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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.
  3 17,416 700
Organic erectile dysfunction in Taiwan: A nationwide, retrospective, age-matched nonrandomized study
Tsu-Ming Chien, Yen-Man Lu, Ching-Chia Li, Yii-Her Chou, Wen-Jeng Wu, Chun-Nung Huang, Chii-Jye Wang
March-April 2018, 29(2):106-110
Objective: We aimed to determine the distribution of patients who sought medical help of organic erectile dysfunction (ED) in Taiwan. We further adjusted the age, insurance range, and other comorbidities to determine the potential risk factors for organic ED. Materials and Methods: Data were sourced from the Longitudinal Health Insurance Database 2000 of Taiwan, Republic of China, compiled by the Taiwan National Health Insurance database from 1996 to 2010. The possible risk factors leading to organic ED were also studied. Results: We included 3229 patients with organic ED and 9687 patients for comparison. A logistic regression model used to adjust for age, insurance, and other comorbidities showed that diabetes mellitus (adjusted odds ratio [OR] 1.71; 95% confidence interval [CI], 1.51–1.92; P < 0.001), hypertension (adjusted OR, 1.46; 95% CI, 1.32–1.61, P < 0.001), chronic kidney disease (CKD; adjusted OR, 1.46; 95% CI, 1.25–1.69; P < 0.001), dyslipidemia (adjusted OR, 1.61; 95% CI, 1.25–1.69; P < 0.001), and depression (adjusted OR, 1.41; 95% CI, 1.13–1.77; P = 0.003) were potential risk factors for organic ED. Conclusion: On the basis of our results, patients aged above 50 years accounted for over 70% of the organic ED patients who sought treatment. Diabetes mellitus, hypertension, CKD, dyslipidemia, and depression were potential risk factors for organic ED.
  2 1,920 167
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
May-June 2018, 29(3):136-144
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.
  2 3,262 363
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.
  2 28,499 890
Detection of circulating tumor cells and the importance of their measurement in urological cancers
Michio Naoe, Mika Ohta, Yuki Hasebe, Yuki Matsui, Tsutomu Unoki, Hideaki Shimoyama, Takehiko Nakasato, Yoshio Ogawa, Mana Tsukada, Masataka Sunagawa, Hikaru Ishii, Masayuki Ishige, Hironori Osawa, Masaharu Matuzaki
July-August 2018, 29(4):176-179
In recent years, various new drugs such as molecularly targeted drugs and immune checkpoint inhibitors have been developed. Liquid biopsy is becoming increasingly important as a guide for selecting these new drugs and determining their efficacy. In urological cancers, given the lack of serum markers for kidney cancer or urothelial cancers, the development of liquid biopsy is strongly desired. Liquid biopsy is less invasive than conventional tissue biopsy, enabling frequent biopsies, and is therefore considered effective for monitoring of the treatment course. Liquid biopsy is largely divided into three types: circulating tumor cells (CTCs), cell-free DNA, and exosomes, each of which has its own set of advantages and disadvantages with regard to the identification method and utility. In the present article, we focus on CTCs and discuss issues in their identification method as well as recent findings.
  2 2,807 445
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.
  1 3,540 336
Urolithiasis is associated with the increased risk for osteoporosis: A nationwide 9-year follow-up study
Yen-Man Lu, Tsu-Ming Chien, Ching-Chia Li, Yii-Her Chou, Wen-Jeng Wu, Chun-Nung Huang
May-June 2018, 29(3):145-150
Objective: We aimed to determine whether urolithiasis is a warning sign indicating long-term osteoporosis. Controls were matched for age, sex, and other comorbidities, including hypertension, diabetes mellitus, dyslipidemia, liver disease, and cardiovascular disease. Materials and Methods: Data were obtained from the Longitudinal Health Insurance Database (LHID2000) of Taiwan, Republic of China, compiled by the NHI from 1996 to 2013. We further evaluated potential risk factors stratified by different comorbidities. Results: After performing the propensity score matching (urolithiasis: control; ratio, 1:3), we included a total of 104,900 patients, including 26,225 patients with urolithiasis and 78,675 control patients. There was a significant difference between the incidence of osteoporosis between the urolithiasis and control groups (adjusted hazard ratio 1.20, 95% confidence interval [CI]: 1.15–1.27, P < 0.001). Interestingly, the impact of urolithiasis on osteoporosis was more prominent in the younger patient population (age < 40 years, adjusted hazard ratio 1.4, 95% CI: 1.12–1.75, P = 0.003; 40–59 years, adjusted hazard ratio 1.3, 95% CI: 1.20–1.40, P < 0.001), than in the older patient population (age >60 years, adjusted hazard ratio 1.13, 95% CI: 1.05–1.21, P = 0.001; P = 0.015 for interaction). We also observed that urolithiasis had an impact on hypertension-free patients (hypertension free, adjusted hazard ratio 1.28, 95% CI: 1.20–1.36, P < 0.001; hypertension, adjusted hazard ratio 1.12, 95% CI: 1.03–1.22, P = 0.006, P = 0.020 for interaction). Conclusion: In conclusion, on the basis of our results, an association exists between urolithiasis patients and subsequent osteoporosis diagnosis. Although the clinical mechanisms are not fully understood, patients who had urolithiasis history may need regular follow-up of bone marrow density.
  1 2,527 246
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.
  1 12,949 371
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.
  1 4,141 416
Pheochromocytoma: A single-center 20-year experience
Lung-Feng Cheng, Shih-Che Tseng, Chia-Cheng Yu, Jen-Tai Lin, Jeng-Yu Tsai, I-Hsuan Chen, Yin-Shen Chen
January-February 2019, 30(1):30-35
Objective: Pheochromocytomas are catecholamine-producing neuroendocrine tumors arising from chromaffin cells of the adrenal medulla or extra-adrenal paraganglia. There is no large-scale study in Taiwan at present. Our retrospective analysis was focused on clinical characteristics of Taiwanese patients with pheochromocytoma. Method: We retrospectively reviewed 48 patients who were pathologically proved as pheochromocytoma at the Kaohsiung Veterans General Hospital between Jan. 1990 and Jan. 2014. Parameters including patient and tumor characteristics, clinical presentation, treatment and long-term followup results were collected from the medical records. Metastasis was confirmed by pathologic proof using surgical removal or percutaneous biopsy. Result: Thirty-one patients (64.5%) had adrenal and 17 (35.4%) had extra-adrenal pheochromocytoma. The locations of extra-adrenal pheochromocytoma included the retroperitoneum in 6 patients (35%), head and neck in 4 (23%), scrotum in 2 (12%), urinary bladder in 2 patients (12%), multiple organs in 2 (12%), and mediastinum in 1 (6%). The most common symptom was sustained hypertension (52%). Five patients were diagnosed as malignant pheochromocytoma due to pathologically proved metastasis. Conclusion: Pheochromocytomas are rare neuro-endocrine tumors with a highly variable clinical presentation. Prompt surgical removal of pheochromocytoma ensures a better prognosis. Radical surgical removal of tumor with vigorous control of blood pressure is the mainstay to improve symptoms and survival for malignant pheochromocytoma. Multi-center and large-scale studies were warranted and Lifelong followup is strongly recommended for all patients with pheochromocytoma.
  1 2,371 316
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.
  1 5,116 485
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