Significance of Kampo medicine in the urological field “1st International Symposium on Kampo Medicine”

To The Editor Urology treats many diseases around urogenital organs in men and women, that is, the kidneys, adrenal glands, ureters, urethra, prostate, testis and pelvic floor. Thus, the world of urology is wider than expected. In addition, urology is advancing in the research field of quality-oflife (QOL) diseases. The important targets of Kampo are the treatment of symptoms of QOL diseases that are not sufficiently covered by modern medicine. There are many results of Kampo treatments for urological QOL diseases. This urology session introduces Kampo treatments for various complaints in urological diseases. The first presentation is about basic research on choreito for overactive bladder. The second presentation covers clinical research of hachimijiogan and goshajinkigan for benign prostate hyperplasia and interstitial cystitis/ bladder pain syndrome. The third presentation concerns clinical research of choreito and seishinrenshiin for chronic urinary tract infection. Finally, basic and clinical research on Kampo medicine for testosterone and cognitive function with urological cancer is presented. Please enjoy the varied world of Kampo medicine for urological diseases. The first presentation is entitled “Therapeutic Effects of Choreito on Urological Diseases.” Choreito (CRT) is one of the most commonly prescribed Kampo medicines in urology and has a “water utilization effect,” a combination of the diuretic effect and an improvement in water imbalance. Therefore, CRT is administered to relieve lower urinary tract symptoms associated with inflammation by promoting the excretion of urinary stones and alleviating edema of the lower body. Kampo medicines work well when administered according to the appropriate body patterns; however, their mechanisms of action remain largely unclear. Although CRT is typically administered to and works best in patients exhibiting decreased urine excretion and thirst, therapeutic effects are observed regardless of whether these symptoms are present. Attempts have been made to elucidate the mechanisms of action of CRT through basic research on rats and cats. These studies suggested the possibility of a water restriction effect in the nocturnal polyuria model, an effect of suppressing detrusor overactivity in the overactive bladder model, and an improvement effect in the urinary component. We hope that these reports will provide an opportunity to further expand the use of CRT. The second presentation is “Lower Urinary Tract Symptoms and Kampo Medicine.” Lower Urinary Tract Symptoms (LUTS) are classified into (1) storage symptoms, (2) voiding symptoms, and (3) postmicturition symptoms. BPH (benign prostatic hyperplasia) is a typical disease that presents all three symptoms, and OAB (overactive bladder) and IC/BPS (interstitial cystitis/bladder pain syndrome) are typical diseases that present storage symptoms. There are kidney supplements (hachimijiogan, goshajinkigan [GJG]) employed for BPH, but there are no randomized controlled clinical trials regarding their effectiveness. There are only a few papers regarding BPH: (a) a report of QOL improvement by additional GJG administration for BPH patients in which OAB symptoms remained even after administration of tamsulosin; (b) a report of improvement of international prostate symptom score (IPSS), QOL score, and uroflowmetric parameters by administration of GJG to 25 BPH patients whose frequent urination was insufficiently improved by an α1 blocker; and (c) a report of OAB symptom score, IPSS, and QOL score improvement by administration of GJG for six weeks to 30 OAB patients associated with BPH. There are only a few reports that GJG was effective for OAB patients, and also few reports that combination therapy of Kampo medicines was useful for IC/BPS patients. Kampo medicine should be considered as complementary therapy for the abovementioned diseases. We present the treatment efficacy of seishinrensiin after HD (hydrodistension) for IC/BPS patients in our department. The third presentation is “Urinary Tract Infection (Clinical Research).” Treatment of bacterial urinary tract infections with the use of antibiotics is essentially. It is difficult to treat bacterial urinary tract infections with herbal medicine alone. However, cystitis symptoms may persist even when urinary findings have improved with antibiotics. Received: 18 May 2022 Revised: 23 June 2022 Accepted: 27 June 2022