Grade Concordance between Transitional Cell Carcinoma of the Bladder and the Upper Urinary Tract / 대한비뇨기과학회지

PURPOSE: Transitional cell carcinoma(TCC) is thought to involve the entire urothelium as a multifocal field change. The tumor grade is a major prognostic factor in TCC and predicting the grade of TCC may be of clinical significance. The objective of this study is to clarify the grade concordance between upper tract TCC and bladder TCC. MATERIALS AND METHODS: From 1994 to 2006, a total of 241 patients underwent nephroureterectomy for upper tract TCC. Seventy-four of the 241 patients who had a history of previous bladder cancer and/or synchronous or metachronous bladder TCC were included in this study. The grade was recorded for each tumor. Fisher's exact test of concordance was used for statistical analysis. RESULTS: For the 74 patients who were analyzed, 42 patients(56.8%) developed bladder TCC during their follow up after nephroureterectomy, 14 patients(18.9%) had a history of bladder TCC prior to nephroureterectomy and 18 patients(24.3%) had a synchronous bladder tumor. In the case of developing bladder TCC during their follow up after nephroureterectomy, the grade concordance is highest between upper tract TCC and bladder TCC in 81.0% of the cases(p=0.005). Overall, the concordance rate between the upper tract TCC grade and the bladder TCC grade was 77.0%(p<0.001). CONCLUSIONS: Concordance of the TCC in the upper urinary tract and bladder was present in 77.0% of the cases. The patients who developed bladder tumor during their follow up after nephroureterectomy had the highest grade concordance between upper tract TCC and bladder TCC in 81.0% of the cases. This knowledge can have a significant impact on the therapeutic and follow up plans for transitional cell carcinoma.

The Refill Rate and Reasons for Abandonment of Phosphodiesterase5 Inhibitors in Erectile Dysfunction Patients / 대한비뇨기과학회지

PURPOSE: The aim of this study was to determine the rate of abandonment of phosphodiesterase (PDE)5 inhibitor therapy in patients who had reported good treatment efficacy, and to assess the reasons for abandonment of therapy and rate of prescription refilling. MATERIALS AND METHODS: Between January 2004 and December 2005, patients with erectile dysfunction (ED) who had begun PDE5 inhibitor therapy in our center were enrolled in this study. A telephone survey of these patients was conducted to determine the rate of prescription refilling and the reasons for abandonment. After receiving the first prescription, patients were asked whether they had used the medication and whether the treatment improved their erectile function using a Global Assessment Questionnaire (GAQ). Medical records for these patients were reviewed retrospectively. RESULTS: 753 patients with ED began PDE5 inhibitor therapy. Only 200 subjects (26.5%) asked for a refill of PDE5 inhibitors. Of 553 subjects, 330 consented to the telephone survey and 226 subjects (68.5%) had positive response on the GAQ. Forty-one patients continued taking PDE5 inhibitors in other clinics. Finally, the reasons for abandonment were assessed in 185 patients who had reported good treatment efficacy but abandoned therapy. The majority reported that they had experienced improvement of spontaneous erectile function (21.6%). Two hundred subjects requested refills in our center (26.5%) and 41 patients (5.4%) continued a prescription in other clinics, so the rate of refill was greater than 31.9%. CONCLUSIONS: According to the results of this study, the improvement of ED was cited as the major reason for abandonment of PDE5 inhibitor therapy. The rate of prescription refilling was greater than 31.9%.

Feasibility of Testis-sparing Surgery for Testicular Tumors in Children / 대한비뇨기과학회지

PURPOSE: We assessed the feasibility of testis-sparing surgery in children with testicular tumors. MATERIALS AND METHODS: Twenty-five pediatric patients who had a testicular tumor were enrolled for retrospective analysis. Testis-sparing surgery was planned in the cases with clinical features that preoperatively suggested the tumors to be benign, which was later determined intraoperatively by frozen section examination. The preoperative-fetoprotein (AFP) and transscrotal ultrasound (US) were evaluated along with the final pathology. We reviewed the immediate and late surgical complications, as well as the tumor recurrence after surgery. RESULTS: Teratoma, epidermoid cyst, yolk sac tumor, and Leydig cell tumor accounted for finding in 40%, 32%, 24%, and 4% of the patients, respectively. Based on the preoperative US, 18 patients had benign-looking tumors. According to the age-matched AFP references, 17 patients showed normal ranges preoperatively. Out of 14 patients, whose US and AFP level suggested the tumors to be benign, 10 (71.4%) were eligible for testis- sparing surgery on retrospective review. Testis-sparing surgery was performed in 5 patients, who showed the same pathology in frozen sections (3 epidermoid cysts, 2 teratomas). None of the 5 patients exhibited perioperative complications, and no recurrence or atrophy was observed at a mean follow-up of 39.8 months. CONCLUSIONS: Out of 14 patients, whose US and AFP analyses were available, 10 (71.4%) were eligible for testis-sparing surgery. Testis-sparing surgery was done in five out of the 10 patients without any complication or recurrence. Testis-sparing surgery is a feasible option in children with testicular tumors if the AFP level is within a normal range and the US suggests benign characteristics.

Clinical and Pathological Characteristics of Micropapillary Transitional Cell Carcinoma of the Bladder / 대한비뇨기과학회지

PURPOSE: Micropapillary bladder carcinoma is a rare variant of urothelial cancer. The clinical course is more aggressive than that of conventional urothelial cancer, but the optimal treatment for this malady has not been confirmed. There are few studies about micropapillary bladder cancer. So, we performed a clinico-pathololic review on 10 cases with micropapillary bladder cancer. MATERIALS AND METHODS: Between December 1994 and May 2003, of the 1,170 cases that had undergone transurethral resection of bladder tumor (TURB), we reviewed the pathology of 440 patients who had stage T1 or T2 disease. Of these, we identified 10 patients(2.3%) with micropapillary bladder cancer, and then the medical records of these 10 patients were reviewed retrospectively. RESULTS: At the initial diagnosis, the average age was 66 years old(range: 48-79) and the male-to-female ratio was 4:1. After initially performing TURB, the pathological stages were T1G2(1 case), T1G3(5 cases) and T2G3(4 cases), and the clinical stages were T1N0M0(5 cases), T2N0M0(2 cases), T3N0M0(1 case), T2N2M0(1 case) and T2N0M1(1 case). Before the initial diagnosis, 75.0%(6/8 cases) of the urine cytology revealed malignancy. There were 4 cases of carcinoma-in-situ(CIS, 40%) and 5 cases of lympho-vascular invasion(50%). p53 gene mutation was reported in 66.7% (4/6 cases). Three quarters of the patients(6/8 cases) needed more aggressive treatments such as radical cystectomy or chemotherapy, with the exception of 2 patients who were lost to follow-up. CONCLUSIONS: At the initial diagnosis, the patients with micropapillary bladder cancer had a high stage and grade. These patients were highly associated with poor prognostic factors such as CIS, lympho-vascular invasion and p53 gene mutation. Three quarters of the patients needed more aggressive treatments, so they need to undergo active surveillance and treatment before progression.