Urology Journal
Volume:11 Issue: 6, Nov-Dec 2014

In the last decades the status of radiotherapy was tremendously increased in terms of conformity to the target as well as image-guided techniques in conjunction with intensity-modulated radiotherapy (IMRT). The technological improvement had a significant clinical outcome for better response and lower toxicity to the surrounding normal tissues. Nowadays the incidence of rectal toxicity has been significantly decreased, especially with image guided radi­ation therapy (IGRT), whereas the dose escalation to the prostate has driven the clinical practice to the fact that radical radiotherapy for low or intermediate risk prostate cancer is definitely equivalent to surgery. The treatment volume can be reduced by reducing the size of the necessary margins to count for inaccuracies in target position and patient setup. This can be achieved either by improving the daily localization of the target before treatment or by adapting the treatment in response to feedback. This is the goal of image-guided and adaptive radiotherapy, respectively. These techniques improve the accuracy of dose delivery with a significant impact on clinical outcome and toxicity.

A randomized clinical trial was designed to compare the efficacy, success rate and surgical complications of percutaneous nephrolithotomy (PCNL) and laparoscopic pyelolithotomy (LP). Sixty patients with renal pelvic stones larger than 2 cm were randomly divided into two groups of LP and PCNL. All patients were followed up to three months after surgery using renal diethylenetriamine­pentaaceticacid (DTPA) scan and determining the glomerular filtration rate (GFR). Mean operation time (149 ± 31 vs. 107 ± 26 min) and mean hospital stay (3.4 vs. 2.16 days) were significant­ly higher in LP, but mean hemoglobin drop (0.85 vs. 1.88 g/dL) and the rate of blood transfusion were significantly lower. Stone free rate was 90% and 86.6% for LP and PCNL, respectively (P =.59), while the changes in GFR were not statistically significant 3 days after surgery between two groups. Those in LP group showed better improvement in GFR at three months postoperatively. Improvement of the affected split kidney function was significantly higher in LP group (P =.04). No major complications were observed in both groups according to Clavien grading system. PCNL remains the gold standard treatment for most large kidney stones, nevertheless, laparoscopic pyelolithotomy can be considered for selected cases especially in whom maximal preservation of renal function is necessary.

To evaluate the effect of stone localization on the success and complication rates of the percutaneous neph­rolithotomy (PNL) procedure. Five hundred seventy-eight PNL procedures that were performed in our clinic were ret­rospectively evaluated. The patients were divided into seven groups according to the localization of the renal stones as: group 1, patients having stones only in the upper calyx; group 2, patients having stones only in the pelvis; group 3, patients having stones only in the lower calyx; group 4, patients having partial staghorn stones; group 5, patients having multiple calyx stones; group 6, patients having stones in both the pelvis and lower calyx and group 7, patients having complete staghorn stones. The first three groups were defined as simple stones, and the other four groups were defined as complex stones. The mean stone clearance rate was 77% in simple stones and 53% in complex stones (P =. 005). The com­plication rate was significantly higher only in the group with complex staghorn stones at a rate of 19.5% (P =. 006). The difference between preoperative and postoperative hematocrit concentrations was the least in the group that had stones in the pelvis and this value was statistically significantly lower than the patients with complex staghorn stones (P =. 027). The mean duration of the operation and the number of ports was higher in patients with complex stones. The localization of stone affects the success and complication rates of the operation.

To compare the quality of life (QoL) of renal cancer patients following laparoscopic and open radical ne­phrectomy. Seventy-two (64.9%) patients who were treated with open radical nephrectomy (ORN group) and 39 (35.1%) patients who were treated with laparoscopic radical nephrectomy (LRN group) were included in this study. QoL was evaluated by Short Form-36 (SF-36) physical domain scores obtained before surgery, 1 and 6 months after surgery. Analgesic requirement and visual analog scale (VAS) pain scores following surgeries were recorded. The demographic features of the groups were similar. There was a significant difference in tumor size be­tween the ORN group (71.59 ± 29.83 mm) and LRN group (57.08 ± 19.33 mm) (P =. 011). In the LRN group there was less blood loss, a lower transfusion rate, earlier ambulation, more rapid convalescence and shorter hospitalization; however, the difference in surgical duration between the ORN group (122.86 ± 36.8 min) and LRN group (140.17 ± 50.71 min) was not significant (P =. 383). Analgesic requirement and VAS pain scores were similar in both groups. In terms of SF-36 physical domain scores, the general health perception score in the LRN group was higher than that in the ORN group at pre-surgery, 1 and 6 months after surgery. SF-36 physical functioning and general health perception scores in both groups were significantly lower in 1 month after surgery and were higher in 6 months after surgery, as compare to before surgery. Bodily pain scores in LRN group did not change significantly after surgery (P =. 376). LRN exhibited some technical advantages, including less blood loss, shorter hospitalization and more rapid recovery. Although the ORN patients had relatively larger tumors, analgesic requirement, postoperative com­plications, body pain, and physical functioning weren''t significantly different between the groups. QoL was higher 6 months after surgery than before surgery in both groups.

To determine the expression of prostate cancer antigen 3 (PCA3) gene in peripheral blood and urine sedi­ments from patients with prostate cancer (PCa) and benign prostatic hyperplasia (BPH) and normal subjects. A total number of 48 patients [24 with biopsy proven prostate cancer (PCa) and 24 with be­nign prostate hyperplasia (BPH)] were studied. Twenty-four healthy individuals were also recruited as control group. After blood and urine sampling, total RNA was extracted and cDNA was synthesized. Expression of PCA3 gene was assessed by quantitative reverse transcription polymerase chain reaction. Comparison of PCA3 gene expression between control and BPH groups indicated no statistically significant differences in both urine and blood samples. Patients with PCa demonstrated an increased PCA3 gene expression rate compared to control and BPH groups (10.64 and 7.17 folds, respectively). The rate of fold increased PCA3 gene ex­pression in urine was 20.90, 20.90, and 20.35 in patients with PCa, BPH and normal subjects, respectively. Evaluation of PCA3 gene expression can be considered as a reliable marker for detection of PCa. In­creased level of this marker in urine sediments is more sensitive than blood for distinguishing between cancerous and non-cancerous groups.

To develop a Korean version of the Functional Assessment of Cancer Therapy (FACT) -Vanderbilt Cys­tectomy Index (VCI) from the original English version, with subsequent linguistic validationin Korean patients who underwent radical cystectomy with urinary diversion. Translation and linguistic validation were carriedout between January and May of 2013, which consisted of the following stages: (1) permission for translation; (2) forward translation; (3) reconciliation; (4) backward translation; (5) cognitived ebriefing and (6) final proof-reading. During the forward translation phases, word ssuch as «bother», «spend time», «support», «coping» and «con­cern» were adjusted to be more comprehensible to the target population. There conciled Korean version was accepted without certain objections because the original version and the backward translation were almost congruent exceptfor minor differences in a subset of questions. The translation was tested using 5 Korean-speaking subjects. The subjects took an average of 8. 2 minutes to complete the questionnaire, without difficulty and found thequestionnaire clear andeasyto understand. The panel discussed each of the issues raised by subjects and most terms were judged by the panel as to not require further changes because the overall comprehension levels were relatively high and because the translated terms were accurately rendered in the target languages. This report has demonstrated that despite translation difficulties, the linguistic validation of the FACT-VCI in the Korean language was successful. The next step is to assess the psychometric properties of the Korean version of FACT-VCI.

To compare the expression rate of sex steroid hormone receptors of estrogen (ER), progesterone (PR) and androgen (AR) in normal urothelium and urothelial bladder cancer (UBC) and to evaluate the possible associations of these receptors expression with cancer progression and patient''s survival. We evaluated the clinical data and tumor specimens of 120 patients with pathologically confirmed primary UBC with 132 normal healthy controls. Both patients and controls selected from list of subjects who have been referred to Sina Urology clinic, and had a minimum of one year follow-up duration. Data collected from medical cords. For evaluation of expression, immunohistochemistry was performed on paraffin-embedded tissue sections using a monoclonal antibody for androgen, estrogen and progesterone receptors. Presence of at least 10% positive cells defined as positive expression. None of the control subjects showed AR expression, while 22% of the patients were AR-positive. ER/PR expressions were observed in 4.2%/ and 2.5% of the cases and in 2.3% and 1.5% of the controls, respectively. A sta­tistically significant correlation was found between AR expression and tumor stage and grade (P <. 001). AR-positive patients showed a significantly poorer prognosis than AR-negative cases (log-rank test, P =. 02, hazard ratio = 2.12; 95% confidence interval: 1.36-4.65). AR expression was significantly associated with higher grade and poorly differentiated tumors with unfavorable outcome. AR expression test might be useful as a diagnostic tool for determining the malignancy and outcome of UBC patients.

To evaluate the clinical value of fluorescence in situ hybridization (FISH) for diagnosis and surveillance of bladder urothelial carcinoma (BUC). Between November 2010 and December 2013, patients suspected of having BUC were ex­amined using urine cytology and FISH assay. Based on histopathological examination results, FISH results were com­pared with urine cytology. In addition, patients with a history of non-muscle invasive BUC were also examined using urine cytology and FISH assay at the first time of visit and then monitored with cystoscopy during follow-up period. A total of 162 patients included in this study and 12 patients were excluded due to uninformative FISH assays. The remaining 150 patients consisted of 108 patients suspected for BUC and 42 patients with a history of non-muscle invasive BUC. The sensitivities of FISH analysis and urine cytology were 72.8% and 27.2%, respectively, and the difference was statistically significant (P <.05). Difference between specificity of urine cytology (100%) and FISH assay (85%) was not statistically significant (P >.05). At the first visit, of 42 patients, one patient had positive cystoscopy, and FISH assay was positive in 26 of 41 patients with negative cystoscopy. During the follow-up period (mean, 29.5 months), 18 of 26 patients developed recurrence, and recurrence occurred in only one of 15 patients with negative FISH analysis. Our results suggest that FISH analysis can be used as a non-invasive diagnostic tool for patients suspect­ed of having new BUC. In addition, FISH analysis may provide important prognostic information to better define the individual risk for BUC recurrence.

To compare estimated prostate volume (PV) based on computed tomography (CT) scan and transrectal ultrasonography (TRUS) in patients with lower urinary tract symptoms (LUTS). Between January 2010 and October 2012, 107 consecutive patients with LUTS were ana­lyzed, retrospectively. PV measures were performed by the means of ellipsoid formula (PV = π/6 [width (cm) thick­ness (cm) length (cm)]) from TRUS (PVTRUS) and CT (PVCT ellipsoid). In addition, PV was calculated as the sum of the area of each slice and the CT slice interval using commercial software program (PVCT 3D reconstruction). Mean PVCT ellipsoid was 40.63 ± 31.06 cm3 (range, 8.34-217.46). Mean PVTRUS and PVCT 3D re­construction were 39.20 ± 33.04 (range, 4.00-223.81) and 45.30 ± 32.98 (range, 8.90-248.30), respectively. PVCT ellipsoid was highly correlated with PVTRUS and PVCT 3D reconstruction (r = 0.935, P <. 001; r =. 970, P <. 001, respectively). Moreover, there was very strong agreement for PV measurements with all three methods (intraclass correlation coefficient = 0.934, P <. 001). PVCT ellipsoid is adequate method for quick volume assessment with reasonable accuracy. Therefore, we can easily predict PV by CT scan using ellipsoid formula without performing additional TRUS in patients with LUTS.