Phichaya Sujijantararat

Outcomes of surgical treatment for upper urinary tract transitional cell carcinoma: Comparison of retroperitoneoscopic and open nephroureterectomy

ObjectivesTo determine the surgical and oncologic outcomes in patients who underwent retroperitoneoscopic nephroureterectomy (RNU) in comparison to standard open nephroureterectomy (ONU) for upper urinary tract transitional cell carcinoma (TCC).Patients and methodsFrom April 2001 to January 2007, 60 total nephroureterectomy were performed for upper tract TCC at Siriraj Hospital. Of the 60 patients, thirty-one were treated with RNU and open bladder cuff excision, and twenty-nine with ONU. Our data were reviewed and analyzed retrospectively. The recorded data included sex, age, history of bladder cancer, type of surgery, tumor characteristics, postoperative course, disease recurrence and progression.ResultsThe mean operative time was longer in the RNU group than in the ONU group (258.8 versus 190.6 min; p = 0. < 001). On the other hand, the mean blood loss and the dose of parenteral analgesia (morphine sulphate) were lower in the RNU group (289.3 versus 313.7 ml and 2.05 versus 6.72 mg; p = 0.868 and p = 0.018, respectively). There were two complications in each group. No significant difference in p stage and grade in both-groups (p = 0.951, p = 0.077). One patient with RNU had lymph node involvement, three in ONU. Mean follow up was 26.4 months (range 3–72) for RNU and 27.9 months (range 3–63) for ONU. No port metastasis occurred during follow up in RNU group. Tumor recurrence developed in 11 patients (bladder recurrence in 9 patients, local recurrence in 2 patients) in the RNU group and 14 patients (bladder recurrence in 13 patients, local recurrence in 1 patient) in the ONU group. No significant difference was detected in the tumor recurrence rate between the two procedures (p = 0.2716). Distant metastases developed in 3 patients (9.7%) after RNU and 2 patients (6.9%) after ONU. The 2 year disease specific survival rate after RNU and ONU was 86.3% and 92.5%, respectively (p = 0.8227).ConclusionRetroperitoneoscopic nephroureterectomy is less invasive than open surgery and is an oncological feasible operation. Thus, the results of our study supported the continued development of laparoscopic technique in the management of upper tract TCC.

Comparative Outcome Between Transverse Island Flap Onlay and Tubularized Incised Plate for Primary Hypospadias Repair

OBJECTIVE To compare the outcome of transverse island flap (TVIF) onlay with tubularized incised plate urethroplasty (TIP) in primary hypospadias repair. PATIENTS AND METHODS We retrospectively evaluated 76 consecutive patients who underwent TVIF onlay (n = 42) and TIP (n = 36) between January 1997 and April 2006. The success rate and complications were compared according to the surgical technique and the severity of the defect (meatal position prior to surgery). RESULTS The mean patient age at surgery was 48 (range, 9-132) months in the TVIF onlay group and 49 (range, 10-348) months in the TIP group. All patients were followed-up for at least 12 months. With mean follow-ups of 40 months and 32 months, the overall complication rates were 30.9% (13/42) and 23.5% (8/34) in the TVIF onlay group and TIP group respectively (p = 0.305). Urethrocutaneous fistula rates were 23.8% (10/42) in the TVIF onlay group compared to 14.7% (5/34) in the TIP group (p = 0.393). No complications were found in either group with distal hypospadias. In proximal hypospadias, the complication rate was 30% (6/20) in the TVIF onlay group, compared to 37.5% (6/16) in the TIP group (p = 0.751). CONCLUSION In this study, the surgical outcomes of TVIF onlay and TIP were comparable. The TIP procedure should be preferred for distal and midshaft defects because of its simplicity and low complication rate. In proximal hypospadias repair, TVIF onlay might be better than TIP; this will be clearer once the number of patients have increased sufficiently to show statistical significance.

Laparoscopic Live-Donor Nephrectomy: A Comparison with the Open Technique and How to Reach Quality Standards: A Single-Center Experience in Thailand

OBJECTIVE We report our experience with laparoscopic donor nephrectomy (LDN) compared with open donor nephrectomy (ODN). Prognostic factors associated with adverse outcomes in LDN were identified. METHODS From January 2000 to December 2009, 243 consecutive live-donor nephrectomies were performed, including 129 LDNs and 114 ODNs. We compared patient demographics, perioperative outcomes, and recipient graft function in each group. Prognostic factors for adverse outcomes in LDN were investigated using uni- and multivariate analyses. RESULTS Patient demographics, except mean donor age (P=.032), were similar between groups. Mean operative time (219 vs 163 minutes; P<.001) and warm ischemia time (WIT; 3.1 vs 1.7 minutes; P<.001) were significantly longer in LDN. Conversely, mean analgesic requirement (9.2 vs 14.7 mg morphine; P<.001) and postoperative hospital stay (6.5 vs 7.1 days; P=.003) were significantly lower with LDN. Mean estimated blood loss (EBL) was slightly lower in LDN (P=.15). There were 7 conversions from LDN to ODN. Complication rates were similar between the groups (P=.38). Delayed graft function (10.9% vs 1.7%; P=.016) and mean serum creatinine level at 1 month (1.47 vs 1.3 mg/dL; P=.04) were higher for LDN. However, 5-year allograft survival was not inferior among LDN (90% vs 85%; P=.42). Mean operative time (268 to 175 minutes; P<.001), EBL (316 to 66 mL; P<.001), and complication incidence (8 to 0 cases; P<.002) gradually decreased from the initial 43 cases to the last 43 cases of LDNs. Among surgeons who had performed-30 LDNs, the mean operative time and WIT were 197 mL and 2.8 minutes, respectively. CONCLUSIONS Based on our evidence, LDN was a feasible and safe surgical option for live-donor nephrectomy, even in a small volume center. Better results can be achieved after a learning curve of experience for both the surgeon and the institution.