Prognostic Impact of Renin-Angiotensin Inhibitors in Patients with Bladder Cancer Undergoing Radical Cystectomy.

BACKGROUND: Renin-angiotensin system blockade has been effective for the treatment of patients with several types of malignancy. This study evaluated the prognostic impact of renin-angiotensin system inhibitors, including angiotensin-2 converting enzyme inhibitors and angiotensin 2 receptor blockers, in patients with bladder cancer undergoing radical cystectomy. METHODS: This retrospective study included 269 patients who had undergone radical cystectomy. The oncologic outcomes of patients treated or not treated with renin-angiotensin system inhibitors after surgery were evaluated. Overall survival and cancer-specific survival were assessed by the Kaplan-Meier method and by Cox regression analysis. RESULTS: The median follow-up duration after radical cystectomy in survivors was 44.5 months. The 5-year, cancer-specific survival rates in patients who did and did not receive renin-angiotensin system inhibitors were 79.0 and 66.4 %, respectively (P = 0.011). Similarly, the 5-year overall survival rates were 76.1 and 61.4 %, respectively (P = 0.0097). Multivariable analyses showed that use of renin-angiotensin system inhibitors was an independent prognostic factor for cancer-specific survival (hazard ratio 0.47, P = 0.036) and for overall survival (hazard ratio 0.36, P = 0.022). CONCLUSIONS: Renin-angiotensin system inhibitors significantly reduced the risks of cancer-specific and overall mortality after radical cystectomy in patients with bladder cancer. Renin-angiotensin system inhibitors may improve oncologic outcomes in high-risk patients with bladder cancer.

Preoperative sexual status of Japanese localized prostate cancer patients: comparison of sexual activity and EPIC scores.

OBJECTIVE: This study aimed to evaluate the relationship between sexual activity and sexual function using questionnaires distributed to middle-aged Japanese patients with localized prostate cancer. METHODS: A total of 145 patients who underwent radical prostatectomy were enrolled in the survey reported on herein. Sexual activity and sexual function were investigated via the Expanded Prostate Cancer Index Composite (EPIC) and an original self-reported questionnaire. RESULTS: Of participants, 24.1% and 20.7% had sexual activity within a month period as investigated via the EPIC and original questionnaire, respectively. However, 29.7% of all those who reported sexual activity rate reported "about once every 2 months to a year," as shown in the original questionnaire. Regarding sexual function as addressed through EPIC, no results within that questionnaire's measure of sexual function showed significant differences among patients with a rate of actual sexual activity. CONCLUSIONS: The present survey showed that more than quarter of preoperative middle-aged Japanese prostate cancer patients surveyed had actual sexual activity, though not within the preceding 4 weeks. To precisely evaluate sexual function of middle-aged Japanese patients, it is necessary to consider actual sexual activity.

Laparoendoscopic single-site surgery for treatment of urachal remnants.

INTRODUCTION: To evaluate safety and excellent cosmetic outcome with laparoendoscopic single-site surgery (LESS). In this study, we compared the usefulness and efficacy of LESS versus conventional laparoscopic surgery for the treatment of urachal remnants. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 20 consecutive patients who underwent either conventional laparoscopic surgery or LESS from January 2007 to February 2015 at Kansai Medical University Hospital. Ten patients underwent surgery using the standard laparoscopic 3-port technique, and 10 patients underwent LESS. The patients included 12 males and 8 females (mean age, 24.5 years; range, 10-68 years). The patients' characteristics, surgical data, and postoperative pain assessment results were retrospectively collected and analyzed. RESULTS: The median operative time, pneumoperitoneal surgery time, and estimated blood loss did not differ between the LESS and conventional laparoscopic groups. However, the total incision length was longer in the conventional laparoscopic group than in the LESS group. The degree of pain at 2 to 5 days postoperatively according to the Wong-Baker FACES Pain Rating Scale was lower in the LESS group than in the conventional laparoscopic group (p < 0.05). CONCLUSIONS: Less is a possible option in the surgical treatment for urachal remnants. In this very small cohort, there is no conversion to traditional laparoscopic surgery or open surgery. This technique is possibly feasible and may achieve less pain. Accumulation of surgical outcomes especially in safety and cosmesis is required to be an established method.

Introduction of an Enhanced Recovery after Surgery Protocol for Robot-Assisted Laparoscopic Radical Prostatectomy.

INTRODUCTION: No studies have shown whether the enhanced recovery after surgery (ERAS) protocol is superior to the conventional protocol after robot-assisted laparoscopic radical prostatectomy (RALP). We compared intestinal function and perioperative parameters of patients with prostate cancer after the ERAS and conventional protocols to determine the superior protocol for recovery of intestinal function. MATERIAL AND METHODS: A retrospective analysis of 198 consecutive patients who underwent RALP between August 2013 and June 2015 was conducted. Our study design included 2 cohorts. Patients underwent conventional care in one group (n = 123) and the ERAS protocol in the other group (n = 75). The primary outcome was the time to first defecation. Secondary outcomes were perioperative parameters and the complication rate. RESULTS: The ERAS group showed a significantly shorter time to first defecation than did the conventional group (p = 0.006). Multivariate analysis showed that selection of the ERAS protocol was significantly associated with the number of days for first time to defecation. CONCLUSIONS: Successful application of an ERAS protocol was applied to our patients who underwent RALP and did not have major complications. The ERAS protocol included enhanced intestinal recovery. The ERAS group showed a significantly shorter time to first defecation than did the conventional group.

Urinary l-type fatty acid-binding protein is a predictor of early renal function after partial nephrectomy.

PURPOSE: Urinary biomarkers of renal injury urinary may identify loss of renal function following nephron-sparing surgery (NSS). This study was designed to evaluate whether urinary l-type fatty acid-binding protein (l-FABP) is an early biomarker of loss of renal function after NSS. Specifically, the kinetics of urinary l-FABP level after NSS and its correlation with factors related to ischemic renal injury were analyzed. METHODS: This study prospectively evaluated 18 patients who underwent NSS between July and December 2014, including 12 who underwent laparoscopic and six who underwent robot-assisted partial nephrectomy. Urinary l-FABP concentrations were measured preoperatively and 1, 2, 3, 6, 12, 24, 48, and 72 h after renal artery declamping. Loss of renal function loss was calculated by comparing the effective renal plasma flow, as determined by 99mTc-mercaptoacetyltriglycine (MAG3) clearance, on the operated and normal sides. The decrease in estimated glomerular filtration rate from before surgery to six months after surgery was also measured. RESULTS: Urinary l-FABP concentration peaked within 2 h of declamping, which may quantify nephron damage caused by ischemia. The decrease in MAG3 reduction ratio correlated with both the ischemia time and peak urinary l-FABP concentration. Peak urinary l-FABP concentration showed a significant correlation with MAG3 reduction ratio. CONCLUSIONS: l-FABP is a suitable urinary biomarker for predicting the extent of ischemic renal injury.

[Devices to Perform Laparo-Endoscopic Single Site Surgery for Urachal Remnants without Additional Ports].

The laparoscopic management of urachal remnants has gradually become a common practice. Recently, laparoscopic single-site surgery (LESS), a minimally invasive approach that provides excellent cosmetic results, has been adopted in several surgical procedures for treating urachal remnants. However, when suturing the bladder wall or peritoneal defect during LESS it may be difficult to conduct the procedure manually, and such cases require an additional port for suturing. Our strategy, however, employs a knot pusher to perform the suturing without the need for an additional port. We compared and examined the perioperative parameters of the patients with the additional port and one without it (knot-pusher group). For the additional-port and knot-pusher groups, the average operative time, was 146.8 and 161.7 minutes respectively, pneumoperitoneal surgery time was 90.8 and 88.0 minutes, respectively, suturing time for the bladder wall was 577 and 502 seconds, respectively suturing time for peritoneal defect was 758 vs 779 seconds, respectively, and estimated blood loss was 19 and 9.6 ml, respectively ; there being no significant difference between the two groups. We report our knot-pusher method because it can achieve comparable results without compromising the surgical outcome.

Prognostic impact of perioperative lymphocyte-monocyte ratio in patients with bladder cancer undergoing radical cystectomy.

Various systemic inflammatory response biomarkers are associated with oncological outcome. We evaluated the superiority of prognostic predictive accuracy between neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR), and the prognostic significance of their perioperative change in patients with bladder cancer undergoing radical cystectomy (RC). We retrospectively analyzed 302 patients who had undergone RC in four institutions. Comparison of predictive accuracy between NLR and LMR was performed using receiver operating characteristic curve analysis. Overall survival (OS) and cancer-specific survival (CSS) were assessed with the Kaplan-Meier method and Cox regression analysis. Preoperative and postoperative LMR showed higher predictive accuracy for OS than NLR did (p = 0.034). Applying a cutoff of 3.41, change in perioperative LMR stratified patients into three groups (low, intermediate, and high risk), showing a significant difference in OS and CSS (p < 0.001, each), and pathological outcomes. Multivariable analyses for OS and CSS showed that poor changes in LMR (high risk) were an independent prognostic factor (hazard ratio 5.70, 95 % confidence interval 3.49-9.32, p < 0.001; hazard ratio 4.53, 95 % confidence interval 2.63-7.82, p < 0.001; respectively). Perioperative LMR is significantly associated with survival in patients with bladder cancer after RC, and it is possibly superior to NLR as a prognostic factor.

Perioperative change in neutrophil-lymphocyte ratio predicts the overall survival of patients with bladder cancer undergoing radical cystectomy.

OBJECTIVE: To assess the prognostic value of perioperative changes in the neutrophil-lymphocyte ratio in patients with bladder cancer undergoing radical cystectomy. METHODS: We performed a retrospective analysis of 323 patients who had undergone radical cystectomy at our institutions. Overall survival was assessed with the Kaplan-Meier method and Cox regression analysis. RESULTS: Preoperative and postoperative neutrophil-lymphocyte ratios were significantly correlated with overall survival (both P = 0.0001). Changes in perioperative neutrophil-lymphocyte ratio stratified the patients into two groups, designated favorable- and poor-risk groups, with significantly different 5-year overall survival rates (75.1% and 41.4%, respectively; P < 0.0001). Multivariate Cox regression analyses showed that the perioperative change in neutrophil-lymphocyte ratio was an independent prognostic factor for overall survival (hazard ratio 2.56, 95% confidence interval 1.75-3.73; P < 0.001). Moreover, a decrease in neutrophil-lymphocyte ratio after adjuvant chemotherapy was associated with favorable overall survival in patients with high postoperative neutrophil-lymphocyte ratio (P < 0.001), indicating that neutrophil-lymphocyte ratio may be a predictive factor for the efficacy of adjuvant chemotherapy. CONCLUSIONS: Perioperative changes in neutrophil-lymphocyte ratio are significantly associated with overall survival in patients with bladder cancer undergoing radical cystectomy. Follow-up of the neutrophil-lymphocyte ratio change may be useful for the clinical management of patients after surgery.

Comparison of diameter-axial-polar nephrometry score and RENAL nephrometry score for surgical outcomes following laparoscopic partial nephrectomy.

OBJECTIVES: To compare diameter-axial-polar nephrometry score with RENAL nephrometry score for surgical outcomes after laparoscopic partial nephrectomy. METHODS: We retrospectively reviewed data from 134 patients who underwent laparoscopic partial nephrectomy, using diameter-axial-polar and RENAL scores. We analyzed data for warm ischemic time and estimated blood loss intraoperatively, and percentage change in estimated glomerular filtration rate 6 months and 1 year postoperatively. Both scores were classified as low-, middle- and high-risk, and were used to compare the three analyzed parameters. RESULTS: The median tumor size was 2.3 cm (range 1.0-5.4 cm); warm ischemic time was 25.4 min (range 6.5-57 min); and at 6 months and 1 year, percentage change in estimated glomerular filtration rate was 93% (range 51.7-133.3%) and 91% (range 49.4-137.6%), respectively. There were no significant differences in warm ischemic time and estimated blood loss for RENAL between risk groups (P = 0.38 and 0.09, respectively), but significant differences between groups for diameter-axial-polar score (P = 0.02 and 0.01, respectively). There were no significant differences in either score between groups for percentage change in estimated glomerular filtration rate at 6 months and 1 year. A total of 27 high-risk cases with a diameter-axial-polar score of seven points underwent laparoscopic partial nephrectomy safely; all three cases with a diameter-axial-polar score of eight points were converted to open partial nephrectomy. CONCLUSIONS: Diameter-axial-polar score seems to estimate the complexity of tumor characteristics in patients undergoing laparoscopic partial nephrectomy better than RENAL score. It has a better correlation with warm ischemic time and estimated blood loss.

Maintenance of sweat glands by stem cells located in the acral epithelium.

The skin is responsible for a variety of physiological functions and is critical for wound healing and repair. Therefore, the regenerative capacity of the skin is important. However, stem cells responsible for maintaining the acral epithelium had not previously been identified. In this study, we identified the specific stem cells in the acral epithelium that participate in the long-term maintenance of sweat glands, ducts, and interadnexal epidermis and that facilitate the regeneration of these structures following injury. Lgr6-positive cells and Bmi1-positive cells were found to function as long-term multipotent stem cells that maintained the entire eccrine unit and the interadnexal epidermis. However, while Lgr6-positive cells were rapidly cycled and constantly supplied differentiated cells, Bmi1-positive cells were slow to cycle and occasionally entered the cell cycle under physiological conditions. Upon irradiation-induced injury, Bmi1-positive cells rapidly proliferated and regenerated injured epithelial tissue. Therefore, Bmi1-positive stem cells served as reservoir stem cells. Lgr5-positive cells were rapidly cycled and maintained only sweat glands; therefore, we concluded that these cells functioned as lineage-restricted progenitors. Taken together, our data demonstrated the identification of stem cells that maintained the entire acral epithelium and supported the different roles of three cellular classes.

A novel risk stratification model, involving preoperative lymphocyte-monocyte ratio and standard pathological factors, for overall survival in patients with bladder cancer undergoing radical cystectomy.

OBJECTIVE: To evaluate the ability of preoperative lymphocyte-monocyte ratio to predict prognosis and determine post-operative risk stratification in patients with bladder cancer undergoing radical cystectomy. METHODS: A retrospective review of the 210 patients who had undergone radical cystectomy for bladder cancer from 2006 to 2013 identified 181 patients with sufficient data to evaluate the prognostic significance of the lymphocyte-monocyte ratio. Overall survival was assessed by the Kaplan-Meier method. The association of clinicopathological findings with overall survival was evaluated by a multivariate Cox proportional model, and a novel risk stratification model to predict prognosis was established. RESULTS: Median follow-up after radical cystectomy was 6.0 years. The 5-year overall survival rate was significantly lower for patients with low than high lymphocyte-monocyte ratio (27.6 vs 80.7%, P < 0.001). Multivariable analyses showed that pT ≥2, pN ≥1, positive margins and low lymphocyte-monocyte ratio were independent predictors of overall survival. A post-operative risk stratification model using these factors showed significant differences among the three subgroups (low, intermediate and high risk) with a concordance index of 0.84. The 5-year overall survival rates in patients at low, intermediate and high risk were 85.4, 45.5 and 0%, respectively (P < 0.001). CONCLUSIONS: Preoperative lymphocyte-monocyte ratio, pathological tumor and lymph node stage and positive margins are significantly associated with overall survival in patients who have undergone radical cystectomy for bladder cancer.

Pathological outcomes of Japanese men eligible for active surveillance after radical prostatectomy.

BACKGROUND: The aim of this study was to analyze the pathological features of prostatectomy specimens from patients with low-risk prostate cancer eligible for active surveillance (AS) and evaluate preoperative data suitable for predicting upstaged (≥pT3) or upgraded disease (Gleason score of ≥7), defined as 'reclassification'. METHODS: A retrospective analysis of 521 consecutive radical prostatectomy procedures (January 2005 through to December 2011) performed at our institution without neoadjuvant hormonal therapy was performed. Eighty-four patients fulfilled the following criteria-clinical T1 or T2 disease, prostate-specific antigen (PSA) level of ≤10 ng/ml, one or two positive biopsies, and Gleason score of <7. Clinicopathological features at diagnosis were compared between patients with and without reclassification after radical prostatectomy. RESULTS: Forty of 84 patients (47.6 %) had a Gleason score of ≥7, and 8 (9.5 %) had upstaged disease (≥pT3). Seven patients with upstaged disease also showed upgraded reclassification. Two patients with reclassification showed biochemical recurrence at 59 and 89 months after surgery, respectively. Preoperative parameters evaluated included age, PSA level, PSA density (PSAD), clinical T stage, and number and percentage of positive prostate cores. Among 82 patients with complete data, univariate analysis showed that PSAD (ng/ml(2)) was a significant parameter to discriminate patients with reclassified disease and those without reclassified disease (p < 0.001). Multivariate analysis revealed that PSAD was the only independent variable to predict disease with reclassification (p = 0.006). CONCLUSIONS: Preoperative PSAD may be a good indicator for selecting patients eligible for AS in the Japanese population.

Two cases of gastrointestinal perforation after radiotherapy in patients receiving tyrosine kinase inhibitor for advanced renal cell carcinoma.

We report two cases of gastrointestinal perforation (GIP) after radiotherapy in patients receiving tyrosine kinase inhibitor (TKI) for advanced renal cell carcinoma (RCC). Case 1 was a 61-year-old woman with lung metastases after a radical nephrectomy for a right RCC (cT3aN0M0) treated with interferon-alpha (OIF, 5 MIU, three times per week). She developed lytic metastases of the left femur and the left acetabulum. She was treated with palliative radiotherapy to the metastatic portion (3 Gy × 10 fractions), and 400 mg sorafenib twice per day plus continuing interferon alpha. She experienced sudden left lower abdominal pain after four weeks of treatment, and was diagnosed with a perforation of the sigmoid colon with fecal peritonitis. Case 2 was a 48-year-old man with lung, lymph node, and bone metastases after a radical nephrectomy for a right RCC (cT2N0M0), and was treated with 400 mg sorafenib twice per day. He developed lytic bone metastases of the lumbar vertebrae, which was treated with palliative radiotherapy to L2-4 (3 Gy × 10 fractions). He experienced sudden abdominal pain after two months of radiation treatment, and was diagnosed with a perforation of the sigmoid colon with fecal peritonitis. These cases underwent radiotherapy, and therefore this may be related to the radiosensitivity of TKI.

A renal epithelioid angiomyolipoma/perivascular epithelioid cell tumor with TFE3 gene break visualized by FISH.

We present a case of renal epithelioid angiomyolipoma (eAML)/perivascular epithelioid cell tumor (PEComa) with a TFE3 gene break visible by fluorescence in situ hybridization (FISH). Histologically, the tumor was composed of mainly epithelioid cells forming solid arrangements with small foci of spindle cells. In a small portion of the tumor, neoplastic cells displayed nuclear pleomorphism, such as polygonal and enlarged vesicular nuclei with prominent nucleoli. Marked vascularity was noticeable in the background, and perivascular hyaline sclerosis was also seen. Immunohistochemically, neoplastic cells were diffusely positive for α-smooth muscle actin and melanosome in the cytoplasm. Nuclei of many neoplastic cells were positive for TFE3. FISH analysis of the TFE3 gene break using the Poseidon TFE3 (Xp11) Break probe revealed positive results. Reverse transcriptase-polymerase chain reactions (RT-PCR) for ASPL/TFE3, PRCC/TFE3, CLTC/TFE3, PSF/TFE3, and NonO/TFE3 gene fusions all revealed negative results. This is the first reported case of renal eAML/PEComa with a TFE3 gene break, and it has unique histological findings as compared to previously reported TFE3 gene fusion-positive PEComas. Pathologists should recognize that PEComa with TFE3 gene fusion can arise even in the kidney.

[A case of inflammatory myofibroblastic tumor of the urinary bladder].

A 61 year-old man complaining of asymptomatic gross hematuria was admitted to our hospital in May 2005. Transurethral resection of bladder tumor (TUR-BT) was performed for a bladder tumor (urothelial carcinoma (UC), pTa, G2). The TUR-BT was performed again because cystoscopy revealed a nonpapillary bladder tumor on the posterior bladder wall in September 2007. The pathological findings showed a UC, pTa, G2 and an inflammatory myofibroblastic tumor (IMT), pT1. The TUR-BT was performed two more times for tumor recurrences. We considered a total cystectomy because of the possibility of a pathologically low grade sarcoma and the considerable enlargement of the tumor size for a month after the TUR-BT. Ultimately, a malignant sarcoma was not diagnosed from the pathological findings. We practiced conservative therapy with a steroid and the tumor was reduced.

Uninterrupted suturing of renal parenchyma in laparoscopic partial nephrectomy decreases renal ischemic time and intraoperative blood loss.

We examined factors affecting renal ischemic time and intraoperative blood loss in laparoscopic partial nephrectomy and attempted to determine which method of suture for parenchymal closure is effective in this operation. Fifty-seven patients who underwent laparoscopic partial nephrectomy were studied. Some variables and methods of suture for parenchymal closure were tested for independent effects on ischemic time and bleeding volume. Mean renal ischemic time and estimated blood loss were 38 min and 175 mL, respectively. Method of suture for parenchymal closure was the only factor independently associated with intraoperative blood loss less than 100 mL. Furthermore, uninterrupted suture for parenchymal closure was a significant factor associated with renal ischemic time less than 30 min. Renal ischemic time or intraoperative blood loss can be decreased by using uninterrupted suture for parenchymal defect.

[Recent advances of urological laparoscopic surgery in Japan].

Urologic laparoscopic surgeries started with varicocelectomies, pelvic lymphadenectomies and nephrectomies in 1989-90. According to the nation-wide survey in Japan, the percentages of surgeries performed laparoscopically are 43, 17 and 21% among all adrenalectomies, radical nephrectomies and partial nephrectomies, respectively. The incidence of complications and open conversion reduced significantly during these 20 years from 9.7 to 5.3% and from 5.2 to 2.6%, respectively. The perioperative mortality rate among 25,393 urologic laparoscopic surgeries was 0.047%. A surgical robot, da Vinci was accepted by the Japanese Government in 2009. Robotic-assisted laparoscopic surgeries and laparoendoscopic single-site surgeries will be the major progress in Japan.

Hematobium schistosomiasis control for health management of labor force generation at Nkhotakota and Lilongwe in the Republic of Malawi-assumed to be related to occupational risk.

BACKGROUND: In Malawi, hematobium schistosomiasis is highly endemic. According to previous studies, countermeasures have been conducted mainly in school-aged children. In this study, we focused on the age groups, which are assumed to be major labor force generation. Hematobium schistosomiasis is supposed to be related to occupational activities in schistosome-endemic countries because of its infectious route. We chronologically followed the transition of schistosome egg-positive prevalence before and after mass drug administration of praziquantel (MDA) by using a urine filtering examination. We also analyzed the effectiveness of urine reagent strips from the cost perspective. RESULTS: The egg-positive prevalence was 34.3% (95% CI 28.5-40.5) just before MDA in June 2010 and the highest prevalence was in the age of twenties. The egg-positive prevalence reduced to 12.7% (95% CI 9.2-17.3, p < 0.01) 8 weeks after the first MDA and the prevalence reduced to 6.9% (95% CI 4.6-10.0, p < 0.01) after the second MDA in August 2011. The egg-positive prevalence after MDA in 2013 was reduced from 3.8% (95% CI 2.1-6.9) to 0.9% (95% CI 0.3-3.4) and p value was 0.050. Using urine reagent strips after MDA, the positive predictive value decreased, but the negative predictive value remained high. The cost of one urine reagent strip and one tablet of praziquantel were US$0.06 and US$0.125 in 2013 in Malawi. If the egg-positive prevalence is 40%, screening subjects for MDA using urine reagent strips, the cost reduction can be estimated to be about 24%, showing an overall cost reduction. CONCLUSIONS: MDA of praziquantel can assuredly reduce schistosome egg-positive prevalence. The combination of MDA and urine reagent strips could be both a practical and cost-effective countermeasure for hematobium schistosomiasis. It is key to recognize that hematobium schistosomiasis could be considered a disease that is assumed to have some concern with occupational risk at Nkhotakota and Lilongwe in Malawi. From this point of view, it is very important to manage workers' health; the sound labor force generation is vital for economic growth and development in these areas and countries.

The narrow vesicourethral angle measured on postoperative cystography can predict urinary incontinence after robot-assisted laparoscopic radical prostatectomy.

OBJECTIVE: Radical prostatectomy is associated with complications including urinary incontinence. A significant association between specific features of the vesicourethral anastomosis and urinary incontinence after radical prostatectomy has been demonstrated. The aim of this study was to identify the most useful predictor of postoperative urinary incontinence after robot-assisted laparoscopic radical prostatectomy (RALP) according to the features of the vesicourethral anastomosis as determined by postoperative cystography. MATERIALS AND METHODS: The final study cohort consisted of 150 patients. Postoperative cystography was performed within 1 week after RALP. The ratio between the longitudinal and horizontal lengths (L/H) of the bladder, the position of the urethrovesical junction (UVJ) and the bladder neck angle as seen on the cystogram were evaluated. Postoperative continence status was evaluated by a 1 h pad test 1 day after catheter removal and by the use of safety pads, retrieved retrospectively from patient records. The association between these variables and urinary incontinence was then analyzed. All patients were followed for at least 1 year postoperatively. RESULTS: The continence rates on the 1 h pad test and 1 month and 1 year after RALP were 31.3%, 56% and 93.3%, respectively. In multivariate analyses, urinary incontinence was significantly associated with nerve sparing, L/H and the vesical angle as determined on the 1 h pad test, but only with the vesical angle at 1 month and 1 year postoperatively. CONCLUSION: A narrow vesical angle measured on cystography is a useful predictor of postoperative urinary incontinence after RALP.

Influence of scars on body image consciousness with respect to gender following laparoendoscopic single-site versus conventional laparoscopic surgery.

OBJECTIVE: The aim of this study was to evaluate and compare the cosmetic outcomes of laparoscopic single-site surgery (LESS) and conventional laparoscopy (CL) in the treatment of ureteropelvic junction obstruction (UPJO) and urachal remnant removal. LESS is thought to produce better cosmetic results than CL; however, patients' perception of their scars has not been assessed. This study compared the subjective body image and cosmesis ratings of patients who had undergone LESS or CL for UPJO and urachal remnant removal. MATERIALS AND METHODS: Fifty patients who underwent LESS or CL for UPJO or urachal remnant removal between June 2008 and June 2015 were included. Cosmetic outcomes were evaluated using the Body Image Questionnaire (BIQ) and Photo-Series Questionnaire (PSQ). RESULTS: The body image and cosmetic scores were significantly higher for patients who underwent LESS than for those who underwent CL, for both pyeloplasty and urachal remnant removal (p < .05 each). When performed for either a pyeloplasty or urachal remnant removal, significantly greater BIQ and PSQ scores were observed in females after LESS compared to CL, but not in males. CONCLUSION: LESS for UPJO and urachal remnant removal has better self-reported body image and cosmesis ratings than CL. This trend is particularly strong in female patients.