Laparoscopic transperitoneal adrenalectomy in the large adrenal tumor from single center experience.

BACKGROUND: The role of laparoscopic adrenalectomy (LA) in a large adrenal tumor is controversial due to the risk of malignancy and technical difficulty. In this study, we compared the perioperative outcomes and complications of LA on large (≥ 6 cm) and (< 6 cm) adrenal tumors. METHODS: We retrospectively reviewed all clinical data of patients who underwent unilateral transperitoneal LA in our institution between April 2000 and June 2019. Patients were classified by tumor size into 2 groups. Patients in group 1 had tumor size < 6 cm (n = 408) and patient in group 2 had tumor size ≥ 6 cm (n = 48). Demographic data, perioperative outcomes, complications, and pathologic reports were compared between groups. RESULTS: Patients in group 2 were significant older (p = 0.04), thinner (p = 0.001) and had lower incident of hypertension (p = 0.001), with a significantly higher median operative time (75 vs 120 min), estimated blood loss (20 vs 100 ml), transfusion rate (0 vs 20.8%), conversion rate (0.25 vs 14.6%) and length of postoperative stays ( 4 vs 5.5 days) than in group 2 (all p < 0.001). Group 2 patients also had significantly higher frequency of intraoperative complication (4.7 vs 31.3%; adjust Odds Ratio [OR] = 9.67 (95% CI 4.22-22.17), p-value < 0.001) and postoperative complication (5.4 vs 31.3%; adjust OR = 5.67 (95% CI 2.48-12.97), p-value < 0.001). Only eight (1.8%) major complications occurred in this study. The most common pathology in group 2 patient was pheochromocytoma and metastasis. CONCLUSIONS: Laparoscopic transperitoneal adrenalectomy in large adrenal tumor ≥ 6 cm is feasible but associated with significantly worse intraoperative complications, postoperative complications, and recovery. However, most of the complications were minor and could be managed conservatively. Careful patient selection with the expert surgeon in adrenal surgery is the key factor for successful laparoscopic surgery in a large adrenal tumor. TRIAL REGISTRATION: This study was retrospectively registered in the Thai Clinical Trials Registry on 02/03/2020. The registration number was TCTR20200312004.

Management of metastatic castration-resistant prostate cancer: Insights from urology experts in Thailand.

Treatment options for castration-resistant prostate cancer (CRPC) are available, but clear instructions for the selection of appropriate treatment are lacking. A meeting of urology experts based in Thailand was convened with the following objectives: (1) to reach a consensus and share real-life experiences about how to identify CRPC; (2) to choose the appropriate treatment for CRPC patients; (3) to evaluate disease progression using novel inhibitors of the androgen receptor pathway; (4) to identify the frequency of monitoring disease; and (5) to promote rational use of corticosteroids in CRPC patients. This consensus document can provide guidance to other urologists in Thailand to provide appropriate treatment to metastatic CRPC patients in a timely manner.

Alveolar Soft Part Sarcoma of Urinary Bladder Occurring as a Second Primary Malignancy: A Case Report and Literature Review.

We report a case of bladder alveolar soft part sarcoma in an 18-year-old Thai male patient who had been treated with testicular radiation and systemic chemotherapy for acute lymphoblastic leukemia with testicular relapse. He presented with recurrent dysuria and gross hematuria. Cystoscopy revealed a 2-centimeter irregular sessile mass at the bladder base adjacent to left ureteral orifice. Transurethral resection of the tumor was performed. The histopathological diagnosis was alveolar soft part sarcoma. Chest and abdominal computed tomography showed no evidence of metastasis. He was treated with partial cystectomy and left ureteral reimplantation with negative surgical margin. No evidence of recurrence was found during a 28-month follow-up period with surveillance cystoscopy and computed tomography of the chest and abdomen.

The Outcome of Soft Silicone Drains in Reducing Shoulder Tip Pain after Laparoscopic Adrenalectomy.

Background: Intraabdominal carbon dioxide following laparoscopic adrenalectomy results in postoperative shoulder tip pain. Several interventions to reduce this pain have been used, but were not so effective. Objective: To evaluate the efficacy of soft silicone drain in reducing shoulder tip pain after laparoscopic adrenalectomy. Material and Method: A prospective randomized control trial was done on 38 patients undergoing laparoscopic adrenalectomy and randomized prospectively into two groups in King Chulalongkorn Memorial Hospital, Bangkok, Thailand. In our previous observational study, we collected data of pain scores from two patient groups after laparoscopic adrenalectomy. There were five cases with soft silicone drains and five cases without soft silicone drains. We found that those with drains had significantly decreased mean pain score. In this study, the patients were divided into two groups. Patients in group A (n = 19) underwent laparoscopic adrenalectomy with soft silicone drains and patients in group B (n = 19) underwent laparoscopic adrenalectomy without soft silicone drains. Shoulder-tip pain was recorded on a visual analogue scale (VAS) at 4, 8, 12, 24, and 48 hours after operation. The quantity of analgesics required by the patients were recorded on the first and second day postoperatively. Results: Twelve patients in group A (63.2%) and 14 patients in group B (73.68%) complained of shoulder-tip pain. However, there was no significant difference in the frequency and intensity of shoulder-tip pain between groups A and B. The postoperative shoulder-tip pain scores were not significantly different between the groups. The quantity of analgesics required by the patients in the two groups were not significantly different. According to VAS, pain scores were found to be highest at the fourth and the eighth hours postoperatively. The trends were similar in both groups. Conclusion: Although our previous observational studies found that drains help reducing shoulder tip pain, our present randomized control trial found that they could not significantly reduce shoulder tip pain. Further studies to reduce shoulder tip pain should be conducted.

Estimated cost of overactive bladder in Thailand.

OBJECTIVE: To estimate the annual direct and indirect costs of overactive bladder (OAB) in indigenous Thai people aged 18 years and over in the year 2005. MATERIAL AND METHOD: Economically based models using diagnostic and treatment algorithms from clinical practice guidelines and current disease prevalence data were used to estimate direct and indirect costs of OAB. Prevalence and event probability estimates were obtained from the literature, national data sets, and expert opinion. Costs were estimated from a small survey using a cost questionnaire and from unit costs of King Chulalongkorn Memorial Hospital. RESULTS: The annual cost of OAB in Thailand is estimated as 1.9 billion USD. It is estimated to consume 1.14% of national GDP The cost includes 0.33 billion USD for direct medical costs, 1.3 billion USD for direct, nonmedical costs and 0.29 billion USD for indirect costs of lost productivity. The largest costs category was direct treatment costs of comorbidities associated with OAB. Costs of OAB medication accountedfor 14% of the total costs ofOAB.