A clinical observation was made on 96 cases of transurethral resection for the benign prostatic hypertrophy, admitted during the period of 3 years from January 1984 to December 1986. Previous to the transurethral resection of prostate, the suprapubic cystostomy was accomplished in 38 cases among them and following advantageous results were obtained. 1. Suprapubic cystostomy before TURP provides better endoscopic vision by continuous flow of irrigating fluid to permit no interrupted resection. 2. By eliminating the time spent for evacuation of the bladder, eye accommodation and reestablishment of surgical land marks, it permits transurethral resection of larger gland, within recognized safety guidelines. 3. It tends to minimize and prevent absorptive complications by lessening intravesical pressure. 4. It decreases operative risk by lessening operative time and the volume of fluid absorbed. 5. It provides an alternative route of irrigation and drainage intraoperatively and postoperatively.
Cystostomy* ; Drainage ; Operative Time ; Prostatic Hyperplasia* ; Transurethral Resection of Prostate ; Urinary Bladder

Fournier's gangrene is a fulminating gangrene of the male genitalia. It is associated with severe systemic toxic effect and a high motality rate, and it requires early diagnosis and intensive care with surgical intervention. We report a case of Fournier's gangrene in 33-year-old man, who showed marked swelling and necrosis of the scrotum, and extending cellulitis on the right flank and chest. With prompt excision of all the gangrenous scrotal skin and drainage incisions made on the flank and chest, the healing was successful.
Adult ; Cellulitis ; Drainage ; Early Diagnosis ; Fournier Gangrene* ; Gangrene ; Genitalia, Male ; Humans ; Critical Care ; Male ; Necrosis ; Scrotum ; Skin ; Thorax

The increasing use and availability of renal transplantation has resulted in a demand for noninvasive methods to study possible complications. One of the most serious adverse reactions is acute rejection, a possibly reversible cause of transplant failure if treated promptly. Sixty-six donors and recipients were evaluated by duplex Doppler examination of intrarenal arteries. A simplified formula, resistive index(RI) ([peak systolic frequency shift-lowest diastolic frequency shift]/[peak systolic frequency shift]), were used to diagnose rejection. All RI values of donors were within normal limit. RI values of recipients were not significantly different according to the number of renal artery and the ischemic time during operation. With a RI greater than 0.90, a 100% positive predictive value was obtained for the diagnosis of acute rejection. A 88% positive predictive value of acute rejection was obtained with a RI greater than 0.80. A value less than 0.70 was unlikely to be rejection(negative predictive value, 95%). The results suggest that the duplex Doppler examination and the resistive index obtained by simple analysis of the wave form would be used as a valuable noninvasive method for the detection of acute renal transplant rejection. The findings of Doppler examination are not necessarily pathognomonic for one specific process, but they can aid the clinician in deciding the kind of treatment necessary and the need for biopsy.
Arteries ; Biopsy ; Diagnosis ; Graft Rejection ; Humans ; Kidney Transplantation* ; Renal Artery ; Tissue Donors

The diagnostic significance of ultrasonography, computed tomography and magnetic resonance imaging for predicting the stage of tumors was evaluated by comparing their results with preoperative and histopathologic findings. The 24 patients who were diagnosed as renal cell carcinoma by histopathologic finding have taken preoperative examination such as ultrasonography, computed tomography. Additionally, magnetic resonance imaging was performed in 15 patients among them. The T stage was determined correctly by magnetic resonance imaging in 87% of the cases, by computed tomography in 80%. We suggested that a computed tomography is reliable imaging method for evaluating the T,N category preoperatively, but magnetic resonance imaging is more sensitive than a computed tomography in predicting the stage of renal cell carcinoma and a magnetic resonance imaging can replace the computed tomography.
Carcinoma, Renal Cell* ; Humans ; Magnetic Resonance Imaging ; Ultrasonography

The posterior lumbotomy was a useful approached for removal of a small kidney, for bilateral nephrectomy in patients with chronic renal failure, for pyeloplasty, for pyelolithotomy when a stone was filled the pelvis and was not able to migrated, or for an upper ureterolithotomy when the stone was firmly impacted. During a 32 month interval 19 patients underwent upper ureterolithotomy through the posterior lumbotomy approach. The intraoperative course and postoperative performance were compared to the patients operated upon using the standard flank incision. Our analysis established the superiority of the posterior lumbotomy incision for all factors evaluated, especially postoperative drainage, analgesic use and postoperative hospitalization.
Drainage ; Hospitalization ; Humans ; Kidney ; Kidney Failure, Chronic ; Nephrectomy ; Pelvis

PURPOSE: The purpose of this study was to find if any clinical or laboratory factors have significant correlations with blood loss caused by a transurethral resection of the prostate (TURP). MATERIALS AND METHODS: The medical records of 218 patients who had undergone a TURP were retrospectively reviewed. For each patient, the preoperative factors evaluated included age, type of presentation (patients who had been treated due to acute urinary retention; retention group, patients who had been treated due to lower urinary tract symptoms; symptomatic group), blood pressure, complete blood count, coagulation screening, prostate size on transrectal ultrasonography (TRUS), urine analysis, urine culture, ECG and drugs. Intraoperative and postoperative factors were also evaluated, including type of anesthesia, operator, operating time, weight of resected prostate tissue, blood transfusion and prostate histology. These factors were analyzed with respect to blood loss during the TURP using student's t, ANOVA and chi-square tests. RESULTS: The mean intraoperative blood loss and resected prostate weight were 415 ml and 15g, respectively. The factors which were found to significantly correlate with blood loss during a TURP were: resected prostate weight (r=0.44, p=0.0001), prostate size on TRUS (r=0.32, p=0.001), operating time (r=0.31, p=0.001), preoperative urine culture (p= 0.020), preoperative antimicrobials taken (p=0.020), and prostate histology (p=0.048). CONCLUSIONS: Of the factors found to correlate with blood loss during the TURP, the only reversible factor was a preoperative urinary tract infection. So, we expect that the prevention of preoperative urinary tract infection and its effective treatment in patients might be helpful in decreasing blood loss during a TURP.
Anesthesia ; Blood Cell Count ; Blood Loss, Surgical ; Blood Pressure ; Blood Transfusion ; Electrocardiography ; Humans ; Lower Urinary Tract Symptoms ; Mass Screening ; Medical Records ; Prostate* ; Retrospective Studies ; Risk Factors* ; Transurethral Resection of Prostate ; Ultrasonography ; Urinary Retention ; Urinary Tract Infections

Purpose: The aim of this study was to determine whether the stone mineral content (SMC) and stone mineral density (SMD), as measured by dual energy X-ray absorptiometry, can predict the stone fragility in extracorporeal shock wave lithotripsy (ESWL). Materials and Methods: In the experimental study, the stone size, weight, SMC and SMD of 111 urinary calculi, obtained by open surgery, were measured. The SMC and SMD were measured using dual energy X-ray absorptiometry, which is the gold standard for measuring the bone mineral content and density. The number of shock waves necessary for full fragmentation was accepted as a measure of the stone fragility in ESWL (EDAP-sonolith Praktis). In the clinical study, the stone size, SMC and SMD were measured in a total of 48 patients with a solitary renal stone of less than 3cm. Prior to ESWL all patients underwent dual energy X-ray absorptiometry to calculate the SMC and SMD. The correlations between the number of total shock waves and the stone size, SMC and SMD were analyzed. Results: In the experimental study, the stone size, stone weight, SMC and SMD values correlated with total shock waves, with a correlation coefficients (R) of 0.79, 0.95, 0.99 and 0.86, respectively (n=111). In the clinical study, the mean stone size, mean MC and MD values differed significantly between the clinically successful and failed ESWL (n=36 and n=12), respectively (p=0.0002, p=0.004, p=0.004). On a simple regression analysis, the SMC (R2=0.74), SMD (R2=0.56) and stone size (R2=0.51) were significant factors in predicting the number of shock waves. Using the receiver operating characteristic curves for comparing the stone size, SMC and SMD in relation to the number of shock waves, the areas under the respective curves were 0.79, 0.84 and 0.81 with cut-off values of 1.8, 1.4 and 1.8. Conclusions: The stone size, SMC and SMD measured by dual energy x-ray absorptiometry may provide a prediction of the outcome of patients prior to ESWL treatment. Patients with high SMC (greater than 1.4gm) could be recommended for percutaneous nephrolithotripsy or another treatment modality, thus, avoiding the unnecessary cost of prior ESWL.
Absorptiometry, Photon* ; Bone Density ; Humans ; Lithotripsy* ; ROC Curve ; Shock* ; Urinary Calculi

Radiologic chain cystourethrography for stress urinary incontinence (SUI) has several disadvantages including the risk of excessive radiation, the time required for the test, and the discomfort of the patients. Nowadays it is widely accepted that transrectal ultrasonography for evaluating bladder and urethra provides similar information about SUI comparing with the conventional radiographic examination. We evaluated the effectiveness of transrectal ultrasonography in the diagnosis of SUI in 30 women with SUI and in normal 20 women as a control. The results of evaluation were as follows: 1. Mean age was 52.9 in SUI group and 48.5 in control group, and mean parity was 2.8 in SUI group and 3 In control group. 2. According to the symptom grading by Stamey, 8 patients (27%) were Grade I and 22 (73%) were Grade II. 3. The mean value of posterior urethrovesical angle (PUVA) at resting state was 139 +/- 14.7 degrees in control group and 145 +/- 15.2 degrees in SUI group (p>0.05). 4. The mean value of PUVA at strain state was 146 +/- 7.9 degrees in control group and 169 +/- 12.1 degrees in SUI group (p<0.05). 5, Bladder neck descent was 7.3 +/- 2.7 mm (mean+/-SD.) in control group and 13.7+/-6.2 mm in SUI group (p<0.05). 6. Diagnostic criteria of SUI in transrectal ultrasonography are more than 149.5 degrees in PUVA at strain state, and more than 9.1 millimeter in bladder neck descent. 7. Sensitivity and specificity of transrectal ultrasonography in the diagnosis of SUI were 86% and 80% in PUVA at strain state, 80% and 80% in bladder neck descent, respectively. 8. There was significant change of transrectal ultrasonographic finding in pre and post-bladder neck suspension (p<0.05). In conclusion, transrectal ultrasonography is simple, non-invasive, not shameful, and free of radiation, so might be a useful diagnostic method in female SUI.
Diagnosis ; Female* ; Humans ; Neck ; Parity ; Sensitivity and Specificity ; Shame ; Ultrasonography* ; Urethra ; Urinary Bladder ; Urinary Incontinence*

A clinical observation was made on 261 cases of transurethral resection of benign prostatic hyperplasia (TURP) by the same operator, admitted during the period of 10 years from January 1984 to December 1993. The objective cases were divided by every 50 cases into 5 groups, and the operation results were compared in each group respectively. The results showed the tendency of increasing weight of resected prostatic tissue and decreasing operating time, consumed time for the resection of l gm of prostatic tissue, blood loss during operation, duration of postoperative gross hematuria and incidence of postoperatively complicated cases, as experiencing more TURP cases. The operation results were markedly improved and stabilized after experience of 150 cases of TURP. Our study suggests that TUR technique of the operator is improving step by step by accumulating experiences of TURP and the expert and stabilized skillful technique will be achieved after experience of more than 150 cases of TURP but the improvement of TUR technique may be accelerated by aid of better TUR instrument and teaching system.
Hematuria ; Incidence ; Prostatic Hyperplasia* ; Transurethral Resection of Prostate

OBJECTIVES: We surveyed this study for knowing the relation within stress, depression and medical comorbidities, and finding the risk factors of major depression. METHODS: 1764 subjects were enrolled from Jan. 2009 to Dec. 2009 who visit Korea University Guro hospital healthcare center. The subjects answered the questionnaire of PSS(Perceived Stress Scale), PHQ-9(Patient Health Questionnaire-9) and the demographic data. We categorized them as the stress group, depressive group, medical comorbidity group and analyzed the correlation analyses and logistic regression analyses. RESULTS: 198 of 1764 subjects(11.8%) were applied to major depression, and the depressive group showed the higher mean stress score(23.19) and mean depression score(12.95) than the normal group. The total PHQ-9 score was increased by perceiving more stress, having more medical comorbidities. The subjects with female, visiting due to recent health problems, irregular exercise, current smoking, history of angina and cerebrovascular disease showed the increased risk of major depression. CONCLUSIONS: In this study, we find the PSS, PHQ-9 were valuable for mental health screening in healthcare center. As perceiving more stress and having more medical comorbidity, risk of major depression were increased. Accordingly the individuals with medical diseases or unhealthy lifestyle would need the mental health screen.
Comorbidity ; Delivery of Health Care ; Depression ; Female ; Humans ; Korea ; Life Style ; Logistic Models ; Mass Screening ; Mental Health ; Questionnaires ; Risk Factors ; Smoke ; Smoking