Chia Chang Wu

Homemade transumbilical port: an alternative access for laparoendoscopic single-site surgery (LESS).

BackgroundLaparoendoscopic single-site surgery (LESS) is a possible advancement for minimally invasive surgical interventions. However, this technique requires a specialized multichannel port for introducing laparoscope and instruments. We present our preliminary experience of using a homemade transumbilical single-port access for performing LESS.MethodAn Alexis wound retractor® was placed through the umbilical incision, and a pair of sterile surgical gloves was then snapped onto it. Standard laparoscopic trocars were inserted through the gloves after the upper half parts of the gloves were truncated. Using this port and Roticulator™ articulating instruments, we performed 14 urologic LESS procedures on porcine laboratory and cadaveric cases, and we performed 10 transabdominal pre-peritoneal inguinal hernia repairs (TAPP), and 5 laparoscopic varicocelectomies on human cases, respectively. All procedures were performed with instruments inserted through this port without the need for any extraumbilical incisions or conversion to standard laparoscopic surgery.ResultsAll LESS procedures were successfully completed without any complications. The time to achieve the transumbilical port ready for subsequent LESS was short (range, 4–8 (median, 6) minutes). The total operative time was between 60 and 190 minutes. No port-related complications were noted, and the cosmetic results were excellent.ConclusionsThis homemade transumbilical port offers a safe, reliable, flexible, and cost-effective access for LESS procedures. This technique may be an alternative for current specialized port systems.

Association Between Survivin Gene Promoter -31 C/G Polymorphism and Urothelial Carcinoma Risk in Taiwanese Population

OBJECTIVESnTo investigate the association between survivin gene promoter -31 C/G polymorphism and urothelial carcinoma (UC) risk in a Taiwanese population.nnnMETHODSnA total of 190 patients with pathologically confirmed UC and 210 unrelated controls without cancer were recruited at Chiayi Christian Hospital from August 2002 to May 2007. The -31 C/G polymorphism in the survivin gene promoter was determined using polymerase chain reaction-restriction fragment length polymorphism analysis.nnnRESULTSnCompared with study subjects carrying the G/G genotype, significantly increased UC risks were found for individuals carrying the C/G genotype (odds ratio 2.8; 95% confidence interval [CI] 1.7-4.6) and those with the C/C genotype (odds ratio 4.0; 95% CI 2.3-7.2). Those carrying the C/C or C/G genotype had a significantly increased UC risk of 3.2 (95% CI 1.9-5.2) compared with those with the G/G genotype. Among heavy smokers (> or = 30 pack-years), we found a significantly increased UC risk of 3.8 (95% CI 1.3-11.3) for individuals with the C/C or C/G genotype compared with those with the G/G genotype. Furthermore, patients with UC carrying the C/C genotype had a significantly greater prevalence of muscle-invasive (Stage T2-T4), high-grade (G3), or invasive, high-grade tumor compared with those carrying the G/G genotype.nnnCONCLUSIONSnThese findings suggest that the -31 C/G polymorphism of the survivin gene promoter is associated with both the clinical tumor stage and the pathologic tumor grade and might be involved in the development of UC.

Minilaparoscopic herniorrhaphy with hernia sac transection in children and young adults: a preliminary report

BackgroundWe designed a technique of pure minilaparoscopic hernia sac transaction and ligation to repair primary inguinal hernias in children and young adults.MethodsBetween September 2003 and December 2004, 83 patients with primary inguinal hernia were treated surgically with minilaparoscopic herniorrhaphy. The mean patient age was 6.8 years. Before the operation there were synchronous bilateral hernias in 2 (2.4%) patients, left inguinal hernias in 39 (47%) patients, and right inguinal hernias in 42 (50.6%) patients. The minilaparoscopic herniorrhaphy was carried out with the 3-mm laparoscopic and hand instrument system. Three 3.5-mm trocar ports were used for the telescope and 3-mm instruments. The peritoneum overlying the internal ring was circumferentially incised, then the peritoneal defect was closed with intracorporeal sutures.ResultsOne hundred and fourteen minilaparoscopic herniorrhaphies were performed. The mean followup period was 12.9 months. The mean operation time was 52 min. There was only one recurrence (1.2%) that was detected nine months after primary repair. All patients were able to return to unrestricted activity immediately and were discharged within 24 h after the operation. There was no reported case of testicular atrophy to date.ConclusionsMinilaparoscopic herniorrhaphy with hernia sac transaction is a safe and effective technique in children and young adults with indirect inguinal hernias.

Minilaparoscopic herniorrhaphy in pediatric inguinal hernia: a durable alternative treatment tostandard herniotomy

BACKGROUNDnThe purpose of the article is to report our long-term results of minilaparoscopic inguinal hernia repair in children.nnnMETHODSnBetween September 2003 and September 2008, 161 children with inguinal hernia were treated with minilaparoscopic herniorrhaphy. The asymptomatic contralateral internal ring was routinely explored and repaired if a patent processus vaginalis of not less than 2 cm was noted. Patients who were followed for less than 1 year and those who were lost to follow-up were excluded from the study. Intraoperative and postoperative complications and hernia recurrences were documented.nnnRESULTSnIn total, 146 patients were eligible for final analysis. A total of 196 minilaparoscopic herniorrhaphies were performed. The mean follow-up period was 3 years. There were 4 hernia recurrences (2%) in 3 boys. There were no procedure-related complications. None of the patients with a negative contralateral exploration or a contralateral patent processus vaginalis of less than 2 cm had a contralateral metachronous inguinal hernia.nnnCONCLUSIONSnOur long-term results reveal that minilaparoscopic herniorrhaphy combined with hernia sac transection is a safe and effective alternative treatment to standard open herniotomy.

Is local anesthesia or oral analgesics necessary after mini-laparoscopic functional surgery in children and young adults?: A prospective randomized trial.

Background This prospective, randomized, single-blind trial was to determine if local anesthesia or oral analgesics reduce postoperative pain after mini-laparoscopic functional surgery. Methods One hundred fifteen patients who underwent mini-laparoscopic herniorrhaphy or varicocelectomy were assigned randomly to receive wound infiltration with xylocaine, regular oral analgesics, or a placebo after the procedures. Visual analog pain scores owing to carbon-dioxide irritation and trocar wounds were recorded 2 hours, 1 day, and 1 week after surgery. Levels of pain were measured by a visual analog pain scale. Patients age, type of procedure, pressure of gas insufflated, length of procedure, dosage of oral/parenteral analgesics, and trocar-related complications were evaluated. Results There were no significant differences between groups in the mean pain scores over trocar wounds 2 hours, 1 day, and 1 week after mini-laparoscopic procedures, respectively. There were no significant differences between groups in satisfaction of pain control regimens. Patients who received local anesthesia required fewer on demand meperidine injections than others. Conclusions Local anesthesia and routine oral analgesic did not significantly reduce postoperative pain after mini-laparoscopic surgeries in children and young adults.

Increased risk of atrial fibrillation in end-stage renal disease patients on dialysis: A nationwide, population-based study in Taiwan

AbstractEnd-stage renal disease (ESRD) patients commonly have a higher risk of developing cardiovascular diseases than general population. Chronic kidney disease is an independent risk factor for atrial fibrillation (AF); however, little is known about the AF risk among ESRD patients with various modalities of renal replacement therapy. We used the Taiwan National Health Insurance Research Database to determine the incident AF among peritoneal dialysis (PD) and hemodialysis (HD) patients in Taiwan.Our ESRD cohort include Taiwan National Health Insurance Research Database, we identified 15,947 patients, who started renal replacement therapy between January 1, 2002 and December 31, 2003. From the same data source, 47,841 controls without ESRD (3 subjects for each patient) were identified randomly and frequency matched by gender, age (±1 year), and the year of the study patients index date for ESRD between January 1, 2002 and December 31, 2003.During the follow-up period (mean duration: 8–10 years), 3428 individuals developed the new-onset AF. The incidence rate ratios for AF were 2.07 (95% confidence interval [CI]u200a=u200a1.93–2.23) and 1.78 (95% CIu200a=u200a1.30–2.44) in HD and PD groups, respectively. After we adjusted for age, gender, and comorbidities, the hazard ratios for the AF risk were 1.46 (95% CIu200a=u200a1.32–1.61) and 1.32 (95% CIu200a=u200a1.00–1.83) in HD and PD groups, respectively. ESRD patients with a history of certain comorbidities including hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease, heart failure, valvular heart disease, and chronic obstructive pulmonary disease (COPD) have significantly increased risks of AF.This nationwide, population-based study suggests that incidence of AF is increased among dialysis ESRD patients. Furthermore, we have to pay more attention in clinical practice and long-term care for those ESRD patients with a history of certain comorbidities.

Minilaparoscopic Varicocelectomy with Preservation of Testicular Artery and Lymphatic Vessels by Using Intracorporeal Knot-tying Technique: Five-year Experience

BackgroundIn this study we present our experience using minilaparoscopic intracorporeal knot tying to ligate internal spermatic veins (ISV) while sparing the spermatic artery and lymphatics.MethodsMinilaparoscopic varicocelectomies were performed in 87 patients between January 2004 and January 2009. All varicoceles were detected clinically according to the World Health Organization (WHO) classification and confirmed by scrotal color Doppler ultrasonography. The surgical indications were scrotal symptoms in 71, infertility in 16, and both conditions in 2. Three 3.5xa0mm minilaparoscopic ports were used for the operation. The ISVs were dissected and then ligated with intracorporeal knot-tying. The testicular artery and lymphatic vessels were carefully preserved to minimize procedure-related complications.ResultsUnilateral laparoscopic varicocelectomy was performed in 21 (24.2%) patients and bilateral in 66 (75.8%). Mean operative time was 71.1xa0±xa029.2 and 46.8xa0±xa012.6xa0min for bilateral and unilateral varicocelectomies, respectively. All patients were discharged within 24xa0h after surgery. Neither immediate major nor late procedure-related complications were noted. Of the 71 patients with scrotal symptoms, the symptoms completely subsided in 55 (77.5%) and partially subsided in 10 (14.1%). Only one (1.2%) recurrent varicocele was detected within a mean follow-up of 21xa0months (rangexa0=xa03–42). Neither hydrocele formation nor testicular atrophy was found during the follow-up period.ConclusionOur 5-year experience revealed that minilaparoscopic varicocelectomy with sparing of artery and lymphatic vessels could safely and effectively ligate all spermatic veins and preserve spermatic arteries and lymphatic channels without leading to a high varicocele persistence or recurrence.

Role of Bladder Capacity in Assessing the Effectiveness of Antimuscarinic Agents on Nocturia in Patients with Overactive Bladders

Abstract Objective The aim of this study was to evaluate the effectiveness of oxybutynin in the treatment of nocturia in patients with overactive bladders (OAB) and to assess predictive factors for the responses to oxybutynin. Patients and Methods Patients with symptoms of OAB and nocturia for more than 3 months were enrolled. A 2.5 mg dose of oxybutynin was given twice daily for 1 week after a baseline study that included a self-administered nocturia questionnaire, uroflowmetry, and frequency/volume chart. Outcome analysis included changes in nocturia episodes, uroflowmetry, and post-void residual urine. Patients were stratified according to a nocturia index (Ni), nocturnal polyuria index (NPi), and nocturnal bladder capacity index (NBCi). Results A total of 59 patients were eligible for analysis. After 1 week of treatment with oxybutynin, the mean number of nocturia episodes had reduced from 2.7 ± 1.3 to 2.3 ± 1.1 ( p 0.35 (−0.4 vs. −0.3, p = 0.34, ANCOVA). Reduction in number of nocturia episodes was more significant in patients with Ni ≤ 1.5 than in those with Ni > 1.5 (−0.9 vs. −0.2, p = 0.03, ANCOVA), and in patients with NBCi > 2 than in those with NBCi ≤ 2 (−1.1 vs. −0.2, p = 0.01, ANCOVA). Conclusion Ni and NBCi are good predicting factors for the effects of antimuscarinic agents on nocturia in patients with OAB.

Testosterone suppresses uropathogenic Escherichia coli invasion and colonization within prostate cells and inhibits inflammatory responses through JAK/STAT-1 signaling pathway

Prostatitis is a common condition in adult men of all ages. Uropathogenic Escherichia coli (UPEC) are most frequent pathogen involved in bacterial prostatitis by refluxing the infected urine into prostatic ducts and resulting in an ascending urethral infection. However, the study about the mechanisms of UPEC to invade, replicate and persist in normal prostate epithelial cell is only few. Given the fact that UPEC is pathogen most frequently involved in prostatitis and that testosterone has been demonstrated to attenuate prostate inflammation caused by other etiologies. In this study we investigated whether the testosterone reduces the prostatitis and related mechanism by regulating IFN-γ/STAT1 signaling pathway. In the current study aimed to clarify whether testosterone influences the process of UPEC-induced prostate inflammation and invasion into the prostate epithelial cells. In addition, we set up a normal prostate cell model for UPEC infection to evaluate the ability to invade the urothelial cells as well as the colonization of intercellular bacterial communities in vitro. By using the model, we examine the effects of testosterone to suppress effectively the invasion and survival of UPEC in the prostate cells, and inhibit LPS-induced inflammatory responses through the JAK/STAT1 pathway have also been indicated. Our results demonstrated testosterone not only suppressed the invasion and colonization of UPEC, but also inhibited the expression of pro-inflammatory IL-1β, IL-6 and IL-8 cytokines expression induced by UPEC in a dose-dependent manner. We found the effective dose of testosterone to suppress UPEC infect prostate cells may be appropriate under 40μg/ml. Our data also revealed 20μg/ml testosterone treated PZ-HPV-7 cells significantly suppressed the LPS-induced JAK/STAT1 pathway and inflammatory responses, and reached to maximal effects at 40μg/ml treatment. These results indicate that testosterone plays an anti-inflammatory role in LPS-induced prostate cell inflammation by down-regulating JAK/STAT1 signaling pathway. Interestingly, the JAK inhibitor and testosterone for 24hr pretreatment rather markedly induced the colonization of UPEC in the PZ-HPV-7 cells. Based on the above data, the suppression of UPEC colonization in the prostate cells by testosterone seems to be unrelated with JAK/STAT signaling pathway, whereas the JAK may involve into the UPEC infection. Summing up these data, our findings have demonstrated the suppressive effects of testosterone on the invasion and survival of UPEC and induced inflammation in prostate epithelial cells. These findings indicate the action mechanism of testosterone as an anti-inflammatory mediator in the prostate cells is regulated through JAK/STAT1 signaling pathway, may be beneficial in treating prostate inflammation. Altogether, this study has provided the possibility that using testosterone in the prevention and clinical treatment of prostatitis is a new direction.

Combined effects of GSTO1 and SULT1A1 polymorphisms and cigarette smoking on urothelial carcinoma risk in a Taiwanese population

BACKGROUND/PURPOSEnCigarette smoking is the main risk factor for urothelial carcinoma of the bladder (UCB). Glutathione S-transferase omega 1 (GSTO1) and sulfotransferase 1A1 (SULT1A1) have been reported to be associated with the metabolism of polycyclic aromatic hydrocarbons (PAHs) and aromatic amines. The aim of the present study was to investigate the combined effects of polymorphisms in GSTO1 and SULT1A1 genes and cigarette smoking on UCB risk in a Taiwanese population.nnnMETHODSnA total of 300 patients with histopathologically confirmed UCB and 233 cancer-free controls were recruited from the Department of Urology of Tungs Taichung Metro Harbor Hospital and Taipei Medical University Hospital. A comprehensive interview was conducted to collect personal information, including demographic characteristics and cigarette smoking status. A multivariate-adjusted logistic regression was performed to estimate the risk of UCB.nnnRESULTSnA significantly increased risk of UCB was observed in ever smokers [odds ratio (OR) = 2.3]. The Ala/Ala genotype of the GSTO1 gene and the Arg/Arg genotype of the SULT1A1 gene were associated with a significantly increased risk of UCB, with ORs of 1.8 [95% confidence interval (CI) = 1.2-2.6] and 2.1 (95% CI = 1.6-4.5), respectively. Significantly increased UCB risks were found in heavy smokers with the Ala/Ala genotype of the GSTO1 gene (OR = 4.2) and the Arg/Arg genotype of the SULT1A1 gene (OR = 6.8). Furthermore, a significant synergistic effect in an additive model (OR = 3.5) between the GSTO1 Ala/Ala genotype and the SULT1A1 Arg/Arg genotype on UCB risk was observed.nnnCONCLUSIONnThe present study provided epidemiological evidence for a significantly increased risk of UCB in ever smokers with the Ala/Ala genotype of the GSTO1 gene and the Arg/Arg genotype of the SULT1A1 gene.