Multivariate Analysis of the Prognostic Significance of Resection Weight after Transurethral Resection of Bladder Tumor for Non-Muscle-Invasive Bladder Cancer

PURPOSE: Tumor size and multiplicity are known to be important prognostic factors in non-muscle-invasive bladder cancer (NMIBC). However, evaluation of accurate tumor size is subjective and difficult. Furthermore, there are limitations to the objectification of tumor volume in the case of multiple lesions. In this study, we investigated the relation between resection weight after transurethral resection of bladder tumor (TURBT) and the prognosis of NMIBC. MATERIALS AND METHODS: This was a retrospective analysis of 406 patients diagnosed with pTa or pT1 bladder tumors after TURBT between September 1999 and May 2010. The patient's age, sex, underlying diseases, cancer stage, grade, multiplicity, tumor size, lymphovascular invasion, and resection weight were analyzed in relation to cancer progression and recurrence. The resection weight was weighted after formaldehyde fixation. RESULTS: The mean follow-up time was 76.9 months (range, 12 to 167 months) in 406 patients diagnosed as having NMIBC. Mean resection weight was 4.5 g (range, 0.1 to 35.0 g). The cancer recurred in 99 patients (24.4%), and disease progression was noted in 30 patients (7.4%). Resection weight was categorized as greater than or less than 2 g by use of receiver operator characteristic curves. Cancer grade (p=0.022) and multiplicity (p=0.043) were significantly related to cancer recurrence in the analysis with Cox's multivariate proportional hazard model. Cancer grade (p=0.001) and resection weight (p=0.018) were related to disease progression. CONCLUSIONS: Resection weight after TURBT was significantly related to progression of NMIBC. Resection weight was an independent factor of progression. Further management should be considered if the resection weight exceeds 2 g.

Multivariate Analysis of the Prognostic Significance of Resection Weight after Transurethral Resection of Bladder Tumor for Non-Muscle-Invasive Bladder Cancer

PURPOSE: Tumor size and multiplicity are known to be important prognostic factors in non-muscle-invasive bladder cancer (NMIBC). However, evaluation of accurate tumor size is subjective and difficult. Furthermore, there are limitations to the objectification of tumor volume in the case of multiple lesions. In this study, we investigated the relation between resection weight after transurethral resection of bladder tumor (TURBT) and the prognosis of NMIBC. MATERIALS AND METHODS: This was a retrospective analysis of 406 patients diagnosed with pTa or pT1 bladder tumors after TURBT between September 1999 and May 2010. The patient's age, sex, underlying diseases, cancer stage, grade, multiplicity, tumor size, lymphovascular invasion, and resection weight were analyzed in relation to cancer progression and recurrence. The resection weight was weighted after formaldehyde fixation. RESULTS: The mean follow-up time was 76.9 months (range, 12 to 167 months) in 406 patients diagnosed as having NMIBC. Mean resection weight was 4.5 g (range, 0.1 to 35.0 g). The cancer recurred in 99 patients (24.4%), and disease progression was noted in 30 patients (7.4%). Resection weight was categorized as greater than or less than 2 g by use of receiver operator characteristic curves. Cancer grade (p=0.022) and multiplicity (p=0.043) were significantly related to cancer recurrence in the analysis with Cox's multivariate proportional hazard model. Cancer grade (p=0.001) and resection weight (p=0.018) were related to disease progression. CONCLUSIONS: Resection weight after TURBT was significantly related to progression of NMIBC. Resection weight was an independent factor of progression. Further management should be considered if the resection weight exceeds 2 g.

Effects of Health Insurance Coverage for Vasovasostomy / 대한남성과학회지

PURPOSE: In early 1980s, vasectomy was performed in more than 10 thousand men of reproductive age annually without cost as a South Korean government policy of birth control, but because the policy has been converted to encouraging childbirth since July 2004, vasovasostomy is now covered by national health insurance. We investigated the effect of national health insurance coverage of vasovasostomy. MATERIALS AND METHODS: From August 1997 to June 2009, a total of 117 patients who underwent vasovasostomy were enrolled in this study. We divided the patients into two groups. The 63 patients undergoing the procedure before national health insurance coverage were included in group A, and the other 54 patients, who underwent the procedure after insurance coverage began, were classified into group B. The two groups were compared according to age, spouse's age, time since vasectomy, number of children at the time of vasectomy, occupation, educational attainment, religion, and the reason for vasovasostomy. RESULTS: The average number of cases of vasovasostomy was almost 3 times higher after insurance coverage was introduced, at 2.3 cases per month. The average spouse's age was significantly higher in group B than group A (35.2+/-4.8 vs. 32.2+/-3.5, p=0.012). Time since vasectomy was shorter in group B than group A (5.7+/-4.7 years vs. 8.9+/-5.0 years, p=0.001). Number of children at the time of vasectomy showed no significant difference between group A and group B, at 1.7+/-0.7 and 1.6+/-0.8 respectively. Cross tabulation analysis of occupation, educational status, religion, and the reason for vasovasostomy showed no significant difference. The patency rate was significantly higher in group A than group B (87.3% vs. 90.7%, p=0.012), but there was no significant difference in pregnancy rate. CONCLUSIONS: A significant increase was seen in patency rate, but not in pregnancy rate, after insurance coverage. However, further follow up will show us that a rise in the patency rate promises positive effects on the rise of pregnancy rate. We suggest that insurance coverage for vasovasostomy has encouraged an increase in births.