Feasibility and safety of elective laparoscopic total extraperitoneal preperitoneal groin hernia repair in the elderly: a propensity score-matched comparison.

BACKGROUND: Several studies of hernia registries have revealed that elderly patients have higher perioperative complication rates compared with younger patients. However, the incidence of hernia increases with the aging process. To evaluate the feasibility and safety of laparoscopic hernia repair in elderly patients (≥75 years), we conducted a prospective case-matched control study to compare perioperative outcomes between patients older and younger than 75 years. METHODS: Between September 2008 and July 2015, 572 consecutive patients undergoing endoscopic hernia repair were included in this prospective study. This case-matched control study was matched based on sex, American Society of Anesthesiologists score, and body mass index between patients younger and ≥75 years. The propensity-score matching of two groups was carried out on a 1:1 basis. Perioperative data were prospectively recorded for all patients including demographic data, operation time, length of hospital stay, narcotic dose, and complications. RESULTS: In the final analysis, 54 patients who were <75 years were extracted to match the 54 patients ≥75 years. These two groups had similar baseline characteristics excluding age. They also had similar perioperative outcomes in hernia recurrence, metachronous contralateral hernia occurrence, complication rate and chronic pain. The patients ≥75 years of age had lower requirements for analgesics than those who were <75 years of age (p=0.047). CONCLUSION: This is the first comparative cohort study investigating the impact of aging in an Asian hernia population. Laparoscopic inguinal hernia repair is feasible and safe for older patients, with comparable perioperative outcomes to patients <75 years.

Laparoendoscopic single-site adrenalectomy in patients with primary hyperaldosteronism: A prospective study with long-term follow up.

OBJECTIVE: Laparoendoscopic single-site (LESS) adrenalectomy is a promising minimally invasive technique, however, the current evidence has not confirmed its long-term effectiveness in primary aldosteronism (PA). We conducted a study to analyze the long-term efficacy of LESS adrenalectomy in patients with PA. METHODS: A total of 49 patients who had been clinically confirmed with PA who had an indication for unilateral adrenalectomy were included in this study. Perioperative data were obtained for all patients. Blood pressure and the levels of serum aldosterone, renin, and potassium were checked periodically. The median follow-up was 16.5 months. RESULTS: No intra- or early post-operative complication occurred. All LESS adrenalectomies were completed successfully, except one with laparoscopic conversion. Hypokalemia was resolved in all cases and no patient required potassium supplements after surgery. Post-operative cure of hypertension was achieved in 63% of our patients. Overall, 84% of our PA patients had clinical improvement in blood pressure control after surgery. CONCLUSIONS: Our long-term experience revealed that LESS adrenalectomy is a safe and effective approach, which demonstrated comparable long-term cure and improvement of hypertension to a conventional laparoscopic series in treating PA.

Feasibility and safety of laparoendoscopic single-site surgery of total extraperitoneal inguinal hernia repair after previous open groin hernia repair: a comparative study.

BACKGROUND: This study is aimed at evaluating the feasibility and safety of laparoendoscopic single-site surgery (LESS) for totally extraperitoneal (TEP) endoscopic hernia surgery after previous open groin hernia repair that may hamper preperitoneal dissection. METHODS: This prospective cohort study included 213 consecutive patients undergoing LESS TEP hernia repair between January 2009 and December 2013. The study group consisted of 36 patients with a history of previous open inguinal hernia repair before undergoing LESS TEP hernia repair. The study enrolled the other 177 patients who underwent LESS TEP during the same period and were enrolled as the control group. We obtained perioperative data for all patients including demographic data, operation time, length of hospital stay, narcotic dose, conversions, and complications. RESULTS: A total of 213 patients with inguinal hernia underwent LESS TEP repair. One case in the control group (0.56 %) required conversion to LESS transabdominal preperitoneal hernia repair, while no cases in the study group required conversion. We observed no differences between the two groups in terms of operative time, analgesic use, hospital stay, and postoperative complications. CONCLUSIONS: LESS TEP hernia repair for patients with previous open inguinal hernia repair can be performed safely by experienced surgeons. Operative outcomes were comparable between both the primary inguinal and recurrent hernia groups.

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.

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

ABSTRACTObjectives: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.

Inter-Observer, Intra-Observer and Intra-Individual Reliability of Uroflowmetry Tests in Aged Men: A Generalizability Theory Approach.

OBJECTIVES: To evaluate the inter-observer, intra-observer and intra-individual reliability of uroflowmetry and post-void residual urine (PVR) tests in adult men. METHODS: Healthy volunteers aged over 40 years were enrolled. Every participant underwent two sets of uroflowmetry and PVR tests with a 2-week interval between the tests. The uroflowmetry tests were interpreted by four urologists independently. Uroflowmetry curves were classified as bell-shaped, bell-shaped with tail, obstructive, restrictive, staccato, interrupted and tower-shaped and scored from 1 (highly abnormal) to 5 (absolutely normal). The agreements between the observers, interpretations and tests within individuals were analyzed using kappa statistics and intraclass correlation coefficients. Generalizability theory with decision analysis was used to determine how many observers, tests, and interpretations were needed to obtain an acceptable reliability (> 0.80). RESULTS: Of 108 volunteers, we randomly selected the uroflowmetry results from 25 participants for the evaluation of reliability. The mean age of the studied adults was 55.3 years. The intra-individual and intra-observer reliability on uroflowmetry tests ranged from good to very good. However, the inter-observer reliability on normalcy and specific type of flow pattern were relatively lower. In generalizability theory, three observers were needed to obtain an acceptable reliability on normalcy of uroflow pattern if the patient underwent uroflowmetry tests twice with one observation. CONCLUSIONS: The intra-individual and intra-observer reliability on uroflowmetry tests were good while the inter-observer reliability was relatively lower. To improve inter-observer reliability, the definition of uroflowmetry should be clarified by the International Continence Society.

Normalized Dysfunctional Voiding Through Timed Voiding.

We report a 3-year-old girl with dysfunctional voiding, febrile urinary tract infection (UTI) and bladder over distention (BOD). After controlling UTI, repeat uroflowmetry depicted staccato flow pattern and postvoid residual (PVR) urine volume was >20 mL. Frequency/volume chart showed voided volume was frequently larger than >100% expected bladder capacity. BOD resulted in dysfunctional voiding and elevated PVR was impressed. Urotherapy with adequate fluids intake, and timed voiding to avoid BOD were taught. Subsequent frequency/volume chart disclosed that voided volume was not greater than 100% expected bladder capacity. Uroflowmetry curves were normalized and PVR decreased. Without prophylactic antibiotics, she was free of UTI for 12 months. Unfortunately, she held urine after attending kindergarten and got febrile UTI again. BOD was impressed and timed voiding was re-initiated after resolution of UTI. She was free of UTI and antibiotics for another 15 months. Bladder over distension may be the cause of dysfunctional voiding, vesicoureteral reflux and UTI. Through timed voiding, BOD may be reversed and UTI may be prevented.