King-Yik Lo

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.

Clinical experience of laparoscopic-assisted radical cystectomy with continent ileal reservoir.

Introduction: Laparoscopic-assisted radical cystectomy with continent ileal reservoir reconstruction is a challenging procedure. We report our experience learned from a hand-assisted laparoscopic technique in our transition to a pure laparoscopic approach. Materials and Methods: Eighteen consecutive patients underwent laparoscopic-assisted radical cystectomy with continent ileal reservoir. Hand-assisted laparoscopy was used for the first 11 patients and pure laparoscopy was performed for the subsequent 7 patients in radical cystectomy. Continent ileal reservoir reconstruction was performed extracorporeally via the hand port wound or trocar extension wound. Surgical outcome was analyzed in a retrospective review of the medical records. Results: In the hand-assisted and pure laparoscopic groups, the mean operative time for cystectomy was 2.5 and 2.3 h, for continent ileal reservoir reconstruction it was 4.0 and 3.7 h, and for bilateral lymph node dissection it was 0.8 and 0.6 h, respectively. Mean intraoperative blood loss was 286 ml for the hand-assisted and 179 ml for the pure laparoscopic group. There were no major intraoperative complications nor need for conversion in any of the procedures. Bowel movement was regained in a mean of 3 days and the mean length of postoperative hospital stay was 7 days. Conclusions: The hand-assisted laparoscopic experience of radical cystectomy learned from the initial 11 patients effectively helped us in the transition to a pure laparoscopic approach. A comparable surgical outcome was found in both groups of patients.

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.

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.

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.

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.