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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Background: Cyperus rotundus L. is used in various dosage forms by Unani physicians in the treatment of urolithiasis. Aims and Objectives: The present study aims to evaluate the effect of hydroalcoholic extract of Cyperus rotundus in nephrolithiatic male Sprague Dawley rats. Materials and Methods: The animals were divided into 6 groups of 6 each. Group I received regular rat food and drinking water ad libitum. Group II to VI were treated with Ethylene glycol (0.75%, V/V) and Ammonium chloride (1%, W/V) in drinking water for 7 days to induce urolithiasis. Group II was sacrificed after 7 days administration of lithogenic agents however, from 8^th day, group IV was treated with Cystone (750 mg/kg) and group V and VI with hydroalcoholic extract of Cyperus rotundus (100 mg/kg and 170 mg/kg, respectively) for further 14 days. Group III left untreated after 7 days administration of lithogenic agent till 14 days and sacrificed on 22^nd day. Urine, biochemical parameters, kidney homogenate analysis and histopathology were carried out. Crystalluria analysed by light microscopy. Results: The test drug at both the doses showed significant reduction (P < 0.001) in number of urinary crystals. Test groups showed significant reduction in urine sodium (P < 0.05) and calcium (P < 0.001) while increased in urine magnesium. Serum creatinine (P < 0.01) and urea (P < 0.05) level significantly reduced in test groups. Histopathology of kidney showed almost normal kidney architecture. Kidney homogenate analysis showed significant reduction (P < 0.05) of calcium in group VI. Conclusion: The results showed that test extract has significant antilithiatic effect in terms of solute balance, reduction in crystal numbers and improvement in renal cell derangement.

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Introduction: Multiple factors contribute to male infertility, with hypogonadism and low testosterone levels possibly affecting fertility in different aspects. This study focused on factors for low testosterone in infertile male patients. Materials and Methods: We retrospectively collected data of patients who were diagnosed with infertility and visited the National Taiwan University Hospital from January 2015 to October 2017. Patients' weight and height, basic blood test results, sperm analysis, and sex hormone profile were recorded. Patients diagnosed with obstructive azoospermia, particularly absence of bilateral vas deferens, those who received a vasectomy or orchiectomy, and patients diagnosed with cancer undergoing chemotherapy or radiotherapy were excluded. Pearson's correlation test was applied for detecting associating factors for serum testosterone. Multivariate linear regression was used for detecting independent factors predicting serum testosterone. An independent t-test was used to analyze continuous variables, and the Chi-square test was used for categorical variables. Results: Two hundred and forty-seven patients had serum sex hormone profile and semen profile recorded. The mean age was 36.48 ± 8.68 years. Pearson's correlation test showed that serum testosterone was correlated with serum triglyceride, total cholesterol, fasting blood sugar, and body mass index (BMI). However, multivariate linear regression showed BMI (P = 0.001) and smoking (P = 0.029) to be independent factors predicting serum testosterone. On comparing sex hormone profile and semen profile between obese (BMI ≥30), overweight patient (BMI ≥25, <30), and nonoverweight patients (BMI <25), (i) serum testosterone was significantly lower in the obese and overweight group comparing to nonoverweight group (nonoverweight: 3.61 ± 1.63 ng/ml vs. overweight: 2.87 ± 1.27, P = 0.001; nonoverweight: 3.61 ± 1.63 vs. obese 2.89 ± 1.59, P = 0.035). Follicle stimulating hormone, luteinizing hormone, and prolactin did not differ significantly between the groups. No significant difference in sperm parameters, namely the total sperm count, sperm concentration, total sperm motility, and morphology, was observed between the groups. Conclusion: In the infertile Taiwanese male population, obese patients (BMI ≥ 30) and overweight patients (BMI ≥25) had a significant lower serum testosterone than the nonoverweight patients. Body weight control and treatment of metabolic syndrome, and diabetes could improve serum testosterone levels.

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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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Context: Sunitinib is the first-line targeted therapy for metastatic renal cell carcinoma (RCC). However, resistance to sunitinib often occurred in patients receiving sunitinib treatment. On the other hand, 17-beta-estradiol (estrogen or E2) has been demonstrated to repress RCC growth in vitro, whether E2 can also affect the growth of sunitinib-resistant RCC remains unknown. Aims: In this study, the role of E2 in inhibiting sunitinib-resistant RCC growth and the underlining acting mechanisms was explored. Settings and Design: Sunitinib resistance was first induced in vitro in ACHN cells. The effect of E2 on cellular growth was then assayed. Label-free phosphoproteomics was also conducted. Subjects and Methods: ACHN cells were first challenged with 10-μM sunitinib up to 4 months to induce drug resistance. Then, E2 at different concentrations were tested in both parental and sunitinib-resistant ACHN cells. To conduct phosphoproteomics study, the total cell lysates from E2-treated ACHN cells were harvested, trypsin digested, and the phosphopeptides were enriched by Fe-IMAC. Statistical Analysis Used: For comparing the E2-induced cell growth inhibition, Student's t-test was used, and P < 0.05 was considered statistically significant. As for label-free phosphoproteomics, false discovery rate <0.01 and phosphosite possibility >0.75 were considered as positive identifications. Results: E2 at the physiological concentration, that is, 10 nM, can repress the cell growth in both parental and sunitinib-resistant ACHN cells. Further, label-free phosphoproteomics revealed that transforming growth factor beta (TGF-β) pathway, cell cycle, and cytoskeleton bindings were enhanced in sunitinib-resistant cells but can be reduced by E2 treatment. On the other hand, programmed cell death and apoptosis were repressed in sunitinib-resistant cells, and E2 at 10 nM did not reverse the effect. We further validated the expression of SMAD3, an important molecule in TGF-β pathway, and found that SMAD3 decreased in sunitinib-resistant cells but can be upregulated by E2 treatment. Conclusions: Our study demonstrated that E2 can inhibit the cell growth in sunitinib-resistant RCC cells at physiological concentration by upregulating SMAD3 in the TGF-β pathway, which may lead to growth inhibition in RCC.

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Objective: Literature documented for the diagnosis and treatment of retroperitoneal fibrosis (RF) is still relatively limited and diverse, which makes it more challenging, especially in the Taiwanese population. This article was aimed to describe the clinical manifestations, laboratory results, diagnostic tool, and treatments in patients with RF from a single tertiary institute. Patients and Methods: The International Classification of Diseases, Ninth Revision code 594.3 was used to identify patients evaluated for RF between January 2005 and August 2015, at Taipei Veterans General Hospital. Medical records were reviewed, and clinical information was collected. RF was diagnosed on the basis of image findings, as well as clinical, pathological, and laboratory data. Different treatments were compared for their efficacy on the protection of renal function. Results: A total of 30 patients were included in the study. Twenty-three (76.7%) were male. The mean age at diagnosis was 65.9 ± 16.37. Mean body mass index was 31.5 ± 3.47. Biopsies were done in 13 patients (43.3%). Half of the patients had serum IgG4 test, and the mean value was 249.3 ± 205.1 mg/dL. Bilateral hydronephrosis was noted in 19 (63.3%) patients and was associated with poorer renal function than unilateral hydronephrosis at baseline. Most (93.3%) of the patients had improved renal function. However, statistically significant improvement was noted in patients with bilateral hydronephrosis instead of unilateral one. Compared with endoscopic ureteral stenting, surgical correction tended to have more renal functional protection, with significant serum creatinine (P = 0.006) and estimated glomerular flow rate (P = 0.035) change. Conclusion: RF in Taipei Veterans General Hospital was diagnosed through image, with the assistance of serum IgG4 and biopsy. There was a posttreatment improvement of renal function, especially in those with bilateral hydronephrosis. Surgical correction tended to be more beneficial than endoscopic procedure.

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Introduction: Although the National Health Insurance regulations for 5-alpha-reductase inhibitor (5ARI) use is well documented, urologists and medical claims review committee members have sometimes felt confused when determining claims for 5ARI use in certain circumstances. Thus, a consensus meeting was held to discuss how to use 5ARI appropriately in such circumstances. Materials and Methods: The expert urologists and medical claim review committee members reviewed seven controversial cases with related clinical evidence and voted for approval of the use of 5ARI after vigorous discussion. Results: Among the seven cases, a consensus was achieved in four. First, transrectal ultrasound of the prostate was not necessary if the patient already had other images. Second, prescribing 5ARI was affirmed in patients who had high prostate-specific antigen but who refused biopsy. Third, the normal prostate-specific antigen range was based on the 2003 version of the consensus of prostatic cancer of the National Health Research Institutes. Four, 5ARI could be prescribed in patients with improved clinical data but who were unable to meet the other regulatory criteria. Finally, of the three remaining cases, one case was denied, and in two cases, half of the members approved, and half rejected the claim for 5ARI use. Conclusion: This consensus report provided clarification for Taiwanese urologists and medical claims review committee members on reimbursable use of 5ARI in controversial cases.

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Introduction: The study aimed to find a secure procedure for circumcision, using monopolar diathermy with several key steps of technique to facilitate the surgical process and minimize the postoperative complications. Methods: Patients who underwent the secure technique for circumcision, due to different reasons, from 2012 to 2016 were retrospectively reviewed. A monopolar coagulator with a needle point probe with energy ranging from 10 to 15 W was used to perform the circumcision by following several key steps. In addition, tissue glue was applied to the wound to provide operative wound care. All data referring to patient demographics were recorded. The outcomes and complications associated with the secure technique for circumcision were assessed. Discussion: One hundred and ten children underwent this technique, carried out by a senior teaching staff member and several senior residents. All patients were followed with a mean of 29.5 ± 30.1 days postoperatively. All these patients were satisfied with the operation and had no major complications, and no second revisions were needed during the follow-up period. Two patients (1.8%) had a minor wound infection, which was resolved with oral antibiotics within 1 week. However, the study limitations included its retrospective nature and the heterogeneity of the study population. Conclusion: Modified diathermy circumcision with the secure technique protects the penile phallus and urethra, and it is associated with a low rate of complications, as hemostasis can be simultaneously ensured. The technique is feasible, simple, and easy to learn. In addition, tissue glue was proved to facilitate postoperative wound care.

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