Kidney transplantation is the preferred renal replacement therapy for patients with end-stage renal disease, but the waiting list for kidneys continues to grow because of a shortage of donor organs. The reuse of transplanted kidneys would seem to be a good approach to expand the pool of available organs. Here, we describe the reuse of a kidney 9 years after the initial transplantation. At 4-year follow-up, the second recipient is showing good renal function. In 2005, a kidney was transplanted from a 40-year-old man, who suffered brain death due to an intracranial hemorrhage, into a 45-year-old man. Nine years later, the recipient suffered a ruptured cerebral aneurysm, resulting in brain death. The kidney was re-transplanted into a 40-year-old man with diabetic nephropathy who had received hemodialysis for 5 years. During 4 years of follow-up, the graft has functioned well. This case demonstrates the successful regrafting of a transplanted kidney. We believe this is the longest period for reuse of kidney after initial transplantation. The outcome suggests that a well-functioning transplanted kidney can be reused years after transplantation.

Background: Partial nephrectomy (PN) has been the main strategy for treating cT1 (≤ 7 cm) renal tumors. Previous studies have established PN’s safety and effectiveness over radical nephrectomy (RN) for cT1 tumors. However, the efficacy and safety of retroperitoneal PN for larger renal tumors (> 7 cm) remained controversial. Through a size-based comparative analysis of cT1 and cT2 tumors undergoing retroperitoneal PN, we explored the impact of renal tumors larger than 7 cm on perioperative, oncological, and functional outcomes. Materials and methods: From January 2017 to April 2021, we collected data from 201 patients undergoing retroperitoneal laparoscopic or robot-assisted PN. Of these, 173 (86.1%) had tumors ≤ 7 cm (Group A) and 28 (13.9%) had tumors > 7 cm (Group B). We analyzed demographics (gender, age, Body Mass Index, Charlson Comorbidity Index, preoperative hemoglobin and renal function, tumor location, operative method, RENAL score, and complexity), perioperative (operative time, warm ischemic time, estimated blood loss, hospital stay, surgical margins, complications), and functional outcomes (changes in renal function pre- and postoperatively), along with recurrence rates. Results: Mean tumor sizes in Group A and Group B were 3.67 ± 1.56 cm and 9.90 ± 2.97 cm, respectively. RENAL score analysis revealed a significant difference (7.64 vs. 9.21, P < 0.0001), attributed to the Radius and Exophytic/Endophytic property parameters. Furthermore, Group B exhibited significantly higher tumor complexity(P = 0.0009). In perioperative outcomes, Group B had a prolonged warm ischemic time (18.90 vs. 22.60 min, P = 0.0486). However, there was no significant difference in estimated blood loss and complication rates. Regarding functional outcomes, only the reduction of estimated glomerular filtration rate on postoperative day 1 was significant (-0.74 vs. -8.31, p = 0.016), with no significant differences at 3 months, 6 months, or 1 year postoperatively. For eGFR changes over time in Group B, declines at postoperative month 3 and postoperative year 1 were noted. Conclusion: Despite higher preoperative RENAL scores and prolonged perioperative warm ischemic time, retroperitoneal PN for tumors > 7 cm demonstrated acceptable functional, oncological, and perioperative outcomes, with no observed gastrointestinal complications. Our findings support its feasibility as a treatment option for patients with > 7 cm or intermediate/high complexity renal tumors.

Purpose: This study aimed to evaluate the feasibility and outcomes of utilizing superselective transarterial indocyanine green (ICG)-lipiodol delivery to arterial branches supplying renal masses. Retroperitoneal robot-assisted partial nephrectomy (RAPN) was performed on 8 patients, and the characteristics of the patients, operative outcomes, and renal function results were assessed. Materials and methods: A preoperative procedure involved the transarterial delivery of an ICG-lipiodol mixture into tertiary-order arterial branches supplying renal masses. Retroperitoneal RAPN was performed on 8 patients, with detailed assessments of patient characteristics, operative outcomes, and renal function results. Results: The tumors were predominantly on the left side (mean size, 2.5 cm; RENAL nephrometry score, 7.3). The operative outcomes were favorable, with minimal ischemia time, no complications, and 100% margin-free resections. Individual renal functions showed a mild decrease in the estimated glomerular filtration rate, emphasizing the safety of ICG. Conclusion: The findings of this study support the effectiveness of retroperitoneal RAPN for challenging endophytic renal masses and introduce a novel approach with superselective transarterial ICG-lipiodol delivery, demonstrating favorable operative outcomes and successful preservation of renal function.

Benign prostatic hyperplasia (BPH) is a prevalent condition in aging males, leading to bladder outlet obstruction (BOO) and associated urinary symptoms. With increasing life expectancy, the incidence of BPH and its co-morbidities, like inguinal hernia, has risen. This study explores the efficacy of combining transurethral resection of the prostate (TURP) and inguinal hernioplasty in a single surgical session to address both conditions, potentially reducing the need for multiple hospitalizations and surgical interventions. This retrospective study at Chi Mei Medical Center included patients from 2014 to 2023 who underwent concurrent TURP and inguinal hernioplasty. A total of 85 patients met the criteria defined for this study. Preoperative, intraoperative, and postoperative characteristics were meticulously documented. Outcomes evaluated included the duration of the surgery, incidence of intraoperative and postoperative complications, duration of Foley catheterization, length of hospital stay, and treatment efficacy. Additionally, we conducted a comparative assessment of the surgical outcomes between two distinct techniques for inguinal hernia repair: open hernioplasty and laparoscopic hernioplasty (LH). In 85 patients who met the criteria, the mean age was 71.1 ± 7.8 years. The study reported no significant intraoperative complications, and postoperative care was focused on monitoring for blood loss, infection, and managing pain. The average postoperative hospital stay was 2.9 ± 1.0 days and the mean duration of catheterization was 51.6 ± 16.7 h, with a minimal complication rate observed during the one-year follow-up. A significant reduction in both operative duration and catheterization interval was observed in patients undergoing LH as opposed to those receiving open hernioplasty. Concurrent TURP and inguinal hernioplasty effectively manage BOO due to BPH and inguinal hernias with minimal complications, suggesting a viable approach to reducing hospital stays and surgical interventions. Laparoscopic techniques, in particular, offer benefits in operative efficiency and recovery time, making combined surgery a feasible option for selected patients.

Prostate cancer (PCa) ranks sixth in cancer mortality among Taiwanese men, with smoking rates remaining high despite the 2009 Tobacco Hazards Prevention Act. This study used the Taiwan Cancer Registry to evaluate smoking’s impact on PCa mortality, providing important information for healthcare strategies and patient management. From 2011 to 2017, 23,107 PCa patients were analyzed, with 7164 smokers and 15,943 non-smokers. The baseline characteristics, clinical stages, comorbidities, and treatment modalities were all included to estimate overall and cancer-specific mortality using the Cox regression model and Kaplan–Meier analysis. The stratified analysis of clinical stage and age group was also estimated. Our study found an association between smoking and increased overall and cancer-specific mortality in PCa patients. Although smokers over 60 had higher risks of overall mortality than non-smokers, cancer-specific mortality did not show significant differences in any age group. Smokers had higher overall mortality than non-smokers across all clinical stages, but cancer-specific mortality was significantly raised only in early-stage cases. In conclusion, smoking is associated with higher overall mortality in PCa patients, with a significant increase in cancer-specific mortality in early-stage cases. Therefore, active smoking management is critical for clinical urologists, particularly in the treatment of early-stage patients.

Purpose: To evaluate the prognostic role of the neutrophil-to-lymphocyte ratio (NLR) in patients with muscle-invasive bladder cancer (MIBC) and its potential in guiding treatment strategies between radical cystectomy (RC) and trimodal therapy (TMT). Materials and methods: This retrospective cohort study included 207 patients diagnosed with MIBC between January 2012 and December 2018. After applying exclusion criteria, 116 patients were analyzed. Preoperative NLR values were recorded, and patients were categorized into high NLR (NLR > 3) and low NLR (NLR ≤ 3) groups. Survival outcomes, including recurrence rate, disease-free survival, and overall survival, were analyzed. Cox regression models and Kaplan-Meier survival curves were used to assess the prognostic significance of NLR. Results: The study comprised 87 men and 29 women with a mean age of 67.7 ± 10.8 years. High NLR was associated with shorter time to recurrence (15.38 ± 12.76 versus 22.86 ± 14.79 mo, P = 0.046) and higher mortality rates (50% versus 29.7%, P = 0.026). Patients with lower NLR who underwent RC demonstrated better disease-free survival compared with those with higher NLR (log-rank test: P = 0.01). Subgroup analysis also revealed that low NLR in TMT patients was associated with significantly longer time to recurrence. Multivariate analysis identified advanced tumor staging as a major predictor of recurrence and death, while overweight status was a protective factor. Conclusion: Elevated NLR is associated with poorer outcomes in MIBC and may help stratify patients for treatment decisions between RC and TMT. NLR may be particularly useful in predicting recurrence risk and informing posttreatment surveillance intensity.