To evaluate the efficacy and safety of intravesical KRP-116D, 50% dimethyl sulfoxide solution compared with placebo, in interstitial cystitis/bladder pain syndrome patients. Methods: Japanese interstitial cystitis/bladder pain syndrome patients with an O'Leary-Sant Interstitial Cystitis Symptom Index score of ≥9, who exhibited the bladder-centric phenotype of interstitial cystitis/bladder pain syndrome diagnosed by cystoscopy and bladder-derived pain, were enrolled. Patients were allocated to receive either KRP-116D (n = 49) or placebo (n = 47). The study drug was intravesically administered every 2 weeks for 12 weeks. Results: For the primary endpoint, the change in the mean O'Leary-Sant Interstitial Cystitis Symptom Index score from baseline to week 12 was À5.2 in the KRP-116D group and À3.4 in the placebo group. The estimated difference between the KRP-116D and placebo groups was À1.8 (95% confidence interval À3.3, À0.3; P = 0.0188). Statistically significant improvements for KRP-116D were also observed in the secondary endpoints including O'Leary-Sant Interstitial Cystitis Problem Index score, micturition episodes/24 h, voided volume/micturition, maximum voided volume/micturition, numerical rating scale score for bladder pain, and global response assessment score. The adverse drug reactions were mild to moderate, and manageable. Conclusions: This first randomized, double-blind, placebo-controlled trial shows that KRP-116D improves symptoms, voiding parameters, and global response assessment, compared with placebo, and has a well-tolerated safety profile in interstitial cystitis/ bladder pain syndrome patients with the bladder-centric phenotype.

This report describes a rare case of an 86-year-old man with an indwelling urethral catheter who developed severe abdominal pain and was diagnosed with intraperitoneal urinary bladder perforation. A home-visiting nurse suspected catheter obstruction and performed a catheter exchange. However, bladder irrigation could not subsequently be performed. Computed tomography of the abdomen and pelvis after transurethral perfusion of contrast medium demonstrated extravasation of the contrast material into the peritoneal cavity. Furthermore, the Foley catheter balloon was positioned in the peritoneal cavity through the bladder. The patient was diagnosed with peritonitis due to spontaneous intraperitoneal perforation of the urinary bladder, and exploratory laparotomy was performed. During exploration, a perforated tear at the top of the bladder was discovered where the Foley catheter had penetrated the bladder. The Foley catheter balloon was floating freely in the peritoneal cavity. There was no evidence of pathologic lesions, such as cancer or inflammatory mass at the site of the injured peritoneum. Successful closure of the damaged peritoneum and bladder was performed. Since the proportion of elderly individuals continues to increase in the general Japanese population, the incidence of the chronic Foley catheterization is expected to increase. Therefore, clinicians should be aware of this potential complication.

Post-prostatectomy urinary incontinence (PPI) is the greatest concern for urologists after radical prostatectomy (RP). It is thought that PPI is composed of multiple factors including static and dynamic components. The purpose of this study is to show visually levator ani muscle (LAM) contraction during pelvic floor muscle contraction and to evaluate the dynamic differences in its contraction between men with and without PPI.Methods: This study was a case-control study of the urinary continent or incontinent men. It investigated whether LAM contraction was involved in urinary leakage based on examination of LAM contraction by cine magnetic resonance imaging. Results: The LAM contracted from the coccyx to the pubis in the same manner before and after surgery. The degree of contraction of the LAM in postprostatectomy groups was smaller than that in the healthy adult group. The contraction distances of each part of the pelvic floor were decreased by 50%-70% in the incontinence group compared to those in the continence group. The bladder neck moved 2.5-fold further in the continence group and the direction of movement was more vertical than in the incontinence group. Urethral compression was attenuated by about 40% in the incontinence group compared to that in the continence group.Conclusions: RP can cause damage to the LAM. LAM contraction is reduced after RP compared with that in healthy adult men. In men with PPI, the reduced muscle contraction might not compress the urethra sufficiently when abdominal pressure is raised. Pelvic floor muscle training might provide a meaningful method for the recovery of LAM contraction in patients with PPI.

An 82 -yearold man presented to our department in December 2020 with a complaint of right lumbar back pain. An abdominal computed tomography showed an irregular mass at the right renal hilum. The abdominal CT, retrograde pyelography, and urine cytology did not reveal a renal or urinary tract malignancy, and retroperitoneal fibrosis was also suspected. An echoguided biopsy was performed to confirm the diagnosis because of high levels of serum IgG and IgG4. The histopathological specimens showed diffuse lymphocyte aggregation and fibrosis. The patient was diagnosed as having IgG4related retroperitoneal fibrosis because the IgG4/IgGpositive cell ratio increased to 40 or more. After treatment with prednisolone 20 mg/day, the right hilar mass shrank and the serum IgG4 level decreased.