PURPOSE: Diagnosis and proper treatment of renal abscesses remains a challenge for physicians. We investigated the characteristics and comorbidity factors of renal abscesses measuring 5 cm or less and critically examined the effectiveness of conservative treatment. MATERIALS AND METHODS: Between February 2001 and March 2009 the records of 63 patients initially diagnosed at our hospital with renal or perirenal abscesses were retrospectively reviewed. In 63 patients with renal and perirenal abscesses, 51 abscesses measured 5 cm or less, and 49 abscesses were treated with intravenous antibiotics alone. RESULTS: Most patients were women (91.8%), and their mean age was 42.3 years. The mean size of renal abscesses was 3.6 cm. The most common predisposing condition was diabetes mellitus (DM) (46.9%). Common clinical features were fever (83.7%) and flank pain (53.1%). On urinalysis, 31 (64.6%) cases had positive bacterial cultures with Escherichia coli (50.0%) being the most common pathogen. All 49 patients were treated with broad-spectrum intravenous antibiotics alone. All patients showed complete clinical regression and resolution of the renal lesions shown by CT between 3 and 14 weeks. The average hospital stay was 15.3 days (range, 5-31 days). Significant predictors of a long hospital stay were age, abscess size, and DM. CONCLUSION: Medium-sized as well as small-sized renal abscesses were treated successfully with intravenous antibiotics alone. DM was a significant predictor of prolonged hospital stay. If therapeutic drainage is believed to involve considerable risk, then intravenous antimicrobial therapy may be a good alternative treatment.

PURPOSE: We aimed to evaluate the efficacy of warm water sitz baths in patients who have undergone transurethral resection of the prostate (TURP) owing to lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS: We reviewed the records of 1,783 patients who had undergone TURP between 2001 and 2009. In the warm water sitz bath group, patients were instructed to sit in a tub containing lukewarm water at 40-45degrees C for 10 minutes each time. Patients were advised to perform the procedure for at least 5 days immediately after the removal of a Foley urethral catheter. The differences in post-TURP complications between the warm water sitz bath group and the no sitz bath group were compared. RESULTS: After TURP, 359 of the 1,561 patients performed a warm water sitz bath. Complications after TURP, such as hemorrhage, urinary tract infection, urethral stricture, and acute urinary retention were found in 19 (5.3%) and 75 (6.2%) patients in the sitz bath and no sitz bath groups, respectively (p=0.09). There was a significant difference in postoperative complications such as urethral stricture between the warm sitz bath group and the no sitz bath group (p=0.04). The group that did not undergo warm water sitz bath treatment showed a 1.13-fold increased risk of rehospitalization within 1 month after TURP due to postoperative complications compared with the warm water sitz bath group (odds ratio [OR]=1.134; 95% confidence interval [CI], 1.022 to 1.193; p=0.06). CONCLUSIONS: Warm water sitz bath treatment reduced postoperative complications such as urethral stricture. These results suggest that large-scale prospective studies are needed to establish an ideal method and optimal duration of sitz baths.
Baths ; Hemorrhage ; Humans ; Hydrotherapy ; Lower Urinary Tract Symptoms ; Postoperative Complications ; Prostate ; Prostatic Hyperplasia ; Transurethral Resection of Prostate ; Urethral Stricture ; Urinary Catheters ; Urinary Retention ; Urinary Tract Infections ; Water

PURPOSE: The efficacy of the artificial urinary sphincter(AUS) in treating sphincteric incontinence has been clearly demonstrated. We report on 20 years of experience using artificial sphincter implantation at a single institute. MATERIALS AND METHODS: The follow-up data for 37 patients who received AUS(AMS 800(TM)) implantation between 1987 and 2006 at Yonsei University were available for this study. We investigated various components of the medical records, such as the number of pads used per day, results of pre-operative urodynamic studies, operative and post-operative complications, and revision rate. RESULTS: Mean patient age was 35.6 years(range 15-64 years), and mean follow-up duration was 12.4 years(range 1.4-19.8 years). Of the 37 patients, 21 had neurogenic bladder, and 9 had traumatic injury. Other causes of incontinence included post-operative complications(4 patients) and congenital anomalies(3 patients). The cuffs were placed were in the bladder necks of 21 patients and in the bulbous urethrae of 16 patients. The average number of pads used daily decreased significantly from 6.2 to 1.2 after the operation, and 27 patients(72.9%) were able to maintain 'dry-up status' (number of pads used< or=1). A total of 32 artificial sphincters remained in place(86.4% survival rate), with 8 revisions(21.6%) required secondary to infection, mechanical failure, or urethral stone. CONCLUSIONS: AUS implantation is a safe and durable treatment for urinary incontinence in patients with intrinsic sphincter deficiency from various underlying diseases.
Follow-Up Studies ; Humans ; Medical Records ; Neck ; Urethra ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Incontinence ; Urinary Sphincter, Artificial ; Urodynamics

PURPOSE: We evaluated the long-term outcomes in patients undergoing augmentation ileocystoplasty with Goodwin(')s ileal cup patched bladder. MATERIALS AND METHODS: This was a retrospective study of 72 consecutive patients who underwent augmentation ileocystoplasty because of decreased bladder capacity, vesico-ureteral reflux and urinary incontinence. The outcomes assessed included the continence status, bladder capacity, upper tract status, and significant post-operative complications. RESULTS: The 72 patients studied(61 men and 11 women) were 12 to 62 years old(mean age 35.6). The follow up was 0.3 to 7.9 years(mean 5.4). The preoperative diagnoses were a neurogenic bladder from spinal cord injury in 54 patients, meningomyelocele in 5, pelvic trauma in 3, polymyelitis in 2, GU tuberculosis in 2, cerebrovascular diseases in 2, and disc rupture in 2. The bladder capacity was significantly increased from 168cc to 392cc postoperatively and the maximal bladder capacity was increased along with the decreased number of daily clean intermittent catheterizations. The most common complication related to surgery was a paralytic ileus. While most cases of unilateral reflux disappeared, bilateral or high grade reflux remained during the postoperative follow up period. CONCLUSIONS: Bladder augmentation provided durable clinical and urodynamic improvement for patients with neurogenic and contracted bladders.
Catheterization ; Catheters ; Contracts ; Follow-Up Studies ; Humans ; Intestinal Pseudo-Obstruction ; Male ; Meningomyelocele ; Retrospective Studies ; Rupture ; Spinal Cord Injuries ; Tuberculosis ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urinary Incontinence ; Urodynamics ; Vesico-Ureteral Reflux

PURPOSE: The International Prostate Symptom Score (IPSS) is generally self- administrated; however, it is doubtful that the self-administrated IPSS score correctly reflects patients' symptoms; therefore, the difference in the IPSS self-administrated score and physician-interviewed patients was studied. MATERIALS AND METHODS: A total of 202 patients completed two IPSS questionnaires during the same office visit, one by self-administration and the other by physician-interview, at two medical centers, one located in an urban area and the other in a rural area. The mean total symptom score and the score for each question, and the quality of life score were compared between the two modes of administration. A multi-logistical regression analysis was performed to identify differences due to the effects of age, the order of administration, location and educational level. RESULTS: The mean total symptom score and quality of life score were higher in the self-administrated than physician-interviewed group (14.16 vs. 13.07, p=0.001, 3.27 vs. 3.2, p=0.090). The residual sense (2.03 vs. 1.97, p=0.20), frequency (2.07 vs. 1.97, p=0.026), interruption (1.83 vs. 1.61, p=0.002), urgency (1.89 vs. 1.55, p=0.001), weak stream (2.74 vs. 2.60, p=0.042), hesitancy (1.77 vs. 1.59, p=0.005) and nocturia (1.82 vs. 1.77, p=0.12) were also higher in the self-administrated group. The multi- logistical regression analysis revealed statistically significant differences in relation to age and location. CONCLUSIONS: The self-administrated IPSS score was higher than the physician-interview score, especially in relation to an older age and an urban location. Therefore, active intervention should be considered during the administration of the IPSS, especially for old aged patients living in urban areas.
Humans ; Lower Urinary Tract Symptoms* ; Nocturia ; Office Visits ; Prostate* ; Quality of Life ; Questionnaires ; Rivers ; Urinary Tract

PURPOSE: To compare duloxetine with placebo for the treatment of Korean women with stress urinary incontinence (SUI). MATERIALS AND METHODS: This was a phase 3, double-blind, stratified, randomized, parallel, placebo-controlled, multi-center study investigating efficacy and safety of a of duloxetine compared with placebo in the treatment of SUI. After a 2-week no-drug screening period, women ages 29-69 were randomly assigned to placebo (n=60) or duloxetine (n=61) as 40mg twice daily for 8 weeks followed by a 2 week no-drug period. Women were seen at 4-week intervals. The primary efficacy variable was percent change in incontinence episodes frequency (IEF)/week. Secondary variables included percent change in, changes in Incontinence Quality of Life (I-QoL) total and 3 sub-scale scores, and Patient Global Impression of Improvement (PGI-I) ratings. Safety was evaluated by treatment emergent adverse events (TEAE), discontinuations due to adverse events, vital signs measurements, and clinical laboratory tests. RESULTS: There were statistically significant improvements with duloxetine compared with placebo in IEF (duloxetine baseline 16.4IEF/wk, endpoint 7.7IEF/wk, median percent reduction=50.0% vs placebo baseline 13.3IEF/ wk, endpoint 8.8IEF/wk, median percent reduction=37.1%, p=0.033), and avoidance and limiting behavior subscale (p=0.006) in I-QoL. TEAEs were reported significantly more often in the duloxetine group compared with the placebo group (82.0% vs 31.7%; p<0.001); common AEs (>or=5% in duloxetine-treated subjects and p<0.05) were nausea, dizziness, anorexia, fatigue, lethargy, abdominal discomfort, and constipation. Discontinuation rates because of AEs were 34.4% for duloxetine and 8.3% for placebo. CONCLUSIONS: These data provide evidence for the safety and efficacy of duloxetine for the treatment for Korean women with SUI.
Anorexia ; Constipation ; Dizziness ; Fatigue ; Female ; Humans ; Lethargy ; Mass Screening ; Nausea ; Quality of Life ; Urinary Incontinence* ; Vital Signs ; Duloxetine Hydrochloride

OBJECTIVE: To classify complete spinal cord injury (SCI) patients based on the preservation of desire to void and to make clear the difference between each group METHOD: This study was performed retrospectively on 117 complete SCI patients with lesions above T11 who were referred to the urodynamic laboratory. Patients were classified according to the preservation of desire to void during conventional urodynamic study. The clinical and urodynamic characteristics of each group were analyzed. RESULTS: There were 37 patients (31.6%) with the preservation of desire to void. There were significantly lower compliance of bladder and longer duration from onset to examination in the sensory preservation group than the nonpreservation group (p<0.05). There were no significant difference in clinical features such as voiding method, the presence of autonomic dysreflexia between each group. CONCLUSION: The presence of desire to void was noted in 31.6% of complete SCI patients observed.
Autonomic Dysreflexia ; Compliance ; Humans ; Retrospective Studies ; Spinal Cord Injuries* ; Spinal Cord* ; Urinary Bladder ; Urinary Bladder, Neurogenic ; Urodynamics

PURPOSE: To evaluate the results of serial prostate biopsy in men with elevated prostate-specific antigen (PSA) levels, where the initial biopsies were negative for cancer. MATERIALS AND METHODS: Between January 2000 and December 2003, 750 men with a serum PSA level of 4.0ng/ml or greater underwent transrectal ultrasound guided needle biopsy of the prostate, with 218 (29.1%) diagnosed as having prostate cancer. Of the other 532 men, 104 (19.5%), whose follow-up PSA level was persistently elevated beyond the normal range, underwent a second biopsy, with 26 (4.9%) undergoing third and subsequent biopsies for the same reason. The cancer detection rates after each biopsy session, and reliable predictors for prostate cancer after the 2nd biopsy in those whose PSA level was in the gray zone, were evaluated. RESULTS: The cancer detection rates of the 1st, 2nd and 3rd biopsies were 29.1, 16.3 and 30.7%, respectively, with 10.3% of the prostate cancers detected in this study missed on the initial biopsy. The detection rate of the second biopsy in gray zone patients was 13.1%, which was comparable to the first biopsy result (12.7%) for the same range group. The median PSA, % free PSA and PSA density were significantly different between the prostate cancer and non-cancer groups after the second biopsy in gray zone patients (p<0.05). CONCLUSIONS: 10.3% of the prostate cancers detected in this study were missed on the initial biopsy. The median PSA, % free PSA and PSA density are reliable predictors of prostate cancer after the second biopsy in gray zone patients.
Biopsy* ; Biopsy, Needle ; Follow-Up Studies ; Humans ; Male ; Prostate* ; Prostate-Specific Antigen ; Prostatic Neoplasms* ; Reference Values ; Ultrasonography

PURPOSE: Augmentation enterocystoplasty is a valuable technique, as a surgical repertoire, for urologists treating a myriad of conditions that cause either a small anatomic or functional bladder capacity. A variety of surgical techniques for augmentation cystoplasty have been developed. The clinical availability of augmentation cystoplasty was evaluated using a Goodwin's ileal cup-patched bladder in patients with a small capacity, high pressure, poorly compliant and unstable bladder. MATERIALS AND METHODS: At our institute, 21 patients, with a neurogenic bladder, have undergone augmentation cystoplasty using a Goodwin's ileal cup-patched bladder, since July 1999. The mean age at operation and follow-up period were 32 years and 11 months, respectively. 9 patients had various degrees of vesicoureteral reflux. The preoperative assessments included urinalysis, urine culture, renal function tests, voiding cystourethrography and urodynamic evaluation. RESULTS: The mean bladder capacity increased from 170cc preoperatively to 438cc postoperatively. The mean maximal end-filling intravesical pressure decreased from 55cmH2O to 22cmH2O, with a significant increase in bladder compliance. There were no significant complications that required surgical revision. CONCLUSIONS: Augmentation cystoplasty using a Goodwin's ileal cup-patched bladder offers a high success rate, with low complications, in selected patients with neurogenic bladder dysfunction.
Compliance ; Follow-Up Studies ; Humans ; Reoperation ; Urinalysis ; Urinary Bladder* ; Urinary Bladder, Neurogenic ; Urodynamics ; Vesico-Ureteral Reflux

Primary localized amyloidosis of the urinary tract is very rare disease. A 72-year-old man, with a history of urethral injury, had a stricture of the anterior urethra about 6cm in length. A segmental resection of urethra and urethroplasty, with penile skin flap, was performed. The resected urethral segment was diagnosed as urethral amyloidosis. There was no involvement of amyloidosis oin the other organs (heart, gastrointestinal system, joint, kidney, skin etc) and no underlying disease (multiple myelomas, rheumatism, cancer, chronic inflammation etc). Also, a 75-year-old woman, with a history of intermittent gross hematuria, had a stricture of the lower ureter. During diagnostic ureteroscopy, there was an irregular mucosal change of her lower ureter. An intraoperative biopsy showed ureteral amyloidosis. Here, we report on these two cases of primary amyloidosis of the urinary tract.
Aged ; Amyloidosis* ; Biopsy ; Constriction, Pathologic ; Female ; Hematuria ; Humans ; Inflammation ; Joints ; Kidney ; Rare Diseases ; Rheumatic Diseases ; Skin ; Ureter ; Ureteroscopy ; Urethra ; Urinary Tract*