Laparoscopic Partial Adrenalectomy: Surgical Technique and Outcome

PURPOSE: To examine the perioperative surgical and long-term outcomes of laparoscopic partial adrenalectomy (LPA) by comparing the results of laparoscopic total adrenalectomy (LTA). MATERIALS AND METHODS: A total of 132 transperitoneal laparoscopic adrenalectomies were performed for adrenal gland tumor between May 2006 and April 2019. All surgeries were performed by a single surgeon. Seventy patients underwent LTAs and 54 underwent LPAs. The data were collected retrospectively through review of the medical charts. We compared the perioperative and long-term outcomes between the 2 surgical methods. RESULTS: A total of 70 patients, including 4 patients with bilateral tumors, underwent LTA. In contrast, 54 patients, including 4 patients with bilateral masses, underwent LPA. There were no differences between the 2 groups with regard to mean age at presentation, mean tumor size, or postoperative stay. However, the mean operating time was significantly shorter in the LPA group than that of the LTA group. The mean estimated blood loss in the LPA group was significantly higher than that in the LTA group. However, none of the LPA patients required blood transfusion. The biochemical markers and laboratory values normalized postoperatively in all patients with functional adrenal tumors. There was no local recurrence during the follow-up period. CONCLUSIONS: Our data demonstrate that the surgical outcomes and perioperative complications in LPA group are similar to those of LTA. When LPA is performed for small adrenal lesions, most patients remain steroid independent, as well as recurrence-free at long-term follow-up.

An Unexpected Course after Simultaneous Urethral Repair and Reimplantation of Penile Prosthesis in a Patient with a Urethral Stricture

We experienced the growth of urethral hair along the urethral stricture six years after simultaneous urethral repair and reimplantation of penile prosthesis (RPP) in a patient with a urethral stricture. We detected hair in the urethra with a stricture on the bulbous urethra. Further, we performed hair removal by using a pair of cystoscopic forceps and internal urethrotomy. Then, we performed RPP, and the patient voided well; the prosthesis worked very well and without any complications. One-stage urethroplasty with a pedicle island of the penile skin and RPP in a simultaneous stage may be an option for treating the long-segment urethral stricture in the penile prosthesis patient. However, we should pay attention to the urethral hair growth that can occur after urethral repair performed using a skin graft.

Efficacy of Repeated Transrectal Prostate Biopsy in Men Younger Than 50 Years With an Elevated Prostate-Specific Antigen Concentration (>3.0 ng/mL): Risks and Benefits Based on Biopsy Results and Follow-up Status

PURPOSE: Prostate cancer is rare in men younger than 50 years. Digital rectal examination (DRE) and measurement of prostate-specific antigen (PSA) concentrations are standard screening methods for detecting prostate cancer. We retrospectively investigated the risks and benefits of repeated transrectal ultrasonography-guided prostate needle biopsies in relation to the follow-up status of men younger than 50 years with a consistently high PSA concentration (>3.0 ng/mL). MATERIALS AND METHODS: During the period from January 2000 through February 2013, we reviewed patient's ages, dates of procedures, DRE results, frequencies of biopsies, results of the biopsies, periods of follow-up, PSA concentrations, and prostate volumes in Chonbuk National University Hospital records. We conducted telephone interviews in patients who did not undergo regular follow-up. RESULTS: The mean age of the patients was 44.7 years, and the mean PSA concentration was 8.59 ng/mL (range, 3.04-131 ng/mL) before biopsy. The PSA concentration was significantly different (p3.0 ng/mL).

Proper Mesh Placement Using the Outer Cylinder of a Ballpoint Pen in the Transobturator Adjustable Tape Sling Procedure for Female Stress Urinary Incontinence

PURPOSE: The transobturator adjustable tape (TOA) sling operation is an effective procedure that allows for correction of postoperative incontinence or obstruction through adjustment of the mesh tension. During the operation, the outer cylinder of a ballpoint pen was used for proper mesh placement with less dissection. We evaluated the efficacy and safety of the TOA sling operation with the use of the outer cylinder of a ballpoint pen. MATERIALS AND METHODS: A total of 127 consecutive women with stress urinary incontinence underwent the TOA sling operation with the use of the outer cylinder of a ballpoint pen. The preoperative evaluations included a stress cough test, urodynamic study, and questionnaires related to quality of life. The mesh tension was adjusted 1 day after the operation. Postoperative evaluation was done at 1 month and included a stress cough test, uroflowmetry, questionnaires, and asking about satisfaction. At 1 year, we evaluated the patients with a stress cough test and by asking about their satisfaction with the procedure. RESULTS: The overall cure rate was 95.3% at 1 month and 96.8% at the 1-year follow-up. Postoperative adjustment of the mesh tension was done for 22 patients (17.3%). Eight patients needed increased tension for remaining stress urinary incontinence, and 14 patients needed reduced tension for urinary obstruction. The maximal flow rate was decreased significantly. However, the residual urine volume was not increased significantly. The total score on the questionnaires increased significantly. CONCLUSIONS: Results were excellent compared with outcomes of the traditional TOA sling procedure. Proper mesh placement by use of the outer cylinder of a ballpoint pen with less dissection and tension adjustment could improve the success rate of the TOA sling operation.

The Direct Anti-Cancer Effect of a Single Instillation of Epirubicin after Transurethral Resection of Bladder Tumor for Non-Muscle-Invasive Bladder Cancer

PURPOSE: To evaluate the direct anti-cancer effect of a single instillation of epirubicin (SIE) after transurethral resection of bladder tumor (TURBT) for non-muscle-invasive bladder cancer (NMIBC) by analysis of immediate urine cytology (IUC). MATERIALS AND METHODS: We reviewed the records of 158 patients who had IUC after TURBT for NMIBC. Fifty-six patients were treated with SIE after TURBT and 102 patients were not treated with SIE. The direct anti-cancer effect of SIE was compared in the two groups according to the result of IUC. The relationship between SIE and IUC in NMIBC was analyzed by use of multivariate Cox proportional hazards regression models. RESULTS: The IUC-positive rate was 33.9% in the SIE group and 42.1% in the non-SIE group (p=0.005). The IUC-positive rate was lower in the SIE group than in the non-SIE group for each factor, including tumor stage, tumor grade, tumor size, tumor multiplicity, and preoperative urine cytology. Multivariate Cox proportional hazards regression analysis revealed that SIE was significantly associated with a negative IUC result in patients with NMIBC (HR, 0.163) (p<0.001). CONCLUSIONS: These results indicate the direct anti-cancer effect of SIE in patients who undergo TURBT for NMIBC.