No abstract available.
Biopsy* ; Prostate*

No abstract available.
Ureter*

PURPOSE: Recent studies report that up to 40 to 50% of patients who were thought to have clinically localized disease were found to be understaged subsequent to radical surgery. Clearly, development of more sensitive means to identify patients with micrometastatic, locally invasive disease is warranted. With the development of molecular biology, we can apply reverse transcriptase-polymerase chain reaction (RT-PCR) that allows us to identify PSA-synthesizing cells in peripheral blood even when they are highly diluted in a population of peripheral lymphocytes. In this study, we will evaluate the role of RT-PCR in molecular staging of prostate cancer to apply it to clinical situations. MATERIALS AND METHODS: Peripheral blood was obtained from a wide variety of patients with and without prostate cancer before radical prostatectomy. After ribonucleic acid isolation, complementary deoxyribonucleic acid was generated and amplified with a hot-start technique. RT-PCR results were compared with pathologic stage, Gleason score, serum PSA and tumor volume. RESULTS: The RT-PCR test was positive in 0 of 20 controls without suspicion of prostate cancer. Before radical prostatectomy a positive test was obtained in 2 of 9(22.2%) with pT2 disease versus 3 of 5(60%) with pT3 disease. A positive test was obtained in 5 of 6(83.3%) with overt lymph node or bone metastatic disease. We obtained intermittent RT-PCR positive results in serial procedures with two overt bone metastatic cancer patients. There was no significant difference in serum PSA, Gleason score or tumor volume between the men with positive or negative results. CONCLUSIONS: The PSA RT-PCR test in our laboratory cannot be used preoperatively to predict accurate pathological stage of prostate cancer who have undertaken radical prostatectomy. But there is a tendency that PSA mRNA was more frequently detected with higher stage. If the methodology of RT-PCR is refined and improved and sample size increased, RT-PCR for PSA mRNA will become a valuable tool for the evaluation of prostate cancer patients.
DNA ; Humans ; Lymph Nodes ; Lymphocytes ; Male ; Molecular Biology ; Neoplasm Grading ; Prostate* ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms* ; RNA ; RNA, Messenger ; Sample Size ; Tumor Burden

Renal cell carcinoma may metastasize to various portions of the body but dissemination to the prostate is very rare. The presenting symptom of a 79 year old man was acute urinary retention which was clinically thought to be benign prostatic hyperplasia. Radical nephrectomy was performed 22 months ago due to renal cell carcinoma. The histologic examination of the transurethral resection specimen demonstrated metastatic renal cell carcinoma and there was no distant metastasis except the lymph node.
Aged ; Carcinoma, Renal Cell* ; Humans ; Lymph Nodes ; Neoplasm Metastasis* ; Nephrectomy ; Prostate* ; Prostatic Hyperplasia ; Urinary Retention

PURPOSE: Recently, many alternative forms of non-surgical treatment modalities were devised for the management of BPH and one of them is transurethral radiofrequency thermotherapy(TURT). In this study, we investigated the long term efficacy of TURT. MATERIALS AND METHOD: A total of 132 patients with symptomatic BPH were treated in a single session with TURT using Thermex-ll(47.5 degrees C, 150minutes) and 88 patients who were available to follow-up for more than 6 months after TURT were enrolled in this study. Among them, 65 patients were available to follow-up for more than 2 years. The baseline and post-treatment mean symptom score(Madson-Iversen), maximal flow rate(MFR), residual urine volume and prostate volume were compared. Improvement was defined as a reduction of more than 50% in at least one of two parameters(symptom score and maximal flow rate). We also investigated whether other treatment modalities were selected in 2 years after TURT. RESULTS: At 3 months follow-up, improvements were observed in 59.1%(52/88), and at 6 months 54.5%(48/88). However, improvements in both symptom score and maximal flow rate at 3 and 6 months after treatment were only 27.3% and 20.5%, respectively. Among 65 patients who were available to follow-up for more than 2 years, 27 patients(41.5%) had undergone transurethral resection of the prostate either with(19) or without medication(8). 28 patients (43.1%) received medical therapy such as alpha blocker during the last two years after TURT. The post-treatment values of the 10 patients who had not received adjuvant therapy were not significantly different from those at baseline. CONCLUSIONS: Although thermal treatment for BPH is an alternative option with minimal complication in selected symptomatic patients who are not clear candidates for surgery or high-risk patients, the long term effect of TURT is not sufficient to relieve the obstructive and irritative symptoms of BPH.
Follow-Up Studies ; Humans ; Hyperthermia, Induced* ; Prostate ; Prostatic Hyperplasia*

PURPOSE: In order to help identifying the subgroups of primary megaureter who neck operation, we retrospectively reviewed the clinical records of the patients who had primary megaureters without vesicoureteral reflux. MATERIALS AND METHODS: We analyzed the initial differential renal function, UTI rate and the incidence of breakthrough infection of each group. Every patient had abdominal renal ultrasonograms and diuretic renograms during his/her follow-up period and the calyceal changes and differential renal functions were assessed. RESULTS: Those who underwent operation in their neonatal period did not have considerable postoperative problems. Those with primary obstructive megaureters who underwent operation had severe calyceal dilatation at the initial evaluation. However, there were severe calyceal dilatation in the nonobstructive-nonrefluxing group, too. Those who had poor differential renal function at the initial evaluation had a greater chance to have surgical correction. Those who were classified as primary obstructive megaureter and underwent operation had a higher rate of urinary tract infection than the counterpart who had consevative care. CONCLUSIONS: In order to differentiate those who need operation, we think that the differential renal function, the calyceal morphology, The diuretic renogram curve and urinary tract infection all act as combined factors altogether and not a single factor acts as a contributing factor. That is, if the diuretic renogram cutie is obstructive and there is urinary tract infection in the initial evaluation or if there is severe calyceal dilatation and decline of the differential renal function, we think that surgical correction should be under consideration. In contrast, if the diuretic renogram cutie is not obstructive and there are other factors combined, we think that conservative treatment should be the choice only if there is no breakthrough infection.
Dilatation ; Follow-Up Studies ; Humans ; Incidence ; Neck ; Retrospective Studies ; Ultrasonography ; Urinary Tract Infections ; Vesico-Ureteral Reflux*

PURPOSE: Video-assisted minilaparotomy surgery (VAMS) is a hybrid of conventional open and laparoscopic surgeries, which combines the benefits of both techniques. Our initial experiences with 33 cases were analyzed to assess the feasibility of VAMS. MATERIALS AND METHODS: Between May 2004 and April 2006, a total of 33 patients underwent VAMS-radical (n=20) and VAMS-live donor nephrectomies (n=13). The results of each operation were analyzed in terms of patient age, operation time, blood loss during surgery, time of oral intake and full ambulation, post operative stay period and amount of analgesic use. RESULTS: The mean age of the patients that had undergone the VAMS- radical and VAMS donor nephrectomies were 55.9 12.4 and 36.0 8.6 years, respectively. The mean results of the VAMS radical nephrectomy and VAMS donor nephrectomy with regard to the operative time, blood losses, time to oral intake, time to ambulation, postoperative length of stay and postoperative length of analgesics use were 225+/-72 / 253+/-67 minutes, 378+/-254 / 447+/-208cc, 2.1+/-0.7 / 1.4+/-0.5 days, 2.1+/-1.1 / 1.6+/-0.7 days, 6.2+/-1.1 / 6.2+/-1.0 days and 1.7+/-0.8 / 1.6+/-0.5 days, respectively. The mean warm ischemic time of VAMS donor nephrectomy was 2.4+/-0.8 minutes. The mean operation time of the 10 earliest cases of VAMS radical nephrectomy was 283 minutes; whereas, that of the last 10 cases decreased to 166 minutes. The mean operation time of the 7 earliest cases of VAMS donor nephrectomy was 299 minutes, which decreased to 206 minutes in the last 6 cases. Complications included 3 wound extensions in 5 patients experiencing massive intraoperative bleeding, 1 pneumonia, 1 wound dehiscence and 1 postoperative bleeding, all of which occurred in the 8 earliest cases. CONCLISIONS: VAMS could be a safe and feasible minimally invasive surgical procedure as experience is accumulated; when the initial learning curve has been overcome.
Analgesics ; Hemorrhage ; Humans ; Laparoscopy ; Laparotomy* ; Learning Curve ; Length of Stay ; Nephrectomy ; Operative Time ; Pneumonia ; Tissue Donors ; Walking ; Warm Ischemia ; Wounds and Injuries

PURPOSE: Men with documented chronic prostatitis, with elevated serum prostate specific antigen (PSA), were investigated to assess whether treatment lowers serum PSA and thus avoids unnecessary biopsies. MATERIALS AND METHODS: The medical records of 46 men who presented with serum PSA higher than 4ng/ml, and subsequently diagnosed with chronic prostatitis, were retrospectively reviewed. After the administration of antibiotics and anti-inflammatory drugs for 4 to 8 weeks, the follow-up PSA levels were determined, and those with levels higher than 4ng/ml underwent a prostate biopsy. RESULTS: The mean PSA level decreased 61% from 11.66ng/ml before, to 3.79ng/ml after, treatment (p<0.001). In 30 patients the serum PSA level decreased to below 4ng/ml (mean 1.69), with these patients no longer having an indication for a prostate biopsy. In the remaining 16 patients the serum PSA level remained elevated above 4ng/ml, so they underwent a prostate biopsy. Pathological study revealed benign prostatic hyperplasia in 11 cases and prostate cancer in 5. The PSA level in patients associated with benign prostatic hyperplasia decreased 61.9% with treatment, from 19.96 to 7.88ng/ml (p=0.006) and the PSA in those associated with prostate cancer decreased 30.6% with treatment, from 12.85 to 7.32ng/ml (p<0.05). CONCLUSIONS: This study demonstrates that chronic prostatitis can cause elevation of serum PSA levels, and when identified, antibiotics and anti-inflammatory treatment can lower these levels and an unnecessary prostate biopsy can be avoided.
Anti-Bacterial Agents ; Biopsy ; Follow-Up Studies ; Humans ; Male ; Medical Records ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Prostatitis* ; Retrospective Studies

PURPOSE: We evaluated the results of Holmium:YAG laser lithotripsy according to the size and location of the ureteral stones. MATERIALS AND METHODS: Between March 1998 and April 2007, the medical records of 203 patients who were treated with ureteroscopic Holmium: YAG laser lithotripsy due to ureteral calculi were reviewed. They were subgrouped by the size and the location of the ureteral stones. The results of treatment were evaluated by the stone free rate and the mean operation time of each group. RESULTS: The stone free rates of the upper, mid and lower ureter stone groups were 73.3%, 96.1% and 100%, respectively. There was a significant difference in the upper ureter stone group compared to the other two groups, and especially for the group with stone less than 10mm. Stone migration into the renal pelvis or calyx was a major cause of failure in the patients with upper ureter stones. 8 cases showed stone migration and 2 cases showed fragment migration. CONCLUSIONS: As Holmium:YAG laser lithotripsy has a low complication rate and a high stone free rate, it is an effective treatment modality for ureteral calculi. However, such procedures should be performed carefully because the thermal effect of the Holmium:YAG laser causes ureteral perforation, and especially in the cases of impacted or large stones. Other effective alternatives such as trapping devices need to be studied for patients with upper ureteral stones to prevent stone migration.
Holmium ; Humans ; Kidney Pelvis ; Lasers, Solid-State ; Lithotripsy ; Lithotripsy, Laser ; Medical Records ; Ureter ; Ureteral Calculi

PURPOSE: Asymptomatic microscopic hematuria is a difficult problem faced at the offices of many urologists. This study was aimed at evaluating the ability for the detection of significant lesions, according to the grade of microscopic hematuria and the comparison of various diagnostic modalities. MATERIALS AND METHODS: Between March 1999 and December 2003, 755 adult patients that visited our hospital due to asymptomatic microscopic hematuria were examined according to the diagnostic algorithm. The male-to-female ratio was approximately 1:1.1 (366:389). Microscopic hematuria was divided into five grades. Lesions found at evaluation were categorized as either highly or moderately significant or insignificant lesions. RESULTS: 221 (29.3%) out of 755 patients were found to have lesions during evaluation. Of these 221 patients, 33 with highly significant lesions, including 4 urologic malignancies, 127 with moderately significant lesions and 61 with insignificant lesions, were detected. Correlation was shown between the degree of microscopic hematuria and the likelihood of detecting significant urologic diseases. The sensitivity and specificity for the detection of significant lesions by urine cytology, ultrasonography (USG), intravenous pyelography (IVP), cystoscopy, computed tomography (CT) and the combination of USG and IVP were 2.5/96.3%, 35.6/96.5%, 34.7/ 96.0%, 7.4/97.7%, 100/98.2% and 44.8/94.8%, respectively. CONCLUSIONS: The combination of USG and IVP for the detection of significant lesions at the initial examination was more beneficial than USG or IVP. Cystoscopy and CT are necessary additional diagnostic modalities for patients with abnormal findings at the initial examination and for those patients with asymptomatic microscopic hematuria who are at high risk.
Adult* ; Cystoscopy ; Hematuria* ; Humans ; Sensitivity and Specificity ; Ultrasonography ; Urography ; Urologic Diseases