Effect of Estrogen Replacement Therapy on Bladder Circulation in Old Female Rats

The effect of estradiol (E2) on the urinary bladder of old female rats was investigated by examining the histology and blood flow in the bladders. A total of 20 female Wistar rats aged 16 months were divided into 4 groups: Group I, 5 normal controls; Group II, 5 rats treated with E2 for 4 weeks; Group III, rats treated with E2 for 8 weeks; and Group IV, 5 rats receiving a placebo for 8 weeks. After the treatment, we removed the bladders, then weighed and stained them with hematoxylin and eosin. The muscle content was analyzed with the Elastica-van Gieson method, and the number of blood vessels with the Masson's trichrome method. Blood circulation in the bladders was also measured. The E2-replaced groups showed higher levels than the other groups in terms of blood flow in the bladder (20.6 ± 1.8 mL/min for Group II and 23.4 ± 1.5 mL/min for Group III, both P < 0.05 versus Groups I and IV), muscle content (2.33 ± 0.47 and 3.11 ± 0.48 for Groups II and III, respectively, both P < 0.05 versus Groups I and IV) and bladder weight (185.3 ± 6.2 mg and 193.2 ± 23.5 mg for Groups II and III; Group III showed P < 0.05 versus Groups I and IV). Differences in body weight and number of blood vessels among groups were not significant. We observed an increase in blood circulation, muscle content and weight of the bladder: E2-replacement therapy positively affected bladder functions

Effect of Long-Term Estrogen Replacement on Bladder Function in Old Female Rats

The effects of estradiol (E2) on urodynamic parameters were studied with twenty 16-month-old female Wistar rats. They were divided into 4 groups, i.e., Group I: untreated; Groups II and III: treated with E2 for 4 and 8 weeks, respectively; Group IV: treated with a placebo for 8 weeks. After treatment, we measured their plasma E2 levels, and recorded their voiding behavior for 24 h. Cystometry was performed and urodynamic parameters were analyzed. Particularly, bladder capacity as well as voided volume and frequency were surveyed. The results obtained were compared among groups. Levels of bladder capacity in the E2-replaced groups (Groups II, 0.52 ± 0.14 mL and Groups III, 0.58 ± 0.09 mL) were significantly (P < 0.05) higher than in the other groups (Group I, 0.38 ± 0.09 mL and Group IV, 0.40 ± 0.11 mL) respectively. The average voided volume was significantly (P < 0.05) higher in the E2-replaced groups (Groups II, 1.06 ± 0.22 mL and Groups III, 1.01 ± 0.16 mL) than in Group IV (0.79 ± 0.15 mL), respectively. Concerning the number of daily micturition per day, a significant difference (P < 0.05) was observed only between Group III (14.2 ± 2.7) and Group IV (18.8 ± 3.7). This suggests that E2-replacement therapy positively affects bladder function

Efficacy of Combination Treatment with Tadalafil and Mirabegron in Patients with Benign Prostatic Hyperplasia Who Presented with Persistent Storage Symptoms After Tadalafil Monotreatment: A Prospective, Multicenter, Open-Labeled Study

Background: The aim of this study is to evaluate the efficacy and safety of tadalafil, a phosphodiesterase type 5 inhibitor, plus mirabegron, a β3-adrenoreceptor agonist, in patients with benign prostatic hyperplasia who presented with persistent storage symptoms after tadalafil monotreatment. Methods: The registration of this study started in August 2016 and ended in July 2019. The inclusion criteria included patients aged ? 50 years who were diagnosed with benign prostatic hyperplasia and who presented with overactive bladder symptoms. Patients were treated with oral tadalafil 5 mg once daily for 4 weeks. Then, its efficacy was evaluated. Patients who responded to the treatment received oral tadalafil 5 mg once daily for 4 more weeks (monotreatment group). Meanwhile, those who did not respond received oral tadalafil 5 mg and mirabegron 50 mg, which is an add-on treatment, once daily for 4 more weeks (combination therapy group). Results: After 8 weeks, the monotreatment group (n = 19) and the combination group (n = 56) had significantly better total Overactive Bladder Symptom Score and International Prostate Symptom Score and International Prostate Symptom Score voiding and storage subscale scores. Moreover, the two groups experienced significant improvements in the total Overactive Bladder Questionnaire and Nocturia Quality of Life Questionnaire scores, and Nocturia Quality of Life Questionnaire Bother/Concern subscale score after 8 weeks. However, there were no cases of urinary retention or serious adverse events. Conclusion: Combination treatment with tadalafil and mirabegron is effective and safe for patients with benign prostatic hyperplasia who presented with persistent storage symptoms after tadalafil monotreatment. Hence, tadalafil plus mirabegron is a promising therapeutic option, and it can improve overactive bladder related-quality of life

A Comparison Between Laparoscopic and Robot-Assisted Laparoscopic Pyeloplasty in Patients with Ureteropelvic Junction Obstruction

Background: The aim of this study is to compare the results of laparoscopic pyeloplasty and robot-assisted laparoscopic pyeloplasty in patients with ureteropelvic junction obstruction. Methods: Between March 2008 and May 2019, the patients who underwent retroperitoneal laparoscopic or robotic-assisted laparoscopic pyeloplasty in our institution were retrospectively reviewed. Results: Thirteen patients underwent laparoscopically, and 12 patients underwent robotic surgery. The significant difference was found in median operative time between laparoscopic group (296 minutes) and robotic group (199 minutes) (P = 0.001). The median time for drain removal in laparoscopic group was longer than robotic group (3 vs. 2 days, respectively, P = 0.029). Conclusion: Laparoscopic and robot-assisted laparoscopic pyeloplasty is safe and excellent success rates in patients with ureteropelvic junction obstruction. However, our experience study suggested that robotic surgery improves a total operative time, decreases drain removal time and less intraoperative blood loss than laparoscopic approach

The Influence of Prior Abdominal Surgery on Robot-Assisted Partial Nephrectomy

[Background] We evaluated the influence of prior abdominal surgery on perioperative outcomes in patients who underwent robot-assisted partial nephrectomy in initial Japanese series. [Methods] We reviewed patients with small renal tumors who underwent robot-assisted partial nephrectomy from October 2011 to September 2020 at our institution. Patients with prior abdominal surgery were compared with those without prior surgery based on perioperative outcomes. The chi-square test and Mann–Whitney U test were used for statistical analyses of variables. [Results] Of 156 patients who underwent robot-assisted partial nephrectomy, 90 (58%) had no prior abdominal surgery, whereas 66 patients (42%) underwent prior abdominal surgery. No significant differences in perioperative outcomes were observed between with and without prior abdominal surgery groups. In transperitoneal approach robot-assisted partial nephrectomy, 31 patients (80.4%) had prior abdominal surgery. Trocar insertion time in the with prior abdominal surgery group took longer than the without prior abdominal surgery group (32 vs. 28.5 min, P = 0.031). No significant difference was observed in the conversion rate between the two groups (P = 0.556). [Conclusion] Robot-assisted partial nephrectomy appears to be a safe approach for patients with prior abdominal surgery. In transperitoneal approach robot-assisted partial nephrectomy with prior abdominal surgery, trocar insertion time was longer, but no significant differences were found in other outcomes. Transperitoneal approach robot-assisted partial nephrectomy is thus considered a safe procedure for patients with prior abdominal surgery

Experience of Cadaver Donor Nephrectomy with Cadaver Surgical Training

As cadaver donor nephrectomy in kidney transplantation is performed in only a limited number of cases, few physicians are skilled in the surgical technique. We performed two cadaver donor nephrectomy sessions during cadaver surgical training. The first session was performed by a lecturer who was skilled in the technique, with physicians and nurses participating in order to learn the methodology. The second session was conducted only for physicians. The procedures undertaken were as follows: cannulation of the femoral artery and vein, skin incision and bowel ligation, cross-clamping of the aorta, diaphragmatic incision and inferior vena cava incision, dissection of the aorta and inferior vena cava, and nephrectomy. Although there were some differences from that normally observed in actual patient surgery, such as no bleeding and formalin fixation, some of the procedures were very useful in helping to better understand cadaver donor nephrectomy

Initial Experience of Robot-Assisted Adrenalectomy in Japan: What is the Optimal Selection of Robotic Forceps for Adrenalectomy?

Minimally invasive adrenalectomy is the preferred technique for managing adrenal tumors. Laparoscopic adrenalectomy is widely performed and covered by insurance in Japan, but robot-assisted adrenalectomy is not. To investigate the best forceps combinations for performing robot-assisted adrenalectomy safely, we performed robot-assisted adrenalectomy for two left and two right adrenal adenomas using different robotic forceps combinations (bipolar forceps, monopolar curved scissors, Vessel Sealer Extend, and SynchroSeal) for each case. Although we evaluated a small number of RAs, lower blood loss was observed in patients where the vessel sealing devices were used. The extent of dissection is small for adrenalectomy, and robotic bipolar vessel sealing tools may not be necessary, especially for the small adrenal tumors. However, considering the risk benefits, the combination of forceps with Vessel Sealer Extend (by the left arm) and monopolar curved scissors (by the right arm) will become one of the best forceps combinations for performing robot-assisted adrenalectomy safely

Utility of the HYBRID Method Incorporating the Advantages of Both Extracorporeal and Intracorporeal Urinary Diversion in Robotic-Assisted Radical Cystectomy

Background: Robotic-assisted radical cystectomy (RARC) is a well-known standard procedure for muscle-invasive bladder cancer. However, it remains controversial whether extracorporeal urinary diversion (ECUD) or intracorporeal urinary diversion (ICUD) is superior in this technique. We have developed a HYBRID method that combines ECUD and ICUD to retain the advantages of each. The purpose of this study was to compare perioperative outcomes between HYBRID and ECUD in RARC and to evaluate the usefulness of the HYBRID method. Methods: We retrospectively analyzed the perioperative outcomes of 36 consecutive bladder cancer patients who underwent RARC with ileal conduit at our institution between March 2013 and December 2021. Propensity-score matching was used to align patient backgrounds between the HYBRID and ECUD groups. Results: After matching, 12 cases were selected for each group. There was no significant difference in patient demographics between the groups except for the rate of neoadjuvant chemotherapy. Mean console time was significantly longer in the HYBRID group due to intracorporeal manipulation; however, a relatively favorable trend of mean blood loss was observed in this group. There was no significant difference between the groups in terms of positive surgical margin, mean number of lymph node removed, or positive lymph node. The incidences of complications associated and non-associated with the urinary tract and grade ≥III complications at postoperative day (POD) 0–30 and 31–90 were similar between the groups. In the HYBRID group, no complications non-associated with the urinary tract or grade ≥III complications were observed at POD 31–90. Conclusion: The HYBRID method takes advantage of the benefits of both ICUD and ECUD and is a highly applicable technique that can be used in a variety of patient backgrounds

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

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