Byeong Kuk Ham

Effects of Combination Treatment of Intravesical Resiniferatoxin Instillation and Hydrodistention in Patients with Refractory Painful Bladder Syndrome/Interstitial Cystitis: A Pilot Study

Purpose Painful bladder syndrome/interstitial cystitis (PBS/IC) is a disabling disease of the urinary bladder, and its etiology and treatment are not yet established. Current medications used in the treatment of PBS/IC have shown limited efficacy. This prospective study investigated the efficacy of intravesical resiniferatoxin (RTX) in PBS/IC refractory to medical treatment. Methods Patients with proven PBS/IC refractory to traditional medical treatment were enrolled. By randomized trial, a total of 18 consecutive patients were divided into two groups: treatment with hydrodistention and intravesical RTX (group 1) or treatment with hydrodistension only (group 2). We assessed bladder pain by use of a visual analogue pain scale, the maximal urine flow rate, post-void residual urine volume, and a voiding diary before and 3 months after treatment. Results The median age of the 18 patients was 55.8±6.9 years, and the median duration of symptoms before diagnosis was 3.6±1.6 years. Frequency, functional bladder capacity, and score on a 5-point pain scale were significantly improved at 3-month after treatment in both groups. Intravesical RTX instillation plus hydrodistention, compared with hydrodistention only, did not have a significant effect on the voiding symptoms or uroflowmetry of the patients but significantly improved scores on the pain scale. Conclusions Intravesical RTX instillation plus hydrodistention was effective in relieving pain but was not effective in improving lower urinary tract symptoms. Further larger studies are needed to clarify the efficacy of combination treatment of intravesical RTX instillation and hydrodistention.

Clinical Features of Mumps Orchitis in Vaccinated Postpubertal Males: A Single-Center Series of 62 Patients

Purpose Although the measles-mumps-rubella vaccination covers most children against mumps in Korea, the development of mumps has been reported. However, the clinical manifestations of mumps orchitis in postpubertal vaccinated patients have never been investigated. Herein we report the clinical features of mumps orchitis in postpubertal vaccinated patients. Materials and Methods This study included a total of 62 postpubertal males who developed acute mumps orchitis from 2005 to 2010. The clinical manifestations such as the incubation period, febrile duration, and the mean duration of orchitis were retrospectively investigated. The laboratory and sonographic findings were also reviewed and compared with the features of previously reported cases of unvaccinated postpubertal mumps orchitis. Results The mean age of the 62 patients was 17.56 years (range, 15 to 29 years). All patients were serologically confirmed with acute mumps infection (positive immunoglobulin [Ig] M and negative or positive IgG). The mean incubation period was 5.39 days (range, 0 to 23 days), with a febrile duration of 1.8 days (range, 0.5 to 3 days), and a mean duration of orchitis of 4.96 days (range, 0 to 17 days). Sonography revealed unilateral orchitis in 58 patients (93.6%) and bilateral orchitis in only 6 (6.4%). Conclusions In our study, mumps orchitis in postpubertal vaccinated patients showed a relatively shorter febrile duration. In addition, less scrotal swelling and a lower incidence of bilaterality were found upon physical examination and ultrasonography. In the future, additional long-term follow-up is needed to determine the features of mumps orchitis in postpubertal vaccinated males, and an additional booster vaccination should be considered.

Metastatic Squamous Cell Carcinoma of the Kidney from Cholangiocarcinoma

We present a rare case of a metastatic renal tumor originating from adenosquamous carcinoma of the intrahepatic bile duct. A 64-year-old man treated with bisegmentectomy and extended cholecystectomy for cholangiocarcinoma had a left cystic renal mass, which had irregular wall thickening, heterogeneously low attenuation, and soft tissue infiltration as determined by a computed tomography scan. The first impression was renal abscess. Left nephrectomy was performed and the nonencapsulated mass was gray in color macroscopically. Histological examination of the specimen revealed alveolar proliferation of small cancer cells, which was consistent with the original tumor of the intrahepatic bile duct. The left renal tumor was misdiagnosed as a renal abscess but finally diagnosed as squamous cell carcinoma metastasized from the intrahepatic bile duct. The patient expired because of lung metastasis after 14 months following left nephrectomy. In our opinion, this case would be the first report of a renal metastasis from a cholangiocarcinoma clinically and was treated with nephrectomy.

Gum chewing promotes bowel motility after a radical retropubic prostatectomy.

To investigate the efficacy of gum chewing in aiding the recovery of bowel motility after a radical retropubic prostatectomy

The Impact of Renal Tumor Size on the Efficacy of Laparoscopic Renal Cryoablation

Purpose We evaluated the impact of renal tumor size on the oncologic and surgical efficacy of laparoscopic renal cryosurgery (LRC) according to our intermediate-term experience in Korea. Materials and Methods From June 2005 to October 2008, we enrolled 37 patients who underwent LRC for 40 renal tumors. Patients were stratified into four groups according to renal tumor size. Patients who presented with a maximum tumor diameter (MTD) of at least 1 cm but less than 2 cm were assigned to Group 1, those with an MTD equal to or greater than 2 but less than 3 cm were assigned to Group 2, those with an MTD equal to or greater than 3 but less than 4 cm were assigned to Group 3, and those with an MTD equal to or greater than 4 cm were assigned to Group 4. Oncologic and clinical outcomes in each group were compared. Results The four groups showed no statistically significant differences in preoperative variables, including age, sex, body mass index, American Society of Anesthesiologists scores, baseline renal function and hemoglobin, and length of hospital stay. Regarding surgical aspects, however, operation time, estimated blood loss, and postoperative complications were significantly increased in patients with larger tumors. Three patients in Group 3 required postoperative transfusions, and 1 patient in Group 4 required conversion to open renal cryosurgery. During the mean follow-up period of 31.6 months, radiologic evidence of tumor recurrence was found in only 2 patients in Group 4. Conclusions In this series, LRC for renal tumors smaller than 3 cm was conducted safely without radiologic evidence of tumor recurrence during intermediate-term follow-up. For tumors larger than 3 cm, however, the transfusion rate increased, and for renal tumors larger than 4 cm, the tumor recurrence rate increased significantly.

Primary testicular carcinoid tumour with mature teratoma in undescended testis metastatic to lymph nodes

We report a case of primary testicular carcinoid tumour with mature teratoma metastatic to the para-aortic lymph node and the lymph node around the left gonadal vein, which was treated with radical orchiectomy, bleomycin, etoposide, and cisplatin chemotherapy, and modified retroperitoneal lymph node dissection. Three days after modified retroperitoneal lymph node dissection, bleomycin induced pneumonitis occurred, which was resolved with steroid administration. The patient is alive without recurrence 31 months after radical orchiectomy.

Squamous cell carcinoma must be considered in patients with long standing upper ureteral stone and pyonephrosis

A 69-year-old male patient with chronic alcoholism presented with a history of swelling and pain of right upper abdomen for the recent 6 months. He complained of generalized weakness and weight loss in the past 3 months. There was no history of fever and hematuria but he had occasional right flank pain. Physical examination revealed moderate right costovertebral angle tenderness and right palpable abdominal mass. Routine hematology, biochemical tests and chest radiograph were normal. Urinalysis revealed microscopic hematuria and pyuria. Urine cytology was negative for malignancy. Ultrasonography of the abdomen showed severe hydronephrosis of the right kidney with hydronephrotic sac suggestive of pyonephrosis and dilatation of the right ureter. The left kidney was normal in size, shape and echogenicity. Computed tomography (CT) of abdomino-pelvis showed severe hydronephrosis filling the right abdominal cavity, thin parenchyma of the right kidney suggestive of non-functioning kidney, several calyceal stones (\10 mm) and one stone (22 mm) in the upper ureter. There was no ascites or lymphadenopathy (Fig. 1). The patient was scheduled for a right nephrectomy through a flank incision. On operation, a huge kidney measuring 27 9 20 9 15 cm was obtained. The whole kidney with pyonephrosis was a distended sac-like structure without any visible renal tissue. The cut surface showed multiple areas with necrotic tissue and multiple calculi (Fig. 2). The final pathology report showed invasive, poorly differentiated squamous cell carcinoma (5 9 2, 5 9 2 cm), several renal stones and a stone in the right upper ureter. The tumor extended to perinephric fat and all surgical margins were negative. There was no regional lymphatic invasion of the tumor and no distant metastasis (pathological stage T3N0M0) (Fig. 3). The patient had an uneventful postoperative course and was discharged on postoperative day 7 in stable condition. At 5-months follow-up visit after the surgery, he presented with pain of right shoulder and generalized weakness. Follow-up CT scan showed multiple metastases in the liver and spleen and metastatic lymphadenopathy in the aortocaval and retrocaval spaces. This pathology was not visible on the previous CT scan (Fig. 4). The patient received one course of chemotherapy but he expired 7 months after surgery. Primary malignant tumors of the renal pelvis are relatively rare and constitute approximately 8–14% of all the renal malignancies [1]. Of these, squamous cell carcinoma of the renal collecting system is rare, accounting for about 0.5–8% of the renal pelvic tumors [2, 3]. This rare malignancy is frequently associated with chronic pyelonephritis and renal stone formation. Other etiologic factors such as tuberculosis, immunosuppression with azathioprine, analgesic abuse with phenacetin, radiation therapy, chronic rejection in a transplant kidney and prior percutaneous nephrolithotomy have been associated with squamous cell carcinoma [4–7]. It is believed that chronic irritation leads to squamous metaplasia which may subsequently develop into squamous cell carcinoma [8]. Squamous cell carcinoma of the renal pelvis usually occurs in old people (50–70 years). Clinical presentation is similar to that of urothelial carcinoma, and a patient with this malignancy might present with flank or abdominal pain, microscopic or gross hematuria, fever, anorexia or cachexia, and a palpable B. k. Ham J. w. Kim J. h. Yoon M. Oh J. h. Bae H. s. Park D. g. Moon (&) Department of Urology, Korea University Institute for Regenerative Medicine, Korea University College of Medicine, 80, Guro-dong, Guro-gu, Seoul 152-703, Korea e-mail: dgmoon@korea.ac.kr