Chi-Hang Yee

Extracorporeal shockwave therapy in the treatment of erectile dysfunction: a prospective, randomized, double-blinded, placebo controlled study.

To investigate the role of low‐intensity extracorporeal shockwave therapy in the treatment of erectile dysfunction.

Inflammatory myofibroblastic tumor of spermatic cord in undescended testis.

Inflammatory myofibroblastic tumor (IMT) is an uncommon condition and only a few cases of IMT in the spermatic cord have been reported, with none associated with an undescended testis. We present the case of a man with an undescended left testis who had an IMT involving the spermatic cord. He was treated with surgery and no adjuvant therapy afterward. He was disease free at 2.5 years of follow-up. A brief discussion of the pathologic features and management of the condition is also provided.

Zoledronic acid to prevent bone loss in Chinese men receiving androgen deprivation therapy for prostate cancer

Aim:  To explore the bone mineral density (BMD) preservation effect of zoledronic acid and its renal safety and tolerability in Chinese patients with prostate cancer on androgen deprivation therapy (ADT).

Secondary hemorrhage after bipolar transurethral resection and vaporization of prostate

Introduction: We evaluated the factors associated with secondary hemorrhage after bipolar transurethral resection of prostate (TURP) and vaporization of prostate. Materials and Methods: The perioperative data of patients undergoing endoscopic surgery for benign prostatic hyperplasia (BPH) were prospectively collected. Procedures involved included bipolar TURP, bipolar vaporization of prostate, and hybrid bipolar TURP/vaporization of prostate. Secondary hemorrhage was defined as bleeding between 48 h and 30 days postsurgery requiring hospital attendance with or without admission. Risk factors for secondary hemorrhage were analyzed. Results: From 2010 to 2013, 316 patients underwent bipolar surgery for BPH. Bipolar TURP accounted for 48.1% of the procedures, bipolar vaporization accounted for 20.3% of the procedures, and the rest were hybrid TURP/vaporization of prostate. Among this cohort of patients, fifty patients had secondary hemorrhage with hospital attendance. Consumption of platelet aggregation inhibitors (PAIs) was found to be associated with secondary hemorrhage (P < 0.0005). Age, prostate volume, operation type, the use of 5-alpha reductase inhibitors, and being with a urethral catheter before operation were not found to be statistically significant risk factors for secondary hemorrhage. Conclusions: Secondary hemorrhage after bipolar surgery for BPH is a common event. Consumption of PAI is a risk factor for such complication.

Extended use of Prostate Health Index and percentage of [-2]pro-prostate-specific antigen in Chinese men with prostate specific antigen 10-20 ng/mL and normal digital rectal examination.

Purpose We investigated the extended use of Prostate Health Index (PHI) and percentage of [-2]pro-prostate-specific antigen (%p2PSA) in Chinese men with prostate-specific antigen (PSA) 10–20 ng/mL and normal digital rectal examination (DRE). Materials and Methods All consecutive Chinese men with PSA 10–20 ng/mL and normal DRE who agreed for transrectal ultrasound (TRUS)-guided 10-core prostate biopsy were recruited. Blood samples were taken immediately before TRUS-guided prostate biopsy. The performances of total PSA (tPSA), %free-to-total PSA (%fPSA), %p2PSA, and PHI were compared using logistic regression, receiver operating characteristic, and decision curve analyses (DCA). Results From 2008 to 2015, 312 consecutive Chinese men were included. Among them, 53 out of 312 (17.0%) men were diagnosed to have prostate cancer on biopsy. The proportions of men with positive biopsies were 6.7% in PHI<35, 22.8% in PHI 35–55, and 54.5% in PHI>55 (chi-square test, p<0.001). The area under curves (AUC) of the base model including age, tPSA and status of initial/repeated biopsy was 0.64. Adding %p2PSA and PHI to the base model improved the AUC to 0.79 (p<0.001) and 0.78 (p<0.001), respectively, and provided net clinical benefit in DCA. The positive biopsy rates of Gleason 7 or above prostate cancers were 2.2% for PHI<35, 7.9% for PHI 35–55, and 36.4% for PHI>55 (chi-square test, p<0.001). By utilizing the PHI cutoff of 35 to men with PSA 10–20 ng/mL and normal DRE, 57.1% (178 of 312) biopsies could be avoided. Conclusions Both PHI and %p2PSA performed well in predicting prostate cancer and high grade prostate cancer. The use of PHI and %p2PSA should be extended to Chinese men with PSA 10–20 ng/mL and normal DRE.

Current management practice for bladder cancer in Hong Kong: a hospital-based cross-sectional survey.

OBJECTIVES To examine current practice in the management of bladder cancer in Hong Kong government and private hospitals. DESIGN Cross-sectional survey. SETTING All government hospitals and the major private institutions in Hong Kong, which provide urological services. PARTICIPANTS Urologists responding to an anonymous, self-administered, web-based questionnaire regarding practices in smoking cessation, treatment of non-muscle invasive bladder cancer and muscle invasive bladder cancer, and research into bladder cancer. RESULTS Of the 29 urologists from 11 government hospitals and eight private institutions who were invited, 18 from 11 (100%) government hospitals and seven from six (75%) private institutions responded, which amounted to an 86% response rate. In all, 88% of the respondents seldom or never referred their bladder cancer patients to smoking cessation programmes. Hong Kong urologists showed good compliance in the management of non-muscle invasive bladder cancer according to international guidelines. There was great variation with regard to regimens for maintenance of intravesical immunotherapy. There was underuse of perioperative systemic chemotherapy, despite wide acceptance of this practice; fewer than 10% of the patients received neo-adjuvant and adjuvant systemic chemotherapy for the treatment of muscle invasive bladder cancer. Of the surveyed urologists, 80% expressed an inadequacy of resources for bladder cancer research and 96% agreed that a local inter-hospital bladder cancer database was needed. CONCLUSIONS This study demonstrated great diversity in the use of intravesical immunotherapy, perioperative systemic chemotherapy, and surgical treatment of bladder cancer among urology service providers. There is a need for clear recommendations in these areas.

Primary paraganglioma of urinary bladder: Case series and review of the literature

Paragangliomas of the urinary bladder (PUB) are uncommon and represent less than 1 per cent of all bladder tumours. They can manifest with classic symptoms and signs similar to those of adrenal pheochromocytoma, but the clinical presentation could be nonspecific. Preoperative diagnosis of this uncommon condition is difficult but important, owing to the potential for catecholamine crisis during surgery. In the present study, we review our experience of four cases of PUB and review the literature on this condition.

The cardiovascular risk factors in men with lower urinary tract symptoms

ObjectiveIt has been hypothesized that endothelial dysfunction and pelvic atherosclerosis may contribute to lower urinary tract symptoms (LUTS). We assessed the relationship between cardiovascular risk factors and LUTS severity in male patients presented to urology clinic.MethodsIt is a cross-sectional study on patients who presented between 2013 and 2015 with LUTS. A total of 1176 male patients were encountered, and 966 were included for analysis after excluding patients with urinary tract malignancy, urethral stricture, bladder stone and history of urinary tract surgery. Cardiovascular risk factors including components of Framingham risk score, body mass index, uroflowmetry, International Prostate Symptoms Score, fasting blood glucose and serum prostate-specific antigen (PSA) were assessed. Correlation between Framingham risk score, cardiovascular risk factors and severity of LUTS was investigated.ResultsMultinomial logistic regression analysis showed that severe LUTS significantly associated with Framingham score (P = 0.008) and its components of total cholesterol (OR = 1.318; P = 0.010) and age (OR = 1.032; P = 0.006) compare with mild symptoms. Framingham risk score was found to correlate with storage symptoms (CC = 0.083; P < 0.0001) but not voiding symptoms (CC = − 0.029; P = 0.185).ConclusionsSeverity of LUTS and storage symptom significantly increases Framingham risk score, particularly with the components of total cholesterol level and age.

Time trend and characteristics of prostate cancer diagnosed in Hong Kong (China) in the past two decades

There was also statistically significant improvement in the survival of prostate cancer patients across the cohorts (Log-rank test, P = 0.0018). There appeared to be a trend of gradual improvement in net survival. The crude hazard ratios for later cohorts were all significantly <1, indicating a better 3-year survival than the reference cohort (1997–1998). However, the 3-year survival did not differ between the cohorts after adjusted for age and disease status. As data have shown, prostate cancer is one of the most common cancers among males in Hong Kong (China).3 In our study, we observed a statistically significant increase in the diagnosis of prostate cancer. When comparing against the cohort 1997–1998, across the four cohorts, there was a significant increase in the number of newly diagnosed prostate cancer (109, 184, 263, and 389 patients, respectively, P < 0.001). This implies that long-term planning addressing prostate cancer is essential to maintain the standard of healthcare, and more resources would be needed. We observed several important trends of prostate cancer in the past two decades. First, more patients presented with an earlier clinical stage, i.e., more patients were found to have normal digital rectal examination (T1c) at the time of diagnosis. Meanwhile, the median serum PSA level at the time of diagnosis was decreasing across our cohorts. Moreover, the proportion of metastatic disease was also found to be decreasing. These suggested that prostate cancers were detected at an earlier stage. It could be attributed by increasing awareness and health checking in Hong Kong (China). Although the trend of earlier detection of prostate cancer was observed, from our study, the 3-year survival was not found to differ between the cohorts after adjusted for age and disease status. The relatively good survival outcome of prostate cancer could account for such observation. The potential advantage of earlier prostate cancer detection may not be reflected in our 3-year survival data. The trend of earlier diagnosis was also observed. The median ages of diagnosis in 1997–1998 and 2012–2013 were 72 and 80 years, respectively, although it was not statistically significant across four cohorts. While this is still higher than that in the Western countries, where patients usually have prostate cancer diagnosed in their 60s, the longer life expectancy in Hong Kong (China) makes radical treatment still an option to many prostate cancer patients. An increasing number of less aggressive prostate cancer were noted with lower PSA, lower Gleason score and less abnormal digital rectal examination. It would imply that more patients would be suitable candidates for active surveillance. In fact, we observed the trend. Dear Editor, Prostate cancer is an important disease worldwide.1 In 2015 it was the third most common cancer diagnosed in male in Hong Kong (China) and the incidence of prostate cancer has been rising in the past 15 years.2 Meanwhile, with increasing public awareness, health education, presentation, and detection of prostate cancer may be changed. Therefore, we would like to review how the epidemiology of prostate cancer in Hong Kong (China) had changed in the past two decades. We have retrospectively reviewed all prostate cancer patients who were managed at public hospitals of the New Territories East Cluster in Hong Kong, China (Prince of Wales Hospital, Alice Ho Miu Ling Nethersole Hospital, and North District Hospital). The study was approved by The Joint Chinese University of Hong Kong (China) – New Territories East Cluster Clinical Research Ethics Committee. Patient consent was not required in this retrospective review. Four 2-year historical cohorts (1997–1998, 2002–2003, 2007–2008, and 2012–2013) were selected. Characteristics of the patients and cancer, treatment approach and survival of these periods were reviewed through patient medical records. A total of 945 patients were included in this study (Table 1). Across four cohorts, there was a significant increase in the number of newly diagnosed prostate cancer (109, 184, 263, and 389 patients, respectively, for each cohort, P < 0.001). The mean age was 71.2 (standard deviation [s.d.]: 8.43) years, without significant difference between the four cohorts (P = 0.232). Using the cohort 1997–1998 as the control, prostate-specific antigen (PSA) level was decreasing across the cohorts (median: 57.5, 44.5, 25.5, and 18.4 ng ml−1, respectively, P < 0.001). Prostate cancer was increasingly diagnosed with normal digital rectal examination (P < 0.001). For the pathological information, there were more cases with Gleason sum <7 (P = 0.002), diagnosed at the stage of localized disease and less metastatic disease at the later cohorts (P < 0.001). Among those patients with localized disease, we observed that an increasing proportion of patients had received radical treatment including radical prostatectomy or radiotherapy. There was also a rising trend for patients who were managed with active surveillance. LETTER TO THE EDITOR

Psoas hitch and ureteral re-implantation in an augmented bladder with ketamine uropathy: A case report

Ketamine has become a popular recreational drug among Asians in recent years. Ketamine uropathy is well known to affect the lower urinary tract leading to urgency, frequency, incontinence and pelvic pain. Concomitant upper urinary tract involvement with ureteric stricture is less common. We hereby present a case of a patient with ketamine‐related bladder contracture initially treated with augmentation cystoplasty, who subsequently developed left lower ureteric stricture requiring psoas hitch and ureteral re‐implantation. We further discussed the fundamental principles in managing ketamine uropathy.