Laparoscopic Management of Complicated Urachal Remnants / 전남의대학술지

Managing persistent and symptomatic urachal anomalies requires wide surgical excision of all anomalous tissue with a cuff of bladder tissue via the open approach. We report 7 cases with complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue. We expected that this technique would be less invasive and have lower morbidity. We report on the feasibility of this approach, including efficacy and outcomes. Eight patients with a mean age of 36.5 years who had symptomatic urachal diseases underwent laparoscopic excision between July 2004 and July 2012. With the use of four ports, the urachal remnant was dissected transperitoneally and then removed via the umbilicus port. The clinical results of laparoscopic urachal remnant excision as a minimally invasive surgery, the perioperative records, and pathologic results were evaluated. There were no intraoperative or postoperative complications. Mean surgery time was 2.7 hours. Mean hospital stay was 14.6 days. The patients with bladder cuff resection had a long admission and Foley catheterization period (mean, 14.4 and 11 days). Pathological evaluations were 6 cases of infected urachal cysts, 1 case of infected urachal sinus, and 1 case of urachal adenocarcinoma. We found no postoperative complications including any symptom recurrence or voiding difficulty during a mean follow-up of 46.3 months. The perioperative surgical outcomes achieved infection control and symptomatic relief and additionally good cosmesis. Complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue seems to be a safe, effective, and better cosmetic alternative with the advantages of a minimally invasive approach.

Safety and Efficacy of Percutaneous Nephrolithotomy for Staghorn Calculi in Patients 70 Years and Older

BACKGROUND: The aim of this study was to analyze the safety and efficacy of percutaneous nephrolithotomy (PNL) for staghorn calculi in patients 70 years and older. METHODS: From March 1990 to December 2011, 76 patients with staghorn calculi underwent PNL. They divided into two groups according to age: 70 years and older (group I, n=32) and younger than 70 years (group II, n=46). Preoperative parameters (stone type, stone volume, concomitant diseases, and preoperative urine culture results) and perioperative parameters (operative time, complication rate, transfusion rate, and success rate) were evaluated. Additionally, we analyzed the composition of the urinary stones using the chemical analysis method. RESULTS: There were no significant differences between the groups for stone size, urine culture rate, operative time, success rate, and complication rate. But comorbidity, American Society of Anaesthesiology score, postoperative hemoglobin level, and transfusion rate were different (p<0.05). There were no serious complications or deaths. Magnesium ammonium phosphate component was found in 53.1% of group I and 60.9% of group II. CONCLUSION: Outcomes of PNL for staghorn calculi in patients 70 years and older were comparable to those seen in younger patients. PNL for this condition can be considered a safe and effective surgical option for appropriately selected elderly patients.

Effect of Low-Dose Triple Therapy Using Gabapentin, Amitriptyline, and a Nonsteroidal Anti-Inflammatory Drug for Overactive Bladder Symptoms in Patients With Bladder Pain Syndrome / 대한배뇨장애요실금학회지

PURPOSE: Patients with bladder pain syndrome/interstitial cystitis (BPS/IC) can have pain as a main symptom and overactive bladder (OAB) symptoms that are directly or indirectly related to a major mechanism that causes pain. The primary purpose of this study is firstly to identify the prevalence rate of OAB symptoms in patients with BPS/IC, secondly to identify changes in OAB symptoms after low-dose triple therapy, and thirdly to build a theoretical foundation to improve quality of life for patients. METHODS: Patients who met the inclusion criteria of BPS/IC through basic tests including the O'Leary-Sant symptom index, overactive bladder symptom score (OABSS), and visual analog scale (VAS) were identified. Treatment-based changes in OAB symptoms were identified using the IC Symptom Index and IC Problem Index (ICSI/ICPI), OABSS, and VAS before, and 4 and 12 weeks after low-dose triple therapy. RESULTS: The patients consisted of 3 men and 20 women, and their mean age was 61.9 years (41.0-83.2 years). Comparing values before treatment, and 4 and 12 weeks after treatment (baseline vs. 4 weeks to baseline vs. 12 weeks), the rates of improvement were as follows: ICSI, 44.2% to 63.7%; ICPI, 46.9% to 59.4%; OABSS, 34.3% to 58.2%; and VAS, 53.6% to 75.0%, which showed statistically significant differences (P0.05). CONCLUSIONS: Low-dose triple therapy in BPS/IC results in a clear decrease in OAB symptoms in the first 4 weeks after treatment, and additional treatment for 8 weeks had a partial effect with varied statistical significances depending on the questionnaires.

Laparoscopic Management of Complicated Urachal Remnants / 전남의대학술지

Managing persistent and symptomatic urachal anomalies requires wide surgical excision of all anomalous tissue with a cuff of bladder tissue via the open approach. We report 7 cases with complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue. We expected that this technique would be less invasive and have lower morbidity. We report on the feasibility of this approach, including efficacy and outcomes. Eight patients with a mean age of 36.5 years who had symptomatic urachal diseases underwent laparoscopic excision between July 2004 and July 2012. With the use of four ports, the urachal remnant was dissected transperitoneally and then removed via the umbilicus port. The clinical results of laparoscopic urachal remnant excision as a minimally invasive surgery, the perioperative records, and pathologic results were evaluated. There were no intraoperative or postoperative complications. Mean surgery time was 2.7 hours. Mean hospital stay was 14.6 days. The patients with bladder cuff resection had a long admission and Foley catheterization period (mean, 14.4 and 11 days). Pathological evaluations were 6 cases of infected urachal cysts, 1 case of infected urachal sinus, and 1 case of urachal adenocarcinoma. We found no postoperative complications including any symptom recurrence or voiding difficulty during a mean follow-up of 46.3 months. The perioperative surgical outcomes achieved infection control and symptomatic relief and additionally good cosmesis. Complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue seems to be a safe, effective, and better cosmetic alternative with the advantages of a minimally invasive approach.

Relationship between the Glutathione-S-Transferase P1, M1, and T1 Genotypes and Prostate Cancer Risk in Korean Subjects

PURPOSE: The glutathione-S-transferase (GST)P1, GSTM1, and GSTT1 genotypes have been associated with an increased risk of prostate, bladder, and lung cancers. The aim of this study was to investigate the association between the GSTP1, GSTM1, and GSTT1 genotypes and the risk of prostate cancer in Korean men. MATERIALS AND METHODS: The study group consisted of 166 patients with histologically confirmed prostate cancer. The control group consisted of 327 healthy, cancer-free individuals. The diagnosis of prostate cancer was made by transrectal ultrasound-guided biopsy. Patients with prostatic adenocarcinoma were divided into organ-confined ( or =pT3) subgroups. The histological grades were subdivided according to the Gleason score. The GSTP1, GSTM1, and GSTT1 genotypes were determined by using polymerase chain reaction-based methods. The relationship among GSTP1, GSTM1, and GSTT1 polymorphisms and prostate cancer in a case-control study was investigated. RESULTS: The frequency of the GSTM1 null genotype in the prostate cancer group (54.2%) was higher than in the control group (odds ratio=1.53, 95% confidence interval=1.20-1.96). The comparison of the GSTP1, GSTM1, and GSTT1 genotypes and cancer prognostic factors, such as staging and grading, showed no statistical significance. CONCLUSIONS: An increased risk for prostate cancer may be associated with the GSTM1 null genotype in Korean men, but no association was found with the GSTT1 or GSTP1 genotypes.

Vesicovaginal Fistula Repair Using a Transurethral Pointed Electrode / 대한배뇨장애요실금학회지

The most common cause of vesicovaginal fistulasis injury to the bladder at the time of surgery. The operation most frequently responsible for vesicovaginal fistula formation is hysterectomy. The first successful transvaginal approach to vesicovaginal fistula repair was reported by Sims in 1838. Although many surgical procedures exist, there is no best approach for all patients with vesicovaginal fistula. However, it is an essential surgical principle that the fistulous tract and scar should be excised completely. Here we report our technique using a transurethral pointed electrode for the treatment of multiple, small vesicovaginal fistulas and its outcome.

Bladder Pain Syndrome Treated with Triple Therapy with Gabapentin, Amitriptyline, and a Nonsteroidal Anti-Inflammatory Drug / 대한배뇨장애요실금학회지

PURPOSE: Bladder pain syndrome is a chronic disease that manifests as bladder pain, frequency, nocturia, and urgency. Gabapentin, amitriptyline, and nonsteroidal anti-inflammatory drugs are efficacious treatments for bladder pain syndrome. Here, we assessed the effect of triple therapy with these drugs in women with bladder pain syndrome. METHODS: Between May 2007 and May 2010, we conducted a prospective nonrandomized study on 74 patients with bladder pain syndrome. Of these patients, 38 (11 men and 27 women; mean age, 55.9 years; range, 25 to 77 years; mean follow-up, 12.6 months) were administered the interstitial cystitis (IC) symptom scales (O'Leary-Sant Symptom Index) and visual analog scale (VAS) 1, 3, and 6 months after treatment to assess the efficacy of triple therapy. RESULTS: The pretreatment O'Leary-Sant IC symptom score was 11.7, and the post-treatment scores were 4.4, 3.8, and 4.0 at 1, 3, and 6 months, respectively; the pretreatment problem index score was 10.5, and the post-treatment scores were 3.7, 2.7, and 2.9 at 1, 3, and 6 months, respectively. The pretreatment VAS score was 6.7, and the post-treatment scores were 1.8, 1.5, and 1.7 at 1, 3, and 6 months, respectively. The O'Leary-Sant IC symptom index and problem index and VAS scores improved considerably 1 month after treatment (P0.05). CONCLUSIONS: Triple therapy was sufficiently effective in patients with bladder pain syndrome and caused no significant adverse effects. However, large-scale studies should be performed to verify our findings.

Safety of Laparoscopic Radical Nephrectomy in the Elderly Patients

BACKGROUND: Elderly patients with underlying cardiovascular or respiratory diseases are more susceptible to anesthesiologic risks or serious complications following laparoscopic operations. We evaluated the safety of laparoscopic radical nephrectomy in elderly patients to compensate for the lack of Korean data on the subject in the field of urology. METHODS: From March 2003 and March 2009, 73 patients with localized renal cell cancer underwent laparoscopic radical nephrectomy. They were divided into two groups according to age; 75 years or older (elderly group, n=21) and under 75 years (young group, n=52). Operative parameters as well as oncological outcomes were evaluated. RESULTS: The mean age was 77.7+/-2.5 years for the elderly group and 55.9+/-10.5 years for the young group. No significant differences existed between the groups in terms of mean operative time, intraoperative blood loss, complications, and hospital stay. However, American Society of Anesthesiologists (ASA) score, co-morbidities (p<0.05), and rate of transfusion (p<0.05) were significantly higher in the elderly group. In overall analyses, we conclude that in elderly patients undergoing laparoscopic radical nephrectomy, close monitoring of hemoglobin level as well as intraoperative transfusion for maintenance of hemoglobin level at 10 mg/L or higher is necessary in elderly patients to achieve adequate circulation. CONCLUSION: Laparoscopic radical nephrectomy can be considered a safe and effective procedure for most elderly patients.

The Efficacy of Epidural Ketamine on Shivering during Transurethral Resection of the Prostate under Epidural Anesthesia / 대한배뇨장애요실금학회지

PURPOSE: Ketamine may decrease core-to-peripheral redistribution of heat through direct central sympathetic stimulation and inhibition of norepinephrine uptake into postganglionic sympathetic nerve endings. The purpose of this study was to evaluate the efficacy of epidural ketamine in preventing shivering during transurethral resection of the prostate (TURP) under epidural anesthesia. MATERIALS AND METHODS: Ninety-three male patients scheduled for TURP under epidural anesthesia were enrolled in this study. Patients were randomized into one of three groups. Group 1 consisted of 31 patients who received epidural 0.75% ropivacaine, group 2 consisted of 32 patients who received epidural ketamine (0.2 mg/kg) in addition to 0.75% ropivacaine, and group 3 consisted of 30 patients who received epidural ketamine (0.4 mg/kg) in addition to 0.75% ropivacaine. Shivering and side effects such as hypotension, bradycardia, nausea, and hallucination were recorded during the anesthesia and for 2 hours while in the postanesthetic recovery room. RESULTS: Shivering was statistically more frequent in group 1 than in the other groups. The incidence of sedation was significantly higher in group 3 than in the other groups. The incidences of side effects such as hypotension, bradycardia, and nausea were significantly higher in group 1 than in the other groups. CONCLUSIONS: In this study, epidural ketamine 0.2 mg/kg and 0.4 mg/kg was shown to have a lower incidence of shivering and other side effects except sedation. In patients who undergo TURP under epidural anesthesia, the prophylactic use of low-dose epidural ketamine would be helpful in preventing any adverse effects, including shivering.

Solitary Fibrous Tumor of Kidney / 대한비뇨기과학회지

Solitary fibrous tumors (SFTs) are a rare spindle-cell neoplasm originating from mesenchymal fibroblast-like cells. Although they generally arise from submesothelial connective tissue in the pleura, many other locations have also been described, including the mediastinum, upper respiratory tract, orbit, salivary gland, thyroid, and prostate. SFT of the kidney, however, has rarely been described, and only 1 case has been reported in Korea. A 53-year-old female visited our hospital for abdominal pain, and abdominopelvic computed tomography showed a heterogeneous well-enhanced mass in the renal pelvis. She was treated with a laparoscopic radical nephroureterectomy, which revealed an SFT of the kidney.

Effect of early oral intake on postoperative bowel function in patients undergoing lower extremities surgery under epidural anesthesia / 대한마취과학회지

BACKGROUND: Early oral intake (EOI) associated with early recovery of normal bowel function has been shown to be an important determinant for improving patients' satisfaction. We investigated the tolerability of EOI and its effects on the recovery of bowel function after epidural anesthesia. METHODS: A prospective randomized trial of patients undergoing lower extremities surgery under epidural anesthesia was performed. A liquid drink was given to 150 patients in the EOI group 1 hours after surgery, and to 150 patients in the delayed oral intake (DOI) group 8 hours after surgery. We recorded presence of bowel sounds immediately after operation, symptoms of ileus, time to the first flatus, time to the first defecation, degree of appetite before the first meal, and patients' satisfaction. RESULTS: There was no significant difference in the presence of immediate postoperative bowel sounds, the degree of appetite before the first meal, mild ileus, and severe ileus between groups. Time to the first flatus and time to the first defecation in the EOI group were shorter than those of the DOI group. The patients' satisfaction in the EOI group was higher than that of the DOI group. CONCLUSIONS: For uncomplicated patients undergoing lower extremities under epidural anesthesia, beginning oral hydration as early as 1 hour after the operation is safe and well tolerated and resulting in faster recovery of bowel function and higher patients' satisfaction.

Initial 4 Cases Experience of Male Sling Procedure for the Treatment in Patients with Post-prostatectomy Incontinence

There are 3 surgical treatments for the management of post-prostatectomy incontinence, including endoscopic injection of periurethral bulking agent, perineal sling procedure, and artificial urinary sphincter (AUS). 4 patients with post-prostatectomy incontinence in our hospital underwent sling procedure using polypropylene mesh. All patients were evaluated for urodynamic result, pad count, operative time, hospital stay, complication, success, and satisfaction. Mean age was 67.8years (64-75). Mean follow-up time was 38.5months (30-51). 2 patients underwent radical prostatectomy, and other 2 patients underwent transurethral prostatectomy. Of the 4 patients, 3 (75%) were successful. In satisfaction, 2 (50%) were unsatisfied due to recurrent incontinence and erectile dysfunction. The male sling procedure using polypropylene mesh is a simple, effective treatment and an additional therapeutic option.

Laparoscopic Excision of a Urachal Cyst Containing Large Stones in an Adult

Stone-containing urachal cysts are extremely rare in adults. Here, we report the case of a 58-year-old man with a urachal cyst who had lower abdominal pain and urinary frequency. Abdominal ultrasonography and computed tomography showed hyperdense stones in the urachus. He was treated with a laparoscopic excision using a transperitoneal approach. The pathological diagnosis was an inflammed urachal cyst. This rare case illustrates an inflammed urachal cyst containing stones treated with laparoscopy.

A Comparison of Minimally Invasive Surgical Techniques for Ureteropelvic Junction Obstructions: Endopyelotomy, Acucise Endopyelotomy, and Laparoscopic Pyeloplasty / 대한비뇨기과학회지

PURPOSE: The aim of this study was to compare the efficacy and outcomes of endopyelotomy, Acucise endopyelotomy, and laparoscopic pyeloplasty for patients with ureteropelvic junction obstructions. MATERIALS AND METHODS: We studied 45 patients with ureteropelvic junction obstructions who underwent minimally invasive surgeries between January 2001 and April 2007. Patients were divided into three groups according to operative procedure: group I, endopyelotomy(n=17); group II, Acucise endopyelotomy(n=12; and group III, laparoscopic pyeloplasty(n=16). RESULTS: The mean patient ages in the three groups were 42.7+/-17.2 years, 48.8+/-14.1 years, and 49.5+/-13.6 years for groups I, II, and III, respectively. The mean stricture lengths were 0.99+/-0.25cm, 0.93+/-0.10cm, and 1.03+/-0.38 cm for groups I, II, and III, respectively, and were not significantly different among the groups(p>0.05). The mean operating time for group II(55.7+/-25.3 minutes) was shorter than that for group I(131.7+/-30.5 minutes) and group III(165.2+/-23.7 minutes)(p<0.05). The length of hospital stay for group II(4.7+/-1.6 days) was shorter than that for group I(6.6+/-1.8 days) and group III(7.4+/-0.6 days)(p<0.05). Rates of symptomatic improvement were 58.8%, 66.7%, and 93.8% for groups I, II, and III, respectively. Rates of radiologic improvement were 58.8%, 66.7%, and 93.8% for groups I, II, and III, respectively. There was no significant correlation between success rate and either stricture length or degree of hydronephrosis. CONCLUSIONS: Laparoscopic pyeloplasty had the highest success rate among the minimally invasive surgeries for patients with ureteropelvic junction obstructions. However, when the stricture length is less than 1cm in length, Acucise endopyelotomy may be considered as the first treatment because the associated operating time and hospital stay are short

Ganglioneuroblastoma in a Patient with Crossed Testicular Ectopia / 대한비뇨기과학회지

Crossed testicular ectopia is a rare anomaly, in which both testes migrate toward the same hemiscrotum. Fewer than 100 cases of this condition have been reported in the literature worldwide. Occasionally, conditions initially suspected to be crossed testicular ectopia have proven to be other anomalies, including hypospadias, renal agenesis, and seminal vesicle cysts. In this case, we diagnosed ganglioneuroblastoma in a patient with testicular ectopia.

Ganglioneuroma in Pelvic Cavity / 대한비뇨기과학회지

Ganglioneuroma is a rare benign tumor which originates in the neural crest, and is found along the path of the sympathetic chain, from the base of the skull to the pelvic cavity. Due to the slow growth of this type of tumor, it may be detected incidentally, or detected by virtue of the attendant pressure effects on adjacent structures. We report one case of ganglioneuroma arising in the pelvic cavity.

The Utility of Amitryptiline in Female Overactive Bladder Patients with Nocturia / 대한비뇨기과학회지

PURPOSE: Anticholinergics suppress the muscarinic receptors in the bladder smooth muscle and, increase the level of urine storage. Their side effects include dry mouth, dry eyes, constipation, drowsiness, and tachycardia. These adverse effects limit the dosing and often decrease patient compliance. This study examined the effect of amitryptline as one of the first- line treatments for overactive bladder patients with nocturia. MATERIALS AND METHODS: Between June 2005 and June 2006, a prospective randomized study was carried out on 45 female patients with an overactive bladder. The mean age was 57.6 years and the patients were treated with doxazosin(Group I), doxazosin with tolterodine(Group II), doxazosin with amitriptyline(Group III). All 45(Group I: 15, Group II: 15, Group III: 15) were followed up for 4 weeks. The treatment efficacy was measured using the 3 days of voiding diaries. RESULTS: The actual number diurnal voids showed considerable improvement after treatment(p0.05). The actual number of nightly voids improved after treatment(p0.05). There was no difference in the total voiding volume, functional bladder capacity, nocturnal bladder capacity index, nocturia index between pre-treatment and post-treatment in each group(p>0.05). CONCLUSIONS: There are some enhanced effects with the actual number of diurnal voids and the actual number nightly voids in patients treated with doxazosin with amitriptyline. Therefore, amitripyline is helpful as a first- line treatment in female overactive bladder patients with nocturia.

Influence of Obesity on Laparoscopic Radical Nephrectomy / 대한비뇨기과학회지

PURPOSE: Our intension was to identify the influence of obesity on the operative results of laparoscopic renal surgery. Our study was performed on the basis of the body mass index(BMI). MATERIALS AND METHODS: Between March 2003 and December 2006, patients with localized renal cell cancer, who underwent a laparoscopic radical nephrectomy, were included in the study. The patients were divided into 3 groups according to their BMI: group I(BMI25). Patients with abdominal operation or radiation exposure histories were excluded from the study. The study started at the time of operator's overcoming of the learning curve for a laparoscopic radical nephrectomy. The operative data were retrospectively reviewed. RESULTS: Forty-one patients were included in the study. The mean ages of the three groups were 61.2+/-6.7, 58.2+/-6.1 and 59.2+/-5.7 years, respectively. The mean BMI were 20.3+/-2.6, 24.1+/-0.8 and 27.9+/-2.2 in groups I, II and III (n=15, 12 and 14), respectively. According to the degree of obesity, the operation time was meaningfully increased in group III(group I: 162.1+/- 39.4, group II: 147.5+/-17.5, group III: 199.4+/-2.2 minutes). The complications of a laparoscopic radical nephrectomy, including transfusion rate, had no relation with the degree of obesity. CONCLUSIONS: For a laparoscopic radical nephrectomy, obesity could influence the operative time, but not the complications.

Testicular T-cell Lymphoma / 대한비뇨기과학회지

Testicular lymphomas are rare, accounting for only 5% of all testicular tumors. The majority of these tumors are part of the disseminated disease process, and only rarely arise as a primary lesion. Most testicular lymphomas are B-cell lymphomas. Testicular T-cell lymphomas, are rarely detected, but have many subtypes according to the immunohistological feature, and have poor outcome and high relapse rates, even with a localized disease. Herein, 2 cases of testicular T-cell lymphoma, initially manifesting in the testis, are reported, with a review of the clinical features and outcomes.