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   2018| September-October  | Volume 29 | Issue 5  
    Online since September 3, 2018

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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.
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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
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.
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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.
  3,020 366 -
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.
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Comparison of urodynamic bladder dysfunction in male patients with pelvic organ malignancies
Chian-Shiung Lin, Mei-Jin Wu, Cheng-Yao Lin, Chih-Cheng Lu
September-October 2018, 29(5):237-242
Objective: Bladder dysfunction is a common complication after pelvic cancer treatments (radical pelvic surgery or chemoradiotherapy) that may affect patient satisfaction and quality of life. The aim of this study is to compare urodynamic bladder dysfunction among male patients with different pelvic organ malignancies (POMs). Materials and Methods: Data were collected from male patients with POM undergoing urodynamic studies (UDSs). Patients were stratified into three groups based on the origin of cancer (prostate, bladder, and colorectum). Selected data, including age, clinical tumor staging, lower urinary tract symptoms or acute urinary retention, and the parametric values of UDSs, were compared among the groups. SPSS 17.0.1 for Windows and Microsoft Office Excel 2007 were used for all statistical analysis. Results: A total of 640 patients with POM from the prostate (40.9%), bladder (33.5%), and colorectum (25.6%) were investigated. Patient age ranged from 39 to 89 years (mean 72.93 ± 9.08 years). In uroflowmetry (525 patients), the maximal urine flow rate was significantly lower in the prostate group (11.49 ± 5.53 ml/s). Cystometrograms (115 patients) showed that the first desire was more sensitive in the bladder group (85.52 ± 49.78 ml). Cystometric capacity was decreased in the prostate group (161.50 ± 94.29 ml); the maximum voiding pressure and compliance were significantly lower in the colorectum group (64.58 ± 50.09 cmH2O). Conclusion: Patients with POM may suffer from urination dysfunction. Impaired bladder function is more predominant in the colorectum oncology compared with urological pelvic organ (prostate or bladder) malignancies. Physicians are encouraged to be aware of these urinary complications after POM treatment.
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Renal Parenchyma Perforation after Double-J Ureteral Stent Insertion: A Very Rare Case Report
Yi-An Liao, Chung-Cheng Wang
September-October 2018, 29(5):259-261
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The role of body mass index predicting outcome of percutaneous nephrolithotomy
Tsai-Feng Chen, Chung-Hsin Chen, Yuan-Ju Lee
September-October 2018, 29(5):252-256
Objective: The objective of this study is to evaluate the impact of body mass index (BMI) on clinical outcomes and safety profiles of percutaneous nephrolithotomy (PCNL). Materials and Methods: We retrospectively reviewed the patients who received PCNL between January 2015 and December 2016. A total of 182 consecutive patients were enrolled. The patients were categorized into three groups according to BMI (normal: BMI ≤24, overweight: 24 < BMI ≤27, obesity: BMI >27). The stone clearance rate, operation time, duration of hospital stay, postoperative analgesic use, and postoperation complications were compared among groups. The categorical variable was analyzed by Chi-square test, and the continuous variable was analyzed by Kruskal–Wallis test. The possible prognosticators for stone clearance were also analyzed using logistic regression method. Results: There were no significant differences among groups in terms of age, gender, stone character, stone size, and laterality. A higher proportion of hypertension was observed in the larger BMI groups and lower hemoglobin level in the smaller BMI group. No significant differences of stone clearance rate (66%, 76%, 70% in normal size, overweight, and obesity groups, respectively), duration of hospital stay, postoperative analgesic use, and complication rate were identified among groups. The most common complication was postoperative fever in overweight and obesity groups. Multivariable analysis showed the stone character was a significant prognosticator for stone clearance. Conclusion: BMI did not reveal the impact on the stone clearance, operative time, duration of hospital stay, postoperative analgesic requirement, and postoperative complication in patients undergoing PCNL.
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Commentary from readers: Role of second-look transurethral resection of bladder tumors
Beuy Joob, Viroj Wiwanitkit
September-October 2018, 29(5):257-257
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Overactive bladder: Shortage of good medicine and potential role of traditional Chinese medicine
Stephen Shei-Dei Yang
September-October 2018, 29(5):215-215
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Editorial Comment: Comparative Persistence, Switch Rates, and Predictors for Discontinuation of Antimuscarinics for Overactive Bladder: A 10-year Nationwide Population-based Study in Taiwan
En Meng
September-October 2018, 29(5):229-230
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Re: Outcome of second-look transurethral resection of bladder tumors for T1 bladder cancer: A five-year
Wen-Hsin Tseng, Alex Chien-Hwa Liao, Steven K Huang, Chien-Liang Liu
September-October 2018, 29(5):258-258
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CME Test

September-October 2018, 29(5):262-263
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