Management of nocturnal enuresis in Taiwan: Consensus statements of the Taiwan enuresis expert committee.

Nocturnal enuresis causes significant psychological distress to affected children and their family and requires appropriate management. A 12-member expert committee of pediatric urologists and pediatric nephrologists in Taiwan with extensive experience in treating enuresis was established to develop consensus statements and a recommended treatment algorithm for the management of patients with nocturnal enuresis in Taiwan after careful consideration of current evidence, existing guidelines, and expert opinion as well as local practice and culture. The finalized consensus statements were reviewed by and have received endorsement from the Taiwan Urological Association and the Taiwan Pediatric Association. Patients with suspected enuresis should undergo a thorough initial assessment to fully evaluate urinary signs and symptoms and to rule out underlying causes of diurnal and nocturnal incontinence. Behavioral therapy is recommended throughout the course of management. Desmopressin in the fast-melting formulation is the recommended first-line pharmacological treatment. Combination therapy may be effective in patients who have failed first-line treatment. These consensus statements and a recommended treatment algorithm were created by the expert committee to provide practical support for clinical decision making by physicians in Taiwan.

Clear cell carcinoma of female urethral diverticulum--a case report.

Primary malignancies of female urethral diverticulum are rare. A well-documented female patient with primary clear cell carcinoma of the urethral diverticulum is presented here. A 65-year-old woman presented with frequency and voiding difficulty for 2 months. Physical examination showed a 4-cm mass protruding from anterior vaginal wall. Intravenous urography, magnetic resonance imaging, and cystoscopy showed a polypoid mass in urethral diverticulum. She then underwent anterior exenteration with ileal conduit diversion and urethrectomy. Pathology confirmed the diagnosis of clear cell adenocarcinoma with bladder neck invasion. She had no disease recurrence at 2-year follow-up. Careful clinical examination and image studies are helpful in making the preoperative diagnosis for the rare disease. Early radical surgery can achieve better survival.

Correlation between clinical manifestations of nocturnal enuresis and attentional performance in children with attention deficit hyperactivity disorder (ADHD).

BACKGROUND/PURPOSE: Children with attention deficit hyperactivity disorder (ADHD) tend to be more vulnerable to various forms of voiding dysfunction and nocturnal enuresis (NE). We attempt to compare the clinical manifestations and attentional performance between ADHD children with NE and those without NE. METHODS: We consecutively enrolled children diagnosed with ADHD in child and adolescent psychiatric clinics. The questionnaires for evaluation of ADHD symptoms and voiding dysfunction symptoms were administered to all study participants. All participants also received the Test Battery for Attention Performance (TAP) for assessment of attentional function. RESULTS: A total of 53 children were enrolled in this study, comprising 47 boys and six girls. The prevalence rate of NE was 28.3%. Children in the NE group had statistically significant higher dysfunctional voiding symptom score (5.40 ± 3.66 vs.3.16 ± 2.74; p = 0.018) and two subscales of "When I wet myself, my underwear is soaked" (p < 0.001) and "I miss having a bowel movement every day" (p = 0.047). There were no significant differences with regard to all psychiatric evaluations between the NE and non-NE groups. In the TAP test, the NE group showed a significantly shorter reaction time in the domain of inhibitory control, working memory, and auditory sustained attention than the non-NE group. CONCLUSION: Children with ADHD have a high prevalence of NE. ADHD children with NE had a significantly higher dysfunctional voiding symptom score and shorter reaction time in most domains of the TAP test. Further study is needed to discern the impact of NE on the neuropsychological function of ADHD children.

Factors associated with delayed pediatric hypospadias surgery in Taiwan: a population-based, nationwide analysis.

BACKGROUND/PURPOSE: Current guidelines recommend that hypospadias repair should be performed before age 18 months. This study aims to investigate the trends of surgical timing and to determine what factors are associated with age at surgery. METHODS: The present study utilized a subset of the National Health Insurance Research Database, known as Longitudinal Health Insurance Database 2005, which contains the data of all paid medical benefit claims over the period from 1997 to 2007 for a subset of one million beneficiaries randomly drawn from the population of 22.72 million individuals in NHI program during any part of calendar year 2005. We analyzed claims data for all subjects with the diagnoses of hypospadias. RESULTS: Among 52,705 live male newborns, 218 were diagnosed with hypospadias and thus were included as subjects in our study. Among them, 89 received repair surgery. Approximately 60.6% of the study subjects received repair after the age of 18 months. Multivariate analysis showed that several factors were significantly associated with age at hypospadias surgery: specialty of clinics where first diagnosis was made; specialty of physician making the first diagnosis, age of physician making the first diagnosis; specialty of surgeon performing the surgery; number of years since surgeon's board certification; urbanization level of subject's residence; modality of surgery; concomitant cryptorchidism; concomitant prematurity and low birth weight; age at diagnosis; and number of well-baby clinic visits. CONCLUSION: This study addresses an important issue of delayed hypospadias surgery in Taiwan, which provides a potential opportunity for improvement in quality of care.

Postconditioning with far-infrared irradiation increases heme oxygenase-1 expression and protects against ischemia/reperfusion injury in rat testis.

AIMS: Studies have shown that heme oxygenase-1 (HO-1) has a protective role in the mechanism underlying hypoxic preconditioning. We used a far-infrared radiation (FIR) heater to investigate the postconditioning protective role of HO-1 against ischemia/reperfusion (I/R) injury in rat testis. MAIN METHODS: Forty rats were used. Testis ischemia was mimicked by total obstructive clamping of testis vessels for 1, 2, or 4 h, and concomitant postconditioning with 30 min FIR or heat light during initially 30 min reperfusion. HO-1 expression and apoptosis of testis tissues were examined by immunohistochemistry and in situ terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL) assay, respectively. HO-1 protein level and caspase-3 activity were analyzed by Western blotting. KEY FINDINGS: There was less apoptotic activity in rat testis after FIR, as determined by TUNEL assay. Higher HO-1 protein expression was observed by immunohistochemistry and Western blotting (p<0.01) in testis cells after FIR postconditioning. In contrast, caspase-3 activity was significantly higher in heat light groups, as compared with FIR groups (p<0.01). SIGNIFICANCE: FIR postconditioning attenuated I/R injury in rat testis by inducing HO-1 expression, which might have a protective role in testis apoptosis after I/R injury.

Metabolic syndrome associated with reduced lower urinary tract symptoms in middle-aged men receiving health checkup.

OBJECTIVE: To investigate the impact of metabolic syndrome on lower urinary tract symptoms in a sample of middle-aged men receiving a health checkup. METHODS: Subjects aged 45 years or older who voluntarily underwent a medical checkup were enrolled. Participant demographics and health history were collected by a self-administered questionnaire. All participants were stratified into 2 groups by the presence of metabolic syndrome, as defined according to the updated National Cholesterol Education Program's Adult Treatment Panel III. Prostate volume and prostate-specific antigen levels were used for subgroup analysis. RESULTS: During January through December of 2010, 708 subjects with a mean age of 55.6 ± 9.72 years were enrolled into the study. Compared to the nonmetabolic syndrome group, the metabolic syndrome group had lower total international prostatic symptoms score (7.89 ± 6.63 vs 6.85 ± 6.52, P = .05) and lower severity of weak urinary stream (1.24 ± 1.60 vs 0.95 ± 1.50, P = .021). In the higher prostate volume group (prostate volume ≥ 30 mL), total international prostatic symptoms score, storage score, and urinary frequency, urgency and incomplete emptying were lower in men vs those without metabolic syndrome (all P < .05). The negative association between voiding score, severity of lower urinary tract symptoms, and metabolic syndrome became particularly pronounced as the number of metabolic syndrome factors increased (P for trend < .01). CONCLUSION: We confirmed that metabolic syndrome had favorable effects on lower urinary tract symptoms, including voiding and storage symptoms in healthy middle-aged men. This beneficial effect was most significant in men with enlarged prostate and/or high prostate specific antigen levels.

Pediatric urolithiasis in Taiwan: a nationwide study, 1997-2006.

OBJECTIVE: To investigate the prevalence, incidence, associated risk factors, and treatment of pediatric urolithiasis in Taiwan. METHODS: The present study used a subset of the National Health Insurance Research Database, known as the Longitudinal Health Insurance Database 2005, which contains the data for all paid medical benefit claims from 1997 to 2006 for a subset of 1 million beneficiaries randomly drawn from the population of 22.72 million individuals during any part of the calendar year 2005. Our analysis included the data of all newly diagnosed pediatric patients with an "International Classification of Disease, 9th revision," diagnosis of urolithiasis from 1997 through 2006. RESULTS: A total of 1679 pediatric subjects who had newly diagnosed urolithiasis without a previous attack were identified from 1997 to 2006 as the study sample. Of the 1679 patients, 808 were boys (48.1%) and 871 were girls (51.9%). The incidence rate of urolithiasis in 2005 was 0.047%. The peak age of pediatric stone occurrence in the study sample was 15-18 years (49.6%). The most common associated disease was urinary tract infection (34.1% of all subjects). The occurrence rate of pediatric urolithiasis correlated significantly with the urbanization level of the residence and geographic area. CONCLUSION: Using a nationwide, population-based study provides important clinical and epidemiologic information regarding pediatric urolithiasis. Additional studies are warranted to determine the effect of geographic area and urbanization level on the occurrence of pediatric stone disease.

Down-regulation of glucose-regulated protein (GRP) 78 potentiates cytotoxic effect of celecoxib in human urothelial carcinoma cells.

Celecoxib is a selective cyclooxygenase-2 (COX-2) inhibitor that has been reported to elicit anti-proliferative response in various tumors. In this study, we aim to investigate the antitumor effect of celecoxib on urothelial carcinoma (UC) cells and the role endoplasmic reticulum (ER) stress plays in celecoxib-induced cytotoxicity. The cytotoxic effects were measured by MTT assay and flow cytometry. The cell cycle progression and ER stress-associated molecules were examined by Western blot and flow cytometry. Moreover, the cytotoxic effects of celecoxib combined with glucose-regulated protein (GRP) 78 knockdown (siRNA), (-)-epigallocatechin gallate (EGCG) or MG132 were assessed. We demonstrated that celecoxib markedly reduces the cell viability and causes apoptosis in human UC cells through cell cycle G1 arrest. Celecoxib possessed the ability to activate ER stress-related chaperones (IRE-1α and GRP78), caspase-4, and CCAAT/enhancer binding protein homologous protein (CHOP), which were involved in UC cell apoptosis. Down-regulation of GRP78 by siRNA, co-treatment with EGCG (a GRP78 inhibitor) or with MG132 (a proteasome inhibitor) could enhance celecoxib-induced apoptosis. We concluded that celecoxib induces cell cycle G1 arrest, ER stress, and eventually apoptosis in human UC cells. The down-regulation of ER chaperone GRP78 by siRNA, EGCG, or proteosome inhibitor potentiated the cytotoxicity of celecoxib in UC cells. These findings provide a new treatment strategy against UC.

Honokiol attenuates torsion/detorsion-induced testicular injury in rat testis by way of suppressing endoplasmic reticulum stress-related apoptosis.

OBJECTIVE: To investigate the protective effect of honokiol, a phytochemical used in traditional medicine, on testicular injury after torsion/detorsion (T/D) in a rat model. Testicular torsion is a medical emergency that can cause impairment of semen quality and permanent testicular atrophy or loss. METHODS: Male Wistar rats were randomized to each time point of each group (n = 6/time point/group). After 2 hours of torsion, the testes were counter-rotated to the natural position. The rats in each group underwent a sham operation, T/D, or T/D with honokiol treatment (5 mg/kg and 10 mg/kg intraperitoneally, immediately before detorsion). Bilateral orchiectomy was performed at 6 and 24 hours and 3 months after detorsion. The testes were examined histologically. Apoptosis and endoplasmic reticulum stress were detected by Western blot. RESULTS: Histologic examination revealed that testicular T/D induced acute injury after 6 and 24 hours, and spermatogenesis was decreased at 3 months of follow-up. At 24 hours after T/D, increases were found in the activation of apoptosis-related molecules [poly (ADP-ribose) polymerase and caspases 3 and 7], and the expression levels of endoplasmic reticulum stress-associated molecules (phosphorylated-eukaryotic translation initiation factor 2 subunit α and CCAAT/enhancer-binding protein homologous protein). These increases were significantly reversed with honokiol treatment. Furthermore, honokiol effectively reversed the inhibition of spermatogenesis in testes treated with T/D for 3 months. CONCLUSION: The results of our study have shown that the endoplasmic reticulum stress-related apoptotic pathway is involved in testicular injury after testicular T/D. It remains to be determined whether alterations in this pathway would have a protective affect against reperfusion damage.

Correlation between symptoms of voiding dysfunction and attention deficit disorder with hyperactivity in children with lower urinary tract symptoms.

PURPOSE: We clarified correlations between symptoms of attention deficit disorder with hyperactivity and voiding dysfunction in children. MATERIALS AND METHODS: The study sample consisted of 92 boys and 38 girls 4 to 14 years old who presented at pediatric urology clinics with untreated lower urinary tract symptoms. Parents completed the Swanson, Nolan and Pelham-IV scale. Each subject with a combined score in the first 2 subscales (inattention, hyperactivity/impulsivity) at or above the 90th percentile was classified as having symptoms of attention deficit disorder with hyperactivity. All other cases were classified as nonattention deficit disorder. Voiding dysfunction symptoms were assessed by the Dysfunctional Voiding Symptom Scale. Sleep quality was assessed by the Pediatric Sleep Questionnaire. We then analyzed correlations between Dysfunctional Voiding Symptom Scale and symptoms of attention deficit disorder with hyperactivity. RESULTS: The group with symptoms of attention deficit disorder with hyperactivity had significantly higher scores on the Dysfunctional Voiding Symptom Scale overall and in the "cannot wait" subscale compared to the group without attention deficit disorder, as well as poorer sleep quality and lower voiding volumes. Overall Dysfunctional Voiding Symptom Scale scores were significantly correlated with overall Swanson, Nolan and Pelham-IV scale scores and also significantly correlated with each of the 3 Swanson, Nolan and Pelham-IV subscales (inattention, hyperactivity/impulsivity and oppositional defiant). Overall Dysfunctional Voiding Symptom Scale scores and scores on the "cannot wait" and "hurt when pee" subscales were significantly higher for males than for females. CONCLUSIONS: Boys with higher scores of attention deficit disorder with hyperactivity symptoms tend to have higher Dysfunctional Voiding Symptom Scale scores. Lower urinary tract symptoms were significantly correlated with overall Swanson, Nolan and Pelham-IV scores and significantly correlated with each of the 3 subscales. Evaluation of concomitant symptoms of attention deficit disorder with hyperactivity in children with lower urinary tract symptoms is an important clinical concern.

Simvastatin induces the expression of hemeoxygenase-1 against ischemia-reperfusion injury on the testes in rats.

We evaluate the protective role of simvastatin-induced HO-1 in remote preconditioning against testis ischemia-reperfusion (IR) injury in vivo. Simvastatin was intraperitoneally (i.p.) injected 24 h before IR injury. Testis was occluded in the right testis for 40 min and followed by 30 min of reperfusion to induce IR injury. Tin protoporphyrin (Snpp), a competitive inhibitor of hemeoxygenase, was i.p. injected 1 h before the IR injury in separate groups of rats. The rat testes were harvested 24 h later. Induction of HO-1 expression by simvastatin was significantly increased at 24 and 48 h. Rats pre-treated with simvastatin showed higher expression of HO-1 protein by Western blotting and immunohistochemistry (IHC), and presented lower caspases-3 activity by caspase-3 activity assay. TUNEL staining analysis revealed simvastatin pretreatment significantly reduced IR induced cellular apoptosis. Contrarily, the simvastatin-induced cytoprotective effect was entirely abolished by administrations of Snpp. Further, lower caspase-3 activities were also noted in simvastatin plus Snpp (SS) group than the control plus Snpp (CS) group. After IR injury, eNOS immunoreactivity was markedly increased in the germ cell and Leydig cell of testicular tissues. Pretreatment of simvastatin significantly decreased eNOS immunoreactivity in the germ cell of the tubules in the rat testes. In conclusion, we suggest HO-1 plays a protective role in IR-induced injury in the testes of rats.

Finasteride upregulates expression of androgen receptor in hyperplastic prostate and LNCaP cells: implications for chemoprevention of prostate cancer.

BACKGROUND: Although finasteride is recognized for its role as a chemopreventive agent for prostate cancer, higher grades of malignancy have been reported. It is questioned whether blocking of testosterone conversion to dihydrotestosterone (DHT) by finasteride in prostate tissue will change expression of androgen receptor (AR). Therefore, this study evaluated the effects of finasteride on AR expression in prostate tissue and in the LNCaP cell line. METHODS: Between January and December 2006, we retrospectively selected and evaluated 47 cases of benign prostatic hyperplasia treated with variable duration of finasteride (5 mg QD) before transurethral resection of the prostate. AR expression in prostate tissue was semiquantified by immunostaining and compared with duration of finasteride treatment. An androgen-dependent prostate cancer cell line (LNCaP) was cultured in charcoal/dextran-treated FBS with DHT or testosterone, and treated with finasteride for 1-3 weeks. Samples of total RNA were collected to analyze expression of AR by real-time quantitative reverse transcription polymerase chain reaction. RESULTS: Immunohistochemical study revealed significant upregulation of ARs by finasteride treatment for 30-180 days. In cell line study, quantitative real-time reverse transcription polymerase chain reaction revealed significant upregulation of ARs treated by finasteride. CONCLUSIONS: In our study, finasteride influenced AR expression in benign prostate tissue and prostate cancer cell. Before we can use finasteride in chemoprevention with confidence, we still need to clarify the influence of finasteride in ARs and its regulation pathway.

Stathmin immunoreactivity in phaeochromocytomas and paragangliomas: differential expression between benign and malignant neoplasms.

OBJECTIVE: This study aimed to assess stathmin expression in benign and malignant phaeochromocytomas and paragangliomas. METHODS: Tissue specimens from 37 patients with malignant phaeochromocytomas (n = 5), malignant paragangliomas (n = 3), benign phaeochromocytomas (n = 24), and benign paragangliomas (n = 5) were analysed for stathmin expression by western blotting and immunohistochemical staining with polyclonal antibodies. Malignancy was defined by metastases in nonchromaffin tissues. RESULTS: There were higher stathmin expression levels in phaeochromocytomas compared to normal adrenal tissue, by western blotting and reverse-transcriptase polymerase chain reaction, whereas immunohistochemical staining showed stathmin immunoreactivity in the cytoplasm of tumour cells. Malignant neoplasms had significantly higher stathmin expression compared to benign neoplasms by western blotting and immunohistochemical staining. CONCLUSION: Malignant phaeochromocytomas and paragangliomas have significantly higher levels of stathmin expression compared to benign tumours. The potential value of stathmin in predicting malignancies requires further studies.

Epidemiology of hypospadias and treatment trends in Taiwan: a nationwide study.

PURPOSE: We investigated the rate of diagnosis and treatment trends of hypospadias in Taiwan within the first 3 years of life. MATERIALS AND METHODS: We used a subset of the Taiwan National Health Insurance Research Database, which contains data on all inpatient and outpatient medical benefit claims, for the period 1997 through 2008 for a sample of 1 million individuals randomly drawn from the population of 25.68 million who held membership in the National Health Insurance program during any part of the calendar year 2005. We analyzed claims data for all subjects who were diagnosed with hypospadias through age 3 years. RESULTS: Among 52,705 newborns (individuals whose claims included live birth) 178 were diagnosed with hypospadias within 3 years of birth. Thus, mean incidence was 33.8 per 10,000 live male births. The hypospadias repair rate was 14.3 per 10,000 live male births. There was no significant tendency toward increase or decrease in rates of diagnoses or repairs, or proportion of severe hypospadias. There were significant associations between rates of hypospadias diagnoses and urbanization level of the community where the diagnosis was made. Approximately 54% of patients who underwent surgical repair did so after age 18 months. CONCLUSIONS: The nationwide incidence of hypospadias in children younger than 3 years in Taiwan is similar to that reported in previous studies. Delayed diagnosis and treatment of hypospadias are important clinical concerns that warrant further investigation.

Lower urinary tract symptoms and urinary flow rates in female patients with hyperthyroidism.

OBJECTIVES: To investigate lower urinary tract symptoms (LUTS) and voiding function in a cohort of hyperthyroid women. The autonomic nervous system (ANS) imbalance has been thought to cause LUTS in hyperthyroidism. METHODS: Between January 2008 and December 2008, 65 newly diagnosed, untreated female hyperthyroid patients were enrolled in this study. Another 62 age-matched healthy women were enrolled as a control group. Demographics, LUTS, urinary flow rates, hyperthyroid symptoms, and serum levels of thyroid hormones were recorded before and after the medical treatment for hyperthyroidism. RESULTS: Compared with the control group, the hyperthyroid patients had a higher mean symptom score of frequency (1.15 ± 1.75 vs 0.31 ± 1.05, P = .01), incomplete emptying (0.91 ± 1.47 vs 0.29 ± 1.12, P = .02), straining (1.05 ± 0.85 vs 0.27 ± 0.51, P <.01), voiding symptoms (3.05 ± 3.28 vs 1.06 ± 2.63, P <.01), and total symptoms (5.88 ± 6.17 vs 2.76 ± 4.65, P <.01). Fifty-three (81.5%) of them had an IPSS of <8, while only 12 (18.5%) had an International Prostate Symptom Score (IPSS) of ≥8. Hyperthyroid women demonstrated a lower mean peak flow rate (25.0 ± 5.3 vs 28.6 ± 6.1 mL/s, P = .02). After treatment, both LUTS and flow rates improved significantly. The severity of LUTS was associated with neither serum levels of thyroid hormone nor other hyperthyroid symptoms. CONCLUSIONS: Hyperthyroid women have worse LUTS and lower peak flow rates than healthy controls. However, the severity of LUTS is only mild (IPSS <8) in the majority, and only 18.5% have moderate-to-severe LUTS. Both LUTS and flow rates improve after the treatment for hyperthyroidism. The exact mechanisms of LUTS and/or lower urinary tract dysfunction in hyperthyroidism require further investigation.

Predictive factors for ureteral double-J-stent-related symptoms: a prospective, multivariate analysis.

BACKGROUND/PURPOSE: Whether the length of stent affects stent-related symptoms after urological procedures remains controversial. We aimed to evaluate the predictive factors for stent-related urinary tract symptoms after uncomplicated ureteroscopic lithotripsy (URSL). METHODS: We prospectively recruited a total of 59 patients who underwent URSL and 6-Fr double-J ureteral stent placement. The demographic and perioperative data and stent characteristics, including the length (22, 24 or 26 cm), position of proximal end (upper calyx or pelvis), position of distal end (crossing midline or not), and configurations of both ends (complete or incomplete curl) were recorded. All patients completed a self-administered questionnaire to evaluate the stent-related urinary symptoms, bladder pain, flank pain and hematuria 1 week after the procedure. All variables were analyzed by a proportional odds logistic regression model. RESULTS: Twenty-two male (37.3%) and 37 (62.7%) female patients were enrolled in this study. Their mean age was 53.7 ± 12.9 years. The mean body height was 161.9 ± 7.9 cm (range, 145.9-178 cm). In multivariate analysis, the 26-cm stent was independently associated with the severity of frequency, urgency, and nocturia symptoms. Crossing the midline of the distal end was significantly associated with urge incontinence. The 24-cm and 26-cm stents were both very strongly associated with the severity of hematuria. Crossing the midline of the distal end was significantly associated with bladder pain. CONCLUSION: The length of stent and crossing the midline of the distal end were significantly associated with stent-related symptoms after URSL. Selection of the proper length of double-J stent is the most important factor in minimizing stent-related symptoms.

Appropriate cut-off value for follicle-stimulating hormone in azoospermia to predict spermatogenesis.

BACKGROUND: This study was undertaken to determine the optimal cut-off value for FSH to predict the presence of spermatogenesis in patients with non-obstructive azoospermia. METHODS: A total of 206 non-obstructive azoospermic men were enrolled in this prospective study. By using receiver operating characteristic (ROC) curves, we determined the optimal cut-off value for FSH and evaluated whether the test could adequately predict successful sperm retrieval. RESULTS: There were 108 non-obstructive azoospermic patients who had evidence of spermatogenesis (group A) and achieved success in sperm retrieval. Another 98 non-obstructive azoospermic patients (group B) failed in sperm retrieval. The mean value of serum FSH in group B was significantly higher than in group A (28.03 +/- 14.56 mIU/mL vs 7.94 +/- 4.95 mIU/mL, p < 0.01; respectively). The area under the receiver operating characteristic curves were 0.939 +/- 0.02 and a cut-off value of 19.4 mIU/mL discriminated between group A and B with a sensitivity of 70%. The positive predictive value for failed sperm retrieval (group B) can reach 100%. CONCLUSIONS: Elevated plasma levels of FSH of more than 19.4 mIU/mL could be used as a reliable criterion for a trial of sperm retrieval from testes in artificial reproductive techniques.

Lower urinary tract symptoms in women with irritable bowel syndrome.

OBJECTIVES: To investigate lower urinary tract symptoms (LUTS) in women with irritable bowel syndrome (IBS) and to evaluate risk factors associated with the psychiatric morbidity of these patients. METHODS: The study group included 52 female patients with a diagnosis of IBS. Fifty-five women without gastrointestinal symptoms were used as controls. LUTS were evaluated using the American Urological Association Symptom Index questionnaire. Psychiatric morbidity was evaluated using a 12-item version of the Chinese Health Questionnaire. Multiple logistic regression analysis was performed to identify the risk factors associated with psychiatric morbidity in IBS patients. RESULTS: There were no significant differences between the two groups in any of the demographic variables. The most common LUTS in patients with IBS were storage symptoms. These patients had significantly higher scores of frequency, nocturia, urge incontinence, lower maximal flow rate and lower voiding volume (P < 0.05). In addition, significantly higher storage and total American Urological Association Symptom Index questionnaire scores were also noted in IBS patients (P < 0.05). The prevalence of psychiatric morbidity in IBS patients was 28.8%, which was significantly higher than in the control group (20%). The urinary storage symptom score (odds ratio: 1.518; 95% confidence interval: 1.17-1.96; P = 0.002) was significantly correlated with psychiatric morbidity. CONCLUSIONS: LUTS are common in IBS patients and have a negative impact on their psychiatric status. Healthcare providers should be aware of the psychological consequences of LUTS in these patients.

Expression of stathmin in localized upper urinary tract urothelial carcinoma: correlations with prognosis.

OBJECTIVES: To investigate the expression of stathmin in upper urinary tract (UUT) urothelial carcinoma (UC) in human tissues and to determine whether the level of stathmin expression was correlated with prognosis because overexpression of stathmin has been observed in various malignancies. METHODS: We first analyzed stathmin mRNA level in 5 UUT-UC paired fresh specimens (tumor and nontumoral urothelium) by RT-PCR. Besides, a total of 58 patients with localized UUT-UC (pT1-3N0M0) treated by nephroureterectomy were enrolled. The stathmin expression in UUT-UC specimens was analyzed by immunohistochemical (IHC) staining. Stathmin IHC score was defined as the proportion of positive staining tumor cells from each patient's specimen. The stathmin IHC score > or = 0.5 was defined as strong (+) immunoreactivity and < 0.5 as weak (-) immunoreactivity. RESULTS: Significant differences in stathmin mRNA between UUT-UC and paired normal urothelium were noted in 5 of the patients. Of the 58 UUT-UC specimens, stathmin immunoreactivity (strong [+] vs weak [-]) was significantly associated with pT stage (P = .006) as well as with recurrence-free and cancer-specific survival. In multivariate analysis, stathmin IHC score was a significant predictor for both recurrence-free survival (hazard rates: 22.4; P = .001) and cancer-specific survival (hazard rates: 39.8; P = .0012). CONCLUSIONS: The stathmin immunostaining is a novel prognosticator for patients with localized UUT-UC stathmin may be a help identify such patients with poor outcomes to benefit from receiving close follow-up and early adjuvant therapy.

Choosing the ideal length of a double-pigtail ureteral stent according to body height: study based on a Chinese population.

OBJECTIVE: We conducted this study to determine the ideal stent length according to body height, as data are limited. PATIENTS AND METHODS: A total of 408 patients undergoing ureteroscopic lithotripsy and stent insertion (22, 24 or 26 cm) were enrolled. The appropriateness of the stent length was determined according to the plain films and was further compared among patients with different body heights and stent lengths. RESULTS: In patients <160 cm, the use of a 22-cm stent was significantly more appropriate than a 24- or 26-cm stent (86.5, 51.9 and 46.4%). In patients between 160 and 175 cm, a 22- or 24-cm stent was significantly more appropriate than a 26-cm stent (79.2, 66.7 and 46.3%), while the difference between the use of a 22- and 24-cm stent was not significant. In patients >175 cm, a 24- or 26-cm stent might be more appropriate. CONCLUSIONS: Body heights can predict the ideal stent length. Based on a Chinese population, a 22-cm stent length is more appropriate for those <175 cm. A longer, 24- or 26-cm stent may be suitable for those >175 cm.