Sung Kwang Chung

Risk factors for the development of urethrocutaneous fistula after hypospadias repair: a retrospective study.

Purpose The purpose of this study was to investigate the risk factors for urethrocutaneous fistula development after hypospadias repair. Materials and Methods Between January 1990 and May 2010, 348 patients underwent hypospadias repair. This study included 294 patients who were followed up for more than 6 months. Potential risk factors for the development of fistula after operation included age, location of hypospadias, type of hypospadias repair, suture materials and methods, methods and duration of catheterization, combined congenital urologic disorders, timing of presentation and repair of fistula, and location of fistula. Data were analyzed retrospectively. Binary logistic regression analysis was used for univariate and multivariate analysis. Results Out of 294 patients, 63 patients (21.4%, 63/294) developed urethrocutaneous fistulas after hypospadias repair. In the univariate analysis, fistula formation was statistically related with type of hypospadias and type of hypospadias repair. In the multivariate analysis with stratification by hypospadias site, however, only the location of hypospadias was a significant independent risk factor in urethrocutaneous fistula development after hypospadias repair (p<0.001). Conclusions Our results suggest that the risk of developing urethrocutaneous fistula after hypospadias repair is associated with the location of hypospadias (more proximal-type hypospadias). Type of hypospadias repair, suture materials, suture techniques, and number of other combined urologic disorders were not related to the development of urethrocutaneous fistulas.

Development of a porcine renal extracellular matrix scaffold as a platform for kidney regeneration

Acellular scaffolds, possessing an intact three-dimensional extracellular matrix (ECM) architecture and biochemical components, are promising for regeneration of complex organs, such as the kidney. We have successfully developed a porcine renal acellular scaffold and analyzed its physical/biochemical characteristics, biocompatibility, and kidney reconstructive potential. Segmented porcine kidney cortexes were treated with either 1% (v/v) Triton X-100 (Triton) or sodium dodecyl sulfate (SDS). Scanning electron microscopy showed both treatments preserved native tissue architecture, including porosity and composition. Swelling behavior was higher in the Triton-treated compared with the SDS-treated scaffold. Maximum compressive strength was lower in the Triton-treated compared with the SDS-treated scaffold. Attenuated total reflective-infrared spectroscopy showed the presence of amide II (-NH) in both scaffolds. Furthermore, richer ECM protein and growth factor contents were observed in the Triton-treated compared with SDS-treated scaffold. Primary human kidney cell adherence, viability, and proliferation were enhanced on the Triton-treated scaffold compared with SDS-treated scaffold. Following murine in vivo implantation, tumorigenecity was absent for both scaffolds after 8 weeks and in the Triton-treated scaffold only, glomeruli-like structure formation and neovascularity were observed. We identified 1% Triton X-100 as a more suitable decellularizing agent for porcine renal ECM scaffolds prior to kidney regeneration.

Pre-Clinical Efficacy and Safety Evaluation of Human Amniotic Fluid-Derived Stem Cell Injection in a Mouse Model of Urinary Incontinence

Purpose Stem cell-based therapies represent new promises for the treatment of urinary incontinence. This study was performed to assess optimized cell passage number, cell dose, therapeutic efficacy, feasibility, toxicity, and cell trafficking for the first step of the pre-clinical evaluation of human amniotic fluid stem cell (hAFSC) therapy in a urinary incontinence animal model. Materials and Methods The proper cell passage number was analyzed with hAFSCs at passages 4, 6, and 8 at week 2. The cell dose optimization included 1×104, 1×105, and 1×106 cells at week 2. The in vivo cell toxicity was performed with 0.25×106, 0.5×106, and 1×106 cells at weeks 2 and 4. Cell tracking was performed with 1×106 cells at weeks 2 and 4. Results The selected optimal cell passage number was smaller than 6, and the optimal cell dose was 1×106 for the mouse model. In our pre-clinical study, hAFSC-injected animals showed normal values for several parameters. Moreover, the injected cells were found to be non-toxic and non-tumorigenic. Furthermore, the injected hAFSCs were rarely identified by in vivo cell trafficking in the target organs at week 2. Conclusion This study demonstrates for the first time the pre-clinical efficacy and safety of hAFSC injection in the urinary incontinence animal model and provides a basis for future clinical applications.

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.

Long-Term Outcomes of Retractile Testis

Purpose Retractile testis is considered to be a variant of normal testis in prepubertal boys. There is no agreed-upon management of retractile testis. The aim of this study was to provide data on the long-term outcomes of patients with retractile testis. Materials and Methods This study retrospectively reviewed the medical record of 43 boys who were referred for suspected undescended or retractile testis and were finally diagnosed with retractile testis between January 2001 and December 2008. All boys were biannually examined by a pediatric urologist to evaluate the presence of retractile, descended, or undescended testis and testicular volume. Results Of 43 boys, there were 22 boys with unilateral retractile testis (51.1%) and 21 boys with bilateral retractile testis (48.9%). Their mean age was 3.0±2.7 years and the follow-up duration was 4.4±1.7 years. Of 64 retractile testes, 29 (45.3%) succeeded in descending, 26 (40.6%) remained retractile, and 9 (14.1%) became undescended testis or of a decreased size requiring orchiopexy. The mean initial diagnostic age of the patients who underwent orchiopexy was 1.3±0.9 years; meanwhile, the mean initial diagnostic age of those who went on to have normal testis was 4.3±3.3 years (p=0.009). The mean follow-up duration was 3.6±1.5 years in the orchiopexy group, 4.0±1.4 years in the descended testis group, and 5.1±1.8 years in group with remaining retractile testis. Conclusions Retractile testis has a risk of requiring orchiopexy. The risk is higher in the population diagnosed at a younger age. Boys with retractile testis should be observed periodically until the testis is descended in the normal position.

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.

Two different surgical approaches for prostatic stromal sarcoma: robot-assisted laparoscopic radical prostatectomy and open radical cysto-prostatectomy with ileal conduit.

Stromal sarcoma of the prostate is very rare and shows rapid growth, which consequently is related to poor prognosis. Recently, we treated two cases of prostatic stromal sarcoma: one with robot-assisted laparoscopic radical prostatectomy and the other with open radical cysto-prostatectomy with an ileal conduit. To the best of our knowledge, this is the first case report of a prostatic stromal sarcoma managed by use of a robotic procedure. Here, we report of our experiences in the treatment of prostatic stromal sarcoma by use of two different methods.

MP09-11 MEASURING AND PREDICTING THE PATIENT-REPORTED GOAL ACHIEVEMENT AFTER TREATING MALE BENIGN PROSTATIC HYPERPLASIA WITH TAMSULOSIN MONOTHERAPY

METHODS: We conducted a Cochrane review based on an a priori, protocol that included published and unpublished randomized controlled trials (RCTs) in any language. We excluded trials of children or adults with primary or secondary enuresis or underlying medical disorders. Primary outcomes were the number of nocturnal voids, quality of life (QoL), and major adverse events (AEs); secondary outcomes were duration of first sleep episode, time to first void, minor AEs, and treatment withdrawal due to AEs. We performed meta-analysis using RevMan 5.3 and rated the quality of evidence using GRADE. RESULTS: Of 271 studies identified through our search, we included 10 studies. Desmopressin was associated with a small decrease in the number of nocturnal voids (mean difference [MD] -1.1, 95% confidence interval [CI] -1.4 to -0.9; low quality evidence) and similar rates of major AEs (risk ratio [RR] 0.9, 95% CI 0.1 to 9.0; very low quality of evidence). We found no evidence for QoL. Compared to alpha-blockers, there was a similar reduction in the number of nocturnal voids (MD -0.2, 95% CI 01.2 to 0.7; very low quality evidence) and similar quality of life (MD -0.2, 95% CI -0.4 to 0.1; moderate quality of evidence). Rates of major AEs were similar (RR not estimable; low quality evidence). CONCLUSIONS: Current best evidence from RCTs in men with the chief complaint of nocturia suggests that desmopressin may result in a small reduction in the number of nocturnal voids with similar major AE rates compared to placebo. We are uncertain whether it reduces the number of nocturnal voids similarly to alpha-blockers. Additional welldesigned studies using active controls are needed.

MP29-04 COMPARISON OF FIVE DIFFERENT ANIMAL MODELS TO ESTABLISH THE BEST INTERSTITIAL CYSTITIS RAT MODEL SIMILAR TO HUMAN DISEASE

INTRODUCTION AND OBJECTIVES: Interstitial cystitis (IC) is a chronic bladder disorder characterized by urinary frequency, urgency and pelvic pain in the absence of bacterial infection or identifiable pathology. To date, there is no reliably effective therapy for IC, and no generally accepted animal model to test novel therapies was established. We therefore analyzed and compared the characterization of five different promising rat models to establish the best interstitial cystitis animal model. METHODS: Five IC models were generated in 8-week-old female Sprague-Dawley rats via transurethral instillation of 0.1M HCl (HCl) or 3% acetic acid (AA), intraperitoneal injection of cyclophosphamide (CYP) or lipopolysaccharide (LPS), or subcutaneous injection of uroplakin II (UPK). Phosphate-buffered saline was transurethrally infused for the control group (PBS). After generating IC models, conscious cystometry was performed at day 3, 7, and 14. All rats were euthanized at day 14 and the bladders were removed for histological, immunohistochemical analysis and real-time quantitative polymerase chain reaction (PCR). RESULTS: In cystometric analysis, all experimental groups, including HCl, AA, CYP, LPS, and UPK, showed significantly decreased intercontraction intervals compared with control group at day 3, but only LPS and UPK group exhibited urinary frequency compared to control and other experimental groups at day 14. Histological analysis revealed that markedly increased infiltration of Toluidine blue-stained mast cells and significantly increased tissue fibrosis in LPS and UPK groups compared to the other groups. PCR analysis showed significantly elevated expression of interleukin-1b, -6, -17a, myeloperoxidase, monocyte chemotactic protein-1, toll-like receptors 2 and 4 in UPK group compared with the other groups. CONCLUSIONS: Rat models generated by infusion of HCl, AA, CYP, LPS and UPK displayed urinary frequency up to 7 days and appropriate histologic changes similar to human interstitial cystitis. However, our study demonstrated that injection of UPK can be the best method to establish the interstitial cystitis rat model, considering longer continuation of bladder overactivity and higher expression of inflammatory factors.

Urethroplasty by Use of Turnover Flaps (Modified Mathieu Procedure) for Distal Hypospadias Repair in Adolescents: Comparison With the Tubularized Incised Plate Procedure

Purpose The purpose of this study was to examine whether urethroplasty with a turnover flap, as an alternative method of distal hypospadias repair in adolescents, improves the outcome of surgery. Materials and Methods Between January 2004 and December 2013, a total of 38 adolescents (aged 11-17 years) underwent distal hypospadias repair with either the tubularized incised plate (TIP) procedure (n=25) or the turnover flap procedure (n=13). The turnover flap procedure was performed with a proximal, ventral penile flap that was turned over to cover the urethral plate. Patient demographics, perioperative outcomes, complications, and postoperative uroflowmetry in each surgical group were analyzed retrospectively. Results The patient demographics were similar in the two groups. There were no significant differences in perioperative outcomes between the groups, including mean operative time, duration of hospital stay, and urethral catheterization. The number of patients with at least one complication, including wound dehiscence, urethrocutaneous fistula, meatal stenosis, and urethral stricture, was lower in the turnover flap group (1/13, 7.7%) than in the TIP group (11/25, 44%, p=0.030). The incidence of meatal stenosis was lower in the turnover flap group (0/12, 0%) than in the TIP group (6/25, 24%). In postoperative uroflowmetry, the plateau-shaped curve rate was lower in the turnover flap group (1/12, 8.3%) than in the TIP group (5/19, 26.3%); the peak flow was higher (p=0.030). Conclusions The turnover flap procedure is clinically useful for repairing adolescent distal hypospadias because it offers lower complication rates and better functional outcomes than TIP.