Objective: The aim of the present study was to evaluate the outcome of second-look transurethral resection of bladder tumors (TURBT) for superficial T1 bladder cancer. Materials and Methods: We enrolled a total of 504 patients who were pathologically diagnosed with urothelial carcinoma and underwent TURBT between January 2012 and December 2016. A total of 240 patients were diagnosed with T1 urothelial carcinoma in the bladder, and 101 (42%) of these patients underwent a second-look TURBT within 4–14 weeks after the initial resection. We assessed the pathological staging of the second-look TURBT. Results: Of the 101 patients who underwent a second-look TURBT, 18 (18%) had residual tumors based on the pathological report: one had pTa disease, seven had pTis disease, nine had pT1 disease, and one had pT2 disease. The residual tumor rate was higher in patients with more than one tumor than in patients with a single tumor; however, there was no significant findings in patients with tumors larger than 3 cm or high histological grade. Conclusion: The results of the present study show that 18% of patients who underwent a second-look TURBT had residual tumors. Early diagnosis of residual tumors or restaging is possible through a second-look TURBT, which could help in deciding the subsequent treatment step if a residual tumor was found.

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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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Objective: The goal of this paper is to evaluate the safety and efficacy of perioperative parecoxib, a cyclooxygenase-2 inhibitor in reducing transient postoperative pyelovenous backflow pain in patients undergoing retrograde intrarenal surgery (RIRS). Materials and Methods: We instituted a change in our institutional clinical practice starting in January 2016. Since January 2016, all patients undergoing RIRS were administered perioperative intravenous parecoxib. Patients with a history of chronic renal failure (Cr over 2.5) or coronary heart disease did not receive parecoxib. The numerical scale NRS (Numerical rating scale) was recorded after postoperative conscious recovery within 24 h of the postoperative hospitalization. The NRS values were compared with a matched cohort of patients treated with RIRS at our center before January 2016 initiation of parecoxib administration to RIRS patients. Results: A total of 116 patients received Parecoxib during RIRS between January 2016 and August 2016. We found that parecoxib infusion was associated with significantly decreased of NRS. Out of 243 patients, 160 patients treated with parecoxib received an NRS of 1.57 points versus 127 of 243 matched controls who had an NRS of 3.32 points (P < 0.0001). The proportion of NRS >4 score in the patients with parecoxib infusion is much lower than those patients who did not receive Parecoxib (9% vs. 30%). Conclusion: Use of perioperative parecoxib during RIRS is associated with a significant reduction in transient postoperative pyelovenous backflow pain and increased operation quality.

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Objective: The objective of this study is to determine whether 5α-reductase inhibitors (5ARIs) prevent secondary benign prostate hyperplasia (BPH)-related acute urinary retention (AUR) after the first episode of urine retention. Materials and Methods: In total, 1161 patients were enrolled using the International Classification of Diseases, Ninth Revision (ICD-9) codes as having AUR (ICD-9 code 788.20) and BPH, with or without lower urinary tract symptoms (ICD-9 codes 600.0 and 600.1) between January 2006 and June 2016. After excluding patients with bladder and external sphincter dysfunction, we enrolled 128 patients in this study. Patients were divided into two groups: Group 1 comprising 33 patients receiving 5ARI (dutasteride) and α-blocker treatment, and Group 2 comprising 95 patients receiving α-blocker treatment alone. Patient characteristics, namely, age, prostate size, maximal urinary flow rate (Qmax), prostate-specific antigen (PSA) level, and duration of dutasteride treatment, were recorded and compared. Patients were followed for at least 6 months to a maximum period of 24 months if no event occurred. Events of secondary BPH-related AUR and surgery were recorded. Results: All patient characteristics, except for prostate size, were similar between the two groups (Group 1 vs. Group 2: 65.0 vs. 36.9 mL, P = 0.001). In total, 43 patients (32%) experienced secondary AUR within 24 months. The rate of secondary BPH-related AUR was significantly lower in the Group 1 than in the Group 2 (18.2% vs. 39.4%, P = 0.030). The rate of BPH-related surgery was lower in the Group 1 (9.1% vs. 14.9%, P = 0.410), although the difference was not significant. Prostate size and PSA levels were significantly lower in the Group 1 (23.5%) than in the Group 2 (60.4%) (P < 0.001). Conclusions: Using 5ARIs to treat patients with first episodes of BPH-related AUR significantly prevents secondary AUR.

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Renal vein aneurysm (RVA) is a rare disease. Only a few cases have been reported in the past. With Institutional Research Board approval (IRB 201600376B0D001), we reported the case of a 51-year-old female without symptoms and incidental finding of a right renal lesion by renal echo during health examination. Computed tomography (CT) angiography showed a large aneurysm connecting to the right renal vein. Thus, a right RVA was diagnosed. Embolization was not performed due to extremely high probability of untargeted embolization, and the patient preferred outpatient follow-up. CT angiography follow-up was done 6 months later and revealed no obvious enlargement of the aneurysm but an arteriovenous fistula was suspected. The main objective of this report is to differentiate between renal vascular disease and malignant renal neoplasms by reviewing and discussing the available literature.

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Background: Quinazolines, which process a wide spectrum of biological properties such as antibacterial, antifungal, antivirus, and anticancer activities, are considered one of the most important heterocycles in medicinal chemistry. Here, we described for the first time the novel quinazoline derivative MJ-56 (6-pyrrolidinyl-2-(3-bromostyryl) quinazoline-4-one) which emits green fluorescent in the cytosol and exhibits phototoxicity toward human bladder cancer (BC) cells under blue-light exposure. Materials and Methods: Human BC cells (5637 and T24) and immortalized uroepithelial cell (SV-HUC1) were utilized in this study. To trace the localization of MJ-56, MitoTracker and LysoTracker were applied. The cell viability with or without blue light exposure were monitored by WST-1 reagent, direct recording, and clonogenic assays. The apoptosis induction in MJ-56 treated cells was detected. Results: MJ-56 emits green fluorescent in the cytosol. Vital staining of mitochondria or lysosomes demonstrated that the MJ-56 fluorescent was not located in either organelles. MJ-56 treatment for 24 h did not cause significant loss of cell viability in BC cells. However, treatment of 0.125 μM MJ-56 for 1 h and exposed to blue light for 15 mins significantly reduced cell viability. Interestingly, our results showed that MJ-56 has minimal impact on SV-HUC1 even with the blue-light exposure. The caspase 3/7 activities in BC cells treated with MJ-56 and exposed to blue light were significantly increased 1 h post-treatment. However, the DNA fragmentation cannot be detected at 1, 6, or 24 h posttreatment due to the loss of viable cells. Conclusions: MJ-56 exhibits phototoxicity toward BC cells with minimal impact on uroepithelial cells, indicating a novel therapeutic agent against BC. The mechanism underlying MJ-56-induced cell death as well as the translational studies warrants further investigation.

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Objective: The pathophysiology mechanism of menopause in the metabolic syndrome-associated bladder dysfunction is still not clear. The major aims of the present study were to examine the impact of high-fat-high-sugar diet and surgical menopause-induced metabolic syndrome in overactive bladder (OAB). Methods: Female Sprague Dawley rats were feed with high-fat-high-sugar diet with/without ovariectomy surgery to mimic menopause and to induce metabolic syndrome. At 6 months after high-fat-high-sugar feeding, cystometrogram, physical indicator, and urine and serum biochemistry parameters were measured. Masson's trichrome stain and Western blots were carried out to examine the expressions of interstitial fibrosis, fibrosis-associated proteins, and muscarinic or purinergic receptors. Results: Bladder hyperactivity was induced accompanied by bladder interstitial fibrosis after 6 months of high-fat-high-sugar feeding, while surgical menopause exacerbated these bladder damages and enhanced interstitial fibrosis level. In addition, surgical menopause enhanced bladder dysfunction via overexpression of muscarinic and purinergic receptors. Conclusions: High-fat-high-sugar feeding induced bladder overactivity, while ovary hormone deficiency enhanced bladder interstitial fibrosis, exacerbated OAB syndrome, and increased muscarinic and purinergic receptors expressions.

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Objective: Tuberous sclerosis complex (TSC) is an autosomal dominant genetic disease that results in multiorgan hamartomas. Patients with TSC also frequently have renal angiomyolipomas, which are rare but benign renal tumors. However, the main causes of mortality in these patients are angiomyolipoma-related chronic kidney disease and acute tumor hemorrhage. Angiomyolipomas are mostly treated in our hospital using mammalian target of rapamycin (mTOR) inhibitor therapy or transarterial embolization (TAE). This study was undertaken to evaluate and compare the short-term outcomes of a combined therapy of mTOR inhibitor and TAE in patients with TSC-associated angiomyolipoma. Materials and Methods: This was a retrospective observational study based on collected data obtained from chart reviews. The single-center data set covered patients diagnosed, treated, and followed up from September 10, 2008, to March 17, 2016, at a specialist center. Patients with TSC-associated angiomyolipoma treated with monotherapy or combined treatment of mTOR inhibitor and TAE were included in this study. We compared the tumor size with image studies in the baseline and follow-up periods in both groups. Results: In total, 15 patients (3 males and 12 females) were included; 8 patients underwent mTOR inhibitor monotherapy and 7 received the combined mTOR inhibitor and TAE therapy. The mean patient age was 37.7 (17–72) years. The maximal diameters of renal angiomyolipomas ranged from 2 to 20.9 (10.2 ± 5.4) cm for all patients at the time of treatment intervention. During an average follow-up duration of 22 (2–56) months, the mean size of the angiomyolipomas decreased from 9.3 ± 5.6 to 8.5 ± 5.3 cm in the monotherapy group and 11.5 ± 5.4–10.0 ± 5.8 cm in the patients in the combined therapy (P = 0.014). Conclusions: In comparison with m-TOR inhibitor monotherapy, TAE combined with mTOR inhibitor therapy allows management of tumor bleeding with acceptable complications, and it also statistically reduces the tumor size in patients with TSC-associated renal angiomyolipomas.

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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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