Bannakij Lojanapiwat

Intravesicle Formalin Instillation with a Modified Technique for Controlling Haemorrhage Secondary to Radiation Cystitis

OBJECTIVE Intractable haemorrhage, secondary to radiation cystitis, is a serious complication of radiotherapy for pelvic malignancies. Formalin instillation is often effective for intractable haemorrhage unresponsive to other agents, but carries the risk of significant morbidity. The placement of formalin-soaked pledgets is a modified technique for the treatment of this complication. We compare the effectiveness and complications of both techniques. METHODS Eleven patients with intractable haemorrhage secondary to radiation cystitis were treated by intravesicle 4% formalin instillation [Group I] and eight were treated by the endoscopic placement of 10% formalin-soaked pledgets on the bleeding points for 15 minutes [Group II]. RESULTS Cessation of bleeding was 9 of 11 [82%] and 6 of 8 [75%] in Group I and Group II, respectively. One patient in Group II required two treatments, due to recurrent haemorrhage. Four major and several minor complications were found in Group I, and only three minor complications were found in Group II. CONCLUSION Formalin instillation is effective in controlling severe bladder haemorrhage after radiation of the pelvis, but the complications secondary to the fixative properties are severe. Topical application of formalin-soaked pledgets is as effective in controlling the haemorrhage as conventional intravesicle formalin instillation, with fewer complications. This technique should be the initial treatment for this complication.

Correlation and diagnostic performance of the prostate-specific antigen level with the diagnosis, aggressiveness, and bone metastasis of prostate cancer in clinical practice

Purpose The common tool for diagnosing prostate cancer is serum prostate-specific antigen (PSA) testing and digital rectal examination, but the disadvantage of the high sensitivity and low specificity of PSA testing in the diagnosis of prostate cancer is a problem in clinical practice. We studied the correlation and diagnostic performance of the PSA level with cancer diagnosis, aggressiveness of prostate cancer (Gleason score>7), and bone metastasis. Methods A total 1,116 patients who underwent transrectal ultrasound and prostate biopsy were retrospectively studied. The patients were divided into subgroups by baseline PSA level as follows: ≤4, 4.1–10, 10.1–20, 20.1–50, 50.1–100, and >100 ng/mL. The area under the receiver operating characteristic curve (AuROC), sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of each PSA level were evaluated for correlation and diagnostic performance with positive biopsy, Gleason score for aggressiveness, and bone metastasis. Results A positive biopsy result was found in 395 patients (35.39%). The PSA level corresponded well with the diagnosis of prostate cancer and a positive bone scan but moderately well with Gleason score as shown by AuROC for diagnosis of prostate cancer (0.82), positive bone scan (0.88), and Gleason score>7 (0.78). The specificity of a PSA level of 4.1–10, 10.1–20, 21.1–50, 50.1–100, and >100 ng/mL in the diagnosis prostate cancer was 9.3, 55.5, 87.5, 98.2, and 99.7, respectively. Conclusions The data showed a strong correlation of PSA level with tumor diagnosis, tumor aggressiveness, and bone metastasis. The prevalence of prostate cancer in this cohort was 35.39%. The chance of diagnosis of prostate cancer was greater than that for benign prostatic hyperplasia when the PSA level was higher than 20 ng/mL.

Endoscopic treatment of benign ureteral strictures.

BACKGROUND The traditional choice of procedure for treatment of ureteral stricture is open surgical repair. Advances in endourology have provided the urological surgeon with an alternative to open surgery for the treatment of benign ureteral stricture. METHODS Twenty-seven benign ureteral strictures in 24 patients were treated by the endourological method. Twelve endoureterotomies were performed using a cold knife via a 9.5Fr Storz ureteroscope and 15 high pressure balloon dilations were performed. The ureters were stented with 7 Fr double-J stents for 6 weeks. RESULTS The success rate was 9/12 (75%) in the endoureterotomy group and 9/15 (60%) in the balloon dilation group after follow-up for more than 6 months. CONCLUSIONS Endoscopic treatment of ureteral strictures appeared to be a safe and reasonably effective modality for the treatment of ureteral strictures, especially for the short type that are non-ischaemic in origin and not associated with radiation therapy. Endourological treatment of ureteral strictures is the procedure of choice for initial management of benign ureteral strictures and has high success rates and fewer complications.

Urologic cancer in Thailand

Cancer is a major health burden among non-communicable diseases, which has had a high impact on the healthcare system in Thailand. Based on GLOBOCAN, the prevalence of urologic cancer is increasing in Thailand. Prostate, bladder and kidney cancers are 6th, 15th and 22nd most common cancers, respectively, in both males and females. Prostate cancer is the fourth most common cancer in male. Cancer in the lower socioeconomic groups is a challenging problem due to greater exposure to the risk factors and more limited access to the healthcare service. The cancers are usually detected in advanced stages of the cancer. The most common histopathological finding of kidney cancer is a renal cell carcinoma. Transitional cell carcinoma is the most common histopathology of bladder. There is a trend of stage migration to earlier stages at first presentation, probably due to public awareness and laboratory screening. Patients with early stage are treated with minimally invasive modalities such as endoscopic, laparoscopic or robot-assisted laparoscopic surgery. Laparoscopic radical prostatectomy and robot-assisted laparoscopic radical prostatectomy is the mainstay treatment of localized prostate cancer with the better outcome and less complication. Androgen deprivation therapy is usually for elderly or unfit patients. The strategy for early detection of early cancer is the important role of Thai urologists to manage these three common urologic cancers.

The efficacy of peritubal analgesic infiltration in postoperative pain following percutaneous nephrolithotomy – A prospective randomized controlled study

ABSTRACT Objective: To study the efficacy of peritubal infiltration in postoperative pain following percutaneous nephrolithotomy in general PCNL patients and PCNL patients with supracostal renal access. Patients and Methods: A total of 105 PCNL patients were randomized into two groups, 53 patients receiving peritubal analgesic infiltration (study group) and 52 patients as the control group. Of these patients, supracostal access was performed in 22 patients of study group and 23 patients of control group. The study group received peritubal injection with 10mL of bupivacain. Postoperative pain as the primary outcome was assessed by using visual analogue scale at 1, 4, 12, 24 and 48 hours postoperatively. The secondary outcomes were the total postoperative morphine usage in 24 hours and time of the first analgesic demand. Results: The average VAS pain at 1 and 4 hours after the operation in the study group were significant lower in the control group (P≤0.001 and 0.026). Doses of morphine usage for controlling postoperative pain and the first analgesic demand were significantly lower and longer in study group. Among patients submitted to supracostal access, the average VAS pain at 1 hour after operation in the study group was lower (P=0.018). Doses of morphine usage for controlling postoperative pain also was lower in the study group (P=0.012). Conclusion: The peritubal local anesthetic infiltration is effective in alleviating immediate postoperative pain after percutaneous nephrolithotomy even with supracostal access.

Asia prostate cancer study (A-CaP Study) launch symposium

The Asian Prostate Cancer (A-CaP) Study is an Asia-wide initiative that has been developed over the course of 2 years. The A-CaP Study is scheduled to begin in 2016, when each participating country or region will begin registration of newly diagnosed prostate cancer patients and conduct prognosis investigations. From the data gathered, common research themes will be identified, such as comparisons among Asian countries of background factors in newly diagnosed prostate cancer patients. This is the first Asia-wide study of prostate cancer and has developed from single country research efforts in this field, including in Japan and Korea. The inaugural Board Meeting of A-CaP was held on December 11, 2015 at the Research Center for Advanced Science and Technology, The University of Tokyo, attended by representatives of all participating countries and regions, who signed a memorandum of understanding concerning registration for A-CaP. Following the Board Meeting an A-CaP Launch Symposium was held. The symposium was attended by representatives of countries and regions participating in A-CaP, who gave presentations. Presentations and a keynote address were also delivered by representatives of the University of California San Francisco, USA, and the Peter MacCallum Cancer Centre, Australia, who provided insight and experience on similar databases compiled in their respective countries.

Renal angiomyolipoma with bleeding.

A 47-year-old woman was referred to our hospital for the management of her large abdominal mass. She had a history of right flank pain off and on for 2-3 years. She was admitted to the provincial hospital in the previous four days due to right flank pain and nausea. She had no history of trauma. Abdominal computed tomography (CT) was performed and liposarcoma was suspected in the right flank. She was pale and was found to have an ill-defined 14x17 cm mass with mild tenderness in the right flank. Her blood pressure and pulse was 130/80 mm Hg and 80/minute, and body temperature was 36.5 o C. Laboratory investigations were: hemoglobin 6.2 g/dL, hematocrit 20.3%, white blood cell count 9.6x103/mm 3 and creatinine 1 mg/dl. Urinalysis revealed red blood cell 1-2 while white blood cell 8-12 in the high power field.

Report of the Second Asian Prostate Cancer (A-CaP) Study Meeting

The Asian Prostate Cancer (A-CaP) Study is an Asia-wide initiative that has been developed over the course of 2 years. The study was launched in December 2015 in Tokyo, Japan, and the participating countries and regions engaged in preparations for the study during the course of 2016, including patient registration and creation of databases for the purpose of the study. The Second A-CaP Meeting was held on September 8, 2016 in Seoul, Korea, with the participation of members and collaborators from 12 countries and regions. Under the study, each participating country or region will begin registration of newly diagnosed prostate cancer patients and conduct prognostic investigations. From the data gathered, common research themes will be identified, such as comparisons among Asian countries of background factors in newly diagnosed prostate cancer patients. This is the first Asia-wide study of prostate cancer and has developed from single country research efforts in this field, including in Japan and Korea. At the Second Meeting, participating countries and regions discussed the status of preparations and discussed various issues that are being faced. These issues include technical challenges in creating databases, promoting participation in each country or region, clarifying issues relating to data input, addressing institutional issues such as institutional review board requirements, and the need for dedicated data managers. The meeting was positioned as an opportunity to share information and address outstanding issues prior to the initiation of the study. In addition to A-CaP-specific discussions, a series of special lectures was also delivered as a means of providing international perspectives on the latest developments in prostate cancer and the use of databases and registration studies around the world.

Report of the third Asian Prostate Cancer study meeting

The Asian Prostate Cancer (A-CaP) study is an Asia-wide initiative that was launched in December 2015 in Tokyo, Japan, with the objective of surveying information about patients who have received a histopathological diagnosis of prostate cancer (PCa) and are undergoing treatment and clarifying distribution of staging, the actual status of treatment choices, and treatment outcomes. The study aims to clarify the clinical situation for PCa in Asia and use the outcomes for the purposes of international comparison. Following the first meeting in Tokyo in December 2015, the second A-CaP meeting was held in Seoul, Korea, in September 2016. This, the third A-CaP meeting, was held on October 14, 2017, in Chiang Mai, Thailand, with the participation of members and collaborators from 12 countries and regions. In the meeting, participating countries and regions presented the current status of data collection, and the A-CaP office presented a preliminary analysis of the registered cases received from each country and region. Participants discussed ongoing challenges relating to data input and collection, institutional, and legislative issues that may present barriers to data sharing, and the outlook for further patient registrations through to the end of the registration period in December 2018. In addition to A-CaP–specific discussions, a series of special lectures were also delivered on the situation for health insurance in the United States, the correlation between insurance coverage and PCa outcomes, and the outlook for robotic surgery in the Asia-Pacific region. Members also confirmed the principles of authorship in collaborative studies, with a view to publishing original articles based on A-CaP data in the future.

Prospective performance of the Prostate Health Index in prostate cancer detection in the first prostate biopsy of men with a total prostatic specific antigen of 4–10 ng/mL and negative digital rectal examination

Background The disadvantage of using total serum prostatic specific antigen (PSA) test for detection of prostate cancer is that it has a low specificity. The low specificity of total PSA (tPSA) test leads to unnecessary prostate biopsies. In this prospective study, we assessed the serum tPSA, free PSA, p2PSA, and the Prostate Health Index (PHI) in the detection of prostate cancer in men with a tPSA of 4–10 ng/mL and a negative digital rectal examination (DRE). Materials and methods 101 male outpatients with a serum PSA of 4–10 ng/mL and nonsuspicious DRE for prostate cancer who underwent first transrectal ultrasound with a prostate biopsy were recruited. A blood sample to enable tPSA, free PSA, and p2PSA levels to be calculated was drawn before the prostate biopsy. The diagnosis and detection of high-grade cancer are correlated with the blood sample. Results Sixteen patients were positive for prostate cancer. All had significantly higher serum 2pPSA and PHI levels than patients with no cancer. A PHI level at 90% sensitivity (cutoff of 34.14) demonstrated a higher area under the receiver operating characteristic curve and more specificity in diagnosis and detection of high-grade prostate cancer than other tests. Conclusions The PHI in men with a PSA level of 4–10 ng/mL with negative DRE increased specificity in the detection of prostate cancer. This test is useful in discriminating between patients with or without cancer and also enables the detection of high-grade cancer avoiding unnecessary biopsies.