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Treatment options for castration-resistant prostate cancer (CRPC) are available, but clear instructions for the selection of appropriate treatment are lacking. A meeting of urology experts based in Thailand was convened with the following objectives: (1) to reach a consensus and share real-life experiences about how to identify CRPC; (2) to choose the appropriate treatment for CRPC patients; (3) to evaluate disease progression using novel inhibitors of the androgen receptor pathway; (4) to identify the frequency of monitoring disease; and (5) to promote rational use of corticosteroids in CRPC patients. This consensus document can provide guidance to other urologists in Thailand to provide appropriate treatment to metastatic CRPC patients in a timely manner.

Objective: To evaluate the incidence and the correlation between the risk factors of ureteric injury and complications in patients who underwent prophylactic ureteric catheterization before pelvic surgeries. Material and Method: From October 2015 to December 2018, the medical records of 130 patients in Rajavithi Hospital who underwent pelvic surgeries and prophylactic ureteric catheterization were retrospectively reviewed. Information included age, history of previous pelvic surgeries, pelvic radiation, presence of hydronephrosis, pathology, stage of cancer, injury of ureters, and complications. Results: Incidence of ureteric injury was 4.6% (n=6). The significant risk of injury was location of the tumor at the ovary (p=0.034); borderline significant risk was malignant pathology (p=0.057). After the procedure, 16.2% (n=21) of the patients had gross hematuria and 14.6% (n=19) of the patients had a urinary tract infection. Average time of catheterization was 20.95 minutes. Significant risk of gross hematuria was older age (p<0.001) and malignant pathology (p=0.006). Conclusion: From this study, ureteric injury may be significantly higher in cases of malignancy at the ovary and may not prevent injury in high-risk patients. Ureteric catheterization should be carefully considered in elderly patients because of the higher rate of complications.

Objective: To study the efficacy of pre-incision infiltration of a local anaesthetic drug in postoperative pain following laparoscopic adrenalectomy. Material and Method: In a randomized placebo controlled study, 52 patients listed for unilateral laparoscopic adrenalectomy were randomized into 2 groups. Group I (n=26) received subcuticular pre-incision infiltration with 0.5% bupivacaine and group II (n=26) received normal saline as a placebo; all the operations were performed with the same technique by only one experienced laparoscopic urologist. Postoperative pain was assessed using the Visual Analogue Scale at the 4th, 8th, 12th, 24th, and 48th hour postoperatively as primary outcomes. The secondary outcomes were the total postoperative analgesic consumption and time to the first analgesic demand. Results: The average pain scores were significantly different at the 4th, 12th, 24th, and 48th hour postoperatively (p=0.00, 0.00, 0.001, 0.00), but insignificantly different at the 8th hour (p=0.311). There was no significant difference in nausea/vomiting, bruising score and wound infection (p=0.223, 0.298, 0.313). Postoperative analgesic consumption was significantly lower in the bupivacaine group, but time to the first analgesic demand was not significantly longer in this study. Conclusion: Our study demonstrated that pre-incision infiltration of a local anaesthetic drug is highly effective for relief of postoperative pain after laparoscopic adrenalectomy in terms of pain perception and intravenous postoperative analgesic consumption without any effects on nausea/vomiting, bruising, and wound infection.

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