Search

Background: Oral 5-aminolevulinic acid for transurethral resection of bladder tumor reduces bladder cancer recurrence compared with standard white-light transurethral resection of bladder tumor. However, data regarding risks of adverse events with this drug are unclear. The aim of the present study was to identify risk factors associated with oral 5-aminolevulinic acid induced adverse events in photodynamic diagnosis-transurethral resection of bladder tumor. Methods: We studied 104 cases of 5-aminolevulinic acid-photodynamic diagnosis-transurethral resection of bladder tumor from October 2021 to April 2023, administering 20 mg/kg 5-aminolevulinic acid orally at least 2 h pre-surgery. Four major adverse events associated with 5-aminolevulinic acid were selected to identify risk factors for their occurrence, including perioperative hypotension, nausea and/or vomiting, photosensitivity, and liver dysfunction. Univariate and multivariate analyses were conducted to identify the risk factors of those adverse events. Results: Perioperative hypotension (11.5 %), nausea and/or vomiting (37.5 %) photosensitivity (31.7 %), and liver dysfunction (51.9 %) were observed. Multivariate analyses revealed that spinal anesthesia was associated with hypotension (p = 0.02), whereas advanced age (p < 0.01) and higher body mass index (p < 0.01) were associated with nausea and/or vomiting. Also, male sex (p < 0.01) and longer operative time (p = 0.01) were associated with photosensitivity, and renin-angiotensin system inhibitors use was associated with postoperative liver dysfunction (p < 0.01). Conclusions: For elderly male obese patients taking renin-angiotensin system inhibitors, particular attention is needed during the perioperative period of photodynamic diagnosis-transurethral resection of bladder tumor under spinal anesthesia due to the higher risk of onset of the adverse events involved in oral administration of 5-aminolevulinic acid.

Background/Aim: The aim of this study was to evaluate the Mayo Adhesive Probability (MAP) score as a predictor of split renal function deterioration after robotassisted partial nephrectomy (RAPN). Patients and Methods: A total of 30 patients who underwent RAPN were identified retrospectively. The parameters evaluated included patient characteristics, tumor diameter, MAP score, warm ischemic time (WIT), and renal function. Split renal function was evaluated using Tc-99m DTPA renal scintigraphy before and six months after surgery. Univariate and multivariate logistic regression analyses were performed. Results: Nine patients (30.0%) showed more than 90% preservation of split renal function on the operated side. The MAP score (p=0.015), cT1b tumor (p=0.0002), and WIT (p=0.044) were associated with preservation of split renal function six months after surgery on univariate analysis. The MAP score was the strongest predictor of preservation of split renal function six months after surgery on multivariable analysis (p=0.007). On receiver-operating characteristic (ROC) curve analysis, the MAP score (cutoff value 3.0; p=0.01) was a significant predictor of split renal function six months after surgery. Conclusion: The MAP score was significantly associated with postoperative split renal function six months after RAPN on the operated kidney side. The MAP score is useful for predicting split renal function after RAPN. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this meta-analysis was to investigate the effect of pharmacotherapy for overactive bladder on the pathogenesis of urinary tract infection. Materials and Methods: A comprehensive search was performed in MEDLINE and the Cochrane Library using terms for overactive bladder, antimuscarinic agents, and beta 3eadrenoceptor agonists. The primary end point was the emergence of urinary tract infection after pharmacotherapy for overactive bladder. The secondary end point was the emergence of urinary retention, dysuria, and/or increased residual urine volume after overactive bladder treatment. Metaanalyses were conducted using random-effects models. Results: A total of 35,939 patients in 33 trials (29 trials of antimuscarinic agents vs placebo, and 9 trials of beta 3eadrenoceptor agonists vs placebo) that included patients with overactive bladder were identified. At 1-3 months after treatment, the incidence of urinary tract infections was statistically significantly higher in the patients treated with antimuscarinic agents (RR: 1.23, 95% CI: 1.04, 1.45; P [ .013) than in the placebo control group. The incidence of urinary tract infections was not increased in the patients treated with beta 3eadrenoceptor agonists (RR: 1.04, 95% CI: 0.76, 1.42; P [ .796). Antimuscarinic agents also statistically significantly increased the risks of urinary retention, dysuria, and/or increased residual urine volume (RR: 2.88, 95% CI: 1.79, 4.63; P < .001), whereas beta 3eadrenoceptor agonists did not (RR: 1.26, 95% CI: 0.38, 4.14; P [ .708). Conclusions: This meta-analysis showed that antimuscarinic agents statistically significantly increased the incidences of urinary tract infection and lower urinary tract symptoms and dysfunction, but beta 3eadrenoceptor agonists did not. To prevent urinary tract infection emergence, beta 3eadrenoceptor agonists might be safer than antimuscarinic agents. [ABSTRACT FROM AUTHOR]

Background/Aim: This study aimed to determine whether psychological stress associated with the COVID-19 pandemic might exacerbate lower urinary tract symptoms (LUTS) and decrease lower urinary tract function in outpatients with LUTS. Patients and Methods: We evaluated 104 patients who visited our hospital during the first wave of the COVID-19 pandemic. Psychological stress was evaluated by the Stress Response Scale-18 (SRS-18). Subjects were divided into aggravation and non-aggravation of psychological stress groups according to the SRS-18. LUTS was evaluated according to the International Prostate Symptom Score (IPSS). Lower urinary tract function was evaluated as the post-void residual urine volume (PVR). Comparisons of scores and changes in scores of each parameter before versus during/after the first wave of the COVID-19 pandemic were performed between the two groups. Results: Forty-two patients were included in each group. We observed no significant differences in the comparison of scores at each time point and in changes in total IPSS score, voiding symptom subscores and PVR between the two groups. Although no significant differences in storage symptom subscores were observed between the two groups, changes in storage symptom subscores increased significantly during the first wave of the pandemic in the aggravation of psychological stress group (p=0.02). However, no significant increase was observed after the first wave. Conclusion: Psychological stress during the COVID- 19 pandemic might transiently aggravate storage symptoms in patients with LUTS. Physicians should be aware of the possibility of transient worsening of LUTS during future pandemics, and transiently additional medication might be effective in such patients. [ABSTRACT FROM AUTHOR]