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PURPOSE: Cloquet’s node, located at the junction between the deep inguinal nodes and the external iliac chain, is easily accessible and commonly excised during pelvic lymph node dissection for prostate cancer. However, we hypothesize that Cloquet’s node is not part of lymphatic metastatic spread of prostate cancer. MATERIALS AND METHODS: Between September 2016 and June 2019, 105 consecutive patients with high-risk prostate cancer (cT3a + or Grade Group 4 / 5 or PSA >20 ng/mL) underwent a laparoscopic radical prostatectomy and pelvic lymph node dissection. First, Cloquet’s node was identified, retrieved, and submitted separately to pathology as right and left Cloquet’s node. Next, a pelvic lymph node dissection was completed including the external iliac, obturator fossa, and hypogastric nodal packets. Each lymph node was cut in 3-mm slices which were separately embedded in paraffin, stained with hematoxylin and eosin, and examined microscopically. RESULTS: The final analysis included 95 patients. In this high-risk population, the median number of nodes removed was 22 (IQR 18–29); 39/95 patients (41%) had lymph node metastasis. The median number of Cloquet’s nodes removed was 2 (IQR 2–3). Cloquet’s node was negative in all but one patient (1.1%), who had very high-risk features and high metastatic burden in the lymph nodes. CONCLUSIONS: In high-risk prostate cancer, metastasis to the ilio-inguinal node of Cloquet is rare. Given this low prevalence, Cloquet’s node can be safely excluded from the pelvic lymph node dissection template.

Androgen deprivation therapy (ADT) alone has been the cornerstone of treatment for patients with newly diagnosed metastatic prostate cancer for the past century. Based on results from landmark trials in the past decade, combination approaches of ADT with chemotherapy or novel hormonal agents have established a new standard of care for these patients. This paradigm shift in treatment has been reflected in the updates to guideline recommendations of major professional associations. However, real-world data from around the world have highlighted the dismal adoption of combination therapy, despite evidence-based recommendations. The disparity between evidence and practice is concerning, especially with emerging evidence of survival benefit with further treatment intensification using triplet combinations (ADT, docetaxel and novel hormonal agents). Thus, a pressing need to raise awareness and call the uro-oncology community to action exists to deliver evidence-based care for these patients.

Pathologic nodal invasion at prostatectomy is frequently associated with persistently elevated prostate-specific antigen (PSA) and with increased risk of disease recurrence. Management strategies for these patients are poorly defined. We aimed to explore the long-term oncologic outcomes and patterns of disease progression.We included men treated between 2000 and 2017 who had lymph node invasion at radical prostatectomy and persistently detectable prostate-specific antigen post-prostatectomy. Postoperative imaging and management strategies were collated. Patterns of recurrence and probability of metastasis-free survival, prostate cancer-specific survival, and overall survival (OS) were assessed.Among our cohort of 253 patients, 126 developed metastasis. Twenty-five had a positive scan within 6 months of surgery; of these, 15 (60%) had a nodal metastasis, 10 (40%) had a bone metastasis, and 4 (16%) had local recurrence. For metastasis-free survival, 5- and 10-year probabilities were 52% (95% CI 45%, 58%) and 37% (95% CI 28%, 46%), respectively. For prostate cancer-specific survival, 5- and 10-year probabilities were 89% (95% CI 84%, 93%) and 67% (95% CI 57%, 76%), respectively. A total of 221 patients proceeded to hormonal deprivation treatment alone. Ten patients received postoperative radiotherapy.Biochemical persistence in patients with lymph node invasion is associated with high risk of disease progression and reduced prostate cancer-specific survival. Management was hindered by the limitation of imaging modalities utilized during the study period in accurately detecting residual disease. Novel molecular imaging may improve staging and help design a therapeutic strategy adapted to patients' specific needs.

Objective: To review the presentation, predisposing factors, treatment and outcome of renal vascular malformation, including arteriovenous malformation (AVM), arteriovenous fistula (AVF) and pseudoaneurysm of the kidney in Ramathibodi Hospital. Material and Method: In-patient medical records from January 2007 to January 2017 were retrospectively reviewed. Patients admitted and diagnosed with any type of vascular malformation of the kidney, comprising AVM, AVF and pseudoaneurysm in Ramathibodi Hospital were included in the study. Baseline characteristics of the patients, including gender, age at diagnosis, and underlying disease were recorded. Vascular malformation, clinical presentation, imaging data, predisposing factors of the disease, treatment and the outcome of patients were summarized and reported. Results: Seventeen patients were diagnosed with vascular malformation; 9 patients were males and 8 females. The most common comorbidity was hypertension, followed by chronic kidney disease. Nine patients had AVF (52.94%), 3 had AVM (17.65%), 2 had pseudoaneurysm (11.76%), and 3 had AVF with pseudoaneurysm (17.65%). Common presentations were gross hematuria, flank pain, anemia, and hypovolemic shock. Previous surgery and history of renal biopsy were mutual predisposing factors. Embolization was the most common treatment option. All patients were asymptomatic on follow-up visit with a median follow-up of 90 days. Conclusion: Vascular malformation of the kidney is not a common condition. The history of previous kidney surgery and renal biopsy may help for diagnostic suspicion. Renal embolization was the proper management with a high success rate.

Purpose Kidney transplantation is one of the best treatment options for end-stage renal disease with an incidence of urologic complications of 2.5 to 30%. One of the most serious and frequent urological complications is urinary leakage from ureteroneocystostomy anastomosis. The purpose of this study was to evaluate risk factors of urinary leakage from ureteroneocystostomy anastomosis after kidney transplantation. Patients and methods A retrospective study was performed on patients who received kidney transplantation and were diagnosed with urinary leakage thereafter based on renal scan or drain creatinine per serum creatinine compared with patients in control group. Risk factor assessment was based on inpatient and outpatient information from hospital database. Results From 459 patients who received kidney transplantation in 2016-2018, there were 20 patients who were diagnosed with urinary leakage after they underwent ureteroneocystostomy anastomosis. The significant risk factors for anastomosis leakage were size of suture materials and duration of ureteral stent insertion. No statistically significant difference in other factors such as underlying disease, surgical technique or duration of urinary catheter was found. About overall urological complication, gender and body mass index significantly affected the outcome. Conclusion The rate of urinary leakage complications was found to be about 4.36%. The risk factors of overall complication comprised gender and body mass index. Although a lot of previous studies revealed many risk factors that could affect urinary leakage, size of suture materials and duration of ureteral stent insertion were the significant risk factors in our study. Proper consideration should be given to the size of suture materials and optimal duration of ureteral stent.

Androgen deprivation therapy as single modality therapy was the standard management for oligometastatic prostate cancer (PCa). Current paradigm shifts toward a multimodality therapy approach, targeting all sites of disease, including treatment of the primary in the form of radical prostatectomy or radiation therapy. The objective of this article was to reveiw the literature regarding the role of surgery in oligometastatic PCa. PubMed and MEDLINE electronic databases were queried for English language articles from January 1, 1980 to March 31, 2019. Keywords use included oligometastatic PCa, metastatic prostate cancer (mPCa), radical prostatectomy, and cytoreductive prostatectomy. Preclinical, prospective, and retrospective studies were included. There is no published randomized controlled trials, evaluating the role of surgery in mPCa. Preclinical and retrospective data suggest benefit of primary tumor treatment in mPCa. Current literature supports the concept of cytoreductive surgery as it can prevent late symptomatic local progression, has acceptable complications, and may prolong survival in patients with mPCa. Surgery is a feasible procedure in mPCa which may improve outcome in mPCa. However, there is no Level 1 evidence, yet that support the role of surgery in mPCa. The results from well-organized prospective, randomized controlled trials are awaited before performing radical prostatectomy for mPCa in clinical practice. Keywords: Cytoreductive radical prostatectomy, Metastatic prostate cancer, Oligometastatic prostate cancer, Radical prostatectomy, Surgery in metastatic, Treatment of primary tumor

Although important advances have been achieved in the development of radiolabeled prostate-specific membrane antigen (PSMA)-targeting ligand constructs for both diagnosis and therapy of prostate cancer (PCa) over the past decade, challenges related to off-target effects and limited treatment responses persist. In this study, which builds upon the successful clinical translation of a series of ultrasmall, dye-encapsulating core-shell silica nanoparticles, or Cornell Prime Dots (C′ dots), for cancer management, we sought to address these limitations by designing a dual-modality, PSMA-targeting platform that evades undesirable accumulations in the salivary glands, kidneys, and reticuloendothelial system, while exhibiting bulk renal clearance. This versatile PCa-targeted particle imaging probe offers significant clinical potential to improve future theranostic applications in a variety of patient care settings.

Purpose: To compare the trifecta outcome and perioperative and postoperative outcomes among open partial nephrectomy (OPN), laparoscopic partial nephrectomy (LPN), and robotic-assisted partial nephrectomy (RAPN) in patients with small renal masses in Ramathibodi Hospital.Methods: We retrospectively reviewed 141 patients who underwent partial nephrectomy from January 2009 to December 2018. The baseline characteristics and preoperative outcomes were compared among the three surgical approaches. Results: Among the 141 patients, 42 (29.79%), 29 (20.57%), and 70 (49.64%) patients underwent OPN, LPN, and RAPN, respectively. Among 116 patients with available data, 71 achieved the trifecta outcome [18 (56.25%), 14 (56.00%), and 39 (73.58%) in the OPN, LPN, and RAPN group, respectively; p=0.276]. The rate of conversion to OPN was higher in the LPN than RAPN group. The number of patients who received intraoperative packed red cells was lowest in the RAPN group. The estimated blood loss was significantly lower in the LPN group than OPN and RAPN groups (p=0.041). The operative time was shorter in the OPN group than LPN and RAPN groups (pConclusion: OPN had the shortest operative time. LPN had the highest rate of conversion to OPN and lowest estimated blood loss. The number of patients who received intraoperative packed red cells was lowest in the RAPN group. However, achievement of the trifecta outcome was not significantly different among the three groups. The predictive factor for trifecta outcome achievement was the intraoperative complication rate.

Purpose Kidney transplantation is one of the best treatment options for end-stage renal disease with an incidence of urologic complications of 2.5 to 30%. One of the most serious and frequent urological complications is urinary leakage from ureteroneocystostomy anastomosis. The purpose of this study was to evaluate risk factors of urinary leakage from ureteroneocystostomy anastomosis after kidney transplantation. Patients and Methods A retrospective study was performed on patients who received kidney transplantation and were diagnosed with urinary leakage thereafter based on renal scan or drain creatinine per serum creatinine compared with patients in control group. Risk factor assessment was based on inpatient and outpatient information from hospital database. Results From 459 patients who received kidney transplantation in 2016–2018, there were 20 patients who were diagnosed with urinary leakage after they underwent ureteroneocystostomy anastomosis. The significant risk factors for anastomosis leakage were size of suture materials and duration of ureteral stent insertion. No statistically significant difference in other factors such as underlying disease, surgical technique or duration of urinary catheter was found. About overall urological complication, gender and body mass index significantly affected the outcome. Conclusion The rate of urinary leakage complications was found to be about 4.36%. The risk factors of overall complication comprised gender and body mass index. Although a lot of previous studies revealed many risk factors that could affect urinary leakage, size of suture materials and duration of ureteral stent insertion were the significant risk factors in our study. Proper consideration should be given to the size of suture materials and optimal duration of ureteral stent.

Objective The aim of this work was to report our experience in robotic-assisted laparoscopic radical prostatectomy for the treatment of localized prostate cancer in a kidney transplant recipient. Methods A 73-year-old man with chronic renal failure underwent living-donor kidney transplantation (KT) in 1993. His baseline creatinine after KT was ∼1.2 mg/dL. He developed lower urinary tract symptoms in 1999. He was diagnosed with benign prostatic hyperplasia and treated accordingly. He was followed regularly with the use of digital rectal examination and measurement of serum prostatic-specific antigen (PSA). In 2014, his serum PSA was 11.53 ng/mL. Prostate biopsy was done and revealed localized prostatic adenocarcinoma with a Gleason score of 7 (3+4). We performed robotic-assisted laparoscopic radical prostatectomy with the use of the Retzius space preservation technique. Results The patient underwent successful robotic-assisted laparoscopic radical prostatectomy without any complications. The operative time was 210 minutes with estimated blood loss of 250 mL. The patient tolerated the procedure well and was discharged on the 6th day after surgery with a retained Foley catheter. A cystogram was done on the 13th day after surgery and showed no urethrovesical anastomosis leakage. After Foley catheter removal, the patient could urinate normally without urinary incontinence. Pathologic analysis revealed positive surgical margin with no extraprostatic extension and no seminal vesical invasion. One month after the operation, PSA was 0.08 ng/mL and renal function remained stable. Conclusions Robotic-assisted laparoscopic radical prostatectomy is technically feasible and safe for the treatment of localized prostate cancer in the renal transplant patient. The Retzius space preservation technique is helpful in minimizing the manipulation of transplanted kidney and urinary bladder during the operation, resulting in favorable postoperative renal function and continence outcome.