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

This study was undertaken to determine incidence, associated risk factors, and clinical outcomes of a diastasis of pubic symphysis. Among 4,151 women, who delivered 4,554 babies at the Department of Obstetrics of Seoul National University Bundang hospital from January 2004 to December 2006, eleven women were diagnosed as having a symptomatic diastasis of pubic symphysis. We estimated the incidence of the diastasis and identified the associated risk factors. To evaluate the pain relief and reduction of diastasis we followed up the 11 diastatic patients. The incidence of the diastasis was 1/385. Primiparity (P = 0.010) and twin gestation (P = 0.016) appeared as risk factors for diastasis by univairable analysis; and twin gestation appeared to be the only risk factor (P = 0.006) by logistic analysis. Two patients were operated due to intractable pain; and the remaining nine patients were treated conservatively. The diastatic gap decreased to less than 1.5 cm by 2 to 6 weeks after the diagnosis and then remained stationary. At a mean follow-up of 22.1 months (range, 12 to 47 months), five of 11 patients had persistent symphysis pubis dysfunction. Diastasis is more frequent than generally acknowledged. Pregnant women with multiple gestations should be informed about the potential risk of pubic symphysis diastasis.
Adolescent ; Adult ; Birth Weight ; Female ; Follow-Up Studies ; Gestational Age ; Humans ; Incidence ; Logistic Models ; Male ; Middle Aged ; Peripartum Period ; Pregnancy ; Pregnancy, Twin ; Pubic Symphysis/radiography ; Pubic Symphysis Diastasis/diagnosis/*epidemiology ; Risk Factors ; Young Adult

No abstract available.
Hodgkin Disease*

PURPOSE: We analyzed factors associated with early recovery of continence after laparoscopic radical prostatectomy. MATERIALS AND METHODS: Among 467 patients treated with laparoscopic radical prostatectomy for localized prostate cancer between 2007 and 2012, 249 patients who underwent a preoperative urodynamic study were enrolled. The patients' age, prostate volume, preoperative serum prostate-specific antigen (PSA), Gleason score, pathologic stage, and preoperative urodynamic parameters were recorded. The preoperative membranous and prostatic urethral length on magnetic resonance image, nerve sparing technique, and type of surgical procedure (extrafascial and intrafascial) were analyzed. Patients were considered to have early recovery of continence when they needed no pad in 3 months or less after surgery. RESULTS: Ninety-two patients were in the early recovery group and 157 were in the late recovery group. The membranous urethral lengths were 12.06+/-2.56 and 11.81+/-2.87 mm, and prostatic urethral lengths were 36.39+/-6.15 and 37.45+/-7.55 mm in each group, respectively. The membranous-posterior urethral length ratios were 0.25+/-0.06 and 0.24+/-0.06, and prostatic-posterior urethral length ratios were 0.75+/-0.06 and 0.76+/-0.06, respectively. In and of themselves, the membranous and prostatic urethral lengths were not associated with recovery duration however, the membranous-total and prostatic-total urethral length ratios were related (p=0.024 and 0.024, respectively). None of the urodynamic parameters correlated with continence recovery time. In the multivariate analysis, the type of surgical procedure (odds ratio [OR], 7.032; 95% confidence interval [CI], 2.660 to 18.590; p<0.001) and membranous urethral length (OR, 0.845; 95% CI, 0.766 to 0.931; p=0.001) were significantly related to early recovery of continence. CONCLUSIONS: The current intrafascial surgical procedure is the most important factor affecting early recovery of continence after laparoscopic radical prostatectomy.
Humans ; Laparoscopy ; Magnetic Resonance Imaging ; Multivariate Analysis ; Neoplasm Grading ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms ; Urinary Incontinence ; Urodynamics