TNM-Based Head-to-Head Comparison of Urachal Carcinoma and Urothelial Bladder Cancer: Stage-Matched Analysis of a Large Multicenter National Cohort / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Outcome analysis of urachal cancer (UraC) is limited due to the scarcity of cases and different staging methods compared to urothelial bladder cancer (UroBC). We attempted to assess survival outcomes of UraC and compare to UroBC after stage-matched analyses. @*Materials and Methods@#Total 203 UraC patients from a multicenter database and 373 UroBC patients in single institution from 2000 to 2018 were enrolled (median follow-up, 32 months). Sheldon stage conversion to corresponding TNM staging for UraC was conducted for head-to-head comparison to UroBC. Perioperative clinical variables and pathological results were recorded. Stage-matched analyses for survival by stage were conducted. @*Results@#UraC patients were younger (mean age, 54 vs. 67 years; p < 0.001), with 163 patients (80.3%) receiving partial cystectomy and 23 patients (11.3%) radical cystectomy. UraC was more likely to harbor ≥ pT3a tumors (78.8% vs. 41.8%). While 5-year recurrence-free survival, cancer-specific survival (CSS) and overall survival were comparable between two groups (63.4%, 67%, and 62.1% in UraC and 61.5%, 75.9%, and 67.8% in UroBC, respectively), generally favorable prognosis for UraC in lower stages (pT1-2) but unfavorable outcomes in higher stages (pT4) compared to UroBC was observed, although only 5-year CSS in ≥ pT4 showed statistical significance (p=0.028). Body mass index (hazard ratio [HR], 0.929), diabetes mellitus (HR, 1.921), pathologic T category (HR, 3.846), and lymphovascular invasion (HR, 1.993) were predictors of CSS for all patients. @*Conclusion@#Despite differing histology, UraC has comparable prognosis to UroBC with relatively favorable outcome in low stages but worse prognosis in higher stages. The presented system may be useful for future grading and risk stratification of UraC.

Clinical Significance of Rab27a as a Urinary Biomarker in Patients With Bladder Cancer

Purpose@#The aims of this study were to investigate the clinical value of Rab27a as a urinary biomarker, and its efficiency in the prediction of bladder cancer grade. @*Materials and Methods@#The expression of Rab27a in urine samples of patients with bladder cancer, cell line (T-24), and tissue samples of patients with bladder cancer was estimated via quantitative reverse transcription polymerase chain reaction (qRT-PCR). The Rab27a expression level was investigated according to sex, age, and histological grade via qRT-PCR and Western blotting. @*Results@#Rab27a was also expressed at high levels in urine compared to cell lines and tissues from bladder cancer patients. In addition, Rab27a expression varied significantly according to tumor grade (p<0.001). Rab27a was expressed at high levels in male and elderly patients, however, there was not statistically significant. @*Conclusions@#Our results indicated that Rab27a is valuable as a urinary diagnostic biomarker for bladder cancer. In addition, it may serve as a predictive factor for determining bladder cancer grade.

Combination of Korean Red Ginseng Extract and Hydrogen-Rich Water Improves Spermatogenesis and Sperm Motility in Male Mice / 中国结合医学杂志

OBJECTIVE@#To investigate the effect of hydrogen-rich Korean Red Ginseng (KRG) water (HRGW) mixture on the spermatogenesis and sperm motility of mice of different ages.@*METHODS@#Eighty young (3 month-old) and aged (12 month-old) male mice were randomly assigned to 4 groups (n =10 per group) including control group, hydrogen-rich water (HRW) group (10 mL/kg daily), KRG group (50 mg/kg daily) and HRGW group (10 mL/kg and 50 mg/kg daily) by an oral zoned needle for 4 weeks. Sperm count and motility were measured using sperm suspension released from cauda epididymis. Serum follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and reactive oxygen species (ROS) in serum have also been estimated. Tubular changes were examined through histological hematoxylin and eosin staining. Expression of antioxidation (PPx3, PPx4, GSTm5 and GPx4), spermatogenesis (inhibin-a, neptin-2 and CREM), antiaging (SIRT1 and SIRT2), and angiogenesis [visfatin and vascular endothelial growth factor (VEGF)] related genes were examined through real-time polymerase chain reaction.@*RESULTS@#HRW and KRG treatment stimulated spermatogenesis followed by increasing sperm production and sperm motility (P <0.05). These effects were strengthened synergistically by a HRGW mixture (P <0.05 or P <0.01). HRGW greatly increased the expressions of antioxidation, antiaging, spermatogenesis related genes and VEGF especially in aged mice (P <0.05). Serum testosterone and FSH levels also increased, while serum ROS level decreased (all P <0.05).@*CONCLUSION@#HRGW increases sperm production and motility by enhancing antioxidation and stimulating spermatogenesis and sex hormone production, particularly in aged mice.

Risk Factors for pT3a Prostate Cancerin the Patients With cT1-2 on PreoperativeMultiparametric Magnetic Resonance Imaging

Purpose@#Our study aimed to evaluate the predictive value of multiparametric magnetic resonance imaging (mpMRI)to assess the capsular extension of prostate cancer. Risk factors for extraprostatic invasion or microscopic invasionof bladder neck (pT3a stage) in the cases showing localized disease findings on MRI scan were also identified. @*Materials and Methods@#We identified 198 patients who underwent robot-assisted or conventional laparoscopicradical prostatectomy in our institute between June, 2016 and May, 2018. Altogether, 170 patients withpreoperational mpMRI scans and complete pathologic data were included. Positive and negative predictive valuesof mpMRI to detect capsular extension were estimated. Chi-square test was performed for ratio variables. Logisticregression analysis was performed to identify capsular invasion risk factors. @*Results@#Median age and prostate-specific antigen level were 68 years and 7.5 ng/mL, respectively. Based onfindings, 16 patients (9.4%) were identified as cT3a stage (unilateral or bilateral extraprostatic extension), whereas37 patients (21.8%) as pT3a stage. Positive and negative predictive values of mpMRI to detect capsular extensionwere 75.0% and 73.9%, respectively. In the logistic regression analysis, positive biopsy core rate was the significantpredictor for pT3a disease in the patients with negative capsular invasion findings on mpMRI (p<0.001). Accordingto receiver-operating characteristic curve (area under the curve=0.691, p=0.001), the positive biopsy core rateof 0.275 was the best threshold. @*Conclusions@#Multiparametric MRI is an appropriate test to predict pT3a disease preoperatively. The patients withpositive core rate over 0.275 may have pT3a diseases despite negative image findings.

Cribriform Pattern at the Surgical Margin is Highly Predictive of Biochemical Recurrence in Patients Undergoing Radical Prostatectomy / 고신대학교의과대학학술지

OBJECTIVES: We investigated the relationship between cribriform patterns and biochemical recurrence in patients with positive surgical margins after radical prostatectomy.METHODS: This study was based on radical prostatectomy specimens obtained from 817 patients (165 with margin-positive status) collected at a single center between 2010 and 2016. We retrospectively analyzed and compared body mass index, preoperative prostate-specific antigen, Gleason score, operative methods, postoperative Gleason score, pathological T-stage, tumor percentage involvement, lymphatic and perineural invasion, prostate-specific antigen nadir, location and length of the positive margin, cribriform pattern status, and Gleason grade at the surgical margin in terms of their association with biochemical recurrence. Risk factors for biochemical recurrence were also investigated.RESULTS: 21% (31/146) of surgical margin-positive patients had a cribriform pattern. Nadir prostate-specific antigen, perineural invasion and biochemical recurrence rates were significantly higher in cribriform pattern present group than absent group (P = 0.031, 0.043 and 0.045, respectively). According to the Cox regression model, postoperative Gleason score, tumor percentage involvement, location and length of the positive margin, and the presence of a cribriform pattern at the surgical margin were significant predictive factors of biochemical recurrence (P = 0.022, < 0.001, 0.015, 0.001, and 0.022, respectively). Moreover, the biochemical recurrence risk was approximately 3-fold higher in patients with a cribriform pattern at the surgical margin than in those without (HR: 3.41, 95% CI 1.20-9.70, P = 0.022).CONCLUSIONS: A cribriform pattern at the surgical margin is a significant predictor of biochemical recurrence in patients who undergo radical prostatectomy.

Relationship between Video Head Impulse Gain and Severity of Dizziness in Patients with Vestibular Neuritis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We evaluated the correlation between video head impulse test (vHIT) and dizziness handicap inventory (DHI), which is commonly used to quantify severity of dizziness in vestibular neuritis (VN). SUBJECTS AND METHOD: Twenty VN patients undergoing vHIT either at the acute or follow-up stages of treatment were assessed by DHI questionnaire. Gain and gain asymmetry (GA) were correlated with DHI scores and abnormal vHIT rates were compared according to the severity of dizziness (mild ≤30; moderate-to-severe ≥32). RESULTS: vHIT gains significantly increased from the acute to follow-up stages (from 0.45±0.18 to 0.70±0.25), whereas GA and DHI scores decreased (GA, from 0.36±0.15 to 0.22±0.18; DHI scores, from 35±26 to 23±23). Although vHIT gains or GA showed no correlation with DHI scores at the acute stage, vHIT gains showed significant correlation with DHI scores at the follow-up (R-sq=0.32, p=0.01) stage. vHIT gains and GA did not differ according to the severity of dizziness during the acute stage; however, vHIT gains (0.78±0.25) of patients with mild dizziness were significantly higher than those (0.51±0.14) with moderate-to-severe dizziness at the follow-up stage. During the follow-up, all patients with moderate-to-severe dizziness showed abnormal vHIT gain, but 43% of patients with mild dizziness showed abnormal vHIT gain, showing a significant difference (p<0.05). CONCLUSION: Reduced vHIT gain was significantly correlated with high degrees of dizziness at the follow-up, but not at the acute stage, suggesting that high-frequency canal dysfunction is contributed in part by the subjective dizziness at the follow-up. Our findings suggest that vHIT might give an indirect evidence for implementing vestibular rehabilitation for enhancing impaired vestibular function and relieving subjective dizziness.

Comparison of Aided and Unaided Thresholds and Selection Processes of Contralateral Routing of Signal Hearing Aids and Implantable Bone Conduction Devices in Patients with Asymmetric Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We reviewed the selection processes of contralateral routing of signal (CROS) hearing aids (HAs) and bone-conduction (BC) Has, and compared aided and unaided hearing thresholds. SUBJECTS AND METHOD: Twenty-four patients with asymmetrical hearing loss who used BC HAs (n=12) and CROS HAs (n=12) were enrolled. The choice of two different HAs were compared with respect to the degree of hearing loss, the unaided hearing thresholds and functional gains. RESULTS: When the hearing thresholds of the better hearing ears were >30 dB HL, most (92%, 11 of 12) chose CROS rather than BC HAs, with significant difference (p=0.001). Both CROS and BC HAs groups showed significantly improved functional gains (46.6 dB and 53.4 dB, respectively). Aided air-conduction (AC) thresholds (40.2 dB HL) in the CROS group were similar to the AC thresholds (43.1 dB HL) of better hearing ears. However, the hearing threshold of Aided AC thresholds (35.8 dB HL) in BC HAs group were less than the BC thresholds (17.3 dB HL) of better hearing ears by 19 dB (p30 dB HL. The CROS group showed aided thresholds similar to the thresholds of better hearing ears, but the BC HAs group showed poorer aided thresholds than the thresholds of better hearing ears. For patients with asymmetric hearing loss, HAs should be selected based on the degree and types of hearing loss and the maximum output level of the selected device.

Relationship between Video Head Impulse Gain and Severity of Dizziness in Patients with Vestibular Neuritis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#We evaluated the correlation between video head impulse test (vHIT) and dizziness handicap inventory (DHI), which is commonly used to quantify severity of dizziness in vestibular neuritis (VN).SUBJECTS AND METHOD: Twenty VN patients undergoing vHIT either at the acute or follow-up stages of treatment were assessed by DHI questionnaire. Gain and gain asymmetry (GA) were correlated with DHI scores and abnormal vHIT rates were compared according to the severity of dizziness (mild ≤30; moderate-to-severe ≥32).@*RESULTS@#vHIT gains significantly increased from the acute to follow-up stages (from 0.45±0.18 to 0.70±0.25), whereas GA and DHI scores decreased (GA, from 0.36±0.15 to 0.22±0.18; DHI scores, from 35±26 to 23±23). Although vHIT gains or GA showed no correlation with DHI scores at the acute stage, vHIT gains showed significant correlation with DHI scores at the follow-up (R-sq=0.32, p=0.01) stage. vHIT gains and GA did not differ according to the severity of dizziness during the acute stage; however, vHIT gains (0.78±0.25) of patients with mild dizziness were significantly higher than those (0.51±0.14) with moderate-to-severe dizziness at the follow-up stage. During the follow-up, all patients with moderate-to-severe dizziness showed abnormal vHIT gain, but 43% of patients with mild dizziness showed abnormal vHIT gain, showing a significant difference (p<0.05).@*CONCLUSION@#Reduced vHIT gain was significantly correlated with high degrees of dizziness at the follow-up, but not at the acute stage, suggesting that high-frequency canal dysfunction is contributed in part by the subjective dizziness at the follow-up. Our findings suggest that vHIT might give an indirect evidence for implementing vestibular rehabilitation for enhancing impaired vestibular function and relieving subjective dizziness.

Comparison of Aided and Unaided Thresholds and Selection Processes of Contralateral Routing of Signal Hearing Aids and Implantable Bone Conduction Devices in Patients with Asymmetric Hearing Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES@#We reviewed the selection processes of contralateral routing of signal (CROS) hearing aids (HAs) and bone-conduction (BC) Has, and compared aided and unaided hearing thresholds.SUBJECTS AND METHOD: Twenty-four patients with asymmetrical hearing loss who used BC HAs (n=12) and CROS HAs (n=12) were enrolled. The choice of two different HAs were compared with respect to the degree of hearing loss, the unaided hearing thresholds and functional gains.@*RESULTS@#When the hearing thresholds of the better hearing ears were >30 dB HL, most (92%, 11 of 12) chose CROS rather than BC HAs, with significant difference (p=0.001). Both CROS and BC HAs groups showed significantly improved functional gains (46.6 dB and 53.4 dB, respectively). Aided air-conduction (AC) thresholds (40.2 dB HL) in the CROS group were similar to the AC thresholds (43.1 dB HL) of better hearing ears. However, the hearing threshold of Aided AC thresholds (35.8 dB HL) in BC HAs group were less than the BC thresholds (17.3 dB HL) of better hearing ears by 19 dB (p30 dB HL. The CROS group showed aided thresholds similar to the thresholds of better hearing ears, but the BC HAs group showed poorer aided thresholds than the thresholds of better hearing ears. For patients with asymmetric hearing loss, HAs should be selected based on the degree and types of hearing loss and the maximum output level of the selected device.

Long-term oncologic outcomes of postoperative adjuvant versus salvage radiotherapy in prostate cancer: Systemic review and meta-analysis of 5-year and 10-year follow-up data

PURPOSE: To evaluate the oncologic outcomes between adjuvant radiotherapy (ART) and salvage radiotherapy (SRT) in patients with locally advanced prostate cancer or with adverse pathologic factors including positive surgical margin and high Gleason score. MATERIALS AND METHODS: We searched the literature published from January 2000 until December 2014 at MEDLINE, PubMed, Web of Science, Embase, ProQuest, and Cochrane Library. To be specific, included were studies comparing ART and SRT settings if they followed up oncologic outcomes more than 5 years. RESULTS: Overall, 3 retrospective, nonrandomized, observational studies, 1 matched control analysis, and 3 prospective randomized controlled studies met our inclusion criteria including a total of 2,380 patients (1,192 ART vs. 1,188 SRT). Higher favorable results were found in ART than in SRT was seen in the 5-year and 10-year biochemical recurrence (BCR)-free survival (risk ratio [RR], 0.61 and 0.70; 95% confidence interval [CI], 0.54-0.69 and 0.63-0.76). ART had a significantly higher 5-year progression-free survival rate than that in SRT (RR, 0.64; 95% CI, 0.51-0.80), but this was not the same for the 10-year progression-free survival rate (RR, 0.88; 95% CI, 0.72-1.08). There was no significant difference for the 5-year and 10-year overall survival rates between ART and SRT (RR, 0.80 and 0.94; 95% CI, 0.59-1.07 and 0.80-1.11). CONCLUSIONS: ART showed favorable results in BCR-free survival during the 5-year follow-up period. However, the 10-year progression-free survival and overall survival did not show any difference between ART and SRT.

Semen Analysis in Cancer Patients Referred for Sperm Cryopreservation before Chemotherapy over a 15-Year Period in Korea

PURPOSE: This study evaluated the demographics and semen parameters of males with cancer who banked their sperm prior to chemotherapy. MATERIALS AND METHODS: This is a retrospective study of 66 cases referred for sperm banking prior to initiation of chemotherapy over a 15-year period (1999~2014). Patients who had previously received cancer treatment including chemotherapy or radiotherapy were not included in this study. RESULTS: We studied a total of 66 cancer patients referred for cryopreservation of sperm prior to chemotherapy. The mean age of the patients at the time of banking was 32.0+/-7.9 years (range, 19~58 years). The types of cancer were testicular cancer (31 cases, 47.0%), non-Hodgkin's disease (10 cases, 15.1%), Hodgkin's disease (5 cases, 7.6%), leukemia (8 cases, 12.1%), gastrointestinal malignancy (5 cases, 7.6%), and musculoskeletal malignancy (5 cases, 7.6%). There were significant differences in sperm concentration and viability among the various types of cancer, but no significant difference in semen volume or sperm motility and morphology. CONCLUSIONS: In this study we found that sperm quality could decrease even before chemotherapy. Because chemotherapy can also negatively affect spermatogenesis, sperm cryopreservation prior to treatment should be strongly recommended for cancer patients of reproductive age.

Learning Curve of Robot-Assisted Laparoscopic Radical Prostatectomy for a Single Experienced Surgeon: Comparison with Simultaneous Laparoscopic Radical Prostatectomy

PURPOSE: Despite the large number of analytical reports regarding the learning curve in the transition from open to robot-assisted radical prostatectomy (RARP), few comparative results with laparoscopic radical prostatectomy (LRP) have been reported. Thus, we evaluated operative and postoperative outcomes in RARP versus 100 simultaneously performed LRPs. MATERIALS AND METHODS: A single surgeon had performed more than 1,000 laparoscopic operations, including 415 cases of radical nephrectomy, 85 radical cystectomies, 369 radical prostatectomies, and treatment of 212 other urological tumors, since 2009. We evaluated operative (operation time, intraoperative transfusion, complications, hospital stay, margin status, pathological stage, Gleason score) and postoperative (continence and erectile function) parameters in initial cases of RARP without tutoring compared with 100 recently performed LRPs. RESULTS: Mean operation time and length of hospital stay for RARP and LRP were 145.5+/-43.6 minutes and 118.1+/-39.1 minutes, and 6.4+/-0.9 days and 6.6+/-1.1 days, respectively (p=0.003 and p=0.721). After 17 cases, the mean operation time for RARP was similar to LRP (less than 2 hours). Positive surgical margins in localized cancer were seen in 11.1% and 8.9% of cases in RARP and LRP, respectively (p=0.733). At postoperative 3 months, sexual intercourse was reported in 14.0% and 12.0%, and pad-free continence in 96.0% and 81.0% in patients with RARP and LRP, respectively (p=0.796 and p=0.012). CONCLUSIONS: Previous large-volume experience of LRPs may shorten the learning curve for RARP in terms of oncological outcome. Additionally, previous experience with laparoscopy may improve the functional outcomes of RARP.

Evaluation of holmium laser for transurethral deroofing of severe and multiloculated prostatic abscesses

PURPOSE: Our objective was to evaluate the use of a holmium laser for transurethral deroofing of a prostatic abscess in patients with severe and multiloculated prostatic abscesses. MATERIALS AND METHODS: From January 2011 to April 2014, eight patients who were diagnosed with prostatic abscesses and who underwent transurethral holmium laser deroofing at Pusan National University Hospital were retrospectively reviewed. RESULTS: Multiloculated or multifocal abscess cavities were found on the preoperative computed tomography (CT) scan in all eight patients. All patients who underwent transurethral holmium laser deroofing of a prostatic abscess had successful outcomes, without the need for secondary surgery. Of the eight patients, seven underwent holmium laser enucleation of the prostate (HoLEP) for the removal of residual adenoma. Markedly reduced multiloculated abscess cavities were found in the follow-up CT in all patients. No prostatic abscess recurrence was found. Transient stress urinary incontinence was observed in three patients. The stress urinary incontinence subsided within 3 weeks in two patients and improved with conservative management within 2 months in the remaining patient. CONCLUSIONS: Transurethral holmium laser deroofing of prostatic abscesses ensures successful drainage of the entire abscess cavity. Because we resolved the predisposing conditions of prostatic abscess, such as bladder outlet obstruction and prostatic calcification, by simultaneously conducting HoLEP, there was no recurrence of the prostatic abscesses after surgery. We recommend our method in patients requiring transurethral drainage.

The effect of continuous androgen deprivation treatment on prostate cancer patients as compared with intermittent androgen deprivation treatment

PURPOSE: To investigate the efficacy of androgen deprivation treatment (ADT) between continuous and intermittent ADT. MATERIALS AND METHODS: Between January 2006 and May 2015, 603 patients were selected and divided into continuous ADT (CADT) (n=175) and intermittent ADT (IADT) (n=428) groups. The median follow-up in this study was 48.19 (1.0-114.0) months. The primary end point was time to castration resistant prostate cancer (CRPC). The types of ADT were monotherapy and maximal androgen blockade (i.e., luteinizing hormone-releasing hormone agonist and antiandrogen). RESULTS: The characteristics of patients showed no significant differences between the CADT and IADT groups, except for the Gleason score (p<0.001). The median time to CRPC of all enrolled patients with ADT was 20.60±1.60 months. The median time to CRPC was 11.20±1.31 months in the CADT group as compared with 22.60±2.08 months in the IADT group. In multivariate analysis, percentage of positive core (p=0.047; hazard ratio [HR], 0.976; 95% confidence interval [CI], 0.953-1.000), Gleason score (p=0.007; HR, 1.977; 95% CI, 1.206-3.240), lymph node metastasis (p=0.030; HR, 0.498; 95% CI, 0.265-0.936), bone metastasis (p=0.028; HR, 1.921; 95% CI, 1.072-3.445), and CADT vs. IADT (p=0.003; HR, 0.254; 95% CI. 0.102-0.633) were correlated with the duration of progression to CRPC. The IADT group presented a significantly longer median time to CRPC compared with the CADT group. Additionally, patients in the IADT group showed a longer duration in median time to CRPC in subgroup analysis according to the Gleason score. CONCLUSIONS: This study found that IADT produces a longer duration in median time to CRPC than does CADT.

Clinical Characteristics and Treatment of Cryptorchidism in Adults: A Single Center Experience

PURPOSE: We evaluated the clinical and therapeutic characteristics of adult cryptorchidism, which have been difficult to establish, given the small number of patients presenting to outpatient clinics. MATERIALS AND METHODS: A retrospective study of 20 adult patients with cryptorchid testis was performed. We analyzed their palpation of testis, location, surgical method, marital status, number of children, histologic findings, and semen analysis. RESULTS: In 17 cases with unilateral cryptorchidism, the mean age at surgery was 31.1+/-12.5 years. Fourteen patients had a palpable, small cryptorchid testis. The location of the testis, as verified, was inguinal in 14, prepubic in 2, and intra-abdominal in 1, respectively. We performed orchiopexy in 14 out of 15 patients who sought to have this procedure. Four among 6 married patients had children. Testis biopsy was performed in 12 patients, and all showed abnormal histologic findings. Three among 4 patients, performed semen analysis, showed abnormal findings. In three cases of bilateral cryptorchidism, the mean age at surgery was 35.7+/-12.5 years. All of these patients had palpated cryptorchid testes in the inguinal area and sought to have a bilateral orchiopexy. Two patients have been married but had no children. All showed abnormal findings in both testis biopsy and semen analysis. No testicular neoplasm was detected during the duration of follow-up. CONCLUSIONS: Most adult patients with cryptorchidism preferred orchiopexy to orchiectomy. However, most of patients showed abnormal histology of the testis and semen analysis. Therefore, orchiopexy with regular scrotal examination may be considered a suitable treatment options for adult cryptorchidism.

Clinical Characteristics and Treatment of Cryptorchidism in Adults: A Single Center Experience

PURPOSE: We evaluated the clinical and therapeutic characteristics of adult cryptorchidism, which have been difficult to establish, given the small number of patients presenting to outpatient clinics. MATERIALS AND METHODS: A retrospective study of 20 adult patients with cryptorchid testis was performed. We analyzed their palpation of testis, location, surgical method, marital status, number of children, histologic findings, and semen analysis. RESULTS: In 17 cases with unilateral cryptorchidism, the mean age at surgery was 31.1+/-12.5 years. Fourteen patients had a palpable, small cryptorchid testis. The location of the testis, as verified, was inguinal in 14, prepubic in 2, and intra-abdominal in 1, respectively. We performed orchiopexy in 14 out of 15 patients who sought to have this procedure. Four among 6 married patients had children. Testis biopsy was performed in 12 patients, and all showed abnormal histologic findings. Three among 4 patients, performed semen analysis, showed abnormal findings. In three cases of bilateral cryptorchidism, the mean age at surgery was 35.7+/-12.5 years. All of these patients had palpated cryptorchid testes in the inguinal area and sought to have a bilateral orchiopexy. Two patients have been married but had no children. All showed abnormal findings in both testis biopsy and semen analysis. No testicular neoplasm was detected during the duration of follow-up. CONCLUSIONS: Most adult patients with cryptorchidism preferred orchiopexy to orchiectomy. However, most of patients showed abnormal histology of the testis and semen analysis. Therefore, orchiopexy with regular scrotal examination may be considered a suitable treatment options for adult cryptorchidism.

Malignant Inflammatory Myofibroblastic Tumor of the Bladder with Rapid Progression

A 71-year-old man was referred for painless hematuria and a bladder tumor. Cystoscopy and computed tomography revealed a 3-cm oval nodular mass on the left lateral side of the bladder. The patient underwent a complete transurethral resection of the lesion and histology showed a proliferation of atypical spindle cells with inflammation consistent with a myofibroblastic tumor. After 4 and 7 months, follow-up cystoscopy demonstrated nodular mass lesions and transurethral resection of bladder tumor was done, which showed chronic cystitis and a recurred myofibroblastic tumor, respectively. Five months later, multiple lymph node, bone, and soft tissue metastases were found by positron emission tomography. The patient was treated first with palliative chemotherapy, including doxorubicin and cisplatin. After that, radiologic studies showed disease progression but the patient refused further treatment and died 6 months later.