Publications by authors named "Atsushi Takenaka"

219 Publications

Impact of penile rehabilitation with phosphodiesterase-5 inhibitors on recovery of erectile function in patients undergoing robot-assisted radical prostatectomy: A propensity score-matched analysis.

Int J Urol 2021 Mar 4. Epub 2021 Mar 4.

Department of Urology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan.

Objective: To investigate the impact of penile rehabilitation on the recovery of erectile function after robot-assisted radical prostatectomy.

Methods: Patients who underwent robot-assisted radical prostatectomy in our department from 2010 to 2019 were included. For penile rehabilitation, a phosphodiesterase-5 inhibitor (tadalafil 20 mg) was administered twice a week for 1-6 months postoperatively. The International Index of Erectile Function questionnaire (question 1 and erectile function domain) and the Expanded Prostate Cancer Index Composite questionnaire (sexual function) were used.

Results: After propensity score matching, there were 79 patients in the penile rehabilitation group and 79 patients in the non-penile rehabilitation group. There was no significant difference in baseline characteristics between the two groups. Significantly higher scores were seen in the penile rehabilitation group compared with the non-penile rehabilitation group at postoperative 3, 6 and 9 months in the International Index of Erectile Function questionnaire-question 1, at 3, 6, 9 and 12 months in erectile function domain, and at 3, 6, 12 and 24 months in Expanded Prostate Cancer Index Composite questionnaire sexual function (P < 0.05). There were significant improvements in the erectile recovery rate in the penile rehabilitation group compared with the non-penile rehabilitation group in the nerve sparing (P = 0.006) and partial nerve sparing (P = 0.037) groups.

Conclusions: The present findings suggest that robot-assisted radical prostatectomy patients who undergo not only nerve sparing, but also those who undergo patial nerve sparing could benefit from penile rehabilitation using a phosphodiesterase-5 inhibitor.
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http://dx.doi.org/10.1111/iju.14527DOI Listing
March 2021

Mirabegron Alleviates the Degree of Burden Experienced by Caregivers of Older Females with Mixed or Urge Incontinence: A Prospective Study.

Clin Interv Aging 2021 16;16:291-299. Epub 2021 Feb 16.

Urology Department, School of Medicine, Ioannina University, Ioannina, Greece.

Purpose: Older people, especially women, have the highest known prevalence of urinary incontinence (UI) of any other age-group. Continual care provision for elderly incontinent females is an incredibly arduous process, yet only very few studies have investigated the issue. Aim of the study was to evaluate the impact of mirabegron's treatment on the degree of burden experienced by caregivers of elderly female patients with UI.

Patients And Methods: A hundred and eighty-six caregivers of older females with mixed or urgency UI besides various conditions (strokes, post-operative recovery after major surgery, etc.) were included in the study. Group A comprised 91 patients that did not want to receive any treatment for UI. Group B consisted of 95 elderly females treated for UI with mirabegron 50 mg/daily for three months. All caregivers completed the Zarit Burden Scale (ZBS) questionnaire at the outset and after the three months. All patients completed a bladder diary at the beginning and at the end of the observation/medication period.

Results: Patients receiving mirabegron presented a statistically significant improvement in UI parameters. Their caregivers showed a statistically significant decrease in the ZBS total score as well as separate domains.

Conclusion: This pilot study confirms that mirabegron administration can improve the quality of life of older females suffering from UI while substantially relieving caregiver burden. Recognizing the physical and emotional reactions of caregivers may help health providers deliver better support and resources to meet the needs of caregivers and patients alike.
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http://dx.doi.org/10.2147/CIA.S283737DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7897712PMC
February 2021

Administration of antioxidants in the infertile male: When may it have a detrimental effect?

Curr Pharm Des 2021 Feb 4. Epub 2021 Feb 4.

Department of Urology, University of Ioannina School of Medicine, Ioannina. Greece.

Background & Objective: Significant advances in the field of male infertility have been witnessed during the last years. Given the well-known detrimental effects of reactive oxygen species (ROS), the administration of antioxidants has emerged as a promising solution for oxidative stress (OS)-induced male infertility. Nevertheless, this perception seems largely oversimplified, and the existing literature fails to recognize a notable superiority of the excessive use of these widely available nutritional compounds. Taking into consideration that several trials have shed light on the so-called "antioxidant paradox" phenomenon, we recognize that over-the-counter consumption of such supplements might be harmful.

Method: The relevant studies indexed in PubMed, Google Scholar and Scopus databases, published until September 2019 were identified and reported.

Conclusion: In this setting, we acknowledge that there is an eminent need for more elaborate studies in the future which will efficiently elucidate the risks and benefits of antioxidants on semen parameters and their impact on fertility potential.
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http://dx.doi.org/10.2174/1381612827666210204160248DOI Listing
February 2021

Robot-assisted partial nephrectomy versus standard laparoscopic partial nephrectomy for renal hilar tumor: A prospective multi-institutional study.

Int J Urol 2021 Apr 26;28(4):382-389. Epub 2020 Dec 26.

Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.

Objective: To investigate whether robot-assisted partial nephrectomy compared with laparoscopic partial nephrectomy is effective for renal hilar tumor removal.

Methods: This was a prospective, multicenter, single-arm, open-label trial with a 2-year enrollment period. A total of 22 academic hospitals in Japan participated in the present study. Comparison with historical control values from reported studies of laparoscopic partial nephrectomy was carried out. The warm ischemia time and positive surgical margin rate were set as primary perioperative and oncological outcomes. In the historical control group, these were 27.7 min and 13%, respectively.

Results: The analysis population included 105 participants. The mean warm ischemia time was 20.2 (95% confidence interval 16.7-21.8; P < 0.0001 vs 27.7). Two of 103 participants (1.9%) had a positive surgical margin (95% confidence interval 0.5-6.8%). Both results satisfy the prespecified decision criteria for the superiority of robot-assisted partial nephrectomy over the historical control of laparoscopic partial nephrectomy. Resected weight and preoperative estimated glomerular filtration rate were predictive factors of functional loss of the partially nephrectomized kidney after robot-assisted partial nephrectomy.

Conclusion: Robot-assisted partial nephrectomy for clinical T1 renal hilar tumors results in shorter warm ischemia time than and comparable positive surgical margin rate to those reported for laparoscopic partial nephrectomy.
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http://dx.doi.org/10.1111/iju.14469DOI Listing
April 2021

Significance of the timing of ureteral ligation on prognosis during radical nephroureterectomy for upper urinary tract urothelial cancer.

Int J Urol 2021 Feb 29;28(2):208-214. Epub 2020 Nov 29.

Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Objectives: To investigate the impact on intravesical recurrence and prognosis according to the ureteral ligation timing during radical nephroureterectomy for upper urinary tract urothelial carcinoma.

Methods: We carried out a retrospective chart review of 664 patients with non-metastatic upper urinary tract urothelial carcinoma who underwent radical nephroureterectomy with ureteral ligation (supplementary analysis of JCOG1110A). We excluded patients with previous and/or synchronous bladder cancer, clinically node-positive disease, no ureteral ligation data, those without ureteral ligation and those with any missing data. We investigated the cumulative incidence of intravesical recurrence and cancer-specific mortality, and overall survival between patients with ureteral ligation before renovascular ligation (early ureteral ligation), or ureteral ligation after renovascular ligation (late ureteral ligation).

Results: Early and late ureteral ligation was carried out in 243 patients (36.6%) and 421 patients (63.4%), respectively. Intravesical recurrence occurred in 218 patients (32.8%) during follow up (median 3.9 years). No significant difference in the intravesical recurrence was found between early and late ureteral ligation groups. Meanwhile, survival in the early ureteral ligation group was significantly worse compared with the late ureteral ligation group. Multivariable analysis showed that early ureteral ligation was an independent prognostic factor for overall survival (hazard ratio 1.88, 95% confidence interval 1.24-2.85, P = 0.003) and cancer-specific mortality (hazard ratio 1.93, 95% confidence interval 1.14-3.25, P = 0.014).

Conclusions: Our findings suggest that the incidence of intravesical recurrence is not affected by the timing of ureteral ligation during radical nephroureterectomy. However, early ureteral ligation might have a negative impact on survival outcomes.
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http://dx.doi.org/10.1111/iju.14435DOI Listing
February 2021

A randomized phase III trial of personalized peptide vaccination for castration‑resistant prostate cancer progressing after docetaxel.

Oncol Rep 2021 Jan 11;45(1):159-168. Epub 2020 Nov 11.

Cancer Vaccine Center and Department of Urology, Kurume University, Kurume, Fukuoka 839‑0863, Japan.

First‑line chemotherapy for men with metastatic castration‑resistant prostate cancer (mCRPC) has been employed to improve overall survival (OS) and progression‑free survival (PFS). However, several new agents for CRPC after first‑line chemotherapy prolonged survival by only a few months. To develop a new treatment modality, we conducted a phase III randomized trial of personalized peptide vaccination (PPV) for human leukocyte antigen (HLA)‑A24‑positive patients with castration‑resistant prostate cancer (CRPC) for whom docetaxel chemotherapy failed. This randomized, double‑blind, placebo‑controlled, phase III trial was carried out at 68 medical centers in Japan. Patients were randomly assigned at a 2:1 ratio to receive PPV or placebo. Four of 12 warehouse peptides selected based on pre‑existing peptide‑specific immunoglobulin G levels or the corresponding placebo were subcutaneously injected in 6 doses weekly and then bi‑weekly following the maximum of 30 doses until disease progression. The primary end‑point was overall survival (OS). Efficacy analyses were performed by the full analysis set. Between August 2013 and April 2016, 310 patients were randomly assigned, and 306 patients were analyzed. Baseline characteristics were balanced between groups. The estimated median OS was 16.1 months [95% confidence interval (CI), 13‑18.2] with PPV and 16.9 months (95% CI, 13.1‑20.4) with placebo [hazard ratio (HR), 1.04, 95% CI, 0.80‑1.37; P=0.77]. Grade ≥3 adverse events were observed in 41% of both groups. The analysis of treatment arm effects among subgroups revealed lower HRs for OS in favor of the PPV arm in patients with <64% neutrophils (HR, 0.55, 95% CI, 0.33‑0.93; P=0.03) or ≥26% lymphocytes (HR, 0.70, 95% CI, 0.52‑0.92; P=0.02) at baseline. PPV did not prolong OS in HLA‑A24‑positive patients with CRPC progressing after docetaxel chemotherapy. Subgroup analysis suggested that the patients with a lower proportion of neutrophils or a higher proportion of lymphocytes at baseline can receive survival benefits from PPV treatment.
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http://dx.doi.org/10.3892/or.2020.7847DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709822PMC
January 2021

Complete response to chemotherapy in Burkitt's Lymphoma of the Bladder: A case report.

Urol Case Rep 2020 Nov 11;33:101298. Epub 2020 Jun 11.

Department of Urology, Tottori University Faculty of Medicine, 86 Nishi-cho, Yonago, Tottori, 683-8503, Japan.

We report a case of a 87-year-old woman with a Burkitt's Lymphoma of the Bladder. She presented with hematuria. Cystoscopy, computed tomography and magnetic resonance imaging revealed extramural invasion of a 6-cm-sized tumor that extended from the right wall to the neck of the bladder. The histological pattern was Burkitt's lymphoma. The patient was then treated by chemotherapy. The tumor disappeared after 4 cycles of chemotherapy. The urogenital tract has been described in the literature as a primary tumor location in cases of non-Hodgkin's lymphoma, however, it is rarely the tumor site in Burkitt's lymphoma cases.
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http://dx.doi.org/10.1016/j.eucr.2020.101298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7573840PMC
November 2020

Intravesical prostatic protrusion may affect early postoperative continence undergoing robot-assisted radical prostatectomy.

BMC Urol 2020 Oct 21;20(1):164. Epub 2020 Oct 21.

Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 36-1 Nishicho, Yonago, Japan.

Background: In this study, we investigated the effect of preoperative prostate morphology, especially intravesical prostatic protrusion (IPP), on continence after robot-assisted radical prostatectomy (RARP).

Methods: Retrospective analysis was applied to patients who underwent RARP between October 2010 and July 2014. The following parameters were assessed in all patients: age, body mass index (BMI), prostate-specific antigen, magnetic resonance imaging and pressure-flow studies findings. The impact of preoperative and intraoperative factors on postoperative urinary incontinence (UI) was assessed using multivariate logistic regression analysis. To evaluate the effects of IPP, the patients were divided into groups according to the IPP length: Group 1, < 5 mm and Group 2, ≥ 5 mm. The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score, Quality of Life index and the number of pads used were assessed.

Results: A total of 119 patients were eligible for this study. Multivariate analyses showed that IPP (odds ratio (OR) 1.14, 95% confidence interval (CI) 1.02-1.28, p < 0.05) and nerve-sparing (NS) (OR 0.23, 95% CI 0.18-0.61, p < 0.01) were significant factors related to UI in the first month after RARP. Twelve months after RARP, multivariate analyses revealed that only NS is a factor related to postoperative UI (OR 0.23, 95% CI 0.18-0.61, p < 0.01). The comparison of Groups 1 and 2 indicated significant differences in age (p < 0.01), prostate volume (p < 0.01), total IPSS and voiding symptom score (p < 0.05), compliance (p < 0.01), and detrusor pressure at maximum flow (p < 0.01). Group 1 had a higher continence rate (38.0%) than Group 2 (20.8%) in the first month after RARP (p < 0.05), but the difference was no longer significant from the third month after RARP. The total IPSS and voiding symptom scores were significantly different between the two groups before RARP, however, the significant difference disappeared from the first month after RARP.

Conclusions: The data suggest that IPP affects early postoperative UI. Although NS was strongly involved in UI in the early and later stages after RARP, IPP had no effect on UI in the later stages.
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http://dx.doi.org/10.1186/s12894-020-00740-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7579942PMC
October 2020

Effects of nerve-sparing procedures on bowel function after robot-assisted radical prostatectomy: A longitudinal study.

Int J Med Robot 2020 Dec 8;16(6):1-10. Epub 2020 Oct 8.

Division of Urology, Tottori University Faculty of Medicine, Tottori, Japan.

Background: This study aimed to evaluate rectal pain and bowel function of the patients following robot-assisted radical prostatectomy (RARP).

Methods: We divided 296 patients who underwent RARP into two groups depending on the intervention: NS (nerve-sparing) group (bilateral NS, unilateral NS and bilateral partial NS) and non-NS group (unilateral partial NS, bilateral non-NS). Bowel function was assessed using the Extended Prostate Cancer Index Composite for 24 months after RARP.

Results: The bowel function score and rectal urgency at 1-6 months after RARP were more significantly impaired in the non-NS group than in the NS group (p < 0.05). In a multivariate analysis of factors affecting the bowel function score at 6 months after RARP, only NS procedure had a significant effect.

Conclusions: In the initial period after RARP, bowel symptoms were significantly impaired. This impairment was affected by the degree of NS. These results could guide patients in their decision to choose RARP.
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http://dx.doi.org/10.1002/rcs.2156DOI Listing
December 2020

Splice variants of lysosome‑associated membrane proteins 2A and 2B are involved in sunitinib resistance in human renal cell carcinoma cells.

Oncol Rep 2020 Nov 4;44(5):1810-1820. Epub 2020 Sep 4.

Division of Experimental Pathology, Faculty of Medicine, Tottori University, Yonago, Tottori 683‑8503, Japan.

Sunitinib, a tyrosine kinase inhibitor, is among the first‑line treatments for metastatic or advanced stage renal cell carcinoma (RCC). However, patients with RCC develop resistance to sunitinib. We have previously demonstrated that lysosome‑associated membrane protein 2 (LAMP‑2), which has three splice variants with different functions (LAMP‑2A, LAMP‑2B, and LAMP‑2C), is involved in RCC. In the present study, we examined which splice variants of LAMP‑2 contributed to sunitinib resistance in RCC cells. In vitro analysis using ACHN, human RCC cell line, revealed that the IC50 of sunitinib was significantly increased by overexpression of LAMP‑2A and LAMP‑2B, but not LAMP‑2C (P<0.01). Kaplan‑Meier survival analysis using clinical samples revealed an association between shorter survival and high expression of LAMP‑2A and LAMP‑2B, but not LAMP‑2C, in patients with RCC treated with sunitinib (P=0.01). Furthermore, high expression of LAMP‑2A and LAMP‑2B in RCC revealed a weak to moderate inverse correlation with the tumor shrinkage rate and progression‑free survival, respectively. Thus, high expression of LAMP‑2A and LAMP‑2B contributed to the acquisition of sunitinib resistance, indicating that the expression of these two variants can predict the efficacy of sunitinib treatment in patients with RCC.
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http://dx.doi.org/10.3892/or.2020.7752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7551029PMC
November 2020

Small-volume lymph node involvement and biochemical recurrence after robot-assisted radical prostatectomy with extended lymph node dissection in prostate cancer.

Int J Clin Oncol 2020 Jul 24;25(7):1398-1404. Epub 2020 Apr 24.

Division of Urology, Department of Surgery, Faculty of Medicine, Tottori University, 86 Nishi-cho, Yonago, Tottori, 683-8503, Japan.

Background: We investigated prognostic factors for biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP) with extended pelvic lymph node (LN) dissection.

Methods: We included 173 patients who underwent RARP with extended pelvic LN dissection without neoadjuvant therapy at our hospital between October 2010 and April 2018. BCR was defined as prostate serum antigen (PSA) levels ≥ 0.2 ng/mL; BCR-free survival rates were determined using Kaplan-Meier analysis. We used Cox regression analysis to evaluate effects of PSA and pathologic variables on BCR.

Results: Median follow-up was 27.9 (range 6.1-86.9) months. Five-year BCR-free survival was 89.5%. In multivariate analysis, positive LNs (HR 7.117; 95% CI 2.826-17.925; P < 0.001) and Gleason score (GS) ≥ 8 (HR 2.612; 95% CI 1.051-6.489; P = 0.039) were significant predictors of BCR. Patients with 1 or 2 positive LNs (n = 10) had significantly higher BCR-free survival rates than patients with ≥ 3 positive LNs (n = 5). We, therefore, stratified the patients as low-risk (GS < 8 and no positive LNs), intermediate-risk: (either GS ≥ 8 or positive LNs) and high-risk (both GS ≥ 8 and positive LNs). Their 1-year BCR-free survival rates were low-risk: 94.6%, intermediate-risk: 88.5%, and high-risk: 33.3% (P < 0.05).

Conclusions: Patients with 1-2 positive LNs and GS < 8 have low risk for BCR; close observation without immediate adjuvant hormonal therapy can be considered for these patients.
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http://dx.doi.org/10.1007/s10147-020-01682-1DOI Listing
July 2020

Therapeutic effects of micronutrient supplements on sperm parameters: Fact or Fiction?

Curr Pharm Des 2020 Apr 15. Epub 2020 Apr 15.

Department of Urology, University of Ioannina School of Medicine, P. O. Box 1186 45110, Ioannina. Greece.

Background: Despite the limited evidence about the effect of micronutrient supplementation on the semen quality, many micronutrient supplements have been used to improve male fertility. Approximately, 40%-50% of male infertility cases in general and up to 80% in men with idiopathic infertility cases are caused by oxidative stress and decreased level of seminal total antioxidant capacity.

Objective: To investigate the beneficial effects of micronutrient supplementation on sperm concentration, motility and morphology.

Methods: A Pub Med, Google Scholar, Embase data, web of Science and Cochrane Library database extensive research of the randomized controlled studies utilizing micronutrient vitamins and supplements was performed.

Results: The existent international literature is rather heterogeneous and a definitive is difficult to be drawn. Several micronutrients have beneficial effects on sperm parameters. Rational use of micronutrients might be helpful for infertile patients.

Conclusion: Further randomized, controlled clinical trials are required to elucidate the efficacy and safety of micronutrients and propose proper protocols for their use. A well-rounded, balanced diet is more preferable than the widespread use of micronutrient supplements beyond the recommended doses. Future studies should concern the pregnancy rate as a primary outcome in their designs. Further research should be done to determine the appropriate antioxidant compounds, the duration of the treatment, as well as a certain dose of antioxidants in clinical practices. The pre-treatment evaluation of the seminal oxidative status is also an important parameter to proceed with micronutrient supplementation without the risk of reductive stress. Under these conditions, supplements could support the quality of sperm and help to alleviate male infertility.
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http://dx.doi.org/10.2174/1381612826666200415173537DOI Listing
April 2020

Health Related Quality of Life in Japanese Patients with Localized Prostate Cancer: Comparative Retrospective Study of Robot-Assisted Laparoscopic Radical Prostatectomy Versus Radiation Therapy.

Yonago Acta Med 2020 Feb 30;63(1):55-62. Epub 2020 Jan 30.

Division of Urology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan.

Background: Radical prostatectomy and radiotherapy are standard treatments for localized prostate cancer. When making decisions about treatment, it is important to not only consider medical information such as the patient's age, performance status, and complications, but also the impact on quality of life (QOL) after treatment.

Our purpose was to compare health related quality of life (HRQOL) after robot-assisted laparoscopic radical prostatectomy (RARP) versus radiation therapy in Japanese patients with localized prostate cancer retrospectively.

Methods: Patients with localized prostate cancer receiving RARP or radiotherapy at Tottori University Hospital between October 2010 and December 2014 were enrolled in a retrospective observational study with follow-up for 24 months to December 2016. The Medical Outcome Study 8-Item Short-Form Health Survey was performed before treatment and 1, 3, 6, 12, and 24 months post-treatment.

Results: Complete responses to the questionnaire were obtained from 154/227 patients receiving RARP, 41/67 patients receiving intensity-modulated radiation therapy, 35/82 patients receiving low dose rate brachytherapy, and 18/28 patients given low dose rate brachytherapy plus external beam radiation therapy. The median physical component summary score of the Medical Outcome Study 8-Item Short-Form Health Survey was significantly lower at 1 month after prostatectomy than radiotherapy, but was similar for both treatments at 3 months, and was significantly higher at 6, 12 and 24 months after prostatectomy. The median mental component summary score was also significantly lower in the prostatectomy group at 1 month, but not from 3 months onwards.

Conclusion: Our study suggested that HRQOL was inferior at 1 month after RARP, however, recovered at 3 months after RARP and was better than after radiotherapy at 6, 12, and 24 months.
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http://dx.doi.org/10.33160/yam.2020.02.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028529PMC
February 2020

The Effect of PDE5 Inhibitors on the Male Reproductive Tract.

Curr Pharm Des 2020 Feb 26. Epub 2020 Feb 26.

Department of Urology, Tottori University Faculty of Medicine, Yonago, Tottori, Japan.

The therapeutic range of cyclic nucleotide phosphodiesterase 5 inhibitors (PDE5) inhibitors is getting wider in the last years. This review study focuses on the potential employment of PDE5 inhibitors as an adjunct tool for the therapeutic management of male infertility. The literature tends to suggest a beneficial effect of PDE5 inhibitors on Leydig and Sertoli cells secretory function. It also appears that PDE5 inhibitors play a role in the regulation of the contractility of the testicular tunica albuginea and the epididymis. Moreover scientific data suggest that PDE5 inhibitors enhance the prostatic secretory function leading to an improvement in sperm motility. Other studies additionally demonstrate a role of PDE5 inhibitors in the regulation of sperm capacitation process. Placebo-controlled, randomized, blind studies are necessary to unambiguously incorporate PDE5 inhibitors as an adjunct tool for the pharmaceutical treatment of semen disorders and male infertility.
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http://dx.doi.org/10.2174/1381612826666200226121510DOI Listing
February 2020

Postoperative inguinal hernia after robotic-assisted radical prostatectomy for prostate cancer: evaluation of risk factors and recommendation of a convenient prophylactic procedure.

Cent European J Urol 2019 6;72(4):418-424. Epub 2019 Dec 6.

Tottori University Faculty of Medicine, Department of Urology, Tottori, Japan.

Introduction: The aim of this article is to evaluate the risk factors and recommend a prophylactic procedure for preventing inguinal hernia (IH) after robotic assisted radical prostatectomy (RARP) without extra products and operative time.

Material And Methods: A total of 279 patients (558 groins) who underwent RARP at our institution from October 2010 to December 2015 were retrospectively reviewed. Age, body mass index, prostate-specific antigen, clinical T stage, prostate volume, console time and the dilatation of internal inguinal ring were evaluated as the risk factors of IH. We also investigated whether the different incision procedures of the peritoneum around the medial side of the internal inguinal ring, 'proximal incision' or 'distal incision', were related to the occurrence of IH.

Results: Postoperative IH occurred in 39 (7.5%) of 558 groins. The dilatation of the internal inguinal ring was observed in 89 of 558 (15.9%) groins. The proximal and distal incision group included 296 groins (52.8%) and 262 groins (47.2%), respectively. Univariate and multivariate analyses revealed the right side (P = 0.041), the dilatation of internal inguinal ring (P <0.01) and the distal incision (P <0.01) were significant risk factors for postoperative IH. Furthermore, the proximal incision significantly reduced the risk of postoperative IH regardless of the dilatation of internal inguinal ring.

Conclusions: The dilatation of the internal inguinal ring represents an important risk factor for IH after RARP. However, incising the peritoneum sufficiently close to the medial edge of the internal inguinal ring can prevent postoperative IH without extra products and time.
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http://dx.doi.org/10.5173/ceju.2019.0002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6979555PMC
December 2019

New technique of transurethral en bloc resection of bladder tumor with a flexible cystoscope and endoscopic submucosal dissection devices for the gastrointestinal tract.

Int J Urol 2020 Mar 8;27(3):268-269. Epub 2020 Jan 8.

Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Tottori, Japan.

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http://dx.doi.org/10.1111/iju.14169DOI Listing
March 2020

'Trifecta' outcomes of robot-assisted partial nephrectomy: a large Japanese multicenter study.

Int J Clin Oncol 2020 Feb 1;25(2):347-353. Epub 2019 Nov 1.

Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.

Objective: The objective of this study was to evaluate the early surgical outcomes of robot-assisted partial nephrectomy (RAPN) for small renal masses in a large Japanese multicenter series.

Methods: A total of 804 consecutive cases of RAPN were examined at 42 institutes between 2011 and 2016. Medical records for clinical, pathological characteristics and perioperative outcomes were retrospectively reviewed. Univariable and multivariable analyses were performed to determine factors predicting Trifecta achievement.

Results: The median tumor size was 2.6 cm. The median RENAL score was 7. The median warm ischemia time was 21 min. The median estimated blood loss was 30 mL. Eight patients (1.0%) were converted to radical nephrectomy. The overall and Clavien-Dindo grade ≥ 3 complication rates were 13.0% and 5.8%, respectively. Pathologically, 91.4% of tumors were malignant and the positive surgical margin (PSM) rate was 1.1%. During the median 27.1-month observation period, the recurrence rate was 1.6%. Postoperative preservation rates of eGFR at 1, 6, 12 and 24 months were 90.3, 89.8, 89.4 and 89.2%, respectively. Trifecta was achieved in 62.1%. Multivariable analysis demonstrated that tumor diameter, estimated blood loss and hilar location of the tumor were significant negative factors predicting Trifecta achievement. The rate of Trifecta achievement for T1b tumors and hilar tumors was significantly lower (48.4% and 50.0%, respectively).

Conclusions: RAPN was safely performed with acceptable oncological and functional outcomes, but the rate of Trifecta accomplishment for T1b or hilar tumors was significantly lower than that for T1a or non-hilar tumors, respectively.
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http://dx.doi.org/10.1007/s10147-019-01565-0DOI Listing
February 2020

Oxidative Stress Alterations in the Bladder of a Short-period Type 2 Diabetes Rat Model: Antioxidant Treatment Can Be Beneficial for the Bladder.

In Vivo 2019 Nov-Dec;33(6):1819-1826

Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.

Background/aim: A short-period type 2 diabetes model was established in order to identify changes in oxidative stress in the bladder at the initiation of the disease. The effect of antioxidant treatment was examined.

Materials And Methods: Diabetes was induced in adult male Wistar rats with a single dose of streptozotocin (40 mg/kg; i.p.). Diabetic animals were then randomly separated into three groups: No treatment (DM), resveratrol treatment, and taurine treatment, and fed with a high-fat diet. Age-matched non-diabetic animals were used and fed with normal diet (control). Two weeks later, animals were sacrificed and bladders were processed for histological evaluation, and further analysis for oxidative stress markers.

Results: The body weight of all diabetic animals was significantly lower compared to the controls. The DM group demonstrated a significantly higher bladder weight to body weight ratio compared to the control. The bladder in the DM group demonstrated abruption of the mucosa from the muscularis and edema in the transitional epithelium. Bladders from the resveratrol-, and taurine-treated groups did not demonstrate these histological alterations. The level of malondialdehyde (MDA) in the bladder was significantly higher in the DM group compared to all other groups. Immunohistochemistry showed that diabetes induced a moderate to strong expression of oxidative stress markers MDA and 4-hydroxynonenal, and DNA oxidative stress marker 8-deoxyguanosine in the DM group compared to the other groups.

Conclusion: Prompt diagnosis and treatment of diabetes is crucial in regard to disease progression. Specifically, in the bladder it appears that both mild damage at the structural level, as well as oxidative damage at the molecular level may be prevented by antioxidant treatment.
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http://dx.doi.org/10.21873/invivo.11674DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6899132PMC
March 2020

Sarcopenia as a significant predictive factor of neutropenia and overall survival in urothelial carcinoma patients underwent gemcitabine and cisplatin or carboplatin.

Int J Clin Oncol 2020 Jan 13;25(1):158-164. Epub 2019 Sep 13.

Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Tottori, 683-8504, Japan.

Background: To evaluate the relationship between sarcopenia and myelosuppression or between sarcopenia and survival outcomes in patients with urothelial carcinoma (UC) undergoing chemotherapy with gemcitabine plus cisplatin (GC) or carboplatin (GCa).

Methods: We evaluated 80 patients with UC who underwent chemotherapy between 2013 and 2017 at our institution. In total, 53 patients had metastatic UC and were ultimately included in the study. Predictive factors for myelosuppression (neutropenia, thrombocytopenia, and anemia) in all patients and overall survival (OS) in metastatic UC patients were analyzed. Sarcopenia was assessed on computed tomography before chemotherapy. Each patient's total psoas area was measured at the lumbar vertebrae (L3) and sarcopenia was defined as median values or lower. Predictive factors for myelosuppression were assessed using logistic regression analysis and survival was evaluated using Cox regression analysis.

Results: The patients' mean age was 71.6 years (range 44.4-89.2 years). Of the initial 80 patients, 39 were diagnosed with sarcopenia and 26 of 53 patients with metastatic UC were diagnosed with sarcopenia. Sarcopenia was an independent predictive factor (P = 0.030; odds ratio, 3.526; 95% confidence interval [CI] 1.128-11.01) for neutropenia on multivariate analysis. Patients without sarcopenia had a significantly longer OS compared to those with sarcopenia (P = 0.013). Sarcopenia and albumin (P = 0.045, 0.023; hazard ratio (HR), 2.309, 2.652; 95% CI 1.021-5.225, 1.141-6.165, respectively) were independent predictors of OS in multivariate analysis.

Conclusions: Sarcopenia was predictive for neutropenia associated with GC or GCa in UC patients and OS in metastatic UC.
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http://dx.doi.org/10.1007/s10147-019-01544-5DOI Listing
January 2020

Effects of intravesical administration of sensory neuron-specific receptor agonist on voiding function in rats with cyclophosphamide-induced cystitis.

Cent European J Urol 2019 6;72(2):142-148. Epub 2019 May 6.

Tottori University Faculty of Medicine, Department of Urology, Yonago, Japan.

Introduction: The aim of this study was to investigate the urodynamic effects of intravesical administration of bovine adrenal medulla 8-22 (BAM8-22), a selective rat sensory neuron-specific receptor 1 agonist, on the micturition reflex in normal rats and rats with cyclophosphamide-induced bladder overactivity.

Material And Methods: Continuous cystometrograms (0.04 ml/min) were performed in urethane-anesthetized rats. After stable micturition cycles were established, vehicle (saline) or BAM8-22 was instilled intravesically and changes in bladder activity were monitored. The experiments using BAM8-22 were also performed in capsaicin-pretreated rats. In another experiment, vehicle (saline) or BAM8-22 was instilled intravesically and changes in bladder activity were monitored in cyclophosphamide-treated rats. Continuous cystometrograms were performed 48 hours after cyclophosphamide injection. Cystometric parameters were recorded and compared before and after intravesical drug administration.

Results: Intravesical administration of BAM8-22 significantly increased the intercontraction interval and threshold pressure in urethane-anesthetized rats, but did not affect the basal pressure or maximum pressure at any doses tested. The inhibitory effects of intravesical administration of BAM8-22 were not inhibited by capsaicin pretreatment. Intravesical administration of BAM8-22 also significantly increased intercontraction interval in the cyclophosphamide-treated rats.

Conclusions: The current results indicate that intravesical administration of a selective rat sensory neuron-specific receptor 1 agonist can inhibit the micturition reflex and can ameliorate cyclophosphamide-induced bladder overactivity in rats.
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http://dx.doi.org/10.5173/ceju.2019.1949DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6715086PMC
May 2019

The circadian rhythm of bladder clock genes in the spontaneously hypersensitive rat.

PLoS One 2019 25;14(7):e0220381. Epub 2019 Jul 25.

Division of Urology, Tottori University Faculty of Medicine, Yonago, Japan.

Circadian expression rhythms of clock gene products in the bladder are reportedly hindered by clock gene abnormalities. However, the role of clock gene products in various pathological lower urinary tract conditions is unknown. The present study examined the relationship between clock genes and voiding dysfunction in spontaneous hypertensive rats (SHR). The voluntary voiding behavior study using metabolic cages was performed in 18-weeks old male Wistar rats (control group, n = 36) and SHR (SHR group, n = 36) under 12-h light/12-h dark conditions. Bladders were harvested every 4 h at six time points (n = 6 for each time point for each group), and we analyzed the messenger RNA (mRNA) expression of several clock genes: period 2 (Per2), cryptochrome 2 (Cry2), brain and muscle aryl hydrocarbon receptor nuclear translocator-like protein 1 (Bmal1), circadian locomotor output cycles kaput (Clock), nuclear receptor subfamily 1, group D, member 1 (Rev-erbα), mechanosensors: transient receptor potential vanilloid channel 1 (TRPV1), TRPV4, Piezo1, and vesicular nucleotide transporter (VNUT) using real-time polymerase chain reaction. Though 24-h urination frequency for both light and dark periods was significantly higher in the SHR group, urine volume per voiding was significantly lower versus control. In controls, urine volume per voiding was significantly lower during the dark period (active phase) than the light period (rest phase); this parameter did not significantly differ between active and rest phases for SHR. SHR bladders showed significantly higher expression of Cry2 and Clock during the active phase compared to controls. In the SHR group, TRPV1, TRPV4, Piezo1, and VNUT mRNA levels were significantly higher during the active phase compared to the control group. We speculate that Cry2 and Clock may be contributing factors in the decrease of bladder capacity during the active phase in SHR through increase of TRPV1, TRPV4, Piezo1, and VNUT expression, but further research will be necessary to elucidate the precise mechanisms.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0220381PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658119PMC
March 2020

Effect of Intravesical Bacilli Calmette-Guerin Therapy After Second Transurethral Resection in Stage Ta T1 High-Grade Bladder Cancer.

Yonago Acta Med 2019 Jun 20;62(2):191-197. Epub 2019 Jun 20.

Division of Urology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan.

Background: To evaluate the efficacy of Bacilli Calmette-Guerin (BCG) induction instillation therapy after second transurethral resection (TUR) in stage Ta T1 high-grade bladder cancer.

Methods: We performed a retrospective analysis of 49 consecutive new onset Ta T1 high-grade bladder cancer patients treated with second TUR at our affiliated institutions. Residual cancer rate, intravesical recurrence-free survival (RFS), and risk factors related to RFS were evaluated by univariate and multivariate Cox proportional hazard model analyses.

Results: Thirty-one patients received BCG therapy after the second TUR (BCG group), and 18 patients were treated with second TUR alone (no BCG group). There were statistically significant differences in the RFS rates between the two groups, ( = 0.037). BCG therapy was the only factor predictive of intravesical recurrence after second TUR in both univariate and multivariate analyses. After the second TUR, BCG therapy significantly decreased intravesical recurrence in the patients with residual tumors ( = 0.014). However, there was no significant difference in intravesical recurrence in the patients with no residual tumors between the two groups ( = 0.359).

Conclusion: BCG therapy after second TUR significantly decreased intravesical recurrence of residual tumors found at the second TUR.
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http://dx.doi.org/10.33160/yam.2019.06.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584257PMC
June 2019

Cross-Sectional Investigations of Pre- and Post-Operative Renal Global Function and Renal Parenchymal Volumetry in Both Partial and Radical Nephrectomy Utilizing Film-Based Technology.

Curr Urol 2019 May;12(3):127-133

Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.

Objectives: To investigate pre- and post-operative renal global function and renal parenchymal volume (RPV) in both partial nephrectomy (PN) and radical nephrectomy (RN) utilizing film-based technology.

Patients And Methods: The patient cohort consisted of 81 and 82 cases with T1 tumors (≤ 7 cm) treated by PN and RN, respectively. Renal global function was assessed using the estimated glomerular filtration rate (eGFR), and RPV was measured using a Synapse Vincent volumetric analyzer which creates a reconstructed image from a computed tomography scan. Renal global function and RPV were evaluated pre-operatively and 6 months post-operatively.

Results: The percent eGFR decline of PN cases was significantly reduced compared with RN cases (p < 0.0001). Post-operative RPV of the contralateral side was significantly increased compared with pre-operative RPV (p < 0.0001) in RN cases. The percent change of the contralat-eral side RPV was slightly increased in RN compared with PN cases (p = 0.1881). A strong positive correlation was noted between post-operative eGFR and post-operative total RPV (r = 0.69, p < 0.0001), and a strong negative correlation was noted between percent eGFR decline and post-operative total RPV (r = -0.63, p < 0.0001).

Conclusions: Prominent compensatory renal hypertrophy occurred within 6 months after RN. Post-operative renal functional outcome was closely correlated with the post-operative total RPV. In addition to RPV, further studies to unravel post-operative renal function from multifactorial aspects including surgical factors and intrinsic medical disease should be performed in the future.
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http://dx.doi.org/10.1159/000489430DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6613317PMC
May 2019

Flutamide as an Alternative Anti-androgen Agent and Predictor of the Efficacy of Novel Androgen Receptor-targeted Agents.

Anticancer Res 2019 Jul;39(7):3879-3885

Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, Yonago, Japan.

Background/aim: There are few reports that verify the relationship between the therapeutic effects of flutamide and novel androgen receptor-targeted agents. We aimed to evaluate the benefits of flutamide as an alternative anti-androgen agent and its effects on the efficacy of novel androgen receptor-targeted agents.

Patients And Methods: Patients with castration-resistant prostate cancer on novel androgen receptor-targeted agents without prior docetaxel therapy were included. Changes in prostate-specific antigen (PSA) level were recorded.

Results: Patients who responded well to flutamide (Flutamide effective) following initial maximum androgen blockade (MAB) showed significantly higher changes in serum PSA levels (p=0.039) and PSA-progression-free survival (PFS) rate (p=0.016) following enzalutamide therapy compared to those who did not respond well to flutamide. Multivariate analysis showed that the factor of Flutamide effective was significantly associated with a good PSA-PFS rate following enzalutamide therapy (HR=7.36, 95%CI=1.4-38.71, p=0.018).

Conclusion: Patients showing good response to flutamide following initial MAB may achieve a satisfactory PSA-PFS rate with subsequent enzalutamide therapy.
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http://dx.doi.org/10.21873/anticanres.13538DOI Listing
July 2019

Peri-operative efficacy and long-term survival benefit of robotic-assisted radical cystectomy in septuagenarian patients compared with younger patients: a nationwide multi-institutional study in Japan.

Int J Clin Oncol 2019 Dec 23;24(12):1588-1595. Epub 2019 May 23.

Department of Urology, Tokushima University Graduate School, Tokushima, Japan.

Background: To determine the peri-operative safety and oncological value of robotic-assisted radical cystectomy (RARC) for older and younger patients in an initial Japanese RARC series.

Methods: We retrospectively analyzed the demographics, complications, peri-operative and oncological outcomes of 253 consecutive patients with bladder cancer who underwent RARC at 34 institutions in Japan between April 2009 and March 2017. The patients were assigned to groups according to ages at surgery of < 70 (younger; n = 125) and ≥ 70 (older; n = 128) years.

Results: Mean Charlson comorbidity index (p = 0.045) and the incidence of a history of previous abdominal surgery (p = 0.002) were significantly higher, whereas a history of neoadjuvant chemotherapy (p = 0.028) and neobladder (p < 0.001) were significantly lower in the older group. Mean total operative time was significantly shorter (p = 0.019) and mean estimated blood loss (p = 0.013) was significantly lower in the older group. Post-operative Grade ≥ II complications were comparable at 0-30, 31-90 and 91 days after surgery despite urinary tract associations. Rates of positive surgical margins and mean numbers of removed lymph nodes were comparable between the two groups. Although 5-year overall survival rates were significantly lower (p = 0.03) for older patients, 5-year cancer-specific (p = 0.10) and recurrence-free survival rates were comparable (p = 0.20) between the groups.

Conclusion: Using RARC potentially allows the application of less invasive procedures and cancer control for septuagenarian patients that are equivalent to those for younger patients.
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http://dx.doi.org/10.1007/s10147-019-01470-6DOI Listing
December 2019

Longitudinal study on the impact of urinary continence and sexual function on health-related quality of life among Japanese men after robot-assisted radical prostatectomy.

Int J Med Robot 2019 Aug 12;15(4):e2018. Epub 2019 Jun 12.

Department of Urology, Tottori University Faculty of Medicine, Yonago, Japan.

Background: The aim of this study is to investigate the impact of robotic-assisted radical prostatectomy (RARP) on the health-related quality of life (HRQOL).

Methods: We prospectively reviewed HRQOL parameters using Short-Form Health Survey, patient self-reporting of urinary incontinence and International Index of Erectile Function, among patients who underwent RARP between 2010 and 2016.

Results: Among 249 men studied, all had significantly worse HRQOL domain scores at 1 month post operatively but 24 months after surgery, all domains reached or surpassed their baseline values. Only Bodily Pain, General Health, Role-Emotional, Mental Health domains, and Mental Health Composite were significantly improved. Improvement in urinary continence was mirrored by improvements in both Mental and Physical Component Scores.

Conclusions: Within a 2-year post-operative period, men who underwent RARP had regained their overall quality of life. The recovery of urinary continence significantly impacted the mental, physical, emotional, and social well-being of those patients.
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http://dx.doi.org/10.1002/rcs.2018DOI Listing
August 2019

Extramammary Paget's disease of the glans penis secondary to urethral recurrence of bladder carcinoma after radical cystectomy: A case report.

IJU Case Rep 2019 Jul 17;2(4):202-205. Epub 2019 May 17.

Department of Urology Tottori University Faculty of Medicine Yonago Japan.

Introduction: Extramammary Paget's disease of the vulva secondary to urothelial carcinoma is rare. It is important to determine whether extramammary Paget's disease is primary or secondary, because the appropriate treatment strategies differ. We report a case of penile extramammary Paget's disease secondary to urothelial carcinoma recurrence.

Case Presentation: A 75-year-old man who was diagnosed with bladder carcinoma and received urethra-sparing radical cystectomy 5 years ago presented with erythema and red spots in the glans penis. Immunostaining (cytokeratin 7 and cytokeratin 20) of skin biopsy specimens suggested a secondary extramammary Paget's disease that originated from the urothelial carcinoma. Under urethroscopy, urethral recurrence was also suspected. A total penectomy was performed, and a final diagnosis of urothelial carcinoma recurrence and secondary extramammary Paget's disease of the glans penis were established.

Conclusion: Using immunostaining, the differential diagnosis between primary and secondary extramammary Paget's disease is more accurate. Secondary extramammary Paget's disease should be considered when a skin lesion is present on the penis of patients with urothelial carcinoma.
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http://dx.doi.org/10.1002/iju5.12077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292052PMC
July 2019

Long-Term Efficacy, Safety, and Tolerability of Modified Intravesical Oxybutynin Chloride for Neurogenic Bladder in Children.

J Clin Med Res 2019 Apr 18;11(4):256-260. Epub 2019 Mar 18.

Department of Urology, Tottori University Faculty of Medicine, Yonago, Tottori 683-8504, Japan.

Background: Children with spinal cord disorders can present with neurogenic bladder, a condition in which the bladder partly or completely loses its ability to store urine and void at low pressure. A bladder with low compliance may cause urinary incontinence, which negatively impacts quality of life and renal function. Long-term high pressure neurogenic bladder can increase the risk of deterioration in renal function. Antimuscarinic pharmacotherapy with clean intermittent catheterization is currently considered one of the most effective treatments for these patients. However, some patients do not respond to oral medication or have unacceptable adverse events (AEs), which may result in medical withdrawal for these patients. Intravesical oxybutynin is an effective treatment with less AEs compared with oral medication. However, an important issue with this treatment is retention of the solution in the bladder. Moreover, as yet no data are available on the very long-term use and outcome of modified intravesical oxybutynin therapy. In the present study, we report on the efficacy, safety, and side effects of long-term modified intravesical oxybutynin therapy in children with neurogenic bladder.

Methods: Modified intravesical oxybutynin (1.25 mg/5 mL, twice a day) was administered to four children (three boys and one girl) with neurogenic bladder (detrusor overactivity and/or low compliance bladder), who were previously unresponsive to or experienced intolerable AEs from oral medications. Results of pretreatment cystometrograms were compared to those from follow-up urodynamic studies. Anticholinergic AEs, occurrence of urinary tract infection, and degree of incontinence during this treatment were also evaluated.

Results: After 1 year, bladder compliance improved in three of the four patients. After 3 years, detrusor overactivity was undetectable in all patients. Bladder compliance at 3 years and 10 years after initiation of therapy was similar for three patients, and they are continuing modified intravesical oxybutynin therapy. One patient discontinued therapy at 118 months due to worsening of bladder compliance and upper urinary tract infection. No anticholinergic systemic AEs were observed in any of the patients.

Conclusions: These results suggest that modified intravesical oxybutynin is an effective and relatively safe long-term therapeutic option for children with neurogenic bladder.
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http://dx.doi.org/10.14740/jocmr3752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6436562PMC
April 2019

Evaluation of a Program of Clean Intermittent Catheterization for Underactive Bladder After Radical Hysterectomy.

Yonago Acta Med 2018 Sep 26;61(3):156-159. Epub 2018 Sep 26.

Division of Urology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8503, Japan.

Background: Dysfunction of the lower urinary tract is the most common complication of radical hysterectomy (RH). However, there are no established treatment protocols for postoperative underactive bladder (PUB). We developed our own new program for the treatment of underactive bladder (UB) after RH and evaluated it retrospectively.

Methods: In this program, there are five steps for patients to follow according to their urinary condition. The first step is the administration of urapidil 30 mg, voiding six times at a predetermined time each day, and clean intermittent catheterization (CIC) after each voiding. As the patient's condition improves, the number of CICs is reduced, and the medication is stopped. The last step includes voiding six times at a predetermined time each day. When the volume of residual urine (RU) is less than 100 mL, patients move on to the next step. When the volume of RU exceeds 100 mL, patients return to the previous step.

Results: Of the 75 patients who visited our department, 41 were eligible for this program. Twenty-two patients visited our department because of urinary retention (UR), and 19 patients were admitted because of increased RU. The mean RU volume was 276.3 mL (range, 150-550 mL). After completing the program, 39 (95.1%) patients no longer required CIC. The mean time to withdrawal of CIC was 25.1 weeks (range, 1-72 weeks). Thirty-six patients no longer required medical treatment, including urapidil, for PUB. Of the 5 patients who had persistent PUB after treatment, 2 patients continued CIC and urapidil, and three patients continued urapidil alone.

Conclusion: The present results demonstrate that the program of CIC in combination with urapidil is effective for the management of PUB after RH.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6158359PMC
September 2018