ABSTRACT
Background@#There is no clear consensus on the optimal treatment with curative intent for patients with positive surgical margins (PSMs) following radical prostatectomy (RP). The aim of this study was to investigate the perceptions and treatment patterns of Korean urologists regarding the resection margin after RP. @*Methods@#A preliminary questionnaire was prepared by analyzing various studies on resection margins after RP. Eight experienced urologists finalized the 10-item questionnaire.In July 2019, the final questionnaire was delivered via e-mail to 105 urologists in Korea who specialize in urinary cancers. @*Results@#We received replies from 91 of the 105 urologists (86.7%) in our sample population.Among them, 41 respondents (45.1%) had performed more than 300 RPs and 22 (24.2%) had completed 500 or more RPs. In the question about whether they usually performed an additional biopsy beyond the main specimen, to get information about surgical margin invasion during surgery, the main opinion was that if no residual cancer was suspected, it was not performed (74.7%). For PSMs, the Gleason score of the positive site (49.5%) was judged to be a more important prognostic factor than the margin location (18.7%), multifocality (14.3%), or margin length (17.6%). In cases with PSMs after surgery, the prevailing opinion on follow-up was to measure and monitor prostate-specific antigen (PSA) levels rather than to begin immediate treatment (68.1%). Many respondents said that they considered postoperative radiologic examinations when PSA was elevated (72.2%), rather than regularly (24.4%). When patients had PSMs without extracapsular extension (pT2R1) or a negative surgical margin with extracapsular extension (pT3aR0), the response ‘does not make a difference in treatment policy’ prevailed at 65.9%. Even in patients at high risk of PSMs on preoperative radiologic screening, 84.6% of the respondents said that they did not perform neoadjuvant androgen deprivation therapy. Most respondents (75.8%) indicated that they avoided nerve-sparing RP in cases with a high risk of PSMs, but 25.7% said that they had tried nerve-sparing surgery. Additional analyses showed that urologists who had performed 300 or more prostatectomies tended to attempt more nerve-sparing procedures in patients with a high risk of PSMs than less experienced surgeons (36.6% vs. 14.0%; P = 0.012). @*Conclusion@#The most common response was to monitor PSA levels without recommending any additional treatment when PSMs were found after RP. Through this questionnaire, we found that the perceptions and treatment patterns of Korean urologists differed considerably according to RP resection margin status. Refined research and standard practice guidelines are needed.
ABSTRACT
PURPOSE: To compare the clinical efficacy of anticholinergics for managing diabetes mellitus-associated overactive bladder (DM OAB) versus idiopathic overactive bladder (OAB) in Korean women. METHODS: We conducted a multicenter, prospective, parallel-group, open-label, 12-week study. Women (20–65 years old) with OAB symptoms for over 3 months were assigned to the DM OAB and idiopathic OAB groups. Changes in the Overactive Bladder Symptom Score (OABSS), urgency, urinary urgency incontinence, nocturia, daytime frequency according to a voiding diary, uroflowmetry, and postvoid residual urine volume (PVR) at the first visit (V1), week 4 (V2), and week 12 (V3) were compared. RESULTS: No significant difference was found between the baseline patient characteristics of the DM OAB and idiopathic OAB groups. Treatment with solifenacin was associated with improvements in urgency, urinary urgency incontinence, nocturia, frequency according to a voiding diary, and the total OABSS between V1 and V2 and between V1 and V3. Moreover, a significant improvement in urgency and urge incontinence was found between V2 and V3 in the DM OAB group. However, no significant changes were found in any other parameters. There were no significant differences between the DM OAB group and the idiopathic OAB group except for urgency and urge incontinence at V2 (3.71 vs. 2.28 and 0.47 vs. 0.32, respectively). CONCLUSIONS: The patients who received solifenacin demonstrated improved urgency, urinary urgency incontinence, nocturia, frequency according to a voiding diary, and total OABSS. Management with solifenacin was equally effective for both DM-related OAB and idiopathic OAB.
Subject(s)
Female , Humans , Cholinergic Antagonists , Diabetes Mellitus , Nocturia , Prospective Studies , Solifenacin Succinate , Treatment Outcome , Urinary Bladder, Overactive , Urinary Incontinence, UrgeABSTRACT
BACKGROUND: Penile cancer is a rare malignancy associated with high rates of mortality and morbidity. Currently, the efficacy of adjuvant treatment (AT), including radiotherapy and chemotherapy, for penile cancer remains unclear. Therefore, we investigated the prognostic factors for treatment outcomes and the efficacy of AT in consecutive patients who underwent penectomy for penile cancer at multiple Korean institutions between 1999 and 2013. METHODS: AT was defined as the administration of chemotherapy, radiotherapy, or both within 12 months after initial treatment. All patients were divided into two groups according to the AT status. RESULTS: Forty-three patients (median age 67.0 years) with a median follow-up after penectomy of 26.4 (interquartile range: 12.0–62.8) months were enrolled. Patients with AT had a significantly higher pathologic stage. However, no differences in age, histologic grade, or type of surgery were identified according to the presence of AT. The 3- and 5-year cancer-specific survival (CSS) rates were 79.0% and 33.0%, respectively. In a multivariate analysis, American Joint Committee on Cancer (AJCC) stage ≥ III disease was an independent predictor of CSS and recurrence-free survival (RFS). However, AT was not associated with CSS and RFS. The type of primary surgical treatment and inguinal lymph node dissection at diagnosis were also not significantly associated with overall survival, CSS, or RFS. CONCLUSION: AJCC stage ≥ III disease, which mainly reflects lymph node positivity, is a significant prognosticator in patients with penile cancer. By contrast, AT does not seem to affect CSS and RFS.
Subject(s)
Humans , Male , Chemotherapy, Adjuvant , Diagnosis , Drug Therapy , Follow-Up Studies , Joints , Lymph Node Excision , Lymph Nodes , Mortality , Multivariate Analysis , Penile Neoplasms , Prognosis , Radiotherapy , Radiotherapy, AdjuvantABSTRACT
PURPOSE: Adverse drug events (ADEs) are associated with high health and financial costs and have increased as more elderly patients treated with multiple medications emerge in an aging society. It has thus become challenging for physicians to identify drugs causing adverse events. This study proposes a novel approach that can improve clinical decision making with recommendations on ADE causative drugs based on patient information, drug information, and previous ADE cases. MATERIALS AND METHODS: We introduce a personalized and learning approach for detecting drugs with a specific adverse event, where recommendations tailored to each patient are generated using data mining techniques. Recommendations could be improved by learning the associations of patients and ADEs as more ADE cases are accumulated through iterations. After consulting the system-generated recommendations, a physician can alter prescriptions accordingly and report feedback, enabling the system to evolve with actual causal relationships. RESULTS: A prototype system is developed using ADE cases reported over 1.5 years and recommendations obtained from decision tree analysis are validated by physicians. Two representative cases demonstrate that the personalized recommendations could contribute to more prompt and accurate responses to ADEs. CONCLUSION: The current system where the information of individual drugs exists but is not organized in such a way that facilitates the extraction of relevant information together can be complemented with the proposed approach to enhance the treatment of patients with ADEs. Our illustrative results show the promise of the proposed system and further studies are expected to validate its performance with quantitative measures.
Subject(s)
Aged , Humans , Aging , Clinical Decision-Making , Complement System Proteins , Data Mining , Decision Trees , Drug-Related Side Effects and Adverse Reactions , Learning , PrescriptionsABSTRACT
Bladder urothelial carcinoma typically occurs in individuals in their sixties or seventies: it rarely occurs in persons <20 years old. Moreover, in young patients, bladder urothelial carcinoma lesions are reported to be solitary and nonmuscle invasive, with low malignant potential. However, 13% of lesions in this age group are reported to be noninvasive high-grade papillary urothelial carcinoma but these are extremely rare in children <15 years. There is no specific consensus regarding treatment of bladder urothelial carcinoma in children and adolescent. In particular, method has been suggested for follow-up of high-grade bladder urothelial carcinoma. Therefore we report our experience of one case the, discuss surveillance methods, and provide a brief review of the literature.
Subject(s)
Adolescent , Child , Humans , Consensus , Follow-Up Studies , Methods , Pediatrics , Urinary BladderABSTRACT
Prostate cancer is the most common type of male cancer worldwide. Although radical prostatectomy (RP) is advised for prostate cancer in patients with a life expectancy of more than 10 years by various guidelines, most elderly men still do not undergo the procedure regardless of increasing life expectancy. This study aimed to determine whether RP is suitable for patients with prostate cancer aged 75 years or older. A retrospective study of patients who underwent RP at 6 institutions between 2005 and 2012 was conducted. Patients were divided into 2 groups at the time of surgery: 65-69 years (younger group) and 75 years or older (older group). We compared clinical characteristics, pathological results, complication rates, and recurrence-free survival between the two groups. Compared with the younger group, the older group had significantly higher preoperative serum prostate-specific antigen level, pre- and postoperative Eastern Cooperative Oncology Group (ECOG) performance status grade, hypertension prevalence, and Gleason score at biopsy and RP. However, except urinary incontinence, there were no statistically significant differences in the peri- and post-operative complications. After median follow-up periods of 36 months (younger group) and 40 months (older group), the biochemical recurrence-free survival rates were not significantly different (P = 0.581). Although the urinary incontinence rate was higher in the older group, RP was a suitable option for selected Korean men aged 75 years or older with limited complication rates and excellent outcomes similar to those for patients aged 65-69 years.
Subject(s)
Aged , Humans , Male , Middle Aged , Age Factors , Biopsy , Disease-Free Survival , Hypertension/epidemiology , Multivariate Analysis , Neoplasm Grading , Prostate-Specific Antigen/blood , Prostatectomy , Prostatic Neoplasms/mortality , Republic of Korea , Retrospective StudiesABSTRACT
PURPOSE: To evaluate the prevalence of bladder neck contracture (BNC) and its risk factors in patients undergoing radical prostatectomy in Korea. MATERIALS AND METHODS: We analyzed data from 488 patients with prostatic cancer who underwent radical prostatectomy performed by seven surgeons in seven hospitals, including 365 open radical prostatectomies (ORPs), 99 laparoscopic radical prostatectomies (LRPs), and 24 robot-assisted laparoscopic radical prostatectomies (RARPs). Patients with BNCs were compared with those without BNCs to identify the risk factors for BNC occurrence. RESULTS: Overall, BNCs occurred in 21 of 488 patients (4.3%): 17 patients (4.7%) who underwent ORP, 4 patients (4%) who underwent LRP, and no patients who underwent RARP. In the univariate analysis, men with BNCs had a longer length of time before drain removal (12 days vs. 6.8 days, p<0.001), which reflected urinary leakage through the vesicourethral anastomosis. In the multivariate analysis, the length of time before drain removal was the only predictor of BNC (odds ratio, 1.12; p=0.001). Intraoperative blood loss was higher in patients with BNC, but the difference was not statistically significant. CONCLUSIONS: The most significant factor related to BNC occurrence after radical prostatectomy in our study was the length of time before drain removal, which reflects urinary leakage from the vesicourethral anastomosis. The proper formation of a watertight anastomosis to decrease urinary leakage may help to reduce the occurrence of BNC.
Subject(s)
Humans , Male , Contracture , Multivariate Analysis , Neck , Prevalence , Prostatectomy , Prostatic Neoplasms , Risk Factors , Urinary Bladder , Urinary Bladder Neck ObstructionABSTRACT
We report two patients with relapsed urethral condyloma treated by interleukin-2(IL-2) instillation. The patients had undergone prior treatment of the urethral condyloma; however, all patients had recurrent disease within one year of the primary treatment. We performed repeated transurethral resection of the urethra. However, the mass was incompletely resected due to its multiplicity and concerns about urethral injury. After surgery, IL-2(18x106IU) mixed with 1.2ml of distilled water was equally divided into six units(3x106IU); 10ml of distilled water was mixed with each unit. The solution was then administered into the urethra. After 6 days of the IL-2 intraurethral treatment, no visible warts were noted. No recurrence has been observed in over 1 year of follow up.
Subject(s)
Humans , Condylomata Acuminata , Interleukin-2 , Recurrence , Urethra , Warts , WaterABSTRACT
Herein, the case of a patient where a pseudo-tumor on the bladder wall, with irritable bladder symptoms following a Bacillus Calmette Guerin (BCG) intravesical instillation, was treated by prednisolone administration is reported. A 40-year-old female underwent a transurethral resection for a bladder carcinoma, with subsequent BCG intravesical instillation. After the final BCG intravesical instillation, the patient presented with lower urinary tract symptoms. A mass on the lateral wall of the bladder, reported as a granuloma formation, was treated with oral prednisolone, after which the symptoms and cystoscopic finding were dramatically improved. Finally, all bladder lesions and irritable bladder symptoms disappeared.
Subject(s)
Adult , Female , Humans , Administration, Intravesical , Bacillus , Granuloma , Lower Urinary Tract Symptoms , Mycobacterium bovis , Prednisolone , Urinary Bladder , Urinary Bladder NeoplasmsABSTRACT
Human sparganosis is an infection that is usually seen in the subcutaneous tissue, and it is caused by the migration of several species of related parasites that can accidentally infect man. We report here on the details of a human case of sparganosis that was identified serendipitously in the course of performing inguinal hernioplasty.
Subject(s)
Humans , Hernia , Hernia, Inguinal , Herniorrhaphy , Parasites , Sparganosis , Subcutaneous TissueABSTRACT
Two examples of the rare case of complete duplicated collecting system with lower pole ureteropelvic junction obstruction are described. Ureteropelvic junction obstruction (UPJO) and duplicated collecting systems seldom occur in combination. Complete duplication of the ureter may be asymptomatic or recognized when complications develop as a result of reflux into the lower pole ureter or obstruction of the upper pole with an ectopic ureterocele. It is difficult to choose an optimal therapy due to the high variability in function, degree of obstruction, damage and potential for regeneration in growing kidneys. The diagnosis and management of UPJO of the lower pole in complete duplicated collecting systems are discussed.
Subject(s)
Female , Humans , Infant , Infant, Newborn , Male , Kidney Pelvis , Kidney Tubules, Collecting/abnormalities , Ureteral Obstruction/complications , UreterostomyABSTRACT
Double-pigtail ureteral stent has been used to prevent the ureteral obstruction from calculi and to pass the urine easily after extracorporeal shock wave lithotripsy (ESWL). One of the complications in stent indwelling is the migration of the stent. Especially the proximal migration of double-pigtail ureteral stents is rare. One of the several theories that have been proposed to account for cephalad migration is a stent movement in conjunction with kidney movement during respiration. The reason is that the respiration makes the kidney move in both upward and downward directions while the stent, held by fragemented ureteral stone, moves only in upward direction. We call this cause of the proximal migration of the stent, 'Jack' phenomenon. Therefore, if the residual calculi remain after ESWL with ureteral stent, we need close observation.
Subject(s)
Calculi , Kidney , Lithotripsy , Respiration , Shock , Stents , Ureter , Ureteral ObstructionABSTRACT
Ureteropelvic junction obstruction and duplicated collecting system are common urologic anomalies in upper urinary system, but they seldom occur in combination. These obstruction can occur in both partial or complete duplicated collecting system. Complete duplication of the ureter may be asymptomatic or recognized when complications develop as a result of reflux into the lower pole ureter or obstruction of the upper pole with an ectopic ureterocele. It is difficult to choose an optimal therapy due to the high variability in function, degree of obsturction, damage and potential for regeneration in growing kidney. We report our experience of successful surgical interventions in the ureteropelvic junction obstruction of the lower pole with complete duplicated collecting system.
Subject(s)
Kidney , Regeneration , Ureter , UreteroceleABSTRACT
No abstract available.
Subject(s)
Humans , Infant, Newborn , Infant, Premature , Nephroma, Mesoblastic , Ultrasonography, PrenatalABSTRACT
We report a case of priapism secondary to bilateral rupture of the cavernosal arteries following perineal blunt trauma in a 34 year old man. He complained of painless but persistent erection for the period of 1 week. We confirmed non-ischemic high-flow priapism by arterial blood gas analysis, Doppler ultrasonography and arteriography. Arteriography showed a leakage on both sides of the end of the cavernosal arteries and the leakage was blocked by superselective cavernosal artery embolization. After the embolization, tumescence began to disappear and the detumescence process was completed on the third day. The examination of the patient after 4 months following embolization revealed that the patient was fully free of priapism and returned to the normal erectile status like before his priapism. During 2 years of follow up, the patient had no complications such as priapism or impotence.