De Ritis Ratio, Neutrophil-to-Lymphocyte Ratio, and Albumin Are Significant Prognostic Factors for Survival Even After Adjusted by the Treatment Duration in Metastatic Kidney and Bladder Cancer Treated With Immune-Checkpoint Inhibitors

Purpose@#This study aimed to determine the prognostic roles of several immune-related laboratory parameters in patients with metastatic kidney and bladder cancer treated with immune checkpoint inhibitors (ICIs). @*Materials and Methods@#Overall, 36 patients with either metastatic bladder (N=18) or kidney cancer (N=18) were enrolled retrospectively. Progression-free survival (PFS) and overall survival according to the pretherapeutic serum De Ritis ratio (DRR), neutrophil-to-lymphocyte ratio (NLR), and albumin level after ICI treatment, were analyzed. Treatment duration was adjusted using Contal and O’Quigley’s method to explore the cutoff and maximize the log-rank test statistic. Cox proportional hazards model was used to analyze the laboratory parameters. @*Results@#A total of 9 patients received a combination therapy of multiple ICIs (N=9) and targeted agents (N=7). The median NLR, DRR, and albumin level at baseline were 1.7, 1.2, and 4.2 mg/dL, respectively. In the univariable analysis, combination of immunotherapies, total ICI cycles, baseline DRR, and albumin level were significant for PFS. Sex ratio, total ICI cycles, and baseline NLR and DRR were significant for cancer-specific survival (CSS). DRR and albumin levels, which were measured for up to 10 cycles, were significant in PFS and CSS. NLR was additionally significant in CSS. After adjusting total ICI cycles, DRR was significant in PFS and CSS, albumin level was significant only in PFS, and NLR was significant only in CSS in the multivariable analysis. @*Conclusions@#NLR, DRR, and albumin level are significant factors associated with the survival of patients with metastatic kidney and bladder cancer treated with ICI.

Urinary Biomarker in Bladder Cancer at Present Time

Current standard diagnostic modality of bladder cancer is cystoscopy with/without urine cytology from patient’s voided urine. Considering several cystoscopic disadvantages such as symptomatic invasiveness and operatordependency, urinary cytology is an asymptomatic, noninvasive tool to detect exfoliated tumor cell in the urine samples. Various targeting molecules have been suggested to detect cancer cells in the urine beside the present urine cytology which has a limited diagnostic power of detection cancer cells. To augment the accuracy of diagnostic power, various supplementary urine biomarkers have been approved and under investigation in these days with different mechanisms and different targets. In this review article, we are going to discuss some urinary biomarkers approved by the U.S. Food and Drug Administration (FDA) and other non-FDA approved potential urinary markers in bladder cancer.

Urinary Biomarker in Bladder Cancer at Present Time

Current standard diagnostic modality of bladder cancer is cystoscopy with/without urine cytology from patient’s voided urine. Considering several cystoscopic disadvantages such as symptomatic invasiveness and operatordependency, urinary cytology is an asymptomatic, noninvasive tool to detect exfoliated tumor cell in the urine samples. Various targeting molecules have been suggested to detect cancer cells in the urine beside the present urine cytology which has a limited diagnostic power of detection cancer cells. To augment the accuracy of diagnostic power, various supplementary urine biomarkers have been approved and under investigation in these days with different mechanisms and different targets. In this review article, we are going to discuss some urinary biomarkers approved by the U.S. Food and Drug Administration (FDA) and other non-FDA approved potential urinary markers in bladder cancer.

The role of vasoepididymostomy for treatment of obstructive azoospermia in the era of in vitro fertilization: a systematic review and meta-analysis / 亚洲男科学杂志(英文版)

This study comprises a systematic review and meta-analysis of microsurgical vasoepididymostomy outcomes in epididymal obstructive azoospermia. A comprehensive literature search was performed using Medline, Embase, and the Cochrane library that included all studies related to microsurgical vasoepididymostomy. Keywords included "vasoepididymostomy," "epididymovasostomy," "epididymal obstruction," and "epididymis obstruction." Event rate and risk ratio (RR) were estimated. Patency rate and pregnancy rate were investigated. The analysis comprised 1422 articles, including 42 observational studies with 2298 enrolled patients performed from November 1978 to January 2017. The overall mean patency rate was 64.1% (95% confidence interval [CI]: 58.5%-69.3%; I2=83.0%), and the overall mean pregnancy rate was 31.1% (95% CI: 26.9%-35.7%; I2=73.0%). We performed a meta-analysis comparing the patency rate of bilateral microsurgical vasoepididymostomy and unilateral microsurgical vasoepididymostomy and found an RR of 1.38% (95% CI: 1.21%-1.57%; P < 0.00001). A comparison of the site of microsurgical vasoepididymostomy showed that caudal or corpus area was favorable for patency rate (RR = 1.17%; 95% CI: 1.01%-1.35%; P = 0.04). Patients with motile sperm in epididymal fluid exhibited an RR of 1.53% (95% CI: 1.11%-2.13%; P = 0.01) with respect to patency rate. Microsurgical vasoepididymostomy is an effective treatment for epididymal obstructive azoospermia that can improve male fertility. We find that performing microsurgical vasoepididymostomy bilaterally, anastomosing a larger caudal area, and containing motile sperm in epididymis fluid can potentially achieve a superior patency rate.

Impact of Pretreatment Hydronephrosis on the Success Rate of Shock Wave Lithotripsy in Patients with Ureteral Stone

PURPOSE: To evaluate predictors of the success rate for one session of shock wave lithotripsy (SWL), focusing on the relationships between pretreatment hydronephrosis grade and one-session SWL success rates. MATERIALS AND METHODS: The medical records of 1824 consecutive patients who underwent an initial session of SWL for treatment of urinary stones between 2005 and 2013 were reviewed. After exclusion, 700 patients with a single, 4–20 mm diameter radiopaque calculus were included in the study. RESULTS: The mean maximal stone length (MSL) and skin-to-stone distance were 9.2±3.9 and 110.8±18.9 mm, respectively. The average values for mean stone density (MSD) and stone heterogeneity index (SHI) were 707.0±272.1 and 244.9±110.1, respectively. One-session success rates were 68.4, 75.0, 75.1, 54.0, and 10.5% in patients with hydronephrosis grade 0, 1, 2, 3, and 4, respectively. Patients were classified into success or failure groups based on SWL outcome. Multivariate logistic regression analyses revealed that MSL [odds ratio (OR) 0.888, 95% confidence intervals (CI): 0.841–0.934, p<0.001], MSD (OR 0.996, 95% CI: 0.995–0.997, p<0.001), SHI (OR 1.007, 95% CI: 1.005–1.010, p<0.001), and pretreatment hydronephrosis grade (OR 0.601, 95% CI: 0.368–0.988, p=0.043) were significantly associated with one-session success. CONCLUSION: Pretreatment grades 3 or 4 hydronephrosis were associated with failure of SWL in patients with a single ureteral stone. In the presence of severe hydronephrosis, especially hydronephrosis grade 4; physicians should proceed cautiously in choosing and offering SWL as the primary treatment for ureteral stone.

Intraoperative Observation of the Degree and Pattern of Urine Leakage before Adjustment of the Mesh during a Transobturator Tape Procedure / 전남의대학술지

Most intraoperative provocative tests previously reported were performed after mesh adjustment to confirm the absence of urine leakage. Instead, our test was performed before adjustment of the mesh to control the tape tension after observing the pattern of the urine leakage. We studied whether this method had an effect on the success rate of transobturator tape (TOT) procedures. A total of 96 patients were included: 47 patients underwent TOT procedures without intraoperative testing (Group I) and 49 patients underwent TOT procedures with testing (Group II). Bladder filling was performed with at least 300 ml of normal saline during the test. After observing the pattern of the urine leakage before adjustment of the mesh by coughing or manual pressure on the suprapubic area, we controlled the mesh tension. In Group I, which did not undergo the intraoperative test, the Valsalva leak-point pressure, cough leak-point pressure, preoperative and postoperative peak flow velocity (Qmax), and postvoiding residual urine (PVR) were 86.46 cmH2O, 101.91 cmH2O, 20.82 ml/s, 22.74 ml/s, 19.77 ml, and 45.98 ml, respectively. Changes in the postoperative and preoperative Qmax and PVR were 1.92 ml/s and 26.21 ml, respectively. In Group II, in which the test was applied, the corresponding results were 85.50 cmH2O, 100.45 cmH2O, 25.60 ml/s, 26.90 ml/s, 17.16 ml, and 29.67 ml, respectively. Changes in the postoperative and preoperative Qmax and PVR were 1.3 ml/s and 12.51 ml, respectively. The two groups showed no significant differences in any of the variables. In Group I, the cure and improvement rates were 70.2% and 27.7%, respectively. In Group II, the rates were 91.8% and 8.2%, respectively. Group II had a significantly higher success rate than Group I (p value= 0.011). In the univariable logistic regression analysis, Group II exhibited a higher odds ratio (4.771) than Group I in terms of cure rate, and Group II had a higher success rate than Group I (p value=0.011). In the multivariable logistic regression analysis, Group II exhibited a higher odds ratio (4.700) than Group I in terms of cure rate under calculation of the variables (namely, age, hypertension, preoperative Qmax, and PVR), and the cure rate of Group II was verified to be significantly higher than that of Group I (p value=0.019). We suggest that our test is an effective method to confirm whether adequate tension is being applied to the tape. Our method presents some advantages in that surgeons can control and adjust the tension of the mesh after observing the degree and pattern of the urine leakage.

Intraoperative Observation of the Degree and Pattern of Urine Leakage before Adjustment of the Mesh during a Transobturator Tape Procedure / 전남의대학술지

Most intraoperative provocative tests previously reported were performed after mesh adjustment to confirm the absence of urine leakage. Instead, our test was performed before adjustment of the mesh to control the tape tension after observing the pattern of the urine leakage. We studied whether this method had an effect on the success rate of transobturator tape (TOT) procedures. A total of 96 patients were included: 47 patients underwent TOT procedures without intraoperative testing (Group I) and 49 patients underwent TOT procedures with testing (Group II). Bladder filling was performed with at least 300 ml of normal saline during the test. After observing the pattern of the urine leakage before adjustment of the mesh by coughing or manual pressure on the suprapubic area, we controlled the mesh tension. In Group I, which did not undergo the intraoperative test, the Valsalva leak-point pressure, cough leak-point pressure, preoperative and postoperative peak flow velocity (Qmax), and postvoiding residual urine (PVR) were 86.46 cmH2O, 101.91 cmH2O, 20.82 ml/s, 22.74 ml/s, 19.77 ml, and 45.98 ml, respectively. Changes in the postoperative and preoperative Qmax and PVR were 1.92 ml/s and 26.21 ml, respectively. In Group II, in which the test was applied, the corresponding results were 85.50 cmH2O, 100.45 cmH2O, 25.60 ml/s, 26.90 ml/s, 17.16 ml, and 29.67 ml, respectively. Changes in the postoperative and preoperative Qmax and PVR were 1.3 ml/s and 12.51 ml, respectively. The two groups showed no significant differences in any of the variables. In Group I, the cure and improvement rates were 70.2% and 27.7%, respectively. In Group II, the rates were 91.8% and 8.2%, respectively. Group II had a significantly higher success rate than Group I (p value= 0.011). In the univariable logistic regression analysis, Group II exhibited a higher odds ratio (4.771) than Group I in terms of cure rate, and Group II had a higher success rate than Group I (p value=0.011). In the multivariable logistic regression analysis, Group II exhibited a higher odds ratio (4.700) than Group I in terms of cure rate under calculation of the variables (namely, age, hypertension, preoperative Qmax, and PVR), and the cure rate of Group II was verified to be significantly higher than that of Group I (p value=0.019). We suggest that our test is an effective method to confirm whether adequate tension is being applied to the tape. Our method presents some advantages in that surgeons can control and adjust the tension of the mesh after observing the degree and pattern of the urine leakage.

The Authors Reply: Renal Cell Carcinoma in Kidney Transplant Recipients and Dialysis Patients

No abstract available.

Renal Cell Carcinoma in Kidney Transplant Recipients and Dialysis Patients

PURPOSE: In a group of surgery patients diagnosed with renal cell cancer, those who underwent dialysis were compared with those who received a kidney transplant. MATERIALS AND METHODS: The 43 subjects included in this study were patients who had been undergoing dialysis because of end-stage renal disease or had undergone kidney transplantation. The patients were diagnosed with renal cell carcinoma (RCC) during follow-up and underwent radical nephrectomy from May 1996 to December 2010. Their medical records were retrospectively analyzed as part of the study. RESULTS: In the transplantation group, the renal replacement therapy period averaged 54 months, and the period from transplantation to RCC averaged 119 months (range, 0 to 264 months). In the dialysis group, RCC was observed after an average of 124 months (range, 2 to 228 months) of dialysis, and nephrectomy was then conducted. Acquired cystic kidney disease (ACKD) was found more frequently in the dialysis group, and it had a statistically relevant effect on the occurrence of RCC by comparison with the transplantation group (p<0.01). CONCLUSIONS: Although the incidence rate of ACKD was significantly higher in the dialysis group among patients undergoing surgery for RCC, cancer was found even without ACKD development in some transplant recipients. Considering that the transplant recipients also underwent dialysis, an informative prospective study will be necessary to determine whether other immunosuppressive agents besides ACKD may function as a cancer risk factor.

Large Oncocytic Adrenocortical Tumor with Uncertain Malignant Potential

Oncocytoma is a neoplasm consisting of oncocytes that is found in the salivary gland, kidney, and thyroid. Adrenocortical oncocytoma is particularly uncommon, and most cases reported are benign and nonfunctioning. Here, we report a 20 cm adrenal mass associated with necrosis that was identified as an oncocytic adrenocortical tumor with uncertain malignant potential through histopathological evaluation after its resection.

A Clinically Silent Case of Prominent Thebesian System: Diagonal Branch of Left Anterior Descending Coronary Artery to Left Ventricular Communication

Fistulous communication from the coronary artery to the left ventricle (LV) is extremely rare and has received little attention in the literature. Moreover, a case of coronary artery fistula (CAF) from a diagonal branch of the left anterior descending coronary artery to the LV has been reported only once in the literature. Herein, we report a case of CAF from a diagonal branch of the left anterior descending coronary artery to the LV, along with a review of the pertinent literature regarding this disorder.

Acute Appendicitis Diagnosed by Colonoscopy / 대한소화기내시경학회지

Acute appendicitis is the most common operative disease in general surgery, but it is not also rate disease to see in other clinical department such as Internal Medicine and Obstetric and Gynecology, because it reqnires to differenciate from many other diseases which have similar symptoms. Expecially, because the clipical aymptoms of acute appendicitis are not typieal in children, elderly, and women, it is hard to be diagnosed as acute appendicitis and it is often misdiagnosed as other disease. We performed colonoscopy due to be interpretated aa one of the colon diseases rather than acute appendicitis. But in colonoscopic findings, there were hyperemie and edematous change on the appendiceal orifice of cecum(cherry or acorn shape). So we report 5 cases of acute appendicitis diagnosed br colonoscopy.

Endoscopic Removal of Badug Stone by Condom / 대한소화기내시경학회지

With remarkable progress in upper GI endoscopy; it has been applied to therapeutid purpose. ln this paper, we present one suceessful case of endoscopic extraction of BADUG STONE by biopsy forceps and contraceytive condom., Using a biopsy forceps and condom inserted through the fiberscope, BADUG STONE' was eaaily made to roll into the self-opening trawl net' and safly removed.