Preoperative factors predictive of continence recovery after radical retropubic prostatectomy.

PURPOSE: We assessed the factors predictive of continence recovery after radical retropubic prostatectomy performed by use a single operative technique by a single surgeon. MATERIALS AND METHODS: Preoperative factors, including age, body mass index (BMI), prostate volume, prostate-specific antigen level, and anatomical information from preoperative magnetic resonance imaging (MRI), such as membranous urethral length, thickness of the levator ani muscle, and urogenital diaphragm, were evaluated in 94 consecutive patients who underwent radical retropubic prostatectomy between April 2005 and October 2010. Patients were also categorized into four different groups according to the overlying pattern of the prostatic apex and the membranous urethra. Continence status was evaluated by direct patient questioning at 12 months after the operation. RESULTS: The overall continence rate at 12 months after the operation was 79.8%. In the age- and BMI-adjusted logistic regression analysis, the membranous urethral length and the overlying pattern of the prostatic apex were significant predictive factors of the continence rate at 12 months after the operation (p=0.006 and p=0.007, respectively). Other predictive factors were not contributory. Patients with no overlapping observed between the prostatic apex and membranous urethra had longer membranous urethral lengths (14.24±2.73 mm) and higher rates of recovery of continence compared with other groups. CONCLUSIONS: Membranous urethral length and shape of the prostatic apex as assessed by preoperative MRI are significantly associated with recovery of urinary continence after radical retropubic prostatectomy.

Monthly intravesical bacillus Calmette-Guérin maintenance therapy for non-muscle-invasive bladder cancer: 10-year experience in a single institute.

Intravesical bacillus Calmette-Guérin (BCG) therapy is the standard prophylaxis for recurrence of non-muscle-invasive bladder cancer (NMIBC). The aim of this study was to confirm the recurrence- and progression-preventing efficacy and safety of 12 times monthly BCG maintenance therapy for NMIBC. This study included 126 patients diagnosed with Ta, T1 and carcinoma in situ bladder cancer between January 2000 and December 2009. Thirty-four patients in the no maintenance group received a single 6-week course of intravesical immunotherapy after transurethral resection of the bladder tumor (TUR-BT). Ninety-two patients in the maintenance group received a 12-month course after a single 6-week course of intravesical immunotherapy. Recurrence, progression and side effects were assessed. End-points were recurrence-free survival (RFS), progression-free survival (PFS) and disease-specific survival (DSS). The estimated median RFS was 87 months (95% CI 53.0-120.9) in the maintenance group and 48 months (95% CI 0-96.8) in the no maintenance group (log-rank test; P=0.002). The 2-year cumulative RFS rates were 77.3% in the maintenance group and 52.6% in the no maintenance group. Median PFS and DSS were not estimable in both groups. The 2-year cumulative PFS rates were 91.1% in the maintenance group and 80.5% in the no maintenance group (log-rank test; P=0.178). The 2-year cumulative DSS rates were 97.7% in the maintenance group and 91.4% in the no maintenance group (log-rank test; P=0.111). The overall side effects were 40.2% in the maintenance group and 44.1% in the no maintenance group. Monthly maintenance immunotherapy appears to increase RFS rates in high-risk NMIBC. Further study is required to evaluate the efficacy of BCG monthly maintenence for increasing the PFS rate.

Renal cell carcinoma in a right malrotated kidney.

The authors report a case of renal cell carcinoma in a right malrotated (horizontal axis) kidney. The patient was treated by hand-assisted laparoscopic radical nephrectomy. This is the first report of a horizontal axis malrotated kidney with renal cell carcinoma.

Life-threatening complications associated with the tyrosine kinase inhibitor sunitinib malate.

Adverse events associated with sunitinib, such as cardiac toxicities, renal damage, and hemostatic complications, are well known. The authors report 3 cases in which patients experienced severe life-threatening complications after commencing sunitinib treatment. One patient developed heart failure with dilation of the left ventricle and decrease in the ejection fraction after one cycle of sunitinib and required treatment with an angiotensin-converting enzyme inhibitor, loop diuretics, and dobutamine. Another patient developed coronary artery stenosis after one cycle of sunitinib and was managed through percutaneous coronary intervention. Although follow-on coronary angiography revealed normal findings after 6 further cycles of sunitinib, this patient eventually expired due to multi-organ failure. The third patient had chronic renal failure before sunitinib treatment and required hemodialysis due to acute-on-chronic renal failure after commencing sunitinib treatment.