PURPOSE: We compared the biochemical and clinical presentation of gouty diathesis in patients with uric acid and calcium nephrolithiasis MATERIALS AND METHODS: We retrospectively reviewed biochemical and clinical data from 69 gouty diathesis patients(48 with uric acid stones and 21 with calcium stones) and 57 normal subjects were performed at our institution. RESULTS: Demographic similarity between two groups was a male predominance. Gouty diathesis patients in both groups showed abnormally low urinary pH(<5.5) and propensity for hyperuricemia and hypertriglyceridemia. Gouty arthritis and hyperuricemia was found in 31% and 44% of those with uric acid stones whereas 9.5% and 23.8% in those with calcium stone respectively. In control group, 1 case presented with hyperuricemia and urinary pH at 6.3. Both urinary pH and citrate increased after potassium citrate treatment in both groups. CONCLUSIONS: The two groups of gouty diathesis with either uric acid stone or calcium stones have similar biochemical and clinical features that are characteristic of primary gout. Calcium stone formation in patients with hyperuricemia or persistent acidic urine may represent a latent form of gout. Patients with calcium stones and biochemical feature of gouty diathesis may manifest primary gouty. Both groups are responsive to potassium citrate treatment.
Arthritis, Gouty ; Calcium* ; Citric Acid ; Disease Susceptibility* ; Gout ; Humans ; Hydrogen-Ion Concentration ; Hypertriglyceridemia ; Hyperuricemia ; Male ; Nephrolithiasis ; Potassium Citrate ; Retrospective Studies ; Uric Acid*

PURPOSE: Splenorenal bypass is a major surgical procedure that's used for the management of renal artery stenosis. Herein, we evaluate the feasibility and efficacy of performing laparoscopic splenorenal bypass in a chronic canine model. MATERIALS AND METHODS: A total of 12 animals were used for this study. The initial 6 acute animals were used to develop the technique. The remaining 6 surviving animals, which form the basis for this report, were used for a chronic study with up to 2 months follow-up. The renal artery and the distal splenic artery was dissected, its proximal end clamped and its distal end cut and spatulated. An end-to-end anastomosis of the splenic artery and renal artery was performed using only laparoscopic freehand suturing and knot-tying techniques. Upon revascularization, a laparoscopic doppler ultrasound probe was used to document blood flow in the renal artery. Three animals were each followed for 1 month and 2 months, respectively. RESULTS: The total operative time was 297+/-36 min. The mean number of suture bites per anastomosis was 14.3. The only intraoperative complication was hemorrhage from the anastomotic site. Intraoperative Doppler ultrasound documented good blood flow in all 6 animals upon releasing the clamp. At the time of euthanasia, intravenous pyelography (IVP) showed early visualization of the left kidney with prompt drainage in 5 of the 6 surviving animals. In one animal that had two left renal arteries, a distal thrombosis was found despite the patent anastomotic site. CONCLUSIONS: Laparoscopic splenorenal bypass can be performed in a reproducible fashion with using only intracorporeal techniques. We believe that with experience, complex urologic vascular procedures can be laparoscopically performed in the future.
Animals ; Drainage ; Euthanasia ; Follow-Up Studies ; Hemorrhage ; Intraoperative Complications ; Kidney ; Laparoscopy ; Models, Animal ; Operative Time ; Renal Artery ; Renal Artery Obstruction ; Splenic Artery ; Splenorenal Shunt, Surgical* ; Sutures ; Thrombosis ; Ultrasonography ; Urography

In this paper, acknowledgments section was omitted unintentionally.

In an outpatient setting, 107 patients were evaluated using a single 24-hour specimen with StoneRisk Diagnostic Profile on a random diet before medication and treatment and updated the classification of nephrolithiasis. For specific subclassification of hypercalciuric calcium(Ca) nephrolithiasis, calcium and sodium restricted diet and sodium cellulose phosphate screening test were underwent. Abnormal urinary biochemistry was classified into one or more of 20 etiologic categories. A single diagnosis was documented in 37(34.6%) patients and the remaining 65.4% had more than one diagnosis. Hypercalciuric Ca nephrolithiasis occurred in 41 (38.3%) patients and specific subclassification of 6 variants was performed. In this study, hypercalciuric Ca nephrolithiasis occurred less frequently in comparison to the incidence of U.S.A. reported by Dr. Pak. Hyperuricosuric Ca nephrolithiasis (HUCN) and gouty diathesis(GD) accounted for 47(43.9%) and 8(7.4%) patients, respectively. Hyperoxaluric Ca nephrolithiasis was in 25(23.4%) patients and all were dietary origin following an oxalate-restricted diet. Hypocitraturic Ca nephrolithiasis was seen in 51(47.6%) patients in idiopathic variant. Hypocitraturia due to RTA and chronic diarrheal syndrome occurred in 1(0.9%) and 2(1.8%) patients. Hypomagnesiuric Ca nephrolithiasis and acquired problem of low urine volume(<1 L/d) were accounted in 3(2.8%) and 13(12.2%) patients, respectively. Infection stones or cystinuria were not detected. No metabolic abnormality was found in 12(11.2%) patients. High sodium take was detected in 60(56.1%) patients, reflecting that Koreans take high sodium containing foods. We think that StoneRisk Diagnostic Profile using a single 24-hour urine specimen is very useful in detecting stone-forming risk factors and providing specific therapeutic guidelines. Additionally, recurrence associated with high cost of medical care can be reduced through adequate diagnostic evaluation as part of the treatment regimen.
Biochemistry ; Calcium ; Cellulose ; Classification ; Cystinuria ; Diagnosis ; Diet ; Humans ; Incidence ; Korea* ; Mass Screening ; Nephrolithiasis* ; Outpatients ; Recurrence ; Risk Factors ; Sodium

Neonatal urologic urgencies are any genitourinary condition during the 1st month of life that jeopardizes the gonads, the kidneys, or the life of the infant if there is a delay in either diagnosis or treatment. Since 1991, we have experienced 41 cases of neonatal urologic urgencies. Of 41 cases, 23 were detected prenatally. Male to female distribution was 29 to 12. The initial symptoms or signs at presentation were antenatal hydronephrosis in 21, fever in 10, scrotal mass in 5. The rest 5 were 1 abdominal mass, 1 cystic adrenal mass, 1 absence of kidney, 1 abnormal micturition and 1 jaundice. The final diagnosis were 1 neuroblastoma, 2 multicystic dysplastic kidney, 1 multicystic dysplastic kidney and contralateral UPJO, 2 unilateral transient hydronephrosis, 3 bilateral transient hydronephrosis, 1 unilateral renal hypoplasia and contralateral hydronephrosis, 1 unilateral and 2 bilateral UPJO, 1 renal agenesis, 5 complete duplicate ureter, 3 primary megaureter, 1 unilateral UVJ0, 2 unilateral and 9 bilateral VUR, 1 PUV, 1 congenital megalourethra with bilateral hydronephrosis, 1 acute epididymitis, 3 torsion of spermatic cord, 1 cystic teratoma. Surgical treatment was performed in 26 and conservative management in 15. Since it has been reported 2/3 of all infant deaths occur during the 1st year of life, especially most are during the neonatal period, we believe it is crucial that urologists be involved in the care of newly born infants and be alert to the clues of underlying genitourinary abnormalities or diseases because the least easily recognizable urologic abnormality may be the one that requires the most immediate attention in the neonate.
Diagnosis ; Epididymitis ; Female ; Fever ; Gonads ; Humans ; Hydronephrosis ; Infant ; Infant, Newborn ; Jaundice ; Kidney ; Male ; Multicystic Dysplastic Kidney ; Neuroblastoma ; Spermatic Cord ; Teratoma ; Ureter ; Urination ; Urogenital Abnormalities

PURPOSE: We wanted to report the our early experience with performing nephron-sparing radiofrequency ablation (RFA) of renal tumor. MATERIALS AND METHODS: Three percutaneous RFAs were performed under combined computed tomography (CT) and ultrasonogram guided, and two intraoperative ultrasonograpy-guided laparoscopic RFAs were performed since June 2004. The treatment indications were localized, small (<4cm), solid renal masses in elderly patients and also the same type masses in the patients with comorbid conditions. The follow-up studies included physical examination, CBC, serum creatinine, urine analysis and kidney CT, and these were performed at day 1, 1 week, 1 month, 3 months, 6 months and 1 year after ablation, and then semi-annually thereafter. The mean follow-up duration was 8.8 months (range: 5-12 months). RESULTS: All five patients underwent successful RFA without any serious events. One patient had a mild perinephric hematoma and another patients had mild gross hematuria postoperatively. With a mean follow-up of 8.8 months, none of the patients showed any residual tumor on follow-up contrast-enhanced CT after the final tumor ablation. Complete tumor ablation was achieved after a single treatment session in 80% of the patients and in 20% of patients after the subsequent ablation sessions. CONCLUSIONS: Percutaneous or laparoscopic RFA is a promising nephron-sparing treatment for selected patients with small renal mass. Contrast-enhanced CT performed immediately after ablation is a reliable method to exclude residual viable tumor. The ultimate role for this modality will continue to evolve and this warrants further studies.
Aged ; Catheter Ablation* ; Creatinine ; Follow-Up Studies ; Hematoma ; Hematuria ; Humans ; Kidney ; Laparoscopy ; Neoplasm, Residual ; Nephrons ; Physical Examination ; Tomography, X-Ray Computed ; Ultrasonography

PURPOSE: In 2004, a joint effort was undertaken between Dong-a University Hospital, Busan, Korea and Singapore General Hospital, Singapore, to promote laparoscopic radical prostatectomy (LRP) to yet another level by enhancing the human performance using a master-slave manipulator, the da VinciTM System. Herein, we report our initial experience of employing robotic telepresent technology to perform a LRP. MATERIALS AND METHODS: A 6-port modified transperitoneal approach was used. The da VinciTM System (Intuitive Surgical, Inc., California) consists of three components: a surgeon console, a robotic manipulator and a vision cart. Cable-driven mechanical "Endowrist" instruments are capable of delivering a complete range of motion at the instrument tips, allowing a total of 6 degrees of freedom. RESULTS: Five robotic-assisted LRP were performed. The mean patient age PSA and Gleason score were 65 years, 7.8ng/ml and 6.2, respectively. Overall, the system functioned well, without significant intraoperative errors. The mean operative time was 185 minutes in 2 patients with preservation of the neurovascular bundle, and 154 minutes in 2 patients with non-nerve sparing. In one patient, a bilateral pelvic lymphadenectomy was performed, with an operative time of 195 minutes. The mean blood loss and hospital stay were 245cc and 2.5 days, respectively. All patients maintained continence at 3 month follow-up. CONCLUSIONS: Intuitive hand-eye coordination, superb depth of perception and "Endowrist" instruments allowed tissue handling and suturing quite feasible during the LRP. Continuous effort is underway to further the surgical experience and advances in robotic technology. We believe robotic surgical systems will greatly facilitate and improve the LRP procedure.
Busan ; Follow-Up Studies ; Freedom ; Hospitals, General ; Humans ; Joints ; Korea ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Neoplasm Grading ; Operative Time ; Prostatectomy* ; Range of Motion, Articular ; Robotics ; Singapore

PURPOSE: Laparoscopy is a standard treatment for many diseases. We developed a laparoscopy training protocol that provides a learning experience equivalent to that of an animal laboratory based laparoscopic training course. We proved that the rabbit can be used as an appropriate model for a laparoscopy training program. MATERIALS AND METHODS: Three operators undertook laparoscopic procedures on 15 rabbits using our developed protocol. We checked both objective and subjective parameters, such as operation times and complications for the former, and hand-eye coordination, tactile sensation, tool handling and total skill difficulty for the later, using visual analogue scores. RESULTS: For the first 5 rabbits, the mean operative times (min.) for the 3 operators were 41, 48 and 46.2 for a simple nephrectomy (SN), 62, 68.2 and 66.2 for a partial nephrectomy (PN), 28.8, 36 and 31.8 for an adrenalectomy (Ax) and 65.4, 69 and 60.6 for a simple cystectomy (SC). For the second 5 rabbits the mean operative times (min.) were; SN 32.2, 46.2 and 40.2, PN 57.8, 66.2 and 61.8, Ax 22.8, 32.6 and 32 and SC 65.4, 64.2 and 57.4. For all 15 rabbits the mean operative times (min.) were; SN 20.6, 35.4 and 30, PN 48.6, 54.6 and 53.4, Ax 15.8, 26.2 and 26.2 and CS 48.2, 53.6 and 47.6. CONCLUSIONS: Our laparoscopic training model, using a small animal, provides practicing urologist with the concepts of laparoscopy concept. The rabbit model is appropriate for addressing laparoscopic procedures, with economic benefits. Based on this model, it would be possible for residents to familiarize themselves with laparoscopic procedures.
Adrenalectomy ; Animals* ; Cystectomy ; Education ; Laparoscopy ; Learning ; Models, Animal* ; Nephrectomy ; Operative Time ; Rabbits ; Sensation ; Urology*

PURPOSE: To report our results on urinary continence after bladder neck preservation (BNP) and posterior urethral reconstruction (PUR) during robot-assisted laparoscopic radical prostatectomy (RALP). MATERIALS AND METHODS: Data from 107 patients who underwent RALP were compared on the basis of whether the patients underwent BNP and PUR, BNP only, or the standard technique (ST). In group A (n=31 patients), ST was performed by using Ven velthoven continuous suturing for urethrovesical anastomosis. In group B (n=28 patients), ST with only PUR was performed. In group C (n=48 patients), both the BNP and PUR techniques were used. "Recovery of continence" was defined as the use of 1 pad (50 ml) or less within 24 hours. RESULTS: The three groups were comparable in terms of patient demographics. The mean operative time and the mean blood loss decreased significantly from group A to group C (p=0.021 for mean operative time and p=0.004 for the mean blood loss). Mean catheterization time was 8.9, 7.8, and 7.1 days in each group (p=0.047). Early return of urinary continence at 3 months was observed in group B (89.2%) and group C (90.6%) compared with group A (71%). However, continence at 6 months was comparable in the 3 groups (87.5% in group A, 92.8% in group B, and 92.3% in group C). Rates of positive surgical margins decreased from 30.2% in group A to 20% in group B and 12% in group C. CONCLUSIONS: BNP and PUR during RALP showed a favorable impact on the early postoperative recovery of continence while not affecting positive surgical margins.
Catheterization ; Catheters ; Demography ; Humans ; Neck ; Operative Time ; Prostatectomy ; Prostatic Neoplasms ; Urinary Bladder ; Urinary Incontinence

PURPOSE: We report here on the safety and efficacy of nephron-sparing radiofrequency ablation(RFA) for treating renal tumor. MATERIALS AND METHODS: Starting June 2004, a total of 14 patients underwent RFA for renal tumor during the following 3 years. Of these, 12 cases were followed up for at least 6 months postoperatively. Eight cases of combined computed tomography(CT) and ultrasonogram-guided percutaneous RFA, and four cases of intraoperative ultrasonography-guided laparoscopic RFA were performed with mean follow-up of 18.2 months(range: 4-27 months). The treatment indications were a localized, small(<4cm), solid renal mass in the elderly patients and those patients with co-morbid conditions. Physical examination, CBC, determining the serum creatinine levels and urine analysis were performed for the follow-up laboratory study and kidney CT was performed at day 1, 1 week, 1 month, 3 months, 6 months and 1 year after ablation and thereafter semi-annually. The mean follow-up duration was 18.2 months(range: 4-27 months). RESULTS: All the patients underwent successful RFA without any serious events. Four patients had mild perinephric hematoma on the follow-up CT scan and there was one case of mild gross hematuria postoperatively. With a mean follow-up of 18.2 months, two patients showed residual tumor at 3 months & 22 months, respectively, on the follow-up contrast- enhanced CT after the first tumor ablation. One patient underwent a second RFA and another patient underwent laparoscopic radical nephrectomy, and no residual tumor was seen on the follow-up CT. Distant metastasis was not found in any cases and all the patients are alive on serial follow-up. CONCLUSIONS: Percutaneous or laparoscopic RFA is considered a useful treatment for selected patients who have a small renal mass, and to spare the nephrons. The ultimate role of this modality will continue to evolve and this warrants further studies.
Aged ; Creatinine ; Follow-Up Studies ; Hematoma ; Hematuria ; Humans ; Kidney ; Laparoscopy ; Neoplasm Metastasis ; Neoplasm, Residual ; Nephrectomy ; Nephrons ; Physical Examination