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Purpose There is some debate over the necessity of ureteral stenting after laparoscopic ureterolithotomy. We evaluated the need for ureteral stenting after retroperitoneal laparoscopic ureterolithotomy (RLU). Materials and Methods Between January 2009 and January 2013, 41 patients underwent RLU to remove upper ureteral stones. The retroperitoneal approach was used in all patients by a single surgeon. A double J (D-J) stent was placed in the first 17 patients after the procedure but not in any of the next 24 patients. Results The mean patient age, serum creatinine levels, and stone size were not significantly different between the two groups. The stone-free rate was 100%. The mean operative time was significantly shorter in the stentless group than in the stent group (59.48 minutes vs. 77.88 minutes, p

Purpose: Prostate cancer is rare in men younger than 50 years. Digital rectal examination (DRE) and measurement of prostate-specific antigen (PSA) concentrations are standard screening methods for detecting prostate cancer. We retrospectively investigated the risks and benefits of repeated transrectal ultrasonography-guided prostate needle biopsies in relation to the follow-up status of men younger than 50 years with a consistently high PSA concentration (＞3.0 ng/mL). Materials and Methods: During the period from January 2000 through February 2013, we reviewed patient’s ages, dates of procedures, DRE results, frequencies of biopsies, results of the biopsies, periods of follow-up, PSA concentrations, and prostate volumes in Chonbuk National University Hospital records. We conducted telephone interviews in patients who did not undergo regular follow-up. Results: The mean age of the patients was 44.7 years, and the mean PSA concentration was 8.59 ng/mL (range, 3.04–131 ng/mL) before biopsy. The PSA concentration was significantly different (p＜0.001) between the patients with prostate cancer and those with benign prostatic hyperplasia (BPH). Nineteen patients underwent repeated prostate biopsy; however, in only one patient did the pathologic findings indicate a change from BPH to prostate cancer. We identified several complications after transrectal biopsy through an evaluation of follow-up data. Conclusions: All patients with benign prostatic disease based on their first biopsy were shown to have benign disease based on all repeated biopsies (15.83%), except for one patient; however, several complications were noted after biopsy. Therefore, the risks and benefits of repeated biopsy in young patients should be considered because of the low rate of change from benign to malignant disease despite continuously high PSA concentrations (＞3.0 ng/mL).

Purpose: Papillary “Randall’s plaques” are theorized to act as nidi for urinary stone formation. In this study, we used endoscopic examination and intraoperative biopsy of renal papilla in stone formers undergoing percutaneous nephrolithotomy (PNL) to investigate the correlation between Randall’s papillary plaque and primary stone composition and metabolic risk factors. Materials and Methods: A total of 34 patients with renal stones were enrolled. During PNL performed for stone removal, biopsy specimens were taken from selected papilla. We evaluated constituents such as volume, sodium, uric acid, calcium, oxalate, and citrate from 24-hour urine samples, and calcium, sodium, uric acid, phosphate, potassium, and chloride from serum samples 1 month after PNL. Results: We identified Randall’s plaque in 26 patients as irregular, whitish lesions, generally located on the papillary tip. We performed intraoperative biopsies of papilla in the kidneys of stone formers and of known regions of crystal deposits in the interstitial tissue surrounding the ducts. There was no correlation between serum variables, 24-hour urine constituents, and presence of plaque. However, 24-hour urine volume was negatively correlated with the presence of plaque. The incidence of papillary plaques varied with the primary composition of extracted stones and was 80% for calcium oxalate, 92% for calcium phosphate, 50% for uric acid, and 25% for struvite stones (p=0.035). Conclusions: The incidence of papillary Randall’s plaques in patients with nephrolithiasis varied with the primary composition of formed urinary stones. Randall’s plaques are found in most patients with calcium stones. Our findings suggest that the presence of papillary plaque is associated with calcium nephrolithiasis and may contribute to the pathogenesis, treatment, and prevention of calcium urinary stones. (Korean J Urol 2009; 50:1009-1013) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Seong Beom Choi, Myung Ki Kim, Young Beom Jeong, Jong Kwan Park, Hyung Jin Kim, Young Gon Kim From the Department of Urology, Chonbuk National University Medical School, Institute for Medical Sciences, Jeonju, Korea Post-traumatic arteriovenous fistula (AVF) and pseudoaneurysm are rare, and mostly occur in stab wound patients. Suspected AVF and pseudoaneurysm requires angiography, with planned simultaneous embolization. Superselective embolization is generally a safe and effective treatment modality for AVF and pseudoaneurysm with minimal associated morbidity. Rare complications of the embolization do occur, including renal abscess, postembolization syndrome, impaired renal function, pulmonary embolism caused by migration of coils, and allergic reaction. We present here the case of a man who presented with a newly discovered pseudoaneurysm after embolization of a renal AVF with pseudoaneurysm after a renal stab wound. (Korean J Urol 2009;50:816-818) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

17개월 남아 환자가 방사선 동위원소를 이용한 배뇨중방 광요도조영술 도중 복강 내로의 비정상적인 방사선 동위원 소 누출로 전과되었다. 과거력에서 생후 3개월 때 좌측 신 우신염의 기왕력이 있었고 당시 시행한 배뇨중방광요도조 영술에서 좌측으로의 grade I 방광요관역류를 진단 받았으 며, 신초음파와 신주사상 특이소견은 없었다. 예방적 항균 치료를 시행하였으며 도중에 요로로감염은 없었다. 추적검 사로 방사선 동위원소를 이용한 배뇨중방광요도조영술을 시행하였다. 6Fr 도뇨관 (Foley catheter)을 요도에 삽입하고 잔뇨를 제거한 후 방사선 동위원소와 생리식염수를 혼합한 용액 100cc를 주사기를 이용해 주입하고 도뇨관을 제거하 였다. 배뇨기에 갑작스런 복강 내 비정상적인 방사선 동위 원소 누출이 관찰되었다 (Fig. 1). 신체검사에서 복부 팽만 이 있었으며 압통이 있었다. 확진을 위해 조영제를 이용한 배뇨중방광요도조영술을 받았으며 복강 내로의 방광파열 로 진단되었다 (Fig. 2). 환아는 응급수술을 시행하였고 방 광 천정부에 약 1.5cm의 복강 내로의 방광파열 소견을 보여 파열부를 봉합하였으며 다른 부위의 방광은 정상 소견을 보였다. 술 후 7일째 도뇨관을 제거하였으며, 현재까지 자 연배뇨를 잘 하고 있다.

Purpose: Increasing evidence suggests that Randalls plaque contributes to the pathogenesis of urinary stone formation. The purpose of our study is to compare the incidence of the abnormal metabolic stone risk factors between the calcium stone former with papillary calcification and the calcium stone former without papillary calcification on unenhanced spiral computed tomography (CT). Materials and Methods: A series of patients with calcium stones (n=49) underwent unenhanced spiral CT and complete metabolic evaluation after they consumed a random diet for 1 month after stone removal. Of the 49 patients, 38 patients showed papillary calcification on unenhanced spiral CT and 11 patients did not. Their blood was evaluated by using a multichannel analysis sequential multichannel autoanalyzer (SMA)-20 and PTH tests. The 24-hour urinary constituents were assayed for calcium, oxalate, citrate, total volume, phosphorus and sodium. We compared the incidence of abnormal metabolic risk factors between the two groups. Statistical analysis was performed by chi-square tests. Results: The incidences of hyperuricemia were 27.3% in the patients without papillary calcification and 31.6% in the patients with papillary calcification. The incidences of hypernatriuria were 18.2% versus 42.1%, the incidences of hypercalciuria were 36.4% versus 26.3%, the incidences of hyperuricosuria were 18.2% versus 18.4%, the incidences of hyperoxaluria were zero versus 28.9%, and the incidences of hypocitraturia were 45.5% versus 44.7%, respectively. The difference between the two groups was statistically significant only for hyperoxaluria (p=0.043). Conclusions: Hyperoxaluria is the only metabolic risk factor that more frequently occurred in the patients with papillary calcification. Our date suggest that hyperoxaluria may be an important factor in the pathogenesis of papillary calcification. (Korean J Urol 2006;47:507-511)

Purpose: We investigated the biochemical characteristics of serum and urine in the patients suffering with uric acid stone. Materials and Methods: A total of 99 patients suffering with uric acid stone underwent routine urine analysis and 24-hour urine analysis for determining the urinary calculi risk factors. We conducted serum analysis for the stone risk factors and also analysis of the stone analysis. To compare the stone risk factors, 93 patients with calcium stone were identified and then the biochemical risk factors in the serum and urine were evaluated. Results: The mean age of patients with uric acid stone was 56.5±12.4 years and the mean age of the patients with calcium stone was 40.2±11.5 years. Serum uric acid, cholesterol and triglyceride were all significantly increased in the patients with uric acid stone compared to that in the patients with calcium stone. The patients with uric acid stone showed a lower urinary pH and also lower urinary uric acid and citric acid excretion compared with those patients with calcium stone. The composition of the uric acid stone was mixed with calcium in 63.6 percent of the stones and 36.4% of the stones were pure. Conclusions: The patients with uric acid stone had higher serum uric acid, cholesterol and triglyceride, and they had a lower urinary pH and lower uric acid and citric acid excretion as compared with the patients with calcium stone. Uric acid-calcium mixed stone was most common in the patients with uric acid stone. There is a great likelihood of uric acid stone in the patients with stone who have one or more of the above mentioned biochemical characteristics. Therefore, these factors are important to conduct metabolic evaluation for preventing stone recurrence. (Korean J Urol 2006;47:712-716) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Purpose: In order to identify the stone risk factors for stone patients with hypertension, we analyzed the stone metabolic studies of stone patients with hypertension and stone patients without hypertension. Materials and Methods: Between January 1998 and December 2005, we analyzed 92 urinary calculi patients with hypertension, and we also 210 urinary calculi patients who had no history of hypertension as a control group. Hypertension was defined as systolic blood pressure >140 mmHg or a diastolic pressure >90mmHg or both, or those patients who were on drug therapy for hypertension. We evaluated such metabolic risk factors as calcium, sodium, potassium, chloride, uric acid, oxalate, phosphorus, the total urine volume and urine citrate level of the 24-hour urine collection, and the uric acid, calcium, phosphorus, cholesterol, triglyceride from the serum. Results: The mean age was 53.2±11.2 in the hypertensive group and 48.4 ±14.0 in the normotensive group. There were significant differences between the hypertensive group and the normotensive group for the body mass index (BMI) (28.7±0.9kg/m vs 25.1±1.1kg/m, respectively), weight (73.2±3.2kg vs 67.4±2.1kg respectively) and urine calcium (262.4±21.7 mg/day vs 205.2±22.3mg/day respectively), uric acid (662.7±184.3mg/ day vs 578.3±179.2 mg/day respectively). Moreover, there were significant differences between the two groups for total cholesterol (198.5±47.4mg/dl vs 167.1±42.5 mg/dl respectively) and triglyceride (207.5±109.5mg/dl vs 160.8±107.1 mg/dl respectively). Conclusions: Our results suggest that higher urinary calcium excretion and higher uric acid excretion appear to be the characteristic risk factors in the hypertensive group. Hypercholesterolemia, hypertriglyceridemia and an excessive BMI are also related to stone patients with hypertension. (Korean J Urol 2006;47:928-932) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Purpose: We evaluated the advantages of the two-stage procedure for percutaneous nephrolithotomy (PNL) for the management of renal calculi. Materials and Methods: Between November 1999 and November 2003, 49 patients with renal calculi were treated with one-stage or two-stage PNL. The medical records of all the patients were retrospectively reviewed for complications associated with percutaneous nephrostomy (PCN), stone size, operation time, success rate, treatments for the postoperative remnant stones, the hospital stay and the complications associated with operation. Results: Thirty cases underwent two-stage PNL and 19 cases underwent one-stage PNL. The mean age of the one-stage PNL group and the twostage group were 55.6±14.7 years old and 58.9±12.5 years old, respectively. There were no significant differences between the two-stage PNL and one-stage PNL for the complications associated with the PCN procedure, stone size, the success rate and the hospital stay. The total operative time was significantly different between the two-stage and one stage PNL groups (136.1±51.6 min vs 191.1±56.9 min, respectively, p=0.02). Eleven total patients with postoperative remnant stones underwent additional extracorporeal shock wave lithotripsy in 8 cases, ureteroscopic removal of stone in 2 cases and PNL in 1 case. The complications associated with two-stage and one-stage PNL were fever, ureteral obstruction by fragmented stones, A-V fistula and discharge through the percutaneous nephrostomy catheter. Conclusions: Two-stage PNL is a more effective approach for the patients with renal calculi comparing to one-stage PNL in terms of the operation time, the operation-associated complications and the psychological and physical pressures on the patients and operators. (Korean J Urol 2006;47: 512-516) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ