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김종우,Bumsik Hong,신지훈,Jihong Park,김진형,권동일,Min-Hee Ryu,Baek-Yeol Ryoo 대한영상의학회 2018 Korean Journal of Radiology Vol.19 No.4
Objective: To compare the safety and efficacy between a covered metallic ureteral stent (CMS) and a double-J ureteral stent (DJS) for the treatment of a malignant ureteral obstruction (MUO). Materials and Methods: Nineteen patients (seven men and 12 women; mean age, 53.4 years) were randomly assigned to the CMS (n = 10) or DJS (n = 9) group. The following were compared between the two groups: technical success, i.e., successful stent placement into desired locations; stent malfunction; stent patency, i.e., no obstruction and no additional intervention; complications; and patient survival. Results: The technical success rate was 100% in all 10 and 12 ureteral units in the CMS and DJS groups, respectively. During the mean follow-up period of 253.9 days (range, 63−655 days), stent malfunction was observed in 40.0% (4/10) and 66.7% (8/12) in the CMS and DJS groups, respectively. In the per-ureteral analysis, the median patency time was 239.0 days and 80.0 days in the CMS and DJS groups, respectively. The CMS group yielded higher patency rates compared with the DJS group at three months (90% vs. 35%) and at six months (57% vs. 21%). The overall patency rates were significantly higher in the CMS group (p = 0.041). Complications included the migration of two metallic stents in one patient in the CMS group, which were removed in a retrograde manner. The two patient groups did not differ significantly regarding their overall survival rates (p = 0.286). Conclusion: Covered metallic ureteral stent may be effective for MUO.
Effect of decreased renal function on poor oncological outcome after radical cystectomy
김동수,남욱,경윤수,유달산,정인갑,홍범식(Bumsik Hong),홍준혁,안한종,임범진 대한비뇨의학회 2023 Investigative and Clinical Urology Vol.64 No.4
Purpose: To evaluate the impact of preoperative renal impairment on the oncological outcomes of patients with urothelial carcinoma who underwent radical cystectomy. Materials and Methods: We retrospectively reviewed the medical records of patients with urothelial carcinoma who underwent radical cystectomy from 2004 to 2017. All patients who underwent preoperative 99mTc-diethylenetriaminepentaacetic acid renal scintigraphy (DTPA) were identified. We divided the patients into two groups according to their glomerular filtration rates (GFRs): GFR group 1, GFR≥90 mL/min/1.73 m2; GFR group 2, 60≤GFR<90 mL/min/1.73 m2. We included 89 patients in GFR group 1 and 246 patients in GFR group 2 and compared the clinicopathological characteristics and oncological outcomes between the two groups. Results: The mean time required for recurrence was 125.5±8.0 months in GFR group 1 and 85.7±7.4 months in GFR group 2 (p=0.030). The mean cancer-specific survival was 131.7±7.8 months in GFR group 1 and 95.5±6.9 months in GFR group 2 (p=0.051). The mean overall survival was 123.3±8.1 months in GFR group 1 and 79.5±6.6 months in GFR group 2 (p=0.004). Conclusions: Preoperative GFR values in the range of 60≤GFR<90 mL/min/1.73 m2 are independent prognostic factors for poor recurrence-free survival, cancer-specific survival, and overall survival in patients after radical cystectomy compared with GFR values of ≥90 mL/min/1.73 m2.
Restaging TURB : 언제 어떻게 하는 것이 좋은가?
한경식(Kyung-sik Han),홍범식(Bumsik Hong) 대한비뇨기종양학회 2014 대한비뇨기종양학회지 Vol.12 No.2
Approximately 70% to 75% of patients with bladder cancer initially present at a low stage (stage 1), a category that includes carcinoma in situ (CIS, 1-10% alone as primary), tumors confined to the urothelial mucosa (Ta, 70%-80%), and those that invade only the underlying lamina propria (T1, 20%). The prognosis for patients with non-muscle invasive bladder cancer (NMIBC) is generally good, with approximately 80% to 90% of patients alive at 5 years. In contrast, muscle-invasive bladder cancer, which represents about 25% of cases, has a significantly lower relative 5-year survival rate of 17% to 66% depending on tumor stage. Thus, adequate TUR is critical not only to ensure accurate staging and guide future management options, but also to remove all tumors from the bladder. However, understaging rates of up to 40% for NMIBC have been reported based on radical cystectomy data. Moreover, absence of muscularis propria in the specimen leads to a significantly higher rate of understaging (50-78%). In these cases, restaging transurethral resection (TUR) should be performed. In addition, patients with high-grade (HG) Ta and HG T1 tumors, regardless of presence of muscle, are also strongly encouraged to undergo a restaging TUR. Restaging resection should be performed 2 to 6 weeks following initial TUR. Deep biopsies in the base and periphery of the old resection site should be performed. The goal of restaging TUR is threefold: to improve staging accuracy, resect any residual tumor, and potentially to improve the response to intravesical treatment.