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PurposeThis retrospective study to determine the effectiveness standardized peri-operative protocol in combination with prophylactic gentamicin and levofloxacin in preventing infectious complications after trans-rectal prostate biopsy.Material and MethodPatients were screened for prostate cancer at our out-patient department, either due to abnormal digital examination or elevated PSA level. Patients who underwent transrectal ultrasound (TRUS) guided prostate biopsy from January 2008 to December 2012 was included in this study. After using surgical code to identify the patients, charts were reviewed, and complications were recorded. Infectious complications were defined as any patient who experienced any signs systemic inflammatory response syndrome (SIRS) within 14 days after undergoing TRUS biopsy. Complications were graded according to Clavien-Dindo classification.ResultsOut of the 577 patients there were 20 patients (3.47 %) with infectious complications. Of the 20 patients with infectious complications, only four patients (0.7%) needed hospitalization due to bacteremia. Minor complications (i.e., hematuria, acute urine retention, hematospermia, etc.) were self-resolving. There were 9 positive urine culture and 4 positive blood culture with Escherichia coli (E. coli) as the predominant species. Three patients had positive urine culture for ciprofloxacin resistant strain, which was susceptible to 2nd an 3rd generation cephalosporin or amikacin. One patient had blood culture positive for extended-spectrum beta-lactamase (ESBL) E. coli infection, which was sensitive to amikacin. The infectious complication rate and number decrease each year without increase in resistant strain.ConclusionOur current peri-operative and post-operative protocol appears to be feasible in reducing infection complications after prostate biopsy; our complication and sepsis rate were similar compared to other English literatures. A prospective randomized controlled trial would be needed to determine if a single factor or a combination of several factors are responsible for the reduction in post-biopsy infections.

Summary Objective This is an initial review of the safety and efficacy of anterior preperitoneal modified Kugel (MK) mesh herniorrhaphy application without using optional onlay mesh. Methods We retrospectively reviewed patients who underwent herniorrhaphy by a single surgeon from July 1st, 2009 to December 31st, 2010. During these 18 months, a total of 72 patients underwent single-layer MK mesh herniorrhaphy. Anterior preperitoneal approach was used to place the mesh. If the patient's inguinal hernia defect did not exceed the memory ring of MK mesh, the onlay mesh was omitted. Postoperative results (wound infection, recurrence, and chronic pain/discomfort) were recorded and analyzed. Results A total of 72 patients underwent anterior preperitoneal single layer MK mesh herniorrhaphy. One patient had recurrent hernia after 1 year and was treated with a laparoscopic transabdominal preperitoneal operation. The most common postoperative complaint was mild soreness which was self-resolving after 1 month. Mean total operative time (skin to skin) was 73 minutes. The average hospital stay was 2 days. Most of the postoperative complications including soreness (14%), pain for > 3 months (1.4%), and scrotal hematoma (1.4%) were self-resolving. One patient experienced wound infection, which was treated with oral antibiotics. One patient had recurrence 1 year after the operation. Conclusion The postoperative complication and recurrence rates of single-layer MK mesh herniorrhaphy was comparable with previously reported tension-free repair. Single-layer application is safe and feasible. A longer follow-up period and larger study group with a control group are needed to verify our method.

Objective This study was carried out to compare infectious complications between patients with and without a set protocol for prostate biopsy. Materials and methods Patients whom underwent prostate biopsy at our hospital from 2001 to 2012 were first identified. Two different groups of patients were then selected from 2 different years. The cut-off year in which we started to implement a standardized protocol for prostate biopsy was 2007. Data from the patient group without a set protocol were collected from January 2001 to December 2001. Data from the patient group with a set protocol were collected from January 2012 to December 2012. Results A total of 246 patients were selected from 2 different years. Ninety-two patients were collected from January to December 2001 (without set protocol). One hundred and fifty-four patients were collected from January to December 2012 (with set protocol). In the first group, the infectious complication rate was 10.75% (10/92), whereas in the second group, the infection rate was 1.3% (2/154). All minor complications (such as hematuria, hematospermia, dysuria, etc.) were self-resolving within 1 month. Most infectious complications were managed during outpatient department (OPD) hours with oral antibiotics. Only one patient required hospitalization (from 2001). None of the positive culture results revealed any resistant strain species. Conclusion The minor complications were similar in both groups and were all self-resolving. Infectious complications were more prevalent in the group without a set protocol. Adequate perioperative preparation and postoperative antibiotic regimens appear to be helpful in the prevention of infectious complications.

Background To assess the morbidities of tubeless percutaneous nephrolithotomy (PCNL) using supra-costal access and re-evaluate traditional concept of increased complications with supra-costal access. Methods From January 2010 to December 2014, a single surgeon performed 118 consecutive one-stage fluoroscopic guided PCNL’s for complex renal and upper ureteral stone. Our definition for complex renal stone is defined as partial or complete staghorn stone, multiple renal stones in more than 2 calyxes, obstructive uretero-pelvic stone > 2 cm, and a renal stone in single functional kidney. Inclusion criteria include: staghorn stones, renal calculi > 2 cm in diameter, upper ureteral stone > 1.5 cm in diameter. Exclusion criteria for tubeless PCNL include: significant bleeding or perforation of the collecting system, large residue stone, multiple PCNL tract and obstructive renal anatomy. Morbidity, operation time, analgesia requirement, length of hospital stay, stone- free rate, were analyzed. Results Of the 118 consecutive PCNL, eighty-six patients underwent tubeless PCNL (56 supra-costal and 30 sub-costal) and included in our prospective follow-up period. The mean age, operation side, stone locations were similar. The male to female ratio is higher in supra-costal than sub-costal. Large renal stones and staghorn stones makes up for most patients (supra-costal: 75%, sub-costal: 80%). The stone–free rate of supra-costal group was 59% (33/56) and in sub-costal group was 50% (15/30). The operative times, length of stay, post-op analgesic use, hematocrit change was similar in both groups. The overall complication rate is 6% [supra-costal (1/56), sub-costal (4/30)] with the majority being infectious complications. Conclusions Supra-costal access above 12th rib during tubeless PCNL is safe and effective procedure and is not associated with higher incidence of post-op complications in experience hands.

Objective To evaluate the predictive role of the Model for End-Stage Liver Disease (MELD) score concerning changes in testosterone levels following living donor liver transplantation (LDLT) and the effects of LDLT on total testosterone and sex hormone-binding globulin (SHBG) levels, the free androgen index (FAI) and erectile function in LDLT recipients. Participants 41 adult male recipients of LDLT were evaluated before transplantation and six months after LDLT. Main outcome measures We evaluated the effects of LDLT on total testosterone and SHBG levels, the FAI and erectile function in LDLT recipients. In this prospective study, MELD score, serum total testosterone, SHBG levels and FAI were measured in the morning of the operation day and 1 month, 3 months and 6 months after LDLT. The 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire was administered before LDLT and six months after LDLT to evaluate erectile function. Results The main outcome measure was dynamic parameter changes of total testosterone, SHBG, FAI and erectile dysfunction. The mean FAI value before LDLT was 16.75±10.10. The mean FAI was significantly higher 1 month (32.75±15.56; p < 0.01), 3 months (25.23±10.26; p < 0.01) and 6 months (29.16±11.05; p < 0.01) after LDLT. Mean IIEF-5 scores significantly increased after LDLT (from 11.7±7.7 before LDLT to 14.7±7.5, p< 0.01). Conclusions MELD score correlates with severity of hypogonadism in men with end-stage liver disease. LDLT results in a reduction in serum levels of SHBG, an increase in FAI and improvement in erectile function.

Context: In Changhua Christian Hospital (CCH), the urology division is a branch of the surgical department. The urology residents in this division are, on average, off duty for 10 days/month; surgical residents from other divisions usually lack training to practice urology. Therefore, attending urology doctors or visiting urology staff members in CCH branches must be on call during off-duty periods in case a patient is indicated for suprapubic cystostomy. Aims:This study aims to promote a safe and efficient approach to train rotating residents to perform suprapubic catheterization. Subjects and Methods: On the basis of ultrasound-guided central venous catheter insertion, we designed training sessions for suprapubic cystostomy for rotating surgical residents during their urology course. Participants and Methods: From 2016 to 2018, senior residents or attending doctors of urology evaluated the clinical skills of rotating residents by using the direct observation of procedural skills tool before and after the training course. Statistical Analysis Used: Mann–Whitney U-test, Wilcoxon signed rank test, and multiple linear regression analysis. Results: The trainees were separated into different groups according to their sex, year of residency, and previous urology training in the postgraduate year (PGY). All groups had significant gain scores. Our multiple linear regression analysis revealed a relationship between previous urology training in the PGY and gain scores and between overall pretest score and gain scores. Conclusions: Real-time ultrasound-guided catheterization with a Seldinger wire is a safe and efficient approach to train rotating residents to perform suprapubic catheterization.

Objective To evaluate the safety and efficacy of diode laser-assisted bipolar transurethral resection of the prostate (TURP) with an oyster procedure for large prostate glands (>80 mL). Methods A total of 43 men who presented with lower urinary tract symptoms because of large prostate (>80 mL) obstruction were enrolled in our study. All of these patients underwent the oyster procedure. Measurements included the urinary flow rate, symptom score, duration of catheterization, length of hospital stay, and urinary flow rate. All patients were re-examined 3, 6, and 12 months after surgery. Results The patients who underwent oyster procedures experienced good and durable subjective and functional outcomes for 1 year. Small changes in hemoglobin were noted, and no patients needed blood transfusions. No cases of TURP syndrome were noted. Bladder neck contracture was noted in 2 patients (Clavien-Dindo grade III) because of subtrigonal injury during prostate enucleation, and the other complications were minor (Clavien-Dindo grade I to II). Conclusion The oyster procedure is a safe and effective procedure for large prostates (>80 mL).

s / Urological Science 26 (2015) 294e300 295 (p< 0.02) which was poor performance in facets of overall QoL(0.046), enjoying of life(p1⁄4 0.001), meaning of life(p1⁄4 0.01), time for leisure activity(p1⁄4 0.002). However, log of PSA showed lack of impact in QoL. Conclusion: Our data demonstrated the PSA values and trend of PSA value play an important role in determining QoL in Taiwanese PC patients. Which could provide information for clinician in decision making. The underlying reason is worth to explore in future. MP1-4: PRIMARY CLEAR CELL ADENOCARCINOMA DERIVED FROM ENDOMETRIOSIS OF URINARY BLADDER Chin-Wei Kuo, Jen-Sen Lin, Meng-Yi Yan, Heng-Chieh Chiang. Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua

Background Impaired liver function in men can result in erectile dysfunction or hypogonadism or both. We investigated whether living donor liver transplantation (LDLT) results in improvement in male sexual function. Methods A total of 58 patients with end-stage liver disease (ESLD) were included in this prospective, cross-sectional study. Erectile function was measured before and after LDLT using a five-item modified version of the International Index of Erectile Function scale (IIEF-5) and hypogonadism was evaluated before and after LDLT using the Androgen Deficiency in the Aging Male (ADAM) questionnaire. Differences in mean values from the questionnaires before and after the operation were than evaluated to determine whether there is an association between LDLT and improvement in sexual function. Results We found that mean IIEF-5 scores significantly increased after LDLT (from 11.7 ± 7.7 before LDLT to 14.7 ± 7.5 after LDLT, p

Testicular dermoid cysts are extremely rare. They are classified as benign tumors, and although a radical orchiectomy is the standard procedure for clinically suspicious malignant tumors, if the preoperative prediction is a benign lesion, testis-sparing surgery is a feasible option. We report a testicular dermoid cyst in a 27-year-old male with the clinical presentation of a painless, hard, testicular mass. Testis-sparing surgery was performed, and no tumor recurrence was noted during 6 months’ follow-up. We review the literature on the clinicopathologic features of this rare testicular tumor and the therapeutic recommendations.

Most spermatic cord masses are benign, and malignant spermatic cord tumors are uncommon. Spermatic cord metastases originating from hepatocellular carcinoma (HCC) have not been previously reported in the English language literature as determined by a PubMed search. We report a male patient who presented with a painful palpable mass in the right inguinal area. The patient was diagnosed with HCC in 2004 and undertook a nonsurgical approach to control the cancer. A radical orchiectomy was performed, and the pathological report showed metastatic HCC in the spermatic cord. The patient received palliative radiation therapy because of a positive surgical margin. No recurrence was noted after 6 months of followup.

Objective This study was conducted to investigate the safety and feasibility of self-retaining barbed absorbable suture application in laparoscopic partial nephrectomy (LPN). Materials and methods From January 2010 to September 2014, 38 cases of LPN were performed at Changhua Christian Hospital, Changhua, Taiwan. The patients were divided into two groups: the nonself-retaining barbed suture (non-SRBS) group ( n = 21) and the SRBS group ( n = 17). There was no significant difference in age, RENAL (Radius, Exophytic/Endophytic properties, Nearness of the tumor to the collecting system or sinus, Anterior/Posterior, Location relative to polar lines) nephrometry score, and tumor type between the two groups. Clinical data and outcomes were analyzed retrospectively. Results All 38 cases of LPN were successfully performed, without conversion to open surgery or serious intraoperative complications. In the SRBS group, renorrhaphy time and length of hospital stay were significantly shorter than those of the non-SRBS group ( p = 0.015 and p = 0.009, respectively). Conclusions The application of SRBS in LPN could shorten renorrhaphy time and hospital stay with good safety and feasibility.