Publications by authors named "Satoshi Funada"

38 Publications

Adjuvant immunotherapy in muscle-invasive urothelial carcinoma.

Lancet Oncol 2021 06;22(6):e236

Department of Health Promotion and Human Behaviour, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan.

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http://dx.doi.org/10.1016/S1470-2045(21)00205-9DOI Listing
June 2021

Protocol for development and validation of a prediction model for 5-year risk of incident overactive bladder in the general population: the Nagahama study.

BMC Urol 2021 May 13;21(1):78. Epub 2021 May 13.

Department of Urology, Faculty of Medicine, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.

Background: An accurate prediction model could identify high-risk subjects of incident Overactive bladder (OAB) among the general population and enable early prevention which may save on the related medical costs. However, no efficient model has been developed for predicting incident OAB. In this study, we will develop a model for predicting the onset of OAB at 5-year in the general population setting.

Methods: Data will be obtained from the Nagahama Cohort Project, a longitudinal, general population cohort study. The baseline characteristics were measured between Nov 28, 2008 and Nov 28, 2010, and follow-up was performed every 5 years. From the total of 9,764 participants (male: 3,208, female: 6,556) at baseline, we will exclude participants who could not attend the follow-up assessment and those who were defined as having OAB at baseline. The outcome will be incident OAB defined using the Overactive Bladder Symptom Score (OABSS) at follow-up assessment. Baseline questionnaires (demographic, health behavior, comorbidities and OABSS) and blood test data will be included as predictors. We will develop a logistic regression model utilizing shrinkage methods (LASSO penalization method). Model performance will be evaluated by discrimination and calibration. Net benefit will be evaluated by decision curve analysis. We will perform an internal validation and a temporal validation of the model. We will develop a web-based application to visualize the prediction model and facilitate its use in clinical practice.

Discussion: This will be the first study to develop a model to predict the incidence of OAB.
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http://dx.doi.org/10.1186/s12894-021-00848-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8120704PMC
May 2021

Considerations Regarding a Network Meta-analysis of Systemic Treatments for Metastatic Castration-Sensitive Prostate Cancer.

JAMA Oncol 2021 Jul;7(7):1068-1069

Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan.

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http://dx.doi.org/10.1001/jamaoncol.2021.0963DOI Listing
July 2021

Re: Cosimo De Nunzio, Benjamin Brucker, Thomas Bschleipfer, et al. Beyond Antimuscarinics: A Review of Pharmacological and Interventional Options for Overactive Bladder Management in Men. Eur Urol 2021;79:492-504.

Eur Urol 2021 May 27;79(5):e145-e146. Epub 2021 Feb 27.

Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan.

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http://dx.doi.org/10.1016/j.eururo.2021.02.030DOI Listing
May 2021

Evaluation of Efficacy and Safety of Nab-Paclitaxel vs Paclitaxel in Platinum-Refractory Metastatic Urothelial Cancer.

JAMA Oncol 2021 Apr;7(4):633-634

Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan.

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http://dx.doi.org/10.1001/jamaoncol.2020.8005DOI Listing
April 2021

Re: Marcus J. Drake, Amanda L. Lewis, Grace J. Young, et al. Diagnostic Assessment of Lower Urinary Tract Symptoms in Men Considering Prostate Surgery: A Noninferiority Randomised Controlled Trial of Urodynamics in 26 Hospitals. Eur Urol 2020;78:701-10.

Eur Urol 2021 Mar 21;79(3):e87-e88. Epub 2020 Dec 21.

Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan.

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http://dx.doi.org/10.1016/j.eururo.2020.12.014DOI Listing
March 2021

Implementing Group-Based Pelvic Floor Muscle Training in Clinical Practice.

JAMA Intern Med 2021 Mar;181(3):405-406

Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan.

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http://dx.doi.org/10.1001/jamainternmed.2020.7116DOI Listing
March 2021

Re: Guohua Zeng, Chao Cai, Xianzhong Duan, et al. Mini Percutaneous Nephrolithotomy Is a Noninferior Modality to Standard Percutaneous Nephrolithotomy for the Management of 20-40mm Renal Calculi: A Multicenter Randomized Controlled Trial. Eur Urol 2021;79:114-21.

Eur Urol 2021 02 15;79(2):e60-e61. Epub 2020 Nov 15.

Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan.

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http://dx.doi.org/10.1016/j.eururo.2020.11.005DOI Listing
February 2021

Systematic Review and Meta-Analysis Comparing Percutaneous Nephrolithotomy, Retrograde Intrarenal Surgery and Shock Wave Lithotripsy for Lower Pole Renal Stones Less Than 2 cm in Maximum Diameter. Letter.

J Urol 2021 06 12;205(6):1843-1844. Epub 2020 Nov 12.

Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto City, Kyoto, Japan.

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http://dx.doi.org/10.1097/JU.0000000000001507DOI Listing
June 2021

Medical history of nocturnal enuresis during school age is an independent risk factor for nocturia in adults: The Nagahama study.

Neurourol Urodyn 2021 01 29;40(1):326-333. Epub 2020 Oct 29.

Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Aim: To evaluate the relationship between nocturia and medical history of nocturnal enuresis: two conditions where diurnal urination rhythm is disturbed.

Methods: The Nagahama study is a longitudinal population-based health survey involving people aged 30-75 years in Nagahama city, Japan. Our analysis included 5,402 participants who completed enuresis and International Prostate Symptom Score questionnaires. Associations between nocturnal enuresis and nocturia were evaluated cross-sectionally and longitudinally with three models: (1) univariate analysis; (2) adjusted for basic characteristics (e.g., age, sex, body mass index, activity, alcohol, and smoking); and (3) adjusted for basic and clinical variables (e.g., hyperglycemia, hyperlipidemia, hypertension, renal insufficiency, insomnia, obstructive sleep apnea, and mental health).

Results: In total, 1,613 participants (29.9%) had a medical history of enuresis. The mean night-time frequency was 0.73 at baseline and 0.85 at the 5-year follow-up. The cross-sectional analysis showed participants with a medical history of enuresis had night-time frequency more often than those without this history (0.84 vs. 0.68, p < .0001). Significant differences were observed in Models 2 (p < .0001) and 3 (p < .0001). The longitudinal analysis showed nocturia progression was significantly related to a history of enuresis, with odds ratios of 1.32 (p < .0001) in Model 1, 1.21 (p < .01) in Model 2, and 1.22 (p < .01) in Model 3.

Conclusions: Medical history of enuresis during school age was significantly related to nocturia in adulthood in the cross-sectional analysis, and to progression to nocturia in the longitudinal analysis. These two conditions may possess a common causative association.
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http://dx.doi.org/10.1002/nau.24562DOI Listing
January 2021

The inherent problems with the generalizability of the CALL score: towards reliable clinical prediction models for COVID-19.

Clin Infect Dis 2020 Oct 16. Epub 2020 Oct 16.

Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto city, Kyoto, Japan.

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http://dx.doi.org/10.1093/cid/ciaa1564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7665360PMC
October 2020

Re: Ashley M. Hopkins, Ganessan Kichenadasse, Christos S. Karapetis, et al. Concomitant Antibiotic Use and Survival in Urothelial Carcinoma Treated with Atezolizumab. Eur Urol 2020;78:540-3.

Eur Urol 2020 12 18;78(6):e225-e226. Epub 2020 Sep 18.

Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan.

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http://dx.doi.org/10.1016/j.eururo.2020.09.008DOI Listing
December 2020

Reply by Authors.

J Urol 2020 11 4;204(5):1002. Epub 2020 Sep 4.

Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.

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http://dx.doi.org/10.1097/JU.0000000000001138.02DOI Listing
November 2020

Cognitive behavioral therapy for overactive bladder in women: study protocol for a randomized controlled trial.

BMC Urol 2020 Aug 20;20(1):129. Epub 2020 Aug 20.

Department of Urology, Kyoto University Graduate School of Medicine, 54 Shogoinkawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.

Background: Overactive bladder (OAB) symptoms affect daily life by decreasing health-related quality of life (HRQol). However, there remain no very effective treatment for OAB. Pharmacotherapy is one of the best treatments, but it is not always efficient and may incur adverse events. Although behavioral therapy is another effective treatment, there are very few structured treatment manuals on how to prescribe behavioral therapy to treat OAB for whom. Cognitive behavioral therapy (CBT) is a psychotherapy consisting of structured sessions to solve problems with the collaborative empiricism between therapists and patients. OAB symptoms are supposed to worsen with cognitive distortion, and CBT is expected to be effective in treating OAB by modifying such cognitive processes. In this trial, we will evaluate the efficacy of CBT for OAB.

Methods: A randomized, controlled, open-label, multicenter parallel-group superiority trial will be conducted. Participants with moderate to severe OAB symptoms with or without pharmacotherapy will be recruited and will be randomly allocated 1:1 to two different groups by minimization (age, baseline OAB severity, treatment status, types of intervention, and treating institutions). The intervention group will be prescribed an individual CBT program covering six techniques in 4 sessions (30 min each), with or without pharmacotherapy. The primary outcome is the change scores in an OAB-questionnaire (OAB-q) from baseline to the end of the trial (week 13). Secondary outcomes will include other patient reported outcome measures and the frequency volume chart. All analyses will be conducted on an intention-to-treat principle.

Discussion: This trial will determine the efficacy of CBT to treat OAB using a rigorous methodology. The effectiveness of CBT with a structured manual may not only lead to a new treatment option for patients suffering from OAB symptoms, but may also reduce the social burden by OAB.

Trial Registration: UMIN-CTR Clinical Trial, CTR-UMIN000038513 . Registered on November 7, 2019.
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http://dx.doi.org/10.1186/s12894-020-00697-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7439638PMC
August 2020

Challenges in Systematic Reviews That Include Observational Studies: Comment on the Article by Karmacharya et al.

Arthritis Rheumatol 2020 12;72(12):2163-2164

Kyoto University Graduate School of Medicine, Kyoto, Japan.

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http://dx.doi.org/10.1002/art.41442DOI Listing
December 2020

Re: Lisa Moris, Marcus G. Cumberbatch, Thomas Van den Broeck, et al. Benefits and Risks of Primary Treatments for High-risk Localized and Locally Advanced Prostate Cancer: An International Multidisciplinary Systematic Review. Eur Urol 2020;77:614-27.

Eur Urol 2020 09 15;78(3):e118-e119. Epub 2020 Jul 15.

Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine and School of Public Health, Kyoto, Japan.

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http://dx.doi.org/10.1016/j.eururo.2020.06.057DOI Listing
September 2020

Clinical feasibility and acceptability of adding cognitive behavioral therapy to pharmacotherapy for drug-resistant overactive bladder in women: A single-arm pilot study.

Low Urin Tract Symptoms 2021 Jan 3;13(1):69-78. Epub 2020 Jul 3.

Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Objectives: Drug-resistant overactive bladder (OAB) represents an unmet medical need in that treatment options are limited. We developed a treatment model based on cognitive behavioral therapy and evaluated its feasibility and acceptability for drug-resistant OAB in women.

Methods: This was an open-label, single-arm, multicenter pilot study. We defined drug-resistant OAB as OAB with moderate to severe symptoms despite pharmacotherapy for more than 12 weeks. A face-to-face intervention was prescribed as six sessions (30 minutes each) over 6 to 12 weeks according to a treatment manual. The effects were assessed by self-reported questionnaires and frequency voiding charts (FVC) at baseline, during intervention, immediately after intervention, and at follow-up.

Results: Ten patients participated in this study. Median age was 72 years, median OAB Symptom Score was nine points, and median duration of prior treatment for OAB was 5.5 years at baseline. Two participants dropped out of the study. Among the remaining patients, the scores of the OAB Questionnaire subscales improved (effect size: 0.75-1.73), and the mean urinary frequency in the FVC also improved from baseline (9.0 times, SD: 2.1) to follow-up (6.2 times, SD: 1.2). All participants were satisfied with the intervention. There were no adverse events during this study.

Conclusions: The new treatment based on cognitive behavioral therapy was well tolerated and feasible in women with drug-resistant OAB. Further randomized research is needed to rigorously evaluate the efficacy of the treatment.
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http://dx.doi.org/10.1111/luts.12333DOI Listing
January 2021

Predicting the treatment response of certolizumab for individual adult patients with rheumatoid arthritis: protocol for an individual participant data meta-analysis.

Syst Rev 2020 06 12;9(1):140. Epub 2020 Jun 12.

Department of Health Promotion and Human Behavior, School of Public Health in the Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan.

Background: A model that can predict treatment response for a patient with specific baseline characteristics would help decision-making in personalized medicine. The aim of the study is to develop such a model in the treatment of rheumatoid arthritis (RA) patients who receive certolizumab (CTZ) plus methotrexate (MTX) therapy, using individual participant data meta-analysis (IPD-MA).

Methods: We will search Cochrane CENTRAL, PubMed, and Scopus as well as clinical trial registries, drug regulatory agency reports, and the pharmaceutical company websites from their inception onwards to obtain randomized controlled trials (RCTs) investigating CTZ plus MTX compared with MTX alone in treating RA. We will request the individual-level data of these trials from an independent platform (http://vivli.org). The primary outcome is efficacy defined as achieving either remission (based on ACR-EULAR Boolean or index-based remission definition) or low disease activity (based on either of the validated composite disease activity measures). The secondary outcomes include ACR50 (50% improvement based on ACR core set variables) and adverse events. We will use a two-stage approach to develop the prediction model. First, we will construct a risk model for the outcomes via logistic regression to estimate the baseline risk scores. We will include baseline demographic, clinical, and biochemical features as covariates for this model. Next, we will develop a meta-regression model for treatment effects, in which the stage 1 risk score will be used both as a prognostic factor and as an effect modifier. We will calculate the probability of having the outcome for a new patient based on the model, which will allow estimation of the absolute and relative treatment effect. We will use R for our analyses, except for the second stage which will be performed in a Bayesian setting using R2Jags.

Discussion: This is a study protocol for developing a model to predict treatment response for RA patients receiving CTZ plus MTX in comparison with MTX alone, using a two-stage approach based on IPD-MA. The study will use a new modeling approach, which aims at retaining the statistical power. The model may help clinicians individualize treatment for particular patients.

Systematic Review Registration: PROSPERO registration number pending (ID#157595).
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http://dx.doi.org/10.1186/s13643-020-01401-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7477831PMC
June 2020

Impact of Nocturia on Mortality: The Nagahama Study.

J Urol 2020 11 12;204(5):996-1002. Epub 2020 May 12.

Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Purpose: Nocturia has been reported as a risk factor for mortality. However, evidence is limited and has a high risk of bias. We evaluated the association between nocturia and mortality using longitudinal data from the general Japanese population.

Materials And Methods: Data were obtained from the Nagahama Cohort Project, a longitudinal, general population cohort study. Nocturia was measured using the International Prostate Symptom Score. Mortality data were obtained from the Basic Resident Register in Nagahama City. We used Cox proportional hazard models and time-varying covariates at baseline and 5-year followup to analyze the association between nocturia and mortality.

Results: We analyzed 9,762 participants (median age 56.8 years, male 32.8%). The prevalence rates of nocturnal voiding at 0, 1, 2 and 3 or more times were 44.3%, 39.1%, 11.7% and 4.9%, respectively. A total of 263 participants died. Followup assessment was performed 3,224 (SD 537) days after baseline. According to multivariable Cox proportional hazard regressions, mortality increased dose dependently with the nocturnal voiding frequency as HR 1.46 for 1 time (95% CI 1.02-2.09), HR 1.85 for 2 times (95% CI 1.23-2.77) and HR 2.06 (95% CI 1.28-3.32) for 3 or more times in comparison with 0 times (p for trend=0.00084). In the time varying Cox proportional hazard regression the association was still significant (p for trend=0.0017).

Conclusions: According to this longitudinal study with a low incidence of missing data and high representation of the general population, nocturia is associated with mortality.
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http://dx.doi.org/10.1097/JU.0000000000001138DOI Listing
November 2020

Re: Is There an Association between Urinary Incontinence and Mortality? A Retrospective Cohort Study.

J Urol 2020 08 19;204(2):353-354. Epub 2020 Mar 19.

Departments of Urology, and Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto City, Kyoto, Japan.

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http://dx.doi.org/10.1097/JU.0000000000001025DOI Listing
August 2020

Longitudinal Analysis of Bidirectional Relationships between Nocturia and Depressive Symptoms: The Nagahama Study.

J Urol 2020 May 21;203(5):984-990. Epub 2019 Nov 21.

Department of Urology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.

Purpose: Although the association between nocturia and depressive symptoms has been demonstrated, the causal direction remains unclear. We investigated the directional association between nocturia and depressive symptoms using longitudinal data from the general population.

Materials And Methods: This longitudinal analysis was conducted as part of the Nagahama Cohort Project, a population based cohort study, with baseline and 5-year followup investigations. Nocturnal voiding frequency and mental health were measured with self-report questionnaires, the International Prostate Symptom Score and the 5-item Mental Health Inventory. Logistic regression analyses and a cross-lagged panel analysis were performed to analyze the bidirectional association between nocturia and depressive symptoms.

Results: With 9,764 participants at baseline, data from 8,285 were used in this analysis. Median age at baseline was 57.3 years and the proportion of men was 32.0%. New onset depressive symptoms and nocturia were observed among 369 and 793 participants, respectively. In adjusted logistic regression analyses we observed a clear dose-relationship between baseline nocturnal voiding frequency and new onset depressive symptoms (p for trend <0.001) and a weak association between baseline 5-item Mental Health Inventory and new onset nocturia (p for trend=0.0087). In a cross-lagged panel analysis the path coefficient from nocturnal voiding frequency to 5-item Mental Health Inventory (β=-0.06, p <0.001) was stronger than that from 5-item Mental Health Inventory to nocturnal voiding frequency (β=-0.02, p=0.047).

Conclusions: This longitudinal study demonstrated a bidirectional association between nocturia and depressive symptoms. The cross-lagged path coefficient suggested that nocturia could more likely be a cause than a result of depressive symptoms.
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http://dx.doi.org/10.1097/JU.0000000000000683DOI Listing
May 2020

Lifestyle habits associated with nocturnal urination frequency: The Nagahama study.

Neurourol Urodyn 2019 11 4;38(8):2359-2367. Epub 2019 Sep 4.

Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Background: Nocturia is a risk factor for poor quality of life and increased mortality. This study was aimed to clarifying dietary habits, eating behaviors, and sleep characteristics associated with nocturia to identify modifiable lifestyle factors for nocturia.

Methods: This cross-sectional study included 5683 community residents (64.5 ± 7.7 years old). The frequency of nocturnal urination was recorded for 1 week using a sleep diary. The frequency of food intake, unfavorable eating behaviors, and sleep characteristics that may have influence on salt intake and wasting were obtained using a structured questionnaire.

Results: The frequency of nocturnal urination was increased with age (β = .312, P < .001). Other basic factors associated with the frequency were the male sex (β = .090), hypertension (β = .038), sleep apnea (β = .030), B-type natriuretic peptide level (β = .089), and spot urine sodium excretion (β = -.058). Dietary factors independently associated with nocturnal urination frequency were coffee (≥1 time/day: β = -.059, P < .001) and green vegetable consumption (≥1 time/week: β = -.042, P = .001), whereas habitual intake of dairy products, miso soup, and alcohol were not associated with urination frequency. Later bedtime was inversely associated with nocturnal urination frequency independent of sleep duration (before 23:00: β = -.096; before 24:00: β = -.225; after midnight: β = -.240; all P < .001).

Conclusion: Coffee and green vegetable consumption and later bedtime but not sleep duration are lifestyle factors associated with nocturnal urination frequency.
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http://dx.doi.org/10.1002/nau.24156DOI Listing
November 2019

Association of weak hip abduction strength with nocturia in older women: The Nagahama study.

Geriatr Gerontol Int 2019 Oct 1;19(10):1010-1016. Epub 2019 Sep 1.

Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.

Aim: Nocturia is a common phenomenon in older individuals, and is associated with poor quality of life. Nocturia is a multifactorial disorder, wherein the frailty of skeletal muscles, particularly muscle weakness in the lower trunk and hip regions, might be a risk factor in women. We analyzed a dataset of the general Japanese population to clarify the hypothesis.

Methods: Study participants included 1207 older women (mean age 67.4 ± 5.2 years). The frequency of nocturnal urination was assessed using a sleep diary for 1 week, and associations with lower muscle strength, skeletal muscle index, sarcopenia and physical performance (one-leg standing time and Timed Up and Go test) were investigated.

Results: The frequency of nocturnal urination more than one voiding per night was 28.1%; this frequency was inversely associated with hip abduction strength quartiles (Q1: 37.0, Q2: 30.5, Q3: 25.1 and Q4: 19.9%, P < 0.001). When a sleep diary-based nocturnal urination frequency >1.5 times/night (corresponding to a ≥2 times/night frequency obtained by questionnaire) was considered as nocturia, logistic regression analysis adjusted for major covariates identified hip abduction strength as an independent inverse determinant of nocturia (odds ratio 0.75, 95% CI 0.52-0.90, P = 0.002). In contrast, no significant association was observed with knee extension (P = 0.322) and hip flexion (P = 0.603) strengths. Physical performance, skeletal muscle index and sarcopenia did not show significant associations with nocturia.

Conclusions: Weak hip abduction strength might be a factor associated with nocturnal urination frequency in older women. Geriatr Gerontol Int 2019; 19: 1010-1016.
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http://dx.doi.org/10.1111/ggi.13761DOI Listing
October 2019

Reply by Authors.

J Urol 2019 08 8;202(2):360-361. Epub 2019 Jul 8.

Department of Urology, Kyoto University Hospital , Kyoto , Japan.

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http://dx.doi.org/10.1097/01.JU.0000559826.09631.1dDOI Listing
August 2019

Sleep Disturbance Worsens Lower Urinary Tract Symptoms: The Nagahama Study.

J Urol 2019 08 8;202(2):354. Epub 2019 Jul 8.

Department of Urology, Kyoto University Hospital , Kyoto , Japan.

Purpose: Multiple factors are associated with lower urinary tract symptoms and sleep disturbance is well known to be associated with nocturia. The association between sleep disturbance and lower urinary tract symptoms has not been sufficiently elucidated. We evaluated the impact of sleep disturbance on lower urinary tract symptoms, especially voiding symptoms, in the Nagahama Study.

Materials And Methods: The Nagahama Study is a prospective cohort study of healthy individuals. Among them study participants 50 years old or older who completed the I-PSS (International Prostate Symptom Score) questionnaire and a sleep problem questionnaire were included in this analysis and followed for 5 years. Sleep disturbance was stratified into poor sleep quality, sleep restriction and sleep medication use. We analyzed the association between sleep disturbance and worsening of lower urinary tract symptoms adjusted by various clinical factors on multivariate logistic regression analysis.

Results: Among the 5,297 participants the prevalence of lower urinary tract symptoms at baseline was 23% and the prevalence rates of poor sleep quality, sleep restriction and sleep medication were 20%, 6% and 7%, respectively. Participants with poor sleep quality, sleep restriction or sleep medication use had a significantly greater incidence of lower urinary tract symptoms and voiding symptoms than those without such characteristics (p <0.01). Poor sleep quality and sleep medication use were significantly associated with worsening lower urinary tract symptoms as defined by an I-PSS score increase of 4 or greater (OR 1.23, p = 0.03, and 1.67, p <0.01), and with worsening voiding symptoms, defined as an increase of 3 or greater (OR 1.35, p <0.005, and 1.85, p <0.001, respectively).

Conclusions: Sleep disturbance was significantly associated with the presence of lower urinary tract symptoms in a cross-sectional manner and with worsening lower urinary tract symptoms longitudinally.
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http://dx.doi.org/10.1097/JU.0000000000000212DOI Listing
August 2019

[Prostate Cancer Diagnosed during Androgen Replacement Therapy for Late-Onset Hypogonadism Treatment: A Case Report].

Hinyokika Kiyo 2018 Dec;64(12):501-504

The Department of Urology, Kyoto City Hospital.

We report a 60-year-old man with prostate cancer diagnosed during androgen replacement therapy (ART) for late onset hypogonadism after surgery for pituitary adenoma. He was refered to the department of urology since prostate specific antigen values were elevated after 6 months of ART. After the diagnosis of prostate cancer, ART was discontinued, and robot-asssited laparoscopic radical prostatectomy with pelvic lymphadenoctomy was performed. Pathological examination revealed Gleason score 4 + 5 prostate adenocarcinoma with seminal vesicle invasion and lymph node metastasis(pT3bN1). He has stayed biochemically and radiologically disease-free 33 months postoperatively.
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http://dx.doi.org/10.14989/ActaUrolJap_64_12_501DOI Listing
December 2018

Bladder urothelial carcinoma producing insulin-like growth factor II: A case report.

IJU Case Rep 2018 Nov 20;1(1):9-12. Epub 2018 Sep 20.

Department of Urology Kyoto University Graduate School of Medicine Kyoto Japan.

Introduction: Non-islet cell tumor hypoglycemia is a rare paraneoplastic syndrome associated with tumors. Although it mainly occurs in solid tumors of mesenchymal and epithelial origin, but rarely also in hematopoietic and neuroendocrine origin.

Case Presentation: We describe a 65-year-old man with a muscle-invasive bladder urothelial carcinoma, which rapidly progressed against systemic chemotherapy consisting of gemcitabine and cisplatin. Notably, the patient developed hypoglycemia at the terminal stage of the disease. Pathological diagnosis was giant cell urothelial carcinoma, which was strongly positive for insulin-like growth factor-II in immunohistochemistry. We established patient-derived xenograft from insulin-like growth factor-II producing bladder urothelial carcinoma that caused non-islet cell tumor hypoglycemia. Although we evaluated the efficacy of the neutralizing antibody, there was no statistically significant inhibitory effect on tumor growth.

Conclusion: To the best of our knowledge, this is the first report of insulin-like growth factor-II-producing urothelial carcinoma that have been recapitulated in a patient-derived xenograft model.
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http://dx.doi.org/10.1002/iju5.12018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292130PMC
November 2018

[CHYLOUS LEAKAGE AFTER LAPAROSCOPIC RENAL AND ADRENAL SURGERY].

Nihon Hinyokika Gakkai Zasshi 2017 ;108(1):1-4

The Department of Urology, Ijinkai Takeda General Hospital.

(Objectives) It is recognized that Chylous leakage is a rare complication but is a relevant clinical problem after major abdominal surgery. It was occasionally reported in urologic surgery, but the data about its incidence and treatment outcome is still lacking. In this study, we reviewed our cases of chylous leakage after laparoscopic adrenalectomy or nephrectomy. (Patients and methods) From January 2005 to September 2014, laparoscopic adrenalectomies or nephrectomies were performed in 300 patients. The factors that affected the development of chylous leakage were analyzed. (Results) The overall incidence of chylous leakage was 4.3% (13 of 300 cases). All chylous leakage was seen on the left side, and it was commonly developed in patients with lymph node dissection or excessive hilar dissection around the left renal pedicle. Importantly, all cases were successfully managed conservatively by a low fat diet with or without octreotide. (Conclusions) Our results suggest that chylous leakage is not a rare complication after laparoscopic adrenalectomy or nephrectomy, but most cases can be treated conservatively. Chylous leakage can occur in patients with lymphadenectomy or hilar dissection on the left side.
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http://dx.doi.org/10.5980/jpnjurol.108.1DOI Listing
February 2019

Standardized and Simplified Retroperitoneal Lymph Node Dissection During Retroperitoneal Laparoscopic Radical Nephroureterectomy for Urothelial Carcinoma of the Upper Ureter or Renal Pelvis: En Bloc Resection Technique.

Urology 2018 Feb 20;112:85-91. Epub 2017 Nov 20.

Department of Urology, Ijinkai Takeda General Hospital, Kyoto, Japan.

Objective: To describe our en bloc technique of retroperitoneal lymph node dissection (RPLND) during retroperitoneal laparoscopic radical nephroureterectomy for upper urinary tract urothelial carcinoma and evaluate perioperative outcomes.

Methods: From 2002 to 2015, 114 patients with urinary tract urothelial carcinoma located at the pelvis or upper or middle ureter underwent retroperitoneal laparoscopic radical nephroureterectomy at 2 institutions. Performance of RPLND began in February 2009. The template of RPLND included the renal hilar and para-aortic lymph nodes (left side) and the renal hilar, paracaval, retrocaval, and intra-aortocaval lymph nodes (right side). After incising Gerota fascia longitudinally, the aorta (left side) or inferior vena cava (right side) was exposed, and the lymphatic and surrounding fatty tissue in the template and kidney was dissected in a single monoblock. Preoperative data were compared between the RPLND and the no-RPLND groups using propensity score matching.

Results: In total, 32 matched pairs were evaluated. RPLND was successfully accomplished without open conversion in all cases. The operative time in the RPLND group was approximately 100 minutes longer than that in the no-RPLND group, but there was no significant difference in the blood loss volume or complication rate. The pathologic stages were similar in both groups. The mean number of retrieved lymph nodes was 10.7 (range 3-27), and lymph node metastasis was detected in 5 (16%) cases.

Conclusion: Retroperitoneoscopic en bloc RPLND permits complete and radical removal of the lymphatic tissue contained in the RPLND template. Our en bloc technique is a safe and feasible procedure with comparable blood loss and complication rates.
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http://dx.doi.org/10.1016/j.urology.2017.11.001DOI Listing
February 2018

Cross-Sectional Epidemiological Analysis of the Nagahama Study for Correlates of Overactive Bladder: Genetic and Environmental Considerations.

J Urol 2018 03 21;199(3):774-778. Epub 2017 Oct 21.

Department of Urology, Kyoto University Hospital, Kyoto, Japan. Electronic address:

Purpose: The prevalence of overactive bladder is increasing globally. It has a substantial impact on quality of life and represents a heavy economic burden. We evaluated the prevalence of overactive bladder in a Japanese population and analyzed whether genetic and environmental factors influence overactive bladder.

Materials And Methods: This cross-sectional study was performed as part of the Nagahama cohort project. It comprised a questionnaire survey as well as anthropometric, physiological and biochemical measures, and genomic information on participants 30 to 74 years old in Nagahama, Japan. A genome-wide association study was performed in 4,645 participants, including 1,521 men and 3,124 women, using 99,059 single nucleotide polymorphisms. Univariate and multivariable logistic regression was done to analyze environmental factors associated with overactive bladder.

Results: The prevalence of overactive bladder was 11.8%, including 15.3% in men and 10.1% in women, and it increased with age. We found no significant association between overactive bladder and any single nucleotide polymorphism in the genome-wide association study. However, in the multivariable logistic regression model overactive bladder was positively associated with environmental factors, including age, depression and the consumption of cake or Japanese confection.

Conclusions: The prevalence of overactive bladder was greater in men than in women, especially among the elderly. Environmental factors rather than genetic variants more likely contribute to overactive bladder.
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http://dx.doi.org/10.1016/j.juro.2017.09.146DOI Listing
March 2018
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