Search

A 61-year-old man presented with a right renal mass with a vena caval thrombus on computed tomography that was consistent with renal cell carcinoma. The results of routine laboratory examinations and urinalysis were within normal limits. Preoperative planning was critical owing to the presence of the vena caval thrombus. A radical nephrectomy, vena caval thrombectomy, and regional lymphadenectomy were done. The pathologic report was consistent with a high-grade, invasive urothelial carcinoma, with sarcomatoid differentiation involving the renal vein and inferior vena cava (Stage IV, T4N0M0). Thus, this was a rare case of upper tract urothelial carcinoma. Adjuvant chemotherapy with the methotrexate, vinblastine, doxorubicin, cisplatinum regimen is scheduled. To our knowledge, this is the first report in Korea of upper tract urothelial carcinoma of the sarcomatoid type with a vena caval thrombus.

To evaluate the effect of bent distortion of the image of the prostate on the accuracy of 3-dimensional measurements during transrectal ultrasonography (TRUS).TRUS images were obtained prospectively from 60 patients with prostate cancer. The degree of rectal compression on the probe was varied in each case to obtain a typical bent distortion image (BDI) and a minimally bent image (MBI). Magnetic resonance imaging (MRI) served as the reference. Axial and midsagittal BDI, MDI, and MRI were selected. Three-dimensional prostate diameters (height, width, and length) and volume were obtained from all images by 2 independent observers. The data were analyzed by using a paired t test, intraclass correlation coefficients (ICCs), and Bland-Altman plots.The MBI and BDI diameters differed significantly (P .001). All ICCs for the MBI diameters and volume and the ICCs for BDI length and volume exceeded 0.9, which indicates high measurement reliability. However, the ICCs for BDI height and width were below 0.9. When the difference in MBI or BDI relative to MRI was calculated for each variable, the MBI differences were all significantly smaller than the BDI differences (P .001).Bent distortion during TRUS affects the accuracy of measurements. MBI is also morphologically more realistic than BDI. Therefore, to minimize prostatic image distortion, the rectal probe should be placed so that the posterior wall of the prostate is as flat as possible.

BMI = body mass indexCT = computed tomographyDVT = deep vein thrombosisEBL = estimated blood lossEERPE = endoscopicextraperitoneal radicalprostatectomyECE = extracapsularextensionEP = extraperitoneal approachGS = Gleason sumHGPIN = high-grade prostaticintraepithelial neoplasiaLN = lymph nodeLRP = laparoscopic radicalprostatectomyMRI = magnetic resonanceimagingNA = not availableOR = odds ratioPCa = prostate cancerPE = pulmonary embolismPLND = pelvic lymph nodedissectionPSA = prostate-specificantigenRARP = robot-assisted radicalprostatectomyRRP = radical retropubicprostatectomySMR = surgical marginpositive rateSVI = seminal vesicleinvasionTP = transperitoneal approach

To conduct a meta-analysis of studies that compared transperitoneal (TP) and extraperitoneal (EP) robot-assisted radical prostatectomy (RARP).PubMed, the Cochrane Library, and EMBASE online databases were searched for studies released prior to June 2012. References were manually reviewed, and two researchers independently extracted the data. To assess the quality of the studies, the Scottish Intercollegiate Guidelines Network Methodology Checklist for case-control and cohort studies was applied.One randomized controlled trial and five case-control studies were identified that met the inclusion criteria. Within these studies, 530 patients underwent EP-RARP, and 312 patients underwent TP-RARP. Operating room (OR) time for EP was shorter than for TP (mean difference, -25.551; 95% confidence interval [CI] -41.668 to -9.434; P=.002). For estimated blood loss, there was no significant difference between EP and TP (mean difference, -12.111; 95% CI -44.087 to 19.865; P=.458). There was a statistical difference in length of stay (LOS) between EP and TP patients (mean difference, -0.488; 95% CI -0.964 to -0.012; P=.044). There was no significant difference in margin positivity between EP and TP (odds ratio=1.023; 95% CI 0.656-1.573; P=.918). In complications including grade 2 or more than 2, there was also no difference between EP and TP (odds ratio=0.610; 95% CI 0.341-1.089; P=.094).This meta-analysis suggests that perioperative parameters, including OR time and LOS, may be more favorable for EP-RARP than for TP-RARP. However, the oncologic outcome of margin positivity did not demonstrate a significant difference between the EP and TP approaches.

Objective: To conduct a meta-analysis examining p53 expression as a potential risk factor in upper urinary tract urothelial carcinoma (UUT-UC) and to systematically review the available data. Methods: A comprehensive literature review was performed from January 1991 to August 2012, using search engines such as PubMed, EMBASE, Cochrane Library and KoreaMed. All retrieved references were manually reviewed, and two authors independently extracted the data. The quality of case-control and cohort studies was assessed using the Scottish Intercollegiate Guidelines Network (SIGN) checklists. Heterogeneity among studies was examined using the Q statistics and Higgins' I2 statistic. Results: Of 302 abstracts of original research studies, nine case-control trials fit our criteria for inclusion in the analysis. Of the nine articles included, four scored ‘low' and five scored ‘modest' in the quality assessment performed according to the SIGN checklists. Analysis of the correlation between different factors and p53 expression in UUT-UC showed that pathologic stage (≥pT3 or Conclusion: The results of our meta-analysis suggest that p53 expression in UUT-UC was correlated with advanced pathologic stage, high histologic grade and female gender.

There is no consensus on the optimal treatment for localized high-risk prostate cancer (PC), and much debate exists regarding the ideal treatment approach. For these reasons, we evaluated the competing risks of PC-specific mortality after initial therapy with radical prostatectomy (RP) versus radiotherapy (RT) in men with clinically localized high-risk PC. We reviewed patients treated with RP and RT combined with androgen-deprivation therapy between 1990 and 2009. High-risk PC is defined as clinical stage ≥T3a, serum prostate-specific antigen (PSA) >20 ng/mL, or a biopsy Gleason sum of 8–10 according to National Comprehensive Cancer Network guidelines. Competing risk analysis was conducted to assess the association of RP (n = 251) or RT (n = 125) with cancer-specific mortality (CSM). Thereafter, secondary analysis with propensity score matching was conducted to further elucidate patient characteristics, with optimal matching of 0.25 times the standard deviation of propensity scores. With an overall median follow-up of 76 months, 35 (9.3 %) men with high-risk PC died due to PC (23 in the RT group and 12 in the RP group). The 5-year estimates of cancer-specific survival rate for men treated with RP and RT were 96.5 % (95 % confidence interval [CI] 94.2–98.9) and 88.3 % (95 % CI 82.8–94.3), respectively. Cumulative incidence estimates for CSM were statistically increased amongst men treated with RT (p = 0.002). Propensity score matching extracted 168 men with high-risk PC from the total patient cohort. Cumulative incidence estimates for CSM were statistically different amongst men treated with RT (p

A 32-year old single man presented with azoospermia and low semen volume which was noted one and half a year ago. Transrectal ultrasonography and seminal vesiculography were performed to evaluate ejaculatory duct obstruction, and transurethral resection of the ejaculatory duct was performed using a hybrid technique of holmium:yttriumaluminium garnet laser with monopolar transurethral resection to overcome the narrow prostatic urethra. To our knowledge, this is the first report on the successful outcome of a hybrid technique applied for transurethral resection of the ejaculatory duct.

We evaluated the effectiveness of photodynamic therapy using Radachlorin in patients with high grade, nonmuscle invasive bladder cancer refractory or intolerant to bacillus Calmette-Guérin therapy who refused radical cystectomy.Between July 2009 and December 2011 photodynamic therapy was performed in 22 men and 12 women. Radachlorin (0.5 to 0.6 mg/kg) was injected intravenously 2 to 3 hours before photodynamic therapy. After complete transurethral resection, a diffuser using a 22Fr cystoscope was placed in the bladder for irradiation with a 662 nm laser. Output beam power was adjusted to 1.8 W and the light dose was 15 J/cm(2). Photodynamic therapy was performed for 16 to 30 minutes. Recurrence after photodynamic therapy was followed by regular cystoscopy at 1, 2 and 3 months, and at 3-month intervals thereafter for up to 2.8 years. Efficacy was assessed by cystoscopy, cytology and histology, and defined as the number of patients who were tumor free after initial photodynamic therapy.Mean ± SD patient age was 62.94 ± 8.71 years. Average followup was 26.74 ± 6.34 months (median 28.12). As the primary efficacy outcome, the recurrence-free rate was 90.9% at 12 months, 64.4% at 24 months and 60.1% at 30 months. As the secondary efficacy outcome, there was no statistical difference in mass size, carcinoma in situ, number of previous bacillus Calmette-Guérin administrations, number of transurethral bladder resections or tumor multiplicity on Kaplan-Meier analysis (each p0.05). No evidence of severe adverse effects was detected after photodynamic therapy.Photodynamic therapy with Radachlorin is a safe, effective treatment for nonmuscle invasive bladder cancer refractory or intolerant to bacillus Calmette-Guérin therapy in select patients.

We report on a case of a 67-year-old man who presented with persistent lower urinary tract symptoms following a potassium titanyl phosphate laser photoselective vaporization of prostate. Upon further diagnostic examinations were performed, he was noted to have an obliterative bladder neck contracture with an incidental, misleading, and rare presence of an unroofed midline anterior prostatic cyst presenting as a stricture. As we were presented with this case, it was imperative to address these complications of bladder neck contracture and incompletely ablated prostatic cyst. This report brings to light underestimated complicating factors in the urinary tract, and the diagnostic and therapeutic interventions we had undertaken to rectify the identified complications and improve patient’s quality of life. The patient underwent internal urethrotomy, resection of prostatic cyst wall and transurethral resection of the prostate directed to improve his quality of life and prevent urinary retention.