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

The changes in the germinal epithelium of 27 azoospermic patients were studied by light and electron microscope. And a brief clinical observation was also made. The results obtained were as follows, 1) The two thirds of 27 cases were in the age group of 26 to 35. Fifteen cases (55.6%) were in the 2nd to 5th year of their marriages. The tendency of decreasing in tuberculous disease, gonorrhea and mumps was observed in their past history. The average volume of seminal fluid was 2.4ml in amount 2) Light microscopically, spermatogenic arrest was found in 22 cases, and followed by germinal tell aplasia in 3 and hypospermatogenesis in 2. Fifteen of 22 cases of spermatogenic arrest were relatively advanced. Two of 3 cases of germinal cell aplaeia were found in the older age group of 35 to 40, and both of two cases of hypospermatogenesis in the younger age group of 21 to 25. 3) On electron microscopic observation in the hypospermatogenesis, increase in number and mild vacuolar dilatation of endoplasmic reticulum and increase in number of lysosomes in the spermatocytes, and deformities and swelling of acrosomes and vacuolization of nucleoplasm in the spermatocytes, but no significant changes were seen in the spermatogonia and the Sertoli cells. 4) In the spermatogenic arrest, severe degenerative changes such as condensation of chromatin, occurrence of electron dense round bodies, and inapparent cell organells were observed in the spermatocytes. Mild to moderate degenerative changes such as increase in number and dilatation of endoplasmic reticulum, deformities, swelling or atrophy. and decrease in number of cristae of mitochondria were seen in the spermstogonia and the Sertoli cells 5) In the germinal cell aplasia, progressive and degenerative changes such as marked increase in number. vacuolar dilatation, and irregular arrangement of endoplasmic reticulum. marked deformities. swelling, vacuolization, and loss of cristae of mitochondria, and increase in number of lysosomes were noticed.
Acrosome ; Atrophy ; Chromatin ; Congenital Abnormalities ; Dilatation ; Endoplasmic Reticulum ; Epithelium* ; Gonorrhea ; Humans ; Infertility, Male ; Lysosomes ; Male ; Marriage ; Mitochondria ; Mumps ; Oligospermia ; Sertoli Cell-Only Syndrome ; Sertoli Cells ; Spermatocytes ; Spermatogonia

It is accepted by urologists that transurethral resection of the prostate(TURP) is a golden standard in the treatment of benign prostatic hyperplasia( BPH). TURP is a safe procedure with low mortality rate but the rare, severe morbidity made the need for nonoperative treatment for BPH. Recently, non-invasive transurethral microwave hyperthermia has been applied as an alternative treatment of TURP. As a part of ongoing effort to evaluate the effect of transurethral microwave hyperthermia for BPH, we compared the outcomes of TURP with transurethral thermal therapy(TUTT). In 34 patients treated with TURP, the preoperative peak urine flow rate was 6.61ml/sec, but has changed to 14.33 and 14.64ml/sec at postoperative 4weeks and 6months respectively. The Boyarsky symptom score was 13.7 preoperatively, but has changed to 4.43 and 4.66 at postoperative 4weeks and 6months respectively Amount of residual urine was 91.35cc preoperatively. but has decreased to 40.7 and 40.32cc at postoperative 4weeks and 6months respectively. In 35 patients treated with TUTT. the preoperative peak urine flow rate was 9.24ml/sec, but has increased to 11.83 and 12.39ml/sec at postoperative 4weeks and 6months respectively. The preoperative Boyarsky symptom score of 12.9 has decreased to 8.58 and 8.97 at postoperative 4weeks and 6months respectively. The preoperative amount of residual urine was 52.45cc, but has changed to 44.74 and 35.2cc at postoperative 4weeks and 6months respectively. When comparing the parameters between two groups, the improvement of peak urine flow rate was greater in TURP than in TUTT group at postoperative 6months(p<0.01). The decreases of symptom score and amount of residual urine also were greater in TURP than in TUTT group, but not significantly different. In both group, no noticeable complications were encountered. These findings suggest that TURP is more effective than TUTT in the treatment of symptomatic BPH. But our data also raise the possibility that TUTT represents a safe outpatient approach to treatment of BPH, particularly for patients not considered to be candidates for conventional surgical treatments of BPH.
Fever ; Humans ; Microwaves ; Mortality ; Outpatients ; Prostate* ; Prostatic Hyperplasia* ; Transurethral Resection of Prostate

We tried to determine the significance of invasion to the muscularis mucosae on the progression and recurrence of the superficial bladder cancer. Muscularis mucosae was composed of the smooth muscle bundles around relatively large vessels and found in the lamina propria approximately midway between the surface mucosa and the true muscular layer, lying parallel to the mucosa. Between January 1984 and December 1993, 81 patients with diagnosed superficial bladder cancer showing lamina propria invasion (pTl) were treated by transurethral resection (TUR) at our hospital. The mean age was 59.4 years ( range, 31-86 years), the mean follow-up period was 35.3 months ( range, 13-120 months) and the male : female ratio was 69 : 12. We subclassified superficial bladder cancer showing lamina propria invasion into two groups with ( pT1b) or without ( pT1a) cancer invasion to the muscularis mucosae. The muscularis mucosae was identified in 58 (71.6%) of 81 cases. In the other cases ( 28.4% ), relatively large vessels were used as the landmark instead of the muscularis mucosae. Of 81 bladder cancers, 52 (64.2%) were diagnosed as pT1a and 29 (35.8%) as pTlb. The progression rate of pT1b cancer (41.4% ) was significantly higher than that of pT1a cancer (3.8% ) (p= 0.001). And the recurrence rate of pT1b cancer (55.2% ) was significantly higher than that of pT1a cancer ( 26.9 %)(p= 0.024). In conclusion, superficial bladder cancer invading to the muscularis mucosae has a high risk for disease progression after TUR. Careful follow-up examination and aggressive therapy should be recommended in patients with these tumors.
Deception ; Disease Progression ; Female ; Follow-Up Studies ; Humans ; Male ; Mucous Membrane* ; Muscle, Smooth ; Recurrence ; Urinary Bladder Neoplasms* ; Urinary Bladder*

We evaluated the usefulness of preoperative computed tomography (CT) in 26 patients with transitional cell carcinoma (TCC) of the renal pelvis or ureter. Also we had comparative analysis between CT and conventional urography in diagnosis. The conventional imaging methods such as excretory urography and retrograde pyelography are helpful in localizing the lesions but usually cannot detect extension into the peripelvic and/or periureteral fat or metastasis to the lymph nodes. Of 17 patients who were thought localized by CT, 16 were localized in the mucosa or muscle layer and 1 was invasive to periureteral or peripelvic tissue pathologically. Of 8 patients who were thought invasive to periureteral or peripelvic tissue by CT, 5 were identical and 3 were metastatic to lymph nodes pathologically In conclusion, preoperative CT is thought to be useful tool for the diagnosis and staging in TCC of the pelvis or ureter and the sensitivity and specificity of CT were higher in localized diseases than in advanced diseases.
Carcinoma, Transitional Cell* ; Diagnosis ; Humans ; Kidney Pelvis* ; Lymph Nodes ; Mucous Membrane ; Neoplasm Metastasis ; Pelvis ; Sensitivity and Specificity ; Ureter* ; Urography