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

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

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

The Oncologic Outcome of Laparoscopic Radical Cystectomy for Invasive Bladder Cancer in Siriraj Hospital Between 2005-2013

Objective: To determine the oncologic outcome of laparoscopic radical cystectomy for invasive bladder cancer in Siriraj Hospital. Methods: A retrospective review of 57 patients with muscle invasive bladder cancer who underwent laparoscopic radical cystectomy in Siriraj Hospital from July 2005 to August 2013. Patient’s demographic data, intraoperative features, pathologic findings, early and late complications were all recorded. Five-year overall survival and 5-year cancer specific survival were evaluated by using Kaplan-Meier analysis. Results: The mean age was 64 years with male/female ratio of 18:1. 47 patients had ileal conduit for urinary diversion (9 neobladder, 1 cutaneous ureterostomy). Extended lymph node dissection was performed in 19 patients (33%), the mean number of removed lymph nodes was 19 (range 6-37). The pathologic report of 50 patients (87.7%) showed high grade urothelial cell carcinoma, and 3 patients (5.3%) had concomitant adenocarcinoma of prostate. Altogether 29 patients had organ confined tumor (pT1-T2; 50.8%), 28 patients had non-organ confined tumor (pT3-T4; 49.2%), and 18 patients (31.6%) had lymph node involvement. Surgical margin was positive in 7 patients (12.3%). The most common early and late complications were urinary tract infection which responded to medical treatment. Seventy five percentile of follow-up time was 5.9 years, the 5-year overall survival was 69.6% in organ confined patient, 72.4% in extended lymph node dissection group, the 5-year cancer specific survival was 80.4% in organ confined patient, and 78.9% in extended lymph node dissection group. Twenty one patients died from bladder cancer, 10 patients died from other causes, and 26 patients were alive with no evidence of recurrence. Conclusion: Radical cystectomy with lymph node dissection is the gold standard for invasive bladder cancer and laparoscopic approach is one of the effective alternative treatments with comparable oncologic outcome to open technique, T stage and extended lymph node dissection were the significant impact factors

Predictive Factors of Intravesical Recurrence after Ureteroscopy in Upper Urinary Tract Urothelial Carcinoma Followed by Radical Nephroureterectomy

Objective: To investigate the risk factors of developing intravesical recurrence (IVR) in patients with upper urinary tract urothelial carcinoma (UTUC) who underwent ureterorenoscopy (URS) before radical nephroureterectomy with bladder cuff excision (RNU). Materials and Methods: This retrospective study collected data from the medical records of patients diagnosed with UTUC between January 2012 and December 2019. All the patients underwent ureteroscopy before radical surgery. Patients previously diagnosed with bladder cancer were excluded. A total of 63 patients were included in the study. Tumour factors, such as multiplicity, location, size, histologic grade, pathologic T-stage, and lymphovascular invasion status, were evaluated. The type of endoscopic procedure and time interval between URS and RNU were analysed to determine the factors affecting IVR. Results: The associated factors with IVR included multifocal tumours (HR = 4.8(1.9–11.9)), large size tumours greater than or equal to 4 cm (HR = 3.3(1.5–7.0)), and time interval greater than or equal to 5 weeks between URS and RNU (HR = 2.6(1.2–5.5)). Factors including tumour location (kidney or ureter), size, grading, T-stage, and lymphovascular invasion as well as the type of endoscopic procedure were not at high risk for IVR. Conclusion: The predictive factors of IVR for UTUC patients who underwent URS before RNU included a multiplicity of primary tumours and a tumour size greater than or equal to 4 cm, while a time interval between URS and RNU greater than or equal to 5 weeks increased the risk of IVR