Utility of the modified 5-item frailty index as a predictor of postoperative febrile urinary tract infection in patients who underwent ureteroscopy with laser lithotripsy.

PURPOSE: This study aimed to assess the effect of the modified 5-item frailty index on perioperative complications and surgical outcomes in patients who underwent ureteroscopy with laser lithotripsy for upper urinary tract stones. METHODS: Patients who underwent ureteroscopy with laser lithotripsy for upper urinary tract stones between 2019 and 2022 were reviewed retrospectively. Assessment was performed using the modified 5-item frailty index based on medical history (hypertension, diabetes, heart failure, chronic obstructive pulmonary disease) and functional status. Patients were categorized into the high (≥ 2) and low (≤ 1) modified 5-item frailty index groups based on the frailty score. We compared the perioperative complications and surgical outcomes between the two groups. RESULTS: Seventy-one (15.8%) and 393 (84.1%) of the 467 patients were classified into the high and low modified 5-item frailty index groups, respectively. The high modified 5-item frailty index group exhibited a significant association with increased febrile urinary tract infections compared to the low modified 5-item frailty index group [≥ 37.8 °C: 15 (20.3%) vs 13 (3.3%), p < 0.001; ≥ 38 °C: 9 (12.2%) vs 7 (1.8%), p < 0.001]. Surgical outcomes, including operative time and stone-free rate, did not differ significantly between the two groups. CONCLUSION: The modified 5-item frailty index is valuable for predicting postoperative complications, particularly febrile urinary tract infections, after ureteroscopy with laser lithotripsy for upper urinary tract stones. This index allows for practical preoperative risk assessment in patients who underwent ureteroscopy with laser lithotripsy.

Transrectal high-intensity focused ultrasound for treatment of localized prostate cancer.

OBJECTIVES: To assess the long-term outcomes of transrectal high-intensity focused ultrasound (HIFU) for patients with localized prostate cancer. METHODS: From May 2003 to present, 137 consecutive patients with T1-2 prostate cancer were treated using the Sonablate 500 and then followed for more than 12 months after their last HIFU treatment. A prostate biopsy was routinely carried out at 6 months and serum prostate-specific antigen (PSA) was measured every 3 months after HIFU. Oncological outcomes as well as treatment-related complications were assessed. Disease-free survival (DFS) was judged using the Phoenix definition (PSA nadir + 2 ng/mL), negative histological findings and no local or distant metastasis. RESULTS: The median follow up after HIFU was 36 months (range 12-84 months). No patients received adjuvant therapy during this period. The PSA nadir occurred at 2 months after HIFU and the median level was 0.07 ng/mL (0.01-2.01 ng/mL). Of the 133 patients who underwent prostate biopsy or transurethral resection of the prostate at 6 months or later after HIFU, six were positive for cancer cells (4.5%). There were no major postoperative complications, but urge incontinence (16 cases) and dysuria (33 cases) occurred after removal of the urethral catheter. The 5-year DFS rate was 78% based on these criteria, and 91%, 81% and 62% in the low-, intermediate- and high-risk group, respectively. CONCLUSIONS: HIFU represents an effective, repeatable and minimally invasive treatment. It is particularly effective for low- and intermediate-risk patients, and it should be considered as an option for localized prostate cancer.

[Experience of nephroureterectomy with modified "pluck" method--En bloc removal of kidney and ureter].

PURPOSE: Transurethral removal of the ureter in nephroureterectomy has been reported by several centers as being a useful procedure. We also have employed this procedure in selective cases, but we had several problems in this procedure. So we tried the modified pluck nephroureterectomy technique (En bloc removal of kidney and ureter) to improve the procedure. MATERIALS AND METHODS: Since October 1999 to September 2000, we employed this technique in 9 cases with renal pelvic or ureteral tumor, 2 with renal cell carcinoma and 3 with benign diseases. Standard nephrectomy is performed. After transurethral resection of the ureteral meatus, the distal ureter is freed by blind retroperitoneal dissection and plucked out of the bladder in continuity with the kidney. The bladder is drainaged for 6-10 days after surgery. RESULTS: The average time and blood loss during the operation were 247 minutes and 287 ml. No appreciable complications such as retroperitoneal urine leakage or hemorrhage during or after the procedure were observed. CONCLUSIONS: The modified pluck technique is useful because of its easiness and minimal invasiveness.

Efficacy of short-term androgen deprivation with high-intensity focused ultrasound in the treatment of prostate cancer in Japan.

OBJECTIVES: To determine whether combining short-term neoadjuvant androgen deprivation therapy (NADT) with high-intensity focused ultrasound (HIFU) had a significant benefit in a large population of men with nonmetastatic prostate cancer (CaP). METHODS: We evaluated the records of 530 patients whose prostate-specific antigen (PSA) level at diagnosis was 30 ng/mL or less and whose follow-up period was not less than 12 months, at seven investigational sites. Two hundred seventy patients had received NADT (within 6 months), and 260 had not. The primary outcome measure was disease-free survival according to the combined criteria satisfying the Phoenix definition (less than nadir + 2), negative prostate biopsy, and no findings of distant metastasis after the last HIFU treatment. The significance of the differences of values or the distributions of each parameter between two groups was evaluated with a Mann-Whitney U test, unpaired t test, or chi-square test, and a multivariate Cox proportional hazards model was used to evaluate the prognostic relevance of preoperative parameters. RESULTS: Statistical analyses showed that the NADT group had worse disease (higher PSA and risk group) than the HIFU-only group. Variables shown by multivariate analyses to be significant prognostic parameters were pretreatment PSA level, clinical stage, and no use of NADT. Short-term NADT significantly improved the 3-year disease-free survival rate of patients with intermediate-risk and high-risk CaP. During follow-up the frequencies of complications did not differ significantly with or without NADT. CONCLUSIONS: Our retrospective study suggests that combining short-term NADT with HIFU treatment is of significant clinical benefit to intermediate-risk and high-risk CaP patients without increasing the likelihood of complications.

Transrectal high-intensity focused ultrasound for treatment for patients with biochemical failure after radical prostatectomy.

Four patients with biochemical prostate-specific antigen (PSA) failure with suspected local recurrence at the vesico-urethral anastomotic site after radical prostatectomy were treated using a high-intensity focused ultrasound (HIFU) device (Sonablate 500) under caudal or spinal anesthesia. The pretreatment PSA levels ranged from 0.318 to 0.898 ng/mL and their Gleason scores ranged between 5 and 7. HIFU treatment was carried out six times in four patients. The median time of operation and follow-up period were 30 min (range, 15-37) and 13 months (range, 7-18), respectively. In all patients, the median PSA levels decreased from 0.555 ng/mL (range, 0.318-0.898) to 0.137 ng/mL (range, 0.102-0.290). The median PSA nadir after each HIFU was 0.054 ng/mL (range, 0.008-0.097). No major complications were noted. HIFU may be useful for the therapy of vesicourethral anastomostic lesion in patients with PSA failure after prostatectomy.

Modified pluck method in en bloc nephroureterectomy with bladder cuff for upper urothelial cancer.

AIM: To evaluate the surgical results of the en bloc removal of the kidney and ureter with a bladder cuff by using our modified pluck method. METHODS: We employed this procedure in 28 patients with renal pelvic and ureteral cancer. The clinical stages of the 28 patients were T(1-3)N(0-1)M(0). These patients were operated on by nephrectomy with standard open or retroperitoneoscopic surgery, and then standard or blind dissection of the distal ureter. After simultaneously making a transurethral circular incision of the ureteral meatus with a J-shaped electrode, the ureteral end was plucked out of the bladder, and en bloc removal of the kidney and ureter was performed from the wound. RESULTS: The mean operating time for nephroureterectomy using the pluck method was 278 min in all cases. The mean time for the pluck procedure after nephrectomy was 24 min in 22 cases, and 73 min in six cases where the nephrectomy was carried out via a new lower pararectal wound. There were no intra- or postoperative complications associated with these procedures. Within the mean follow-up period of 25 months, there was no recurrence of tumors in the perivesical retroperitoneal space; however, the usual rate of intravesical recurrence was observed. Three patients died, two of metastatic urothelial cancer and one of heart disease. CONCLUSIONS: En bloc nephroureterectomy using our modified pluck method is a useful procedure for patients with upper urothelial cancer because of the simplicity and ease of the procedure.