Tadalafil 5 mg Once Daily Improved Each IPSS Subscore, QOL, and Nocturia in Elderly BPH Patients over 70 Years Old in a Real-World Clinical Setting.

OBJECTIVE: No reports have evaluated the treatment effects of tadalafil by age group in a positive, noninterventional observational study of Japanese men. The present study aimed to evaluate the treatment effects of tadalafil by age group in a positive, noninterventional observational study of Japanese men. We therefore divided patients into 2 groups about the age of 70 years and investigated the treatment effects of tadalafil regarding voiding and storage functions by age group. METHODS: Changes from baseline in each parameter (International Prostate Symptom Score [IPSS], quality of life [QOL] score, Overactive Bladder Symptom Score [OABSS], and residual urine volume) at 4, 12, and 24 weeks after initiating tadalafil for benign prostatic hyperplasia (BPH) patients were compared between groups (50-69 years vs. ≥70 years). In addition, side effects of tadalafil were investigated by age group. RESULTS: In the 50-69 years group, significant improvements from baseline were seen in IPSS total and QOL score for all time points. In addition, significant improvements in IPSS storage subscore from baseline were observed at the 4- and 24-week time points. In the ≥70 years group, significant improvements from baseline were seen in IPSS total, IPSS voiding and storage subscores, and QOL score at each time point. CONCLUSIONS: Tadalafil 5 mg once daily appeared effective in clinical settings for elderly BPH patients even over 70 years old.

Vibegron 50 mg Once Daily Improves OABSS, OAB-q SF Score in OAB Patients ≥80 Years Old in Real-World Clinical Settings and Switching from Other OAB Drugs May Reduce Residual Urine Volume.

Objective: The treatment effects of vibegron have not previously been evaluated in a prospective, non-interventional observational study of elderly Japanese patients, particularly those ≥80 years old. In addition, no reports have referred to residual urine volume in switching cases. We therefore grouped patients by condition and investigated the treatment effects of vibegron on Overactive Bladder Symptom Score (OABSS), Overactive Bladder Questionnaire Short Form (OAB-q SF), and residual urine volume in each group. Methods: This multicenter, prospective, non-interventional, observational study consecutively enrolled OAB patients with total OABSS score ≥3 and OABSS question 3 score ≥2. Sixty-three patients from six centers were recruited. Vibegron 50 mg once daily was administered for 12 weeks as first-line monotherapy (first-line group), monotherapy switching from antimuscarinics or mirabegron due to failure of prior therapy (no washout period), or combination therapy with antimuscarinics (second-line group). OABSS, OAB-q SF, and residual urine volume were collected after 4 and 12 weeks. Adverse events were also recorded at each visit. Results: Of the 63 patients registered, 61 were eligible for analysis (first line, n=36; second line, n=25). The OABSS, excluding daytime frequency scores, and OAB-q SF scale showed significant improvement in all conditions. Switching from mirabegron to vibegron significantly reduced residual urine volume. No serious treatment-related adverse events were encountered. Conclusion: Vibegron 50 mg once daily significantly improved OABSS and OAB-q SF even in patients ≥80 years old. Notably, switching from mirabegron to vibegron resulted in significant improvements to residual urine volume.

Endoscopic surgery for plantar fasciitis: application of a deep-fascial approach.

PURPOSE: The purpose of this study was to determine the clinical results of deep-fascial medial and lateral portals in performing endoscopic surgery for plantar fasciitis. METHODS: In 10 feet in 8 patients who were treated conservatively for more than 6 months with failure to relieve their symptoms, endoscopic surgery was performed. After the patient was placed in the supine position, a medial portal was made 5 mm deep to the plantar fascia and 10 mm anterior to its origin on the calcaneus under fluoroscopy. The lateral portal was established by placing a blunt trocar deep and perpendicular to the plantar fascia. A 2.7-mm-diameter arthroscope was passed through the deep-lateral portal, and the operative devices were inserted through the deep-medial portal. A motorized shaver was used for making a working space to excise the fat tissue along with a portion of the flexor digitorum brevis muscle. If a heel spur existed, it was resected to establish a clear view of the plantar fascia by use of an arthroscopic burr. After exposure of the plantar fascia, its medial half was removed with electric devices such as an Arthro-Knife (ConMed Linvatec, Largo, FL). RESULTS: The mean score on the American Orthopedics Foot and Ankle Society Ankle Hindfoot Scale was 64.2 ± 6.3 points before surgery and 92.6 ± 7.1 points at 2 years after surgery (P < .0001). The mean duration to full weight bearing after surgery was 13.9 ± 8.4 days. All patients returned to full athletic activities by a mean of 10.7 ± 2.6 weeks. CONCLUSIONS: Endoscopic surgery for plantar fasciitis through a deep-fascial approach allows a wide field of vision and working space, permitting reliable resection of the plantar fascia and heel spur. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Optimum location of knot for tendon surgery in side-locking loop technique.

BACKGROUND: Although various tendon repair techniques have been reported to achieve stronger repair, suture failures tend to occur near the knot. We experimentally investigated whether the location of a single core suture knot affects the biomechanical properties of the repair. METHODS: Transected bovine tendons (male Japanese black cattle, 24 months old) of the medial gastrocnemius (9-11 x 14-16 mm in diameter) were sutured with the side-locking loop technique using a USP2-sized polyethylene and polyester multifilament suture or polyester multifilament suture. The knot was made using 7 simple square ties (a surgeon's knot plus 5 ties) at three locations; on the loop, between the tendon stumps, or between the loops burying the knot in a tendon slit using a scalpel. A cyclical loading protocol from 10N to 100N was used and the loading was repeated 10,000 times. FINDINGS: The gap was most decreased and the ultimate strength was most increased when the knot was located between the loops when using a polyethylene and polyester multifilament suture. Cross-sectional area of the tendon showed the ratio of the buried knot relative to the tendon was only 1.6-2.3%, and the polyethylene and polyester multifilament suture was very durable against frictional abrasion. INTERPRETATION: We found that the knot between the loops, buried in the bovine tendon provided the optimum results.

Reconstruction of lateral ligament with arthroscopic drilling for treatment of early-stage osteoarthritis in unstable ankles.

PURPOSE: The purpose of this study was to investigate the clinical, radiologic, and arthroscopic results of lateral stabilization with reconstruction of the lateral ligaments and cartilage regeneration with arthroscopic drilling for the treatment of moderate osteoarthritis of the ankle with simultaneous lateral instability of the ankle (LIA). METHODS: There were 16 cases with LIA, 7 of which had stage 2 osteoarthritis of the ankle according to the radiographic classification of Takakura et al. and 9 of which had stage 3 osteoarthritis. Arthroscopic drilling was performed with a motorized drill for the chondral defect, and anatomic reconstruction of the lateral ligament with an autologous gracilis tendon graft was performed for LIA. Clinical, radiologic, and arthroscopic evaluations were performed before surgery and at the most recent follow-up. RESULTS: In stage 2 cases the mean score on the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale was 42.5 +/- 6.8 points before surgery and 87.4 +/- 4.2 points at the most recent follow-up (P = .0002). In stage 3 cases the mean score was 41.4 +/- 8.0 points before surgery and 61.2 +/- 7.4 points at the most recent follow-up (P = .0001). The talar tilt angles on standard stress radiography in stage 2 cases were 17.4 degrees +/- 4.5 degrees before surgery and 3.4 degrees +/- 0.9 degrees at the most recent follow-up (P = .0009). In stage 3 cases the mean talar tilt angles were 18.2 degrees +/- 4.7 degrees before surgery and 3.6 degrees +/- 0.7 degrees at the most recent follow-up (P < .0001). In all cases the radiographic classification of Takakura et al. was unchanged between assessments before surgery and at the most recent follow-up. With regard to arthroscopic findings at 1 year after surgery, the International Cartilage Repair Society's cartilage repair assessment score showed 6 nearly normal and 1 abnormal stage 2 cases and 1 abnormal and 8 severely abnormal stage 3 cases. CONCLUSIONS: Reconstruction of the lateral ligament with arthroscopic drilling as a surgical procedure for the treatment of stage 2 osteoarthritis with LIA can be recommended. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

[Partial nephrectomy using microwave tissue coagulator--application for laparoscopic operation].

We report our clinical findings on 12 tumors (11 patients) successfully resected by partial nephrectomy with a microwave tissue coagulator (MTC) without renal pedicle clamping, including laparoscopic operation in 4 patients. All patients presented with a renal tumor detected incidentally by ultrasonography or computed tomography. The mean size of renal tumor was 1.9 (range 0.8-3.4) cm. Pathological diagnosis was renal cell carcinoma in 9 tumors and hemorrhagic cyst in 3 tumors. Mean operative time was 249 minutes. Mean blood loss was 183 ml in cases with a laparoscopic operation, that was statistically less than 486 ml in cases with an open operation (p<0.05), and 376 ml in all cases. There was no significant change in the creatinine clearance of cases with laparoscopic operation, compared with that of cases with an open operation. There were no other serious complications postoperatively. These findings suggested that partial nephrectomy with the MTC can be safely and successfully carried out while sparing renal function. Moreover, partial nephrectomy with the MTC for a laparoscopic operation may provide these patients with more benefits.

Retrograde cancellous bone plug transplantation for the treatment of advanced osteochondral lesions with large subchondral lesions of the ankle.

BACKGROUND: The surgical results have been reported as poor for advanced osteochondral lesions of the ankle with large subchondral lesions including subchondral cyst. HYPOTHESIS: Transplanting an autologous cancellous bone plug from the pelvis to the lesions retrogradely may bring good clinical results for the treatment of advanced osteochondral lesions with large subchondral lesions including subchondral cyst of the ankle. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Twenty-five osteochondral lesion patients who had large subchondral lesions of the ankle (diameter > or =10 mm on magnetic resonance imaging) met the criteria of this study. Fourteen of those patients were treated with arthroscopic antegrade drilling (group AD), and the other 11 patients were treated with arthroscopic retrograde cancellous bone plug transplantation from the iliac crest (group RC). The clinical results in conjunction with the American Orthopaedic Foot and Ankle Society (AOFAS) scores, diameters of the subchondral lesions on magnetic resonance imaging, and the regenerative cartilage in second-look arthroscopy using International Cartilage Repair Society (ICRS) visual repair assessment score were evaluated. RESULTS: The mean AOFAS score at 2 years after surgery was 82.2 +/- 7.2 in group AD and 95.8 +/- 4.6 in group RC (P < .0001). Diameter of the subchondral lesion was almost unchanged in 11 cases (78.5%) in group AD, compared with disappearance in 7 cases (73.8%) and decreased lesion size in 4 cases (36.4%) in group RC. The mean ICRS score at second-look arthroscopy was 5.1 +/- 1.9 in group AD and 10.5 +/- 0.8 in group RC (P = .0001). CONCLUSION: The authors recommend arthroscopic retrograde autologous cancellous bone plug transplantation from the iliac crest as a surgical procedure for the treatment of advanced osteochondral lesions with large subchondral lesions of the ankle.

Proximal oblique-domed osteotomy of the first metatarsal for the treatment of hallux valgus associate with flat foot: effect to the correction of the longitudinal arch of the foot.

INTRODUCTION: Flat foot and/or metatarsal primus varus are the major causes of hallux valgus, and it is important to correct these deformities in order to prevent the recurrence of this condition. We demonstrate the clinical and radiological assessment of the correction of hallux valgus, metatarsal primus varus, and flat foot after proximal oblique-domed osteotomy of the metatarsus with distal soft tissue reconstruction. MATERIALS AND METHODS: Twenty-seven feet of 22 patients with moderate or severe hallux valgus who had undergone proximal oblique-domed osteotomy were studied. After the adductor hallucis tendon was cut at the attachment of the proximal phalanx and at the sesamoid bone, the osteotomy was performed 3 cm dorsal-distal to the metatarsocuneiform joint to transfer distal fragment approximately 5 mm in the plantar direction, and rotated laterally decreasing the first-second intermetatarsal angle to 5 degrees. RESULTS: The mean AOFAS score was 54.1 +/- 2.8 points at pre-operation and 92.8 +/- 4.8 points at the most recent follow-up (P < 0.0001). Significant improvement was seen between the hallux valgus angle (P < 0.0001), first-second intermetatarsal angle (P < 0.0001), first-fifth intermetatarsal angle (P < 0.0001), talar pitch (P = 0.0032), and calcaneal plantar angle (P = 0.0327) before surgery and at one year after surgery. The average improvement of the talar pitch and calcaneal plantar angle was 2.6 +/- 1.4 and 2.4 +/- 1.5 degrees, respectively. CONCLUSION: This study suggest that proximal oblique-domed osteotomy of the metatarsal as a surgical procedure for the treatment of moderate or severe hallux valgus with flat foot can be recommended to correct the longitudinal arch of the foot and the first-second intermetatarsal angle.

Optimum surgical suture material and methods to obtain high tensile strength at knots: problems of conventional knots and the reinforcement effect of adhesive agent.

BACKGROUND: Strong suture material and a firmly tight knot that never loosens are necessary for tendon suture, but the appropriate combination of suture materials and the methods to make a knot are matters of uncertainty. METHODS: The tensile strength of four conventional tendon suture materials (Surgilon, Ethibond, Ethilon, PDS II) and newly developed FiberWire were examined. An experienced orthopedic surgeon formed surgical knots with USP2 wire (0.5-0.599 mm in diameter) by making loops and then pulled them at 20 mm/min using Instron. RESULTS: With the conventional surgical suture method (the addition of one throw on a surgeon's knot), Surgilon proved to have the highest tensile strength (163.6 +/- 6.5 N). Other suture materials, when tied under the same conditions, slipped and did not reach the ultimate tensile strength. When four additional throws were made, FiberWire provided the highest tensile strength (316.6 +/- 12.2 N) among the five suture materials tested (others were 140-200 N). When an adhesive agent, cyanoacrylate, was applied to a knot, PDS II provided the highest tensile strength (182.0 +/- 10.1 N). CONCLUSIONS: Our study suggests three suitable combinations of suture materials and methods for suture knot formation, depending on the site of surgery, that provide optimum treatment outcomes. Surgilon provides the most stable strength for general suture techniques. FiberWire is the strongest suture material for a site where a large number of throws is clinically possible. PDS II provides a strong suture when combined with cyanoacrylate reinforcement.