Metastasis of transitional cell carcinoma to the lower abdominal wall 20 years after cystectomy

Iatrogenic implantation has been the main cause in the majority of cases of transitional call carcinoma (TCC) with metastasis to the abdominal wall. A 66-year-old woman had undergone radical cystectomy 20 years prior to presenting. Radiological investigations revealed one mass in the left lower abdominal wall and one mass in the right inguinal area. She underwent wide excision of the lesions that revealed metastasis of TCC. This report describes this case of a woman with bladder carcinoma who developed a metastasis in the anterior abdominal wall following an apparent disease-free interval of 20 years.

Emphysematous pyelonephritis recovered by ureteral stenting in a functionally solitary kidney

A 62-year-old male diabetic presented with emphysematous pyelonephritis and contralateral atrophic kidney. He failed to improve with a supportive management, and we placed a double-J stent instead of performing percutaneous nephrostomy or nephrectomy with marked improvement. We report a case of emphysematous pyelonephritis recovered by ureteral stenting.

The one year outcome after KTP laser vaporization of the prostate according to the calculated vaporized volume

The aim of this study was to develop a new simple method for measuring the vaporized volume and to evaluate the outcome of high-power potassium-titanyl-phosphate (KTP) photoselective laser vaporization. A total of 65 patients, with a mean age of 67.7 yr (range 53 to 85), were included in the primary analysis. The vaporized volume was calculated as the pre-operative volume minus the immediate post-operative volume plus the volume of the defect. For all patients, the subjective and objective parameters improved significantly after surgery. Six and 12 months after surgery, the group with a smaller vaporized volume (<15 g) had a lower reduction of the mean International Prostate Symptom Score (P=0.006 and P=0.004) and quality of life index (P=0.006 and P=0.004) when compared to the group with a greater vaporized volume (>or=15 g). There were no differences in the change of the maximum flow rate and post-void residual based on the vaporized volume. Our findings suggest that the subjective improvement, after a high-power KTP laser vaporization, may be dependent on the vaporized volume obtained after the procedure.

Infected hydrocele in a neonate

A case of infected hydrocele in a neonate is presented. We describe this unusual condition, and discuss the diagnosis, pathophysiology and treatment.

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.

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.

External Validation of Models for Prediction of Lymph Node Metastasis in Urothelial Carcinoma of the Bladder

PURPOSE

To externally validate models to predict LN metastsis; Karakiewicz nomogram, clinical nodal staging score (cNSS), and pathologic nodal staging score (pNSS) using a different cohort.

MATERIALS AND METHODS

Clinicopathologic data from 500 patients who underwent radical cystectomy and pelvic lymphadenectomy were analyzed. The overall predictive values of models were compared with the criteria of overall performance, discrimination, calibration, and clinical usefulness.

RESULTS

Presence of pN+ stages was recorded in 117 patients (23.4%). Agreement between clinical and pathologic stage was noted in 174 (34.8%). Based on Nagelkerke's peudo-R2 and brier score, pNSS demonstrated best overall performance. Area under the receiver operating characteristics curve, showed that pNSS had the best discriminatory ability. In all models, calibration was on average correct (calibration-in-the-large coefficient = zero). On decision curve analysis, pNSS performed better than other models across a wide range of threshold probabilities.

CONCLUSIONS

When compared to pNSS, current precystectomy models such as the Karakiewicz nomogram and cNSS cannot predict the probability of LN metastases accurately. The findings suggest that the application of pNSS to Asian patients is feasible.

Disease-specific survival in patients with renal cell carcinoma: an audit of a large series from Korea

BACKGROUND

To evaluate the question of whether or not young age is an independent prognostic factor for disease-specific survival in Korean patients with renal cell carcinoma.

METHODS

A total of 785 patients with an age range of 22-84 years (median, 56) were included in the study. Patients were categorized according to age; 40 years or less (n = 93), 41-60 years (n = 416) and older than 60 years (n = 276).

RESULTS

Patients 40 years or less at diagnosis differed significantly from older patients for the following parameters: smaller tumour diameter (P = 0.001), less advanced stage (P = 0.002), lower Fuhrman nuclear grade (P = 0.017) and fewer clear cell carcinomas (P < 0.001). Five-year disease-specific survival rate in patients 40 years or younger was also higher than that of older patients (92.7% versus 86.0% versus 69.2%; P < 0.001). When subgroup analysis was performed, only in patients with tumour diameter 4.1-7.0 cm (P = 0.018), pT1-pT2,N0,M0 (P = 0.001) or clear cell type carcinoma (P < 0.001), disease-specific survival probability for patients 40 years or younger was higher than that of older patients. When the Cox proportional hazards model was applied, age at diagnosis was not an independent prognostic predictor of disease-specific survival.

CONCLUSIONS

Tumours found in young adults show more favourable histological features than those found in older adults. However, according to results from multivariate analysis, young patients do not have higher disease-specific survival rate after adjusting for clinical and pathological variables.

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.

Significance of nocturnal hesitancy in treatment of men with lower urinary tract symptoms

OBJECTIVES

To determine the significance of nocturnal hesitancy in the treatment of men with lower urinary tract symptoms.

METHODS

A total of 123 patients with nocturia were prospectively studied. The nocturnal hesitancy scores ranged from 0 to 5 and were scored according to the International Prostate Symptom Score. The patients were stratified on the basis of their nocturnal hesitancy scores as group 1 (0 to 1, n = 57), group 2 (2 to 3, n = 45), and group 3 (4 to 5, n = 21). All patients received treatment with an alpha-blocker once daily for 4 weeks.

RESULTS

Group 3 scored significantly higher on the International Prostate Symptom Score at baseline and after treatment than did group 1. The actual number of nightly voids was greatest in group 3 and was lowest in group 1 (P = 0.011 at baseline and P = 0.046 after treatment, respectively). The baseline nocturia indexes were greatest in group 3 and were lowest in group 2 (P = 0.027). A significant but weak correlation was also noted between the nocturia hesitancy score and the differences in scores between the posttreatment and baseline voiding symptoms (r = -0.234, P = 0.021) and total International Prostate Symptom Score (r = -0.270, P = 0.011), respectively. In our multivariate analyses, the straining score was a significant determinant of nocturnal hesitancy.

CONCLUSIONS

The results of our study revealed that more emphasis should be placed on nocturnal hesitancy in the terminology of lower urinary tract symptoms. Additional research regarding the pathophysiologic mechanisms underlying nocturnal hesitancy, as well as its effects on those with it, is clearly warranted.

Risk stratification and management of non-muscle-invasive bladder cancer: A physician survey in six Asia-Pacific territories

OBJECTIVES

Multiple clinical practice guidelines, conflicting evidence, and physician perceptions result in variations in risk stratification among patients with non-muscle-invasive bladder cancer (NMIBC). This study aims to describe the extent of this variation and its impact on management approaches in the Asia-Pacific region.

METHODS

We conducted a cross-sectional survey involving 32 urologists and seven medical oncologists with ≥8 years of experience managing early-stage bladder cancer patients across Australia, Hong Kong, Japan, South Korea, Singapore, and Taiwan. The physicians completed an anonymous questionnaire that assessed their risk stratification and respective management approaches, based on 19 NMIBC characteristics. For each NMIBC characteristic, they were required to select one risk group, and their most preferred management approach.

RESULTS

Our results demonstrated a higher consensus on risk classification versus management approaches. More than 50% of the respondents agreed on the risk classification of all NMIBC characteristics, but 42% or fewer chose the same treatment option as their preferred choice for all but two characteristics-existence of variant histology (55%) and persistent high-grade T1 disease on repeat resection (52%). Across territories, there was the greatest variation in preferred treatment options (i.e., no treatment, intravesical chemotherapy, or Bacillus Calmette-Guérin [BCG] treatment) for intermediate-risk patients and the highest consensus on the treatment of very high-risk patients, namely radical cystectomy.

CONCLUSIONS

Our study revealed considerable variation in risk stratification and management of NMIBC in the region. It is critical to develop practical algorithms to facilitate the recognition of NMIBC and standardize the treatment of NMIBC patients.

External validation of an international multicenter study to predict survival in Korean patients with pT2N0M0 renal cell carcinoma

OBJECTIVES

To determine whether a tumor size cut-off can improve the prognostic accuracy of the current tumor-node-metastasis staging system in Korean patients with pT2 renal cell carcinoma (RCC).

METHODS

We identified 819 patients treated with radical nephrectomy for clinical RCC between 1995 and 2005. The study included 102 patients of pT2N0M0 RCC.

RESULTS

When 5-year survival rates were calculated using 0.5-cm increments between 7.5 and 12.5 cm, none of the cut-offs provided a significant difference in 5-year overall and cancer-specific survival. Cut-offs of 9.5 and 10.0 cm provided significant difference in 5-year progression-free survival (log-rank score 4.37, P = .037; log-rank score 6.75, P = .009, respectively). However, a 10.5-cm cut-off provided the greatest difference in 5-year progression-free survival (log-rank score 7.19; P = .007). Multivariate Cox proportional hazards model analysis using the variables of age, sex, American Society of Anesthesiologists score, tumor side, histologic type, tumor grade, and tumor diameters showed that tumor diameter was an independent predictor of progression-free survival when 10.0 cm (hazard ratio [HR], 2.72; 95% confidence interval [CI] 1.19-6.22; P = .018), and 10.5 cm (HR, 2.77; 95% CI 1.21-6.33; P = .016) were chosen as the cut-offs.

CONCLUSIONS

In our study, only size-related recurrence or metastatic potential was found, and a 10.5-cm cut-off best stratified this difference. However, size-related cancer-specific and overall survival differences were not found among patients.

Risk of connective-tissue disease in men with testicular or penile prostheses: a preliminary study

AIM

To help clarifying the possibility of connective-tissue diseases in men with penile or testicular prostheses.

METHODS

Eight patients underwent inflatable penile prostheses and 15, testicular prostheses consented to the study. Their medical records were reviewed and a follow-up interview and physical and serological examinations were performed.

RESULTS

In patients with penile prostheses, there was no abnormal antinuclear antibody (ANA) or IgM elevation. The serum levels of the rheumatoid factor (RF), C4, IgA and IgG were abnormal in one patient, and the levels of erythrocyte sedimentation rate (ESR) and C3, abnormal in two. Four had elevated IgE. In patients with testicular prostheses, there was no abnormal RF, ANA or IgM. The serum levels of ESR and IgA were abnormal in two, and three had abnormal C4, ten abnormal C3, and eleven decreased IgG. All had increased IgE. Men with penile prostheses had higher serum levels of IgG and IgM than those with testicular prostheses (P=0.001, P=0.016, respectively). The rates of abnormal values of IgE and IgG were higher in men with testicular prostheses than in men with penile prostheses (P=0.008, P=0.009, respectively). Physical examination was normal in all patients and nobody had documented symptoms pertinent to connective-tissue diseases.

CONCLUSION

Our findings suggest that the risk of connective-tissue diseases is not higher in patients wearing prostheses as the ANA is negative and there is no apparent manifestation suggestive of connective-tissue diseases.