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

The impact of surgical experience on outcomes of retrograde intrarenal surgery for kidney stones

Objective: To evaluate the impact of surgical experience on the outcomes of retrograde intrarenal surgery (RIRS) to treat kidney stones. Material and Method: Retrospective chart review of patients who underwent RIRS between November 1st, 2014 and January 11th, 2017; the outcomes were divided into 2 groups. Group 1 was the less experienced surgeons (fewer than 30 cases for each surgeon) whereas group 2 was the highly experienced surgeon (more than 300 cases). The surgical outcomes, including operative time, stone-free rates, complications and scope damage, were compared between the 2 groups. Results: There were 6 surgeons in group 1 and a single surgeon in group 2. Seventy-four procedures were performed by group 1. Group 2 included the first 30 procedures after the surgeon had passed the learning curve. Patient demographic data, including age, sex and location of the stone, were not different between group 1 and group 2. Group 1 had a smaller stone size than group 2 (1.59 cm vs. 2.34 cm; p=0.006). The outcomes of group 2 were better than group 1, including operative time (80.48 minutes vs. 43.50 minutes; p&lt;0.001) and stone-free rates (52.05% vs. 90%; p&lt;0.001). Serious complications were determined to be sepsis or a high degree of ureter injury that required surgical correction. Sepsis occurred in 6 patients in group 1 (8.10%), whereas no sepsis was found in group 2 (p=0.013). There was no high degree of ureteric injury in either group. Three scopes were damaged in group 1 whereas no scope damage occurred in group 2 (p=0.045). Conclusion: RIRS is a popular procedure for the treatment of kidney stones. Surgical experience is mandatory to achieve excellent outcomes.Keywords: retrograde intrarenalsurgery, kidney stone, surgical experience</jats:p

Factors affecting the durability of flexible ureteroscopes: An academic center review

Objective: To analyze the factors which affect the durability of the flexible ureteroscope and the causes of scope damage in a single academic center. Material and Method: Between March 2014 and August 2017, 479 flexible ureteroscopic procedures, using 6 flexible ureteroscopes (Olympus model URF-V), were systematically reviewed. Data including indication for procedures, auxiliary device usage, the characteristics of scope damage, and the number of times a scope was used before requiring major repair were gathered. Fisher exact test and Chi-square test were used to evaluate the factors which caused the damage. Results: The major flexible ureteroscopic procedure performed was treatment of renal calculi (81%). The most common auxiliary device used was the Holmium laser (70%). The most common cause of damage requiring repair was working channel leakage (93%). The factor that affected the durability of flexible ureteroscopes was the size of laser fiber. Utilizing laser fiber 200 nm decreased scope damage significantly compared to various other sizes (p-value=0.002 and p-value&lt;0.001). However, the usage of nitinol basket and ureteral access sheath did not affect the durability of flexible ureteroscopes. Conclusion: Large laser fibers are a risk factor for flexible ureteroscope damage. Utilizing small laser fibers during flexible ureteroscopy can decrease scope damage significantly.</jats:p

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