Taiwan Purpose Research Articles

Explore the characteristics of bladder function of the patients with pelvic organ malignancy

Explore the characteristics of bladder function of the patients with pelvic organ malignancy

Analysis of prostate cancer foci in patients with transrectal 10-core systemic random biopsy—Can we predict pathological stage of prostate cancer through trus biopsy?

Analysis of prostate cancer foci in patients with transrectal 10-core systemic random biopsy—Can we predict pathological stage of prostate cancer through trus biopsy?

Comparison of the post-operative infection by using different type of prophylactic antibiotics and placebo in healthy adult patients who underwent ureterorenoscopic surgery

Comparison of the post-operative infection by using different type of prophylactic antibiotics and placebo in healthy adult patients who underwent ureterorenoscopic surgery

Pituitary gland adenoma with hyperprolactinemia and male erectile dysfunction – A case report

Pituitary gland adenoma with hyperprolactinemia and male erectile dysfunction – A case report

Bacterial emphysematous prostatic abscess – A case report

s / Urological Science 26 (2015) 301e310 310 Materials and Methods: An 82 years old female patient presented to the Emergency Department with feeling unwell, pyrexia, gross hematuria, nausea and abdominal pain. She gave a history of type 2 Diabetes mellitus with regular follow-up in our hospital. A large right renal mass was detected near 4 years ago. However, she and family refused operation since then due to old age. On examination she looked weakness. A mass was palpable in the right upper quadrant and lumbar region. Liver and spleen were not palpable. There were no signs of peritonitis. Her pulse rate was 121/minute, BP 189/104 and temp 39.3 degree. She had blood tests in the Emergency Department which revealed the following: Hb 15.6 g/dL, WBC 11,400 and platelets 202,000. Electrolytes were as follows: Na 136 mmol/ litre, K 3.3 mmol/litre, BUN: 12, creatinine: 0.8, blood sugar: 213. Chest X ray showed 1) Mild coarse and crowding lung markings, some infiltration in bilateral lungs; but no focal active lung lesion. 2) Borderline cardiomegaly and mild tortuosity of aorta with some calcified atheroma plaques of aortic arch wall.. The patient had ultrasound scanwhich showed mass in the right kidney. Computerised tomography (CT) scan image of abdomen showed anterior upper pole tumor 9.5 x 12 x9.0 cm in size with heterogeneous enhancement and area of necrosis. Extension to perirenal fat and renal sinus fat but not Gerota fascia. Positron emission tomography (PET) revealed: 1. F-18 FDG avid lesion in the left thyroid, malignancy should be considered. 2. Right paraaortic lymph node metastases should be considered. She underwent right-side radical nephrectomy after full staging procedures and appropriate investigations. NDP32: BACTERIAL EMPHYSEMATOUS PROSTATIC ABSCESS e A CASE REPORT Chih-Cheng Lu, Wen-Chou Fan. Division of Urology, Department of Surgery, Chi Mei Medical Center, Liouying, Tainan, Taiwan Purpose: We present a case of emphysematous prostatic infection complicated with multiple organs abscess by Klebsiella pneumoniae. Materials and Methods: A 47 year-old male patient suffered from uncontrolled diabetes. Four days before admission, he had fever and general weakness. He visited our emergent department after empirical treatment at local clinic. After admission, intensive care was given due to diabetic ketoacidosis and septic shock. Although multiple drains for liver and lung, spiking fever persisted. Sequential CT showed air and abscess in the prostate region. Urgent transurethral prostate incision was done to drain the abscess. Afterwards, the general condition became stable. He was discharged with oral antibiotics and antidiabetic drugs. After one year followup, the patient kept uneventful condition with tight diabetic control. Conclusion: Emphysematous prostatic abscess is an unusual acute disease with high morbidity and mortality. The predisposing factors include diabetes mellitus, hepatic cirrhosis, and intravesical obstruction. CT provides a good tool for immediate diagnosis. Treatment of prostatic abscess includes parenteral antibiotics and abscess drainage. Transperineal needle aspiration, transrectal needle aspiration, open perineal incision, and transurethral resection or unroofing are available routes for drainage.

Outcomes of low-risk prostate cancer with robotic-assisted laparoscopic radical prostatectomy in our center

s / Urological Science 26 (2015) 294e300 300 female subjects. The hazard ratio (HR) of hysterectomy in non-IC/BPS cohort compare with IC/BPS cohort is 2.932 (95% CI1⁄4 2.018-4.261, p1⁄4 .000) after controlling the age and five comorbidities by Cox regression analysis Conclusions: Our results imply us that the incidence of hysterectomy was lower, instead of higher, in PBS/IC female patient after PBS/IC diagnosed in these matched subjects. That is, PBS/IC is a protective factor of hysterectomy for Taiwan female. The incidence of hysterectomy of PBS/IC female patient before PBS/IC diagnosed should be further investigated to clarify the relationship between PBS/IC and hysterectomy. MP4-5: OUTCOMES OF LOW-RISK PROSTATE CANCER WITH ROBOTIC-ASSISTED LAPAROSCOPIC RADICAL PROSTATECTOMY IN OUR CENTER Keng-Kok Tan, Kun-Hung Shen, Chien Liang Liu, Steven K. Huan. Division of Urology, Department of Surgery, Chi Mei Medical Center, Taiwan Purpose: In prostate cancer, very low-risk tumors are often managed well with active surveillance, low to intermediate-risk tumors generally respond well to localized treatment (surgery or radiation alone, brachytherapywith or without external-beam therapy). Intermediate to high-risk tumors often require multimodal therapy (surgery with radiation, or radiation therapy with hormonal therapy). All available treatments for prostate cancer carry a risk of complications, side effects, and other impacts to the patient's long-term quality of life. Therefore, some practice suggested active surveillance in low-risk patient to avoid over treatment and complication. However, new surgical technique and instrument development, there can decrease surgical complication and improve patient outcome. We present the outcome of low-risk prostate cancer with robotic-assisted laparoscopic radical prostatectomy (RALRP) in our institution. Materials and Methods: From April 2012 to August 2015, 128 male patients with prostate cancer underwent RALRP in Chi Mei Medical Center. We follow the NCCN prostate cancer treatment guideline in our clinical practice. Patient characteristics, DRE, PSA, Gleason score, preoperative clinical staging, postoperative data and outcomes including final pathological staging, continence, potency, biochemical recurrence, postoperative complications and surgical margins were analyzed. Results: Only 7 patients are low risk group, the rest of 121 patients are intermediate, high and very high risk group. The average age of the low risk patients was 65.3 years (47~73). Pre-op mean PSA was 4.65 ng/ml (1.8~5.59), only 2 patients had palpable hard nodule while DRE, Gleason score were (3+3) in 6 patients and (2+2) in 1 patient. Post operation pathology showed margin free in all 7 cases, but 4 patients up-staging to T2c, 5 patients had total Gleason score 7 points and 6 patients shift to intermediate risk group compare to pre-op evaluation. After 6 weeks of surgery, PSA decrease to <0.01 ng/ml in all patient and during mean f/u times 19 months (9~33), no biochemical recurrence was noted. Conclusion: Although pre-op are low-risk group, but we found that more than half of the patient showed up-staging and up-grading after operation. Due to the robotic assisted system development, less complication and better outcome can be expected. May by operation can provided better oncology outcome in low-risk prostate cancer patient. MP4-6: ESWL POTENTIALLY IMPROVE RENAL FUNCTION IN UROLITHIASIS INTERVENTION. AN EXPERIENCE FROM SHOW CHWAN MEMORIAL HOSPITAL Wong Jin-Kiong , Lin Mao-Sheng , Lin Ta-Chong , Wang ChienHsiang , Chou chih-yuan , Wu Chyi-Hsiang , Hsih Hui-Lung , Chen Chao-Chih . Department of Urology, Chang Hua Show Chwan Memorial Hospital, Taiwan; Department of Urology, Chang Bin Show Chwan Memorial Hospital, Taiwan; Department of Urology, Chu Shang Show Chwan Memorial Hospital, Taiwan; 4 Sun Mei Urology Clinic, Taichung,

Pearls, tricks, and quirks of the reconstruction for hypospadias and chordee

s / Urological Science 26 (2015) 294e300 297 Can that save the cost with avoidance of repeated semen analysis if the first semen analysis had nonmotile sperm density <100,00/ml. Materials and Methods: From Jan 2010 to Dec. 2014 a total of 419 men underwent vasectomy for birth control in our hospital. Patients demographics and postvasectomy semen analysis results were collected retrospectively. Results: During the period of recent 5 years, 419 patients underwent vasectomy in our hospital. Most of the patients has 2 or more children after marriage. Postvasectomy semen analysis was completed within the 3-6 months after surgery. No patient has motile sperm in their PVSA. Few patients had nonmotile sperm with the concentration <100,000/ml (AUA clearance parameter). Repeated semen analysis confirm the azospermia later. The cost saving is not high. Conclusion: The AUA special clearance parameter is not applied in our hospital. The cost saving is not efficacy than the compensation of legal problem. So repeated semen analysis is still warranted in our hospital until azospermia confirmed. MP2-6: PEARLS, TRICKS, AND QUIRKS OF THE RECONSTRUCTION FOR HYPOSPADIAS AND CHORDEE Jesun Lin , Herng-Jye Jiang , Jian Ting Chen , Bai-Fu Wang , Chin-pao Chang , Mon-I. Yen , Sheng-Hsien Huang , Hon-Jen Shi , Ming-Chih Chou . Division of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan; 2 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan Purpose: We reviewed our 33 years experience in the management of hypospadias, chordee and their complications after reconstruction in order to understand their presenting Problems. We would recommend the factors of successful techniques for this congenital disease of penis. Materials and Methods:We reviewed the records of 998 hypospadias and chordee patients between January 1981 and December 2014. The complications after reconstruction might be single or combined with several presenting problems in the same patient. This article represents a collection of recommendations, technical nuances, and innovative management techniques that have been found to contribute to the success of hypospadias and chordee surgery. We would classify the main problems of complications to be (1) 89 urethrocutaneous fistulae, (2) 36 urethral strictures, (3) 15 meatal stenosis (4) 38 remaining chordee, (5) 14 diverticula and (6) 6 hairy urethra. The penile shaft and perineum fistulae were repaired with the “pants-over-vest urethroplasty modified to the procedure of Turner-Warwick. The coronal fistulas were converted into repair for coronal hypospadias. The remaining urethral plate was tubularized with or without a relaxing midline incision (Reddy-Snodgrass). We wrapped dorsal dartos or subcutaneous flap to cover the neourethra for preventing urethrocutaneous fistula. The meatal stenosis was performed with dorsal meatotomy, Y-V glans flap, meatal skin graft and transverse meatotomy. Residual chordee were performed with dorsal plication, excision the chordee, the urethral diverticula were excised and tailored for redo-urethroplasty. Hairy urethra were resected and then urethroplasty. We performed double-tube stent and vacuum drain in subcutaneous layer for prevention of bladder spasm, hematoma and infection. Results: The over all successful rate is 85% in one stage surgery for the fresh cases. The number of redo-operations for their presenting problems of complications ranged from 1 to 8 attempts. The successful rate for urethrocutaneous fistula is 76%, for urethral strictures is 82%, for meatal stenosis is 70%, for chordee is about 70%, for diverticula is about 85%, for the hairy urethra is about 70%. We followed up the outcome of consequent surgery from 6 months to more than ten years. Conclusions: The successful surgery of the hypospadias, chordee redo operation for them requires radical correction of all deformities. It is true that“Experience is by far the best teacher. It might be said that unless the technique and subsequent good results of an individual method are transferable to others, the technique as taught is suspect”said by Dr. John W. Duckett. Moderated Poster-3

Synovial sarcoma of the penis: A case report

s / Urological Science 26 (2015) 294e300 298 MP3-3: SYNOVIAL SARCOMA OF THE PENIS: A CASE REPORT Chao-An Chen , Kam-Fai Lee , Kuo-Cai Huang , Kuo-Hsiung Chiu , TzuHsin Yang , Yin-Lun Chang , Jian-Hui Lin , Yung-Chin Huang , Dong-Ru Ho , Chih-Shou Chen , Wei-Yu Lin . Division of Urology, Department of Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Anatomic Pathology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan Purpose: Primary synovial sarcoma of the penis is extremely rare. We report a case of synovial sarcoma initially discovered as a painless penile mass with no image evidence of distal metastasis. Synovial sarcoma was reported in the final pathology. Materials and Methods: A 59-year-old male patient is a case of panic disorder under alprazolam treatment for 4 years. He came to our outpatient department for gradual enlargement of penile mass in recentmonths. He is a married man without circumcision. The mass was painless, spherical, and movable over penile base, without skin abnormality or infection signs. Computed tomography revealed a 3.2 cm hypodense mass lesion over left side of corpus cavernosum without enlargement of pelvis or retroperitoneal lymph nodes. Partial penectomy with bilateral inguinal lymph node dissection was performed. Synovial sarcoma within tunica abluginea (pT2) was reported in the final pathology. Results: To our knowledge; this is the first case of primary synovial sarcoma of penis in Taiwan. MP3-4: ADENOCARCINOMA OF URINARY BLADDERe A CASE REPORT Ping-Hao Tsai, Heng-Chieh Chiang, Pao-Hwa Chen. Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan This 78 years old manwho was under regular follow-up post transurethral rsection of prostate gland. During last cystoscope, tumor biopsy was done and the pathologic report reveal possibility of urothelial carcinoma with glandular differentiation, which primary adenocarcinoma or secondary adenocarcinoma involvement especially colorectal origin may be consideration on July, 2015. Afterward, we arranged MRI for tumor staging and it reveals T3N0M0, Stages III. Then, after explain to patient, transurethral resection of bladder tumor was performed on Aug, 2015. The final pathologic report reveals adenocarcinoma arising from urinary bladder. We also arranged colon scope which reveals negative finding. PET scan reveals no uptake for gastrointestinal tract. As exclude colorectal origin of adenocarcinoma, patient is under radiotherapy and chemotherapy for adneomcarcinoma currently. MP3-5: ASSOCIATION BETWEEN HUMAN GLUTATHIONE S-TRANSFERASE OMEGA RS4925 POLYMORPHISM AND BLADDER CANCER Zhon-Min Huang , Jow-Yu Sheu , Min-Che Tung , Chia-Chang Wu, Yuan-Hung Wang . Divisions of Urology, Department of Surgery, Tungs’ Taichung Metro Harbor Hospital, Taichung, Taiwan; Divisions of Urology, Shuang Ho Hospital, Taipei Medical University New Taipei City,

Robotic-assisted laparoscopic partial nephrectomy for small renal cell carcinoma: Chi Mei Medical Center experience

Robotic-assisted laparoscopic partial nephrectomy for small renal cell carcinoma: Chi Mei Medical Center experience

Management of ureteral obstruction with daVinci laparoscopic surgery

Management of ureteral obstruction with daVinci laparoscopic surgery

Our experience of tissue glue injection in tubeless percutaneous nephrolithotomy

Our experience of tissue glue injection in tubeless percutaneous nephrolithotomy

Management of erectile dysfunction in patients who failed prior vascular intervention

Management of erectile dysfunction in patients who failed prior vascular intervention

Synchronous ipsilateral renal cell carcinoma and urothelial carcinoma of kidney or ureter: Cases report and literature review

Synchronous ipsilateral renal cell carcinoma and urothelial carcinoma of kidney or ureter: Cases report and literature review

Robotic-assisted partial nephrectomy for hilar and non-hilar tumors: Perioperative ouctomes

Robotic-assisted partial nephrectomy for hilar and non-hilar tumors: Perioperative ouctomes

The impact of pseudephedrine on lower urinary tract symptoms in male patients without concomitant voiding dysfunction

The impact of pseudephedrine on lower urinary tract symptoms in male patients without concomitant voiding dysfunction

Is there necessary to perform ureterectomy in renal cell carcinoma treatment

Is there necessary to perform ureterectomy in renal cell carcinoma treatment

Postoperative outcomes and safety of bipolar transurethral enucleation and resection of the prostate

Postoperative outcomes and safety of bipolar transurethral enucleation and resection of the prostate

Stone component analysis of 1000 patients in yi-lan county

Stone component analysis of 1000 patients in yi-lan county

Rare giant bladder stone with the size of an adults' fist in healthy young male

Rare giant bladder stone with the size of an adults' fist in healthy young male

Comparison of surgical intervention and non-surgery result in early prostate cancer

s / Urological Science 26 (2015) S50eS81 S57 The operation began with 7ecm midline incision above the umbilicus. A small hole of cystic wall was created and more than 6 L of yellowish clear fluid was drained. The hand-assisted device was placed in midline wound. While other two 10-mm trocar were placed in left lower abdomen and left anterior axillary line subcostally. The membrane of cyst was dissected as much as possible. Nephropexy was done to attach migrating left kidney to the back of the abdominal wall. The postoperative course was uneventful and the patient was discharged 3 days after the operation. Intravenous urography done 3 months later showed normal kidney position and bilateral patent ureters. Discussion: A huge renal cyst measuring more than 15 cm is an extremely rare. Cases presenting simply with progressive abdominal distention can lead to misdiagnosis, such as obesity or ascites. In our case, huge left renal cyst caused left kidney migration to right side, leading to initial misdiagnosis of right acute pyelonephritis. Surgery has been considered the mainstay of treatment for giant cyst. We performed hand assisted laparoscopic renal cyst unroofing and nephropexy with uneventful postoperative course and good outcome. NDP028: UNUSUAL URETHRAL FOREIGN BODIES Wei-Chung Hsiao , Sung-Lang Chen , Yu-Lin Kao , Wen-Jung Chen , Tzuo-Yi Hsieh , Shao-Chuan Wang . Division of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan; 2 Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan Purpose: Urethral foreign bodies are uncommon clinical conditions. Most of the foreign bodies are self-introduced under the circumstances of autoerotic impulses, sexual curiosity, psychiatric illness, or rarely migration from adjacent organs. Retrieval of the urethral foreign body is casespecific due to wide variety of foreign bodies. Materials and Methods: A 75-year-old man was sent to emergency department after a motorcycle accident. Serial examinations including pelvic radiography and computed tomography discovered 5 fishhooks within the urethra unexpectedly. Ingrowth into urethral mucosa of the fishhooks with related inflammatory process was noted. Due to complexity of the fishhook position and pelvic fracture condition, cystourethroscopic retrieval of the foreign bodies was performed successfully in a two-step manner. Results: Self-inflicted urethral foreign bodies have a very low incidence. Major complications of urethral foreign bodies include trauma, infection, urine retention, and urethral stricture. Most of the foreign bodies of lower urinary tract can be treated with endourological modalities. The key point of urethral foreign body extraction relies on its physical attributes and morphology with the purpose of minimal urothelial injury. Conclusion: The urethral foreign bodies could be removed successfully by cystourethroscopic procedure without any complication, even in the presentation of mucosal ingrowth.