Chen-Hsun Ho

Metabolic Syndrome Components Worsen Lower Urinary Tract Symptoms in Women with Type 2 Diabetes

CONTEXT Diabetic women are more susceptible to develop lower urinary tract symptoms (LUTS), especially overactive bladder (OAB). However, data regarding the effect of components of metabolic syndrome (MS) on this association are conflicting. OBJECTIVE The objective of the study was to examine the potential role of MS in the development of LUTS in diabetic women. DESIGN The study was a prevalence study conducted between 2005 and 2007. SETTING The study was conducted in a university hospital. PARTICIPANTS A total of 518 women with type 2 diabetes aged 50-75 yr were included. They were subgrouped as MS (47.5%) and non-MS (52.5%) groups according to whether they fulfilled the criteria of MS. MAIN OUTCOME MEASURE We used American Urological Association Symptom Index (AUA-SI) to evaluate LUTS and Indevus Urgency Severity Scale to evaluate OAB, respectively. RESULTS Women in the MS group had significantly higher storage and total AUA-SI scores as well as a higher prevalence of LUTS and OAB. Most intriguingly, the number of MS components was strongly associated with the LUTS severity because the AUA-SI scores increased in parallel to the number of components were present. Similar results were found between MS and OAB. Multivariate analysis revealed that peripheral neuropathy, but not MS, significantly predicted LUTS in diabetic women after age adjustment. However, MS remained significantly predictive for LUTS and OAB after additional adjustment for neuropathy. CONCLUSIONS Our results suggest that MS may especially influence LUTS and OAB in diabetic women, probably by compounding the effect of peripheral neuropathy.

Determining the appropriate length of a double-pigtail ureteral stent by both stent configurations and related symptoms.

PURPOSE To evaluate whether stent length affects the symptoms after stent insertion and to determine the appropriate stent length according to the stent configurations and the related symptoms simultaneously. PATIENTS AND METHODS A total of 87 patients who underwent ureteroscopic lithotripsy (URSL) and double-pigtail ureteral stent (22, 24, or 26 cm) insertion were enrolled. The stent configurations on the images were reviewed to determine whether the length was appropriate. All patients completed a questionnaire to assess the symptoms related to stent insertion. The incidence and severity of the symptoms were compared among the patients with different stent lengths. RESULTS The demographic data were similar among the three groups with different stent lengths (22, 24, or 26 cm). The stent length was associated with the position of the distal loop (P = 0.02), while it was not associated with the position of the proximal loop (P = 0.50). The use of a longer stent was significantly associated with a higher incidence of urinary frequency (P = 0.04) and urgency (P = 0.02). Also, the use of a longer stent was also significantly associated with higher symptom scores of urinary frequency (P < 0.01) and urgency (P < 0.01). CONCLUSIONS The stent length is associated with the position of the distal loop and the related urinary symptoms. A longer stent causes an overlong intravesical segment and more irritative symptoms. On the other hand, the stent length is not associated with either the position of the proximal loop or flank pain. Based on the analysis of both stent configurations on images and related symptoms, a 22-cm stent is more appropriate for those whose height ranges from 149.5 cm to 178.5 cm with a median of 161.9 cm.

Lower urinary tract symptoms in women with irritable bowel syndrome

Objectives:  To investigate lower urinary tract symptoms (LUTS) in women with irritable bowel syndrome (IBS) and to evaluate risk factors associated with the psychiatric morbidity of these patients.

Solifenacin and Tolterodine are Equally Effective in the Treatment of Overactive Bladder Symptoms

BACKGROUND/PURPOSE Various antimuscarinic agents have been developed for the treatment of overactive bladder (OAB). More data comparing these agents are still required. This study evaluated the efficacy and safety of solifenacin and tolterodine in Taiwanese patients with OAB symptoms. METHODS This was a prospective, randomized, open-label study. A total of 75 patients (25 men and 50 women) with OAB symptoms were randomized to treatment with solifenacin (n = 39) or tolterodine (n = 36). Efficacy and safety variables were assessed and compared with the baseline and between the two groups. RESULTS At week 12, solifenacin and tolterodine demonstrated equal efficacy in reducing the number of micturition (-2.56 ±3.31 vs. -2.44 ± 4.56, p = 0.58), urgency (-1.70 ± 3.07 vs. -1.15 ± 2.68, p =0.37) and incontinence (-2.79 ± 2.82 vs. -4.67 ± 9.29, p =0.28) episodes per 24 hours. There was no difference in improvement of the quality of life. The patient and physician assessments of treatment benefit were not statistically different for solifenacin and tolterodine (p = 0.23 and p = 0.52, respectively), with the majority showing benefits in both groups. The incidence of major adverse events, including dry mouth (18.0%vs. 8.3%, p = 0.31) and constipation (12.8%vs. 2.8%, p = 0.20) was not significantly different. Compared with baseline, the severity of dry mouth did not increase in either group. CONCLUSION Both solifenacin and tolterodine are effective in treating key OAB symptoms, including urinary frequency, urgency and incontinence in the Taiwanese population. Both medications are comparably effective and safe, with the most common adverse effects being dry mouth and constipation.

Urodynamic findings in female diabetic patients with and without overactive bladder symptoms

The purpose was to analyze urodynamic findings in female diabetic patients with OAB symptoms.

Erectile dysfunction, loss of libido and low sexual frequency increase the risk of cardiovascular disease in men with low testosterone

Abstract Introduction: Testosterone deficiency increases the cardiovascular disease (CVD) risk. Aim: To evaluate the effect of erectile dysfunction (ED), sexual frequency and hypogonadal symptoms on CVD risk. Methods: A total of 395 hypogonadal men aged 45–74 years were surveyed using the Androgen Deficiency in the Aging Male and the International Index of Erectile Function. Main outcome measures: The 10-year CVD risk was measured with the Framingham Risk Score. Logistic regression was performed to obtain the odds ratios of sexual function and hypogonadal symptoms for a 10-year CVD risk ≥20% (high risk). Results: The mean age was 56.1 ± 6.7 years. The mean 10-year CVD risk of the whole cohort was 18.1% ± 11.4%, while 131 subjects (33.2%) were classified as high risk. Logistic regression revealed that ED severity was associated with CVD risk [OR = 2.37 (CI 1.24–4.51) for mild-to-moderate ED, OR = 4.39 (1.78–8.43) for moderate ED and OR = 12.81 (4.65–26.11) for severe ED]. Compared to sexual frequency <1 per month, sexual frequency ≥4 decreased the risk of high CVD risk [OR = 0.35 (0.23–0.780)]. Loss of libido [OR = 2.95 (1.91–4.12)] and less strong erection [OR = 3.87 (CI 2.11–4.95)] increased the risk of high CVD risk. All remained significant after adjustment for age and testosterone. Conclusions: ED, decreased sexual frequency and loss of libido predict a high 10-year CVD risk in hypogonadal men.

The Prevalence and the Risk Factors of Testosterone Deficiency in Newly Diagnosed and Previously Known Type 2 Diabetic Men

INTRODUCTION While the epidemiology of testosterone deficiency has been well described in men with previously known type 2 diabetes mellitus (T2DM), it was less reported in those with untreated, newly diagnosed T2DM. AIM The aim of this study was to investigate the prevalence and the risk factors of testosterone deficiency of men with newly diagnosed T2DM. METHODS The cross-sectional study included 105 men (mean age: 61.2 ± 6.8 years) with previously known T2DM and another 81 (57.8 ± 8.8 years) with newly diagnosed T2DM. All received health checkup and sex hormone measurement at our institute in 2009. MAIN OUTCOME MEASURES We calculated the prevalence and explored the risk factors of low total (<300 ng/dL) and free (<6 ng/dL) testosterone in men with newly diagnosed and previously known T2DM. RESULTS Men with previously known T2DM were older and had higher diastolic pressure and greater fasting glucose. There was no significant difference in total (358.0 [155.0] ng/dL vs. 363.0 [154.0] ng/dL, P=0.68) and free (7.2 [2.5] ng/dL vs. 7.4 [2.4]ng/dL, P=0.84) testosterone and sex-hormone binding globulin (SHBG) (27.3 [22.3]nmol/L vs. 28.7 [14.9]nmol/L, P=0.46). The prevalence of low total and free testosterone was 28.4% and 21.0%, respectively, in men with newly diagnosed T2DM, and was 26.7% and 19.0% in those with previously known T2DM. In men with previously known T2DM, better glycemic control (HbA1c <7%) was associated with a higher level of total testosterone and a lower risk of low total testosterone. Men with newly diagnosed and previously known T2DM shared similar risk factors of low total testosterone, including high HbA1c (≥ 7%), low SHBG (<20 nmol/L), obesity, hyperuricemia, hypertriglycemia, and metabolic syndrome. Elevated prostate-specific antigen was a protective factor of low total testosterone. However, none of these factors was associated with low free testosterone. CONCLUSIONS The prevalence and the risk factors of testosterone deficiency are similar between newly diagnosed and previously known type 2 diabetic men.

Laparoendoscopic single-site surgery: adult hernia mesh repair with homemade single port.

Background Laparoendoscopic single-site surgery (LESS) is a novel technique developed to reduce the port-related morbidities and improve the cosmetic outcomes of laparoscopic surgery. To date, no series of LESS inguinal hernia repair has been published or documented. This study aimed to determine the safety and feasibility of LESS technique for inguinal hernia repairs. Methods Between December 2008 and March 2009, LESS procedures for inguinal hernia repair through a transumbilical incision were performed for 16 patients with symptomatic inguinal hernias. The initial 9 cases were performed by a transabdominal preperitoneal method and the remaining 7 were completed with a totally extraperitoneal approach. All procedures were accessed with our homemade single port for simultaneous passage of laparoscope and instruments. Results All procedures were completed successfully without conversion to standard laparoscopic or open surgery. These patients ranged in age from 21 to 80 years (median, 46.5 y) with a male to female ratio of 15:1. A total of 24 inguinal hernias, including 3 complicated types, were repaired. The median operative time was 83.5 minutes (range, 52 to 150 min). Two of the 16 patients suffered postoperative complications (12.5%). Most patients were discharged home on the second postoperative day. No port-related complications occurred. The cosmetic results were excellent. Conclusions In our experience, LESS procedures for inguinal hernia repair shows this technique to be both safe and feasible, even for complicated cases. More studies are needed to compare LESS inguinal hernia repair with standard laparoscopic techniques.

Choosing the Ideal Length of a Double-Pigtail Ureteral Stent according to Body Height: Study Based on a Chinese Population

Objective: We conducted this study to determine the ideal stent length according to body height, as data are limited. Patients and Methods: A total of 408 patients undergoing ureteroscopic lithotripsy and stent insertion (22, 24 or 26 cm) were enrolled. The appropriateness of the stent length was determined according to the plain films and was further compared among patients with different body heights and stent lengths. Results: In patients <160 cm, the use of a 22-cm stent was significantly more appropriate than a 24- or 26-cm stent (86.5, 51.9 and 46.4%). In patients between 160 and 175 cm, a 22- or 24-cm stent was significantly more appropriate than a 26-cm stent (79.2, 66.7 and 46.3%), while the difference between the use of a 22- and 24-cm stent was not significant. In patients >175 cm, a 24- or 26-cm stent might be more appropriate. Conclusions: Body heights can predict the ideal stent length. Based on a Chinese population, a 22-cm stent length is more appropriate for those <175 cm. A longer, 24- or 26-cm stent may be suitable for those >175 cm.

Laparoendoscopic Single-Site (LESS) Retroperitoneal Nephropexy with Standard Laparoscopic Instruments

A 65-year-old female suffered from recurrent urinary tract infection and intermittent right-flank soreness when active. Serial renal ultrasonography and supine/erect intravenous (i.v.) pyelography work-up revealed a floating right kidney with a descent of two vertebral bodies. A Laparoendoscopic single-site retroperitoneal nephropexy was performed. A homemade single port was created by using a commercially available wound retractor through a 3-cm incision at the tip of the 12th rib. With conventional 5-mm laparoscopy and instruments, a retroperitoneal nephropexy was perfomed. The procedure was completed successfully without any complication and with minimal blood loss. The total operative time was 110 minutes. The postoperative course was uneventful. The follow-up erect i.v. pyelographies revealed a normal right kidney position without descent. Laparoendoscopic single-site retroperitoneal nephropexy was a safe, effective procedure, according to our initial experience.