Bumjin Lim

Comparing Argus sling and artificial urinary sphincter in patients with moderate post-prostatectomy incontinence

Post-prostatectomy incontinence (PPI) is a main complication of radical prostatectomy. The purpose of this study was to compare the efficacy and safety of the Argus male sling (Argus) with that of artificial urinary sphincters (AUS) in patients with moderate PPI. A total of 33 moderate PPI patients underwent AUS or Argus implantation from January 2009 to June 2013 (13 AUS, 20 Argus). We defined moderate PPI as the use of 2–4 pads per day. To compare efficacy, we assessed the success rate between the two groups. Success was defined as the daily need for no pads or one small safety pad that remained dry most of the day. The mean patient age was 73.5±6.3 yr in the AUS group and 70.9±5.1 yr in the Argus group, and the mean follow-up period was 29.8±14.9 months in the AUS group and 24.7±11.8 months in the Argus group. The success rate was 72.7% in the AUS group and 85.0% in the Argus group (P=0.557). Abnormal postoperative pain persisted in more patients in the Argus group (6/20, 30%) than in the AUS group (1/13, 7.7%) (P=0.126). However, the rate of other complications was not different between the two groups (7.7% and 15.0% for AUS and Argus, respectively, P=0.822). Argus surgery showed similar success and complication rates to those of AUS in moderate PPI patients, indicating that it could be an alternative surgical option for the treatment of moderate PPI.

Clinicopathological features of Xp11.2 translocation renal cell carcinoma

Purpose Xp11.2 translocation renal cell carcinoma (RCC) is characterized by various translocations of the TFE3 transcription factor gene. These rare cancers occur predominantly in children and young adults. Here, we review the clinicopathological features of Xp11.2 translocation RCC. Materials and Methods We identified 21 patients with Xp11.2 translocation RCC. We retrospectively analyzed patient characteristics, clinical manifestations, and specific pathological features to assess definitive diagnosis, surgical and systemic treatments, and clinical outcomes. Results The mean age at diagnosis was 43.4±20.0 years (range, 8-80 years; 8 males and 13 females). Eleven patients were incidentally diagnosed, nine patients presented with local symptoms, and one patient presented with systemic symptoms. The mean tumor size was 6.2±3.8 cm (range, 1.9-14 cm). At the time of diagnosis, 11, 1, and 5 patients showed stage I, II, and III, respectively. Four patients showed distant metastasis. At analysis, 15 patients were disease-free after a median follow-up period of 30.0 months. Four patients received target therapy but not effectively. Conclusions Xp11 translocation RCC tends to develop in young patients with lymph node metastasis. Targeted therapy did not effectively treat our patients. Surgery is the only effective therapy for Xp11 translocation RCC, and further studies are needed to assess systemic therapy and long-term prognosis.

Simple Renal Cyst and Renal Dysfunction: A Pilot Study Using Dimercaptosuccinic Acid Renal Scan

Little is known about the association between renal cyst and renal dysfunction. We evaluated the deterioration of renal function in patients with unilateral, large, simple renal cysts.

Changes of calcific density in pediatric patients with testicular microlithiasis

Purpose Testicular microlithiasis (TM) is a relatively rare clinical entity of controversial significance characterized by the existence of hydroxyapatite microliths located in the seminiferous tubules. The aim of this study was to observe the natural course of changes in the calcific density of pediatric TM. Materials and Methods We included a total of 23 TM patients undergoing scrotal ultrasound (US) on at least two occasions from July 1997 to August 2014. We retrospectively analyzed the patient characteristics, clinical manifestations, specific pathological features, and clinical outcomes. We measured the calcified area and compared the calcific density between the initial and final USs. Results The mean age at diagnosis was 11.3±4.6 years, and the follow-up period was 79.1±38.8 months (range, 25.4-152.9 months). During the follow-up period, no patients developed testicular cancer. Calcific density on US was increased in the last versus the initial US, but not to a statistically significant degree (3.74%±6.0% vs. 3.06%±4.38%, respectively, p=0.147). When we defined groups with increased and decreased calcification, we found that diffuse TM was categorized into the increased group to a greater degree than focal TM (10/20 vs. 4/23, respectively, p=0.049). In addition, five of eight cases of cryptorchidism (including two cases of bilateral cryptorchidism) were categorized in the increased calcification group. Conclusions Diffuse TM and cryptorchidism tend to increase calcific density. Close observation is therefore recommended for cases of TM combined with cryptorchidism and cases of diffuse TM.

MP55-18 ADJUVANT CHEMOTHERAPY AFTER RADICAL CYSTECTOMY FOR MUSCLE-INVASIVE BLADDER CANCER: A COMPARATIVE STUDY USING INVERSE-PROBABILITY-OF-TREATMENT WEIGHTING (IPTW)

INTRODUCTION AND OBJECTIVES: Inflammation plays an important role in the biology of many malignancies and is considered a hallmark of cancer. An elevated ratio of peripheral neutrophils to lymphocytes (NLR), a marker of host inflammation, has been associated with poor outcome in various solid tumors. We aimed to assess the association between pre-treatment NLR and survival in a large series of patients undergoing radical cystectomy (RC) for urothelial carcinoma of the bladder (UCB). METHODS: Patients undergoing RC for UCB between 19882012 were identified using our institutional RC database. NLR was computed using complete blood counts with differentials performed preRC, or prior to neo-adjuvant chemotherapy where applicable. Given the heterogeneity of cutpoints used in the literature, time dependent receiver operator characteristics (ROC) curves were used to determine the optimal cutpoint for predicting recurrence-free (RFS), cancer-specific (CSS) and overall survival (OS) among the range of values used in the existing literature. The predictive ability of NLR was then assessed using Kaplan-Meier analyses and multivariable Cox-proportional hazards models adjusting for age, gender, co-morbidity score, hemogloblin, platelet count, stage, surgical margin status, and receipt of neo-adjuvant or adjuvant chemotherapy. Lastly, the likelihood ratio test was used to determine if multivariable models were improved by the inclusion of NLR. RESULTS: Of the final cohort of 416 patients, median follow up was 58.4 months. There were 178 (42%) deaths overall, 110 (26%) UCB-related deaths, and 138 recurrences (33%). An NLR of 3 was determined as the optimal cut-off value for predicting survival outcomes based on the inflection point of the ROC curves. Patients with NLR 3 had significantly worse survival outcomes (5y-RFS: 53% vs. 64%, logrank p1⁄40.013; 5y-CSS: 57% vs. 75%, log-rank p<0.001; 5y-OS: 43% vs. 64%, log-rank p<0.001). Upon adjusting for patient and diseasespecific predictors, NLR 3 was significantly associated with worse RFS (HR1⁄41.79; 95%CI1⁄41.22-2.63, p1⁄40.003), CSS (HR1⁄41.94; 95% CI1⁄41.44-2.60, p<0.001) and OS (HR1⁄41.66; 95%CI1⁄41.23-2.25, p1⁄40.001). The likelyhood ratio test confirmed that prognostic models were improved by including NLR. CONCLUSIONS: NLR is an inexpensive prognostic biomarker for patients undergoing radical cystectomy for UCB. It offers pre-treatment prognostic value in addition to established patient and disease-related prognostic indicators, and may be helpful in guiding treatment decisions.

MP52-14 SYNERGISTIC EFFECTS OF COMBINATION OF DOCETAXEL AND SAHA ON AR SIGNALING IN PROSTATE CANCER

INTRODUCTION AND OBJECTIVES: Globally it is the sixth leading cause of cancer-related death in men, and it is now the first in the United Kingdom and second in the United States. At the early stage, androgen is required for cell growth and progression of prostate cancer. Therefore, androgen-deprivation therapy (ADT) is effective to patient with prostate cancer by inhibition of androgen synthesis. With time, however, most patients with prostate cancer eventually lose sensitivity to androgen withdrawal and progress to the development of hormone-refractory prostate cancer (HRPC) or castration-resistant prostate cancer (CRPC). Since the treatment for patient with CRPC is very limited, the novel therapeutic strategies and combination therapy are needed to overcome this resistance. Therefore, we examined whether histone deacetylase inhibitor (HDACI) might enhance the effects of docetaxel in CRPCs. METHODS: Hormone-independent CWR22Rv1 cells harboring androgen receptor (AR) were treated with docetaxel and/or HDACI, suberoylanilide hydroxamic acid (SAHA). Cell viability was measured with CellTiter-Glo¢c reagent. AR signaling was analyzed by immunocytochemistry andWestern blot of total cell lysates and nuclear fractionated proteins. RESULTS: The growth inhibitory effect of sequential treatment with docetaxel and SAHA was synergistic in CWR22Rv1 cells. Combination treatment decreased the levels of androgen receptor (AR), prostate specific antigen (PSA), and anti-apoptotic Bcl-2 proteins (Mcl-1, Bcl-xl) more efficiently, compared with docetaxel or SAHA alone. And combination treatment increased activation of caspase-3 remarkably, while docetaxel or SAHA alone increased it slightly. Moreover, combination treatment induced acetylation and bundling of tubulin, inhibiting nuclear accumulation of AR significantly. These synergistic effects of combination treatment were also observed in hormone-dependent LNCaP cells. CONCLUSIONS: Docetaxel in combination with SAHA inhibited cell growth efficiently and induced apoptosis by repressing AR expression and translocation to nucleus, resulting in down regulation of AR signaling in hormone-independent CWR22Rv1 cells. These results suggest that combination treatment with docetaxel and SAHA can be a useful therapeutics for the treatment of CRPC patients.

MP57-16 THE IMPACT OF SURGERY ON THE PROGNOSIS OF METASTATIC RENAL CELL CARCINOMA WITH IVC THROMBUS

INTRODUCTION AND OBJECTIVES: Biomarkers may be useful as prognostic indicators prior to and during systemic therapy. We evaluated change in platelet count (DPlt) as a biomarker for response to neoadjuvant tyrosine kinase inhibitor (TKI) therapy for metastatic renal cell carcinoma (mRCC). METHODS: Multi-center retrospective study of mRCC patients undergoing neoadjvant TKI therapy from 5/2005-8/2013. DPlt was defined as post-treatment Plt after first cycle minus pre-treatment Plt. Primary outcome was response of disease to TKI defined by RECIST criteria for partial response (PR), stable disease (SD), and progressive disease (PD). Demographic and clinical characteristics were analyzed between subgroups with stable/increased (+DPlt) and decreased (-DPlt) counts. Cox proportional hazards model evaluated factors associated with changes in tumor response. Kaplan-Meier analysis estimated overall survival (OS) and compared Plt groups with log-rank test. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated for DPlt and disease response PR/SD. RESULTS: A total of 69 patients treated with neoadjuvant TKI therapy were analyzed for DPlt. Overall, 15 patients (22%) were noted to have +DPlt and 54 (78%) had eDPlt after neoadjuvant TKI therapy. There were no other differences in clinical or demographic variables between these two groups (comorbidities, ECOG, tumor size, number of metastases, stage, grade and number of TKI cycles). Patients with +DPlt count had a lower post TKI treatment creatinine (1.0 vs. 1.3, p1⁄40.041). PD was more common among +DPlt 86.7% vs. eDPlt 33.3%, (p1⁄40.001), and SD/PR was more common in eDPlt 66.7% vs. +DPlt 13.3%, (p1⁄40.001). On MVA, -DPlt below baseline was a significant predictor of SD/PR (OR 6.96, p1⁄40.028). A Kaplan Meier analysis (Figure) demonstrated a higher overall survival in -DPlt versus +DPlt (p1⁄40.009), with median survival 13.8 of and 5.7 months respectively. -DPlt had sensitivity of 94.7%, specificity of 41.9%, PPV of 66.7% and NPV of 86.7% for PR/SD after neoadjuvant TKI therapy. CONCLUSIONS: Patients with -DPlt were more likely to respond to TKI therapy and had longer median overall survival. Further investigation is requisite to determine the utility of DPlt as a biomarker for RCC response to TKI.

Endoscopic surgery as an adjuvant treatment modality before or after definitive correction of cloacal anomalies

OBJECTIVE To evaluate the effectiveness of endoscopic surgery before or after definitive correction in patients with a persistent cloaca. MATERIALS AND METHODS The medical records of 16 patients diagnosed with persistent urogenital sinus at our institution were retrospectively reviewed. Of these 16 patients, five underwent endoscopic surgery, such as visual internal urethrotomy or transurethral incision by a single surgeon at the time of or after colostomy formation or corrective surgery. RESULTS All patients underwent colostomy 1-2 days after birth. Three patients were treated by endoscopic procedures before corrective surgery owing to voiding difficulty, urinary tract infection, or hydrocolpos, at a median age of 1 month. Another two patients underwent endoscopic surgery after definitive correction of the cloaca owing to urethral stricture or urinary incontinence. After endoscopic surgery, all patients voided well without residual urine or were catheterised easily without incontinence. Endoscopic modality played a substantial role in managing complications or resolving the anatomical barrier to decompress the genitourinary tract in patients with a common urogenital sinus length of <3 cm. CONCLUSIONS Endoscopic surgery for a cloacal anomaly is a minimally invasive adjuvant technique for bladder neck obstruction, urethral stricture, and hydrocolpos with a thickened vaginal septum.