Chun-Hou Liao

Adverse Events of Intravesical Botulinum Toxin A Injections for Idiopathic Detrusor Overactivity: Risk Factors and Influence on Treatment Outcome

BACKGROUND Intravesical injection of botulinum toxin type A (BoNTA) provides effective treatment for detrusor overactivity and overactive bladder (OAB). However, the high rates of treatment-related adverse events (AEs) prevent its more widespread use. OBJECTIVE To investigate the risk factors of increasing AEs after BoNTA injection for idiopathic detrusor overactivity (IDO). DESIGN, SETTING, AND PARTICIPANTS This study included a total of 217 patients receiving their first intravesical BoNTA injection for refractory IDO in a tertiary university hospital from 2004 to 2009. MEASUREMENTS AE incidence was analyzed according to gender, age, comorbidities, prostate condition in men, OAB subtype, BoNTA dose, injection site, and baseline urodynamic parameters. Successful outcome was determined based on patient perception of improvement of bladder condition at 3 mo. RESULTS AND LIMITATIONS Successful outcomes were reported by 144 (66.3%) patients. By multivariable analysis, male gender (p=0.013) and baseline postvoid residual (PVR) ≥100ml (p=0.003) were independent predictors of acute urinary retention (AUR). Baseline PVR ≥100ml (p=0.007) and receiving >100 U BoNTA (p=0.029) were predictors of straining to void. The incidence of large PVR after treatment was associated with comorbidity (p=0.011). Urinary tract infection occurred more frequently in women (p=0.003) and in men with retaining prostate (p=0.008). No AUR developed after bladder base/trigonal injection. Nevertheless, the occurrence of AUR or large PVR did not affect therapeutic outcome. This study is limited by nonconsecutive enrollment of patients. CONCLUSIONS Male gender, baseline PVR ≥100ml, comorbidity, and BoNTA dose >100 U are risk factors for increasing incidence of AEs after intravesical BoNTA injection for IDO.

Urgency severity scale could predict urodynamic detrusor overactivity in patients with overactive bladder syndrome

To evaluate the correlation between an urgency severity scale (USS) based on a voiding diary with detrusor overactivity (DO) in a videourodynamic study in patients with an overactive bladder (OAB).

Laparoscopic Adrenalectomy Using Needlescopic Instruments for Adrenal Tumors Less Than 5 cm in 112 Cases

OBJECTIVE To examine the safety and efficacy of laparoscopic adrenalectomy with needlescopic instruments for most adrenal tumors less than 5cm. METHODS Transperitoneal laparoscopic adrenalectomy with needlescopic instruments for 112 patients with presumptively benign adrenal tumors < 5cm were enrolled from July 2000 to February 2005. Operative time, blood loss, conversion and complication rates, and postoperative data were analyzed by appropriate statistical methods. RESULTS All 112 operations were completed without any mortality or reoperation. Mean operative time was 151min and mean blood loss was 30ml. Only one patient required a blood transfusion and application of a hand-assisted device. Conversion to conventional laparoscopic instruments was necessary in another five patients (4.5%). The operative time of the latter 100 cases (147+/-5.1min, mean+/-standard error of mean) was significantly shorter than that of the initial 12 cases (183+/-8.8min, p=0.001). Larger tumors, previous abdominal surgery, and pheochromocytoma group were independent risk factors of a longer operative time. Except for one leiomyosarcoma, all other tumors were benign adrenal pathologies (57 aldosterone-producing adenomas, 23 Cushings adenomas, 12 pheochromocytomas, and 20 incidentalomas). CONCLUSION The safety and effectiveness of laparoscopic adrenalectomy employing needlescopic instruments for most adrenal tumors less than 5cm was feasible with acceptable operative time. Pheochromocytomas can also be managed with a longer operative time. Patients with previous upper midline or ipsilateral upper quadrant open surgery might not be suitable candidates for such a technique.

Modelling control measures to reduce the impact of pandemic influenza among schoolchildren

We coupled the Wells-Riley equation and the susceptible-exposed-infected-recovery (SEIR) model to quantify the impact of the combination of indoor air-based control measures of enhanced ventilation and respiratory masking in containing pandemic influenza within an elementary school. We integrated indoor environmental factors of a real elementary school and aetiological characteristics of influenza to estimate the age-specific risk of infection (P) and basic reproduction number (R(0)). We combined the enhanced ventilation rates of 0.5, 1, 1.5, and 2/h and respiratory masking with 60%, 70%, 80%, and 95% efficacies, respectively, to predict the reducing level of R0. We also took into account the critical vaccination coverage rate among schoolchildren. Age-specific P and R(0) were estimated respectively to be 0.29 and 16.90; 0.56 and 16.11; 0.59 and 12.88; 0.64 and 16.09; and 0.07 and 2.80 for five age groups 4-6, 7-8, 9-10, 11-12, and 25-45 years, indicating pre-schoolchildren have the highest transmission potential. We conclude that our integrated approach, employing the mechanism of transmission of indoor respiratory infection, population-dynamic transmission model, and the impact of infectious control programmes, is a powerful tool for risk profiling prediction of pandemic influenza among schoolchildren.

The efficacy of additive tolterodine extended release for 1-year in older men with storage symptoms and clinical benign proastatic hyperplasia.

To determine the efficacy of toterodine extended release (ER) treatment for 1 year in older men with benign prostatic hyperplasia (BPH) and storage symptoms treated with alpha‐blockers and/or 5‐alpha‐reductase inhibitors (5ARI).

Serum C-reactive Protein Levels are Associated With Residual Urgency Symptoms in Patients With Benign Prostatic Hyperplasia After Medical Treatment

OBJECTIVE Urinary urgency is a common and bothersome symptom in patients with benign prostatic hyperplasia (BPH); this symptom may persist even after medical treatment. Chronic inflammation has been reported to be associated with the pathogenesis of BPH and lower urinary tract symptoms (LUTS). We investigate the association between serum C-reactive protein (CRP) level and residual urgency symptoms in BPH patients after medical treatment. METHODS Two-hundred-five men undergoing stable medical treatment for BPH, defined as a total prostate volume ≥40 mL, were enrolled. Patients with acute infection or those taking nonsteroid antiinflammatory drugs or aspirin were excluded. Uroflowmetry, postvoid residual volume, transrectal ultrasound parameters, serum prostate specific antigen (PSA), and CRP level were measured. A three-day void diary was recorded to identify the presence of urinary urgency. RESULTS The mean serum CRP level was 0.24 mg/dL (range 0.01-2.84), and residual urgency was identified in 90 patients (43.9%). Patients with residual urgency were older and had significantly higher serum CRP levels (0.39 ± 0.54 mg/dL) than those without urgency (0.13 ± 0.20, P <.001). On multivariable logistic regression analysis, men with CRP levels ≥0.3 mg/dL were more likely to have urgency (odds ratio 8.08, 95% confidence interval 3.26-20.0) after adjusting for age, serum PSA level, total prostate volume, and antimuscarinic use. Patients with serum CRP levels ≥0.30 mg/dL had more urgency (82.1%) than those with serum CRP levels <0.30 mg/dL (34.9%). CONCLUSION Serum CRP level is significantly associated with residual urgency in BPH patients after medical treatment. Chronic inflammation may play a role in the occurrence of residual urgency in BPH patients.

Serum Testosterone Levels Significantly Correlate With Nocturia in Men Aged 40-79 Years

OBJECTIVE To investigate the association between serum sex hormone levels and lower urinary tract symptoms in men aged 40-79 years. METHODS A cross-sectional study was conducted in 509 men (mean age 58 years). The serum total testosterone (TT), dihydrotestosterone, and estradiol levels were measured. The total prostate volume measured by transrectal ultrasonography and International Prostate Symptom Score (IPSS) questionnaire were obtained. Correlations were determined using univariate and multivariate regression analysis. RESULTS The subjects with moderate to severe lower urinary tract symptoms (total IPSS≥8) were older, with a greater incidence of hypertension and diabetes, a larger prostate, and had lower serum TT levels. On the univariate analysis, the serum TT levels were negatively associated with the total IPSS, IPSS storage subscore, weak stream, and nocturia. After adjusting for age, hypertension, diabetes, and total prostate volume, only the serum TT level was significantly associated with nocturia (>2 times/night; P=.042), and men with serum TT levels in the greatest quartile had a 44% reduced risk of nocturia than in the lowest quartile (P=.037). CONCLUSION In our relative healthy male cohort, most IPSS items showed no significant association with serum sex hormone levels, except for nocturia, which showed a negative correlation with the serum testosterone level.

Anti‐angiogenic effects and mechanism of prazosin

Alpha1‐adrenoceptors antagonists (doxazosin, terazosin, prazosin) are commonly prescribed for benign prostate hyperplasia and hypertension. Doxazosin and terazosin exhibit anti‐angiogenic effects and apoptotic activities against multiple cell types and are potential preventive agents for prostate cancer. Prazosin induces apoptosis in three prostate cancer cell lines. We hypothesized that prazosin, a more potent alpha1‐adrenoceptor antagonist with a distinct mechanism, exhibits anti‐angiogenic activity.

Predictors of Successful First-line Antimuscarinic Monotherapy in Men With Enlarged Prostate and Predominant Storage Symptoms

OBJECTIVE To identify predictors of successful first-line antimuscarinic monotherapy for patients with enlarged prostate and predominant storage symptoms. METHODS Men aged ≥ 50 years with total International Prostate Symptom Score (IPSS-T) ≥ 8, total prostate volume (TPV) ≥ 20 mL, IPSS quality of life (QOL) index ≥ 2, IPSS voiding to storage (IPSS-V/S) subscore ratio ≤ 1, and post-void residual (PVR) ≤ 250 mL were recruited into a prospective open-label study. All men received tolterodine ER (4 mg) daily. Global response assessment (GRA) ≥ 1 after treatment was considered successful treatment and an indication for continued antimuscarinic monotherapy. RESULTS One hundred ninety-seven men aged 50-89 years (average TPV 44.4 mL) received first-line tolterodine monotherapy. Mean IPSS-T, IPSS storage (IPSS-S) subscore, and QOL improved significantly at 2, 4, and 12 weeks. Average PVR increased significantly; no patient developed acute urinary retention. One hundred thirty-six patients (69.0%) showed improvement (GRA ≥ 1) at both 2 and 4 weeks. Regression analysis showed that IPSS-S (P = .039) and maximum urine flow (Qmax, P = .033) were significant predictors of therapeutic success. Patients with smaller baseline TPV, higher IPSS-S, and higher Qmax had significantly higher treatment success rates. CONCLUSION First-line antimuscarinic monotherapy is safe and effective within 12 weeks in selected patients with benign prostatic hyperplasia (BPH) Higher baseline IPSS-S, higher baseline Qmax, and lower TPV were predictors of successful antimuscarinic monotherapy.

Significant association between serum dihydrotestosterone level and prostate volume among Taiwanese men aged 40-79 years.

Introduction. We evaluated the association between serum sex hormone levels and prostate volume in Taiwanese men. Methods. A cross-sectional study was conducted in 505 men (aged 40–79 years, mean age 58 years). Serum total testosterone (TT), free testosterone (FT), dihydrotestosterone (DHT) and estradiol (E2) levels were measured. Total prostate volume (TPV) and transition zone volume (TZV) were measured by transrectal ultrasonography. Body mass index (BMI), DHT/TT and E2/TT were calculated. Correlations were determined using univariate and multivariate regression analyses. Results. Apart from DHT, an age-dependent change of sex hormone levels were observed. On univariate analyses, age, BMI, serum DHT level and DHT/TT ratio, as well as serum E2 level and E2/TT ratio, but not serum TT and FT levels showed a significant association with prostate volume. On multivariate analysis, however, only serum DHT level and DHT/TT ratio remained significant. Logistic regression analysis showed that the odds ratios (95% confidence interval) of the second, third, and fourth quartiles of serum DHT levels for benign prostatic hyperplasia (defined as TPV ≥20 ml) risk were 2.06 (1.21–3.51), 2.66(1.56–4.53) and 7.15(4.0–12.6), respectively (p < 0.001). Conclusions. Higher serum DHT level and DHT/TT ratio were associated with larger prostate volume and higher prevalence of BPH in Taiwanese men.