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Background: The prediction of positive surgical margins (SM) after radical prostatectomy (RP) is important for planning the surgical modality and adjuvant therapy in patients with prostate cancer (PCa)., Objectives: To investigate factors affecting SM positivity in patients diagnosed with PCa who underwent RP using the PCa database of the Urooncology Association (Turkey)., Methods: Patients who underwent RP due to clinically T1c-T3 PCa and who had detailed SM data for the RP specimen were included in the study. Pathological data of 12 core transrectal ultrasound prostate biopsies and RP were evaluated. Patients were divided into 2 groups (SM positive and SM negative) according to SM status after RP. Data were compared between the groups. Factors affecting SM positivity, the number of positive SM sites, and the location of positive SM were separately evaluated with regression models., Results: A total of 2,643 patients from 6 different centers (median age: 63 years) with a prostate-specific antigen (PSA) level of 7.3 ng/mL were investigated in the study. BMI, PSA, biopsy Gleason score (GS), and perineural invasion (PNI) were found to be independent predictive factors for SM positivity and the number of positive SM locations, respectively (p < 0.05). According to the positive SM location, PSA was found to be associated with positive SM in apex, anterior prostate, and bladder neck locations. Also, according to posterolateral SM status, PNI and nerve-sparing RP (nsRP) rates were 21.3 and 44% for patients with negative posterolateral SM, and rates were 35.4 and 50.6% for patients with positive posterolateral SM, respectively (p < 0.05). In patients who underwent nsRP, positive SM was present in 22.2% of patients who did not have PNI on prostate biopsy, whereas positive SM was present in 40.6% of patients with PNI (p < 0.001). Similarly, 10.9% of patients without PNI had positive posterolateral SM, whereas 17.3% of patients with PNI had positive posterolateral SM (p = 0.031)., Conclusions: BMI, PSA, biopsy GS, and biopsy PNI positivity were found to be predictive factors affecting SM positivity. The most important factors affecting posterolateral positive SM were biopsy PNI and nsRP, indicating that the nsRP approach may cause positive SM in the posterolateral margin of the prostate (neurovascular bundle location) in patients with positive PNI on biopsy., (© 2020 S. Karger AG, Basel.)

Aim of this study is to compare the effects of partial nephrectomy (PN) and radical nephrectomy (RN) for stage I renal cell carcinoma (RCC) on renal functions in patients with diabetes mellitus (DM) and/or hypertension (HT). Charts of patients who underwent surgery for stage I RCC in our department were retrospectively reviewed and patients with DM and/or HT were enrolled. Preoperative and postoperative estimated glomerular filtration rates (eGFR) were calculated according to the Modification of Diet in Renal Disease (MDRD) formulation for both RN and PN groups. Groups were compared for patient demographics, preoperative eGFR, postoperative eGFR and ΔeGFR [(preoperative eGFR) - (postoperative eGFR)] which reflects the renal functional loss. There were 85 patients in the RN and 33 patients in the PN groups. Demographic data were similar but the patients in the PN group had smaller tumor size compared to RN group (32.2 ± 11.8 mm vs 47.1 ± 15.2 mm, p < 0.001). Preoperative eGFR did not differ between groups (75 ± 28.4 mL/min/1.73 m 2 vs 75.5 ± 23.8 mL/min/1.73 m 2 in RN and PN groups, p = 0.929). However, there were significant differences between groups in terms of postoperative eGFR (57.5 ± 21.7 mL/min/1.73 m 2 vs 74 ± 27.5 mL/min/1.73 m 2 in RN and PN groups, p < 0.001) and ΔeGFR (17.5 ± 4.2 mL/min/1.73 m 2 vs 1.5 ± 0.4 mL/min/1.73 m 2 in RN and PN groups, p < 0.001). Our findings favor the use of PN over RN for stage I RCC whenever feasible in patients with predisposing systemic diseases for chronic kidney disease for better preservation of renal functions., (Copyright © 2017 Kaohsiung Medical University. Published by Elsevier Taiwan. All rights reserved.)

Purpose: The aim of this study was to investigate the effect of tumor volume on prognosis and the relation of tumor volume with other prognostic factors in patients with renal cell carcinoma (RCC)., Materials and Methods: The study included 46 retrospectively assessed patients with RCC (32 males and 14 females; mean age, 58.13±10.47 years) who underwent surgery between January 2002 and January 2009. Patients were staged according to clinical, radiological, and pathological data. The basic radiological characteristics of tumors and tumor volumes were defined by two observers. The clinical information and the last health status of all patients were recorded. The life duration of the patients after surgery was determined, and cumulative survival rates were calculated., Results: The survival rates showed no difference between the male and female patients (P = 0.569); the five-year survival was 75.7% and 78.5%, respectively. The survival rates demonstrated differences between groups according to potential prognostic markers such as cell type, Fuhrman's grade, the diameter, invasion of perinephric fat, sinus, or adrenal gland, pathological stage, and presence of metastasis. The inter- and intra-observer reliability of radiological volume measurements were 93.6% and 100%, respectively (P < 0.001). Two groups of tumor volume (i.e., smaller and greater than 110 cm < sup > 3 < /sup > ) showed statistically significant difference in terms of survival (P < 0.032). In univariate analysis, only Fuhrman's grade and T stage were independent prognostic variables., Conclusion: Tumor volume is predictive of survival in patients with RCC; however, it does not appear to be an independent prognostic factor. The prognostic factors for overall survival are Fuhrman's grade and T stage.

Percutaneous closure of a calyceal fistula following partial nephrectomy for kidney cancer was achieved with fistula embolization with n-butyl-2-cyanoacrylate. Previous attempts at closure by conservative and endoscopic means were unsuccessful. Tissue adhesives are useful in the management of persistent urinary leakage after partial nephrectomy.

Objective: The ability of prostate-specific antigen (PSA), free/total PSA and PSA density to predict the pathologic stage in prostate cancer has not been clear yet. In this study, we evaluated the value of PSA subgroups in the prediction of pathologic stage after radical prostatectomy., Methods: A total of 42 subjects 55-78-years-old who underwent radical retropubic prostatectomy were included in the study. Preoperative PSA, free/total PSA and PSA density (PSAD) values were compared according to the pathologic stages of radical prostatectomy specimens. Receiver operating characteristics (ROC) curves were measured for each parameter., Results: The clinical stage that was estimated for all patients was between T1N0M0 and T2bN0M0. Pathologic examination revealed organ-confined disease in 18 patients. The area under curve (AUC) for organ confinement was 0.553 for PSA, 0.446 for free/total PSA ratio and 0.706 for PSAD. Cut-off values providing the best sensitivity and specificity in ROC analysis for PSA, free/total PSA and PSAD were 7.1, 0.15, and 0.17, respectively (likelihood ratio: 0.9, 1 and 2). The positive predictive values at these cut-off values were 0.54, 0.56, and 0.70, respectively. Only PSAD cut-off values was found statistically borderline significant for predicting organ-confined disease., Conclusion: While PSAD is more helpful than PSA and free/total PSA ratio for prediction of organ-confined disease, none of these parameters are significant predictor of pathologic stage for clinically localized prostate cancer.

A 70-year-old patient with acute renal infarction due to chronic atrial fibrillation is presented. The clinical presentation of the patient was suggestive of renal colic. Computerized tomography was consistent with acute renal infarction and confirmed the diagnosis. After giving anticoagulation and antiarrhythmic treatment, she was discharged with clinical improvement. High clinical suspicion is necessary on an old patient who has thromboembolic risk factors with the complaint of abrupt-onset flank pain.

We report a rare case of ascites developing in the early post-prostatectomy period due to a mass originating from the head of the pancreas. Comorbid diseases that are not documented preoperatively may emerge with signs mimicking the complication of prostate surgery.

Objective: Our aim was to determine the safety and feasibility of catheter removal on the first morning after transurethral prostatectomy., Methods: Fifty-four patients who underwent transurethral prostatectomy were included in a prospective study. The decision to remove the catheters on the first morning after surgery was based on the color of the catheter effluent, absence of clots, normal vital signs and adequate urine output. Patients who voided successfully were discharged on the same day as catheter removal., Results: Catheters were removed in 43 (79.6%) patients on postoperative day 1. Of these patients 40 (93%) voided successfully, however 3 of them required recatheterization due to bleeding or urinary retention. The criteria for catheter removal were not met in 11 patients and their catheters were removed on postoperative day 2 in 2 and on postoperative day 3 in 9. The mean length of hospital stay after surgery was 1.74 days for the entire group and 1.41 days for those in whom the catheter was removed on postoperative day 1., Conclusion: Overnight catheterization after transurethral prostatectomy seems to be a feasible approach without leading to significant morbidity in selected patients., (Copyright 2002 S. Karger AG, Basel)