Endoscopic Suturing for the Prevention and Treatment of Complications Associated with Endoscopic Mucosal Resection of Large Duodenal Adenomas

Background/Aims@#Endoscopic mucosal resection (EMR) is the primary treatment for duodenal adenomas; however, it is associated with a high risk of perforation and bleeding, especially with larger lesions. The goal of this study was to demonstrate the feasibility and safety of endoscopic suturing (ES) for the closure of mucosal defects after duodenal EMR. @*Methods@#Consecutive adult patients who underwent ES of large mucosal defects after EMR of large (>2 cm) duodenal adenomas were retrospectively enrolled. The OverStitch ES system was employed for closing mucosal defects after EMR. Clinical outcomes and complications, including delayed bleeding and perforation, were documented. @*Results@#During the study period, ES of mucosal defects was performed in seven patients in eight sessions (six for prophylaxis and two for the treatment of perforation). All ES sessions were technically successful. No early or delayed post-EMR bleeding was recorded. In addition, no clinically obvious duodenal stricture or recurrence was encountered on endoscopic follow-up evaluation, and no patients required subsequent surgical intervention. @*Conclusions@#ES for the prevention and treatment of duodenal perforation after EMR is technically feasible, safe, and effective. ES should be considered an option for preventing or treating perforations associated with EMR of large duodenal adenomas.

Primary Androgen Deprivation Therapy for Prostate Cancer in Koreans: A Retrospective Multicenter Study

PURPOSE: To evaluate the characteristics of patients who received primary androgen deprivation therapy (PADT) for prostate cancer and the clinical efficacy of this treatment. MATERIALS AND METHODS: Two hundred forty patients treated by PADT were reviewed. These patients could not receive definitive therapy owing to old age, patient need, and medical comorbidity. The patients were divided into three groups according to the extent of prostate cancer: localized, locally advanced, and metastatic. Then, prostate-specific antigen (PSA) progression in these groups was analyzed. RESULTS: The median age of the patients was 73.0 years, and the median pretreatment PSA level was 47.0 ng/mL. Of the patients, 91.7% were treated with combined androgen blockade, and 8.3% were treated with monotherapy. Clinical factors for PSA progression were a PSA nadir and a high clinical stage. Estimated PSA recurrence-free median survival time in each group was 57, 24, and 12 months, respectively. A PSA nadir of >0.2 ng/mL and metastatic stage were independent factors for expecting a poor response to PADT (hazard ratio 4.26, p<0.001; and 2.60, p<0.001). CONCLUSIONS: Patients with localized or locally advanced prostate cancer who did not receive definitive therapy had lower PSA progression rates than those at metastatic stage during PADT. Further, a PSA nadir of < or =0.2 ng/mL showed better progression-free survival. Therefore, PADT can be another therapeutic option in well-selected patients with localized or locally advanced prostate cancer and PSA change should be checked carefully.

Clinical Significance of Wnt/beta-Catenin Signalling and Androgen Receptor Expression in Prostate Cancer

PURPOSE: To investigate the relationships among the Wnt/beta-catenin pathway, androgen receptor (AR), and clinicopathological factors in hormone-naive prostate cancer. MATERIALS AND METHODS: This study was conducted with132 cases of hormone-naive prostate cancer treated by prostatectomy and prostate needle biopsy. An immunohistochemical study using antibodies against beta-catenin, matrix metalloproteinase-7 (MMP-7), and the AR was performed. For the in vitro study, PC-3, LNCaP, 22Rv1, and DU145 cell lines were used. RESULTS: The clinical or pathological stage ware a localized cancer in 36 patients (27.3%), locally advanced cancer in 31 (23.5%), and metastatic cancer in 65 (49.2%). We detected increased beta-catenin, AR, and MMP-7 expression with a high Gleason grade, disease progression, and increasing serum prostate-specific antigen (PSA) levels (p<0.01). In Spearman's rank correlations, the expression of cytoplasmic beta-catenin, MMP-7, and the AR were found to be significantly positively correlated. In addition, the expression of beta-catenin, MMP-7, and the AR were significantly correlated with clinicopathological variables indicative of a poor prognosis. Forty-nine patients with primary androgen deprivation had short response durations from hormone therapy to PSA progression with elevated MMP-7 expression on the Kaplan-Meier curve (p=0.0036). CONCLUSIONS: These data show that an activated Wnt/beta-catenin pathway and AR expression in prostate cancer are correlated with metastasis and aggressiveness. In addition, the expression of MMP-7 protein, a target of the Wnt/beta-catenin pathway, is associated with PSA progression in prostate cancer patients undergoing primary hormone therapy.

Predictive Factors of the Long-term Medical Treatment Failure in Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The aim of this study was to identify the clinical baseline factors that affect failure of medical treatment(and especially surgical treatment) for benign prostatic hyperplasia(BPH) in spite of long-term medication. MATERIALS AND METHODS: 802 men who were over 50 years of age with BPH were enrolled for this study. Patients were allocated to a medication group and a surgical treatment group(after having at least a 12 month duration of medication). We compared the differences between the two groups for their initial International Prostate Symptom Score(IPSS), the uroflowmetry, the prostate volume, the postvoid residual urine and the serum prostate specific antigen(PSA). RESULTS: 397 patients had surgical treatment following medication due to BPH progression(acute urinary retention, aggravating LUTS) and 405 patients were given maintenance medical treatment during follow-up. Statistically significant differences were found in the IPSS(23.3+/-6.6 vs. 12.7+/-8.4), the prostate volume(53.5+/-28.1ml vs. 38.3+/-12.6ml), the maximal flow rate(7.8+/-4.7ml/sec vs. 12.7+/-5.4ml/sec), the postvoid residual urine volume(92.7+/-144.4cc vs. 36.5+/-147.1cc), and the PSA(6.1+/-7.6ng/ml vs. 2.8+/- 2.8ng/ml) between the surgical and medication groups. According to the area under the curve(AUC), the IPSS, prostate volume, maximal flow rate, postvoid residual urine volume and PSA are important in descending order. According to the receiver operating characteristic(ROC) curve- based prediction of the surgical intervention, the best cutoff value for the IPSS and prostate volume were 17(area under ROC curve: 0.83) and 40ml (area under ROC curve: 0.68), respectively. Conclusions: The results show that BPH patients with more severe IPSS (>or=17) and a larger prostate volume(>40ml) have a higher risk of surgical intervention, and this suggests that the IPSS and prostate volume may be useful predictors at the initial visit for surgical intervention.

Adenomatoid Tumor of the Testis with Infiltration to the Seminiferous Tubules / 대한비뇨기과학회지

A 41-year-old man presented a bean sized, solid, painless left scrotal mass he'd had for 10 years. The mass was well demarcated and it showed homogeneous echogenecity on ultrasonography. Simple mass excision was performed and the specimen revealed a relatively well circumscribed mass lesion composed of dilated tubules with flattened lining cells. A focal infiltration to the seminiferous tubule and involvement of the biopsy margins were observed. The tubules had a positive reaction to the calretinin and anti-mesothelial antibody on immunohistochemical stain. Therefore, the tumor was diagnosed as adenomatoid tumor of the testis. Adenomatoid tumors of testis are rare benign neoplasms that are thought to originate from mesothelum. Most cases were reported in the epididymis, spermatic cord and testicular tunica, and rare cases were from the ejaculatory duct, prostate and adrenal gland. The findings of adenomatoid tumor infiltrating through the testis parenchyme and seminiferous tubule, like for our case, have not been previously reported in Korea.