Radical versus partial nephrectomy for T1 renal cancer: equivalent oncological outcome with better renal preservation

OBJECTIVE: To examine and compare the outcome of radical and partial nephrectomy for T1 renal cancer (≤7 cm) in our centre. PATIENTS AND METHOD: Between January 2005 and December 2010, 38 (44.2%) radical nephrectomies (RN) and 48 (55.8%) partial nephrectomies (PN) were performed for solitary, T1 renal cancer in patients with normal contralateral kidney. GFR was estimated with the Modification of Diet in Renal Disease (MDRD) formula. CKD was defined as GFR lower than 60 mL/min per 1.73 m2. Cox regression model was used to compare overall survival and new onset of CKD. RESULTS: At last follow-up 32 RN patients (84.2%) and 43 PN patients (89.6%) were alive. There was no significant difference in overall survival between RN and PN patients (hazard ratio, 0.673; 95% confidence interval [CI], 0.128–3.529; p = 0.64). 1 RN patient (2.6%) developed systemic metastasis. RN patients had significantly higher reduction rate in GFR (35.4% vs 12.6%, p = 0.000), and higher risk in developing CKD (hazard ratio, 6.308; 95% CI, 2.074–19.189, p = 0.001). CONCLUSION: Relative to RN in managing T1 renal cancer, PN has equivalent survival and oncological clearance, with superiority in renal preservation and lower incidence of new CKD onset. PN should be the treatment of choice for T1 renal cancer.postprin

Impact of skeletal-related events on survival in patients with metastatic prostate cancer prescribed androgen deprivation therapy

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Robotic Partial Nephrectomy: Selective Arterial Clamping Technique (Video)

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Does combined perianal-intrarectal lidocaine-prilocaine cream and periprostatic nerve block provide better pain relief than periprostatic nerve block alone during transrectal ultrasound guided prostate biopsy?

Moderated poster presentationObjective: To compare the efficacy of combined perianal-intrarectal (PI) lidocaine-prilocaine (LP) cream (EMLA cream) and periprostatic nerve block (PNB) with PNB alone during transrectal ultrasound guided prostate biopsy (TRUS Bx). Patients & Methods: This is a prospective study without blinding. All patients attending Queen Mary Hospital (QMH) and Tung Wah Hospital (TWH) for TRUS Bx were recruited. LP cream with PNB was used in QMH patients, and PNB only in TWH patients. Visual analogue scale (VAS) scores were collected during probe insertion, peri-prostatic nerve block and biopsy taking. Results: From 7/2012 to 4/2013, 246 patients were recruited, 162 from QMH and 84 from TWH. The mean VAS during probe insertion, peri-prostatic block and biopsy taking were 2.31, 2.34 and 3.14 respectively in combination arm and 2.87, 2.50 and 3.90 respectively in PNB only arm. Only the difference in VAS during biopsy taking reached statistical significance (p = 0.037). Subgroup analysis of patients aged below 70 revealed significant differences in VAS during probe insertion and biopsy taking, ie. probe insertion (2.37 vs 3.29, p = 0.046), peri-prostatic block (2.29 vs 2.67, p = 0.368) and biopsy taking (3.25 vs 4.29, p = 0.024) in combination arm and in PNB respectively. Conclusion: EMLA cream in addition to peri-prostatic nerve block is superior to peri-prostatic nerve block alone, especially for patients aged below 70

Impact of skeletal-related events on overall survival in patients with metastatic carcinoma of prostate receiving androgen deprivation therapy

Conference Theme: New Era of Asian UrologyThis journal suppl. is Special Issue: Abstracts of the 11th Asian Congress of Urology of the Urological Association of Asia, Thailand 2012Abstract and Poster PresentationINTRODUCTION AND OBJECTIVES: To study the impact of skeletal-related events (SREs) on overall survival in patients with metastatic carcinoma of prostate receiving androgen deprivation therapy. METHODS: Patients with diagnosis of metastatic carcinoma of prostate and received hormonal therapy in terms of either bilateral orchidectomy or luteinizing hormone releasing hormone (LHRH) analogue injection from 2006 to 2011 in our hospital were reviewed. Demographic data, incidences of SREs and overall mortality were collected and analysed. RESULTS: There were in total 123 patients reviewed. The mean age at diagnosis was 75 years old. 58 patients had bilateral orchidectomy performed alone and 65 patients received LHRH analogue injection with 7 of them received subsequent bilateral orchidectomy. The SREs rate was 39.8% and overall mortality rate was 56.1%. The median follow up period was 21 months (Min: 1 month; Max: 125 months). Median time of survival for patients with SREs was significantly shorter than patients without SREs (25 vs 45 months, p =0.03). Timing of SREs after commencement of hormonal therapy (12 months) also have significant correlation to median survival (6 months vs 15 months, p =0.004) CONCLUSIONS: Occurrence and timing of SREs have significant correlation on median survival in patients with metastatic carcinoma of prostate. However, their causal relationships require further evaluation and elucidation. With such high prevalence of SREs and its impact on survival demonstrated in our study, every measure should be encouraged to minimize the incidence of SREs in this group of patient.link_to_OA_fulltextThe 11th Asian Congress of Urology of the Urological Association of Asia, Pattaya, Thailand, 22-26 August 2012. In International Journal of Urology, 2012, v. 19 suppl. 1, p. 282, abstract no. MP2504P-1

Iatrogenic ureteral injuries: a 20-year retrospective review in a university teaching hospital

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Effect of osteoporotic fractures on overall survival in patients with non-metastatic prostatic cancer having androgen deprivation therapy

Conference Theme: New Era of Asian UrologyAbstract and Oral PresentationThis journal suppl. is Special Issue: Abstracts of the 11th Asian Congress of Urology of the Urological Association of Asia, Thailand 2012INTRODUCTION AND OBJECTIVES: Patients with prostatic cancer who received androgen deprivation therapy (ADT) have high risk of developing osteoporosis with prevalence as high as 80% after 10 years of ADT. These patients have higher risk in developing osteoporotic fracture, which may result in significant morbidity and mortality. We study the correlations of incidence of osteoporotic fractures on overall survival in patients with non-metastatic prostatic cancer receiving ADT. METHODS: We retrospectively reviewed the records of 118 patients with non-metastatic prostatic cancer who received ADT in terms of bilateral simple orchidectomy or luteinizing hormone releasing hormone analogue (LHRHa) injection from 2006-2011. Demographics, evidence of bone metastasis, incidence of osteoporotic fracture and overall mortality were analysed. RESULTS: Of the 118 patients, 63 underwent bilateral orchidectomy and 50 received LHRHa. 5 patients initially on LHRHa subsequently underwent bilateral simple orchidectomy. 88 had bone scan to confirm the absence of bone metastasis, with the rest showed no clinical evidence of bone metastases. The median follow-up was 32 months. Group 1 included 106 patients without fractures, and Group 2 included 12 patients who developed osteoporotic fractures, in which 3 were vertebral fractures and 9 were hip fractures. The two groups were demographically similar, with median age 77.5 vs. 74.2, p=0.4. The median survival of patients of Group 1 and 2 was 26 months (1-82 months) and 40 months (15-86 months) respectively. There is no statistically difference in overall survival of these two groups of patients (p=0.679). CONCLUSIONS: Osteoporotic fractures in non-metastatic prostatic cancer patients on ADT are not associated with the overall survival. Prevention of osteoporotic fractures may improve patientÕs quality of life and decrease morbidity but does not affect overall survival.link_to_OA_fulltextThe 11th Asian Congress of Urology of the Urological Association of Asia, Pattaya, Thailand, 22-26 August 2012. In International Journal of Urology, 2012, v. 19 suppl. 1, p. 254, abstract no. OP2504P-0

R.E.N.A.L nephrometry scoring system for management of solid renal mass

Conference Theme: New Era of Asian UrologyAbstract and Poster PresentationThis journal suppl. is Special Issue: Abstracts of the 11th Asian Congress of Urology of the Urological Association of Asia, Thailand 2012INTRODUCTION AND OBJECTIVES: With advances in imaging quality and availability, more renal mass were detected at an early stage. To achieve maximum renal preservation, partial nephrectomy has become the standard for management of small renal mass Decision on partial nephrectomy has been mostly depending on the size of tumor. In order to provide a more objective means to describe the complexity of renal masses in relation to surgery, scoring system has been developed and validated. We investigate the usage of the R.E.N.A.L nephrometry score in relations to the choice of treatment and post-operative complications for renal masses. METHODS: Data of patients undergoing partial or total nephrectomy in a tertiary referral hospital were collected retrospectively from a clinical database and analyzed. R.E.N.A.L nephrometry score was allocated to each renal tumor utilizing computerized imaging systems (GE Advantage Workstations) single blinded by qualified radiologist. Patient demographics, choice of surgery (radical vs partial), approaches (open vs minimally invasive (MIS)) were analyzed with respected to their R.E.N.A.L score. RESULTS: There were together 74 patients included during the study period, of which 38 undergone partial nephrectomy and 36 undergone radical nephrectomy. There were significant differences between the partial and radical nephrectomy group in terms of their mean nephrometry sum (6.89 vs 9.31, P< 0.001). Individual parameter of R.E.N.A.L score were significantly different between two group in terms of radius (P< 0.001), nearest to collecting system (P < 0.001) and locations relative to polar lines (P= 0.017) but not for exophytic component or location (anterior or posterior). The mean nephrometry sum was also significantly different between open approach versus minimal invasive approach in the partial nephrectomy group (7.79 vs 6.00, P= 0.001). There was no difference in post-operative 90 days morbidity and mortality between the two group. CONCLUSIONS: R.E.N.A.L nephromery score of a renal mass has a significant correlations with our choice of surgery and our approach to surgery, particularly in the partial nephrectomy group. It dose not correlate with post-operative complication. Nephrometry score provide a useful tool in objectifying renal mass character and enhance operative planning in the management of renal masses.link_to_OA_fulltextThe 11th Asian Congress of Urology of the Urological Association of Asia, Pattaya, Thailand, 22-26 August 2012. In International Journal of Urology, 2012, v. 19 suppl. 1, p. 292, abstract no. MP2504-1

Optimizing prostate cancer diagnosis: 10-core versus 12-core prostate biopsy protocol

Oral PresentationObjective: To review the prostate cancer detection rate of a new 12-core prostate biopsy protocol. Patients & Methods: From August and October 2011 onwards, 2 additional cores were added to the existing 10-core protocol during transrectal ultrasound-guided prostate biopsy (TRUS-Bx) in the diagnosis of early prostate cancer in Queen Mary and Tung Wah Hospitals respectively. Patient demographics, cancer detection rates and complications using the new 12-core protocol were retrieved from our prospective database and compared with those using the 10-core protocol. Results: From January 2010 to March 2013, 626 and 631 patients underwent TRUS-Bx using a 10-core and 12-core protocol respectively. Overall for clinically benign prostates, there was a trend towards superior cancer detection using the 12-core protocol (5.3% vs. 7.2%, p = 0.077). Subgroup analysis showed the 12-core protocol had significantly higher cancer detection in patients with pre-biopsy PSA <10 ng/ml (OR 1.69; 95% CI 1.10–2.56; p = 0.019) and prostates sized 20–40 ml (OR 1.96; 95% CI 1.16–3.30; p = 0.014). There was a trend towards increased rate of septic complications after 12-core TRUS-Bx (1.9% vs. 3.1%; OR 1.68; 95% CI 0.95–2.97; p = 0.09). Conclusion: 12-core TRUS-Bx can detect more prostate cancer in selected groups of patients, namely those with PSA <10 ng/ml and prostates sized 20–40 ml. Post-biopsy infection rate has increased with the new protocol marginally, owing to the increased number of cores