Seung Hyun Jeon

Effects of tissue-cultured mountain ginseng (Panax ginseng CA Meyer) extract on male patients with erectile dysfunction

Korean ginseng and mountain ginseng (Panax ginseng CA Meyer) are important traditional herbal plants whose ginsenosides are generally accepted as serving to improve sexual functions, such as penile erection. We investigated the effects of tissue-cultured mountain ginseng extract (TMGE) on male patients with erectile dysfunction (ED). A double-blind, placebo-controlled study was conducted with 143 patients experiencing ED. Over the course of 8 weeks, one group took 1 000 mg of TMGE twice a day, and the other group took 1,000 mg of placebo twice a day. The effects of the TMGE and the placebo were analyzed using the Korean version of the International Index of Erectile Function (IIEF) questionnaire. A total of 86 patients completed 8 weeks of treatment. The scores on the five domains of the IIEF after medication were significantly higher than the baseline scores in the group treated with TMGE (P<0.05), whereas no significant improvement was observed in the placebo group (P>0.05). Erectile function and overall satisfaction scores after medication were significantly higher in the TMGE group than in the placebo group (P<0.05). Erectile function of patients in the TMGE-treated group significantly improved, suggesting that TMGE could be utilized for improving erectile function in male patients.

Comparison of urodynamics between ischemic and hemorrhagic stroke patients; Can we suggest the category of urinary dysfunction in patients with cerebrovascular accident according to type of stroke?

The aim of this study is to compare the urodynamic parameters in ischemic and hemorrhagic stroke patients with bladder dysfunction.

Comparison of laparoscopic versus open radical nephrectomy for large renal tumors: a retrospective analysis of multi‐center results

Study Type – Therapy (case series)

Comparison of laparoscopic and open partial nephrectomies in t1a renal cell carcinoma: a korean multicenter experience.

Purpose We analyzed a series of patients who had undergone laparoscopic partial nephrectomies (LPNs) and open partial nephrectomies (OPNs) to compare outcomes of the two procedures in patients with pathologic T1a renal cell carcinomas (RCCs). Materials and Methods From January 1998 to May 2009, 417 LPNs and 345 OPNs were performed on patients with small renal tumors in 15 institutions in Korea. Of the patients, 273 and 279 patients, respectively, were confirmed to have pT1a RCC. The cohorts were compared with respect to demographics, peri-operative data, and oncologic and functional outcomes. Results The demographic data were similar between the groups. Although the tumor location was more exophytic (51% vs. 44%, p=0.047) and smaller (2.1 cm vs. 2.3 cm, p=0.026) in the LPN cohort, the OPN cohort demonstrated shorter ischemia times (23.4 min vs. 33.3 min, p<0.001). The LPN cohort was associated with less blood loss than the OPN cohort (293 ml vs. 418 ml, p<0.001). Of note, two patients who underwent LPNs had open conversions and nephrectomies were performed because of intra-operative hemorrhage. The decline in the glomerular filtration rate at the last available follow-up (LPN, 10.9%; and OPN, 10.6%) was similar in both groups (p=0.8). Kaplan-Meier estimates of 5-year local recurrence-free survival (RFS) were 96% after LPN and 94% after OPN (p=0.8). Conclusions The LPN group demonstrated similar rates of recurrence-free survival, complications, and postoperative GFR change compared with OPN group. The LPN may be an acceptable surgical option in patients with small RCC in Korea.

Is chronic inflammatory change in the prostate the major cause of rising serum prostate‐specific antigen in patients with clinical suspicion of prostate cancer?

Aim:  To evaluate the cause of elevated prostate‐specific antigen (PSA) in patients with transrectal needle biopsy negative for prostate cancer.

Effect of dominant hemispheric stroke on detrusor function in patients with lower urinary tract symptoms.

Objectives:  To determine the effect of unilateral hemispheric lesion on voiding dysfunction by comparing urodynamic parameters in dominant, non‐dominant and bilateral hemispheric stroke patients.

The Unidirectional Barbed Suture for Renorrhaphy During Laparoscopic Partial Nephrectomy: Stanford Experience

PURPOSE Using barbed suture represents a novel technical modification in the performance of minimally invasive partial nephrectomy. Our purpose of this study was to evaluate the safety and efficacy of this suture for renorrhaphy during laparoscopic partial nephrectomy (LPN). PATIENTS AND METHODS Thirteen consecutive patients underwent LPN using V-Loc™ 180 (Covidien, Dublin, Ireland) suture, and a nonconsecutive control group of 24 patients, matched according to tumor size and R.E.N.A.L. nephrometry score, underwent LPN using absorbable polyglactin suture. All 37 patients underwent LPN performed by a single surgeon. Perioperative and postoperative indicators of morbidity, estimated blood loss, and warm ischemia time (WIT) were compared between the groups. RESULTS Baseline characteristics including age, body mass index, American Society of Anesthesiologists score, tumor size, laterality, and R.E.N.A.L nephrometry score were identical between the groups. On multivariable analysis, there were no significant differences between the two groups with regard to operative time, estimated blood loss, transfusion rates, rates of surgical complications, and length of hospital stay. However, mean WIT was significantly shorter in the V-Loc group compared with the control group (24.5±5.3 minutes versus 31.9±8.9 minutes, P=.01). CONCLUSIONS The use of V-Loc sutures for renorrhaphy during LPN is safe and feasible and, in our series, significantly reduces WIT. Further studies are needed to corroborate these findings, but these results indicate a promising development in reducing WIT during minimally invasive partial nephrectomy.

Acute Pyelonephritis: Clinical Characteristics and the Role of the Surgical Treatment

The epidemiology of acute pyelonephritis (APN) has changed with time. Therefore we investigated the current clinical characteristics of APN and the significance of proper surgical management for treatment of 1,026 APN patients in South Korea for the past 5 yr. The male-to-female ratio was about 1:8. The peak ages of female patients were 20s (21.3%) and over 60s (23.7%), while that of male was over 60s (38.1%). The occurrence of sepsis was 10.1%. Complicated APN patients were 35.4%. Ninety-four patients (9.2%) needed urological procedures. The duration of the flank pain and of the costovertebral angle tenderness in complicated APN patients was statistically significantly longer than that with simple APN patients (4.3 vs. 3.4 days, 4.4 vs. 4.0 days). If flank pain and costovertebral angle tenderness sustain over 4 days, proper radiologic studies should be performed immediately with the consideration of surgical procedure. Also the resistance to antibiotics was increasing. As the sensitivities to ampicillin (27.2%) and trimethoprim/sulfamethoxazole (44.7%) of Escherichia coli and Klebsiella pneumoniae were very low, it is necessary to take the careful choice of antibiotics into consideration.

How many cases are necessary to develop competence for laparoscopic radical nephrectomy

PURPOSE We evaluated the number of cases necessary to develop competence for performing laparoscopic radical nephrectomy (LRN) by chronologically analyzing the results of 150 cases. PATIENTS AND METHODS 150 patients were included in this study, each of whom had had pure transperitoneal LRNs between March 2003 and February 2008 performed by three surgeons who were all novices in laparoscopic surgery. Each surgeon performed 50 LRNs. These were divided into 10 groups chronologically, with five cases in each group (individual-group). Subsequently, we combined the data of the three surgeons, with 15 cases assigned to each group (combined-group). We identified the groups that demonstrated a statistically significant difference in operative time, compared with the most recent group. Based on this finding, we divided the cases into two groups: The novice group and the competent group. The complication rate, transfusion rate, and estimated blood loss were then compared between the two groups. RESULTS The total average operative time was 187.6 +/- 46.56 minutes; from group 4 onward, there was no significant decrease in the operative time. Therefore, groups 1 to 3 were defined as the novice groups, and groups 4 to 10 as the competent groups. Incidence of intraoperative complications was six (13.3%) in the novice group and nine (8.6%) in the competent group. There were 14 cases with postoperative complications--4 (8.9%) in the novice group and 10 (9.5%) in the competent group. There were significant differences in the estimated blood loss and transfusion rate between the novice and competent groups (236.4 +/- 41.85 mL vs 191.5 +/- 21.9 mL, 17.8% vs 4.8%, respectively). CONCLUSIONS Our results suggest that 15 cases are needed for a novice surgeon to achieve competence in LRN. Surgical outcomes and morbidity can be improved once this learning curve has been overcome.

Simple Renal Cyst Sclerotherapy with Acetic Acid: Our 10-Year Experience

BACKGROUND AND PURPOSE The combination of percutaneous aspiration and sclerotherapy is an effective method for managing benign renal cysts. Many substances have been used as sclerosing agents. Here, we report the long-term outcome after simple renal cyst sclerotherapy with acetic acid. MATERIALS AND METHODS We retrospectively reviewed medical records and identified 60 cases of renal cysts that were managed with percutaneous sclerotherapy from June 1998 to December 2007. All patients were followed up with ultrasonography. We divided the treatment results into three groups: Complete regression (<10%), partial regression (11%-50%), and no response (>51%). RESULTS The mean volume of the renal cysts on presclerotherapy images was 244 mL (range 12-1216 mL), the mean volume of the aspirate was 233 mL (range 10-1450 mL), and the mean volume of acetic acid administered was 34.6 mL (range 4-100 mL). The median follow-up period was 10 months (range 3-84 months); 46 cases exhibited complete regression (76.7%); 12, partial regression (20.0%); and 2, no response (3.3%). The complications were local pain (nine cases, 15.0%) and nausea and/or vomiting (three cases, 5.0%). CONCLUSIONS The results reveal that acetic acid as a sclerosing agent exhibits a high long-term success rate even at a low dose and produces few complications during the procedure. Thus, we suggest that sclerotherapy with acetic acid offers a more effective management option.