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ABSTRACT: Background and purpose: Malignant ureteral obstruction (MUO) is a common condition and an intractable situation for patients with advanced cancer. There is currently no ideal ureteral stent to release the obstruction. Our purpose was to evaluate the clinical efficacy and safety of a novel, double-layered, coated, self-expandable metallic mesh stent (Uventa<sup>TM</sup>) in MUO. Patients and Methods: In a retrospective design, a total of 71 ureter units (54 patients) were included from December 2009 to March 2012. Indications were those who had MUO with a polymeric double-J stent malfunction, severe double-J stent irritations, severe pain during periodic stent change. Patients underwent retrograde approach Uventa<sup>TM</sup> stent placement. Results All stents were positioned at the proper site without procedure-related complications. The overall success (no obstruction and no additional intervention except supplementary Uventa<sup>TM</sup> placement) and primary success (no obstruction and no additional intervention) rates were 81.7% (58/71 ureter units) and 64.8% (46/71 ureter units) during the follow-up period, which had a median of 308 days (35-802 days). The most common reason for primary failure was tumor progression beyond the stent segment (75.0%), followed by reactive hyperplasia at the stent tips (12.5%), bladder invasion of the primary tumor (8.0%), and stent-related pain (8.0%). Twelve patients had overall success after secondary Uventa<sup>TM</sup> placement. There were no severe complications. The complications included persistent flank pain (15.5%), lower urinary tract symptoms (7.0%), acute pyelonephritis (2.8%), stent migration (2.8%), and persistent hematuria (2.8%). Conclusions: These data show that UventaTM can be an effective and safe option for palliative treatment of MUO in a large series of patients.
Journal of endourology / Endourological Society 04/2013; · 1.75 Impact Factor
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Sung Yul Park,
Koon Ho Rha,
Riccardo Autorino,
Ithaar Derweesh,
Evangelos Liastikos,
Yao Chou Tsai,
Ill Young Seo,
Ugo Nagele,
Aly M Abdel-Karim,
Thomas Herrmann, [......],
Shih-Chieh Jeff Chueh,
Chen-Hsun Ho,
Kamol Panumatrassamee,
Ryan Kopp,
Jens-Uwe Stolzenburg,
Lee Richstone,
Jae Hoon Chung,
Tae Young Shin,
Francesco Greco,
Jihad H Kaouk
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ABSTRACT: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: LESS-NU may be an alternative minimally-invasive treatment option for patients eligible to undergo laparoscopic surgery for upper urinary tract urothelial carcinoma. The true benefits of LESS-NU remain to be determined and require randomized control trials in the future. Despite encouraging early findings, clinical trials still are warranted before this procedure is adopted widely, and longer follow-up is needed to determine its oncological durability. OBJECTIVE: To report a large multi-institutional series of laparoendoscopic single-site (LESS) nephroureterectomy (NU). MATERIALS AND METHODS: Data on all cases of LESS-NU performed between 2008 and 2012 at 15 institutions were retrospectively gathered. The main demographic data and perioperative outcomes were analysed. RESULTS: The study included 101 patients whose mean (sd) age was 66.4 (9.9) years and mean (sd) body mass index was 24.8 (4) kg/m2 , and of whom 29.7% had undergone previous abdominal/pelvic surgery. The mean (sd) operating time was 221.4 (73.7) min, estimated blood loss 231.7 (348.0) mL. A robot-assisted LESS technique was applied in 25.7% of cases. An extra trocar was inserted in 28.7% of cases to complete the procedure. Conversion to open surgery was necessary in three cases (3.0%). There was no bladder cuff excision in 20.8% of cases, and excision was carried out using a variety of techniques in the remaining cases. Six intra-operative complications occurred (5.9%). The mean (sd) length of hospital stay was 6.3 (3.5) days. The overall postoperative complication rate was 10.0%, and most of the complications were low grade (Clavien grades 1 and 2). The mean tumour size was 3.1 (1.9) cm. Pathological staging was pTis in two patients, pTa in 12 patients, pT1 in 42 patients, pT2 in 20 patients, pT3 in 23 patients and pT4 in two patients. Pathological grade was high in 71 and low in 30 patients. At a mean follow-up of 14 months, six patients (5.9%) had died. Disease recurrence (including distant and bladder recurrence) was detected in 22.8% of patients, with a mean time to recurrence of 11.5 months. CONCLUSIONS: This study reports the largest multi-institutional experience of LESS-NU to date. Peri-operative outcomes mirror those of published standard laparoscopy series. Despite encouraging early findings, longer follow-up is needed to determine the oncological efficacy of the procedure.
BJU International 03/2013; · 2.84 Impact Factor
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ABSTRACT: There is little data evaluating the changes of severity of bladder outlet obstruction after 80 W-potassium-titanyl-phosphate (KTP) photoselective laser vaporization prostatectomy (PVP) by pressure-flow study. We evaluated the efficacy of PVP to relieve the obstruction in benign prostate hyperplasia (BPH) compared with transurethral resection of the prostate (TURP).
This is a prospective, non-randomized single center study. The inclusion criteria were as follows: Men suffering from lower urinary tract symptoms (LUTS) secondary to BPH, age ≥50 years, International Prostatic Symptom Score (IPSS) ≥13, maximum flow rate (Qmax) ≤15 ml/s, and ability to give fully informed consent. Patients with neurogenic cause or detrusor underactivity were excluded. The IPSS, bother score, Qmax, postvoid residual volume (PVR), detrusor pressure at maximum flow rate (PdetQmax), bladder outlet obstruction index (BOOI), and prostate volume were measured before and 6 months after surgery and compared between PVP and TURP.
Sixty-seven patients (53 in PVP, 14 in TURP) were evaluable. In both groups, the IPSS, bother score, Qmax, and PVR had significantly improved (p<0.05), and there were no differences between the changes in those parameters. PVP could effectively reduce the PdetQmax, prostate volume, and BOOI from baseline (from 68.7±23.3 to 40.6±11.2 cmH2O, 49.5±16.3 to 31.3±12.1 ml, 49.8±25.6 to 9.8±20.7), similar to TURP. There were no differences in postoperative PdetQmax, prostate volume, or BOOI between the two groups. The percentage of patients with BOOI ≥40 was decreased from 64% to 4% in the PVP group and from 86% to 14% in the TURP group.
PVP could reduce the prostate volume effectively and relieve bladder outlet obstruction similar to TURP by the 6-month follow up in men with BPH.
The world journal of men's health. 12/2012; 30(3):160-5.
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ABSTRACT: ObjectiveDespite growing interest in overactive bladder (OAB), urinary incontinence (UI), and lower urinary tract symptoms (LUTS),
there is no epidemiologic study on the prevalence in general population of Korea. This survey was aimed at estimating the
prevalence of OAB, UI, and other LUTS among Korean men and women.
MethodsPopulation-based cross-sectional telephone survey was conducted between May and September 2006 using questionnaire regarding
demographics and the prevalence. A geographically stratified random sample of men and women aged≥18years were selected.
Current International Continence Society definitions were used for individual LUTS and OAB.
ResultsOf a total of 9,067 individuals contacted, 2,000 (888 men, 1,112 women) agreed to participate. Overall prevalence of LUTS
was 61.4% (53.7% of men, 68.9% of women) and the prevalence increased with age. Storage LUTS was more prevalent than voiding
or post-micturition LUTS in both men (storage; 44.6%, voiding; 28.5%, post-micturition; 15.9%) and women (storage; 64.4%,
voiding; 25.9%, post-micturition; 13.9%). Nocturia was the most frequently reported symptom (36.6% of men, 48.2% of women).
Overall prevalence of OAB was 12.2% (10.0% of men, 14.3% of women). UI was reported by 2.9% of men and 28.4% of women. The
most prevalent type was other UI in men and stress urinary incontinence in women.
ConclusionsLower urinary tract symptoms and OAB are prevalent among Korean men and women and the prevalence increases with age. Storage
LUTS is more prevalent than voiding or post-micturition LUTS and nocturia is the most common symptom.
KeywordsEpidemiologic study–Lower urinary tract symptoms–Overactive bladder–Urinary incontinence
World Journal of Urology 04/2012; 29(2):185-190. · 2.41 Impact Factor
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Riccardo Autorino,
Jihad H Kaouk,
Rachid Yakoubi,
Koon Ho Rha,
Robert J Stein,
Wesley M White,
Jens-Uwe Stolzenburg,
Luca Cindolo,
Evangelos Liatsikos,
Soroush Rais-Bahrami, [......],
Paolo Fornara,
Carlo Terrone,
Camilo Giedelman,
Joo Yong Lee,
Sebastien Crouzet,
Georges-Pascal Haber,
Lee Richstone,
Sun Yinghao,
Fernando J Kim,
Jeffrey A Cadeddu
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ABSTRACT: We analyzed the incidence of and risk factors for complications and conversions in a large contemporary series of patients treated with urological laparoendoscopic single site surgery.
The study cohort consisted of consecutive patients treated with laparoendoscopic single site surgery between August 2007 and December 2010 at a total of 21 institutions. A logistic regression model was used to analyze the risks of conversion, and of any grade and only high grade postoperative complications.
Included in analysis were 1,163 cases. Intraoperatively complications occurred in 3.3% of cases. The overall conversion rate was 19.6% with 14.6%, 4% and 1.1% of procedures converted to reduced port laparoscopy, conventional laparoscopic/robotic surgery and open surgery, respectively. On multivariable analysis the factors significantly associated with the risk of conversion were oncological surgical indication (p=0.02), pelvic surgery (p<0.001), robotic approach (p<0.001), high difficulty score (p=0.004), extended operative time (p=0.03) and an intraoperative complication (p=0.001). A total of 120 postoperative complications occurred in 109 patients (9.4%) with major complications in only 2.4% of the entire cohort. Reconstructive procedure (p=0.03), high difficulty score (p=0.002) and extended operative time (p=0.02) predicted high grade complications.
Urological laparoendoscopic single site surgery can be done with a low complication rate, resembling that in laparoscopic series. The conversion rate suggests that early adopters of the technique have adhered to the principles of careful patient selection and safety. Besides facilitating future comparisons across institutions, this analysis can be useful to counsel patients on the current risks of urological laparoendoscopic single site surgery.
The Journal of urology 04/2012; 187(6):1989-94. · 4.02 Impact Factor
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ABSTRACT: Laparoscopic adrenal surgery is a standard procedure for the management of benign adrenal pathology and small malignant tumors. There has been an increasing interest over the last few years in the use of laparoendoscopic single-site surgery (LESS). From recent literatures, LESS adrenalectomy was demonstrated that this technique was safe and feasible despite the relatively difficult anatomical location of the adrenal gland. We reviewed the surgical techniques and outcomes of LESS adrenalectomy including robot-assisted approach and gave an overview of the current role of LESS in adrenalectomy.
Archivos españoles de urología 04/2012; 65(3):336-41.
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ABSTRACT: We investigated the molecular identity and functional activity of STIM1 and ORAI in human cavernous smooth muscle. We also determined whether transferring dominant negative mutants of the STIM1 or ORAI gene would correct diabetes related erectile dysfunction in a rat model.
Reverse transcriptase-polymerase chain reaction was done to identify ORAI and STIM in human cavernous smooth muscle. For the in vivo study intracavernous pressure, blood pressure and their ratio were assessed after cavernous nerve stimulation to diabetic rats transfected with pcDNA encoding the ORAI1(DN) or the STIM1(DN) gene.
ORAI (1, 2 and 3) and STIM (1 and 2) were identified in human cavernous smooth muscle cells. After [Ca(2+)] depletion by thapsigargin and cyclopiazonic acid we recorded store operated Ca(2+) entry in human cavernous smooth muscle cells. Entry was decreased by the store operated Ca(2+) channel blockers La(3+) and SKF96365. Mean ± SE intracavernous pressure/blood pressure in rats with ORAI1(DN) or STIM1(DN) gene transfer was 78.8% ± 2.2% and 77.1% ± 1.2% in 11 and 10, respectively. This result was significantly higher than that in 10 diabetic controls (51.0% ± 3.7%) and similar to that in 9 normal controls (85.8% ± 2.6%). Using reverse transcriptase-polymerase chain reaction we confirmed transgene expression in rat cavernous tissue.
Transfer of ORAI(DN) or STIM1(DN) genes restored erectile function in diabetic rats. It might be applicable to develop new therapy for erectile dysfunction.
The Journal of urology 03/2012; 187(5):1903-10. · 4.02 Impact Factor
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ABSTRACT: To investigate the feasibility of diffusion-weighted MRI (DWI) as an early and reproducible change indicator in patients receiving radiotherapy for prostate cancer (PC).
Eight consecutive patients with biopsy-proven PC underwent DWI at 3T. All patients who received external-beam radiotherapy had four serial MR scans, as follows: before therapy (PreTx); after 1 week of therapy (PostT1); after 3 weeks of therapy (PostT2); and 1 month after the completion of therapy (PostT3). At each time, the apparent diffusion coefficient (ADC) was measured in tumors and normal tissues. For reproducibility of the ADC measurement, five patients also had two separate pretreatment DWI scans at an interval of <2 weeks. Serum prostate-specific antigen (PSA) levels were evaluated at the same time as MR scans.
Thirteen tumors (peripheral zone = 10; transition zone = 3) were found. The mean ADC values for the tumors from PreTx to PostT3 were 0.86, 1.03, 1.15, and 1.26 × 10(-3) mm(2)/s in sequence, respectively. Compared with PreTx, PostT1 (p = 0.005), PostT2 (p = 0.003), and PostT3 (p < 0.001) showed a significant increase in ADC values. The mean ADC values of the benign tissues from PreTx to PostT3 were 1.60, 1.58, 1.47, and 1.46 × 10(-3) mm(2)/s in sequence, respectively. Reproducibility of ADC measurements was confirmed with a mean difference in ADC of -0.04 in peripheral zone and -0.017 in transition zone between two separate pretreatment MR scans. The mean PSA levels from PreTx to PostT3 were 9.05, 9.18, 9.25, and 4.11 ng/mL in sequence, respectively.
DWI, as a reproducible biomarker, has the potential to evaluate the early therapeutic changes of PC to radiotherapy.
International journal of radiation oncology, biology, physics 12/2011; 83(2):749-55. · 4.59 Impact Factor
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ABSTRACT: What's known on the subject? And what does the study add? Schisandra chinensis extract (SCE) has been known to have relaxative effects on penile smooth muscle. A recent study showed that SCE could enhance slidenafil citrate-induced relaxation of penile corpus cavernosum. The current study investigated the mechanism of action of SCE and its constituents on corporal smooth muscle cells. And this study shows that SCE induced relaxation of CSM primarily through an endothelium independent pathway and the relaxation effects of SCE on corporal smooth muscle are, in part, due to the activation of K(+) channels and inhibition of TRPC6 channels, resulting in decreased [Ca(2+)].
• To evaluate the relaxant effects of Schisandra chinensis extract (SCE) on corporal tissue in the penis and to investigate the mechanism of action of SCE and its constituents on corporal smooth muscle (CSM) cells.
• The fruit of SC was collected and extracted with ethanol. Six SC lignans (schisandrol A, schisandrol B, schisandrin A, schisandrin B, gomisin N, and schisandrin C) were isolated and purified, and the chemical structures were confirmed by (1)H-nuclear magnetic resonance (NMR) and (13)C-NMR data. • Isolated rabbit CSM strips were mounted in an organ-bath system, and the effects of SCE were evaluated. • To estimate the intracellular Ca(2+) level ([Ca(2+)](i)), we used a Fura-2 fluorescent technique, and a conventional whole-cell patch-clamp technique was used to measure the calcium-sensitive K(+) channels (K(Ca)), inward rectifier K(+) channels (K(IR)), and canonical transient receptor potential cation channel 6 (TRPC6) currents.
• SCE induced concentration-dependent relaxation in contracted CSM tissue, and the removal of the endothelium did not significantly affect their relaxation potencies. • In CSM cells, extracellular application of SCE significantly increased whole-cell K(Ca) currents (117.4%) and K(IR) currents (110.0%). These effects were completely abolished by charybdotoxin or BaCl(2). • In contrast, carbachol-induced TRPC6 channel activity was significantly inhibited (87.3%) by SCE in green fluorescent protein-TRPC6 pcDNA transfected HEK 293 cells. [Ca(2+)](i) measurements showed that SCE effectively reduced basal [Ca(2+)](i) in both cell lines (CSM cells and A7r5 cells) and the [Arg8]-vasopressin (AVP)-induced [Ca(2+)](i) increase in A7r5 cells. • Among the six SC lignans, schisandrin A and schisandrin B most effectively attenuated the AVP-induced [Ca(2+)](i) increase.
• SCE induced relaxation of CSM that occurred primarily via an endothelium-independent pathway. • The relaxation effects of SCE on CSM were, in part, due to the activation of K(+) channels and inhibition of TRPC6 channels, resulting in decreased [Ca(2+)](i).
BJU International 09/2011; 109(9):1404-13. · 2.84 Impact Factor
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ABSTRACT: Despite a recent surge in the performance of laparoendoscopic single-site surgery (LESS), concerns remain about performing LESS pyeloplasty (LESS-P) because of the technical difficulty in suturing. We report our techniques and initial experiences with LESS-P using additional needlescopic instruments and compare the results with conventional laparoscopic pyeloplasty (CL-P).
Nine patients undergoing LESS-P were matched 2:1 with regard to age and side of surgery to a previous cohort of 18 patients who underwent CL-P. In both groups, the operating procedures were performed equally except for the number of access points. In the LESS-P group, we made a single 2 cm incision at the umbilicus and used a homemade port. We also used additional 2 mm needlescopic instruments at the subcostal area to facilitate suturing and the ureteral stenting.
The preoperative characteristics were comparable in both groups. Postoperatively, no significant differences were noted between the LESS-P and CL-P cases in regard to length of stay, estimated blood loss, analgesics required, and complications. But, LESS-P was associated with a shorter operative time (252.2 vs. 309.7 minutes, p=0.044) and less pain on postoperative day one (numeric rating scale 3.7 vs. 5.6, p=0.024). The success rate was 94% with CL-P (median, 23 months) and 100% with LESS-P (median, 14 months).
Our initial experiences suggest that LESS-P is a feasible and safe procedure. The use of additional 2 mm instruments can help to overcome the difficulties associated with LESS surgery.
Korean journal of urology 09/2011; 52(9):616-21.
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ABSTRACT: The purpose of the present study was to conduct a comprehensive evaluation of clinical and metabolic factors in order to determine the characteristics of urolithiasis in a Korean population, compared with other ethnic groups. In addition, clinical and metabolic factors associated with calcium oxalate (CaOx) and uric acid (UA) stone formation were compared.
A total of 211 Korean patients with urolithiasis were analysed. Biochemical components in 24-hour urine were determined and the relative supersaturation (RSS) was calculated using the EQUIL 3 software program. Physical analysis of stone composition using Fourier Transform-Infrared spectrometry (FT-IR), blood chemistry, and demographics were also investigated.
A previous history of urolithiasis and male gender were found to be clinical risk factors related to urolithiasis. Metabolic abnormalities, including hypercalciuria, low urine volume, natriuresis, hypocitraturia, and hyperoxalaturia were commonly found in 24-hour urine. Korean patients had higher calcium, lower citrate, lower phosphate, lower urine volume, and higher RSS with respect to UA than Caucasian patients. Patients with CaOx stone formation (n = 100) were younger and excreted a higher level of calcium and higher UA at a higher pH than patients with UA stones (n = 37). A significant difference in RSS was observed with respect to CaOx, while there was no significant difference in RSS with respect to UA between them.
Metabolic abnormalities, including hypercalciuria, low urine volume, natriuresis, hypocitraturia, and hyperoxalaturia were important findings in Korean patients with urolithiasis. In addition, clinical and metabolic characteristics of CaOx stone formers differed in comparison with UA stone formers.
Scandinavian journal of clinical and laboratory investigation 06/2011; 71(6):481-5. · 1.38 Impact Factor
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Jihad H Kaouk,
Riccardo Autorino,
Fernando J Kim, Deok Hyun Han,
Seung Wook Lee,
Sun Yinghao,
Jeffrey A Cadeddu,
Ithaar H Derweesh,
Lee Richstone,
Luca Cindolo, [......],
Sara Best,
Sean P Stroup,
Soroush Rais-Bahrami,
Luigi Schips,
Paolo Fornara,
Phillip Pierorazio,
Camilo Giedelman,
Jae Won Lee,
Robert J Stein,
Koon Ho Rha
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ABSTRACT: Laparoendoscopic single-site surgery (LESS) has gained popularity in urology over the last few years.
To report a large multi-institutional worldwide series of LESS in urology.
Consecutive cases of LESS done between August 2007 and November 2010 at 18 participating institutions were included in this retrospective analysis.
Each group performed a variety of LESS procedures according to its own protocols, entry criteria, and techniques.
Demographic data, main perioperative outcome parameters, and information related to the surgical technique were gathered and analyzed. Conversions to reduced-port laparoscopy, conventional laparoscopy, or open surgery were evaluated, as were intraoperative and postoperative complications.
Overall, 1076 patients were included in the analysis. The most common procedures were extirpative or ablative operations in the upper urinary tract. The da Vinci robot was used to operate on 143 patients (13%). A single-port technique was most commonly used and the umbilicus represented the most common access site. Overall, operative time was 160±93 min and estimated blood loss was 148±234 ml. Skin incision length at closure was 3.5±1.5 cm. Mean hospital stay was 3.6±2.7 d with a visual analog pain score at discharge of 1.5±1.4. An additional port was used in 23% of cases. The overall conversion rate was 20.8%; 15.8% of patients were converted to reduced-port laparoscopy, 4% to conventional laparoscopy/robotic surgery, and 1% to open surgery. The intraoperative complication rate was 3.3%. Postoperative complications, mostly low grade, were encountered in 9.5% of cases.
This study provides a global view of the evolution of LESS in the field of minimally invasive urologic surgery. A broad range of procedures have been effectively performed, primarily in the academic setting, within diverse health care systems around the world. Since LESS is performed by experienced laparoscopic surgeons, the risk of complications remains low when stringent patient-selection criteria are applied.
European urology 06/2011; 60(5):998-1005. · 7.67 Impact Factor
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ABSTRACT: Single-system ectopic ureter with dysplastic kidney is a rare urologic anomaly. We report our early experience in 4 children who underwent laparoendoscopic single-site (LESS) nephrectomy for single-system ectopic ureters with dysplastic kidney.
We diagnosed 4 consecutive children (aged 18-59 months; mean: 3.2 years) with single-system ectopic ureter with dysplastic kidney. A single, experienced surgeon performed LESS nephrectomy using a homemade single-port device in all patients.
LESS nephrectomy was completed successfully in all 4 patients without complications, insertion of an additional port, or open conversion. Blood loss was minimal. Mean operation time was 83.3 minutes (range: 55-125 minutes), and patients began oral intake on the first postoperative day. Mean postoperative hospital stay was 1.3 days (range: 1-2 days). Urine dribbling and wetting resolved immediately after surgery, and no patient has developed a urinary tract infection to date.
LESS nephrectomy for an ectopic ureter with dysplastic kidney is a safe and feasible method with better cosmesis, compared with classic nephrectomy. LESS nephrectomy is a promising method in pediatrics.
Journal of Laparoendoscopic & Advanced Surgical Techniques 06/2011; 21(5):461-5. · 1.40 Impact Factor
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ABSTRACT: In this study, we investigated the effects of a combination of Ginkgo biloba extracts (GBE) and phosphodiesterase type 5 (PDE-5) inhibitors on the muscular tone of the corpus cavernosum and potassium channel activity of corporal smooth muscle cells. Strips of corpus cavernosum from male New Zealand white rabbits were mounted in organ baths for isometric tension studies. After contraction with 1×10⁻⁵ mol l⁻¹ norepinephrine, GBE (0.01-1 mg ml⁻¹) and mirodenafil (0.01-100 nmol l⁻¹) were added together into the organ bath. In electrophysiological studies, whole-cell currents were recorded by the conventional patch-clamp technique in cultured smooth muscle cells of the human corpus cavernosum. The corpus cavernosum was relaxed in response to GBE in a dose-dependent manner (from 0.64%±8.35% at 0.01 mg ml⁻¹ to 52.28% ± 11.42% at 1 mg ml⁻¹). After pre-treatment with 0.03 mg ml⁻¹ of GBE, the relaxant effects of mirodenafil were increased at all concentrations. After tetraethylammonium (TEA) (1 mmol l⁻¹) administration, the increased effects were inhibited (P<0.01). Extracellular administration of GBE increased the whole-cell K(+) outward currents in a dose-dependent fashion. The increase of the outward current was inhibited by 1 mmol l⁻¹ TEA. These results suggest that GBE could increase the relaxant potency of mirodenafil even at a minimally effective dose. The K(+) flow through potassium channels might be one of the mechanisms involved in this synergistic relaxation.
Asian Journal of Andrology 04/2011; 13(5):742-6. · 1.52 Impact Factor
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ABSTRACT: Denys-Drash syndrome (DDS) is a rare genetic disorder featuring the triad of Wilms' tumor, early-onset renal failure, and 46, XY disorder of sex development. DDS is usually caused by heterozygous missense mutations in the zinc-finger region of the WT1 gene. The most frequent constitutional WT1 mutations in DDS patients are missense mutations in exons 8 and 9. We present a new case of variable DDS in a child who was found to have a novel heterozygous missense mutation in exon 7 (c.905G>T) and a splicing mutation in exon 6 (IVS6-1G>T).
European Journal of Pediatrics 03/2011; 170(8):1079-82. · 1.88 Impact Factor
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ABSTRACT: We investigated the relationship between ultrasound estimated bladder weight/corrected ultrasound estimated bladder weight and the bladder outlet obstruction index derived from pressure flow study to evaluate its diagnostic efficacy to predict bladder outlet obstruction.
A total 193 men older than 50 years with lower urinary tract symptoms were enrolled in this study. Ultrasound estimated bladder weight measurements were made with a 3-dimensional ultrasound system. Corrected bladder weight was defined as ultrasound estimated bladder weight divided by body surface area on data analysis. The study population was classified into obstructed and unobstructed groups (bladder outlet obstruction index 40 or greater and less than 40, respectively). We evaluated the correlation between bladder outlet obstruction and clinical parameters, including bladder weight/corrected bladder weight and the diagnostic accuracy of bladder weight/corrected bladder weight for bladder outlet obstruction.
A total of 50 (26%) and 143 patients (74%) were categorized as obstructed and nonobstructed, respectively. Corrected bladder weight, maximum urine flow and the bladder contraction index showed statistically significant differences between the groups. Bladder weight/corrected bladder weight positively correlated with the bladder outlet obstruction index and corrected bladder weight showed a stronger correlation. Corrected bladder weight was significantly increased depending on obstruction severity. When corrected bladder weight was used to diagnose obstruction, sensitivity, specificity, and positive and negative predictive values were 61.9%, 59.8%, 33.8% and 82.6%, respectively, at a 28 gm/m(2) cutoff.
Ultrasound estimated bladder weight/corrected ultrasound estimated bladder weight is a statistically significant parameter correlating with bladder outlet obstruction. However, bladder weight/corrected bladder weight alone was insufficient to predict bladder outlet obstruction due to its weak correlation with and low accuracy for diagnosing obstruction.
The Journal of urology 03/2011; 185(3):964-9. · 4.02 Impact Factor
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ABSTRACT: We report our initial experience with 100 laparoendoscopic single site (LESS) and hybrid LESS procedures for benign urologic disease. Between December 2008 and April 2010, we performed LESS and hybrid LESS urologic procedures in 100 cases for various benign urologic diseases. Conversion to standard laparoscopy was necessary in six cases, conversion to hand-assisted laparoscopic surgery occurred in one case, and conversion to open surgery was necessary in one case. Intra- and postoperative complications occurred in nine and four cases, respectively. Totally, the mean operative time was 170 minutes, the mean blood loss was 221 ml, and the mean hospital stay was 5.1 days. The mean patient controlled anesthesia (PCA) equivalents used were 81.5 ml and the mean Visual Analog Pain Scale (VAPS) scores at postoperative day 1 and discharge were 3.8 and 2.1, respectively. The study was limited by retrospective design and short-term follow-up periods. LESS and hybrid LESS procedures are technically feasible in a variety of ablative and reconstructive applications of benign urologic diseases. However, apparent benefits of LESS surgical techniques over conventional laparoscopy are needed to be further explored.
Minimally invasive therapy & allied technologies: MITAT: official journal of the Society for Minimally Invasive Therapy 02/2011; 21(1):63-70. · 1.33 Impact Factor
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ABSTRACT: Premature ejaculation (PE) is the most prevalent male ejaculation disorder. The premature ejaculation diagnostic tool (PEDT) was developed to systematically apply the DSM-IV-TR criteria in diagnostic PE.
To evaluate the diagnostic value of the PEDT and its association with intravaginal ejaculatory latency time (IELT).
(i) Korean validation of PEDT: data was collected from men interviewed by one of the two clinical experts, who made a diagnostic of present or absence of PE, using DSM-IV-TR criteria. A total of 103 patients with PE and 100 men without PE were enrolled into the study and requested to complete the PEDT; and (ii) The correlation between IELT and PEDT: 200 participants were enrolled and each participant was asked to make out PEDT. All participants were requested to measure IELT.
Validity and reliability of the PEDT and its association with IELT.
The geometric mean IELT of the PE group was 115.37 ± 78.14 seconds. The number of men reporting IELTs of <1, 1 to ≤ 2, and >2 minutes were 28 (28.6%), 29 (29.6%), and 41 (41.8%), respectively. The Cronbach's alpha score was calculated as 0.93, showing adequate internal consistency. The test-retest correlation coefficients of each item were higher than 0.72 and the correlation coefficients of the total score was 0.88. (P < 0.001) Sensitivity and specificity analyses suggested a score of ≤ 8 indicated no PE, 9 and 10 probable PE, and ≥ 11 PE. The PEDT total score and IELT showed an adequate negative correlation. (ρ = -0.77, P < 0.0001) also, the PEDT total score of the PE subgroup (IELT ≤ 2 minutes) and IELT showed a negative correlation. (ρ = -0.6, P < 0.0001)
The PEDT was highly effective in detecting the presence of PE. The result of our study supports its validity as a diagnostic tool in the clinical setting.
Journal of Sexual Medicine 12/2010; 8(3):865-71. · 3.55 Impact Factor
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ABSTRACT: To investigate the efficacy and safety of desmopressin in patients with mixed nocturia, Patients aged ≥ 18 yr with mixed nocturia (≥ 2 voids/night and a nocturnal polyuria index [NPi] >33% and a nocturnal bladder capacity index [NBCi] >1) were recruited. The optimum dose of oral desmopressin was determined during a 3-week dose-titration period and the determined dose was maintained for 4 weeks. The efficacy was assessed by the frequency-volume charts and the sleep questionnaire. The primary endpoint was the proportion of patients with a 50% or greater reduction in the number of nocturnal voids (NV) compared with baseline. Among 103 patients enrolled, 94 (79 men and 15 women) were included in the analysis. The proportion of patients with a 50% or greater reduction in NV was 68 (72%). The mean number of NV decreased significantly (3.20 to 1.34) and the mean nocturnal urine volume, nocturia index, NPi, and NBCi decreased significantly. The mean duration of sleep until the first NV was prolonged from 118.4 ± 44.1 to 220.3 ± 90.7 min (P<0.001). The overall impression of patients about their quality of sleep improved. Adverse events occurred in 6 patients, including one asymptomatic hyponatremia. Desmopressin is an effective and well-tolerated treatment for mixed nocturia.
Journal of Korean medical science 12/2010; 25(12):1792-7. · 0.84 Impact Factor
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ABSTRACT: Heavy alcohol consumption is associated with an increased risk of erectile dysfunction (ED); however, the acute effects of ethanol (EtOH) on penile tissue are not fully understood. We sought to investigate the effects of EtOH on corporal tissue tonicity, as well as the intracellular Ca(2+) concentration ([Ca(2+)](i)) and potassium channel activity of corporal smooth muscle. Strips of corpus cavernosum (CC) from rabbits were mounted in organ baths for isometric tension studies. Electrical field stimulation (EFS) was applied to strips precontracted with 10 μmol L(-1) phenylephrine as a control. EtOH was then added to the organ bath and incubated before EFS. The [Ca(2+)](i) levels were monitored by the ratio of fura-2 fluorescence intensities using the fura-2 loading method. Single-channel and whole-cell currents were recorded by the conventional patch-clamp technique in short-term cultured smooth muscle cells from human CC tissue. The corpus cavernosal relaxant response of EFS was decreased in proportion to the concentration of EtOH. EtOH induced a sustained increase in [Ca(2+)](i) in a dose-dependent manner, Extracellular application of EtOH significantly increased whole-cell K(+) currents in a concentration-dependent manner (P < 0.05). EtOH also increased the open probability in cell-attached patches; however, in inside-out patches, the application of EtOH to the intracellular aspect of the patches induced slight inhibition of Ca(2+)-activated potassium channel (KCa) activity. EtOH caused a dose-dependent increase in cavernosal tension by alterations to [Ca(2+)](i). Although EtOH did not affect KCa channels directly, it increased the channel activity by increasing [Ca(2+)](i). The increased corpus cavernosal tone caused by EtOH might be one of the mechanisms of ED after heavy drinking.
Asian Journal of Andrology 11/2010; 12(6):890-8. · 1.52 Impact Factor
