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BACKGROUND This study aimed to investigate the presence of circulating tumor cells (CTCs) in patients with penile squamous cell carcinoma (PSCC). METHODS CTCs were isolated from 14 patients with PSCC, 6 patients with balanoposthitis, and 6 healthy individuals. CTCs were enriched based on cell surface markers and filtered through the IsoFlux device, followed by identification according to cell morphology and immunofluorescence studies. RESULTS CTCs were found in all PSCC blood samples, but not in balanoposthitis samples and samples from healthy individuals. Immunofluorescence studies confirmed the tumor origin. When the patients with PSCC were stratified according to metastatic inguinal lymph node status, a statistically significant difference was observed in the number of detected CTCs. CONCLUSION Our study showed that CTCs in PSCC may represent a valuable marker for differentiating PSCC from other tumors. Based on the correlation with some clinical parameters, CTC analysis is possibly relevant for non-invasive monitoring of disease progression and prognosis. The results also suggested a potential role of CTCs in preventing overtreatment, such as inguinal lymph node dissection.

Simple Summary Metastasis is critical to the prognosis of patients with bladder cancer, and it is important to understand the mechanism of its occurrence. S1PR1 expression is thought to be associated with poor prognosis, but it is unknown whether it is associated with tumor metastasis. Analysis of clinical gene expression data suggests that endothelial or immune cells in tumor tissue may be the source of S1PR1 expression. Comparative analysis of clinical tumor tissues with bladder cancer cells suggests that S1PR1 expression is associated with cellular adhesion. In vitro experiments demonstrated that S1PR1 expression was negatively correlated with cancer cell motility, and that S1PR1 inhibition by FTY-720 may cause an increase in cancer cell motility, suggesting that the use of S1PR1 inhibition as a synergistic therapy requires additional observations and considerations. Abstract Clinical bladder tumor histological analysis shows that high expression of S1PR1 is associated with poor patient prognosis. However, there are no studies that describe the underlying mechanism. To investigate the relative distribution and actual function of S1PR1 in bladder tumors, we analyzed multiple clinical databases in combination with tumor purity and immune cell infiltration simulations, as well as databases of well-defined histological phenotypes of bladder cancer, and single-cell sequencing of adjacent normal tissues and bladder tumors, and further compared them with bladder cancer cell lines. The results showed that S1PR1 expression was generally higher in normal tissues than in bladder cancer tissues, and its distribution was mainly in endothelial cells or immune cells. The association between high S1PR1 expression and poor prognosis may be due to tumor invasion of adjacent normal tissues, where highly expressed S1PR1 may affect prognostic interpretation. The effect of S1PR1 itself on cancer cells was associated with cell adhesion, and in bladder cancer cells, S1PR1 expression was negatively correlated with cell motility. Moreover, the use of FTY-720 will cause an increased metastatic ability of bladder cancer cells. In conclusion, we suggest that the use of S1PR1-specific inhibition as a synergistic treatment requires more observation and consideration.

To compare perioperative circulating tumor cells (CTC) in primary upper tract urothelial carcinoma (UTUC) patients who underwent hand-assisted retroperitoneoscopic nephroureterectomy (HANU) or robotic-assisted nephroureterectomy (RANU). A total of 29 patients received RANU (n = 10) or HANU (n = 19). Peripheral blood samples were collected before, 24 h after surgery (POh24) and on postoperative day 28 (POD28). The demographic and pathologic data are similar in both groups. RANU had a longer operative time (p = 0.031), less bleeding volume (p = 0.004), and comparable pain sore (p = 0.169). The mean CTC numbers before surgery (2.4 vs. 2.3, p = 0.482), POh24 (2.4 vs. 1.9, p = 0.668) and POD28 (0.5 vs. 0.6, p = 0.280) were not significant different among groups. The amount of CTCs in both groups decreased and reached similar level on POD28. No significant difference of overall and intravesical recurrence rate between the two approaches. In comparison to RANU, more surgical manipulation does not affect tumor cell translocation into the bloodstream in UTUC patients who received HANU. However, a longer follow-up would be needed for the final comparison of tumor recurrence.

Background: Wilms' tumor (nephroblastoma) is the most common solid primary renal malignancy in children but extremely rare in adult population. We report the clinical presentation and therapeutic results of our adult Wilms' tumor patients and review the previous literatures about diagnosis and treatments. Methods: A retrospective review was carried out to investigate the patients with adult Wilms' tumor at the Tri-Service General Hospital during a 35-year period (1980–2014). Seven patients ≥16 years old (one female and six males; median age at the time of diagnosis of 24 years; range: 21–48 years) were staged according to the National Wilms' Tumor Study staging system as follows: three patients had Stage II disease, two patients had Stage III disease, and two patients had Stage IV disease. All statistical values were represented as mean ± standard deviation. All tests were two-sided, with P < 0.05 considered statistically significant. All statistical analyses were carried out using SPSS software (IBM, Armonk, NY, USA). Results: The most common clinical presentation is flank pain (57%) followed by palpable mass (43%). Only one patient presented with gross hematuria. Four patients underwent renal arteriography, which all disclosed irregular, tortuous vessel pattern with faint tumor stain. All patients underwent radical nephrectomy (one – hand-assisted laparoscopic nephrectomy and six – open transperitoneal nephrectomy). Two patients developed lung metastases after radical surgery. Six patients received multimodal therapy, including surgery, chemotherapy, and radiation therapy. The mean disease-free survival is 81 months. The 3- and 5-year survival rates are 83% and 71% separately. Conclusions: Selective renal arteriography could provide a valuable diagnostic hint in adult Wilms' tumor. Using multimodality therapy, improved prognosis could be achieved.

The aim of this study was to investigate the effects of metformin supplementation on metabolic dysfunction, testicular antioxidant capacity, apoptosis, inflammation and spermatogenesis in male mice with high-fat and high-cholesterol diet-induced obesity. Forty male C57BL/6 mice were fed a normal diet (NC group, n = 10) or a high-fat and high-cholesterol diet (HFC group, n = 30) for 24 weeks, and mice randomly chosen from the HFC group were later treated with metformin for the final 8 weeks of HFC feeding (HFC + Met group, n = 15). Compared with the HFC group, the obese mice supplemented with metformin exhibited improved blood cholesterol, glucose and insulin resistance. The HFC group diminishes in the sperm motility and normal sperm morphology, while the poorer maturity of testicular spermatogenesis was improved by metformin treatment. The HFC group exhibited a higher estradiol level and a lower 17&beta, HSD protein expression. Further analyses showed that metformin treatment increased the activities of superoxide dismutase, catalase and glutathione peroxidase and reduced lipid peroxidation. Nevertheless, both the HFC and HFC + Met groups exhibited increased expressions of apoptosis and inflammation proteins in the testis. Metformin treatment ameliorated obesity-induced poor testicular spermatogenesis and semen quality through increasing the testosterone level and antioxidant capacity.

ZIEL: Diese Studie erfolgte zum Vergleich der Wirksamkeit einer intravesikalen Instillation von Mitomycin C (MMC) zur Prävention eines nicht muskelinvasiven Ta- oder T1-High-Risk-Harnblasenkarzinoms (NMIBC) unter Verwendung verschiedener Schemata. Diese retrospektive Kohortenstudie wurde bei 152 Patienten durchgeführt, die zwischen April 2009 und September 2016 mit einer intravesikalen MMC-Injektion behandelt wurden. Der mittlere Nachbeobachtungszeitraum lag bei 32,67 Monaten. Alle Patienten unterzogen sich einer vollständigen transurethralen Resektion des Blasentumors (TURBT), an die sich innerhalb von 24 Stunden eine postoperative Instillation von MMC anschloss. Die Patienten wurden in 4 Behandlungsgruppen unterteilt: Bei Gruppe 1 erfolgte die Nachbeobachtung ohne MMC-Erhaltungsdosis; Gruppe 2 erhielt in den ersten 8 Wochen einmal pro Woche eine MMC-Instillation; Gruppe 3 erhielt in den ersten 8 Wochen einmal pro Woche und in den darauffolgenden 6 Monaten einmal pro Monat eine MMC-Instillation; Gruppe 4 erhielt in den ersten 8 Wochen einmal pro Woche und in den darauffolgenden 12 Monaten einmal pro Monat eine MMC-Instillation. Die allgemeine Rezidivrate lag bei 27,6 %. Gruppe 1 zeigte eine signifikant hohe (p 0,05) Rezidivrate von 50 %, während sich bei den Rezidivraten der übrigen 3 Schemata kein Unterschied fand (Gruppe 2: 15 %; Gruppe 3: 24,1 %; Gruppe 4: 27,2 %). Darüber hinaus zeigte sich zwischen diesen Patientengruppen kein statistischer Unterschied bei den Rezidivraten von Ta- oder T1-Tumoren sowie niedrig- oder hochgradigen Tumoren. Unser Vergleich der verschiedenen Schemata einer intravesikalen MMC-Instillation ergab bei einer einzigen MMC-Instillation nach TURBT eine signifikant höhere Rezidivrate als bei Patienten, die nach 8 Wochen, 6 Monaten und 12 Monaten eine Erhaltungsdosis erhielten. Zeitlich fanden sich beim MMC-Erhaltungsschema keine signifikanten Unterschiede zwischen der 8. Woche und dem 12. Monat. Daraus folgern wir, dass bei T1- oder Ta-High-Risk-NMIBC nach TURBT einmalig eine MMC-Instillation mit anschließender Erhaltungstherapie mit einmal wöchentlicher Verabreichung über 8 Wochen durchgeführt werden kann. This study was performed to compare the efficacy of intravesical mitomycin C (MMC) instillation for the prophylaxis of Ta or T1 high-risk nonmuscle invasive bladder cancer (NMIBC) using different schedules. This retrospective cohort study was conducted on 152 patients treated with intravesical MMC from April 2009 to September 2016. The mean follow-up time was 32.67 months. All patients underwent a complete transurethral resection of bladder tumor (TURBT) and postoperative instillation of MMC within 24 h. The patients were divided into 4 treatment groups: Group 1 was followed-up without any maintenance MMC dose treatment; Group 2 received an MMC instillation once per week for the first 8 weeks; Group 3 received an MMC instillation once per week for the first 8 weeks, and once per month for the following 6 months; and Group 4 received an MMC instillation once per week for the first 8 weeks, and once per month for the following 12 months. The overall recurrence rate was 27.6 %. Group 1 had a significantly high (p 0.05) recurrence rate of 50 %, while there was no difference in the recurrence rate between the last 3 schedules (Group 2:15 %; Group 3: 24.1 %; group 4: 27.2 %). Moreover, the recurrence rates of Ta or T1 tumors, and low-grade or high-grade tumors were not statistically different among these patient groups. Our comparison of the different schedules of intravesical MMC instillation revealed a significantly higher recurrence rate with one MMC instillation post-TURBT than in patients with a maintenance dose of 8 weeks, 6 months, and 12 months. The time of the MMC maintenance schedule exhibited no significant differences between 8 weeks and 12 months. Thus, we conclude that for T1 or Ta high-risk NMIBC, MMC instillation can be performed once after TURBT, followed by a maintenance treatment once per week for 8 weeks.

Background: In this study, we aimed to identify the association between chronic periodontal disease (CPD) and erectile dysfunction (ED) in a large young population. Patients and Methods: Totally 2191 male participants aged 18–28 years attended the Army Training Center in Taiwan between August 2012 and May 2013. All 1932 included participants filled in the International Index of Erectile Function-5 (IIEF-5) questionnaire and received a comprehensive dental examination to classify whether CPD. Results: There was a statistically significant correlation between the presence of ED and CPD (P < 0.001). Multivariate logistic regression analysis indicated that men with CPD were 1.6 (95% confidence interval = 1.280–2.009, P < 0.001) times more likely to have ED than men without CPD after adjusting confounders. Conclusion: This study demonstrates a link between ED and CPD, and it may be attributed to a combination of psychogenic and organic etiologies, such as systemic inflammation, oxidative stress, and endothelial dysfunction. This study highlights the significance of oral health, which may take a role in sexual function, even in young males. In clinical practice, more comprehensive management strategies to address participants with ED and CPD need to be investigated.

Background: To compare the results of endoureterotomy for benign ureteral strictures by using holmium: yttrium-aluminum-garnet (Ho:YAG) and thulium lasers. Methods: A total of 25 patients (15 men and 10 women, mean age: 49.16 years) underwent endoureterotomy with either Ho:YAG or thulium lasers for benign ureteral strictures (13 proximal, 3 middle, and 9 distal), using semirigid ureteroscopy and a 365-μm fiber (Ho-YAG laser) at 1.2 J/pulse and 10 Hz, or a 300-μm fiber (thulium laser) at 8W to 15W. Following incision, a 7-Fr double-J ureteral stent was left for 4 to 6 weeks. Thereafter, patients were followed-up using ultrasonography and/or intravenous urography at 3- to 6-month intervals. Results: Success was defined as the absence of symptoms, plus radiographic resolution of obstructions, as assessed by diuretic renography and/or intravenous urography. With a mean follow-up of 43 months, success was achieved in 10 (52.6%) of 19 patients treated with Ho:YAG laser and in 5 (83.3%) of 6 patients treated with thulium laser. A total of 10 patients developed recurrent strictures and were considered to have treatment failures. Stricture length and the severity of hydronephrosis were correlated with successful outcome. Sex, etiology, side, and stricture location did not predict outcome. Conclusions: Although endoureterotomies using Ho:YAG and thulium lasers had equal efficacy, our analysis revealed that a patient with longer stricture length or severe hydronephrosis is more suitable to receive thulium laser. This general laser procedure is recommended as a safe therapeutic option for the initial management of patients presenting with benign ureteral strictures because it is less invasive.

Hyperphosphatemia is a serious complication in chronic kidney disease (CKD) that occurs due to insufficient excretion of phosphorus during failure of renal function. Both CKD and an excessive phosphorus intake have been reported to increase oxidative stress and result in poor male fertility, but little is known about the reproductive function of the CKD under a poorly controlled phosphate intake. Eight-week-old C57BL/6 mice (n = 66) were randomly divided into four groups: a sham operation group received a chow diet as control (SC group, n = 14), CKD-induced mice received a chow diet (CKDC group, n = 16), control mice received a high phosphorus (HP) diet (SP group, n = 16), and CKD-induced mice received a HP diet (CKDP group, n = 20). CKD was induced by performing a 5/6 nephrectomy. The chow diet contained 0.6% phosphorus, while the HP diet contained 2% phosphorus. Impaired testicular function and semen quality found in the CKD model may result from increased oxidative stress, causing apoptosis and inflammation. The HP diet aggravated the negative effects of testicular damage in the CKD-induced mice.

Introduction Long-term ketamine abuse may cause variable lower urinary tract symptoms (LUTS) and severe cystitis. The clinical features of ketamine-associated cystitis (KC) are very similar to bladder pain syndrome/interstitial cystitis (BPS/IC). Intravesical administration of hyaluronic acid (HA) is one of the regimens for treating BPS/IC. In this study, we aim to investigate whether intravesical HA therapy may improve the LUTS of patients with KC. Materials and methods Four female patients and one male patient with KC who failed oral medications were enrolled in this study. HA (Cystistat) at a dose of 40 mg in a volume of 50 mL of phosphate-buffered saline was injected into the bladder on a weekly basis for 6 weeks and then monthly for a further 3 months. Response to therapy was evaluated by the visual analog scale (VAS) for pain, International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), O'Leary-Sant Interstitial Cystitis Symptom Index (ICSI), and Interstitial Cystitis Problem Index (ICPI). Treatment efficacy was assessed by comparing the pretreatment and posttreatment mean scores of the five questionnaires using the paired t test. Results The mean age of the patients was 22 ± 1.5 years. The mean duration of ketamine abuse was 68 ± 16.7 months. After intravesical HA therapy for 4 weeks, statistically significant mean decreases in VAS (from 7 to 4.4, p = 0.03), IPSS voiding subscore (from 16.2 to 11.6, p = 0.017), and ICSI (from 16.4 to 13.6, p = 0.016) questionnaire scores were seen. However, only ICSI constantly reduced after 4 weeks of treatment. Conclusion Intravesical HA therapy may have short-term benefits for improving bladder pain and voiding symptoms in patients with KC.

Objective There are currently no practical guidelines regarding recurrent or complex urethral strictures in Taiwan. Furthermore a specific urological reconstruction center focusing on urethroplasties in this area is currently unavailable. In this study we aim to share the experience of our institute according to an algorithm for this disease entity. Materials and methods From December 2007 to October 2013, adult males with complex urethral strictures were enrolled. Six different surgical techniques were used for treatment. Clinical features and outcomes were analyzed through a retrospective chart review. Results The mean age was 39 years, with a mean follow-up period of 42 months (range, 5–76 months). An average of three sessions of previous treatments was noted. The overall primary success, requiring no further intervention, was 46%. Permanent failure occurred in one patient (2.6%). The primary success for urethroplasty in distal, penile, bulbar, posterior urethra, and in stricture with hypospadias was 100%, 40%, 83%, 29%, and 60%, respectively. From the perspective of procedure type, anterior anastomotic urethroplasty (80%) and skin-based flaps (75%) resulted in the highest success rate. Following anterior or posterior buccal mucosal graft-augmented urethroplasties, 40% of patients received additional short-term dilatations or urethrotomies. Conclusion Complex urethral strictures can be managed by a variety of surgical techniques according to specific stricture locations. However, a careful postoperative follow-up for recurrences is mandatory, since ∼40% of patients undergoing buccal mucosal graft-augmented urethroplasties were expected to have additional procedures after the index urethroplasty.

Background We developed an artificial neural network (ANN) model to predict prostate cancer pathological staging in patients prior to when they received radical prostatectomy as this is more effective than logistic regression (LR), or combined use of age, prostate-specific antigen (PSA), body mass index (BMI), digital rectal examination (DRE), trans-rectal ultrasound (TRUS), biopsy Gleason sum, and primary biopsy Gleason grade. Methods Our study evaluated 299 patients undergoing retro-pubic radical prostatectomy or robotic-assisted laparoscopic radical prostatectomy surgical procedures with pelvic lymph node dissection. The results were intended to predict the pathological stage of prostate cancer (T2 or T3) after radical surgery. The predictive ability of ANN was compared with LR and validation of the 2007 Partin Tables was estimated by the areas under the receiving operating characteristic curve (AUCs). Results Of the 299 patients we evaluated, 109 (36.45%) displayed prostate cancer with extra-capsular extension (ECE), and 190 (63.55%) displayed organ-confined disease (OCD). LR analysis showed that only PSA and BMI were statistically significant predictors of prostate cancer with capsule invasion. Overall, ANN outperformed LR significantly (0.795 ± 0.023 versus 0.746 ± 0.025, p = 0.016). Validation using the current Partin Tables for the participants of our study was assessed, and the predictive capacity of AUC for OCD was 0.695. Conclusion ANN was superior to LR at predicting OCD in prostate cancer. Compared with the validation of current Partin Tables for the Taiwanese population, the ANN model resulted in larger AUCs and more accurate prediction of the pathologic stage of prostate cancer.

Perirenal hematoma after extracorporeal shock wave lithotripsy (ESWL) is an unusual but underdiagnosed complication. Most hematomas are asymptomatic, but severe complications are possible, which may require intervention such as a blood transfusion. We present the case of a 41-year-old Asian man suffering from a symptomatic huge perirenal/subcapsular hematoma with scrotal hematoma after ESWL; we reviewed the literature and examined the possible risk factors and treatments. This case was a very rare presentation of hematoma extension into the scrotum region from an ipsilateral perirenal hemorrhage caused by shock wave lithotripsy treatment.

Objectives Ketamine abuse may cause variable lower urinary tract symptoms and severe cystitis. In this study, we evaluated the relevance of urodynamic parameters according to the dose and duration of ketamine use and investigate the value of urodynamic studies in determining the severity of ketamine-associated cystitis (KC). Methods The urodynamic study results of 30 patients with KC between January 2009 and December 2012 were analyzed retrospectively. All patients had been diagnosed based on their history and clinical features before urodynamic investigations. Cystoscopy was performed to confirm the diagnosis and measure the maximum anesthetic bladder bladder capacity (MBC) (under spinal anesthesia). Results The mean (± standard deviation) age of patients with KC was 22.0 ± 3.3 years. The mean duration of ketamine abuse was 39.0 ± 20.8 months. Maximum cystometric capacity was 115 ± 66.6 mL. Seventy-five percent of patients had a high maximal urethral closure pressure (MUCP) (> 90 cmH2O). There was no significant difference of urodynamic parameters between the high-dose (≥ 5 gm/day) and low-dose groups (

Intravesical Bacillus Calmette–Guerin (BCG) is usually a well-tolerated treatment for urethelial carcinoma of the bladder. A 60-year-old male endured multiple erythematous white-scaled maculopapules over his trunk, back, and four extremities after 2 months of the 6-weekly intravesical instillation of BCG. Skin biopsy revealed parakeratotic hyperkeratosis, intracorneal neutrophilic Munro's abscess, and acanthosis. Guttate psoriasis was diagnosed, and he was treated successfully with topical steroid and narrow band UV-B phototherapy. We present the first Asian case of guttate psoriasis associated with intravesical BCG immunotherapy and review the literatures.

Low-molecular-weight heparins (LMWHs) have been widely used in many clinical settings. LMWH-associated spontaneous retroperitoneal hematoma (SRH) has been reported mostly in patients treated with enoxaparin. We here present a 76-year-old man with renal insufficiency treated with dalteparin for acute myocardial infarction, who developed catastrophic SRH with intra-abdominal hypertension (IAH) and hemothorax. Because of the high risk of surgical intervention, we performed ultrasound-guided abdominal paracentesis and thoracentesis to relieve IAH and respiratory distress. Vigorous supportive care with massive blood product transfusions was given to stabilize his hemodynamics. Finally, the bleeding was stopped with a powerful hemostatic agent, recombinant factor VIIa. Surgical evacuation of a 3,600 mL blood clot was performed successfully 1 month later.

At present, robot-assisted radical prostatectomy (RARP) is a gold standard in radical prostatectomy. The aim of this study was to evaluate the incidence, risk factors, and timing of occurrence of inguinal hernia (IH) after RARP.We included 427 patients with prostate cancer who underwent RARP

Rationale: Ketamine abuse is an emerging issue in many countries, and ketamine cystitis (KC) is a growing disease which more and more urologists may encounter with. There was no gold standard diagnostic criteria of ketamine cystits established yet, but well-accepted with the positive substance abuse history and clinical symptoms. The clinical presentation of ketamine cystitis varies and may mimic those presented in interstitial cystitis (IC), such as voiding frequency, urgency with urge incontinence, dysuria, nocturia, burning sensation during urination, post urination pain, painful hematuria, and small bladder capacity, but there are still differences that KC presented with more urgency, hematuria, pyuria and upper urinary tract involvement such as ureteral stenosis, vesico-ureteric reflux, hydronephrosis and renal function impairment. Patient concerns: We presented an interesting case with a 36-year-old man who's symptoms mimic acute prostatitis but there was no positive pathogen been cultured. The computed tomography (CT) findings revealed asymmetrical bladder wall thickening, which misleading us to the impression of bladder cancer. After the cystoscopy with bladder biopsy, the pathology revealed severe inflammation without malignancy. After that, we prescribed anticholinergic agent, beta-3 agonist and nonsteroidal anti-inflammatory drug (NSAID) for him, but in vain. Diagnoses: Erosive cystitis with prominent infiltration by eosinophils, lymphocytes, neutrophils and plasma cells. Interventions: Then we introduced hyaluronic acid (HA) instillation, once a week for total 10 times. Outcomes: After the treatment, his urgency, frequency, nocturia improved and his bladder capacity increased from less than 100ml to 350mL per urination. The following magnetic resonance imaging (MRI) and bladder biopsy result revealed complete reversal. Lessons: To our literature review, this is the first case of ketamine cystitis presented with asymmetrical bladder wall thickening, which may be considered as an irreversible change, but turns out complete reversal of the clinical symptoms and image morphology after merely intravesical hyaluronic acid instillation

To determine whether a relationship between obesity and varicocele occurrence exists, the prevalence and severity of varicoceles related to obesity were investigated in a general population of young males. A total of 1050 young males attending the Navy Recruit Training Center were evaluated from their physical screening examinations. All subjects underwent history taking and physical examinations to evaluate for the presence and severity of varicocele. The anthropometric indexes including body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) were recorded. All subjects were categorized by quartiles according to each anthropometric index. Means were compared with the Student's t-test. Severity was compared by analysis of variance testing and frequency was analysed using the chi-square method. Statistical significance was considered at p

The study investigated the correlation between obesity and sexual function in young men. It was a cross-sectional study in an unselected consecutive sample of military men aged less than 28 years old attending to the Navy Recruit Training Center. There were 772 subjects included in the study, excluding subjects with comorbidities and subjects who had not engaged in sexual intercourse. All men underwent a detailed health examination, including physical assessment and taking of medical history. Obesity was assessed by anthropometric means, including body mass index, waist circumference (WC), and waist-to-hip ratio. Subjects were categorized into 4 groups by increasing order according to each anthropometric indicator (quartile method). Clinical sexual function was evaluated with the International Index of Erectile Function-5 (IIEF-5) scale score. There was no statistical difference in IIEF-5 score between smoking and nonsmoking groups (t test, P = .422). According to analysis of variance, only the anthropometric indicator WC showed a statistically significant correlation with IIEF-5 severity (P = .032). A possible explanation was that the systemic effects of obesity and smoking would take place while combined with the process of aging.

Background: Plasmacytoid urothelial carcinoma (PUC) is a distinct variant of urinary bladder cancer, with a high propensity for invasion and poor prognosis. These tumors occur most commonly in male patients with the age of reported cases ranging from 46 to 87 years. Case report: We present a case of a 74-year-old male patient having massive ascites and bilateral lower leg edema. Colonoscopy showed a 3-cm lesion in the sigmoid colon and an edematous nonpapillary tumor was found by cystoscopy in the bladder. Histopathology analysis of the biopsies showed adenocarcinoma of colon and PUC of bladder. The diagnosis of PUC with peritoneal carcinomatosis was then confirmed by immunohistochemical stain. Conclusion: The diagnostic dilemmas of the unusual variant of urothelial malignancy, the origin of peritoneal metastasis, and its clinical impact are discussed in the present case.

Background: Ureteral stricture is a complication of several etiologies including idiopathic retroperitoneal fibrosis, infection, radiotherapy, instrumentation, and surgical procedures. A variety of techniques have been reported for management. The transureteroureterostomy and bladder flap have been the standard procedures for repairing distal ureteral defects of unilateral ureter. Bilateral ureteral stricture is an uncommon condition that challenges usual reconstructive procedures. It is a difficult task to reconstruct the complex situation of bilateral ureteral strictures. Case presentation: A 54-year-old female underwent concurrent chemoradiotherapy for stage IVB squamous cell carcinoma of cervix. Subsequently, she had stricture of bilateral distal ureters with bilateral hydroureteronephrosis which was found by computed tomography. The renal function deteriorated during the follow-up period. She had periodic change of double-J stents and percutaneous nephrostomy. However, the renal function still deteriorated. We performed a combined Y-shaped common channel transureteroureterostomy with Boari flap to reconstruct bilateral long-segment ureteral strictures. The patient recovered uneventfully. Conclusion: Reconstruction of bilateral ureteral strictures is a difficult treatment. We developed a modified technique for the complex situation of bilateral ureteral strictures. To our knowledge, this has not been previously reported in the scientific literature and it is a feasible procedure to treat bilateral long-segment ureteral strictures.

Whether sexual function is affected by circumcision is a subject of considerable debate among advocate and opponent opinions. We analyzed the sexual function of young men, and the differences between those who were uncircumcised and circumcised, in Taiwan. A total of 506 patients who received circumcision between January 2009 and March 2011 at the urology department in our center were enrolled. Before circumcision, the patients' sexual performances were evaluated using the International Index of Erectile Function-5 (IIEF-5), and the Brief Male Sexual Function Inventory (BMSFI) questionnaires. They were evaluated using the questionnaires again, after a postoperative interval of 90 days. Furthermore, intravaginal ejaculation latency times (IELT) of the patients were also measured. The IELT and scores in five main domains of the BMSFI, and IIEF, before and after circumcision, were analyzed. A total of 442 patients were available for follow up. The mean age was 25.14 ± 4.46 years (range = 19–35 years). The differences in the BMSFI scores were statistically significant (p

Renal infarction is an uncommon condition that resulted from inadequate perfusion of the kidney and is easily missed diagnosed due to its nonspecific clinical presentations. Major risk factors for renal infarction are atrial fibrillation, previous embolism, and ischemic and valvular heart disease. Progressive decrease in renal function or even death can occur if renal infarction is not diagnosed accurately and promptly. Ketamine abuse may cause variable urinary tract injury. However, renal infarction caused by ketamine abuse has never been reported. To our knowledge, this is the first documented case of renal infarction following nasal insufflation of ketamine.

INTRODUCTION Emphysematous epididymo-orchitis is a rare cause of acute scrotum pain characterized by gas formation within the tissue. Diabetes mellitus and recto-seminal fistula secondary to sigmoid diverticulitis are generally accepted as being responsible for this disease. However, prostate invasion secondary to rectal cancer may be considered to be a newly identified pathogenetic mechanism. Herein, we report this rare case and illustrate the pathogenesis. CASE PRESENTATION A 69-year-old man arrived at our emergency department presenting with sepsis and acute scrotal pain. Emphysematous epididymo-orchitis was diagnosed by scrotal sonography initially; however, advanced rectal cancer with prostate invasion was diagnosed by CT after a recurrent episode. An exploratory laparotomy with abdominoperineal resection and radical prostectomy were performed after neoadjuvant chemoradiotherapy. Histopathologic analysis confirmed the previous diagnosis. Emphysematous epididymo-orchitis caused by advanced rectal cancer is very rare, and our case is the first to be reported according to a literature search. Neoadjuvant chemoradiotherapy plus extended surgery can achieve a good oncological outcome. CONCLUSION This case indicated that the very rare presentation as emphysematous epididymo-orchitis caused by locally advanced colorectal cancer.

Background: This study investigated the correlation between epicardial adipose tissue (EAT), a measure of central obesity, and sexual function in males with vasculogenic erectile dysfunction (ED). Materials and Methods: The study was a cross-sectional study of selected males with ED aged

Background The proper use of endorectal coil MRI (eMRI) images provide detailed information for the real extent of locally prostate cancer invasion and involvement of pelvic lymph nodes. This study evaluated the accuracy of endorectal coil magnetic resonance imaging (eMRI) results, combining the preoperative prostate-specific antigen (PSA), and the biopsy Gleason score to improve the diagnostic accuracy of prostate cancer (PCa) with organ-confined disease (OCD) or extracapsular extension (ECE)/seminal vesicle invasion (SVI). Methods Between 2001 and 2007, 94 PCa patients received eMRI testing during presurgical evaluation and underwent radical prostatectomy. As a part of routine patient workup, serum PSA level and Gleason score after pathology examination were recorded. The eMRI images were used to help assess patient PCa staging status regarding OCD or ECE/SVI. These stage assessments as evaluated through the use of MRI were compared with the final specimen pathological stage after the patients underwent radical prostatectomy. Results Of the total 94 patients in our study, 65 had stage pT2, 12 had stage pT3a, and 17 had stage pT3b PCa. In patients with clinical stage T2 PCa, the Gleason score significantly improved the discriminative ability of eMRI to successfully predict PCa at the OCD stage. Otherwise, in cases of clinical stage T3 PCa, accurate determination of PSA levels significantly improved eMRI predictive ability to assess ECE or SVI staging. Conclusion In clinical stage T2 PCa patients, integrating the biopsy Gleason score improved the discriminative ability to assess OCD PCa staging. Additionally, combining the preoperative PSA levels of clinical T3 prostate cancer cases with Gleason scores significantly improved the sensitivity and accuracy of eMRI diagnosis to distinguish ECE from SVI.

For patients who are suffering from neurogenic lower urinary tract dysfunction, intermittent urinary catheterization is an efficient way to empty the bladder. 1 However, the method may result in various complications. Herein we present a rare complication of extraperitoneal abscess owing to intermittent urinary catheterization in a 62-year-old male who had cervical spine injury and was treated with intermittent urethral catheterization for neurogenic lower urinary tract dysfunction. Treatment and a literature review are also described.

To assess the impact of ketamine abuse on genitourinary tract dysfunction.Eleven patients with urinary tract symptoms and a history of ketamine abuse in recent years were studied. Urinalysis, urine culture, renal function tests, abdominal sonography and urodynamic studies were done. Bladder biopsies were carried out in selected cases.The most common complaints were lower urinary tract symptoms, including dysuria, frequency, urgency and gross hematuria. Urinalyses showed nonbacterial pyuria and were negative for tuberculosis. All biopsy specimens showed infiltrations of granulocytes (mostly eosinophils) and mast cells within the bladder tissue. Medications produced only slight clinical improvements. Intravesical instillation of hyaluronan solution was performed for some patients and a significant improvement of lower urinary tract symptoms was observed.Although the dosage and duration of ketamine abuse causing severe side-effects are still unclear, some patients develop irreversible histological changes in the urinary tract. Therefore, clinicians should be aware of the negative effects of ketamine abuse on genitourinary tract function.

Objective To explore the associations between different dietary patterns and semen quality in a general Asian male population. Methods Cross-sectional study. Healthy Taiwanese men aged 18 years or older who participated in a standard medical screening program from 2008-2013 run by a private firm were included in this study. Semen parameters including sperm concentration (SC), total sperm motility (TSM), progressive motility (PRM) and normal sperm morphology (NSM) were recorded. A dietary questionnaire was used to categorize the participants into 5 groups: “Healthy diet”, “Western diet”, “High-carbohydrate diet”, “High sweet snacks & sugar-sweetened drinks” and “High-sodium diet”. Results A total of 7282 men completed the questionnaire regarding dietary pattern, and examination of anthropometric indexes was performed and laboratory data were obtained. A high intake of a “Western diet” resulted in statistically linear declines of SC and NSM (P < 0.001 and P < 0.001). Similarly, a greater intake of “High sweet snacks & sugar-sweetened drinks” was associated with a lower SC (P = 0.001). Increased intake of a “High-carbohydrate diet” was related to higher prevalences of abnormal TSM and PRM (P = 0.012 and P = 0.025). Similarly, a greater intake of a “High-sodium diet” was correlated with an elevated prevalence of abnormal NSM (P = 0.035). Conclusions This study showed that a greater intake of a “Western diet” is associated with poorer SC and NSM, a “High sweet snacks and sugar-sweetened drinks” intake is correlated with a lower SC, and high-carbohydrate food is related to elevated prevalences of abnormal TSM and PRM.

AIM: To investigate the effect of epidermal growth factor (EGF) on mucosal healing in rats with duodenal ulcer. METHODS: Male Sprague-Dawley rats were randomly divided into sham operation without EGF, sham operation with EGF, duodenal ulcer without EGF, or duodenal ulcer with EGF groups. Additionally, normal rats without operation served as the control group. Duodenal ulcer was induced in rats by 300 mL/L acetic acid. Rats with EGF were orally administered at a dose of 60 μg/kg/day in drinking water on the next day of operation (day 1). Healing of duodenal ulcer was detected by haematoxylin and eosin staining. Cell growth of damaged mucosa was determined by the contents of nucleic acids and proteins. The level of EGF in duodenal mucosa was measured by ELISA. RESULTS: The pathological results showed that duodenal ulcer rats with EGF improved mucosal healing compared with those without EGF after day 5. Duodenal ulcer rats with EGF significantly increased duodenal DNA content compared with those without EGF on day 15 (6.44±0.54 mg/g vs 1.45±0.52 mg/g mucosa, P

Background Angiomyolipomas are benign tumors of the kidney. Typical angiomyolipomas are usually recognized by identifying fat components before any intervention. On the contrary, solid renal masses without evident fatty components but containing calcifications on the computed tomography scan are suspicious for malignancy. However, as in this rare case, rules of diagnostic imaging are of exceptions. Case presentation A 40-year-old man presented with left flank pain. The plain X-ray showed multiple coarse calcifications of 4.0 x 3.2 cm in diameter on the left upper quadrant abdomen. Computed tomography scan further revealed a solid renal mass and inside the mass there were calcifications. The size of the tumor was 5.6 × 5.5 × 6.3 cm. We performed a radical nephrectomy, and the histopathology showed a minimally fat-contained angiomyolipoma of multiple calcifications. The patient was free of recurrence or metastases after a follow-up period of 3 years. Conclusion An angiomyolipoma containing calcification is rare. An angiomyolipoma with minimal fat concomitant with calcifications is an even rarer presentation. It is very difficult to differentiate a minimal-fat angiomyolipoma with calcifications from a renal cell carcinoma preoperatively. In such a circumstance, a well-planned partial nephrectomy may be optimal for the patient, regardless of the tumor size.