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

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

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

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

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

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

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

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

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

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

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

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

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

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