A Case of Xanthogranulomatous Prostatitis Concurrent with a Prostatic Abscess / 대한남성과학회지

Xanthogranulomatous prostatitis is a rare inflammatory condition of the prostate. We report a case of xanthogranulomatous prostatitis. An 82-year-old man presented to our emergency department complaining of gross hematuria. A hard, enlarged, non-tender prostate was palpated on digital rectal examination. Urinalysis showed hematuria and pyuria, and the complete blood count (CBC) revealed leukocytosis. The prostate-specific antigen (PSA) level was elevated at 86.8 ng/ml. Computed tomography (CT) showed an enlarged prostate (volume 100 ml) that protruded into the bladder base. In the left lobe of the prostate, a 1.2x1.1-cm abscess was seen. Transurethral resection of the prostate was done. The pathological diagnosis was xanthogranulomatous prostatitis. The natural progression of the disease is unknown because of the paucity of cases and long-term follow-up reports. To evaluate the pathogenesis and long-term features of progression of this disease, more clinical cases should be collected.

The Efficacy of Prostate Biopsy by Use of the Vienna Nomogram

PURPOSE: No standard number of cores is obtained with a prostate needle biopsy. Routinely, we obtain 10 core biopsies but do not consider prostate volume or patient age. Consequently, we evaluated the clinical efficacy of prostate biopsy when taking into account prostate volume and patient age by use of the Vienna nomogram to suggest the proper number of cores. MATERIALS AND METHODS: Transrectal ultrasonography (TRUS)-guided prostate needle biopsies were performed in 326 patients between November 2006 and June 2009. Group A (10 cores biopsy) was 131 patients. Group B (biopsy using Vienna nomogram) was 134 patients. We compared the cancer detection rate between the two groups, especially according to age and prostate volume. The chi-squared test was used for statistical analysis. RESULTS: The overall cancer detection rates in groups A and B were 33.6% and 32.1%, respectively. In older patients (age> or =60 years), group B had a higher detection rate than did group A (37.0% vs. 35.6%). For patients with a small prostate (<30 g), group B had a significantly higher detection rate than did group A (62.1% vs. 30.4%, p=0.023). CONCLUSIONS: There was no significant difference in the overall cancer detection rate. However, in patients with a small prostate and in older patients, the Vienna nomogram was more effective than a 10-core biopsy. The Vienna nomogram could help to establish guidelines for prostate biopsy in Korea that take into account the prostate volume and the age of the patient. It could also help urologists to reduce unnecessary cores when diagnosing prostate cancer in the elderly population and in those with small prostates.

Effects of Prostate Volume and Lower Urinary Tract Symptoms on Erectile Function / 대한비뇨기과학회지

PURPOSE: To assess whether the prostate volume and two types of lower urinary tract symptoms independently affect erectile function. MATERIALS AND MATHODS: One hundred and fifty two men, who visited outpatient department of Urology and health examination center, were investigated using validated symptom scales, including International Prostatic Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5). The Prostate volume was measured by one examiner using transrectal ultrasonography (TRUS). The correlations between the IIEF-5, emptying and storage symptoms of IPSS, prostate volume and age were subjected to univariate and multivariate analyses. RESULTS: The mean age, prostate volume, and IPSS and IIEF-5 scores were 54.0+/-10.6 years (31-77), 29.1+/-20.4cm(3) (7.9-170.0), and 15.1+/-9.4 (1-35) and 14.6+/-7.1 (1-25), respectively. From the univariate analysis, significant correlations were found between the IPSS and IIEF-5 scores, and the prostate volume and IIEF-5 score, and the age and IIEF-5. When the data were subjected to a multivariate analysis, statistically significant correlations were still observed between the IPSS and IIEF-5 scores and the age and IIEF-5 score, but not between the prostate volume and IIEF-5 score. Furthermore, the storage symptoms of IPSS affected erectile function, with statistical significance, whereas the emptying symptoms did not. CONCLUSIONS: In patients with benign prostatic hyperplasia, lower urinary tract symptoms, especially storage symptoms and age, caused decreases in erectile function. However, the prostate volume itself did not reduce erectile function.

Effects of Alpha-lipoic Acid on Nitric Oxide Synthase Expression and Ultrastructural Changes in the Bladder of Rats with Streptozotocin-induced Diabetes / 대한비뇨기과학회지

PURPOSE: To evaluate whether alpha-lipoic acid (ALA) is effective at restoring the levels of nitric oxide synthase (NOS) expression and preventing ultrastructural changes in the bladder of rats with streptozotocin- induced diabetes. MATERIALS AND METHODS: Nine-week-old male Sprague-Dawley rats were used. The experimental groups included a control group (n=6), a diabetes group (n=6), and two groups of diabetic rats treated with intraperitoneal injections of ALA (n=12) at either 50 (ALA50) or 100mg/kg/day (ALA100) for 8 weeks after the induction of diabetes. Diabetic oxidative stress was determined based on evaluation of immunohistochemical staining for 8-hydroxy-2-deoxyguanosine (8-OHdG). The measurements of the levels of eNOS and nNOS expressions, as well as an assessment of the ultrastructural changes in detrusor smooth muscle cells were performed. RESULTS: The highest expression of 8-OHdG was observed in the diabetes group; whereas, the 8-OHdG expression in the ALA-treated groups was similar to that in the control group. Both eNOS and nNOS were constitutively expressed in the control group. The expression levels of both eNOS and nNOS proteins were higher in the diabetes group, which had experienced increased oxidative stress, than in the ALA50 and ALA100 groups. Compared with the control group, the diabetes group exhibited severe degeneration of the detrusor muscle cells. In the rats treated with ALA, the detrusor muscle cells showed mild to moderate degeneration. The mean numbers of mitochondria per smooth muscle cell in the control, diabetes, ALA50 and ALA100 groups were 12.6+/-1.5, 5.1+/-0.7, 18.3+/-0.7 and 19.3+/-1.3, respectively (p<0.01). CONCLISIONS: Our data suggest that diabetes enhanced the levels of eNOS and nNOS expressions in the bladder, and ALA inhibited the expressions of eNOS and nNOS. ALA had a protective effect against the degeneration of intracellular micro-organelles produced by diabetic oxidative damage in detrusor muscle cells. This study suggests that early treatment with ALA can reduce the damage caused by diabetic oxidative stress.

Cytologic Findings of a Plasmacytoid Variant of Urothelial Carcinoma of the Urinary Bladder in Voided Urine / 대한세포병리학회지

The plasmacytoid variant is an extremely rare form of urothelial carcinoma in which the malignant cells resemble those of plasmacytoma. We report the cytologic features of 3 cases of this disorder. All 3 patients were male and presented with painless macroscopic hematuria. The voided urine cytology revealed a few scattered clusters of tumor cells in a bloody background. Each tumor cell had an abundant amount of cytoplasm that was clear or densely stained and characterized by eccentrically located nuclei. A histological examination of tissue obtained from a radical cystectomy confirmed the cytologic diagnosis in each 3 case, revealing a diffusely infiltrating tumor composed of round, noncohesive tumor cells demonstrating a high nuclear grade. These cells had infiltrated the tunica propria in 2 cases, but were limited to the submucosa in 1 case. The tumor cells were plasmacytoid in appearance, each demonstrating an eccentric nucleus and dense cytoplasm, as seen in the cytologic findings. All of the tumors were immunoreactive for pancytokeratin, CK7, CK20; negative for epithelial membrane antigen (EMA), leukocyte common antigen (LCA), kappa, lambda, and CD79a. Thus, it is important to consider the plasmacytoid variant of urothelial carcinoma in addition to plasmacytoma or lymphoma as a diagnosis when encountering plasmacytoid tumor cells in a voided urine sample.

Comparative Analysis of Extracorporeal Shock Wave Lithotripsy: Does Sonolith Praktis Have Any Advantage over EDAP LT-02? / 대한비뇨기과학회지

PURPOSE: We wanted to compare the effectiveness, safety and cost of performing extracorporeal shock wave lithotripsy (ESWL), and so we reviewed the outcomes of patients with urinary calculi that were treated with the EDAP LT-02 lithotriptor (LT-02) and the Sonolith Praktis lithotriptor (Sonolith). MATERIALS AND METHODS: 2,141 cases treated with the LT-02 and 198 cases treated with the Sonolith were retrospectively reviewed. The success rate and the number of sessions, according to the size and location of the stones, were statistically analyzed. Auxiliary measures, other treatment modalities, complications and the running cost of the entire treatment were also reviewed. RESULTS: The success rate (stone free or residual fragments <4mm in diameter) between the LT-02 and Sonolith, according to the stone size and location, showed no significant difference. The overall success rate was 96.4% and 96.5%, respectively. The mean number of treatment sessions was 3.0 for the LT-02 and 2.0 for the Sonolith. The efficiency quotient was 45.5 for the LT-02, which was lower than 54.0 for the Sonolith. No significant difference was observed in the occurrence rate of complications and the auxiliary measure rate between the LT-02 and the Sonolith. The cost of overall treatment was 1.33x10(6) won for LT-02 and 1.12x10(6) won for Sonolith. CONCLUSIONS: The results suggest that the efficacy of the Sonolith is approximately equal that of the LT-02. However, the Sonolith has superiority in reducing the number of treatment sessions and lowering the overall treatment cost.

Expression of Cyclooxygenase-2 in Urothelial Carcinoma of the Human Urinary Bladder / 대한비뇨기과학회지

PURPOSE: Urinary bladder cancer is the most common tumor of all urologic cancers in Korea. Recent studies have supported the important role of cyclooxygenase-2 (COX-2) in various cancers derived from epithelial cells, such as the breast, gastrointestinal tract, prostate, head and neck. This study was performed to evaluate the relationship between cyclooxygenase-2 expression and prognosis in urothelial carcinoma of the human urinary bladder. MATERIALS AND METHODS: We assessed the clinicopathologic results from 57 bladders of urothelial carcinomas patients who underwent radical cystectomy. To evaluate the expression of COX-2, paraffin sections were assessed with immunohistochemistry using the anti-human COX-2 monoclonal antibody and staining intensity was evaluated. The relationships between COX-2 expressions and stage, grade and lymph node metastasis were statistically analyzed and the association with survival rate was also evaluated. RESULTS: COX-2 was overexpressed in 12 out of the 57 cases (21%) in urothelial carcinomas of the urinary bladder. COX-2 overexpression rate was gradually increased from stage T1 (7.1%) and T2 (31.2%) to stage T3 (50.0%) (p=0.0177) and was increased in high grade urothelial carcinoma (32.3%) compared with that in low grade urothelial carcinoma (7.7%) (p=0.0235). The survival rate of patients with higher stage and high histologic grade was poorer than that of patients with lower stage and low histologic grade (p0.05). CONCLUSIONS: This study showed that COX-2 overexpression was highly correlated with stage and histologic grade in urothelial carcinomas of the human urinary bladder. These results support the possibility that COX-2 might be an important factor related to the aggressive behavior of urothelial carcinoma of the urinary bladder.

Effects of the Single Administration of the Anticholonergics, Trospium Chloride, on the Patients with Nocturia

PURPOSE: The aim of this study was to evaluate the effects of the single administration of the anticholonergics, trospium chloride, in the nocturic patients without bladder outlet obstruction for mid-term. MATERIALS AND METHODS: We included the 22 male and 102 female patients with nocturia over 3 times and without bladder outlet obstruction. Exclusion criteria was under 15 ml/sec in maximal flow rate, over 30 ml in post-void residual urine, nocturnal polyuria and medication affecting lower urinary tract symptoms including alpha-blockers, sedatives, muscle relaxants. Based on voiding diary for 3 days, frequency of the nocturia, daytime frequency and frequency of the urgency and urge incontinence were measured at pretreatment, post-treatment 1st month, 3rd month and 6th month. Additionally maximal flow rate and post-void residual urine were also recorded at the same periods. Anticholinergics was administered in flexible dose. RESULTS: In frequency of nocturia, single administration of the anticholonergics improved significantly at post-treatment 1st, 3rd and 6th month compared to pre-treatment level. The more severe the frequency of the nocturia was, the more it was improved by medication but there is no significant difference. Daytime frequency is significantly improved 3 month and 6 month after medication. In urgency and urge incontinence, the significant improvement was also observed at post-treatment 3rd month and 6th month. The significant differences between pre-treatment and post-treatment were not demonstrated in maximal flow rate and post-void residual urine. Dry mouth was the most common side effect but mild and tolerable. CONCLUSION: The single administration of the trospium chloride demonstrated a clinically significant improvement in nocturia as well as symptoms of the overactive bladder and did not affect negatively on bladder contractility.

The Effect of a Transition Zone Resection Rate of the Transurethral Resection of Prostate (TURP) according to the Prostate Volume / 대한비뇨기과학회지

PURPOSE: Transurethral resection of prostate (TURP) was the gold standard for the treatment of benign prostatic hyperplasia (BPH). BPH is the enlargement of the transition zone; so a TURP was the resection of the enlarged transition zone. The transition zone resection rate is important if a good result is expected. The effect of the transition zone resection rate of TURP was evaluated according to the prostate volume. MATERIALS AND METHODS: Between January 2000 and December 2003, 61 patients with symptomatic BPH, who had undergone TURP by one surgeon, were enrolled in this retrospective study. 25 patients with a BPH less than 60cc (Group I), and 36 equal or greater than 60cc (Group II) were evaluated using the International Prostate Symptom Score (IPSS), uroflowmetry and post voiding residual urine volume (PRV) both before and after the TURP. The total prostate volume, transition zone volume (TZV), transition zone resection ratio (TZRR), total volume of resected prostate, operating time, period of hospital stay and complications were assessed. RESULTS: In groups I and II, the TZV was 21.3 6.9cc and 38 19.5cc (p=0.43), respectively. The resected prostate volumes were 16.5 7.1gm and 26.6 10.34gm in groups I and II (p=0.050), respectively. The TZRR were equal, at 0.8 0.4, in both groups. The postoperative IPSS, voiding volume, PRV and maximal flow rate (Qmax) were significantly improved in both groups. Overall, the IPSS, VV and PRV were significantly improved after the TURP when the TZRR was greater than 0.5. However, the Qmax was significantly improved when the TZRR was greater than 0.7. There were no significant differences in the periods of hospital stay or complications between the two groups. CONCLUSIONS: With TURP, the transition zone resection ratio was important, without concern of the prostate size. Also, to obtain good results, more than 70% of the enlarged transition zone has to be resected.

Retroperitoneal Lymphangioma Following Pyeloplasty in Child / 대한비뇨기과학회지

A lymphangioma is a rare benign congenital tumor of the lymphatic system, resulting from the failure of lymphatic drainage into the venous system, which is due to atresia or the insufficiency of an efferent lymphatic channel. A lymphangioma usually occurs in the neck or axillary region. A retroperitoneal lymphangioma is very rare. Herein, a case of a retroperitoneal lymphangioma incidentally found four months after performing pyeloplasty on a child, is reported.

The Early Experience of Various Treatment Modalities for Female Sexual Dysfunction / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate various medical treatments for the improvement of sexual function in women with sexual dysfunction. MATERIALS AND METHODS: Forty two patients that complained of desire and arousal disorders received treatments with androgen replacement, local administration of prostaglandin E1 (PGE1), administration of apomorphine and phosphodiesterase 5 inhibitor (PDE5I), and the application of a clitoral suction device. The treatment options were applied sequentially in some case. The improvement in sexual function was evaluated with respect to sexual desire, sexual sensation, sexual excitement, vaginal lubrication, orgasm and sexual satisfaction, using the Female Sexual Function Index and a subjective assessment, during masturbation. RESULTS: Androgen replacement over a 3 month period increased the sexual desire and sexual arousal response in 35.7% (5/14) and 21.4% (3/14) of the subjects, with no side effects. The local application of PGE1 improved the vaginal lubrication in 42.8% (3/7). Apomorphine increased vaginal lubrication in 12.5% (2/16) of the subjects. PDE5I improved sexual excitement and vaginal lubrication in 26.3% (5/19) of the subjects. A clitoral suction device improved the sexual sensation in 62.5% (25/40) and vaginal lubrication in 45.0% (18/40) of the subjects. Each treatment modality was more effective in secondary than in primary female sexual dysfunction. All of these modalities tested demonstrated an improvement in at least part of the sexual response, but not in the general sexual satisfaction. CONCLUSIONS: Although no improvement in sexual satisfaction was demonstrated, further studies to develop a proper indication for each treatment modality, due to their partial effectiveness toward each sexual response are warranted. Since female sexual dysfunction is not solved with a simple treatment, various treatment modalities must be applied for a significant time period.

Effect of Extracorporeal Magnetic Innervation Therapy in the Patient with Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The purpose of this study was to assess the treatment effect of extracorporeal magnetic innervation (ExMI) therapy, and determine how long the effect of this treatment lasts. MATERIALS AND METHODS: Among the demonstrable stress urinary incontinent patients, 28 were selected. Before the ExMI therapy, voiding diary, incontinence episodes, pad test, and quality of life questionnaires were evaluated. The treatment was performed for 30 minutes, 3 times a week, for 6 weeks. All of the evaluations were repeated at the first and sixth months following treatment. The treatment outcomes were classified as: cure, good, fair, poor and failure, according to a new outcome score. RESULTS: The overall cure rate was 35.7% (10/28) by the 1st month and 17.9% (5/28) by the 6th. From further a classification, the cure rate in grade I was 43.8 (7/16) and 25% (4/16) by the 1st and 6th months, respectively, and in grade II were 25 (3/12) and 8.3% (1/12) respectively. Incontinence episode was reduced from 4.2+/-2.8 to 1.5+/-1.5 and 2.8+/-2.3 by the 1st and 6th months, respectively. The urine loss was reduced from 21.0+/-31.4g to 6.0+/-8.2g and 14.0+/-24.7g by the 1st and 6th months, respectively. The results were statistically analyzed using Wilcoxon rank sum and Fisher's exact tests. CONCLUSIONS: It was suggested that the ExMI therapy was an effective treatment for stress urinary incontinence, but its effect decreased over time. In order to sustain, or improve its effect, a regular interval, or prolonged ExMI therapy, would be need

Effect of Insulin and Testosterone on Damage to the Erection-Related Nervous System in Experimentally Diabetic Rats / 대한남성과학회지

PURPOSE: Diabetic autonomic neuropathy can cause organic sexual dysfunction in men. The possibilities of preventing or inhibiting erection-related nerve damage by early administration of insulin and testosterone were investigated in the streptozotocin(STZ)-induced diabetic rat model. MATERIALS AND METHODS: Forty Sprague-Dawley rats were divided into normal control and four experimental diabetic groups(untreated, insulin treated, testosterone treated, and insulin and testosterone treated). The pathologic effects were evaluated by nicotinamide adenine dinucleotide phosphate diaphorase staining of nitric oxide synthase(NOS)-containing nerve fibers and neurons of the corpus cavernosum, the dorsal nerve, and the pelvic ganglion. RESULTS: The NOS-containing nerve fibers and neurons in the corpus cavernosum, dorsal nerves, and pelvic ganglia were decreased significantly in untreated diabetic rats. In the insulin- and/or testosterone-treated diabetic rats, a significant increase was observed compared with the untreated diabetic rats. In the number of axons in the dorsal nerves, the same results were demonstrated as for the NOS-containing nerve fibers. In all groups, there was a significant correlation between the ratio of NOS-containing neurons in the pelvic ganglia and the numbers of NOS-containing nerve fibers in the corpus cavernosum(r=0.641, p<0.05). CONCLUSIONS: Early administration of insulin, testosterone, or both may prevent or ameliorate neural damage related to sexual dysfunction in a STZ-induced diabetic animal model.

Clinical Experience of Extracorporeal Shock Wave Lithotripsy with EDAP LT-02 in Urinary Calculi / 대한비뇨기과학회지

PURPOSE: To evaluate the efficacy of the EDAP LT-02 (LT-02) lithotriptor in the treatment of urinary stones. MATERIALS AND METHODS: We analysed 2,176 cases with urinary calculi, primarily treated by LT-02, between January 1995 and December 2001. There were 591 cases with renal, and 1,585 with ureteral, calculi. The distribution of stones, success rate in relation to the location and size of stones, comparisons of success rate in relation to radio-opacity, causes of failure and complications of extracorporeal shock wave lithotripsy (SWL), were reviewed. Renal and upper ureteral calculi were treated with the patients in the supine position, and mid and lower ureteral calculi were treated with the patients in the prone position. RESULTS: The success rates (stone free or residual fragments with a diameter <4mm) in relation to the stone location, size and radio-opacity were as follows: 1. The success rates of the renal and ureteral stones were 90.9 and 98.4%, respectively. 2. With renal stones, the success rates were 96.4, 92.2, 74.5, 73.5 and 28.6% for stone sizes of less than 10, 11-20, 21-30, 31-40 and above 41mm, respectively (p<0.001). With ureteral stones, the success rates were 100, 98.4, 83.3 and 0% for stone sizes of less than 10, 11-20, 21-30 and 31-40mm, respectively (p<0.001) 3. In relation to the radio-opacities, for the renal and ureteral stones, there were no significantly differences in the success rates. The retreatment rate for stones was 64.1% and that for auxiliary treatment was 2.4%. Thus, the efficiency quotient was 43.5% with SWL using LT-02. CONCLUSIONS: We suggest that SWL using LT-02 is a safe and effective method, which should be considered as an acceptable option for the primary management of urinary calculi in selected patients.

Significance of Nephrectomy in Renal Tuberculosis Patients with Negative Urine (AFB) Culture and Asymptomatic Nonfunctioning Kidney / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate the surgical treatment of incidentally detected, asymptomatic, unilateral nonfunctioning tuberculous kidney. MATERIALS AND METHODS: Thirty-three patients with incidentally detected, asymptomatic, unilateral nonfunctioning kidney, negative urine AFB culture and radiologic diagnosis of renal tuberculosis were reviewed. They were divided into three groups: surgical, medical, and observation groups. Twelve patients in the surgical group were nephrectomized at initial diagnosis. Eleven patients in the medical group received anti-tuberculous medication with isoniazid, rifampin, and pyrazinamide for 4 months. Ten patients in the observation group remained under observation. RESULTS: There was no evidence of decreased renal function or recurrence of renal tuberculosis in the surgical and medical groups. Pathologic confirmation of renal tuberculosis was obtained in all nephrectomy patients. The follow-up loss rate of the surgical group (7.7%) was lower than that of the other groups (p<0.05). CONCLUSIONS: Nephrectomy is more acceptable than either medicine or observation. (1) Because preoperative chemotherapy was not justified in the case of negative urine AFB culture, pathologic confirmation was necessary. (2) Nephrectomy associated morbidity was quite low. (3) The follow-up loss rate of the surgical group was lower than that of the other groups. Short course anti-tuberculous medication should be administered after nephrectomy.

Case-Control Study for Contralateral Vesicoureteral Reflux in Patient with Unilateral Cohen's Reimplantation: Is Contralateral Vesicoureteral Reflux Caused by Postoperative Trigonal Distortion? / 대한비뇨기과학회지

PURPOSE: The development of contralateral reflux after successful unilateral antireflux surgery has led to controversy regarding etiology. Our aim was to analyze the incidence of newly developed contralateral reflux after successful unilateral Cohen's reimplantation in patients with grade III and IV reflux and to explain the postoperative trigonal distortion responsible for new contralateral reflux with case-control study. MATERIALS AND METHODS: We compared the incidence and outcome of contralateral reflux between the medical group with prophylactic antibiotics and the surgical group with unilateral Cohen's reimplantation in patients with unilateral vesicoureteral reflux. We retrospectively reviewed the records of 84 children seen in a 17-year period who had grade III (48 patients) and IV (36 patients) primary unilateral vesicoureteral reflux. Unilateral Cohen's reimplantation was done in 48 patients and prophylactic chemotherapy was done in 36 patients. RESULTS: Overall contralateral reflux developed in 13.8% of patients who underwent medical treatment and 14.6% of patients who underwent unilateral Cohen's reimplantation. In patients with grade III reflux, 13% of patients with medical treatment and 12% of patients with unilateral Cohen's reimplantation had contralateral reflux. Twelve patients with contralateral reflux had grade I (7 patients) and grade II (5 patients) reflux and resolved spontaneously within 18.2 months. CONCLUSIONS: The likelihood of trigonal distortion as the etiology of contralateral reflux is low given the similar incidence in cross-trigonal Cohen's reimplantation group and medical group with prophylactic chemotherapy in patients with grade III and IV primary vesicourerteral reflux.

Extracorporeal Shock Wave Lithotripsy Monotherapy for Staghorn Stone with EDAP LT-02 Lithotriptor / 대한비뇨기과학회지

PURPOSE: The clinical efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy with EDAP LT-02 (LT-02) lithotriptor for staghorn stone was estimated. MATERIALS AND METHODS: Thirty eight patients (39 renal units) with staghorn stone had been treated by ESWL monotherapy with LT-02 lithotriptor that had piezoelectric system with mounted C-arm and ultrasound unit (dual localization system) between Jan. 1996 and Dec. 2000. Success rate (SR) and stone free rate (SFR) were evaluated according to the stone type, volume and associated hydronephrosis. RESULTS: Overall SR and SFR were 56% and 38%. SR (SFR) of complete and incomplete staghorn stone were 57 (36%) and 56 (40%). SR (SFR) of stone under and over 20ml of volume were 53 (40%) and 58 (38%). SR (SFR) according to the associated hydronephrosis were 78 (57%), 44 (27%), and 42 (27%) in patients with no (group 1), mild (group 2), and severe hydronephrosis (group 3). SR (SFR) were not different in terms of stone type and volume but significantly low in patients with hydronephrosis. Auxillary procedures (percutaneous nephrostomy: 4 renal units, ureteral stent: 1 renal unit) were required in 5 renal units due to complete ureteral obstruction. CONCLUSIONS: In spite of low SR and SFR and multiple treatment sessions, we consider ESWL monotherapy to be a minimally invasive alternative treatment in patients with staghorn stone as outpatient procedure without the fear of ureteral stent, percutaneous nephrostomy and other auxillary procedures. Associated hydronephrosis is considered to be poor outcome factor of ESWL monotherapy in patients with staghorn stone.

Clinical Characteristics of Postoperative Delirium after Urological Surgery / 대한비뇨기과학회지

PURPOSE: Delirium in the elderly is common in the postoperative period but there are only few reports on detailed studies of this condition. Number of urologic patients with postoperative delirium was increas ed in our hospital for recent 24 months. The clinical characteristics of patients with postoperative delirium was analyzed retrospectively. MATERIALS AND METHODS: We selected the patients with postoperative delirium from 1010 patients who had undergone urological surgery under general or spinal anesthesia in the period from Jan. 1997 to Dec. 1999. Diagnosis of postoperative delirium was established with Diagnostic and Statistical Manual of Mental Disorders(DAM-III-R) by psychiatric clinicians. Onset and recovery of symptoms, risk factors, previous psychiatric clinicians. Onset and recovery of symptoms, risk factors, previous psychiatric disorder, relationship with anesthesia, drugs, and surgical procedures, concomittant medical conditions, and complications were retrospectively reviewed. RESULTS: Postoperative delirium was observed in 13 patients (1.3%). All patients were male and mean age was 70.4 years (46-86 years). Surgical procedures included TURP(8 patients), cystectomy (3 patients), nephroureterectomy (1 patient), and bladder rupture repair (1 patient). Delirium became apparent between one day and two days after the operation (mean 32.2 hours) and lasted for up to 7 days (mean 53 hours). Several factors such as older age (>65 years), male patient, longterm medication, past history of CVA, memory impairment, hearing difficulty, traumatic brain contusion, and obsessive personality were thought to be risk factors of postoperative delirium. Treatment with Haloperidol(R) intramuscular injection (2.5-5mg, every 30 minutes, 2-4 times until symptom resolution was achieved) with or without Ativan(R) intravenous injection (2mg) were effective. Complete symptom recovery was seen in 92.3% (12/13) of patients. One patient (7.7%) with previous history of dementia had persistent memory disturbance and disorientation during follow-up periods. CONCLUSIONS: Generally, postoperative delirium is an acute transient confusional state without considerable sequeles. Treatment is sedation and prevention of inadvertent accident associated with confusional state. Urologic surgeon must be attentive to the development of this illness especially when high risk factors were present.

A Case of Collecting Duct Carcinoma of the Kidney Detected by Metastasis to Descending Colon / 대한비뇨기과학회지

No abstract available.

Conservative Management of Urinary Extravasation after Blunt Renal Trauma : Longterm Result of Management According to the Site of Urinary Extravasation / 대한비뇨기과학회지

No abstract available.