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Background: Few prognostic factors have been proposed for patients with locally advanced renal cell carcinoma (RCC). This study aimed to investigate the possible predictive factors for disease-free survival (DFS) after curative surgery for RCC stage T3 or higher. Methods: Patients with locally advanced RCC who underwent cure-intended partial or radical nephrectomy, with or without tumor thrombectomy, at our institution from April 1, 2005 to October 31, 2013 were retrospectively reviewed. Those undergoing cytoreductive nephrectomy were excluded. Preoperative data, including surgical and pathologic characteristics, were assessed for correlation with DFS. Chi-square tests, univariate and multivariate Cox regression analysis, and Kaplan-Meier survival curve analyses were performed to determine potential predictive factors. A p value less than 0.05 was considered statistically significant. Results: A total of 159 patients were included for analysis. The mean duration of follow-up was 37.9 months, and 119 (74.8%) patients remained disease-free during follow-up. Disease recurrence was found in 40 (25.2%) patients, and pathologic T stage, capsule penetration, Fuhrman grade, thrombocytosis, renal vein thrombosis, and elevated serum alkaline phosphatase, platelet/lymphocyte ratio, and γ-glutamyl transpeptidase levels were significantly associated with disease recurrence on univariate analysis. On multivariate analysis, Fuhrman grade 3 or 4 (HR = 5.70, p = 0.0003, 95% CI = 2.23-14.56) showed significant associations with DFS. Conclusion: In patients with locally advanced RCC, Fuhrman grade was associated with worse DFS after curative surgery. Urologists should closely monitor patients with high Fuhrman grades. [ABSTRACT FROM AUTHOR]

Background: To evaluate the efficacy of an autoregistration monitoring system (ARMS) for tracking the placement and removal of ureteral stents. Methods: The system was designed to tie in closely with the billing system. Once a stent was used and charged, a stent "episode" was created in the ARMS. When the stent was removed and the charge for the procedure was issued, the stent episode for that stent was removed automatically. The ARMS identified stents which exceeded their deadline, generating an alarm until the stent was removed and the ARMS updated. Results: A total of 10 105 patients with 12 440 stent episodes were registered in the ARMS between March 2010 and August 2018. Of the 10 105 patients, 8597 (85.07%) were automatically detected to have had their stents removed before their deadline. We contacted the 1508 (14.93%) patients whose stents were not registered as having been removed by their deadline, of whom 122 (1.21%) had undergone stent removal at other hospitals, 490 (4.85%) had died, and 875 (8.66%) knew that they had ureteral stents inserted and were urged to come back for stent removal. Twenty-one patients (0.21%) did not know that they had implanted stents. None of these 21 patients were urological patients, and they had stents placed during urological consultation in an operating room. Conclusion: Our study showed that the ARMS reduced the manpower in tracking stent removal by 85.07% and that it was useful for detecting and preventing forgotten stents. [ABSTRACT FROM AUTHOR]

Background: In vitro studies have confirmed that cardiac glycosides can induce apoptosis in both hormone-dependent and -independent prostate cancer (PCa) cell lines. The aim of this study was to investigate the incidence of PCa among patients treated with and without digoxin using a nationwide population-based database in Taiwan. Methods: We retrieved data of men aged 30 years or older who were newly diagnosed with heart failure between January 1998 and December 2003 from the National Health Insurance program database in Taiwan. We divided the patients into digoxin users and non-digoxin users. Kaplan-Meier curves and Cox proportional hazard analysis were used to examine the risk of subsequent PCa between the digoxin and non-digoxin groups. Results: The mean ± SD follow-up (years) periods in the digoxin and non-digoxin groups were 8.6 ± 1.78 and 8.3 ± 1.75, respectively. The cumulative incidence of PCa during the follow-up period was 3.5% (147/4233) in the non-digoxin group compared with 3.0% (65/2154) in the digoxin group. The log-rank test revealed that the digoxin group had a similar incidence of PCa to the nondigoxin group (p = 0.18). After adjusting for age, benign prostatic hyperplasia, and comorbidities, Cox proportional hazard regression analysis showed that digoxin was associated with a significantly decreased risk of developing PCa (hazard ratio, 0.74; 95% CI, 0.548-0.993; p = 0.045). Moreover, logistic regression analysis showed that the risk of PCa decreased with a longer duration of digoxin use during the study period compared to those who had never used digoxin (p = 0.043). Conclusion: The cardiac glycoside digoxin had significant effects on reducing the incidence of PCa in a time-dependent manner. Our findings may imply the potential application of cardiac glycosides in the prevention and management of PCa. [ABSTRACT FROM AUTHOR]