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: Laparoscopic pyeloplasty is an alternative, minimally invasive approach for the repair of an ureteropelvic junction obstruction (UPJO). However, it has a technical difficulty, and various laparoscopic approaches are available. We present our initial experience of laparoscopic pyeloplasty using a transperitoneal approach in patients with an UPJO. MATERIALS AND METHODS: Between January 2002 and January 2004, 11 patients underwent laparoscopic pyeloplasty using a transperitoneal approach. Of these 11, 10 patients were followed up and enrolled in this study. They were comprised of 6 males and 4 females, with a mean age of 44 years (19-62). The chief complaints were flank pain in 8 patients, with a further 2 incidental detected. Three patients had had previous abdominal surgeries. The mean length of stricture was 1.1cm in the radiologic studies, and the degree of hydronephrosis was grade 3/4 in 6 patients and grade 4/4 in 4. An obstructive pattern in the 99mTc-MAG3 renal scan was present in 9 patients. RESULTS: Eight patients were treated with dismembered Anderson-Hynes pyeloplasty and 2 patients with Fenger pyeloplasty. The mean operating time and hospital stay were 225 minutes (120-450) and 7.4 days (5-10), respectively. During the operation, crossing vessels were found in 4 patients and an ureteral polyp in 1. One patient had an ascending colon injury, which was postoperatively detected and repaired. The mean follow- up period was 42.5 weeks (26-135). Follow-up excretory urography and a 99mTc-MAG3 renal scan showed improvements in 8 of the 10 patients (80%) at the 3 month follow-up. The flank pain disappeared in all the patients (100%) who had previously complained of this symptom. CONCLUSIONS: Laparoscopic pyeloplasty could be an alternative treatment for an ureteropelvic junction obstruction, especially using a transperitoneal approach, which seems to have a technical convenience over that of the retroperitoneal approach.
Colon, Ascending ; Constriction, Pathologic ; Female ; Flank Pain ; Follow-Up Studies ; Humans ; Hydronephrosis ; Kidney Diseases ; Laparoscopy ; Length of Stay ; Male ; Polyps ; Technetium Tc 99m Mertiatide ; Ureter ; Ureteral Obstruction ; Urography

PURPOSE: Heme oxygenase-1 (HO-1), an inducible heat shock protein, catalyzes the heme to iron, biliverdin and carbon monoxide. It also has an inhibitory effect on necrosis and inflammation. Cobalt (III)-protoporphyrin IX (CoPP) is known to be a HO-1 inducer. Our intension was to find whether CoPP has an anti-inflammatory effect through the induction of HO-1 in rats with epididymitis. MATERIALS AND METHODS: Thirty two Sprague-Dawley male rats (age: 8-12 weeks, weight: 200-250gm) were selected for the experiments. Anesthesia was performed with an intraperitoneal injection of ketamine hydrochloride (140mg/kg). Four rats were taken and used as a control group. Epididymitis was induced in 28 rats by an injection of E. coli (1 x 10(5)/ml) to the epididymis. In the first step, groups of 4 rats were sacrificed serially after 4, 12, 48, and 72 hours for Hematoxylin & Eosin (H&E) staining and Western blot for inducible nitric oxide synthase (iNOS) and cyclooxygenase (COX)-2. In the second step, groups of 4 rats were injected with either dimethyl sulphoxide (DMSO) 7 microliter, DMSO 7 microliter with 50mg/ml CoPP or DMSO 7 microliter with 100mg/ml CoPP. They were then sacrificed 72 hours later for H&E staining and Western blot for iNOS and COX-2. RESULTS: In the first step, increased inflammation was evident H&E staining over time. Western blots, iNOS expression was detected after 48 hours and COX-2 was after 12 hours. In the second step, decreased inflammation was evident H&E staining, and the expressions of iNOS and COX-2 were suppressed in the CoPP treated group. CONCLUSIONS: CoPP can reduce the inflammation of epididymis in rats, and the mechanism may be related with HO-1.
Anesthesia ; Animals ; Biliverdine ; Blotting, Western ; Carbon Monoxide ; Cobalt ; Dimethyl Sulfoxide ; Eosine Yellowish-(YS) ; Epididymis ; Epididymitis* ; Escherichia coli Infections* ; Escherichia coli* ; Escherichia* ; Heat-Shock Proteins ; Hematoxylin ; Heme ; Heme Oxygenase (Decyclizing) ; Heme Oxygenase-1 ; Humans ; Inflammation ; Injections, Intraperitoneal ; Iron ; Ketamine ; Male ; Necrosis ; Nitric Oxide Synthase Type II ; Prostaglandin-Endoperoxide Synthases ; Rats* ; Rats, Sprague-Dawley

A testicular Sertoli cell tumor is a very rare, usually benign, testicular neoplasm. Of the total number of reported Sertoli cell tumors, only 30 cases were malignant. Usually, these patients have a history of a slowly growing scrotal mass and gynecomastia. These neoplasms vary greatly in size and in their microscopic appearances. A radical inguinal orchiectomy is the initial treatment, with the efficacy of chemotherapy or radiotherapy being controversial. They have an aggressive metastatic behavior and a poor prognosis. Herein, the case of 67-year-old man with a malignant Sertoli cell tumor is reported.
Aged ; Drug Therapy ; Gynecomastia ; Humans ; Male ; Orchiectomy ; Prognosis ; Radiotherapy ; Sertoli Cell Tumor* ; Testicular Neoplasms ; Testis*

A complicated urachal cyst requires surgical excision to prevent symptom recurrence and complications, most notably malignant degeneration. However, a traditional open excision is associated with significant morbidity and prolonged convalescence, especially in children. A seven year old male, with a complicated urachal cyst, underwent a laparoscopic excision of the urachal remnant. Through a transperitoneal approach, using three ports, the urachus was excised and separated from the bladder dome. We report our experience of a laparoscopic excision of an urachal cyst, with a review other reports, to find the efficacy and outcome of this approach as a minimally invasive alternative.
Child* ; Convalescence ; Humans ; Laparoscopy ; Male ; Recurrence ; Urachal Cyst* ; Urachus ; Urinary Bladder

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