Although the degenerative changes with aging of the male urethral rhabdosphincter (URS) have been investigated, its individual morphological variations are still unclear. To provide an anatomical basis for clinical evaluation of the individual URS function in the aged, we investigated the structural differences in the URS of 25 elderly Japanese men using semiserial sections stained immunohistochemically and by hematoxylin-eosin. Before removal of the histological specimens, we dissected the ischioanal fossa and labeled several structures by carbon particles to allow proper orientation during the histological observations. In addition, macroscopic slices (10 mm thickness) made from five other male pelves were examined and, when necessary, followed by routine histological procedure to confirm the gross observations. An extended circular URS (over (1/2) circumferential configuration) was found in 15/25 cadavers, but showed very limited height (proximal-distal length) and thickness. A more restricted URS, including even a thin, arc-like pattern, was observed in the remaining cadavers. The attachment of the URS to the smooth muscle layer was loose and usually clearly separated. Continuation between the URS and deep transverse perineal muscle was sometimes observed. The thick fascia of the levetor ani, with high content of smooth muscles, usually provided the lateral or dorsal insertions of the URS. Our results in elderly Japanese subjects suggest that the sphincteric action is weak or incomplete. We suggest that the elderly URS maintains continence by retracting the urethra backward and upward with the aid of the levator sling, rather than the real sphincteric action expected in younger men.

Objectives To investigate the incidence and risk factors of postoperative delirium among patients aged ≥65 years undergoing elective urological surgery. Methods From April 2015 through December 2016, 1023 consecutive patients aged ≥65 years who received transurethral, laparoscopic (with or without robot assistance) or open surgery in eight institutions were enrolled in this prospective observational study. Their preoperative cognitive status was assessed with the Hasegawa Dementia Scale‐Revised score. The treating physician or nurse assessed delirium using the Intensive Care Delirium Screening Checklist. Multivariate logistic regression analysis was used to determine predictive factors for postoperative delirium. Results We analyzed 946 patients whose median age was 74 years (range 65–95 years). Postoperative delirium was observed in 32 patients (3.4%). Multivariate analysis showed that a history of cerebrovascular disease (odds ratio 5.24, 95% confidence interval 2.05–13.40), low Hasegawa Dementia Scale‐Revised score <20 points (odds ratio 3.50, 95% confidence interval 1.36–9.02), low serum albumin level <3.5 g/dL (odds ratio 3.12, 95% confidence interval 1.25–7.83) and long surgery duration >4 h (odds ratio 4.94, 95% confidence interval 2.20–11.10) were independent risk factors for the development of postoperative delirium. Conclusions The preoperative medical history, cognitive status, low serum albumin level and operative duration were associated with the development of postoperative delirium, although the incidence was just 3.4% in elective urological surgery. The present results suggest that the Hasegawa Dementia Scale‐Revised is a useful tool for assessment of the risk for delirium.

Open radical cystectomy is associated with a high incidence of postoperative complications. Most, however, are of low grade. Our results suggest that obesity, a smoking history, and increasing comorbidity are risk factors for major complications.

Patients without a muscle layer in the specimen had high risk for progression. The initial TUR must have a muscle layer in the specimen. Variations of progression rates in previous studies might be due to different proportions of patients who had a muscle layer in TUR specimens.