Purpose: In Taiwan and other Asian countries, the role of focal cryoablation for prostate cancer remains underexplored. While cryoablation is recognized as a minimally invasive treatment, data on its long-term outcomes, especially in patients with higher-risk or locally advanced disease, have been scarce. Materials and methods: We reviewed 34 men treated with primary focal cryoablation at our institution between 2008 and 2020. Clinical characteristics, prostate-specific antigen kinetics, oncological outcomes, functional results, and complications were analyzed. Potency and continence were assessed by patient report and validated questionnaires. Results: After a median follow-up of more than 11 years, biochemical recurrence (BCR) was observed in 21 patients (61.7%). Five-year BCR-free survival differed markedly by risk groups: 77.8% in low-risk disease, 48.5% in intermediate-risk disease, and 0% in high-risk disease. Despite the high BCR rates, 10-year cancer-specific and overall survival were excellent (100%), largely due to timely salvage therapies. Functional outcomes were encouraging. Nearly 80% of men who were potent before treatment retained erectile function, and continence was preserved in all patients. Complications were minor and manageable. Conclusion: Our long-term experience suggests that focal cryoablation can maintain good urinary and sexual function while providing reasonable cancer control in selected patients with low- to intermediate-risk disease. However, the unsatisfactory outcomes in high-risk patients highlight the need for careful selection and integration with other treatment strategies.
Purpose: This study aimed to identify clinical and psychosocial factors associated with caregiver and patient acceptance of clean intermittent catheterization (CIC) in pediatric patients with spina bifida, with a specific focus on gender-related disparities in an Asian population. Materials and methods: We conducted a retrospective review of 72 pediatric patients (35 boys and 37 girls) with spina bifida evaluated for CIC initiation at a single Japanese center between 2011 and 2024. Data on caregiver consent and transition to self-catheterization were collected. Multivariate logistic regression was used to assess the impact of demographic and clinical variables on CIC acceptance. Results: Caregiver consent for CIC was obtained in 73.6% of cases. Girls were significantly more likely to receive caregiver consent (89.1%) than boys (57.1%, P = 0.0038), and more likely to achieve self-catheterization (83.8% vs. 42.8%, P < 0.001). Female sex independently predicted lower odds of both caregiver consent (odds ratio = 5.14, P = 0.0205) and patient self-consent (odds ratio = 5.58, P = 0.0101). A history of follow-up interruption was also a strong negative predictor. Other factors, such as wheelchair use, cognitive disability, and residential location, were not significantly associated. Conclusion: This study is the first to quantitatively demonstrate gender-based disparities in CIC acceptance among Asian pediatric patients with spina bifida. Our findings suggest that boys encounter greater psychosocial barriers to CIC, likely influenced by family dynamics and cultural norms. Targeted, gender-sensitive education and continuous caregiver support are essential for improving CIC uptake and adherence in this population.
Purpose: Laparoendoscopic single-site donor nephrectomy (LESSDN) is a well-accepted technique in renal transplantation, yet data on the retroperitoneal (RP) approach are sparse. We compared LESSDN outcomes via transperitoneal (TP) and RP approaches against conventional laparoscopic donor nephrectomy (CLDN). Materials and methods: This study retrospectively evaluated patients undergoing CLDN, LESSDN-TP, and LESSDN-RP from May 2002 to April 2023, analyzing donor characteristics, perioperative outcomes, complications as categorized by the Clavien-Dindo classification, and cosmetic outcomes using a body image questionnaire and donor renal function. Additionally, recipient outcomes were assessed for 1 year. Results: Of the 36 laparoscopic donor nephrectomies, 13 were CLDN, 10 were LESSDN-TP, and 13 were LESSDN-RP. The operative time of LESSDN-RP (177 minutes) was shorter than that of LESSDN-TP (275 minutes) and CLDN (258 minutes). Warm ischemia times for LESSDN-TP (2.9 minutes) and LESSDN-RP (2.8 minutes) were shorter than CLDN (4.3 minutes). LESSDN-RP patients had the shortest hospital stays (4 days). Half of the LESSDN-TP cases required an extra port. Incision lengths for LESSDN-TP (6.1 cm) and LESSDN-RP (6.7 cm) were shorter than CLDN (9.2 cm). Pain scores were similar on postoperative day 3. No significant differences were found in complication rates, cosmetic outcomes, or recipient results across the 3 approaches. Conclusion: LESSDN-RP offers advantages in operative time, warm ischemia time, and hospital stay, with donor outcomes similar to those of CLDN and LESSDN-TP. Given its technical demands and high learning curve, selecting the approach in which the surgeon is most confident may provide the best outcomes. This is the first study to compare the RP and TP approaches in LESSDN alongside CLDN, demonstrating a potential reduction in recovery time without compromising clinical outcomes.
Purpose: To analyze epidemiological data and treatment trends for upper-tract urothelial carcinoma (UTUC) in Taiwan over a 30-year period (1988–2022). Materials and methods: This retrospective, multi-institutional study conducted by the Taiwan Upper-Tract Urothelial Carcinoma Collaboration Group analyzed clinical data between 1988 and 2022 across 19 hospitals. Variables included demographics, comorbidities, risk factors, renal function, tumor characteristics, diagnostic methods, surgical approaches, chemotherapy status, pathological features, and oncological outcomes. Results: In Taiwan, UTUC showed a female predominance (56.8% women vs 43.2% men; female-to-male ratio 1.3:1), and the overall mean age was 68.7 years. Chronic kidney disease and end-stage renal disease were present in 63% and 16.7% of patients, respectively. Nephroureterectomy was performed in 88% of patients, with nearly 60% of these procedures employing either robotic-assisted or pure laparoscopy techniques during the past 5 years. Chemotherapy was administered in 25.2% of cases, including 2.4% receiving neoadjuvant chemotherapy and 15.6% receiving adjuvant chemotherapy. Postoperative intravesical chemotherapy instillation was performed in 5.3% of cases. Pathological T stages included pT1 or lower (38.8%), pT2 (17.0%), pT3 (25.5%), and pT4 (8.3%). Carcinoma in situ was present in 20.1% of cases, lymphovascular invasion in 16.8%, and positive surgical margins in 4.1%. Major postoperative complications occurred in 4.6% of cases, while 1% of patients experienced grade V complications. Conclusion: Our study demonstrates that Taiwan’s treatment outcomes for UTUC are comparable to those reported internationally, reflecting its proficiency in adopting advanced technologies and maintaining high standards of medical care. However, unique epidemiological factors, such as a higher prevalence of end-stage renal disease, pose challenges to treatment implementation, particularly in the use of nephrotoxic regimens like neoadjuvant chemotherapy.
Purpose: Metastatic hormone-sensitive prostate cancer (mHSPC) demonstrates heterogeneous treatment responses despite the use of androgen deprivation therapy (ADT) combined with androgen receptor pathway inhibitors (ARPi). Identifying early prognostic indicators is essential to guide treatment monitoring and optimize therapeutic strategies. This study aimed to evaluate clinical characteristics, metastatic burden, and prostate-specific antigen (PSA) kinetics as potential predictors of treatment outcomes in patients with high-risk mHSPC treated with ADT plus ARPi in a real-world clinical setting. Methods: We retrospectively reviewed 51 patients with high-risk de novo mHSPC treated between 2020 and 2024 at a single tertiary center. Patients received continuous ADT plus abiraterone, enzalutamide, or apalutamide for a planned 24 months. Clinical characteristics, PSA kinetics, testosterone levels, and metastatic patterns were analyzed using Kaplan–Meier and Cox regression models. Results: Of 51 patients, 38% completed 24 months without progression (responders), while 62% progressed or died (nonresponders). Responders had significantly fewer nonaxial bone metastases ( P < 0.001) and no visceral disease ( P = 0.044). A PSA nadir ≤0.02 ng/mL was more common among responders (63.2% versus 21.1%, P < 0.01) and independently predicted superior overall survival ( P = 0.001). Enzalutamide use trended toward better progression-free survival (HR: 0.07, P = 0.053). Testosterone levels remained in the castrate range but were higher in responders, likely reflecting pharmacologic differences. Conclusion: In Taiwanese men with high-risk mHSPC, achieving an ultralow PSA nadir and profound PSA decline within 9 months predicted superior outcomes. Metastatic burden—especially nonaxial bone and visceral metastases—remained the strongest adverse prognostic factor. These findings support PSA kinetics as a key risk stratification tool and underscore the need for early treatment intensification in suboptimal responders.
Detrusor underactivity (DUA) significantly impacts the quality of life in patients and is often associated with nonspecific symptoms, including both voiding and storage issues. Current treatment options, such as behavioral modifications, pharmacologic therapy, and sacral neuromodulation, are commonly employed but often result in unsatisfactory outcomes. Botulinum toxin A, known for its ability to temporarily paralyze muscles, is widely used in fields like the treatment of gastroparesis, dysphagia, and anal obstruction, and in cosmetic procedures. This property positions it as a potential option for reducing bladder outlet resistance, potentially improving voiding function in patients with DUA. In this review, we examine the application of botulinum toxin A in the management of DUA and discuss its use in sphincteric injections for other sphincter dysfunction conditions. We provide a comprehensive, up-to-date review of the use of sphincteric injections of botulinum toxin in addressing DUA and other sphincter dysfunctions.
Purpose: The use of the supine position is even less explored, although comparisons to the prone position are promising, with great advantages of the supine position. The reproducibility of the miniperc technique in the pediatric population prompted this study to focus on the proposed enhanced maneuverability of the mini-nephoscope to navigate the targeted intrarenal system while maintaining a comparable stone-free rate in the supine position. Materials and methods: This study analyzed 50 children, 7 years old or less, with renal stones (>1.5 cm) indicated for mini-percutaneous nephrolithotomy (mini-PNL) at the Tertiary University Hospital. Patients were randomly assigned to the supine position mini-PNL (group I) and the standard prone mini-PNL (group II). Patients were followed for 3 months from the last operative intervention. Perioperative variables, including patient and stone demographics, intraoperative accessibility, access fluoroscopy time, operative time, and operative adverse events, are documented. Stone free rate (SFR), complications, and the need for accessory measures were also reported, and all were compared between groups. Results: Both supine (96%) and prone (88%) positions primarily used a single access. The supine position demonstrated significantly greater accessibility to all calyces (84% vs 48%, P = 0.02). SFR was higher in the supine (96%) versus the prone position (84%), without significance. Shorter operative (53.9 min vs 65.4 min, P = 0.01) and fluoroscopy times (117.2 s vs 136.4 s, P = 0.02) in supine versus prone cases. Operative complications were comparable in both groups. Conclusion: The findings of this study support that supine miniperc in children offers a variety of access options, and it allows for more accessibility to the entire pelvicalyceal system than encountered in the prone position. This allows for enhanced stone clearance in a lesser operative time with comparable safety and SFR.
Purpose: Transurethral resection of the prostate (TURP) remains the standard surgical treatment for benign prostatic hyperplasia. Perioperative bleeding is a major concern and may lead to blood transfusion, prolonged catheterization, and extended hospital stay. Tranexamic acid (TXA), an antifibrinolytic agent, has been used to reduce surgical bleeding; however, its efficacy in TURP remains controversial. This systematic review and meta-analysis aimed to evaluate the effectiveness of TXA in reducing perioperative bleeding and improving operative outcomes in patients undergoing TURP. Materials and methods: A systematic search of multiple electronic databases was conducted to identify controlled trials comparing TXA with placebo or no intervention in patients undergoing TURP. Eligible studies were required to report hemoglobin change as the primary outcome. Data were pooled using mean differences (MD) with 95% confidence intervals (CI) were calculated. Results: Thirteen studies comprising 1127 participants met the inclusion criteria. Meta-analysis demonstrated a significantly smaller decline in hemoglobin levels in the TXA group compared with control (MD, −0.62; 95% CI, −0.93 to −0.32; P < .0001). TXA significantly reduced operative blood loss (MD, −104.35 mL; 95% CI, −163.35 to −45.41; P = .0005), shortened operative time (MD, −6.95 minutes, 95% CI, −11.62 to −2.27; P = .004), and decreased catheterization duration (MD, −0.18 days; 95% CI, −0.36 to −0.01; P = 0.04). Conclusion: TXA appears to significantly reduce perioperative bleeding and improve operative efficiency in patients undergoing TURP. Nevertheless, further large-scale, high-quality randomized controlled trials are warranted to confirm these findings and establish definitive clinical recommendations.
Purpose: The presence of Hyaluronidase (HAase) in the human body has garnered significant attention among urologists and researchers due to its crucial role and the accurate measurement methods in early detection of bladder carcinoma, which is classified as the fourth most predominant malignancy among the 5 leading oncological afflictions in the male population and seventh in all gender population over the past quinquennium. The use of a cutoff value of 10 mU/mg has proven to offer a good balance in its diagnostic value. By integrating meta-analysis data and the latest research, HAase-based approaches could become a revolutionary step toward enhancing diagnostic accuracy while reducing dependence on invasive procedures. Materials and methods: PICO strategy and PRISMA guideline were utilized to evaluate the diagnostic value of urinary HAase as a noninvasive modality for the detection of bladder carcinoma specifically focused on diagnostic test accuracy studies. Key metrics were defined as follows: sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, positive predictive value, negative predictive value, diagnostic odds ratio, and the area under the curve (AUC). Statistical analyses were performed using Meta-DiSc version 1.4 and R Studio version 4.2.2. The sensitivity analysis was conducted in the form of subanalyses where the comparisons will be conducted by stratifying the studies based on the urinary HAase concentration 10 mU/mg cutoff. Results: A total of 2786 voided urine samples were analyzed across 15 studies, the pooled of both Sn, Sp, LR+, LR−, DOR, PPV, and NPV in all concentration was estimated at 0.87 (95% CI: 0.85-0.90, I ² = 66.4%); 0.88 (95% CI: 0.84-0.92, I ² = 88.4%); 6.93 (95% CI: 4.84-9.91, I ² = 79.9%); 0.16 (95% CI: 0.12-0.20, I ² = 61.8%); 54.11 (95% CI: 30.15-97.11, I ² = 76.7%); 0.90 (95% CI: 0.83-0.95, I ² = 84.9%); 0.86 (95% CI: 0.81-0.90, I ² = 77.6%), respectively. In a cutoff concentrations of ≤10 mU/mg urine HAase, the pooled of both same diagnostic outcome was 0.85 (95% CI: 0.81-0.89, I ² = 75.1%); 0.82 (95% CI: 0.80-0.85, I ² = 0%); 4.67 (95% CI: 4.01-5.44, I ² = 7.6%); 0.20 (95% CI: 0.15-0.26, I ² = 47.3%); 24.52 (95% CI: 16.67-36.05, I ² = 38.4%); 0.81 (95% CI: 0.73-0.87; I ² = 77.9%); 0.85 (95% CI: 0.77-0.91; I ² = 77.3%). In the subgroup with a urinary HAase cutoff concentration >10 mU/mg the pooled of both diagnostic outcome was 0.92 (95% CI: 0.89-0.94, I ²=43.1%); 0.97 (95% CI: 0.92-0.98, I ² = 81.7%); 29.29 (95% CI: 10.20-84.09, I ² = 70.8%); 0.09 (95% CI: 0.07-0.13, I ²=20.8%); 381.23 (95% CI: 162.35-895.24, I ²= 22.6%); 0.97 (95% CI: 0.93-0.99; I ² = 71.6%); 0.87 (95% CI: 0.80-0.92; I ² = 80.6%). Conclusion: The superior diagnostic precision of urinary HAase in identifying bladder cancer has been rigorously established in this meta-analysis, specifically if we take a concern in >10 mU/mg cutoff concentration. Urinary HAase testing offers a pivotal prescreening noninvasive method, and its easily accessible nature underscores its clinical appeal, presenting a compelling case for its integration into early detection protocols.
The effects and safe profile of VR in urological procedures are examined in this review. This systematic review conducted a literature search across PubMed, ScienceDirect, Cochrane Library, and Scopus in September 2024 using relevant keywords to identify studies assessing VR effects on patients undergoing urological procedures. Study quality was assessed using the Revised Cochrane’s risk of bias (RoB 2.0), and meta-analyses were conducted using Review Manager (RevMan) 5.4. The Protocol was registered in PROSPERO (CRD42024623102). Six studies comprising 830 participants (398 intervention group and 432 control group) met the eligibility criteria. Our analysis showed that VR significantly reduced pain (standardized mean difference [MD]: −0.49; P = 0.003), heart rate (MD: −6.21; P < 0.00001), and systolic blood pressure (MD: −11.49; P < 0.00001) in patients undergoing urological procedures. Procedure duration was not significantly affected (MD: −0.84; P = 0.77). Adverse events were minimal across all studies. Our study showed that VR resulted in a statistically significant reduction in pain, heart rate, and systolic blood pressure among patients undergoing urological procedures with a safe profile. Further research is necessary to explore VR applications across a broader range of urological procedures.
To evaluate the outcomes of flexible ureteroscopy (FURS) in the treatment of upper tract urolithiasis in pediatric patients at a single medical institution in Taiwan. Pediatric patients aged ≤16 years who underwent FURS between November 2015 and November 2024 were included. Cases involving middle and lower ureteral stones were excluded. A retrospective analysis of demographic, preoperative, intraoperative, and postoperative data was conducted using electronic medical records. Stone-free status was defined as residual fragments being smaller than 4 mm on follow-up imaging. A total of 15 retrograde intrarenal surgery (RIRS) procedures were performed in 9 children (mean age, 10.87 years). The median cumulative stone diameter was 31 mm (interquartile range, 11.5–52.5 mm). Preoperative ureteral stenting was performed in 10 of 15 cases (66.67%). The ureteral access sheath placement was successful in 14 of 15 cases (93.33%), and all patients (100%) underwent successful RIRS with FURS. The median operative time was 98 minutes, and the median hospital stay was 3 days. Stone-free status was achieved in 9 patients, indicating an overall stone-free rate of 60%. Stratified by size, a stone-free rate of 81.81% was achieved in children with a cumulative stone diameter ≤5 cm, and 90% in the same group if the embedded renal parenchymal stones were excluded. No intraoperative complications were reported, and 2 patients (13.33%) experienced infection-related complications (Clavien II and IV). Advances in RIRS have facilitated its application in pediatric upper tract urolithiasis. When performed under appropriately selected conditions, FURS is a safe and effective treatment modality in this population.
Purpose: Percutaneous nephrolithotomy is an effective treatment for large and complicated renal stones, performed in different techniques including placement of an external nephrostomy tube, placement of an internal ureteral stent, and no external or internal tube. We aimed to compare the safety and feasibility of totally tubeless (without ureteral stenting or nephrostomy) with tubeless (with ureteral stenting), in complete supine percutaneous nephrolithotomy (csPCNL). Materials and methods: This randomized clinical trial was performed on 83 patients who underwent csPCNL by a single urologist between September 2022 and June 2023. Patients were divided into 2 groups: group A, tubeless csPCNL (n = 40), and group B, totally tubeless csPCNL (n = 43). Demographical data and intraoperative and postoperative parameters were recorded for all patients and compared between groups. Results: No significant differences were observed among the groups in preoperative and perioperative variables (P > 0.05). Thirty-six (90.0%) patients in group A and 40 (93.0%) in group B were stone-free, which was not statistically significant (P = 0.706). The mean operative time between groups A and B (43.50 +/- 24.21 and 43.56 +/- 23.64, respectively) was not considered significant (P = 0.991). There was also no significant difference between groups with regard to serum creatinine change, hemoglobin drop, analgesic requirement, hospital stay, and time of return to normal life (P > 0.05). The postoperative complication rate was higher in group A than in group B with no statistically significant difference (P > 0.05). Conclusion: Both tubeless and totally tubeless csPCNL are technically feasible with comparable outcomes. Concerning the high stone-free and low complications rate associated with the totally tubeless approach, it can be considered as a safe and cost-effective alternative to tubeless csPCNL in selected patients.
Purpose: Prostate cancer (PCa) staging often includes bone scans to detect metastases, particularly in intermediate-risk patients classified under International Society of Urological Pathology (ISUP) grade groups II and III. However, the necessity of routine bone scans in this group remains debated. Limited data exist on this specific objective, especially regarding ISUP grade groups II and III. Our study aims to determine the rate of positive bone scan findings among intermediate-risk PCa patients (ISUP grade groups II and III), identify clinical and pathological predictors of bone metastases, and assess whether routine bone scans are necessary for this population. Materials and methods: This retrospective observational study, conducted from 2022 to 2024 at the University Hospitals of Derby and Burton National Health Service Trust, analyzed 400 intermediate-risk PCa patients. Clinical stage, radiological T stage, prostate-specific antigen (PSA) levels, perineural invasion, and ISUP grade were evaluated as potential predictors of bone scan positivity. Logistic regression analysis and receiver operating characteristic curve analysis were used to assess predictive accuracy. Results: Bone scan positivity increases with advancing clinical stages (from 7.8% in cT2b to 28.6% in cT4) and radiologic T stages (0% for T1a/T2a to 50% for T4). In addition, it was found to be significantly related to PSA values, with maximum frequency in patients who had PSA >20 ng/mL (10.1%). ISUP grade also had a significant association, where group III had higher bone scan positivity at 5.8% compared with group II at 1.3%. Receiver operating characteristic analysis revealed an area under the curve of 0.836 (95% confidence interval: 0.729-0.943), which is an excellent discriminatory ability of PSA levels. Conclusion: Clinical stage, radiological T stage, and levels of PSA can be significant predictors of bone scan positivity in the intermediate-risk patient with PCa. These facts suggest that universal routine bone scanning may not always be necessary, and clinical as well as radiological factors might guide their use.
Purpose:This study aimed to report our 17-year experience with open urethroplasties for the treatment of urethral strictures.Materials and methods:From 2007 through 2023, 100 patients underwent open urethroplasty for the treatment of urethral strictures. Of these patients, 58 had posterior urethral stenosis and 42 had anterior urethral strictures. Preoperative evaluation of the urethral strictures included simultaneous retrograde urethrography and voiding cystourethrography. A total of 42 patients underwent urethroplasty for anterior urethral strictures, 21 of whom had buccal mucosa graft-augmented urethroplasty and 21 had anastomotic urethroplasty. Transperineal posterior urethroplasty was performed on the remaining 58 cases of posterior urethral distraction defects. Among the 58 patients who underwent posterior urethroplasty, 38 received standard excision and primary anastomosis and the other 20 patients received the pull-through procedure.Results:The causes of urethral strictures were idiopathic in 6 (6%), iatrogenic in 10 (10%), and traumatic in 84 (84%). The postoperative evaluation included voiding cystourethrography, urethroscopy, and uroflow study. Voiding cystourethrography performed postoperatively revealed a wide, patent anastomosis in all but 11 cases. The results were successful in 49 (84.5%) cases of posterior urethral stenosis and 40 (95%) of anterior urethral stricture. Despite the different number of complete obliterations between the 2 groups of anterior urethral strictures, augmented urethroplasty exhibited the same success rates as anastomotic urethroplasty (95%).Conclusion:From our experience, buccal mucosa graft-augmented urethroplasty and anastomotic urethroplasty are reliable methods in the management of anterior urethral strictures. Regardless of whether excision and primary anastomosis or a pull-through procedure was performed to treat posterior urethral stenosis, the success rate is nearly 85%.
Purpose:Urolithiasis affects nearly 10% of the global population and exhibits significant geographic variability. Despite its prevalence, there is limited research on changes in stone composition over time. This study investigates the clinical characteristics and epidemiological trends of urolithiasis in Taiwan from 2010 to 2018 and synthesizes evidence on temporal changes in stone composition across the Asia-Pacific region, including Japan, China, South Korea, Thailand, and India.Materials and methods:This retrospective cohort study analyzed data from 1364 patients with urolithiasis, either spontaneously passed or collected surgically, from July 2010 to March 2018. Patient demographics and stone compositions, determined by Fourier-transform infrared spectroscopy, were collected. Relevant nationwide studies in the Asia-Pacific region were identified to investigate changes in stone composition over time.Results:Of the 1364 patients, 75% were male, and the mean age was 53.5 years. Calcium oxalate stones were the most common (53.3%), followed by calcium phosphate (27.6%) and uric acid (UA, 13.6%). A significant gender difference was observed, with males more likely to have calcium oxalate and UA stones, while females were more likely to have calcium phosphate and struvite stones. The prevalence of UA stones significantly increased with age, particularly among those aged 65 and older, where UA stones accounted for nearly one-third of all stones. Notably, the proportion of UA stones increased from 3.2% before 2000 to 13.6% in our study period, reflecting a notable rise in the prevalence of UA stones in Taiwan.Conclusion:The prevalence of UA stones has significantly increased in Taiwan, particularly among older adults. This trend highlights the need for ongoing surveillance and tailored public health strategies to address the rising burden of UA stones.
Purpose: About half of upper tract urothelial carcinoma (UTUC) patients undergoing radical nephroureterectomy (RNU) exhibit bladder recurrence during follow-up. The bladder involvement in these patients may affect the UTUC outcomes. In this study, we analyzed the survival outcomes of UTUC patients with bladder involvement after RNU. Materials and methods: From July 1988 to September 2020, we retrospectively analyzed a total of 532 UTUC patients undergoing RNU using Taiwan's UTUC Collaboration Group Database. The propensity score matching was used to reduce the imbalance between the 2 study groups. Group differences for categorical variables were assessed using the 2-sample Pearson chi-square test, while continuous variables were using Student's t-test. Survival rates and curves were estimated using the Kaplan-Meier estimator and compared through the stratified log-rank test. Results: Concurrent bladder involvement in UTUC patients was associated with poor overall survival (hazard ratio [HR], 1.568; 95% confidence interval [CI], 1.045-2.354; P = 0.03), cancer-specific survival (HR, 1.986; 95% CI; 1.190-3.314; P = 0.009), disease-free survival (HR, 1.895; 95% CI, 1.304-2.754; P = 0.001), and bladder recurrence-free survival (HR, 1.602; 95% CI, 1.132-2.266; P = 0.008) in multivariate survival analysis. Old age (>70 y), presence of diabetes, male gender, tumor size (>3 cm), multiplicity, lower ureter involvement, high grade and high stage (>pT2), positive surgical margin, and lymphovascular invasion were significant factors that impact the survival rates in our study. Conclusion: Our study found that concurrent bladder involvement in UTUC patients significantly reduces survival rates. Closer surveillance of the bladder with early treatment strategies would be needed to improve the survival outcomes, especially in high-risk UTUC patients.
Purpose:Advanced renal cell carcinoma (RCC) has 2 classifications: cases that have recurred after radical surgery and cases that have metastasis at the initial diagnosis. This study clarified the predictive factors for the prognosis of patients with advanced RCC that recurred after radical surgery.Materials and methods:We retrospectively studied 146 patients who experienced a relapse of RCC after radical surgery and who had been treated with combined immunotherapy or tyrosine kinase inhibitors (TKIs) at Kobe University and affiliated institutions since 2016. The association between clinicopathological characteristics and overall survival (OS) was analyzed.Results:First-line treatment was combined with immunotherapy in 74 cases and TKIs in 72 cases. Multivariate analyses revealed that age greater than 70 years and bone metastasis were independent predictive factors for worse OS. Using these 2 parameters to stratify the 146 patients, the OS in cases with one risk factor was significantly worse than that with no risk factor (P = 0.0149) and significantly better than with 2 risk factors (P = 0.0220), while no significant difference was found in the OS between intermediate risk and poor risk in the International Metastatic Renal Cell Carcinoma Database Consortium criteria (P = 0.2949). In cases with 1 or 2 factors, OS in cases treated with combined immunotherapy was significantly better than in cases treated with TKIs (P = 0.0337).Conclusion:Advanced RCC that recurred after radical surgery can be stratified by different parameters other than the International Metastatic Renal Cell Carcinoma Database Consortium criteria, which may provide useful information for treatment selection.
Purpose: Prostate cancer is the most common cancer among Japanese men, with many cases diagnosed at advanced stages. Neoadjuvant hormone therapy (NHT) may reduce prostate size and positive surgical margins, but its impact on recurrence and survival remains unclear. Materials and methods: This study analyzed 428 prostate cancer patients who underwent robot-assisted radical prostatectomy at Saga University Hospital (2012-2023); 100 received NHT, while 328 did not. NHT was administered for 2 to 45 months based on waiting time, clinical stage (T3a+), and patient preference. Pathological outcomes were analyzed, with P values <0.05 considered significant. Results: The NHT group had significantly higher prostate-specific antigen levels, D'Amico scores, and clinical T stages. Pathological downgrading was more frequent in the NHT group (44.0% versus 7.6%, P < 0.001), and 24.0% had pT0 status. Longer NHT was associated with absent residual cancer (10.5 versus 3.0 mo, P < 0.001). Conclusion: In Japanese patients with advanced prostate cancer, prolonged NHT (>= 10 mo) before surgery may significantly reduce positive surgical margin and biochemical recurrence. Given the potential differences between Western and Japanese populations, further studies are needed to confirm these findings.
