BackgroundTo evaluate mid-term oncological and functional outcomes in patients with prostate cancer treated by robot-assisted laparoscopic radical prostatectomy (RALP) at our institution.MethodsWe retrospectively reviewed the medical records of 128 patients with prostate cancer who underwent RALP at our institution between February 2008 and April 2010. All patients enrolled in this study were followed up for at least 5 years. We analyzed biochemical recurrence (BCR)-free survival using a Kaplan-Meier survival curve analysis and predictive factors for BCR using multivariate Cox regression analysis. Continence recovery rate, defined as no use of urinary pads, was also evaluated.ResultsBased on the D’Amico risk classification, there were 30 low-risk patients (23.4%), 47 intermediate-risk patients (38.8%), and 51 high-risk patients (39.8%), preoperatively. Based on pathological findings, 50.0% of patients (64/128) showed non-organ confined disease (≥T3a) and 26.6% (34/128) had high grade disease (Gleason score ≥8). During a median follow-up period of 71 months (range, 66-78 months), the frequency of BCR was 33.6% (43/128) and the median BCR-free survival was 65.9 (0.4-88.0) months. Multivariate Cox regression analysis revealed that high grade disease (Gleason score ≥8) was an independent predictor for BCR (hazard ratio=4.180, 95% confidence interval=1.02-17.12, p=0.047). In addition, a majority of patients remained continent following the RALP procedure, without the need for additional intervention for post-prostatectomy incontinence.ConclusionOur study demonstrated acceptable outcomes following an initial RALP procedure, despite 50% of the patients investigated demonstrating high-risk features associated with non-organ confined disease.
Purpose: The accuracy of extraprostatic extension (EPE) on multiparametric magnetic resonance imaging (mpMRI) for the preoperative staging of prostate cancer (PCa) remains controversial. This study aimed to determine the effect of mpMRI for EPE prediction in the final pathology after radical prostatectomy (RP) according to the National Comprehensive Cancer Network (NCCN) risk stratification in patients with clinically localized PCa.Materials and Methods: This retrospective study analyzed 340 consecutive patients diagnosed with clinically localized PCa who underwent RP with preoperative mpMRI between March 2020 and December 2021. They were stratified according to the NCCN risk stratification into low (LR), favorable intermediate (FIR), unfavorable intermediate (UIR), and high risk (HR) groups to assess final pathological EPE. The accuracy of staging mpMRI was assessed in each group. Univariate and multivariate analyses evaluated the predictors of EPE in the final pathology after RP.Results: Preoperative mpMRI showed suspicious EPE in 87 patients (25.6%), whereas postoperative pathological evaluation revealed EPE in 137 patients (40.3%). The LR group showed relatively low sensitivity and positive predictive value compared with other groups. In the multivariate analysis, suspicious EPE on mpMRI was a significant predictive factor for EPE in the final pathology in the FIR, UIR, and HR groups (p=0.012, p=0.011, and p=0.001, respectively), whereas no correlation was observed in the LR group (p=0.711).Conclusions: A strong correlation was observed between suspicious EPE on mpMRI and EPE in the final pathology in the FIR, UIR, and HR groups but not in the LR group.
Introduction
Traditionally, a pigtail catheter (PCN) is placed for preoperative renal access before performing percutaneous nephrolithotomy (PCNL). However, PCN can hamper the passage of the guidewire to the ureter, due to which, access tract can be lost. Therefore, Kumpe Access Catheter (KMP) has been proposed for preoperative renal access before PCNL. In this study, we analyzed the efficacy and safety of KMP for surgical outcomes in modified supine PCNL compared to those in PCN.
Materials and methods
From July 2017 to December 2020, 232 patients underwent modified supine PCNL at a single tertiary center, of which 151 patients were enrolled in this study after excluding patients who underwent bilateral surgery, multiple punctures, or combined operations. Enrolled patients were divided into two groups according to the type of pre-PCNL nephrostomy catheter used: PCN versus KMP. A pre-PCNL nephrostomy catheter was selected based on the radiologist’s preference. A single surgeon performed all PCNL procedures. Patient characteristics and surgical outcomes, including stone-free rate, operation time, radiation exposure time (RET), and complications, were compared between the two groups.
Results
Of the 151 patients, 53 underwent PCN placement, and 98 underwent KMP placement for pre-PCNL nephrostomy. Patient baseline characteristics were comparable between the two groups, except for the renal stone type and multiplicity. The operation time, stone-free rate, and complication rate were not significantly different between the two groups; however, RET was significantly shorter in the KMP group.
Conclusion
The surgical outcomes of KMP placement were comparable to those of PCN and showed shorter RET during modified supine PCNL. Based on our results, we recommend KMP placement for pre-PCNL nephrostomy, particularly for reducing RET during supine PCNL.
We report our first experience with the use of contrast-enhanced ultrasonography (CEUS) to differentiate between a complicated hemorrhagic renal cyst and a cystic renal cell carcinoma in a 50-year-old man diagnosed with autosomal dominant polycystic kidney disease undergoing hemodialysis for end-stage renal disease. CEUS could successfully differentiate between a complicated hemorrhagic renal cyst and a cystic renal cell carcinoma, as opposed to computed tomography (CT) or magnetic resonance imaging (MRI), which could not distinguish between the 2 disease conditions. CEUS is comparable diagnostic tool as CT or MRI to distinguish between benign and malignant cystic renal masses.
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