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We present the first report of LESS bilateral nephroureterectomy via the transperitoneal approach using the home-made single port. Two patients received LESS bilateral nephroureterectomies and bladder cuffs resection with homemade single ports, which were created by using an Alexis wound retractor as an access platform through a 4 cm incision. Distal ureters were resected through the same incision with Endo-loop. No additional ports were used and both procedures were completed successfully without traditional laparoscopic/open conversion or complication. LESS nephreoureterectomy with bladder cuff excision was performed in 460 and 635 minutes with an estimated blood loss of 50 and 400 mL, respectively. Patients were discharged on postoperative day 3 and 7, respectively. Our report demonstrates that LESS bilateral nephroureterectomy and bladder cuff resection is a safe and feasible procedure for urothelial carcinoma of upper urinary tract in patients at dialysis. [ABSTRACT FROM AUTHOR]

Introduction. We evaluated the association between serum sex hormone levels and prostate volume in Taiwanese men. Methods. A cross-sectional study was conducted in 505 men (aged 40-79 years, mean age 58 years). Serum total testosterone (TT), free testosterone (FT), dihydrotestosterone (DHT) and estradiol (E2) levels were measured. Total prostate volume (TPV) and transition zone volume (TZV) were measured by transrectal ultrasonography. Body mass index (BMI), DHT/TT and E2/TT were calculated. Correlations were determined using univariate and multivariate regression analyses. Results. Apart from DHT, an age-dependent change of sex hormone levels were observed. On univariate analyses, age, BMI, serum DHT level and DHT/TT ratio, as well as serum E2 level and E2/TT ratio, but not serum TT and FT levels showed a significant association with prostate volume. On multivariate analysis, however, only serum DHT level and DHT/TT ratio remained significant. Logistic regression analysis showed that the odds ratios (95%% confidence interval) of the second, third, and fourth quartiles of serum DHT levels for benign prostatic hyperplasia (defined as TPV ≥20 ml) risk were 2.06 (1.21-3.51), 2.66(1.56-4.53) and 7.15(4.0-12.6), respectively ( p < 0.001). Conclusions. Higher serum DHT level and DHT/TT ratio were associated with larger prostate volume and higher prevalence of BPH in Taiwanese men. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the relationship between sex hormones and metabolic syndrome (MS) in an Asian population. Methods: A cross-sectional study was conducted in 237 men aged 20-88 years (mean age 52 years). Serum lipids, glucose, insulin, total testosterone (TT), estradiol (E2), sex hormone-binding globulin (SHBG), and dehydroepiandosterone sulfate (DHEA-S) were measured along with body height, weight, waist circumference, and blood pressure. Free testosterone (FT) and bioavailable testosterone (BT) were calculated. Correlations were determined using univariate and multivariate regression analyses. Results: Men with MS had lower levels of TT, BT, FT, SHBG and DHEA-S than men without MS. Multivariate analysis, after adjusting for age and smoking status, indicated that TT (OR: 0.909, 95% CI: 0.836-0.988, p == 0.003) and SHBG (OR: 0.948, 95% CI: 0.913-0.985, p == 0.006) were significantly associated with MS ( R2 == 0.314). TT was associated with waist circumference ( p == 0.008) and abnormal triglycerides level ( p == 0.006); SHBG was associated with blood pressure ( p == 0.003), blood glucose ( p == 0.043) and abnormal triglycerides ( p == 0.048). A significant trend was observed between decreasing levels of TT, BT, FT, and SHBG and increasing numbers of MS components. Conclusion: Results show that serum testosterone and SHBG levels inversely correlate with MS in an Asian population applying the Asian MS definition. [ABSTRACT FROM AUTHOR]

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Background. Prostate cancer incidence varies significantly among different ethnic groups. However, the report concerning the clinical outcome after radical prostatectomy (RP) in the low incidence Asian population is still limited. We aimed to compare the clinical outcome in patient treated with RP among different ethnic groups and to identify significant prognostic factors in Taiwanese patients. Methods. A total of 341 patients with clinical localized prostate cancer undergoing curative RP in three medical centers in Taiwan were included in this study. Ethnic group comparison was performed using the CaPSURE, SEARCH databases from United States (US) and one large European series. The Kaplan–Meier analysis and Cox proportional hazard model were used to identify significant predictors for prostate-specific antigen (PSA) recurrence. Results. Compared to the Caucasian white population in the US and Europe studies, the Taiwanese population have higher age at surgery and higher pre-operative PSA level. With mean and median follow-up of 39.1 months and 31.0 months (range 5–120 months), 127 men (37.2%) had PSA recurrence which was significant higher than the Western series. Significant predictors for PSA recurrence identified in the post-operative overall model were PSA level, pathological Gleason Score, pathological tumor stage and lymph node metastasis. Conclusions. The clinical outcome of Taiwanese male with prostate cancer post-RP appears inferior to the Western country, which is largely due to delay surgery at higher PSA level. Earlier diagnosis and treatment may improve the cancer control of RP. [ABSTRACT FROM AUTHOR]

Aims The purpose was to analyze urodynamic findings in female diabetic patients with OAB symptoms. Methods Data from 94 female diabetic patients who underwent urodynamic studies in evaluation of various LUTS were retrospectively reviewed. Urodynamic findings, demographic data, and clinical symptoms were compared between patients with and without OAB. Results Among the 94 subjects analyzed, 34 (36.2%) were diagnosed as OAB. Demographic data were similar between the patients with and without OAB. In the OAB group, patients had significantly higher storage symptom scores and marginally higher voiding symptom scores. On cystometry, the OAB group had a higher percentage of increased bladder sensation (41.2% vs 11.7%, P = 0.001) and detrusor overactivity (29.4% vs 10.0%, P = 0.023). The OAB group had lower peak flow rate (16.2 ± 5.9 vs 19.3 ± 6.3 ml/s, P = 0.023), greater PVR volume (60.3 ± 29.4 vs 45.0 ± 25.1 ml, P = 0.009), and lower bladder voiding efficiency (BVE, 75.2 ± 2.8 vs 81.5 ± 2.9%, P < 0.001). On pressure-flow studies, the OAB group had a higher percentage of BOO (26.5% vs 6.7%, P = 0.008). Conclusions Our study shows that the most frequent urodynamic finding of OAB in female diabetic patients is increased bladder sensation, followed by detrusor overactivity. Compared to those without OAB, female diabetic patients with OAB are more likely to have impaired voiding function, characterized by lower peak flow rate, greater PVR volume, lower BVE, and a higher percentage of BOO. In these patients, BOO not only causes voiding difficulty but may also contribute to the development of OAB. Neurourol. Urodynam. 29:424-427, 2010. © 2009 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Purpose: We compared clinicopathological characteristics and outcomes in patients with bladder cancer who were exposed to graded arsenic levels in drinking water. Materials and Methods: From 1993 through 2006, 977 patients with bladder cancer in Taiwan were studied retrospectively. Patients were from 3 areas, including the core zone (arsenic related blackfoot disease endemic area with a well water arsenic level of 350 to 1,100 ng/ml), zone 1 (a well water arsenic level of 350 ng/ml or greater but not a blackfoot disease endemic area) and zone 2 (a well water arsenic level of less than 350 ng/ml). Clinicopathological characteristics and survival outcome were compared among the groups. Results: Of these patients 81 (8.3%), 246 (25.2%) and 650 (66.5%) lived in the core zone, and zones 1 and 2, respectively. More high grade and high stage tumors were observed in core zone patients than in those in zones 1 and 2, including high grade in 48.7% vs 41.4% and 39.2% of patients, advanced disease in 39.5% vs 31.0% and 18.5% and nodal metastasis in 8.6% vs 3.3% and 3.4%, respectively. Median overall and cancer specific survival in core zone patients was significantly shorter than in patients in zones 1 and 2, including 69 vs 119 and 113-month overall survival and for the 75th percentile of cancer specific survival 34.5 vs 119 and 113 months, respectively. On multivariate analysis with adjustment for tumor grade and stage the zonal difference was not a significant factor for overall or cancer specific survival. Conclusions: Patients with arsenic related bladder cancer may have decreased overall and cancer specific survival because they have more unfavorable tumor phenotypes than patients in other areas in Taiwan. [Copyright &y& Elsevier]

Purpose: We studied urodynamic characteristics and bladder sensory function in the early stages of diabetic bladder dysfunction in diabetic women. Materials and Methods: A total of 86 consecutive type 2 diabetic women with minimal confounders of voiding dysfunction followed at a diabetes clinic were prospectively enrolled and subjected to urodynamic studies. The sensory response of Aδ and C fibers of the bladder was measured by intravesical current perception threshold testing at frequencies of 250 and 5 Hz, respectively. Results: Of these 86 women 30 (34.9%) were classified as having detrusor underactivity, 12 (14.0%) presented signs of detrusor overactivity, 11 (12.8%) were referred to as having bladder outlet obstruction and 33 (38.4%) showed normal detrusor function on urodynamics. The normal detrusor function group was the reference group. The detrusor underactivity group showed impaired emptying function and decreased sensation on cystometry and intravesical current perception threshold testing. The detrusor overactivity group showed impaired storage and emptying function but had no significant changes in intravesical current perception threshold values. When the normal detrusor function group and detrusor underactivity group were pooled to perform multivariate analysis, an increase in current perception threshold values was associated with a decrease in bladder voiding efficiency on 5 and 250 Hz current perception threshold testing. Conclusions: Our data provide the electrophysiological evidence that indicates an association between impaired Aδ as well as C fiber bladder afferent pathways and poor emptying function in diabetic women with detrusor underactivity. Diabetes can affect the bladder presumably via peripheral pathogenetic mechanisms to induce detrusor overactivity with impaired contractility. [Copyright &y& Elsevier]

We present an alternative access technique to facilitate preperitoneoscopic (extraperitoneal laparoscopic) approach for radical prostatectomy, herniorrhaphy, and other pelvic procedures. A 0° telescope was mounted into a Visiport Optical Trocar (Visiport), and via a periumbilical incision it was advanced under direct vision at first vertically through different layers of the anterior abdominal wall. Immediately before the posterior rectus sheath, it was redirected caudally and horizontally toward the symphysis pubis. The Visiport was withdrawn and replaced by a dissection balloon that was inflated for developing the working space, then it was substituted with a 12-mm trocar to begin the pneumo-extraperitoneum. The surgical procedures are detailed in the attached video. This technique was used in 168 of 179 patients undergoing preperitoneoscopic surgery (97 radical prostatectomies, 80 totally extraperitoneal herniorrhaphies, and 2 urinary bladder diverticulectomies). Operative parameters were compared with 11 preceding patients approached with the open Hasson technique. All of the procedures to create the preperitoneoscopic space were successfully with no complications. For radical prostatectomy, there was a significantly faster access to the preperitoneal space (38 ± 12 vs 540 ± 69 seconds) and a faster setup of the whole operative space (15 ± 5 vs 29 ± 9 minutes, both P < .05) with the new technique. Less pericannular CO2 leakage was experienced during the preperitoneoscopy with our technique. This alternative technique offers a simple, safe, quick, and effective access for creating a preperitonescopic working space. [ABSTRACT FROM AUTHOR]

Purpose: We studied the effects of long-term fructose feeding and metabolic perturbations on bladder function in rats. Materials and Methods: Female Wistar rats were fed a fructose enriched (60%) or control diet for 3 and 6 months. In vitro contractile responses to electrical field stimulation, KCl, carbachol and adenosine triphosphate, and in vivo cystometry were used to evaluate bladder function. Tissue staining and electron microscopy were also performed to evaluate the structural changes in rats subjected to metabolic syndrome. Biochemical and physiological data were compared between fructose fed rats and age matched controls. Results: All rats fed a fructose enriched diet for 3 months showed insulin resistance, hyperinsulinemia, hypertriglyceridemia and hypertension. These fructose fed rats showed a decreased contractile response to high concentrations of KCl but not to other parameters tested compared to controls. Eight of the 12 rats (66.7%) showed abnormal cystometry, mainly by increased phasic contractions. In 6-month fructose fed rats contractile responses to electrical field stimulation, KCl and carbachol were decreased significantly. However, responsiveness to high concentrations of adenosine triphosphate was significantly increased. Morphological studies in fructose fed rats showed swollen mitochondria in bladder smooth muscle, increased leukocyte infiltration between interstitial tissue and neutrophil adhesion around the endothelium of vessels. Conclusions: Our data show that a significant proportion of fructose fed rats show time related alterations in bladder biochemical, morphological and functional properties. The proinflammation and myopathy of the bladder induced by metabolic perturbations have important roles in causing bladder dysfunction. [Copyright &y& Elsevier]

Abstract: Objective: We retrospectively reviewed the medical records of patients who underwent hand-assisted laparoscopic nephroureterectomy using a retroperitoneal or transperitoneal approach at National Taiwan University Hospital. Early postsurgical pain scores and the amount of morphine equivalents consumed were evaluated. Patients and Methods: From July 2001 to June 2005, a total of 96 patients who underwent hand-assisted laparoscopic nephroureterectomy and bladder cuff resection were retrospectively evaluated. Perioperative parameters, postoperative opioid dose, and daily pain score based on a 10-point visual analog scale (VAS) were recorded prior to discharge. Potential predictive factors included patient age, gender, body mass index, comorbid conditions, surgical time, patient controlled analgesia (PCA) use and surgical access. These were analyzed with regard to pain based on a daily VAS score and morphine dose (equivalents). Results: The daily VAS score decreased from 4.7 ± 1.5 on the day of surgery to 2.0 ± 0.7 on postoperative day (POD) 6. Only the operation time was associated with a high VAS score on POD1 (p < 0.01). On univariate analysis, a longer operation time (p = 0.04) and PCA use (p < 0.01) were associated with higher intake of morphine equivalents. Patients with end-stage renal disease (ESRD) required less morphine postoperatively (p = 0.02). On multivariate analysis, PCA use (p = 0.04), ESRD (p = 0.045), and operation time (p = 0.049) were independently associated with postoperative morphine dosage. Women had a trend of increased postoperative morphine use (p = 0.06) The postoperative daily VAS score and opioid dosage were comparable in patients receiving trans-and retroperitoneal access. Conclusion: Patients who had a longer operation had a significantly higher POD1 pain score. PCA use and prolonged operation time were predictive factors for a higher dosage of morphine. [Copyright &y& Elsevier]

Abstract: Objectives: To evaluate factors predicting the effect of nocturia in a community-based cohort of adults using a nocturia-specific quality-of-life (N-QOL) questionnaire. Methods: From October 2004 to February 2005, adults aged 40 years old or older living in Matsu, Taiwan and reporting nocturia of one episode or more per night were interviewed with a 12-item N-QOL questionnaire consisting of Sleep/Energy and Bother/Concern subscales. Univariate analyses were used to analyze the effects of demographic characteristics, frequency and duration of nocturia, and sleeping characteristics on the N-QOL score. Multiple linear regression analysis was used to identify factors predicting the N-QOL score. Results: A total of 663 adults completed this study (mean age 59.4 years). The average N-QOL scores (a lower score indicates worse QOL) were 91.4 ± 11.2, 83.7 ± 13.2, 77.6 ± 16.8, and 67.6 ± 21.2 for nocturia episodes of 1, 2, 3, and 4 or more per night, respectively (P <0.001). Men reported significantly lower N-QOL (85.6 ± 15.1 versus 88.9 ± 13.1, P = 0.003) and Bother/Concern subscale scores (42.0 ± 8.4 versus 44.0 ± 7.4, P <0.001), but not Energy/Sleep subscale scores (43.6 ± 7.8 versus 44.4 ± 7.3, P = 0.158) than women. On multiple linear regression analysis, increasing nocturia episodes (regression coefficient −6.2, 95% confidence interval −7.4 to −5.0), male sex (regression coefficient −3.5, 95% confidence interval −5.4 to −1.5), and degree of sleeping disturbance after nocturia (regression coefficient −4.5, 95% confidence interval −5.6 to −3.4) independently predicted a significantly lower N-QOL score. Conclusions: The results of our study have confirmed that nocturia has a more significant QOL impact when the patient has two or more episodes per night. Moreover, men experienced a greater impact from nocturia than women, particularly in the Bother/Concern domain. [Copyright &y& Elsevier]

The objective of this study was to investigate the quality of life (QOL) impact of urinary incontinence (UI) and to examine its relationship with treatment seeking in adult Taiwanese women. We conducted a cross-section in-person questionnaire interview of 1608 adult women living in the Taipei area. The characteristics and incontinence status were recorded. A short form incontinence impact questionnaire (IIQ-7) was used to evaluate the QOL impact of UI. Multiple logistic regression analysis was used to assess the determinative factors for treatment seeking. The mean IIQ-7 score of the 205 (12.7%) women who reported urinary leakage more than once per month in the preceding 12 months was 5.0 (range: 0-19), which showed a significant correlation with the severity of incontinence (r = 0.59, p < 0.001). Women with mixed type UI had a higher IIQ-7 score compared to those with stress or urge UI. Fifty-five (26.8%) incontinent women had sought medical help. Treatment seeking was highly related to IIQ-7 scores as 75% of incontinent women with an IIQ-7 score > 10 in contrast to 5% of those with an IIQ-7 score < or = 3 (p < 0.001) had sought medical care. On multiple logistic regression analysis, perceiving UI as a disease and a higher IIQ-7 score were independent factors predicting treatment seeking. We concluded that UI is a common problem that brings substantial QOL impact to Taiwanese women. The IIQ-7 questionnaire may provide a useful measurement to quantitate the degree of QOL impact, which is largely affected by the severity and type of incontinence. Women who perceive UI as a disease and those with a higher degree of QOL impact are more likely to seek medical help. Furthermore, treatment seeking in Taiwanese women with significant UI may be more common than thought as a great majority of women with higher IIQ-7 scores had sought medical help. [ABSTRACT FROM AUTHOR]

UPEC can internalize clonally in prostate to form biofilm-like intracellular bacterial communities (IBCs) for recurrent or chronic infection. We previously indicated that the exposure of prostate cells to testosterone could suppress UPEC invasion and their persistent survival within cells by effectively inhibiting the JAK/STAT1 signaling pathway. However, the regulatory mechanism by which testosterone affects UPEC-induced prostatitis via STAT3, another latent transcription factor signaling pathway is still unclear. The present study aimed to clarify the role of STAT3 in the process of UPEC-induced inflammation and colonization in prostate epithelial cells. The effects of testosterone-mediated inhibition were compared between the prostatitis by different UPEC strains (CFT073 and J96) through the specific GFP-UPEC-infected prostate cell model. Fluorescence microscopy was used for UPEC IBCs detection and quantifying, and Flow cytometry, RT-PCR and western blotting were used for analyzing related gene and protein expressions. Pretreatment of JAK and STAT3 inhibitors were also applied to verify the regulation of transduction pathway in testosterone-mediated anti-UPEC infection. This study revealed that testosterone effectively suppresses UPEC infection and IBC formation in prostate cells through the JAK/STAT3 pathway. The results show that CFT073 and J96 UPEC infection rates and colony numbers were dose-dependently reduced in RWPE-1 cells pretreated with 5 and 20 μg/mL testosterone at 0 and 24 h post-infection. Further, testosterone reduced the amounts of UPEC infecting and surviving within the prostate cells, as well as suppressed the size of IBCs formed. We demonstrated that pretreating testosterone effectively inhibited UPEC infection along with dose-dependent suppression of STAT3 and the phosphorylated-STAT3 expression in prostate cells, especially in 24 h J96 UPEC infected groups. The STAT inhibitor, SOCS3 also up-regulated at the same time. In addition, we pretreated the JAK1 or STAT3 inhibitor with testosterone to block the signaling transduction before CFT073 and J96 UPEC infection, and found the significant restoring in both the sizes of IBCs and bacterial numbers in RWPE-1 cells. Therefore, our results suggest that the suppression of STAT3 by testosterone treatment attenuate UPEC growing within IBCs and interfere with their infection to prostate cells. Overall, our study demonstrates that testosterone suppresses the initial infection of prostate epithelial cells by UPEC and reduces the survival of UPEC within IBCs after infection. These results indicate a critical role for STAT3 in facilitating UPEC infection and persistence, and its participation in driving testosterone-suppressive responses in prostate epithelial cells. In conclusion, this study suggests that testosterone may be beneficial in treating clinically recurrent UPEC infections and, thus, the persistent recurrence of prostatic inflammation. [ABSTRACT FROM AUTHOR]

A correction is presented to the article "Alterations in peripheral purinergic and muscarinic signaling of rat bladder after long‑term fructose‑induced metabolic syndrome" published in a previous issue of the periodical.

A letter to the editor is presented in response to the article "Clinical significance of lymphovascular invasion in upper urinary tract urothelial cancer."

We retrospectively evaluated the efficacy of prophylaxis with pipemidic acid and levofloxacin in transrectal ultrasound guided prostate biopsy (TRUSP-Bx). From January 2002 to December 2004, patients receiving oral pipemidic acid 500 mg twice daily for three days with or without a preoperative intravenous cefazolin 1 gm injection comprised group A. Between January 2005 and December 2009, patients receiving oral levofloxacin 500 mg one hour before biopsy comprised group B. We calculated the annual febrile urinary tract infection (fUTI) rates. Patients' characteristics, including age, prophylactic antibiotics, biopsy core numbers, pathologic results, PSA, and the spectrums and susceptibility of pathogens, were also evaluated. A total of 1313 (35.5%) patients belonged to group A, while 2381 (64.5%) patients belonged to group B. Seventy-three patients experienced postoperative infectious complications. There was a significant difference in the fUTI rate between groups A and B (3.7% versus 1.0%, P < 0.001). The yearly fUTI rates varied from 0.6 to 3.9% between 2002 and 2009. Of the 73 patients with fUTI, those receiving levofloxacin prophylaxis were more likely to harbor fluoroquinolone-resistant pathogens (P < 0.001). E. coli was the most common pathogen in both groups. Levofloxacin remains effective and appears superior to pipemidic acid based prophylaxis. [ABSTRACT FROM AUTHOR]

Purpose: We explored the pathophysiologic mechanisms of long-term fructose-induced lower urinary tract symptoms (LUTS) in rats. Methods: Male Wistar rats were fed with fructose for 3 or 6 months. Biochemical and transcystometric parameters were compared between fructose-fed and age-matched normal-diet rats. Pelvic nerve and external urethral sphincter-electromyogram activity recordings were performed to investigate fructose effects on neural control of bladders. Mitochondrial structure, ATP and acetylcholine content and purinergic and muscarinic cholinergic receptors were examined. Cytosolic cytochrome C staining by Western blot and immunocytochemistry for mitochondrial injury and PGP 9.5 stain for nerve density were also determined. Results: The fructose-fed rats with higher plasma triglyceride, LDL and fasting glucose levels displayed LUTS with increased frequency and suppressed voiding contractile amplitude in phase 1 and phase 2 duration versus normal-diet control. Fructose feeding altered the firing types in pelvic afferent and efferent nerves and external urethral sphincter-electromyogram activity. Increased mast cell number, disrupted and swollen mitochondria, increased cytosolic cytochrome C stain and expression and decreased nerve density in bladder smooth muscle layers appeared in the fructose-fed rats. Fructose feeding also significantly reduced ATP and acetylcholine content and enhanced protein expression of postsynaptic PX, PX and PX purinergic receptors and M and M muscarinic cholinergic receptors expression in the smooth muscles of urinary bladder. Conclusion: Long-term fructose feeding induced neuropathy and myopathy in the urinary bladders. Impaired mitochondrial integrity, reduced nerve density, ATP and acetylcholine content and upregulation of purinergic and muscarinic cholinergic receptors expression may contribute to the bladder dysfunction of fructose-fed animals. [ABSTRACT FROM AUTHOR]

Abstract: Background/purpose: To evaluate the efficacy of ketoconazole in castration-resistant prostate cancer. Materials and methods: We reviewed the medical records of consecutive patients with pathologically confirmed prostate cancer from May 2006 to December 2008. The inclusion criteria were: (1) receiving 200 or 400 mg ketoconazole three times daily and replacement doses of prednisolone; (2) antiandrogen withdrawal for at least 2 months before ketoconazole treatment; and (3) no prior cytotoxic agents or other CYP17 inhibitors. Treatment consisted of ketoconazole at 200 mg three times daily (Group A) and 400 mg three times daily (Group B). Patients'' characteristics, time to prostate-specific antigen (PSA) progression, duration of PSA response, and adverse events were evaluated. Results: Of the 37 patients in Group A, 14 (37.8%) experienced a PSA response. Of the seven patients in Group B, four (57.1%) experienced a PSA response. Median durations of time to progression in those who experienced a > 50% PSA decline were 7.5 and 11.5 months in Group A and Group B, respectively. Median duration of PSA response was 5.5 and 9.0 months in Group A and Group B, respectively. There was no difference in the PSA response or time to progression between the two groups. Orchiectomy had a borderline unfavorable effect on the PSA response rate (p = 0.067). Conclusion: The present study demonstrated that ketoconazole contributed to the PSA response in patients with castration-resistant prostate cancer. The efficacy and toxicity profiles were comparable to those in previous studies. Orchiectomy had a borderline unfavorable effect on PSA response rate. Further studies are required to confirm the efficacy of ketoconazole therapy in surgically castrated patients. [Copyright &y& Elsevier]

Abstract: Background: Low sex hormone-binding globulin (SHBG) is associated with metabolic syndrome (MetS), but its relationship with inflammation is unclear. Methods: This cross-sectional study included 696 subjects (255 men, 235 pre-menopausal women, and 206 postmenopausal women). Body mass index, waist circumference, blood pressure, lipid profiles, plasma glucose, insulin, FSH, LH, total testosterone (TT), estradiol, SHBG, dehydroepiandrosterone sulfate (DHEA-S), and hs-CRP concentrations were measured. MetS was defined according to the updated National Cholesterol Education Program criteria with modification of waist circumference for Asians. Results: Serum hs-CRP and SHBG were negatively correlated in men (r=−0.29, p<0.001), pre-menopausal women (r=−0.38, p<0.001), and postmenopausal women (r=−0.27, p<0.001). In men, TT and hs-CRP showed a negative association (r=−0.25, p<0.001), but the association was attenuated after adjusting for SHBG (r=−0.14, p=0.039). Multivariate regression models showed that SHBG was independently associated with hs-CRP in men (r=−0.18, p=0.009), pre-menopausal women (r=−0.15, p=0.025), and postmenopausal women (r=−0.21, p=0.005), adjusted for age, MetS components, insulin resistance, low-density lipoprotein-cholesterol, and serum sex hormone levels. Conclusions: Serum SHBG and hs-CRP concentrations were inversely correlated in men, pre-menoposal, and post-menopausal women independently. [Copyright &y& Elsevier]

Objective: To investigate the association between serum sex hormone levels and lower urinary tract symptoms in men aged 40-79 years. Methods: A cross-sectional study was conducted in 509 men (mean age 58 years). The serum total testosterone (TT), dihydrotestosterone, and estradiol levels were measured. The total prostate volume measured by transrectal ultrasonography and International Prostate Symptom Score (IPSS) questionnaire were obtained. Correlations were determined using univariate and multivariate regression analysis. Results: The subjects with moderate to severe lower urinary tract symptoms (total IPSS ≥8) were older, with a greater incidence of hypertension and diabetes, a larger prostate, and had lower serum TT levels. On the univariate analysis, the serum TT levels were negatively associated with the total IPSS, IPSS storage subscore, weak stream, and nocturia. After adjusting for age, hypertension, diabetes, and total prostate volume, only the serum TT level was significantly associated with nocturia (>2 times/night; P = .042), and men with serum TT levels in the greatest quartile had a 44% reduced risk of nocturia than in the lowest quartile (P = .037). Conclusion: In our relative healthy male cohort, most IPSS items showed no significant association with serum sex hormone levels, except for nocturia, which showed a negative correlation with the serum testosterone level. [Copyright &y& Elsevier]

Background/Purpose: This study examined the psychometric properties and clinical validity of the EORTC QLQ-PR25, a questionnaire for assessing the quality of life of patients with prostate cancer. Methods: The Taiwan Chinese version of the prostate cancer module (EORTC QLQ-PR25) and the core questionnaires (EORTC QLQ-C30) were administered to 81 patients with prostate cancer after they had been treated with surgery or hormone therapy or both. The QLQ-PR25 module assesses urinary symptoms, bowel symptoms, hormonal treatment-related symptoms, sexual activity and sexual functioning. Results: The questionnaires were well accepted by the patients and very few of the items had missing data. Only the urinary symptom scale showed satisfactory internal consistency. Scales were able to differentiate clinical groups of patients with corresponding symptoms, but the differences were smaller than that of major functioning scales in the core questionnaire. Conclusion: The Taiwan Chinese version of the EORTC QLQ-PR25 is acceptable in patients with prostate cancer in Taiwan, able to differentiate corresponding symptoms, but the scale structure needs further improvement. [ABSTRACT FROM AUTHOR]

References 1 Tsai W-H, Wu C-H, Cheng C-H, Chien C-T. Ba-Wei-Di-Huang-Wan through its active ingredient loganin counteracts substance P-enhanced NF- B/ICAM-1 signaling in rats with bladder hyperactivity. 26287995 2 Tsai W-H, Wu C-H, Yu H-J, Chien C-T. l-Theanine inhibits proinflammatory PKC/ERK/ICAM-1/IL-33 signaling, apoptosis, and autophagy formation in substance P-induced hyperactive bladder in rats. [Extracted from the article]

Introduction Although testosterone deficiency has a well-known association with increased risk of cardiovascular disease (CVD), the threshold remains to be determined. Aim To investigate whether there is a discriminatory testosterone level below which the CVD risk increases. Methods The study included 876 men 45 to 74 years old who underwent a general health checkup. The Framingham Risk Score was used to estimate the 10-year CVD risk; a high-sensitivity C-reactive protein (hsCRP) level of at least 1 mg/L was considered an indicator of increased CVD risk. Aging symptoms and sexual function were evaluated with the Aging Males’ Symptom Scale. Main Outcome Measures Locally weighted regression was performed to determine the testosterone threshold for Framingham CVD risk and increased hsCRP. Results The mean age was 56.6 ± 7.0 years. The mean total testosterone level was 394.3 ± 115.7 ng/dL. The mean 10-year Framingham CVD risk was 16.6 ± 10.7%, and 169 (19.3%) had increased hsCRP. The locally weighted regression showed that total testosterone levels of 440 and 480 ng/dL were associated with increased Framingham CVD risk and an increased probability of increased hsCRP, respectively. Men with sexual dysfunction (poor sexual performance, decreased morning erection, and loss of libido) had significantly greater CVD risk. Their risk appeared to increase at a relatively higher testosterone level, and it reached a plateau at a testosterone level of 300 to 350 ng/dL. In contrast, the risk in those with no or less sexual dysfunction remained low at a higher testosterone level, and a threshold level of 425 to 475 ng/dL was associated with increased CVD risk. A similar pattern and threshold were identified in the analyses of the relation between testosterone and hsCRP. Conclusion These data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk. The threshold level was higher in men with sexual dysfunction. Further study is required to evaluate the validity of these testosterone thresholds for CVD risk. [ABSTRACT FROM AUTHOR]

Atherosclerosis-associated pelvic ischemia has been reported to be a risk factor for bladder dysfunction and subsequent lower urinary tract symptoms (LUTS) in the elderly population. However, the molecular mechanisms of this association remain unclear. We hypothesized that stress-induced cellular responses might play a role in the pathogenesis of ischemia-induced bladder dysfunction. In the present study, the animal model of bladder ischemia was induced by bilateral partial arterial occlusion (BPAO) in rats. We found that BPAO significantly induced the presence of detrusor overactivity (DO) and upregulated the expression of several molecular reactions, including biomarkers in endoplasmic reticulum stress (78 kDa glucose-regulated protein, GRP78 and C/EBP-homologous protein, CHOP), autophagy (Beclin-1, p62 and LC3 II) and apoptosis (caspase 3). BPAO also disturbed the Kelch-like ECH-associated protein 1–nuclear factor erythroid-2-related factor 2 (Keap1–Nrf2) pathways. These responses might collectively alter muscarinic and purinergic signaling and contribute to the presence of DO in the ischemic bladder. Therapeutically, treatment with neither a muscarinic nor purinergic receptor antagonist restored bladder function. Interestingly, sulforaphane effectively attenuated ischemia-enhanced endoplasmic reticulum stress, autophagy and apoptosis in the bladder, subsequently ameliorated ischemia-induced bladder dysfunction and might emerge as a novel strategy to protect the bladder against ischemia-induced oxidative damage. [ABSTRACT FROM AUTHOR]

Aims Patients with diabetes are predisposed to develop a variety of complications, including lower urinary tract (LUT) dysfunction. We aimed to examine the associations between glycemic control and LUT dysfunction in women with type 2 diabetes (T2D). Methods We included 400 women with T2D (age range, 48–75 years) in this cross-sectional analysis. The participants were divided into tertiles according to glycosylated hemoglobin (Hb A1c ) measurements. The mean Hb A1c levels for tertiles 1, 2, and 3 were 6.2% (N = 132), 7.1% (N = 132), and 8.4% (N = 136), respectively. We evaluated LUT dysfunction with the American Urological Association Symptom Index (AUA-SI) questionnaire, uroflowmetry (UFM), and post-void residual (PVR). Results No significant differences were found among Hb A1c tertiles regarding storage, voiding and total AUA-SI scores, and prevalence of LUT symptoms. However, women in tertile 3 had higher prevalences of severe LUT symptoms (AUA-SI ≥ 20) and clinically significant PVR (≥ 100 mL) compared to women in the other tertiles. Multivariate analysis revealed that diabetic neuropathy, but not Hb A1c , significantly predicted LUT symptoms in women with T2D after adjustment for age, body mass index (BMI) and hypertension. However, Hb A1c was associated with an increased risk of developing clinically significant PVR. Conclusions Our findings do not support significant associations between glycemic control and LUT symptoms in women with T2D. However, women with poor glycemic control are more likely to develop urinary retention than women with proper glycemic control. Clinicians should, therefore, be aware of and educate patients about the association between urinary retention and glycemic control. [ABSTRACT FROM AUTHOR]