Jun Nyung Lee

Impact of surgical wait time on oncologic outcomes in upper urinary tract urothelial carcinoma.

To assess the effect of surgical wait time on the oncologic outcomes of patients with upper urinary tract urothelial carcinoma (UTUC), particularly in the ureter.

Comparison of Surgical Outcomes Between Holmium Laser Enucleation and Transurethral Resection of the Prostate in Patients With Detrusor Underactivity

Purpose Currently, holmium laser enucleation of the prostate (HoLEP) and transurethral resection of the prostate (TURP) are the standard surgical procedures used to treat benign prostatic hyperplasia (BPH). Several recent studies have demonstrated that the surgical management of BPH in patients with detrusor underactivity (DU) can effectively improve voiding symptoms, but comparative data on the efficacy of HoLEP and TURP are insufficient. Therefore, we compared the short-term surgical outcomes of HoLEP and TURP in patients with DU. Methods From January 2010 to May 2015, 352 patients underwent HoLEP or TURP in procedures performed by a single surgeon. Of these patients, 56 patients with both BPH and DU were enrolled in this study (HoLEP, n=24; TURP, n=32). Surgical outcomes were retrospectively compared between the 2 groups. DU was defined as a detrusor pressure at maximal flow rate of <40 cm H2O as measured by a pressure flow study. Results The preoperative characteristics of patients and the presence of comorbidities were comparable between the 2 groups. The TURP group showed a significantly shorter operative time than the HoLEP group (P=0.033). The weight of the resected prostate was greater in the HoLEP group, and postoperative voiding parameters, including peak flow rate and postvoid residual urine volume were significantly better in the HoLEP group than in the TURP group. Conclusions HoLEP can be effectively and safely performed in patients with DU and can be expected to have better surgical outcomes than TURP in terms of the improvement in lower urinary tract symptoms.

Endopelvic fascia preservation during robot-assisted laparoscopic radical prostatectomy: does it affect urinary incontinence?

Abstract Objective. Urinary incontinence has a significant impact on the quality of life after radical prostatectomy. This study aimed to determine whether preserving the endopelvic fascia influences subsequent urinary incontinence. Material and methods. Consecutive patients (n = 138) who underwent robot-assisted laparoscopic radical prostatectomy (RALP) for prostate cancer between October 2010 and June 2012 with a minimum of 1 year follow-up were retrospectively analysed. The subjects were divided into two groups: the non-preserved endopelvic fascia group (nPE group) and the preserved endopelvic fascia group (PE group). Continence was defined as not using any pads and having no urine leakages. Continence rates at set time-points after RALP were compared using the chi-squared test. Continence recovery rates were analysed with the Kaplan–Meier method and the log-rank test. Prognostic factors of incontinence were identified using the Cox proportional hazards model. Results. The age, body mass index, preoperative prostate-specific antigen levels, prostate volume, estimated blood loss, mean operative time, Gleason score and pathological stage were not significantly different between the two study groups. The continence rate of the nPE group and PE group was 88.4% and 97.1%, respectively, at 12 months after surgery (p = 0.049), which was also significant according to the Kaplan–Meier analysis (p < 0.001). Preservation of endopelvic fascia was the only significant prognostic factor for urinary incontinence (p = 0.002, hazard ratio = 1.867) according to the multivariate analysis. Conclusions. Endopelvic fascia preservation during RALP significantly enhances postoperative continence and is related to the speed of recovery of continence.

A Case of Duplicated Vas Deferens Found Incidentally during Varicocelectomy

Duplication of the vas deferens is a very rare congenital anomaly in which two vasa deferentia coexist within the spermatic cord. Duplication of the vas deferens can be found during herniorrhaphy, vasectomy, and varicocelectomy performed on the spermatic cord or around the spermatic cord. However, it is estimated that the incidence of duplication of the vas deferens is under-reported and under-recognized. Unless anomalies of the vas deferens such as duplication of the vas deferens are recognized by surgeons, it will be difficult to reduce vas deferens injuries and achieve a satisfactory surgical outcome. In addition, care should be taken in cases of duplication of the vas deferens because it can be complicated by non-testicular genitourinary anomalies. We report a case of duplication of the vas deferens discovered during routine varicocelectomy.

Comparison of 5 Different Rat Models to Establish a Standard Animal Model for Research Into Interstitial Cystitis

Purpose We evaluated 5 different rat models using different agents in order to establish a standard animal model for interstitial cystitis (IC) in terms of the functional and pathologic characteristics of the bladder. Methods Five IC models were generated in 8-week-old female Sprague-Dawley rats via transurethral instillation of 0.1M hydrogen chloride (HCl) or 3% acetic acid (AA), intraperitoneal injection of cyclophosphamide (CYP) or lipopolysaccharide (LPS), or subcutaneous injection of uroplakin II (UPK2). After generating the IC models, conscious cystometry was performed on days 3, 7, and 14. All rats were euthanized on day 14 and their bladders were obtained for histological and pro-inflammatory-related gene expression analysis. Results In the cystometric analysis, all experimental groups showed significantly decreased intercontraction intervals compared with the control group on day 3, but only the LPS and UPK groups maintained significantly shorter intercontraction intervals than the control group on day 14. The histological analysis revealed that areas with severe urothelial erosion (HCl, AA, and UPK) and hyperplasia (CYP and LPS), particularly in the UPK-treated bladders, showed a markedly increased infiltration of toluidine blue-stained mast cells and increased tissue fibrosis. In addition, significantly elevated expression of interleukin-1b, interleukin-6, myeloperoxidase, monocyte chemotactic protein 1, and Toll-like receptors 2 and 4 was observed in the UPK group compared to the other groups. Conclusions Among the 5 different agents, the injection of UPK generated the most effective IC animal model, showing consequent urothelial barrier loss, inflammatory reaction, tissue fibrosis stimulation, and persistent hyperactive bladder.

Clinical Significance of Subclassification of Papillary Renal Cell Carcinoma: Comparison of Clinicopathologic Parameters and Oncologic Outcomes Between Papillary Histologic Subtypes 1 and 2 Using the Korean Renal Cell Carcinoma Database

Micro‐Abstract The aim of the present study was to investigate the clinical significance of the subclassification of papillary renal cell carcinoma (pRCC) in a multi‐institutional study of 274 Korean patients with pRCC. Type 2 pRCC displayed more aggressive clinicopathologic characteristics; however, no significant differences in prognosis were found between types 1 and 2 pRCC. Among patients with pRCC, the pathologic T stage was the only prognosticator. Introduction: The aims of the present study were to compare the clinicopathologic characteristics between type 1 and type 2 papillary renal cell carcinoma (pRCC) and to evaluate the effect of the subclassification of pRCC on the oncologic outcomes after surgery. Materials and Methods: The records of 274 patients with pRCC in the Korean renal cell carcinoma (KORCC) database were included for evaluation. Of the 274 patients, 118 had type 1 pRCC and 156 had type 2 pRCC. The patient characteristics, including clinicopathologic parameters, were investigated, and the oncologic outcomes were evaluated. Results: The mean patient age was significantly older in the type 2 pRCC group. Compared with type 1 pRCC tumors, type 2 pRCC tumors were more often localized to the renal hilum (P = .030). Patients with type 2 pRCC had a greater incidence of Fuhrman grade 3 and 4 tumors than those with type 1 pRCC (78.8% vs. 22.8; P < .001). Tumor necrosis and capsular invasion were more frequently found in type 2 pRCC (P = .008 and P = .007, respectively). At a mean follow‐up period of 38.0 months (interquartile range, 11.8‐57.3 months), the subclassification of pRCC did not influence the prognosis of patients with pRCC. Conclusion: From the information available in the KORCC database, we identified significant differences in clinicopathologic variables, including age, Fuhrman grade, tumor location, tumor necrosis, and capsular invasion between type 1 and 2 pRCC. Although type 2 pRCC had more aggressive clinicopathologic characteristics, subclassification of pRCC did not affect the oncologic outcomes.

Is it necessary to actively remove stone fragments during retrograde intrarenal surgery

Purpose Based on the experiences of our center, we sought to verify the necessity of actively removing stones during retrograde intrarenal surgery (RIRS) for the management of renal stones. Materials and Methods From March 2010 to March 2015, 248 patients underwent RIRS at our center. We classified these patients into 2 groups according to the performance of active stone removal; group A (n=172) included the patients whose stones were actively removed using a stone basket, and group B (n=76) included the patients whose stones were fragmented with laser lithotripsy without active removal of the fragments. We retrospectively compared the operation time, success rate, and complication rate between the 2 groups. Results There were no significant differences between groups A and B in terms of mean age (56.1 years vs. 58.6 years), male to female ratio (115:57 vs. 46:30), mean body mass index (24.5 kg/m2 vs. 25.0 kg/m2), mean preoperative size of stone (11.1 mm vs. 11.1 mm), the ratio of unilateral and bilateral stones (136:36 vs. 64:12), success rate (89.0% vs. 86.8%), operation time (82.5 minutes vs. 82.1 minutes), overall complication rate (9.9% vs. 11.8%), incidence of febrile urinary tract infection (6.4% vs. 2.6%), gross hematuria (1.7% vs. 2.6%), or postoperative de novo hydronephrosis (2.9% vs. 5.3%). Conclusions This study demonstrated that during RIRS, fragmentation only, without the active removal of stones, is a safe and effective technique in which the surgical outcomes are comparable to those of procedures involving the active removal of stones.

Comparison of efficacy and bladder irritation symptoms among three different ureteral stents: a double-blind, prospective, randomized controlled trial.

Abstract Objective. Various ureteral stents have been developed to reduce ureteral stent-related discomfort. The aim of this prospective, randomized study was to compare the efficacy and morbidity of three different ureteral stents. Materials and methods. Between June 2012 and May 2013, patients who underwent ureteral stent insertion after ureteroscopic stone removal were randomized in a double-blind fashion to receive three different stents (group 1, Endo-Sof™ double-pigtail ureteral stent, Cook Medical; group 2, Enhanced Durometer loop stent, Bioteq; group 3, Polaris™ Ultra ureteral stent, Boston Scientific). Ninety patients who met the inclusion criteria were administered the International Prostate Symptom Score (IPSS) and Overactive Bladder Symptom Score (OABSS) preoperatively, after 2 weeks with the stent in situ and 4 weeks after its removal. The Visual Analogue Pain Scale (VAPS), presence of gross hematuria and ultrasound for hydronephrosis grade were checked at 2 weeks with the stent in situ and 4 weeks after its removal. Results. After stent insertion, the degree of hydronephrosis was not significantly different among the three groups. Patients in group 3 showed significantly less increase in the total IPSS and storage symptom subscores than did those in the other groups. Mean VAPS after ureteral stent insertion was significantly lower in group 3 than in the other groups. The presence of gross hematuria after ureteral stent insertion occurred more frequently in groups 1 and 2 than in group 3. Conclusions. The Polaris Ultra ureteral stent showed similar efficacy and favorable tolerability in regard to bladder irritation symptoms, stent-related pain and presence of gross hematuria compared with other stents.

Early experience with a thermo-expandable stent (memokath) for the management of recurrent urethral stricture.

Purpose To report our early experience with thermo-expandable urethral stents (Memokath) for the management of recurrent urethral stricture and to assess the efficacy of urethral stents. Materials and Methods Between March 2012 and February 2013, 13 patients with recurrent urethral stricture after several attempts with direct visual internal urethrotomy (DVIU) or failed urethroplasty underwent DVIU with thermally expandable, nickel-titanium alloy urethral stent (Memokath) insertion. Follow-up study time points were at 1, 3, 6, 9, and 12 months after stent insertion. Follow-up evaluation included uroflowmetry, retrograde urethrogram, plain radiography, and urinalysis. Results The mean patient age was 47.7 years (range, 18 to 74 years). The mean urethral stricture length was 5.54 cm (range, 1 to 12 cm). There were six patients with bulbar, four patients with proximal penile, one patient with distal penile, and two patients with whole penile urethral strictures, respectively. The overall success rate was 69% (9/13) and the mean postoperative peak flow rate was 17.7 mL/s (range, 6 to 28 mL/s). Major complications occurred in four patients including one patient (7.7%) with urethrocutaneous fistula induced by the stent and three patients with urethral hyperplasia. The mean follow-up duration was 8.4 months. Conclusions Our initial clinical experience indicates that thermo-expandable stents can be another temporary management option for recurrent urethral stricture patients who are unfit for or refuse urethroplasty. Distal or whole penile urethral stricture can be factors predicting poor results.

Risk factors for hypertensive attack during pheochromocytoma resection

Purpose We aimed to retrospectively evaluate the risk factors for hypertensive attack during adrenalectomy in patients with pheochromocytoma. Despite the development of newer surgical and anesthetic techniques for the management of pheochromocytoma, intraoperative hypertensive attack continues to present a challenge. Materials and Methods Data from 53 patients diagnosed with pheochromocytoma at Kyungpook National Uriversity Medical Center between January 2000 and June 2012 were retrospectively analyzed. The subjects were divided into 2 groups depending on the presence or absence of hypertensive attack at the time of surgery. Patient demographic characteristics and preoperative evaluations were assessed for their prognostic relevance with respect to hypertensive attack. A univariate analysis was conducted, and a multivariate logistic regression analysis was also performed. Results In the univariate analysis, systolic blood pressure at presentation, preoperative hormonal status (including epinephrine, norepinephrine, vanillylmandelic acid, and metanephrine levels in a 24-hour urine sample), tumor size, and postoperative systolic blood pressure were significantly associated with the development of hypertensive attack. In the multivariate analysis, preoperative epinephrine level and tumor size were independent factors that predicted hypertensive attack. The highest odds ratio for tumor size (2.169) was obtained at a cutoff value of 4.25 cm and the highest odds ratio for preoperative epinephrine (1.020) was obtained at a cutoff value of 166.3 µg/d. Conclusions In this study, a large tumor size and an elevated preoperative urinary epinephrine level were risk factors for intraoperative hypertensive attack in patients with pheochromocytoma.