Jong-Ming Hsu

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.

Is Fournier’s Gangrene Severity Index Useful for Predicting Outcome of Fournier’s Gangrene?

Objectives: Fournier’s gangrene (FG) is a rare but life-threatening disease. Although antibiotics and aggressive debridement have been broadly accepted as the standard treatment, the mortality rate remains high. We conducted a retrospective study to analyze the outcome and identify the risk factors and prognostic indicators. Methods: We retrospectively reviewed the medical records of 25 patients diagnosed with FG between July 1993 and August 2003. Data collected included age, predisposing factors, treatment modalities, length of hospital stay, surgical debridement times, and outcome. The FG severity index was used to predict outcome. Univariate analysis of the different prognostic factors was performed using t test and Fisher’s exact probability test. Results: All patients were male, 60% were diabetic, and the mean age was 55.8 years. The mean hospital stay was 20 days and the mortality rate was 32%. The mean age of 53.8 ± 18.3 (SD) years in the survival group (n = 17) was significantly lower than the 59.9 ± 10.2 years (n = 8) of the non-survival group (p < 0.05). Non-survival group patientshad lower serum hematocrit (mean 28.9, p = 0.019) and albumin (mean 1.93, p = 0.024) levels. In our series, the mean FG severity index for survivors was 4.41 ± 2.45 (range 2–9) compared to 12.75 ± 2.82 (range 9–18) for those who died (t test, p < 0.0001). Conclusion: The survival rate of younger patients with FG was higher. We agree that a FG severity index cutoff value of 9 is an excellent predictor of outcome.

Common variants at 8q24 are associated with prostate cancer risk in Taiwanese men.

Recently, independent genome‐wide scans have found multiple genetic variants at 8q24 to be associated with prostate cancer risk. This study was performed to determine whether two of the variants more strongly associated with prostate cancer risk in European and American populations, specifically rs16901979 and rs6983561, were also associated with prostate cancer risk in Taiwanese men.

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.

Emphysematous Pyelonephritis: Patient Characteristics and Management Approach

Introduction: Emphysematous pyelonephritis (EPN) is an acute, severe, necrotizing infection of the renal parenchyma and perirenal tissue that requires immediate treatment. However, the ideal approach to its management remains controversial. We conducted this study to determine the appropriate treatment modalities. Materials and Methods: A retrospective review of EPN cases revealed 10 consecutive cases from July 2003 to June 2012. Clinical and demographic data were collected from each patient. Results: All patients had diabetes mellitus, 5 presented with urinary tract obstruction by urolithiasis. Seven patients had type I disease and 3 had type II disease. Six of the type I patients underwent emergent nephrectomy and 1 of these died, the remaining patient refused surgical intervention and died after receiving medical management only. The type II patients underwent percutaneous drainage, and 2 of them subsequently underwent elective nephrectomy; all 3 survived. Conclusion: Our results suggest that emergency nephrectomy may be considered the initial management for type I EPN, while percutaneous drainage may be an effective initial treatment option for type II EPN.

Severe acute pancreatitis with abscess after extracorporeal shock wave lithotripsy: a rare complication

Extracorporeal shock wave lithotripsy (ESWL) is a widely accepted procedure for urolithiasis. However, the shock waves do not pass through the body without damage. Here, we reported a 57-year-old man who underwent ESWL four times before, and immediately developed acute pancreatitis and peritoneal abscess after ESWL for a right renal stone. Although the possibility of post-ESWL acute pancreatitis is extremely low, urologists must be aware of this vital complication.

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.

Wide Resection of Recurrent Adrenocortical Carcinoma in a Patient with Concomitant Hepatocellular Carcinoma

Introduction: Adrenocortical carcinoma (ACC) is a rare tumor with a high recurrence rate. Despite complete removal of the tumor, many patients will eventually relapse.Case Report: A 62-year-old man with recurrent hepatocellular carcinoma (HCC) who had undergone transcatheter arterial embolization six times in two consecutive years, was found to have a left adrenal incidentaloma by computed tomography (CT) of the abdomen. A stage III ACC was confirmed after surgical removal. Five months later, he underwent complete resection of recurrent ACC involving multiple adjacent organs. HCC recurrence and possible ACC recurrence were noted six months after the second surgery. The patient received Doxorubicin as systemic therapy for 3 month.Conclusions: Complete resection of locally recurrent disease (ACC) without causing severe morbidity may be feasible.

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.