No abstract available.
Humans ; Lymphocyte Count/*methods ; Male ; Neutrophils/*pathology ; *Spermatic Cord Torsion ; *Testis

No abstract available.
Humans ; Lymphocyte Count/*methods ; Male ; Neutrophils/*pathology ; *Spermatic Cord Torsion ; *Testis

PURPOSE: Hypospadias is the most common congenital penile anomaly. Information about current utilization patterns of inpatient hypospadias repair as well as complication rates remain poorly evaluated. MATERIALS AND METHODS: The Nationwide Inpatient Sample was used to identify all patients undergoing inpatient hypospadias repair between 1998 and 2010. Patient and hospital characteristics were attained and outcomes of interest included intra- and immediate postoperative complications. Utilization was evaluated temporally and also according to patient and hospital characteristics. Predictors of complications and excess length of stay were evaluated by logistic regression models. RESULTS: A weighted 10,201 patients underwent inpatient hypospadias repair between 1998 and 2010. Half were infants (52.2%), and were operated in urban and teaching hospitals. Trend analyses demonstrated a decline in incidence of inpatient hypospadias repair (estimated annual percentage change, -6.80%; range, -0.51% to -12.69%; p=0.037). Postoperative complication rate was 4.9% and most commonly wound-related. Hospital volume was inversely related to complication rates. Specifically, higher hospital volume (>31 cases annually) was the only variable associated with decreased postoperative complications. CONCLUSIONS: Inpatient hypospadias repair have substantially decreased since the late 1990's. Older age groups and presumably more complex procedures constitute most of the inpatient procedures nowadays.
Adolescent ; Adult ; Age Distribution ; Child ; Child, Preschool ; Hospitalization/statistics & numerical data/*trends ; Humans ; Hypospadias/epidemiology/*surgery ; Infant ; Length of Stay/statistics & numerical data/trends ; Male ; Outcome Assessment (Health Care) ; Postoperative Complications/epidemiology ; United States/epidemiology ; Workload/statistics & numerical data ; Young Adult

PURPOSE: To report on lessons learnt in the management of primary invasive penile cancer in a major tertiary hospital in Australia. MATERIALS AND METHODS: Medical records for all patients who underwent surgery for primary invasive penile cancer between January 2000 and January 2011 were obtained. Patient demographics, clinical status of inguinal node, cancer stage and clinical outcomes were reviewed. All patients were followed up for a minimum of 48 months postoperative unless patient deceased within the first 48 months from the time of penile cancer surgery. RESULTS: Over the 11-year period, a total of 23 cases of invasive penile cancer were identified. Partial penectomy was the most common form of organ preserving surgery and the majority of patients have pT1b disease. Of the 9 patients with clinically palpable inguinal nodes, 7 patients were diagnosed with pN3 disease following inguinal lymphadenectomy. The Kaplan-Meier cancer-specific survival at 72 months showed decreasing survival based on tumour stage (83% in pT1, 79% in pT2, and 64% in pT3 disease) and nodal disease (100% in node negative, 50% in superficial inguinal lymphadenopathy, and 38% in patients with deep inguinal and/or pelvic lymphadenopathy) (p=0.082). The Kaplan-Meier cancer-specific survival revealed statistically significant difference in survival outcome in patients with local recurrence vs. systemic metastasis disease (33% vs. 17%, p=0.008). CONCLUSIONS: The presence of high risk features such as tumour stage, lymph node involvement and distant metastasis carries a significant higher risk of death and tumour recurrence in patients with penile cancer and inguinal lymph node metastasis.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell/pathology/secondary/*surgery ; Follow-Up Studies ; Humans ; Kaplan-Meier Estimate ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Staging ; Penile Neoplasms/pathology/*surgery ; Prognosis ; Retrospective Studies ; Risk Factors ; Treatment Outcome

PURPOSE: To evaluate the perioperative, functional, and oncological outcomes of renal cryoablation (RC) of small renal masses (SRMs) performed in Korea University Hospital. MATERIALS AND METHODS: We reviewed an Institutional Review Board-approved database of 70 patients who underwent RC and were followed up for a minimum of 3 months by a single surgeon in Korea University Hospital from August 2007 to May 2014. Among these patients, 68 patients (79 renal masses) were enrolled in our research. We evaluated perioperative, functional, and oncologic outcomes of RC. RESULTS: A total of 68 patients (79 renal masses) underwent RC in our institution. The mean age of the patients was 62.0 years. The mean tumor size was 2.25 cm. Among the 59 patients who underwent laparoscopic surgery, only 1 patient (1.47%) was converted to open surgery. No other perioperative complications occurred. The mean preoperative and 1-month postoperative estimated glomerular filtration ratio (eGFR) were 71.8 and 68.3 mL/min/1.73 m2, respectively (p=0.19). The mean 1-year postoperative eGFR was 65.0 mL/min/1.73 m2 (p=0.25). The mean follow-up period was 59.76 months (range, 3-119 months). Local tumor recurrence occurred in eight tumors (15.4%; a total of 52 renal cell carcinomas). Concerning treatment in the patients with recurrence, five patients underwent re-treatment and three patients are under active surveillance. None of the eight patients who experienced local recurrence had additional recurrence or tumor progression during the follow-up period. In our study, the recurrence-free rate was 83.0% and the cancer-specific survival rate was 100%. Moreover, the 5- and 10-year overall survival rates were both 100%. CONCLUSIONS: Long-term experience with RC in our institution demonstrates that RC is a safe and effective treatment for patients with SRMs.
Adult ; Aged ; Aged, 80 and over ; Biopsy ; Carcinoma, Renal Cell/pathology/radiography/*surgery ; Cryosurgery/adverse effects/*methods ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Kidney Neoplasms/pathology/radiography/*surgery ; Laparoscopy/adverse effects/methods ; Middle Aged ; Neoplasm Recurrence, Local ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

PURPOSE: Genetic variations among prostate cancer (PCa) patients who underwent radical prostatectomy (RP) and pelvic lymph node dissection were evaluated to predict lymph node invasion (LNI). Exome arrays were used to develop a clinicogenetic model that combined clinical data related to PCa and individual genetic variations. MATERIALS AND METHODS: We genotyped 242,186 single-nucleotide polymorphisms (SNPs) by using a custom HumanExome BeadChip v1.0 (Illumina Inc.) from the blood DNA of 341 patients with PCa. The genetic data were analyzed to calculate an odds ratio as an estimate of the relative risk of LNI. We compared the accuracies of the multivariate logistic model incorporating clinical factors between the included and excluded selected SNPs. The Cox proportional hazard models with or without genetic factors for predicting biochemical recurrence (BCR) were analyzed. RESULTS: The genetic analysis indicated that five SNPs (rs75444444, rs8055236, rs2301277, rs9300039, and rs6908581) were significant for predicting LNI in patients with PCa. When a multivariate model incorporating clinical factors was devised to predict LNI, the predictive accuracy of the multivariate model was 80.7%. By adding genetic factors in the aforementioned multivariate model, the predictive accuracy increased to 93.2% (p=0.006). These genetic variations were significant factors for predicting BCR after adjustment for other variables and after adding the predictive gain to BCR. CONCLUSIONS: Based on the results of the exome array, the selected SNPs were predictors for LNI. The addition of individualized genetic information effectively enhanced the predictive accuracy of LNI and BCR among patients with PCa who underwent RP.
Aged ; Biomarkers, Tumor/*genetics ; Biopsy ; DNA, Neoplasm/genetics ; Exome ; Gene Frequency ; Genome ; Genotype ; Humans ; Lymph Node Excision ; Lymph Nodes/pathology ; Lymphatic Metastasis ; Male ; Middle Aged ; *Models, Genetic ; Neoplasm Invasiveness ; Polymorphism, Single Nucleotide ; Predictive Value of Tests ; Prospective Studies ; Prostatectomy ; Prostatic Neoplasms/*genetics/pathology/surgery

Although disease-free survival remains the primary goal of prostate cancer treatment, erectile dysfunction (ED) remains a common complication that affects the quality of life. Even though several preventive and therapeutic strategies are available for ED after radical prostatectomy (RP), no specific recommendations have been made on the optimal rehabilitation or treatment strategy. Several treatment options are available, including phosphodiesterase-5 inhibitors, vacuum erection devices, intracavernosal or intraurethral prostaglandin injections, and penile prostheses. Urologists must consider more effective ways to establish optimal treatments for ED after RP. ED is an important issue among patients with prostate cancer, and many patients hope for early ED recovery after surgery. This review highlights the currently available treatment options for ED after RP and discusses the limitations of each.
Alprostadil/therapeutic use ; Erectile Dysfunction/etiology/*rehabilitation ; Humans ; Male ; Penile Implantation ; Phosphodiesterase 5 Inhibitors/therapeutic use ; Prostatectomy/*adverse effects/rehabilitation ; Prostatic Neoplasms/*surgery ; Risk Factors ; Vacuum ; Vasodilator Agents/therapeutic use

Substantial efforts are being made in research on the molecular genetic characterization of prostate cancer. The number of fundamental research programs in prostate cancer molecular biology and genetics is overwhelming. However, a significant gap appears to exist between the huge number of studies on the genetic characterization of prostate cancer, which often have limited translation into clinical practice or simply were not conceived to be so translated, and clinical practice. From a clinical point of view, this balance should be urgently shifted towards rapid translation into urological practice. However, prostate cancer is characterized by prominent genetic heterogeneity, which could be a very difficult barrier to overcome. In this review, we discuss the possible clinical applications of scientific data from fundamental studies of prostate cancer genetics, the main problems with the translation of these data to clinics, and future perspectives.
Biomarkers, Tumor/genetics ; Epigenesis, Genetic ; Gene Expression Regulation, Neoplastic ; Genetic Predisposition to Disease ; Goals ; Humans ; Male ; Prostatic Neoplasms/*genetics ; Transcriptome

No abstract available.
DNA, Neoplasm/genetics ; High-Throughput Nucleotide Sequencing/*methods ; Humans ; Sequence Analysis, DNA/methods ; Urologic Neoplasms/*genetics

PURPOSE: To assess the rates of infectious complications before and after the change of prophylactic antibiotic regimens in prostate needle biopsy. MATERIALS AND METHODS: The records of 5,577 patients who underwent prostate needle biopsy at Asan Medical Center between August 2005 and July 2012 were retrospectively reviewed. Group 1 (n=1,743) included patients treated between 2005 and 2009 with fluoroquinolone for 3 days, group 2 (n=2,723) included those treated between 2009 and 2012 with ceftriaxone once before the biopsy and fluoroquinolone before biopsy and continue therapy for 3 days, and group 3 (n=1,111) received the same treatment for more than 7 days after the biopsy. Univariable and multivariable logistic regression models addressed risk factors associated with infectious complication after prostate needle biopsy. RESULTS: Infectious complication after prostate needle biopsy developed in 18 (group 1), seven (group 2), and two patients (group 3) (p=0.001). In group 1, seven patients with infectious complication had positive blood cultures and harbored fluoroquinolone-resistant Escherichia coli, four had ceftriaxone susceptible isolates, and three had extended spectrum beta-lactamase-positive E. coli. Two patients in group 1 required intensive care because of septic shock. In multivariable analysis, the patients with combination of fluoroquinolone and ceftriaxone had significantly lower infectious complication rate than the fluoroquinolon alone (p=0.003). CONCLUSIONS: Antibiotic prophylaxis with ceftriaxone and fluoroquinolone before prostate needle biopsy decreased the risk of potentially serious infectious complications.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Antibiotic Prophylaxis/*methods ; Biopsy, Needle/adverse effects/methods ; Ceftriaxone/*therapeutic use ; Cross Infection/epidemiology/etiology/*prevention & control ; Drug Evaluation/methods ; Drug Resistance, Bacterial ; Drug Therapy, Combination ; Escherichia coli/drug effects ; Escherichia coli Infections/epidemiology/prevention & control ; Fluoroquinolones/*therapeutic use ; Humans ; Incidence ; Male ; Middle Aged ; Prostatic Neoplasms/*pathology ; Republic of Korea/epidemiology ; Retrospective Studies ; Ultrasonography, Interventional ; Young Adult