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Objective: Laparoendoscopic single-site surgery (LESS) is a new laparoscopy development that avoids the use of multiple ports and minimizes morbidity. Combined with retroperitoneoscopy, LESS is suitable for adrenalectomy. We compared open, conventional laparoscopic, and LESS-retroperitoneoscopic adrenalectomy (LESS-RA) surgeries for adrenal tumor removal. Furthermore, we analyzed the conventional retroperitoneoscopic adrenalectomy (CRA) and LESS-RA outcomes. Materials and Methods: We examined 178 patients who underwent adrenalectomy: 43 by open surgery, 72 by conventional laparoscopy, and 63 by LESS-RA. We analyzed the outcomes of operative time, estimated blood loss (EBL), complications, postoperative convalescence, time to resuming oral intake, analgesics on demand, and hospital stay. Results: We found that the open surgery group had a significantly greater mean EBL than the conventional laparoscopy or LESS-RA group (353.1±313.6 mL vs. 62.3±76.9 mL vs. 60.9±64.3 mL, respectively; p

Objectives The prevalence of both chronic kidney disease (CKD) and upper tract urothelial carcinoma (UTUC) in Taiwan is unusually high, and we aimed to investigate the impact of preoperative renal function on UTUC after radical nephroureterectomy. Materials and methods Between 2000 and 2013, 248 UTUC patients were enrolled in this retrospective study after excluding patients who had concomitant muscle-invasive bladder cancer, whose tumor metastasized at initial presentation, and who received perioperative chemotherapy or radiotherapy. The significance of CKD on overall survival (OS), cancer-specific survival (CSS), and bladder recurrence-free survival (BRFS) was evaluated by Cox proportional hazard model. Results The median follow-up time was 45.41 months. Overall 5-year OS, CSS, and BRFS rates were 78.27%, 87.81%, and 70.42%, respectively. Aging, late-stage CKD, and nonorgan-confined primary tumor stage were independent predictors for OS after adjustment. Nonorgan-confined primary tumor stage and lymph node involvement were two independent predictors for CSS after adjustment. Concomitant bladder tumor was the only significant predictor for BRFS after adjustment. Conclusion Patients with late-stage CKD had a higher risk of having poor OS. Patients with concomitant bladder tumor had a greater risk of having bladder cancer recurrence despite primary tumor stage. Concomitant bladder tumor, however, had no effect on OS and CSS in this study.

Purpose: In recent years, single-incision laparoscopic surgery (SILS) became more popular worldwide for its safety and feasibility. This study aims to compare the clinical outcomes of open- and single-incision laparoscopic total extraperitoneal (TEP) hernia repair procedures. Materials and Methods: This retrospective study included 498 consecutive patients undergoing open- and single-incision laparoscopic surgeries for inguinal hernia between January 2012 and December 2016 at Kaohsiung Municipal Ta-Tung Hospital. Results: Open inguinal hernia repairs were performed in 436 patients and SILS-TEP repairs in 62 patients. There were no significant differences between the two groups in patients' characteristics except hernia laterality. Mean operative time was significantly longer in the SILS-TEP compared with the open group (108.9 vs. 87.6 min, P = 0.001), but less mean operative duration was observed when surgeons performed bilateral SILS-TEP repairs. Minor amount of analgesic agent usage was noted in the SILS-TEP group. There were no significant differences between the two groups in bleeding volume and postoperative hospital stay and complications. There were 6/453 (1.3%) recurrences in the open group and no recurrences in the SILS-TEP group at a 1-year follow-up. Conclusion: SILS-TEP is both possibly safe and technically feasible and provides less postoperative pain, acceptable operative implications, and better cosmetic outcomes for patients. It also has less possibility of conversion to laparotomy and recurrence rate.

Purpose: The aim of the study was to compare the outcomes of simultaneous supine percutaneous nephrolithotomy (sPCNL) with semi-rigid ureteroscopic lithotripsy (SR-URSL) (Group A) and SR-URSL (Group B) for treating large proximal ureteral calculus. Materials and Methods: Between January 2015 and April 2019, all patients with large proximal ureteral stones (≥10 mm) who underwent simultaneous sPCNL with SR-URSL or SR-URSL at three medical centers were retrospectively included. Two surgical options were provided based on patients and doctors' decision. The intraoperative and postoperative results, including operating time, hospital stay, need for auxiliary procedures, and complications, were compared between the two groups. Stone-free clearance was defined as the absence of fragments or a single fragment of ≤4 mm on standard radiography 1 month after surgery. Results: A total of 38 and 27 patients were included in Groups A and B, respectively. The mean stone size was 21 mm and 18.2 mm and stone-free rate (SFR) was 97% and 33% in Groups A and B, respectively. Larger ureteral stones (P

Objective: We aimed to determine whether urolithiasis is a warning sign indicating long-term osteoporosis. Controls were matched for age, sex, and other comorbidities, including hypertension, diabetes mellitus, dyslipidemia, liver disease, and cardiovascular disease. Materials and Methods: Data were obtained from the Longitudinal Health Insurance Database (LHID2000) of Taiwan, Republic of China, compiled by the NHI from 1996 to 2013. We further evaluated potential risk factors stratified by different comorbidities. Results: After performing the propensity score matching (urolithiasis: control; ratio, 1:3), we included a total of 104,900 patients, including 26,225 patients with urolithiasis and 78,675 control patients. There was a significant difference between the incidence of osteoporosis between the urolithiasis and control groups (adjusted hazard ratio 1.20, 95% confidence interval [CI]: 1.15–1.27, P < 0.001). Interestingly, the impact of urolithiasis on osteoporosis was more prominent in the younger patient population (age < 40 years, adjusted hazard ratio 1.4, 95% CI: 1.12–1.75, P = 0.003; 40–59 years, adjusted hazard ratio 1.3, 95% CI: 1.20–1.40, P < 0.001), than in the older patient population (age >60 years, adjusted hazard ratio 1.13, 95% CI: 1.05–1.21, P = 0.001; P = 0.015 for interaction). We also observed that urolithiasis had an impact on hypertension-free patients (hypertension free, adjusted hazard ratio 1.28, 95% CI: 1.20–1.36, P < 0.001; hypertension, adjusted hazard ratio 1.12, 95% CI: 1.03–1.22, P = 0.006, P = 0.020 for interaction). Conclusion: In conclusion, on the basis of our results, an association exists between urolithiasis patients and subsequent osteoporosis diagnosis. Although the clinical mechanisms are not fully understood, patients who had urolithiasis history may need regular follow-up of bone marrow density.

Objective: The use of 10–12-core systemic transrectal ultrasound (TRUS)-guided prostate biopsy protocols with extended-sampling has been an optimizing strategy for diagnosis of prostate cancer. In this study, we aim to examine the cancer detection rate (CDR) and the complications following prostate biopsy at our institution. Materials and Methods: We retrospectively reviewed medical data of patients who underwent TRUS-guided prostate biopsy between 2007 and 2013 at our institution. The pathological outcomes, major complications, and morbidities were recorded and assessed clinically. Results: During the study period, 425 patients who underwent TRUS-guided prostate biopsy were enrolled. The mean age of the participants was 67.9 years. Overall, 75 (17.6%) patients were diagnosed with prostate cancer. Cancer was detected in 0% (0/10), 7.0% (15/215), 16.5% (20/121), and 50.6% (40/79) of patients in the subgroups with patient prostate-specific antigen (PSA) 20 ng/ml, respectively. The optimal cutoff values of PSA density were 0.19, 0.29, and 0.78 in the subgroups with patient PSA 4–10 ng/ml, 10–20 ng/ml, and >20 ng/ml. In total, 11 patients had afebrile urinary tract infections (UTI), 9 patients had febrile UTI, and another 2 patients had septic shock after biopsy. The overall incidence of infectious complications was 5.17% (22/425). Other complications were infrequent, consisting only of urinary retention in three patients, hematospermia in two patients, and acute hemorrhagic cerebellar infarction in 1 patient. Conclusion: Our study demonstrated the CDR, the incidence, and type of complications following TRUS-guided prostate biopsy. Further prospective studies are required to determine methods for reducing complications from prostate biopsy.