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Urologist
11 years of experience
Video profile
Accepting new patients

Education ?

Medical School Score Rankings
Brown University (1999)
  • Currently 4 of 4 apples
Top 25%

Awards & Distinctions ?

Associations
American Board of Urology
American Urological Association

Affiliations ?

Dr. Hsiao is affiliated with 16 hospitals.

Hospital Affilations

Score

Rankings

  • John Muir Medical Center, Walnut Creek Campus
    1601 Ygnacio Valley Rd, Walnut Creek, CA 94598
    • Currently 4 of 4 crosses
    Top 25%
  • Alameda Hospital
    2070 Clinton Ave, Alameda, CA 94501
    • Currently 4 of 4 crosses
    Top 25%
  • Alta Bates Summit Medical Center- Summit Campus
    350 Hawthorne Ave, Oakland, CA 94609
    • Currently 4 of 4 crosses
    Top 25%
  • San Ramon Regional Medical Center
    6001 Norris Canyon Rd, San Ramon, CA 94583
    • Currently 3 of 4 crosses
    Top 50%
  • Alta Bates Summit Medical Center - Alta Bates Campus
    Urology
    2450 Ashby Ave, Berkeley, CA 94705
    • Currently 3 of 4 crosses
    Top 50%
  • John Muir Medical Center, Concord Campus
    Urology
    2540 East St, Concord, CA 94520
    • Currently 1 of 4 crosses
  • Walnut Creek Campus
  • Summit Medical Center
  • Clarian Health Partners
  • Concord Campus
  • Alta Bates Medical Center
  • Indiana University Hospital
  • John Muir Physician Network
  • Riley Hospital For Children
  • Alta Bates Medical Summit Center - Herrick Campus
    2001 Dwight Way, Berkeley, CA 94704
  • 2007
  • Publications & Research

    Dr. Hsiao has contributed to 19 publications.
    Title Comparison of Laparoscopic and Abdominal Sacrocolpopexy for the Treatment of Vaginal Vault Prolapse.
    Date December 2007
    Journal Journal of Endourology / Endourological Society
    Excerpt

    BACKGROUND AND PURPOSE: Laparoscopic sacrocolpopexy (LSCP) offers a minimally invasive treatment for vaginal vault prolapse. We describe the surgical technique and offer insight into the learning curve. In addition, we performed a case series review comparing the laparoscopic procedure with its open surgical counterpart with respect to various demographic and perioperative parameters. PATIENTS AND METHODS: The Institutional Review Board-approved continence database at our institution was queried to identify all patients undergoing sacrocolpopexy between August 1999 and October 2004. The LSCP was performed in 25 patients, and open abdominal sacrocolpopexy (ASCP) was performed in 22 patients. Data were analyzed using Student's t-test and the Fisher exact test. RESULTS: No significant difference was observed in the demographic characteristics of the patients undergoing the two approaches. The mean estimated blood loss (P = 0.0002) and mean length of hospitalization (P < 0.0001) were significantly less for LSCP, whereas the operative time was significantly longer (219.9 minutes v 185.2 minutes; P = 0.045). The success rate for LSCP at 5.9 months was 100%; the ASCP success rate at 11.0 months was 95%. CONCLUSIONS: Laparoscopic sacrocolpopexy led to shorter hospitalization, better hemostasis, and less pain than the open procedure. Early follow-up suggests that LSCP is as effective as ASCP for the treatment of vaginal vault prolapse.

    Title Suitability of Different Sling Materials for the Treatment of Female Stress Urinary Incontinence.
    Date April 2006
    Journal Nature Clinical Practice. Urology
    Excerpt

    Stress urinary incontinence (SUI) is defined as leakage of urine with a sudden increase in intra-abdominal pressure, such as that seen with laughing, lifting, or changing position, without a concomitant rise in detrusor (bladder-generated) pressure. The proposed mechanism of SUI is that an increase in intra-abdominal pressure resulting from various activities causes the bladder pressure to rise above the urethral pressure. The pubovaginal sling remains the standard treatment for female SUI in the US. The market has been flooded with innumerable sling materials. This review discusses the currently available sling materials, surgical approaches, and clinical outcomes data. Long-term data on efficacy is lacking, but early results with new materials and delivery techniques indicate that excellent cure rates with minimal morbidity and high patient satisfaction may be achievable.

    Title Initial Experience with Rectocele Repair Using Nonfrozen Cadaveric Fascia Lata Interposition.
    Date January 2006
    Journal Urology
    Excerpt

    OBJECTIVES: To describe a rectocele repair reinforced with solvent-dehydrated, gamma-irradiated, human fascia lata and report our early results with a technique we are confident will have a greater, more durable success rate, with a lower incidence of dyspareunia, than the classic repair. METHODS: A total of 73 patients, aged 31 to 86 years, with symptomatic (stool trapping and/or vaginal/perineal splinting or postural modifications to facilitate stool evacuation) rectoceles underwent a site-specific repair reinforced with cadaveric fascia. Perioperative questionnaires, retrospective chart review, and telephone interview by a blinded third-party reviewer and physical examination was conducted. Issues thought to be relevant to the rectocele repair were assessed. RESULTS: Of the 73 patients, 62 responded to the postoperative questionnaire and 50 underwent physical examination. The mean follow-up was 13.7 months (range 6 to 23). Of the 62 patients, 52 (93.6%) denied postoperative stool trapping requiring vaginal/perineal splinting. Of the 39 sexually active patients, 4 (10.3%) experienced de novo dyspareunia. Minor complications were seen in 15 patients (24%). One developed a symptomatic enterocele. CONCLUSIONS: Interposition of cadaveric fascia lata avoids dependence on weakened native rectovaginal support to facilitate the rectocele repair. Our technique uses fascial interposition, rather than obliteration of the defect, preventing vaginal narrowing, and should thereby decrease the incidence of dyspareunia. Patient symptom improvement and satisfaction rates were competitive with those after traditional rectocele repair. Follow-up is ongoing with the hope that the fascial reinforcement will translate into more durable results.

    Title Time Management in the Operating Room: an Analysis of the Dedicated Minimally Invasive Surgery Suite.
    Date March 2005
    Journal Jsls : Journal of the Society of Laparoendoscopic Surgeons / Society of Laparoendoscopic Surgeons
    Excerpt

    BACKGROUND: Dedicated minimally invasive surgery suites are available that contain specialized equipment to facilitate endoscopic surgery. Laparoscopy performed in a general operating room is hampered by the multitude of additional equipment that must be transported into the room. The objective of this study was to compare the preparation times between procedures performed in traditional operating rooms versus dedicated minimally invasive surgery suites to see whether operating room efficiency is improved in the specialized room. METHODS: The records of 50 patients who underwent laparoscopic procedures between September 2000 and April 2002 were retrospectively reviewed. Twenty-three patients underwent surgery in a general operating room and 18 patients in an minimally invasive surgery suite. Nine patients were excluded because of cystoscopic procedures undergone prior to laparoscopy. Various time points were recorded from which various time intervals were derived, such as preanesthesia time, anesthesia induction time, and total preparation time. A 2-tailed, unpaired Student t test was used for statistical analysis. RESULTS: The mean preanesthesia time was significantly faster in the minimally invasive surgery suite (12.2 minutes) compared with that in the traditional operating room (17.8 minutes) (P=0.013). Mean anesthesia induction time in the minimally invasive surgery suite (47.5 minutes) was similar to time in the traditional operating room (45.7 minutes) (P=0.734). The average total preparation time for the minimally invasive surgery suite (59.6 minutes) was not significantly faster than that in the general operating room (63.5 minutes) (P=0.481). CONCLUSION: The amount of time that elapses between the patient entering the room and anesthesia induction is statically shorter in a dedicated minimally invasive surgery suite. Laparoscopic surgery is performed more efficiently in a dedicated minimally invasive surgery suite versus a traditional operating room.

    Title Hair As Nidus for Ureteral Calculus Formation: Case Report.
    Date June 2004
    Journal Journal of Endourology / Endourological Society
    Excerpt

    A 52-year-old man with a significant history of nephrolithiasis was found to have a calcium oxalate dihydrate ureteral calculus that apparently formed on a hair. This nidus may have been introduced during previous instrumentation, perhaps on the tip of the ureteroscope, laser fiber, or even during the placement of a ureteral stent.

    Title Direct Vision Internal Urethrotomy for the Treatment of Pediatric Urethral Strictures: Analysis of 50 Patients.
    Date September 2003
    Journal The Journal of Urology
    Excerpt

    PURPOSE: In an attempt to evaluate our experience with the treatment of pediatric urethral stricture disease we performed a retrospective review of patients undergoing direct vision internal urethrotomy (DVIU). MATERIALS AND METHODS: The computerized surgical logs at 2 pediatric hospitals were reviewed to identify patients who underwent DVIU between 1992 and 2001. Hospital and clinical charts were then reviewed. Many variables were analyzed, including patient age, etiology of stricture, technique and clinical outcomes. Minimum followup to be included in clinical outcome analysis was 12 months. RESULTS: A total of 50 patients were identified (mean age 7.7 years, range 6 months to 17 years). The most common etiology for stricture formation was previous hypospadias repair (20 patients [40%]). Forty patients met the 12-month minimum followup requirement for clinical outcome analysis. Of these patients 20 (50%) had no symptoms to suggest recurrent stricture at a median of 2.0 years (mean 2.7 years, range 12 months to 7 years). Seventeen patients (42.5%) had symptoms of recurrent stricture at a median of 8 months (mean 13 months, range 2 months to 5 years). Technical factors did not influence the ultimate success or failure of the procedure. CONCLUSIONS: DVIU provides a therapeutic option that successfully treats approximately half of the patients with a reasonably low complication rate. Complications following DVIU should not preclude its use as a therapeutic modality for the treatment urethral strictures in children. If the child fails the initial DVIU, repeat attempts at endoscopic correction of urethral stricture should be abandoned in favor of definitive urethroplasty.

    Title Ly191704 Inhibits Type I Steroid 5 Alpha-reductase in Human Scalp.
    Date December 1996
    Journal The Journal of Clinical Endocrinology and Metabolism
    Excerpt

    Conversion of testosterone to dihydrotestosterone (DHT) has been demonstrated to be catalyzed by two isoforms of steroid 5 alpha-reductase, designated types I and II. Although several classes of steroid-based inhibitors of the type II isoform have been identified, these agents have not demonstrated highly selective pharmacological activity against human type I 5 alpha-reductase. LY191704 is representative of a series of nonsteroidal agents that have potent [apparent inhibitory constant (Ki) = 11.3 nM] inhibitory activity in human scalp skin homogenates (pH 7.5), a source of type I 5 alpha-reductase. [3H]-DHT production in the presence and absence of LY191704 is consistent with a noncompetitive mode of inhibition. In human prostatic homogenates (pH 5.5), a source of type II 5 alpha-reductase, LY191704 is virtually inactive as an inhibitor [concentration of inhibitor producing 50% inhibition of enzymatic activity (IC50) > 1,000 nM] of [3H]-DHT formation. LY191704 does not inhibit the type I or type II isoforms of rat 5 alpha-reductase, nor does the compound compete for binding to the murine androgen receptor expressed in SF9 cells using a baculo virus expression system. The benzoquinolinones, as exemplified by LY191704, possess exquisite pharmacological selectivity and provide a tool to understand the role of human type I 5 alpha-reductase in normal and pathophysiological states. These agents may also find clinical utility in treating androgen-dependent dermatological conditions.

    Title Characterization of Type I 5 Alpha-reductase Activity in Du145 Human Prostatic Adenocarcinoma Cells.
    Date November 1996
    Journal The Journal of Steroid Biochemistry and Molecular Biology
    Excerpt

    The conversion of testosterone (T) to dihydrotestosterone (DHT) has been demonstrated to be catalysed by at least two isoforms of human steroid 5 alpha-reductase, designated types I and II. Type II 5 alpha-reductase expression predominates in human accessory sex tissues, localized to the fibromuscular stromal compartment. The type I isoform predominates in skin, prostatic epithelia and, to a lesser extent, in prostatic fibromuscular stroma. The significance of the type I isoform to prostatic cellular growth and function remains undefined. In cultured DU145 cells, we evaluated the metabolism of [14C]-T and demonstrated the time-dependent formation of [14C]-DHT. Oxidative metabolism (conversion of [14C]-T to [14C]-androstenedione) and the formation of conjugated androgen metabolites occurred at a relatively low rate in the DU145 cells. Using human type I 5 alpha-reductase cDNA, Northern blot analysis of DU145 cell mRNA revealed high levels of type I isoform expression. Analogous probing of the DU145 cells with a human 5 alpha-reductase II cDNA failed to reveal expression of the type II isoform. The expression of functional type I activity has been confirmed pharmacologically using isoform-selective 5 alpha-reductase inhibitors. Reductive metabolism of [3H]-T in the DU145 cells was inhibited in a concentration-dependent manner by LY306089, a potent non-steroidal type I-selective inhibitor (IC50 = 10.0 nM). SKF105657, a steroidal type II-specific inhibitor was distinctly less active at inhibiting [3H]-DHT formation. LY306089 was a non-competitive inhibitor of type I 5 alpha-reductase in DU145 cellular homogenates with an apparent Ki value of 4.0 nM. These studies have identified and pharmacologically defined type I 5 alpha-reductase activity in an androgen-insensitive prostatic cancer cell line and provide the basis for additional investigations into the significance of type I 5 alpha-reductase to human prostatic pathophysiology.

    Title Responses of Lncap Prostatic Adenocarcinoma Cell Cultures to Ly300502, a Benzoquinolinone Human Type I 5alpha-reductase Inhibitor.
    Date June 1996
    Journal The Prostate. Supplement
    Excerpt

    We evaluate the metabolic inhibitory, antiproliferative, and antisecretory effects of LY300502, a benzoquinolinone human-specific type I-selective steroid 5alpha-reductase inhibitor in LNCaP human prostatic adenocarcinoma cell cultures. Reductive metabolism of [3H-T] in the LNCaP cells was inhibited in a concentration-dependent manner by LY300502 (IC50 approximately 5.77 nM). The proliferative responses of LNCaP cells to LY300502 were examined in the presence of 0.1 NM testosterone (T), a concentration that stimulates maximal LNCaP cell numbers 40% above control levels. LY300502 significantly anatagonized T-induced stimulation of LNCaP cellular proliferation at concentrations greater that 10 nM (P<0.05), and at 1,000 nMcompletely blocked the mitogenic effects of T on LNCaP cells. In the absence of androgen, LY300502 had no effect on LNCaP cellular proliferation. In the presence of 100 nM T, an androgen concentration that maximally stimulates in vitro PSA production, LY300502 significantly antagonized T-induced PSA secretion at a concentration equal to or greater than 30 nM (P<0.05). These studies provide the basis for additional investigations into the pathophysiologic significance of type I 5alpha-reductase to prostatic cancer and the potential utility of selective inhibitors as therapeutic agents.

    Title Intraindividual Variation in Drug Disposition.
    Date December 1979
    Journal Clinical Pharmacology and Therapeutics
    Excerpt

    Large interindividual differences occur in the in vivo metabolism of drugs due to genetic and environmental factors. Our studies show that intraindividual variabilities in rates of metabolism are relatively low for antipyrine and phenylbutazone, which are drugs that are primarily metabolized by the liver and have low hepatic extractions; whereas in the case of phenacetin, a drug that undergoes extensive metabolism in the gastrointestinal tract or during its first pass through the liver, or both, intraindividual variations in plasma half-lifes and areas under the plasma concentration-time curves are of much greater magnitude. In our studies, no effort was made to control the lifestyles of our subjects. The variations in rates of drug metabolism did not result from assay procedures, since there was little variation in measured concentrations when the drugs were added to plasma and assayed on multiple occasions. Intraindividual variation occurring in subjects given the drug on 5 different occasions may be due to changes in the external environment or changes in internal physiologic parameters or both. Our studies confirm the usefulness of antipyrine as a test drug in studying drug metabolism in man and also demonstrate that the antipyrine test may be able to detect those subjects whose environments are perturbed by unidentified factors.

    Title Regulation of Drug Metabolism in Man by Environmental Chemicals and Diet.
    Date May 1977
    Journal Federation Proceedings
    Excerpt

    Studies in animals have shown that many environmental pollutants induce the synthesis or inhibit the activity of microsomal mixed-function oxygenases that metabolize drugs, carcinogens and normal body constituents such as steroid hormones. These effects on microsomal enzyme activity alter the duration and intensity of action of foreign and endogenous chemicals in animals, and such effects on metabolism may influence the carcinogenicity of some pollutants in man. Studies on the effects of environmental chemicals on drug metabolism in man are sparse. Exposure of humans to DDT or lindane in a pesticide factory results in an enhanced rate of metabolism of antipyrine and phenylbutazone and an increased urinary excretion of 6-beta-hydroxycortisol. Polycyclic aromatic hydrocarbons present in cigarette smoke, in charcoal-broiled meats, and in polluted city air are potent inducers of drug-metabolizing enzymes in animals. In humans, cigarette smoking stimulates the activity of placental enzymes that metabolize several drugs and carcinogens. In addition, cigarette smokers metabolize phenacetin, theophylline, and other drugs more rapidly in vivo than nonsmokers. Dietary factors are important in the regulation of drug metabolism in animals and man. Feeding rats brussels sprouts or cabbage stimulates the intestinal and hepatic metabolism of drugs in animals. This effect is caused, at least in part, by certain indoles normally present in these vegetables. The feeding of a charcoal-broiled beef diet to rats stimulates the metabolism of phenacetin in vitro, and a similar diet stimulates the in vivo metabolism of phenacetin in man. It is likely that polycyclic aromatic hydrocarbons are the major inducers in charcoal-broiled beef.

    Title Quantitative Determination of Phenacetin and Its Metabolite Acetaminophen by Glc-chemical Ionization Mass Spectrometry.
    Date May 1977
    Journal Journal of Pharmaceutical Sciences
    Excerpt

    A quantitative GLC-mass spectrometric procedure was developed for the determination of phenacetin and its O-desethyl metabolite, acetaminophen, in human plasma. The assay utilizes selective ion detection to monitor, in a GLC effluent, the MH+ molecular ions of both phenacetin and the methyl derivative of acetaminophen, p-acetanisidine, generated by isobutane chemical ionization. Deuterated analogs of phenacetin and acetaminophen, phenacetin-d3 and acetaminophen-d3, respectively, are added to the plasma before extraction to serve as internal standards. To determine phenacetin and unconjugated acetaminophen, 1.0 ml of plasma is extracted with 5 ml of benzene-dichloroethane (7:3). The extraction solvent is removed, and the residue is methylated with diazomethane. Th solution is again evaporated to dryness, and the residue is reconstituted in ethyl acetate. A portion of this solution is then analyzed by GLC-mass spectrometry, with the mass spectrometer set to monitor m/e 166 (p-acetanisidine), 169 (p-acetanisidine-d3), 180 (phenacetin), and 183 (phenacetin-d3). To determine total acetaminophen, 0.1 ml of plasma is treated with a mixture of beta-glucuronidase and sulfatase, extracted with ethyl acetate, methylated, and analyzed by GLC-mass spectrometry. The procedure has a sensitivity limit of 1 ng of phenacetin/ml and 0.1 mug of acetaminophen/ml. The curves relating the amount of phenacetin and acetaminophen added versus the amount of phenacetin and acetaminophen found for 12 known phenacetin concentrations over the 9.9-246.6-ng/ml range and for 16 known acetaminophen concentrations over the 0.52-13.10-mug/ml range are straight lines with intercepts of nearly zero and with slopes of unity. Analyses of six separate plasma samples, each containing 25 ng of phenacetin/ml and 1.31 mug of acetaminophen/ml, had a precision of +/- ng/ml for phenacetin and +/- 0.08 mug/ml for acetaminophen.

    Title Enhanced Phenacetin Metabolism in Human Subjects Fed Charcoal-broiled Beef.
    Date January 1977
    Journal Clinical Pharmacology and Therapeutics
    Excerpt

    There were marked individual differences in the plasma levels of phenacetin after oral administration of a 900-mg dose to 9 normal volunteers eating customary home diet. Feeding a diet that contained charcoal-broiled beef for 4 days prior to the administration of phenacetin markedly decreased the plasma levels of this drug without appreciably influencing the plasma concentrations of phenacetin's metabolite, N-acetyl-p-aminophenol (APAP), or the plasma half-life of phenacetin. The average peak concentration of phenacetin in plasma, after a 900-mg oral dose, fell from 1,628 ng/ml, when the subjects were fed a control diet for 7 days, to 352 ng/ml after they were fed the same diet which contained charcoal-broiled beef for 4 days. The average peak concentration of phenacetin rose to 1,885 ng/ml after the subjects were subsequently fed the control diet for 7 days. The ratios of the average concentrations of APAP in plasma to those of phenacetin markedly increased after the charcoal-broiled beef diet. The results suggest that a diet containing charcoal-broiled beef enhances the metabolism of phenacetin in the gastrointestinal tract and/or during its first pass through the liver. This effect greatly decreases the bioavailability of phenacetin.

    Title Effect of Charcoal-broiled Beef on Phenacetin Metabolism in Man.
    Date January 1977
    Journal Science (new York, N.y.)
    Excerpt

    When charcoal-broiled beef was fed to human volunteers, who were then given phenacetin orally, the concentration of phenacetin in the plasma was lowered, but its half-life in the plasma was not changed. The data suggest that feeding charcoal-broiled beef enhances the metabolism of orally administered phenacetin in the intestine or during its first pass through the liver, or both.

    Title Stimulatory Effect of Vegetables on Intestinal Drug Metabolism in the Rat.
    Date September 1976
    Journal The Journal of Pharmacology and Experimental Therapeutics
    Excerpt

    The intestinal metabolism of hexobarbital, phenacetin, 7-ethoxycoumarin and benzo [a] pyrene in vitro was increased in rats fed either dried Brussels sprouts or dried cabbage in a nutritionally complete semisynthetic diet as compared to rats fed only the semisynthetic diet. Pretreatment of rats with several indoles present in Brussels sprouts and cabbage also stimulated intestinal drug metabolism, but the effect was smaller than when dried Brussels sprouts or dried cabbage was fed. The results obtained suggest a need for studies in man to determine whether vegetables and other dietary constituents can stimulate the intestinal metabolism of drugs and thereby alter their biological effects.

    Title Intestinal Metabolism of Phenacetin in the Rat: Effect of Charcoal-broiled Beef and Rat Chow.
    Date May 1975
    Journal Science (new York, N.y.)
    Excerpt

    The intestinal metabolism of phenacetin in vitro was increased 1100 percent in rats fed charcoal-broiled ground beef in a semisynthetic diet. The intestinal metabolism of phenacetin was increased 200 percent in rats fed a chow diet, as compared to rats fed the semisynthetic diet. The results obtained suggest a need for studies in man to determine whether charcoal-broiled meat and other dietary constituents can stimulate the intestinal metabolism of phenacetin or other drugs and thereby decrease their absorption and bioavailability.

    Title Effects of Enzyme Induction on Intestinal Phenacetin Metabolism in the Rat.
    Date January 1975
    Journal The Journal of Pharmacology and Experimental Therapeutics
    Title Effect of Cigarette Smoking on Phenacetin Metabolism.
    Date February 1974
    Journal Clinical Pharmacology and Therapeutics
    Title Peptides Identify Multiple Hotspots Within the Ligand Binding Domain of the Tnf Receptor 2.
    Date
    Journal Proteome Science
    Excerpt

    BACKGROUND: Hotspots are defined as the minimal functional domains involved in protein:protein interactions and sufficient to induce a biological response. RESULTS: Here we describe the use of complex and high diversity phage display libraries to isolate peptides (called Hotspot Ligands or HSPLs) which sub-divide the ligand binding domain of the tumor necrosis factor receptor 2 (TNFR2; p75) into multiple hotspots. We have shown that these libraries could generate HSPLs which not only subdivide hotspots on protein and non-protein targets but act as agonists or antagonists. Using this approach, we generated peptides which were specific for human TNFR2, could be competed by the natural ligands, TNFalpha and TNFbeta and induced an unexpected biological response in a TNFR2-specific manner. CONCLUSIONS: To our knowledge, this is the first report describing the dissection of the TNFR2 into biologically active hotspots with the concomitant identification of a novel and unexpected biological activity.

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