Factors predicting the development of urethral stricture after bipolar transurethral resection of the prostate.

OBJECTIVE: We aimed to investigate the rate of urethral stricture development, predictor factors, and the reliability following bipolar transurethral resection of the prostate. METHODS: A total of 124 patients participated in this study. Patient data were retrospectively reviewed. The patients were divided into group 1 (those who developed urethral stricture) and group 2 (those who did not develop urethral stricture). Annual checkups were performed after the postoperative months 1 and 6. The patients were checked by uroflowmetry + post-voiding residue and international index of erectile function. We evaluated the complications that developed during the perioperative period according to the Clavien system. RESULTS: Urethral stricture developed in 10.5% (13/124) of the patients. It was found that patients who underwent transurethral resection of the prostate for the second time (p=0.007), patients with a preoperative catheter or history of catheter insertion (p=0.009), patients with high preoperative median white blood cell (103) counts (p=0.013), and patients with long postoperative catheterization time had a higher rate of urethral stricture after bipolar transurethral resection of the prostate (p=0.046). No grade 4 and grade 5 complications were observed according to the Clavien system in patients. CONCLUSION: Factors such as second transurethral resection of the prostate surgery, history of preoperative catheter insertion, high postoperative white blood cell count, and long postoperative catheterization time increase the risk of urethral stricture after bipolar transurethral resection of the prostate.

Factors predicting the development of urethral stricture after bipolar transurethral resection of the prostate

SUMMARY OBJECTIVE: We aimed to investigate the rate of urethral stricture development, predictor factors, and the reliability following bipolar transurethral resection of the prostate. METHODS: A total of 124 patients participated in this study. Patient data were retrospectively reviewed. The patients were divided into group 1 (those who developed urethral stricture) and group 2 (those who did not develop urethral stricture). Annual checkups were performed after the postoperative months 1 and 6. The patients were checked by uroflowmetry + post-voiding residue and international index of erectile function. We evaluated the complications that developed during the perioperative period according to the Clavien system. RESULTS: Urethral stricture developed in 10.5% (13/124) of the patients. It was found that patients who underwent transurethral resection of the prostate for the second time (p=0.007), patients with a preoperative catheter or history of catheter insertion (p=0.009), patients with high preoperative median white blood cell (103) counts (p=0.013), and patients with long postoperative catheterization time had a higher rate of urethral stricture after bipolar transurethral resection of the prostate (p=0.046). No grade 4 and grade 5 complications were observed according to the Clavien system in patients. CONCLUSION: Factors such as second transurethral resection of the prostate surgery, history of preoperative catheter insertion, high postoperative white blood cell count, and long postoperative catheterization time increase the risk of urethral stricture after bipolar transurethral resection of the prostate.

Does skip metastasis or other lymph node parameters have additional effects on survival of patients undergoing radical cystectomy for bladder cancer?

PURPOSE: To investigate the effects of lymph node metastasis, skip metastasis, and other factors related to lymph node status on survival in patients who underwent radical cystectomy (RC) and extended lymph node dissection (eLND). MATERIALS AND METHODS: RC and eLND were performed in 85 patients with a diagnosis of bladder cancer. Disease-free survival (DFS) and overall survival (OS) were determined by using a Cox proportional hazards model that included the number of excised lymph nodes, the presence of pathological lymph node metastasis, the anatomical level of positive nodes, the number of positive lymph nodes, lymph node density, and the presence of skip metastasis. RESULTS: The mean number of lymph nodes removed per patient was 29.4±9.3. Lymph node positivity was detected in 85 patients (34.1%). The mean follow-up duration was 44.9±27.4 months (2-93 months). Five-year estimated OS and DFS for the 85 patients were 62.6% and 57%, respectively. Three of 29 lymph node-positive patients (10.3%) had skip metastasis. Only lymph node positivity had a significant effect on 5-year OS and DFS (p<0.001). No difference in OS and DFS was found between the three patients with skip metastasis and other lymph node-positive patients. Other factors related to lymph node status had no significant effect on 5-year OS and DFS. CONCLUSIONS: No factors related to lymph node status predict DFS and OS, except for lymph node positivity. OS and DFS were comparable between patients with skip metastasis and other lymph node-positive patients.

A prospective randomized multicenter study of Turkish Society of Urooncology comparing two different mechanical bowel preparation methods for radical cystectomy.

OBJECTIVE: To investigate the outcomes and complication rates of urinary diversion using mechanical bowel preparation (BP) with 3 day conventional and limited BP method through a standard perioperative care plan. MATERIALS AND METHODS: This study was designed as a prospective randomized multicenter trial. All patients were randomized to 2 groups. Patients in standard 3-day BP protocol received diet restriction, oral antibiotics to bowel flora, oral laxatives, and saline enemas over a 3-day period, whereas limited the BP arm received liberal use of liquid diet, sodium phosphate laxative, and self administered enema the day before surgery. All patients received same perioperative treatment protocol. The endpoints for the assessment of outcome were anastomotic leakage, wound infection, wound dehiscence, intraperitoneal abscess, peritonitis, sepsis, ileus, reoperation, and mortality. Bowel function recovery, including time to first bowel movement, time to first oral intake, time to regular oral intake, and length of hospital stay were also assessed. RESULTS: Fifty-six patients in 3-day BP and 56 in limited BP arm were evaluable for the study end points. Postoperatively, 1 patient in limited BP and 2 patients in 3-day BP arm died. There was no statistical difference in any of the variables assessed throughout the study, however, a favorable return of bowel function and time to discharge as well as lower complication rate were observed in limited BP group. CONCLUSIONS: Regarding all endpoints, including septic and nonseptic complications, current clinical research offers no evidence to show any advantage of 3-day BP over limited BP.

Extended pelvic lymph node dissection: before or after radical cystectomy? A multicenter study of the Turkish society of urooncology.

PURPOSE: We aimed to ascertain the effects of performing extended pelvic lymph node dissection (PLND) on the duration of surgery, morbidity, and the number of lymph nodes removed when the dissection was performed before or after radical cystectomy (RC). MATERIALS AND METHODS: We used the database of our previous prospective multicenter study. A total of 118 patients underwent RC and extended PLND. Of the 118 patients, 48 (40.7%) underwent extended PLND before RC (group 1) and 70 (59.3%) underwent extended PLND after RC (group 2). The two groups were compared for extended PLND time, RC time, and total operation times, per operative morbidity, and the total numbers of lymph nodes removed. RESULTS: Clinical and pathologic characteristics were comparable in the two groups (p>0.05). The mean RC time and mean total operation times were significantly shorter in group 1 than in group 2 (p<0.001). The mean number of lymph nodes removed was 27.31±10.36 in group 1 and 30.87±8.3 in group 2 (p=0.041). Only at the presacral region was the mean number of lymph nodes removed significantly fewer in group 1 than in group 2 (p=0.001). Intraoperative and postoperative complications and drain withdrawal time were similar in both groups (p=0.058, p=0.391, p=0.613, respectively). CONCLUSIONS: When extended PLND was performed before RC, the duration of RC and consequently the total duration of the operation were significantly shorter than when extended PLND was performed after RC. Practitioners may consider performing extended PLND before RC and rechecking the presacral area for additional lymph nodes after RC, particularly in elderly patients with high co-morbidity for whom the duration of surgery matters.

The effects of transurethral resection of the prostate on morbidity and mortality in patients with nondialysis-requiring renal insufficiency.

OBJECTIVES: To compare the prevalence of preoperative co-morbid factors and complications of transurethral resection of prostate (TUR-P) in patients with normal and non-dialysis requiring elevated serum creatinine levels. METHODS: The records of 357 consecutive patients with IPSS≥20, serum creatinine level ≤ 3 mg/dl, residual urine volume ≤ 300 ml and with no upper urinary tract dilatation or evidence of prostate cancer that underwent TUR-P were retrospectively evaluated. 60 patients who did not fulfill the inclusion criteria were excluded. The preoperative Na, K, creatinine levels and the early changes observed in these parameters after TUR-P of the patients with normal (Group1, n = 272) and elevated (Group2, n = 25) serum creatinine levels, as well as the preoperative baseline data and postoperative complications were compared. RESULTS: Preoperative PSA, serum urea, creatinine and K levels were significantly higher in group2. No significant differences were observed between early and late postoperative complications of the two groups. Co-morbid diseases were significantly more common in group2. No progression in renal failure or de novo need for hemodialysis was observed in group2. CONCLUSIONS: TUR-P can be safely performed in BPH patients with mild serum creatinine elevations (1.6-3 mg/dl) and moderately increased prostate volumes without additional morbidity and mortality.

The correlation among the percentage of positive biopsy cores from the dominant side of prostate, adverse pathology, and biochemical failure after radical prostatectomy.

The aim of this study was to evaluate the correlation among various preoperative clinical variables, including certain prostate needle biopsy parameters, biochemical failure, and adverse pathology, after radical retropubic prostatectomy (RRP). We retrospectively evaluated the records of our 156 patients who underwent RRP because of localized prostate cancer. Serum prostate-specific antigen level, clinical stage, and the information obtained from biopsy [Gleason score, number of positive cores, percentage of positive cores (PPCs) from the dominant side of prostate, and overall PPC] were evaluated as predictors of adverse pathology and biochemical failure. Of the patients, 30.2% (n=38) had nonorgan-confined disease, 19.1% (n=24) had positive surgical margins, 11.9% (n=15) had positive seminal vesicle invasion, and 16.7% (n=21) had biochemical failure after RRP. Multivariate analysis demonstrated that a PPC value of 55% or more from the dominant side of prostate is the only independent predictor of nonorgan-confined disease and seminal vesicle invasion. Clinical stage (T2b), biopsy Gleason score, and PPC values of 55% or more from the dominant side of prostate were found to be statistically significant predictors of positive surgical margin and biochemical failure. Our results support that PPC from the dominant side of prostate is a useful parameter for the prediction of adverse pathology and biochemical failure after RRP.

Reliability of frozen section examination of obturator lymph nodes and impact on lymph node dissection borders during radical cystectomy: results of a prospective multicentre study by the Turkish Society of Urooncology.

OBJECTIVE: To evaluate the accuracy of frozen section examination (FSE) for detecting lymph node (LN) metastases and whether we can use this information to decide the extent of LN dissection during cystectomy. PATIENTS AND METHODS: From August 2005 to August 2009 FSE of obturator LNs was performed in 118 patients with bladder cancer, who were undergoing radical cystectomy with extended LN dissection. Removed tissues from 12 well defined LN regions were sent separately for pathologic evaluation. The FSE results of obturator regions were compared with the final histopathologic results of these node regions. RESULTS: The mean number of removed nodes per patient was 29.4 ± 9.3 (median 28, range 12 to 51). The sensitivity, specificity, positive and negative predictive values of FSE for the 118 right obturator LN regions were 94.7%, 100%, 100% and 99%, respectively. The same values for the 118 left obturator LN regions were 86.7%, 100%, 100% and 98.1%, respectively. At final pathologic examination 28 of 118 (23.7%) patients had LN metastasis at obturator regions. Skipped metastasis was found in 15/90 patients (16.7%). Clinical and pathological stage of the primary tumour were found to be significant parameters for skipped metastasis (P = 0.008 and P < 0.001, respectively). CONCLUSIONS: Performing FSE of the obturator LNs seems to be a reliable procedure for their evaluation with acceptable negative and positive predictive values. The information obtained with FSE of obturator LNs can be used to determine intraoperatively the extent of LN dissection, especially in patients with significant comorbidity. Our study also showed that if the clinical stage of the primary tumour is < cT2, the possibility of skipped metastasis is zero.

Experiences in laparoscopic removal of upper ureteral stones: multicenter analysis of cases, based on the TurkUroLap Group.

BACKGROUND AND PURPOSE: Laparoscopic surgery for ureteral stones was restricted to special cases-those with large or impacted ureteral stones. We present special cases of patients who underwent laparoscopic ureterolithotomy at various clinics in Turkey. PATIENTS AND METHODS: Forty-one patients were included in the study from five urology clinics in which laparoscopic surgery was being performed. After a disease-specific history and physical examination, age and sex were recorded. The mean patient age was 41.8 years (30 men and 11 women). Urinalysis, determination of creatinine level, intravenous urography, and ultrasonography were performed. The parameters of stone size, presence of hydronephrosis, previous shockwave lithotripsy, previous ureteroscopic stone therapy, type of laparoscopic approach, operative time, ureteral incision, insertion of a Double-J stent, amount of drainage, hospitalization period, and perioperative complications were evaluated. RESULTS: Mean ureteral stone size was 22 mm. The retroperitoneoscopic approach was preferred in 35 (85.3%) patients, while the transperitoneal approach was used in 6 (14.7%) patients. Grade I hydronephrosis was detected in 4 patients, grade 2 in 22 patients, and grade 3 in 12 patients. In six patients, a history of shockwave lithotripsy was confirmed. The ureteral wall was incised with a cold knife in 5, scissors in 16, J-hook in 3, and a monopolar or bipolar dissector in 17 patients. In six patients, a Double-J stent was inserted, while in one patient, the operation was converted to an open procedure. The mean operative time was 124 minutes. The mean amount of drainage was 220 ml. Mean hospitalization time was 4.8 days. In five (12.5%) of seven patients, persistent drainage was a major complication that was managed by insertion of a Double-J stent. All patients were discharged stone free. CONCLUSION: Increased hospitalization and operative time can be related to the large stone sizes and prolonged urine leakage. In our opinion, however, the overall success of laparoscopic ureterolithotomy makes it a feasible and effective procedure, especially for stones that could not be managed easily with ureteroscopic stone therapy.

Impacts of antibiotic and anti-inflammatory therapies on serum prostate-specific antigen levels in the presence of prostatic inflammation: a prospective randomized controlled trial.

INTRODUCTION: The aim of this study was to determine if antibiotic or anti-inflammatory medications lower serum prostate-specific antigen (PSA) in the presence or absence of inflammation in the prostatic secretions of patients with PSA levels between 2.5 and 10 ng/ml and normal digital rectal examinations (DRE). MATERIALS AND METHODS: Patients with PSA levels between 2.5 and 10 ng/ml and normal DRE were candidates for the study. One hundred and eight patients with positive expressed prostate secretion (EPS) were randomized into antibiotics, anti-inflammatory and control groups (groups 1, 2 and 3, respectively), and 108 patients with negative EPS were randomized into similar groups (groups 4, 5 and 6, respectively). Repeat PSA levels of all patients were obtained 6 weeks after randomization and 10 core prostate biopsies were performed. RESULTS: Median PSA levels in group 1 before and after treatment were 5.2 (4.3-6.4) and 4.0 ng/ml (3.1-4.9), respectively (p < 0.001). The only significant decrease in PSA was observed in group 1. The percent change in PSA levels in group 1 was significantly greater than both in its control group (group 3; p < 0.001) and the EPS- antibiotics group (group 4; p < 0.001). CONCLUSIONS: Antibiotherapy significantly reduces serum PSA only in EPS+ patients, which justifies limiting the use of prebiopsy antibiotics to EPS+ patients with a normal DRE and PSA level between 2.5 and 10 ng/ml, minimizing the major drawbacks of empirical antibiotics usage.

Single-knot running suture anastomosis (one-knot pyeloplasty) for laparoscopic dismembered pyeloplasty: training model on a porcine bladder and clinical results.

OBJECTIVES: The one-knot running ureteropelvic anastomosis is a modification of the single-knot running suture that was previously described for urethrovesical anastomosis. In this study, we present a novel porcine model for laparoscopic pyeloplasty training and report the results obtained in patients who underwent one-knot pyeloplasty. MATERIALS AND METHODS: A porcine bladder was used for the ureteropelvic junction simulation in this training model. The laparoscopic one-knot pyeloplasty technique was attempted by five laparoscopic surgeons using this model, and the technique was then incorporated into clinical practice. The data of all patients who underwent this procedure between January 2006 and February 2008 were evaluated. RESULTS: The one-knot pyeloplasty technique was easily applied in a short time by laparoscopic surgeons in a novel porcine pyeloplasty model. The participants successfully performed a watertight anastomosis in the porcine bladder model, completing the task in <30 min by the fifth attempt. The time required to succeed before and after training decreased by 20.8% (P = 0.01). In the clinical portion, 40 laparoscopic pyeloplasty procedures were performed with this technique, and the mean time to complete the anastomosis was 27.1 min (range: 12-41). This time was concordant with the final anastomosis time performed in the pelvitrainer. CONCLUSIONS: The one-knot pyeloplasty is feasible and reproducible, and it overcomes the obstacles caused by multiple intracorporeal knots when performing laparoscopic pyeloplasty. Furthermore, the porcine bladder model that we introduce herein is a readily available and simple model to refine suturing techniques for pyeloplasty.

Correlation between upgrading of prostate biopsy and biochemical failure and unfavorable pathology after radical prostatectomy.

OBJECTIVE: To evaluate whether upgrading of the biopsy after radical prostatectomy (RP) affects disease outcome in terms of unfavorable pathology and biochemical failure. PATIENTS AND METHODS: We retrospectively evaluated the records of 174 patients who underwent RP. Prostate biopsy and RP specimen Gleason scores (GSs) and correlative clinical data were recorded, and a multivariate analysis was applied. RESULTS: Overall (138 patients), the disease of 69 men (50.0%) was upgraded, in 19 (13.8%) it was downgraded, and in 50 (36.2%) it had an identical biopsy and pathological GS. Accuracy rates were significantly higher for GS 8-10 compared to low GSs, with a concordance of 50.0 and 12.2%, respectively (p < 0.01). Multivariate analysis revealed the single independent prognostic factor for a non-organ-confined disease as a RP GS 8-10 (p = 0.035). The factors associated with a positive surgical margin were a biopsy GS 8-10 (p < 0.001) and the presence of biopsy score upgrading (p = 0.02). Biopsy GS >or=8 (p < 0.001) and presence of biopsy score upgrading (p = 0.009) were the two independent predictors of relapse after RP. CONCLUSION: This study demonstrated that biopsy upgrading was present in almost half of the patients who underwent RP and it was significantly related to positive surgical margins and biochemical relapse after RP.

Comparison of four different anesthesia methods for relief of all pain during transrectal ultrasound-guided prostate biopsy.

INTRODUCTION: To find the most beneficial method, we assessed patient comfort and morbidity rates during prostate biopsy procedures performed using periprostatic nerve blockade, unilateral pudendal nerve blockade, intrarectal lidocaine gel, and a combination of periprostatic nerve blockade and intrarectal lidocaine gel. MATERIALS AND METHODS: A total of 159 patients were included in this study. Pain evaluation results were retrospectively assessed and retrieved from the patient charts. Patients in group 1 (n = 64) received no anesthesia, group 2 (n = 34) received periprostatic nerve blockade, group 3 (n = 26) received unilateral pudendal nerve blockade, group 4 (n = 20) received intrarectal lidocaine gel, and group 5 (n = 15) received a combination of periprostatic nerve blockade and intrarectal lidocaine gel. A visual analog scale (VAS) was used for pain evaluations. RESULTS: According to pain scores (VAS) during probe insertion, only group 2 did not show a statistically significant difference (P > 0.05), while the other groups were found to be significantly different when compared to group 1. Groups 2, 3, and 5 were found to be significantly different when compared to group 1 according to pain scores (VAS) during insertion of needles. Groups 3 and 5 displayed statistically significant differences when compared to group 1 as regards pain scores during both the insertion of the probe and biopsy. CONCLUSIONS: Our data suggests that using either a combination of intrarectal lidocaine gel and periprostatic block or solely unilateral pudendal nerve block for prostate biopsy procedures provides efficient patient comfort by reducing pain both during probe insertion and needle passing through the prostate gland.

Testicular microlithiasis in patients with scrotal symptoms and its relationship to testicular tumors.

OBJECTIVES: To evaluate in a prospective study the coexistence of testicular microlithiasis with various scrotal pathologies and the relationship with testicular tumors in symptomatic patients presenting with various scrotal complaints. METHODS: A total of 197 male patients of reproductive age who applied to our clinic between December 2004 and June 2005 with various scrotal complaints were included in the study. Patient complaints were of pain, swelling, smallness of the testes, and infertility. Patients were evaluated according to their medical history, scrotal ultrasonograms, tumor markers, and hormone profiles after physical examination. Independent t test and Fisher's exact test were used for statistical analysis. RESULTS: The mean (+/-SD) age of the 197 patients was 28.3 +/- 8.5 years. Pathologic findings were testicular tumors (1.8%), cryptorchidism (3.5%), varicoceles (75%), hydroceles (9.8%), epididymal cysts (9%), and atrophic testes (0.9%). Testicular tumors were found in 4 patients, and testicular microlithiasis was observed in 3 (75%) of these patients. Testicular microlithiasis ratios were determined as 25% in cryptorchidism, 6.5% in varicocele, 23% in hydrocele, 10% in epididymal cyst, and 50% in atrophic testes. The rate of testicular microlithiasis was significantly higher in patients with testicular tumors. The mean follow-up of patients was 19.5 months (range, 16 to 23 months), during which no new cancer case was detected. CONCLUSIONS: Testicular microlithiasis was more frequently observed in patients presenting with mass lesions and testicular tumors. Our findings suggest that symptomatic patients should be warned and kept aware of this issue, particularly if they have risk factors for testicular cancer.

Can pain during digital rectal examination help us to decide the necessity and the method of anesthesia for transrectal ultrasound guided prostate needle biopsy?

OBJECTIVE: Transrectal ultrasound (TRUS) guided prostate biopsy is well tolerated by patients but the lack of an effective marker to predict pain prevents us from determining pre-procedurally which patient group needs local anesthesia for biopsy and probe pain. Thus in this study, we investigated predictor factors for prostate biopsy and probe insertion pain. MATERIALS AND METHODS: 71 patients who were undergoing prostate biopsy without anesthesia were included in the study retrospectively. Pain had been assessed with visual analogue scale (VAS 0-10). Digital rectal examination (DRE) pain was analyzed for biopsy and probe insertion pain. RESULTS: DRE pain was related to both probe pain and biopsy pain. CONCLUSION: Although level of pain during DRE determines patients in need of local anesthesia, since the number of patients with moderate-severe pain is rather big, it seems efficient in determining the patients in need of additional anesthesia due to probe pain.

Can pain during digital rectal examination help us to decide the necessity and the method of anesthesia for transrectal ultrasound guided prostate needle biopsy?

OBJECTIVE: Transrectal ultrasound (TRUS) guided prostate biopsy is well tolerated by patients but the lack of an effective marker to predict pain prevents us from determining pre-procedurally which patient group needs local anesthesia for biopsy and probe pain. Thus in this study, we investigated predictor factors for prostate biopsy and probe insertion pain. MATERIALS AND METHODS: 71 patients who were undergoing prostate biopsy without anesthesia were included in the study retrospectively. Pain had been assessed with visual analogue scale (VAS 0-10). Digital rectal examination (DRE) pain was analyzed for biopsy and probe insertion pain. RESULTS: DRE pain was related to both probe pain and biopsy pain. CONCLUSION: Although level of pain during DRE determines patients in need of local anesthesia, since the number of patients with moderate-severe pain is rather big, it seems efficient in determining the patients in need of additional anesthesia due to probe pain.

Effects of simultaneous transurethral resection of prostate and solitary bladder tumors smaller than 3 cm on oncologic results.

OBJECTIVES: To investigate the effect on the oncologic outcomes of treatment with transurethral resection of patients with a solitary bladder tumor smaller than 3 cm with a superficial appearance and benign prostatic hyperplasia. METHODS: The follow-up data from 34 men (group 1) who had undergone transurethral bladder tumor resection alone and 31 men who had undergone both transurethral prostate resection and transurethral bladder tumor resection at the same operation (group 2) in our clinic from 1996 to 2004 were retrospectively examined. The groups were also compared with each other. The recurrence and progression rates, elapsed time to recurrence, and the recurrence rates in the bladder neck and prostatic urethra were determined and compared. Statistical analysis was performed using the Mann-Whitney U and chi-square tests. RESULTS: The patients were followed up for at least 12 months (mean 28.9, range 12 to 98). The average follow-up period for group 1 was 27.4 months (range 12 to 91) and was 30.5 months (range 12 to 98) for group 2. The recurrence and progression rates for groups 1 and 2 were 41.2% and 8.8% and 35.5% and 9.7%, respectively. Recurrence in the bladder neck and/or prostatic urethra developed in 1 patient in each group. No statistically significant differences were found between groups in terms of follow-up time, recurrence, progression, recurrence in the prostatic urethra and/or bladder neck, and elapsed time to recurrence. CONCLUSIONS: According to our results, transurethral prostate resection can be safely performed with transurethral bladder tumor resection simultaneously in selected patients with severe lower urinary tract symptoms and a superficial solitary tumor smaller than 3 cm.

Embryonal paratesticular rhabdomyosarcoma: a case of young adult patient who has inguinal relapse.

Scrotal rhabdomyosarcomas originating from paratesticular tissue are most frequently seen in childhood and young adulthood. These are rarely seen malignant tumors. We present a young male with inguinal relapse in the early period that we had achieved a good clinical outcome with chemotherapy and radiotherapy protocols.

Reliability of frozen section examination of external iliac, hypogastric, and obturator lymph nodes during radical cystectomy: a multicenter study.

OBJECTIVES: To evaluate the accuracy of frozen section examination (FSE) for detecting lymph node (LN) metastasis in patients with bladder cancer undergoing radical cystectomy and pelvic LN dissection. To our knowledge, the accuracy of FSE to identify LN metastases in patients with bladder cancer is still undetermined. METHODS: The clinical data of 360 patients who had undergone radical cystectomy with pelvic lymphadenectomy for bladder cancer in six urologic institutions were retrospectively analyzed. The nodal regions included were the external iliac, hypogastric, and obturator LNs. The FSE results of the right and left LN regions were compared with the final histopathologic results of the respective LN regions. RESULTS: The final pathologic examination revealed nodal metastases in 65 patients (18.1%). Of the 720 right and left LN regions in 360 patients, 88 (12.2%) were metastatic at the final pathologic examination. Although the FSE findings were negative, the final pathologic examination revealed LN metastases in 26 patients and in 29 pelvic LN regions. All LN regions with positive FSE findings were positive at the final pathologic examination. When we considered the 720 LN regions, the sensitivity, specificity, and positive and negative predictive values for FSE were 67%, 100%, 100%, and 95.6%, respectively. CONCLUSIONS: Until innovations in imaging methods improve nodal staging in patients with bladder cancer, performing FSE of the external iliac, hypogastric, and obturator LNs seems to be a reliable procedure for the evaluation of the LNs. The information obtained with FSE of the LNs can be used to determine intraoperatively the extent of LN dissection.

A large seminal vesicle cyst with contralateral renal agenesis.

Seminal vesicle cysts (SVC) are rather rare disorders. Our case is the first in literature where contralateral renal agenesis was seen together with SVC and surgically managed. We believe that the occurrence of these two coinciding abnormalities is incidental.