Sung Hyun Paick

Characteristics of bacterial colonization and urinary tract infection after indwelling of double-J ureteral stent

OBJECTIVES To investigate the natural history of bacterial colonization on the stent and in the urine after different periods of indwelling ureteral stent placement. METHODS A total of 57 double-J stents from 52 patients (21 men and 31 women, mean age 52 years, range 20 to 79) were examined. In all patients, short-term (2 to 3 days) antimicrobial therapy was administered at the time of stenting. Regular urinalysis and urine culture were performed until the stent was removed. The stents were removed by aseptic manipulation, and the proximal and distal tip segments of the stents were obtained. Three culture specimens were acquired from each stent segment (inner surface washing suspension, outer surface washing suspension, and from the stent tip itself). RESULTS Bacterial colonies were found in 44% (25 of 57) of the stents. Of the multiple pathogens identified, Enterococcus species (6 of 25) was the most common, followed by Escherichia coli (5 of 25). After short-term antibiotic prophylaxis, the bacteria did not colonize within the first 2 weeks of stent placement. However, the colonization rate increased as the duration of the stent placement lengthened. Colonization of the stent was followed by colonization of the urine. CONCLUSIONS The results of our study demonstrated that bacterial colonization at the stent began 2 weeks after indwelling stent placement and that stent colonization preceded urine colonization. The rate of colonization increased with longer periods of stenting.

The epidemiology of reno-ureteral stone disease in Koreans: a nationwide population-based study.

The objective of this study was to evaluate the annual incidence of upper tract urolithiasis based on a large population-based study in Korea. This study used a subset of the 2009 Health Insurance and Review and Assessment service-National Patient Sample (HIRA-NPS). The 2009 HIRA-NPS contains data for 1,115,721 patients (711,285 inpatients and 404,436 outpatients) from January 2009 to December 2009. Based on these data, we selected patients who had been diagnosed with urolithiasis using the ICD code and calculated the incidence of urolithiasis. The total number of estimated urolithiasis patients was 219,328. The annual incidence of upper tract urolithiasis was estimated to be 457.02 per 100,000 in the overall population, with 589.09 per 100,000 men and 326.64 per 100,000 women. The male-to-female ratio was about 1.8:1. The annual incidence of urolithiasis in Korea was 457 per 100,000. It is higher than that previously reported in Japan, but lower than that in Western countries.

The natural history of hydronephrosis after radical hysterectomy with no intraoperatively recognisable injury to the ureter: a prospective study

To investigate, in a prospective study, the natural history of hydronephrosis of the urinary tract after radical hysterectomy.

Erratum to: The effect of climate variability on urinary stone attacks: increased incidence associated with temperature over 18 °C: a population-based study

The aim of this study was to evaluate the effect of seasonal variation and climate parameters on urinary tract stone attack and investigate whether stone attack is increased sharply at a specific point. Nationwide data of total urinary tract stone attack numbers per month between January 2006 and December 2010 were obtained from the Korean Health Insurance Review and Assessment Service. The effects of climatic factors on monthly urinary stone attack were assessed using auto-regressive integrated moving average (ARIMA) regression method. A total of 1,702,913 stone attack cases were identified. Mean monthly and monthly average daily urinary stone attack cases were 28,382 ± 2,760 and 933 ± 85, respectively. The stone attack showed seasonal trends of sharp incline in June, a peak plateau from July to September, and a sharp decline after September. The correlation analysis showed that ambient temperature (r = 0.557, p < 0.001) and relative humidity (r = 0.513, p < 0.001) were significantly associated with urinary stone attack cases. However, after adjustment for trends and seasonality, ambient temperature was the only climate factor associated with the stone attack cases in ARIMA regression test (p = 0.04). Threshold temperature was estimated as 18.4 °C. Risk of urinary stone attack significantly increases 1.71 % (1.02–2.41 %, 95 % confidence intervals) with a 1 °C increase of ambient temperature above the threshold point. In conclusion, monthly urinary stone attack cases were changed according to seasonal variation. Among the climates variables, only temperature had consistent association with stone attack and when the temperature is over 18.4 °C, urinary stone attack would be increased sharply.

Sparganosis in the Scrotum Sonographic Findings

Sparganosis is a rare parasitic disease that is caused by the larva, sparganum, of the genus Spirometra. 1 It usually manifests as a mass in various locations, Such as the brain, eyelids, oral cavity, pleura, breast, abdominal wall, scrotum, and skeletal muscle of the lower extremities. 1,2 It tends to mainly involve the subcutaneous tissue. 1 Hence, sonography can play a major role in diagnosing this entity. However, there are few case reports of the sonographic findings of sparganosis involving the breast 3,4 and the lower extremities. 5 To our knowledge, there is no report describing the detailed sonographic findings of scrotal sparganosis. Here, we describe a case of scrotal sparganosis with the sonographic findings.

Clinical value of acute pyelonephritis grade based on computed tomography in predicting severity and course of acute pyelonephritis.

Purpose This study aimed to evaluate the efficacy of computed tomography (CT)–based acute pyelonephritis (APN) grades for predicting clinical severity and disease course. Materials and Methods This study involved the analysis of the data of 204 consecutive patients with APN who underwent a CT examination at admission. Patients who had undergone prior treatment and those with ureteral calculi or an abscess by CT were excluded. Computed tomographic findings were divided into 4 grades according to renal parenchymal involvement, as follows: no renal parenchyma involvement (grade 1), less than 25% involvement (grade 2), 25% to 50% involvement (grade 3), and greater than 50% (grade 4). Patients with these grades were compared with respect to APN severity index (highest body temperature, initial C-reactive protein, and leukocytosis) and recovery index (hospital stay, fever duration, and leukocytosis duration). Results A total of 204 patients of mean age 39.3 years were included. Acute pyelonephritis severity indices and recovery indices increased with APN grade. Mean highest body temperature values were 38.3°C and 38.9°C in grades 1 and 4, respectively (P = 0.002). Mean hospital stay increased from 5.7 days for grade 1 to 7.6 days for grade 4 (P < 0.001). Initial C-reactive protein, initial leukocytosis, fever duration, and leukocytosis duration also increased with APN grade. Conclusions This study suggests that APN grades, as determined by CT examination, valuably predict the clinical course of APN.

Comparison of hand-assisted laparoscopic radical nephrectomy with open radical nephrectomy for pT1-2 clear cell renal-cell carcinoma: a multi-institutional study.

PURPOSE This multiinstitutional report assesses the oncologic efficacy of hand-assisted laparoscopic radical nephrectomy (HLRN) compared with open radical nephrectomy (ORN) in patients with localized clear cell renal-cell carcinoma (RCC). PATIENTS AND METHODS We analyzed the data from 2561 patients who underwent radical nephrectomy at 26 institutions in Korea between June 1998 and December 2007 for localized RCC. One hundred ninety-seven patients with clear cell RCC in the HLRN group were compared with 917 patients with clear cell RCC in the ORN group. To evaluate the technical adequacy and oncologic outcome, we compared the operative time, estimated blood loss, and 5-year overall and disease-free survival rates. RESULTS The median follow-up was 36 months for the HLRN group and 27 months for the ORN group. The operative time was significantly longer in the HLRN group than in the ORN group (206.8 +/- 68.7 minutes vs. 179.1 +/- 61.5 minutes, p < 0.001), and blood loss was significantly lower in the HLRN group than in the ORN group (311.6 +/- 238.7 mL vs. 372.4 +/- 367.3 mL, p = 0.003). There was no significant difference in pathologic T stage and Fuhrmans nuclear grade in the two groups. No statistically significant difference was found in the 5-year overall (91.2% vs. 90.3%, p = 0.286) and disease-specific (95.2% vs. 92.1%, p = 0.222) survival rates between the HLRN and ORN groups. CONCLUSIONS Despite the longer operative time, HLRN was an effective and less-invasive treatment option for localized clear cell RCC. HLRN could achieve cancer control similar to that obtained with ORN.

Temporary Placement of Covered Retrievable Expandable Nitinol Stents with Barbs in High-risk Surgical Patients with Benign Prostatic Hyperplasia: Work in Progress

PURPOSE To report the use of a newly constructed, covered, retrievable, expandable nitinol stent with barbs to overcome the problem of stent migration associated with conventional covered prostatic expandable stents and to evaluate prospectively the technical feasibility and clinical effectiveness of the stents in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS A covered retrievable expandable nitinol stent with four barbs was placed with use of an 18-F stent delivery system in seven consecutive patients with symptomatic BPH who had high operative risks. Age range of patients was 62-83 years (mean 74 years). In cases in which the stent migrated, it was replaced with a stent with eight barbs. The stents were routinely removed 4 months after placement using a 21-F stent removal set. RESULTS Stent placement was technically successful and well tolerated in six of the seven patients. The remaining patient needed a second stent placement after removal of the first stent. The stent with four barbs migrated into the urinary bladder in four patients (57%); three of these patients received a second stent with eight barbs with good results, and the fourth patient did not need further treatment because his symptoms improved. Routine removal of the stent 4 months after placement was performed in three of the seven patients with good results. CONCLUSIONS Retrievable stents with eight barbs seem to overcome the problem of stent migration associated with conventional prostatic expandable stents. Preliminary results suggest that stents with barbs are both feasible and effective in patients with BPH.

Is a 22 cm Ureteric Stent Appropriate for Korean Patients Smaller than 175 cm in Height

Purpose Determining the ideal length of a ureteric stent is important to avoid complications associated with stent placement. Clinically, most urologists usually choose the length of a ureteric stent according to the patients height. On the basis of a Chinese population study, a 22 cm ureteric stent has been recommended for patients smaller than 175 cm. We evaluated the appropriateness of this recommendation in Korean patients. Materials and Methods A total of 70 patients who were smaller than 175 cm and who underwent ureteroscopic lithotripsy and ureteric stent insertion were studied. The appropriateness of the stent length was determined on the basis of plain film findings. Patient discomfort was measured by use of a visual analogue scale (VAS) before the removal of the ureteric stent. Results In 29 patients with a 22 cm ureteric stent, 21 patients (72.4%) had an appropriate ureteric stent length and the mean VAS was 4.1. In 36 patients with a 24 cm ureteric stent, 20 patients (55.6%) had an appropriate ureteric stent length and the mean VAS was 4.0. Among 5 patients with a 26 cm ureteric stent, 1 patient (20%) had an appropriate ureteric stent length and the mean VAS was 5.4. Conclusions In Korean patients smaller than 175 cm in height, a 22 cm ureteric stent was an appropriate length.

Nocturia Improvement With Surgical Correction of Sleep Apnea

Purpose To evaluate changes in nocturia after surgical correction of obstructive sleep apnea (OSA). Methods A total of 66 patients were included in the present study. All had been diagnosed with OSA syndrome by polysomnography and underwent uvulopalatopharyngoplasty (UPPP). Preoperative and postoperative lower urinary tract symptoms (LUTS), quality of life (QoL), and nocturia episodes were evaluated using the International Prostate Symptom Score (IPSS) and overactive bladder symptom score (OABSS) questionnaires. Three months postoperatively, telephone interviews were performed to determine the success of surgery, current LUTS, and nocturia episodes. Patients were divided into surgical success and failure groups. Surgical success was defined as snoring decrease more than 50% based on the patient’s subjective judgment. Results The response rate was 56% and success rate was 73%. In all patients, nocturia episodes significantly decreased from 1.7±1.1 to 0.8±1.2 (P=0.002). Mean IPSS score, OABSS score, and QoL scores were also significantly improved. The success group showed a significant decrease in nocturia episodes, and total IPSS, OABSS, and QoL scores. However, the failure group did not show significant changes in all parameters. Conclusions OSA correction improved nocturia as well as other LUTS. These improvements were not observed in the failure group. This study shows that OSA is a cause of nocturia and that other LUTS and nocturia can be improved by surgical correction of OSA.