[EFFICACY OF SCHEDULED INTRAVENOUS OR ORAL ACETAMINOPHEN ADMINISTRATION AFTER ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY].

(Purpose) To determine the efficacy of scheduled intravenous or oral acetaminophen administration after robotic-assisted laparoscopic radical prostatectomy (RARP) in our hospital. (Subjects and methods) We retrospectively analyzed 173 patients who underwent RARP at our hospital between April 2019 and December 2020. The patients were divided into three groups (A, B, and C) according to the use of postoperative analgesia. Group A patients were administered acetaminophen only when needed. Group B patients were administered intravenous acetaminophen every 6 h from the day of surgery to postoperative day 2. Group C patients were prescribed oral acetaminophen from 3 to 7 days postoperatively in addition to being administered intravenous acetaminophen (similar to group B). Multivariate analysis was performed to determine whether scheduled intravenous or oral acetaminophen administration reduced unscheduled analgesic use. (Results) There were 110, 33, and 30 patients in groups A, B, and C, respectively. Significant differences in lymph node dissection rates were observed between groups A and B (70.9% vs 36.4%; P=0.001) and groups A and C (70.9% vs 33.3%; P< 0.001); furthermore, significant differences in the frequency of preoperative androgen blockade therapy were observed between groups A and C (20% vs 3.3%; P=0.029). Logistic regression analysis showed that only scheduled intravenous and oral administration of acetaminophen on postoperative days 0 to 2 was an independent factor for postoperative pain (group A vs group B: OR=0.127; 0.046-0.355; P< 0.001 and group A vs group C: OR=0.133; 0.046-0.390; P< 0.001). On postoperative days 3 to 7, there was no significant difference in the unscheduled use of analgesics between groups A and B. Only 1 of the 30 group C patients received unscheduled analgesia. (Conclusions) Scheduled intravenous or oral administration of acetaminophen may reduce unscheduled analgesic use after RARP.

[Mucinous Adenocarcinoma of the Prostate Diagnosed after Transurethral Treatment of a Prostatic Abscess].

A 70-year-old man visited his doctor because of hip pain and gross hematuria. Digital rectal examination and computed tomography revealed a prostatic abscess. Although antibiotics were prescribed, his symptoms did not improve; he was transferred to our hospital, where transurethral fenestration of the prostatic abscess was performed. During prostatic fenestration, a papillary mucous membrane was confirmed inside the cavity of the prostatic abscess. Pathological examination revealed a mucinous adenocarcinoma of the prostate. Although hormonal therapy was administered, magnetic resonance imaging revealed tumor extension necessitating robot-assisted radical prostatectomy. Mucinous adenocarcinoma of the prostate is rare, and to our knowledge this is the first report of mucinous adenocarcinoma of the prostate diagnosed after transurethral treatment of a prostatic abscess.

Testicular rupture successfully treated with a tunica vaginalis flap.

INTRODUCTION: Testicular injury with a tunica albuginea tear is typically reconstructed by primary closure. We herein describe the successful use of a tunica vaginalis flap for reconstruction of a ruptured testis for which primary closure was not possible. CASE PRESENTATION: A 21-year-old man visited our hospital with scrotal swelling after a baseball struck his left testis. Magnetic resonance imaging and ultrasonography indicated a left tunica albuginea tear, and emergency surgery was performed. Primary closure of the tunica albuginea was impossible since a tight closure could cause secondary damage. A vascular pedicle flap was prepared by shaping the tunica vaginalis to replace the tunica albuginea. He was discharged 2 days postoperatively. Ultrasonography showed normal size and blood flow in the ruptured testis at the 2-week and 3-month follow-up. CONCLUSION: A testicular vaginalis flap should be considered when primary closure is difficult in cases of testicular rupture with tunica albuginea damage.