Laparoscopic Excision of Giant Seminal Vesicle Cyst Associated with Ipsilateral Renal Agenesis / 대한비뇨기과학회지

Seminal vesicle cysts associated with ipsilateral renal agenesis are very rare, with most being congenital, and two-thirds associated with renal dysplasia or agenesis and ectopic ureter opening into the seminal vesicle. When they are symptomatic, surgical excision has been the treatment of choice. Herein, a case of a symptomatic giant seminal vesicle cyst associated with ipsilateral renal agenesis is reported, which was treated by laparoscopic excision.

Laparoscopic Repair of Bladder Injury Detected after Gynecological Laparoscopic Surgery / 대한비뇨기과학회지

An intraperitoneal bladder rupture needs immediate surgical repair. Classically, the rule is to perform laparotomy and then suture the disrupted bladder wall. However, the advent of laparoscopic surgery offered new possibilities in treating intraperitoneal bladder ruptures, whether it is traumatic or iatrogenic. We report a case of laparoscopic repair in a patient with intraperitoneal bladder perforation, which occurred by an insult of a disposable trocar and was recognized postoperatively.

Influence of Nuclear Grade on Prognosis in Patients with Renal Cell Carcinoma Treated by Radical Nephrectomy / 대한비뇨기과학회지

PURPOSE: The aim of the study was to determine the prognostic factors influencing the survival rate in patients with renal cell carcinomas treated by radical nephrectomy. MATERIALS AND METHODS: 90 patients, with a renal cell carcinoma, who underwent a radical nephrectomy between January 1992 and December 2001, were retrospectively reviewed. The survival rate according to the prognostic factors, such as the 1997 TNM stage, tumor size, cell type and nuclear grade of the tumor, age and gender, tumor location and erythrocyte sedimentation rate (ESR), were analyzed using the Kaplan-Meier method. A univariate analysis, using log rank tests, was performed to evaluate the prognostic factors. A multivariate analysis was performed to determine which factors had an independent impact on the survival of patients with a renal cell carcinoma. RESULTS: The overall 1- and 5-year cancer survival rates were 93.6 and 74.7%, respectively. The 1- and 5-year cancer survival rates by stage were 100 and 93.8% in stage I, 100 and 80.0% in stage II, 87.4 and 57.4% in stage III and 66.7 and 27.8% in stage IV (p<0.0001). The univariate analysis showed significant differences in the TNM stage and nuclear grade and the tumor size and the ESR. The multivariate analysis revealed that the TNM stage and nuclear grade of the tumor were the best prognostic indicators for a renal cell carcinoma. CONCLUSIONS: The TNM stage, nuclear grade, size of tumor and enhanced ESR are important prognostic factors in renal cell carcinomas. The TNM stage and nuclear grade of the tumor are independent prognostic factors.

Comparison of Transurethral Resection of Prostate Plus Incision of Bladder Neck and Prostate with Transurethral Resection of Prostate in Patients with Benign Prostatic Hyperplasia / 대한남성과학회지

PURPOSE: We evaluated the effectiveness and complications of transurethral resection of the prostate plus incision of the bladder neck and prostate(TUR-P+I) and transurethral resection of the prostate(TUR-P). MATERIALS AND METHODS: We reviewed 101 patients with benign prostatic hyperplasia(BPH) who were randomized to TUR-P+I(N=78; Group I) or TUR-P(N=23; Group II) from December 2000 to March 2002. After TUR of the adenoma, the trigone, bladder neck, and surgical capsule of the prostate were incised with a pointed coagulating electrode at the 5- and 7-o'clock positions from the distal edge of the ureteral orifice to the verumontanum. Patients were evaluated at 1 month, 3 months, and 6 months after operation in terms of the change in International Prostatic Symptom Score(IPSS), peak urinary flow rate, and complications. RESULTS: The mean prostatic weight of Groups I and II was 40.5+/-15.5 g and 36.7+/-10.6 g, respectively. The operative time and resected prostatic weight of Group I were 59.0+/-23.8 min and 16.2+/-11.4 g and those of Group II were 64.1+/-27.5 min and 11.5+/-5.8 g. The postoperative complication rates were similar in the two groups. The preoperative IPSS symptom score and peak urinary flow rate were 22.4+/-6.4 and 9.8+/-5.4 mL/sec, respectively, in Group I and 23.7+/-7.6 and 9.3+/-4.4 mL/sec in Group II. The 1-, 3-, and 6-month IPSS were 13.2+/-6.0, 10.1+/-5.1, and 9.2+/-4.8 in Group I and 13.2+/-5.0, 10.1+/-4.2, and 9.2+/-4.4 in Group II. The peak urinary flow rates at those times were 15.6+/-4.9, 15.8+/-5.6, and 15.9+/-5.1 mL/sec in Group I and 14.6+/-4.2, 14.6+/-3.9, and 14.3+/-4.5 mL/sec in Group II. CONCLUSIONS: The TUR-P+I could be a safe, effective surgical method for BPH. However, longer follow-up and more patients are required to establish the value of this technique.

Relationship of Serum Insulin-Like Growth Factor I and Parameters in Patients with Prostate Cancer / 대한비뇨기과학회지

PURPOSE: Insulin-like growth factor I (IGF-I) is a ubiquitous peptide, which influences cell proliferation and differentiation in many tissues through the actions of endocrine, autocrine and paracrine. Recent studies have suggested that individuals with increased IGF-I levels have an increased risk of prostate cancer (Pca). We determined the serum IGF-I levels in patients with Pca to evaluate the clinical use of IGF-I. MATERIALS AND METHODS: The control group was composed of 60 age-matched healthy subjects, and the BPH group comprised of 40 patients with benign prostatic hyperplasia (BPH). Serum samples were collected from the control and Pca groups, both before and during the hormonal therapy, and in the hormone-refractory state (n=103). The median PSA levels in the healthy subjects and the patients with BPH and Pca were 1.7, 2.9 and 71.9ng/ml, respectively. The median prostate volume in the healthy subjects and the patients with BPH and Pca were 17, 39 and 42gm, respectively. The IGF-I levels between the groups were compared, according to the age, prostate volume, prostate-specific antigen (PSA) and treatment. RESULTS: The median serum IGF-I levels in the healthy subjects and the patients with BPH and Pca were 61.4, 55.5 and 53.5ng/ml, respectively, with no statistical significance. The median IGF-I level during treatment for Pca (51.5ng/ml) was not significantly altered compared to that in the pretreated Pca. The median IGF-I level was lower in the hormone-refractory Pca (50.7ng/ml) than in the pretreated Pca, but this decrease was not statistically significant. There was no association between the serum IGF-I levels and PSA in the patients with BPH and Pca. No correlation was detected between the serum IGF-I levels and the prostate volume. There was no significant difference between the serum IGF-I levels and age. CONCLUSIONS: Our results suggest IGF-I is not a useful marker in the diagnosis and management of Pca.

Metastatic Tumor of the Spermatic Cord from Gastric Cancer / 대한비뇨기과학회지

Metastatic tumors of the spermatic cord are rare. In the majority of cases the primary tumor occurs in the gastrointestinal tract, with metastasis to the spermatic cord by retrograde lymphatic flow, or direct invasion of tumor cells through the peritoneal cavity. The possibility of metastasis or recurrence of prior malignancies should be considered when a palpable tumor is identified in the scrotum or spermatic cord. Here, we document a case of gastric cancer involving metastasis to the spermatic cord.

Ureteral Obstruction Caused by Crohn's Disease / 대한비뇨기과학회지

Obstructive uropathy with hydronephrosis is a well-known complication of Crohn's disease. This complication is treacherous, since symptoms of urinary tract disease are mostly absent. Inflammatory ureteral engagement should always be suspected in patients with Crohn's disease, particularly when located in the terminal ileum. The treatment for this condition is still controversial. We report a case of a 25 year-old man who presented with intermittent diarrhea, weight loss, and RLQ pain. Diagnostic studies confirmed Crohn's disease, and revealed an abdominal mass obstructing the right ureter with hydroureteronephrosis. The patient was successfully treated with corticosteroid and mesalamine, without resection of the ileocecal lesion, drainage of the iliopsoas abscess and ureterolysis. We discuss a ureteral obstruction as a complication of Crohn's disease, with emphasis on conservative treatment.

Cutaneous Fistula in Patient with Augmentation Penoplasty / 대한남성과학회지

A man's self-esteem can be influenced by his external genitalia. If a man perceives his penis as inadequate size, whether real or imagined, such feelings invade his sexual activities. Most patients seek increased thickness and length to improve appearance during intercourse. Many men want to enlarge their penes despite of normal function or above average size. Dermal fat graft is extracted from a patient and penile augmentation with it is highly satisfactory since the amount of dermal fat graft absorption to the body itself is pretty low and rare cases of complication, and its natural appearance of penis without physical comfort. The most common complications after dermal grafting are penile skin edema and erythema. Sebaceous glands usually disappear within 2 weeks and hair follicles generally within 2 months. We report our experience with the evaluation and management of patient who present with uncommon penile cutaneous fistula after penile augmentation with dermal fat grafting.