Surgical treatment of penile foreign body granuloma: Penile shaft reconstruction with single- versus two-stage scrotal flap techniques.

OBJECTIVES: To report outcomes of surgical treatment in patients with penile foreign body granuloma and compare surgical outcomes between single- and two-stage scrotal flap reconstructions. METHODS: Medical records of patients with penile foreign body granuloma who underwent surgical treatment were reviewed. Patients with single- and two-stage scrotal flap reconstructions were compared. RESULTS: Forty-two patients underwent surgical treatment from January 1, 2018 to October 31, 2022. Twenty-three patients underwent single-stage reconstruction with bilateral scrotal flap while 12 patients underwent two-stage repair with 19 operations. Five patients underwent circumcision; one had excision with primary closure. Another patient underwent reconstruction by penile skin preservation technique. There was no statistically significant differences between single- and two-stage groups in wound infection (8.69% vs. 0%, RR 2.71, 95%CI; 0.14-52.29), wound dehiscence (21.74% vs. 8.33%, RR 2.61, 95%CI 0.34-19.87), reoperation rate (26.08% vs. 8.33%, RR 3.13, 95%CI; 0.42-23.10). Postoperative fever was significantly higher in single-stage group (56.52 vs. 8.33%, RR 6.78, 95%CI; 1.01-43.83). Total length of hospital stay was shorter in single-stage group (7.43 ± 3.19 days vs. 10.86 ± 1.57 days, MD -3.42, 95%CI; -5.28 to -1.57). Incidence of patients without Clavien-Dindo surgical complications was significantly lower in single-stage group (43.48% vs. 83.33%, RR 0.53, 95%CI; 0.31-0.89). CONCLUSIONS: Both single- and two-stage techniques may be considered for penile foreign body granuloma reconstruction. Although the hospital stay was longer in two-stage group, the complication rates were lower.

High XB130 expression in renal cell carcinoma is strongly associated with poor prognosis.

The aim of this study was to assess the prognostic value of XB130 expression in three major RCC subtypes, and its association with clinical outcomes and adverse clinicopathologic features. A total of 101 nephrectomy samples at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand, from 2007 to 2017 were included in the study. XB130 immunohistochemistry was performed on slides from a tissue microarray comprised of 71 clear cell RCCs, 23 papillary RCCs, and 7 chromophobe RCCs, and were scored using a Histoscore system on a 0-300 scale. High XB130 expression in clear cell RCC and papillary RCC patients was associated with poor prognosis (log-rank test, P = 0.013, and P = 0.001, respectively). WHO/ISUP grade (P = 0.001) and XB130 high expression (P = 0.019) were found to be independent risk factors for mortality in clear cell RCC using multivariate analysis. The high expression of XB130 in clear cell RCC patients was also associated with high WHO/ISUP grade (P = 0.011), distant metastasis (P = 0.036), TNM stage (P = 0.007), sarcomatoid/rhabdoid differentiation (P = 0.061), and urinary collecting system invasion (P = 0.002). Similarly, high XB130 expression (P = 0.038) was associated with poor prognosis among papillary RCC patients as well as with lymphovascular invasion (P = 0.022), TNM stage (P = 0.030), and sarcomatoid/rhabdoid differentiation (P = 0.044). Overall, our findings showed that high XB130 expression in clear cell RCC and papillary RCC patients are associated with a worse prognosis.

Single-dose intravenous nefopam on postoperative catheter-related bladder discomfort in patients undergoing transurethral resection of prostate: a randomized, double-blind placebo-controlled trial.

PURPOSE: Transurethral resection of prostate (TURP) with postoperative catheter traction can lead to significant catheter-related bladder discomfort (CRBD). This condition causes many postoperative complications and low patient satisfaction. This study aimed to evaluate the effectiveness of preoperative single-dose intravenous nefopam on the incidence and severity of CRBD and its adverse effects. METHODS: This randomized, controlled, double-blind study included patients who underwent TURP under spinal anesthesia with postoperative urinary catheter traction. Patients were allocated into nefopam (NF) and normal saline (NS) groups. Twenty mg of nefopam in normal saline solution (NSS) 100 mL or NSS 100 mL were given intravenously before TURP. The primary outcome was the incidence of CRBD. RESULTS: Seventy-three patients were randomized into NF (n = 37) and NS (n = 36) groups. There were 35 and 33 patients in the NF and NS groups, respectively, in the final analysis. The incidences of CRBD were 45.71% and 84.85% in the NF and NS groups at 6 h after operation, respectively, OR 0.54 (95% CI 0.36, 0.73), while before the end of catheter traction, the corresponding incidences were 37.14% and 75.76%, respectively, OR 0.49 (95% CI 0.28, 0.84). The CRBD scores were statistically significantly lower in the NF group at both time points. Morphine consumptions and adverse effects were not different between groups. Patient satisfaction was higher in the NF group. CONCLUSIONS: Single-dose nefopam significantly reduced the incidence and severity of CRBD in patients undergoing TURP with urinary catheter traction at 6 h after the procedure and before the end of catheter traction without increasing the adverse effects.

Prevalence of moderate to severe lower urinary tract symptoms in systemic sclerosis.

OBJECTIVE: Lower urinary tract symptoms (LUTS) are common in SSc. The severity of symptoms can affect the quality of life (QOL); however, LUTS is often neglected during routine assessments. We determined the prevalence of moderate to severe LUTS in SSc and its associated factors. METHODS: A cross-sectional study was conducted between March 2020 and June 2020. Adult SSc patients were enrolled from the Scleroderma Clinic, Khon Kaen University, Thailand. All completed a self-administered questionnaire on LUTS using the International Prostate Symptom Score (IPSS), categorized into absent, mild, moderate or severe LUTS. In addition, we investigated the factors associated with moderate to severe LUTS, and the correlation between IPSS-QOL score and IPSS severity. RESULTS: A total of 135 patients were enrolled. Most cases were female (87 cases; 64.4%) and had dcSSc (88 cases; 65.2%). Twenty-six were defined as having moderate to severe LUTS, for a prevalence of 19.3% (95% CI 13.0, 26.9%). In addition, most had storage symptoms (63.0%), followed by voiding symptoms (19.3%) and post-voiding symptoms (12.6%). The factors associated with moderate to severe LUTS per the multivariable logistic regression included a modified Rodnan skin score ≥20 points and gastrointestinal symptoms with adjusted odds ratios 7.64 and 5.78, respectively. In addition, the IPSS-QOL score had a moderate positive correlation with IPSS severity (rho = 0.560, P < 0.001). CONCLUSION: Moderate to severe LUTS occurred in about one-fifth of SSc patients, particularly those with extensive skin tightness and gastrointestinal involvement. The more severe the LUTS, the poorer the QOL.

Crizotinib-Associated Renal Cysts in Anaplastic Lymphoma Kinase-Positive Lung Cancer Patients: A Single-Center Experience.

Crizotinib is an anaplastic lymphoma kinase (ALK) inhibitor that was approved for ALK-harboring lung cancer. There have been reports about the development and progression of renal cysts from crizotinib. We report a series of 3 cases of crizotinib-associated renal cysts in patients admitted to our institution, with different kinds of presentation. A monitor for complex renal cysts is warranted in patients receiving crizotinib.

Management of blunt renal trauma in Srinagarind Hospital: 10-year experience.

BACKGROUND: Renal trauma is the most common injury in the urogenital system. In the last decade the management has beer shifted f rom a mandatory exploration to conservative treatment. So, the present study was conducted to evaluate the result f, renal trauma patients. MATERIAL AND METHOD: The data of renal trauma patients treated at Srinagarind Hospital since 1 January 1998 to 31 December 2007 was collected. Clinical data and trauma score were obtained via medical record review. RESULTS: Sixty-nine patients were included; 59 were male (82%). Mean age was 29.8 years (1-68 years). Forty-nine patiens: (80%) were injured by traffic accident. Eighteen percents of patients also had splenic injury. Fifty-five patients (80%) of blunt renal injury patients were treated by Non-Operative Management (NOM). In this group, most patients had grade I injury (39%). Mean injury severity score (ISS), revised trauma score (RTS), trauma and injury severity score (TRISS) were 20, 7.3 and 0.93, respectively. Successful rate of non-operative management was 87.2%. Mean hospital stay was 11.8 days and urinary tract infection was the most frequent complication (10%). Fourteen patients (20%) underwent surgery. Mean ISS, RTS, TRISS were 20.8, 5.5, and 0.72, respectively. In the operative group, 71% were grade 5 injury and almost all were treated by nephrectomy. Mean hospital stay was 9 days. CONCLUSION: Blunt injury is the major cause of renal trauma and the main mechanism is traffic accident. The success rate of Non-Operative Management in Srinagarind Hospital was high. However operative management is still the standard treatment in unstable patients.

Prevalence of erectile dysfunction in Thai scleroderma patients and associated factors.

BACKGROUND: Erectile dysfunction (ED) has been reported among patients with systemic sclerosis (SSc) and primarily limited cutaneous SSc in Caucasians. While there is no data on ED among Thais in whom the diffuse cutaneous SSc subset is common. OBJECTIVES: We aimed to estimate the prevalence of ED among Thais with SSc, evaluate its severity, and determine the associated factors. METHODS: We did a cross-sectional study among adult Thai male SSc patients. All eligible patients: a) completed the IIEF-15 questionnaire by themselves; b) underwent a genital examination by an experienced urologist to evaluate skin tightness of the penis, scrotum, and phimosis; and, c) were evaluated for Erection Hardness Score. RESULTS: A total of 60 male SSc patients were included. The respective mean age and median disease duration was 54.8±7.2 years and 3.1 years (IQR 1.2-7.2). The definition of ED was fulfilled in 53 cases for a prevalence of 88.3% (95%CI 77.4-95.2), while 65% had severe ED, and none had skin tightness of the genitalia. Eight cases had acquired phimosis, and all were in the ED group. The patients with ED vs. those without ED had significantly lower scores for orgasm, sexual desire, and intercourse satisfaction, and trended to be older, have more severe skin tightness and have higher BMI. CONCLUSION: ED is a common problem in men with SSc and is mainly categorized as severe. The severity of SSc might increase the risk of developing ED. We found phimosis was a common genital abnormality co-occurring with ED in SSc.

Programmed death­ligand 1 expression in tumor cells and tumor­infiltrating lymphocytes are associated with depth of tumor invasion in penile cancer.

The present study aimed to demonstrate the proportion of the programmed death-ligand 1 (PD-L1) expression in penile cancer patients and the association with clinicopathological parameters. Formalin-fixed paraffin-embedded specimens were obtained from 43 patients with primary penile squamous cell carcinoma treated at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, between 2008 and 2018. PD-L1 expression was evaluated by the immunohistochemistry using an SP263 monoclonal antibody. PD-L1 positivity was defined as >25% tumor cell staining or >25% tumor-associated immune cell staining. The correlation between PD-L1 expression and clinicopathological parameters was analyzed. A total of eight of 43 patients (18.6%) were identified as positive for PD-L1 expression in tumor cells and tumor-infiltrating lymphocytes. In the PD-L1 positive group, there was a significant association with pathological T stage (P=0.014) with a higher percentage of PD-L1 positive tumors in T1 stage compared with T2-T4 stage. In this cohort, there was a trend towards longer survival in patients with positive PD-L1 expression (5-year OS: 75% vs. 61.2%, P=0.19). Lymph node involvement and the location of tumor at the shaft of penis were two independent prognostic factors for survival. In conclusion, the PD-L1 expression was detected in 18% of penile cancer patients and high expression of PD-L1 was associated with the early T stage.

Laparoscopic vesicovaginal fistula repair: a novel approach.

BACKGROUND: Vesicovaginal fistula (VVF) is a common consequence of gynecologic procedures. Treatments include transabdominal, transvaginal and laparoscopic surgery. New methods for laparoscopic VVF repair aim to improve treatment outcomes and reduce post-operative complications. OBJECTIVE: To report a novel approach for laparoscopic VVF repair. MATERIAL AND METHOD: Medical records were reviewed of 5 patients who underwent a novel approach for laparoscopic VVF repair for benign fistula between October 2008 and December 2010. None had previously undergone operative repair Preoperative cystoscopy revealed supratrigonal VVFs in all patients. Each patient was placed in the lithotomy position and four or five trocars used. Cystoscopy combined with laparoscopy was performed to identify the site of the fistula. Limited cystotomy was done and the fistula tract excised. The bladder and vagina were closed independently and the omentum interposed between them. RESULTS: All cases were successfully managed using the laparoscopic technique. The respective mean operative time and length of hospital stay was 229 min (range, 150-300) and mean 4.4 days (range, 4-6). All patients were able to take food and drink within a day of surgery. The post-procedural cystogram showed no leakage. The urethral catheter was removed after 24.4 days (range, 18-34 days). CONCLUSION: Laparoscopic transperitoneal repair of VVF is a feasible and safe technique, Cystoscopy combined with laparoscopy simplifies limited cystotomy.

Prevalence of prostate cancer in northeastern Thailand.

BACKGROUND: Prostate cancer is a major problem and the prostatic specific antigen (PSA) blood test is the most effective test for early detection. There is, however, a paucity of confirmatory prevalence data for the Thai population. OBJECTIVE: To determine the prevalence of prostate cancer in the northeastern region of Thailand. MATERIAL AND METHOD: This was a cross-sectional study at the Health Check-up Clinic of Srinagarind Hospital between July 2008-2009. Recruits included 129 patients > 45 years of age. Prostatic specific antigen (PSA) was measured and patients with a high PSA level were counseled to undergo a transrectal ultrasound (TRUS)-guided biopsy. The cancer detection rate was calculated and the specificity of the diagnostic test determined using the ROC curve. The Spearman correlation between the PSA level and the Gleason score was established. RESULTS: The respective mean age and PSA level was 61 and 2.3 ng/ml. Thirteen patients had a PSA level > 4 ng/ml; all of whom underwent TRUS-guided biopsy; eight were positive for prostate adenocarcinoma. The prevalence of prostate cancer was thus 6.2% (8/129 patients). The specificity of the cut-off PSA level at 4 ng/ml as per the ROC curve was 40%. There was no correlation between the PSA level and the Gleason score. CONCLUSION: The prevalence of prostate cancer was 6.2%. According to the ROC curve, a cut-off PSA level of 4 ng/ml would be an appropriate for prostate cancer screening among Thai males.

Quality of life after donor nephrectomy for living donor kidney transplantation at Srinagarind Hospital.

OBJECTIVE: To determine the quality of life (QoL) of donors who have undergone nephrectomy for living donor kidney transplantation at Srinagarind Hospital, using the Thai version of the Short-Form, 36-item, health survey (SF-36). MATERIAL AND METHOD: The SF-36 questionnaires were sent by mail to 93 living donors who underwent nephrectomy between Jan 1, 1990 and Dec 31, 2008. The first part collected demographic data and the donor/recipient relationship, the second surveyed QoL, and the third asked about decision-making, donation-related stress and feedback. RESULTS: Forty-nine questionnaires were returned completed (30 women; 19 men: mean age 44.2 +/- 9.5 (range, 28-65) years). Thirty-one participants (61%) were siblings of the recipients. The QoL scores were not significantly different from the general Thai population; albeit nominally higher for mental health and social function. Upon reflection, only 5 (10%) had second thoughts. CONCLUSION: Donor nephrectomy did not affect QoL; thus, from that perspective living kidney transplantation is a suitable procedure for donors.

Artificial intelligence (AI) vs. human in hip fracture detection.

Objective: This study aimed to assess the diagnostic accuracy and sensitivity of a YOLOv4-tiny AI model for detecting and classifying hip fractures types. Materials and methods: In this retrospective study, a dataset of 1000 hip and pelvic radiographs was divided into a training set consisting of 450 fracture and 450 normal images (900 images total) and a testing set consisting of 50 fracture and 50 normal images (100 images total). The training set images were each manually augmented with a bounding box drawn around each hip, and each bounding box was manually labeled either (1) normal, (2) femoral neck fracture, (3) intertrochanteric fracture, or (4) subtrochanteric fracture. Next, a deep convolutional neural network YOLOv4-tiny AI model was trained using the augmented training set images, and then model performance was evaluated with the testing set images. Human doctors then evaluated the same testing set images, and the performances of the model and doctors were compared. The testing set contained no crossover data. Results: The resulting output images revealed that the AI model produced bounding boxes around each hip region and classified the fracture and normal hip regions with a sensitivity of 96.2%, specificity of 94.6%, and an accuracy of 95%. The human doctors performed with a sensitivity ranging from 69.2 to 96.2%. Compared with human doctors, the detection rate sensitivity of the model was significantly better than a general practitioner and first-year residents and equivalent to specialist doctors. Conclusions: This model showed hip fracture detection sensitivity comparable to well-trained radiologists and orthopedists and classified hip fractures highly accurately.

Prevalence and clinical associations with primary hypogonadism in male systemic sclerosis.

Background: Systemic sclerosis may affect male and female fertility. Premature ovarian failure has been reported in female systemic sclerosis patients, but the effects on male fertility in systemic sclerosis have not been studied. Objectives: We aimed to determine the prevalence and clinical associations with primary hypogonadism among male systemic sclerosis patients. Methods: This was a cross-sectional pilot study, including 30 adult male systemic sclerosis patients attending the Scleroderma Clinic, Khon Kaen University. Testosterone deficiency symptoms were assessed using the Aging Males' Symptoms Rating Scale, urological examination, and blood testing (for total testosterone, free testosterone, follicle-stimulating hormone, and luteinizing hormone). We excluded patients with congenital hypogonadism and any acquired disorders of the testes and genitalia. The definition of primary hypogonadism was based on the International Society for the Study of the Aging Male 2015 diagnostic criteria for hypogonadism. Results: Seven patients met the definition of primary hypogonadism-a prevalence of 23.3% (95% confidence interval: 9.9-42.3). The respective mean age and mean systemic sclerosis duration was 59.4 ± 11.9 and 5.5 ± 4.7 years. Older age at onset, high triglyceride level, and older age starting corticosteroid treatment were significantly associated with primary hypogonadism (p = 0.02, 0.02, and 0.03, respectively). Systemic sclerosis subset, disease severity, and immunosuppressant use were not associated with primary hypogonadism among Thai male systemic sclerosis patients. Conclusion: Around one-quarter of male systemic sclerosis patients had primary hypogonadism. Elderly onset of systemic sclerosis, hypertriglyceridemia, and late corticosteroid treatment were risk factors for developing primary hypogonadism.

High prevalence of chronic kidney disease and its related risk factors in rural areas of Northeast Thailand.

In Thailand, chronic kidney disease (CKD) screening was reported in 2009 with an overall prevalence of 17.5% and the highest at 22.2% in the northeastern region. This study aimed to find out CKD prevalence of the Kidney Disease Improving Global Outcomes criteria and their related risk factors in the rural community. A population-based study was conducted in the rural sub-districts of northeastern Thailand. Data of socio-demographic status, lifestyle, underlying diseases, blood pressure, and body mass index were recorded. Blood and urine analysis was conducted along with ultrasonography of kidneys. Specimen collection and analyses were repeated after 3 months, and the factors associated with CKD were studied by logistic regression analysis. A total of 2205 participants with a mean age of 57.8 ± 11.7 years and female predominance (66.7%) completed the study. The prevalence of CKD was 26.8%, i.e., stages 1 (7.3%); stage 2 (9.0%); stage 3a (6.0%); stage 3b (2.8%); stage 4 (1.4%); and stage 5 (0.3%). Hypertension, diabetes mellitus, and renal stones were the major underlying diseases. Only 3.5% of the participants were aware of having CKD. An increase in age, male, unemployment, current smoking, diabetes, hypertension, underweight, anemia, hyperuricemia, and leukocytosis were significantly associated factors with the disease. The study revealed that CKD has developed as a significant public health problem in rural northeastern Thailand and one out of every four people has CKD. Therefore, early interventions are essential for the proper management and prevention of CKD.

Improvement of allograft kidney biopsy yield by using a handheld smartphone microscope as an on-site evaluation device.

BACKGROUND: Smart lens is a magnifying device that turns the smartphone into a microscopic exploring instrument. It is a convenient and inexpensive tool as an on-site evaluation device for the kidney biopsy specimen. We demonstrate the benefit of using a handheld smartphone microscope compared to the standard procedure in allograft kidney specimens. MATERIAL AND METHODS: This was a cohort study of allograft kidney biopsies performed between June 2015 and November 2017 in Srinagarind Hospital, Khon Kaen University, Thailand. The clinical utility of the "Chula smart lens" applied to the smartphone as an on-site evaluation device was studied. Clinical data, diagnostic quality, and complications were retrospectively reviewed and compared between the smart lens group and the standard group. RESULTS: The study cohort consisted of 93 allograft kidney biopsies (standard:47, smart lens:46). The mean age was 40.6 (18-48) years, and 63 patients (67.7%) were male. By using the smart lens device, the number of obtained tissue cores was higher (3.5 vs 2.9, p = 0.019) and the inadequacy rate for diagnosis was significantly lower (7% vs 21.3%, p = 0.05). CONCLUSION: Using a handheld smartphone microscope as an on-site evaluation device resulted in more positive glomeruli and diagnostic yield compared to the standard procedure.

Prevalence of Geriatric Syndromes in Elderly Cancer Patients Receiving Chemotherapy.

The number of elderly patients with cancer is growing. Our study goals were to determine the prevalence of geriatric syndromes in elderly cancer patients receiving chemotherapy and its related factors using a basic geriatric screening tool. A cross-sectional study using the basic geriatric screening tool was conducted to survey geriatric problems in a population of elderly cancer patients receiving chemotherapy. There were 85 participants who were ≥60 years old. Descriptive statistics and regression analyses were used. The prevalence of having at least one geriatric syndrome was 58.8% (50 out of 85 cases). Depression was the most common component both in male and female patients. Age ≥65 years old was significantly associated with the geriatric syndrome (AOR 4.23, p=0.018), and a factor associated with depression was underweight (BMI<18.5 kg/m2) (AOR 13.2, p=0.003). In summary, geriatric syndromes are common in elderly cancer patients. Screening for geriatric syndrome adds substantial data on the assessment of elderly cancer patients, even those with a good performance status.

Prognostic Factors for Penile Cancer and Survival in Response to Multimodality Therapy.

PURPOSE: To report treatment outcomes of penile cancer in a single institution in Thailand and to identify prognostic factors for survival, highlighting the crucial role of multi-modality treatment (MMT). PATIENTS AND METHODS: Squamous cell carcinoma of penis patients who were treated at Srinagarind hospital between 2007-2015 were retrospectively analyzed. Clinical and pathological data were retrospectively reviewed. Overall survival (OS) was calculated using the Kaplan-Meier method and data were compared using the Log rank test. Cox regression analysis of factors affecting survival was conducted. RESULTS: A total of 70 patients were identified with a median follow-up of 69.4 months. Twenty-eight patients (40%) presented with early-stage (stage I or II), whereas 42 patients (60%) were stage III or IV disease. The median OS was 29.3 months (Interquartile range 10.5 months - not reached) for the entire cohort. Nodal involvement was the only factor identified from the multivariate model with the adjusted HR or 5.74 (95% CI 2.52-13.04). For patients with stage IIIB/IV, multi-modality treatment (MMT) resulted in longer survival when compared with surgery alone (HR 0.37; 95% CI 0.16-0.90). CONCLUSION: Patients with penile cancer in Thailand presented with younger age and more locally advanced stage. Nodal involvement is the single poor prognostic factor for OS and MMT was associated with longer survival in stage IIIB/IV disease.

Renal Artery Embolization for Acute Renal Hemorrhage: A Single-Center Experience.

BACKGROUND: Emergency renal artery embolization (RAE) is a useful method in treating renal trauma and bleeding renal tumors. The aim of this study was to evaluate the clinical efficacy and safety of emergency RAE, and factors associated with RAE failure. METHODS: This retrospective study included patients treated with emergency RAE for acute renal hemorrhage between 1 January 2009 and 31 October 2019 in Srinagarind Hospital. The embolization was performed using coils, glues, and/or gel foams. Factors associated with unsuccessful outcomes were analyzed using univariate and multivariate regression analyses. RESULTS: A total of 94 patients were treated at the center during the study period with the clinical success rate of 91.5%. The most common cause of acute renal hemorrhage was iatrogenic injury (76.5%). Factors associated with unsuccessful RAE according to multivariate analyses were hypertension (adjusted odds ratio [AOR] 24.2) and ruptured tumor/aneurysm (AOR 26.8). CONCLUSION: RAE is an effective procedure for acute renal hemorrhage. Hypertension and ruptured tumor/aneurysm were negative predictors for success.

Perioperative outcomes in elderly patients undergoing nephrectomy for renal cell carcinoma.

PURPOSE: To determine if age should be considered a relative contraindication to surgery for safety reasons. METHODS: Renal cell carcinoma (RCC) patients who underwent nephrectomy from January 2007 to December 2017 were analyzed retrospectively. Patients were grouped into age<65 and age≥65 years. The demographic data, surgical outcomes, complication, hospital stay, blood loss, and survival were compared between the two groups. RESULTS: A total of 101 patients were included; 74 in the younger group, and 27 in the older group. Compared to the young group, lower BMI, higher anemia, higher ASA grade, and comorbidities were frequent in the elderly. The operative time, blood loss, and renal function decline were comparable between two age groups. The complication rates in the older and younger group were 22% and 12%, respectively. The survival time was shorter in older patients compared to the younger ones; hazard ratio 2.25; 95%CI 1.08-4.69, p-value=0.031. CONCLUSION: Nephrectomy in elderly patients is safe and feasible and preoperative assessment along with diligent postoperative care may further increase survival. Age alone cannot be regarded as a contraindication for nephrectomy in RCC.

Bladder Malakoplakia in Systemic Sclerosis Patient: A Case Report and Review Literature.

Malakoplakia, an anecdotal reactive granulomatous lesion, is a rare pathologic entity but relatively more common in genitourinary tracts. Here we report a case of malakoplakia in the urinary bladder in systemic sclerosis. The patient was a 66-year-old female treated with long-term corticosteroid and cyclophosphamide. She presented with gross hematuria, and cystoscopy and biopsy revealed malakoplakia. There was no tumor and the stains for infectious organism were all negative. To the best of our knowledge, this is the first case report of malakoplakia in a systemic sclerosis patient.