Purpose) To conduct a prospective study on the efficacy and safety of desmopressin for nocturnal polyuria.(Materials and methods) We selected 51 Japanese men, aged !50 years, with complaints of nocturia and a nocturnal polyuria index of !0.33. We administered 25 or 50 μg desmopressin (Minirinmelt Orally Disintegrating Tablet Ⓡ ), once daily at bedtime. We evaluated the nighttime urinary frequency and urine volume, nocturnal polyuria index, time to the first urination after falling asleep, and International Prostate Symptom Score (IPSS) at baseline and at 4, 8, and 12 weeks after administration. In addition, they underwent clinical examinations and blood tests at 1, 4, and 12 weeks to evaluate the safety of the drug.(Results) We observed a decrease in the nighttime urinary frequency and urine volume, and nocturnal polyuria index, increased prolonged time to the first urination after falling asleep, and improved IPSS at and after 4 weeks, compared to baseline data. Furthermore, the drug remained effective even at 12 weeks for all parameters. We observed adverse events in 31.3% of the patients. The incidence of hyponatraemia was particularly high in 15.7% of the patients.Those with a lower serum sodium level and lesser body weight at baseline were more likely to develop hyponatraemia.(Conclusion) Desmopressin was identified as a potential drug for the treatment of nocturnal polyuria. However, hyponatraemia, an important adverse event, resulted in treatment discontinuation in several patients. A sodium level lower than the normal level and low body weight at baseline were the risk factors for hyponatraemia.
BackgroundThe association between the combination of platelet count and neutrophil–lymphocyte ratio (COP-NLR) at the time of adverse events during sunitinib treatment and prognosis is unclear, and prognostic models combining the prognostic factors of sunitinib have not been well studied. To develop a prognostic model that includes the COP-NLR to predict the prognosis of patients with metastatic renal cell carcinoma (mRCC) treated with sunitinib.MethodsWe performed a retrospective cohort study of 102 patients treated with sunitinib for mRCC between 2008 and 2020 in three hospitals associated with Showa University, Japan. The primary outcome was overall survival (OS). The collected data included baseline patient characteristics, adverse events, laboratory values, and COP-NLR scores within the first 6 weeks of sunitinib treatment. Prognostic factors of OS were analyzed using the Cox proportional hazards model. The integer score was derived from the hazard ratio (HR) of these factors and was divided into three groups. The survival curves were visualized using the Kaplan–Meier method and estimated using a log-rank test.ResultsThe median OS was 32.3 months. Multivariate analysis showed that the number of metastatic sites, Memorial Sloan Kettering Cancer Center risk group, number of metastases, hypertension, modified Glasgow Prognostic Score, and 6-week COP-NLR were significantly associated with OS. A higher 6-week COP-NLR was significantly associated with a shorter OS (p < 0.001). The HRs of the five factors for OS were scored (hypertension, mGPS, and 6-week COP-NLR=1 point; number of metastatic sites=2 points; MSKCC risk group=3 points) and patients divided into three groups (≤1, 2–3, and ≥4). The low-risk (≤1) group had significantly longer OS than the high-risk (≥4) group (median OS: 99.0 vs 6.2 months, p < 0.001).ConclusionsThe 6-week COP-NLR, which was associated with OS, was an important prognostic factor in patients with mRCC treated with sunitinib. The developed prognostic model for OS, including the 6-week COP-NLR, will be useful in decision-making to continue sunitinib in the early treatment stage of patients with mRCC.
We aimed to report the background of patients with vesicovaginal fistulas (VVFs) at our center, which has treated a relatively large number of such patients in Japan, as well as the ingenuity and outcomes of vesicovaginal fistula closure (VVFC). We also investigated the causes of VVFs. Methods: A retrospective review was performed for 28 patients with VVFs treated at our center. Age, body mass index, etiology, site of fistula, and postoperative outcomes were investigated.Results: Twenty-one (75%) fistulas occurred following hysterectomy. The overall success rate of VVFC was 85.7%, and the success rate limited to the first attempt was 89.5%. In 68% of cases, no bladder injury suspected as the cause of VVF was noticed during the surgery. Energy devices were used in all 12 patients for whom information on the type of device used for hysterectomy was confirmed. Conclusions: To our knowledge, this is the first report to evaluate a relatively large number of VVFCs in Japan. Although VVF is thought to be caused by bladder injury during hysterectomy, delayed thermal damage might also result in this pathology, even if there is no apparent intraoperative bladder injury.
Introduction It is generally recognized that erectile dysfunction (ED) is largely attributable to vascular endothelial dysfunction which develops secondary to atherosclerotic changes and blood flow disorder. It is suggested that many patients with ED usually have advanced atherosclerosis because both ED and atherosclerosis share common risk factors. Objective Many erectile dysfunction(ED) cases are attributed to vascular endothelial dysfunction and impaired blood flow due to arteriosclerotic changes. In this study, we examined the association among the erection hardness score (EHS), Pulse Wave Velocity(PWV), and the presence of carotid artery plaques. Materials and Methods The study was enrolled 67 patients who visited our hospital with the chief complaint of ED. Based on the history at the first visit, 28 of the 67 patients were categorized into the EHS 3-4 group and the remaining 39 into the EHS 0-2 group. The two groups were retrospectively analyzed. Results The PWV points were significantly higher in the EHS 0-2 group than in the EHS 3-4 group (P = 0.047). In consideration for error in age, the modified points (PWV at the first visit - reference PWV by age) were significantly higher in the EHS 0-2 group than in the EHS 3-4 group (P = 0.026). This group also showed a higher detection rate of plaques by carotid ultrasound (66.7%). Conclusions This study showed that patients with lower points of EHS had higher PWV and were more likely to have carotid artery plaques. While ED has occasionally been considered as an early risk marker for the onset of cardiovascular events, this study suggests that the hardness of the penis can be an easier-to-measure and more sensitive index. Disclosure Work supported by industry: no.
Introduction Tadalafil is a phosphodiesterase type 5 (PDE-5) inhibitor, and it is used globally as a highly effective and safe drug for the treatment of erectile dysfunction (ED) and lower urinary tract symptom (LUTS). Tadalafil relieve ED or LUTS by relaxing vascular smooth muscle and increasing blood flow to the lower urinary tract tissue. PDE is distributed in pelvic organs, including the corpus spongiosum of the penis and the urethra and prostate, as well as in the lung, heart, and vascular smooth muscle. In other words, PDE is distributed throughout the body. Thus, we hypothesized that the administration of tadalafil might reduce not only systemic arteriosclerosis but also ischemia of the lower urinary tract. Objective To prospectively investigate whether the long-term administration of tadalafil, which is commonly used for erectile dysfunction, could reduce arteriosclerosis. Methods This study included 85 patients who presented to one of three hospitals with lower urinary tract symptoms. Tadalafil was administered daily (5 mg/d), and pulse wave velocity was measured before administration and at weeks 12, 24, 36, and 48. The International Prostate Symptom Score, Overactive Bladder Symptom Score, and Erection Hardness Score were simultaneously assessed at the same time points. Further sub analyses were performed in patients with a high risk of cardiovascular events, those aged 75 years or older, and those younger than 75 years. The Wilcoxon signed rank test was used for statistical analysis. Results Compared with pretreatment values, the pulse wave velocity did not show any statistically significant decrease at any time point. However, the three aforementioned scores significantly improved compared. The group at high risk of cardiovascular events showed significant improvement at weeks 24 and 36, whereas the 75 years or older group showed significant improvement at only week 24. Conclusions The long-term administration of tadalafil (5 mg daily) reduced arteriosclerosis or inhibited its progression, and relieved dysuria and improved erectile function. In particular, the drug was revealed to be more effective in patients at a high risk of cardiovascular events and those aged 75 years or older. Hence, tadalafil may have the potential to be used as an anti-aging medicine, although further studies with longer observation periods are needed to confirm its effectiveness and safety. Disclosure Work supported by industry: no.
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