Pattern of Failure in Bladder Cancer Patients Treated with Radical Cystectomy: Rationale for Adjuvant Radiotherapy

Thus far, the role of adjuvant radiotherapy (RT) after radical cystectomy (RC) in urinary bladder cancer patients has yet to be defined. The purpose of this study is to analyze patterns of failure, and suggest the rationale for RT. Between 1986 and 2005, a total of 259 patients treated with RC and pelvic lymph node dissection was enrolled. The age range was 27-82 yr (median, 62 yr). Node positivity increased according to tumor staging. Patients were divided into the following two groups based on pathologic analysis: organ-confined disease group (n=135) and extravesical/lymph node-positive disease group (n=80). Pelvic failures (PF) were observed in 8 (4.9%) in organ-confined disease group, and 21 (21.7%) in extravesical/lymph node-positive disease group. Five-year PF-free survival rates were 91.2% in organ-confined disease group and 68.0% in extravesical/lymph node-positive disease group. Five-year cancer-specific survival rates were 86.2% in organ-confined disease group and 53.9% in extravesical/lymph node-positive disease group. In conclusion, a relatively high PF rate was observed in extravesical lymph node-negative and lymph node-positive disease patients in this study. Adjuvant pelvic RT may be considered to reduce pelvic failures in extravesical lymph node-positive bladder cancer. Future prospective trials are required to test the clinical benefit of adjuvant RT.

Retroperitoneal Laparoscopic Marsupialization of Simple Renal Cyst / 대한비뇨기과학회지

PURPOSE: The minimally invasive technique in urologic treatment such as percutaneous cyst aspiration with sclerotherapy is increasing in recent years to treat symptomatic simple renal cyst. However, this method has a high recurrence rate. The laparoscopic approach can be an alternative method which is far less invasive than open surgery and less recurrence rate than sclerotherapy. Furthermore, the retroperitoneal approach can avoid unnecessary intraperitoneal manipulation and thereby reduce complications such as injury and adhesion of the bowel. We evaluated the recurrence rate, hospital stay, and postoperative morbidity of retroperitoneal laparoscopic marsupialization of simple renal cyst. MATERIALS AND METHODS: From July 1996 to May 1997, 27 patients(male 7, female 20) with simple renal cyst, presenting with pain(14 patients), recurrent cyst after percutaneous aspiration(9), and incidentally found renal cyst(4) was managed with retroperitoneal laparoscopic marsupialization of simple renal cyst. Mean patient age and cyst size were 50 years(range 35-66 years) and 7.8cm(range 3.0-12.0cm), respectively. RESULTS: Mean operative time, hospital stay, and follow-up period were 58.9 minutes(range 40-110 minutes), 2.3 days(range 1-4 days) and 14.2 months(range 6-25 months), respectively. There was no recurrence and cytologic and pathologic examinations were benign in all patients. There was no significant difference in the operative time according to the position and the side of the renal cyst. CONCLUSIONS: Retroperitoneal laparoscopic cyst marsupialization is an effective therapy for recurrent or symptomatic large simple renal cyst with low recurrence rate and postoperative morbidity.

A Case or Nutcracker Syndrome Surgically Corrected by Extraperitoneal Flank Approach / 대한비뇨기과학회지

Nutcracker syndrome is a rare disease caused by the compression of the renal vein between the aorta and superior mesenteric artery. It is known to cause of venous hypertension, peripelvic and periureteral varicosities. Clinical manifestations include varicocele, hematuria, and flank or abdominal pain. Surgical correction is needed in nutcracker syndrome cases with severe or recurrent hematuria and abdominal or flank pain. Reanastomosis of the renal vein at 5cm below the original insertion site at the inferior vena cava is the one of the most common corrective methods and the transabdominal approach is usually employed. This disease usually appears in healthy young people and in order to decrease postoperative complications such as intestinal obstruction and bowel adhesion by avoiding unnecessary intraperitoneal manipulation, the authors used the extraperitoneal approach through a flank incision. We report because, in selected cases, we consider that this extraperitoneal approach is one of the alternative methods for the usual transperitoneal approach.

Extraperitoneal Laparoscopic Surgery using Balloon Dissector / 대한비뇨기과학회지

The use of conventional laparoscopic technique in surgeries of kidney, ureter, and bladder requires unnecessary manipulations in the peritoneal cavity. Despite such disadvantages, the inevitable advantages of laparoscopic surgery such as reduced wound pain and scar along with reduced hospital stay, and the difficulties in securing sufficient operative space in retroperitoneum, the urologists had to resort to the conventional laparoscopic surgeries. Recently to avoid unnecessary intraperitoneal manipulations thereby reducing postoperative complications such as bowel injury and adhesion, balloon dissectors were introduced. We have performed 9 renal cystectomy in symptomatic or obstructive renal cysts, and 6 bladder neck suspensions(Burch) in females with stress urinary incontinence. Mean operative time and hospital stay were 120 minutes(range: 90-210 minutes) and 3 days(range: 2-4 days) for bladder neck suspensions and 70 minutes(range: 45-120 minutes) and 2 days(range: 1-3 days) for renal cystectomy, respectively Few problems were encountered during pelvic procedures, but for renal cystectomy it was difficult to secure operative field in case of peritoneal perforations. The need for development or improvement of appropriate operative equipments required for these cases.

Gasless Extraperitoneal Retroperitoneoscopically Assisted Surgery / 대한비뇨기과학회지

Conventional laparoscopic surgery requires definite leaming curve, and must be converted to an open procedure in the event of a large vessel injury. The usage of carbon dioxide gas for securing operative field is generally accepted, but such field rapidly disappears when air pressure decreases. To overcome these shortcomings without sacrificing advantages of excellent cosmetic results and reduced wound pain of laparoscopy without using the gas insufflation, various urologic operations utilizing incisions 2 to 5 cm long were made without cutting abdominal musculature with the help of specially designed retractors and video systems used in conventional laparoscopic surgery. It can be performed in familiar anatomical settings and all the surgical skills of open procedures can be utilized. We have performed 3 living donor nephrectomies, 6 simple nephrectomies, 2 partial nephrectomies, 9 pyeloplasties, 16 ureterolithotomies, 1 ureteroureterostomy, and 2 renal cyst marsupializations. Mean operative time and hospital stay were 185 minutes and 7 days for living donor nephrectomies, 150 minutes and 6.7 days for simple nephrectomies, 255 minutes and 7.5 days for partial nephrectomies, 130 minutes and 4.8 days for pyeloplasties, 85 minutes and 4.1 days for ureterolithotomies, 90 minutes and 5 days for ureteroureterostomy, and 75 minutes and 5.5 days for renal cyst marsupializations, respectively. Immediate wound pain was severe probably due to intense traction of abdominal musculature, but the recovery of such pain was remarkably rapid. No postoperative wound paresthesia was seen and early discharge was possible. In conclusion, the gasless retroperitoneoscopically assisted surgery can take advantage of both conventional open and laparoscopic surgery, and it can be a valid option to conventional open surgery for any surgical procedures in retroperitoneum, including kidney, ureter, and bladder.

Two Cases or Primary Small Cell Carcinoma of the Prostate / 대한비뇨기과학회지

Small cell carcinoma of the prostate is rare, accounting for approximately 1% of all prostatic cancer. However the identification of small cell carcinoma of the prostate has increased in recent years, probably reflecting the increasing use of the electron microscope and immunohistochemistry. We report a case of pure small cell carcinoma and a case of small cell carcinoma mixed with adenocarcinoma of the prostate.

Mid Ureteral Stones: 5 Cases Treated with ESWL / 대한비뇨기과학회지

Use of ESWL has made many changes in the treatment of urinary trat stones. However, the treatment of the stone below the iliac crest was not possible owing to the arrangement of the apparatus and the location of the stone within the bony pelvis. For solving the problem, we selected 5 patients having mid ureteral stone. They were placed in prone position and administered shockwave from 500 times to 2600 times. The result was 3 patients had no residual stone and 2 patients showed decreased size of stones in follow-up examinations. All the patients showed no specific complication. The ESWL is able to disintegrate mid ureteral stone by using the change of patient`s position and avoiding the shield of bone around the stone.

A Review of Four Years Experience with Urine Cytology in Bladder Tumor / 대한비뇨기과학회지

Management of bladder tumors depends upon early detection and adequate follow-up. Urine Cytology plays an increasingly important and prominent role in the multidisciplinary approach to this problem. Herein we review our experience with urine cytology in the diagnosis and follow-up of bladder cancer at Department of Urology, College of Medicine, Yonsei University from 1981 to 1985. 1. A total of 478 cytologic evaluations were performed in the 198 patients. 2. The overall incidence of positive cytology was 49.2%. 3. The incidence of positive cytology in the presence of biopsy proven bladder tumor was 71.1%. 4.The incidence of positive cytology after TUR followed by adriamycin instillation was 72.2% at diagnosis, 41.7% after 3 months, 31.0% after 6 months, 33.3% after 9 months and 36.8% after 12 months. 5. The Number of cases with negative cytology after TUR and adriamycin instillation was 11 cases after 3 months, 7 cases after 6 months, 2 cases after 9 months and 1 case after 12 months. 6. Of the 5 patients having recurred tumor, there was 4 patients who constantly class IV, and 1 patient who had conversion from class I or II to class IV.