Twelve-Month Follow-up Results of Photoselective Vaporization of the Prostate With a 980-nm Diode Laser for Treatment of Benign Hyperplasia

PURPOSE: This study was conducted with the use of 12 months of follow-up data to evaluate the efficacy of photoselective vaporization of the prostate (PVP) with the 980-nm diode laser for the treatment of symptomatic benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: The clinical data of 84 men with symptomatic BPH who underwent PVP with the 980-nm K2 diode laser between March 2010 and October 2011 were retrospectively analyzed. Postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and postvoid residual volume (PVR), were assessed and compared with preoperative baseline values. RESULTS: Mean patient age was 72.4+/-6.5 years, and mean preoperative prostate volume was 47.2+/-16.3 g. Mean operative time was 23.3+/-19.1 minutes, and total amount of energy was 128+/-85 kJ. Mean catheterization time was 23.7+/-5.9 hours. At 1 month, significant improvements were noted in IPSS (11.5+/-6.8), QoL score (2.2+/-1.3), Qmax (12.9+/-6.5 mL/s), and PVR (41.2+/-31.3 mL). Three months after surgery, all postoperative follow-up parameters showed significant improvements, and the 6- and 12-month data showed sustained improvement of postoperative follow-up parameters. Bladder neck strictures were observed in 10.7% of the patients and urge incontinence in 16.6%. CONCLUSIONS: PVP using a K2 diode laser is an effective procedure for the treatment of lower urinary tract symptoms secondary to BPH. PVP leads to an immediate and sustained improvement of subjective and objective voiding parameters. Surgeons should be vigilant for postoperative bladder neck stricture and urge incontinence.

Initial Experiences with a 980 nm Diode Laser for Photoselective Vaporization of the Prostate for the Treatment of Benign Prostatic Hyperplasia

PURPOSE: This study was conducted to analyze the efficacy of photoselective vaporization of the prostate (PVP) with the use of a 980 nm diode laser for benign prostatic hyperplasia (BPH) according to postoperative period. MATERIALS AND METHODS: Data were collected from 96 patients who were diagnosed with BPH and who underwent PVP with the 980 nm K2 diode laser. Postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and post-void residual volume (PVR), were assessed and compared with preoperative baseline values. RESULTS: The mean prostate volume was 45.3+/-15.6 g, the mean operative time (lasing time) was 22.9+/-18.3 minutes, the total amount of energy was 126+/-84 kJ, and the Foley catheter maintenance period after PVP was 24.8+/-5.6 hours. At 1 month, significant improvements were noted in IPSS (11.7+/-6.6), QoL score (2.3+/-1.1), Qmax (12.7+/-6.1 ml/sec), and PVR (41.9+/-30.5 ml). After 3 months, all follow-up parameters showed significant improvements that were sustained throughout a period of 6 months after PVP. CONCLUSIONS: PVP using a K2 diode laser is a minimally invasive and effective surgical method for improvement of BPH and is associated with minimal morbidity.

Analysis of the Results of ABO-Incompatible Kidney Transplantation: In Comparison with ABO-Compatible Kidney Transplantation

PURPOSE: The number of patients waiting for kidney transplantation is incessantly increasing, but the number of cadaveric kidney transplantations or ABO-compatible donors is so insufficient that ABO-incompatible kidney transplantation is being performed as an alternative. There are overseas studies and research showing that the 5-year survival rate and 5-year graft survival rate of ABO-incompatible kidney transplantation are not much different from those of ABO-compatible kidney transplantation. However, domestic research on the subject is rare. Therefore, we report the results of 22 ABO-incompatible kidney transplantation cases performed in our hospital. MATERIALS AND METHODS: This research was from 22 patients in our hospital who underwent ABO-incompatible kidney transplantation from 15 February 2007 to 20 May 2010. RESULTS: As yet, there have been no donor graft losses and no deaths after transplantation. The results of the two groups were analyzed by analysis of covariance of the creatinine value of the recipients at 6 months after the operation, corrected for the preoperative value in order to statistically identify whether there were differences in renal function after the operation between ABO-compatible and ABO-incompatible kidney transplantation. The results of the analysis of covariance showed no statistical difference in renal function after the operation between the two groups. CONCLUSIONS: Even though there were not many cases, our initial results for ABO-incompatible kidney transplantation were positive. Considering the increasing number of patients waiting for kidney transplantation, longer-term domestic research studies of ABO-incompatible kidney transplantation are necessary.

Changes and Implications of Serum Uric Acid Levels After Living-Donor Nephrectomy

PURPOSE: The aim of this study was to investigate the changes in and implications of preoperative and postoperative serum uric acid levels in patients with living donor nephrectomy. MATERIALS AND METHODS: We studied 207 patients between 1998 and 2007 at our hospital undergoing living-donor nephrectomy for kidney transplantation. The serum uric acid level and estimated glomerular filtration rate (eGFR) were measured preoperatively and at 1 year postoperatively. We also analyzed multiple independent variables such as age, sex, blood pressure, body mass index (BMI), serum total cholesterol, hemoglobin, hematocrit, total protein, albumin, calcium, and phosphorus. RESULTS: The mean age of the study patients was 38.3+/-10.8 years. The mean serum uric acid concentration at 1 year after kidney donation was higher than preoperatively (5.05+/-1.39 mg/dl preoperatively vs. 5.85+/-1.14 mg/dl postoperatively) and was significantly greater in patients with hyperuricemia (uric acid> or =6.8 mg/dl) than in patients without hyperuricemia (uric acid or =5.7 mg/dl) require careful observation before and after living-donor nephrectomy.

Long Term Effectiveness of Doxazosin in Men with Lower Urinary Tract Symptoms Suggesting of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate the efficacy of doxazosin over 6 years in men with benign prostatic hyperplasia(BPH). MATERIALS AND METHODS: This retrospective study enrolled 33 patients with symptomatic BPH who were prescribed an alpha-blocker from January 1999 to December 2000. We evaluated the changes of International Prostate Symptom Score(IPSS), maximal flow rate(Qmax), quality of life(QoL) and residual urine volume(RUV) between before and after 6-year of treatment. RESULTS: The percentages of improvement were 40.2% in total IPSS, 40.6% in obstructive symptom, 39.4% in irritative symptom, 44.7% in QoL, 124.8% in Qmax, 33.5% in RUV(p<0.05). Three patients(9.1%) experienced acute urinary retention and BPH-related surgery was performed in 6 patients (18.2%). CONCLUSIONS: Our study revealed that long-term treatment over 6 years with alpha-blocker resulted in significant improvements in the IPSS, QoL, Qmax and RUV.

Myxofibrosarcoma of Bladder / 대한비뇨기과학회지

Myxofibrosarcoma is also known as a myxoid variant of malignant fibrous histiocytoma, and this is one of the most common sarcomas in the extremities of elderly people; it is characterized by a high frequency of local recurrence. We herein report on a case of myxofibrosarcoma of the bladder. A 58-year-old man was referred to our hospital because of microscopic hematuria. Computed tomography(CT) and intravenous pyelography(IVP) showed a 12x7cm sized bladder mass in the pelvic cavity. The cystoscopic finding shows a protruding mass at the dome and posterior wall of the bladder. After exploratory laparotomy and tissue frozen biopsy were done, radical cystectomy and uretero-ileo-cutaneous anastomosis were then carried out. The diagnosis of the tumor was confirmed by histopathological examination. The myxofibrosarcoma of the bladder was completely excised, and there was no evidence of recurrence after 10 months of follow-up.

Ectopic Prostate Tissue in the Posterior Wall of the Bladder / 대한비뇨기과학회지

We herein report a case of ectopic prostate tissue involving the posterior wall of the bladder. A 33-year-old man was referred to our hospital because of a bladder tumor that was incidentally discovered on abdominal ultrasonography (US). US and computed tomography (CT) showed a 1.5x2.0cm sized tumor in the posterior wall of the bladder. Cystoscopic examination revealed a sessile tumor, covered with normal bladder mucosa in the posterior wall of the bladder. Transurethral resection of the bladder tumor was carried out and the origin of the tissue was confirmed by immunohistochemical staining for prostate specific antigen. The histopathological examination revealed benign prostate tissue that was situated ectopically.

The Use of Dual Energy X-ray Absorptiometry in the Prediction of Stone Fragility in Extracorporeal Shock Wave Lithotripsy / 대한비뇨기과학회지

Purpose: The aim of this study was to determine whether the stone mineral content (SMC) and stone mineral density (SMD), as measured by dual energy X-ray absorptiometry, can predict the stone fragility in extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: In the experimental study, the stone size, weight, SMC and SMD of 111 urinary calculi, obtained by open surgery, were measured. The SMC and SMD were measured using dual energy X-ray absorptiometry, which is the gold standard for measuring the bone mineral content and density. The number of shock waves necessary for full fragmentation was accepted as a measure of the stone fragility in ESWL (EDAP-sonolith Praktis). In the clinical study, the stone size, SMC and SMD were measured in a total of 48 patients with a solitary renal stone of less than 3cm. Prior to ESWL all patients underwent dual energy X-ray absorptiometry to calculate the SMC and SMD. The correlations between the number of total shock waves and the stone size, SMC and SMD were analyzed. Results: In the experimental study, the stone size, stone weight, SMC and SMD values correlated with total shock waves, with a correlation coefficients (R) of 0.79, 0.95, 0.99 and 0.86, respectively (n=111). In the clinical study, the mean stone size, mean MC and MD values differed significantly between the clinically successful and failed ESWL (n=36 and n=12), respectively (p=0.0002, p=0.004, p=0.004). On a simple regression analysis, the SMC (R2=0.74), SMD (R2=0.56) and stone size (R2=0.51) were significant factors in predicting the number of shock waves. Using the receiver operating characteristic curves for comparing the stone size, SMC and SMD in relation to the number of shock waves, the areas under the respective curves were 0.79, 0.84 and 0.81 with cut-off values of 1.8, 1.4 and 1.8. Conclusions: The stone size, SMC and SMD measured by dual energy x-ray absorptiometry may provide a prediction of the outcome of patients prior to ESWL treatment. Patients with high SMC (greater than 1.4gm) could be recommended for percutaneous nephrolithotripsy or another treatment modality, thus, avoiding the unnecessary cost of prior ESWL.

Bladder Xanthoma / 대한비뇨기과학회지

A xanthoma is an abnormal localized collection of histiocytic tissue containing lipid. It is not a true tumor, but is a reactive histiocytic proliferation often secondary to alternations in serum lipids. Xanthoma lesions are seen in the skin and tendons, and may occur at other sites, such as the stomach and arytenoepiglottic fold. However, a xanthoma is rare in the bladder, with only 9 reported cases. Here, a case of a xanthoma of the bladder detected incidentally during cystoscopic examination for a gross hematuria is reported.

The Renal Function and the Preoperative Predictive Factors Influencing Renal Function after Living Donor Nephrectomy / 대한비뇨기과학회지

PURPOSE: The aim of this study is to identify postoperative renal function and preoperative factors that can predict renal impairment after living donor nephrectomy. MATERIALS AND METHODS: We studied 172 patients undergoing living donor nephrectomy for kidney transplantation (115 males, 57 females). We analyzed the renal function measured by serum creatinine and the 99mTc- diethylenetriamine penta-acetic acid (DTPA) renal scan. Using a univariate and multivariate analysis, we also analyzed multiple independent variables for the remaining renal function following living donor nephrectomy, such as serum creatinine, glomerular filtration rate (GFR), age, sex, duration of follow-up, blood pressure, body mass index (BMI), serum calcium, serum phosphate, serum uric acid. RESULTS: The mean age of the donors was 34 years, and the mean duration of the follow-ups was 11 months. The mean serum creatinine at 11 months after kidney donation was increased compared to preoperative creatinine (1.26mg/dl vs. 0.93mg/dl), and significantly greater in the males than in the females (1.36mg/dl vs. 1.09mg/dl). Mean GFR measured by the 99mTc- DTPA renal scan at 11 months after kidney donation was 69.2 ml/min/ 1.73m2 and similar for men and women (72.3ml/min/1.73m2 vs. 68.3ml/ min/1.73m2). The univariate analysis showed that preoperative creatinine was significantly associated with postoperative creatinine only (p<0.001), and age and sex were associated with the change in creatinine (p=0.046, p<0.001). The univariate analysis also showed that preoperative GFR and age were significantly associated with postoperative GFR (p<0.001, p<0.001), and age was associated with compensatory change in GFR (p= 0.008). The multivariate analysis showed that preoperative GFR was the primary predictive factor of postoperative GFR (r=0.73, p<0.001), and age was an independent secondary predictive factor (r= 0.67, p<0.001). CONCLUSIONS: These results suggest that postoperative renal function has been preserved in kidney donors, and preoperative creatinine, preoperative GFR, and age at donation were the important predictive factors of renal function after living donor nephrectomy.

PSAD and TZ-PSAD as Predictors of the Response to Alpha-adrenergic Blocker in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: To determine whether prostate-specific antigen density(PSAD) and transition zone prostate-specific antigen density(TZ-PSAD) can predict the clinical response of patients with benign prostatic hyperplasia(BPH) to alpha-adrenergic blocker(terazosin). MATERIALS AND METHODS: From January 2000 to June 2002, 202 patients with BPH who were treated with alpha-adrenergic blocker(terazosin) were enrolled in this study. The peak flow rate(Qmax) and the International Prostate Symptom Score(IPSS) were compared prior to and 3 months following medication. We analyzed total prostate volume(TPV), transition zone volume(TZV), transition zone index(transition zone volume/total prostate volume, TZI), PSAD(PSA/total prostate volume), and TZ-PSAD (PSA/transition zone volume) as predictors of the response to alpha-adrenergic blocker (terazosin). RESULTS: At 3 months following medication with terazosin, a statistically significant improvement was shown in the IPSS and Qmax. There was no significant correlation between pretreatment TPV, TZV, TZI and the percent change in the IPSS and Qmax. However, there was a significant negative correlation between pretreatment PSAD (r=-0.632, p<0.001), TZ-PSAD (r=-0.599, p<0.001) and the percentage change in Qmax, while there was a positive correlation between pretreatment PSAD (r=0.620, p<0.001), TZ-PSAD(r=0.604, p<0.001) and the percentage change in the IPSS. Using the receiver operating characteristic curves to compare PSAD and TZ-PSAD for IPSS, the areas under the respective curves were 0.867 and 0.874(cut-off values were 0.04 and 0.1), and for the Qmax, the areas under the respective curves were 0.876 and 0.873(cut-off values were 0.04 and 0.1). CONCLUSIONS: Patients with a lower pretreatment PSAD and TZ-PSAD responded better to alpha-adrenergic blocker than those with a higher pretreatment PSAD and TZ-PSAD. PSAD and TZ-PSAD were predictors of the response to alpha-adrenergic blocker (terazosin) in patients with BPH.

Spontaneous Rupture of the Kidney Due to Metastatic Choriocarcinoma during Pregnancy / 대한비뇨기과학회지

A spontaneous rupture of the kidney due to a metastatic choriocarcinoma, which is associated with a normal pregnancy, is very rare. A 33-year-old female patient presented with sudden colicky right flank pain on the 5th day after a Cesarian Section. An abdominal CT scan showed evidence of a right renal rupture with a perirenal hematoma. Under the impression of a spontaneous rupture of right kidney, an exploratory laparotomy with a radical nephrectomy was performed. The pathologic findings revealed a renal parenchymal rupture due to a metastatic choriocarcinoma.

Risk Factors Associated with Blood Loss During a Transurethral Resection of the Prostate / 대한비뇨기과학회지

PURPOSE: The purpose of this study was to find if any clinical or laboratory factors have significant correlations with blood loss caused by a transurethral resection of the prostate (TURP). MATERIALS AND METHODS: The medical records of 218 patients who had undergone a TURP were retrospectively reviewed. For each patient, the preoperative factors evaluated included age, type of presentation (patients who had been treated due to acute urinary retention; retention group, patients who had been treated due to lower urinary tract symptoms; symptomatic group), blood pressure, complete blood count, coagulation screening, prostate size on transrectal ultrasonography (TRUS), urine analysis, urine culture, ECG and drugs. Intraoperative and postoperative factors were also evaluated, including type of anesthesia, operator, operating time, weight of resected prostate tissue, blood transfusion and prostate histology. These factors were analyzed with respect to blood loss during the TURP using student's t, ANOVA and chi-square tests. RESULTS: The mean intraoperative blood loss and resected prostate weight were 415 ml and 15g, respectively. The factors which were found to significantly correlate with blood loss during a TURP were: resected prostate weight (r=0.44, p=0.0001), prostate size on TRUS (r=0.32, p=0.001), operating time (r=0.31, p=0.001), preoperative urine culture (p= 0.020), preoperative antimicrobials taken (p=0.020), and prostate histology (p=0.048). CONCLUSIONS: Of the factors found to correlate with blood loss during the TURP, the only reversible factor was a preoperative urinary tract infection. So, we expect that the prevention of preoperative urinary tract infection and its effective treatment in patients might be helpful in decreasing blood loss during a TURP.

A Case of Adrenal Cavernous Hemangioma / 대한비뇨기과학회지

No abstract available.

An Evaluation of Vesical Urodynamics before and after Renal Transplantation in the Patients of Chronic Renal Failure / 대한비뇨기과학회지

PURPOSE: There are ample experimental and clinical data showing that if the bladder does not receive a significant urine input for a prolonged period it suffers a reduction in capacity and develops hypertonicity. We investigated the urodynamic changes before and after renal transplantation in the patients of chronic renal failure(CRF) under dialysis. MATERIALS AND METHODS: Urodynamic evaluations were performed in 47 CRF patients(25 males and 22 females, average age : 39 years) prior to renal transplantation and 4 weeks after renal transplantation. The clinical notes of each of the patients were reviewed to ascertain the cause of renal failure, duration and type of dialysis. RESULTS: The maximal flow rate , voiding volume, voiding time, volume of first sensation of fullness and the volume of urge sense were abnormally low in the patients of CRF, and the degree of deterioration was more remarkable in the patients of longer duration of dialysis, but the voiding detrusor pressure was within normal range in the patients of CRF irrespective of duration and type of dialysis. The maximal flow rate, voiding volume, voiding time, volume of first sensation of fullness and the volume of urge sense were increased significantly after successful renal transplantation, but the change of voiding detrusor pressure was not significant. CONCLUSIONS: The bladder capacity of CRF patients under dialysis is decreased to physiologic disuse state because of decreased urine input into the bladder for a prolonged period, but the contractility is well preserved irrespective of duration of dialysis, and the bladder capacity is recovered in the course of time after successful renal transplantation.

Transitional Zone Index: a Predictor of Acute Urinary Retention in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: To investigate the efficacy of age, International Prostate Symptom Score(I-PSS), quality of life(QOL) score, various parameters obtained by transrectal ultrasonography(TRUS) as predictors of the onset of acute urinary retention in patients with benign prostatic hyperplasia(BPH). MATERIALS AND METHODS: From January 1996 to December 1997, 101 men(mean age 70years, range 52-92) with symptoms of BPH were enrolled in this study. Among them, 36 patients had suffered from acute urinary retention. TRUS was used to calculate the total prostate(TP) volume, the transitional zone(TZ) volume, the transitional zone index(TZ index=TZ volume/TP volume). To compare the usefulness of various indices, the area under the receiver-operator characteristic(ROC) curve was calculated for each index. RESULTS: There were significant differences in age, TP volume, TZ volume, TZ index between patients with and without acute urinary retention, but no significant differences in I-PSS and QOL score. In patients with acute urinary retention, the area under the ROC curve was 0.911 for the TZ index, 0.892 for the TZ volume, 0.769 for the TP volume and 0.660 for the age. CONCLUSIONS: The TZ index is a useful predictor of acute urinary retention in patients with BPH and may be a useful parameter for decision of surgical intervention.

An Experience of Vaginoplasty with Rectos Abdominis Myocutaneous Flap for Testicular Feminization Syndrome / 대한비뇨기과학회지

Testicular feminization syndrome is characterized by 46,XY karyotype, bilateral testes, absent or hypoplastic wolffian duct, female appearing external genitalia, blind vaginal pouch, and absent or rudimentary muillerian derivatives. We experienced vaginoplasty using rictus abdominis myocutaneous flap with modified Burch bladder neck suspension in a 51-year-old patient with testicular feminization syndrome combined with stress urinary incontinence.

Transrectal Ultrasonography in Female Stress Urinary Incontinence / 대한비뇨기과학회지

Radiologic chain cystourethrography for stress urinary incontinence (SUI) has several disadvantages including the risk of excessive radiation, the time required for the test, and the discomfort of the patients. Nowadays it is widely accepted that transrectal ultrasonography for evaluating bladder and urethra provides similar information about SUI comparing with the conventional radiographic examination. We evaluated the effectiveness of transrectal ultrasonography in the diagnosis of SUI in 30 women with SUI and in normal 20 women as a control. The results of evaluation were as follows: 1. Mean age was 52.9 in SUI group and 48.5 in control group, and mean parity was 2.8 in SUI group and 3 In control group. 2. According to the symptom grading by Stamey, 8 patients (27%) were Grade I and 22 (73%) were Grade II. 3. The mean value of posterior urethrovesical angle (PUVA) at resting state was 139 +/- 14.7 degrees in control group and 145 +/- 15.2 degrees in SUI group (p>0.05). 4. The mean value of PUVA at strain state was 146 +/- 7.9 degrees in control group and 169 +/- 12.1 degrees in SUI group (p<0.05). 5, Bladder neck descent was 7.3 +/- 2.7 mm (mean+/-SD.) in control group and 13.7+/-6.2 mm in SUI group (p<0.05). 6. Diagnostic criteria of SUI in transrectal ultrasonography are more than 149.5 degrees in PUVA at strain state, and more than 9.1 millimeter in bladder neck descent. 7. Sensitivity and specificity of transrectal ultrasonography in the diagnosis of SUI were 86% and 80% in PUVA at strain state, 80% and 80% in bladder neck descent, respectively. 8. There was significant change of transrectal ultrasonographic finding in pre and post-bladder neck suspension (p<0.05). In conclusion, transrectal ultrasonography is simple, non-invasive, not shameful, and free of radiation, so might be a useful diagnostic method in female SUI.

A Case of Huge Retroperitoneal Lipoma / 대한비뇨기과학회지

Retroperitoneal lipoma probably constitute the group of the most massive solid abdominal tumors; their etiology is unknown; their symptoms insidious; and recurrence and sarcomatous change frequent. The clinical diagnosis was made by clinical symptoms, physical findings and radiologic evaluation such as intravenous urography, ultrasonography, computed tomography, angiography and so on. Abdominal CF scan provided clinically the most useful information regarding the state of tumors and also their effect on adjacent structures and shows homogenous appearing fat tissue with a low attenuation coefficient identical to that found in the subcutaneous fat. We present a case of treatment for a huge retroperitoneal lipoma in a 46-year-old man.

Significance of Resistive index in Renal Transplantation / 대한비뇨기과학회지

The increasing use and availability of renal transplantation has resulted in a demand for noninvasive methods to study possible complications. One of the most serious adverse reactions is acute rejection, a possibly reversible cause of transplant failure if treated promptly. Sixty-six donors and recipients were evaluated by duplex Doppler examination of intrarenal arteries. A simplified formula, resistive index(RI) ([peak systolic frequency shift-lowest diastolic frequency shift]/[peak systolic frequency shift]), were used to diagnose rejection. All RI values of donors were within normal limit. RI values of recipients were not significantly different according to the number of renal artery and the ischemic time during operation. With a RI greater than 0.90, a 100% positive predictive value was obtained for the diagnosis of acute rejection. A 88% positive predictive value of acute rejection was obtained with a RI greater than 0.80. A value less than 0.70 was unlikely to be rejection(negative predictive value, 95%). The results suggest that the duplex Doppler examination and the resistive index obtained by simple analysis of the wave form would be used as a valuable noninvasive method for the detection of acute renal transplant rejection. The findings of Doppler examination are not necessarily pathognomonic for one specific process, but they can aid the clinician in deciding the kind of treatment necessary and the need for biopsy.