Laparoscopic Management of Complicated Urachal Remnants / 전남의대학술지

Managing persistent and symptomatic urachal anomalies requires wide surgical excision of all anomalous tissue with a cuff of bladder tissue via the open approach. We report 7 cases with complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue. We expected that this technique would be less invasive and have lower morbidity. We report on the feasibility of this approach, including efficacy and outcomes. Eight patients with a mean age of 36.5 years who had symptomatic urachal diseases underwent laparoscopic excision between July 2004 and July 2012. With the use of four ports, the urachal remnant was dissected transperitoneally and then removed via the umbilicus port. The clinical results of laparoscopic urachal remnant excision as a minimally invasive surgery, the perioperative records, and pathologic results were evaluated. There were no intraoperative or postoperative complications. Mean surgery time was 2.7 hours. Mean hospital stay was 14.6 days. The patients with bladder cuff resection had a long admission and Foley catheterization period (mean, 14.4 and 11 days). Pathological evaluations were 6 cases of infected urachal cysts, 1 case of infected urachal sinus, and 1 case of urachal adenocarcinoma. We found no postoperative complications including any symptom recurrence or voiding difficulty during a mean follow-up of 46.3 months. The perioperative surgical outcomes achieved infection control and symptomatic relief and additionally good cosmesis. Complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue seems to be a safe, effective, and better cosmetic alternative with the advantages of a minimally invasive approach.

Laparoscopic Management of Complicated Urachal Remnants / 전남의대학술지

Managing persistent and symptomatic urachal anomalies requires wide surgical excision of all anomalous tissue with a cuff of bladder tissue via the open approach. We report 7 cases with complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue. We expected that this technique would be less invasive and have lower morbidity. We report on the feasibility of this approach, including efficacy and outcomes. Eight patients with a mean age of 36.5 years who had symptomatic urachal diseases underwent laparoscopic excision between July 2004 and July 2012. With the use of four ports, the urachal remnant was dissected transperitoneally and then removed via the umbilicus port. The clinical results of laparoscopic urachal remnant excision as a minimally invasive surgery, the perioperative records, and pathologic results were evaluated. There were no intraoperative or postoperative complications. Mean surgery time was 2.7 hours. Mean hospital stay was 14.6 days. The patients with bladder cuff resection had a long admission and Foley catheterization period (mean, 14.4 and 11 days). Pathological evaluations were 6 cases of infected urachal cysts, 1 case of infected urachal sinus, and 1 case of urachal adenocarcinoma. We found no postoperative complications including any symptom recurrence or voiding difficulty during a mean follow-up of 46.3 months. The perioperative surgical outcomes achieved infection control and symptomatic relief and additionally good cosmesis. Complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue seems to be a safe, effective, and better cosmetic alternative with the advantages of a minimally invasive approach.

Transurethral Procedures for Lower Urinary Tract Symptoms Resulting From Benign Prostatic Enlargement: A Quality and Meta-Analysis / 대한배뇨장애요실금학회지

PURPOSE: Thanks to advancements in surgical techniques and instruments, many surgical modalities have been developed to replace transurethral resection of the prostate (TURP). However, TURP remains the gold standard for the surgical treatment of benign prostatic hyperplasia (BPH). We conducted a meta-analysis on the efficacy and safety of minimally invasive surgical therapies for BPH compared with TURP. METHODS: This meta-analysis used a Medline search assessing the period from 1997 to 2011. A total of 784 randomized controlled trials were identified in an electronic search. Among the 784 articles, 36 randomized controlled trials that provided the highest level of evidence (level 1b) were included in the meta-analysis. We also conducted a quality analysis of selected articles. RESULTS: Only 2 articles (5.56%) were assessed as having a low risk of bias by use of the Cochrane collaboration risk of bias tool. On the other hand, by use of the Jadad scale, there were 26 high-quality articles (72.22%). Furthermore, 28 articles (77.78%) were assessed as high-quality articles by use of the van Tulder scale. Holmium laser enucleation of the prostate (HoLEP) showed the highest reduction of the International Prostate Symptom Score compared with TURP (P<0.0001). Bipolar TURP, bipolar transurethral vaporization of the prostate, HoLEP, and open prostatectomy showed superior outcome in postvoid residual urine volume and maximum flow rate. The intraoperative complications of the minimally invasive surgeries had no statistically significant inferior outcomes compared with TURP. Also, there were no statistically significant differences in any of the modalities compared with TURP. CONCLUSIONS: The selection of an appropriate surgical modality for BPH should be assessed by fully understanding each patient's clinical conditions.

Effect of Low-Dose Triple Therapy Using Gabapentin, Amitriptyline, and a Nonsteroidal Anti-Inflammatory Drug for Overactive Bladder Symptoms in Patients With Bladder Pain Syndrome / 대한배뇨장애요실금학회지

PURPOSE: Patients with bladder pain syndrome/interstitial cystitis (BPS/IC) can have pain as a main symptom and overactive bladder (OAB) symptoms that are directly or indirectly related to a major mechanism that causes pain. The primary purpose of this study is firstly to identify the prevalence rate of OAB symptoms in patients with BPS/IC, secondly to identify changes in OAB symptoms after low-dose triple therapy, and thirdly to build a theoretical foundation to improve quality of life for patients. METHODS: Patients who met the inclusion criteria of BPS/IC through basic tests including the O'Leary-Sant symptom index, overactive bladder symptom score (OABSS), and visual analog scale (VAS) were identified. Treatment-based changes in OAB symptoms were identified using the IC Symptom Index and IC Problem Index (ICSI/ICPI), OABSS, and VAS before, and 4 and 12 weeks after low-dose triple therapy. RESULTS: The patients consisted of 3 men and 20 women, and their mean age was 61.9 years (41.0-83.2 years). Comparing values before treatment, and 4 and 12 weeks after treatment (baseline vs. 4 weeks to baseline vs. 12 weeks), the rates of improvement were as follows: ICSI, 44.2% to 63.7%; ICPI, 46.9% to 59.4%; OABSS, 34.3% to 58.2%; and VAS, 53.6% to 75.0%, which showed statistically significant differences (P0.05). CONCLUSIONS: Low-dose triple therapy in BPS/IC results in a clear decrease in OAB symptoms in the first 4 weeks after treatment, and additional treatment for 8 weeks had a partial effect with varied statistical significances depending on the questionnaires.

Effects of a Short Course of Oral Prednisolone in Patients with Bladder Pain Syndrome with Fluctuating, Worsening Pain despite Low-Dose Triple Therapy / 대한배뇨장애요실금학회지

PURPOSE: Triple therapy with gabapentin, amitriptyline, and nonsteroidal antiinflammatory drugs is efficacious for chronic bladder pain syndrome/interstitial cystitis (BPS/IC). However, transient, fluctuating, worsening pain or flare-up symptoms may develop during treatment for a variety of reasons. Here, we assessed the validity of our observational experience regarding a short course of oral prednisolone therapy, which might be of value in the management of flare-up symptoms of BPS/IC. METHODS: Between May 2007 and May 2012, 7 women (mean age, 61.5 years; range, 44.8 to 75.4 years) with BPS/IC presenting with transient, fluctuating, worsening pain as a flare-up symptom despite low-dose triple therapy received a 1- to 3-month course of oral prednisolone 10 mg. The outcome measures used were the IC symptom scale (ICSS, O'Leary-Sant Interstitial Cystitis Symptom Index) and a visual analogue scale (VAS), which were completed at baseline and after treatment. RESULTS: There were statistically significant differences in the ICSS and VAS score before and after prednisolone treatment (P<0.05 by Wilcoxon singed-rank test). The pretreatment IC symptom index (ICSI), IC problem index (ICPI), and VAS score were 16.7+/- 2.2, 13.7+/-2.3, and 8.3+/-1.5 (mean+/-standard deviation [SD]), and the posttreatment scores were 4.9+/-2.3, 4.3+/-1.1, and 2.5+/-0.9 (mean+/-SD), respectively. The ICSI, ICPI, and VAS scores were improved after prednisolone treatment by 70.7%, 68.6%, and 69.9%, respectively. Low-dose triple therapy with prednisolone caused no significant adverse effects. CONCLUSIONS: In patients with BPS/IC who show transient, fluctuating, worsening pain as flare-up symptoms despite undergoing low-dose triple therapy, a short course of oral prednisolone therapy was sufficiently effective. However, large-scale studies should be performed to verify our findings.

Perineum-based Pediculated Scrotal Flap for Reconstructive Urethral Surgery / 대한배뇨장애요실금학회지

Herein, we describe a perineum-based pediculated scrotal flap procedure for urethral reconstruction. A scrotal tubular flap was used as a substitute to correct a proximal penile urethral stricture in case 1. In case 2, a scrotal island patch was performed to treat an iatrogenic penile urethral injury. In both cases, the urethral catheter was removed on postoperative day 14 with simultaneous normal voiding cystourethrography. The excellent axial vascularization of this perineum-based pediculated scrotal flap procedure allows successful urethral reconstruction, regardless of extension, location, and etiology.

Relationship between the Glutathione-S-Transferase P1, M1, and T1 Genotypes and Prostate Cancer Risk in Korean Subjects

PURPOSE: The glutathione-S-transferase (GST)P1, GSTM1, and GSTT1 genotypes have been associated with an increased risk of prostate, bladder, and lung cancers. The aim of this study was to investigate the association between the GSTP1, GSTM1, and GSTT1 genotypes and the risk of prostate cancer in Korean men. MATERIALS AND METHODS: The study group consisted of 166 patients with histologically confirmed prostate cancer. The control group consisted of 327 healthy, cancer-free individuals. The diagnosis of prostate cancer was made by transrectal ultrasound-guided biopsy. Patients with prostatic adenocarcinoma were divided into organ-confined ( or =pT3) subgroups. The histological grades were subdivided according to the Gleason score. The GSTP1, GSTM1, and GSTT1 genotypes were determined by using polymerase chain reaction-based methods. The relationship among GSTP1, GSTM1, and GSTT1 polymorphisms and prostate cancer in a case-control study was investigated. RESULTS: The frequency of the GSTM1 null genotype in the prostate cancer group (54.2%) was higher than in the control group (odds ratio=1.53, 95% confidence interval=1.20-1.96). The comparison of the GSTP1, GSTM1, and GSTT1 genotypes and cancer prognostic factors, such as staging and grading, showed no statistical significance. CONCLUSIONS: An increased risk for prostate cancer may be associated with the GSTM1 null genotype in Korean men, but no association was found with the GSTT1 or GSTP1 genotypes.

Continence Rate and Oncological Feasibility after Total Transurethral Resection of the Prostate as an Alternative Therapy for the Treatment of Prostate Cancer: A Pilot Study / 대한배뇨장애요실금학회지

PURPOSE: The value of total transurethral resection of prostate cancer (TURPC) as an alternative therapy was first recognized by Hans J. Reuter. Thus, we conducted the study of prospectively collected data to verify total TURPC as an alternative therapy forlocalized prostate cancer. METHODS: From January 2008 to July 2011, 14 patients with a mean age of 76.1 years (range, 66 to 89 years) with clinically localized prostate cancer were treated by prostatic resection by the corresponding author with curative intention. RESULTS: The mean duration of TURPC was 51.7 minutes (range, 30 to 120 minutes) and the mean amount of prostatic tissue resected was 21.2 g (range, 5 to 66 g). An intra- and/or postoperative blood transfusion was necessary in 2 cases. Hyponatremia was found in 7 patients. Six months after TURPC, 3 cases of grade 1 and 1 case of grade 2 incontinence were observed. Three patients in the high-risk group did not achieve a prostate specific antigen (PSA) nadir of < or =0.2 ng/mL. PSA recurrence occurred in one case in our series. Newly developed lymph node or distant metastases were not observed during the follow-up period. CONCLUSIONS: According to our results, transurethral resection for prostate cancer can be performed with reasonable oncological results. The PSA nadir levels, and rates of biochemical failure and postoperative complications, including incontinence, were comparable with the published results for other procedures. TURPC is also inexpensive and non-invasive, and requires short hospitalization and a short surgical time without vesicourethral anastomosis.

Dimethoxycurcumin, a Structural Analogue of Curcumin, Induces Apoptosis in Human Renal Carcinoma Caki Cells Through the Production of Reactive Oxygen Species, the Release of Cytochrome c, and the Activation of Caspase-3

PURPOSE: Curcumin (Cur) has been reported to induce apoptosis in human renal carcinoma Caki cells. Dimethoxycurcumin (DMC), one of several synthetic Cur analogues, has been reported to have increased metabolic stability over Cur. We determined whether DMC, like Cur, induces apoptosis in Caki cells and also compared the apoptosis-inducing activity of DMC with that of Cur. MATERIALS AND METHODS: Caki cells were treated with DMC possessing four methoxy groups, Cur possessing two methoxy groups, or bis-demethoxycurcumin (BMC), which lacks a methoxy group. Cell viability was measured by using a methyltetrazolium assay. Flow cytometry and the caspase-3 activity assay were used to detect apoptosis. The release of cytochrome-c (Cyt c) was detected by Western blot analysis. The production of reactive oxygen species (ROS) was measured by flow cytometry. RESULTS: DMC, Cur, and BMC reduced cell viability and induced apoptosis, but the potency varied; DMC was the most potent compound, followed by Cur and BMC. ROS production, Cyt c release, and caspase-3 activity were increased, again in the order DMC>Cur>BMC. N-Acetylcysteine, a potent antioxidant, inhibited ROS production, Cyt c release, caspase-3 activation, and apoptosis induction in DMC-treated cells. CONCLUSIONS: These results indicate that DMC, like the original form of Cur, may induce apoptosis in human renal carcinoma Caki cells through the production of ROS, the release of mitochondrial Cyt c, and the subsequent activation of caspase-3. In addition, DMC is more potent than Cur in the ability to induce apoptosis.

Vesicovaginal Fistula Repair Using a Transurethral Pointed Electrode / 대한배뇨장애요실금학회지

The most common cause of vesicovaginal fistulasis injury to the bladder at the time of surgery. The operation most frequently responsible for vesicovaginal fistula formation is hysterectomy. The first successful transvaginal approach to vesicovaginal fistula repair was reported by Sims in 1838. Although many surgical procedures exist, there is no best approach for all patients with vesicovaginal fistula. However, it is an essential surgical principle that the fistulous tract and scar should be excised completely. Here we report our technique using a transurethral pointed electrode for the treatment of multiple, small vesicovaginal fistulas and its outcome.

The Efficacy of Epidural Ketamine on Shivering during Transurethral Resection of the Prostate under Epidural Anesthesia / 대한배뇨장애요실금학회지

PURPOSE: Ketamine may decrease core-to-peripheral redistribution of heat through direct central sympathetic stimulation and inhibition of norepinephrine uptake into postganglionic sympathetic nerve endings. The purpose of this study was to evaluate the efficacy of epidural ketamine in preventing shivering during transurethral resection of the prostate (TURP) under epidural anesthesia. MATERIALS AND METHODS: Ninety-three male patients scheduled for TURP under epidural anesthesia were enrolled in this study. Patients were randomized into one of three groups. Group 1 consisted of 31 patients who received epidural 0.75% ropivacaine, group 2 consisted of 32 patients who received epidural ketamine (0.2 mg/kg) in addition to 0.75% ropivacaine, and group 3 consisted of 30 patients who received epidural ketamine (0.4 mg/kg) in addition to 0.75% ropivacaine. Shivering and side effects such as hypotension, bradycardia, nausea, and hallucination were recorded during the anesthesia and for 2 hours while in the postanesthetic recovery room. RESULTS: Shivering was statistically more frequent in group 1 than in the other groups. The incidence of sedation was significantly higher in group 3 than in the other groups. The incidences of side effects such as hypotension, bradycardia, and nausea were significantly higher in group 1 than in the other groups. CONCLUSIONS: In this study, epidural ketamine 0.2 mg/kg and 0.4 mg/kg was shown to have a lower incidence of shivering and other side effects except sedation. In patients who undergo TURP under epidural anesthesia, the prophylactic use of low-dose epidural ketamine would be helpful in preventing any adverse effects, including shivering.

Bladder Pain Syndrome Treated with Triple Therapy with Gabapentin, Amitriptyline, and a Nonsteroidal Anti-Inflammatory Drug / 대한배뇨장애요실금학회지

PURPOSE: Bladder pain syndrome is a chronic disease that manifests as bladder pain, frequency, nocturia, and urgency. Gabapentin, amitriptyline, and nonsteroidal anti-inflammatory drugs are efficacious treatments for bladder pain syndrome. Here, we assessed the effect of triple therapy with these drugs in women with bladder pain syndrome. METHODS: Between May 2007 and May 2010, we conducted a prospective nonrandomized study on 74 patients with bladder pain syndrome. Of these patients, 38 (11 men and 27 women; mean age, 55.9 years; range, 25 to 77 years; mean follow-up, 12.6 months) were administered the interstitial cystitis (IC) symptom scales (O'Leary-Sant Symptom Index) and visual analog scale (VAS) 1, 3, and 6 months after treatment to assess the efficacy of triple therapy. RESULTS: The pretreatment O'Leary-Sant IC symptom score was 11.7, and the post-treatment scores were 4.4, 3.8, and 4.0 at 1, 3, and 6 months, respectively; the pretreatment problem index score was 10.5, and the post-treatment scores were 3.7, 2.7, and 2.9 at 1, 3, and 6 months, respectively. The pretreatment VAS score was 6.7, and the post-treatment scores were 1.8, 1.5, and 1.7 at 1, 3, and 6 months, respectively. The O'Leary-Sant IC symptom index and problem index and VAS scores improved considerably 1 month after treatment (P0.05). CONCLUSIONS: Triple therapy was sufficiently effective in patients with bladder pain syndrome and caused no significant adverse effects. However, large-scale studies should be performed to verify our findings.

Retroperitoneoscopic Nephrectomy for a Horseshoe Kidney with Unilateral Severe Hydronephrosis and Ureteral Hypoplasia

A horseshoe kidney is the most common renal fusion anomaly. It is well known that horseshoe kidneys may be associated with many urological problems, including calculi, vesicoureteral reflux, and ureteropelvic junction obstruction. However, a horseshoe kidney with unilateral severe hydronephrosis and ureteral hypoplasia is very rare. We report an 11-year-old female who underwent a retroperitoneoscopic nephrectomy for a horseshoe kidney with severe hydronephrosis and unilateral ureteral hypoplasia.

Retroperitoneoscopic Nephrectomy for a Horseshoe Kidney with Unilateral Severe Hydronephrosis and Ureteral Hypoplasia

A horseshoe kidney is the most common renal fusion anomaly. It is well known that horseshoe kidneys may be associated with many urological problems, including calculi, vesicoureteral reflux, and ureteropelvic junction obstruction. However, a horseshoe kidney with unilateral severe hydronephrosis and ureteral hypoplasia is very rare. We report an 11-year-old female who underwent a retroperitoneoscopic nephrectomy for a horseshoe kidney with severe hydronephrosis and unilateral ureteral hypoplasia.

Clinical Significance of Infected Prostate Tissue in Patients with Benign Prostatic Hyperplasia

PURPOSE: Benign prostatic hyperplasia (BPH) and prostatitis are the most common benign diseases of the prostate gland and over time affect a significant majority of men. We evaluated the relation between BPH and infection in prostatic tissue in men who underwent transurethral resection of the prostate (TURP). MATERIALS AND METHODS: This prospective study included 63 consecutive patients diagnosed with BPH and scheduled for TURP. During the TURP, 1-2 g chips were collected after resection of the prostatic urethra, and specimens were transported to the laboratory in sterile saline. Homogenized specimens were incubated for 7 days. The patients were divided into 2 groups (group 1: culture positive, group 2: culture negative). We compared prostate volume, prostate calculi, serum prostate-specific antigen (PSA), International Prostate Symptom Score (IPSS), maximum flow rate (Qmax), post-void residual urine, and ratio of the transitional zone prostate to total prostate (transitional zone ratio). RESULTS: Mean age was 72 years and mean serum PSA was 4.36 ng/dl. Group 1 included 7 patients (11.1%) and group 2 included 57 patients (88.9%). There were no significant differences in prostate volume, prostate calculi, serum PSA, IPSS, Qmax, or post-void residual urine between groups, but the transitional zone ratio was higher in group 1 (45.4%) than in group 2 (30.3%) (p<0.05). CONCLUSIONS: About 11% of the prostate tissue cultures showed bacterial growth. The transitional zone ratio was higher in patients with bacteria growth. Bacterial infection may be related to benign prostatic hyperplasia.

Solitary Fibrous Tumor of Kidney / 대한비뇨기과학회지

Solitary fibrous tumors (SFTs) are a rare spindle-cell neoplasm originating from mesenchymal fibroblast-like cells. Although they generally arise from submesothelial connective tissue in the pleura, many other locations have also been described, including the mediastinum, upper respiratory tract, orbit, salivary gland, thyroid, and prostate. SFT of the kidney, however, has rarely been described, and only 1 case has been reported in Korea. A 53-year-old female visited our hospital for abdominal pain, and abdominopelvic computed tomography showed a heterogeneous well-enhanced mass in the renal pelvis. She was treated with a laparoscopic radical nephroureterectomy, which revealed an SFT of the kidney.

The Utility of Amitryptiline in Female Overactive Bladder Patients with Nocturia / 대한비뇨기과학회지

PURPOSE: Anticholinergics suppress the muscarinic receptors in the bladder smooth muscle and, increase the level of urine storage. Their side effects include dry mouth, dry eyes, constipation, drowsiness, and tachycardia. These adverse effects limit the dosing and often decrease patient compliance. This study examined the effect of amitryptline as one of the first- line treatments for overactive bladder patients with nocturia. MATERIALS AND METHODS: Between June 2005 and June 2006, a prospective randomized study was carried out on 45 female patients with an overactive bladder. The mean age was 57.6 years and the patients were treated with doxazosin(Group I), doxazosin with tolterodine(Group II), doxazosin with amitriptyline(Group III). All 45(Group I: 15, Group II: 15, Group III: 15) were followed up for 4 weeks. The treatment efficacy was measured using the 3 days of voiding diaries. RESULTS: The actual number diurnal voids showed considerable improvement after treatment(p0.05). The actual number of nightly voids improved after treatment(p0.05). There was no difference in the total voiding volume, functional bladder capacity, nocturnal bladder capacity index, nocturia index between pre-treatment and post-treatment in each group(p>0.05). CONCLUSIONS: There are some enhanced effects with the actual number of diurnal voids and the actual number nightly voids in patients treated with doxazosin with amitriptyline. Therefore, amitripyline is helpful as a first- line treatment in female overactive bladder patients with nocturia.

Ganglioneuroma in Pelvic Cavity / 대한비뇨기과학회지

Ganglioneuroma is a rare benign tumor which originates in the neural crest, and is found along the path of the sympathetic chain, from the base of the skull to the pelvic cavity. Due to the slow growth of this type of tumor, it may be detected incidentally, or detected by virtue of the attendant pressure effects on adjacent structures. We report one case of ganglioneuroma arising in the pelvic cavity.

Ganglioneuroblastoma in a Patient with Crossed Testicular Ectopia / 대한비뇨기과학회지

Crossed testicular ectopia is a rare anomaly, in which both testes migrate toward the same hemiscrotum. Fewer than 100 cases of this condition have been reported in the literature worldwide. Occasionally, conditions initially suspected to be crossed testicular ectopia have proven to be other anomalies, including hypospadias, renal agenesis, and seminal vesicle cysts. In this case, we diagnosed ganglioneuroblastoma in a patient with testicular ectopia.

Initial 4 Cases Experience of Male Sling Procedure for the Treatment in Patients with Post-prostatectomy Incontinence

There are 3 surgical treatments for the management of post-prostatectomy incontinence, including endoscopic injection of periurethral bulking agent, perineal sling procedure, and artificial urinary sphincter (AUS). 4 patients with post-prostatectomy incontinence in our hospital underwent sling procedure using polypropylene mesh. All patients were evaluated for urodynamic result, pad count, operative time, hospital stay, complication, success, and satisfaction. Mean age was 67.8years (64-75). Mean follow-up time was 38.5months (30-51). 2 patients underwent radical prostatectomy, and other 2 patients underwent transurethral prostatectomy. Of the 4 patients, 3 (75%) were successful. In satisfaction, 2 (50%) were unsatisfied due to recurrent incontinence and erectile dysfunction. The male sling procedure using polypropylene mesh is a simple, effective treatment and an additional therapeutic option.