An 81-year-old man with castration-resistant prostate cancer experienced general fatigue while receiving enzalutamide treatment. In some patients we encountered the enzalutamide treatment had to be interrupted or the dose decreased because of this adverse effect. We evaluated the patient's general fatigue using the Cancer Fatigue Scale (CFS) score and clarified the quantitative information about his general fatigue. In order to maintain the optimal dose, we advised the patient to take enzalutamide at night. This alleviated the adverse effect, and he could maintain the optimal dose of this medicine. We compared the CFS score before and after switching to nighttime treatment and found improvement. This is the first report of a CFS-based evaluation of the improvement in general fatigue caused by enzalutamide by switching to nighttime treatment.

You have accessJournal of UrologyStone Disease: Shock Wave Lithotripsy1 Apr 2017MP62-13 COMPARISON OF PATIENT SATISFACTION FOR TREATMENT EFFICACY AND ASSOCIATED FACTORS BETWEEN SWL AND URS FOR URINARY STONE: ANALYSIS FROM PATIENTS' VIEW Yoshikazu Sato, Musashi Tobe, Kosuke Uchida, Kazunori Haga, Ichiya Honma, Keigo Akagashi, Toshikazu Nitta, Hisao Nakajima, and Tatsuo Hanzawa Yoshikazu SatoYoshikazu Sato More articles by this author , Musashi TobeMusashi Tobe More articles by this author , Kosuke UchidaKosuke Uchida More articles by this author , Kazunori HagaKazunori Haga More articles by this author , Ichiya HonmaIchiya Honma More articles by this author , Keigo AkagashiKeigo Akagashi More articles by this author , Toshikazu NittaToshikazu Nitta More articles by this author , Hisao NakajimaHisao Nakajima More articles by this author , and Tatsuo HanzawaTatsuo Hanzawa More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1944AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Goals of this study were to compare satisfaction for treatment efficacy and associated factors in treatment for upper urinary stone with shock wave lithotripsy (SWL) and ureteroscopic surgery (URS) and to clarify significant factors for desirable treatment from patients view. METHODS In current study, 294 consecutive patients who underwent SWL (n=194) or URS (n=71) and both surgical procedures (n=29) for upper urinary stone in one treatment period were enrolled. We evaluated satisfaction for treatment outcomes and significant factors for desirable treatment used a self-administered ad-hock questionnaire. Satisfaction for treatment were analyzed in five domains (overall satisfaction, pain during treatment and after treatment, voiding symptom, and overall difficulty) using a visual analog scale. RESULTS There is no significant differences in age and sex distribution between the SWL and URS group (a mean age of 50.7years, range 21-76). There were no significant difference in overall satisfaction values between both groups. However, other objective outcomes from patients' view (pain during treatment and after treatment, voiding symptom, and overall difficulty) were significantly better in the SWL group compared to those in the URS group. The patients considered many factors to decide for counseling treatment options, such as efficacy of treatment, cost, safety, hospitalization, kind of anesthesia, pain associated with treatment. Rate of patients who selected SWL as a next desirable treatment in the SWL group, the URS group and both treatment group were 61.5, 81.0, and 93.5%, respectively. CONCLUSIONS Overall satisfaction were not significantly different between SWL and URS. However, pain and convenience associated treatment around operative period are better in SWL than TUL. The patients considered many factors to decide for counseling treatment options in addition to treatment efficacy. Consequently, significantly higher percentage of patients selected SWL treatment as a desirable treatment option. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e832 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Yoshikazu Sato More articles by this author Musashi Tobe More articles by this author Kosuke Uchida More articles by this author Kazunori Haga More articles by this author Ichiya Honma More articles by this author Keigo Akagashi More articles by this author Toshikazu Nitta More articles by this author Hisao Nakajima More articles by this author Tatsuo Hanzawa More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Erectile dysfunction following radical prostatectomy (RP) is still a significant burden as a post-operative morbidity, despite advances in nerve-sparing techniques and penile (erectile function) rehabilitation (PR) programs. We assessed the effects of stimulation with the masturbation device "EGG" on enhancement of erectile response along with administration of phospho diesterase type 5 inhibitor. We also studied the change of self-esteem and motivation for continuation of PR after stimulation with EGG. Eight nonresponders for PDE5-I who underwent retropubic RP were enrolled. Patients' median age was 71.5 years old. No patients received adjuvant therapy for prostate cancer. The patients' erectile response in the penile rehabilitation session (masturbation) with PDE5-I＋manual stimulation and PDE5-I＋stimulation with EGG were evaluated by erection hardness score (EHS). Changes of self-esteem and motivation for penile rehabilitation were assessed by the self-esteem subscale of the Self-Esteem and Relationship (SEAR) questionnaire and one original question, respectively. PDE5-I ＋ stimulation with EGG significantly enhanced EHS compared to PDE5-I＋manual stimulation in the eight patients (p＝0.027). Transformed score of self-esteem subscale score of SEAR questionnaire was significantly increased in the PR session with EGG compared to the PR session with manual stimulation (p＝0.043). Six patients who showed a better erectile response with EGG retained motivation for continuation of PR. PDE5-I＋stimulation with EGG improved the erectile response in post-RP patients. EGG as a masturbation device may have a potential for contribution to successful PR.

To determine the follow-up schedule in patients with non-muscle-invasive bladder cancer who had remained recurrence-free for 5 or more years, we retrospectively reviewed 258 patients with Ta and T1 bladder cancer who had been free of recurrence for at least 5 years. Of these 258 patients, subsequent recurrences developed in 100 patients. In spite of our recommendation that cystoscopic follow-up be done at 12-month intervals for patients who remained recurrence-free for more than 5 years, 45 had been followed at intervals of more than 12 months (range, 13-77 months) when the recurrences were found. Of 100 recurrent tumors, 20 (20.0%) showed bladder muscle invasion. Muscle-invasive cancer was identified more often in the patients with cytoscopic intervals of more than 12 months than in those of less than 12 months (35.6% versus 7.3%). Therefore, we recommend that cystoscopy be performed at intervals of less than 12 months in patients with non-muscle invasive bladder cancer for recurrence detection before tumors become muscle invasive, even when patients remain free of recurrence for a long period.

We experienced two cases of isolated ACTH deficiency (IAD) in patients self referred for late-onset hypogonadism (LOH) syndrome. IAD is secondary adrenal insufficiency due to lack of secretion of ACTH and delayed diagnosis of this rare condition may be life-threatening. The predominant symptoms of IAD, such as general malaise and weakness, resemble those of LOH syndrome creating the possibility that IAD may be referred as LOH syndrome. Two middle aged men with severe general malaise visited our clinic requesting evaluation for LOH syndrome. Previous treatments had been ineffective and based on varying incorrect diagnoses by previous doctors. The patients self referred themselves for LOH syndrome. Some of their symptoms were consistent with LOH syndrome but others were atypical, in particular, the severity of malaise and appetite loss. Hormonal assays were compatible with adrenal insufficiency secondary to ACTH deficiency. Steroid replacement dramatically improved their symptoms. The clinical course of our two patients and points of differential diagnosis between IAD and LOH syndrome are reported here.

Premature ejaculation is a common sexual problem, as is erectile dysfunction. We evaluated silodosin, a highly selective α1A-adrenoceptor antagonist, as a new treatment option for premature ejaculation. α1-Adrenoceptor antagonists are widely used for lower urinary tract symptoms, and clinical studies on silodosin have shown excellent clinical efficacy for lower urinary tract symptoms. However, compared with other α1-adrenoceptor antagonists, silodosin appeared to suppress ejaculation in a relatively higher percent of trial participants. This suppression of ejaculation by silodosin suggested its potential for treating premature ejaculation. Consequently, we evaluated the feasibility of off-label silodosin as a new treatment option for premature ejaculation. Eight patients suffering premature ejaculation were treated with silodosin. Silodosin (4 mg) was given 2 h before sexual intercourse. Intravaginal ejaculatory latency time, premature ejaculation profile item, clinical global impression change in premature ejaculation and systemic adverse events were recorded. Intravaginal ejaculatory latency time was significantly prolonged (from 3.4 min to 10.1 min, P = 0.003). All patients answered better (much better) or slightly better for their own premature ejaculation problem compared with pretreatment condition in the clinical global impression change. Premature ejaculation profile also significantly improved. Two (25%), three (37.5%) and seven patients (87.5%) experienced anejaculation, reduced semen volume and discomfort during orgasm, respectively. However, these problems were not of major concern for the participants. No systemic adverse effects were reported. The current results support the possible use of silodosin as a new treatment option for premature ejaculation, and suggest that a placebo controlled study assessing its clinical usefulness would be worthwhile.

Leiomyosarcoma is a malignant soft-tissue cancer arising from tissues containing smooth muscle. It commonly occurs in the gastrointestinal system and retroperitoneum, but is rare in the genito-urinary system. We experienced a case of primary testicular leiomyosarcoma. A 71-year-old man presented with painless swelling of the right scrotal contents for 4 months. A high orchiectomy was performed. Histological examination revealed primary testicular leiomyosarcoma. The patient did not receive any adjuvant therapy. Seven months after the operation, there has been no recurrence. Cases of primary intratesticular leiomyosarcoma are rare. To the best of our knowledge, only sixteen cases have been reported in the literature.

We present a case of isolated adrenocorticotrophic hormone (ACTH) deficiency (IAD) in a late onset hypogonadism (LOH) clinic, not diagnosed by examinations in internal medicine. A 54-year-old man showed body weight loss with severe appetite loss, general malaise and hypotension. He visited our clinic for a checkup for LOH after general examinations in internal medicine. His hormonal examination showed undetectable ACTH and cortisol levels. However, the values of other pituitary hormones and testosterone were normal. A load test for anterior pituitary hormone (CRH + TRH + LHRH + GRH test) revealed that the ACTH-cortisol system showed no response although the other pituitary hormones responded. These findings confirmed the diagnosis of isolated ACTH deficiency. Administration of hydrocortisone dramatically improved his symptoms. Symptoms of IAD are similar to those of LOH syndrome and depression. Thus, we should consider IAD as one of the differential diagnoses in LOH clinics.

OBJECTIVES:To clarify the influences of shock wave lithotripsy (SWL) treatments for renal and ureteropelvic junction stones on new onsets of hypertension and diabetes mellitus (DM).METHODS:We compared the new onsets of hypertension and DM after SWL in renal and ureteral stone groups. The renal stone group consisted of 772 patients treated with SWL, who had a possibility of renal and pancreatic shock wave damage. The ureteral stone group consisted of 505 patients treated with SWL, who were unlikely to have suffered SWL damage in the kidney and pancreas areas. Both treatment groups received SWL between 1984 and 1994.RESULTS:The rates of new onset of hypertension in the renal stone and ureteral stone groups were 22.8% and 20.0% in men and 23.1% and 20.5% in women, respectively. The rates of new onset of DM in the renal stone and ureteral stone groups were 7.4% and 11.0% in men and 8.7% and 8.7% in women, respectively. There was no significant difference in the new onsets of hypertension and DM between renal and ureteral stone groups depending on each age decade or sex. Treatment for renal stone was not a significant risk factor for new onsets of hypertension and DM by logistic regression analysis.CONCLUSIONS:Our findings suggest that SWL treatment for renal and UPJ stones might not be associated with new onset of hypertension or DM.

is well known that forest community is consisted of multiple layers of tree populations, from shrubs to taller tree species; especially, tropical forests have 3 or 4 layers with 30 to 50 meters tall. Individuals of the same species also occupy the dierent layers as they grow up from seedlings or saplings to mature trees. They transit from lower layer to middle and top layer during their lifetime. Therefore, dynamics of multi-layer population can be described as the transitions among discrete layers, using variables which represent the number of individuals at each layer. In this paper, we constructed discrete transition system and examined the local stability of the equilibrium of the system. The preceding studies examined the local stability of the two-layer system and obtained several theorems on permanence and persistence (Thieme (2003), Baer et a1.(2006)). We extended the system to three-layered one and discussed about the relationship between local stability and the pattem of interaction among individuals at