Young Beom Jeong

Vascular endothelial growth factor-C and -D are involved in lymphangiogenesis in mouse unilateral ureteral obstruction

Lymphatic remodeling in inflammation has been found in tracheal mycoplasma infection, human kidney transplant, skin inflammation, peritonitis, and corneal inflammation. Here we investigated lymphangiogenesis in fibrotic area in unilateral ureteral obstruction, a model of progressive renal fibrosis, and evaluated the roles of vascular endothelial growth factor (VEGF)-C and -D in the obstructed kidney. Compared to sham-operated mice, the number of LYVE-1-positive lymphatic vessels, the proliferation of LYVE-1-positive lymphatic endothelial cells, along with VEGF-C and -D mRNA expression were all significantly increased following ureteral obstruction. Depletion of macrophages with clodronate decreased lymphangiogenesis in the obstructed kidney. VEGF-C expression was higher in M2- than in M1-polarized macrophages from bone marrow-derived macrophages, and also increased in Raw 264.7 or renal proximal tubule cells by stimulation with TGF-β1 or TNF-α. VEGF-D reversed the inhibitory effect of TGF-β1 on VEGF-C-induced migration, capillary-like tube formation, and proliferation of human lymphatic endothelial cells. Additionally, the blockade of VEGF-C and VEGF-D signaling decreased obstruction-induced lymphangiogenesis. Thus, VEGF-C and VEGF-D are associated with lymphangiogenesis in the fibrotic kidney in a mouse model of ureteral obstruction.

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

Study Type – Therapy (case series)

Effect of Discontinuation of 5α-Reductase Inhibitors on Prostate Volume and Symptoms in Men With BPH: A Prospective Study

OBJECTIVES To investigate the change in prostate volume and symptoms after discontinuation of 5alpha-reductase inhibitors (5ARIs) in men with moderate to severe symptoms due to benign prostatic hyperplasia (BPH). METHODS A total of 120 patients with BPH were enrolled from December 2004 to May 2008. The patients were randomized into 2 groups: group 1 received finasteride 5 mg plus alfuzocin 10 mg or tamsulosin 0.2 mg daily, and group 2 received dutasteride 0.5 mg plus alfuzocin 10 mg or tamsulosin 0.2 mg daily. All the patients received combination therapy for 1 year, followed by 1 year of alpha-blocker monotherapy. The prostate volume, International Prostate Symptom Score, and serum prostate-specific antigen level were determined at baseline and at 12 and 24 months after treatment. RESULTS At 1 year after treatment, the prostate volume was reduced by 24.5% +/- 10.01% (P < .001) in group 1 and by 26.1% +/- 5.06% (P < .001) in group 2. One year after withdrawal of the 5ARIs, the prostate volume had increased by 20.7% +/- 14.1% (P < .001) and 18.6% +/- 7.4% (P < .001) in groups 1 and 2, respectively, compared with at the end of 1 year of treatment. Furthermore, the International Prostate Symptom Score had significantly deteriorated at 1 year after cessation of the 5ARIs in both groups compared with the values at the end of 1 year of combination therapy. CONCLUSIONS Our data demonstrate that the discontinuation of 5ARIs during combination therapy induces prostate regrowth, as well as aggravation of symptoms in men with BPH. This result, therefore, suggests that the life-long use of 5ARIs should be considered for the prevention of BPH progression.

Urinary urgency outcomes after propiverine treatment for an overactive bladder: the ‘Propiverine study on overactive bladder including urgency data’

Study Type – Therapy (RCT)
Level of Evidence 1b

RECANALIZATION OF EMBOLIZED CAVERNOSAL ARTERY: RESTORING POTENCY IN THE PATIENT WITH HIGH FLOW PRIAPISM

High flow priapism is an uncommon disease. Most cases are secondary to trauma. An arteriocavernous fistula caused by laceration of the cavernosal artery or one of its branches is the most common cause of this hemodynamic alteration. Immediate treatment with reduction of abnormal arterial flow is better possibly than other treatments. In addition, angiographic embolization is safe, selective and affords return to premorbid function and, therefore, it has been the most widely used. In our patient we evaluated the cavernosal blood gas analysis, and performed color Doppler ultrasonography and angiography for diagnosis, and superselective embolization of the internal pudendal artery with the autologous blood clots. The patient was followed with color Doppler ultrasonography and magnetic resonance imaging (MRI) 2 months after embolization. CASE REPORT A 17-year-old man presented with a 7-day history of sustained, painless and incomplete erection that occurred 3 days after blunt penile injury when he fell down on a bicycle. The erection did not subside and drainage of the corpora cavernosa with needle aspiration and several irrigations with 10 mg./ml. phenylephrine, which produced transient flaccidity, had been performed elsewhere. When referred to us, the penis was engorged with no tenderness, except bruising. A color Doppler scan showed abnormal arterial and venous flow in the corpora, and turbulent flow in the pseudoaneurysm. Peak systolic velocity was 30 cm. per second (end diastolic velocity of 3 cm. per second) in the right cavernosal artery and 52 cm. per second (end diastolic velocity of 6 cm. per second) in the left cavernosal artery before embolization. Blood gas analysis of the corpora cavernosa revealed a high oxygen partial pressure tension (93.8%) and oxygen saturation (97.1%). Superselective pudendal angiography performed with the patient under local anesthesia clearly demonstrated extravasation consistent with the presence of a pseudoaneurysm from a branch of the left cavernosal artery (fig. 1, A). Superselective embolization of the left internal pudendal artery with 3 ml. of autologous blood was performed. Repeat contrast injections confirmed a dramatic reduction in blood flow to the penis (fig. 1, B). The penis became gradually flaccid in the following 48 hours. During followup 2 months later, the patient stated that sexual arousal was associated with the return of erections, which were not complete. Physical examination revealed a ring-like fibrotic mass in the penile base but the lesion could not be differentiated as to whether it was in the tunica albuginea or intracavernosum. Color Doppler ultrasonography after injection with intracavernosal vasoactive agents revealed a well circumscribed hypoechoic mass that was no longer connected with the cavernosal artery, and there was no turbulent flow in the hypoechoic cystic mass (fig. 2, A).

Comparison of Laparoscopic Radical Nephrectomy and Open Radical Nephrectomy for Pathologic Stage T1 and T2 Renal Cell Carcinoma With Clear Cell Histologic Features: A Multi-institutional Study

OBJECTIVES To assess the oncologic efficacy of laparoscopic radical nephrectomy (LRN) compared with open radical nephrectomy (ORN) in patients with clear cell renal cell carcinoma (RCC). METHODS We analyzed the data from 2561 patients who had undergone radical nephrectomy for RCC at 26 institutions in Korea from June 1998 to December 2007. The clinical data of 631 patients with clear cell RCC in the LRN group were compared with the clinical data of 924 patients in the ORN group. The patients with Stage pT3 or greater and those with lymph node or distant metastases were excluded to avoid a selection bias. To evaluate the technical adequacy and oncologic outcome, we compared the perioperative parameters and 5-year overall and disease-free survival rates. RESULTS The operative time was significantly longer in the LRN group than in the ORN group (219 ± 77 vs 182 ± 62 minutes, P < .001), but the estimated blood loss and complication rate were significantly lower in the LRN group than in the ORN group (P < .001 and P < .001, respectively). On univariate analysis, the LRN group had 5-year overall (93.5% vs 89.8%, P = .120) and recurrence-free (94.0% vs 92.8%, P = .082) survival rates equivalent to those of the ORN group. Even after adjusting for age, sex, T stage, tumor grade, and body mass index in a Cox proportional hazards model, statistically significant differences between the 2 groups were not found for the 5-year overall (hazard ratio 1.523, P = .157) and recurrence-free (hazard ratio 0.917, P = .773) survival rates. CONCLUSIONS Our large multi-institutional data have shown that LRN provides survival outcomes equivalent to those of ORN in patients with Stage pT1-T2 clear cell RCC.

Characteristics and prognosis of chromophobe non‐metastatic renal cell carcinoma: A multicenter study

Objectives:  To analyze the characteristics and the prognostic significance of chromophobe renal cell carcinomas (chRCC).

Floating Hem-o-Lok Clips in the Bladder without Stone Formation after Robot-Assisted Laparoscopic Radical Prostatectomy

Hem-o-Lok clips (Weck Surgical Instruments, Teleflex Medical, Durham, NC, USA) are widely used in robot-assisted laparoscopic radical prostatectomy because of their easy application and secure clamping. To date, there have been some reports of intravesical migration of these clips causing urethral erosion, bladder neck contractures, and subsequent calculus formation. We report the first case of bladder migration of Hem-o-Lok clips without stone formation after robot-assisted laparoscopic radical prostatectomy. The Hem-o-Lok clips were found during urethral dilation with a guide wire for bladder neck contracture under cystourethroscopy. The Hem-o-Lok clips were floating in the bladder without stone formation and were removed by a cystoscopic procedure.

Clinical significance of immediate urine cytology after transurethral resection of bladder tumor in patients with non‐muscle invasive bladder cancer

Objectives:  To assess the clinical significance of immediate urine cytology (IUC) after transurethral resection of bladder tumor (TURBT) for non‐muscle invasive bladder cancer (NMIBC).

Is It Transitional Cell Carcinoma or Renal Cell Carcinoma on Computed Tomography Image

We report on a 58-year-old female patient with renal cell carcinoma simulating transitional cell carcinoma on computed tomography. The computed tomography scan showed an enhancing 2.5-cm left renal pelvic mass without renal parenchymal mass. Urinalysis revealed microscopic hematuria. Cystoscopy and urine cytology was negative for transitional cell carcinoma. Laparoscopic nephroureterectomy was done under the preoperative diagnosis of localized transitional cell carcinoma of the renal pelvis according to the computed tomography findings. The histologic result, however, was a clear cell renal cell carcinoma.