Open Ureterolithotomy Via Lumbotomy Incision vs Laparoscopic Ureterolithotomy for Upper Ureteric Calculi

To compare the efficacy and morbidity of laparoscopic ureterolithotomy and open ureterolithotomy via the posterior lumbar approach. Meterials and Methods : A retrospective study was performed by reviewing patient records. Ten patients in the laparoscopic ureterolithotomy group were compared with 15 patients in the open ureterolithotomy via lumbotomy incision group. Twelve patients who had flank ureterolithotomy comprised a control group. Details of age, sex, size and site of the stone, haematocrit, blood urea nitrogen, serum creatinine, degree of hydronephrosis of the affected kidney, contralateral renal function, operative time, operative complication, the amount of postoperative analgesics and length of hospital stay were all compared. Statistical analysis was carried out by the Chi- square test, Anova and LSD multiple comparisons. Results : The preoperative status of the three groups were similar. When the ureterolithotomy via lumbotomy group was compared with the control group (flank ureterolithotomy) the results were similar except that ureterolithotomy via lumbotomy required less analgesics postoperatively (mean 50 mg vs 104, p < 0.001). Ureterolithotomy via lumbotomy patients required the same analgesics as laparoscopic ureterolithotomy. However, laparoscopic ureterolithotomy had a longer operating time (mean 181.5 min vs 88, p < 0.001) and longer period of urine leak postoperatively (mean 6.6 days vs 2.4, p < 0.003) when compared with ureterolithotomy via lumbotomy. Conclusion : Ureterolithotomy via lumbotomy offers similar low discomfort postoperatively compared with laparoscopic ureterolithotomy but had a shorter operating time and less complications

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

Metastatic Malignant Melanoma of the Urinary Bladder: A Case Report and Review of Literature

Objective: Metastatic malignant melanoma of the urinary bladder is extremely rare in clinical practice, herein, we review literature to demonstrate epidemiology, management and prognosis of this rare condition. Case presentation: A 57-year-old male with history of malignant melanoma of left big toe was referred to the urology division with the complaint of intermittent painless gross hematuria. Cystoscopy revealed multiple bladder masses, hence transurethral resection of bladder tumor was performed. Histologic and immunohistochemical examination revealed metastatic malignant melanoma involving urinary bladder mucosa. Conclusion: Suspicion of metastasis should be raised in a patient with urinary symptom, especially if the history of malignant melanoma is present. Cystoscopy and biopsy is recommended if metastatic disease is suspected. While long-term survival is poor, management should be individualized according to the patient’s conditions, symptoms and severity of disease

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

Ewing's Sarcoma Arising in Prostate Gland : A Case Report

An 18-year-old Thai male presented with weight loss and urinary retention. Physical examination revealed an enlarged prostate gland. Serum prostate specific antigen (PSA) level was 0.3ng/ml. Histologic section demonstrated a small round cell tumor with intracytoplasmic glycogen. Immunohistochemical and ultrastructural studies were compatible with Ewing's sarcoma. Since no other osseous or extraosseous lesions of the same tumor were found in this patient, we concluded that this was a case of primary extraskeletal Ewing's sarcoma of the prostate gland. Case follow-up after one year revealed a good response to chemotherapy

Surgical Treatment of Renal Cell Carcinoma with Inferior Vena Cava Thrombus: Using Liver Mobilization Technique to Avoid Cardiopulmonary Bypass

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 Radical Prostatectomy in Thai Men with Prostate Cancer

ObjectiveRadical 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.MethodsA 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.ResultsOf 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.ConclusionRadical 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