Impact of tumor contact surface area on collecting system entry in robot-assisted partial nephrectomy: a retrospective analysis.

BACKGROUND: Collecting system entry in robot-assisted partial nephrectomy may occur even in cases showing a low N factor in the R.E.N.A.L nephrometry score. Therefore, in this study, we focused on the tumor contact surface area with the adjacent renal parenchyma and attempted to construct a novel predictive model for collecting system entry. METHODS: Among 190 patients who underwent robot-assisted partial nephrectomy at our institution from 2015 to 2021, 94 patients with a low N factor (1-2) were analyzed. Contact surface was measured with three-dimensional imaging software and defined as the C factor, classified as C1, < 10 cm [2]; C2, ≥ 10 and < 15 cm [2]; and C3: ≥ 15 cm [2]. Additionally, a modified R factor (mR) was classified as mR1, < 20 mm; mR2, ≥ 20 and < 40 mm; and mR3, ≥ 40 mm. We discussed the factors influencing collecting system entry, including the C factor, and created a novel collecting system entry predictive model. RESULTS: Collecting system entry was observed in 32 patients with a low N factor (34%). The C factor was the only independent predictive factor for collecting system entry in multivariate regression analysis (odds ratio: 4.195, 95% CI: 2.160-8.146, p < 0.0001). Models including the C factor showed better discriminative power than the models without the C factor. CONCLUSIONS: The new predictive model, including the C factor in N1-2 cases, may be beneficial, considering its indication for preoperative ureteral catheter placement in patients undergoing robot-assisted partial nephrectomy.

Changes in strain energy density in the temporomandibular joint disk after sagittal split ramus osteotomy using a computed tomography-based finite element model.

PURPOSE: We evaluated the changes in the strain energy density (SED) in the temporomandibular joint (TMJ) disk after sagittal split ramus osteotomy (SSRO) at three time points. A finite element model (FEM) based on real patient-based computed tomography (CT) data was used to examine the effect of SSRO on the TMJ. METHODS: Measurements of the condylar position and angulation in CT images and FEM analyses were performed for 17 patients scheduled to undergo SSROs at the following time points: before surgery, immediately after surgery, and 1 year after surgery. SED on the entire disk was calculated at each of the three time points using FEM. Furthermore, the relationship between individual SED values and the corresponding condylar position was also evaluated. RESULTS: No significant change was observed in the condylar position at the three time points. The FEM analysis showed that SED was the highest and lowest immediately after and 1 year after surgery, respectively. A possible SED distribution imbalance between the left and right joints was improved 1 year after SSRO. Concerning the effect of fossa morphometry and condylar position, wide and deep glenoid fossae and a more posterior condylar position tended to show lower SED. CONCLUSION: SED in the articular disk temporarily increased after surgery and significantly decreased 1 year after surgery compared with that before surgery. SSRO generally improved the imbalance between the left and right joints. Thus, SSRO, which improves maxillofacial morphology, may also improve components of temporomandibular disorders.

Usefulness of LacdiNAc-glycosylated Prostate-specific Antigen Density for Predicting Pathological Findings of Magnetic Resonance Imaging-transrectal Ultrasound Fusion Image-guided Prostate Biopsy for the Patients With Highest Prostate Imaging Reporting and Data System Category ≥3.

PURPOSE: This study aimed to evaluate the usefulness of the LDN-PSA (LacdiNAc-glycosylated-prostate specific antigen) in detecting clinically significant prostate cancer in patients suspected of having clinically significant prostate cancer on multiparametric magnetic resonance imaging. MATERIALS AND METHODS: Patients with prostate specific antigen levels ranging between 3.0 ng/mL and 20 ng/mL and suspicious lesions with PI-RADS (Prostate Imaging-Reporting and Data System) category ≥3 were included prospectively. The LDN-PSA was measured using an automated 2-step Wisteria floribunda agglutinin lectin-anti-prostate specific antigen antibody sandwich immunoassay. RESULTS: Two hundred four patients were included. Clinically significant prostate cancer was detected in 105 patients. On multivariable logistic regression analysis, prostate specific antigen density (OR 1.61, P = .010), LDN-PSAD (OR 1.04, P = .012), highest PI-RADS category (3 vs 4, 5; OR 14.5, P < .0001), and location of the lesion with highest PI-RADS category (transition zone vs peripheral zone) (OR 0.34, P = .009) were significant risk factors for detecting clinically significant prostate cancer. Among the patients with the highest PI-RADS category 3 (n=113), clinically significant prostate cancer was detected in 28 patients. On multivariable logistic regression analysis to predict the detection of clinically significant prostate cancer in patients with the highest PI-RADS category 3, age (OR 1.10, P = .026) and LDN-PSAD (OR 1.07, P < .0001) were risk factors for detecting clinically significant prostate cancer. CONCLUSIONS: LDN-PSAD would be a biomarker for detecting clinically significant prostate cancer in patients with prostate specific antigen levels ≤20 ng/mL and suspicious lesions with PI-RADS category ≥3. The use of LDN-PSAD as an adjunct to the use of prostate specific antigen levels would avoid unnecessary biopsies in patients with the highest PI-RADS category 3. Multi-institutional studies with large population are recommended.

Risk Factors for Severe Erectile Dysfunction after Focal Therapy with High-Intensity Focused Ultrasound for Prostate Cancer.

The present study aimed to analyze the effect of predisposing clinical factors for severe erectile dysfunction (ED) in patients treated with focal therapy using high-intensity focused ultrasound (HIFU) for localized prostate cancer (PC). Patients without severe ED (International Index of Erectile Function-5 [IIEF-5] score ≥ 8) before focal HIFU therapy were included. A total of 92 of the 240 patients met the inclusion criteria and were included. The rate of severe ED (IIEF-5 ≤ 7) was 36% 12 months after treatment. Multivariable logistic regression analysis showed that the pre-procedural lower IIEF-5 score (odds ratio [OR] 0.812, p = 0.005), the pre-procedural lower score of the sexual domain of the Expanded Prostate Cancer Index Composite (OR 0.960, p = 0.038), and the treatment of the edge of the peripheral zone (PZ) in proximity to the neurovascular bundle (NVB) [treated vs. untreated, OR 8.048, p = 0.028] were significant risk factors for severe ED at 12 months after treatment. In conclusion, pre-procedural lower erectile function and treatment of the part in proximity to the NVB were significant risk factors for severe ED after focal therapy.

Preoperative factors affecting the operative outcomes of laparoscopic nephrectomy.

OBJECTIVES: Laparoscopic radical nephrectomy is the standard surgery for localized renal cell carcinoma. Both tumor and patient factors affect the difficulty of laparoscopic radical nephrectomy. Obesity is a major factor influencing technical difficulty in surgical procedures. This study examined preoperative tumor and patient factors affecting the operating time. METHODS: The data of 123 patients who underwent laparoscopic radical nephrectomy at our institution between January 2014 and December 2018 were retrospectively analyzed. The operating time was determined based on the median pneumoperitoneum time. Surgical procedures with a pneumoperitoneum time of ≥130 min were defined as having prolonged pneumoperitoneum time. Multiple logistic regression analyses were performed to identify the preoperative factors affecting the prolonged pneumoperitoneum time, and risk stratification was performed based on these factors. RESULTS: Multiple logistic regression analyses revealed that a total number of renal pedicle blood vessels ≥3 and a visceral fat volume ≥3000 cm3 were associated with prolonged pneumoperitoneum time of laparoscopic radical nephrectomy. Based on the multivariate analysis results, these factors were considered individually, and the cohort was stratified into three risk groups: low (0 point), intermediate (1 point), and high (2 points) risk groups. The pneumoperitoneum time was significantly prolonged as the number of risk factors increased. CONCLUSIONS: We developed a risk stratification model using preoperative factors to predict the prolonged pneumoperitoneum time of laparoscopic radical nephrectomy, which can help select suitable cases that are appropriate for each surgeon's skill level.

Impact of stone volume on treatment outcomes of percutaneous nephrolithotripsy.

PURPOSE: We aimed to evaluate the impact of stone volume on the surgical outcomes of patients who underwent percutaneous nephrolithotripsy, which is the preferred treatment for renal and upper ureteral stones. MATERIALS AND METHODS: This retrospective study included 37 patients who underwent percutaneous lithotripsy between 2013 and 2019. Preoperative and postoperative stone volumes were quantified using computed tomography scan data. RESULTS: The mean preoperative and postoperative stone volumes were 10.7 cm3 (1.1-50.2 cm3 ) and 2.1 cm3 (0-18.2 cm3 ), respectively. The correlation coefficient between the stone volume and maximum stone length was 0.62 (P < .01). A residual stone volume of >5 mm was observed in 17 cases (45.9%). Thirteen cases underwent secondary treatment (35.1%) who had a preoperative stone volume of >15 cm3 or a postoperative stone volume of <2 cm3 . The areas under the curve for the stone volume for treatment success and the requirement for secondary treatment were 0.701 and 0.739, respectively, and were higher than those of stone length (0.638 and 0.558) and shape (0.644 and 0.641). CONCLUSIONS: Measurement of stone volume using three-dimensional imaging is simple and greatly impacted the course of stone treatment. Information on stone volume may predict an increased likelihood of secondary treatment in patients with a preoperative stone volume of >15 cm3 .

Development and future prospective of treatment for localized prostate cancer with high-intensity focused ultrasound.

High-intensity focused ultrasound (HIFU) was experimentally used for focal therapy for anti-cancer effects in prostate cancer (PC). Focal therapy is a diagnosis-based investigational treatment option for localized PC that cures clinically significant PC (csPC) while preserving the anatomical structures related to urinary and sexual function based on its spread observed using multi-parametric magnetic resonance imaging (mpMRI). The European Association of Urology indicated that the current status of focal therapy for localized PC was an investigational modality and encouraged prospective recording of outcomes and recruitment of suitable patients in 2018. During the last few years, large-population multi- and single-center prospective studies have investigated focal therapy as a treatment strategy for localized PC. In a multicenter prospective study with 5-year follow-up, failure-free survival, which was defined as avoidance of local salvage therapy (surgery or radiotherapy), systemic therapy, metastases, and prostate cancer-specific death, was 88%. In the previous studies, there was no significant influence on urinary function before and at 3 months after the treatment, although transient impairment was reported 1 month after the treatment. Pad- and leak-free continence was preserved in 80-100% of the patients after treatment. Erectile function was significantly impaired in the initial 3 months after treatment compared to the pretreatment values, but it improved 6 months after the focal therapy in the previous reports. Paired comparison studies and cohort studies with long-term follow-up will contribute to verifying this treatment's clinical outcomes for patients with localized PC.

How long should urologists observe patients with prostate cancer after radical prostatectomy? Weibull analysis.

OBJECTIVES: There is no recommended observation time for patients who have undergone radical prostatectomy for prostate cancer. This study was undertaken to determine the postoperative observation time by investigating the hazard rate for prostate-specific antigen failure and other-cause death using Weibull analysis. METHODS: We included 612 patients who underwent laparoscopic radical prostatectomy for localized prostate cancer between June 2002 and December 2017. Risk classification was categorized by the D'Amico risk classification, and the patients were divided into three age groups: <60, 60-69 and ≥70 years. The hazard rates at each point were derived using Weibull analysis. The optimal observation time after laparoscopic radical prostatectomy was determined as the intersection point at which the hazard rate of other-cause death overtakes the hazard rate of prostate-specific antigen failure. RESULTS: In all groups classified by age, the hazard rate of other-cause deaths increased over time. In contrast, the hazard rate of prostate-specific antigen failure decreased gradually. The ≥70 years age group showed the highest hazard rate. The hazard rate of prostate-specific antigen failure was highest in the high-risk group. The patients aged ≥70 and 60-69 years in the low-risk group were recommended 6 years 6 months and 14 years 8 months, respectively, for observation. The remaining patients were recommended >25 years of postsurgical observation. CONCLUSIONS: The observation time after laparoscopic radical prostatectomy could be estimated by comparing the estimated hazard rates of prostate-specific antigen failure and other-cause death based on Weibull analysis. Urologists should pay attention to age and risk classifications for optimal postoperative observation.

Analysis of oncological outcomes of whole-gland therapy with high-intensity focused ultrasound for localized prostate cancer in clinical and technical aspects: a retrospective consecutive case-series analysis with a median 5-year follow-up.

PURPOSE: This study aimed to analyze technical and clinical factors related to oncological outcomes in patients with localized prostate cancer (PC) who were treated with whole-gland high-intensity focused ultrasound (HIFU). MATERIALS AND METHODS: From 2007-2014, patients diagnosed with localized PC who underwent whole-gland HIFU were consecutively included retrospectively. Biochemical failure was defined according to the Phoenix ASTRO guidelines. The relationship between oncological outcomes and technical and clinical factors was evaluated. RESULTS: The study cohort included 428 patients. The median age was 67 years, and the median prostate-specific antigen level was 7.61 ng/mL. Patient risk classifications were low (n = 102), intermediate (n = 240), and high (n = 86). Biochemical disease-free survival rates of patients with HIFU for localized PC in the total, low-, intermediate-, and high-risk groups according to D'Amico risk groups over a median follow-up period of 5 years (range 9-144) were 68.4%, 80.4%, 65.6%, and 61.6%, respectively. In multivariate logistic regression analyses to predict biochemical failure of the treatment, neoadjuvant hormonal therapy (NHT) in the high-risk group (OR 0.225, p = 0.015), and compression method in the low- (OR 0.178, p = 0.030), intermediate- (OR0.291, p < 0.0001), and high-risk (OR 0.316, p = 0.049) groups were significant factors that reduced the risk of biochemical failure after treatment. There were no significant differences in complications between patients treated with compression and those treated conventionally. CONCLUSIONS: NHT may potentially improve oncological outcomes for patients in the high-risk group, and compression methods can improve the oncological outcomes of whole-gland therapy with HIFU.

Effects of psoas major muscle volume in predicting the prognosis of patients with upper urinary tract urothelial carcinoma treated with radical nephroureterectomy.

BACKGROUND: This study evaluated the impact of sarcopenia and psoas major muscle volume on the survival of patients with upper urinary tract urothelial carcinoma who had undergone radical nephroureterectomy. METHODS: We reviewed data from 110 patients treated with radical nephroureterectomy in our department between June 2007 and February 2017. Psoas major muscle volume was quantified based on computed tomography data using Synapse Vincent software. The psoas major muscle volume index was calculated as psoas major muscle volume/height squared (cm3/m2). We analysed relapse-free survival, cancer-specific survival and overall survival after radical nephroureterectomy to identify factors that predicted patient survival. RESULTS: The median psoas major muscle volume index was 121.5 cm3/m2, and the psoas major muscle volume index was <100 cm3/m2 in 34 of 110 patients (30.9%). Multivariate analysis indicated that ≥pT3-stage cancer, lymphovascular invasion and a psoas major muscle volume index of <100 cm3/m2 were independent predictors of shorter relapse-free survival, cancer-specific survival and overall survival. Using these factors, patients were stratified into three groups: low, intermediate and high risks for relapse-free survival, cancer-specific survival and overall survival. CONCLUSIONS: Low psoas major muscle volume resulting from sarcopenia, high T stage and the presence of lymphovascular invasion was associated with poor survival in patients with urinary tract urothelial carcinoma who had undergone radical nephroureterectomy, supporting the use of psoas major muscle volume as a new objective prognostic marker.

Laparoscopic pyeloureterostomy for ureteropelvic junction obstruction occurring in incomplete ureteral duplication of the solitary kidney.

INTRODUCTION: Ureteropelvic junction obstruction associated with ureteral duplication is rare, with prevalence reported to be around 2-7%. Ureteropelvic junction obstruction of the lower pole with both complete and incomplete duplex systems is a common cause of obstruction. Here, we report a case of ureteropelvic junction obstruction associated with incomplete ureteral duplication of the solitary kidney successfully treated by pyeloureterostomy. CASE PRESENTATION: The patient was a 39-year-old woman who presented with right hydronephrosis, right back pain, and deteriorated renal function. The patient was referred to our department from the rheumatology department. Her medical history included congenital left renal hypoplasia, Sjogren's syndrome, and hyperphospholipid antibody syndrome. CONCLUSION: We encountered a case of hydronephrosis occurring in a solitary kidney with incomplete ureteral duplication. This case was successfully managed after pyeloureterostomy.

Transumbilical laparoendoscopic single-site surgery versus conventional laparoscopic surgery for patients with symptomatic urachal remnants: an experience with 57 patients.

PURPOSE: To evaluate the surgical feasibility and postoperative cosmesis of a novel transumbilical laparoendoscopic single-site (LESS) surgical approach involving Y-shaped incisions and three-flap umbilicoplasty in urachal remnant patients. METHODS: Patients with symptomatic urachal remnants who underwent either conventional laparoscopic surgery (CL group, n = 21) or LESS surgery with Y-shaped incisions and three-flap umbilicoplasty (LESS group, n = 36) between May 2010 and September 2019 were retrospectively assessed. Perioperative factors and postoperative esthetic outcomes were compared between the groups using univariate and multivariate analyses. Esthetic outcomes were assessed using the body image questionnaire consisting of the body image scale (BIS) and the cosmetic scale (CS); a higher score indicated a better outcome. RESULTS: The median operative time was greater and the insufflation time was shorter in the LESS group than in the CL group. The estimated blood loss and postoperative hospital stay and surgical site infection rate did not differ significantly between the groups. While the BIS score also did not differ significantly between the groups, the CS score was greater in the LESS group than in the CL group. Multivariate analysis revealed that the surgery type (LESS surgery) was an independent predictor of greater postoperative esthetic satisfaction. CONCLUSION: Transumbilical LESS surgery with Y-shaped incisions and subsequent three-flap umbilicoplasty is feasible in patients with symptomatic urachal remnants. Regarding postoperative cosmesis, the higher CS score suggests that this technique is superior to CL surgery. Furthermore, the selection of this procedure was an independent predictor of good postoperative esthetic outcomes.

Significant Impact of the Anterior Transition Zone Portion Treatment on Urinary Function After Focal Therapy with High-Intensity Focused Ultrasound for Prostate Cancer.

Background: There is lack of evaluation of the effect of the treated area on the urinary function after focal therapy. The objectives of the study is to evaluate the effects of focal therapy on urinary function in the anterior portion of the transition zone (TZ) with transrectal high-intensity focused ultrasound (HIFU) for localized prostate cancer (PCa). Methods: From 2016 to 2018, patients who were diagnosed as having localized PCa and treated with focal therapy with HIFU, were included prospectively. The urinary function and complications were evaluated separately in the treated regions of the anterior TZ (TZ group) and other portions (other group) for 12 months. Before and after the treatment, the International Prostate Symptom Score (IPSS), IPSS Quality Of Life (QOL), Overactive Bladder Symptom Score (OABSS), and uroflowmetry were evaluated to assess the urinary function. Results: Ninety patients were included in the study. There was no significant differences in the patients' characteristics between the two groups. At 1 month after the treatment, IPSS (p = 0.011), IPSS QOL (p = 0.002), OABSS (p = 0.002), maximum flow rates (p = 0.011), and residual urine volume (p = 0.011) in TZ group were significantly deteriorated compared with the other group. Multivariate logistic regression analysis revealed that anterior TZ treatment (odds ratio, 3.386; p = 0.029) was an independent risk factor for the deterioration with ≥32% of preoperative status of maximum flow rates. Concerning complication, the rates of Grade 2 urinary retention and Grade 3 urethral stricture were 15.4% and 11.5% in the TZ group and 0% and 0% in the other group, respectively. Conclusions: There was a greater risk of urinary dysfunction with treatment in the anterior TZ portion than in the other portion at 1 month after focal therapy with HIFU.

Clinical impact of psoas muscle volume on the development of inguinal hernia after robot-assisted radical prostatectomy.

BACKGROUND: Sarcopenia, a syndrome characterized by the loss of skeletal muscle mass, has attracted attention in the field of oncology, as it reflects poor nutritional status. The present study aimed to determine the risk factors for postoperative inguinal hernia (PIH) development after robot-assisted laparoscopic radical prostatectomy (RARP) for prostate cancer, and discuss whether sarcopenia could be used as a sensitive predictor of PIH. METHODS: We reviewed the medical records of 147 patients who underwent RARP at our institution. The psoas muscle volume (PMV), as an indicator of sarcopenia, was quantified from computed tomography images using a 3-dimensional image analysis system. Multivariate cox regression analyses were performed to identify independent predictors of PIH, including pre- and peri-operative factors. RESULTS: The mean PMV was 393 cm3, and the correlation coefficient between PMV and body mass index was 0.37 (p < 0.01). The PIH-free rate at 2 years postoperatively was 78.2% among all patients. The multivariate analysis revealed that a PMV < 350 cm3 was a significant risk factor for PIH (p = 0.03; hazard ratio 2.19). Body mass index, age, prostate volume, lymph node dissection, nerve sparing, rectus muscle thickness, and console time were not related to PIH development. The PIH-free rate at 2 years postoperatively was 83.4% and 68.9% in patients with a PMV ≥ 350 cm3 and < 350 cm3, respectively (p < 0.05). CONCLUSIONS: PIH occurred significantly more frequently in patients with a PMV < 350 cm3 than in patients with a PMV ≥ 350 cm3, and a low PMV was an independent risk factor for PIH. Thus, urologists should pay attention to the cumulative incidence of IH after RARP, especially in patients with a PMV < 350 cm3.

What factors affect the operative time of robot-assisted laparoscopic radical prostatectomy?

BACKGROUND: Robot-assisted radical prostatectomy (RARP) has gained prominence since the da Vinci surgical system was introduced in 2000. RARP has now become a standard procedure for treating cases with localized prostate cancer. However, no study has examined its surgical time by accurately measuring the pelvic visceral fat (PVF) volume. This study aimed to investigate the factors associated with prolonged console time and surgical difficulty by RARP surgeons. METHODS: This study included 405 patients who underwent RARP between 2014 and 2019 at our institution. Given that the anatomical characteristics were considered to affect RARP, PVF and working space (WS) were estimated preoperatively by computed tomography using a 3D image analysis system. Univariate and multivariate logistic regression analyses were performed to identify the factors prolonging console time, such as body mass index (BMI), prostate volume, previous abdominal surgery, nerve-sparing procedure, PVF, and WS. We also investigated whether post-operative complications were associated with any of these factors. RESULTS: Larger PVF (p = 0.028, odds ratio (OR) 1.43), smaller WS (p < 0.001, OR 2.48), and the nerve-sparing procedure (p = 0.037, OR 1.61) were statistically significant factors associated with prolonged console time. Furthermore, higher BMI (p = 0.013, OR 1.49) and smaller pelvic width (p < 0.001, OR 2.63) were the alternative and more practical factors associated with prolonged console time. The post-operative anastomotic leakage occurrence rate increased with the number of risk factors, while post-operative complications did not change even in high-risk cases. CONCLUSION: PVF and WS are significant factors associated with prolonged console time in RARP cases. However, BMI can be as useful as PVF, since BMI significantly correlated with PVF. Additionally, pelvic width (PW) can be an alternative to WS, since PW correlated with WS. This study demonstrated that preoperative BMI and PW might predict the surgical risk and identify suitable RARP cases for novice surgeons.

Conditional Survival and Time of Biochemical Recurrence of Localized Prostate Cancer in Japanese Patients Undergoing Laparoscopic Radical Prostatectomies.

PURPOSE: Using conditional survival (CS) analysis, we investigated whether the duration of survival without biochemical recurrence (BCR) of prostate cancer after laparoscopic radical prostatectomies (LRP) affected the BCR rate. We also investigated the impact of well-known risk factors for BCR. METHODS: Between 2002 and 2014, 627 consecutive patients underwent LRPs at our institution. Prostate-specific antigen (PSA) concentrations above 0.2  ng/mL were defined as BCR. Conditional BCR-free survival rates were determined through Kaplan-Meier analysis. Assessment of potential BCR risk factors was performed using a Cox proportional hazard analysis. RESULTS: The 10-year BCR-free rates after LRP increased to 82.4%, 84.5%, 86.6%, 90.1%, and 94.7% in patients surviving 1, 2, 3, 5, and 7.5 years without BCR, respectively. Multivariate analyses of age, PSA concentrations, neoadjuvant therapy, and pathological findings were performed for all patients. In all patients, positive surgical margins (PSM) and Gleason Grade Groups (GG) ≥ 4 were independent risk factors for BCR (p < 0.001, hazard ratio [HR] = 2.45; and p < 0.001, HR = 2.83, respectively,). Similarly, PSM and GG ≥ 4 were significant risk factors in patients surviving 1-5 years without BCR. No clear risk factors were observed in patients surviving > 5 years without BCR after LRPs. CONCLUSIONS: The BCR-free rate increased with time after LRP. It is recommended that patients with PSM, GG ≥ 4, or with both factors are strictly monitored for 5 years postoperatively. CS analysis is particularly useful for predicting the postoperative course of patients.

Functional outcomes of transurethral thulium laser enucleation versus bipolar transurethral resection for benign prostatic hyperplasia over a period of 12 months: A prospective randomized study.

OBJECTIVE: To evaluate functional outcomes over a year for benign prostatic hyperplasia treated with thulium laser enucleation of the prostate or bipolar transurethral resection of the prostate. METHODS: In this study, we prospectively included 140 patients who were treated for benign prostatic hyperplasia from April 2017 to February 2019. A randomization list was used for non-blind assignment to treatment groups (thulium laser enucleation of the prostate or bipolar transurethral resection of the prostate). The International Prostate Symptom Score, International Prostate Symptom Score quality of life, Overactive Bladder Symptom Score, uroflowmetry and International Index of Erectile Function-5 were used for the assessment of outcomes. Scores were taken before treatment, and at 1, 3, 6, 9 and 12 months after treatment. RESULTS: Preoperatively, characteristics of patients in the thulium laser enucleation of the prostate group (n = 70) and the bipolar transurethral resection of the prostate group (n = 70) did not significantly differ. The thulium laser enucleation of the prostate group had a lower median decrease in hemoglobin (0.10 g/dL vs 0.69 g/dL, P < 0.0001) and shorter median catheterization (2 days vs 3 days, P < 0.0001) than the bipolar transurethral resection of the prostate group. Both groups had significantly improved International Prostate Symptom Score, International Prostate Symptom Score quality of life, Overactive Bladder Symptom Score, maximum flow rate and residual urine compared with preoperative values. In the thulium laser enucleation of the prostate group, erectile function was significantly impaired at 1 month post-treatment compared with pretreatment, but improved to baseline at 3 months; however, the transurethral resection of the prostate group did not recover. However, total energy (P = 0.001) and laser irradiation time (P = 0.025) were significantly different between the patients who had preserved erectile function and those who did not after the treatment in the thulium laser enucleation of the prostate group. CONCLUSIONS: Thulium laser enucleation of the prostate is superior to bipolar transurethral resection of the prostate in resection efficacy, hemostasis, catheterization time and preservation of erectile function. However, excessive laser irradiation time in thulium laser enucleation of the prostate has the possibility to delay improvement of overactive bladder symptoms and decrease sexual function.

Possible abscopal effect after discontinuation of nivolumab in metastatic renal cell carcinoma.

INTRODUCTION: Renal cell carcinoma has been considered radioresistant. Recently, several studies have reported the efficacy of combination therapy using radiotherapy and immune checkpoint inhibitors. CASE PRESENTATION: In 1999, a 56-year-old woman underwent left nephrectomy (clear cell carcinoma, pT1bN0M0). Seventeen years postoperatively, recurrence in the left lung hilum was observed. Despite administration of three molecular target drugs, all treatments were terminated due to adverse events. Nivolumab was initiated in December 2016. In August 2017, subcutaneous and lung metastases were observed. Moreover in January 2018, right renal metastasis was noted. After 22 cycles of nivolumab treatment, metastasis in the iliac bone was observed, and the patient was subjected to conventional palliative external beam radiation therapy. Five months after radiotherapy, there was significant reduction in multiple metastases. Here, we reported the case presenting with possible abscopal effect. CONCLUSION: Radiotherapy combined with immune checkpoint inhibitors may induce systemic effects against metastatic renal carcinoma.

The Role of the Wnt Signaling Pathway in Upper Jaw Development of Chick Embryo.

Cleft lip with or without cleft palate (CLP) usually results from a failure of the medial nasal prominences to fuse with the lateral and maxillary prominences. This failure inhibits facial morphogenesis regulated by several major morphogenetic signaling pathways. We hypothesized that CLP results from the failure of the Wnt signaling pathway. To examine whether Wnt signaling can influences upper jaw development, we applied beads soaked with Dickkopf-1 (Dkk-1), Alsterpaullone (AL) or Wnt3a to the right side of the maxillary prominence of the chick embryo. The embryo showed a defect of the maxilla on the treated side, and skeletal staining revealed hypoplasia of the premaxilla and palatine bone as a result of Dkk-1-soaked bead implantation. 5-bromo-2'-deoxyuridine (BrdU)-positive cell numbers in the treated maxillary prominence were significantly lower at both 24 and 48 hr after implantation. Down-regulation of the expression of Bmp4, Tbx22, Sox9, and Barx1 was confirmed in the maxillary prominence treated with Dkk-1, which indicated that the deformity of the maxillary bone was controlled by gene targets of the Wnt signaling pathway. Expression of N-cadherin was seen immunohistochemically in the maxillary prominences of embryos at 6 hr and increased at 24 hr after AL treatment. Wnt signaling enhanced by AL or Wnt3a up-regulated the expression levels of Msx1, Bmp4, Tbx22, Sox9, and Barx1. Our data suggest that the Wnt signaling pathway regulates maxillary morphogenesis and growth through Bmp4, Tbx22, Sox9, and Barx1. Wnt signaling might regulate N-cadherin expression via Msx1, resulting in cell aggregation for osteochondrogenesis.