Comparison of the Clinical Outcomes of Open Surgery Versus Arthroscopic Surgery for Chronic Refractory Lateral Epicondylitis of the Elbow

Numerous surgical options have been introduced for the treatment of chronic refractory lateral epicondylitis of the elbow, but it remains unclear which option is superior. The clinical outcomes of an open surgery group and an arthroscopic surgery group were evaluated, and the results of the 2 procedures were compared. From among patients with lateral epicondylitis refractory to 6 months of conservative treatment, 68 patients satisfying study criteria were recruited. Open surgery was performed in 34 cases (group 1), and arthroscopic surgery was performed in 34 cases (group 2). Compared with preoperatively, the 2 groups had significantly improved values for grip strength, range of motion, and Disabilities of the Arm, Shoulder and Hand score at 12 months postoperatively. Group 1 had significantly greater improvements in grip strength and visual analog scale pain score compared with group 2 (P=.048 vs P=.006). Group 2 had significantly greater (P=.045) improvement in pronation compared with group 1. Group 2 returned to work sooner than group 1. On the questionnaire regarding satisfaction with surgery 24 months postoperatively, 4 patients (12%) in group 2 reported dissatisfaction compared with no patients in group 1. Open surgery and arthroscopic surgery both yielded good clinical results. Nonetheless, for patients requiring muscle strength or having severe pain at work, open surgery would be more effective

Transitional Cell Carcinoma in a Remnant Ureter after Retroperitoneoscopic Simple Nephrectomy for Benign Renal Disease

A 70-yr-old man presented with painless gross hematuria. He underwent right nephrectomy for benign disease 9 yr ago. Computed tomography and cystoscopy showed a mass in the distal region of the right ureteral stump. He underwent right ureterectomy and bladder cuff resection. Pathological examination showed T1 and WHO grade 2 transitional cell carcinoma. At 6 months postoperatively, the patient is alive without any evidence of recurrence

Are urothelial carcinomas of the upper urinary tract a distinct entity from urothelial carcinomas of the urinary bladder? Behavior of urothelial carcinoma after radical surgery with respect to anatomical location: a case control study

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.Abstract Background To compare the prognosis of upper urinary tract (UUT)-urothelial carcinoma (UC) and UC of the bladder (UCB) by pathological staging in patients treated with radical surgeries. Methods The study population comprised 335 and 302 consecutive radical surgery cases performed between 1991 and 2010 for UUT-UC and UCB, respectively. Five-year recurrence-free survival (RFS) and cancer-specific survival (CSS) rates were analyzed. The median follow-up period of all subjects was 59.3 months (range, 0.1–261.0 months). Results No difference was observed in median patient age, distribution of pathologic T stage, or rates of positive surgical margin between the two groups. The UUT-UC group had significantly more frequent hydronephrosis than the USB group (48.1% vs. 20.2%, p < 0.001). However, the UUT-UC group showed significantly less frequent grade III tumors (28.1% vs. 58.6%, p < 0.001), lymphovascular invasion (18.8% vs. 35.8%, p < 0.001), and associated carcinoma in situ (9.0% vs. 21.9%, p < 0.001) than the UCB group. Five year RFS rates in the UUT-UC and UCB groups were 77.0% and 75.9%, respectively (p = 0.546). No significant difference in RFS rate was observed between pathological T stage subgroups. Five year CSS rates in the UUT-UC and UCB groups were 76.1% and 76.2%, respectively (p = 0.462). No significant difference was observed in CSS rate between the pathologic T stage subgroups. Conclusions UUT-UC and UCB showed comparable prognosis at identical stages. However, our results should be verified in a prospective study due to the retrospective study design in this study

Laparoendoscopic Single-Site Nephroureterectomy with Bladder Cuff Excision for Upper Urinary Tract Transitional-Cell Carcinoma: Technical Details Based on Oncologic Principles

Purpose: To describe our technical details of laparoendoscopic single-site (LESS) nephroureterectomy with bladder cuff excision for the management of upper urinary tract transitional-cell carcinoma (TCC) based on oncologic principles. Patients and Methods: Two patients underwent LESS nephroureterectomy for upper urinary tract TCC. In both cases, we used a homemade single-port device that consisted of a wound retractor and a surgical glove. Using the flexible laparoscopic instruments, nephrectomy was performed using procedures similar to those of conventional laparoscopic nephrectomy. Bladder cuff excision was performed laparoscopically using the same procedure with open technique. Results: All procedures were completed successfully without conversion to conventional laparoscopic or open surgery and without additional extraumbilical trocars or incisions. LESS nephreoureterectomy with bladder cuff excision was performed in 385 and 285 minutes with estimated blood loss of 100 and 350 mL, respectively. Both patients were discharged on postoperative day 3 without perioperative complications. Conclusions: LESS nephroureterectomy with bladder cuff excision for upper urinary tract TCC is a minimally invasive technique that may reproduce the open surgical technique and adhere to oncologic principles.White WM, 2009, UROLOGY, V74, P801, DOI 10.1016/j.urology.2009.04.030Desai MM, 2009, UROLOGY, V74, P805, DOI 10.1016/j.urology.2009.02.083Ponsky LE, 2009, UROLOGY, V74, P482, DOI 10.1016/j.urology.2009.06.002Park YH, 2009, J ENDOUROL, V23, P833, DOI 10.1089/end.2009.0025STOLZENBURG JU, 2009, WORLD J UROL 0801Brown JA, 2005, UROLOGY, V66, P1192, DOI 10.1016/j.urology.2005.06.086ELFETTOUH HA, 2002, EUR UROL, V42, P447Shalhav AL, 2000, J UROLOGY, V163, P1100Gill IS, 1999, J UROLOGY, V161, P430CLAYMAN RV, 1991, J LAPAROENDOSC SURG, V1, P343MCDONALD HP, 1952, J UROLOGY, V67, P804

Lymph node density as a prognostic variable in node-positive bladder cancer: a meta-analysis

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.Abstract Background Although lymph node (LN) status and the LN burden determine the outcome of bladder cancer patients treated with cystectomy, compelling arguments have been made for the incorporation of LN density into the current staging system. Here, we investigate the relationship between LN density and clinical outcome in patients with LN-positive disease, following radical cystectomy for bladder cancer. Methods PubMed, SCOPUS, the Institute for Scientific Information Web of Science, and the Cochrane Library were searched to identify relevant published literature. Results Fourteen studies were included in the meta-analysis, with a total number of 3311 patients. Of these 14 publications, 6 studies, (533 patients), 10 studies (2966 patients), and 5 studies (1108 patients) investigated the prognostic association of LN density with disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS), respectively. The pooled hazard ratio (HR) for DFS was 1.45 (95 % confidence interval [CI], 1.10–1.91) without heterogeneity (I2 = 0 %, p = 0.52). Higher LN density was significantly associated with poor DSS (pooled HR, 1.53; 95 % CI, 1.23–1.89). However, significant heterogeneity was found between studies (I2 = 66 %, p = 0.002). The pooled HR for OS was statistically significant (pooled HR, 1.45; 95 % CI, 1.11–1.90) without heterogeneity (I2 = 42 %, p = 0.14). The results of the Begg and Egger tests suggested that publication bias was not evident in this meta-analysis. Conclusions The data from this meta-analysis indicate that LN density is an independent predictor of clinical outcome in LN-positive patients. LN density may be useful in future staging systems, thus allowing better prognostic classification of LN-positive bladder cancer

Elevated Neutrophil to Lymphocyte Ratio Predicts Poor Prognosis in Non-muscle Invasive Bladder Cancer Patients: Initial Intravesical Bacillus Calmette-Guerin Treatment After Transurethral Resection of Bladder Tumor Setting

The objective of this study was to investigate pretreatment systemic inflammatory response (SIR) markers in patients who underwent initial intravesical treatment for high-risk non-muscle invasive bladder cancer (NMIBC). A total of 385 patients who underwent initial intravesical Bacillus Calmette-Guerin treatment after transurethral resection of bladder tumor (TURB) were included. We analyzed the relationship between oncological outcomes and ratios of SIR markers, including neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), and platelet-to-lymphocyte ratio (PLR). Each SIR marker was used for analysis. Their cut-off values were determined through receiver operation characteristics curves analysis. Patients were divided into two groups according to pretreatment NLR (&lt;1.5 vs. ≥1.5), dNLR (&lt;1.2 vs. ≥1.2), and PLR values (171&lt; vs. ≥171). Patients with NLR ≥ 1.5 and dNLR ≥ 1.2 were associated with poor prognosis in terms of overall survival and cause-specific survival. However, no serum SIR marker was associated with prognosis in recurrence-free survival or progression-free survival. Cox multivariate analysis revealed that age, NLR, dNLR, hemoglobin, and pathologic T stage were significant factors predicting overall survival. Age, NLR, and pathologic T stage were significant factors predicting cancer-specific survival, NLR and tumor number were the most important predictors of bladder preserving survival. NLR before treatment was correlated with both oncological outcomes and survival outcome in NMIBC patients undergoing initial intravesical BCG treatment after TURB. Increased NLR reflects a poor prognosis of these outcomes

Metastasis of Transitional Cell Carcinoma to the Lower Abdominal Wall 20 Years after Cystectomy

Iatrogenic implantation has been the main cause in the majority of cases of transitional call carcinoma (TCC) with metastasis to the abdominal wall. A 66-year-old woman had undergone radical cystectomy 20 years prior to presenting. Radiological investigations revealed one mass in the left lower abdominal wall and one mass in the right inguinal area. She underwent wide excision of the lesions that revealed metastasis of TCC. This report describes this case of a woman with bladder carcinoma who developed a metastasis in the anterior abdominal wall following an apparent disease-free interval of 20 years

Comparison of Laparoendoscopic Single-Site Radical Nephrectomy with Conventional Laparoscopic Radical Nephrectomy for Localized Renal-Cell Carcinoma

Purpose: To compare the results of laparoendoscopic single-site (LESS) radical nephrectomy with conventional laparoscopic radical nephrectomy for localized renal-cell carcinoma (RCC). Patients and Methods: This study was designed as a matched case-controlled study from our institute`s RCC database. Nineteen consecutive patients who were undergoing LESS radical nephrectomy were compared with 38 patients who were undergoing conventional laparoscopic radical nephrectomy. The matching process accounted for sex, age, operative side, and tumor size. Results: No significant differences were observed in mean operative time (190.8 vs 172.4 min, P - 0.249), estimated blood loss (143.2 vs 199.5 mL, P - 0.235), and complication rate (15.8% vs 21.1 %, P - 0.635) between the LESS and conventional laparoscopy groups. Postoperative hospital stay after LESS radical nephrectomy was 2.7 (2-4) days, compared with 3.9 (3-7) days in the conventional laparoscopy group (P < 0.001). Postoperative pain, as measured by visual analog scale at postoperative day 1 (4.7 vs 5.8 points, P - 0.001), 2 (3.4 vs 4.6 points, P < 0.001), and 3 (2.7 vs 4.0 points, P = 0.008) was significantly lower in the LESS group. Conclusion: LESS radical nephrectomy is a feasible and safe surgical option for localized RCC that demonstrates improved cosmetic outcomes and the additional benefits of decreased postoperative pain and decreased hospital stay.Desai MM, 2009, UROLOGY, V74, P805, DOI 10.1016/j.urology.2009.02.083Stolzenburg JU, 2009, EUR UROL, V56, P644, DOI 10.1016/j.eururo.2009.06.022Stolzenburg JU, 2009, J ENDOUROL, V23, P1287, DOI 10.1089/end.2009.0120Raman JD, 2009, EUR UROL, V55, P1198, DOI 10.1016/j.eururo.2008.08.019Park YH, 2009, J ENDOUROL, V23, P833, DOI 10.1089/end.2009.0025Kommu SS, 2009, BJU INT, V103, P1034, DOI 10.1111/j.1464-410X.2008.08282.xRAYBOURN JH, 2009, UROLOGY 0721Canes D, 2008, EUR UROL, V54, P1020, DOI 10.1016/j.eururo.2008.07.009Bandi G, 2008, BJU INT, V101, P459, DOI 10.1111/j.1464-410X.2007.07235.xDELGADO S, 2008, GASTROENTEROL HEPATO, V31, P515Raman JD, 2007, UROLOGY, V70, P1039, DOI 10.1016/j.urology.2007.10.001Colombo JR, 2007, CLINICS, V62, P251Hemal AK, 2007, J UROLOGY, V177, P862, DOI 10.1016/j.juro.2006.10.053Kawauchi A, 2007, UROLOGY, V69, P53, DOI 10.1016/j.urology.2006.09.009KAVOUSSI LR, 1993, UROLOGY, V42, P603CLAYMAN RV, 1991, J UROLOGY, V146, P2781

Clinical outcomes of muscle invasive bladder Cancer according to the BASQ classification

Background We evaluated the clinical efficacy and prognosis of muscle-invasive bladder cancer according to the basal/squamous-like (BASQ) classification system based on immunohistochemical staining [CK5/6(+), CK14(+), GATA3(−), and FOXA1(−)]. Methods One hundred patients diagnosed with muscle-invasive bladder cancer (cT2-4 N0-3 M0) were included in the study. All patients underwent radical cystectomy after transurethral removal of bladder tumor. Immunostaining was performed for CK5/6, CK14, FOXA1, and GATA3 antibodies on tissue microarray slides, and expression patterns were quantitatively analyzed using a scanning program. Results The median follow-up time was 77.4 (interquartile range: 39–120.9) months. The mean age of the patients was 65.1 ± 11.2 years. FOXA1 or CK14 expression greater than 1% was respectively positively and negatively correlated with overall survival (OS; p = 0.011 and p = 0.042, respectively), cancer-specific survival (CSS; p = 0.050 for both), and recurrence-free survival (RFS; p = 0.018 and p = 0.040, respectively). For CK5/6+ and GATA3- or FOXA1- expression, 10% CK5/6+ cells were negatively correlated with OS (p = 0.032 and p = 0.039, respectively) and with RFS in combination with FOXA1- only (p = 0.050). Conclusions In this study, CK14 expression was associated with a poor prognosis. The new classification system of bladder cancer based on molecular characteristics is expected to helpful tool for the establishment of personalized treatment strategies and associated prediction of therapeutic responses.This study was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (Grant number: 2016R1A2B4011623). No funders had any role in study concept and design, experiments, analysis of data, writing manuscript, or the decision for publication. This study was supported by the 2015 Korean Urologic Oncology Society Gran