Retroperitoneoscopic Pyeloplasty / 대한비뇨기과학회지

PURPOSE: To assess the feasibility and results of retroperitoneoscopic pyeloplasty in the treatment of ureteropelvic junction obstruction. MATERIALS AND METHODS: A total of 10 extraperitoneal laparoscopic pyeloplasties were performed for ureteropelvic junction obstructions. The patients were followed with excretory urographies. RESULTS: Two separate types of reconstruction were performed; 9 dismembered and 1 Fenger pyeloplasty. No cases resulted in an open conversion. The mean operating time was 294 minutes, ranging from 210 to 510 minutes. 3 patients were found to have aberrant vessels (30%). There were no intra-operative complications. The mean analgesic use and post-operative hospital stay were 328mg of diclofenac sodium, ranging from 150 to 450mg, and 4.3 days, ranging from 3 to 7 days, respectively. There were no post-operative complications, with the exception of 1 case of pain after the removal of double-J catheter. With the exception of 1 case that was lost during follow up, the average return to normal activity occurred in 2.6 weeks, ranging from 1 to 8 weeks. The excretory urographs, taken after 2 months, showed improvements in 6 of the 9 cases (67%), and of the remaining 3 cases, 2 showed an improvement over 6 months, and 1 over 12 months (total 9/9, 100%). The mean follow-up period was 18 months, ranging from 6 to 32 months, with no patient requiring further surgery. No pain was reported in 6 (6/9, 67%) of the cases and 3 cases reported a marked decrease in their pain (3/9, 33%). CONCLUSIONS: Retroperitoneoscopic pyeloplasty seems to be feasible and valuable alternative treatment for ureteropelvic junction obstruction, but a long term follow-up is required.

Hand-assisted Laparoscopic Donor Nephrectomy: A Comparison with Open Approach / 대한비뇨기과학회지

PURPOSE: We report our initial experience with hand-assisted laparoscopic donor nephrectomy (HALDN) and compare it to our results with open donor nephrectomy (ODN). MATERIALS AND METHODS: Using the medical records of consecutive, renal, living donor-recipient pairs, 60 HALDN patients were compared with 19 ODN patients. In addition, the HALDN group was divided into two groups, initial HALDNs (n=20) and late HALDNs (n=40), for consideration of the surgeons' learning curve. RESULTS: Except 1 case of open conversion, 59 patients underwent HALDN successfully. Mean operation times were 202, 255, and 201 minutes for ODNs, initial HALDNs, and late HALDNs respectively. Mean warm ischemic time decreased from 4.5 minutes in the initial HALDNs to 3.1 minutes in the late HALDNs. Major intraoperative complications included 1 transfusion in the ODNs, 1 open conversion and 1 transfusion in the initial HALDNs, but none in the late HALDNs. Mean hospital stay decreased from 6.4 days in the ODNs to 4.6 and 3.8 days in the initial and late HALDNs, respectively. Mean analgesic use decreased from 403mg and 323mg in ODNs and initial HALDNs, respectively, to 219mg in late HALDNs. Serum creatinine levels of the recipients on post operation days 7 and 30 showed no differences among the three groups. CONCLUSIONS: All but one, HALDNs resulted in a safe donor operation with a kidney of excellent quality. The length of hospital stay and postoperative analgesic use were decreased. The cosmetic result was enhanced. Additionally, the number of living donors can be potentially increased.

Effects of Frequency and Urgency on Urinary Nerve Growth Factor and Transforming Growth Factor beta-1

PURPOSE: Frequency and urgency are common symptoms in women. Growth factors have been reported to play a role in these irritative symptoms. This study was performed to investigate the changes in urinary growth factors according to frequency and urgency in adult female patients. MATERIALS AND METHODS: The study groups included 30 patients with frequency and urgency and 10 normal patients as reference controls. Evaluation included history taking, urinalysis, voiding diary, and urodynamics. Voided urine was collected. The urinary concentration of nerve growth factor(NGF) and transforming growth factor beta-1(TGF-beta1) were analyzed and these results were compared with control groups. RESULTS: From the analysis of voiding diary, the degree of frequency was increased and functional bladder capacity was decreased in the frequency and urgency patients. Also, capacity for first voiding sense and full capacity were decreased in frequency and urgency patients from urodynamic study. The urinary concentration of NGF and TGF-beta1 were significantly increased in frequency and urgency patients compared with control patients. CONCLUSIONS: NGF and TGF-beta1 may play a role in irritative symptoms such as frequency and urgency and these changes can be detected in urine sample. Thus, these growth factors may be a marker to evaluate bladder function.