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   Table of Contents - Current issue
Coverpage
May-June 2020
Volume 31 | Issue 3
Page Nos. 89-144

Online since Friday, June 26, 2020

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EDITORIAL  

Functional urology – Renew our understanding of overactive bladder and lower urinary tract symptoms Highly accessed article p. 89
Yao-Chi Chuang
DOI:10.4103/UROS.UROS_56_20  
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REVIEW ARTICLE Top

Perspectives of medical treatment for overactive bladder p. 91
Chu-Tung Lin, Bing-Juin Chiang, Chun-Hou Liao
DOI:10.4103/UROS.UROS_16_20  
Overactive bladder (OAB) syndrome is a clinical symptom diagnosis. Treatment strategies are aimed at relieving symptoms. Because antimuscarinic drugs are applied for OAB, several targets of treatment about OAB had been found and newer treatments were also discovered. Besides, further studies about the potential advantages of combination therapy are proved to have increased efficacy and acceptable tolerability. Our study aims to update clinicians managing an OAB with an overview of the existing and newer medical therapies for OAB, including pharmacology, efficacy, side effects, and impact on the patient's quality of life. We review the most frequently used pharmacological therapies and new agents aimed at treating OAB. PubMed and Medline were explored for randomized controlled drug trials in adults with OAB, meta-analyses of medical therapy for OAB, and individual drug names, including the keywords efficacy, tolerability, quality of life, and compliance. In conclusion, newer antimuscarinic drugs focus on more selective muscarinic receptors with less side effects. Some β3-adrenoceptor (β-AR) agonists had also been approved in Japan, and Phase III study is ongoing in the USA. In addition to antimuscarinic drugs and β-AR agonists, several newer treatments, such as intravesical botulinum toxin injection and phosphodiesterase-5 inhibitors, were proved to improve OAB symptoms. The new targets of treatment should be the focus of future studies.
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ORIGINAL ARTICLES: CLINICAL SCIENCE Top

Combination alpha blocker and phosphodiesterase 5 inhibitor versus alpha-blocker monotherapy for lower urinary tract symptoms associated with benign prostate hyperplasia: A systematic review and meta-analysis Highly accessed article p. 99
Po-Cheng Chen, Chung-Cheng Wang, Yu-Kang Tu
DOI:10.4103/UROS.UROS_59_19  
Purpose: The prevalence of erectile dysfunction (ED) is higher in patients with lower urinary tract symptoms (LUTS). Phosphodiesterase 5 inhibitors (PDE5is) can improve both ED and LUTS and therefore is useful for these patients. Our aim of this study is to evaluate whether combination therapy of alpha blockers and PDE5i is more effective than alpha-blockers monotherapy for the treatment of LUTS. Materials and Methods: A systematic review and meta-analysis were undertaken to assess the difference between the combination therapy and alpha-blockers monotherapy by searching published randomized controlled trials from electronic databases PubMed, Embase, and the Cochrane Library up to April 2018. Results: A total of 13 randomized controlled studies with 1173 patients were included in our meta-analysis. Compared with alpha-blocker monotherapy, the combination therapy obtained a significantly better improvement in International Prostate Symptom Score (IPSS) (1.73, 95% confidence interval [CI]: 1.1–2.35), voiding subscore (0.99, 95% CI: 0.54–1.44), storage subscore (0.57, 95% CI: 0.03–1.1), peak flow rate (0.69 cc/s, 95% CI: 0.27–1.1), and erectile function (EF) symptom score. Meta-regression showed that baseline IPSS, baseline peak flow rate, baseline prostate volume, age, baseline EF symptom score, and dosage of PDE5is were not associated with the difference in IPSS improvement. Conclusion: A combination of alpha blockers and PDE5is has better therapeutic effects than alpha-blocker monotherapy on LUTS related to benign prostate hyperplasia.
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The impact of pseudoephedrine and antihistamine on lower urinary tract symptoms in male patients with rhinitis: A prospective randomized study p. 108
Chen-Che Lee, Yuan-Yun Tam, Ying-Hsu Chang, Ming-Li Hsieh, I-Hung Shao
DOI:10.4103/UROS.UROS_85_19  
Purpose: The effects of medications for treating nasal congestion on voiding function remain unclear. In this study, we aimed to elucidate the effects of the common decongestants, pseudoephedrine, and antihistamine, on voiding dysfunction in men without clinical lower urinary tract symptoms. Materials and Methods: We prospectively enrolled 200 consecutive male patients who visited the otolaryngology department for rhinitis from August 2015 to August 2016. These patients were then randomized to the pseudoephedrine or antihistamine groups. The International Prostate Symptom Score (IPSS) and postvoiding residual urine (PVR) were assessed before and 1 week after treatment and the results were analyzed. Patients were further stratified by age (≥50 years old vs. <50 years old) and IPSS (>7 vs. ≤7) in each group and comparison analyses were conducted. Results: There were no significant differences between the baseline characteristics of the pseudoephedrine and antihistamine groups. The IPSS total, IPSS voiding, and IPSS storage (IPSS-T, IPSS-V, and IPSS-S, respectively) tended to increase in the pseudoephedrine group but did not reach statistical significance. Similar results regarding IPSS-T and IPSS-V were seen in the antihistamine group. The IPSS-T increased significantly in patients ≥50 years old treated with pseudoephedrine, which was not observed in the antihistamine group. The IPSS-V was significantly higher in patients <50 years old treated with antihistamine. The PVR did not significantly change after treatment with both drugs. However, in patients with baseline IPSS-T >7 treated with pseudoephedrine, the PVR tended to increase. Conclusion: Pseudoephedrine and antihistamine have minimal effects on lower urinary tract function in the general male population. However, pseudoephedrine worsened IPSS-T in elderly men, whereas antihistamines worsened IPSS-V in younger men. In self-unaware voiding dysfunction male with IPSS-T > 7, pseudoephedrine may cause more PVR. Thus, in elderly men with rhinitis, antihistamines may be more suitable, while pseudoephedrine would be preferable in younger men.
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Editorial comment: The impact of pseudoephedrine and antihistamine on lower urinary tract symptoms in male patients with rhinitis: A prospective randomized study p. 114
Chung-Cheng Wang
DOI:10.4103/UROS.UROS_55_20  
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A lower urine white blood cell median can be a predictor of undiscovered urolithiasis in patients with acute urinary tract symptoms p. 115
Yuan Chen, Chun-Hou Liao, Bing-Juin Chiang, Hsu-Che Huang, Yu-Wei Chou
DOI:10.4103/UROS.UROS_12_20  
Purpose: Acute urinary tract infection (UTI) causes symptoms including urgency, frequency, dysuria, and pain in the lower urinary tract. However, these symptoms are not unique to infection. Urolithiasis, injury, neurological disease, and malignancy present with the same symptoms. We aimed to find predictors in urinalysis to detect underlying causes in patients with acute UTI symptoms. Materials and Methods: We recruited 192 patients who presented with acute UTI symptoms from a single institute between September 2012 and September 2018. Each patient received urinalysis, kidney–ureter–bladder X-ray, and kidney plus transabdominal bladder sonography as primary surveys. Patients with flank pain and hydronephrosis but without definitive radiopaque lesion received computed tomography (CT) scan as an advanced intervention. Cystoscopy was ordered by the physician if the patient had gross hematuria and was suspected to have intravesical lesion. We correlated the urine nitrate, the median of red blood cells (RBCs) and white blood cells (WBCs), and the ratio of red and WBCs with the finding on image studies, which included sonography, X-ray, and CT by statistical models. Results: In patients with urolithiasis detected by either X-ray or CT, logistic regression showed that higher urine RBC and lower urine WBC medians were predictors of urolithiasis. In the ROC analysis, WBC median lower than 7.75 per high power field (HPF) was a significant predicting factor for the positive finding of urolithiasis on a CT scan. Conclusion: When presenting with acute UTI symptoms, patients with a lower urine WBC median are correlated with a higher probability to have urolithiasis. In addition, WBC median lower than 7.75 per HPF in urinalysis is a predictor for urolithiasis found on CT in patients with flank pain or hydronephrosis.
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Editorial comment: A lower urine white blood cell median can be a predictor of undiscovered urolithiasis in patients with acute urinary tract symptoms p. 122
Yung-Shun Juan
DOI:10.4103/UROS.UROS_70_20  
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Smoking behavior and survival outcomes in bladder cancer patients p. 123
Wei-Chung Chu, Chung-Hsin Chen
DOI:10.4103/UROS.UROS_95_19  
Purpose: The purpose of this study was to compare the survival outcomes of bladder cancer patients with different smoking behaviors. Materials and Methods: Between January 2011 and December 2014, a total of 565 bladder cancer patients were included from one institute retrospectively. Regarding smoking behavior, among these patients, 337 were nonsmokers, 52 were “quitters” (patients who had quit smoking ≥10 years ago), 54 were ex-smokers (patients who had quit smoking <10 years ago), and 117 were current smokers. We compared the clinicopathological characteristics and survival outcomes among these four groups. Results: In this cohort, the 3-year overall survival (OS) (95% confidence interval [CI]) of the nonsmoker, quitter, ex-smoker, and current smoker groups were 75.6% (95% CI: 72.9%–78.3%), 67.4% (95% CI: 59.8%–75%), 84.1% (95% CI: 78.9%–89.3%), and 83.2% (95% CI: 79.3%–87.1%), respectively. Nonsmoker patients included a higher number of females, and quitters were older than the patients in the other groups. Larger tumors in quitters and higher clinical stages in ex-smokers were observed more frequently than in the patients of the other groups. Compared with nonsmokers, quitters, and ex-smokers, current smokers had no impact on OS (P = 0.541, 0.406, and 0.175, respectively) nor on cancer-specific survival (CSS) (P = 0.631, 0.388, and 0.193, respectively). Higher diagnostic age, being underweight, larger tumor sizes, and higher clinical stages were independent factors predicting OS. Conclusion: Smoking behavior seemed to not directly contribute to the deterioration of overall or CSS duration in patients with bladder cancer.
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Clinical profile of patients with renal trauma: A cross-sectional observational study p. 131
JB Narendra, CS Ratkal, R Keshavamurthy, VS Karthikeyan
DOI:10.4103/UROS.UROS_50_19  
Background: Renal trauma is generally managed with conservative or surgical treatment. This study evaluated the clinicoradiological profile of renal trauma patients (Grades I–V) and their management to determine the association of grade of renal trauma with length of hospital stay and type of treatment. Materials and Methods: This cross-sectional prospective observational study included patients with renal trauma aged >18 years. All the study patients underwent computed tomography for identification and grading of renal injury (I–V). Results: A total of 121 patients with renal trauma were included in this study. The mean (standard deviation) age was 42.36 (17.95) years. The majority of the study patients (n = 101) were managed conservatively. Rib fracture (n = 15) was the most common associated injury, and the majority had unilateral renal injury (n = 117). The distribution of patients according to grades of renal trauma was 21 (17.35%) in Grade I; 32 (26.45%), Grade II; 25 (20.66%), Grade III; 38 (31.40%), Grade IV; and 5 (4.13%), Grade V. Length of hospital stay was ranging from 7 to 15 days, increasing with the severity of grades from Grade I to Grade V. Grade of renal trauma was positively correlated with length of hospital stay, respectively (r = 0.390, P = 0.003). Grade of renal injury (P = 0.019) and type of treatment (P = 0.028) significantly affected the variations in the length of hospital stay. Conclusion: Conservative treatment is the preferred management approach for renal trauma; grade of renal trauma and type of treatment are responsible for variation in the length of hospital stay.
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CASE REPORTS Top

Accidentally found metastatic adenocarcinoma of prostate in an incised inguinal hernia sac p. 136
Shang-Rong Zhong, Yu-Wei Lai, Yih-Yiing Wu
DOI:10.4103/UROS.UROS_94_19  
An 83-year-old male patient received hernioplasty, and the submitted specimen was incidentally found to microscopically have adenocarcinoma of prostatic. He received transrectal ultrasound-guided prostate biopsy and prostate adenocarcinoma with confirmed Gleason score 4 + 5. Inguinal hernia sacs obtained from hernioplasty are routinely sent for pathological examination in some medical facilities although meaningful results are rare. A retrospective study released in 2014 presented only 11 cases (0.35%) of malignancy in a total of 3117 specimens, while one-third of the patients had preexisting malignancies before operations. There were only sporadic cases reports on the prostate cancer disclosed in hernia sacs, while nearly all cases displayed metastasis that was found in the inguinal hernia sac. These findings suggested the advanced nature of the disease and diminished survival time. This report reminds us of the polymorphic characteristics of prostate cancer and its possibility of metastasis in an unusual way.
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Cavernous hemangioma of ureter masquerading as malignancy – A rare case report p. 139
K Sajitha, HL Kishan Prasad, Ashwathy Pradeep, TP Rajeev, Michelle Mathias, K Jayaprakash Shetty
DOI:10.4103/UROS.UROS_15_20  
Hemangiomas of the genitourinary tract are rare. They may be clinically silent or present with profuse or recurrent hematuria. They result from embryological remains of unipotent angioblastic cells that show anomalous development within the blood vessels. They can be single or multiple. Multiple hemangiomas are called cutaneous angiomatosis, occurring in the setting of genetic disorders such as Klippel–Trenaunay syndrome or Sturge–Weber syndrome. Careful correlation between the clinical, radiological, and histological findings may help in avoiding unnecessary radical procedures. Here, we present a case of cavernous hemangioma occurring in the proximal ureter, causing hydronephrosis and posing a diagnostic challenge.
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LETTER TO THE EDITOR Top

Prostate tuberculosis: A rare complication of pulmonary tuberculosis with malignant features mimicking prostate cancer p. 142
Mahmood Dhahir Al-Mendalawi
DOI:10.4103/UROS.UROS_38_20  
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CME TEST Top

CME Test p. 143

DOI:10.4103/1879-5226.287972  
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