Questionnaire survey were conducted three times to evalute the social life and functional problems in patients with orthotopic neobladder after cystectomy. A total of 34 responses were collected froml9 patients with a mean age of 66 years at diagnosis. The patients with orthotopic neobladder were found to be troubled with prolonged urinary incontinence such as nocturnal enuresis and stress incontinence. The problems was deteriorating the quality of life of the patients.

[Objective and Patients] We carried out surveys of urinary condition and its change, and anxiety and depression status and its change in 44 male outpatients with a chief complaint of urinary difficulty. In these surveys, we distributed questionnaires of the International Prostate Symptom Score (IPSS) and the Hospital Anxiety and Depression Scale (HAD Scale) to the patients twice-at their first visit and six monthslater.
[Results] The survey using the IPSS found that the urinary condition improved in 27 patients in six months, deteriorated in five and did not change in 12. The HAD Scale survey found that psychologicasl status improved in 17 patients, deteriorated in 11 and did not change in 16. The patients who had better points in the second IPSS test showed a tendency to make a good QOL score and get an improved state on the HAD Scale. However, the HAD Scale deteriorated in some of the patients who got improved IPSS.
[Conclusions] Although the patients who got better results in the second IPSS trial showed a tendency to get better marks on the HAD Scale, patients' anxiety and depression condition might have been affected by other factors than urinary difficulty.

Loss of bladder control has a significant psychological and social impact on the well-being of affected individuals. In the present study, a questionnaire survey regarding the incidence of urination trouble was conducted on individuals aged 40-86 years from a selected community.
A total of 281 individuals (137 males and 144 females) responded to our survey. In this study, urination trouble was categorized into: painful urination, retension and a decreased daily activity due to loss of bladder control. Of the 281 respondents, 122 (43.4%) said they had one or more symptoms of dysuria, 89 (31.7%) had irritative symtoms, 67 (23.8%) had obstructive symtoms, and 53 (18.9%) experienced a decrease in daily activities due to loss of bladder control.
The cases of abnormal urination showed no relationship to age, disease, or exercise. However, urinary abnormalities appeared to be related to frequent nocturnal and diurncl urination.
Loss of bladder control showed a positive correlation with the individual's perception concerning the quality of life. Thus, it was made clear that urinary trouble should be grappled with in earnest in the field of community health care.

Natural-orifice transluminal endoscopic surgery (NOTES) using flexible endoscopy has attracted attention as a minimally invasive surgical method that does not cause an operative wound on the body surface. However, minimizing the number of devices involved in endoscopic, compared to laparoscopic, surgeries has remained a challenge, causing endoscopic surgeries to gradually be phased out of use. If a flexible endoscopic full-thickness suturing device and a counter-traction device were developed to expand the surgical field for gastrointestinal-tract collapse, then endoscopic full-thickness resection using NOTES, which is seen as an extension of endoscopic submucosal dissection for full-thickness excision of tumors involving the gastrointestinal-tract wall, might become an extremely minimally invasive surgical method that could be used to resect only full-thickness lesions approached by the shortest distance via the mouth. It is expected that gastroenterological endoscopists will use this surgery if device development is advanced. This extremely minimally invasive surgery would have an immeasurable impact with regard to mitigating the burden on patients and reducing healthcare costs. Development of a new surgical method using a multipurpose flexible endoscope is therefore considered a socially urgent issue.
Dissection/economics/instrumentation/*methods ; Gastrointestinal Neoplasms/pathology/*surgery ; Health Care Costs ; Humans ; Medical Illustration ; Mouth ; Natural Orifice Endoscopic Surgery/economics/instrumentation/*methods ; Upper Gastrointestinal Tract/*surgery

Endoscopic treatment can be a curative option for small carcinoid tumors with an extremely low risk of metastasis. Since most carcinoid tumors are characterized by a specific growth pattern in the submucosal (SM) layer, specialized endoscopic techniques for deeper resection to achieve clear vertical margins are needed. The endoscopic submucosal dissection (ESD) method in the SM space is superior to conventional endoscopic mucosal resection. However, the standard ESD technique sometimes fails to provide complete deep SM dissection due to insufficient SM lifting. Here, to resolve this problem, we describe our initial experience with an endoscopic SM tunneling technique that is effective for treating rectal carcinoid tumors.
Carcinoid Tumor* ; Endoscopy, Gastrointestinal ; Lifting ; Methods ; Neoplasm Metastasis

Health-related quality-of-life (HRQOL) after a radical prostatectomy (RP) or external beam radiation therapy (EBRT) has not been studied in conjunction with oncological outcomes in relation to disease risk stratification. Moreover, the long-term outcomes of these treatment approaches have not been studied. We retrospectively analyzed oncological outcomes between consecutive patients receiving RP (n=86) and EBRT (n=76) for localized prostate cancer. HRQOL and functional outcomes could be assessed in 62 RP (79%) and 54 EBRT (79%) patients over a 3-year follow-up period (median: 41 months) using the Medical Outcomes Study Short Form-36 (SF-36) and the University of California Los Angeles Prostate Cancer Index (UCLA PCI). The 5-year biochemical progression-free survival did not differ between the RP and EBRT groups for low-risk (74.6% vs. 75.0%, P=0.931) and intermediate-risk (61.3% vs. 71.1%, P=0.691) patients. For high-risk patients, progression-free survival was lower in the RP group (45.1%) than in the EBRT group (79.7%) (P=0.002). The general HRQOL was comparable between the two groups. Regarding functional outcomes, the RP group reported lower scores on urinary function and less urinary bother and sexual bother than the EBRT group (P<0.001, P<0.05 and P<0.001, respectively). With risk stratification, the low- and intermediate-risk patients in the RP group reported poorer urinary function than patients in the EBRT group (P<0.001 for each). The sexual function of the high-risk patients in the EBRT group was better than that of the same risk RP patients (P<0.001). Biochemical recurrence was not associated with the UCLA PCI score in either group. In conclusion, low- to intermediate-risk patients treated with an RP may report relatively decreased urinary function during long-term follow-up. The patient's HRQOL after treatment did not depend on biochemical recurrence.
Aged ; Disease-Free Survival ; Follow-Up Studies ; Health Status ; Humans ; Male ; Middle Aged ; Prostatectomy ; methods ; Prostatic Neoplasms ; epidemiology ; radiotherapy ; surgery ; Quality of Life ; Radiotherapy ; methods ; Retrospective Studies ; Risk Factors ; Treatment Outcome