Objective: Quercetin, a natural dietary compound, has been demonstrated with antitumor activities against several types of cancers by disrupting cell cycle and inducing apoptotic cell death. However, human bladder cancer cells such as 5637 and T24 cells expressing mutant p53 are resistant to a 24 hrs quercetin treatment. In this study, the anticancer effect of quercetin was evaluated in these bladder cancer cells. Materials and Methods: The bladder cancer cells treated with quercetin were subjected to evaluated cell apoptosis by caspase activity, TUNEL assay and cell viability assay. The cell autophagy was assessed by detecting procession of LC3-II autophagic marker protein. Results: After 48 and 72 hrs of incubation, quercetin was found to be significantly effective in inhibiting proliferation of 5637 and T24 cells in a dose-dependent manner. Quercetin treatment increased the caspase 3/7 activities, percentage of subG0/G1 cells, and DNA fragmentation, indicating an induced apoptotic cell death. Pretreatment of a pan-caspase inhibitor, Z-VAD-FMK, attenuated the quercetin-decreased cell viability, suggesting that the cytotoxicity caused by quercetin mainly via apoptotic cell death. We also found that quercetin induced autophagy, as evidenced by the increased processing of LC3-II, a specific marker of autophagy. The disruption of autophagic flux by using bafilomycin A1, an autophagy inhibitor, caused significant accumulation of cellular p62 and LC3-II. In addition, the pretreatment of autophagy inhibitors, Baf A1 and chloroquine, strongly augmented apoptosis in 5637 and T24 cells, indicating the suppression of quercetin-induced autophagy enhanced apoptosis. Furthermore, the decreased cell viability and increased LC3-II processing were attenuated in quercetin-treated cells which pretreated with a reactive oxygen species (ROS) scavenger, N-acetyl cystine (NAC) suggested that quercetin-induced cytotoxicity and autophagy were initiated by the generation of ROS. Conclusion: This study proposes that combined treatment of autophagy inhibitor which sensitizes cells to quercetin treatment may be a better therapeutic approach to reduce bladder cancer cells proliferation.

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Objectives: Prostatic abscesses are rare. The incidence of prostatic abscess has declined markedly with the widespread use of antibiotics. Obtaining improvement is difficult in many cases of prostate abscess. Today, there are no guidelines or algorithms for the treatment of prostatic abscess. In this study, the shape and size of the abscess, in addition to patient background characteristics and the clinical course, were evaluated, and the treatment strategy for prostatic abscess was examined. Methods and Material: All patients with a diagnosis of prostatic abscess in Showa University Hospital between 2003 and 2017 were retrospectively reviewed. Regarding the treatment options, the patients were divided into two groups, the conservative therapy group and the drainage group. In each group, background characteristics, culture reports, shape/size of abscess, and the presence of recurrence were evaluated. Results: All 18 patients with a diagnosis of prostatic abscess between 2003 and 2017 were retrospectively reviewed; 13 patients improved with conservative treatment alone, but drainage was performed in five patients with poor response to antibiotic therapy. All five cases requiring transurethral drainage were multifocal abscesses. Conclusions: In making a decision about the approach for drainage, it is important to assess the size and shape of the abscess using transrectal ultrasonography (TRUS), computed tomography (CT) and magnetic resonance imaging (MRI). If the abscess is the multifocal type, drainage should be considered. Based on the present study, whether the abscess is focal type or multifocal type, transurethral drainage should be considered if the abscess size exceeds 30 mm.

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Overactive bladder (OAB) has a high prevalence of approximately 16%–18% of the population worldwide. Currently, the understanding of and strategies for pharmacological treatment of OAB remain limited to antimuscarinics and β3 agonists. Ethnopharmacology applies knowledge from traditional medicine to treat diseases. For example, several presently used drugs, such as aspirin, digoxin, and artemisinin, have originated from plant extracts. Ancient people have historically required treatments for urinary urgency, urinary frequency, nocturia, and urgent incontinence. Traditional Chinese medicine (TCM) has been developed in China over the course of thousands of years. Some regimens and single-herb medicines of TCM have been demonstrated to manage such OAB symptoms. Herein, we summarize the evidence, obtained through current scientific methodology, which supports the use of regimens and single-herb medicine for treatment of OAB. An understanding of the pros and cons of TCM from the viewpoint of current science would improve future research and provide patients with more alternative and complementary therapies.

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The prevalence of renal stones, or nephrolithiasis, has been increasing consistently over the past few decades. Changes in lifestyles and dietary habits of the population may be responsible for the rise. Moreover, chronic diseases such as diabetes, hypertension, obesity, and metabolic syndrome are significant risk factors for renal stone formation. The 5-year recurrence rate of renal stones is around 50%. Those affected have a higher risk of comorbidities such as recurrent urinary tract infections, chronic kidney disease, and even end-stage renal disease. There is exciting ongoing research into newer treatments for renal stones. Currently, the prevailing hypothesis is that renal stones originate from Randall's plaques, which are patches of creamy-yellow calcium deposits found attached to the renal pelvis. However, the early steps involved in stone formation are still unclear. With the help of advanced technology and newer modalities, we can now observe the formative events upstream to actual stone formation. There are two recently updated theories that detail the biochemical events and structural changes that occur during this initial period. These well-designed works have expanded our awareness of Randall's plaques and provided direction for further research.

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Lower urinary tract symptoms (LUTSs) in women are common in urological practice but are usually uninformative for diagnosing the underlying lower urinary tract dysfunction. To obtain a precise diagnosis and devise a precise treatment strategy, a videourodynamic study (VUDS) is an essential tool for investigating the bladder and bladder outlet dysfunction, especially when LUTS cannot be relieved after initial medical treatment. An accurate VUDS diagnosis can guide effective treatment and prevent unnecessary or incorrect surgical intervention. This article reviews updated applications of VUDS in the diagnosis and treatment of LUTS in women.

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Introduction: Infertility has been a major problem for several years. Previously, infertility was often attributed to female factors. Recently, however, male factors have been found to contribute to 50% of the infertility cases overall. Male infertility is a multifactorial issue. A genetic disorder, abnormal endocrine system, structural anomaly, and environmental causes could lead to male infertility. Studies have revealed a link between fine air particles and decreased fertility. The aim of this study was to discover the effect of particulate matter 2.5 (PM2.5), representing environmental fine particles, on male infertility. Materials and Methods: We retrospectively collected data from patients diagnosed as having infertility and visited National Taiwan University Hospital from January 2015 to October 2017. We recorded each patient's body weight, height, basic blood test, sperm analysis, and sex hormone profile. Air quality data, especially PM2.5 concentration, were acquired from the Environmental Protection Administration of Taiwan. A total of 78 monitoring stations throughout Taiwan record PM2.5 concentrations (μg/m³) each hour automatically. Multivariate linear regression was used to detect independent factors affecting sperm count, concentration, motility, and morphology and sex hormone profile. Results:We observed regional and seasonal differences in the distributions of PM2.5 concentrations. In nearly all cities in Taiwan, the PM2.5 concentrations increased during early winter and continued to increase until next spring, with a peak around January and February. In particular, regional differences were observed in winter. The peak PM2.5 concentrations in southern and northern cities in Taiwan ranged between 35 and 40 μg/m³ and between 18 and 23 μg/m³, respectively. PM2.5 in central Taiwan reached as high as 30 μL/m³. By contrast, the eastern part of Taiwan had the lowest peak PM2.5, which was mostly <15 μg/m³. The average 24-month PM2.5 concentration had a negative effect on sperm count, but the result was nonsignificant. Additionally, the effect of PM2.5 on sperm motility and morphology was minimal. Conclusion: In infertile Taiwanese men, there is a trend of a negative association between exposure to PM2.5 and sperm concentration and total sperm count. Exposure to ambient fine particles, especially PM2.5, might have a negative correlation with sperm quality, sex hormone balance, and the testicular microenvironment through different mechanisms.

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Introduction: The relationship between prostate cancer (PCa) and benign prostatic hyperplasia is unclear. Reduction in androgenicity and lower intraprostatic growth factor concentrations in smaller prostates may serve a more ideal environment for the development of aggressive tumors. We determined if prostate volume was associated with adverse pathological features, tumor volume, and biochemical recurrence (BCR) in men undergoing radical prostatectomy (RP) for PCa. Materials and Methods: We retrospectively identified 192 men who underwent RP at our institution for PCa from 2010 to 2016 years. Prostate volume was based on RP specimen weight, and cumulative tumor volume was calculated. Means were compared with one-way ANOVA test and proportions with Chi-square analysis. Multivariate logistic regression was performed to determine independent predictors of BCR after RP. Results: Patients with prostate volume >60 g were less likely to have high-risk PCa (Gleason grade group >4) (7.1% vs. 13.4%; P = 0.042), node-positive disease (7.1% vs. 13.4%, P = 0.042), and BCR (10.7% vs. 25.0%, P = 0.002) after surgery. Linear regression showed an inverse relationship between prostate and tumor volume (R = 0.267; P < 0.05). On multivariate logistic regression, prostate volume >30 g (odds ratio [OR]: 0.21, 95% confidence interval [CI]: 0.09–0.88; P = 0.015) and >60 g (OR: 0.14, 95% CI: 0.03–0.74; P = 0.002) were independent predictors of reduced BCR at mean follow-up of 24 months.Conclusions: Smaller prostate volume was associated with adverse pathological features, increased tumor volume, higher incidence of pathological node-positive disease, and increased rates of BCR. Prostate volume should be considered as a prognostic feature when counseling patients with both elevated prostate-specific antigen and newly diagnosed PCa.

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Diagnosing interstitial cystitis/bladder pain syndrome (IC/BPS) is difficult as there is no definitive test for IC/BPS. Instead, the diagnosis is based on urinary symptoms and cystoscopy may be recommended. However, cystoscopic diagnosis is associated with potentially exacerbating painful side effects and is highly subjective among physicians. Furthermore, IC/PBS symptoms overlap with symptoms of bladder cancer, urinary tract infection, or overactive bladder. As a result, many patients may go years without a correct diagnosis and proper disease management. The goal of our current IC/BPS research is to develop a simple diagnostic test based on several urine proteins called the IC-risk score (IC-RS). A machine learning (ML) algorithm uses this information to determine if a person has IC/BPS or not; if they have IC/BPS, whether their IC/BPS is characterized by Hunner's lesions. We are currently in the middle of a grant to collect urine samples from 1000 patients with IC/BPS and 1,000 normal controls from across the United States. We are using social media such as Twitter and Facebook and working with patient advocacy organizations to collect urine samples from across the country. We hope to validate the IC-RS and apply for regulatory approval. Having a validated diagnostic test for IC/BPS would be a major advancement to help urology patients. In addition, drug companies developing new drugs and therapies for IC/BPS would have a better way to determine who to include in their clinical trials, and possibly another way to measure if their drug or therapy is effective. We will hereby review the steps that have led us in urine biomarker discovery research from urine protein assessment to use crowdsourcing stakeholders participation to ML algorithm IC-RS score development.

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Objective: We aimed to determine whether urolithiasis is a warning sign indicating long-term osteoporosis. Controls were matched for age, sex, and other comorbidities, including hypertension, diabetes mellitus, dyslipidemia, liver disease, and cardiovascular disease. Materials and Methods: Data were obtained from the Longitudinal Health Insurance Database (LHID2000) of Taiwan, Republic of China, compiled by the NHI from 1996 to 2013. We further evaluated potential risk factors stratified by different comorbidities. Results: After performing the propensity score matching (urolithiasis: control; ratio, 1:3), we included a total of 104,900 patients, including 26,225 patients with urolithiasis and 78,675 control patients. There was a significant difference between the incidence of osteoporosis between the urolithiasis and control groups (adjusted hazard ratio 1.20, 95% confidence interval [CI]: 1.15–1.27, P < 0.001). Interestingly, the impact of urolithiasis on osteoporosis was more prominent in the younger patient population (age < 40 years, adjusted hazard ratio 1.4, 95% CI: 1.12–1.75, P = 0.003; 40–59 years, adjusted hazard ratio 1.3, 95% CI: 1.20–1.40, P < 0.001), than in the older patient population (age >60 years, adjusted hazard ratio 1.13, 95% CI: 1.05–1.21, P = 0.001; P = 0.015 for interaction). We also observed that urolithiasis had an impact on hypertension-free patients (hypertension free, adjusted hazard ratio 1.28, 95% CI: 1.20–1.36, P < 0.001; hypertension, adjusted hazard ratio 1.12, 95% CI: 1.03–1.22, P = 0.006, P = 0.020 for interaction). Conclusion: In conclusion, on the basis of our results, an association exists between urolithiasis patients and subsequent osteoporosis diagnosis. Although the clinical mechanisms are not fully understood, patients who had urolithiasis history may need regular follow-up of bone marrow density.

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Overactive bladder (OAB) syndrome is a clinical symptom diagnosis. Treatment strategies are aimed at relieving symptoms. Because antimuscarinic drugs are applied for OAB, several targets of treatment about OAB had been found and newer treatments were also discovered. Besides, further studies about the potential advantages of combination therapy are proved to have increased efficacy and acceptable tolerability. Our study aims to update clinicians managing an OAB with an overview of the existing and newer medical therapies for OAB, including pharmacology, efficacy, side effects, and impact on the patient's quality of life. We review the most frequently used pharmacological therapies and new agents aimed at treating OAB. PubMed and Medline were explored for randomized controlled drug trials in adults with OAB, meta-analyses of medical therapy for OAB, and individual drug names, including the keywords efficacy, tolerability, quality of life, and compliance. In conclusion, newer antimuscarinic drugs focus on more selective muscarinic receptors with less side effects. Some β₃-adrenoceptor (β-AR) agonists had also been approved in Japan, and Phase III study is ongoing in the USA. In addition to antimuscarinic drugs and β-AR agonists, several newer treatments, such as intravesical botulinum toxin injection and phosphodiesterase-5 inhibitors, were proved to improve OAB symptoms. The new targets of treatment should be the focus of future studies.

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In recent years, various new drugs such as molecularly targeted drugs and immune checkpoint inhibitors have been developed. Liquid biopsy is becoming increasingly important as a guide for selecting these new drugs and determining their efficacy. In urological cancers, given the lack of serum markers for kidney cancer or urothelial cancers, the development of liquid biopsy is strongly desired. Liquid biopsy is less invasive than conventional tissue biopsy, enabling frequent biopsies, and is therefore considered effective for monitoring of the treatment course. Liquid biopsy is largely divided into three types: circulating tumor cells (CTCs), cell-free DNA, and exosomes, each of which has its own set of advantages and disadvantages with regard to the identification method and utility. In the present article, we focus on CTCs and discuss issues in their identification method as well as recent findings.

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Purpose: We reviewed the clinical experience of using the ureteral tumor stent (Bard^®, angiomed UROSOFT) in the National Taiwan University Hospital. We focused on the efficacy and durability of the ureteral tumor stent. Materials and Methods: We collected the patient data from April 2013 to 2014. A total of 94 patients with 157 ureteral units which received ureteral tumor stent in the National Taiwan University Hospital were enrolled. We analyzed the effectiveness according to the hydronephrosis grading. The durability was counted if it did not match any of the failure criteria including the following: 1. Hydronephrosis upgrade, 2. Serum creatinine elevated over 150% of baseline, 3. Ipsilateral percutaneous nephrostomy insertion or failure to remove it after antegrade insertion, and 4. Replacement due to clinically significant symptoms. Results: In general, 65% hydronephrosis downgrade, 25% remained stationary without severe hydronephrosis, while only 10% deteriorated or remain severe hydronephrosis. The median durability was 6.8 months. The bacteriuria and size of the ureteral tumor stent were the significant factors about the durability in single variant analysis. Conclusion: The ureteral tumor stent would improve the obstructive uropathy and persist functional for an average period over half a year.

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Purpose: Renal colic due to urinary system stone disease is one of the main complaints in emergency department (ED) admissions. The STONE score is the most used model. The “race” item in the nomogram is not useful for communities where the Black race is not dominant. Therefore, we aimed at investigating the diagnostic value of a new modified scoring system, in which we replaced the “race” item in the original nomogram by “obstruction = pelvicalyceal dilation.” Materials and Methods: The study included patients who were admitted to a tertiary university ED with flank pain and underwent ultrasonography (US) from June 2017 to November 2017. Patients' demographic data such as US findings and the STONE score parameters were recorded. “Obstruction (pelvicalyceal dilation)” replaced the “race” item of the original STONE score. The diagnostic value of the modified system was investigated by categorizing the scores as low risk (0–5 points), moderate risk (6–9 points), and high risk (10–13). Results: The study included 305 patients who met the inclusion criteria. The mean age was 39.45 ± 13.83 years, and 170 patients (55.7%) were male. Pelvicalyceal dilation was detected on US at a statistically significantly higher percentage in patients with stones compared to stone-free patients (P < 0.001). The modified STONE score was statistically significantly higher in patients with stones compared to stone-free patients (P < 0.001). Conclusion: We suggest that the replacement of the race parameter of the original STONE score by the US finding of pelvicalyceal dilation will enhance the diagnostic value of scoring in societies mostly comprising a non-Black population.

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Objective: The objective of this study is to evaluate the impact of body mass index (BMI) on clinical outcomes and safety profiles of percutaneous nephrolithotomy (PCNL). Materials and Methods: We retrospectively reviewed the patients who received PCNL between January 2015 and December 2016. A total of 182 consecutive patients were enrolled. The patients were categorized into three groups according to BMI (normal: BMI ≤24, overweight: 24 < BMI ≤27, obesity: BMI >27). The stone clearance rate, operation time, duration of hospital stay, postoperative analgesic use, and postoperation complications were compared among groups. The categorical variable was analyzed by Chi-square test, and the continuous variable was analyzed by Kruskal–Wallis test. The possible prognosticators for stone clearance were also analyzed using logistic regression method. Results: There were no significant differences among groups in terms of age, gender, stone character, stone size, and laterality. A higher proportion of hypertension was observed in the larger BMI groups and lower hemoglobin level in the smaller BMI group. No significant differences of stone clearance rate (66%, 76%, 70% in normal size, overweight, and obesity groups, respectively), duration of hospital stay, postoperative analgesic use, and complication rate were identified among groups. The most common complication was postoperative fever in overweight and obesity groups. Multivariable analysis showed the stone character was a significant prognosticator for stone clearance. Conclusion: BMI did not reveal the impact on the stone clearance, operative time, duration of hospital stay, postoperative analgesic requirement, and postoperative complication in patients undergoing PCNL.

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Objective: The main objective of this study is to evaluate the impact of early and late removal of urinary catheter after acute urine retention (AUR) in patients with benign prostatic hyperplasia (BPH) under tamsulosin treatment on the success of trial without catheter (TWOC). Materials and Methods: This is a prospective randomized study, 60 men with AUR secondary to BPH, after fulfilling the inclusion criteria in the absence of the exclusion criteria of the study were catheterized and then were randomly assigned to receive 0.4 mg tamsulosin hydrochloride for 3 days or 7 days, after that the catheter was removed and the ability to void unaided assessed. Results: Eighteen men taking tamsulosin for 3 days and 21 patients taking tamsulosin for 7 days did not require recatheterization on the day of the TWOC (60% and 70%, respectively, P = 0.417). Complication as urinary tract infection, urine leakage, hematuria, or catheter obstruction occurred in five (16.7%) men who received tamsulosin for 3 days and 13 (43.3%) men who received tamsulosin for 7 days (P = 0.024). Conclusions: Men catheterized for AUR can void successfully after catheter removal if treated with alpha-1 blockade, and success rate of TWOC is controversial regarding the duration of catheterization. However, the complications were increased with period of catheterization.

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Urinary drainage for hydronephrosis including the placement of an internal double J (D-J) or external percutaneous nephrostomy tube is common practice. Although D-J insertion is less invasive and may provide better quality of life than percutaneous nephrostomy, patients commonly complain of associated symptoms like discomfort, resulting in decreasing work performance and lifestyle changes. The incidence of lower urinary tract symptoms (LUTS) following D-J insertion is 50%–70%. Urologists who perform this procedure need to know how to prevent and manage common symptoms and educate patients. The physical activity of patients, material of D-J, size, and length of the stent are factors that increase the incidence of LUTS. Recently, several studies have suggested medical treatment for relief D-J-related symptoms. This article reviews the general background, factors, evaluation, and management of D-J associated LUTS.

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Objective: We aimed to determine the distribution of patients who sought medical help of organic erectile dysfunction (ED) in Taiwan. We further adjusted the age, insurance range, and other comorbidities to determine the potential risk factors for organic ED. Materials and Methods: Data were sourced from the Longitudinal Health Insurance Database 2000 of Taiwan, Republic of China, compiled by the Taiwan National Health Insurance database from 1996 to 2010. The possible risk factors leading to organic ED were also studied. Results: We included 3229 patients with organic ED and 9687 patients for comparison. A logistic regression model used to adjust for age, insurance, and other comorbidities showed that diabetes mellitus (adjusted odds ratio [OR] 1.71; 95% confidence interval [CI], 1.51–1.92; P < 0.001), hypertension (adjusted OR, 1.46; 95% CI, 1.32–1.61, P < 0.001), chronic kidney disease (CKD; adjusted OR, 1.46; 95% CI, 1.25–1.69; P < 0.001), dyslipidemia (adjusted OR, 1.61; 95% CI, 1.25–1.69; P < 0.001), and depression (adjusted OR, 1.41; 95% CI, 1.13–1.77; P = 0.003) were potential risk factors for organic ED. Conclusion: On the basis of our results, patients aged above 50 years accounted for over 70% of the organic ED patients who sought treatment. Diabetes mellitus, hypertension, CKD, dyslipidemia, and depression were potential risk factors for organic ED.

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Background: Escherichia coli, an extraintestinal flora, develops virulence traits through a persistent encounter with host and constant exposure to antibiotics, which makes it line up as the most common urinary pathogen. Thus, this study aimed to screen the presence of virulence traits among multidrug-resistant urinary pathogenic E. coli among the urine samples collected from inpatients and outpatients of the multispecialty hospitals. Materials and Methods: Standard microbiological laboratory protocols were followed, and about 210 samples were processed and screened. Results: Among those samples, 114 were reported positive for the presence of uropathogenic E. coli(UPEC). Gender-wise distribution was found to be more among female patients (56%) than male patients (51%). During screening for hemolytic activity, 37% of test isolates were α hemolytic, 48% were β hemolytic, and 15% were γ hemolytic. Screening virulence among test isolates, sfa gene (49%), afa (42%), hly (68%), CNF (43%), and aer, accounts for 65%. Further, the multidrug resistance of the isolates was done by using ten antibiotics. All the isolates exhibited the multiple antibiotic resistance (MAR), and the highest percentage of resistance was found against ceftazidime (100%), and the least percentage of resistance was observed against imipenem (2%) followed by amikacin (8%). MAR index values of all the isolates ranged from 0.4 to 1. Conclusion: The presence of various virulence genes and the high degree of resistance among the isolates against the antibiotics used in this study confirm the prevalence of extended-spectrum β-lactamase producers among the UPEC.

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Purpose: The purpose of this study is to investigate the clinical oncological outcomes and prognostic factors of high-volume disease (HVD) in the Asian population with metastatic hormone-sensitive prostate cancer. Methods: We retrospectively analyzed 503 patients with newly diagnosed metastatic prostate cancer. Patients were classified as HVD if visceral metastases were present and/or ≥4 bone lesions with ≥1 lesion beyond the vertebral bodies and pelvis. Overall survival (OS) and cancer-specific survival were investigated based on the disease burden. The Cox proportional hazards regression model was used to evaluate the prognostic factors. Results: About 50.7% patients were classified as low-volume disease (LVD) and 49.3% were HVD at diagnosis. The medians of OS and cancer-specific survival were 64 and 116 months, respectively, for patients with LVD and 26 and 46 months, respectively, for men with HVD (both P < 0.001). Among patients with HVD, 76.6% had both high-volume bone disease (HBD) (≥4 bone metastases) and appendicular bone involvement. There was no significant difference in both OS and cancer-specific survival between patients with visceral metastases and those with HBD combined with appendicular bone involvement. In the multivariable analysis, presence of Gleason score ≥8, HBD, or HVD may predict poorer OS and cancer-specific survival outcomes (all P < 0.05). Conclusions: Asian patients with high-volume metastatic prostate cancer had a larger proportion of HBD with appendicular bone involvement, who had a comparably poor prognosis to those with visceral metastases. Patients with HBD or HVD had reduced survival outcomes.

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Objective: The use of 10–12-core systemic transrectal ultrasound (TRUS)-guided prostate biopsy protocols with extended-sampling has been an optimizing strategy for diagnosis of prostate cancer. In this study, we aim to examine the cancer detection rate (CDR) and the complications following prostate biopsy at our institution. Materials and Methods: We retrospectively reviewed medical data of patients who underwent TRUS-guided prostate biopsy between 2007 and 2013 at our institution. The pathological outcomes, major complications, and morbidities were recorded and assessed clinically. Results: During the study period, 425 patients who underwent TRUS-guided prostate biopsy were enrolled. The mean age of the participants was 67.9 years. Overall, 75 (17.6%) patients were diagnosed with prostate cancer. Cancer was detected in 0% (0/10), 7.0% (15/215), 16.5% (20/121), and 50.6% (40/79) of patients in the subgroups with patient prostate-specific antigen (PSA) <4 ng/ml, 4–10 ng/ml, 10–20 ng/ml, and >20 ng/ml, respectively. The optimal cutoff values of PSA density were 0.19, 0.29, and 0.78 in the subgroups with patient PSA 4–10 ng/ml, 10–20 ng/ml, and >20 ng/ml. In total, 11 patients had afebrile urinary tract infections (UTI), 9 patients had febrile UTI, and another 2 patients had septic shock after biopsy. The overall incidence of infectious complications was 5.17% (22/425). Other complications were infrequent, consisting only of urinary retention in three patients, hematospermia in two patients, and acute hemorrhagic cerebellar infarction in 1 patient. Conclusion: Our study demonstrated the CDR, the incidence, and type of complications following TRUS-guided prostate biopsy. Further prospective studies are required to determine methods for reducing complications from prostate biopsy.

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Objective: To compare pathological and oncological outcomes between robotic-assisted laparoscopic radical prostatectomy (RaLRP) and laparoscopic radical prostatectomy (LRP) among high-risk prostate cancer patient in a tertiary center in Taiwan. Materials and methods: From November 2003 to October 2013, 129 high-risk prostate cancer patients receiving minimally-invasive radical prostatectomy were included. The Kaplan–Meier analysis was used for measuring biochemical recurrence-free survival (BFS). Multivariate logistic regression models and Cox proportional hazards regression models were used to determine predictors of positive surgical margin and BFS. Results: Among the 129 high-risk prostate cancer patients included, 80 (62%) patients received LRP and 49 (38%) patients received RaLRP. There was no significant difference of positive surgical margin and biochemical recurrence rate between RaLRP and LRP group (P = 0.802 and 0.292). Higher pathological T stage predicted an increased likelihood of positive margins (OR = 3.44, 95% CI [1.45, 8.18], P = 0.005). Higher initial PSA level (HR = 2.88, 95% CI [1.04, 7.94], P = 0.041) and positive surgical margin (HR = 2.55, 95% CI [1.20, 5.44], P = 0.015) were poor prognostic factors for BFS. Conclusion: RaLRP can be considered among high-risk prostate cancer in Asian people with comparable oncological outcomes to LRP. Higher pathological T stage was associated with increased likelihood of positive margins, patients with higher iPSA level and positive surgical margin had worsen biochemical recurrence-free survival.

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Purpose: This study compared the perioperative parameters and early functional outcomes between robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) at a urological laparoscopic center. Materials and Methods: Between January 2006 and May 2017, 242 patients underwent endoscopic radical prostatectomy (LRP for 208 cases; RARP for 34 cases). Patients who were followed up > 12 months were included in the study. Propensity score-matched groups of patients who underwent LRP or RARP were created based on age, body mass index, history of diabetes mellitus, history of smoking, preoperative prostate-specific antigen level, clinical T status, risk group classification, American Society of Anesthesiologists score, and whether the nerve-sparing technique was performed. Results: There were no significant differences in the blood transfusion rate, surgical margin status, length of stay, catheterization time, or days to oral intake for both procedures. Although RARP is more time-consuming, it provided significant benefits regarding the yield of dissected lymph nodes (19 vs. 9; P < 0.001) and early urinary continence recovery (i.e., continence rates after 1 month [56.2% vs. 21.9%; P = 0.006] and after 3 months [84.4% vs. 53.1%; P = 0.001]). No difference was observed for early complications, although the RARP group had more late complications. Conclusion: Our experience indicated that RARP could provide less blood loss and faster recovery of urinary continence and yield more dissected lymph nodes compared to LRP. Further studies are needed to determine whether the long-term clinical, functional, and oncological outcomes are superior.

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Objective: Interstitial cystitis (IC) is a chronic syndrome without effective definite treatment. Partial cystectomy with augmentation enterocystoplasty (AE) is considered a treatment of last resort for ulcer-type IC. This study investigated the long-term satisfaction and complications of IC patients undergoing AE. Methods: Fifteen IC (12 ulcer-type and 3 nonulcer-type) patients who underwent AE at a single medical center from 2010 to 2016 were retrospectively reviewed. The clinical symptoms and urodynamic study results of each patient were recorded before the operation. The long-term satisfaction of each patient was then evaluated using the global response assessment (GRA), and the postoperative symptoms were graded on a 4-point scale. The complications of AE were also recorded. Results: The mean age of the patients was 58.7 ± 12.7 years, and the mean follow-up period was 36.9 ± 23.1 months. The complications associated with AE included bladder stones, hydronephrosis, acute pyelonephritis, acute urinary retention, and recurrent bladder ulcers. The patients with ulcer-type IC who underwent AE reported better GRA results compared to those with nonulcer IC. The postoperative symptoms of bladder pain, dysuria, frequency, and urinary tract infection (UTI) were present in both groups of patients. No benefit was reported in all nonulcer IC patients. Conclusions: Although AE can improve bladder symptoms in ulcer-type IC patients, postoperative dysuria and UTI remain problems, and IC patients might have complications related to AE. Meanwhile, most of the patients with nonulcer IC reported no benefit from AE and hence AE should not be recommended.

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As the number of elderly population increase, prostate cancer (CaP) becomes the most common cause of urological cancer of men in Taiwan. Multiparametric MRI (mp-MRI) combines standard pulse sequences and Functional Imaging, is a promising tool for CaP detection. Its role has changed from detection to preoperative staging. A consensus scoring system, PI-RAD™, is developed for interpretation and reporting.

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The catabolic process of autophagy is an essential cellular function that directs the breakdown and recycling of cellular macromolecules. Increased autophagy causes various cancers, mainly bladder cancer (BC), to survive under microenvironmental stress and promotes cancer cell growth and aggressiveness. Cancer cells with rapid proliferation require a high basal level of autophagy to deal with the increased metabolic rate that generates reactive oxygen species, misfolded proteins, and damaged organelles. The regulation of autophagy by a class of small noncoding microRNAs (miRNAs) in human cancer has been discovered in recent years. In BC, a high basal level of autophagy plays critical roles in cancer survival and resistance to chemotherapy. Some studies have suggested that miRNAs participate in regulating these functions. In this review, we focused on recent key findings in the study of dysregulated miRNAs and their involvement in the regulation of autophagy in BC.

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