Metastatic carcinoma of breast in the urinary bladder

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Partial nephrectomy for T1 renal cancer can achieve an equivalent oncological outcome to radical nephrectomy with better renal preservation: the way to go

INTRODUCTION: Patients who undergo partial nephrectomy have been shown to be at decreased risk of renal impairment compared with radical nephrectomy. We examined the oncological outcome of patients in our centre who underwent partial or radical nephrectomy for T1 renal cancer (7 cm or smaller), and compared the likelihood of developing chronic kidney disease. METHODS: This historical cohort study with internal comparison was conducted in a tertiary hospital in Hong Kong. A cohort of 86 patients with solitary T1 renal cancer and a normal contralateral kidney who underwent radical (38 patients) or partial (48 patients) nephrectomy between January 2005 and December 2010 was included. The overall and cancer-free survival, change in glomerular filtration rate, and new onset of chronic kidney disease were compared between the radical and partial nephrectomy groups. RESULTS: A total of 32 (84%) radical nephrectomy patients and 43 (90%) partial nephrectomy patients were alive by 31 December 2012. The mean follow-up was 43.5 (standard deviation, 22.4) months. There was no significant difference in overall survival (P=0.29) or cancer-free survival (P=0.29) between the two groups. Both groups enjoyed good oncological outcome with no recurrence in the partial nephrectomy group. Overall, 18 (21%) patients had pre-existing chronic kidney disease. The partial nephrectomy group had a significantly smaller median reduction in glomerular filtration rate (12.6% vs 35.4%; P<0.001), and radical nephrectomy carried a significantly higher risk of developing chronic kidney disease (hazard ratio=5.44; 95% confidence interval, 1.26-23.55; P=0.02). CONCLUSIONS: Compared with radical nephrectomy, partial nephrectomy can prevent chronic kidney disease and still achieve an excellent oncological outcome for T1 renal tumours, in particular T1a tumours and tumours with a low R.E.N.A.L. score.published_or_final_versio

Isolated penile urethral injury: a rare case following male coital trauma

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The Chinese version of the pelvic pain and urgency / frequency symptom scale: a useful assessment tool for street-ketamine abusers with lower urinary tract symptoms

OBJECTIVE: To investigate the use of a translated Chinese version of the pelvic pain and urgency/frequency symptom scale as an assessment and prognostic tool to evaluate the severity of street-ketamine-associated lower urinary tract symptoms and their reversibility after abstinence. DESIGN: Cross-sectional study. SETTING: A special designated out-patient clinic in a regional hospital in Hong Kong. PARTICIPANTS: There were 50 patients with street-ketamine-associated lower urinary tract symptoms and 20 healthy individuals. MAIN OUTCOME MEASURES: Reliability and validity of the questionnaire; frequency of individual lower urinary tract symptoms, cystoscopic, urodynamic and radiological abnormalities, and their correlation with pelvic pain and the urgency/frequency score. RESULTS: The test-retest reliability coefficient was 0.755 (P<0.001). Cronbach's alpha was 0.974. Mann-Whitney U test proved the discriminatory ability of the questionnaire (P<0.001). Patients with specific lower urinary tract symptoms had a higher mean pelvic pain and urgency/frequency total score compared to those without them: frequency (23.8 vs 17.3), nocturia (22.4 vs 14.0), urgency (22.5 vs 15.1), dysuria (22.7 vs 13.3), and haematuria (24.8 vs 16.2). The number of daytime voids and nocturia episodes correlated well with pelvic pain and urgency/frequency scores. With an increasing score, the likelihood of having cystitis changes, urodynamic abnormalities and hydronephrosis increased, while the cystometrically determined bladder capacity decreased. None of the patients with a score of 16 or below had urodynamic abnormality or hydronephrosis. The mean score change in the abstinence group was -4.33, versus +3.33 in their counterparts. CONCLUSIONS: The Chinese version of the pelvic pain and urgency/frequency questionnaire is reliable and valid for assessment in patients with street-ketamine-associated lower urinary tract symptoms. The pelvic pain and urgency/frequency score correlates well with symptom severity as well as endoscopic, urodynamic and radiological abnormalities in patients with street-ketamine-associated lower urinary tract symptoms. A cut-off total pelvic pain and urgency/frequency score of 17 may suggest more serious urological sequelae from ketamine abuse. Abstinence from ketamine reduced lower urinary tract symptoms, but the extent of reversibility of urinary tract damage is yet to be evaluated.published_or_final_versio

Subinguinal microsurgical varicocelectomy for male factor subfertility: a ten-year experience

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Disease spectrum and treatment patterns in a local male infertility clinic

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Disease spectrum and treatment patterns in a local male infertility clinic

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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

Predictive factors for extracorporeal shockwave lithotripsy success in ureteric stones, does skin-stone distance and hounsfield unit matter?

OBJECTIVE: To evaluate the usefulness of measuring stone skin distance and stone attenuation values by non-contrast computed tomography for predicting treatment outcome of ureteric stones by extracorporeal shockwave lithotripsy (ESWL). PATIENT AND METHOD : Retrospective review of 66 patients who underwent ESWL for ureteric stones with pre-ESWL NCCT in 2010–2012. Subjects were stratified into 2 groups, successful ESWL and failed ESWL, with ESWL success defined as stone fragment less than 4 mm at 6 weeks after ESWL. Patient age, sex, stone size, stone location, laterality, shockwave energy, number of shockwave administered, Hounsfield unit (HU), skin to stone distance (SSD), presence of hydronephrosis, pre-ESWL JJ stent or PCN were studied as predictive factors. RESULTS : Patient demographics and stone characteristics were similar between the 2 groups. On univariate analysis, the mean stone size for successful ESWL was 7.9 mm compared with 10.2 mm in the failure group (P = 0.02). For the skin-stone distance, the mean distance for the successful group was 95 mm compared with 104 mm in the failure group (P = 0.04). Concerning the Hounsfield Unit, a mean of 1034 HU was found in the successful compared with 1129 HU in the failure group (P = 0.16) CONCLUSION : Skin to stone distance on non-contrast CT scan is a useful predictive factors for ESWL success for ureteric stones.postprin