The addition of 5mg/day of oral olanzapine to standard therapy can reduce the frequency of CINV and improve QOL of patients receiving highly or moderately emetogenic chemotherapy.

Combined tamsulosin and mirabegron treatment is effective and safe for patients with benign prostatic obstruction who have overactive bladder symptoms after tamsulosin monotherapy.

Open radical cystectomy is associated with a high incidence of postoperative complications. Most, however, are of low grade. Our results suggest that obesity, a smoking history, and increasing comorbidity are risk factors for major complications.

Introduction The evidence on gender-affirming hormonal treatment (HT) for transgender persons is still insufficient. Aim To characterize the physical and psychological effects of HT using testosterone enanthate in transgender men, and to validate the safety of this treatment. Methods A total of 85 Japanese transgender men who were followed up for at least 1 year at our gender clinic from 2004 to 2017 were included in this study. All self-reported effects that they recognized and regularly acquired laboratory data were investigated after initiation of HT. Main Outcome Measure HT mainly using testosterone enanthate 250 mg every 2 weeks caused the most desired physical effects to appear promptly and effectively, whereas small but not negligible numbers of undesired physical and psychological effects were also confirmed. Results The initial dose of testosterone enanthate was 250 mg for 72 (84.7%) subjects, and the injection interval was maintained every 2 weeks for 70 (82.3%). Most physical effects appeared within 6 months. A deepened voice (87.1%), cessation of menses (78.8%), acne (69.4%), and facial (52.9%)/body (37.6%) hair growth occurred within 3 months. Although recognition of psychological effects was rare, emotional instability (9.4%) and increased libido (7.1%) appeared in the relatively early phase after beginning HT. The mean values for red blood cells, hemoglobin, uric acid, and alkaline phosphatase were significantly increased for 2 year. During the observation period, there were no life-threatening adverse effects in any subjects. Conclusion The present HT strategy is effective and safe for Japanese transgender men. The information from self-reported effects and objective data from blood tests can help both physicians and transgender men to understand testosterone HT. Kirisawa T, Ichihara K, Sakai Y, et al. Physical and Psychological Effects of Gender-Affirming Hormonal Treatment Using Intramuscular Testosterone Enanthate in Japanese Transgender Men. Sex Med 2021;9:100306.

Toll-like receptor 7 (TLR7) is associated with the pathophysiology of systemic lupus erythematosus and Sjögren syndrome, well-known diseases accompanying interstitial cystitis (IC). We studied TLR7 expression in the bladder of patients with Hunner-type IC (HIC) and its functional roles in bladder inflammation and nociception using mice. Bladder biopsy specimens were obtained from patients with HIC. Specimens from the noncancerous portion of the bladder of patients with bladder cancer served as controls. The specimens were examined by immunohistochemistry and real-time polymerase chain reaction of TLR7. Loxoribine (LX), a TLR7 agonist, was instilled in the bladder of C57BL/6N female mice, and TLR7-mRNA expression and histological changes of the bladder, bladder pain-like licking behavior, voiding behavior, cystometry, and bladder afferent nerve activities were investigated. The effects of hydroxychloroquine, a TLR7 antagonist, on the LX-induced changes on cystometry and voiding behavior were studied. The number of TLR7 immuno-reactive cells and the mRNA expression of TLR7 were significantly increased in HIC specimens. Intravesical instillation of LX induced edema, congestion, inflammation, and significantly increased TLR7-mRNA expression in the mouse bladder. Loxoribine-instillation also significantly increased licking behavior, voiding frequency, and afferent nerve activities associated with decreased single-voided volume and intercontraction interval of micturitions. Hydroxychloroquine reversed the LX-induced cystometric and voiding behavioral changes. Toll-like receptor 7 was up-regulated in the bladder mucosa of patients with HIC, and activation of TLR7 in the mouse bladder induced cystitis with sensory hyperactivity of the bladder. Blocking the TLR7 pathway may be an innovative treatment target of HIC.

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Abbreviations & Acronyms AA = anticholinergic agents BC = bladder compliance BoNT-A = botulinum toxin A CC = cystometric capacity CE = cleansing enema CIC = clean intermittent catheterization DO = detrusor overactivity Dx/HA = dextranomer hyaluronic acid copolymer injection for vesicoureteral reflux FDV = first desire to void JUH = Jikei University Hospital LUTD = lower urinary tract dysfunction OAB = overactive bladder P abd = abdominal pressure (cmH 2 O) P det = detrusor pressure P ves = intravesical pressure (cmH 2 O) UTH = The University of Tokyo Hospital UTI = urinary tract infection Vol. = infusion volume (mL) V-UDS = video-urodynamic study VUR = vesicoureteral reflux Objectives: To investigate video-urodynamic effects of mirabegron, a b 3 -adrenoceptor agonist, on low-compliance bladder. Methods: We retrospectively reviewed nine patients (three men, six women, age 17-68 years) who had been diagnosed with lower urinary tract dysfunction with lowcompliance bladder, and who underwent video-urodynamic study before and during administration of mirabegron 50 mg once daily. Urodynamic parameters were compared before and after treatment. Results: Mirabegron treatment significantly increased first desire to void and cystometric capacity with an average increment of 80 mL (P = 0.027) and 123 mL (P = 0.005), respectively. Bladder compliance also significantly increased (mean value 8.1 mL/cmH 2 O before, 18.2 mL/cmH 2 O after, P = 0.024). In the six patients who had been taking anticholinergic agents at baseline video-urodynamic study and then switched to mirabegron, mean cystometric capacity and bladder compliance were also increased significantly from 208.3 to 346.8 mL (P = 0.015) and from 7.2 to 17.5 mL/cmH 2 O (P = 0.047), respectively. Vesicoureteral reflux grade was improved in three of the four patients who had shown vesicoureteral reflux on cystography before treatment. Conclusions: Mirabegron improves cystometric capacity and bladder compliance, and it lowers vesicoureteral reflux grade in patients with low-compliance bladder. Thus, mirabegron might represent a good alternative drug for low-compliance bladder refractory to anticholinergic treatment.

Abbreviations & Acronyms AKI = acute kidney injury AKIN = Acute Kidney Injury Network BMI = body mass index CI = confidence interval CVD = cardiovascular disease DM = diabetes mellitus eGFR = estimated glomerular filtration rate HT = hypertension IHD = ischemic heart disease KDIGO = Kidney Disease: Improving Global Outcomes NAC = neoadjuvant chemotherapy NSAID = non-steroidal antiinflammatory drugs OR = odds ratio POD = postoperative day RC = radical cystectomy RIFLE = Risk, Injury, Failure, Loss, End-Stage Renal Disease RRT = renal replacement therapy sCr = serum creatinine UD = urinary diversion UTI = urinary tract infection Objectives: To clarify the incidence, risk factors and clinical impact of acute kidney injury after radical cystectomy. Methods: A total of 210 patients who underwent radical cystectomy at Sapporo Medical University Hospital, Sapporo, Japan, from January 2006 through December 2012 were evaluated. The incidence of acute kidney injury was evaluated over the first 7 days postoperatively, during which time a ureteral catheter was inserted. Risk factors for postoperative acute kidney injury and its impacts on short-term clinical outcomes were evaluated. Results: Finally, 145 patients were eligible for this study. Postoperative acute kidney injury was observed in 48 patients (33.1%), with stages 1, 2, and 3 found in 33 (22.7%), 14 (9.6%) and 1 (0.7%), respectively. All patients with stage 1 and 2 acute kidney injury recovered by postoperative day 7, except for one with stage 1. Hypertension (P < 0.001), preoperative estimated glomerular filtration rate <60 mL/min/1.73 m 2 (P = 0.04) and neoadjuvant chemotherapy (P = 0.03) were independent risk factors for postoperative acute kidney injury. Furthermore, postoperative acute kidney injury was an independent risk factor for acute kidney injury after ureteral stent removal, but not of persistent elevated serum creatinine, prolonged hospital stay or the new onset of cardiovascular disorders during the hospital stay. Conclusions: The incidence of acute kidney injury after radical cystectomy is relatively high, although most cases are low grade and can be resolved. We should be aware of the risk for postoperative acute kidney injury, especially in patients who have comorbid hypertension, impaired renal function and received naoadjuvant chemotherapy.