PURPOSE: Cases of ureteroscopic lithotripsy (URS) were retrospectively reviewed to define the efficacy of an ureteroscopic lithotripsy in the treatment of upper ureteral stones. The success rates, reasons for failure and complications of URS were compared with extracoporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: URS for upper ureteral stones was performed in 48 cases, between January, 2000 and December, 2002. A 7.5Fr, or 9.5Fr, rigid ureteroscopy and stone basket were used with, or without, electrohydraulic lithotripsy. There were 29 males and 19 females, with a mean age of 43.3 years. RESULTS: The overall success rate of the URS was 91.6%. According to the stone size, the success rates were 92.1 and 90% in stones smaller than 10mm and larger than 10mm, respectively. With the ESWL treatments, the overall stone free rate was 71.7% with only one session. The stone free rate was significantly affected by the size, was and were 77.9 and 46.3% in stones smaller than 10mm and larger than 10mm, respectively. The stone free rate after the second and third ESWL sessions were 81.3 and 91.3%, respectively. The associated complication rate for URS was 18.1%, with the complications consisting of ureteral mucosal injuries in 3 patient, flank pain (>48 hours) in 2, a ureteral perforation in 1, fever in 1 and a gross hematuria (>48 hours) in 1, which were all treated successfully with conservative treatment. CONCLUSIONS: URS can be a successful and safe treatment modality for upper ureteral stones, even if larger than 10mm.
Female ; Fever ; Flank Pain ; Hematuria ; Humans ; Lithotripsy* ; Male ; Retrospective Studies ; Shock* ; Ureter* ; Ureteroscopy

A 76-year-old woman with a history of chest pain and palpitation, was diagnosed with bilateral coronary to pulmonary artery fistulae with a concomitant saccular aneurysm, which is quite rare. Suture closure of the fistular vessels around the pulmonary artery root, the removal of a saccular aneurysm, and the transpulmonary closure of coronary to pulmonary artery fistulae were performed. The patient was well at 4 months after surgery.
Aged ; Aneurysm* ; Chest Pain ; Female ; Fistula* ; Humans ; Pulmonary Artery* ; Sutures

Priapism is a relatively rare condition of prolonged painful penile erection, unrelated to sexual activity. It is caused by idiopathic, leukemia, sickle cell disease, oral medication, intracavernosal injection therapy, spinal cord injury and malignant cell infiltration. Malignant lymphoma involving the genitourinary system is uncommon and when it occurs the testes is the most common site. However malignant lymphoma involving the penis is even more rare, with only 20 cases reported in literature. To our knowledge, priapism caused by penile lymphoma has not been reported previously in literature. We report a case with a brief review of literature.
Anemia, Sickle Cell ; Leukemia ; Lymphoma* ; Male ; Penile Erection ; Penis ; Priapism* ; Sexual Behavior ; Spinal Cord Injuries ; Testis ; Urogenital System

A 47-year-old male with hypertension, diabetes mellitus and heavy smoking, but no anginal symptoms, presented with claudication of the lower extremities. Extremity angiography with coronary angiography revealed peripheral arterial lesions including a left subclavian artery occlusion with coronary artery disease. The patient underwent an initial off-pump coronary artery bypass with an ascending aorto-axillary bypass. The right internal mammary artery was anastomosed to the left anterior descending coronary artery. The greater saphenous vein graft was connected from the ascending aorto-axillary bypass graft to the diagonal branch. At postoperative day 18, femorofemoral and bilateral femoropopliteal bypasses were performed. We report a case of the combined repair of coronary artery disease and a left subclavian artery occlusion.
Angiography ; Coronary Angiography ; Coronary Artery Bypass, Off-Pump ; Coronary Artery Disease* ; Coronary Vessels* ; Diabetes Mellitus ; Extremities ; Humans ; Hypertension ; Lower Extremity ; Male ; Mammary Arteries ; Middle Aged ; Peripheral Vascular Diseases ; Saphenous Vein ; Smoke ; Smoking ; Subclavian Artery* ; Transplants

PURPOSE: The purpose of this study is to evaluate the risk factors for clinical anastomotic leakage after laparoscopic resection for rectal cancer. METHODS: From March 2001 and February 2006 in Seoul Veterans' Hospital, the prospective laparoscopic colorectal resection database identified 101 patients who a had laparoscopic rectal resection with colorectal or coloanal anastomosis. The associations between clinical anastomotic leakage and patient-, tumor-, surgery- and laparoscopic-related variables were studied. RESULTS: The rate of clinical anastomotic leakage was 4 percent (4 of 101). The patient-related variable significantly associated with clinical anastomotic leakage was preoperative radiotherapy. The surgery-related factor that turned out to be significant was anastomosis situated less than 5 cm from the anal verge. No tumor- or laparoscopic-related variables were significantly associated with clinical anastomotic leakage. CONSLUSIONS: A protective ileostomy should be considered after a laparoscopic rectal resection for an rectal cancer for anastomosis situated less than 5 cm from the anal verge, particularly when preoperative radiotherapy is being used.
Anastomotic Leak* ; Humans ; Ileostomy ; Prospective Studies ; Radiotherapy ; Rectal Neoplasms* ; Risk Factors* ; Seoul

PURPOSE: The aim of this study was to assess the feasibility and safety of laparoscopic multivisceral resection of colorectal cancer adherent to adjacent organs. METHODS: We reviewed retrospectively 32 patients undergoing elective laparoscopic multivisceral resection for colorectal cancer adherent to adjacent organs between June 2003 and May 2009. Survival curves were generated by Kaplan-Meier method. RESULTS: The median age of 32 patients was 73 years. In 10 of 17 rectal cancer patients (59%), neoadjuvant chemoradiation was performed. All the surgeries were completed laparoscopically. The postoperative complications occurred in 21.9% and there was no operative mortality. The median length of hospital stay was 15.5 days. In 23 of 32 patients (72%), the resection was considered curative. Median follow-up period of all patients and curatively resected patients was 22 (range, 2~65) months, 34 (range, 4~65) months respectively. Local recurrence rate, the 3-year overall survival rate and the 3-year disease free survival rate of 23 curatively resected patients was 4.3%, 92.9% and 84.4%, respectively. CONCLUSION: Laparoscopic multivisceral resection is feasible and safe in highly selected patients with colorectal cancer adherent to adjacent organs. Further validation is needed.
Colorectal Neoplasms ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Laparoscopy ; Length of Stay ; Postoperative Complications ; Rectal Neoplasms ; Recurrence ; Retrospective Studies ; Survival Rate

Ureteral tumors are relatively uncommon, accounting for approximately 1.2% of all urothelial tumors. Metastatic ureteral tumors are even rarer. The primary lesions include breast, melanomas, bladder, colon, stomach, lung, and esophageal, prostate, ovarian, kidney, urethral and vaginal carcinomas. Patients usually have lumbar or flank pain, dysuria, frequency, and in the latter stages, anuria. We report a case of a metastatic ureteral tumor from a lung squamous cell carcinoma after complete remission.
Anuria ; Breast ; Carcinoma, Squamous Cell* ; Colon ; Dysuria ; Flank Pain ; Humans ; Kidney ; Lung* ; Melanoma ; Neoplasm Metastasis ; Prostate ; Stomach ; Ureter* ; Ureteral Neoplasms ; Urinary Bladder

PURPOSE: The purpose of this study is to assess the periopertive morbidity and mortality rates in relation to the principal variables in aged patients who undergo laparoscopic colorectal resection. METHODS: From March 2001 to March 2006, the prospective laparoscopic colorectal resection database was used to identify 233 patients. Among them, 132 were 70 years of age or older and they were classified as the aged group. 101 were younger than 70 years of age and they were classified as the younger group. RESULTS: Comorbidity was more common in the aged group than in the younger group (67.4% and 53.5%, respectively) (P=0.030). There were higher ASA scores in the aged group (I: 2.3% II: 68.2% III: 29.5%) than in the younger group (I: 27.7% II: 56.4% III: 15.8%) (P<0.0001). There was a higher postoperative complication rate for the aged group than for the younger group (25.0% and 8.9%, respectively) (P=0.002). Only one case of mortality (0.8%) was found in the aged group. The period of the postoperative hospital stay was longer for the aged group than that for the younger group (21.9+/-3/416.3 days and 16.3+/-3/48.1days, respectively) (P= 0.002). For the aged group, univariate analysis revealed that the operative procedure, disease, the T stage and the operation time were significant variables for the postoperative complications, and multivariate analysis identified the operation time as an independent variable faor the postoperative complications. CONCLUSION: More prudent care is needed to prevent postoperative complications for the aged patients who undergo laparoscopic colorectal resection, and particularly for those who can be expected to have a longer operation time.
Comorbidity ; Humans ; Length of Stay ; Mortality ; Multivariate Analysis ; Postoperative Complications ; Prospective Studies ; Surgical Procedures, Operative

Retroperitoneal fibrosis, although benign, has a malignant course due to an encasement and obstruction of the retroperitoneal structures, particularly the urinary system. The most common treatment is often a surgical exploration followed by urologic intervention. However, steroid or azathioprine therapy has been advocated, with varying results and major side-effects. Recently, the successful medical therapy in patients with an early stage and low malignant potential has been reported. Here we report a male patient who underwent successful treatment of an idiopathic retroperitoneal fibrosis with tamoxifen and prednisolone.
Azathioprine ; Humans ; Male ; Prednisolone ; Retroperitoneal Fibrosis* ; Tamoxifen ; Ureter

PURPOSE: Although urachal anomalies are rarely observed clinically, they often give rise to a number of problems, such as infection and late malignant changes. Because of variable clinical presentations, uniform guidlines for evaluation and treatment are lacking. The authors discuss the problems involved in both the diagnosis and the treatment of these anomalies. METHODS: We retrospectively analyzed 15 patients (9 males and 6 females) who had undergone surgery for urachal anomalies from July 1995 to December 1999. RESULTS: The age distribution ranged from 14 days to 38 years old, and the male to female ratio was 1.5:1. The 4 variants of urachal anomalies included a urachal sinus in 7 patients (47%), a urachal cyst in 4 (27%), a patent urachus in 3 (20%), and a bladder diverticulum in 1 (6%). The presenting complaint was periumbilical discharge in 6 patients, fever in 5, umbilical granuloma in 4, low abdominal mass in 3, and low abdominal pain in 1. Eight combined anomalies were seen in 7 patients; 2 umbilical hernias, 1 inguinal hernia, 1 hydrocele, 1 urachal vessel anomaly, 1 vesicoureteral reflux, 1 hydronephrosis, 1 Hirschsprung's disease, and 1 hypertrophic pyloric stenosis. Ultrasound examination disclosed a cyst or a sinus in 5 patients, and CT was performed in 1 case. Excision was performed in all patients, and there was no postoperative complication or recurrence. CONCLUSION: Urachal anomalies most frequently present in infancy or childhood, and the initial presentation is umbilical discharge with infection. Furthermore, the large number of associated genitourinary and gastrointestinal anomalies suggests that a complete work-up for these conditions should be performed. Definitive surgical excision appears to be appropriate for most patients.
Abdominal Pain ; Adult ; Age Distribution ; Diagnosis ; Diverticulum ; Female ; Fever ; Granuloma ; Hernia, Inguinal ; Hernia, Umbilical ; Hirschsprung Disease ; Humans ; Hydronephrosis ; Male ; Postoperative Complications ; Pyloric Stenosis, Hypertrophic ; Recurrence ; Retrospective Studies ; Ultrasonography ; Urachal Cyst ; Urachus ; Urinary Bladder ; Vesico-Ureteral Reflux