A Model and a Program for Training Laparoscopic Urethrovesical Anastomosis / 대한비뇨기과학회지

PURPOSE: A model and a program was developed for training surgeons in laparoscopic urethrovesical anastomosis in order to improve the laparoscopic suture technique for urologists with no previous experience. MATERIALS AND METHODS: The procedures were performed on a pelvic trainer using a videolaparoscopic unit. The program consisted of a simple suture, urethrovesical anastomosis with interrupted sutures, and urethrovesical anastomosis with continuous sutures. The trainees enrolled in this study were 5 residents from the urologic department who had little experiences in laparoscopic suturing. The trainees performed each procedure 10 times and the elapsed time was recorded. Univariate analysis of the general linear model was used to assess the significance of progression. RESULTS: In the first lesson of the simple suture, the mean elapsed time was 5.45+/-3.00 minutes (range 2.78-9.83minutes) and each trainee demonstrated a difference in the elapsed time for suturing. After the tenth lesson was complete, the mean elapsed time was 1.48+/-0.17 minutes (range 1.35- 1.70 minutes) and the time differences between each trainee decreased. In urethrovesical anastomosis with interrupted sutures, the mean elapsed time decreased from 24.07+/-3.97 minutes at the 1st lesson (range 16.13- 29.47 minutes) to 13.10+/-2.53 minutes (range 11.75-19.47 minutes) after 10 lessons. In urethrovesical anastomosis with continuous sutures, the mean time decreased from 39.61+/-3.60 minutes (range 34.41-45.71 minutes) after one lesson to 30.42+/-5.75 minutes (range 19.50-38.82 minutes) after 10 lessons. There were significant differences in the elapsed time up to the 2nd lesson compared with the 10th lesson in all procedures (p-value<0.05). CONCLUSIONS: The skills of the trainee can be improved by a model and a program for training laparoscopic urethrovesical anastomosis. In particular, urethrovesical anastomosis, in which many urologists find difficulty, may become more accessible using this model and program.

Efficacy of Combined Gemcitabine/Cisplatin Chemotherapy for Locally Advanced or Metastatic Urothelial Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We wanted to determine and report on the outcome of combined gemcitabine/cisplatin chemotherapy for patients suffering with locally advanced or metastatic urothelial cancer. MATERIALS AND METHODS: Between July 1999 and December 2004, 43 selected patients were enrolled in this study. Group 1 (the adjuvant chemotherapy group) had undergone radical surgery with removal of evident tumor from the following primary sites: bladder (n=8), renal pelvis (n=7) and ureter (n=3). Group 2 (the salvage chemotherapy group) had undergone palliative surgery with a remnant tumor at the following primary sites; bladder (n=23) and renal pelvis (n=2). All the patients were given gemcitabine/ciplatin and they evaluated for the therapeutic effect and toxicity. The patients were initially treated with gemcitabine 1000 mg/m2 intravenously for 30 minutes on days 1, 8 and 15 of a 28-day cycle, and cisplatin 70 mg/m2 was administered intravenously on day 1 using prehydration measures. RESULTS: Group 1: The median follow-up period was 16.5 months. The mean age was 63 years (males: 15 cases, females: 3 cases), and eleven patients (61%) remained alive. The estimated median relapse-free survival period and 2-year survival rate were 24 months and 63%, respectively. Group 2: the median follow-up period was 20 months, the mean patient age was 63.8 years (males: 22 cases, females: 3 cases), and nine patients (36%) remained alive. The overall response and 2-year survival rates were 36% and 43%, respectively. Toxicities: Grade 3 toxicities developed in 14 cycles during the total 232 cycles. Grade 4 toxicity did not occur. CONCLUSIONS: The results of this study confirm that adjuvant and salvage chemotherapy with using gemcitabine and cisplatin is tolerable and safe.

Clinical Characteristics of Renal Transplant Recipients that Underwent Urologic Surgery for de novo Disease Before and After Transplantation

The pre-transplantation goal of the urologist is the optimization of urinary tract condition. Therefore, urologic surgery may be needed before or after renal transplantation. We analyzed the results of urologic surgery performed because of de novo urologic diseases. Between January 1986 and January 2001, 281 patients underwent renal transplantation, and 23 urologic surgical procedures were performed on 21 transplant recipients before or after renal transplantation because of de novo urologic diseases. By review the major reasons for urologic surgery in recipients were polycystic kidney diseases, vesicoureteral reflux, and dysfunctional voiding disorders. Nineteen surgical corrective procedures were done average 2.9 months before transplantation. The mortality rate was 10.5%. Four patients underwent urologic surgery at an average 57.5 months after transplantation. We highlight the fact that patients with uremia are vulnerable to surgical complications, and conclude that more intensive longterm urologic follow-ups should be conducted on recipients.

Staghorn Calculi in Renal Allograft Treated with Percutaneous Nephrolithotripsy through Graft Renal Pelvis / 대한비뇨기과학회지

The formation of urinary calculi following renal transplantation is rare event with a frequency of less than 5%. Although infection, renal tubular acidosis and cyclosporine-induced hyperuricosuria can predispose toward stone formation in a renal allograft. The modalities of treatment used, were percutaneous nephrolithotripsy, shock wave lithotripsy and chemolysis. We report a case in which a double-J ureteral stent that had been forgotten for 10 years induced staghorn calculi in allograft. The stone was successfully removed by percutaneous ultrasonic nephrolithotripsy through graft renal pelvis.

Comparative Analysis between Sextant Biopsy and 12-samples Needle Biopsy for Detection of Stage T1c Prostate Cancer / 대한비뇨기과학회지

PURPOSE: The incidence of stage T1c prostate cancer has been reported to have increased more than any other prostate cancer. To evaluate whether a sextant biopsy is useful for the detection of stage T1c prostate cancer, the detection rates were compared between the sextant and 12-sample needle biopsies, in relation to the prostate volume (PV) and serum prostate specific antigen (PSA) level. MATERIALS AND METHODS: Between January, 1986 and December, 2002, 123 patients who were found to be normal upon digital rectal examination, with negative findings on a transrectal ultra sonography (TRUS) examination and elevated serum PSA (>4ng/ml), underwent either a sextant or 12-sample needle biopsy, under local anesthesia, to detect the presence of prostate cancer. RESULTS: There was no statistically significant difference in the cancer detection rate between the sextant (11/41) and 12-sample (24/82) needle biopsies of the prostate. According to the total PSA level, the detection rates of prostate cancer for the 6 and 12 core groups were 31.6 (6/19) and 22.8% (8/35), respectively, (PSA: 4.1-9.9ng/ml), 23.1 (3/13) and 32.0% (8/25) (PSA: 10.0-19.9ng/ml), and 22.2 (2/9) and 36.4% (8/22) (PSA >or=20.0ng/ml). According to the prostate volume, the detection rates of prostate cancer for the 6 and 12 core groups were 28.6 (2/7) and 31.0% (9/29), respectively (PVor=60ml). Our study did not have the statistical power required to rule out small differences. CONCLUSIONS: These findings imply that a sextant biopsy constitutes a useful method for the detection of prostate cancer.