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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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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Webbed penis may be congenital or acquired in etiology. Treatments are indicated for reasons such as cosmetic concerns and erection pain. This study aims at reviewing the etiology, symptoms, types of surgical correction, and outcomes of webbed penis. We searched Medline/PubMed for “webbed penis” and “inconspicuous penis” from 1956 through 2019. In this study, we discuss the advantages, drawbacks, and outcomes of each surgical method. We also explain the postoperative cosmetic outcomes and complications of the previously proposed surgical methods. Since the isolated congenital webbed penis is uncommon, there is a paucity of large-scale studies for the treatment of webbed penis. A variety of methods are proposed to correct webbed penis, including traditional transverse incision and vertical closure, Z-plasty, V-Y advancement technique, Byars preputial flap method, and other methods. Preoperative design is essential and is based on not only the degree of penoscrotal fusion but also the surgeon's experience and preference of the surgical methods. Some methods call for elaborate skin flaps that may be technically complicated. The immediate outcomes of surgical correction for webbed penis are good. However, studies on long-term cosmetic results and patient satisfaction remain scarce. Hence, surgical correction of the webbed penis generally yields good results. Long-term follow-up of postoperative cosmetic outcomes, patient satisfaction, and the impact of surgery on the psychological development of children are indicated.

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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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Purpose: The effects of medications for treating nasal congestion on voiding function remain unclear. In this study, we aimed to elucidate the effects of the common decongestants, pseudoephedrine, and antihistamine, on voiding dysfunction in men without clinical lower urinary tract symptoms. Materials and Methods: We prospectively enrolled 200 consecutive male patients who visited the otolaryngology department for rhinitis from August 2015 to August 2016. These patients were then randomized to the pseudoephedrine or antihistamine groups. The International Prostate Symptom Score (IPSS) and postvoiding residual urine (PVR) were assessed before and 1 week after treatment and the results were analyzed. Patients were further stratified by age (≥50 years old vs. <50 years old) and IPSS (>7 vs. ≤7) in each group and comparison analyses were conducted. Results: There were no significant differences between the baseline characteristics of the pseudoephedrine and antihistamine groups. The IPSS total, IPSS voiding, and IPSS storage (IPSS-T, IPSS-V, and IPSS-S, respectively) tended to increase in the pseudoephedrine group but did not reach statistical significance. Similar results regarding IPSS-T and IPSS-V were seen in the antihistamine group. The IPSS-T increased significantly in patients ≥50 years old treated with pseudoephedrine, which was not observed in the antihistamine group. The IPSS-V was significantly higher in patients <50 years old treated with antihistamine. The PVR did not significantly change after treatment with both drugs. However, in patients with baseline IPSS-T >7 treated with pseudoephedrine, the PVR tended to increase. Conclusion: Pseudoephedrine and antihistamine have minimal effects on lower urinary tract function in the general male population. However, pseudoephedrine worsened IPSS-T in elderly men, whereas antihistamines worsened IPSS-V in younger men. In self-unaware voiding dysfunction male with IPSS-T > 7, pseudoephedrine may cause more PVR. Thus, in elderly men with rhinitis, antihistamines may be more suitable, while pseudoephedrine would be preferable in younger men.

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Purpose: We compared tamsulosin, silodosin, and alfuzosin in catheter-free trials after acute urinary retention (AUR) due to benign prostatic hyperplasia (BPH). This study aims at assessing the efficacy of tamsulosin, silodosin, and alfuzosin, and the factors affecting the success of catheter-free trials. Materials and Methods: An observational, prospective, randomized study of 49 men with AUR due to BPH was performed from July 2015 to August 2017. Participants were catheterized after the assessment of prevoid urine volume. The prostate size was measured, and IPSS at presentation was calculated. The participants were divided into tamsulosin, silodosin, and alfuzosin groups and were given a catheter-free trial after administration of alpha-blockers for three doses. Descriptive analysis, independent t-test, and Chi-square test were used for data analysis. Univariate and multivariate analyses were done using STATA software version 14.2. P < 0.05 was considered to indicate statistical significance. Results: The overall success of trial without catheter (TWOC) was 62.5% (30 out of 49). There was no difference in the efficacy of tamsulosin, silodosin, and alfuzosin in catheter-free trials after AUR due to BPH. The success of TWOC was affected by median lobe enlargement, and patients with Grade 3 intravesical protrusion of prostate were less likely to have a successful TWOC. Conclusion: TWOC after administration of three doses of alpha-blockers was shown to be useful in most patients irrespective of prostate size. There was no difference in the efficacy of tamsulosin, silodosin, and alfuzosin in catheter-free trials.

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Objective: Bladder tumor antigen (BTA) is a common biomarker for urothelial carcinoma while bladder wall thickening (BWT) is a sign of urinary bladder irritation which suggests cystitis or early-stage bladder cancer pathology, most especially in the absence of bladder outlet obstruction. The aim of this study was to find the incidence of urinary bladder thickness and evaluate the relationship between BTA and BWT in a low schistosomiasis-endemic Nigerian village. Materials and Methods: The study was descriptive and cross-sectional. Freshly passed mid-day urine samples of 56 individuals were screened using chemical reagent strips and then diagnosed microscopically for Schistosoma haematobium. Subsequent follow-up involving ultrasound examination was carried out on distended bladder. The lower urinary tract symptoms (LUTS) were also recorded. Urinary BTA analysis was carried out on the urine samples using enzyme-linked immunosorbent assay. Results: The prevalence of urogenital schistosomiasis in the area was 3.6%. The overall prevalence of human BTA and BWT in the individuals was 44.6 and 35.7%, respectively. The LUTS were associated with BWT (P = 0.004; odds ratio = 6.0; 95% confidence interval = 1.8–20.3). BTA, BWT, and LUTS were not sex and age dependent (P > 0.05). In addition, there was no association between urinary BTA, BWT, and LUTS (P > 0.05). The sensitivity of BWT and LUTS (60.0%) was improved than when either was used to diagnose BTA. Conclusion: The high occurrence of BTA and BWT in the individuals suggests that they may be prone to urothelial carcinoma and urinary bladder irritation, respectively. The role of urogenital schistosomiasis in urinary BTA levels needs to be further explored.

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Objective: Erectile dysfunction (ED) is a major complication of radical prostatectomy. Despite advances in surgical techniques, the postoperative continence and potency rates are still not satisfactory. Many studies have reported experiences with penile rehabilitation using tadalafil for patients receiving nerve-sparing robotic-assisted radical prostatectomy, but similar reports are still lacking in Taiwan. Patients and Methods: We collected 163 patients that had undergone unilateral or bilateral nerve-sparing robotic-assisted radical prostatectomy from January 2013 to December 2014 in Tungs' Hospital. One month after operation, 5 mg tadalafil once daily was prescribed for 54 patients whose Foley's catheter had been removed and who had ED. We recorded the International Index of Erectile Function (IIEF-5) score at the 12^th month after surgery. We defined postsurgery IIEF-5 ≥22 as potency or no ED. We compared the differences in clinical parameters and postsurgery potency rates between patients with or without tadalafil treatment. Results: The postsurgery potency rates of those with tadalafil treatment were significantly higher than that of those without tadalafil treatment (55.6% vs. 32.1%) after a 1-year follow-up observation. The mean (standard deviation) of IIEF-5_preamong those with and without tadalafil treatment was 21.3 (4.5) and 19.2 (4.2), respectively. There were no significant differences in baseline clinical condition parameters between patients with potency with or without tadalafil treatment. The results indicated that the tadalafil-treated patients had a higher odds ratio (OR) of potency (adjusted OR = 2.58, 95% confidence interval [CI] = 1.28–5.22) than the nontadalafil-treated patients. However, those ≥65 years old were associated with a lower potency rate (adjusted OR = 0.94, 95% CI = 0.89-0.99). Conclusion: Starting penile rehabilitation with tadalafil 5 mg daily 1 month after nerve-sparing radical prostatectomy is safe for patients. Patients with mild-to-moderate ED should use tadalafil 5 mg daily after receiving nerve-sparing robotic-assisted laparoscopic prostatectomy due to its significant benefit in erectile function recovery.

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Purpose: Acute urinary tract infection (UTI) causes symptoms including urgency, frequency, dysuria, and pain in the lower urinary tract. However, these symptoms are not unique to infection. Urolithiasis, injury, neurological disease, and malignancy present with the same symptoms. We aimed to find predictors in urinalysis to detect underlying causes in patients with acute UTI symptoms. Materials and Methods: We recruited 192 patients who presented with acute UTI symptoms from a single institute between September 2012 and September 2018. Each patient received urinalysis, kidney–ureter–bladder X-ray, and kidney plus transabdominal bladder sonography as primary surveys. Patients with flank pain and hydronephrosis but without definitive radiopaque lesion received computed tomography (CT) scan as an advanced intervention. Cystoscopy was ordered by the physician if the patient had gross hematuria and was suspected to have intravesical lesion. We correlated the urine nitrate, the median of red blood cells (RBCs) and white blood cells (WBCs), and the ratio of red and WBCs with the finding on image studies, which included sonography, X-ray, and CT by statistical models. Results: In patients with urolithiasis detected by either X-ray or CT, logistic regression showed that higher urine RBC and lower urine WBC medians were predictors of urolithiasis. In the ROC analysis, WBC median lower than 7.75 per high power field (HPF) was a significant predicting factor for the positive finding of urolithiasis on a CT scan. Conclusion: When presenting with acute UTI symptoms, patients with a lower urine WBC median are correlated with a higher probability to have urolithiasis. In addition, WBC median lower than 7.75 per HPF in urinalysis is a predictor for urolithiasis found on CT in patients with flank pain or hydronephrosis.

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Background: We investigated the association between balanoposthitis and the risk of type 2 diabetes mellitus (type 2 DM) from a retrospective cohort study. Methods: From the Longitudinal Health Insurance Database (LHID) 2000, we selected male patients aged over 20 years and first diagnosed with balanoposthitis during 2000–2010. Men without balanoposthitis were also included in our analysis through frequency matching for age and index year. All participants were followed up until the diagnosis of type 2 DM. Diseases were coded in accordance with the International Classification of Diseases, Ninth Revision, Clinical Modification. Baseline comorbidity history for each participant was determined from the LHID dataset. A multivariable Cox proportional hazard regression model was established, and a Kaplan–Meier survival curve was plotted. Results: The incidence of type 2 DM was higher in the balanoposthitis cohort than in the nonbalanoposthitis cohort (14.8 vs. 5.42/1000 person-years) with a hazard ratio of 2.55 (95% confidence interval = 2.22–2.92) after adjusting for age and other comorbidities. The incidence of type 2 DM increased with age in both cohorts. Balanitis patients with hypertension, hyperlipidemia, or obesity had higher risks for type 2 DM than those without these conditions (all P < 0.05). Conclusions: Men with balanoposthitis may have a higher risk of type 2 DM in the future. Therefore, clinical physicians should pay more attention to the early evaluation and management of type 2 DM in the patients with balanoposthitis.

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Adenomatoid tumors are rare benign neoplasms in the scrotum that can occur in both sexes. The majority of the patients was asymptomatic and was incidentally found with scrotal mass. It is difficult to distinguish adenomatoid tumors from malignant intratesticular solid tumors, which may result in unnecessary orchiectomy. The present report describes a 64-year-old male presented with right testicular enlargement for 6 months. Radiological images and intra-operative findings all showed cystic mass attached to right testis. Right orchiectomy was performed and final pathology was adenomatoid tumor. The present report also summarizes the morphological and immunohistochemical features of adenomatoid tumors and reviews the literature to share this rare intrascrotal benign tumors.

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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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Lower urinary tract symptoms (LUTSs) are common neurological sequelae of stroke, which negatively impact the mortality of patients with stroke and the quality of life of both patients and their caregivers. There are three hierarchical micturition centers: the sacral spinal center, subconscious structures, and conscious structures. Several brain imaging modalities for micturition studies on humans and animals and neuroanatomical studies on animals have facilitated a better understanding of LUTSs. The urodynamic findings in patients with stroke may vary and tend to evolve with time; the identification of the underlying cause of poststroke voiding dysfunction helps optimize the management of these patients. For patients with stroke with overactive bladders, the first-line treatments include behavioral therapies and the second-line therapies include the use of drugs. Intermittent or indwelling catheterization can be used for patients with stroke with detrusor underactivity. In this article, we discuss the current consensus, relevant assessment modalities, and management of LUTSs in patients with stroke.

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Purpose: The aim of this study is to prospectively investigate whether the long-term administration of tadalafil, which is commonly used for erectile dysfunction, could reduce arteriosclerosis. Materials and Methods: This study included 85 patients who presented to one of the three hospitals with lower urinary tract symptoms. Tadalafil was administered daily (5 mg/d), and pulse wave velocity (PWV) was measured before administration and at weeks 12, 24, 36, and 48. The International Prostate Symptom Score, Overactive Bladder Symptom Score, and Erection Hardness Score were simultaneously assessed at the same time points. Further subanalyses were performed in patients with a high risk of cardiovascular events, those aged 75 years or older, and those younger than 75 years. The Wilcoxon signed-rank test was used for statistical analysis. Results: Compared with pretreatment values, the PWV did not show any statistically significant decrease at any time point. The group at high risk of cardiovascular events showed significant improvement at weeks 24 and 36, whereas the 75 years or older group showed significant improvement at only week 24. However, the three aforementioned scores significantly improved in all patients during treatment. Conclusions: The long-term administration of tadalafil (5 mg/d) might inhibit the progression of arteriosclerosis or prevent its future development.

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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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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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Objectives: The objective is to compare monopolar transurethral resection of the prostate (M-TURP) versus bipolar TURP (B-TURP). Methods: In this prospective comparative study, 102 patients scheduled to undergo transurethral resection of prostate were enrolled and table randomized to surgery by M-TURP or B-TURP. International Prostate Symptom Score (IPSS), uroflowmetry, ultrasonography (kidney-ureter-bladder), prevoid, postvoid and laboratory investigations (for preanesthetic fitness) were done preoperative and 3-month postsurgery. Results: Patients were divided into two groups namely M-TURP and B-TURP. The mean age of patients was comparable between both groups. There is a significantly lower mean resection time in M-TURP compared to B-TURP. IPSS, postvoid residual volume, and Q_maximproved in both groups, and it was statistically insignificant. Drop in hemoglobin levels (g/dl) in patients of M-TURP was higher compared than B-TURP. Conclusions: Both M-TURP and B-TURP are safe and effective modality. However, B-TURP will surely replace M-TURP as gold standard.

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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: Atypical small acinar proliferation (ASAP) and high-grade prostatic intraepithelial neoplasia (HGPIN) are two pathological findings occasionally noted in prostate biopsies. Previous Western studies reported that they were associated with prostate cancer. However, none Taiwanese series report the subsequent cancer detection in ASAP and HGPIN patients. This study aimed to examine the results of repeated biopsies in the patients with ASAP and HGPIN. Materials and Methods: A total of 220 consecutive patients with ASAP and/or HGPIN at our institute between January 1990 and December 2010 were enrolled. Patient demographics and clinical information were extracted from the electronic database of our institute. Prostate biopsies were performed through transrectal ultrasound guidance. The patients who had concurrent prostate cancer (n = 51) and no repeated prostate biopsies (n = 103) were excluded from the study. Patients with biopsy pathologies reporting low-grade prostatic intraepithelial neoplasia (n = 2) were also excluded. The remaining 64 patients were available for the final analysis. Results: Nearly, 38, 24, and 2 patients were initially diagnosed as ASAP, HGPIN, and ASAP along with HGPIN, respectively. After 10 years of follow-up, 36.8% patients in ASAP group developed prostate cancer, while 16.7% in HGPIN group and 100% in ASAP + HGPIN group. Median time to developing prostate cancer were 20 months in ASAP group, 31 months in HGPIN group, and 48 months in ASAP + HGPIN group. There was no significant difference of prostate cancer development between ASAP and HGPIN group (P = 0.291). Only older age, classified by 65 years, was significantly associated with a higher detection rate of prostate cancer. Conclusion: Patients with the initial diagnosis of ASAP or PIN has a high risk of developing prostate cancer. Therefore, those patients should be well announced and followed regularly.

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The evolution of therapy for advanced or metastatic renal cell carcinoma (RCC) progressed over the past decade from using cytokine immunotherapy to targeted therapy which predominantly inhibits angiogenesis via the vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) pathways. Currently, there are several approved agents in the first-line (e.g. sunitinib, pazopanib, ipilimumab/nivolumab, bevacizumab/IFN-α combination and temsirolimus) and second-line settings (e.g. everolimus, axitinib, sorafenib, cabozantinib, nivolumab and lenvatinib/everolimus combination). These agents are used in sequence upon progression due to drug resistance or intolerable toxicities. The European Association of Urology (EAU), European Society for Medical Oncology (ESMO) and National Comprehensive Cancer Network (NCCN) guidelines recommend the use of these agents based on evidence from clinical trials and expert committee consensus. The recent approval of immune checkpoint inhibitors due to the encouraging results from clinical trials has expanded the treatment options for patients with advanced or metastatic RCC. This will hopefully improve the treatment outcomes, reduce toxicities and ameliorate quality of life for these patients.

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Objective: This study elaborated on the clinical experience of patients who underwent urologic management due to urologic complications after receiving a total hysterectomy at a regional hospital. Materials and methods: A total of 696 female patients received the four types of total hysterectomy including total abdominal hysterectomy, transvaginal hysterectomy, lapaparoscopic hysterectomy or robotic hysterectomy for variant gynecologic pathologies. Only 22 cases (3.2%) had urologic procedures performed during or after the operations from 2012/1/1 to 2016/6/30. Results: Of the 22 cases, thirteen (1.9%) received a series of conservative managements only, including cystoscopy, ureteroscopy, endoscopic ureterotomy, ureteral catheterization or double J stenting during the follow-up period. Nine more complicated cases (1.3%) eventually had definitive management, including repair of the urinary bladder rupture, repair of the vesicovaginal fistula, ureteroureterostomy or ureteroneocystostomy. However, five of these nine cases had both conservative and definitive management. The mean delay interval between the initial management and gynecologic procedure was 19.3 days. For definitive management and the gynecologic procedure, the period was 52.8 days. Conclusions: Compared to previous studies, the incidence of urologic injuries following a total hysterectomy in our hospital was similar. From the paper review, it seems early recognition does not improve the outcome but we found a 100% good outcome in patients with definitive management. Copyright © 2017, Taiwan Urological Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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Objective: In this study, antiurolithiasic and hepatoprotective effects of Ferula assa-foetida oleo-gum-resin (asafoetida) were evaluated in Wistar rats. Methods: Negative control rats were provided with ethylene glycol (EG, 1%) in drinking water for 28 days. In treatment group, asafoetida was used simultaneously once daily for 28 days at the dose of 25 mg/kg. 8-h urine was collected from experimental animals at the end of the experiment. Urine level of creatinine, uric acid, urea, K+, Ca2+, Mg2+, Na+, phosphorus, and serum level of transaminase (alanine aminotransferase (ALT) and aspartate aminotransferase (AST), alkaline phosphatase (ALP), and lactate dehydrogenase (LDH) were evaluated. In addition, histopathological changes in kidney and liver were stained in hematoxylin and eosin. Results: Asafoetida showed a significant effect on urine volume; water intake and urinary ionic parameters were altered by EG, which elevated the calcium and inorganic phosphate; and asafoetida significantly reduced the elevated levels of these ions. In addition, asafoetida significantly elevated the urinary concentration of magnesium. ALT, AST, LDH, and ALP were elevated by EG and asafoetida significantly reduced the elevated levels of these parameters. The histological findings also showed improvement after treatment with the asafoetida. Conclusion: The presented data indicate that administration of asafoetida prevented the growth of urinary stones and also have hepatoprotective effect in experimental EG nephrolithiasis in Wistar rats.

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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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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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