A case of congenital laryngeal atresia of infraglottic type in a newborn infant is described for is rarity and importance of early diagnosis. This case was associated with tracheoesophageal fistula, and died in 5 minutes of life due to asphxia. Failure to intubate in the neonate should raise the possibility of laryngeal atresia and emergency management should be provided. The lung tissue was normally developing despite the complete obstruction of the outlet of the air and possible amniotic fluid passage.
Infant ; Male ; Female ; Infant, Newborn ; Humans

PURPOSE: We evaluated the feasibility of robot-assisted laparoscopic radical cystectomy (RARC) with pelvic lymph node dissection (PLND), especially extended PLND (ePLND), during our initial experience with this technique. MATERIALS AND METHODS: From August 2007 to March 2009, prospective data were obtained from the 21 consecutive patients who underwent RARC with PLND at Korea University Hospital. Data included baseline characteristics, perioperative variables, pathological outcomes, and complications. Evidence of the lymph node yield curve was examined by using linear regression to compare the number of lymph nodes obtained. RESULTS: Among 21 patients who underwent RARC, 13 had ileal conduit urinary diversion and 8 had orthotopic neobladder. Standard PLND (sPLND) was performed in the first 15 patients, and ePLND was performed in the more recent 6 patients. The mean total operative time was 515.5+/-145.1 minutes, and the mean estimated blood loss was 346.8+/-205.9 ml. The mean time for PLND was 106.7+/-25.2 minutes in patients with ePLND and 72.1+/-14.1 minutes in patients with sPLND (p=0.001). All patients had negative surgical margins. The mean number of retrieved nodes was 23.5+/-12.8 (range, 8-50) in all patients: 38.6+/-10.8 (range, 29-50) in ePLND and 15.7+/-12.2 (range, 8-21) in sPLND. CONCLUSIONS: Perioperative data and oncologic features showed that RARC with PLND is feasible. Robot-assisted laparoscopic surgery is a safe and effective procedure with acceptable morbidity and good oncologic results from the viewpoint of PLND, especially ePLND.
Cystectomy ; Humans ; Korea ; Laparoscopy ; Linear Models ; Lymph Node Excision ; Lymph Nodes ; Operative Time ; Prospective Studies ; Robotics ; Urinary Bladder Neoplasms ; Urinary Diversion

PURPOSE: We evaluated the efficacy of parenchymal compression in open partial nephrectomies (OPNs) compared with that of the conventional vascular clamping method. MATERIALS AND METHODS: OPNs were conducted by means of the parenchymal compression technique at our institution from April 2006. Among these, the operative outcomes of 20 consecutive patients with normal preoperative renal function (Group 1) were matched with those of 20 control patients from the database of previous operations who underwent OPN with a conventional vascular clamping method (Group 2). RESULTS: All preoperative characteristics were similar in both groups. The operative time was significantly higher for Group 2 (132.4+/-17.7 vs. 151.4+/-21.4 minutes, p=0.031). Estimated blood loss was slightly higher for Group 2, with marginal statistical significance (173.7+/-11.5 vs. 211.2+/-43.8 ml, p=0.06). Histologic examination revealed that over 80% of the tumors in both groups were renal cell carcinomas. For all patients, the pathology results of specimens were negative. Serum creatinine, checked at 1, 3, and 7 days after the operation, was significantly increased in both groups to a similar degree. However, 30 days after surgery, the patterns of serial serum creatinine levels demonstrated statistically significant differences by repeated-measures ANOVA (p<0.001), with a trend of more elevated in Group 2 than in Group 1, although values were within the normal range. No major complications occurred in either group. CONCLUSIONS: OPN using the parenchymal compression method had acceptable outcomes in terms of complete tumor control, avoiding warm ischemic time, and minimizing blooding, with good preservation of renal function and minimal complications.
Carcinoma, Renal Cell ; Constriction ; Creatinine ; Humans ; Kidney Neoplasms ; Nephrectomy ; Operative Time ; Organ Preservation ; Reference Values ; Warm Ischemia

PURPOSE: To evaluate the efficacy and safety of laparoscopic renal cryoablation (LRC) of small endophytic renal cell carcinoma, for which surgical treatment is technically difficult. MATERIALS AND METHODS: We enrolled patients with endophytic tumors from a prospectively collected database of 45 renal tumors in 39 patients who had undergone LRC from June 2005 to May 2009. An endophytic tumor was defined as less than 40% of the lesion extending off the surface of the kidney. We evaluated surgical and oncological outcomes. RESULTS: Among the treated tumors, 17 tumors (37.8%) were defined as endophytic tumors and 15 tumors from 14 patients were confirmed as renal cell carcinoma (RCC) in the pathologic examination of the tissue biopsy that was conducted at the time of LRC. The mean American Society of Anesthesiologists (ASA) score of the whole patient group was 2.9 (range, 1-4), and 85.7% (12/14) of the patients had an ASA physical status score over 3. The mean tumor size was 2.8 cm (range, 1.7-3.7 cm). The layout of the cryoprobe was carefully planned preoperatively on the basis of radiologic evaluation in all tumors. Multiple cryoprobes (mean, 3.2; range, 2-5) were used. No major complications, including open surgical conversion and nephrectomy due to bleeding, occurred. No patient experienced clinical symptoms of collecting system injuries. During the mean follow-up of 32.6 months (range, 12-51 months), radiologic evidence of tumor recurrence was found in one patient (6.7% for RCC). With the exception of this patient, all other patients have remained free of recurrence or metastasis, as determined by periodic radiologic workups. CONCLUSIONS: In this series of patients with intermediate-term follow-up, LRC for endophytic renal cell carcinoma showed acceptable oncological and surgical outcomes without sequelae in the collecting system.
Biopsy ; Carcinoma, Renal Cell ; Cryosurgery ; Follow-Up Studies ; Hemorrhage ; Humans ; Kidney ; Neoplasm Metastasis ; Nephrectomy ; Prospective Studies ; Recurrence

PURPOSE: The incidence of single positive core prostate cancer at the time of biopsy appears to be increasing in the prostate-specific antigen (PSA) era. To determine the clinical implication of this disease, we analyzed surgical and pathological characteristics in comparison with multiple positive core disease. MATERIALS AND METHODS: Among 108 consecutive patients who underwent robotic radical prostatectomy following a diagnosis of prostate cancer based on a 12-core transrectal biopsy performed by the same method in a single institute, outcomes from 26 patients (Group 1) diagnosed on the basis of a single positive biopsy core and from 82 patients (Group 2) with multiple positive biopsy cores were analyzed. RESULTS: The preoperative PSA value, Gleason score, prostate volume, and D'Amico's risk classification of each group were similar. The proportion of intermediate+highrisk patients was 69.2% in Group 1 and 77.9% in Group 2 (p=0.22). Total operative time and blood loss were similar. Based on prostatectomy specimens, only 3 patients (11.5%) in Group 1 met the criteria for an indolent tumor (7.31% in Group 2). Although similarities were observed during preoperative clinical staging (p=0.13), the final pathologic stage was significantly higher in Group 2 (p=0.001). The positive-margin rate was also higher in Group 2 (11.5% vs. 31.7%, p=0.043). Despite similarity in upstaging after prostatectomy in each group (p=0.86), upgrading occurred more frequently in Group 1 (p=0.014, 42.5% vs. 19.5%). No clinical parameters were valuable in predicting upgrading. CONCLUSIONS: Most single positive core prostate cancer diagnoses in 12-core biopsy were clinically significant with similar risk stratification to multiple positive core prostate cancers. Although the positive-margin rate was lower than in multiple positive core disease, an increase in Gleason score after radical prostatectomy occurred more frequently.
Biopsy ; Humans ; Incidence ; Neoplasm Grading ; Operative Time ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Neoplasms

We report a case of an intravesical foreign body that was incompletely removed endoscopically and that defied diagnosis with current diagnostic tools. A 65-year-old man visited Korea University Anam Hospital complaining of dysuria and a sensation of residual urine. His medical history included an intravesical foreign body caused by penetrating trauma, and he had undergone endoscopic removal of foreign bodies 1 year previously. After additional remnant intravesical foreign bodies were found, he had undergone additional endoscopic removal and his urinary symptoms subsided. After 2 years, however, he again presented to the clinic complaining of dysuria and gross hematuria. Cystoscopy and computed tomography for intravesical foreign bodies were performed, but no evidence of a remnant foreign body was found. Open exploration revealed a remnant foreign body penetrating the bladder. A partial cystectomy including the foreign body was performed. We suggest that cases of penetrating injury with a radiolucent object may warrant primary open exploration and foreign body removal owing to the inherent difficulties in diagnosis and endoscopic treatment of such objects.
Aged ; Cystectomy ; Cystoscopy ; Dysuria ; Foreign Bodies ; Hematuria ; Humans ; Korea ; Sensation ; Urinary Bladder ; Wounds, Penetrating

PURPOSE: To evaluate the perioperative, functional, and oncological outcomes of renal cryoablation (RC) of small renal masses (SRMs) performed in Korea University Hospital. MATERIALS AND METHODS: We reviewed an Institutional Review Board-approved database of 70 patients who underwent RC and were followed up for a minimum of 3 months by a single surgeon in Korea University Hospital from August 2007 to May 2014. Among these patients, 68 patients (79 renal masses) were enrolled in our research. We evaluated perioperative, functional, and oncologic outcomes of RC. RESULTS: A total of 68 patients (79 renal masses) underwent RC in our institution. The mean age of the patients was 62.0 years. The mean tumor size was 2.25 cm. Among the 59 patients who underwent laparoscopic surgery, only 1 patient (1.47%) was converted to open surgery. No other perioperative complications occurred. The mean preoperative and 1-month postoperative estimated glomerular filtration ratio (eGFR) were 71.8 and 68.3 mL/min/1.73 m2, respectively (p=0.19). The mean 1-year postoperative eGFR was 65.0 mL/min/1.73 m2 (p=0.25). The mean follow-up period was 59.76 months (range, 3-119 months). Local tumor recurrence occurred in eight tumors (15.4%; a total of 52 renal cell carcinomas). Concerning treatment in the patients with recurrence, five patients underwent re-treatment and three patients are under active surveillance. None of the eight patients who experienced local recurrence had additional recurrence or tumor progression during the follow-up period. In our study, the recurrence-free rate was 83.0% and the cancer-specific survival rate was 100%. Moreover, the 5- and 10-year overall survival rates were both 100%. CONCLUSIONS: Long-term experience with RC in our institution demonstrates that RC is a safe and effective treatment for patients with SRMs.
Adult ; Aged ; Aged, 80 and over ; Biopsy ; Carcinoma, Renal Cell/pathology/radiography/*surgery ; Cryosurgery/adverse effects/*methods ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Kidney Neoplasms/pathology/radiography/*surgery ; Laparoscopy/adverse effects/methods ; Middle Aged ; Neoplasm Recurrence, Local ; Tomography, X-Ray Computed ; Treatment Outcome ; Young Adult

We report a case of tuberous sclerosis associated with two histologically different renal cell carcinomas (RCCs) and multiple angiomyolipomas (AMLs) in the same kidney. A 43-year-old female was admitted to our hospital with left flank pain and a huge palpable mass in the left flank area. Abdominal computed tomography revealed two concurrent RCCs and multiple AMLs in the left kidney. Because of the clinical suspicion of RCC, the patient underwent left radical nephrectomy. On gross examination, the total size of the resected left kidney was 30.5x17x8 cm. Microscopically, the upper pole tumor features were consistent with chromophobe RCC and the midpole tumor was a clear-cell RCC. The multifocal masses in the remaining remnant parenchyma were AMLs. Six months after surgery, the patient is healthy without signs of tumor recurrence.
Adult ; Angiomyolipoma ; Carcinoma, Renal Cell ; Female ; Flank Pain ; Humans ; Kidney ; Nephrectomy ; Recurrence ; Tuberous Sclerosis

PURPOSE: We previously described a new procedure specific module (Tube 3) to allow the practice of vesicourethral anastomosis after robot-assisted radical prostatectomy. Herein, we report a predetermined proficiency level of Tube 3 and preliminary validation to explore whether this new module can lead to performance improvement in the da Vinci system. MATERIALS AND METHODS: Eight urology residents and three urology fellows performed the Tube 3 module 1 hour daily for 7 days. The learning curve was depicted through a scatterplot and the stable point was identified through the cumulative sum chart. Concurrent and predictive validations were performed with the da Vinci system. The mean time to complete the task and end product rating score between Tube 3 training group and no Tube 3 training group were compared. RESULTS: Concerning the learning curve, about 41 repetitions comprising about 5 hours were needed to achieve this stable point when the mean time to complete Tube of 384 seconds was set as a target. With regarding to the concurrent and predictive validation, there significant differences were evident in the mean time to complete 16 needle passages and the vesicourethral anastomosis and the end product rating score. CONCLUSIONS: The virtual reality (VR) simulator can yield sufficient improvement in technical performance in Tube 3 within 5 hours. The acquired proficiency can be transferable to the vesicourethral anastomosis using the da Vinci system.
Anastomosis, Surgical/methods ; Clinical Competence ; Computer Simulation ; Education, Medical, Graduate/*methods ; Humans ; Learning Curve ; Male ; Prostatectomy/*education/methods ; Robotic Surgical Procedures/*education/methods ; Simulation Training/methods ; Urethra/surgery ; Urinary Bladder/surgery ; User-Computer Interface

PURPOSE: To evaluate tumor-specific immunity and define the mechanisms involved in the cryoimmunologic response, we compared the tumor control efficacy and immunologic responses of cryoablation with those of surgical excision in a tumor rechallenge model. MATERIALS AND METHODS: Sixty BALB/c mice with RENCA tumors that were generated in the left flank area underwent cryoablation or radical excision. The mice successfully treated were rechallenged with RENCA or an undifferentiated colon carcinoma cell line, CT26, in the contralateral right flank area. The recurrence rate after tumor rechallenge in each group was then observed. To assess the immunologic response of each treatment modality, fluorescent-activated cell sorting (FACS) analysis and a cytotoxicity assay using 51Cr release were performed. RESULTS: After reinoculation of the RENCA cells, the rate of tumor growth was significantly higher in the surgical excision group than in the cryoablation group (94.4% vs. 11.1%, p=0.001). In the cryoablation group, the tumor growth rate was significantly increased after rechallenge of CT26 cells compared with RENCA (94.1% vs. 11.1%, p=0.001). The cryoablation group showed an elevated CD3, CD4, CD8 T, and natural killer cell count in the FACS analysis and also showed significantly increased cytotoxicity in the 51Cr release assay compared with the excision group. CONCLUSIONS: These results showed that cryoablation, compared to surgical resection, was more effective in preventing tumor growth after rechallenge with RENCA cells and that this response was tumor-specific, because the CT26 cells did not have the same effect.
Animals ; CD4-Positive T-Lymphocytes/immunology ; CD8-Positive T-Lymphocytes/immunology ; Carcinoma, Renal Cell/*immunology/pathology/*surgery ; Cell Death ; Cryosurgery/*methods ; Cytotoxicity, Immunologic ; Disease Models, Animal ; Kidney Neoplasms/*immunology/pathology/*surgery ; Lymphocyte Count ; Lymphocytes, Tumor-Infiltrating/immunology ; Mice, Inbred BALB C ; Neoplasm Recurrence, Local/immunology ; Neoplasm Transplantation