Motofumi Suzuki

Objectives: Desmopressin is an established treatment for nocturia due to nocturnal polyuria. In Japan, low‐dose formulations (25 and 50 μg) were approved only for men in 2019. However, age‐ and dose‐specific prescribing patterns in real‐world practice remain unclear. Using nationwide aggregated claims data, we analyzed age‐stratified prescribing trends and dose selection patterns. Methods: Publicly available NDB Open Data (fiscal years 2020–2023) were used. Outpatient prescriptions for desmopressin orally disintegrating tablets (25 and 50 μg) were extracted by sex and 5‐year age categories. Population‐adjusted prescription rates per 1000 persons and 95% confidence intervals (CIs) were calculated. Temporal trends were evaluated using Poisson regression models with log‐population offset. Results: In men, the population‐adjusted prescription rate increased from 21.5 per 1000 persons in 2020 to 84.6 in 2023 ( p for trend < 0.001). More than 90% of prescriptions were issued to individuals aged ≥ 65 years. Overall, use of the 25 and 50 μg formulations was balanced; however, the proportion of the 25 μg formulation increased with advancing age, and the 25 μg/50 μg ratio reached 1.37 among those aged ≥ 90 years. Prescriptions in women also increased, with predominance of the 25 μg formulation. Conclusions: Desmopressin prescribing has increased nationwide in Japan, particularly among older men. Increased selection of the lower‐dose formulation in older patients may reflect safety considerations. Off‐label use in women is increasing, indicating the need for further safety evaluation and appropriate prescribing guidelines.

Objective: This study examined prescription trends for benign prostatic hyperplasia (BPH) drug therapy in Japan over the past decade, focusing on drugs rated as grade A according to Japanese clinical guidelines.Methods: Using the National Database Open Data, this study analyzed prescription data from the fiscal years of 2014 to 2021, tracking α1‐blockers, 5α‐reductase inhibitors, and phosphodiesterase type 5 inhibitors. We adjusted for demographics and calculated medication costs to determine prescribing patterns and changes in drug utilization.Results: Prescriptions for α1‐blockers increased from 9898 per 1000 males in 2014 to 12 613 in 2021. Prescriptions for 5α‐reductase inhibitors rose from 1441 per 1000 males in 2014 to 2310 in 2021. Tadalafil prescriptions saw a significant increase, from 900 in 2015 to 2520 in 2021. Despite these increases, the overall market size for BPH drugs decreased from 664 million dollars in 2014 to 279 million dollars in 2021, indicating a shift toward generic medications driven by healthcare policies.Conclusions: Although BPH medication prescriptions are increasing, driven by Japan's aging population and clinical guidelines, market dynamics are shifting owing to generic and government price adjustments. This analysis underscores the changing BPH treatment landscape in Japan, highlighting the importance of continuous evaluation of treatment efficacy and cost‐effectiveness in evolving healthcare policies and demographics.

The Japanese government withdrew its recommendation for human papillomavirus (HPV) vaccination in June 2013 and resumed it in April 2022. This period is known as the vaccine crisis in Japan. This study aimed to elucidate the prevalence and genotype distribution of HPV among Japanese female citizens, and the effect of vaccination against HPV-16/18 in the era of the vaccine crisis. We recruited Japanese female citizens and asked them to provide self-collected samples from the vaginal wall using cotton swabs for HPV genotyping. Furthermore, we collected the participants’ characteristics, including lifestyle and experience of vaccination against HPV, to determine the significant association with HPV infection. HPV-16/18 positivity was found in 5.6% (115/2044) of participants. The highest vaccination rate was observed in the age group of 20–24 years (60.6%), whereas the lowest HPV-16/18 positivity was observed in the age group of 45–49 years (2.8%), followed by the age group of 20–24 years (4.0%). Experience with HPV vaccination significantly reduced the risk of HPV-16/18 infection (adjusted odds ratio, 0.047; 95% confidence interval, 0.011–0.196). Vaccinated women were much less likely to be infected by HPV-16/18, regardless of the HPV vaccine type or the vaccination dose.

Introduction: Sepsis with concomitant acute pyelonephritis, secondary to urolithiasis, is common. We report a case of sepsis‐induced cardiomyopathy with acute pyelonephritis, successfully managed with venoarterial extracorporeal membrane oxygenation.Case presentation: A 64‐year‐old woman presented with fever and disturbed consciousness. Abdominal computed tomography revealed right hydronephrosis with ipsilateral ureteral stone. Despite ureteral stent placement and antibiotic treatment, her hemodynamics worsened. She was diagnosed with sepsis‐induced cardiomyopathy and underwent venoarterial extracorporeal membrane oxygenation. Her hemodynamics improved rapidly; venoarterial extracorporeal membrane oxygenation was withdrawn on postoperative day‐3. She was discharged from our hospital after sufficient antibiotic treatment.Conclusion: Venoarterial extracorporeal membrane oxygenation may be initiated in patients with sepsis‐induced cardiomyopathy. Evaluation of left ventricular ejection fraction via echocardiography is important to determine the indication for venoarterial extracorporeal membrane oxygenation.

Introduction The popularity of robot-assisted radical cystectomy over open radical cystectomy has been increasing because the former, a minimally invasive surgery, contributes to earlier recovery and shorter hospitalization. However, atypical recurrences may be more frequent after robot-assisted radical cystectomy than after open radical cystectomy. We report a case of an atypical early recurrence of bladder cancer including the descending colon. Case presentation A 70-year-old Japanese man underwent robot-assisted radical cystectomy for muscle-invasive bladder cancer. Four months later, he was hospitalized for severe anemia (hemoglobin, 5.1 g/dL). Colonoscopy revealed a 4-cm submucosal oozing tumor in the descending colon. Computed tomography revealed multiple recurrent lesions including recurrence in the descending colon, all of which disappeared completely after chemotherapy with six cycles of dose-dense methotrexate, vinblastine, doxorubicin, and cisplatin. Conclusion We encountered a rare case of an atypical recurrence of bladder cancer in the colon after robot-assisted radical cystectomy.

Background: Nationwide epidemiological surveys of behavioral factors and human papillomavirus (HPV) infection among Japanese women are scarce. This study aimed to determine the prevalence, genotype distribution, and significant predictive factors of HPV infection using self-collected vaginal samples from Japanese female people. Methods: The study population consisted of 1,050 female subjects aged 16–75 years (median 30 years). The participants were asked to provide self-collected samples from the vaginal wall using cotton swabs for genotyping of HPV. We compared the participants’ characteristics and detected HPV genotypes to determine significant predictors of HPV infection. Results: After excluding 47 participants (34 participants of unknown age, 11 virgin participants, 1 participant who engaged in sex with another woman, and 1 participant who did not undergo β-globin detection), 1,003 participants were included in the analysis. Of the 1,003 participants, 426 (42.5%) participants had at least one HPV genotype, 282 (28.1%) participants had high-risk HPV genotypes, 306 (30.5%) had low-risk HPV genotypes, and 162 (16.2%) participants had both HPV genotypes. HPV-16/18 positivity was found in 5.4% (54/1,003) participants. The most frequently detected high-risk HPV genotype was HPV-52 (86/1,003; 8.6% participants). The number of lifetime sex partners (≥6) and a present history of sexually transmitted infection (STI) were significant predictors of high-risk HPV infection. The number of lifetime sex partners (≥6), age of coitarche (≥20 years of age), unmarried status, and a present history of STI were significant predictors of low-risk HPV infection. Conclusions: The prevalence of high-risk and low-risk HPV infection among Japanese female subjects was 28.1% and 30.5%, respectively. The number of lifetime sex partners (≥6) and present history of sexually transmitted infection were the common significant predictors of high-risk and low-risk HPV infection.

Background: Vulvar Paget’s disease (VPD) is a rare malignant disorder originating in the external genitalia. It occasionally invades into urethral or vaginal mucosa of female, making surgical treatment more complicating. In case of urethral invasion of Paget’s cells, systematic mapping biopsy of urethral mucosa is the standard of care to determine the range of surgical resection. Resection of urethral mucosa and simple skin grafting often result in urethral stricture after surgery, which severely deteriorates patient’s quality of life. Case presentation: We applied a new technique of advancement urethral meatoplasty using buccal mucosa, in two Japanese cases of VPD with urethral invasion. After broad resection of vulvar skin together with the urethral mucosa, buccal mucosa was implanted between advanced urethral mucosa and skin graft. In both cases, we could prevent urethral stricture one year and two years after surgery, respectively. Conclusion: This technique prevented urethral stricture after surgery and could be a useful technique as part of urethroplasty for VPD.

Urinary and fecal incontinence as well as skin pressure injury are common healthcare problems in nursing homes; however, the prevalence and related risk factors were not well understood in the Japanese special elderly nursing home settings. We surveyed the prevalence of urinary, fecal and double incontinence, and skin pressure injury among the elderly living in special elderly nursing homes in Japan. A nationwide cross-sectional epidemiological survey was conducted with a total of 4881 residents. The prevalence of urinary, fecal and double incontinence was 82.9%, 68.9% and 64.9%, respectively. Skin pressure injury was found in 283 residents (283/4881, 5.8%). Age, Care-Needs level, loss of voiding desire, and fecal incontinence were significant risk factors for urinary incontinence. Residential period, Care-Needs level, loss of voiding and defecation desires, and urinary incontinence were significant risk factors for fecal incontinence. Only male sex was a significant risk factor for skin pressure injury. Our study revealed continence status and the prevalence of pressure skin injury among older adult residents who receive end-of-life care in special elderly nursing homes in Japan. Further studies should be conducted to examine whether recovery of urinary and fecal sensations improves continence status.