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In this study, we investigated the effect of mTOR inhibitor (mTORi) drug-eluting biodegradable stent (DE stent), a putative restenosis-inhibiting device for coronary artery, on thermal-injury-related ureteral stricture in rabbits. In vitro evaluation confirmed the dose-dependent effect of mTORi, i.e., rapamycin, on fibrotic markers in ureteral component cell lines. Upper ureteral fibrosis was induced by ureteral thermal injury in open surgery, which was followed by insertion of biodegradable stents, with or without rapamycin drug-eluting. Immunohistochemistry and Western blotting were performed 4 weeks after the operation to determine gross anatomy changes, collagen deposition, expression of epithelial–mesenchymal transition markers, including Smad, α-SMA, and SNAI 1. Ureteral thermal injury resulted in severe ipsilateral hydronephrosis. The levels of type III collagen, Smad, α-SMA, and SNAI 1 were increased 28 days after ureteral thermal injury. Treatment with mTORi-eluting biodegradable stents significantly attenuated thermal injury-induced urinary tract obstruction and reduced the level of fibrosis proteins, i.e., type III collagen. TGF-β and EMT signaling pathway markers, Smad and SNAI 1, were significantly modified in DE stent-treated thermal-injury-related ureteral stricture rabbits. These results suggested that intra-ureteral administration of rapamycin by DE stent provides modification of fibrosis signaling pathway, and inhibiting mTOR may result in fibrotic process change.

Objective: To examine the 10-year risk of stroke among patients with acute urinary retention (AUR) in Taiwan, using a population-based dataset. Methods: This retrospective cohort study included 38,433 patients aged > 50 years with AUR, with or without catheterization, and 38,433 matched patients without AUR (controls) sourced from the Longitudinal Health Insurance Database from 2001 to 2010. Cox proportional hazards regression was used to evaluate the association between AUR and the risk of stroke during the subsequent 10-year follow-up period, after adjusting for sociodemographic characteristics, hypertension, diabetes, hyperlipidemia, coronary heart disease, and urinary tract infection. Results: Of the 38,433 patients with AUR, 2805 (7.3%) had strokes during the follow-up period compared with 1077 (2.8%) controls (crude hazard ratio, 2.69; 95% confidence interval, 2.5–2.88). After adjusting for potential confounders, risk of stroke was increased in patients with AUR (hazard ratio, 2.36; 95% confidence interval, 2.19–2.53). There was a significant difference in the 10-year stroke-free survival rate between the patients with and without AUR (p

Background Diet is associated with self-reported indices of sexual health. The mechanisms responsible for these changes remain poorly understood. Aim To investigate the hemodynamic and histological impact of dietary change in a rat model of hyperlipidemia-associated erectile dysfunction. Methods 40 2-month old male Sprague–Dawley rats were divided into 4 groups. 10 rats were fed a diet of standard chow and served as negative controls (N group). The remaining 30 age-matched rats were divided at random into 3 groups: (i) high-fat diet for 5 months starting at age 5 months (H group); (ii) high-fat diet for 5 months starting at age 4 months followed by 1 month of standard chow (H+N1M group); and (iii) high-fat diet for 5 months starting at age 2 months followed by 3 months of standard chow (H+N3M group). All rats underwent erectile function testing and sacrifice at age 10 months. Outcomes Intracavernous pressure (ICP) and mean arterial pressure (MAP) were measured to evaluate erectile function. Blood samples were collected to measure serum testosterone and lipid levels, and penile tissue specimens were obtained for histological examination. Results Total body weight, low-density lipoprotein, and serum glucose were significantly higher in the H group compared with the N and H+N3M groups. Serum high-density lipoprotein level was significantly lower in the H group compared with the N and H+N3M groups. The mean ICP/MAP ratio was significantly lower in the H group compared with the N and H+N3M groups (0.33 ± 0.05 vs 0.79 ± 0.07 vs 0.73 ± 0.13; P < .05 for both). Markers for intracorporal neuronal nitric oxide synthase and endothelial cells were more weakly expressed in the H group compared with the N and H+N3M groups. There was no significant difference in smooth muscle content among the groups. Mean cavernosal oxidative stress and the apoptotic index were significantly higher in the H group compared with the N and H+N3M groups. No significant between-group differences were noted with respect to serum testosterone; the H group had significantly higher serum glucose and low-density lipoprotein levels, effects that were partially mitigated in the H +N1M and H+N3M groups. Clinical Translation Administration of a healthy diet is associated with normalization of functional and histological penile defects associated with a high-fat diet. Strengths & Limitations Metabolic changes were clearly linked to functional improvements in penile blood flow. Differences between rat and human lipoprotein metabolism are a limitation of this study. Conclusion Dietary changes may have positive effects on penile hemodynamics in a rat model of hyperlipidemia-associated erectile dysfunction.

Objective The purpose of this study was to report the feasibility, safety, and benefits of laparoscopic radical cystectomy (LRC) for patients with bladder cancer who are older than 75 years and with marginal cardiopulmonary function in a regional teaching hospital. Materials and methods The charts of 30 patients who underwent LRC between 2013 and 2016 in a community teaching hospital were reviewed. The patients were sub-grouped into the age groups ≥75 years and Results A significant difference was observed in the data of the group ≥75 years group compared with the p = 0.0007) and higher rate of marginal cardiopulmonary function (80% vs. 26.7%, p = 0.0092). No significant difference was observed in sex, CCI score (3.93 vs. 3.27), Body Mass Index (BMI) (24.8 vs. 24.4), ejection fraction (69% vs. 70.97%), operation time (473 vs. 465 min), blood loss (503 vs. 380 mL), urinary diversion type, intensive care unit care (1.13 vs. 0.6 days), interval to ambulation (2 vs. 1.8 days), interval to oral food intake (3.2 vs. 2.6 days), interval to normal bowel function (4.6 vs. 3.6 days), post-op hospitalization (15.67 vs. 11.67 days), and blood transfusion rate (33.3% vs. 26.7%) between the two groups. No conversion to open surgery or mortality was observed. Surgical complications occurred in 15 patients, with a complication rate of 50%. No surgical mortality was noted in 30 or 90 days. Most pathological cases revealed urothelial carcinoma. Conclusions LRC is a safe option with favorable outcomes in bladder cancer patients older than 75 years with marginal cardiopulmonary function in a regional teaching hospital.

// Cih-En Huang 1, 2, 3 , Yao-Hsu Yang 4, 5, 6 , Wen-Cheng Chen 5, 7, 8 , Kuo-Tsai Huang 9 , Pau-Chung Chen 5, 10, 11, 12 , Ying-Huang Tsai 13, 14 and Wei-Yu Lin 3, 8, 9 1 Division of Hematology Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan 2 Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan 3 Chang Gung University of Science and Technology, Chiayi, Taiwan 4 Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan 5 Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan 6 School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan 7 Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan 8 College of Medicine, Chang Gung University, Taoyuan, Taiwan 9 Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan 10 Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan 11 Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan 12 Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 13 Division of Pulmonary and Critical Care Medicine, Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan 14 Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan Correspondence to: Wei-Yu Lin, email: Lwy0912@yahoo.com Keywords: nephroureterectomy, dialysis, elderly, upper tract urothelium carcinoma Received: May 01, 2017 Accepted: August 02, 2017 Published: August 11, 2017 ABSTRACT Background: There is a high incidence rate of upper tract urothelial carcinoma (UTUC) in patients on dialysis. However, the studies about nephroureterectomy (NU) in this high surgical risk group are limited. The aim of this study is to investigate the outcomes of NU in this population. Results: There were total 931 patients enrolled and 218, 582, 131 patients were non-NU, unilateral and one-stage bilateral NU, respectively. NU provided better 5-year overall survival (66% versus 51% in non-NU, P = 0.001). 19.7% of patients with unilateral NU had successive contralateral NU with a mean interval period of 695 days. Even for the elderly, there were no significant difference in duration of hospitalization, 30- and 90-day mortality between unilateral and bilateral NU. Materials and Methods: Patients on dialysis with UTUC between January 1998 and December 2012 were assessed from the nationwide cohort of Taiwan National Health Insurance Research Database. We classified these patients into non-NU and NU groups. In NU group, we analyzed clinical outcomes of patient groups between different NU types and surgical methods. Conclusions: Although the high surgical risk in patients on dialysis with UTUC, NU provided better 5-year overall survival. One-stage bilateral NU both provides comparable safety profile and avoids 19.7% of successive contralateral NU in less than two years. Even in the elderly, one-stage bilateral NU is safe and feasible.

Objectives: Atherosclerosis may lead to chronic bladder ischemia, which eventually results in lower urinary tract symptoms (LUTS). Patients with venous thromboembolism (VTE) have a higher prevalence of atherosclerosis. Methods: A total of 31,559 patients had been diagnosed with or without LUTS between 2000 and 2010 in Taiwan National Health Insurance Research Database, each was enrolled in the LUTS and non-LUTS cohorts, respectively. The risk of VTE in LUTS and non-LUTS cohorts was calculated by Cox proportional hazards regression model. Results: After adjustment for age, sex, and comorbidities, the risk of subsequent VTE was 1.34-fold higher in the LUTS than in the non-LUTS cohort. The adjusted risk of VTE was highest in patients with LUTS with any comorbidity. The age-specific relative risk of VTE was significantly higher in patients aged ≥50 years, particularly in those aged 50–64 years, in the LUTS than in the non-LUTS cohort. Conclusions: LUTS is a risk factor for VTE. Physicians should consider the possibility of underlying VTE in patients aged ≥50 years having cardiovascular comorbidities.