Abdominal fat distribution on computed tomography predicts ureteric calculus fragmentation by shock wave lithotripsy.

OBJECTIVES: To assess the effects of abdominal fat on shock wave lithotripsy (SWL). We used pre-SWL unenhanced computed tomography (CT) to evaluate the impact of abdominal fat distribution and calculus characteristics on the outcome of SWL. METHODS: One hundred and eighty-five patients with a solitary ureteric calculus treated with SWL were retrospectively reviewed. Each patient underwent unenhanced CT within 1 month before SWL treatment. Treatment outcomes were evaluated 1 month later. Unenhanced CT parameters, including calculus surface area, Hounsfield unit (HU) density, abdominal fat area and skin to calculus distance (SSD) were analysed. RESULTS: One hundred and twenty-eight of the 185 patients were found to be calculus-free following treatment. HU density, total fat area, visceral fat area and SSD were identified as significant variables on multivariate logistic regression analysis. The receiver-operating characteristic analyses showed that total fat area, para/perirenal fat area and visceral fat area were sensitive predictors of SWL outcomes. CONCLUSION: This study revealed that higher quantities of abdominal fat, especially visceral fat, are associated with a lower calculus-free rate following SWL treatment. Unenhanced CT is a convenient technique for diagnosing the presence of a calculus, assessing the intra-abdominal fat distribution and thereby helping to predict the outcome of SWL. KEY POINTS: • Unenhanced CT is now widely used to assess ureteric calculi. • The same CT protocol can provide measurements of abdominal fat distribution. • Ureteric calculi are usually treated by shock wave lithotripsy (SWL). • Greater intra-abdominal fat stores are generally associated with poorer SWL results.

The impact of physical health and socioeconomic factors on sexual activity in middle-aged and elderly Taiwanese men.

Sexual activity in older people has become a topic of growing interest. The aim of this study is to investigate the effect of physical health and socioeconomic factors on the sexual activity of middle-aged and elderly Taiwanese men. From August 2007 to April 2008, 744 men older than 40 years were enrolled from a free health screening in Kaohsiung, Taiwan. All participants received detailed physical examination and answered questionnaires that collected demographic and lifestyle information, and medical history as well as answered items from the International Prostate Symptoms Score and five-item version of the International Index of Erectile Function (IIEF-5). Overall, 100 (13.4%) participants reported to be sexually inactive in previous 6 months. Older age, lower education levels, loss of a partner, erectile dysfunction, and increased number of comorbidities were found to be independent predictors for sexual inactivity. In conclusion, most middle-aged and elderly Taiwanese men remain sexually active. In addition to erectile dysfunction and loss of a partner, lower education levels and increased number of comorbidities were found to be predictors for sexual inactivity. Further research would need to elucidate whether improvement of those factors could help to preserve sexual activity.

Complications of laparoscopic radical prostatectomy--a single institute experience.

Laparoscopic radical prostatectomy (LRP) is a demanding procedure that requires surgical skill, a long learning curve and significant laparoscopic expertise. We report herein our initial experience with 41 laparoscopic radical prostatectomies to assess all perioperative complications in our initial 5-year experience. We reviewed retrospectively the case records of 41 patients who underwent laparoscopic radical prostatectomy for clinically localized prostate cancer from 2005 to 2010 at our institution. All abnormal symptoms were developed during the 30 days after the operation. Complications were noted as well as their severity according to the Clavien grading system. No conversion to open surgery was necessary in all cases. The median postoperative hospital stay was 10 days (range 9-16). The median duration of bladder catheterization was 8 days (range 7-35). There was no case of multiple-organ dysfunction or death. Minor complications constituted 82.6% of all complications. The incidence of severe complications was 17.4%. LRP displayed some advantages over open surgery in the perioperative period. Our complication rates were significantly higher than those indicated in the series previously reported. We found that most complications occurred in the first 30 patients who underwent LRP. We suggest that the surgeons should pay more attention to the difficulties of the procedure.

The comparison of the aging male symptoms (AMS) scale and androgen deficiency in the aging male (ADAM) questionnaire to detect androgen deficiency in middle-aged men.

The prevalence of androgen deficiency in men increases with aging. Two common instruments, the Aging Male Symptoms (AMS) scale and the Androgen Deficiency in the Aging Male (ADAM) questionnaire, are often used to screen for androgen deficiency in clinical practice. The aim of this study is to compare the capability of the AMS scale and the ADAM questionnaire to detect androgen deficiency in middle-aged Taiwanese men. In April 2008, a free health screening was conducted by Kaohsiung Medical University Hospital. All participants completed a health questionnaire and had blood samples drawn between 8:00 am and noon. Serum total testosterone (TT), albumin, and sex hormone-binding globulin levels were measured. The level of free testosterone (FT) was calculated. Clinical symptoms associated with androgen deficiency were screened by using the AMS scale and ADAM questionnaire. Androgen deficiency was defined as TT < 300 ng/dL or both TT < 300 ng/dL and FT< 5 ng/dL. In total, 339 men were included in the final analysis, with the mean age of 54.6 ± 4.9 years (range, 47-65 years). Androgen deficiency was found in 75 men (22.1%) based on the criteria of TT < 300 ng/dL, and in 54 men (15.9%) based on the criteria of TT < 300 ng/dL and FT < 5 ng/dL. When detecting participants with both TT < 300 ng/dL and FT < 5 ng/dL, the sensitivity and specificity of the AMS scale were 57.4% and 48.1%, compared with 66.7% and 25.6% for the ADAM questionnaire. In a sample of middle-aged Taiwanese men, neither the AMS scale nor the ADAM questionnaire had sufficient sensitivity and specificity to detect androgen deficiency. In addition to using those 2 screening instruments, a thorough physical and biochemical workup should still be conducted in patients at risk or suspected of androgen deficiency.

Endoscopic management of a ureteral obstruction caused by endometriosis: a case report.

Ureteral obstruction secondary to endometriosis is relatively uncommon. We present a 49-year-old female (gravida 3, para 2, abortion 1), who was identified as suffering from right hydronephrosis while undergoing her regular health examination. Retrograde pyelography demonstrated a partial obstruction of the right ureter in the distal third. She underwent ureteroscopy and biopsy to remove a right ureteral tumor. Histological examination confirmed ureteral endometriosis. During follow-up at the obstetrics and gynecology outpatient department, an abdominal echo was detected that revealed a right endometrioma (size, 7.5 x 4.8 x 5.5 cm) on the ovary. As a result, a total hysterectomy and bilateral salpingo-oophorectomy was performed. Although the patient had right residual hydronephrosis, the creatinine level improved to 1.2 mg/dL during follow-up.

Müllerianosis of ureter: a rare cause of hydronephrosis.

Müllerianosis of the urinary tract is a very rare and morphologically complex tumor-like lesion. It is composed of several types of müllerian-type lesions, including endometriosis, endocervicosis, and endosalpingiosis. We present a case of ureteral müllerianosis in woman with a history of a cesarean section about 20 years previously but with silent clinical symptoms. She was treated with segmental ureteral resection, followed by ureteroureteral anastomosis. The pathogenesis and treatment of this lesion are discussed.