Shu-Yu Wu

Repeated intravesical injections of platelet-rich plasma are effective in the treatment of interstitial cystitis: a case control pilot study

Interstitial cystitis (IC), also known as bladder pain syndrome (BPS), is a debilitating chronic disease. There are few treatment options for IC/BPS refractory to current medical therapy. This study investigated the clinical efficacy of intravesical injections of platelet‐rich plasma (PRP) in IC/BPS.

Detrusor Underactivity and Bladder Outlet Procedures in Men

Purpose of ReviewDetrusor underactivity (DU) is a common but poorly understood clinical problem. The diagnosis and treatment of DU are difficult and full of uncertainties. There are many overlaps between DU and bladder outlet obstruction (BOO) in clinical symptoms and managements. In this review, we discuss the relationship of clinical diagnosis and treatment between DU and BOO in men, especially the outcome of bladder outlet surgery in patients with DU.Recent FindingsDU could be resulted from many different etiologies, including psychogenic, neurogenic, myogenic, and the reduced detrusor contractility after increasing muscle work against the increase of bladder outlet resistance. Current managements are usually focused on relieving voiding difficulty and prevent urine retention to avoid urinary tract infection and upper urinary tract deterioration. Since there is no suitable medical treatment to enhance bladder contractility, most of the researches focus on reducing bladder outlet resistance and treat BOO. Many recent studies have reported the therapeutic outcome of transurethral incision of the bladder neck, transurethral resection of the prostate and urethral sphincter botulinum toxin A injection.SummaryThe current treatment options in DU are limited. Even if there are many clinical trials revealing good results in patients with DU after BOO surgery, the evidence that BOO surgeries benefit patients with DU are still controversial. The actual mechanism of detrusor function recovery after BOO surgery in men with DU has not been well elucidated. Nevertheless, a portion of men with DU can safely and effectively improve their voiding symptoms and voiding efficiency after BOO surgeries. Further research of the underlying pathophysiology between DU and BOO is mandatory.

Therapeutic Efficacy of a New Procedure for Male Urinary Incontinence Combining a Suburethral Polypropylene Mesh and Cardiovascular Patch

Purpose Stress urinary incontinence (SUI) in men is a complication secondary to prostatectomy or resulting from neurological lesions. This study presents our experiences with male suburethral slings over the past decade. Methods In this study, we considered patients who presented with SUI and were diagnosed with an intrinsic sphincteric deficiency due to postprostatectomy incontinence (PPI) or other causes (non-PPI). Patients who underwent the suburethral sling procedure using a polypropylene mesh and a cardiovascular patch were retrospectively included. An urodynamic study was performed before and after the operation. Global response assessment (GRA) and SUI grading were used for surgical outcome. The revision rate and the infection rate were also evaluated. Results A total 31 patients were enrolled in this study; the mean patient age was 59.5±18.9 years, and the mean follow-up period was 36.9±29.4 months. Fourteen patients comprised the non-PPI group and 17 were in the PPI group. The preoperative SUI of all patients were categorized as a moderate to severe problem according to the SUI grade, with a mean score of 2.32±0.48 before the operation and 0.48±0.57 after the operation. With a mean score of 2.35±0.71, GRA showed that the patients were satisfied with the treatment. After the sling procedure, 4 patients (13%) reported a mild improvement, 12 (38.7%) a moderate improvement, while 15 (48.4%) reported an excellent improvement. Six patients (19.4%), including 5 from the non-PPI group (35.7%) and 1 (5.9%) from the PPI group (P=0.037), underwent sling removal because of infection. Conclusions The male suburethral sling procedure using a polypropylene mesh and a cardiovascular patch is a safe, efficacious, and inexpensive surgical procedure for PPI. In cases of neurological incontinence, however, the higher infection rate in non-PPI patients means that they should be carefully managed.

Long-term Outcomes of Augmentation Enterocystoplasty in Patients With End-Stage Bladder Diseases: A Single-Institute Experience Involving 102 Patients

Purpose Augmentation enterocystoplasty (AE) has been shown to improve clinical symptoms in patients with end-stage bladder disease (ESBD). Herein, we report the long-term outcomes of a series of patients with different etiologies of ESBD who received AE. Methods We retrospectively reviewed 102 patients with ESBD who received AE at the Hualien Tzu Chi General Hospital from 1992 to 2014. ESBD in this study was defined as including neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI) or myelomeningocele, inflammatory bladder disease (IBD), ESBD occurring after pelvic cancer surgery, and other etiologies. Complications including active lower urinary tract problems and urinary tract infection (UTI), as well as patients’ self-reported satisfaction with the procedure, were evaluated. Results A total of 102 patients were included in the study. A majority of patients received AE for NLUTD (n=43), followed by IBD (n=38), ESBD after pelvic cancer surgery (n=15), and the other etiologies (n=6). Patients had a mean age of 39.4±18.7 years and were followed for a mean of 78 months. All patients had significantly increased cystometric bladder capacity and compliance at the time of follow-up. Fifty-four patients (52.9%) reported moderate to excellent satisfaction with the outcome, and there were no significant differences among the groups (P=0.430). The most common reason for dissatisfaction was the need for clean intermittent catheterization (CIC; 41.7%), followed by urinary incontinence (25.0%) and recurrent UTI (16.7%). Conclusions AE is a safe and effective procedure for patients with ESBD. Postoperative urinary incontinence and UTI as well as the need for CIC may affect quality of life and decrease patient satisfaction.

Single institution experience of over 100 cases of augmentation enterocystoplasty in the patients with end-stage bladder diseases

Hypothesis / aims of study The patients with irrevisible contracted bladder or lower compliance due to different disease might be clinically categorized to end stage bladder diseases (ESBD). Conventionally, augmentation enterocystoplasty (AE) is indicated in ESBD patients and could effectively imporve clinical symptoms. However, the outcome and complication between different etiologies had not been reported and compared. We reported the long-term results of currently largest series of patients with ESBD and recived AE.