Holmium:YAG Laser Lithotripsy as a Treatment Modality for Ureteral Calculi / 대한비뇨기과학회지

PURPOSE: We evaluated the results of Holmium:YAG laser lithotripsy according to the size and location of the ureteral stones. MATERIALS AND METHODS: Between March 1998 and April 2007, the medical records of 203 patients who were treated with ureteroscopic Holmium: YAG laser lithotripsy due to ureteral calculi were reviewed. They were subgrouped by the size and the location of the ureteral stones. The results of treatment were evaluated by the stone free rate and the mean operation time of each group. RESULTS: The stone free rates of the upper, mid and lower ureter stone groups were 73.3%, 96.1% and 100%, respectively. There was a significant difference in the upper ureter stone group compared to the other two groups, and especially for the group with stone less than 10mm. Stone migration into the renal pelvis or calyx was a major cause of failure in the patients with upper ureter stones. 8 cases showed stone migration and 2 cases showed fragment migration. CONCLUSIONS: As Holmium:YAG laser lithotripsy has a low complication rate and a high stone free rate, it is an effective treatment modality for ureteral calculi. However, such procedures should be performed carefully because the thermal effect of the Holmium:YAG laser causes ureteral perforation, and especially in the cases of impacted or large stones. Other effective alternatives such as trapping devices need to be studied for patients with upper ureteral stones to prevent stone migration.

Renal Ruptures with Active Bleeding Treated with Emergency Selective Renal Arterial Embolization / 대한비뇨기과학회지

Selection of a treatment modality for traumatized renal rupture depends on the renal injury grade, hemodynamic stability, combined organ injury, and the physician's experience. Treatment for renal injury tends to be conservative to maintain renal function and lessen the morbidity of surgery. If renal injuries were well-staged and selected by radiologic evaluation, hemodynamically stable patients with significant injuries (grades II through V) can usually be managed without surgical exploration. We report 3 cases of grade 4 renal injuries successfully treated with selective renal arterial embolization.

Solitary Fibrous Tumor as Misdiagnosed as Bladder Cancer / 대한비뇨기과학회지

Solitary fibrous tumor(SFT) was previously named localized fibrous mesothelioma, and this is a rare mesenchymal neoplasm that usually shows benign behavior. It is the most commonly recognized tumor of the pleura. These tumors have been recently reported to be found in unexpected locations. To the best of our knowledge, there have been only 2 reports of SFT arising from the urinary bladder in Koreans. We review this third case of SFT that was misdiagnosed as bladder cancer. This tumor was removed from a 40-year-old man who had a history of lower urinary tract symptoms.

The Early Experience of Video-assisted Minilaparotomy Surgery (VAMS) / 대한비뇨기과학회지

PURPOSE: Video-assisted minilaparotomy surgery (VAMS) is a hybrid of conventional open and laparoscopic surgeries, which combines the benefits of both techniques. Our initial experiences with 33 cases were analyzed to assess the feasibility of VAMS. MATERIALS AND METHODS: Between May 2004 and April 2006, a total of 33 patients underwent VAMS-radical (n=20) and VAMS-live donor nephrectomies (n=13). The results of each operation were analyzed in terms of patient age, operation time, blood loss during surgery, time of oral intake and full ambulation, post operative stay period and amount of analgesic use. RESULTS: The mean age of the patients that had undergone the VAMS- radical and VAMS donor nephrectomies were 55.9 12.4 and 36.0 8.6 years, respectively. The mean results of the VAMS radical nephrectomy and VAMS donor nephrectomy with regard to the operative time, blood losses, time to oral intake, time to ambulation, postoperative length of stay and postoperative length of analgesics use were 225+/-72 / 253+/-67 minutes, 378+/-254 / 447+/-208cc, 2.1+/-0.7 / 1.4+/-0.5 days, 2.1+/-1.1 / 1.6+/-0.7 days, 6.2+/-1.1 / 6.2+/-1.0 days and 1.7+/-0.8 / 1.6+/-0.5 days, respectively. The mean warm ischemic time of VAMS donor nephrectomy was 2.4+/-0.8 minutes. The mean operation time of the 10 earliest cases of VAMS radical nephrectomy was 283 minutes; whereas, that of the last 10 cases decreased to 166 minutes. The mean operation time of the 7 earliest cases of VAMS donor nephrectomy was 299 minutes, which decreased to 206 minutes in the last 6 cases. Complications included 3 wound extensions in 5 patients experiencing massive intraoperative bleeding, 1 pneumonia, 1 wound dehiscence and 1 postoperative bleeding, all of which occurred in the 8 earliest cases. CONCLISIONS: VAMS could be a safe and feasible minimally invasive surgical procedure as experience is accumulated; when the initial learning curve has been overcome.

Cystic Renal Cell Carcinoma Associated with Von Hippel-Lindau Disease Treated by Nephron Sparing Surgery / 대한비뇨기과학회지

Von Hippel-Lindau disease (VHL) is a rare, autosomal dominantly transmitted familial, hereditary disease. This disease genetically predisposes affected people to the development of some types of tumor, such as cerebellar, spinal and medullary hemangioblastomas, and retinal angiomas, renal cell carcinomas and pheochromocytomas. Herein, a case of a cystic renal cell carcinoma, accompanied by Von Hippel-Lindau disease, treated by nephron sparing surgery, is reported. The VHL gene mutation of this case was also identified.

Clinical Features and Efficacy of Diagnostic Methods in Adults with Asymptomatic Microscopic Hematuria / 대한비뇨기과학회지

PURPOSE: Asymptomatic microscopic hematuria is a difficult problem faced at the offices of many urologists. This study was aimed at evaluating the ability for the detection of significant lesions, according to the grade of microscopic hematuria and the comparison of various diagnostic modalities. MATERIALS AND METHODS: Between March 1999 and December 2003, 755 adult patients that visited our hospital due to asymptomatic microscopic hematuria were examined according to the diagnostic algorithm. The male-to-female ratio was approximately 1:1.1 (366:389). Microscopic hematuria was divided into five grades. Lesions found at evaluation were categorized as either highly or moderately significant or insignificant lesions. RESULTS: 221 (29.3%) out of 755 patients were found to have lesions during evaluation. Of these 221 patients, 33 with highly significant lesions, including 4 urologic malignancies, 127 with moderately significant lesions and 61 with insignificant lesions, were detected. Correlation was shown between the degree of microscopic hematuria and the likelihood of detecting significant urologic diseases. The sensitivity and specificity for the detection of significant lesions by urine cytology, ultrasonography (USG), intravenous pyelography (IVP), cystoscopy, computed tomography (CT) and the combination of USG and IVP were 2.5/96.3%, 35.6/96.5%, 34.7/ 96.0%, 7.4/97.7%, 100/98.2% and 44.8/94.8%, respectively. CONCLUSIONS: The combination of USG and IVP for the detection of significant lesions at the initial examination was more beneficial than USG or IVP. Cystoscopy and CT are necessary additional diagnostic modalities for patients with abnormal findings at the initial examination and for those patients with asymptomatic microscopic hematuria who are at high risk.

Primary Malignant Melanoma of the Male Urethra / 대한비뇨기과학회지

A primary malignant melanoma occurring within the male urethra is a very rare disease, which usually shows highly malignant potential. Due to the low incidence, the clinical features of this disease remain unclear, and the mode of treatment controversial. Herein, we report a case of a malignant melanoma of the male urethra in a 77 year old man, who was managed by transurethral resection, and has remained uneventful for a 6 month follow-up period.

Testicular Tuberculosis Mimicking Testicular Malignancy / 대한비뇨기과학회지

Genitourinary tuberculosis is the most common manifestation of an extrapulmonary tuberculous infection. The most common site of genital tuberculosis is the epididymis, but testicular tuberculosis is very rare. A 30 year old patient presented with a painless right testicular mass. Under the clinical diagnosis of a right testicular tumor, a right radical inguinal orchiectomy was performed. The pathological diagnosis revealed testicular tuberculosis, without involvement of the epididymis.

The Efficacy of Oral Levofloxacin in the Treatment of Patient with Chronic Prostatitis / 감염과화학요법

PURPOSE: Antibiotic is widely used in the treatment of chronic prostatitis. In this study, we evaluated the clinical efficacy and safety of levofloxacin (Cravit(R)) in the treatment of patients with chronic prostatitis. MATERIALS AND METHODS: Between March 2001 and February 2003, 64 patients with chronic bacterial (NIH-category II) and nonbacterial inflammatory prostatitis (NIH-category IIIa) were enrolled in this study. Daily 400 mg of levofloxacin was administered orally for 4-18 weeks. To determine the efficacy of levofloxacin, patients were assessed with the NIH-CPSI and examined of expressed prostatic secretion (EPS) at 3 months follow-up period. RESULTS: The CPSI of 16 patients stratified into NIH-category II was 24.9+/-4.7 before and 14.1+/-6.5 after the treatment. For 48 patients stratified into NIH-category IIIa, the CPSI value before and after the treatment was 23.9+/-4.4 and 13.2+/-5.7, respectively. 40 patients (62.5%) showed mild to moderate improvement in NIH-CPSI, and 23 patients (35.9%) showed improvement in the laboratory profile according to the count of leukocytes (WBC <10/HPF) in EPS. Adverse reaction was noted in 1 patient during the treatment. Conclusions:This study shows that levofloxacin may be a safe and effective agent in treating either chronic bacterial prostatitis or chronic nonbacterial inflammatory prostatitis with few adverse reactions.

The Efficacy of Oral Levofloxacin in the Treatment of Patient with Chronic Prostatitis / 감염과화학요법

PURPOSE: Antibiotic is widely used in the treatment of chronic prostatitis. In this study, we evaluated the clinical efficacy and safety of levofloxacin (Cravit(R)) in the treatment of patients with chronic prostatitis. MATERIALS AND METHODS: Between March 2001 and February 2003, 64 patients with chronic bacterial (NIH-category II) and nonbacterial inflammatory prostatitis (NIH-category IIIa) were enrolled in this study. Daily 400 mg of levofloxacin was administered orally for 4-18 weeks. To determine the efficacy of levofloxacin, patients were assessed with the NIH-CPSI and examined of expressed prostatic secretion (EPS) at 3 months follow-up period. RESULTS: The CPSI of 16 patients stratified into NIH-category II was 24.9+/-4.7 before and 14.1+/-6.5 after the treatment. For 48 patients stratified into NIH-category IIIa, the CPSI value before and after the treatment was 23.9+/-4.4 and 13.2+/-5.7, respectively. 40 patients (62.5%) showed mild to moderate improvement in NIH-CPSI, and 23 patients (35.9%) showed improvement in the laboratory profile according to the count of leukocytes (WBC <10/HPF) in EPS. Adverse reaction was noted in 1 patient during the treatment. Conclusions:This study shows that levofloxacin may be a safe and effective agent in treating either chronic bacterial prostatitis or chronic nonbacterial inflammatory prostatitis with few adverse reactions.

Effect of Asymptomatic Prostatitis in Prostate Needle Biopsies on the Serum Prostate Specific Antigen and Prostate Specific Antigen Density / 대한비뇨기과학회지

PURPOSE: The relationship between morphological parameters of inflammation in prostatic tissue and the levels of serum prostate specific antigen (PSA) and prostate specific antigen density (PSAD) were investigated. MATERIALS AND METHODS: 95 prostate biopsies performed on 95 men with elevated serum PSA and/or abnormal digital rectal examinations of the prostate were reviewed. Of these, 42 malignant biopsies and 2 cases of clinical prostatitis were excluded. In the remaining 51 prostate biopsies, the extent of inflammation, aggressiveness of inflammation and presence of polymorphonuclear leukocytic infiltration were scored at both the acini and ducts. RESULTS: The mean serum PSA levels in grades 0, 1 and 2 for the extent of inflammation were 11.4, 8.5 and 9.3, respectively. The mean PSAD levels in these groups were 0.27, 0.17 and 0.17, respectively. The mean serum PSA levels in grades 0, 1 and 2 for the aggressiveness of inflammation were 9.2, 9.5 and 3.8, respectively. The mean PSAD levels in these groups were 0.19, 0.18 and 0.09, respectively. The mean serum PSA levels in the absence and presence of polymorphonuclear leukocytic infiltration were 8.8 and 9.13, respectively. The mean PSAD levels in these groups were 0.18 and 0.15, respectively. The mean serum PSA and PSAD levels were not significantly increased with the proportional increases in the morphological parameters of inflammation. CONCLUSIONS: The serum PSA and PSAD levels were found not to be significantly increased with proportional increases in the morphological parameters of inflammation in asymptomatic histological prostatitis. It is propose that asymptomatic inflammation in prostate tissue is not the reason for delayed repeat prostate biopsies.

Crossed Testicular Ectopia in a Patient with Bilateral Cryptorchism / 대한비뇨기과학회지

Crossed testicular ectopia is an uncommon anatomical abnormality in which both gonads migrate toward the same hemiscrotum. We report a case of crossed testicular ectopia associated with bilateral cryptorchism. The crossed ectopic and intra-abdominal testis was fixed in it's own hemiscrotum by laparoscopic orchiopexy.

The Change of Prostate Specific Antigen after Treatment in Chronic Prostatitis Associated with Elevated Serum Prostate Specific Antigen / 대한비뇨기과학회지

PURPOSE: Men with documented chronic prostatitis, with elevated serum prostate specific antigen (PSA), were investigated to assess whether treatment lowers serum PSA and thus avoids unnecessary biopsies. MATERIALS AND METHODS: The medical records of 46 men who presented with serum PSA higher than 4ng/ml, and subsequently diagnosed with chronic prostatitis, were retrospectively reviewed. After the administration of antibiotics and anti-inflammatory drugs for 4 to 8 weeks, the follow-up PSA levels were determined, and those with levels higher than 4ng/ml underwent a prostate biopsy. RESULTS: The mean PSA level decreased 61% from 11.66ng/ml before, to 3.79ng/ml after, treatment (p<0.001). In 30 patients the serum PSA level decreased to below 4ng/ml (mean 1.69), with these patients no longer having an indication for a prostate biopsy. In the remaining 16 patients the serum PSA level remained elevated above 4ng/ml, so they underwent a prostate biopsy. Pathological study revealed benign prostatic hyperplasia in 11 cases and prostate cancer in 5. The PSA level in patients associated with benign prostatic hyperplasia decreased 61.9% with treatment, from 19.96 to 7.88ng/ml (p=0.006) and the PSA in those associated with prostate cancer decreased 30.6% with treatment, from 12.85 to 7.32ng/ml (p<0.05). CONCLUSIONS: This study demonstrates that chronic prostatitis can cause elevation of serum PSA levels, and when identified, antibiotics and anti-inflammatory treatment can lower these levels and an unnecessary prostate biopsy can be avoided.

Clear Cell Adenocarcinoma of the Urinary Bladder / 대한비뇨기과학회지

A case of a clear cell carcinoma of the urinary bladder is reported. A 48-year-old female was referred to our hospital complaining of gross hematuria and terminal dysuria. She had a nodular tumor, 3x4cm in diameter, located on the bladder neck, trigone and posterior urethra. The patient underwent anterior pelvic exenteration and urinary diversion with an ileal conduit. A histopathological examination revealed a tumor composed of cells with eosinophilic cytoplasm, and partly of cells with clear cytoplasm or hobnail-shaped cells, arranged in tubular and papillary architectures. This showed the findings of a clear cell adenocarcinoma of the bladder and urethra. The patient underwent 6 courses of adjuvant chemotherapy with cisplatin and 5-FU. The patient shows no evidence of recurrence or metastasis at the 8 month postoperative follow-up.

Relationship between the Amount of Tissue Removed at Transurethral Resection of the Prostate and Clinical Improvement in Benign Prostate Hyperplasia / 대한비뇨기과학회지

PURPOSE: Patients that had undergone transurethral resection of the prostate (TURP) for benign prostate hyperplasia (BPH) were evaluated to assess the influence of the amount of resected tissue on the symptomatic improvement. MATERIALS AND METHODS: 42 men, with symptomatic BPH that had undergone TURP, were enrolled in this retrospective study. 20 and 22 patients with prostate volumes equal or less 30ml (group I) and greater than 30ml (group II), respectively, were evaluated. The resected tissue weight (RTW) and the resected tissue weight ratio (RTWR) were taken as preoperative parameters. The percent changes in the International Prostate Symptom Score (IPSS) and in the Quality of Life, and the satisfaction score, were used as measures of the symptomatic outcomes. The symptomatic outcomes of the two groups were compared, and the correlations between the RTW and RTWR and the outcomes in each group assessed. RESULTS: All the symptomatic outcomes of group II were more favorable than those of group I. There were significant correlations between the RTW (and RTWR) and all three outcomes in group II, but there were no correlations between groups I and II. CONCLUSIONS: The patients with the smaller prostate volume (equal or less than 30ml in volume) had less symptomatic improvement after TURP, with no benefit in increasing the amount of resected tissue during TURP. It is recommended excessive resection for BPH should be avoided with a small prostate.

Ureteroscopic Management of Ureteral Calculi: Comparisons of Stone Basket Electrohydraulic Lithotripsy Swiss Lithoclast and Holmium:YAG Laser / 대한비뇨기과학회지

No abstract available.

Patterns of Tumor Recurrence after Nephron Sparing Surgery for Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: We evaluated patterns of tumor recurrence after nephron sparing surgery for sporadic renal cell carcinoma MATERIALS AND METHODS: From December 1992 to October 1997, 20 patients(21 renal units) underwent nephron sparing surgery(partial nephrectomy, wedge resection, enucleation) for sporadic renal cell carcinoma at our department. Mean postoperative followup period was 25.4+/-0.3 months. All patients were evaluated with a medical history, physical examination, blood chemistry, chest x-ray, abdominal CT every 6 months. The clinical course and outcome for patients who had recurrence after nephron sparing surgery were reviewed retrospectively. We also reviewed 122 patients who underwent radical nephrectomy at the same period for patterns of tumor recurrence. RESULTS: Renal cell carcinoma were recurred after nephron sparing surgery in 3 patients (15%, 3/21 renal units:14.2%). Local tumor recurrence with(1) or without(1) metastatic disease developed in 2 patients(10%). Metastatic disease without local tumor recurrence developed in 1 patient(5%). One patient with only local recurrence had positive resection margin. Initial pathological tumor stage and period to tumor recurrence were T3a and 4 months for patient with local recurrence, T2 and 10 months for patient with local recurrence and brain metastasis, T2 and 12 months for patient with lung metastasis without local recurrence. Renal cell carcinoma recurred after radical nephrectomy in 8 patients(6.6%). Local recurrence was none and all recurrent tumors were distant metastasis. CONCLUSIONS: The incidence of metastatic disease after nephron sparing surgery for renal cell carcinoma was not different from that occurring after radical nephrectomy but the incidence of local tumor recurrence after nephron sparing surgery was greater than that occurring after radical nephrectomy. Nephron sparing surgery must be done with enough negative resection margin.

Use of Serum PSA in Comparison of Biopsy Gleason Score with Radical Prostatectomy Gleason Score / 대한비뇨기과학회지

PURPOSE: The Gleason score of needle biopsies of the prostate and preoperative serum level of prostate-specific antigen(PSA) are two useful factors in predicting the final pathological staging of patients with prostate cancer treated by radical prostatectomy. Unfortunately, the Gleason score of the biopsy cores often differs from the Gleason score of radical prostatectomy specimen. We evaluated the role of Gleason scores of biopsy cores and the influence of PSA in predicting the Gleason scores of prostatectomy specimens and final pathological staging. MATERIALS AND METHODS: The records of 52 patients with prostate cancer treated by radical prostatectomy from June 1990 to June 1997 were reviewed. The patients were divided into three groups according to the sum of the Gleason scores, i.e. well differentiated(Gleason score 2-4), intermediate(5-7) and poorly differentiated tumors(8-10). The concordance between Gleason score of biopsy and prostatectomy specimen was analysed according to the Gleason score of tumor in biopsy specimen. Furthermore, we evaluated the different level of PSA could affect the concordance rate between Gleason scoreofbiopsyandprostatectomyspecimen. RESULTS: In well-differentiated tumors(Gleason score 2-4) in biopsy specimen, the concordance rate was 55.6%, In intermediate(5-7) differentiated cancers the Gleason score remained the same in 68%. In poorly differentiated tumors, the concordance rate was 72.2%. When PSA was less than 10ng/m1, concordance rate of well differentiated tumors and poorly differentiated tumors was 75%, 40%, respectively. Whereas the concordance rate of well differentiated tumors was 50% and that of poorly differentiated tumors was 90% when the PSA was higher than 20ng/m1. Using linear regression analysis, the preoperative PSA highly correlated with radical prostatectomy Gleason score(correlation coefficient(r)=0.38, p =0.005). CONCLUSIONS: The Gleason score of prostatectomy specimen was upgraded in 44.4% when the biopsy Gleason score was well differentiated, especially when preoperative PSA was higher than 20ng/m1. Therefore, the significance of biopsy Gleason score in the clinical application must be used cautiously when it is used to predict the pathological stage or biological potential of the cancer especially when it is low Gleason score with high PSA( > 20ng/m1). In the meantime, the level of PSA plays an significant role in determining organ confined disease, while high Gleason scone reflect the Iymph node positive disease.

Early Catheter Removal Following Transurethral Prostatectomy : A Prospective Study of 101 Consecutive Patients / 대한비뇨기과학회지

We managed 118 patients with benign prostatic hyperplasia by transurethral resection during January 1994 and December 1995 in Eul Ji Medical Center and all patients were operated upon by 2 staff doctors. Among 118 cases, 7 cases with intraoperative complications such as bladder injury or severe prostatic capsule injury and 8 cases with combined neuropathic bladder or chronic urinary retention and 2 cases with urethral stricture were excluded. The average age of 101 cases were 66.4 years old (50-92), and average weight of resected adenoma was 10.0 gm (2-32). We categorized these patients randomly into 2 groups. In group I (n=48), we removed the urethral catheter within 2 days after TURP and in group II (n=53), we removed it after 3 days (mean 4.2 days) following surgery. The average hospital stay postoperatively was4.1 days in group I and 7.4 days in group II. Recatheterization rate was 8.3% (4/48) in group I and 5.6% (3/53) in group II (p>0.05). There was no statistical difference in other complication including failure to void, intraoperative bleeding, urethral stricture, incontinence and TUR syndrome. This study supports early catheter removal after TURP would become an accepted and routine postsurgical practice following uncomplicated TURP.

Two Cases of the Fournier's Gangrene / 대한비뇨기과학회지

Genitourinary gangrene is an uncommon, potentially lethal disorder characterized by the abrupt onset of a rapidly progressive necrotizing soft tissue infection caused by the synergistic action of various organisms that spread along fascial planes, causing subfascial soft tissue necrosis and destruction. Many factors, debilitating condition such as carcinoma, diabetes and alcoholism, contribute to the development and perpetuate the course of Fournier's gangrene. In our two cases , predisposing causes were as follow ; chronic liver disease, diabetes mellitus, chronic alcoholism, perianal abscess. The patients were hemodynamically unstable and extensive necrosis was noted. After aggressive debridement of the wound and triple antibiotic therapy, general condition became improved and then we performed split thickness skin grafts and the results of reconstructive surgery were satisfactory.