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PURPOSE: Health-related quality of life (HRQoL) outcomes, in addition to being useful for monitoring a person's health and well-being, may also predict overall survival (OS) in cancer patients. This study's objective was to examine the association of longitudinally assessed HRQoL and OS in patients with a history of bladder cancer (BC). MATERIALS AND METHODS: This longitudinal retrospective cohort study used the 1998 to 2013 Surveillance, Epidemiology and End Results database linked with Medicare Health Outcomes Survey. Study cohort included patients having HRQoL assessments both pre- and post-BC diagnosis using Short Form-36/Veterans Rand-12. Using Cox Proportional Hazards adjusted for demographics, tumor characteristics, and surgery type, we studied the associations of 3-point difference in HRQoL assessed pre- and post-BC diagnosis and change from pre-to-post diagnosis with overall survival. RESULTS: The study cohort included 438 BC patients with deceased patients (n = 222; 50.7%) being significantly older than those alive (77.2 vs. 75.4 years; P = 0.004). Adjusting for covariates, a 3-point difference in physical HRQoL (physical component summary [PCS]) pre-, post-, and pre-to-post BC diagnosis was associated with respectively 6.1%, 8.7%, and 7.3% (P < 0.01 for all) decreased risk of death for higher PCS. Similarly, a 3-point difference in mental HRQoL (mental component summary [MCS]) post-BC diagnosis was associated with 4.5% (P < 0.05) decreased risk of death for higher MCS. CONCLUSIONS: Associations between PCS/MCS and OS imply that elderly BC patients with better physical/mental health are more likely to survive longer. Monitoring HRQoL in routine cancer care would facilitate early detection of HRQoL decline and enable timely intervention by clinicians to improve OS.

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OBJECTIVE: Salvage surgery (SS) for penile cancer (PC) is indicated in the management of local failure following radiation therapy (RT). Reports describing survival outcome are rare. This study aims to assess survival outcome of SS following RT failure in PC. MATERIALS AND METHODS: We used The Surveillance, Epidemiology, and End Results database to identify patients received SS on the penis following RT. Social, demographic and pathological criteria of the patients were gathered. The 1-, 3-, 5-, 10-year survival rates were assessed. RESULTS: Between 1976 and 2013, 17 patients received penile SS following RT. Median age was 65 years (range 47-91 years). The mean follow-up was 51 months (range 3-213 months). Sixteen (94.12%) patients received external beam radiation and 1 (5.88%) received combined external beam radiation with brachytherapy. Tumor histology was squamous cell carcinoma in 16 (94.12%) patients and mucinous adenocar-cinoma in 1 (5.88%). The 1-, 3-, 5- and 10-year overall survival rates were 68.8, 35.7, 35.7 and 10.7%, respectively. The 1-, 3-, 5- and 10-year cancer specific survival rate was 72.7, 48.4, 48.4, and 36.3% respectively. CONCLUSION: Our results demonstrate, the overall survival of PC patients underwent SS was poor with nearly one third of patients dying within the first year and only one third surviving up to 3 years from the SS.

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To determine the role of noninvasive, minimally invasive diagnostic modalities and current management recommendations for cN0 PNC, a literature review using PubMed and Web of Science search engines were conducted. We found that for predicting ILN+: physical exam has limitations, nomograms are not validated, conventional computerized tomography/magnetic resonance imaging/positron imaging tomography scans have minimal role, and dynamic sentinel lymph node biopsy is the most reliable minimally invasive modality. Adverse pathological features: G3, stage ≥ T2, presence of LVI, and rare histopathological variants are important predictors of ILN+ and their presence warrants prophylactic ILND or dynamic sentinel lymph node biopsy. In the absence of these adverse pathological features conservative management is justified.

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OBJECTIVE: To explore the relationship between insurance status and differences in treatment and survival of testicular cancer patients. The Surveillance, Epidemiology, and End Results (SEER) database was utilized for this study. MATERIALS AND METHODS: Between 2007 and 2011, 5986 testicular cancer patients were included in the SEER database. Patients were classified into nonseminoma and seminoma groups. We compared mortality rates, metastasis (M+) at diagnosis, and rates of adjuvant treatments between the uninsured (UI) and insured (I) populations. RESULTS: Overall, 2.64% of UI vs 1.36% of I died from testicular cancer (P = .025) and 16.73% of UI vs 10.52% of I had M+ at diagnosis (P <.0001). In the nonseminoma group, 4.19% of UI vs 2.79% of I died from testicular cancer (P = .326) and 25.92% of UI vs 18.46% of I had M+ at diagnosis (P = .0007). Also 17.28% of UI vs 20.88% of I had retroperitoneal lymph node dissection (RPLND; P = .1). In the seminoma group, 1.06% of UI vs 0.33% of I died from testicular cancer (P = .030) and 7.43% of UI vs 4.81% of I had M+ at diagnosis (P = .029). Also 34.75% of UI vs 48.4% of I received adjuvant radiation (P = .0083). The lack of health insurance predicted poor survival after adjusting for tumor stage, receiving adjuvant radiation or RPLND. CONCLUSION: UI testicular cancer patients present with more advanced cancer stages and have higher mortality rates than I patients. UI seminoma patients received less adjuvant radiation. This may be related to lack of access to care or more advanced cancer stage at diagnosis.

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OBJECTIVE: The objective of our retrospective study was to provide evidence on the efficacy of the intercostal versus subcostal access route for percutaneous nephrolithotripsy. MATERIALS AND METHODS: 642 patients underwent nephrolithotomy or nephrolithotripsy from 1996 to 2005. A total of 127 had an intercostal access tract (11th or 12th); 515 had a subcostal access tract. RESULTS: Major complications included one pneumothorax (1.0%), one arterio-calyceal fistula (1.0%) and three arteriovenous fistulae (2.7%) for intercostal upper pole access; two pneumothoraces (1.7%), one arteriovenous fistula (1.0%), one pseudoaneurysm (1.0%), one ruptured uretero-pelvic junction (1.0%), 4 perforated ureters (3.4%) for subcostal upper pole access; one hemothorax (1.6%), one colo-calyceal fistula (1.6%), one AV fistula (1.6%), and two perforated ureters (3.2%) with subcostal interpolar access. Diffuse bleeding from the tract with a subcostal interpolar approach occurred 3.2% of the time compared with 2.4% with a lower pole approach. Staghorn calculi demonstrated similar rates of complications. CONCLUSION: Considering the advantages that the intercostal access route offers the surgeon, it is reasonable to recommend its use after proper pre-procedural assessment of the anatomy, and particularly the respiratory lung motion.

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OBJECTIVE:The objective of our retrospective study was to provide evidence on the efficacy of the intercostal versus subcostal access route for percutaneous nephrolithotripsy. MATERIAL AND METHODS: 642 patients underwent nephrolithotomy or nephrolithotripsy from 1996 to 2005. A total of 127 had an intercostal access tract (11th or 12th); 515 had a subcostal access tract. RESULTS: Major complications included one pneumothorax (1.0 percent), one arterio-calyceal fistula (1.0 percent) and three arteriovenous fistulae (2.7 percent) for intercostal upper pole access; two pneumothoraces (1.7 percent), one arteriovenous fistula (1.0 percent), one pseudoaneurysm (1.0 percent), one ruptured uretero-pelvic junction (1.0 percent), 4 perforated ureters (3.4 percent) for subcostal upper pole access; one hemothorax (1.6 percent), one colo-calyceal fistula (1.6 percent), one AV fistula (1.6 percent), and two perforated ureters (3.2 percent) with subcostal interpolar access. Diffuse bleeding from the tract with a subcostal interpolar approach occurred 3.2 percent of the time compared with 2.4 percent with a lower pole approach. Staghorn calculi demonstrated similar rates of complications. CONCLUSION: Considering the advantages that the intercostal access route offers the surgeon, it is reasonable to recommend its use after proper pre-procedural assessment of the anatomy, and particularly the respiratory lung motion.

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