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Table of Contents
April-June 2022
Volume 33 | Issue 2
Page Nos. 47-98
Online since Thursday, June 9, 2022
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EDITORIAL
Editorial
p. 47
Yao-Chi Chuang
DOI
:10.4103/UROS.UROS_36_22
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REVIEW ARTICLE
Bladder neck contracture as a complication of prostate surgery: Alternative treatment methods and prospects (literature review)
p. 49
Shukhrat Anvarovich Abbosov, Nikolay Ivanovich Sorokin, Azizbek Bakhodirovich Shomarufov, Aleksey Viktorovich Kadrev, Khusniddin Zafariddin Ugli Nuriddinov, Shukhrat Tursunovich Mukhtarov, Farkhad Ataullaevich Akilov, Armais Albertovich Kamalov
DOI
:10.4103/UROS.UROS_127_21
Bladder neck contracture (BNC) is one of the most common complications of surgical treatment of prostate diseases. The rate of postoperative BNC varies depending on the type of surgical treatment used. The options for treatment techniques for BNC can vary from endoscopic interventions to complex (abdominal) surgical interventions. This review evaluates various alternative surgical methods of BNC treatment. The search and analysis of publications in the databases PubMed (MEDLINE), Scopus, Cochrane Library, according to the keywords, “bladder neck sclerosis,” “benign prostatic hyperplasia,” “BNC,” “bladder neck stenosis,” “balloon dilation,” “treatment.” As a result, 71 publications were selected and included in this review. In addition to the standard treatment methods in the form of transurethral resection and incision of the bladder neck using electricity and laser energy, the urologist also has alternative methods of treatment, such as balloon dilation, placement of urethral stents, instillation of the bladder or intraoperative injection of cytostatic drugs, hormones, hyaluronic acid derivatives, and biomedical cell products into the bladder neck area. Although transurethral resection is currently the main treatment option for BNC, the recurrence rate after this procedure can reach up to 38%. According to the literature, balloon dilation can be a promising and minimally invasive method of treatment for recurrent BNC. This method can be used as the first stage in the treatment of recurrent contracture deformity. Furthermore, intravesical instillation of various anti-inflammatory drugs and cytostatics can be promising directions in the treatment and prevention of BNC.
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ORIGINAL ARTICLES
The impact of socioeconomic inequality on urological cancer: A nationwide population-based study in Taiwan
p. 56
Yi-Hsuan Wu, Hung-Lung Ke, Hung-Pin Tu, Ching-Chia Li, Wen-Jeng Wu, Wei-Ming Li
DOI
:10.4103/UROS.UROS_60_21
Purpose:
Socioeconomic inequality may contribute to different risk factors for cancers. This study aims to analyze the socioeconomic patterns of urological cancer incidence and mortality in Taiwan.
Materials
and
Methods:
Using data from the National Health Insurance, we designed a retrospective longitudinal cohort study of 3686 subjects who were newly diagnosed with bladder cancer (BC), kidney cancer (KC), and upper urinary tract cancer (UTUC) between 2000 and 2010. We analyzed patients' characteristics and mortality among the three cancers.
Results:
The average age of KC diagnosis was the youngest among the cancers. Moreover, KC tends to occur in patients with higher-income occupations who reside in urban areas. Both BC and UTUC were much more prevalent in patients with less socioeconomic means and those living in rural areas. Varied comorbidities showed different distributions among urological cancers. Although the extent was most prominent in KC, both overall mortality and cancer-specific mortality of the three cancers increased every year during the follow-up period.
Conclusion:
Our results demonstrate different patient characteristics and mortality among BC, KC, and UTUC in Taiwan.
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Does the timing of performing robot-assisted radical prostatectomy after prostate biopsy affect the outcome?
p. 63
Chien-Ming Lai, Richard C Wu, Chun-Hsien Wu, Chiang-Ting Wang, Victor C Lin
DOI
:10.4103/UROS.UROS_39_21
Purpose:
Prostate biopsy induced prostate hemorrhage and periprostate tissue inflammation which raised the concerns of increasing difficulty even in the era of robot-assisted radical prostatectomy (RARP). To evaluate the correlation between postoperative outcomes and the interval after biopsy, we compared surgical outcomes in different time interval (≤4 weeks, 4–8 weeks, and ≥8 weeks).
Materials and Methods:
We collected patients with localized prostate cancer who underwent RARP by a single experienced surgeon at our institute between April 2016 and February 2019. The complicated statuses such as previously transurethral resection of prostate, grossly nodal positive disease, or locally advanced disease were excluded. A total of 83 patients were enrolled retrospectively according to the regulation of the institutional review board in the institute. The patients were divided into three groups according to the time interval between prostate biopsy and RARP (≤4 weeks, 4-8 weeks and ≥ 8 weeks). The demographic information and perioperative and postoperative outcomes were collected and analyzed.
Results:
Regarding preoperative characteristics, there were similarities in the three groups. Concerning intraoperative outcomes, statistical difference was observed in mean estimated blood loss (253.1 vs. 158.9 vs. 170.9 ml,
P
= 0.047). In addition, operative time was similar among three groups (221.9 vs. 248.5 vs. 226.7,
P
= 0.199). There was no difference in positive surgical margin rate among three groups. The time interval groups did not correlate to prolonged days either urinary catheter indwelling or hospitalization (
P
> 0.05). There was no difference in decreased erection hardness scores at 12 months between 3 groups (−0.75 vs. −0.77 vs. −0.57,
P
= 0.556).
Conclusion:
In our experience, RARP can be effectively and safely performed in different time intervals after prostate biopsy without increasing total operative time or adversely compromising postoperative functionally and oncologic outcomes. However, performing RARP < 4 weeks after prostate biopsy did probably have the risk of increase estimated blood loss.
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Monopolar transurethral resection of the prostate versus holmium laser enucleation in men with prostate volume greater than 100 mL
p. 70
Chun-Kai Chang, Cheng-Hsueh Lee, Chun-Hsuan Lin, Ching-Chia Li, Sheng-Chen Wen, Hsin-Chih Yeh, Jiun-Hung Geng
DOI
:10.4103/UROS.UROS_114_21
Purpose:
The surgical treatment for severe benign prostatic hyperplasia is challenging. The aim of our study was to compare the safety and efficacy of monopolar transurethral resection of the prostate (M-TURP) and holmium laser enucleation of the prostate (HOLEP) for prostate size >100 ml.
Materials
and
Methods:
We retrospectively evaluated our database of two groups of patients. Thirteen patients underwent M-TURP (group 1), and 27 underwent HOLEP (group 2).
Results:
The mean prostate size was 163.1 ± 49.0 ml in group 1 and 143.4 ± 40.9 ml in group 2 (
P
= 0.19). There was no significant difference in resected tissue volume, days of catheter removal, admission days, and postoperative serum hemoglobin between treatment groups. However, in group 1, mean postoperative serum sodium dropped from 137.1 mmol/L to 131.4 mmol/L, which was significantly lower than postoperative serum sodium in group 2 (
P
< 0.0001). There were more complications in group 1 than group 2, especially for patients undergoing transfusion (76.9% in group 1 and 22.2% in group 2) and with hyponatremia (15.4% in group 1 and 0% in group 2). At 3-month follow-up, the international prostate symptom score, quality of life score, and residual urine volume revealed no significant differences between groups.
Conclusion:
M-TURP and HOLEP in men with prostate volume greater 100 ml had similar operative time, admission days and postoperative functional outcomes. However, higher transfusion rates and postoperative hyponatremia were noted in the M-TURP group comparing to the HOLEP group.
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Correlations of tumor depth and width with lymphovascular invasion in non-muscle invasive bladder cancer
p. 77
Kevin Anthony Glorius Tampubolon, Sawkar Vijay Pramod, Ferry Safriadi, Maya Noor Fitriana, Bethy S Hernowo
DOI
:10.4103/UROS.UROS_112_21
Purpose:
Around 75% of all bladder cancers are classified into nonmuscle invasive bladder cancer (NMIBC). The NMIBC's high recurrence and progressivity rate are most commonly found in tumors invading the lamina propria (LP), classified as staged pT1 when it extended to the LP with a heterogeneous recurrence and progression. This study aimed to correlate the measurement of tumor depth and width to lymphovascular invasion (LVI) in NMIBC.
Materials and Methods:
A 5-year retrospective analytical study (2015–2019) was conducted in a tertiary hospital in Indonesia. We reassessed and analyzed the tumor depth and width of 64 patients with pT1 bladder cancer based on histopathological reports and analyzed the correlation of tumors and LVI. The depth was reassessed by measuring the transitional urothelium with the LP as an initial marking point, up to the tumor's edge in the LP, and tumor's width by measuring the largest width of one tumor focus in the LP, along with the presence of LVI by histopathological exams. Data were analyzed using the Mann − Whitney test.
Results:
The participants were 64 patients with pT1 bladder cancer. The mean tumor pT1 invasion depth was 2.03 ± 0.918 mm. The non-LVI group's mean tumor invasion depth was 1.72 ± 0.721 mm, whereas the LVI group was 2.21 ± 0.980 mm. The tumor invasion depth was a significant factor for LVI, whereas the tumor maximum diameter was not.
Conclusion:
The tumor invasion's depth was significantly associated with the LVI. The pT1 tumor invasion depth measurement might serve as a predictive variable of tumor recurrence and progressivity.
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Reliability and validity of a new baseline renal function calculator after radical nephrectomy in a Malaysian population
p. 82
Chin Chuan Ooi, Yee Ling Wong, Shankaran Thevarajah
DOI
:10.4103/UROS.UROS_140_21
Purpose:
This study aimed to determine the reliability and validity of a new baseline renal function calculator after radical nephrectomy in Malaysian patients.
Materials and Methods:
This study retrospectively collected data on patients' demographics, tumor characteristics, and baseline estimated glomerular filtration rate (eGFR) during radical nephrectomy from a single urology center from 2015 to 2020. The predicted eGFR was determined using a calculator. Predicted eGFR was validated by performing simple linear regression and Pearson coefficient correlations; reliability was determined by calculating Shrout and Fleiss's intraclass correlation coefficients.
Results:
Fifty-two patients (mean age, 57.5 years) were enrolled in this study. Thirty-seven (71.2%) patients were men, and 15 (28.8%) had diabetes. Most of the patients (90.2%) had a baseline eGFR of >60 mL/min/1.73 m2. The mean preoperative eGFR was 85.33 mL/min/1.73 m2, whereas the mean postoperative eGFR was 59.88 mL/min/1.73 m2. Simple linear regression analysis resulted in an R2 value of 0.700. The predicted eGFR was significantly correlated with the actual eGFR 6 months after radical nephrectomy (
r
= 0.837,
P
< 0.0001). The intraclass correlation coefficient value of 0.83 indicated good reliability of the formula.
Conclusion:
Our new validated and reliable baseline renal function calculator can provide easy and rapid prediction of renal function in patients scheduled for radical nephrectomy in a sample Malaysian population.
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The comparison of efficacy between the connaught and tice strains of bacillus calmette-guérin in patients with non-muscle-invasive bladder cancer in Taiwan
p. 86
Chih-Chun Kuo, Bing-Juin Chiang, Jung-Yang Yu, Yu-Ting Hsieh, Chung-Hsin Chen, Yeong-Shiau Pu
DOI
:10.4103/UROS.UROS_141_21
Purpose:
The purpose of the study is to compare the efficacy of Bacillus Calmette-Guérin (BCG) strains, Connaught (ImmuCyst
®
), and TICE (OncoTICE
®
) in patients with nonmuscle invasive bladder cancer (nMIBC).
Materials and Methods:
Patients with nMIBC who underwent transurethral resection between March 1997 and December 2017 were enrolled. TICE was used due to the Connaught strain shortage since 2012; hence, direct comparison of the two strains could not be performed. An intravesical instillation (IVI) regimen of mitomycin-C, doxorubicin, and cisplatin (MDP) was used as the reference for comparison. The MDP group was separated into two cohorts (MDP-1 and MDP-2) that matched the same time period of Connaught and TICE treatment. Patients who did not complete the IVI course before disease recurrence or progression or were not followed up for at least 24 months were excluded.
Results:
A total of 730 patients were included in the analysis. There were 67 (9.2%), 38 (5.2%), and 625 (85.6%) patients who received the Connaught, TICE, and MDP treatment, respectively. During a median follow-up duration of 59 months, the recurrence rates of the Connaught, MDP-1, TICE, and MDP-2 groups were 10.5%, 22.8%, 28.9%, and 23.0%, respectively. Both BCG groups had higher tumor grades and more instances of carcinoma
in situ
than their corresponding MDP cohorts. The Connaught and TICE strains had similar effects in preventing tumor recurrence (Connaught vs. MDP,
P
= 0.876; TICE vs. MDP,
P
= 0.556). In the multivariable Cox proportional hazard model that included all patients, the Connaught and TICE groups had a similar risk (hazard ratio = 0.784 and 0.850) of recurrence compared to the MDP protocol. Although progression events were more frequently noticed in the Connaught group, the small number of events limited the analysis.
Conclusion:
The BCG strains, Connaught and TICE, had similar efficacy in reducing bladder tumor recurrence in nMIBC patients. Both strains resulted in similar bladder recurrence-free survival rates to chemotherapeutic agents.
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Sildenafil citrate effects on seminal parameters in male participants with idiopathic infertility; A randomized, double-blind, controlled cross-over clinical trial study
p. 93
Gholamreza Mokhtari, Ali Hamidi Madani, Ehsan Kazemnezhad Leyli, Alireza Jafari
DOI
:10.4103/UROS.UROS_113_21
Purpose:
Sildenafil is a phosphodiesterase Type 5 inhibitor, which is a powerful and effective therapy for male erectile dysfunction (ED) and enables to restore temporary ED. The aim of this study was to evaluate the effects of sildenafil on seminal parameters in male participants with idiopathic infertility.
Materials
and
Methods:
This randomized, double-blind, controlled cross-over clinical trial study was conducted on 79 participants who had been referred to urology clinics in Rasht. Participants were assigned to two Groups A (
n
= 40), and B (
n
= 39). In Phase I, participants in Group A received a pill of sildenafil (50 mg) and then received a pill of placebo after the washout period, and participants in Group B received a pill of placebo and then received a pill of sildenafil after the washout period. In Phase II, participants in Group A received a pill of placebo and then received a pill of sildenafil after the washout period; and participants in group B received sildenafil and then received a placebo after the washout period.
Results:
The mean age of patients was 34 ± 5 years. There was no significant difference in the mean sperm count before receiving the drug in all groups. Sperm count, motility, morphology, pH, viscosity, and liquefaction time of semen did not significantly change after receiving sildenafil in comparison to their corresponding placebo group (
P
> 0.05).
Conclusion:
Sildenafil did not change sperm parameters in treating infertile patients; sildenafil also had no positive effect on semen parameters.
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