We evaluated the therapeutic effects on overactive bladder (OAB) symptoms and sexual function of ... more We evaluated the therapeutic effects on overactive bladder (OAB) symptoms and sexual function of behavioral therapy with or without mirabegron in sexually active male patients with OAB. Mirabegron, a selective β3 adrenoceptor agonist for the treatment of OAB, has been shown to induce corpus cavernosum relaxation. Methods: In this 4-site, randomized controlled trial, 150 sexually active men with OAB were enrolled between June 2020 and May 2022. Participants were randomly allocated (1:2) into 2 treatment groups: (1) behavioral therapy alone (n = 50) and (2) a combination of mirabegron 50 mg daily and behavioral therapy (n = 100). The evaluation was based on the overactive bladder symptoms score (OABSS), the International Index of Erectile Function, the ejaculatory domain short form, the International Prostate Symptom Score, patient perception of bladder condition, quality of life, and urodynamic parameters. The therapeutic outcomes were assessed at baseline, 4 weeks, and 12 weeks. Results: There were 65 patients (65%) in the combination subgroup and 36 patients in the behavioral therapy who completed all 12 weeks of treatment. Both groups had a statistically significant improvement in OABSS after 12 weeks of treatment. The combination therapy group achieved a statistically significant improvement in all 4 subscores of OABSS, however, the urinary frequency (P = 0.120) and urinary incontinence (P = 0.234) subscores in the behavioral therapy only group did not show a significant change. Additionally, the combination group had a significant improvement in functional bladder capacity, which was not seen in the behavioral therapy group. However, both groups did not have a significant change in erectile or ejaculatory function. Conclusions: Behavioral therapy combined with mirabegron had more significant impact on the improvement of OAB than behavior therapy alone. However, both groups did not have significant changes in erectile or ejaculatory function.
increased urinary frequency (control 4.86AE0.634 vs. cystitis 9.0AE0.447 voids, p<0.001), and dec... more increased urinary frequency (control 4.86AE0.634 vs. cystitis 9.0AE0.447 voids, p<0.001), and decreased average volume voided per micturition (control 0.26AE0.036 vs. cystitis 0.14AE0.016 g, p¼0.022). These changes were associated with increased splenocyte production of IL-1ß, IL-6 and TNF-a in response to TLR2/4 stimulations. Elevated expressions of IL-6, TNF-a, TLR4 and CD11b mRNAs in the lumbar spinal cords were observed in cystitis-induced mice, which was also associated with phenotypic and functional changes. CONCLUSIONS: Central and peripheral TLR activations are associated with bladder inflammation, pelvic pain and voiding dysfunction in URO-OVA mice, providing a potential mechanistic insight for human IC/BPS.
Neurogenic lower urinary tract dysfunction, common in patients with chronic spinal cord injury, i... more Neurogenic lower urinary tract dysfunction, common in patients with chronic spinal cord injury, inevitably results in urological complications. To address neurogenic lower urinary tract dysfunction after spinal cord injury, proper and adequate bladder management is important in spinal cord injury rehabilitation, with the goal and priorities of the protection of upper urinary tract function, maintaining continence, preserving lower urinary tract function, improvement of SCI patients' quality of life, achieving compatibility with patients' lifestyles, and decreasing urological complications. This concise review aims to help urologists address neurogenic lower urinary tract dysfunction by focusing on the risks of long-term urological complications and the effects of different bladder management strategies on these complications based on scientifically supported knowledge.
International Journal of Women's Health, Dec 1, 2022
Background: Stress urinary incontinence (SUI) is common among adult women with negative effects o... more Background: Stress urinary incontinence (SUI) is common among adult women with negative effects on psychosocial well-being, mental health, and health-related quality of life. The purpose of the research is to determine if SUI in women is a factor implicated in changes in health-related quality of life (HRQoL) in both physical and mental health domains and in work difficulties. Methods: Data of women 40 years or older from a cross-sectional, population-based, internet survey were examined post-hoc. The effect of SUI frequency on HRQoL (SF12 score), in physical and mental health domains, was assessed. In addition, multivariate and univariate analyses were used to show the influence of SUI on HADS (Hospital Anxiety and Depression Scale) depression score and HADS anxiety score. The effects of demographic factors and physical ailments and SUI on work difficulties were similarly analyzed using multivariate logistic regression. Results: A total of 4208 women with mean age of 60 were included in the analysis. The more frequent SUI episodes were associated with a greater reduction of HRQoL in both physical and mental health domains. In addition, both multivariate and univariate analyses showed that SUI could be correlated with a negative effect on HADS anxiety score (OR 1.617, CI 1.335-1.958, p=0.000) and HADS depression score (OR 1.263, CI 1.044-1.527, p=0.016). Univariate analyses suggested that work difficulties were correlated with SUI. Available data revealed that many sufferers, including up to 40% of individuals with SUI frequency rating 1 (less than once a month) to 3 (a few times a week), failed to seek treatment. Conclusion: SUI, common in women ≥40 years of age, impairs quality of life in both physical and mental health domains. SUI is an independent risk factor for anxiety and depression and has been linked to significant work dysfunctions. Trial Registration: This study is registered at ClinicalTrials.gov: NCT02618421 (Date of registration: December 1, 2015).
Purpose: To evaluate the prognostic impact of the lowest level of tumor location for upper tract ... more Purpose: To evaluate the prognostic impact of the lowest level of tumor location for upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Materials and methods: Data were collected from patients with UTUC treated with RNU (01/2005-06/2020) at a single center in Taiwan. Patients were stratified by the lowest level of tumor location into three groups: renal pelvis only (RPO), above upper ureter (AUU), and below upper ureter (BUU). We compared characteristics between groups and examined the association of the lowest level of tumor involvement with intravesical recurrence (IVR), systemic metastasis (SM), and cancer-specific mortality (CSM). Results: Overall, 1239 patients (542 RPO, 260 AUU, 437 BUU) were enrolled. Concurrent bladder cancer, multifocality, tumor architecture, lymphovascular invasion, carcinoma in situ, and variant histology were significantly different across different tumor locations. BUU had worse five-year intravesical recurrence (IVR), systemic metastasis (SM) and cancer-specific mortality (CSM) (p < 0.001, p = 0.056 and p = 0.13, respectively). In multivariable models, the lowest level of tumor involvement was an independent predictor of IVR (AUU hazard ratio (HR) = 1.52, p = 0.007; BUU HR = 1.75, p < 0.001), but only BUU was an independent predictor of SM (HR = 1.61, p = < 0.001) and CSM (HR = 1.51, p = 0.008). The lowest level of tumor involvement in UTUC, especially BUU, was associated with a higher risk of IVR, SM and CSM. Assessment of the lowest Frontiers in Oncology frontiersin.org 01
Background: With the increasing interest with botulinum toxin -A (BTX-A) application in the lower... more Background: With the increasing interest with botulinum toxin -A (BTX-A) application in the lower urinary tract, we investigated the BTX-A effects on the canine prostate and also in men with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH). Methods: Transperineal injection into the prostate using transrectal ultrasound (TRUS) was performed throughout the study. Saline with or without 100 U of BTX-A was injected into mongrel dogs prostate. One or 3 months later, the prostate was harvested for morphologic and apoptotic study. In addition, eight BPH patients refractory to α-blockers were treated with ultrasound guided intraprostatic injection of 200 U of BTX-A. In the BTX-A treated dogs, atrophy and diffuse apoptosis was observed with H&E stain and TUNEL stain at 1 and 3 months. Clinically, the mean prostate volume, symptom score, and quality of life index were significantly reduced by 18.8%, 73.1%, and 61.5% respectively. Maximal flow rate significantly increased by 72.0%. Intraprostatic BTX-A injection induces prostate apotosis in dogs and relieves BOO in humans. It is therefore a promising alternative treatment for refractory BOO due to BPH.
Interstitial cystitis/bladder pain syndrome (IC/BPS) negatively affects the quality of life. In t... more Interstitial cystitis/bladder pain syndrome (IC/BPS) negatively affects the quality of life. In this study, we investigated the lifestyle behavioral changes patients with IC/BPS make to cope with their symptoms. This prospective study was conducted between August 2018 and June 2019. All patients had a primary symptom of suprapubic pain with a full bladder and other lower urinary tract symptoms for more than 6 weeks as well as cystoscopic findings. All participants completed our self-developed questionnaire, which included informations about their living and work environment, occupational garments, dietary habits, and personal habits. Continuous variables were compared using an independent sample t test, and categorical variables were compared using a chi-square test. We recruited 86 patients with IC/BPS and age-matched 86 controls without IC/BPS. In our study, patients with IC/BPS had more cranberry intake (45.34% vs. 5.81%, P < 0.05) than non-IC/BPS controls; the IC/ BPS group had decreased consumption of coffee and spicy food; and wore less makeup or special work garments. In conclusion, patients with IC/BPS tend to make several lifestyle behavioral changes to cope with their symptoms. Interstitial cystitis (IC) or interstitial cystitis/ bladder pain syndrome (IC/BPS) is a heterogeneous condition involving chronic and often severe pain in the urinary bladder 1 . According to the European Society for the Study of Interstitial Cystitis, IC/BPS is diagnosed on the basis of the presence of chronic pelvic pain or discomfort related to the bladder and at least one other lower urinary tract symptom (LUTS), such as urinary frequency or urgency 2 . Our previous study showed patients with LUTS are associated with subsequent increased risk of outpatient visits and hospitalizations 3 . In addition to the healthcare seeking behavioral changes, the threshold of visiting the emergency room decreases either due to medical reasons, but also due to mental dependency 3 . Our study on IC/BPS indicted the similar medical healthcare-seeking behavioral changes among them (manuscript in revision), and a significantly higher incidence rate of anxiety, depression, and insomnia 4 . The etiology of IC/BPS remains poorly understood, but a number of pathogenic mechanisms have been proposed, including bladder epithelial dysfunction, epigenetic reprogramming of the bladder uroepithelium, autoimmune conditions, and nitric oxide synthase imbalance 5 . The complexity of IC/BPS is reflected by the multitude of etiologic factors implicated in the pathogenesis of the disease, absence of universally accepted disease definitions, and lack of appropriate tools to discriminate individuals having the actual disease from those with transient manifestations of bladder pain 5 . It has a negative impact on several aspects of life, for instance, quality of life and sexuality 6 . Hung et al. reported that patients with overactive bladder (OAB) tend to make some adaptations, such as locating restrooms in unfamiliar places, restricting fluid intake, avoiding outdoor activities, limiting attendance of social gatherings, making efforts to conceal odors and to maximize hygiene, using pads, and avoiding sexual intimacy 7 . Therefore, patients with IC/BPS may choose to make some lifestyle modifications to cope with their LUTS symptoms.
Purpose Pure ureter cancers are rare and account for only 1-3 % of urothelial carcinomas with lim... more Purpose Pure ureter cancers are rare and account for only 1-3 % of urothelial carcinomas with limited data. Nowadays, nephron-sparing methods are reserved mainly for imperative cases. This study intends to assess the oncologic outcome between segmental ureterectomy (SU) and radical nephroureterectomy (RNU) for pure ureteral urothelial carcinoma. Methods From July 2004 to August 2010, 112 patients at a single tertiary referral center were included. Perioperative data were obtained from our institutional database. Postoperative CT scan, cystoscopy, and contralateral renal echo were performed regularly for survey of disease recurrence. The mean length of follow-up was 43.8 and 48.3 months for the RNU and SU group, respectively. The bladder recurrences, local recurrences, distant metastasis, and cancer-specific survival rates showed no significant differences between RNU and SU (36.4 vs. 34.2 %, p = 0.83; 23.4 vs. 14.3 %, p = 0.27; and 16.9 vs. 8.6 %, p = 0.244, and 13.0 vs. 5.7 %, p = 0.249, respectively). The study suggested that SU is not inferior to RNU for ureter cancer in oncologic outcomes and is less invasive and better nephron preservation.
Background: Stress urinary incontinence (SUI) is common among adult women with negative effects o... more Background: Stress urinary incontinence (SUI) is common among adult women with negative effects on psychosocial well-being, mental health, and health-related quality of life. The purpose of the research is to determine if SUI in women is a factor implicated in changes in health-related quality of life (HRQoL) in both physical and mental health domains and in work difficulties. Methods: Data of women 40 years or older from a cross-sectional, population-based, internet survey were examined post-hoc. The effect of SUI frequency on HRQoL (SF12 score), in physical and mental health domains, was assessed. In addition, multivariate and univariate analyses were used to show the influence of SUI on HADS (Hospital Anxiety and Depression Scale) depression score and HADS anxiety score. The effects of demographic factors and physical ailments and SUI on work difficulties were similarly analyzed using multivariate logistic regression. Results: A total of 4208 women with mean age of 60 were included in the analysis. The more frequent SUI episodes were associated with a greater reduction of HRQoL in both physical and mental health domains. In addition, both multivariate and univariate analyses showed that SUI could be correlated with a negative effect on HADS anxiety score (OR 1.617, CI 1.335-1.958, p=0.000) and HADS depression score (OR 1.263, CI 1.044-1.527, p=0.016). Univariate analyses suggested that work difficulties were correlated with SUI. Available data revealed that many sufferers, including up to 40% of individuals with SUI frequency rating 1 (less than once a month) to 3 (a few times a week), failed to seek treatment. Conclusion: SUI, common in women ≥40 years of age, impairs quality of life in both physical and mental health domains. SUI is an independent risk factor for anxiety and depression and has been linked to significant work dysfunctions. Trial Registration: This study is registered at ClinicalTrials.gov: NCT02618421 (Date of registration: December 1, 2015).
We introduced a novel surgery that combines ultrasound guidance, miniaturization and Galdakao-mod... more We introduced a novel surgery that combines ultrasound guidance, miniaturization and Galdakao-modified supine Valdivia (GMSV) position in percutaneous nephrolithotomy (PCNL) and evaluated the safety and efficacy. This retrospective, single-center study retrospectively reviewed 150 patients who underwent ultrasound-guided mini-PCNL in the GMSV position from November 2019 to March 2022. All perioperative parameters were collected. Stone-free status was defined as no residual stones or clinically insignificant residual fragments (CIRF) <0.4 cm on postoperative day one. Among the 150 patients, the mean age was 56.96 years. The mean stone size was 3.19 cm (427 mm2). The mean S.T.O.N.E. score was 7.61, including 36 patients (24%) with scores ≥9. The mean operative time was 66.22 min, and the success rate of renal access creation in the first attempt was 88.7%. One hundred and forty (93.3%) patients were stone free. The mean decrease in Hemoglobin was 1.04 g/dL, and no patient needed a ...
Chapple C1, Castro-Díaz D M2, Chuang Y3, Lee K4, Liao L5, Liu S6, Wang J7, Yoo T K8, Chu R9, Suma... more Chapple C1, Castro-Díaz D M2, Chuang Y3, Lee K4, Liao L5, Liu S6, Wang J7, Yoo T K8, Chu R9, Sumarsono B9 1. The Royal Hallamshire Hospital, 2. Universidad de La Laguna/Hospital Universitario de Canarias, 3. Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 4. Samsung Medical Center, Sungkyunkwan University School of Medicine, 5. China Rehabilitation Research Center, Capital Medical University, 6. National Taiwan University Hospital and College of Medicine, 7. Beijing Hospital, 8. Eulji General Hospital, 9. Astellas Pharma Singapore Pte. Ltd
To investigate the association between nocturia and erectile dysfunction, androgen deficiency, ov... more To investigate the association between nocturia and erectile dysfunction, androgen deficiency, overactive bladder and systemic diseases in men with type 2 diabetic mellitus. A self-administered questionnaire containing overactive bladder symptom score and sexual health inventory for men was obtained from subjects with type 2 diabetic mellitus. Nocturia and severe nocturia were defined as rising ≥2 or ≥3 per night to void, respectively. Patient characteristics and diabetes-related complications to risk of nocturia were evaluated. Of 632 consecutive subjects, 56.0 and 24.2 % reported having nocturia and severe nocturia, respectively. After adjustment of age, diabetic mellitus duration, and overactive bladder, the presence of erectile dysfunction, stroke, hypertension, and higher serum creatinine level was associated with nocturia and severe nocturia. The patients with the lowest quartile of testosterone level (2.21 ± 0.51 ng/mL) had higher prevalence of nocturia (65.1 %) and severe no...
increased urinary frequency (control 4.86AE0.634 vs. cystitis 9.0AE0.447 voids, p<0.001), and dec... more increased urinary frequency (control 4.86AE0.634 vs. cystitis 9.0AE0.447 voids, p<0.001), and decreased average volume voided per micturition (control 0.26AE0.036 vs. cystitis 0.14AE0.016 g, p¼0.022). These changes were associated with increased splenocyte production of IL-1ß, IL-6 and TNF-a in response to TLR2/4 stimulations. Elevated expressions of IL-6, TNF-a, TLR4 and CD11b mRNAs in the lumbar spinal cords were observed in cystitis-induced mice, which was also associated with phenotypic and functional changes. CONCLUSIONS: Central and peripheral TLR activations are associated with bladder inflammation, pelvic pain and voiding dysfunction in URO-OVA mice, providing a potential mechanistic insight for human IC/BPS.
International urology and nephrology, Jan 19, 2016
To evaluate the impact of chronic kidney disease (CKD) on oncologic outcomes among non-muscle-inv... more To evaluate the impact of chronic kidney disease (CKD) on oncologic outcomes among non-muscle-invasive bladder cancer (NMIBC) patients who underwent transurethral resection of bladder cancer. We followed up the medical data of 158 newly diagnosed NMIBC patients enrolled in this study for more than 4 years. The ten putative risk factors included patient age, gender, white blood cells, neutrophil to lymphocyte ratio, tumor count, size, grade, stage, CKD (estimated glomerular filtration rate, eGFR < 60) and histological differentiation. Total recurrent bladder and upper urinary tract (UUT) tumors were observed in 51 patients (32 %) and 5 patients (3 %), respectively. Cancer progression to the high pT(≥pT2) stage was found in 9 patients (6 %). Cancer-specific and overall survival rates were 91 % (144/158 patients) and 78 % (123/158 patients), respectively. In univariate analysis, significant predictive determinants were tumor count, size, grade, stage, CKD and squamous differentiatio...
before RFA and 22 been proved RCC. The number of RFA needle treatment were significantly correlat... more before RFA and 22 been proved RCC. The number of RFA needle treatment were significantly correlated to PADUA score. 13 patients were under local anesthesia, the other were under IVGA by anesthesiologist. Only one patient presented mild pneumothorax after RFA without intervention treatment. Renal function deterioration after procedure did not reveal clinical significance. Tumor recurrence was recognized by CT scan in 3 patients during followup, who repeated RFA treatment without recurrence. Conclusion: For carefully selected patients, RFA represent a less invasive alternative associated with less morbidity and fewer complications and a promising treatment compared with partial nephrectomy. However, the long-term efficacy of these approaches remains to be established.
Background: Cyclooxygenase 2 (COX-2) elevation and subsequent prostaglandin E 2 (PGE 2 ) producti... more Background: Cyclooxygenase 2 (COX-2) elevation and subsequent prostaglandin E 2 (PGE 2 ) production play a major role in bladder inflammation and hyperactivity. EP4 receptor, a subtype of PGE 2 receptors, mediates tissue inflammation and hypersensitivity. Objective: To investigate the effect of intravesical botulinum toxin A (BoNT-A) on COX-2 and EP4 expression in cyclophosphamide (CYP)-induced cystitis in rats. Design, setting, and participants: Experimental (N = 40) and control animals (N = 20) were injected with CYP (75mg/kg intraperitoneally) or saline on days 1, 4, and 7. BoNT-A (1 ml, 20 unit/ml) or saline were administered into the bladder and retained for 1 h on day 2. Intervention: Waking cystometrograms (CMGs) were performed. Bladder and L6 and S1 spinal cord were harvested on day 8. Measurements: CMG parameters, histology, and COX-2 and EP4 expression by immunostaining or western blotting were measured. Results and limitations: CYP induced increased bladder inflammatory reaction, bladder hyperactivity, and COX-2 and EP4 expression in the bladder and spinal cord. The CYP effects were suppressed by BoNT-A treatment. BoNT-A treatment decreased inflammatory reaction (56.5% decrease), COX-2 expression (77.8%, 61.7%, and 54.8% decrease for bladder, L6, and S1 spinal cord, respectively), EP4 expression (56.8%, 26.9%, and 84.2% decrease for bladder, L6, and S1 spinal cord, respectively), and suppressed bladder hyperactivity (intercontraction interval, 107% increase and contraction amplitude, 43% decrease). Conclusions: CYP injection activated COX2 and EP4 expression in the bladder and spinal cord and induced bladder inflammation and hyperactivity, which effects were suppressed by BoNT-A treatment. These findings suggest a potential benefit of EP4-targeted pharmacotherapy and BoNT-A treatment for bladder inflammatory conditions.
The potent immunosuppressive effect of systemic tacrolimus is limited by the high incidence of se... more The potent immunosuppressive effect of systemic tacrolimus is limited by the high incidence of severe adverse effects, including nephrotoxicity and hypertension. Intravesical application of tacrolimus is hindered by its poor aqueous solubility, justifying the search for novel delivery platforms such as liposomes. We evaluated the pharmacokinetics of tacrolimus encapsulated in liposomes (lipo-tacrolimus), which is being developed as a potential orphan drug indication for hemorrhagic cystitis. Materials and Methods: A single dose of lipo-tacrolimus was instilled in the bladder with the rat under anesthesia. Also, tacrolimus was instilled intravesically or injected intraperitoneally in other rat groups. The tacrolimus dose was constant in all formulations at 200 g/ml. At different times blood, urine and bladder samples were collected and stored at Ϫ80C until analysis. Tacrolimus levels in samples were analyzed using microparticle enzyme immunoassay II. The AUC of lipo-tacrolimus in serum at 0 to 24 hours was significantly lower than that of tacrolimus instillation or injection. Noncompartmental pharmacokinetic data analysis revealed maximum concentration of lipo-tacrolimus and tacrolimus in serum and urine at 1 and at 2 hours, respectively. Urine AUC (0 -24) after intravesical administration was significantly higher than in the intraperitoneal group (p Ͻ0.05). Bladder tacrolimus AUC (0 -24) did not differ significantly between the groups. Conclusions: Single dose pharmacokinetics revealed that bladder instillation of liposome encapsulated tacrolimus significantly decreased systemic exposure to instilled tacrolimus as well as vehicle related toxicity. Intravesical liposomal tacrolimus may be a promising approach as an orphan drug indication for hemorrhagic cystitis.
Purpose Pure ureter cancers are rare and account for only 1-3 % of urothelial carcinomas with lim... more Purpose Pure ureter cancers are rare and account for only 1-3 % of urothelial carcinomas with limited data. Nowadays, nephron-sparing methods are reserved mainly for imperative cases. This study intends to assess the oncologic outcome between segmental ureterectomy (SU) and radical nephroureterectomy (RNU) for pure ureteral urothelial carcinoma. Methods From July 2004 to August 2010, 112 patients at a single tertiary referral center were included. Perioperative data were obtained from our institutional database. Postoperative CT scan, cystoscopy, and contralateral renal echo were performed regularly for survey of disease recurrence. The mean length of follow-up was 43.8 and 48.3 months for the RNU and SU group, respectively. The bladder recurrences, local recurrences, distant metastasis, and cancer-specific survival rates showed no significant differences between RNU and SU (36.4 vs. 34.2 %, p = 0.83; 23.4 vs. 14.3 %, p = 0.27; and 16.9 vs. 8.6 %, p = 0.244, and 13.0 vs. 5.7 %, p = 0.249, respectively). The study suggested that SU is not inferior to RNU for ureter cancer in oncologic outcomes and is less invasive and better nephron preservation.
We evaluated the therapeutic effects on overactive bladder (OAB) symptoms and sexual function of ... more We evaluated the therapeutic effects on overactive bladder (OAB) symptoms and sexual function of behavioral therapy with or without mirabegron in sexually active male patients with OAB. Mirabegron, a selective β3 adrenoceptor agonist for the treatment of OAB, has been shown to induce corpus cavernosum relaxation. Methods: In this 4-site, randomized controlled trial, 150 sexually active men with OAB were enrolled between June 2020 and May 2022. Participants were randomly allocated (1:2) into 2 treatment groups: (1) behavioral therapy alone (n = 50) and (2) a combination of mirabegron 50 mg daily and behavioral therapy (n = 100). The evaluation was based on the overactive bladder symptoms score (OABSS), the International Index of Erectile Function, the ejaculatory domain short form, the International Prostate Symptom Score, patient perception of bladder condition, quality of life, and urodynamic parameters. The therapeutic outcomes were assessed at baseline, 4 weeks, and 12 weeks. Results: There were 65 patients (65%) in the combination subgroup and 36 patients in the behavioral therapy who completed all 12 weeks of treatment. Both groups had a statistically significant improvement in OABSS after 12 weeks of treatment. The combination therapy group achieved a statistically significant improvement in all 4 subscores of OABSS, however, the urinary frequency (P = 0.120) and urinary incontinence (P = 0.234) subscores in the behavioral therapy only group did not show a significant change. Additionally, the combination group had a significant improvement in functional bladder capacity, which was not seen in the behavioral therapy group. However, both groups did not have a significant change in erectile or ejaculatory function. Conclusions: Behavioral therapy combined with mirabegron had more significant impact on the improvement of OAB than behavior therapy alone. However, both groups did not have significant changes in erectile or ejaculatory function.
increased urinary frequency (control 4.86AE0.634 vs. cystitis 9.0AE0.447 voids, p<0.001), and dec... more increased urinary frequency (control 4.86AE0.634 vs. cystitis 9.0AE0.447 voids, p<0.001), and decreased average volume voided per micturition (control 0.26AE0.036 vs. cystitis 0.14AE0.016 g, p¼0.022). These changes were associated with increased splenocyte production of IL-1ß, IL-6 and TNF-a in response to TLR2/4 stimulations. Elevated expressions of IL-6, TNF-a, TLR4 and CD11b mRNAs in the lumbar spinal cords were observed in cystitis-induced mice, which was also associated with phenotypic and functional changes. CONCLUSIONS: Central and peripheral TLR activations are associated with bladder inflammation, pelvic pain and voiding dysfunction in URO-OVA mice, providing a potential mechanistic insight for human IC/BPS.
Neurogenic lower urinary tract dysfunction, common in patients with chronic spinal cord injury, i... more Neurogenic lower urinary tract dysfunction, common in patients with chronic spinal cord injury, inevitably results in urological complications. To address neurogenic lower urinary tract dysfunction after spinal cord injury, proper and adequate bladder management is important in spinal cord injury rehabilitation, with the goal and priorities of the protection of upper urinary tract function, maintaining continence, preserving lower urinary tract function, improvement of SCI patients' quality of life, achieving compatibility with patients' lifestyles, and decreasing urological complications. This concise review aims to help urologists address neurogenic lower urinary tract dysfunction by focusing on the risks of long-term urological complications and the effects of different bladder management strategies on these complications based on scientifically supported knowledge.
International Journal of Women's Health, Dec 1, 2022
Background: Stress urinary incontinence (SUI) is common among adult women with negative effects o... more Background: Stress urinary incontinence (SUI) is common among adult women with negative effects on psychosocial well-being, mental health, and health-related quality of life. The purpose of the research is to determine if SUI in women is a factor implicated in changes in health-related quality of life (HRQoL) in both physical and mental health domains and in work difficulties. Methods: Data of women 40 years or older from a cross-sectional, population-based, internet survey were examined post-hoc. The effect of SUI frequency on HRQoL (SF12 score), in physical and mental health domains, was assessed. In addition, multivariate and univariate analyses were used to show the influence of SUI on HADS (Hospital Anxiety and Depression Scale) depression score and HADS anxiety score. The effects of demographic factors and physical ailments and SUI on work difficulties were similarly analyzed using multivariate logistic regression. Results: A total of 4208 women with mean age of 60 were included in the analysis. The more frequent SUI episodes were associated with a greater reduction of HRQoL in both physical and mental health domains. In addition, both multivariate and univariate analyses showed that SUI could be correlated with a negative effect on HADS anxiety score (OR 1.617, CI 1.335-1.958, p=0.000) and HADS depression score (OR 1.263, CI 1.044-1.527, p=0.016). Univariate analyses suggested that work difficulties were correlated with SUI. Available data revealed that many sufferers, including up to 40% of individuals with SUI frequency rating 1 (less than once a month) to 3 (a few times a week), failed to seek treatment. Conclusion: SUI, common in women ≥40 years of age, impairs quality of life in both physical and mental health domains. SUI is an independent risk factor for anxiety and depression and has been linked to significant work dysfunctions. Trial Registration: This study is registered at ClinicalTrials.gov: NCT02618421 (Date of registration: December 1, 2015).
Purpose: To evaluate the prognostic impact of the lowest level of tumor location for upper tract ... more Purpose: To evaluate the prognostic impact of the lowest level of tumor location for upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). Materials and methods: Data were collected from patients with UTUC treated with RNU (01/2005-06/2020) at a single center in Taiwan. Patients were stratified by the lowest level of tumor location into three groups: renal pelvis only (RPO), above upper ureter (AUU), and below upper ureter (BUU). We compared characteristics between groups and examined the association of the lowest level of tumor involvement with intravesical recurrence (IVR), systemic metastasis (SM), and cancer-specific mortality (CSM). Results: Overall, 1239 patients (542 RPO, 260 AUU, 437 BUU) were enrolled. Concurrent bladder cancer, multifocality, tumor architecture, lymphovascular invasion, carcinoma in situ, and variant histology were significantly different across different tumor locations. BUU had worse five-year intravesical recurrence (IVR), systemic metastasis (SM) and cancer-specific mortality (CSM) (p < 0.001, p = 0.056 and p = 0.13, respectively). In multivariable models, the lowest level of tumor involvement was an independent predictor of IVR (AUU hazard ratio (HR) = 1.52, p = 0.007; BUU HR = 1.75, p < 0.001), but only BUU was an independent predictor of SM (HR = 1.61, p = < 0.001) and CSM (HR = 1.51, p = 0.008). The lowest level of tumor involvement in UTUC, especially BUU, was associated with a higher risk of IVR, SM and CSM. Assessment of the lowest Frontiers in Oncology frontiersin.org 01
Background: With the increasing interest with botulinum toxin -A (BTX-A) application in the lower... more Background: With the increasing interest with botulinum toxin -A (BTX-A) application in the lower urinary tract, we investigated the BTX-A effects on the canine prostate and also in men with bladder outlet obstruction (BOO) due to benign prostatic hyperplasia (BPH). Methods: Transperineal injection into the prostate using transrectal ultrasound (TRUS) was performed throughout the study. Saline with or without 100 U of BTX-A was injected into mongrel dogs prostate. One or 3 months later, the prostate was harvested for morphologic and apoptotic study. In addition, eight BPH patients refractory to α-blockers were treated with ultrasound guided intraprostatic injection of 200 U of BTX-A. In the BTX-A treated dogs, atrophy and diffuse apoptosis was observed with H&E stain and TUNEL stain at 1 and 3 months. Clinically, the mean prostate volume, symptom score, and quality of life index were significantly reduced by 18.8%, 73.1%, and 61.5% respectively. Maximal flow rate significantly increased by 72.0%. Intraprostatic BTX-A injection induces prostate apotosis in dogs and relieves BOO in humans. It is therefore a promising alternative treatment for refractory BOO due to BPH.
Interstitial cystitis/bladder pain syndrome (IC/BPS) negatively affects the quality of life. In t... more Interstitial cystitis/bladder pain syndrome (IC/BPS) negatively affects the quality of life. In this study, we investigated the lifestyle behavioral changes patients with IC/BPS make to cope with their symptoms. This prospective study was conducted between August 2018 and June 2019. All patients had a primary symptom of suprapubic pain with a full bladder and other lower urinary tract symptoms for more than 6 weeks as well as cystoscopic findings. All participants completed our self-developed questionnaire, which included informations about their living and work environment, occupational garments, dietary habits, and personal habits. Continuous variables were compared using an independent sample t test, and categorical variables were compared using a chi-square test. We recruited 86 patients with IC/BPS and age-matched 86 controls without IC/BPS. In our study, patients with IC/BPS had more cranberry intake (45.34% vs. 5.81%, P < 0.05) than non-IC/BPS controls; the IC/ BPS group had decreased consumption of coffee and spicy food; and wore less makeup or special work garments. In conclusion, patients with IC/BPS tend to make several lifestyle behavioral changes to cope with their symptoms. Interstitial cystitis (IC) or interstitial cystitis/ bladder pain syndrome (IC/BPS) is a heterogeneous condition involving chronic and often severe pain in the urinary bladder 1 . According to the European Society for the Study of Interstitial Cystitis, IC/BPS is diagnosed on the basis of the presence of chronic pelvic pain or discomfort related to the bladder and at least one other lower urinary tract symptom (LUTS), such as urinary frequency or urgency 2 . Our previous study showed patients with LUTS are associated with subsequent increased risk of outpatient visits and hospitalizations 3 . In addition to the healthcare seeking behavioral changes, the threshold of visiting the emergency room decreases either due to medical reasons, but also due to mental dependency 3 . Our study on IC/BPS indicted the similar medical healthcare-seeking behavioral changes among them (manuscript in revision), and a significantly higher incidence rate of anxiety, depression, and insomnia 4 . The etiology of IC/BPS remains poorly understood, but a number of pathogenic mechanisms have been proposed, including bladder epithelial dysfunction, epigenetic reprogramming of the bladder uroepithelium, autoimmune conditions, and nitric oxide synthase imbalance 5 . The complexity of IC/BPS is reflected by the multitude of etiologic factors implicated in the pathogenesis of the disease, absence of universally accepted disease definitions, and lack of appropriate tools to discriminate individuals having the actual disease from those with transient manifestations of bladder pain 5 . It has a negative impact on several aspects of life, for instance, quality of life and sexuality 6 . Hung et al. reported that patients with overactive bladder (OAB) tend to make some adaptations, such as locating restrooms in unfamiliar places, restricting fluid intake, avoiding outdoor activities, limiting attendance of social gatherings, making efforts to conceal odors and to maximize hygiene, using pads, and avoiding sexual intimacy 7 . Therefore, patients with IC/BPS may choose to make some lifestyle modifications to cope with their LUTS symptoms.
Purpose Pure ureter cancers are rare and account for only 1-3 % of urothelial carcinomas with lim... more Purpose Pure ureter cancers are rare and account for only 1-3 % of urothelial carcinomas with limited data. Nowadays, nephron-sparing methods are reserved mainly for imperative cases. This study intends to assess the oncologic outcome between segmental ureterectomy (SU) and radical nephroureterectomy (RNU) for pure ureteral urothelial carcinoma. Methods From July 2004 to August 2010, 112 patients at a single tertiary referral center were included. Perioperative data were obtained from our institutional database. Postoperative CT scan, cystoscopy, and contralateral renal echo were performed regularly for survey of disease recurrence. The mean length of follow-up was 43.8 and 48.3 months for the RNU and SU group, respectively. The bladder recurrences, local recurrences, distant metastasis, and cancer-specific survival rates showed no significant differences between RNU and SU (36.4 vs. 34.2 %, p = 0.83; 23.4 vs. 14.3 %, p = 0.27; and 16.9 vs. 8.6 %, p = 0.244, and 13.0 vs. 5.7 %, p = 0.249, respectively). The study suggested that SU is not inferior to RNU for ureter cancer in oncologic outcomes and is less invasive and better nephron preservation.
Background: Stress urinary incontinence (SUI) is common among adult women with negative effects o... more Background: Stress urinary incontinence (SUI) is common among adult women with negative effects on psychosocial well-being, mental health, and health-related quality of life. The purpose of the research is to determine if SUI in women is a factor implicated in changes in health-related quality of life (HRQoL) in both physical and mental health domains and in work difficulties. Methods: Data of women 40 years or older from a cross-sectional, population-based, internet survey were examined post-hoc. The effect of SUI frequency on HRQoL (SF12 score), in physical and mental health domains, was assessed. In addition, multivariate and univariate analyses were used to show the influence of SUI on HADS (Hospital Anxiety and Depression Scale) depression score and HADS anxiety score. The effects of demographic factors and physical ailments and SUI on work difficulties were similarly analyzed using multivariate logistic regression. Results: A total of 4208 women with mean age of 60 were included in the analysis. The more frequent SUI episodes were associated with a greater reduction of HRQoL in both physical and mental health domains. In addition, both multivariate and univariate analyses showed that SUI could be correlated with a negative effect on HADS anxiety score (OR 1.617, CI 1.335-1.958, p=0.000) and HADS depression score (OR 1.263, CI 1.044-1.527, p=0.016). Univariate analyses suggested that work difficulties were correlated with SUI. Available data revealed that many sufferers, including up to 40% of individuals with SUI frequency rating 1 (less than once a month) to 3 (a few times a week), failed to seek treatment. Conclusion: SUI, common in women ≥40 years of age, impairs quality of life in both physical and mental health domains. SUI is an independent risk factor for anxiety and depression and has been linked to significant work dysfunctions. Trial Registration: This study is registered at ClinicalTrials.gov: NCT02618421 (Date of registration: December 1, 2015).
We introduced a novel surgery that combines ultrasound guidance, miniaturization and Galdakao-mod... more We introduced a novel surgery that combines ultrasound guidance, miniaturization and Galdakao-modified supine Valdivia (GMSV) position in percutaneous nephrolithotomy (PCNL) and evaluated the safety and efficacy. This retrospective, single-center study retrospectively reviewed 150 patients who underwent ultrasound-guided mini-PCNL in the GMSV position from November 2019 to March 2022. All perioperative parameters were collected. Stone-free status was defined as no residual stones or clinically insignificant residual fragments (CIRF) <0.4 cm on postoperative day one. Among the 150 patients, the mean age was 56.96 years. The mean stone size was 3.19 cm (427 mm2). The mean S.T.O.N.E. score was 7.61, including 36 patients (24%) with scores ≥9. The mean operative time was 66.22 min, and the success rate of renal access creation in the first attempt was 88.7%. One hundred and forty (93.3%) patients were stone free. The mean decrease in Hemoglobin was 1.04 g/dL, and no patient needed a ...
Chapple C1, Castro-Díaz D M2, Chuang Y3, Lee K4, Liao L5, Liu S6, Wang J7, Yoo T K8, Chu R9, Suma... more Chapple C1, Castro-Díaz D M2, Chuang Y3, Lee K4, Liao L5, Liu S6, Wang J7, Yoo T K8, Chu R9, Sumarsono B9 1. The Royal Hallamshire Hospital, 2. Universidad de La Laguna/Hospital Universitario de Canarias, 3. Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 4. Samsung Medical Center, Sungkyunkwan University School of Medicine, 5. China Rehabilitation Research Center, Capital Medical University, 6. National Taiwan University Hospital and College of Medicine, 7. Beijing Hospital, 8. Eulji General Hospital, 9. Astellas Pharma Singapore Pte. Ltd
To investigate the association between nocturia and erectile dysfunction, androgen deficiency, ov... more To investigate the association between nocturia and erectile dysfunction, androgen deficiency, overactive bladder and systemic diseases in men with type 2 diabetic mellitus. A self-administered questionnaire containing overactive bladder symptom score and sexual health inventory for men was obtained from subjects with type 2 diabetic mellitus. Nocturia and severe nocturia were defined as rising ≥2 or ≥3 per night to void, respectively. Patient characteristics and diabetes-related complications to risk of nocturia were evaluated. Of 632 consecutive subjects, 56.0 and 24.2 % reported having nocturia and severe nocturia, respectively. After adjustment of age, diabetic mellitus duration, and overactive bladder, the presence of erectile dysfunction, stroke, hypertension, and higher serum creatinine level was associated with nocturia and severe nocturia. The patients with the lowest quartile of testosterone level (2.21 ± 0.51 ng/mL) had higher prevalence of nocturia (65.1 %) and severe no...
increased urinary frequency (control 4.86AE0.634 vs. cystitis 9.0AE0.447 voids, p<0.001), and dec... more increased urinary frequency (control 4.86AE0.634 vs. cystitis 9.0AE0.447 voids, p<0.001), and decreased average volume voided per micturition (control 0.26AE0.036 vs. cystitis 0.14AE0.016 g, p¼0.022). These changes were associated with increased splenocyte production of IL-1ß, IL-6 and TNF-a in response to TLR2/4 stimulations. Elevated expressions of IL-6, TNF-a, TLR4 and CD11b mRNAs in the lumbar spinal cords were observed in cystitis-induced mice, which was also associated with phenotypic and functional changes. CONCLUSIONS: Central and peripheral TLR activations are associated with bladder inflammation, pelvic pain and voiding dysfunction in URO-OVA mice, providing a potential mechanistic insight for human IC/BPS.
International urology and nephrology, Jan 19, 2016
To evaluate the impact of chronic kidney disease (CKD) on oncologic outcomes among non-muscle-inv... more To evaluate the impact of chronic kidney disease (CKD) on oncologic outcomes among non-muscle-invasive bladder cancer (NMIBC) patients who underwent transurethral resection of bladder cancer. We followed up the medical data of 158 newly diagnosed NMIBC patients enrolled in this study for more than 4 years. The ten putative risk factors included patient age, gender, white blood cells, neutrophil to lymphocyte ratio, tumor count, size, grade, stage, CKD (estimated glomerular filtration rate, eGFR < 60) and histological differentiation. Total recurrent bladder and upper urinary tract (UUT) tumors were observed in 51 patients (32 %) and 5 patients (3 %), respectively. Cancer progression to the high pT(≥pT2) stage was found in 9 patients (6 %). Cancer-specific and overall survival rates were 91 % (144/158 patients) and 78 % (123/158 patients), respectively. In univariate analysis, significant predictive determinants were tumor count, size, grade, stage, CKD and squamous differentiatio...
before RFA and 22 been proved RCC. The number of RFA needle treatment were significantly correlat... more before RFA and 22 been proved RCC. The number of RFA needle treatment were significantly correlated to PADUA score. 13 patients were under local anesthesia, the other were under IVGA by anesthesiologist. Only one patient presented mild pneumothorax after RFA without intervention treatment. Renal function deterioration after procedure did not reveal clinical significance. Tumor recurrence was recognized by CT scan in 3 patients during followup, who repeated RFA treatment without recurrence. Conclusion: For carefully selected patients, RFA represent a less invasive alternative associated with less morbidity and fewer complications and a promising treatment compared with partial nephrectomy. However, the long-term efficacy of these approaches remains to be established.
Background: Cyclooxygenase 2 (COX-2) elevation and subsequent prostaglandin E 2 (PGE 2 ) producti... more Background: Cyclooxygenase 2 (COX-2) elevation and subsequent prostaglandin E 2 (PGE 2 ) production play a major role in bladder inflammation and hyperactivity. EP4 receptor, a subtype of PGE 2 receptors, mediates tissue inflammation and hypersensitivity. Objective: To investigate the effect of intravesical botulinum toxin A (BoNT-A) on COX-2 and EP4 expression in cyclophosphamide (CYP)-induced cystitis in rats. Design, setting, and participants: Experimental (N = 40) and control animals (N = 20) were injected with CYP (75mg/kg intraperitoneally) or saline on days 1, 4, and 7. BoNT-A (1 ml, 20 unit/ml) or saline were administered into the bladder and retained for 1 h on day 2. Intervention: Waking cystometrograms (CMGs) were performed. Bladder and L6 and S1 spinal cord were harvested on day 8. Measurements: CMG parameters, histology, and COX-2 and EP4 expression by immunostaining or western blotting were measured. Results and limitations: CYP induced increased bladder inflammatory reaction, bladder hyperactivity, and COX-2 and EP4 expression in the bladder and spinal cord. The CYP effects were suppressed by BoNT-A treatment. BoNT-A treatment decreased inflammatory reaction (56.5% decrease), COX-2 expression (77.8%, 61.7%, and 54.8% decrease for bladder, L6, and S1 spinal cord, respectively), EP4 expression (56.8%, 26.9%, and 84.2% decrease for bladder, L6, and S1 spinal cord, respectively), and suppressed bladder hyperactivity (intercontraction interval, 107% increase and contraction amplitude, 43% decrease). Conclusions: CYP injection activated COX2 and EP4 expression in the bladder and spinal cord and induced bladder inflammation and hyperactivity, which effects were suppressed by BoNT-A treatment. These findings suggest a potential benefit of EP4-targeted pharmacotherapy and BoNT-A treatment for bladder inflammatory conditions.
The potent immunosuppressive effect of systemic tacrolimus is limited by the high incidence of se... more The potent immunosuppressive effect of systemic tacrolimus is limited by the high incidence of severe adverse effects, including nephrotoxicity and hypertension. Intravesical application of tacrolimus is hindered by its poor aqueous solubility, justifying the search for novel delivery platforms such as liposomes. We evaluated the pharmacokinetics of tacrolimus encapsulated in liposomes (lipo-tacrolimus), which is being developed as a potential orphan drug indication for hemorrhagic cystitis. Materials and Methods: A single dose of lipo-tacrolimus was instilled in the bladder with the rat under anesthesia. Also, tacrolimus was instilled intravesically or injected intraperitoneally in other rat groups. The tacrolimus dose was constant in all formulations at 200 g/ml. At different times blood, urine and bladder samples were collected and stored at Ϫ80C until analysis. Tacrolimus levels in samples were analyzed using microparticle enzyme immunoassay II. The AUC of lipo-tacrolimus in serum at 0 to 24 hours was significantly lower than that of tacrolimus instillation or injection. Noncompartmental pharmacokinetic data analysis revealed maximum concentration of lipo-tacrolimus and tacrolimus in serum and urine at 1 and at 2 hours, respectively. Urine AUC (0 -24) after intravesical administration was significantly higher than in the intraperitoneal group (p Ͻ0.05). Bladder tacrolimus AUC (0 -24) did not differ significantly between the groups. Conclusions: Single dose pharmacokinetics revealed that bladder instillation of liposome encapsulated tacrolimus significantly decreased systemic exposure to instilled tacrolimus as well as vehicle related toxicity. Intravesical liposomal tacrolimus may be a promising approach as an orphan drug indication for hemorrhagic cystitis.
Purpose Pure ureter cancers are rare and account for only 1-3 % of urothelial carcinomas with lim... more Purpose Pure ureter cancers are rare and account for only 1-3 % of urothelial carcinomas with limited data. Nowadays, nephron-sparing methods are reserved mainly for imperative cases. This study intends to assess the oncologic outcome between segmental ureterectomy (SU) and radical nephroureterectomy (RNU) for pure ureteral urothelial carcinoma. Methods From July 2004 to August 2010, 112 patients at a single tertiary referral center were included. Perioperative data were obtained from our institutional database. Postoperative CT scan, cystoscopy, and contralateral renal echo were performed regularly for survey of disease recurrence. The mean length of follow-up was 43.8 and 48.3 months for the RNU and SU group, respectively. The bladder recurrences, local recurrences, distant metastasis, and cancer-specific survival rates showed no significant differences between RNU and SU (36.4 vs. 34.2 %, p = 0.83; 23.4 vs. 14.3 %, p = 0.27; and 16.9 vs. 8.6 %, p = 0.244, and 13.0 vs. 5.7 %, p = 0.249, respectively). The study suggested that SU is not inferior to RNU for ureter cancer in oncologic outcomes and is less invasive and better nephron preservation.
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