Difference in symptom manifestation between postmenopausal and premenopausal women in acute uncomplicated cystitis:A multi-institutional pilot study

Objectives:We aimed to prospectively compare lower urinary tract symptoms in premenopausal and postmenopausal women with acute uncomplicated cystitis before and after antibiotic therapy.Materials and methods:This study included adult women with acute uncomplicated cystitis who visited 4 institutions between 2019 and 2020.After registration,we administered oral antibiotics and prospectively documented the changes in lower urinary tract symptoms from the first visit to a follow-up visit at 1 week using the Core Lower Urinary Tract Symptoms Score(CLSS)questionnaire.Results:After treatment,pyuria disappeared in 60 of the 66 patients(14 premenopausal and 46 postmenopausal).The CLSS total score(range)changed from 13(3-29)to 4(0-18)with a significant improvement in all CLSS items.At baseline,nocturia,urgency,and urgency incontinence were more prominent in postmenopausal women than in premenopausal women.In contrast,baseline urethral pain and quality of life index were more severe in premenopausal women than in postmenopausal women.After treatment,the CLSS total score was still higher in postmenopausal women,as reflected by the relatively higher scores for nocturia and urgency,irrespective of the comparable scores for urethral pain and the quality of life index in the 2 groups.Conclusions:Our results suggest that if storage symptoms persist,they should be carefully interpreted according to menopausal status.

Clinical characteristics and treatment outcomes of patients with small cell carcinoma of the urinary bladder

Background:Small cell carcinoma of the urinary bladder(SCUB)is rare.The optimal treatment for SCUB remains unclear.To address the problem of appropriate treatment for each case,we assessed single-modality and surgery-based multimodality treatments in patients with SCUB.Materials and methods:We retrospectively reviewed the medical records of 12 patients with SCUB between 1990 and 2013.All pa-tients underwent transurethral resection of the bladder tumor and were diagnosed with SCUB.Their clinicopathological characteristics were assessed,and the outcomes were compared according to the treatment modality.Results:The median(range)age at diagnosis was 66 years(range,53-85 years).T1-4N0M0 was observed in 8 patients(66%),N1-3M0 in 2(17%),and NanyM1 in 2(17%).After transurethral resection of the bladder tumor,6 patients(50%)underwent cystectomy alone,and 4(33%)underwent cystectomy and presurgical or adjuvant chemotherapy with etoposide and cisplatin.During the median follow-up period of 20.7 months,6 patients(50%)died of cancer,and 2 patients(17%)died of other causes.The median overall survival period was 1.9 years.The 5-year overall survival rate in patients who underwent cystectomy and chemotherapy was 75%,whereas that in those who underwent cystectomy alone and transurethral resection alone were 22%and 0%,respectively(p=0.012).Recurrence-free survival was significantly correlated with cause-specific survival(r=0.95;95%confidence interval,0.81-0.99;p<0.001).Conclusions:Radical cystectomy with chemotherapy using the etoposide and cisplatin regimen improved the prognosis of patients with SCUB and TxNxM0.The time from initial progression to death due to cancer was very short,indicating that the initial treatment strategy is crucial.

Which characteristics are associated with changes in medication status for lower urinary tract symptoms among patients with prostate cancer receiving external beam radiotherapy?

Background:We clarified the predictive factors for changes in the status ofmedications for lower urinary tract symptoms(LUTS)2 years after local radiotherapy for nonmetastatic prostate cancer.Materials and methods:We retrospectively included patients who underwent local external radiotherapy for nonmetastatic prostate cancer in 8 institutions between April 2001 and March 2016.Patients were divided into themedication and no-medication group based on the use of drugs for LUTS before radiotherapy.We defined improvement of LUTS as when the patient did not require medication for LUTS at 24 months after radiotherapy in the medication group and as deterioration whenmedication was required in the no-medication group.Logistic regression analysis was used to evaluate predictive factors for changes in medication status.Results:Altogether,505 patients were divided into a no-medication group(n=352)and a medication group(n=153).The number of patients with deterioration and improvement in LUTS was 49(14%)and 36(23%),respectively.In the multivariate analysis,the predictive variables for deterioration were the International Prostate SymptomScore(≥8;odds ratio[OR],2.21;p=0.014)and the biopsy Gleason score(≤3+4=7;OR,2.430;p=0.008)in the no-medication group,whereas those for improvement were age(<75 years old;OR,5.81;p=0.002),the quality of life score(<3;OR,3.15;p=0.028),and a positive biopsy core rate(≥50%;OR,2.530;p=0.027)in the medication group.Conclusions:These predictive factors for changes in the status ofmedications for LUTS at 2 years after external radiotherapymay help determine the definitive therapy for nonmetastatic prostate cancer.

Comparison of incidence of acute kidney injury after robot-assisted radical prostatectomy with that after open retropubic and extraperitoneal laparoscopic radical prostatectomies in patients with prostate cancer

Background:We retrospectively evaluated the postoperative renal function in patients who had undergone radical prostatectomy to compare the incidences of postoperative acute kidney injury(AKI)among the patients who had undergone robot-assisted radical prostatectomy(RARP),retropubic radical prostatectomy(RRP),and extraperitoneal laparoscopic radical prostatectomy(exLRP).Materials and methods:Patients with prostate cancer who had undergone radical prostatectomy at our institution between 2008 and 2014 were included.Robot-assisted radical prostatectomy was performed using an intraperitoneal approach in a 25-degree Trendelenburg position,whereas other procedures were performed with the patient in the supine position.We evaluated the serum creatinine levels and estimated glomerular filtration rates immediately after surgery and on postoperative day 1.We evaluated the incidence of AKI after prostatectomy using the Acute Kidney Injury Network criteria of the Kidney Disease:Improving Global Outcomes guidelines.Results:A total of 150 consecutive patients were included,with each of the 3 groups(RARP,RRP,and exLRP)comprising 50 patients.Postoperative AKI was observed in 15(30.0%),1(2.0%),and 3(6.0%)patients in the RARP,RRP,and exLRP groups,respectively.Stage 1 AKI was observed in all the patients except one.The incidence of AKI in RARP group was significantly higher than that in the other groups(p<0.001).In the RARP group,the serum creatinine level was significantly elevated immediately after the surgery;however,it returned to baseline on postoperative day 1.Surgical procedures were the only independent factor associated with AKI incidence.Conclusions:This study suggest that compared with RRP and exLRP,RARP is associated with a higher incidence of postoperative AKI,although most patients recover rapidly.Intra-abdominal pneumoperitoneum may contribute to AKI onset.