BACKGROUND: Emphysematous pyelonephritis (EPN) is a severe gas-forming infection of renal parenchyma with high mortality and its adequate treatment modality remains controversial. There have been only a limited number of studies about EPN, particularly in Korea. Therefore, we present our experience in patients with EPN. MATERIALS AND METHODS: Twenty-four patients that were diagnosed with EPN between January 1999 and June 2010 at a single medical center were retrospectively evaluated. Patient characteristics, causative pathogens, clinical features, complications, and mortality rates as modalities of managements and radiological classes of EPN were analyzed. RESULTS: All of the 24 patients selected for the study were diabetic. Twenty-one patients were positive at urine culture and Escherichia coli (85.7%) was the predominant pathogen identified. Of the 24 patients, 17 were managed by broad-spectrum antibiotics and percutaneous renal drainage, whereas 7 were managed by direct nephrectomy. The total mortality rates were 12.5%, regardless of the modalities of management. The mortality rates were 12.5% in Class 3A and 40% in Class 3B, according to computed tomography (CT) findings. CONCLUSIONS: Although conservative treatment included antibiotics, and percutaneous renal drainage offered an effective therapy for EPN, nephrectomy should be considered in patients with Class 3 EPN.
Anti-Bacterial Agents ; Drainage ; Escherichia coli ; Humans ; Korea ; Nephrectomy ; Pyelonephritis ; Retrospective Studies

PURPOSE: The cause and pathogenesis of lower urinary tract symptoms (LUTS) in elderly men is unclear. We analyzed the clinical and urodynamic findings of elderly patients with LUTS to search for accurate diagnosis and effective treatments. MATERIALS AND METHODS: We performed a retrospective chart review of 154 male patients older than 65 years old with LUTS who underwent urodynamic studies between January 2002 and December 2008. The patients were divided into irritative and obstructive symptom groups according to their chief complaints. The urodynamic findings between two groups were compared. And the prevalence of detrusor dysfunction (either detrusor underactivity; DU or detrusor overactivity; DO) according to age, history of urinary retention, the presence of an indwelling urethral catheter, neurologic disease, or diabetes was estimated. RESULTS: The mean age of men was 70.8+/-4.5 years. On urodynamics, detrusor dysfunction was detected in 116 (75.4%) of 154 patients. Seventy eight (50.6%) patients showed demonstrable evidence of DU of whom 33 (21.4%) had concomitant DO, while 18 (11.7%) had concomitant bladder outlet obstruction (BOO). BOO and DO was identified in 67 (43.5%) and 71 (46.1%) patients, respectively. The prevalence of was significantly greater in the presence of history of acute urinary retention and an indwelling urethral catheter. CONCLUSION: One hundred forty one (91.6%) elderly patients with LUTS showed urodynamic abnormalities such DO, DU and BOO. Urodynamic study would play a important role in establishing a correct diagnosis in elderly patients with LUTS and deciding on additional treatments.
Aged ; Diagnosis ; Humans ; Lower Urinary Tract Symptoms* ; Male ; Multiple Endocrine Neoplasia Type 1 ; Prevalence ; Retrospective Studies ; Urinary Bladder Neck Obstruction ; Urinary Catheters ; Urinary Retention ; Urinary Tract ; Urodynamics*

We describe a case of cutaneous angiomyolipoma found in the ear lobe, that is not associated with tuberous sclerosis. The lesion developed on the youngest patient yet reported in the literature.
Angiomyolipoma* ; Ear ; Humans ; Tuberous Sclerosis

Priapism is a persistent penile erection that continues for hours beyond, or is unrelated to, sexual stimulation. Priapism requires a prompt evaluation and usually requires an emergency management. There are two types of priapism: 1) ischemic (veno-occlusive or low-flow), which is found in 95% of cases, and 2) nonischemic (arterial or high-flow). Stuttering (intermittent or recurrent) priapism is a recurrent form of ischemic priapism. To initiate appropriate management, the physician must decide whether the priapism is ischemic or nonischemic. In the management of an ischemic priapism, resolution should be achieved as promptly as possible. Initial treatment is therapeutic aspiration with or without irrigation of the corpora. If this fails, intracavernous injection of sympathomimetic agents is the next step. Surgical shunts should be performed in cases involving failure of nonsurgical treatment. The first management of a nonischemic priapism should be observation. Selective arterial embolization is recommended for the management of nonischemic priapism in cases that request treatment. The goal of management for stuttering priapism is prevention of future episodes. This article provides a review of recent clinical developments in the medical and surgical management of priapism and an investigation of scientific research activity in this rapidly developing field of study.
Emergencies ; Erectile Dysfunction ; Male ; Penile Erection ; Priapism* ; Stuttering ; Sympathomimetics

The geriatric population is at a greater risk of postoperative complications than young adults. This risk is associated with the physiologic decline seen in this population known as frailty. Unlike fitter patients, frail patients who undergo operative treatment have a greater likelihood of developing postoperative complications and endure prolonged hospital stays. This circumstance is comparable to the urological status. Therefore, tolerable measurement of frailty as a domain of preoperative health status has been suggested to ascertain vulnerability in elderly patients. In this review, we will elaborate on the concept of frailty and examine its importance with respect to surgical complications, focusing on the urological status.

Ureterosciatic hernia is extremely rare. In ureteral herniation, ureter prolapses occur through either the greater or lesser sciatic foramen. Atrophy of the piriformis muscle, hip joint diseases, and defects in the parietal pelvic fascia are predisposing factors for the development of ureterosciatic hernia. Most symptomatic patients have been treated surgically, with conservative treatment reserved only for asymptomatic patients. To the best of our knowledge, long-term follow-up outcomes after ureterosciatic hernia management are sparse. In this paper, we report the case of a 68-year-old woman who presented with colicky left abdominal pain. After computed tomography (CT) scan and anterograde pyelography, she was diagnosed ureterosciatic hernia with obstructive uropathy. We performed ureteral balloon dilatation and double-J ureteral stent placement. After this minimally invasive procedure, CT scan demonstrated that the left ureter had returned to its normal anatomical position without looping into the sciatic foramen. The patient remained asymptomatic with no adverse events 7 years after the minimally invasive procedures. This brief report describes ureterosciatic hernia successfully managed with minimally invasive procedures with long-term follow-up outcomes.

PURPOSE: Tumor size and multiplicity are known to be important prognostic factors in non-muscle-invasive bladder cancer (NMIBC). However, evaluation of accurate tumor size is subjective and difficult. Furthermore, there are limitations to the objectification of tumor volume in the case of multiple lesions. In this study, we investigated the relation between resection weight after transurethral resection of bladder tumor (TURBT) and the prognosis of NMIBC. MATERIALS AND METHODS: This was a retrospective analysis of 406 patients diagnosed with pTa or pT1 bladder tumors after TURBT between September 1999 and May 2010. The patient's age, sex, underlying diseases, cancer stage, grade, multiplicity, tumor size, lymphovascular invasion, and resection weight were analyzed in relation to cancer progression and recurrence. The resection weight was weighted after formaldehyde fixation. RESULTS: The mean follow-up time was 76.9 months (range, 12 to 167 months) in 406 patients diagnosed as having NMIBC. Mean resection weight was 4.5 g (range, 0.1 to 35.0 g). The cancer recurred in 99 patients (24.4%), and disease progression was noted in 30 patients (7.4%). Resection weight was categorized as greater than or less than 2 g by use of receiver operator characteristic curves. Cancer grade (p=0.022) and multiplicity (p=0.043) were significantly related to cancer recurrence in the analysis with Cox's multivariate proportional hazard model. Cancer grade (p=0.001) and resection weight (p=0.018) were related to disease progression. CONCLUSIONS: Resection weight after TURBT was significantly related to progression of NMIBC. Resection weight was an independent factor of progression. Further management should be considered if the resection weight exceeds 2 g.
Disease Progression ; Follow-Up Studies ; Formaldehyde ; Humans ; Multivariate Analysis ; Prognosis ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Tumor Burden ; Urinary Bladder ; Urinary Bladder Neoplasms

PURPOSE: Tumor size and multiplicity are known to be important prognostic factors in non-muscle-invasive bladder cancer (NMIBC). However, evaluation of accurate tumor size is subjective and difficult. Furthermore, there are limitations to the objectification of tumor volume in the case of multiple lesions. In this study, we investigated the relation between resection weight after transurethral resection of bladder tumor (TURBT) and the prognosis of NMIBC. MATERIALS AND METHODS: This was a retrospective analysis of 406 patients diagnosed with pTa or pT1 bladder tumors after TURBT between September 1999 and May 2010. The patient's age, sex, underlying diseases, cancer stage, grade, multiplicity, tumor size, lymphovascular invasion, and resection weight were analyzed in relation to cancer progression and recurrence. The resection weight was weighted after formaldehyde fixation. RESULTS: The mean follow-up time was 76.9 months (range, 12 to 167 months) in 406 patients diagnosed as having NMIBC. Mean resection weight was 4.5 g (range, 0.1 to 35.0 g). The cancer recurred in 99 patients (24.4%), and disease progression was noted in 30 patients (7.4%). Resection weight was categorized as greater than or less than 2 g by use of receiver operator characteristic curves. Cancer grade (p=0.022) and multiplicity (p=0.043) were significantly related to cancer recurrence in the analysis with Cox's multivariate proportional hazard model. Cancer grade (p=0.001) and resection weight (p=0.018) were related to disease progression. CONCLUSIONS: Resection weight after TURBT was significantly related to progression of NMIBC. Resection weight was an independent factor of progression. Further management should be considered if the resection weight exceeds 2 g.
Disease Progression ; Follow-Up Studies ; Formaldehyde ; Humans ; Multivariate Analysis ; Prognosis ; Proportional Hazards Models ; Recurrence ; Retrospective Studies ; Tumor Burden ; Urinary Bladder ; Urinary Bladder Neoplasms

PURPOSE: To establish criteria for the safe reduction of unnecessary biopsies, we compared transrectal ultrasonography (TRUS) findings, serum prostate-specific antigen (PSA), and PSA density (PSAD) in the decision criteria for the TRUS guided prostate biopsy (TRUS-Bx). MATERIALS & METHODS: A total of 914 patients underwent TRUS-Bx due to elevated PSA and/or focal nodules on the TRUS. The patients were divided into the prostate cancer (n=286, 31.3%) and the non-prostate cancer groups (n=628, 68.7%). The sensitivity, specificity, and accuracy of TRUS, PSA, and PSAD were retrospectively evaluated, and the single criterion or the combinations of the criteria which can safely reduce the unnecessary biopsies without missing prostate cancer were investigated. RESULTS: The sensitivity, specificity and accuracy of TRUS, PSA (cut-off value, 4ng/ml) and PSAD (cut-off level, 0.20ng/ml/cc) were 75.9%/78.3%/53.8%, 33.0%/52.5%/73.7%, and 34.0%/42.9%/48.3%, respectively. At the cut-off level of PSAD (0.20 ng/ml/cc), 65.1% of unnecessary biopsies were spared but 132 cases (22.2%) of prostate cancer were detected. However a focal nodule was detected on TRUS in 120 cases (90.9%) and the remaining 12 cases (9.1%) had PSA above 10ng/ml. By the combinations of criteria (PSAD, TRUS and PSA), 27.7% of unnecessary biopsies were spared without missing cancer. CONCLUSIONS: A short-interval follow-up seems to substitute for the prostate biopsy if PSAD is below 0.20ng/ml/cc without nodular lesions on TRUS and PSA value is below 10ng/ml.
Biopsy ; Follow-Up Studies ; Humans ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Retrospective Studies ; Sensitivity and Specificity

PURPOSE: To establish criteria for the safe reduction of unnecessary biopsies, we compared transrectal ultrasonography (TRUS) findings, serum prostate-specific antigen (PSA), and PSA density (PSAD) in the decision criteria for the TRUS guided prostate biopsy (TRUS-Bx). MATERIALS & METHODS: A total of 914 patients underwent TRUS-Bx due to elevated PSA and/or focal nodules on the TRUS. The patients were divided into the prostate cancer (n=286, 31.3%) and the non-prostate cancer groups (n=628, 68.7%). The sensitivity, specificity, and accuracy of TRUS, PSA, and PSAD were retrospectively evaluated, and the single criterion or the combinations of the criteria which can safely reduce the unnecessary biopsies without missing prostate cancer were investigated. RESULTS: The sensitivity, specificity and accuracy of TRUS, PSA (cut-off value, 4ng/ml) and PSAD (cut-off level, 0.20ng/ml/cc) were 75.9%/78.3%/53.8%, 33.0%/52.5%/73.7%, and 34.0%/42.9%/48.3%, respectively. At the cut-off level of PSAD (0.20 ng/ml/cc), 65.1% of unnecessary biopsies were spared but 132 cases (22.2%) of prostate cancer were detected. However a focal nodule was detected on TRUS in 120 cases (90.9%) and the remaining 12 cases (9.1%) had PSA above 10ng/ml. By the combinations of criteria (PSAD, TRUS and PSA), 27.7% of unnecessary biopsies were spared without missing cancer. CONCLUSIONS: A short-interval follow-up seems to substitute for the prostate biopsy if PSAD is below 0.20ng/ml/cc without nodular lesions on TRUS and PSA value is below 10ng/ml.
Biopsy ; Follow-Up Studies ; Humans ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Retrospective Studies ; Sensitivity and Specificity