Endourologic Management for Calyceal Diverticular Stone / 대한비뇨기과학회지

PURPOSE: A symptomatic renal calyceal diverticular stone is a rare occurrence. Endourologic techniques, including laparoscopy, retrograde ureterorenoscopy (URS) and percutaneous nephrolithotomy (PNL) have been used for the treatment of this disease. Herein, we reviewed our experiences of treating stones in calyceal diverticulum with URS or PNL. MATERIALS AND METHODS: We retrospectively reviewed 23 patients who underwent PNL (12 cases) or URS (11 cases) for the treatment of symptomatic calyceal diverticular stones. A direct target puncture of the diverticulum was made in the PNL group and a flexible or semi-rigid ureteroscope was used to reach the diverticulum in the URS group. The diverticular neck was either incised with Holmium:YAG laser or dilated. Extracorporeal shockwave lithotripsy (ESWL) was performed prior to the procedure in 9 of the 23 cases (2 in the PNL group and 7 in the URS group). RESULTS: A complete stone-free state, with symptomatic resolution, was obtained in 11 of the 12 in the PNL group and in 7 of the 11 in the URS group. Success in the PNL group depended on an accurate puncture into the diverticulum and successful placement of the nephrostomy catheter into the renal pelvis through the diverticular neck. Success with the URS was achieved when the ureteroscope passed into the diverticulum and the double-J stent had been optimally placed. Seven of the 9 cases with prior ESWL achieved a stone-free state, while all the prior ESWL cases with successful access achieved a stone-free state. CONCLUSIONS: A calyceal diverticular stone can be treated with PNL or URS in most cases, although they are technically challenging procedures. In both procedures, access into the diverticulum is the most important step for a successful outcome. If access can be gained, preoperative ESWL could facilitate clearance of the stone and reduce the operating time, as there is no need for intraoperative lithotripsy.

A Prospective Randomized Study Comparing Effectiveness of Local Anesthesia Techniques in Patients undergoing Transrectal Ultrasound-guided Prostate Biopsy / 대한비뇨기과학회지

PURPOSE: This study was designed to compare the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during TRUS-guided biopsies. MATERIALS AND METHODS: From April 2003 to September 2003, 90 men undergoing a transrectal prostate biopsy were randomized into three groups. In group 1, 30 patients intrarectally received 20ml of 2% lidocaine gel; and group 2, 30 patients received 5ml(2.5ml per side) of 2% lidocaine solution injected along each side of the prostate, near the junction of the seminal vesicle and the base of the prostate(along the neurovascular bundles); in group 3, 30 patients received 5ml(2.5ml per side) of normal saline injected along the neurovascular bundles. The pain level after the biopsy was assessed using a 10-point linear visual analog pain scale(VAS). A statistical analysis was performed using the Wilcoxon Rank Sum test, and the results compared. RESULTS: Patient who received lidocaine solution injections along the neurovascular bundles (Group 2) had significantly lower VAS scores compared to the control group(mean score 3.56+/-2.13 versus 5.83+/-1.94, p<0.0001), but patients who received intrarectal lidocaine gel did not (mean score 5.46+/-2.70 versus 5.83+/-1.94, p=0.671). Gross hematuria, rectal bleeding and hemospermia occurred in 36(40.0%), 6(6.7%) and 5(5.6%) subjects, respectively. One patient had a vasovagal syncope. No patient reported febrile UTI or urinary retention. CONCLUSIONS: Bilateral nerve blockade with local anesthetic is a safe technique that significantly reduces pain during a prostate biopsy. However, in this study, intrarectal lidocaine injection did not reduce the pain compared to the control group during the prostate biopsy.

Expression of Bcl-2 and Bax in cis-Diamminedichloroplatinum (II)-Resistant Bladder Cancer Cell Lines / 대한비뇨기과학회지

PURPOSE: Development of drug resistance has been the major obstacle in cis-Diamminedichloroplatinum (II) (cisplatin)-based combination chemotherapy in the treatment of advanced bladder cancer for which a variety of mechanisms has been suggested. We investigated to determine the changes of expression of apoptotic regulator proteins Bcl-2 and Bax in cisplatin-resistant bladder cancer cell lines and the reversibility of chemoresistance with antisense oligonucleotide against Bcl-2. MATERIALS AND METHODS: In T24, J82, 253J, 253J-BV and HT-1376 bladder cancer cell lines, we established cisplatin-resistance using stepwise exposure to cisplatin. The changes of Bcl-2 and Bax proteins in the resistant cell lines were determined by Western blot. Then, after administration of antisense oligonucleotide targeting the Bcl-2 coding sequence to the T24, T24-R1, and T24-R2 cell lines with lipofectamine, changes of Bcl-2 expression were determined along with cisplatin cytotoxicity before and after transfection. RESULTS: We confirmed the acquisition of cisplatin resistance in all 5 cell lines as the percent increase of IC50 in each cell lines were 210%, 175%, 181%, 280% and 153%, respectively. The expression of Bcl-2 protein increased in all 5 cisplatin-resistant cell lines, while the expressions of Bax decreased in 4 of 5 cisplatin-resistant cell lines. Treatment with antisense oligonucleotide significantly enhanced the cytotoxicity of cisplatin in T24, T24-R1 and T24-R2 cell lines. CONCLUSIONS: These results suggest that the up-regulation of Bcl-2 expression as well as down-regulation of Bax expression may be one of the mechanisms of cisplatin resistance in bladder cancer cells, and antisense Bcl-2 oligonucleotide may be helpful in chemotherapy of bladder cancer by reversing cisplatin resistance.