See-Ming Hou

Effect of Vardenafil on Blood Pressure Profile of Patients With Erectile Dysfunction Concomitantly Treated With Doxazosin Gastrointestinal Therapeutic System for Benign Prostatic Hyperplasia

PURPOSE We investigated the effect of the combination of the doxazosin gastrointestinal therapeutic system and 10 mg vardenafil on the hemodynamic status of patients with benign prostatic hyperplasia and erectile dysfunction. MATERIALS AND METHODS This was a double-blinded, randomized, placebo controlled crossover trial. Patients with benign prostatic hyperplasia and erectile dysfunction treated with the doxazosin gastrointestinal therapeutic system on a regular basis, with no other antihypertensive events, were recruited. Subjects took 10 mg vardenafil or placebo in a randomized crossover fashion with a washout period of at least 7 days between each treatment. The supine and standing blood pressure of the subjects was recorded from 1 hour before to 6 hours after the administration of vardenafil or placebo. The primary outcome of the study was the maximal change in standing systolic blood pressure of the subjects from 1 half hour before to 6 hours after the administration of drugs. RESULTS A total of 37 patients, 25 (67.6%) and 12 (32.4%) on the doxazosin gastrointestinal therapeutic system at 4 mg and 8 mg, respectively, completed the trial. The combination drug therapy resulted in a maximal decrease in standing systolic blood pressure of 6.18 mm Hg (95% CI -12.02, -0.33; p = 0.039). Only 1 patient had an asymptomatic standing systolic blood pressure of less than 85 mm Hg. Otherwise no symptomatic hypotension or clinically significant adverse cardiovascular event was observed during the study. CONCLUSIONS In patients on the doxazosin gastrointestinal therapeutic system for benign prostatic hyperplasia a single 10 mg dose of vardenafil had no symptomatic hemodynamic effects.

Novel Approach of Laparoscopic Transperitoneal En Bloc Resection of Urachal Tumor and Umbilectomy with a Comparison of Various Techniques

Urachal carcinoma is a rare cancer that accounts for less than 1% of all bladder cancers. Surgical resection remains the mainstay of treatment. With partial cystectomy, long-term survival is possible following complete resection of the tumor. In this paper, we describe a novel approach of laparoscopic en bloc partial cystectomy and umbilectomy. We emphasize the importance of complete resection of the tumor and umbilicus and prevention of tumor spillage during the procedure. The literature is also reviewed for the comparison of various laparoscopic techniques.

Primary bladder amyloidosis – case report of a patient with delayed upper urinary tract obstruction 3 years after the diagnosis

Primary bladder amyloidosis is a rare disease. There are approximately 100 reported cases. The lesions can be confused with bladder neoplasm and are characterised histologically by the classical apple green birefringence under polarised light. In this article, we report a 51-year-old lady with known history of primary bladder amyloidosis presenting with gross hydronephrosis 3 years after the first diagnosis. Laparoscopic ileal replacement of bilateral ureters was performed. There was no recurrent ureteric obstruction 2 years after surgery. This case demonstrates the progressive nature of primary amyloidosis of bladder. The diagnosis of primary bladder amyloidosis warrants long-term surveillance of upper urinary tract.

Age, tumour stage, and preoperative serum albumin level are independent predictors of mortality after radical cystectomy for treatment of bladder cancer in Hong Kong Chinese.

OBJECTIVES To evaluate the association between patient age, other clinical factors and mortality following radical cystectomy for treatment of bladder cancer. DESIGN Historical cohort study. SETTING A urology unit in Hong Kong. PATIENTS The outcomes of 117 patients who had radical cystectomies performed in one urological unit from 2003 to 2011 were reviewed. Demographic and perioperative data, including tumour stage, Charlson Comorbidity Index, and preoperative serum albumin levels were retrieved from computerised medical records. Risk factors for 30-day mortality, and cancer-specific, other-cause, and overall death rates at 5 years were calculated. The data were subsequently stratified and analysed according to age. RESULTS Of the 117 patients, 83 (71%) were aged 75 years or below. The mean follow-up duration was 31 (standard deviation, 29) months. Age, tumour stage, and preoperative serum albumin level, but not the Charlson Comorbidity Index, were found to be predictors of survival following radical cystectomy. The overall 30-day mortality rate was 3% in the full sample, 1% in patients aged 75 years or below, and 10% in patients aged over 75 years. There was no significant difference in 5-year cancer-caused mortalities between patients aged 75 years or below and those aged over 75 years (33% vs 33%, P=0.956). In patients older than 75 years, the 5-year other-cause and overall mortality rates were 47% and 80%, respectively; such rates were higher than those for younger patients (13% and 46%, respectively). CONCLUSION Age, tumour stage, and preoperative serum albumin level were predictors of survival after radical cystectomy. Non-cancer-related death played a crucial role in the overall mortality rate in elderly patients having radical cystectomy for bladder cancer.

Inflammatory myofibroblastic tumor of spermatic cord in undescended testis.

Inflammatory myofibroblastic tumor (IMT) is an uncommon condition and only a few cases of IMT in the spermatic cord have been reported, with none associated with an undescended testis. We present the case of a man with an undescended left testis who had an IMT involving the spermatic cord. He was treated with surgery and no adjuvant therapy afterward. He was disease free at 2.5 years of follow-up. A brief discussion of the pathologic features and management of the condition is also provided.

Zoledronic acid to prevent bone loss in Chinese men receiving androgen deprivation therapy for prostate cancer

Aim:  To explore the bone mineral density (BMD) preservation effect of zoledronic acid and its renal safety and tolerability in Chinese patients with prostate cancer on androgen deprivation therapy (ADT).

Secondary hemorrhage after bipolar transurethral resection and vaporization of prostate

Introduction: We evaluated the factors associated with secondary hemorrhage after bipolar transurethral resection of prostate (TURP) and vaporization of prostate. Materials and Methods: The perioperative data of patients undergoing endoscopic surgery for benign prostatic hyperplasia (BPH) were prospectively collected. Procedures involved included bipolar TURP, bipolar vaporization of prostate, and hybrid bipolar TURP/vaporization of prostate. Secondary hemorrhage was defined as bleeding between 48 h and 30 days postsurgery requiring hospital attendance with or without admission. Risk factors for secondary hemorrhage were analyzed. Results: From 2010 to 2013, 316 patients underwent bipolar surgery for BPH. Bipolar TURP accounted for 48.1% of the procedures, bipolar vaporization accounted for 20.3% of the procedures, and the rest were hybrid TURP/vaporization of prostate. Among this cohort of patients, fifty patients had secondary hemorrhage with hospital attendance. Consumption of platelet aggregation inhibitors (PAIs) was found to be associated with secondary hemorrhage (P < 0.0005). Age, prostate volume, operation type, the use of 5-alpha reductase inhibitors, and being with a urethral catheter before operation were not found to be statistically significant risk factors for secondary hemorrhage. Conclusions: Secondary hemorrhage after bipolar surgery for BPH is a common event. Consumption of PAI is a risk factor for such complication.

Extended use of Prostate Health Index and percentage of [-2]pro-prostate-specific antigen in Chinese men with prostate specific antigen 10-20 ng/mL and normal digital rectal examination.

Purpose We investigated the extended use of Prostate Health Index (PHI) and percentage of [-2]pro-prostate-specific antigen (%p2PSA) in Chinese men with prostate-specific antigen (PSA) 10–20 ng/mL and normal digital rectal examination (DRE). Materials and Methods All consecutive Chinese men with PSA 10–20 ng/mL and normal DRE who agreed for transrectal ultrasound (TRUS)-guided 10-core prostate biopsy were recruited. Blood samples were taken immediately before TRUS-guided prostate biopsy. The performances of total PSA (tPSA), %free-to-total PSA (%fPSA), %p2PSA, and PHI were compared using logistic regression, receiver operating characteristic, and decision curve analyses (DCA). Results From 2008 to 2015, 312 consecutive Chinese men were included. Among them, 53 out of 312 (17.0%) men were diagnosed to have prostate cancer on biopsy. The proportions of men with positive biopsies were 6.7% in PHI<35, 22.8% in PHI 35–55, and 54.5% in PHI>55 (chi-square test, p<0.001). The area under curves (AUC) of the base model including age, tPSA and status of initial/repeated biopsy was 0.64. Adding %p2PSA and PHI to the base model improved the AUC to 0.79 (p<0.001) and 0.78 (p<0.001), respectively, and provided net clinical benefit in DCA. The positive biopsy rates of Gleason 7 or above prostate cancers were 2.2% for PHI<35, 7.9% for PHI 35–55, and 36.4% for PHI>55 (chi-square test, p<0.001). By utilizing the PHI cutoff of 35 to men with PSA 10–20 ng/mL and normal DRE, 57.1% (178 of 312) biopsies could be avoided. Conclusions Both PHI and %p2PSA performed well in predicting prostate cancer and high grade prostate cancer. The use of PHI and %p2PSA should be extended to Chinese men with PSA 10–20 ng/mL and normal DRE.

Current management practice for bladder cancer in Hong Kong: a hospital-based cross-sectional survey.

OBJECTIVES To examine current practice in the management of bladder cancer in Hong Kong government and private hospitals. DESIGN Cross-sectional survey. SETTING All government hospitals and the major private institutions in Hong Kong, which provide urological services. PARTICIPANTS Urologists responding to an anonymous, self-administered, web-based questionnaire regarding practices in smoking cessation, treatment of non-muscle invasive bladder cancer and muscle invasive bladder cancer, and research into bladder cancer. RESULTS Of the 29 urologists from 11 government hospitals and eight private institutions who were invited, 18 from 11 (100%) government hospitals and seven from six (75%) private institutions responded, which amounted to an 86% response rate. In all, 88% of the respondents seldom or never referred their bladder cancer patients to smoking cessation programmes. Hong Kong urologists showed good compliance in the management of non-muscle invasive bladder cancer according to international guidelines. There was great variation with regard to regimens for maintenance of intravesical immunotherapy. There was underuse of perioperative systemic chemotherapy, despite wide acceptance of this practice; fewer than 10% of the patients received neo-adjuvant and adjuvant systemic chemotherapy for the treatment of muscle invasive bladder cancer. Of the surveyed urologists, 80% expressed an inadequacy of resources for bladder cancer research and 96% agreed that a local inter-hospital bladder cancer database was needed. CONCLUSIONS This study demonstrated great diversity in the use of intravesical immunotherapy, perioperative systemic chemotherapy, and surgical treatment of bladder cancer among urology service providers. There is a need for clear recommendations in these areas.

Psoas hitch and ureteral re-implantation in an augmented bladder with ketamine uropathy: A case report

Ketamine has become a popular recreational drug among Asians in recent years. Ketamine uropathy is well known to affect the lower urinary tract leading to urgency, frequency, incontinence and pelvic pain. Concomitant upper urinary tract involvement with ureteric stricture is less common. We hereby present a case of a patient with ketamine‐related bladder contracture initially treated with augmentation cystoplasty, who subsequently developed left lower ureteric stricture requiring psoas hitch and ureteral re‐implantation. We further discussed the fundamental principles in managing ketamine uropathy.