Insight Urology

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2025-06-26T21:51:07+07:00

Editorial Board

2025-06-26T22:03:46+07:00

A large urinary bladder sarcoma treated with transurethral resection: a case report

2025-04-01T12:14:33+07:00

The objective of this study is to report a case of a large urinary bladder sarcoma treated with transurethral resection and to evaluate the feasibility and efficacy of endoscopic surgery for urinary bladder sarcoma. We present a case report of a 64-year-old woman who underwent transurethral resection of a large urinary bladder sarcoma. Pathologic findings and immunohistochemistry were used to confirm the diagnosis of undifferentiated sarcoma. The patient was followed up for 48 months for local recurrence and distant metastasis. Nearly complete transurethral resection was performed, yielding 500 g of tissue. The patient underwent repeated transurethral resection because she declined radical surgery. The patient has survived for 48 months without local recurrence or metastasis. Transurethral resection could be an alternative option for urinary bladder sarcoma, particularly in cases where radical resection may not be feasible or desired by the patient. Careful selection of appropriate patients and long-term follow-up are crucial. Further studies are needed to evaluate the efficacy and safety of endoscopic surgery for urinary bladder sarcoma.

Editorial

2025-06-26T22:08:13+07:00

Oncological outcomes of neoadjuvant chemotherapy in muscle-invasive bladder cancer in Rajavithi Hospital

2025-04-06T12:57:54+07:00

Objective: Neoadjuvant chemotherapy (NAC) can provide better survival benefits than radical cystectomy (RC) alone in patients with muscle-invasive bladder cancer (MIBC). At Rajavithi Hospital neoadjuvant chemotherapy has been used with some patients diagnosed with MIBC and in this study the oncologic outcomes have been evaluated. The precise objectives of this study are to assess the outcomes, overall survival, and factors which show a correlation with a downstaging of neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer before radical cystectomy at Rajavithi Hospital.

Materials and Methods: This is a single-center, retrospective case control study conducted at this large public hospital in Thailand. Forty patients (31 males, 9 females) were enrolled onto the study and had been diagnosed with MIBC. All had received neoadjuvant chemotherapy before undergoing radical cystectomy from January 2012 to December 2020. The primary endpoint was to assess the pathologic complete response (pCR) rate in MIBC after treatment with neoadju- vant chemotherapy. The secondary endpoints were overall survival (OS), tumor downstaging, and factors correlated with downstaging following NAC.

Results: The overall complete response rate for all patients was 7.50%. Tumor downstaging occurred in 47.50% of patients, upstaging in 22.50%, and no change in 30.00%. At a median follow-up period of 35 months, the overall survival (OS) rate was 52.80%.

Conclusion: The complete response rate and overall survival were lower than those reported in previous studies. This may be due to the primary regimen being gemcitabine and carboplatin rather than one of the other pharmaceutical combinations, and also patients not completing the full course of neoadjuvant chemotherapy. We found a correlation between non-response and chronic kidney disease (CKD), positive lymphovascular invasion (LVI), and positive pelvic lymph nodes. A correlation between non-response and mortality was also found.

Accuracy of detecting recurrent rate of NMIBC by NBI and WLC: the prospective study

2023-09-07T11:25:32+07:00

Objective: The aim of this study was to investigate the accuracy of narrow-band imaging cystoscopy (NBI) in cases of recurrent non-muscle invasive bladder cancer (NMIBC) compared to standard white light cystoscopy (WLC).

Materials and Methods: All NMIBC patients at Rajavithi Hospital, Thailand were enrolled onto this single-center prospective cohort study. The patients were diagnosed by transurethral resection of bladder tumor (TURBT) then underwent both WLC and NBI carried out by the same two urologists. Cold cup biopsy was performed for all visible lesions.

Results: A total of 67 NMIBC patients were enrolled onto the study. The male to female ratio was 3.5 : 1, the mean age was 69.2±10.7 years, and stage Ta and T1 were 56.7% and 43.3% respectively. Papillary urothelial neoplasm of low malignant potential (PUNLMP), low and high grade were 3.0%, 37.3%, and 59.7% respectively. The NBI significantly improved the detection rate of NMIBC and carcinoma in situ (CIS) in comparison to standard WLC (100.0% versus 80.0% and 100.0% versus 0.0% respectively). Also, NBI cystoscopy resulted in significantly superior detection rates for CIS and overall tumors. However, specificity was lower (84.0% versus 93.0%) and the false positive rates of NBI were higher than WLC (15.7% versus 7.01%).

Conclusion: NBI cystoscopy is an alternative procedure for patients with recurrent NMIBC, with significant levels of improvement regarding tumor detection. This technique may lead to better outcomes from early treatment.

Prostate cancer detection rate of 16-core TRUS-guided prostate biopsy in Rajavithi Hospital

2024-03-23T20:42:16+07:00

Objective: Prostate cancer is one of the most prevalent malignancies in the male Thai population. Early detection of prostate cancer increases the chance of organ confined and potentially curable disease. To date, the grayscale transrectal ultrasound (TRUS) is a common modality for prostate diagnosis and the extended 12-core biopsy is con- sidered adequate for cancer detection. With the aim of increasing the peripheral zone of prostate biopsy sampling, Rajavithi Hospital performed a 16-core TRUS-guided prostate biopsy instead. The objectives of this study are to evaluate the rate of prostate cancer detection and to review the factors associated in 16-core TRUS-guided prostate biopsy in Rajavithi Hospital.

Materials and Methods: TRUS-guided prostate biopsy was performed in 243 patients between October 2019 and September 2021 in Rajavithi Hospital. Using retrospective methods, 200 patients were included in this study. The factors associated with prostate cancer detection were analyzed by independent sample t-test, Mann-Whitney U test, Chi-square test and Fisher’s exact test, and Multiple logistic regression methods.

Results: The average age of TRUS-guided prostate biopsy patient in Rajavithi Hospital was 69.28 ± 8.41 years. Prostate cancer was detected in 70 patients (35.0%). Factors significantly associated with a positive diagnosis were: abnormal digital rectal exam (DRE) (74.3%, p < 0.001), PSA level > 10 ng/ml (mean 9.87 ng/ml, p < 0.001), and PSAD ≥ 15 ng/ml/g (94.3%, p < 0.001). Among prostate cancer patients, in the majority of cases the positive tissue was found at lateral core (31.0%), followed by the apical core (28.5%), medial core (27.5%) and anterior core (23.5%). No factors were found to be related to increasing prostate cancer detection tissue in the lateral core with the exception of abnormal DRE.

Conclusion: A 16-core TRUS-guided prostate biopsy may be useful for the detec- tion of prostate cancer in patients with abnormal DRE, high PSA, and high PSAD.

The role of prostate MRI in clinical staging of prostate cancer before radical prostatectomy

2024-05-04T20:53:55+07:00

Objective: Transrectal ultrasonography (TRUS) guided biopsy is the main method used for the diagnosis of prostate cancer. However, it may be challenging to determine the extraprostatic extension (EPE) and seminal vesicle invasion (SVI) based solely on pathology alone. Newer imaging techniques may have the potential to improve differentiation between localized and locally advanced diseases. The objective of this study is to evaluate the accuracy of mpMRI in the determination of extraprostatic extension EPE and SVI of prostate cancer with regard to the final pathology, and to predict lymph node (LN) involvement.

Materials and Methods: This retrospective study evaluated the data from the medical records of male patients with prostate cancer who underwent preoperative mpMRI (at either 3.0 Tesla or 1.5 Tesla) followed by either robotic-assisted laparoscopic radical prostatectomy or laparoscopic radical prostatectomy, between January 2017 and October 2022. The area under the receiver operating characteristic curve (AUC) value was used in multivariable analysis to compare the performance of mpMRI and clinical data (prostate-specific antigen, ISUP category) in predicting pathologic EPE or SVI.

Results: The study looked at the data pertinent to 98 men with prostate cancer who underwent an MRI scan (mpMRI) before surgery (radical prostatectomy). The average age was 67 and the average PSA level was 19.81 ng/ml. The final pathology was reviewed to see if the cancer had spread outside the prostate (extracapsular extension, EPE) or into the SVI. These are signs of a more advanced cancer. At radical prostatectomy a total of 56 out of 98 (57.14%) patients had pathologic EPE, and 22 out of 98 (22.45%) patients had pathologic SVI. To determine the relationship between mpMRI staging and pathological staging, univariate analysis was conducted. EPE and SVI were combined to characterize them as locally progressed diseases and to enhance effective prediction. The data indicated 50.88%, 95.12%, 93.55%, and 58.21% of cases, for specificity, sensitivity, positive predictive value, and negative predictive value respectively. In summary, the mpMRI has a strong ability to inform the treatment of locally advanced disease due to its ability to determine the EPE and SVI on the final pathology. The limited level of sensitivity is currently limiting and warrants further research.

Conclusion: This study suggests that mpMRI can be a valuable tool for the identification of prostate cancer in patients who are unlikely to have advanced stages of the disease (EPE or SVI). However, due to its limited sensitivity, it may limit the diagnosis of cases of advanced cancer. Therefore, a negative mpMRI result should not completely rule out the possibility of advanced disease, and additional evaluation may be necessary.

Incidence of nocturia in post kidney transplant patients at Chiang Mai University Hospital: a descriptive study

2024-05-04T23:55:41+07:00

Objective: Kidney transplantation is the most effective long term treatment for ESRD patients one reason being the decrease in complications related to hemodialysis/ peritoneal dialysis. However, the transplantation is associated with high urine volume which makes ESRD patients experience increased nocturia affecting quality of life. The objective of this study is to investigate incidence and frequency of nocturia at different periods of time after kidney transplantation and the percentage of increase in bladder capacity.

Materials and Methods: This descriptive and ambispective study was carried out using data from medical records and self-frequency voiding charts recorded after transplantation at 1, 3 and 6 months. Data used was pertinent to kidney transplant patients at Chiang Mai University Hospital from June 2018 to February 2020 and August 2020 to December 2021.

Results: Data from a total of 132 patients fitted the criteria, 68 patients from prior study and 64 patients who were enrolled onto a prospective study. Virtually 100% of patients (131/132) have nocturia (nighttime voiding ≥ 2) at 1 month after surgery, the frequency decreasing in incidence at 3 and 6 months (96.21 & 87.88% respectively). The mean frequency of nighttime voiding is also decreasing at 1, 3, and 6 months (5.72, 4.24, 3.29 respectively). Meanwhile, the mean post-operative bladder capacity(ml) is increasing, at 360, 449, and 486 ml at 1, 3, and 6 months respectively. These results may show a correlation between increase in bladder capacity and decrease in frequency of nighttime voiding

Conclusion: Post-kidney transplant patients will face nocturia, but in most cases this will improve in time because of the increase of bladder capacity. Further research into this area needs to include a longer follow up period to enable the identification of the timing of the plateau phase when nighttime voiding and bladder capacity are stable. This will enable both patients and health professionals to plan and advise regarding any idiosyncracies in recovery after kidney transplantation.

Identification of somatic mutations and their effects in a Thai population with both non-muscle invasive and muscle invasive bladder cancer using whole exome sequencing analysis

2025-05-24T10:30:24+07:00

Objective: Whole exome sequencing is a new technology which enables the detection of genetic mutation in cancer. Genetic alterations in urothelial carcinoma have been identified and studies are being carried out with regard to clinical applications. Proposals have been made pertinent to molecular classifications for the prediction of treatment response and prognosis. To date, there is a paucity of data regarding somatic mutation of bladder cancer in Thailand, therefore, the aim of this study is to identify specific somatic mutations associated with different types of bladder cancer in Thailand.

Materials and Methods: Fourteen patients were enrolled onto this study, 7 with non-muscle invasive (NMIBC) and 7 with muscle invasive bladder cancer (MIBC). DNA was isolated from peripheral blood mononuclear cells and tumor tissue for whole exome sequencing to identify any tumor somatic mutations and the mutation burden in each patient. The results were analyzed and correlated with the clinical status of the patients after treatment.

Results: In the NMIBC group, the most common mutated genes were found to be HLA-F, KDM6A, and TTN. In the MIBC group, the most common mutated genes were TP53, TTN, and KMT2D. Patients with urothelial carcinoma with small cell variant show TP53 and RB1 mutation. This is the same as the current consensus on molecular classification. The disease has usually metastasized after 1 year. This supports the evidence that Neuroendocrine-like groups have poorer prognosis.

Conclusion: The somatic mutations of bladder cancer in this Thai population showed greater diversity of genetic alteration in comparison with the worldwide database. The mutations in the muscle invasive bladder cancer were the same as previous findings. We also found a similar association in neuroendocrine-like genomic mutations. Despite the number of patients in this study being small, there is evidence of genetic diversity and tumor origins of mutation in our patients.

Comparison of heated topical intrarectal anesthesia and periprostatic nerve block in transrectal ultrasound-guided prostate biopsy in Chaophrayayommarat Hospital: a prospective randomized trial

2025-04-06T10:52:50+07:00

Objective: To compare efficacy between heated intrarectal local anesthesia (HIRLA) and periprostatic nerve block (PNB) with respect to pain reduction during transrectal ultrasound-guided prostate biopsy (TRUS-Bx).

Materials and Methods: A prospective randomized trial including 60 participants scheduled for TRUS-Bx from July to December 2024. Participants were assigned to a group using heated intrarectal local anesthesia with 10 ml 40 C 2% lidocaine gel (n=30) or PNB (n=30). Primary outcome was the level of pain as measured by pain score using a visual analog scale (VAS) during TRUS-Bx. The secondary outcome was complications which occurred during and after the procedure.

Results: The level of pain in the HIRLA group was greater in comparison to PNB (4.03±1.85 versus 2.57±1.68; p=0.002). No differences in complications were observed between the two groups.

Conclusion: PNB provides more effective pain reduction in comparison to HIRLA during TRUS-Bx.

Ofloxacin prophylaxis can reduce bacteriuria in patients with sterile urine who underwent extracorporeal shockwave lithotripsy (ESWL) for treatment of upper urinary tract stone: a randomized controlled trial

2025-05-11T14:57:45+07:00

Objective: Urinary tract infections (UTI) are a serious complication in patients undergoing extracorporeal shock wave lithotripsy (ESWL). While antibiotic prophylaxis has proven beneficial in various surgical procedures, this study aimed to evaluate its benefits in ESWL patients with sterile urine.

Materials and Methods: This double-blind, randomized clinical trial was conducted in patients with upper urinary tract stones admitted for ESWL at Sunpasitthiprasong Hospital, Thailand. Patients were randomly assigned to receive either ofloxacin (200 mg) or placebo one hour before ESWL. The incidence of UTI, bacteriuria, pyuria, and patient characteristics including gender, age, underlying conditions, and stone location were assessed in both groups.

Results: Data were collected from a total of 598 patients who were admitted for ESWL between 2008 and 2015. No cases of UTI were observed, and the incidence of pyuria did not differ significantly between the two groups (p = 0.399). However, bacteriuria was found in 11 patients, with 2 (0.60%) in the antibiotic group (n = 310) and 9 (3.10%) in the placebo group (n = 286), showing a statistically significant difference (p = 0.023).

Conclusions: Ofloxacin prophylaxis in sterile urine ESWL patients showed a benefit in reducing the incidence of bacteriuria but incidence of UTI and pyuria showed no change.

2025-06-26T22:11:49+07:00

Are your kidneys OK? detect early to protect kidney health

2025-05-11T20:29:34+07:00

Early identification of kidney disease can protect kidney health, prevent kidney disease progression and related complications, reduce cardiovascular disease risk and decrease mortality. We must ask “Are your kidneys ok?” using serum creatinine to estimate kidney function and urine albumin to assess for kidney and endothelial damage. Evaluation for causes and risk factors for chronic kidney disease (CKD) includes testing for diabetes and measurement of blood pressure and body mass index. This World Kidney Day we assert that case-finding in high-risk populations, or even population level screening, can decrease the burden of kidney disease globally. Early-stage CKD is asymptomatic, simple to test for and recent paradigm shifting CKD treatments such as sodium glucose co-transporter-2 inhibitors dramatically improve outcomes and favor the cost-benefit analysis for screening or case-finding programs. Despite this, numerous barriers exist, including resource allocation, healthcare funding, healthcare infrastructure and healthcare-professional and population awareness of kidney disease. Coordinated efforts by major kidney non-governmental organizations to prioritise the kidney health agenda for governments and aligning early detection efforts with other current programs will maximise efficiencies.

Parenchymal volume analysis and functional recovery after partial and radical nephrectomy for renal cell carcinoma

2025-06-10T15:58:19+07:00

Renal cell carcinoma (RCC) accounts for 2–3% of adult malignancies and has the highest mortality among genitourinary cancers. With the increasing use of cross-sectional imaging, RCC is now frequently diagnosed incidentally and at earlier stages, and partial nephrectomy (PN) has become the standard treatment for small renal masses. In appropriately selected patients, PN can significantly reduce the risk of chronic kidney disease (CKD), CKD-related mortality, and cardiovascular events. In cases where PN is high-risk or not feasible, radical nephrectomy (RN) remains a valid alternative, particularly when the new baseline glomerular filtration rate (NBGFR) is anticipated to be greater than 45 ml/min/1.73 m2.

Functional recovery after surgery depends on multiple factors. Among these, parenchymal volume loss has been identified as the primary determinant, accounting for 70–80% of the decline in function associated with PN. Ischemia, particularly warm ischemia exceeding 30 minutes, can also contribute to renal impairment albeit to a lesser extent. Cold ischemia has a comparatively minor effect and is generally protective. Vascularized parenchymal loss results from both tumor resection and devascularization during reconstruction, with the latter playing the predominant role. Preserving well-perfused renal parenchyma is thus crucial for optimal recovery.

To analyze functional recovery after PN, accurate estimates of split renal function (SRF) are required to evaluate outcomes specific to the kidney exposed to ischemia. Our recent studies have used parenchymal volume analysis (PVA) rather than nuclear renal scans to estimate SRF, and this has allowed us to provide a more discerning analysis. PVA presumes that the amount of parenchyma on each side is proportionate to its function and this approach has proven to be more accurate than nuclear renal scans

Instructions for Authors

2025-06-26T22:22:05+07:00