Yi-Hong Cheng

Complications after transrectal ultrasound-guided prostate biopsy: A 10-year experience in a single institution

Background: Transrectal ultrasound-guided prostate (TRUS-P) biopsy is the standard diagnostic procedure for patients with suspected prostate cancer. However, infectious complications can occur. Purpose: To analyze the patients from a single institution who were hospitalized for infectious complications after TRUS-P biopsy. Materials and Methods: From 2003 to 2012, 985 TRUS-P biopsy procedures were performed in a medical center in Northern Taiwan; among these, 28 patients were admitted for infectious complications following the procedure. A retrospective review of the medical records was performed, and data regarding the demographics, details of infectious complications, and hospital course of these patients were collected. Results: The median age of the patients was 62 (27–82) years; the comorbidity rate was 57.1% (16/28); the admission rate was 2.8% (28/985). The most common causative pathogen was Escherichia coli. More than half of the cultured E. coli were not resistant to fluoroquinolones. The median hospital stay was 6 (3–16) days, and one patient was admitted to the intensive care unit. No mortality was observed in this study. Although the number of biopsies increased, no obvious increasing trend in the number of hospitalizations was noted in recent years. Conclusion: TRUS-P biopsy can be safely performed, and no obvious increasing trend in infectious complications and resistant strains has been observed in recent years.

Spontaneous Renal Hemorrhage：An Unusual Presentation of Renal Cell Carcinoma

Spontaneous renal hemorrhage as the presenting symptom of renal cancer is rare. A 44-year-old female visited our emergency room due to sudden onset of sever right upper quadrant and right flank pain. Abdominal sonography showed a mass over the upper pole of the right kidney with heterogeneous echogenicity. Computed tomography revealed a huge hyperattenuated mass with bleeding over the right kidney. Physical examination revealed relatively low blood pressure (90/70 mmHg). Conservative treatment including a blood transfusion was done first to maintain stable vital signs. Exploratory laparotomy was done and right radical nephrectomy was performed due to renal cell carcinoma. She was regularly followed up without local recurrence for 2 years after the operation.

Endoscopic Management of Upper Urinary Tract Transitional Cell Carcinoma: Cases Report and Literature Review

The standard treatment of an upper urinary tract transitional cell carcinoma is neph-roureterectomy with removal of the bladder cuff. Recently, conservative approaches have been suggested for selected patients. With technological advances in instrumentation and techniques the endoscopic approach to upper tract transitional cell carcinoma becomes an alternative to the open surgery. We report our initial experience in the treatment of two patients with upper urinary tract transitional cell carcinoma with intracavitary bacillus Calmette-Guerin (GCG). Both of them had smooth outcome and were free of tumor recurrence. We conclude that endoscopic techniques may provide satisfactory treatment for selected for selected individuals with upper urinary tract transitional cell carcinoma when preservation of functioning kidney is necessary. (J Urol R.O.C., 8:148-151,1997)

Extracorporeal Shock Wave Lithotripsy of Renal Calculi with Siemens Lithostar 2 System-C

Between August 1993 and December 1994, a total of 621 patients with renal stones were treated with extracorporeal shock wave lithotripsy (ESWL) in our hospital. We used Siemens Lithostar 2 system-C, being recognized as an upgraded second generation lithotriptor, for ESWL. The stones burden were 4mm-63mm. The average shock wave number delivered was 2,798±697 for each session. The average maximal energy delivered was 16.41±1.27kv. The auxilliary procedures were performed before and after ESWL in 31.1% (193/621) and 3.4% (21/621) of treatments. The success rate and stone- free rate were 49.2% and 31.9% after 3-month follow-up, respectively. The retreatment rate was 10.1% (63/621). Based on the results of this study, the upgraded second generation lithotriptor did not offer a better quality in treating renal calculi compared to the other second generation lithotriptors. Patients with residual fragments should be followed up regularly, and the more aggressive managements should be considered for them.