Various laparoscopic nephroureterectomy techniques for urothelial carcinoma of the upper urinary tract have been developed to minimize postoperative discomfort and the necessity for a lengthy convalescence. We performed hand-assisted retroperitoneoscopic nephroureterectomy without hand-assisted device in 3 male patients with urothelial carcinoma of the distal ureter. Average operative time and estimated blood loss were 251 min (range 235 to 280) and 250 mL (range 200 to 300), respectively. Complication did not occur and conversion to open surgery was not necessary in all cases. Postoperative analgesic requirements were moderate and the time to regular diet intake averaged 3 days (range 2 to 4). None of the patients had a positive margin on the final pathologic specimen. At the average follow-up of 8.1 months, no regional recurrence, port-site metastasis, bladder recurrence, or distant metastasis were noted in any patient. We described our initial experience with the described technique, which obviates the need for midprocedural patient repositioning.
Aged ; Humans ; Laparoscopes ; Laparoscopy/*methods ; Male ; Middle Aged ; Nephrectomy/instrumentation/*methods ; Retroperitoneal Space/pathology/*surgery ; Treatment Outcome ; Ureter/pathology/*surgery ; Ureteral Neoplasms/pathology/*surgery

PURPOSE: We wanted to assess the efficacy of bipolar transurethral resection of the prostate (TURP) compared with standard monopolar TURP. MATERIALS AND METHODS: All 25 patients with symptomatic benign prostatic hyperplasia (BPH) who underwent TURP from July 2004 to June 2005 were retrospectively reviewed. Thirteen consecutive patients underwent standard monopolar TURP and 12 underwent bipolar TURP using the Gyrus PlasmaKinetic system. RESULTS: The mean weight of resection was 29.7g for the bipolar TURP and 22.5g for the monopolar TURP. The operative time was shorter (82.5 vs 98.1 minutes, respectively), the estimated blood loss was less (252 vs 268cc, respectively) and the mean post-operative hospital stay was shorter (5.3 vs 5.7 days, respectively) in the bipolar TURP group. However, these differences were not statistically significant. The acute complications were significant hyponatremia in one patient and clot retention in one patient after monopolar TURP, but no complications occurred after bipolar TURP. The maximal flow rate increased from 6.4 to 14.7ml/sec in the bipolar TURP group, and it increased from 6.7 to 15.2ml/sec in the monopolar TURP group. CONCLUSIONS: Compared to monopolar TURP, bipolar TURP can be easily and safely used for treating symptomatic BPH with less morbidity.
Bipolar Disorder ; Humans ; Hyponatremia ; Length of Stay ; Operative Time ; Prostate* ; Prostatic Hyperplasia ; Retrospective Studies ; Transurethral Resection of Prostate

PURPOSE: Intravesical prostatic protrusion (IPP) is a morphological change of prostate protruded into bladder and might be related to bladder outlet obstruction (BOO) depending on the extent of protrusion. There is a high possibility that lower urinary tract symptoms (LUTS) tends to get worse as IPP grows. Therefore, it is necessary to examine the effect of IPP on LUTS after revision of prostate volume in order to identify the direct effect of IPP on BOO and LUTS. MATERIALS AND METHODS: A retrospective study of 296 male patients diagnosed with benign prostate hyperplasia (BPH) between August 2006 and December 2008 were performed. The patients were evaluated with international prostate symptoms score (IPSS) and quality of life (QoL), uroflowmetry (UFR), post-void residual urine volume (PVR), prostate volume and IPP as measured by transurectal ultrasound (TRUS). The changes of IPSS after 8 weeks of medication treatment and the occurrence rates of transurethral resection of prostate (TURP) and acute urinary retention (AUR) were compared. By checking IPSS and UFR, the improvement of voiding symptom was evaluated. RESULTS: The population of patients with moderate enlargement (30-50gm) of prostate extent was 147 (49.6%) out of 296, the whole examined population. There were correlation between IPP and IPSS (p=0.002) and the storage symptoms score was significantly increased (p=0.014). After 8 weeks of medication treatment, both moderate BPH patients with IPP showed similar improvement in storage symptom compared to non-IPP groups. But, the TURP was significantly performed more with IPP (p=0.040) than non-IPP groups and more AUR has occurred (p=0.013). After TURP, IPP group resulted in improvement of IPSS, storage symptoms score and voiding symptoms score statistically compared to non-IPP group. As the change of UFR and IPSS after TURP had shown, the improvements of voiding volume, maximal flow rate (Qmax), and average flow rate (Qavg) in IPP groups were smaller however, it is no correlation in statistical view. CONCLUSIONS: Moderate BPH group with IPP has a higher possibility of having AUR and surgical treatment while showing significant correlation with storage symptoms. A further prospective study is necessary for identification of improvement of IPSS and UFR after TURP and IPP should be checked carefully during TRUS.
Humans ; Hyperplasia ; Indoles ; Lower Urinary Tract Symptoms ; Male ; Prostate ; Prostatic Hyperplasia ; Quality of Life ; Retrospective Studies ; Transurethral Resection of Prostate ; Urinary Bladder ; Urinary Bladder Neck Obstruction ; Urinary Retention

We aimed to determine normal reference ranges for prostate volume (PV) and annual PV change rate in a Korean nationwide screening population. Data from men who underwent a routine health check-up were collected from 13 university hospitals. The cohort comprised men aged > or =40 yr who had undergone 2 or more serial transrectal ultrasonographies. Men with initial PV>100 mL; serum PSA level>10 ng/mL; PV reduction>20% compared with initial PV, or who had history of prostate cancer or prostate surgery, were excluded. Linear regression and mixed effects regression analyses were used to predict mean PV and longitudinal change in PV over time. A total of 2,967 men formed the study cohort. Age, body mass index (BMI), and serum prostate-specific antigen (PSA) level were found to be significant predictors of PV. A predicted PV table, with a 95% confidence interval (CIs), was developed after adjusting for these 3 variables. Annual PV change rate was 0.51 mL/year (95% CI, 0.47-0.55). Annual PV change rate according to age was 0.68 mL/year, 0.84 mL/year, 1.09 mL/year, and 0.50 mL/year for subjects in their 40s, 50s, 60s, and > or =70 yr, respectively. Predicted annual PV change rate differed depending on age, BMI, serum PSA level and baseline PV. From a nationwide screening database, we established age-, PSA-, and BMI-specific reference ranges for PV and annual PV change rate in Korean men. Our newly established reference ranges for PV and annual PV change rate will be valuable in interpreting PV data in Korean men.
Adult ; Aged ; Aged, 80 and over ; Aging/*pathology ; Humans ; Male ; Mass Screening/*standards ; Middle Aged ; Organ Size ; Prostate/*anatomy & histology/ultrasonography ; Reference Values ; Reproducibility of Results ; Republic of Korea ; Sensitivity and Specificity ; Ultrasonography/*standards ; Urology/*standards

This study aimed to investigate pressure changes of renal pelvis and histological change of kidneys in a surgically induced sterile rabbit vesicoureteral reflux (VUR) model. Five rabbits served as a control group, 7 as the sham-operated group, and 8 served as the VUR group. Three weeks later, urodynamic studies were performed, and histological examinations evaluated degree of inflammation, fibrosis, and tubular damage in the kidneys. At a low infusion rate, renal pelvic pressure in the VUR group was stable until late filling phase and then increased slightly. At a high infusion rate, the renal pelvic pressures of the sham-operated and control groups were stable until late filling phase and then increased slightly, whereas the renal pelvic pressure in the VUR group steadily increased from mid filling phase. Focal thinning of the tubular epithelium and interstitial widening were observed in certain cortical areas of refluxing kidneys, without inflammatory cell infiltration. Obvious changes in the mean diameters of distal tubules and extracellular matrix volume fractions were observed in two highly refluxing kidneys. High pressure reflux with bladder instability may result in renal cortical changes.
Animals ; Disease Models, Animal ; Female ; Kidney/pathology/physiopathology ; Rabbits ; Urinary Bladder/pathology/physiopathology ; Urodynamics ; Vesico-Ureteral Reflux/etiology/*pathology/*physiopathology

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

The widespread use of prenatal ultrasound results in an increased recognition of fetal hydronephrosis. To determine clinical characteristics and postnatal outcome of fetal hydronephrosis, we performed a retrospective study in children diagnosed as having fetal hydronephrosis between 1990 and 2001. 341 children with 427 dilated kidneys were included. Dilatation of the renal pelvis was caused by primary ureteropelvic junction obstruction in 65.6%, multicystic kidney in 9.4%, vesicoureteral reflux in 7.0%, duplex system in 5.4%, ureterovesical junction obstruction in 4.0%, and posterior urethral valves in 3.0%. Hydronephrosis resolved spontaneously in 126 (29.5%) kidneys, with 52.7% of mild hydronephrosis, and 2.6% of severe hydronephrosis. Mean interval to spontaneous resolution was 1.39 (+/-1.41, SD) yr. Surgery was performed in 174 kidneys, including pyeloplasty in 105, ureteroneocystostomy in 23, transurethral incision in 11 and nephrectomy in 9. Most patients had initially high-grade hydronephrosis (p<0.05). Mild hydronephrosis appears to be relatively benign, and in most cases, dilatation improves with time, and thus surgical intervention is not required. On the other hand, moderate or severe hydronephrosis often results in a significantly poor outcome and requires surgical intervention, and therefore, requires closer follow-up both antenatally and postnatally.
Adolescent ; Child ; Child, Preschool ; Female ; Gestational Age ; Human ; Hydronephrosis/surgery/*ultrasonography ; Infant ; Infant, Newborn ; Kidney/pathology/surgery/ultrasonography ; Male ; Pregnancy ; Retrospective Studies ; Treatment Outcome ; *Ultrasonography, Prenatal

PURPOSE: The role of apoptosis in the pathogenesis of ureteral damage from obstructive uropathy has rarely been studied. This study was performed to determine the protein expression of the apoptosis-associated genes in the pathogenesis of ureteral damage during the course of obstructive uropathy in ligated rat ureters. MATERIALS AND METHODS: After unilateral ligation of the ureter, each group of five Sprague-Dawley rats was sacrificed and examined at 1, 5, 10, 15, 20, 25, 30 and 35 days after ligation: five rats with normal ureters were also examined as controls. The protein expressions of the fas-associated death domain (FADD), Bax, Bcl-xL and cyclooxygenases (COX)-2 genes in obstructed ureters were assessed by performing Western blotting. RESULTS: The expressions of FADD protein in the 20 and 25 day-obstructed ureters (DOUs) were significantly higher than that in control ureters and the peak was reached in the 25 DOUs. The expressions of Bcl-xL protein in the 20, 25 and 30 DOUs were significantly higher than that in the control ureters and the peak was reached in the 25 DOUs. The expression of COX-2 protein in the 5, 10, 15, 25 DOUs were significantly higher than that in the control ureters and the peak was reached in the 10 DOUs. CONCLUSIONS: The FADD and Bcl-xL genes were involved in apoptosis of the obstructed ureter. The peaks of their expressions were at 25 DOUs. The expression of the COX-2 gene may be related with apoptosis in the obstructed ureter.
Animals ; Apoptosis ; bcl-X Protein ; Blotting, Western ; Ligation ; Prostaglandin-Endoperoxide Synthases ; Rats* ; Rats, Sprague-Dawley ; Ureter* ; Ureteral Obstruction

PURPOSE: To assess the long-term outcomes of tension-free vaginal tape (TVT) for stress urinary incontinence (SUI) with intrinsic sphincter deficiency (ISD) and to identify influencing factors for failure in these cases. METHODS: A total of 136 women who underwent TVT procedures with minimum follow-up duration of 3 years were included in the study. Patients were divided into two groups (non-ISD and ISD groups) based on preoperative urodynamic studies. Patient outcomes were assessed from retrospective chart review and telephone research. Cure was defined as the subjective resolution of SUI in any circumstances. Improvement was defined as the subjective improvement of SUI without complete resolution. Failure was defined as the subjective lack of improvement of SUI. Patients in ISD group were subdivided into two subgroups (cure and non-cure groups) and were compared to identify influencing factors for TVT procedure failure. RESULTS: Eighty-nine patients were in non-ISD group, and 47 in ISD group. The mean follow-up durations were 50.3+/-9.2 and 49.7+/-9.7 months, respectively. Subjective cure rate was 75.3% for non-ISD group, and 76.7% for ISD group (P>0.05). Improvement rate was 6.7% for non-ISD group, and 2.1% for ISD group (P>0.05). Satisfaction scores was 3.8+/-1.2 points in the non-ISD group, and 3.5+/-1.2 points in ISD group (P>0.05). In ISD subgroups, VLPP was 41.9+/-12.0 cmH2O for non-cure group, and 50.5+/-8.6 cmH2O for cure group, and was the only factor that showed significant statistical difference between the two subgroups (P=0.011). CONCLUSIONS: With our long-term results, TVT is an effective treatment even in women with ISD. However, ISD patients with low VLPP should be counseled carefully about TVT outcome.
Female ; Follow-Up Studies ; Humans ; Retrospective Studies ; Suburethral Slings ; Telephone ; Urinary Incontinence ; Urodynamics