Robot-assisted laparoscopic radical prostatectomy - A report of our current robotic surgery -

　This report is an examination of the results of the initial 200 cases that underwent robot assisted laparoscopic radical prostatectomy (RALP) at Kawasaki Medical School General Medical Center in Okayama, Japan. Two hundred patients that had RALP using the da Vinci Xi Surgical System from August 2016 to October 2019 were examined retrospectively. The median age was 70 years old, and the median PSA was 7.65 ng/ml. 35% of the cases had received a previous abdominal surgery. RALP was performed on all the patients. The median surgery time was 237.5 minutes, the median console time was 173 minutes and the median amount of bleeding was 150 ml. There were no intraoperative blood transfusions, complications or anastomotic failures. Histopathological examination found pT2 in 73.0% of cases and pT3 in 26.5% with positive surgical margins in 10.3% and 50.9% of cases, respectively. There were 17 postoperative cases confirmed to have an inguinal hernia and 3 cases with an incisional hernia. Also, one case had postoperative bleeding from the trocar insertion site, which required hemostasis and a blood transfusion. Urinary continence rates three months after surgery was 76.6% and was 95.3% after twelve months. RALP is a safe and minimally invasive method, but there are aspects that require improvement such as the pT3 positive surgical margin rate and postoperative continence

当院の女性過活動膀胱患者における抗コリン薬とβ3アドレナリン受容体作動薬の内服継続率に関する検討

　過活動膀胱（overactive bladder：以下OAB）は，尿意切迫感や頻尿などの下部尿路症状を有し，加齢とともに増加する傾向がある．OAB 患者の治療薬として，本邦では抗コリン薬とβ3アドレナリン受容体作動薬が推奨，使用されている．今回，女性OAB 患者に対する，抗コリン薬とβ3アドレナリン受容体作動薬の内服継続率，副作用，内服中止理由に関してretrospective に検討した．対象は，2013年１月から12月の１年間に当院泌尿器科を受診した初診の女性OAB 患者，87名とした．β3アドレナリン受容体作動薬投与群と抗コリン薬投与群の内服継続率は，β3アドレナリン受容体作動薬投与群は，12か月で38.8％，60か月で18.1％，抗コリン薬投与群は，12か月18.4%，60か月で7.9％であり，β3アドレナリン受容体作動薬投与群の方が若干継続率は良いものの，両群間に差は認めなかった．副作用に関しては，抗コリン薬投与群の方が多く，口喝が17例（44.7%），便秘が15例（39.5%）であった．薬剤中止の理由は両群とも自然寛解によるものが多かった．　Overactive bladder (OAB) involves lower urinary tract symptoms such as urinary urgency and polyuria, and tends to increase with age. In Japan, the drugs recommended and used for treatment of OAB patients are anticholinergic agents and β3 adrenalin receptor agonists. The present study was a retrospective investigation of the rates of long-term administration of anticholinergic agents and β3 adrenalin receptor agonists, adverse effects with these drugs, and reasons for discontinuation of administration, with female OAB patients. The subjects were 87 female patients who were examined at this hospital\u27s Urology Dept. over 1 year between January and December 2013, and diagnosed as having OAB for the first time. With respect to the rates of long-term administration, in the β3 adrenalin receptor agonist group the rates of administration for 12 and 60 months, respectively, were 38.8% and 18.1%, and these rates in the anticholinergic agent group were 18.4% and 7.9%, so the long-term administration rates were somewhat higher in the β3 adrenalin receptor agonist group, but no difference between the groups was found. Adverse effects were more frequent in the anticholinergic agent group, with 17 subjects in that group (44.7%) developing buccal dryness, and 15 (39.5%) developing constipation. In both groups, the most frequent reason for discontinuation of administration was spontaneous remission

Anti-inflammatory effect of tadalafil, a phosphodiesterase 5 (PDE5) inhibitor, in autoimmune prostatitis

　Prostatitis is one of the most common diseases in urology. The pathology involves intricate interactions among multiple factors, and this has limited the establishment of evidence-based treatment for prostatitis. An autoimmune prostatitis mouse model has recently been suggested to be appropriate as a model of human prostatitis pathology. PDE5 inhibitors are indicated as therapy for benign prostatic hyperplasia with lower urinary tract symptoms, pulmonary arterial hypertension and erectile dysfunction, and have also been shown to have an anti-inflammatory effect against tissue inflammation. Thus, we hypothesized that a PDE5 inhibitor may have a preventive effect on prostatitis. To verify this hypothesis, the anti-inflammatory effects of a PDE5 inhibitor, tadalafil, were examined in an autoimmune prostatitis mouse model. C57BL/6 male mice aged 15 weeks were used in the study. Prostate glands from Wistar rats aged 5 weeks were used as a source of prostate antigen (protein concentration 10 mg/ml). 　Prostate antigen (100 μg in 100 μl of adjuvant) was subcutaneously injected into C57BL/6 mice. Tadalafil (25 μg in 50 μl of water) was orally administered every day for up to 10 weeks after establishment of the model. Control mice received water only (50 μl). Inflammatory changes were investigated using histological, biochemical and immunohistochemical analyses. 　Histological analysis using hematoxylin-eosin and Masson-Trichrome staining showed inhibitory effects on tissue fibrosis following invasion by inflammatory cells in tadalafil-treated mice compared with control mice. Biochemical and immunohistochemical analyses using an inflammation-related proteome assay and immunostaining showed decreased levels of M-CSF, TREM-1, TIMP-1, CCL2, CCL3 and CXCL2 in tadalafil-treated mice compared with control mice.Tadalafil has an inhibitory effect on tissue fibrosis and decreases cytokine levels after an inflammatory response. These results suggest that PDE5 inhibitors might be effective as therapy for prostatitis