No abstract

Purpose: We wanted to compare the treatment outcome, safety, efficacy and complications of transurethral resection of the prostate (TURP), interstitial laser coagulation (ILC), transurethral needle ablation (TUNA) and transurethral ethanol ablation of the prostate (TEAP) for the treatment of benign prostatic hyperplasia (BPH). Materials and Methods: In this prospective, randomized study, a total of 403 patients with symptomatic BPH were treated by TURP, ILC, TUNA or TEAP from January 1998 to December 2002. ILC was performed using the Indigo 830e LaserOptic TM System with a specially designed interstitial thermotherapy light guide, TUNA was performed using the VidaMed TUNA System and TEAP was performed using the Prostaject TM device. The treatment outcomes were evaluated at 3 months, 6 months and 1 year with the International Prostate Symptom Score (IPSS), the prostate volume, the maximal urinary flow rate (Qmax), the post-void residual urine (PVR), and the quality of life (QoL) assessment score. Results: All the patients in the four groups showed significant improvement for all the parameters. After 1 year, the four groups showed significant improvement in the clinical and voiding parameters (IPSS, Qmax, PVR, prostate volume and QoL). Our results did not show significant differences in the IPSS, prostate volume and QoL among the four groups. However, the TURP group showed a higher Qmax, and the TEAP group showed a less reduced prostate volume than the other groups during the follow-up period (p 0.05). The period of hospital admission showed no significant difference between the ILC, TUNA and TEAP groups, but the TURP group showed a longer hospital admission period compared to the other groups. The TURP group was markedly associated with more complications than the other groups. Conclusions: These early results indicate that ILC, TUNA and TEAP are safe, effective and useful alternative therapies to TURP for the patients with symptomatic BPH. (Korean J Urol 2006;47:13-19) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

We developed nomograms to predict disease recurrence in patients with Ta, T1 transitional cell carcinoma of the bladder. Thirty-eight training hospitals participated in this retrospective multicenter study. Between 1998 and 2002, a total of 1,587 patients with newly diagnosed non-muscle invasive bladder cancer were enrolled in this study. Patients with prior histories of bladder cancer, non-transitional cell carcinoma, or a follow-up duration of less than 12 months were excluded. With univariate and multivariate logistic regression analyses, we constructed nomograms to predict disease recurrence, and internal validation was performed using statistical techniques. Three-year and five-year recurrence-free rates were 64.3% and 55.3%, respectively. Multivariate analysis revealed that age (hazard ratio [HR]=1.437, p<0.001), tumor size (HR=1.328, p=0.001), multiplicity (HR=1.505, p<0.001), tumor grade (HR=1.347, p=0.007), concomitant carcinoma in situ (HR=1.611, p=0.007), and intravesical therapy (HR=0.681, p<0.001) were independent predictors for disease recurrence. Based on these prognostic factors, nomograms for the prediction of disease recurrence were developed. These nomograms can be used to predict the probability of disease recurrence in patients with newly diagnosed Ta, T1 transitional cell carcinoma of the bladder. They may be useful for patient counseling, clinical trial design, and patient follow-up planning.

Costunolide is an effective HO-1 inducer capable of inhibiting macrophage-derived pro-inflammatory cytokines. CH2-BL moiety of costunolide is essential for Nrf2 activation leading to HO-1 expression.

Objective: To evaluate the efficacy of adjuvant cisplatin-based chemotherapy for locally advanced upper tract urothelial cell carcinoma (UTUC) following radical nephroureterectomy with bladder cuff resection (RNU) in terms of survival and recurrence.Materials and methods: Between January 2000 and January 2013, among 145 patients with upper tract urothelial cell carcinoma, a total of 65 patients with locally advanced UTUC (a diagnosis of pT3 or pT4 or pT1-2N1-3) underwent RNU. Of these 65 patients, 36 patients received at least three cycles of adjuvant gemcitabine plus cisplatin chemotherapy and the remaining 29 patient did not receive adjuvant chemotherapy. Clinical characteristics, bladder recurrence, distant metastasis, and cancer-specific survival were retrospectively reviewed.Results: The mean age of the 65 patients was 60.4 (range, 37-87) years and the median follow-up period was 34 (range, 12-114) months. Patent demographics were not statistically different between the two groups. During the follow-up period, 14 patients (21.5%) experienced distant metastasis; 8 (8/36, 22.2%) patients who had undergone adjuvant chemotherapy and 6 (6/29, 20.7%) patients who did not. Bladder recurrence was noted in 17 patients (26.2%), 5 (5/36, 13.9%) of whom received adjuvant chemotherapy while the remaining 12 (12/29, 41.4%) did not. Kaplan-Meire and multivariate analysis showed that the incidence of bladder recurrence was significantly higher in patients who did not undergo adjuvant chemotherapy, and cancer specific survival was not significantly associated with adjuvant chemotherapy.Conclusions: Adjuvant chemotherapy for locally advanced UTUC can prevent bladder recurrence, but has a minimal effect on cancer-specific survival.

PurposeTo evaluate the relationship between RENAL nephrometry score (RNS) and operative approach for renal masses.Materials and MethodsThis study included 206 consecutive patients who underwent renal tumor surgery between January 2008 and October 2012. We divided the patients into four groups by surgical approach: open radical nephrectomy (ORN, 53 patients), laparoscopic radical nephrectomy (LRN, 83 patients), open partial nephrectomy (OPN, 31 patients), and laparoscopic partial nephrectomy (LPN, 39 patients). We retrospectively assessed the RNS for each surgery group and evaluated the relationship between this score and operative approach.ResultsThe mean RNSs of the ORN, LRN, OPN, and LPN groups were 9.75, 8.35, 6.72, and 5.76, respectively. When the RNS was analyzed according to nephron-sparing, the mean RNSs of the RN groups (ORN and LRN) and the PN groups (OPN and LPN) were significantly different (8.89 and 6.09, respectively; p<0.001). All the individual components of the RNS were significantly different between RN and PN. In the RN groups, the criteria for open versus laparoscopic surgery were based on tumor size ('R' score=2.43 for open, 1.54 for laparoscopic, p<0.001) and tumor location relative to the polar line ('L' score=2.55 for open, 2.09 for laparoscopic, p=0.006). In the PN groups, the criteria for open or laparoscopic surgery were based only on exophytic/endophytic property ('E' score=1.87 for open, 1.41 for laparoscopic, p=0.046).ConclusionsThe RNS was significantly different in all surgery groups. The decision to take a laparoscopic approach was primarily influenced by the R and L scores for RN and by the E score for PN.

PurposeHER-2/neu overexpression is documented in some bladder cancers. To our knowledge, there are no current studies evaluating urine HER-2/neu levels. Therefore, we examined the clinical significance of serum and urine HER-2/neu protein in bladder cancer.Materials and MethodsUrothelial bladder carcinoma patients (n=38, including 31 men and 7 women) and healthy controls (n=25, including 20 men and 5 women) were included in the study. Urine cytology and serum and urine HER-2/neu levels were measured before the transurethral resection of bladder tumor procedure. Prognostic factors including tumor stage, histologic grade, tumor size, multiplicity, and preoperative urine cytology and their association with urinary HER-2/neu were analyzed by simple and multiple regression analyses.ResultsThere was no significant difference in serum HER-2/neu between the two groups (p=0.489). The mean urinary HER-2/neu was 7,586.82 relative luminescence unit (RLU) in bladder cancer patients and 4,245.84 RLU in healthy controls. The mean RLU values of urinary HER-2/neu in the bladder cancer patient group were significantly higher than in healthy controls (p=0.012). An receiver operating characteristic curve was generated, and using the cutoff value of ≥4,800 RLU of urinary HER-2/neu, 71.1% sensitivity and 84.0% specificity were obtained. Among the clinical factors, only positive preoperative urine cytology samples were associated with urinary HER-2/neu levels by both simple and multiple regression analyses.ConclusionsBladder cancer patients demonstrated significantly higher urinary HER-2/neu than did healthy controls. These findings suggest that urinary HER-2/neu may be valuable as a new urinary marker. The application of urinary HER-2/neu needs additional investigation.

OCNR-LPN with the perirenal fat and Gerota's fascia reapproximation technique is feasible. Our initial experience with OCNR-LPN demonstrates encouraging results of minimal renal function loss and complications.