Apirak Santingamkun

Management of metastatic castration-resistant prostate cancer: Insights from urology experts in Thailand

Treatment options for castration-resistant prostate cancer (CRPC) are available, but clear instructions for the selection of appropriate treatment are lacking. A meeting of urology experts based in Thailand was convened with the following objectives: (1) to reach a consensus and share real-life experiences about how to identify CRPC; (2) to choose the appropriate treatment for CRPC patients; (3) to evaluate disease progression using novel inhibitors of the androgen receptor pathway; (4) to identify the frequency of monitoring disease; and (5) to promote rational use of corticosteroids in CRPC patients. This consensus document can provide guidance to other urologists in Thailand to provide appropriate treatment to metastatic CRPC patients in a timely manner.

Alveolar Soft Part Sarcoma of Urinary Bladder Occurring as a Second Primary Malignancy: A Case Report and Literature Review

We report a case of bladder alveolar soft part sarcoma in an 18-year-old Thai male patient who had been treated with testicular radiation and systemic chemotherapy for acute lymphoblastic leukemia with testicular relapse. He presented with recurrent dysuria and gross hematuria. Cystoscopy revealed a 2-centimeter irregular sessile mass at the bladder base adjacent to left ureteral orifice. Transurethral resection of the tumor was performed. The histopathological diagnosis was alveolar soft part sarcoma. Chest and abdominal computed tomography showed no evidence of metastasis. He was treated with partial cystectomy and left ureteral reimplantation with negative surgical margin. No evidence of recurrence was found during a 28-month follow-up period with surveillance cystoscopy and computed tomography of the chest and abdomen.

Brief communication (Original). Predictive factors for postoperative complications in radical nephrectomy for renal cell carcinoma

Abstract Background: Radical nephrectomy is the treatment of choice for large renal cell carcinoma (RCC). Objectives: To describe the complications after radical nephrectomy for suspected or proven RCC and analyze the risk factors. Materials and methods: We retrospectively reviewed medical records from 110 patients who underwent radical nephrectomy for RCC in our institution between January 2007 and December 2013. The clinicopathological data of all patients were recorded and complications were graded using modified Clavien classification. Univariate and multivariate analysis was made of the predictive factors for complications. Results: Fifty postoperative complications occurred in 34 patients (31%) within 30 days, including 11% transfusion related complications. There were 22% minor complications (6% grade 1, 16% grade 2) and 9% major complication (5% grade 3, 2% grade 4, and 2% grade 5). The most common complications were transfusion-related, re-laparotomy because of bleeding, and prolong ileus. In univariate analysis, pathological T-stage (P = 0.001), American Society of Anesthesiologists (ASA) score (P = 0.007), tumor size (P = 0.01), and tumor diameter >4 cm (P = 0.03) were significant predicting factors. Major Charlson comorbidity index (CCI >2) was the only significant factor for major complications (P = 0.04). In multivariate analysis, ASA score was a significant independent predictor for overall complications (odds ratio 4.83, P = 0.01). Conclusions: ASA score was a significant predictive factor for overall postoperative complications. Comorbidities was also a predictor for major complications in radical nephrectomy. Preoperative risk stratification for complications should be considered during decision-making and for proper counseling of patients.

Long-term lower urinary tract dysfunction after radical hysterectomy in patients with early postoperative voiding dysfunction: reply to comments by Sansone et al.

Dear Editor, We would like to thank Sansone et al. [1] for their interest in our article [2]. In response, we have the following comments. Late lower urinary tract (LUT) dysfunction such as decreased bladder compliance, detrusor overactivity, urinary incontinence, and voiding dysfunction usually resolve within 6–12 months. We hypothesized that some of them may persist beyond 1 year. LUT dysfunction is the most common long-term complication which may affect quality of life. Our focus was on the long-term sequelae. Since cancer recurrence beyond 2 year is infrequent, we chose to explore the LUT dysfunction at least 2 years after radical hysterectomy. Median time since surgery in our study was 5 years (2–11 years), which was similar in both groups (groups A and B). Age has been determined to be the most significant risk factor for LUT dysfunction [3]. Although median age in the patients after surgery (groups A and B) is higher than the patients before surgery (group C), there was no statistical significance. Voiding dysfunctions in the difference were diagnosed from both validated questionnaire (UDI and IIQ) and urodynamic studies and were more prevalent in the patients after surgery. Patients who had early postoperative voiding dysfunction (group A) were particularly affected. In contrast, storage dysfunction as diagnosed by urodynamic studies was similar in all groups. We agree that the followup timing may be one of the major factors that influence the detection of bladder dysfunction after radical hysterectomy. However, it is interesting to note that only voiding dysfunction was significantly higher in the patients after surgery, despite that storage dysfunction should be more common. If the follow-up timing had an effect to the incidence of LUT dysfunction, patients after surgery should have a significantly higher incidence of both storage and voiding dysfunction. From our result, it was possible that only voiding dysfunction may persist in the long term. Early voiding dysfunction might influence late voiding dysfunction. However, we agree that large prospective trials should be conducted to prove this possibility. Neurological damage from radical surgery, especially the loss of control from alpha adrenergic receptors, will relax the internal urethral sphincter at the bladder neck and proximal urethra, causing stress urinary incontinence. Benedetti-Panici et al. reported that maximal urethral closure pressure (MUCP) decreased significantly after type 3–4 radical hysterectomy [4]. Although, MUCP was lower in patients after surgery and lowest in group A, there was no significant difference noted. This parameter was shown in Table 2 (page 98). No patient had MUCP lower than 20 cmH2O even in patients who were diagnosed as experiencing urodynamic stress incontinence. Our finding was similar to the report of Lin et al. [5]. We agree that large prospective trials with a translational component including multicenter collaboration would be beneficial to draw definite conclusions. T. Manchana :C. Prasartsakulchai Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand