseline to 12 months: (1) IPSS-total, IPSS-empty, IPSS-storage, (2) QoL index,
(3) TPV, (4) transition zone index (TZI), (5) Qmax, (6) voided volume, (7) PVR, (8) prostatic specific antigen (PSA)
values. When patients had intolerable LUTS progression they were advised to resume combination therapy or surgical
intervention including TURP. The rate of LUTS progression and all parameters at baseline of discontinuation and 12
months were compared between two groups.
Results
Among the patients, 87 were assigned to DC-5ARI group (mean age 76.3±8.2 years) and 113 were DC-alpha-blocker
group (mean age 74.3±8.7 years). The prostate and uroflow parameters were similar between two groups either at baseline
or 2 years after combination therapy. The changes of parameters from baseline of discontinuation to 12 months were
similar in both groups, but the TPV and PSA showed greater increase in DC-5ARI group than DC-alpha-blocker group
at 12 months. Resumed combination therapy was necessary in 30 (35.5%) patients of DC-5ARI group and in 35 (31%) of
DC-alpha-blocker group (p=0.875). The mean duration from discontinued to resumed medication was 5±4.4 months in
DC-alpha-blocker group and 7.8±3.8 months in DC-5ARI group (p<0.05). By the end of study, the progression rates of
IPSS, Qmax, PVR were similar in both groups and were significantly higher in patients who continued to DC medication
than those who resumed combination therapy (Table 1). The TPV progression was significantly higher in DC-5ARI group
(34/87, 38%) than DC-alpha-blocker group (9/113, 8%) (p<0.01). Occurrence of AUR or TURP was noted in 14 (16%) of
DC-5ARI group and in 8 (7%) of DC-alpha-blocker group (p<0.05).
Combination therapy for 2 years is effective in improving LUTS in men with LUTS/BPH. After 2-year combination
therapy, discontinuation of either one medication induced progression of LUTS or uroflow parameters in most of patients.
Increased TPV and greater risk of the occurrence of AUR or needing TURP were noted in patients who discontinued
5ARI. However, resuming combination therapy in either group greatly improved LUTS and uroflow parameters after
discontinuing one medication from the combination therapy.
Conclusions
Combination 5ARI and alpha-blocker therapy for men with BPH and bothersome LUTS is effective. Discontinuing
one medication from combination therapy for 2 years resulted in high LUTS progression rate and the need for surgical
intervention in DC-5ARI or DC-alpha-blocker group. Resuming medication could reverse the progression of LUTS.
160
Table 2. Progression of BPH/LUTS after discontinuing (DC) one drug after combination therapy (Tx) for 2 years
Progression
IPSS-Total increased≥4
Qmax reduced≥2mL/s
PVR increased≥50%
TPV increased≥20%
AUR, TURP,
Or AUR+TURP
Any one of the above items
DC 5-ARI (n=87)
Continued DC
(n=57)
10 (17.5%)
45 (79%)
12 (21%)
23 (40%)
Resume Tx
(n=30)
12 (40%)
21 (70%)
8 (26.7%)
11(36.6%)
DC alpha–blocker (n=113)
Continued DC
Resume Tx (n=35)
(n=78)
10 (12%)
19 (54%)
51 (65%)
24 (68%)
21 (26%)
12 (34%)
7 (8.9%)
2 (5.7%)
11 (19%)
49 (86%)
3 (10%)
27 (90%)
5 (6%)
68 (87%)
3 (8%)
32 (90%)
DC 5-ARI n=87; no progression n=11; progression n=76; DC alpah-blocker n=113; no progression n=13; progression n=100
PT31 Urinary incontinence might not improve the evaluation of
benign prostatic obstruction by american urological association
symptom index
Chih-Cheng Lu1, Jin-Sheng Roan2
1
Department of Management in Medical Records & Information, Chi Mei Medical Center, Liouying, Tainan, Taiwan;
National Chung Cheng University, Chiayi, Taiwan
2
Aims of Study
The American Urological Association Symptom Index (AUASI)—with 7 questions or International Prostate
Symptom Score (IPSS)—with 8 questions is used for evaluating patients with prostatism. IPSS is not sufficient for final
clinical diagnosis. Urinary incontinence were noted in some patients with prostatic obstruction. To evaluate the clinical
improving effects of non-invasive prediction by adding this factor in the diagnosis of men with lower urinary tract
symptoms (LUTS) by a traditional linear regression (LR) model for evaluating prostatic obstruction.
This was a subgroup analysis of a prospective clinical study for artificial neural networks. There were 331 qualified
patients visiting outpatient clinic for routine investigation. It included sonography of prostate, measuring serum prostate
specific antigen, assessment of AUASI, urinary flowmetry with of maximum flow rate. The severity of urinary incontinence
was measured by Lickert scales (0 to 5 points) and hypothesized as a new factor. Each final diagnosis of prostate condition
was made by two independent urologists. The performance of the new factor was quantified by using LR analyses by
independent t-tests.
Results
There were three different sets of results for analyzed groups: AUASI-7 (urinary symptoms in IPSS), Logi-7 (AUASI
by LR), and Logi-8 (AUASI plus the new factor by LR). The accuracy of AUASI-7 was 65.9%. The mean accuracy was
67.5% in Logi-8. After comparison, no significance (p>0.1) was noted among AUASI-7, Logi-7 and Logi-8. The new
added factor showed no significance in prediction of benign prostatic obstruction by LR.
Conclusions
This study suggested that the severity of urinary incontinence is not a significant factor in the prediction of the
patients with benign prostatic obstruction.
161
PT32 Maximal uroflowmetry and transrectal evaluation of prostate
before prostatic biopsy—a local experience
Chih-Cheng Lu, Chia-Ho Lin, Dennis Chian-Shiung Lin, Wen-Chou Fan, Tse-Chou Cheng
Divisions of Urology, Department of Surgery, Chi Mei Medical Center, Liouying, Tainan, Taiwan
Aims of Study
To assess and understand the clinical relationship between transrectal prostatic sonography and maximal uroflow
rate in a local regional teaching hospital.
The patients received transrectal ultrasound for guided prostatic biopsies were enrolled. The clinical data were
collected by chart review.
Results
A total of 82 patients were included between 2005 and 2008. Two main reasons for transrectal prostatic biopsy
were abnormal digital rectal prostatic examination, and elevated serum prostate specific antigen (PSA). The mean age of
the patients was 70.5 years (range, 40 to 88). PSA ranged from 0.25 to higher than 500 ng/mL. All the patients received
prophylactic antibiotic use. No biopsy related mortality was noted. There were 81 sonographic prostatic evaluations. Mean
prostate volume was 40.0 mL (range, 9.1 to 111.1). In those 82 patients with available uroflowmetry, mean maximal flow
rate was 11.3 mL/sec (range, 3 to 31) which was lower than normal values of the population. The statistical regression
between measured prostatic volume and maximal flow rate showed negative relation but the statistic R square was less than
0.5.
Conclusions
In this limited retrospective study, selection bias may contribute to the detection of maximal flow rate. Further
research with longer follow-up is needed to have better understanding of the relationship.
PT33 Urinary storage symptoms in patients with chronic heart failure
Aih-Fung Chiu1, Chun-Hou Liao2, Chung-Cheng Wang3, Hann-Chorng Kuo4
1
Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan; 2Department of Urology, Cardinal Tien Hospital,
Taipei, Taiwan; 3Department of Urology, En Chu Kong Hospital, Taipei, Taiwan; 4Department of Urology, Buddhist Tzu
Aims of Study
To assess urinary storage symptoms among patients with chronic heart failure (CHF) and the correlates of these
urinary symptoms were also explored.
A total of 214 consecutive chronic CHF patients from the outpatient departments of a medical center in eastern
Taiwan were recruited. The CHF patients with a NYHA stage verified by their cardiologists were referred to participate
in this study. After informed consents were obtained from CHF patients, they were invited to complete the survey, which
contained questions about urgency, daytime frequency, nocturia, urge urinary incontinence (UUI) and stress incontinence
(SUI). In addition, medications, NYHA stage of heart failure and other doctor-diagnosed diseases, such as hypertension,
diabetes, chronic obstructive pulmonary disease (COPD)/asthma, chronic constipation, stroke and body mass index
(BMI), were also collected via medical record reviews and self-reports. CHF patients with urinary symptoms during the
last month, which was suspected to be a current urinary tract infection, were excluded. No urodynamic studies or urinary
diaries were performed. The study was conducted from January to June of 2010, and each took approximately 15-20
minutes to complete.
162
Results
The mean age of participants was 69.64±11.69 years. The prevalence of urgency was 40.2% among CHF patients,
while nocturia, daytime frequency, urge urinary incontinence (UUI) and SUI occurred at rates of 55.6%, 54.2%, 21.0%
and 7.0%, respectively. Using conditional logistic regression analyses, the results showed that gender, stroke, the NYHA
class significantly correlated with urgency, while age and pulmonary diseases significantly correlated with nocturia, gender,
age and the NYHA class significantly correlated with UUI, and gender was significantly correlated with SUI (Table 1).Only
11.6% of CHF participants with OAB had ever sought to health care providers for their bladder problems during the prior
year.
The storage urinary symptoms were highly prevalent in CHF patients. The NYHA stage of heart failure was an
independent factor for urgency and UUI subjective to overactive bladder, but not an independent factor for daytime
frequency, nocturia or SUI. This result implied that the poor heart function might attribute to the pathogenesis of
overactive bladder. However, few people tend to not discuss with their physician for their urinary problems.
Conclusion
Urinary storage symptoms were prevalent in CHF patients. The severity of CHF (NYHA stage) was might involve
the pathogenesis of overactive bladder. When treating people with CHF, health care providers should increase the
awareness that the possibility of urinary storage symptoms existed in CHF patients and provide high quality of care.
Table 1: Conditional logistic regression for urinary storage symptoms
Item
Factors for urgency (≥1/week)
Gender (reference: male)
females
Stroke
NYHA stage (reference: stage 1)
stage 2
stage 3
Constant
Factors for nocturia (≥2/nighttime)
Age
Pulmonary diseases
Constant
B
SE
df
Sig. (p)
Lower
Exp (B)
Upper
95 % CI
.626
1.491
.300
.562
1
1
.037
.008
1.87
4.44
1.04
1.48
3.37
13.36
.812
1.248
-1.488
.368
.420
.331
1
1
1
.027
.003
.000
2.25
3.48
.23
1.10
1.53
4.64
7.94
.049
1.107
-3.282
.013
.559
.918
1
1
1
.000
.048
.000
1.05
3.03
.04
1.02
1.01
1.08
9.05
1
.219
1.18
.358
1
1
.048
.014
1.04
2.41
1.00
1.19
1.07
1
1
1
.752
.021
.000
.86
3.05
.01
.34
1.19
2.17
7.86
1
1
.004
.000
6.904
.024
1.89
25.27
Factors for daytime frequency (≥8/daytime)
Constant
.169
.137
Factors s for urge urinary incontinence(≥1/week)
females .879
Age
.034
.017
NYHA stage (reference: stage 1)
stage 2
-.149
.472
stage 3
1.115
.483
Constant
-4.427
1.258
Factors for stress urinary incontinence(≥1/week)
females females
1.932
.662
Constant
-3.738
.584
4.86
Model included gender, age, hypertension, diabetes, heart diseases (congestive heart failure, myocardial infarction, angioplasty, or
bypass surgery.), pulmonary diseases (chronic obstructive pulmonary disease, asthma), stroke, history of UTI in the past year. Urinary
symptoms were not mutually exclude
163
PT34 Benign prostate hyperplasia with high prostate specific antigen
levels fares the same treatment outcome of combined therapy
with 5-alpha-reductase inhibitor and alpha-blocker as low PSA
level
Victor C. Lin1, Chun-Hou Liao2, Shiu-Dong Chung3, Hann-Chorng Kuo4
1
Department of Urology, E-DA Hospital, Kaohsiung, Taiwan; 2Department of Urology, Cardinal Tien Hospital, Taipei,
Taiwan; 3Department of Urology, Far Eastern Memorial Hospital, Taipei, Taiwan; 4Department of Urology, Buddhist Tzu
Aims of Study
Benign prostate hyperplasia (BPH) is highly prevalent in aging men, which has significant negative impact on the
quality of life (QoL). Prostatic volume is considered as an important contributor to static component of bladder outlet
obstruction, therefore, 5-alpha-eductase inhibitor (5ARI) has been found to be more effective in treatment of men with
LUTS and large BPH. Prostatic specific antigen (PSA) is the secreting protein from the prostatic gland. A higher PSA
level indicates more active prostatic growth, chronic or acute inflammation and a possibility of prostatic cancer. There was
no study to compare the therapeutic results between patients with high and low PSA levels in LUTS/BPH. The aim of this
study was to investigate whether a higher PSA level predicts a lower treatment outcome in men with BPH and LUTS.
This study is a multicenter open-label observational study of 5ARI (dutasteride) in men with symptomatic BPH in
Taiwan. Mae patients aged at least 45 years, with International Prostate Symptom Score (IPSS)≥8, total prostate volume
(TPV)≥20 mL, maximum flow rate (Qmax)<15 mL/s and no digitally palpable prostatic nodule were prospectively
enrolled. Prostatic biopsy was performed and proven no cancer in the patients with a serum PSA level>4 ng/mL. All
patients were treated with combined 5ARI (dutasteride 5 mgQD) and alpha-blocker (doxazosin 4 mgQD) for 2 years. The
IPSS, TPV, transition zone index (TZI), Qmax, voided volume, postvoid residual (PVR) and PSA levels were assessed at
baseline, 6, 12, 18 and 24 months after treatment. The treatment outcome was assessed by all variables between patients
with a PSA<4 and PSA≥4 ng/mL at baseline.
Results
A total of 304 men aged 71±9 years (45 to 95) completed the two-year treatment and follow-up, including 230 men
with a PSA<4 ng/mL and 74 with a PSA≥4 ng/mL. All patients with a baseline PSA≥4 ng/mL received prostatic biopsy and
no malignancy was found. The IPSS, QoL index, Qmax, voided volume and PVR all showed significantly improved from
baseline to 24 months in both groups. No significant difference was found in the change for variables from baseline to 24
months between groups. The TPV reduced more (from 59.8±27.8 to 48.2±22.1) in PSA≥4 group than the PSA<4 group
(from 41.3±17.9 to 36.2±22.6) (p<0.001). PSA levels also showed significant reduction in PSA≥4 group (from 8.04±4.49 to
3.98±3.21) compared with PSA<4 group (from 1.57±0.97 to 1.35±1.34) (p<0.001).
Although the TPV and PSA levels reduced significantly greater in patients with a baseline PSA≥4 ng/mL, the other
parameters including IPSS, QoL index, Qmax and PVR all showed no significant difference between the two groups. A
higher PSA level is likely associated with active proliferation of prostatic gland or chronic inflammation in these patients.
The two-year 5ARI treatment can effectively reduce the TPV and TZI and PSA levels to half of the baseline level. Patients
also have improvement in LUTS and QoL after the treatment. If PSA level cannot be reduced after 5ARI treatment,
second prostate biopsy might be necessary to prove any possibility of prostate cancer.
Conclusions
Patients with LUTS due to BPH and a high PSA level fared the same treatment outcome as those with a low PSA
level. The PSA level reduced significantly along with the reduction of TPV after two-year 5ARI treatment.
164
Table 1. The changes of IPSS and QoL index between patients with PSA<4 and ≥4 groups
IPSS-E
PSA≥4
PSA<4
IPSS-S
PSA≥4
PSA<4
IPSS-T
PSA≥4
PSA<4
QoL-I
PSA≥4
PSA<4
Baseline
6M
12M
18M
24M
p value
7.86±6.14
8.47±5.16
4.25±4.51
4.67±4.48
3.71±4.07
3.81±3.94
2.65±3.19
3.37±3.83
2.35±3.59
3.35±3.90
0.223
6.58±3.90
6.33±3.38
4.98±2.98
4.65±2.77
4.68±2.72
4.30±2.55
4.52±2.92
4.08±2.27
3.88±2.58
3.63±2.11
0.268
14.4±8.29
14.8±6.73
9.23±6.18
9.32±5.94
8.38±5.40
8.11±5.42
7.17±5.25
7.46±5.12
6.23±5.21
6.98±5.08
0.703
3.55±1.26
3.55±1.22
2.35±1.07
2.54±1.00
2.25±0.73
2.30±1.18
2.43±1.51
2.69±2.73
2.05±0.74
2.33±.2.00
0.281
IPSS-E: empty IOPSS, IPSS-S: storage IPSS, IPSS-T: total IPSS scores
Table 2. The changes of uroflow and prostate parameters between patients with PSA<4 and ≥4 groups
Qmax
PSA≥4
PSA<4
Volume
PSA≥4
PSA<4
PVR
PSA≥4
PSA<4
TPV
PSA≥4
PSA<4
TZI
PSA≥4
PSA<4
PSA
PSA≥4
PSA<4
Baseline
6M
12M
18M
24M
p value
10.3±4.68
10.3±5.45
11.6±4.75
11.5±5.93
11.6±4.78
11.8±5.54
12.6±5.29
12.5±5.48
12.7±6.00
12.5±5.83
0.969
183±106
190±118
195±99.0
222±134
216±104
219±126
224±142
243±130
228±135
248±152
0.278
82.6±77.1
70.7±67.4
76.6±69.0
61.4±57.2
57.9±51.0
55.7±55.9
65.2±62.8
59.9±56.0
66.4±68.5
59.8±58.8
0.126
59.8±27.8
41.3±17.9
49.5±21.8
36.5±19.0
47.2±20.1
36.4±19.8
46.5±21.6
36.2±23.9
48.2±22.1
36.2±22.6
0.000
0.51±0.15
0.46±0.15
0.48±0.13
0.44±0.14
0.48±0.13
0.43±0.14
0.46±0.13
0.42±0.14
0.43±0.14
0.41±0.14
0.022
8.04±4.49
1.57±0.97
4.77±3.54
1.33±1.25
4.61±5.53
1.27±1.10
4.05±3.09
1.27±1.23
3.98±3.21
1.35±1.34
0.000
PT35 International prostate symptom score is not suitable for
assessing emptying lower urinary tract dysfunction in women
Sheng-Mou Hsiao1, Qian-Sheng Ke2, Yih-Chou Chen3, Hann-Chorng Kuo2
1
Department of Obstetrics and Gynecology, Far Eastern Memorial Hospital, Taipei, Taiwan; 2Department of Urology,
Buddhist Tzu Chi General Hospital, Hualien, Taiwan; 3Department of Urology, Hualien Hospital, Hualien, Taiwan
Aims of Study
Lower urinary tract symptoms (LUTS) are symptoms reported by patients’ perception of bladder feeling. The real
pathophysiology for LUTS might be difficult to interpret based on symptoms alone. As in men, LUTS in women also
include storage, voiding, pain and postvoiding symptoms. The pathophysiology of female LUTS may also involve bladder,
urethral, and pelvic floor disorders. However, there is no suitable questionnaire validated for assessing female LUTS so
far. Researchers used to adapt International Prostate Symptom Score (IPSS) in evaluation of female LUTS. The aim f this
study is to evaluate whether IPSS can be used in assessment of female LUTS.
165
A total of 245 women aged 19 to 88 (mean 57.5) presenting with LUTS were enrolled prospectively. Patients were
evaluated with IPSS with quality of life index, self reported OABSS and urgency severity score USS). A total of 27 women
had test and retest at baseline and 2 weeks after the first visit without any treatment. The alpha-value was calculated for
reliability analysis of IPSS in assessing LUTS. The patients further received urological examinations and their lower
urinary tract dysfunctions (LUTD) were classified as storage and empty LUTD. The total IPSS score, IPSS-storage (IPSS-S)
subscore, IPSS-empty (IPSS-E) subscore, OABSS, urgency severity score (USS) were analyzed by correlation coefficient.
According to ROC analysis, an IPSS empty to storage subscore ratio (E/S ratio) of 1.5 had the best sensitivity and
selectivity rate for differential diagnosis between storage and empty LUTD. The total IPSS, IPSS-E, IPSS-S and IPSS-E/S
ratio were compared between storage and empty LUTD. Predictive value of storage or empty LUTD using IPSS-E/S ratio
of 1.5 was assessed in different final LUTD based on the results of videourodynamic study.
Results
The test retest reliability was good in total IPSS, IPSS-E, IPSS-S, and LUTS item of incomplete emptying,
frequency, urgency, straining to void and nocturia (Table1). There was significant correlation between OABSS and IPSStotal, IPSS-S and E/S ratio (all p=0.000). USS was also correlated with IPSS-total, IPSS-S and IPSS-E/S ratio (all p=0.000).
Among all women, empty LUTD was diagnosed in 41 patients and storage LUTD in 201, the baseline IPSS-total showed
no significant difference between two LUTD subgroups (16.86±6.74 v 19.10±6.74, p=0.054), but IPSS-E was significantly
greater in empty LUTD (12.12±5.36 v 8.84±5.38, p=0.001) whereas IPSS-S was greater in storage LUTD (7.96±6.98 v
6.98±2.67, p=0.038) . The mean E/S ratio was 1.99±1.12 in empty LUTD and 1.27±1.08 in storage LUTD (p=0.000).
However, using E/S ratio =1.5 as cut off value, only 78 (75.7%) of women with OAB and 50 (63.3%) of women with
increased bladder sensation had an E/S≤1.5, whereas only 30 (76.9%) of women with voiding dysfunction had an E/S ratio
>1.5. The predictive values of E/S≤1.5 was 93.4% for storage LUTD, but was only 36% for empty LUTD.
IPSS-total and IPSS-S had high correlation with OAB symptom score assessed by OABSS or USS. However,
IPSS-E was not correlated with OAB symptom well. Intermittency and slow stream did not show good test retest reliability
in assessing LUTS using IPSS. Total IPSS score was not a good predictor to differentiate storage and empty LUTD, but
an IPSS E/S ratio of 1.5 provided a better predictive value to reflect the difference between IPSS-E and IPSS-S subscores
in LUTD subgroups. Nevertheless, the predictive value of emptying LUTD using E/S ratio of >1.5 was very low. A high
percentage of women with storage may present with empty LUTS which interfere the interpretation of LUTS using
IPSS-E sbscore.
Conclusion
IPSS-storage subscore can be adapted to assess women with storage LUTS. An IPSS-E/S ratio of ≤1.5 provides a
high predictive value for diagnosis of storage LUTD in women, however, IPSS-E subscore or E/S ratio of >1.5 are not
suitable for assessing emptying LUTD in women. Therefore, we concluded that IPSS is not suitable for assessing emptying
LUTD in women.
Table 1. Reliability test of IPSS in female LUTS
IPSS-Total
IPSS-Empty
IPPS-Storage
IPSS-E/S ratio
Incomplete voiding
Frequency
Intermittency
Urgency
Slow Stream
Straining to void
Nocturia
QoL
Baseline
18.57±5.43
11.04±4.28
7.54±2.22
1.69±1.22
3.89±1.45
4.39±1.31
2.96±1.73
0.39±0.96
2.50±1.71
1.68±1.66
2.93±1.44
4.47±0.72
2 weeks
15.14±5.15
8.18±3.75
6.96±2.52
1.25±0.60
3.00±1.49
3.71±1.08
1.96±1.86
0.36±0.99
2.11±1.55
1.29±1.54
2.71±1.33
3.65±1.06
Alpha
0.77
0.65
0.72
0.27
0.75
0.59
0.29
0.95
0.49
0.81
0.84
0.26
p value
0.000
0.009
0.002
0.433
0.001
0.026
0.380
0.000
0.088
0.000
0.000
0.442
166
PT36 Pharmacotherapy for underactive detrusor related to diabetes in
female
Wei-Che Wu1, Bin Chiu1, Shiu-Dong Chung1,2
1
Department of Surgery, Far Eastern Memorial Hospital, Ban Ciao, Taipei, Taiwan; 2Department of Urology, National
Taiwan University Hospital, Taipei, Taiwan
Purpose
Patients with diabetes mellitus have many chronic complications, such as neuropathy, retinopathy and nephropathy.
However, the chronic diabetic complication for urinary bladder as neurogenic cystopathy is far less attention. The diabetic
cystopathy may induce lower urinary tract symptoms in women as significant impact on quality of life. The pathophysiology
of diabetic cystopathy suggested that the long-term diabetes mellitus causes paralysis of the detrusor muscle leading to
voiding difficulties. According to the pathophysiology, we wanted to study the further medication as alpha-blocker and
cholinergic agent for improving the symptoms of the women with diabetic cystopathy.
Methods
A prospective cohort study was conducted in 31 patients with type 2 diabetes mellitus. Based on ordinary treatment
and diet control, the patients were treated by tamsulosin orally (0.2 mg/day) and urecholine (75mg daily, divided in three
doses). The treatment course was 12 weeks. The lower urinary tract symptoms and impact of quality of life by lower
urinary tract symptoms was evaluated with questionnaires. The standard videourodynamic study was performed and
parameters were recorded.
Results
There was significance difference for the AUA symptom score index between after and before treatment (19.10
vs 23.39, p<0.05). Besides, the scoring of quality of life after treatment was significantly better than before (1.97 vs 3.55,
p<0.05). In urodynamic study, the maximum urine flow rate after treatment showed improvement (9.24 vs 7.16, p<0.05).
The first sensation of bladder after treatment became less than before treatment. The bladder capacity after treatment was
larger than before treatment (353 vs 309, p< 0.05). Postvoid residual volume after treatment showed significant decrease (
149.39 vs 192.74, p<0.05). The voiding efficiency after treatment is better than before ( 61.06 vs 47.92, p< 0.05).
Conclusion
Combination of the alpha-blocker and cholinergic agent for the underactive detrusor may be effective for the LUTS
of woman with type 2 diabetes mellitus.
PT37 The role of non-adrenergic non-cholinergic neurotransmission in
ketamine-induced bladder dysfunction
E. Meng, T. L. Cha, G. H. Sun, D. S. Yu, S.Y. Chang
Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei,
Taiwan
Purpose
Long-term ketamine abuse in man causes significant lower urinary tract symptoms. However, the etiology of
ketamine-associated cystitis is still not clear. We created a mouse model of ketamine-induced lower urinary tract
dysfunction to explore the pathogenesis of this condition.
Materials and Methods: Female C57BL/6 mice were randomly distributed into control and ketamine groups,
and received daily intraperitoneal injection of saline or ketamine (100 mg/kg). Cystometry was performed for each
group at 4, 8 and 16 weeks. After sacrifice, the bladders were harvested for isometric muscle tension recordings and
immunohistolochemical examination.
167
Results
After 8 weeks of treatment, body weight growth of ketamine mice was significantly reduced. Cystometry
demonstrated significantly decreased inter-contraction intervals (ketamine: 237±9 s vs. control: 360±20 s; p<0.001)
and reduced bladder capacity (ketamine: 0.1±0.004 mL vs. control: 0.13±0.006 mL; p<0.001) in the ketamine-injected
animals compared to saline-injected. Increased ATP-evoked contraction of detrusor developed in the ketamine group.
The immunohistolochemical examination revealed an increased expression of P2X1 receptors in the ketamine mouse
bladders; the expression of M2 and M3 receptors was unchanged.
Conclusions
After 8 weeks of treatment, the ketamine mice developed increased voiding frequency and decreased bladder
capacity; the symptoms that occur in human ketamine abusers. The enhanced non-cholinergic contractions and P2X1
receptor expression in the ketamine bladder indicate that dysregulation of purinergic neurotransmission may underlie the
detrusor overactivity in ketamine-induced bladder dysfunction.
PT38 Urethrovestibular reflux: an unusual cause of daytime
incontinence in young girls – two cases report and review of the
literature
Su Chia-Cheng1, Shang-Jen Chang2, Stephen Shei Dei Yang2
1
Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan; 2Buddhist Tzu Chi General
Hospital, Taipei Branch, New Taipei, Taiwan; Scool of Medicine, Buddhist Tzu Chi University, Hualien, Taiwan
Aim of the Study
We report urethrovestibular reflux, a variant of urethrovaginal reflux, as the causes of daytime urinary incontinence
in two young girls.
Case 1
A 5-year-9-month old girl complained of urine leakage before reaching toilet and after voiding when she stood up
putting on pants. Urinalysis, uroflowmetry and post-void residual urine were within normal limit. Fluid restriction, antimuscarinics and minirin were prescribed without effect. Subsequent videourodynamic study demonstrated that contrast
medium passed through urethra smoothly, and retrogradely filled to form wedge shape. Physical examination disclosed
close approximation of the two labia majora at supine position. Since the accumulation of contrast medium was not a
tubular shape, urethrovaginal reflux is less likely. We proposed that the refluxed contrast medium was pooled in the
vestibular space, just outside of the hymen and inside of the labia majora. With the impression of urethrovestibular
reflux, the correct voiding posture, such as good foot support and with well separated knee, was taught and all the urinary
symptoms subsided in one week.
Case 2
A 5-year-11-month girl was referred for the evaluation of recurrent febrile UTI (9 episodes in 5 years) with
right VUR grade 4-5. Deflux was injected twice, 2 and 4 years ago. VCUG in June 2010 did not show signs of VUR.
Videourodynamics disclosed dysfunctional voiding with contrast medium accumulating in a wedge shape after the
voiding phase. Mom admitted that her daughter had urgent incontinence and post-void urine leakage. Urotherapy with
biofeedback relaxation of pelvic floor were performed. She was free of UTI without prophylatic antibiotics 1 year.
Conclusion
Urethrovestibular reflux, a variant of urethrovaginal reflux, should be considered in girls with post-void urine leakage.
Urethrovestibular reflux may also be a cause of recurrent UTI.
memo

Document 6430590

Transcription

Similar documents

Find the Vasectomy Doctors Near Me

Malakoplakia of the bladder associated with advanced obstructive

Reconstructive surgery for OAB

Urinary incontinence and bladder control Talk to your doctor about

Erectile Dysfunction and Penile Implant Surgery

Case stuart bauer tuesday

Unique clinically trialled natural alternative for bladder control

BVI 6100

bladder-troubles

Ranger, Ranger LTD, and Tech 10 BCD Custom Color