Comparative Study on the Treatment Outcome and Safety of TURP, ILC, TUNA and TEAP for Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: We wanted to compare the treatment outcome, safety, efficacy and complications of transurethral resection of the prostate (TURP), interstitial laser coagulation (ILC), transurethral needle ablation (TUNA) and transurethral ethanol ablation of the prostate (TEAP) for the treatment of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: In this prospective, randomized study, a total of 403 patients with symptomatic BPH were treated by TURP, ILC, TUNA or TEAP from January 1998 to December 2002. ILC was performed using the Indigo 830e LaserOptic(TM) System with a specially designed interstitial thermotherapy light guide, TUNA was performed using the VidaMed TUNA System and TEAP was performed using the Prostaject(TM) device. The treatment outcomes were evaluated at 3 months, 6 months and 1 year with the International Prostate Symptom Score (IPSS), the prostate volume, the maximal urinary flow rate (Qmax), the post-void residual urine (PVR), and the quality of life (QoL) assessment score. RESULTS: All the patients in the four groups showed significant improvement for all the parameters. After 1 year, the four groups showed significant improvement in the clinical and voiding parameters (IPSS, Qmax, PVR, prostate volume and QoL). Our results did not show significant differences in the IPSS, prostate volume and QoL among the four groups. However, the TURP group showed a higher Qmax, and the TEAP group showed a less reduced prostate volume than the other groups during the follow-up period (p<0.05). The period of hospital admission showed no significant difference between the ILC, TUNA and TEAP groups, but the TURP group showed a longer hospital admission period compared to the other groups. The TURP group was markedly associated with more complications than the other groups. CONCLUSIONS: These early results indicate that ILC, TUNA and TEAP are safe, effective and useful alternative therapies to TURP for the patients with symptomatic BPH.

The Prevalence of BPH in Busan City over Age 40 / 대한비뇨기과학회지

PURPOSE: We studied 278 men who are over 40 years of age to educate BPH and to evaluate the prevalence of BPH in Busan city of Korea. MATERIALS AND METHODS: Between December 1997 and February 1998, 278 men in Busan city were investigated. The screening tests included urinary symptom questionnaire (IPSS), digital rectal examination (DRE), prostate specific antigen (PSA) and uroflometry. RESULTS: Based on the IPSS, 36.3%, 49.7% and 14.0% of the men were mild (1-7), moderately (8-19) and severely (20-35) symptomatic. The mean maximal flow rate and PSA for men 40 to 49, 50 to 59, 50 to 69 and over 70 years old were 18.4 ml/sec, 14.2 ml/sec, 12.9 ml/sec, 10.6 ml/sec and 1.081 ng/ml, 1.195 ng/ml, 1.527 ng/ml, 2.352 ng/ml respectively. CONCLUSIONS: The prevalence rate of clinical BPH(IPSS>7 and peak urinary flow rate<10 ml/sec) in community-based study of 278 men was 25.5%.

A comparison of radioisotope erection penogram, penile angle and nocturnal penile tumescence test / 대한비뇨기과학회지

Intracavernous papaverine injection may be the first step in the assessment of the impotent patient Since measurement of the rigidity requires a sophisticated procedures that may not be available to the majority of the practitioners, we attempted to find an objective method to evaluate the results or this common test. We tested 44 patients complaining of impotence and 2 normal potent men with intracavernous injection of 30mg. papaverine and measured the angle between the penis and the legs with the patient in the standing position and obtained radioisotope erection penogram. Various penogram indexes were calculated from the time activity curve and their usefulness was evaluated and was compared with the findings of nocturnal penile tumescence. The papaverine test can distinguish between the vasculogenic and psychogenic impotent patients. Measurement of the erectile angle after intracavernous injection of papaverine is a simple, objective and reliable method to evaluate patients with vascular impotence. The penogram indexes were significantly correlated with the penile arterial inflow and venous outflow during erection. but not significantly correlated with nocturnal penile tumescence test.

Effect of Combination Therapy Including Alpha-Interferon in Advanced Renal Cell Carcinoma / 대한비뇨기과학회지

The patient with metastatic renal cell carcinoma at the time of presentation have an average survival of approximately 4 months, and only 10% can be expected to survive 1 year. The treatment of metastatic renal cell carcinoma remains a major public health problem in clinical medicine. Hormonal therapies, including progestational agents, and chemotherapies as single agent or in combinations seldom result in objective tumor regression or prolongation of survival and the response are usually temporary. Immunotherapic approaches to this tumor has not demonstrated a clear impact on growth of the tumor. But alpha-interferon therapy that initiated by deKernion produced 16. 5% response rate. The following results and conclusions are obtained with combination therapy such as a-interferon. nitrosourea, vinblastine and medroxyprogesteron acetate in metastatic renal cell carcinoma. 1. From March 1988 to August 1989, 15 patients with metastatic renal cell carcinoma were studied. Average patient age was 49.3 years. There was 11 men and 4 women. The disease was confined to lung in 46.7% of the patients and a Karnofsky performance status (PS) of 100 was identified in 7%: 13.3 % had PS score <70. 2. Of 15 patients, 4(26.7%) had a complete responses, 1 (6.7%) had a partial response, 3 (20.0%) had a minimal response and 7 (46.7%) had progression with no evidence of response to treatment. Of patients with pulmonary metastases alone, 5 (71.4%) had objective response or stabilization of disease and 2 (28.6%) had progression with no evidence of response to treatment. 1 (100.0%) patient with PS of 100 had partial response and no patients with PS<70 had response to therapy. 3. Median duration of survival in the overall subjects was 47 weeks : nonresponders survived for median of 21 weeks. Median duration of survival in nonresponders with pulmonary metastasis alone was 20 weeks. All responders are alive at least 33 weeks later. 4. The most common side effects were constitutional symptoms (73.3%). Hematologic toxicity (60%), gastrointestinal toxicity (40%), hepatic toxicity (26.7%) and nephrotoxicity (6.7%) occurred. Severe toxicity was noted only in 1 patient. 5. Natural killer cell activity in responders was 35.4 % and in nonresponders was 43.0%. Increased natural killer cell in responders was noted after treatment. T Lymphocyte subletting (T3 : cytotoxic T cell, T4 : helper T cell, T8 : suppressor T cell) performed at peritreatment had no statistic significance.In spite of short-term study, combination therapies includirrg alpha-interferon cause objective more regression and prolongation of survival. Futher trial with these regimens seem warranted in the management of metastatic renal cell carcinoma.

A Case of Malakoplakia with Duplex Kidney / 대한비뇨기과학회지

Malakoplakia is a very rare disease which affects middle-aged women and usually involves the urinary tract. Of these, the bladder is the most common site and the renal parenchyme is involved in 16%. It is a type of granulomatous inflammation in which the histiocyte contains distinct basophilic inclusion called Michaelis-Gutmann bodies. It may be caused by a defect of phagocytic activity of the lysosome. We experienced a cases of malakoplakia with duplex kidney in a 59-year old female, which was treated successfully with left nephrectomy and antibiotics. Herein we report this case with a brief review of literature.

A Case of Extensive Female Urethral Loss Treated Using Bulbocavernous Myocutaneous Flap / 대한비뇨기과학회지

Loss of the urethral floor with total urinary incontinence is a difficult problem that is infrequently encountered by the urologist. The techniques required for the urethral reconstruction are different and can be much more; delicate and demanding than the typical vesicovaginal fistula repair. Herein we report a case of the female urethral loss caused by chemical injury 3 years age and treated using bulbocavernous myocutaneous flap successfully.

100 Cases of Renal Transplantations / 대한비뇨기과학회지

Various clinical evaluations in urological aspects were performed on 100 renal transplantations in the Department of Urology, Kosin Medical College from December 1984 to August l988. The following results were obtained. 1. Year distributions were as follows : 1 case was done in 1984, 5 cases in 1986, 31 cases in 1986, 30 cases in 1987, 33 cases in 1988. 2. Of 100 donors 44 cases were male and 56 cases were female. Sixth decade was most common. Of 100 recipients 71 cases were male and 29 cases were female. Fourth decade was must common. 3. Of all living-related donors 89 cases were related donors and 11 cases were unrelated donors. 4. The most common underlying renal disease requiring transplantation was chronic glomerulonephritis (90%) and reflux nephropathy was 2 cases(2 %). 5. All surgical approaches of donor nephrectomy were flank incision, usually with removal of 12th rib(59%). Selected kidney side was follow : 79 cases were left side and 21 cases was right side. 6. The ureteroneocystostomy was performed with modified Politano-Leadbetter method in initial 3 cases and extravesical Mac Kinnon method in 97 cases. 7. Our incidence of urological complications in 100 renal transplantations was 8%(8 cases). 6 cases were ureteral obstructions due to perinephric hematoma, 1 case was ureterotaneous fistula and 1 cases was bladder leakage. 8. Our incidence of complications in 100 donor nephrectomy was 3%(3 cases). 1 case was pleural effusion, 1 case was atelectasis and 1 case was perforation of stomach. 9. Results and prognosis in complicated cases were good.

A Case of Malignant Renal Lymphoma / 대한비뇨기과학회지

Renal lymphoma is usually clinically silent and occurs late in the disease, after the diagnosis of generalized lymphoma has been established. Rarely, however, renal disease may be the earliest manifestation. Herein we report a case of malignant lymphoma involving kidney in a 41-year-old male who underwent radical nephrectomy because of a presumptive diagnosis of renal cell carcinoma.

Partial Hydronephrosis in a Patient with Horseshoe Kidney and Bilateral Duplicated Ureter / 대한비뇨기과학회지

The horseshoe kidney results from fusion of the two renal blastema at the time when they lie closeset together, usually at the fifth or sixth weeks of intrauterine life and occurs in 0.25% of the general population. Hydronephrosis, infection, calculus formation and concomitant other malformation are associated in the one third of patients. The duplicated ureter occurs in 6 to 10% congenital associated anomalies. This report concerns a case of rare combination of horseshoe kidney, bilateral duplication of ureter with obstruction of one ureteropelvic junction causing symptomatic hydronephrosis due to renal artery of right low moiety, which was treated with heminephrectomy.