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*

PURPOSE: Although percutaneous aspiration and sclerotherapy is a simple, noninvasive and cost-effective therapy for symptomatic renal cysts, the recurrence rate is high. Recently, a laparoscopy has been attempted on symptomatic renal cysts. To assess the clinical efficacy and safety of the laparoscopic cyst marsupialization, the clinical characteristics and operative parameters were evaluated, and compared with the results of sclerotherapy. MATERIALS AND METHODS: Between November 1993 and February 2003, 71 patients with symptomatic simple renal cysts were treated with either laparoscopic marsupialization or sclerotherapy. Respectively, 26 of 31 laparoscopy patients and 27 of 40 sclerotherapy patients were followed-up over a 2 months period and included in this study. The laparoscopic marsupialization was accomplished with either transperitoneal (15 patients) or retroperitoneal approaches (11). The sclerotherapy was composed of percutaneous aspiration followed by an injection of 99% ethanol. RESULTS: The clinical characteristics, including cyst size, location and laterality, were no different in either group. The mean follow-up durations were 19.7 and 18.1 months in laparoscopy and sclerotherapy groups, respectively. Comparing the laparoscopy with the sclerotherapy group, the operation time (106.2 vs. 15.3 min.), hospital stay (7.8 vs. 4.6 days) and complication rate (23.1 vs. 3.7%) were significantly decreased in the sclerotherapy group. However, the success rate (96.2 vs. 77.8%) was significantly increased in the laparoscopy group. With either the transperitoneal or retroperitoneal approaches in the laparoscopy group, there was no statistical difference in the operative time, hospital stay and complication and success rates. CONCLUSIONS: For a symptomatic renal cyst, laparoscopic marsupialization is an effective therapy, with a high success rate on the long-term follow-up. The clinical results, according to the approach method, were not different for the transperitoneal and retroperitoneal approaches.
Ethanol ; Follow-Up Studies* ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Recurrence ; Sclerotherapy*

PURPOSE: Laparoscopic surgery has been generalized for the treatment of localized renal cell carcinoma(RCC). Recently, laparoscopic radical nephrectomy for an RCC over the pT2 stage has gained rapid momentum as an effective surgery for treatment. We evaluated the possibility of the use of laparoscopic surgery for a large RCC, using the surgical results according to tumor size. MATERIALS AND METHODS: Between June 2003 and June 2007, a total of 46 patients that under underwent a laparoscopic radical nephrectomy for RCC were divided into three groups according to tumor size: group 1 (n=16, tumor size 7cm). The surgical outcomes and perioperative morbidities were evaluated retrospectively, and were compared for each group. RESULTS: The transfusion rate for group 3 patients was higher than for the other groups(group 1: 0%, group 2: 13.3%, group 3: 26,7%). However, the mean operative time(group 1: 154.3 minutes, group 2: 158.4 minutes, group 3: 197.9 minutes), postoperative initiative time to ambulate(group 1: 1.88 days, group 2: 2.00 days, group 3: 1.87 days) postoperative initiative time to diet(group 1: 1.38 days, group 2: 1.53 days, group 3: 1.53 days), total hospital stay(group 1: 7.94 days, group 2: 8.47 days, group 3: 8.20 days) and complication rate(group 1: 12.5%, group 2: 13.3%, group 3: 13.3%) were similar for patients in the three groups. Pathological results indicated that all cases showed a renal cell carcinoma with a negative surgical margin. CONCLUSIONS:There were no differences in the operative and postoperative results of the performance of laparoscopic radical nephrectomy according to tumor size, except for the transfusion rate. If the use of the technique and experience accumulate, laparoscopic radical nephrectomy will be feasible for all localized RCC regardless of tumor size.

PURPOSE: Some authors have suggested that erectile dysfunction correlates with the level of glycemic control and glycosylated hemoglobin can be used to predict erectile dysfunction in diabetic patients. This study evaluated whether or not glycosylated hemoglobin level can predict the effectiveness of sildenafil citrate, which is a first line therapy for erectile dysfunction. MATERIALS AND METHODS: A consecutive sample of 32 men with type 2 diabetes and erectile dysfunction completed the International Index of Erectile Function (IIEF) and had their glycosylated hemoglobin levels measured. 50mg of sildenafil citrate was prescribed at the first visit, which was then increased to 100mg if the symptom persisted. According to the response, the patients were divided into responders and nonresponders. The pretreatment clinical parameters (age, diabetic duration, erectile dysfunction duration, glycosylated hemoglobin level, body mass index, IIEF, diabetic complications, smoking, alcohol drinking) were recorded. The patients were divided into 3 groups according to the drug dosage (group 1 was 50mg responders, group 2 was 100mg responders, group 3 was nonresponders in any dosage) and the clinical parameters were compared and analyzed. RESULTS: The mean hemoglobin A1c level was 8.68 0.74% and 7.64 1.67% in the nonresponders and responders (p < 0.05), respectively. Diabetic neuropathy and diabetic retinopathy were significantly higher in the nonresponders (p < 0.05). The mean hemoglobin A1c levels of the three groups were 7.36 1.01, 7.78 0.98, and 8.64 0.44%, respectively and group 3 was significantly higher than the other groups (p < 0.05). CONCLUSIONS: High levels of glycosylated hemoglobin suggests a poor response to sildenafil citrate in diabetic patients with erectile dysfunction. Diabetic patients with neuropathy or retinopathy may have a low response for sildenafil citrate.
Body Mass Index ; Citric Acid* ; Diabetes Complications ; Diabetic Neuropathies ; Diabetic Retinopathy ; Erectile Dysfunction* ; Hemoglobin A, Glycosylated* ; Humans ; Male ; Smoke ; Smoking ; Sildenafil Citrate

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

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

PURPOSE: Rodent models that mimic human renal diseases are being increasingly recognized as powerful tools in the development of new drugs and for evaluating the efficacy of novel therapeutics in a preclinical setting. However, there are few reports on microvasculature imaging of the urinary system in small animals. An experimental study was performed to evaluate the microvasculature in a rat kidney using micro- computed tomography(CT) with three-dimensional images. MATERIALS AND METHODS: Five Sprague-Dawley male rats(age: 10-12 weeks, weight: 200-250g) underwent a laparotomy under anesthesia with an intramuscular injection of 0.5cc xylazine hydrochloride and ketamine mixed solution(1:10). After ligation of the abdominal aorta and inferior vena cava immediately above the renal artery, a 24 gazed catheter was inserted into the abdominal aorta. A physiological solution and heparin(500U) were infused through the catheter to flush the blood from the renal vasculature. The kidney was enhanced using self-made contrast material. The excised kidney was frozen for the micro-CT scan. RESULTS: The mean longitudinal diameter and weight of the 10 resected kidneys was 1.95+/-0.15cm and 2.0+/-0.28g, respectively. The images were represented by three-dimensional arrays of cubic voxels with opacities in the blood vessels. In the section taken from the arrays, four regions of the kidney could be identified easily by their characteristic vascular features. CONCLUSIONS: Micro-CT is a promising method for evaluating the renal microvascular architecture in a rat kidney. It can for the foundation of an experimental study aimed at providing quantitative information on the urinary system in a rodent model.
Anesthesia ; Animals ; Aorta, Abdominal ; Blood Vessels ; Catheters ; Humans ; Hydrazines ; Imaging, Three-Dimensional ; Injections, Intramuscular ; Ketamine ; Kidney ; Laparotomy ; Ligation ; Male ; Microcirculation ; Microvessels ; Rats ; Renal Artery ; Rodentia ; Vena Cava, Inferior ; Xylazine