Allen W. Chiu

Purpose: To investigate the association between COVID-19 infection and the 1-year risk of acute urinary retention (AUR) and related urological complications in patients with benign prostatic hyperplasia (BPH) and lower urinary tract symptoms (LUTs). Materials and Methods: Using the TriNetX global network, patients with BPH and LUTs between January 2020 and January 2024 were identified. Participants were classified into a COVID-19 cohort (N = 32,948) and a non-COVID control cohort (N = 434,123). Propensity score matching (1:1) balanced demographics, comorbidities, medications, and laboratory parameters. The primary outcome was AUR within one year. Secondary outcomes included Foley catheterization, urinary tract infection (UTI), gross hematuria, bladder stones, and prostate-related surgery. Results: After matching, 32,918 patients remained in each cohort. The COVID-19 group showed a significantly higher 1-year incidence of AUR compared with controls (2.18% vs. 0.32%; aHR 6.89, 95% CI 5.62–8.45; p < 0.0001). Increased risks were also observed for Foley catheterization (aHR 4.10), UTI (aHR 3.52), and prostate-related surgery (aHR 6.02). Kaplan–Meier analysis demonstrated persistent divergence in AUR-free survival. Conclusion: COVID-19 infection is independently associated with a markedly increased risk of AUR and urological complications in patients with BPH, highlighting the need for closer post-infection monitoring.

Purpose: This study aimed to evaluate early cystography after robot-assisted radical prostatectomy (RARP) in prostate cancer patients to expedite discharge, examine urinary leakage incidence, and assess related factors. Materials and methods: We retrospectively reviewed records from January 2017 to December 2022 for 316 RARP patients at Chi Mei Foundation Hospital. Patients were grouped by postoperative day (POD) of cystography (≤3 vs >3 days). Data collected included preoperative characteristics, hospitalization, catheter duration, leakage, and complications. Results: Of 316 patients, 142 (44.9%) had cystography on POD ≤3, while 174 (55.1%) had it on POD >3. The early group had shorter catheterization (3 vs 6 days) and hospitalization (4 vs 7 days) durations (P < 0.0001). Leakage rates were similar between groups (14.08% vs 12.07%), though acute urine retention (9.15% vs 3.45%, P = 0.0338) and Foley catheter reinsertion (13.38% vs 5.17%, P = 0.0106) were significantly higher in the early group. Prolonged catheterization and hospitalization were associated with postoperative leakage (P < 0.0001). Patients with transurethral resection of the prostate and bladder neck reconstruction history or increased blood loss showed higher leakage risk (P = 0.0309 and P = 0.0221, respectively). Conclusion: Early cystography can reduce hospitalization and catheter duration after RARP without increasing leakage risk, though careful monitoring is advised due to higher acute urine retention rates with early catheter removal. Transurethral resection of the prostate with bladder neck reconstruction history and increased blood loss warrant additional caution.

Purpose: This study aims to identify the incidence and risk factors associated with postoperative urinary retention (POUR) in patients undergoing laparoscopic total extraperitoneal (TEP) inguinal hernia repair, a common complication that significantly impacts patient recovery and health care resources. Materials and methods: A retrospective review was conducted of male patients who underwent laparoscopic TEP inguinal hernia repair and were observed overnight at our institution from January 2020 to December 2022. POUR was defined as the inability to void postoperatively, necessitating catheterization before discharge. Univariate and multivariate logistic regression analyses were conducted on perioperative variables to determine their association with POUR. Results: Of 618 analyzed patients, the incidence of POUR was 13.3% (82/618). Univariate analysis identified age ≥ 65 years, a history of benign prostatic hyperplasia (BPH), blood loss > 10 mL, operative duration > 60 minutes, intraoperative urinary catheter placement, and less surgeon experience as factors significantly associated with POUR. Multivariate logistic regression showed that age ≥ 65 years (odds ratio = 2.05, P = 0.01) and a history of BPH (odds ratio = 2.97, P < 0.001) were significant predictors of POUR. Conclusion: POUR is a significant postoperative complication following laparoscopic TEP inguinal hernia repair, particularly affecting male patients aged 65 years or older and those with a history of BPH. Identifying these risk factors preoperatively can help tailor perioperative care to mitigate POUR incidence and enhance recovery.

Purpose: This study aimed to evaluate the feasibility and outcomes of utilizing superselective transarterial indocyanine green (ICG)-lipiodol delivery to arterial branches supplying renal masses. Retroperitoneal robot-assisted partial nephrectomy (RAPN) was performed on 8 patients, and the characteristics of the patients, operative outcomes, and renal function results were assessed. Materials and methods: A preoperative procedure involved the transarterial delivery of an ICG-lipiodol mixture into tertiary-order arterial branches supplying renal masses. Retroperitoneal RAPN was performed on 8 patients, with detailed assessments of patient characteristics, operative outcomes, and renal function results. Results: The tumors were predominantly on the left side (mean size, 2.5 cm; RENAL nephrometry score, 7.3). The operative outcomes were favorable, with minimal ischemia time, no complications, and 100% margin-free resections. Individual renal functions showed a mild decrease in the estimated glomerular filtration rate, emphasizing the safety of ICG. Conclusion: The findings of this study support the effectiveness of retroperitoneal RAPN for challenging endophytic renal masses and introduce a novel approach with superselective transarterial ICG-lipiodol delivery, demonstrating favorable operative outcomes and successful preservation of renal function.

Prostate cancer (PCa) ranks sixth in cancer mortality among Taiwanese men, with smoking rates remaining high despite the 2009 Tobacco Hazards Prevention Act. This study used the Taiwan Cancer Registry to evaluate smoking’s impact on PCa mortality, providing important information for healthcare strategies and patient management. From 2011 to 2017, 23,107 PCa patients were analyzed, with 7164 smokers and 15,943 non-smokers. The baseline characteristics, clinical stages, comorbidities, and treatment modalities were all included to estimate overall and cancer-specific mortality using the Cox regression model and Kaplan–Meier analysis. The stratified analysis of clinical stage and age group was also estimated. Our study found an association between smoking and increased overall and cancer-specific mortality in PCa patients. Although smokers over 60 had higher risks of overall mortality than non-smokers, cancer-specific mortality did not show significant differences in any age group. Smokers had higher overall mortality than non-smokers across all clinical stages, but cancer-specific mortality was significantly raised only in early-stage cases. In conclusion, smoking is associated with higher overall mortality in PCa patients, with a significant increase in cancer-specific mortality in early-stage cases. Therefore, active smoking management is critical for clinical urologists, particularly in the treatment of early-stage patients.

Laser ureteroscopic lithotripsy (URSL) is an efficacious treatment for ureteral stones. There have been few previous studies comparing the different energy and frequency settings for URSL in a single center. We compared these two laser modalities, which were simultaneously used in our medical center for the treatment of ureteral stones. Patients who underwent fragmentation or dusting laser URSL between September 2018 and June 2020 were retrospectively reviewed. We compared patients who underwent fragmentation and dusting laser and assessed the enhancing factors for stone free rate. There were a total of 421 patients with ureteral stones who met the study criteria. There was no significant difference between the characteristics of both groups. The fragmentation group had a better stone free rate and a lower retropulsion rate compared with the dusting group. Multivariate analysis revealed that stone basket use, no upper ureteral stone or pyuria significantly improved the stone free rate. Both laser modes were effective and safe for ureteral lithotripsy although the fragmentation system showed slightly higher effectiveness and lower complication rate.

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.

Primary renal carcinoid tumors are exceedingly rare. We report a 37-year-old woman with primary infertility, who was found to have a primary renal carcinoid tumor. She became pregnant and gave birth to a baby after removal of the tumor. This is the first case in the English literature of primary renal carcinoid tumor related with primary infertility.

The spontaneous regression of metastatic renal cell carcinoma is a rare phenomenon, with an estimated incidence of < 1%. We report a case of post-nephrectomy renal cell carcinoma adrenal metastasis, followed by the spontaneous regression of the metastasis after withdrawal of sunitinib. The patient was a 55-year-old male with clear cell type renal cell carcinoma who previously underwent a left laparoscopic radical nephrectomy. After 51 months of follow up, a recurrence in the left renal fossa was observed and subsequently excised. Four months after excision, an abdominal Computerized tomography (CT) identified an adrenal metastasis of 1.6 cm. The patient was treated with sunitinib. However, the treatment was discontinued because of gastrointestinal side effects and fatigue. Eleven months after the discontinuation of sunitinib treatment, a progression in the adrenal metastasis growth (5.7 cm) was observed, whereas 16 months after the discontinuation, a regression of the adrenal metastasis growth (3.4 cm) was observed. During subsequent follow-ups, a gradual reduction in the size of the adrenal metastasis (1.8 cm) was observed. After 44 months from the discontinuation of sunitinib treatment, the patient was still alive and followed up in the outpatient department. Sunitinib is a multi-targeted inhibitor of vascular endothelial growth factor (VEGF) receptors. This compound reduces tumor angiogenesis and has been approved worldwide for the treatment of advanced renal cell carcinoma. To our knowledge, this is the fourth case of the spontaneous regression of metastatic renal cell carcinoma after the discontinuation of sunitinib treatment.