Bilateral Nephroureterectomy with Radical Cystectomy for Urothelial Tumor Involving the Renal Pelvis, Ureter and Bladder in a Patient Receiving Hemodialysis / 대한비뇨기과학회지

Transitional cell carcinoma such as renal cell carcinoma is the relatively common urinary tract cancer in patients who are on dialysis. A 66-year-old male patient, who had been on maintenance hemodialysis for 5 years, was suffering from gross hematuria. The subsequent image studies revealed multiple masses at the right renal pelvis, the right distal ureter and the trigonal area at the bladder. We performed cystoscopy to evaluate the multiple bladder papillary masses and their blood clots. The patient then underwent bilateral radical nephroureterectomy and radical cystectomy. Histological examination revealed the papillary urothelial carcinoma. Our case may imply that dialysis patients have an increased susceptibility to urological malignancies. Physicians should always raise the possibility of urological malignancy when encountering a dialysis patient with gross hematuria. Because of the high recurrence rate, a more extensive operation and aggressive follow-up protocols should be done for these patients on dialysis.

Treatment of Simple Renal Cysts by Percutaneous Aspiration and OK-432 Sclerotherapy / 대한비뇨기과학회지

PURPOSE: Percutaneous aspiration with sclerotherapy has been widely used for the treatment of symptomatic or large simple renal cysts. Ethanol has been most commonly used as a sclerosing agent; however, a temporary percutaneous nephrostomy for multiple ethanol injections is necessary to achieve a low recurrence rate. Thus, we used OK-432 as a new sclerosing agent without a temporary percutaneous nephrostomy for multiple injections, and also compared our results with the results of previous studies. MATERIALS AND METHDOS: Between October 2005 and April 2006, 50 patients (63 simple renal cysts) who underwent percutaneous OK-432 sclerotherapy for simple renal cysts were evaluated. The simple renal cysts were aspirated under ultrasonography and fluoroscopy, after which OK-432 was injected into the cyst. Follow-up was performed with ultrasonography or CT scan after 3 months. Regression of the renal cyst or a >70% reduction in size with no symptoms was considered a treatment success. RESULTS: Among 63 renal cysts in 50 patients, complete regression occurred in 17(27.0%). Greater than a 90% reduction in size occurred in 8(12.7%), a 80-90% reduction in size occurred in 21(33.3%), and a 70-80% reduction in size occurred in 15(23.8%); a <70% reduction in size occurred in 2 (3%). The overall efficacies of success were 96.8%. After the procedure, there were only some minor complications, such as mild fever, local pain, and liver function test elevation that subsided with symptomatic treatment. CONCLUSIONS: Percutaneous OK-432 sclerotherapy is simple, safe, and effective and can be an alternative first-line therapy of simple renal cysts.

Percutaneous Treatment of Renal Cysts with OK-432 Sclerosis

PURPOSE: The aim of this study was to demonstrate OK- 432 sclerotherapy efficacy for treatment of simple renal cysts. MATERIALS AND METHODS: Twenty patients with 25 symptomatic or large simple cysts were treated by ultrasonography (US)-guided percutaneous aspiration and injection of OK-432 (8 men and 12 women, mean age 63.6 years, SD 9.5). Six patients presented with flank pain, 14 presented with renal mass; renal cyst location was right, left, or bilateral sided in 9, 8, and 8 kidneys, respectively. Patients were evaluated by clinical assessment, US, or CT scan 3 months following the procedure. Complete and partial success was defined as symptom resolution with either total cyst ablation or greater than 70% reduction, respectively. Failure was defined as 30% of cyst size recurrence and/or persistent symptoms. RESULTS: Average reduction was 93.0%. Complete and partial resolution occurred in 11 (44.0%) and 13 (52.0%) cysts, respectively. One case was defined as failure, with a 64.2% size reduction from 10.9cm to 3.9cm (volume reduction rate 95.4%). Renal pain improved in all patients, regardless of complete or partial resolution. Minor complications occurred in 3 patients, 2 developed leukocytosis and 1 had mild fever (< 38.5 degrees C) following aspiration and sclerotherapy. Successful treatment was achieved with conservative measures and NSAID therapy. CONCLUSION: Percutaneous treatment of simple renal cysts with OK-432 sclerotherapy was found to be a safe, effective and minimally invasive procedure.

Prognostic Significance of p53, pRb, and p21(waf1) in T1G3 Bladder Cancer / 대한비뇨기과학회지

PURPOSE: There is no reliable method for predicting which patient with a T1G3 bladder tumor will progress and possibly benefit from an early cystectomy. The prognostic significance of p53, pRb, and p21(waf1) expression was evaluated in patients with a T1G3 bladder tumor. MATERIALS AND METHODS: Of the 787 patients with a newly diagnosed bladder tumor, 485 were superficial. Of these patients, 57 had a T1G3 transitional cell carcinoma. Overall, a total of 30 patients were included in this study. A tumor with nuclei staining more than 10% with either p53 or p21(waf1) antibodies were defined as having altered p53 or p21(waf1) expression. The relationship between recurrence and progression and the results of immunostaining in a T1G3 bladder cancer was analyzed. RESULTS: A pathological diagnosis consisted of 14 papillary and 16 non-papillary including 2 mixed transitional cell cancers. An associated carcinoma in situ was noted in 3 patients. Of the 30 patients, 11 had a recurrence. A progression to muscle invasive bladder cancer had developed in 6 cases at a mean interval of 10.2 months. Each separate expression of p53, p21(waf1) and pRb did not correlate with tumor recurrence or progression. However, patients with combination of a positive p53 with a negative p21(waf1) and a negative pRb test had a significantly higher rate of progression to muscle invasive disease. CONCLUSIONS: A combination of altered immunostaining for a positive p53 with a negative p21(waf1) and a negative pRb test correlated with progression of a T1G3 TCCa of the bladder but not with a recurrence. Therefore, early cystectomy should be considered in a T1G3 bladder tumor with an altered expression of p53 with either p21(waf1) or with pRb.

Prognostic Significance of p53, pRb, and p21(waf1) in T1G3 Bladder Cancer / 대한비뇨기과학회지

PURPOSE: There is no reliable method for predicting which patient with a T1G3 bladder tumor will progress and possibly benefit from an early cystectomy. The prognostic significance of p53, pRb, and p21(waf1) expression was evaluated in patients with a T1G3 bladder tumor. MATERIALS AND METHODS: Of the 787 patients with a newly diagnosed bladder tumor, 485 were superficial. Of these patients, 57 had a T1G3 transitional cell carcinoma. Overall, a total of 30 patients were included in this study. A tumor with nuclei staining more than 10% with either p53 or p21(waf1) antibodies were defined as having altered p53 or p21(waf1) expression. The relationship between recurrence and progression and the results of immunostaining in a T1G3 bladder cancer was analyzed. RESULTS: A pathological diagnosis consisted of 14 papillary and 16 non-papillary including 2 mixed transitional cell cancers. An associated carcinoma in situ was noted in 3 patients. Of the 30 patients, 11 had a recurrence. A progression to muscle invasive bladder cancer had developed in 6 cases at a mean interval of 10.2 months. Each separate expression of p53, p21(waf1) and pRb did not correlate with tumor recurrence or progression. However, patients with combination of a positive p53 with a negative p21(waf1) and a negative pRb test had a significantly higher rate of progression to muscle invasive disease. CONCLUSIONS: A combination of altered immunostaining for a positive p53 with a negative p21(waf1) and a negative pRb test correlated with progression of a T1G3 TCCa of the bladder but not with a recurrence. Therefore, early cystectomy should be considered in a T1G3 bladder tumor with an altered expression of p53 with either p21(waf1) or with pRb.