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*

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

In this paper, acknowledgments section was omitted unintentionally.

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

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: 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

Bilateral renal cell carcinoma is very rare. In the past, bilateral renal cell carcinoma indicated a poor prognosis. But recently, aggressive operative intervention with nephron salvaging procedure can improve the survival of bilateral renal cell carcinoma. The conservative treatment of bilatera1 renal cell carcinoma depends on the size, the location and the stage of the tumor. Of several conservative surgical procedures, either enucleation or extracorporeal partial nephrectomy with autotransplantation were performed followed by radical nephrectomy in our cases. The advantages of an extracorporeal approach in such case include an optimum exposure, a bloodless surgical field, an ability to perform a more precise operation with maximum conservation of renal parenchyma, and a greater protection of the kidney from prolonged ischemia. Although this technique involves increased operative time with greater potential morbidity, we performed this procedure without much difficulties with the surgical skills culminated from renal transplantation.
Autografts ; Carcinoma, Renal Cell* ; Ischemia ; Kidney ; Kidney Transplantation ; Nephrectomy ; Nephrons ; Operative Time ; Prognosis

PURPOSE: The prevalence of prostate cancer is increasing in the general population. This study aimed to determine the prevalence of prostate cancer in the general population of Kangseo-Gu, Busan, Korea and to estimate the overall prevalence of prostate cancer in Korea. MATERIALS AND METHODS: We studied 497 community volunteers of a random selection from August to September 2001. The included volunteers were older than 50 years and were not within the area of general urologic practice. Screening protocols included International Prostatic Symptom Score(I-PSS), digital rectal examination(DRE) and serum prostate specific antigen(PSA) with an immunoenzymatic assay(Tandem-E). Transrectal ultrasound guided prostate biopsy was recommended in patients with a PSA value higher than 4ng/ml, suspicious nodules on DRE or a hypoechoic region on TRUS, or more than two of these findings. RESULTS: The mean age of the volunteers was 61.0 years old with a range of 50-88 years. The most common age range for men was 50-54 years old in Kangseo-Gu with a total of 144 men(28.3%). Overall, the age distribution of Kangseo-Gu residents was similar to that of the study population. Estimated prostate cancer prevalence was 1.81%, and 9 out of the 497 men were diagnosed with prostate cancer based on prostate biopsy. CONCLUSIONS: Our study indicated prostate cancer detection rate of 1.8% in Kangseo-Gu which translates to an estimated 77,400 men who suffer from prostate cancer in Korea. This result reflects an increase in the prevalence of prostate cancer of 43% in 2002 as compared with the reported value of 1.27% in 1996.
Age Distribution ; Biopsy ; Busan* ; Humans ; Korea* ; Male ; Mass Screening ; Prevalence* ; Prostate* ; Prostatic Neoplasms* ; Ultrasonography ; Volunteers