Yen-Shen Hsu

Correlation between serum prostate specific antigen and prostate volume in Taiwanese men with biopsy proven benign prostatic hyperplasia.

PURPOSE We studied the correlation between serum prostate specific antigen and the volume of different zones of the prostate in Taiwanese men with biopsy proven benign prostatic hyperplasia. MATERIALS AND METHODS A total of 233 patients with a mean age of 71.4 years (range 42 to 89), serum prostate specific antigen less than 10 ng/ml and pathologically confirmed benign prostatic hyperplasia were enrolled in this study. Total prostate and transitional zone volumes were measured with transrectal ultrasonography. Peripheral zone volume was determined by subtracting transitional zone volume from total prostate volume. Correlations between patient age, total serum prostate specific antigen and the volume of each prostate zone were analyzed with the Pearson correlation coefficient. A linear regression model was used to determine the relationship between prostate specific antigen and prostate volume. The prostate specific antigen-prostate volume relationship in our patients was compared with published data on white and Japanese men. RESULTS Age did not significantly correlate with serum prostate specific antigen and prostate volume. Serum prostate specific antigen significantly correlated with the volume of each prostate zone. After log transformation the Pearson correlation coefficient between total prostate specific antigen and the volume of the whole prostate gland, the transitional zone and the peripheral zone were 0.369, 0.377 and 0.272, respectively (p <0.001). Taiwanese men had lower prostate volume per unit prostate specific antigen comparing with white men, while the prostate specific antigen-total prostate volume relationship between Taiwanese and Japanese men was similar. CONCLUSIONS In Taiwanese men with biopsy proven benign prostatic hyperplasia the volume of each prostate zone has significantly correlates with serum prostate specific antigen. The prostate specific antigen-total prostate volume relationship in Taiwanese men is different from that in white men. However, the prostate specific antigen-total prostate volume relationship between Taiwanese and Japanese men is similar.

Predictive factors of lower calyceal stone clearance after extracorporeal shockwave lithotripsy (ESWL): the impact of radiological anatomy.

Background: This study was carried out to determine whether or not there is a significant relationship between the radiologic anatomy of the lower calyx, as seen on preoperative intravenous urography (IVU), and the outcome of stone clearance after extracorporeal shockwave lithotripsy (ESWL) for lower renal calyceal stones. Methods: Between June 1998 and April 2007, 112 patients with a solitary lower renal calyceal stone measuring 20 mm or less in size were enrolled in this retrospective study. Pretreatment IVU was reviewed for measuring the anatomical predictors, such as lower pole infundibular length, infundibular width (IW) and infundibulopelvic angle, while the stone location and size were determined on plain abdominal X‐ray. All patients were treated with ESWL using a Siemens Lithostar Plus lithotriptor and were followed‐up for the outcome of stone clearance 3 months after ESWL with plain abdominal X‐ray films and ultrasonography. Results: Three months after ESWL, only 49 (43.7%) patients were stone‐free. Under multivariate analysis with logistic regression, smaller stone size (10 mm or less, p = 0.005) and greater IW (4 mm or more, p = 0.029) were significant favorable predictors for better stone clearance. Conclusions: In addition to the influence of stone size, lower pole anatomy, especially IW, has a significant impact on stone clearance for lower calyceal stone after ESWL.

E-Cadherin Expression in Prostate Adenocarcinomas in Chinese and Its Pathological Correlates

Introduction: We examined the E-cadherin expression in prostate adenocarcinomas in Chinese to correlate this immunohistochemical marker with histopathological features. Materials and Methods: Primary adenocarcinomas from 122 radical prostatectomy specimens were stained using anti-E-cadherin (HECD-1) antibody. The association of E-cadherin expression with serum prostate-specific antigen (PSA), pathological stage and Gleason score was assessed by Kendall’s tau-b test. Results: Aberrant E-cadherin expression was identified in 79 tumors (64.8%). Abnormal E-cadherin expression did not correlate to serum PSA (p = 0.802), tumor stage (p = 0.684) and Gleason score (p = 0.385). Conclusions: The frequency of aberrant E-cadherin expression was higher in prostate adenocarcinomas of Chinese as compared to that reported in Caucasians. No association with pathological stage, Gleason score and serum PSA was identified.

Complications of pure transperitoneal laparoscopic surgery in urology: the Taipei Veterans General Hospital experience.

Background: We present our experience of complications of pure transperitoneal laparoscopic surgery in urology at Taipei Veterans General Hospital. Methods: Between September 2003 and March 2006, 185 laparoscopic urologic operations were performed, consisting of 70 nephrectomies (36 radical, 17 partial, 11 simple, 6 donor), 28 adrenalectomies, 28 nephroureterectomies, 22 radical prostatectomies, 17 ureterolithotomies, 6 radical cystectomies, 5 pyeloplasties, 2 renal cyst unroofings, 2 nephropexies and 5 other operations. We reviewed the database of the patients to evaluate the complications and analyze factors related to laparoscopic surgeries. Results: A total of 25 patients had 26 complications (14.1%, major in 4, minor in 22). The complications were categorized into intraoperative and postoperative complications in 10 and 16 patients, respectively. The mortality rate was 0%. The conversion rate was 0.54% (1 patient). The re‐operation rate was 1.08% (2 patients). The most common intraoperative complication was vascular injury (5 patients). The incidence of complication was related to the difficulty level of operation. No statistically significant differences were found between complication rate and patient age, patient body mass index or the American Society of Anesthesiologist score. Conclusion: The complications of laparoscopic urologic surgeries are strongly correlated with the operative difficulties. In spite of elevated complication rates in difficult surgeries, the major complication rate in this study was very low. As the laparoscopic surgeries in urology involve more and more technique‐dependent difficult fields, documentation and analysis of experience of complications is important for the development of this surgical modality.

Tuberculosis of the Prostate

OBJECTIVE: To evaluate the clinical manifestations and management of tuberculous prostatitis at Taipei Veterans General Hospital. PATIENTS AND METHODS: Nine adult males presented to the urology clinic with an enlarged prostate. Clinically, a malignant tumor was suspected after digital rectal examination (DRE). Core needle biopsy was performed for further diagnosis at Taipei Veterans General Hospital during a period of over 10 years (from January 1989 to October 1999). They were well identified histologically. RESULTS: The histopathological sections depicted chronic inflammation in all cases and caseous necrosis in 7 patients (78%). Acid-fast stain revealed positive acid-fast bacilli (AFB) in 7 patients (78%). These cases were diagnosed as tuberculosis of the prostate and were treated with an antituberculous drug regimen. CONCLUSIONS: Tuberculosis of the prostate is sometimes difficult to differentiate from carcinoma of the prostate. Transrectal ultrasound-guided biopsy of the prostate allows a reliable diagnosis in tuberculous prostatitis. Therefore, it is recommended as the method of choice for diagnosis and follow-up, as has been advocated for the diagnosis of prostate cancer.

Urethral Diverticulum - 10 Case Analysis and Review of Literature

Urethral diverticulum is a rare disease. From 1983 to 1992, ten cases have been seen here, of which seven were males and three were females; the average age was 45.7 years. Four of them had a history of indwelling Foley catheter. Seven cases were demonstrated by urethrography. One was diagnosed with cystourethroscopy. Two cases were found incidentally during operation for urethral stricture. Seven patients received surgical intervention with diverticulectomy as treatment of choice. Three underwent transurethral unroofing urethrotomy since the diverticulum was small. Only one had a residual diverticulum aftersurgery.

The Pelvic Lymph Nodes Metastasis in Canaer of Rostate - Preliminary Report

Twenty-one patients with clinically clinically localized prostatic carcinima undergoing radical prostatectp,u wotj [e;voc ;u,[j mpdes dossectopm were studied retrospectively. They were 61to 73 yaer old (mean 68.5). The preoperative staging were A1 in 3 patients, A2 in 4, B1 in 6, B2 in 5 and C in 3, respectively. The number of lymphnodes which were removed in 17 patients was from 16 to 20(mean 20.5). The distributions of each subgroup of pelvic lymph nodes were common iliac:3-8 (mean 6.1), internal iliac: 2-8 (mean 5.3), external iliac: 2-7 (mean 5.2) and obturator:3-6 (mean 4.9). Common iliac lymph node was positive in 6 of 11 patients (54.5%) and positive internal lilac lymph node was noted in 5 of 11 patients (45.5%). Positive external iliac and obturator lymph node were noted in 6(54.5%) and 4(36.4%) of 11 patients, respectively. We found that there was no predilection subgroup of pelvic lymph node metastasis in our series. Bilateral involvement and increased probability of pelvic lymph nodes metastasis were most common in patients with cancer of prostate with high Gleasion scores. In the patients with clinical stage B1 cancer, the side of lymph nodes metastasis is the same as the side of cancer in the prostate.