Cross-cultural translation into Chinese and psychometric evaluation of a screening tool for nocturia: the Targeting the individual's Aetiology of Nocturia to Guide Outcomes (TANGO) questionnaire

INTRODUCTION

We conducted translation and psychometric validation of a self-administered, 22-item dichotomous response-based questionnaire to identify nocturia aetiologies and co-morbidities in adult patients.

METHODS

The Targeting the individual's Aetiology of Nocturia to Guide Outcomes (TANGO) questionnaire was forward- and backward-translated, then finalised using a standardised methodology. The resulting version, a Chinese version of the TANGO [TANGO (CV)], was evaluated for internal consistency, test-retest reliability, content validity, convergent validity, criterion validity, and discriminant validity via responses from 65 participants (46 men and 19 women; mean age, 67 years, range, 50-88), in comparison with other validated questionnaires and a 4-day bladder/sleep diary.

RESULTS

Only 0.4% of responses were missing; 3% of participants required assistance with comprehension. The Kuder-Richardson Formula 20 (KR-20) coefficient for the whole tool was 0.711. Kappa values for individual domains and the whole tool varied from 0.871 to 0.866, indicating satisfactory test-retest reliability. There was strong agreement between the sum of positive responses to each domain and the whole tool (intra-class correlation coefficient=0.878-1.000). Modest correlations (ρ=0.4-0.6) were detected between the tool and bladder/sleep diary-based parameters for convergent validity. Criterion validity was confirmed for each domain and the whole tool [ρ=0.287-0.687]. In receiver operating characteristic analysis, the tool could distinguish patients (≥2 nocturia episodes/night) from controls (≤1 nocturia episode/night) [Youden's J statistic=0.453, area under the curve=0.818, 95% confidence interval (CI)=0.683-0.953] and patients with significant nocturia distress from patients with mild nocturia distress (Youden's J statistic=0.398, area under the curve=0.729, 95% CI=0.581-0.878).

CONCLUSION

The TANGO (CV) was formally crossculturally adapted and translated. Its psychometric properties (except sensitivity to change) were validated.

Transurethral resection of prostate for acute urinary retention is linked to shorter survival in younger men

It is largely unknown whether lower urinary tract symptoms (LUTS) or acute retention of urine (AROU) is linked to shorter life expectancy in men. We conducted a multicenter, retrospective database analysis of patients undergoing transurethral resection of prostate (TURP) to study their relationships. Multivariate Cox regression analysis and Kaplan–Meier analysis with stratification to age and indication of TURP were performed. We further performed an age- and sex-matched survival analysis with the general population using data from the Census and Statistics Department of the Hong Kong Special Administrative Region (Hong Kong, China). From January 2002 to December 2012, 3496 patients undergoing TURP were included in our study, with 1764 patients in the LUTS group and 1732 patients in the AROU group. Old age, ischemic heart disease, cerebrovascular accident, and AROU were risk factors of mortality. Patients aged <70 years (adjusted hazard ratio [HR]: 1.52, 95% confidence interval [CI]: 1.11–2.09, P = 0.010) and 70–80 years (adjusted HR: 1.39, 95% CI: 1.15–1.70, P = 0.001) in the AROU group had worse survival than those in the LUTS group, but such difference was not demonstrated in patients aged >80 years. Compared to the general population, younger patients in the LUTS group appeared to have better survival (<70 years, P = 0.091; 70–80 years, P = 0.011), but younger patients in the AROU group had worse survival (<70 years, P = 0.021; 70–80 years, P = 0.003). For patients aged >80 years, survival was similar with the general population in both the LUTS and AROU groups. In conclusion, AROU at young age was associated with mortality, while early detection and management of LUTS may improve survival.

Attitudes, acceptance, and registration in relation to organ donation in Hong Kong: a cross-sectional study

INTRODUCTION

The objective of this study was to investigate the discrepancy between individuals with positive attitudes towards organ donation and the actual number of registered organ donors in Hong Kong, and to investigate the best modalities for promoting more organ donor registrations.

METHODS

This cross-sectional telephone survey was conducted in Hong Kong. Telephone numbers were selected randomly. Upon successful contact with a household, the eligible household member who had the most recent birthday was selected to participate in the telephone interview.

RESULTS

A total of 1000 Hong Kong Chinese residents were interviewed successfully. The response rate was 53.8%. The majority of the respondents were female (68.3%) and were aged 51 to 60 years (24%) or ≥61 years (43.6%). Among the respondents, 31.3% were willing to donate their organs after death; 43.3% were indecisive, and 25.4% refused. Among those who were willing to donate organs after death, only 34.2% had registered with the Centralised Organ Donation Register (CODR). Among those who were willing to donate organs after death but had not yet registered on CODR, 52.2% said they were not determined enough to take action, 47.8% said they were too busy, 37.8% said they were too lazy, and 20.4% said they were always forgetful about registering. In all, 32.8% of the interviewees were not aware of the ways to register as a prospective organ donor. Among non-messenger social media platforms, Facebook, YouTube, and Instagram were the most commonly used. Most participants believed that Facebook and YouTube were effective for engaging audiences.

CONCLUSIONS

More effort should be made to facilitate organ donor registration in face-to-face settings via promotional booths and in online settings via appropriate social media platforms.

Survey on prevalence of lower urinary tract symptoms in an Asian population

INTRODUCTION

Lower urinary tract symptoms (LUTS) have a strong effect on socio-economic and individual quality of life. The aim of the present study was to investigate the prevalence of LUTS in an Asian population.

METHODS

A telephone survey of individuals aged ≥40 years and of Chinese ethnicity was conducted. The survey included basic demographics, medical and health history, drinking habits, International Prostate Symptom Score, overactive bladder symptom score, Patient Health Questionnaire (PHQ-9) score, and Short Form (SF)-12v2 score.

RESULTS

From March to May 2017, 18 881 calls were made, of which 1543 fulfilled the inclusion criteria. In the end, 1000 successful respondents were recruited (302 men and 698 women). Age-adjusted prevalence of overactive bladder syndrome was 15.1%. The older the respondent, the more prevalent the storage symptoms and voiding symptoms (storage symptoms: r=0.434, P<0.001; voiding symptom: r=0.190, P<0.001). Presence of hypertension and diabetes were found to be significantly and positively correlated with storage and voiding symptoms. Storage and voiding symptoms were found to affect PHQ-9 scores (storage symptoms: r=0.257, P<0.001; voiding symptoms: r=0.275, P<0.001) and SF-12v2 scores (storage symptoms: r=0.467, P<0.001; voiding symptoms: r=0.335; P<0.001). Nocturia was the most prominent symptom among patients who sought medical help for their LUTS.

CONCLUSIONS

Lower urinary tract symptoms are common in Asian populations. Both storage and voiding symptoms have a negative impact on mental health and general well-being of individuals.

Use of the International Prostate Symptom Score (IPSS) in Chinese male patients with benign prostatic hyperplasia

PURPOSE

To test the psychometric properties of the International Prostate Symptom Score (Hong Kong Chinese version 2) (IPSS) in Chinese male patients with benign prostatic hyperplasia (BPH) under secondary care.

METHODS

A prospective longitudinal study was done by interviewing subjects at baseline, at 2 week after baseline for assessing test-retest reliability and at 26 week after baseline for assessing responsiveness. All subjects were interviewed to complete a structured questionnaire including IPSS, Short Form-12 Health Survey version 2 (SF-12v2) and Depression Anxiety Stress Scale (DASS).

RESULTS

The IPSS HRQOL score had weak correlations with SF-12v2 summary and DASS domain scores. For reliability analysis, Cronbach's alpha coefficient was 0.90 for the seven symptom-related items. The intraclass correlation coefficients of the IPSS total symptom score and HRQOL score were 0.90 and 0.86, respectively. For sensitivity, statistically significant differences were detected between the subjects with BPH and those without for IPSS total symptom score (effect size = 0.68) but not the IPSS HRQOL score. The areas under ROC curves for the IPSS total symptom and HRQOL scores were 0.67 and 0.60, respectively.

CONCLUSIONS

The IPSS was valid, reliable instrument in Chinese patients with BPH. The IPSS total symptom score, but not the HRQOL score, is sensitive in differentiating subgroups.

Comparison of Detrusor Muscle Sampling Rate in Monopolar and Bipolar Transurethral Resection of Bladder Tumor: A Randomized Trial

PURPOSE

Our aim was to investigate the detrusor muscle sampling rate after monopolar versus bipolar transurethral resection of bladder tumor (TURBT).

METHODS

This was a single-center, prospective, randomized, phase III trial on monopolar versus bipolar TURBT. Baseline patient characteristics, disease characteristics and perioperative outcomes were compared, with the primary outcome being the detrusor muscle sampling rate in the TURBT specimen. Multivariate logistic regression analyses on detrusor muscle sampling were performed.

RESULTS

From May 2012 to December 2015, a total of 160 patients with similar baseline characteristics were randomized to receive monopolar or bipolar TURBT. Fewer patients in the bipolar TURBT group required postoperative irrigation than patients in the monopolar TURBT group (18.7 vs. 43%; p = 0.001). In the whole cohort, no significant difference in the detrusor muscle sampling rates was observed between the bipolar and monopolar TURBT groups (77.3 vs. 63.3%; p = 0.057). In patients with urothelial carcinoma, bipolar TURBT achieved a higher detrusor muscle sampling rate than monopolar TURBT (84.6 vs. 67.7%; p = 0.025). On multivariate analyses, bipolar TURBT (odds ratio [OR] 2.23, 95% confidence interval [CI] 1.03-4.81; p = 0.042) and larger tumor size (OR 1.04, 95% CI 1.01-1.08; p = 0.022) were significantly associated with detrusor muscle sampling in the whole cohort. In addition, bipolar TURBT (OR 2.88, 95% CI 1.10-7.53; p = 0.031), larger tumor size (OR 1.05, 95% CI 1.01-1.10; p = 0.035), and female sex (OR 3.25, 95% CI 1.10-9.59; p = 0.033) were significantly associated with detrusor muscle sampling in patients with urothelial carcinoma.

CONCLUSIONS

There was a trend towards a superior detrusor muscle sampling rate after bipolar TURBT. Further studies are needed to determine its implications on disease recurrence and progression.

Extracorporeal shockwave therapy in the treatment of erectile dysfunction: a prospective, randomized, double-blinded, placebo controlled study

OBJECTIVES

To investigate the role of low-intensity extracorporeal shockwave therapy in the treatment of erectile dysfunction.

METHODS

This was a double-blinded, single-center, prospective, randomized, placebo-controlled trial. After a 2-week phosphodiesterase type 5 inhibitor washout period, patients were assessed with Sexual Health Inventory for Men, International Index of Erectile Function-ED domain scores and Erection Hardness Score. Randomization into either the low-intensity extracorporeal shockwave therapy group or the sham group took place. After the 9-week treatment period, patients were followed up 4 weeks later. Follow-up assessment was in the form of International Index of Erectile Function-ED domain score and Erection Hardness Score.

RESULTS

A total of 70 patients were recruited into the study, 58 patients completed the study. A total of 28 patients were randomized into the sham therapy arm, and 30 patients were randomized into the low-intensity extracorporeal shockwave therapy arm. There was no significant difference between these two groups in baseline International Index of Erectile Function-ED domain score and Erection Hardness Score. The mean International Index of Erectile Function-ED domain score of the low-intensity extracorporeal shockwave therapy arm and sham arm in week 13 were 17.8 ± 4.8 and 15.8 ± 6.1, respectively (P = 0.156). The mean Erection Hardness Scores in week 13 were 2.7 ± 0.5 and 2.4 ± 0.9, respectively (P = 0.163). When patients were stratified into different baseline Sexual Health Inventory for Men subgroups, the pre-intervention and post-intervention difference in low-intensity extracorporeal shockwave therapy was found to be significant in the subgroup with severe erectile dysfunction (low-intensity extracorporeal shockwave therapy International Index of Erectile Function-ED domain improvement: 10.1 ± 4.1 vs sham therapy International Index of Erectile Function-ED domain improvement: 3.2 ± 3.3; P = 0.003).

CONCLUSION

The present trial shows the tolerability and clinical efficacy of low-intensity extracorporeal shockwave therapy in a subgroup of patients with erectile dysfunction.

The prevalence of lower urinary tract symptoms in a Chinese population, and the correlation with uroflowmetry and disease perception

OBJECTIVES

To evaluate the prevalence of lower urinary tract symptoms (LUTS) in a population of Chinese men, and its correlation with uroflowmetry and disease perception.

MATERIALS AND METHODS

Male volunteers above 40-year old were recruited in the community. Assessment with International Prostatic Symptom Score (IPSS), uroflowmetry, and a quiz on prostatic disease knowledge with 12 true-false-type questions were performed. Correlation of IPSS with uroflowmetry results and prostatic disease knowledge was analyzed.

RESULTS

A total of 319 men were recruited for the study, with a mean age of 62 ± 8 years. About 69.3 % of them had moderate-to-severe symptoms on IPSS. A statistically significant correlation was found between IPSS and Q max (r = -0.260, p < 0.001), IPSS and quality of life (r = -0.172, p = 0.002), and IPSS and post-void residuals (r = 0.223, p < 0.001). About 53.0 % of subjects had less than 4 correct answers for the 12 true-false questions. Negative correlation was noted between the number of correct answers and IPSS (r = -0.185, p = 0001). In other words, for the better knowledge on prostatic diseases, the lower IPSS was found.

CONCLUSIONS

In a cohort of community-dwelling Chinese men, a significant portion of the population had moderate-to-severe LUTS. While uroflowmetry parameters were found to correlate with IPSS, the degree of knowledge on prostatic diseases also shared a statistically significant correlation with IPSS. This has an implication on the role of urological health education in the future.

Late retroperitoneal recurrence of hepatocellular carcinoma 12 years after initial diagnosis

Hepatocellular carcinoma (HCC) is an aggressive tumor with poor long-term prognosis. Here, we present an unusual patient with a solitary recurrence of HCC in the right kidney 12 years after the initial diagnosis. This illustrates the importance of considering late recurrence in patients with a history of HCC and the management of these metastases.

Short-term outcome of patients with robot-assisted versus open radical prostatectomy: for localised carcinoma of prostate

OBJECTIVE

To compare the short-term outcome of patients undergoing robot-assisted versus open radical prostatectomy.

DESIGN

Retrospective analysis of prospectively collected data.

SETTING

A university teaching hospital in Hong Kong.

PATIENTS

Twenty consecutive cases having robot-assisted radical prostatectomy were compared with the last 20 cases of open radical prostatectomy (prior to November 2005 when the robotic system was introduced).

MAIN OUTCOME MEASURES

Perioperative functional evaluation (with special emphasis on continence) and oncological evaluation (included margin studies and prostate-specific antigen levels).

RESULTS

Regarding baseline clinical characteristics of the patients, there was no statistically significant difference between the robotic and open radical prostatectomy groups. For perioperative outcome, in the robotic group the blood transfusion rate was significantly lower (5 vs 65%), hospital stay was shorter (8 vs 17 days), and the catheter time was shorter (12 vs 18 days). For early oncological outcome, there was no statistically significant difference in the margin positive rate and early prostate-specific antigen results. Regarding continence (use of 0-1 pads/day), it was achieved by 95% in the robotic group with a mean follow-up of 6 months compared to 85% in the open group with a mean follow-up of 42 months.

CONCLUSIONS

Robot-assisted radical prostatectomy offered the benefits of a minimally invasive operation with less blood loss, shorter catheter time and hospital stay, and earlier continence. It has therefore become the preferred surgical option in our institution.

Prospective randomized controlled trial comparing plasmakinetic vaporesection and conventional transurethral resection of the prostate

OBJECTIVE

Plasmakinetic vaporesection of the prostate (PKVP) using normal saline irrigation has the theoretical advantage of avoiding transurethral resection syndrome and minimizing blood loss. It may also shorten the operative time since tissue is resected instead of just vaporized. The aim of this study was to evaluate the efficiency, safety and advantages of PKVP compared with standard transurethral resection of the prostate (TURP) at a regional acute hospital.

METHODS

A total of 60 consecutive men admitted from a waiting list for surgery for benign prostatic hyperplasia (BPH) were prospectively randomized to either PKVP or TURP. Peri- and postoperative outcome data at 3 months were obtained.

RESULTS

The PKVP loop achieved a fast and sharp cutting action similar to that with the traditional TURP loop. Data analysis was based on 51 patients. There were no significant differences between the methods in resection time, postoperative catheterization time and hospital stay. The mean reductions in serum sodium 2 hours after PKVP and on postoperative day 1 were 0.52 mmol/L and 3.35 mmol/L, respectively, while mean reductions in haemoglobin were 0.36 g/dL and 0.24 g/dL, respectively. There was no significant difference in haemoglobin reductions between PKVP and TURP (p = 0.326 at 2 hours; p = 0.192 on day 1) and serum sodium (p = 0.757 at 2 hours; p = 0.888 on day 1). Both groups achieved comparable improvement in International Prostate Symptom Score (p = 0.862), quality-of-life score (p = 0.169) and peak flow rate (p = 0.96) at 3-month follow-up.

CONCLUSION

PKVP achieved comparable results to traditional TURP and was an effective and safe procedure. However, it did not demonstrate obvious advantages over TURP in this acute regional hospital regular TURP list setting.