Shing-Hwa Lu

Thulium Laser Laparoscopic Partial Nephrectomy Without Renal Hilar Control in a Porcine Model

Objective Laparoscopic partial nephrectomy is a technically challenging procedure. The most important step is to achieve hemostasis during parenchymal resection. We evaluated the feasibility of thulium:yttrium-aluminum-garnet (Th:YAG) laser partial nephrectomy in a porcine model. Materials and Methods We performed bilateral transperitoneal laparoscopic partial nephrectomies with a 600 μm end-firing laser fiber and a 70 W Th:YAG laser setting in five pigs. Perioperative data including operative time, laser time, estimated blood loss and serum creatinine before and after surgery were collected. Ex vivo retrograde pyelography was performed to detect collecting system leakage after specimen removal. Results Laser resection and hemostasis were successfully accomplished in all cases, and no perioperative complications occurred. Mean estimated blood loss was 50 mL. Mean laser time was 20 minutes. Mean resected renal mass was 25% of total kidney mass. After 14 and 28 days, exploratory laparotomy found no urinoma formation. Conclusion Laparoscopic partial nephrectomy using Th:YAG laser is a feasible surgical method in the porcine model. Future clinical application is warranted.

Quantitative analysis of urinary stone composition with micro-Raman spectroscopy

Urolithiasis is a common, disturbing disease with high recurrent rate (60% in five years). Accurate identification of urinary stone composition is important for treatment and prevention purpose. Our previous studies have demonstrated that micro-Raman spectroscopy (MRS)-based approach successfully detects the composition of tiny stone powders after minimal invasive urological surgery. But quantitative analysis of urinary stones was not established yet. In this study, human urinary stone mixed with two compositions of COM, HAP, COD, and uric acid, were analyzed quantitatively by using a 632.98 nm Raman spectrometric system. This quantitative analysis was based on the construction of calibration curves of known mixtures of synthetically prepared pure COM, HAP, COD and uric acid. First, the various concentration (mole fraction) ratio of binary mixtures including COM and HAP, COM and COD, or COM and uric acid, were produced. Second, the intensities of the characteristic bands at 1462cm -1(IRCOM), 1477cm-1(IRCOD), 961cm-1(IRHAP) and 1402cm-1(IRuric acid), for COD, COM, HAP and uric acid were used respectively for intensity calculation. Various binary mixtures of known concentration ratio were recorded as the basis for the quantitative analysis. The ratios of the relative intensities of the Raman bands corresponding to binary mixtures of known composition on the inverse of the COM concentration yielded a linear dependence. Third, urinary stone fragments collected from patients after management were analyzed with the use of the calibration curve and the quantitative analysis of unknown samples was made by the interpolation analysis. We successfully developed a MRS-based quantitative analytical method for measuring two composition.

Holmium Laser Ablation of Prostate for Benign Prostate Hyperplasia

Background and Purpose: Transurethra resection of prostate (TURP) remains the gold standard treatment for benign prostate hyperplasia (BPH). Recently, several minimally invasive therapies for BPH were developed, such as holmium laser ablation of prostate (HoLAP). We report our preliminary results of HoLAP for BPH. Methods: From Sep. to Dec. 2005, we used OmniPulse(superscript TM) MAX 80 Watt Holmium Laser (Trimedyne®)for 20 patients, age 58 to 84 years old (mean 70.8±8.1), with BPH. Pre-operative prostate specific antigen (PSA), international prostate symptom score (IPSS), uroflow rate, residual urine (assessed by bladder scan), prostate size (assessed by transrectal ultrasound) and international index of erectile function (IIEF-15 and -5) were surveyed. The operation time, Foley catheter indwellation period and immediate post-operative complications were documented. The patients received post-operative survey one month later and every 3 months. Results: The level of PSA was 2.83 ng/dl. The pre-operative mean total IPSS, obstructive and irritative scores were 20.7, 11.7 and 9.0, respectively. Maximum flow rate was 11.9 ml/sec, residual urine 38.8 ml, and prostate size 50.4 ml. The operation time was 30 minutes, Foley indwellation period 28.3 hours, and mean hospital stay 3.0 days. Three patients suffered from urine retention after removal of Foley catheter and needed re-indwellation. The IPSS in one month after surgery was 11.2, obstructive scores were 3.5, and uroflow rate was 25.0 ml/sec. The pre-operative and one month after surgery IIEF-15 and -5 scores were 33.5, 12.7, and 30.3, 10.0, respectively. No significant difference on erectile function was noted after surgery. Conclusion: Though HoLAP reduced surgical risk as TURP, and most patients got benefit from it, 15% patients still suffered from urine retention after early removal of Foley catheter. Longer post-operative survey is necessary to evaluate the true outcome of HoLAP.

Prevalence and Impact of Female Lower Urinary Tracts Symptoms in the Eastern Area of Taipei City

Background and Purpose: To investigate the prevalence of female urinary incontinence in the eastern area of Taipei City and evaluate the impact of female lower urinary tract symptoms on health-related quality of life. Methods: From October 2005 to December 2005, total 1137 women with the mean age of 48.3 years old were successfully interviewed at the eastern area of Taipei metropolitan by The Bristol Female Lower Urinary Tract Symptoms Questionnaire. Age, marital status, vaginal delivery number and educational status were used as comparison parameters. Chi-square test and Fishers exact test were used for statistical analysis while p＜0.05 was considered significance. Results: The overall prevalence of urinary incontinence was 36.43% and 39.97% in women older than 40 years old. Irritative symptoms including frequency, urgency and nocturia had strong correlation in 4 parameters Regarding voiding symptoms and quality of life, vaginal delivery number and educational status factors revealed correlation results in all the question domains. Regarding pelvic symptoms, low back pain and pain during intercourse revealed highly correlated results in all 4 parameters. Conclusion: The prevalence of urine incontinence was 36.43% in the eastern area of Taipei metropolitan, which is similar to that in western countries.

Flow Cytometric Deoxyribonucleic Acid Analysis of Bilateral Renal Cell Carcinoma

Four tumors from two patients with bilateral renal cell carcinoma (RCC) were analyzed by flow cytometry. Significant differences in the pattern of deoxyribonucleic acid (DNA) histogram were noted between the tumors on either side in each case. In Case 1, the histogram revealed an aneuploid stem line with DNA content of 3.66N in the right-side tumor, whereas the left had the diploid pattern, In case 2, the histogram showed a diploid pattern in the right-side tumor, while two aneuploid cell populations with 3.45N and 3.81N were noted in the left one. This suggests separate primaries, rather than kidney-to-kidney metastasis in these cases. Flow cytometric analysis may be helpful for better understanding of the nature of bilateral RCC.