Novel method of laparoendoscopic single-site and natural orifice specimen extraction for live donor nephrectomy: single-port laparoscopic donor nephrectomy and transvaginal graft extraction

Laparoscopic live donor nephrectomy (DN) has been established as a useful alternative to the traditional open methods of procuring kidneys. To maximize the advantages of the laparoendoscopic single-site (LESS) method, we applied natural orifice specimen extraction to LESS-DN. A 46-year-old woman with no previous abdominal surgery history volunteered to donate her left kidney to her husband and underwent single-port laparoscopic DN with transvaginal extraction. The procedure was completed without intraoperative complications. The kidney functioned well immediately after transplantation, and the donor and recipient were respectively discharged 2 days and 2 weeks postoperatively. Single-port laparoscopic DN and transvaginal graft extraction is feasible and safe.

Transumbilical pure single-port laparoscopic donor nephrectomy

Transumbilical single-port laparoscopic donor nephrectomy (SPLDN) is a novel, rapidly evolving, minimally invasive treatment modality for kidney transplantation. This method causes minimal parietal injury, has cosmetic advantages, and allows rapid recovery because of low postoperative pain and short hospital stay. Like other abdominal surgeries, when conducted by experienced laparoscopic surgeons, it can meet the same graft requirements as conventional laparoscopic surgery. Here, we report the first two cases of transumbilical SPLDN at Daejeon St. Mary's Hospital, The Catholic University of Korea. We used the umbilicus as a common path for laparoscopic procedures and as a route for specimen retrieval. The operating times were 230 and 265 minutes in cases 1 and 2, respectively. No intra- or postoperative complications were noted. In case 1, the wound length was 4 cm and duration of hospitalization was 2 days. In case 2, the wound length was only 2.5 cm, and the duration of hospitalization was only 1 day.

The Changes of Testis and the Effects of Anthocyanin on Spermatogenesis in Rat Induced Varicocele / 대한남성과학회지

PURPOSE: Varicocele is known as a main cause of primary male infertility and it supposed to be associated with oxidative stress. Anthocyanin is known as a natural plant pigment and novel antioxidant. This study was designed to investigate the effects of anthocyanin on a rat model of varicocele. MATERIALS AND METHODS: Twenty four male rats, induced varicocele by partial obstruction of left renal vein, were divided into four experimental groups: the group induced varicocele for four weeks without anthocyanin, the group received anthocyanin (80 mg/kg) right after varicocele induction, group induced varicocele for eight weeks without anthocyanin, and the group received anthocyanin (80 mg/kg) after four weeks observation following varicocele induction. After anthocyanin treatment, testes from the rats in all groups were removed, weighed, and subjected to histological examination. Apoptosis in the testes was measured by the TUNEL assay. And the oxidative stress was evaluated by measurement of 8-hydroxy-2'-deoxyguanosine (8-OHdG). RESULTS: Induction of varicocele led to decreasing left testis weight, decreasing spermatogenic cell density significantly (p<0.05). Also it led to increasing apoptotic body counts and increasing concentration of 8-OHdG significantly (p<0.05). However administration of anthocyanin right after varicocele induction prevent this change meaningfully (p<0.05). In group received anthocyanin after four weeks observation following varicocele induction, interestingly, there was no significant difference in testis weight, spermatogenic cell density, apoptotic body count and concentration of 8-OHdG compared to group induced varicocele for eight weeks without anthocyanin administration. CONCLUSIONS: These results suggest that anthocyanin is effective in decreasing the oxidative stress of testis in rat induced varicocele and may be effective in making a healthy sperm in patient of varicocele in early stage. However in patient under way in advanced stage, it is supposed that the anthocyanin cannot help having a protective effect from oxidative stress narrowly unless the condition of oxidative stress by varicocele is corrected. Further studies are needed to better understand the mechanisms and actions of anthocyanin and varicocele, and these studies may lead to the clinical application of anthocyanin in preventing male infertility by varicocele.

The Effects of Anthocyanin Extracted from Black Soybean on a Benign Prostatic Hyperplasia-induced Rat Model / 대한남성과학회지

PURPOSE: Anthocyanin is known as a water soluble natural pigment and potent antioxidant. We extracted anthocyanin mediating antioxidant reaction from black soybeans, administered the extract to rats induced prostatic hyperplasia, and evaluate the effect of anthocyanin. MATERIALS AND METHODS: Twenty four male rats were divided into 4 experimental groups: the control, BPH-induced, BPHinduced, and oral anthocyanin (40 mg/kg, 80 mg/kg)-administered groups. For exclusion of intrinsic testosterone influence, a bilateral orchiectomy was done on all except the control group. An experimental prostate hyperplasia was induced by the subcutaneous administration of 3 mg/kg testosterone propionate for 4 weeks to all except the control group. Anthocyanin administration was done in the last 4 weeks in the anthocyanin-administered groups. After 8 weeks, the prostates were removed and analyzed for their prostatic weight and histological examination. Then TUNEL staining was done on each group's specimens, and they were analyzed for their apoptotic body counts. RESULTS: The mean prostate weight was found to be 674.17+/-28.24 mg, 1,098.33+/-131.31 mg, 323.00+/-22.41 mg, and 324.00+/-26.80 mg in the control, BPH-induced, and oral anthocyanin-administered (40 mg/kg, 80 mg/kg) groups, respectively. The BPH-induced group showed statistically significant increases in their prostate weights compared with the control group (p<0.05) and the anthocyanin administered groups showed statistically significant decreases compared to the control and BPH-induced groups (p<0.05). Histologically injected testosterone led to prostatic hyperplasia, but anthocyanin-administered groups experienced this change to a lesser extent. Apoptotic body counts in 5x400/HPF were found to be 3.67+/-0.86, 1+/-0.94, 15.67+/-2.36, and 28.33+/-1.71 in each group. The anthocyanin-administered groups showed statistically significant increases in apoptotic body counts compared with the control and BPH induced groups (p<0.05). CONCLUSIONS: In a prostatic hyperplasia-induced rat model, administration of anthocyanin showed the reduction of prostate weight and the increase of apoptosis. We thought that such results were caused by antioxidant reactions of anthocyanin, and administration of the anthocyanin may be effective in benign prostatic hyperplasia, which is the representative geriatric disease of the urological system.

The Beneficial Effect of Korean Red Ginseng on Rat Bladder Contractility and Oxidant Damage Following Ischemia/Reperfusion

PURPOSE: N-acetylcysteine (NAC) is a potent antioxidant, and a free radical scavenger. We investigated the possible effects of NAC after ischemia/reperfusion (I/R) of rat bladder. MATERIALS AND METHODS: I/R injury was induced by abdominal aorta clamping and ischemia for 60minutes, followed by 120minutes reperfusion. Twenty rats were divided into four groups: sham operation + saline group (S+S), sham operation + NAC group (S+NAC), I/R + saline group (I/R+S), I/R + NAC group (I/R+NAC). Blood levels of reactive oxygen species (ROS) were determined using the free oxygen radical tests (FORT). Superoxide generation was measured based on lucigenin-enhanced chemiluminescence. The level of malondialdehyde (MDA) was analyzed in order to measure lipid peroxidation. RESULTS: In I/R+S group, the isometric contractile responses to carbachol were significant lower than other groups and were reversed by the pretreatment with NAC. The level of FORT and MDA showed a marked increase in I/R+S group compared with S+S group. NADPH-stimulated superoxide production was also significantly increased. I/R+NAC decreased these parameters compared with I/R+S group. CONCLUSION: Our results suggest that treatment with NAC reversed the low contractile responses of rat bladder and prevented oxidative stress following I/R.

The Evaluation of a Dissolvable Ureteral Catheter in a Rabbit Model / 대한비뇨기과학회지

PROPOSE: Ureteral stents are commonly placed after routine ureteroscopic procedures to prevent acute obstruction. However, stents can cause significant symptoms and they can require a secondary procedure for removal; further, they may possibly be forgotten. In order to overcome these problems, a temporary ureteral drainage stent capable of dissolving spontaneously was developed to evaluate the tissue reaction and toxicity. MATERIALS AND METHODS: We developed a dissolvable ureteral catheter composed of polydioxanone (PDO). We evaluated the toxicity and tissue reaction by hematologic (CBC, aminotransferase/alanine transaminase (AST/ALT), blood urea nitrogen, creatinine (BUN, Cr), alkaline phosphatase) and histologic examination (ureter, kidney and liver tissue). Twelve rabbits were placed into groups of four rabbits each: the uninserted control group, group I that had a dissolvable ureteral catheter inserted with harvest at four weeks, group II that had a dissolvable ureteral catheter inserted with harvest at eight weeks, and group III that had a dissolvable ureteral catheter inserted with harvest at twelve weeks. RESULTS: On histologic examination, the ureter had a normal appearance of transitional cells and it contained the dissolvable ureteral catheter in the ureteral lumen without any inflammatory change. The ureteral surface cells appeared normal after contact with the dissolvable ureteral catheter during the 12 weeks. Liver and kidney tissue showed mild focal inflammatory change, but no definitive difference was noted between the control and groups I, II and III. On the hematologic examination, there was no significant change of the value of CBC, AST/ALT, BUN, Cr and alkaline phosphatase due to the inserted dissolvable ureteral catheter during the 12 weeks. CONCLUSIONS: A dissolvable ureteral catheter appeared to have no toxic effect, as evidenced by histological and hematological examination. However, further study is warranted in order to overcome the catheter's limitations like for its flexibility.