De Ritis Ratio (Aspartate Transaminase/Alanine Transaminase) as a Significant Prognostic Factor With Upper Urinary Tract Carcinoma Who Underwent Radical Nephroureterectomy and Adjuvant Chemotherapy

Purpose@#To investigate the correlation between preoperative De Ritis ratio (aspartate transaminase [AST]/alanine transaminase [ALT]) and postoperative clinical outcome in patients with upper urinary tract carcinoma (UTUC) who underwent radical nephroureterectomy (RNU) and adjuvant chemotherapy (ACH). @*Materials and Methods@#We respectively analyzed the clinical and pathological data of 102 patients who underwent RNU and ACH for UTUC. Patients were divided into 2 groups, according to the optimal value of AST/ALT ratio. The effect of the AST/ALT ratio was analyzed by the Kaplan-Meier method and Cox regression hazard models for patients’ cancer-specific survival (CSS) and overall survival (OS). @*Results@#Mean survival time was 50.5±41.2 months. Mean age was 61.4±9.7years. Forty-one of the patients (46.5%) were in the high AST/ALT group. According to receiver operating characteristic analysis, the optimal AST/ALT ratio was 1.2. In Kaplan-Meier analyses, the high AST/ALT group showed worse outcomes in OS (p=0.007) and CSS (p=0.011). Using Cox regression models of clinical and pathological parameters to predict OS, high AST/ALT ratio (hazard ratio [HR], 5.428; 95% confidence interval [CI]; 1.803–16.334; p=0.002), pathological T3 (pT3) or higher (HR, 1.464; 95% CI; 1.156-1.857; p=0.002), and to predict CSS, high AST/ALT ratio (HR, 4.417; 95% CI; 1.545–12.632; p=0.005), and pT3 or higher (HR, 1.475; 95% CI; 1.172–1.904; p=0.002) were determined as independent prognostic factors. @*Conclusions@#Pretreatment AST/ALT ratio is a significant independent predictor of CSS and OS in advanced UTUC patients receiving systemic ACH after RNU.

Clinical Usefulness and Predictability of Seoul National University Prostate Cancer Risk Calculator (SNU-PCRC)

Purpose@#To evaluate the clinical usefulness of the Seoul National University Prostate Cancer Risk Calculator (SNU-PCRC) to reduce unnecessary prostate biopsy and to increase the detection rate of high-risk cancer. @*Materials and Methods@#We retrospectively analyzed 546 patients who underwent prostate biopsy between 2014 and 2016. The subjects were divided into 2 groups based on the type of risk calculator used: conventional and SNU-PCRC group. In the SNU-PCRC group, prostate biopsy was recommended when the probability of SNU-PCRC was more than 30%. @*Results@#The SNU-PCRC group had significantly smaller prostate volume (p=0.010) and significantly more digital rectal examination and transrectal ultrasonography (TRUS) abnormalities (p=0.011 and p=0.010, respectively). Overall detection (71.9% vs. 32.1%) and high-risk cancer detection rates (40.6% vs. 19.3%) were significantly higher in the gray zone (prostate-specific antigen=4-10 ng/mL) (p<0.001 and p=0.006). The group with prostate cancer risk ≥30% on the SNU-PCRC compared to <30% group, overall detection rate of 72.3% versus 30.2% and high-risk detection rate of 60.6% versus 18.3% were significantly different (p<0.001 and p<0.001). Applying the SNU-PCRC to the conventional group could avoid unnecessary prostate biopsy in 50.6%. @*Conclusions@#SNU-PCRC is clinically useful to reduce unnecessary prostate biopsy and increase overall detection rate and high-risk cancer detection rate.

Clinical Usefulness and Predictability of Seoul National University Prostate Cancer Risk Calculator (SNU-PCRC)

Purpose@#To evaluate the clinical usefulness of the Seoul National University Prostate Cancer Risk Calculator (SNU-PCRC) to reduce unnecessary prostate biopsy and to increase the detection rate of high-risk cancer. @*Materials and Methods@#We retrospectively analyzed 546 patients who underwent prostate biopsy between 2014 and 2016. The subjects were divided into 2 groups based on the type of risk calculator used: conventional and SNU-PCRC group. In the SNU-PCRC group, prostate biopsy was recommended when the probability of SNU-PCRC was more than 30%. @*Results@#The SNU-PCRC group had significantly smaller prostate volume (p=0.010) and significantly more digital rectal examination and transrectal ultrasonography (TRUS) abnormalities (p=0.011 and p=0.010, respectively). Overall detection (71.9% vs. 32.1%) and high-risk cancer detection rates (40.6% vs. 19.3%) were significantly higher in the gray zone (prostate-specific antigen=4-10 ng/mL) (p<0.001 and p=0.006). The group with prostate cancer risk ≥30% on the SNU-PCRC compared to <30% group, overall detection rate of 72.3% versus 30.2% and high-risk detection rate of 60.6% versus 18.3% were significantly different (p<0.001 and p<0.001). Applying the SNU-PCRC to the conventional group could avoid unnecessary prostate biopsy in 50.6%. @*Conclusions@#SNU-PCRC is clinically useful to reduce unnecessary prostate biopsy and increase overall detection rate and high-risk cancer detection rate.

Maternal and fetal outcomes of pregnancies in kidney donors: A 30-year comparative analysis of matched non-donors in a single center

BACKGROUND: Woman kidney donors face obstetric complication risks after kidney donation, such as gestational hypertension and preeclampsia. Studies on childbirth-related complications among Asian women donors are scarce. METHODS: This retrospective cohort study included woman donors aged 45 years or younger at the time of kidney donation in a single tertiary hospital between 1985 and 2014. Pregnancy associated complications were investigated using medical records and telephone questionnaires for 426 pregnancies among 225 donors. Matched non-donor controls were selected by propensity score and the maternal and fetal outcomes were compared with those of donors. Primary outcomes were differences in maternal complications, and secondary outcomes were fetal outcomes in pregnancies of the donor and control groups. RESULTS: A total of 56 cases had post-donation pregnancies. The post-donation pregnancies group was younger at the time of donation and older at the time of delivery than the pre-donation pregnancies group, and there were no differences in primary outcomes between the groups except the proportion receiving cesarean section. Comparison of the complication risk between post-donation pregnancies and non-donor matched controls showed no significant differences in gestational hypertension, preeclampsia, or composite outcomes after propensity score matching including age at delivery, era at pregnancy, systolic blood pressure, body weight, and estimated glomerular filtration ratio (odds ratio, 0.63; 95% confidence interval, 0.19–2.14; P = 0.724). CONCLUSION: This study revealed that maternal and fetal outcomes between woman kidney donors and non-donor matched controls were comparable. Studies with general population pregnancy controls are warranted to compare pregnancy outcomes for donors.

Partial versus Radical Nephrectomy for T1-T2 Renal Cell Carcinoma in Patients with Chronic Kidney Disease Stage III: a Multiinstitutional Analysis of Kidney Function and Survival Rate

BACKGROUND: To examine survival rates and renal function after partial nephrectomy (PN) and radical nephrectomy (RN) in patients with chronic kidney disease (CKD). METHODS: We studied 4,332 patients who underwent PN or RN for pathological T1a-T2N0M0 renal cell carcinoma from 1988 to 2014. Patients were divided into two subgroups of CKD stage I–II and stage III. Kidney function, and survival outcomes were compared between groups. RESULTS: We included 1,756 patients with CKD I–II and 276 patients with CKD III in the final pair-matched analysis. Kidney function was significantly better preserved in the PN than in the RN group among all patients. However, the beneficial effect of PN on kidney function gradually disappeared over time in CKD III patients. The 5-year overall survival (OS) rates after PN and RN differed in patients with CKD I–II disease (99.4% vs. 96.5%, respectively, P = 0.015). The 5-year OS rates after surgery were not affected by mode of nephrectomy in CKD III patients (97.8% vs. 93.5%, P = 0.103). The 5-year cancer-specific survival rates did not differ between treatment groups in all CKD stage. Cox hazard analysis showed that the operative method was a significant factor for OS in CKD I–II patients (hazard ratio [HR], 0.320; confidence interval [CI], 0.122–0.840; P = 0.021). However, PN was not beneficial in terms of OS in CKD III patients (HR, 0.395; CI, 0.086–1.172; P = 0.117). CONCLUSION: PN is associated with a higher OS rate and better kidney function in patients with preoperative CKD stage I and II, but not in those with CKD stage III.

Effects of Aspirin, Nonsteroidal Anti-inflammatory Drugs, Statin, and COX2 Inhibitor on the Developments of Urological Malignancies: A Population-Based Study with 10-Year Follow-up Data in Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to determine the impact of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), statin, and cyclooxygenase 2 (COX-2) inhibitor on the development of kidney, prostate, and urothelial cancers by analyzing the Korean National Health Insurance Service–National Sample Cohort (NHIS-NSC) database. MATERIALS AND METHODS: Among a representative sample cohort of 1,025,340 participants in NHIS-NSC database in 2002, we extracted data of 799,850 individuals who visited the hospital more than once, and finally included 321,122 individuals aged 40 and older. Following a 1-year washout period between 2002 and 2003, we analyzed 143,870 (male), 320,861 and 320,613 individuals for evaluating the risk of prostate cancer, kidney cancer and urothelial cancer developments, respectively, during 10-year follow-up periods between 2004 and 2013. The medication group consisted of patients prescribed these drugs more than 60% of the time in 2003. To adjustfor various parameters of the patients, a multivariate Cox regression model was adopted. RESULTS: During 10-year follow-up periods between 2004 and 2013, 9,627 (6.7%), 1,107 (0.4%), and 2,121 (0.7%) patients were diagnosed with prostate cancer, kidney cancer, and urothelial cancer, respectively. Notably, multivariate analyses revealed that NSAIDs significantly increased the risk of prostate cancer (hazard ratio [HR], 1.35). Also, it was found that aspirin (HR, 1.28) and statin (HR, 1.55) elevated the risk of kidney cancer. No drugs were associated with the risk of urothelial cancer. CONCLUSION: In sum, our study provides the valuable information for the impact of aspirin, NSAID, statin, and COX-2 inhibitor on the risk of prostate, kidney, and urothelial cancer development and its survival outcomes.

Value of the New 5-Tiered Prostate Cancer Grade Group System on Predicting Oncological Outcomes for Radical Prostatectomy Population in Korea

PURPOSE: We evaluated the prognostic value of the 5-tiered grade group in Korean patients who underwent radical prostatectomy. MATERIALS AND METHODS: Between 1996 and 2016, a number of 2,883 consecutive patients who underwent radical prostatectomy were included for the analysis. The impacts of biopsy and pathologic grade group on predicting biochemical recurrence (BCR) were assessed using multivariate analysis. Median follow-up duration was 49.0 months. RESULTS: Mean age was 66.5 years and prostate-specific antigen (PSA) was 11.8 ng/mL. Prostate cancer was locally advanced on magnetic resonance imaging in 13.4%. Biopsy grade group was as follows: 1 (46.8%), 2 (19.8%), 3 (14.2%), 4 (14.1%), and 5 (5.1%). Pathology stage was ≤T2 in 63.6%, T3a in 26.0%, and T3b/T4 in 10.4% patients. Pathologic grade was as follows: 1 (31.3%), 2 (37.9%), 3 (20.2%), 4 (4.7%), and 5 (5.1%). In multivariate analysis using biopsy-related variables, biopsy grade group (1, reference; 2, hazard ratio [HR], 1.771; p=0.001; 3, HR, 2.736; p < 0.001; 4, HR, 2.966; p < 0.001; 5, HR, 3.707; p < 0.001) was associated with BCR-free survival, PSA level and % positive core. In multivariate analysis using pathologic outcomes, pathologic grade group (1, reference; 2, HR, 1.882; p < 0.001; 3, HR, 3.352; p < 0.001; 4, HR, 3.890; p < 0.001; 5, HR: 3.118, p < 0.001) was associated with BCR-free survival in addition to pathologic stage and positive surgical margin. CONCLUSIONS: New 5-tiered grading system could be useful for predicting oncological outcomes in Korean patients although its role for distinguishing outcomes between patients with grade groups 3–5 need to be validated before wide application of this grade system in Korea.

Clinicopathologic and Oncological Outcomes in Korean Men With Advanced Metastatic Testicular Cancer Undergoing Postchemotherapeutic Retroperitoneal Lymph Node Dissection

PURPOSE: To evaluate the clinicopathologic and oncological outcomes of advanced metastatic testicular cancer in Korean men who underwent retroperitoneal lymph node dissection (RPLND) following chemotherapy. MATERIALS AND METHODS: Data of 26 patients with testicular cancer who underwent RPLND after chemotherapy at 2 hospitals in Korea between September 2004 and June 2016 were retrospectively analyzed. Clinical and histopathological variables such as stage of the testicular cancer, age of the patients during surgery, size of the retroperitoneal lymph nodes (RPLNs), histopathological results, duration and complications related to the surgery, cancer recurrence, and mortality were analyzed. RESULTS: During testicular surgery, the T stage was pT1, pT2, and pT3 in 50% (n=13), 26.9% (n=7), and 15.3% (n=4) of the patients, respectively. Mixed germ cell tumor was the most common finding, seen in 73.1% (n=19) of patients. The indications for RPLND were residual lymph nodes after chemotherapy, 84.6% (n=22); and disease progression and remission, 7.7% (n=2). Pathological analysis revealed viable tumors in 19.2% of patients (n=5), necrotic/fibrotic tissue in 42.3% (n=11), and teratoma in 34.6% (n=9). Intraoperative and postoperative complications occurred in 23.1% (n=6) and 19.2% of patients (n=5). The median duration of follow-up was 27.5 months (interquartile range, 1.3–108.2 months); 11.5% (n=3) patients had recurrence, and 3.8% (n=1) died of progressive metastatic testicular cancer. CONCLUSIONS: Viable germ cell tumors were present in 19.2% of patients with testicular cancer who underwent RPLND after chemotherapy. This is the first study of its kind in the Korean population.

Preclinical safety assessment of Angelica acutiloba using a 13-week repeated dose oral toxicity study in rats / 한국실험동물학회지

Angelica acutiloba (AA), a Japanese species of Danggui, has been used worldwide as a traditional herbal medicine with several bioactivities including anti-diabetic, anti-allergic, anti-inflammatory, anti-tumor, and anti-obesity. However, there is lack of toxicological data available to evaluate potential long-term toxicity and the no-observed-adverse-effect level (NOAEL) of AA extract in accordance with the test guidelines published by the Organization for Economic Cooperation and Development. In the 14-day repeat-dose toxicity study, no adverse effects on mortality, body weight change, clinical signs, and organ weights was found following repeat oral administration to rats for 14 days (125, 250, 500, 1000, and 2000 mg/kg body weight), leading that 2000 mg/kg is the highest recommended dose of AA extract for the 13-week repeat-dose oral toxicity study. In the 13-week repeat-dose oral toxicity study, the AA extract was orally administered to groups of rats for 13 weeks (125, 250, 500, 1000, and 2000 mg/kg body weight) to compare between control and AA extract groups. The administration of AA extract did not produce mortality or remarkable clinical signs during this 13-week study. And, the data revealed that there were no significant differences in food/water consumption, body weight, hematological parameters, clinical chemistry parameters, gross macroscopic findings, organ weight and histopathology in comparison to the control group. On the basis of these results, the subchronic NOAEL of the AA extract was more than 2000 mg/kg/day when tested in rats. And, the AA extract is considered safe to use orally as a traditional herbal medicine.

Evaluation of in vitro and in vivo genotoxicity of Angelica acutiloba in a standard battery of assays / 한국실험동물학회지

Among three representative species of Angelica found in Asian countries, including Korea, China, and Japan, Angelica acutiloba (AA) has been used as traditional herbal medicine with antitumor, anti-inflammatory, anti-obesity, and anti-diabetes activities. In this study, the potential genotoxicity and mutagenicity of the AA extract were examined in a battery of in vitro and in vivo tests (bacterial reverse mutation assay, in vitro chromosomal aberrations assay, and in vivo micronucleus assay) in accordance with the test guidelines for toxicity testing developed by the Organization for Economic Cooperation and Development. Upon testing in the bacterial mutation assay (Ames test) using five Salmonella typhimurium TA98, TA100, TA102, TA1535 and TA1537, no significant increase the number of revertant colonies in the metabolic activation system and non-activation system was noted in the AA extract groups. Also, in the chromosome aberration test, the AA extract did not cause chromosomal aberration with or without metabolic activation by S9 mix. A bone marrow micronucleus test of mice demonstrated that the incidence of micronucleated polychromatic erythrocytes in the AA extract groups (500, 1000 and 2000 mg/kg BW) was equivalent to that of the negative control group. Based on these results from a standard battery of assays, the AA extract was concluded to have no genotoxic at the proper dose.

Impact of Young Age at Diagnosis on Survival in Patients with Surgically Treated Renal Cell Carcinoma: a Multicenter Study

The prognostic significance of age in renal cell carcinoma (RCC) is a subject of debate. The aim of the present multi-institutional study was to evaluate the impact of age on clinicopathological features and survival in a large cohort of patients with RCC. A total of 5,178 patients who underwent surgery for RCC at eight institutions in Korea between 1999 and 2011 were categorized into three groups according to age at diagnosis as follows: young age (< 40 years, n = 541), middle-age (≥ 40 and < 60 years, n = 2,551), and old age (≥ 60 years, n = 2,096) groups. Clinicopathological variables and survival rates were compared between the three groups. Young patients had lower stage tumors with a low Fuhrman grade, a lower rate of lymphovascular invasion than patients in the other age groups. Regarding histologic type, the young age group had a lower percentage of clear cell histology and a greater incidence of Xp11.2 translocation RCC. Kaplan-Meier estimates showed that cancer-specific survival was significantly better in the young age group than in the other groups (log rank test, P = 0.008). However, age at diagnosis was not an independent predictor of survival in multivariate analysis. In conclusion, young age at diagnosis was associated with favorable pathologic features, although it was not an independent prognostic factor for survival in patients with surgically-treated RCC. Age itself should not be regarded as a crucial determinant for the treatment of RCC.

Conditional Survival and Associated Prognostic Factors in Patients with Upper Tract Urothelial Carcinoma after Radical Nephroureterectomy: A Retrospective Study at a Single Institution / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study is to evaluate the changes of conditional survival (CS) probabilities and to identify the prognostic parameters that significantly affect CS over time post-surgery in upper tract urothelial carcinoma (UTUC) patients. MATERIALS AND METHODS: A total of 330 patients were examined in the final analysis. Primary end point was conditional cancer-specific survival (CSS), overall survival (OS), and intravesical recurrence-free survival (IVRFS) after surgery. The Kaplan-Meier method was used for calculation of CS. Cox regression hazard ratio model was used to determine the predictors of CS. RESULTS: UTUC patients who had already survived 5 years after radical nephroureterectomy had a more favorable CS probability in all given survivorships compared to those with shorter survival times. Patients with unfavorable pathologic features showed a higher increment of 5-year conditional CSS and OS compared to their counterparts. For 5-year conditional CSS, several factors, including high-grade tumor, lymphovascular invasion, and tumor location showed significant association with risk elevation over time. Only age remained as a predictor of 5-year conditional OS with increased risk in all given survivorships. For 5-year IVRFS, no variables remained as significant predictive factors over time after surgery. CONCLUSION: Our study provides valuable information for practical survival estimation and relevant prognostic factors for patients with UTUC after surgery.

The Characteristics of Recurrent Upper Tract Urothelial Carcinoma after Radical Nephroureterectomy without Bladder Cuff Excision

PURPOSE: To investigate oncological outcomes based on bladder cuff excision (BCE) during radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC) and to provide clinical evidence of tumor recurrence in patients without BCE. MATERIALS AND METHODS: We retrospectively collected data of 372 consecutive patients who underwent RNU at our institution from May 1989 through October 2010. After excluding some data, we reviewed 336 patients for the analysis. RESULTS: Of the patients who underwent RNU with BCE (n=279, 83.0%) and without BCE (n=57, 17.0%), patients without BCE had poorer cancer-specific and overall survival rates. Among 57 patients without BCE, 35 (61.4%) experienced tumor recurrence. Recurrence at the remnant ureter resulted in poor oncological outcomes compared to those in patients with bladder recurrence, but better outcomes were observed compared to recurrence at other sites. No significant predictors for tumor recurrence at the remnant ureter were identified. In patients without BCE, pathological T stage [hazard ratio (HR), 5.73] and lymphovascular invasion (HR, 3.65) were independent predictors of cancer-specific survival, whereas age (HR, 1.04), pathological T stage (HR, 5.11), and positive tumor margin (HR, 6.50) were independent predictors of overall survival. CONCLUSION: Patients without BCE had poorer overall and cancer-specific survival after RNU than those with BCE. Most of these patients experienced tumor recurrence at the remnant ureter and other sites. Patients with non-organ confined UTUC after RNU without BCE may be considered for adjuvant chemotherapy with careful follow-up.

The clinical application of the sliding loop technique for renorrhaphy during robot-assisted laparoscopic partial nephrectomy: Surgical technique and outcomes

PURPOSE: To report the initial clinical outcomes of the newly devised sliding loop technique (SLT) used for renorrhaphy in patients who underwent robot-assisted laparoscopic partial nephrectomy (RALPN) for small renal mass. MATERIALS AND METHODS: We reviewed the surgical videos and medical charts of 31 patients who had undergone RALPN with the SLT renorrhaphy performed by two surgeons (CWJ and CK) between January 2014 and October 2014. SLT renorrhaphy was performed after tumor excision and renal parenchymal defect repair. Assessed outcomes included renorrhaphy time (RT), warm ischemic time, perioperative complications, and perioperative renal function change. RT was defined as interval from the end of bed suture to the renal artery declamping. RESULTS: In all patients, sliding loop renorrhaphy was successfully conducted without conversions to radical nephrectomy or open approaches. Mean renorrhaphy and warm ischemic time were 9.0 and 22.6 minutes, respectively. After completing renorrhaphy, there were no adverse events such as dehiscence of approximated renal parenchyma, renal parenchymal tearing, or significant bleeding. Furthermore, no postoperative complications or significant renal function decline were observed as of the last follow-up for all patients. The limitations of this study include the small volume case series, the retrospective nature of the study, and the heterogeneity of surgeons. CONCLUSIONS: From our initial clinical experience, SLT may be an efficient and safe renorrhaphy method in real clinical practice. Further large scale, prospective, long-term follow-up, and direct comparative studies with other techniques are required to confirm the clinical applicability of SLT.

The prognostic impact of perioperative blood transfusion on survival in patients with bladder urothelial carcinoma treated with radical cystectomy

PURPOSE: The aim of our study was to assess the influence of perioperative blood transfusion (PBT) on survival outcomes following radical cystectomy (RC) and pelvic lymph node dissection (PLND). MATERIALS AND METHODS: We reviewed and analyzed the clinical data of 432 patients who underwent RC for bladder cancer from 1991 to 2012. PBT was defined as the transfusion of allogeneic red blood cells during RC or postoperative hospitalization. RESULTS: Of all patients, 315 patients (72.9%) received PBT. On multivariate logistic regression analysis, female gender (p=0.015), a lower preoperative hemoglobin level (p=0.003), estimated blood loss>800 mL (p4 packed red blood cell units was an independent predictor of overall survival (p=0.007), but not in cancer specific survival. CONCLUSIONS: Our study was not conclusive to detect a clear association between PBT and survival after RC. However, the efforts should be made to continue limiting the overuse of transfusion especially in patients who are expected to have a high probability of PBT, such as females and those with a low preoperative hemoglobin level and history of neoadjuvant chemotherapy.

Survival Outcomes and Predictive Factors for Female Urethral Cancer: Long-term Experience with Korean Patients

The aim of this study was to evaluate female urethral cancer (UCa) patients treated and followed-up during a time period spanning more than 20 yr at single institution in Korea. We reviewed medical records of 21 consecutive patients diagnosed with female UCa at our institution between 1991 and 2012. After exclusion of two patients due to undefined histology, we examined clinicopathological variables, as well as survival outcomes of 19 patients with female UCa. A Cox proportional hazards ratio model was used to identify significant predictors of prognosis according to variables. The median age at diagnosis was 59 yr, and the median follow-up duration was 87.0 months. The most common initial symptoms were voiding symptoms and blood spotting. The median tumor size was 3.4 cm, and 55% of patients had lesions involving the entire urethra. The most common histologic type was adenocarcinoma, and the second most common type was urothelial carcinoma. Fourteen patients underwent surgery, and 7 of these patients received adjuvant radiation or systemic chemotherapy. Eleven patients experienced tumor recurrence after primary therapy. Patients with high stage disease, advanced T stage (> or =T3), and positive lymph nodes had worse survival outcomes compared to their counterparts. Particularly, lymph node positivity and advanced T stage were significant predictive factors for all survival outcomes. Tumor location was the only significant predictor for recurrence-free survival. Although our study included a small number of patients, it conveys valuable information about this rare female urologic malignancy in a Korean population.

Comparison of retrograde intrarenal surgery versus a single-session percutaneous nephrolithotomy for lower-pole stones with a diameter of 15 to 30 mm: A propensity score-matching study

PURPOSE: To investigate surgical outcomes between retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PNL) groups for a main stone sized 15 to 30 mm and located in the lower-pole calyx. MATERIALS AND METHODS: Patients who underwent PNL or RIRS for a main stone sized 15 to 30 mm and located in the lower-pole calyx were retrospectively reviewed. Each patient in the RIRS group was matched to one in the PNL group on the basis of calculated propensity scores by use of age, sex, body mass index, previous treatment history, stone site, maximum stone size, and stone volume. We compared perioperative outcomes between the unmatched and matched groups. RESULTS: Patients underwent PNL (n=87, 66.4%) or RIRS (n=44, 33.6%). After matching, 44 patients in each group were included. Mean patient age was 54.4+/-13.7 years. Perioperative hemoglobin drop was significantly higher and the hospital stay was longer in the PNL group than in the RIRS group. The operative time was significantly longer in the RIRS group than in the PNL group. Stone-free rates were higher and complications rates were lower in the RIRS group than in the PNL group without statistical significance. The presence of a stone located in the lower-anterior minor calyx was a predictor of stone-free status. CONCLUSIONS: RIRS and single-session PNL for patients with a main stone of 15 to 30 mm located in the lower-pole calyx showed comparable surgical results. However, RIRS can be performed more safely than PNL with less bleeding. Stones in the lower-anterior minor calyx should be carefully removed during these procedures.

Laparoscopic Stone Surgery With the Aid of Flexible Nephroscopy

PURPOSE: To report the outcome of laparoscopic pyelo- and ureterolithotomies with the aid of flexible nephroscopy. MATERIALS AND METHODS: A retrospective analysis was performed in 71 patients with complex renal stones or large and impacted proximal ureteral stones. Patients underwent laparoscopic pyelo- or ureterolithotomies with or without the removal of small residual stones by use of flexible nephroscopy between July 2005 and July 2010. Operative success was defined as no residual stones in the intravenous pyelogram at 12 weeks postoperatively. Perioperative results and surgical outcomes were analyzed. RESULTS: The patients' mean age was 54.7+/-13.7 years, and 53 males (74.6%) and 18 females (25.4%) were included. The mean maximal stone size was 19.4+/-9.4 mm. A total of 47 cases were complex renal stones and 24 cases were impacted ureteral stones. Mean operative time was 139.0+/-63.7 minutes. Stones were completely removed in 61 cases (85.9%), and no further ancillary treatment was needed for clinically insignificant residual fragments in 7 cases (9.9%). For complex renal stones, the complete stone-free rate and clinically significant stone-free rate were 80.9% and 93.6%, respectively. Multivariate analysis showed that the use of flexible nephroscopy for complex renal stones can reduce the risk of residual stones. A major complication occurred in one case, in which open conversion was performed. CONCLUSIONS: Laparoscopic stone surgery is a safe and minimally invasive procedure with a high success rate, especially with the aid of flexible nephroscopy, and is not associated with procedure-specific complications.

Extramammary Paget Disease of External Genitalia: Surgical Excision and Follow-up Experiences With 19 Patients

PURPOSE: There are only a few reports of extramammary Paget disease (EMPD) of the external genitalia because it is a rare malignancy. We investigated patients with EMPD of the penis and scrotum and report the outcome of surgical management. MATERIALS AND METHODS: From 2000 to 2012, a total of 19 patients diagnosed as having penile and scrotal EMPD underwent wide local excision with or without intraoperative frozen biopsy or preoperative mapping biopsy. The medical charts of these patients were reviewed and analyzed retrospectively. Mean follow-up was 22.5 months (range, 1 to 60 months). RESULTS: The mean age of the patients was 68 years (range, 57 to 82 years). In some patients, the lesions were misdiagnosed as either eczema or some other benign skin lesion at outside institutions, with a mean delay in diagnosis of 43.5 months (range, 1 to 198 months). Intraoperative frozen biopsy or preoperative mapping biopsy was performed in 18 patients. The resection margin was negative in 9 patients (47.4%) and positive in 10 patients (57.6%). Intraepithelial EMPD without dermis invasion was observed in 5 patients (26.3%), whereas diseases with dermis invasion were noted in 14 patients (73.7%). During the follow-up period, recurrences occurred in four patients, and two patients with dermis invasion and recurrence died from the disease. CONCLUSIONS: Diagnosis of EMPD should not be delayed to allow for prompt management. Our findings suggest that intraoperative frozen biopsy or preoperative mapping biopsy cannot guarantee negative margins on final pathology. However, preoperative mapping biopsy and wide local excision with intraoperative frozen biopsy demonstrates good prognosis of EMPD, especially in those cases without dermal invasion.

A Prospective Randomized Controlled Trial of the Efficacy of Tamsulosin After Extracorporeal Shock Wave Lithotripsy for a Single Proximal Ureteral Stone

PURPOSE: The objective of this study was to evaluate the efficacy of tamsulosin on stone clearance after extracorporeal shock wave lithotripsy (ESWL) in patients with a single proximal ureteral stone. MATERIALS AND METHODS: This prospective randomized controlled trial was performed on 88 patients with a single proximal ureteral stone. After consenting with a doctor, the patients were allocated to the treatment (tamsulosin 0.2 mg once a day) or control (no medication) group, and the efficacy of tamsulosin was evaluated. The primary outcome of this study was the stone-free rate, and the secondary outcomes were the period until clearance, pain intensity, analgesic requirement, and incidence of complications. RESULTS: A stone-free state was reported in 37 patients (84.1%) in the treatment group and 29 (65.9%) in the control group (p=0.049). The mean expulsion period of the stone fragments was 10.0 days in the treatment group and 13.2 days in the control group (p=0.012). There were no statistically significant differences in aceclofenac requirement or pain score between the two groups. Only one patient in the treatment group experienced transient dizziness associated with medical expulsive therapy, and this adverse event disappeared spontaneously. CONCLUSIONS: The results of this prospective randomized controlled trial of the efficacy of tamsulosin after ESWL for a single proximal ureteral stone suggest that tamsulosin helps in the earlier clearance of stone fragments and reduces the expulsion period of stone fragments after ESWL.