Background: To compare open partial nephrectomy (OPN) and robot-assisted partial nephrectomy (RAPN) in the management of renal tumors larger than 4 cm. Methods: Clinical records of 220 patients who underwent OPN or RAPN for a single renal tumor ≥ 4.0 cm with a normal contralateral kidney were reviewed. After determining the propensity score, surgical parameters, functional outcomes, and oncological outcomes were compared between OPN (n = 67) and RAPN (n = 67) groups of patients. Results: The RAPN group had longer operation time (149.0 min vs. 173.3 min, P = 0.030) and longer ischemic time (20.3 min vs. 29.4 min, P = 0.001), but shorter hospital stay (8.2 days vs 6.0 days, P = 0.001) than the OPN group. Estimated blood loss (P = 0.053), pain visual analog score at 1 day postoperatively (P = 0.194), and complications of grade III or higher (P = 0.403) were similar between OPN and RAPN groups. There was no radical conversion or positive surgical margin in either group. Mean change in 6-month estimated glomerular filtration rate was significantly better in the RAPN group (−8.2 vs. −3.1, P = 0.027). There was no statistical difference in recurrence-free survival (P = 0.970) or cancer-specific survival (P = 0.345) between the two groups. Conclusion RAPN is a safe and feasible surgical modality comparable to OPN for managing renal tumors larger than 4 cm in terms of surgical, functional, and oncological outcomes.

Background: To compare open partial nephrectomy (OPN) and robot-assisted partial nephrectomy (RAPN) in the management of renal tumors larger than 4 cm. Methods: Clinical records of 220 patients who underwent OPN or RAPN for a single renal tumor ≥ 4.0 cm with a normal contralateral kidney were reviewed. After determining the propensity score, surgical parameters, functional outcomes, and oncological outcomes were compared between OPN (n = 67) and RAPN (n = 67) groups of patients. Results: The RAPN group had longer operation time (149.0 min vs. 173.3 min, P = 0.030) and longer ischemic time (20.3 min vs. 29.4 min, P = 0.001), but shorter hospital stay (8.2 days vs 6.0 days, P = 0.001) than the OPN group. Estimated blood loss (P = 0.053), pain visual analog score at 1 day postoperatively (P = 0.194), and complications of grade III or higher (P = 0.403) were similar between OPN and RAPN groups. There was no radical conversion or positive surgical margin in either group. Mean change in 6-month estimated glomerular filtration rate was significantly better in the RAPN group (−8.2 vs. −3.1, P = 0.027). There was no statistical difference in recurrence-free survival (P = 0.970) or cancer-specific survival (P = 0.345) between the two groups. Conclusion RAPN is a safe and feasible surgical modality comparable to OPN for managing renal tumors larger than 4 cm in terms of surgical, functional, and oncological outcomes.

PURPOSE: We aimed to study clinicopathological parameters and complications of patients who underwent magnetic resonance imaging-transrectal ultrasonography fusion guided prostate biopsy (MRI-TRUS FGB). MATERIALS AND METHODS: We investigated 576 patients who underwent MRI-TRUS FGB of prostate from May 2003 to December 2017 retrospectively. The clinicopathological features and complications were presented, using the modified Clavien-Dindo classification system. RESULTS: Fourteen patients (2.4%) readmitted within 30 days after MRI-TRUS FGB due to complications, and 85.7% (12 of 14) of them complained mild to moderate complications, the Clavien-Dindo classification grades I and II. The most common complication was hematuria (n=5, 0.9%), followed by acute urinary retention (n=3, 0.5%), dysuria (n=2, 0.3%), fever (n=1, 0.2%), hematochezia (n=1, 0.2%). According to multivariate analysis, only age was the significant risk factor of overall complications and bleeding related complications. Two hundred thirteen patients were diagnosed as prostate cancer after MRI-TRUS FGB. When the Likert suspicious scale of prostate cancer on apparent diffusion coefficient (ADC) was ≤4, 27.8% (137 of 493) were diagnosed as prostate cancer, of whom 56.2% (77 of 137) were confirmed as prostate cancer only at randomized 12 cores. When the ADC suspicious level was grade 5, 91.6% (76 of 83) were diagnosed as prostate cancer, of whom 11.8% (7 of 76) were confirmed as prostate cancer only at randomized 12 cores. CONCLUSIONS: The present study demonstrates the safety of MRI-TRUS FGB in terms of complications. When ADC suspicious level is grade 5, MRI-TRUS FGB alone could be a reasonable measure to diagnose prostate cancer, but randomized 12-core prostate biopsy would be recommended additionally when ADC suspicious level is ≤4.
Biopsy ; Classification ; Diffusion ; Dysuria ; Fever ; Gastrointestinal Hemorrhage ; Hematuria ; Hemorrhage ; Humans ; Magnetic Resonance Imaging ; Multivariate Analysis ; Pathology ; Prostate ; Prostatic Neoplasms ; Retrospective Studies ; Risk Factors ; Ultrasonography ; Urinary Retention

PURPOSE: The critical pathway (CP) for radical retropubic prostatectomy (RRP), which is the efficient standardized guideline of clinical practice, was established for all the medical staff, nurses, patients and hospital managers for managing patients with RRP. The aim of this study was to evaluate the usefulness of this CP for RRP. MATERIALS AND METHODS: Our series consisted of 256 consecutive patients who had undergone RRP at a single institution from March 1, 2002 till May 31, 2005. The CP of RRP was implemented January 1, 2004. The patients were subdivided into two groups: (1) the non critical pathway (NCP) group that was made of 91 patients who were treated other than by the CP (from March, 2002 through December, 2003) and (2) the CP group of 134 patients who were placed on CP (from January, 2004 through May, 2005). The factors compared in this study included the average length of stay (LOS), the average hospital charges, the postoperative complications and the patient satisfaction between the two groups. RESULTS: There were no significant differences in the parameters between the two groups including age, the prostate-specific antigen (PSA) level, the Gleason score and the stage. The average LOS decreased significantly after implementation of CP without increasing the incidence of postoperative complications. The average hospital charges were significantly lower for the CP group than for the group without CP. The patients in the CP group were more satisfied than the other patients. CONCLUSIONS: The CP for RRP seems to be effective practical guidelines for managing radical retropubic prostatectomy patients.
Critical Pathways* ; Hospital Charges ; Humans ; Incidence ; Length of Stay ; Medical Staff ; Neoplasm Grading ; Patient Satisfaction ; Postoperative Complications ; Prostate-Specific Antigen ; Prostatectomy* ; Prostatic Neoplasms

Purpose: This study aimed to evaluate the accuracy and reliability of a new smartphone-based acoustic uroflowmetry compared to conventional uroflowmetry. Methods: This was a prospective validation study enrolling 128 subjects from September 2017 to April 2018 comparing a novel acoustic uroflowmetry to conventional uroflowmetry in an outpatient urologic clinic at Seoul National University Bundang Hospital. Visual comparison of flow patterns and uroflow parameters such as maximum flow rate (Qmax), average flow rate (Qavg), and voided volume were compared between the 2 techniques. Reliability and accuracy of the uroflowmetry results were compared using Pearson correlation coefficient (PCC) and Student t-test, respectively. Results: One hundred twelve participants were included in the study. Of these, 77 had baseline urologic comorbidities while 35 were normal participants. Flow patterns between the 2 uroflowmetry techniques demonstrated strong visual correlation. When compared to conventional uroflowmetry, all 3 parameters of voiding in male participants showed a very robust correlation with PCC of 0.88, 0.91, and 0.95 for Qmax, Qavg, and voided volume, respectively. Among female participants, we observed a PCC of 0.78, 0.93, and 0.96 for Qmax, Qavg, and voided volume, respectively. The Qmax showed a statistically significant difference in both sexes between the 2 methods, although the absolute value was small. Conclusions Uroflowmetry using acoustic analysis demonstrates comparable findings to conventional uroflowmetry. This provides an opportunity to perform uroflowmetry in the clinic or at home in a reliable, inexpensive manner. Future large-scale prospective studies are required to further validate our results.

Purpose: This study aimed to evaluate the accuracy and reliability of a new smartphone-based acoustic uroflowmetry compared to conventional uroflowmetry. Methods: This was a prospective validation study enrolling 128 subjects from September 2017 to April 2018 comparing a novel acoustic uroflowmetry to conventional uroflowmetry in an outpatient urologic clinic at Seoul National University Bundang Hospital. Visual comparison of flow patterns and uroflow parameters such as maximum flow rate (Qmax), average flow rate (Qavg), and voided volume were compared between the 2 techniques. Reliability and accuracy of the uroflowmetry results were compared using Pearson correlation coefficient (PCC) and Student t-test, respectively. Results: One hundred twelve participants were included in the study. Of these, 77 had baseline urologic comorbidities while 35 were normal participants. Flow patterns between the 2 uroflowmetry techniques demonstrated strong visual correlation. When compared to conventional uroflowmetry, all 3 parameters of voiding in male participants showed a very robust correlation with PCC of 0.88, 0.91, and 0.95 for Qmax, Qavg, and voided volume, respectively. Among female participants, we observed a PCC of 0.78, 0.93, and 0.96 for Qmax, Qavg, and voided volume, respectively. The Qmax showed a statistically significant difference in both sexes between the 2 methods, although the absolute value was small. Conclusions Uroflowmetry using acoustic analysis demonstrates comparable findings to conventional uroflowmetry. This provides an opportunity to perform uroflowmetry in the clinic or at home in a reliable, inexpensive manner. Future large-scale prospective studies are required to further validate our results.

BACKGROUND: This study was performed to characterize the long term observations after the use of a round needle for the management of chronic musculoskeletal pain. METHODS: The study subjects were 71 patients with musculoskeletal pain who had failed at least two previous treatments. They received interventional muscle and nerve stimulation (IMNS) using a 0.8 to 1.2 mm diameter dry needle with a streamlined shaped and a round tip from March, 2002 to July, 2002. Patients received IMNS as a bilateral segmental treatment mainly in the paraspinal, sometimes in the radicular region at 2 week intervals. The follow-up rate was 97%. Follow-up occurred at 6 months after the last IMNS treatment. Main outcomes were measured using a pain relief scale and a visual analog scale. RESULTS: Spinal stenosis, Herniated Nucleus Pulposus and an unclassified group (radicular symptoms existed, but no correlatable radiographic findings of radiculopathy were found) produced positive responses whereas fibromyalgia and failed back surgery syndrome did not. CONCLUSIONS: These results reveal that IMNS has a potential value in musculoskeletal pain originating from a spinal nerve root.
Failed Back Surgery Syndrome ; Fibromyalgia ; Fluoroscopy* ; Follow-Up Studies ; Humans ; Musculoskeletal Pain ; Needles ; Radiculopathy ; Spinal Nerve Roots ; Spinal Stenosis ; Visual Analog Scale

The funding acknowledgment in this article was omitted as published.

PURPOSE: The aim of this study is evaluating the accuracy of preoperative magnetic resonance imaging (MRI) in patients who underwent pelvic lymph node dissection (PLND). MATERIALS AND METHODS: The medical records of 1,528 patients who underwent radical prostatectomy and PLND from 2003 to 2017 in Seoul National University Bundang Hospital were retrospectively reviewed. We evaluated the various clinicopathologic variables including preoperative MRI findings and pathologic lymph node (LN) metastasis. The prediction model for pathologic LN metastasis was assessed using univariate and multivariable logistic regression analyses and areas under receiver operating characteristic (ROC) curves. RESULTS: The mean age of our cohort was 66.4±6.7 years. Positive LN finding of preoperative MRI finding was observed in 9.4% (145 of 1,528) of patients. 5.3% (81 of 1,528) of patients had confirmed final pathologic LN metastases. Sensitivity and specificity of preoperative MRI were 30.8% and 91.7%, respectively. Multivariable analysis showed that preoperative MRI findings, clinical stage and biopsy Gleason score were independent significant predictors for pathologic LN metastasis (p < 0.001, p=0.002, and p < 0.001, respectively). Prediction model using preoperative MRI findings and National Comprehensive Control Network risk stratification showed fair accuracy using ROC analysis. CONCLUSIONS: Preoperative MRI findings for pathologic LN metastasis showed limited prediction value. A large-scale, multicenter, prospective study is needed to fully evaluate the clinical significance of preoperative MRI.
Biopsy ; Cohort Studies ; Humans ; Logistic Models ; Lymph Node Excision* ; Lymph Nodes* ; Magnetic Resonance Imaging* ; Medical Records ; Neoplasm Grading ; Neoplasm Metastasis* ; Prospective Studies ; Prostate* ; Prostatectomy ; Prostatic Neoplasms* ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Seoul

PURPOSE: To evaluate the impact of primary Gleason grade in Gleason score (GS) 7 prostate cancer on biochemical recurrence (BCR) after radical prostatectomy in Korean men. MATERIALS AND METHODS: We retrospectively reviewed records of 1,026 patients who underwent radical prostatectomy at Seoul National University Bundang Hospital between November 2003 and June 2009. We excluded patients who had received neoadjuvant therapy and had positive resection margins. Finally, 295 and 113 patients with GS 3+4 and GS 4+3, respectively, were included in this study. All patients were followed for at least 2 years. RESULTS: Of the 408 GS 7 patients, 295 (72.3%) were 3+4 and 113 (27.7%) were 4+3. Mean serum prostate specific antigen level in primary Gleason 3 was 8.99 ng/ml and primary Gleason 4 was 11.11 ng/ml. Patients with GS 4+3 were more likely to have extracapsular extension (30.1% vs. 17.6%, p<0.010) and lymphatic invasion (16.8% vs. 7.1%, p<0.005). After 2 years follow up BCR was detected in a total of 40 patients. In GS 7 with primary Gleason 3, BCR occurred in 15 (5.08%) patients while 20 (17.70%) showed BCR in GS 7 with primary Gleason 4. CONCLUSIONS: In this study of a large, single center cohort of Korean men with GS 7 prostate cancer a noticeable difference in BCR was seen. Primary Gleason grade 4 have a higher risk of BCR compared to primary Gleason grade 3. This information may be useful when counseling patients on their prognosis and further management options.
Biopsy ; Cohort Studies ; Counseling ; Follow-Up Studies ; Humans ; Male ; Neoadjuvant Therapy ; Neoplasm Grading ; Prognosis ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Recurrence ; Retrospective Studies