No abstract

The objective of the present study was to investigate whether patient age is associated with vascular access failure during maintenance hemodialysis. Thus, patients who had a successful permanent hemodialysis vascular access installed (Group N: 314 cases), and those who required vascular access revision (Group R: 108 patients) were studied. To assess the association between patient age and the risk of vascular access failure, Cox proportional hazards regression was used to determine hazard ratios (HR) and 95% confidence intervals (CI). We found that in Group N, the significant risk factors were age, gender, and diabetes mellitus (95% CI: 1.004-1.013, 0.380-0.827, 1.279-2.859). Using a univariate analysis model, significant hazard ratios (HR) were found with ages of 60 (CI: 1.062-2.302), 65 (CI: 1.052-2.280), and 70 (CI: 1.082-2.537) years, with the largest HR at 70 years of age (HR: 1.657). In contrast, in Group R, multivariate analysis using Cox proportional hazards identified only one prognostic variable, the location of the vascular access. In Group R, univariate analysis models showed that age was not a significant factor. We conclude that our data show that age is a risk factor for the successful maintenance of initial permanent hemodialysis vascular access. Other risk factors include gender and diabetes mellitus. However, these factors were not related to the successful maintenance of revised vascular access.

No abstract

Background To investigate the prognostic value of pre-surgical modified Glasgow prognostic score in upper urinary tract urothelial carcinoma patients treated with radical nephroureterectomy. Methods We retrospectively reviewed the clinical records of 273 urinary tract urothelial carcinoma patients treated with radical nephroureterectomy. The modified Glasgow prognostic score was evaluated based on pre-surgical serum C-reactive protein and albumin. Association of modified Glasgow prognostic score with recurrence-free survival, cancer-specific survival and overall survival rates was estimated using Kaplan−Meier method and log-rank test was used to compare survival outcome. Cox regression analyses were performed for the assessment of the modified Glasgow prognostic score with recurrence-free survival, cancer-specific survival and overall survival. Results Of total 273 patients, the modified Glasgow prognostic score 0, 1 and 2 were assigned in 216 (79%), 45 (17%) and 12 (4%), respectively. The recurrence-free survival, cancer-specific survival and overall survival of urinary tract urothelial carcinoma patients with modified Glasgow prognostic score 2 were significantly worse than those with modified Glasgow prognostic score 0. On univariate analysis, modified Glasgow prognostic score 2 was associated with worse recurrence-free survival, cancer-specific survival and overall survival (all P value <0.01). On multivariate analyses, modified Glasgow prognostic score 2 was independently associated with worse cancer-specific survival and overall survival (hazard ratio: 4.73, 95% confidence interval: 1.31–17.2 and hazard ratio: 3.66, 95% confidence interval: 1.08–12.4, respectively). In the subgroup analyses of advanced urinary tract urothelial carcinoma patients, modified Glasgow prognostic score 2 was independently associated with worse recurrence-free survival (hazard ratio 4.31, 95% confidence interval: 1.69–11.1). Conclusions Pre-surgical modified Glasgow prognostic score independently predicts cancer-specific survival and overall survival of urinary tract urothelial carcinoma patients. Assessment of pre-surgical modified Glasgow prognostic score status could help identifying the worse survivor of urinary tract urothelial carcinoma patients.

BackgroundVesicourethral anastomotic stricture (VAS) is a rare but serious complication following radical prostatectomy (RP), and various types of managements for VAS have been proposed. We investigated the efficacy of transurethral balloon dilation in the management of VAS after RP.MethodsA total of 128 consecutive patients underwent open RP at our hospital between 2008 and 2013; of these, 10 patients (7.8 %) developed VAS. Transurethral balloon dilation was performed in all 10 patients, using a high pressure balloon catheter under fluoroscopic and endoscopic guidance. Follow-up endoscopy was performed, and patients in whom the stricture had recurred underwent repeat dilation. We retrospectively evaluated the management of VAS and short-term efficacy of high pressure balloon dilation.ResultsThe mean time from RP to diagnosis of VAS was 9 months (2–40 months); eight patients (80 %) were diagnosed within 6 months of RP. Balloon dilation of VAS was technically successful in all patients, and no perioperative complications were recorded. The median follow-up after balloon dilation was 24 months (7–67 months). There was no recurrence of VAS in eight patients (80 %) after the first balloon dilation, and all patients were controlled within the twice.ConclusionHigh pressure balloon dilation is a highly effective and minimally invasive procedure for treating VAS.