Clinical Experience of Laser Prostatectomy under Regional or Local Anesthesia in 77 Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: This prospective study was designed to evaluate the efficacy and safety of Nd: YAG laser for the treatment of benign prostatic hyperplasia(BPH). MATERIALS AND METHODS: From January 1994 to March 1995, 77 patients with BPH were underwent laser prostatectomy. Of the 77 patients 17 were performed under local anesthesia. Preoperative and postoperative(at 1, 3 and 6months after operation) evaluation consisted of uroflowmetry, American Urological Association(AUA) symptom score and posboid residual urine. There were no limits of the prostatic size for operation and 2 cases had 100gm of prostatic weight. Multiple dragging technique(from the bladder neck to the verumontanum) with 90 degrees fiber at 80 to 90watts power were used in near contact or contact. RESULTS: 69 patients of total 77 patients have completed 6months follow-up evaluation. Mean prostatic size was 39.7gm. Preoperative mean urine flow rate was 3.0ml/sec and postoperative urine flow rate at one, three and six months was 10.7, 13.8 and 13.6m1/sec, respectively. Preoperative AUA score was 26.6 and postoperative AUA score at one, three and six month was 9.6, 7.6, respectively. Preoperative residual urine was 251.4ml and postoperative residual urine at one, three and six months was 57.0, 15.3 and 19.4ml, respectively. In 17 cases laser prostatectomy was done under local anesthesia due to poor medical condition. The results of laser prostatectomy under local anesthesia was not different from the cases with regional anesthesia. And the degree of subjective Pain of the Patients in local anesthesia was tolerable. The total energy used was about 129,000 Joules and the mean operative time was 103 minutes. Foley catheter was removed on postoperative 5th day. A total of 7 patients failed in initial voiding trials and required catheterization longer than 2weeks postoperatively. In 3 cases of seven patients who complained discomfort on voiding after 3months, necrotic tissue was present on cystoscopy. There were no severe complications. CONCLUSIONS: It is concluded that the technique of transurethral laser-induced prostatectomy is effective and less invasive technique alterative than traditional transurethral resection of the prostate.

Changes of Renal Calcium Content and CaOx Crystal Deposit after Unilateral Nephrectomy in Rats / 대한비뇨기과학회지

PURPOSE: The surgical removal of normal kidney elicits dramatic changes in the remaining kidney. Changes in urinary excretion of lithogenlc substances and urinary inhibitor may increase or decrease the stone-forming potential. The aim of this study was to determine if unilateral nephrectomy could enhance urinary calculi formation in animal model. MATERIALS AND METHODS: Adult male rats were divided randomly into 3 groups. Group 1(n=5) were fed with pellet and tap water for 4 weeks without nephrectomy Group 2(n=5) were fed with the same pellet and 0.8% ethylene glycol plus 1% ammonium chloride in drinking water for 4 weeks without nephrectomy Group 3(n=5) were fed with the same pellet and the same lithogenic diet from 2 weeks after uninephrectomy for 4 weeks. Each right kidney was harvested after 4 weeks feeding. One half of the each kidney were fixed for H & E stain to examine crystal deposits. The remaining half of the kidneys were treated with 12N KOH and 6N HCI for the measurement of calcium content with atomic absorption spectrophotometer. About 3-5cc of blood was collected from the inferior vela cava for determinations of serum creatinine, calcium, magnesium and phosphorus & chloride. Urine was collected over a 24 hour interval before and after lithogenic diet, and urine volume, 24-hour urinary excretions of oxalate, citrate, uric acid, calcium, magnesium, phosphate, sodium, potassium, chloride, and creatinine were measured. RESULTS: There was a significant difference between group 1(0.243 +/- 0.014mmo1/kg) and lithogenic diet groups(group 2 and group 3 in calcium content(p 0.05). There were no calcium oxalate crystal deposit in the group 1, but there were about 2-5 crystal deposits with partially polarized light microscope( x 100) in group 2 and group 3, and there was no significant difference between group 2 and group 3. After taking lithogenic diet, the serum creatinine, serum magnesium, serum phosphors, urine pH & 24-hour urinary excretions of oxalate increased significantly in group 2 and group 3, whereas creatinine clearance & 24-hour urinary excretions of calcium, sodium, potassium, chloride, citrate decreased significantly in the same groups(p < 0.05). But, there were no significant difference of serum calcium, chloride, and 24-hour urinary excretions of magnesium, uric acid among three groups after 4 weeks feeding. CONCLUSIONS: Unilateral nephrectomy would not increase stone forming potential.

A Case of Leiomyosarcoma of the Penis Treated with Nd: YAG Laser and Chemotherapy / 대한비뇨기과학회지

Leiomyosarcoma of the penis is a very rare tumor. We experienced a patient with a leiomyosarcoma on the dorsal surface of penis in a 44-year old man. The patient was treated with local wide excision with Nd: YAG laser and chemotherapy. Herein, we report this case with the review of literatures.