Ted H. Hsu

Effects of aging on mitochondrial enzyme activity of rat urinary bladder

Objectives: Our previous study showed that aged rat bladders became fatigued faster than young bladders following repeated contraction induced by electrostimulation. One factor might be a lower energy-producing capability secondary to a decreased mitochondrial enzyme activity of the aged bladder. This study examined this possibility. Materials and Methods: Mitochondria from 3- (n = 11) and 24-month-old (n = 10) Sprague-Dawley rats were isolated. Activities of the following enzymes were assayed: two key enzymes in the citric acid cycle, citrate synthase and malate dehydrogenase, and three enzymes in the respiratory chain reaction, NADH-cytochrome c reductase, succinate-cytochrome c reductase and cytochrome c oxidase. The concentration of phosphocreatine and ATP in the aged rat bladders and a separate group of young bladders (n = 12) was determined using high-performance liquid chromatography. Results: (1) The aged bladders have a significantly lower level of phosphocreatine and ATP content than those of young bladders. (2) The activities of all five enzymes assayed were significantly lower in the aged bladders than in young bladders, especially for citrate synthase, which had only 46.8% of the activity of young bladders. Conclusions: Aging reduces the mitochondrial enzyme activity of the rat bladder resulting in a lower energy-production capability, which might explain some of the voiding dysfunctions found in the elderly.

Is Renal Function at the Tumor Side a Prognostic Factor in Ureteral Transitional Cell Carcinoma

OBJECTIVES To evaluate whether the ipsilateral renal function on the tumor side is a prognostic factor in transitional cell carcinoma (TCC) of the ureter. PATIENTS AND METHODS We retrospectively reviewed 129 consecutive patients with ureteral TCC between September 1973 and July 1993 at our hospital. There were 98 males and 31 females aged from 31 to 84 years (mean 64.9). Of them, 126 patients who received intravenous pyelography (IVP) were divided into 3 groups according to their radiological findings (group 1: nonvisualization of kidney at tumor side; group 2: hydronephrosis or hydroureter; group 3: no obstruction). Eighty patients receiving radionuclide (131I-hippuran) renal function test (RRFT) with available effective renal plasma flow (ERPF) were divided into 2 groups using ipsilateral ERPF 50 ml/min as a cutoff value (group 1: < 50 ml/min; group 2: > or = 50 ml/min). The mean survival of each group was estimated by the Kaplan-Meier method. RESULTS For patients receiving IVP, the mean survivals were 61.7, 99.7 and 83.8 months for groups 1, 2, and 3, respectively, and the differences between each 2 of the 3 groups were statistically significant (p < 0.05). For patients having RRFT, the mean survivals were 65.8 months for group 1 and 89.2 months for group 2 patients, and the difference between them was statistically significant (p < 0.05). When renal function, tumor number, grade, stage and type of treatment were analyzed using a multivariate method, only tumor stage was statistically significant as a prognostic factor. CONCLUSION Ipsilateral renal function at the tumor side is not a good prognostic factor for patients with ureteral TCC. However, when the stage of tumor is not available, renal function at the tumor side may provide an implication of the patients prognosis.

Cost-effectiveness of Intravenous Urography and Abdominal Ultrasonography in Pre-operative Evaluation of Symptomatic

本研究即是評估對於攝護腺肥大患者以靜脈注射腎盂照影及腹部超音波做為手術前常規檢查之經濟效益。自1995 年l月至1995年6 月，排除過去有泌尿系統疾患、血尿、或腎絞痛病史者，共有266位病人（年齡分布由46 至89 歲，平均70.8 歲）接受經尿道攝護腺切除手術。常規實驗室檢查包括血液分析（血紅素，白血球，血小板，尿素氮及肌酸酐）和尿液分析。共收集靜脈注射腎盂照影161人次，腹部超音波124人次。其中19人接受兩種檢查。從靜脈注射腎盂照影和腹部超音波分別可發現37.9％及68.5％異常。其中從靜脈注射腎盂照影中發現的異常表現包括水腎（8 %）、輸尿管水腫（5.6 % ）、尿路結石（13.7 % ）、顯影缺陷（3.7 % ）及疑腎腫瘤( 9.3 % ）。腹部超音波中發現的異常表現包括水腎( 8.9 % ）、尿路結石（24.2 % ）、單純腎水囊（29 % ）、及疑似腫瘤（3.2 % ）。所有靜脈注射腎盂照影中發現的疑腎腫瘤後來經腹部超音波證實都為單純腎水囊。在靜脈注射腎盂照影及腹部超音波中可發現的顯著異常分別有29.3％和25.7％可在接受經尿道攝護腺切除手術時發現。大部分靜脈注射腎盂照影及腹部超音波的顯著異常，常常伴隨有尿液檢查異常。靜脈注射腎盂照影及腹部超音波檢查只對極少的病人有幫助。而這些檢查對於醫療費用卻顯著地增加。因此，從本研究結果顯示對於攝護腺肥大患者以靜脈注射腎盂照影及腹部超音波做為手術前常規檢查並不符合經濟效益。

The Correlation between Diuretic Renography and Retrograde Pyelography in Dilated Upper Urinary Tract

Dilatation of upper urinary tract does not necessarily indicate obstruction. We evaluate the correlation between diuretic renography and retrograde pyelography in an attempt to understand the diagnostic accuracy rate of diuretic renography for obstruction. A total of 68 patients with dilatation of upper urinary tract receiving both diuretic renography and retrograde pyelography were enrolled in this retrospective study. Non-obstruction was defined as the ureter catheter could be inserted into the renal pelvis in the retrograde pyelographic examination. Of the 68 patients, 52 had non-obstruction in diuretic renography. Retrograde pyelography also showed non-obstruction in 48 of these 52 patients (92.3%). The remaining 16 of 68 patients had obstruction in the diuretic renographic study. Retrograde pyelography also showed obstruction in 11 of these 16 patients. Overall, the same interpretation (correlation) between these 2 examinations was found in 59 of 68 patients (86.8 %). In conclusion, our results suggest that there is a good correlation between diuretic renography and retrograde pyelography. Diuretic renography may be a good examination to evaluate the status of obstruction (organic or non-organic) in a dilated upper urinary tract.

Transurethral Needle Ablation for the Management of Benign Prostatic Hyperplasia - Preliminary Report

To investigate the effectiveness and safety of transurethral needle ablation of prostate (TUNA), these procedures have been used for the management of six patients with symptomatic benign prostatic hyperplasia (BPH). Another six patients who underwent transurethral resection of the prostate (TURP) were also enrolled in this study as a comparative group. These 12 patients were from 63 to 78 years (mean: 70.5) old. Preoperative evaluation included digital rectal examination, American urological association (AUA) symptom scoring, uroflow rate, serum prostate specific antigen (PSA), transrectal ultrasonography and cystourethroscopy. In the TUNA group, the initial two patients were treated under spinal anesthesia and the other four were under topical anesthesia and intravenous sedation. All of the patients who underwent either TUNA or TURP tolerated the procedures well. In the TUNA group, all six patients have been followed up for more than three months. The mean peak flow rate increased from 11.5 ± 4.8 to 12.1 ± 1.9 mL/s and the mean AUA symptom score improved from an average of 26.2 ± 7.3 to 18.8 ± 4.3. In the TURP group, peak flow rate increased from 15.5 ± 6.7 to 19.5 ± 4.8 mL/ s, and AUA symptom score improved from 25.8 ± 9.2 to 13.3 ± 2.8 three months after operation. In the TUNA group, mild hematuria was found in all patients. Urinary retention developed in 4 patients, and urethral catheterization was needed from 2 to 14 days (mean 7.0). In conclusion, these preliminary results suggest that TUNA is an effective and minimally invasive procedure for the treatment of BPH. However, the early effect of TUNA is not equivalent to TURP.

Urinary Crystals in Patients with and without Urolithiasis

The present study was conducted to evaluate urinary crystals in patients with and without urinary calculi. Three hundred and twenty-two patients were enrolled retrospectively, including 219 stone-formers and 103 cases with non-calculus genitourinary tract diseases. The stones were analyzed with infrared spectrophotometer or scanning electron microscopy. Components of the stones included whewellite, weddelite, carbonated-apatite, struvite, brushite and uric acid. Various kinds of crystals were detected from urinalysis including calcium oxalate, amorphous phosphate, triple phosphate and uric acid in 83 patients (37.9%) of the urinary calculus group and 13 patients (12.6%) of the non-calculus group. Of the 83 cases, 75 (90.4%) showed that urinary crystals corresponded to the components of the urinary calculi. Calcium oxalate was the most common crystal in the urinalysis (44.4%). Concerning the pH values from urinalysis, the urine containing uric acid crystals had the lowest pH value (mean 5.30), and the triple phosphate crystals-containing urine had the highest pH value (mean 7.47). The study showed that approximately two-fifths of the patients with urinary calculi had crystals in urine, and there was good correlation between the urinary crystals and the components of the urinary calculi. Further, urinary crystals were found more frequently in patients with urinary calculus than in those without.

Renal Cell Carcinoma and Adrenal Metastasis: Is Adrenalectomy an Indispensable Component of Radical Nephrectomy?

Renal cell carcinoma is known to metastasize to every organ. The most often in volved sites are the lung, lymph nodes, liver and bone. Adrenal metastasis of renal cell carcinoma usually is an autopsy finding and seldom a clinical diagnosis. Preoperative diagnosis of adrenal involvement is not so easy as described. Retrospective examination of 91 nephrectomies for renal cell carcinoma found 4 cases of adrenal metastases (4.4 per cnet). In Stage I, the difference of cumulative survival between those undergoing radical nephrectomy (41 cases) and those spared adrenalectomy (10 cases) is insignificant (P=0.646). The cumulative survicval of Stages I and II (13 cases) undergoing radical nephrectomies also showed no difference (p=0.449). There is no significant survival difference when leaving the adrenal gland in situ while performing radical nephrectomy. For localized renal cell carcinoma, routine removal of the adrenal gland may provide a chance for cure, especially for patients with solitary adrenal metastasis. But solitary adrenal metastasis of renal cell carcinoma is very rare. One the other hand, “solitary” may turn out to be “multiple” in due course. One of the four cases of adrenal metastases was presumed to be solitary, but lung and bone metastases developed 56 months later. Besides, even lower pole renal lesions can metastasize to the adrenal gland.

Transurethral Hyperthermic Treatment for Benign Prostatic Hyperplasia

From December 1990 to December 1991, a total of 54 patients with benign prostatic hyperplasia were treated by a transurethral hyperthermic device using 44.5℃ in a single session of three hours duration. Twelve of 20 patients (60%) with indwelling urethral catheter became catheter free after hyperthermic treatment. There were 48.5%, 75.8%, 60.9% and 76.2% of the patients who showed more than 50% decrease in subjective symptom scores at 1-, 3-, 6- and 12-month follow-up, respectively. However, only 21.2%, 27.6%, 17.4% and 14.3% of the patients had more than 50% increase of peak uroflow rate; 18.1%, 20.7% 13%, and 9.5% of the patients showed more than 50% decrease of residual urine at each follow-up visit. During treatment, some had urtethral pain (63%) or bladder spasm (37%). In the following days, 42 patients (79%) had dysuria, 27 cases (37%). In the following days, 42 patients (79%) had dysuria, 27 cases (51%) had microscopic to gross hematuria and 8 patients (15%) suffered from acute urinary reatention. All symptoms were tolerable and self-limiting. Thus, based on our limited experience transurethral hyperthermic treatment might be considered as an alternative for patients with BPH who otherwise run high operational risk.

Vesicoureteral Refulx in the Adult

A retrospective analysis of the voiding cystourethrographys(VCUG) on 518 adults was performed. Vesicoureteral reflux (VUR) was found in 19 mlaes (7.45%) and 16 females (6.08%). Of these, 11 patients (4 males, 7 females )were primary reflux, 24 patients (15 males, 9 females) were sceondary reflux. Sixteen patients were managed surgically, and 19 cases with oral prophylactic antibiotics. Follow-up serum creatinine level showed that the outcome of renal function is determined mainly by the preexisted renal functional status and grade of reflux rather than the method of treatment. If analysized separatively, patients with secondry reflux had better outcome when treated surgically.