Yen-Man Lu

Is Extracorporeal Shock Wave Lithotripsy Really Safe in Long-Term Follow-Up? A Nationwide Retrospective 6-Year Age-Matched Non-Randomized Study

Introduction: Shock wave lithotripsy (SWL) is widely used. However, several studies have reported increased blood pressure immediately after SWL. Until now, the association between SWL and new-onset hypertension has been a topic of discussion. This study is aimed at determining whether SWL leads to new-onset hypertension. Methods: Data were sourced from the Longitudinal Health Insurance Database 2000 of Taiwan, Republic of China, which was compiled from 1996 to 2010 using National Health Insurance data. Patients who had undergone SWL were compared with controls that were matched for age, sex, obesity, diabetes mellitus, and hyperlipidemia. Results: Patients who had undergone SWL had a higher incidence of new-onset hypertension compared to the control groups. Furthermore, new hypertension developed faster in the SWL group. Conclusions: The results of this study demonstrated that an association exists between nephrolithiasis patients who were treated with SWL and subsequent hypertension diagnosis. Patients who undergo SWL may need regular follow-up of blood pressure.

Percutaneous Nephrolithotomy Increases the Risk of New-onset Hypertension: A Nationwide 6-Year Follow-up Study

OBJECTIVE To determine whether percutaneous nephrolithotomy or ureteroscopic lithotripsy leads to the development of hypertension, using the Taiwan National Health Insurance database. METHODS Data were sourced from the Longitudinal Health Insurance Database (LHID2000) of Taiwan, Republic of China, compiled by the Taiwan National Health Insurance database from 1996 to 2010. Percutaneous nephrolithotomy and ureteroscopic lithotripsy were studied as time-dependent covariates in a Cox proportional hazard model to estimate the hazard ratio for the effect of new-onset hypertension. RESULTS A total of 2552 patients were included, with 232 PNL percutaneous nephrolithotomy, 1160 ureteroscopic lithotripsy patients, and 1160 comparison patients. There was a significant difference between the incidence of new-onset hypertension between the percutaneous nephrolithotomy and comparison groups (adjusted hazard ratio 1.48, 95% confidence interval 1.13-1.95, P = .005). The percutaneous nephrolithotomy group also had a higher incidence of new-onset hypertension than the ureteroscopic lithotripsy group (adjusted hazard ratio 1.39, 95% confidence interval 1.06-1.83, P = .018). The incidence rate of new hypertension during the follow-up period was 44.5 per 1000 person-years in the percutaneous nephrolithotomy group, 33.0 per 1000 person-years in the ureteroscopic lithotripsy group, and 30.2 per 1000 person-years in the comparison group. CONCLUSION An association exists between nephrolithiasis patients who were treated with percutaneous nephrolithotomy and subsequent hypertension diagnosis. Although the exact mechanisms for this phenomenon are not clear, patients who undergo percutaneous nephrolithotomy may need close monitoring of blood pressure during postoperative follow-up.

Epidermal growth factor receptor inhibitor with fluorouracil, leucovorin, and irinotecan as an alternative treatment for advanced upper tract urothelial carcinoma: a case report

BackgroundCurrently, there is no standard salvage regimen after the failure of cisplatin-based chemotherapy for advanced urothelial carcinoma. The combination of epidermal growth factor receptor inhibitor with fluorouracil, leucovorin, and irinotecan was originally designed for the treatment of metastatic colorectal cancer. Until now, there have been no reports using this combination therapy in treating advanced upper tract urothelial carcinoma. To the best of our knowledge, this is the first report showing this possible treatment regimen for advanced upper tract urothelial carcinoma.Case presentationWe report the case of a 90-year-old Chinese woman who was diagnosed with metastatic colorectal cancer and urothelial carcinoma of the bladder, ureter, and renal pelvis. The upper tract urothelial carcinoma was well controlled by the chemotherapy regimen for metastatic colorectal cancer. Considering her age, we used only laser ablation for the treatment of her urothelial carcinoma in combination with intravesical mitomycin C chemotherapy. Follow-up cystoscopy and ureterorenoscopy showed an unexpected regression of the upper tract urothelial tumor. Contrast-enhanced computed tomography also demonstrated the same results.ConclusionsThis novel regimen for the treatment of upper tract urothelial carcinoma may merit further investigation or evaluation in clinical trials.

An unexpected number of bladder stones

antidiabetic drugs (metformin) for sugar control, and the latest hemoglobin A1c test showed a value of 6.6 % (The American Diabetes Association suggests diabetes patients controlled their hemoglobin A1c value below 7 %). Benign prostate hyperplasia was treated by the α-adrenergic blockers (Doxaben). According to the patient, the lower urinary tract symptoms got improved after the oral medications. He was never a smoker and denied gouty arthritis. Body mass index (BMI) revealed 26.13 kg/m. His family had no history of either kidney stones or metabolic disorders. Based on these findings, transurethral cystolithotripsy was performed and the result was unexpected. There were total 1050 stones inside the bladder (Fig. 2). Cystolithotripsy was mainly evacuation of all stones without crushing the stone. Infrared spectroscopic analysis of urinary stones showed a curve resembling for uric acid. The uric acid value of urine and serum were 40.6 and 6.2 mg/dL, respectively (normal range of the random urine uric acid was between 16.8 and 50.4 mg/dL, and the serum uric acid value was between 3.1 and 8.3 mg/dL in male). His urine pH value was 5.4. After the operation, the lower urinary tract symptoms all got improved and the patient was doing well.

Patients' Renal Function Is Important When Evaluating Preoperative Anemia in Upper Tract Urothelial Carcinoma.

anemia had a greater risk of having a high-grade tumor, an advanced tumor stage, and lymph node metastasis. They also showed that preoperative anemia was significantly associated with extraurothelial recurrence and worse cancer-specific survival (CSS). However, their well-organized study could still benefit from additional discussion, in particular, regarding the role of anemia in UTUC at different stages of chronic kidney disease (CKD). Anemia is important from a clinical perspective, because this biomolecular marker can assist in treatment and follow-up planning. Nevertheless, anemia can be attributed to a variety of causes, including CKD. In addition, both preoperative anemia and CKD are not uncommon in patients with UTUC. 1-4 From 2000 to 2013, we enrolled 352 patients who had undergone RNU with bladder cuff excision for nonmetastatic UTUC at our institution. Of the 352 patients, 234 (66.5%) met the World Health Organization criteria for anemia. A total of 81 patients (23.0%) experienced disease progression during the follow-up period. We found that the metastasis-free survival (MFS) rates did not significantly correlate with the presence of preoperative anemia in the Kaplan-Meier analysis (P ¼ .079; Figure 1A). In addition, 66 patients (18.8%) died of cancer-specific causes in our cohort. The Kaplan-Meier analysis also indicated that the CSS rates were not significantly influenced by the presence of preoperative anemia (P ¼ .074; Figure 1B). The results seem to indicate that anemia is not associated with disease progression and prognosis; however, we observed interesting findings after additional subgroup analysis in which we considered the patients’ renal function. A total of 72 patients (20.5%) had end-stage renal disease (ESRD) before RNU. Of these 72 patients, 68 (94.4%) were anemic preoperatively. In contrast, 166 of 280 patients (59.3%) without ESRD had anemia, and 70 (25.0%) experienced metastatic progression. The Kaplan-Meier analysis demonstrated significantly different MFS rates according to the presence of preoperative anemia in patients without ESRD (P ¼ .010; Figure 2A). Moreover, 58 of the patients (20.7%) without ESRD had died of UTUC. Also, the CSS rates were significantly associated with the presence of preoperative anemia (P ¼ .009; Figure 2B).

Predictors of Positive Bone Metastasis in Newly Diagnosed Prostate Cancer Patients

BACKGROUND The prevalence of prostate cancer (PCa) has been increasing in recent years. Treatment strategies are largely based on the results of bone scan screening. Therefore, our aim was to investigate predictors of positive bone metastasis in newly diagnosed PCa patients. MATERIALS AND METHODS After extensive review, 336 consecutive patients newly diagnosed with PCa between April 2010 and November 2013 at our institution were enlisted in the study. Patients were divided into two groups according to bone scan results. Univariate analyses (Chi-square test for discrete variables and independent t-test for continuous variables) were applied to determine the potentially significant risk factors associated with distant bone metastasis. Binary logistic regression analyses were used to further investigate the influence of these factors on bone metastasis. RESULTS The patient mean age was 71.9 ± 8.6 years (range: 48 to 94 years). The mean prostate specific antigen (PSA) level and biopsy Gleason score were 260.2 ± 1107.8 ng/mL and 7.4 ± 1.5, respectively. The body mass index (BMI) for the series was 24.5 ± 3.4 kg/m2. Sixty-four patients (19.0%) had a positive bone scan result. Patients with positive bone scan results had a significantly lower BMI (23.3 ± 3.5 vs. 24.8 ± 3.3; p=0.003), a higher Gleason score (8.5 ± 1.1 vs. 7.1 ± 1.5; p < 0.001), and a higher PSA level (1071.3 ± 2337.1 vs. 69.4 ± 235.5; p < 0.001) than those without bone metastasis. Multivariate logistic regression analysis employing the above independent predictors demonstrated that a Gleason score of ≥7, clinical stage ≥T3, BMI ≤22 kg/m2, and an initial PSA level of ≥20 ng/mL were all independent predictors of bone metastasis. CONCLUSIONS A bone scan might be necessary in newly diagnosed PCa patients with any of the following criteria: clinical stage T3 or higher, a Gleason score of 7 or higher, BMI equal to or less than 22, and a PSA level of 20 or higher.