Tai-Hou Yang

Snail-Headed Catheter Retriever: A Simple Way to Remove Catheters from Female Patients

A snail-headed catheter retriever was designed to remove the Double-J* catheter from female patients. The catheter can be removed within a few minutes using topical anesthesia at the outpatient department without endoscopic instrumentation and lithotomy position. No infection or bleeding developed following the procedure and all patients tolerated it well. The cost-effective retriever can be used as a convenient alternative for Double-J catheter removal from female patients.

Restenosis within Implanted Urethral Stent in Complicated Urethral Stricture

The management of urethral stricture is always a challenge to the urologists. Here we report a case who suffered from pelvic fracture and complete bulbomembranous urethral disruption. After several attempts the endoscopic means failed to restore his urethral continuity. A self-expandable urethral stent 2.5 cm in length was implanted for bulbomembranous urethral stricture 2 cm in length after visual internal urethrotomy and dilatation. The urinary stream decreased 9 months after the stent placement due to ingrowth of granulation tissue at the proximal end of stent lumen. Even endoscopic means for resecting scar tissue or internal urethrotomy could not keep the satisfactory results of urethral patency. Finally, the patient underwent transperineal removal of urethral stent with segmental resection of the stenosed urethra and end-to-end anastomosis one year after implantation with acceptable result. In conclusion, implant of urethral stent cannot resolve all the urethral obstructions. Preoperative selection of the patients and postoperative long-term follow-up are necessary.

Management of Renal Abscesses – 10 years of Experiences at Tri-Service General Hospital

Renal abscess, either intrarenal or peninephric, is a fatal disease when complicated with sepsis High morbidity and mortality rates are associated with delayed diagnosis, with vague symptoms derived from the retroperitoneum. For clarification of clinical presentation, treatment and outcome, a review was done of 32 patients who were diagnosed and managed as renal or perirenal abscesses at this Hospital from November 1986 to October 1995. The predisposing factors were diabetes mellitus, urinary tract infection or renal stones. Ultrasound and computerized tomography (CT) were valuable in early identifying the location and size of abscess and helpful in further therapy as well as follow-up. Esherichia coli (E. coli) and Klebsiella pneumoniae were the most common organisms (70%) identified. Staphylococcus aureus was found in two patients with infectious skin lesions. Six patients received effective antibiotics without surgery. Eighteen patients received sonoguided percutaneous abscess drainage (PAD) with antimicrobial therapy as initial treatment, seven of them received open surgery later, including multiple drainage in four and nephrectomy in three. The initial open surgeries done in six patients, included open drainage in four, nephrectomy in one and partial nephrectomy in one. One patient received PAD after open drainage for residual pus. Finally, a total of 13 (43.3%) patients had received open surgery during the hospital course. Five patients expired, including four who received PAD as initial therapy and one conservative treatment as mono therapy. These results indicated that early diagnosis and aggressive management attained better outcome, and appropriate systemic antibiotics and/or adequate drainage were successful treatments in most patients. Open drainage and nephrectomy were necessary in patients with multiple intrarenal abscesses, military abscesses, polycystic kidney disease, renal stone, resistance to antibiotics or with non-functioning kidney

Changes in Serum Prostate-Specific Antigen after Orchiectomy and Complete Androgen Blockade in Patients with Stage D Prostatic Carcinoma

Prostate-specific antigen (PSA) is a unique serum marker highly sensitive to any form of therapy for prostatic cancer. Based on the character of hormonal dependence of the cancer cell, and rogen ablation is one of the best therapies for advanced prostatic cancer. From April 1990 to April 1995, 74 patients with the diagnosis of stage D prostatic cancer had received bilateral orchiectomy. Twenty-four of them had completed regular follow-up at our out-patient clinic. Serum PSA level was checked every two to three months and analyzed. Twelve patients who had no adjuvant anti-androgen therapy were categorized as group I. Another twelve patients who received post-operative anti-androgen medication were categorized as group II. In the group I patients, the serum PSA level reduced to the minimum 7.3±5.2 months after orchiectomy but relapsed 10.6±10.6 months later. In the group II patients, the post-operative PSA level reduced to the minimum in 9.9±6.6 months and raised 7.8±5.7 months later. There were no statistic differences between both groups (p＞0.05, Student’s t test). Our preliminary results, warranted no conclusion on the role of adjuvant complete androgen blockade therapy for stageD prostatic adenocarcinoma.

Effectiveness of Topical Eutectic Mixture of Local Anesthetics (EMLA) on Pain Response and Sedatives Requirement during Extracorporeal Shock Wave Lithotripsy

Nowadays a majority of patients with urolithiasis are treated primarily with extracorporeal shock wave lithotripsy (ESWL). Almost 50% of the patients need intravenous anesthetics with subsequent extensive vital signs monitoring during the ESWL procedure. A trial was carried out, of local application of a eutectic mixture of local anesthetics (EMLA) in patients with urolithiasis to assess the pain and the consumption of anesthetics during the ESWL procedure. From April to May 1995, a total of 40 patients were enrolled in this study. They were randomly divided into study and control groups. EMLA cream (2.5% lidocaine and prilocaine, 30 gm, Astra Pharmaceutical) was applied to 20 patients at least 90 minutes before the ESWL procedure, and 20 patients without EMLA application served as controls. The verbal pain scoring and systemic analgesic requirement were recorded. The results showed that there was no significant difference between the two groups in terms of pain score and sedative requirements. In conclusion, topical EMLA application alone is not effective for pain control in ESWL treatment of stone patients.

Intravesical Migration of an Intrauterine Device with Stone Formation

Migration of IUD (intrauterine device) is not uncommon. However, intravesical migration of IUD with stone formation is very rare. To our knowledge, only 20 cases had been reported in the literature since 1972 to 1993. Herein, we report a 42-year-old woman in whom an IUD (Copper-7) migrated into the bladder 2 months after insertion and she got pregnancy in 1980. The child was delivered by nature. The woman remained asymptomatic for 13 years until she presented with urinary symptoms. The foreign body induced vesical calculus was removed by cystoscopy and EHL (Electrohydraulic lithotripsy).

Retroperitoneal Ganglioneuroblastoma – A Case Report

Ganglioneuroblo.stoma originates from neural crest tissue; it is the intermediate type between mature neuroblastoma to ganglioneuroma. Its frequency is about one-fifth that of the neuroblastoma, with half of the cases is younger than 14 years of age. From 1983 to 1995, two ganglioneuroblastomas were diagnosed by pathology at Tri-Service General Hospital. One of the two cases had tumor recurrence three times postoperatively during a 44-month follow-up period. In addition to similar histopathological features, DNA flow cytometric analysis revealed the same DNA stemlines in tumor specimens from different locations. This indicates that these metachronous tumors could be a serial peritoneal implantations of tumor cells from the original huge retroperitoneal tumor. Multicentricity of different stem lines is unlikely in this case. Extraperitoneal radical excision of the tumor and delicate manipulation to prevent intraperitoneal seeding is advised.

Adenocarcinoma Found Among Prostatic Intraepithelial Neoplasia Patients

A retrospective review was done of the results in 204 patients who had received prostatic flee- die biopsy for prostate specific antigen (PSA) elevation or abnormal digital rectal examination (DRE) in the past five years, and the clinical significance of prostatic intraepithelial neoplasia (PIN) on prostate biopsy was investigated. Thirteen patients had atypical hyperplasia or dysplasia, and one was PIN in original pathological results. All were reclassified according to the histological criteria of PIN; there were seven low-grade, and seven high-grade, PINs. The average PSA level in the groups was 17.8 ng/ml and 21.8 ng/ml, respectively. Seven patients had adenocarcinoma identified on the surgical specimens of the same biopsy or following transurethral resection of prostate (TURP) and retropubic prostatectomy; one had benign nodular hyperpiasia (BPH) and the remaining six cases had no final pathoigocial diagnosis. Of the seven patients with adenocarcinoma, five cases had been high-grade PIN, and two cases were low-grade PIN in the original prostate biopsy. In conclusion, there is a strong association between PIN and adenocarcinoma of prostate. Immediate repeat biopsies and close follow-up are recommended for patients with PIN identified on prostatic biopsy to detect any possible missed prostatic carcinoma; there should be close follow-up even if the second biopsy is negative.

Nephrogenic Diabetes Insipidus and Bilateral Nonobstructive Hydronephrosis - A Case Report and Review of the Literature

This report concerns a 20-year-old male admitted due to slipping-down injury with gross hematuria and acute urinary retention. The patient had no past history of genitourinary tract disorder, except for polyuria, since his childhood. Daily urine output was about 8 - 9 L during the hospital course, and urine specific gravity was almost always fixed (1.000-1.001). Electrolytes and renal function were within normal range without any medical support. The computerized tomography and ultrasound of abdomen revealed severe bilateral hydroureteronephrosis. Cystourethroscopy showed normal urethra without definite obstructive lesion, severe distended bladder with marked trabeculation. Urodynamic studies revealed marked increase of maximal urethral closure pressure (MUCP) - 210 cm H20, caused by decompensation of polyuria. Diagnosis of nephrogenic diabetes insipidus (NDI) was confirmed by water deprivation test. The abnormalfinding persisted for seven months in spite of suprapubic tube cystostomy drainage. The literature is reviewed.

Calculi in the Patients with Urinary Diversion: 5-Year Experience in Tri-Service General Hospital

The relationship between urinary diversion and calculi formation has been well documented. This is a retrospective review of the patients who had calculi formation after the urinary diversion in the past five years and visited our hospital. The incidence of calculi formation was 16.7% (11/66) in all patients with diversion and 15.7% (8/51) among these patients having ileal conduit patients. None of these patients (8 men and 3 women) had history of urinary stone before diversion. The causes of diversion included TCC (transitional cell carcinoma) of bladder (8/11) and neurogenic baldder (3/11). ileal conduit remained the most popular method of diversion (8/11). Urinary tract infection and sepsis were common in these patients. Totally 19 units of calculi were treated differently according to the size and location of the calculi. Larger and complicated renal stones were managed with open surgery, but complication rate was higher and hospital days were longer. Extracorporeal shock wave lithotripsy (ESWL) became the first choice in the majority of simple stone units to achieve high stone free rate (85%), but the follow-up found high recurrent rate (7/11). Adequate hydration and effective antibiotics play an important role in the prevention of calculi recurrence.