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Chen JC, Huang TH, Wei TC, Huang IS, Fan YH, Lin CC, Lin TP, Chung HJ, Lu SH, Kuo JY, Wu HHH, Chang YH, Lin ATL, Huang WJ, Huang EYH. Influence of preoperative body mass index on prognosis for patients with upper urinary tract urothelial carcinoma treated with radical nephroureterectomy. World J Urol 2023; 41:3575-3583. [PMID: 37924334 DOI: 10.1007/s00345-023-04685-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 10/08/2023] [Indexed: 11/06/2023] Open
Abstract
PURPOSE The impact of body mass index (BMI) on patients with upper urinary tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy (RNU) is controversial. Increasing evidence suggests an age-dependent relationship between obesity and outcomes for some solid organ tumors. Herein, we aimed to assess the prognostic value of preoperative BMI in UTUC patients treated with RNU in Taiwan. METHODS This was a retrospective single-center study of 468 UTUC patients undergoing RNU during January 2010-December 2017, with preoperative BMI classification and subgroup analysis based on ages of < or ≥ 70 years. All UTUC patients underwent RNU and bladder cuff excision. Overall survival (OS), cancer-specific survival, and disease-free survival (DFS) were analyzed. Fisher's exact test, Mann-Whitney U test, Kaplan-Meier method, and Cox regression model were used for data analysis. RESULTS The median follow-up duration was 36 months. Patients with higher versus lower BMI (cutoff: 25 kg/m2) showed no differences in OS; older patients had poor OS (hazard ratio [HR] 1.74; 95% confidence interval [CI] 1.24-2.40; p < 0.001). Older age was an independent predictor of poor OS in multivariate Cox regression analysis (p = 0.001). Younger patients with higher BMI (p = 0.02) had better DFS than older patients with no BMI-related survival differences. Higher BMI was an independent predictor of favorable DFS in younger patients in multivariate Cox regression analysis (HR, 0.53; 95% CI 0.28-0.99; p = 0.043). CONCLUSION Younger UTUC patients with higher BMI were independently associated with a favorable DFS.
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Affiliation(s)
- Jen-Chieh Chen
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, Taiwan
| | - Tzu-Hao Huang
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, Taiwan
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzu-Chun Wei
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, Taiwan
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - I-Shen Huang
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, Taiwan
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, Taiwan
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Chieh Lin
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, Taiwan
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzu-Ping Lin
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, Taiwan
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiao-Jen Chung
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, Taiwan
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shing-Hwa Lu
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, Taiwan
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Junne-Yih Kuo
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, Taiwan
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Howard H H Wu
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, Taiwan
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, Taiwan
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, Taiwan
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - William J Huang
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, Taiwan
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Eric Yi-Hsiu Huang
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei, Taiwan.
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Huang YP, Lin TP, Shen SH, Cheng WM, Huang TH, Huang IS, Fan YH, Lin CC, Huang EYH, Chung HJ, Lu SH, Chang YH, Lin ATL, Huang WJ. Combining prostate health index and multiparametric magnetic resonance imaging may better predict extraprostatic extension after radical prostatectomy. J Chin Med Assoc 2023; 86:52-56. [PMID: 36346752 DOI: 10.1097/jcma.0000000000000845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In patients undergoing radical prostatectomy (RP) for prostate cancer (PCa), preoperative prediction of extraprostatic extension (EPE) can facilitate patient selection for nerve-sparing procedures. Since both multiparametric magnetic resonance imaging (mpMRI) and prostate health index (PHI) have shown promise for the diagnosis and prognostication of PCa, we investigated whether a combination of mpMRI and PHI evaluations can improve the prediction of EPE after RP. METHODS Patients diagnosed with PCa and treated with RP were prospectively enrolled between February 2017 and July 2019. Preoperative blood samples were analyzed for PHI (defined as [p2PSA/fPSA] × √tPSA), and mpMRI examinations were performed and interpreted by a single experienced uroradiologist retrospectively. The area under the receiver operating characteristic curve (ROC) was used to determine the performance of mpMRI, PHI, and their combination in predicting EPE after RP. RESULTS A total of 163 patients were included for analysis. The pathological T stage was T3a or more in 59.5%. Overall staging accuracy of mpMRI for EPE was 72.4% (sensitivity and specificity: 73.2% and 71.2%, respectively). The area under the ROC of the combination of mpMRI and PHI in predicting EPE (0.785) was higher than those of mpMRI alone (0.717; p = 0.0007) and PHI alone (0.722; p = 0.0236). mpMRI showed false-negative non-EPE results in 26 patients (16%), and a PHI threshold of >40 could avoid undiagnosed EPE before RP in 21 of these 26 patients. CONCLUSION The combination of PHI and mpMRI may better predict the EPE preoperatively, facilitating preoperative counseling and tailoring the need for nerve-sparing RP.
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Affiliation(s)
- Yu-Pin Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzu-Ping Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University and Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Shu-Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wei-Ming Cheng
- Department of Urology, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University and Shu-Tien Urological Institute, Taipei, Taiwan, ROC
- Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan, ROC
| | - Tzu-Hao Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University and Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - I-Shen Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University and Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University and Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Chih-Chieh Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University and Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Eric Y H Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University and Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Hsiao-Jen Chung
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University and Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Shing-Hwa Lu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University and Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University and Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University and Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - William J Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University and Shu-Tien Urological Institute, Taipei, Taiwan, ROC
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Chen YK, Huang EYH, Chang YH, Kuo JY, Chung HJ, Wu HHH, Lin TP, Lin CC, Fan YH, Huang IS, Lin ATL, Huang WJ. The comparison of different BCG strains in the intravesical treatment of non-muscle invasive urothelial carcinoma of urinary bladder-A real-world practice. J Chin Med Assoc 2022; 85:928-934. [PMID: 36150105 DOI: 10.1097/jcma.0000000000000768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Bacillus Calmette-Guérin (BCG) has been well recognized as the first-line intravesical therapy for high-risk non-muscle-invasive bladder cancer (NMIBC). Oncotice, the Tice strain of BCG, serves as a viable alternative to the Connaught strain owing to the worldwide shortage of the latter. We retrospectively compared these two strains in terms of efficacy and adverse effects (AE) in patients who underwent at least one maintenance course after induction. METHODS In this single-institution, retrospective study, patients diagnosed with NMIBC who were administered either Connaught or Tice intravesical therapy were enrolled. Recurrence was defined as the reappearance of urothelial carcinoma. Progression was defined as stage/grade advance, metastasis, or cancer-related death. The primary outcomes were recurrence-free survival (RFS) and progression-free survival (PFS), and the secondary outcome was AE. RESULTS A total of 76 and 84 patients receiving Tice and Connaught, respectively were enrolled. The median follow-up periods for the Tice and Connaught groups were 32.0 months (range, 7-69 months) and 81.5 months (range, 9-154 months), respectively. Kaplan-Meier method showed no intergroup difference with regard to 3-year RFS and PFS. On Cox multivariate regression analysis, Tice was a significant predictor for inferior PFS (HR = 5.30; 95% CI, 1.11-25.29; p = 0.036). The AE incidence was 38.3% in the Connaught group and 25.0% in the Tice group (p = 0.079). CONCLUSION Tice and Connaught were comparable in terms of RFS, PFS, and AE for patients with NMIBC accepting BCG induction and at least one maintenance course in our real-world practice. However, Tice was a predictor of inferior PFS on multivariate analysis.
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Affiliation(s)
- Yu-Kuang Chen
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Eric Yi-Hsiu Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Junne-Yih Kuo
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsiao-Jen Chung
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Howard Hung-Hao Wu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Tzu-Ping Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chih-Chieh Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - I-Shen Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - William J Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Tsai CH, Fan YH, Lin ATL, Huang WJ. Risk factors for pharmacotherapy for storage symptoms after transurethral resection of the prostate in patients with benign prostatic hyperplasia. Low Urin Tract Symptoms 2022; 14:329-333. [PMID: 35313391 DOI: 10.1111/luts.12438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/25/2022] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Postoperative persistence of storage symptoms after transurethral resection of the prostate (TURP) is bothersome, and evidence of its cause is sparse. We sought to analyze risk factors for using antimuscarinics or beta-3 agonists after TURP in benign prostatic hyperplasia (BPH) patients. METHODS BPH patients who underwent TURP and were followed up for >6 months after surgery were retrospectively enrolled. Postoperative pharmacotherapy for storage symptoms was defined as the prescription of antimuscarinics or beta-3 agonists within 3 months after TURP for >3 months. Preoperative and perioperative variables were evaluated for their effect on the postoperative prescription of antimuscarinics or beta-3 agonists. RESULTS Of the 376 patients, 45 (12.0%) received postoperative pharmacotherapy for storage symptoms. Patients who underwent bipolar TURP were significantly more likely to receive postoperative pharmacotherapy than those who underwent monopolar TURP (15.7% vs 6.9%; P = 0.01). Significantly more patients with intravesical prostatic protrusions >1 cm used postoperative pharmacotherapy than those with protrusions of ≤1 cm (14.4% vs 5.2% respectively; P = 0.02). Multivariate logistic regression analysis revealed age >75 years (odds ratio [OR] 3.04; 95% CI 1.29-7.16; P = 0.011), intravesical prostatic protrusion >1 cm (OR, 3.48; 95% CI, 1.32-9.15; P = 0.012), and bipolar transurethral resection (OR 4.25; 95% CI 1.53-11.80; P = 0.005) as significant risk factors for postoperative pharmacotherapy. CONCLUSIONS Advanced age, intravesical prostatic protrusion, and bipolar TURP were significantly associated with postoperative pharmacotherapy for storage symptoms after TURP in BPH patients. Therefore, patients with these risk factors might be informed about the risk of postoperative storage symptoms that may require medications after TURP.
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Affiliation(s)
- Cheng-Han Tsai
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - William J Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Lin KJ, Huang EYH, Huang IS, Fan YH, Lin CC, Lin TP, Chung HJ, Lu SH, Kuo JY, Wu HHH, Chang YH, Lin ATL, Huang WJS. Patients with preoperative asymptomatic pyuria are not prone to develop febrile urinary tract infection after ureteroscopic lithotripsy. BMC Urol 2021; 21:154. [PMID: 34763689 PMCID: PMC8582222 DOI: 10.1186/s12894-021-00919-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to evaluate the association of asymptomatic pyuria before ureterorenoscopic lithotripsy (URSL) with postoperative febrile urinary tract infection (UTI). Methods This observational case–control study identified the patients undergoing URSL for ureteral stones between May 2011 and October 2015. The included patients were classified into two groups: the asymptomatic pyuria group (6–50 white blood cells [WBCs]/high-power field [HPF]) and the non-pyuria group (≤ 5 WBCs/HPF). All data were collected by reviewing medical records. Postoperative outcomes were collected in terms of febrile UTI, emergency visits, and stone-free rate. Results A total of 232 patients were included, 101 in the pyuria group, 131 in the non-pyuria group. Two (0.9%) patients developed febrile UTI after URSL and 12 (5.2%) patients visited emergency department for URSL-related symptoms. The overall stone-free rate was 90.9%. There was no significant difference between the pyuria and non-pyuria groups regarding febrile UTI, emergency visits, and stone-free rate. Multivariate analysis revealed that pyuria was neither significantly associated with postoperative febrile UTI (OR = 1.03, 95% CI = 0.06–18.10, P = 0.98), nor with emergency visits (OR = 0.48, 95% CI = 0.13–1.85, P = 0.29). Conclusions Compared to the patients with sterile urine prior to URSL, those with asymptomatic pyuria were not prone to develop febrile UTI after URSL.
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Affiliation(s)
- Kuan-Jung Lin
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.,Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Eric Y H Huang
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei City, 11217, Taiwan, ROC. .,Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - I-Shen Huang
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei City, 11217, Taiwan, ROC.,Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei City, 11217, Taiwan, ROC.,Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Chieh Lin
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei City, 11217, Taiwan, ROC.,Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tzu-Ping Lin
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei City, 11217, Taiwan, ROC.,Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiao-Jen Chung
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei City, 11217, Taiwan, ROC.,Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shing-Hwa Lu
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei City, 11217, Taiwan, ROC.,Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Junne-Yih Kuo
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei City, 11217, Taiwan, ROC.,Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Howard Hung-Hao Wu
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei City, 11217, Taiwan, ROC.,Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei City, 11217, Taiwan, ROC.,Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei City, 11217, Taiwan, ROC.,Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - William J S Huang
- Department of Urology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei City, 11217, Taiwan, ROC.,Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Yu PH, Lin CC, Fan YH, Lin ATL, Huang WJS. Correlations between bladder wall thickness and clinical manifestations in female patients with detrusor underactivity and detrusor overactivity-with-detrusor underactivity. J Chin Med Assoc 2021; 84:937-941. [PMID: 34347649 DOI: 10.1097/jcma.0000000000000593] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Among female patients with lower urinary tract symptoms, detrusor underactivity (DU), and detrusor overactivity-with-detrusor underactivity (DO-DU) are two common diagnoses. Here, we investigated the correlations between bladder wall thickness (BWT) and clinical manifestations of the two diagnoses. METHODS From 2011 to 2016, female patients with DU or DO-DU, diagnosed at our institute, were recruited. We analyzed their urodynamic parameters and collected three questionnaires (IPSS, UDI-6, OABSS). Using transabdominal sonography, the BWT was recorded. DU was defined as follows: maximum free flow rate (Qmax) ≤ 15 cc/s; detrusor pressure at maximum flow (PdetQmax) ≤ 20 cmH2O; bladder capacity > 150 cc. DO-DU was defined as follows: Qmax ≤ 15 cc/s; PdetQmax ≤ 20 cmH2O; bladder capacity ≤ 150 cc. The BWTs of the two groups were compared using the Mann-Whitney U test; the correlations among the BWTs and the results of three questionnaires were analyzed using Spearman's rank correlation coefficient. RESULTS Forty-eight female patients with DU and 13 with DO-DU were recruited. Demographic data revealed no differences between the two groups. The mean BWT of the DO-DU patients was significantly larger than that of the DU patients (4.11 vs 3.42 mm; p = 0.001). In the DO-DU group, a high correlation existed between the BWT and some of the UDI-6 items (urgency incontinence: r = 0.831, p = 0.006; incontinence related to activity: r = 0.884, p = 0.002; small amounts of leakage: r = 0.809, p = 0.008). The BWT of the DO-DU patients also exhibited a moderate correlation with the urgency incontinence from the OABSS questionnaire (r = 0.679; p = 0.044). No correlations existed between the BWT of the DU patients and any of the data from the three questionnaires. CONCLUSION The BWT in the DO-DU patients was significantly thicker than that in the DU patients. The DO-DU patients with thicker bladder walls also had higher UDI-6 scores for both urgency and urgency incontinence.
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Affiliation(s)
- Ping-Hsuan Yu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chih-Chieh Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - William J S Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Hung ZC, Hsu TH, Jiang LY, Chao WT, Wang PH, Chen WJ, Huang EYH, Chen YJ, Lin ATL. Robot-assisted laparoscopic ureteral reconstruction for ureter endometriosis: Case series and literature review. J Chin Med Assoc 2020; 83:288-294. [PMID: 32080024 DOI: 10.1097/jcma.0000000000000249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The aim of this report was to review experience from a single hospital in treating ureteral obstruction related to endometriosis with robot-assisted laparoscopic ureteral reconstruction. METHODS This retrospective analysis study (Canadian Task Force classification II-3) was conducted at an academic tertiary hospital. Five female patients with hydronephrosis without significant elevation of serum creatinine levels were enrolled. Ureteral endometriosis with obstruction was suspected on radiological images. Previous treatment with double-J stenting with or without medical treatment had failed in all of the patients. We performed robot-assisted laparoscopic segmental resection for ureteral endometriosis and reconstructed the ureter through ureteroureterostomy (RUU) or ureteroneocystostomy (RUC). The involved ureters included left lower ureter in three patients and right lower ureter in two patients. RUU was performed in four patients and RUC in one patient. All of the operations were completed smoothly without complications. RESULTS All ureteral endometrioses were successfully resected, and follow-up sonography or intravenous pyelography showed resolution of hydronephrosis in all of the patients. CONCLUSION Our experience proves the feasibility and efficacy of a robot-assisted approach for this rare situation with good outcomes.
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Affiliation(s)
- Zhi-Chen Hung
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzu-Hsiang Hsu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ling-Yu Jiang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wei-Ting Chao
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wei-Jen Chen
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Eric Yi-Hsiu Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Jen Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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Huang YP, Lin TP, Cheng WM, Wei TC, Huang IS, Fan YH, Lin CC, Huang EYH, Chung HJ, Kuo JY, Wu HHH, Lu SH, Chang YH, Lin ATL, Huang WJS. Prostate health index density predicts aggressive pathological outcomes after radical prostatectomy in Taiwanese patients. J Chin Med Assoc 2019; 82:835-839. [PMID: 31425303 DOI: 10.1097/jcma.0000000000000169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There are models to predict pathological outcomes based on established clinical and prostate-specific antigen (PSA)-derived parameters; however, they are not satisfactory. p2PSA and its derived biomarkers have shown promise for the diagnosis and prognosis of prostate cancer (PCa). The aim of this study was to investigate whether p2PSA-derived biomarkers can assist in the prediction of aggressive pathological outcomes after radical prostatectomy (RP). METHODS We prospectively enrolled patients who were diagnosed with PCa and treated with RP between February 2017 and December 2018. Preoperative blood samples were analyzed for tPSA, free PSA (fPSA), percentage of fPSA (%fPSA), [-2]proPSA (p2PSA), and percentage of p2PSA (%p2PSA). Prostate health index (PHI) was calculated as (p2PSA/fPSA) × √tPSA. Prostate volume was determined by transrectal ultrasound using the ellipsoid formula, and PHI density was calculated as PHI/prostate volume. The areas under the receiver operating characteristic curve were estimated for various PSA/p2PSA derivatives. Aggressive pathological outcomes measured after RP were defined as pathological T3 or a Gleason score (GS) >6 as determined in RP specimens. RESULTS One hundred and forty-four patients were included for analysis. Postoperative GS was >6 in 86.1% of the patients, and pT stage was T3a or more in 54.2%. Among all PSA- and p2PSA-derived biomarkers, PHI density was the best biomarker to predict aggressive pathological outcomes after RP. The odds ratio of having an aggressive pathological outcome of RP was 8.796 (p = 0.001). In multivariate analysis, adding %fPSA to base model did not improve the accuracy (area under curve), but adding PHI and PHI density to base model improved the accuracy by 2% and 16%, respectively, in predicting pT3 stage or GS ≥ 7. The risk of pT3 stage or GS ≥ 7 was 20.8% for PHI density <1.125, and 64.6% for PHI density >1.125 (sensitivity: 74.6% and specificity: 88.9%). CONCLUSION PHI density may further aid in predicting aggressive pathological outcomes after RP. This biomarker may be useful in preoperative counseling and may have potential in decision making when choosing between definitive treatment and active surveillance of newly diagnosed PCa.
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Affiliation(s)
- Yu-Pin Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzu-Ping Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Wei-Ming Cheng
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
- Division of Urology, Department of Surgery, Taipei City Hospital Zhongxiao Branch, Taipei, Taiwan, ROC
| | - Tzu-Chun Wei
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - I-Shen Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Chih-Chieh Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Eric Y H Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Hsiao-Jen Chung
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Junne-Yih Kuo
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Howard H H Wu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Shing-Hwa Lu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
| | - William J S Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, Taipei, Taiwan, ROC
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Lu CH, Wu HHH, Lin TP, Huang YH, Chung HJ, Kuo JY, Huang WJ, Lu SH, Chang YH, Lin ATL. Is intravesical prostatic protrusion a risk factor for hydronephrosis and renal insufficiency in benign prostate hyperplasia patients? J Chin Med Assoc 2019; 82:381-384. [PMID: 30893258 DOI: 10.1097/jcma.0000000000000088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Some patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms hesitate to undergo surgical treatment until acute urinary retention (AUR) occurs. Some of these patients have been found to have hydronephrosis or even renal insufficiency. This study aimed to analyze the risk factors for hydronephrosis in patients with AUR who needed to receive transurethral resection of the prostate (TURP). METHODS We retrospectively analyzed 91 patients from January 2014 to June 2015, who had BPH and received TURP for AUR. Patients with urolithiasis, prostate cancer, bladder cancer, gross hematuria, previous bladder radiation therapy, or urinary tract surgery were excluded. Parameters of intravesical prostatic protrusion (IPP), serum prostatic specific antigen (PSA), total prostate volume (PV), age, body mass index (BMI), hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), and serum creatinine (Cr) were compared between the hydronephrosis and non-hydronephrosis groups. RESULTS There were significant differences in IPP (p < 0.001) and Serum Cr (p < 0.001) between the hydronephrosis and non-hydronephrosis groups. For IPP, the cut-off values of the highest risk of hydronephrosis was 1.95 cm. There were no significant differences in age, BMI, DM, HTN, CAD, total PV, and PSA between the two groups. IPP was not correlated with total PV (p = 0.423). Most of the patients with hydronephrosis had renal function improvement after TURP. CONCLUSION IPP was a significant risk factor for hydronephrosis in BPH patients. If the patients' IPP exceeded 1.95 cm, they had a higher risk of having hydronephrosis when AUR occurred. Hydronephrosis is a risk factor for renal insufficiency, and Serum Cr levels decreased significantly in the patients of our study.
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Affiliation(s)
- Chin-Heng Lu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Howard H H Wu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Tzu-Ping Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Hsiu Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsiao-Jen Chung
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Junne-Yih Kuo
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - William J Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shing-Hwa Lu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
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Chen WJ, Pan CC, Shen SH, Chung HJ, Lin CC, Lin ATL, Chang YH. Clear cell papillary renal cell carcinoma - An indolent subtype of renal tumor. J Chin Med Assoc 2018; 81:878-883. [PMID: 30037497 DOI: 10.1016/j.jcma.2018.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 04/20/2018] [Accepted: 04/23/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Clear cell papillary renal cell carcinoma (CCPRCC) is a new but rare tumor entity as listed in the World Health Organization 2016 renal tumor classification. Around 360 cases have been reported in the English literature to date, and only one tumor with sarcomatoid change was reported to develop distant metastasis. In the present study, we aim to review the clinical course and analyze the treatment outcome of CCPRCC in our institution. METHODS We retrospectively collected patients diagnosed with CCPRCC between January 2008 and September 2016 in our institute. The clinical features, pathology slides, and clinical outcomes were reviewed. RESULTS Twenty-five patients were collected during the study period, with a mean age at diagnosis of 62.8 years (range 35-85 years). Three patients developed the tumor in their native kidney following a kidney transplant, and three patients were diagnosed by needle biopsy before cryoablation therapy due to high surgical risk. The mean follow-up time was 49.7 months (range 12-119 months). During the follow-up period, all patients were alive without local recurrence or distant metastasis. All tumor specimens in our series expressed cytokeratin 7 (CK7) diffusely in immunohistochemistry staining. One patient was diagnosed with pT3a cN0M1, Fuhrman grade 3 CCPRCC with renal vein invasion and lung metastasis in 2010 on the basis of the histologic pattern and immunoreactivity for CK7. The clinical course was not compatible with any of the reported cases in the literature, so the kidney specimen was re-examined using whole-exome sequencing. The diagnosis was then revised to clear cell renal cell carcinoma. CONCLUSION Our series confirmed that CCPRCC has an indolent clinical behavior. When the diagnosis is made in a high-grade renal tumor, it should be carefully re-confirmed using cytogenetic or genomic methods.
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Affiliation(s)
- Wei-Jen Chen
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chin-Chen Pan
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Pathology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shu-Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Radiology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsiao-Jen Chung
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Science Research Center, Taipei, Taiwan, ROC
| | - Chih-Chieh Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Science Research Center, Taipei, Taiwan, ROC
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Science Research Center, Taipei, Taiwan, ROC
| | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Science Research Center, Taipei, Taiwan, ROC.
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Lu SY, Chung HJ, Huang EYH, Lin TP, Lin ATL. The perioperative outcomes between renal hilar and non-hilar tumors following robotic-assisted partial nephrectomy (RAPN). J Chin Med Assoc 2018; 81:676-681. [PMID: 29551485 DOI: 10.1016/j.jcma.2017.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 10/12/2017] [Accepted: 11/02/2017] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND The aim of this study was to compare the perioperative outcomes between renal hilar tumors and non-hilar tumors after robotic-assisted partial nephrectomy (RAPN). METHODS A retrospective review of consecutive patients who underwent RAPN from December 2009 to September 2015 at our institution was recruited. Perioperative outcomes including demographic characteristics, perioperative, pathological and renal function outcomes were compared between the hilar group (n = 30) and non-hilar group (n = 170). RESULTS In characteristics, hilar group was younger (52.4 vs. 58 years, p = 0.04) and had less body mass index (23.7 vs. 25.4 kg/m2, p = 0.018). Hilar group had larger tumor size (4.8 vs. 3.7 cm, p = 0.009), higher Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score (10.7 vs. 8.5, p < 0.001) and higher RENAL (radius, exophytic/endophytic properties of the tumor, nearness of tumor deepest portion to the collecting system or sinus, anterior/posterior description and the location relative to polar lines) score (9.0 vs. 7.4, p < 0.001). Hilar tumor was associated with longer operative time (293.6 vs. 240.5 min, p = 0.001) and warm ischemia time (39.9 vs. 21.8 min, p < 0.001). But there was no statistically difference in estimated blood loss (EBL), postoperative stay and complication rate. For pathological outcomes, there was no difference of positive margin rate and pathological T stage between these groups. For renal function outcomes, hilar tumor patients had no difference of the change of creatinine and estimated glomerular filtration rate (eGFR) at postoperative 6 and 12 month as compared with non-hilar tumor patients. CONCLUSION For renal hilar tumor, RAPN could provide acceptable results of perioperative, pathological and renal function outcome as compared with non-hilar tumor group. Thus RAPN is a safe and effective nephron-sparing surgery technique for renal hilar tumors.
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Affiliation(s)
- Shih-Yen Lu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Shu-Tien Urological Science Research Center, Taipei, Taiwan, ROC
| | - Hsiao-Jen Chung
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Science Research Center, Taipei, Taiwan, ROC.
| | - Eric Yi-Hsiu Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Science Research Center, Taipei, Taiwan, ROC
| | - Tzu-Pin Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Science Research Center, Taipei, Taiwan, ROC
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Science Research Center, Taipei, Taiwan, ROC
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Cheng WM, Fan YH, Lin ATL. Urodynamic characteristics might be variable in bladder pain syndrome/interstitial cystitis patients with different non-bladder co-morbid conditions. J Chin Med Assoc 2018; 81:248-254. [PMID: 29223727 DOI: 10.1016/j.jcma.2017.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/14/2017] [Accepted: 06/13/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The aim of the study was to identify the impact of non-bladder co-morbid conditions on the urodynamic characteristics of patients with bladder pain syndrome/interstitial cystitis. METHODS Patients with bladder pain syndrome/interstitial cystitis completed the screening questionnaires for chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia, temporo-mandibular disorders, multiple chemical sensitivities, tension/migraine headache, and localized myofascial pain disorder. They underwent either conventional pressure-flow urodynamic studies or video-urodynamic studies. Urodynamic variables were compared between patients with and those without co-morbid conditions. RESULTS Of 111 patients (16 males and 95 females) with bladder pain syndrome/interstitial cystitis, 87 (78.4%) had at least one co-morbid condition (62% males vs 82% females, p = 0.005). Those with concomitant irritable bowel syndrome were younger and had urodynamic characteristics of smaller catheter-free voided volume, lower catheter-free average flow rate, smaller bladder volume on the first desire to void, and more prevalent dysfunctional voiding than those without irritable bowel syndrome. Patients with concomitant localized myofascial pain disorder also had larger bladder volume at the first desire to void and lower pressure at maximum flow than those without co-morbid myofascial pain disorder. There were no significant differences in urodynamic parameters between bladder pain syndrome/interstitial cystitis patients with and those without other co-morbidities. CONCLUSION Bladder pain syndrome/interstitial cystitis patients, especially females, are more likely to have non-bladder co-morbidities, especially tension/migraine headache and localized myofascial pain. Bladder pain syndrome/interstitial cystitis Patients with co-morbid irritable bowel syndrome are younger and more likely to have abnormal urodynamic findings.
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Affiliation(s)
- Wei-Ming Cheng
- Division of Urology, Department of Surgery, Taipei City Hospital, Zhongxiao Branch, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Science Research Center, Taipei, Taiwan, ROC
| | - Yu-Hua Fan
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Science Research Center, Taipei, Taiwan, ROC.
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Science Research Center, Taipei, Taiwan, ROC
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13
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Lu CH, Kuo JY, Lin TP, Huang YH, Chung HJ, Huang WJS, Wu HHH, Chang YH, Lin ATL, Chen KK. Clinical analysis of 48-h emergency department visit post outpatient extracorporeal shock wave lithotripsy for urolithiasis. J Chin Med Assoc 2017; 80:551-557. [PMID: 28802985 DOI: 10.1016/j.jcma.2016.11.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 10/13/2016] [Accepted: 11/07/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patients suffering from renal or ureteral stones can undergo significant discomfort, even when timely diagnosed and treated. The aim of this study was to assess the risk factors and safety of outpatient Extracorporeal Shock Wave Lithotripsy (ESWL) in the management of patients with renal or ureteral stones. METHODS In this study, our cohort consisted of 844 outpatients who underwent outpatient ESWL treated between February 2012 and November 2014 at Taipei Veterans General Hospital. Patients who visited the emergency room (ER) within 48 h after Outpatient ESWL were included in this article. This article analyzes the stone size, stone shape (long to short axis ratio), stone location, previous medical management, urinalysis data, complications and treatment received in the emergency department. RESULTS Among the 844 initial consecutive patients who underwent outpatient ESWL a total of 1095 times, there were 22 (2%) patients who sought help at our emergency room within 48 h after the outpatient ESWL. Of those 22 patients, the mean age was 54.3 ± 12.6 years, and the BMI was 25.9 ± 3.2. The most common complication complaint was flank pain (55.2%). Other complications included hematuria (13.8%), fever (17.2%), nausea with vomiting (6.9%), acute urinary retention (3.4%) and chest tightness with cold sweating (3.4%). In 22 patients who went back to the ER, 7 patients were admitted to the ward and 1 patient again returned to the ER. All patients received medical treatment without ESWL or surgical management. The meaningful risk factor of ER-visiting rate following outpatient ESWL within 48 h was stone location, and the renal stones showed statistic significant (p = 0.047) when compared to ureteral stones. CONCLUSION Our study indicated that renal stone contributed to a significantly higher risk of ER-visiting rate to patients than did ureteral stone, following outpatient ESWL within 48 h. This study confirmed that Outpatient ESWL is a safe treatment for renal or ureteral stones, while inpatient ESWL is not absolutely necessary.
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Affiliation(s)
- Chin-Heng Lu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Junne-Yih Kuo
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC.
| | - Tzu-Ping Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Hsiu Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsiao-Jen Chung
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - William J S Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Howard H H Wu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Kuang-Kuo Chen
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
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14
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Lu CH, Lin TP, Shen SH, Huang YH, Chung HJ, Kuo JY, Huang WJS, Wu HHH, Chang YH, Lin ATL, Chen KK. Clinical efficacy of transrectal ultrasound-guided prostate biopsy in men younger than 50 years old with an elevated prostate-specific antigen concentration (>4.0 ng/mL). J Chin Med Assoc 2017; 80:413-418. [PMID: 28529023 DOI: 10.1016/j.jcma.2016.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/26/2016] [Accepted: 07/01/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Prostate cancer (PCa) is not commonly found in men younger than 50 years of age. However, serum prostate-specific antigen (PSA) concentration has been examined more frequently at a younger age in Asia partially due to an increased awareness of prostate cancer. The purpose of our study was to investigate the efficacy and complication of PSA-triggered transrectal ultrasonography-guided prostate (TRUSP) biopsies. We retrospectively reviewed TRUSP biopsies in young men with elevated PSA concentration in Taipei Veterans General Hospital. METHODS We reviewed the cases of patients younger than 50 years of age with elevated PSA concentration (>4.0 ng/mL), who received 12 cores TRUSP biopsies at TPEVGH from January 2008-December 2013. The age, family history, digital rectal examination (DRE) results, PSA concentration, free/total PSA ratio, total prostate volume, PSA density, lower urinary tract symptoms and complications after the procedure were reviewed. The pathologic findings of TRUSP biopsy and clinical follow-up were reviewed and analyzed according to the Epstein criteria. RESULTS A total of 77 patients were included and were divided into 2 groups: 1) the younger group consisted of 20 patients <40 years of age; and 2) the elder group had 57 patients who were 40-50 years of age. The overall detection rate of PCa was 11.69% (9/77), and all of the PCa cases were diagnosed in the elder group (group detection rate: 15.8%). There was a significant difference in the severity of lower urinary tract symptoms (LUTS) between these 2 groups. All PCa patients were clinically significant according to the Epstein criteria. Two patients experienced fever (2.60%) after TRUSP biopsy. CONCLUSION From our patient cohort, it appears that no benefit was apparent for patients younger than 40 years old who received TRUSP biopsy, even with elevated PSA. However, PCa detected in men between 40 and 50 years of age were all clinically significant. Overall, our results supported current major practice guidelines which recommend an initial PSA checkup at 40 years of age.
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Affiliation(s)
- Chin-Heng Lu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzu-Ping Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC.
| | - She Huei Shen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yi-Hsiu Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsiao-Jen Chung
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Junne-Yih Kuo
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - William J S Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Howard H H Wu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Kuang-Kuo Chen
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Research Institute, National Yang-Ming University, Taipei, Taiwan, ROC
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15
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Huang TH, Kuo JY, Huang YH, Chung HJ, Huang WJS, Wu HHH, Chang YH, Lin ATL, Chen KK. Prostate cancer in young adults-Seventeen-year clinical experience of a single center. J Chin Med Assoc 2017; 80:39-43. [PMID: 27914715 DOI: 10.1016/j.jcma.2016.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 06/30/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND In the general population, prostate adenocarcinoma affects predominately older men. If fact, most current guidelines suggest that males over the age of 50 years should undergo prostate cancer screening. However, the clinical behavior and prognosis of prostate cancer in young adults is not well defined. The aim of this study was to evaluate the clinical behavior, pathological characteristics, and prognosis of prostate cancer in young adults. METHODS We retrospectively reviewed the records of young patients (age, ≤50 years) in our hospital with prostate adenocarcinoma between 1997 and 2013. We compared data including initial presentation, cancer cell type, Gleason score, disease stage, prostate-specific antigen (PSA) level, prostate volume, treatment, and survival between patients both younger and older than 50 years. Data were analyzed using the Kaplan-Meier method to assess survival. RESULTS Twenty-six patients were enrolled in our study, accounting for 0.55% of all patients with a diagnosis of prostate cancer at our facility. All 26 patients had a pathology diagnosis of adenocarcinoma, with a mean age on diagnosis of 46.8±2.8 years (range, 39-50 years). On initial presentation, patients older than 50 years more frequently displayed lower urinary tract symptoms (LUTS) than younger patients (62.3% vs. 30.4%, p=0.008). There was no statistical difference in histological grade, disease stage, PSA level, overall survival, and biochemical-free survival between the two groups. CONCLUSION The result of our investigation indicated that prostate adenocarcinoma patients younger than 50 years had similar histological grade, disease stage, PSA level, overall survival, and biochemical-free survival as the older population. However, patients younger than 50 years with prostate cancer less frequently showed initial symptoms of LUTS.
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Affiliation(s)
- Tzu-Hao Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Junne-Yih Kuo
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
| | - Yi-Hsiu Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsiao-Jen Chung
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - William J S Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Howard H H Wu
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Kuang-Kuo Chen
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Shu-Tien Urological Institute, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
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Doggweiler R, Whitmore KE, Meijlink JM, Drake MJ, Frawley H, Nordling J, Hanno P, Fraser MO, Homma Y, Garrido G, Gomes MJ, Elneil S, van de Merwe JP, Lin ATL, Tomoe H. A standard for terminology in chronic pelvic pain syndromes: A report from the chronic pelvic pain working group of the international continence society. Neurourol Urodyn 2016; 36:984-1008. [PMID: 27564065 DOI: 10.1002/nau.23072] [Citation(s) in RCA: 101] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 05/23/2016] [Indexed: 12/27/2022]
Abstract
AIMS Terms used in the field of chronic pelvic pain (CPP) are poorly defined and often confusing. An International Continence Society (ICS) Standard for Terminology in chronic pelvic pain syndromes (CPPS) has been developed with the aim of improving diagnosis and treatment of patients affected by chronic pelvic pain syndromes. The standard aims to facilitate research, enhance therapy development and support healthcare delivery, for healthcare providers, and patients. This document looks at the whole person and all the domains (organ systems) in a systematic way. METHODS A dedicated working group (WG) was instituted by the ICS Standardisation Steering Committee according to published procedures. The WG extracted information from existing relevant guidelines, consensus documents, and scientific publications. Medline and other databases were searched in relation to each chronic pelvic pain domain from 1980 to 2014. Existing ICS Standards for terminology were utilized where appropriate to ensure transparency, accessibility, flexibility, and evolution. Consensus was based on majority agreement. RESULTS The multidisciplinary CPPS Standard reports updated consensus terminology in nine domains; lower urinary tract, female genital, male genital, gastrointestinal, musculoskeletal, neurological aspects, psychological aspects, sexual aspects, and comorbidities. Each is described in terms of symptoms, signs and further evaluation. CONCLUSION The document presents preferred terms and definitions for symptoms, signs, and evaluation (diagnostic work-up) of female and male patients with chronic pelvic pain syndromes, serving as a platform for ongoing development in this field. Neurourol. Urodynam. 36:984-1008, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Kristene E Whitmore
- Chair of Urology and Female Pelvic Medicine and Reconstructive Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Jane M Meijlink
- International Painful Bladder Foundation, Naarden, Netherlands
| | - Marcus J Drake
- Department of Urology, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - Helena Frawley
- Physiotherapy at La Trobe University, Melbourne, Cabrini Health, Melbourne, Australia
| | - Jørgen Nordling
- Department of Urology, University of Copenhagen, Herlev Hospital, Herlev, Denmark
| | - Philip Hanno
- Department of Urology, Division of Urology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew O Fraser
- Department of Urology Surgery, Duke University and Durham Veterans Affairs Medical Centers, Durham, North Carolina
| | - Yukio Homma
- Department of Urology, The University of Tokyo, Tokyo, Japan
| | - Gustavo Garrido
- Head of Voiding Dysfunctions and Urodynamics Section, Urology Division, Hospital de Clínicas, University of Buenos Aires, Argentina
| | - Mario J Gomes
- Department of Urology, St. António Hospital, Oporto, Portugal
| | - Sohier Elneil
- Department of Urogynecology, University College Hospital, National Hospital for Neurology and Neurosurgery, GB
| | | | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan
| | - Hikaru Tomoe
- Department of Urogynecology, Chair of Pelvic Reconstructive Surgery and Urology, Tokyo Women's Medical University Medical Center East, Japan
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17
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Wei TC, Lin TP, Chang YH, Chen TJ, Lin ATL, Chen KK. Transrectal ultrasound-guided prostate biopsy in Taiwan: A nationwide database study. J Chin Med Assoc 2015; 78:662-5. [PMID: 26239148 DOI: 10.1016/j.jcma.2015.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Accepted: 04/11/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND For patients with an elevated prostate specific antigen (PSA) level or a suspected lesion detected by digital rectal examination, transrectal ultrasound-guided (TRUS) prostate biopsy is the standard procedure for prostate cancer diagnoses. In Taiwan, TRUS prostate biopsy has not been well-studied on a nationwide scale. This article aimed to study TRUS prostate biopsy in Taiwan and its related complications, according to the claims generated through the National Health Insurance (NHI) program. METHODS We applied for access to claims from the NHI Research Database of Taiwan of all patients who visited the urology clinic during the period of 2006 to 2010. In the 5-year urology profile, we obtained all records, which included admission and ambulatory clinical records. The definition of TRUS biopsy included codes for ultrasound-guided procedure and for prostate puncture; other codes involving complications such as postbiopsy voiding difficulty, significant bleeding, or infection requiring treatment were also included. Risk factors included age, diagnosis of prostate cancer, hospitalization or nonhospitalization, and the Charlson Comorbidity Index (CCI; with a value of 0, 1, 2 or ≥ 3). Descriptive and comparative analyses were also performed. RESULTS In the 5-year urology profile, 12,968 TRUS biopsies performed of which 6885 were in-patient procedures and 6083 were ambulatory clinic procedures. After the procedures, 1266 (9.76%) biopsies were associated with voiding difficulty; 148 (1.14%) biopsies, with significant bleeding; and 855 (6.59%) biopsies, with infection that required treatment. The prostate cancer diagnosis rate was 36.02%. The overall biopsy-related mortality rate within 30 days was 0.25%, and the postbiopsy sepsis-related mortality rate was 0.13%. Age, diagnosis of cancer, hospitalization, and CCI value ≥ 1 were all significant factors in univariate analysis and multivariate analysis for postbiopsy voiding difficulty and severe infection. A diagnosis of cancer and a CCI value ≥ 2 were significant factors for significant bleeding after biopsy. Patients diagnosed as having prostate cancer had fewer bleeding complications after biopsy. CONCLUSION The most frequent complication was postbiopsy voiding difficulty, followed by infection that required treatment and significant bleeding. The sepsis-related mortality rate was 0.13%. Significant risk factors for postbiopsy complications included age, diagnosis of prostate cancer, hospitalization, and the CCI value.
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Affiliation(s)
- Tzu-Chun Wei
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Tzu-Ping Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC.
| | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Kuang-Kuo Chen
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
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18
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Chang CH, Lin TP, Chang YH, Huang WJS, Lin ATL, Chen KK. Vapoenucleation of the prostate using a high-power thulium laser: a one-year follow-up study. BMC Urol 2015; 15:40. [PMID: 25956819 PMCID: PMC4438483 DOI: 10.1186/s12894-015-0032-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 04/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prostate vaporization and enucleation is a novel treatment option for bladder outlet obstruction caused by benign prostate enlargement. This surgical technique, however, has not yet been standardized. We present our findings of using a high-power thulium laser to accomplish vapoenucleation of the prostate (ThuVEP). METHODS We prospectively collected and analyzed data from 29 patients who underwent ThuVEP between August 2010 and May 2012. The control group included 30 patients who underwent traditional transurethral resection of the prostate (TURP). Operative variables, patient profiles, preoperative and postoperative urine flow rates, prostate volume (measured using transrectal ultrasonography), and the international prostate symptom score (IPSS) were recorded and analyzed using a two-tailed Student's t-test and analysis of variance. RESULTS The ages (mean ± SD) of the patients were 76.1 ± 9.4 and 72.6 ± 7.4 years (p = 0.28) in the ThuVEP and TURP groups, respectively. The average urinary flow rates before and 12 months after the operation (volume/maximum flow/average flow) were 243.3/10.5/5.0 and 302.8/17.6/9.4 (in mL, mL/s, mL/s, respectively) in the ThuVEP group and 247.2/10.8/4.6 and 369.9/20.8/12.0, respectively, in the TURP group. Preoperative and postoperative IPSSs were 17.1 ± 5.0 and 6.5 ± 3.8, respectively, in the ThuVEP group and 18.2 ± 4.5 and 6.2 ± 3.3, respectively, in the TURP group. The mean ratio of the estimated postoperative residual prostate volume to the preoperative total volume was 0.47 (p = 0.449) in both groups. The overall complication rate was 20.7% in the ThuVEP group and 30.0% in the TURP group. CONCLUSIONS One year of follow-up showed that ThuVEP and TURP effectively alleviated subjective and objective voiding symptoms with a low rate of complications. Thus, vapoenucleation using a high-power laser is feasible in elderly patients. TRIAL REGISTRATION ISRCTN registry with study ID ISRCTN52339705 . Date assigned: 06/03/2015.
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Affiliation(s)
- Ching-Hsin Chang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan. .,Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Tzu-Ping Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Urology, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Shu-Tien Urological Science Research Center, Taipei, Taiwan.
| | - Yen-Hwa Chang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Urology, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Shu-Tien Urological Science Research Center, Taipei, Taiwan.
| | - William J S Huang
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Urology, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Shu-Tien Urological Science Research Center, Taipei, Taiwan.
| | - Alex T L Lin
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Urology, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Shu-Tien Urological Science Research Center, Taipei, Taiwan.
| | - Kuang-Kuo Chen
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan. .,Department of Urology, National Yang-Ming University School of Medicine, Taipei, Taiwan. .,Shu-Tien Urological Science Research Center, Taipei, Taiwan.
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19
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Yang CM, Chung HJ, Huang YH, Lin TP, Lin ATL, Chen KK. Standardized analysis of laparoscopic and robotic-assisted partial nephrectomy complications with Clavien classification. J Chin Med Assoc 2014; 77:637-41. [PMID: 25441770 DOI: 10.1016/j.jcma.2014.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 05/02/2014] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Laparoscopic partial nephrectomy (LPN) and robotic-assisted partial nephrectomy (RPN) are accepted as alternatives of open partial nephrectomy for managing renal tumors. However, LPN and RPN are technically challenging procedures. This report analyzed, according to the Clavien classification, the complications after LPN and RPN. METHODS We analyzed consecutive LPN (n = 85) and RPN (n = 93) cases at our institution between April 1994 and December 2012. The data were retrospectively reviewed from a prospectively collected database. All complications that occurred within 3 months postoperatively were recorded and classified according to the modified Clavien classification system. RESULTS The mean tumor size was 3.90 ± 1.77 cm. The mean operative time was 255.0 ± 83.5 minutes, and the mean warm ischemia time was 31.6 ± 22.0 minutes. The overall complication rate was 18.5%. Clavien Grades I, II, IIIa, and IIIb complications accounted for 3.93%, 11.2%, 2.81%, and 1.69% of patients, respectively. The most common complication was perioperative hemorrhage that required blood transfusion. Delayed bleeding occurred in seven patients, and four patients underwent angiographic embolization. The proportions of intermediate and high PADUA (Preoperative Aspects and Dimensions Used for an Anatomical) score (≥ 8) and RENAL (Radius/Exophytic/Nearness to collecting system/Anterior/Location) score (≥ 7) were 70.8% and 74.2%, respectively. A higher PADUA or RENAL score was associated with a significantly greater complication rate (p = 0.024 and p = 0.02, respectively). CONCLUSION The overall complication rate in the present study was comparable to that reported in previous studies, although our patients had a larger mean tumor size and higher-complexity procedures.
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20
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Cheng WM, Lin TP, Lin CC, Huang EYH, Chung HJ, Kuo JY, Huang WJS, Chang YH, Lin ATL, Chen KK. Standardized report for early complications of radical prostatectomy. J Chin Med Assoc 2014; 77:234-41. [PMID: 24767582 DOI: 10.1016/j.jcma.2014.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 10/14/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Radical prostatectomy (RP) is one of the curative treatment options for patients with prostate cancer to achieve long-term survival, but it is accompanied by potential complications. The Martin criteria used as a format for reporting complications has become standard in recent years. However, it has not been applied in RP in Asian countries. In the present study, we investigated the early complications of RP developing within 90 days in our institute according to the Martin criteria. METHODS Between January 2003 and November 2011, patients with organ-confined adenocarcinoma of the prostate who received RP in our institute were retrospectively reviewed. The operation was done as open RP, or minimally invasive RP, including laparoscopic RP and robot-assisted laparoscopic RP (RaLP). The preoperative, operative, postoperative, and pathological parameters were recorded for analysis. Definitions of complications were adopted from previous reports. Surgical and medical complications developed within 90 days postoperatively were identified respectively; severity of each complication was classified according to Clavien-Dindo classification. Clavien-Dindo classification grade III or higher complications were viewed as major complications. RESULTS A total of 359 patients were included; 280 (78%) underwent open RP, 45 (12.5%) received laparoscopic RP, and 34 (9.5%) had RaLP. The overall complication rate was 40.1%, and the major complication rate was 13.1%. There was no surgical mortality. Diarrhea requiring conservative treatment (13.6%), minor urine leakage (9.5%), and gout attack (4.2%) were the leading complications. Minimally invasive RP had higher rates of lymph leakage (p = 0.015) and upper-extremity neuropathy (p = 0.048). Body mass index >25 kg/m(2) and use of neoadjuvant hormone therapy were predictors for overall and major complications, whereas diabetes mellitus also predicted the development of major complications. Besides lower case volume and learning curve for RaLP, patients' higher age at surgery and higher risk for disease progression compared to the Western series may be responsible for the higher complication rates. CONCLUSION The early complication rates of RP in our patients were slightly high compared to the Western series. By standardized report, being overweight, diabetes mellitus, and use of neoadjuvant hormone therapy were identified as predictors of early complications in our series.
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Affiliation(s)
- Wei-Ming Cheng
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Tzu-Ping Lin
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC.
| | - Chih-Chieh Lin
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Eric Yi-Hsiu Huang
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsiao-Jen Chung
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Junne-Yih Kuo
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
| | - William J S Huang
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Yen-Hwa Chang
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Alex T L Lin
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Kuang-Kuo Chen
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine, and Shu-Tien Urological Research Center, National Yang-Ming University, Taipei, Taiwan, ROC
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21
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Abstract
BACKGROUND With growing ketamine abuse, ketamine-induced uropathy (KIU) has become more prevalent in recent years. This research evaluates the presence, distribution and extent of KIU in the upper and lower urinary tracts by retrospectively reviewing CT urography (CTU) images. METHODS Patients diagnosed with KIU who underwent CT scanning from 1 January 2006 to 31 December 2011 were recruited. The CT protocols included three-phase CTU in six patients, split-bolus CTU in 17, two-phase CT in one and unenhanced CT in three. The CT images were retrospectively reviewed by two radiologists. RESULTS A total of 27 patients participated in this study. The common CT findings included diffuse bladder wall thickening (88.9%), small bladder volume (66.7%) and perivesical inflammation (44.4%). Twelve patients (44.4%) were diagnosed with hydronephrosis, including three patients with unilateral hydronephrosis and nine with bilateral hydronephrosis. Of these patients, nine had ureteral wall thickening (33.3%) and two (7.4%) had ureterovesical junction involvement (ie, they had hydronephrosis but no ureteral wall thickening). One patient had a ureteral obstruction because of a ureter stone. The correlation between upper urinary tract involvement and grading of the interstitial cystitis was statistically non-significant (p=0.33). Four patients (14.8%) had a vesicovaginal fistula which could be detected in the excretory phase only. CONCLUSIONS Upper urinary tract involvement is common in patients with KIU. CTU might aid evaluation of the extent of KIU and prompt adequate management.
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Affiliation(s)
- Li-Kuo Huang
- Department of Radiology, Taipei Veterans General Hospital, , Taipei, Taiwan
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22
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Abstract
During the past few years, robotic surgical systems have been rapidly developed. The progress and advantages of these systems include three-dimensional vision and enhanced ergonomics. These advantages have helped a new generation of minimally invasive surgery to evolve. The da Vinci Surgical System seems to greatly resolve problems (e.g., wide exposure and retraction of peritoneal organs) that are confronted by traditional laparoscopic surgeries for retroperitoneal tumors that are near great vessels. There have been few reported cases concerning laparoscopic excision of retroperitoneal tumors situated between the inferior vena cava, the right renal vessel, and the kidney. We report the use of a robotic surgical system for this type of treatment. A 54-year-old female patient had a hypoechoic lesion near the inferior vena cava and superior to the right renal vessels. It was incidentally found by ultrasound during a health check-up examination. The computed tomography (CT) scan revealed a heterogeneous contrast-enhanced retroperitoneal mass approximately 4.4 cm medial to the right kidney with the inferior vena cava slightly deviated to the left. Robot-assisted laparoscopic excision of the retroperitoneal tumor was performed on October 15, 2010 with an operation time of 135 minutes and an estimated blood loss of less than 30 mL. The J-Vac drainage tube was removed on postoperative Day 3, and the patient was discharged in a stable condition the following day. The pathology of the tumor was retroperitoneal schwannoma. A re-evaluation was arranged postoperatively for the 15-month ambulatory visit. No local recurrence or distal metastasis was present.
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Affiliation(s)
- Tzu-Chun Wei
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology, School of Medicine and Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
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23
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Wei TC, Huang WJ, Lin ATL, Chen KK. The role of hormones on semen parameters in patients with idiopathic or varicocele-related oligoasthenoteratozoospermia (OAT) syndrome. J Chin Med Assoc 2013; 76:624-8. [PMID: 23933342 DOI: 10.1016/j.jcma.2013.07.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 03/12/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Oligoasthenoteratozoospermia (OAT) syndrome is the most frequently seen phenotype in male infertility. Spermatogenesis relies closely on hormone regulation. The aim of this study was to assess the correlation between hormone profile and semen parameters in infertile men with idiopathic or varicocele-related OAT syndrome. We tried to illustrate the correlative factors for better semen parameters in these patients. METHODS A total of 96 patients with idiopathic or varicocele-related OAT were included for assessment. Serum levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), estradiol (E2), prolactin (PRL), and the combinative ratios of these hormones, such as T/E2, T/FSH, T/LH, T/(FSH × LH), PRL × T/FSH, PRL × T/LH, PRL × T/(FSH × LH), were compared individually with sperm parameters. The parameters included sperm concentration, total sperm count (TC), percent motile sperm count, percent normal sperm count, total motile sperm count (TMC), total normal sperm count (TNC), and total motile normal sperm count (TMNC). RESULTS T correlated well with percent normal sperm count (p = 0.031). PRL positively correlated with sperm concentration (p = 0.019), TMC (p < 0.001), TNC (p = 0.003), and TMNC (p < 0.001). In hormonal combinative ratios, T/FSH, T/LH, T/(FSH × LH), PRL × T/FSH, PRL × T/LH, and PRL × T/(FSH × LH) all showed significant correlations to concentration and count-related parameters including TC, TMC, TNC, and TMNC. CONCLUSION For patients with OAT syndrome, T, PRL, T/FSH, T/LH, T/(FSH × LH), PRL × T/FSH, PRL × T/LH, and PRL × T/(FSH × LH) may be used as predictive markers for better semen quality. This investigation could be a catalyst for future studies on the extent to which manipulating the hormonal combinative ratios can affect the quality of spermatogenesis in infertile males with OAT syndrome.
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Affiliation(s)
- Tzu-Chun Wei
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Urology and Physiology, Shu-Tien Urological Institute, National Yang-Ming University, Taipei, Taiwan, ROC
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24
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Abstract
BACKGROUND Erectile dysfunction (ED) has been a prevalent disease worldwide. The mainstay of treatment for ED focused on oral medications such as phosphodiesterase-5 (PDE-5) inhibitors or other medical aids with variable acceptance. Trazodone is a second-generation antidepressant approved by the U.S. Food and Drug Administration in 1981. Some evidence has suggested that trazodone may be helpful in improving ED, especially for problems dealing with male arousal. Although controversial, trazodone can sometimes be used for ED as an off-label medication for urological patients. By using a nationwide health insurance database, we attempted to estimate and thereafter analyze the existence and extent of off-label use of trazodone for ED in Taiwan. METHODS The 1/500 randomly sampled outpatient visits dataset and the 1/1 million randomly selected dataset issued in 2000 in the National Health Insurance Research Database were used to estimate the total number of visits and the urological visits involving trazodone prescriptions. The refill rate, patient age at first prescription, and the diagnoses assigned to the prescription visits were also gathered and analyzed. RESULTS The prescription visits in urological clinics consisted exclusively of male patients (99.0 ± 1.3%, p < 0.001). The use of trazodone was more prevalent and regular among the elderly (p < 0.001), which happens to parallel the trend of incidence rates of ED. Starting in 1998, the prescription rate for trazodone increased rapidly, but then slowed, equalized, and topped out in 2003. One of the reasons for this marked change in prescriptions rates in Taiwan may be the increased awareness of ED as a treatable disease under the promotion and marketing of three PDE-5 inhibitors. ED-related diagnoses assigned to the prescription visits accounted for 55% of total visits, whereas anxiety/depression-associated diagnoses were the bases of less than 13%, and those attributed to insomnia accounted for 2.3% of visits. CONCLUSION Despite the fact that trazodone was not officially approved for patients with urological conditions, this medication has been used as an ED treatment in Taiwan at least since 1997; the prescriptions of trazodone were more prevalent among the elderly, and this trend increased, then evened out, and eventually reached its maximum point in 2003, correlating with the introduction of PDE-5 inhibitors.
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Affiliation(s)
- Wei-Ming Cheng
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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25
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Abstract
OBJECTIVES The aim of the present study was to determine the causes for overactive bladder (OAB) symptoms in women visiting a urological clinic. METHODS We prospectively recruited female patients with OAB symptoms between December 2008 and February 2010. All patients were interviewed for their detailed personal and medical history. All patients completed a 3-day frequency-volume chart. Symptom severity was evaluated using the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) questionnaires. All patients underwent either conventional pressure-flow urodynamic studies or video-urodynamic studies. On the basis of these evaluations, patients were assigned to one of the following categories: idiopathic OAB, stress urinary incontinence (SUI)-associated, neurogenic bladder, or bladder outlet obstruction (BOO). RESULTS A total of 108 female patients were recruited into the study. The mean age of the patients was 63.75 ± 14.02 years (range: 23-89). Detrusor overactivity was demonstrated in 55 patients (51%). The differential diagnosis was idiopathic OAB in 51 women (47.2%), SUI-associated in 46 (42.6%), neurogenic bladder in 13 (12.0%) and BOO in 7 (6.5%). CONCLUSION Our study suggests that the causes for OAB symptoms could be defined in half of the women visiting a urological clinic. Among them, SUI was the most common. Moreover, OAB symptoms in women might relate to BOO. Detailed history taking and sophisticated urodynamic studies are required for a substantial group of female patients with OAB symptoms to make the correct diagnosis and provide optimal therapy.
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Affiliation(s)
- Yu-Hua Fan
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, TaiwanDepartment of Urology, School of Medicine, National Yang-Ming University, Taipei, TaiwanShu-Tien Urological Science Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Alex T L Lin
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, TaiwanDepartment of Urology, School of Medicine, National Yang-Ming University, Taipei, TaiwanShu-Tien Urological Science Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Kuang-Kuo Chen
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, TaiwanDepartment of Urology, School of Medicine, National Yang-Ming University, Taipei, TaiwanShu-Tien Urological Science Research Center, National Yang-Ming University, Taipei, Taiwan
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26
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Yang CW, Lin TP, Huang YH, Chung HJ, Kuo JY, Huang WJS, Wu HHH, Chang YH, Lin ATL, Chen KK. Does extended prostate needle biopsy improve the concordance of Gleason scores between biopsy and prostatectomy in the Taiwanese population? J Chin Med Assoc 2012; 75:97-101. [PMID: 22440266 DOI: 10.1016/j.jcma.2012.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 11/28/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Discordance between the Gleason scores of prostate needle biopsies and radical prostatectomy specimens has been reported by several investigators. We conducted this study to determine if increasing the number of prostate needle biopsies in patients with prostate cancer improves the accuracy of Gleason scores in the Taiwanese population. METHODS Between March 2000 and September 2009, 281 patients underwent radical prostatectomy at Taipei Veterans General Hospital. All of these patients had prostate cancer that was diagnosed and graded either by extended needle biopsy (121 patients, ≥ 10 cores/patient, range: 10-13, median: 12) or by traditional sextant transrectal biopsy (160 patients, <10 cores/patient, range: 6-9, median: 6). We analyzed the patients' Gleason scores of their biopsies and radical prostatectomy specimens. RESULTS The concordance rate, defined as similarity between the Gleason score of a patient's biopsy and prostatectomy specimens, was 57.9% in the extended biopsy group and 45.6% in the nonextended biopsy group (χ(2) test: p = 0.042). The primary Gleason pattern was accurately predicted by extended needle biopsy in 81% of cases (98/121 cases), higher than the 70% accuracy rate of the nonextended biopsies (112/160 cases, p = 0.036). Undergrading was found in 43/121 cases (32%) and 63/160 cases (39.4%) (p = 0.511). However, overgrading was found in 8/121 cases (6.6%) and in 24/160 cases (15.0%) (p = 0.028) by extended and nonextended biopsies, respectively. Forty-seven (16.7%) of those patients who fit the criteria of active surveillance were upgraded to a Gleason score >7 after radical prostatectomy. CONCLUSION The addition of an extended transrectal needle biopsy increases the accuracy of the Gleason score for predicting the final prostate cancer grade in the Taiwanese population.
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Affiliation(s)
- Ching-Wei Yang
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Hung CC, Pan CC, Lin CC, Lin ATL, Chen KK, Chang YH. XP11.2 translocation renal cell carcinoma: clinical experience of Taipei Veterans General Hospital. J Chin Med Assoc 2011; 74:500-4. [PMID: 22100019 DOI: 10.1016/j.jcma.2011.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 06/22/2011] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Xp11.2 translocation renal cell carcinoma (RCC), a recently recognized distinct subtype of RCC, is characterized by various translocations, all involving the TFE3 transcription factor gene. These rare cancers occur predominantly in children and young adults and comprise about one-third of pediatric RCCs. In the present study, we review the clinical course of Xp11.2 translocation renal cell carcinoma in our institution. METHODS We identified eight cases with Xp11.2 translocation RCC between 2007 and 2010 from the pathological archives of the Taipei Veterans General Hospital. We retrospectively analyzed the patients' characteristics, clinical manifestations, and specific pathological features for definitive diagnosis, surgical and systemic treatment and clinical outcome of these rare cancers. RESULTS Patients were aged 20 years to 49 years (mean age 28 years) with female predominance (6 females, 2 males). One patient presented with asymptomatic renal mass detected incidentally during abdominal sonography. Four patients complained of flank or abdominal pain, and the other three complained of gross hematuria at initial presentation. The mean tumor size was 9.2 cm (range, 4 cm-17 cm). Seven patients underwent radical nephrectomy for the primary tumor, while one presented with multiple metastases. All cases were confirmed by TFE3 immunohistochemistry, a sensitive and specific marker of tumors with TFE3 gene fusion, which showed positive nuclear staining. Three patients presented initially with metastatic diseases, and another three patients progressed to lung, liver and bone metastases at eight, seven and nine months postoperatively. CONCLUSION Although RT-PCR and DNA sequencing are the final diagnoses of the molecular identity of Xp11.2 translocation RCC, experienced pathologists could confirm the histologic diagnosis based on the distinctive morphologic features with positive TFE3 immunochemical nuclear stain. Surgical resection is the only treatment. The role of systemic therapy for local recurrence and metastasis remains to be determined.
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Affiliation(s)
- Chia-Chen Hung
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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28
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Fan YH, Lin CC, Lin ATL, Chen KK. Are patients with the symptoms of overactive bladder and urodynamic detrusor overactivity different from those with overactive bladder but not detrusor overactivity? J Chin Med Assoc 2011; 74:455-9. [PMID: 22036137 DOI: 10.1016/j.jcma.2011.08.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Accepted: 06/06/2011] [Indexed: 10/16/2022] Open
Abstract
BACKGROUND The aim of this study is to identify the differences between patients with overactive bladder (OAB) and detrusor overactivity (DO) and those with OAB but without DO. METHODS We prospectively recruited patients with OAB symptoms between December 2008 and September 2009. All patients were required to complete a 3-day frequency-volume chart. Symptom severity was evaluated using the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) questionnaires. All patients also underwent urodynamic studies. Demographics, symptom severity, urinary frequency and volume, and urodynamic variables of patients with and without DO were compared. RESULTS Of the 133 enrolled patients (76 women and 57 men), DO was diagnosed in 80 patients (60.2%). All demographic variables were similar among the OAB patients, regardless of DO status. Total IPSS and OABSS scores did not differ between the OAB and DO groups. However, the nighttime urinary frequency subscore on the OABSS differed significantly between OAB patients with DO and without DO (p = 0.048). There were no significant differences in terms of urodynamic variables, urinary frequency, or urine volume between OAB patients with and without DO. CONCLUSION Patients with OAB symptoms and urodynamic DO show different clinical symptoms than OAB patients without DO. Patients with DO experience more frequent nocturnal urinary episodes.
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Affiliation(s)
- Yu-Hua Fan
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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29
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Lu SH, Lin ATL, Chen KK, Chiang HS, Chang LS. Characterization of smooth muscle differentiation of purified human skeletal muscle-derived cells. J Cell Mol Med 2011; 15:587-92. [PMID: 20132408 PMCID: PMC3922380 DOI: 10.1111/j.1582-4934.2010.01017.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 01/12/2010] [Indexed: 01/10/2023] Open
Abstract
The purpose of this study is to characterize the smooth muscle differentiation of purified human muscle-derived cells (hMDCs). The isolation and purification of hMDCs were conducted by modified preplate technique and Dynal CD34 cell selection. Smooth muscle cell differentiation was induced by the use of smooth muscle induction medium (SMIM) and low-serum medium. The gene expressions at the mRNA and protein levels of undifferentiated and differentiated hMDCs were tested by RT-PCR, Western blot and immunofluorescence studies. Western blot and immunofluorescence studies demonstrated the purified hMDCs cultured in SMIM for 4 weeks and expressed significant amount of smooth muscle myosin heavy chain (MHC) and α-smooth muscle actin (ASMA). The cells cultured in low-serum medium for 4 weeks also expressed ASMA, while the control group did not. RT-PCR analysis showed increased gene expression of smooth muscle markers, such as ASMA, Calponin, SM22, Caldesmon, Smoothelin and MHC when purified hMDCs were exposed to SMIM for 2 and 4 weeks when compared to the controls. In conclusion, we confirmed the smooth muscle differentiation capability of purified hMDCs. The gene expression of smooth muscle differentiation of purified hMDCs was characterized. These cells may be potential biomaterials for human tissue regeneration.
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Affiliation(s)
- Shing-Hwa Lu
- Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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Nitti VW, Kopp Z, Lin ATL, Moore KH, Oefelein M, Mills IW. Can we predict which patient will fail drug treatment for overactive bladder? A think tank discussion. Neurourol Urodyn 2010; 29:652-7. [PMID: 20432330 DOI: 10.1002/nau.20910] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The treatment of overactive bladder (OAB) has evolved over the past 20 years to include a number of behavioral, pharmacological, and minimally invasive treatments. After behavioral therapy, pharmacological therapy with antimuscarinics remains the mainstay of treatment. Despite this, a large number of patients will "fail" or be unsatisfied with drugs therapy. It would be extremely helpful to patients and clinicians to be able to predict who those patients are. However, there are a number of barriers. First and foremost are defining "success" and "failure" and this can vary dramatically from one patient to another. Endpoints other than the traditional variables used in clinical trials may be more effective in evaluating treatments and helping to predict outcomes. Along similar lines, there are various definitions for OAB that is "refractory" to conventional treatments and this term needs clarification. In many cases, response to therapy may be affected by factors such as comorbidities, metabolism of drugs, concurrent therapies, etc. These factors are sometimes obvious and sometimes not, and for a variety of reasons it can be quite difficult to predict or determine their effect on outcome. Finally, many patients with OAB include have mixed (stress and urgency) symptoms. It is important to sort out the OAB component of mixed symptoms and mixed urinary incontinence (MUI) when determining effects of therapy.
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Affiliation(s)
- Victor W Nitti
- Urogynaecology Department, Cambridge Wing, St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed St, London, UK.
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Lin YS, Chung HJ, Lin ATL, Huang WJS, Huang YH, Lin TP, Chen KK. Laparoscopic partial nephrectomy: Taipei veterans general hospital experience. J Chin Med Assoc 2010; 73:364-8. [PMID: 20688302 DOI: 10.1016/s1726-4901(10)70079-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Accepted: 06/15/2010] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Laparoscopic partial nephrectomy (LPN) is a definitive therapy in patients with a small renal tumor. The aim of this study was to present our interim results of LPN with its complications and outcomes. METHODS We conducted a retrospective chart review of 46 LPNs in 45 patients at Taipei Veterans General Hospital from April 2004 to September 2008. The perioperative data were prospectively collected. The follow-up data, including local recurrence, distant metastasis, and renal function, were recorded. RESULTS The mean age of these 45 patients was 54.8 years (range, 26-85 years). Three (6.5%) LPNs were converted to laparoscopic radical nephrectomy. The mean tumor diameter was 3.81 cm (range, 2.0-7.5 cm). The mean operative time was 319 minutes (range, 180-660 minutes). The mean blood loss was 501 mL (range, 20-3,300 mL). Pedicle clamping was performed in 37 (80.4%) cases and the mean warm ischemic time was 56 minutes (range, 24-100 minutes). There were 17 (40.0%) benign cases and 26 (56.5%) renal cell carcinomas, which were stage pT1a in 19 (73.1%) cases, pT1b in 5 (19.2%) cases, pT2 in 1 (3.8%) case, and pT3a in 1 (3.8%) case. The major complication rate was 4.3% (delayed bleeding in 1 case and urine leakage in 1 case). All margins were free for the malignant cases. Neither distant metastasis nor mortality was found. Local recurrence was found in 1 patient. The mean preoperative creatinine was 1.04 mg/dL (range, 0.6-2.4 mg/dL) and the mean elevated creatinine level was 0.10 mg/dL at 3 months (p < 0.05) and 0.13 mg/dL at 6 months (p < 0.05) postoperatively. The function of the operated kidney was reduced by a mean of 21.9% at 3 months (p < 0.05) and 27.7% at 6 months (p < 0.05) postoperatively. CONCLUSION Although our warm ischemic time and operative time were longer than those of other LPN studies, the interim results of our oncologic and renal functional outcomes were encouraging. Further refinement of the procedure is needed to shorten the warm ischemic time and improve the hemostatic technique. In addition, based on postoperative renal function, LPN does not significantly influence long-term renal function.
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Affiliation(s)
- Yi-Shung Lin
- Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taiwan, R.O.C
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Chang YL, Lin ATL, Chen KK, Chang LS. Simultaneous Treatment of Female Urethral Diverticulum and Stress Urinary Incontinence with Urethral Diverticulectomy and Suburethral Synthetic Mesh Sling. Low Urin Tract Symptoms 2010; 2:22-6. [PMID: 26676215 DOI: 10.1111/j.1757-5672.2009.00058.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Yu-Lung Chang
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, TaiwanDepartment of Urology, School of Medicine, National Yang-Ming University, Taipei, TaiwanDivision of Urology, Taoyuan General Hospital, Department of Health, Executive Yuan, Taoyuan, Taiwan
| | - Alex T L Lin
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, TaiwanDepartment of Urology, School of Medicine, National Yang-Ming University, Taipei, TaiwanDivision of Urology, Taoyuan General Hospital, Department of Health, Executive Yuan, Taoyuan, Taiwan
| | - Kuang-Kuo Chen
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, TaiwanDepartment of Urology, School of Medicine, National Yang-Ming University, Taipei, TaiwanDivision of Urology, Taoyuan General Hospital, Department of Health, Executive Yuan, Taoyuan, Taiwan
| | - Luke S Chang
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, TaiwanDepartment of Urology, School of Medicine, National Yang-Ming University, Taipei, TaiwanDivision of Urology, Taoyuan General Hospital, Department of Health, Executive Yuan, Taoyuan, Taiwan
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Yuan LH, Lin ATL, Chen KK. Vibratory perception and female stress urinary incontinence. J Urol 2009; 182:607-11. [PMID: 19535101 DOI: 10.1016/j.juro.2009.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2008] [Indexed: 10/20/2022]
Abstract
PURPOSE We investigated the value of measuring the vibratory perception threshold with a biothesiometer to clinically evaluate women with stress urinary incontinence. MATERIALS AND METHODS The study consisted of 3 groups, including group 1--66 women with stress urinary incontinence, group 2--44 age matched women without stress urinary incontinence and group 3--60 younger women without stress urinary incontinence. A total of 50 patients with stress urinary incontinence underwent videourodynamics. Using a biothesiometer the vibratory perception threshold was measured over the middle finger, middle toe and clitoris in all study subjects. A higher threshold indicated lower sensitivity to vibratory stimulation. Motions leading to stress urinary incontinence were also determined. RESULTS The stress urinary incontinence and age matched control groups were older than the younger control group and had greater parity. The incontinence group had a higher vibratory perception threshold than the younger control group but there was no difference between women with incontinence and age matched women without incontinence. Women in whom incontinence was induced by walking upstairs or downstairs had a higher finger and toe vibratory perception threshold than those without incontinence. The threshold in the groups with and without intrinsic sphincter deficiency did not differ significantly. CONCLUSIONS Vibratory perception is not related to stress urinary incontinence in females. Finger and toe vibratory perception is less sensitive in patients with stress urinary incontinence while walking upstairs or downstairs.
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Affiliation(s)
- Lun-Hsiang Yuan
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
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Chen SS, Chen KK, Lin ATL, Chang YH, Wu HHH, Chang LS. Correlation between pretreatment serum biochemical markers and treatment outcome for prostatic cancer with bony metastasis. J Chin Med Assoc 2009; 72:301-6. [PMID: 19541565 DOI: 10.1016/s1726-4901(09)70376-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study was undertaken to evaluate whether or not pretreatment serum biochemical markers are prognostic factors for prostatic cancer with bony metastasis in patients on hormonal treatment. METHODS Between 1983 and 1998, 127 patients with prostatic cancer and bony metastasis were included for evaluation. Serum prostate-specific antigen, alkaline phosphatase, calcium (Ca), lactic dehydrogenase, inorganic phosphate, gamma-glutamine transpeptidase, uric acid, albumin (Alb), iron, cholesterol (Cho), triglyceride, alanine aminotransferase, aspartate aminotransferase, and hemoglobin (Hb) were checked before treatment. The patients were divided into 2 groups according to their response (group 1, good response; group 2, poor response). RESULTS There were 54 patients in group 1 and 73 patients in group 2. Pretreatment levels of serum Ca, Alb, Cho and Hb were higher in group 1 than in group 2, while the other parameters were lower in group 1 than in group 2; only pretreatment levels of serum Ca, Alb and Hb were significantly different between groups (p < 0.05). When stratified by tumor grading, patients in group 1 still had significantly higher pretreatment levels of Ca, Alb and Hb than those in group 2. CONCLUSION Higher pretreatment serum levels of Ca, Alb and Hb are good prognostic factors for patients with metastatic prostatic cancer on hormonal treatment, irrespective of tumor grading.
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Affiliation(s)
- Shiou-Sheng Chen
- Division of Urology, Taipei City Hospital Renai Branch, and National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C
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Abstract
BACKGROUND Transrectal ultrasound-guided biopsy of the prostate is the major method by which prostate cancer is diagnosed. However, many patients might be overlooked with the initial biopsy. Not uncommonly, patients need repeated biopsies when they continue to exhibit suspicious clinical signs. This may cause psychological stress to both patients and doctors. The purpose of this study was to determine how many repeat transrectal biopsies are adequate for prostate cancer detection and when to switch to transurethral resection. METHODS We retrospectively studied a cohort of 2,996 patients who had undergone prostate biopsy. If the biopsy specimen was negative for malignancy, patients were given the choice of either being managed with observation or undergoing transurethral resection of the prostate (TURP) if indicated. If there was a high suspicion of cancer, patients were advised to undergo additional biopsies. The primary endpoint of this study was a diagnosis of cancer. RESULTS The cancer detection rate was 22.9% (685 of 2,996 patients) in specimens taken during the first transrectal biopsy, 8.7% in those taken during the second biopsy (32 of 336 patients), and 6.1% in those taken during the third biopsy (6 of 98 patients). The cancer detection rate of TURP after 1 negative biopsy result was 9.3% (35 of 375 patients), and that after 2 negative biopsy results was 17.1% (6 of 35 patients). TURP-derived specimens that were pathologically diagnosed as malignant had lower Gleason grade on average, no matter how many repeat biopsies there were in patients whose previous transrectal biopsy specimens were negative for malignancy (p=0.002 for 2 negative biopsy results and p=0.007 for 3 negative biopsy results). CONCLUSION The chance of detecting malignancy beyond a third transrectal biopsy procedure is low. TURP, therefore, might be an alternative procedure for obtaining tissue for pathologic diagnosis, especially in patients with rising prostate-specific antigen levels and comorbid illnesses such as obstructive symptoms.
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Affiliation(s)
- Chih-Chieh Lin
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Abstract
BACKGROUND Due to the rarity of testicular tumors in the prepubertal population, adequate information about their biological course is difficult to document well in a single institution. The purpose of this study was to focus on prepubertal males in an attempt to evaluate clinical features and optimal management among various testicular germ cell tumors with long-term follow-up. METHODS We retrospectively reviewed the records of children younger than 12 years of age with primary testicular germ cell tumors between February 1981 and December 2005 at Taipei Veterans General Hospital. Thirty-four children were diagnosed with adequate clinical and pathologic data. The stage of the disease was determined according to the staging system used by the Children's Oncology Group. Mean follow-up time was 139 months (range, 2-283 months). RESULTS All of the 34 prepubertal patients were diagnosed initially with a painless scrotal mass. The mean age of the patients at diagnosis ranged from 6 months to 84 months (mean, 20.5 months). All patients underwent radical orchiectomy as an initial treatment. Twenty-nine (85.3%) patients had yolk sac tumors, and 5 (14.7%) had mature teratomas. Of the 29 patients with yolk sac tumor, 26 (89.7%) were diagnosed as stage I, 1 (3.4%) as stage III, and 2 (7.0%) as stage IV. Five (19.2%) of the 26 stage I yolk sac tumors progressed to metastasis after radical orchiectomy, and all of these 5 patients later received chemotherapy. One patient initially with stage III yolk sac tumor and 2 patients with stage IV yolk sac tumor were also treated with chemotherapy. Eventually, 1 patient with stage IV yolk sac tumor died due to tumor progression; the remaining 28 patients with yolk sac tumor all survived without tumor relapse after appropriate treatment. In the 5 patients with teratomas, there was no tumor relapse after radical orchiectomy with a mean follow-up time of 139.1 months. The 5-year survival rates for yolk sac tumor and teratomas were 96.5% and 100%, respectively. CONCLUSION The most common prepubertal malignant testicular tumor is yolk sac tumor, and the most common benign testicular tumor is teratoma. Children with testicular germ cell tumors have excellent long-term survival rates after appropriate treatment.
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Affiliation(s)
- Yin-Shen Chen
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, and Department of Urology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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Chang YL, Lin ATL, Chen KK. Presentation of female urethral diverticulum is usually not typical. Urol Int 2008; 80:41-5. [PMID: 18204232 DOI: 10.1159/000111728] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 01/12/2007] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Symptoms or signs of female urethral diverticulum are usually not typical, thereby resulting in delayed or wrong diagnosis. This paper relates to our experience on the diversity of presenting symptoms and signs of female urethral diverticula. MATERIALS AND METHODS We reviewed the medical records and conducted telephone interviews of 14 patients with the diagnosis of female urethral diverticulum in our institution. RESULTS The mean patient age at diagnosis was 47.5 years (range 22-65 years) and the mean duration between symptom presentation and diagnosis was 6.46 years (range 1 month to 30 years). Their presenting symptoms were so diverse that many were initially treated under the diagnosis other than urethral diverticulum. Most patients were treated as uncomplicated urinary tract infection for a long time. Stress urinary incontinence (SUI) was so dominant in 2 patients with big diverticula that they were falsely treated with anti-incontinence surgery. Total incontinence happened in 1 patient with genuine SUI and a big urethral diverticulum. One patient with a huge diverticulum, which had a fistula opening into the vagina, presented with day- and night-time incontinence. Some patients even did not have incontinence, but only had dysuria or a painful anterior vaginal wall nodule. Nevertheless, detailed analysis on symptoms and signs usually may suggest urethral diverticulum. We found that recurrent urinary tract infection, urinary incontinence, palpable suburethral mass, vaginal tenderness, and dysuria are the five major presenting symptoms and signs. The diagnostic rate of voiding cystourethrography during video-urodynamics, double-balloon urethrography and MRI were 10/10 (100%), 6/6 (100%) and 10/11 (90.9%) respectively. CONCLUSIONS The presenting symptoms and signs of female urethral diverticula are often diverse and easily overlooked. High suspicion of this disorder, detailed history-taking and physical examination are essential for detecting urethral diverticulum in females.
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Affiliation(s)
- Yu-Lung Chang
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
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Lin YH, Chung HJ, Lin ATL, Chang YH, Huang WJS, Hsu YS, Chang SC, Chen KK. Complications of pure transperitoneal laparoscopic surgery in urology: the Taipei Veterans General Hospital experience. J Chin Med Assoc 2007; 70:481-5. [PMID: 18063501 DOI: 10.1016/s1726-4901(08)70045-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We present our experience of complications of pure transperitoneal laparoscopic surgery in urology at Taipei Veterans General Hospital. METHODS Between September 2003 and March 2006, 185 laparoscopic urologic operations were performed, consisting of 70 nephrectomies (36 radical, 17 partial, 11 simple, 6 donor), 28 adrenalectomies, 28 nephroureterectomies, 22 radical prostatectomies, 17 ureterolithotomies, 6 radical cystectomies, 5 pyeloplasties, 2 renal cyst unroofings, 2 nephropexies and 5 other operations. We reviewed the database of the patients to evaluate the complications and analyze factors related to laparoscopic surgeries. RESULTS A total of 25 patients had 26 complications (14.1%, major in 4, minor in 22). The complications were categorized into intraoperative and postoperative complications in 10 and 16 patients, respectively. The mortality rate was 0%. The conversion rate was 0.54% (1 patient). The re-operation rate was 1.08% (2 patients). The most common intraoperative complication was vascular injury (5 patients). The incidence of complication was related to the difficulty level of operation. No statistically significant differences were found between complication rate and patient age, patient body mass index or the American Society of Anesthesiologist score. CONCLUSION The complications of laparoscopic urologic surgeries are strongly correlated with the operative difficulties. In spite of elevated complication rates in difficult surgeries, the major complication rate in this study was very low. As the laparoscopic surgeries in urology involve more and more technique-dependent difficult fields, documentation and analysis of experience of complications is important for the development of this surgical modality.
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Affiliation(s)
- Yu-Hung Lin
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Abstract
BACKGROUND To investigate the effect of a selective P2X(3-)P2X(2/3) purinergic receptor antagonist (a-317491) on detrusor hyperreflexia in conscious chronic spinal cord-injured female rats. METHODS Six chronic spinal cord-transected female Sprague-Dawley rats (290-336 g) were used in this study. Spinal transection at the T8-T9 segmental level was performed using aseptic techniques under halothane anesthesia. Fourteen to 16 weeks after spinal transection, A-317491, a selective P2X(3-)P2X(2/3) purinergic receptor antagonist, was administered intravenously in cystometry studies at increasing doses of 0.03, 0.1, 0.3, 1, 3, 10 and 30 micromol/kg at 40-50 minute intervals. Cystometrograms (CMGs) were performed before and after the administration of each dose of the drug. RESULTS The continuous filling of CMGs revealed a large number of small-amplitude (> 8 cmH(2)O), non-voiding contractions (NVCs) (average, 9.7 per voiding cycle) preceding voiding contractions (mean amplitude, 31 cmH(2)O; duration, 2.5 minutes), which occurred at an interval of 539 seconds and at a pressure threshold of 5.7 cmH(2)O. When tested in a range of doses (0.03-30 micromol/kg, intravenous), A-317491 in doses between 1 and 30 micromol/kg significantly (p < 0.05) increased the interval between voids by 25%, reduced the number of NVCs by 42-62%, and increased the pressure threshold for voiding by 53-73%, but did not change the amplitude of the duration of the voiding contractions. The effects of the drug were apparent within 10 minutes following administration. CONCLUSION These results indicate that purinergic mechanisms, presumably involving P2X(3) or P2X(2/3) receptors on bladder C-fiber afferent nerves, play an important role in the detrusor hyperreflexia that occurs after spinal cord injury in rats.
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Affiliation(s)
- Shing-Hwa Lu
- Department of Urology, National Yang-Ming University School of Medicine, Division of Urology, Taipei City Hospital, Taipei, Taiwan, ROC.
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Chang YL, Lin ATL, Chen KK. Short-Term Effects of Desmopressin on Water and Electrolyte Excretion in Adults With Nocturnal Polyuria. J Urol 2007; 177:2227-9; discussion 2230. [PMID: 17509326 DOI: 10.1016/j.juro.2007.01.145] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Indexed: 11/29/2022]
Abstract
PURPOSE Increased calcium excretion due to desmopressin has been reported in children with nocturnal enuresis. Desmopressin is often used to treat adult patients with nocturnal polyuria. However, data on the effect of desmopressin on water/electrolyte excretion in adults are scarce. We present the short-term effects of desmopressin on water and electrolyte excretion in adult patients with nocturnal polyuria. MATERIALS AND METHODS A total of 16 male patients with nocturnal polyuria, mean age 76.3 years, received 0.1 or 0.2 mg desmopressin before sleep. Frequency volume chart was recorded, and daytime and nighttime urine samples were collected separately before and after desmopressin administration. Urinary excretions of sodium, potassium and calcium were determined, and compared before and after treatment with desmopressin. RESULTS Desmopressin significantly increased urine osmolality, decreased nocturnal total urine volume, reduced the ratio of nocturnal urine volume-to-whole day urine volume and decreased nocturnal voiding frequency. Nocturnal urinary excretion of calcium (mean 0.137 vs 0.169 mg/kg body weight per hour, p = 0.004) and whole day excretion of calcium (mean 165.9 vs 200.0 mg per day, p = 0.012) were increased after desmopressin treatment. Nocturnal urinary potassium excretion (mean 0.030 vs 0.025 mEq/kg body weight per hour, p = 0.030) and whole day potassium excretion (mean 40.7 vs 36.1 mEq per day, p = 0.017) were decreased by desmopressin treatment. However, desmopressin treatment did not significantly change urinary secretion of sodium and chloride at nighttime or for the whole day. CONCLUSIONS Desmopressin reduces nocturnal urine volume and nocturnal voiding frequency in male patients with nocturnal polyuria. However, increased calcium and decreased potassium excretion following desmopressin treatment deserve attention particularly when it is used on a long-term basis.
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Affiliation(s)
- Yu-Lung Chang
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital and Department of Urology, National Yang-Ming University, School of Medicine, No. 201 Sec. 2 Shih-Pai Road, Taipei, Taiwan 11217
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Abstract
AIM Few studies have examined the voiding pattern of healthy females, despite the importance of such research for diagnosing abnormal voiding behavior. This study investigates the voiding behavior of healthy women in Taiwan. METHODS 68 healthy women, aged 19-66 years and claiming to void normally were enrolled. Twenty-two of the subjects (32.4%) were postmenopausal. Each woman completed a 3-day voiding diary. The diary recorded urine volume, voiding frequency, urine volume per voiding for the whole day (24 h), and urine volume during both daytime and nighttime. Age and various other voiding parameters were correlated, and the voiding patterns were compared between premenopausal and postmenopausal women. RESULTS All women voided 7.34 +/- 1.63 times daily. Higher age was associated with higher whole day and daytime voiding frequency. Nocturia was not common for the group as a whole, with a mean nocturnal voiding of 0.25 times per night. However, higher age was significantly associated with a higher nighttime voiding frequency. A significantly positive correlation was also observed between age and whole day urine volume. Compared with regularly menstruating women, postmenopausal women had a significantly higher whole day and nighttime voiding frequency. Menopause and age both independently affect voiding parameters after multivariate analysis. CONCLUSIONS The results of this study provide invaluable baseline data on female voiding behavior. Additionally, this study found that for healthy women, age and menstruation status significantly affect voiding patterns. Analysis of female voiding behavior thus should consider these two factors.
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Affiliation(s)
- Yi-Hsiu Huang
- Division of Urology, Department of Surgery, Taipei City Hospital, Taipei, Taiwan, ROC
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Wang SC, Lin ATL, Chen KK. Stress urinary incontinence as the presenting symptom of primary male urethral diverticulum-A case report and literature review. Neurourol Urodyn 2006; 26:271-3. [PMID: 17034037 DOI: 10.1002/nau.20205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Primary male urethral diverticulum is quite uncommon. It is even more unusual for urinary incontinence to be a presenting symptom of primary male urethral diverticulum. Herein, we report on a 32-year-old male presenting with urine leakage on coughing or abdominal strain beginning from his early twenties. A congenital type bulbar urethral diverticulum is diagnosed by voiding cystourethrography and cystourethroscopy. Endoscopic unroofing of the diverticulum freed the patient from stress urinary incontinence after the surgery.
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Affiliation(s)
- Shao-Chuan Wang
- Department of Surgery, Division of Urology, Taipei Veterans General Hospital, National Yang-Ming University, No. 201 Section 2 Shih-Pai Road, Taipei, Taiwan 11217, China
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Chang YL, Lin ATL, Chen KK, Chang YH, Wu HHH, Kuo JY, Huang WJS, Lu SH, Hsu YS, Chung HJ, Chang SC. Correlation Between Serum Prostate Specific Antigen and Prostate Volume in Taiwanese Men With Biopsy Proven Benign Prostatic Hyperplasia. J Urol 2006; 176:196-9. [PMID: 16753400 DOI: 10.1016/s0022-5347(06)00568-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2005] [Indexed: 10/24/2022]
Abstract
PURPOSE We studied the correlation between serum prostate specific antigen and the volume of different zones of the prostate in Taiwanese men with biopsy proven benign prostatic hyperplasia. MATERIALS AND METHODS A total of 233 patients with a mean age of 71.4 years (range 42 to 89), serum prostate specific antigen less than 10 ng/ml and pathologically confirmed benign prostatic hyperplasia were enrolled in this study. Total prostate and transitional zone volumes were measured with transrectal ultrasonography. Peripheral zone volume was determined by subtracting transitional zone volume from total prostate volume. Correlations between patient age, total serum prostate specific antigen and the volume of each prostate zone were analyzed with the Pearson correlation coefficient. A linear regression model was used to determine the relationship between prostate specific antigen and prostate volume. The prostate specific antigen-prostate volume relationship in our patients was compared with published data on white and Japanese men. RESULTS Age did not significantly correlate with serum prostate specific antigen and prostate volume. Serum prostate specific antigen significantly correlated with the volume of each prostate zone. After log transformation the Pearson correlation coefficient between total prostate specific antigen and the volume of the whole prostate gland, the transitional zone and the peripheral zone were 0.369, 0.377 and 0.272, respectively (p <0.001). Taiwanese men had lower prostate volume per unit prostate specific antigen comparing with white men, while the prostate specific antigen-total prostate volume relationship between Taiwanese and Japanese men was similar. CONCLUSIONS In Taiwanese men with biopsy proven benign prostatic hyperplasia the volume of each prostate zone has significantly correlates with serum prostate specific antigen. The prostate specific antigen-total prostate volume relationship in Taiwanese men is different from that in white men. However, the prostate specific antigen-total prostate volume relationship between Taiwanese and Japanese men is similar.
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Affiliation(s)
- Yu-Lung Chang
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, No. 201 Section 2 Shih-Pai Road, Taipei, Taiwan 11217, Republic of China
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Abstract
OBJECTIVES To conduct a prospective study to determine the causes of nocturia in men. METHODS The study included 41 male patients (mean age 72.5 years) bothered by nocturia (two or more micturitions per night). Eleven asymptomatic young men (mean age 28.4 years) were enrolled as a control group. All completed a 3-day voiding diary. Daytime and nighttime urine samples were collected to determine osmolality and sodium and potassium levels. Urodynamic studies were performed for all patients with nocturia to evaluate for bladder outlet obstruction using the International Continence Society definition. Polysomnography was performed on selected patients to detect sleep apnea. RESULTS The average nighttime voiding frequency was 3.9 in the patients with nocturia. Nocturnal polyuria (NP) was found in 34 (82.9%) of 41 patients. In these patients, the nighttime urinary sodium excretion was significantly greater than the daytime excretion, with lower nighttime urine osmolality. In contrast, nighttime and daytime sodium excretion was not significantly different in patients without NP, and greater nighttime urine osmolality was noted in the patients without NP and the control group. Of the 41 patients, 24 (58.5%) had a small nocturnal bladder capacity, with detrusor overactivity in 14 of 24 patients. Eighteen patients (43.9%) had both NP and a small nocturnal bladder capacity. Another 18 patients had bladder outlet obstruction and NP. Two patients had sleep apnea. CONCLUSIONS Our observations have shown that a significant contributor to male nocturia is NP, which results from a disordered diurnal rhythm of sodium excretion and other unknown factors causing nocturnal urinary dilution. However, male nocturia can also be secondary to a combination of factors. Detailed workup is necessary to elucidate all causes.
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Affiliation(s)
- Shyh-Chyi Chang
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
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Wen YC, Kuo JY, Chen KK, Lin ATL, Chang YH, Hsu YS, Chang LS. Urothelial carcinoma of the urinary bladder in young adults--clinical experience at Taipei Veterans General Hospital. J Chin Med Assoc 2005; 68:272-5. [PMID: 15984821 DOI: 10.1016/s1726-4901(09)70149-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The clinical behavior and prognosis of bladder cancer in young patients is not well defined. The aim of this study was, therefore, to evaluate the clinical behavior, pathologic characteristics and prognosis of urothelial carcinoma of the urinary bladder in young adults. METHODS We retrospectively reviewed records from 30 young patients (23 males, 7 females; age < or = 40 years) with urothelial carcinoma of the urinary bladder who had been treated in our hospital between May 1990 and October 2003. Data were analyzed by the Kaplan-Meier method to assess disease recurrence and survival. RESULTS The mean age at diagnosis was 34.3 +/- 5 years (range, 22-40 years). Fifteen patients presented with pTa, 9 with pT1, 4 with pT2, 1 with pT3, and 1 with pT4. Twenty-six patients (87.2%) had low-grade bladder cancer, and the other 4 had high-grade disease. The most frequent initial presenting symptom was gross hematuria. The mean postoperative follow-up period was 72.8 months (range, 4-149 months). Fifty percent of superficial bladder cancers recurred a mean of 10.7 months (range, 3-68 months) after operation. One patient died from invasive bladder cancer after radical cystectomy, and 1 died from superficial bladder cancer due to tumor progression. The 5-year cancer-specific survival rate was 95.2% for superficial cancer and 83.3% for invasive cancer. The overall survival rate was 93.3%. CONCLUSION Urothelial carcinoma of the urinary bladder in young adults is usually associated with low grade and low stage. Invasive bladder cancer had no worse a survival rate than superficial bladder cancer.
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Affiliation(s)
- Yu-Ching Wen
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
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Sheu JY, Chung HJ, Chen KK, Lin ATL, Chang YH, Wu HHH, Huang WJS, Hsu YS, Kuo JY, Chang LS. Lymphangioma of male exogenital organs. J Chin Med Assoc 2004; 67:204-6. [PMID: 15244022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
Lymphangioma manifesting in the genitourinary tract is an uncommon disease. Cystic lymphangioma is a congenital lymphatic hamartoma known as lymphatic malformation. Herein we report 2 cases of lymphangioma of male exogenital organs. After complete excision of the tumor and subsequent follow-up for 6 months, both of them were free of recurrence. Ultrasonography and computed tomography scans are very useful in the differential diagnosis of this cystic disease.
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Affiliation(s)
- Jow-Yu Sheu
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Lin ADY, Chen KK, Lin ATL, Chang YH, Wu HHH, Kuo JY, Huang WJS, Hsu YS, Chung HJ, Chang LS. Antiandrogen-associated hepatotoxicity in the management of advanced prostate cancer. J Chin Med Assoc 2003; 66:735-40. [PMID: 15015823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Antiandrogens available for patients with advanced prostate cancer are reported to cause hepatotoxicity. The aim of this study is to investigate the antiandrogen-associated hepatotoxicity in patients with advanced prostate cancer. METHODS By retrospective charts review, 229 patients (47-89 years old) with advanced prostate cancer treated by total androgen blockade (TAB) with bilateral orchiectomy or LHRH (luteinizing hormone-releasing hormone) analogues plus antiandrogen, or antiandrogen-radiotherapy were enrolled in this study. There were 124 patients taking flutamide 750 mg daily and 105 patients taking cyproterone acetate (CPA) 150 mg daily. Hepatotoxicity defined by the International Consensus Meeting in 1990 and Food and Drug Administration, USA was used to evaluate the hepatotoxicity (including serious hepatotoxicity). RESULTS There was a higher occurrence of hepatotoxicity in patients taking flutamide (15.3%) than taking CPA (9.5%) (p = 0.034). The occurrence of serious hepatotoxicity of flutamide and CPA was 4.8% (6/124) and 3.8% (4/105), respectively. The mean latency period of hepatotoxicity for CPA was 4.8 +/- 2.0 months for flutamide and 5.8 +/- 1.9 months for CPA, respectively. The 2 groups made no significant difference of liver enzyme (mean maximal alanine aminotransaminase (ALT) and aspartate aminotransaminase (AST) = 284.2 +/- 99.3/300.6 +/- 58.5 U/L versus 341.8 +/- 67.1/301.6 +/- 80.5 U/L). All of the 19 patients (100%) and 9 of 10 patients (90%) with flutamide and CPA-induced hepatotoxicity got self-resolution after discontinuation of the antiandrogens. The average time of self-resolution is 4.5 +/- 3.1 months and 6.3 +/- 4.7 months for flutamide and CPA, respectively. Five patients of flutamide-induced and 2 patients of CPA-induced hepatotoxicity got resolution after changing to other antiandrogen. CONCLUSIONS Flutamide and CPA appear to cause hepatotoxic effects in some patients. Discontinuation of the antiandrogens seems to be the resolution of hepatotoxicity. A change to other antiandrogen may be the alternative strategy to the antiandrogen-induced hepatotoxicity. The results of this study suggest that all patients received flutamide and CPA should be monitored carefully for signs and symptoms referable to hepatic injury to prevent the development of serious hepatic dysfunction.
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Affiliation(s)
- Alpha D Y Lin
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC
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Sheu JY, Chen KK, Lin ATL, Chang YH, Wu HHH, Huang WJS, Hsu YS, Kuo JY, Chung HJ, Chang LS. Long-term efficacy and safety of sildenafil for patients with erectile dysfunction. J Chin Med Assoc 2003; 66:480-6. [PMID: 14604312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND To investigate the long-term efficacy and safety of sildenafil for patients with erectile dysfunction (ED). METHODS Between March 1999 and February 2001, a total of 3168 patients visited Taipei Veterans General Hospital for prescription of sildenafil. The follow-up period was 1-3 years. A questionnaire was designed for evaluation of efficacy and safety of sildenafil via telephone survey. RESULTS Of the 3168 patients, 1414 were interviewed by telephone. Data from telephone questionnaires were successfully obtained in 1074 cases. Achievement of the first penile erection after sildenafil was reported in 58.8% of our patients. The distribution of the first doses was 0.6%, 8.5%, 81.9% and 90% for 12.5 mg, 25 mg, 50 mg and 100 mg, respectively. After administration of sildenafil, 72.1% men had successful intercourses "sometimes" or "always achieving vaginal penetration", and 72.3% had "slight difficulty" or "no difficulty" in maintaining of sexual intercourses. The "sometimes/most times/always" satisfaction accounted 63.9% and 62.8%, respectively for patients and partners. The global assessment of penile erection was improved in 58.6% of the patients. The sexual confidence of the patients was moderate, high and very high in 72.4% of the patients. Of the 434 patients who failed first penile erections, 400 (92.2%) were related to improper administration of sildenafil. Discontinuation of sildenafil in the last 3 months before telephone survey was found in 852 patients (80.2%). The causes of discontinuation were loss of efficacy in 51.6% of patients, lack of sexual desire in 8.8%, and chronic diseases in 8.2%. Spontaneous erection without sildenafil was claimed in 21.5% of the patients (most times in 9.5% and always in 12.0%). The rate of adverse events after taking sildenafil were 16.6%, and the most common adverse event was facial flushing (9.2%). CONCLUSIONS The results of this study demonstrated that the efficacy of sildenafil was similar to the previous clinical trials. The adverse events after sildenafil were mild and tolerable. Recovery of complete or partial spontaneous erection was noted in some patients (21.5% in our study) after long-term usage of sildenafil.
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Affiliation(s)
- Jow-Yu Sheu
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Lin TP, Hsu YS, Chen KK, Lin ATL, Chang YH, Wu HHH, Huang WJS, Kuo JY, Chung HJ, Chang LS. Chyluria--experience of Taipei Veterans General Hospital. J Chin Med Assoc 2003; 66:109-12. [PMID: 12716009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Chyluria is caused by rupturing of lymphatic varices into the pyelocaliceal system. Although Chyluria is rare in western countries, it is not uncommon in Asia. We would like to present the experience of diagnosis, evaluation and treatment of chyluria in Taipei Veterans General Hospital. METHODS From 1973 to 1999, a total of 30 patients with chyluria were reviewed. All had the chief complaint of milky white urine passage. They were investigated by multiple workup modalities including computed tomography, intravenous urography, lymphangiography, and cystoscopy. Fifteen cases received 1% silver nitrate instillation and 4 cases underwent nephrolysis either as primary or salvage treatment. RESULTS Lymphangiography was performed in 24 of the 30 cases and responsible causes of chyluria were noted in 21. They were followed up for at least 12 months in 9 patients treated by intrarenal pelvic instillation of silver nitrate and 3 by nephrolysis, respectively. Recurrence was found in 1 patient (11.1%) receiving silver nitrate only and no significant adverse effect was noted. CONCLUSIONS Lymphangiography is the most powerful diagnostic tool. Intrarenal silver nitrate instillation is a safe and effective management of chyluria.
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Affiliation(s)
- Tzu-Ping Lin
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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Chen SS, Chen KK, Lin ATL, Chang YH, Wu HH, Chang LS. The correlation between pretreatment serum hormone levels and treatment outcome for patients with prostatic cancer and bony metastasis. BJU Int 2002; 89:710-3. [PMID: 11966629 DOI: 10.1046/j.1464-410x.2002.02733.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate whether pretreatment serum hormone levels are a prognostic factor for prostatic cancer with bony metastasis under hormonal treatment. PATIENTS AND METHODS Between 1980 and 1994, 96 patients with prostate cancer and bony metastasis were included for an evaluation by a retrospective review of their charts. All 96 had received hormonal treatment after a diagnosis of metastatic prostatic carcinoma. Serum testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and prolactin were assessed before treatment. The patients were divided into two groups according to their response during the follow-up. Group 1 (good response) had no change or resolution of metastatic lesion(s) on the bone scan and a declining prostate-specific antigen (PSA) level. Group 2 had increased PSA or progression of metastatic lesion(s) on the bone scan. Tumours were graded as low (2-4), intermediate (5-7) and high (8-10) using the Gleason score. RESULTS There were 43 patients in group 1 and 53 in group 2; the overall mean (sd) age was 72.5 (6.8) years and the follow-up 29.5 (0.5) months. The respective mean (sd) levels of testosterone, LH, FSH and prolactin before treatment were 4.6 (1.6) ng/mL, 20.2 (13.3) mIU/mL, 19.6 (18.6) mIU/mL and 20.7 (12.1) ng/mL in group 1, and 2.6 (1.0) ng/mL, 27.3 (11.0) mIU/mL, 27.1 (9.8) mIU/mL and 41.3 (28.4) ng/mL in group 2. The level of testosterone was significantly higher in group 1 than in group 2, while LH, FSH and prolactin were significantly lower in group 1 than in group 2. When stratified by tumour grade, patients in group 1 still had significantly higher pretreatment testosterone and lower LH, FSH and prolactin than those in group 2. CONCLUSION Higher testosterone and lower LH, FSH and prolactin levels were good prognostic factors for patients with metastatic prostatic cancer under hormonal treatment, irrespective of tumour grading.
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Affiliation(s)
- S S Chen
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan 112, Republic of China
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