Comparison of the Surgical Outcome between Onlay Island Flap and Tubularized Incised Plate Urethroplasty in Hypospadias Repair / 대한비뇨기과학회지

PURPOSE: The onlay island flap and tubularized incised plate (TIP) urethroplasty commonly preserve the urethral plate during each procedure, but there is a dearth of comparative data. Thus, we retrospectively reviewed our clinical data to compare the surgical outcome of the onlay and TIP urethroplasty for hypospadias correction. MATERIALS AND METHODS: We performed onlay urethroplasty in 23 patients and TIP urethroplasty in 28 patients between 1995 and 2002. The age at the time of surgery, operation time, postoperative complications, and the duration for the development of complications in each procedure were compared. RESULTS: Among the 28 cases of TIP urethroplasty, 21 were primary, 6 were secondary, and the last case was a tertiary repair, while all of the 23 cases of onlay urethroplasty were primary (age range: 8 month to 11 year). The most common complication in both procedures was urethrocutaneous fistula. Residual curvature was more common in the onlay urethroplasty group. Delayed complications, which developed later than 6 months after surgery, were 30% in both groups. The success rate was similar between the two groups, but the TIP urethroplasty group illustrated a significantly shorter operation time than the onlay group. CONCLUSIONS: The most common complication was fistula in both the onlay and TIP urethroplasty groups. Even though the success rate was similar in both groups, the operation time of the TIP urethroplasty group was shorter than that of the onlay group. Also, the TIP urethroplasty procedure resulted in more acceptable cosmetic results including a slit like neourethral meatus.

Predictors of Biochemical Failure after Radical Perineal Prostatectomy for Localized Prostate Cancer / 대한비뇨기과학회지

PURPOSE: We analyzed the radical prostatectomy cases retrospectively to stratify the risk of biochemical failure in order to appropriately select patients who potentially may benefit from adjuvant therapy. MATERIALS AND METHODS: A Cox multiple regression test was used to identify the variables associated with biochemical failure in 82 patients that underwent a radical perineal prostatectomy for prostate cancer, between 1995 and 2001, at the Samsung Medical Center. Numerous clinicopathological variables, including preoperative PSA, clinical stage, prostatectomy Gleason score, perineural invasion, seminal vesicle invasion, margin status, and pathological stage were evaluated. The Kaplan-Meier method was used to calculate the biochemical failure rates(BFR). RESULTS: Of the 82 patients, a biochemical failure developed in 17(20.7%) after a mean follow-up of 30.5 months. The overall BFR's calculated by the Kaplan-Meier method at 3 and 5 years were 24.9 and 29.3%, respectively. A biochemical failure was associated with the preoperative PSA, perineural invasion, seminal vesicle invasion, margin status and pathological stage(all log rank test p<0.05) in a univariate analysis. However, all the predictors, with the exception of the preoperative PSA, failed to remain significant with the multivariate model. CONCLUSIONS: The preoperative PSA is a strong independent predictor of biochemical failure in patients that underwent a radical perineal prostatectomy as a definitive local therapy for prostate cancer.

Preoperative Evaluation of Living Renal Transplant Donors Using Helical CT Angiography: Comparison with Conventional Angiography / 대한비뇨기과학회지

PURPOSE: This study evaluated the accuracy of helical CT angiography (HCTA) in a preoperative evaluation of living renal transplant donors (LRTDs) for visualizing the renal vascular anatomy with an emphasis on identifying the number of renal arteries and the presence of small branches and venous anomalies. MATERIALS AND METHODS: From Jan. 2000 to Feb. 2001, a total of 50 potential LRTDs were evaluated with conventional renal angiography (CRA) and HCTA. All candidates then underwent a donor nephrectomy. The HCTA was done according to a standard HCTA protocol. The intraoperative findings on the number of renal vessels were compared with those of the CRA and HCTA respectively. RESULTS: There was an overall agreement on the number of renal arteries and veins between the CRA findings and 3-D reconstruction of the HCTA (91%, 95%). The overall accuracies for predicting the number of renal arteries and veins relative to the intraoperetive findings were 84%, 94% for CRA and 80%, 94% for HCTA respectively. The CRA missed 8 accessory renal arteries while HCTA missed 10. In HCTA, cases with an accessory renal artery with a diameter < or =5 Fr. (1.65mm) and two cases of an early branching single vessel simulating dual arteries, were misdiagnosed. Despite the misdiagnosed cases, there was no significant intraoperative morbidity. The HCTA revealed another lesion of a renal parenchyme, the urinary collecting system and other viscera. There were no significant complications in the process of both techniques. The cost of HCTA was 48% less than the CRA plus the excretory urography (EU) for imaging the potential LRTDs. CONCLUSIONS: A HCTA appears to be as accurate as a CRA for visualizing the renal vascular anatomy in the preoperative assessment of potential LRTDs. A HCTA has the potential to be a good alternative to a CRA plus EU for assessing potential LRTDs.