Preputial Stones as a Rare Complication of Buried Penis: A Case Report

Preputial calculi are a very rare manifestation of urolithiasis that occur most often in uncircumcised elderly males with poor hygiene and low socioeconomic status. Here, we present a case of preputial calculi in a 13-year-old boy with a buried penis. No penile shaft was observed and hard materials palpated around the penile foreskin. Imaging examinations showed several stones around the penis and surgical correction was indicated. The stones were removed and a circumferential incision along the coronal edge allowed for degloving with rotated skin flaps. Surgical removal of the stones and reconstruction was performed to promote hygiene and prevent future infection.

Preputial Stones as a Rare Complication of Buried Penis: A Case Report

Preputial calculi are a very rare manifestation of urolithiasis that occur most often in uncircumcised elderly males with poor hygiene and low socioeconomic status. Here, we present a case of preputial calculi in a 13-year-old boy with a buried penis. No penile shaft was observed and hard materials palpated around the penile foreskin. Imaging examinations showed several stones around the penis and surgical correction was indicated. The stones were removed and a circumferential incision along the coronal edge allowed for degloving with rotated skin flaps. Surgical removal of the stones and reconstruction was performed to promote hygiene and prevent future infection.

A Case Giving Proof of Pathogenesis of Abdominoscrotal Hydrocele: A Case Report

An abdominoscrotal hydrocele (ASH) is an uncommon condition characterized by cystic mass that occupies the scrotum and abdomen. The characteristic aspect is the presence of two hydrocele sacs in the abdominal cavity and the scrotum, and compression of one side causes enlargement of the other side, thereby connecting the two sacs. There are several hypotheses regarding the occurrence of ASH. However, the evidence of the hypotheses is lacking. The patient was a 52-year-old male. During observation of the right inguinoscrotal hydrocele, the patient complained of a palpable mass lesion on the right lower quadrant of the abdomen. Physical examination revealed ASH that occurred with the growth of the inguinoscrotal hydrocele. This was further confirmed by sequential imaging test thereby proposing the verification of cephalad extension of hydrocele. The surgical excision was recommended and inguinal exploration was performed under general anesthesia. No evidence of relapse was observed during the 2-year follow-up period after surgery. The present case proves the cephalad extension of hydrocele among other hypotheses on the etiology of ASH.

Holmium Laser Enucleation of the Prostate is Effective in the Treatment of Symptomatic Benign Prostatic Hyperplasia of Any Size Including a Small Prostate

PURPOSE: Although transurethral resection of the prostate (TURP) is considered the standard surgical treatment for benign prostatic hyperplasia (BPH), Holmium laser enucleation of the prostate (HoLEP) is replacing TURP. We compared TURP with HoLEP with matching for prostate size. MATERIALS AND METHODS: We retrospectively reviewed the medical charts of patients who underwent TURP and HoLEP performed by one surgeon at our institute. All patients were categorized into 3 groups on the basis of prostate size (group 1, 80 g), and 45 patients were selected for each method. RESULTS: No major intraoperative complications were encountered. The mean resected tissue weight was 6.3, 18.3, and 28.0 g for groups 1, 2, and 3, respectively, for TURP and 8.7, 25.0, and 39.8 g, respectively, for HoLEP. The mean operation time was 51.8, 89.3, and 101.9 minutes for TURP and 83.6, 122.8, and 131.2 minutes for HoLEP in groups 1, 2, and 3, respectively. HoLEP had better resection efficacy than TURP for any size prostate, but there was no statistical difference between the methods. Both methods resulted in an immediate and significant improvement of International Prostate Symptom Score, peak urinary flow rates, and postvoid residual urine volume. CONCLUSIONS: HoLEP is effective for BPH treatment, regardless of prostate size, even in a small prostate. The perioperative morbidity of HoLEP is also comparable to that of TURP.

Altered Gene Expression Profile After Exposure to Transforming Growth Factor beta1 in the 253J Human Bladder Cancer Cell Line

PURPOSE: Transforming growth factor beta1 (TGF-beta1) inhibits the growth of bladder cancer cells and this effect is prominent and constant in 253J bladder cancer cells. We performed a microarray analysis to search for genes that were altered after TGF-beta1 treatment to understand the growth inhibitory action of TGF-beta1. MATERIALS AND METHODS: 253J bladder cancer cells were exposed to TGF-beta1 and total RNA was extracted at 6, 24, and 48 hours after exposure. The RNA was hybridized onto a human 22K oligonucleotide microarray and the data were analyzed by using GeneSpring 7.1. RESULTS: In the microarray analysis, a total of 1,974 genes showing changes of more than 2.0 fold were selected. The selected genes were further subdivided into five highly cohesive clusters with high probability according to the time-dependent expression pattern. A total of 310 genes showing changes of more than 2.0 fold in repeated arrays were identified by use of simple t-tests. Of these genes, those having a known function were listed according to clusters. Microarray analysis showed increased expression of molecules known to be related to Smad-dependent signal transduction, such as SARA and Smad4, and also those known to be related to the mitogen-activated protein kinase (MAPK) pathway, such as MAPKK1 and MAPKK4. CONCLUSIONS: A list of genes showing significantly altered expression profiles after TGF-beta1 treatment was made according to five highly cohesive clusters. The data suggest that the growth inhibitory effect of TGF-beta1 in bladder cancer may occur through the Smad-dependent pathway, possibly via activation of the extracellular signal-related kinase 1 and Jun amino-terminal kinases Mitogen-activated protein kinase pathway.

Growth Inhibition After Exposure to Transforming Growth Factor-beta1 in Human Bladder Cancer Cell Lines

PURPOSE: Transforming growth factor-beta1 (TGF-beta1) plays a dual role in apoptosis and in proapoptotic responses in the support of survival in a variety of cells. The aim of this study was to determine the function of TGF-beta1 in bladder cancer cells. MATERIALS AND METHODS: The role of TGF-beta1 in bladder cancer cells was examined by observing cell viability by using the tetrazolium dye (MTT) assay after treating the bladder cancer cell lines 253J, 5637, T24, J82, HT1197, and HT1376 with TGF-beta1. Among these cell lines, the 253J and T24 cell lines were coincubated with TGF-beta1 and the pan anti-TGF-beta antibody. Fluorescence-activated cell sorter (FACS) analysis was performed to determine the mechanism involved after TGF-beta1 treatment in 253J cells. RESULTS: All six cell lines showed inhibited cellular growth after TGF-beta1 treatment. Although the T24 and J82 cell lines also showed inhibited cellular growth, the growth inhibition was less than that observed in the other 4 cell lines. The addition of pan anti-TGF-beta antibodies to the culture media restored the growth properties that had been inhibited by TGF-beta1. FACS analysis was performed in the 253J cells and the 253J cells with TGF-beta1. There were no significant differences in the cell cycle between the two treatments. However, there were more apoptotic cells in the TGF-beta1-treated 253J cells. CONCLUSIONS: TGF-beta1 did not stimulate cellular proliferation but was a growth inhibitory factor in bladder cancer cells. However, the pattern of its effects depended on the cell line. TGF-beta1 achieved growth inhibition by enhancing the level of apoptosis.

Experience of Ultrasonography-Guided Percutaneous Core Biopsy for Renal Masses

PURPOSE: We evaluated the safety and accuracy of ultrasonography-guided percutaneous core biopsy collection in patients with renal masses. MATERIALS AND METHODS: From June 2008 to August 2012, 30 percutaneous core biopsies of renal masses were performed. The biopsies obtained were small tumors (<4 cm) with ambiguous radiologic findings or that met classic renal biopsy indications. The biopsy results were compared with the final pathological results after definitive surgical treatment. Ultrasonography was performed on the day after biopsy collection to rule out any complications. RESULTS: The mean age of the patients was 57.7 years, and the mean tumor size was 3.39 cm. Twelve of the lesions were in the left kidney, and 18 were in the right kidney. All but one core biopsy contained sufficient material for histopathological analysis. The biopsy results showed 17 renal cell carcinomas (56.7%), 3 angiomyolipomas (10.0%), 2 oncocytomas (6.7%), 1 adenocarcinoma (3.3%), and 7 benign lesions (23.3%). A total of 18 cases underwent surgery, and the pathological results confirmed the initial biopsy diagnosis for 17 of 18 cases (94.4%). The one (5.9%) inaccurate biopsy result was found to be a urothelial carcinoma of the kidney. No needle tract seeding was found in the pathological specimens or on follow-up imaging. A small perinephric hematoma (1-2 cm) was seen in 5 cases (16.7%), but all patients remained hemodynamically stable. CONCLUSIONS: Ultrasonography-guided renal biopsy is a safe, effective, and accurate method for evaluating small renal masses. This procedure may help in selecting treatment modalities for small renal masses.

A Case of Renal Schwannoma

Schwannomas are benign tumors that arise from the neural sheath of Schwann cells. Renal schwannomas are extremely rare and are commonly misdiagnosed as renal cell carcinoma, which typically results in a radical nephrectomy. We present a case of a renal schwannoma that mimics a renal pelvis tumor.

Anterior Urethral Valve and Diverticulum in a Neonate with Febrile Urinary Tract Infection

Anterior urethral valve is a rare congenital anomaly that can cause obstructive uropathy. Herein, we report a case of an anterior urethral valve that led to the development of febrile urinary tract infection in a neonate.

A Case of Ureteral Fistula through the Intervertebral Space

We present a case of urinary tract fistula between ureter and intervertebral space that developed spontaneously. A 73-year-old woman with left flank pain and fever was referred to the Soonchunhyang University Cheonan Hospital. Abdominal computed tomography and retrograde pyelography revealed the presence of fistula between left upper ureter and L4-5 intervertebral space after spontaneous ureteral rupture. We performed percutaneous nephrostomy and antegrade a Double-J ureteral stent insertion. Three months later, after removal of the stent, repeat retrograde pyelography showed healed ureter. To our knowledge, we report the first case of fistula between ureter and intervertebral space after spontaneous ureteral rupture, as well as the description of endourologic management, instead of open surgery.

Use of Cystoscopic Tattooing in Laparoscopic Partial Cystectomy

PURPOSE: During laparoscopic partial cystectomy (LPC), lesion identification is essential to help to determine the appropriate bladder incisions required to maintain adequate resection margins. The inability to use tactile senses makes it difficult for surgeons to locate lesions during laparoscopic surgery. Endoscopic India ink marking techniques are often used in laparoscopic gastroenterological surgery. We present our experience with performing LPC with India ink during the surgical resection of various bladder lesions. MATERIALS AND METHODS: LPC with cystoscopic fine needle tattooing was performed on 10 patients at our institute. Tattooing was performed at 1- to 2-cm intervals approximately 1 cm away from the outer margin of the lesion with enough depth (the deep muscle layer) under cystoscopic guidance. LPC was performed by the transperitoneal approach. The clinical courses and pathologic results were analyzed. RESULTS: All LPC with cystoscopic tattooing cases were performed successfully. The mean patient age was 39.1 years. The mean operative time was 130.5 minutes, and the mean estimated blood loss was 93 ml. The mean hospital stay was 13.1 days, and the mean duration of indwelling Foley catheterization was 10.7 days. There were no significant intraoperative or postoperative complications except 1 case of delayed urinary leak and 1 case of delayed wound healing. The pathological diagnosis included 1 urachal cancer, 1 urachal remnant, 4 urachal cysts, 2 pheochromocytomas, and 2 inflammatory masses. All specimens showed adequate surgical margins. CONCLUSIONS: Cystoscopic tattooing in LPC is a simple and effective technique to assist in locating pathological bladder lesions intraoperatively. This technique can help to determine appropriate resection margins during LPC without incurring additional complicated procedures.

Efficacy of Anticholinergics for Chronic Prostatitis/Chronic Pelvic Pain Syndrome in Young and Middle-Aged Patients: A Single-Blinded, Prospective, Multi-Center Study / 대한배뇨장애요실금학회지

PURPOSE: Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) exhibits variable lower urinary tract symptoms (LUTS). The aim of this study was to evaluate the incidence of LUTS and the efficacy of an anticholinergic agent in young and middle-aged CP/CPPS patients. METHODS: Ninety-six men with CP/CPPS were randomly assigned in a single-blind fashion and received either ciprofloxacin (group 1, 49 patients) or ciprofloxacin and solifenacin (5 mg/day; group 2, 47 patients) for 8 weeks. The National Institutes of Health chronic prostatitis symptom index (NIH-CPSI), the International Prostate Symptom Score (IPSS), and the International Index of Erectile Function-5 (IIEF-5) were used to grade the patients' symptoms and the quality of life impact at the start of the study, and at 4 and 8 weeks from the initiation of the study. RESULTS: There was no significant difference between groups 1 and 2 with respect to age, duration of disease, or sub-domains of the IPSS, NIH-CPSI, or IIEF-5 at baseline. Of these patients, 67.4% had LUTS. Statistically significant differences were determined via the NIH-CPSI for total score and the pain and urinary domain scores. Statistically significant differences were determined via the IPSS for total score and the storage domain score. The total score of the IIEF-5 increased, but the change was not significant. There was no statistically significant difference in residual urine. CONCLUSIONS: Many CP/CPPS patients had LUTS. Solifenacin in CP/CPPS demonstrated improvements in the NIH-CPSI and the IPSS total score and storage score. Storage factors significantly improved via the NIH-CPSI and IPSS assessments in the solifenacin treatment group.

The Efficacy, Safety and Effectiveness of the Laparoscopic Varicocelectomy: Comparative Study of 2 Trocars and 3 Trocars

OBJECTIVE: Varicocelectomy can be accomplished using a variety of approaches, including retroperitoneal, transinguinal, subinguinal or scrotal approach and there are advantage and disadvatage, respectively. The goal of this study is to evaluate the efficacy, safety and effect of the laparoscopic varicocelectomy and compare 2 trocars laparoscopic technique with 3 trocars. METHODS: Between March 2003 and December 2007, 46 patients with varicocele were treated using 3 trocars (group A) or 2 trocars (group B) laparoscopic varicocelectomy. Data regarding operative time, time of vein ligation, hospital stay, recurrence rate and complications of each procedure were retrospectively evaluated. RESULTS: Of the 46 patients 39 with left side varicocele constituted the population of the present study; the others, with bilateral varicocele, were excluded. No significant differences were found in terms of mean operative time, mean time of vein ligation, mean hospital stay and morbidity between group A and B. CONCLUSION: Laparoscopic varicocelectomy is feasible, safety and effective surgical technique. Compared with 3 trocars, 2 trocars laparoscopic varicocelctomy results in similar operative and postoperative outcomes. In addition, it is cost-effective and cosmetic.

Retroperitoneal Laparoscopic Nephrectomy for Inflammatory Renal Diseases / 대한비뇨기과학회지

PURPOSE: Retroperitoneal laparoscopic nephrectomy for inflammatory renal conditions remains technically challenging, but can prevent intraperitoneal contamination by inflammatory or pathologic materials and decrease the risk of visceral injury or peritoneal morbidity. We evaluated retroperitoneal laparoscopic nephrectomy in terms of feasibility, safety, and efficacy in inflammatory renal disease. MATERIALS AND METHODS: Between March 2003 and June 2006, retroperitoneal laparoscopic nephrectomy was performed in 39 patients with benign renal disease. Of the 39 patients, 18(group 1) had inflammatory renal diseases with perinephric stranding on CT, which was confirmed as an adhesion during surgery. The remaining 21 patients(group 2) had nonfunctioning kidneys without significant inflammation. Intraoperative and postoperative clinical parameters were analyzed and compared between the 2 groups. RESULTS: Retroperitoneal laparoscopic nephrectomy was successful in all 39 patients without conversion to open surgery. Group 1 included tuberculous pyelonephritic kidney(n=11), xanthogranulomatous pyelonephritis (n=3), pyonephrosis(n=2) and renal abscess(n=2). Group 2 included chronic pyelonephritis(n=12), ureteropelvic junction obstruction(UPJ) stricture(n=6), and cystic disease(n=3). The mean operating time and the mean estimated blood loss were significantly different between the 2 groups(p<0.001). The mean time to oral intake and ambulation, and the mean duration of hospitalization were not different between the 2 groups. There were 1 major and 2 minor complications in group 1 and 2 minor complications in group 2. CONCLUSIONS: Retroperitoneal laparoscopic nephrectomy is a feasible and safe treatment modality in inflammatory renal diseases as well as other benign renal diseases.

Functional Paraganglioma of the Pelvic Cavity / 대한비뇨기과학회지

Paraganglioma is one of the pheochromocytomas, and this arises in the extra-adrenal tissue. It is a rare tumor of neural crest origin; it accounts for at least 10% of all the pheochromocytomas. Paragangliomas produce catecholamines and on the basis of this, they are classed as either functional or nonfunctional. We report here on our experience with laparoscopic removal of functional paragangliomas of the pelvic cavity and we include a brief review of literatures.

The Usefulness of P504S/34betaE12 Immunostaining for the Detection of Prostate Cancer / 대한비뇨기과학회지

PURPOSE: We evaluated the significance of the P504S expression in prostate cancer and also the usefulness of the P504S/34betaE12 combined immunostaining method for diagnosing prostate cancer, and we did this by performing histological analysis of needle biopsy specimens. MATERIALS AND METHODS: Prostate tissue specimens were obtained from 83 patients with clinically suspected prostate cancer. A total of 54 prostate needle biopsy specimens were immunostained with an enzyme commonly overexpressed in prostate cancer(P504S) and also with an antibody against a basal cell marker(34betaE12). A total of 83 cases were immunostained with 34betaE12, including 29 cases that were stained with only with HMW- CK(34betaE12). RESULTS: P504S immunostaining was positive in 96.3%(26 of 27 cases) of the prostate cancer specimens. 34betaE12 immunostaining was positive in 97.2%(35 of 36 cases) of the benign prostate tissues. Of the 30 P504S positive immunostaining cases, 26 cases were prostate cancers, 3 cases were ASAP and 1 case was ASAP+PIN. Of the 36 34betaE12 positive immunostained cases, 35 cases were benign and 1 case was ASAP. In the P504S(+)/34betaE12(-) cases, there are no benign prostate lesions. There are no benign prostate lesions in the P504S(-)/34betaE12(+) cases, and all the cases were benign. There were no statistical correlations between the grade of P504S staining and the clinical parameters such as serum PSA, the clinical stage and the Gleason scores. CONCLUSIONS: Combining P504S as a positive marker for prostate cancer with 34betaE12 as a negative marker might improve the diagnostic performance.

Thrombophlebitis of the Penile Superficial Vein, Penile Mondor's Disease: A Case Report

Mondor's disease is commonly known as thrombophlebitis of the superficial vein in the breast, and this disease occurs rarely in the penis. Despite extensive information about the clinical presentation and course of this disease, imaging findings for this disease are limited. We report gray scale and power Doppler sonographic findings of penile Mondor's disease.

Prognosis Associated with Thrombocytosis in Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: Thrombocytosis has been reported in many types of malignancies and it has been studied as a prognostic factor. To better define the relationship between the platelet count and survival, we performed a retrospective analysis of patients with thrombocytosis and renal cell carcinoma, and some of whom had a lower survival rate than those with a normal platelet count. MATERIALS AND METHODS: We reviewed the medical records of patients with renal cell carcinoma and who had undergone radical nephrectomy between January, 1995 and December, 2004. A total of 112 patients were treated by radical nephrectomy for renal cell carcinoma. Among them, 67 patients without primary thrombocytosis, no familial history of renal cell carcinoma and no history of adjuvant therapy were enrolled in this study. The patients were divided into a normal platelet count group and a thrombocytosis group(greater than 400,000/microliter) according to the peri-operative platelet count. The two groups were compared pathologically and clinically, including comparing the prognosis. RESULTS: The mean follow-up was 55.8 months(range: 21 to 80). Thrombocytosis was present in 19 patients. The mean survival for the normal platelet count group was 67.8+/-39.36 months, compared with 41.4+/-30.65 months for the thrombocytosis group(p<0.05). The difference of survival between the 2 groups remained significant when controlling for the established prognostic indicators like the pathological stage, nuclear grade and cell types. CONCLUSIONS: This study documents the association of thrombocytosis with decreased survival in patients with renal cell carcinoma. The peri-operative platelet count appears to be a significant independent predictor for determining the prognosis for patients with renal cell carcinoma.

The Natural History of Simple Renal Cysts in Adults / 대한비뇨기과학회지

PURPOSE: Simple renal cysts are common in older patients and they are usually left untreated, yet only a few studies have been done on the natural history of simple renal cysts. We investigated the sequential changes in their size and number in 103 patients. MATERIALS AND METHODS: From January 1993 to August 2003, we followed 103 patients who were suffering with simple renal cysts. Their mean age was 55.8+/-18.72 years old (M:F=58:51). Using Abdominal USG and CT, the annual changes in renal cysts were analyzed through the follow-up period, and the mean follow-up period was 52.3+/-17.58 months. The values of the parameters were compared with using a 2-tailed Student's t-test, multivariate logistic regression analysis and the chi-square test. RESULTS: At the time of diagnosis, the mean number and size of simple renal cyst were 1.5+/-1.31 cysts per each kidney and 25.3+/-12.42mm, respectively. On the consecutive imaging study, the size of the renal cysts was increased 4.4+/-1.54mm per year. The average size increase was significantly greater in the individuals younger than 50 versus the patients 50 years or older (5.7+/-2.14mm/year vs 3.7+/-1.45mm/year, respectively). The multiple cysts showed a significantly larger size increase than did the single cysts (8.1+/-3.27mm/year vs 3.6+/-1.64mm/year, respectively). The size increase of the bilateral renal cysts was significantly larger than that of the unilateral renal cysts (5.6+/-1.48mm/year vs 4.1+/-1.02mm/year, respectively). No significant difference was observed for the average size increase with regard to gender or the initial cyst size. Only the number of cysts was a significant predictor of aggressiveness on the multivariate logistic regression analysis. CONCLUSIONS: The simple renal cysts progress in size and they appear to grow with aging. They seem to grow more rapidly in patients with a younger age, and for multiple and bilateral renal cysts.

Unilateral Renal Agenesis in 2 Siblings / 대한비뇨기과학회지

Unilateral renal agenesis associated with genito-urinary disease was found in 2 siblings of a single family. There are a few reports of familial unilateral renal agenesis. Bilateral renal agenesis is a fetal condition and unilateral renal agenesis or hypoplasia is usually asymptomatic, so investigations for renal anomalies have not been frequently undertaken in healthy members of families in which bilateral agenesis has occurred. The present report suggests that unilateral renal agenesis could occur as a manifestation of a genetic disorder.