Chung-Yang Yen

Value of prostate-specific antigen in the staging of Taiwanese patients with newly diagnosed prostate cancer.

Records of 71 patients diagnosed with prostate cancer were reviewed retrospectively regarding clinical stage, prostate-specific antigen (PSA), Gleason score, CT scan of pelvis, bone scan, and pelvic lymph node dissection. Fourteen patients had pelvic lymphadenopathy based on the CT scan. Of these, no patient had a PSA level <4 ng/mL, 1 patient had a PSA level between 4 and 10 ng/mL, and 3 had a PSA level between 10 and 20 ng/mL. Twelve of 13 patients with positive bone scan results had a PSA level >20 ng/mL, and 1 patient had a PSA level between 10 and 20 ng/mL. PSA can be cost-effective in selecting and identifying appropriate staging for patients with newly diagnosed prostate cancer. CT scans are not indicated in men with clinical localized prostate cancer when PSA levels are h 10 ng/mL. Bone scan is not required for staging asymptomatic men with PSA levels of h 20 ng/mL. Pelvic lymphadenectomy for localized prostate cancer may not be necessary if PSA levels is h 20 ng/mL and Gleason score is h 5.

EPIDERMOID CYSTS OF THE TESTES IN TAIWANESE MEN

Epidermoid cyst is a rare benign tumor of the testes. The records from the last 20 years of Taiwanese patients in whom a testicular tumor was diagnosed were reviewed retrospectively. Patients with a confirmed epidermoid cyst of testis were evaluated for age, clinical assessment and follow-up. Among a total 146 testicular tumors, 28 (19%) patients had a benign tumor including 15 patients (10%; mean age 23 years, range 17–32 years) with an epidermoid cyst diagnosed pathologically. Pre-operative suspicion of the benign nature of the lesions was supported by testicular ultrasonography in 11 patients. Seven patients underwent magnetic resonance imaging after which benign epidermoid cyst was impressed in five patients. A testicular-sparing operation was performed in 12 patients after frozen sections confirmed the diagnosis. Three patients were treated by radical orchiectomy. There was no relapse after a median follow-up of 42 months (range, 2–82 months). Ultrasonography and magnetic resonance imaging of the scrotum may allow the diagnosis of epidermoid cyst of the testes to be made pre-operatively. The absence of relapse in these patients further supports the use of organ sparing surgery in these young men.

Transperineal Urethroplasty for Treatment of Traumatic Severe Stricture of the Urethra：Experience and Literature Review

OBJECTIVE: Transperineal urethroplasty is the treatment of choice for pelvic fractures with posterior urethral distractions, especially in cases of long-segment defect of the urethra or cases which are challenging to urologists. We present our experiences and long-term follow-up results. MATERIALS AND METHODS: From 1993 through 1999, eight patients with severe posterior urethral disruption due to pelvic fractures were treated at Tri-Service General Hospital (TSGH) in Taipei, Taiwan. All patients received including mechanism of injury, associated complications and secondary operative procedures was recorded. Recurrence was determined using cystoscopy or retrograde urethrography and long-term voiding functions were determined using residual urine and uroflowmetry. Sexual functions were also determined using apatient questionnaire. RESULTS: The mean age was 29.4 years (range 23-50 years). The mean interval between suprapubic cystostomy and transperineal urethroplasty was 5.6 months (range 4-9 months). The mean urethral stricture length was 2.8 cm (range 1.5-7 cm). During the follow-up period (range 17-73 months; mean 45.8), the overall postoperative re-stricture rate was 75% (6/8); 15 visual internal urethrotomies and 20 urethral dilations with sounds were performed subsequently. All eight patients now have patent urethras, and seven (87.5%) void well and are continent except one who has an underactive neurogenic bladder secondary to the injury. Erectile dysfunction (ED) was present both preoperatively and postoperatively in four (50%) of the patients. Of these, three had urethral re-stricture postoperatively. CONCLUSIONS: In our experience, the principal problem was re-stricturing which can usually can be treated by secondary urethrotomy or dilation. Re-stricture of the urethra was easily noted in severely injured urethras. There were no changes in ED before or after operations. The long-term postoperative follow-up of voiding and sexual functions is mandatory.

Coincident Renal Cell Carcinoma and Angiomyolipoma in the Same Kidney – A Case Report and Review of Literatures

Renal angiomyolipomas are found in more than half of the patients with tuberous sclerosis. We report a case of angiomyolipoma and renal cell carcinoma occurring in the same kidney without stigmata of tuberous sclerolsis. (J Uorl R.O.C., 1: 233-240,1990)

Occult Blood in the Feces after Extracoporeal Shock - Wave Lithotripsy (ESWL): A Preliminary Study

A prospective study was conducted to evaluate the occurrence of occult blood in the faces in 48 patients after receiving extracoporeal shock-wave lithotripsy (ESWL) treatment. This study showed that occult blood in the feces could develop in 53 per cent of patients (10/19) with left renal stones, in 27 per cent (3/11) with bilateral renal stones, and in 11 per cent (2/18) with right renal stones. There was no direct relation between the patientss weight and the development of occult blood in the feces. The incidence of occult blood in the feces was closely related to the number and intensity of shock waves. Higher intensity of energy given, but to the anatomic position and gas-fluid effect of the stomach. The presentation of occult blood lasted less than 48 hours and was reversible. To our knowledge, this is the first repost in literature on the detection of ESWL-induced gastrointestinal damage with occult blood in the feces int clinical patients. (J Urol R.O.C., 1:264-268, 1990)

Intravesical Instillation of Taipei-NIPM Bacillus Calmette-Guerin in Prophylactic Treatment of Superficial Bladder Cancer: A Preliminary Report of Phase I-II Clinical Trial

A domestically produced bacillus Calmette-Guerin (named), derived from Tokyo-172 strain, was used to treat 11 patients (M: F=7: 4) with superficial bladder cancer (10 stage A and 1 stage B2; 2 grade I, 8 grade II, and 1 grade III). The phase I-II clinical trial was performed to assess the side effects and efficacy of BCG as a prophylaxis againt recurrence. BCG, 50 mg in 50 ml distilled water, was instilled intravesically without cutaneous inoculation. Instillations were given weekly for 6 consecutive weeks. Hematology and biochemistry, including hepatic and renal function, were monitored. Only minor toxicity and/or side effects were observed during therapy and for a period of 5 to 12 months after treatment. Complications included cystitis in 55 per cent of the patients, hematuria in 27 per cent, fever in 9 per cent, and a flu-like syndrome in 9 per cent. A progressive decrease of white blood cell count (55%), hemoglobin (73%), and an increase in the lymphocytic ratio in peripheral white cells (82%) were noticed. Of the patients, 64 per cent had no tumor recurrence 5 to 12 months (mean 8.7 months) after therapy. These preliminary results suggest that intravesical Taipei-NIPM strian BCG instillation is effective as a prophylaxis against recurrent superficial bladder tumors.