Human Amniotic Fluid Stem Cell-derived Muscle Progenitor Cell Therapy for Stress Urinary Incontinence

The most promising treatment for stress urinary incontinence can be a cell therapy. We suggest human amniotic fluid stem cells (hAFSCs) as an alternative cell source. We established the optimum in vitro protocol for the differentiation from hAFSCs into muscle progenitors. These progenitors were transplanted into the injured urethral sphincter and their therapeutic effect was analyzed. For the development of an efficient differentiation system in vitro, we examined a commercial medium, co-culture and conditioned medium (CM) systems. After being treated with CM, hAFSCs were effectively developed into a muscle lineage. The progenitors were integrated into the host urethral sphincter and the host cell differentiation was stimulated in vivo. Urodynamic analysis showed significant increase of leak point pressure and closing pressure. Immunohistochemistry revealed the regeneration of circular muscle mass with normal appearance. Molecular analysis observed the expression of a larger number of target markers. In the immunogenicity analysis, the progenitor group had a scant CD8 lymphocyte. In tumorigenicity, the progenitors showed no teratoma formation. These results suggest that hAFSCs can effectively be differentiated into muscle progenitors in CM and that the hAFSC-derived muscle progenitors are an accessible cell source for the regeneration of injured urethral sphincter.

Comparison of Endo-GIA Stapler and Hem-o-lok Clip for the Vascular Control during Laparoscopic Nephrectomy / 대한비뇨기과학회지

PURPOSE: Vascular control is an important step during a laparoscopic nephrectomy. The application of an endovascular gastrointestinal anastomosis (endo-GIA) stapler has become a standard method for control of the renal vein during a laparoscopic nephrectomy. However, the device is expensive, and malfunctions resulting in significant complications have been reported. Recently, another stapling device (Hem-o-lok clip) has been developed and used for the management of the renal hilum during a laparoscopic nephrectomy. Herein, the uses of an endo-GIA stapler and Hem-o-lok clip were compared. MATERIALS AND METHODS: Between August 2002 and April 2006, 288 laparoscopic nephrectomies (68 simple, 115 radical, 70 live donor nephrectomies, 35 nephroureterectomies) were performed via transperitoneal (n= 211), retroperitoneal (n=11) or hand-assisted (n=66) approaches. All patients were evaluated by detailed history taking, physical examination and laboratory investigations. Renal vein control was achieved solely using either an endo-GIA stapler (n=146) or Hem-o-lok clip (n=142), and renal artery control was obtained using Hem-o-lok clips alone or in combination with metal clips. The technical difficulty in obtaining vascular control, and the safety, cost, transfusion requirement and clinical outcomes were evaluated. RESULTS: There were no statistically differences in the mean operation times and hospitalization stays between the two groups. No perioperative or postoperative complications occurred in the Hem-o-lok group. In contrast, two cases of inferior vena caval injury requiring open conversion, and one of postoperative rebleeding resulting in a reoperation, occurred in the endo-GIA group. Postoperative transfusions were required 17 and 7 cases in the endo-GIA and Hem-o-lok groups, respectively. CONCLISIONS: The Hem-o-lok technique is easy, safe and cost-effective compared to the endo-GIA stapler for vascular control during a laparoscopic nephrectomy.

A Comparison of Laparoscopic and Open Adrenalectomy in Patients with Pheochromocytoma / 대한비뇨기과학회지

PURPOSE: While the safety and efficacy of laparoscopic adrenalectomy are relatively well documented, this procedure remains challenging for pheochromocytoma. The purpose of our investigation was to assess the perioperative profiles of laparoscopic adrenalectomy (LA) with those of open adrenalectomy (OA) in patients with pheochromocytoma. MATERIALS AND METHODS: Between January 1997 and October 2005, 31 patients with pheochromocytoma underwent surgical removal, including 15 LA and 16 OA. The LA was performed via a lateral decubitus transperitoneal approach. The mean tumor size was similar in both groups (LA 6.0cm vs. OA 5.7cm). All patients underwent extensive preoperative medical preparation with alpha-blockers. The intraoperative hemodynamic instabilities and perioperative profiles were retrospectively analyzed. RESULTS: No conversion to open surgery was required with either procedure and no mortality was observed. Hypertensive crisis (systolic blood pressure>200mmHg) and severe tachycardia (heart rate>100/min) were more common in the OA group (LA 13.3 and 26.7% vs. OA 56.3 and 62.5%). The mean operating times for both groups were similar (LA 182.0+/-47.0 min vs. OA 183.1+/-66.5 min), but the duration of hospitalization was shorter in the LA group (LA 5.3+/-2.2 days vs. OA 6.8+/-1.0 days). The estimated blood loss was greater in the OA group (LA 103.3+/-44.2ml vs. OA 159.4+/-66.8ml). Intravenous morphine was needed in 56.3% of the OA, but in only 13.3% of the LA group. There were no significant differences in the postoperative complications between the two groups. CONCLUSIONS: The laparoscopic resection of pheochromocytomas can be accomplished safely and effectively. A short hospital stay, with minimal perioperative morbidity and the eradication of endocrinopathy, support the minimally invasive approach for adrenalectomy in patients with pheochromocytoma.

Amyloidosis of the Prostate / 대한남성과학회지

Amyloidosis of the prostate is a rare disease. With more patients undergoing biopsy of the prostate to exclude malignancy, the likelihood of identifying primary or secondary amyloidosis of the prostate has increased. We report a case of amyloidosis of the prostate in a 70-year-old man. The diagnosis was made from prostatic biopsy. Later, he was diagnosed with prostatic adenocarcinoma after transurethral resection of the prostate due to persistent lower urinary tract symptoms.

Amyloidosis of the Prostate / 대한남성과학회지

Amyloidosis of the prostate is a rare disease. With more patients undergoing biopsy of the prostate to exclude malignancy, the likelihood of identifying primary or secondary amyloidosis of the prostate has increased. We report a case of amyloidosis of the prostate in a 70-year-old man. The diagnosis was made from prostatic biopsy. Later, he was diagnosed with prostatic adenocarcinoma after transurethral resection of the prostate due to persistent lower urinary tract symptoms.

Risk Factors for Subsequent Bladder Cancer Recurrence following Radical Surgery for Upper Urinary Tract Urothelial Cancer / 대한비뇨기과학회지

PURPOSE: The purpose of this study was to determine the clinical and pathological risk factors for subsequent bladder recurrence for the patients suffering with transitional cell carcinoma in the upper urinary tract (UUT-TCC) following radical surgery, and these factors should allow more accurate prediction of the disease outcome. MATERIALS AND METHODS: Between 1995 and 2004, a total of 71 patients underwent total nephroureterectomy for UUT-TCC. Patients with concomitant or previous bladder tumor or a follow-up period of less than 1 year were excluded in this study. Univarariate and multivariate analysis by Cox's proportional hazards model was used to determine the independent risk factors for intravesical tumor recurrence. RESULTS: Fifteen out of 71 patients (21.1%) experienced subsequent intravesical tumor recurrence during a mean follow-up period of 16.5 months (range: 3-28). On univariate analysis, tumor size, multiplicity, stage and grade were significantly correlated with subsequent intravesical tumor recurrence. On the multivariate analysis, tumor stage and multiplicity had a statistically significant impact on the risk of subsequent intravesical tumor recurrence. CONCLUSIONS: Tumor stage and multiplicity are important factors for subsequent intravesical tumor recurrence in the patients who suffer with UUT-TCC following surgery. Therefore, closer follow-up might necessary for patients with multiple foci and high stage UUT-TCC for the early detection of subsequent intravesical tumor recurrences.