Yung-Chiong Chow

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.

Pneumomediastinum and subcutaneous emphysema as the manifestation of emphysematous pyelonephritis

Abstract  Pneumomediastinum, a collection of mediastinal air, often results from the rupture of intrathoracic structures. A 41‐year‐old diabetic woman initially presented with signs of pneumomediastinum and nuchal subcutaneous emphysema, but was finally diagnosed with unilateral emphysematous pyelonephritis. Pneumomediastinum as a presentation in retroperitoneal infection has not been reported previously, which prompts us to discuss its etiology and emphasize the importance of physical examination.

Prophylactic Intravesical Instillation of Epinephrine Prevents Cyclophosphamide-Induced Hemorrhagic Cystitis in Rats

The objective of this study is to investigate the potential protective effects of intravesical instillation of epinephrine in cyclophosphamide-induced hemorrhagic cystitis. In an earlier study, we have shown that epinephrine promotes hemostasis on established hemorrhagic cystitis induced by cyclophosphamide. Female Sprague-Dawley rats were divided into seven groups as follows: group 1: positive control (150 mg/kg, cyclophosphamide, i.p.), group 2: negative control (10 μ g/ml, epinephrine, intravesical), co-administration of cyclophosphamide (150 mg/kg, i.p.), group 3: saline (intravesical), groups 4–6: epinephrine (2.5, 5, and 10 μ g/ml, intravesical), and group 7: mesna (50 mg/kg, i.p.). Rats were sacrificed on 3 consecutive days and the urinary bladders were removed, weighed, and evaluated. The vesical vascular permeability was determined by wet bladder weight and Evan’s blue dye absorbance. After 24 hours of cyclophosphamide administration, severe hemorrhagic cystitis was induced with marked edema, hemorrhage, and inflammation. In the epinephrine-treated groups, symptoms of hemorrhagic cystitis (such as edema, inflammation, and hemorrhage) were reduced significantly. Intravesical instillation of epinephrine prevents edema, hemorrhage, and inflammation in rats with cyclophosphamide-induced hemorrhagic cystitis.

Comparison of safety and outcomes of shock wave lithotripsy between elderly and non-elderly patients

Background This study compared the clinical outcomes of extracorporeal shock wave lithotripsy between elderly (aged

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

65 years) and non-elderly (aged <65 years) patients. Methods A retrospective review of medical records was performed on 483 (non-elderly: 245, elderly: 238) patients with upper urinary tract stones who underwent shock wave lithotripsy between 2007 and 2015. The demographic data, stone parameters, stone-free rate, retreatment rate, and complication rate were analyzed in both elderly and non-elderly patient groups. Results There was no significant difference between non-elderly and elderly patients in terms of stone-free rate (46.5% vs 41.1%, P>0.05) regardless of stone site or stone size and overall retreatment rate (41.6% vs 37.0%, P>0.05). Elderly patients had a higher complication rate than non-elderly patients (15.5% vs 23.5%, P=0.026). The most common complication was flank pain. Receiver operating characteristic curves predicted that elderly patients (cutoff value: 65 years of age) had a higher risk of complications and that patients with smaller stones (cutoff value: 0.8 cm) had a higher stone-free rate. Conclusion This study showed that elderly patients with upper urinary tract stones undergoing shock wave lithotripsy had comparable efficacy for stone-free rates and retreatment rates, but higher complication rates.

Spontaneous Rupture of the Kidney due to Genitourinary Tuberculosis

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.

SQUAMOUS CELL CARCINOMA OF THE URACHUS

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.