Search

Objective: This study was conducted to investigate the efficacy and safety of ureteral dilation and placement of a long-term ureteral stent for patients with various types of ureteral obstructions. Methods: We retrospectively reviewed the records of 39 patients presenting with ureteral obstruction secondary to malignant strictures (n = 9) or nonmalignant strictures (n = 30). The mean age of these patients was 55.8 ± 16.1 years (range, 13–87 years). All patients underwent retrograde ureteral balloon dilation and placement of one to three ureteral stents. Stent patency rate and complications including febrile urinary tract infection, stent encrustation, and stent fragmentation were recorded. Results: A total of 117 ureteral stents were implanted during the 83 procedures. Three stents were placed in seven patients and two stents in 20 patients. The patency rate was 95.2% with a mean 75-day follow-up. There was no encrustation in 104 stents and Grade 1 in 13 stents. The patency rate was similar between the patients with malignant strictures and those with nonmalignant strictures (100% vs. 94.7%, p = 0.57). However, three episodes of febrile urinary tract infection were noted only in patients with malignant strictures. The improvement of hydronephrosis and complications were also comparable between those patients with ureteral stents indwelling for >90 days and those for

Purpose: The prevalence of erectile dysfunction (ED) is higher in patients with lower urinary tract symptoms (LUTS). Phosphodiesterase 5 inhibitors (PDE5is) can improve both ED and LUTS and therefore is useful for these patients. Our aim of this study is to evaluate whether combination therapy of alpha blockers and PDE5i is more effective than alpha-blockers monotherapy for the treatment of LUTS. Materials and Methods: A systematic review and meta-analysis were undertaken to assess the difference between the combination therapy and alpha-blockers monotherapy by searching published randomized controlled trials from electronic databases PubMed, Embase, and the Cochrane Library up to April 2018. Results: A total of 13 randomized controlled studies with 1173 patients were included in our meta-analysis. Compared with alpha-blocker monotherapy, the combination therapy obtained a significantly better improvement in International Prostate Symptom Score (IPSS) (1.73, 95% confidence interval [CI]: 1.1–2.35), voiding subscore (0.99, 95% CI: 0.54–1.44), storage subscore (0.57, 95% CI: 0.03–1.1), peak flow rate (0.69 cc/s, 95% CI: 0.27–1.1), and erectile function (EF) symptom score. Meta-regression showed that baseline IPSS, baseline peak flow rate, baseline prostate volume, age, baseline EF symptom score, and dosage of PDE5is were not associated with the difference in IPSS improvement. Conclusion: A combination of alpha blockers and PDE5is has better therapeutic effects than alpha-blocker monotherapy on LUTS related to benign prostate hyperplasia.

The use of the flexible ureteroscope for treating renal and ureteral calculi has rapidly increased in the last decade. Although the use of the flexible ureteroscope by experienced surgeons has excellent outcomes and safety profiles, several studies have reported many surgical complications with its use. We conducted a narrative review of the published literature sourced from PubMed. We used a combination of three keywords: “ureteroscope,” “morbidity,” and “urolithiasis,” with or without the additional keywords of “infection,” “mortality,” “hematoma,” and “ureteral injury.” Infection, bleeding, and ureteral injury are the main complications. We analyzed the possible causes of morbidity and death after the use of a flexible ureteroscope. Finally, we propose recommendations to prevent these complications.

This article reports the current evidence and expert opinions on the diagnosis and management of neurogenic lower urinary tract dysfunction (NLUTD) in Taiwan. The main problems of NLUTD are failure to store, failure to empty, and a combination of these two. Priorities in the management of NLUTD, in order of importance, should be the following: (1) preservation of renal function; (2) freedom from urinary tract infection; (3) efficient bladder emptying; (4) freedom from indwelling catheters; (5) patient agreement with the management modality; and (6) avoidance of medication after proper management. Management of the urinary tract in patients with spinal cord injuries or multiple sclerosis must be based on urodynamic findings rather than on inferences from the neurological evaluation. Identification of high-risk patients is important to prevent renal functional impairment in those with chronic NLUTD. The lower urinary tract function of patients with NLUTD should be regularly followed up by urodynamic study, and any urological complication should be treated adequately. Avoiding a chronic indwelling catheter can reduce the incidence of developing a low compliant bladder. Intravesical instillation of vanilloids and injecting botulinum toxin-A are alternative treatments for refractory detrusor overactivity or a low compliant bladder, and can replace the need for bladder augmentation. When surgical intervention is necessary, less invasive types of surgery and reversible procedures should be considered first, and any unnecessary surgery in the lower urinary tract should be avoided. Keeping the bladder and urethra in good condition without the interference of neuromuscular continuity provides patients with NLUTD the opportunity to use new technologies in the future. Improving the quality of life in patients with neurogenic voiding dysfunction is the most important aspect of treatment.

Voiding dysfunction is an uncommon condition in young men. With increased understanding of the etiology of chronic lower urinary tract dysfunction, there has been significant improvement in the management of the condition. We have reviewed the current literature and make suggestions about diagnosis, treatment, and further research on this topic. We searched the PubMed database for the management of voiding dysfunction in young men using the following terms: voiding dysfunction, lower urinary tract symptoms, young men, risk factor, urodynamics study, uroflowmetry, magnetic resonance imaging, primary bladder neck obstruction/bladder neck dysfunction, dysfunctional voiding/pseudodyssynergia, impaired detrusor contractility/detrusor underactivity, adrenergic antagonist, transurethral incision, urotherapy, baclofen, and botulinum toxin. Uroflowmetry is an important noninvasive examination for screening young men for possible voiding dysfunction. A videourodynamic study is recommended for patients with low urine flow. Primary bladder neck obstruction and dysfunctional voiding are the two most common diagnoses. α-Adrenergic antagonists and urotherapy are widely used for treating bladder neck obstruction and dysfunctional voiding, respectively. Botulinum toxin A may become a potential therapeutic option in the future. Although the published reports usually included a small number of patients and lacked randomization and a placebo-controlled group, these clinical studies still provide great advances in managing voiding dysfunction in young men. Further well-designed studies are warranted to support optimal management of these conditions.

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.

Emphysematous prostatic abscess is a rare but relatively serious infectious disease, and its association with rectoprostatic fistula is extremely unusual. The reported risk factors for this condition include diabetes mellitus, immunosuppression, and prostate surgery. We report a rare case of emphysematous prostatic abscess successfully treated by transurethral drainage. Nonetheless, a rectoprostatic fistula was found postoperatively. The fistula healed spontaneously without fasting or fecal diversion after suprapubic cystostomy and placement of a urethral catheter. This case highlights the importance of surgical drainage for the treatment of an emphysematous prostatic abscess and that conservative treatment can be a safe and effective approach for an associated rectoprostatic fistula.