Urological Science最新文献

{"title":"Retroperitoneal dedifferentiated liposarcoma with a compressed invasion-free kidney: A rare case report","authors":"Shang-Rong Zhong, Thomas Y. Hsueh, J. Chou","doi":"10.4103/UROS.UROS_60_20","DOIUrl":"https://doi.org/10.4103/UROS.UROS_60_20","url":null,"abstract":"A 68-year-old female patient presented an evident drop in weight within half a year. A heterogeneous huge tumor was found in the left retroperitoneal space through a nonenhanced abdominal computed tomography. The tumor contributed mass effect on adjacent organs and structures, with equivocal left kidney outline. Enhanced kidney magnetic resonance imaging illustrated its hyper-vascular content and clear border. Radical excision was performed through an open approach. The mass was 25 cm in length and weighed about 5 kg. Grossly, it was accompanied by a compressed but invasion-free kidney. The diagnosis of dedifferentiated liposarcoma was made, and a focally involved margin was identified. The average annual incidence of retroperitoneal sarcomas is 2.7 cases/million. Retroperitoneal soft-tissue sarcoma seldom induces symptoms until the tumor makes a mass effect on adjacent organs. The tumor of this patient stands out as the compressed, yet invasion-free left kidney. Surgical resection is regarded as the only potential curative therapy. Due to the large size at presentation and wide extent of the tumor, it often results in limited resectability or positive margin. Important prognostic factors of retroperitoneal sarcoma involve surgical margin, tumor grade, differentiation, and histologic subtype. Dedifferentiated liposarcoma has a worse prognosis and a positive gross margin implies a higher chance of local recurrence as well as a higher mortality rate.","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"32 1","pages":"137 - 139"},"PeriodicalIF":0.5,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47846778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of starting low-dose pazopanib in patients with metastatic renal cell carcinoma who do not meet eligibility criteria for clinical trials","authors":"J. Akatsuka, G. Kimura, K. Obayashi, Kotaro Tsutsumi, M. Yanagi, Y. Endo, H. Takeda, Tatsuro Hayashi, Y. Toyama, Yasutomo Suzuki, T. Hamasaki, Yoichiro Yamamoto, Y. Kondo","doi":"10.4103/UROS.UROS_145_20","DOIUrl":"https://doi.org/10.4103/UROS.UROS_145_20","url":null,"abstract":"Purpose: Eligibility for clinical trials is very strict and only patients who satisfy various criteria can enter trials. The individual use of pazopanib has not been adequately investigated. An optimal administration regimen for pazopanib in “real-world” patients with metastatic renal cell carcinoma (mRCC) is required. Our purpose was to determine the tolerability and efficacy of first-line pazopanib with a low starting dose in patients with mRCC who were ineligible for clinical trials. Materials and Methods: This study included patients with mRCC who underwent treatment with first-line pazopanib and were previously excluded from clinical trials because they did not meet the inclusion criteria. A 400 mg pazopanib starting dose is used routinely in patients with mRCC; if tolerated, dose escalation up to 800 mg may occur. Results: We identified 18 patients with mRCC who received first-line pazopanib and were previously determined ineligible for clinical trials. Pazopanib dose was escalated in 12 patients (66.6%), to 600 mg/day in 8 patients (44.4%) and to 800 mg/day in 4 patients (22.2%), and was not escalated in 6 patients (33.3%). In 3 patients (16.7%), pazopanib was discontinued owing to intolerability. The most common frequent adverse event was elevated alanine aminotransferase levels in 6 patients (33.3%), followed by a decreased platelet count in 5 patients (27.8%) and anorexia in 5 patients (27.8%). Partial response was seen in 5 patients (27.8%) and stable disease in 10 patients (55.6%); median progression-free survival was 11.9 months (95% confidence interval: 6.3–28.7 months). Conclusion: Our data indicated that a low starting dose of 400 mg pazopanib did not negatively affect treatment tolerability and efficacy in patients with mRCC ineligible for clinical trials. We found that lower starting doses may lead to better results. Additional studies are needed in a larger cohort and longer follow-up to attain authentic outcomes.","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"32 1","pages":"104 - 110"},"PeriodicalIF":0.5,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46923875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Everted Saphenous Vein Graft (eSVG) urethroplasty in long-segment anterior urethral strictures: Medium-term follow-up results","authors":"S. Rao, N. Khattar, A. Akhtar, Anuj Varshney, H. Goel","doi":"10.4103/UROS.UROS_70_21","DOIUrl":"https://doi.org/10.4103/UROS.UROS_70_21","url":null,"abstract":"Purpose: An everted saphenous vein graft (eSVG) has been used for urethroplasty in men with long segment anterior urethral stricture and chronic tobacco exposed oral mucosa with good initial results. The present study aimed to assess the medium-term outcomes of eSVG urethroplasty (eSVGU) in such patients. Materials and Methods: Prospectively maintained database of 32 patients with chronic tobacco exposed oral mucosa, who underwent an eSVGU for long segment anterior urethral stricture (≥9 cm), was reviewed. Outcomes were assessed with International Prostate Symptom Score (IPSS), uroflowmetry with postvoid residual urine at 1, 3, and 6 months, and thereafter 6 monthly symptomatic assessments. Retrograde urethrogram was done at 3 months and repeated only if there was a recurrence. Successful urethroplasty was defined as satisfactory voiding (maximum flow rate [Qmax] >15 ml/sec) and no need for any auxiliary procedures in follow-up. Patients who lost to follow-up before 3 years were excluded from the final analysis. Data from the patients were recorded on a spreadsheet and expressed as mean and standard deviation wherever feasible. Results: Mean stricture length was 13.75 cm. Two patients were lost to follow-up after 12 months and were excluded from the final analysis. At a mean follow-up of 58 months, 19 patients (63.33%) were voiding successfully with mean IPSS 8.15 and Qmax 23.54 ml/s respectively, while 11 patients (36.67%) required auxiliary procedures and were considered failed. Conclusion: Medium-term results suggest that an eSVG can be considered as a good alternative graft for urethroplasty in patients with long anterior urethral strictures.","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"32 1","pages":"117 - 124"},"PeriodicalIF":0.5,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41661333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biphasic change in renal function after radical cystectomy and urinary diversion: Result from tertiary center in Thailand","authors":"Worapat Attawettayanon, Apiwich Anukoolphaiboon, Virote Chalieopanyarwong, C. Pripatnanont","doi":"10.4103/UROS.UROS_102_20","DOIUrl":"https://doi.org/10.4103/UROS.UROS_102_20","url":null,"abstract":"Purpose: Radical cystectomy (RC) with urinary diversion has been established as the gold standard treatment for muscle invasive bladder cancer. This provides excellent local control and increases the survival rate. The postoperative renal function (RF) usually declines, especially with those with risky conditions such as increasing age, hypertension, diabetes, or the presence of preoperative hydronephrosis (HN). However, there are limited data about the potential preoperative factors to predict the postoperative RF following the RC. The current retrospective article aims at reviewing patients treated with RC with urinary diversion presenting demographics data, assessing the RF after performing the operation and identifying the associated factors that reduce the RF. Materials and Methods: Bladder cancer patients who underwent RC with a urinary diversion from January 2001 to December 2017 were reviewed. RF was assessed by using the estimated glomerular filtration rate (eGFR) through the MDRD formula. Multivariate analysis was performed to evaluate the association of the changing of RF. Results: One hundred and fifty-six patients were included in the study. The median age was 65 years (interquartile ranges [IQR] 57, 72), and the median follow-up time was 16.4 months (IQR 7.1, 33.4). Overall, 86 patients (55.12%) had HN at the initial treatment of RC. Baseline mean eGFR was 57.7 mL/min/1.73 m2 (standard deviation [SD] = 23.7). The value of eGFR observed at 1, 12, and 60 months was 67.2 (SD = 29.5), 55.7 (SD = 26.3), and 55.8 (SD = 21.4) mL/min/1.73 m2, respectively. At 1 month, female gender, no HN, and neobladder were independently associated with worse RF outcomes in both univariate and multivariate analysis (P < 0.05). The factors associated with eGFR under 60 mL/min/1.73 m2 at 1 year were age, presence of HN, and adjuvant treatment. Conclusion: RF after cystectomy and urinary diversion improves for 1 month after the procedure, especially in patients with the presence of preoperative HN and then RF gradually decreases. There are no significant differences in preoperative and postoperative RF after a 5-year follow-up.","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"32 1","pages":"59 - 63"},"PeriodicalIF":0.5,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42230451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unusual presentation of mixed epithelial and stromal tumor of ureter posing diagnostic dilemma","authors":"Gaurvi Piplani, Kishan L. Prasad, K. Sajitha, T. Rajeev, S. Bhat, Suraj P. Hegde","doi":"10.4103/UROS.UROS_69_20","DOIUrl":"https://doi.org/10.4103/UROS.UROS_69_20","url":null,"abstract":"The mixed epithelial and stromal tumor (MEST) family comprises a spectrum of tumors varying from predominantly cystic tumors such as adult cystic nephroma, to variably solid tumors such as MESTs. These rare renal tumors typically affect women in their perimenopausal age. Most of these tumors are benign; however, at some rare occasions, they are associated with malignant transformation. The current article reports a rare case of MEST arising from the proximal ureter in a perimenopausal woman, manifested as a cord-like structure in the ureter, and posing the diagnostic dilemma.","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"32 1","pages":"89 - 92"},"PeriodicalIF":0.5,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46589328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early penile rehabilitation with a vacuum erectile device in patients undergoing robotic-assisted radical prostatectomy: A randomized trial","authors":"S. Rujinithiwat, M. Usawachintachit, K. Panumatrassamee, A. Santingamkun, K. Tantiwongse","doi":"10.4103/UROS.UROS_118_20","DOIUrl":"https://doi.org/10.4103/UROS.UROS_118_20","url":null,"abstract":"Purpose: This aim was to study the efficacy of a vacuum erectile device (VED) in rehabilitating the erectile function of patients undergoing nerve-sparing robotic-assisted radical prostatectomy. Materials and Methods: This prospective randomized study enrolled 35 prostate cancer patients from Thailand who had intact baseline erectile function and underwent nerve-sparing robotic-assisted radical prostatectomy. These patients were randomly assigned into either a study group which applied the VED for 10 min daily for 6 months or a control group which received no additional interventions. A 5-item version of the International Index of Erectile Function (IIEF-5) score, stretched penile length, and midshaft circumference were measured at 1, 3, and 7 months after surgery, respectively. Results: The mean patient age was 65.6 years, and the mean baseline IIEF-5 score was 22.91, which were comparable between the two groups. Three patients in the study group did not follow the VED protocol due to postoperative urinary incontinence. A per-protocol analysis revealed that the mean IIEF-5 score at 7 months was significantly higher in the study group compared to the control group (11.29 ± 7.47 vs. 6.61 ± 5.33, P = 0.047). The mean midshaft circumference was also higher in the study group (9.24 ± 1.43 cm vs. 7.91 ± 0.37 cm, P = 0.002). No statistically significant difference in the mean stretched penile length between the two groups was found. Conclusion: Early VED usage for penile rehabilitation following radical prostatectomy significantly improves IIEF-5 score and better preserves penile circumference but not penile length. A larger-scale multi-institutional study is required to validate these findings.","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"32 1","pages":"77 - 82"},"PeriodicalIF":0.5,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42995682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Circulating miR-210 and miR-23b in bladder Cancer","authors":"Normeen Hany, Amal Bahgat, O. Youssef, Amr Fayyad, A. Kotb, Sara Al-Khatib, M. Fathy","doi":"10.4103/UROS.UROS_112_20","DOIUrl":"https://doi.org/10.4103/UROS.UROS_112_20","url":null,"abstract":"Purpose: This study is aimed to assess the serum expression levels of miR-210 and microRNA-23b (miR-23b) in bladder cancer (BC) patients to evaluate their potential as noninvasive biomarkers. Materials and Methods: This study included 93 subjects divided into the following three groups: Group Ia, 31 patients newly diagnosed with BC; Group Ib, Group Ia patients 6 months after medical and/or surgical treatment; and Group II, 31 healthy controls. The gene expressions of miR-210 and miR-23b were determined using quantitative SYBR Green reverse transcription real-time polymerase chain reaction. Results: The expression of miR-210 was significantly higher in BC patients compared to the controls (P = 0.012), while miR-23b did not show any difference. miR-210 expression in BC patients did not differ before and after treatment (P = 0.89). Area under the curve of the receiver operating characteristic analysis for miR-210 in distinguishing BC from controls was 0.686 (95% confidence interval, 0.553–0.818) with 71% sensitivity and 61% specificity. Conclusion: miR-210 can serve as a noninvasive diagnostic marker for BC; however, it cannot be used during treatment follow-up. miR-23b cannot be used as a diagnostic nor prognostic marker for BC.","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"32 1","pages":"64 - 70"},"PeriodicalIF":0.5,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45926232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Key steps in performing robotic-assisted radical cystectomy with intracorporeal urinary diversion and the evidence that we have so far","authors":"J. Teoh, C. Yee, P. Chiu, V. Chan, E. Chan, C. Ng, E. Chan","doi":"10.4103/UROS.UROS_108_20","DOIUrl":"https://doi.org/10.4103/UROS.UROS_108_20","url":null,"abstract":"Robotic-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) has been proposed as the most minimally invasive surgical approach in performing radical cystectomy for patients with bladder cancer. However, iRARC is a highly technical and complex procedure with a steep learning curve. Without appropriate training and adequate experiences, iRARC may become a lengthy procedure and may lead to significant morbidities with a prolonged hospital stay. Essentially, the robotic approach in performing RARC is to replicate what is being done in the open approach, and the key steps in performing iRARC were described in this article. There were five randomized controlled trials (RCTs) comparing between RARC and open radical cystectomy (ORC). RARC has been shown to have a lower blood transfusion rate and short hospital stay than ORC. When compared to ORC, RARC had a similar positive surgical margin rate and time of recurrence. Given such potential benefits, a decision-analytic model has shown that RARC might be a more cost-effective treatment approach than ORC. On the other hand, previous RCTs focused mainly on RARC with extracorporeal urinary diversion; high-quality studies on the total intracorporeal approach are lacking. The iROC trial is a multicenter study comparing between iRARC and ORC. Preliminary results showed that iRARC is well tolerated by patients. The iROC trial has completed patient recruitment and the final results are eagerly awaited. By then, hopefully, we will be able to understand the true value of iRARC in managing patients with bladder cancer.","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"32 1","pages":"46 - 51"},"PeriodicalIF":0.5,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46991459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"On the way of internationalization","authors":"Y. Chuang","doi":"10.4103/UROS.UROS_74_21","DOIUrl":"https://doi.org/10.4103/UROS.UROS_74_21","url":null,"abstract":"","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"32 1","pages":"45 - 45"},"PeriodicalIF":0.5,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47094830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Conservative management of vesicoureteral reflux: A literature review","authors":"Safendra Siregar, A. Kurniawan, A. Mustafa","doi":"10.4103/UROS.UROS_132_20","DOIUrl":"https://doi.org/10.4103/UROS.UROS_132_20","url":null,"abstract":"Vesicoureteral reflux (VUR) is defined as the retrograde flow of urine from the bladder to the upper urinary tract (the ureters and kidneys), caused by ureterovesical junction dysfunction. VUR is the most common congenital urinary tract abnormality; nevertheless, the conservative treatment for VUR remains controversial. In addition, the limited data availability made it difficult to establish a widely accepted treatment protocol. This study aimed to review available treatment modalities and recommendations with regard to the conservative management for VUR. An online literature search was performed on PubMed, PubMed Central, and Google Scholar. Studies were compared with several available guidelines. Based on literature search, the conservative management of VUR involves a multimodality approach, including the bladder-bowel dysfunction management through bladder training, anticholinergics and alpha-blockers, continuous antibiotic prophylaxis, and circumcision in male patients. Operative and other invasive treatment modalities may be considered in treatment failure or breakthrough urinary tract infection and should not be used as a first-line treatment.","PeriodicalId":23449,"journal":{"name":"Urological Science","volume":"32 1","pages":"52 - 58"},"PeriodicalIF":0.5,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42330635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}