Yuichiro Kato

Introduction: To investigate the nationwide trends in pharmacological treatment for overactive bladder among Japanese adults, specifically focusing on the β3‐agonists to anticholinergics prescribed tablet ratio (BAPR) and how this ratio differs by sex and age. Methods: National Database Open Data from fiscal year 2015 to 2023 were utilized and the prescription volumes of β3‐agonists (mirabegron and vibegron) and anticholinergics (propiverine, solifenacin, imidafenacin, and fesoterodine) were aggregated. The data were categorized by sex and 10‐year age groups to analyze prescribed tablet trends per 1000 population for each demographic. We calculated the BAPR by dividing the number of prescribed tablets for β3‐agonists by those for anticholinergics and investigated the annual trends for younger and older men and women using an ordinary least squares linear regression model. Results: During the study period, the total number of prescribed tablets for β3‐agonists, anticholinergics, and overall total showed changes of +285.3%, −24.7%, and +59.3%, respectively. Total and β3‐agonist prescriptions rose annually across all groups, whereas anticholinergic use declined beginning in fiscal year 2018. Additionally, nearly all drugs showed an increase in prescribed tablets per 1000 population as age progressed. Although the BAPR increased significantly in all groups, there were significant differences in the rates of change between groups ( p < 0.001), with older men exhibiting the highest rate of increase. Conclusions: A nationwide shift in overactive bladder treatment, where the growth in β3‐agonist prescriptions outweighed the decline in anticholinergics, was observed across all demographic groups in Japan.

Background: Urachal carcinoma (URC) is a rare tumor of the urinary bladder, of which the histology usually resembles that of colorectal adenocarcinoma. Achievement of cure in patients with metastatic URC is difficult, and the survival rate of these patients has remained unsatisfactory despite various efforts.Case: A 74‐year‐old female patient presented to us complaining of gross hematuria. Abdominal and thoracic computed tomography revealed a mass in the dome of the bladder with a single lung nodule. The two tumors, which were resected by partial cystectomy and video‐assisted thoracic surgery, respectively, were diagnosed by postoperative histopathology as adenocarcinomas. Subsequent to the surgeries, bilateral ovarian metastases and another lung metastasis, which appeared metachronously, were also resected. The repeated cytoreductive surgery combined with administration of S‐1 plus cisplatin chemotherapy at each instance of disease progression eventually yielded a durable progression‐free survival; even at 5 years after the initial therapy, the patient remained asymptomatic with no limitation of activities despite the failure to achieve “cure”.Conclusion: Not only some degree of sensitivity of the tumor to chemotherapy, but also the repeated cytoreductive surgeries might allow prolonged survival with a good quality of life in elderly patients with metastatic URC, even in the absence of cure and failure of genetic testing to suggest any potentially effective second‐line drugs. To improve the survival of patients with metastatic URC, complementary therapy suggested by the results of genomic profiling may be necessary along with other multimodality therapy, including sequential metastasectomy and chemotherapy.