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Traditional chinese medicine and herbal supplements for treating overactive bladder
Yu-Liang Liu, Wei-Chia Lee
September-October 2018, 29(5):216-222
Overactive bladder (OAB) has a high prevalence of approximately 16%–18% of the population worldwide. Currently, the understanding of and strategies for pharmacological treatment of OAB remain limited to antimuscarinics and β3 agonists. Ethnopharmacology applies knowledge from traditional medicine to treat diseases. For example, several presently used drugs, such as aspirin, digoxin, and artemisinin, have originated from plant extracts. Ancient people have historically required treatments for urinary urgency, urinary frequency, nocturia, and urgent incontinence. Traditional Chinese medicine (TCM) has been developed in China over the course of thousands of years. Some regimens and single-herb medicines of TCM have been demonstrated to manage such OAB symptoms. Herein, we summarize the evidence, obtained through current scientific methodology, which supports the use of regimens and single-herb medicine for treatment of OAB. An understanding of the pros and cons of TCM from the viewpoint of current science would improve future research and provide patients with more alternative and complementary therapies.
  1,471 161 -
Role of second-look transurethral resection of bladder tumors for newly diagnosed T1 bladder cancer: Experience at a single center
Wen-Hsin Tseng, Alex Chien-Hwa Liao, Kun-Hung Shen, Chun-Hao Chen, Chien-Liang Liu, Shun-Hsing Hung, Chia-Cheng Su, Jhih-Cheng Wang, Kau-Han Lee, Chien-Feng Li, Steven K Huang
March-April 2018, 29(2):95-99
Objective: The aim of the present study was to evaluate the outcome of second-look transurethral resection of bladder tumors (TURBT) for superficial T1 bladder cancer. Materials and Methods: We enrolled a total of 504 patients who were pathologically diagnosed with urothelial carcinoma and underwent TURBT between January 2012 and December 2016. A total of 240 patients were diagnosed with T1 urothelial carcinoma in the bladder, and 101 (42%) of these patients underwent a second-look TURBT within 4–14 weeks after the initial resection. We assessed the pathological staging of the second-look TURBT. Results: Of the 101 patients who underwent a second-look TURBT, 18 (18%) had residual tumors based on the pathological report: one had pTa disease, seven had pTis disease, nine had pT1 disease, and one had pT2 disease. The residual tumor rate was higher in patients with more than one tumor than in patients with a single tumor; however, there was no significant findings in patients with tumors larger than 3 cm or high histological grade. Conclusion: The results of the present study show that 18% of patients who underwent a second-look TURBT had residual tumors. Early diagnosis of residual tumors or restaging is possible through a second-look TURBT, which could help in deciding the subsequent treatment step if a residual tumor was found.
  844 83 -
Do 5α-reductase inhibitors prevent secondary benign prostate hyperplasia-related urinary retention?
Chi-Fong Lu, Chun-You Chen, Liang-Ming Lee, Ke-Hsun Lin, Yung-Wei Lin, Chi-Hao Hsiao, Yu-Ching Wen
March-April 2018, 29(2):86-90
Objective: The objective of this study is to determine whether 5α-reductase inhibitors (5ARIs) prevent secondary benign prostate hyperplasia (BPH)-related acute urinary retention (AUR) after the first episode of urine retention. Materials and Methods: In total, 1161 patients were enrolled using the International Classification of Diseases, Ninth Revision (ICD-9) codes as having AUR (ICD-9 code 788.20) and BPH, with or without lower urinary tract symptoms (ICD-9 codes 600.0 and 600.1) between January 2006 and June 2016. After excluding patients with bladder and external sphincter dysfunction, we enrolled 128 patients in this study. Patients were divided into two groups: Group 1 comprising 33 patients receiving 5ARI (dutasteride) and α-blocker treatment, and Group 2 comprising 95 patients receiving α-blocker treatment alone. Patient characteristics, namely, age, prostate size, maximal urinary flow rate (Qmax), prostate-specific antigen (PSA) level, and duration of dutasteride treatment, were recorded and compared. Patients were followed for at least 6 months to a maximum period of 24 months if no event occurred. Events of secondary BPH-related AUR and surgery were recorded. Results: All patient characteristics, except for prostate size, were similar between the two groups (Group 1 vs. Group 2: 65.0 vs. 36.9 mL, P = 0.001). In total, 43 patients (32%) experienced secondary AUR within 24 months. The rate of secondary BPH-related AUR was significantly lower in the Group 1 than in the Group 2 (18.2% vs. 39.4%, P = 0.030). The rate of BPH-related surgery was lower in the Group 1 (9.1% vs. 14.9%, P = 0.410), although the difference was not significant. Prostate size and PSA levels were significantly lower in the Group 1 (23.5%) than in the Group 2 (60.4%) (P < 0.001). Conclusions: Using 5ARIs to treat patients with first episodes of BPH-related AUR significantly prevents secondary AUR.
  768 97 -
New face and faster publication
Stephen Shei-Dei Yang
January-February 2018, 29(1):1-1
  748 115 -
Treatment strategy for prostatic abscess: Eighteen cases' report and review of literature
Kazuhiko Oshinomi, Yuki Matsui, Tsutomu Unoki, Hideaki Shimoyama, Takehiko Nakasato, Jun Morita, Yoshiko Maeda, Michio Naoe, Kohzou Fuji, Yoshio Ogawa
July-August 2018, 29(4):206-209
Objectives: Prostatic abscesses are rare. The incidence of prostatic abscess has declined markedly with the widespread use of antibiotics. Obtaining improvement is difficult in many cases of prostate abscess. Today, there are no guidelines or algorithms for the treatment of prostatic abscess. In this study, the shape and size of the abscess, in addition to patient background characteristics and the clinical course, were evaluated, and the treatment strategy for prostatic abscess was examined. Methods and Material: All patients with a diagnosis of prostatic abscess in Showa University Hospital between 2003 and 2017 were retrospectively reviewed. Regarding the treatment options, the patients were divided into two groups, the conservative therapy group and the drainage group. In each group, background characteristics, culture reports, shape/size of abscess, and the presence of recurrence were evaluated. Results: All 18 patients with a diagnosis of prostatic abscess between 2003 and 2017 were retrospectively reviewed; 13 patients improved with conservative treatment alone, but drainage was performed in five patients with poor response to antibiotic therapy. All five cases requiring transurethral drainage were multifocal abscesses. Conclusions: In making a decision about the approach for drainage, it is important to assess the size and shape of the abscess using transrectal ultrasonography (TRUS), computed tomography (CT) and magnetic resonance imaging (MRI). If the abscess is the multifocal type, drainage should be considered. Based on the present study, whether the abscess is focal type or multifocal type, transurethral drainage should be considered if the abscess size exceeds 30 mm.
  745 77 -
Adenomatoid tumor of epididymis: A rare case report and literature review
Chan-Jung Liu, Ho-Siang Huang
May-June 2018, 29(3):168-171
Adenomatoid tumors are rare benign neoplasms in the scrotum that can occur in both sexes. The majority of the patients was asymptomatic and was incidentally found with scrotal mass. It is difficult to distinguish adenomatoid tumors from malignant intratesticular solid tumors, which may result in unnecessary orchiectomy. The present report describes a 64-year-old male presented with right testicular enlargement for 6 months. Radiological images and intra-operative findings all showed cystic mass attached to right testis. Right orchiectomy was performed and final pathology was adenomatoid tumor. The present report also summarizes the morphological and immunohistochemical features of adenomatoid tumors and reviews the literature to share this rare intrascrotal benign tumors.
  752 67 -
Management of urinary tract injuries following total hysterectomy: A single-hospital experience
Chao-Yu Hsu, Kim-Seng Law, Hao-Ping Tai, Hsiang-Lai Chen, Siu-San Tse, Zhon-Min Huang, Wei-Chun Weng, Li-Hua Huang, I-Yen Lee, Min-Che Tung
January-February 2018, 29(1):12-19
Objective: This study elaborated on the clinical experience of patients who underwent urologic management due to urologic complications after receiving a total hysterectomy at a regional hospital. Materials and methods: A total of 696 female patients received the four types of total hysterectomy including total abdominal hysterectomy, transvaginal hysterectomy, lapaparoscopic hysterectomy or robotic hysterectomy for variant gynecologic pathologies. Only 22 cases (3.2%) had urologic procedures performed during or after the operations from 2012/1/1 to 2016/6/30. Results: Of the 22 cases, thirteen (1.9%) received a series of conservative managements only, including cystoscopy, ureteroscopy, endoscopic ureterotomy, ureteral catheterization or double J stenting during the follow-up period. Nine more complicated cases (1.3%) eventually had definitive management, including repair of the urinary bladder rupture, repair of the vesicovaginal fistula, ureteroureterostomy or ureteroneocystostomy. However, five of these nine cases had both conservative and definitive management. The mean delay interval between the initial management and gynecologic procedure was 19.3 days. For definitive management and the gynecologic procedure, the period was 52.8 days. Conclusions: Compared to previous studies, the incidence of urologic injuries following a total hysterectomy in our hospital was similar. From the paper review, it seems early recognition does not improve the outcome but we found a 100% good outcome in patients with definitive management. Copyright © 2017, Taiwan Urological Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
  657 88 -
A novel quinazoline derivative, MJ-56, exhibits phototoxicity toward human bladder cancer cells
Hung-En Chen, Ji-Fan Lin, Thomas I-Sheng Hwang, Yi-Chia Lin, Kuang-Yu Chou, Mann-Jen Hour, Tefu Tsai
March-April 2018, 29(2):64-72
Background: Quinazolines, which process a wide spectrum of biological properties such as antibacterial, antifungal, antivirus, and anticancer activities, are considered one of the most important heterocycles in medicinal chemistry. Here, we described for the first time the novel quinazoline derivative MJ-56 (6-pyrrolidinyl-2-(3-bromostyryl) quinazoline-4-one) which emits green fluorescent in the cytosol and exhibits phototoxicity toward human bladder cancer (BC) cells under blue-light exposure. Materials and Methods: Human BC cells (5637 and T24) and immortalized uroepithelial cell (SV-HUC1) were utilized in this study. To trace the localization of MJ-56, MitoTracker and LysoTracker were applied. The cell viability with or without blue light exposure were monitored by WST-1 reagent, direct recording, and clonogenic assays. The apoptosis induction in MJ-56 treated cells was detected. Results: MJ-56 emits green fluorescent in the cytosol. Vital staining of mitochondria or lysosomes demonstrated that the MJ-56 fluorescent was not located in either organelles. MJ-56 treatment for 24 h did not cause significant loss of cell viability in BC cells. However, treatment of 0.125 μM MJ-56 for 1 h and exposed to blue light for 15 mins significantly reduced cell viability. Interestingly, our results showed that MJ-56 has minimal impact on SV-HUC1 even with the blue-light exposure. The caspase 3/7 activities in BC cells treated with MJ-56 and exposed to blue light were significantly increased 1 h post-treatment. However, the DNA fragmentation cannot be detected at 1, 6, or 24 h posttreatment due to the loss of viable cells. Conclusions: MJ-56 exhibits phototoxicity toward BC cells with minimal impact on uroepithelial cells, indicating a novel therapeutic agent against BC. The mechanism underlying MJ-56-induced cell death as well as the translational studies warrants further investigation.
  646 80 -
Antilithiatic and hepatoprotective effects of Ferula assa-foetida oleo-gum-resin on ethylene glycol-induced lithiasis in rats
Seyyed Majid Bagheri, Maryam Yadegari, Maliheh Behpur, Davood Javidmehr
July-August 2018, 29(4):180-185
Objective: In this study, antiurolithiasic and hepatoprotective effects of Ferula assa-foetida oleo-gum-resin (asafoetida) were evaluated in Wistar rats. Methods: Negative control rats were provided with ethylene glycol (EG, 1%) in drinking water for 28 days. In treatment group, asafoetida was used simultaneously once daily for 28 days at the dose of 25 mg/kg. 8-h urine was collected from experimental animals at the end of the experiment. Urine level of creatinine, uric acid, urea, K+, Ca2+, Mg2+, Na+, phosphorus, and serum level of transaminase (alanine aminotransferase (ALT) and aspartate aminotransferase (AST), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) were evaluated. In addition, histopathological changes in kidney and liver were stained in hematoxylin and eosin. Results: Asafoetida showed a significant effect on urine volume; water intake and urinary ionic parameters were altered by EG, which elevated the calcium and inorganic phosphate; and asafoetida significantly reduced the elevated levels of these ions. In addition, asafoetida significantly elevated the urinary concentration of magnesium. ALT, AST, LDH, and ALP were elevated by EG and asafoetida significantly reduced the elevated levels of these parameters. The histological findings also showed improvement after treatment with the asafoetida. Conclusion: The presented data indicate that administration of asafoetida prevented the growth of urinary stones and also have hepatoprotective effect in experimental EG nephrolithiasis in Wistar rats.
  624 88 -
Surgical menopause exacerbated high-fat and high-sugar diet-induced overactive bladder in a rat model
Yao-Hsuan Tsao, Yung-Chin Lee, Shu-Mien Chuang, Yi-Lun Lee, Jung-Tsung Shen, Jiun-Hung Geng, Hsun-Shuan Wang, Mei-Yu Jang, Kai-Fu Yang, Yung-Shun Juan, Wen-Jeng Wu
March-April 2018, 29(2):73-80
Objective: The pathophysiology mechanism of menopause in the metabolic syndrome-associated bladder dysfunction is still not clear. The major aims of the present study were to examine the impact of high-fat-high-sugar diet and surgical menopause-induced metabolic syndrome in overactive bladder (OAB). Methods: Female Sprague Dawley rats were feed with high-fat-high-sugar diet with/without ovariectomy surgery to mimic menopause and to induce metabolic syndrome. At 6 months after high-fat-high-sugar feeding, cystometrogram, physical indicator, and urine and serum biochemistry parameters were measured. Masson's trichrome stain and Western blots were carried out to examine the expressions of interstitial fibrosis, fibrosis-associated proteins, and muscarinic or purinergic receptors. Results: Bladder hyperactivity was induced accompanied by bladder interstitial fibrosis after 6 months of high-fat-high-sugar feeding, while surgical menopause exacerbated these bladder damages and enhanced interstitial fibrosis level. In addition, surgical menopause enhanced bladder dysfunction via overexpression of muscarinic and purinergic receptors. Conclusions: High-fat-high-sugar feeding induced bladder overactivity, while ovary hormone deficiency enhanced bladder interstitial fibrosis, exacerbated OAB syndrome, and increased muscarinic and purinergic receptors expressions.
  638 73 -
Multiparametric magnetic resonance imaging of prostate cancer
Siu-Wan Hung, Yen-Ting Lin, Ming-Cheng Liu
November-December 2018, 29(6):266-276
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.
  605 103 -
Practical updates in medical therapy for advanced and metastatic renal cell carcinoma
Ning Yi Yap, Wan Thien Khoo, Komathi Perumal, Kar Aik Ng, Retnagowri Rajandram, Adlinda Alip, Marniza Saad, Teng Aik Ong
May-June 2018, 29(3):120-128
The evolution of therapy for advanced or metastatic renal cell carcinoma (RCC) progressed over the past decade from using cytokine immunotherapy to targeted therapy which predominantly inhibits angiogenesis via the vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) pathways. Currently, there are several approved agents in the first-line (e.g. sunitinib, pazopanib, ipilimumab/nivolumab, bevacizumab/IFN-α combination and temsirolimus) and second-line settings (e.g. everolimus, axitinib, sorafenib, cabozantinib, nivolumab and lenvatinib/everolimus combination). These agents are used in sequence upon progression due to drug resistance or intolerable toxicities. The European Association of Urology (EAU), European Society for Medical Oncology (ESMO) and National Comprehensive Cancer Network (NCCN) guidelines recommend the use of these agents based on evidence from clinical trials and expert committee consensus. The recent approval of immune checkpoint inhibitors due to the encouraging results from clinical trials has expanded the treatment options for patients with advanced or metastatic RCC. This will hopefully improve the treatment outcomes, reduce toxicities and ameliorate quality of life for these patients.
  582 125 -
The effectiveness and durability of ureteral tumor stent, the national taiwan university hospital experience
Shih Chun Hung, I Ni Chiang, Chao Yuan Huang, Yeong Shiau Pu
January-February 2018, 29(1):7-11
Purpose: We reviewed the clinical experience of using the ureteral tumor stent (Bard®, angiomed UROSOFT) in the National Taiwan University Hospital. We focused on the efficacy and durability of the ureteral tumor stent. Materials and Methods: We collected the patient data from April 2013 to 2014. A total of 94 patients with 157 ureteral units which received ureteral tumor stent in the National Taiwan University Hospital were enrolled. We analyzed the effectiveness according to the hydronephrosis grading. The durability was counted if it did not match any of the failure criteria including the following: 1. Hydronephrosis upgrade, 2. Serum creatinine elevated over 150% of baseline, 3. Ipsilateral percutaneous nephrostomy insertion or failure to remove it after antegrade insertion, and 4. Replacement due to clinically significant symptoms. Results: In general, 65% hydronephrosis downgrade, 25% remained stationary without severe hydronephrosis, while only 10% deteriorated or remain severe hydronephrosis. The median durability was 6.8 months. The bacteriuria and size of the ureteral tumor stent were the significant factors about the durability in single variant analysis. Conclusion: The ureteral tumor stent would improve the obstructive uropathy and persist functional for an average period over half a year.
  608 93 -
Urinary bladder thickness, tumor antigen, and lower urinary tract symptoms in a low Schistosoma haematobium-endemic rural community of Nigeria
Oyetunde Oyeyemi, Adekunle Adefalujo, Kolawole Ayeni, Williams Nabofa, Chinomso Nwozichi, Adeyemi Dada, Adebola Yusuf
May-June 2018, 29(3):151-155
Objective: Bladder tumor antigen (BTA) is a common biomarker for urothelial carcinoma while bladder wall thickening (BWT) is a sign of urinary bladder irritation which suggests cystitis or early-stage bladder cancer pathology, most especially in the absence of bladder outlet obstruction. The aim of this study was to find the incidence of urinary bladder thickness and evaluate the relationship between BTA and BWT in a low schistosomiasis-endemic Nigerian village. Materials and Methods: The study was descriptive and cross-sectional. Freshly passed mid-day urine samples of 56 individuals were screened using chemical reagent strips and then diagnosed microscopically for Schistosoma haematobium. Subsequent follow-up involving ultrasound examination was carried out on distended bladder. The lower urinary tract symptoms (LUTS) were also recorded. Urinary BTA analysis was carried out on the urine samples using enzyme-linked immunosorbent assay. Results: The prevalence of urogenital schistosomiasis in the area was 3.6%. The overall prevalence of human BTA and BWT in the individuals was 44.6 and 35.7%, respectively. The LUTS were associated with BWT (P = 0.004; odds ratio = 6.0; 95% confidence interval = 1.8–20.3). BTA, BWT, and LUTS were not sex and age dependent (P > 0.05). In addition, there was no association between urinary BTA, BWT, and LUTS (P > 0.05). The sensitivity of BWT and LUTS (60.0%) was improved than when either was used to diagnose BTA. Conclusion: The high occurrence of BTA and BWT in the individuals suggests that they may be prone to urothelial carcinoma and urinary bladder irritation, respectively. The role of urogenital schistosomiasis in urinary BTA levels needs to be further explored.
  629 59 -
Outcomes of prostate atypical small acinar proliferation and high-grade prostate intraepithelial neoplasm patients
Sheng-Yung Tung, Yeong-Shiau Pu, Chao-Yuan Huang, Hong-Chiang Chang, Kuo-How Huang, Shuo-Meng Wang, Huai-Ching Tai, Chung-Hsin Chen
May-June 2018, 29(3):161-165
Objective: Atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) are two pathological findings occasionally noted in prostate biopsies. Previous Western studies reported that they were associated with prostate cancer. However, none Taiwanese series report the subsequent cancer detection in ASAP and HGPIN patients. This study aimed to examine the results of repeated biopsies in the patients with ASAP and HGPIN. Materials and Methods: A total of 220 consecutive patients with ASAP and/or HGPIN at our institute between January 1990 and December 2010 were enrolled. Patient demographics and clinical information were extracted from the electronic database of our institute. Prostate biopsies were performed through transrectal ultrasound guidance. The patients who had concurrent prostate cancer (n = 51) and no repeated prostate biopsies (n = 103) were excluded from the study. Patients with biopsy pathologies reporting low-grade prostatic intraepithelial neoplasia (n = 2) were also excluded. The remaining 64 patients were available for the final analysis. Results: Nearly, 38, 24, and 2 patients were initially diagnosed as ASAP, HGPIN, and ASAP along with HGPIN, respectively. After 10 years of follow-up, 36.8% patients in ASAP group developed prostate cancer, while 16.7% in HGPIN group and 100% in ASAP + HGPIN group. Median time to developing prostate cancer were 20 months in ASAP group, 31 months in HGPIN group, and 48 months in ASAP + HGPIN group. There was no significant difference of prostate cancer development between ASAP and HGPIN group (P = 0.291). Only older age, classified by 65 years, was significantly associated with a higher detection rate of prostate cancer. Conclusion: Patients with the initial diagnosis of ASAP or PIN has a high risk of developing prostate cancer. Therefore, those patients should be well announced and followed regularly.
  635 45 -
The risk of venous thromboembolism in patients with lower urinary tract symptoms
Kuo-Tsai Huang, Wei-Yu Lin, Cheng-Li Lin, Chia-Hung Kao
September-October 2018, 29(5):231-236
Objectives: Atherosclerosis may lead to chronic bladder ischemia, which eventually results in lower urinary tract symptoms (LUTS). Patients with venous thromboembolism (VTE) have a higher prevalence of atherosclerosis. Methods: A total of 31,559 patients had been diagnosed with or without LUTS between 2000 and 2010 in Taiwan National Health Insurance Research Database, each was enrolled in the LUTS and non-LUTS cohorts, respectively. The risk of VTE in LUTS and non-LUTS cohorts was calculated by Cox proportional hazards regression model. Results: After adjustment for age, sex, and comorbidities, the risk of subsequent VTE was 1.34-fold higher in the LUTS than in the non-LUTS cohort. The adjusted risk of VTE was highest in patients with LUTS with any comorbidity. The age-specific relative risk of VTE was significantly higher in patients aged ≥50 years, particularly in those aged 50–64 years, in the LUTS than in the non-LUTS cohort. Conclusions: LUTS is a risk factor for VTE. Physicians should consider the possibility of underlying VTE in patients aged ≥50 years having cardiovascular comorbidities.
  595 83 -
Long-term satisfaction and complications in women with interstitial cystitis undergoing partial cystectomyand augmentation enterocystoplasty
Hsiu-Jen Wang, Hann-Chorng Kuo
March-April 2018, 29(2):81-85
Objective: Interstitial cystitis (IC) is a chronic syndrome without effective definite treatment. Partial cystectomy with augmentation enterocystoplasty (AE) is considered a treatment of last resort for ulcer-type IC. This study investigated the long-term satisfaction and complications of IC patients undergoing AE. Methods: Fifteen IC (12 ulcer-type and 3 nonulcer-type) patients who underwent AE at a single medical center from 2010 to 2016 were retrospectively reviewed. The clinical symptoms and urodynamic study results of each patient were recorded before the operation. The long-term satisfaction of each patient was then evaluated using the global response assessment (GRA), and the postoperative symptoms were graded on a 4-point scale. The complications of AE were also recorded. Results: The mean age of the patients was 58.7 ± 12.7 years, and the mean follow-up period was 36.9 ± 23.1 months. The complications associated with AE included bladder stones, hydronephrosis, acute pyelonephritis, acute urinary retention, and recurrent bladder ulcers. The patients with ulcer-type IC who underwent AE reported better GRA results compared to those with nonulcer IC. The postoperative symptoms of bladder pain, dysuria, frequency, and urinary tract infection (UTI) were present in both groups of patients. No benefit was reported in all nonulcer IC patients. Conclusions: Although AE can improve bladder symptoms in ulcer-type IC patients, postoperative dysuria and UTI remain problems, and IC patients might have complications related to AE. Meanwhile, most of the patients with nonulcer IC reported no benefit from AE and hence AE should not be recommended.
  577 74 -
Comparative persistence, switch rates, and predictors for discontinuation of antimuscarinics for overactive bladder: A 10-year nationwide population-based study in Taiwan
Hao-Wei Chen, Yu-Chen Chen, Wen-Jeng Wu, Ching-Chia Li, Yu-Han Chang, Jiun-Hung Geng, Jung-Tsung Shen, Mai-Yu Jang, Kai-Fu Yang, Yung-Shun Juan
September-October 2018, 29(5):223-228
Objectives: Although antimuscarinic drugs are considered the gold standard for overactive bladder (OAB), high discontinuation rates have been observed. However, no information is known about this in Taiwan. We investigated the persistence and switch rates among different antimuscarinics prescribed for OAB and evaluated whether different comorbidities impacted the persistence with prescribed antimuscarinics in Taiwan. Materials and Methods: We obtained retrospective claims from a Taiwanese health insurance database for patients with OAB; any first claim for the target drugs (tolterodine extended release [ER], tolterodine immediate release [IR], oxybutynin ER, oxybutynin IR, solifenacin, propiverine, and flavoxate) between January 2004 and December 2013 was included. The prescription claims were tracked for 1 year to calculate the time of persistence and switch rates. Comorbidities, including hypertension, diabetes mellitus, and hyperlipidemia, were recorded. Significant factors for discontinuation were investigated by using a Cox proportional hazards model. Results: A total of 24,381 patients with OAB were prescribed the target antimuscarinics. The most prescribed drug during the 10-year period was flavoxate (8339 patients). Of the 3481 patients with chronic OAB, the drug with the longest mean persistence was solifenacin (125 days). At 12 months, the persistence rate varied from 7.6% for oxybutynin ER to 4.3% for propiverine. The switch rates varied from 40.3% for propiverine to 25.7% for solifenacin. The Cox proportional hazards model showed that hyperlipidemia was the only comorbidity significantly associated with discontinuation (hazards ratio: 1.12, 95% confidence interval: 1.03–1.21, P = 0.006). Conclusions: In this large nationwide Taiwanese study, 12-month persistence was generally low for all antimuscarinics. Solifenacin was associated with the longest mean persistence and the lowest switch rates, oxybutynin ER had the highest 12-month persistence rate, and hyperlipidemia was significantly associated with lower persistence.
  518 118 -
Early versus late trail of catheter removal in patients with urinary retention secondary to benign prostatic hyperplasia under tamsulosin treatment
Salem Hassan Salem Mohamed, Mohamed Fathy El Saeed El Ebiary, Mohamed Mabrouk Badr
November-December 2018, 29(6):288-292
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.
  553 80 -
Oncological outcomes of high-risk prostate cancer patients between robot-assisted laparoscopic radical prostatectomy and laparoscopic radical prostatectomy in Taiwan
Chieh-Chun Liao, Yu-Chuan Lu, Huai-Chin Tai, Chung-Hsin Chen, Yeong-Shiau Pu, Chao-Yuan Huang
January-February 2018, 29(1):43-48
Objective: To compare pathological and oncological outcomes between robotic-assisted laparoscopic radical prostatectomy (RaLRP) and laparoscopic radical prostatectomy (LRP) among high-risk prostate cancer patient in a tertiary center in Taiwan. Materials and methods: From November 2003 to October 2013, 129 high-risk prostate cancer patients receiving minimally-invasive radical prostatectomy were included. The Kaplan–Meier analysis was used for measuring biochemical recurrence-free survival (BFS). Multivariate logistic regression models and Cox proportional hazards regression models were used to determine predictors of positive surgical margin and BFS. Results: Among the 129 high-risk prostate cancer patients included, 80 (62%) patients received LRP and 49 (38%) patients received RaLRP. There was no significant difference of positive surgical margin and biochemical recurrence rate between RaLRP and LRP group (P = 0.802 and 0.292). Higher pathological T stage predicted an increased likelihood of positive margins (OR = 3.44, 95% CI [1.45, 8.18], P = 0.005). Higher initial PSA level (HR = 2.88, 95% CI [1.04, 7.94], P = 0.041) and positive surgical margin (HR = 2.55, 95% CI [1.20, 5.44], P = 0.015) were poor prognostic factors for BFS. Conclusion: RaLRP can be considered among high-risk prostate cancer in Asian people with comparable oncological outcomes to LRP. Higher pathological T stage was associated with increased likelihood of positive margins, patients with higher iPSA level and positive surgical margin had worsen biochemical recurrence-free survival.
  560 67 -
Outcomes and complications after transrectal ultrasound-guided prostate biopsy: A single-center study involving 425 consecutive patients
Jhen-Hao Jhan, Shu-Pin Huang, Wei-Ming Li, Ching-Chia Li, Tsung-Yi Huang, Hung-Lung Ke, Chun-Nung Huang, Yii-Her Chou, Shen-Chen Wen
May-June 2018, 29(3):129-133
Objective: The use of 10–12-core systemic transrectal ultrasound (TRUS)-guided prostate biopsy protocols with extended-sampling has been an optimizing strategy for diagnosis of prostate cancer. In this study, we aim to examine the cancer detection rate (CDR) and the complications following prostate biopsy at our institution. Materials and Methods: We retrospectively reviewed medical data of patients who underwent TRUS-guided prostate biopsy between 2007 and 2013 at our institution. The pathological outcomes, major complications, and morbidities were recorded and assessed clinically. Results: During the study period, 425 patients who underwent TRUS-guided prostate biopsy were enrolled. The mean age of the participants was 67.9 years. Overall, 75 (17.6%) patients were diagnosed with prostate cancer. Cancer was detected in 0% (0/10), 7.0% (15/215), 16.5% (20/121), and 50.6% (40/79) of patients in the subgroups with patient prostate-specific antigen (PSA) <4 ng/ml, 4–10 ng/ml, 10–20 ng/ml, and >20 ng/ml, respectively. The optimal cutoff values of PSA density were 0.19, 0.29, and 0.78 in the subgroups with patient PSA 4–10 ng/ml, 10–20 ng/ml, and >20 ng/ml. In total, 11 patients had afebrile urinary tract infections (UTI), 9 patients had febrile UTI, and another 2 patients had septic shock after biopsy. The overall incidence of infectious complications was 5.17% (22/425). Other complications were infrequent, consisting only of urinary retention in three patients, hematospermia in two patients, and acute hemorrhagic cerebellar infarction in 1 patient. Conclusion: Our study demonstrated the CDR, the incidence, and type of complications following TRUS-guided prostate biopsy. Further prospective studies are required to determine methods for reducing complications from prostate biopsy.
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Lower urinary tract symptoms associated with double-J stent
Sheng-Wei Lee, Po-Jen Hsiao, Chao-Hsiang Chang, Eric Chieh-Lung Chou
Ahead of print schedule 0, 0(0):0-0
Urinary drainage for hydronephrosis including the placement of an internal double J (D-J) or external percutaneous nephrostomy tube is common practice. Although D-J insertion is less invasive and may provide better quality of life than percutaneous nephrostomy, patients commonly complain of associated symptoms like discomfort, resulting in decreasing work performance and lifestyle changes. The incidence of lower urinary tract symptoms (LUTS) following D-J insertion is 50%–70%. Urologists who perform this procedure need to know how to prevent and manage common symptoms and educate patients. The physical activity of patients, material of D-J, size, and length of the stent are factors that increase the incidence of LUTS. Recently, several studies have suggested medical treatment for relief D-J-related symptoms. This article reviews the general background, factors, evaluation, and management of D-J associated LUTS.
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Performing laparoscopic radical cystectomy is feasible for the elderly with marginal cardiopulmonary function
Jian-Hui Lin, Kuo-Hsiung Chiu, Dong-Ru Ho, Yung-Chin Huang, Kuo-Tsai Huang, Chih-Shou Chen, Wei Yu Lin
January-February 2018, 29(1):20-24
Purpose: The purpose of this study was to report the feasibility, safety, and benefits of laparoscopic radical cystectomy (LRC) for patients with bladder cancer (BC) who are older than 75 years and with marginal cardiopulmonary function in a regional teaching hospital. Materials and Methods: The charts of thirty patients who underwent LRC between 2013 and 2016 in a community teaching hospital were reviewed. The patients were subgrouped into the age groups ≥75 years and <75 years. Data extracted from the charts included patient demographics, American Society of Anesthesiologists (ASA) Score, Charlson Comorbidity Index (CCI) Score, cardiopulmonary function test result, pathological results, conversion rate, operative time, Intensive Care Unit days, and postoperative recovery time. Results: A significant difference was observed in the data of the group ≥75 years group compared with the <75 years group, with a higher ASA score (P = 0.0007) and higher rate of marginal cardiopulmonary function (80% vs. 26.7%, P = 0.0092). No significant difference was observed in sex, CCI score (3.93 vs. 3.27), body mass index (24.8 vs. 24.4), ejection fraction (69% vs. 70.97%), operation time (473 vs. 465 min), blood loss (503 vs. 380 mL), urinary diversion type, Intensive Care Unit care (1.13 vs. 0.6 days), interval to ambulation (2 vs. 1.8 days), interval to oral food intake (3.2 vs. 2.6 days), interval to normal bowel function (4.6 vs. 3.6 days), postoperative hospitalization (15.67 vs. 11.67 days), and blood transfusion rate (33.3% vs. 26.7%) between the two groups. No conversion to open surgery or mortality was observed. Surgical complications occurred in 15 patients, with a complication rate of 50%. No surgical mortality was noted in 30 or 90 days. Most pathological cases revealed urothelial carcinoma. Conclusions: LRC is a safe option with favorable outcomes in BC patients older than 75 years with marginal cardiopulmonary function in a regional teaching hospital.
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Mammalian target of rapamycin inhibitor and transarterial embolization for treatment of tuberous sclerosis complex patients with renal angiomyolipoma
Wei-Chung Hsiao, Jeng-Dau Tsai, Shao-Chun Wang, Sung-Lang Chen
March-April 2018, 29(2):100-105
Objective: Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disease that results in multiorgan hamartomas. Patients with TSC also frequently have renal angiomyolipomas, which are rare but benign renal tumors. However, the main causes of mortality in these patients are angiomyolipoma-related chronic kidney disease and acute tumor hemorrhage. Angiomyolipomas are mostly treated in our hospital using mammalian target of rapamycin (mTOR) inhibitor therapy or transarterial embolization (TAE). This study was undertaken to evaluate and compare the short-term outcomes of a combined therapy of mTOR inhibitor and TAE in patients with TSC-associated angiomyolipoma. Materials and Methods: This was a retrospective observational study based on collected data obtained from chart reviews. The single-center data set covered patients diagnosed, treated, and followed up from September 10, 2008, to March 17, 2016, at a specialist center. Patients with TSC-associated angiomyolipoma treated with monotherapy or combined treatment of mTOR inhibitor and TAE were included in this study. We compared the tumor size with image studies in the baseline and follow-up periods in both groups. Results: In total, 15 patients (3 males and 12 females) were included; 8 patients underwent mTOR inhibitor monotherapy and 7 received the combined mTOR inhibitor and TAE therapy. The mean patient age was 37.7 (17–72) years. The maximal diameters of renal angiomyolipomas ranged from 2 to 20.9 (10.2 ± 5.4) cm for all patients at the time of treatment intervention. During an average follow-up duration of 22 (2–56) months, the mean size of the angiomyolipomas decreased from 9.3 ± 5.6 to 8.5 ± 5.3 cm in the monotherapy group and 11.5 ± 5.4–10.0 ± 5.8 cm in the patients in the combined therapy (P = 0.014). Conclusions: In comparison with m-TOR inhibitor monotherapy, TAE combined with mTOR inhibitor therapy allows management of tumor bleeding with acceptable complications, and it also statistically reduces the tumor size in patients with TSC-associated renal angiomyolipomas.
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Impact of high-Volume disease in Asian population with newly diagnosed metastatic prostate cancer
Yung-Ting Cheng, Jian-Hua Hong, Yu-Chuang Lu, Yeong-Shiau Pu, Chao-Yuan Huang, Kuo-How Huang, Shih Ping Liu, Chung-Hsin Chen
Ahead of print schedule 0, 0(0):0-0
Purpose: The purpose of this study is to investigate the clinical oncological outcomes and prognostic factors of high-volume disease (HVD) in the Asian population with metastatic hormone-sensitive prostate cancer. Methods: We retrospectively analyzed 503 patients with newly diagnosed metastatic prostate cancer. Patients were classified as HVD if visceral metastases were present and/or ≥4 bone lesions with ≥1 lesion beyond the vertebral bodies and pelvis. Overall survival (OS) and cancer-specific survival were investigated based on the disease burden. The Cox proportional hazards regression model was used to evaluate the prognostic factors. Results: About 50.7% patients were classified as low-volume disease (LVD) and 49.3% were HVD at diagnosis. The medians of OS and cancer-specific survival were 64 and 116 months, respectively, for patients with LVD and 26 and 46 months, respectively, for men with HVD (both P < 0.001). Among patients with HVD, 76.6% had both high-volume bone disease (HBD) (≥4 bone metastases) and appendicular bone involvement. There was no significant difference in both OS and cancer-specific survival between patients with visceral metastases and those with HBD combined with appendicular bone involvement. In the multivariable analysis, presence of Gleason score ≥8, HBD, or HVD may predict poorer OS and cancer-specific survival outcomes (all P < 0.05). Conclusions: Asian patients with high-volume metastatic prostate cancer had a larger proportion of HBD with appendicular bone involvement, who had a comparably poor prognosis to those with visceral metastases. Patients with HBD or HVD had reduced survival outcomes.
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