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REVIEW ARTICLE
Traditional chinese medicine and herbal supplements for treating overactive bladder
Yu-Liang Liu, Wei-Chia Lee
September-October 2018, 29(5):216-222
DOI:10.4103/UROS.UROS_8_18  
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.
  20,959 749 2
ORIGINAL ARTICLES
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
DOI:10.4103/UROS.UROS_59_18  
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.
  11,888 595 2
REVIEW ARTICLE
Lower urinary tract symptoms associated with Double-J stent
Sheng-Wei Lee, Po-Jen Hsiao, Chao-Hsiang Chang, Eric Chieh-Lung Chou
May-June 2019, 30(3):92-98
DOI:10.4103/UROS.UROS_56_18  
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.
  10,659 562 -
ORIGINAL ARTICLES
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
DOI:10.4103/UROS.UROS_3_17  
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.
  7,695 311 1
LETTERS TO THE EDITOR
Adenomatoid tumor of epididymis: A rare case report and literature review
Chan-Jung Liu, Ho-Siang Huang
May-June 2018, 29(3):168-171
DOI:10.4103/UROS.UROS_44_18  
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.
  5,611 380 -
ORIGINAL ARTICLES: UROLOGICAL TUMOR
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
DOI:10.4103/UROS.UROS_17_17  
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.
  4,814 361 -
ORIGINAL ARTICLES: CLINIC SCIENCE
Effect of tadalafil on erectile function in patients after robotic-assisted radical prostatectomy with unilateral or bilateral nerve sparing
I-Yen Lee, Min-Che Tung, Chao-Yu Hsu, Jue-Hawn Yin, Yu-Kang Chang, Wei-Chun Weng, Li-Hua Huang, Zhon-Min Huang, Cheng-Kuang Yang, Yen-Chuan Ou
January-February 2019, 30(1):14-18
DOI:10.4103/UROS.UROS_74_18  
Objective: Erectile dysfunction (ED) is a major complication of radical prostatectomy. Despite advances in surgical techniques, the postoperative continence and potency rates are still not satisfactory. Many studies have reported experiences with penile rehabilitation using tadalafil for patients receiving nerve-sparing robotic-assisted radical prostatectomy, but similar reports are still lacking in Taiwan. Patients and Methods: We collected 163 patients that had undergone unilateral or bilateral nerve-sparing robotic-assisted radical prostatectomy from January 2013 to December 2014 in Tungs' Hospital. One month after operation, 5 mg tadalafil once daily was prescribed for 54 patients whose Foley's catheter had been removed and who had ED. We recorded the International Index of Erectile Function (IIEF-5) score at the 12th month after surgery. We defined postsurgery IIEF-5 ≥22 as potency or no ED. We compared the differences in clinical parameters and postsurgery potency rates between patients with or without tadalafil treatment. Results: The postsurgery potency rates of those with tadalafil treatment were significantly higher than that of those without tadalafil treatment (55.6% vs. 32.1%) after a 1-year follow-up observation. The mean (standard deviation) of IIEF-5preamong those with and without tadalafil treatment was 21.3 (4.5) and 19.2 (4.2), respectively. There were no significant differences in baseline clinical condition parameters between patients with potency with or without tadalafil treatment. The results indicated that the tadalafil-treated patients had a higher odds ratio (OR) of potency (adjusted OR = 2.58, 95% confidence interval [CI] = 1.28–5.22) than the nontadalafil-treated patients. However, those ≥65 years old were associated with a lower potency rate (adjusted OR = 0.94, 95% CI = 0.89-0.99). Conclusion: Starting penile rehabilitation with tadalafil 5 mg daily 1 month after nerve-sparing radical prostatectomy is safe for patients. Patients with mild-to-moderate ED should use tadalafil 5 mg daily after receiving nerve-sparing robotic-assisted laparoscopic prostatectomy due to its significant benefit in erectile function recovery.
  4,626 364 -
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
DOI:10.4103/UROS.UROS_12_18  
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.
  4,588 376 -
REVIEW ARTICLES
Stroke and lower urinary tract symptoms: A neurosurgical view
Yu-Cheng Chou, Yuan-Hong Jiang, Tomor Harnod, Hsu-Tung Lee, Hann-Chorng Kuo
January-February 2019, 30(1):8-13
DOI:10.4103/UROS.UROS_82_18  
Lower urinary tract symptoms (LUTSs) are common neurological sequelae of stroke, which negatively impact the mortality of patients with stroke and the quality of life of both patients and their caregivers. There are three hierarchical micturition centers: the sacral spinal center, subconscious structures, and conscious structures. Several brain imaging modalities for micturition studies on humans and animals and neuroanatomical studies on animals have facilitated a better understanding of LUTSs. The urodynamic findings in patients with stroke may vary and tend to evolve with time; the identification of the underlying cause of poststroke voiding dysfunction helps optimize the management of these patients. For patients with stroke with overactive bladders, the first-line treatments include behavioral therapies and the second-line therapies include the use of drugs. Intermittent or indwelling catheterization can be used for patients with stroke with detrusor underactivity. In this article, we discuss the current consensus, relevant assessment modalities, and management of LUTSs in patients with stroke.
  3,766 482 -
REVIEW ARTICLE
Multiparametric magnetic resonance imaging of prostate cancer
Siu-Wan Hung, Yen-Ting Lin, Ming-Cheng Liu
November-December 2018, 29(6):266-276
DOI:10.4103/UROS.UROS_57_18  
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.
  3,687 409 1
ORIGINAL ARTICLES
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
DOI:10.4103/UROS.UROS_18_18  
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.
  3,319 361 1
Adult balanoposthitis patients have a higher risk of Type 2 diabetes mellitus: A nationwide population-based cohort study
Chi-Ping Huang, Chi-Shun Lien, Sheng-Wei Lee, Chao-Hsiang Chang, Cheng-Li Lin
January-February 2018, 29(1):55-60
DOI:10.4103/UROS.UROS_6_18  
Background: We investigated the association between balanoposthitis and the risk of type 2 diabetes mellitus (type 2 DM) from a retrospective cohort study. Methods: From the Longitudinal Health Insurance Database (LHID) 2000, we selected male patients aged over 20 years and first diagnosed with balanoposthitis during 2000–2010. Men without balanoposthitis were also included in our analysis through frequency matching for age and index year. All participants were followed up until the diagnosis of type 2 DM. Diseases were coded in accordance with the International Classification of Diseases, Ninth Revision, Clinical Modification. Baseline comorbidity history for each participant was determined from the LHID dataset. A multivariable Cox proportional hazard regression model was established, and a Kaplan–Meier survival curve was plotted. Results: The incidence of type 2 DM was higher in the balanoposthitis cohort than in the nonbalanoposthitis cohort (14.8 vs. 5.42/1000 person-years) with a hazard ratio of 2.55 (95% confidence interval = 2.22–2.92) after adjusting for age and other comorbidities. The incidence of type 2 DM increased with age in both cohorts. Balanitis patients with hypertension, hyperlipidemia, or obesity had higher risks for type 2 DM than those without these conditions (all P < 0.05). Conclusions: Men with balanoposthitis may have a higher risk of type 2 DM in the future. Therefore, clinical physicians should pay more attention to the early evaluation and management of type 2 DM in the patients with balanoposthitis.
  3,448 225 -
REVIEW ARTICLE
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
DOI:10.4103/UROS.UROS_25_18  
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.
  3,121 485 -
ORIGINAL ARTICLES
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
DOI:10.4103/UROS.UROS_52_18  
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.
  3,151 295 -
ORIGINAL ARTICLES: FUNCTIONAL UROLOGY
Long-term satisfaction and complications in women with interstitial cystitis undergoing partial cystectomy and augmentation enterocystoplasty
Hsiu-Jen Wang, Hann-Chorng Kuo
March-April 2018, 29(2):81-85
DOI:10.4103/UROS.UROS_21_17  
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.
  2,839 229 -
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
DOI:10.4103/UROS.UROS_6_17  
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.
  2,738 273 -
ORIGINAL ARTICLES
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
DOI:10.4103/UROS.UROS_10_18  
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.
  2,660 294 1
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
DOI:10.4103/UROS.UROS_11_17  
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/).
  2,614 300 -
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
DOI:10.4103/UROS.UROS_11_18  
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.
  2,456 307 -
ORIGINAL ARTICLE
Effect of long-term administration of tadalafil on arteriosclerosis: A prospective cohort study
Keiichiro Hayashi, Haruaki Sasaki, Takashi Fukagai, Tetsuo Noguchi, Kidai Hirayama, Yu Ogawa, Atsushi Igarashi, Masashi Morita, Kimiyasu Ishikawa, Yoshio Ogawa
July-August 2019, 30(4):164-169
DOI:10.4103/UROS.UROS_113_18  
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.
  2,593 150 -
ORIGINAL ARTICLES: CLINIC SCIENCE
Gonadectomy in patients with disorder of sexual development
Kuan-Ting Chen, Yi-Sheng Tai, I-Ni Chiang, Hong-Chiang Chang, Kuo-How Huang
September-October 2018, 29(5):243-251
DOI:10.4103/UROS.UROS_35_18  
Objective: The objective of this study is to investigate clinical characteristics and treatment outcomes of patients with disorder of sexual development (DSD) who underwent gonadectomy at a single tertiary center. Materials and Methods: We retrospectively enrolled patients with DSD who received gonadectomies in our hospital from 2000 to 2015. The clinical presentations, laboratory tests, image studies, operative findings, and pathology reports were collected by reviewing medical records. Results: A total of 18 patients with DSD were analyzed, including 17 46XY karyotype and one 45X/46XY karyotype. Among them, 17 patients were assigned female gender. The most common diagnoses were androgen insensitive syndrome (n = 5), 46XY gonad dysgenesis (n = 5), and 17α-hydroxylase deficiency (n = 3). Initial presentations included amenorrhea (n = 9), ambiguous genitalia (n = 5), and abnormal prenatal screening (n = 3). The peak age of gonadectomies was 5 at infantile (1–2 years) and 7 at adolescent period (11–15 years). A total of 19 gonadectomies were performed without complications; pure inguinal approach in 6, inguinal plus laparoscopy exploration in 13. There were no malignancies in all resected gonads; in addition, spermatogenesis was found in only one resected gonad. Conclusions: Female gender assignment was more frequently chosen in our series. The presentations and diagnoses in children with DSD were various; it is important to select individualized treatment strategy for these patients.
  2,485 233 -
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
DOI:10.4103/UROS.UROS_2_18  
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.
  2,400 317 -
REVIEW ARTICLE
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
DOI:10.4103/UROS.UROS_42_18  
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.
  2,253 398 1
LETTER TO THE EDITOR
Renal vein aneurysm
Shih-Huan Su, Wenghou A O, Li-Jen Wang, Hsin-Chia Angela Lin, Cheng-Keng Chuang
March-April 2018, 29(2):111-113
DOI:10.4103/UROS.UROS_1_18  
Renal vein aneurysm (RVA) is a rare disease. Only a few cases have been reported in the past. With Institutional Research Board approval (IRB 201600376B0D001), we reported the case of a 51-year-old female without symptoms and incidental finding of a right renal lesion by renal echo during health examination. Computed tomography (CT) angiography showed a large aneurysm connecting to the right renal vein. Thus, a right RVA was diagnosed. Embolization was not performed due to extremely high probability of untargeted embolization, and the patient preferred outpatient follow-up. CT angiography follow-up was done 6 months later and revealed no obvious enlargement of the aneurysm but an arteriovenous fistula was suspected. The main objective of this report is to differentiate between renal vascular disease and malignant renal neoplasms by reviewing and discussing the available literature.
  2,440 162 -
ORIGINAL ARTICLES: CLINIC SCIENCE
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
DOI:10.4103/UROS.UROS_33_18  
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.
  2,358 224 -