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Since 2005 when the da Vinci surgical system was approved as a medical device by the Korean Ministry of Health and Welfare, 51 systems have been installed in 40 institutions as of May 2015. Although robotic surgery is not covered by the national health insurance service in Korea, it has been used in several urologic fields as a less invasive surgery. Since the first robotic-assisted laparoscopic radical prostatectomy in 2005, partial nephrectomy, radical cystectomy, pyeloplasty, and other urologic surgeries have been performed. The following should be considered to extend the indications for robotic surgery: training systems including accreditation, operative outcomes from follow-up results, and cost-effectiveness. In this review, the history and current status of robotic surgeries in Korea are presented.

Purpose: Ultrasound (US) is highly sensitive in the detection of renal masses. However, it may not be able to differentiate benign and malignant lesions in smaller masses. The purpose of this study was to determine the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) for small renal masses. Materials and Methods: From January 2011 to December 2013, a total of 85 patients underwent CEUS for evaluation of renal masses. Of these patients, CEUS findings were retrospectively analyzed for small renal cell carcinoma (RCC) cases (n=38) and angiomyolipoma (AML) cases (n=11). The tumor echogenicity and enhancement patterns and degrees were evaluated. The diagnostic efficacy of CEUS in differentiating the two diseases was compared. Results: On CEUS, the findings of diffuse heterogeneous enhancement (observed in 78.9% of RCCs and 27.3% of AMLs, p=0.003), washout from hyperenhancement or isoenhancement to hypoenhancement in late phase (73.7% of RCCs and 18.2% of AMLs, p=0.001), and perilesional rim-like enhancement (57.9% of RCCs and 9.1% of AMLs, p=0.006) were significantly different between AML and RCC cases. The corresponding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 86.8% (33/38), 63.6% (7/11), 89.2% (33/37), 58.3% (7/12), and 81.6% (40/49), respectively. Conclusions: Our results suggest that the characteristic CEUS features could have diagnostic value in the evaluation of small renal mass. CEUS showed a higher diagnostic efficacy than conventional US for differentiating RCC and AML.

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

Purpose To assess the potential of dual-energy computed tomography (DECT) to identify urinary stone components, particularly uric acid and calcium oxalate monohydrate, which are unsuitable for extracorporeal shock wave lithotripsy (ESWL). Materials and Methods This clinical study included 246 patients who underwent removal of urinary stones and an analysis of stone components between November 2009 and August 2013. All patients received preoperative DECT using two energy values (80 kVp and 140 kVp). Hounsfield units (HU) were measured and matched to the stone component. Results Significant differences in HU values were observed between uric acid and nonuric acid stones at the 80 and 140 kVp energy values (p

Purpose: To assess the long-term follow-up results of laparoscopic pyeloplasty for ureteropelvic junction obstruction. Materials and Methods: Sixty-five patients (mean age, 43.8 years) who underwent standard laparoscopic pyeloplasty by transperitoneal approaches were enrolled in this study. The chief complaint was flank pain (n=57 patients); the remaining cases were detected incidentally. Twenty-three patients had undergone previous abdominal surgeries, including open pyeloplasty and endopyelotomy. Mean stricture length was 1.06 cm. Grade 3/4 and 4/4 hydronephrosis was detected in 36 and 14 patients, respectively. An obstructive pattern was present on the renal scan in 53 patients (81.5%). Results: Fifty-seven patients were treated with dismembered Anderson-Hynes pyeloplasty and eight patients with Fenger pyeloplasty. During the operation, crossing vessels were found in 27 patients (41.5%). Mean operating time was 159.42 minutes. Although there were no cases of open conversion, two patients with colon and spleen injuries were detected postoperatively. The mean starting time of postoperative ambulation and diet was 1.54 days and 1.86 days, respectively. Mean hospital stay was 8.09 days. Mean follow-up period was 36.5 months. Follow-up intravenous pyelography and renal scan showed improvements in 59 patients, and the radiologic success rate was 90.8%. Eight patients showed failure on radiologic or symptomatic evaluation, and the overall success rate was 87.7%. In the comparative analysis between the success and failure groups, drained amount was the only risk factor related to failure (554.41 mL. vs. 947.70 mL, p=0.024). Conclusions: Long-term follow-up results support laparoscopic pyeloplasty as the standard treatment for ureteropelvic junction obstruction. Drained amount is a risk factor for failure of the operation.

Purpose We evaluated the feasibility of a laparoendoscopic single-site (LESS) nephroureterectomy for an upper urinary tract tumor. Materials and Methods Between March 2009 and September 2009, 4 patients with upper urinary tract tumors underwent LESS nephroureterectomy. The mean age of the 2 female and 2 male patients was 69 years old, and their mean body mass index was 23.0. We used a homemade single-port device made with a surgical glove and a wound retractor, which were put into a 4 cm periumbilical incision. Operations with articulating and rigid laparoscopic instruments were performed transperitoneally. An open technique with a 4 cm additional midline incision and laparoscopic technique with an endoscopic stapler were used for the treatment of the distal ureter and bladder cuff. Results All cases were completed successfully, without conversion to conventional laparoscopy or open surgery. The mean operative time was 169.5 minutes. The mean estimated blood loss was 361.4 ml. One patient had transfusion and wound infection. The mean hospital stay was 7.8 days. The mean specimen weight and tumor size were 271.8 g and 2.9 cm. Pathologic results of all cases showed urothelial carcinoma with a negative surgical margin. Three patients were in stage T3N0M0 and 1 was in stage T2N0M0. Conclusions Our initial experience shows that LESS nephroureterectomy with a homemade single-port device is technically feasible. However, long term follow-up for the effect on cancer control and technical development for comfortable surgery are needed.

Purpose: The objective was to determine predictive factors for premature discontinuation of docetaxel-based systemic chemotherapy in men with castration-resistant prostate cancer (CRPC). Materials and Methods: We retrospectively reviewed the medical records of men who were treated with docetaxel-based systemic chemotherapy for CRPC in a single institution between May 2005 and April 2010. After being screened, 30 patients fit the eligibility criteria for inclusion in this study. Group 1 included 12 patients who were treated with five or fewer cycles of docetaxel chemotherapy for CRPC, and group 2 included 18 patients who were treated with six or more cycles of docetaxel chemotherapy for CRPC. The treatment consisted of 5 mg prednisolone twice daily and 75 mg/m 2 docetaxel once every 3 weeks. Results: The median age was 72 years, and the median Eastern Cooperative Oncology Group (ECOG) performance status was 0. The median baseline prostate-specific antigen (PSA) level was 33.8 ng/mL. The median cycle of docetaxel-based chemotherapy was 5.8. Of 30 patients, 13 patients (48.2%) had a decline in PSA of ＞50% from baseline; 3 of 22 patients (13.6%) with measurable disease had achieved partial response on imaging. No differences in age, ECOG performance status, hemoglobin, serum creatinine, or PSA response were observed between the two groups. Body mass index was significantly lower (p=0.034) in group 1 (21.8 kg/m 2 ) than in group 2 (23.6 kg/m 2 ). Group 1 included more patients with prior systemic chemotherapy (p=0.039), and group 1 had a shorter overall survival rate (p=0.039). Conclusions: Premature discontinuation of docetaxel-based systemic chemotherapy is associated with lower body mass index and prior systemic chemotherapy. Premature discontinuation of docetaxel-based chemotherapy is associated with a shorter overall survival rate.

Purpose To study the feasibility and safety of the procedure, we present our early experience with laparoendoscopic single-site (LESS) pyelolithotomy performed by use of a Carter-Thomason needle grasper. Materials and Methods Four patients underwent LESS pyelolithotomy for the removal of renal pelvic stones. The patients' mean age was 57.8 years, and their mean body mass index was 23.01. We used a homemade single-port device made with a surgical glove that was inserted into a 2.5-cm periumbilical incision. The operation was performed transperitoneally by using a Carter-Thomason grasper. After removal of the stone, a double-J stent was placed in situ, and laparoscopic intracorporeal suturing was performed. No additional ports were used. Results All surgeries were completed successfully without conversion to conventional laparoscopy or open surgery. The mean operative time was 124.5 minutes, and the mean estimated blood loss was 255.2 mL. There were no significant complications, except in one patient who required a blood transfusion. The mean duration of hospital stay was 8.3 days. The mean stone size was 3.9 cm. Chemical analysis of the stones showed that three patients had calcium-containing stones and one patient had a uric acid stone. Postoperative radiologic study showed a stone clearance rate of 100%. Conclusions Our results, albeit limited, showed that LESS pyelolithotomy is a feasible and safe procedure. Especially with the use of a Carter-Thomason needle grasper, this operation can be performed without an additional port.

Purpose To determine the feasibility and safety of robotic partial nephrectomy (RPN), we compared the operative outcomes of patients who had undergone RPN with those of patients who had undergone laparoscopic partial nephrectomy (LPN). Materials and Methods Between February 2009 and June 2010, 13 patients underwent transperitoneal RPN (group 1) and 14 patients underwent transperitoneal LPN (group 2) by a single surgeon. The operative outcomes of the 2 groups were compared by using Mann-Whitney U and Fisher's exact tests. Results All cases were completed successfully without conversion to open surgery. The mean operative time was 153.2±22.3 and 117.5±32.0 minutes in groups 1 and 2, respectively (p=0.003). The mean robotic console time of group 1 was 101.2±21.5 minutes, and the mean laparoscopic time of group 2 was 86.8±32.3 minutes (p=0.139). The mean warm ischemic time was 35.3±8.5 minutes and 36.4±6.8 minutes in groups 1 and 2, respectively (p=0.823). The mean estimated blood loss was 283.6±113.5 ml and 264.1±163.7 ml (p=0.382), respectively. The mean length of hospital stay was 6.1 and 5.3 days (p=0.290), respectively. The mean tumor size was 2.7±1.2 cm and 2.0±1.2 cm (p=0.035), respectively. The surgical margins were negative in all cases. Conclusions Although the operative time of RPN was longer than that of LPN, there were no significant differences in operative outcomes including robotic console time and laparoscopic time between the procedures.

Purpose: Renal vascular clamping during a laparoscopic partial nephrectomy is a time-consuming procedure with a risk of renal ischemia. To study the feasibility of laparoscopic partial nephrectomy without renal arterial clamping, we compared the procedure with laparoscopic partial nephrectomy with vascular clamping. Materials and Methods: Seventeen patients underwent laparoscopic partial nephrectomy without renal arterial clamping (group 1) from February 2004 to June 2008. The operative results were reviewed retrospectively and compared with those of 16 patients who underwent laparoscopic partial nephrectomy with arterial clamping (group 2). Patient characteristics did not differ significantly between the 2 groups. However, exophytic tumors were detected in 13 patients in group 1 and 3 patients in group 2 (p=0.001). Scores on the preoperative aspects and dimensions used for an anatomical (PADUA) classification were 6.9 in group 1 and 7.7 in group 2 (p=0.037). All surgeries by the transperitoneal approach were performed by a single surgeon. Results: The mean operative times were 103 and 130 minutes in groups 1 and 2, respectively (p=0.312). The mean renal arterial clamping time of group 2 was 27.6 minutes (range, 20-42 minutes). The mean estimated blood loss was 327 ml in group 1 and 315 ml in group 2 (p=0.971). The mean postoperative change in the glomerular filtration rate was 20.11 ml/min/1.73 m in group 1 and 18.95 ml/min/1.73 m in group 2 (p=0.748). The mean times to postoperative initiation of ambulation and of oral intake were 1.6 and 1.7 days (p=0.486) and 1.3 and 1.6 days (p=0.811) in groups 1 and 2, respectively. The mean length of hospital stay was 7.4 and 7.9 days in groups 1 and 2, respectively (p=0.9). The mean tumor size was 2.1 cm (range, 1-7 cm) in group 1 and 3.3 cm (range, 1.5-9 cm) in group 2. Conclusions: Laparoscopic partial nephrectomy without renal arterial clamping is feasible for a localized renal tumor. However, patients should be selected carefully, such as those with an exophytic tumor. (Korean J Urol 2009;50:1208-1212) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Solitary Fibrous Tumor of Kidney Dong Youp Han, Hyang Jeong Jo, Hee Jong Jeong, Gang Deuk Kim, Ill Young Seo From the Departments of Urology, Pathology and Radiology, Wonkwang University School of Medicine, Iksan, Korea Solitary fibrous tumors (SFTs) are a rare spindle-cell neoplasm originating from mesenchymal fibroblast-like cells. Although they generally arise from submesothelial connective tissue in the pleura, many other locations have also been described, including the mediastinum, upper respiratory tract, orbit, salivary gland, thyroid, and prostate. SFT of the kidney, however, has rarely been described, and only 1 case has been reported in Korea. A 53-year-old female visited our hospital for abdominal pain, and abdominopelvic computed tomography showed a heterogeneous well-enhanced mass in the renal pelvis. She was treated with a laparoscopic radical nephroureterectomy, which revealed an SFT of the kidney. (Korean J Urol 2009;50:89-91)

Purpose: Nephron-sparing surgery for renal tumors in solitary kidneys has several technical difficulties and complications, including renal failure. We evaluated operative outcome and feasibility in patients with renal cell carcinoma in a solitary kidney treated with laparoscopic partial nephrectomy. Materials and Methods: Between September 2003 and September 2008, 59 patients with renal tumors underwent laparoscopic partial nephrectomy. Among them, 4 patients with a solitary kidney were enrolled in the study. The mean age of the 2 male and 2 female patients was 66.8 years old, and their mean body mass index was 24.7. The mean size of the tumor was 3.5 cm. Results: The mean operative time was 138.5 minutes, and estimated blood loss was 163.8 ml. In 2 patients, warm ischemic times were 25 and 55 minutes. Initiation of postoperative oral intake and ambulation were at 1.0 and 1.5 days. The mean hospital stay was 15.0 days. One patient had a complication of urinary leakage. Pathologic examination revealed renal cell carcinomas with negative surgical margins in all patients. The mean serum creatinine level of preoperative and postoperative day 1 was 1.04 and 1.73 mg/dl, respectively. One patient required temporary hemodialysis. At the mean follow-up of 21.3 months, there was no recurrence of tumors. The mean serum creatinine level at the final visit was 1.36 mg/dl. Conclusions: Laparoscopic partial nephrectomy for renal tumors in solitary kidneys can be performed safely. Although it is a possible modality with excellent outcome, long-term follow-up for cancer control, along with advanced laparoscopic technique and experience, is necessary. (Korean J Urol 2009;50:463-467) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: The location of renal cysts is related with the symptoms and signs. Parapelvic cysts are a rare form of simple renal cysts, and they are much more commonly associated with the symptoms of obstruction, pain, infection and stone formation. We evaluated the surgical outcomes of laparoscopic renal cyst marsupialization for treating the peripheral and parapelvic types of renal cysts. Materials and Methods: Between November 1993 and April 2007, 87 patients (91 cases) who presented with symptomatic renal cysts underwent laparoscopic renal cyst marsupialization. There were 76 cases in the peripheral cyst group and 15 cases in the parapelvic cyst group. The mean age was 59.2 years (age range: 20-77) for the patients with peripheral renal cysts and 62.9 years (age range: 47-79) for the patients with parapelvic cysts. Results: The mean operative time was 108 minutes (30-280) for the patients with peripheral renal cysts and 144 minutes (80-270) for the patients with parapelvic cysts, and there was a significant difference (p=0.031). However for the other factors, including the time for the first oral intake, the time to remove the drain and the length of the hospital stay, there were no significant differences (p=0.671, 0.088, 0.268, respectively). Complications, including bleeding and leakage, were detected in 11 patients (14.4%) of the peripheral cyst group and in 4 patients (26.6%) of the parapelvic cyst group; there was a statistical difference (p=0.035). Both groups had a high success rate, 98.7% in the peripheral cyst group and 100% in the parapelvic cyst group.

Laparoscopic radical nephrectomy is a standard treatment for localized renal cell carcinoma. Although it is less invasiveness than open surgery, it has a steeper learning curve compared with open surgery. We analyzed the results of laparosopic radical nephrectomy that was per-formed by 3 surgeons who had finished a 1-year laparoscopy educational program.

Purpose: We assessed the success rate of internal ureteral stenting and the complications for patients with ureteral obstruction secondary to non-genitourinary malignancy. Materials and Methods: Between January 2001 and December 2005, ureteral stenting were attempted in 62 patients with ureteral obstruction secondary to non-genitourinary malignancy. Their medical records were reviewed for the primary diagnosis, the symptoms, the degree of hydronephrosis, the location of obstruction, stent failure, the time period until stent replacement due to stent failure, the complications and the status at the last followup. Results: A total 62 patients underwent an attempt at retrograde ureteral stenting for malignant extrinsic obstruction. The mean patient age was 57.6 years(range: 32-84) and the mean follow-up was 12.6 months. 44 patients(71%) were women, and the most common cancer diagnoses were cervical cancer(19), rectal cancer(16) and stomach cancer(11). A total of 23 patients(37%) required immediate percutaneous nephrostomy(PCN) referral. A total of 14 patients experienced late failure and required PCN. A total of 39 patients underwent stent replacement at a mean interval of 3.5 months. Conclusions: At almost 1 year follow-up, stent failure due to extrinsic compression occurred in 55.7% of the patients(37 of 62). We should carefully monitor patient who undergo ureteral stenting for ongoing obstruction and complication.

Purpose: Laparoscopic surgery has been generalized for the treatment of localized renal cell carcinoma (RCC). Recently, laparoscopic radical nephrectomy for an RCC over the pT2 stage has gained rapid momentum as an effective surgery for treatment. We evaluated the possibility of the use of laparoscopic surgery for a large RCC, using the surgical results according to tumor size. Materials and Methods: Between June 2003 and June 2007, a total of 46 patients that under underwent a laparoscopic radical nephrectomy for RCC were divided into three groups according to tumor size: group 1 (n=16, tumor size ≤4cm), group 2 (n=15, tumor size 4cm 7cm). The surgical outcomes and perioperative morbidities were evaluated retrospectively, and were compared for each group. Results: The transfusion rate for group 3 patients was higher than for the other groups (group 1: 0%, group 2: 13.3%, group 3: 26,7%). However, the mean operative time (group 1: 154.3 minutes, group 2: 158.4 minutes, group 3: 197.9 minutes), postoperative initiative time to ambulate (group 1: 1.88 days, group 2: 2.00 days, group 3: 1.87 days) postoperative initiative time to diet (group 1: 1.38 days, group 2: 1.53 days, group 3: 1.53 days), total hospital stay (group 1: 7.94 days, group 2: 8.47 days, group 3: 8.20 days) and complication rate (group 1: 12.5%, group 2: 13.3%, group 3: 13.3%) were similar for patients in the three groups. Pathological results indicated that all cases showed a renal cell carcinoma with a negative surgical margin. Conclusions: There were no differences in the operative and postoperative results of the performance of laparoscopic radical nephrectomy according to tumor size, except for the transfusion rate. If the use of the technique and experience accumulate, laparoscopic radical nephrectomy will be feasible for all localized RCC regardless of tumor size. (Korean J Urol 2008;49:203-207) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: The aim of this study was to compare the efficacy and outcomes of endopyelotomy, Acucise endopyelotomy, and laparoscopic pyeloplasty for patients with ureteropelvic junction obstructions. Materials and Methods: We studied 45 patients with ureteropelvic junction obstructions who underwent minimally invasive surgeries between January 2001 and April 2007. Patients were divided into three groups according to operative procedure: group I, endopyelotomy (n=17); group II, Acucise endopyelotomy (n=12; and group III, laparoscopic pyeloplasty (n=16). Results: The mean patient ages in the three groups were 42.7±17.2 years, 48.8±14.1 years, and 49.5±13.6 years for groups I, II, and III, respectively. The mean stricture lengths were 0.99±0.25cm, 0.93±0.10cm, and 1.03±0.38 cm for groups I, II, and III, respectively, and were not significantly different among the groups (p>0.05). The mean operating time for group II (55.7±25.3 minutes) was shorter than that for group I (131.7±30.5 minutes) and group III (165.2±23.7 minutes) (p

Purpose: Rodent models that mimic human renal diseases are being increasingly recognized as powerful tools in the development of new drugs and for evaluating the efficacy of novel therapeutics in a preclinical setting. However, there are few reports on microvasculature imaging of the urinary system in small animals. An experimental study was performed to evaluate the microvasculature in a rat kidney using microcomputed tomography (CT) with three-dimensional images. Materials and Methods: Five Sprague-Dawley male rats (age: 10-12 weeks, weight: 200-250g) underwent a laparotomy under anesthesia with an intramuscular injection of 0.5cc xylazine hydrochloride and ketamine mixed solution (1:10). After ligation of the abdominal aorta and inferior vena cava immediately above the renal artery, a 24 gazed catheter was inserted into the abdominal aorta. A physiological solution and heparin (500U) were infused through the catheter to flush the blood from the renal vasculature. The kidney was enhanced using self-made contrast material. The excised kidney was frozen for the micro-CT scan. Results: The mean longitudinal diameter and weight of the 10 resected kidneys was 1.95±0.15cm and 2.0±0.28g, respectively. The images were represented by three-dimensional arrays of cubic voxels with opacities in the blood vessels. In the section taken from the arrays, four regions of the kidney could be identified easily by their characteristic vascular features. Conclusions: Micro-CT is a promising method for evaluating the renal microvascular architecture in a rat kidney. It can for the foundation of an experimental study aimed at providing quantitative information on the urinary system in a rodent model. (Korean J Urol 2008;49:669-674) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: Our intension was to identify the influence of obesity on the operative results of laparoscopic renal surgery. Our study was performed on the basis of the body mass index (BMI). Materials and Methods: Between March 2003 and December 2006, patients with localized renal cell cancer, who underwent a laparoscopic radical nephrectomy, were included in the study. The patients were divided into 3 groups according to their BMI: group I (BMI 25). Patients with abdominal operation or radiation exposure histories were excluded from the study. The study started at the time of operator's overcoming of the learning curve for a laparoscopic radical nephrectomy. The operative data were retrospectively reviewed. Results: Forty-one patients were included in the study. The mean ages of the three groups were 61.2±6.7, 58.2±6.1 and 59.2±5.7 years, respectively. The mean BMI were 20.3±2.6, 24.1±0.8 and 27.9±2.2 in groups I, II and III (n=15, 12 and 14), respectively. According to the degree of obesity, the operation time was meaningfully increased in group III (group I: 162.1± 39.4, group II: 147.5±17.5, group III: 199.4±2.2 minutes). The complications of a laparoscopic radical nephrectomy, including transfusion rate, had no relation with the degree of obesity. Conclusions: For a laparoscopic radical nephrectomy, obesity could influence the operative time, but not the complications. (Korean J Urol 2007; 48:771-774) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: We evaluated the feasibility of laparoscopic nephropexy for treating patients with symptomatic nephroptosis according to our early experiences. Materials and Methods: Between June 2005 and June 2006, 3 patients with nephroptosis underwent laparoscopic nephropexy. They presented with long-standing flank pain. Nephroptosis was confirmed with performing supine and erect excretory urography (EU). The mean age of the 3 women was 40.7 years old, and their mean body mass index was 19.3kg/m. The mean length of the nephroptosis was 7.5cm on EU. The operation was performed with a 3 trocar system through the transperitoneal approach. The renal capsule and parenchyme were fixed to the fascia of the quadratus lumborum muscle using 2-0 black silk. Results: Laparoscopic nephropexy was performed successfully in all patients. The mean operative time was 58.3 minutes. There was no operative complication and transfusion. Initiation of the oral intake and ambulation took place on postoperative day 1. The mean hospital stay was 5.7 days. Flank pain disappeared in 2 patients, and it was decreased in one patient for the 17.7 months of the mean follow-up. The mean length of the nephroptosis was 3.0cm on postoperative EU. Conclusions: Laparoscopic nephropexy for treating symptomatic nephroptosis could be performed easily and safely with an excellent outcome. (Korean J Urol 2007;48:1139-1142) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: To evaluate the feasibility of laparoscopic partial nephrectomy for patients with renal tumors from our early experiences. Materials and Methods: Between February 2004 and February 2006, 20 patients with renal tumors underwent a laparoscopic partial nephrectomy, and of these, 15 were enrolled in our study. The mean age and body mass index of 6 male and 9 female were 55.2 years and 23.9, respectively. The mean tumor size was 4.2 cm. The operation was performed with a 4 trocar system through a transperitoneal approach. Bleeding from the renal parenchyme was controlled using sutures, argon beam coagulation, fibrin glue and cellulose meshes. Results: The laparoscopic partial nephrectomies were successfully performed in all patients. The mean operative time and transfusion rate were 180.7 minutes and 60%, respectively. In 6 patients, vascular bulldog clamps were used to remove the tumor mass, with a mean warm ischemic time of 32.5 minutes. The initiation of the postoperative oral intake and ambulation were 1.6 and 2.7 days, respectively, with a mean hospital stay of 8.8 days. Complications were detected in 2 patients, one case each of urinary leakage and an incisional hernia. Pathological examinations revealed renal cell carcinomas with negative surgical margins in 9 patients and angiomyolipomas in a further 6. There was no recurrence during the mean follow-up of 11.4 months. Conclusions: A laparoscopic partial nephrectomy for a renal tumor can be safely performed. Although excellent perioperative outcomes were observed, long-term follow-up is still necessary to confirm theist effect on cancer control. (Korean J Urol 2007;48:1-5) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

was lower in group C than in groups A and B. According to the location, group C had a lower success rate than groups A and B for renal stones, while there were no differences between the three groups in the treatment of other stone locations. The number of treatment sessions for group A was greater than those for groups B and C (group A, 3.83; group B, 1.85; group C, 1.93). Many more sessions were required for group A in comparison with groups B and C in case of renal stones, ureteropelvic junction and upper ureteral stones. The number of sessions for group B was the least for lower ureteral stones. Complications, including stein- strasse, fever, perirenal hematoma and hematuria, were detected in groups A, B and group C at 10, 15.3 and 7.1%, respectively. Conclusions: There were no differences in the success rates between the three extracorporeal shock wave lithotripters using a shock wave gener- ator. The mean number of treatment sessions was most with the pie- zoelectric type; whereas, complications were most prevalent with the electromagnetic type. (Korean J Urol 2007;48:54-60) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Purpose: To evaluate the results of our experience with a retroperitoneoscopic nephroureterectomy, in patients with transitional cell carcinomas of the renal pelvis and ureter, compared to those treated by open nephroureterectomy. Materials and Methods: Between August 2003 and February 2006, 17 patients with a transitional cell carcinoma of the upper urinary tract underwent retroperitoneoscopic nephroureterectomy. The distal ureter and bladder cuff was treated with a Gibson incision in 11 patients, with an endoscopic stapler employed in 6 patients. During the endoscopic stapler firing of the bladder cuff, complete removal of the ureteral orifice was confirmed using a flexible cystoscope. The patients’ operative and clinical records were retrospectively reviewed, and compared to 16 patients with a transitional cell carcinoma of the upper urinary tract treated using an open nephroureterectomy. Results: The retroperitoneoscopic nephroureterectomies were successfully performed in all patients. The mean operative time, transfusion rate and time to drain removal were not significantly different between the two groups. The initiations of the postoperative oral intake and ambulation, as well as the hospital stay were shorter in the retroperitoneoscopy than the open group. Complications were detected in 1 and 5 patients of the retroperitoneoscopy and open groups, respectively. With respect to the follow-up results, no statistical differences were seen in either bladder or extravesical recurrence between the two groups. Conclusions: A retroperitoneoscopic nephroureterectomy is a less invasive technique than an open nephroureterectomy for patients with a transitional cell carcinoma of the renal pelvis and ureter. Especially, using an endoscopic stapler for the lower ureter and bladder cuff may shorten the operative time. However, long term follow-up will be necessary to confirm the cancer control effects. (Korean J Urol 2006;47:1263-1268)

30세 여자 환자가 14일 전 발생한 발열과 좌측복통을 주 소로 내원하였다. 환자는 15일 전에 정상 질식분만을 하였 는데, 초산으로 12시간의 진통과 1시간 45분간의 분만유도 후 회음절개술을 통해 출산하였다. 과거력과 가족력에서 특이사항은 없었고 체온, 호흡 및 맥박수, 혈압은 정상이었 다. 신체검사에서 심한 좌측 늑골각압통을 호소하였다. 일 반혈액검사에서 혈색소치 9.4g/dl, 백혈구 19,690/μl, 혈소판 651x10 /μl이었고, 소변검사에서 적혈구 many/HPF, 백혈구 3-5/HPF이었다. 혈중 protein S가 19% (정상범위: 59-119%) 으로 감소되어 있었고 혈중 fluorescent antinuclear antibody (FANA), antidsDNA, anti-neutrophil cytoplasmic antibody (ANCA), lupus anticoagulant는 음성으로 혈전증을 발생시킬 전신질환의 증거는 없었다. 흉부 X선 촬영에서 이상소견은 없었고, 복부 초음파검사 에서 좌측신이 14cm 이상으로 비대해 있었다. 좌측 신정맥 은 확장되어 있었고 혈류가 관찰되지 않았으며, 저에코의 종물이 정맥 내에서 관찰되었다(Fig. 1). 복부전산화단층촬 영에서 좌측 신이 비대되어 있었고 신문부에 1.5cm 크기의 림프절이 관찰되었으며 신정맥에 저음영의 1.3x6.1cm 크기 의 타원형의 종물이 보였다 (Fig. 2). 좌측 신정맥혈전증과 신우신염으로 진단하고 보존적 치료를 시작하였다. 양측 하지에 고탄력 스타킹을 착용하게 한 후 입원 직후 부터 저분자량헤파린 (low molecular weight heparin) 70mg을 1일 2회 (140mg/day) 피하 주사하였다. 혈액응고검사로 추 적관찰하면서 투여를 지속하다가 내원 5일째부터는 와파 린 40mg를 추가로 경구 투여하였다. 좌측 측복통은 소실되 었으며 복부 도플러초음파검사에서 좌측 신동맥의 수축기 혈류는 정상적으로 관찰되었으며, 좌측 신에서 대정맥으로 가는 측부 순환이 발생하였다. 내원 7일째 카테터 혈전 용 해술을 시행하였다. 좌측 신동맥에 도관을 유치하고 시간 당 우로키나아제 50,000IU과 헤파린 300IU를 동시에 지속 적으로 점적하였다. 내원 8일째도 같은 방법으로 카테터 혈 출산 후 발생한 신정맥혈전증

From the Department of Urology, College of Medicine, Hallym University, Chuncheon, Dongguk University, Gyeongju, Kyungpook National University, Daegu, The Catholic University of Korea, Seoul, Asan Medical Center, Seoul, Inje University, Busan, Kosin University, Busan, Chonnam National University, Gwangju, Pochon CHA University, Seongnam, Daegu Catholic University, Daegu, Chonbuk National University, Jeonju, Wonkwang University, Iksan, Sungkyunkwan University, Masan, Seoul National University, Seoul, Yonsei University, Seoul, Dong-A University, Busan, Yeungnam University, Daegu, Keimyung University, Daegu, Korea

Malignant Peripheral Nerve Sheath Tumor of the Retroperitoneum in Patient with Neurofibromatosis Il Sang Kang, Seung Hwa Choi, Hyung Bae Moon, Ill Young Seo From the Departments of Urology and Pathology, Wonkwang University School of Medicine, Iksan, Korea A malignant peripheral nerve sheath tumor (MPNST), also known as a malignant neurilemmoma or malignant schwannoma, is significantly associated with neurofibromatosis type 1 (NF 1). NF 1 is characterized by multiple dermal neurofibromas, cafe-au-lait spots, MPNST and other abnormalities. MPNST is often metastatic, and is detected in the extremities, frequently in the head and neck, but rarely in the retroperitoneal and pelvic spaces. We experienced a case of MPNST in the retroperitoneal space of a 38-year-old male with NF 1, who also had metastatic lesions of the lung and liver. (Korean J Urol 2006;47:1240-1242) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Neoplasms of the spermatic cord are rare tumors. Especially, the spermatic cord is an extremely unusual site for cavernous hemangioma. We experienced a recurrent cavernous hemangioma in a 12 year-old boy. His chief complaint was recurrent inguinal mass and he was pathologically diagnosed as having a cavernous hemangioma of the spermatic cord. To the best of our knowledge, this is the first Korean report of a recurrent cavernous hemangioma of the spermatic cord. (Korean J Urol 2006;47:341-343) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Purpose: We compared the results of our experience with hand-assisted laparoscopic simple nephrectomy (HALN) and the standard laparoscopic simple nephrectomy with the transperitoneal approach for treating benign renal diseases. Materials and Methods: Between March 2002 and March 2004, 38 patients, including 36 patients with a non-functioning kidney and 2 angiomyolipomas, received laparoscopic simple nephrectomies. The HALN approach method was used for 11 patients and transperitoneal standard laparoscopy was used for 27 patients. The operative and clinical records were retrospectively reviewed. Results: The mean patient age and gender were not significantly different in the HALS and standard groups. The procedures were performed successfully in all but 2 patients. Intraoperatively, one patient of HALN group had spleen injury, which was treated with splenectomy. One patient of the standard group had open conversion due to dissection difficulty because of severe adhesions. Postoperatively, one patient of the standard group had intraperitoneal hematoma, which was treated conservatively. The mean operative time, initiation of the postoperative oral intake and the initiation day for ambulation were not significantly different in both groups. The analgesic use (diclofenac sodium, 90.0mg versus 22.5mg, respectively) and the postoperative hospital stay (7.2 days versus 5.6 days, respectively) was shorter in the standard group than in the HALN group (p