Publications by authors named "Lawrence H Kim"

20 Publications

  • Page 1 of 1

Metastatic testicular choriocarcinoma to the rectum requiring diverting colostomy.

ANZ J Surg 2021 Feb 24. Epub 2021 Feb 24.

Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ans.16683DOI Listing
February 2021

Transurethral resection of bladder tumour (TURBT).

Transl Androl Urol 2020 Dec;9(6):3056-3072

Department of Urology, Westmead Hospital, Sydney, Australia.

The goals of transurethral resection of bladder tumour (TURBT) are to identify and eradicate visualized bladder tumour if technically safe and feasible and to obtain a specimen of satisfactory quality to enable accurate histological diagnosis. In the setting of high grade bladder tumour this generally entails the inclusion of detrusor muscle and assessment for the presence of associated carcinoma in situ (CIS), lymphovascular involvement or any variant form of bladder cancer. This will assist in determining risk stratification and prognostication of the bladder cancer and guides further treatment planning. Conversely, if suboptimal TURBT is performed there will be detrimental consequences on patient outcomes in regards to undergrading or understaging, increased recurrence or progression, and subsequently need for further treatments including more invasive interventions. This review article firstly summarises the key principles and complications of TURBT, as well as significance of re-TURBT. We also discuss a number of modifications and advances in detection technology and resection techniques that have shown to improve perioperative as well as pathological and oncological outcomes of bladder cancer. They include enhanced cystoscopy such as blue light cystoscopy (BLC), narrow band imaging (NBI) and en bloc resection of bladder tumour (ERBT) technique using various types of energy source.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.21037/tau.2019.09.38DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807319PMC
December 2020

Transperineal systematic biopsies in addition to targeted biopsies are important in the detection of clinically significant prostate cancer.

ANZ J Surg 2021 04 5;91(4):584-589. Epub 2021 Jan 5.

Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.

Background: This study aimed to determine whether the addition of transperineal systematic biopsies (SB) to targeted biopsies (TB) improved clinically significant prostate cancer (csPC) detection rates without high increase in insignificant prostate cancer detection rates in an Australian population.

Methods: In this retrospective review, a total of 254 patients who had a Prostate Imaging-Reporting and Data System score between 3 and 5, and a transperineal TB and SB between 2014 and 2019 from two centres were included in this study. The primary outcome of this study was to determine csPC rates on TB and SB. The secondary outcome was a comparison of the Gleason Grade Group between TB and SB. csPC was defined as an International Society of Urological Pathology Gleason Grade Group of 2 or greater.

Results: SB alone detected more csPC overall compared to TB (152/254 (60%) versus 128/254 (51%), respectively). An additional 40 of 254 (16%) csPC cases were diagnosed with the addition of SB. Furthermore, the cost of diagnosing insignificant prostate cancer by SB when TB were negative was an additional 13/254 (5.1%).

Conclusion: A combination of TB and SB provides the best outcomes for detecting csPC and is especially warranted for patients with a higher Prostate Imaging-Reporting and Data System score on multiparametric magnetic resonance imaging.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ans.16524DOI Listing
April 2021

A Systematic Review and Meta-Analysis of the Significance of Body Mass Index on Kidney Cancer Outcomes.

J Urol 2021 02 18;205(2):346-355. Epub 2020 Sep 18.

Department of Urology, Westmead Hospital, Westmead, New South Wales, Australia.

Purpose: Obesity is a well-known risk factor for kidney cancer incidence. However, a number of studies have demonstrated more favorable kidney cancer prognosis in patients with elevated body mass index conferring a survival advantage, termed the "obesity paradox." We aimed to evaluate the association between body mass index and kidney cancer outcomes (progression-free survival, cancer specific survival and overall survival).

Materials And Methods: A computerized systematic search of Medline®, Embase®, ProQuest®, PubMed® and Google Scholar™ for literature published in English was performed between its inception and December 2018, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for reporting.

Results: Overall, 34 publications comprising a total of 50,717 patients were included in the analysis. The majority assessed the association between body mass index and cancer specific survival. Overweight and obese patients were associated with improved cancer specific survival compared to patients with normal body mass index (HR 0.85, 95% CI 0.79-0.93). A similar trend was demonstrated for progression-free survival (HR 0.68, 95% CI 0.59-0.78) and overall survival (HR 0.66, 95% CI 0.55-0.79). On the contrary, the underweight group was associated with inferior cancer specific survival (HR 2.16, 95% CI 1.15-4.04). Main drawbacks limiting the interpretation were the retrospective design in the majority of studies, heterogeneity in study population, body mass index classification and covariates in multivariate analysis.

Conclusions: This is the largest systematic review evaluating the potential phenomenon of the obesity paradox in kidney cancer outcomes. It demonstrated a favorable effect of body mass index on kidney cancer outcomes. However, due to significant heterogeneity of studies, multicenter prospective studies and further research on the fundamental biological mechanisms are warranted to confirm the significance of body mass index on kidney cancer prognosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/JU.0000000000001377DOI Listing
February 2021

The value of pre-operative MRI in management of penile fractures.

Urol Case Rep 2020 Jul 6;31:101185. Epub 2020 Apr 6.

Urology Department, Westmead Hospital, Westmead, NSW, 2145, Australia.

Penile fracture is a urological emergency which requires urgent assessment and surgical intervention to avoid long term complications. In this report, we describe a case in which penile MRI was used for initial assessment and surgical planning. This allowed exact localisation of the tunical tear and allowed direct incision over the tear for repair. In this case, the man avoided circumcision, which would be often required with the conventional degloving approach.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.eucr.2020.101185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7160193PMC
July 2020

Increased utilization of partial nephrectomy in the robotic surgery era.

ANZ J Surg 2020 01;90(1-2):9-10

Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/ans.15644DOI Listing
January 2020

Association Between Preoperative Magnetic Resonance Imaging-based Urethral Parameters and Continence Recovery Following Robot-assisted Radical Prostatectomy.

Eur Urol Focus 2020 09 25;6(5):1013-1020. Epub 2019 Jan 25.

Royal Marsden Hospital, London, UK.

Background: Studies demonstrated the significance of membranous urethral length (MUL) as a predictor of continence following robot-assisted radical prostatectomy (RARP). There are other magnetic resonance imaging (MRI) parameters that might be linked to continence outcome.

Objective: To evaluate the association between preoperative urethral parameters on MRI and continence outcome, to estimate the risk of incontinence using different cut-off values, and to assess interobserver variability in measuring urethral parameters.

Design, Setting, And Participants: Patients with localised prostate cancer who underwent RARP were retrospectively reviewed. Baseline patient characteristics, perioperative, and pathological outcomes were assessed. Continence was defined as no pad or a safety pad with <2g/24h pad weight.

Outcome Measurements And Statistical Analysis: Several MRI variables were measured by a uroradiologist, a uro-oncology fellow, and a urologist. Binary logistic regression analyses were performed to identify predictors of incontinence. Interclass correlation was used to evaluate interobserver variability.

Results And Limitations: A total of 190 patients met the study inclusion criteria. The mean MUL was 14.6mm. Age and MUL were significantly associated with incontinence outcome. The area under the receiver operating characteristic curve for continence based on MUL was 0.78 at 12 mo. The risk of incontinence in patients with MUL of <10mm was 27.8% (13.8% and 39.1% for patients aged <65 and >65 yr respectively). Conversely, the risk of incontinence with MUL >15mm was 2.7% (1.5% and 4.5% for patients aged <65 and >65 yr, respectively). The concordance rate between different observers was 89% for coronal MUL, but 77%, 74%, and 62% for sagittal MUL, membranous urethral thickness, and intraprostatic urethral length, respectively.

Conclusions: This study confirmed the significance of MUL for the continence outcome following RARP. There was also excellent consistency in measuring MUL values between different observers.

Patient Summary: Although further studies would be required to verify our findings, we support the significance of membranous urethral length in predicting the risk of incontinence and the need to incorporate it as part of preoperative assessment and counselling. This can reliably be measured by urologists and can further facilitate a patient-tailored approach to radical treatment of prostate cancer.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.euf.2019.01.011DOI Listing
September 2020

Off-Clamp Robot-Assisted Partial Nephrectomy: How Far Shall We Proceed?

J Laparoendosc Adv Surg Tech A 2018 May 19;28(5):579-585. Epub 2017 Oct 19.

1 Department of Urology, Urological Science Institute, Yonsei University College of Medicine , Seoul, South Korea .

Background: Off-clamp robot-assisted partial nephrectomy (RAPN) is associated with increased intraoperative blood loss compared with on-clamp technique. Our aim was to demonstrate our surgical technique and to determine which tumors are ideally suited for this technique.

Methods: Sixty-two patients who underwent off-clamp RAPN for renal tumor between 2006 and 2016 were retrospectively analyzed. Increased estimated blood loss (EBL) volume was defined as more than 75 percentile. receiver operating characteristic (ROC) analysis was used to determine exact cut-off tumor size and the preoperative aspects and dimensions used for an anatomical (PADUA) score that are associated with increased EBL. Risk factors for increased EBL >400 mL and chronic kidney disease (CKD) upstaging were evaluated using logistic regression analysis.

Results: The median follow-up period was 20 months (interquartile range [IQR]: 12-84). Patient's mean age, mean tumor size, and mean body mass index were 53.5 ± 12.2 years, 2.6 ± 1.5 cm, and 25 ± 4.1 kg/m, respectively. Median EBL volume was 200 mL (IQR: 100-400). ROC analysis showed that tumor size of 3.2 cm (area under the curve [AUC] = 0.82, P < .001) and PADUA score of 9 (AUC = 0.79, P = .001) were cut-off values for increased EBL >400 mL. Patients with tumor size >3.2 cm had longer operative time (116 versus 163 minutes, P = .002), more EBL (150 versus 575 mL, P < .001), and higher blood transfusion rate (0% versus 18.8%, P = .015), with increased tendency of conversion to radical nephrectomy (0% versus 12.5%, P = .063) compared with tumor size ≤3.2 cm. Overall CKD upstaging was present in 22 patients (35.4%). Multivariable logistic regression analysis showed that EBL >400 mL was the only predictor of CKD upstaging (odds ratio: 6.704, P = .009).

Conclusions: Our study showed that the risk of intraoperative bleeding and transfusion rate during off-clamp RAPN is increased if tumor size >3.2 cm and/or PADUA complexity score ≥9. Moreover, EBL >400 mL was a risk factor of CKD upstaging, despite zero ischemia. Further larger prospective studies are warranted to validate our results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1089/lap.2017.0464DOI Listing
May 2018

Effect of Preoperative Risk Group Stratification on Oncologic Outcomes of Patients with Adverse Pathologic Findings at Radical Prostatectomy.

PLoS One 2016 7;11(10):e0164497. Epub 2016 Oct 7.

Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.

Background: Current National Comprehensive Cancer Network guidelines recommend postoperative radiation therapy based only on adverse pathologic findings (APFs), irrespective of preoperative risk group. We assessed whether a model incorporating both the preoperative risk group and APFs could predict long-term oncologic outcomes better than a model based on APFs alone.

Methods: We retrospectively reviewed 4,404 men who underwent radical prostatectomy (RP) at our institution between 1992 and 2014. After excluding patients receiving neoadjuvant therapy or with incomplete pathological or follow-up data, 3,092 men were included in the final analysis. APFs were defined as extraprostatic extension (EPE), seminal vesicle invasion (SVI), or a positive surgical margin (PSM). The adequacy of model fit to the data was compared using the likelihood-ratio test between the models with and without risk groups, and model discrimination was compared with the concordance index (c-index) for predicting biochemical recurrence (BCR) and prostate cancer-specific mortality (PCSM). We performed multivariate Cox proportional hazard model and competing risk regression analyses to identify predictors of BCR and PCSM in the total patient group and each of the risk groups.

Results: Adding risk groups to the model containing only APFs significantly improved the fit to the data (likelihood-ratio test, p <0.001) and the c-index increased from 0.693 to 0.732 for BCR and from 0.707 to 0.747 for PCSM. A RP Gleason score (GS) ≥8 and a PSM were independently associated with BCR in the total patient group and also each risk group. However, only a GS ≥8 and SVI were associated with PCSM in the total patient group (GS ≥8: hazard ratio [HR] 5.39 and SVI: HR 3.36) and the high-risk group (GS ≥8: HR 6.31 and SVI: HR 4.05).

Conclusion: The postoperative estimation of oncologic outcomes in men with APFs at RP was improved by considering preoperative risk group stratification. Although a PSM was an independent predictor for BCR, only a RP GS ≥8 and SVI were associated with PCSM in the total patient and high-risk groups.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0164497PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5055349PMC
June 2017

Perioperative and short-term outcomes of Retzius-sparing robot-assisted laparoscopic radical prostatectomy stratified by gland size.

BJU Int 2017 Jan 12;119(1):135-141. Epub 2016 Sep 12.

Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.

Objective: To investigate the effect of preoperative prostate volume (PV) on the perioperative, continence and early oncological outcomes among patients treated with Retzius-sparing robot-assisted laparoscopic radical prostatectomy (RS-RALP).

Patients And Methods: This is a retrospective analysis of 294 patients with organ-confined prostate cancer treated with RS-RALP in a high-volume centre from November 2012 to February 2015. Patients were divided into three groups based on their transrectal ultrasonography estimated PV as follows: group 1, <40 mL (231 patients); group 2, 40-60 mL (47); group 3, >60 mL (16). Perioperative, oncological, and continence outcomes were compared between the three groups.

Results: The median [interquartile range (IQR)] PV for each group was; 26.1 (22-31) mL, 45.9 (41-50) mL, and 70 (68-85) mL. Blood loss was higher in group 3 compared to groups 2 and 1; at a median (IQR) of 475 (312-575) mL, 200 (150-400) mL, and 250 (150-400) mL, respectively (P = 0.001). The intraoperative transfusion rate was higher in group 3 patients (P = 0.004), while the complication rate did not differ (P = 0.05). The console time was slightly higher but was not statistically significant in group 3 compared to groups 2 and 1; at a mean (sd) of 100 (35) min, 92 (34.4) min, and 93 (24.8) min, respectively (P = 0.70). Biochemical recurrence and the continence rate did not differ between the three groups (P = 0.89 and P = 0.25, respectively).

Conclusion: RS-RALP is oncologically and functionally equivalent for all prostate sizes but technically demanding for larger prostates. We therefore recommend that surgeons initiate their RS-RALP technique with smaller prostates.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/bju.13632DOI Listing
January 2017

Comparison of Trifecta and Pentafecta Outcomes between T1a and T1b Renal Masses following Robot-Assisted Partial Nephrectomy (RAPN) with Minimum One Year Follow Up: Can RAPN for T1b Renal Masses Be Feasible?

PLoS One 2016 17;11(3):e0151738. Epub 2016 Mar 17.

Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.

Purpose/objectives: To investigate the feasibility of RAPN on T1b renal mass by assessment of Trifecta and Pentafecta rate between T1a and T1b renal mass.

Materials/methods: We retrospectively reviewed the medical records of 277 cases of RPN performed from 2006 to 2015. Sixty patients with clinically T1b renal masses (> 4 cm and ≤ 7 cm) were identified, and from 180 patients with clinically T1a renal mass, 60 patients were matched with T1b renal mass by propensity score. Tumor complexity was investigated according to R.E.N.A.L nephrometry score. "Pentafecta" was defined as achievement of Trifecta (negative surgical margin, no postoperative complications and warm ischemia time of ≤ 25 minutes) with addition of over 90% estimated GFR preservation and no chronic kidney disease stage upgrading at 1 year postoperative period. Propensity score matching was performed by OneToManyMTCH. Logistic regression models were used to identify the variables which predict the Trifecta, and Pentafecta ac.

Results: Preoperative variables (age, sex, body mass index, ASA score) were similar between T1a and T1b after propensity score matching. The median R.E.N.A.L. nephrometry score was 8 vs 9 for T1a and T1b respectively (p<0.001). The median warm ischemia time was 20.1 min vs 26.2 min (p<0.001). Positive surgical margin rate was 5% vs 6.6% (p = 0.729) and overall complication rate of 13.3%. vs 15% (p = 0.793). The rate of achievement of Trifecta rate were 65.3% vs 43.3% (p = 0.017) and Pentafecta rate were 38.3% vs 26.7% (p = 0.172). For achievement of Pentafecta, R.E.N.A.L nephrometry score (HR 0.80; 95% CI (0.67-0.97); p = 0.031) was significant predictor of achieving Pentafecta. Subanalyis to assess the component of R.E.N.A.L nephrometry score, L component (location relative to the polar lines, HR 0.63; 95% CI (0.38-1.03); P = 0.064) was relatively important component for Pentafecta achievement.

Conclusions: The rate of Pentafecta after RAPN was comparable between T1a and T1b renal masses. RAPN is a feasible modality with excellent long term outcome for patients with larger renal mass (cT1b).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0151738PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4795597PMC
August 2016

Design and evaluation of a trilateral shared-control architecture for teleoperated training robots.

Annu Int Conf IEEE Eng Med Biol Soc 2015 Aug;2015:4887-93

Multilateral teleoperated robots can be used to train humans to perform complex tasks that require collaborative interaction and expert supervision, such as laparoscopic surgical procedures. In this paper, we explain the design and performance evaluation of a shared-control architecture that can be used in trilateral teleoperated training robots. The architecture includes dominance and observation factors inspired by the determinants of motor learning in humans, including observational practice, focus of attention, feedback and augmented feedback, and self-controlled practice. Toward the validation of such an architecture, we (1) verify the stability of a trilateral system by applying Llewellyn's criterion on a two-port equivalent architecture, and (2) demonstrate that system transparency remains generally invariant across relevant observation factors and movement frequencies. In a preliminary experimental study, a dyad of two human users (one novice, one expert) collaborated on the control of a robot to follow a trajectory. The experiment showed that the framework can be used to modulate the efforts of the users and adjust the source and level of haptic feedback to the novice user.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1109/EMBC.2015.7319488DOI Listing
August 2015

Microcystic adnexal carcinoma: successful management of a large scalp lesion.

J Plast Surg Hand Surg 2014 Apr 23;48(2):158-60. Epub 2013 Aug 23.

Department of Plastic and Reconstructive Surgery, Bankstown Hospital , New South Wales.

Microcystic adnexal carcinoma (MAC) is a rare, malignant cutaneous neoplasm. It is important for us to become more aware of it, as it is often misdiagnosed, either clinically or histopathologically. We report a case of an extensive scalp lesion that was successfully treated using a combination of resection and adjuvant radiotherapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/2000656X.2013.777218DOI Listing
April 2014

Propranolol: useful therapeutic agent for the treatment of ulcerated infantile hemangiomas.

J Pediatr Surg 2011 Apr;46(4):759-763

Department of Pediatric Surgery, Sydney Children's Hospital, Randwick, New South Wales, Australia.

Infantile hemangioma (IH) is the most common vascular tumor in early childhood. Ulceration is the most frequent complication, and its management can be challenging. We present 6 cases of ulcerated IH at a single pediatric center, which responded to oral propranolol within 2 to 6 weeks. We recommend that oral propranolol therapy be considered for the management of ulcerated IH as first-line treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpedsurg.2011.01.012DOI Listing
April 2011

Acute abducens nerve palsy and weight loss due to skull base osteomyelitis.

Med J Aust 2010 Jun;192(12):719-20

Department of Geriatric Medicine, Northern Sydney Central Coast Area Health Service, Gosford Hospital, Gosford, NSW, Australia.

A 90-year-old man presented to the emergency department with multiple symptoms including double vision, reduced mobility, dysphagia, recent rapid weight loss, ear discharge and deafness. He had diabetes and other chronic medical problems, including otitis media with mastoiditis. This case highlights the difficulty of investigating weight loss in older people, who may not show the usual clinical features of infection, and of distinguishing between infection and malignancy when radiological findings are inconclusive. His eventual diagnosis was osteomyelitis of the skull base with cranial nerve involvement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5694/j.1326-5377.2010.tb03713.xDOI Listing
June 2010

The impact of laser Doppler imaging on time to grafting decisions in pediatric burns.

J Burn Care Res 2010 Mar-Apr;31(2):328-32

Children's Hospital Burns Research Institute and Burns Unit, Department of Surgery, New South Wales, Australia.

Early definitive treatment of burns facilitates optimal results by reducing the risk of subsequent hypertrophic scarring. Laser Doppler imaging (LDI) has been shown to assist in predicting burn wound healing potential. This study sought to determine whether use of LDI in pediatric burn patients has led to earlier decision making for grafting. The study cohort were patients who underwent a skin grafting procedure for a burn wound at a single institution, a state referral center for all major pediatric burns, between June 2006 and December 2007. Patients were divided into two groups: those who underwent LDI scanning and those who were only assessed clinically. Time of burn injury to time of decision making for the grafting procedure was calculated in days. Forty-nine percent of 196 patients underwent LDI. The mean time from the date of injury to decision making for graft procedure was 8.9 days in those patients who had an LDI scan vs 11.6 days in the group assessed by clinical observation alone. This trend for earlier decision for grafting procedure in the LDI group was statistically significant (P = .01). There was no significant difference between those patients who were scanned and those only assessed clinically in relation to gender, age, mechanism of injury, percentage BSA burnt, and wound culture results. There was a significant reduction in time to grafting decision in the LDI group. This would potentially lead to reduced length of stay, reduced number of hospital visits, and streamlined care for the patient and their family.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/BCR.0b013e3181d0f572DOI Listing
June 2010

Survival after a massive overdose of arsenic trioxide.

Crit Care Resusc 2009 Mar;11(1):42-5

Intensive Care Unit, Royal Prince Alfred Hospital, Sydney, NSW.

Arsenic poisoning remains a therapeutic challenge, and outcomes are often poor. An 18-year-old man deliberately ingested termiticide containing a massive dose of arsenic trioxide. Arsenic concentration was 6.3 micromol/L in serum on ICU Day 1, and 253 micromol/L in the first 24-hour urine sample, with a urinary arsenic/creatinine ratio of 84 200 micromol/mol. He was treated with the chelating agent meso-2,3-dimercaptosuccinic acid (DMSA) (replaced by dimercaprol on Days 2-5) and required intensive support for multisystem organ failure, but recovered slowly. Nine weeks after the ingestion the only ongoing clinical issue was persistent but slowly improving peripheral neuropathy.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2009