Surgical Outcome of Proximal Hypospadias with Penoscrotal Transposition / 대한비뇨기과학회지

PURPOSE: Penoscrotal transposition is found in cases with severe form of hypospadias. In those cases, severe chordee generally coexists and a long length of urethra may be necessary for its correction. We evaluated the clinical outcome of surgical repairs for 12 patients of proximal hypospadias with penoscrotal transposition. MATERIALS AND METHODS: Out of 12 cases, there were 2 with penoscrotal type, 7 with scrotal type and 3 with perineal type hypospadias. All cases had moderate to severe chordee. Five cases were treated with one-stage repair and seven cases with multi-stage repair. We analysed operative methods, postoperative complications and those managements between the cases of one-stage and multi-stage repairs. RESULTS: For one-stage repair, we used transverse preputial island flap method in 3 cases and urethroplasty using scrotal skin flap in 2 cases. For multi-stage repair, we performed Thiersh-Duplay urethroplasty in 2 cases, bladder mucosal graft in 2 cases and Belt-Fugua urethroplasty in 3 cases. Correction of penoscrotal transposition was performed successfully in all cases. In all cases, a paucity of skin was the most difficult problem. The overall complication rate was 50.0%. In cases treated with one-stage repair, there were two cases with urethrocutaneous fistulas. However, in cases treated with multi-stage repair, there were four cases with complications such as urethral strictures, urethrocutaneous fistulas with or without large skin defect. Overall the complications in cases with multi-stage repair were more severe than those in cases with one-stage repair. CONCLUSIONS: Our experience suggests that multi-stage operation may be not superior to one-stage operation in cases with proximal hypospadias associated with penoscrotal transposition. Thus we recommand one-stage repair in those cases despite a paucity of foreskin.

Short-term Follow-up of Renal Function after Donor Nephrectomy / 대한비뇨기과학회지

PURPOSE: Eventhough cadaveric renal grafts are increasing, kidneys from living donors remain as the major mode of renal transplantations and there is a need to establish theoretical bases for securing the safety of the donors. Follow-up of donors was done for a year using several indices of renal function to evaluate the function of the remaining kidneys after donor nephrectomies. MATERIALS AND METHODS: Two hundred and sixty one living donors were included in this study. Blood urea nitrogen(BUN), serum creatinine, 24 hour creatinine clearance, 24 hour urine protein, and blood pressure were checked preoperatively. The same indices were checked at one, six, and twelve months after the operation. These indices were compared with those before the operation. RESULTS: Although some increase was observed in serum BUN, creatinine, and 24hr urine protein, and decrease in creatinine clearance after donor nephrectomies, all were within normal limits, which did not show clinically significant differences. All indices did not deviate from the normal limits through-out one year. CONCLUSIONS: Renal indices varied within normal limits and donor nephrectomies seemed to cause no significant harmful effect on the donors. Prospective and long term follow-up of the donors after donor nephrectomies are needed to ensure a high quality life of living donors.

Comparison of Penetration Capability of Levofloxacin and Ciprofloxacin into Prostatic Tissue / 대한비뇨기과학회지

PURPOSE: To evaluate the penetration capability of Levofloxacin and Ciprofloxacin into prostatic tissue, we analysed the concentration of each drug in serum and prostatic tissue simultaneously after oral administration. MATERIALS AND METHODS: Eleven patients with benign prostatic hyperplasia treated with transurethral resection of the prostate were entered in this study. A single dose of 200mg Levofloxacin(LVFX) and 250mg ciprofloxacin(CPFX) were administered orally. Two hours after administration, blood and prostatic tissue samples were taken during operation. Concentration of each drug in serum and prostatic tissue was measured simultaneously by high performance liquid chromatography. RESULTS: The mean concentration of LVFX in serum was 1.970 +/- 0.759 microgram/ml, which was significantly higher than that of CPFX(0.903 +/- 0.291 microgram /ml)(p < 0.05). The mean concentration of LVFX in prostatic tissue(2.256 +/- 1.121 microgram/g), however, was not significantly different from that of CPFX(2.395 +/- 0.846 microgram/g). And the concentration ratio(tissue/serum concentration) of LVFX and CPFX was 1.16 and 2.76, respectively. CONCLUSIONS: These results show that LVFX is not superior to CPFX with respect to the penetration capability into prostatic tissue. Considering that the concentration of LVFX in prostatic tissue was higher than that in serum and not different from that of CPH, LVFX may be another potential effective agent in treating patients with chronic bacterial prostatitis.

A Case of Prostatic Rhabdomyosarcoma in Adult / 대한비뇨기과학회지

Rhabdomyosarcoma of the prostate is a very rare tumor in adulthood. Twenty five-year-old man with obstructive urinary symptoms was admitted. He was diagnosed as embryonal type rhabdomyosarcoma of the prostate, and treated with multimodal therapies, i.e. radical prostatectomy, radiation therapy and adjutant chemotherapy. He is now being followed up without any evidence of recurrence for 11 months. This case is presented with reviewing references.

Percutaneous Nephrolithotomy: Complication and Management / 대한비뇨기과학회지

Of 105 patients who underwent percutaneous nephrolithotomy (PNL) for 10 years, 22.9% had complications. Major complications were severe hemorrhage (6cases), renal pelvis perforation (2cases), ureteral perforation (1case) and pyonephrosis (1case). The patients with severe hemorrhage were treated with nephrectomy (1case), transarterial embolization (1case) and transfusion (4cases, 5pints or more). All the cases with pelvis perforation were treated with primary repair. And the patient with postoperative pyonephrosis required nephrectomy Minor complications included hemorrhage (4cases), urinary tract infection (5cases), paralytic ileus (2cases) and fever (3cases), which were treated with conservative managements. We compared the success and complication rates between early and late 5-year periods. The success rates in the early and late periods were 82.0% and 92.7%, respectively. On the other hand, the complication rates in the early and late periods were 30.0% and 16.4%, respectively Thus we conclude that PNL must be included in the effective treatment of upper urinary tract stone disease if experiences and operation technique for PNL were accumulated and appropriate therapy for the complications were taken.

Comparative Study on Diagnostic Value of Digital Rectal Examination, Serum Prostate Specific Antigen and Transrectal Ultrasound in Prostate Cancer / 대한비뇨기과학회지

We analysed 101 patients with voiding symptoms of suggestive prostatism to evaluate the diagnostic values of digital rectal examination (DRE), serum prostate specific antigen (PSA) and transrectal ultrasonography (TRUS) in the detection of prostate cancer. Final diagnoses confirmed histopathologically by TRUS-guided needle biopsy resulted in 31 prostate cancers. The prostate cancer detection rates by DRE, PSA (>2.5 ng/ml) and TRUS were 47.5%, 34.1% and 48.1%, respectively. Sensitivity and specificity of DRE, TRUS and serum PSA were 90%, 40%, 81%, 42.9% and 100%, 14.3% respectively. Especially PSA had too low specificity in discrimination of malignant diseases from the benign. Three out of 31 patients with prostate cancer showed only one abnormal findings from three items. Patients with abnormal findings in DRE-PSA, TRUS-PSA and DRE-TRUS showed the detection` rates of cancer 57.1%, 54.3% and 62.5% respectively. The detection rate was highest as 73.5% when patients showed abnormal findings in all three items. Our results suggest that the combination of DRE, TRUS and serum PSA increased the detection rate of cancer but several points such as cost-effectiveness and efforts to increase specificity methodologically should be taken into consideration before we apply those diagnostic modalities to screening of prostate cancers as routine procedures.