PURPOSE: We evaluated the incidence and impact of vesico-ureteral reflux(VUR) on renal function after a radical cystectomy and the use of orthotopic bladder substitutes, using refluxing and antirefluxing type uretero-intestinal anastomosis. MATERIALS AND METHODS: Sixty-five patients(124 renal units) had undergone a radical cystectomy with an ileal orthotopic substitute and received postoperative follow-up for longer than 12 months. For these patients, we evaluated the presence and grade of VUR using voiding cystourethrography(VCUG) and measured the individual glomerular filtration rate (GFR) of the corresponding renal units using a (99m)technetium diethylenetetraminepentaacetic acid(DTPA) renal scan. According to the urinary diversion(refluxing or antirefluxing methods), we analyzed the incidence of VUR and the impact of VUR on renal function. The mean follow-up time was 52 months(range 13-132 months) after surgery. RESULTS: The incidence of VUR was higher in the refluxing anstomosis group(group R, 60.3%) of patients than in the antirefluxing group of patients(group NR, 21.7%)(p=0.001). However, the mean GFR was not significantly different(72.5ml/min/m2 for group R patients, 76.4ml/min/ m2 for group NR patients, respectively). Between the refluxing and nonrefluxing renal units, no significant difference of GFR was also noted (38.3ml/min/m2 versus 37.7ml/min/m2). When GFR was stratified by the duration of the diversion, it was not significantly different (38.2, 36.2, and 41.7ml/min/m2 at 12-24, 25-48 and > 48 months, p>0.05, respectively) regardless of the diversion methods. The degree of reflux was not related to the renal function. CONCLUSIONS: Although there was a higher incidence of VUR in the refluxing type than in the antirefluxing type of orthotopic bladder substitutes, VUR developing after a radical cystectomy does not significantly alter renal function regardless of its severity or the methods and duration of the diversion.
Cystectomy* ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Incidence ; Kidney Function Tests ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Vesico-Ureteral Reflux*

PURPOSE: We evaluated the efficacy and the availability of laparoscopic orchiopexy to manage a nonpalpable intra-abdominal testis and studied outcomes including the testicular survival rate and associated complications. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 67 children (86 testicular units) who underwent laparoscopic orchiopexy for a nonpalpable intra-abdominal testis between 1996 and 2008. The mean patient age was 2.4 years (median, 1 year; range, 0.5-9 years), and the mean follow-up period was 21.8 months (range, 0.3-138.4 months). Testicular viability and orchiopexed positioning were evaluated within 1 month and beyond 3 months. RESULTS: Of 86 testes, 69 testes were treated with primary laparoscopic orchiopexy (PLO) sparing the internal spermatic vessel, 14 testes were treated with one-stage Fowler-Stephens laparoscopic orchiopexy 1, and 3 testes were treated with two-stage Fowler-Stephens laparoscopic orchiopexy 2. The testicular survival rates were 97.7% (84/86) within 1 month and 93.7% (59/63) beyond 3 months. Of 59 viable testes followed up beyond 3 months, 48 (81.4%) testes were positioned in the lower scrotum and 11 (18.6%) testes in the mid to high scrotum. CONCLUSIONS: Laparoscopic orchiopexy was successful for a nonpalpable intra-abdominal testis with a high testicular survival rate irrespective of the location from the internal ring. However, atrophy of the testis or upward migration of the testis can occur during follow-up, so we suggest watchful, periodic follow-up evaluating the viability and location of orchiopexed testes that are located in the lower scrotum in the immediate postoperative period or during short-term follow-up.
Atrophy ; Child ; Follow-Up Studies ; Glycosaminoglycans ; Humans ; Laparoscopy ; Medical Records ; Orchiopexy ; Postoperative Period ; Retrospective Studies ; Scrotum ; Survival Rate ; Testis

Purpose: The purpose of this study was to analyze the content of consultations by an oncology nurse practitioner by period and the characteristics of gastric cancer surgery patients. Methods: Qualitative content analysis research was used. The data of this study consisted of counseling records by an oncology nurse practitioner. Data for analysis comprised a total of 898 counseling records of 118 patients. Counseling patients were gastric cancer patients who were diagnosed and received operations from January 1, 2019, to December 31, 2019. Data were analyzed using the qualitative content analysis method. Results: The data were classified and analyzed as follows: three major categories of physical needs, information needs, and psychosocial needs; five middle categories of symptom management, self-management information, medical information, financial information, emotional support; and 16 subcategories. Regarding the number of consultations by category, the most frequent requests for information were 141 cases (15.7%) for physical needs, 634 cases (70.6%) for information requests, and 123 cases (13.7%) for psychosocial needs. Conclusion Gastric cancer patients who have undergone operations were wanted the tailored counseling and education are needed for each period from diagnosis to treatment. Oncology nurse practitioners should provide counseling with integrated nursing perception. The recording of all counseling content, including psychosocial needs, is important to illustrate the performance outcome. This research is a meaningful study demonstrating the counseling performed by an oncology nurse practitioner.

No abstract available.
Carcinoma, Adenoid Cystic* ; Humans ; Knee* ; Male

BACKGROUND: Many kinds of method have been tried for the management of allergic rhinitis. However, there is no completely satisfactory modality of treatment. Recent studys are reporting that laser vaporization on the inferior turbinate for the treatment of allergic rhinitis may be a valuable surgical method with safety, less morbidity and good efficasy. But, long term effects are unkown as yet. OBJECTIVES: We aimed to observe histopathologic changes of nasal mucosal membrane about 2 years after laser surgery and to investigate relationships between improvement in subjective symptoms, frequency of surgery, and histopathologic findings. MATERIALS AND METHODS: The inferior turbinates of 24 patients with perennial allergic rhinitis were vaporized by Contact ND: YAG laser. About 2 years after surgery, specimens obtained from the inferior turbinate were examined under the light microscopy. RESULTS: 1. Common findings of histopathologic change in all cases: 1) Fibrous proliferation and scar formation in the superficial layer of the submucosa. 2) Decreased number and atrophy of goblet cells, glands and vessels. 3) Complete regeneration of ciliated pseudostratified columnar epithelium. 2. Generally, grade of fibrosis in the submucosal superficial layer tend to increase as the frequency of surgery increase. but there is no relation, statistically. The higher grade of fibrosis do not induce the better subjective improvement. 3. Significant subjective improvement(Good and excellent results) was 75%. CONCLUSION: These results suggest that allergic symptoms may be inhibited by fibrous scar formation of the submucosal superficial layer and by decreased number and atrophy of overproliferation of cells leading to allergic reaction. In addition laser surgery may be a safe and effective method with good regeneration of ciliated epithelium and high rate of improvement for treatment of allergic rhinitis. However, further study is necessary to proper explanation for result that grade of fibrosis have not a relation with subjective improvement and for long term effect of the laser surgery.
Atrophy ; Cicatrix ; Epithelium ; Fibrosis ; Goblet Cells ; Humans ; Hypersensitivity ; Laser Therapy ; Lasers, Solid-State* ; Membranes ; Microscopy ; Regeneration ; Rhinitis* ; Turbinates

PURPOSE: Although its incidence has decreased with the widespread use of less invasive surgical techniques including laparoscopic surgery, postoperative ileus remains a common postoperative complication. In the field of urologic surgery, with the major exception of radical cystectomy, few studies have focused on postoperative ileus as a complication of laparoscopic surgery. The present study aims to offer further clues in the management of postoperative ileus following urological laparoscopic surgery through an assessment of the associated risk factors. METHODS: The medical records of 267 patients who underwent laparoscopic surgery between February 2004 and November 2009 were reviewed. After excluding cases involving radical cystectomy, combined surgery, open conversion, and severe complications, a total of 249 patients were included for this study. The subjects were divided into a non-ileus group and an ileus group. The gender and age distribution, duration of anesthesia, American Society of Anesthesiologists Physical Status Classification Score, body mass index, degree of operative difficulty, presence of complications, surgical procedure and total opiate dosage were compared between the two groups. RESULTS: Of the 249 patients, 10.8% (n = 27) experienced postoperative ileus. Patients with ileus had a longer duration of anesthesia (P = 0.019), and perioperative complications and blood loss were all correlated with ileus (P = 0.000, 0.004, respectively). Multiple linear regression analysis showed that the modified Clavien classification was an independent risk factor for postoperative ileus (odds ratio, 5.372; 95% confidence interval, 2.084 to 13.845; P = 0.001). CONCLUSION: Postoperative ileus after laparoscopic urologic surgery was more frequent in patients who experienced more perioperative complications.
Age Distribution ; Anesthesia ; Body Mass Index ; Cystectomy ; Humans ; Ileus ; Incidence ; Laparoscopy ; Linear Models ; Medical Records ; Postoperative Complications ; Risk Factors ; Urology

PURPOSE: The aim of this research was to compare surgical outcomes and complications of obese and non-obese patients who underwent open radical nephrectomy (ORN) and laparoscopic radical nephrectomy (LRN). MATERIALS AND METHODS: The data of 26 ORN patients and 30 LRN patients between January 2006 and December 2008 were analyzed. Patients with a body mass index (BMI) of 25.0 kg/m2 or more were defined as obese, and those with a BMI of <25.0 kg/m2 were defined as non-obese. All patients were divided into two groups according to the criteria above to compare demographic and clinical and pathologic parameters. RESULTS: The mean BMIs of the 15 obese patients in the ORN group and the 13 obese patients in the LRN group were 26.8+/-1.1 and 27.7+/-2.4, respectively. LRN was enormously effective for lowering estimated blood loss (EBL) and postoperative days compared with ORN. Operation times and EBL in ORN were affected by obesity, both of which were increased. In contrast, the data of both LRN groups indicated similar outcomes. The perioperative data of obese patients revealed LRN to have reduced blood loss (143.0+/-62.7 vs. 446.7+/-222.4 ml, p=0.001) and not significantly different postoperative days (7.3+/-2.2 vs. 8.4+/-1.5 days, p=0.065). Operation time, however, did not differ significantly among obese patients between ORN and LRN. The complications due to LRN had no relation with obesity, whereas ORN had an increased complications rate (34.6% vs. 3.8%). CONCLUSIONS: This study shows that LRN is more effective than ORN for both obese and non-obese patients with regard to perioperative outcomes and complication rates.
Body Mass Index ; Carcinoma, Renal Cell ; Humans ; Laparoscopy ; Nephrectomy ; Obesity

There are diverse surgical methods for treating large bladder stones, such as transurethral cystolithotripsy (TUCL), percutaneous suprapubic cystolithotripsy (PCCL), open surgery, and laparoscopic methods. We report here a case of two large bladder stones treated by using a combined surgical method of a laparoscopic approach and direct visual lithotripsy.
Chimera ; Laparoscopy ; Lithotripsy ; Surgical Procedures, Minimally Invasive ; Urinary Bladder ; Urinary Bladder Calculi

Incontinentia pigmenti (IP) is an uncommon X-linked, dominantly inherited disorder due to a mutation in the NEMO (NF-kappaB essential modulator) gene on the X chromosome. IP mostly occurs in female infants, it is usually embryonic lethal in males. The mechanisms for survival of affected males are explained by the presence of an extra X chromosome (Klinefelter's syndrome), hypomorphic mutations, and somatic mosaicism. We report here a rare case of incontinentia pigmenti in a 13-year-old boy with Klinefelter's syndrome, NEMO gene mutation, and whorled, hyperkeratotic, hyperpigmented, linear lesions along the lines of Blaschko on the trunk and leg.
Adolescent ; Female ; Humans ; Incontinentia Pigmenti* ; Infant ; Klinefelter Syndrome* ; Leg ; Male ; Mosaicism ; X Chromosome

PURPOSE: To evaluate the frequency and clinical characteristics of postoperative hemorrhage as a complication of partial nephrectomy. MATERIALS AND METHODS: The demographics, physical statistics, tumor size, R.E.N.A.L. nephrometry score, operative method, warm ischemic time, and presence of postoperative hemorrhage and its severity and method of intervention were examined in 300 partial nephrectomy patients in two medical centers (Stanford Medical Center and Kyung Hee University Medical Center) between March 2000 and March 2012. RESULTS: Of the 300 subjects, 13 (4.3%) experienced postoperative hemorrhage severe enough to require intervention more invasive than transfusion (Clavien grade III or higher). Univariate analysis of the bleeding and nonbleeding groups showed that whereas age, ischemic time, tumor size and stage, body mass index, American Society of Anesthesiologists class, and operative method did not differ significantly, the exophyticity (E) score was significantly higher for severe postoperative hemorrhage (p=0.04). However, multivariate analysis showed none of the factors to differ significantly. In most of the cases requiring intervention, selective embolization was sufficient, but in one case explorative laparotomy and nephrectomy were required. Clinical characteristics varied significantly among severe hemorrhage cases, with time of onset ranging from the first to the 30th postoperative day and symptoms presenting in a diverse manner, such as gross hematuria and pleuritic chest pain. Computed tomography and angiographic findings were consistent with either arteriovenous fistula or pseudoaneurysms. CONCLUSIONS: Severe hemorrhage after partial nephrectomy is rare. Nonetheless, with the great variability in presenting symptoms and time of onset after surgery, surgeons should exercise great vigilance during the postoperative care of partial nephrectomy patients.
Aneurysm, False ; Arteriovenous Fistula ; Body Mass Index ; Chest Pain ; Demography ; Hematuria ; Hemorrhage ; Humans ; Laparotomy ; Methods ; Multivariate Analysis ; Nephrectomy* ; Postoperative Care ; Postoperative Hemorrhage* ; Risk Factors* ; Warm Ischemia