Wen-Chou Lin

Gyrus Plasmasect: Is It Better than Monopolar Transurethral Resection of Prostate?

Introduction: This randomized prospective study was conducted to compare the efficacy and safety of the Gyrus Plasmasect loop bipolar transurethral resection of prostate (TURP) and conventional monopolar TURP in the treatment of benign prostatic hyperplasia (BPH). Materials and Methods: A total of 117 men were enrolled in this study. Fifty-eight patients underwent Gyrus Plasmasect TURP and 59 patients underwent monopolar TURP. They were followed up for 3 months after surgery. Results: Significant improvements were seen postoperatively in both the Gyrus and monopolar groups in terms of prostatic volume, International Prostate Symptom Score, quality of life score, peak flow rate, and post-void residual urine volume. However, the degree of improvement was not statistically different between the 2 groups. Significantly less blood loss, shorter postoperative catheterization time and length of hospital stay were seen in the Gyrus group. Conclusions: Gyrus Plasmasect TURP yielded comparable results to monopolar TURP; however, this is only a preliminary study and follow-up is necessary to assess its long-term efficacy.

Is Fournier’s Gangrene Severity Index Useful for Predicting Outcome of Fournier’s Gangrene?

Objectives: Fournier’s gangrene (FG) is a rare but life-threatening disease. Although antibiotics and aggressive debridement have been broadly accepted as the standard treatment, the mortality rate remains high. We conducted a retrospective study to analyze the outcome and identify the risk factors and prognostic indicators. Methods: We retrospectively reviewed the medical records of 25 patients diagnosed with FG between July 1993 and August 2003. Data collected included age, predisposing factors, treatment modalities, length of hospital stay, surgical debridement times, and outcome. The FG severity index was used to predict outcome. Univariate analysis of the different prognostic factors was performed using t test and Fisher’s exact probability test. Results: All patients were male, 60% were diabetic, and the mean age was 55.8 years. The mean hospital stay was 20 days and the mortality rate was 32%. The mean age of 53.8 ± 18.3 (SD) years in the survival group (n = 17) was significantly lower than the 59.9 ± 10.2 years (n = 8) of the non-survival group (p < 0.05). Non-survival group patientshad lower serum hematocrit (mean 28.9, p = 0.019) and albumin (mean 1.93, p = 0.024) levels. In our series, the mean FG severity index for survivors was 4.41 ± 2.45 (range 2–9) compared to 12.75 ± 2.82 (range 9–18) for those who died (t test, p < 0.0001). Conclusion: The survival rate of younger patients with FG was higher. We agree that a FG severity index cutoff value of 9 is an excellent predictor of outcome.

Ureteroscopic Management of Sepsis Associated with Ureteral Stone Impaction: Is It Still Contraindicated?

Introduction: Retrograde decompression is generally not advocated for patients with sepsis owing to ureteral obstruction by stone impaction, and the initial treatment of choice is percutaneous nephrostomy (PCN). We report our experience with the treatment of urosepsis with retrograde ureteroscopy (URS) instead of PCN drainage. Patients and Methods: Fifty-six consecutive patients diagnosed with ureteral stone-related sepsis received URS as primary treatment at our institution. Patients with uncontrollable sepsis underwent emergent URS and hemodynamically stable patients underwent elective URS within two days of diagnosis. Results: URS was successful in 53 (94.6%) of the 56 patients. PCN was performed in the 3 cases of URS failure. Internal ureteral stenting was performed in 48 patients. Secondary procedures were performed in 10 (18.9%) patients. Twenty-six patients suffered from postoperative fever for an average of 1.6 days (range 1–4 days). There were no anesthesia-related morbidities, postoperative exacerbations of the clinical condition, or postoperative deaths. The median length of hospital stay was 7 days (range 3–94 days). Conclusion: PCN drainage is the standard treatment of sepsis associated with ureteral stone obstruction. However, our results show that URS can be safely and successfully performed by skilled endourologists in select clinical situations.

Concomitant transrectal ultrasound-guided biopsy and transurethral resection of prostate in patients with urinary retention and elevated serum prostate-specific antigen levels

Background There was no consensus about the management of patients with urinary retention and elevated serum prostate‐specific antigen (PSA) levels. This study aimed to determine whether concomitant transrectal ultrasound (TRUS)‐guided biopsy and transurethral resection of prostate (TURP) is practical in patients with urinary retention and elevated serum PSA levels. Methods From March 2007 to May 2015, a total of 34 patients with urinary retention and elevated PSA (≥ 4 ng/mL) underwent concomitant TRUS‐guided biopsy and TURP. The medical records were evaluated retrospectively, and data including PSA, prostate volume, TURP results, TRUS‐guided biopsy results, length of hospitalization, and complications were collected. These patients were then compared with 40 patients with urinary retention who underwent TURP alone. Results The mean age of the patients was 71.6 years. The mean PSA levels were 16.9 ng/mL. Prostate cancer was detected in eight cases (23.5%): one case by TRUS‐guided biopsy alone, two cases by TURP alone, and five cases by both TRUS‐guided biopsy and TURP. Complications included fever in five patients (14.7%), recatheterization for urine retention in two patients (5.9%), urinary tract infection in two patients (5.9%), and de novo urge incontinence in seven patients (20.6%). The complication rate was not significantly increased compared with that of the patients who underwent TURP alone. Conclusion This study showed that concomitant TRUS‐guided biopsy and TURP was safe and of possible clinical significance in urinary retention patients with elevated serum PSA.

Spontaneous Rupture of the Kidney due to Genitourinary Tuberculosis

Spontaneous rupture of the kidney is a rare condition generally associated with underlying diseases, and most cases are due to renal tumors. Spontaneous rupture of the kidney with a huge urinoma was found in a 26-year-old man with genitourinary tuberculosis during anti-tuberculosis chemotherapy. The patient was successfully treated with percutaneous drainage, which saves the patient from having a radical operation. Subsequent endoureterotomy with balloon dilatation effectively treated stenosis of the ureter. To our knowledge, this is the first case of kidney rupture as the consequence of genitourinary tuberculosis.

Urothelial Tumors of the Upper Urinary Tract Following Transurethral Resection of Bladder Transitional Cell Carcinoma:Mackay Memorial Hospital Experience炯

OBJECTIVE: Urothelial carcinoma is characterized by a tendency for multifocal locations at the initial diagnosis and subsequent tumors after treatment of the initial tumors occurring anywhere within the entire urinary tract. The aim of this study was to determine the incidence and risk factors of upper urinary tract tumor occurrence following TURBT. We also determine a reasonable follow-up scheme for postoperative monitoring. MATERIALS AND METHODS: From January 1988 to December 1993, 150 patients who underwent a transurethral resection of primary bladder transitional cell carcinoma were re-viewed at our hospital. Each patient was followed for at least 5 years or until death. Follow-up tests included cystoscopy, intravenous pyelography or sonography, and urine cytology. To analyze the risk factors for upper urinary tract tumor occurrence, the Kaplan-Meier method was performed. RESULTS: Subsequent upper tract tumor development was found in 5 of 150(3.3%) patients at an interval of 9 to 46 months(mean, 24.2 months).Patients with a primary bladder tumor of high tumor grade, associated with a carcinoma in situ or a multifocal tumor, are at in-creased risk for subsequent upper tract tumor development. CONCLUSIONS: High-risk patients must be minitored with IVP yearly for at least 3 years for early detection of upper tract tumors, and thereafter IVP can be replaced by renal sonography. Once a patient presents with a sign or symptom suggesting upper tract TCC, IVP, ureteroscopy with biopsy, or selective upper tract urinary cytology must be performed to help establish a diagnosis.

Seat Belt Transection of the Ureter and Laceration of kidney and Liver：A Case Report and Literature Review

Seat belt can cause different patterns of injury including blunt traumatic disruption of inferior vena cava, right renal vein transection, laceration of kidney, duodenal, colon and appendiceal injury, mesenteric laceration, lumbar vertebral fracture and thoracic trauma. We report a motor vehicle accident with seat belt transection of ureter and laceration of kidney in a 26-year-old female who was sitting in the back seat of a car.

Value of Preoperative Transcatheter Arterial Embolization for Renal Cell Carcinoma: Ten-year Experience in Mackay Memorial Hospital

Based on literature review, TAE will facilitate the surgical procedure, reduce transfusion requirement during nephrectomy for renal cell carcinoma (RCC). To evaluate these effects, a consecutive series of 55 patients who underwent nephrectomy for RCC from 1984 to 1994 in Mackay Memorial Hospital were divided into two groups, prenephrectomy TAE (n=22) vs. nephrectomy without TAE (n=33) and studied retrospectively. The operative time, blood loss and intraoperative blood transfusion requirements were assessed. Our study showed that the operative time, blood loss and transfusion volume are not significantly different in both groups f the tumor volume is ＜ 250m1. On the other hand, for tumor volume ＞ 250 ml, blood loss and transfusion volume are reduced in embolized group. The operative time is also reduced. In conclusion, a complete preoperative TAE reduces the blood loss, blood transfusion during nephrectomy and shorten operative time.

Actinomycosis Mimicking Abdominal Tumor with Bladder Infiltration – A Case Report

Actinomycosis is an unusual intra-abdominal infection, often mistaken for other conditions, and is difficult to diagnose non-operatively. A rare case of actinomycosis mimicking abdominal tumor with bladder infiltration was presented. Laparotomy, drainage of the abscess cavity and biopsy of the lesion were performed under the impression of abdominal tumor with small bowel and bladder involvement. Post-operative parenteral penicillin for fourteen days and oral tetracycline for six months were used with a good result.

The Current Role of Cutaneous Ureterostomy in Treatment of Pelvic Malignancy

From December, 1985 to June, 1991, 181 cases of palliative urinary diversions were performed at Mackay Memorial Hospital. Among these cases, there were 104 (57.5%) percutaneous nephrostomies, 68 (37.6%) double-J ureteral steents, and only 9 cutaneous ureterostomies (4.9%). Cutaneous ureterostomy was performed to correct fistula formation in four cases (three cervical and one rectal cancers), persistent hematuria from lower urinary tract in four cases, and initial treatment for late stage bladder cancer in one. There were no operative mortalities in these nine cases. The two complications – one ureteral necrosis and one obstruction from kinking – were resolved easily. The patients lived for 8 to 910 days, with an average of 311 days. Five of the patients lived for more than six months. With the advent of simpler and safer techniques of percutaneous nephrostomy and double-J ureteral stents, cutaneous ureterostomy is no longer a primary palliative procedure for treatment of pelvic malignancy. However, this procedure is recommended only selectively in high-risk patients with advanced pelvic cancer with life expectancy of more than three months, persistent hematuria or urinary fistula formation, and when double-J insertion or percutaneous nephropstomy fails.