The incidence of kidney cancer has been rising over the past two decades, especially in cases in which the disease is localized and small in size (<4 cm). This rise is mainly due to the widespread use of routine abdominal imaging such as ultrasonography, computed tomography, and magnetic resonance imaging. Early detection was initially heralded as an opportunity to cure an otherwise lethal disease. However, despite increasing rates of renal surgery in parallel to this trend, mortality rates from renal cell carcinoma have remained relatively unchanged. Moreover, data suggest that a substantial proportion of small renal masses are benign. As a result, the management of small renal masses has continued to evolve along two basic themes: it has become less radical and less invasive. These shifts are in part a reflection of an improved understanding that the biology of incidentally discovered renal cell carcinoma may be more indolent than previously thought. However, not all small renal masses are indolent, and de novo metastatic disease can develop at the initial presentation. Therefore, it is with this background of clinical uncertainty and biological heterogeneity that clinicians must interpret the benefits and disadvantages of various clinical approaches to small renal masses.
Biology ; Carcinoma, Renal Cell ; Incidence ; Kidney Neoplasms ; Magnetic Resonance Imaging ; Nephrectomy ; Population Characteristics ; Uncertainty ; Watchful Waiting

PURPOSE: The prevalence of antibiotic-resistant bacteria on rectal swabs in patients undergoing transrectal ultrasound (TRUS)-guided prostate biopsy and the factors affecting resistance to antibiotics were evaluated. MATERIALS AND METHODS: Two hundred twenty-three men who underwent TRUS-guided prostate biopsy from November 2011 to December 2012 were retrospectively evaluated. Rectal swabs were cultured on MacConkey agar to identify antibiotic-resistant bacteria in rectal flora before TRUS-guided prostate biopsy. All patients were admitted and received intravenous antibiotics before prostate biopsy. Clinical variables including underlying disease, infectious complications, and antibiotics associated with resistance were evaluated. Logistic regression was used to determine the factors influencing antibiotic resistance. RESULTS: Of the 233 patients, 161 had positive rectal cultures. Escherichia coli was cultured in 130 (80.7%) and Klebsiella pneumonia in 16 (9.9%). The prevalence of quinolone resistance was 16.8% and the prevalence of extended-spectrum beta-lactamase (ESBL) positivity was 9.3%. A previous history of prostatitis was correlated with quinolone resistance and ESBL positivity (both p=0.001). The factors affecting quinolone resistance in the univariate analysis were a previous history of prostatitis (p=0.003) and previous exposure to antibiotics (p=0.040). Only a previous history of prostatitis was statistically significant in the multivariate analysis (p=0.014). Four patients had infectious complications. CONCLUSIONS: The prevalence of quinolone resistance was 16.8% in rectal swabs performed before TRUS-guided prostate biopsy. A previous history of prostatitis was influential. In patients with a history of prostatitis, selection of prophylactic antibiotics before the biopsy may be reconsidered.
Agar ; Anti-Bacterial Agents* ; Bacteria* ; beta-Lactamases ; Biopsy* ; Communicable Diseases ; Drug Resistance ; Drug Resistance, Microbial ; Escherichia coli ; Humans ; Klebsiella ; Logistic Models ; Male ; Multivariate Analysis ; Pneumonia ; Prevalence* ; Prostate* ; Prostatitis ; Retrospective Studies ; Risk Factors ; Ultrasonography

The efficacy of antibiotic prophylaxis in radical prostatectomy (RP) remains to be established. We retrospectively compared the occurrence of perioperative infections after RP between the 2 different antibiotic protocols. This study involved 428 cases of laparoscopic radical prostatectomy (LRP). After excluding patients who had no perioperative urine culture data, 313 consecutive patients who underwent LRP for prostate carcinoma were classified into 2 groups according to the duration of antimicrobial prophylaxis. To group 1 (153 patients), a second-generation cephalosporin was administered for less than 2 days, whilst the remaining 160 patients in group 2 were administered the drug for more than 2 days. The overall incidence of postoperative bacteriuria was 50.8%, being significantly higher in group 1 (56.9%) than in group 2 (45%). The incidence of surgical site infection (SSI) was significantly higher in group 1 (5.2%) than in group 2 (0.6%). Multivariate analysis revealed that old age, duration of antibiotics for more than 2 days, and duration of Foley catheter placement were independently associated with postoperative infectious complications (all, P < 0.05). Multivariate analysis revealed that duration of antibiotics for more than 2 days, duration of Foley catheter placement, and duration of surgical drain placement were independently associated with postoperative SSI (all, P < 0.05). The incidence of postoperative bacteriuria and SSI were higher in patients who received antibiotics for a short duration. Based on our results, we demonstrated that the outcome of postoperative infectious complications is dependent on old age, short antibiotic administration duration, and prolonged Foley catheterization. Prolonged drain placement is associated with SSI, whilst a longer duration of antibiotics use and prolonged Foley catheterization are associated with a decrease in the incidence of SSI.
Anti-Bacterial Agents ; Antibiotic Prophylaxis* ; Bacteriuria ; Catheters ; Humans ; Incidence ; Multivariate Analysis ; Prostate ; Prostatectomy* ; Retrospective Studies ; Surgical Wound Infection ; Urinary Catheterization

No abstract available.
Kidney Pelvis* ; Polyps*

OBJECTIVE: To acquire normal values of nerve conduction study of the superficial radial sensory nerve (SRN) distal branches to the second web space (2 WEB) and second digit (2 DIG) and compare them with the results of the conventional method. METHOD: Forty-three healthy adult subjects (25 males, 18 females) were included. Nerve conduction study was performed in both hands. Superficial radial sensory responses were obtained with 2 recording montages: 1) antidromic stimulation, recording electrode placed between the 2nd and 3rd metacarpals with stimulation 10 cm proximally on the lateral forearm (2 WEB); 2) orthodromic stimulation, stimulation at the second digit with recording 10 cm proximally at the snuff box (2 DIG). Each stimulation was performed twice, and onset latency, peak latency, and sensory nerve action potential (SNAP) amplitude (baseline-to- peak) were measured. Correlations between the values and body mass index (BMI), sex, and finger circumference were tested statistically. RESULTS: The age of the subjects was 36.0+/-10.4 years (range, 23~64 years), and the BMI was 22.6+/-2.8 kg/m2. The onset latency, peak latency and SNAP amplitude of the 2 WEB response were 1.7+/-0.1 ms, 2.2+/-0.2 ms, and 24.6+/- 8.2 micro V, respectively. The onset latency, peak latency and SNAP amplitude of the 2 DIG response were 1.6+/-0.2 ms, 2.2+/-0.2 ms, and 15.2+/-6.0 micro V, respectively. A statistically significant difference was observed between male and female subjects for both 2 WEB and 2 DIG responses. Weak correlations were found between the nerve conduction values and BMI, sex, and finger circumference. CONCLUSION: Sensory nerve action potentials can be successfully obtained from the distal branches of the superficial radial nerve.
Action Potentials ; Adult ; Body Mass Index ; Electrodes ; Female ; Fingers ; Forearm ; Hand ; Humans ; Male ; Metacarpal Bones ; Neural Conduction* ; Radial Nerve* ; Reference Values ; Tobacco, Smokeless

Idiopathic retroperitoneal fibrosis (IRF) is a rare condition in which a mass of fibrous tissue encompasses the abdominal aorta and the common iliac arteries. Although the histologic findings of IRF are mostly benign, its diagnosis is often delayed, leading to significant physiologic deteriorations, namely renal insufficiency, and poor treatment prognosis. Back pain, which is a common presenting symptom, may lead to confusion in determining the diagnosis of IRF. This report presents a patient with retroperitoneal fibrosis whose diagnosis was delayed due to the concomitant presence of myofascial pain syndrome and lumbar intervertebral disc herniation.
Aorta, Abdominal ; Back Pain ; Humans ; Iliac Artery ; Intervertebral Disc ; Myofascial Pain Syndromes ; Prognosis ; Renal Insufficiency ; Retroperitoneal Fibrosis

Purpose: The aims of this study were to investigate the clinical value of Rab27a as a urinary biomarker, and its efficiency in the prediction of bladder cancer grade. Materials and Methods: The expression of Rab27a in urine samples of patients with bladder cancer, cell line (T-24), and tissue samples of patients with bladder cancer was estimated via quantitative reverse transcription polymerase chain reaction (qRT-PCR). The Rab27a expression level was investigated according to sex, age, and histological grade via qRT-PCR and Western blotting. Results: Rab27a was also expressed at high levels in urine compared to cell lines and tissues from bladder cancer patients. In addition, Rab27a expression varied significantly according to tumor grade (p<0.001). Rab27a was expressed at high levels in male and elderly patients, however, there was not statistically significant. Conclusions Our results indicated that Rab27a is valuable as a urinary diagnostic biomarker for bladder cancer. In addition, it may serve as a predictive factor for determining bladder cancer grade.

PURPOSE: A morphologic contour method for assessing an exophytic renal mass as benign versus malignant on the basis of the shape of the interface with the renal parenchyma was recently developed. We investigated the usefulness of this morphologic contour method for predicting angiomyolipoma (AML) in patients who underwent partial nephrectomy for small renal masses (SRMs). MATERIALS AND METHODS: From January 2004 to March 2013, among 197 patients who underwent partial nephrectomy for suspicious renal cell carcinoma (RCC), the medical records of 153 patients with tumors (AML or RCC) < or =3 cm in diameter were retrospectively reviewed. Patient characteristics including age, gender, type of surgery, size and location of tumor, pathologic results, and specific findings of the imaging study ("ice-cream cone" shape) were compared between the AML and RCC groups. RESULTS: AML was diagnosed in 18 patients and RCC was diagnosed in 135 patients. Gender (p=0.001), tumor size (p=0.032), and presence of the ice-cream cone shape (p=0.001) showed statistically significant differences between the AML group and the RCC group. In the multivariate logistic regression analysis, female gender (odds ratio [OR], 5.20; 95% confidence interval [CI], 1.45 to 18.57; p=0.011), tumor size (OR, 0.34; 95% CI, 0.12 to 0.92; p=0.034), and presence of the ice-cream cone shape (OR, 18.12; 95% CI, 4.97 to 66.06; p=0.001) were predictors of AML. CONCLUSIONS: This study confirmed a high incidence of AML in females. Also, the ice-cream cone shape and small tumor size were significant predictors of AML in SRMs. These finding could be beneficial for counseling patients with SRMs.
Angiomyolipoma ; Carcinoma, Renal Cell ; Counseling ; Diagnostic Imaging ; Female ; Humans ; Incidence ; Kidney ; Logistic Models ; Medical Records ; Nephrectomy ; Retrospective Studies

PURPOSE: The purposes of this study were to investigate the effect of cyclophosphamide (CYP)-induced inflammatory cystitis on caveolin 1 in rat urinary bladder and to determine the role of these molecules in the bladder dysfunction that occurs in inflammatory change in rat urinary bladder. METHODS: Female Sprague-Dawley rats were divided into control (n=30) and experimental (n=30) groups. Cystitis in experimental group was induced by intraperitoneal injection of CYP (200 mg/kg). The control group underwent an intraperitoneal saline injection. After 3 days, urodynamic studies were done to measure the contraction interval and contraction pressure. The expression and cellular localization of caveolin 1 were determined by Western blot and immunofluorescent study in rat urinary bladder. RESULTS: In cystometrograms, the contraction interval (minute) was significantly increased in the CYP-induced cystitis rats (15.8+/-1.5) than in the control group (6.3+/-0.5) (P<0.05). Conversely, the average contraction pressure (mmHg) was significantly higher in the CYP-induced cystitis rats (15.6+/-1.7) than in the control group (11.3+/-0.5) (P<0.05). Caveolin 1 was expressed in the capillaries, arteriols and venules. The protein expression of caveolin 1 was significantly decreased in the CYP-induced cystitis rats (P<0.05). CONCLUSIONS: Inflammatory change of urinary bladder maybe causes a significant change in the expression of caveolin 1. These findings suggest that caveolin 1 might have a functional role in the bladder dysfunction related with cystitis in rat urinary bladder.
Animals ; Blotting, Western ; Capillaries ; Caveolin 1 ; Contracts ; Cyclophosphamide ; Cystitis ; Female ; Humans ; Injections, Intraperitoneal ; Rats ; Rats, Sprague-Dawley ; Urinary Bladder ; Urodynamics ; Venules

PURPOSE: The purpose of this study is to determine the predictive factors that are associated with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD) in women. METHODS: Between January 2008 and December 2009, 185 women with urodynamically proven SUI were included in this study and retrospectively reviewed the medical record. Preoperative SUI symptoms were classified by Stamey grade. Valsalva leak point pressure (VLPP) determination series was repeated two times in each subject after finishing one series of VLPP measurement. The patients were classified into three groups according to VLPP; 1) ISD: VLPP< or =60 cm H2O, 2) equivocal: 6090 cm H2O. Chi-square test and multivariate (logistic regression test) analyses were performed to determine the factors associated with ISD. RESULTS: The mean patient age was 54.2 years (range, 44.5 to 68.4 years). Seventy-one women (38.3%) were in the ISD group and 70 (37.8%) in the AI group. The results of univariate and multivariate analyses found that women with ISD had a higher symptom grade than women with AI (P=0.001 and 0.0001, respectively). The number of patients in the ISD and AI group in accordance with the symptom grade were 7 (10%) and 44 (62%) in grade I, 50 (54%) and 23 (25%) in grade II, and 14 (63%) and 3 (14%) in grade III respectively. There was no correlation between VLPP and other clinical factors. CONCLUSIONS: High symptom grade was the only independent clinical factor that predicted the presence of ISD. This should be considered when counseling the patients with SUI.
Counseling ; Female ; Humans ; Medical Records ; Multivariate Analysis ; Retrospective Studies ; Urinary Incontinence