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   Table of Contents - Current issue
November-December 2018
Volume 29 | Issue 6
Page Nos. 265-322

Online since Thursday, November 22, 2018

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Precise diagnosis of prostate cancer and more p. 265
Stephen Shei-Dei Yang
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Multiparametric magnetic resonance imaging of prostate cancer Highly accessed article p. 266
Siu-Wan Hung, Yen-Ting Lin, Ming-Cheng Liu
As the number of elderly population increase, prostate cancer (CaP) becomes the most common cause of urological cancer of men in Taiwan. Multiparametric MRI (mp-MRI) combines standard pulse sequences and Functional Imaging, is a promising tool for CaP detection. Its role has changed from detection to preoperative staging. A consensus scoring system, PI-RAD™, is developed for interpretation and reporting.
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The incremental benefit of upfront surgery in renal cell carcinoma with venous tumor thrombus of the inferior venae cavae p. 277
Daanesh Huned, John Allen Carsen, Hong Hong Huang, Lui Shiong Lee
Background: Surgical extirpation for renal cell carcinoma (RCC) with inferior venae cavae (IVC) thrombi is the standard of care. The incremental impact of upfront surgery has not been well described. Objective: We aim to quantify the overall survival (OS) benefit of upfront surgery in RCC with IVC thrombi when compared to a conservative approach and also analyze perioperative outcomes. Materials and Methods: Patients with RCC with IVC thrombus between January 1, 2001, and December 31, 2014, in a single institution were identified, and data reviewed for demographics, performance status, and tumor thrombus levels. Pathological and operative outcomes were analyzed in the surgical cohort (Sx). Survival outcomes were computed with Kaplan–Meier analysis. Prognostic factors were determined using univariate and multivariate analyses. Statistical significance was defined as P < 0.1. Results: There were 51 patients identified, comprising 31 and 20 in the Sx and nonsurgical (NSx) cohorts. For the Sx cohort, 5-year OS and recurrence-free survival were 48% and 45%, respectively, with a median OS of 51.7 months. Nodal involvement was an independent predictor for OS (P < 0.1) on multivariate analysis. In the NSx cohort, 75% (15/20) had distant metastasis at diagnosis, with a 5-year OS of 13.4 months. Patients with better baseline ECOG statuses had better survival outcomes (P < 0.1). The mean OS of patients (n = 5) with M0 disease was 18.8 months. The advantage conferred by surgery was a 38.2-month longer median OS (P < 0.0001). In the Sx cohort, 87% had no or minor perioperative complications. Conclusion: Nephrectomy and IVC thrombectomy have an OS survival advantage of 38.2 months with acceptable perioperative morbidity. Therefore, it is preferred over an initial nonsurgical approach where possible.
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Is it worth removing prostatic anterior fat pad to detect lymph node metastasis of prostate cancer during robotic-assisted radical prostatectomy? p. 284
Chia-Hung Chen, Hsiao-Jen Chung, Alex T L. Lin, Kuang-Kuo Chen
Objectives: To determine the number of lymph node in prostatic anterior fat pad (PAFP) and the incidence of metastasis in lymph nodes dissected during robotic-assisted radical prostatectomy (RARP). Methods: From May 2011 to November 2015, PAFP were removed in 146 patients who underwent RARP and sent for pathological analysis to determine the number of lymph nodes and incidence of metastasis to the lymph nodes. Another 48 patients without PAFP removal were enrolled as the control group. Operative features including operative time, estimated blood loss, post-operative hospital stay, and the incidence of complications were compared between the two groups. Results: Lymph nodes within PAFP were detected in 14/146 (9.6%) patients, with metastatic lymph nodes in 2/146 (1.3%) patients. The patients with metastatic lymph nodes in the PAFP had no obturator lymph node involvement. There were no significant differences in operative features between the two groups. Conclusions: Our findings demonstrated that PAFP contain lymph nodes, and that the incidence rate of lymph node metastasis was high. There was no increase in the surgical risk when removing PAFP, and therefore we suggest that PAFP be routinely removed during RARP and then analyzed pathologically to allow for precise lymph node staging.
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Early versus late trail of catheter removal in patients with urinary retention secondary to benign prostatic hyperplasia under tamsulosin treatment p. 288
Salem Hassan Salem Mohamed, Mohamed Fathy El Saeed El Ebiary, Mohamed Mabrouk Badr
Objective: The main objective of this study is to evaluate the impact of early and late removal of urinary catheter after acute urine retention (AUR) in patients with benign prostatic hyperplasia (BPH) under tamsulosin treatment on the success of trial without catheter (TWOC). Materials and Methods: This is a prospective randomized study, 60 men with AUR secondary to BPH, after fulfilling the inclusion criteria in the absence of the exclusion criteria of the study were catheterized and then were randomly assigned to receive 0.4 mg tamsulosin hydrochloride for 3 days or 7 days, after that the catheter was removed and the ability to void unaided assessed. Results: Eighteen men taking tamsulosin for 3 days and 21 patients taking tamsulosin for 7 days did not require recatheterization on the day of the TWOC (60% and 70%, respectively, P = 0.417). Complication as urinary tract infection, urine leakage, hematuria, or catheter obstruction occurred in five (16.7%) men who received tamsulosin for 3 days and 13 (43.3%) men who received tamsulosin for 7 days (P = 0.024). Conclusions: Men catheterized for AUR can void successfully after catheter removal if treated with alpha-1 blockade, and success rate of TWOC is controversial regarding the duration of catheterization. However, the complications were increased with period of catheterization.
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A single-institution experience with laparoendoscopic single-site retroperitoneal adrenalectomy p. 293
Yu-Chen Chen, Hsiang-Ying Lee, Hao-Wei Chen, Hsin-Chih Yeh, Chia-Chun Tsai, Kuang-Shun Chueh, Yii-Her Chou, Chun-Nung Huang, Wen-Jeng Wu, Nien-Ting Hou, Yech-Huei Lin, Ching-Chia Li
Aims: Laparoendoscopic single-site (LESS) adrenalectomy has become a feasible choice for adrenal lesions and can substitute for conventional open adrenalectomy. This report shares our surgical experience and describes the characteristics of adrenal tumors after LESS retroperitoneal adrenalectomy. Subjects and Methods: Between January 2010 and August 2016, 123 patients underwent an LESS adrenalectomy by retroperitoneal approach in our hospital. We retrospectively reviewed the records of these patients and analyzed the characteristics of adrenal tumors. The incision is below the 12th rib in the posterior axillary line and is about 2.3–3.2 cm in length. A 5 mm 30° rigid laparoscope and other conventional laparoscopic instruments are manipulated through a commercial port. No postoperative drain is placed. Results: Among 123 patients, the mean operative time was 114.1 ± 31.1 min, and mean blood loss was 65.1 ± 68.7 ml. Mean hospital stay was 5.4 ± 1.2 days. The postoperative course was uneventful without complications. Among all adrenal tumors undergoing surgery, Conn's disease is the most common (68.3% Conn's disease, 19.5% nonfunctioning, 4.9% Cushing's disease, 3.3% pheochromocytoma, and 0.8% malignancy). We found that left-side adrenal tumors (64.2%) were more common than right-side tumors (35.8%). Conclusions: Our experience shows that retroperitoneal LESS adrenalectomy is promising. Conn's disease accounts for more than half of adrenal tumors undergoing surgery. In the future, further comparative study is warranted to define the role of LESS in adrenal surgery.
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A tertiary center experience of fracture penis: Early surgical management with a clinical diagnosis p. 298
Lalit Kumar, Rahul Tiwari, MC Arya, Amit Sandhu, Vivek Vasudeo, Mayank Baid
Introduction: Fracture penis is uncommon and often a result of sexual trauma. Diagnosis remains clinical and early surgical management is advocated. Herein, we share our experience of 20 such cases. Materials and Methods: Twenty fracture penis patients presented between August 2014 and April 2017 were included. Patients' data were retrieved retrospectively using case sheets and followed by outpatient department visits and telephonically. Eighteen patients had penile exploration while two patients were managed conservatively. Erectile and voiding functions were assessed by asking single question to the patient, which was limited to only two options in the form of normal and abnormal. All patients were followed up for a minimum of up to 6 months. Results: The patients were aged between 20 and 60 years (mean 37.7 years). Mean timing of presentation was 28.8 h (range 2 h to 7 days). Mean follow-up was 22.5 months (6–42 months). There were no long-term postoperative complications. Eighteen patients had coital trauma, one unmarried patient had a history of manipulation of erect penis, while one patient had a fall-on erect penis. Three patients had associated urethral injury. All patients had almost the same potency as preoperatively, but for one who had erectile dysfunction for a short period recovered spontaneously on tablet sildenafil. No patient had long-term voiding dysfunction, penile curvature, or sexual dysfunction. Conclusion: History and clinical examination clinch the diagnosis. Considering it as a urological emergency, radiological imaging is not required routinely. Early surgical repair preserves the potency and voiding functions.
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The impact of body mass index on the stone composition of 191 patients who received percutaneous nephrolithotomy in a single hospital p. 303
Li-Meng Kang, Yen-Man Lu, Wei-Tung Cheng, Tsu-Ming Chien, Yii-Her Chou, Wen-Jeng Wu, Ching-Chia Li
Objective: We aimed to analyze the renal stone composition and evaluate the epidemiology of body mass index (BMI) and renal stones. Materials and Methods: We conducted a retrospective, single-center study of patients with large stones (ɮ cm) who underwent percutaneous nephrolithotomy for renal stones between 2010 and 2015. We performed stone analysis using stereomicroscopy and infrared spectroscopy to determine the chemical composition of these stones. Chi-square analysis was used to determine the relationship between BMI and renal stone formation. Results: We examined stones from 191 procedures. Among these stones, we classified 58.6% as having “pure” composition and 40.8% as having “mixed” composition. Most stones (68.1%) were composed of calcium oxalate monohydrate (COM), followed by carbonate apatite (50.8%), calcium oxalate dihydrate (COD) (36.6%), uric acid (14.1%), struvite (8.9%), ammonium hydrogen urate (2.1%), and brushite (1.0%). Chi-square analysis revealed that stones in obese patients (BMI >27 kg/m2) were more likely to contain COM (hazards ratio [HR]: 1.66, 95% confidence interval [CI]: 1.10–2.49, P = 0.008) and less COD (HR: 0.77, 95% CI: 0.60–0.99, P = 0.049) than stones in nonobese patients (BMI ≦27 kg/m2). Conclusion: COM is the most frequently occurring compound in renal stones. Obese patients were significantly more likely to develop COM-containing renal stones. One must consider these factors when choosing a treatment modality.
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The effect of dextrose instillation on a man with chylous hematuria: A case report p. 307
Yu Liang Liu, Shun Chen Huang, Hao Lun Luo
Chyluria is a morbid condition and sclerotherapy is a minimally invasive treatment modality in treatment of chyluria. The benefit of sclerosing agents have been analyzed in previous studies; however, our patient has iodine allergy and silver nitrate is not available at our institution. So we chose 50% dextrose as sclerosing agents. We found that chyluria was cured without any complication. This result might offers a simple and safe modality of treatment.
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CME test p. 311

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Author Index p. 313
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Keyword Index p. 317
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Title Index p. 320
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