No abstract available.
Amyloidosis*

The stone disease of urinary tract is common and familiar to urologist. But intrascrotal calculus is a rare disease. It is believed to originate either as a fibrinous deposit in tunica vaginalis testis or as a remnant of the appendix testis or appendix epididymis that has undergone torsion and become freely movable. Herein I report a case of intrascrotal calculi in the patient who complained scrotal mass.
Appendix ; Calculi* ; Epididymis ; Fibrin ; Humans ; Male ; Rare Diseases ; Scrotum ; Testis ; Urinary Tract

No abstract available.
Prostatectomy*

No abstract available.
Biopsy* ; Prostate*

No abstract available.
Recurrence* ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: Radical cystectomy has been a standard method in the treatment for invasive bladder cancer. Recently the orthotopic substitutions have been generally performed for urinary diversion. Ghoneim introduced a new method for orthotopic substitution which has used relatively short segment of ileum, and the method is regarded to have few complications. We performed this method for our study and analyzed the results and complications. MATERIALS AND METHODS: Among total 29 patients underwent ileal W-neobladder with serous-lined extramural tunnel, 27 patients had invasive bladder cancer and the remaining two patients had contracted bladder with vesicoureteral reflux. There were 25 male patients with the mean age of 59.2 years(45-70) and 4 female patients with 61.8 years(51-68). Mean follow-up period for the entire group was 8.4 months(3?17 month). History taking, physical examination, and complete laboratory tests were performed postoperatively and IVP or CT scan was taken at 3 month and 9 month after the operation for the evaluation of recurrence and upper tract change. RESULTS: The average operating time was 8 hours 35 minutes(420-670 min). Paralytic ileus developed in two patients and wound dehisced in 4. In all 29 patients, vesicoureteral reflux was not detected. Stricture of ureteroileal anastomosis was observed in 4 left renal units. We performed percutaneous nephrostomy and antegrade double J stenting on all the patients with stricture primarily, but one patient underwent neoureteroileostomy because of the failure of the primary management. Four patients complained enuresis, but no daytime incontinence was observed. There were no clinical symptoms of complications in all 29 patients and no metabolic acidosis was observed in laboratory tests. CONCLUSIONS: Serous-lined extramural tunnel method of orthotopic substitution showed an acceptable and safe reservoir with a large capacity at low pressure and absence of reflux with relatively short segment of ileum.
Acidosis ; Constriction, Pathologic ; Cystectomy ; Enuresis ; Female ; Follow-Up Studies ; Humans ; Ileum ; Intestinal Pseudo-Obstruction ; Male ; Nephrostomy, Percutaneous ; Physical Examination ; Recurrence ; Stents ; Tomography, X-Ray Computed ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Diversion ; Vesico-Ureteral Reflux ; Wounds and Injuries

PURPOSE: Although the advent of orthotopic bladder substitution in women was a major achievement in the evolution of urinary diversion, the mechanism of voiding dysfunction remains to be fully understood. This is a report on the voiding function of the ileal neobladder, based on a questionnaire survey of 6 female patients. MATERIALS AND METHODS: Between 1995 and 2002, 7 of 10 women(mean age 56.1) that underwent an orthotopic bladder substitution were evaluated using uroflowmetry, bladder diary and voiding cystourethrography. Six patients completed the questionnaire. The mean follow-up period was 24.6 months(range 1 to 72 months). RESULTS: From the uroflowmetry, the mean maximum flow rate was 12.2ml/sec, with a low average flow rate(mean 6.2ml/sec), and the voiding time was considerably prolonged(mean 68.5sec). According to the bladder diary and questionnaire responses, although the frequency and tidal volume of micturition were normal, the majority of patients were conscious of retarded, intermittent, prolonged and weak streams, with straining during voiding. Of the 7 patients, 5(71.4%) achieved excellent daytime continence, but 6(85.7%) had nighttime incontinence. One patient was unable to void and required regular intermittent catheterization. Two patients sometimes, or often, performed self-catheterization due to residual urine. According to the questionnaire responses, 4(66.7%) of the 6 patients stated that their micturition status was better or the same compared with their preoperative status, and 4(66.7%) of the patients felt satisfied. The degree of inconvenience was low for every item and the limitation on daily life was considered minimal. Cystograms revealed a descent of the pouch and urethral angulation in the 3 patients with difficulty in urination or hypercontinence. CONCLUSIONS: Orthotopic bladder substitution after a radical cystectomy in women provides relatively satisfactory functional outcomes.
Catheterization ; Catheters ; Cystectomy ; Female ; Follow-Up Studies ; Humans ; Surveys and Questionnaires* ; Rivers ; Tidal Volume ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Diversion ; Urination

No abstract available.
Vesicovaginal Fistula*

PURPOSE: Orthotopic neobladder following radical cystectomy are currently preferred to the other urinary diversions. We have compared three different ureteroenteric anastomoses regarding change of the upper urinary tracts and evaluated correlation between the length of bowel used for bladder reconstruction and metabolic acidosis. MATERIALS AND METHODS: Between Sep. 92 and Jul. 97, 37 patient(range 34-69 yrs) with bladder cancer underwent an orthotopic Mainz pouch with antireflux submucosal tunnel(n=10), an ileal low-pressure bladder substitute with direct ureteroileal anastomosis(Stuffier, n=15) and an ileal W-neobladder with serouslined ertramural tunnel(Ghoneim, n=12) following radical cystectomy Mean follow up was 22 months(7-64 twos). IVP and VCUG were performed at 6, 12 months postoperatively and annually thereafter. The measurement of serum electrolyte and/or arterial blood gas analysis were carried out every 3-6 months. RESULTS: The vesicoureteral reflux occurred in 37%(11/30 renal unit) with Stuffier pouch, 10%(2/20) with Mainz pouch, and none with Ghoneim(p=0.01). Moderate to severe hydronephrosis resulting from reflux was noted in 4 renal units with Stuffier pouch, while an atrophic kidney due to obstruction at ureteroenteric anastomosis was noted with each Mainz pouch and Ghoneim. Metabolic acidosis was identified in 5 patients(33%) with an Stuffier pouch whereas it was noted in less than 10% with Mainz pouch and Ghoneim(p=0.07). Two patients with deteriorated renal function need bicarbonate replacement therapy for correction of metabolic acidosis. CONCLUSIONS: Although most patients with direct ureteroileal anastomosis preserved renal function, antireflux ureteroenteric anastomosis using submucosal tunnel or serous-lined extramural tunnel is better in terms of occurrence of hydronephrosis and vesicoureteral reflux. The length of bowel less than 45cm used for bladder reconstruction may avoid metabolic acidosis
Acidosis* ; Blood Gas Analysis ; Cystectomy ; Follow-Up Studies ; Humans ; Hydronephrosis ; Kidney ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Diversion ; Urinary Tract* ; Vesico-Ureteral Reflux

Prostatic carcinoma is the most commonly diagnosed cancer in the United States in men. Prostatic carcinoma in Korean men is uncommon and accounts for less than 1% of total cancer: however, the incidence of prostatic carcinoma is continuously increasing. Several clinicopathologic parameters including stage, Gleason score, and serum PSA level have been widely accepted as well established prognostic factors. To study the clinicopathologic features of prostatic carcinoma in Korean men, 58 cases of prostatic carcinoma, which were diagnosed on radical prostatectony specimens at Asan Medical Center from Jan. 1993 to June 1998 (1993; 3 cases, 1994; 3, 1995; 6, 1996; 12, 1997; 24, 1998; 10), were evaluated. The prostatic carcinomas were divided into three groups according to Gleason score. Tumors with Gleason score 6 or lower, 7, and 8 to 10 were categorized as low-grade, intermediate-grade and high-grade tumor, respectively. The overall mean age of the patients was 62.6 years (range, 4 6~76 years); mean age was 65.4, 62.8 and 61.1 in low, intermediate and high-grade tumor, respectively (p>0.05). The overall mean serum PSA level was 38.6 ng/ml (range, 0.3~276.0 ng/ml); mean serum PSA level was 17.0, 29.0 and 60.9 ng/ml in low, intermediate and high-grade tumor, respectively (p=0.002). The mean T stage was 2.3, 2.4 and 3.1 in low, intermediate and high-grade tumor (p=0.001). The percentage of positive resection margin was 33.3, 50.0 and 91.0 % in low, intermediate and high-grade tumor (p=0.001). The overall presence of prostatic intraepithelial neoplasia (PIN) was 79.3 %; percentage of the presence of PIN was 100, 79.2 and 68.2 % in low, intermediate and high-grade tumor (p>0.05). As reported in the literature, our results indicated that Gleason score was a good predictor of stage and prognosis. The higher Gleason score, the more cases were with positive surgical margins, advanced pathologic stage, and high serum PSA level (p<0.05).
Adenocarcinoma* ; Chungcheongnam-do ; Humans ; Incidence ; Male ; Multiple Endocrine Neoplasia Type 1 ; Neoplasm Grading ; Prognosis ; Prostatectomy* ; Prostatic Intraepithelial Neoplasia ; United States