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   Table of Contents - Current issue
July-August 2019
Volume 30 | Issue 4
Page Nos. 143-196

Online since Monday, July 29, 2019

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Primary care urology and andrology p. 143
Stephen Shei-Dei Yang
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Metabolic profiling based on nuclear magnetic resonance spectroscopy and mass spectrometry as a tool for clinical application p. 144
Herney Andrés Garcia-Perdomo, Felipe García Vallejo, Adalberto Sanchez
Metabolomics provides an abundance of information with the potential to accurately describe the physiological state of an organism. It aims to identify small molecules under physiological conditions that might serve as biomarkers and aid in the identification and treatment of health problems. Combining nuclear magnetic resonance (NMR) with mass spectrometry (MS) yields better identification and quantification of compounds, especially in mixtures, as well as the ability to cross-analyze data from both techniques and thereby increase the number of compounds identified. Metabolomic profiling using NMR and/or MS provides an important diagnostic tool for identifying metabolites under different conditions. This also requires a valid and reliable way to standardize the way we use it to identify biomarkers. Regarding the clinical application of metabolomics, for bladder cancer, threonine, phenylalanine, valine, isoleucine, lysine, methionine, leucine, glutamate, histidine, arginine, aspartic acid, tyrosine, glutamine, and serine were found discriminative in diagnosing this entity. On the other side, sarcosine, choline, phosphocholines, phosphorylcholines, carnitines, citrate, amino acids (lysine, glutamine, and ornithine), arachidonoyl amine, and lysophospholipids were found discriminative regarding the prostate cancer diagnosis.
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Olea europaea subsp. Cuspidata and Juniperus procera hydroalcoholic leaves' extracts modulate stress hormones in stress-induced cystitis in rats p. 151
Anmar M Nassir, Ibrahim Abdel Aziz Ibrahim, Mohamed A Afify, Naser A ElSawy, Mohammad Tarique Imam, Mohammad Hassan Shaheen, Mohammed Adel Basyuni, Ammar Bader, Raed A Azhar, Naiyer Shahzad
Objective: To study the effect of Saudi medicinal plant in stress-induced cystitis in experimental rats. Materials and Methods: Seventy-two female Sprague Dawley rats (200–250 g) were divided into eight groups of 9 rats each. Group 1 and 2 are controls assigned nonstressed and stressed, respectively. Other six groups received different treatments for 2 weeks. After the 14 days of treatment, each group was exposed to water-immersion restraint stress (WIRS) for 30 min. Blood samples were collected to measure the corticotropin-releasing hormone (CRH) and adrenocorticotropic hormone (ACTH) levels. The rats were sacrificed, and their urinary bladders were isolated immediately for a histological and immunohistochemical examination. Results: Rats exposed to WIRS had lesions in the urinary bladder, with a significant increase in plasma CRH and ACTH levels in comparison to the nonstressed controls. Bladder cut sections in stressed rats showed no gross structural abnormality in smooth muscle and connective tissue ratio. There were noticeable variations in mast cell (MC) infiltration and activity with a loss of more than 20% of cellular staining and a significant increase in the number of red blood cell-filled blood vessels. Our findings showed that supplementation of Olea europaea leaf extract (OEE) or Juniperus procera leaf extract (JPE) reduced the MC infiltration and significantly reduced stress hormones compared to the stressed controls. Conclusions: The present study demonstrated that OEE/JPE alone and their combination have a potential protective effect against stress-induced cystitis in rats. The underlying mechanism of the present study also resulted in a decrease in CRH and ACTH stress hormones.
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Robot-assisted radical cystectomy with intracorporeal urinary diversion: A feasible option for elderly patients? Results from a single high-volume center p. 157
Daniele Romagnoli, Federico Mineo Bianchi, Marco Giampaoli, Paolo Corsi, Daniele D'agostino, Riccardo Schiavina, Eugenio Brunocilla, Walter Artibani, Angelo Porreca
Aim: We report the oncological and functional outcomes of a population of elderly patients who underwent robotic-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (IUD) at a single high-volume center with extensive experience in robotic surgery.Patients and Methods: Each procedure was performed by a single main surgeon, who previously attained a 30-day modified modular training program at a referring center. None technical variation was performed, and the surgical technique was performed exactly as taught. Demographics, intraoperative data, and postoperative complications were recorded for each patient of the aforementioned population. Results: From July 2015 to December 2018, we submitted to RARC with totally IUD at our institution 29 elderly patients (aged ≥75 years). Median age was 78 years (interquartile range [IQR]: 76–82). Eleven (37.9%), 12 (41.4%), and 6 (20.7%) patients received RARC with ureterocutaneostomy, ileal conduit, and orthotopic neobladder, respectively. Overall, median operative time was 360 min (IQR: 270–410). The median number of lymph node retrieved was 24 (17–34), the median intraoperative estimated blood loss (EBL) was 200 mL (150–300), with median hospitalization time of 7 days (IQR: 6–9). Each procedure was successfully completed without open conversion. A statistically significant reduction was found in the operative time, when compared to a population of younger patients (aged <75 years), probably reflecting the significant reduction in the choice of the nerve-sparing approach. Early (<30 days) and late (≥30 and <90 days) complication rates and cancer-specific mortality and overall mortality rates were not found statistically significant difference. Conclusions: In experienced hands, RARC with IUD can be safely applied to elderly patients, without a significant difference in terms of complication rates, cancer-specific survival, and overall survival.
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Effect of long-term administration of tadalafil on arteriosclerosis: A prospective cohort study p. 164
Keiichiro Hayashi, Haruaki Sasaki, Takashi Fukagai, Tetsuo Noguchi, Kidai Hirayama, Yu Ogawa, Atsushi Igarashi, Masashi Morita, Kimiyasu Ishikawa, Yoshio Ogawa
Purpose: The aim of this study is to prospectively investigate whether the long-term administration of tadalafil, which is commonly used for erectile dysfunction, could reduce arteriosclerosis. Materials and Methods: This study included 85 patients who presented to one of the three hospitals with lower urinary tract symptoms. Tadalafil was administered daily (5 mg/d), and pulse wave velocity (PWV) was measured before administration and at weeks 12, 24, 36, and 48. The International Prostate Symptom Score, Overactive Bladder Symptom Score, and Erection Hardness Score were simultaneously assessed at the same time points. Further subanalyses were performed in patients with a high risk of cardiovascular events, those aged 75 years or older, and those younger than 75 years. The Wilcoxon signed-rank test was used for statistical analysis. Results: Compared with pretreatment values, the PWV did not show any statistically significant decrease at any time point. The group at high risk of cardiovascular events showed significant improvement at weeks 24 and 36, whereas the 75 years or older group showed significant improvement at only week 24. However, the three aforementioned scores significantly improved in all patients during treatment. Conclusions: The long-term administration of tadalafil (5 mg/d) might inhibit the progression of arteriosclerosis or prevent its future development.
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Knowledge, attitude, confidence, and barriers in the practice of erectile dysfunction screening among primary health-care providers in Taiping Perak, Malaysia p. 170
Chai Li Tay, Abdul Rahim Bin Abdul Razak, Chun Khui Tan, Min Zin Tan
Background: Erectile dysfunction (ED) is a common health problem and has clinical importance. it is well documented that ED is associated with coronary heart disease. However, the practice of ED screening is poor in primary care settings. Objectives: To assess primary health-care providers' knowledge and attitude toward ED and to determine the confidence and barriers in the screening of ED. Materials and Methods: A cross-sectional study using self-administered questionnaires was conducted at 11 government health clinics in Taiping Perak in 2018 involving all health-care providers who run the outpatient and noncommunicable disease unit. SPSS (version 25) statistical package was used to analyze the data. Mann–Whitney U-test, Kruskal–Wallis test, and Chi-square test were employed. Results: A total of 77 primary health-care providers participated in this study. The median age of the participants was 31 years (interquartile range 7). A total of 38 (49.4%) participants scored above the median knowledge. Participants who were doctors, users of clinical practice guide in ED, confident in ED screening, and perceived adequate training scored higher in knowledge (P ≤ 0.05). Smoking as a cause of ED (98.7%) recorded the highest percentage of correct responses, whereas the prevalence of ED (18.2%) recorded the lowest. All participants perceived ED as an important health issue and felt that proper treatment is required. Only 16 (20.8%) participants had confidence in ED screening practice. Lack of training in ED screening and assessment was the barrier that significantly affects the confidence of practice (P = 0.012). Conclusion: The knowledge on ED and confidence in its screening were unsatisfactory among the primary health-care providers. Our work suggests the requirement to equip health-care professionals with adequate training on ED screening, assessment, and management for early prevention of cardiovascular disease and improvement of men's quality of life.
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The impact of the fine ambient particle on infertile male's sperm quality p. 177
Yuan Chen, Hong-Chiang Chang, Chun-Hou Liao, Bing-Juin Chiang, Yi-Kai Chang
Introduction: Infertility has been a major problem for several years. Previously, infertility was often attributed to female factors. Recently, however, male factors have been found to contribute to 50% of the infertility cases overall. Male infertility is a multifactorial issue. A genetic disorder, abnormal endocrine system, structural anomaly, and environmental causes could lead to male infertility. Studies have revealed a link between fine air particles and decreased fertility. The aim of this study was to discover the effect of particulate matter 2.5 (PM2.5), representing environmental fine particles, on male infertility. Materials and Methods: We retrospectively collected data from patients diagnosed as having infertility and visited National Taiwan University Hospital from January 2015 to October 2017. We recorded each patient's body weight, height, basic blood test, sperm analysis, and sex hormone profile. Air quality data, especially PM2.5 concentration, were acquired from the Environmental Protection Administration of Taiwan. A total of 78 monitoring stations throughout Taiwan record PM2.5 concentrations (μg/m3) each hour automatically. Multivariate linear regression was used to detect independent factors affecting sperm count, concentration, motility, and morphology and sex hormone profile. Results:We observed regional and seasonal differences in the distributions of PM2.5 concentrations. In nearly all cities in Taiwan, the PM2.5 concentrations increased during early winter and continued to increase until next spring, with a peak around January and February. In particular, regional differences were observed in winter. The peak PM2.5 concentrations in southern and northern cities in Taiwan ranged between 35 and 40 μg/m3 and between 18 and 23 μg/m3, respectively. PM2.5 in central Taiwan reached as high as 30 μL/m3. By contrast, the eastern part of Taiwan had the lowest peak PM2.5, which was mostly <15 μg/m3. The average 24-month PM2.5 concentration had a negative effect on sperm count, but the result was nonsignificant. Additionally, the effect of PM2.5 on sperm motility and morphology was minimal. Conclusion: In infertile Taiwanese men, there is a trend of a negative association between exposure to PM2.5 and sperm concentration and total sperm count. Exposure to ambient fine particles, especially PM2.5, might have a negative correlation with sperm quality, sex hormone balance, and the testicular microenvironment through different mechanisms.
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Sonography-assisted seldinger wire technique: A safe way of a suprapubic catheterization training program for rotating staff p. 184
Chao-An Chen, Yu-Jun Chang, Man-Lok Lio, Heng-Chieh Chiang, Bai-Fu Wang, Pao-Hwa Chen
Context: In Changhua Christian Hospital (CCH), the urology division is a branch of the surgical department. The urology residents in this division are, on average, off duty for 10 days/month; surgical residents from other divisions usually lack training to practice urology. Therefore, attending urology doctors or visiting urology staff members in CCH branches must be on call during off-duty periods in case a patient is indicated for suprapubic cystostomy. Aims:This study aims to promote a safe and efficient approach to train rotating residents to perform suprapubic catheterization. Subjects and Methods: On the basis of ultrasound-guided central venous catheter insertion, we designed training sessions for suprapubic cystostomy for rotating surgical residents during their urology course. Participants and Methods: From 2016 to 2018, senior residents or attending doctors of urology evaluated the clinical skills of rotating residents by using the direct observation of procedural skills tool before and after the training course. Statistical Analysis Used: Mann–Whitney U-test, Wilcoxon signed rank test, and multiple linear regression analysis. Results: The trainees were separated into different groups according to their sex, year of residency, and previous urology training in the postgraduate year (PGY). All groups had significant gain scores. Our multiple linear regression analysis revealed a relationship between previous urology training in the PGY and gain scores and between overall pretest score and gain scores. Conclusions: Real-time ultrasound-guided catheterization with a Seldinger wire is a safe and efficient approach to train rotating residents to perform suprapubic catheterization.
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Management of right-sided polyorchidism with torsion: A case report with literature review p. 191
Sat Prasad Nepal, Takehiko Nakasato, Michio Naoe, Hideaki Shimoyama, Yoshio Ogawa, Kohzo Fuji, Yoshiko Maeda, Jun Morita, Kazuhiko Oshinomi, Yuki Matsui, Tsutomu Unoki, Aya Hiramatsu
Polyorchidism is a rare congenital condition associated with various anomalies; triorchidism is the most common form of this condition. A 21-year-old patient visited our hospital with pain in the right testis. He was diagnosed with right-sided polyorchidism with torsion and underwent manual detorsion followed by orchidopexy. We preserved the extra testis but did not perform histology, as radiological examination revealed no malignant features.
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Corrigendum: The impact of obesity on serum testosterone levels and semen quality in a population of infertile men p. 194

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CME Test p. 195

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