Clinical Outcomes of Continuous Addition of Androgen Deprivation Therapy During Docetaxel Chemotherapy for Patients With Castration-Resistant Prostate Cancer

PURPOSE: This study compared the oncologic results of docetaxel chemotherapy (DOC) in castration-resistant prostate cancer (CRPC) according to continuous addition of androgen deprivation therapy (ADT) during chemotherapy. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 106 patients who received DOC in 6 medical institutes. Among them, 72 patients had a complete medical record: 28 patients with ADT (DOC+continuous ADT group) and 44 without ADT (DOC only group). We compared the progression-free survival of these groups after DOC. RESULTS: Docetaxel was administered an average of 28 months after primary ADT as the first treatment. A median number of 6 cycles of DOC was administered in both groups. In the DOC+continuous ADT group, orchiectomy was performed in 18 patients and luteinizing hormone-releasing hormone agonist was injected in 10 patients. During DOC treatment, prostate-specific antigen (PSA) progression-free survival was statistically different (6.0±4.75 months in DOC+continuous ADT group vs. 4.8±3.2 months in DOC only group, p=0.024), whereas radiologic progression-free survival was not statistically different (5.0±3.12 months in DOC+continuous ADT group vs. 5.0±2.79 months in DOC only group, p=0.387). CONCLUSIONS: In our cohort, continuous addition of ADT showed a significant benefit in PSA progression-free survival during DOC in CRPC patients. Further prospective studies are needed to confirm these observations.

Clinicopathologic Characteristics and Treatment Outcomes of Penile Cancer

PURPOSE: The aim of this study was to assess the clinicopathologic characteristics of penile cancer, including patterns of therapy, oncologic results, and survival. MATERIALS AND METHODS: Between January 2005 and July 2015, 71 patients at 6 institutions who had undergone penectomy or penile biopsy were enrolled. Their medical records were reviewed to identify the mode of therapy, pathology reports, and cancer-specific survival (CSS) rate. RESULTS: Clinicopathologic and outcome information was available for 52 male patients (mean age, 64.3 years; mean follow-up, 61.4 months). At presentation, 17 patients were node-positive, and 4 had metastatic disease. Management was partial penectomy in 34 patients, total penectomy in 12 patients, and chemotherapy or radiotherapy in 6 patients. The pathology reports were squamous cell carcinoma in 50 patients and other types of carcinoma in the remaining 2 patients. Kaplan-Meier survival analysis showed a 5-year CSS rate of 84.0%. In univariate and multivariate analyses, the American Joint Committee on Cancer (AJCC) stage and pathologic grade were associated with survival. CONCLUSIONS: Partial penectomy was the most common treatment of penile lesions. The oncologic outcomes were good, with a 5-year CSS of 84.0%. The AJCC stage and pathologic grade were independent prognostic factors for survival.

Predicting Progression and Survival in Korean Patients with High Grade T1 Bladder Cancer Using EORTC Risk Tables

The treatment of high grade T1 bladder cancer remains controversial because of the particularly high risk of recurrence and progression. The purpose of this study was to compare the oncological outcomes of radical cystectomy and a bladder preservation approach using European Organization for Research and Treatment of Cancer (EORTC) risk tables. Among 688 transurethral resections of bladder tumors for patients with non-muscle invasive bladder cancer conducted between 2000 and 2010, 102 patients who had a history of high grade T1 were included. All patients were treated by transurethral resection with additional intravesical Bacillus Calmette-Guerin and 33 patients were treated with deferred radical cystectomy. The risk classifications for tumor recurrence, and progression and survival rates were calculated using the EORTC risk tables. At a follow-up between 48 and 164 months (mean 90.1 months), 53 patients recurred, 34 patients progressed, and 18 patients died. In high grade T1 patients, the probability of progression was 15% in patients in the high risk group and 57% in patients with highest risk at 5 years. The bladder cancer specific survival was 95% in high risk patients and 88% in patients at highest risk at 5 years. High grade T1 bladder cancers are heterogeneous in nature, which complicates treatment decisions. Patients in the highest risk group in EORTC risk tables have different feasible treatment options including early cystectomy.

Misplacement or Migration? Extremely Rare Case of Cardiac Migration of a Ureteral J Stent

A 29-year-old woman with mild back pain when coughing and suprapubic discomfort after voiding was admitted to Pusan National University Hospital. Two weeks earlier, she had undergone a hysterectomy and right-sided ureteroneocystostomy for uterine atony and right ureteral injury with bladder rupture. Computed tomography showed that a ureteral J stent extended from the right ovarian vein to the right cardiac chamber. The stent was retrieved via both femoral veins with a snare loop and pigtail catheter. Computed tomography showed that the urinary and vascular tracts were normal 5 months after the procedure.

Treatment Strategy for Non-Responders to PDE5 Inhibitors

Currently, phosphodiesterase type 5 (PDE5) inhibitors are the initial treatment option for erectile dysfunction. The reported efficacy of PDE5 inhibitors is about 70%, although it is significantly lower in difficult-to-treat subpopulations. Treatment failures might be due to the severity of the underlying pathophysiology, improper use of medication, unrealistic patient expectations, difficult relationship dynamics, severe performance anxiety, and other psychological problems. Physicians must address these issues to identify true treatment failures attributable to the drugs. This article discusses factors that might affect the response to PDE5 inhibitors and develops a strategy to maximize the overall efficacy of PDE5 inhibitors in initial non-responders to PDE5 inhibitors.

The Studer Orthotopic Neobladder: Long-Term (More Than 10 Years) Functional Outcomes, Urodynamic Features, and Complications

PURPOSE: Radical cystectomy and urinary diversion are the standard treatment for invasive bladder cancer. We analyzed the long-term (>10 years postoperatively) functional outcomes, complications, and urodynamic findings in a single center series of patients who underwent cystectomy and a Studer ileal neobladder substitution. MATERIALS AND METHODS: A retrospective chart review of 108 Studer pouches constructed during 1990 and 2011 was performed. Data were analyzed in terms of long-term (>10 years) outcomes. Complications, incontinence, voiding difficulties, upper urinary tract changes, overall satisfaction, and urodynamic findings of the reservoir were obtained. RESULTS: We evaluated 19 out of 50 patients who had lived for over 10 years postoperatively. Another 31 patients were not traced: 7 patients died following recurrence, 15 died due to exacerbation of a comorbidity, and 9 patients were lost to follow-up. Concerning complications, 6 patients had an atrophied kidney, 5 patients had moderate hydronephrosis, 5 patients had chronic recurrence of pylelonephritis, and 2 patients had voiding difficulty because of bladder neck stricture due to clean intermittent catheterization. One patient underwent an operation due to intestinal obstruction. Seven patients had incontinence; all 7 patients showed intermittently at night and 2 patients even in waking hours. Maximum bladder capacity was 484.1+/-119.2 mL, maximum flow rate was 13.6+/-9.7 mL/sec, and post-void residual urine volume was 146.8+/-82.7 mL. CONCLUSION: Long-term outcomes with the Studer orthotopic ileal neobladder have an acceptable complication rate and good functional results. However, potential adverse outcomes such as renal deterioration, dysfunctional voiding should also be considered.

The Effect of 5-alpha Reductase Inhibitors on the Efficacy of Photoselective Vaporization of the Prostate with 120 W GreenLight HPS Laser / 대한남성과학회지

PURPOSE: To evaluate the effect of preoperative 5-alpha reductase inhibitor (ARI) administration on the operative results of photoselective vaporization of prostate with 120W GreenLight HPS laser. MATERIALS AND METHODS: Data were collected from 98 benign prostatic hyperplasia (BPH) patients who underwent transurethral electrovaporization of prostate by 120W Greenlight HPS laser between Jan. 2010 and Dec. 2010. We compared the time of operation, the energy required in lasering, postoperative maximum uroflow velocity, change in residual urine volume and complications between 5-ARI administrating group and control group. RESULTS: 56 patients administrated 5-ARI at least 3 months before surgery. 30 and 26 patients administrated finasteride and dutasteride, respectively. Mean follow up period was 4.1+/-1.8 months. Mean age of the subjects and mean prostate volume were not different. Mean change of postoperative hemoglobin, lasing time and energy required in lasering were greater in 5-ARI administrating group. There were 3 and 1 cases of acute urinary retension in 5-ARI administrating group and control group, respectively. CONCLUSIONS: The mean change of hemoglobin and mean energy required in lasering were greater and mean lasing time was longer in the patients who administrated 5-ARI before photoselective vaporization of prostate by 120W Greenlight HPS laser. Further investigation and extensive study will be needed to confirm these results.

Comparison of Pain Control Method and Assessment on Postoperative Pain in Pediatric Urological Surgery of Penoscrotal and Inguinal Regions / 대한비뇨기과학회지

PURPOSE: This study was designed to evaluate the effects of caudal block or/and local infiltration on postoperative pain control in pediatric patients, and whether the faces pain rating scale (FPS), visual analogue scale (VAS) or sleep disturbance scale (SDS) values were estimator dependent (parents, doctors and nurses). MATERIALS AND METHODS: Thirty four children (average age 2.8+/-2.4 years), undergoing inguinal and scrotal surgery, were randomly allocated to one of three groups; combined caudal block with local infiltration (group I), caudal block only (group II) and neither of the above two (group III). Parents, doctors and nurses assessed the FPS, VAS and SDS before and after surgery, and the side effects were assessed after surgery. RESULTS: The mean SDS, FPS and VAS values in Group III were significantly higher than those in groups I and II at 1 and 3 hours postoperatively. All patients slept with a discontented look 1 hour postoperatively, but gradually improved and normalized 12 hours postoperatively. The mean FPS and VAS values were highest 1 hour postoperatively, and decreased with time in all groups. The mean pain value, as assessed by parents, tended to be higher than those assessed by healthcare professionals - doctors and nurses, but the correlation between the parents and healthcare professionals for the SDS, FPS and VAS assessments was statistically significant (intraclass correlation coefficients; 0.64, p<0.05). There were no side effects in any patient. CONCLISIONS: This study suggests that caudal block with local infiltration may be more useful for postoperative pain control, and all three pain scales are useful for assessing the postoperative pain associated with pediatric urological surgery of the penoscrotal and inguinal regions.

A Randomized, Prospective, Placebo/Controlled Study for the Effect of Phenazopyridine HCl on Pain Perception following Cystoscopy / 대한비뇨기과학회지

PURPOSE: This study was designed to evaluate the analgesic effect, the side effects and the safety of using phenazopyridine HCl after cystoscopy, which is a drug that exerts a topical analgesic effect on the mucosa of the urinary tract. MATERIALS AND METHODS: The 63 patients who underwent cystoscopy at Pusan National University of Hospital from May 2004 to March 2005 were assigned to one of two groups (the experimental group had 35 patients and the control group had 30 patients). The experimental group was administrated antibiotics and phenazopyridine 200mg tid for 4 days and the control group was administrated antibiotics and digestives tid for 4 days. The analgesic effects were assessed with using the Numeric Pain Intensity Scale (NPIS) and the 4-point Categorical scale (CAT). RESULTS: The mean age of the phenazopyridine and control groups were 62.5+/-8.5 and 60.4+/-10.4 years, respectively, and follow-up period was 7 days. The amount of pain gradually decreased from the day 1 to day 7. The score of the NPIS in the experimental group was less than that of the control group, especially on day 1 and 2 after cystoscopy (p<0.05). The score of the CAT in the experimental group was less than that in the control group, especially on day 1 after cystoscopy (p<0.05). At for the degree of pain for consecutive cystoscopy in the same patients, 22 patients (84.7%) answered it was less painful, 3 (11.5%) answered it was the same as before and 1 (3.8%) answered it was more painful in the experimental group; 2 patient (8.7%) said it was less painful, 19 (82.6%) said it was the same as before and 2 (8.7%) said it was more painful in the control group. Side effects were not observed in all cases. CONCLUSIONS: We conclude that phenazopyridine HCl is effective for early acute pain relief following cystoscopy without side effects, and it is safe when used in combination with antibiotics.

Blood Flow and Genetic Expression Changes of the Rat Bladder to Short Term Partial Outlet Obstruction / 대한비뇨기과학회지

PURPOSE: This study was aimed at evaluating the expressions of types I and III collagen, inducible nitric oxide synthase (iNOS), hypoxic inducible factor-1alpha(HIF-1alpha), vascular endothelial growth factor (VEGF) and the hemodynamic changes of the bladder during the acute stages of a partial bladder outlet obstruction (PBOO) in adult rats. MATERIALS AND METHODS: Bladder specimens were aseptically removed from 35 Sprague-Dawley adult rats (8 week old, weight 250-300gm) of both sham and experimental groups at 6, 12 and 24 hours, and 2, 3, 5 and 7 days after establishing a partial bladder outlet obstruction. Bladder blood flow was measured at the left vesicular artery using a laser flowmeter. The expressions of types I and III collagen, iNOS, HIF-1alpha and VEGF in relation to changes of the bladder wall were evaluated by immunohistochemical staining and Western blot assay. RESULTS: There was a significant difference in the vesical blood flow between the sham and experimental groups after the establishment of a PBOO. The bladder blood flow of the experimental groups was significantly decreased after establishing a PBOO of 3 days duration. The expressions of type III collagen and iNOS from the immunohistochemical staining of the bladder were markedly increased during the acute stages of a PBOO. The expressions of HIF-1alpha and VEGF from the Western blot of the bladder increased with duration of the obstruction. CONCLUSIONS: A decreased bladder blood flow during the acute stages of PBOO generally enhanced the expressions of iNOS and type III collagen. This study suggests that hypoxia of the bladder after establishing a PBOO induces the expression of HIF-1alpha, and then enhances the production of nitric oxide (NO) due to activation of iNOS, which finally results in bladder growth and a decrease in bladder wall compliance.

Clinical Experience of Laparoscopic Transperitoneal Adrenalectomy / 대한비뇨기과학회지

PURPOSE: A laparoscopic procedure is considered the treatment of choice for an adrenalectomy. We report our experience of a laparoscopic transperitoneal adrenalectomy in a series of 41 patients. MATERIALS AND METHODS: Between February 1999 and September 2004, 41 consecutive patients underwent a laparoscopic transperitoneal adrenalectomy. The indications for a adrenalectomy were primary aldosteronism in 16 patients, Cushing's syndrome in 7, pheochromocytoma in 6, nonfunctional adenoma in 5, adrenal cyst in 3, benign cystic teratoma in 2, myelolipoma in 1 and metastatic renal cell carcinoma in 1. The author analyzed the results of each operation. RESULTS: The affected adrenal gland was successfully removed, with the exception of 3 cases. Conversion to open surgery was necessary in 3 of the pheochromocytoma patients due to massive intraoperative bleeding and severe adhesion to retroperitoneal fat. The mean operative time was 245.3 minutes (125-420). The mean intraoperative blood loss and adrenal mass size were 189.6ml (20-2100) and 3.6cm (1.0-10.4), respectively. The mean post-operative hospital stay was 10.4 days (5-29). The mean times to oral intake and ambulation were 1.4 (1-3) and 1.0 days (1-2) after the operation, respectively. The mean number of days of analgesic administration was 2.1 (0-6). The conversion and major complication rates were 7.3 and 10.5%, respectively. CONCLUSIONS: A laparoscopic adrenalectomy is safe and effective in nearly all adrenal pathologies, with early oral intake, ambulation and a low number of days of pain control.

The Effect of Expressions of Vasoactive Intestinal Polypeptide and Nicotinamide Adenine Dinucleotide Phosphate Diaphorase in the Anterior Vaginal Wall on Female Urinary Incontinence and Sexual Function / 대한비뇨기과학회지

PURPOSE: We performed immunohistochemical analysis of vasoactive intestinal polypeptide (VIP) and nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase in the anterior vaginal wall, and we investigated their relations to the females sexual life and their stress urinary incontinence. MATERIALS AND METHODS: From December 2002 to April 2003, 55 urinary incontinent women, who were treated with tension-free vaginal tape (TVT), participated in this study. Their average age was 52.3 years old. We evaluated their sexual function with the Korean version of female sexual function index (FSFI). Anterior vaginal wall tissues 1x1cm in size were obtained during the TVT operation, and they were analyzed by immunohistochemical technique for VIP and NADPH diaphorase. We counted the number of nerve fibers containing VIP or NADPH diaphorase in the microscopic field of view. We verified the results with a Student's t-test and spearman test to identify the relations immunohistochemical results to the females sexual function and urinary incontinence. RESULTS: Expression of VIP was significantly low in grade III incontinence, but there was not a significant difference for the other parameters of incontinence. Expression of NADPH diaphorase had no significant relation with any factor of incontinence. For the relation between expression of VIP and NADPH diaphorase and the FSFI score, the domain of arousal shows a significant difference with the expression of VIP and NADPH diaphorase, according to FSFI score. CONCLUSIONS: From the above results, we suggest that VIP and NADPH diaphorase may affect the structure and functions of the female pelvic floor and these neurotransmitters act on the arousal phase of female sexual function.

The Effect of Expressions of Vasoactive Intestinal Polypeptide and Nicotinamide Adenine Dinucleotide Phosphate Diaphorase in the Anterior Vaginal Wall on Female Urinary Incontinence and Sexual Function / 대한비뇨기과학회지

PURPOSE: We performed immunohistochemical analysis of vasoactive intestinal polypeptide (VIP) and nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase in the anterior vaginal wall, and we investigated their relations to the females sexual life and their stress urinary incontinence. MATERIALS AND METHODS: From December 2002 to April 2003, 55 urinary incontinent women, who were treated with tension-free vaginal tape (TVT), participated in this study. Their average age was 52.3 years old. We evaluated their sexual function with the Korean version of female sexual function index (FSFI). Anterior vaginal wall tissues 1x1cm in size were obtained during the TVT operation, and they were analyzed by immunohistochemical technique for VIP and NADPH diaphorase. We counted the number of nerve fibers containing VIP or NADPH diaphorase in the microscopic field of view. We verified the results with a Student's t-test and spearman test to identify the relations immunohistochemical results to the females sexual function and urinary incontinence. RESULTS: Expression of VIP was significantly low in grade III incontinence, but there was not a significant difference for the other parameters of incontinence. Expression of NADPH diaphorase had no significant relation with any factor of incontinence. For the relation between expression of VIP and NADPH diaphorase and the FSFI score, the domain of arousal shows a significant difference with the expression of VIP and NADPH diaphorase, according to FSFI score. CONCLUSIONS: From the above results, we suggest that VIP and NADPH diaphorase may affect the structure and functions of the female pelvic floor and these neurotransmitters act on the arousal phase of female sexual function.

The Early Outcomes of Extraperitoneal Radical Cystectomy / 대한비뇨기과학회지

PURPOSE: Radical cystectomy with pelvic lymphadenectomy is an effective therapeutic modality in invasive bladder cancer. The development of another technique for a radical cystectomy for the early recovery and reduction of complications was attempted. MATERIALS AND METHODS: Between March 1997 and June 2003, an extraperitoneal radical cystectomy was attempted in 18 patients with invasive bladder cancer (pT1-pT4). Not only standard or extended pelvic lymphadenectomy, but also re-positioning of the ureter to the opposite side, could be performed extraperitoneally. An intestinal segment could be taken out through a small window within the peritoneum and manipulated as desired. The clinical safety and complications of other surgical approaches for radical cystectomy were also investigated. RESULTS: The procedure was successful in 15 of the 18 patients (4 studer pouches, 3 ileal conduits and 8 ureterocutaneostomies). Failure to peel out the peritoneum occurred in 3 cases, 1 each due to technical difficulties, tumor invasion at the bladder dome and adhesion due to a previous radical prostatectomy. Complications occurred in 8 cases (53.1%). The intestinal obstruction progressed in 1 case (12.5%) due to a high positioned mesentery of the Studer pouch. There were no significant gastrointestinal complications in any of the 8 patients that underwent the extraperitoneal radical cystectomy with ureterocutaneostomy. CONCLUSIONS: An extraperitoneal radical cystectomy seems to reduce the gastrointestinal complications and be worthwhile in certain cases with advanced bladder cancer. Despite the visual limitation, it is an acceptable surgical technique compared to the conventional transperitoneal methods.