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Background: In patients undergoing radical prostatectomy (RP) for prostate cancer (PCa), preoperative prediction of extraprostatic extension (EPE) can facilitate patient selection for nerve-sparing procedures. Since both multiparametric magnetic resonance imaging (mpMRI) and prostate health index (PHI) have shown promise for the diagnosis and prognostication of PCa, we investigated whether a combination of mpMRI and PHI evaluations can improve the prediction of EPE after RP. Methods: Patients diagnosed with PCa and treated with RP were prospectively enrolled between February 2017 and July 2019. Preoperative blood samples were analyzed for PHI (defined as [p2PSA/fPSA] × vtPSA), and mpMRI examinations were performed and interpreted by a single experienced uroradiologist retrospectively. The area under the receiver operating characteristic curve (ROC) was used to determine the performance of mpMRI, PHI, and their combination in predicting EPE after RP. Results: A total of 163 patients were included for analysis. The pathological T stage was T3a or more in 59.5%. Overall staging accuracy of mpMRI for EPE was 72.4% (sensitivity and specificity: 73.2% and 71.2%, respectively). The area under the ROC of the combination of mpMRI and PHI in predicting EPE (0.785) was higher than those of mpMRI alone (0.717; p = 0.0007) and PHI alone (0.722; p = 0.0236). mpMRI showed false-negative non-EPE results in 26 patients (16%), and a PHI threshold of >40 could avoid undiagnosed EPE before RP in 21 of these 26 patients. Conclusion: The combination of PHI and mpMRI may better predict the EPE preoperatively, facilitating preoperative counseling and tailoring the need for nerve-sparing RP. [ABSTRACT FROM AUTHOR]

Background: Bacillus Calmette-Guérin (BCG) has been well recognized as the first-line intravesical therapy for high-risk nonmuscle-invasive bladder cancer (NMIBC). Oncotice, the Tice strain of BCG, serves as a viable alternative to the Connaught strain owing to the worldwide shortage of the latter. We retrospectively compared these two strains in terms of efficacy and adverse effects (AE) in patients who underwent at least one maintenance course after induction. Methods: In this single-institution, retrospective study, patients diagnosed with NMIBC who were administered either Connaught or Tice intravesical therapy were enrolled. Recurrence was defined as the reappearance of urothelial carcinoma. Progression was defined as stage/grade advance, metastasis, or cancer-related death. The primary outcomes were recurrence-free survival (RFS) and progression-free survival (PFS), and the secondary outcome was AE. Results: A total of 76 and 84 patients receiving Tice and Connaught, respectively were enrolled. The median follow-up periods for the Tice and Connaught groups were 32.0 months (range, 7-69 months) and 81.5 months (range, 9-154 months), respectively. Kaplan-Meier method showed no intergroup difference with regard to 3-year RFS and PFS. On Cox multivariate regression analysis, Tice was a significant predictor for inferior PFS (HR = 5.30; 95% CI, 1.11-25.29; p = 0.036). The AE incidence was 38.3% in the Connaught group and 25.0% in the Tice group (p = 0.079). Conclusion: Tice and Connaught were comparable in terms of RFS, PFS, and AE for patients with NMIBC accepting BCG induction and at least one maintenance course in our real-world practice. However, Tice was a predictor of inferior PFS on multivariate analysis. [ABSTRACT FROM AUTHOR]

Objectives: Postoperative persistence of storage symptoms after transurethral resection of the prostate (TURP) is bothersome, and evidence of its cause is sparse. We sought to analyze risk factors for using antimuscarinics or beta‐3 agonists after TURP in benign prostatic hyperplasia (BPH) patients. Methods: BPH patients who underwent TURP and were followed up for >6 months after surgery were retrospectively enrolled. Postoperative pharmacotherapy for storage symptoms was defined as the prescription of antimuscarinics or beta‐3 agonists within 3 months after TURP for >3 months. Preoperative and perioperative variables were evaluated for their effect on the postoperative prescription of antimuscarinics or beta‐3 agonists. Results: Of the 376 patients, 45 (12.0%) received postoperative pharmacotherapy for storage symptoms. Patients who underwent bipolar TURP were significantly more likely to receive postoperative pharmacotherapy than those who underwent monopolar TURP (15.7% vs 6.9%; P = 0.01). Significantly more patients with intravesical prostatic protrusions >1 cm used postoperative pharmacotherapy than those with protrusions of ≤1 cm (14.4% vs 5.2% respectively; P = 0.02). Multivariate logistic regression analysis revealed age >75 years (odds ratio [OR] 3.04; 95% CI 1.29‐7.16; P = 0.011), intravesical prostatic protrusion >1 cm (OR, 3.48; 95% CI, 1.32‐9.15; P = 0.012), and bipolar transurethral resection (OR 4.25; 95% CI 1.53‐11.80; P = 0.005) as significant risk factors for postoperative pharmacotherapy. Conclusions: Advanced age, intravesical prostatic protrusion, and bipolar TURP were significantly associated with postoperative pharmacotherapy for storage symptoms after TURP in BPH patients. Therefore, patients with these risk factors might be informed about the risk of postoperative storage symptoms that may require medications after TURP. [ABSTRACT FROM AUTHOR]

Background: The aim of this report was to review experience from a single hospital in treating ureteral obstruction related to endometriosis with robot-assisted laparoscopic ureteral reconstruction. Methods: This retrospective analysis study (Canadian Task Force classification II-3) was conducted at an academic tertiary hospital. Five female patients with hydronephrosis without significant elevation of serum creatinine levels were enrolled. Ureteral endometriosis with obstruction was suspected on radiological images. Previous treatment with double-J stenting with or without medical treatment had failed in all of the patients. We performed robot-assisted laparoscopic segmental resection for ureteral endometriosis and reconstructed the ureter through ureteroureterostomy (RUU) or ureteroneocystostomy (RUC). The involved ureters included left lower ureter in three patients and right lower ureter in two patients. RUU was performed in four patients and RUC in one patient. All of the operations were completed smoothly without complications. Results: All ureteral endometrioses were successfully resected, and follow-up sonography or intravenous pyelography showed resolution of hydronephrosis in all of the patients. Conclusion: Our experience proves the feasibility and efficacy of a robot-assisted approach for this rare situation with good outcomes. [ABSTRACT FROM AUTHOR]

Objectives: To determine the number of lymph node in prostatic anterior fat pad (PAFP) and the incidence of metastasis in lymph nodes dissected during robotic-assisted radical prostatectomy (RARP). Methods: From May 2011 to November 2015, PAFP were removed in 146 patients who underwent RARP and sent for pathological analysis to determine the number of lymph nodes and incidence of metastasis to the lymph nodes. Another 48 patients without PAFP removal were enrolled as the control group. Operative features including operative time, estimated blood loss, post-operative hospital stay, and the incidence of complications were compared between the two groups. Results: Lymph nodes within PAFP were detected in 14/146 (9.6%) patients, with metastatic lymph nodes in 2/146 (1.3%) patients. The patients with metastatic lymph nodes in the PAFP had no obturator lymph node involvement. There were no significant differences in operative features between the two groups. Conclusions: Our findings demonstrated that PAFP contain lymph nodes, and that the incidence rate of lymph node metastasis was high. There was no increase in the surgical risk when removing PAFP, and therefore we suggest that PAFP be routinely removed during RARP and then analyzed pathologically to allow for precise lymph node staging. [ABSTRACT FROM AUTHOR]

Background. The purpose of this study was to investigate the relationship between chronic periodontitis (CP) and upper urinary tract stone (UUTS) in Taiwan by using a population-based data set. Methods. A total of 16,292 CP patients and 48,876 randomly-selected controls without chronic periodontitis were selected from the National research database and studied retrospectively. Subjects selected have not been diagnosed with UUTS previously. These subjects were prospectively followed for at least eight years. Cox regression models were used to explore the connection between risk factors and the development of UUTS. Results. The CP patients have a greater chance of developing UUTS compared to controls (1761/16292, 10.8% vs. 4775/48876, 9.8%, p-values < 0.001). Conditioned logistic regression suggested CP increases the risk of UUTS development (HR 1.14, 95% CI [1.08-1.20], p<0:001). After respective adjustment for age, gender, hypertension and diabetes, results showed that CP still increases the risk of developing UUTS (HR 1.14, 95% CI [1.08-1.20], p<0:001). Conclusion. By using a population-based database with a minimum eight 8 follow-up of CP in Taiwan, we discovered patients with CP are more likely to develop UUTS. [ABSTRACT FROM AUTHOR]

Background: Prostate vaporization and enucleation is a novel treatment option for bladder outlet obstruction caused by benign prostate enlargement. This surgical technique, however, has not yet been standardized. We present our findings of using a high-power thulium laser to accomplish vapoenucleation of the prostate (ThuVEP). Methods: We prospectively collected and analyzed data from 29 patients who underwent ThuVEP between August 2010 and May 2012. The control group included 30 patients who underwent traditional transurethral resection of the prostate (TURP). Operative variables, patient profiles, preoperative and postoperative urine flow rates, prostate volume (measured using transrectal ultrasonography), and the international prostate symptom score (IPSS) were recorded and analyzed using a two-tailed Student's t-test and analysis of variance. Results: The ages (mean ± SD) of the patients were 76.1 ± 9.4 and 72.6 ± 7.4 years (p = 0.28) in the ThuVEP and TURP groups, respectively. The average urinary flow rates before and 12 months after the operation (volume/maximum flow/average flow) were 243.3/10.5/5.0 and 302.8/17.6/9.4 (in mL, mL/s, mL/s, respectively) in the ThuVEP group and 247.2/10.8/4.6 and 369.9/20.8/12.0, respectively, in the TURP group. Preoperative and postoperative IPSSs were 17.1 ± 5.0 and 6.5 ± 3.8, respectively, in the ThuVEP group and 18.2 ± 4.5 and 6.2 ± 3.3, respectively, in the TURP group. The mean ratio of the estimated postoperative residual prostate volume to the preoperative total volume was 0.47 (p = 0.449) in both groups. The overall complication rate was 20.7% in the ThuVEP group and 30.0% in the TURP group. Conclusions: One year of follow-up showed that ThuVEP and TURP effectively alleviated subjective and objective voiding symptoms with a low rate of complications. Thus, vapoenucleation using a high-power laser is feasible in elderly patients. Trial registration: ISRCTN registry with study ID ISRCTN52339705. Date assigned: 06/03/2015. [ABSTRACT FROM AUTHOR]

Background: With growing ketamine abuse, ketamineinduced uropathy (KIU) has become more prevalent in recent years. This research evaluates the presence, distribution and extent of KIU in the upper and lower urinary tracts by retrospectively reviewing CT urography (CTU) images. Methods: Patients diagnosed with KIU who underwent CT scanning from 1 January 2006 to 31 December 2011 were recruited. The CT protocols included three-phase CTU in six patients, split-bolus CTU in 17, two-phase CT in one and unenhanced CT in three. The CT images were retrospectively reviewed by two radiologists. Results: A total of 27 patients participated in this study. The common CT findings included diffuse bladder wall thickening (88.9%), small bladder volume (66.7%) and perivesical inflammation (44.4%). Twelve patients (44.4%) were diagnosed with hydronephrosis, including three patients with unilateral hydronephrosis and nine with bilateral hydronephrosis. Of these patients, nine had ureteral wall thickening (33.3%) and two (7.4%) had ureterovesical junction involvement (ie, they had hydronephrosis but no ureteral wall thickening). One patient had a ureteral obstruction because of a ureter stone. The correlation between upper urinary tract involvement and grading of the interstitial cystitis was statistically non-significant ( p=0.33). Four patients (14.8%) had a vesicovaginal fistula which could be detected in the excretory phase only. Conclusions: Upper urinary tract involvement is common in patients with KIU. CTU might aid evaluation of the extent of KIU and prompt adequate management. [ABSTRACT FROM AUTHOR]

A clinical guideline and algorism for interstitial cystitis and hypersensitive bladder syndrome has been developed by a group of East Asian urologists as a revised form of the Japanese guideline for interstitial cystitis. The guideline defines interstitial cystitis (IC) as a disease of the urinary bladder diagnosed by 3 requirements; 1) a characteristic complex of lower urinary tract symptoms, 2) bladder pathology such as Hunner's ulcer and bladder bleeding after overdistension, and 3) exclusions of confusable diseases. The characteristic symptom complex is termed as hypersensitive bladder syndrome (HBS), which is defined as bladder hypersensitivity, usually associated with urinary frequency, with or without bladder pain. For the definite diagnosis of IC, cytoscopy or hydrodistension is crutial; HBS is the diagnosis when IC is suspected but not confirmed by the 3 requirements. Numerous therapeutic options are available; however, most of them lack in high level of evidence, leaving a few as recommended therapies. Etiology of IC are multifactorial; the interaction among nervous, immune and endocrine factors forms a vicious cycle, provocating and maintaining inflammatory reactions in the bladder. The inclusion and efficacy criteria for clinical trials should be standardized to enhance the clinical research for this disabling disease, which has proved to be more prevalent than previously believed. [ABSTRACT FROM AUTHOR]

Introduction: Symptoms or signs of female urethral diverticulum are usually not typical, thereby resulting in delayed or wrong diagnosis. This paper relates to our experience on the diversity of presenting symptoms and signs of female urethral diverticula. Materials and Methods: We reviewed the medical records and conducted telephone interviews of 14 patients with the diagnosis of female urethral diverticulum in our institution. Results: The mean patient age at diagnosis was 47.5 years (range 22–65 years) and the mean duration between symptom presentation and diagnosis was 6.46 years (range 1 month to 30 years). Their presenting symptoms were so diverse that many were initially treated under the diagnosis other than urethral diverticulum. Most patients were treated as uncomplicated urinary tract infection for a long time. Stress urinary incontinence (SUI) was so dominant in 2 patients with big diverticula that they were falsely treated with anti-incontinence surgery. Total incontinence happened in 1 patient with genuine SUI and a big urethral diverticulum. One patient with a huge diverticulum, which had a fistula opening into the vagina, presented with day- and night-time incontinence. Some patients even did not have incontinence, but only had dysuria or a painful anterior vaginal wall nodule. Nevertheless, detailed analysis on symptoms and signs usually may suggest urethral diverticulum. We found that recurrent urinary tract infection, urinary incontinence, palpable suburethral mass, vaginal tenderness, and dysuria are the five major presenting symptoms and signs. The diagnostic rate of voiding cystourethrography during video-urodynamics, double-balloon urethrography and MRI were 10/10 (100%), 6/6 (100%) and 10/11 (90.9%) respectively. Conclusions: The presenting symptoms and signs of female urethral diverticula are often diverse and easily overlooked. High suspicion of this disorder, detailed history-taking and physical examination are essential for detecting urethral diverticulum in females. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aim: Few studies have examined the voiding pattern of healthy females, despite the importance of such research for diagnosing abnormal voiding behavior. This study investigates the voiding behavior of healthy women in Taiwan. Methods: 68 healthy women, aged 19–66 years and claiming to void normally were enrolled. Twenty-two of the subjects (32.4%) were postmenopausal. Each woman completed a 3-day voiding diary. The diary recorded urine volume, voiding frequency, urine volume per voiding for the whole day (24 h), and urine volume during both daytime and nighttime. Age and various other voiding parameters were correlated, and the voiding patterns were compared between premenopausal and postmenopausal women. Results: All women voided 7.34 ± 1.63 times daily. Higher age was associated with higher whole day and daytime voiding frequency. Nocturia was not common for the group as a whole, with a mean nocturnal voiding of 0.25 times per night. However, higher age was significantly associated with a higher nighttime voiding frequency. A significantly positive correlation was also observed between age and whole day urine volume. Compared with regularly menstruating women, postmenopausal women had a significantly higher whole day and nighttime voiding frequency. Menopause and age both independently affect voiding parameters after multivariate analysis. Conclusions: The results of this study provide invaluable baseline data on female voiding behavior. Additionally, this study found that for healthy women, age and menstruation status significantly affect voiding patterns. Analysis of female voiding behavior thus should consider these two factors. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Aim: Reports specifically addressing transitional cell carcinoma (TCC) of the ureteral orifice are scarce. This paper presents our experiences of such tumors, including the characteristics of the disease and the incidence of subsequent upper urinary tract recurrence. Methods: This study included 572 new cases of TCC of the urinary bladder diagnosed in our institute during a period of 5 years. Thirty-one (5.4%) patients had superficial tumors involving ureteral orifices. All 31 patients underwent transurethral resection of the bladder tumors, including the involved ureteral orifices. After the surgery, patients received regular follow up with cystourethroscopy, urine cytology and periodic intravenous pyelography (IVP). Ureterorenoscopy was performed in cases of suspicious IVP or urine cytology findings. Results: Thirty-one patients with superficial tumors involving the ureteral orifice were followed up for 5–8 years or until death. The pathological stage was Ta in 16 cases and T1 in 15 cases. Bladder tumor recurrence was noted in three (18.8%) of the pTa patients and in seven (46.7%) of the pT1 patients. Subsequent upper urinary tract tumors developed in four (12.9%) patients between 33 and 67 months (mean: 33.5) after the first transurethral resection. All four cases of upper tract recurrence had pT1 primary bladder tumor, which recurred for 1–3 times (mean 1.8) before upper tract recurrence. None of these patients had ureteral stenting after bladder tumor resection. Three of four patients with upper tract recurrence had single lower ureteral tumor, while the remaining one patient had multiple tumors. Patients with subsequent upper urinary tract tumors underwent nephroureterectomy and bladder cuff excision. One died of the disease; the other three cases were free of the disease after the therapy. Conclusions: Patients with primary superficial bladder transitional cell carcinoma involving the ureteral orifice have a higher risk of developing subsequent upper urinary tract tumors, particularly for pT1 primary bladder tumors. Frequent and close follow up is recommended. [ABSTRACT FROM AUTHOR]

Objectives: The correlation between anxiety and interstitial cystitis has, as best we know, not yet been reported on. The present study investigated the psychological profile, including anxiety and depression, of patients suffering from interstitial cystitis (IC). Methods: A total of 47 IC patients, all of whom met National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases (NIDDK) criteria, plus a group of 31 age-matched, asymptomatic women received a structured interview on depression (Hamilton Rating Scale for Depression) and also on anxiety symptoms (Hamilton Rating Scale for Anxiety). IC patients also completed questionnaires relating to IC symptom severity, including urgency and frequency (visual analog scale) and O'Leary Sant index. Results: A total of 85% of our IC patients featured significant affective symptoms. The average depression scores were 16.6. Fifteen patients (31.9%) featured mild depressive symptoms, five (10.6%) had mild to moderate and 20 (42.6%) had moderate to severe depression symptoms. The mean anxiety score was 21.0, with 21 (44.7%), nine (19.1%) and 17 (36.2%) patients revealing mild, mild to moderate, and moderate to severe anxiety symptoms, respectively. Further, IC patients reported a significantly greater extent of depression and anxiety than was the case for controls. Pain scale and O'Leary Sant index were significantly correlated to anxiety and depression score. Conclusions: Most of our IC patients feature significant depression and anxiety. The extent of affective symptoms would appear to correlate well with IC symptom severity. [ABSTRACT FROM AUTHOR]

Background: Prostate vaporization and enucleation is a novel treatment option for bladder outlet obstruction caused by benign prostate enlargement. This surgical technique, however, has not yet been standardized. We present our findings of using a high-power thulium laser to accomplish vapoenucleation of the prostate (ThuVEP).Methods: We prospectively collected and analyzed data from 29 patients who underwent ThuVEP between August 2010 and May 2012. The control group included 30 patients who underwent traditional transurethral resection of the prostate (TURP). Operative variables, patient profiles, preoperative and postoperative urine flow rates, prostate volume (measured using transrectal ultrasonography), and the international prostate symptom score (IPSS) were recorded and analyzed using a two-tailed Student's t-test and analysis of variance.Results: The ages (mean ± SD) of the patients were 76.1 ± 9.4 and 72.6 ± 7.4 years (p = 0.28) in the ThuVEP and TURP groups, respectively. The average urinary flow rates before and 12 months after the operation (volume/maximum flow/average flow) were 243.3/10.5/5.0 and 302.8/17.6/9.4 (in mL, mL/s, mL/s, respectively) in the ThuVEP group and 247.2/10.8/4.6 and 369.9/20.8/12.0, respectively, in the TURP group. Preoperative and postoperative IPSSs were 17.1 ± 5.0 and 6.5 ± 3.8, respectively, in the ThuVEP group and 18.2 ± 4.5 and 6.2 ± 3.3, respectively, in the TURP group. The mean ratio of the estimated postoperative residual prostate volume to the preoperative total volume was 0.47 (p = 0.449) in both groups. The overall complication rate was 20.7% in the ThuVEP group and 30.0% in the TURP group.Conclusions: One year of follow-up showed that ThuVEP and TURP effectively alleviated subjective and objective voiding symptoms with a low rate of complications. Thus, vapoenucleation using a high-power laser is feasible in elderly patients.Trial Registration: ISRCTN registry with study ID ISRCTN52339705 . Date assigned: 06/03/2015. [ABSTRACT FROM AUTHOR]

Background: Bacillus Calmette-Guérin (BCG) has been well recognized as the first-line intravesical therapy for high-risk non-muscle-invasive bladder cancer (NMIBC). Oncotice, the Tice strain of BCG, serves as a viable alternative to the Connaught strain owing to the worldwide shortage of the latter. We retrospectively compared these two strains in terms of efficacy and adverse effects (AE) in patients who underwent at least one maintenance course after induction., Methods: In this single-institution, retrospective study, patients diagnosed with NMIBC who were administered either Connaught or Tice intravesical therapy were enrolled. Recurrence was defined as the reappearance of urothelial carcinoma. Progression was defined as stage/grade advance, metastasis, or cancer-related death. The primary outcomes were recurrence-free survival (RFS) and progression-free survival (PFS), and the secondary outcome was AE., Results: A total of 76 and 84 patients receiving Tice and Connaught, respectively were enrolled. The median follow-up periods for the Tice and Connaught groups were 32.0 months (range, 7-69 months) and 81.5 months (range, 9-154 months), respectively. Kaplan-Meier method showed no intergroup difference with regard to 3-year RFS and PFS. On Cox multivariate regression analysis, Tice was a significant predictor for inferior PFS (HR = 5.30; 95% CI, 1.11-25.29; p = 0.036). The AE incidence was 38.3% in the Connaught group and 25.0% in the Tice group (p = 0.079)., Conclusion: Tice and Connaught were comparable in terms of RFS, PFS, and AE for patients with NMIBC accepting BCG induction and at least one maintenance course in our real-world practice. However, Tice was a predictor of inferior PFS on multivariate analysis., Competing Interests: Conflicts of interest: Dr. William J. Huang, an editorial board member at Journal of the Chinese Medical Association, had no role in the peer review process of or decision to publish this article. The other authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article., (Copyright © 2022, the Chinese Medical Association.)

Background: The aim of this report was to review experience from a single hospital in treating ureteral obstruction related to endometriosis with robot-assisted laparoscopic ureteral reconstruction., Methods: This retrospective analysis study (Canadian Task Force classification II-3) was conducted at an academic tertiary hospital. Five female patients with hydronephrosis without significant elevation of serum creatinine levels were enrolled. Ureteral endometriosis with obstruction was suspected on radiological images. Previous treatment with double-J stenting with or without medical treatment had failed in all of the patients. We performed robot-assisted laparoscopic segmental resection for ureteral endometriosis and reconstructed the ureter through ureteroureterostomy (RUU) or ureteroneocystostomy (RUC). The involved ureters included left lower ureter in three patients and right lower ureter in two patients. RUU was performed in four patients and RUC in one patient. All of the operations were completed smoothly without complications., Results: All ureteral endometrioses were successfully resected, and follow-up sonography or intravenous pyelography showed resolution of hydronephrosis in all of the patients., Conclusion: Our experience proves the feasibility and efficacy of a robot-assisted approach for this rare situation with good outcomes.

Background: There are models to predict pathological outcomes based on established clinical and prostate-specific antigen (PSA)-derived parameters; however, they are not satisfactory. p2PSA and its derived biomarkers have shown promise for the diagnosis and prognosis of prostate cancer (PCa). The aim of this study was to investigate whether p2PSA-derived biomarkers can assist in the prediction of aggressive pathological outcomes after radical prostatectomy (RP)., Methods: We prospectively enrolled patients who were diagnosed with PCa and treated with RP between February 2017 and December 2018. Preoperative blood samples were analyzed for tPSA, free PSA (fPSA), percentage of fPSA (%fPSA), [-2]proPSA (p2PSA), and percentage of p2PSA (%p2PSA). Prostate health index (PHI) was calculated as (p2PSA/fPSA) × √tPSA. Prostate volume was determined by transrectal ultrasound using the ellipsoid formula, and PHI density was calculated as PHI/prostate volume. The areas under the receiver operating characteristic curve were estimated for various PSA/p2PSA derivatives. Aggressive pathological outcomes measured after RP were defined as pathological T3 or a Gleason score (GS) >6 as determined in RP specimens., Results: One hundred and forty-four patients were included for analysis. Postoperative GS was >6 in 86.1% of the patients, and pT stage was T3a or more in 54.2%. Among all PSA- and p2PSA-derived biomarkers, PHI density was the best biomarker to predict aggressive pathological outcomes after RP. The odds ratio of having an aggressive pathological outcome of RP was 8.796 (p = 0.001). In multivariate analysis, adding %fPSA to base model did not improve the accuracy (area under curve), but adding PHI and PHI density to base model improved the accuracy by 2% and 16%, respectively, in predicting pT3 stage or GS ≥ 7. The risk of pT3 stage or GS ≥ 7 was 20.8% for PHI density <1.125, and 64.6% for PHI density >1.125 (sensitivity: 74.6% and specificity: 88.9%)., Conclusion: PHI density may further aid in predicting aggressive pathological outcomes after RP. This biomarker may be useful in preoperative counseling and may have potential in decision making when choosing between definitive treatment and active surveillance of newly diagnosed PCa.

Background: Some patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms hesitate to undergo surgical treatment until acute urinary retention (AUR) occurs. Some of these patients have been found to have hydronephrosis or even renal insufficiency. This study aimed to analyze the risk factors for hydronephrosis in patients with AUR who needed to receive transurethral resection of the prostate (TURP)., Methods: We retrospectively analyzed 91 patients from January 2014 to June 2015, who had BPH and received TURP for AUR. Patients with urolithiasis, prostate cancer, bladder cancer, gross hematuria, previous bladder radiation therapy, or urinary tract surgery were excluded. Parameters of intravesical prostatic protrusion (IPP), serum prostatic specific antigen (PSA), total prostate volume (PV), age, body mass index (BMI), hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), and serum creatinine (Cr) were compared between the hydronephrosis and non-hydronephrosis groups., Results: There were significant differences in IPP (p < 0.001) and Serum Cr (p < 0.001) between the hydronephrosis and non-hydronephrosis groups. For IPP, the cut-off values of the highest risk of hydronephrosis was 1.95 cm. There were no significant differences in age, BMI, DM, HTN, CAD, total PV, and PSA between the two groups. IPP was not correlated with total PV (p = 0.423). Most of the patients with hydronephrosis had renal function improvement after TURP., Conclusion: IPP was a significant risk factor for hydronephrosis in BPH patients. If the patients' IPP exceeded 1.95 cm, they had a higher risk of having hydronephrosis when AUR occurred. Hydronephrosis is a risk factor for renal insufficiency, and Serum Cr levels decreased significantly in the patients of our study.

Background: Clear cell papillary renal cell carcinoma (CCPRCC) is a new but rare tumor entity as listed in the World Health Organization 2016 renal tumor classification. Around 360 cases have been reported in the English literature to date, and only one tumor with sarcomatoid change was reported to develop distant metastasis. In the present study, we aim to review the clinical course and analyze the treatment outcome of CCPRCC in our institution., Methods: We retrospectively collected patients diagnosed with CCPRCC between January 2008 and September 2016 in our institute. The clinical features, pathology slides, and clinical outcomes were reviewed., Results: Twenty-five patients were collected during the study period, with a mean age at diagnosis of 62.8 years (range 35-85 years). Three patients developed the tumor in their native kidney following a kidney transplant, and three patients were diagnosed by needle biopsy before cryoablation therapy due to high surgical risk. The mean follow-up time was 49.7 months (range 12-119 months). During the follow-up period, all patients were alive without local recurrence or distant metastasis. All tumor specimens in our series expressed cytokeratin 7 (CK7) diffusely in immunohistochemistry staining. One patient was diagnosed with pT3a cN0M1, Fuhrman grade 3 CCPRCC with renal vein invasion and lung metastasis in 2010 on the basis of the histologic pattern and immunoreactivity for CK7. The clinical course was not compatible with any of the reported cases in the literature, so the kidney specimen was re-examined using whole-exome sequencing. The diagnosis was then revised to clear cell renal cell carcinoma., Conclusion: Our series confirmed that CCPRCC has an indolent clinical behavior. When the diagnosis is made in a high-grade renal tumor, it should be carefully re-confirmed using cytogenetic or genomic methods., (Copyright © 2018. Published by Elsevier Taiwan LLC.)

Background: The aim of this study was to compare the perioperative outcomes between renal hilar tumors and non-hilar tumors after robotic-assisted partial nephrectomy (RAPN)., Methods: A retrospective review of consecutive patients who underwent RAPN from December 2009 to September 2015 at our institution was recruited. Perioperative outcomes including demographic characteristics, perioperative, pathological and renal function outcomes were compared between the hilar group (n = 30) and non-hilar group (n = 170)., Results: In characteristics, hilar group was younger (52.4 vs. 58 years, p = 0.04) and had less body mass index (23.7 vs. 25.4 kg/m 2 , p = 0.018). Hilar group had larger tumor size (4.8 vs. 3.7 cm, p = 0.009), higher Preoperative Aspects and Dimensions Used for an Anatomical (PADUA) score (10.7 vs. 8.5, p < 0.001) and higher RENAL (radius, exophytic/endophytic properties of the tumor, nearness of tumor deepest portion to the collecting system or sinus, anterior/posterior description and the location relative to polar lines) score (9.0 vs. 7.4, p < 0.001). Hilar tumor was associated with longer operative time (293.6 vs. 240.5 min, p = 0.001) and warm ischemia time (39.9 vs. 21.8 min, p < 0.001). But there was no statistically difference in estimated blood loss (EBL), postoperative stay and complication rate. For pathological outcomes, there was no difference of positive margin rate and pathological T stage between these groups. For renal function outcomes, hilar tumor patients had no difference of the change of creatinine and estimated glomerular filtration rate (eGFR) at postoperative 6 and 12 month as compared with non-hilar tumor patients., Conclusion: For renal hilar tumor, RAPN could provide acceptable results of perioperative, pathological and renal function outcome as compared with non-hilar tumor group. Thus RAPN is a safe and effective nephron-sparing surgery technique for renal hilar tumors., (Copyright © 2018. Published by Elsevier Taiwan LLC.)

Background: The purpose of this study was to investigate the relationship between chronic periodontitis (CP) and upper urinary tract stone (UUTS) in Taiwan by using a population-based data set., Methods: A total of 16,292 CP patients and 48,876 randomly-selected controls without chronic periodontitis were selected from the National research database and studied retrospectively. Subjects selected have not been diagnosed with UUTS previously. These subjects were prospectively followed for at least eight years. Cox regression models were used to explore the connection between risk factors and the development of UUTS., Results: The CP patients have a greater chance of developing UUTS compared to controls (1761/16292, 10.8% vs. 4775/48876, 9.8%, p -values < 0.001). Conditioned logistic regression suggested CP increases the risk of UUTS development (HR 1.14, 95% CI [1.08-1.20], p  < 0.001). After respective adjustment for age, gender, hypertension and diabetes, results showed that CP still increases the risk of developing UUTS (HR 1.14, 95% CI [1.08-1.20], p  < 0.001)., Conclusion: By using a population-based database with a minimum eight 8 follow-up of CP in Taiwan, we discovered patients with CP are more likely to develop UUTS., Competing Interests: The authors declare there are no competing interests.

Background: The aim of the study was to identify the impact of non-bladder co-morbid conditions on the urodynamic characteristics of patients with bladder pain syndrome/interstitial cystitis., Methods: Patients with bladder pain syndrome/interstitial cystitis completed the screening questionnaires for chronic fatigue syndrome, irritable bowel syndrome, fibromyalgia, temporo-mandibular disorders, multiple chemical sensitivities, tension/migraine headache, and localized myofascial pain disorder. They underwent either conventional pressure-flow urodynamic studies or video-urodynamic studies. Urodynamic variables were compared between patients with and those without co-morbid conditions., Results: Of 111 patients (16 males and 95 females) with bladder pain syndrome/interstitial cystitis, 87 (78.4%) had at least one co-morbid condition (62% males vs 82% females, p = 0.005). Those with concomitant irritable bowel syndrome were younger and had urodynamic characteristics of smaller catheter-free voided volume, lower catheter-free average flow rate, smaller bladder volume on the first desire to void, and more prevalent dysfunctional voiding than those without irritable bowel syndrome. Patients with concomitant localized myofascial pain disorder also had larger bladder volume at the first desire to void and lower pressure at maximum flow than those without co-morbid myofascial pain disorder. There were no significant differences in urodynamic parameters between bladder pain syndrome/interstitial cystitis patients with and those without other co-morbidities., Conclusion: Bladder pain syndrome/interstitial cystitis patients, especially females, are more likely to have non-bladder co-morbidities, especially tension/migraine headache and localized myofascial pain. Bladder pain syndrome/interstitial cystitis Patients with co-morbid irritable bowel syndrome are younger and more likely to have abnormal urodynamic findings., (Copyright © 2017. Published by Elsevier Taiwan LLC.)

Background: Patients suffering from renal or ureteral stones can undergo significant discomfort, even when timely diagnosed and treated. The aim of this study was to assess the risk factors and safety of outpatient Extracorporeal Shock Wave Lithotripsy (ESWL) in the management of patients with renal or ureteral stones., Methods: In this study, our cohort consisted of 844 outpatients who underwent outpatient ESWL treated between February 2012 and November 2014 at Taipei Veterans General Hospital. Patients who visited the emergency room (ER) within 48 h after Outpatient ESWL were included in this article. This article analyzes the stone size, stone shape (long to short axis ratio), stone location, previous medical management, urinalysis data, complications and treatment received in the emergency department., Results: Among the 844 initial consecutive patients who underwent outpatient ESWL a total of 1095 times, there were 22 (2%) patients who sought help at our emergency room within 48 h after the outpatient ESWL. Of those 22 patients, the mean age was 54.3 ± 12.6 years, and the BMI was 25.9 ± 3.2. The most common complication complaint was flank pain (55.2%). Other complications included hematuria (13.8%), fever (17.2%), nausea with vomiting (6.9%), acute urinary retention (3.4%) and chest tightness with cold sweating (3.4%). In 22 patients who went back to the ER, 7 patients were admitted to the ward and 1 patient again returned to the ER. All patients received medical treatment without ESWL or surgical management. The meaningful risk factor of ER-visiting rate following outpatient ESWL within 48 h was stone location, and the renal stones showed statistic significant (p = 0.047) when compared to ureteral stones., Conclusion: Our study indicated that renal stone contributed to a significantly higher risk of ER-visiting rate to patients than did ureteral stone, following outpatient ESWL within 48 h. This study confirmed that Outpatient ESWL is a safe treatment for renal or ureteral stones, while inpatient ESWL is not absolutely necessary., (Copyright © 2017. Published by Elsevier Taiwan LLC.)

Background: Prostate cancer (PCa) is not commonly found in men younger than 50 years of age. However, serum prostate-specific antigen (PSA) concentration has been examined more frequently at a younger age in Asia partially due to an increased awareness of prostate cancer. The purpose of our study was to investigate the efficacy and complication of PSA-triggered transrectal ultrasonography-guided prostate (TRUSP) biopsies. We retrospectively reviewed TRUSP biopsies in young men with elevated PSA concentration in Taipei Veterans General Hospital., Methods: We reviewed the cases of patients younger than 50 years of age with elevated PSA concentration (>4.0 ng/mL), who received 12 cores TRUSP biopsies at TPEVGH from January 2008-December 2013. The age, family history, digital rectal examination (DRE) results, PSA concentration, free/total PSA ratio, total prostate volume, PSA density, lower urinary tract symptoms and complications after the procedure were reviewed. The pathologic findings of TRUSP biopsy and clinical follow-up were reviewed and analyzed according to the Epstein criteria., Results: A total of 77 patients were included and were divided into 2 groups: 1) the younger group consisted of 20 patients <40 years of age; and 2) the elder group had 57 patients who were 40-50 years of age. The overall detection rate of PCa was 11.69% (9/77), and all of the PCa cases were diagnosed in the elder group (group detection rate: 15.8%). There was a significant difference in the severity of lower urinary tract symptoms (LUTS) between these 2 groups. All PCa patients were clinically significant according to the Epstein criteria. Two patients experienced fever (2.60%) after TRUSP biopsy., Conclusion: From our patient cohort, it appears that no benefit was apparent for patients younger than 40 years old who received TRUSP biopsy, even with elevated PSA. However, PCa detected in men between 40 and 50 years of age were all clinically significant. Overall, our results supported current major practice guidelines which recommend an initial PSA checkup at 40 years of age., (Copyright © 2017. Published by Elsevier Taiwan LLC.)

Aims: Terms used in the field of chronic pelvic pain (CPP) are poorly defined and often confusing. An International Continence Society (ICS) Standard for Terminology in chronic pelvic pain syndromes (CPPS) has been developed with the aim of improving diagnosis and treatment of patients affected by chronic pelvic pain syndromes. The standard aims to facilitate research, enhance therapy development and support healthcare delivery, for healthcare providers, and patients. This document looks at the whole person and all the domains (organ systems) in a systematic way., Methods: A dedicated working group (WG) was instituted by the ICS Standardisation Steering Committee according to published procedures. The WG extracted information from existing relevant guidelines, consensus documents, and scientific publications. Medline and other databases were searched in relation to each chronic pelvic pain domain from 1980 to 2014. Existing ICS Standards for terminology were utilized where appropriate to ensure transparency, accessibility, flexibility, and evolution. Consensus was based on majority agreement., Results: The multidisciplinary CPPS Standard reports updated consensus terminology in nine domains; lower urinary tract, female genital, male genital, gastrointestinal, musculoskeletal, neurological aspects, psychological aspects, sexual aspects, and comorbidities. Each is described in terms of symptoms, signs and further evaluation., Conclusion: The document presents preferred terms and definitions for symptoms, signs, and evaluation (diagnostic work-up) of female and male patients with chronic pelvic pain syndromes, serving as a platform for ongoing development in this field. Neurourol. Urodynam. 36:984-1008, 2017. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Background: In the general population, prostate adenocarcinoma affects predominately older men. If fact, most current guidelines suggest that males over the age of 50 years should undergo prostate cancer screening. However, the clinical behavior and prognosis of prostate cancer in young adults is not well defined. The aim of this study was to evaluate the clinical behavior, pathological characteristics, and prognosis of prostate cancer in young adults., Methods: We retrospectively reviewed the records of young patients (age, ≤50 years) in our hospital with prostate adenocarcinoma between 1997 and 2013. We compared data including initial presentation, cancer cell type, Gleason score, disease stage, prostate-specific antigen (PSA) level, prostate volume, treatment, and survival between patients both younger and older than 50 years. Data were analyzed using the Kaplan-Meier method to assess survival., Results: Twenty-six patients were enrolled in our study, accounting for 0.55% of all patients with a diagnosis of prostate cancer at our facility. All 26 patients had a pathology diagnosis of adenocarcinoma, with a mean age on diagnosis of 46.8±2.8 years (range, 39-50 years). On initial presentation, patients older than 50 years more frequently displayed lower urinary tract symptoms (LUTS) than younger patients (62.3% vs. 30.4%, p=0.008). There was no statistical difference in histological grade, disease stage, PSA level, overall survival, and biochemical-free survival between the two groups., Conclusion: The result of our investigation indicated that prostate adenocarcinoma patients younger than 50 years had similar histological grade, disease stage, PSA level, overall survival, and biochemical-free survival as the older population. However, patients younger than 50 years with prostate cancer less frequently showed initial symptoms of LUTS., (Copyright © 2016. Published by Elsevier Taiwan LLC.)

Background: Surgery is the potentially curative treatment for retroperitoneal sarcoma (RS), but complete resectability is frequently a challenge. This study aimed to characterize the clinical features, prognostic factors and treatment outcomes., Methods: A cohort of 144 patients with RS was surveyed retrospectively from January 1st, 2000 to July 30th, 2011. The prognostic influence of clinicopathological characteristics as well as treatments on local recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and overall survival (OS), were examined by univariate and multivariate analyses. A histology-specific nomogram developed by Gronchi et al was used for validation., Results: Liposarcoma, leiomyosarcoma, and malignant peripheral sheath tumor (MPNST) were the most common histologies (70%). Multivariate analysis revealed FNCLCC tumor grade was the most significant prognostic factor for OS (P = 0.001) and DMFS (P < 0.001) and complete resection was the only significant prognostic factor for LRFS (P = 0.043). Incomplete resection of grade 3 tumor was significantly associated with a worse OS. Despite some differences in characteristics between our patients and Gronchi's cohort, external validation of Gronchi's nomogram demonstrated excellent concordance in predicting survival., Conclusions: Our study demonstrated tumor grade and surgical margins had significant prognostic influence and the Gronchi's nomogram has an excellent applicability in predicting survival of STS patients. J. Surg. Oncol. 2016;113:355-360. © 2016 Wiley Periodicals, Inc., (© 2016 Wiley Periodicals, Inc.)

Background: For patients with an elevated prostate specific antigen (PSA) level or a suspected lesion detected by digital rectal examination, transrectal ultrasound-guided (TRUS) prostate biopsy is the standard procedure for prostate cancer diagnoses. In Taiwan, TRUS prostate biopsy has not been well-studied on a nationwide scale. This article aimed to study TRUS prostate biopsy in Taiwan and its related complications, according to the claims generated through the National Health Insurance (NHI) program., Methods: We applied for access to claims from the NHI Research Database of Taiwan of all patients who visited the urology clinic during the period of 2006 to 2010. In the 5-year urology profile, we obtained all records, which included admission and ambulatory clinical records. The definition of TRUS biopsy included codes for ultrasound-guided procedure and for prostate puncture; other codes involving complications such as postbiopsy voiding difficulty, significant bleeding, or infection requiring treatment were also included. Risk factors included age, diagnosis of prostate cancer, hospitalization or nonhospitalization, and the Charlson Comorbidity Index (CCI; with a value of 0, 1, 2 or ≥ 3). Descriptive and comparative analyses were also performed., Results: In the 5-year urology profile, 12,968 TRUS biopsies performed of which 6885 were in-patient procedures and 6083 were ambulatory clinic procedures. After the procedures, 1266 (9.76%) biopsies were associated with voiding difficulty; 148 (1.14%) biopsies, with significant bleeding; and 855 (6.59%) biopsies, with infection that required treatment. The prostate cancer diagnosis rate was 36.02%. The overall biopsy-related mortality rate within 30 days was 0.25%, and the postbiopsy sepsis-related mortality rate was 0.13%. Age, diagnosis of cancer, hospitalization, and CCI value ≥ 1 were all significant factors in univariate analysis and multivariate analysis for postbiopsy voiding difficulty and severe infection. A diagnosis of cancer and a CCI value ≥ 2 were significant factors for significant bleeding after biopsy. Patients diagnosed as having prostate cancer had fewer bleeding complications after biopsy., Conclusion: The most frequent complication was postbiopsy voiding difficulty, followed by infection that required treatment and significant bleeding. The sepsis-related mortality rate was 0.13%. Significant risk factors for postbiopsy complications included age, diagnosis of prostate cancer, hospitalization, and the CCI value., (Copyright © 2015. Published by Elsevier Taiwan.)

Background: Laparoscopic partial nephrectomy (LPN) and robotic-assisted partial nephrectomy (RPN) are accepted as alternatives of open partial nephrectomy for managing renal tumors. However, LPN and RPN are technically challenging procedures. This report analyzed, according to the Clavien classification, the complications after LPN and RPN., Methods: We analyzed consecutive LPN (n = 85) and RPN (n = 93) cases at our institution between April 1994 and December 2012. The data were retrospectively reviewed from a prospectively collected database. All complications that occurred within 3 months postoperatively were recorded and classified according to the modified Clavien classification system., Results: The mean tumor size was 3.90 ± 1.77 cm. The mean operative time was 255.0 ± 83.5 minutes, and the mean warm ischemia time was 31.6 ± 22.0 minutes. The overall complication rate was 18.5%. Clavien Grades I, II, IIIa, and IIIb complications accounted for 3.93%, 11.2%, 2.81%, and 1.69% of patients, respectively. The most common complication was perioperative hemorrhage that required blood transfusion. Delayed bleeding occurred in seven patients, and four patients underwent angiographic embolization. The proportions of intermediate and high PADUA (Preoperative Aspects and Dimensions Used for an Anatomical) score (≥ 8) and RENAL (Radius/Exophytic/Nearness to collecting system/Anterior/Location) score (≥ 7) were 70.8% and 74.2%, respectively. A higher PADUA or RENAL score was associated with a significantly greater complication rate (p = 0.024 and p = 0.02, respectively)., Conclusion: The overall complication rate in the present study was comparable to that reported in previous studies, although our patients had a larger mean tumor size and higher-complexity procedures.

Objectives: To detect non-bladder conditions in patients with interstitial cystitis/hypersensitive bladder syndrome., Methods: A total of 122 female interstitial cystitis/hypersensitive bladder syndrome patients and a control group of 122 age-matched female patients with stress urinary incontinence completed screening questionnaires for irritable bowel syndrome, temporomandibular disorder, multiple chemical sensitivities, tension and migraine headache, localized myofascial pain disorder, and fibromyalgia. Interstitial cystitis/hypersensitive bladder syndrome patients also completed questionnaires on interstitial cystitis/hypersensitive bladder syndrome symptom severity, including the O'Leary-Sant symptom index, and the visual analog scale for pain and urgency., Results: Interstitial cystitis/hypersensitive bladder syndrome patients were more likely to meet diagnostic criteria for irritable bowel syndrome than controls (37.5% vs 11.5%), and tension/migraine headache (38.7% vs 15.7%; all P < 0.001). The prevalence of temporomandibular disorder, multiple chemical sensitivities, localized myofascial pain disorders and fibromyalgia did not reach a statistical significant difference between the two groups. In the multivariate model, associations were also observed for irritable bowel syndrome (odds ratio 2.546; 95% confidence interval 1.136-5.704) and tension/migraine headache (odds ratio 2.684; 95% confidence interval 1.233-5.842). Patients with more comorbid conditions had more severe and bothersome interstitial cystitis/hypersensitive bladder syndrome symptoms as measured by the visual analog scale of pain (P = 0.008) and O'Leary-Sant bother index (P = 0.035)., Conclusions: Interstitial cystitis/hypersensitive bladder syndrome patients are more likely to have multiple non-bladder conditions. These conditions correlate with the severity of interstitial cystitis/hypersensitive bladder syndrome symptoms., (© 2014 The Japanese Urological Association.)