PURPOSE: To search for a safer and easier approach for laparoscopic donor nephrectomy, hand-assisted laparoscopic techniques have been added to the surgical armamentrium. Hand-assisted live donor nephrectomy (HALDN) for renal transplantation is being performed in increasing numbers with the goal of broadening organ supply while minimizing pain and duration of convalescence for donors. Here, we compared our initial series of HALDN with open donor nephrectomy (ODN). MATERIALS AND METHODS: Between July 2001 and February 2003, a total of 63 patients underwent consecutive live donor nephrectomy in our hospital, which were all performed by a single surgeon. Of these patients 22 underwent HALDN and 41 underwent ODN. Objective data and subjective recovery information was obtained from medical records, telephone interviews, and questionnaires. RESULTS: Twenty-two HALDNs were performed successfully without open conversion. There was a significant reduction in postoperative visual analogue pain scale (p<0.05), and there were characteristics of rapid return to normal activities (p<0.05) in the HALDN group. The mean operative time, estimated blood loss, hospitalization, and complications were similar in both groups. The mean warm ischemic time was significantly longer in the HALDN group (p<0.05). However, warm ischemic time between the latter HALDN and the ODN group was not significant (p=0.46). In terms of allograft function, serum creatinine at 1, 2 days, 1 week, 2 weeks, 1 month, 2 months, delayed graft function, episodes of rejection, and ureteral complication were similar in both groups. Transfusion was required in one patient of the HALDN group. CONCLUSIONS: HALDN is efficacious and reproducible, and it is safe for live donor nephrectomy. Compared with ODN, HALDN significantly lessened the pain for the donor, and it allows a more complete convalescence, while enabling excellent allograft function.
Allografts ; Convalescence ; Creatinine ; Delayed Graft Function ; Hand ; Hospitalization ; Humans ; Interviews as Topic ; Kidney ; Kidney Transplantation ; Laparoscopy ; Medical Records ; Nephrectomy* ; Operative Time ; Pain Measurement ; Surveys and Questionnaires ; Tissue Donors* ; Transplantation ; Ureter ; Warm Ischemia

PURPOSE: Radical cystectomy with urinary tract reconstruction currently remains the standard treatment for invasive bladder cancer, and adjuvant chemotherapy is usually considered for patients with a clinical stage >T2 or nodal metastasis. The aim of this study was to assess the safety of adjuvant chemotherapy in patients with orthotopic bladder substitution in comparison to ileal conduit. MATERIALS AND METHODS: We retrospectively analyzed the patients who underwent radical cystectomy and urinary diversion between 1990 and 2005. The patients who underwent adjuvant chemotherapy were stratified into two groups: those who had orthotopic bladder substitution and those who had ileal conduit. The chemotherapy regimen, renal function change, complications from adjuvant chemotherapy and other relevant data were analyzed. RESULTS: Overall, 341 patients had radical cystectomy, 89 had adjuvant chemotherapy, 28 had orthotopic bladder substitution and 61 had ileal conduit. The patient characteristics, including age, stage and follow-up, were similar in both groups. In all, 42% of patients had grade 1 toxicity, 16% had grade 2, 14% had grade 3 and 0% had grade 4. No patients had serious organ toxicity and none died. There were no significant differences in the chemotherapy toxicity and renal function change among the two groups. CONCLUSIONS: Adjuvant chemotherapy is safe and well tolerated by patients with either orthotopic bladder substitution or ileal conduit. There was no increased morbidity or mortality due to adjuvant chemotherapy in the patients who had orthotopic bladder substitution. Hence, orthotopic bladder substitution should not be denied to those patients with bladder cancer and who might require adjuvant chemotherapy.
Chemotherapy, Adjuvant* ; Cystectomy ; Drug Therapy ; Follow-Up Studies ; Humans ; Mortality ; Neoplasm Metastasis ; Retrospective Studies ; Urinary Bladder Neoplasms ; Urinary Bladder* ; Urinary Diversion* ; Urinary Tract

Iatrogenic implantation has been the main cause in the majority of cases of transitional call carcinoma (TCC) with metastasis to the abdominal wall. A 66-year-old woman had undergone radical cystectomy 20 years prior to presenting. Radiological investigations revealed one mass in the left lower abdominal wall and one mass in the right inguinal area. She underwent wide excision of the lesions that revealed metastasis of TCC. This report describes this case of a woman with bladder carcinoma who developed a metastasis in the anterior abdominal wall following an apparent disease-free interval of 20 years.
Abdominal Wall/*pathology ; Aged ; Bladder Neoplasms/*pathology/*surgery ; Carcinoma, Transitional Cell/*secondary/*surgery ; Cystectomy ; Female ; Humans ; Soft Tissue Neoplasms/*secondary ; Time Factors

PURPOSE: Conflicting results have been reported for western populations on associations of serum insulin-like growth factor I (IGF-I) and major IGF-binding protein-3 (IGFBP-3) with the risk of prostate cancer. However, few data have been available for oriental populations. We undertook a matched case-control study in a low-risk Korean population to extend our knowledge about potential associations. MATERIALS AND METHODS: Serum IGF-I and IGFBP-3 levels were determined for 330 men (165 cases and 165 healthy age-matched controls). Conditional logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for the association between plasma IGF levels and prostate cancer. We also investigated the potential influence of the associations according to clinical risk for advanced disease at diagnosis. RESULTS: We noted that the risks of prostate cancer were unrelated to the IGF-1 level and IGF-I/IGFBP-3 molar ratio. In contrast, a strong inverse association was observed between IGFBP-3 levels and the risk for prostate cancer. Men in the highest quartile of IGFBP-3 levels had a 71% reduced risk of prostate cancer compared with men in the lowest quartile (OR=0.29, 95% CI: 0.11-0.64, P(trend)<0.001). Subgroup analysis revealed a significant inverse association between plasma IGFBP-3 and the likelihood of a high risk prostate cancer. CONCLUSIONS: Plasma IGFBP-3 levels were inversely associated with the risk of prostate cancer and the likelihood for high-risk disease, suggesting that IGFBP-3 plays a protective role against prostate cancer in the Korean population.
Case-Control Studies ; Humans ; Insulin-Like Growth Factor Binding Protein 3 ; Insulin-Like Growth Factor I ; Logistic Models ; Male ; Molar ; Odds Ratio ; Plasma ; Prostate ; Prostatic Neoplasms

PURPOSE: We examined the risk factors for postoperative ileus, and we investigated whether the duration of postoperative nasogastric tube (NGT) use affects the rate of postoperative ileus in patients undergoing radical cystectomy with urinary diversion. MATERIALS AND METHODS: A total of 101 patients underwent radical cystectomy with urinary diversion from 1999 to 2003. We examined the demographic and perioperative variables of patients who developed postoperative ileus and those who did not. We divided the patients into two groups; a group of patients who had the NGT removed within 24 hours and a group of patients who had the NGT removed at first flatus. We compared the two groups for the incidence of ileus and for the clinical variables. RESULTS: Postoperative ileus was observed in 23 patients (23%). The demographic data for both groups were not different in terms of age and the American Society of Anesthesiology (ASA) score. Also, the operative time, estimated blood loss, the type of diversion and the postoperative complication rates were not significantly different for the two groups (p>0.05). However, the risk of postoperative ileus was significantly higher for those patients who took a polyethylene glycol bowel preparation than for those who took a sodium phosphate bowel preparation (40%:18%, p=0.02). No significant difference in the prevalence of ileus was found between the patients whose NGT were removed within 1 days and those patients whose NGT was removed beyond 2 days (25%:22%, p>0.05). CONCLUSIONS: The results of our study suggest that the use of sodium phosphate for bowel preparation may reduce postoperative ileus and that early NGT removal after cystectomy is not correlated with ileus.
Anesthesiology ; Cystectomy* ; Flatulence ; Humans ; Ileus* ; Incidence ; Intestinal Obstruction ; Operative Time ; Polyethylene Glycols ; Postoperative Complications ; Prevalence ; Risk Factors* ; Sodium ; Urinary Diversion