Alex T. L. Lin

Clinical guidelines for interstitial cystitis and hypersensitive bladder syndrome.

A clinical guideline and algorism for interstitial cystitis and hypersensitive bladder syndrome has been developed by a group of East Asian urologists as a revised form of the Japanese guideline for interstitial cystitis. The guideline defines interstitial cystitis (IC) as a disease of the urinary bladder diagnosed by 3 requirements; 1) a characteristic complex of lower urinary tract symptoms, 2) bladder pathology such as Hunners ulcer and bladder bleeding after overdistension, and 3) exclusions of confusable diseases. The characteristic symptom complex is termed as hypersensitive bladder syndrome (HBS), which is defined as bladder hypersensitivity, usually associated with urinary frequency, with or without bladder pain. For the definite diagnosis of IC, cytoscopy or hydrodistension is crutial; HBS is the diagnosis when IC is suspected but not confirmed by the 3 requirements. Numerous therapeutic options are available; however, most of them lack in high level of evidence, leaving a few as recommended therapies. Etiology of IC are multifactorial; the interaction among nervous, immune and endocrine factors forms a vicious cycle, provocating and maintaining inflammatory reactions in the bladder. The inclusion and efficacy criteria for clinical trials should be standardized to enhance the clinical research for this disabling disease, which has proved to be more prevalent than previously believed.

Are There Useful CT Features to Differentiate Renal Cell Carcinoma From Lipid-Poor Renal Angiomyolipoma?

OBJECTIVEnThis study was an attempt to identify key CT features that can potentially be used to differentiate between lipid-poor renal angiomyolipoma and renal cell carcinoma (RCC).nnnMATERIALS AND METHODSnWe conducted an analysis of patients who received nephrectomy or renal biopsy from 2002 to 2011 with suspected RCC. We included tumors smaller than 7 cm with a completed three-phase CT examination. A radiologist and a urology fellow, blinded to histopathologic diagnosis, recorded the imaging findings by consensus and compared the values for each parameter between lipid-poor angiomyolipoma, RCC subtypes, and RCC as a group. Multivariate logistic regression analysis was performed for each univariate significant feature.nnnRESULTSnThe sample in our study consisted of 132 patients with 135 renal tumors, including 51 men (age range, 26-84 years; mean age, 57 years) and 81 women (age range, 29-91 years; mean age, 57 years). These tumors included 33 lipid-poor angiomyolipomas, 54 clear-cell RCC, 31 chromophobe RCC, and 17 papillary RCC. Multivariate analysis revealed four significant parameters for differentiating RCC as a group from lipid-poor angiomyolipoma (angular interface, p = 0.023; hypodense rim, p = 0.045; homogeneity, p = 0.005; unenhanced attenuation > 38.5 HU, p < 0.001), five for clear-cell RCC, two for chromophobe RCC, and one for papillary RCC. Lipid-poor angiomyolipoma and clear-cell RCC showed early strong enhancement and a washout pattern, whereas chromophobe RCC and papillary RCC showed gradual enhancement over time.nnnCONCLUSIONnSpecific CT features can potentially be used to differentiate lipid-poor renal angiomyolipoma from renal cell carcinoma.

Clinical guidelines for interstitial cystitis and hypersensitive bladder updated in 2015

Clinical guidelines for interstitial cystitis and hypersensitive bladder have been updated as of 2015. The guidelines define interstitial cystitis by the presence of hypersensitive bladder symptoms (discomfort, pressure or pain in the bladder usually associated with urinary frequency and nocturia) and bladder pathology, after excluding other diseases explaining symptoms. Interstitial cystitis is further classified by bladder pathology; either Hunner type interstitial cystitis with Hunner lesions or non‐Hunner type interstitial cystitis with mucosal bleeding after distension in the absence of Hunner lesions. Hypersensitive bladder refers to a condition, where hypersensitive bladder symptoms are present, but bladder pathology or other explainable diseases are unproven. Interstitial cystitis and hypersensitive bladder severely affect patients quality of life as a result of disabling symptoms and/or comorbidities. Reported prevalence suggestive of these disorders varies greatly from 0.01% to >6%. Pathophysiology would be an interaction of multiple factors including urothelial dysfunction, inflammation, neural hyperactivity, exogenous substances and extrabladder disorders. Definite diagnosis of interstitial cystitis and hypersensitive bladder requires cystoscopy with or without hydrodistension. Most of the therapeutic options lack a high level of evidence, leaving a few as recommended therapeutic options.

Metastatic Tumors Involving the Testes

From 1979 to 1999, totally 200 cases of testicular tumor were diagnosed and treated at Taipei Veterans General Hospital. With the exception of lymphoma and leukemia, a total of 14 cases with metastatic tumor to the testis was collected. Eight cases(51.7%)were derived from adenocarcinoma of the prostate, 2 cases(13.6%) from lung cancer, 2(13.6%) from cancer of the gastrointestinal tract, 1(7.1%) from carcinoma of the seminal vesicles and 1(7.1%) from undetermined origin. There were 2 cases with bilateral testicular involvement(13.6%), and another 12 cases were unilateral involvement as well as all cases combined with multiple metastases. Nine cases(64.3%) presented with a scrotal mass without elevation of AFP or B-HCG clinically, and 5 cases were discovered incidentally ofter therapeutic orchiectomy due to adenocarcinoma of the prostate. One of the 14 cases was still alive. In the 13 expired cases, the average survival was 12.8 mo for the 7 patients with prostate cancer after orchiectomy and 7.4 mo for the 6 non-prostate cancer patients. Prognosis was very poor in metastatic carcinoma to the testis due to the late stage.

Non-bladder conditions in female Taiwanese patients with interstitial cystitis/hypersensitive bladder syndrome

To detect non‐bladder conditions in patients with interstitial cystitis/hypersensitive bladder syndrome.

Folic acid prevents neural tube defects : International comparison of awareness among obstetricians/gynecologists and urologists

Aim:u2002 It has been suggested that periconceptional intake of folic acid prevents risks of having fetuses afflicted with neural tube defects. We aim to internationally investigate knowledge of the role of folic acid and attitudes toward the life‐style of young women of child‐bearing age among obstetricians/gynecologists and urologists.

Vapoenucleation of the prostate using a high-power thulium laser: a one-year follow-up study

BackgroundProstate vaporization and enucleation is a novel treatment option for bladder outlet obstruction caused by benign prostate enlargement. This surgical technique, however, has not yet been standardized. We present our findings of using a high-power thulium laser to accomplish vapoenucleation of the prostate (ThuVEP).MethodsWe prospectively collected and analyzed data from 29 patients who underwent ThuVEP between August 2010 and May 2012. The control group included 30 patients who underwent traditional transurethral resection of the prostate (TURP). Operative variables, patient profiles, preoperative and postoperative urine flow rates, prostate volume (measured using transrectal ultrasonography), and the international prostate symptom score (IPSS) were recorded and analyzed using a two-tailed Student’s t-test and analysis of variance.ResultsThe ages (meanu2009±u2009SD) of the patients were 76.1u2009±u20099.4 and 72.6u2009±u20097.4xa0years (pu2009=u20090.28) in the ThuVEP and TURP groups, respectively. The average urinary flow rates before and 12xa0months after the operation (volume/maximum flow/average flow) were 243.3/10.5/5.0 and 302.8/17.6/9.4 (in mL, mL/s, mL/s, respectively) in the ThuVEP group and 247.2/10.8/4.6 and 369.9/20.8/12.0, respectively, in the TURP group. Preoperative and postoperative IPSSs were 17.1u2009±u20095.0 and 6.5u2009±u20093.8, respectively, in the ThuVEP group and 18.2u2009±u20094.5 and 6.2u2009±u20093.3, respectively, in the TURP group. The mean ratio of the estimated postoperative residual prostate volume to the preoperative total volume was 0.47 (pu2009=u20090.449) in both groups. The overall complication rate was 20.7% in the ThuVEP group and 30.0% in the TURP group.ConclusionsOne year of follow-up showed that ThuVEP and TURP effectively alleviated subjective and objective voiding symptoms with a low rate of complications. Thus, vapoenucleation using a high-power laser is feasible in elderly patients.Trial registrationISRCTN registry with study ID ISRCTN52339705. Date assigned: 06/03/2015.

Kidney Trauma - A Review of 28 Cases

From March 1979 to ,28 patients with renal injuries seen at Veterans General Hospital-Teipei were reviewed. Sixteen injuries (57.1%) were caused by traffic accident, 4 (14.3%) by falling accident and 4 (14.3%) by stab wounds. Two of 24 patients (8.3%) had a normal urinalysis. One of 11 patients who received intravenous urography (IVU) normal finding. Computerized tomography (CT) was performed in 18 patients to find all with abnormalities. The most common one was perirenal hematoma (44.4%). Associated injuries were found in 17 of 28 patients (60.7%), and the most common were spleen rupture and hemothrax. Among 14 stable renal injuries initially treated conservatively, there were 4 complications including 3 cases of renal function deterioration and I case of elevation of blood pressure. The 14 injuries that were explored included 7 with shattered kidney (50.0%), 1 with renal pedicle injury (7.1%), 4 with renal laceration (28.6%) and 2 with renal contusion (14.3%). Two patients (7.6%) expired due to severe shock CT was more accurate than IVUin the diagnosis of renal trauma and the surgical treatment for renal laceration or fragmentation provides a satisfactory outcome.

Clinical Experiences of Primary Urothelial Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) is an unusual cancer in the urinary tract. In order to investigate the clinical status of primary urothelial SCC, we retrospectively reviewed the records of 12 patients treated at Veterans General Hospital-Taipei between January 1979 and April 1998. Mean age at diagnosis was 70 yr (range 48 to 84). Of these patients, SCC in 11 (92%) was found in the urinary bladder, and 1 (8%) in the ureter. The original specimen of I patient was not available. Of the other 11 patients, 4 (36%) had well-differentiated cancer, 4 (36%) moderately differentiated cancer, and 3 (2 7%) poorly differentiated cancer. Four patients (36%) presented with stage T2N0, 2 (18%) with stage T3N0, 3 (2 7%) with stage T4NQ, and 2 (18%) with stage N1. Mean follow-up period was 9.2 mo (range I to 23). Of 12 patients, 10 underwent surgery, I radiotherapy only, and I no treatment. The postoperative adjuvant treatments were added in 10 patients which included radiotherapy in 4 patients (40%), chemoradiotherapy in 2 (20%), and chemotherapy in 2 (20%). Six patients expired during the follow-up period. Their average survival time from diagnosis was only 5.5 mo. The cumulative survival rate at 23 mo was 40.9%. In conclusion, primary urothelial SCC is a rare cancer. Because most patients have advanced disease as well as moderately to poorly differentiated tumors at the time of diagnosis, the prognosis is grim.

Cost-effectiveness of Intravenous Urography and Abdominal Ultrasonography in Pre-operative Evaluation of Symptomatic

本研究即是評估對於攝護腺肥大患者以靜脈注射腎盂照影及腹部超音波做為手術前常規檢查之經濟效益。自1995 年l月至1995年6 月，排除過去有泌尿系統疾患、血尿、或腎絞痛病史者，共有266位病人（年齡分布由46 至89 歲，平均70.8 歲）接受經尿道攝護腺切除手術。常規實驗室檢查包括血液分析（血紅素，白血球，血小板，尿素氮及肌酸酐）和尿液分析。共收集靜脈注射腎盂照影161人次，腹部超音波124人次。其中19人接受兩種檢查。從靜脈注射腎盂照影和腹部超音波分別可發現37.9％及68.5％異常。其中從靜脈注射腎盂照影中發現的異常表現包括水腎（8 %）、輸尿管水腫（5.6 % ）、尿路結石（13.7 % ）、顯影缺陷（3.7 % ）及疑腎腫瘤( 9.3 % ）。腹部超音波中發現的異常表現包括水腎( 8.9 % ）、尿路結石（24.2 % ）、單純腎水囊（29 % ）、及疑似腫瘤（3.2 % ）。所有靜脈注射腎盂照影中發現的疑腎腫瘤後來經腹部超音波證實都為單純腎水囊。在靜脈注射腎盂照影及腹部超音波中可發現的顯著異常分別有29.3％和25.7％可在接受經尿道攝護腺切除手術時發現。大部分靜脈注射腎盂照影及腹部超音波的顯著異常，常常伴隨有尿液檢查異常。靜脈注射腎盂照影及腹部超音波檢查只對極少的病人有幫助。而這些檢查對於醫療費用卻顯著地增加。因此，從本研究結果顯示對於攝護腺肥大患者以靜脈注射腎盂照影及腹部超音波做為手術前常規檢查並不符合經濟效益。