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Laparoscopic Partial Nephrectomy Using a Water (Hydro)-Jet System: A Case Report.

Sin Woo LEE ; Hyun Hwan SUNG ; Hwang Gyun JEON ; Byong Chang JEONG ; Seong Soo JEON ; Hyun Moo LEE ; Han Yong CHOI ; Seong Il SEO

Korean Journal of Urological Oncology.2015;13(3):138-142.

The water-jet system (WJS) can be used for selective dissection of kidney parenchyma without renal artery clamping in laparoscopic partial nephrectomy (LPN). We report our experiences regarding LPN with a WJS. The first case was a 59 year old male with a 1.8 cm solid mass in the Rt. mid-lateral area (R.E.N.A.L score: 5a). The second case was a 24 year old female with a 2.3cm solid mass in the Lt. mid-lateral area (R.E.N.A.L score: 7x). We successfully finished non-clamping LPN using a WJS without perioperative complications. Surgical margins were negative (7mm and 1mm for cases 1 and 2, respectively). Post-operative renal function was not decreased significantly. LPN using a WJS is a feasible and safe technique which can be performed for small renal masses without ischemic damage.
Constriction ; Female ; Humans ; Kidney ; Laparoscopy ; Male ; Nephrectomy* ; Renal Artery ; Water*

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Leukemoid Reaction, a Rare Paraneoplastic Syndrome in Urothelial Cell Carcinoma: Is It an Indicator of a Poor Prognosis?.

Ho Seok CHUNG ; Bo Sung SHIN ; Ho Song YU ; Eu Chang HWANG ; Sun Ouck KIM ; Sung Il JUNG ; Taek Won KANG ; Dong Deuk KWON ; Kwangsung PARK

Korean Journal of Urological Oncology.2015;13(3):134-137.

A leukemoid reaction is usually associated with malignancies of the lung, stomach, and thyroid. In contrast, urothelial cell carcinoma is rarely associated with leukemoid reactions, with few cases reported over the past 30 years. Here, we describe a patient with urothelial cell carcinoma who exhibited a leukemoid reaction. The patient had an elevated white blood cell count and experienced a rapid and aggressive clinical course, terminating in death. For urothelial cell carcinoma patients exhibiting a leukemoid reaction, removal of the inciting tumor is the definitive treatment. However, considering the aggressive nature of these tumors, if the patient is unsuitable for radical surgical management, palliative chemotherapy should be considered.
Drug Therapy ; Humans ; Leukemoid Reaction* ; Leukocyte Count ; Lung ; Paraneoplastic Syndromes* ; Prognosis* ; Stomach ; Thyroid Gland

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Utilization Trend of Partial Nephrectomy for the Treatment of Renal Cell Carcinoma in Korea: An Multicenter study using URO-PDS.

Seung Jea SHIN ; Hyung Joon KIM ; Kwang Jin KO ; Hyun Hwan SUNG ; Hwang Gyun JEON ; Byong Chang JEONG ; Seong Il SEO ; Hyun Moo LEE ; Han Yong CHOI ; Seong Soo JEON

Korean Journal of Urological Oncology.2015;13(3):128-133.

PURPOSE: Partial nephrectomy has a similar oncologic outcome to radical nephrectomy while reducing cardiac and metabolic morbidity. However, previous studies reported that partial nephrectomy had been underutilized. The purpose of this study is to analyze trends in the use of partial nephrectomy in Korea and evaluate which individual factors and hospital factor influenced the operative approach. MATERIALS AND METHODS: Using URO-PDS database, 11560 patients underwent nephrectomy for renal cell carcinoma between 2006 and 2010 were identified. International Classification of Disease (ICD-9) diagnosis codes were applied to target subject of interest. Logistic regression was applied to identify determinants of partial nephrectomy. RESULTS: Over the study period, the proportion of partial nephrectomies has steadily increased from 9.4% in 2006 to 30.4% in 2010 (p<0.001). Deviation of utilization in partial nephrectomy has been observed based on the area (p<0.001) and type of surgery (p<0.001). Individual of younger age, as well as male, were more likely to be treated with partial nephrectomy (p<0.001 for each). Furthermore, Patient treated at hospitals with higher nephrectomy volume were more prone to be treated with partial nephrectomy (p<0.001 for each). CONCLUSIONS: Partial nephrectomies have been increasingly performed over the study period but are still underutilized.
Carcinoma, Renal Cell* ; Classification ; Diagnosis ; Humans ; Korea* ; Logistic Models ; Male ; Nephrectomy*

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The Relationship Among Obesity, Benign Prostatic Hyperplasia and Erectile Dysfunction in Korea Men.

Jun Sang SUH ; Jung Hoon CHO ; Won Sik JEONG ; U Syn HA ; Jae Hyun BAE ; Tae Hyo KIM ; Jae Heon KIM ; Seung Hwan LEE ; Hee Ju CHO ; Koo Han YOO ; Hyung Lae LEE ; In Ho JANG ; Seung Wook LEE ; Jae Hoon CHUNG

Korean Journal of Urological Oncology.2015;13(3):122-127.

PURPOSE: Pathogenically, both erectile dysfunction (ED) and benign prostatic hyperplasia (BPH) are closely related to vascular problems, and vascular problems are closely associated with obesity. This study evaluated the relationships between obesity, BPH, and ED. MATERIALS AND METHODS: The medical history of male patients, aged > or =40 years, evaluated at urology outpatient clinics of 11 university hospitals in Korea with chief complaints of lower urinary tract symptoms (LUTS)/BPH and ED were retrospectively evaluated. The correlations of medical history, body mass index (BMI), international prostate symptom score (IPSS), prostate volume, International Index of Erectile Function -5 (IIEF-5), and serum testosterone level were assessed. RESULTS: Body mass index showed significant correlations with IPSS (r=0.087, p=0.003), prostate volume (r=0.384, p<0.001), IIEF (r=-0.072, p=0.015), and serum testosterone concentration (r=-0.303, p<0.001). CONCLUSIONS: Body mass index correlates with testosterone concentration, prostate volume, and markers of LUTS and ED in men with the latter conditions.
Ambulatory Care Facilities ; Body Mass Index ; Erectile Dysfunction* ; Hospitals, University ; Humans ; Korea* ; Lower Urinary Tract Symptoms ; Male ; Obesity* ; Prostate ; Prostatic Hyperplasia* ; Retrospective Studies ; Testosterone ; Urology

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Comparison of Erectile Dysfunction Treatment Efficacy of Mirodenalfil 50mg Once Daily and 100mg On-Demand in Patients with Benign Prostatic Hyperplasia and Erectile Dysfunction: Multicenter, Randomized.

Jung Hoon CHO ; Jun Sang SEO ; Kyu Shik KIM ; Tae Hyo KIM ; Joon Hwa NOH ; Jae Hyun BAE ; Cheol Young OH ; Seung Hwan LEE ; Sung Yong CHO ; Jae Duck CHOI ; Jun Hyun HAN ; Seung Wook LEE

Korean Journal of Urological Oncology.2015;13(3):115-121.

PURPOSE: To Compare the improvement of erectile dysfunction (ED) and lower urinary tract symptoms (LUTS) as well as the efficacy of mirodenalfil 50mg once daily and 100mg on-demand in patients with benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). MATERIALS AND METHODS: Prospective study was done with 220 patients who had BPH and ED from June 2013 to October 2014. Out of 220 individuals, 260 met inclusion criteria and 204 finished the research. Patients were divided into two groups. Group 1 had mirodenafil 50mg once daily and Group 2 had mirodenafil 100mg on-demand. The five-item version of the International Index of Erectile Function (IIEF-5), International Prostate Symptom Score (IPSS), Qmax, and residual urine volume(PVR) were assessed immediately before initiation of treatment (V1) and after four (V2) and twelve weeks of treatment (V3). RESULTS: No difference of IIEF-5, IPSS, Qmax, and PVR between two groups in V1. At V3, both groups had improvements of IPSS and group 1 had better improvements (-5.1+/-4.4 vs. -3.1+/-3.9 p<0.001). And Group 1 had larger improvements than Group 2 in Qmax significantly. No difference in PVR in both groups comparing V1 vs. V2 and V1 vs V3. Group 1 had better improved IIEF-5 than Group 2 (V1 vs. V3: 4.8+/-5.8 vs. 4.4+/-5.1; p=0.032). There was no drop out patients due to cardiovascular problems. CONCLUSIONS: Once daily mirodenafil 50mg was more efficacious in treating both ED and LUTS than on-demand dosing mirodenafil 100mg without any complication of cardiovascular problems.
Erectile Dysfunction* ; Humans ; Lower Urinary Tract Symptoms ; Male ; Outpatients ; Prospective Studies ; Prostate ; Prostatic Hyperplasia* ; Treatment Outcome*

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Predicting Progression and Survival in Korean Patients with High Grade T1 Bladder Cancer Using EORTC Risk Tables.

Jong Kil NAM ; Dong Hoon LEE ; Tae Nam KIM ; Sung Woo PARK ; Moon Kee CHUNG

Korean Journal of Urological Oncology.2015;13(3):109-114.

The treatment of high grade T1 bladder cancer remains controversial because of the particularly high risk of recurrence and progression. The purpose of this study was to compare the oncological outcomes of radical cystectomy and a bladder preservation approach using European Organization for Research and Treatment of Cancer (EORTC) risk tables. Among 688 transurethral resections of bladder tumors for patients with non-muscle invasive bladder cancer conducted between 2000 and 2010, 102 patients who had a history of high grade T1 were included. All patients were treated by transurethral resection with additional intravesical Bacillus Calmette-Guerin and 33 patients were treated with deferred radical cystectomy. The risk classifications for tumor recurrence, and progression and survival rates were calculated using the EORTC risk tables. At a follow-up between 48 and 164 months (mean 90.1 months), 53 patients recurred, 34 patients progressed, and 18 patients died. In high grade T1 patients, the probability of progression was 15% in patients in the high risk group and 57% in patients with highest risk at 5 years. The bladder cancer specific survival was 95% in high risk patients and 88% in patients at highest risk at 5 years. High grade T1 bladder cancers are heterogeneous in nature, which complicates treatment decisions. Patients in the highest risk group in EORTC risk tables have different feasible treatment options including early cystectomy.
Bacillus ; Classification ; Cystectomy ; Follow-Up Studies ; Humans ; Organ Preservation ; Recurrence ; Survival Rate ; Urinary Bladder Neoplasms* ; Urinary Bladder*

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Neuropathic Pain in Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS).

Seung Ju LEE

Korean Journal of Urological Oncology.2015;13(3):105-108.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) has been a frustrating condition that is characterized by pain in areas including the perineum, rectum, prostate, penis, testicles, and abdomen. Unfortunately, effective treatment for the chronic pelvic pain remains uncertain and most urologists still believe we have little to offer these patients once traditional therapy including antibiotics has failed. Proposed mechanisms in development of pain in CP/CPPS is that biological insult in the context of alterations in psychoimmunoneurendocrine factors produces the chronic pain experience. There is increasing evidence that the chronic pain is associated with long-lasting changes both to the structure and function of the nervous system. Nerve injury, such as in neuropathic pain, peripheral sensitization, and central sensitization might play an important role in CP/CPPS and therefore be a therapeutic target. Newer medications, such as the anticonvulsant gabapentin and pregabalin, are becoming increasingly used for neuropathic pain in CP/CPPS. Now, urologists should understand the neuropathic pain in CP/CPPS and become on some level a pain doctor.
Abdomen ; Anti-Bacterial Agents ; Central Nervous System Sensitization ; Chronic Pain ; Humans ; Male ; Nervous System ; Neuralgia* ; Pelvic Pain* ; Penis ; Perineum ; Prostate ; Prostatitis ; Rectum ; Testis ; Pregabalin

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Collecting Duct Carcinoma (Bellini Duct Carcinoma) Presented as a Renal Cyst.

Hyun Jin JUNG ; Hoon Kyu OH ; Hong Seok SHIN

Korean Journal of Urological Oncology.2017;15(3):187-191. doi:10.22465/kjuo.2017.15.3.187

Renal cysts are frequently seen in the general population. Most small simple renal cysts are managed by conservative treatment. A renal cell carcinoma (RCC) presenting as a renal cyst is extremely uncommon, and collecting duct carcinoma is a rare type of RCC. This report describes a collecting duct carcinoma initially presnted as a renal cyst. The patient was a 52-year-old man who had been diagnosed with a renal cyst in the left lower pole 8 years earlier but was not regularly follow-up. He presented with left flank pain and gross hematuria. Computed tomography revealed a heterogeneous enhanced mass in the left lower pole and multiple para-aortic lymph nodes. He underwent radical nephrectomy and lymph nodes dissection which confirmed collecting duct carcinoma with sarcomatoid differentiation.
Carcinoma, Renal Cell* ; Flank Pain ; Follow-Up Studies ; Hematuria ; Humans ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Nephrectomy

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Poloxamer 407 Hydrogels for Intravesical Instillation to Mouse Bladder: Gel-Forming Capacity and Retention Performance.

Sang Hyun KIM ; Sung Rae KIM ; Ho Yub YOON ; In Ho CHANG ; Young Mi WHANG ; Min Ji CHO ; Myeong Joo KIM ; Soo Yeon KIM ; Sang Jin LEE ; Young Wook CHOI

Korean Journal of Urological Oncology.2017;15(3):178-186. doi:10.22465/kjuo.2017.15.3.178

PURPOSE: Poloxamer 407 (P407) thermo-sensitive hydrogel formulations were developed to enhance the retention time in the urinary bladder after intravesical instillation. MATERIALS AND METHODS: P407 hydrogels (P407Gels) containing 0.2 w/w% fluorescein isothiocyanate dextran (FD, MW 4 kDa) as a fluorescent probe were prepared by the cold method with different concentrations of the polymer (20, 25, and 30 w/w%). The gel-forming capacities were characterized in terms of gelation temperature (G-Temp), gelation time (G-Time), and gel duration (G-Dur). Homogenous dispersion of the probe throughout the hydrogel was observed by using fluorescence microscopy. The in vitro bladder simulation model was established to evaluate the retention and drug release properties. P407Gels in the solution state were administered to nude mice via urinary instillation, and the in vivo retention behavior of P407Gels was visualized by using an in vivo imaging system (IVIS). RESULTS: P407Gels showed a thermo-reversible phase transition at 4℃ (refrigerated; sol) and 37℃ (body temperature; gel). The G-Temp, G-Time, and G-Dur of FD-free P407Gels were approximately 10℃–20℃, 12–30 seconds, and 12–35 hours, respectively, and were not altered by the addition of FD. Fluorescence imaging showed that FD was spread homogenously in the gelled P407 solution. In a bladder simulation model, even after repeated periodic filling-emptying cycles, the hydrogel formulation displayed excellent retention with continuous release of the probe over 8 hours. The FD release from P407Gels and the erosion of the gel, both of which followed zero-order kinetics, had a linear relationship (r²=0.988). IVIS demonstrated that the intravesical retention time of P407Gels was over 4 hours, which was longer than that of the FD solution ( < 1 hour), even though periodic urination occurred in the mice. CONCLUSIONS: FD release from P407Gels was erosion-controlled. P407Gels represent a promising system to enhance intravesical retention with extended drug delivery.
Administration, Intravesical* ; Animals ; Dextrans ; Drug Liberation ; Fluorescein ; Hydrogel* ; Hydrogels* ; In Vitro Techniques ; Kinetics ; Methods ; Mice* ; Mice, Nude ; Microscopy, Fluorescence ; Optical Imaging ; Phase Transition ; Poloxamer* ; Polymers ; Urinary Bladder* ; Urination

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Comparison of 5-Year Outcomes of Robot-Assisted Laparoscopic and Laparoscopic Partial Nephrectomy in Patients With Localized Renal Cell Carcinoma.

Chung Un LEE ; Minyong KANG ; Hyun Hwan SUNG ; Hwang Gyun JEON ; Deok Hyun HAN ; Byung Chang JEONG ; Seong Soo JEON ; Hyun Moo LEE ; Han Yong CHOI ; Seong Il SEO

Korean Journal of Urological Oncology.2017;15(3):172-177. doi:10.22465/kjuo.2017.15.3.172

PURPOSE: To compare the 5-year oncologic and functional outcomes of robot-assisted laparoscopic partial nephrectomy (RALPN) and laparoscopic partial nephrectomy (LPN) as treatment for localized renal cell carcinoma (RCC). MATERIALS AND METHODS: We analyzed the records of 181 patients with localized RCC who underwent RALPN (n=97) or LPN (n=84) between 2007 and 2011. Demographic and preoperative data with estimated glomerular filtration rate (eGFR), intraoperative data including warm ischemic time (WIT) and complications, oncologic outcomes (recurrence, metastasis), and rate of eGFR preservation at most recent follow-up were examined. RESULTS: WIT was shorter in the RALPN group (27±9.1 minutes) than the LPN group (31±10 minutes, p=0.019). Intraoperative complication rates were also lower in RALPN patients than LPN patients (4.1% vs. 14.3%). The eGFR preservation rate was higher in the RALPN group (84.6%) than in the LPN group (81.5%, p=0.049). Particularly, a relatively high difference in the eGFR preservation rate was observed in the RALPN group compared with the LPN group according to R.E.N.A.L. score 7–10 values (RALPN, 86.5±12.9 vs. LPN, 76.7±16.0; p=0.003). During the follow-up period, there was no local recurrence in either group and distant metastases only occurred in one patient in the RALPN group and in 2 patients in the LPN group. CONCLUSIONS: RALPN and LPN showed similar 5-year oncologic outcomes, but RALPN was superior to LPN in terms of WIT, intraoperative complications, and long-term eGFR preservation rate, especially in complex cases.
Carcinoma, Renal Cell* ; Follow-Up Studies ; Glomerular Filtration Rate ; Humans ; Intraoperative Complications ; Neoplasm Metastasis ; Nephrectomy* ; Recurrence ; Warm Ischemia

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