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Purpose:. This study aims to investigate the efficacy and safety of Allium metallic ureteral stents in treating patients with refractory ureteral strictures. Materials and methods:. A total of 13 patients with refractory ureteral strictures were prospectively enrolled in the study. After ureteral balloon dilation, an Allium stent was inserted into the ureter through the stricture. Serum blood urea nitrogen and creatinine levels, kidney-ureter-bladder x-ray, and renal ultrasonography reports were evaluated preoperatively, 3 months after the procedure, and at the last outpatient visit. Treatment success was defined as improvement in both renal function and the grade of hydronephrosis. Improvement was defined as the enhancement of renal function without the resolution of hydronephrosis. Adverse events were recorded. Results:. The median (interquartile range [IQR]) age of the patients was 63 (46–76) years. The median (IQR) follow-up was 15 (13.5–21) months. Treatment success and improvement were noted in 9 (69.2%) and 3 (23.1%) patients, respectively. Compared with the preoperative levels, the median (IQR) serum creatinine levels were significantly improved at 3 months after the operation (1.6 [1.25–2.85] versus 1.2 [1.05–2.05]; P = 0.02) and at the last visit (1.6 [1.25–2.85] versus 1.2 [1.05–1.8]; P = 0.02). Stent migration and encrustation were noted in 3 (23.1%) and 1 (7.7%) patients, respectively. Conclusion:. Allium ureteral stents are safe and effective for patients with refractory ureteral strictures.

This article reports the current evidence and expert opinions on patient-centered bladder management of neurogenic lower urinary tract dysfunction (NLUTD) among chronic spinal cord injured (SCI) patients in Taiwan. The main problems with SCI-NLUTD are failure to store, empty, or both. The management of SCI-NLUTD should be prioritized as follows: (a) preservation of renal function, (b) freedom from urinary tract infection, (c) efficient bladder emptying, (d) freedom from indwelling catheters, (e) patient agreement with management, and (f) avoidance of medication after proper management. The management of NLUTD in SCI patients must be based on urodynamic findings rather than neurologic evaluation inferences. It is important to identify high-risk patients to prevent renal functional deterioration in those with chronic SCI-NLUTD. Urodynamic studies should be performed on patients with SCI on a regular basis, and any urological complications should be adequately treated. When surgery is required, less invasive and reversible procedures should be considered first, and any unnecessary surgery in the lower urinary tract should be avoided. The most important aspect of treatment is to improve the quality of life in SCI patients with NLUTD. Annual active surveillance of bladder and renal function is required to avoid renal function deterioration and urological complications, particularly in high-risk SCI patients.

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.

Objectives: We studied patients who underwent extracorporeal shock wave lithotripsy (SWL) to investigate the factors influencing the outcome, and built a logistic regression model to estimate the stone-free rate (SFR) after SWL. Material and methods: From January 2013 to December 2013, we retrospectively reviewed the clinical status of 641 patients with a solitary urinary calculus who underwent SWL in our hospital. Univariate logistic regression was used to identify the factors leading to a high SFR, and significant factors were further analyzed by multivariate logistic regression. After the optimal model had been developed, we placed it on the website so others could calculate the SFR at their institutions. Results: The overall SFR for all patients, patients with ureteral stones, and patients with renal stones were 54.8%, 67.8%, and 46.7%, respectively. Multivariate logistic regression showed that body mass index (BMI), stone length, stone width, and stone location were the independent factors that affected the overall successful rate. Stone length was the only significant factor to predict SFR for ureteral stones. BMI, stone length, and stone width were significant SFR predictors for renal stones. A logistic regression model was designed to estimate SFR, which has a sensitivity of 77.8% and specificity of 75.5%. Conclusion: BMI, stone length, stone width, and kidney and ureteral stones were all prognostic factors influencing the outcome of SWL. We built a logistic regression formula to predict the SFR, which helps urologists to select patients for SWL.

Objective: To investigate the risk factors of perirenal hematoma (PRH) after flexible ureteroscopic lithotripsy (FURSL). Materials and methods: We retrospectively reviewed the medical records of 45 patients who underwent FURSL with a holmium:yttrium–aluminum–garnet laser. We divided all patients in two groups: the PRH group and the non-PRH group. The patient demographic and baseline characteristics, surgical outcomes, and complications were compared and risk factors were identified and analyzed. Results: Of the 45 consecutive patients treated with FURSL, four (8.9%) developed PRH. Compared with patients without PRH, patients with PRH had a lower body mass index (BMI; 20.2 ± 3.2 kg/m2 vs 26.9 ± 5.5 kg/m2, p = 0.015), thinner kidney cortex thickness (0.88 ± 0.41 cm vs 1.39 ± 0.41 cm, p = 0.024), and a history of chronic kidney disease (CKD; 75% vs 14.6%, odds ratio = 17.5, confidence interval = 1.55–197.46, p = 0.021). However, patient age, diabetes mellitus, hypertension, liver disease, coronary artery disease, history of urolithiasis, presence of multiple stones, and stone size and location were comparable in both groups. Three patients with PRH were successfully managed with conservative treatment. One patient with PRH underwent an emergency nephrectomy within 1 day but died 2 weeks later despite vigorous resuscitation. Conclusion: Among our patients, those with lower BMI, CKD, and a thinner renal cortex had a higher risk of developing PRH after FURSL. Endourologists should have a heightened awareness for potential PRH when treating patients who present with low BMI, CKD, and a thin renal cortex.

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

The purpose of this guideline is to direct urologists and patients regarding how to identify overactive bladder (OAB) in male patients with lower urinary tract symptoms (LUTS) and to make an accurate diagnosis and establish treatment goals to improve the patients' quality of life (QoL). LUTS are commonly divided into storage, voiding, and postmicturition symptoms, and are highly prevalent in elderly men. LUTS can result from a complex interplay of pathophysiologic features that can include bladder dysfunction and bladder outlet dysfunction such as benign prostatic obstruction (BPO) or poor relaxation of the urethral sphincter. Diagnosis of OAB in male LUTS leads to accurate diagnosis of pure OAB and bladder outlet-related OAB, and appropriate treatment in men with residual storage symptoms after treatment for LUTS.

This article reports the current evidence and expert opinions on 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 combined failure to store and empty. The priority of management of NLUTD should follow the order of: (1) preservation of renal function; (2) freedom from urinary tract infection (UTI); (3) efficient bladder emptying; and (4) freedom from indwelling catheter, and patients' expectation of management should be respected. Management of the urinary tract in patients with spinal cord injury (SCI) or multiple sclerosis (MS) must be based on urodynamic findings, rather than inferences from the neurologic evaluation. Selecting high risk patients is important to prevent renal function impairment in patients with chronic NLUTD. Patients with NLUTD should be regularly followed up for their lower urinary tract dysfunction by urodynamic study and any urological complication should be adequately treated. Avoiding a chronic indwelling catheter can reduce the incidence of developing a low compliant bladder. Antimuscarinic agents with clean intermittent catheterization (CIC) may reduce urological complications and improve quality of life (QoL) in patients with NLUTD. Intravesical injection of botulinum toxin A provides an alternative treatment for refractory detrusor overactivity (DO) or low compliant bladder and can replace the need for bladder augmentation. When surgical intervention is necessary, we should consider the least invasive type of surgery and reversible procedure first and avoid any unnecessary surgery of the lower urinary tract. Keeping the bladder and urethra in a good condition without interference of the neuromuscular continuity provides patients with NLUTD a chance for future new technologies. It is most important to never give up on improving the QoL in patients with NLUTD.

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.