Influence of Ureteral Stone Components on the Outcomes of Electrohydraulic Lithotripsy

PURPOSE: We evaluated the influence of urinary stone components on the outcomes of ureteroscopic removal of stones (URS) by electrohydraulic lithotripsy (EHL) in patients with distal ureteral stones. MATERIALS AND METHODS: Patients with a single distal ureteral stone with a stone size of 0.5 to 2.0 cm that was completely removed by use of EHL were included in the study. Operating time was defined as the time interval between ureteroscope insertion and complete removal of ureteral stones. Ureteral stones were classified into 5 categories on the basis of their main component (that accounting for 50% or more of the stone content) as follows: calcium oxalate monohydrate (COM), calcium oxalate dihydrate, carbonate apatite (CAP), uric acid (UA), and struvite (ST). RESULTS: A total of 193 patients (131 males and 62 females) underwent EHL. The mean operating time was 25.1+/-8.2 minutes and the mean stone size was 1.15+/-0.44 cm. Calcium oxalate stones accounted for 64.8% of all ureteral stones, followed by UA (19.7%), CAP (8.3%), and ST (7.2%) stones. The mean operating time was significantly longer in the UA group (28.6+/-8.3 minutes) than in the COM group (24.0+/-7.8 minutes, p=0.04). In multivariate analyses, the stone size was negatively associated with the odds ratio (OR) for successful fragmentation. UA as a main component (OR, 0.42; 95% confidence interval, 0.20 to 0.89; p=0.023) was also found to be significantly important as a negative predictive factor of successful fragmentation after adjustment for stone size. CONCLUSIONS: The results of the present study suggest that successful fragmentation by URS with EHL could be associated with the proportion of the UA component.

Primary Malignant Melanoma of the Female Urethra

We report here on a rare case of primary malignant melanoma of the female urethra. A 69-year-old female presented at our hospital with a several month history of dysuria, poor stream, gross hematuria, intermittent blood spots, and a painful mass at the external urethral meatus. The physical examination revealed a soft, small, chestnut-sized lesion through the urethral orifice. The mass was tan colored, ulcerated, covered with necrotic tissue, and protruded from the external urethral meatus. The mass was removed by wide local excision under spinal anesthesia. The pathological diagnosis was malignant melanoma of the urethra. Computed tomography of the abdomen as well as a whole-body bone scan showed no evidence of metastasis. The patient has been free of disease for 6 months postoperatively. We discuss the clinicopathologic features and treatment of this tumor.

Our Experiences with Robot-Assisted Laparoscopic Radical Cystectomy: Orthotopic Neobladder by the Suprapubic Incision Method

PURPOSE: To report our technique for and experience with robot-assisted laparoscopic radical cystectomy (RARC) with orthotopic neobladder (ON) formation in a cohort of bladder cancer patients. MATERIALS AND METHODS: Between December 2007 and December 2011, a total of 35 patients underwent RARC. The patients' mean age was 63.3 years and their mean body mass index was 23.7 kg/m2. Thirty patients had a clinical stage of T2 or higher. Postoperative mean follow-up duration was 25.5 months. In 5 patients, a 4-cm midline infraumbilical skin incision was made for an ileal conduit (IC) and the stoma formation was similar to the open procedure. In 30 patients undergoing the ON procedure, the skin for specimen removal and extracorporeal enterocystoplasty was incised infraumbilically in the early 5 cases with redocking (ON-I) and suprapubically in the latter 25 cases without redocking (ON-S). RESULTS: The mean operative times of the IC, ON-I, and ON-S groups were 442.5, 646.0, and 531.3 minutes, respectively (p=0.001). Mean console and lymph node dissection time were not significantly different between the groups. Mean urinary diversion times in each group were 68.8, 125.0, and 118.8 minutes, respectively (p=0.001). In the comparison between the ON-I and ON-S group, only operative time was significant. Four patients required a blood transfusion. We had no cases of intraabdominal organ injury or open conversion. Thiry-three patients (94.2%) had a pathologic stage of T2 or higher. Two patients (5.7%) had lymph node-positive disease. Postoperative complications included ileus (n=4), stricture in the uretero-ileal junction (n=2), and vesicovaginal fistula (n=1). CONCLUSIONS: Our robotic neobladder-suprapubic incision without redocking procedure is easier and more rapid than that of infraumbilical incision with redocking.

Our Experiences with Robot-Assisted Laparoscopic Radical Cystectomy: Orthotopic Neobladder by the Suprapubic Incision Method

PURPOSE: To report our technique for and experience with robot-assisted laparoscopic radical cystectomy (RARC) with orthotopic neobladder (ON) formation in a cohort of bladder cancer patients. MATERIALS AND METHODS: Between December 2007 and December 2011, a total of 35 patients underwent RARC. The patients' mean age was 63.3 years and their mean body mass index was 23.7 kg/m2. Thirty patients had a clinical stage of T2 or higher. Postoperative mean follow-up duration was 25.5 months. In 5 patients, a 4-cm midline infraumbilical skin incision was made for an ileal conduit (IC) and the stoma formation was similar to the open procedure. In 30 patients undergoing the ON procedure, the skin for specimen removal and extracorporeal enterocystoplasty was incised infraumbilically in the early 5 cases with redocking (ON-I) and suprapubically in the latter 25 cases without redocking (ON-S). RESULTS: The mean operative times of the IC, ON-I, and ON-S groups were 442.5, 646.0, and 531.3 minutes, respectively (p=0.001). Mean console and lymph node dissection time were not significantly different between the groups. Mean urinary diversion times in each group were 68.8, 125.0, and 118.8 minutes, respectively (p=0.001). In the comparison between the ON-I and ON-S group, only operative time was significant. Four patients required a blood transfusion. We had no cases of intraabdominal organ injury or open conversion. Thiry-three patients (94.2%) had a pathologic stage of T2 or higher. Two patients (5.7%) had lymph node-positive disease. Postoperative complications included ileus (n=4), stricture in the uretero-ileal junction (n=2), and vesicovaginal fistula (n=1). CONCLUSIONS: Our robotic neobladder-suprapubic incision without redocking procedure is easier and more rapid than that of infraumbilical incision with redocking.

Investigation of the Location of the Ureteral Stone and Diameter of the Ureter in Patients with Renal Colic

PURPOSE: The objective of this study were to evaluate the location of ureteral stones and the diameter of the ureter in patients with renal colic. MATERIALS AND METHODS: We retrospectively reviewed the records of 95 consecutive patients who presented to the emergency department with renal colic in whom urinary stones were diagnosed by computed tomography between January 2009 and August 2009. The size and location of the stones were investigated. The length and diameter of unaffected ureters were also measured. RESULTS: The mean size of the stones was 4.87+/-3.49 mm (range, 0.9-22 mm). Stones were located at ureterovesical junction (UVJ) in 44 cases (46.3%), proximal ureter in 29 (30.5%), distal ureter in 16 (16.8%), ureteropelvic junction (UPJ) in 5 (5.2%), and the ureter crossing external iliac vessel (UEIV) in 1 case (1%). The mean length of the ureter was 226.8+/-20.8 mm (range, 175-286 mm). The mean diameter of the ureter was 3.40+/-0.61 mm (range, 1.9-5.3 mm). The mean diameter of the UEIV was 3.28+/-0.59 mm (range, 2.2-5.3 mm). CONCLUSIONS: The UPJ and UEIV were not common sites of ureteral stones. The smaller the stones, the closer to the UVJ that the stones were located. Spontaneous passage of the stones was most frequently observed for stones in the UVJ. The UEIV was not significantly narrower than the other parts of the ureter.

Predictors of Postoperative Voiding Dysfunction following Transobsturator Sling Procedures in Patients with Stress Urinary Incontinence / 대한배뇨장애요실금학회지

PURPOSE: We evaluated the influence of preoperative physical examination (PE) and urodynamic study (UDS) findings on objective postoperative bladder emptying, the subjective development of bladder storage symptoms, and patient-reported success of correction of stress urinary incontinence (SUI). MATERIALS AND METHODS: From January 2007 to August 2008, a total of 159 female patients with SUI underwent transobturator midurethral sling surgery (TOT). The patients were selected for SUI, with no overactive bladder (OAB) symptoms, no detrusor overactivity (DO) on UDS, no pelvic organ prolapse, and no history of prior anti-incontinence surgery. Of these patients, 128 patients (aged 38-74 years; mean age, 51.8+/-7.1 years) with follow-up of at least 12 months were included in the analysis. All patients had PE and UDS findings, including Q-tip testing, free maximal flow rates (Qmax), filling cystometry, Valsalva leak point pressure, detrusor pressure at maximal flow, and maximal urethral closing pressure. The primary outcome was postoperative voiding dysfunction, defined as the subjective feeling of not empting one's bladder completely and a postvoid residual > or =100 ml. A secondary outcome, "cure" of SUI, was defined as "a negative result on the cough stress test and no subjective complaint of urine leakage." We analyzed the preoperative parameters by univariate and multivariate regression for voiding dysfunction, de novo OAB, cure rate, and the patients' satisfaction. RESULTS: Patients with a preoperative Qmax < 15 ml/s (7 patients) had a tendency for postoperative voiding dysfunction compared with those with a Qmax 15 ml/s (15 patients) (35.0% vs. 13.9%, respectively; p=0.046). No other preoperative parameters had a statistically significant influence on postoperative voiding dysfunction. Receiver operating characteristic (ROC) analysis revealed that Qmax was a good predictor because the area under the ROC curve value of Qmax was 0.81 (95% CI: 0.73 to 0.89, p<0.001). The univariate and multivariate analysis of the preoperative PE and UDS parameters demonstrated that no significant differences and no independent risk factors were related to the postoperative de novo OAB, cure rate, or the patients' satisfaction. CONCLUSIONS: These findings suggest that preoperative UDS results, especially Qmax, could be used to predict postoperative voiding dysfunction after the TOT procedure.

A Penile Fracture with the Complete Urethral Rupture / 대한남성과학회지

A penile fracture is an injury caused by the rupture of the tunica albuginea. We report an uncommon case of penile fracture with the complete urethral rupture in a 48-year-old man who sustained the injury during the sexual intercourse. He presented with acute penile pain, swelling on the ventral aspect of the penile shaft and the inability to pass urine associated with urethral bleeding. Retrograde urethrography revealed the complete obstruction of the urethra. Exploration and repair of the penile fracture with the urethra rupture were performed. The patient recovered successfully with good erectile and voiding function.

The Effects of Simultaneous Vaginal Hysterectomy on the Outcomes of a Tension-free Vaginal Tape Procedure for Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: Hysterectomy, regardless of the surgical technique, increases the risk of having to undergo stress urinary incontinence surgery later in life. Furthermore, transvaginal hysterectomy may cause some changes in the normal architecture and tension of the tissues surrounding the pelvic floor, and this may also cause some changes in the continence mechanisms of the bladder and urethra. We investigated if there are any adverse effects of concomitant vaginal hysterectomy on the outcomes of a tension-free vaginal tape procedure. MATERIALS AND METHODS: The outcomes of the tension-free vaginal tape (TVT)/transvaginal total hysterectomy(VTH) group were compared with that of the TVT group in terms of cure and improvement of incontinence, satisfaction with the procedure and the complications. The preoperative evaluation included history taking, physical examination and stress tests and determining the stress-related leakage, the emptying ability, the anatomy, the protection and the inhibition(SEAPI) scores. The outcomes were evaluated at over one year after operation. RESULTS: The cure and improvement rates were 77.5% and 15% in the TVT group, and 88.9% and 7.4% in the TVT/VTH group, respectively, without any statistical difference between the two groups. The rates of patient- satisfaction with the procedure were similar in two groups. There were no serious or long term complications related to the procedure except for a case of local hematoma in the hysterectomy site, which was controlled conservatively. CONCLUSIONS: Our findings suggest that a TVT operation can be done simultaneously with vaginal hysterectomy with similar results as those of TVT operation only. In addition, it is thought that the simultaneous TVT operation in a patient who is undergoing hysterectomy and has urinary stress incontinence deserves to be recommended in a positive light

Analysis of the Causes of Nephrectomy in 1980-2005 / 대한비뇨기과학회지

PURPOSE: Neoplastic, infectious and calculous diseases, as well as congenital anomaly and vascular disorder of the kidney, are known to be the main indications of a nephrectomy. However, the incidences of a nephrectomy in various renal diseases differ with respect to several factors, such as the socioeconomic situation, and differences in time and regions. This study was performed to investigate the changes of the causes of a nephrectomy and the associated factors between 1980 and 2005. MATERIALS AND METHODS: All 116,535 in-patients admitted to the Urological Department of Kangnam Sacred Heart Hospital from 1980 to 2005 were enrolled in this study,and divided into 3 groups, Period I from January 1980 to December 1987, Period II from January 1990 to December 1997, and Period III from January 2000 to December 2005. Of these patients, 11,565(9.9%) underwent urological operations, and 234(2.0%) were treated with a nephrectomy for various renal diseases. RESULTS: The causes for the nephrectomy in Period I were renal stones (30%), infection-inflammatory diseases(28.75%), congenital anomalies(15%), renal tumors(13.75%), renal injuries(10%), but tumors(41.7%), renal stones (21.4%), congenital anomalies(19.05%), infection-inflammatory diseases (8.3%) and renal injuries(5.6%) in Period II, and tumors(57.1%), congenital anomalies(17.1%), renal stones(14.3%), infection-inflammatory diseases (8.57%) and renal injuries(1.4%) in Period III, in that order(p<0.001). CONCLUSIONS: The incidence of renal tumors has increased, but those of infection-inflammatory diseases and renal injuries have decreased. Among the renal diseases requiring a nephrectomy, renal tumors were ranked in first position, but the nephrectomy rate for benign renal diseases has markedly decreased over time, which is similar to that of developed countries.

Intrauterine Device Migrating into the Bladder / 대한비뇨기과학회지

Migration of an intrauterine contraceptive device (IUD) into the urinary bladder is very rare. We experienced a case of a foreign-body migrating into the bladder of a 35-year-old women who has been suffering from frequency and dysuria for the recent 5 months. The IUD had originally been inserted 10 years ago. Removal of the IUD had been performed for achieving pregnancy, but the IUD was not detected at the correct site 7 years ago. One year later, the patient had given birth without complication. It is thought that it took less than 6 years for the IUD to invade the bladder wall.

Segmental Testicular Infarction Masquerading as Testicular Neoplasm / 대한비뇨기과학회지

Segmental testicular infarction is an uncommon and usually idiopathic phenomenon. Some case reports have linked segmental infarction to sickle cell anemia, hypersensitivity angiitis, polycythemia, and an idiopathic cause. Magnetic resonance imaginge (MRI) might be of great diagnostic value as the ischemic lesions have a characteristic pattern. Nonetheless, as its clinical and radiological presentation may resemble testicular tumors, a definite diagnosis can only be established following surgery. We report a case of testicular infarction which presented as a malignancy even in the frozen biopsy.

Primary Retroperitoneal Cyst Presented as Simple Renal Cyst / 대한비뇨기과학회지

Primary retroperitoneal cysts are rare. Symptoms may be absent, or only an increased abdominal size observed. However, some patients present with complaints associated with pressure or displacement of an abdominal organ due to the cyst. Most patients display some chronic symptoms that necessitate therapeutic intervention. These cysts may occur at any age, with the highest incidence being the fourth decade, but one-third of patients present at less than 10 years of age. A case of a retroperitoneal cyst, which presented as a simple renal cyst, and removed with a laparoscopy, is reported in a sixty one-year-old woman.

Vascular Injury Following Tension-Free Vaginal Tape in Stress Incontinence

Tension-free vaginal tape (TVT) has been accepted for a therapeutic modality of stress incontinence and presented as easy, safe, effective, and time-saving procedure with cure rate of more than 86% and another 11% significantly improved with no serious complication. However, there is not always safe without severe complications, because the TVT needle has to pass blindly through the pelvic cavity. Furthermore, it may be very serious once it happened. We, herein, present a case who bled to shock following TVT procedure but was controlled conservatively, and review its complications in the literatures.

Estrogen Producing Adrenocortical Carcinoma / 대한비뇨기과학회지

An estrogen producing adrenocortical carcinoma is a rare, highly malignant tumor. Fewer than 100 cases of feminizing adrenocortical carcinomas in men have been reported. These tumors are usually large in size and show high levels of serum total estrogen and estradiol. Recently, two cases of estrogen producing adrenocortical carcinoma were experienced by our selves during in year. A unilateral adrenalectomy, with mass excision, was performed in both patients, with an ipsilateral nephrectomy performed in just one. Mitotane or cisplatin based adjuvant chemotherapy was also performed.

Penoplasty with a Sensate Radial Forearm Free Flap after Removal of Paraffinoma / 대한비뇨기과학회지

A 33-year-old man who self injected paraffin into his penis to facilitate an erection and increase his potency suffered from diffuse ulceration and a wide defect on the penile skin involving the proximal glans to the penopubic junction with a high fever. The compromised skin and subcutaneous tissue had to be completely removed and a sensate radial forearm free flap was performed around the penile shaft. This method gave the patient excellent satisfaction in both cosmetic and sexual function. Therefore, this method might be a good therapeutic alternative, especially for young adults indulging in active sexual activity and suffer from wide skin defects even though this operation is expensive and not easy.

Age of Spontaneous Regression of Congenital Hydronephrosis in Children / 대한비뇨기과학회지

PURPOSE: It is difficult to anticipate the prognosis of hydronephrotic kidneys in children. Therefore, the progress of hydronephrosis detected after birth were investigated prospectively according to the ultrasonographic findings. MATERIALS AND METHODS: The study included 36 patients (51 kidneys) who were diagnosed with hydronephrosis caused by a ureteropelvic junction stricture. The patients' age ranged from newborn to 9.8 years (mean, 10.2 months). There were 26 boys (72.2%) and 10 girls (27.8%). 4 cases (11.1%) were in the right kidneys, 17 cases (47.2%) were in the left kidneys and 15 cases (41.7%) in both. The patients were divided into three groups; the spontaneous regression group (SR), the no change group (NC) and the operation group (OP). The average age of each group were 1.5 months, 2.4 months, and 53 months, respcetively. Regression was defined as a decrease in the anteroposterior diameter (APD) of less than 4mm or more than 50% of the initial diameter during the follow up period. RESULTS: The SR group had 21 cases (27 kidneys, 52.9%). The NC group included 10 cases (14 kidneys, 27.5%) and the OP group had 8 cases (10 kidneys, 19.6%). In the SR group (N=27 kidneys), the APDs of the renal pelvis decreased abruptly from 8.6mm to 1.3mm by the average age of 5.9 months. However, in NC group (N=14 kidneys), there was no significant interval change (from mean 10.1mm to 10.3mm) in the APDs of the renal pelvis by 10.4 months of average age. CONCLUSIONS: The congenital hydronephrosis, which was caused by a ureteropelvic junction stricture and was identified after birth, regressed spontaneously in 52.9% of cases and it had usually occurred by 5.9 months of age. Therefore, it is supposed that age is an important factor in the follow-up and management of hydronephrosis in children.

Retroperitoneal Ancient Schwannoma / 대한비뇨기과학회지

The term 'ancient' schwannoma was proposed for a group of neural tumors showing degenerative changes and marked nuclear atypia. The findings from abdominal ultrasound and computed tomography, in a patient with a retroperitoneal ancient schwannoma, are presented, and the histological features of this unusual type of tumor are reviewed. The presence of a large, well-delineated complex cystic mass in the deep soft tissues should raise the possibility of an ancient schwannoma. The treatment of choice for an ancient schwannoma is complete excision. It is important to recognize these tumors as benign, with excellent prognosis, so as to avoid unnecessary radical surgery. A recurrence, or persistence, seems to be associated with incomplete resection, which occurred in 10% of the reported cases.

Complications of Various Genital Procedures Performed by Non-medical Personnel / 대한비뇨기과학회지

PURPOSE: The penis has been attracted to everyone associated with various diseases and sexual activity. Lots of materials and instruments has been applied to the penis for sexual arousal. Furthermore, those ar e usually made and applied in inappropriate ways by non-medical personnel. This resulted in lots of complications in various degrees. So, we investigated the real problems concerning various procedures performed on the genitalia by non-medical personnel. MATERIALS AND METHODS: We reviewed retrospectively medical records of 32 male and one female patients having complications which had been developed following some procedures on the genitalia by non-medical personnel from January 1995 to December 1999. These patients were analyzed according to characteristics of the patients, the methods, purposes, complications and treatments. RESULTS: Their age at first visit was various from 12 years to 70 years (mean, 35.8 years). At that time when procedures had been performed, their age were 12 years to 56 yeats (mean, 30.8 years) in 26 cases whose ages were identified. Among them 22cases (66.7%) were the married and 11 (33.3%) were the unmarried. Occupations were various and out-of-work were 10 (30.4%), commerce 8 (24.2%), firm worker 6(18.2%), student 5 (15.2%), and private job manager and the not-identified 2 (6.1%). according to the school career, the high school graduates were 18 (54.6%), the college graduates 7 (21.2%), middle school graduates 4 (12.1%), and 4 were under middle school. These procedures were performed for sexual satisfaction in 29 cases (87.9%) and for cheap and easy circumcision in 4 cases (12.1%), of which 26 cases (78.8%) had been performed by other person and 7 cases (21.2%) by himself. According to the materials used, 22 (66.7%) cases had been injected vaseline or paraffin in to the penis and one (3.0%) into the vulva, and one (3.0%) plicated his penile skin with rubber band using sewing needle, which 24 cases (72.7%) were for enlargement of the genitalia. 2 (6.0%) cases inserted plastic balls into the penile skin for sexual arousal of partner. 3 (9.1%) cases put a metallic ring, a ceramic ring, and a vacuum device over their penis for improving erection quality, respectively. 4(12.1%) cases had applied the commercially-maid self-circumcision devices over their prepuce, Complications were foreign body sensation, pain at erection, inflammation, skin necrosis, and septic condition, which were variable case by case. Treatments were removal of foreign materials and devices, necrotic tissue, and primary repair of defected skin, for that, in 2 (6.0%) cases, skin flap and graft were needed. CONCLUSIONS: Lots of complications, severe in some cases, had been developed on external genitalia following various procedures performed by medically unauthorized person. So, we have to strongly for their purpose and it would be rather harmful. At the same time, we have to strongly recommend the government to control strictly such materials and instruments not to be sold and used inappropriately.

A Case of Leiomyoma of Testicular Tunica Albuginea / 대한비뇨기과학회지

Leiomyoma is an uncommon lesion which may originate anywhere including the genitourinary system where smooth muscle is present. Five cases of leiomyoma of the testicular tunica albuginea were reported in the world literature. A case of leiomyoma of testicular tunica albuginea in a 58 year old male is presented. We preserved the testis with tumor resection. This is the first report of leiomyoma of testicular tunica albuginea in Korea.

A Study on the Obesity and Stress of Elementary School Children in the Kangnung Area / 대한지역사회영양학회지

This study was carried to estimate the prevalence of obesity and to investigate the relationship between stress and obesity in children. The subjects were 508 children, who were randomly selected from the fifth and sixth grade at nine elementary schools in Kangnung. The height, body weight, waist and hip circumferences and body fat(%) were measured and the levels of stress were assessed by a questionnaire consisting of the following 3 domains ; 4 items for personal factors, 11 for home, and 18 for school. The prevalence of obesity in male and female children greatly varied by the indices from 2.5% and 1.7% when judged by BMI, 9.5% and 4.0% by obesity index, and 29.7% and 34.4% by body fat(%). The stress scores from personal(47.1%) and school (47.9%) factors were higher than the stress score from home(38.5%). The stress score from personal factors of female children is significantly higher than that of male children, but the stress score from home of female children is significantly lower than that of male children. The personal stress score and the total stress score of obese female children were significantly higher than those of non-obese female children. In male children, the obesity index(%) or body fat(%) have a significant positive correlation with the stress scores from over-expectation of parents, a lack of conversation with family, examinations, discontent about school, teacher's partiality to students, and sexual curiosity. The female children have a significantly positive correlation of obesity index (%) or body fat(%) with stress scores from appearance, quarrels of parents, and inferiority complex to brothers or sisters. These results suggested that counselling and education about not only balanced diet but also the strategies for actively coping with stress are needed to prevent and treat childhood obesity.