No abstract available.

PURPOSE: Laparoscopic patial nephrectomy is still one of challenging surgeries in laparoscopic urologic field and needs skillful technique of surgeons. When performing laparoscopic partial nephrectomy, initial plan of how to approach affects the whole course of the surgery. To propose a systematic decision guideline, we used the tumor location as the determining factor for selecting initial plan and analyzed our initial experience. MATERIALS AND METHODS: From September 2005 to April 2008, we performed 22 LPNs for small renal tumors less than 40mm in diameter, as measured from the preoperative computed tomography scans. We divided the tumor locations into 18 categories with the combinations of the anterior and posterior renal axes, and the upper, middle, lower parts of the kidney and the peripheral, central and hilar locations of the tumor. According to the tumor location categories, we performed LPNs through the retroperitoneal simple and complex approaches, and the transperitoneal simple and complex approaches. RESULTS: Twenty of twenty-two tumors(91%) were removed successfully through 4 different approaches, but 2 cases were converted to laparoscopic radical nephrectomies(LRNs). The mean operation time was 203 minutes, including a mean warm ischemic time(WIT) of 30.7 minutes. Among the 17 cases of RCC, 15 tumors were successfully removed via LPNs, and there were no cases with positive margins and no tumor recurrence during a mean of 14.9 months follow-up with a maximum follow-up period of 34 months. CONCLUSIONS: Dividing the tumor location into 18 categories is useful for deciding on the appropriate laparoscopic approach.
Decision Making ; Follow-Up Studies ; Kidney ; Kidney Neoplasms ; Laparoscopy ; Nephrectomy ; Recurrence ; Warm Ischemia

PURPOSE: To evaluate the histopathological prognostic factors, relapse pattern and survival in patients with endometrial carcinoma who were treated with surgery and postoperative adjuvant radiotherapy (RT). METHODS AND MATERIALS: From September 1991 to December 1997, 27 patients with endometrial carcinoma treated with surgery and postoperative adjuvant RT at Asan Medical Center were entered in this study. Surgery was performed with total abdominal hysterectomy in six, total abdominal hysterectomy with pelvic lymph node dissection in eight and radical hysterectomy in 13 patients. External RT of 50.4 Gy was done to all patients and among these, additional high dose rate vaginal vault irradiation of 20-25 Gy with fractional dose of 4-5 Gy was boosted in 16 patients. The patients were followed for 6-95 months (median 30). RESULTS: The number of patients according to FIGO stage were I 18 (67%), II 1 (4%) and III 7 (26%). Patients with poor histologic grade, deep myometrial invasion, adnexal involvement, lymphovascular invasion showed more pelvic lymph node involvement, but no statistical significance was indicated. The 5year overall and disease free survival were 100% and 76.8%, respectively. Relapse sites were pelvic, para-aortic lymph node, and multiple metastases including lung, and no vaginal relapse was developed. Factors that were associated with disease free survival were FIGO stage (p=0.01), lymphovascular invasion (p=0.03), pelvic lymph node involvement (p=0.000 1). There was only one Grade 1 rectal bleeding without moderate to severe complications. CONCLUSION: Postoperative adjuvant RT is considered to reduce the loco-regional failure, resulting the improvement of survival. The group of patients with the risk of vaginal failure without vaginal vault irradiation should be investigated according to stage and grade.
Chungcheongnam-do ; Disease-Free Survival ; Endometrial Neoplasms* ; Female ; Hemorrhage ; Humans ; Hysterectomy ; Lung ; Lymph Node Excision ; Lymph Nodes ; Neoplasm Metastasis ; Radiotherapy, Adjuvant ; Recurrence

PURPOSE: The presence of a contralateral patent processus vaginalis (CPPV) is a risk factor for a metachronous hernia and may alter the surgical approach in unilateral cryptorchidism. We prospectively investigated the prevalence of a CPPV and compared the results between ultrasound (US) and transinguinal laparoscopy (TIL). MATERIALS AND METHODS: We analyzed a single surgeon's experience with preoperative US, TIL, and inguinal orchiopexy. We included 74 patients with a palpable (or identified by US) cryptorchidism with patent processus vaginalis who underwent inguinal orchiopexy. We performed an inguinal exploration when we could identify an opened internal ring through TIL. RESULTS: The prevalence of a CPPV was 18.9%. There was no significant difference in the occurrence of a CPPV by laterality, age, gestational age, or location of testis. A CPPV was detected 10 patients by US and in 15 patients by TIL, but one of them was revealed to be a blind pouch. The sensitivity and the specificity of US were 71.4% and 100%, respectively. Four CPPV cases were undiagnosed by US; all had a narrow internal ring. The accuracy of US was dependent on the width of the CPPV and the morphology of the internal ring. CONCLUSIONS: It was considerable that about 20% of patients with unilateral cryptorchidism had a CPPV, a risk factor for metachronous hernia. The presence of a CPPV in unilateral cryptorchidism should be considered in clinical practice.
Cryptorchidism ; Gestational Age ; Hernia ; Humans ; Laparoscopy ; Male ; Orchiopexy ; Prevalence ; Prospective Studies ; Risk Factors ; Sensitivity and Specificity ; Testis

PURPOSE: Currently, no studies have examined the diurnal variation of sex hormones in Korean men. We realized that accurate models of the diurnal variation of the sex hormones in Korean males are needed to evaluate and manage patients in urology. Therefore diurnal variation of testosterone and related sex hormones were investigated in young Korean men. MATERIALS AND METHODS: Healthy Korean men from 20 to 25 years old who had evident secondary growth were enrolled. We drew blood from each subject 12 times at 2-hour intervals for 24 hours. The concentrations of total testosterone, estradiol, luteinizing hormone, sex hormone binding globulin and albumin were measured. The free and bioavailable testosterone were calculated by Vermeulen's equation. To analyze the rhythmicity of diurnal variation in sex hormones, 24-hr cosine regression analysis was used for the statistical analysis. RESULTS: Total testosterone, free testosterone, estradiol, and testosterone estradiol ratio demonstrated a significant diurnal cosinor rhythm. The diurnal variation of bioavailable testosterone did not demonstrate a statistically significant cosinor rhythm. CONCLUSIONS: The diurnal variations of serum total and free testosterone concentration in Korean young men were similar to those found in studies of Caucasian men. Our study provides basic data for future studies of Korean male sex hormones. Furthermore, additional studies targeted toward various male age groups are needed to make the standard models of sex hormones in Korean men.
Adult ; Circadian Rhythm* ; Estradiol* ; Gonadal Steroid Hormones ; Humans ; Lutein* ; Luteinizing Hormone* ; Male ; Periodicity ; Sex Hormone-Binding Globulin* ; Testosterone* ; Urology

BACKGROUND: Balloon kyphoplasty is the new technique that helps to decrease the pain and improve mobility as well as restore the vertebral body height and kyphotic curve in fractured vertebrae. We evaluated the outcome of balloon kyphoplasty in the reduction of vertebral body height, kyphotic curve and clinical improvement in the patients with painful vertebral compression fractures. METHODS: From July 2002 to February 2005, 84 levels of vertebral compression fractures in 66 patients were treated with balloon kyphoplasty. The assessment criteria were the changes over time in visual analogue scale (VAS) and mobility score. We evaluated the vertebral body height and kyphotic curve at preoperative 1 day and postoperative 1 day. RESULTS: Procedures were performed in 66 patients with a total of 84 affected vertebral bodies. The anterior wall height was restored in 74 / 84 (88%) levels with a mean increment of 2.9 mm, and the mid-vertebral body height was restored in 79 / 84 (94%) levels with a mean increment of 4.2 mm. Kyphosis correction was achieved in 60 / 84 (71.4%) from 10.1 degrees to 7.5 degrees. Pain intensity reduced by 60% in one day after operation and by 75-85% in later time. Mobility scores of all patients were improved immediately after the procedure. Cement leakage occurred in 3 levels but there was no clinical problem. CONCLUSIONS: Kyphoplasty is an efficient and safe treatment of painful vertebral compression fracture in pain relief, mobility improvement, and reduction of deformity.
Body Height ; Congenital Abnormalities ; Fractures, Compression* ; Humans ; Kyphoplasty* ; Kyphosis ; Spine

BACKGROUND: Chemical lumbar sympathetic ganglion block could potentially be used to treat plantar hyperhidrosis; therefore, we analyzed the outcome of lumbar sympathetic ganglion block using alcohol for the treatment of plantar hyperhidrosis. METHODS: Between March 1992 and June 2003, 356 patients with plantar hyperhidrosis underwent lumbar sympathetic ganglion block using alcohol. All 356 patients were followed up for 2 years and the results evaluated. There were 185 and 171 male and female patients, respectively, with a mean age of 25.1 years, ranging from 15.3 to 56.5 years old. Lumbar sympathetic ganglion block using alcohol was performed with fluoroscopic guidance under local anesthesia. RESULTS: The recurrence rate after 2 years was 34%. Compensatory hyperhidrosis, ejaculation failure, lower back pain and genitofemoral neuritis developed as complications in 132, 4, 12 and 2 patients, respectively. Of the 356 patients, 65% were satisfied. CONCLUSIONS: Lumbar sympathetic ganglion block using alcohol is an effective and safe method for the treatment of plantar hyperhidrosis, but more information about the complications and relatively high recurrence rates should be provided to the patient.
Anesthesia, Local ; Ejaculation ; Female ; Ganglia, Sympathetic* ; Humans ; Hyperhidrosis* ; Low Back Pain ; Male ; Neuritis ; Recurrence

PURPOSE: This study evaluated the feasibility of a laparoscopic approach in children with generalized peritonitis secondary to perforated appendicitis. MATERIALS AND METHODS: We retrospectively analyzed the medical records of patients who underwent laparoscopic appendectomy with drainage for generalized peritonitis secondary to perforated appendicitis at our hospital between September 2001 and April 2012. Laparoscopic outcomes were compared with outcomes of an open method for perforated appendicitis. RESULTS: Ninety-nine patients underwent laparoscopic appendectomy (LA) for generalized peritonitis from perforated appendicitis, and 87 patients underwent open appendectomy (OA) for perforated appendicitis. Wound infection was more common in the OA group (12.6%) than in the LA group (4.0%; p=0.032). The incidence of intestinal obstruction during long-term follow-up was significantly higher in the OA group (4.6% vs. 0.0% in the LA group; p=0.046). LA was possible in most patients for whom LA was attempted, with a conversion rate of 10.8%. Conversion to OA was affected by the preoperative duration of symptoms and the occurrence of intraoperative complications. CONCLUSION: LA is feasible for use in children with generalized peritonitis from perforated appendicitis, with reasonable open conversion and perioperative complication rates comparable to those of the OA group.
Appendicitis/*complications/*etiology/*surgery ; Child ; Child, Preschool ; Female ; Humans ; Laparoscopy/*methods ; Male ; Retrospective Studies ; Treatment Outcome

PURPOSE: We examined patient satisfaction with treatment outcomes after shock wave lithotripsy (SWL) and ureteroscopic removal of stone (URS) for proximal ureteral stones. MATERIALS AND METHODS: We evaluated 224 consecutive patients who underwent SWL (n=156) or URS (n=68) for a single radiopaque proximal ureteral stone. Stone-free rates, defined as no visible fragment on a plain X-ray; complications; and patient satisfaction were compared. Patient satisfaction was examined through a specifically tailored questionnaire that included overall satisfaction (5 scales) and 4 domains (pain, voiding symptoms, cost, and stone-free status). RESULTS: The stone-free rates after the first, second, and third sessions of SWL were 36.5%, 65.4%, and 84.6%, respectively. The overall stone-free rate of URS was 82.4%, which was comparable to that of the third session of SWL. Complications were similar between the two groups except for greater steinstrasse in the SWL group. Overall satisfaction and voiding symptoms, cost, and stone-free status showed no significant difference between the groups. In the pain domain, the SWL group had a relatively lower satisfaction rate than did the URS group (p=0.05). Subanalysis showed that the satisfaction rate of the URS group with stone-free status was significantly lower than that of the SWL group in patients with > or =10 mm stones (p=0.032). CONCLUSIONS: Overall treatment outcomes and patient satisfaction were not significantly different between SWL and URS. However, patients undergoing URS for > or =10 mm proximal ureteral stones had lesser satisfaction with stone-free status, because of relatively lower stone-free rates due to upward stone migration. We suggest that factors regarding the subjective satisfaction of patients be included in counseling about treatment options for proximal ureteral stones.
Counseling ; Humans ; Lithotripsy ; Patient Satisfaction ; Shock ; Ureter ; Ureteral Calculi ; Ureteroscopy

PURPOSE: In patients with diabetic end stage renal disease (ESRD), glycated albumin (GA) reflects recent glycemic control more accurately than glycated hemoglobin (HbA1c). We evaluated the relationship between GA and average blood glucose (AG) level and developed an estimating equation for translating GA values into easier-to-understand AG levels. MATERIALS AND METHODS: A total of 185 ESRD patients, including 154 diabetic and 31 non-diabetic participants, were enrolled (108 hemodialysis, 77 peritoneal dialysis). Patients were asked to perform four-point daily self-monitoring of capillary blood glucose (SMBG) at least three consecutive days each week for four weeks. Serum levels of GA, HbA1c and other biochemical parameters were checked at baseline, as well as at 4 and 8 weeks. RESULTS: Approximately 74.3+/-7.0 SMBG readings were obtained from each participant and mean AG was 169.1+/-48.2 mg/dL. The correlation coefficient between serum GA and AG levels (r=0.70, p<0.001) was higher than that of HbA1c and AG (r=0.54, p<0.001). Linear regression analysis yielded the following equation: estimated AG (eAG) (mg/dL)=4.71xGA%+73.35, and with this formula, serum GA levels could be easily translated to eAG levels. Multivariate analysis revealed significant contributions of postprandial hyperglycemia (beta=0.25, p=0.03) and serum albumin (beta=0.17, p=0.04) in determining serum GA level, independent to other clinical parameters. CONCLUSION: Compared to HbA1c, serum GA levels were better correlated with AG levels. Using the estimating equation, an average blood glucose level of 155-160 mg/dL could be matched to a GA value of 18-19% in patients with ESRD.
Adolescent ; Adult ; Aged ; Blood Glucose/*metabolism ; Female ; Humans ; Kidney Failure, Chronic/*blood/metabolism ; Male ; Middle Aged ; Prospective Studies ; Serum Albumin/*metabolism ; Young Adult