PURPOSE: Our experience of laparoscopic surgeries in pediatric patients was analyzed to search for a convenient approach method during the procedure. MATERIALS AND METHODS: Between March 2003 and March 2005, 24 children underwent laparoscopic renal surgeries (16 nephrectomies or nephroureterectomies and 8 partial nephrectomies) at our institution. The children consisted of 10 boys and 14 girls, aged from 5 months to 16 years old, with a median age of 3 years. The final diagnoses consisted of 11 non- functioning kidneys, two dysplastic kidneys associated with an ectopic ureter, three multicystic dysplastic kidneys and eight complicated duplex kidneys. RESULTS: All operations were successfully performed; by either a transperitoneal or retroperitoneal approach in 13 and 11 cases, respectively. The transperitoneal approach was applied for an ureterectomy, including renal surgery (five cases), or a partial nephrectomy (eight cases), and the retroperitoneal approach was used for a simple nephrectomy of dysplastic (five cases) or non-functioning kidney (six cases). The operative times were 98-220 (mean 168) and 71-415 (mean 189) minutes in transperitoneal and retroperitoneal approaches, respectively. The blood loss was less than 50ml in most cases. No severe complications occurred, with the exception of postoperative urine leakage from the ureterectomy stump in one case. An ureterectomy and partial nephrectomy favored a transperitoneal approach because of the wide vision and working space. For dysplastic or non-functioning kidneys, the localization of the kidney using a ureteral catheter and fluoroscopy reduced the operative time. CONCLUSIONS: Laparoscopic renal surgery in pediatric patients is an adaptable technique, regardless of the anatomical structures. The transperitoneal approach may be better adapted for a nephroureterectomy and partial nephrectomy, and fluoroscopy-guided kidney localization is useful for a retroperitoneal nephrectomy in dysplastic or non-functioning kidneys.
Adolescent ; Child ; Diagnosis ; Female ; Fluoroscopy ; Humans ; Kidney ; Laparoscopy ; Multicystic Dysplastic Kidney ; Nephrectomy ; Operative Time ; Pediatrics ; Ureter ; Urinary Catheters

No abstract available.
Hydronephrosis

High-risk localized prostate cancer traditionally includes patients with clinical T3 disease but also includes those with apparently localized disease but with adverse prognostic factors such as a Gleason score of 8 to 10, prostate-specific antigen of more than 20 ng/ml, or extensive disease on biopsy. In the past, these patients were treated primarily with radiation therapy due to concerns that surgery was not likely to be curative and was associated with a high incidence of side-effects. In addition, the lack of randomized trials comparing curative treatments for high-risk prostate cancer makes treatment decisions in this patient population difficult. Several retrospective series have reported the long-term efficacy of radical prostatectomy monotherapy in a high-risk population, showing that the 5-year cancer-specific survival rate was more than 80% and the 5-year biochemical recurrence-free survival rate was about 50%. In addition, comparisons of different treatment options by means of nonrandomized trials have shown improved outcomes with surgery compared with radiation therapy or observation. Thus, there is renewed interest in radical prostatectomy as the primary treatment for patients with high-risk prostate cancer. Here, we reviewed the outcomes of radical prostatectomy, with or without neoadjuvant or adjuvant therapies, in high-risk patients and what is known about the choice and timing of adjuvant therapies.
Biopsy ; Humans ; Incidence ; Neoplasm Grading ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Retrospective Studies ; Risk Assessment ; Survival Rate

Despite the wide diffusion of robot-assisted laparoscopic radical prostatectomy (RALP) as a surgical approach for clinically localized prostate cancer, no randomized controlled trial has been performed to compare RALP to radical retropubic prostatectomy (RRP) or laparoscopic radical prostatectomy (LRP). Because it is difficult to perform a randomized controlled trial to determine the risks and benefits of RALP, we focused on the results of systematic reviews of the published literature to compare the perioperative complications, functional outcomes (continence and potency), and oncologic results (surgical margin status and biochemical recurrence) among RRP, LRP, and RALP. With regard to perioperative complications, RALP seemed to be superior to RRP and LRP. With regard to the functional results, RALP showed a tendency toward early continence and potency recovery, compared with RRP. With regard to the surgical margin status, RRP and RALP showed mixed results, but RALP tended to show favorable results in organ-confined disease. Experts have obtained good results whether they performed RRP or RALP. Consequently, experts have been continuing to debate this issue. The higher cost associated with RALP was another criticism, especially in Korea. Because most of the published studies had low quality of evidence and were underpowered to prove the superiority of any surgical approach, a special effort to standardize the research methodology is required. Further high-quality, prospective, comparative studies, integrating specialized research methodology may give us a vital clue about the value of RALP.
Diffusion ; Evidence-Based Medicine ; Korea ; Prostate ; Prostatectomy ; Prostatic Neoplasms ; Research Design ; Risk Assessment ; Robotics

PURPOSE: To guide pediatric urologists to start laparoscopic renal surgery in children, we analyze our experience with various laparoscopic renal surgeries to highlight the surgical outcomes and the degree of completion of specific laparoscopic skills. MATERIALS AND METHODS: We retrospectively analyzed 51 children who underwent laparoscopic renal surgery by a single surgeon between March 2002 and July 2008 (25 nephrectomies, 12 nephroureterectomies, 10 heminephrectomies, 3 heminephroureterectomies, and 1 heminephrectomy in a horseshoe kidney). We compared the degree of completion of specific laparoscopic skills as well as operative parameters such as operative time, estimated blood loss, and complication rate. RESULTS: All laparoscopic renal surgeries were completed as planned without open conversions. In the nephrectomy group (nephrectomy+nephroureterectomy), the mean operative time decreased after 10 cases (239 minutes vs. 145 minutes, p<0.001). A decrease in mean estimated blood loss was also noted after 10 cases (119 vs. 32 ml, p<0.05). The complication rate decreased after 20 cases (30% vs. 4%, p<0.05). In all patients, the completion rates for specific laparoscopic skills were 98% for trocar insertion, 80% for removal of a pathological lesion, 82% for retroperitoneal insufflation, and 73% for refluxing ureterectomy and suturing. The overall completion rate increased after 18 cases (79% vs. 91%, p<0.05). CONCLUSIONS: Operative time and blood loss in pediatric laparoscopic renal surgery are rapidly improved with experience. Improvement in the complication rate and specific laparoscopic skills require more time. We recommend that pediatric urologists beginning laparoscopic surgery try complex surgeries such as heminephrectomy or heminephroureterectomy after they have surmounted the learning curve of easy surgeries such as nephrectomy or nephroureterectomy.
Child ; Humans ; Insufflation ; Laparoscopy ; Learning ; Learning Curve ; Nephrectomy ; Operative Time ; Retrospective Studies ; Surgical Instruments

PURPOSE: The purpose of this study was to investigate the clinical presentation and outcomes of metastatic spinal cord compression (MSCC) caused by prostate cancer (PCa) and to determine the prognostic factors for relieving the symptoms of MSCC. MATERIALS AND METHODS: A total of 52 patients (47 who underwent radiotherapy and 5 who underwent surgery) treated between 1989 and 2007 were included. We investigated potential prognostic factors for the improvement of symptoms caused by MSCC. Multivariate Cox proportional hazards regression was used to determine the independent significant factors for disease-specific survival (DSS). RESULTS: Twenty-four (51.1%) of 47 patients and 3 (60%) of 5 patients showed symptom improvement after radiotherapy or surgery, respectively. The number of involved vertebrae (1 or 2) as well as ambulatory and Eastern Cooperative Oncology Group performance status (ECOG PS, 1 or 2) before radiotherapy or surgery were significant predictors of improvement of symptoms caused by MSCC (p=0.024, p=0.001, and p=0.001, respectively). In the multivariate analysis, hemoglobin (> or =11.1), the number of involved vertebrae (1 or 2), and ECOG PS (1 or 2) remained significant predictors (p=0.021, p=0.033, and p=0.034, respectively). On the Kaplan-Meier curve, however, only ECOG PS (1 or 2) was a significant factor predicting DSS (p=0.014). CONCLUSIONS: In our study, improvement of symptoms after treatment was observed in half of the MSCC patients; however, there were no factors predicting symptom improvement other than the number of involved vertebrae and the patients' ambulatory and performance status at the time of treatment. Patients with ECOG PS 1 or 2 may therefore be expected to have good DSS after radiotherapy or surgery.
Hemoglobins ; Humans ; Multivariate Analysis ; Prostate ; Prostatic Neoplasms ; Spinal Cord ; Spinal Cord Compression ; Spine ; Survival Rate

PURPOSE: We compared the efficacy of radical cystectomy (RC) and non-RC treatment [transurethral resection of bladder tumor (TURB) only, partial cystectomy, or TURB followed by radiotherapy] in octogenarians with muscle-invasive bladder cancer (MIBC). MATERIALS AND METHODS: A total of 177 patients aged 80 years or more underwent TURB at our institute, and 41 patients had MIBC according to the histologic examination. Fourteen patients with lymph node or distant metastasis were excluded, and 27 patients were ultimately included. Patients were stratified by treatment modality (RC vs. non-RC), Charlson Comorbidity Index (low CCI vs. high CCI), and clinical tumor stage (organ-confined disease vs. extravesical disease). The effects of several variables on cancer-specific and overall survival were assessed. RESULTS: Of the 27 patients, 11 (41%) underwent RC and 16 (59%) underwent non-RC treatment. Patients in the RC group were younger and more likely to have low CCI scores. There were no significant differences in overall or cancer-specific survival in the RC and non-RC groups. Patients with clinically organ-confined disease had better survival outcomes than did those with extravesical disease. Stratification of patients by CCI indicated that overall survival was better in patients with low CCI scores (p=0.013), although cancer-specific survival was similar in the two CCI groups. Univariate and multivariate analysis indicated that clinical tumor stage and CCI were independently associated with overall survival. CONCLUSIONS: RC in octogenarians with MIBC does not improve overall survival compared with other treatment modalities. However, clinically organ-confined disease and low CCI score were associated with better overall survival.
Aged ; Aged, 80 and over ; Comorbidity ; Cystectomy ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Urinary Bladder ; Urinary Bladder Neoplasms

PURPOSE: It is well known that male erectile dysfunction and lower urinary tract symptoms are common in aging men. We evaluated whether treatment for erectile dysfunction with vardenafil might improve lower urinary tract symptoms. MATERIALS AND METHODS: From January 2004 to May 2005, 34 patients with erectile dysfunction attending the outpatient clinic were treated with vardenafil and followed up 1, 3, and 6 months after the treatment. They completed the International Index of Erectile Function (IIEF) and the International Prostate Symptom Score (IPSS) questionnaire at baseline and at each follow-up (1, 3, 6 months). RESULTS: After treatment with vardenafil, IIEF and IPSS were significantly improved at 1 month compared to baseline,and the improvement was maintained during the 3 to 6 month follow-up period. There was no correlation between IPSS and IIEF score either before or after treatment. There was no statistical significance between the severity of IPSS and the response to vardenafil. There were mild side effects, including 2 patients with headache, 2 patients with facial flushing, and 1 patient with eye discomfort. CONCLUSIONS: Vardenafil appears to improve not only erectile function but also lower urinary tract symptoms in men with erectile dysfunction. However, the severity of IPSS does not appear to predict the response to vardenafil therapy.
Aging ; Ambulatory Care Facilities ; Erectile Dysfunction* ; Flushing ; Follow-Up Studies ; Headache ; Humans ; Lower Urinary Tract Symptoms* ; Male ; Prostate ; Vardenafil Dihydrochloride

PURPOSE: The objective was to investigate the clinicopathological characteristics and the prognosis of prostate cancer patients affected by other primary malignancies. MATERIALS AND METHODS: From 1990 to 2008, we retrospectively reviewed the medical records of 1,317 patients who underwent radical prostatectomy (RP) for prostate cancer. We assessed the effect of other primary malignancies on clinicopathological features, biochemical recurrence (BCR)-free survival, cancer-specific survival (CSS), and overall survival (OS). RESULTS: Of 1,317 patients, at least one additional other primary malignancy was detected in 187 patients (14.2%). A comparison of patient groups according to the presence or absence of other primary malignancies showed no significant differences in preoperative serum prostate-specific antigen concentrations, pathological Gleason scores, or pathological staging. Prostate cancer patients with other primary malignancies were older than patients without other primary malignancies (p<0.001). No significant differences in 5-year BCR-free survival (80.2% compared with 77.7%; p=0.656) or CSS (98.9% compared with 98.5%; p=0.733) were found between these groups, respectively. Five-year OS was significantly lower in prostate cancer patients with than in those without other primary malignancies (89.3% compared with 95.4%; p<0.001). Multivariate analysis showed that other primary malignancies diagnosed after RP for prostate cancer were independent predictors of OS (hazard ratio, 4.10; p<0.001) but not of BCR-free survival or CSS. Conversely, other primary malignancies diagnosed before RP for prostate cancer did not independently predict BCR-free survival, OS, or CSS. CONCLUSIONS: Prostate cancer prognosis after RP is not dependent on the presence or absence of other primary malignancies. However, other primary malignancies diagnosed after RP for prostate cancer negatively affect OS.
Humans ; Medical Records ; Multivariate Analysis ; Prognosis* ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms* ; Recurrence ; Retrospective Studies

PURPOSE: The aim of this study was to review clinical features of penile fracture and to characterize risk factors for the development of long-term complications after its surgical correction. MATERIALS AND METHODS: We retrospectively reviewed the cases of 10 patients who underwent surgical therapy for penile fracture between June 1995 and September 2003. Patient age at presentation ranged from 17 to 54 years (mean 32 years). All patients underwent surgical therapy in an emergency setting. The time between the injury and surgery ranged from 7 to 240 hours (mean 44.5 hours). Radiologic work-up included penile ultrasonography for 9 patients and retrograde urethrography for patients suspected of having concomitant urethral injury. We investigated multiple clinical features to characterize risk factors relevant to the development of long-term complications. The mean follow-up was 36.5 month. RESULTS: Penile ultrasonography revealed defects in the tunica albuginea in seven patients, including six in whom the defect was identical to the injury site. At surgery, the size of the injury was between 3 mm and 50 mm. Two patients with concomitant urethral injury showed larger defects than those with an intact urethra. Long-term complications such as penile curvature and erectile dysfunction were found in two men with large defects involving the urethra and three with long lapses from injury to surgical correction. CONCLUSIONS: Long-term complications after surgical therapy for penile fracture are likely to occur in patients with a large defect in the tunica albuginea involving the urethra or with delayed surgical correction.
Emergencies ; Erectile Dysfunction ; Follow-Up Studies ; Humans ; Male ; Retrospective Studies ; Risk Factors* ; Ultrasonography ; Urethra