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: We compared a single surgeon's experience with radical prostatectomy by laparoscopic radical prostatectomy (LRP) versus robot-assisted laparoscopic radical prostatectomy (RARP) with regard to preoperative, intraoperative, and postoperative parameters. MATERIALS AND METHODS: We retrospectively reviewed 120 patients undergoing LRP and RARP from January 2003 to December 2008. The patients were matched for age, body mass index, prostate-specific antigen, pathological stage, and Gleason score. Preoperative, perioperative, and postoperative data, including complications, and trifecta results (positive surgical margin, potency, and continence) were analyzed between the two groups. RESULTS: The two groups were statistically similar with respect to age, body mass index, prostate-specific antigen, Gleason score, and clinical stage. The RARP group showed better results in operative time, estimated blood loss, hospital stay, and bladder catheterization duration. There were no major complications, but minor complications occurred in 25.0% versus 10.0% of cases. The trifecta results were better in the RARP group than in the LRP group. CONCLUSIONS: RARP showed excellent results in several operative parameters compared with LRP. If the economic hurdle to RARP can be overcome, it will become the standard treatment in radical prostatectomy.
Body Mass Index ; Catheterization ; Catheters ; Humans ; Laparoscopy ; Length of Stay ; Neoplasm Grading ; Operative Time ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Retrospective Studies ; Robotics ; Urinary Bladder

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 describe our initial experience with the second-generation Single Port Instrument Delivery Extended Reach (SPIDER) laparoendoscopic single-site surgical system in a porcine model. MATERIALS AND METHODS: In four swine weighing approximately 32 to 35 kg, five nephrectomies, four adrenalectomies, three pyeloplasties, and three partial cystectomies and closures were performed by a single surgeon. The swine were placed in the lateral flank position under general anesthesia. The SPIDER surgical system was introduced through a single incision and the various urological procures were performed by use of flexible instrumentation. RESULTS: All five nephrectomies, four adrenalectomies, three pyeloplasties, and three partial cystectomies and closures were performed successfully without additional skin incisions. The mean time to set up the SPIDER platform was 3.5 minutes. The mean operative time for the right and left nephrectomies was 45.4 minutes and 47.8 minutes, respectively. The mean operative time for the right and left adrenalectomies was 37.6 minutes and 35.4 minutes, respectively. The mean operative time for the pyeloplasties for one right and two left ureters was 45.6 minutes and 47.3 minutes, respectively. The mean operative time for the partial cystectomies and closures was 18.6 minutes. There were no noticeable intraoperative complications except for minimal urine leakage in the first pyeloplasty. CONCLUSIONS: In this initial pilot evaluation, the second-generation SPIDER surgical system offered intuitive instrument maneuverability and restored triangulation. However, retraction was challenging because of the lack of strength and the limited ability for precise manipulation of the tip. Future refinements of the technology and prospective studies are needed to optimize the application of this technology in urology.
Adrenalectomy ; Anesthesia, General ; Cystectomy ; Intraoperative Complications ; Laparoscopy ; Nephrectomy ; Operative Time ; Robotics ; Skin ; Spiders ; Swine ; Ureter ; Urologic Surgical Procedures ; Urology

PURPOSE: We analyzed the perioperative and early oncological outcomes following radical cystectomy with using the laparoscopic method, and we compared these findings with those of the conventional open method. MATERIALS AND METHODS: Between January 2003 and December 2006, we performed laparoscopic radical cystectomy(LRC) with an extracorporeal ileal conduit for treating bladder cancer in 22 patients, and the results of the LRC were compared with those of open radical cystectomy(ORC) in 20 cases. The surgical results such as the operation time, the estimated blood loss(EBL), the transfusion rate, the hospital stay, the complications and the oncological results were reviewed retrospectively and then analyzed via the Mann-Whitney U test. RESULTS: There were no significant differences of demographic data between the two groups. The pathologic reports showed a transitional cell type in all cases. For the LRC and ORC groups, the mean operation time for cystectomy was 186.5 min(150-240) vs 192.4 min(150-240), respectively (p=0.276), the EBL was 228.18ml(150-380) vs 995.0ml(400-1,200), respectively(p<0.01), the transfusion rate was 15.7% vs 85.0%, respectively, the hospital stay was 11.2 days vs 12.4 days, respectively(p=0.67), the intraoperative complications was 3/22 cases(13.6%) vs 9/20 cases(45.0%), respectively. The pathologic surgical margins were all negative. The surgical and pathologic parameters of the LRC group showed no significant differences compared to those of the ORC group, except for the EBL and transfusion rate. CONCLUSIONS: LRC resulted in less blood loss, a lower transfusion rate and earlier, more rapid recovery than did ORC. In our opinion, lararoscopic surgery is a feasible treatment for bladder cancer.
Cystectomy* ; Humans ; Intraoperative Complications ; Laparoscopy ; Length of Stay ; Retrospective Studies ; Urinary Bladder Neoplasms ; Urinary Diversion*