Pembrolizumab Plus Olaparib for Patients With Previously Treated and Biomarker-Unselected Metastatic Castration-Resistant Prostate Cancer: The Randomized, Open-Label, Phase III KEYLYNK-010 Trial.

PURPOSE: There is an unmet need for therapeutic options that prolong survival for patients with heavily pretreated, metastatic castration-resistant prostate cancer (mCRPC). The phase III, open-label KEYLYNK-010 study evaluated pembrolizumab plus olaparib versus a next-generation hormonal agent (NHA) for biomarker-unselected, previously treated mCRPC. METHODS: Eligible participants had mCRPC that progressed on or after abiraterone or enzalutamide (but not both) and docetaxel. Participants were randomly assigned (2:1) to pembrolizumab plus olaparib or NHA (abiraterone or enzalutamide). The dual primary end points were radiographic progression-free survival (rPFS) by blinded independent central review per Prostate Cancer Working Group-modified RECIST 1.1 and overall survival (OS). Time to first subsequent therapy (TFST) was a key secondary end point. Safety and objective response rate (ORR) were secondary end points. RESULTS: Between May 30, 2019, and July 16, 2021, 529 participants were randomly assigned to pembrolizumab plus olaparib and 264 to NHA. At final rPFS analysis, median rPFS was 4.4 months (95% CI, 4.2 to 6.0) with pembrolizumab plus olaparib and 4.2 months (95% CI, 4.0 to 6.1) with NHA (hazard ratio [HR], 1.02 [95% CI, 0.82 to 1.25]; P = .55). At final OS analysis, median OS was 15.8 months (95% CI, 14.6 to 17.0) and 14.6 months (95% CI, 12.6 to 17.3), respectively (HR, 0.94 [95% CI, 0.77 to 1.14]; P = .26). At final TFST analysis, median TFST was 7.2 months (95% CI, 6.7 to 8.1) versus 5.7 months (95% CI, 5.0 to 7.1), respectively (HR, 0.86 [95% CI, 0.71 to 1.03]). ORR was higher with pembrolizumab plus olaparib versus NHA (16.8% v 5.9%). Grade ≥3 treatment-related adverse events occurred in 34.6% and 9.0% of participants, respectively. CONCLUSION: Pembrolizumab plus olaparib did not significantly improve rPFS or OS versus NHA in participants with biomarker-unselected, heavily pretreated mCRPC. The study was stopped for futility. No new safety signals occurred.

High-Performance Two-Dimensional Electronics with a Noncontact Remote Doping Method.

Because of the intrinsic low carrier density of monolayer two-dimensional (2D) materials, doping is crucial for the performance of underlap top-gated 2D devices. However, wet etching of a high-k (dielectric constant) dielectric layer is difficult to implement without causing performance deterioration on the devices; therefore, finding a suitable spacer doping technique for 2D devices is indispensable. In this study, we developed a remote doping (RD) method in which defective SiOx can remotely dope the underlying high-k capped 2D regions without directly contacting these materials. This method achieved a doping density as high as 1.4 × 1013 cm-2 without reducing the mobility of the doped materials; after 1 month, the doping concentration remained as high as 1.2 × 1013 cm-2. Defective SiOx can be used to dope most popular 2D transition-metal dichalcogenides. The low-k properties of SiOx render it ideal for spacer doping, which is very attractive from the perspective of circuit operation. In our experiments, MoS2 and WS2 underlap top-gate devices exhibited 10× and 200× increases in their on-currents, respectively, after being doped with SiOx. These results indicate that SiOx doping can be conducted to manufacture high-performance 2D devices.

Comparing the Detection Performance Between Multiparametric Magnetic Resonance Imaging and Prostate-Specific Membrane Antigen PET/CT in Patients With Localized Prostate Cancer: A Systematic Review and Meta-analysis.

PURPOSE: Multiparametric MRI (mpMRI) has been promoted as an auxiliary diagnostic tool for prostate biopsy. However, prostate-specific membrane antigen (PSMA) including 68 Ga-PSMA-11, 18 F-DCFPyL, and 18 F-PSMA-1007 applied PET/CT imaging was an emerging diagnostic tool in prostate cancer patients for staging or posttreatment follow-up, even early detecting. Many studies have used PSMA PET for comparison with mpMRI to test the diagnostic ability for early prostate cancer. Unfortunately, these studies have shown conflicting results. This meta-analysis aimed to compare the differences in diagnostic performance between PSMA PET and mpMRI for detecting and T staging localized prostatic tumors. METHODS: This meta-analysis involved a systematic literature search of PubMed/MEDLINE and Cochrane Library databases. The pooling sensitivity and specificity of PSMA and mpMRI verified by pathological analysis were calculated and used to compare the differences between the 2 imaging tools. RESULTS: Overall, 39 studies were included (3630 patients in total) from 2016 to 2022 in the current meta-analysis and found that the pooling sensitivity values for localized prostatic tumors and T staging T3a and T3b of PSMA PET were 0.84 (95% confidence interval [CI], 0.83-0.86), 0.61 (95% CI, 0.39-0.79), and 0.62 (95% CI, 0.46-0.76), respectively, whereas those of mpMRI were found to be 0.84 (95% 0.78-0.89), 0.67 (95% CI, 0.52-0.80), and 0.60 (95% CI, 0.45-0.73), respectively, without significant differences ( P > 0.05). However, in a subgroup analysis of radiotracer, the pooling sensitivity of 18 F-DCFPyL PET was higher than mpMRI (relative risk, 1.10; 95% CI, 1.03-1.17; P < 0.01). CONCLUSIONS: This meta-analysis found that whereas 18 F-DCFPyL PET was superior to mpMRI at detecting localized prostatic tumors, the detection performance of PSMA PET for localized prostatic tumors and T staging was comparable to that of mpMRI.

Management of metastatic renal cell carcinoma following prior vascular endothelial growth factor-targeted therapy: A real-world retrospective study from Taiwan.

BACKGROUND: There are limited real-world data to guide the sequencing of targeted therapies in patients with metastatic renal cell carcinoma (mRCC). The objective of this study was to characterize real-world treatment patterns (primarily second line [2L]) after prior vascular endothelial growth factor (VEGF) targeted therapy in an unselected mRCC population from Taiwan between 2013 and 2017. Treatment-related adverse events (TRAEs) and their management were also evaluated (NCT03633579). METHODS: This retrospective cohort study included patients who had received prior VEGF-targeted therapy and were treated at the National Taiwan University Hospital or the Taipei Veterans General Hospital between June 2013 and December 2017. Outcomes were characterized using descriptive statistics. RESULTS: Overall, 27 patients were included: 22 (81.5%) male; mean standard deviation (SD) age, 63.1 (11.1) years; 18 (66.7%) initiated targeted therapy during the year immediately following mRCC diagnosis. All patients received sunitinib as their first-line (1L) targeted therapy, with a median (range) treatment duration of 10 (1.8-65.8) months. The most common reason for discontinuing 1L sunitinib was disease progression (88.9% of patients). Everolimus was the most common 2L targeted therapy, in 23 patients (85.2%); 4 patients (14.8%) received 2L axitinib. Median (range) duration of 2L therapy was 4.0 (0.1-30.5) months for everolimus and 4.2 (0.5-9.2) months for axitinib. Ten TRAEs were reported among seven patients receiving 2L everolimus: hypertension (n = 5), hand-foot syndrome (n = 2), hyperglycemia (n = 1), renal failure (n = 1), and interstitial pneumonitis (n = 1). The majority (80%) of TRAEs were managed in the outpatient setting. No TRAEs were reported in the axitinib group. CONCLUSION: Real-world management of patients with mRCC in Taiwan broadly aligned with clinical guidelines and national reimbursement policy at the time of the study. These findings may be a useful reference for assessing the implications of evolving mRCC management approaches in Taiwan.

The effects of a Chinese herbal medicine (VGHBPH0) on patients with benign prostatic hyperplasia: A pilot study.

BACKGROUND: The current Western medicine treatment options for benign prostatic hyperplasia (BPH) have various degrees of documented effectiveness. However, the uses of these interventions are limited to specific patient populations or have certain side effects that interfere with patient quality of life. This study evaluated the clinical effects of a Chinese herbal medicine (CHM) on patients with BPH. METHODS: This was a single-arm pilot study. Twenty BPH patients were enrolled, and they were required to take the investigated CHM three times a day for 8 weeks, along with their Western medicine. Patients returned to clinics as scheduled and completing international prostate symptoms scores (IPSS), aging male symptoms score, international index of erectile function, and body constitution questionnaire of traditional Chinese medicine. Uroflowmetry and sonography were also applied to evaluate the changes in urinary velocity and post-voiding residual urine volume from the baseline to the end of the study. RESULTS: The mean IPSS total score was significantly decreased by 2.5 points after 8 weeks of treatment with the CHM (from 17.5 to 15.0, p = 0.03). The mean IPSS voiding subscore was decreased by 1.7 points (from 10.1 to 8.4, p = 0.02), and the mean incomplete emptying subscore was decreased by 0.8 points (from 2.9 to 2.1, p = 0.02), with both decreases being statistically significant. A descending trend in the post-voiding residual urine volume was also observed (from 52.9 to 30.8 mL, p = 0.07). CONCLUSION: This trial indicated that the add-on CHM treatment (VGHBPH0) might be a potential treatment for improving the lower urinary tract symptoms of BPH patients.

Is intravesical prostatic protrusion a risk factor for hydronephrosis and renal insufficiency in benign prostate hyperplasia patients?

BACKGROUND: Some patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms hesitate to undergo surgical treatment until acute urinary retention (AUR) occurs. Some of these patients have been found to have hydronephrosis or even renal insufficiency. This study aimed to analyze the risk factors for hydronephrosis in patients with AUR who needed to receive transurethral resection of the prostate (TURP). METHODS: We retrospectively analyzed 91 patients from January 2014 to June 2015, who had BPH and received TURP for AUR. Patients with urolithiasis, prostate cancer, bladder cancer, gross hematuria, previous bladder radiation therapy, or urinary tract surgery were excluded. Parameters of intravesical prostatic protrusion (IPP), serum prostatic specific antigen (PSA), total prostate volume (PV), age, body mass index (BMI), hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), and serum creatinine (Cr) were compared between the hydronephrosis and non-hydronephrosis groups. RESULTS: There were significant differences in IPP (p < 0.001) and Serum Cr (p < 0.001) between the hydronephrosis and non-hydronephrosis groups. For IPP, the cut-off values of the highest risk of hydronephrosis was 1.95 cm. There were no significant differences in age, BMI, DM, HTN, CAD, total PV, and PSA between the two groups. IPP was not correlated with total PV (p = 0.423). Most of the patients with hydronephrosis had renal function improvement after TURP. CONCLUSION: IPP was a significant risk factor for hydronephrosis in BPH patients. If the patients' IPP exceeded 1.95 cm, they had a higher risk of having hydronephrosis when AUR occurred. Hydronephrosis is a risk factor for renal insufficiency, and Serum Cr levels decreased significantly in the patients of our study.

2018 Expert Consensus on the Management of Adverse Effects of Antiplatelet Therapy for Acute Coronary Syndrome in Taiwan.

Antiplatelet therapy is a key component in the treatment of acute coronary syndrome (ACS). The management of ACS has evolved considerably over recent years with the development of new and more potent antiplatelet agents. Clinical trials on ACS have demonstrated that potent antiplatelet agents can more effectively reduce cardiovascular events. However, there is a tipping point between safety and efficacy, beyond which the risk of bleeding and other adverse effects can outweigh the benefits of antiplatelet therapy. Striking a balance between safety and efficacy remains a major challenge. A consensus meeting of an expert panel composed of Taiwanese experts was held to provide recommendations for the management of adverse effects in patients with ACS receiving antiplatelet therapy. The common adverse effects of antiplatelet therapy include upper gastrointestinal bleeding, ecchymosis, hematuria, epistaxis and ticagrelor-related dyspnea. In this study, a literature review of these adverse events was performed and recommendations for the management were made.

Clinical analysis of 48-h emergency department visit post outpatient extracorporeal shock wave lithotripsy for urolithiasis.

BACKGROUND: Patients suffering from renal or ureteral stones can undergo significant discomfort, even when timely diagnosed and treated. The aim of this study was to assess the risk factors and safety of outpatient Extracorporeal Shock Wave Lithotripsy (ESWL) in the management of patients with renal or ureteral stones. METHODS: In this study, our cohort consisted of 844 outpatients who underwent outpatient ESWL treated between February 2012 and November 2014 at Taipei Veterans General Hospital. Patients who visited the emergency room (ER) within 48 h after Outpatient ESWL were included in this article. This article analyzes the stone size, stone shape (long to short axis ratio), stone location, previous medical management, urinalysis data, complications and treatment received in the emergency department. RESULTS: Among the 844 initial consecutive patients who underwent outpatient ESWL a total of 1095 times, there were 22 (2%) patients who sought help at our emergency room within 48 h after the outpatient ESWL. Of those 22 patients, the mean age was 54.3 ± 12.6 years, and the BMI was 25.9 ± 3.2. The most common complication complaint was flank pain (55.2%). Other complications included hematuria (13.8%), fever (17.2%), nausea with vomiting (6.9%), acute urinary retention (3.4%) and chest tightness with cold sweating (3.4%). In 22 patients who went back to the ER, 7 patients were admitted to the ward and 1 patient again returned to the ER. All patients received medical treatment without ESWL or surgical management. The meaningful risk factor of ER-visiting rate following outpatient ESWL within 48 h was stone location, and the renal stones showed statistic significant (p = 0.047) when compared to ureteral stones. CONCLUSION: Our study indicated that renal stone contributed to a significantly higher risk of ER-visiting rate to patients than did ureteral stone, following outpatient ESWL within 48 h. This study confirmed that Outpatient ESWL is a safe treatment for renal or ureteral stones, while inpatient ESWL is not absolutely necessary.

Clinical efficacy of transrectal ultrasound-guided prostate biopsy in men younger than 50 years old with an elevated prostate-specific antigen concentration (>4.0 ng/mL).

BACKGROUND: Prostate cancer (PCa) is not commonly found in men younger than 50 years of age. However, serum prostate-specific antigen (PSA) concentration has been examined more frequently at a younger age in Asia partially due to an increased awareness of prostate cancer. The purpose of our study was to investigate the efficacy and complication of PSA-triggered transrectal ultrasonography-guided prostate (TRUSP) biopsies. We retrospectively reviewed TRUSP biopsies in young men with elevated PSA concentration in Taipei Veterans General Hospital. METHODS: We reviewed the cases of patients younger than 50 years of age with elevated PSA concentration (>4.0 ng/mL), who received 12 cores TRUSP biopsies at TPEVGH from January 2008-December 2013. The age, family history, digital rectal examination (DRE) results, PSA concentration, free/total PSA ratio, total prostate volume, PSA density, lower urinary tract symptoms and complications after the procedure were reviewed. The pathologic findings of TRUSP biopsy and clinical follow-up were reviewed and analyzed according to the Epstein criteria. RESULTS: A total of 77 patients were included and were divided into 2 groups: 1) the younger group consisted of 20 patients <40 years of age; and 2) the elder group had 57 patients who were 40-50 years of age. The overall detection rate of PCa was 11.69% (9/77), and all of the PCa cases were diagnosed in the elder group (group detection rate: 15.8%). There was a significant difference in the severity of lower urinary tract symptoms (LUTS) between these 2 groups. All PCa patients were clinically significant according to the Epstein criteria. Two patients experienced fever (2.60%) after TRUSP biopsy. CONCLUSION: From our patient cohort, it appears that no benefit was apparent for patients younger than 40 years old who received TRUSP biopsy, even with elevated PSA. However, PCa detected in men between 40 and 50 years of age were all clinically significant. Overall, our results supported current major practice guidelines which recommend an initial PSA checkup at 40 years of age.

Prostate cancer in young adults-Seventeen-year clinical experience of a single center.

BACKGROUND: In the general population, prostate adenocarcinoma affects predominately older men. If fact, most current guidelines suggest that males over the age of 50 years should undergo prostate cancer screening. However, the clinical behavior and prognosis of prostate cancer in young adults is not well defined. The aim of this study was to evaluate the clinical behavior, pathological characteristics, and prognosis of prostate cancer in young adults. METHODS: We retrospectively reviewed the records of young patients (age, ≤50 years) in our hospital with prostate adenocarcinoma between 1997 and 2013. We compared data including initial presentation, cancer cell type, Gleason score, disease stage, prostate-specific antigen (PSA) level, prostate volume, treatment, and survival between patients both younger and older than 50 years. Data were analyzed using the Kaplan-Meier method to assess survival. RESULTS: Twenty-six patients were enrolled in our study, accounting for 0.55% of all patients with a diagnosis of prostate cancer at our facility. All 26 patients had a pathology diagnosis of adenocarcinoma, with a mean age on diagnosis of 46.8±2.8 years (range, 39-50 years). On initial presentation, patients older than 50 years more frequently displayed lower urinary tract symptoms (LUTS) than younger patients (62.3% vs. 30.4%, p=0.008). There was no statistical difference in histological grade, disease stage, PSA level, overall survival, and biochemical-free survival between the two groups. CONCLUSION: The result of our investigation indicated that prostate adenocarcinoma patients younger than 50 years had similar histological grade, disease stage, PSA level, overall survival, and biochemical-free survival as the older population. However, patients younger than 50 years with prostate cancer less frequently showed initial symptoms of LUTS.

Cognitive MRI-TRUS fusion-targeted prostate biopsy according to PI-RADS classification in patients with prior negative systematic biopsy results.

BACKGROUND: The purpose of this study was to evaluate the prostate cancer yield rate of targeted transrectal ultrasound (TRUS)-guided biopsy with cognitive magnetic resonance imaging (MRI) registration without concurrent systematic biopsy in patients with previous negative systematic TRUS-guided biopsy results and persistently elevated prostate-specific antigen (PSA) levels. METHODS: In this prospective study conducted from August 2013 to January 2015, patients with at least one previous negative systematic TRUS-guided biopsy and persistently high PSA (≥4 ng/mL) levels were referred for multiparametric MRI (mpMRI). Those patients with suspicious findings on mpMRI received a subsequent cognitive MRI-TRUS fusion biopsy. The cancer-detection rate, tumor location, and Gleason score were confirmed, and PSA-related data were compared between cancer-yield and noncancer-yield groups. RESULTS: In total, 48 patients were included in this study. MRI was designated to be four and five in 17 patients. Fifteen patients received a cognitive fusion-targeted biopsy, and prostate cancers were detected in 10 patients. The cancer-detection rate was 20.8% (10/48), and the positive-predictive value of MRI was 66.7%. No significant differences were observed in the PSA level, PSA velocity, or transitional zone volume between the cancer-yield and noncancer-yield groups; however, the corresponding difference in PSA transitional zone density was significant (p=0.025). CONCLUSION: Cognitive MRI-TRUS fusion-targeted biopsy without concurrent systematic biopsy can detect significant prostate cancer in patients with previous negative systematic biopsy results and persistently elevated PSA levels. Noncancer-yield patients should undergo active surveillance and further follow-ups.

Standardized analysis of laparoscopic and robotic-assisted partial nephrectomy complications with Clavien classification.

BACKGROUND: Laparoscopic partial nephrectomy (LPN) and robotic-assisted partial nephrectomy (RPN) are accepted as alternatives of open partial nephrectomy for managing renal tumors. However, LPN and RPN are technically challenging procedures. This report analyzed, according to the Clavien classification, the complications after LPN and RPN. METHODS: We analyzed consecutive LPN (n = 85) and RPN (n = 93) cases at our institution between April 1994 and December 2012. The data were retrospectively reviewed from a prospectively collected database. All complications that occurred within 3 months postoperatively were recorded and classified according to the modified Clavien classification system. RESULTS: The mean tumor size was 3.90 ± 1.77 cm. The mean operative time was 255.0 ± 83.5 minutes, and the mean warm ischemia time was 31.6 ± 22.0 minutes. The overall complication rate was 18.5%. Clavien Grades I, II, IIIa, and IIIb complications accounted for 3.93%, 11.2%, 2.81%, and 1.69% of patients, respectively. The most common complication was perioperative hemorrhage that required blood transfusion. Delayed bleeding occurred in seven patients, and four patients underwent angiographic embolization. The proportions of intermediate and high PADUA (Preoperative Aspects and Dimensions Used for an Anatomical) score (≥ 8) and RENAL (Radius/Exophytic/Nearness to collecting system/Anterior/Location) score (≥ 7) were 70.8% and 74.2%, respectively. A higher PADUA or RENAL score was associated with a significantly greater complication rate (p = 0.024 and p = 0.02, respectively). CONCLUSION: The overall complication rate in the present study was comparable to that reported in previous studies, although our patients had a larger mean tumor size and higher-complexity procedures.

Evenly distributed thin-film Ag coating on stainless plate by tricomponent Ag/silicate/PU with antimicrobial and biocompatible properties.

A tricomponent nanohybrid dispersion in water comprising silver nanoparticles (AgNP), nanometer-thick silicate platelets (NSP), and water-based polyurethane (PU) was developed for surface coating on orthopedic metal plates. The previously developed AgNP-on-NSP nanohybrid was homogeneously blended into a selected waterborne PU dispersion at varied weight ratios from 1/0.1 to 1/10 (w/w). PU was used to adhere the Ag nanohybrid to the metal surface. The resultant dispersions were analyzed and found to contain AgNP 2-18 nm in diameter and characterized by using UV absorption and TEM micrograph. The subsequent coating of AgNP/NSP-PU dispersion generated a film of 1.5 µm thickness on the metal plate surface, further characterized by an energy dispersive spectroscope (EDS) to show the homogeneous distribution of Ag, Si, and C elements on the metal plates. The surface antimicrobial efficacy was proven for the coating composition of AgNP/NSP to PU ranging from 1/1 to 1/5 by weight ratio but irrelevant to the thickness of the coated materials. The metal plate coated with the high Ag content at 1/1 (w/w) ratio was shown to have very low cytotoxicity toward the contacted mammal fibroblasts. Overall, the optimized tricomponent Ag/silicate/PU in water dispersion from 1/2 to 1/3 (w/w) could generate a stable film on a metal surface exhibiting both antimicrobial and biocompatible properties. The facile coating technique of the AgNP/NSP in waterborne PU is proven to be viable for fabricating infection- and cytotoxicity-free medical devices.

Does extended prostate needle biopsy improve the concordance of Gleason scores between biopsy and prostatectomy in the Taiwanese population?

BACKGROUND: Discordance between the Gleason scores of prostate needle biopsies and radical prostatectomy specimens has been reported by several investigators. We conducted this study to determine if increasing the number of prostate needle biopsies in patients with prostate cancer improves the accuracy of Gleason scores in the Taiwanese population. METHODS: Between March 2000 and September 2009, 281 patients underwent radical prostatectomy at Taipei Veterans General Hospital. All of these patients had prostate cancer that was diagnosed and graded either by extended needle biopsy (121 patients, ≥ 10 cores/patient, range: 10-13, median: 12) or by traditional sextant transrectal biopsy (160 patients, <10 cores/patient, range: 6-9, median: 6). We analyzed the patients' Gleason scores of their biopsies and radical prostatectomy specimens. RESULTS: The concordance rate, defined as similarity between the Gleason score of a patient's biopsy and prostatectomy specimens, was 57.9% in the extended biopsy group and 45.6% in the nonextended biopsy group (χ(2) test: p = 0.042). The primary Gleason pattern was accurately predicted by extended needle biopsy in 81% of cases (98/121 cases), higher than the 70% accuracy rate of the nonextended biopsies (112/160 cases, p = 0.036). Undergrading was found in 43/121 cases (32%) and 63/160 cases (39.4%) (p = 0.511). However, overgrading was found in 8/121 cases (6.6%) and in 24/160 cases (15.0%) (p = 0.028) by extended and nonextended biopsies, respectively. Forty-seven (16.7%) of those patients who fit the criteria of active surveillance were upgraded to a Gleason score >7 after radical prostatectomy. CONCLUSION: The addition of an extended transrectal needle biopsy increases the accuracy of the Gleason score for predicting the final prostate cancer grade in the Taiwanese population.

Laparoscopic partial nephrectomy: Taipei veterans general hospital experience.

BACKGROUND: Laparoscopic partial nephrectomy (LPN) is a definitive therapy in patients with a small renal tumor. The aim of this study was to present our interim results of LPN with its complications and outcomes. METHODS: We conducted a retrospective chart review of 46 LPNs in 45 patients at Taipei Veterans General Hospital from April 2004 to September 2008. The perioperative data were prospectively collected. The follow-up data, including local recurrence, distant metastasis, and renal function, were recorded. RESULTS: The mean age of these 45 patients was 54.8 years (range, 26-85 years). Three (6.5%) LPNs were converted to laparoscopic radical nephrectomy. The mean tumor diameter was 3.81 cm (range, 2.0-7.5 cm). The mean operative time was 319 minutes (range, 180-660 minutes). The mean blood loss was 501 mL (range, 20-3,300 mL). Pedicle clamping was performed in 37 (80.4%) cases and the mean warm ischemic time was 56 minutes (range, 24-100 minutes). There were 17 (40.0%) benign cases and 26 (56.5%) renal cell carcinomas, which were stage pT1a in 19 (73.1%) cases, pT1b in 5 (19.2%) cases, pT2 in 1 (3.8%) case, and pT3a in 1 (3.8%) case. The major complication rate was 4.3% (delayed bleeding in 1 case and urine leakage in 1 case). All margins were free for the malignant cases. Neither distant metastasis nor mortality was found. Local recurrence was found in 1 patient. The mean preoperative creatinine was 1.04 mg/dL (range, 0.6-2.4 mg/dL) and the mean elevated creatinine level was 0.10 mg/dL at 3 months (p < 0.05) and 0.13 mg/dL at 6 months (p < 0.05) postoperatively. The function of the operated kidney was reduced by a mean of 21.9% at 3 months (p < 0.05) and 27.7% at 6 months (p < 0.05) postoperatively. CONCLUSION: Although our warm ischemic time and operative time were longer than those of other LPN studies, the interim results of our oncologic and renal functional outcomes were encouraging. Further refinement of the procedure is needed to shorten the warm ischemic time and improve the hemostatic technique. In addition, based on postoperative renal function, LPN does not significantly influence long-term renal function.

Survival analysis in patients with upper urinary tract transitional cell carcinoma: a comparison between open and hand-assisted laparoscopic nephroureterectomy.

OBJECTIVE: To evaluate the stage- and grade-specific survival rate in patients with upper urinary tract (UUT) transitional cell carcinoma (TCC) after open (ONU) or hand-assisted laparoscopic nephroureterectomy (LNU) with bladder-cuff excision. PATIENTS AND METHODS: From January 1998 to April 2005, 143 patients with UUT-TCC were treated with either ONU or LNU and enrolled in the study. The peri-operative data were collected by retrospective chart review. The recurrence, metastasis and survival rate were calculated. RESULTS: The 5-year disease-specific survival of patients with pT1 disease was 88.1% after ONU and 92.0% after LNU (P = 0.745); the respective values for patients with pT2 were 11/17 and 12/15 (P = 0.874), and for pT3 were six/11 and 12/15 (P = 0.476). The incidence of bladder recurrence within 2 years after surgery was 24.7% for ONU and 19.7% for LNU (P = 0.475). CONCLUSION: The results were similar after ONU or LNU with bladder-cuff excision; bladder-cuff excision using a hand-assisted device is effective and serves as a treatment option for patients with UUT-TCC.

Voiding pattern of healthy Taiwanese women.

AIM: Few studies have examined the voiding pattern of healthy females, despite the importance of such research for diagnosing abnormal voiding behavior. This study investigates the voiding behavior of healthy women in Taiwan. METHODS: 68 healthy women, aged 19-66 years and claiming to void normally were enrolled. Twenty-two of the subjects (32.4%) were postmenopausal. Each woman completed a 3-day voiding diary. The diary recorded urine volume, voiding frequency, urine volume per voiding for the whole day (24 h), and urine volume during both daytime and nighttime. Age and various other voiding parameters were correlated, and the voiding patterns were compared between premenopausal and postmenopausal women. RESULTS: All women voided 7.34 +/- 1.63 times daily. Higher age was associated with higher whole day and daytime voiding frequency. Nocturia was not common for the group as a whole, with a mean nocturnal voiding of 0.25 times per night. However, higher age was significantly associated with a higher nighttime voiding frequency. A significantly positive correlation was also observed between age and whole day urine volume. Compared with regularly menstruating women, postmenopausal women had a significantly higher whole day and nighttime voiding frequency. Menopause and age both independently affect voiding parameters after multivariate analysis. CONCLUSIONS: The results of this study provide invaluable baseline data on female voiding behavior. Additionally, this study found that for healthy women, age and menstruation status significantly affect voiding patterns. Analysis of female voiding behavior thus should consider these two factors.

Clinical experience of laparoscopic-assisted radical cystectomy with continent ileal reservoir.

INTRODUCTION: Laparoscopic-assisted radical cystectomy with continent ileal reservoir reconstruction is a challenging procedure. We report our experience learned from a hand-assisted laparoscopic technique in our transition to a pure laparoscopic approach. MATERIALS AND METHODS: Eighteen consecutive patients underwent laparoscopic-assisted radical cystectomy with continent ileal reservoir. Hand-assisted laparoscopy was used for the first 11 patients and pure laparoscopy was performed for the subsequent 7 patients in radical cystectomy. Continent ileal reservoir reconstruction was performed extracorporeally via the hand port wound or trocar extension wound. Surgical outcome was analyzed in a retrospective review of the medical records. RESULTS: In the hand-assisted and pure laparoscopic groups, the mean operative time for cystectomy was 2.5 and 2.3 h, for continent ileal reservoir reconstruction it was 4.0 and 3.7 h, and for bilateral lymph node dissection it was 0.8 and 0.6 h, respectively. Mean intraoperative blood loss was 286 ml for the hand-assisted and 179 ml for the pure laparoscopic group. There were no major intraoperative complications nor need for conversion in any of the procedures. Bowel movement was regained in a mean of 3 days and the mean length of postoperative hospital stay was 7 days. CONCLUSIONS: The hand-assisted laparoscopic experience of radical cystectomy learned from the initial 11 patients effectively helped us in the transition to a pure laparoscopic approach. A comparable surgical outcome was found in both groups of patients.