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   2021| October-December  | Volume 32 | Issue 4  
    Online since December 14, 2021

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Mitochondrial dysfunction in patients with urogenital disease
Tzu-Yu Chuang, Te-Wei Chang, Shiou-Sheng Chen, Chan-Chi Chang, Wei-Ming Cheng, Yau-Huei Wei
October-December 2021, 32(4):143-150
Mitochondria are intracellular organelles responsible for the production of the majority of adenosine triphosphate (ATP). In addition to energy production, mitochondria also contribute to cellular apoptosis, the regulation of intracellular Ca2+ homeostasis, signaling through reactive oxygen species (ROS), and the coordination of the cell cycle. The prevalence rate of primary mitochondrial disease was estimated at nearly 1:5000. In this review, we have integrated recent evidence to discuss new insights into how mitochondrial dysregulation plays a role in bladder dysfunction, reproductive disorder and the correlation between mtDNA mutation and bladder cancer.
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Clinical features of patients with nonmalignant upper tract lesions mimicking urothelial cancer
Ze-Hong Lu, Chien-Hui Ou, Kun-Che Lin
October-December 2021, 32(4):151-156
Purpose: The purpose is to evaluate the incidence and clinical features of patients who have undergone nephroureterectomy with nonmalignant upper tract lesions presumed to be urothelial carcinoma from images in Taiwan. Materials and Methods: Between October 2004 and October 2015, our institute had 350 patients who underwent retroperitoneoscopic nephroureterectomy for possible upper urinary tract urothelial carcinoma without a routine diagnostic ureteroscopy (URS) or ureteroscopic biopsy. Trauma, urolithiasis, or infection were excluded. We collected imaging findings; urine cytology results; renal function status; previous urothelial history; and the final pathology results. Twenty-three (6.6%) patients had nonmalignant benign lesions found from pathology. Results: The 23 patients comprised nine men and fourteen women. Most patients were middle-aged. Initial symptoms included gross hematuria, hydronephrosis, and flank pain. From self-voided urine cytology, the most common result was atypical cells. The number of patients was equal in the end-stage renal disease (ESRD) plus postkidney transplantation group and the non-ESRD group. In addition, we divided patients into two groups according to lesioned kidney function status: Nonfunctional kidney (NFK) or functional kidney (FK). The most common pathologic feature found in the NFK group was atrophic kidneys. On the other hand, the most common diagnosis in the FK group was pyelonephritis. Conclusion: Nonmalignant pathologic lesions were detected in 23 patients who had undergone retroperitoneoscopic nephroureterectomy without preoperative diagnostic URS for upper tract lesions. Self-voided urine cytology provided limited information for diagnosis in this group. For the almost 75% of patients with NFK, nephroureterectomy may be a feasible diagnostic and therapeutic method.
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Comparison of trimodal therapy versus radical cystectomy for each stage of muscle-invasive bladder cancer
Wen-Hsin Tseng, Steven K Huang, Chien-Liang Liu, Jinn-Rung Kuo, Shun-Hsing Hun, Chun-Hao Chen, Chia-Cheng Su, Jhih-Cheng Wang, Kau-Han Lee, Kun-Lin Hsieh, Allen W Chiu
October-December 2021, 32(4):164-170
Purpose: Radical cystectomy (RC) has long been the standard of care for the management of muscle-invasive bladder cancer (MIBC). However, an increasing trend of bladder-sparing trimodal therapy (TMT) using maximal transurethral resection of bladder tumor, followed by radiation therapy (RT) with concomitant radiosensitizing chemotherapy, has been advocated. We compared the differences regarding long-term oncological outcomes between patients who accepted RC or TMT for MIBC. Materials and Methods: Between January 2012 and December 2018, 207 patients were diagnosed with MIBC at our center. We excluded patients with metastasis disease, received other treatments, and lost to follow-up. The patients were categorized into Group 1 (TMT) and Group 2 (RC). Both the groups with each tumor stage were compared for disease-free survival (DFS) and overall survival (OS) rates, and the risk factors for recurrence and survival were assessed. Results: In total, 58 (48.7%) patients in Group 1 underwent TMT and 61 (51.3%) patients in Group 2 underwent RC. The mean follow-up was 39.8 months. The 3-year DFS rates were 44.1% and 69.7% for Groups 1 and 2, respectively (P = 0.003). The 3-year OS rates were 61.7% and 72.5% for Groups 1 and 2, respectively (P = 0.226). We also analyzed the DFS with each stage, and the results showed a lower DFS rate for T2 and N0 stages. Conclusion: There was no significant survival benefit for MIBC with either RC or TMT. However, RC is associated with better outcome of DFS rate, especially for patients with early stages of MIBC in stages T2 and N0.
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Sperm motility is the best semen parameter to predict sperm DNA fragmentation
Wei-Lun Huang, Yi-Kai Chang, Sheng-Yung Tung, Bo-Hua Peng, Hong-Chiang Chang
October-December 2021, 32(4):157-163
Purpose: Sperm DNA fragmentation (SDF) is associated with male infertility and abnormal semen parameters. However, the effect of SDF on each parameter may differ. In this study, we evaluated the correlation between different semen parameters and SDF to identify the most suitable predictor for abnormal SDF. Materials and Methods: We conducted a retrospective review from a prospective database. Enrollees who underwent conventional semen analysis and an SDF test for medical purposes or elective examinations were enrolled. SDF ≥20% was regarded as abnormal. Spearman correlation coefficient was used to determine the correlations. Area under the receiver operating characteristic curve area under the curve (AUC) was calculated to determine the predictive value. Youden index was used to determine the optimal cutoff value of conventional semen parameters to predict abnormal SDF. Results: In total, 90 men were enrolled, of whom 44 (48.89%) visited for infertility and 51 (56.67%) had abnormal semen analysis. Immotile sperm (IM) and nonprogressive sperm (NPS, NPS = nonprogressive motility + IM) were significantly correlated with SDF (r = 0.50, P < 0.001 for NPS; r = 0.49, P < 0.001 for IM) and were the most predictive for abnormal SDF (AUC = 0.77 for NPS; AUC = 0.78 for IM). By using Youden index, the cutoff values for the prediction of abnormal SDF were 66.37% for NPS and 48.73% for IM. Conclusion: Sperm motility is the most predictive and relevant parameter for the prediction of abnormal SDF. Suboptimal sperm motility should be considered an indication for SDF testing.
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Yao-Chi Chuang
October-December 2021, 32(4):141-142
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A short term follow up for intracavernosal injection of platelet rich plasma for the treatment of erectile dysfunction
Shin-Mei Wong, Bing-Juin Chiang, Hui-Chun Chen, Yi-No Wu, Ying-Hung Lin, Chun-Hou Liao
October-December 2021, 32(4):171-176
Purpose: The objective of this study was to investigate the safety and efficacy of intracavernosal platelet-rich plasma (PRP) injection in patients with erectile dysfunction (ED). Materials and Methods: Between September 2018 and September 2020, thirty participants with ED were enrolled in this prospective single-arm study. All participants received three sessions of intracavernosal PRP injection. Oral phosphodiesterase type 5 (PDE5) inhibitors or testosterone replacement therapy (TRT) without a change in dosing was permitted during the treatment period. Efficacy was assessed using the International Index of Erectile Function-5 (IIEF-5), Erectile Hardness Score (EHS), Sexual Encounter Profile (SEP) 2 and 3, and Global Assessment Question, every 2 weeks after each treatment session. Any adverse events were recorded. Results: The mean age of participants was 54.93 years. Oral PDE5 inhibitors were prescribed to 76.7% of participants (n = 23), and 50% of participants (n = 15) received concurrent TRT. A significant improvement in erectile function was measured by an average of 4.556 points in IIEF-5 (P < 0.001) and 0.72 points in EHS (P < 0.001). In total, 4 (13.3%) and 15 (50%) participants reported “no” to “yes” in SEP2 and SEP3 questions after therapy, respectively. Overall, 82.8% of participants agreed that the study therapy improved erectile function. No significant adverse events were reported. Conclusion: This single-arm prospective study revealed that preliminary experience with penile PRP significantly improves erectile function without obvious adverse events.
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Effects of varicocelectomy on sleep quality: Varicocele may affect sleep quality
Fatih Atac, Unal Oztekin, Mehmet Caniklioglu, Sercan Sari, Adem Tokpinar, Gokhan Sonmez
October-December 2021, 32(4):182-185
Purpose: The relationship between sleep quality and testosterone levels has been known. However, there are no data whether sleep quality and varicocelectomy have a relationship. Therefore, we aimed to investigate the effect of varicocelectomy on sleep quality and testosterone levels. Materials and Methods: A total of 39 patients with painful left grade 3 varicocele were included in the study. Visual analog scale, serum testosterone levels, Pittsburgh sleep quality index (PSQI) including subparameters of sleep were questioned and recorded preoperatively and postoperatively. Results: There was a significant difference between the preoperative and postoperative parameters of both PSQI and subparameters of sleep (P < 0.05). After the operation, 36 (92.3%) patients had remarkable pain relief. Testosterone levels of 32 (82%) patients increased. Conclusion: We concluded that a remarkable improvement in sleep quality was provided after varicocelectomy. Furthermore, evaluation of varicocele may be useful in male patients with unexplained sleep disorders.
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Measuring individual ureteral length using computed tomography urography to determine the appropriate lengths of ureteral stents
Cheng-Han Tsai, I-Shen Huang, Wei-Jen Chen, Wei-Ming Cheng, Cheng-Yen Chiang, Wei-Tang Kao, Eric Yi-Hsiu Huang, William J Huang
October-December 2021, 32(4):177-181
Purpose: The purpose of the study was to describe and validate a method for calculating ureteral length using computed tomography (CT) images acquired before ureteral stent placement and to evaluate the appropriateness of fit based on this calculation. Materials and Methods: We analyzed 57 patients who underwent computed tomography urography (CTU). The axial ureteral length (AUL) and coronal ureteral length (CUL) were derived from measurements made on the CTU images, and the length of each patient-specific ureteral stent was chosen based on the calculated ureteral length. Results: Overall, 105 ureters were measured: 54 (51.4%) right side and 51 (48.6%) left side ureters. The mean CUL and AUL of right ureters were 22.5 ± 2.3 cm and 22.5 ± 2.3 cm, respectively, whereas the mean CUL and AUL of left ureters were 23.6 ± 2.2 cm and 23.4 ± 2.1 cm, respectively. Pearson correlation analysis showed that body height was significantly correlated with ureteric length (right CUL and patient height: r =0.441, P = 0.001; right AUL and patient height: R = 0.445, P = 0.001; left CUL: R = 0.341, P = 0.029; left AUL: R = 0.339, P = 0.015). Thirteen of 57 patients underwent ureteral stent insertion; none experienced stent migration (upward or downward) before the removal of the ureteral stent. Comparison of proposed stent size with actual stent size in the 13 patients shows the percentage of size appropriateness (as defined by concordance between proposed and actual stent length) to be 76.9% (10/13). Conclusion: The patient's height was found to correlate significantly with CT-derived measurements of ureteral length. Accordingly, the choice of ureteral stent length can be reliably decided from CT measurements.
  1,057 150 -
Achieving the best RNA quality in urologic tumor samples intended for transcriptome analysis
Tzu-Chun Lai, Tai-Lung Cha, Yi-Ta Tsai, Shu-Yu Liu, Sheng-Tang Wu, En Meng, Chih-Wei Tsao, Chien-Chang Kao, Chin-Li Chen, Guang-Huan Sun, Dah-Shyong Yu, Ming-Hsin Yang
October-December 2021, 32(4):186-192
Purpose: To conduct research on the molecular oncology, physiology, and immunology of urologic tumors requires dissociated viable samples. Improper collection compromises the quality of data attained in molecular and functional assays due to the increased quantities of degraded proteins and RNA. We sought to improve the methods for tissue collection which can avoid generating considerable loss in the viability of cells for further analyses. Materials and Methods: Fifty resected tumor samples from 35 patients were obtained with different surgical techniques and at various time points for viability and RNA quality evaluation. The degradation of RNA was evaluated by its Qubit IQ score, OD 260/280 ratio, total yield, and quantity of β-actin. Results: Snap-frozen tissue samples obtained within 30 min showed better cell viability (P < 0.0001), RNA total yield (P = 0.0081), Qubit ratio (P = 0.003), OD 260/280 ratio (P = 0.4213), and quantity of β-actin (P = 0.0015). Moreover, the bladder tumor samples collected from transurethral biopsy presented more satisfied cell viability results than the ones resected by transurethral electroresection (P < 0.0001). Conclusion: Tumor samples should be processed or frozen freshly within 30 min once removed from human body. Furthermore, transurethral biopsy of bladder tumor is considered a better method for collecting samples for further molecular oncology studies. The high-quality RNA produced enable researchers to conduct more reliable studies by avoiding the experimental artifacts due to the presence of cellular debris or dead cells.
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