Comparison of perioperative outcomes between running versus interrupted vesicourethral anastomosis in open radical prostatectomy: A single-surgeon experience

PURPOSE: To compare perioperative outcomes between running and interrupted vesicourethral anastomosis in open radical prostatectomy (RP). MATERIALS AND METHODS: The medical records of 112 patients who underwent open RP for prostate cancer at our institution from 2006 to 2008 by a single surgeon were retrospectively reviewed. Preoperative, intraoperative, and postoperative parameters were measured. RESULTS: Of 112 consecutive patients, 62 patients underwent vesicourethral anastomosis by use of the running technique, whereas 50 patients underwent anastomosis with the interrupted technique. The groups did not differ significantly in age, body mass index, prostate-specific antigen, prostate volume, or pathologic findings. The intraoperative extravasation rate was significantly lower in the running group (8.1% vs. 24.0%, p=0.01). The mean anastomosis time was 15.1+/-5.3 and 19.3+/-4.6 minutes in the running and interrupted groups, respectively (p=0.04). The rates of postoperative extravasation were similar for both groups (6.4% vs. 10.0%, p=0.12). The duration of catheterization was significantly shorter in the running group (9.0+/-3.0 days vs. 12.9+/-6.4 days, p<0.01). The rate of urinary retention after catheter removal and the rate of bladder neck contracture were not significantly different between the two groups. The rate of urinary continence at 3, 6, 9, and 12 months after RP was also similar in both groups. CONCLUSIONS: Both anastomosis techniques provided similar functional results and a similar rate of postoperative urine extravasation. However, running vesicourethral anastomosis decreased the rate of intraoperative extravasation and time for anastomosis, without increasing the risk of urinary retention or bladder neck contracture.

External Validation of the Cancer of the Prostate Risk Assessment-S Score in Koreans Undergoing Radical Prostatectomy

PURPOSE: To evaluate the validity of the University of California San Francisco Cancer of the Prostate Risk Assessment-S score (CAPRA-S score), a biochemical indicator of recurrent prostate cancer that uses histopathologic data, in Korean prostate cancer patients. MATERIALS AND METHODS: A total of 203 prostate cancer patients who underwent radical prostatectomy between February 1997 and November 2010 were observed for longer than 6 months. The CAPRA-S score of 134 patients for whom records were available for preoperative prostate-specific antigen (PSA), pathologic specimen Gleason score, surgical margin, seminal vesicle invasion, extracapsular extension, and lymph node invasion were calculated. Biochemical recurrence was defined as repetitive measurement of PSA > or =0.2 ng/mL at least 6 months after surgery with at least a 4-week interval. The Cox proportional hazard model and Kaplan-Meier analysis were used for the statistical testing. RESULTS: The CAPRA-S scores were divided into nine groups. The 5-year disease-free survival rate was reduced as the CAPRA-S score increased compared with the group with a CAPRA-S score of 0-1. The CAPRA-S score in this study was more sensitive to biochemical recurrence than was the CAPRA score conducted at this institution (CAPRA-S concordance index, 0.776; CAPRA concordance index, 0.728). CONCLUSIONS: The CAPRA-S score is judged to be a useful tool for predicting the disease-free survival rate of Korean prostate cancer patients and is thought to assist in establishing postoperative management.

pT3 Predictive Factors in Patients with a Gleason Score of 6 in Prostate Biopsies

PURPOSE: Often, a diagnosis of pT3 is made on the basis of radical retropubic prostatectomy specimens, despite a Gleason score of 6 on the preoperative prostate biopsy. Thus, we investigated the preoperative variables in patients displaying these characteristics. MATERIALS AND METHODS: Study subjects comprised patients at our institute from 1996 to July 2010 who had exhibited a Gleason score of 6 on their prostate biopsies and had undergone a radical retropubic prostatectomy. Through univariate and multivariate analysis, we investigated pT3 predictive factors including age, preoperative prostate-specific antigen (PSA) levels, transrectal ultrasonography (TRUS)-weighted prostate volume, digital rectal examination findings, bilaterality via prostate biopsy, prostatic cancer in prostate base cores via prostate biopsy, maximum length and percent of prostatic cancer, and number of cores detected in prostatic cancer via prostate biopsy. RESULTS: In the univariate logistic regression mode, a PSA value of 7.4 ng/ml or higher, TRUS-weighted PSA density of 0.2 ng/ml/cc or higher, prostate cancer detected in the basal core, and prostate cancer detected in 2 or more cores out of 12 were predictive factors for extraprostatic extension. Independent predictive factors for stage pT3 were a PSA of 7.4 ng/ml or higher and prostate cancer detected in 2 or more cores out of 12. CONCLUSIONS: In the case of patients with the foregoing risk factors, it is advisable not to perform nerve-sparing surgery but to prepare for the possibility of a pT3 stage.

Erratum: pT3 Predictive Factors in Patients with a Gleason Score of 6 in Prostate Biopsies

No abstract available.

Vaginal Mucosal Flap as a Sling Preservation for the Treatment of Vaginal Exposure of Mesh

PURPOSE: Tension-free vaginal tape (TVT) procedures are used for the treatment of stress urinary incontinence in women. The procedures with synthetic materials can have a risk of vaginal erosion. We experienced transobturator suburethral sling (TOT) tape-induced vaginal erosion and report the efficacy of a vaginal mucosal covering technique. MATERIALS AND METHODS: A total of 560 female patients diagnosed with stress urinary incontinence underwent TOT procedures at our hospital between January 2005 and August 2009. All patients succeeded in follow-ups, among which 8 patients (mean age: 50.5 years) presented with vaginal exposure of the mesh. A vaginal mucosal covering technique was performed under local anesthesia after administration of antibiotics and vaginal wound dressings for 3-4 days. RESULTS: Seven of the 8 patients complained of persistent vaginal discharge postoperatively. Two of the 8 patients complained of dyspareunia of their male partners. The one remaining patient was otherwise asymptomatic, but mesh erosion was discovered at the routine follow-up visit. Six of the 8 patients showed complete mucosal covering of the mesh after the operation (mean follow-up period: 16 moths). Vaginal mucosal erosion recurred in 2 patients, and the mesh was then partially removed. One patient had recurrent stress urinary incontinence. CONCLUSIONS: Vaginal mucosal covering as a sling preservation with continued patient continence may be a feasible and effective option for the treatment of vaginal exposure of mesh after TOT tape procedures.

Efficacy of the Stone Cone for Treatment of Proximal Ureteral Stones: an Initial Clinical Experience / 대한비뇨기과학회지

PURPOSE: Due to the recent trend of performing ureteroscopic removal of stone (URS) for treating upper ureter stones, stone migration into renal pelvis and calices has increased the morbidity and the need for auxillary procedures. The Stone Cone is a device that prevents stone migration during URS. We report here our initial experience of using the Stone Cone during the treatment of upper ureteral stones. MATERIALS AND METHODS: From February 2005 till May 2005, we treated fifteen consecutive patients who were suffering with upper ureteral stones by using the Stone Cone and performing semi-rigid ureteroscopy and pneumatic lithoclast. Pneumatic lithotripsy was done in 11 patients and the remaining 4 cases were treated by using a stone basket and forceps. RESULTS: The Stone Cone was successfully placed in all 15 cases. In 13 patients, it was placed via cystoscopy under fluroscopic guidance, while 2 patients with 2 impacted stones required ureteroscopic placement. No patients had residual fragments greater than 3mm and they didn't require auxiliary procedures. CONCLUSIONS: The Stone Cone is a new device that prevents stone migration and allows safe extraction of fragments during URS. This study shows that the success rate of URS for proximal ureteral stones was 100% with using the Stone Cone.

The Varying Success of Ureteroscopic Removal of Stone (URS) in Relation to the Different Locations and Sizes of Upper Ureter Stones / 대한비뇨기과학회지

PURPOSE: There has been a recent trend of using ureteroscopic removal of stone (URS) for treating upper ureter stones, due to its safety and success rate; therefore we attempted to find the varying success of URS for different locations and sizes of upper ureter stone. MATERIALS AND METHODS: 107 patients with upper ureter stones, who were treated with URS in our hospital, between January 2000 and May 2005, were retrospectively reviewed. The patients were classified into three groups according to the locations (named L3, L4 and L5) and sizes ( or=10mm) of the upper ureter stones. RESULTS: The overall success rate of URS was 71.0%. With regard to the three locations, L3 had a 46.3% success rate, while L4 and L5 had success rates of 76.9 and 92.5%, respectively. The success rates of URS were significantly higher in L4 and L5 locations compared with that in L3 (p<0.05). In addition, the success rates of URS for stones equal to or larger than 10mm and less than 10mm were 59.5 and 78.5%, respectively, with the former being significantly lower than the latter (p=0.036). CONCLUSIONS: The success rates of URS were significantly higher when the location of upper ureter stones was lower than L4 and when the size of the stone was less than 10mm. Therefore, both the location and size of the stones are important factors potentially influencing the outcome of URS for upper ureter stones.

Preoperative Evaluation of Living Renal Transplant Donors Using Helical CT Angiography: Comparison with Conventional Angiography / 대한비뇨기과학회지

PURPOSE: This study evaluated the accuracy of helical CT angiography (HCTA) in a preoperative evaluation of living renal transplant donors (LRTDs) for visualizing the renal vascular anatomy with an emphasis on identifying the number of renal arteries and the presence of small branches and venous anomalies. MATERIALS AND METHODS: From Jan. 2000 to Feb. 2001, a total of 50 potential LRTDs were evaluated with conventional renal angiography (CRA) and HCTA. All candidates then underwent a donor nephrectomy. The HCTA was done according to a standard HCTA protocol. The intraoperative findings on the number of renal vessels were compared with those of the CRA and HCTA respectively. RESULTS: There was an overall agreement on the number of renal arteries and veins between the CRA findings and 3-D reconstruction of the HCTA (91%, 95%). The overall accuracies for predicting the number of renal arteries and veins relative to the intraoperetive findings were 84%, 94% for CRA and 80%, 94% for HCTA respectively. The CRA missed 8 accessory renal arteries while HCTA missed 10. In HCTA, cases with an accessory renal artery with a diameter < or =5 Fr. (1.65mm) and two cases of an early branching single vessel simulating dual arteries, were misdiagnosed. Despite the misdiagnosed cases, there was no significant intraoperative morbidity. The HCTA revealed another lesion of a renal parenchyme, the urinary collecting system and other viscera. There were no significant complications in the process of both techniques. The cost of HCTA was 48% less than the CRA plus the excretory urography (EU) for imaging the potential LRTDs. CONCLUSIONS: A HCTA appears to be as accurate as a CRA for visualizing the renal vascular anatomy in the preoperative assessment of potential LRTDs. A HCTA has the potential to be a good alternative to a CRA plus EU for assessing potential LRTDs.

Comparision of Extracoporeal Shock Wave Lithotripsy (ESWL) and Ureteroscopic Lithotripsy (URS) for Treatment of Upper Ureteral Calculi / 대한비뇨기과학회지

PURPOSE: The aim of this study is to compare extracoporeal shock wave lithotripsy (ESWL) with ureteroscopic lithotripsy (URS) to establish the efficacy in treating upper ureteral calculi. MATERIALS AND METHODS: We retrospectively reviewed our experience with 279 patients treated with ESWL and URS for a upper ureteral calculi. Two hundred and four patients were treated with ESWL using MPL-9000 while 75 patients were treated with URS using 8/9.8Fr rigid ureteroscopes. Upper ureteral calculi were classified as those above L3 and below L4. We determined the comparative efficacies of ESWL with URS in the treatment of upper ureteral calculi according to location and size of stones. RESULTS: In the ESWL treatment, the overall stone free rate was 90.2%. The stone free rates were significantly affected by the location of the calculi with 92% above L3, and 84% below L4. The stone free rates according to the size were 91.9% for stones OR =21mm. Regardless of the size of the calculi, complete removal of all stone fragments was achieved in 86.7% of the patients treated with URS. The stone free rates according to the location of calculi were 79.2% in those above L3, and 90.1% in those below L4 with URS. ESWL has been found with a statistically significant higher success rate than URS in the treatment of above L3 ureteral calculi (p<0.05). On the other hand, URS showed a statistically significant higher success rate in the treatment of calculi larger than 21mm in size. The cost of URS was cheaper than ESWL but the complication rate was higher than ESWL. CONCLUSIONS: Our study demonstrates that the highly successful stone free rates can be achieved with either ESWL or URS. ESWL is useful as the first-line therapy for treatment of the upper ureteral calculi whereas URS should be considered as a treatment modality when the calculi are below L4 of the upper ureter and sizes of the calculi are larger than 21mm (URS).

A Follow-up Guideline after Radical Nephrectomy for Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: To establish the stage specific follow-up guideline for renal cell carcinoma (RCC), we evaluated the pattern of metastases and the clinical course of patients who had underwent radical nephrectomy. MATERIALS AND METHODS: We reviewed retrospectively the records of 165 patients who underwent radical nephrectomy with a final pathologic diagnosis of RCC. We compared the time of the first recurrence, the site of metastasis and detection modality according to the pathologic stages. RESULTS: Metastases were found in 18 patients in an average of 12.9 9.5 months after nephrectomy. None of the 77 patients with pT1 ( or = 5cm), 4 of the 47 patients with pT2 disease and 10 of the 20 patients with pT3 disease. CONCLUSIONS: The risk of recurrence and metastasis in RCC is stage-dependent. Therefore, a different follow-up guideline should be applied for each stage of RCC after surgical treatment. There is no need for follow-up in patients with pT1 tumors smaller than 5cm. For patients with pT1 tumor larger than 5cm, pT2, pT3 diseases, follow-up studies including history of symptoms, laboratory studies, chest x-ray, and computerized tomography are indicated at defined intervals.

Improved Quality of Life (QOL) During the Off-treatment Intervals of the Intermittent Androgen Deprivation (IAD) in the Prostate Cancer Patients / 대한비뇨기과학회지

No abstract available.