Invasive Aspergillosis Arising from Ureteral Aspergilloma

Ureteral obstruction may develop in immunocompromised patients with an Aspergillus fungal infection. Infections can progress to invasive aspergillosis, which is highly lethal. We report a case of a 56-year-old man with alcoholic cirrhosis of the liver and diabetes. He had ureteral aspergilloma, discovered as a saprophytic whitish mass. It was treated by ureteroscopic removal, however, he refused antifungal treatment. His condition progressed to invasive aspergillosis, and died from sepsis and hepatorenal syndrome.

Early Experience of Laparoendoscopic Single-Site Nephroureterectomy for Upper Urinary Tract Tumors

PURPOSE: We evaluated the feasibility of a laparoendoscopic single-site (LESS) nephroureterectomy for an upper urinary tract tumor. MATERIALS AND METHODS: Between March 2009 and September 2009, 4 patients with upper urinary tract tumors underwent LESS nephroureterectomy. The mean age of the 2 female and 2 male patients was 69 years old, and their mean body mass index was 23.0. We used a homemade single-port device made with a surgical glove and a wound retractor, which were put into a 4 cm periumbilical incision. Operations with articulating and rigid laparoscopic instruments were performed transperitoneally. An open technique with a 4 cm additional midline incision and laparoscopic technique with an endoscopic stapler were used for the treatment of the distal ureter and bladder cuff. RESULTS: All cases were completed successfully, without conversion to conventional laparoscopy or open surgery. The mean operative time was 169.5 minutes. The mean estimated blood loss was 361.4 ml. One patient had transfusion and wound infection. The mean hospital stay was 7.8 days. The mean specimen weight and tumor size were 271.8 g and 2.9 cm. Pathologic results of all cases showed urothelial carcinoma with a negative surgical margin. Three patients were in stage T3N0M0 and 1 was in stage T2N0M0. CONCLUSIONS: Our initial experience shows that LESS nephroureterectomy with a homemade single-port device is technically feasible. However, long term follow-up for the effect on cancer control and technical development for comfortable surgery are needed.

Early Experience of Laparoendoscopic Single-Site Nephroureterectomy for Upper Urinary Tract Tumors

PURPOSE: We evaluated the feasibility of a laparoendoscopic single-site (LESS) nephroureterectomy for an upper urinary tract tumor. MATERIALS AND METHODS: Between March 2009 and September 2009, 4 patients with upper urinary tract tumors underwent LESS nephroureterectomy. The mean age of the 2 female and 2 male patients was 69 years old, and their mean body mass index was 23.0. We used a homemade single-port device made with a surgical glove and a wound retractor, which were put into a 4 cm periumbilical incision. Operations with articulating and rigid laparoscopic instruments were performed transperitoneally. An open technique with a 4 cm additional midline incision and laparoscopic technique with an endoscopic stapler were used for the treatment of the distal ureter and bladder cuff. RESULTS: All cases were completed successfully, without conversion to conventional laparoscopy or open surgery. The mean operative time was 169.5 minutes. The mean estimated blood loss was 361.4 ml. One patient had transfusion and wound infection. The mean hospital stay was 7.8 days. The mean specimen weight and tumor size were 271.8 g and 2.9 cm. Pathologic results of all cases showed urothelial carcinoma with a negative surgical margin. Three patients were in stage T3N0M0 and 1 was in stage T2N0M0. CONCLUSIONS: Our initial experience shows that LESS nephroureterectomy with a homemade single-port device is technically feasible. However, long term follow-up for the effect on cancer control and technical development for comfortable surgery are needed.

Robot-Assisted Laparoscopic Augmentation Ileocystoplasty: a Case Report / 대한배뇨장애요실금학회지

Augmentation cystoplasty is suitable for a contracted bladder with low compliance that is refractory to conservative treatment. However, the procedure is associated with operative morbidity such as a long surgical wound, postoperative pain, and a long hospital stay. With the goal of reducing the morbidity associated with open surgery, minimally invasive surgery is increasingly being performed as laparoscopic and robotic surgeries. Here we report an initial case of robot-assisted laparoscopic augmentation cystoplasty using the ileum in a male patient with a contracted bladder.

Comparison of Hand-assisted versus Transperitoneal Laparoscopic Simple Nephrectomy / 대한비뇨기과학회지

PURPOSE: We compared the results of our experience with hand-assisted laparoscopic simple nephrectomy (HALN) and the standard laparoscopic simple nephrectomy with the transperitoneal approach for treating benign renal diseases. MATERIALS AND METHODS: Between March 2002 and March 2004, 38 patients, including 36 patients with a non-functioning kidney and 2 angiomyolipomas, received laparoscopic simple nephrectomies. The HALN approach method was used for 11 patients and transperitoneal standard laparoscopy was used for 27 patients. The operative and clinical records were retrospectively reviewed. RESULTS: The mean patient age and gender were not significantly different in the HALS and standard groups. The procedures were performed successfully in all but 2 patients. Intraoperatively, one patient of HALN group had spleen injury, which was treated with splenectomy. One patient of the standard group had open conversion due to dissection difficulty because of severe adhesions. Postoperatively, one patient of the standard group had intraperitoneal hematoma, which was treated conservatively. The mean operative time, initiation of the postoperative oral intake and the initiation day for ambulation were not significantly different in both groups. The analgesic use (diclofenac sodium, 90.0mg versus 22.5mg, respectively) and the postoperative hospital stay (7.2 days versus 5.6 days, respectively) was shorter in the standard group than in the HALN group (p<0.05). CONCLUSIONS: Standard laparoscopic simple nephrectomy with the transperitoneal approach is a less invasive technique than hand-assisted nephrectomy. There is no difference in the technical difficulty according to the operative time and complication rate.

Malignant Peripheral Nerve Sheath Tumor of the Retroperitoneum in Patient with Neurofibromatosis / 대한비뇨기과학회지

A malignant peripheral nerve sheath tumor (MPNST), also known as a malignant neurilemmoma or malignant schwannoma, is significantly associated with neurofibromatosis type 1 (NF 1). NF 1 is characterized by multiple dermal neurofibromas, cafe-au-lait spots, MPNST and other abnormalities. MPNST is often metastatic, and is detected in the extremities, frequently in the head and neck, but rarely in the retroperitoneal and pelvic spaces. We experienced a case of MPNST in the retroperitoneal space of a 38-year-old male with NF 1, who also had metastatic lesions of the lung and liver.

The Correlation between the Prostatic Morphology Seen on Cystourethroscopy, the Clinical Findings and the Outcomes of Transurethral Resection of the Prostate / 대한비뇨기과학회지

PURPOSE: Cystourethroscopy provides information on the cause, size and severity of obstruction and the patency of the bladder neck, prostatic occlusion of the urethra and the estimated prostatic size. We evaluated the relationship between the prostatic morphology on the cystourethroscopic findings and the clinical findings and the outcomes of transurethral resection of the prostate (TURP). MATERIALS AND METHODS: We evaluated 291 patients who underwent TURP between January 1999 and June 2004. The prostate volume, the preoperative maximal flow rate (MFR), the postvoid residual urine volume (PVR) and the International Prostate Symptom Score (IPSS) were determined. The patients were divided into 4 groups by the cystourethroscopic findings before TURP: group I - isolated middle lobe enlargement, group II - isolated lateral lobe enlargement, group III - middle and lateral lobe enlargement, group IV - posterior commissural hyperplasia (median bar type). RESULTS: The analyses included 250 patients who had a mean age of 71.2 years, a mean prostate volume of 46.2g, a mean preoperative MFR of 7.8ml/s, a PVR of 73.1ml and an IPSS of 25.6. The prostate volume was larger in group II and III than in group l. The preoperative MFR and IPSS were not correlated with the prostatic morphology, but the storage symptom score was significantly higher in group IV. The postoperative parameters were not correlated with the prostatic morphology noted on cystourethroscopy. CONCLUSIONS: The cystourethroscopic findings are not prognostic factors for the expected surgical outcomes in TURP. TURP is a good surgical therapeutic tool for treating benign prostatic hyperplasia regardless of the prostatic morphology seen on cystourethroscopy. Cystourethroscopy might need to be performed only in limited cases.

Renal Cell Carcinoma Associated with Von Hippel-Lindau Disease Treated by Wedge Resection / 대한비뇨기과학회지

The Von Hippel-Lindau disease is an autosomal dominant condition manifested by the cerebellar hemangioblastomas, retinal angiomas, cysts of the pancreas, the kidney, and the epididymis, pheochromocytoma, and renal cell carcinoma. Renal cell carcinoma occurs in 35% to 38% of affected individuals and may cause pain or a palpable mass. We report a case of a 45-year-old female with renal cell carcinoma, cerebellar hemangioblastoma, and cysts of the pancreas and kidney, to which a wedge resection was performed.