Pelvic Schwannoma Causing Recurrent Acute Urinary Retention / 대한비뇨기과학회지

Schwannoma is a tumor that arises from neural sheath Schwann cells of peripheral nerves. Schwannoma is mostly solitary, except when it occurs in association with Von Recklinghausen's disease. Solitary schwannoma can occur in association with a nerve anywhere within the body, but rarely occurs in the pelvis. Microscopically, the tumors can be divided into hypercellular bundles of spindle-shaped cells (Antoni A area) and areas of lower cellularity, with loose myxomatous arrangement of cells and fibers (Antoni B area). Complete resection of pelvic schwannoma is a curative treatment. We report a case of benign presacral cystic schwannoma that caused recurrent acute urinary retention in a 79-year-old woman, along with a review of the literature.

Early Experience of Laparoscope Assisted Radical Retropubic Prostatectomy / 대한비뇨기과학회지

PURPOSE: A laparoscopic radical prostatectomy (LRP) is a less invasive alternative to a conventional radical prostatectomy. However, the learning curve for a LRP is steep; therefore, becoming skilled at the procedure is difficult. Herein, our experience of laparoscope assisted radical retropubic prostatectomy (LARRP) is reported. MATERIALS AND MATHODS: LARRP was performed on 16 patients with clinically organ confined prostate cancer. The mean age and serum prostate- specific antigen (PSA) of the patients were 63+/-5.7 years (51-70) and 20.01+/-24.8ng/ml (3.45-97.50), respectively. A longitudinal skin incision was made from the symphysis pubis to midway of the umbilicus. The incision was retracted with a self-retractor, without port placement and gas insufflation. The laparoscope was directly inserted into the wound, with modified bilateral pelvic lymph node dissection, prostatectomy and vesicourethral anastomosis performed under laparoscopic monitoring, using both open and laparoscopic instruments in the same order as for open surgery. RESULTS: The mean operative time was 282+/-45.7 minutes (200-375), including the time required for the modified bilateral pelvic lymphadenectomy. The mean estimated blood loss and specimen weight were 2,500+/-1,247ml (500-5,000) and 53+/-19.0gm (20-98), respectively. The surgical margins and lymph nodes were positive in 3 (19%) and 2 patients (13%), respectively. The mean number of dissected lymph node and incision length were 12+/-7.5 (4-31) and 11+/-3.2cm (6-15), respectively. Gradual recovery of continence occurred in 13 (93%) for 1 years after the operation. CONCLUSIONS: LARRP is a feasible and less invasive alternative to conventional RRP, which is also devoid of the steep learning curve associated with a LRP. LARRP may be a bridge between an open RRP and a pure LRP. With the increase in the number of cases, LARRP may prove to be an effective treatment option for localized prostate cancer.

Analysis of Risk Factors for Acute Urinary Retention after Non-urogenital Surgery / 대한비뇨기과학회지

PURPOSE: We performed this study to analyze the risk factors that are related to acute urinary retention in patients undergoing non-urogenital surgery. MATERIALS AND METHODS: We retrospectively analyzed the records of 127 patients who were referred to the urology department because of acute urinary retention after non-urogenital surgery at our institution between January 2004 and December 2005, and we also recuited 258 consecutive patients who were undergoing non-urogenital surgery at our institution during the same period as a control group. Multiple parameters were divided into patient factors, surgical factors and anesthetic factors, and these factors were analyzed using univariate and multivariate regression analyses between the non-retention and the retention groups. RESULTS: On the multivariate analysis, age(> or =50 years, p=0.037; odds ratio (OR)=2.8), gender(women, p=0.028; OR=2.5), comorbidity with diabetes mellitus(p=0.003; OR=5.8) were found to independently increase the risk of acute urinary retention. After re-adjustment for the patients' gender, age, body mass index, diabetes, hypertension, the inability to self-ambulate after the removal of a Foley catheter(p=0.001; adjusted odds ratio (AOR)= 3.8), the amount of intraoperative fluids(> or =4,000ml, p=0.017; AOR=4.8) were found to independently increase the risk of acute urinary retention. CONCLUSIONS: The possibility of acute urinary retention for patients undergoing non-urogenital surgery and who have these risk factors is high; therefore, carefully managing urination for the prevention of postoperative acute urinary retention is needed. It is also necessary to make doctors in other departments recognize the importance of this issue.