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Lin KJ, Hou CP, Tsai HY, Tsao SH, Juang HH, Lin YH. Impact of age and anterior fibromuscular stroma preservation on post-enucleation voided volume. World J Urol 2024; 42:278. [PMID: 38691246 DOI: 10.1007/s00345-024-04996-1] [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: 12/14/2023] [Accepted: 04/11/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE This study is centered on the critical role of anterior fibromuscular stroma (AFS) preservation in prostate enucleation, an emerging strategy aimed at minimizing postoperative urinary incontinence-a common concern in benign prostatic hyperplasia (BPH) surgeries. By focusing on postoperative voiding volumes (VV), our research investigates the efficacy of AFS preservation. This approach, distinct in its methodology, is hypothesized to improve urinary function post-surgery, thereby offering a potentially significant advancement in BPH surgical treatments. MATERIALS AND METHODS A retrospective analysis was conducted, comparing patients who underwent prostate enucleation in 2017 without intentional AFS preservation to those in 2019 with this technique. We examined variables including age, BMI, diabetes, hypertension, and preoperative VV to assess their effect on post-catheter removal VV. The study's methodology includes a thorough review of the primary statistical analysis methods employed. RESULTS Our analysis indicates that while the 2017 and 2019 cohorts were similar in most preoperative parameters, the 2019 group that underwent AFS-preserved surgery showed a significant improvement in postoperative VVs. This was less pronounced in the patient group aged over 70, underscoring the importance of this demographic in our study. CONCLUSIONS The study concludes that intentional preservation of AFS during prostate enucleation positively impacts early postoperative VVs, with limited improvement in older patients. These findings highlight the potential of AFS preservation not only in enhancing urinary outcomes post-surgery but also in shaping future BPH surgical procedures and research directions.
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Affiliation(s)
- Kuo-Jen Lin
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Han-Yu Tsai
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Shu-Han Tsao
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Horng-Heng Juang
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan
- Department of Anatomy, School of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan
| | - Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital-Linkou, 5 Fu-Shing Street, Kweishan, Taoyuan, 333, Taiwan.
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.
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Lin YH, Tsai HY, Tsao SH. Re: Steven Monda, Manolis Pratsinis, Hansen Lui, et al. Secondary Bladder Cancer After Prostate Cancer Treatment: An Age-matched Comparison Between Radiation and Surgery. Eur Urol Focus. In press. http://doi.org/10.1016/j.euf.2023.09.002. Eur Urol Focus 2024:S2405-4569(24)00061-0. [PMID: 38670841 DOI: 10.1016/j.euf.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Accepted: 01/08/2024] [Indexed: 04/28/2024]
Affiliation(s)
- Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Han-Yu Tsai
- Department of Urology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Han Tsao
- Department of Urology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Hsu TS, Weng SC, Lin YH, Chen CL, Tsao SH, Tsai HY, Juang HH, Chang PL, Hou CP. Surgical outcomes of endoscopic enucleation of the prostate in community aging males with or without preoperative urinary retention. Int Urol Nephrol 2024:10.1007/s11255-024-04007-7. [PMID: 38564078 DOI: 10.1007/s11255-024-04007-7] [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: 12/21/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES This study aims to investigate the surgical outcomes of endoscopic enucleation of the prostate in older males with or without preoperative urinary retention (UR). MATERIAL AND METHODS We conducted a study on selected patients with symptomatic benign prostatic hyperplasia (BPH) who underwent either thulium:YAG laser (vela XL) prostate enucleation (ThuLEP) or bipolar plasma enucleation of the prostate (B-TUEP) at the geriatric urology department of our institution. The studied patients were categorized into two groups, namely the UR group and the non-UR group, on the basis of whether they experienced UR in the 1 month preceding their surgery. Their clinical outcomes following prostate endoscopic surgery were evaluated and analyzed. RESULTS Our results revealed comparable outcomes for operation time, length of hospital stay, percentage of tissue removed, re-catheterization rate, and urinary tract infection rate within the 1 month between the B-TUEP and ThuLEP surgery groups, regardless of UR history. However, the non-UR B-TUEP group experienced more blood loss relative to the non-UR ThuLEP group (P = .004). Notably, patients with UR exhibited significantly greater changes in IPSS total, IPSS voiding, and prostate-specific antigen values relative to those without UR. CONCLUSIONS Both ThuLEP and B-TUEP were effective in treating BPH-related bladder outlet obstruction. Our study identified more pronounced changes in IPSS total, IPSS voiding, and prostate-specific antigens within the UR group. Moreover, the rate of postoperative UR in this group was not higher than that observed in the non-UR group. Our study also revealed that the presumed benefits of laser surgery in reducing blood loss were less pronounced for patients with UR.
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Affiliation(s)
- Tung-Shiun Hsu
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Shu-Chuan Weng
- Department of Health and Management, Yuanpei University of Medical Technology, Hsinchu, 330, Taiwan
- Bachelor Degree Program of Senior Health and Management, Yuanpei University of Medical Technology, Hsinchu, 330, Taiwan
| | - Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Chien-Lun Chen
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan
| | - Shu-Han Tsao
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan
| | - Han-Yu Tsai
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan
| | | | - Phei-Lang Chang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan
| | - Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan, 333, Taiwan.
- Department of Health and Management, Yuanpei University of Medical Technology, Hsinchu, 330, Taiwan.
- School of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.
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Lin YH, Tsai HY, Tsao SH. Re: Rano Matta, Refik Saskin, Sarah Neu, et al. Predicting Mirabegron Treatment Response in Patients with Overactive Bladder: A Post Hoc Analysis of Data from Clinical Trials. Eur Urol Focus 2023;9:957-65. Eur Urol Focus 2024:S2405-4569(24)00044-0. [PMID: 38493068 DOI: 10.1016/j.euf.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/13/2024] [Indexed: 03/18/2024]
Affiliation(s)
- Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Han-Yu Tsai
- Department of Urology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shu-Han Tsao
- Department of Urology, Chang Gung Memorial Hospital-Linkou, Taoyuan, Taiwan; School of Medicine, Chang Gung University, Taoyuan, Taiwan
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Chia SY, Fang YT, Su YT, Tsai PY, Hsieh C, Tsao SH, Juang JY, Hung CM, Tuanmu MN. A global database of bird nest traits. Sci Data 2023; 10:923. [PMID: 38129417 PMCID: PMC10739861 DOI: 10.1038/s41597-023-02837-1] [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: 06/26/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
The reproductive success of birds is closely tied to the characteristics of their nests. It is crucial to understand the distribution of nest traits across phylogenetic and geographic dimensions to gain insight into bird evolution and adaptation. Despite the extensive historical documentation on breeding behavior, a structured dataset describing bird nest characteristics has been lacking. To address this gap, we have compiled a comprehensive dataset that characterizes three ecologically and evolutionarily significant nest traits-site, structure, and attachment-for 9,248 bird species, representing all 36 orders and 241 out of the 244 families. By defining seven sites, seven structures, and four attachment types, we have systematically classified the nests of each species using information from text descriptions, photos, and videos sourced from online databases and literature. This nest traits dataset serves as a valuable addition to the existing body of morphological and ecological trait data for bird species, providing a useful resource for a wide range of avian macroecological and macroevolutionary research.
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Affiliation(s)
- Stephanie Yuan Chia
- Biodiversity Research Center, Academia Sinica, Taipei, Taiwan
- Department of Biology, University of Maryland, College Park, Maryland, USA
| | - Yi-Ting Fang
- Biodiversity Research Center, Academia Sinica, Taipei, Taiwan
| | - Yi-Ting Su
- Biodiversity Research Center, Academia Sinica, Taipei, Taiwan
- Department of Life Sciences, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Yu Tsai
- Biodiversity Research Center, Academia Sinica, Taipei, Taiwan
| | - Chia Hsieh
- Biodiversity Research Center, Academia Sinica, Taipei, Taiwan
- Program in Ecology and Evolutionary Biology, BioSciences Department, Rice University, Houston, Texas, USA
| | - Shu-Han Tsao
- Department of Mechanical Engineering, National Taiwan University, Taipei, Taiwan
| | - Jia-Yang Juang
- Department of Mechanical Engineering, National Taiwan University, Taipei, Taiwan
- Program in Nanoengineering and Nanoscience, Graduate School of Advanced Technology, National Taiwan University, Taipei, Taiwan
| | - Chih-Ming Hung
- Biodiversity Research Center, Academia Sinica, Taipei, Taiwan.
| | - Mao-Ning Tuanmu
- Biodiversity Research Center, Academia Sinica, Taipei, Taiwan.
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Wang CH, Chen YK, Tsao SH, Lee CH. Trends in Palliative Care Research During the COVID-19 Pandemic. Am J Hosp Palliat Care 2023; 40:1271-1278. [PMID: 36503251 PMCID: PMC9748525 DOI: 10.1177/10499091221145202] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
To demonstrate the trends and variety of research on palliative care during the COVID-19 pandemic. A systematic search of the Web of Science database. Since the outbroke of the COVID-19 pandemic, the adjustment of palliative care systems is warranted to maintain a high quality of care. The COVID-19 -related palliative care studies account for approximately 4% of all publications on palliative care. However, there is a dearth of research investigating the nature of these studies. A total of 293 studies were included. Of the included studies, those related to system improvement were the most common (181/293, 61.8%), followed by those related to patient care (79/293, 27.0%), bereavement support for patients or family members (19/293, 6.5%), and the mental health of frontline practitioners (14/293, 4.8%). From these studies, 82, 137, and 74 studies were published in 2020, 2021, and 2022 (until August 1), respectively. The research trends of palliative care demonstrate the flexibility and rapid response of the global palliative care system to the COVID-19 pandemic and show how the palliative care system is evolving. While most studies are interested in system improvement, patient care, and bereavement support, the mental health of frontline practitioners has received less attention. Our findings provide palliative care practitioners with current valuable information and highlight possible future trends.
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Affiliation(s)
- Chien-Ho Wang
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yu-Kai Chen
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Han Tsao
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ching-Hsing Lee
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Keelung, Taiwan
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Lin YH, Chang SY, Tsao SH, Hou CP, Chen CL, Lin WC, Tsui KH, Juang HH. Anterior fibromuscular stroma-preserved endoscopic enucleation of the prostate: a precision anatomical approach. World J Urol 2023; 41:2127-2132. [PMID: 36585497 DOI: 10.1007/s00345-022-04270-2] [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: 08/11/2022] [Accepted: 12/19/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Benign prostate obstruction (BOO) is becoming increasingly important in this aging society. Some urge/stress urinary incontinence (UUI/SUI) still occurs after endoscopic enucleation of the prostate (EEP). It remains unclear how post-EEP incontinence can be avoided. Currently, early apical release to ameliorate the traction of the external sphincter is the best technique for incontinence prevention. OBJECTIVE To describe our surgical technique of anterior fibromuscular stroma (AFS)-preserved EEP for BOO. DESIGN, SETTING, AND PARTICIPANTS The medical records of 60 consecutive patients who underwent AFS-preserved EEP for BOO in our center from September 2019 to December 2019 were retrospectively reviewed. SURGICAL PROCEDURE AFS-preserved EEP starts at the 12 o'clock position of the urethra, and the junction between the AFS and transitional zone (T-zone) was identified. The AFS and T-zone were separated first to protect the AFS in the initial operative procedure. Then, following the usual enucleation procedure, AFS-preserved EEP could be achieved. MEASUREMENTS Postoperative prostate-specific antigen (PSA), testosterone, urethral stricture, and voiding status, such as incontinence, uroflow, and postvoiding residual urine were assessed. RESULTS AND LIMITATIONS The data show that AFS-preserved EEP could achieve similar surgical outcomes as other early apical release approaches. CONCLUSIONS The preserved AFS provides a nice landmark at the 12 o'clock position during EEP.
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Affiliation(s)
- Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan.
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
| | - Shin-Yuan Chang
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Shu-Han Tsao
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chien-Lun Chen
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wen-Chou Lin
- Department of Urology, MacKay Memorial Hospital, Taipei 112, Taiwan
| | - Ke-Hung Tsui
- Department of Urology, Shuang Ho Hospital, Taipei Medical University, Taipei 112, Taiwan.
- TMU Research Center of Urology and Kidney (TMU-RCUK), Taipei Medical University, Taipei 112, Taiwan.
| | - Horng-Heng Juang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan.
- Department of Anatomy, School of Medicine, Chang Gung University, Kwei-Shan, Taoyuan 333, Taiwan.
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Yeh YJ, Weng SC, Lin YH, Chen CL, Tsao SH, Tsai HY, Juang HH, Chang PL, Hou CP. Comparative Analysis of Surgical Outcomes of Flexible Ureteroscopy and Da Vinci Robotic Surgery in Community Patients with Renal Pelvic Stones Larger than 2 cm. Medicina (Kaunas) 2023; 59:1395. [PMID: 37629685 PMCID: PMC10456386 DOI: 10.3390/medicina59081395] [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] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/27/2023]
Abstract
Background and Objectives: This study evaluated and compared the surgical outcomes of retrograde intrarenal surgery (RIRS) lithotripsy versus robot-assisted laparoscopic pyelolithotomy (RAPL) in community patients with renal pelvic stones larger than 2 cm. Materials and Methods: A total of 77 patients who underwent RIRS (RIRS group, n = 50) or RAPL (RAPL group, n = 27) at our institution between December 2016 and July 2022 were recruited. A single surgeon performed all surgical operations. Preoperative, operative, and postoperative data were recorded. The study evaluated various clinical outcomes, namely, urinary tract infections, analgesic use, emergency room readmissions, stone clearance rates, surgical complications, and medical expenditures associated with the treatment courses, and compared them between the groups. Results: The RAPL group had a larger mean stone diameter and higher degree of hydronephrosis than the RIRS group did. The RIRS group had superior outcomes regarding operative time, length of postoperative hospital stay, surgical wound pain, and medical expenditures. Regarding postoperative outcomes, comparable rates of postoperative urinary tract infection, prolonged analgesic use, and emergency room readmissions were observed between the groups. However, the RAPL group had a higher stone clearance rate than the RIRS group did (81.5% vs. 52.0%, p = 0.014). Conclusions: For the surgical treatment of renal pelvis stones larger than 2 cm, RAPL has a superior stone clearance rate than RIRS; however, RIRS achieves superior outcomes in terms of medical expenditures, length of hospital stay, and surgical wound pain. Both procedures were equally safe.
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Affiliation(s)
- Yu-Ju Yeh
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (Y.-J.Y.); (Y.-H.L.); (C.-L.C.); (S.-H.T.); (H.-Y.T.); (P.-L.C.)
| | - Shu-Chuan Weng
- Department of Health and Management, Yuanpei University of Medical Technology, Hsinchu 330, Taiwan;
- Bachelor Degree Program of Senior Health and Management, Yuanpei University of Medical Technology, Hsinchu 330, Taiwan
| | - Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (Y.-J.Y.); (Y.-H.L.); (C.-L.C.); (S.-H.T.); (H.-Y.T.); (P.-L.C.)
| | - Chien-Lun Chen
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (Y.-J.Y.); (Y.-H.L.); (C.-L.C.); (S.-H.T.); (H.-Y.T.); (P.-L.C.)
| | - Shu-Han Tsao
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (Y.-J.Y.); (Y.-H.L.); (C.-L.C.); (S.-H.T.); (H.-Y.T.); (P.-L.C.)
| | - Han-Yu Tsai
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (Y.-J.Y.); (Y.-H.L.); (C.-L.C.); (S.-H.T.); (H.-Y.T.); (P.-L.C.)
| | | | - Phei-Lang Chang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (Y.-J.Y.); (Y.-H.L.); (C.-L.C.); (S.-H.T.); (H.-Y.T.); (P.-L.C.)
| | - Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (Y.-J.Y.); (Y.-H.L.); (C.-L.C.); (S.-H.T.); (H.-Y.T.); (P.-L.C.)
- Department of Health and Management, Yuanpei University of Medical Technology, Hsinchu 330, Taiwan;
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Wu HJ, Tseng YC, Tsao SH, Chiang PL, Tai WY, Hsieh HI, Yu HT, Juang JY. A Comparative Study on the Microstructures, Mineral Content, and Mechanical Properties of Non-Avian Reptilian Eggshells. Biology (Basel) 2023; 12:688. [PMID: 37237502 PMCID: PMC10215611 DOI: 10.3390/biology12050688] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/25/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
We analyze 214 freshly laid eggs belonging to 16 species across three orders of Class Reptilia. Using mechanical compression tests, we measure each egg's absolute stiffness (K, unit: N m-1) and relative stiffness (C number). The effective Young's modulus, E, was obtained by combining experimental and numerical methods. The mineral (CaCO3) content was measured by acid-base titration, the microstructures by scanning electron microscopy (SEM), and the crystallography by electron backscatter diffraction (EBSD). We find that the C number of reptilian eggs is, on average, higher than that of bird eggs, indicating that reptilian eggs are stiffer with respect to the egg mass than birds. However, Young's moduli of the reptilian eggshells (32.85 ± 3.48 GPa) are similar to those of avian eggshells (32.07 ± 5.95 GPa), even though those eggshells have different crystal forms, microstructures, and crystallography. Titration measurement shows that the reptilian eggshells are highly mineralized (>89% for nine Testudines species and 96% for Caiman crocodilus). Comparing the species with aragonite and calcite crystals, we find that calcite shells, including those of the Kwangsi gecko (inner part) and spectacled caiman (outer part), generally have larger grains than the aragonite ones. However, the grain size is not correlated to the effective Young's modulus. Also, as measured by the C number, the aragonite shells are, on average, stiffer than the calcite ones (except for the Kwangsi gecko), primarily due to their thicker shells.
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Affiliation(s)
- Hsio-Jou Wu
- Department of Mechanical Engineering, National Taiwan University, Taipei 10617, Taiwan; (H.-J.W.); (Y.-C.T.); (S.-H.T.); (P.-L.C.)
- Department of Life Science, National Taiwan University, Taipei 10617, Taiwan;
| | - Yu-Chien Tseng
- Department of Mechanical Engineering, National Taiwan University, Taipei 10617, Taiwan; (H.-J.W.); (Y.-C.T.); (S.-H.T.); (P.-L.C.)
| | - Shu-Han Tsao
- Department of Mechanical Engineering, National Taiwan University, Taipei 10617, Taiwan; (H.-J.W.); (Y.-C.T.); (S.-H.T.); (P.-L.C.)
| | - Pei-Lin Chiang
- Department of Mechanical Engineering, National Taiwan University, Taipei 10617, Taiwan; (H.-J.W.); (Y.-C.T.); (S.-H.T.); (P.-L.C.)
| | - Wei-Yu Tai
- Taipei Zoo, Taipei 11656, Taiwan; (W.-Y.T.); (H.-I.H.)
| | - Hsin-I Hsieh
- Taipei Zoo, Taipei 11656, Taiwan; (W.-Y.T.); (H.-I.H.)
| | - Hon-Tsen Yu
- Department of Life Science, National Taiwan University, Taipei 10617, Taiwan;
- Degree Program of Genome and Systems Biology, National Taiwan University, Taipei 10617, Taiwan
| | - Jia-Yang Juang
- Department of Mechanical Engineering, National Taiwan University, Taipei 10617, Taiwan; (H.-J.W.); (Y.-C.T.); (S.-H.T.); (P.-L.C.)
- Program in Nanoengineering and Nanoscience, Graduate School of Advanced Technology, National Taiwan University, Taipei 10617, Taiwan
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Li XW, Wang CH, Dai JW, Tsao SH, Wang PH, Tai CC, Chien RN, Shao SC, Lai ECC. Comparison of clinical outcomes between aggressive and non-aggressive intravenous hydration for acute pancreatitis: a systematic review and meta-analysis. Crit Care 2023; 27:122. [PMID: 36949459 PMCID: PMC10035244 DOI: 10.1186/s13054-023-04401-0] [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: 01/10/2023] [Accepted: 03/12/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Current practice guidelines for optimal infusion rates during early intravenous hydration in patients with acute pancreatitis (AP) remain inconsistent. This systematic review and meta-analysis aimed to compare treatment outcomes between aggressive and non-aggressive intravenous hydration in severe and non-severe AP. METHODS This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We systematically searched PubMed, Embase and Cochrane Library for randomized controlled trials (RCTs) on November 23, 2022, and hand-searched the reference lists of included RCTs, relevant review articles and clinical guidelines. We included RCTs that compared clinical outcomes from aggressive and non-aggressive intravenous hydration in AP. Meta-analysis was performed using a random-effects model for participants with severe AP and non-severe AP. Our primary outcome was all-cause mortality, and several secondary outcomes included fluid-related complications, clinical improvement and APACHE II scores within 48 h. RESULTS We included a total of 9 RCTs with 953 participants. The meta-analysis indicated that, compared to non-aggressive intravenous hydration, aggressive intravenous hydration significantly increased mortality risk in severe AP (pooled RR: 2.45, 95% CI: 1.37, 4.40), while the result in non-severe AP was inconclusive (pooled RR: 2.26, 95% CI: 0.54, 9.44). However, aggressive intravenous hydration significantly increased fluid-related complication risk in both severe (pooled RR: 2.22, 95% CI 1.36, 3.63) and non-severe AP (pooled RR: 3.25, 95% CI: 1.53, 6.93). The meta-analysis indicated worse APACHE II scores (pooled mean difference: 3.31, 95% CI: 1.79, 4.84) in severe AP, and no increased likelihood of clinical improvement (pooled RR:1.20, 95% CI: 0.63, 2.29) in non-severe AP. Sensitivity analyses including only RCTs with goal-directed fluid therapy after initial fluid resuscitation therapy yielded consistent results. CONCLUSIONS Aggressive intravenous hydration increased the mortality risk in severe AP, and fluid-related complication risk in both severe and non-severe AP. More conservative intravenous fluid resuscitation protocols for AP are suggested.
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Affiliation(s)
- Xiu-Wei Li
- Division of Hepatogastroenterology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Ho Wang
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Jhih-Wei Dai
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Cardiology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Shu-Han Tsao
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Hsi Wang
- Department of Nephrology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Cheng-Chen Tai
- Medical Library, Department of Medical Education, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Rong-Nan Chien
- Division of Hepatogastroenterology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Hepatogastroenterology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Chieh Shao
- Department of Pharmacy, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
- Center for Evidence-Based Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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11
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Tsao SH, Wang CH, Juang HH, Lin YH, Yang PS, Chang PL, Chen CL, Hou CP. Surgery for Xanthogranulomatous Pyelonephritis: A Comparison of Midline Transperitoneal and Flank Retroperitoneal Laparotomy Approaches to Nephrectomy. J Clin Med 2022; 11:jcm11154476. [PMID: 35956092 PMCID: PMC9369389 DOI: 10.3390/jcm11154476] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/29/2022] [Accepted: 07/29/2022] [Indexed: 02/01/2023] Open
Abstract
Xanthogranulomatous pyelonephritis (XGP) is a rare inflammatory disease often associated with high morbidity and mortality. Whether the midline transperitoneal or the flank retroperitoneal approach is superior remains unknown. We searched through pathology databases and reviewed 86 patients with an XGP diagnosis from 2000 to 2021 at our institution. After the patients who did not meet the inclusion criteria were excluded, 35 patients who had undergone nephrectomy through the midline transperitoneal or the flank retroperitoneal laparotomy approach were recruited. Nine (25.71%) of the thirty-five patients underwent nephrectomy through a midline approach, whereas twenty-six (74.29%) received a flank approach. Patients in the midline approach group had a longer surgical time (p = 0.03) than those in the flank approach group. In addition, patients in the flank approach group took less time after surgery to resume oral intake than those in the midline approach group (p = 0.01). No significant differences in the rates of intraoperative and postoperative complications such as peritonitis or intraabdominal infection were observed between the groups. For the patients with XGP who are good candidates for surgery, nephrectomy is a relatively safe surgical treatment method. Both surgical methods produced favorable surgical outcomes, and the patients who received these methods had similar complication rates.
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Affiliation(s)
- Shu-Han Tsao
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (S.-H.T.); (H.-H.J.); (Y.-H.L.); (P.-S.Y.); (P.-L.C.); (C.-L.C.)
| | - Chien-Ho Wang
- Deartment of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan;
| | - Horng-Heng Juang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (S.-H.T.); (H.-H.J.); (Y.-H.L.); (P.-S.Y.); (P.-L.C.); (C.-L.C.)
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Anatomy, School of Medicine, Chang Gung University, Kwei-Shan, Taoyuan 333, Taiwan
| | - Yu-Hsiang Lin
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (S.-H.T.); (H.-H.J.); (Y.-H.L.); (P.-S.Y.); (P.-L.C.); (C.-L.C.)
| | - Pei-Shan Yang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (S.-H.T.); (H.-H.J.); (Y.-H.L.); (P.-S.Y.); (P.-L.C.); (C.-L.C.)
| | - Phei-Lang Chang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (S.-H.T.); (H.-H.J.); (Y.-H.L.); (P.-S.Y.); (P.-L.C.); (C.-L.C.)
| | - Chien-Lun Chen
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (S.-H.T.); (H.-H.J.); (Y.-H.L.); (P.-S.Y.); (P.-L.C.); (C.-L.C.)
| | - Chen-Pang Hou
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan; (S.-H.T.); (H.-H.J.); (Y.-H.L.); (P.-S.Y.); (P.-L.C.); (C.-L.C.)
- School of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Healthcare Management, Yuanpei University of Medical Technology, Hsinchu 300, Taiwan
- Correspondence:
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12
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Hung CM, Tsao SH, Chiang PL, Wu SP, Tuanmu MN, Juang JY. Functional connections between bird eggshell stiffness and nest characteristics through risk of egg collision in nests. Ecol Lett 2022; 25:1421-1431. [PMID: 35291055 PMCID: PMC9315002 DOI: 10.1111/ele.14001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 02/13/2022] [Accepted: 03/01/2022] [Indexed: 11/29/2022]
Abstract
Eggs and nests are two critical traits for the ecological success of birds. Their functional interactions, however, remain unclear. Here, we examined the functional connections between egg stiffness and nest attachment, site and structure for 1350 avian species. We revealed high eggshell stiffness for eggs in nests with a pensile attachment, located on non-tree vegetation or having a domed shape, suggesting that birds produce stiffer eggs in response to higher egg-collision risk in unstable or enclosed nests. Interdependence models suggested that the evolution of eggshell stiffness was more likely to be driven by than drive that of nest characters. Our results implied a trade-off between investment in competing for established nesting niches and producing stiff eggs to explore novel niches with high collision risk, possibly mediated by predation or thermoregulation. This study highlights an overlooked connection between nests and eggshells that may have broadened the ecological niches of birds.
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Affiliation(s)
- Chih-Ming Hung
- Biodiversity Research Center, Academia Sinica, Taipei, Taiwan
| | - Shu-Han Tsao
- Department of Mechanical Engineering, National Taiwan University, Taipei, Taiwan
| | - Pei-Lin Chiang
- Department of Mechanical Engineering, National Taiwan University, Taipei, Taiwan
| | - Shang-Ping Wu
- Department of Mechanical Engineering, National Taiwan University, Taipei, Taiwan
| | - Mao-Ning Tuanmu
- Biodiversity Research Center, Academia Sinica, Taipei, Taiwan.,Thematic Center for Systematics and Biodiversity Informatics, Biodiversity Research Center, Academia Sinica, Taipei, Taiwan
| | - Jia-Yang Juang
- Department of Mechanical Engineering, National Taiwan University, Taipei, Taiwan.,Program in Nanoengineering and Nanoscience, Graduate School of Advanced Technology, National Taiwan University, Taipei, Taiwan
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13
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Teng TC, Shao IH, Hsu YC, Chen Y, Tsao SH, Kang YT, Hsieh ML. Risk Factors of Emergency Room Visits for Bleeding Complications Following Transurethral Procedures in the Treatment of Benign Prostatic Hyperplasia: A Retrospective Cohort Study. Clin Interv Aging 2021; 16:1747-1756. [PMID: 34616148 PMCID: PMC8487796 DOI: 10.2147/cia.s329468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 09/15/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose Transurethral procedures, including transurethral resection of the prostate (TURP) and laser prostatectomy, are often linked to emergency room (ER) visits for postoperative bleeding. Although some studies have been conducted, the risk factors associated with these ER visits are not completely understood. This retrospective cohort study identified potential risk factors associated with ER visits for postoperative bleeding. Patients and Methods Preoperative assessment data and operational and postoperational parameters recorded at Chang Gung Memorial Hospital, Taiwan between December 2015 and January 2017 for patients who underwent elective transurethral procedures were analyzed to identify potential risk factors. The primary endpoint was ER visits for gross hematuria within three months following operation, and the secondary endpoint was ER visits for blood clot-induced urinary retention (clot retention) within three months following operation. Results A total of 665 patients who underwent elective transurethral procedures were enrolled. The transurethral procedures included monopolar transurethral resection of the prostate (M-TURP), bipolar TURP (B-TURP), greenlight photoselective vaporization of the prostate (PVP), thulium laser enucleation of the prostate (ThuLEP) and thulium laser transurethral vaporesection of the prostate (ThuVARP). Regarding ER visits for clot retention within three months, multivariable logistic regression revealed significantly lower rates of clot retention in patients who received B-TURP than in those who underwent ThuVARP (AOR, 0.18; 95% confidence interval [CI], 0.04–0.82, p = 0.027). Moreover, significantly higher clot retention was observed in patients who underwent two or more rounds of manual irrigation (AOR, 9.51; 95% CI, 1.66–54.43, p = 0.011). Conclusion Multiple manual irrigations shortly after operation can be considered a novel predictor of postoperative clot retention-related ER visits. Among the transurethral procedures, ThuVARP was associated with a higher risk of clot retention-related ER visits than was B-TURP.
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Affiliation(s)
- Tzu-Chi Teng
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - I-Hung Shao
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Yu-Chao Hsu
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Yu Chen
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Shu-Han Tsao
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Yen-Te Kang
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
| | - Ming-Li Hsieh
- Division of Urology, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, 33302, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, 33302, Taiwan
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14
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Chiang PL, Tseng YC, Wu HJ, Tsao SH, Wu SP, Wang WC, Hsieh HI, Juang JY. Elastic Moduli of Avian Eggshell. Biology (Basel) 2021; 10:989. [PMID: 34681088 PMCID: PMC8533214 DOI: 10.3390/biology10100989] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 09/28/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022]
Abstract
We analyze 700 freshly-laid eggs from 58 species (22 families and 13 orders) across three orders of magnitude in egg mass. We study the elastic moduli using three metrics: (i) effective Young's modulus, EFEM, by a combined experimental and numerical method; (ii) elastic modulus, Enano, by nanoindentation, and (iii) theoretical Young's modulus, Etheory. We measure the mineral content by acid-base titration, and crystallographic characteristics by electron backscatter diffraction (EBSD), on representative species. We find that the mineral content ranges between 83.1% (Zebra finch) and 96.5% (ostrich) and is positively correlated with EFEM-23.28 GPa (Zebra finch) and 47.76 GPa (ostrich). The EBSD shows that eggshell is anisotropic and non-homogeneous, and different species have different degrees of crystal orientation and texture. Ostrich eggshell exhibits strong texture in the thickness direction, whereas chicken eggshell has little. Such anisotropy and inhomogeneity are consistent with the nanoindentation tests. However, the crystal characteristics do not appear to correlate with EFEM, as EFEM represents an overall "average" elasticity of the entire shell. The experimental results are consistent with the theoretical prediction of linear elasticity. Our comprehensive investigation into the elastic moduli of avian eggshell over broad taxonomic scales provides a useful dataset for those who work on avian reproduction.
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Affiliation(s)
- Pei-Lin Chiang
- Department of Mechanical Engineering, National Taiwan University, Taipei 10617, Taiwan; (P.-L.C.); (Y.-C.T.); (H.-J.W.); (S.-H.T.); (S.-P.W.)
| | - Yu-Chien Tseng
- Department of Mechanical Engineering, National Taiwan University, Taipei 10617, Taiwan; (P.-L.C.); (Y.-C.T.); (H.-J.W.); (S.-H.T.); (S.-P.W.)
| | - Hsiao-Jou Wu
- Department of Mechanical Engineering, National Taiwan University, Taipei 10617, Taiwan; (P.-L.C.); (Y.-C.T.); (H.-J.W.); (S.-H.T.); (S.-P.W.)
- Department of Life Science, National Taiwan University, Taipei 10617, Taiwan
| | - Shu-Han Tsao
- Department of Mechanical Engineering, National Taiwan University, Taipei 10617, Taiwan; (P.-L.C.); (Y.-C.T.); (H.-J.W.); (S.-H.T.); (S.-P.W.)
| | - Shang-Ping Wu
- Department of Mechanical Engineering, National Taiwan University, Taipei 10617, Taiwan; (P.-L.C.); (Y.-C.T.); (H.-J.W.); (S.-H.T.); (S.-P.W.)
| | | | - Hsin-I Hsieh
- Taipei Zoo, Taipei 11656, Taiwan; (W.-C.W.); (H.-I.H.)
| | - Jia-Yang Juang
- Department of Mechanical Engineering, National Taiwan University, Taipei 10617, Taiwan; (P.-L.C.); (Y.-C.T.); (H.-J.W.); (S.-H.T.); (S.-P.W.)
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15
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Tsao SH, Chuang CK. Krukenberg tumor with concomitant ipsilateral hydronephrosis and spermatic cord metastasis in a man: A case report. World J Clin Cases 2021; 9:278-283. [PMID: 33511197 PMCID: PMC7809680 DOI: 10.12998/wjcc.v9.i1.278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tumors of the spermatic cord are rare, and approximately 25% are malignant neoplasms. Metastatic spermatic cord tumors are even rarer. Several studies have revealed that the most frequent primary tumors metastasizing to the spermatic cord and peritesticular tissues are neoplasms of the stomach and prostate. Furthermore, metastasis to the spermatic cord or epididymis may occur via retrograde lymphatic and hematic routes. We present the case of a man with gastric cancer that metastasized to the spermatic cord and epididymis, with concomitant ipsilateral hydronephrosis after surgical resection and chemotherapy for his primary tumor.
CASE SUMMARY A 71-year-old man underwent total gastrectomy for pT4aN2 poorly differentiated gastric adenocarcinoma in December 2016. Two months after surgery, he received adjuvant chemotherapy with TS-1 from February 2017 to February 2018. Surveillance computed tomography (CT) was performed in June 2018, which did not reveal any sign of tumor recurrence. In November 2019, he presented with left lower quadrant abdominal pain and a palpable left inguinal-scrotal mass. CT revealed left mild hydronephrosis and a left scrotal mass measuring 4.0 cm × 1.7 cm. Tumor biomarkers, including alpha-fetoprotein (AFP), lactate dehydrogenase (LDH), beta-human chorionic gonadotropin (βHCG), carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9) were all normal. Renal and testicular echography showed left hydronephrosis and a left peritesticular soft tissue lesion with blood flow. Diagnostic ureteroscopy showed left lower ureter narrowing without an intraluminal lesion. A biopsy was obtained for the indurated spermatic cord and epididymis, which showed poorly differentiated adenocarcinoma. Immunohistochemical staining demonstrated that the tumor was diffusely and strongly positive for homeobox protein CDX2. The features were consistent with metastatic adenocarcinoma of a primary gastric tumor.
CONCLUSION In patients with a history of primary cancer, an inguinal mass of unknown cause with accompanying ipsilateral hydronephrosis may be a sign of distant metastasis from a primary tumor, especially of gastrointestinal origin.
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Affiliation(s)
- Shu-Han Tsao
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
| | - Cheng-Keng Chuang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Taoyuan City 333, Taiwan
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Wang HH, Tsao SH, Lin KJ, Chu SH, Hsieh ML. Risk factors in delayed postoperative hematuria after transurethral prostatectomy: The role of preoperative leukocytosis and preliminary antibiotic treatment. Formos J Surg 2021. [DOI: 10.4103/fjs.fjs_215_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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