Vesicoureteral reflux (VUR), a common congenital urinary tract anomaly, refers to retrograde flow of urine from the bladder into the upper urinary tract. The main goal in the treatment of pediatric VUR is to preserve renal function by preventing pyelonephritis. Many surgical management options are available for pediatric VUR. Open ureteral reimplantation has a high success rate but is invasive and is associated with postoperative pain and morbidity. Endoscopic therapy is minimally invasive but has the disadvantages of decreased short-term success and recurrence of reflux over the long term. Laparoscopic or robotic ureteral reimplantation has become increasingly popular owing to its effectiveness and minimal invasiveness, but long-term outcomes have yet to be documented. Urologists should make an effort to select the appropriate surgical strategy by taking into consideration the individual characteristics of the patient such as age, gender, grade of reflux at presentation, status of renal parenchyma, combined bladder and ureteral circumstances, functional status of the bladder and bowel, and preferences of the patients' family.
Humans ; Pain, Postoperative ; Pediatrics ; Pyelonephritis ; Recurrence ; Replantation ; Ureter ; Urinary Bladder ; Urinary Tract ; Urinary Tract Infections ; Vesico-Ureteral Reflux*

Non-neurogenic pediatric voiding dysfunction is defined as a problem during bladder filling or emptying without any neurogenic abnormality in children. The appropriate treatment of non-neurogenic pediatric voiding dysfunction is important because the disorder is frequently seen in clinical practice and might result in damages of the child's bladder or kidney. Urotherapy can be defined as nonsurgical nonpharmacological treatment for voiding dysfunction, categorized into standard urotherapy or specific intervention. Understanding of the underlying pathophysiology of non-neurogenic pediatric voiding dysfunction will lead to a change in management, from expensive and potentially harmful medications and invasive procedures to effective, noninvasive treatment of urotherapy.
Child ; Humans ; Kidney ; Urinary Bladder

Vesicoureteral reflux (VUR) is a common cause of urinary tract infection in children. The primary goals of managing VUR are to prevent pyelonephritis, renal damage, and long-term complications. Management may be either medical or surgical. The rationale of medical therapy is that spontaneous resolution of reflux often occurs with time. Surgical therapy is based on the principle that eliminating the reflux will minimize the likelihood of renal damage and other reflux related complications. Open ureteral reimplantation is 95~98% effective for correcting reflux, and has been the standard surgical treatment for many years. In recent years, the management of VUR has changed dramatically, mostly because of the widespread acceptance of endoscopic treatment. Optimal materials for endoscopic treatment need to be easy to inject, nontoxic, and not to migrate to other organs, result in minimal local inflammation, and be well encapsulated. Since the first clinical application of endoscopic treatment for VUR in 1984 employed subureteric polytetrafluoroethylene injection, the materials and techniques have improved considerably. Following the approval of dextranomer/hyaluronic acid by the U.S. Food and Drug Administration in 2001, the endoscopic treatment of VUR has become increasingly popular in many parts of the world. The combination of increased success, minimal morbidity, a reasonable safety profile, and short operative time has strengthened the role of endoscopic treatment for VUR. The long-term durability and reproducibility of results will make endoscopic treatment an effective alternative to antibiotic prophylaxis in low-grade reflux and to open surgery in high-grade reflux.
Antibiotic Prophylaxis ; Child ; Endoscopy ; Humans ; Inflammation ; Operative Time ; Pediatrics ; Polytetrafluoroethylene ; Pyelonephritis ; Replantation ; Reproducibility of Results ; United States Food and Drug Administration ; Ureter ; Urinary Tract Infections ; Vesico-Ureteral Reflux

PURPOSE: To examine and compare the perioperative outcomes of laparoscopic adrenalectomy (LA) and to determine its efficacy in patients with nonfunctioning adrenal adenomas (NFA) and subclinical Cushing syndrome (SCS). MATERIALS AND METHODS: We retrospectively analyzed the clinical data obtained from 79 consecutive patients who underwent LA for the treatment of either NFA (n=35) or SCS (n=44) between 2011 and 2016. All patients had undergone computed tomography, as well as endocrinological tests to confirm the diagnosis prior to the adrenalectomy. The primary endpoint was improved metabolic parameters relating to diabetes, hypertension, dyslipidemia, and obesity. RESULTS: Patients with SCS compared to those with NFA showed a higher occurrence of diabetes (29.5% vs. 11.4%), hypertension (59.1% vs. 34.3%), and dyslipidemia (43.2% vs. 14.3%). Patients with SCS showed a smaller median tumor size compared to those with NFA (2.5 cm vs. 5 cm). No significant perioperative complications ≥ Clavien-Dindo classification grade III were observed in any patient (SCS or NFA group). In terms of their metabolic profile, patients with SCS showed a significant postoperative improvement in hypertension (50.0%), diabetes (53.9%), dyslipidemia (31.6%), and obesity (29.2%). However, patients with NFA showed a postoperative improvement only in dyslipidemia (40.0%) and obesity (4.8%). CONCLUSIONS: Owing to absence of significant perioperative complications and the marked postoperative improvement in metabolic impairment, LA is a useful treatment strategy in patients diagnosed with SCS. In contrast, LA was not observed to show beneficial effects in correcting/improving the metabolic profile in patients presenting with NFA.
Adenoma* ; Adrenalectomy* ; Classification ; Cushing Syndrome* ; Diagnosis ; Dyslipidemias ; Humans ; Hypertension ; Metabolome ; Obesity ; Retrospective Studies

PURPOSE: We aimed to evaluate the overall outcomes of endoscopic dextranomer/hyaluronic acid copolymer (Deflux) injection for vesicoureteral reflux (VUR) and analyze the factors predicting success. MATERIALS AND METHODS: A total 99 patients (58 males, 41 females) and 154 refluxing ureter units were treated with a endoscopic Deflux injection for VUR. At 3 months, radioisotope-voiding cystograms were performed to evaluate treatment responsiveness; success was defined as a resolving of VUR to less than grade I. We evaluated various perioperative factors such as gender, operation age, preoperative antibiotics duration, urinary tract infection, relative renal function and cortical defect, preoperative VUR grade, maximal flow rate in uroflowmetry, laterality of reflux, voiding dysfunction, constipation, orifice shape and trabeculation, injection technique, injection volume, number of punctures, and learning curve. RESULTS: The overall success rate was 62.3% (96/154) in refluxing ureter units (50.5% in patients). According to grade of VUR, the success rate was 87.5% (8/9), 82.2% (37/45), 67.8% (38/56), 33.3% (13/39), and 16.7% (1/6) in grade I, II, III, IV, and V, respectively (p=0.001). In multivariate analysis, preoperative VUR grade and mound morphology were identified as predictive factors (p<0.05). No significant surgery-related complications developed. CONCLUSIONS: Endoscopic Deflux injection for VUR was effective for grade I-III VUR, although the cure rate was low for grade IV-V. The factors predicting success were preoperative VUR grade and mound morphology.
Anti-Bacterial Agents ; Constipation ; Dextrans ; Endoscopy ; Humans ; Hyaluronic Acid ; Learning Curve ; Male ; Multivariate Analysis ; Punctures ; Ureter ; Urinary Tract Infections ; Vesico-Ureteral Reflux

Although prostatic calculi are common, complications are fortunately rare. Here, we report a case of prostatic calculi causing urethral obstruction. A 66-year-old man presented with severe voiding difficulty and urge incontinence. He was found to have multiple large prostatic calculi obstructing the prostatic urethra as well as several bladder calculi. Attempts at endoscopic removal were unsuccessful, which resulted in an iatrogenic urethral diverticulum due to fragmented calculi. The residual calculi and diverticulum were removed successfully by open surgery.
Aged ; Calculi ; Diverticulum ; Humans ; Prostate ; Urethra ; Urethral Obstruction ; Urinary Bladder ; Urinary Bladder Calculi ; Urinary Incontinence, Urge

Sarcomatoid urothelial carcinoma is a rare malignancy with a poor prognosis. We experienced a case of sarcomatoid urothelial carcinoma of the renal pelvis with extremely aggressive clinical behavior. An 81-year-old woman underwent a laparoscopic radical nephroureterectomy to remove a 4.5x3.1 cm sized localized left renal pelvis mass. The mass was pathologically confirmed as a sarcomatoid urothelial carcinoma. Although the operation was successful, the patient died 2 months postoperatively with widely metastatic disease.
Aged, 80 and over ; Female ; Humans ; Kidney Pelvis ; Prognosis

PURPOSE: Extracorporeal shock wave lithotripsy (ESWL) is a first-line treatment for pediatric urinary stone disease. We aimed to determine the factors affecting the outcome of ESWL for unilateral urinary stones in children. MATERIALS AND METHODS: A total of 81 pediatric patients aged 0 to 16 years with urinary stones treated by ESWL from January 1995 through May 2012 were retrospectively reviewed. All patients were required to have unilateral urinary stone disease. Children who underwent other surgical procedures before ESWL were excluded. Outcomes evaluated after ESWL were the stone-free rate at 3 months after ESWL, success within a single session, and success within three sessions. Factors affecting the success within three sessions were also analyzed. RESULTS: The final analysis was for 42 boys and 22 girls (mean age, 9.2+/-5.2 years). Of these 64 patients, 58 (90.6%) were treated by ESWL without other surgical procedures and 54 (84.4%) were successfully treated within three ESWL sessions. In the multivariate analysis, multiplicity (odds ratio [OR], 0.080; 95% confidence interval [CI], 0.012 to 0.534; p=0.009) and large stone size (>10 mm; OR, 0.112; 95% CI, 0.018 to 0.707; p=0.020) were significant factors that decreased the success rate within three ESWL sessions. CONCLUSIONS: Most of the pediatric urinary stone patients in our study (90.6%) were successfully treated by ESWL alone without additional procedures. If a child has a large urinary stone (>10 mm) or multiplicity, clinicians should consider that several ESWL sessions might be needed for successful stone fragmentation.
Aged ; Child ; Humans ; Lithotripsy ; Multivariate Analysis ; Pediatrics ; Retrospective Studies ; Shock ; Treatment Outcome ; Urinary Calculi

We aimed to investigate the clinical value of persistent but downgraded vesicoureteral reflux (VUR) after dextranomer/hyaluronic acid (Dx/HA) injection in children. The medical records of 128 children (195 ureters) who underwent Dx/HA injections for VUR were reviewed. The incidences of pre- and post-operative febrile urinary tract infections (UTIs) were analyzed in children with or without persistent VUR on voiding cystourethrography (VCUG) 3 months postoperatively. The surgical results of VUR persistent children who underwent a single additional injection were assessed. The VUR resolved completely in 100 ureters (51.3%), was persistent in 95 ureters, and newly developed in 2 ureters. The incidence of pre/post-operative febrile UTIs were 0.35 +/- 0.39 per year and 0.07 +/- 0.32 per year in VUR resolved children (P < 0.001), and 0.76 +/- 1.18 per year and 0.20 +/- 0.61 per year in VUR persistent children (P < 0.001). A single additional Dx/HA injection (44 ureters) resolved VUR in 29 ureters (65.9%), and also reduced the VUR to grade I in 7 ureters (15.9%), II in 4 (9.1%), and III in 4 (9.1%). Even in children with persistent VUR after Dx/HA injection, the incidence of febrile UTIs decreased markedly. The VUR grade significantly decreases after single additional Dx/HA injection.
Antibiotic Prophylaxis ; Child ; Child, Preschool ; Dextrans/*therapeutic use ; Female ; Fever/complications/epidemiology ; Humans ; Hyaluronic Acid/*therapeutic use ; Incidence ; Male ; Retrospective Studies ; Treatment Outcome ; Urinary Tract Infections/complications/drug therapy/*epidemiology ; Vesico-Ureteral Reflux/*drug therapy/surgery

PURPOSE: The exact role of angiogenesis in prostate cancer is unknown. We investigated whether endocrine therapy inhibits angiogenesis, and influences the expression of thrombospondin-1 (TSP-1), a potent inhibitor of angiogenesis, and vascular endothelial growth factor (VEGF) in prostate cancer. MATERIALS AND METHODS: Employing immunohistochemistry, we assessed the expression of VEGF and TSP-1 in archival tissues from 46 patients with metastatic prostate cancer (30 before androgen deprivation therapy and 16 after at least 6-months' duration of androgen deprivation therapy). For each tumour, microvascular density (MVD) counts were determined using immunohistochemical staining for factor VIII. The relationship between MVD and the expression of VEGF and TSP-1, the tumour grade was assessed in metastatic prostate cancer. RESULTS: The mean MVD counts (71.1 vessels per 200x high-power field) in 16 patients with metastatic cancer after androgen deprivation therapy was significantly higher than that (51.7) in 30 patients before androgen deprivation therapy (p<0.05). The immunohistochemical analysis demonstrated a higher TSP-1 expression (p<0.01), and a lower VEGF expression (p<0.01), in androgen deprivation group. There was no significant correlation between VEGF or TSP-1 expression and the mean MVD counts. The MVD counts had no correlation with Gleason scores or initial PSA levels. CONCLUSIONS: Endocrine therapy in metastatic prostate cancer significantly decreased MVD counts, the expression of VEGF and significantly increased the expression of TSP-1. The present study shows that decreased angiogenesis including changes in the expressions of angiogenic factors, might have an important role in the therapeutic effect of androgen deprivation in metastatic prostate cancer.
Angiogenesis Inducing Agents ; Factor VIII ; Humans ; Immunohistochemistry ; Prostate* ; Prostatic Neoplasms* ; Thrombospondin 1 ; Vascular Endothelial Growth Factor A*