PURPOSE: Radical cystectomy has been a standard method in the treatment for invasive bladder cancer. Recently the orthotopic substitutions have been generally performed for urinary diversion. Ghoneim introduced a new method for orthotopic substitution which has used relatively short segment of ileum, and the method is regarded to have few complications. We performed this method for our study and analyzed the results and complications. MATERIALS AND METHODS: Among total 29 patients underwent ileal W-neobladder with serous-lined extramural tunnel, 27 patients had invasive bladder cancer and the remaining two patients had contracted bladder with vesicoureteral reflux. There were 25 male patients with the mean age of 59.2 years(45-70) and 4 female patients with 61.8 years(51-68). Mean follow-up period for the entire group was 8.4 months(3?17 month). History taking, physical examination, and complete laboratory tests were performed postoperatively and IVP or CT scan was taken at 3 month and 9 month after the operation for the evaluation of recurrence and upper tract change. RESULTS: The average operating time was 8 hours 35 minutes(420-670 min). Paralytic ileus developed in two patients and wound dehisced in 4. In all 29 patients, vesicoureteral reflux was not detected. Stricture of ureteroileal anastomosis was observed in 4 left renal units. We performed percutaneous nephrostomy and antegrade double J stenting on all the patients with stricture primarily, but one patient underwent neoureteroileostomy because of the failure of the primary management. Four patients complained enuresis, but no daytime incontinence was observed. There were no clinical symptoms of complications in all 29 patients and no metabolic acidosis was observed in laboratory tests. CONCLUSIONS: Serous-lined extramural tunnel method of orthotopic substitution showed an acceptable and safe reservoir with a large capacity at low pressure and absence of reflux with relatively short segment of ileum.
Acidosis ; Constriction, Pathologic ; Cystectomy ; Enuresis ; Female ; Follow-Up Studies ; Humans ; Ileum ; Intestinal Pseudo-Obstruction ; Male ; Nephrostomy, Percutaneous ; Physical Examination ; Recurrence ; Stents ; Tomography, X-Ray Computed ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Diversion ; Vesico-Ureteral Reflux ; Wounds and Injuries

PURPOSE: Orthotopic neobladder following radical cystectomy are currently preferred to the other urinary diversions. We have compared three different ureteroenteric anastomoses regarding change of the upper urinary tracts and evaluated correlation between the length of bowel used for bladder reconstruction and metabolic acidosis. MATERIALS AND METHODS: Between Sep. 92 and Jul. 97, 37 patient(range 34-69 yrs) with bladder cancer underwent an orthotopic Mainz pouch with antireflux submucosal tunnel(n=10), an ileal low-pressure bladder substitute with direct ureteroileal anastomosis(Stuffier, n=15) and an ileal W-neobladder with serouslined ertramural tunnel(Ghoneim, n=12) following radical cystectomy Mean follow up was 22 months(7-64 twos). IVP and VCUG were performed at 6, 12 months postoperatively and annually thereafter. The measurement of serum electrolyte and/or arterial blood gas analysis were carried out every 3-6 months. RESULTS: The vesicoureteral reflux occurred in 37%(11/30 renal unit) with Stuffier pouch, 10%(2/20) with Mainz pouch, and none with Ghoneim(p=0.01). Moderate to severe hydronephrosis resulting from reflux was noted in 4 renal units with Stuffier pouch, while an atrophic kidney due to obstruction at ureteroenteric anastomosis was noted with each Mainz pouch and Ghoneim. Metabolic acidosis was identified in 5 patients(33%) with an Stuffier pouch whereas it was noted in less than 10% with Mainz pouch and Ghoneim(p=0.07). Two patients with deteriorated renal function need bicarbonate replacement therapy for correction of metabolic acidosis. CONCLUSIONS: Although most patients with direct ureteroileal anastomosis preserved renal function, antireflux ureteroenteric anastomosis using submucosal tunnel or serous-lined extramural tunnel is better in terms of occurrence of hydronephrosis and vesicoureteral reflux. The length of bowel less than 45cm used for bladder reconstruction may avoid metabolic acidosis
Acidosis* ; Blood Gas Analysis ; Cystectomy ; Follow-Up Studies ; Humans ; Hydronephrosis ; Kidney ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Diversion ; Urinary Tract* ; Vesico-Ureteral Reflux

PURPOSE: Renal cell carcinoma(RCC) in solitary kidney is an absolute indication for partial nephrectomy. We evaluated the renal function after partial nephrectomy for renal cell carcinoma in a solitary kidney. MATERIALS AND METHODS: Partial nephrectomy was performed in 14 patients with localized sporadic RCCs that developed in a solitary kidney between January 1993 and December 2005. In 8 patients(57%), the contralateral kidney had been surgically removed. In the remaining 6 patients, 4 had a contralateral nonfunctioning kidney(29%) and 2 had nephrolithiasis (14%). Three patients were treated with enucleation, and partial nephrectomy was done in 11 patients. The recorded variables we studied were the preoperative and postoperative serum creatinine levels, whether renal ischemia and hypothermia was used, the duration of renal ischemia and the percent of renal parenchyma that was resected. RESULTS: At mean follow-up of 55.6 months(range: 16.3-106.6), the mean serum creatinine had increased from 1.03mg/dl preoperatively to 1.26 mg/dl postoperatively(p>0.05). The mean serum creatinine had significantly increased at 3, 6 and 12 months after surgery(p<0.05). The postoperative serum creatinine after 16 months was still increased compared to the preoperative serum creatinine, but there was no statistical significance(p>0.05). None of the 14 patients required dialysis for end stage renal disease after surgery. The normal preoperative serum creatinine had increased above 1.5mg/dl in two patients, but not above 2.0mg/dl. One patient had multiple renal cell carcinoma masses and one had diabetes mellitus. The postoperative creatinine of the 9 patients who had renal warm ischemia was not significantly different from the 5 patients who had no ischemia(p>0.05). The renal ischemia time, cold ischemia and the resected percent volume of the renal parenchyma were found to have no statistically significant impact on postoperative renal function(p>0.05). CONCLUSIONS: Partial nephrectomy safely preserves renal function in patients with solitary kidney.
Carcinoma, Renal Cell* ; Cold Ischemia ; Creatinine ; Diabetes Mellitus ; Dialysis ; Follow-Up Studies ; Humans ; Hypothermia ; Ischemia ; Kidney Failure, Chronic ; Kidney* ; Nephrectomy* ; Nephrolithiasis ; Warm Ischemia

OBJECTIVES: This study examined the role of free/total prostate specific antigen (PSA) in the differentiation between prostate cancer and benign prostatic hyperplasia (BPH) in patients with total PSA higher than 4.0 ng/ml. MATERIALS AND METHODS: Fourteen untreated patients with prostate Cancer and 63 patients with BPH were included in this study. All patients were pathologically diagnosed by sextant transrectal biopsy before treatment. The level of total PSA and free PSA were determined by immunoradiometric assay (Cis bio international). The median values of total PSA and F/T (free/ total PSA) were compared between prostate cancer and BPH in the three different ranges of total PSA (PSA>4.0ng/ml, 4.0 ng/ml Characteristic (ROC) curves were obtained using sensitivity and specificity of total PSA and F/T at each cutoff level. RESULTS: In the range of PSA between 4.0 and 10.0 ng/ml, the median value of F/T was significantly different between prostate cancer and BPH (p<0.05), while that of total PSA was not. In other ranges of PSA, both total PSA and F/T were significantly different between prostate cancer and BPH. The area under the F/T ROC curve was significantly larger than that of total PSA ROC curve only in the range of PSA between 4.0 and 10.0 ng/ml.. In the mean time, F/T was more specific than total PSA (52% vs 32%) at the identical sensitivity (93%) of F/T and total PSA cutoff values (F/T cutoff, 0.2; total PSA cutoff, 6.0 ng/ml). CONCLUSIONS: Free/Total PSA might provide us more reliable information on the differential diagnosis of the prostate cancer, especially in patients with PSA range between 4.0 and 10.0 ng/ml.
Biopsy ; Diagnosis, Differential* ; Humans ; Immunoradiometric Assay ; Prostate* ; Prostate-Specific Antigen ; Prostatic Hyperplasia* ; Prostatic Neoplasms* ; ROC Curve ; Sensitivity and Specificity

Over the past decade, continent urinary diversion, especially orthotopic bladder substitutions, has become increasingly popular following radical cystectomy for bladder cancer. The ultimate goal of orthotopic bladder substitution is to offer patients the best quality of life, similar to that of patients with native bladders. To achieve that purpose, surgeons should be familiar with the characteristics of good candidates for neobladders, the possible intraoperative and postoperative problems related to the surgery, and the solutions to these problems. Postoperative surveillance and instructions given to the patients also contribute to successful, functional results. Here, we reviewed the indications, pitfalls, and solutions for orthotopic bladder substitutions and the patients' quality of life after surgery. When performed properly, orthotopic continent diversion offers good quality of life with few long-term complications. Therefore, we believe it is the best option for the majority of patients requiring cystectomy.
Cystectomy ; Humans ; Ileum ; Quality of Life ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Diversion

PURPOSE: It has been believed that o-blocker affects the stromal component of BPH, while 5 alpha -reductase inhibitor affects the glandular component. Information on the tissue composition of BPH might be helpful to choose an appropriate medical therapeutic agent. We evaluated whether transrectal ultrasonographic findings could reflect the histologic composition of BPH and the correlation of the composition of BPH and the clinical parameters such as patient's age, peak flow rate, IPSS symptom score, and prostate volume. MATERIALS AND METHODS: Fifty five patients with BPH treated by transurethral resection were studied. The proportions of stromal and glandular area in the resected prostate were determined by image analyzer. "Stromal hyperplasia"was defined when more than 75% of the resected prostate was composed of stromal tissue and microscopically, abundant stromal tissue with normal or atrophic glands were dominant. "Glandular hyperplasia" was defined when more than 25% of the prostate was composed of glandular tissue and microscopically, hyperplastic glandular cells and dilated lumen with occasional cystic changes were dominant. Ultrasonographically, it is classified as stromal hyperplasia when the echo of central gland is fine and lower echogenic than that of peripheral gland, and classlfied as glandular hyperplasia when the echo of central gland Is coarse and isoechogenic or hyperechogenic with focal echopenic areas. Statistical significance was judged by Student t-test and linear regression analysis. Concordance of ultrasonographic findings and histopathologic findings of BPH was determined by Kappa index. RESULTS: Sixty nine percent of resected prostate tissue were composed of stromal tissue. The proportion of stromal tissue in stromal hyperplasia and glandular hyperplasia was 85.8+/- 1.6% and 64.8+/- 1.0%, respectively(p<0.001). Ultrasonography accurately reflect histopathologlc type in 50 of 55 BPH. Two of 12 stromal hyperplasia and 3 of 43 glandular hyperplasia were falsely interpreted on ultrasonography. Three of 5 falsely interpreted cases showed marginal stromal tissue composition(60.9%, 72.9%, 73.3%, 76.4%, and 84.2%). Kappa index of ultrasonogrhaphic finding and histopathologic classification was 0.74(fair to good). In the meantime, clinical parameters including patient's age, peak flow rate, IPSS symptom scores did not correlate with tissue composition. Only prostate volume and resected prostate weight showed negative correlation with proportion of stromal tissue(p=0.0953 and p=0.0794, respectively). CONCLUSIONS: Using our sonographic criteria, transrectal ultrasonography could reflect histologic type of BPH so that choice of medical therapeutic agent may be possible. Larger prostates had less stromal tissue, however, the histologic composition of the prostate was not related to the severity of symptoms or peak flow rate.
Classification ; Humans ; Hyperplasia ; Linear Models ; Prostate ; Prostatic Hyperplasia ; Ultrasonography

The prostatic glandular cells are largely composed of secretory cells and basal cells. Secretory cells produce various enzymatic substance including prostatic specific antigen (PSA), while basal cells have been known to play an important role in the proliferation of the glandular cells. We evaluated the proliferative potential of secretory cells and basal cells in benign prostatic hyperplasia (BPH) and prostate cancer (CAP) by immunohistochemistry. The prostate tissue obtained from 19 patients with BPH and 19 patients with CaP was used in this study. Double staining with PSA and a basal cell marker, cytokeratin (34betaE12) was performed to evaluate the distribution of each cell type in BPH and CaP. Double staining with proliferating cell nuclear antigen (PCNA) and 34betaE12 was carried out to determine the proliferative potential of each cell type. Partial or total loss of basal cell layer was identified in CaP in contrast to intact basal cell layer in BPH. Proportion of basal cells and secretory cells in PCNA positive cells in BPH were 84.6+/-2.0% and 15.4+/-2.0%. In contrast, proportion of basal cells and secretory cells in PCNA positive cells were 1.1+/-1.5% and 98.9+/-1.5% in CaP. PCNA index (PCNA positive cells in 1,000 cells) in CaP was well correlated with Gleason score, but not with pathologic stage. Interestingly, PCNA index in basal cell was significantly higher in stromal type BPH (including fibrous, fibromuscular and muscular type) than that in glandular type BPH (including fibroadenomatous and fibromyoadenomatous type). Taken together, the basal cell play a major role in the proliferation of glandular cells of BPH, while loss of basal cell layer and overproliferation of secretory cells in CaP might lead cancer cells to invade into the stroma. Since higher basal cell PCNA index was noted in glandular type BPH, it is probable that the proliferative potential of basal cell induce secretory cell proliferation.
Cell Proliferation ; Humans ; Immunohistochemistry ; Keratins ; Neoplasm Grading ; Proliferating Cell Nuclear Antigen ; Prostate ; Prostatic Hyperplasia* ; Prostatic Neoplasms*

PURPOSE: There is a trend towards early catheter removal after radical retropubic prostatectomy (RRP). Therefore, the feasibility of early catheter removal after RRP was explored. MATERIALS AND METHODS: Twenty-four consecutive patients having undergone a RRP performed by one surgeon were divided into two groups. Groups A and B comprised the patients who had their cystography taken either 6 or 14 days after surgery, respectively. Voiding symptoms in the immediate (after catheter removal) and late postoperative (1 month after catheter removal) periods were assessed. The mean patient ages were 68.8, ranging from 59 to 76 and 66.8, ranging from 61 to 73 years in groups A and B (p=0.37), respectively. The Mean follow-up was 4.3 months (1-9). RESULTS: One patient in each group showed significant urine leakage on cystography, which required a further week of catheter indwelling. In group A, 8 patients (72.7%) needed pads for their incontinence immediately after catheter removal and 3 (27.3%) required pads continuously 1 month after catheter removal. In group B, incontinence that required pads developed in 9 patients (81.8%) immediately after catheter removal, and in 3 (27.3%) 1 month after catheter removal. One patient in group A required a 3-day Foley catheter indwelling for urinary retention. There were 4 (36.4%) and 2 (18.2%) patients in groups A and B, respectively, with weak urinary stream (Qmax<15ml/sec). CONCLUSIONS: A catheter can be safely removed, with caution, 6 days after a radical retropubic prostatectomy for the development of urinary retention and weak stream, which might be caused by anastomotic edema and transiently decreased bladder contractility.
Catheters* ; Edema ; Follow-Up Studies ; Humans ; Prostatectomy* ; Rivers ; Urinary Bladder ; Urinary Catheterization ; Urinary Retention

PURPOSE: With the widespread use of screening for prostate-specific antigen (PSA), T1c prostate cancer has shown a marked increase in Western countries. We reviewed the trends in clinical stage migration and the changes in the clinical characteristics for patients with prostate cancer in Korea, and we compared these values with those of Western men. MATERIALS AND METHODS: Between 1997 and 2006, 758 men (mean age: 68.6 years) were diagnosed with prostate cancer at our institution. According to the diagnostic period, the patients were divided into 3 groups (the 1997-2000, 2001-2003 and 2004-2006 groups) for comparative analysis of the clinical stage, the serum PSA level and the biopsy Gleason score. RESULTS: The proportion of clinically localized prostate cancer significantly increased by the period (56.8%, 62.5% and 75.4%, respectively; p<0.001) with that of metastatic disease showing a decreasing according to groups (40.0%, 27.5% and 17.6%, respectively; p<0.001). For localized disease, T1c cancers also increased from 26.4% to 19.2% to 31.6% (p=0.002), respectively. The median serum PSA level at diagnosis decreased from 34.5 ng/ml to 16.6ng/ml to 10.8ng/ml (p<0.001), respectively, with the proportion of patients with a PSA level< or =10ng/ml increasing significantly (19.2%, 33.3% and 47.7%, respectively; p<0.001). Although the proportion of biopsy Gleason scores that were 8-10 decreased from 71.2% to 50.2% to 38.3%, respectively, it still comprised 20.8% of the T1c cancers and 22.8% of the cancers with a PSA< or =10ng/ml in the last period, and these values were significantly higher than those in the Western reports. CONCLUSIONS: Downward migration of the clinical stage along with decreases for the serum PSA level and biopsy Gleason score were evident in Korean men. However, the proportion of T1c cancer was still lower than that in the Western series and the fraction of Gleason score 8-10 cancer was distinctively high. We believe this mandates establishing PSA screening programs and administering vigorous management.
Biopsy ; Diagnosis ; Humans ; Korea* ; Male ; Mass Screening ; Neoplasm Grading ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms*

PURPOSE: There is no consensus about a definition of benign prostatic hyperplasia, but there are various definitions based on a combination of clinical parameters used to describe the properties of BPH: symptoms of prostatism, increase of prostate volume, and bladder outlet obstruction. The prevalence of clinical BPH in Asian was believed to be lower than Caucasian. The lower urinary tract symptoms associated with BPH in Korea was reported by some authors and it was similar to the results of other studies in western countries. We report the prevalence of BPH in Korean men through a community-based study in Jeong-Eup county, Korea. MATERIALS AND METHODS: A total of 653 men aged 50 and over in Jeong-Eup area, Korea was randomly selected for determination of the prevalence of BPH. The definition of BPH in this study was combination of moderate(8-19) to severe(>19) I-PSS, enlargement of the prostate over 30gms on digital rectal examination by one board certified urologist, and decreased peak flow rate below 15ml/sec. Men with abnormal digital rectal examination(DRE) and elevated serum prostate specific antigen(PSA) above 3.5ng/ml were undergone sextant prostate biopsy to exclude the prostate cancer. RESULTS: I-PSS questionnaires were completed in 431 men and the response rate was 66.1%. Based on I-PSS, 162 men(37.6%) had moderate symptoms and 51 men(11.9%) severe symptoms. Of 213 men with moderate to severe symptoms, 35.7% had enlarged prostate by DRE, and 63.1% decreased flow rate. The prevalence of BPH by the definition in this study was 4.3% in their fifties, 13.2% in sixties and 16.3% in seventies and over eighty(overall, 11.1%). The population-adjusted prevalence of BPH in Korean men aged 50 and over was 8.7%. A good correlation was found between the total symptom score and the quality of life score that is included in the I-PSS. CONCLUSIONS: Men with moderate to severe I-PSS was 49.5%, which was similar to the results from other studies in Caucasian and Japanese. The prevalence of BPH in Korea by aforementioned definition was 8.7%, which seems to be lower than Caucasian. This results suggest that approximately 1,600,000 Korean men had moderate to severe urinary symptoms and 300,000 clinical BPH by the definition in this study.
Asian Continental Ancestry Group ; Biopsy ; Consensus ; Digital Rectal Examination ; Humans ; Jeollabuk-do* ; Korea ; Lower Urinary Tract Symptoms ; Male ; Prevalence* ; Prostate ; Prostatic Hyperplasia* ; Prostatic Neoplasms ; Prostatism ; Quality of Life ; Surveys and Questionnaires ; Urinary Bladder Neck Obstruction