PURPOSE: Extracorporeal shock wave lithotripsy (SWL) has been established as the treatment of choice for the urinary stones. But, for the treatment of staghorn calculi, the efficacy of this therapeutic procedure is controversal. We intended to study the therapeutic results and the usefulness of ureteral stent between 2 types of lithotriptor, EDAP LT-01 and Storz Modulith SLX. MATERIALS AND METHODS: Sixty cases were diagnosed as staghorn calculi from February 1990 to December 1998. Among them, 31 patients were treated with EDAP LT-01 SWL (group A) and 29 patients with Storz Modulith SLX SWL (group B). We inserted a double-J stent in 45 patients that consisted of 24 patients from group A and 21 patients from group B. The number of treatment sessions, complications and success rates were compared regarding each SWL and volume of the stone. RESULTS: The success rates of each SWL were 70.9% in group A and 75.9% in group B. The success rates, according to staghorn morphology, were 71.4% and 85.7% in partial staghorn of group A and B. The average shock wave sessions were 12.0 and 7.4 in partial staghorn of group A and B. The success rates, according to staghorn volume, were 67.8% and 88.9% in less than 60cm3 of group A and B. The average shock wave sessions were 12.6 and 9.6 in less than 60cm3 of group A and B. The findings were statistically significant between the two groups in less than 60cm3 or partial staghorn. After SWL, incidence of steinstrasse was 12.5% and 33.3% in the double-J stent inserted patients of group A and B. CONCLUSIONS: SWL could be a method of primary treatment for staghorn calculi. Storz Modulith SLX SWL was more effective than EDAP LT-01 SWL for staghorn calculi of which the volume was less than 60cm3. Placement of ureteral stents would be effective in the treatment of staghorn calculi by EDAP LT-01 SWL and not in Storz Modulith SLX.
Calculi* ; Humans ; Incidence ; Lithotripsy ; Shock ; Stents ; Ureter ; Urinary Calculi

Bronchogenic cysts are rare congenital malformations, most often occurring in the pulmonary parenchyma or posterior mediastinum. But they can develop in the ectopic area, especially in the retroperitoneal space. We report a case of adrenal bronchial cyst treated with laparoscopic excision. A 55-year-old woman was admitted with a left adrenal tumor on computed tomography during a study for dyspnea, cough, and sweats. The function of the adrenal glands was examined, and as a result, the adrenal tumors were determined to be nonfunctional. Magnetic resonance imaging showed about an 8-cm-sized large unilocular cystic lesion with mild and high signal intensities at left suprarenal fossa on T1 and T2 images. Iodine-123 metaiodobenzylguanidine scan showed no scintigraphic evidence of neuroendocrine tumor in the left adrenal gland. We performed laparoscopic adrenalectomy with transperitoneal approach. The round, cystic mass was completely excised saving normal adrenal tissues. The operative time was 75 minutes and there was no definitive bleeding and complication. The pathologic tissue weighed 35 g and measured 88 mm×45 mm×28 mm, and cystic changes were observed on the cut surface. The pathologic examination confirmed an adrenal bronchogenic cyst. We report a very rare disease, adrenal bronchial cyst, which could be easily and safely treated with laparoscopic surgery.

When surgical treatment for symptomatic seminal vesicle cyst is deemed necessary, conventional surgery is invasive because of the deep location and dissection difficulty of the seminal vesicles in the retrovesical space. Recently, the laparoscopic approach has been advocated as an optimal yet minimally invasive technique for the surgical treatment of seminal vesicle pathology. It provides a good image and easy approach to the seminal vesicles. We report a case of a symptomatic giant cyst of the left seminal vesicle that is associated with ipsilateral renal agenesis, which was treated by transperitoneal laparoscopic excision.
Laparoscopy ; Pathology ; Seminal Vesicles*

PURPOSE: During transrectal ultrasound guided prostate biopsy, 65% to 90% of patients reportedly have discomfort. We compared the anesthetic effects of a periprostatic injection of lidocaine under ultrasound guidance with the effects of a rectal instillation of lidocaine gel before the transrectal ultrasound guided prostate biopsy. MATERIALS AND METHODS: A prospective randomized double-blind study was performed in 72 patients requiring a systematic biopsy of the prostate. Patients were randomized into two groups according to the method of anesthetic delivery that was used. Group 1 consisted of 37 patients who intrarectally received 10 ml of 2% lidocaine gel 10 minutes before biopsy, and 5 ml of normal saline was injected into the periprostatic nerve plexus just before biopsy under ultrasound guidance using an 18 gauge 16 cm needle on each side. Group 2 consisted of 35 patients who received 10 ml of sterile gel without lidocaine and a 5 ml 1% lidocaine injection using the same method as group 1. The pain score was assessed using a visual analogue scale immediately after biopsy. RESULTS: There was a statistical difference in the mean pain score between the two groups (5.1+/-1.7 in group 1 versus 3.3+/-1.5 in group 2) (p<0.001), but The complication rates were not significantly different. CONCLUSIONS: We believe that performing the transrectal ultrasound guided prostatic nerve blockade before biopsy significantly diminishes the discomfort associated with the procedure, which, in turn, improves patient tolerance more so than rectal instillation of lidocaine gel. In addition, this procedure is a safe, simple, and rapid technique that should be considered in all patients undergoing transrectal ultrasound guided prostate biopsy.
Administration, Rectal* ; Anesthetics ; Biopsy* ; Double-Blind Method ; Humans ; Lidocaine* ; Needles ; Nerve Block ; Prospective Studies ; Prostate* ; Ultrasonography*

Pelvic inflammatory disease can induce tubo-ovarian abscess, peritonitis, perihepatitis as sequelae. It can result in an associated hydroureteronephrosis or ureteral obstruction. We experienced a case of ureteral obstruction with urinoma in a 22-year old woman who had tubo-ovarian abscess, presented with fever, chills and left flank pain. She was treated with ureteroureterostomy and urinoma excision.
Abscess* ; Chills ; Female ; Fever ; Flank Pain ; Humans ; Pelvic Inflammatory Disease ; Peritonitis ; Ureter* ; Ureteral Obstruction* ; Urinoma* ; Young Adult

Neoplasms of the spermatic cord are rare tumors. Especially, the spermatic cord is an extremely unusual site for cavernous hemangioma. We experienced a recurrent cavernous hemangioma in a 12 year-old boy. His chief complaint was recurrent inguinal mass and he was pathologically diagnosed as having a cavernous hemangioma of the spermatic cord. To the best of our knowledge, this is the first Korean report of a recurrent cavernous hemangioma of the spermatic cord.
Child ; Hemangioma, Cavernous* ; Humans ; Male ; Spermatic Cord*

PURPOSE: We compared the results of our experience with hand-assisted laparoscopic simple nephrectomy (HALN) and the standard laparoscopic simple nephrectomy with the transperitoneal approach for treating benign renal diseases. MATERIALS AND METHODS: Between March 2002 and March 2004, 38 patients, including 36 patients with a non-functioning kidney and 2 angiomyolipomas, received laparoscopic simple nephrectomies. The HALN approach method was used for 11 patients and transperitoneal standard laparoscopy was used for 27 patients. The operative and clinical records were retrospectively reviewed. RESULTS: The mean patient age and gender were not significantly different in the HALS and standard groups. The procedures were performed successfully in all but 2 patients. Intraoperatively, one patient of HALN group had spleen injury, which was treated with splenectomy. One patient of the standard group had open conversion due to dissection difficulty because of severe adhesions. Postoperatively, one patient of the standard group had intraperitoneal hematoma, which was treated conservatively. The mean operative time, initiation of the postoperative oral intake and the initiation day for ambulation were not significantly different in both groups. The analgesic use (diclofenac sodium, 90.0mg versus 22.5mg, respectively) and the postoperative hospital stay (7.2 days versus 5.6 days, respectively) was shorter in the standard group than in the HALN group (p<0.05). CONCLUSIONS: Standard laparoscopic simple nephrectomy with the transperitoneal approach is a less invasive technique than hand-assisted nephrectomy. There is no difference in the technical difficulty according to the operative time and complication rate.
Angiomyolipoma ; Hand ; Hematoma ; Humans ; Kidney ; Laparoscopy ; Length of Stay ; Nephrectomy* ; Operative Time ; Retrospective Studies ; Sodium ; Spleen ; Splenectomy ; Walking

BACKGROUND: Elderly patients with underlying cardiovascular or respiratory diseases are more susceptible to anesthesiologic risks or serious complications following laparoscopic operations. We evaluated the safety of laparoscopic radical nephrectomy in elderly patients to compensate for the lack of Korean data on the subject in the field of urology. METHODS: From March 2003 and March 2009, 73 patients with localized renal cell cancer underwent laparoscopic radical nephrectomy. They were divided into two groups according to age; 75 years or older (elderly group, n=21) and under 75 years (young group, n=52). Operative parameters as well as oncological outcomes were evaluated. RESULTS: The mean age was 77.7+/-2.5 years for the elderly group and 55.9+/-10.5 years for the young group. No significant differences existed between the groups in terms of mean operative time, intraoperative blood loss, complications, and hospital stay. However, American Society of Anesthesiologists (ASA) score, co-morbidities (p<0.05), and rate of transfusion (p<0.05) were significantly higher in the elderly group. In overall analyses, we conclude that in elderly patients undergoing laparoscopic radical nephrectomy, close monitoring of hemoglobin level as well as intraoperative transfusion for maintenance of hemoglobin level at 10 mg/L or higher is necessary in elderly patients to achieve adequate circulation. CONCLUSION: Laparoscopic radical nephrectomy can be considered a safe and effective procedure for most elderly patients.
Aged ; Carcinoma, Renal Cell ; Hemoglobins ; Humans ; Laparoscopy ; Length of Stay ; Nephrectomy ; Operative Time ; Urology

Renal vein thrombosis is a rare, renal disease in adults that is related to hypercoagulability. We experienced a case of renal vein thrombosis in a 30-years old woman who presented with fever, chills and left flank pain after delivery. She was treated with catheter-directed thrombolytic therapy and oral anticoagulants.
Adult ; Anticoagulants ; Chills ; Female ; Fever ; Flank Pain ; Humans ; Pregnancy ; Renal Veins* ; Thrombolytic Therapy ; Thrombophilia ; Thrombosis*

Malakoplakia is a chronic inflammatory disease. Approximately 75% of cases are located in the genitourinary system. The etiology remains obscure but it appears related to an underlying infection. It mainly occurs in females in a 4:1 ratio, and the peak age is in the sixth decade. Apart from the symptoms associated with urinary tract infections, the clinical manifestations are usually unremarkable. Here, we report a 44-year-old woman suffering from an intraabdominal mass, with histology that was specific for a malakoplakia of the bladder. This case was difficult to differentiate from a urachal cancer.
Adult ; Female ; Humans ; Malacoplakia* ; Urinary Bladder ; Urinary Tract Infections ; Urogenital System