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Background The benefit of adjuvant chemotherapy was investigated for patients with T3 upper urinary tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy. Methods This is a multicenter retrospective observational study of 482 patients with pathological T3 N0 and Nx UTUC who underwent radical nephroureterectomy with and without adjuvant chemotherapy. The median overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) of patients who received adjuvant chemotherapy were analyzed to determine predictors of patient prognosis. Results Of the 482 patients, 140 (29.0%) received adjuvant chemotherapy. Adjuvant chemotherapy showed a benefit only for the median DFS rate (58% vs 49%; p = 0.04). Multivariate analyses revealed that adjuvant chemotherapy improved median DFS (HR 0.537; CI 0.35–0.83; p = 0.005). Surgical margin also significantly influenced median OS (HR 4.038; p

BackgroundThe advantage of adjuvant chemotherapy for upper urinary tract urothelial cancer (UTUC) has been reported, whereas its impact on upper tract cancer with variant histology remains unclear. We aimed to answer the abovementioned question with our real-world data.Design, Setting, and ParticipantsPatients who underwent radical nephroureterectomy (RNU) and were confirmed to have variant UTUC were retrospectively evaluated for eligibility of analysis. In the Taiwan UTUC Collaboration database, we identified 245 patients with variant UTUC among 3,109 patients with UTUC who underwent RNU after excluding patients with missing clinicopathological information.InterventionThose patients with variant UTUC were grouped based on their history of receiving adjuvant chemotherapy or not.Outcome Measurements and Statistical AnalysisPropensity score matching was used to reduce the treatment assignment bias. Multivariable Cox regression model was used for the analysis of overall, cancer-specific, and disease-free survival.Results and LimitationsFor the patients with variant UTUC who underwent adjuvant chemotherapy compared with those without chemotherapy, survival benefit was identified in overall survival in univariate analysis (hazard ratio (HR), 0.527; 95% confidence interval (CI), 0.285–0.973; p = 0.041). In addition, in multivariate analysis, patients with adjuvant chemotherapy demonstrated significant survival benefits in cancer-specific survival (OS; HR, 0.454; CI, 0.208–0.988; p = 0.047), and disease-free survival (DFS; HR, 0.324; 95% CI, 0.155–0.677; (p = 0.003). The main limitations of the current study were its retrospective design and limited case number.ConclusionsAdjuvant chemotherapy following RNU significantly improved cancer-related survivals in patients with UTUC with variant histology.

The clinical efficacy of adjuvant chemotherapy in upper tract urothelial carcinoma (UTUC) is unclear. We aimed to assess the therapeutic outcomes of adjuvant chemotherapy in patients with advanced UTUC (pT3-T4) after radical nephroureterectomy (RNU). We retrospectively reviewed the data of 2108 patients from the Taiwan UTUC Collaboration Group between 1988 and 2018. Comprehensive clinical features, pathological characteristics, and survival outcomes were recorded. Univariate and multivariate Cox proportional hazards models were used to evaluate overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Of the 533 patients with advanced UTUC included, 161 (30.2%) received adjuvant chemotherapy. In the multivariate analysis, adjuvant chemotherapy was significantly associated with a reduced risk of overall death (hazard ratio (HR), 0.599; 95% confidence interval (CI), 0.419–0.857; p = 0.005), cancer-specific mortality (HR, 0.598; 95% CI, 0.391–0.914; p = 0.018), and cancer recurrence (HR, 0.456; 95% CI, 0.310–0.673; p < 0.001). The Kaplan–Meier survival analysis revealed that patients receiving adjuvant chemotherapy had significantly better five-year OS (64% vs. 50%, p = 0.002), CSS (70% vs. 62%, p = 0.043), and DFS (60% vs. 48%, p = 0.002) rates compared to those who did not receive adjuvant chemotherapy. In conclusion, adjuvant chemotherapy after RNU had significant therapeutic benefits on OS, CSS, and DFS in advanced UTUC.

Bladder calcification is a rare presentation that was first interpreted to be related to a urea-splitting bacterial infection. Aside from infection, other hypotheses such as schistosomiasis, tuberculosis, cancer, and cytokine-induced inflammatory processes have also been reported. Severe coronavirus disease 2019 (COVID-19) is known for its provoking cytokine storm and uninhibited systematic inflammation, and calcification over the coronary artery or lung has been reported as a long-term complication.We presented a 68 years old man who had persistent lower urinary tract symptoms after recovery from severe COVID-19. No urea-splitting bacteria were identified from urine culture.Cystoscopy examination revealed diffuse bladder mucosal and submucosa calcification.Transurethral removal of the mucosal calcification with lithotripsy.The patient's lower urinary tract symptoms improved, and stone analysis showed 98% calcium phosphate and 2% calcium oxalate. No newly formed calcifications were found at serial follow-up.Diffuse bladder calcification may be a urinary tract sequela of COVID-19 infection. Patients with de novo lower urinary tract symptoms after severe COVID-19 should be further investigated.

Background A high incidence of upper urinary tract urothelial carcinoma has been reported in the southwestern area of Taiwan, where arsenic water contamination was considered the main cause. However, there is no definite proof to show a correlation between arsenic water contamination and upper urinary tract urothelial carcinoma. To investigate the clinical and epidemiological features of patients with upper urinary tract urothelial carcinoma between arsenic water endemic and non-endemic areas, we analyzed patients in terms of characteristics, stratified overall survival, disease-free survival, and cancer-specific survival. Methods The records of a total of 1194 patients diagnosed with upper urinary tract urothelial carcinoma were retrospectively reviewed. Clinical data and current medical status were collected from the medical records. Statistical analyses were performed to determine the clinical variables and stratified survival curves between endemic and non-endemic groups. Results Female predominance was revealed in both endemic and non-endemic groups (male:female ratio = 1:1.2–1.4). No statistical differences were found in histological types, staging, and tumor size between the two groups. Nonetheless, patients with characteristics of aging and having end-stage renal disease were outnumbered in the non-endemic group, while a higher prevalence of previous bladder tumors and more ureteral tumors were found in the endemic group. Adjusted stratified cumulative survival curves suggested a poorer prognosis in endemic patients, especially in disease-free survival of early stage disease. Conclusions A higher mortality rate with more previous bladder cancer history and ureteral tumors was seen in patients with upper urinary tract urothelial carcinoma residing in the arsenic water contamination area. This may be attributed to the long-term carcinogenic effect of arsenic underground water.

We sought to examine the effect of tumor location on the prognosis of patients with upper tract urothelial carcinoma (UTUC) treated with radical nephroureterectomy (RNU). This retrospective study came from the Taiwan UTUC Collaboration Group, which consisted of 2658 patients at 15 institutions in Taiwan from 1988 to 2019. Patients with kidney-sparing management, both renal pelvic and ureteral tumors, as well as patients lacking complete data were excluded, the remaining 1436 patients were divided into two groups: renal pelvic tumor (RPT) and ureteral tumor (UT), with 842 and 594 patients, respectively. RPT was associated with more aggressive pathological features, including higher pathological T stage (p &lt, 0.001) and the presence of lymphovascular invasion (p = 0.002), whereas patients with UT often had synchronous bladder tumor (p &lt, 0.001), and were more likely to bear multiple lesions (p = 0.001). Our multivariate analysis revealed that UT was a worse prognostic factor compared with RPT (overall survival: HR 1.408, 95% CI 1.121&ndash, 1.767, p = 0.003, cancer-specific survival: HR 1.562, 95% CI 1.169&ndash, 2.085, p = 0.003, disease-free survival: HR 1.363, 95% CI 1.095&ndash, 1.697, p = 0.006, bladder-recurrence-free survival: HR 1.411, 95% CI 1.141&ndash, 1.747, p = 0.002, respectively). Based on our findings, UT appeared to be more malignant and had a worse prognosis than RPT.

Objective High incidence of upper urinary tract urothelial carcinoma has been reported in South- Western area of Taiwan, where arsenic water contamination was considered to be the main cause. However, there is no definite proof to show the correlation between the arsenic water contamination and upper urinary tract urothelial carcinoma. To investigate the clinical and epidemiological features of the patients with upper urinary tract urothelial carcinoma between arsenic water endemic and non-endemic areas, we analyzed patients in terms of characteristics, stratified overall survival, disease-free survival and cancer-specific survival Method The records of a total 1194 patients diagnosed with upper urinary tract urothelial carcinoma were retrospectively reviewed. Clinical data and current medical status were collected from medical records. Statistical analyses were performed to determine the clinical variables and stratified survival curves between endemic and non-endemic groups. Results Female predominance was revealed in both endemic and non-endemic groups (Male:Female=1:1.2- 1.4). No statistical differences were found in histological types, staging and tumor size among two groups. Nonetheless, patients with characteristics of aging and having end stage renal disease outnumbered in non-endemic group while higher prevalence of previous bladder tumor and more ureteral tumor were found in endemic group. Adjusted stratified cumulative survival curves suggested poorer prognosis fashion in endemic patients, especially in disease free survival of early stage disease. Conclusions Higher mortality rate with more previous bladder cancer history and ureteral tumor were seen in patients with upper urinary tract urothelial carcinoma residing in arsenic water contamination area. This may attribute to the long-term carcinogenesis effect of arsenic underground water.

Objective To assess the efficacy and safety of different endoscopic surgical treatments for benign prostatic hyperplasia. Design Systematic review and network meta-analysis of randomised controlled trials. Data sources A comprehensive search of PubMed, Embase, and Cochrane databases from inception to 31 March 2019. Study selection Randomised controlled trials comparing vapourisation, resection, and enucleation of the prostate using monopolar, bipolar, or various laser systems (holmium, thulium, potassium titanyl phosphate, or diode) as surgical treatments for benign prostatic hyperplasia. The primary outcomes were the maximal flow rate (Qmax) and international prostate symptoms score (IPSS) at 12 months after surgical treatment. Secondary outcomes were Qmax and IPSS values at 6, 24, and 36 months after surgical treatment; perioperative parameters; and surgical complications. Data extraction and synthesis Two independent reviewers extracted the study data and performed quality assessments using the Cochrane Risk of Bias Tool. The effect sizes were summarised using weighted mean differences for continuous outcomes and odds ratios for binary outcomes. Frequentist approach to the network meta-analysis was used to estimate comparative effects and safety. Ranking probabilities of each treatment were also calculated. Results 109 trials with a total of 13 676 participants were identified. Nine surgical treatments were evaluated. Enucleation achieved better Qmax and IPSS values than resection and vapourisation methods at six and 12 months after surgical treatment, and the difference maintained up to 24 and 36 months after surgical treatment. For Qmax at 12 months after surgical treatment, the best three methods compared with monopolar transurethral resection of the prostate (TURP) were bipolar enucleation (mean difference 2.42 mL/s (95% confidence interval 1.11 to 3.73)), diode laser enucleation (1.86 (−0.17 to 3.88)), and holmium laser enucleation (1.07 (0.07 to 2.08)). The worst performing method was diode laser vapourisation (−1.90 (−5.07 to 1.27)). The results of IPSS at 12 months after treatment were similar to Qmax at 12 months after treatment. The best three methods, versus monopolar TURP, were diode laser enucleation (mean difference −1.00 (−2.41 to 0.40)), bipolar enucleation (0.87 (−1.80 to 0.07)), and holmium laser enucleation (−0.84 (−1.51 to 0.58)). The worst performing method was diode laser vapourisation (1.30 (−1.16 to 3.76)). Eight new methods were better at controlling bleeding than monopolar TURP, resulting in a shorter catheterisation duration, reduced postoperative haemoglobin declination, fewer clot retention events, and lower blood transfusion rate. However, short term transient urinary incontinence might still be a concern for enucleation methods, compared with resection methods (odds ratio 1.92, 1.39 to 2.65). No substantial inconsistency between direct and indirect evidence was detected in primary or secondary outcomes. Conclusion Eight new endoscopic surgical methods for benign prostatic hyperplasia appeared to be superior in safety compared with monopolar TURP. Among these new treatments, enucleation methods showed better Qmax and IPSS values than vapourisation and resection methods. Study registration CRD42018099583.

Although shock wave lithotripsy is minimally invasive, earlier studies argued that it may increase patients’ subsequent risk of hypertension and diabetes mellitus. This study evaluated the association between shock wave lithotripsy and new-onset hypertension or diabetes mellitus. The Taiwanese National Health Insurance Research Database was used to identify 20 219 patients aged 18 to 65 years who underwent the first stone surgical treatment (shock wave lithotripsy or ureterorenoscopic lithotripsy) between January 1999 and December 2011. A Cox proportional model was applied to evaluate associations. Time-varying Cox models were applied to evaluate the association between the number of shock wave lithotripsy sessions and the incidence of hypertension or diabetes mellitus. After a median follow-up of 74.9 and 82.6 months, 2028 and 688 patients developed hypertension in the shock wave lithotripsy and ureterorenoscopic lithotripsy groups, respectively. Patients who underwent shock wave lithotripsy had a higher probability of developing hypertension than patients who underwent ureterorenoscopic lithotripsy, with a hazard ratio of 1.20 (95% confidence interval, 1.10–1.31) after adjusting for covariates. The risk increased as the number of shock wave lithotripsy sessions increased. However, the diabetes mellitus risk was similar in the shock wave lithotripsy and ureterorenoscopic lithotripsy groups. Furthermore, the hazard ratio did not increase as the number of shock wave lithotripsy sessions increased. Shock wave lithotripsy consistently increased the incidence of hypertension on long-term follow-up. Therefore, alternatives to urolithiasis treatment (eg, endoscopic surgery or medical expulsion therapy) could avoid the hypertension risk. Furthermore, avoiding multiple sessions of shock wave lithotripsy could also evade the hypertension risk.

Purpose: This study aimed to determine the predictive value of concomitant carcinoma in situ (CIS) for cancer-specific survival (CSS) in patients with upper-tract urothelial carcinoma (UTUC) undergoing radical nephroureterectomy. Methods: This was a retrospective analysis of the clinicopathological features in a cohort of 126 patients with localized lymph node–negative UTUC who underwent radical nephroureterectomy with bladder-cuff excision in a tertiary medical center between January 1, 2007, and June 30, 2018. Cox proportional hazards models were used to identify risk factors for CSS in UTUC. Additionally, Kaplan–Meier analyses were performed in subgroups according to pathological tumor stage. Results: The median age and follow-up duration were 70 years and 3.5 years, respectively. Concomitant CIS, which was present in 21% of the patient specimens, was not associated with most clinical or pathological features, except for lymphovascular invasion and multifocality. Concomitant CIS (adjusted hazard ratio (HR)=4.64, 95% confidence interval (CI) 1.78–12.06, p=0.002) and pathological tumor stage (adjusted HR=4.07, 95% CI 1.99–8.31, pConclusion: The pathological presence of concomitant CIS was independently associated with poor CSS in patients with localized lymph node–negative UTUC undergoing radical nephroureterectomy. These findings provide crucial information relevant for postoperative patient counseling, use of adjuvant therapy, follow-up intensity, and clinical trial enrollment. Level of evidence Level II.

False positive alerts in CDSS incorrectly prompt when "no-risk" patients are encountered.A randomized controlled trial investigates physician responses toward false positive alerts.Physicians are not likely to adopt recommendations provided by false positive alerts in patient-safety-related CDSS.Reporting the adoption rate of CDSS as a whole without differentiation leads to an underestimation of system effectiveness. ObjectivesFalse positive alerts in patient-safety-related clinical decision support systems (CDSS) are defined as alerts which incorrectly prompt when no-risk patients are encountered. It is an unfavorable condition which may potentially mislead physicians. The aim is to investigate physician responses toward false positive (FP) and true positive (TP) alerts in CDSS for the prevention of contrast-induced nephropathy (CIN). MethodsA two-arm cluster randomized controlled trial was conducted in university hospitals. Eligible physicians were randomized to receive alert intervention or no intervention (groups 1 and 2, respectively). The alert system was embedded with a deliberately non-specific risk detection tool in order to generate TP and FP alerts. The naive alert system would alert the physician to cancel the order regardless of the patient being at-risk or not at-risk. CIN risk was stratified as at-risk and no-risk according to a patient's pre-existing renal function. Contrast imaging order-cancellation rate was measured as primary outcome. Results3802 contrast-enhanced examination orders from 66 physicians were analyzed. Demographic data and risk distributions of patients were similar and well-balanced between two groups. In the intervention group, a total of 1892 alerts were generated (332 TP alerts and 1560 FP alerts). Order-cancellation rates were 5.1% versus 1.4% in groups 1 and 2 for at-risk patients (relative risk RRź=ź3.69) from TP alerts, and 1.0% versus 1.4% for no-risk patients (RRź=ź0.71) from FP alerts. Using generalized linear model with generalized estimating equation, the FP alerts had no order-cancellation effect when compared to the control arm (adjusted RRź=ź0.69; 95%CI, 0.36-1.32). The TP alerts had a larger order-cancellation effect than that of the control arm (adjusted RRź=ź2.95; 95%CI, 0.94-9.27), which revealed a marginal trend toward significance. However, the effect was not statistically significant (adjusted RRź=ź1.24; 95%CI, 0.71-2.18) if TP and FP alerts were mixed. ConclusionsPhysicians are not likely to adopt recommendations provided by false positive alerts in patient-safety-related CDSS. If reporting only the adoption rate of CDSS as a whole without differentiating between TP and FP alerts, the effects of TP and FP alerts will be mixed, and thus, will lead to an underestimation of system effectiveness.

Upper tract urothelial carcinoma (UT-UC), including tumors evolving from the renal pelvis and ureter, accounts for around 5% of all UCs and 10% of all renal tumor cases. In Taiwan, the incidence of UT-UC is higher than the western countries especially in the female and patients at renal replacement therapy. The standard care of UT-UC is nephroureterectomy with bladder cuff excision. In the past decades, minimally invasive surgery is proved to achieve comparable oncological results as conventional open procedure. Though laparoscopic nephroureterectomy with bladder cuff excision including pure laparoscopic or hand-assisted technique have been very common practice in Taiwan, several institutes have the early experience of robot-assisted nephroureterectomy which is believed to provide 3-D visualization with magnification, better surgical exposure, and safer watertight suture of the cystostomy. In this review, we review the published reports of robot-assisted nephroureterectomy with bladder cuff excision.

Background Nosocomial infections (NIs) are among the important indicators used for evaluating patients’ safety and hospital performance during accreditation of hospitals. NI rate is higher in Intensive Care Units (ICUs) than in the general wards because patients require intense care involving both invasive and non-invasive clinical procedures. The emergence of Superbugs is motivating health providers to enhance infection control measures. Contact behavior between health caregivers and patients is one of the main causes of cross infections. In this technology driven era remote monitoring of patients and caregivers in the hospital setting can be performed reliably, and thus is in demand. Proximity sensing using radio frequency identification (RFID) technology can be helpful in capturing and keeping track on all contact history between health caregivers and patients for example. Objectives This study intended to extend the use of proximity sensing of radio frequency identification technology by proposing a model for inferring RFID tag reader recordings into clinical events. The aims of the study are twofold. The first aim is to set up a Contact History Inferential Model (CHIM) between health caregivers and patients. The second is to verify CHIM with real-time observation done at the ICU ward. Method A pre-study was conducted followed by two study phases. During the pre-study proximity sensing of RFID was tested, and deployment of the RFID in the Clinical Skill Center in one of the medical centers in Taiwan was done. We simulated clinical events and developed CHIM using variables such as duration of time, frequency, and identity (tag) numbers assigned to caregivers. All clinical proximity events are classified into close-in events, contact events and invasive events. During the first phase three observers were recruited to do real time recordings of all clinical events in the Clinical Skill Center with the deployed automated RFID interaction recording system. The observations were used to verify the CHIM recordings. In second phase the first author conducted 40 h of participatory observation in the ICU, and observed values that were used as golden standard to validate CHIM. Results There were a total of 193 events to validate the CHIM in the second phase. The sensitivity, specificity, and accuracy of close-in events were 73.8%, 83.8%, and 81.6%; contact events were 81.4%, 78.8%, and 80.7%; and invasive events were 90.9%, 98.0%, and 97.5% respectively. Conclusion The results of the study indicated that proximity sensing of the RFID detects proximity events effectively, and the CHIM can infer proximity events accurately. RFID technology can be used for recording complete clinical contact history between caregivers and patients thus assisting in tracing cause of NIs. Since this model could infer the ICU activities accurately, we are convinced that the CHIM can also be applied in other wards and can be used for additional purposes.

Surgical repair is the standard therapy for intraperitoneal bladder rupture (IPR); however, there has been an increasing tendency toward conservative management in cases of genitourinary trauma. We herein present a case of IPR that was successfully managed conservatively.

We read with great interest the article by Chen et al in the April issue of the Journal of the Formosan Medical Association. In their study, the authors retrospectively evaluated the bladder condition of 62 adults with end-stage renal disease (ESRD) by cystoscopy and videourodynamic study. The results showed that the prevalence of bladder dysfunction is high, which is consistent with previous reports. Their findings included poor bladder compliance, reduced bladder capacity and detrusor overactivity. The abnormalities were more severe while the duration of ESRD was longer. It is expected that poor compliance of the bladder will result in further graft renal damage after kidney transplantation. In addition, the dysfunctioning bladder, which has poor compliance and reduced capacity, fails to store the urine produced by the renal graft and also impairs patients’ quality of life. Recently, Tsunoyama et al reported that their patients, who underwent kidney transplantation, experienced a dramatic improvement of bladder dysfunction, which is related to prolonged anuria or oliguria. They also evaluated the effect of solifenacin, which is one of the antimuscarinic agents, in treating patients’ voiding dysfunction. They demonstrated that

Nosocomial (i.e., hospital-acquired) infections (NI) is a major cause of morbidity and mortality in hospitals. NI rate is higher in intensive care units (ICU) than in the general ward due to patients with severe symptoms, poor immunity, and accepted many invasive therapies. Contact behaviors between health caregivers and patients is one of the infect factors. It is difficult to obtain complete contact records by traditional method of retrospective analysis of medical records. This paper establishes a contact history inferential model (CHIM) intended to extend the use of Proximity Sensing of rapid frequency identification (RFID) technology to transferring all proximity events between health caregivers and patients into clinical events (close-in events, contact events and invasive events).The results of the study indicated that the CHIM can infer proximity care activities into close-in events and contact events. The infection control team could redesign and build optimal workflow in the ICU according to the patient-specific contact history which provided by our automatic tracing system., {"references":["WHO, World Health Organization, http://www.who.int/emc","Eggimann P, Pittet D. Infection control in the ICU. Chest 2001;\n120:2059-93.","Vincent LJ, Bihari DJ, Suter PM, et. al. The prevalence of nosocomial\ninfection in intensive care units in Europe: result of the EPIC study.\nJAMA 1995; 274:639-644.","Hajo Grundmann, Sina Barwolff, Adriana Tami, et.al.How many\ninfections are caused by patient to patient transmission in intensive care\nunits. Crit Care Med 2005 Vol. 33, No. 5:946-951.","Garner JS, Favero MS. CDC guidelines for the prevention and control\nof nosocomial infections. Guideline for handwashing and hospital\nenvironmental control. AJIC. 1986;14(3):110-115.","Jongchul Song, Carl T. Haas, Carlos H. Caldas. A proximity-based\nmethod for locating RFID tagged objects. Advanced Engineering\nInformatics 2007; 367-376","Jill A. Fisher, Torin Monahan, Tracking the social dimensions of RFID\nsystems in hospitals. International journal of medical informatics 2008;\n176-183","Yung-Ting Chang, Chung-You Tsai, Pei-San Lee , Yu-Chuan Li. Using\nActive RFID for Proximity Sensing-Capturing Nosocomial Infections\nin MICU. Asia Pacific Association for Medical Informatics\n2009,Hiroshima, Japan,2009"]}