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Purpose: Zinc is one of the trace minerals in the body and is known to have an anticancer effect by inducing apoptosis in prostate cancer. We aimed to investigate the antiproliferative effects of a zinc-citrate compound in bladder cancer. Materials and Methods: A bladder cancer cell line (MBT-2) was treated with a zinc-citrate compound at different time intervals and concentrations. Mitochondrial (m)-aconitase activity was determined by use of the aconitase assay. DNA laddering analysis was performed to investigate apoptosis of MBT-2 cells. The molecular mechanism of apoptosis was investigated by Western blot analysis of p53, p21 waf1 , Bcl-2, Bcl-xL, and Bax and also by caspase-3 activity analysis. Results: Treatment with the zinc-citrate compound resulted in a time- and dose-dependent decrease in cell number of MBT-2 cells. M-aconitase activity was significantly decreased. DNA laddering analysis indicated apoptosis of MBT-2 cells. The zinc-citrate compound increased the expression of p21 waf1 and p53 and reduced the expression of Bcl-2 and Bcl-xL proteins but induced expression of Bax protein. The zinc-citrate compound induced apoptosis of MBT-2 cells by activation of the caspase-3 pathway. Conclusions: We have shown that a zinc-citrate compound induces apoptotic cell death in a bladder cancer cell line, MBT-2, by caspase-3 activation through up-regulation of apoptotic proteins and down-regulation of antiapoptotic proteins.

Purpose: Transrectal ultrasound-guided prostate biopsy is the procedure of choice for diagnosing prostate cancer. We compared with pain-relieving effect of acetaminophen, a known drug for enhancing the pain-relieving effect of tramadol, and eutectic mixture of local anesthetics (EMLA), a local anesthetic agent, with that of the conventional periprostatic nerve block method. Materials and Methods: This was a prospective, randomized, single-blinded study. A total of 430 patients were randomly assigned to three groups. Group 1 received a periprostatic nerve block with 1% lidocaine, group 2 received acetaminophen 650 mg, and group 3 received EMLA cream for pain control. All patients were given 50 mg of tramadol intravenously 30 minutes before the procedure. At 3 hours after completion of the procedure, the patients were asked to grade their pain on a horizontal visual analogue scale (VAS). The patients were also asked whether they were willing to undergo future biopsy if required. Results: There were no significant differences between the three groups in terms of age, prostate-specific antigen, prostate size, or numbers of biopsy cores. The pain scores for groups 2 and group 3, which were 3.47±1.92 and 3.50±1.36, respectively, were similar and were significantly lower than that of group 1, which was 5.24±2.07. Conclusions: Acetaminophen and EMLA cream with intravenous injection of tramadol are safe, easy, and effective methods of controlling pain during the procedure. These methods were more effective for pain relief than was the conventional periprostatic nerve block method.

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: We aimed to prove the safety and feasibility of right-sided hand-assisted laparoscopic donor nephrectomy (HALDN). Materials and Methods: Between May 2006 and May 2009, 16 patients underwent right-sided HALDN at our institution. Of these patients, 15 showed significantly lower renal function in the right kidney than in the left one and 1 had a stone in the right kidney. When the right renal vein was divided, an EndoGIA stapling device was placed on the wall of the inferior vena cava to gain a maximal length of the vein. We evaluated intraoperative and postoperative parameters such as operative time, delivery time, warm ischemic time, estimated blood loss, intraoperative and postoperative complication rates, length of hospital stay, and serum creatinine levels of donors (at the time of discharge) and recipients (4 weeks postoperatively), comparing the right-sided HALDN group (our study) with a left-sided HALDN group (from a previously reported study). Results: A total of 16 right-sided HALDNs were successfully performed without any complications or open conversion. All of the intraoperative and postoperative parameters were similar between the right-sided HALDN and left-sided HALDN groups. There were no technical problems in the recipients in the anastomosis of the renal vein, and the ureteral anastomoses were also successful. Conclusions: Right-sided HALDN is safe and technically feasible in a donor, showing favorable graft outcomes. The results of our study suggest that right-sided HALDN may be preferable in patients with significantly lower renal function in the right kidney than in the left one.

Purpose To evaluate the combined role of mescenchymal stem cells (MSCs) infected with recombinant adenoviruses expressing human BDNF (rAd/hBDNF) on the erectile dysfunction in rat with cavernous nerve injury. Materials and methods Rats divided into 4 groups: control group, bilateral cavernous nerve crushing group (BCNC group), BCNC with MSCs group and BCNC with MSCs infected with rAd/hBDNF group. After 4-week, functional assessment was done. PKH26 and BDNF staining of major pelvic ganglion and masson's trichrome staining of corpus cavernosum were performed. Western blot analysis of endothelial nitric oxide synthase (eNOS) and neuronal nitric oxide synthase (nNOS) was done in corpus cavernosum. Results After 4 weeks, BCNC with MSCs and MSCs infected with rAd/hBDNF groups showed significantly well-preserved erectile function compared with BCNC group. Moreover, the erectile function of MSCs infected with rAd/hBDNF group was significantly well-preserved than BCNC with MSCs group. The smooth muscle of corpus cavernosum was significantly preserved in BCNC with MSCs and MSCs infected with rAd/hBDNF groups compared with BCNC group. More preservation of smooth muscle was observed in rats with MSCs infected with rAd/hBDNF than with MSCs alone. Significant increase expression of eNOS and nNOS was noted in rats with MSCs infected with rAd/hBDNF than with MSCs alone. Conclusions The erectile function was more preserved after injection with MSCs infected with rAd/hBDNF in rat with ED caused by cavernous nerve injury. Therefore, the use of MSC infected with rAd/hBDNF may have a better treatment effect on ED cause by cavernous nerve injury.

Purpose To assess the risk factors for developing urinary retention after removal of the urethral catheter on postoperative day 1 in benign prostatic hyperplasia patients who underwent Greenlight HPS laser photoselective vaporization prostatectomy (PVP). Materials and Methods The study included 427 men who underwent Greenlight HPS laser PVP between 2009 and 2012, excluding patients in whom a catheter was maintained for more than 1 day because of urethral procedures. In all patients, a voiding trial was performed on postoperative day 1; if patients were unable to urinate, the urethral catheter was replaced before hospital discharge. The patients were divided into two groups: early catheter removal (postoperative day 1) and late catheter removal (urethral catheter reinsertion). Preoperative and perioperative parameters were compared between the groups. Results Catheters were successfully removed in 378 (88.6%) patients on postoperative day 1. In 49 patients, the catheters were reinserted and removed a mean of 6.45±0.39 days after surgery. In a multivariate analysis, a history of diabetes was the most significant predictor (p=0.028) of failure of early catheter removal, followed by operative time (p=0.039). There were no significant differences in age, prostate volume, International Prostate Symptom Score, or urodynamic parameters between the two groups. Conclusions It is feasible, safe, and cost-effective to remove the urethral catheter on postoperative day 1 after Greenlight HPS laser PVP, but the procedure should be done carefully in patients who have history of diabetes or an extended operative time.

Purpose Prostate cancer foci have a characteristic feature in magnetic resonance imaging (MRI). We aimed to assess the clinical value of MRI before prostate biopsy in prostate cancer detection. Materials and Methods From March 2009 to June 2010, 154 patients were enrolled in this study. A total of 51 patients with a clinical suspicion of prostate cancer underwent prostate MRI by a 3T scanner before transrectal ultrasound (TRUS)-guided biopsies. A total of 103 patients with a clinical suspicion of prostate cancer underwent prostate MRI after biopsies. The sensitivity, specificity, and positive predictive value (PPV) were evaluated. In addition, tumor location of pathologic findings and ADC mapping on MRI were matched and compared. Results The sensitivity of MRI before and after biopsy was 84.8% and 92.4%, respectively. The PPV of MRI before and after biopsy was 75.7% and 92.4%, respectively. The MRI location match percentage before and after biopsy was 89.3% and 94.1%, respectively. Conclusions Compared with other previous reports, our results show that the prostate cancer detection sensitivity of MRI is on the rise. Furthermore, MRI before prostate biopsy can provide more information by which to identify prostate cancer during prostate biopsy and thus reduce the false-negative rate.

Purpose: We examined changes in the clinicopathologic characteristics of renal cell carcinoma (RCC) in the past 25 years and aimed to obtain indicators for its diagnosis and treatment. Materials and Methods: The medical records of 563 patients with confirmed primary RCC after surgical treatment from 1985 to 2010 at Seoul St. Mary’s Hospital were retrospectively reviewed. Patient and tumor characteristics were compared over 3 time periods (period 1: 1985-1994, period 2: 1995-2004, period 3: 2005-2010). Results: Period 1 included 65 patients, period 2 included 183 patients, and period 3 included 315 patients, showing an exponential growth in the number of patients. Frequency was highest in the late 50s age group. The review of clinical symptoms showed that incidental diagnosis increased significantly. The tumor size at diagnosis gradually decreased and the proportion of small tumors less than 4 cm increased remarkably. Concerning tumor spread, organ-confined tumors (T1-2N0M0) increased and distant metastasis decreased. Histologically, the clear cell type made up the greatest proportion, about 90% in each period, but subtypes besides the clear cell type increased over the study period. The rate of nephron-sparing surgery increased, and exophytic masses were the most common. Conclusions: Our review of the recent 25 year’s worth of data on RCC from Seoul St. Mary’s Hospital showed that the incidental diagnosis of RCC increased over the study period in accordance with the development of screening tests. Tumor size decreased in accordance with the progress in imaging modalities. In the future, multicenter research will be needed to analyze the characteristics of whole renal cancer in Korea.

Purpose: To examine the effectiveness and safety of photoselective vaporization of the prostate (PVP) with the 120 W high-performance system (HPS) Greenlight laser procedure in benign prostatic hyperplasia (BPH) patients taking oral anticoagulant medications. Materials and Methods: This study was conducted on BPH patients taking oral anticoagulant medications form March 2009 to December 2010. Group I consisted of patients who stopped oral anticoagulant medications before surgery (n=30), and group II consisted of patients who continued oral anticoagulant medications before surgery (n=30). PVP applying the 120 W HPS Greenlight laser was done, and followed up for 12 weeks. Follow-up variables were International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoid residual urine volume (PVR), and hemoglobin level change. Results: At 12 weeks after surgery, we confirmed the improvement in the IPSS score of Group I compared with preoperative scores. The quality of life (QoL) score, Qmax and PVR were also improved. respectively, both of which were significantly improved. In Group II, similarly, the total IPSS score, the voiding symptom score, and the storage symptom score were improved in comparison with the preoperative scores. The QoL score, Qmax and the PVR were improved in comparison with the preoperative scores. During the 12-week follow-up period, no major postsurgical complications requiring transfusion, rehospitalization, etc. were observed. Conclusions: The 120 W HPS Greenlight laser PVP procedure can be performed effectively and safely in BPH patients, even those who cannot stop oral anticoagulant medications despite requiring surgery.

Purpose Muscle-derived stem cells (MDSCs) harvested from skeletal muscles have the advantage of providing easier access and do not pose the immunogenic risks of embryonic stem cells. We investigated the effect of intracavernosal transplantation of MDSCs on erectile function in rats with bilateral cavernous nerve injury. Materials and Methods Adult male white rats underwent experimentation in 3 groups: group I, sham operation; group II, bilateral cavernous nerve injury; group III, bilateral cavernous nerve injury with MDSC injection. MDSCs were harvested from the femoral muscle of rats and were then injected into the cavernosum. Survival of MDSCs and measurement of erectile function was studied after 4 weeks. We checked the intracavernosal pressure (ICP) and obtained penile tissue. The expression of cyclic guanosine monophosphate (cGMP) was analyzed. Results Four weeks after transplantation, PKH-26-labeled MDSCs were identified in the cavernosal tissues of group III. Peak ICP and the drop rate of group II were 52±8.7 mmHg and 34±6.5 mmHg/min, respectively, whereas peak ICP and the drop rate of group III were 97±15.6 mmHg and 17±4.9 mmHg/min, respectively, showing that erectile function improved after MDSC transplantation (p

Purpose To stratify complications of percutaneous nephrolithotomy (PCNL) in a single, tertiary hospital by use of the modified Clavien system. Materials and Methods From May 1987 to December 2010, 1,236 cases of PCNL were performed at our institute. Medical records were available for 826 cases of PCNL from 698 patients, from February 1995 to December 2010. Using multiple factors, we retrospectively reviewed and analyzed 698 patients for complication rates classified by the modified Clavien grading system, along with success rates. Results In 698 patients, staghorn stone patients accounted for 33.8% (236 patients). Initial and overall stone-free rates were 69.9% and 88.8%. A total of 297 complications were documented in 282 patients. According to the modified Clavien classification, grade I, II, IIIa, IIIb, IVa, IVb, and V complications were observed in 88 (12.6%), 145 (20.8%), 31 (4.4%), 5 (0.7%), 6 (0.9%), 4 (0.6%), and 3 (0.4%) patients, respectively. Transient peri-nephrostomy catheter urine leakage (15.2%) was the most common complication, followed by transient fever >38° (11%) and transfusion (6.9%). Other individual complications occurred in less than 1.5% of cases. In patients with staghorn stones, grade I, II, IIIb, and IVa complications were significantly more common, and all grade IVb and V complications occurred in patients with staghorn stones. Conclusions The modified Clavien classification provides a standardized grading system for complications of PCNL, although consensus on specific complications would prompt better comparison between centers. A shorter operation time is imperative to achieve less bleeding. Previous stone-related fever and staghorn stones are significant contributing factors for developing postoperative fever.

Purpose: Most men with benign prostatic hyperplasia (BPH) have bothersome lower urinary tract symptoms (LUTS). This study aimed to investigate the safety and efficacy of high-performance system (HPS) laser photoselective vaporization of the prostate (PVP) for the treatment of BPH in men with detrusor underactivity (DU). Materials and Methods: From March 2009, 371 patients with BPH were divided into 2 groups according to the findings of preoperative urodynamic study: 239 (64.4%) patients with bladder outlet obstruction (BOO) and 132 (35.6%) patients with bladder outlet obstruction with detrusor underactivity (BOO+DU). 120 W HPS laser PVP was performed to resolve the BOO. The perioperative data and postoperative results at 1 month and 12 months, including the International Prostate Symptom Score (IPSS), maximum urinary flow (Qmax), and postvoid residual urine (PVR) values, were evaluated. Results: Compared with the preoperative parameters, significant improvements in IPSS, Qmax, and PVR were observed in each group at 1 and 12 months after the operation. In addition, IPSS, Qmax, and PVR were not significantly different between the BOO and BOO+DU groups at 1 and 12 months after the operation. Conclusions: Surgery to relieve BOO in the patients with BPH seems to be an appropriate treatment modality regardless of the existence of DU.

Purpose: With the use of 12 months of follow-up data, this study was conducted to evaluate the efficacy of photoselective vaporization of the prostate (PVP) with the 120 W Greenlight high performance system (HPS) laser for the treatment of symptomatic benign prostatic hyperplasia. Materials and Methods: Data were collected from 104 patients who were diagnosed with benign prostatic hyperplasia and who underwent PVP with the 120 W Greenlight HPS Laser. Postoperative parameters, including International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and postvoid residual volume (PVR), were assessed and compared with preoperative baseline values. Results: The mean age of the patients was 71.1±7.7. The baseline mean prostate-specific antigen level was 3.8±2.7 ng/ml, the mean prostate size was 43.9±20.6 g, the mean preoperative IPSS was 18.4±8.5, the mean QoL score was 4.1±1.0, the mean Qmax was 9.9±5.5 ml/sec, and the mean PVR was 89.6±207.1 ml. During surgery, the mean operation time was 21.8±11.3 minutes, the mean lasing time was 16.9±10.5 minutes, and the mean total applied energy was 170,068±63,181 J. At 1 month, significant improvements were observed in total IPSS (11.5±6.7, p＜0.05), voiding symptom score (6.1±5.4, p＜0.05), and QoL score (2.2±1.5, p＜0.05); however, there were no significant improvements in storage symptom score (4.8±3.8, p=0.06), Qmax (12.6±10.2, p=0.06), and PVR (40.1±30.5, p=0.41). However, 3 months after surgery, all postoperative follow-up parameters showed significant improvements, and the 6- and 12-month data showed sustained improvement of postoperative follow-up parameters. Conclusions: Significant improvements were observed in subjective and objective voiding parameters, which were evident at 3 months after PVP and were sustained throughout a period of 12 months after PVP.

With the development of techniques for percutaneous access and equipment to disintegrate calculi, percutaneous nephroscopic surgery is currently used by many urologists and is the procedure of choice for the removal of large renal calculi and the management of diverticula, intrarenal strictures, and urothelial cancer. Although it is more invasive than shock wave lithotripsy and retrograde ureteroscopic surgery, percutaneous nephroscopic surgery has been successfully performed with high efficiency and low morbidity in difficult renal anatomies and patient conditions. These advantages of minimal invasiveness were rapidly perceived and applied to the management of ureteropelvic junction obstruction, calyceal diverticulum, infundibular stenosis, and urothelial cancer. The basic principle of endopyelotomy is a full-thickness incision of the narrow segment followed by prolonged stenting and drainage to allow regeneration of an adequate caliber ureter. The preferred technique for a calyceal diverticulum continues to be debated. Excellent long-term success has been reported with percutaneous, ureteroscopic, and laparoscopic techniques. Each approach is based on the location and size of the diverticulum. So far, percutaneous ablation of the calyceal diverticulum is the most established minimally invasive technique. Infundibular stenosis is an acquired condition usually associated with inflammation or stones. Reported series of percutaneously treated infundibular stenosis are few. In contrast with a calyceal diverticulum, infundibular stenosis is a more difficult entity to treat with only a 50-76% success rate by percutaneous techniques. Currently, percutaneous nephroscopic resection of transitional cell carcinoma in the renal calyx can be applied in indicated cases.

Purpose: The aim of this study was to analyze oncologic outcomes based on 7 years of consecutive experience with laparoscopic radical prostatectomy (LRP) and to assess the prognostic difference between an apical positive margin and a non-apical positive margin. Materials and Methods: We reviewed 202 patients who underwent LRP between July 2001 and July 2007 (pathologic stage: T2-T3b, without any adjunctive therapy). Biochemical recurrence (bR) was defined as two consecutive prostate-specific antigen (PSA) values greater than 0.2 ng/ml. We analyzed the differences in bR among the negative margin group (N), the apical positive margin group (A), and the non-apical positive margin group (NA) and factors predicting bR. Results: Overall 3-year probability of bR-free survival (bRFS) was 78% (pT2, 83.7%; pT3, 60.9%). For low-, intermediate-, and high-risk cancer, 3-year bRFS was 94.7%, 82.8%, and 60.7%, respectively. Of the 155 men who had negative and single-site positive margins, the numbers in the N, A, and NA groups were 108, 19, and 28, respectively. bR rates for the N, A, and NA groups were 14.8%, 36.8%, and 46.4%, respectively. Kaplan-Meier curves showed that a positive surgical margin had a significant higher bR compared with the N group; however, the A group experienced a similar bRFS compared with the NA group (p=0.613). Multivariate Cox proportional hazards analysis indicated no significant difference of effect on time to bR between the A and NA groups (hazard ratio=1.213; 95% confidence interval: 0.482-3.052). Conclusions: Our results were almost identical to previous reports of radical prostatectomy in pT2 disease. With increasing experience, we could expect improved oncologic outcomes. In comparison with the NA group, the A group did not show a significant prognostic difference. (Korean J Urol 2009;50:955-962) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Hyuk-Jin Cho, Su Jin Kim, U-Syn Ha, Sung-Hoo Hong, Joon Chul Kim, Tae-Kon Hwang From the Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea We report a case of a bladder stone that formed on a Hem-o-lok clip used to suture an urethrovesical anastomosis. A 65-year-old man presented with intermittent perineal pain, dysuria, and gross hematuria 4 years after laparoscopic radical prostatectomy for localized prostate cancer. Cystoscopy demonstrated a stone formed around a Hem-o-lok clip that had possibly eroded into the urethra. Ultrasonic lithotripsy of the bladder stone with endoscopic extraction of the Hem-o-lok clip was performed. (Korean J Urol 2009;50:613-614) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: In neurogenic bladder, both smooth muscle contraction and nerve regeneration are very important for functional improvement. Glycineisoleucine-lysine-valine-alanine-valine (GIKVAV) is a peptide that can induce nerve regeneration in vivo. In this study, we evaluated bladder function after injection of muscle-derived stem cells (MDSCs) and GIKVAV into the cryo-injured bladder of nude mice. Materials and Methods: Human muscle samples were obtained from the rectus abdominis muscle of 12 patients who underwent laparotomy. The purpose and entire method of the study were explained to the patients, and all subjects who participated in this study provided written informed consent. The MDSCs were isolated by a modified preplate technique, and only CD34+ human MDSC were extracted by use of Mini-MACS kits. The nude mice were subdivided into 5 groups (n=40): normal group (N, n=8), saline injection group after cryo-injury (S, n=8), GIKVAV injection group after cryo-injury (G, n=8), human MDSC injection group after cryo-injury (M, n=8), and GIKVAV and human MDSC injection group after cryo-injury (GM, n=8). At 2 weeks after injection, we compared the contractility of a bladder muscle strip of each group by organ bath and polygraph by using electronic field stimulation (EFS). Nerve regeneration was evaluated by choline acetyl transferase (ChAT) immunostaining. Results: The contractile powers of the N, S, G, M, and GM groups were 3.58±0.27, 1.54±0.25, 1.54±0.31, 2.49±0.36, and 2.44±0.34 mN/mg, respectively, by EFS. The contractility of the bladder muscle strip in the S and G groups was lower than that in the N group. The contractile powers of the M and GM groups were lower than those of the N group but greater than those of the S and G groups. In ChAT immunohistochemical staining, nerve regeneration was increased in the G and GM groups compared with the S and M groups. Conclusions: Nerve regeneration was induced by GIKVAV injection regardless of human MDSC injection. There was no direct effect of GIKVAV on bladder muscle contractility. (Korean J Urol 2009;50:480-485) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: Our study was undertaken to investigate changes in the bladder according to duration of diabetes mellitus in the Otsuka Long Evans Tokushima Fatty (OLETF) rat model, which is similar to type 2 diabetes. Materials and Methods: OLETF rats (n=14) and Long Evans Tokushima Otsuka (LETO, n=14) rats were used. LETO is a normal control of OLETF. The animals were assigned to 4 groups: L-40 group, LETO rats 40 weeks after birth (n=7); O-40 group, OLETF rats 40 weeks after birth (n=7); L-60 group, LETO rats 60 weeks after birth (n=7); and O-60 group, OLETF rats 60 weeks after birth (n=7). At 40 weeks or 60 weeks after birth, blood glucose, cystometry, bladder weight, detrusor contractility, and mRNA expression of nerve growth factor (NGF) were assessed. Results: Cystometry showed that diabetic bladders had increased compliance compared with the control groups at 40 and 60 weeks, and the O-60 group had greater compliance than the O-40 group. Contractile responses to electrical stimulation, bethanecol (250μM), and ATP (10 mM) were decreased in the experimental groups compared with the control groups at 40 and 60 weeks, and the O-60 group had a lower contractile response than the O-40 group. The mRNA expression of NGF was decreased in the experimental groups compared with the control groups, and the O-60 group had lower expression than the O-40 group. Changes in NGF were identified through immunohistochemical staining. Conclusions: The degree of diabetic cystopathy in OLETF rats was changed by duration of type 2 diabetes mellitus. Our results showed that the changes in the bladder in type 2 diabetes mellitus can be identified through a new rat model. (Korean J Urol 2009;50:387-395) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: Because of the lack of conclusive and well-conducted randomized studies, the optimal therapy for high-risk prostate cancer remains controversial. We investigated the results of patients with high-risk prostate cancer after laparoscopic radical prostatectomy (LRP). Materials and Methods: The records of 75 prostate cancer patients undergoing LRP between 2001 and 2008 with preoperative high-risk prostate cancer were reviewed. Patients who underwent radiation therapy for prostate cancer before LRP and patients with lymph node or distant metastases were excluded. High-risk prostate cancer was defined as a prostate-specific antigen (PSA) level of more than 20 ng/ml, a biopsy Gleason score of greater than 7, or a clinical stage greater than T2c. Biochemical recurrence (BCR)-free survival was plotted via the KaplanMeier method. Results: After a mean follow-up of 36.1 months, 24 (32%) patients experienced PSA progression with a median time of 17.6 months. Twenty patients received adjuvant hormonal or external beam radiation therapy or both before BCR. The BCR-free survival calculated by the Kaplan-Meier method at 3 and 5 years was 47.4% and 33.8%, respectively. A total of 44.0% of the patients had stage pT2 disease and 56.0% had stage pT3 disease. Surgical margins were positive in 35 patients (46.7%), of whom 11 (31.4%) had positive margins of more than 1. Preoperative PSA, postoperative pathologic Gleason score, and stage were correlated with BCR. Conclusions: Our results suggest that LRP is a useful tool in the management of high-risk prostate cancer because it provides adequate local control of the prostate and pathological stage. Selection of patients with high-risk prostate cancer who require surgical treatment should be evaluated further in more studies. (Korean J Urol 2009;50:1101-1107) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Ureteral cavernous hemangiomas are an extremely rare, benign tumor. Most cavernous hemangiomas of ureter are diagnosed postoperatively by pathologic examination. A 39-year-old female patient presented with a bladder mass found incidentally by abdominal ultrasound. The patient underwent computed tomography, urine cytology, and cystoscopy. Cystoscopy showed 2 masses protruding from the right ureteral orifice. The ureteral mass was resected endoscopically. The patient was finally diagnosed with cavernous hemangioma in the right ureter. Here we report this case of a ureteral cavernous hemangioma and review the literature. (Korean J Urol 2009;50:192-194) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Bladder diverticulum is a herniation of the bladder mucosa through the bladder wall musculature. Traditionally, bladder diverticulum has been excised by the open surgical method. However, laparoscopic technique has been widely used to treat many urologic diseases, including bladder diverticulum. Laparoscopic diverticulectomy can be performed transperitoneally or extraperitoneally. We report here on our experience with transperitoneal laparoscopic diverticulectomy. (Korean J Urol 2008;49:379-382) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: We wanted to present the feasibility and safety of hand-assisted laparoscopic donor nephrectomy (HALDN) for treating patients with multiple renal arteries. Materials and Methods: Between February 2000 and July 2006, 252 patients underwent HALDN. The results for the patients with a single renal artery (n=187) (Group I) and those patients with multiple renal arteries (n=65) (Group II) were compared in terms of the donor and recipient outcomes. A retrospective chart review was performed and statistical analysis included Student's t-test, the chi square test and Kaplan-Meier survival probability analysis. Results: HALDN was technically successful in 251 patients (1 patient had to be converted to open donor nephrectomy). The operative times were increased in group II, but the differences between the groups were not statistically significant. The warm ischemic times were significantly longer in group II. The intraoperative blood loss, postoperative hospital stay and complication rate in the donor group were not associated with the number of renal arteries. The recipients' renal function and overall graft survival were similar between groups I and II. Conclusions: In our single-center study, the presence of renal artery multiplicity when performing HALDN does not have a significant impact on the outcomes of the renal donors or recipients. (Korean J Urol 2008;49:443-448) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: The definition of continence after radical prostatectomy has not been established. We examined the continence rate and changes in voiding and storage symptoms after laparoscopic radical prostatectomy (LRP). Materials and Methods: Fifty-seven patients were enrolled and followed for more than 12 months after a LRP. Postoperative evaluation of urinary incontinence was performed by interview, and was classified as completely dry, intermittent (occasional dribbling only), using only 1 pad/day, using more than 1 pad/day, and no control. Pre- and post-operative International Prostate Symptom Scores (IPSS) were compared (Total, each criterion, and quality of life, voiding, and storage symptom subscores). Results: Sixty seven percent of patients were completely dry and 17% of patients were classified as intermittent. Those using 1 pad/day, more than 1 pad/day, or no control accounted for 2%, 9%, and 5%, respectively. Preand post-operative total IPSS and quality of life scores were not different, but urgency and nocturia scores increased (p＜0.05). The voiding subscore decreased and the storage subscore increased after LRP (p＜0.05), suggesting aggravation of storage symptoms after LRP. Conclusions: We need to determine which definition of continence is most clinically useful. It is important to assess lower urinary tract symptoms, especially storage symptoms, as well as urinary incontinence after LRP. (Korean J Urol 2008;49:134-138)

Purpose: We evaluated the early results and the learning curve of laparoscopic radical prostatectomy in the first 150 patients. Materials and Methods: Between July 2001 and March 2007, 150 consecutive patients with clinically organ-confined prostate cancer underwent laparoscopic radical prostatectomy. For evaluation of the learning curve, morbidity, oncologic, and functional results of the first 50 (group 1) and last 50 (group 3) procedures were compared. Results: The mean operating time and hospital stay was 289±66 minutes and 6.3±2.9 days, respectively. The median postoperative period of an indwelling Foley catheter was 5 days (range, 3-46 days). The intraoperative complication rate, including transfusion, was 15.3%. A positive surgical margin rate was 37.3%. After a mean follow-up of 33.5 months, a PSA relapse was observed in 39 (33.6%) patients. The continence rate was 77.1, 92.2, and 93.7% at 1, 6, and 12 months. Analysis of the learning curve revealed significant differences in the operating time, hospital stay, intraoperative complication rate, and indwelling Foley catheter days, whereas the postoperative complication rate, mean estimated blood loss, positive surgical margin rate, and continence rate 6 months postoperatively showed no influence. Conclusions: Although laparoscopic radical prostatectomy requires significant expertise with a learning curve, the morbidity is low and the oncologic continence result was promising. The learning curve for laparoscopic radical prostatectomy depends not only on the technical skills, but also on the self-perceived definition. It is likely that no complete plateau of the learning curve exists for any article. Standardized expectations and reporting of outcomes could help to better define the true learning curve for laparoscopic radical prostatectomy. (Korean J Urol 2008;49:879-885) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: We retrospectively evaluated the intraoperative and perioperative complications of 150 laparoscopic radical prostatectomies that were performed at our institution. Materials and Methods: Between July 2001 and March 2007, 150 consecutive patients underwent laparoscopic radical prostatectomy. The inpatient and outpatient medical records were reviewed. We divided the patients into three groups: the first 50 patients in group I, the middle 50 patients in group II and last 50 patients in group III. The major and minor complications were evaluated in each group. Results: The overall complication rate was 36%. The major complication rate was 7% and the minor complication rate was 29%. The major complication rate was 18% in group I, 2% in group II and 0% in group III. The minor complication rate was 48% in group I, 24% in group II and 16% in group III. The result showed that the complication rate declined with accumulating experience with laparoscopic radical prostatectomy (p

Purpose: We studied the role of the muscarinic receptor subtype on the urothelium and detrusor activity in rats with detrusor overactivity induced by bladder outlet obstruction (BOO). Materials and Methods: Forty Sprague-Dawley rats were used for this study. They were divided into 15 controls and 25 experimental rats. Partial BOO was induced for 3 weeks and a sham operation was performed on the control group animals. A cystometrogram (CMG) was performed in 20 BOO and 10 control rats. During the CMG, M2 selective muscarinic receptor antagonist (methoctramine) and nonselective muscarinic receptor antagonist (tolterodine) drugs were administrated intravesically. The contraction intervals and pressure were evaluated. Bladder muscle strips were prepared from five BOO and five control rats. The contractile responses were evaluated at 2-, 4-, 8-, 16-, and 32Hz field stimulation in the control and BOO groups and after administration of the methoctramine and tolterodine. Results: The results of the CMG showed that the rats in the BOO group had a decreased contraction interval and increased contraction pressure compared to the control group (p＜0.05). The contraction intervals were increased after intravesical administration of methoctramine and tolterodine compared to the BOO group (p＜0.05). However, the contraction pressures were similar among the methoctramine, tolterodine and BOO groups. For the muscle strip study, the BOO group demonstrated increased contractile responses compared to the control group (p＜0.05). However, the contractile responses were decreased after administration of methoctramine (only in 32Hz) and tolterodine (p＜0.05). Conclusions: The results of this study showed that detrusor overactivity induced by BOO in rats is primarily mediated by M3 muscarinic receptors in the detrusor muscle, and by M2 and M3 muscarinic receptors in the

Purpose: To analyze the predictors of the antimuscarinic treatment response for female patients with an overactive bladder (OAB). Materials and Methods: Eighty women diagnosed with an OAB, who had also undergone 3 months of treatment with propiverine hydrochloride (20mg/day), were enrolled. All patients were assessed by history taking, physical examination, urinalysis, frequency/volume charts and urodynamic study (UDS) prior to treatment; frequency/volume charts and a patients' satisfaction were analyzed 3 months after treatment. Patients were divided into satisfied, moderate and unsatisfied groups according to their subjective satisfaction. Results: Subgroups according to the patients' subjective satisfaction included 57, 14 and 9 patients for satisfied, moderate and unsatisfied group, respectively. In the UDS, detrusor overactivity was noted in 15 patients of the satisfied group, 2 of the moderate group, but none of the unsatisfied group. Maximum detrusor pressure and detrusor pressure at maximum flow were higher in the unsatisfied group. The incidence of bladder outlet obstruction (BOO) was higher in the moderate and unsatisfied groups. In pre-treatment frequency/volume chart, the frequency of urge symptom was significantly increased in the satisfied group. Comparing the preand post-treatment frequency/volume charts revealed that the satisfied and moderate groups showed decreased frequency and nocturia, and increased functional bladder capacity compared to unsatisfied group after treatment. Conclusions: The efficacy of antimuscarinic treatment in female OAB could be associated with the frequency of urge symptom, detrusor overactivity and BOO; an UDS may aid in predicting the efficacy of antimuscarinic treatment. (Korean J Urol 2007;48:66-71) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Currently, partial nephrectomy for patients with malignant renal tumors has become the procedure of choice for elective indications. Attempts have been made to use minimally invasive endoscopic procedures to replace the standard open partial nephrectomy. Laparoscopic partial nephrectomy can be technically challenging and be associated with vascular complications such as pseudoaneurysm. We report here on a case of renal artery pseudoaneurysm that occurred after laproscopic partial nephrectomy for renal cell carcinoma treated by percutaneous selective angioembolization.

Purpose: We compared the clinical and urodynamic findings of patients suffering with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) and who underwent transurethral resection of the prostate, and we tried to determine the effect of urodynamical obstruction and the bladder function on the result of this operation. Materials and Methods: 101 patients with LUTS/BPH were categorized in four groups based on the findings of the preoperative urodynamic study: 15 (14.8%) patients without bladder outlet obstruction [(BOO ( )], 50 (49.5%), patients with BOO [(BOO (+)], 12 patients (11.8%) with BOO and with detrusor underactivity (BOO+DU), and 24 patients (23.7%) with BOO and with detrusor overactivity (BOO+DO). The outcomes and satisfaction were analyzed by the changes of the International Prostate Symptom Score (IPSS) and the quality of life (QoL) index before and after transurethral resection of the prostate (TURP), respectively. Results: The Qmax was significantly high and residual urine was significantly low in group BOO ( ). The PdetQmax was significantly high in group BOO (+) and also in the BOO+DO group. In group BOO ( ), the decrease of the total IPSS was smaller than that noted in the other groups. There were significant decreases of the IPSS after TURP in groups BOO (+), BOO+DU and BOO+DO each voiding and storage subscore were decreased,but in group BOO+DO, the improvement was not as much as that in the other groups. The QoL was improved significantly in group BOO compared to the other groups. Conclusions: Performing urodynamics preoperatively helps to predict the degree of symptom relief, and a higherbaseline BOO positively predicts the postoperative improvement of the IPSS and the QoL. The outcome of the BOO+DU group was satisfactory, but storage symptoms still existed for the BOO+DO group. (Korean J Urol 2007;48:965-970)

Purpose: The popularity of a partial nephrectomy has grown as a consequence of the increased detection of small incidental renal masses. Herein, our experience of laparoscopic partial nephrectomies is reported. Materials and Methods: Between December 2003 and April 2006, 27 cases underwent a laparoscopic partial nephrectomy for renal tumors up to 4cm in diameter. The tumors, and an approximate 0.5cm margin around the tumors, were resected with cold scissors. Hemostasis was achieved with freehand suturing of the pelvocalyceal system and renal parenchyme, over the surgical bolster, using fibrin glue. Results: Transperitoneal and retroperitoneal approaches were chosen in 14 and 13 cases, respectively. Hilar clamping of small exophytic tumors was performed in all but 3 cases, with minimal parenchymal invasion. The mean renal tumor size was 2.5cm (ranging from 1 to 4cm). The mean operative and warm ischemia times, and blood loss were 193 minutes (ranging from 115 to 300) and 27.8 minutes (ranging from 15 to 43), and 493ml (ranging from 32 to 1,248), respectively. The mean hospitalization stay was 5.2 days (ranging from 3 to 8 days). Conversion to a laparoscopic radical nephrectomy was required in one case due to a positive frozen biopsy of the resection bed. There were no perioperative complications or open conversions. Histological examinations yielded a renal cell carcinoma in 20 cases, an angiomyolipoma or oncocytoma in 2 cases each, a lipoma in 1 and a leiomyosarcom in 2 cases, two of which had positive margins. One patient underwent selective angioembolization for an asymptomatic renal artery pseudoaneurysm three months postoperatively. All patients were alive, without any local recurrence or metastatic disease, at a mean follow up of 11.4 months (ranging from 3 to 24 months). Conclusions: A laparoscopic partial nephrectomy can be performed safely. However, long-term follow-up is required to compare its cancer control with that of an open partial nephrectomy. (Korean J Urol 2006;47:1256-1262) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Purpose: A laparoscopic radical nephrectomy is known to cause less morbidity than a traditional open radical nephrectomy. In our institution, the laparoscopic approach, with intact specimen removal, has become the standard technique for radical nephrectomies. Herein, we report the results and oncological outcome of the experience of a single center. Materials and Methods: We reviewed 68 transperitoneal laparoscopic radical nephrectomies, performed for suspected renal cell carcinoma between December 1999 and June 2006. All data were collected from the patient's medical records. Results: The mean tumor size, surgical time and estimated blood loss were 4.82cm (1.7-14), 228.5 min (120-480) and 409.1cc (32-1,312), respectively. Conversion to open surgery was required in one case due to Endo-GIA malfunction, and conversion to hand-assisted surgery was performed in one case. The histological findings were pT1, pT2 and pT3 in 40 (59.7%), 9 (13.4%) and 18 patients (26.9%), respectively. In one case, the histology confirmed a non-malignant disease. The follow-up period was from 3 to 80 months (median 18). Distant metastasis was observed in 2 cases, but there was no local recurrence or port metastasis. Conclusions: A laparoscopic radical nephrectomy is a safe and feasible treatment for localized renal cell carcinomas. Longer follow-up and large scale studies are necessary to evaluate the long-term survival and diseasefree rates, and confirm the effectiveness of performing a radical laparoscopic nephrectomy. (Korean J Urol 2006;47:1144-1148) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏