PURPOSE: Despite the large number of analytical reports regarding the learning curve in the transition from open to robot-assisted radical prostatectomy (RARP), few comparative results with laparoscopic radical prostatectomy (LRP) have been reported. Thus, we evaluated operative and postoperative outcomes in RARP versus 100 simultaneously performed LRPs. MATERIALS AND METHODS: A single surgeon had performed more than 1,000 laparoscopic operations, including 415 cases of radical nephrectomy, 85 radical cystectomies, 369 radical prostatectomies, and treatment of 212 other urological tumors, since 2009. We evaluated operative (operation time, intraoperative transfusion, complications, hospital stay, margin status, pathological stage, Gleason score) and postoperative (continence and erectile function) parameters in initial cases of RARP without tutoring compared with 100 recently performed LRPs. RESULTS: Mean operation time and length of hospital stay for RARP and LRP were 145.5+/-43.6 minutes and 118.1+/-39.1 minutes, and 6.4+/-0.9 days and 6.6+/-1.1 days, respectively (p=0.003 and p=0.721). After 17 cases, the mean operation time for RARP was similar to LRP (less than 2 hours). Positive surgical margins in localized cancer were seen in 11.1% and 8.9% of cases in RARP and LRP, respectively (p=0.733). At postoperative 3 months, sexual intercourse was reported in 14.0% and 12.0%, and pad-free continence in 96.0% and 81.0% in patients with RARP and LRP, respectively (p=0.796 and p=0.012). CONCLUSIONS: Previous large-volume experience of LRPs may shorten the learning curve for RARP in terms of oncological outcome. Additionally, previous experience with laparoscopy may improve the functional outcomes of RARP.
Coitus ; Cystectomy ; Humans ; Laparoscopy ; Learning Curve* ; Length of Stay ; Nephrectomy ; Prostatectomy* ; Prostatic Neoplasms ; Robotics ; Treatment Outcome

A 26-year-old man complained of a vague low abdominal discomfort for the previous 2 months. Radiologic evaluations demonstrated that there was tubular structure connected with the right side wall of the bladder, suggesting Meckel's diverticulum with fistula formation to the bladder as well as a mass-like bladder wall thickening. With an impression of Meckel's diverticulum with fistula with the bladder, laparoscopic surgery was performed to confirm a diagnosis and to manage the Meckel's diverticulum with fistula with the bladder. The distal tip of the appendix was firmly attached to the right side of the bladder. The final diagnosis was corrected by laparoscopy followed by laparoscopic appendectomy and fistula repair. Vesico-appendiceal fistula is an uncommon type of vesico-enteral fistula and a rare complication of unrecognized appendicitis. Additionally, this report showed the significant value of laparoscopy as a diagnostic and therapeutic tool to this entity.
Appendectomy ; Appendicitis ; Appendix ; Fistula ; Laparoscopy ; Meckel Diverticulum ; Urinary Bladder

PURPOSE: We retrospectively evaluated the outcome and risk factors of tubularized incised plate (TIP) urethroplasty in patients with reoperative hypospadias repairs. MATERIALS AND METHODS: Thirty-nine patients with reoperative hypospadias repairs by the TIP method were evaluated. The meatal location, interval between prior urethroplasty and reoperation, length from meatus to penile tip, coexistence of chordee, type of prior urethroplasty, shape of glans, scarring on urethral plate, times of prior urethroplasty, and complications were reviewed. We also evaluated the outcome of reoperative hypospadias repairs and the relationships between these factors and outcomes. RESULTS: The mean age of the patients was 47.7+/-77.9 months (range: 5-384 months) at prior urethroplasty and 92.7+/-115.6 months (12-480 months) at reoperative urethroplasty, and the mean follow-up duration was 54.2+/-90.5 months (6-443 months). Complications at prior urethroplasty included urethrocutaneous fistula in 18 patients, wound dehiscence in 9, meatal stenosis in 5, persistent chordee in 5, and urethral diverticulum in 3. Complications at TIP reoperation were urethrocutaneous fistula and wound dehiscence in 11 and 4 patients, respectively (complication rate: 38.5%). Older age at the time of the repeat urethroplasty, long urethral defect, and scarring in the urethral plate at reoperation were related with poor outcomes in reoperative urethroplasty. CONCLUSIONS: TIP urethroplasty for reoperative hypospadias repair can result in good cosmetic and functional outcomes. However, caution is necessary in patients of old age or with a long urethral defect and scarring at the urethral plate at reoperation.
Cicatrix ; Constriction, Pathologic ; Cosmetics ; Diverticulum ; Female ; Fistula ; Follow-Up Studies ; Humans ; Hypospadias ; Male ; Reoperation ; Retrospective Studies ; Risk Factors

PURPOSE: HIF-1alpha(Hypoxia inducible factor-1alpha) and VEGF(vascular endothelial growth factor) have been reported to be involved in tumor growth and metastasis but little data concerning their role in transitional bladder cancer is available and few studies have yet evaluated their prognostic values. The aim of the present study was to assess HIF-1alpha and VEGF expression and to evaluate the relationship between HIF-1alpha/ VEGF and histopathologic characteristics in bladder tumors. MATERIALS AND METHODS: HIF-1alpha and VEGF immunohistochemical stainings were performed on formalin-fixed, paraffin-embedded archival tissues from 27 transitional bladder cancer tissues and from 4 normal bladder tissues as a control group. Interpretation of immunohistochemical staining was performed semi-quantitatively by one pathologist. RESULTS: Expressions of HIF-1alpha and VEGF tended to be higher in the patient group than in the control group. HIF-1alpha expression was correlated with VEGF expression. HIF-1alpha and VEGF tended to be positively correlated with pathologic stage and grade of transitional bladder cancer. CONCLUSIONS: HIF-1alpha and VEGF expression might be independent predictors of outcome, as well as stage and grade of transitional bladder cancer. This study suggests that HIF-1alpha and VEGF may be potential prognostic factors in bladder cancer.
Angiogenesis Inducing Agents ; Anoxia* ; Humans* ; Neoplasm Metastasis ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Vascular Endothelial Growth Factor A*

PURPOSE: Renal angiomyolipoma (AML) is a benign renal tumor composed of fat, blood vessels, and smooth muscle elements in variable proportion. Radiologic diagnosis of AML depends on the amount of fat in AML, but AML with minimal fat is difficult to differentiate with renal cell carcinoma. We evaluated the accuracy of the radiologic study in the diagnosis of AML and radiologic characteristics of AML with minimal fat. MATERIALS AND METHODS: From 1993 to 2002, five AMLs with minimal fat of 14 AMLs, which were diagnosed radiologically or pathologically, and 26 renal cell carcinoma, which were classified pathologically as stage 1 (pT1N0M0), were included. The echogenecity on the sonogram, the attenuation on unenhanced and contrast material-enhanced computed tomographic (CT) images, and the signal intensity on T1-, T2-weighted magnetic resonance images (MRI) were investigated and compared retrospectively. RESULTS: Nine of 14 AMLs were radiologically diagnosed (64.3%). Five AMLs with minimal fat were diagnosed pathologically (1 of renal biopsy, 3 of partial nephrectomy, and 1 of radical nephrectomy). Four of five AMLs with minimal fat showed homogeneous iso-echogenecity, and one showed low-echogenecity on the sonograms. Five AMLs with minimal fat showed homogeneously attenuation on unenhanced CT. Four showed mild enhancement, and one showed heterogenous enhancement. Capsules were not observed in the AMLs with minimal fat but were observed in 20 of 26 renal cell carcinoma on CT. All 4 AMLs with fat demonstrated high signal intensity on the T1- and T2-weighted MRI. AMLs with minimal fat demonstrated low and intermediate signal intensity in 2 and 1 on T1-weighted image, respectively, and demonstrated low and high signal intensity in 2 and 1 on T2-weighted images, respectively. CONCLUSIONS: In the kidney, the renal mass that was homogenously minimal enhanced renal mass without capsule are suggestive of renal angiomyolipoma that contains abundant muscles and minimal fat and should be considered for nephron sparing surgery.
Angiomyolipoma* ; Biopsy ; Blood Vessels ; Capsules ; Carcinoma, Renal Cell ; Diagnosis ; Fats ; Kidney ; Magnetic Resonance Imaging ; Muscle, Smooth ; Muscles ; Nephrectomy ; Nephrons ; Retrospective Studies

No abstract available.
Anemia, Dyserythropoietic, Congenital*

Desmoplastic cerebral glioblastoma has been described recently and is a very rare histologic variant of glioblastoma. We report a case of congenital cerebral glioblastoma associated with intense desmoplastic stromal reaction. A male infant was born at 36 gestational weeks by Cesarian section. He had a brain tumor, which was detected by fetal ultrasonography. The tumor was partially resected 2 months after the day of the boy's birth and totally resected when he was one year old. The microscopic features of the tumor were those of glioblastoma, including high cellularity, frequent mitotic figures, vascular endothelial proliferation, and geographic palisading necrosis. The tumor showed an area of intense desmoplasia where tumor cells were surrounded by dense reticulin fibers. The desmoplastic cerebral tumors in children may be a distinct group of brain tumor, and it is important to understand the entity of these tumors which generally seem to be associated with more favorable prognosis compared to other high grade brain tumors.
Brain Neoplasms ; Child ; Glioblastoma* ; Humans ; Infant ; Male ; Necrosis ; Parturition ; Prognosis ; Reticulin ; Ultrasonography, Prenatal

PURPOSE: Postoperative ileus (POI) is common following bowel resection for radical cystectomy with ileal conduit (RCIC). We investigated perioperative factors associated with prolonged POI following RCIC, with specific focus on opioid-based analgesic dosage. MATERIALS AND METHODS: From March 2007 to January 2013, 78 open RCICs and 26 robot-assisted RCICs performed for bladder carcinoma were identified with adjustment for age, gender, American Society of Anesthesiologists grade, and body mass index (BMI). Perioperative records including operative time, intraoperative fluid excess, estimated blood loss, lymph node yield, and opioid analgesic dose were obtained to assess their associations with time to passage of flatus, tolerable oral diet, and length of hospital stay (LOS). Prior to general anaesthesia, patients received epidural patient-controlled analgesia (PCA) consisted of fentanyl with its dose adjusted for BMI. Postoperatively, single intravenous injections of tramadol were applied according to patient desire. RESULTS: Multivariate analyses revealed cumulative dosages of both PCA fentanyl and tramadol injections as independent predictors of POI. According to surgical modality, linear regression analyses revealed cumulative dosages of PCA fentanyl and tramadol injections to be positively associated with time to first passage of flatus, tolerable diet, and LOS in the open RCIC group. In the robot-assisted RCIC group, only tramadol dose was associated with time to flatus and tolerable diet. Compared to open RCIC, robot-assisted RCIC yielded shorter days to diet and LOS; however, it failed to shorten days to first flatus. CONCLUSION: Reducing opioid-based analgesics shortens the duration of POI. The utilization of the robotic system may confer additional benefit.
Aged ; Analgesics, Opioid/*administration & dosage/therapeutic use ; Carcinoma/*surgery ; Cystectomy/*adverse effects ; Dose-Response Relationship, Drug ; Female ; Humans ; Ileus/*epidemiology ; Length of Stay ; Linear Models ; Male ; Middle Aged ; Multivariate Analysis ; Robotic Surgical Procedures/adverse effects ; Time Factors ; Tramadol/*administration & dosage/therapeutic use ; Treatment Outcome ; Urinary Bladder Neoplasms/*surgery ; Urinary Diversion/*adverse effects

PURPOSE: The purpose of this study was to understand the principle of percutaneous nephrolithotomy(PNL), toincrease its success rate, and to base the radiologic approach on preoperative interventional tract dilatation. MATERIALS AND METHODS: Twenty-six patients(male, 19, female, 7) with staghorn or pelviocalyceal calculi who hadundergone PNL were included in this study. After percutaneous nephrostomy(PCN) was performed in each patient, thetract was dilated to 30F with Amplatz dilators using coaxial techniques or a 30F, 10cm high-pressure tractdilatation balloon. One day before the calculi were fragmented and removed by PNL, a 30F Amplatz sheath wasinserted under local anesthesia. The time required for tract dilatation, complications, and surgery was analyzed. RESULTS: Percutaneous tract dilatation were successful in all patients, and forceps, a nephrolithotome and anephroscope were successfully introduced into the pelvocalyceal system. The average procedure time was 19.5minutes ; a double J stent was replaced in the pelvocalyceal system of 13 of 26 patients (50%) ; because ofimproper catheter direction or/and bleeding, the Amplatz sheath was replaced in three. After PNL, complicationsinvolving renal hematoma occurred in one patient. This did not affect the patient's prognosis, however. CONCLUSION:Owing to its short procedure time and low complication rate, interventional preoperative tract dilatation forPNL is thought to be an effective technique for patients with staghorn or pelvocalceal calculi.
Anesthesia, Local ; Calculi ; Catheters ; Dilatation* ; Female ; Hematoma ; Hemorrhage ; Humans ; Nephrostomy, Percutaneous* ; Prognosis ; Stents ; Surgical Instruments

Although prostate-specific antigen (PSA) is a very useful screening tool, prostate biopsy is still necessary to confirm prostate cancer (PCA). However, it is reported that PSA is associated with a high false-positive rate and prostate biopsy also has various procedure-related complications. Therefore, the authors have devised a nomogram, which can be used to estimate the risk of PCA, using available clinical data for men with a serum PSA less than 10 ng/mL. Prostate biopsies were obtained from 2,139 patients from January 1998 to March 2011. Of them, 1,171 patients with a serum PSA less than 10 ng/mL were only included in this study. Patient age, PSA, free PSA, prostate volume, PSA density and percent free PSA ratio were analyzed. Among 1,171 patients, 255 patients (21.8%) were diagnosed as PCA. Multivariate analyses showed that patient age, prostate volume, PSA and percent free PSA had statistically significant relationships with PCA (P < 0.05) and were used as nomogram predictor variables. The area under the (ROC) curve for all factors in a model predicting PCA was 0.759 (95% CI, 0.716-0.803).
Adult ; Age Factors ; Aged ; Aged, 80 and over ; Area Under Curve ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; *Nomograms ; Predictive Value of Tests ; Prostate/physiology ; Prostate-Specific Antigen/*blood ; Prostatic Neoplasms/*diagnosis/pathology ; ROC Curve ; Risk Factors