Efficacy of Combined Gemcitabine/Cisplatin Chemotherapy for Locally Advanced or Metastatic Urothelial Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We wanted to determine and report on the outcome of combined gemcitabine/cisplatin chemotherapy for patients suffering with locally advanced or metastatic urothelial cancer. MATERIALS AND METHODS: Between July 1999 and December 2004, 43 selected patients were enrolled in this study. Group 1 (the adjuvant chemotherapy group) had undergone radical surgery with removal of evident tumor from the following primary sites: bladder (n=8), renal pelvis (n=7) and ureter (n=3). Group 2 (the salvage chemotherapy group) had undergone palliative surgery with a remnant tumor at the following primary sites; bladder (n=23) and renal pelvis (n=2). All the patients were given gemcitabine/ciplatin and they evaluated for the therapeutic effect and toxicity. The patients were initially treated with gemcitabine 1000 mg/m2 intravenously for 30 minutes on days 1, 8 and 15 of a 28-day cycle, and cisplatin 70 mg/m2 was administered intravenously on day 1 using prehydration measures. RESULTS: Group 1: The median follow-up period was 16.5 months. The mean age was 63 years (males: 15 cases, females: 3 cases), and eleven patients (61%) remained alive. The estimated median relapse-free survival period and 2-year survival rate were 24 months and 63%, respectively. Group 2: the median follow-up period was 20 months, the mean patient age was 63.8 years (males: 22 cases, females: 3 cases), and nine patients (36%) remained alive. The overall response and 2-year survival rates were 36% and 43%, respectively. Toxicities: Grade 3 toxicities developed in 14 cycles during the total 232 cycles. Grade 4 toxicity did not occur. CONCLUSIONS: The results of this study confirm that adjuvant and salvage chemotherapy with using gemcitabine and cisplatin is tolerable and safe.

A Model and a Program for Training Laparoscopic Urethrovesical Anastomosis / 대한비뇨기과학회지

PURPOSE: A model and a program was developed for training surgeons in laparoscopic urethrovesical anastomosis in order to improve the laparoscopic suture technique for urologists with no previous experience. MATERIALS AND METHODS: The procedures were performed on a pelvic trainer using a videolaparoscopic unit. The program consisted of a simple suture, urethrovesical anastomosis with interrupted sutures, and urethrovesical anastomosis with continuous sutures. The trainees enrolled in this study were 5 residents from the urologic department who had little experiences in laparoscopic suturing. The trainees performed each procedure 10 times and the elapsed time was recorded. Univariate analysis of the general linear model was used to assess the significance of progression. RESULTS: In the first lesson of the simple suture, the mean elapsed time was 5.45+/-3.00 minutes (range 2.78-9.83minutes) and each trainee demonstrated a difference in the elapsed time for suturing. After the tenth lesson was complete, the mean elapsed time was 1.48+/-0.17 minutes (range 1.35- 1.70 minutes) and the time differences between each trainee decreased. In urethrovesical anastomosis with interrupted sutures, the mean elapsed time decreased from 24.07+/-3.97 minutes at the 1st lesson (range 16.13- 29.47 minutes) to 13.10+/-2.53 minutes (range 11.75-19.47 minutes) after 10 lessons. In urethrovesical anastomosis with continuous sutures, the mean time decreased from 39.61+/-3.60 minutes (range 34.41-45.71 minutes) after one lesson to 30.42+/-5.75 minutes (range 19.50-38.82 minutes) after 10 lessons. There were significant differences in the elapsed time up to the 2nd lesson compared with the 10th lesson in all procedures (p-value<0.05). CONCLUSIONS: The skills of the trainee can be improved by a model and a program for training laparoscopic urethrovesical anastomosis. In particular, urethrovesical anastomosis, in which many urologists find difficulty, may become more accessible using this model and program.

Laparoscopic Excision of a Huge Pelvic Kidney Associated with a Didelphic Uterus and a Single Urethral Ectopic Ureter: a Case Report with a Review of the Literature / 대한비뇨기과학회지

A pelvic kidney with a didelphic uterus and a single ectopic ureter into the urethra is an extremely rare finding. We present here a case of a huge ectopic dysplastic kidney with a didelphic uterus and a single urethral ectopic ureter of a 32-year-old women who has been suffering from urinary incontinence. The huge ectopic dysplastic kidney was successfully removed by laparoscopic surgery. The patient became continent after operation.

The Efficacy of Arterial Embolization in Patients with a Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: We evaluated the efficacy of an arterial embolization in patients with a renal cell carcinoma. MATERIALS AND METHODS: We studied 17 patients with a renal cell carcinoma that underwent a transcatheter arterial embolization between 1995 and 2004. We studied the patients' character, performance status (ECOG), tumor location, size, stage, symptoms, cause of embolization, prognosis, and survival rate, as well as the follow up period. Patients were classified into three groups: group (I) consisted of patients where the procedure was performed with an angioinfarction only; group (II) consisted of patients where the procedure was performed with an angioinfarction, followed by additional immunotherapy with interferon; group (III) consisted of patients where the procedure was performed with an angioinfarction, followed by additional immunotherapy with interleukin-2, interferon, 5-flourouracil, 13-cis-retinoic acid and H2-blocker. RESULTS: The patients' ECOG (Eastern Co-operative Oncology Group criteria) scores were 1, 2, 3 and 4 in 2, 6, 6 and 3 patients, respectively. After the transcatheter arterial embolization, symptomatic improvement of the hematuria and pain were observed. All patients had disease progression, with the exception of one stable disease. Group I had a better survival than groups II or III (p=0.036). CONCLUSIONS: Transcatheter arterial embolization is a safe treatment for patients with a renal cell carcinoma where an operation is unavailable due to a poor performance status or advanced stage. The procedure may not influence the survival rate, but does improve the symptoms; additional immunotherapy may not improve the survival rate either.