Seok Heun Jang

Chronic kidney disease among men with lower urinary tract symptoms due to benign prostatic hyperplasia

Study Type – Diagnosis (case series)
Level of Evidence 4

Dedifferentiated Liposarcoma of the Retroperitoneum

A dedifferentiated liposarcoma of the retroperitoneum is an extremely rare tumor. A 51-year old man was admitted to our department because a retroperitoneal mass was seen on abdominal computed tomography at another hospital. Computed tomography of the abdomen and magnetic resonance imaging showed a large pelvic mass located in the right hemipelvis, and it was pushing the right ureter and invading the right kidney, duodenum, colon and inferior vena cava. The patient underwent right radical nephrectomy, pylorus preserving pancreatoduodenectomy, right hemicolectomy and artificial blood vessel replacement for the inferior vena cava. The histopathological diagnosis was dedifferentiated liposarcoma and the patient was free from recurrence on the computed tomography that was done 6 months after the operation.

Comparison of Non-contrast-Enhanced Computed Tomography and Intravenous Pyelogram for Detection of Patients With Urinary Calculi.

Purpose The aim of this study was to investigate the changing pattern in the use of intravenous pyelogram (IVP), conventional computed tomography (CT), and non-contrast-enhanced computed tomography (NECT) for evaluation of patients with acute flank pain. Materials and Methods We retrospectively reviewed the medical records of 2,180 patients with acute flank pain who had visited Bundang Jesaeng General Hospital between January 2008 and December 2012 and analyzed the use of IVP, conventional CT, and NECT for these patients. Results During the study period there was a significant increase in NECT use (p<0.001) and a significant decrease in IVP use (p<0.001). Conventional CT use was also increased significantly (p=0.001). During this time the proportion of patients with acute flank pain who were diagnosed with urinary calculi did not change significantly (p=0.971). Conclusions There was a great shift in the use of imaging study from IVP to NECT between 2008 and 2012 for patients with acute flank pain.

Optimal shock wave rate for shock wave lithotripsy in urolithiasis treatment: a prospective randomized study.

Purpose We aimed to compare the effects of a fast shock wave rate (120 shocks per minute) and a slow shock wave rate (60 shocks per minute) on the shock wave lithotripsy (SWL) success rate, patients pain tolerance, and complications. Materials and Methods A total of 165 patients with radiopaque renal pelvis or upper ureter stones were included in the study. Patients were classified by use of a random numbers table. Group I (81 patients) received 60 shock waves per minute and group II (84 patients) received 120 shock waves per minute. For each session, the success rate, pain measurement, and complication rate were recorded. Results No statistically significant differences were observed in the patients according to age, sex, body mass index, stone size, side, location, total energy level, or number of shocks. The success rate of the first session was greater in group I than in group II (p=0.002). The visual analogue pain scale was lower in group I than in group II (p=0.001). The total number of sessions to success and the complication rate were significantly lower in group I than in group II (p=0.001). Conclusions The success rate of SWL is dependent on the interval between the shock waves. If the time between the shock waves is short, the rate of lithotripsy success decreases, and the pain measurement score and complications increase. We conclude slow SWL is the optimal shock wave rate.

The Initial Experience of Pneumovesicoscopic Bladder Stone Removal Using a Laparoscopic Entrapment Sac

INTRODUCTION In this article, we aim to present our novel experience of bladder stone removal under pneumovesicoscopic field using a laparoscopic entrapment sac. TECHNICAL CONSIDERATIONS We retrospectively reviewed the medical records of 21 patients who had pneumovesicoscopic bladder stone removal to assess a variety of patient characteristics and surgical outcomes. We considered stone burden, stone removal time including pneumovesicoscopic procedure time, postoperative catheter indwelling duration, postoperative hospital stay, and complications. The procedure was performed in the following steps: Under cystoscopy filled with saline solution, a 10-mm suprapubic transvesical trocar was inserted. After changing optical transmission medium from saline to CO(2) gas, pneumovesicoscopic procedure was performed to put stones in an entrapment sac inserted through the trocar. The stones trapped in the sac were extracorporeally broken with a lithotripter via the suprapubic route. The mean patient age was 58.95 ± 22.03 years. The mean stone burden was 4.88 ± 2.63 cm. Eleven patients had a single stone, whereas 10 had multiple stones. All stones were completely removed. The mean operative time was 31.66 ± 7.25 minutes, including the pneumovesicoscopic procedure time of 13.81 ± 7.30 minutes. In all but 6 patients with a cystostomy or a combined transurethral resection of the prostate, the urethra catheter was removed on the day after surgery; the mean postoperative hospital stay was 1.67 ± 0.49 days. There were 5 postoperative complications of Clavien grade I or II. CONCLUSION We report the technical feasibility of pneumovesicoscopic bladder stone removal using a laparoscopic entrapment sac as a minimally invasive method. This technique will likely become more important as a useful option for treating bladder stones.

Rethinking Suprapubic Cystostomy in Voiding Dysfunction: New Trial with Timed Drainage

Purpose Today, many patients with voiding dysfunction select suprapubic cystostomy (SPC) instead of clean intermittent catheterization (CIC) for practical reasons. There is thus a need to reconsider SPC as a management for voiding dysfunction. We designed SPC with timed drainage (TSPCD) and evaluated its effectiveness compared with continuous drainage with a urine bag (CSPCD). Materials and Methods Between January 2006 and January 2010, a total of 82 patients underwent SPC. Patients undergoing SPC were randomly assigned to CSPCD or TSPCD. Patient characteristics, complications, and the results of urine cultures were compared between the two groups through retrospective chart reviews. Also, preferences for CSPCD and TSPCD in another 15 patients who had experienced both CSPCD and TSPCD were investigated. Results The CSPCD and TSPCD groups comprised 46 and 36 patients, respectively. In a comparison of complications between the two groups, the incidence of acute symptomatic cystitis was significantly lower in the TSPCD group than in the CSPCD group (43% vs. 20%, p=0.032). The incidence of symptomatic urinary tract infection (UTI) was lower in the TSPCD group. Positive urine culture rates were 89.7% and 72.4% in groups 1 and 2, respectively. There was a significant difference between the two groups (p=0.004). In another 15 patients who experienced both CSPCD and TSPCD, 14 patients (93%) stated a preference for TSPCD after converting from CSPCD to TSPCD, and one patient (7%) returned to CSPCD only at night. Conclusions In this study, TSPCD had the advantages of less morbidity as UTI and being more preferable by patients with relatively good daily activity compared with CSPCD. TSPCD is an alternative to CSPCD for the treatment of voiding dysfunction.

MP81-08 THE COMPARISON OF THERAPEUTIC EFFICACY OF CHA1 MSC AND ADMSC AND EVALUATE THE THERAPEUTIC MECHANISM IN A CHRONIC INTERSTITIAL CYSTITIS RAT MODEL

the therapeutic outcomes were examined by conscious cystometry, histological analyses, and gene expression analyses. Next, we compared the efficacy of M-MSCs at a low dosage (1 x 10 cells) with adult bone-marrow (BM)-derived MSCs. RESULTS: Rats in the KC group exhibited irregular voiding frequencies and decreased micturition interval (MI) compared with the sham group rats. A transplantation of M-MSCs (0.25, 0.5, and 1 x 10 cells; KC þ M-MSC group) significantly increased the MI as a dose dependent manner. Bladder capacity and micturition volume of rats in the KC group decreased significantly compared with those in the sham group. However, these parameters were reversed after transplantation of M-MSCs with every cell dosage. The bladders in the KC group exhibited markedly increased infiltration of Toluidine blue stained mast cells and a higher number of TUNEL stained apoptotic cells, compared to the sham group. The administration of M-MSCs significantly reversed the infiltration of mast cell and apoptosis detected in the KC bladders. Furthermore, M-MSC therapy helped to prevent the bladder tissue fibrosis. The gene expression analyses indicated that several genes related to tissue fibrosis, including TGF-b1 and TGF-b2, were markedly upregulated in the KC bladder. However their expression was significantly suppressed by the administration of M-MSCs. Importantly, MMSCs ameliorated the bladder function of KC rats at a low dose (1 x 10) of cells for which BM-derived MSCs did not substantially improve aberrant bladder function. CONCLUSIONS: This study demonstrates for the first time the therapeutic efficacy of hESC-derived M-MSCs on KC in rats. The injection of M-MSCs restores bladder function with superior efficacy compared to BM-derived MSCs by protecting against the abnormal alteration in mast cell infiltration, apoptosis and fibrotic damage.