Muscle-invasive bladder cancer (MIBC) is classified into a heterogeneous life-threatening epithelial tumor with a high rate of metastasis and a dismal survival rate. Dissimilarity in genetic or epigenetic environment of MIBC causes considerable uncertainty in cancer aggressiveness, progression, and response rates, representing this cancer especially tough to manage. Several definite cases consist of point mutations in genes encoding receptor tyrosine or cytosolic kinases and alterations in epigenetics machinery, including both methylated genes and respective effector enzymes. Considering the highly aggressive and invasive character of MIBC, various attempts have been made to accurately detect and treat the disease using radical cystectomy alone or in combination with adjuvant chemo- and/or radiotherapy including neo-adjuvant chemotherapy. Nowadays advances in the field of immunotherapy with the introduction of checkpoint inhibitors have led to paradigm shifts in the treatment of MIBC. In current review, several published biological markers were introduced from diverse experimental techniques including gene expression profiling, mutations, single nucleotide polymorphisms, and epigenetic alterations. Moreover, the clinical evidence of new therapeutic targets with focus on checkpoint inhibitor in MIBC was summarized. These markers may be the excellent tools to predict MIBC prognosis and drug-responsiveness in the near future. (Korean J Urol Oncol 2020;18:1-10)

Human body contains diverse microbes. Different microbes are identified at different organs. Urine was thought as sterile, but according to progression in important technologies like 16S rRNA gene sequencing and expanded quantitative urine culture, it is known that diverse microbes exist in genitourinary tract. Microbiome contains the microbes and surrounding microenvironments. In addition to urologic difficulties like interstitial cystitis or chronic prostatitis, malignancies are thought to be related to microbiomes. In this review, we summarized several studies in urologic malignancies, especially prostate cancer and kidney cancer.

PURPOSE: We performed nerve-sparing robot-assisted radical cystectomy (nsRARC) and compared the operative outcomes of nsRARC and open radical cystectomy (ORC). MATERIALS AND METHODS: The data of 38 patients that underwent ORC or nsRARC for bladder cancer between July 2009 and April 2014 (23 ORC and 15 RARC) were retrospectively analyzed. Data were collected on patient demographics, pathologic stages, perioperative outcomes, and oncologic outcomes as well as on erectile function. Five-year overall survival and cancer-specific survival were analyzed using the Kaplan-Meier method. Erection function recovery was defined as the ability to achieve penetration ≥50% of the time and to maintain an erection sufficient enough for penetration ≥50% of the time at 12 months after surgery. RESULTS: No significant differences were found between the nsRARC and ORC groups in terms of age, sex, body mass index, American Society of Anesthesiologists physical status, or clinical stage. Mean estimated blood loss was significantly less in the nsRARC group (205.3 mL vs. 394 mL, p=0.011), but mean operative time was significantly greater (520.3 minutes vs. 415.0 minutes, p=0.004). Five-year overall survival and cancer-specific survival were 86.7% and 86.7%, respectively, for nsRARC, and 77.7% and 86.7% for ORC. With respect to erectile function, the overall postoperative potency rate at 12 months was 40.0% in the RARC group and 9.5% in the ORC group, and this difference was significant (p=0.021). CONCLUSIONS: Our clinical experiences indicate nsRARC in selected patients is a feasible procedure in terms of oncologic outcome and that it preserves erectile function relatively effectively.
Body Mass Index ; Cystectomy ; Demography ; Humans ; Methods ; Operative Time ; Recovery of Function ; Retrospective Studies ; Urinary Bladder Neoplasms

Human body contains diverse microbes. Different microbes are identified at different organs. Urine was thought as sterile, but according to progression in important technologies like 16S rRNA gene sequencing and expanded quantitative urine culture, it is known that diverse microbes exist in genitourinary tract. Microbiome contains the microbes and surrounding microenvironments. In addition to urologic difficulties like interstitial cystitis or chronic prostatitis, malignancies are thought to be related to microbiomes. In this review, we summarized several studies in urologic malignancies, especially prostate cancer and kidney cancer.

Despite recent advances in the management of a wide variety of solid tumors, the outcomes for patients with advanced urothelial carcinoma remain relatively poor. Cisplatin-based combination chemotherapy remains the standard of care for first-line systemic treatment of advanced urothelial carcinoma and for more than 10 years there have been no other Korean health insurance system-approved treatment options available for these patients. In this review article, we summarize the current state of chemotherapeutic agents, used either alone or in combination with other chemotherapy in advanced urothelial carcinoma. Our discussion focuses on the new agents for the cisplatin ineligible patients, including carboplatin, gemcitabine, paclitaxel, docetaxel and pemetrexed. Moreover, we addressed that neoadjuvant chemotherapy was supported in the patients planning radical cystectomy as an optimal treatment option by qualified studies.
Carboplatin ; Carcinoma, Transitional Cell ; Cisplatin ; Cystectomy ; Drug Therapy* ; Drug Therapy, Combination ; Humans ; Insurance, Health ; Paclitaxel ; Pemetrexed ; Standard of Care

Male stress urinary incontinence (SUI) can undoubtedly reduce quality of life and promote personal distress and psychosocial alienation. The frequency of postprostatectomy urinary incontinence (PPI) counts on the characterization of urinary incontinence and the periods of patient follow-up. Operational therapeutics, for instance, urethral male slings and artificial urinary sphincters, are well-chosen as adequate and secure surgeries for male SUI in men with continual PPI when conservative treatment is ineffective. Over the former 2 decades, surgery has progressed regarding both operative approach and sling architecture. However, there are no guidelines about when surgery should be carried out and which is the most appropriate surgical option. In this review, we summarize recent advances in implantable devices for PPI and also discuss traditional surgical care. When we are planning the male PPI surgery, careful preoperative work-up should be performed and surgical method should be chosen according to the severity of the disease. Male sling is preferred in mild and moderate symptomatic patients with normal detrusor pressure and it is recommended to select traditional artificial urinary sphincter device in those with severe symptoms. It is expected that effective devices without adverse events will be developed with technical advances in near future.
Emigrants and Immigrants ; Follow-Up Studies ; Humans ; Male ; Methods ; Prostatectomy ; Quality of Life ; Suburethral Slings ; Urinary Incontinence ; Urinary Incontinence, Stress ; Urinary Sphincter, Artificial

PURPOSE: Urolithiasis develops more frequently in patients with a family history (FHx). However, little is known about risk factors in stone formers with a FHx. The aim of this study was to examine the clinico-metabolic characteristics of urinary stone formers according to FHx. MATERIALS AND METHODS: A database of 1,068 stone formers who underwent a complete metabolic evaluation was reviewed. The patients were divided into two groups on the basis of the presence of a FHx. Clinical factors and metabolic parameters were compared between the two groups. RESULTS: There were no significant differences in clinical characteristics, such as gender, age, body mass index, stone episodes, or multiple stones, between the two groups (p>0.05, respectively). Compared with stone formers without a FHx, however, serum calcium concentrations were more elevated in stone formers with a FHx. Also, the urinary excretion of calcium was higher in stone formers with a FHx than in those without a FHx. Other urinary metabolites showed no significant differences between the two groups (p>0.05, respectively). CONCLUSIONS: Our study revealed that stone formers with a FHx had increased urinary calcium excretion as well as elevated concentrations of serum calcium. This finding suggests that urolithiasis in stone formers with a FHx may be associated with calcium metabolic abnormalities.
Body Mass Index ; Calcium ; Family Characteristics ; Humans ; Risk Factors ; Urinary Calculi ; Urolithiasis

PURPOSE: Smoothened(Smo) encodes a 1,024 amino acid transmembrane protein that acts as a transducer of the hedgehog(Hh) signal and maps to 7q31-q32 in humans. In the absence of Hh, Patched(Ptc) prevents Smo from signaling. When M-Hh-N binds to Ptc, however, Smo is free to upregulate downstream genes in the network. Activating mutations in Smo have been identified in sporadic basal cell carcinomas. This study was performed to evaluate the significance of Smo expression in humanzbladder cancer. MATERIALS AND METHODS: Tumor tissues were obtained from 140 patients with bladder cancer and normal bladder mucosa were acquired from 17 patients without bladder cancer as controls. Smo expression was assessed from paraffin sections of tissues using immunohistochemistry and graded on a scale of 0-12 according to the intensity and rate of staining. Differences of Smo expression between the bladder tumors and normal mucosa were compared. The relationships between their expression and the pathological or clinical characteristics such as tumor stage, grade, recurrence, and progression were also analyzed. RESULTS: There was no difference in the Smo expression in comparisons between the bladder cancers and the normal tissues(4.96+/-1.92 vs.4.52+/-0.87, p=0.111). Superficial bladder tumors had a higher Smo expression compared with normal tissues(0.005). Smo expression in the superficial and low-grade bladder tumors were higher than in the invasive and high-grade bladder tumors(p=0.002 and 0.001, respectively). The progression status was correlated with Smo expression but not the recurrence status(p=0.041 and 0.357, respectively). However, the Smo expression levels were not associated with the overall survival of patients(p=0.406). CONCLUSIONS: The results of this study showed that the enhanced expression of Smo was correlated with superficial, low-grade bladder cancer and tumors without progression. These results suggest that Smo is closely correlated with the differentiation and progression of bladder cancer and may, therefore, be useful as a prognostic marker for bladder cancer in the clinical setting.
Carcinoma, Basal Cell ; Humans* ; Immunohistochemistry ; Mucous Membrane ; Paraffin ; Recurrence ; Transducers ; Urinary Bladder Neoplasms* ; Urinary Bladder*

Bleeding from ileal conduit stomal varices is a rare complication. The standard treatment for the management of stomal varices has not been established yet. We present the case of a 65-yearold man with recurrent fatal bleeding from his ileal conduit stomal varices who was successfully treated with ligation of the engorged venous varices using hemostatic agents.

We report our first experience with the use of contrast-enhanced ultrasonography (CEUS) to differentiate between a complicated hemorrhagic renal cyst and a cystic renal cell carcinoma in a 50-year-old man diagnosed with autosomal dominant polycystic kidney disease undergoing hemodialysis for end-stage renal disease. CEUS could successfully differentiate between a complicated hemorrhagic renal cyst and a cystic renal cell carcinoma, as opposed to computed tomography (CT) or magnetic resonance imaging (MRI), which could not distinguish between the 2 disease conditions. CEUS is comparable diagnostic tool as CT or MRI to distinguish between benign and malignant cystic renal masses.
Carcinoma, Renal Cell ; Humans ; Kidney Failure, Chronic ; Magnetic Resonance Imaging ; Middle Aged ; Polycystic Kidney, Autosomal Dominant ; Renal Dialysis ; Ultrasonography