A novel transurethral resection technique for superficial flat bladder tumor: Grasp and bite technique

PURPOSE: Transurethral resection of bladder tumor (TURBT) can be a challenging procedure for an inexperienced surgeon. We suggest an easy technique for TURBT, which we have named the "grasp and bite" technique. We describe this technique and compare its effectiveness and safety with that of conventional TURBT. MATERIALS AND METHODS: Monopolar TURBT (24-Fr Karl Storz) was performed in 35 patients who had superficial bladder tumors. After defining the tumor margin, the tumor and surrounding mucosa were grasped by use of a loop electrode and resectoscope sheath. With tight grasping, linear moving resection was performed. The patients' demographic, intraoperative, and postoperative data were analyzed between the conventional and grasp and bite TURBT groups. RESULTS: Of 35 patients, 16 patients underwent conventional TURBT (group 1), and the other 19 patients underwent grasp and bite TURBT (group 2). Both groups were similar in age, tumor multiplicity, size, anesthesia method, and location. Grasp and bite TURBT could be performed as safely and effectively as conventional TURBT. There were no significant differences in irrigation duration, urethral catheterization, postoperative hemoglobin drop, or length of hospital stay. No significant side effects such as bladder perforation, severe obturator reflex, or persistent bleeding occurred. There were no significant pathological differences between specimens according to the type of resection technique. CONCLUSIONS: The grasp and bite TURBT technique was feasible for superficial bladder tumors. It may be a good tool for inexperienced surgeons owing to its convenient and easy manner.

Effect of Tamsulosin HCl (0.2 mg) on Female Lower Urinary Tract Symptoms with Maximal Urinary Flow Rate Less Than 12 ml/sec

PURPOSE: Alpha adrenergic components do not seem prevalent in the female bladder neck. Nevertheless, some studies using alpha-blockers in women suffering from obstructed urine flow have been reported. We assessed the effectiveness of administering an alpha 1-adrenoceptor antagonist, tamsulosin, in patients with a maximal flow rate less than 12 ml/sec. MATERIALS AND METHODS: From January 2007 to December 2007, 150 patients with a maximal flow rate less than 12 ml/sec were selected for this study. Patients were treated with tamsulosin at a dose of 0.2 mg per day. The effectiveness of tamsulosin was assessed by analyzing the International Prostate Symptom Score (IPSS) and other parameters, including the maximal urinary flow rate (Qmax) and the amount of postvoid residual urine. The data for these parameters were acquired at baseline and after 4 and 12 weeks of treatment. RESULTS: Of the 150 patients, 113 patients (75.3%) completed the study. Except for the storage symptom score, all clinical parameters, including total IPSS, voiding symptom score, Qmax, and the amount of residual urine, showed significant improvement after 4 and 12 weeks of treatment (p<0.05). The incidence of adverse events was only 4.4%, including dizziness in 3 patients, stress incontinence in 1 patient, and lethargy in 1 patient. CONCLUSIONS: The alpha-1 adrenoceptor antagonist tamsulosin significantly improved subjective symptoms and uroflowmetric parameters in female patients with a low maximal flow rate of less than 12 ml/sec. The use of tamsulosin may be an initial treatment option in females with a low maximal urinary flow rate.

The Functional Effect of Palliative Transurethral Resection of the Prostate on Lower Urinary Tract Symptoms in Patients with Prostate Cancer

PURPOSE: Voiding dysfunction occurs frequently in patients with prostate cancer. We investigated the functional effect of palliative transurethral resection of the prostate (pTURP) on lower urinary tract symptoms in patients with prostate cancer. MATERIALS AND METHODS: We retrospectively assessed all patients who had a pTURP at our institution between 1999 and 2006. Patients with incidental prostate cancer were excluded. In all, 64 patients were enrolled in the study. The International Prostate Symptom Score (IPSS), the quality of life (QoL), the maximal flow rate (Qmax), and the postvoid residual urine volume (PVR) were evaluated before and after 3 months of pTURP. A positive functional outcome was defined as PVR below 100 ml, no additional catheterization, no repeat pTURP, and no development of urinary incontinence. RESULTS: The patients' mean age was 76.32+/-6.8 years, and their mean prostate volume was 46.38+/-19.43 g. After pTURP, the mean IPSS improved from 25.83+/-6.71 to 18.63+/-5.96, the mean QoL score improved from 4.33+/-0.87 to 3.02+/-0.83, the mean maximal flow rate increased from 6.11+/-3.68 ml/sec to 14.20+/-6.30 ml/sec, and the PVR decreased from 153.69+/-32.03 ml to 41.89+/-25.35 ml. All voiding parameters showed significant improvement (p<0.001). Of the 64 patients, 12 had poor functional outcome after pTURP. The functional improvement rate of pTURP was 81.25%. CONCLUSIONS: The pTURP performed in patients with prostate cancer showed a favorable effect and resulted in significant improvement in voiding dysfunction. In patients with high-stage metastatic prostate cancer or cancer unsuitable for curative therapy, pTURP could be considered as a safe treatment method to improve lower urinary tract symptoms.

Age Related Changes of Voiding Patterns in Women with Overactive Bladder

PURPOSE: We tried to discover the voiding patterns, which was diurnal & nocturnal urinary volume and voiding frequencies in women with overactive bladder (OAB). MATERIALS AND METHODS: All voided volumes, times and frequencies were recorded in 249 women with overactive bladder. The subjects age related changes in bladder capacity, urinary volume and frequency were evaluated. The causes of nocturnal urinary frequency and its increase with age in older women with OAB were evaluated using 3 days of voiding diaries. Nocturia was devided into three types: nocturnal polyuria, decreased nocturnal bladder capacity and mixed type. RESULTS: Total voided volume, daytime urine volume, functional bladder capacity were decreased with the age. Nocturnal urine volume and nocturnal urinary frequency were increased with age. Nocturnal polyuria was the major cause for nocturia, and mixed type was increased with age. CONCLUSIONS: Voiding symptoms as well as storage symptoms were increased with age in OAB female. In most cases, nocturia was caused by nocturnal polyuria.

Anterior Urethral Recurrence from an Upper Urinary Tract Urothelial Tumor

We report a case of a metachronous transitional cell carcinoma (TCC) of the penile urethra in an elderly male after nephroureterectomy. The patient had a history of right nephroureterectomy 18 months previously due to TCC of the upper urinary tract. A solitary urethral recurrence from a TCC of the upper urinary tract is rare. An anterior urethral recurrence of a TCC of the upper urinary tract has not been previously reported in the literature. The prognosis of a metachronous anterior urethral recurrence of an upper-tract TCC is poor.

The Clinical Roles of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computerized Tomography for Urological Disease / 대한비뇨기과학회지

PURPOSE: We evaluate the clinical roles of 18F-fluorodeoxyglucose positron emission tomography/computerized tomography(18F-FDG PET/CT) for diagnosing disease in the urogenital tract, and we compared this with the other established radiologic and pathologic diagnoses. MATERIALS AND METHODS: From June 2006 to June 2007, the total number of subjects who underwent 18F-FDG PET/CT was 4,438. The mean patient age was 57.4+/-7.6 years and the ratio of males to females was 1.28:1. During the study period, except for 152 patients who had been given a diagnosis of urologic tumor, 614(14.3%) healthy subjects and 3,672(85.7%) patients with non-urologic tumors were enrolled. The results of detecting urologic disease by 18F-FDG PET/CT were compared with the results of detecting urologic disease by conventional imaging techniques and the postoperative histopathological diagnoses. RESULTS: With including 147 healthy subjects and 251 non-urologic tumor patients, 398 (9.3%) urologic diseases were detected on 18F-FDG PET/CT. Diseases of the kidney, adrenal and prostate were frequently found(215, 95 and 52 patients, respectively). A thorough examination was indicated for 153(3.6%) of the patients as a result of positive findings that suggested possible tumor. A total 93 urologic cancers were confirmed, and the overall positive predictive value of 18F-FDG PET/CT was 60.7%. The positive predictive value for adrenal, kidney, bladder and prostate cancer were 87.7%, 73.3%, 57.1% and 14.0%, respectively. CONCLUSIONS: 18F-FDG PET/CT was not superior to conventional imaging for making the diagnosis of urologic disease. But 18F-FDG PET/CT was more predictive for adrenal and renal tumor than for bladder and prostate tumor. So, urologic tumor that is incidentally detected on 18F-FDG PET/ CT, and especially adrenal and renal tumor, should be closely evaluated.