Ming-Chung Ko

Incidence of renal and perinephric abscess in diabetic patients: a population-based national study

This population-based cohort study aimed to investigate the incidence and relative hazard of renal and perinephric abscess (RA) in the diabetic population in Taiwan. More than a half million diabetic patients and sex- and age-matched controls were identified from the 1997 Taiwan National Health Insurance data and were linked to in-patient claims from 1997 to 2007. Person-year approach with Poisson assumption was used to estimate the incidence density (ID) of RA. The hazard ratios (HRs) of hospitalization due to RA in relation to diabetes were analysed using a Cox proportional hazard model. The ID for the diabetic and control subjects was 4·6 and 1·1/10,000 person-years, respectively, in 11 years of follow-up, representing an adjusted HR of 3·81 (95% confidence interval 3·44-4·23). This study confirmed the association of diabetes with RA, and argued that more aggressive urological care should be administered to diabetic patients.

Age-specific Prevalence Rates of Phimosis and Circumcision in Taiwanese Boys

BACKGROUND/PURPOSE To estimate the age-specific prevalence rates of phimosis and circumcision in an urban sample of Taiwanese boys. METHODS A convenience sample of 1145 boys aged from 7 to 13 years was enrolled and cross-sectionally evaluated for preputial retractability and status of circumcision. Another convenience sample of 59 newborn male infants was enrolled from the infant room of a city municipal hospital. These infants were examined for preputial development at birth. RESULTS None of the newborn male infants had a completely retractable prepuce (i.e. type 3). The prevalence rate of type 3 prepuce increased with age from 71.7% (95% confidence interval [CI], 66.5-75.5%) for boys aged 7 years to 72.4% (95% CI, 67.3-77.0%) for boys aged 10 years and 84.1% (95% CI, 79.6-88.0%) for boys aged 13 years. In contrast, the prevalence rate of type 1 prepuce decreased with age from 83.1% (95% CI, 71.0-91.6%) for newborn infants to 0.3% (95% CI, 0.0001-1.8%) for boys aged 13 years. On the other hand, the prevalence of circumcision slightly increased with age from 7.2% (95% CI, 5.3-10.8%) for boys aged 7 years to 8.7% (95% CI, 6.5-13.3%) for boys aged 13 years. CONCLUSION Nonretractability of the prepuce was very common among the Taiwanese newborns. Among the school boys, the degree of preputial separation and exposure of glans increased with age and progressed even more rapidly in adolescence. Very few boys still suffered from unretractable prepuce by the age of 13.

Transurethral RollerLoop vapor resection of prostate for treatment of symptomatic benign prostatic hyperplasia: a 2-year follow-up study.

Objective. We compared the 2-year safety and efficacy of two transurethral resection techniques—transurethral vapor resection of the prostate (TUVRP) and conventional loop transurethral resection of the prostate (TURP)—in the surgical management of benign prostatic hyperplasia. Material and methods. Between August 1997 and September 2002, 441 patients underwent transurethral prostatectomy, either TUVRP (n=221) or TURP (n=220). TUVRP was performed using a “RollerLoop” resection loop. All patients were assessed preoperatively by means of International Prostate Symptom Score (IPSS), quality of life (QOL) score, prostate volume, peak urinary flow (Qmax) and post-void residual volume (PVR) measurements and a sexual function questionnaire. Patients were followed up for 3, 6, 12 and 24 months after surgery, and this was followed by a comparison of the incidences of sexual dysfunction, complications and re-treatment. Results. After 2 years of follow-up, no differences were noted between the TUVRP and TURP groups with respect to average IPSS (p = 0.9), QOL scores (p = 0.56), Qmax (p = 0.89) or PVR (p = 0.55), as well as the incidences of bladder neck contracture or urethral stricture (p = 0.34), re-treatment (p = 0.49) or sexual dysfunction (p = 0.57). However, significant reductions in operative time (p = 0.005), decrease in serum hemoglobin levels (p < 0.001), catheterization time (p < 0.001), postoperative hospital stay (p < 0.001) and hospitalization costs (p < 0.001) were observed in the TUVRP group compared to the TURP group. Conclusion. Our results suggest that TUVRP provides equivalent safety and efficacy to TURP during a 2-year follow-up period, in which short-term advantages in perioperative morbidity and cost savings were also demonstrated.

Factors predicting a home death among home palliative care recipients.

Abstract Awareness of factors affecting the place of death could improve communication between healthcare providers and patients and their families regarding patient preferences and the feasibility of dying in the preferred place. This study aimed to evaluate factors predicting home death among home palliative care recipients. This is a population-based study using a national representative sample retrieved from the National Health Insurance Research Database. Subjects receiving home palliative care, from 2010 to 2012, were analyzed to evaluate the association between a home death and various characteristics related to illness, individual, and health care utilization. A multiple-logistic regression model was used to assess the independent effect of various characteristics on the likelihood of a home death. The overall rate of a home death for home palliative care recipients was 43.6%. Age; gender; urbanization of the area where the patients lived; illness; the total number of home visits by all health care professionals; the number of home visits by nurses; utilization of nasogastric tube, endotracheal tube, or indwelling urinary catheter; the number of emergency department visits; and admission to intensive care unit in previous 1 year were not significantly associated with the risk of a home death. Physician home visits increased the likelihood of a home death. Compared with subjects without physician home visits (31.4%) those with 1 physician home visit (53.0%, adjusted odds ratio [AOR]: 3.23, 95% confidence interval [CI]: 1.93–5.42) and those with ≥2 physician home visits (43.9%, AOR: 2.23, 95% CI: 1.06–4.70) had higher likelihood of a home death. Compared with subjects with hospitalization 0 to 6 times in previous 1 year, those with hospitalization ≥7 times in previous 1 year (AOR: 0.57, 95% CI: 0.34–0.95) had lower likelihood of a home death. Among home palliative care recipients, physician home visits increased the likelihood of a home death. Hospitalizations ≥7 times in previous 1 year decreased the likelihood of a home death.

Outcome of Transurethral Wedge Loop Vaporization-Resection versus Conventional Transurethral Resection Treatment for Benign Prostatic Hyperplasia

Background and Purpose: To study the 5-year outcome of transurethral Wedge Loop raporization-resection versus conventional transurethral resection treatment for patients with prostatic hyperplasia (BPH). Methods: This prospective randomized study was performed between January 1997 and November 1999. Seventy-two patients with symptomatic BPH undergoing transurethral vaporization-resection (TUVRP) using ”Wedge Loop” compared to that of seventy-four cases with conventional transurethral resection of the prostate (TURP). All cases were assessed international prostate symptom score (I-PSS), quality of life (QOL) score, peak urinary flow rate (Qmax), prostatic volume, and post-void residual volume (PVR). Perioperative details and postoperative complications were recorded. Baseline, 3 months, 1, 2, 3 and 5 years follow-up data were analyzed. Results: The operation time was no difference (p=0.1) whereas perioperative hemorrhage, fluid irrigation amount, catheterization and length of hospital stay were significant between these two groups. Improvement in I-PSS, Qmax, prostate volume, and PVR were also significant in each group at 3-month review. Adverse events included that the sexual impotence, retrograde ejaculation, urethral stricture and urinary incontinence were no difference between two groups at 2-year end. The retreatment rates were 8% versus 9.8% (p=0.51) at 2 years and 9.7% versus 11.1% (p=0.59) at 5 years. 20 (27.8%) cases of TUVRP and 21 (28.4%) cases of TURP completed 5 years follow-up, and revealed no difference in treatment durability (p＞0.05). Conclusion: Transurethral Wedge Loop electrovapour resection appears to have perioperative advantages over TURP and the long-term outcome durability seems equivalent each other.

Ingestion of Multiple Sharp Foreign Objects with Spontaneous Passage

Foreign body ingestion is a common clinical problem and can be managed by observation, endoscopic removal and surgical retrieval. Multiple, long, pointed and sharp objects are more complicated to manage, and have a higher risk of complications such as obstruction, bleeding and perforation of the alimentary tract. It is sometimes difficult to make a decision regarding the most appropriate management. We report one patient who swallowed multiple foreign bodies, including more than ten nails, two staples, one length of wire and many coins. He refused endoscopic treatment and experienced several episodes of cramping abdominal pain. The ingested objects eventually passed without any complications. We present the clinical course and review papers about the management of foreign body ingestion.

Safety and Efficacy of Transurethral Non-Contact Nd: YAG Laser Treatment of High Risk Patients with Benign Prostatic Hyperplasia

Objective: To study the safety and efficacy of transurethral non-contact Nd: YAG laser prostatectomy in high surgical risk patients with lower urinary tract symptoms due to benign prostatic hyperplasia (BPH). Patients and Methods: A randomized controlled study was performed between March 2000 and September 2002. The study included 211 patients with symptomatic BPH divided into three groups. Thirty-three cases with high surgical risk undergoing transurethral non-contact Nd: YAG laser ablation of the prostate, 25 cases with high surgical risk and another 153 low risk cases were treated with conventional TURP. Over a 30 month period, all patients with bladder outlet obstruction due to BPH were evaluated by lnternational Prostate Symptom Score (IPSS), urinary flow rate, prostate volume and post-void residual volume. Patients with carcinoma of the prostate, elevated levels of prostate specific antigen and chronic urinary retention were excluded. Each patient was followed for up to 12 months after the procedure. Results: Symptom scores improved by 130% and residual volume by 90% in non-retention patients, the mean peak flow rate increased from an average of 6.3 mL／s before treatment to 10.7 mL／s at the six week follow-up in the Nd: YAG laser treatment group. The procedure was safe and simple, mean operation duration was 28.7 minutes, and no patient required a blood transfusion. Most patients had their catheters removed successfully on 10th day after the procedure. Conclusion: This study has demonstrated that Nd: YAG laser ablation was safe and effective in improving symptoms and other urologic parameters in high surgical risk BPH patients, had minimal adverse effects and maintained quality of life. It appeared to have several advantages over other surgical treatments for BPH, but further study is needed to determine the long-term results.