During the last 10 years, 90 penile prostheses were implanted in 82 patients with spinal cord injury. Surgery was done 1 month to 25 years (average 4.8 years) after the injury. The follow up period ranged from 1 to 10 years (average 4 years). A prosthesis was implanted for urinary management in 51 patients (62%), for sexual dysfunction in 10 patients (12%) and for both purposes in 21 patients (26%). Ninety-three per cent of the patients who used the implant for urinary management and 64% of the patients who used it for sexual dysfunction were satisfactory. We experienced three extrusions and nine surgical removals due to pain, difficulty of catheterisation and infection (the complication rate was 13.3%). Generally speaking, a penile prosthesis improves the quality of life of patients with spinal cord injury significantly; however, extrusion and infection are still significant problems.

The Injury Prevention Committee of the Japan Medical Society of Paraplegia (JMSoP) conducted a nationwide epidemiological survey on spinal cord injury (SCI) using postal questionnaires for 3 years periods from 1990 to 1992, and the annual incidence of the spinal cord injury was estimated as 40,2 per million. From this registry, we investigated SCI related to sports activities.In 3 years, 528 patients were registered and 374 of them had neurological deficits. The incidence was l.95 per million per annum. Mean age at injury was 28.5 years (10-77), and 88.1 % of the patients were males. Diving was the commonest cause of SCI (21.6%), which was followed by skiing (13.4%), football including rugby, American football and soccer (12.7%), sky sports (7.0%), judo (6.8%) and gymnastics (6.6%). Mean age at injury was higher than 30 years in skiing (38.6 years) and sky sports (38.2 years). Cervical injury was predominant in all but sky sports and accounted for 83.5% of SCI. Motor complete paralysis was reported in 35.0% of the patients. Bony injury was observed in 55.9% of the patients; most of the patients who sustained the SCI in diving and sky sports had bony injury, and no bony injury was detected in more than a half of the patients who sustained injuries in skiing, judo or gymnastics.Although the percentage of sports-related SCI was small in the present study as compared to the data from previous reports, it is not difficult to imagine the increase in the number of sports-related SCI. We have launched an injury prevention campaign and are planning to conduct a similar study in future to evaluate the effect of the campaign as well as the changes in the incidence and pattern of SCI.

Objectives:To assess individually tailored ultrasound-assisted prompted voiding as a means of managing urinary incontinence in hospitalized elderly patients. Methods: A total of 88 incontinent elderly individuals who were inpatients in general hospitals were included. Each individual's mean bladder volume before starting to void (voided urine volume plus residual urine volume) was regarded as the optimal bladder volume. Bladder volume was regularly monitored with an ultrasound device, and when the urine volume had reached the individual's optimal bladder volume, the subject was prompted to void. The outcomes were evaluated on the basis of scores on a four-grade scale for items in six domains: urine volume, voiding function, urinary control, physical and cognitive function for toileting, and caregivers' burden in regard to continence care. The score for use of a pad/diaper, an item of urinary control domain, was used as the primary outcome measure. Results: A total of 80 participants were included for analysis. After ultrasound-assisted prompted voiding care for a 4-week period, the score for use of a pad/diaper in 50 out of 80 participants (62.5%) had decreased, and 21 out of 80 participants (26.3%) no longer required the use of a pad/diaper at all. The scores of the other 30 out of 80 participants (37.5%) were unchanged. The improvement was not significantly affected by patients' backgrounds at baseline. The mean scores in the domains of urinary control, physical function, cognitive function and caregivers' burden improved significantly. Conclusion:The present preliminary study suggests that individually tailored ultrasoundassisted prompted voiding can improved urinary incontinence of institutionalized elderly patients. Further studies are worth carrying out.

Study design: Analysis of answers to a new questionnaire. Objective: To examine current practice patterns of physicians in the urological surveillance and management of spinal cord injury (SCI) patients in Japan. Setting: Nationwide questionnaire survey to physicians in Japan. Methods: A Japanese version of the 14-item questionnaire survey carried out in US was mailed to 770 members of the Japanese Neurogenic Bladder Society (JNBS). Results: We received answers to our questionnaire from 333 (43.2%) members of JNBS. The responders were all urologists. The management of lower urinary tract (LUT) disorders is very important in order to prevent serious complications that may result in upper urinary tract (UUT) disorders such as hydronephrosis. There have been arguments as to the strategy of observation and therapeutic approaches in SCI patients. For improvement in life expectancy and quality, research and evidenced-based practices related to urinary tract dysfunction are requisite. Recently, results of questionnaires on the current practice patterns in urological surveillance and management of SCI patients were reported in the United States (US) and United Kingdom (UK).3,4 The present inquiry by questionnaire was performed on the current practice patterns of the physician (urologist) in urological management of SCI patients in Japan. Spinal Cord (2006) 44, 362-368 & 2006 International Spinal Cord Society All rights reserved 1362-4393/06 $30.00 www.nature.com/sc MethodsA Japanese version of the 14-item questionnaire (see Appendix A) with which a survey was carried out recently in the US 3 was mailed to 770 members of the Japanese Neurogenic Bladder Society (JNBS) in January 2004. The society consists of urologists, neurologists, pharmacologists, and others. More than 90% of the members of the society are urologists. The number of urologists of JNBS is approximately 10% of the total members of the Japan Urological Association (JUA), which is the only official society of urologists in Japan. We thought that almost all of the members of JNBS were engaged more routinely in urologic management of patients with SCI than those of any other nationwide academic medical society. Answers to the questionnaire returned to us by the deadline (within 1 month) were analyzed in this study. The first eight questions concern surveillance of the neuropathic bladder and bladder cancer due to spinal cord lesions, and the remaining questions deal with treatment modality and background of the respondents. The US and Japanese questionnaires were not identical, because Razden et al 3 did not publish details of their questionnaire. ResultsWe received a response to our questionnaire from 388 (50.3%) members of JNBS. In all, 55 members declined to answer our questions because they were not engaged in urological management of SCI patients. A total of 333 (43.2%) urologists out of the JNBS members replied to our questions. Some of them did not answer all questions in the questionnaire because of unknown reasons. In total, 314 (40.8%) urologists a...