We examined the efficacy of combination therapy with α1-blocker tamsulosin and hypnotic zolpidem in patients who had suffered from sleep disturbance associated with nocturia.A total of 35 patients diagnosed with nocturia with lower urinary tract symptoms (LUTS) suggestive of benign prostatic hyperplasia (BPH) were studied. After treatment with tamsulosin for 4 weeks, 16 patients dissatisfied with nocturia (nocturiaquality of life index ≥4) and suspected to have sleep disturbance (Athens Insomnia Scale ≥6) received additional treatment with tamsulosin and zolpidem for 2 weeks. Outcomes were evaluated by the International Prostate Symptom Score (IPSS) and quality of life index (QOL), Athens Insomnia Scale (AIS) and nocturia-quality of life index (nocturia-QOL).After monotherapy with tamsulosin, significant reductions in IPSS (18.9 ±3.8 to 9.9 ±3.0, p <0.001), QOL (4.5 ±0.9 to 3.2 ±0.9, p <0.001) and nocturia episodes (3.4 ±0.7 to 2.6 ±1.0, p <0.001) were observed. However 20 patients were dissatisfied with nocturia (nocturia- QOL ≥4). Among 20 patients, 16 patients were suspected to have sleep disturbances (AIS ≥6). In these patients, additional therapy with tamsulosin and zolpidem significantly reduced nocturia episodes (3.3 ±0.8 to 1.9 ±0.7, p <0.001), AIS (10.6 ±2.9 to 6.8 ±25, p <0.001) and nocturia - QOL (5.6 ±0.5 to 3.6 ±1.1, p <0.001) compared with patients after treatment with tamsulosin only.Combination therapy with tamsulosin and zolpidem may be useful for patients with BPH dissatisfied with nocturia and suspected to have sleep disturbance.
We present a 71-year-old woman with spontaneous perinephric hematoma due to a rupture of pseudoaneurysm of the right renal artery on the fourth day after radical cystectomy and bilateral ureterocutaneostomy for bladder cancer. This patient received steroid therapy for chronic rheumatoid arthritis for several years. The digital subtraction angiography of the right renal artery showed two pseudoaneurysms in the anterior inferior segmental branch and the posterior inferior segmental branch. Transarterial coil embolization of the right renal artery proximally and distally to the two aneurysms was performed without complications. Moreover, the additional angiography showed typical string-of-beads appearance and small aneurysms in abdominal visceral arteries, suggesting segmental arterial mediolysis (SAM) as a possible etiology. Differential diagnoses of SAM are discussed.
A 62-year-old Japanese man had been suffering from dysuria since January 2011. Since symptoms persisted regardless of antibiotics therapy at a urological clinic, he consulted our clinic in February 2011. Digital rectal examination revealed a large irregular and stony hard prostatic mass, with the serum prostated specific antigen (PSA) of 2.76 ng/ml. T2-weighted magnetic reasonance imaging showed diffuse hypointensity and sharp margin in prostatic peripheral zone. Transperineal biopsy of the prostate was performed in March 2011. Considering histopathological findings of tumor cells in all specimens combined with positive immunoreactivity of neoplastic cells to chromogranin A but negative immunoreactivity to PSA, we diagnosed him with small cell carcinoma. The whole body computed tomography showed no metastatic lesion, he was diagnosed with small cell carcinoma of the prostate at clinical stage T2cN0M0. He received 4 cycles of chemotherapy (cisplatinum and etoposide) and underwent external beam radiotherapy to the pelvis and prostate, up to a total dose of 64 Gy. The urologic and radiologic outcomes including the serum levels of neuron-specific enolase and pro-gastrin releasing peptide have been satisfactory after more than 3 years of follow-up.
Thyroidization (thyroid-like appearance) in renal tissue which is made up of a colloid-like hyaline cast formation of Tamm-Horsfall glycoprotein (THP) is a common finding in chronic pyelonephritis and obstructive nephropathy. This type of pathological change is sometimes observed in renal allograft specimens. We examined allograft specimens for thyroidization and other pathological findings related to thyroidization to characterize the conditions causing such changes. One-hundred three patients who underwent renal transplantation between January 2006 and April 2008 at Gifu University Hospital (251 renal allograft biopsy specimens) were enrolled in this study. Sixteen patients had thyroidization (11 mild, 4 moderate, and 1 severe). In four patients, THP reflux on Bowman's capsule was found, and in three patients interstitial THP deposits were observed. In four patients, tubulointerstitial nephritis was diagnosed. Fifteen of 16 patients were examined for vesicoureteral reflux (VUR) with voiding cystourethrography. Three of 15 patients had VUR. In the past medical histories of the 16 patients with thyroidization, three had low capacity bladders, two had prostate diseases, and six had previous urinary tract infections. In cases of thyroidization with additional findings, including THP reflux into Bowman's space and interstitial THP deposits, we need to examine the patients for the presence of urinary tract diseases. In cases of thyroidization and tubulointerstitial nephritis urinary tract infections were suspected. Such subclinical urological diseases in the grafts might affect the prognosis of renal function. Therefore, appropriate management of urinary tract diseases is required.
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