A Case of Giant Hydronephrosis Hidden by Obesity in an 11-year-old Boy

Giant hydronephrosis (GH) is a rare urological entity and usually presents with more than a liter of fluid in the collecting system. It may mimic a progressive and benign abdominal cystic tumor. We report a case of GH in an 11-year-old obese boy who presented with abdominal distension and dyspnea on exercise. Hydronephrosis was caused by ureteropelvic junction obstruction, with 2,300 mL of fluid in the collecting system. Diagnostic and therapeutic features of this case are discussed, with reference to current literature.

A Case of Giant Hydronephrosis Hidden by Obesity in an 11-year-old Boy

Giant hydronephrosis (GH) is a rare urological entity and usually presents with more than a liter of fluid in the collecting system. It may mimic a progressive and benign abdominal cystic tumor. We report a case of GH in an 11-year-old obese boy who presented with abdominal distension and dyspnea on exercise. Hydronephrosis was caused by ureteropelvic junction obstruction, with 2,300 mL of fluid in the collecting system. Diagnostic and therapeutic features of this case are discussed, with reference to current literature.

Alpha-Blocker Treatment Response in Men With Lower Urinary Tract Symptoms Based on Sympathetic Activity: Prospective, Multicenter, Open-Labeled, Observational Study / 대한배뇨장애요실금학회지

PURPOSE: In this study, we compared the treatment outcomes for an alpha-blocker between 2 groups of men, one with high sympathetic activity (HSA) and another with low sympathetic activity (LSA) or normal sympathetic activity. METHODS: A total of 159 men (> or =50 years of age) with lower urinary tract symptoms resulting from benign prostatic hyperplasia were analyzed. We assigned patients to groups according to their sympathetic activity, which was evaluated by heart ratevariability measurements. HSA was defined as a low frequency/high frequency ratio greater than 1.6. All patients received 10mg of alfuzosin once a day for 12 weeks. The primary end point was a change in the total International Prostate SymptomScore (IPSS) at 12 weeks from baseline. RESULTS: Sixty-seven men were assigned to the HSA group and 92 men were assigned to the LSA group. The baseline characteristics were not significantly different between the 2 groups, and the response to alfuzosin was good in both groups. Themean total IPSS change was not different between the groups. Both groups were not significantly different with respect to the changes in maximal flow rate, IPSS voiding or storage symptom subscores, quality of life, and rates of adverse drug events. TheHSA group showed a similar willingness to continue treatment compared to the LSA group, although their treatment satisfaction rating was lower. CONCLUSIONS: The therapeutic effects of alfuzosin did not differ in regards to the differences in sympathetic activity, but treatment satisfaction ratings were lower in the HSA group.

Interval from Prostate Biopsy to Radical Prostatectomy Does Not Affect Immediate Operative Outcomes for Open or Minimally Invasive Approach

Traditionally, urologists recommend an interval of at least 4 weeks after prostate biopsy before radical prostatectomy. The aim of our study was to evaluate whether the interval from prostate biopsy to radical prostatectomy affects immediate operative outcomes, with a focus on differences in surgical approach. The study population of 1,848 radical prostatectomy patients was divided into two groups according to the surgical approach: open or minimally invasive. Open group included perineal and retropubic approach, and minimally invasive group included laparoscopic and robotic approach. The cut-off of the biopsy-to-surgery interval was 4 weeks. Positive surgical margin status, operative time and estimated blood loss were evaluated as endpoint parameters. In the open group, there were significant differences in operative time and estimated blood loss between the or =4-week interval subgroups, but there was no difference in positive margin rate. In the minimally invasive group, there were no differences in the three outcome parameters between the two subgroups. Multivariate analysis revealed that the biopsy-to-surgery interval was not a significant factor affecting immediate operative outcomes in both open and minimally invasive groups, with the exception of the interval > or =4 weeks as a significant factor decreasing operative time in the minimally invasive group. In conclusion, performing open or minimally invasive radical prostatectomy within 4 weeks of prostate biopsy is feasible for both approaches, and is even beneficial for minimally invasive radical prostatectomy to reduce operative time.

Relationship Between Patient Position and Pain Severity During Shock Wave Lithotripsy for Renal Stones With the MODULITH SLX-F2 Lithotripter: A Matched Case-Control Study

PURPOSE: We evaluated the association between shock wave lithotripsy (SWL)-related pain and patient positioning during SWL. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 162 patients who underwent their first SWL session for single renal stones from May 2010 to August 2011. One hundred thirteen patients underwent SWL in the supine position and 49 did so in the lateral position. To evaluate an unbiased estimation of the positional effect on pain severity during SWL, both groups (supine vs. lateral) were matched according to sex, age, body mass index, stone location, and stone size. Thirty-four patients from each group were selected for analysis. Pain was evaluated with an average visual analogue scale (VAS-avg) and maximum visual analogue scale (VAS-max). Analgesic usage was also compared between the groups. RESULTS: All patients (n=34) in the supine group had radio-opaque stones compared with only 47.1% of the patients in the lateral group (n=16). The VAS-avg and VAS-max of the lateral group were significantly lower than those of the supine group (1.2+/-1.0 and 3.1+/-1.7 for VAS-avg and 2.5+/-1.8 and 4.7+/-1.9 for VAS-max, respectively, p<0.05). However, analgesic usage between groups did not differ significantly (17.6% in the supine group vs. 5.9% in the lateral group, p=0.259). In a subgroup analysis confined to patients with radio-opaque stones, the supine group still suffered more pain. CONCLUSIONS: Patients with renal stones suffered more SWL-related pain in the supine position than in the lateral position. During SWL, positioning of patients should be considered a predictive factor for SWL-related pain.

Can 80 W KTP Laser Vaporization Effectively Relieve the Obstruction in Benign Prostatic Hyperplasia?: A Nonrandomized Trial

PURPOSE: There is little data evaluating the changes of severity of bladder outlet obstruction after 80 W-potassium-titanyl-phosphate (KTP) photoselective laser vaporization prostatectomy (PVP) by pressure-flow study. We evaluated the efficacy of PVP to relieve the obstruction in benign prostate hyperplasia (BPH) compared with transurethral resection of the prostate (TURP). MATERIALS AND METHODS: This is a prospective, non-randomized single center study. The inclusion criteria were as follows: Men suffering from lower urinary tract symptoms (LUTS) secondary to BPH, age > or =50 years, International Prostatic Symptom Score (IPSS) > or =13, maximum flow rate (Qmax) or =40 was decreased from 64% to 4% in the PVP group and from 86% to 14% in the TURP group. CONCLUSIONS: PVP could reduce the prostate volume effectively and relieve bladder outlet obstruction similar to TURP by the 6-month follow up in men with BPH.

The Impact of Primary Spontaneous Pneumothorax on Multiphasic Personal Inventory Test Results in Young South Korean Males

PURPOSE: Few reports have documented psychopathological abnormalities in patients with primary spontaneous pneumothorax (PSP). We analyzed the results of a multiphasic personal inventory test to investigate the psychopathologic impact of PSP in young Korean males. MATERIALS AND METHODS: The authors reviewed the results of a Korean military multiphasic personal inventory (KMPI) administered to military conscripts in South Korea. A total of 234 young males participated in this study. The normal volunteer group (n=175) comprised individuals who did not have any lung disease. The PSP group (n=59) included individuals with PSP. None of the examinees had any psychological problems. The KMPI results of both groups were compared. RESULTS: There were more abnormal responses in the PSP group (17.0%) than the normal volunteer group (9.1%, p=0.002). The anxiety scale and depression scale scores of the neurosis category were greater for the PSP group than the normal group (p=0.039 and 0.014, respectively). The personality disorder and paranoia scale scores of the psychopathy category were greater for the PSP group than the normal group (p=0.007 and 0.018, respectively). CONCLUSION: Young males with PSP may have greater tendencies to suffer from anxiety, depression, personality disorders, and paranoia compared to normal individuals. Clinicians should be advised to evaluate the psychopathological aspects of patients with PSP.

Pathologic Features of Renal Masses, 4cm or Less in Diameter: The Prevalence of Benign Tumors / 대한비뇨기과학회지

PURPOSE: We examined the clinical and pathologic findings of small renal masses that were suspected to be malignant. We investigated the prevalence and the predictors of benign tumors. MATERIALS AND METHODS: We retrospectively reviewed the medical records of the patients who underwent surgeries for renal lesions between September 1994 and June 2007. We analyzed the pathologic reports and medical records of 586 patients who had a renal mass that was 4cm or less. The mean patient age was 53 years(age range: 15-82). There were 418 male patients(71.3%) and 168 females(28.7%). Multiple logistic regression analysis was done to determine the clinical factors associated with benign renal masses, including the radiological tumor size, a cystic versus solid appearance, gender, age and the presenting symptoms. RESULTS: Of the 586 renal masses, 62(10.6%) were benign, 520(88.7%) were renal cell carcinoma and 4(0.7%) were other malignancies. The proportion of benign lesions was significantly higher in the females than that in the males(21.4% vs. 6.2%, respectively, p<001) and the proportion of benign lesions was significantly higher for the smaller masses(0-2cm) than for the 2.1-4cm sized tumors(14.7% vs. 9.1%, respectively, p=0.048). On multivariate analysis, gender and tumor size were significantly associated with malignant histology with the males having an odds ratio(OR) of 4.16 (95% CI 2.41-7.19, p<0.001) and the tumor size more than 2cm having an OR of 1.93(95% CI 1.08-3.44, p=0.03). CONCLUSIONS: A considerable number(10.6%) of benign lesions 4cm or less in the radiological diameter were operated on based on suspicious preoperative imaging. The results of this study seem to help not only for counseling the patients, but also for deciding on a therapeutic modality preoperatively.

The Efficacy and Safety of KTP Photoselective Vaporization of the Prostate for the Treatment of Benign Prostatic Hyperplasia: The 2-year Results / 대한비뇨기과학회지

PURPOSE: This study was conducted to evaluate, with using the 2-year follow-up data, the clinical efficacy and safety of performing photoselective vaporization of the prostate(PVP) for the treatment of symptomatic benign prostatic hyperplasia(BPH). MATERIALS AND METHOD: We analyzed the clinical data of 104 men with symptomatic BPH and who had undergone PVP. The efficacy parameters were the changes from baseline of the International Prostate Symptom Score(IPSS), the quality of life(QoL) score, the maximum urinary flow rate(Qmax) and the postvoid residual volume(PVR). The patients were evaluated preoperatively and then at post-operative 1, 3, 6, 12 and 24 months. Their complications were also evaluated. RESULTS: The mean prostate volume was 45.6ml. The mean lasing time was 44.9 minutes and there was no significant blood loss or fluid absorption during or immediately after PVP. Significant improvements in the IPSS, the QoL score, the Qmax and the PVR were noted as early as 1 month after PVP treatment. After 24-month follow-up, the mean IPSS decreased from 22.4 to 9.9(p<0.0001) and the QoL score decreased from 4.4 to 2.3 (p<0.0001), while the mean Qmax changed from 8.3 to 14.4ml/sec(p< 0.0001). The PVR decreased from 82.0 to 49.9ml(p=0.033). The complications were retrograde ejaculation(26.9%), transient catheterization(6.7%), transient dysuria(2.9%), bladder neck contracture(1.9%), urethral stricture (0.9%) and meatal stenosis(0.9%). 1 patient was diagnosed with prostate cancer 32 months after operation. CONCLUSIONS: Significant improvements of the subjective and objective voiding parameters were achieved and these were sustainable for at least 2-year, with minimal complications, after PVP. PVP seems to be a safe and effective treatment for symptomatic BPH.

Efficacy and Safety of Doxazosin GITS over 4 weeks for the Treatment of Non-neurogenic Voiding Dysfunction in Females: Short-term Outcomes

PURPOSE: We administered doxazosin gastrointestinal therapeutic system (GITS) to women with non-neurogenic voiding dysfunction to evaluate its therapeutic effects. MATERIALS AND METHODS: Women who had voiding dysfunctions for at least 3 mo were included. Inclusion criteria were age > or =18yr, an International Prostate Symptom Score (IPSS) > or =15, and a maximum flow rate (Qmax) or =150mL. Patients with neurogenic voiding dysfunction or anatomical bladder outlet obstruction were excluded. All patients were classified according to the Blaivas-Groutz nomogram. After 4 weeks, treatment outcomes were evaluated. RESULTS: Sixty-two patients were evaluated of mean age 53.8 (32-78)yr. According to the Blaivas-Groutz nomogram, 24 patients had no or mild obstruction (group A) and 38 had moderate or severe obstruction (group B). After treatment, mean IPSS decreased significantly and by more than 5 points in 42 (67.7%). Mean bother scores, Qmax, and PVR also changed significantly. Thirty-seven (59.7%) showed Qmax increases of more than 50%. No significant difference were observed between the groups in terms of IPSS, bother score, Qmax, PVR, micturition frequencies, or functional bladder capacity changes. Adverse effects related to medication were de novo stress urinary incontinence (SUI) (1 case) and underlying SUI aggravation (1 case). By satisfaction assessments, 16 patients (25.8%) were 'mainly satisfied', 31 (50%) were 'slightly satisfied', and 15 (24.2%) were 'dissatisfied'. CONCLUSION: Doxazosin GITS was found to be effective in female patients with voiding dysfunction regardless of obstruction grade. The alpha-adrenoceptor antagonists should be viewed as initial treatment option for women with a non-neurogenic voiding dysfunction.