Effects of resection volume on postoperative micturition symptoms and retreatment after transurethral resection of the prostate.

PURPOSE: Despite advances in technology, such as advent of laser enucleation and minimally invasive surgical therapies, transurethral resection of the prostate (TURP) remains the most widely performed surgical technique for benign prostatic hyperplasia (BPH). We evaluated resection volume (RV)-derived parameters and analyzed the effect of RV on post-TURP outcomes. METHODS: This observational study used data from patients who underwent TURP at two institutions between January 2011 and December 2021 Data from patients with previous BPH surgical treatment, incomplete data, and underlying disease affecting voiding function were excluded. The collected data included age, prostate-specific antigen, transrectal ultrasound (TRUS)- and uroflowmetry-derived parameters, RV, perioperative laboratory values, perioperative International Prostatic Symptom Score (IPSS), follow-up period, retreatment requirements and interval between the first TURP and retreatment. RESULTS: In 268 patients without prior BPH medication, there were no differences in prostate volume (PV), transitional zone volume (TZV), or RV according to IPSS. A total of 60 patients started retreatment, including medical or surgical treatment, within the follow-up period. There was a significant difference in RV/PV between the groups without and with retreatment respectively (0.56 and 0.37; p = 0.008). However, preoperative TRUS- and uroflowmetry-derived parameters did not differ between the two groups. Multiple linear regression analysis showed that RV (p = 0.003) and RV/TZV (p = 0.006) were significantly associated with differences in perioperative IPSS. In the multivariate logistic regression analysis, only RV/PV was correlated with retreatment (p = 0.010). CONCLUSION: Maximal TURP leads to improved postoperative outcomes and reduced retreatment rate, it may gradually become a requirement rather than an option.

Lessons learned from clinical outcome and tumor features of patients underwent selective artery embolization due to postoperative bleeding following 2076 partial nephrectomies: propensity scoring matched study.

PURPOSE: To evaluate the clinical and tumor characteristics in patients undergoing selective artery embolization (SAE) for bleeding after partial nephrectomy (PN). METHODS: We retrospectively evaluated patients who underwent SAE from 2076 patients who underwent PN. The clinical and tumor characteristics of these patients were analyzed using entire data and propensity score matching (PSM). 76 patients who underwent PN (control, n = 38 patients; SAE, n = 38) were enrolled in PSM. RESULTS: SAE was performed in 41 patients who underwent open (19/1171), laparoscopic (4/60), and robot-assisted PN (18/845). The median period from PN to SAE was 12 days (interquartile range 8-24 day). The most common symptom of 31 (75.61%) patients was gross hematuria, followed by flank pain (3/41). Follow-up imaging revealed large pseudoaneurysm in 7 asymptomatic patients. The main reason for SAE on angiography was pseudoaneurysm (32/41), followed by arteriovenous fistula (5/41). Technical and clinical success was achieved in all patients. There was no statistical difference in the estimated glomerular filtration rate after 1 year, surgical methods, or baseline characteristics between the two groups. Conversely, there was statistically significant difference in ischemic time in the entire data and PSM. In the embolization group, renal masses showed statistically significant endophytic (p = 0.006) and posterior (p = 0.028) characteristics. CONCLUSIONS: SAE is an effective method for controlling postoperative bleeding while preserving renal function after PN. And, we suggest more attentive postoperative surveillance about vascular complications in patients with longer ischemia time or renal masses with endophytic and posterior locations.

The Impact of Preoperative α-Adrenergic Antagonists on Ureteral Access Sheath Insertion Force and the Upper Limit of Force Required to Avoid Ureteral Mucosal Injury: A Randomized Controlled Study.

PURPOSE: Excessive bulking force during primary access of the ureteral access sheath may induce ureteral injury. We investigated the efficacy of preoperative α-blockade to reduce ureteral access sheath insertion force and determine the upper limit required to avoid ureteral injury. MATERIALS AND METHODS: In this randomized controlled trial 135 patients from a single institution who had ureteropelvic junction or renal pelvis stones and were scheduled to undergo retrograde intrarenal surgery were prospectively enrolled from December 2015 to January 2017. Of the patients 41 and 42 were randomly assigned to the control and experimental groups, respectively. The experimental group received α-blockade preoperatively. The 21 patients who were pre-stented were assessed separately. We developed a homemade device to measure maximal ureteral access sheath insertion force. RESULTS: Our ureteral access sheath insertion force measurement device showed excellent reproducibility. Higher insertion velocity resulted in greater maximal sheath insertion force. Maximal insertion force in the α-blockade group was significantly lower than in the control group at the ureterovesical junction (p = 0.008) and the proximal ureter (p = 0.036). Maximal insertion force in the α-blockade group was comparable to that in pre-stented patients. Female patients and patients 70 years old or older showed a lower maximal ureteral access sheath insertion force than their counterparts. The rate of grade 2 or greater ureteral injury was lower in the α-blockade group than in controls (p = 0.038). No injury occurred in any case in which ureteral access sheath insertion force did not exceed 600 G. CONCLUSIONS: Preoperative α-blockade and slow sheath placement may reduce maximal ureteral access sheath insertion force. If the force exceeds 600 G, a smaller diameter sheath may be an alternative. Alternatively the procedure can be terminated and followed later by pre-stented retrograde intrarenal surgery.

Carbon-nanotube-assisted nanoepitaxy of Si-doped GaN for improved performance of InGaN/GaN light-emitting diodes.

Using single-walled carbon nanotubes (SWCNTs) as nanomasks on an undoped GaN template, a significant biaxial stress relaxation was achieved in the subsequently-grown Si-doped n-GaN layer. Enhanced near band edge (NBE) emission intensity, similar free carrier concentrations, and the reduced peak width of the asymmetric (102) crystallographic plane all confirmed the suppression of threading dislocations due to the nanoepitaxial growth process. Temperature-dependent photoluminescence (PL) revealed improved internal quantum efficiency (IQE) of InGaN/GaN multi-quantum wells (MQWs) grown on this n-GaN layer. Furthermore, enhanced light output power and a remarkable reduction in efficiency droop were observed for the blue light-emitting diodes (LEDs), especially at higher injection currents. Our results emphasize the strong potential for SWCNTs as nanomasks in the heteroepitaxy of GaN-based devices without the exploitation of complicated lithography or etching processes.

Transurethral resection of the prostate for patients with Gleason score 6 prostate cancer and symptomatic prostatic enlargement: a risk-adaptive strategy for the era of active surveillance.

OBJECTIVE: To investigate whether transurethral resection of the prostate can be used as both (i) treatment for symptomatic prostatic enlargement in patients with prostate cancer and (ii) a risk-adaptive strategy for reducing prostate-specific antigen levels and broadening the indications of active surveillance. METHODS: We retrospectively reviewed data of 3680 patients who underwent prostate biopsies at a single institution (March 2006 to January 2012). Of 529 men who had Gleason score 6 prostate cancer and were ineligible for active surveillance, 86 (16.3%) underwent transurethral resection of the prostate for symptomatic prostatic enlargement. We assessed how changes in prostate-specific antigen and prostate-specific antigen density influenced the eligibility for active surveillance and the outcome of subsequent therapy. The following active surveillance criteria were used: prostate-specific antigen ≤ 10 ng/ml, prostate-specific antigen density ≤ 0.15, positive cores ≤ 3 and single core involvement ≤ 50%. RESULTS: The median age, pre-operative prostate-specific antigen and prostate volume were 71 years, 6.95 ng/ml, and 45.8 g, respectively. In 82.6% (71/86) of analyzed cases, ineligibility for active surveillance had resulted from elevated prostate-specific antigen level or prostate-specific antigen density. With a median resection of 16.5 g, transurethral resection of the prostate reduced the percentage of prostate-specific antigen and the percentage of prostate-specific antigen density by 34.5 and 50.0%, respectively, making 81.7% (58/71) of the patients eligible for active surveillance. Prostate-specific antigen level remained stabilized in all (21/21) patients maintained on active surveillance without disease progression during the median follow-up of 50.6 months. Among patients who underwent radical prostatectomy, 96.7% (29/30) exhibited localized disease. CONCLUSIONS: Risk-adaptive transurethral resection of the prostate may prevent overtreatment and allay prostate-specific antigen-associated anxiety in patients with biopsy-proven low-grade prostate cancer and elevated prostate-specific antigen. Additional benefits include voiding symptom improvement and the avoidance of curative therapy's immediate side effects.

Size dependence of silica nanospheres embedded in 385 nm ultraviolet light-emitting diodes on a far-field emission pattern.

We demonstrate that the use of silica nanospheres (SNs) with sizes close to the emission wavelength of light-emitting diodes (LEDs) can enhance the light output power and manipulate the far-field emission pattern. Near-ultraviolet (NUV)-LEDs grown on a patterned sapphire substrate embedded with 300 nm SNs show a three times higher light output power than that without SNs, when measured through the top side. For far-field emission measurements, the LEDs embedded with 300 nm SNs show the significant increase of front emission due to the improved crystal quality of epitaxial films as well as the increase of Mie scattering effect of SNs. These experimental results indicate the important role of the size of embedded SNs in enhancing the light output power for NUV-LEDs.

Air-ring microstructure arrays for enhanced light extraction from a face-up light-emitting diode.

In this Letter, a light-emitting diode (LED) with prism-shaped-air-ring microstructures (PSAMs) formed on flat sapphire substrate is demonstrated as an alternative design to face-up LEDs on patterned sapphire substrate (PSS) for enhanced light extraction efficiency. In this LED design, the emitted photons can be deflected to the top of the chip for its effective extraction, contrary to the PSS-LED wherein photons are guided to sapphire and get absorbed by packaging materials. The PSAM-LED showed an enhancement in the radiometric power as high as 10% with a low far-field angle of 129° over that of a PSS-LED under an injection current of 20 mA.

Venadaparib Is a Novel and Selective PARP Inhibitor with Improved Physicochemical Properties, Efficacy, and Safety.

PARP inhibitors have been approved by the FDA for use in the treatment of patients with ovarian, breast, pancreatic, and prostate cancers. PARP inhibitors show diverse suppressive effects on PARP family members and PARP-DNA trapping potency. These properties are associated with distinct safety/efficacy profiles. Here, we report the nonclinical characteristics of venadaparib (also known as IDX-1197 or NOV140101), a novel potent PARP inhibitor. The physiochemical properties of venadaparib were analyzed. Furthermore, the efficacy of venadaparib against PARP enzymes, PAR formation, and PARP trapping activities, and growth inhibition of cell lines with BRCA mutations were evaluated. Ex vivo and in vivo models were also established to study pharmacokinetics/pharmacodynamics, efficacy, and toxicity. Venadaparib specifically inhibits PARP-1 and -2 enzymes. Oral administration of venadaparib HCl at doses above 12.5 mg/kg significantly reduced tumor growth in the OV_065 patient-derived xenograft model. Intratumoral PARP inhibition remained at over 90% until 24 hours after dosing. Venadaparib had wider safety margins than olaparib. Notably, venadaparib showed favorable physicochemical properties and superior anticancer effects in homologous recombination-deficient in vitro and in vivo models with improved safety profiles. Our results suggest the possibility of venadaparib as a next-generation PARP inhibitor. On the basis of these findings, phase Ib/IIa studies on the efficacy and safety of venadaparib have been initiated.

Does hydronephrosis after extravesical ureteral reimplantation deteriorate renal function?

PURPOSE: We analyzed whether newly developed or aggravated hydronephrosis deteriorates differential renal function after extravesical ureteral reimplantation. MATERIALS AND METHODS: We performed extravesical ureteral reimplantation in 93 patients with unilateral vesicoureteral reflux between January 2006 and December 2009. Excluding 3 patients with other combined disease, a retrospective cohort analysis of 90 consecutive patients was conducted. We performed ultrasonography before and 1 month after extravesical ureteral reimplantation, and dimercapto-succinic acid scan before and 6 months after extravesical ureteral reimplantation. Of the patients 83 underwent final dimercapto-succinic acid scan at 6 months postoperatively. We analyzed the preoperative studies and perioperative parameters to evaluate the factors affecting newly developed or aggravated hydronephrosis at 1 month, and decrease in differential renal function at 6 months after extravesical ureteral reimplantation. RESULTS: Newly developed or aggravated hydronephrosis was observed in 25 patients (28.4%) 1 month after extravesical ureteral reimplantation. Younger age at surgery was a risk factor (p = 0.003). Of the patients 23 showed improvement on ultrasound 6 months postoperatively. In 12 patients (15.7%) a decrease in differential renal function of more than 5% was observed 6 months postoperatively. Preoperative parenchymal reduction on dimercapto-succinic acid scan was the only significant factor (p = 0.008). There was no correlation between newly developed or aggravated hydronephrosis and final decrease in differential renal function (p >0.999). CONCLUSIONS: Although newly developed or aggravated hydronephrosis after extravesical ureteral reimplantation is common, especially in younger patients, it is transient and does not affect differential renal function. A postoperative decrease in differential renal function without further urinary tract infection could develop when there is a parenchymal reduction on preoperative dimercapto-succinic acid scan.

Prerequisite for successful surgical outcome in urothelium lined seromuscular colocystoplasty.

PURPOSE: Urothelium lined seromuscular colocystoplasty is an ideal method of augmentation cystoplasty that avoids various complications caused by the use of gastrointestinal segments. We reviewed the long-term outcomes using this technique at a single institution. MATERIALS AND METHODS: We retrospectively analyzed 34 patients who underwent urothelium lined seromuscular colocystoplasty between January 1996 and December 2007. A total of 33 patients, excluding 1 who had previously undergone artificial urinary sphincter implantation, were included in the study. Changes in urodynamic parameters, duration of anticholinergic use, incontinence and surgical complications were analyzed. RESULTS: Mean±SD age at surgery was 10.0±5.7 years (range 3.0 to 26.0) and duration of followup was 6.0±2.3 years (2.7 to 13.4). A total of 17 patients (51.5%) underwent simultaneous anti-incontinence surgery and urothelium lined seromuscular colocystoplasty. Mean bladder capacity increased by a factor of 2.96 and mean percentage of expected bladder capacity for age increased by a factor of 1.96 postoperatively. Of patients who underwent anti-incontinence surgery 4 of 10 whose abdominal leak point pressure was less than 40 cm H2O required additional surgery, whereas none whose abdominal leak point pressure was 40 to 60 cm H2O required reoperation. Two of 16 patients who did not undergo anti-incontinence surgery eventually required continence surgery. A total of 13 patients (39.4%) were able to discontinue anticholinergics at 47.3 months postoperatively. There were no bladder perforations, bowel obstructions or metabolic abnormalities. CONCLUSIONS: Urothelium lined seromuscular colocystoplasty can be primarily considered in patients without prior bladder mucosal injury. Constant high bladder outlet pressure to facilitate adhesion of bladder mucosa and seromuscular patch is critical for the best results. We recommend abdominal leak point pressure 60 cm H2O or less as an indication for simultaneous anti-incontinence surgery and urothelium lined seromuscular colocystoplasty.

High performance of InGaN light-emitting diodes by air-gap/GaN distributed Bragg reflectors.

The effect of air-gap/GaN DBR structure, fabricated by selective lateral wet-etching, on InGaN light-emitting diodes (LEDs) is investigated. The air-gap/GaN DBR structures in LED acts as a light reflector, and thereby improve the light output power due to the redirection of light into escape cones on both front and back sides of the LED. At an injection current of 20 mA, the enhancement in the radiometric power as high as 1.91 times as compared to a conventional LED having no DBR structure and a far-field angle as low as 128.2° are realized with air-gap/GaN DBR structures.

Improving the optical performance of InGaN light-emitting diodes by altering light reflection and refraction with triangular air prism arrays.

The effect of triangular air prism (TAP) arrays with different distance-to-width (d/w) ratios on the enhancement of light extraction efficiency (LEE) of InGaN light-emitting diodes (LEDs) is investigated. The TAP arrays embedded at the sapphire/GaN interface act as light reflectors and refractors, and thereby improve the light output power due to the redirection of light into escape cones on both the front and back sides of the LED. Enhancement in radiometric power as high as 117% and far-field angle as low as 129° are realized with a compact arrangement of TAP arrays compared with that of a conventional LED made without TAP arrays under an injection current of 20 mA.

Profiling Cannabinoid Contents and Expression Levels of Corresponding Biosynthetic Genes in Commercial Cannabis (Cannabis sativa L.) Cultivars.

Cannabis (Cannabis sativa L.) is widely cultivated and studied for its psychoactive and medicinal properties. As the major cannabinoids are present in acidic forms in Cannabis plants, non-enzymatic processes, such as decarboxylation, are crucial for their conversion to neutral active cannabinoid forms. Herein, we detected the levels of cannabidivarin (CBDV), cannabidiol (CBD), cannabichromene (CBC), and Δ9-tetrahydrocannabinol (Δ9-THC) in the leaves and vegetative shoots of five commercial Cannabis cultivars using a combination of relatively simple extraction, decarboxylation, and high-performance liquid chromatography analyses. The CBDV, CBC, and Δ9-THC levels were 6.3-114.9, 34.4-187.2, and 57.6-407.4 µg/g, respectively, and the CBD levels were the highest, ranging between 1.2-8.9 µg/g in leaf and vegetative shoot tissues of Cannabis cultivars. Additionally, correlations were observed between cannabinoid accumulation and transcription levels of genes encoding key enzymes for cannabinoid biosynthesis, including CsCBGAS, CsCBDAS, CsCBCAS, and CsTHCAS. These data suggest that the high accumulation of cannabinoids, such as CBC, Δ9-THC, and CBD, might be derived from the transcriptional regulation of CsCBGAS and CsCBDAS in Cannabis plants.

Comparison of various surface textured layer in InGaN LEDs for high light extraction efficiency.

The various surface texturing effects of InGaN light emitting diodes (LEDs) have been investigated by comparison of experimented data and simulated data. The single-layer and double-layer texturing were performed with the help of ITO nanospheres using wet etching, where the ITO ohmic contact layer and the p-GaN layer are textured using ITO nanospheres as an etch mask. In case of single-layer texturing, p-type GaN layer texturing was more effective than ITO ohmic contact layer texturing. The maximum enhancement of wall-plug efficiency of double-layered textured LEDs is 40% more than conventional LEDs, after packaging at an injected current of 20 mA. The increase of light scattering at the textured GaN surfaces is a major reason for increasing the light extraction efficiency of LEDs.

Effect of embedded silica nanospheres on improving the performance of InGaN/GaN light-emitting diodes.

We report on the effect of embedded silica nanospheres on improving the performance of InGaN/GaN light-emitting diodes (LEDs). The silica nanospehres were coated on the selectively etched GaN using a spin-coating method. With the embedded silica nanospheres structures, we achieved a smaller reverse leakage current due to the selective defect blocking-induced crystal quality improvement. Moreover, the reflectance spectra show strong reflectance modulations due to the different refractive indices between the GaN and silica nanospheres. By using confocal scanning electroluminescence microscopy, a strong light emission from silica nanospheres demonstrates that the silica nanospheres acted as a reflector. We found that the optimized embedded silica nanospheres structure, whose the average size of the etched pits was about 3.5 µm and EPD was 3 x 10(7) cm(-2), could enhance light output power by a factor of 2.23 due to enhanced the probability of light scattering at silica nanospheres.

Enhanced light emission in blue light-emitting diodes by multiple Mie scattering from embedded silica nanosphere stacking layers.

We demonstrate enhanced light emission in blue light-emitting diodes (LEDs) by multiple Mie scattering from embedded silica nanosphere stacking layers (SNSL). A honeycomb cone structure is introduced in the GaN epilayer to confine a maximum number of silica nanospheres (SNs). We found that the light is predominantly directed vertically by scattering and geometrical effect in SNSL embedded LEDs. Consequently, the light output power is enhanced by 2.7 times, which we attribute to the improvement in light extraction efficiency due to the multiple Mie scattering of light from the embedded SNSL. The experimental results are verified by simulation using finite difference time domain method (FDTD).

Enhanced light output power of near UV light emitting diodes with graphene / indium tin oxide nanodot nodes for transparent and current spreading electrode.

We report GaN-based near ultraviolet (UV) light emitting diode (LED) that combines indium tin oxide (ITO) nanodot nodes with two-dimensional graphene film as a UV-transparent current spreading electrode (TCSE) to give rise to excellent UV emission efficiency. The light output power of 380 nm emitting UV-LEDs with graphene film on ITO nanodot nodes as TCSE was enhanced remarkably compared to conventional TCSE. The increase of the light output power is attributed to high UV transmittance of graphene, effective current spreading and injection, and texturing effect by ITO nanodots.

Trap-state-assisted white light emission from a CdSe nanocrystal integrated hybrid light-emitting diode.

This Letter reports on the fabrication of hybrid white-light-emitting diodes made of semiconductor nanocrystals (NCs) integrated on InGaN/GaN LEDs. Using core type and core/shell type CdSe NCs, the white light properties are systematically engineered for white light generation with high color rendering index (CRI). Unlike CdSe/ZnS core/shell NCs, which exhibited a unique narrowband edge emission, core type CdSe NCs offered extended broad emission toward orange/red wavelengths associated with deep trap states. Consequently, the light-emitting properties of the devices showed strong dependence on the type of NCs used, and devices with CdSe NCs offered admirable characteristics, such as Commission Internationale d'Eclairage coordinates of (0.356, 0.330) and a CRI as high as 87.4.

Clinical course of vesicoureteral reflux in patients with hypospadias.

OBJECTIVES: The prevalence of vesicoureteral reflux (VUR) in hypospadic patients is reportedly higher than in healthy children. We investigated the prevalence and the clinical course of VUR in hypospadic patients. METHODS: We carried out intraoperative cystography to detect VUR in 338 patients who underwent hypospadias repair. Age, severity of hypospadias and the presence of VUR were investigated. A dimercaptosuccinic acid renal scan and follow-up voiding cystourethrography (VCUG) were carried out if VUR was detected. RESULTS: VUR was detected in 41 patients (12.1%). Of 156 patients who were younger than 1 year-of-age, 34 (21.8%) were found to have VUR. The prevalence of VUR was significantly higher in patients younger than 1year (P<0.001), but was not associated with hypospadias type (P=0.212). The reflux grades were I, II and III in 6, 52 and 1 renal units, respectively. Renal scarring was shown in one of 36 patients. Follow-up VCUG was carried out in 30 patients at a mean of 14.28±3.89months, and reflux resolved in 27 and improved from grade II to grade I in three patients. CONCLUSIONS: Although its prevalence is higher in hypospadic children than in healthy children, it is not necessary to screen for VUR in hypospadic patients, because it is likely to be low-grade and to resolve in most cases.

Development and Validation of the Stent Tracking Algorithm Registry for Monitoring and Retrieving Forgotten Ureteral Stents.

Purpose: Forgotten ureteral stents are associated with safety issues, increased cost, and medicolegal disputes. Tracking ureteral stents is cumbersome because of the variety in placement periods. We developed and validated an electronic medical record (EMR) system-based algorithm for monitoring patients with ureteral stent placements. Materials and Methods: The Stent Tracking Algorithm Registry (STAR) is automatically activated once the physician enters the stent placement or replacement billing code into the EMR billing system. At 120 days, an overdue notification is generated and sent to the attending physician through an EMR pop-up dashboard and e-mail. The model is automatically deactivated when the stent of the corresponding laterality is removed. To validate the feasibility of STAR, we performed a retrospective review of 2194 patients who received stent placements between November 2006 and September 2019. Results: Among 2194 patients, STAR retrospectively identified 354 (16.1%) patients suspected of harboring forgotten ureteral stents. A total of 12 (0.5%) patients actually had forgotten ureteral stents and were contacted for removal. A total of 124 (5.7%) patients were identified because of the omission of the stent removal billing code, whereas 209 (9.5%) patients were identified because of being lost to follow-up after referral to another health care facility or death. There were no cases in which STAR identified patients whose stents were removed or replaced at an appropriate time frame. Conclusions: STAR provides an efficient interface with which to prevent the occurrence of forgotten ureteral stents. This model can be integrated into any EMR system that utilizes coding algorithms.