PURPOSE: Laparoscopic nephroureterectomy (LNUx) has recently been done to treat patients with upper tract transitional cell carcinoma. We retrospectively evaluated the efficacy and safety of LNUx in comparison with open nephroureterectomy (ONUx). MATERIALS AND METHODS: Between May 2001 and March 2006, a total of 51 patients underwent radical nephroureterectomy for upper tract transitional cell carcinoma, including 22 LNUx and 29 ONUx. LNUx was performed transperitoneally and the ureteral end with a bladder cuff was transected through a 5-7cm modified Gibson incision. All the specimens were extracted intact. The patients' characteristics and the perioperative and followup data were analyzed retrospectively. RESULTS: LNUx was successfully performed in all the patients without open conversion. The analgesic requirement was lower, and the average time to oral intake and the length of hospitalization were shorter for LNUx than for ONUx. The average operative time, estimated blood loss and complications were not statistically different between the LNUx and ONUx. The mean follow-up periods of the LNUx and ONUx were 13.7 and 30.0 months, respectively. Both groups were similar in regard to bladder recurrence, local recurrence and distant metastasis. There was no sign of the trocar site or peritoneal seeding after LNUx. CONCLUSIONS: Our results suggest that LNUx is an acceptable alternative to ONUx for treating upper urinary tract transitional cell carcinoma. However, a longer follow-up period and comparative studies to the standard open techniques will be required.
Carcinoma, Transitional Cell* ; Follow-Up Studies ; Hospitalization ; Humans ; Laparoscopy ; Neoplasm Metastasis ; Nephrectomy ; Operative Time ; Recurrence ; Retrospective Studies ; Surgical Instruments ; Ureter ; Urinary Bladder ; Urinary Tract*

PURPOSE: Open prostatectomy have been considered primarily when the prostate volume is large(e.g. >75 cc). However, with the development of surgical skills and instruments, transurethral resection of prostate(TURP) can be an alternative. We assessed the feasibility of TURP for patients with large benign prostatic hyperplasia(BPH) by comparing the efficacy of TURP with that of open prostatectomy, retrospectively. MATERIALS AND METHODS: From January 2000 to March 2005, a total of 54 BPH patients with a prostate larger than 75 cc in volume on transrectal ultrasonography underwent surgery in our hospital. Among these patients, 26 patients underwent TURP(Group T) and 28 patients underwent suprapubic prostatectomy(Group O). Group T was subclassified Group T-1(prostate volume 75~100 cc, n=12) and T-2(prostate volume > or = 100 cc, n=14). In the same way, Group O was divided into Group O-1(n=9) and O-2(n=19). Operative time, time to catheter removal, hospitalization, and complications were compared. Operative results were evaluated at 6 months postoperative by comparing preoperative and postoperative International Prostate Symptom Scores(IPSS), maximal flow rates(Qmax) and post void residual(PVR). RESULTS: Preoperatively, there were no significant differences in IPSS, Qmax or PVR between Groups T-1 and O-1 or between Groups T-2 and O-2. Although delta IPSS, delta Qmax and delta PVR improved in Group O-2 more than T-2, there were no statistically significant differences between Group T-1 and O-1. The mean operative time, time to catheter removal, and hospitalization were shorter in Group T than Group O. Postoperative complication rates were similar in the T and O groups. In Group T, there was no TUR syndrome, but urinary tract infections and urethral stricture were more common than in Group O. However, Group O had higher incidences of severe complications, including wound infection or bleeding requiring transfusion. CONCLUSIONS: Open prostatectomy is commonly considered when prostate volume is greater than 75 cc. If enough resection is performed, TURP is a valuable non-invasive surgical method with respect to absence of incision, effective symptom improvement, and short hospitalization in symptomatic BPH patients who have prostate volume less than 100 cc.
Catheters ; Hemorrhage ; Hospitalization ; Humans ; Incidence ; Operative Time ; Postoperative Complications ; Prostate ; Prostatectomy* ; Prostatic Hyperplasia* ; Retrospective Studies ; Transurethral Resection of Prostate* ; Ultrasonography ; Urethral Stricture ; Urinary Tract Infections ; Wound Infection

PURPOSE: Community-Acquired Pneumonia (CAP) is a common cause of mortality and serious morbidity. Regardless of the condition of the patients, almost all are hospitalized. And it seems to be a standard procedure to obtain blood cultures before the administration of antibiotics in suspected pneumonic patients. Recent studies show that the blood cultures don't affect the treatment of the patients with CAP. Accordingly, this study was designed to examine the usefulness of the blood cultures routinely performed and to evaluate the stratification of the patients with CAP by Pneumonia Severity Index (PSI) in the Emergency Department (ED). METHODS: Research subjects were patients over 16 years old who had been diagnosed with CAP in a general hospital between January and December 2008 and were admitted by way of the ED. We evaluated their records retrospectively. RESULTS: A total of 261 patients were diagnosed with CAP. According to the PSI, 155 (59%) of the 261 were classified as being in the low risk group and 106 (41%) in the high risk group. Blood cultures were positive in 13 of 261 (5%). Three of 13 patients belonged to the low risk group, and 10 to the high risk group. Antibiotics were changed in 43 of 261 patients. Nineteen of those belonged to the low risk group and 24 to the high risk group. Of the 13 bacteremic patients, blood cultures results altered therapy for 4 patients. CONCLUSION: Most often, blood cultures performed in the ED do not alter the therapy of patients with CAP. But we do recommend blood cultures for the high risk group.
Anti-Bacterial Agents ; Community-Acquired Infections ; Emergencies ; Hospitals, General ; Humans ; Pneumonia ; Research Subjects ; Retrospective Studies ; Severity of Illness Index

In the past several decades there has been a remarkable development of small-caliber, flexible ureteroscopes and various ancillary instruments for stone manipulation and retrieval. Percutaneous antegrade ureteroscopy can be substituted in select cases for retrograde ureteroscopy. We report a case of a 60-year-old man with severe ankylosis in both hip joints who was diagnosed with bilateral ureteral stones. The patient underwent antegrade flexible ureteroscopy and laser lithotripsy. This case illustrates the role of antegrade flexible ureteroscopy combined with the holmium:YAG laser as a minimally invasive, safe, and effective technique for the management of stones in a patient who cannot undergo a retrograde approach.
Ankylosis ; Hip ; Hip Joint ; Humans ; Lithotripsy, Laser ; Middle Aged ; Ureter ; Ureteroscopes ; Ureteroscopy ; Urinary Calculi

A gastrointestinal stromal tumor is the most common mesenchymal tumor of the gastrointestinal tract, and is diagnosed on the basis of the combined expression of CD34 and CD117 (C-kit protein). An extragastrointestinal stromal tumor of the urinary bladder is a very rare neoplasm. In this report, we describe a case of an extragastrointestinal stromal tumor originating from the inner surface of the urinary bladder. A 46-year-old man presented with an incident bladder mass, and he was diagnosed with an extragastrointestinal stromal tumor after transurethral resection of the bladder tumor. A tumor on the inner urinary bladder wall is an unusual presentation of an extragastrointestinal stromal tumor. The patient is doing well with no recurrence at 18 months after surgery.
Gastrointestinal Stromal Tumors ; Gastrointestinal Tract ; Humans ; Middle Aged ; Recurrence ; Urinary Bladder Neoplasms ; Urinary Bladder*

Duplication of the vas deferens is a very rare congenital anomaly in which two vasa deferentia coexist within the spermatic cord. Duplication of the vas deferens can be found during herniorrhaphy, vasectomy, and varicocelectomy performed on the spermatic cord or around the spermatic cord. However, it is estimated that the incidence of duplication of the vas deferens is under-reported and under-recognized. Unless anomalies of the vas deferens such as duplication of the vas deferens are recognized by surgeons, it will be difficult to reduce vas deferens injuries and achieve a satisfactory surgical outcome. In addition, care should be taken in cases of duplication of the vas deferens because it can be complicated by non-testicular genitourinary anomalies. We report a case of duplication of the vas deferens discovered during routine varicocelectomy.
Congenital Abnormalities ; Herniorrhaphy ; Incidence ; Spermatic Cord ; Varicocele ; Vas Deferens* ; Vasectomy

PURPOSE: The purpose of this study was to examine whether urethroplasty with a turnover flap, as an alternative method of distal hypospadias repair in adolescents, improves the outcome of surgery. MATERIALS AND METHODS: Between January 2004 and December 2013, a total of 38 adolescents (aged 11-17 years) underwent distal hypospadias repair with either the tubularized incised plate (TIP) procedure (n=25) or the turnover flap procedure (n=13). The turnover flap procedure was performed with a proximal, ventral penile flap that was turned over to cover the urethral plate. Patient demographics, perioperative outcomes, complications, and postoperative uroflowmetry in each surgical group were analyzed retrospectively. RESULTS: The patient demographics were similar in the two groups. There were no significant differences in perioperative outcomes between the groups, including mean operative time, duration of hospital stay, and urethral catheterization. The number of patients with at least one complication, including wound dehiscence, urethrocutaneous fistula, meatal stenosis, and urethral stricture, was lower in the turnover flap group (1/13, 7.7%) than in the TIP group (11/25, 44%, p=0.030). The incidence of meatal stenosis was lower in the turnover flap group (0/12, 0%) than in the TIP group (6/25, 24%). In postoperative uroflowmetry, the plateau-shaped curve rate was lower in the turnover flap group (1/12, 8.3%) than in the TIP group (5/19, 26.3%); the peak flow was higher (p=0.030). CONCLUSIONS: The turnover flap procedure is clinically useful for repairing adolescent distal hypospadias because it offers lower complication rates and better functional outcomes than TIP.
Adolescent ; Child ; Follow-Up Studies ; Humans ; Hypospadias/*surgery ; Male ; Reconstructive Surgical Procedures/*methods ; Retrospective Studies ; *Surgical Flaps ; Suture Techniques/*instrumentation ; Time Factors ; Treatment Outcome ; Urethra/*surgery ; Urologic Surgical Procedures, Male/*methods ; Wound Healing

Bleeding from ileal conduit stomal varices is a rare complication. The standard treatment for the management of stomal varices has not been established yet. We present the case of a 65-yearold man with recurrent fatal bleeding from his ileal conduit stomal varices who was successfully treated with ligation of the engorged venous varices using hemostatic agents.

Bleeding from ileal conduit stomal varices is a rare complication. The standard treatment for the management of stomal varices has not been established yet. We present the case of a 65-yearold man with recurrent fatal bleeding from his ileal conduit stomal varices who was successfully treated with ligation of the engorged venous varices using hemostatic agents.

Kleefstra syndrome is a rare genetic disease characterized by mental retardation, hypotonia, and a characteristic facial appearance. Furthermore, in some cases, Kleefstra syndrome is associated with various anorectal and genitourinary complications, including imperforated anus, vesicoureteral reflux, hydronephrosis, and chronic kidney disease. Herein, we present a case of Kleefstra syndrome with recurrent urinary tract infections associated with vesicoureteral reflux and rectourethral fistula, which was treated by a multidisciplinary approach.