A novel one lobe technique of thulium laser enucleation of the prostate: 'All-in-One' technique

PURPOSE: The thulium laser is the most recently introduced technology for the surgical treatment of benign prostatic hyperplasia (BPH). Until recently, most thulium laser enucleation of the prostate (ThuLEP) was performed by use of the three-lobe technique. We introduce a novel one-lobe enucleation technique for ThuLEP called the "All-in-One" technique. We report our initial experiences here. MATERIALS AND METHODS: From June 2013 to May 2014, a total of 47 patients underwent the All-in-One technique of ThuLEP for symptomatic BPH performed by a single surgeon. All patients were assessed with the International Prostate Symptom Score (IPSS), transrectal ultrasonography, serum prostate-specific antigen (PSA), maximal urine flow rate (Qmax), and postvoid residual urine volume (PVR) before and 1 month after surgery. We reassessed IPSS, Qmax, and PVR 3 months after surgery. To assess the efficacy of the All-in-One technique, we checked the PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate. RESULTS: The mean operative time was 82.1+/-33.3 minutes. The mean enucleation time and morcellation time were 52.7+/-21.7 minutes and 8.2+/-7.0 minutes, respectively. The mean resected tissue weight and decrease in hemoglobin were 36.9+/-24.6 g and 0.4+/-0.8 g/dL, respectively. All perioperative parameters showed significant improvement (p<0.05). No major complications were observed. The PSA reduction ratio, transitional zone volume reduction ratio, and enucleation failure rate were 0.81, 0.92, and 4.3%, respectively. CONCLUSIONS: The All-in-One technique of ThuLEP showed efficacy and effectiveness comparable to that of other techniques. We expect that this new technique could reduce the operation time and the bleeding and improve the effectiveness of enucleation.

An Analytical Comparison of Short-term Effectiveness and Safety Between Thulium:YAG Laser Vaporesection of the Prostate and Bipolar Transurethral Resection of the Prostate in Patients With Benign Prostatic Hyperplasia

PURPOSE: In recent years, laser surgery has been widely used to treat benign prostatic hyperplasia (BPH). A thulium:yttrium-aluminium-garnet (Tm:YAG) laser was recently introduced for BPH surgery. We compared the effectiveness and safety of Tm:YAG laser vaporesection of the prostate (ThuVaRP) with that of bipolar transurethral resection of the prostate (TURP). MATERIALS AND METHODS: From January 2010 to December 2012, 86 patients underwent surgical treatment for symptomatic BPH by a single surgeon. We retrospectively analyzed and compared the medical records of 43 patients who underwent ThuVaRP and 43 patients who underwent bipolar TURP. All patients were assessed by using the International Prostate Symptom Score, transrectal ultrasonography, the serum prostate-specific antigen (PSA) level, uroflowmetry, and postvoid residual volume before and 1 month after surgery. All complications were compared between the two groups. RESULTS: ThuVaRP was superior to TURP in catheterization time (p50 g), operation time was much longer with ThuVaRP. One month after surgery, the decrease in PSA was greater (p=0.045) with ThuVaRP than with TURP, and the increase in maximal urine flow rate was greater (p<0.001) with ThuVaRP than with TURP. The postoperative complication transient urinary incontinence was significantly different between the ThuVaRP group (nine cases, 20.9%) and the TURP group (two cases, 4.7%). Other complications were comparable between groups. CONCLUSIONS: The effectiveness and safety of ThuVaRP and TURP were comparable. ThuVaRP is a promising alternative surgical technique to TURP for BPH.

Comparative Study between Standard and Totally Tubeless Percutaneous Nephrolithotomy

PURPOSE: Several recent studies have reported the benefits of tubeless percutaneous nephrolithotomy (PNL). Postoperatively, tubeless PNL patients have an indwelling ureteral stent placed, which is often associated with stent-related morbidity. We have performed totally tubeless (tubeless and stentless) PNL in which no nephrostomy tube or ureteral stent is placed postoperatively. We evaluated the safety, effectiveness, and feasibility of totally tubeless PNL. MATERIALS AND METHODS: From March 2008 to February 2012, 57 selected patients underwent standard or totally tubeless PNL. Neither a nephrostomy tube nor a ureteral stent was placed in the totally tubeless PNL group. We compared patient and stone characteristics, operation time, length of hospitalization, analgesia requirements, stone-free rate, blood loss, change in creatinine, and perioperative complications between the standard and totally tubeless PNL groups. RESULTS: There were no significant differences in preoperative patient characteristics, postoperative complications, or the stone-free rate between the two groups, but the totally tubeless PNL group showed a shorter hospitalization and a lesser analgesic requirement compared with the standard PNL group. Blood loss and change in creatinine were not significantly different between the two groups. CONCLUSIONS: Totally tubeless PNL appears to be a safe and effective alternative for the management of renal stone patients and is associated with a decrease in length of hospital stay.

Comparative Study between Standard and Totally Tubeless Percutaneous Nephrolithotomy

PURPOSE: Several recent studies have reported the benefits of tubeless percutaneous nephrolithotomy (PNL). Postoperatively, tubeless PNL patients have an indwelling ureteral stent placed, which is often associated with stent-related morbidity. We have performed totally tubeless (tubeless and stentless) PNL in which no nephrostomy tube or ureteral stent is placed postoperatively. We evaluated the safety, effectiveness, and feasibility of totally tubeless PNL. MATERIALS AND METHODS: From March 2008 to February 2012, 57 selected patients underwent standard or totally tubeless PNL. Neither a nephrostomy tube nor a ureteral stent was placed in the totally tubeless PNL group. We compared patient and stone characteristics, operation time, length of hospitalization, analgesia requirements, stone-free rate, blood loss, change in creatinine, and perioperative complications between the standard and totally tubeless PNL groups. RESULTS: There were no significant differences in preoperative patient characteristics, postoperative complications, or the stone-free rate between the two groups, but the totally tubeless PNL group showed a shorter hospitalization and a lesser analgesic requirement compared with the standard PNL group. Blood loss and change in creatinine were not significantly different between the two groups. CONCLUSIONS: Totally tubeless PNL appears to be a safe and effective alternative for the management of renal stone patients and is associated with a decrease in length of hospital stay.

A Feasible Technique for Transient Vascular Occlusion by Using a Vessel Loop and Hem-o-Lok Clips in Laparoscopic Partial Nephrectomy

PURPOSE: We introduce our transient vascular occlusion technique that uses a vessel loop and Hem-o-Lok clips in laparoscopic partial nephrectomy. MATERIALS AND METHODS: From March 2009 to March 2011, 15 consecutive patients underwent laparoscopic partial nephrectomy. All operations were performed by a single surgeon using the transperitoneal approach. The transient vascular occlusion technique was as follows. After dissection of renal vessels, the vessel loop is winded twice around the vessel. Both distal portions of the vessel loop are clipped with a Hem-o-Lok clip. When vascular occlusion is required, an additional Hem-o-Lok clip is applied to the proximal portion of the vessel loop by pulling the distal portion. When no longer needed, the vessel loop is simply cut. RESULTS: All operations were performed successfully without open conversion. The mean tumor size was 2.5 cm (range, 1.1-3.5 cm). There were 8 cases of renal cell carcinoma and 7 cases of angiomyolipoma. All cases of renal cell carcinoma had a negative surgical margin. The mean operative time and the mean warm ischemic time were 176 minutes (range, 104-283 minutes) and 26.1 minutes (range, 18-34 minutes), respectively. There were no cases of uncontrollable intraoperative bleeding and no postoperative complications. CONCLUSIONS: The transient vascular occlusion technique with a vessel loop and Hem-o-Lok clips is a feasible technique with simplicity, effectiveness, and safety. It is an acceptable alternative to standard vascular occlusion techniques, such as laparoscopic bulldog or Satinsky clamps.

Early Experience with Laparoscopic Retropubic Simple Prostatectomy in Patients with Voluminous Benign Prostatic Hyperplasia (BPH)

PURPOSE: Laparoscopic simple prostatectomy was recently developed to treat voluminous benign prostatic hyperplasia (BPH). We describe the surgical technique and assess the feasibility of laparoscopic simple prostatectomy through our early experience. MATERIALS AND METHODS: The medical records of 11 patients who underwent laparoscopic simple prostatectomy between March 2008 and January 2010 were retrospectively analyzed. The subjects were limited to the patients who satisfied the following conditions: prostate volume was at least 75 g, acute urinary retention repeatedly occurred or maximal flow rate (Qmax) was at most 10 ml/s, and International Prostate Symptom Score (IPSS) was at least 12. The surgery was performed by the laparoscopic extraperitoneal approach with a transcapsular route. Feasibility was assessed by objective operative parameters (reconversion, operating time, and blood loss) and perioperative complications. Data on short-term follow-up were also available. RESULTS: The mean age of the patients was 70.6 years. Mean preoperative prostate-specific antigen and prostate volume were 6.1 ng/ml and 109.3 cc, respectively. Mean operation time was 191.9 minutes and estimated blood loss was 390.9 cc. The resected adenoma weighed on average 72.4 g. No conversion to open surgery was required. Mean preoperative IPSS and quality of life (QoL) scores were 26.86 and 4.86. Mean Qmax, measured before the surgery, was 4.5 ml/s and residual urine was 106 ml. Mean postoperative IPSS and QoL scores were 4.2 and 1.5. After the surgery, mean Qmax was 15.5 ml/s and residual urine was 24.1 ml. CONCLUSIONS: In the case of voluminous BPH, laparoscopic retropubic simple prostatectomy is expected to be a useful treatment on the condition that the learning curve can be overcome with clinical experience.

Lymphoepithelioma-like Carcinoma of the Urinary Bladder

A 78-yr-old woman presented with gross hematuria for 2 weeks. On cystoscopy, a frond-like mass was observed at the bladder trigone. Transurethral resection of bladder tumor was performed for the mass. Histopathological findings showed that 90% of lesions were lymphoepithelioma-like carcinoma (LELCA) and a few lesions were non-invasive transitional cell carcinoma. On microscopy, syncytial growth pattern and indistinct cytoplasmic borders were observed with the severe infiltration of lymphoid cells. The case was followed-up for 8 months without recurrence. This is the first report of a LELCA case in Korea.

Adenomatoid Tumor of the Spermatic Cord / 대한비뇨기과학회지

Adenomatoid tumors are rare benign neoplasms thought to be of mesothelial origin. Although most reported cases developed from the epididymis, rare cases have been reported in the testicular tunica, spermatic cord and ejaculatory ducts. Because of the benign nature of this tumor, the treatment of choice is local excision. We report a rare case of adenomatoid tumor of the spermatic cord treated by local excision.

Effects of Medication with Dutasteride on Detection of Prostate Cancer in Patients with Serum Prostate-specific Antigen Level of 4~10 ng/ml / 대한남성과학회지

Purpose: We assessed the effects of medication with dutasteride on serum prostate-specific antigen (PSA), PSA density (PSAD) and prostate volume to avoid unnecessary biopsies. Materials and Methods: Between 2005 and 2007 patients with serum PSA level of 4~10 ng/ml were recruited in this prospective study. Patients were treated with 0.5 mg of dutasteride once daily for 3 months. PSA, PSAD and prostate volume were measured at baseline and at the end of treatment. The patients with a high PSA level (> or =4 ng/ml) after medication with dutasteride had a prostate biopsy. The patients were divided as group I (prostate cancer; n=29) and group II (benign disease; n=55). We compared the changes of serum PSA, PSAD, and prostate volume change between two groups. Results: In group I, PSA, PSAD and prostate volume decreased from baseline means of 8.16 ng/ml, 0.23 ng/ml/cm3 and 46.81 cc to 5.69 ng/ml, 0.18 ng/ml/cm3 and 40.41 cc. The difference in PSA, PSAD and prostate volume was -0.2%, -2.1% and -3.6% for group I. On the contrary, in group II, PSA, PSAD and prostate volume decreased from baseline means of 7.65 ng/ml, 0.16 ng/ml/cm3 and 56.48 cc to 4.48 ng/ml, 0.11 ng/ml/cm3 and 51.35 cc. The difference in PSA, PSAD and prostate volume was -41.4%, -33.3% and -9.1% for group II. When 4.83 ng/ml and 0.15 ng/ml/cm3 were chosen as the PSA and PSAD cutoff levels after treatment with dutasteride, unnecessary biopsies could be avoided effectively. Conclusions: These data suggest that the magnitude of changes in serum PSA and PSAD after 3 months of dutasteride challenge could be useful to avoid unnecessary prostate biopsies in patients with elevated PSA level.

Scrotal Arteriovenous Malformation / 대한비뇨기과학회지

Arteriovenous malformation (AVM) of the scrotum is a rare vascular lesion, which is distinguished histologically by ambiguous vessels displaying both arterial and venous characteristics and abnormal muscularization of variable sized ectatic vessels. Complete excision is recommended as a definitive treatment. Here, a case of arteriovenous malformation involving the scrotal vessels is reported.

Xanthogranulomatous Pyelonephritis in a Child / 대한비뇨기과학회지

Xanthogranulomatous pyelonephritis (XGP) is a rare, severe, chronic infection of the kidney resulting in the normal renal parenchyma being replaced by characteristic lipid-laden macrophages (foam cells). It may occur at any age but is extremely rare in children. Correct pre-operative diagnosis is essential for appropriate surgical approach. We report a case of diffuse XGP in a 6-year-old boy which was pre-operatively diagnosed as XGP.

Comparison of Medical Therapeutic Efficacy in the Patinet with Diabetic Cystopathy According to Prevalence Period of Diabetes Mellitus / 대한비뇨기과학회지

PURPOSE: Patients with diabetic cystopathy ultimately undergo morphometric and functional changes in their bladder. Therefore, various voiding symptoms such as frequency, nocturia, urgency, hesitancy, retention and weak stream were evaluated. Irritative symptoms usually develop in cases where the prevalence period of diabetes mellitus (DM) is short, and the obstructive symptoms develop in the opposite case. Improving the voiding symptoms might differ according to prevalence period. Therefore, the therapeutic efficacy of the treatment was compared. MATERIALS AND METHODS: One hundred ten patients were divided into three groups according to how long they had suffered from DM, and were treated with medical therapy over a 4 week period: group A (10yrs). The patients were asked to write their subjective symptoms in a voiding diary and a urodynamic study was undertaken. RESULTS: After medical therapy, the frequency, nocturia and urgency in group A had improved to 72%, 77% and 88% respectively (p0.05). In a urodynamic study of group B, the maximum detrusor pressure had increased from 20.3+/-6.7cmH2O to 53.5+/-8.1cmH2O and the post void residuals decreased from 62.3+/-36.4ml to 21.2+/-17.1ml (p0.05). In group C, there was little improvement in the urodynamic study (p>0.05). CONCLUSIONS: The medical therapeutic efficacy for these patients reduces as the DM revalence period is longer.

Comparison of Medical and Surgical Therapy in Benign Prostatic Hyperplasia Patients with Diabetes Mellitus / 대한비뇨기과학회지

PURPOSE: The treatment was done on benign prostatic hyperplasia (BPH) patients and BPH wth diabetes mellitus patients. Comparisons have been made before and after the treatment international prostatic symptom score (IPSS), quality of life index (QOL index), maximal flow rate (Qmax) and patient's satisfaction to find what kind of treatment results in the most effect and contentment. MATERIALS AND METHODS: 361 cases were chosen as subjects who were able to follow up for more than 3 months following the treatment. This retrospective study comprised of two groups; one is a BPH patients group (A group: n=246) and the other is BPH with DM patients group (B group: n=115). Each group was treated with medical or surgical therapy. The IPSS, QOL index, Qmax and patient's satisfaction were analyzed and compared between the groups. RESULTS: After medical therapy in the A group, the IPSS reduced from 18.8+/-4.3 to 10.8+/-2.8, QOL index from 3.9+/-1.0 to 2.1+/-1.7 and Qmax improved from 9.7+/-1.6ml/sec to 12.8+/-1.9ml/sec. In B group, from 19.4+/-4.7 to 15.2+/-3.6, 4.8+/-1.0 to 3.1+/-0.9 and 8.6+/-0.9ml/sec to 10.9+/-0.5ml/sec respectively (p<0.05). After surgical therapy in the A group, the IPSS reduced from 21.9+/-6.1 to 8.2+/-5.4, QOL index from 4.1+/-1.2 to 1.8+/-0.8 and Qmax improved from 8.6+/-1.7ml/sec to 16.6+/-2.9ml/sec. In B group, from 24.7+/-7.2 to 10.3+/-5.7, 4.3+/-1.5 to 2.2+/-0.7 and 7.7+/-1.8ml/sec to 14.0+/-1.8ml/sec respectively (p<0.05). In B group much more improvement was made than medical therapy group. CONCLUSIONS: In BPH with DM patients, the initial surgical therapy was found to have better effect than through medical therapy in the degree of the patients satisfaction, IPSS, QOL index and Qmax. We suggest that surgical therapy is good therapeutic option even in BPH with DM patients at short term postoperative period.

Comparison Between the Early and Late Results of Operative Therapy and Thermotherapy for the Benign Prostatic Hyperplasia / 대한비뇨기과학회지

Alternative treatment modalities for benign prostatic hyperplasia(BPH) have during the last few years been introduced including transurethral microwave thermotherapy(TUMT). The aim of this presentation is to compare a new non-surgical treatment to a well-established surgical procedure(TURP, open prostatectomy) and to report our updated early 3 months and late mean 15 months results of this TUMT versus operative therapy in patients with BPH. From Sep.1992 to Aug.1993, 33 and 29 patients who was underwent TUMT and surgical procedure respectively with BPH in Taegu Fatima Hospital have been followed for early 3 months, 26 and 22 patients for late mean 15 months. 1 The two groups were almost identical regard to mean age, prostate volume, modified Boyarsky symptom score, maximal and mean flow rate (P>0.05). 2. The modified Boyarsky symptom score decreased significantly from 19.5 to 6.7, at 3 months and 8.5 at l5 months after surgical procedure and from 18.9 to 9.8 at 3 months and 14.7 at 15 months after TUMT respectively. The decrease was more pronounced after surgica1 procedure at 3 and 15 months (P0.05), but significantly decreased at the late 15 months after TUMT(p<0.01) respectively. 5. The degree of satisfaction of the patients themselves with each prescription was 96.6% at 3 months and 87.0% at 15 months after surgical procedure and 66.7% at 3 months and 34.6% at 15 months after TUMT respectively. To conclude, significant improvements were observed in both groups with regard to symptom score, maximal and mean flow rate. The improvements in all regards were more pronounced after surgical procedure, and improvement degree was significantly decreased at the late 15 months after TUMT. Therefore, our study suggest that the clinical results in treating the BPH patients with TUMT will be better with the proper patients selection and retreatment in the decreasing point of treatment effectiveness.

Effects of Doxazosin Mesylate in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

The clinical effect of doxazosin mesylate, a selective long acting alpha-1 adrenergic blocker, were evaluated in 31 patients with symptomatic benign prostatic hyperplasia ranging from 49- 85 years old. All patients underwent a urodynamic evaluation and symptom score checking before enrollment into the study. The dose of doxazosin was 2mg per day. And the mean duration of treatment was 157 days. 31 patients were followed on doxazosin for 3 to 12 months with mean 7.5 months. The adverse drug reactions were observed only 1 case. The parameters used to assess the effectiveness of doxazosin included peak and mean urinary flow rates, micturition symptom scores and residual urine, and global assessment by the patient The peak and mean urinary flow rates increased by 77% and 86%, respectively. The obstructive and irritative symptom scores were improved by 51% and 41% respectively. The improvements in urinary flow rates and symptom scores were maintained for this interval. Although this preliminary experience with doxazosin is encouraging, the ultimate role of doxazosin for the long term treatment of benign prostatic hyperplasia needs further evaluation.

Results of endoscopically guided foley catheterization as a treatment of urethral rupture / 대한비뇨기과학회지

Endoscopically guided Foley catheterization was performed as an initial management of 32 patients with anterior urethral rupture and 7 patients with posterior urethral rupture during 6 years from December 1985 to April 1992. The duration of indwelling of the catheter was proportion to the degree and extent of the rupture. As a complication, urethral stricture was developed in 12 patients with anterior urethral rupture (8 patients with partial rupture and 4 patients with complete rupture), and 2 patients with posterior urethral rupture. The complication could be treated with endoscopic internal urethrotomy and some sounding with ease. We suggest that initial procedure have some profit as availability. simplicity. economy, reproducibility and diagnostic accuracy. And so, we would like to recommend this procedure as a initial management of urethral rupture.

Comparison of the transvaginal procedure and retropubic procedure for stress incontinence / 대한비뇨기과학회지

For the successful surgical treatment of genuine stress urinary uncontinence many procedures have been applied. We report on 36 cases of stress incontinence surgically treated by the tansvaginal procedure (19 cases) and retropubic procedure(17 cases) during the period from November, 1981 to October, 1991. The patient varied in age from 34 to 65 years in the transvaginal procedure and 26 to 68 years in the retropubic procedure(total mean age was 47.2 years). The surgical procedures were performed by Pereyra`s method 17 cases. Stamey`e method 2 cases. MMK's method 11 cases. Montague`s method 1 case. Burch`s method 5cases. Clinical symptom classification (grade I - Grade IV)of stress incontinence reported by Ball was used. There were symptom distribution of Grade I, 3 cases ; Grade II, 14 cases; Grade III, 2 cases in the transvaginal procedure. Grade I, 3 cases; Grade II, 11 cases : Grade III, 3 cases were done by the retropubic procedures. The success rate was 84% in the trensvaginal procedure and 89% in the retropubic procedure with minimum follow up of six months. Postoperative complications were urinary retention 8 cases, bladder perforation 1 case, vaginitis 1 case (total 59%) in the transvaginal procedures, while urinary retention10 cases. wound infection 1 case (total 70%) in the retropubic procedures. The values of post-operative days on catheter, operative time and postoperative hospitalization in the transvaginal procedures were 6.8+/-2.1 days. 91.6+/-23.2 minutes and 7.2+/-0.5 days, and in the retropubic procedures 6.9+/-3.2, 123.5+/-21.5 and 7.8+/-0.6 respectively (p<0.01). On the basis of the results we concluded that the transvaginal procedure had advantages including operative simplicity, extensive indication, rarer postoperative complication, compared with retropubic procedures.

A case of renomedullary interstitial cell tumor(so-called renal medullary fibroma) / 대한비뇨기과학회지

Although fibromas are the most common renal medullary tumor identified at autopsy. their small sized and benign course make clinical detection extremely difficult. Only 9 clinical cases of renal medullary fibromas have been reported. Many fibromas of the renal medulla, previously considered as bamahomas. seemed to be composed of tumerous transformation of renomedullary interstitial calls Herein we report on a patient with huge renal medullary fibroma treated by right radical nephrectomy.

The Urologic Complications following Radical Hysterectomy with Pelvic Lymph node Dissection / 대한비뇨기과학회지

Radical hysterectomy with pelvic lymph node dissection (RHPLD) was considered as primary management of cervical cancer (stage I and IIa). RHPLD provides for resection of paracervical and paravaginal tissues at the lateral pelvic walls, transaction of the uterosacral ligament, ligation of uterine vessels and excision of pelvic lymph node from the surrounding vessels. The urinary tract disturbance was the most frequent and significant postoperative complication. Among 82 patients who had undergone radical hysterectomy with pelvic lymph node dissection for cervical cancer from July 1983 to December 1989, 43 patients who were treated for urologic complications, were reviewed retrospectively. The age distribution was even from 4th to 6th decades. The common urologic complications were neurogenic bladder dysfunction 28 (34.2%). Ureteral injury 15 (18.3% ), UTI 12 (14.6% ), stress incontinence 5 (6.1%). Each urologic complication and its management are discussed.

A Papillary Adeno-carcinoma of the Renal Pelvis / 대한비뇨기과학회지

A papillary adeno-carcinoma of the renal pelvis is very rare tumor and mostly diagnosed by histopathologic findings. A 10-years-old female was admitted to Fatima Hospital with Rt. flank pain and intermittent gross hematuria.Herein, we report a case of papillary adeno-carcinoma of the renal pelvis.