Characterization of renal stone composition by using fast kilovoltage switching dual-energy computed tomography compared to laboratory stone analysis: a pilot study.

PURPOSE: To prospectively examine the diagnostic performance of fast kilovoltage switching dual-energy computed tomography (DECT) in characterization of in vivo renal stone composition compared with postoperative stone analysis. METHODS: Consecutive consenting patients scheduled for endoscopic kidney stone surgery in a tertiary referral hospital from June 2015 to January 2016 were enrolled. Patients were preoperatively scanned with single-source, fast kilovoltage switching DECT. Stone compositions were determined regarding the effective atomic number measurements. Results of the stone compositions from DECT were compared to postoperative infrared spectroscopy stone analysis as the standard reference. RESULTS: For the 39 patients enrolled in the study, DECT was able to detect uric acid stone with sensitivity of 88.9% and specificity of 100%. There was 100% positive predictive value, 96.8% negative predictive value, and 97.4% accuracy. For non-contrast CT scan, sensitivity was 88.9%, specificity was 96.7%, positive predictive value was 88.9%, negative predictive value was 96.7%, and accuracy was 94.8%. Of the 39 samples examined, 21 (54%) were single composition, whereas 18 (46%) were combined. Single composition stones were correctly characterized by DECT in 100% (8/8) for uric acid. Whereas the result of uric acid stone containing stone discrimination in mixed composition was not so good with Zeff alone, iodine imaging can compensated this fault. CONCLUSIONS: DECT provides excellent accuracy in characterizing uric acid stone compositions. With the addition of iodine image, all of uric acid-containing stones can be determined by the DECT.

The Impact of Arterial Clamping Technique in Robot-Assisted Partial Nephrectomy on Renal Function and Surgical Outcomes: Six-Year Experience at Siriraj Hospital, Thailand.

INTRODUCTION: Robot-assisted partial nephrectomy (RAPN) with different arterial clamping techniques has increasingly been performed to avoid ischemic injury to nephron. However, postoperative renal function remains controversial. We determine the impact of each renal arterial clamping on surgical and renal outcomes after RAPN. MATERIALS AND METHODS: Patients who underwent RAPN at Siriraj Hospital from 2010 to 2016 were retrospectively reviewed and stratified into 3 cohorts: main-clamp (MAC), selective-clamp, and off-clamp. RESULTS: Main, selective, and off-clamping were performed in 27, 38, and 12, respectively. Median tumor size and Radius, Exophytic or endophytic, Nearness to collecting system or sinus, Anterior or posterior, and Location relative to polar lines (RENAL) score were 3 cm and 7, respectively. Longer operative time was observed in MAC (p = 0.002) although estimated blood loss, transfusion rate, and complication were comparable. Warm ischemia time was not different between cohorts. However, number of patients with prolonged ischemia time in MAC were greater (p ≤ 0.01). All margins were negative. Median postoperative and latest glomerular filtration rate reduction were 3.8 and 5.3 mL/min/1.73 m2, respectively without significant difference between cohorts. On multivariable analysis, hypertension independently associated with reduced renal function preserved (p = 0.03). Median follow-up was 18 months. CONCLUSIONS: Our study is the first to report surgical and renal functional outcomes after RAPN in Southeast-Asian population. Based on our experience, clamping techniques does not impact on renal functions and complication rate was low even in small-volume center.

A Case Report of Ruptured Malignant Neuroendocrine Tumor of Kidney, an Extraordinary Presentation.

We report the case of a 51-year-old Thai female presented with right abdominal mass with pain and anemia. The radiographic findings showed ruptured renal mass. She underwent radical nephrectomy and the pathological report was malignant neuroendocrine tumor. Palliative chemotherapy was administered. The patient passed away three months after the operation. Renal neuroendocrine tumors are rare. Moreover, ruptured renal tumors are very rare. They are usually considered to be angiomyolipoma or renal cell carcinoma. Poor differentiation and rupture at presentation are aggressive features of tumors. To the best of our knowledge, this is the first case report of ruptured renal malignant neuroendocrine tumor.

Comparison of urinary continence outcome between robotic assisted laparoscopic prostatectomy versus laparoscopic radical prostatectomy.

OBJECTIVE: To compare urinary continent rate at six and 12-month postoperative period, and perioperative outcome between robotic-assisted laparoscopic radical prostatectomy (RALP) and laparoscopic radical prostatectomy (LRP) at Siriraj Hospital. MATERIAL AND METHOD: All medical records of patients performed RALP and LRP between 2005 and 2010 were reviewed. Data composed of demographic information, perioperative outcome, and oncologic outcome. Moreover, the urinary continence rate was also collected at six and 12-month postoperative period by questionnaires based research design. RESULTS: Between 2005 and 2010, we performed 548 cases of RALP and 613 cases of LRP. Only 486 cases of RALP (88.6%) and 561 cases of LRP (91.5%) had been followed-up more than 12 months. All demographic data including age, biopsy Gleason score, and preoperative PSA level in both groups were comparably. On the other hand, the perioperative outcome in RALP differed from LRP group significantly, including operative time (210 min vs. 255 min), blood loss (449 ml vs. 766 ml), blood transfusion rate (7.6% vs. 25.2%), and length of hospital stay (7 days vs. 8.6 days) (p < 0.001). The oncological outcome including pathologic tumor staging and Gleason score were comparably. Late complication such as anastamosis stricture was not different between the two groups (3.1% in RALP vs. 2.4% in LRP, p = 0.584). The continence rate of RALP and LRP groups at 6-month was 67.8% and 39% and at 12-month was 80% and 63.7%, respectively. The continence rate of RALP was better than LRP significantly. CONCLUSION: From our experience, perioperative outcome and continence rate at six and 12-month of RALP group was significantly better than LRP group. The demographic data, oncological outcome, and anastamosis stricture rate were comparably in both groups. The most relevant preoperative predictors of urinary continence were patient's age and prostatic weight.

Laparoscopic radical prostatectomy: oncological and functional outcomes of 559 cases in Siriraj Hospital, Thailand.

OBJECTIVE: To evaluate the results of oncological and functional outcomes of laparoscopic radical prostatectomy (LRP) during the first five years experience in Siriraj hospital. MATERIALS AND METHOD: Between September 2004 and September 2009, the functional and oncological outcomes of 559 patients that underwent LRP were retrospectively evaluated. RESULTS: The distribution of pathological T stage was T2 (52.1%), T3 (39.9%), and T4 (2.9%). Lymph node metastasis (N1) were found in 19 patients (3.4%). The positive margin rates in pT2a-b, pT2c, pT3a, pT3b and pT4 were 13.2%, 34.7%, 65.9%, 72.7% and 76.9%, respectively. The 3-year biological progression free survival (bPFS) rate for all patients was 87.2%. Three-year bPFS rates in pT2a-b, pT2c, pT3a, pT3b and pT4 were 96.3%, 93%, 75%, 55.6% and 62.5% respectively. The continent rate at 12 months was 84% and potency rate at 12 months in group that received bilateral nerve sparing was 29.1%. CONCLUSION: The oncological and functional results of our first LRPs in Thai men are acceptable and compared well with the early experience of previous studies. However, longer follow up is needed for further evaluation.

Laparoscopic radical prostatectomy: perioperative outcomes and morbidity of 559 consecutive cases in Siriraj Hospital, Thailand.

OBJECTIVE: To evaluate perioperative outcomes and morbidity of laparoscopic radical prostatectomy in Siriraj Hospital during a 5-year experience. MATERIAL AND METHOD: Five hundred fifty nine patients who underwent laparoscopic radical prostatectomy (LRP) by seven surgeons at Siriraj Hospital between September 2004 and September 2009 were included in the study. Data of perioperative results and postoperative parameters were retrospectively evaluated. RESULTS: Mean operative time was 257 minutes SD 75 (range 125 to 680 min). The mean operative time of the first 100 cases was significantly higher than of the last 100 cases (307 ml/min SD 95 versus 223 ml/min SD 56; p-value = 0.001). Mean estimated blood loss was 779 ml SD 607 (range 40 to 6,000 ml). Of 559 patients, 148 patients (26.5%) had blood transfusions. The blood transfusion rate in the first 100 cases was significantly higher than those of the last 100 cases (36.5% versus 15%; p-value = 0.016). The median duration of catheterization time was 8 days. The mean time of drain insertion was 4.2 days SD 1.8 (range 2 to 18 days) postoperatively. Hospital stay was 8.8 days SD 7.6 (range 3 to 149 days). Overall perioperative complications rate was 17.1%. Of these patients, 13.4% were minor complication (Clavien 1, 2) and 3.7% were major complication (Clavien 3, 4). There were no mortalities. Late complication rate was 2.1%, which most of them were stricture of anastomosis. CONCLUSION: Perioperative outcomes and morbidity of LRP in a 5-year period were acceptable. Laparoscopic radical prostatectomy is technically demanding with an initially longer operative time and higher blood transfusion rate. The learning curve of the surgical team is needed to achieve good results.

Laparoscopic radical prostatectomy, Siriraj resident experiences: the first resident series in Thailand.

OBJECTIVE: To evaluate laparoscopic radical prostatectomy (LRP) performed by urological residents trained from Siriraj Hospital. MATERIAL AND METHOD: Twenty-four laparoscopic radical prostatectomies were performed by 12 urological residents between April 2007 and October 2009 (23 intraperitoneal approaches and one extraperitoneal approach). We used five to six ports. Vesico-urethral anastomosis was sutured by interrupted stitches in two cases and continuous technique in 22 cases. Bilateral pelvic lymphadenectomy were performed in all cases. Demographic data, operative outcome, and pathological outcomes were analyzed. Pathological reports were used with TNM stage following AJCC 2002. The peri-operative parameters and follow-up data were studied. RESULTS: Mean age was 71.3 years and mean serum PSA level was 18.34 ng/ml. Eighty seven percent was clinical localized disease. Most Gleason score was 7. Mean operative time was 208.9 minutes and mean blood loss was 295.8 ml. Blood transfusion rate was 16.7%. Mean hospital stay was 6.1 days and surgical drain was removed at mean time of 3.9 days. Mean catheter time was 12.5 days. Pathological report shows pT1, pT2, and pT3 at 4.2%, 20.8% and 75.0%, respectively No patients had lymph node metastasis. Positive surgical margin rate was 20.0% and 88.9% in pT2 and pT3, respectively Ten cases received adjuvant hormonal therapy because ofp T3. Twenty-three cases were followed at the mean time of 14.8 months and mean serum PSA level was 0.03 ng/ml. At the mean time of follow-up, patients had urinary incontinence in 10 cases. This group had only two cases that used pads, which were more than two pads per day. Two cases had anastomotic stricture that was treated by urethral dilatation. CONCLUSION: Laparoscopic radical prostatectomy is a difficult operation. Training from an experience surgeon is an important step to shorten the learning curve.

Acute appendicitis as primary symptom of prostatic adenocarcinoma: report of a case.

The most common disease ofappendix is acute appendicitis. There have been at least 20 case reports of metastasis-induced appendicitis in English literature. The authors reported a 62-year-old Thai man who underwent appendectomy due to classical symptoms and signs of acute appendicitis and was subsequently referred to Siriraj Hospital for proper management after a pathological report of metastatic adenocarcinoma to the appendix. By morphology, the primary site was thought to be the prostate gland. Confirmation was done based on serum PSA study, transrectal ultrasound-guided core needle biopsy, and review of the material from Hua Hin Hospital. Orchidectomy was performed with satisfactory outcome. The patient was doing well for two years before upper gastrointestinal hemorrhage and obstructive jaundice caused by another aggressive tumor developed. He died of the second tumor associated with subsequent renal failure in spite of good response to orchidectomy.

Laparo-endoscopic single site (LESS) robotic radical prostatectomy in an Asian man with prostate cancer: an initial case report.

OBJECTIVE: To report the feasibility of laparo-endoscopic single site (LESS) robotic radical prostatectomy performed in Asian man. MATERIAL AND METHOD: A 71 year-old man with adenocarcinoma of prostate presented at Faculty of Medicine Siriraj Hospital, Bangkok. Prostate-specific antigen level was 16.5 ng/ml and digital rectal examination approximately showed 30 gram prostate with nodule in both lobes. No clinical metastasis was found. Leuprorelin acetate and 50 mg of bicalutamide were used for 3 months. The patient's body mass index was 22 and healthy. With the consent form signed, laparo-endoscopic single site (LESS) robotic radical prostatectomy was performed with the robot daVinci S system. RESULTS: The total operative time was 335 minutes; docking time was 12 minutes; console time was 275 minutes. The estimate blood loss was 250 ml and no blood transfusion required. No intraoperative or postoperative complication was found. Jackson drain was removed within 60 hours after surgery. The patient was discharged from the hospital within 84 hours after surgery. The urethral catheter was removed within 14 days after surgery. CONCLUSION: Laparo-endoscopic single site (LESS) robotic radical prostatectomy is feasible to be performed In the initial experience, patient selection is required.

Surgical treatment of renal cell carcinoma with inferior vena cava thrombus: using liver mobilization technique to avoid cardiopulmonary bypass.

OBJECTIVE: To evaluate the results of surgical treatment of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus and describe the use of a transabdominal approach with liver mobilization to avoid cardiopulmonary bypass (CPB). METHODS: From February 2002 to January 2006, 109 patients with RCC were surgically treated at Siriraj Hospital. Twelve patients had an IVC thrombus, infrahepatic (level I), retrohepatic (level II), suprahepatic (level III) and intra-atrial (level IV) in one, two, eight and one patient, respectively. Patients' characteristics, pathological features, survival and morbidity were evaluated. RESULTS: Mean age was 58 years (range, 37-74 years). CPB was used in one patient with level IV thrombus. All patients (92%) with level I-III IVC thrombi underwent successful removal by transabdominal approach without any form of bypass. Mean operative time was 302 minutes (range, 195-420 minutes). The mortality rate was 16% (2 of 12) with sepsis and pulmonary embolism. One patient had colonic injury requiring primary repair. At the mean follow-up of 17 months (range, 3-35 months), of 10 patients, one died due to distant metastases, two were lost to follow-up and seven (60%) were still alive. Five patients (42%) were disease-free at the last follow-up. CONCLUSION: These results support the aggressive surgical removal of RCC with IVC thrombus as the initial treatment. Most of the thrombi can be approached and safely controlled by a transabdominal approach without any form of bypass. Tumour thrombus removal provides a high survival chance and offers improvement in quality of life.

Outcomes of surgical treatment for upper urinary tract transitional cell carcinoma: comparison of retroperitoneoscopic and open nephroureterectomy.

OBJECTIVES: To determine the surgical and oncologic outcomes in patients who underwent retroperitoneoscopic nephroureterectomy (RNU) in comparison to standard open nephroureterectomy (ONU) for upper urinary tract transitional cell carcinoma (TCC). PATIENTS AND METHODS: From April 2001 to January 2007, 60 total nephroureterectomy were performed for upper tract TCC at Siriraj Hospital. Of the 60 patients, thirty-one were treated with RNU and open bladder cuff excision, and twenty-nine with ONU. Our data were reviewed and analyzed retrospectively. The recorded data included sex, age, history of bladder cancer, type of surgery, tumor characteristics, postoperative course, disease recurrence and progression. RESULTS: The mean operative time was longer in the RNU group than in the ONU group (258.8 versus 190.6 min; p = 0. < 001). On the other hand, the mean blood loss and the dose of parenteral analgesia (morphine sulphate) were lower in the RNU group (289.3 versus 313.7 ml and 2.05 versus 6.72 mg; p = 0.868 and p = 0.018, respectively). There were two complications in each group. No significant difference in p stage and grade in both-groups (p = 0.951, p = 0.077). One patient with RNU had lymph node involvement, three in ONU. Mean follow up was 26.4 months (range 3-72) for RNU and 27.9 months (range 3-63) for ONU. No port metastasis occurred during follow up in RNU group. Tumor recurrence developed in 11 patients (bladder recurrence in 9 patients, local recurrence in 2 patients) in the RNU group and 14 patients (bladder recurrence in 13 patients, local recurrence in 1 patient) in the ONU group. No significant difference was detected in the tumor recurrence rate between the two procedures (p = 0.2716). Distant metastases developed in 3 patients (9.7%) after RNU and 2 patients (6.9%) after ONU. The 2 year disease specific survival rate after RNU and ONU was 86.3% and 92.5%, respectively (p = 0.8227). CONCLUSION: Retroperitoneoscopic nephroureterectomy is less invasive than open surgery and is an oncological feasible operation. Thus, the results of our study supported the continued development of laparoscopic technique in the management of upper tract TCC.

Retroperitoneoscopic nephrectomy in dialysis dependent patients and comparison with open surgery.

OBJECTIVE: To evaluate the surgical outcomes and morbidity of retroperitoneoscopic nephrectomy compared with open nephrectomy for dialysis dependent patients. MATERIAL AND METHOD: Between November 2002 and August 2007, 14 hemo or peritoneal dialysis patients underwent nephrectomy or nephroureterectomy at Siriraj Hospital. Of the 14 patients, seven were treated with retroperitoneoscopic nephrectomy and seven with open nephrectomy. A retrospective review and data were carried out. The patient factors, type of surgery, perioperative outcomes and complications were analyzed. RESULTS: There was no conversion rate in the retroperitoneoscopic group. The mean estimated blood loss, analgesic requirement and time before starting oral intake were lower in the retroperitoneoscopic group (141.4 +/- 95 versus 292.8 +/- 226 ml, 5.0 +/- 4.5 versus 7.6 +/- 1.9 mg and 14.5 +/- 16.1 versus 23.1 +/- 23.3 hours, respectively). On the other hand, the mean operative time in the retroperitoneoscopic group was longer than the open group but with no significant difference (177.14 +/- 51 versus 160.71 +/- 84 min, p = 0.521). Two patients in the open group required intraoperative blood transfusion. There were two complications. One patient developed a large retroperitoneal hematoma after retroperitoneoscopic nephrectomy. Another had a perivesical collection in the open nephrectomy group. No mortality related to the procedures occurred. CONCLUSION: Retroperitoneoscopic nephrectomy should be considered as the procedure of choice for dialysis dependent patients. This has all the benefits of minimally invasive surgery such as reduced blood loss, minimal post operative pain leading to faster convalescence.

Nerve-sparing laparoscopic radical prostatectomy at Siriraj Hospital.

BACKGROUND: Quality of life after laparoscopic radical prostatectomy has been a discussed issue among patients. Nerve-sparing radical prostatectomy has been shown to be superior to non-nerve-sparing radical prostatectomy in terms of potency and continence. The authors have reported their experience of laparoscopic radical prostatectomy and now developed our technique of nerve-sparing laparoscopic radical prostatectomy. OBJECTIVE: To evaluate the feasibility of nerve-sparing laparoscopic radical prostatectomy done at our institute. MATERIAL AND METHOD: From December 2005 to August 2006, 28 patients with localized prostate cancer underwent a nerve-sparing laparoscopic radical prostatectomy. Perioperative data was compared to those 34 patients who underwent non-nerve-sparing laparoscopic radical prostatectomy during the same period. All patients had PSA of less than 10 and pre-operative Gleason Score of 7 or less. Quality of life including incontinence and impotency rates was analyzed during three months post-operation. RESULTS: Patients' dermographic data, except ages, was similar in the two groups. Operating time was not different (217 vs. 212 minutes in favor of nerve-sparing). Blood loss was significantly high in nerve-sparing laparoscopic radical prostatectomy (814 mls vs. 543 mls, p = 0.01). Tumor control was not different within both groups. Three months after surgery incontinent rates of both groups were not different. 43.75% of patients with nerve-sparing technique had experienced erection at three months after surgery. CONCLUSION: The authors' early experience has shown that nerve-sparing laparoscopic radical prostatectomy does not compromise cancer control, although blood loss is higher. This operation should be encouraged in cancer-localized patients as the patients may gain benefit of better quality of life.

Laparoscopic radical prostatectomy: transperitoneal laparoscopic radical prostatectomy versus extraperitoneal endoscopic radical prostatectomy.

OBJECTIVE: To compare the perioperative results between Transperitoneal Laparoscopic Radical Prostatectomy (T-LRP) and Extraperitoneal Endoscopic Radical Prostatectomy (E-LRP). MATERIAL AND METHOD: Retrospective reviews of 125 patients who underwent laparoscopic radical prostatectomy by single surgeon (C.N) for stage T2-T3 adenocarcinoma of the prostate between May 2001 and July 2006 at Siriraj Hospital. Fifty-six cases had T-LRP and 69 cases had E-LRP The preoperative data (age, presenting PSA, and Gleason score), perioperative data (prostatic weight, operative time, intraoperative blood loss, the day of full oral diet, length of drain, and catheter time), pathologic stage, and margin status were compared. RESULTS: Mean age and Gleason score were comparable in both groups. Mean presenting PSA was lower in T-LRP (9.93) as compared to E-LRP (21.84) (p = 0.046). The mean prostatic weight was comparable in both T-LRP and E-LRP. The mean operative time of T-LRP (350) was significant longer than E-LRP (220) (p < 0.001). Mean intraoperative blood loss was more in T-LRP (883) as compared to E-LRP (605) (p = 0.001). Average blood transfusion was higher in T-LRP (1.23 unit) as compared to E-LRP (0.32). Postoperative full oral diet, length of drain, and catheter time in E-LRP were shorter than T-LRP (full diet: median 2 days vs. 3 days, p = 0.001) (length of drain: 4.98 days vs. 6.69 days, p = 0.002) (Catheter time: 8.9 days vs. 11.9 days, p = 0.002). Margin status were comparable in both groups but mean postoperative Gleason score was higher in E-LRP as compared to T-LRP (7.2 vs. 6.85, p = 0.022). CONCLUSIONS: E-LRP resulted in significant less operative time, intraoperative blood loss, postoperative oral diet, length of drain and catheter time where as the pathological margin status was the same in both T-LRP and E-LRP.

Endoscopic extraperitoneal radical prostatectomy (EERPE): a new approach for treatment of localized prostate cancer.

UNLABELLED: Laparoscopic radical prostatectomy is usually performed by transperitoneal approach. Patients may encounter; intraperitoneal organs injury, and prolonged ileus during recovery period. The authors firstly performed endoscopic extraperitoneal radical prostatectomy (EERPE) in Thailand, which is mimicking open radical prostatectomy, the gold standard for treatment of localized prostate cancer. OBJECTIVE: Assess and evaluate the feasibility and early outcomes of the authors' experience in endoscopic extraperitoneal laparoscopic radical prostatectomy (EERPE). MATERIAL AND METHOD: From December 2005 to May 2006, 27 cases of EERPE were performed at the authors' institute for clinically localized prostate cancer by one surgeon (group I). Operative data was compared to those 55 patients who underwent open radical prostatectomy from February 2001 to August 2005 for early prostate cancer by the same surgeon (group II). Early postoperative results, clinical outcomes and complication were analyzed between the two groups using Chi-Square, student unpaired t-test and Mann-Whitney U tests. RESULTS: Patients' age and clinical staging were not different between the two groups. Mean operative time was longer in the EERPE group (268 minutes vs 157 minutes; p < 0.01). Median blood loss was 500 mls and 1000 mls in the EERPE and open groups, respectively (p < 0.001). The likelihood of transfusion rate in the open group was higher than the EERPE group, with odd ratio of 8.75 (95%CI = 2.09-39.86), p = 0.001. Hospitalization time and pathological stage were not different between the two groups. In the EERPE group, there were two rectal complications, including rectal injury and rectal necrosis, which were treated laparoscopically and conservatively without long-term problems. CONCLUSION: The authors' early experience has shown that EERPE is feasible. Although operative time was longer; the patients may gain benefit of minimally invasive surgery and decreased operative blood loss. In EERPE group, oncological outcomes are equal to open surgery, however more cases and long-term follow up are required to evaluate the efficacy of such an approach.

Laparoscopic radical prostatectomy: preliminary result of Thailand series.

OBJECTIVES: Several published series from Western countries have demonstrated that laparoscopic radical prostatectomy is a safe and feasible approach to the management of localized prostate cancer. The authors report the initial experience with the first 56 cases of laparoscopic radical prostatectomy. MATERIAL AND METHOD: Between June 2001 and November 2005, 56 patients with clinically localized prostate cancer underwent transperitoneal laparoscopic radical prostatectomy. Their mean (range) age was 64.98 (50-77) years, prostate specific antigen (PSA) level was 9.92 (2.1-33.8) ng/ml, and Gleason sum was 6.28 (3-8). RESULTS: Complete laparoscopic removal of the prostate was achieved in 47 cases and conversions to open surgery were needed in 9 cases. The mean (range) operating time was 350 (200- 750) min. and blood loss was 883 (200-2050) ml. The transfusion rate was 27.6%. Laparoscopic pelvic lymphadenectomy was done in 31 cases and all were negative. The positive surgical margin rate was 29.8%. There were 20 postoperative complications; catheter dislodged (2), urine leakage more than 2 weeks (5), peroneal nerve numbness (1), flank hematoma (1), pelvic collection (1), late recto-urethral fistula (1), anastomotic stricture (2), port site hernia (1), and inguinal hernia (6). Median catheter time was 7 (6-90) days. The complete continence rate at 3, 6 and 12 months were 27.7%, 55.9% and 72.2%. CONCLUSION: Laparoscopic radical prostatectomy is a demanding procedure that is a feasible option for the surgical treatment of localized prostate cancer Intraoperative results were improved once experience was gained. Some parameters of the present results, i.e. transfusion rate, positive surgical margin and continence rate were still inferior compared to those reported by other centers.

Novel technique to prevent lymphocele recurrence after laparoscopic lymphocele fenestration in renal transplant patients.

PURPOSE: To describe the use of nonabsorbable polymer ligating (NPL) clips to prevent recurrence after laparoscopic lymphocele fenestration and to determine the efficacy and safety of this treatment in renal-transplant patients at our center. PATIENTS AND METHODS: From December 2000 to October 2005, nine patients with a mean age of 38.5 years (range 26-54 years) and symptomatic lymphoceles were treated laparoscopically among 144 renal-transplant patients. The overall incidence of symptomatic lymphocele was 6.2% (9/144). The mean time from transplantation to diagnosis was 55.5 days (range 20-98 days). Patient and lymphocele characteristics, complications, recurrence rate, and outcomes of this procedure were analyzed retrospectively. RESULTS: Laparoscopic treatment was successful in eight patients; the other was converted to open surgery. One patient sustained an allograft-ureteral injury. The mean operative time was 90.7 minutes (range 75-120 minutes), and the mean postoperative stay was 4.1 days (range 1-7 days). Lymphocele recurrence was found in the first two patients after laparoscopic surgery without NPL clips. With a mean follow-up of 42.3 months (range 31-51 months), no recurrence was observed in patients in whom NPL clips were used to maintain the patency of the peritoneal window. No late laparoscopy-related complications occurred. CONCLUSION: Laparoscopic lymphocele fenestration with NPL clips is a safe, technically easy, and efficacious procedure for the treatment of symptomatic lymphoceles after renal transplantion.

Prevalence of prostate cancer in aging males receiving PSA (prostate specific antigen) screening test (A campaign for celebration of Siriraj Established Day).

UNLABELLED: Prostate cancer is a potential men's health problem. The prevalence of prostate cancer continues to rise. Serum PSA (Prostate Specific Antigen) can be used as a screening tool for detection of early prostate cancer However, a screening program for prostate cancer has not yet been accepted as cost-effective and long term survival benefits have not been shown. Nevertheless, some doctors request PSA testing in men who present with lower urinary tract symptoms (LUTS) to detect prostate cancer OBJECTIVE: To study for prevalence of prostate cancer in healthy men seeking medical check-up for prostate cancer. MATERIAL AND METHOD: During the anniversary celebration of Siriraj established day (26/07/1888), a cohort study of Prevalence of prostate cancer in aging males using PSA Screening Test was carried out, 200 men over 45 years of age were invited to PSA testing and prostate glands check-up including, IPSS (international prostatic symptoms score), QOL (quality of life score) and DRE (digital rectal examination). Patients with elevated PSA were advised to undergo transrectal-ultrasound-guided-biopsy of the prostate (TRUS-biopsy). Cancer detection rate was calculated according to symptoms described by patients, IPSS and age groups. Data was compared using Chi-Square test. RESULTS: Median values from data of men's ages, IPSS, QOL and PSA were 63 years, 11, 2, and 1.23 ng/ml, respectively. 9 of 200 patients (4.5%) were found to have prostate adenocarcinoma on biopsy. Most of the cancer cases showed a localized lesion. Prostate cancer was found more common in patients who described themselves as having abnormal urination. There was no prostate cancer found in patients with a mild degree of LUTS (IPSS less than 8). Prostate cancer tended to be more common in men with high IPSS. CONCLUSION: Screening prostate cancer by PSA testing detected the cancer in 4.5%. Most cancers were found on symptomatic patients. Patients with LUTS should be made aware of prostate cancer and PSA testing may be offered in such patients. However screening of prostate cancer in all men regardless of symptoms must wait for a larger study looking at long term survival benefit, cost-effectiveness of screening, and lastly, quality of life of patients on a screening program.

Outcomes of radical prostatectomy in thai men with prostate cancer.

OBJECTIVE: Radical prostatectomy remains the standard treatment for early prostate cancer. Few data in the literature are from South East Asia. This study was conducted to evaluate the outcome of radical prostatectomy in Thai men. METHODS: A total of 151 patients with prostate cancer underwent radical prostatectomy at Siriraj Hospital, Bangkok, between 1994 and 2003. Clinical staging, preoperative prostate-specific antigen (PSA) and Gleason score were evaluated with pathological stage and margin status. Follow-up PSA monitoring and survival were analysed. RESULTS: Of 121 patients with clinical localized disease, 79 (65.3%), 40 (33.1%) and two (1.6%) had localized, locally advanced and metastatic disease, respectively, on pathology. The chance of localized disease with a preoperative PSA of 10 ng/mL or less, more than 10-50 ng/mL and more than 50 ng/mL was 75.5%, 50% and 12.5%, respectively (all p < 0.001). The chance of localized disease with a Gleason score of 2-4, 5-7 and 8-10 was 85%, 55.1% and 20.8%, respectively (all p < 0.02). Mean follow-up was 30 months. Among 140 evaluable patients, 51 (36.4%) had adjuvant therapy and 136 (97.1%) had undetectable PSA without clinical progression. The cumulative PSA progression-free survival among patients with pathological T1N0, T2N0 and T3N0 disease was 0.83 at 82 months, 0.48 at 85 months and 0.31 at 57 months, respectively. CONCLUSION: Radical prostatectomy in Thai men shows excellent results. The trend is the same as in Western series. The chance of organ-confined disease and free margin was high in patients with clinical T2 or less, PSA less than 10 ng/mL and low Gleason score. PSA progression-free survival was high in patients with organ-confined disease.

Is radical prostatectomy in thai men a high morbidity surgery for localized or locally advanced prostate cancer?

OBJECTIVE: To assess the morbidity of radical prostatectomy in Thai patients with localized or locally advanced prostate cancer MATERIAL AND METHOD: A total of 151 patients with prostate cancer underwent radical prostatectomy at Faculty of Medicine Siriraj Hospital, Bangkok, between 1994 to 2003. Operative complications and long term morbidity were evaluated with clinical stage T1, T2 and T3. RESULTS: Mean operative duration, blood loss and blood transfusion were 162 minutes (range 71-540), 1088 ml (range 200-4000) and 1.7 unit (range 0-12), respectively. Of 151 patients, 139 (92.6%) did not have perioperative complications and 42 (2 7.8%) did not have blood transfusion. Of 12 patients with morbidity, all patients were safely managed. There was no mortality. Of 140 patients with follow up results, 131 (93.7%) had no incontinence. Seven patients had mild stress incontinence. Only 2 patients had a significant incontinence. Eight patients had stricture of anatomosis. Strictures were simply managed with dilatation. There was no significant difference of operative time, blood loss, blood transfusion, incontinence and stricture parameters among clinical T stage (all p value > 0. 05). CONCLUSION: Radical prostatectomy in Thai men is not a high morbidity surgery in terms of immediate complications and long term morbidity. For clinical T3 prostate cancer, morbidity is not significantly higher than in patients with clinical localized disease.