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   Table of Contents - Current issue
March-April 2021
Volume 32 | Issue 2
Page Nos. 45-92

Online since Tuesday, June 22, 2021

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On the way of internationalization p. 45
Yao-Chi Chuang
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Key steps in performing robotic-assisted radical cystectomy with intracorporeal urinary diversion and the evidence that we have so far p. 46
Jeremy Yuen-Chun Teoh, Chi-Hang Yee, Peter Ka-Fung Chiu, Vinson Wai-Shun Chan, Erica On-Ting Chan, Chi-Fai Ng, Eddie Shu-Yin Chan
Robotic-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) has been proposed as the most minimally invasive surgical approach in performing radical cystectomy for patients with bladder cancer. However, iRARC is a highly technical and complex procedure with a steep learning curve. Without appropriate training and adequate experiences, iRARC may become a lengthy procedure and may lead to significant morbidities with a prolonged hospital stay. Essentially, the robotic approach in performing RARC is to replicate what is being done in the open approach, and the key steps in performing iRARC were described in this article. There were five randomized controlled trials (RCTs) comparing between RARC and open radical cystectomy (ORC). RARC has been shown to have a lower blood transfusion rate and short hospital stay than ORC. When compared to ORC, RARC had a similar positive surgical margin rate and time of recurrence. Given such potential benefits, a decision-analytic model has shown that RARC might be a more cost-effective treatment approach than ORC. On the other hand, previous RCTs focused mainly on RARC with extracorporeal urinary diversion; high-quality studies on the total intracorporeal approach are lacking. The iROC trial is a multicenter study comparing between iRARC and ORC. Preliminary results showed that iRARC is well tolerated by patients. The iROC trial has completed patient recruitment and the final results are eagerly awaited. By then, hopefully, we will be able to understand the true value of iRARC in managing patients with bladder cancer.
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Conservative management of vesicoureteral reflux: A literature review p. 52
Safendra Siregar, Andri Pratama Kurniawan, Akhmad Mustafa
Vesicoureteral reflux (VUR) is defined as the retrograde flow of urine from the bladder to the upper urinary tract (the ureters and kidneys), caused by ureterovesical junction dysfunction. VUR is the most common congenital urinary tract abnormality; nevertheless, the conservative treatment for VUR remains controversial. In addition, the limited data availability made it difficult to establish a widely accepted treatment protocol. This study aimed to review available treatment modalities and recommendations with regard to the conservative management for VUR. An online literature search was performed on PubMed, PubMed Central, and Google Scholar. Studies were compared with several available guidelines. Based on literature search, the conservative management of VUR involves a multimodality approach, including the bladder-bowel dysfunction management through bladder training, anticholinergics and alpha-blockers, continuous antibiotic prophylaxis, and circumcision in male patients. Operative and other invasive treatment modalities may be considered in treatment failure or breakthrough urinary tract infection and should not be used as a first-line treatment.
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Biphasic change in renal function after radical cystectomy and urinary diversion: Result from tertiary center in Thailand p. 59
Worapat Attawettayanon, Apiwich Anukoolphaiboon, Virote Chalieopanyarwong, Choosak Pripatnanont
Purpose: Radical cystectomy (RC) with urinary diversion has been established as the gold standard treatment for muscle invasive bladder cancer. This provides excellent local control and increases the survival rate. The postoperative renal function (RF) usually declines, especially with those with risky conditions such as increasing age, hypertension, diabetes, or the presence of preoperative hydronephrosis (HN). However, there are limited data about the potential preoperative factors to predict the postoperative RF following the RC. The current retrospective article aims at reviewing patients treated with RC with urinary diversion presenting demographics data, assessing the RF after performing the operation and identifying the associated factors that reduce the RF. Materials and Methods: Bladder cancer patients who underwent RC with a urinary diversion from January 2001 to December 2017 were reviewed. RF was assessed by using the estimated glomerular filtration rate (eGFR) through the MDRD formula. Multivariate analysis was performed to evaluate the association of the changing of RF. Results: One hundred and fifty-six patients were included in the study. The median age was 65 years (interquartile ranges [IQR] 57, 72), and the median follow-up time was 16.4 months (IQR 7.1, 33.4). Overall, 86 patients (55.12%) had HN at the initial treatment of RC. Baseline mean eGFR was 57.7 mL/min/1.73 m2 (standard deviation [SD] = 23.7). The value of eGFR observed at 1, 12, and 60 months was 67.2 (SD = 29.5), 55.7 (SD = 26.3), and 55.8 (SD = 21.4) mL/min/1.73 m2, respectively. At 1 month, female gender, no HN, and neobladder were independently associated with worse RF outcomes in both univariate and multivariate analysis (P < 0.05). The factors associated with eGFR under 60 mL/min/1.73 m2 at 1 year were age, presence of HN, and adjuvant treatment. Conclusion: RF after cystectomy and urinary diversion improves for 1 month after the procedure, especially in patients with the presence of preoperative HN and then RF gradually decreases. There are no significant differences in preoperative and postoperative RF after a 5-year follow-up.
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Circulating miR-210 and miR-23b in bladder Cancer p. 64
Normeen Hany, Amal Bahgat, Omnya Youssef, Amr Fayyad, Amira Kotb, Sara Al-Khatib, Mona Fathy
Purpose: This study is aimed to assess the serum expression levels of miR-210 and microRNA-23b (miR-23b) in bladder cancer (BC) patients to evaluate their potential as noninvasive biomarkers. Materials and Methods: This study included 93 subjects divided into the following three groups: Group Ia, 31 patients newly diagnosed with BC; Group Ib, Group Ia patients 6 months after medical and/or surgical treatment; and Group II, 31 healthy controls. The gene expressions of miR-210 and miR-23b were determined using quantitative SYBR Green reverse transcription real-time polymerase chain reaction. Results: The expression of miR-210 was significantly higher in BC patients compared to the controls (P = 0.012), while miR-23b did not show any difference. miR-210 expression in BC patients did not differ before and after treatment (P = 0.89). Area under the curve of the receiver operating characteristic analysis for miR-210 in distinguishing BC from controls was 0.686 (95% confidence interval, 0.553–0.818) with 71% sensitivity and 61% specificity. Conclusion: miR-210 can serve as a noninvasive diagnostic marker for BC; however, it cannot be used during treatment follow-up. miR-23b cannot be used as a diagnostic nor prognostic marker for BC.
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Factors associated with the success of trial without catheter in acute urinary retention due to benign prostatic hyperplasia p. 71
Dinh Thi Phuong Hoai, Luu Lam Thang Tai, Tran Thai Huu Loc, Muawia Yousif Fadlelmola Mohamed, Ali Mahmoud Ahmed, Nguyen Tien Huy, Le Dinh Khanh
Purpose: This study aims to evaluate the parameters that can predict the success or failure of trial without catheter (TWOC) for acute urinary retention (AUR) due to benign prostatic hyperplasia (BPH). Materials and Methods: A prospective cohort study was conducted to include 73 medically treated patients with AUR due to BPH. All patients underwent catheterization and were started on alfuzosin (10 mg/day), followed by TWOC. Age, international prostate symptom score (IPSS), quality of life, prostate volume, and urine volume after catheterization were analyzed. Results: Patients' mean age was 74.23 ± 9.63 years; the first successful and failed TWOC was reported in 47 (64.4%) and 26 patients (35.6%), respectively. On the one hand, 89.4% of the patients continued medical treatment with alfuzosin (10 mg/day) in the first successful TWOC group. On the other hand, 30.8% showed the second successful TWOC and continued medical treatment in the first TWOC failure group. The uni- and multivariable analyses in this study showed that severe lower urinary tract symptoms (IPSS ≥20 points), prostatic pain during digital rectal examination (DRE), high urine volume after catheterization (≥950 mL), and high blood urea (≥4.55 mmol/L) were the predictive factors of TWOC failure. Conclusion: Severe lower urinary tract symptoms, prostatic pain during DRE, large urine volume after catheterization, and high blood urea are the predictive factors for TWOC failure in AUR due to BPH.
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Early penile rehabilitation with a vacuum erectile device in patients undergoing robotic-assisted radical prostatectomy: A randomized trial p. 77
Supichamon Rujinithiwat, Manint Usawachintachit, Kamol Panumatrassamee, Apirak Santingamkun, Kavirach Tantiwongse
Purpose: This aim was to study the efficacy of a vacuum erectile device (VED) in rehabilitating the erectile function of patients undergoing nerve-sparing robotic-assisted radical prostatectomy. Materials and Methods: This prospective randomized study enrolled 35 prostate cancer patients from Thailand who had intact baseline erectile function and underwent nerve-sparing robotic-assisted radical prostatectomy. These patients were randomly assigned into either a study group which applied the VED for 10 min daily for 6 months or a control group which received no additional interventions. A 5-item version of the International Index of Erectile Function (IIEF-5) score, stretched penile length, and midshaft circumference were measured at 1, 3, and 7 months after surgery, respectively. Results: The mean patient age was 65.6 years, and the mean baseline IIEF-5 score was 22.91, which were comparable between the two groups. Three patients in the study group did not follow the VED protocol due to postoperative urinary incontinence. A per-protocol analysis revealed that the mean IIEF-5 score at 7 months was significantly higher in the study group compared to the control group (11.29 ± 7.47 vs. 6.61 ± 5.33, P = 0.047). The mean midshaft circumference was also higher in the study group (9.24 ± 1.43 cm vs. 7.91 ± 0.37 cm, P = 0.002). No statistically significant difference in the mean stretched penile length between the two groups was found. Conclusion: Early VED usage for penile rehabilitation following radical prostatectomy significantly improves IIEF-5 score and better preserves penile circumference but not penile length. A larger-scale multi-institutional study is required to validate these findings.
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Comparative study of extracorporeal shock wave lithotripsy versus mini percutaneous nephrolithotomy for the treatment of nonlower calyceal 10–20 mm size kidney stone p. 83
Pinaki Roy, Debansu Sarkar, Vishal Jalan, Dilip Kumar Pal
Purpose: Urolithiasis is a common medical condition and the treatment is mainly minimally invasive methods. There exists no specific guidelines for the treatment of radio-opaque solitary non lower calyceal kidney stones of 10–20 mm in literature and no head to head study comparing both the procedures. Hence, this study was performed to have a specific guide for the treatment of such stones. Materials and Methods: This study, included all patients aged >18 years, with solitary radiopaque calculi of 10–20 mm size in upper or middle calyx or pelvis of the kidney. A total of 105 patients were assigned to receive extracorporeal shock wave lithotripsy (ESWL) or mini-percutaneous nephrolithotomy (PCNL) for treatment of stone were enrolled in the study and the results were compared in terms of retreatment, stone-free rate (SFR), and complications. Results: The SFR was statistically higher in the mini PCNL group for all locations. The SFR for the ESWL group was low after 1st session; however, it increased with multiple sessions. We had a total of 9 complications in both groups, which was statistically insignificant. Conclusion: This study showed that the mini PCNL is a viable, safe option for the treatment of 10–20 mm non lower calyceal stones, having superior SFRs compared to ESWL with statistically insignificant complications. It can be offered as first-line option for the management of such stones.
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Unusual presentation of mixed epithelial and stromal tumor of ureter posing diagnostic dilemma p. 89
Gaurvi Piplani, Kishan H L. Prasad, K Sajitha, TP Rajeev, Shubha Bhat, Suraj Hegde
The mixed epithelial and stromal tumor (MEST) family comprises a spectrum of tumors varying from predominantly cystic tumors such as adult cystic nephroma, to variably solid tumors such as MESTs. These rare renal tumors typically affect women in their perimenopausal age. Most of these tumors are benign; however, at some rare occasions, they are associated with malignant transformation. The current article reports a rare case of MEST arising from the proximal ureter in a perimenopausal woman, manifested as a cord-like structure in the ureter, and posing the diagnostic dilemma.
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