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Metastasis of Renal Cell Carcinoma to the Bladder.

Seung Whan DOO ; Woong Bin KIM ; Bong Ki KIM ; Won Jae YANG ; Jong Hyun YOON ; So Young JIN ; Yun Seob SONG

Korean Journal of Urology.2013;54(1):69-72. doi:10.4111/kju.2013.54.1.69

Renal cell carcinoma is an uncommon source of bladder metastases. Here we report a case of renal cell carcinoma that metastasized to the bladder. A 73-year-old woman complained of gross hematuria. Abdominopelvic computerized tomography showed a bladder mass and a heterogenous enhancing mass in the lower pole of the left kidney with left vein thrombosis. The pathological analysis of the resected bladder specimen revealed metastatic renal cell carcinoma of the clear cell type.
Carcinoma, Renal Cell ; Female ; Hematuria ; Humans ; Kidney ; Neoplasm Metastasis ; Thrombosis ; Urinary Bladder ; Veins

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Brain and Skin Metastasis From Urothelial Carcinoma of the Bladder.

Jae Hoon CHUNG ; Joo Yong LEE ; Ju Yeon PYO ; Young Ha OH ; Seung Wook LEE ; Hong Sang MOON ; Hong Yong CHOI

Korean Journal of Urology.2013;54(1):66-68. doi:10.4111/kju.2013.54.1.66

Brain and skin metastasis from urothelial carcinoma of the bladder is rare. There have been few case reports of the clinical course of patients with metastatic urothelial carcinoma of the brain and skin. In the present case, a 60-year-old man had undergone radical cystectomy with an ileal conduit owing to urothelial carcinoma (T1N0M0). The patient developed dizziness 9 years later and a solitary brain tumor was discovered in his left cerebellar hemisphere. The tumor was totally resected and the mass was verified to be metastatic urothelial carcinoma. One year after the metastasectomy of the brain lesion, multiple erythematous nodular lesions developed on his abdominal skin. The skin lesions were excised and verified to be metastatic urothelial carcinoma. This report describes this case of urothelial carcinoma of the bladder that metastasized to the brain and abdominal skin.
Brain ; Brain Neoplasms ; Cystectomy ; Dizziness ; Humans ; Metastasectomy ; Neoplasm Metastasis ; Skin ; Urinary Bladder ; Urinary Bladder Neoplasms ; Urinary Diversion

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Factors That Affect Nosocomial Catheter-Associated Urinary Tract Infection in Intensive Care Units: 2-Year Experience at a Single Center.

Joon Ho LEE ; Sun Wook KIM ; Byung Il YOON ; U Syn HA ; Dong Wan SOHN ; Yong Hyun CHO

Korean Journal of Urology.2013;54(1):59-65. doi:10.4111/kju.2013.54.1.59

PURPOSE: This study took a retrospective approach to investigate patients with catheter-associated urinary tract infection (CAUTI) over 2 years at a single hospital's intensive care unit (ICU) to identify meaningful risk factors and causative organisms. MATERIALS AND METHODS: A retrograde analysis was performed on patients with indwelling catheters between January 2009 and December 2010 in Yeouido St. Mary Hospital medical and surgical ICU. CAUTI was defined as isolated bacterial growth of 100,000 colony-forming units or more either 48 hours after transfer to the ICU if a urinary catheter was placed before the transfer or 48 hours after insertion if the catheter was inserted in the ICU. Only the patients whose culture results were negative before ICU admission were included. RESULTS: There were a total of 1,315 patients with indwelling urinary catheters in our hospital's medical and surgical ICU between January 2009 and December 2010. Of these patients, 241 had positive urine culture results, and 61 had CAUTI. Using multivariate logistic regression analysis, those with diabetes were 4.55 (p<0.001) times as likely to have occurrences of CAUTI than were those without and also had a 1.10-fold (p<0.01) longer duration of an indwelling catheter. Upon urine culture, among the 61 patients with CAUTI, Escherichia coli was the most common bacterium grown; it was identified in 24 patients (38.7%). CONCLUSIONS: The factors and causative organisms contributing to the development of CAUTI in the management of ICU patients must be considered to prevent the occurrence of UTIs in this setting.
Catheters ; Catheters, Indwelling ; Escherichia coli ; Humans ; Critical Care ; Intensive Care Units ; Logistic Models ; Retrospective Studies ; Risk Factors ; Stem Cells ; Urinary Catheters ; Urinary Tract ; Urinary Tract Infections

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Prevalence and Associated Factors for Four Sexually Transmissible Microorganisms in Middle-Aged Men Receiving General Prostate Health Checkups: A Polymerase Chain Reaction-Based Study in Korea.

Jae Young CHOI ; In Chang CHO ; Gyeong In LEE ; Seung Ki MIN

Korean Journal of Urology.2013;54(1):53-58. doi:10.4111/kju.2013.54.1.53

PURPOSE: To investigate the prevalence of Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), Mycoplasma genitalium (MG), and Ureaplasma urealyticum (UU) in first-voided urine samples and to determine the factors associated with positivity for sexually transmissible microorganisms in healthy, middle-aged Korean men. MATERIALS AND METHODS: Five hundred fifty-one men who came to the hospital for a general prostate health checkup were tested between August 2011 and December 2011. PCR assays for CT, NG, MG, and UU were done with first-voided urine samples and the prevalence of microorganism positivity and association with several clinical parameters were evaluated. RESULTS: The mean age of the men studied was 50.8+/-4.7 years. Among the 551 men, 72 (13.1%) had a positive result for at least one microorganism; one (0.2%) had two different species. The overall prevalence of asymptomatic sexually transmitted infections was 11.1% (61/551). The prevalence rates of CT, NG, MG, and UU infection in the general population were 0.4% (2/551), 0.0% (0/551), 1.0% (6/551), and 11.8% (65/551), respectively. CT-positive patients had a lower mean age than did CT-negative patients. There were no significant differences in symptoms by positivity of each microorganism. CONCLUSIONS: We checked the prevalence rates of four microorganisms, the proportion of symptomatic people, and the association of microbes, age, and symptoms, as the baseline data for Korean middle-aged men. In this population, CT, NG, MG, and UU infections do not seem to be symptomatic. However, the potential role of CT in young men and of UU in middle-aged men with a high rate of detection should be studied continuously as a source of opportunistic infection.
Chlamydia ; Chlamydia trachomatis ; Humans ; Korea ; Male ; Mycoplasma genitalium ; Neisseria gonorrhoeae ; Opportunistic Infections ; Polymerase Chain Reaction ; Porphyrins ; Prevalence ; Prostate ; Ureaplasma ; Ureaplasma urealyticum

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A Retrospective Study of the Management of Vulvodynia.

Yongseok JEON ; Youngjun KIM ; Bosun SHIM ; Hana YOON ; Youngyo PARK ; Bongsuk SHIM ; Woosik JEONG ; Donghyun LEE

Korean Journal of Urology.2013;54(1):48-52. doi:10.4111/kju.2013.54.1.48

PURPOSE: Vulvodynia is characterized by chronic vulvar pain caused by sexual intercourse and often results in female sexual dysfunction. Because the causes of vulvodynia are not clear, many patients do not receive optimal treatment. Recently, gabapentin and botulinum toxin A have both been shown to be effective treatments for vulvodynia. In this study, we retrospectively analyzed the clinical outcomes of botulinum toxin A and gabapentin treatment for chronic pain in women with this condition. MATERIALS AND METHODS: Seventy-three women with vulvar pain were administered either gabapentin (n=62) or botulinum toxin A (n=11) injections. Effectiveness was measured by use of a visual analogue scale (VAS). We analyzed the treatment method, treatment duration, success of treatment, and side effects or adverse reactions. RESULTS: Pain levels in both groups significantly decreased after treatment. In the gabapentin group, the VAS score decreased from 8.6 before treatment to 3.2 after treatment (p<0.001). The VAS score in the botulinum toxin A group was reduced from 8.1 to 2.5 (p<0.001). Side effects for both therapies were few and subsided with treatment with general antibiotics and nonsteroidal antiinflammatory drugs. CONCLUSIONS: Gabapentin and botulinum toxin A are safe and effective treatments for vulvodynia. This condition can cause sexual dysfunction and affect quality of life. However, with proper management, satisfactory outcomes for women with vulvodynia can be achieved.
Amines ; Anti-Bacterial Agents ; Botulinum Toxins ; Chronic Pain ; Coitus ; Cyclohexanecarboxylic Acids ; Dyspareunia ; Female ; gamma-Aminobutyric Acid ; Humans ; Quality of Life ; Retrospective Studies ; Vulvodynia

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Is Concomitant Bladder Neck Reconstruction Necessary in Neurogenic Incontinent Patients Who Undergo Augmentation Cystoplasty?.

Hahn Ey LEE ; Jungbum BAE ; Jin Kyu OH ; Seung June OH

Korean Journal of Urology.2013;54(1):42-47. doi:10.4111/kju.2013.54.1.42

PURPOSE: In patients with neurogenic bladder due to spinal cord injury or disease who undergo augmentation cystoplasty (AC) for not only bladder dysfunction but also sphincteric incontinence, the need for concomitant bladder neck reconstruction at the time of AC has not yet been established. The aim of this study was to evaluate whether concomitant bladder neck reconstruction is necessary when performing AC. MATERIALS AND METHODS: We retrospectively investigated 35 patients who underwent AC from January 2006 to September 2010. Medical history, preoperative and postoperative fluoroscopic urodynamic study (FUDS) parameters, and responses to an incontinence questionnaire (ICIQ Korean version) were reviewed. RESULTS: A final analysis was performed on 17 patients (9 male, 8 female) who were diagnosed with sphincteric incontinence. Continence status, the number of pads used, and the bother score were significantly improved postoperatively in this subpopulation. Preoperatively, all patients used pads, and the average daily number was 2.2 (median; range 0 to 6). Postoperatively, the number of pads used decreased significantly to 0.9 (median; range 0 to 3) pads a day (p=0.002). Urodynamic parameters including bladder capacity, compliance, involuntary detrusor contraction, and bladder neck incompetence proven by FUDS were also significantly improved. CONCLUSIONS: Our study demonstrated that both objective urodynamic parameters and subjective incontinence symptoms improved significantly after the completion of AC as a single procedure in patients with sphincteric incompetence. This implies that anti-incontinence bladder outlet surgery does not have to be performed simultaneously and can be considered later as a staged operation.
Compliance ; Contracts ; Humans ; Male ; Neck ; Retrospective Studies ; Spinal Cord Injuries ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Incontinence ; Urodynamics

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Effect of Photoselective Vaporization Prostatectomy on Lower Urinary Tract Symptoms in Benign Prostatic Hyperplasia With or Without Intravesical Prostatic Protrusion.

Myung Soo KIM ; Kyung Kgi PARK ; Byung Ha CHUNG ; Seung Hwan LEE

Korean Journal of Urology.2013;54(1):36-41. doi:10.4111/kju.2013.54.1.36

PURPOSE: Intravesical protrusion of the prostate (IPP) can affect voiding. We evaluated the improvement in lower urinary tract symptoms and patient satisfaction after laser prostate photovaporization in benign prostatic hyperplasia (BPH) patients with or without IPP. MATERIALS AND METHODS: This prospective study included 134 patients who underwent GreenLight HPS laser photoselective vaporization prostatectomy (PVP) between January 2010 and July 2011 patient. Preoperative IPP was evaluated by using the retroflexed view from flexible cystoscopy. evaluation included complete medical history, International Prostate Symptom Scores (IPSS), maximum flow rate (Qmax), postvoid residual (PVR), serum prostate-specific antigen (PSA), and transrectal ultrasonogram. Changes from baseline in Qmax, PVR, total IPSS, and IPSS subscores (voiding and storage) were analyzed at postoperative months 1, 3, and 6. RESULTS: The patients' mean age was 66.6+/-7.8 years. Mean serum PSA and prostate volume were 1.7+/-1.5 ng/mL and 42.9+/-16.7 g, respectively. No significant differences existed between the IPP and no IPP groups in preoperative prostate volume, total IPSS, PSA, or lasing time and energy. The mean follow-up duration was 6.2+/-1.9 months. IPP patients showed significant improvements in total IPSS and voiding subscores at months 1 and 3. Improvements in the quality of life score and storage subscore were not significantly different between the groups. Qmax was significantly improved at 6 months postoperatively in the IPP group versus the no IPP group. CONCLUSIONS: Among patients who underwent PVP for BPH, the IPP group showed more symptom improvement, especially in voiding symptoms, than did the no IPP group. Preoperative cystoscopy is helpful for evaluating IPP and for anticipating postoperative outcome.
Cystoscopy ; Follow-Up Studies ; Humans ; Indoles ; Lower Urinary Tract Symptoms ; Patient Satisfaction ; Prospective Studies ; Prostate ; Prostate-Specific Antigen ; Prostatectomy ; Prostatic Hyperplasia ; Quality of Life ; Transurethral Resection of Prostate ; Urinary Bladder Neck Obstruction ; Volatilization

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Risk Factors for Failure of Early Catheter Removal After Greenlight HPS Laser Photoselective Vaporization Prostatectomy in Men With Benign Prostatic Hyperplasia.

Woong Jin BAE ; Sun Gook AHN ; Jun Ho BANG ; Jang Ho BAE ; Yong Sun CHOI ; Su Jin KIM ; Hyuk Jin CHO ; Sung Hoo HONG ; Ji Youl LEE ; Tae Kon HWANG ; Sae Woong KIM

Korean Journal of Urology.2013;54(1):31-35. doi:10.4111/kju.2013.54.1.31

PURPOSE: To assess the risk factors for developing urinary retention after removal of the urethral catheter on postoperative day 1 in benign prostatic hyperplasia patients who underwent Greenlight HPS laser photoselective vaporization prostatectomy (PVP). MATERIALS AND METHODS: The study included 427 men who underwent Greenlight HPS laser PVP between 2009 and 2012, excluding patients in whom a catheter was maintained for more than 1 day because of urethral procedures. In all patients, a voiding trial was performed on postoperative day 1; if patients were unable to urinate, the urethral catheter was replaced before hospital discharge. The patients were divided into two groups: early catheter removal (postoperative day 1) and late catheter removal (urethral catheter reinsertion). Preoperative and perioperative parameters were compared between the groups. RESULTS: Catheters were successfully removed in 378 (88.6%) patients on postoperative day 1. In 49 patients, the catheters were reinserted and removed a mean of 6.45+/-0.39 days after surgery. In a multivariate analysis, a history of diabetes was the most significant predictor (p=0.028) of failure of early catheter removal, followed by operative time (p=0.039). There were no significant differences in age, prostate volume, International Prostate Symptom Score, or urodynamic parameters between the two groups. CONCLUSIONS: It is feasible, safe, and cost-effective to remove the urethral catheter on postoperative day 1 after Greenlight HPS laser PVP, but the procedure should be done carefully in patients who have history of diabetes or an extended operative time.
Catheters ; Humans ; Laser Therapy ; Male ; Multivariate Analysis ; Operative Time ; Prostate ; Prostatectomy ; Prostatic Hyperplasia ; Risk Factors ; Urinary Catheterization ; Urinary Catheters ; Urinary Retention ; Urodynamics ; Volatilization

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Laparoscopic Ureteroneocystostomy: Modification of Current Techniques.

Jae Hyun AHN ; Ji Yeon HAN ; Jong Kil NAM ; Sung Woo PARK ; Sang Don LEE ; Moon Kee CHUNG

Korean Journal of Urology.2013;54(1):26-30. doi:10.4111/kju.2013.54.1.26

PURPOSE: To review the feasibility of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end in various distal ureteral lesions. MATERIALS AND METHODS: We conducted a retrospective review of 5 laparoscopic procedures of ureteroneocystostomy with extracorporeal eversion of the ureteral end. Of these, 4 patients (range, 45 to 54 years) had distal ureter stricture or obstruction after gynecological surgeries for endometriosis or a large uterine myoma. One patient (male, 67 years) had low-grade distal ureter cancer. The laparoscopic procedure was combined with cystoscopic insertion of a ureteral stent and extracorporeal eversion of the ureter through the 10-mm port on the affected side. RESULTS: The laparoscopic ureteral reimplantations with and without a psoas hitch in patients with distal ureteral lesions was successful in all patients. The mean operation time was 137 minutes (range, 104 to 228 minutes). Two patients underwent additional psoas hitch. In all patients, short-term success was confirmed by voiding cystourethrography and intravenous pyelography conducted 3 months after the operation. The mean follow-up of the entire group was 12 months (range, 3 to 30 months). We noted no major or minor complications over the follow-up period. CONCLUSIONS: The technique of laparoscopic ureteroneocystostomy for benign or malignant ureteral strictures continues to evolve. Surgeons should be versatile with various options and technical nuances when dealing with these cases. Simple modifications of laparoscopic ureteroneocystostomy with extracorporeal eversion of the ureteral end, nonreflux extravesical anastomosis, and simultaneous cystoscopy will be crucial to the ease of performance and a successful outcome.
Constriction, Pathologic ; Cystoscopy ; Endometriosis ; Female ; Follow-Up Studies ; Gynecologic Surgical Procedures ; Humans ; Laparoscopy ; Myoma ; Replantation ; Retrospective Studies ; Stents ; Ureter ; Ureteral Neoplasms ; Urography

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Changes in Renal Function After Laparoscopic Partial Nephrectomy: Comparison With Laparoscopic Radical Nephrectomy.

Su Hwan KANG ; Hyun Yul RHEW ; Taek Sang KIM

Korean Journal of Urology.2013;54(1):22-25. doi:10.4111/kju.2013.54.1.22

PURPOSE: To evaluate alterations in renal function after laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN) for renal tumors. MATERIALS AND METHODS: From March 2008 to August 2011, we performed 175 cases of laparoscopic kidney resection. Among these, we excluded patients who received perioperative immunotherapy or target therapy and also patients with a preoperative estimated glomerular filtration rate (eGFR) <60 mL/min. A total of 32 patients undergoing LPN and 92 patients undergoing LRN were enrolled. We retrospectively reviewed the changes in eGFR (by the modification of diet in renal disease method) at the following time points: preoperative, postoperative 1 week, and postoperative 1, 3, 6, and 12 months. RESULTS: The mean warm ischemia time of the LPN group was 22 minutes (range, 0 to 47 minutes). Mean eGFR values (mL/min/1.73 m2) during postoperative week 1 and 1, 3, 6, and 12 months were 70.8, 71.5, 76.7, 76.0, and 75.3 in the LPN group and 52.1, 50.6, 52.8, 53.4, and 52.4 in the LRN group, respectively. One year after the operation, 6.3% (2 patients) of LPN patients and 68.5% (63 patients) of LRN patients had progressed to chronic renal insufficiency (eGFR<60 mL/min/1.73 m2). CONCLUSIONS: Renal function recovered slightly after LPN and LRN and was maintained constantly after 3 months. However, renal function showed different patterns of decrease. Despite the concern for warm ischemia, LPN can preserve renal function better than can LRN. LPN should be considered for selected patients to prevent chronic renal insufficiency.
Diet ; Glomerular Filtration Rate ; Humans ; Immunotherapy ; Kidney ; Laparoscopy ; Nephrectomy ; Renal Insufficiency, Chronic ; Retrospective Studies ; Warm Ischemia

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