Ureterocystoplasty in a Girl with Bilateral Ureterovesical Junction Obstructions and Small Bladder Capacity: The First Case Report of Thailand

Objective: Ureterocystoplasty is one of the treatment options for small bladder capacity with hydroureter. To the best of our knowledge, there was no report of a patient who underwent this procedure in Thailand. Case presentation: A 4-year-old girl, who presented with obstructive anuria at birth was diagnosed with bilateral ureteropelvic junction obstruction and small bladder capacity. At the age of 2 years old, she underwent a teapot ureterocystoplasty with left to right transuretero-ureterostomy with right ureteral reimplantation. Postoperative complication was observed. The bladder capacity was evaluated and kidney ultrasonography was done during the follow-up. There was no complication during the perioperative period. The bladder capacity was increased from 25 ml to 240 mL in 2 years postoperatively. Both kidneys also showed the decrease in degree of hydronephrosis. Conclusion: Ureterocystoplasty is a favorable treatment option for the patients with small bladder capacity and marked hydroureter. The procedure itself is not difficult to perform. Moreover, there are no mucous related complications and metabolic disturbances

Administration of Renin-Angiotensin System Inhibitor Affects Tumor Recurrence and Progression in Non-Muscle Invasive Bladder Cancer Patients

Objective: To evaluate the effects of renin-angiotensin system inhibitors (RASIs) on tumor-recurrence and diseaseprogression in non-muscle invasive bladder cancer (NMIBC) patients. Methods: From 2006-2015, 348 NMIBC patients at Siriraj Hospital were recruited for this study. Tumor-recurrence was identified after the transurethral resection of bladder cancer (TUR-BT) and pathological confirmation of NMIBC, while stage-progression was defined as muscularis-propria invasion after pathological review or metastases. Cox proportional hazards models were used to assess the recurrence-free survival (RFS) and progression-free survival (PFS) rates. Results: Of the 348 patients, 86 (24.7%) received RASIs at the first TUR-BT. The median age was 68 years, and it was significantly older for the RASI cohort. No differences in the tumor characteristics of the groups were found. The median follow-up periods for tumor-recurrence and stage-progression were 2.3 and 3.7 years, respectively. Forty percent of the patients experienced tumor-recurrence, with the no-RASI cohort experiencing a significantly higher tumor-recurrence rate (46% versus 22%, p<0.001). The 5-year RFS rates were 54% and 78% for the no-RASI and RASI cohorts, respectively (p=0.001). Stage-progression was observed in 6% of the patients. The 5-year PFS rates were 87% and 97% for the no-RASI and RASI cohorts, respectively. On univariate and multivariate analyses, a tumor size ≥3 cm and tumor multifocality were associated with recurrent bladder cancer (p<0.02). On the other hand, the administration of RASIs was associated with a reduced recurrence (p≤0.002). Conclusion: Our study suggests that RASI administration might be a potential factor to prevent bladder cancer recurrence. Further study is needed to evaluate the effects of RASIs

Administration of Renin-Angiotensin System Inhibitor Affects Tumor Recurrence and Progression in Non-Muscle Invasive Bladder Cancer Patients

Objective: To evaluate the effects of renin-angiotensin system inhibitors (RASIs) on tumor-recurrence and disease-progression in non-muscle invasive bladder cancer (NMIBC) patients. Methods: From 2006-2015, 348 NMIBC patients at Siriraj Hospital were recruited for this study. Tumor-recurrence was identified after the transurethral resection of bladder cancer (TUR-BT) and pathological confirmation of NMIBC, while stage-progression was defined as muscularis-propria invasion after pathological review or metastases. Cox proportional hazards models were used to assess the recurrence-free survival (RFS) and progression-free survival (PFS) rates. Results: Of the 348 patients, 86 (24.7%) received RASIs at the first TUR-BT. The median age was 68 years, and it was significantly older for the RASI cohort. No differences in the tumor characteristics of the groups were found. The median follow-up periods for tumor-recurrence and stage-progression were 2.3 and 3.7 years, respectively. Forty percent of the patients experienced tumor-recurrence, with the no-RASI cohort experiencing a significantly higher tumor-recurrence rate (46% versus 22%, p<0.001). The 5-year RFS rates were 54% and 78% for the no-RASI and RASI cohorts, respectively (p=0.001). Stage-progression was observed in 6% of the patients. The 5-year PFS rates were 87% and 97% for the no-RASI and RASI cohorts, respectively. On univariate and multivariate analyses, a tumor size ≥3 cm and tumor multifocality were associated with recurrent bladder cancer (p<0.02). On the other hand, the administration of RASIs was associated with a reduced recurrence (p≤0.002). Conclusion: Our study suggests that RASI administration might be a potential factor to prevent bladder cancer recurrence. Further study is needed to evaluate the effects of RASIs

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

<p>Abstract</p> <p>Objectives</p> <p>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).</p> <p>Patients and methods</p> <p>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.</p> <p>Results</p> <p>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).</p> <p>Conclusion</p> <p>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.</p

Comparative Outcome Between Transverse Island Flap Onlay and Tubularized Incised Plate for Primary Hypospadias Repair

ObjectiveTo compare the outcome of transverse island flap (TVIF) onlay with tubularized incised plate urethroplasty (TIP) in primary hypospadias repair.Patients and MethodsWe retrospectively evaluated 76 consecutive patients who underwent TVIF onlay (n = 42) and TIP (n = 36) between January 1997 and April 2006. The success rate and complications were compared according to the surgical technique and the severity of the defect (meatal position prior to surgery).ResultsThe mean patient age at surgery was 48 (range, 9–132) months in the TVIF onlay group and 49 (range, 10–348) months in the TIP group. All patients were followed-up for at least 12 months. With mean follow-ups of 40 months and 32 months, the overall complication rates were 30.9% (13/42) and 23.5% (8/34) in the TVIF onlay group and TIP group respectively (p = 0.305). Urethrocutaneous fistula rates were 23.8% (10/42) in the TVIF onlay group compared to 14.7% (5/34) in the TIP group (p = 0.393). No complications were found in either group with distal hypospadias. In proximal hypospadias, the complication rate was 30% (6/20) in the TVIF onlay group, compared to 37.5% (6/16) in the TIP group (p = 0.751).ConclusionIn this study, the surgical outcomes of TVIF onlay and TIP were comparable. The TIP procedure should be preferred for distal and midshaft defects because of its simplicity and low complication rate. In proximal hypospadias repair, TVIF onlay might be better than TIP; this will be clearer once the number of patients have increased sufficiently to show statistical significance

Surgical Outcomes of Upper Tract Approach and Lower Tract Approach in Duplex Kidney: Single Center Experience

Objective: We reviewed the result of upper and lower tract approaches in duplex collecting systems at Siriraj Hospital between January 2011 and January 2017, focusing on reoperation rate and postoperative urinary tract infection. Methods: We analyzed the medical records of 57 patients with duplex kidneys, ectopic ureter and ureterocele. 45 patients were treated with open surgical therapy including upper tract approach which consisted of upper pole nephrectomy and ureteropyelostomy, and lower tract approach which was common sheath reimplantation. Information included age at operation, gender, ectopic ureter and ureterocele location, vesicoureteral reflux (VUR), hydrohephrosis status and presenting symptoms. Results: Upper tract approach was performed in 23 patients, 3 patients were reoperated because of persistent ureterocele in 2 cases and VUR in 1 case (13.6%, p = 0.233). One was lost to follow-up. Among 22 patients who underwent lower tract approach, no patient required second operation with antibiotic prophylaxis. Conclusion: In the absence of ureterocele and VUR, upper tract approach surgery appears to be successful treatment of duplex kidneys. When compared with upper tract approach, the lower tract approach surgery is more effective for open surgical therapy in duplex kidneys if sample size increases