International Journal of Urology

Background: We determined the long‐term result of our percutaneous antegrade balloon dilation technique performed for adult patients with ureterointestinal anastomotic stricture between 1992 and 1997.

Methods: Balloon dilation was performed on 13 ureterointestinal anastomotic strictures in 10 patients. After a nephrostomy was performed, a guide wire was introduced into the intestinal loop through the stenotic portion under direct observation using a ureterorenoscope. Dilation was performed using the Olbert balloon dilator (30‐Fr) inserted along a guide wire into the stenotic portion. A 20‐Fr or 22‐Fr multihole catheter was left for approximately 6 weeks. No major complications were encountered during or after these procedures. After removal of the indwelling catheters, the progress of each patient was followed for at least 14 months.

Results: Additional dilation was necessary in three of 10 patients for the recurrent stricture. The balloon dilation was ineffective in two patients with a long stenosis of the ureter or a previous history of radiation therapy for uterine cancer. Eight of 10 patients showed satisfactory outcomes during the mean follow‐up period of 47.1 months.

Conclusions: Based on these results, we believe that the balloon dilation could be the first line of treatment for strictures of uro‐digestive anastomosis, except for some patients with a long stenosis or a previous history of intrapelvic radiation.

As a result of significant improvements in current therapies, the life expectancy of cancer patients with bone metastases has dramatically improved. Unfortunately, these patients often experience skeletal complications that significantly impair their quality of life. The major skeletal complications associated with bone metastases include: cancer‐induced bone pain, hypercalcemia, pathological bone fractures, metastatic epidural spinal cord compression and cancer cachexia. Once cancer cells invade the bone, they perturb the normal physiology of the marrow microenvironment, resulting in bone destruction, which is believed to be a direct cause of skeletal complications. However, full understanding of the mechanisms responsible for these complications remains unknown. In the present review, we discuss the complications associated with bone metastases along with matched conventional therapeutic strategies. A better understanding of this topic is crucial, as targeting skeletal complications can improve both the morbidity and mortality of patients suffering from bone metastases.

Objectives:  The efficacy and outcome of a laparoscopic radical nephrectomy (LRN) were retrospectively evaluated in patients aged ≥70 years, and the results were compared with those obtained from patients younger than 70 years undergoing laparoscopic surgery for the same indications.

Methods:  Data were collected for all patients undergoing an LRN for renal cell carcinoma between March 1999 and November 2006. A total of 129 LRN were performed. There were 34 elderly patients (≥70 years) and 95 adult patients (<70 years). The two groups were compared for comorbidity, previous surgical history, operative time, estimated blood loss, tumor size, complications during and after surgery, time to oral intake/ambulation, hospital stay, overall survival and disease free survival rates.

Results:  In preoperative comorbid conditions, the number of patients with hypertension/ischemic heart disease in the elderly group was significantly greater than that in the adult group (p = 0.01). The elderly group had a mean operative time (247 min vs. 244 min) and blood loss (120 ml vs. 180 ml) similar to those in the adult group. In addition, the incidence of perioperative complications was not different between the two groups (intra‐op: 2.9% vs. 5.3%/ post‐op: 8.8% vs. 4.2%). All other variables before, during and after surgery were compatible between the two groups.

Conclusions:  The efficacy and oncological outcome of laparoscopic surgery in elderly patients was as promising as those in their younger counterparts. Therefore, elderly patients should not be excluded from undergoing an LRN, even though they usually present with more comorbidities.

Background: A pressure‐flow study, although a slightly invasive procedure, can evaluate bladder outlet obstruction and detrusor contractility. This study was conducted in men with a non‐enlarged prostate to determine the cause of urinary disturbance by less invasive examinations that might eventually replace pressure‐flow study.

Methods: Thirty‐six men with lower urinary tract symptoms were enrolled. Their prostate volume, estimated by transrectal ultrasonography, was less than 20 mL. All patients were examined using pressure‐flow study, free‐flowmetry, transrectal ultrasonography, prostate specific antigen and an interview using the International Prostate Symptom Score and Quality of Life Index. With determination of the cause for urinary disturbance, parameters that correlated with outflow obstruction or impaired detrusor contractility were sought.

Results: Twenty‐one (60%) of the 36 men were judged as having outflow obstruction, and 16 of these 21 men had normal detrusor function. Impaired detrusor contractility was observed in 17 men. Only three of these 17 men had no outflow obstruction. Four patients had an unstable bladder. All these four had normal detrusor contractility, but had outflow obstruction. Among the parameters examined, only the maximum flow rate in a flow metrogram (Q_max) correlated significantly with the degree of outflow obstruction (P = 0.04). The positive predictive value of Q_max for outflow obstruction was 65% at a flow rate of less than 10 mL/s, and 100% at that of less than 5 mL/s. No parameter correlated with detrusor contractility.

Conclusion: The only parameter that was a clear indicator of outflow obstruction was Q_max. Other indicators of detrusor contractility should be sought.

Background: A filled bladder acts as an acoustic window for transabdominal ultrasound measurements of intravesical prostatic protrusion and volume. The aim of this study is to evaluate the effects of bladder volume on transabdominal ultrasound measurements of these parameters.

Methods: Twenty‐two patients undergoing transurethral resection of the prostate (TURP) were studied. Under general anesthesia just before TURP, a transrectal ultrasound measurement of prostate volume was obtained. The bladder was then filled in a stepwise manner with 100, 200, 300, 400 and 500 mL. At each volume, the intravesical prostatic protrusion and prostatic volume were measured transabdominally using ultrasound.

Results: There was an obvious trend of decreasing mean transabdominal intravesical prostatic protrusions with increasing bladder volume. The mean transabdominal intravesical prostatic protrusion at bladder volumes 100, 200, 300, 400 and 500 mL was 9.1, 8.8, 7.4, 5.8 and 4.6 mm, respectively. The bladder volume at which maximum prostatic protrusion occurred was between 100 and 200 mL. The mean transabdominal prostate volume at the five increasing bladder volumes was 50.6, 48.7, 49.2, 47.9 and 41.4 mL, and these were correlated to transrectal prostate volume, particularly when the bladder volume was less than 400 mL.

Conclusions: Transabdominal ultrasound measurement of prostatic protrusion is dependent on bladder volume. Transabdominal ultrasound measurement of prostatic volume correlates well with the transrectal measurement of the same parameter when the bladder volume is less than 400 mL.

Objectives:  To assess intravesical prostatic protrusion (IPP) as a novel predictor of clinical progression in patients with benign prostatic enlargement (BPE).

Methods:  All patients attending the outpatient clinic at our institution who were being treated for lower urinary tract symptoms (LUTS) secondary to BPE between January 1997 and December 2003 were recruited into the study. International Prostate Symptom Score (IPSS) scores, uroflowmetry parameters, post‐void residual urine volume (PVR), IPP and serum prostate‐specific antigen (PSA) were collected. IPP was classified into Grade 1, 2 or 3. Patients were stratified to different treatment options including watchful waiting, alpha blockers or 5‐alpha reductase inhibitors. Those who developed high post‐void residual urine volume (>100 mL), acute urinary retention or a deterioration of at least 4 points in IPSS score were considered to have disease progression. Using the Grade 1 IPP group as a reference, the odds ratio for clinical progression of Grade 2 and Grade 3 IPP were calculated by using multivariate analysis.

Results:  A total of 259 patients with a mean age of 63 years (range 50–90 years) and mean follow‐up time of 32 months were available for analysis. Fifty‐two patients were found to have clinical progression. Odds ratio for progression of a Grade 2 IPP was 5.1 (95% confidence interval [CI] 1.6–16.2) and that of a Grade 3 IPP was 10.4 (95% CI 3.3–33.4).

Conclusion:  A higher IPP grade is associated with a higher risk of clinical progression in BPE. IPP is a useful non‐invasive predictor for clinical progression in BPE.

Aim: The aims of this study were to define the relationship between intravesical prostatic protrusion (IPP), prostate‐specific antigen (PSA) and prostate volume (PV) and to determine which one of them is the best predictor of bladder outlet obstruction (BOO) due to benign prostatic enlargement.

Methods: A prospective study of 114 male patients older than 50 years examined between November 2001 and 2002 was performed. They were evaluated with digital rectal examination, International Prostate Symptoms Score, PSA, uroflowmetry, postvoid residual urine measurement, IPP and PV using transabdominal ultrasound scan. Statistical analysis included scatter plot with Spearman’s correlation coefficients and nominal logistic regression

Results: Prostate volume, IPP and PSA showed parallel correlation. Although all three indices had good correlation with BOO index, IPP was the best. The Spearman rho correlation coefficients were 0.314, 0.408 and 0.507 for PV, PSA and IPP, respectively. Using receiver‐operator characteristic curves, the areas under the curve for PV, PSA and IPP were 0.637, 0.703 and 0.772, respectively. The positive predictive values of PV, PSA and IPP were 65%, 68% and 72%, respectively. Using a nominal regression model, IPP remained the most significant independent index to determine BOO.

Conclusions: All three non‐invasive indices correlate with one another. The study showed that IPP is a better predictor for BOO than PSA or PV.

The incidence of prostate cancer has been increasing worldwide in recent years. The GLOBOCAN project showed that prostate cancer was the second most frequently diagnosed cancer and the fifth leading cause of cancer mortality among men worldwide in 2012. This trend has been growing even in Asian countries, where the incidence had previously been low. However, the accuracy of data about incidence and mortality as a result of prostate cancer in some Asian countries is limited. The cause of this increasing trend is multifactorial. One possible explanation is changes in lifestyles due to more Westernized diets. The incidence is also statistically biased by the wide implementation of early detection systems and the accuracy of national cancer registration systems, which are still immature in most Asian countries. Mortality rate decreases in Australia, New Zealand and Japan since the 1990s are possibly due to the improvements in treatment and/or early detection efforts employed. However, this rate is increasing in the majority of other Asian countries. Studies of latent and incidental prostate cancer provide less biased information. The prevalence of latent and incidental prostate cancer in contemporary Japan and Korea is similar to those in Western countries, suggesting the influence of lifestyle changes on carcinogenesis. Many studies reported evidence of both congenital and acquired risk factors for carcinogenesis of prostate cancer. Recent changes in the acquired risk factors might be associated with the increasing occurrence of prostate cancer in Asian countries. This trend could continue, especially in developing Asian countries.

Objectives:  To identify an appropriate reference gene for the analysis of circulating micro‐ribonucleic acid in patients with urological malignancies.

Methods:  Serum from patients with prostate cancer (n = 24), bladder cancer (n = 24), renal cell carcinoma (n = 24) and control subjects (n = 48) was spiked with cel‐miR‐39, and then ribonucleic acid was isolated. Quantitative real‐time polymerase chain reaction was used to determine the levels of candidate reference genes (RNU1‐4, RNU6‐2, SNORD43, SNORD44, SNORD48, SNORA74A, miR‐let‐7a‐1, miR‐106a). Reference gene stability was determined using the NormFinder, geNorm and comparative delta‐Ct algorithm. The effect of normalization was tested with miR‐21 as the target gene, as this was previously suggested to be upregulated in cancer patients' serum.

Results:  Recovery of cel‐miR‐39 (mean 11.6%, range 1–56%) was similar in control subjects and cancer patients. SNORD44 and SNORD74A levels were around the detection limit of the assay and were thus omitted. All remaining candidates showed satisfying stability; SNORD43 was the most stable reference gene using all three algorithms. A combination of two genes (SNORD43, RNU1‐4) increases the stability somewhat. The level of miR‐21 was similar in cancer patients and healthy controls, irrespective of the normalization strategy.

Conclusions:  SNORD43 is a suitable reference gene for the analysis of circulating micro‐ribonucleic acid in patients with urological malignancies. Our study questions the suitability of miR‐21 as a biomarker for uro‐oncological patients.