Laparoscopic stone surgery with the aid of flexible nephroscopy.

PURPOSE: To report the outcome of laparoscopic pyelo- and ureterolithotomies with the aid of flexible nephroscopy. MATERIALS AND METHODS: A retrospective analysis was performed in 71 patients with complex renal stones or large and impacted proximal ureteral stones. Patients underwent laparoscopic pyelo- or ureterolithotomies with or without the removal of small residual stones by use of flexible nephroscopy between July 2005 and July 2010. Operative success was defined as no residual stones in the intravenous pyelogram at 12 weeks postoperatively. Perioperative results and surgical outcomes were analyzed. RESULTS: The patients' mean age was 54.7±13.7 years, and 53 males (74.6%) and 18 females (25.4%) were included. The mean maximal stone size was 19.4±9.4 mm. A total of 47 cases were complex renal stones and 24 cases were impacted ureteral stones. Mean operative time was 139.0±63.7 minutes. Stones were completely removed in 61 cases (85.9%), and no further ancillary treatment was needed for clinically insignificant residual fragments in 7 cases (9.9%). For complex renal stones, the complete stone-free rate and clinically significant stone-free rate were 80.9% and 93.6%, respectively. Multivariate analysis showed that the use of flexible nephroscopy for complex renal stones can reduce the risk of residual stones. A major complication occurred in one case, in which open conversion was performed. CONCLUSIONS: Laparoscopic stone surgery is a safe and minimally invasive procedure with a high success rate, especially with the aid of flexible nephroscopy, and is not associated with procedure-specific complications.

Impact of prostate size on pathologic outcomes and prognosis after radical prostatectomy.

PURPOSE: We investigated prostate size and its correlation with final pathologic outcomes and prognosis. MATERIALS AND METHODS: From 1993 to 2009, 830 consecutive patients who underwent radical prostatectomy with follow-up duration of 12 months or more were included in this study. Patients were categorized according to prostate size as follows: group 1, prostate size ≤40 g (n=458), and group 2, prostate size >40 g (n=472). Preoperative parameters and postoperative pathologic outcomes were compared between groups. Multivariate analysis with Cox proportional hazards regression model was used to identify the pathologic and clinical factors affecting biochemical recurrence. RESULTS: Patients in group 1 had higher pathologic T stage (pT2a=17.7% vs. 23.9%, pT2b=1.1% vs. 0%, pT2c=40.4% vs. 39.8%, pT3a=29.5% vs. 21.0%, pT3b=10.7% vs. 13.2%, p=0.003) and higher positive surgical margin (40.3% vs. 33.1%, p=0.033) than did patients in group 2. Pathologic Gleason score was not significantly different between the two groups. The 5-year biochemical-recurrence-free survival was 62.3% for patients in group 1 and 73.2% for patients in group 2 (p=0.005). Multivariate Cox regression analysis showed that prostate size of 40 g or less (hazard ratio [HR], 1.378; 95% confidence interval [CI], 1.027 to 1.848; p=0.032), extracapsular extension (HR, 1.592; 95% CI, 1.147 to 2.209; p=0.005), positive surgical margin (HR, 2.348; 95% CI, 1.701 to 3.242; p<0.001), and pathologic Gleason sum (HR, 1.507; 95% CI, 1.292 to 1.758; p<0.001) were independent predictors of biochemical recurrence. CONCLUSIONS: Smaller prostate size was associated with increased risk of higher pT stage and positive surgical margin after radical prostatectomy. Also, prostate size less than 40 g was an independent prognostic factor for biochemical recurrence.

Impact of sunitinib treatment on blood glucose levels in patients with metastatic renal cell carcinoma.

OBJECTIVE: To investigate the effects of sunitinib treatment on blood glucose levels in patients with metastatic renal cell carcinoma. METHODS: We reviewed the records of 48 patients who received sunitinib treatment for metastatic renal cell carcinoma between April 2007 and December 2010 at our institution. Patients' data including diabetic status, diabetes mellitus medication and mean blood glucose levels before, during and after the treatment with sunitinib were assessed. RESULTS: In 10 of the 48 (20.8%) patients who were diabetic, the blood glucose level was observed to be significantly decreased after 4 weeks of sunitinib treatment with the mean decrease in blood glucose level being 76.1 ± 29.0 mg/dl (P = 0.002). Subsequently, after a 2-week off-treatment period, the mean blood glucose level rebound and increased (21.9 ± 6.3 mg/dl, P = 0.038) in these 10 patients. With sunitinib treatment, one patient was able to discontinue diabetes mellitus medication completely during a 4-week treatment period, and three other patients had dosages of their oral diabetes mellitus medication reduced. Among 38 non-diabetic patients, no significant changes in blood glucose levels were observed during both the 4-week sunitinib treatment period and the 2-week off-treatment period. No severe hypoglycemic episode was observed among our subjects. CONCLUSIONS: Sunitinib treatment in diabetic patients with metastatic renal cell carcinoma may result in significantly decreased blood glucose levels. Thus, blood glucose levels should be checked more vigilantly in diabetic patients undergoing sunitinib treatment to adjust diabetes mellitus medications as needed. Further investigation via a larger scaled, prospective study would be needed.

Orthotopic ileal neobladder reconstruction in a woman who developed squamous cell carcinoma of the urinary bladder after kidney transplantation.

The case of a 62-year-old woman who developed squamous cell carcinoma of the bladder 16 years after a kidney transplant is reported here. After the transplant, immunosuppressive therapy was maintained with cyclosporin A (200 mg/day) and the patient's serum creatinine level was 0.9 mg/dL. She was diagnosed with squamous cell carcinoma of the bladder 16 years later and underwent radical cystectomy with an orthotopic ileal neobladder. The Studer technique was used and the afferent ileal loop was anastomosed to the graft ureter. The postoperative course was uneventful. At the 6-month follow-up visit, the patient showed no evidence of recurrence. Her serum creatinine level was 1.0 mg/dL. The patient was continent during the day and the night. This case shows that the construction of an orthotopic ileal neobladder after cystectomy is safe and feasible in kidney transplant recipients.

Modified vaporization-resection for photoselective vaporization of the prostate using a GreenLight high-performance system 120-W Laser: the Seoul technique.

OBJECTIVES: The most popular technique of photoselective vaporization of the prostate (PVP) for benign prostatic hyperplasia (BPH) involves vaporization only. We developed a modified vaporization-resection technique that consists of vaporizing a prostate along outlined margins and retrieving the wedge-shaped prostate tissue. We report the operative procedure and clinical outcomes of our technique with the GreenLight high performance system (HPS). METHODS: A total of 104 patients with a prostate volume greater than 40 mL who underwent PVP were included in this retrospective study. Forty patients were treated with the vaporization-only technique (Group non-S) and 64 patients with the Seoul technique (group S). The clinical outcomes were assessed at 1, 3, 6, and 12 months postoperatively using the International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum flow rate (Q(max.)), and postvoid residual urine volume (PVR). RESULTS: The Q(max.), PVR, IPSS, and QoL scores improved significantly from 1 to 12 months after the PVP compared with the baseline in both groups (P <.05). In the S group, the volume reduction of the prostate per operative time, lasing time, and laser energy were significantly smaller than in the non-S group (P <.05). In general, the overall complication rates were low in the 2 groups. Two patients were found to have prostate cancer on pathology. CONCLUSIONS: The Seoul technique for PVP showed good short-term efficacy and safety for the treatment of BPH. With this technique, we can conserve on the operative time, lasing time, and energy, and obtain prostatic tissue for pathologic evaluation.