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 One and Two Stage Repairs in 83 Cases of Hypospadias / 대한비뇨기과학회지

The majority of hypospadias repairs can now be accomplished in one stage, providing a better result with reduced morbidity. To evaluate the efficacy of one stage repairs of hypospadias, a total of 83 patients treated with various urethroplasty technique was stratified according to 2 different stage repairs of hypospadias and compared to clinical outcome during the period of the last 15 years. The study included the age of the patients, anatomical variants of the hypospadias, accompanying congenital anomaly, the technique used, postoperative complication and management, success rate according to the technique used and the methods of urinary diversion. The method of repair was based on individual patient pathology. Transverse preputial island flap was the most common operation performed (n=24) followed by parameatal-based flap (n=15), meatal advancement and granuloplasty repair (MAGPI) in one stage repairs. Thiersch-Duplay (n=8), Belt-Fuqua (n=3), Byars (n=3), Modified Denis-Brown (n=7) techniques were performed in two stage repairs. Of the 83 cases of hypospadias, one stage repairs were done in 62 cases and two stage repairs in 21 cases and their successful outcome, defined as a controllable urinary stream, an acceptable cosmetic appearance and functional erection, was achieved in 60% and 51% respectively. The postoperative complication were fistula in 25 cases (18 in one stage repairs/7 in two stage repairs), stricture in 6 (4/2), wound dehiscence in 2 (1/1), diverticulum in 1 (1/0), persistent chordee in 1 (1/0). There were no significant difference between one and two stage repairs in success rate (60%/ 51%), so we thought that one stage hypospadias repairs could be applicable in most cases of hypospadias and gave satisfactory cosmetic and functional results with a low incidence of serious complications and low costs.

Renal Angiomyolipoma: Superselective Arterial Embolization and Long Term Follow-up

PURPOSE: To evaluate the effectiveness of superselective arterial embolization in symptomatic renal angiomyolipoma by assessing tumoral changes and clinical symptoms in long term follow up after embolization. MATERIALS AND METHODS: For the treatment of their condition, nine patients with symptomatic renal angiomyolipoma underwent ten superselective arterial embolization procedures. In all patients, angiomyolipoma had been diagnosed by computed tomography (CT), and in two, had been confirmed by ultrasonography-guided aspiration biopsy. The embolic materials used were absolute alcohol in four sessions, absolute alcohol mixed with lipiodol in three, and Giantruco coils in three. In all patients, follow-up after embolization lasted for between 12 and 54 months, and involved the use of CT. We reviewed retrospectively patients' clinical symptoms, and changes in the size and internal components of tumors, as seen on preembolization and postembolization CT scans. RESULTS: On postembolization angiography, devascularization of the tumor was seen in all patients; the initial symptoms disappeared and tumor size decreased during the follow up period. In nine patients, tumor size decreased after embolization by between 26 and 92%. During the long term (over 12 months) follow up of all patients, seven tumors with a considerable angiomyogenic component markedly decreased in size, but tumors in which the mature fatty component was substantial became only slightly smaller. Reembolization was performed in one patient. CONCLUSION: Superselective arterial embolization is effective in the management of symptomatic renal AML; during long-term follow-up, tumors became smaller and clinical symptoms improved. Embolization is more effective in tumors in which the angiomyogenic components is large.