Vascular Regression After Pinguecula Excision and Conjunctival Autograft Using Fibrin Glue.

OBJECTIVES: To determine the change in local vascularization after pinguecula excision and conjunctival autograft secured with fibrin glue at 12 months. METHODS: Thirty-one eyes of 31 patients which underwent excision and conjunctival autografting with fibrin glue were retrospectively reviewed. Anterior segment photography was obtained before and after the surgery. Cosmetic outcome was evaluated by patient self-grading (five-point scale; excellent (5), good (4), acceptable (3), poor (2), and very poor (1)), and medical evaluation of treatment outcome was based on subjective evaluation of vascularization on anterior segment photography (four-point severity scale; 0 [low] to 3 [high]). Clinical outcome and complications are reported at 12 months. RESULTS: Overall cosmetic results were excellent or good in 93.5% (29 of 31) (score 4.68±0.60). Anterior segment photography showed that most cases demonstrated complete removal of pinguecula and regression of surrounding vascularization with mean change in score from 2.13±0.34 preoperatively to 0.09±0.30 postoperatively. CONCLUSIONS: Pinguecula excision and conjunctival autograft using fibrin glue is an effective and safe method to remove pinguecula for cosmetic purposes. The method presented facilitated regression of vascularization.

A Novel Surgical Approach for Oculodermal Melanocytosis: Superficial Sclerectomy.

OBJECTIVE: To report the outcomes of a new surgical method for oculodermal melanocytosis (nevus of Ota)-superficial scleral separation. METHODS: Twenty-five eyes of 25 patients with scleral pigmentation arising from oculodermal melanocysis. These patients underwent superficial scleral separation between March 2012 and February 2013. Each patient was evaluated with the followings: ocular examinations, the preoperative extent of scleral involvement of nevus of Ota, satisfaction score after surgery, histologic examination, and postoperative complications. Main outcome measures were best-corrected visual acuity (BCVA), induced refractive error, intraocular pressure (IOP), patient satisfaction scores, and anterior segment photographs. RESULTS: All patients showed cosmetic improvement without any serious complications. Preoperative and postoperative BCVA, IOP, and refractive outcomes did not change significantly. CONCLUSIONS: Superficial scleral separation is an effective procedure for cosmetic improvement of oculodermal melanocytosis.

Is larger tumor size a contraindication to retroperitoneal laparoscopic adrenalectomy?

PURPOSE: To evaluate the surgical feasibility of retroperitoneal laparoscopic adrenalectomy for tumors exceeding 5 cm. METHODS: A retrospective review was carried out on all adrenalectomies performed between 2002 and 2011. All surgical procedures were performed or supervised by one of two experienced laparoscopic surgeons. A total of 133 patients who underwent retroperitoneal laparoscopic adrenalectomy were divided according to tumor size: group I (n = 57) had tumors <5 cm and group II (n = 76) had tumors ≥5 cm. The operative outcomes included surgical time, change in hemoglobin level, estimated blood loss, necessity for blood transfusion, time to ambulation, hospitalization duration, postoperative complications according to the Clavien-Dindo classification, and the rate of conversion to open surgery. RESULTS: The estimated blood loss (271.75 ± 232.98 mL vs. 367.24 ± 275.11 mL; p = 0.037), time to ambulation (1.60 ± 0.49 days vs. 1.89 ± 0.31 days; p = 0.001), and postoperative hospitalization (7.88 ± 3.08 days vs. 9.264 ± 3.10 days; p = 0.012) were significantly higher in group II. The operation time and hemoglobin level change were not statistically different between groups. Blood transfusions were performed in 3 patients from group I and 6 patients from group II (5.3 vs. 7.9 %; p = 0.449). No patients experienced conversion to open surgery. CONCLUSIONS: Retroperitoneal laparoscopic adrenalectomy can be used in patients with tumors larger than 5 cm.

Prognostic value of preoperative systemic inflammation markers in localized upper tract urothelial cell carcinoma: a large, multicenter cohort analysis.

BACKGROUND: The aim of this study was to investigate the prognostic value of preoperative systemic inflammation markers in upper tract urothelial carcinoma (UTUC). METHODS: A total of 1137 patients who underwent radical nephroureterectomy with bladder cuff excision at 9 institutions from 2004 to 2015, were retrospectively reviewed. The Glasgow Prognostic Score (GPS), modified GPS (mGPS), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) for each patient were calculated. Univariable and multivariable analysis was performed using the Cox proportional hazards regression model. Cut-off values for NLR and PLR were calculated using a receiver operating characteristic curve. RESULTS: The median follow-up period was 39.1 (interquartile range: 18.3-63.8) months. Univariable analysis revealed that GPS, mGPS, PLR, and NLR (all, P=0.001) were significantly associated with both recurrence-free survival (RFS) and cancer-specific survival (CSS). Multivariable analysis revealed that GPS (P=0.001), PLR (hazards ratio [HR] =1.32; 95% CI: 1.08-1.62, P=0.007 and HR =1.87; 95% CI: 1.21-2.92, P=0.005), NLR (HR =1.38; 95% CI: 1.12-1.69, P=0.003 and HR =1.70; 95% CI: 1.10-2.62, P=0.017) were significantly associated with RFS and CSS. CONCLUSIONS: Our results suggest that preoperative systemic inflammation markers such as GPS, PLR, and NLR are independent prognostic factors in patients with UTUC after surgery.

New surgical approach for limbal dermoids in children: simple excision, corneal tattooing, and sutureless limboconjunctival autograft.

PURPOSE: To evaluate the efficacy of combined surgery of simple excision, corneal tattooing, and a sutureless limboconjunctival autograft in pediatric patients with grade 1 limbal dermoids. METHODS: We treated 4 eyes of 4 patients with combined surgery of corneal tattooing and a sutureless limboconjunctival autograft with simple excision of limbal dermoids. Preoperative and postoperative visual acuity, postoperative recovery time, cosmetic improvements, patient compliance, and complication rates were reviewed. RESULTS: The mean follow-up period in this study was 27.3 ± 2.8 (range, 24-30) months. Visual acuity was stable during the follow-up period. Resolution of patient discomfort and wound epithelialization was achieved in 1 week. Cosmetic outcomes improved in view of corneal opacity and conjunctival vascularization. All patients were satisfied with the cosmetic results with no complications. CONCLUSIONS: Corneal tattooing and a sutureless limboconjunctival autograft after simple excision of limbal dermoids can lead to a satisfactory cosmetic outcome, better compliance, and early postoperative recovery without complications for grade 1 limbal dermoids in pediatric patients.

Factors influencing the failure of extracorporeal shock wave lithotripsy with Piezolith 3000 in the management of solitary ureteral stone.

Studies of predictive factors of extracorporeal shockwave lithotripsy (ESWL) failure in patients with ureteral stones have not yielded results sufficient to prevent ESWL failure. The present study investigated patients with ureteral stone and analyzed the predictive factors of ESWL failure. Ninety patients with ureteral stone treated from January 2006 to June 2012 using ESWL for ureteral stone were enrolled. Patient's demographic data including age, gender, body mass index (BMI), symptoms and calculous characteristics including location, size, episode and the grade of hydronephrosis were recorded. Statistical results were performed using univariate and multivariate analyses for the predictive factors of ESWL failure. In univariate analysis, calculous location, size, and grade of hydronephrosis between two groups displayed significant differences (p < 0.05). The predictive factors of ESWL failure were BMI >25 kg/m(2) [Odds ratio (OR) = 3.5, 95% confidence interval (CI) 1.1-11.0], calculous size ≥ 1 cm (OR = 10.5, 95% CI 3.0-36.2), calculous location (mid-ureter; OR = 8.49, 95% CI 1.5-45.7) and severe grade of hydronephrosis (OR = 12.3, 95% CI 1.9-79.5). In conclusions, ESWL failure can be predicted in cases of obesity, calculous size exceeding 1 cm, mid-ureteral stone and severe hydronephrosis. When we consider calculous management in patients with these risk factors, initial surgical approach is recommended instead of ESWL.

Application of bone scans for prostate cancer staging: Which guideline shows better result?

INTRODUCTION: We evaluated the accuracy of current guidelines by analyzing bone scan results and clinical parameters of patients with prostate cancer to determine the optimal guideline for predicting bone metastasis. METHODS: We retrospectively analyzed patients who were diagnosed with prostate cancer and who underwent a bone scan. Bone metastasis was confirmed by bone scan results with clinical and radiological follow-up. Serum prostate-specific antigen, Gleason score, percent of positive biopsy core, clinical staging and bone scan results were analyzed. We analyzed diagnostic performance in predicting bone metastasis of the guidelines of the European Association of Urology (EAU), American Urological Association (AUA), and the National Comprehensive Cancer Network (NCCN) guidelines as well as Briganti's classification and regression tree (CART). We also compared the percent of positive biopsy core between patients with and without bone metastases. RESULTS: A total 167 of 806 patients had bone metastases. Receiver operating curve analysis revealed that the AUA and EAU guidelines were better for detecting bone metastases than were Briganti's CART and NCCN. No significant difference was observed between AUA and EAU guidelines. Patients with bone metastases had a higher percent positive core than did patients without metastasis (the cut-off value >55.6). CONCLUSION: The EAU and AUA guidelines showed better results than did Briganti's CART and NCCN for predicting bone metastasis in the enrolled patients. A bone scan is strongly recommended for patients who have a higher percent positive core and who meet the EAU and AUA guidelines.

Genetic variation in PSCA is associated with bladder cancer susceptibility in a Korean population.

BACKGROUND: Genetic factors play important roles in the pathogenesis of human cancer. A recent genome wide association study (GWAS) identified an association between the rs2294008 polymorphism of the prostate stem cell antigen (PSCA) gene and bladder cancer risk in Caucasians. The aim of this study was to determine whether the rs2294008 polymorphism is similarly associated with bladder cancer susceptibility in a Korean population. MATERIALS AND METHODS: We conducted a case-control study of 411 bladder cancer patients and 1,700 controls. RESULTS: The frequencies of the CC, CT, and TT genotypes of the rs2294008 polymorphism were 16.9, 54.0, and 28.8% in bladder cancer patients and 24.4, 48.1, and 27.5% in controls, respectively. We found that the combined CT/TT genotypes were associated with a significantly increased risk of bladder cancer (OR CT/TT=1.58, 95% CI=1.15-2.17), compared with the CC genotype. Smoking habits, tumor grade and tumor stage did not modify the association between rs2294008 and the risk of bladder cancer. CONCLUSIONS: Our study showed that the rs2294008 polymorphism in the PSCA gene is associated with the risk of bladder cancer in a Korean population, providing evidence that it may contribute to bladder carcinogenesis regardless of ethnicity.

A preliminary study of the variability in location of the ureteral orifices with bladder filling by fluoroscopic guidance: the gender difference.

BACKGROUND AND PURPOSE: To determine landmarks for stent positioning in both ureteral orifices (UOs) and the gender differences in their location in men and women. PATIENTS AND METHODS: The location of the UO and the bladder neck (BN) was measured fluoroscopically by the intravesical distal location of an open-ended catheter marked with radiopaque materials. We compared the location in men (n = 12) and women (n = 12) with a full bladder (hydrostatic pressure of 50 cmH2O) or an empty bladder. RESULTS: The mean distances from BN to UO in men and women were significantly different both in an empty bladder (2.5 ± 0.4 and 2.1 ± 0.3 cm, respectively) and in a full bladder (2.9 ± 1.0 and 2.3 ± 0.6 cm, respectively). The location of UO was changed by bladder filling in women but not in men. In women, most UOs were found superior to the symphysis pubis (SP) in empty bladder (66.6 %). Most of this location was observed at behind the upper boarder of SP in full bladder of women (75 %). The BN of women was located at the lower level in basal state compared to men. Also, the location of BN was markedly changed by bladder fulling in women (p = 0.04) but not in men. CONCLUSIONS: Significant gender differences were observed in the location of UO and BN. Clinicians should keep in mind the anatomical differences between men and women during fluoroscopic-guided procedure.

Is further evaluation needed for incidental focal uptake in the prostate in 18-fluoro-2-deoxyglucose positron emission tomography-computed tomography images?

OBJECTIVE: The aim of this study was to investigate the frequency of secondary evaluation to detect prostate cancer that was primarily manifested as abnormal hypermetabolism detected by 18-fluoro-2-deoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT). We also evaluated the association of maximum standardized uptake values (SUVmax) on PET/CT with clinicopathologic results. MATERIALS AND METHODS: We evaluated PET/CT reports from a total of 12,037 patients to find cases with abnormal prostate hypermetabolism. Patients with known prostate cancer or a recent prostate procedure were excluded. We analyzed the frequency of secondary evaluations such as digital rectal exams (DRE), levels of serum prostate-specific antigen (PSA), and/or biopsy to confirm prostate cancer. Biopsied patients were categorized into benign and cancer groups. Clinicopathologic characteristics were compared between the groups. RESULTS: Among 12,037 PET/CT images, 184 (1.5%) showed abnormal hypermetabolism in the prostate. Secondary evaluation was carried out in 120 patients. Biopsy was performed in 38 patients and prostate cancer was confirmed in 23 patients. The median serum PSA level was 3.2 and 49.7 ng/mL in the benign group and cancer group, respectively. The SUVmax was higher in the cancer group (5.7 ± 5.1) than in the benign group (4.8 ± 2.7), but the difference was not statistically significant (p = 0.37). In the cancer group, a high serum PSA level (≥ 20 ng/mL) was detected in 78.3% of the patients. The Gleason score was 7 in 34.7% and 8-10 in 56.5% of prostate cancer patients. CONCLUSIONS: Hypermetabolism in the prostate was incidentally detected in 1.5% of patients, and only 65.2% of these patients underwent further evaluation (DRE and/or serum PSA levels). Among cases of incidentally detected hypermetabolism in the prostate, patients with abnormal findings (DRE and/or PSA levels) showed high positivity by biopsy, and more than two-thirds of the positive biopsies showed significant prostate cancer. Therefore, patients with hypermetabolism in the prostate should not be ignored and should be secondarily evaluated by DRE and PSA level.

Expression and localization of aquaporins in benign prostate hyperplasia and prostate cancer.

The aquaporin (AQP) families of water channels are intrinsic membrane proteins that facilitate selective water and small solute movement across the plasma membrane. The purposes of this study were to determine the expression and localization of AQPs in benign prostatic hyperplasia and prostate cancer. Prostatic tissue was collected from patients with benign prostatic hyperplasia or prostate cancer by transurethral resection of the prostate. The expression and cellular localization of the AQPs were determined in the human prostate by Western blot and immunohistochemistry. AQP1, 3, and 9 were expressed in the human prostate. Western blot analysis revealed bands at 28-36 kDa for the AQP1, 3, and 9 proteins. Of these proteins, AQP3 and 9 were expressed in the epithelium. Immunolabeling showed that AQP1 was mainly expressed in the capillaries and venules of the prostate, AQP9 was expressed in the cytoplasm of the epithelium, and AQP3 was mainly associated with the plasma membrane of the prostatic epithelium. Only AQP3 expression was localized in the cell membrane, and expressed AQP3 was translocated to the cytoplasm in prostate cancer. The epithelium in the human prostate expresses AQP3 and 9 proteins, and the capillaries and venules of the prostate express AQP1. Characterizing or modifying the expression of AQP3 may lead to an understanding of the role of the AQPs in human prostatic disease.

Prostate calculi in cancer and BPH in a cohort of Korean men: Presence of calculi did not correlate with cancer risk.

Prostatic calculi are common and are associated with inflammation of the prostate. Recently, it has been suggested that this inflammation may be associated with prostate carcinogenesis. The aim of this study was to investigate the relationship between prostatic calculi and prostate cancer (PCa) in prostate biopsy specimens. We retrospectively analyzed 417 consecutive patients who underwent transrectal ultrasonography (TRUS) and prostate biopsies between January 2005 and January 2008. Based on the biopsy findings, patients were divided into benign prostatic hyperplasia and PCa groups. TRUS was used to detect prostatic calculi and to measure prostate volume. The correlations between PCa risk and age, serum total PSA levels, prostate volume, and prostatic calculi were analyzed. Patient age and PSA, as well as the frequency of prostatic calculi in the biopsy specimens, differed significantly between both the groups (P < 0.05). In the PCa group, the Gleason scores (GSs) were higher in patients with prostatic calculi than in patients without prostatic calculi (P = 0.023). Using multivariate logistic regression analysis, we found that patient age, serum total PSA and prostate volume were risk factors for PCa (P = 0.001), but that the presence of prostatic calculi was not associated with an increased risk of PCa (P = 0.13). In conclusion, although the presence of prostatic calculi was not shown to be a risk factor for PCa, prostatic calculi were more common in patients with PCa and were associated with a higher GS among these men.