Use of the International Prostate Symptom Score (IPSS) in Chinese male patients with benign prostatic hyperplasia.

PURPOSE: To test the psychometric properties of the International Prostate Symptom Score (Hong Kong Chinese version 2) (IPSS) in Chinese male patients with benign prostatic hyperplasia (BPH) under secondary care. METHODS: A prospective longitudinal study was done by interviewing subjects at baseline, at 2 week after baseline for assessing test-retest reliability and at 26 week after baseline for assessing responsiveness. All subjects were interviewed to complete a structured questionnaire including IPSS, Short Form-12 Health Survey version 2 (SF-12v2) and Depression Anxiety Stress Scale (DASS). RESULTS: The IPSS HRQOL score had weak correlations with SF-12v2 summary and DASS domain scores. For reliability analysis, Cronbach's alpha coefficient was 0.90 for the seven symptom-related items. The intraclass correlation coefficients of the IPSS total symptom score and HRQOL score were 0.90 and 0.86, respectively. For sensitivity, statistically significant differences were detected between the subjects with BPH and those without for IPSS total symptom score (effect size = 0.68) but not the IPSS HRQOL score. The areas under ROC curves for the IPSS total symptom and HRQOL scores were 0.67 and 0.60, respectively. CONCLUSIONS: The IPSS was valid, reliable instrument in Chinese patients with BPH. The IPSS total symptom score, but not the HRQOL score, is sensitive in differentiating subgroups.

Inflammatory myofibroblastic tumours of the urinary bladder: multi-centre 18-year experience.

OBJECTIVE: To review a series of inflammatory myofibroblastic tumours (IMTs) of the urinary bladder in 10 hospitals in Hong Kong. METHODS: A database search in the pathology archives of 10 hospitals in Hong Kong from 1995 to 2013 was performed using the key words 'inflammatory myofibroblastic tumour', 'inflammatory pseudotumour' and 'spindle cell lesion'. Patient characteristics, clinical features, histological features, immunohistochemical staining results and treatment outcomes were reviewed. RESULTS: Nine cases of IMT of the urinary bladder were retrieved. The mean age was 45.4 ± 22.8 years (range 11-78). Eight patients (88.9%) presented with haematuria and 5 patients (55.6%) had anaemia with a mean haemoglobin level of 6.8 ± 1.3 g/dl. Histologically, the majority of patients (77.8%) had a compact spindle cell pattern. Anaplastic lymphoma kinase staining was positive in 75% of cases. During a mean follow-up period of 43.4 months (range 8-94), none of them developed any local recurrence or distant metastasis. CONCLUSIONS: A high index of suspicion of IMT should be maintained for young patients presenting with bleeding bladder tumours and significant anaemia. IMTs of the urinary bladder run a benign disease course, and good prognosis can be achieved after surgical resection.

Prevalence and predictive factors of harboring fluoroquinolone-resistant and extended-spectrum ß-lactamase-producing rectal flora in Hong Kong Chinese men undergoing transrectal ultrasound-guided prostate biopsy.

OBJECTIVE: To study the prevalence of fluoroquinolone-resistant (FQ-resistant) and extended-spectrum ß-lactamase-producing (ESBL-producing) bacteria in the rectums of patients undergoing transrectal ultrasound-guided prostate biopsy (TRUS-Bx), identifying predictive factors for such carriage and to correlate with the microbiology of those who developed postbiopsy infection (PBI). METHODS: A total of 371 men undergoing TRUS-Bx were prospectively enrolled from August 2011 to March 2012. Rectal swab was obtained before antimicrobial prophylaxis on the day of biopsy and grown in selective media for resistant bacteria. Standard FQ prophylaxis was used without guidance from rectal swab results. Univariate and multivariate analyses were performed to identify predictive factors of either FQ-resistant or ESBL-producing bacteria carriage. RESULTS: A total of 199 of 371 patients (53.6%) carried antimicrobial-resistant rectal flora, with 150 (40.4%) and 152 (41.0%) patients having FQ-resistant and ESBL-producing bacteria, respectively. Diabetes mellitus (odds ratio, 2.075; P = .028) and the use of antimicrobials within the prior 5 years (odds ratio, 1.550; P = .047) were independent predictors of rectal carriage of such flora. PBI occurred in 9 patients, of which 7 harbored prebiopsy antimicrobial-resistant bacteria, which completely matched the microbiological data collected during the patients' PBI episodes. CONCLUSION: A high prevalence of FQ-resistant and ESBL-producing rectal flora in Chinese men undergoing TRUS-Bx was found. Diabetes mellitus and prior antimicrobial use within 5 years were significant predictors for resistant bacterial carriage. Despite the high-resistant bacteria prevalence, PBI rate remained low. A targeted approach of antimicrobial prophylaxis using prebiopsy culture swab in areas with high prevalence of resistant bacteria should be further investigated.

Subcapsular hematoma after ureteroscopy and laser lithotripsy.

BACKGROUND AND PURPOSE: Renal hematoma after ureteroscopic lithotripsy (URSL) using holmium:yttrium-aluminum-garnet (Ho:YAG) laser is a rare complication. We aimed to review our center's experience of post-URSL subcapsular hematoma. PATIENTS AND METHODS: From 2007 to 2012, 1114 URSLs using 7.5F semi-rigid ureteroscopes were performed. Patients with post-URSL symptomatic renal hematoma were reviewed. Perioperative information on patients' preoperative morbidity, renal function, stone characteristics, and degree of hydronephrosis were reviewed. Operative information, postoperative presentation of symptoms, changes in blood parameters, CT findings, and subsequent management were documented. RESULTS: Post-URSL subcapsular hematoma was diagnosed in 4 of 1114 (0.36%) patients, who ranged in age from 43 to 63 years. Preoperative imaging showed that all four patients had obstructing proximal ureteral stones ranging in size from 0.7 to 2.1 cm, and three of them had thin renal cortices. Pressure bags were not used, and Double-J ureteral stents were inserted in all cases. All four patients had the triad of loin pain, fever, and significant hemoglobin drop necessitating transfusion. Three patients presented within 2 days of URSL, and one patient presented on day 20. One patient was treated conservatively and recovered with bed rest and antibiotics. Urgent angiography was performed on one patient in view of a significant drop in hemoglobin, but no embolization was needed. One patient underwent ultrasonography-guided drainage of the hematoma, and another had an emergency open clot evacuation because of significant compression on the kidney by the hematoma. Follow-up CT scans confirmed the resolution of the hematoma in all cases. CONCLUSIONS: Post-URSL subcapsular hematoma is a rare but potentially serious complication. A high index of suspicion is needed when patients present with significant loin pain and fever after URSL for obstructing proximal ureteral stones with thin renal cortices. The management of post-URSL subcapsular hematomas needs to be customized for each patient.

Emphysematous pyelonephritis: an 8-year retrospective review across four acute hospitals.

OBJECTIVE: To retrospectively review our experience of managing patients with emphysematous pyelonephritis (EPN). METHODS: Case notes of patients with EPN were reviewed. The patients' demographic data, clinical presentation, investigation findings, treatment, and outcome were studied. RESULTS: Twelve patients were diagnosed with EPN. Majority (66.7%) of them had diabetes mellitus. All patients had been evaluated by computed tomography (CT). Using the classification proposed by Wan et al, five patients had type 1 EPN, whereas six, two, and four patients had Huang and Tseng CT class 2, 3a, and 3b EPN, respectively. Immediate nephrectomy was performed in six patients, whereas conservative treatment was adopted in the other six. In the nephrectomy group, one patient died of disseminated sepsis after a protracted course. Conservative treatment failed in three patients, who succumbed despite salvage nephrectomy in two of them. Analysis revealed that severe hyperglycemia and radiological CT class (both Wan and Huang systems) were significant predictors of mortality from EPN. CONCLUSION: Severe hyperglycemia and CT class of EPN are significant risk factors for death. CT is the investigation of choice for correct diagnosis of EPN. Additional intervention should be offered to EPN patients with Wan type 1 and Huang and Tseng class 3 CT features.