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Abstract Background Incidence of renal dysfunction and risks of progression to end-stage renal disease (ESRD) were reported higher in upper urinary tract urothelial carcinoma (UTUC) than in renal cell carcinoma (RCC) patients after unilateral nephrectomy. Methods Totally 193 renal cancer patients, including 132 UTUC and 61 RCC, were studied to clarify whether the pathological changes of the kidney remnant removed from nephrectomy and the clinical factors might predict the risk of ESRD. Renal tubulointerstitial (TI) score and global glomerulosclerosis (GGS) rate were examined by one pathologist and two nephrologists independently under same histopathological criteria. Results The glomerular filtration rates at the time of surgery were lower in UTUC than RCC groups (p

Background We aimed to identify prognostic biomarkers of upper tract urothelial carcinomas (UTUCs), including microRNAs (miRNAs) and genes which account for only 5% to 10% of all urothelial carcinomas (UCs). In Taiwan, this figure is markedly higher, where it can reach up to 30% of UC cases. Materials and Methods Using next-generation sequencing (NGS), we analyzed two pairs of renal pelvis tumors and adjacent normal urothelial tissues to screen miRNAs and messenger RNAs. By combining bioinformatics analysis from miRmap, Gene Expression Omnibus (GEO), and Oncomine and Ingenuity® Pathway Analysis databases, we identified candidate genes. To search for upstream miRNAs with exact target binding sites, we used miRmap, TargetScan, and miRDB to enforce evidence. Then, we clarified gene and protein expression through an in vitro study using western blot analysis and quantitative real-time reverse transcriptase-PCR. Results Interactions between selected target genes obtained using the NGS and miRmap methods were assessed through a Venn diagram analysis. Six potential genes, namely, PDE5A, RECK, ZEB2, NCALD, PLCXD3 and CYBRD1 showed significant differences. Further analysis of gene expression from the GEO dataset indicated lower expression of PDE5A, RECK, ZEB2, and CYBRD1 in bladder cancer tissue than in normal bladder mucosa, which indicated that PDE5A, RECK, ZEB2, and CYBRD1 may act as tumor suppressors in UTUC. In addition, we compared the expression of these genes in various UC cell lines (RT4, BFTC905, J82, T24, UMUC3, 5637, BFTC 909, UMUC14) and found decreased expression of PDE5A in muscle-invasive UC cells compared with the RT4 cell line. Furthermore, by using paired UTUC and normal tissues from 20 patients, lower PDE5A expression was also demonstrated in tumor specimens. Conclusions Our findings suggest these candidate genes may play some roles in UTUC progression. We propose that these markers may be potential targets clarified by in vitro and in vivo experiments. PDE5A also potentially presents tumor suppressor genes, as identified by comparing the expression between normal and tumor specimens.

Abstract Background To clarify if diagnostic ureteroscopy (URS) before radical nephroureterectomy for patients with upper tract urothelial carcinoma (UTUC) will increase the risk of intravesical recurrence. Methods From retrospective review of cohort at our institution, 502 patients with UTUC who underwent radical nephroureterectomy with bladder cuff excision were enrolled from 1990 to 2013. Cox proportional hazards model was used to analyze the overall survival (OS), disease-free survival (DFS), metastasis-free survival (MFS), and intravesical recurrence-free survival (IVRFS). The log-rank test was used for comparing survival curves. All potential risk factors were included in the multivariate Cox proportional hazards model to recognize independent predictors. From NHI database, we included patients of UTUC without bladder cancer history using population-based database in Taiwan from 1996 to 2013. In total, 3079 URS and 2634 non-URS patients with UTUC were identified. Univariate and multivariate Cox proportional hazards regressions were performed to measure the risk of IVRFS and all-cause mortality. Results From our database, the comparison of clinicopathological characteristics in UTUC patients between with URS biopsy group (URS+) (n = 206, 41%) and without URS biopsy group (URS−) (n = 296, 59%) was insignificantly different excluding surgical method. URS biopsy is not associated with worse OS (p = 0.720), DFS (p = 0.294), MFS (p = 0.808), and IVRFS (p = 0.560) by multivariate analysis. Only bladder cancer history is an independent significant factor to predict IVR (p

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.

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.

Aims: Laparoendoscopic single-site (LESS) adrenalectomy has become a feasible choice for adrenal lesions and can substitute for conventional open adrenalectomy. This report shares our surgical experience and describes the characteristics of adrenal tumors after LESS retroperitoneal adrenalectomy. Subjects and Methods: Between January 2010 and August 2016, 123 patients underwent an LESS adrenalectomy by retroperitoneal approach in our hospital. We retrospectively reviewed the records of these patients and analyzed the characteristics of adrenal tumors. The incision is below the 12th rib in the posterior axillary line and is about 2.3–3.2 cm in length. A 5 mm 30° rigid laparoscope and other conventional laparoscopic instruments are manipulated through a commercial port. No postoperative drain is placed. Results: Among 123 patients, the mean operative time was 114.1 ± 31.1 min, and mean blood loss was 65.1 ± 68.7 ml. Mean hospital stay was 5.4 ± 1.2 days. The postoperative course was uneventful without complications. Among all adrenal tumors undergoing surgery, Conn's disease is the most common (68.3% Conn's disease, 19.5% nonfunctioning, 4.9% Cushing's disease, 3.3% pheochromocytoma, and 0.8% malignancy). We found that left-side adrenal tumors (64.2%) were more common than right-side tumors (35.8%). Conclusions: Our experience shows that retroperitoneal LESS adrenalectomy is promising. Conn's disease accounts for more than half of adrenal tumors undergoing surgery. In the future, further comparative study is warranted to define the role of LESS in adrenal surgery.

Objective: Shock wave lithotripsy (SWL) is widely available due to its ease of use and noninvasive nature, and it is highly effective for fragmentation of stones. After SWL became widely used, a number of urinary tract complications, such as hematuria, infection, and pain due to difficulty passing fragmented stones, were also reported. Long-term complications, such as hypertension and diabetes mellitus, were also raised by the previous reports. The association between SWL and development of new hypertension has become a matter of debate due to the publication of controversial data. In the present study, we aimed to determine whether SWL led to the development of hypertension. Methods: Data were sourced from the Longitudinal Health Insurance Database (LHID2000) of Taiwan, Republic of China, compiled by Taiwan National Health Insurance (NHI) from 1996 to 2010. Patients who underwent SWL were compared with controls matched for age, sex, obesity, diabetes mellitus, and hyperlipidemia using the Taiwan NHI database. Results: There was no difference in the incidence of new hypertension between SWL and comparison groups. Interestingly, the average new hypertension onset time was faster in the SWL group than in the control groups. Conclusion: On the basis of our results, SWL is a safe procedure for properly managed nephrolithiasis patients.

Abstract In addition to testosterone (T), the emerging role of sex hormone-binding globulin (SHBG) in pathogenesis of metabolic syndrome (MetS) has been noted recently. However, reports of associations with serum adipocytokine levels are still limited. Therefore, we conducted this study to evaluate whether serum T and SHBG levels are independent predictors for the risk of MetS that are associated with adiponectin and leptin levels in 614 Taiwanese men over 40 years old collected from a free health screening. Subjects in the lowest quartile of TT and SHBG levels are exposed to a 1.58 and 3.22 times risk of developing MetS, as compared to those in the highest quartile of TT and SHBG levels. However, SHBG retains its significance independent of TT as a MetS risk predictor, but not vice versa. In addition, SHBG was significantly correlated with both adiponectin and leptin levels even after adjusting for TT levels. In conclusion, SHBG served as a major predictor for the risk of MetS and was correlated with serum adiponectin and leptin levels that are independent of T. Further studies are needed to elucidate the true role of SHBG in the pathogenesis of MetS and possible mechanisms associated with serum adiponectin and leptin levels.

Objective: Nephroureterectomy with bladder cuff excision is the current gold standard for the treatment of upper-tract urothelial carcinoma (UTUC). Currently, routine follow-up cystogram is performed prior to Foley catheter removal to evaluate the bladder cuff excision wound. The aim of this study was to investigate the role of the postoperative cystogram in the bladder cuff excision procedure. Materials and methods: This was a retrospective study of 193 patients diagnosed with UTUC post nephroureterectomy and bladder cuff excision between January, 2010, and January, 2016. Patient demographics, performance of cystogram, types of bladder cuff excision, and postoperative outcomes were recorded. Patients were classified into two groups depending on whether or not routine postoperative cystogram was performed. Results: A total of 125 patients were included in this study and, of these, 102 patients underwent routine cystogram on Postoperative Day 7 (Group 1), while 23 patients underwent Foley catheter removal on Postoperative Day 7 without any imaging studies (Group 2). Univariate analysis showed no differences in age, sex, comorbidities, surgical approach, or stage of the primary tumor. No patient from either group had urinoma, pelvic abscesses, and tumor growth from bladder cuff wound was not observed in any patient within the 1-year postoperative follow-up period. Both groups of patients had a similar rate of postoperative urinary tract infections with sepsis (p = 0.639), time to Foley catheter removal (p = 0.630), time to drainage tube removal (p = 0.264), and length of hospitalization (p = 0.373). Conclusion: Foley catheter removal on Postoperative Day 7 after nephroureterectomy with bladder cuff excision without routine cystogram appears to be safe in the majority of the UTUC patients. A large, multi-institutional study is required before this method can be recommended for widespread clinical practice.

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

Objective: A urethral stricture is the narrowing of the urethra caused by scar formation. The etiologies include infection, trauma with total urethral disruption, and iatrogenic procedures. The impact of urethral stricture diseases is very high. Several kinds of endoscopic procedures have become available for managing the disease. Among them, complete obliteration of the urethra during endoscopic procedures remains a challenge for surgeons. We describe a modified procedure in which laser urethrotomy was guided under the light source from an antegrade flexible cystoscope for treating a short completely obliterated urethra. This procedure is indicated if the obliterated segment is less than 10 mm because longer strictures may increase the chance of extra false lumen formation and bleeding. Materials and Methods: Forty-three male patients who underwent optical urethrotomy for urethral strictures at Kaohsiung Municipal Ta-Tung Hospital (Kaohsiung, Taiwan) between March 2013 and January 2015 were induced in the study. Five of these patients were diagnosed as having complete urethral obliteration. Results: In all five patients with a completely obliterated urethra, retrograde laser incision was performed successfully. Three patients had total bulbar urethral obstruction and two had penile obstruction. All patients experienced improved urination after the procedure. Conclusion: Our preliminary data showed that our modified method for treating a completely obliterated urethra yielded satisfactory results. Long-term follow-up and large-scale studies should be conducted to better examine technique efficacy; however, our current results regarding the simple modification of endoscopic urethrotomy seem promising.

Abstract An infectious disease with obstructive hydronephrosis, pyonephrosis causes suppurative destruction of the renal parenchyma. In such cases, retrograde ureteric stenting is considered a good choice for the drainage of pyonephrosis, as an alternative to percutaneous nephrostomy and nephrectomy. The complication rate is minimal in retrograde ureteric stenting compared with about 4% in percutaneous nephrostomy.

Objective: The necessity of bone scans in newly diagnosed prostate cancer patients is still a matter of debate. We attempt to evaluate the validity of currently published guidelines by analyzing bone scan results in newly diagnosed prostate cancer (PCa) patients to determine the optimal staging strategies. Materials and methods: Between January 2011 and July 2014, there were 362 consecutive newly diagnosed PCa patients at Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. Bone scans were performed for all patients at initial staging. Patients positive for bone metastasis were characterized at diagnosis in terms of age, prostate-specific antigen (PSA) level, Gleason score (GS), and clinical stage. We analyzed the sensitivity and specificity of the American Urological Association (AUA) best practice policy, European Association of Urology guidelines, National Comprehensive Cancer Network guidelines, and the classification and regression tree by Briganti et al for diagnostic performance in predicting bone metastasis. Results: A total 73 of 362 (20.2%) patients were diagnosed with bone metastasis. Patients positive for metastasis on bone scans had significantly higher PSA levels (median: 196.5 ng/mL, interquartile range: 904.3 vs. median: 18.5 ng/mL, interquartile range: 35.7; p

Upper tract urothelial carcinomas are tumors derived from urothelium along the urinary tract. Currently, there are no reliable biomarkers for their diagnosis or for prediction of tumor progression outcomes. It has a high incidence in Taiwanese populations at specific locations with exposure histories, and occurs relatively more frequent in the ureter than in the pyelocaliceal cavities. Radical nephroureterectomy with bladder cuff excision is the gold standard treatment for adequate local tumor control and better long-term survival. Despite optimal surgical treatment, the patient outcomes are still not satisfactory. An improved understanding of the biomolecular predictors is urgently needed to plan neoadjuvant/adjuvant therapy and proper follow-up strategies. In this study, a literature search was carried out through the PubMed database using the key words “upper tract urothelial carcinoma,” “prognostic factors,” and “outcome” from January 1985 to August 2015. The results showed that several preoperative clinical characteristics (such as chronic kidney disease, female sex, synchronous urothelial carcinoma of the bladder, and tumor location) and molecular markers (such as glutathione S-transferase, p53 protein, cyclooxygenase-2, TG-interacting factor, nuclear factor-kB, osteopontin, and hypoxia-inducible factor-1α) could serve as candidate biomarkers for the early detection of progression to upper tract urothelial carcinomas. Additional investigations of these results are required to resolve the gene combinations precisely and personalize the management of upper tract urothelial carcinomas.

Introduction: Docetaxel-based chemotherapy has been demonstrated to improve survival in patients with metastatic castration-resistant prostate cancer (mCRPC). The aim of this study is to analyze the possible prognostic factors associated with survival and to attract physicians' attention to high-risk patients. Material and methods: Thirty-nine consecutive patients with mCRPC who received docetaxel-based chemotherapy between July 2007 and November 2013 were enrolled in this study. The Kaplan–Meier curve was used to assess the association between prostate-specific antigen (PSA) response (defined as PSA level decreases ≥ 50%), and overall survival and cancer-specific survival. Cox regression analysis was performed to identify the independent significant predictors of overall survival and cancer-specific survival. Results: Twenty-one of the 39 patients (54%) experienced PSA response and the median overall survival was 13.51 months (range, 3–43 months). Patients with PSA response had longer time to PSA nadir level compared with patients without PSA response (p = 0.010). PSA response was an independent factor of overall survival and cancer-specific survival from Cox regression analysis (p = 0.014 and p = 0.05, respectively). In both univariate and multivariate analysis, cycles of chemotherapy, time to PSA nadir, and time to PSA progression were significant predictors for overall survival. Conclusion: The present study showed that PSA response demonstrated significance as a predictor for clinical outcome. However, Charlson comorbidity index (CCI) is not related to survival. A further prospective analysis is warranted.

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.

Torsion of undescended testis located within the inguinal canal is a rare entity, represents a surgical emergency, and must be dealt with immediately. We present a case of torsion of undescended testis in a 44-year-old man, who had progressive left inguinal pain for 2 days and in whom surgical exploration showed a twisted gangrenous testis. Orchiectomy was performed and pathological examination confirmed the diagnosis of testicular torsion. The English literature since 1978 was also reviewed to illustrate the clinical characteristics and current treatments.

Radical surgery (RS) with adjuvant chemotherapy (AC) or radiotherapy has been conventionally used for patients with advanced urothelial carcinoma (AUC). Recent research has indicated that systemic neoadjuvant chemotherapy (NC) with RS yields better outcomes than RS alone for patients with locally advanced bladder cancer. However, there are no reports indicating whether NC or AC would be beneficial for patients with AUC. The present study compared the survival rate for AUC patients receiving NC or AC. A retrospective analysis was conducted using data for 64 patients with AUC who underwent RS and systemic chemotherapy at our institution between March 2002 and March 2011. Of the 64 patients, 30 received NC before RS and 34 received RS followed by systemic AC. Pathologic stages (p=0.002), grades (p=0.018) and lymphovascular invasion (p=0.047) were significantly lower in the patients who received NC first than in those who received RC first. Furthermore, analysis of the surgical specimens revealed that 26.7% of patients who received NC before RS had complete remission. There were no significant differences in demographic data, surgical complications, and chemotoxicity between the two patient groups. The progression-free survival (PFS) and overall survival (OS) of patients who received initial NC were significantly better than those of patients who received initial RC (p=0.002 and 0.018, respectively). Our results indicate that NC administration before RS significantly improved the PFS and OS of AUC patients, without increasing surgical complications and chemotoxicity. Further prospectively controlled trials need to be conducted to confirm the effectiveness of NC for AUC patients.

Ammonium acid urate (AAU) urolithiasis is a rare condition; however, it is endemic in some countries, with an especially high incidence in Asia. This study was conducted to investigate the special presentation of patients with AAU urolithiasis in Taiwan. Reports of 3457 stones were retrospectively reviewed from January 2005 to January 2010 and 25 patients with urinary stones (0.7%) containing AAU crystals were identified. The clinical and biochemical presentation of all stones were compared to evaluate the specific comorbidities of AAU stones. AAU stones were observed in 11 males (44%) and 14 females (56%) with a mean age of 60.60 ± 16.81 years and mean body mass index of 25.55 ± 3.73 kg/m2. AAU stones were frequently observed in the bladder (44%) and they were significantly larger (mean size 1.90 cm) than the non-AAU stones (mean size 1.22 cm). Other significant comorbidities of AAU stones included chronic kidney disease (CKD) (60%), urinary tract infections (UTIs) (52%), irritable bowel syndrome (IBS) (36%), and gout (28%). In addition, there were also three patients with coexisting urothelial carcinoma (12%) in the AAU-stone group. Patients with AAU urolithiasis were predominantly female, older in age, had increased bladder presentation, larger stones and a high percentage of coexisting CKD, UTIs, IBS, gout, and even urothelial carcinoma. Therefore, it is important for clinicians to evaluate and protect renal function in patients with AAU urolithiasis.

To investigate the impact of preoperative hydronephrosis and flank pain on prognosis of patients with upper tract urothelial carcinoma.In total, 472 patients with upper tract urothelial carcinoma managed by radical nephroureterectomy were included from Kaohsiung Medical University Hospital Healthcare System. Clinicopathological data were collected retrospectively for analysis. The significance of hydronephrosis, especially when combined with flank pain, and other relevant factors on overall and cancer-specific survival were evaluated.Of the 472 patients, 292 (62%) had preoperative hydronephrosis and 121 (26%) presented with flank pain. Preoperative hydronephrosis was significantly associated with age, hematuria, flank pain, tumor location, and pathological tumor stage. Concurrent presence of hydronephrosis and flank pain was a significant predictor of non-organ-confined disease (multivariate-adjusted hazard ratio = 2.10, P = 0.025). Kaplan-Meier analysis showed significantly poorer overall and cancer-specific survival in patients with preoperative hydronephrosis (P = 0.005 and P = 0.026, respectively) and in patients with flank pain (P < 0.001 and P = 0.001, respectively) than those without. However, only simultaneous hydronephrosis and flank pain independently predicted adverse outcome (hazard ratio = 1.98, P = 0.016 for overall survival and hazard ratio = 1.87, P = 0.036 for and cancer-specific survival, respectively) in multivariate Cox proportional hazards models. In addition, concurrent presence of hydronephrosis and flank pain was also significantly predictive of worse survival in patient with high grade or muscle-invasive disease. Notably, there was no difference in survival between patients with hydronephrosis but devoid of flank pain and those without hydronephrosis.Concurrent preoperative presence of hydronephrosis and flank pain predicted non-organ-confined status of upper tract urothelial carcinoma. When accompanied with flank pain, hydronephrosis represented an independent predictor for worse outcome in patients with upper tract urothelial carcinoma.

Metabolic syndrome (MetS) confers increased risks of cardiovascular disease (CVD). Both vitamin D3 and adipocytokines (especially adiponectin and leptin) have a great impact on CVD and MetS. In vitamin D3 metabolism, the vitamin D3 25-hydroxylase (CYP27A1) and 25-hydroxyvitamin D3 1-alpha-hydroxylase (CYP27B1) are two key enzymes. This study aimed to examine the influence of vitamin D3 CYP27 single nucleotide polymorphisms (SNPs) on adipocytokines and MetS. Cross-sectional data and DNA samples were collected from male volunteers (n=649, age: 55.7 ± 4.7 years). Two tagging SNPs, CYP27A1 rs4674344 and CYP27B1 rs10877012, were selected from the HapMap project. MetS was significantly associated with the CYP27A1 rs4674344 SNP (P=0.04) and the ratio of adiponectin/leptin (A/L ratio) was most correlated to the CYP27A1 rs4674344 SNP, appearing to be significantly lower in T-carriers than in AA subjects (3.7 ± 4.0 versus 5.1 ± 6.0, P=0.001) and significantly negatively associated after adjustment. For each MetS component associated with the CYP27A1 rs4674344 SNP, the A/L ratios were significantly negative in preclinical stage (condition not meeting the individual criteria), except the blood pressure. In conclusion, CYP27A1 rs4674344 SNP, A/L ratio, and MetS are significantly associated and T-carriers might have a higher risk of developing MetS due to low A/L ratios in the preclinical stage.

In addition to adipocytokines, estradiol (E2) and vitamin D have been reported to affect insulin sensitivity, glucose homeostasis and body weight. However, studies about the impact of E2 and vitamin D on metabolic syndrome (MetS) are still limited. The aim of this study is to clarify the roles of circulating E2 and vitamin D on the risk of MetS in middle-aged Taiwanese males. A total of 655 male volunteers, including 243 subjects with MetS (mean age: 56.7±5.8 years) and 412 normal controls (mean age: 55.1±3.6 years), were evaluated. Subjects with MetS had significantly lower circulating E2, 1,25(OH)2D3, and adiponectin, and higher leptin than those without MetS (P

Although most advanced prostate cancer patients respond to androgen-deprivation therapy (ADT), the efficacy is widely variable. We investigated whether the host genetic variations in sex hormone pathway genes are associated with the efficacy of ADT. A cohort of 645 patients with advanced prostate cancer treated with ADT was genotyped for 18 polymorphisms across 12 key genes involved in androgen and estrogen metabolism. We found that after adjusting for known risk factors in multivariate Cox regression models, AKR1C3 rs12529 and AR-CAG repeat length remained significantly associated with prostate cancer-specific mortality (PCSM) after ADT (P ≤ 0.041). Furthermore, individuals carrying two unfavorable genotypes at these loci presented a 13.7-fold increased risk of PCSM compared with individuals carrying zero (P

Several genome-wide association studies (GWAS) have been conducted to identify the common single nucleotide polymorphisms (SNPs) that influence the risk of prostate cancer. It was hypothesized that some prostate cancer-associated SNPs might relate to the clinical outcomes in patients treated for prostate cancer using androgen-deprivation therapy (ADT). A cohort of 601 patients who have received ADT for prostate cancer was genotyped for 29 SNPs that have been associated with prostate cancer in Cancer Genetic Markers of Susceptibility GWAS, and within the genes that have been implicated in cancer. Prognostic significance of these SNPs on the disease progression, prostate cancer-specific mortality (PCSM) and all-cause mortality (ACM) after ADT were assessed by Kaplan-Meier analysis and Cox regression model. Three SNPs, namely CASP3 rs4862396, BMP5 rs3734444 and IRS2 rs7986346, were found to be closely associated with the ACM (P≤0.042), and BMP5 rs3734444 and IRS2 rs7986346 were also noted to be significantly related to the PCSM (P≤0.032) after adjusting for the known clinicopathologic predictors. Moreover, patients carrying a greater number of unfavorable genotypes at the loci of interest had a shorter time to ACM and PCSM during ADT (P for trend