Simple Retrograde Balloon Dilation for the Treatment of Ureteral Strictures: an Etiology-based Analysis / 대한비뇨기과학회지

PURPOSE: The results of a simple retrograde balloon dilation for treating ureteral strictures was analyzed in order to evaluate the efficacy of this procedure and the factors affecting the success rate. MATERIALS AND MTHODS: A prospective study was performed on 43 ureteral strictures (22 malignant, 21 benign) from 37 patients, who were treated with retrograde balloon dilation from October 1997 to May 1999. After the stricture segments were dilated, ureteral stents were indwelled uniformly for 3 weeks. The strictures were followed up radiographically at 1, 3, 6, 12 and 24 months after treatment. The success was defined by a symptomatic and radiographic improvement. The follow-up period ranged from 3 to 43 months (mean 21 months). The prognostic factors affecting the success rate were analyzed. RESULTS: The success rate of the benign strictures at 12 months was much higher than that of malignant strictures (60% vs, 15%, p=0.0019). Although 48% of the patients with strictures shorter than 2cm were successful after 12 months, only 9% of those with strictures longer than 2cm were successful (p=0.0124). Other prognostic factors such as sex, age, location, presence of immediate success and the grade of hydronephrosis were has little effect on the success rate. Multivariate analysis revealed that etiology was the only significant prognostic factor affecting the final outcome (p=0.0371), and that stricture length was the only significant prognostic factor in the benign cases (p=0.0375). CONCLUSIONS: Considering its minimal invasiveness, a simple retrograde balloon dilation appears to be a reasonably effective treatment modality for a benign ureteral stricture with a short segment (2cm).

Simple Retrograde Balloon Dilation for the Treatment of Ureteral Strictures: an Etiology-based Analysis / 대한비뇨기과학회지

PURPOSE: The results of a simple retrograde balloon dilation for treating ureteral strictures was analyzed in order to evaluate the efficacy of this procedure and the factors affecting the success rate. MATERIALS AND MTHODS: A prospective study was performed on 43 ureteral strictures (22 malignant, 21 benign) from 37 patients, who were treated with retrograde balloon dilation from October 1997 to May 1999. After the stricture segments were dilated, ureteral stents were indwelled uniformly for 3 weeks. The strictures were followed up radiographically at 1, 3, 6, 12 and 24 months after treatment. The success was defined by a symptomatic and radiographic improvement. The follow-up period ranged from 3 to 43 months (mean 21 months). The prognostic factors affecting the success rate were analyzed. RESULTS: The success rate of the benign strictures at 12 months was much higher than that of malignant strictures (60% vs, 15%, p=0.0019). Although 48% of the patients with strictures shorter than 2cm were successful after 12 months, only 9% of those with strictures longer than 2cm were successful (p=0.0124). Other prognostic factors such as sex, age, location, presence of immediate success and the grade of hydronephrosis were has little effect on the success rate. Multivariate analysis revealed that etiology was the only significant prognostic factor affecting the final outcome (p=0.0371), and that stricture length was the only significant prognostic factor in the benign cases (p=0.0375). CONCLUSIONS: Considering its minimal invasiveness, a simple retrograde balloon dilation appears to be a reasonably effective treatment modality for a benign ureteral stricture with a short segment (2cm).

Clinical Analysis of Abdominal Aortic Aneurysm

PURPOSE: As a common and dangerous disease, an abdominal aortic aneurysm (AAA) occurs in approximately 2-4% of the general population and recently the incidence of AAA has been gradually increasing in Korea. Since rupture of an AAA is recognized as a lethal event, a more aggressive policy of early diagnosis and of an elective repair of the AAA are that can be performed with a mortality rate of less than 5 percent is the approach of choice for treating an AAA nowadays. METHODS: This retrospective study reports our experience managing forty-two patients with an AAA who had been operated on between January 1993 and December 1999 at Korea University hospitals. RESULTS: Thirty- seven of the patients were male, and five were female. The mean age was 67.1 years. The most common clinical manifestation was abdominal pain in 26 cases (61.9%), followed by abdominal pulsatile mass in 20 cases (47.6%), and back pain in 12 cases (28.5%). The most common associated disease was hypertension in 24 cases (57.1%). An abdominal CT scan was performed in 26 cases (61.9%) and was the most commonly used method for diagnosis. Emergency repair of the AAA was performed in 10 cases; the repair was performed electively in the other cases. Among the 42 aortic grafts implanted for AAA repair, 37 were bifurcated Y grafts and 4 were straight tube grafts. Axillobifemoral bypass surgery was performed in the case of one infected aneurysm. Among the 42 cases, 10 cases (23.8%) experienced ruptures, requiring 4 urgent operation and 6 emergency procedures. Among the 42 cases, 6 patients (14.2%) expired. In the elective cases, one (3.1%) expired. In the urgent cases, one (25.0%) expired, and in the emergency cases, four (66.6%) expired. CONCLUSION: This study showed that an AAA should be considered as a possible cause of unexplained abdominal pain in aged patients. In such patients, various diagnostic tools must be used to eliminate the possibility of an abdominal aortic aneurysm. Early diagnosis and elective surgery are crucial for a better outcome in the management of patients with an abdominal aortic aneurysm.

Relationship among Symptom Score, Urinary Flow Rates, and Prostate Volume in 620 Men with Lower Urinary Tract Symptoms / 대한비뇨기과학회지

PURPOSE: We aimed to investigate the relationships among age, International Prostate Symptom Score(IPSS), uroflowmetry and prostate volume in men with lower urinary tract symptom(LUTS). MATERIALS AND METHODS: Among the 847 men who participated in the BPH awareness program, 620 men(73.2%) who had not LUTS or had LUTS without concomitant conditions(except BPH) known to interfere with normal voiding were selected. All of them completed IPSS questionnaire, uroflowmetry and transrectal ultrasonography. We calculated correlation coefficient to investigate the association among age, maximal flow rate, mean flow rate, and prostate volume. Additionally, total men were stratified by 3 age groups and 3 IPSS groups, and we also evaluated relationships among the parameters according to these groups. RESULTS: The statistically significant correlations were found among the age, uroflowmetry and prostate volume. Total symptom score did not show significant correlation with age. However, irritative symptom score increased with increasing age in statistically significant manner. When we stratified men into three age groups, most of the correlations were stronger in the younger than 60 years old group than those observed in the entire population. According to a multivariate regression analysis, age and prostate volume did not show statistically significant correlation with IPSS. When the all men were classified according to the IPSS, there were significant differences between maximal flow rate, mean flow rate and prostate volume. CONCLUSIONS: Emerging from this analysis showed that age is the important factor influencing the relationship among symptom score, urinary flow rate and prostate volume. LUTS may be affected by some factor such detrusor tone as well as prostate volume. We suggest that the development of more objective and sophisticated studies such as urodynamic study, molecular biologic study for functional morphology of detrusor and community-based study with longitudinal measurements will be necessary to approach the pathogenesis of LUTS.

Initial Experience of Retroperitoneoscopic Surgery / 대한비뇨기과학회지

PURPOSE: We tried to evaluate the safety, feasibility and the clinical usefulness of the retroperitoneoscopic surgery for the treatment of variable renal diseases. MATERIALS AND METHODS: Between June 1998 and March 1999, a total of 18 patients (9 nonfunctioning kidneys, 1 ureter tumor, 3 simple renal cysts, 1 polycystic kidney, 3 ureter stones, 1 UPJ obstruction) underwent retroperitoneoscopic surgery (9 nephrectomies, 1 nephroureterectomy, 4 cyst marsupialization, 3 ureterolithotomy, 1 pyeloplasty) in our hospital. We analyzed the results of each operations. RESULTS: Out of total 18 cases, 15 retroperitoneoscopic surgeries were performed successfully as planed. Mean operative time was 194 minutes(ranged from 100 to 355 minutes) and mean postoperative hospital stay was 4.1 days(2-7 days). There was no significant intraoperative or postoperative complication in successfully completed cases. Open conversion was needed in three patients, all of them were not in an emergent condition, and there was no significant complication. Transfusion was not required in all cases. CONCLUSIONS: Retroperitoneoscopic surgery is a safe and feasible procedure for benign renal diseases, and there seems to be enough rooms for malignant diseases also.

Laparoscopy-Assisted Extracorporeal Ureteral Anastomosis : a New Technique / 대한비뇨기과학회지

We investigated the feasibility of the extracorporeal suture technique in laparoscopic pyeloplasty and laparoscopic ipsilateral ureteroureterostomy in child with ureteropelvic junction obstruction or duplex kidney. Laparoscopic pyeloplasty and laparoscopic ureteroureterostomy were performed in a child with ureteropelvic junction obstruction and in a 3-year old child with duplex kidney, respectively. Ureteropelvic junction or ureters were dissected laparoscopically and were drawn out of the abdominal cavity through the 10mm trocar tracts and subsequently anastomosed extracorporeally. We were able to draw the ureteropelvic junction or the ureters out of the abdominal cavity without difficulty owing to the laxity and thin abdominal wall in children. Operating time was 120 minutes in both cases, and all anastomses between ureter and pelvis were completed without any intraoperative complication. There was no postoperative complication. Significant improvements in urinary drainage were shown in both children on postoperative intravenous pyelogram. These early results suggest that the extracorporeal suture technique in children is feasible and easy to perform. Therefore, the drawbacks of intracorporeal suture technique during the laparoscopic pyeloplasy or ureteroureterostomy could be overcome by using this novel teehnique.

Trimix Intracavernosal Self-injection Therapy: Long-term Follow-up Results in the Patients with Erectile Dysfunction / 대한비뇨기과학회지

PURPOSE: Trimix, the mixture of papaverine, phentolamine and PGE1 , has been widely used in intracavernosal therapy for patients with erectile dysfunction. Although several results have been reported in Korean patients using the Trimix, no long-term follow-up studies have been carried out. Therefore, we analysed our long-term follow-up results of Trimix therapy PATIENTS AND METHODS: A total of 216 patients(46.2 years of mean age) with erectile dysfunction underwent intracavernosal self-injection therapy with the Trimix(mixture of papaverine 48mg, phentolamine 2mg, PGE1 18microgram in 2 microliter solution). Once chosen, all patients were tested for an appropriate dosage. They were also given education upto 5 times for an successful self-injection therapy. During follow-up periods, ranging 12 to 34 months, evaluations of the effectiveness and safety of the therapy were made by inteNiewing patients upon their visits to our clinic. RESULTS: The final drop-out rate of cases were 107(49.5%). Most drop-out cases (80 cases) occurred within the first month of the therapy. It was also found that drop-out rate was Inversely correlated with number of attendance at the preself-injection education(p< 0.05). A total of 168 patients failed to attend more than 3 times. The drop-out rate of this group was 55%(92 cases) while 31% in those with more than 3 attendances. A total of 109(50.5%) patients completed longer than 12-month follow-up durations and 85(77%) patients were satisfied with the therapy. Their mean dosage was 0.16 microliter and mean frequency of applications was 5.0 times per month, Although no patient developed corporal fibrosis or infection, other side-effects including prolonged erection(14 cases) and penile pain during intercourse(3 cases) were reported. CONCLUSIONS: Trimix intracavernous injection therapy is minimally invasive, safe and effective for the treatment of patients with erectile dysfunction. While high drop-out rate was thought to be a major problem with this therapy, our results suggest that adequate educations can encourage patients to a certain degree.

Two Cases of Gasless Laparoscopic Ureterolithotomy / 대한비뇨기과학회지

Laparoscopic ureterolithotomy has been attempted in the management of the large, long-standing, impacted ureter stone. However it was not commonly used because of difficulties in technique. So we report 2 cases of laparoscopic ureterolithotomy using the gasless technique. We performed the laparoscopic ureterolithotomy in two patients with ureter stones by transperitoneal approach. We used the laparolift system which was connected by laparofan retractor. The abdominal wall was elevated effectively, and the ureters were exposed with ease. The stone was successfully removed in all two cases. The operative time was 120 and 140 miniutes respectively. There was no intraoperative or postoperative complication including urinary leak in all cases. Postoperative pain was minimal. This gasless technique is convenient and safe because an operator can use the conventional surgical instruments and avoid the complications directly associated with pneumoperitoneum.