Feasibility and Safety of Performing Hand-assisted Laparoscopic Donor Nephrectomy for Patients with Multiple Renal Arteries / 대한비뇨기과학회지

PURPOSE: We wanted to present the feasibility and safety of hand-assisted laparoscopic donor nephrectomy(HALDN) for treating patients with multiple renal arteries. MATERIALS AND METHODS: Between February 2000 and July 2006, 252 patients underwent HALDN. The results for the patients with a single renal artery (n=187)(Group I) and those patients with multiple renal arteries(n=65) (Group II) were compared in terms of the donor and recipient outcomes. A retrospective chart review was performed and statistical analysis included Student's t-test, the chi square test and Kaplan-Meier survival probability analysis. RESULTS: HALDN was technically successful in 251 patients(1 patient had to be converted to open donor nephrectomy). The operative times were increased in group II, but the differences between the groups were not statistically significant. The warm ischemic times were significantly longer in group II. The intraoperative blood loss, postoperative hospital stay and complication rate in the donor group were not associated with the number of renal arteries. The recipients' renal function and overall graft survival were similar between groups I and II. CONCLUSIONS: In our single-center study, the presence of renal artery multiplicity when performing HALDN does not have a significant impact on the outcomes of the renal donors or recipients.

Feasibility and Safety of Performing Hand-assisted Laparoscopic Donor Nephrectomy for Patients with Multiple Renal Arteries / 대한비뇨기과학회지

PURPOSE: We wanted to present the feasibility and safety of hand-assisted laparoscopic donor nephrectomy(HALDN) for treating patients with multiple renal arteries. MATERIALS AND METHODS: Between February 2000 and July 2006, 252 patients underwent HALDN. The results for the patients with a single renal artery (n=187)(Group I) and those patients with multiple renal arteries(n=65) (Group II) were compared in terms of the donor and recipient outcomes. A retrospective chart review was performed and statistical analysis included Student's t-test, the chi square test and Kaplan-Meier survival probability analysis. RESULTS: HALDN was technically successful in 251 patients(1 patient had to be converted to open donor nephrectomy). The operative times were increased in group II, but the differences between the groups were not statistically significant. The warm ischemic times were significantly longer in group II. The intraoperative blood loss, postoperative hospital stay and complication rate in the donor group were not associated with the number of renal arteries. The recipients' renal function and overall graft survival were similar between groups I and II. CONCLUSIONS: In our single-center study, the presence of renal artery multiplicity when performing HALDN does not have a significant impact on the outcomes of the renal donors or recipients.

The factors of pain and anxiety associated with urodynamics in female patients

PURPOSE: Urodynamic study (UDS) is widely used to evaluate voiding dysfunction, however, it is invasive and bothersome for patients because it requires catheterization into the urethra and anus. We assessed patients' anxiety and pain levels caused by UDS. MATERIALS AND METHODS: A total of 60 female patients who were undergoing UDS were included in the study on a prospective basis. Anxiety level was taken prior to the procedure and pain level was taken immediately after the procedure by visual analogue scale (VAS). Just after the procedures, they were asked if they were willing to undergo the same procedure and if they could recommend the procedure to another people if medically indicated. 60 patients were divided into 2 groups: urodynamic urethral catheters (9Fr, PVC, n=30) were used in group I and Foley catheters (10Fr, Silicon, n=30) were used in group II. RESULTS: The mean age of both groups were 45.5+/-5.3 (group I)and 45.5+/-3.8 (group II)years old. The anxiety and pain levels were relatively high, but there was no significant difference between both groups in pain level. Anxiety level prior to UDS was correlated with pain level (r=0.492, p<0.001). 42 out of 60 patients (70.0%) answered they were willing to undergo UDS if they were asked again and 37 patients (61.7%) answered they could recommend the procedure to another people. 21 patients (35.0%) were menopausal women and they showed higher anxiety level compared to non-menopausal women. CONCLUSION: Female patients felt anxiety before UDS and pain immediately after UDS, especially in menopausal women, and the more anxious they were, the more painful they felt. Therefore, we need to provide sufficient explanation with regard to the procedure for patients prior to UDS to diminish patients' anxiety and pain.

Infective Cellulitis of Obturator Foramen and Persistent Vaginal Erosion following Transobturator tape (TOT) procedure

We experienced the case of infected mesh with subsequent infective cellulitis of obturator foramen after a TOT procedure. We reported our case of a 47-year-old woman who presented with persistent vaginal discharge, pain and motion limitation of left leg after having a TOT placed for stress incontinence. Inflammation around obturator foramen was demonstrated on computed tomography (CT) scan. We performed total excision of the mesh material. She ultimately had an uneventful postoperative course and no recurrence of incontinence after follow-up 1 month.

Primary Cavernous Hemangioma of Penile Shaft with Painful Erection and Penile Curvature / 대한남성과학회지

Hemangiomas result from proliferation of immature capillary vessels. This disorder in the genitourinary tract is a rare lesion. We experienced one case of a 31 years old man suffered from cavernous hemangioma of the penis shaft with painful erection. He was treated successfully with surgical excision. Herein, we report our experience and a critical review of the literature.

Mesh Cutting after Midurethral Sling Procedure in Female Stress Urinary Incontinence: 1 Year Follow-up

PURPOSE: Midurethral sling procedure is widely used as a primary choice for managing female stress urinary incontinence(SUI) in many countries. But some complications are inevitable, although the incidence is very low. Mesh cutting may be required to correct unwanted problems in some patients. We evaluated the outcome of mesh cutting in patients having mesh-related complications. MATERIALS AND METHODS: Medical records of patients who underwent cutting of midurethral tape from January 2001 to December 2005 were reviewed and a detailed telephone interview was done to see if stress urinary incontinence recurred at least a year after cutting. RESULTS: Eleven patients were included in this study. Mean age was 51.2 ranging from 41 to 70. The reasons why their meshes should be cut were as follows; eight(72.7%) had voiding difficulty, two(18.2%) had a tape erosion and one had voiding difficulty and overactive bladder. These problems were corrected by mesh cutting except one. However, a year after cutting, four out of eleven patients(36.4%) developed recurrent stress urinary incontinence. Recurrence occurred in three out of five patients(60.0%) whose meshes were cut within 1 month after implant, while occurred in 1 out of 6(16.7%) whose meshes were cut after 2 months of implant. Three out of four patients(75.0%) who had mixed urinary incontinence developed recurrence after mesh cutting. In particular, two patients who had detrusor overactivity confirmed by cystometry before surgery showed recurrence of incontinence after mesh cutting. CONCLUSION: A total 36.4% of patients who required mesh cutting developed recurrence of SUI. These data demonstrate that mesh cutting may cause recurrence and urologists should be aware that mesh cutting may be disappointing. Mixed urinary incontinence and duration from implant to mesh cutting seem to be the risk factors of recurrence after mesh cutting.

Alteration in Renal Function for Patients with Ileal Conduit and Ileal Orthotopic Neobladder / 대한비뇨기과학회지

PURPOSE: We performed this study to evaluate the alterations in renal function for patients with ileal conduit and ileal orthotopic neobladder MATERIALS AND METHODS: From January 1999 to June 2004, 48 patients who had undergone radical cystectomy with urinary diversion were included in our study. The patients were divided into two groups according to the types of urinary diversion. One group consisted of 29 patients with ileal conduit and the other group consisted of 19 patients with ileal W neobladder. The mean age of the ileal conduit group and the ileal W neobladder group were 65.6+/-9.9 years and 60.8+/-8.3 years, respectively. The preoperative and postoperative blood urea nitrogen/creatinine (BUN/Cr) levels, postoperative complications and postoperative GFR, as measured by (99m)Tc-DTPA scans, were compared between the two groups. RESULTS: For the postoperative complications, stricture at the ureterovesical anastomosis site occurred in 1.7% (1/58 renal units) of the ileal conduit group and in 10.5% (4/38 renal units) of the ileal W neobladder group. Acute pyelonephritis occurred in 5.2% (3/58 renal units) of the ileal conduit group and in 5.3% (2/38 renal units) of the ileal W neobladder group. The pre- and postoperative serum BUN/Cr levels were 20.8/1.3 and 24.8/1.6, respectively, in the ileal conduit group, and 17.2/1.1 and 18.8/1.2, respectively, in the ileal W neobladder group. There were no statistical significant differences between the pre- and postoperative changes of the serum BUN/Cr levels for both groups. The GFR, as measured by (99m)Tc-DTPA scans, were 77.6 and 78.7ml/ min/1.73m2 in the ileal conduit group and the ileal W neobladder group, respectively. There were no statistical significant differences between the two groups. CONCLUSIONS: There were no significant differences in renal function between the ileal conduit and ileal W neobladder.