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Partial nephrectomy is now a standard approach for small renal masses and tumour recurrences after partial nephrectomy are uncommon. In the absence of spillage, port site recurrences are most commonly reported. We report a case of tumour recurrence near the surgical site as well as beyond the posterior renal fascia and Gerotas fascia in a 60-year-old woman who underwent robot-assisted partial nephrectomy for a 4.6 cm suspicious left renal tumour despite the absence of gross tumour spillage or rupture intraoperatively. Histology showed a 5 cm clear cell renal cell carcinoma with negative surgical margins, nuclear grade 4 with focal malignant rhabdoid differentiation. The practice of not bagging the specimen immediately after tumour excision especially for higher risk tumours should be reviewed as there may be inadvertent microscopic spillage of tumour cells.

Objective: Despite high-grade intravesical prostatic protrusion (IPP) being closely related to bladder outlet obstruction (BOO), up to 21% of patients with low IPP remain obstructed. This study evaluates the characteristics and urodynamic findings of men with small prostates and low IPP. Methods: One hundred and fourteen men aged >50 years old with lower urinary tract symptoms (LUTS) were assessed with symptoms, uroflowmetry, serum prostate-specific antigen (PSA), transabdominal ultrasound measurement of prostate volume (PV), IPP and post-void residual urine (PVRU). All patients underwent pressure flow studies. Patients with PV

Purpose: To analyze the long-term clinical outcomes of men with large prostate sizes of 80 mL and greater who were managed conservatively.Materials and Methods: We retrospectively analyzed men with prostate sizes of 80 mL and greater from our electronic hospital database. Clinical parameters such as age, International Prostate Symptom Score (IPSS), quality of life (QoL) scoring, serum pros-tate-specific antigen (PSA), uroflowmetry variables, and transabdominal ultrasound findings were evaluated. These parameters were compared at entry to our study and at the patient’s latest follow-up visit.Results: For the 50 men included in our analysis, mean age was 68 years, median PSA was 9.9 ng/mL, and median prostate volume was 94 mL. Seven men underwent upfront prostate surgery, whereas the other 43 were managed conservatively, predominantly with pharmacotherapy (98%). Only serum PSA, QoL scores, and postvoid residual urine demonstrated a significant reduction at the end of a median follow-up period of 62 months. Fourteen men (33%) were considered to have progressed clinically, with 8 experi-encing retention of urine and 6 having symptomatic deterioration. Of the 35 men who were still receiving conservative treatment at the end of the follow-up period, 24 men (69%) had a peak flow rate of 10 mL/s or greater, a QoL score of 3 or less, and mild to moderate (IPSS, 0–19) symptoms.Conclusions: Although the incidence of clinical progression in men with prostate sizes of 80 mL and greater is high, there is still a role for conservative management with pharmacotherapy.

Objective: Men with benign prostate hyperplasia (BPH) with good urinary flow may still have bladder outlet obstruction (BOO). Intravesical prostatic protrusion (IPP) has been shown to be able to predict BOO. We aim to investigate the use of IPP to predict BOO in men with good urinary flow. Methods: One hundred and fourteen consecutive men (>50 years old) presenting with lower urinary tract symptoms suggestive of BPH were recruited in 2001 and 2002. They were evaluated with serum prostate specific antigen (PSA), uroflowmetry and transabdominal ultrasound measurement of IPP and prostate volume (PV). Pressure-flow urodynamic studies were performed on all men and BOO was defined by BOO index > 40. Men with Qmax ≥ 12.0 mL/s were considered to have good flow. Results: Among the 114 men, 61 patients had good urinary flow. Their median age, PV and Qmax were 66 years, 32.9 mm3 and 14.5 mL/s respectively. 14/61 (23.0%) patients had BOO and their distribution of IPP were as follows: Grade 1 – 0/20 (0%) obstructed, Grade 2 – 6/22 (27.3%) and Grade 3 – 8/19 (42.1%). Sensitivity of Grade 2/3 IPP for BOO was 100% while specificity of Grade 3 IPP was 76.6%. The area-under-curve (AUC) for IPP was greater than that for PV (0.757 vs. 0.696). Conclusion: Even in men with good flow, high grades of IPP were more likely to have BOO and hence, may be a useful adjunct to predict BOO.

Hematuria is not uncommonly seen among children. We describe the case of a 13-year-old boy who was diagnosed with urothelial carcinoma after presenting with persistent gross hematuria for 2weeks. We highlight the importance of adequate workup for gross hematuria as it is often associated with an underlying pathology that could lead to significant morbidity if left undiagnosed. [ABSTRACT FROM AUTHOR]

Purpose Primary ADT (pADT) monotherapy is used significantly for patients with clinically localised disease in Asia and is acceptable even by guidelines, especially in intermediate- and high-risk disease. This occurs despite controversy in the West and data suggesting association with adverse effects, notably cardiovascular events. We therefore sought to assess the impact of pADT on all-cause mortality and prostate cancer-specific mortality (PCSM) in Asian men with high-risk and unfavourable intermediate-risk PCa. Methods With cancer registry data, men from a single centre in Singapore with clinically localised high-risk/unfavourable intermediate-risk PCa diagnosed between 2004 and 2014 and either treated conservatively with no therapy or started on pADT within 1 year of diagnosis were followed up through January 2017. Patients with non-localised PCa (clinical stage T4, regional/distant lymph node involvement, metastases), or receipt of local therapy (radical prostatectomy/radiotherapy) were excluded. The primary outcomes of all-cause mortality and PCSM were analysed with Cox proportional hazards regression models. Results Three hundred and forty Asian men were analysed, and 177 (52.1%) were started on pADT, with mean age of 77 (49-98) years. There were 119 deaths in the cohort, and 68 (38.4%) occurred in patients treated with pADT (median followup, 4.4 years). After adjusting for comorbidities and clinical characteristics, pADT did not provide benefit to all-cause mortality, PCSM or cardiovascular mortality. Conclusion For clinically localised unfavourable intermediate-risk and high-risk PCa, starting pADT within 12 months of diagnosis is not associated with improved 5-year all-cause mortality or PCSM compared to patients treated conservatively with no therapy and should be discouraged due to lack of mortality benefit. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the long-term clinical outcomes of men with large prostate sizes of 80 mL and greater who were managed conservatively. Materials and Methods: We retrospectively analyzed men with prostate sizes of 80 mL and greater from our electronic hospital database. Clinical parameters such as age, International Prostate Symptom Score (IPSS), quality of life (QoL) scoring, serum prostate- specific antigen (PSA), uroflowmetry variables, and transabdominal ultrasound findings were evaluated. These parameters were compared at entry to our study and at the patient’s latest follow-up visit. Results: For the 50 men included in our analysis, mean age was 68 years, median PSA was 9.9 ng/mL, and median prostate volume was 94 mL. Seven men underwent upfront prostate surgery, whereas the other 43 were managed conservatively, predominantly with pharmacotherapy (98%). Only serum PSA, QoL scores, and postvoid residual urine demonstrated a significant reduction at the end of a median follow-up period of 62 months. Fourteen men (33%) were considered to have progressed clinically, with 8 experiencing retention of urine and 6 having symptomatic deterioration. Of the 35 men who were still receiving conservative treatment at the end of the follow-up period, 24 men (69%) had a peak flow rate of 10 mL/s or greater, a QoL score of 3 or less, and mild to moderate (IPSS, 0-19) symptoms. Conclusions: Although the incidence of clinical progression in men with prostate sizes of 80 mL and greater is high, there is still a role for conservative management with pharmacotherapy. [ABSTRACT FROM AUTHOR]

Sinensetin, a plant-derived polymethoxylated flavonoid found in Orthosiphon aristatus var. aristatus and several citrus fruits, has been found to possess strong anticancer activities and a variety of other pharmacological benefits and promising potency in intended activities with minimal toxicity. This review aims to compile an up-to-date reports of published scientific information on sinensetin pharmacological activities, mechanisms of action and toxicity. The present findings about the compound are critically analyzed and its prospect as a lead molecule for drug discovery is highlighted. The databases employed for data collection are mainly through Google Scholar, PubMed, Scopus and Science Direct. In-vitro and in-vivo studies showed that sinensetin possessed strong anticancer activities and a wide range of pharmacological activities such as anti-inflammatory, antioxidant, antimicrobial, anti-obesity, anti-dementia and vasorelaxant activities. The studies provided some insights on its several mechanisms of action in cancer and other disease states. However, more detail mechanistic studies are needed to understand its pharmacological effects. More in vivo studies in various animal models including toxicity, pharmacokinetic, pharmacodynamic and bioavailability studies are required to assess its efficacy and safety before submission to clinical studies. In this review, an insight on sinensetin pharmacological activities and mechanisms of action serves as a useful resource for a more thorough and comprehensive understanding of sinensetin as a potential lead candidate for drug discovery. [ABSTRACT FROM AUTHOR]