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Purpose: Androgen signaling is associated with various secondary cancer, which could be promising for potential treatment using androgen deprivation therapy (ADT). This study investigated whether ADT use was associated with secondary cancers other than prostate cancer in a nationwide population-based cohort. Materials and Methods: A total, 278,434 men with newly diagnosed prostate cancer between January 1, 2002 and December 31, 2017 were identified. After applying the exclusion criteria, 170,416 men were enrolled. The study cohort was divided into ADT and non-ADT groups by individual matching followed by propensity score matching (PSM). Study outcomes were incidence of all male cancers. Cox proportional hazard regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of events. Results: During a median follow-up of 4.5 years, a total of 11,059 deaths (6,329 in the ADT group and 4,730 in the non- ADT group) after PSM were found. After PSM, the overall all-cause of secondary cancer incidence risk of the ADT group was higher than that of the non-ADT group (HR: 1.312, 95% CI: 1.23–1.36; adjusted HR: 1.344, 95% CI: 1.29–1.40). The ADT group showed higher risk of overall brain and other central nervous system (CNS) cancer-specific incidence than the non- ADT group (adjusted HR: 1.648, 95% CI: 1.21–2.24). The ADT group showed lower risks of overall cancer-specific incidence for stomach, colon/rectum, liver/inflammatory bowel disease (IBD), gall bladder/extrahepatic bile duct, lung, bladder, and kidney cancers than the non-ADT group. When the duration of ADT was more than 2 years of ADT, the ADT group showed higher risk of cancer-specific incidence for brain and other CNS cancers but lower risk of cancer-specific incidence for liver/ IBD and lung cancers than the non-ADT group. Conclusions: This study demonstrates that ADT could affect cancer-specific incidence for various cancers.

Purpose This study evaluates the viability of a new method that employs transperineal targeted biopsy with frozen section analysis immediately followed by robot-assisted radical prostatectomy (RARP), bypassing the traditional systematic biopsy deemed essential by current guidelines. Materials and Methods Patient selection was based on the following inclusion criteria: those who underwent magnetic resonance imaging (MRI)-ultrasound fusion-targeted biopsy with frozen section analysis and concurrent RARP. Eligibility also required features indicative of Prostate Imaging-Reporting and Data System (PI-RADS) 5 lesion on multiparametric MRI, along with one of these additional criteria: (1) MRI evidence suggesting extracapsular extension (ECE) with a prostate-specific antigen (PSA) level >10 ng/mL, or (2) a PSA level > 20 ng/mL. Results Twelve patients were enrolled in this study according to inclusion criteria. The median age (interquartile range) was 73.5 (69.5–75.3) years and PSA was 22.9 (17.0–29.9) ng/mL. Three patients had PI-RADS 5 lesions, and 9 had PI-RADS 5 lesions with findings of ECE. In all cases, the diagnosis based on frozen sections confirmed adenocarcinoma. Following confirmation, each patient underwent immediate RARP. According to the final pathology report, 2 patients had International Society of Urological Pathology (ISUP) grade 2 disease, 7 patients had ISUP grade 3, 1 had ISUP grade 4, and 2 had ISUP grade 5 disease. Four patients had stage pT2 disease, 3 had stage pT3a, and 5 had stage pT3b. The median immediate reporting time of the target biopsy frozen section was 20 (19.3–24.5) minutes. No perioperative complications related to target biopsy were observed. Conclusion For patients with a strong suspicion of prostate cancer and a PI-RADS 5 lesion, integrating simultaneous prostate frozen target biopsy with radical prostatectomy may offer a feasible treatment alternative, obviating the necessity for a preoperative systematic biopsy.

Abstract Background Advancements in the diagnosis, treatment, and surveillance of castration-resistant prostate cancer (CRPC) have progressed considerably, but a new biomarker that combines existing clinical and pathological data could be useful for a more precise diagnosis and prognosis. Some investigations have found that extracellular vesicle (EV)-derived miRNAs play crucial roles in various types of malignant tumors. The objective of this study was to explore EV miRNA and identify its biologic function as a biomarker for the diagnosis and prognosis of CRPC. Methods Plasma samples were collected from five healthy donors (Control, CT) and 17 CRPC patients, categorizing into two groups based on their endocrine treatment response: partial response (PR; n = 10) and progressive disease (PD; n = 7). Candidate extracellular vesicle (EV) miRNAs were identified using miRNA microarray and RT-qPCR. The biological functions of the selected miRNAs were evaluated using the MTT assay, wound healing assay, trans-well assay, and RNA sequencing in CRPC cells after transient miRNA expression. Results Microarray analysis revealed a significant downregulation of EV-miR-6880-5p in the PD samples compared to both CT and PR samples (p

Purpose: Erectile dysfunction (ED) is considered a microvascular disorder and serves as an indicator for the potential development of cardiovascular disease (CVD). Although left ventricular diastolic dysfunction (LVDD) reflects early myocardial damage caused by microvascular disorders, the association between ED and LVDD remains poorly elucidated. Materials and Methods: A cross-sectional study was conducted on 123 patients with ED. They underwent RigiScan, and conventional echocardiography, and attempted International Index of Erectile Function (IIEF) questionnaire. ED severity was evaluated by measuring changes in the penile base circumference and duration of penile rigidity (≥70%) during erection. The early diastolic velocity of mitral inflow (E) and early diastolic velocity of the mitral annulus (e′) were measured using echocardiography. The patients were grouped based on the presence of CVD. Results: Among 123 patients, 29 had CVD and 94 did not. Patients with CVD exhibited more pronounced ED and more severe LVDD. Associations between increased penile circumference with echocardiographic parameters were more prominent in patients with CVD than in those without CVD (ΔTtop and e′ wave, r=0.508 and r=0.282, respectively, p for interaction=0.033; ΔTbase and E/e′ ratio, r=-0.338 and r=-0.293, respectively, p for interaction

Abstract To investigate the characteristics and impact of asymptomatic (silent) ureteral stones on renal function and compare them with those of symptomatic stones. We retrospectively reviewed the medical records of 677 patients who underwent ureteroscopic lithotripsy or laparoscopic ureterolithotomy for ureteral stones between 2016 and 2020. Patients were divided into two groups according to the presence of recognizable symptoms. We investigated the characteristics and impact of silent stones on post-treatment renal function recovery and compared them with those of symptomatic stones. Among the 677 patients, 43 (6.4%) had asymptomatic ureteral stones, and 634 (93.6%) had symptomatic ureteral stones. Compared to symptomatic stones, asymptomatic stones were larger (11.4 mm vs. 9.6 mm, p = 0.003), more commonly present in the upper ureter (62.7% vs. 48.0%, p = 0.04), and more commonly associated with high-grade hydronephrosis (32.8% vs. 12.3%, p

Objectives Postprostatectomy urinary incontinence (PPUI) is a serious complication despite surgical advances. Treatment options for PPUI include conservative care like Pelvic floor muscle exercise (PFME), which is a physiotherapy performed by the patients themselves; Pelvic floor muscle therapy (PFMT), a physiotherapy performed under the guidance of a therapist, and duloxetine treatment; and surgical interventions. In this study, network meta-analysis (NMA) was performed for direct comparison of these treatment options. Materials and Methods The NMA pooled the odds ratios and 95% credible intervals using the number of patients achieving urinary continence and the total number of patients in an intention-to-treat population. The treatments were ranked based on the surface under the cumulative ranking curve (SUCRA) probabilities and the rankograms. Results The pooled overall ORs of patients achieving urinary continence compared with no treatment was 1.73 (95% CrI: 0.657, 4.71) in PFME, 2.62 (95% CrI: 0.553, 13.5) in PFME plus Duloxetine, and 4.05 (95% CrI: 1.70, 10.2) in PFMT. The SUCRA values of ranking probabilities for each treatment showed high rates of continence in the order of PFMT, PFME plus Duloxetine, and PFME. Conclusion The results suggest that patients with PPUI should undergo PFMT and consider duloxetine as an additional treatment option.

Abstract This study aimed to compare the diagnostic validity of biparametric magnetic resonance imaging (bpMRI) with that of multiparametric MRI (mpMRI) based on the Vesicle Imaging-Reporting and Data System (VI-RADS) in predicting muscle invasion by bladder cancer (BCa). We retrospectively examined 357 patients with an initial diagnosis of BCa who underwent preoperative MRI; 257 and 100 patients underwent mpMRI and bpMRI, respectively. Two urogenital radiologists evaluated all bpMRI and mpMRI scans using VI-RADS, and the diagnostic validity of VI-RADS for predicting muscle invasion by BCa was analyzed based on histopathology of the first and/or second transurethral resection of bladder tumors and radical cystectomy. Receiver operating characteristic (ROC) curves were plotted with the calculation of area under the curves (AUCs), and the level of significance was P

Purpose: Recently, the modified apical dissection (MAD) technique in robot-assisted laparoscopic radical prostatectomy (RARP) has shown excellent functional outcomes but has never been rigorously validated at various institutions. This study aimed to evaluate the effect of MAD on early continence and potency compared with the anterior suspension stitch (SS) technique. Materials and Methods: A total of 100 patients who underwent RARP with SS and 100 who underwent RARP with MAD by a single surgeon were propensity score matched and retrospectively compared for continence and potency recovery at 1 week and 1, 3, 6, 9, and 12 months. Results: Continence was reached in 20.6%, 33.3%, 67.2%, 74.1%, 81.1%, and 83.0% of patients in the SS group, compared with 49.2%, 73.3%, 86.8%, 96.6%, 100.0%, and 100.0% in the MAD group at postoperative 1 week and 1, 3, 6, 9, and 12 months, respectively. In the SS group, potency rates were 0.0%, 20.0%, 50.0%, 66.7%, 75.0%, and 83.3%; in the MAD group, the rates were 50.0%, 90.0%, 88.9%, 100.0%, 100.0%, and 100.0%. Recovery of continence was higher in the MAD group within the first 6 months (p=0.005,

Abstract The current guidelines for targeted prostate biopsy recommend an additional systematic biopsy regardless of clinical risk assessment. To evaluate frozen section biopsy utilization in targeted prostate biopsy to omit systematic biopsies in cases of positive frozen section results of patients with clinical features suggestive of high-risk prostate cancer. In this prospective, single-center study, we enrolled patients with a Prostate Imaging-Reporting and Data System (PI-RADS) 5 lesion on magnetic resonance imaging (MRI) with clinical evidence suggestive of high-risk prostate cancer (either an extracapsular extension or prostate-specific antigen level > 20 ng/ml). All patients underwent 2–4 core targeted biopsies utilizing frozen section biopsy with immediate results, allowing patients with a positive result to omit a systematic biopsy. In case of a negative result, additional systematic biopsies were performed. The primary endpoint was the detection rate of targeted biopsy. Patient demographics, clinical variables were analyzed using SPSS version 20. Sixty-six patients were enrolled in this study. Among them, 63 patients were diagnosed with cancer without the need for an additional systematic biopsy. Three patients were non-diagnostic with target biopsy alone. Hence an additional systematic biopsy was performed. Two of these patients were diagnosed with prostate cancer and one tested negative for cancer. In this report we looked into the necessity of taking a routine systematic biopsy in patients with high risk features of prostate cancer. We found that utilizing frozen section biopsy for targeted biopsy reduces unneccessary systematic biopsy in 97% of cases and still provides a means for systematic biopsy when targeted biopsy alone fails to make the diagnosis.

Background: With the implementation of da Vinci SP robot platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA), we described our initial experience with the da Vinci SP robot platform (Intuitive Surgical, Inc., Sunnyvale, CA, USA) for single-port robotic-assisted radical prostatectomy (SP-RARP). Methods: This retrospective review included 30 consecutive patients with prostate biopsy-confirmed prostate cancer who underwent SP-RARP by a single surgeon between June and November 2020. SP-RARP was performed with a single-incision plus one method, in which the multichannel guide port was inserted directly with an additional assist port. We report our initial experience of perioperative and early functional outcomes. Results: The mean operative time (SD), console time (SD), and blood loss were 142.8 (15.1) min, 109.9 (15.7) min, and 133.0 (72.9) mL, respectively. No intraoperative complications or blood transfusions were reported. Of the 30 patients, 21 (70.0%), 7 (23.3%) and 2 (6.7%) had stage pT2, pT3a and pT3b disease, respectively. Positive surgical margins were reported in 5 of the 30 (16.7%) patients in the final pathology report, including 2 of 21 (9.5%) with stage pT2 and 3 of 9 (33.3%) with ≥ pT3. At 12 weeks after SP-RARP, 80.0% of patients had achieved continence and the potency was 46.7%; 8 of 11 (72.7%) had sexual health inventory for men (SHIM) scores ≥ 17 and 6 of 19 (31.6%) had SHIM scores < 17. Conclusions: The SP platform for radical prostatectomy was technically safe and feasible. After overcoming the technical learning curve, this platform may provide high-quality outcomes comparable to those of multi-port platforms.

Abstract We aimed to confirm the reliability of the results of bi-parametric magnetic resolution imaging-ultrasound fusion targeted and systematic biopsies (bpMRI-US transperineal FTSB) compared to prostatectomy specimens. We retrospectively analyzed the records of 80 men who underwent bpMRI-US transperineal FTSB with region of interest (ROI) and subsequent robot-assisted radical prostatectomy. Changes in the grade group determined by MRI and biopsy versus surgical specimens were analyzed. Thirty-five patients with insignificant prostate cancer and 45 with significant cancer were diagnosed using bpMRI-US transperineal FTSB. Among those with insignificant PCa, 25 (71.4%) were upgraded to significant PCa in prostatectomy specimens: 9/12 (75.0%) with Prostate Imaging Reporting and Data System (PI-RADS) 3, 12/16 (75.0%) with PI-RADS 4, and 4/7 (57.1%) with PI-RADS 5. In the PI-RADS 3 group, the upgraded group showed higher prostate specific antigen (PSA) and PSA density (PSAD) than the concordance group; PSA 8.34(2.73) vs. 5.31(2.46) (p = 0.035) and PSAD 0.29(0.11) vs. 0.18(0.09) (p = 0.025). The results of prostate biopsy and prostatectomy specimens were inconsistent and underestimated in patients with MRI-visible lesions. Therefore, for precise and individualized treatment strategies for PCa with MRI-visible lesions, careful interpretation of biopsy result is required.

PurposeTo compare the diagnostic performance of transperineal targeted biopsy (TB) or systematic biopsy (SB) alone based on combined TB+SB and radical prostatectomy (RP) specimen for detecting prostate cancer (PCa) according to the prostate imaging reporting and data system (PI-RADS) score. Materials and methodsThis study included 1077 men who underwent transperineal bi-parametric (bp) magnetic resonance imaging (MRI)–ultrasound (US) fusion TB+SB (bpMRI-US FTSB) between April 2019 and March 2022. To compare the performance of each modality (TB, SB, and combined TB+SB) with the RP specimen (as the standard) for detecting PCa and clinically significant PCa (csPCa), receiver operating characteristic (ROC) curves were plotted.ResultsPCa was detected in 581 of 1077 men (53.9%) using bpMRI-US FTSB. CsPCa was detected in 383 of 1077 men (35.6%), 17 of 285 (6.0%) with PI-RADS 0 to 2, 35 of 277 (12.6%) with PI-RADS 3, 134 of 274 (48.9%) with PI-RADS 4, and 197 of 241 (81.7%) with PI-RADS 5, respectively. The additional diagnostic value of TB vs. SB compared to combined TB+SB for diagnosing csPCa were 4.3% vs. 3.2% (p=0.844), 20.4% vs 5.1% (p

Abstract Background To identify the association of meteorological factors/ambient air pollutants with medical care utilization for urolithiasis and estimate the effect size/time lags. Methods This is a population-based time-series analysis of 300,000 urolithiasis cases from eight large metropolitan areas in Korea. Seventeen meteorological factors and ambient air pollutants were measured daily during 2002–2017 for each metropolis. Data on daily medical utilization owing to urolithiasis were collected. A generalized additive model was used while factoring in the nonlinear relationship between meteorological factors/ambient air pollutants and urolithiasis and a time lag of ≤10 days. A multivariate analysis was performed. Backward elimination with an Akaike information criterion was used for fitting the multivariate model. Results Urolithiasis was significantly associated with average temperature, diurnal temperature range, sunshine duration, particulate matter (PM) ≤2.5 μm, and carbon monoxide (CO) levels. The incidence of ureteral stones was positively correlated with average temperature, PM ≤2.5 μm level, and CO level (time lags 0–9, 2–4, and 0–9 days, respectively). The incidence of renal stones was positively correlated with PM ≤2.5 μm and CO levels (time lags 2–4 and 0–9 days, respectively). PM ≤2.5 μm (0.05 and 0.07% per 10 μg/m3) and CO (2.05 and 2.25% per 0.1 ppm) conferred the highest excess risk on ureteral and renal stones. Conclusions Urolithiasis is affected by various meteorological factors and ambient air pollutants, PM ≤2.5 μm, and CO levels may be novel potential risk factors for this condition.

ObjectiveTo analyze the learning curve for robot- assisted radical cystectomy (RARC) with total intracorporeal urinary diversion (ICUD) in terms of both time efficiency and quality of surgery based on radical cystectomy (RC)-pentafecta.Patients and methodsWe identified 203 consecutive patients who underwent RARC with ICUD of the ileal conduit (IC, 85) and orthotopic neobladder (ONB, 118) performed by a single surgeon between 2011 and 2021. We grouped ten consecutive patients into time-associated blocks according to the operation order. Process efficiency and operation quality were measured based on the surgeon’s console time and attainment/score sum of RC-pentafecta. The overcoming point of the learning curve was defined graphically and statistically.ResultsThe mean follow-up period was 44.5 ± 30.7 months. Of the 203 patients, 109 (53.7%) attained the five criteria of RC-pentafecta (ONB vs IC, 50.6% vs. 55.9%, p = 0.35). The attainment rate and sum of the RC-pentafecta score of the third group were not significantly different from those of all patients (40.0% vs. 53.7%, p = 0.369, 4.00 ± 1.05 vs. 4.41 ± 0.75, p = 0.137, respectively), and the proficiency in operation quality was satisfactory in the third group. The console times continually improved and stabilized after the 140th case (IC, 60; ONB, 80), and the attainment rate and sum of the RC-pentafecta were significantly different between before and after the 140th case (p

Abstract This study aimed to investigate the effect of intraoperative fluid volume on the postoperative ileus (POI) recovery period. A retrospective review of the Korean robot-assisted radical cystectomy database identified 718 patients who underwent robot-assisted radical cystectomy (RARC). Regression analyses were performed to identify the associations between the amount of intraoperative fluid administration (crystalloid/colloid/total), POI period (time to flatus/bowel movements), and length of hospital stay (LOS) after adjusting for covariates. In addition, we analyzed the risk factors for gastrointestinal complications and prolonged POI using a logistic regression model. An increasing volume of the administered crystalloid/total fluid was associated with prolonged POI (crystalloid R2 = 0.0725 and P

ABSTRACT: Background: Despite the widespread practice of nerve-sparing robot-assisted radical prostatectomy (nsRARP) for the treatment of localized prostate cancer (PCa), erectile dysfunction remains a significant sequela of radical prostatectomy. Aim: This study aimed to compare the efficacy of tadalafil 5 mg once daily for erectile function recovery in patients who underwent nsRARP according to the timing of rehabilitation initiation. Methods: In this double-blind, prospective pilot study, a total of 41 patients who underwent nsRARP were randomly assigned into 2 groups according to the timing of rehabilitation initiation. In the preRARP group (n = 20), tadalafil was started 2 weeks before nsRARP, and in the postRARP group (n = 21), it was started 4 weeks after nsRARP. Erectile function recovery after nsRARP was defined as an International Index of Erectile Function (IIEF-5) score of ≥17. Outcomes: The measures of EF recovery were the changes in IIEF-5 score. Results: The rate of erectile function recovery at 12-month follow-up was 80.0% and 71.4% in the preRARP and postRARP groups, respectively. The mean differences between baseline and postoperative IIEF-5 scores at 1-, 3-, 6-, and 12-month follow-up were −11.7 ± 3.2, −7.4 ± 3.2, −5.6 ± 1.5, and −4.1 ± 1.1 in the preRARP group and −14.7 ± 4.7, −12.0 ± 5.0, −9.7 ± 3.9, and −6.0 ± 3.1 in the postRARP group, respectively (1-month, P = .259; 3-months, P = .077; 6-months, P = .014; 12-months, P = .007). Clinical implications: Preoperative tadalafil 5 mg once a day could be used effectively and safely as a strategy for penile rehabilitation after nsRARP. Strengths and Limitations: This study is the first prospective trial of penile rehabilitation with tadalafil 5 mg once a day prior to nsRARP. This is a pilot study with the limitations of a small sample; further and large-scale studies with multiple cohorts, such as an untreated control group and an early immediate rehabilitation group for EF recovery, are needed. Conclusion: This study suggests that preoperative penile rehabilitation using tadalafil may lead to better erectile function recovery than postoperative penile rehabilitation using tadalafil.Noh T, Shim JS, Kang SG, et al. Efficacy of Tadalafil in Penile Rehabilitation Started Before Nerve-Sparing Robot-Assisted Radical Prostatectomy: A Double-Blind Pilot Study. Sex Med 2022;10:100508.

Purpose The aim of this study was to assess the voiding dysfunction after rectal cancer surgery with total mesorectal excision (TME). Methods This was part of a prospective study done in the rectal cancer patients who underwent surgery with TME between November 2006 and June 2008. Consecutive uroflowmetry, post-voided residual volume, and a voiding questionnaire were performed at preoperatively and postoperatively. Results A total of 50 patients were recruited in this study, including 28 male and 22 female. In the comparison of the preoperative data with the postoperative 3-month data, a significant decrease in mean maximal flow rate, voided volume, and post-voided residual volume were found. In the comparison with the postoperative 6-month data, however only the maximal flow rate was decreased with statistical significance (P=0.02). In the comparison between surgical methods, abdominoperineal resection patients showed delayed recovery of maximal flow rate, voided volume, and post-voided residual volume. There was no significant difference in uroflowmetry parameters with advances in rectal cancer stage. Conclusions Voiding dysfunction is common after rectal cancer surgery but can be recovered in 6 months after surgery or earlier. Abdominoperineal resection was shown to be an unfavorable factor for postoperative voiding. Larger prospective study is needed to determine the long-term effect of rectal cancer surgery in relation to male and female baseline voiding condition.

Purpose: Erectile dysfunction (ED) is considered a microvascular disorder and serves as an indicator for the potential development of cardiovascular disease (CVD). Although left ventricular diastolic dysfunction (LVDD) reflects early myocardial damage caused by microvascular disorders, the association between ED and LVDD remains poorly elucidated. Materials and Methods: A cross-sectional study was conducted on 123 patients with ED. They underwent RigiScan, and conventional echocardiography, and attempted International Index of Erectile Function (IIEF) questionnaire. ED severity was evaluated by measuring changes in the penile base circumference and duration of penile rigidity (=70%) during erection. The early diastolic velocity of mitral inflow (E) and early diastolic velocity of the mitral annulus (e') were measured using echocardiography. The patients were grouped based on the presence of CVD. Results: Among 123 patients, 29 had CVD and 94 did not. Patients with CVD exhibited more pronounced ED and more severe LVDD. Associations between increased penile circumference with echocardiographic parameters were more prominent in patients with CVD than in those without CVD (?Ttop and e' wave, r=0.508 and r=0.282, respectively, p for interaction=0.033; ?Tbase and E/e' ratio, r=-0.338 and r=-0.293, respectively, p for interaction <0.001). In the multivariate linear regression, the increase of penile base circumference was an independent risk factor for LVDD (e', B=0.503; E/e' ratio, B=-1.416, respectively, p<0.001). Conclusions: ED severity correlated well with LV diastolic dysfunction, particularly in the presence of CVD. This study highlighted the potential role of ED assessment as early indicator of CVD development. [ABSTRACT FROM AUTHOR]

Objective: To analyze the learning curve for robot-assisted radical cystectomy (RARC) with total intracorporeal urinary diversion (ICUD) in terms of both time efficiency and quality of surgery based on radical cystectomy (RC)-pentafecta. Patients and methods: We identified 203 consecutive patients who underwent RARC with ICUD of the ileal conduit (IC, 85) and orthotopic neobladder (ONB, 118) performed by a single surgeon between 2011 and 2021. We grouped ten consecutive patients into time-associated blocks according to the operation order. Process efficiency and operation quality were measured based on the surgeon's console time and attainment/score sum of RC-pentafecta. The overcoming point of the learning curve was defined graphically and statistically. Results: The mean follow-up period was 44.5 ± 30.7 months. Of the 203 patients, 109 (53.7%) attained the five criteria of RC-pentafecta (ONB vs IC, 50.6% vs. 55.9%, p = 0.35). The attainment rate and sum of the RC-pentafecta score of the third group were not significantly different from those of all patients (40.0% vs. 53.7%, p = 0.369, 4.00 ± 1.05 vs. 4.41 ± 0.75, p = 0.137, respectively), and the proficiency in operation quality was satisfactory in the third group. The console times continually improved and stabilized after the 140th case (IC, 60; ONB, 80), and the attainment rate and sum of the RC-pentafecta were significantly different between before and after the 140th case (p<0.001). Conclusion: A single surgeon's learning curve for RARC with ICUD and pelvic lymph node dissection (PLND) showed an acceptable level of proficiency after 30 consecutive cases in terms of the operation quality. However, for an expert surgeon, 140 cases were required to reach a plateau in time efficiency and second leap with the RC-pentafecta. RARC with ICUD and PLND can be performed safely without compromising functional outcomes and complications through sharing and transmission of standardized techniques. [ABSTRACT FROM AUTHOR]

Purpose This study aimed to develop and validate a predictive model for the assessment of clinically significant prostate cancer (csPCa) in men, prior to prostate biopsies, based on bi-parametric magnetic resonance imaging (bpMRI) and clinical parameters. Materials and Methods We retrospectively analyzed 300 men with clinical suspicion of prostate cancer (prostate-specific antigen [PSA] ≥ 4.0 ng/mL and/or abnormal findings in a digital rectal examination), who underwent bpMRI-ultrasound fusion transperineal targeted and systematic biopsies in the same session, at a Korean university hospital. Predictive models, based on Prostate Imaging Reporting and Data Systems scores of bpMRI and clinical parameters, were developed to detect csPCa (intermediate/high grade [Gleason score ≥ 3+4]) and compared by analyzing the areas under the curves and decision curves. Results A predictive model defined by the combination of bpMRI and clinical parameters (age, PSA density) showed high discriminatory power (area under the curve, 0.861) and resulted in a significant net benefit on decision curve analysis. Applying a probability threshold of 7.5%, 21.6% of men could avoid unnecessary prostate biopsy, while only 1.0% of significant prostate cancers were missed. Conclusion This predictive model provided a reliable and measurable means of risk stratification of csPCa, with high discriminatory power and great net benefit. It could be a useful tool for clinical decision-making prior to prostate biopsies. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate the diagnostic value of magnetic resonance imaging (MRI)-ultrasound (US) fusion transperineal targeted biopsy (FTB) and fusion template systematic biopsy (FSB) for prostate cancer (PCa) and clinically significant prostate cancer (csPCa) (intermediate/high grade [Gleason score ≥ 3+4]) based on bi-parametric MRI (bpMRI). Materials and Methods: Retrospectively, we analyzed 300 patients with elevated prostate-specific antigen (≥ 4.0 ng/mL) and/or abnormal findings in a digital rectal examination at the Korea University Hospital. All 300 men underwent bpMRI-US fusion transperineal FTB and FSB in the period from April 2017 to March 2019. Results: PCas were detected in 158 of 300 men (52.7%), and the prevalence of csPCa was 34.0%. CsPCas were detected in 12 of 102 (11.8%) with Prostate Imaging-Reporting and Data System (PI-RADS) 3, 42 of 92 (45.7%) with PI-RADS 4, respectively; and 45 of 62 (72.6%) men with PI-RADS 5, respectively. BpMRI showed a sensitivity of 95.1% and negative predictive value of 89.6% for csPCa. FTB detected additional csPCa in 33 men (12.9%) compared to FSB. Compared to FTB, FSB detected additional csPCa in 10 men (3.9%). Conclusion: BpMRI-US FTB and FSB improved detection of PCa and csPCa. The accuracy of bi-parametric MRI is comparable with that of multi-parametric MRI. Further, it is rapid, simpler, cheaper, and no side effects of contrast media. Therefore, it is expected that bpMRI-US transperineal FTB and FSB could be a good alternative to conventional US-guided transrectal biopsy, which is the current gold standard. [ABSTRACT FROM AUTHOR]

Purpose: This study was designed to estimate the value of a second transurethral resection of bladder tumor (TURBT) procedure in patients with initially diagnosed T1 high-grade bladder cancer. Materials and Methods: Between August 2009 and January 2013, a total of 29 patients with T1 high-grade bladder cancer prospectively underwent a second TURBT procedure. Evaluation included the presence of previously undetected residual tumor, changes to histopathological staging or grading, and tumor location. Recurrence-free and progression-free survival curves were generated to compare the prognosis between the groups with and without residual lesions by use of the Kaplan-Meier method. Results: Of 29 patients, 22 patients (75.9%) had residual disease after the second TURBT. Staging was as follows: no tumor, 7 (24.1%); Ta, 5 (17.2%); T1, 6 (20.7%); Tis, 6 (20.7%); Ta+Tis, 1 (3.4%); T1+Tis, 1 (3.4%); and ±T2, 3 (10.3%). The muscle layer was included in the surgical specimen after the initial TURBT in 24 patients (82.7%). In three patients whose cancer was upstaged to pT2 after the second TURBT, the initial surgical specimen contained the muscle layer. In the group with residual lesions, the 3-year recurrencefree survival and 3-year progression-free survival rates were 50% and 66.9%, respectively, whereas these rates were 68.6% and 68.6%, respectively, in the group without residual lesions. This difference was not statistically significant. Conclusions: Initial TURBT does not seem to be enough to control T1 high-grade bladder cancer. Therefore, a routine second TURBT procedure should be recommended in patients with T1 high-grade bladder cancer to accomplish adequate tumor resection and to identify patients who may need to undergo prompt cystectomy. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the relationship of transrectal ultrasound (TRUS) findings with the pathological characteristics of prostate cancer (PCa). Materials and Methods: The study was conducted retrospectively by analyzing the data for 970 patients who underwent prostate biopsies. Gleason scores and other clinical variables were compared between PCa patients with and without hypoechoic lesions on TRUS. Results: Of the 970 patients, PCa was diagnosed in 291 (30%). Of these, high-grade PCa (Gleason score of 7 or more) was diagnosed in 190 (65%). The cancer detection rate was higher in patients with hypoechoic lesions (43.9%) than in those without hypoechoic lesions (21.4%, p<0.001). High-grade PCa was detected more often in patients with hypoechoic lesions than in those without hypoechoic lesions (p<0.001). Independent predictors for high-grade PCa by logistic regression analysis included hypoechoic lesions on TRUS and abnormal digital rectal examination findings. Conclusions: Patients with PCa who had hypoechoic lesions on TRUS had more aggressive pathological disease than did those without lesions. Therefore, hypoechoic lesions on TRUS could be a marker for clinically significant PCa. [ABSTRACT FROM AUTHOR]

We present a rare case of a metastatic renal tumor originating from adenosquamous carcinoma of the intrahepatic bile duct. A 64-year-old man treated with bisegmentectomy and extended cholecystectomy for cholangiocarcinoma had a left cystic renal mass, which had irregular wall thickening, heterogeneously low attenuation, and soft tissue infiltration as determined by a computed tomography scan. The first impression was renal abscess. Left nephrectomy was performed and the nonencapsulated mass was gray in color macroscopically. Histological examination of the specimen revealed alveolar proliferation of small cancer cells, which was consistent with the original tumor of the intrahepatic bile duct. The left renal tumor was misdiagnosed as a renal abscess but finally diagnosed as squamous cell carcinoma metastasized from the intrahepatic bile duct. The patient expired because of lung metastasis after 14 months following left nephrectomy. In our opinion, this case would be the first report of a renal metastasis from a cholangiocarcinoma clinically and was treated with nephrectomy. [ABSTRACT FROM AUTHOR]

Malignant lymphoma of the bladder is a rare lesion, representing approximately 0.2% of the primary lesions and approximately 1.8% of the secondary lesions. A disseminated lymphoma presenting as a bladder mass is an infrequent phenomenon. The authors report the case of a 71-year-old patient with concurrent bladder lymphoma and bladder cancer presenting as metastatic bladder cancer. To the best of our knowledge, this is the first report of concurrent bladder lymphoma and bladder cancer. [ABSTRACT FROM AUTHOR]