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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.

The present study investigates the properties and use as wound-dressing materials of hydrogels made of negatively charged 3-sulfopropyl methacrylate (SA) and positively charged [2-(methacryloyloxy)ethyl]trimethylammonium (TMA) to form poly(SA-co-TMA) gels with/without a charge bias. Their actual chemical compositions were ascertained by XPS which revealed a fair control of the final gel composition obtained from the initial molar ratio in the reaction solution. Zeta potential measurements confirmed the controlled charge bias on which swelling ratio was found to strongly depend, i.e., positively charged or negatively charged gels have a higher tendency to swell than poly(SA-co-TMA) made of 50 mol% of each unit. The anti-biofouling properties were also correlated to the charge bias, i.e., negatively charged and neutral gels resisted well to biofouling by fibrinogen and whole blood, and were much less cytotoxic than their positive counterparts. Applied as wound-dressing materials onto diabetic wounds, it was found that wound closure was almost reached after 21 days, regardless of the gel composition. However, histological analysis revealed that positively charged gels accelerated hemostasis, while neutral gels, much less cytotoxic, were more efficient in the following stages during which the granulation layer and dermis were fully remodelled leading to a dense fibroblast population and thick collagen with no sign of inflammation. All in all, this study sheds light on the effects of charge bias on different wound healing stages and proves the efficiency of pseudo-zwitterionic poly(SA-co-TMA) to heal diabetic wounds for the first time.

Polydimethylsiloxane (PDMS) is extensively used in the field of biomaterials. However, its hydrophobicity still limits its range of applications and makes it prone to biofouling. Various techniques are currently utilized to overcome this limitation, but most of them reduce some of the PDMS prime characteristics, such as its mechanical strength and optical transparency. In this work, we employed an original two-step coating process to bypass harsh treatments on PDMS like UV–ozone or plasma treatment. A pre-coating step of tannic acid-Fe(III) complex was performed prior to the zwitterionization of the PDMS with poly(glycidyl methacrylate-co-sulfobetaine methacrylate) or poly(GMA-co-SBMA) by a “grafting-to” approach. Successful coating was evidenced by a decrease of the water-contact angle from 118° to 79°. The process was optimized, and the optimized coating condition led to a significant improvement of the PDMS biocompatibility while maintaining its mechanical property and optical transparency. In addition...

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.

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.

We describe the first case of severe palmar hyperhidrosis treated with single-incision subxiphoid thoracoscopic ablative sympathectomy, bilaterally, at T3 level. The single-incision subxiphoid thoracoscopic approach required only a 2-cm incision in the upper abdomen. In addition, the technique does not cause postoperative intercostal neuropathy and postoperative pain is minimal as the intercostal space is bypassed. Total operative time was ∼60 min and the volume of blood loss was 10 ml. The patient was discharged from the hospital the next day with complete remission of her symptoms. Excess palmar sweating released after operation and there was no compensatory sweating after a 6-month follow-up.

Regulatory factor X-1 (RFX-1) is a transcription factor that has been linked to negative regulation of tumor progression; however, its biological function and signaling cascades are unknown. Here, we performed several studies to elucidate the roles of RFX-1 in the regulation of SHP-1 in hepatocellular carcinoma (HCC) cells. Overexpression of RFX-1 resulted in the activation of SHP-1 and repressed colony formation of HCC cells. In addition, by a mouse xenograft model, we demonstrated that RFX-1 overexpression also inhibited the tumor growth of HCC cells in vivo, suggesting that RFX-1 is of potential interest for small-molecule-targeted therapy. We also found that SC-2001, a bipyrrole molecule, induced apoptosis in HCC cells through activating RFX-1 expression. SC-2001 induced RFX-1 translocation from the cytosol to nucleus, bound to the SHP-1 promoter, and activated SHP-1 transcription. In a xenograft model, knockdown of RFX-1 reversed the antitumor effect of SC-2001. Notably, SC-2001 is much more potent than sorafenib, a clinically approved drug for HCC, in in vitro and in vivo assays. Our study confirmed that RFX-1 acts as a tumor suppressor in HCC and might be a new target for HCC therapy. The findings of this study also provide a new lead compound for targeted therapy via the activation of the RFX-1/SHP-1 pathway.

The biological properties of commercial pure titanium (cp-Ti) dental implants can be improved by surface treatment. In this study, the cp-Ti surfaces were prepared to enable machined surfaces (TM) to be compared to the machined, sandblasted, laser irradiated and dual-acid etched surfaces (TA). The surface elements and roughness were characterized. The biocompatibility was evaluated by cell and organ culture in vitro. The removal torque was measured in rabbit implantation. Surface characterization revealed that TA surface was more oxidized than TM surface. The TA surface had micrometric, beehive-like coarse concaves. The average roughness (2.28 mum) was larger than that typical of acid-etched surfaces. Extracts of both materials were not cytotoxic to bone cells. The morphology of cells attached on the TA surface was superior to that on the TM surface. TA promoted cell migration and repaired damaged bones more effectively in organ culture. The formation of bone-like nodules on TA disk exceeded that on TM disk. Rabbit tibia implantation also proved that TA implant had greater removal torque value. These results suggested that TA had good osteoconductivity and was a potential material for dental implantation.

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.