Predictive Factors for Bleeding During Percutaneous Nephrolithotomy

PURPOSE: Although percutaneous nephrolithotomy (PCNL) has been accepted as a standard method for the management of large renal stones, the incidence of renal hemorrhage is relatively high. This study investigated the variables that affect bleeding during PCNL. MATERIALS AND METHODS: The medical records of 370 patients who underwent PCNL by a single surgeon from January 2005 to December 2010 were reviewed retrospectively. All patients were divided into two groups according to median blood loss (lesser bleeding group and higher bleeding group). Various clinical and perioperative factors including age, sex, stone size and position, degree of hydronephrosis, operative time, underlying disease, history of anticoagulant medication, presence of previous nephrostomy catheter, stone composition, and thickness of the renal cortex were assessed. For statistical assessment, univariate and multivariate logistic regression analyses were used. RESULTS: The mean patient age was 48.8 years (range, 22 to 75 years). Forty-three patients (11.6%) received a transfusion and 9 patients (2.4%) underwent angioembolization after surgery. The mean blood loss was 511.8+/-341.3 mL. Body mass index (BMI), stone size, stone position, operation time, and degree of preoperative hydronephrosis were predictive factors for severe bleeding during PCNL. CONCLUSIONS: On the basis of the results achieved by a single surgeon, staghorn stones, high BMI, large stones, prolonged operation time, and absence of hydronephrosis were significantly associated with the risk of severe bleeding during PCNL.

Efficacy of Percutaneous Nephrostomy During Flexible Ureteroscopy for Renal Stone Management

PURPOSE: Preoperative percutaneous nephrostomy (PCN) can be applied to urinary stone patients with pyelonephritis as well as obstructive uropathy; thus, some patients undergo flexible ureteroscopy (fURS) in the presence of a PCN tube. We evaluated the effectiveness of PCN during fURS for the management of renal stones. MATERIALS AND METHODS: We retrospectively analyzed 130 consecutive patients who underwent fURS for renal stones between January 2009 and December 2011. All fURS procedures were performed by a single experienced surgeon. The patients were divided into two groups depending on the presence of PCN during the surgery: patients with PCN (group 1, n=41) and patients without PCN (group 2, n=89). To evaluate operative outcomes, we compared success rates, operative times, and complication rates. We defined success as the absence of any residual stones in the kidney or stone fragments less than 2 mm that were too small to be extracted during follow-up. RESULTS: There were no significant differences in age, sex, body mass index, stone laterality, burden, or location between the two groups. The mean operative times of groups 1 and 2 were 50.1 and 58.3 minutes, respectively (p=0.102). The success rates of groups 1 and 2 were 95.1% and 82.0%, respectively (p=0.044). There was no statistically significant difference in the complication rate between groups 1 and 2 (p=0.888). CONCLUSIONS: Flexible ureteroscopy in the presence of PCN produced a superior outcome in terms of the success rate without increasing the operative time or complication rate. PCN may be helpful to induce better outcomes of fURS.

A Trial of Screening of Genes Involved in Odontoblasts Differentiation from Human Dental Pulp Stem Cells

This study investigated the genes involved in the differentiation of odontoblasts derived from human dental pulp stem cells (hDPSCs). hDPSCs isolated from human tooth pulp were validated by fluorescence activated cell sorting (FACS). After odontogenic induction, hDPSCs were analyzed investigated by Alizaline red-S staining, ALP assay, ALP staining and RT-PCR. Differential display-polymerase chain reaction (DD-PCR) was performed to screen differentially expressed genes involved in the differentiation of hDPSCs. By FACS analysis, the stem cell markers CD24 and CD44 were found to be highly expressed in hDPSCs. When hDPSCs were treated with agents such as beta-glycerophosphate (beta-GP) and ascorbic acid (AA), nodule formation was exhibited within six weeks. The ALP activity of hDPSCs was found to elevate over time, with a detectable up-regulation at 14 days after odontogenic induction. RT-PCR analysis revealed that dentin sialophosphoprotein (DSPP) and osteocalcin (OC) expression had increased in a time-dependent manner in the induction culture. Through the use of DD-PCR, several genes were differentially detected following the odontogenic induction. These results suggest that these genes may possibly be linked to a variety of cellular process during odontogenesis. Furthermore, the characterization of these regulated genes during odontogenic induction will likely provide valuable new insights into the functions of odontoblasts.

Apoptotic Effects of Genistein, Biochanin-A and Apigenin on LNCaP and PC-3 Cells by p21 through Transcriptional Inhibition of Polo-like Kinase-1

Natural isoflavones and flavones are important dietary factors for prostate cancer prevention. We investigated the molecular mechanism of these compounds (genistein, biochanin-A and apigenin) in PC-3 (hormone-independent/p53 mutant type) and LNCaP (hormone-dependent/p53 wild type) prostate cancer cells. A cell growth rate and apoptotic activities were analyzed in different concentrations and exposure time to evaluate the antitumor activities of genistein, biochanin-A and apigenin. The real time PCR and Western blot analysis were performed to investigate whether the molecular mechanism of these compounds are involving the p21 and PLK-1 pathway. Apoptosis of prostate cancer cells was associated with p21 up-regulation and PLK-1 suppression. Exposure of genistein, biochanin-A and apigenin on LNCaP and PC-3 prostate cancer cells resulted in same pattern of cell cycle arrest and apoptosis. The inhibition effect for cell proliferation was slightly greater in LNCaP than PC-3 cells. In conclusion, flavonoids treatment induces up-regulation of p21 expression, and p21 inhibits transcription of PLK-1, which promotes apoptosis of cancer cells.

Antegrade Flexible Ureteroscopy for Bilateral Ureteral Stones in a Patient with Severe Hip Joint Ankylosis

In the past several decades there has been a remarkable development of small-caliber, flexible ureteroscopes and various ancillary instruments for stone manipulation and retrieval. Percutaneous antegrade ureteroscopy can be substituted in select cases for retrograde ureteroscopy. We report a case of a 60-year-old man with severe ankylosis in both hip joints who was diagnosed with bilateral ureteral stones. The patient underwent antegrade flexible ureteroscopy and laser lithotripsy. This case illustrates the role of antegrade flexible ureteroscopy combined with the holmium:YAG laser as a minimally invasive, safe, and effective technique for the management of stones in a patient who cannot undergo a retrograde approach.

Transurethral Resection of Prostate for Large Benign Prostatic Hyperplasia: a Comparative Study with Open Prostatectomy / 대한남성과학회지

PURPOSE: Open prostatectomy have been considered primarily when the prostate volume is large(e.g. >75 cc). However, with the development of surgical skills and instruments, transurethral resection of prostate(TURP) can be an alternative. We assessed the feasibility of TURP for patients with large benign prostatic hyperplasia(BPH) by comparing the efficacy of TURP with that of open prostatectomy, retrospectively. MATERIALS AND METHODS: From January 2000 to March 2005, a total of 54 BPH patients with a prostate larger than 75 cc in volume on transrectal ultrasonography underwent surgery in our hospital. Among these patients, 26 patients underwent TURP(Group T) and 28 patients underwent suprapubic prostatectomy(Group O). Group T was subclassified Group T-1(prostate volume 75~100 cc, n=12) and T-2(prostate volume > or = 100 cc, n=14). In the same way, Group O was divided into Group O-1(n=9) and O-2(n=19). Operative time, time to catheter removal, hospitalization, and complications were compared. Operative results were evaluated at 6 months postoperative by comparing preoperative and postoperative International Prostate Symptom Scores(IPSS), maximal flow rates(Qmax) and post void residual(PVR). RESULTS: Preoperatively, there were no significant differences in IPSS, Qmax or PVR between Groups T-1 and O-1 or between Groups T-2 and O-2. Although delta IPSS, delta Qmax and delta PVR improved in Group O-2 more than T-2, there were no statistically significant differences between Group T-1 and O-1. The mean operative time, time to catheter removal, and hospitalization were shorter in Group T than Group O. Postoperative complication rates were similar in the T and O groups. In Group T, there was no TUR syndrome, but urinary tract infections and urethral stricture were more common than in Group O. However, Group O had higher incidences of severe complications, including wound infection or bleeding requiring transfusion. CONCLUSIONS: Open prostatectomy is commonly considered when prostate volume is greater than 75 cc. If enough resection is performed, TURP is a valuable non-invasive surgical method with respect to absence of incision, effective symptom improvement, and short hospitalization in symptomatic BPH patients who have prostate volume less than 100 cc.

Analysis of Urinary Stone Components during the Last Two Decades / 대한비뇨기과학회지

PURPOSE: The accurate analysis of urinary stone components is fundamental for studying of the etiology of stone formation and it is essential for the treatment of urinary stone and its prevention. We compared the analysis of urinary stone components during the last two decades. MATERIALS AND METHODS: Stone analysis was performed by Louis C. Herring and Company. The urinary stones were aobtained from January, 1986 to December, 2005. We compared the stone components of the first decade (Group A, 301 cases) with that of the second decade(Group B, 158 cases). RESULTS: The mean age was 47.2+/-14.5 in Group A and 46.0+/-10.2 in Group B(p=0.658). The ratio of males to females was 2.04:1 in Group A and 1.98:1 in Group B(p=0.888). Ureteral stones were the most common stones in both groups. Among all the components analyzed in Group A, calcium oxalate made up 73.1% of the total. Other components found in the stones were uric acid 12.3%, calcium phosphate 8.3%, magnesium ammonium 5.3%, ammonium acid urate 0.7% and cystine 0.3%. In Group B, calcium oxalate was only 56.3% of the total and uric acid was 22.2%, calcium phosphate was 11.4%, magnesium ammonium phosphate was 8.2%, ammonium acid urate was 1.3% and cystine was 0.6%. On comparison of the stones of the two groups, the incidence of calcium oxalate was decreased in Group A(73.1% vs 56.3%, p0.05). CONCLUSIONS: In this study, the incidence of calcium oxalate was decreased and that of the uric acid was increased in the recent decade. These changes of stone components probably resulted from the increased animal protein diet.

A Randomised, Double-Blind, Parallel, Placebo-Controlled Study of the Efficacy and Safety of Tadalafil Administered On-Demand to Men with Erectile Dysfunction in Korea / 대한비뇨기과학회지

PURPOSE: Tadalafil is a phosphodiesterase type 5 inhibitor that is used for the treatment of erectile dysfunction (ED). Previous clinical trials have assessed its efficacy and safety in Western populations, but this drug has not been investigated in a large clinical trial involving Korean men with ED. Thus, the aim of this study was to assess the efficacy and safety of 20 mg tadalafil in comparison to placebo when it is taken on demand by Korean men suffering with ED over a study period of 12 weeks. MATERIALS AND METHODS: Men more than 18 years of age with mild to severe ED of various etiologies were randomized to receive placebo or tadalafil 20 mg that was taken as needed (maximum once daily). Efficacy assessments included the International Index of Erectile Function (IIEF), the Sexual Encounter Profile (SEP) diary and Global Assessment Questions (GAQ). RESULTS: Tadalafil significantly improved erectile function, as measured by the erectile function domain of the IIEF, compared to placebo (p<0.001). At the endpoint, the patients receiving tadalafil 20mg reported a greater mean per-patient percentage of successful intercourse attempts (SEP3: 71% compared to 31% for placebo) and a greater proportion of improved erections (GAQ: 80% compared to 44%). The most common treatment emergent adverse events were headache (16.3%), flushing (5%) and eye pain (5%), and most of the adverse events were mild or moderate in severity. CONCLUSIONS: Tadalafil was an effective, well-tolerated therapy for Korean men suffering with ED of broad-spectrum severity and etiology.

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.

Comparison of Renal Hemorrahge According to Technique of Percutaneous Tract Dilation in Percutaneous Nephrolithotomy / 대한비뇨기과학회지

Purpose: The incidence of renal hemorrhage and the transfusion rates in patients undergoing balloon or Amplatz fascial dilation of the nephrostomy tract during percutaneous nephrolithotomy (PCNL) were compared. Materials and Methods: The medical records of 100 patients who underwent PCNL were reviewed. The nephrostomy tract was dilated with either a balloon (53 patients) or Amplatz sequential (47 patients) dilators. The time required for nephrostomy tract dilation, the stone burden, perioperative blood hemoglobin level and blood transfusion rates were compared between the two groups. Results: Of the 47 patients that underwent percutaneous renal Amplatz dilatation, 14 (29%) required a blood transfusion, compared to only 7 of the 53 (13%) that underwent balloon dilation. The difference in the transfusion rates between the 2 groups was statistically significant (p=0.04). The time required for nephrostomy tract dilation was also shorter with balloon than Amplatz dilation (6.5 versus 12.3 minutes, p=0.02). Conclusions: Balloon dilation led to less renal hemorrhage and lower transfusion rates compared to Amplatz dilation during PCNL. Additionally, the time required for nephrostomy tract dilation was shorter with balloon dilation.)

Embryonic Developmental Capacity and Pregnancy Rates of Fertilized Oocytes in IVF, ICSI and TESE-ICSI Cycles / 대한불임학회지

OBJECTIVE: This study was performed to evaluate and compare the embryonic developmental capacity and pregnancy rates in conventional in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) with ejaculated sperm or testicular sperm cycles. MATERIALS AND METHODS: Fertilization was examined in the following morning after IVF (group I), ICSI (group II) or TESE-ICSI cycles (group III). Fertilized oocytes were co-cultured with Vero cells until embryo transfer (ET). On day 2 and 5~7, grades of embryos ( or =4-cell) and blastocysts (BG1, 2, 3 or early) were evaluated. Clinical pregnancy rate was determined by detecting G-sac with transvaginal ultrasonogram. We analyzed the results bychi2 and Student's t-test and considered statistically significant when P value was less than 0.05. RESULTS: Fertilization rate was significantly higher (p<0.05) in group I (79.0+/-21.2%) than in group II and III (56.8+/-21.6% and 36.7+/-25.3%). Cleavage and blastulation rate of group I (95.8+/-13.8% and 59.5+/-25.3%) were significantly higher (p<0.05) than those of group III (83.4+/-18.6% and 40.4+/- 36.5%). Clinical pregnancy rate was significantly higher (p<0.05) in group I and II (40.7% and 41.7%) than that in group III (12.5%). No differences were found in the rates of multiple pregnancy and abortion among three groups. Embryonic implantation rate was higher in group I (15.1+/-20.2%, p<0.05) and II (14.7+/-20.6%, NS) than that in group III (5.1+/-15.6%). However, embryonic implantation rate was increased in ET with blastocyst(s) among three groups. CONCLUSIONS: Fertilized oocytes obtained from TESE-ICSI were harder to be successfully cultured to blastocyst stage for 5~7 days than that from IVF cycles. However, all blastocyst(s) ET increased the embryonic implantation rate equally in IVF, ICSI and TESE-ICSI cycles.

Laparoscopic Nephrectomy for Ectopic Dysplastic Kidney / 대한비뇨기과학회지

A single dysplastic ectopic kidney associated with ectopic ureter or ureterocele defies detection even with repeated examinations using conventional imaging modalities and cystovaginoscopy under anesthesia, thus leading to significant delay in diagnosis and appropriate treatment. Laparoscopy can be a useful modality for the diagnosis, and also the treatment, of small ectopic kidney not found with conventional diagnostic method. We report three cases of transperitoneal laparoscopic nephrectomy for ectopic dysplastic kidney.

Intrarenal Epidermal Cyst / 대한비뇨기과학회지

Epidermal cysts are benign cysts, which rarely localize in solid organs, but have an unclear pathogenesis. Herein, a case of an intrarenal epidermal cyst, in a 60-year-old woman with right flank pain, is reported. Multiple renal stones in the right kidney were identified by an intravenous pyelogram. A percutaneous nephrolithotomy (PCNL) was performed under the assumption of renal stones. Amorphorous cysts, containing calcification, were identified during the PCNL, which were histologically identical in appearance to an epidermal cyst within the skin. We suspected the pathogenetic mechanism of this lesion was a metaplasia of traumatic origin, due to the patient's history of renal stones, which had been previously treated with an open nephrolithotomy. According to the literature, an intrarenal epidermal cyst was usually treated by nephrectomy, under the assumption of a renal mass. Although the intrarenal epidermal cyst was incidentally found during the PCNL, an additional nephrectomy was not performed as it had almost been removed.

Intrarenal Epidermal Cyst / 대한비뇨기과학회지

Epidermal cysts are benign cysts, which rarely localize in solid organs, but have an unclear pathogenesis. Herein, a case of an intrarenal epidermal cyst, in a 60-year-old woman with right flank pain, is reported. Multiple renal stones in the right kidney were identified by an intravenous pyelogram. A percutaneous nephrolithotomy (PCNL) was performed under the assumption of renal stones. Amorphorous cysts, containing calcification, were identified during the PCNL, which were histologically identical in appearance to an epidermal cyst within the skin. We suspected the pathogenetic mechanism of this lesion was a metaplasia of traumatic origin, due to the patient's history of renal stones, which had been previously treated with an open nephrolithotomy. According to the literature, an intrarenal epidermal cyst was usually treated by nephrectomy, under the assumption of a renal mass. Although the intrarenal epidermal cyst was incidentally found during the PCNL, an additional nephrectomy was not performed as it had almost been removed.

The Supracostal Transhepatic Approach for Percutaneous Nephrolithotomy / 대한비뇨기과학회지

The optimal approach for a staghorn, large upper calyceal or complex renal stone burden is through the upper pole posterior calyx, which at times is best accomplished by a supracostal puncture. A supracostal posterior calyx puncture is usually of concern due to the potential complications of pneumothorax, hydrothorax and lung injury. A case of right upper calyceal calculi is reported in a 25-year-old male, who was managed by a supracostal transhepatic percutaneous nephrolithotomy.

Comparison of Artificial Synthetic Material and Antibacterial Ointment for Treatment of Partial Thickness Skin Burn

BACKGROUND: Burn is one of the most common illness in primary care. Most burns are partial skin thickness burns. The purpose of this study was to evaluate the use ofSilvadene (silver sulfadiazine) ointment (antibacterial agent) and DuoDERMR (artificial syntheticmaterial). METHODS: The subjects of this study were 46 patients with partial skin thickness burns who had visited a general hospital burn clinic from May 1, 2002 to June 30, 2002. They were randomly assigned to the silvadine ointment or DuoDERMR group. The patients were evaluated for pain, the number of dressing change, the ease of dressing application and removal, limitation of activity, comfortableness, satisfaction with the appearance, sleep disturbance, treatment cost, and the number of days for complete epithelialization. RESULTS: DuoDERMR treated burns had a fewer dressing change (3.19 times vs 5.36 times), less time for dressing change (4.13 min vs 6.26 min) and less cost (P<0.01). But there was no statistical difference in the number of days for complete epithelialization (P=0.197) and it depended on the size of the wounds (P=0.005). The cost of treatment was related with the number of dressing change (P=0.000). CONCLUSION: Treatment methods had no effect on duration of treatment but artificial synthetic material was shown to reduce the time for dressing and the cost.

Therapeutic Effectiveness of In Situ Anterior Vaginal Wall Sling in Patients with Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: To determine the efficacy and safety of the in situ anterior vaginal wall sling procedure for the treatment of anatomical incontinence (AI) and intrinsic sphincter dysfunction (ISD). MATERIALS AND METHODS: A total of 53 women (31 with AI and 22 with ISD), having undergone in situ anterior vaginal wall sling procedures, were reviewed. The preoperative evaluation included a detailed history taking, physical examination and urodynamic study, including Valsalva leak point pressure (VLPP) and incontinence staging, with Stamey grade. The efficacy and clinical outcome of this procedure were accessed by telephone interviews. RESULTS: With a mean follow up of 30.8 months (24-52), 49 (92.5%) of the 53 patients were completely continent or improved. The success rate of AI and ISD patients were 93.5 and 90.9% respectively. One patient (1.9%) required a prolonged Foley catheter drainage of up to 2 weeks. Sixteen (84.2%) out of the 19 patients with preoperative urge incontinence improved postoperatively, and de novo urge incontinence developed in 1 patient (1.9%). Postoperative wound infections developed in 3 patients (5.7%). CONCLUSIONS: The in situ anterior vaginal wall sling procedure can be an effective and safe surgical treatment option in both AI and ISD patients.

Ureteral Obstruction Caused by Pelvic Actinomycosis / 대한비뇨기과학회지

Actinomycosis is a chronic suppurative granulomatous disease caused by anaerobic gram positive Actinomyces. Pelvic actinomycosis is a rare, but not unusual complication in the use of intrauterine contraceptive devices. In most cases, unilateral or bilateral tubo-ovarian abscesses are present. Pelvic actinomycosis can lead to pelvic inflammatory disease, abdominal wall abscess, vesico-uterine fistula, ureteral obstruction, ileopelvic fistula, and pyometra. Only a few cases of ureteral obstruction caused by pelvic actinomycosis in intrauterine contraceptive device users have been reported. We report a case of ureteral obstruction caused by pelvic actinomycosis in a patient with an intrauterine contraceptive device.

A Clinical Analysis of Thyroglossal Duct Cyst and Sinus

PURPOSE: Anomalies in the thyroglossal duct are the most common midline, or paramedian cervical lesions of congenital origin. Presenting as a thyroglossal duct cyst (TGDC) or a thyroglossal duct sinus (TGDS), they are found in all age groups. This clinical study was intended to elucidate the clinical characteristics, and the outcomes, of surgical treatment of these anomalies. METHODS: Between January 1992 and May 2002, 91 patients underwent surgery for a TGDC or a TGDS at 4 hospitals affiliated to Hallym University. The demographics of the patients, the clinical characteristics of the lesions, and the outcomes of the treatments were retrospectively evaluated. These characteristics were evaluated according to age groups; younger than 15 (38 patients) and older than 15 (53 patients) years. RESULTS: The male to female ratio was 1.67: 1 (It is better to give the actual figures.), with the first decade showing the highest incidence in the age distribution (33%). Painless masses (83.6%) were the most common presenting symptom, with most symptoms having been manifest for less than 1 year (67%). TGDCs were 90% and TGDSs were 10%. There were 62 cases of infrahyoid and 18 of suprahyoid lesions, with 80 cases on the midline and 11 on the paramedian within 2 cm from the midline. Of the paramedian lesions, 2 cases were in the younger group and 9 were in the older group. This tendency of laterality in the location by age group showed no statistical significance (p=0.172). All the patients underwent a Sistrunk operation, and one experienced a recurrence. CONCLUSION: This study justified the Sistrunk operation as the treatment of choice for anomalies of the thyroglossal duct. The lateral lesions occurred in the old age groups more frequently. A careful approach is needed with paramedian cervial lesions in adults to avoid the loss of the proper treatment of possible hidden congenital lesions.