Huang-Kuang Chang

Gyrus Plasmasect: Is It Better than Monopolar Transurethral Resection of Prostate?

Introduction: This randomized prospective study was conducted to compare the efficacy and safety of the Gyrus Plasmasect loop bipolar transurethral resection of prostate (TURP) and conventional monopolar TURP in the treatment of benign prostatic hyperplasia (BPH). Materials and Methods: A total of 117 men were enrolled in this study. Fifty-eight patients underwent Gyrus Plasmasect TURP and 59 patients underwent monopolar TURP. They were followed up for 3 months after surgery. Results: Significant improvements were seen postoperatively in both the Gyrus and monopolar groups in terms of prostatic volume, International Prostate Symptom Score, quality of life score, peak flow rate, and post-void residual urine volume. However, the degree of improvement was not statistically different between the 2 groups. Significantly less blood loss, shorter postoperative catheterization time and length of hospital stay were seen in the Gyrus group. Conclusions: Gyrus Plasmasect TURP yielded comparable results to monopolar TURP; however, this is only a preliminary study and follow-up is necessary to assess its long-term efficacy.

Ureteroscopic Management of Sepsis Associated with Ureteral Stone Impaction: Is It Still Contraindicated?

Introduction: Retrograde decompression is generally not advocated for patients with sepsis owing to ureteral obstruction by stone impaction, and the initial treatment of choice is percutaneous nephrostomy (PCN). We report our experience with the treatment of urosepsis with retrograde ureteroscopy (URS) instead of PCN drainage. Patients and Methods: Fifty-six consecutive patients diagnosed with ureteral stone-related sepsis received URS as primary treatment at our institution. Patients with uncontrollable sepsis underwent emergent URS and hemodynamically stable patients underwent elective URS within two days of diagnosis. Results: URS was successful in 53 (94.6%) of the 56 patients. PCN was performed in the 3 cases of URS failure. Internal ureteral stenting was performed in 48 patients. Secondary procedures were performed in 10 (18.9%) patients. Twenty-six patients suffered from postoperative fever for an average of 1.6 days (range 1–4 days). There were no anesthesia-related morbidities, postoperative exacerbations of the clinical condition, or postoperative deaths. The median length of hospital stay was 7 days (range 3–94 days). Conclusion: PCN drainage is the standard treatment of sepsis associated with ureteral stone obstruction. However, our results show that URS can be safely and successfully performed by skilled endourologists in select clinical situations.

Complications of Urinary Diversion after Pelvic Exenteration for Gynecological Malignancy

A series of 21 patients who underwent pelvic exenteration for local advanced or recurrent gynecological malignancies and urinary diversions was retrospectively reviewed. The major disease process was carcinoma of the cervix. Early complications included sepsis with wound infection and dehiscence in 4 patients, intestinal insuffency in 2 patients, 4 urinary fistulas and 3 ureteral obstructions. Six patients had a late urinary complication of stenosis of the ureterointestinal anastomosis; stones in the urinary reservoir and pyelonephritis were also noted. Factors responsible for these complications are identified and discussed with a view to reducing the morbidity related to urinary diversion in such patients.

Concomitant transrectal ultrasound-guided biopsy and transurethral resection of prostate in patients with urinary retention and elevated serum prostate-specific antigen levels

Background There was no consensus about the management of patients with urinary retention and elevated serum prostate‐specific antigen (PSA) levels. This study aimed to determine whether concomitant transrectal ultrasound (TRUS)‐guided biopsy and transurethral resection of prostate (TURP) is practical in patients with urinary retention and elevated serum PSA levels. Methods From March 2007 to May 2015, a total of 34 patients with urinary retention and elevated PSA (≥ 4 ng/mL) underwent concomitant TRUS‐guided biopsy and TURP. The medical records were evaluated retrospectively, and data including PSA, prostate volume, TURP results, TRUS‐guided biopsy results, length of hospitalization, and complications were collected. These patients were then compared with 40 patients with urinary retention who underwent TURP alone. Results The mean age of the patients was 71.6 years. The mean PSA levels were 16.9 ng/mL. Prostate cancer was detected in eight cases (23.5%): one case by TRUS‐guided biopsy alone, two cases by TURP alone, and five cases by both TRUS‐guided biopsy and TURP. Complications included fever in five patients (14.7%), recatheterization for urine retention in two patients (5.9%), urinary tract infection in two patients (5.9%), and de novo urge incontinence in seven patients (20.6%). The complication rate was not significantly increased compared with that of the patients who underwent TURP alone. Conclusion This study showed that concomitant TRUS‐guided biopsy and TURP was safe and of possible clinical significance in urinary retention patients with elevated serum PSA.

Ureteral carcinoid tumor.

Abstract  Most ureteral tumors are transitional cell neoplasms. Neuroendocrine tumors of the genitourinary tract are extremely rare. To our knowledge, only one ureteral carcinoid tumor has been reported before. We report a second case of ureteral carcinoid tumor found in a 70‐year‐old female.

Urothelial Tumors of the Upper Urinary Tract Following Transurethral Resection of Bladder Transitional Cell Carcinoma:Mackay Memorial Hospital Experience炯

OBJECTIVE: Urothelial carcinoma is characterized by a tendency for multifocal locations at the initial diagnosis and subsequent tumors after treatment of the initial tumors occurring anywhere within the entire urinary tract. The aim of this study was to determine the incidence and risk factors of upper urinary tract tumor occurrence following TURBT. We also determine a reasonable follow-up scheme for postoperative monitoring. MATERIALS AND METHODS: From January 1988 to December 1993, 150 patients who underwent a transurethral resection of primary bladder transitional cell carcinoma were re-viewed at our hospital. Each patient was followed for at least 5 years or until death. Follow-up tests included cystoscopy, intravenous pyelography or sonography, and urine cytology. To analyze the risk factors for upper urinary tract tumor occurrence, the Kaplan-Meier method was performed. RESULTS: Subsequent upper tract tumor development was found in 5 of 150(3.3%) patients at an interval of 9 to 46 months(mean, 24.2 months).Patients with a primary bladder tumor of high tumor grade, associated with a carcinoma in situ or a multifocal tumor, are at in-creased risk for subsequent upper tract tumor development. CONCLUSIONS: High-risk patients must be minitored with IVP yearly for at least 3 years for early detection of upper tract tumors, and thereafter IVP can be replaced by renal sonography. Once a patient presents with a sign or symptom suggesting upper tract TCC, IVP, ureteroscopy with biopsy, or selective upper tract urinary cytology must be performed to help establish a diagnosis.

Treatment of Ruptured Renal Artery Aneurysm with Transcather Embolization - A Case Report

Ruptured of an aneurysm of a renal artery is rare, and emergency nephrectomy is often necessary. We report a 47 year-old female patient suffered from ruptured of left renal artery aneurysm. The kidney was preserved after transcather embolization of the ruptured aneurysm.

Actinomycosis Mimicking Abdominal Tumor with Bladder Infiltration – A Case Report

Actinomycosis is an unusual intra-abdominal infection, often mistaken for other conditions, and is difficult to diagnose non-operatively. A rare case of actinomycosis mimicking abdominal tumor with bladder infiltration was presented. Laparotomy, drainage of the abscess cavity and biopsy of the lesion were performed under the impression of abdominal tumor with small bowel and bladder involvement. Post-operative parenteral penicillin for fourteen days and oral tetracycline for six months were used with a good result.

Blood Pressure Change in Patients with a Benign Adrenal Tumor after Unilateral Adrenalectomy

Forty-four patients with hypertension who were diagnosed with benign adrenal tumor (adenoma or hyperplasia) underwent unilateral adrenalectomy from 1984 to 1992 and were followed long-term. Forty of the 44 with a definite functional diagnosis (such as primary aldosteronism, Cushing’s syndrome and pheochromocytoma) had dramatic improvement of their hypertension immediately after the surgery, and this recovery persisted. After one year of follow-up, 71.4% became normotensive, 25.7% had mild hypertension and only 2.9% had persistent hypertension. The improvement in the hypertension and the percentage of patients who returned to normal was most notable in those with pheochromocytoma. The improvement in blood pressure was more gradual in patients with primary aldosteronism and Cushing’s syndrome. Four patients with hypertension only were found to have either adrenal adenoma or hyperplasia. On functional evaluation, they were not found to have any definite endocrinologic abnormality. Unilateral adrenalectomy resulted in only temporary improvement in three of these patients, and all four remained hypertensive on long term follow-up.

The Current Role of Cutaneous Ureterostomy in Treatment of Pelvic Malignancy

From December, 1985 to June, 1991, 181 cases of palliative urinary diversions were performed at Mackay Memorial Hospital. Among these cases, there were 104 (57.5%) percutaneous nephrostomies, 68 (37.6%) double-J ureteral steents, and only 9 cutaneous ureterostomies (4.9%). Cutaneous ureterostomy was performed to correct fistula formation in four cases (three cervical and one rectal cancers), persistent hematuria from lower urinary tract in four cases, and initial treatment for late stage bladder cancer in one. There were no operative mortalities in these nine cases. The two complications – one ureteral necrosis and one obstruction from kinking – were resolved easily. The patients lived for 8 to 910 days, with an average of 311 days. Five of the patients lived for more than six months. With the advent of simpler and safer techniques of percutaneous nephrostomy and double-J ureteral stents, cutaneous ureterostomy is no longer a primary palliative procedure for treatment of pelvic malignancy. However, this procedure is recommended only selectively in high-risk patients with advanced pelvic cancer with life expectancy of more than three months, persistent hematuria or urinary fistula formation, and when double-J insertion or percutaneous nephropstomy fails.