Trifecta outcome of ureteral reconstruction in iatrogenic injury and non-iatrogenic ureteral lesions: a 10-year experience at a tertiary referral center.

PURPOSE: To analyze the trifecta outcome (functional, anatomical, and surgical aspects) of surgical reconstruction for ureteral lesions and investigate the factors affecting the success rate of such reconstruction. METHODS: We retrospectively reviewed the data of patients who underwent ureteral reconstruction at our institute between March 2007 and November 2016. Patient profiles, surgical methods, complications, ureteral stenting, laboratory data, and image studies were collected. The trifecta outcome was defined as preserved renal function, no progression of hydronephrosis, and no long-term stenting. The primary endpoint was the percentage of patients who achieved the trifecta outcome. The secondary endpoint was risk factors for trifecta outcome failure. RESULTS: We retrospectively reviewed 178 adult patients who had undergone ureteral reconstruction. The median follow-up period was 37.4 months. In total, 70 (39.3%) patients had iatrogenic ureteral injuries and 108 (60.7%) patients had non-iatrogenic ureteral lesions. Overall, 70% of the patients achieved the trifecta outcome after ureteral reconstruction. A multivariate analysis revealed that risk factors for trifecta failure were malignant diseases [odds ratio (OR) 2.93, p = 0.005], a history of pelvic radiation (OR 3.08, p = 0.032), preoperative estimated glomerular filtration rate < 60 (OR 2.52, p = 0.039), and a type of reconstruction ureteroureterostomy (OR 2.99, p = 0.014). CONCLUSIONS: Trifecta outcome could be used to evaluate the ureteral reconstruction in iatrogenic injury and non-iatrogenic ureteral lesions. This study revealed several risk factors that affected the trifecta outcome.

Rapid differentiation of cocci/mixed bacteria from rods in voided urine culture of women with uncomplicated urinary tract infections.

OBJECTIVES: To evaluate the ability of laser flow cytometry to predict cocci/mixed growth in the pre-analytical phase of urine specimens. METHODS: We retrospectively reviewed urine samples from women with uncomplicated urinary tract infections from urologic clinics for study. Urine analyses were performed with laser flow cytometry (UF1000i, Sysmex, Kobe, Japan) and then diagrams were generated (forward scatter vs. fluorescent light scatter). Each specimen (bacteria count >357 BACT/µL) was classified as either cocci bacteria or rods/mixed growth according to the diagrams. Standard urine cultures were performed, and the agreement between cultures and the UF1000i interpretations was analyzed with kappa statistics. RESULTS: Finally, 491 specimens met the criteria for analysis. Among the 376 specimens with single bacteria growth, there were 26 gram-positive cocci (13 Streptococci spp., 7 Staphylococci spp., 6 Enterococci spp.), 1 gram-positive rods (Corynebacterium spp.), and 349 gram-negative rods (273 Escherichia coli, 33 Klebsiella spp., 29 Proteus spp., 6 Citrobacter spp., 4 Enterobacter spp., 3 Pseudomonas spp., and 1 Providencia spp.). There were 115 specimens with two bacteria species or more that were regarded as mixed growth. Agreement of rods or cocci/mixed growth between the laser flow cytometry and urine cultures yielded a kappa value of 0.58. The positive and negative predictive rate of the UF1000i for cocci/mixed growth in voided urine culture was 81.8% and 84.7%, respectively. CONCLUSIONS: Through laser flow cytometry, we can predict growth of cocci/mixed growth in the pre-analytical phase of urine culture, thus avoiding unnecessary urine culture and waiting time.

Obese children at higher risk for having overactive bladder symptoms: a community-based study.

AIMS: To investigate the association between obesity and lower urinary tract symptoms (LUTS) in healthy children. METHODS: Healthy community children (5-12 years) were enrolled to evaluate LUTS and voiding function, and classified by body mass index as being of normal weight, overweight, or obese. A questionnaire was completed by one parent of each child and included baseline characteristics, Dysfunctional Voiding Symptom Score, obstructive sleep apnea-related symptoms, stressful events, and nocturnal enuresis status in the past months. Overactive bladder (OAB) was defined by an urgency symptom score of ≥ 2. Monosymptomatic nocturnal enuresis (MNE) was defined as nocturnal enuresis without either OAB or daytime incontinence. RESULTS: A total of 838 children (mean age, 8.0 ± 2.0 years) were eligible for analysis. The prevalence of overweight and obesity was 14.0% and 10.7%, respectively, without gender disparity. Obese children had higher urgency symptom score than children of normal weight (0.87 ± 1.00 vs. 0.60 ± 0.87; P = 0.03). Multivariate analysis showed that significant risk factors for OAB were younger age (OR, 1.17; 95% CI, 1.06-1.29) and obesity (OR, 1.97; 95% CI, 1.14-3.40), while not gender, overweight, obstructive sleep apnea-related symptoms, and stressful events. Statistically significant risk factors for MNE were younger age and stressful events, while not obesity. CONCLUSIONS: Obese community children were at a higher risk of having OAB while not for MNE.

Reliability and Validity of a Chinese Version of Urinary Tract Infection Symptom Assessment Questionnaire.

OBJECTIVES: Our study evaluates the reliability and validity of a Chinese version of the Urinary Tract Infection Symptom Assessment questionnaire (UTISA). MATERIAL AND METHODS: Our study enrolled women who were diagnosed with uncomplicated urinary tract infection (uUTI) at clinics. The Chinese version of UTISA was completed upon first visit to the clinic for uUTI and at 1-week follow-up. We enrolled 124 age-matched women without uUTI from the community as the control group. The UTISA consists of 14 items (seven symptom items and seven related to quality of life), with each item scoring 0 to 3. The internal consistency was assessed with Chronbach's alpha test. Factor analysis was used to classify symptoms into latent factors. The predictive validity was analyzed by using logistic regression and Receiver Operating Characteristic (ROC) curve analysis. RESULTS: Mean total symptom scores of the UTISA in the 169 cases and 124 controls were 8.9 ± 4.6 and 1.4 ± 2.4, respectively (p < 0.01). The alpha coefficient was 0.77, showing a homogeneous composition of symptoms. At a cut-off value of greater than 3, the UTISA symptom score had good predictive value for uUTI (sensitivity of 87.0%, and specificity of 93.1%). Factor analysis revealed two latent variables: 1) lower urinary tract symptoms and 2) physical symptoms. Among the seven items, we found that urinary frequency (OR = 2.6), dysuria (OR = 5.0), sense of incomplete emptying (OR=2.0), and hematuria (OR=7.6) were significant predictors for uUTI. CONCLUSIONS: The Chinese version of UTISA is reliable to predict uncomplicated UTI in women with an optimal cut-off point at > 3.

The Tzu Chi nomograms for maximum urinary flow rate (Qmax ) in children: comparison with Miskolc nomogram.

OBJECTIVE: To report the first ranking method-based age- and gender-specific nomograms for maximum urinary flow rate (Qmax ) in children. PATIENTS AND METHODS: Healthy children aged 4-12 years were enrolled for two sets of uroflowmetry tests. The first and the higher value of the two consecutive Qmax of each child with a voided volume (VV) of ≥50 mL were included for establishing single- and dual-Qmax nomograms. Children with possible urinary tract infection or lower urinary tract dysfunctions were excluded. RESULTS: In all, 1128 children (583 boys and 545 girls) with a mean (sd) age of 7.7 (2.2) years were eligible for analysis and construction of nomograms. Multivariate analysis showed that the Qmax was significantly affected by age, VV and gender (all P < 0.01). The values of the corresponding percentile of the Qmax were significantly higher in the dual-Qmax nomogram compared with the single-nomogram. In boys aged 8-12 years, the 5th percentile line of the Miskolc nomogram was significantly lower than that of the present nomograms at all VVs. Minimally acceptable Qmax values, around the 10th percentile of the dual-Qmax nomogram, were >11.5 mL/s in children aged ≤6 years and >15.0 mL/s in children aged ≥7 years. External validation is required for the present dual-Qmax nomograms. CONCLUSION: We recommend repeating uroflowmetry in cases with a Qmax lower than the minimally acceptable age- and gender-specific Qmax values.

Prostate volume did not affect voiding function improvements in diode laser enucleation of the prostate.

PURPOSE: We compared safety and surgical outcomes in patients with different prostate sizes treated with diode laser enucleation of the prostate. MATERIALS AND METHODS: From 2008 to 2012 consecutive patients with benign prostatic obstruction undergoing diode laser prostate enucleation at our institution were enrolled for analysis. A single surgeon performed diode laser prostate enucleation with an end firing, continuous wave diode laser (980 nm). Based on preoperative prostate volume on transrectal ultrasound, patients were stratified into 2 groups, including group 1-65 with less than 60 ml and group 2-55 with 60 ml or greater. Baseline and perioperative characteristics, and postoperative surgical outcomes were compared between the 2 groups. RESULTS: A total of 120 men with a mean ± SD age of 70.2 ± 9.0 years were enrolled for analysis. Compared with group 1 patients, those in group 2 had larger mean total prostate volume (85.0 ± 24.6 vs 40.9 ± 10.8 ml), longer mean operative time (117.7 ± 48.2 vs 60.7 ± 25.0 minutes), higher mean retrieved prostate weight (37.3 ± 16.1 vs 12.5 ± 7.3 gm) and a higher mean tissue retrieval ratio (74.4% ± 22.2% vs 58.8% ± 23.2%, p <0.01). There was no significant difference in the postoperative hemoglobin decrease in the 2 groups (median 0.5 vs 0.9 mg/dl, p = 0.11). The rate of temporary postoperative urinary retention after Foley catheter removal was significantly lower in group 2 (15.4% vs 3.6%, p = 0.04). Postoperative improvements in the peak flow rate, post-void residual urine volume and International Prostate Symptom Score were comparable in the 2 groups. CONCLUSIONS: Although patients with a larger prostate required significantly longer operative time and laser energy, voiding function improvements and surgical complication rates of diode laser prostate enucleation were comparable in patients with a larger vs smaller prostate.

Age- and gender-specific nomograms for single and dual post-void residual urine in healthy children.

PURPOSE: To establish the first age- and gender-specific nomograms for single and two consecutive tests for post-void residual urine (PVR). MATERIAL AND METHODS: Healthy children aged 4-12 years were enrolled for two sets of uroflowmetry and PVR. The first PVR and the lower value of the two consecutive PVRs of each child with a voided volume ≥50 ml were included for construction of Single- and Dual-PVR nomograms. Children with possible urinary tract infection or lower urinary tract dysfunctions were excluded. RESULTS AND LIMITATIONS: Totally, 1,128 children (583 boys and 545 girls) with a mean age of 7.7 ± 2.2 years were eligible for analysis. The 95th percentile of Single-PVR for all children was 27.2 ml, or 19.2% of bladder capacity (BC), while that for Dual-PVR were 11.2 ml or 6.0% of BC, respectively. Multivariate studies showed that PVR was positively associated with BC, negatively associated with age, higher in boys than girls, and higher in abnormal uroflow patterns. For children aged ≤6 years, a single PVR >30 ml or >21% BC, or repetitive PVR >20 ml or >10% BC can be regarded as elevated. For children aged ≥7 years, a single PVR >20 ml or 15% BC, or repetitive PVR >10 ml or 6% BC can be redefined as elevated. CONCLUSIONS: Age, gender, and BC should be taken into considerations at interpretation of PVR tests in children. Repeating PVR test is recommended when a single PVR is higher than the 95th percentile of age- and gender-specific PVR. Neurourol. Urodynam. 32: 1014-1018, 2013. © 2013 Wiley Periodicals, Inc.

Quinolone prophylaxis in transrectal ultrasound guided prostate biopsy: an eight-year single center experience.

We retrospectively evaluated the efficacy of prophylaxis with pipemidic acid and levofloxacin in transrectal ultrasound guided prostate biopsy (TRUSP-Bx). From January 2002 to December 2004, patients receiving oral pipemidic acid 500 mg twice daily for three days with or without a preoperative intravenous cefazolin 1 gm injection comprised group A. Between January 2005 and December 2009, patients receiving oral levofloxacin 500 mg one hour before biopsy comprised group B. We calculated the annual febrile urinary tract infection (fUTI) rates. Patients' characteristics, including age, prophylactic antibiotics, biopsy core numbers, pathologic results, PSA, and the spectrums and susceptibility of pathogens, were also evaluated. A total of 1313 (35.5%) patients belonged to group A, while 2381 (64.5%) patients belonged to group B. Seventy-three patients experienced postoperative infectious complications. There was a significant difference in the fUTI rate between groups A and B (3.7% versus 1.0%, P < 0.001). The yearly fUTI rates varied from 0.6 to 3.9% between 2002 and 2009. Of the 73 patients with fUTI, those receiving levofloxacin prophylaxis were more likely to harbor fluoroquinolone-resistant pathogens (P < 0.001). E. coli was the most common pathogen in both groups. Levofloxacin remains effective and appears superior to pipemidic acid based prophylaxis.

Conservative Bladder Management and Medical Treatment in Chronic Spinal Cord Injury Patients.

To review the available data on non-surgical management for neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic spinal cord injury (SCI) and provide the most updated knowledge for readers. We categorized the bladder management approaches into storage and voiding dysfunction separately; both are minimally invasive, safe, and efficacious procedures. The main goals for NLUTD management are to achieve urinary continence; improve quality of life; prevent urinary tract infections and, last but not least, preserve upper urinary tract function. Annual renal sonography workups and regular video urodynamics examinations are crucial for early detection and further urological management. Despite the extensive data on NLUTD, there are still relatively few novel publications and there is a lack of high-quality evidence. There is a paucity of new minimally invasive and prolonged efficacy treatments for NLUTD, and a partnership between urologists, nephrologists and physiatrists is required to promote and ensure the health of SCI patients in the future.

Advances in non-surgical treatments for urinary tract infections in children.

OBJECTIVE: With growing antibiotics failure due to emerging resistance of bacteria, non-surgical management of pediatric UTI plays a more important role because of its non-invasive characteristics and little adverse effects. METHODS: We searched the Pubmed for management of UTI in children other than surgical correction and antibiotics using terms: risk factor, prepuce/phimosis, steroid cream/steroid, behavioral therapy, urotherapy, biofeedback/pelvic floor exercise, adrenergic antagonist, anticholinergics, diet/dietary, dysfunctional voiding/dysfunctional elimination syndrome, constipation, dietary, clean intermittent catheterization, probiotics/lactobacillus, cranberry, vitamin supplement, breastfeeding, breast milk, with infant/child/children/pediatrics/pediatrics and urinary tract infection. RESULTS: The proposed non-surgical management of pediatric UTI included behavioral modification (timed voiding and adequate fluids intake), topical steroid for phimosis, nutrient supplements (breast milk, cranberry, probiotics, and vitamin A), biofeedback training for dysfunctional voiding, anticholinergics for reducing intravesical pressure, alpha-blockers in dysfunctional voiding and neurogenic bladder, and intermittent catheterization for children with large PVR. CONCLUSION: The published reports usually included small number of patients and were lacking of randomization and controlled group. Further well-designed studies are warranted to support the concepts of non-operative management for pediatric UTI.

A case report of right cardiac ventricle perforation by uncontrolled embolization coil inserted for treating penile veno-occlusive dysfunction.

Coil embolization (CE) is believed effective-safe for treating penile veno-occlusive dysfunction (VOD). From 2012 to 2016, refractory impotence prompted four men to seek further treatment, although they underwent six CEs elsewhere. Uncontrolled coils scattered along penile drainage veins including the deep dorsal veins (n = 3), periprostatic plexus (n = 1), iliac vein (n = 1), right pulmonary artery (n = 2), left pulmonary artery (n = 1), and right ventricle (n = 1). The last one occurred in a 40-year-old house builder, and the coil perforated the right ventricle wall and diaphragm 18 months later. Given no sustainable improvement, CE's safety and efficacy are unreliable for treating patients with VOD.

Large voided volume suggestive of abnormal uroflow pattern and elevated post-void residual urine.

AIM: To report the cut-off value for large voided volume (LVV) suggestive of abnormal uroflow pattern or elevated post-void residual urine (PVR) in healthy kindergarteners. METHODS: From 2003 through 2008, we enrolled 417 healthy kindergarten children for evaluation of uroflowmetry tests and PVR. The uroflowmetry curves were interpreted if voided volumes (VV) were >50 ml, and categorized as bell-shaped, staccato, plateau, and interrupted. Only bell-shaped curves were categorized as normal. After 2006, PVR was assessed within 5 min after each voiding with a VV >50 ml. A PVR >20 ml is regarded as elevated. Receiver operative characteristic (ROC) curves were constructed to evaluate the cut-off value of VV/expected bladder capacity (EBC) with regard to nonbell-shaped uroflowmetry curves, and/or elevated PVR. RESULTS: Of 385 children (mean age: 4.85 ± 0.96 years), 699 uroflowmetry, and 556 PVR data were eligible for analysis. There were 502 (71.8%) bell-shaped, 76 (10.9%) plateau, 102 (14.6%) staccato, and 19 (2.7%) interrupted curves. Mean and median PVR were 12.4 ± 21.2 and 5.5 ml, respectively. Of 556 PVRs, 96 (17.3%) were >20 ml. Based on the ROC curve for the nonbell-shaped curves and/or elevated PVR, VV >100% EBC was best defined as LVV. There were statistically more elevated PVR, and more nonbell-shaped curves in the voidings with than without LVV. There is a trend that peak flow rate decreased when VV was >150% EBC. CONCLUSIONS: VV of more than 100% EBC can be defined as LVV which was associated with higher rates of abnormal uroflow pattern and/or elevated PVR.

Preoperative %p2PSA and Prostate Health Index Predict Pathological Outcomes in Patients with Prostate Cancer Undergoing Radical Prostatectomy.

To evaluate the predictive accuracy of the %p2PSA and prostate health index (PHI) in predicting aggressive pathological outcomes in patients with prostate cancer (PCa) undergoing radical prostatectomy (RP), we enrolled 91 patients with organ-confined PCa who were treated with robot-assisted RP. p2PSA levels and the PHI were investigated for their ability to predict pathological results. The %p2PSA and PHI were both significantly higher in patients with ≥pT3 disease, high-risk disease, positive surgical margin, or seminal vesical invasion (SVI). In univariable analysis, p2PSA derivatives were significant predictors of the presence of ≥pT3 disease, high-risk disease, positive surgical margin, and SVI. To predict adverse pathological outcomes at a sensitivity of 90%, p2PSA derivatives had higher specificity than standard PSA derivatives. In multivariable analysis, additional increases in the area under the receiver operating characteristic curve (AUC) were observed with the %p2PSA and PHI for ≥pT3 disease, high-risk disease, and positive surgical margin (8.2% and 2.7%, 6.2% and 4.1%, and 8.6% and 5.4%, respectively). A PHI ≥61.26 enhanced the predictive accuracy of the model for SVI by increasing the AUC from 0.624 to 0.819 (p = 0.009). The preoperative %p2PSA and PHI accurately predict adverse pathological results and are useful for decision-making.

Comparison of 6- and 12-core prostate biopsy in Taiwanese men: impact of total prostate-specific antigen, prostate-specific antigen density and prostate volume on prostate cancer detection.

INTRODUCTION: We retrospectively compared 6- and 12-core prostate biopsies in Taiwanese men and evaluated the impact of prostate volume (PV), prostate-specific antigen (PSA), and PSA density (PSAD) on the prostate cancer detection rate (PCDR). PATIENTS AND METHODS: 1,086 consecutive patients with a total PSA of 4.1-20.0 ng/ml and/or abnormal digital rectal examination undergoing first-time transrectal ultrasound-guided biopsy were included. Group I patients (n = 562) underwent sextant biopsy and group II patients (n = 524) underwent sextant biopsy with an extra three lateral cores on both sides. The patients were further stratified into subgroups according to PV (cut-off: 35 ml), PSA (cut-off: 10.0 ng/ml), and PSAD (cut-off: 0.2). RESULTS: Prostate cancer was diagnosed in 228/1,086 (21.0%) patients. The PCDR was higher in group II (23.7%) than group I (18.5%). 12-Core biopsy yielded a significantly higher PCDR than 6-core biopsies in patients with PV >35 ml, PSA 4.1-10.0 ng/ml, PSAD 0.20. CONCLUSIONS: 12-Core biopsy yielded a significantly higher PCDR in Taiwanese men with a total PSA of 4.1-20.0 ng/ml, especially in patients with PSA 4.1-10.0 ng/ml, PSAD 35 ml.

Diagnostic value of finger-guided prostate nodule biopsy combined with systemic random biopsy.

BACKGROUND/PURPOSE: The purpose of this study was to compare prostate cancer detection rates and pathology results, using the Gleason grading system, of 12-core systemic random transrectal ultrasound-guided prostate biopsy (SB) and 3-core finger-guided prostate nodule biopsy (FGNB). METHODS: Between January 2002 and December 2006, 148 patients with digitally palpable prostate nodules received SB and additional FGNB. The prostate cancer detection rates and Gleason scores of positive cancer specimens were compared between SB and combination biopsy (SB + FGNB). The patients' characteristics, including age, prostate specific antigen (PSA), percentage of free PSA and prostate volume were also recorded. RESULTS: With simple SB, FGNB, and combination biopsy, the prostate cancer detection rates were 39.9%, 37.9%, and 44.6%, respectively. Of the 66 patients with prostate cancer, the Gleason sum was underestimated in three patients with simple SB only and in one patient with FGNB only. The false-negative rates for SB and FGNB were 10.6% and 15.2%, respectively. CONCLUSION: In patients with a palpable prostate nodule, combination biopsy with systemic and nodule biopsy could avoid some misdiagnoses of prostate cancer and provide more accurate information for pathology grading.

The impact of primary location and age at orchiopexy on testicular atrophy for congenital undescended testis.

In this study, we investigated post-orchiopexy testicular growth of undescended testes (UDTs) at different primary locations and determined the risk factors for testicular atrophy (TA). We conducted a retrospective chart review of boys who had undergone orchiopexy for UDTs during January 2001-December 2013. Patient profile, age at operation, primary UDT location, and testicular volume were noted. TA was defined as ≥50% loss of volume after orchiopexy. The primary endpoints were testicular growth and TA after orchiopexy. The secondary endpoint was risk factors for TA. In total, 182 boys had undergone regular ultrasonography; the median follow-up period was 34 months. Among 230 UDTs, 18 (7.8%) atrophic testicles were identified within a median interval of 13 months after orchiopexy. TA rates were 3.3% (1/30), 6.9% (12/173), and 18.5% (5/27) in primary suprascrotal, canalicular, and above-inguinal UDTs, respectively. The survival probability of UDT was 91%, 92% and 100% when orchiopexy was performed in age ≤1 year, 1 < age ≤2 years, and 100% in age >2 years, respectively. Multivariate analysis revealed that inguinal and above-inguinal UDTs (hazard ratio [HR] 11.76, 95% confidence interval [CI] 1.55-89.33, p = 0.017) and genetic or endocrine disorders (HR 3.19, 95% CI 1.19-8.56, p = 0.021) were the risk factors for TA, but not age at operation, premature birth, and laterality. Thus, TA incidence was higher when patients had high primary testicular locations. Early orchiopexy before two years of age may be associated with higher TA risk, while most testicles have promising growth after orchiopexy.

Management of ischemic penile gangrene: prompt partial penectomy and other treatment options.

INTRODUCTION: Penile gangrene is a rare but troublesome problem with high mortality rates. The etiologies could be infectious, traumatic, or vasculogenic. The treatment algorithm is controversial because of limited case numbers. AIM: To describe our experiences in treating the patients with ischemic penile gangrene, to review the related literatures, and to try to summarize a practical algorithm for penile gangrene. METHODS: We retrospectively reviewed the medical records of five patients with penile gangrene treated between 1996 and 2006. Data obtained include the patients' ages initial presentation, detailed histories, comorbidity, renal status, other vascular diseases, coagulation profile, treatment course, histology presentations, and prognosis were obtained. MAIN OUTCOME MEASURES: Comparison of the patients' ages, presentations, underlying diseases, the duration of conservative treatments, surgical options, resected penile length, and prognosis. RESULTS: All of the five patients underwent partial penectomy. One patient underwent immediate surgery while the other four had delayed partial penectomy because of progressive distal penile gangrenous change. There was no postoperative wound infection noted in any of the five patients and all had survived after 1 year follow-up. Three of them could void independently with a neourethra meatus. Two of them kept suprapubic cystostomy as a result of bladder outlet obstruction caused by an enlarged prostate and bed-ridden status. CONCLUSIONS: Penile dry gangrene is an irreversible process. Early partial penectomy and correction of the underlying disease can prevent wound liquefaction, preserve more penile length, and improve quality of life.

Delayed presentation of splenic laceration due to remote trauma in laparoscopic surgery.

Splenic laceration is a recognized complication of both open and laparoscopic renal and adrenal surgery. Most injuries reported occur intraoperatively via the transperitoneal approach and require immediate management. Herein we report a patient with a delayed presentation of splenic laceration 17 days after undergoing retroperitoneal hand-assisted laparoscopic nephroureterectomy. Emergent splenectomy was performed and the postoperative course was uneventful. To our knowledge, there has not been a similar case reported before. Because laparoscopic renal surgery is becoming the gold standard of treatment, urologists must be aware of the possibility of splenic laceration during this type of surgery.

The effectiveness of tamsulosin in treating women with voiding difficulty.

OBJECTIVES: To prospectively evaluate the effectiveness of tamsulosin in treating women with voiding difficulty. METHODS: Female patients presenting chronic, bothersome voiding symptoms, combined with subnormal uroflow were treated with 0.2 mg tamsulosin daily for six weeks. Outcome analyses included the International Prostate Symptom Score and uroflowmetry with post-void residual urine. Patients achieving a 50% or greater reduction in their voiding symptom score, combined with a 30% or greater increment in their maximal flow rate were regarded as having a good therapeutic response. Subgroup analysis was performed in patients classified as having bladder outlet obstruction, or detrusor underactivity based on pressure-flow study, excluding those with indwelling catheterization or intermittent self-catheterization as well as those with anatomic obstruction. RESULTS: Ninety-seven patients met the study inclusion criteria and were enrolled. Significant improvements in voiding symptom score, storage symptom score, maximal flow rate, post-void residual urine and voiding efficiency were observed in all patients while on tamsulosin. A good therapeutic response was observed in 35.1% of patients. Of these, 33 were classified as having bladder outlet obstruction and 52 had detrusor underactivity. Although both groups experienced significant reduction in their voiding symptom scores, patients with bladder outlet obstruction were more likely to achieve a reduction of their voiding symptom score. The magnitude of improvement in uroflow parameters as well as the proportion of patients achieving a good therapeutic response (39.4% for bladder outlet obstruction vs 32.7% for detrusor underactivity, P = 0.69) were similar between the two groups. Adverse events were mild and tolerable. CONCLUSIONS: Tamsulosin has beneficial effects in a significant proportion of women with voiding difficulty.

Chitosan delaying human fibroblast senescence through downregulation of TGF-ß signaling pathway.

This study evaluated the effect of chitosan, poly vinyl alcohol (PVA) and poly (2-hydroxyethyl methacrylate) (pHEMA) on delaying the human fibroblast senescence. Cells could form suspending multicellular spheroids on these biomaterials, but only chitosan was capable of decreasing the SA ß-gal activity and increasing the proliferation ability of senescent fibroblasts. Therefore, in addition to the structure of multicellular spheroids, chitosan itself should play an important role in delaying fibroblast senescence. The main difference of senescence-related protein expressions for cells cultured on chitosan, PVA and pHEMA occurred on the TGF-ß signaling pathway. In addition to the intracellular TGF-ß expression, the extracellular TGF-ß expression was also downregulated. Chitosan with cationic amino structure was assumed to bind with anionic TGF-ß by forming polyelectrolyte complexes. This assumption was demonstrated by directly adding chitosan into the medium to downregulate the cell TGF-ß expression and further to delay cell senescence, indicating TGF-ß signaling pathway was involved in the chitosan-mediating fibroblast senescence process. Finally, the delaying cell senescence ability of chitosan increased with increasing the amount of amino groups in chitosan and its ionization degree. In summary, these results provide important information for considering the application of chitosan in the future cell therapy and regeneration medicine.