Browsing by Author "Leewansangtong S."

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    In vitro Comparison of the Mechanical and Optical Characteristics of 5 Disposable Flexible Ureteroscopes
    (2024-01-01) Phromprathum P.; Srinualnad S.; Leewansangtong S.; Taweemonkongsap T.; Phinthusophon K.; Jitpraphai S.; Ramart P.; Woranisarakul V.; Suk-Ouichai C.; Mankongsrisuk T.; Hansomwong T.; Jongjitaree K.; Chotikawanich E.; Phromprathum P.; Mahidol University
    Introduction: Disposable (single-use) flexible ureteroscopes are alternatives to reusable ureteroscopes. With their superior surgical efficacy and safety in the presence of upper urinary calculi, disposable ureteroscopes aim to overcome the main limitations of conventional reusable ureteroscopes. However, studies on the performance of the most recently developed models of single-use flexible ureteroscopes are scarce. This study aimed to compare the in vitro performance of several recently introduced, single-use, flexible ureteroscopes. Methods: Five disposable flexible ureteroscopes were tested in vitro to evaluate their mechanical and optical characteristics. To this end, their degrees of deflection, irrigation flow rates, and image qualities were investigated. The models examined were Innovex US31-B12, OTU-100RR, Redpine RP-U-C12, Sciavita SUV-2A-B, and Seplou URS3016E. Their performance was also compared with that of a reusable flexible ureteroscope, Olympus URV-F. Results: The OTU device had the highest degrees of deflection and the smallest loop diameter of the disposable ureteroscopes. The single-use ureteroscopes had identical image resolutions at a distance of 1 cm. The Innovex and Redpine devices had the best color representation. Conclusions: Of the tested disposable ureteroscopes, the OTU device had the best mechanical attributes, given its small loop diameter, high deflection angles, and low irrigation flow loss. As to their optical properties, the resolutions of all 5 single-use models were identical at an image distance of 1 cm.
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    Outcomes of Robot-assisted Radical Prostatectomy in Men Aged 75 Years Old or Older: A Single-center Study in Thailand
    (2025-01-01) Mahalelakul A.; Assavavirojekul P.; Leewansangtong S.; Woranisarakul V.; Hansomwong T.; Srinualnad S.; Mahalelakul A.; Mahidol University
    Objective: The aim of this study was to evaluate the surgical, oncological outcomes, and complications in men ≥75 years of age who have undergone robot-assisted radical prostatectomy (RARP). Materials and Methods: A retrospective analysis was performed on data from patients who underwent RARP between July 2018 and December 2020. This analysis included the patients’ characteristics, perioperative outcomes, postoperative outcomes, oncologic outcome and biochemical recurrence(BCR) comparing an elderly group (≥75 years old) with a younger group (<75 years old). Results: In total, 455 patients were classified into two groups: 57 patients aged ≥75 and 398 patients aged <75 years old. No significant differences were observed in BCR at 12 months10.3% vs. 17.5% (p=0.1), perioperative and postoperative complications, pathological positive lymph node, or resection margins. The pathological T-staging and Gleason grade groups were more aggressive in the older group with pT3 64.9 vs. 48.7% (p < 0.05) and Gleason grade group 4 and 5 41.3% vs. 25.1%, (p < 0.05). Conclusion: RARP is safe and feasible procedure in selected elderly patients, offering comparable perioperative and postoperative surgical outcomes to those seen in younger patients.
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    Predictive Factors of Intravesical Recurrence after Ureteroscopy in Upper Urinary Tract Urothelial Carcinoma Followed by Radical Nephroureterectomy
    (2023-01-01) Srinualnad S.; Sawangchareon A.; Jongjitaree K.; Phinthusophon K.; Taweemonkongsap T.; Leewansangtong S.; Nualyong C.; Liangkobkit K.; Chotikawanich E.; Mahidol University
    Objective: To investigate the risk factors of developing intravesical recurrence (IVR) in patients with upper urinary tract urothelial carcinoma (UTUC) who underwent ureterorenoscopy (URS) before radical nephroureterectomy with bladder cuff excision (RNU). Materials and Methods: This retrospective study collected data from the medical records of patients diagnosed with UTUC between January 2012 and December 2019. All the patients underwent ureteroscopy before radical surgery. Patients previously diagnosed with bladder cancer were excluded. A total of 63 patients were included in the study. Tumour factors, such as multiplicity, location, size, histologic grade, pathologic T-stage, and lymphovascular invasion status, were evaluated. The type of endoscopic procedure and time interval between URS and RNU were analysed to determine the factors affecting IVR. Results: The associated factors with IVR included multifocal tumours (HR = 4.8 (1.9–11.9)), large size tumours greater than or equal to 4 cm (HR = 3.3 (1.5–7.0)), and time interval greater than or equal to 5 weeks between URS and RNU (HR = 2.6 (1.2–5.5)). Factors including tumour location (kidney or ureter), size, grading, T-stage, and lymphovascular invasion as well as the type of endoscopic procedure were not at high risk for IVR. Conclusion: The predictive factors of IVR for UTUC patients who underwent URS before RNU included a multiplicity of primary tumours and a tumour size greater than or equal to 4 cm, while a time interval between URS and RNU greater than or equal to 5 weeks increased the risk of IVR.
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    Role of preoperative magnetic resonance imaging on the surgical outcomes of radical prostatectomy: Does preoperative tumor recognition reduce the positive surgical margin in a specific location? Experience from a Thailand prostate cancer specialized center
    (2023-01-01) Hansomwong T.; Saksirisampant P.; Isharwal S.; Aussavavirojekul P.; Woranisarakul V.; Jitpraphai S.; Leewansangtong S.; Taweemonkongsap T.; Srinualnad S.; Mahidol University
    Objective: Multiparametric magnetic resonance imaging (MRI) has become the standard of care for the diagnosis of prostate cancer patients. This study aimed to evaluate the influence of preoperative MRI on the positive surgical margin (PSM) rates. Methods: We retrospectively reviewed 1070 prostate cancer patients treated with radical prostatectomy (RP) at Siriraj Hospital between January 2013 and September 2019. PSM rates were compare between those with and without preoperative MRI. PSM locations were analyzed. Results: In total, 322 (30.1%) patients underwent MRI before RP. PSM most frequently occurred at the apex (33.2%), followed by posterior (13.5%), bladder neck (12.7%), anterior (10.7%), posterolateral (9.9%), and lateral (2.3%) positions. In preoperative MRI, PSM was significantly lowered at the posterior surface (9.0% vs. 15.4%, p=0.01) and in the subgroup of urologists with less than 100 RP experiences (32% vs. 51%, odds ratio=0.51, p<0.05). Blood loss was also significantly decreased when a preoperative image was obtained (200 mL vs. 250 mL, p=0.02). Multivariate analysis revealed that only preoperative MRI status was associated with overall PSM and PSM at the prostatic apex. Neither the surgical approach, the neurovascular bundle sparing technique, nor the perioperative blood loss were associated with PSM. Conclusion: MRI is associated with less overall PSM, PSM at apex, and blood loss during RP. Additionally, preoperative MRI has shown promise in lowering the PSM rate among urologists who are in the early stages of performing RP.
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    Surgical outcomes of patients who underwent retrograde intrarenal surgery using a ureteral access sheath to manage kidney stones sized 1–2 cm compared between patients who did and did not undergo preoperative ureteral stenting
    (2023-05-01) Assantachai K.; Srinualnad S.; Leewansangtong S.; Taweemonkongsap T.; Liangkobkit K.; Chotikawanich E.; Mahidol University
    Objective: To investigate the surgical outcomes of patients who underwent retrograde intrarenal surgery (RIRS) using a ureteral access sheath (UAS) to manage kidney stones sized 1–2 cm compared between patients who did and did not undergo preoperative ureteral prestenting. Materials and methods: This retrospective cohort study included 166 patients (aged ≥18 years) who underwent RIRS at Siriraj Hospital (Bangkok, Thailand) during February 2015–February 2020. All patients had renal calculi (stone size: 1–2 cm) located within the pelvicalyceal system. 80 and 86 patients were allocated to the prestent and non-prestent groups, respectively. Patient baseline characteristics, renal stone details, operative equipment, stone-free rate (SFR) at 2 weeks and 6 months, and perioperative complications were compared between groups. Results: All patient baseline characteristics were similar between groups. At 2 weeks after surgery, the overall SFR was 65.1%, and the SFRs in the prestent and non-prestent groups were 73.4% and 59.5%, respectively (p = 0.09). At 6 months after surgery, the overall SFR was 80.1%, and the SFRs in the prestent and non-prestent groups were 90.7% and 79.3%, respectively (p = 0.08). The incidence of perioperative complications was not significantly different between groups. Conclusions: There was no significant difference in the SFR between the presenting and non-prestenting groups at both the 2-week and 6-month postoperative time points. There was also no significant difference in intraoperative and postoperative complications between groups. The SFR was higher at 6 months than at 2 weeks in both groups with no additional procedure.
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    The Feasibility and Outcomes of Retrograde Intrarenal Surgery to Treat Staghorn Renal Calculi
    (2023-01-01) Leewansangtong S.; Liangkobkit K.; Nualyong C.; Srinualnad S.; Chaiyaprasithi B.; Taweemonkongsap T.; Phinthusophon K.; Jitpraphai S.; Ramart P.; Woranisarakul V.; Suk-ouichai C.; Mankongsrisuk T.; Hansomwong T.; Jongjitaree K.; Chotikawanich E.; Mahidol University
    Materials and Methods: This retrospective observational study was carried out between May 2016 and October 2020, which is when we performed RIRS in staghorn stone patients. Medical records of all patients with this condition in the database of Siriraj Hospital were reviewed. A total of 35 patients were eligible for this study. Descriptive statistics were used to assess the safety and efficacy of RIRS in patients with staghorn stones. Results: In total, 31.43% of patients were stone-free after the first round of RIRS and 59.55% achieved stone-free status after the second procedure. The stone-free rate did not increase after a second round of RIRS. The median size of all staghorn stones was 3.1 cm. Unfortunately, we found two sepsis patients in this study. We also found eight events of minor complications, including fever and minimal ureteric injury in 54 sessions of RIRS we performed. However, no major injuries or bleeding requiring blood transfusion was identified. Conclusion: Percutaneous nephrolithotomy (PCNL) is still considered the first-line therapy for kidney stones over two centimeters with a favorable stone-free rate. But, in some patients with limitations such as uncorrectable coagulopathies, impaired renal function, single kidney, and morbid obesity, RIRS is a good choice to reduce the likelihood of serious complications and have an acceptable stone-free rate. However, a prospective study should be performed to confirm these findings.