Oncologic and Functional Outcomes after Partial Nephrectomy Versus Radical Nephrectomy in T1b Renal Cell Carcinoma: A Multicenter, Matched Case-Control Study in Korean Patients / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The study was to compare the oncologic and functional outcomes of partial nephrectomy (PN) and radical nephrectomy (RN) for pathologically proven T1b renal cell carcinoma using pair-matched groups. MATERIALS AND METHODS: We reviewed our prospectively maintained database for RN and PN in T1b renal tumors surgically treated between 1999 and 2011 at five institutions in Korea. Of 611 patients treated with PN or RN for a solitary and NX/N0 M0 renal mass (4-7 cm), 577 (PN, 100; RN, 477) patients with pathologically confirmed pT1b remained for analysis. Study subjects were grouped by PN or RN, then matched by age, sex, comorbidities, body mass index, tumor size and depth, histologic type, and preoperative estimated glomerular filtration rate (eGFR) using propensities score. To evaluate oncologic outcomes, overall survival (OS), cancer-specific survival (CSS), and progression-free survival (PFS) rates were analyzed. The functional outcomes were evaluated by postoperative eGFR. RESULTS: The median follow-up in the RN group was 48.1 and 42.6 months in the PN group. The estimated 10-year CSS rate (PN 85.7% vs. RN 84.4%, p=0.52) and 5- and estimated 10-year PFS rates (PN: 86.4% and 79.2% vs. RN: 86.0% and 66.1%, p=0.66) did not differ significantly between groups. The estimated 10-year OS rate was significantly higher in the PN group (85.7%) compared to the RN group (73.3%) (p=0.003). PN was less likely to induce new-onset chronic kidney disease (CKD) and end-stage CKD compared with RN. CONCLUSION: Our study suggests that patients treated with PN demonstrate a superior OS rate and postoperative renal function with analogous CSS and PFS rates compared with pair-matched patients treated with RN.

An Organic Intravesical Foreign Body Caused by Penetrating Trauma that was Missed during Initial Management / 대한배뇨장애요실금학회지

We report a case of an intravesical foreign body that was incompletely removed endoscopically and that defied diagnosis with current diagnostic tools. A 65-year-old man visited Korea University Anam Hospital complaining of dysuria and a sensation of residual urine. His medical history included an intravesical foreign body caused by penetrating trauma, and he had undergone endoscopic removal of foreign bodies 1 year previously. After additional remnant intravesical foreign bodies were found, he had undergone additional endoscopic removal and his urinary symptoms subsided. After 2 years, however, he again presented to the clinic complaining of dysuria and gross hematuria. Cystoscopy and computed tomography for intravesical foreign bodies were performed, but no evidence of a remnant foreign body was found. Open exploration revealed a remnant foreign body penetrating the bladder. A partial cystectomy including the foreign body was performed. We suggest that cases of penetrating injury with a radiolucent object may warrant primary open exploration and foreign body removal owing to the inherent difficulties in diagnosis and endoscopic treatment of such objects.

Clinical Implications of Residual Urine in Korean Benign Prostatic Hyperplasia (BPH) Patients: A Prognostic Factor for BPH-Related Clinical Events / 대한배뇨장애요실금학회지

PURPOSE: Although post-void residual urine (PVR) is frequently utilized clinically in patients with benign prostatic hyperplasia (BPH), mainly because of its procedural simplicity, its role as a clinical prognostic factor, predictive of treatment goals, is still under much dispute. We investigated the predictive value of PVR for BPH-related clinical events including surgery, acute urinary retention (AUR), and admission following urinary tract infection (UTI). METHODS: From January to June of 2006, patients over 50 years of age who were diagnosed with BPH for the first time at the outpatient clinic and were then treated for at least 3 years with medications were enrolled in this study. The variables of patients who underwent surgical intervention for BPH, had occurrences of AUR, or required admission due to UTI (Group 1, n=43) were compared with those of patients who were maintained with medications only (Group 2, n=266). RESULTS: Group 1 had a significantly higher PVR, more severe symptoms, and a larger prostate at the time of the initial diagnosis in both the univariate and the multivariate analysis. In the 39 patients who underwent BPH-related surgery, although there was a significant change in Qmax at the time of surgery (mean, 13.1 months), PVR and the symptom score remained unchanged compared with the initial evaluation. In the receiver-operating characteristic curve analysis, the area under the curve of Group 1 was in the order of prostate volume (0.834), PVR (0.712), and symptom score (0.621). When redivided by arbitrarily selected PVR cutoffs of 50 mL, 100 mL, and 150 mL, the relative risk of clinical BPH progression was measured as 3.93, 2.61, and 2.11. CONCLUSIONS: These data indicate that, in the symptomatic Korean population, increased PVR at baseline is a significant indicator of BPH-related clinical events along with increased symptom score or prostate volume.

Single Positive Core Prostate Cancer in a 12-Core Transrectal Biopsy Scheme: Clinicopathological Implications Compared with Multifocal Counterpart

PURPOSE: The incidence of single positive core prostate cancer at the time of biopsy appears to be increasing in the prostate-specific antigen (PSA) era. To determine the clinical implication of this disease, we analyzed surgical and pathological characteristics in comparison with multiple positive core disease. MATERIALS AND METHODS: Among 108 consecutive patients who underwent robotic radical prostatectomy following a diagnosis of prostate cancer based on a 12-core transrectal biopsy performed by the same method in a single institute, outcomes from 26 patients (Group 1) diagnosed on the basis of a single positive biopsy core and from 82 patients (Group 2) with multiple positive biopsy cores were analyzed. RESULTS: The preoperative PSA value, Gleason score, prostate volume, and D'Amico's risk classification of each group were similar. The proportion of intermediate+highrisk patients was 69.2% in Group 1 and 77.9% in Group 2 (p=0.22). Total operative time and blood loss were similar. Based on prostatectomy specimens, only 3 patients (11.5%) in Group 1 met the criteria for an indolent tumor (7.31% in Group 2). Although similarities were observed during preoperative clinical staging (p=0.13), the final pathologic stage was significantly higher in Group 2 (p=0.001). The positive-margin rate was also higher in Group 2 (11.5% vs. 31.7%, p=0.043). Despite similarity in upstaging after prostatectomy in each group (p=0.86), upgrading occurred more frequently in Group 1 (p=0.014, 42.5% vs. 19.5%). No clinical parameters were valuable in predicting upgrading. CONCLUSIONS: Most single positive core prostate cancer diagnoses in 12-core biopsy were clinically significant with similar risk stratification to multiple positive core prostate cancers. Although the positive-margin rate was lower than in multiple positive core disease, an increase in Gleason score after radical prostatectomy occurred more frequently.

Incidence and Risk Factors of Postoperative De Novo Voiding Dysfunction following Midurethral Sling Procedures

PURPOSE: To compare the incidence of postoperative de novo voiding dysfunction and to identify the risk factors affecting the development of de novo voiding dysfunction after various midurethral sling (MUS) procedures for female stress urinary incontinence (SUI). MATERIALS AND METHODS: Women with SUI underwent MUS by various procedures [tension-free vaginal tape (TVT(R)), tension-free vaginal tape obturator (TVTO(R)), tension-free obturator tape (TOT(R)), or TVT-secure(R)]. Cases were reviewed retrospectively with follow-up of at least 6 months. The subjects were divided into 2 groups according to the presence of postoperative de novo voiding dysfunction. De novo voiding dysfunction was defined as a low maximal uroflow rate (Qmax100 ml) observed at 6 months postoperatively. Clinical and urodynamic parameters were compared between the voiding dysfunction (Group I) and normal voiding (Group II) groups according to MUS procedure. RESULTS: Of the 625 subjects, 163 (26%) patients showed evidence of de novo voiding dysfunction (Group I). Of these 163 subjects, 12 (7.3%) patients complained of voiding symptoms. There was no difference in the incidence of de novo voiding dysfunction according to MUS procedure. Multivariate analysis showed Qmax to be the only independent risk factor for de novo voiding dysfunction. CONCLUSIONS: This study confirmed the considerable incidence of postoperative de novo voiding dysfunction, which is, however, mostly asymptomatic. As preoperative Qmax decreased, the chance of postoperative de novo voiding dysfunction increased. Identification of risk factors of voiding dysfunction in women undergoing MUS may help in planning for better follow-up and early detection of possibly inherent late complications of voiding dysfunction.

Risk Factors of the Infectious Complications and Causative Microorganisms after Transrectal Ultrasound-guided Prostate Needle Biopsy / 대한남성과학회지

PURPOSE: Transrectal ultrasound-guided prostate needle biopsy (TRUS-PBx) is the standard procedure to diagnose prostate cancer. We evaluated the incidence and risk factors of infectious complications, the species cultured and rates of resistance for antibiotics of microorganism in infectious complications after TRUS-PBx. MATERIALS AND METHODS: We retrospectively evaluated the medical records of 742 patients who underwent TRUS-PBx from January 2004 to May 2007. All patients were treated with intravenous ciprofloxacin and oral ciprofloxacin for 1 week after discharge. Patients who presented infectious complications were performed chest x-ray, blood analysis, urine analysis and culture studies. RESULTS: Among 742 patients, 15 patients (2.0%) developed infectious complications. There were no significant differences between the complication and non-complications groups in age, PSA, prostate volume, nodule, hypoechoic lesion on transrectal sonography and underlying medical diseases. Twelve cases were performed in outpatient department and 3 cases were in operation room and that suggests high frequency of infectious complication when transrectal prostate biopsy is performed in outpatient department (p=0.007). Six kinds of microorganisms were cultivated in 12 patients (1.9%). E. coli (7/12) was most common. Extended-spectrum beta-lactamase suggesting nosocomial infection was positive in 3 cases of outpatient department. On logistic regression analysis, urethral catheter indwelling was a significant risk factor increasing infectious complications. CONCLUSIONS: After TRUS-PBx, the rate of severe infectious complications and nosocomial infections were more frequent in outpatient department. And urethral catheter indwelling significantly increased infectious complication rate. So we should sublate the urethral catheter and keep in mind the aseptic technique at outpatient department.

Metachronous Bilateral Renal Lymphangiomatosis Mimicking as a Simple Renal Cyst / 대한비뇨기과학회지

Renal lymphangiomatosis is a rare developmental malformation of the perirenal lymphatic system, and this can result in the development of cystic masses in the peri-pelvic or peri-renal areas. This is difficult to differentiate from other cystic renal disease on imaging studies. We present here a case of metachronous bilateral renal lymphangiomatosis that was falsely diagnosed as a simple renal cyst. A 47 year-old man was referred for a large amount of drainage after right renal cyst marsupialization. The abdominal computed tomography(CT) findings and fluid analysis were compatible with a lymphangiomatosis. After 6 month, he presented with flank pain on his left side and CT showed intracystic hemorrhage on the left renal lymphangiomatosis. Percutaneus drainage and conservative management were done.

Metachronous Bilateral Renal Lymphangiomatosis Mimicking as a Simple Renal Cyst / 대한비뇨기과학회지

Renal lymphangiomatosis is a rare developmental malformation of the perirenal lymphatic system, and this can result in the development of cystic masses in the peri-pelvic or peri-renal areas. This is difficult to differentiate from other cystic renal disease on imaging studies. We present here a case of metachronous bilateral renal lymphangiomatosis that was falsely diagnosed as a simple renal cyst. A 47 year-old man was referred for a large amount of drainage after right renal cyst marsupialization. The abdominal computed tomography(CT) findings and fluid analysis were compatible with a lymphangiomatosis. After 6 month, he presented with flank pain on his left side and CT showed intracystic hemorrhage on the left renal lymphangiomatosis. Percutaneus drainage and conservative management were done.