Okayama University Medical School Acta Medica Okayama 0386-300X 75 6 2021 The Significance of Age and Causative Bacterial Morphology in the Choice of an Antimicrobial Agent to Treat Acute Uncomplicated Cystitis 719 724 EN Shinya Uehara Department of Urology, Abiko Toho Hospital Kei Fujio Department of Urology, Abiko Toho Hospital Tomoya Yamasaki Department of Urology, Abiko Toho Hospital Hideo Otsuki Department of Urology, Abiko Toho Hospital Original Article 10.18926/AMO/62812 Differentiating patients by age and causative bacterial morphology might aid in making the appropriate choice of antimicrobial agent when treating acute uncomplicated cystitis. In this retrospective analysis, the non-susceptibility rates of the causative bacteria to cefcapene-pivoxil (CFPN-PI) and levofloxacin (LVFX) were determined after dividing patients with acute uncomplicated cystitis by age group (15-54 and 55-74 years old) and by bacterial morphology: gram-positive cocci (GPC) or gram-negative rod (GNR). The overall non-susceptibility rates for CFPN-PI and LVFX were 19.4% and 15.3%, respectively. When the subjects were divided by age, only the non-susceptibility rate for LVFX in the younger group significantly decreased (to 8.7%). When the groups were divided by both age and bacterial morphology, the younger GNR group had non-susceptibility rates of 6.9% to CFPN-PI and 7.8% to LVFX, whereas the younger GPC group showed 10.2% non-susceptibility to LVFX. The older GNR group showed 9.8% non-susceptibility to CFPN-PI, while the older GPC group showed 7.2% non-susceptibility to LVFX. All the non-susceptibility rates were lower than 10.2% in the sub-divided groups. Differentiating patients by age and the morphology of causative bacteria can aid in making the appropriate choice of antimicrobial agent and may improve treatment outcomes in patients with acute uncomplicated cystitis. No potential conflict of interest relevant to this article was reported.

Elsevier Acta Medica Okayama 1341-321X 25 6 2019 Second nationwide surveillance of bacterial pathogens in patients with acute uncomplicated cystitis conducted by Japanese Surveillance Committee from 2015 to 2016: antimicrobial susceptibility of Escherichia coli, Klebsiella pneumoniae, and Staphylococcus saprophyticus 413 422 EN Hiroshi Hayami The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID and the Japanese Society for Clinical Microbiology (JSCM) Satoshi Takahashi The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID and the Japanese Society for Clinical Microbiology (JSCM) Kiyohito Ishikawa The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID and the Japanese Society for Clinical Microbiology (JSCM) Mitsuru Yasuda The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID and the Japanese Society for Clinical Microbiology (JSCM) Shingo Yamamoto The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID and the Japanese Society for Clinical Microbiology (JSCM) Koichiro Wada The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID and the Japanese Society for Clinical Microbiology (JSCM) Kanao Kobayashi The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID and the Japanese Society for Clinical Microbiology (JSCM) Ryoichi Hamasuna The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID and the Japanese Society for Clinical Microbiology (JSCM) Shinichi Minamitani The Urogenital Sub-committee and the Surveillance Committee of Japanese Society of Chemotherapy (JSC), The Japanese Association for Infectious Diseases (JAID and the Japanese Society for Clinical Microbiology (JSCM) Tetsuya Matsumoto The Surveillance Committee of JSC, JAID and JSCM Hiroshi Kiyota The Surveillance Committee of JSC, JAID and JSCM Kazuhiro Tateda The Surveillance Committee of JSC, JAID and JSCM Junko Sato The Surveillance Committee of JSC, JAID and JSCM Hideaki Hanaki Infection Control Research Center, Kitasato University Naoya Masumori Department of Urology, Sapporo Medical University School of Medicine Hiroyuki Nishiyama Department of Urology, University of Tsukuba Jun Miyazaki Department of Urology, University of Tsukuba Kiyohide Fujimoto Department of Urology, Nara Medical University Kazushi Tanaka Division of Urology, Department of Surgery Related Faculty of Medicine, Kobe University Graduate School of Medicine Shinya Uehara Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Akio Matsubara Department of Urology, Institute of Biomedical & Health Sciences, Hiroshima University Kenji Ito iClinic Kenji Hayashi Tomakomai Urology and Cardiology Clinic Yuichiro Kurimura Tomakomai Urology and Cardiology Clinic Shin Ito iClinic Toshimi Takeuchi Takeuchi Urology and Dermatology Clinic Harunori Narita Narita Clinic Masanobu Izumitani Izumitani Fureai Clinic Hirofumi Nishimura Nishimura Urology Clinic Motoshi Kawahara Kawahara Urology Clinic Makoto Hara Department of Urology, Tsujinaka Hospital Kashiwanoha Takahide Hosobe Hosobe Clinic Kenji Takashima Takashima Urology Clinic Hirofumi Chokyu Cyokyu Tenma Clinic Masaru Matsumura Matsumura Urology Clinic Hideari Ihara Ihara Clinic Satoshi Uno Hirajima Clinic Koichi Monden Araki Urological Clinic Toru Sumii Shuichi Kawai Sumii Clinic Satoru Kariya Ootemachi Clinic Takashi Sato Nissin Urological Clinic Masaru Yoshioka Yoshioka Urology Clinic Hitoshi Kadena Kadena Urological Clinic Shinji Matsushita Department of Urology, Kagoshima Prefectural Ohshima Hospital Shohei Nishi Nishi Urology and Dermatology Clinic Yukinari Hosokawa Department of Urology, Tane General Hospital Takeshi Shirane Shirane Urology Clinic Mutsumasa Yoh Yoh Urology and Dermatology Clinic Syuji Watanabe Department of Urology, Saiseikai Chuwa Hospital Shinichi Makinose Makinose Urological Clinic Tetsuji Uemura Remedy Kitakyushu Nephro Clinic Hirokazu Goto Department of Urology, Fuji City Genaral Hospital The Japanese Surveillance Committee conducted a second nationwide surveillance of antimicrobial susceptibility patterns of uropathogens responsible for acute uncomplicated cystitis (AUC) in premenopausal patients aged 16–40 years old at 31 hospitals throughout Japan from March 2015 to February 2016. In this study, the susceptibility of causative bacteria (Escherichia coli, Klebsiella pneumoniae, Staphylococcus saprophyticus) for various antimicrobial agents was investigated by isolation and culturing of organisms obtained from urine samples. In total, 324 strains were isolated from 361 patients, including E. coli (n = 220, 67.9%), S. saprophyticus (n = 36, 11.1%), and K. pneumoniae (n = 7, 2.2%). The minimum inhibitory concentrations (MICs) of 20 antibacterial agents for these strains were determined according to the Clinical and Laboratory Standards Institute (CLSI) manual. At least 93% of the E. coli isolates showed susceptibility to fluoroquinolones and cephalosporins, whereas 100% of the S. saprophyticus isolates showed susceptibility to fluoroquinolones and aminoglycosides. The proportions of fluoroquinolone-resistant and extended-spectrum β-lactamase (ESBL)-producing E. coli strains were 6.4% (13/220) and 4.1% (9/220), respectively. The antimicrobial susceptibility of K. pneumoniae was retained during the surveillance period, while no multidrug-resistant strains were identified. In summary, antimicrobial susceptibility results of our second nationwide surveillance did not differ significantly from those of the first surveillance. Especially the numbers of fluoroquinolone-resistant and ESBL-producing E. coli strains were not increased in premenopausal patients with AUC in Japan. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 66 1 2012 Laparoscopic-Assisted Tension-free Vaginal Mesh: An Innovative Approach to Placing Synthetic Mesh Transvaginally for Surgical Correction of Pelvic Organ Prolapse 23 29 EN Toyohiko Watanabe Miyabi Inoue Ayano Ishii Toyoko Yamato Masumi Yamamoto Katsumi Sasaki Yasuyuki Kobayashi Motoo Araki Shinya Uehara Takashi Saika Hiromi Kumon Original Article 10.18926/AMO/48078 Polypropylene mesh implants for the correction of pelvic organ prolapse (POP) are now available in Japan. We developed an innovative approach for correcting POP by placing polypropylene mesh transvaginally with laparoscopic assistance. From June 2007 through March 2010, sixteen consecutive patients with symptomatic stage 2 or 3 pelvic organ prolapse underwent the laparoscopic-assisted tension-free vaginal mesh procedure at Okayama University Hospital. All patients were evaluated before and at 1, 3, 6, and 12 months after surgery. Female sexual function was also evaluated with the Female Sexual Function Index (FSFI). The procedure was performed successfully without significant complications. Fifteen of 16 patients were considered anatomically cured (93.8%) at 12 months postoperatively. One patient with a recurrent stage 3 vaginal vault prolapse required sacral colpopexy six months postoperatively. Total FSFI scores improved significantly from 10.3±1.3 at baseline to 18.0±1.2 at 12 months after surgery. The laparoscopic-assisted trans-vaginal mesh is a safe, effective, and simple procedure for POP repairs. The procedure not only restores anatomic relationships but also improves sexual function. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 63 5 2009 Experimental and Clinical Studies on Fluoroquinolone-insusceptible Escherichia coli Isolated from Patients with Urinary Tract Infections from 1994 to 2007 263 272 EN Koichiro Wada Reiko Kariyama Ritsuko Mitsuhata Shinya Uehara Toyohiko Watanabe Koichi Monden Hiromi Kumon Original Article 10.18926/AMO/31836 Urinary tract infections (UTIs) due to fluoroquinolone-insusceptible Escherichia coli have become increasingly common in recent years. We investigated the potential relationships between clinical measures to combat fluoroquinolone-insusceptible E. coli and experimental analyses on E. coli isolates. Over a 14-year period from 1994 through 2007, a total of 828 E. coli isolates were collected from patients (one isolate per patient) with UTI at the urology ward of Okayama University Hospital. We analyzed the mutations in quinolone resistance-determining regions of DNA gyrase (gyrA) and topoisomerase IV (parC). The production of biofilm by these isolates was also examined and the associated medical records were retrospectively reviewed. Seven of 189 (3.7%) strains from uncomplicated UTIs and 82 of 639 (12.8%) strains from complicated UTIs were insusceptible to fluoroquinolones. Amino acid replacements of type II topoisomerases were frequently observed at positions 83 and 87 in GyrA and at positions 80 and 84 in ParC. No significant difference in the biofilm-forming capabilities was observed between fluoroquinolone-susceptible and -insusceptible E. coli. Our study suggests that biofilm formation of fluoroquinolone-insusceptible E. coli isolates is not a major mechanism of resistance in patients with UTI. No potential conflict of interest relevant to this article was reported.

Okayama University Medical School Acta Medica Okayama 0386-300X 62 6 2008 Initial Report of Hybrid Radical Prostatectomy for Prostate Cancer:Reduced Bleeding, Clear Vision, and Secure Surgical Margins 379 384 EN Takashi Saika Yasuyuki Kobayashi Toyohiko Watanabe Daisuke Manabe Shin Ebara Shinya Uehara Yasutomo Nasu Hiromi Kumon Original Article 10.18926/AMO/30950 To evaluate morbidity in Hybrid Radical Prostatectomy (HRP, hybridized laparoscopic and open retropubic radical prostatectomy). The operative and pathological outcomes obtained in 25 consecutive patients who underwent HRP were reviewed. The median operating time was 220min, median blood loss was 550ml, and no patient required an allogenic blood transfusion. No severe postoperative complications were observed. The surgical margin was positive in 12% of all patients, and in 1 patient with pT2 or less (4.5%). These results indicate that HRP is safe and may be able to combine the benefits of both laparoscopic and open procedures. No potential conflict of interest relevant to this article was reported.

Acta Medica Okayama 2007 A pilot study evaluating the safety and effectiveness of Lactobacillus vaginal suppositories in patients with recurrent urinary tract infection EN Shinya Uehara Changes in the indigenous vaginal microflora with uropathogenic bacteria can predispose women to frequently recurring bacterial cystitis. Lactobacilli used as probiotics have played an important role in preventing the colonization of pathogenic bacteria in the vagina. A prospective clinical pilot study was performed to confirm the safety and effectiveness of Lactobacillus vaginal suppositories against the recurrence of bacterial urinary tract infection (UTI). The patients enrolled in the study were instructed to administer vaginal suppositories containing the strain Lactobacillus crispatus GAI 98322. A significant reduction in the number of recurrences was noted, without any adverse complication (P=0.0007). The administration of vaginal suppositories containing L. crispatus GAI 98332 seemed to be a safe and promising treatment for the prevention of recurrent UTI. No potential conflict of interest relevant to this article was reported.