Bang-Ping Jiaan

Recurrence rate and risk factors for urinary calculi after extracorporeal shock wave lithotripsy

PURPOSE We determined the recurrence rate after extracorporeal shock wave lithotripsy (ESWL*) and evaluated its associated risk factors, such as patient sex and age, volume of daily water intake, related diseases, family history of urinary calculi, number, burden and location of stones, residual stones after ESWL, serum uric acid level before ESWL and so forth. MATERIALS AND METHODS We conducted a retrospective study of 841 patients who underwent ESWL for primary treatment of urinary calculi between 1985 and 1987. Charts were reviewed for stone characteristics, outcomes and associated laboratory data. Followup 6 to 9 years later was done by mail and telephone interviews. RESULTS Followup data were available for 436 patients (52%). Overall, stones recurred in 51% of the 436 patients at a mean followup of 7.1 years. Late recurrences were common, and were noted in as many as 70% of the patients after 9 years. This rate is greater than what has been previously reported after other treatments. Cox regression analysis indicated that the major risk factors associated with recurrence were male gender (relative risk 1.406, p < 0.05) and multiple stones (relative risk 1.777, p < 0.05). CONCLUSIONS The frequent late recurrences support the speculation that ESWL might lead to greater recurrence rates. Therefore, the cost-effectiveness of ESWL versus other modalities for stone removal warrants more long-term evaluation.

Role of p21WAF1 and p27KIP1 in Predicting Biochemical Recurrence for Organ-confined Prostate Adenocarcinoma

Background: Both p21WAF1 and p27KIP1 have been reported as prognostic markers predicting biochemical failure for prostate cancers. We examined the expression and prognostic significance of p21WAF1 and p27KIP1 in organ‐confined (pT2) prostate cancer patients. Methods: The medical records of 53 pT2 prostate adenocarcinomas were analyzed retrospectively. Radical prostatectomy specimens were stained using anti‐p21WAF1 and anti‐p27KIP1 antibodies. Biochemical relapse was defined as 2 consecutive elevations in serum prostate specific antigen (PSA) level > 0.2 ng/mL with an interval of more than 3 months. The prognostic significance of p21WAF1 and p27KIP1 expression was assessed. Results: p21WAF1 immunoreactivity was found in 19 patients (35.8%). Twenty‐nine tumors (54.7%) had decreased p27KIP1 expression. Both markers were not associated with Gleason scores (p = 1.00 for both). At a median follow‐up of 49 months, 15 patients (28.3%) experienced biochemical recurrence. Both p21 and p27 had no prognostic significance in log‐rank test (p = 0.98 and p = 0.64, respectively). Conclusion: p21WAF1 and p27KIP1 expression have no role in predicting biochemical relapse for stage pT2 prostate cancers.

Simultaneous bilateral adrenal metastases from renal cell carcinoma : surgical implications and review of the literature

We report a case of left-side renal cell carcinoma with contemporary bilateral adrenal involvement discovered preoperatively with computerized tomography and other imaging techniques. Surgical treatment consisted of radical nephrectomy with a nearly total contralateral adrenalectomy and the unroofing of a lower pole renal cyst. Postoperative cortisone acetate replacement was instituted. The surgical implications of renal cell carcinoma with metastasis are also discussed.

Functional and urodynamic characteristics of Camey II ileal neobladder

The object of this study is to evaluate the functional and urodynamic characteristics of 16 patients who had undergone the Camey II orthotopic bladder replacement after radical cystoprostatectomy. Questionnaires regarding the voiding pattern and urinary continence were answered by 14 patients. Daytime continence was achieved in 13 of 14 patients (93%) at a mean interval of 3 months postoperatively. Eight patients (62%) attained their nighttime continence at an average interval of 10 months. Six of these 8 patients had to void to keep dry at night. Urodynamic studies were completed in 13 patients at an average of 11 months (range 6-23) postoperatively. Patients with nighttime continence had a significantly higher cystometric filling capacity (323 vs. 196 ml, p < 0.001), lower basal pouch pressure (24.5 vs. 35.2 cm water, p = 0.04), lower maximal voiding pressure (62.1 vs. 88.0 cm water, p = 0.01) and higher maximal urethral closure pressure (65.5 vs. 44.0 cm water, p = 0.03). There is no significant difference among the parameters of the age at operation, the amount of residual urine and the functional profile length between these two groups of patients. The antireflux procedure was successful in 11 of 12 patients (92%). We conclude that the Camey II operation could fulfill all the criteria of ideal bladder substitution with adequate volume, low resting pressure, satisfactory continence rate and antireflux characteristic.

Scrotal Cystocele Coexistent with Lipoma - Report of Two Case

Urinary bladder herniation is not an unusual disease. The reason for its occurrence is the same as that for inguinal hernia: a defect in the abdominal wall or degenerative weakening of the supportive tissues. However, scrotal cystocele, which involves inguinoscrotal herniation of the bladder, is a rare urological condition. This report describes two cases of scrotal cystocele coexistent with lipoma and the possible correlation between these two conditions.

Soluble Urinary Macromolecular Protein in Normal Males and in Urinary Stone Formers

This study was designed to detect the differences in soluble urinary proteins between 20 normal male individuals and 35 urinary-stone-formers by electrophoresis. Twenty urine samples were obtained from normal male individuals and 35, from male urinary stone formers. In these recurrent stone formers, urine samples were collected at a time they were free of urinary stone and urinary tract infection. The crystalline composition of urinary stones of these 35 stone-formers were calcium oxalate in 13, uric acid in 7, carbonate apatite in 12 and brushite in 3. Two hundred milliliter fresh, and midstream, voiding urine was collected for analysis. The urine was concentrated, dialyzed, frozen and lyophilized. The resulting powder was stored at-70#0C until further use. The powdered samples of the same stone composition catagory were pooled and analyzed by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Comparision of protein profiles of stone formers with those of normal individuals identified the following different urinary proteins: seven with calcium oxalate, two with uric acid, five with apatite and two with brushite, for the stone formers. The proteins comprised protein A(61kDa), B(37kDa), C(30kDa), D(26kDa), E(25kDa), F(23kDa) and G(22kDa) for calcium oxalate, protein H(63kDa) and I(59kDa) for uric acid, protein J(65kDa), K(42kDa), C(30.0kDa), F(23kDa) and G(22kDa) for carbonate apatite and protein A(61kDa) and I(59kDa) for brushite. Our results showed that the different soluble urinary proteins existed in urine of stone-formers when compared with normal individuals. Whether these proteins may play a role in the formation of urinary stone, it has been investigated by further studies such as western blotting and crystalllization model to confirm these proteins as potential markers of stone formation.

Serum C-reactive Protein Change after Extracorporeal Shock Wave Lithotripsy

The purpose of this study was to evaluate the tissue effect of extracorporeal shock wave lithotripsy (ESWL), based on changes in serum C-reactive protein (CRP) levels. Forty-eight patients received 51 treatments of ESWL for 36 renal and 15 ureteral stones. Shock waves were applied by Siemens Lithostar-II unit with mean 3508 impulses (range 874 to 4000) and with mean voltage 17.2 KV (range 15.3 to 18.9). Patients who were treated with ESWL for urinary stones were evaluated by serum CRP level before ESWL, immediately after, then six hours, one day and one week after ESWL. Two-way analysis of variance (ANOVA) was used to compare the changes in serum CRP levels. The post-ESWL CRP levels increased, ranging from 38% to 65% in all the group studies. But statistically, there was no significant change in serum CRP levels among these groups. To conclude, ESWL did not cause significant tissue damage, according to evaluation of CRP level.

Bloody Ejaculation as an Initial Presenting Symptom of Prostate Cancer; Its Clinical Implication: Report of There Cases

Hemospermia is a not uncommon complaint of men after middle-age. In the past decade hemospermia has been thought to be a benign, self-limiting condition which did not require full urologic investigation. However, more recent sporadic reports have disclosed the possibility of hemospermia associated with prostate cancer. Three patients who presented with the initial symptom of bloody ejaculation were then diagnosed with prostate cancer. It is therefore believed that further investigation of prostate gland, including digital rectal palpation, prostate specific antigen determination and transrectal ultrasound of prostate should be performed as initial investigations for patients who have complaints of hemospermia, especially in aged men.

Carcinosarcoma of Urinary Bladder: Case Report and Literature Review

Carcinosarcoma of urinary bladder is a rare and highly aggressive tumor with poor prognosis. The case of a 62-year-old man with urinary bladder carcinosarcoma is described. The patient underwent surgical extirpation of the bladder and reconstruction of the neobladder with modified Camey procedure. He was in good health one year postoperatively, without adjuvant therapy.

The Study of Protein Content in Urinary Calculi

Between july 1990 and june 1991, 36 urinary calculi removed by open surgery were analyzed by in fraire spectrophotometer. The protein content of these stones were analyzed by one and two-dimensional gel electrophoresis. The stone composition of 36 urinary calculi were whewellite in 5, uric acid 4, struvite 2, carbonate apatite 2, whewellite + carbonate apatite 3, whewellite + weddllite 2, struvite + content in different urinary calculi was varied, carbonate apatite contained more protein than other composition: 45.61± 17.20 ug protein/g stone, followed bue uric acid 24.94±16.57, struvite+ carbonate apatite 21.84±12.03, whewellite + weddellite ±19.09 ±3.34, whewellite + weddellite + carbonate apatite 18.10±13.44, struvite 16.50 ± 10.72, whewellite 14.77 ±14.30. The result of the protein map analyzed by one and two-dimensional electrophoresis from the same stone was consisent, which showed a molecular weight pattern ranged from less than 14 kDa to 18 kDa. Furthermore, different urinary calculi had a distinct protein map. This finding strongly suggests that protein may play an active role in selective incorporation of stone formation. In conclusion, one and two-dimensional electrophoresis is a novel method to analyze urinary calculi protein, the results are characteristic and reproducible.