PURPOSE: To compare the clinical characteristics between intraperitoneal and extraperitoneal bladder ruptures. MATERIALS AND METHODS: 58 patients with a bladder rupture were divided into group A (34 intraperitoneal rupture) and group B (24 extraperitoneal rupture). The medical records and radiological findings were retrospectively reviewed. RESULTS: The follow up period in all patients was 5.8 4.5 months (1-20 months). The male to female ratios and the mean ages in groups A and B were 14:3, 17:7 and 43.9+/-14.2, 46.4+/-14.8 years, respectively (p>0.05), with the peak incidence being in the fifth and sixth decades. There were no statistical differences in the urologic symptoms and signs between groups A and B. The common cause of injuries in groups A and B were direct blow (41.3%) and out-car traffic accident (54.1%), respectively (p<0.05). The main associated injuries in groups A and B were pelvic bone fractures or intestinal injuries and pelvic bone fractures, respectively. The treatment modalities were an operation in 32 (94.1%) in group A; all group B cases were conservatively managed. The durations of catheter indwelling were 17.0+/-9.4 and 22.7+/-10.9 days in groups A and B, respectively (p<0.05). CONCLUSIONS: The bladder rupture occurred commonly in the fifth and sixth decades, especially in males. The most frequent causes of intraperitoneal and extraperitoneal ruptures were a direct blow and a traffic accident, respectively. Pelvic bone fractures were the most common associated injury, especially with extraperitoneal ruptures. In contrast to an extraperitoneal rupture, most intraperitoneal ruptures were managed by operative methods. The duration of catheter indwelling was significantly shorter with intraperitoneal than extraperitoneal ruptures.
Accidents, Traffic ; Catheters ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Medical Records ; Pelvic Bones ; Retrospective Studies ; Rupture* ; Urinary Bladder*

PURPOSE: To review the clinical manifestations, indications and the management outcomes of adult patients with ureteroceles. MATERIALS AND METHODS: Between 1995 and 2006, 20 adult patients (9 females, 3 males) with ureteroceles were investigated for their clinical symptoms, type of ureterocele and renal function. The outcomes of surgical or conservative management, according to the patients' symptoms were also individually analyzed. The median follow-up was 38 months (12-50 months). RESULTS: The ages at diagnosis of the ureteroceles ranged from 19 to 70 years (mean 37.9 years). The ureterocele-related symptoms were flank pain (3), hematuria (1) and lower urinary tract symptoms (4). Two cases were incidentally detected with ultrasound (1) or computed tomography (1), and another 2 patients presented with non-specific flank pain or a hematuria. Eight patients exhibited an intravesical single system and 4 were associated with upper pole of a duplex system. Only one patient had an ectopic ureterocele, in which the orifice was located in the mid-urethra. The ureterocele-related symptoms were managed using a transurethral incision (5) or resection (1) of the ureterocele, with ureteroscopic stone retrieval (2). The symptoms were resolved after surgery, and there were no recurrence of symptoms or any deterioration of the renal function during follow-up. CONCLUSIONS: To diagnose an ureterocele in adult patients requires a high index of suspicion, as not all patients present with the typical clinical manifestations associated in children. Our results suggested that ureterocele-related symptoms are the main indication for surgery in adult patients. While methods with lower morbidity may be a useful, expectant treatment, they may also be an appropriate option for the management of incidentally detected ureteroceles.
Adult* ; Child ; Diagnosis ; Female ; Flank Pain ; Follow-Up Studies ; Hematuria ; Humans ; Lower Urinary Tract Symptoms ; Recurrence ; Ultrasonography ; Ureterocele*

PURPOSE: Lentinus edodes is used in both foods and drugs, and is also known to be an antioxidant agent. Some investigators have noted that renal scarring following pyelonephritis is closely related to inflammation or free oxygen radicals, rather than to direct injury due to bacterial infection. The efficiency of the antioxidant agent, lentinus edodes, in preventing the renal scarring caused by experimental pyelonephritis was evaluated in rats. MATERIALS AND METHODS: Twenty eight male Sprague Dawley rats (n=28) were injected into both renal parenchyma with 0.1ml of a solution containing Escherichia coli (10(8)/ml). The control group, consisting of 4 rats, received an injection of isotonic saline instead of the bacterial solution. Three days after surgery, the animals were given the following treatments: in the pyelonephritis group, 7 rats received isotonic saline for 5 days; in the antibiotics treatment group, 6 rats were treated with an antibiotic only, ciprofloxacin, for 5 days. In the lentinus edodes treatment group, 5 rats were treated with lentinus edodes only. In the combined group, 6 rats received both lentinus edodes and ciprofloxacin. The kidneys were harvested 6 weeks after infection, and histopathologically examined for renal scarring. RESULTS: Delayed treatment with antibiotics-only or lentinus edodes-only had no effect on the scarring compared with the untreated controls. However, the addition of lentinus edodes to the delayed antibiotic therapy significantly inhibited the renal scarring compared with the pyelonephritis, antibiotic-only treated and the lentinus edodes-only treated groups (p<0.05). CONCLUSIONS: The administration of lentinus edodes in combination with antibiotics significantly reduced the renal scar formation in pyelonephritis.
Animals ; Anti-Bacterial Agents ; Bacterial Infections ; Cicatrix* ; Ciprofloxacin ; Escherichia coli ; Humans ; Inflammation ; Kidney ; Lentinula* ; Male ; Pyelonephritis* ; Rats ; Rats, Sprague-Dawley ; Reactive Oxygen Species ; Research Personnel ; Shiitake Mushrooms*

PURPOSE: The subjective pain felt by patients during shockwave lithotripsy (SWL) and need of analgesics in patients with urinary stones were investigated. MATERIALS AND METHODS: Between September 2004 and January 2006, one hundred and ninety seven SWLs were undertaken (151 patients) using a SDS 5000 (spark gap type, Comed, Korea). Ninety-five and 102 cases proceeded without premedication (no analgesics group) and diclofenac sodium, 1mg/kg IM, respectively, 30 minutes before lithotripsy (analgesics group). After the procedure, the subjective pain was estimated using a prospective questionnaire, with a 10-point visual analogue scale. RESULTS: The average subjective pain scores were 3.77 and 3.25 in the non analgesics and analgesics groups, respectively. There was no significantly difference between the two groups. However, the pain scores in the analgesics group were significantly lower in females (3.37 vs. 4.71) and cases of first SWL (3.10 vs. 4.09). In the no analgesics group, the pain score was not affected by the laterality, stone size, location of stone and tolerability, but was affected by sex, age and number of SWL attempts. In the analgesics group, the pain score was only affected by age. Seventy eight percent (74/95) and 63% (64/102) of the patients in the no analgesics and analgesics groups agreed that analgesic should not be recommended to other patients. CONCLUSIONS: The subjective pain during SWL was tolerable; therefore, routine analgesics are not required. However, on the initial SWL in young female patient, the application of analgesics is considerable.
Analgesics* ; Diclofenac ; Female ; Humans ; Lithotripsy* ; Premedication ; Prospective Studies ; Questionnaires ; Urinary Calculi

PURPOSE: Chronic prostatitis frequently occurs in men of all ages. Recent studies suggest that fastidious microorganisms may play a role in chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). The aim of this study was to evaluate the usefulness and significance of multiplex polymerase chain reaction (PCR) in the diagnosis of CP/CPPS. MATERIALS AND METHODS: First voided urine (FVU) and/or expressed prostatic secretions (EPS) were collected from 92 patients. Multiplex PCR, using Dual Specificity Oligo (DSO(TM)) primers, was used to test for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG), Mycoplasma hominis (MH), Neisseria gonorrhoeae (NG), Trichomonas vaginalis (TV) and Ureaplasma urealyticum (UU). RESULTS: Multiplex PCR can be easily analyzed via visual comparison. Nine (39.1%) of the 23 CP/CPPS IIIa and 12 (17.4%) of the 69 IIIb patients had positive multiplex PCR, with a total of 27 microorganisms isolated, including CT, MH, MG, UU, TV and NG in 9, 7, 4, 4, 2 and 1 case, respectively. Co-infections with 2 or 3 organisms occurred in 5 cases. For the samples collected from 32 patients for both FVU and EPS, 68.7% gave the same results. CONCLUSIONS: Multiplex PCR, using DSO(TM) primers, can be useful for the simple detection of fastidious microorganisms in CP/CPPS. To achieve reliable results with multiplex PCR, feasible guidelines and standardization are of major importance. Further studies will be required to define the usefulness of molecular tests for CP/CPPS in clinical practice.
Chlamydia trachomatis ; Coinfection ; Diagnosis ; Humans ; Male ; Multiplex Polymerase Chain Reaction* ; Mycoplasma genitalium ; Mycoplasma hominis ; Neisseria gonorrhoeae ; Pelvic Pain ; Polymerase Chain Reaction ; Prostatitis* ; Sensitivity and Specificity ; Trichomonas vaginalis ; Ureaplasma urealyticum

PURPOSE: We prospectively compared the treatment outcomes of photoselective vaporization of the prostate (PVP) with those of the gold standard transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Between October 2004 and April 2006, a prospective clinical trial was performed with 131 and 41 patients treated by PVP and TURP, respectively. The efficacy of the two procedures were compared in terms of the International Prostate Symptom Score, quality of life score, peak urinary flow rate, postvoid residual volume, complications and perioperative outcomes at 1, 3, 6 and 12 months following treatment. RESULTS: The baseline characteristics of the two groups were similar. The operative times, catheter indwelling times and hospital stays were significantly shorter in the PVP group. All efficacy parameters were significantly improved in both groups compared to those obtained preoperatively. In addition, the degrees of improvement in the efficacy parameters were similar between the two groups within 12 months. With respect to the prostatic volume reduction, the difference between the pre- and post-PVP volumes during the study period was less than that of the TURP group (p<0.001). There were no differences in the overall complications between the two groups, with the exception of more common bleeding reguiring a transfusion and capsule perforation in the TURP group. CONCLUSIONS: PVP provides excellent intraoperative and postoperative safety, and facilitates immediate relief from obstructive voiding symptoms; similarly to TURP, but has the advantages of shorter hospital stays and catheter indwelling times. The short-term treatment outcomes 12 months after PVP and TURP were comparable, with the exception of the prostatic volume reduction.
Catheters ; Hemorrhage ; Humans ; Laser Therapy ; Length of Stay ; Operative Time ; Prospective Studies ; Prostate* ; Prostatic Hyperplasia* ; Quality of Life ; Residual Volume ; Transurethral Resection of Prostate ; Volatilization*

PURPOSE: The International Prostate Symptom Score (IPSS) is generally self- administrated; however, it is doubtful that the self-administrated IPSS score correctly reflects patients' symptoms; therefore, the difference in the IPSS self-administrated score and physician-interviewed patients was studied. MATERIALS AND METHODS: A total of 202 patients completed two IPSS questionnaires during the same office visit, one by self-administration and the other by physician-interview, at two medical centers, one located in an urban area and the other in a rural area. The mean total symptom score and the score for each question, and the quality of life score were compared between the two modes of administration. A multi-logistical regression analysis was performed to identify differences due to the effects of age, the order of administration, location and educational level. RESULTS: The mean total symptom score and quality of life score were higher in the self-administrated than physician-interviewed group (14.16 vs. 13.07, p=0.001, 3.27 vs. 3.2, p=0.090). The residual sense (2.03 vs. 1.97, p=0.20), frequency (2.07 vs. 1.97, p=0.026), interruption (1.83 vs. 1.61, p=0.002), urgency (1.89 vs. 1.55, p=0.001), weak stream (2.74 vs. 2.60, p=0.042), hesitancy (1.77 vs. 1.59, p=0.005) and nocturia (1.82 vs. 1.77, p=0.12) were also higher in the self-administrated group. The multi- logistical regression analysis revealed statistically significant differences in relation to age and location. CONCLUSIONS: The self-administrated IPSS score was higher than the physician-interview score, especially in relation to an older age and an urban location. Therefore, active intervention should be considered during the administration of the IPSS, especially for old aged patients living in urban areas.
Humans ; Lower Urinary Tract Symptoms* ; Nocturia ; Office Visits ; Prostate* ; Quality of Life ; Questionnaires ; Rivers ; Urinary Tract

PURPOSE: To investigate the significance of various preoperative factors with regard to postoperative erectile function in Korean men undergoing a bilateral nerve sparing radical retropubic prostatectomy (BNSRRP), using the validated Korean version of the International Index of Erectile Function (IIEF-5). MATERIALS AND METHODS: Between March 2004 and March 2005, 83 consecutive patients, who underwent a BNSRRP, with preoperative IIEF-5 scores greater than 13, were retrospectively analyzed. All patients were asked to answer the IIEF-5 questionnaire during the preoperative period and 1 year postoperatively. The responses were stratified on the basis of the clinical characteristics and the preoperative predictive factors for regaining a normal erectile function (NEF: IIEF-5 score> or =18) investigated. RESULTS: At the baseline, 56 patients (67.5%) had NEF. At the 1 year follow-up after the BNSRRP, 58 (70.5%) patients reported a return of a sufficient erection for sexual intercourse, with or without oral phosphodiesterase type 5 (PDE5) inhibitors, but 37 (44.6%) patients regained a NEF. Of these 37 patients, 15 (40.5%) were able to spontaneously regain a NEF, but 22 (59.5%) needed the help of oral PDE5 inhibitors. When the patients were divided according to postoperative NEF and erectile dysfunction (ED: 14< or =IIEF-5 score<18), the preoperative IIEF-5 score was the only significant factor for predicting postoperative NEF after a BNSRRP in univariate (p=0.018) and multivariate analyses [p=0.030, odds ratio: 3.482, 95% confidence interval (CI): 1.125-10.774]. Changes in the IIEF-5 score after a BNSRRP significantly decreased for those with preoperative NEF compared with ED ( 6.1+/-5.24 vs. 9.1+/-7.34, p=0.039). CONCLUSIONS: Our data indicated that preoperative erectile function, as assessed using the IIEF-5 questionnaire, was an independent variable for predicting the recovery of erectile function after a BNSRRP when performed in Korean men.
Coitus ; Erectile Dysfunction ; Follow-Up Studies ; Humans ; Male ; Multivariate Analysis ; Odds Ratio ; Phosphodiesterase 5 Inhibitors ; Preoperative Period ; Prostatectomy* ; Prostatic Neoplasms ; Questionnaires ; Retrospective Studies

PURPOSE: Our experience of laparoscopic surgeries in pediatric patients was analyzed to search for a convenient approach method during the procedure. MATERIALS AND METHODS: Between March 2003 and March 2005, 24 children underwent laparoscopic renal surgeries (16 nephrectomies or nephroureterectomies and 8 partial nephrectomies) at our institution. The children consisted of 10 boys and 14 girls, aged from 5 months to 16 years old, with a median age of 3 years. The final diagnoses consisted of 11 non- functioning kidneys, two dysplastic kidneys associated with an ectopic ureter, three multicystic dysplastic kidneys and eight complicated duplex kidneys. RESULTS: All operations were successfully performed; by either a transperitoneal or retroperitoneal approach in 13 and 11 cases, respectively. The transperitoneal approach was applied for an ureterectomy, including renal surgery (five cases), or a partial nephrectomy (eight cases), and the retroperitoneal approach was used for a simple nephrectomy of dysplastic (five cases) or non-functioning kidney (six cases). The operative times were 98-220 (mean 168) and 71-415 (mean 189) minutes in transperitoneal and retroperitoneal approaches, respectively. The blood loss was less than 50ml in most cases. No severe complications occurred, with the exception of postoperative urine leakage from the ureterectomy stump in one case. An ureterectomy and partial nephrectomy favored a transperitoneal approach because of the wide vision and working space. For dysplastic or non-functioning kidneys, the localization of the kidney using a ureteral catheter and fluoroscopy reduced the operative time. CONCLUSIONS: Laparoscopic renal surgery in pediatric patients is an adaptable technique, regardless of the anatomical structures. The transperitoneal approach may be better adapted for a nephroureterectomy and partial nephrectomy, and fluoroscopy-guided kidney localization is useful for a retroperitoneal nephrectomy in dysplastic or non-functioning kidneys.
Adolescent ; Child ; Diagnosis ; Female ; Fluoroscopy ; Humans ; Kidney ; Laparoscopy ; Multicystic Dysplastic Kidney ; Nephrectomy ; Operative Time ; Pediatrics ; Ureter ; Urinary Catheters

PURPOSE: A laparoscopic adrenalectomy has become the treatment of choice for an adrenal mass. However, there have been few reports on retroperitoneal laparoscopic adrenalectomies (RLA) in Korea. The results of retroperitoneal laparoscopic adrenalectomies were compared with those of a transperitoneal approach to evaluate efficacy of the former approach. MATERIALS AND METHODS: Between September 1999 and August 2006, 28 consecutive patients, with surgical adrenal disease, underwent a laparoscopic adrenalectomy via either a retroperitoneal (RLA, n=18) or transperitoneal approach (TLA, n=10). The groups were matched for age (years, p=0.79) and body mass index (kg/m2, p=0.53). The mean tumor sizes were 4.2 (1.6-7.5) and 3.9cm (2.2-7.0) in RLA and TLA groups, respectively (p= 0.90). RESULTS: A RLA was found to be comparable to a TLA in terms of operative time (115 vs. 128 minutes, p=0.61), estimated blood loss (217 vs. 191cc, p=0.92), hospital stay (5.5 vs. 6.1 days, p=0.45), return to diet (0.4 vs. 0.5 days, p=0.68), time to ambulation (0.6 vs. 1.0 days, p=0.11), analgesic requirements (Ketorolac tromethamine, 110 vs. 88mg, p=0.07), time to drain removal (4.2 vs. 5.1 days, p=0.17) and mean specimen weight (24.7 vs. 17.8 g, p=0.14). One case in each group was converted to open surgery for control of bleeding. CONCLUSIONS: A retroperitoneal laparoscopic adrenalectomy is as safe, minimally invasive and effective as the transperitoneal approach for the treatment of adrenal lesions that require surgery.
Adrenal Glands ; Adrenalectomy* ; Body Mass Index ; Diet ; Hemorrhage ; Humans ; Korea ; Laparoscopy ; Length of Stay ; Operative Time ; Tromethamine ; Walking