Comparison of perioperative outcomes between running versus interrupted vesicourethral anastomosis in open radical prostatectomy: A single-surgeon experience

PURPOSE: To compare perioperative outcomes between running and interrupted vesicourethral anastomosis in open radical prostatectomy (RP). MATERIALS AND METHODS: The medical records of 112 patients who underwent open RP for prostate cancer at our institution from 2006 to 2008 by a single surgeon were retrospectively reviewed. Preoperative, intraoperative, and postoperative parameters were measured. RESULTS: Of 112 consecutive patients, 62 patients underwent vesicourethral anastomosis by use of the running technique, whereas 50 patients underwent anastomosis with the interrupted technique. The groups did not differ significantly in age, body mass index, prostate-specific antigen, prostate volume, or pathologic findings. The intraoperative extravasation rate was significantly lower in the running group (8.1% vs. 24.0%, p=0.01). The mean anastomosis time was 15.1+/-5.3 and 19.3+/-4.6 minutes in the running and interrupted groups, respectively (p=0.04). The rates of postoperative extravasation were similar for both groups (6.4% vs. 10.0%, p=0.12). The duration of catheterization was significantly shorter in the running group (9.0+/-3.0 days vs. 12.9+/-6.4 days, p<0.01). The rate of urinary retention after catheter removal and the rate of bladder neck contracture were not significantly different between the two groups. The rate of urinary continence at 3, 6, 9, and 12 months after RP was also similar in both groups. CONCLUSIONS: Both anastomosis techniques provided similar functional results and a similar rate of postoperative urine extravasation. However, running vesicourethral anastomosis decreased the rate of intraoperative extravasation and time for anastomosis, without increasing the risk of urinary retention or bladder neck contracture.

External Validation of the Cancer of the Prostate Risk Assessment-S Score in Koreans Undergoing Radical Prostatectomy

PURPOSE: To evaluate the validity of the University of California San Francisco Cancer of the Prostate Risk Assessment-S score (CAPRA-S score), a biochemical indicator of recurrent prostate cancer that uses histopathologic data, in Korean prostate cancer patients. MATERIALS AND METHODS: A total of 203 prostate cancer patients who underwent radical prostatectomy between February 1997 and November 2010 were observed for longer than 6 months. The CAPRA-S score of 134 patients for whom records were available for preoperative prostate-specific antigen (PSA), pathologic specimen Gleason score, surgical margin, seminal vesicle invasion, extracapsular extension, and lymph node invasion were calculated. Biochemical recurrence was defined as repetitive measurement of PSA > or =0.2 ng/mL at least 6 months after surgery with at least a 4-week interval. The Cox proportional hazard model and Kaplan-Meier analysis were used for the statistical testing. RESULTS: The CAPRA-S scores were divided into nine groups. The 5-year disease-free survival rate was reduced as the CAPRA-S score increased compared with the group with a CAPRA-S score of 0-1. The CAPRA-S score in this study was more sensitive to biochemical recurrence than was the CAPRA score conducted at this institution (CAPRA-S concordance index, 0.776; CAPRA concordance index, 0.728). CONCLUSIONS: The CAPRA-S score is judged to be a useful tool for predicting the disease-free survival rate of Korean prostate cancer patients and is thought to assist in establishing postoperative management.

Erratum: pT3 Predictive Factors in Patients with a Gleason Score of 6 in Prostate Biopsies

No abstract available.

pT3 Predictive Factors in Patients with a Gleason Score of 6 in Prostate Biopsies

PURPOSE: Often, a diagnosis of pT3 is made on the basis of radical retropubic prostatectomy specimens, despite a Gleason score of 6 on the preoperative prostate biopsy. Thus, we investigated the preoperative variables in patients displaying these characteristics. MATERIALS AND METHODS: Study subjects comprised patients at our institute from 1996 to July 2010 who had exhibited a Gleason score of 6 on their prostate biopsies and had undergone a radical retropubic prostatectomy. Through univariate and multivariate analysis, we investigated pT3 predictive factors including age, preoperative prostate-specific antigen (PSA) levels, transrectal ultrasonography (TRUS)-weighted prostate volume, digital rectal examination findings, bilaterality via prostate biopsy, prostatic cancer in prostate base cores via prostate biopsy, maximum length and percent of prostatic cancer, and number of cores detected in prostatic cancer via prostate biopsy. RESULTS: In the univariate logistic regression mode, a PSA value of 7.4 ng/ml or higher, TRUS-weighted PSA density of 0.2 ng/ml/cc or higher, prostate cancer detected in the basal core, and prostate cancer detected in 2 or more cores out of 12 were predictive factors for extraprostatic extension. Independent predictive factors for stage pT3 were a PSA of 7.4 ng/ml or higher and prostate cancer detected in 2 or more cores out of 12. CONCLUSIONS: In the case of patients with the foregoing risk factors, it is advisable not to perform nerve-sparing surgery but to prepare for the possibility of a pT3 stage.

Vaginal Mucosal Flap as a Sling Preservation for the Treatment of Vaginal Exposure of Mesh

PURPOSE: Tension-free vaginal tape (TVT) procedures are used for the treatment of stress urinary incontinence in women. The procedures with synthetic materials can have a risk of vaginal erosion. We experienced transobturator suburethral sling (TOT) tape-induced vaginal erosion and report the efficacy of a vaginal mucosal covering technique. MATERIALS AND METHODS: A total of 560 female patients diagnosed with stress urinary incontinence underwent TOT procedures at our hospital between January 2005 and August 2009. All patients succeeded in follow-ups, among which 8 patients (mean age: 50.5 years) presented with vaginal exposure of the mesh. A vaginal mucosal covering technique was performed under local anesthesia after administration of antibiotics and vaginal wound dressings for 3-4 days. RESULTS: Seven of the 8 patients complained of persistent vaginal discharge postoperatively. Two of the 8 patients complained of dyspareunia of their male partners. The one remaining patient was otherwise asymptomatic, but mesh erosion was discovered at the routine follow-up visit. Six of the 8 patients showed complete mucosal covering of the mesh after the operation (mean follow-up period: 16 moths). Vaginal mucosal erosion recurred in 2 patients, and the mesh was then partially removed. One patient had recurrent stress urinary incontinence. CONCLUSIONS: Vaginal mucosal covering as a sling preservation with continued patient continence may be a feasible and effective option for the treatment of vaginal exposure of mesh after TOT tape procedures.

Predictive Factors of the Long-term Medical Treatment Failure in Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The aim of this study was to identify the clinical baseline factors that affect failure of medical treatment(and especially surgical treatment) for benign prostatic hyperplasia(BPH) in spite of long-term medication. MATERIALS AND METHODS: 802 men who were over 50 years of age with BPH were enrolled for this study. Patients were allocated to a medication group and a surgical treatment group(after having at least a 12 month duration of medication). We compared the differences between the two groups for their initial International Prostate Symptom Score(IPSS), the uroflowmetry, the prostate volume, the postvoid residual urine and the serum prostate specific antigen(PSA). RESULTS: 397 patients had surgical treatment following medication due to BPH progression(acute urinary retention, aggravating LUTS) and 405 patients were given maintenance medical treatment during follow-up. Statistically significant differences were found in the IPSS(23.3+/-6.6 vs. 12.7+/-8.4), the prostate volume(53.5+/-28.1ml vs. 38.3+/-12.6ml), the maximal flow rate(7.8+/-4.7ml/sec vs. 12.7+/-5.4ml/sec), the postvoid residual urine volume(92.7+/-144.4cc vs. 36.5+/-147.1cc), and the PSA(6.1+/-7.6ng/ml vs. 2.8+/- 2.8ng/ml) between the surgical and medication groups. According to the area under the curve(AUC), the IPSS, prostate volume, maximal flow rate, postvoid residual urine volume and PSA are important in descending order. According to the receiver operating characteristic(ROC) curve- based prediction of the surgical intervention, the best cutoff value for the IPSS and prostate volume were 17(area under ROC curve: 0.83) and 40ml (area under ROC curve: 0.68), respectively. Conclusions: The results show that BPH patients with more severe IPSS (>or=17) and a larger prostate volume(>40ml) have a higher risk of surgical intervention, and this suggests that the IPSS and prostate volume may be useful predictors at the initial visit for surgical intervention.

Significance of Neuroendocrine Cell Differentiation in Specimens from Patients with Prostate Cancer / 대한비뇨기과학회지

PURPOSE: The neuroendocrine cell(NEC) is one of the constitutional cells found in the prostate gland; these cells secret neurotransmitters. These neuroendocrine products have been associated with prostate cancer progression. We evaluated the significance of neuroendocrine differentiation(NED) in radical prostatectomy specimens. MATERIALS AND METHODS: We studied 45 patients who underwent bilateral pelvic lymphadenectomy and radical prostatectomy. The patients were classified into three groups according to their pathological stage. Group A included cases with organ confined tumors, Group B local advanced tumors and Group C cases had any T stage and lymph node metastasis. The cellular expression of chromogranin A in matched samples from the same patients was evaluated by immunohistochemical staining using commercially available monoclonal antibodies. RESULTS: Sixteen(35.6%) tumors had chromogranin A stained cells. Chromogranin A immunoreactivity was greatest in cases with lymph node involvement(75.0%) compared to those with primary prostate cancer(5.9% in group A and 37.5% in group B). Pathologically advanced tumors or tumors with the highest histological grades were associated with increased NED. The median staining score was 0 in Group A, 0 in Group B and 1 in Group C. The logistic regression analysis the odds ratio for group C cases showed a relative risk of 32.07(95% CI: 2.783-369.416) for NED compared to Group A. An increased prostate-specific antigen(PSA) and Gleason score were also associated with the NED. CONCLUSIONS: The degree of NEC immunohistochemical staining using the chromogranin A monoclonal antibody was marginally useful for predicting the outcome in prostate cancer patients after radical prostatectomy, especially in node positive patients. However, it is important to determine a therapeutic plan for patients with low PSA and internal organ metastasis.

Small Cell Carcinoma of the Kidney in a Young Male / 대한비뇨기과학회지

Small cell carcinoma was first described in the lung, and extrapulmonary small cell carcinoma has been reported at sites throughout the body. Small cell carcinoma of the genitourinary tract has more commonly been reported to arise from the urinary bladder. Small cell carcinoma of the kidney is extremely rare, rapidly progressive and lethal. Most of the reported cases have occurred in relatively old age people. We report here on a case of primary small cell carcinoma of the kidney in a young male, and this was managed via radical nephrectomy and cisplatin-based chemotherapy.

Colorectal Cancer with Sigmoidovesical Fistula that was Misdiagnosed as Bladder Cancer / 대한비뇨기과학회지

Sigmoidovesical fistula is a rare disease. Most of these patients have symptoms of chronic and recurrent urinary tract infection, pneumaturia and fecaluria. Furthermore, colorectal cancer with enterovesical fistula is very rare in the population. We have recently experienced a patient who had adenocarcinoma that originated colon along with sigmoidovesical fistula, and this was misdiagnosed as bladder cancer with urinary tract infection. We present here a case report of a 66-year-old woman who exhibited these diseases.

Comparison of Operative Versus Conservative Management in Pediatric Renal Trauma / 대한비뇨기과학회지

PURPOSE: Despite the increasing incidence of renal trauma, the management of renal injuries still remains controversial. Because the renal anatomy of children is different to that of adults, the management of their renal injuries will differ. We attempted to clarify the efficacy of conservative management for pediatric renal trauma by comparing our experiences of conservative and operative managements. MATERIALS AND METHODS: The medical records of 46 patients, with blunt renal injuries, were retrospectively reviewed. All patients were evaluated by computed tomographic scanning. Injuries were graded according to the American Association for the Surgery of Trauma Organ Injury Scale. RESULTS: 37 patients were initially managed conservatively and 9 by an early operation. 35 of the 37 patients (94.6%) were successfully managed conservatively, but the other 2 required a delayed operation (1 renorrhaphy, 1 open clot drainage), but a delayed nephrectomy was not required. Two of the 3 patients with urine leakage spontaneously resolved, and the other was resolved with endoscopic ureteral stenting. 7 of the 9 patients having undergone an early operation resulted in a nephrectomy, but kidney preservation was only possible in 2. CONCLUSIONS: Except for the hemodynamically unstable patients and those with a pedicle injury, conservative management was effective from the view point of renal preservation. Major renal lacerations and most of the urine leakages resolved spontaneously. Persistent extravasation can be managed with minimally invasive treatment, such as ureteral stenting. We consider the conservative management of renal injuries, even with abdominal exploration, for the treatment of associated organ injuries.

Primary Localized Amyloidosis of the Ureter Associated with Osseous Metaplasia / 대한비뇨기과학회지

Since localized amyloid deposits of the ureter were first described by Lehmann in 1937, approximately 90 cases have been reported. Isolated primary amyloidosis of the ureter is a rare disease, and its diagnosis cannot be made by radiologic findings. Because of radiographic similarity to transitional cell carcinoma, these lesions are often clinically mistaken for malignancies, and nephroureterectomy is usually performed. Here, we report a case of localized ureteral amyloidosis with osseous metaplasia, which was managed successfully by renal sparing segmental resection with the bladder Boari flap.

Multiple Organ Involvement of Lymphoepithelioma-Like Carcinoma in the Kidney and the Ureter / 대한비뇨기과학회지

A lymphoepithelioma-like carcinoma is a tumor with morphological features identical to an undifferentiated nasopharyngeal carcinoma that occurs outside the nasopharynx. This kind of tumor has been found in the salivary gland, stomach, lung, thymus, bladder, prostate, vagina and skin, but is particularly rare in the urinary tract. We report a case of a lymphoepithelioma-like carcinoma, which are usually found simultaneously in the kidneys and ureter. This is the first case of multiorgan involvement of this tumor.

The Role of the UBC Test in Transitional Cell Carcinomas of the Bladder / 대한비뇨기과학회지

PURPOSE: We evaluated the diagnostic performance of a noninvasive bladder cancer test, the urinary bladder cancer (UBC) antigen test, on voided urine samples from patients with active transitional cell carcinomas, on follow-up and controls. MATERIALS AND METHODS: We measured the UBC antigen in the urine from 136 patients with active transitional cell carcinomas of the bladder (group 1), 56 patients with no evidence of tumor recurrence, confirmed by cystoscopy at follow-up (group 2), 60 patients with urinary tract infections (group 3), 52 patients with other genitourinary tract malignancies (group 4) and 74 healthy subjects, free from urological diseases (group 5). RESULTS: The mean UBC antigen concentrations were 75.79, 28.95, 52.90, 16.90 and 7.56micro gram/L, in groups 1 to 5, respectively. Group 2, 4 and 5 showed statistically significant differences in the UBC concentrations compared to group 1 (p=0.03, <0.001 and <0.001, respectively). Sensitivity and specificity were 61.8 and 68.2%, at a threshold value of 9.7micro gram/L, from group 1, compared to groups 2 to 5. As for the tumor grade in group 1, there were significant differences between grade I and II (p<0.001) or between grade I and III (p<0.001), but there were no significant differences according to the T stage. CONCLUSIONS: The UBC test might have a role as a potential tumor marker for the diagnosis of transitional cell carcinomas of the bladder adjunct to cystoscopy.

The Role of the UBC Test in Transitional Cell Carcinomas of the Bladder / 대한비뇨기과학회지

PURPOSE: We evaluated the diagnostic performance of a noninvasive bladder cancer test, the urinary bladder cancer (UBC) antigen test, on voided urine samples from patients with active transitional cell carcinomas, on follow-up and controls. MATERIALS AND METHODS: We measured the UBC antigen in the urine from 136 patients with active transitional cell carcinomas of the bladder (group 1), 56 patients with no evidence of tumor recurrence, confirmed by cystoscopy at follow-up (group 2), 60 patients with urinary tract infections (group 3), 52 patients with other genitourinary tract malignancies (group 4) and 74 healthy subjects, free from urological diseases (group 5). RESULTS: The mean UBC antigen concentrations were 75.79, 28.95, 52.90, 16.90 and 7.56micro gram/L, in groups 1 to 5, respectively. Group 2, 4 and 5 showed statistically significant differences in the UBC concentrations compared to group 1 (p=0.03, <0.001 and <0.001, respectively). Sensitivity and specificity were 61.8 and 68.2%, at a threshold value of 9.7micro gram/L, from group 1, compared to groups 2 to 5. As for the tumor grade in group 1, there were significant differences between grade I and II (p<0.001) or between grade I and III (p<0.001), but there were no significant differences according to the T stage. CONCLUSIONS: The UBC test might have a role as a potential tumor marker for the diagnosis of transitional cell carcinomas of the bladder adjunct to cystoscopy.

Primary Transitional Cell Carcinoma of Female Urethra Treated with Anterior Pelvic Exenteration / 대한비뇨기과학회지

Primary urethral carcinoma in females is a relatively rare disease representing only 0.02% of all types of cancer in women. Primary transitional cell carcinoma of the female urethra is about 20% of all female urethral cancer. We report a case of primary transitional cell carcinoma of the female urethra treated with anterior pelvic exenteration in an 80-year-old woman.

Natural History of Refluxign Distal Stumps following Upper Tract Sugery in Children with Ectopic Ureter or Ureterocele / 대한비뇨기과학회지

No abstract available.