Significance of nuclear grade and tumor size in Korean patients with chromophobe renal cell carcinoma: a comparison with conventional renal cell carcinoma

OBJECTIVES

To analyze the clinical behavior of chromophobe renal cell carcinoma (RCC) in Korean patients.

MATERIALS AND METHODS

A total of 657 patients with conventional RCC and 71 with chromophobe RCC were included in the analysis. The median follow-up for all patients was 44 months (95% confidence interval, 10 to 126).

RESULTS

Patients with chromophobe RCC differed significantly from those with conventional RCC on the following parameters: a greater female ratio (P = 0.019), less advanced TNM stage (P = 0.004), and higher Fuhrman nuclear grade (P < 0.001). There was no statistical difference with regard to age and tumor diameter. The 5- and 10-year disease-specific survival rates in patients with chromophobe RCC (92.9% and 92.9%) were higher than in patients with conventional RCC (84.9% and 79.8%). When patients were divided according to T stage, Fuhrman's grade, and tumor size for the subgroup analysis, disease-specific survival probabilities of chromophobe RCC were higher in only tumors with a high Fuhrman's grade (G3/G4) (P = 0.002) and larger than 4 cm (P = 0.025). The multivariate analysis showed that the histologic type was not an independent predictor of disease-specific survival.

CONCLUSIONS

Although Korean patients with chromophobe RCC had a better survival probability than patients with conventional RCC, the histologic type was not an independent predictor of survival probability. In addition, our findings suggest that chromophobe RCC has a better survival probability than conventional RCC in patients with Fuhrman's grade 3 to 4 or with a tumor diameter > 4.0 cm.

Laparoscopic nephrectomy for congenital benign renal diseases in children: comparison with adults

AIM

To compare the results of laparoscopic nephrectomy for congenital benign renal diseases in children and adults.

METHODS

From August 1996 to February 2003, laparoscopic nephrectomies were performed on 26 children and 60 adults. Of these patients, 33 patients (17 children, 16 adults) with comparable diseases were included in the analysis.

RESULTS

Disease was on the right side in 16 patients and on the left in 17. Operative and convalescence parameters, including operative time, blood loss, transfusion rate, conversion rate to open surgery, resumption of oral intake, hospital stay, and complication rate, were evaluated in both groups. Median operative time in the paediatric group was 140 min compared to 147.5 in adults (p=0.626). The estimated blood loss was significantly different (median 25 and 75 cm(3) in children and adults, respectively; p<0.001). Other operative and convalescence parameters were not statistically different. However, whereas no child required a blood transfusion, three adults (18.8%) did. No major perioperative complications occurred in the paediatric group, but open surgical exploration was needed due to retroperitoneal bleeding in a single adult.

CONCLUSION

Our findings indicate that laparoscopic nephrectomy for congenital benign disease in children is achieved safely and that the modality offers additional advantages in children as compared to adults.

Testicular volume and masculine identity in men with unilateral cryptorchidism: results of a community-based survey in Korea

We determined the influence of cryptorchidism on testicular volume and masculine identity in young men living in a community. Of the 27,202 men aged 20 years dwelling in the community, we randomly selected a 10% sampling fraction of whom 2,080 men (a response rate of 77.0%) agreed to participate in the study. All volunteers underwent a standard evaluation, including a detailed medical history and physical examination. For the evaluation of the influence of cryptorchidism on masculine identity, we used the Bem Sex Role Inventory (BSRI). Among participants, 38 (1.8%) had cryptorchidism or a history of surgery for cryptorchidism (right 15, left 21, bilateral 2). In total, 29 had had undergone surgery (mean age at the time of operation; 8.9+/-3.9 years, range; 2-19 years). Of 25 men who had undergone orchiopexy due to unilateral cryptorchidism, the testicular volume of the affected side was significantly smaller than that of the contralateral side. Of the 36 patients with unilateral cryptorchidism, the contralateral testicular volume of men who had undergone orchiopexy was not different with that of those who had undergone orchiectomy or had not undergone surgery. When we compared the scores for masculinity and femininity using the BSRI between men with and without testis in the scrotum, there were no differences between the two groups. Our results demonstrate that delayed orchiopexy does not improve the testicular volume of the affected side or the masculine identity in men with unilateral cryptorchidism. In addition, these findings suggest that there is a need to increase the awareness of cryptorchidism among all parties involved in the health care of children.

Comparison of Renal Function after Radical Surgery for Upper Tract Urothelial Carcinoma versus Renal Cell Carcinoma: Propensity Score Matching

OBJECTIVES

To compare renal function after radical nephrectomy for renal cell carcinoma (RCC) and for upper tract urothelial carcinoma (UTUC).

METHOD

Data from 1,236 patients with RCC or UTUC treated surgically from 2000 to 2013 were enrolled. The estimated glomerular filtration rate (eGFR) was calculated preoperatively and postoperatively at 12, 24, 36, 48, and 60 months. A multivariate logistic regression was used to determine independent factors for a decrease in eGFR to < 60 mL/min/1.73 m2 and end-stage renal disease.

RESULT

After propensity score matching, a total of 554 patients were included. During follow-up for 5 years, there was statistically significant difference in eGFR between 2 groups. And there was a statistically significant difference in the number of patients developing impaired renal function between the 2 groups (UTUC 73.3 vs. RCC 66.1%, p = 0.039). Multivariate analysis showed that old age (OR 3.957, p < 0.001), UTUC (OR 1.838, p = 0.006), BMI (OR 2.463, p = 0.001) and a baseline eGFR (OR 0.976, p = 0.001) were independent risk factors for postoperative impaired renal function.

CONCLUSION

Patients with UTUC had worse baseline eGFR, old age, comorbidities than RCC patients. Even after adjusting by PS matching, UTUC patients had lower postoperative eGFR and higher rates of CKD development than RCC patients.

Questionnaire survey of urologists' initial treatment practices for acute urinary retention secondary to benign prostatic hyperplasia in Korea

BACKGROUND

We undertook a survey of Korean urologists to establish initial treatment practices for acute urinary retention secondary to benign prostatic hyperplasia.

METHODS

Probability samples were drawn from the Korean Urological Association Registry of Physicians, and a random sample of 850 Korean urologists were asked to complete a questionnaire that explored practice characteristics and treatment strategies in the management of acute urinary retention. The returned questionnaires were statistically analyzed.

RESULTS

Of the 850 questionnaires sent, 302 were returned, and 277 of those were included in the final analysis (response rate 32.6%). Korean urologists preferred urethral catheterization as the initial management. Of respondents, 154 (55.6%) and 109 (39.4%) started their patients on alpha-blockers and alpha-blockers with finasteride, respectively. Nearly half (50.2%) used a trial without catheter 7 days after catheterization. One failed trial without catheter was an indication for surgery for only 69 (24.9%) of the respondents. A second trial without catheter was advocated by 108 (39.0%). Most urologists (82.3%) expected to be successful with the above management in 50% or greater. Physician's demographics or types of initial management did not influence physician's perception of expected success rate when the expected success rate was divided as < or =50% and >50.

CONCLUSIONS

These data provide a picture of current practice regarding the management of acute urinary retention secondary to benign prostatic hyperplasia in Korea. There is no uniformity in the management of acute urinary retention in Korea.

Significance of suspicious lesions at transrectal ultrasonography in men with serum prostate-specific antigen levels of < 20 ng/ml

AIMS AND BACKGROUND

The objective of the study was to evaluate the significance of suspicious lesions at transrectal ultrasonography for prostate cancer diagnosis.

PATIENTS AND METHODS

A total of 1,009 men with a mean age of 65.0 +/- 7.7 years (range, 40.0-79.0) constituted the study cohort and 265 (26.3%) were diagnosed with prostate cancer on initial biopsy.

RESULTS

The cancer detection rate was higher in patients with suspicious lesions (33.2%) than in those with no suspicious lesion (21.5%) (P < 0.001). Pathologic findings of the needle biopsy samples also showed more aggressive characteristics in men with suspicious lesions (P < 0.05). Of 413 men with suspicious lesions, additional lesion-directed biopsies were performed in 133 patients. The positive predictive value of additional lesion-directed biopsy was 18.0%. Of patients who had positive cores on lesion-directed biopsies, all were also found to have positive cores on random biopsies, and no patient had positive cores only on lesion-directed biopsies. The Gleason score was not changed by the findings of lesion-directed biopsies in these patients.

CONCLUSIONS

Our findings do not provide a rationale to recommend the addition of lesion-directed biopsy in patients with suspicious lesions at transrectal ultrasonography. However, men with suspicious lesions at transrectal ultrasonography had a higher risk of being diagnosed with prostate cancer.

Hand-assisted retroperitoneoscopic nephroureterectomy without hand-assisted device

Various laparoscopic nephroureterectomy techniques for urothelial carcinoma of the upper urinary tract have been developed to minimize postoperative discomfort and the necessity for a lengthy convalescence. We performed hand-assisted retroperitoneoscopic nephroureterectomy without hand-assisted device in 3 male patients with urothelial carcinoma of the distal ureter. Average operative time and estimated blood loss were 251 min (range 235 to 280) and 250 mL (range 200 to 300), respectively. Complication did not occur and conversion to open surgery was not necessary in all cases. Postoperative analgesic requirements were moderate and the time to regular diet intake averaged 3 days (range 2 to 4). None of the patients had a positive margin on the final pathologic specimen. At the average follow-up of 8.1 months, no regional recurrence, port-site metastasis, bladder recurrence, or distant metastasis were noted in any patient. We described our initial experience with the described technique, which obviates the need for midprocedural patient repositioning.

Developing a prediction model for disease-free survival from upper urinary tract urothelial carcinoma in the Korean population

BACKGROUND

In this study, we aimed to propose a validated prediction model for disease-free survival (DFS) after radical nephroureterectomy (RNU) in a Korean population with upper urinary tract urothelial carcinoma (UTUC).

METHODS

We performed a retrospective review of 1561 cases of UTUC who underwent either open RNU (ONU, n = 906) or laparoscopic RNU (LNU, n = 615) from five tertiary Korean institutions between January 2000 and December 2012. Data were used to develop a prediction model using the Cox proportional hazards model. Prognostic factors were selected using the backward variable selection method. The prediction model performance was investigated using Harrell's concordance index (C-index) and Hosmer-Lemeshow type 2 statistics. Internal validation was performed using a bootstrap approach, and the National Cancer Center data set (n = 128) was used for external validation.

RESULTS

A best-fitting prediction model with seven significant factors was developed. The C-index and two Hosmer-Lemeshow type statistics of the prediction model were 0.785 (95% CI, 0.755-0.815), 4.810 (P = 0.8506), and 5.285 (P = 0.8088). The optimism-corrected estimate through the internal validation was 0.774 (95% CI, 0.744-0.804) and the optimism-corrected calibration curve was close to the ideal line with mean absolute error = 0.012. In external validation, the discrimination was 0.657 (95% CI, 0.560-0.755) and the two calibration statistics were 0.790 (P = 0.9397) and 3.103 (P = 0.5408), respectively.

CONCLUSION

A validated prediction model based on a large Korean RNU cohort was developed with acceptable performance to estimate DFS in patients with UTUC.

Transitional cell carcinoma in a remnant ureter after retroperitoneoscopic simple nephrectomy for benign renal disease

A 70-yr-old man presented with painless gross hematuria. He underwent right nephrectomy for benign disease 9 yr ago. Computed tomography and cystoscopy showed a mass in the distal region of the right ureteral stump. He underwent right ureterectomy and bladder cuff resection. Pathological examination showed T1 and WHO grade 2 transitional cell carcinoma. At 6 months postoperatively, the patient is alive without any evidence of recurrence.

PDLIM2 Suppression Inhibit Proliferation and Metastasis in Kidney Cancer

We evaluated the expression of PDLIM2 in human kidney cancer cell lines from primary or metastatic origins and found that PDLIM2 expression was highly elevated in metastatic kidney cancers. We evaluated the effect of PDLIM2 inhibition by RNA interference method. PDLIM2 knockdown showed the decreased proliferation and metastatic character in human metastatic kidney cancer cells. By repeated round of orthotopic injection of RenCa mouse kidney cancer cell line, we obtained metastatic prone mouse kidney cancer cell lines. PDLIM2 expression was highly expressed in these metastatic prone cells comparing parental cells. In addition, we evaluated the in vivo efficacy of PDLIM2 knockout on the tumor formation and metastasis of kidney cancer cells using a PDLIM2 knockout mice. The experimental metastasis model with tail vein injection and orthotopic metastasis model injected into kidney all showed reduced lung metastasis cancer formation in PDLIM2 knockout mice comparing control Balb/c mice. Overall, our findings indicate that PDLIM2 is required for cancer formation and metastasis in metastatic kidney cancer, indicating that PDLIM2 may be a new therapeutic target for metastatic kidney cancer.

Chronic pulmonary disease negatively influences the prognosis of patients with advanced prostate cancer

OBJECTIVE

We examined the prognostic value of chronic pulmonary disease (CPD), which can cause hypoxemic hypoxia possibly resulting in tumor hypoxia, in patients with advanced prostate cancer (APC).

METHODS

We evaluated 295 patients with APC who had initially received androgen deprivation therapy. The progression to hormone refractory prostate cancer (HRPC), and the overall and disease specific survival were analyzed; the relationship to clinicopathological variables, including the presence of CPD, result of pulmonary function tests (PFT), smoking history and hemoglobin level were evaluated by the Kaplan-Meier method. A multivariate analysis was then performed according to the Cox regression model.

RESULTS

The median time to HRPC was 14 and 38 months in patients with and without CPD, respectively (P = 0.001). The median overall survival from diagnosis was 51 and 81 months (P = 0.007), and the median disease specific survival was 56 and 135 months, respectively (P = 0.008). A univariate analysis showed that the result of PFT was a significant variable for progression to HRPC. In addition, the hemoglobin level (11.4 g/dl, 25th percentile) was a significant variable for overall and disease specific survival. As a result of the multivariate analysis, the presence of CPD was an independent prognostic variable for progression to HRPC, as were the Gleason score and stage. As well, CPD was an independent prognostic variable for overall and disease specific survival, as were alkaline phosphatase levels and nadir PSA.

CONCLUSION

Our findings strongly implicate CPD as a factor that contributes to a poor prognosis in patients with APC.

Korean version of the G-8 geriatric screening tool: Translation and linguistic validation

OBJECTIVE

To develop a Korean version of the G-8 questionnaire validated with Korean patients over 70 years-of-age who were scheduled to undergo cancer surgery.

MATERIALS AND METHODS

We conducted a translation study over a nine-month period from February to November 2017. Permission was received to use the original version of the G-8 questionnaire for forward translation into Korean and reconciliation, for backward translation of the translated Korean version into English, for cognitive debriefing, and final proofreading. These steps were performed in the order of translation and then language validation. Forward translation was performed independently by two translators who were fluent in Korean and English. The cognitive debriefing was carried out through interviews with ten Korean nurses who cared for the patients surveyed.

RESULTS

In the forward translation, "mobility" was replaced by "degree of activity". During the reconciliation, the difference in meaning between the terms "loss of appetite" and "severe," as determined by the two translators, was adjusted. Moreover, to achieve more natural Korean expression, some revisions were made to the questions and answers. In the backward translation, most of the forward translations were accepted without any objection. During the final proofreading, no difficulties were found in understanding the questionnaire's content, and most terms were deemed easy to understand.

CONCLUSION

This Korean version of the G-8 questionnaire has been validated in accordance with appropriate procedures. Therefore, the questionnaire is appropriate for use as a geriatric screening tool for older patients with cancer in Korea.

Preoperative maximal flow rate may be a predictive factor for the outcome of tension-free vaginal tape procedure for stress urinary incontinence

This study examined factors potentially predicting on the outcome of the tension-free vaginal tape procedure for stress urinary incontinence. A total of 60 women (aged 35-71 years, mean 57) with at least follow-up of 2 years were included in the study. The tension-free vaginal tape procedure was performed under local anesthesia except in two patients. At the latest follow-up 50 (83.3%) were cured of stress urinary incontinence. Two patients had new-onset urge symptoms without urge incontinence episodes. Multivariate regression analysis showed maximal flow rate to be associated with 0.9-fold risk of the failure; no other parameters had statistical significance. Our results confirm the feasibility and safety of the tension-free vaginal tape procedure and demonstrate that preoperative low maximal flow rate may be associated with the failure of the tension-free vaginal tape procedure.

Influence of stage discrepancy on outcome in patients treated with radical cystectomy

AIMS AND BACKGROUND

To evaluate the influence of stage discrepancy on clinical outcome in patients with bladder cancer who have undergone radical cystectomy.

METHODS AND STUDY DESIGN

We reviewed the records of 155 patients who had undergone radical cystectomy. Of the 155 patients (128 males, 27 females), 68 had clinical nonmuscle invasive disease and 87 had muscle invasive disease. Follow-up ranged from 1.0 to 162.4 months (median, 34.3).

RESULTS

There was no significant difference in overall survival according to clinical T stage (P = 0.483). However, the actuarial overall survival rate of the pathological muscle invasive disease group was significantly less than that in the pathological nonmuscle invasive disease group (P < 0.001). Multivariate analysis with the Cox regression model revealed that lymphovascular invasion (P = 0.001, relative risk [RR] = 2.463) and pathological T stage (P = 0.003, RR = 3.148) were strongly associated with overall survival. There was no difference in cancer-specific survival according to clinical T stage (P = 0.455). However, cancer-specific survival rate of the pathological muscle invasive disease group was significantly less than that in the pathological nonmuscle invasive disease group (P < 0.001). Multivariate Cox proportional hazards model analysis showed that lymphovascular invasion (P = 0.001, RR = 2.545) and pathological T stage (P = 0.002, RR = 3.823) were independent predictors of cancer-specific survival.

CONCLUSIONS

Our findings indicate that clinical stage determined by transurethral resection is not predictive of clinical outcome after radical cystectomy in patients with bladder cancer.

Programmed Cell Death-Ligand 1 Expression Status in Urothelial Carcinoma According to Clinical and Pathological Factors: A Multi-Institutional Retrospective Study

Purpose: To investigate programmed cell death-ligand 1 (PD-L1) expression status and the clinical and pathological factors related to its expression in urothelial carcinoma (UC) patients. Materials and Methods: Data from 761 UC patients who underwent testing for PD-L1 expression using the VENTANA (SP-142 immunohistochemistry assay) for measuring PD-L1 expression according to the manufacturer's protocol between February 2016 and July 2019 were retrospectively reviewed. Patients were categorized into three groups based on the percentage of tumor area covered by PD-L1-expressing tumor-infiltrating immune cells (ICs) as follows: IC0 (<1%), IC1 (≥1% and <5%), and IC2/3 (≥5%). Positive PD-L1 expression was defined as IC2/3 (≥5%). The factors related to positive PD-L1 expression were assessed by using unadjusted and adjusted logistic regression analyses. Results: In the entire cohort, 213 (28%) patients showed positive PD-L1 expression. Final adjusted regression analyses for positive PD-L1 expression revealed that several factors, including intravesical BCG prior to PD-L1 testing (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.37-0.96), advanced tumor stage (stage III/IV) (OR 2.04, 95% CI 1.41-2.93), and high tumor grade (OR 5.31, 95% CI 2.38-11.83) were significantly associated with positive PD-L1 expression. Conclusions: This study showed that the PD-L1 expression is associated with several clinical and pathological factors for the first time in a real-world setting. Further follow-up clinical trials should consider adjusting these factors, including intravesical BCG treatment, tumor stage and grade to clarify the utility of PD-L1 as a biomarker.

Influence of Tumor Thrombus on Occurrence of Distant Venous Thromboembolism and Survival in Patients With Renal Cell Carcinoma After Surgery

Tumor thrombus is a unique characteristic of renal cell carcinoma (RCC). However, only a few studies have reported its clinical influence on the occurrence of venous thromboembolism (VTE). This study aimed to clarify the influence of tumor thrombus and other risk factors for VTE and to elucidate the impact of tumor thrombus on survival outcomes. We retrospectively reviewed data from patients with RCC who underwent radical or partial nephrectomy from September 1999 to August 2015 at Seoul National University Hospital. A total of 2762 patients were enrolled. The 1- and 5-year cumulative incidences of VTE were 0.5% ± 0.1% and 1.5% ± 0.3%, respectively. During a median follow-up of 39.0 months (95% confidence interval [CI], 37.1-41.0 months), deep vein thrombosis occurred in 13 patients and pulmonary embolism in 15 patients. Patients with tumor thrombus (diagnosed by surgical pathology findings) had a significantly higher incidence of VTE than those without thrombus (odds radio 8.160, 95% CI, 1.480-45.004). Older age (≥60 years) and higher preoperative C-reactive protein (>0.5 mg/dL) were also significant risk factors for VTE. Additionally, tumor thrombus was independently associated with worse progression-free survival (PFS) but not with overall survival (OS) in multivariable analysis (hazard ratio [HR] 1.916, 95% CI, 1.295-2.834 for PFS; HR 1.164, 95% CI, 0.755-1.793 for OS). In conclusion, the incidence of VTE was relatively low in patients who underwent surgery for RCC. Nevertheless, patients with tumor thrombus had an increased risk of VTE and should be closely monitored for VTE.

Estimated Glomerular Filtration Rate as a Prognostic Factor in Urothelial Carcinoma of the Upper Urinary Tract: A Systematic Review and Meta-Analysis

Preoperative renal function is associated with worse outcomes in patients undergoing radical nephroureterectomy (RNU). The purpose of this systemic review and meta-analysis was to determine the association of preoperative renal function with oncological outcome in patients who underwent RNU. We searched articles published up to March 2021 in PubMed, Scopus, and Embase by combining "urothelial carcinoma", "radical nephroureterectomy", and "estimated glomerular filtration rate". We also manually screened the reference list for publications following general guidelines recommended by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. The relationship between preoperative renal function and survival was expressed as overall survival (OS), progression-free survival (PFS), and cancer-specific survival (CSS). This review and meta-analysis included 13 studies involving a total of 4668 patients who received RNU. Pooled analysis showed significant negative association of preoperative renal function with PFS (HR: 1.51, 95% CI: 1.23-1.80, p < 0.00001), CSS (HR: 1.63, 95% CI: 1.38-1.92, p < 0.00001), and OS (HR: 1.22, 95% CI: 1.10-1.35, p < 0.00001). Patients with upper tract urothelial carcinoma (UTUC) who received RNU showed a significant negative association of preoperative renal function with survival.

Prognostic Implication of Body Mass Index on Survival Outcomes in Surgically Treated Nonmetastatic Renal Cell Carcinoma: A Single-Institutional Retrospective Analysis of a Large Cohort

PURPOSE

Obesity is a well-known risk factor for renal cell carcinoma (RCC). However, the prognostic role of obesity in RCC has not been clearly established thus far. We aim to assess the effect of preoperative body mass index (BMI) on survival outcomes in nonmetastatic RCC patients.

PATIENTS AND METHODS

We retrospectively analyzed data on 2329 patients who underwent curative surgery for RCC between 2000 and 2014 in a single institution. Patients were divided into normal (< 23 kg/m2), overweight (23-24.9 kg/m2), and obese (≥ 25 kg/m2) groups depending on cutoffs for Asian population. Kaplan-Meier analysis with log-rank test was used to estimate and compare survival outcomes, including recurrence-free, overall, and cancer-specific survival, among each BMI group. The influence of BMI on each survival outcome was evaluated using multivariate Cox regression analyses.

RESULTS

Obese patients presented favorable 5-year recurrent-free (90.7% vs 84.9%, p < 0.001), overall (91.8% vs 86.8%, p = 0.002), and cancer-specific (94.8% vs 89.4%, p = 0.002) survival rates than the normal group. Multivariate analyses revealed that increasing BMI was an independent predictor of favorable survival outcomes (all p values < 0.05). In particular, overweight (p = 0.009) and obese (p = 0.009) patients showed better cancer-specific survival compared with normal patients.

CONCLUSIONS

Our data suggest that overweight and obesity defined based on BMI are generally related to favorable survival outcomes after surgery for RCC. Additional basic research is required to find out the biological mechanisms explaining the correlation between BMI and survival outcomes.

Laparoscopic resection of metastatic pelvic liposarcoma

We report a pelvic liposarcoma originating from the left spermatic cord that recurred following inadequate excision. In our case, the tumor was resected without performing orchiectomy previously. The patient was managed by laparoscopic resection, before undergoing radical orchiectomy in the left inguinal region. To our knowledge, no case of laparoscopic resection for the recurrent liposarcoma has been described. In addition, the present case serves to demonstrate that radical orchiectomy with wide excision is needed for paratesticular tumor.

Does the degree of experience for the tension-free vaginal tape procedure influence the results of the suprapubic arc sling procedure during the learning phase?

AIM

The object was to evaluate whether the degree of experience for the tension-free vaginal tape (TVT) procedures influenced the early results of the suprapubic arc (SPARC) sling procedure.

MATERIALS AND METHODS

We performed the TVT from March 1999 to May 2003 and SPARC from June to April 2004 by experienced surgeon (A) and inexperienced surgeon (B), respectively. Patients were divided as four subgroups: first 50 patients who underwent the TVT by surgeon A (TVT A); first 15 patients who underwent the TVT by surgeon B (TVT B); first 50 patients who underwent the SPARC by surgeon A (SPARC A); first 15 patients who underwent the SPARC by surgeon B (SPARC B).

RESULTS

Bladder perforations were noted in 4 (8.5%) in the TVT A group and 2 (13.3%) in the TVT B group, respectively (P = 0.626). There was no bladder perforation occurred in the SPARC A and B groups. The rates of transient postoperative urinary retention were 6.4% in the TVT A group and 0.0% in the TVT B group, respectively (P = 1.000). No retention occurred in the SPARC A and B groups. Stress urinary incontinence was cured by 89.4% in the TVT A group and 80.0% in the TVT B group, respectively (P = 0.388). Similar success rates were found in the SPARC A (85.4%) and SPARC B (92.3%) group (P = 1.000).

CONCLUSION

Our findings suggest that the degree of experience for the TVT procedure does not influence the results of the SPARC procedure during the learning phase.

Differences in risk factors for biochemical recurrence after radical prostatectomy stratified by the degree of obesity: Focused on surgical methods

This study aims to evaluate differences in the risk factors for biochemical recurrence (BCR) for radical prostatectomy stratified by degree of obesity, focusing on the surgical method used. All 3099 patients who underwent radical prostatectomy in two medical centres from January 2008 to March 2018 were retrospectively reviewed. Patients were divided into three groups based on body mass index: 'normal', 'overweight', and 'obese'. Risk factors associated with biochemical recurrence were compared between different degrees of obesity. We analysed the contributing risk factors of BCR-free survival using univariate and multivariable Cox hazard models. There were 378 (12.2%) and 1815 (58.6%) patients in the 'obese' and 'overweight' groups, respectively. Accordingly, 1324 patients underwent retropubic radical prostatectomy (RRP), and 1775 underwent robotic-assisted laparoscopic prostatectomy (RALP). Multivariable analysis showed that patients who underwent RALP had significantly lower BCR free survival in the 'overweight' and 'obese' groups than those who underwent RRP, with adjusted hazard ratios of 0.75 (95% CI 0.59-0.95, p-value = 0.01) and 0.55 (95% CI 0.33-0.90, p-value = 0.02), respectively. The degree of obesity was not directly associated with BCR-free survival. Robotic prostatectomy showed greater benefits in BCR-free survival than open prostatectomy in the 'overweight' and 'obese' groups.