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Results: The mean age was 77.7±2.5 years for the elderly group and 55.9±10.5 years for the young group. No significant differences existed between the groups in terms of mean operative time, intraoperative blood loss, complications, and hospital stay. However, American Society of Anesthesiologists (ASA) score, co-morbidities (p

Managing persistent and symptomatic urachal anomalies requires wide surgical excision of all anomalous tissue with a cuff of bladder tissue via the open approach. We report 7 cases with complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue. We expected that this technique would be less invasive and have lower morbidity. We report on the feasibility of this approach, including efficacy and outcomes. Eight patients with a mean age of 36.5 years who had symptomatic urachal diseases underwent laparoscopic excision between July 2004 and July 2012. With the use of four ports, the urachal remnant was dissected transperitoneally and then removed via the umbilicus port. The clinical results of laparoscopic urachal remnant excision as a minimally invasive surgery, the perioperative records, and pathologic results were evaluated. There were no intraoperative or postoperative complications. Mean surgery time was 2.7 hours. Mean hospital stay was 14.6 days. The patients with bladder cuff resection had a long admission and Foley catheterization period (mean, 14.4 and 11 days). Pathological evaluations were 6 cases of infected urachal cysts, 1 case of infected urachal sinus, and 1 case of urachal adenocarcinoma. We found no postoperative complications including any symptom recurrence or voiding difficulty during a mean follow-up of 46.3 months. The perioperative surgical outcomes achieved infection control and symptomatic relief and additionally good cosmesis. Complete laparoscopic removal of symptomatic urachal remnants with or without a cuff of bladder tissue seems to be a safe, effective, and better cosmetic alternative with the advantages of a minimally invasive approach.

The most common cause of vesicovaginal fistulasis injury to the bladder at the time of surgery. The operation most frequently responsible for vesicovaginal fistula formation is hysterectomy. The first successful transvaginal approach to vesicovaginal fistula repair was reported by Sims in 1838. Although many surgical procedures exist, there is no best approach for all patients with vesicovaginal fistula. However, it is an essential surgical principle that the fistulous tract and scar should be excised completely. Here we report our technique using a transurethral pointed electrode for the treatment of multiple, small vesicovaginal fistulas and its outcome.

Stone-containing urachal cysts are extremely rare in adults. Here, we report the case of a 58-year-old man with a urachal cyst who had lower abdominal pain and urinary frequency. Abdominal ultrasonography and computed tomography showed hyperdense stones in the urachus. He was treated with a laparoscopic excision using a transperitoneal approach. The pathological diagnosis was an inflammed urachal cyst. This rare case illustrates an inflammed urachal cyst containing stones treated with laparoscopy.

Background: Early oral intake (EOI) associated with early recovery of normal bowel function has been shown to be an important determinant for improving patients' satisfaction. We investigated the tolerability of EOI and its effects on the recovery of bowel function after epidural anesthesia. Methods: A prospective randomized trial of patients undergoing lower extremities surgery under epidural anesthesia was performed. A liquid drink was given to 150 patients in the EOI group 1 hours after surgery, and to 150 patients in the delayed oral intake (DOI) group 8 hours after surgery. We recorded presence of bowel sounds immediately after operation, symptoms of ileus, time to the first flatus, time to the first defecation, degree of appetite before the first meal, and patients' satisfaction. Results: There was no significant difference in the presence of immediate postoperative bowel sounds, the degree of appetite before the first meal, mild ileus, and severe ileus between groups. Time to the first flatus and time to the first defecation in the EOI group were shorter than those of the DOI group. The patients' satisfaction in the EOI group was higher than that of the DOI group. Conclusions: For uncomplicated patients undergoing lower extremities under epidural anesthesia, beginning oral hydration as early as 1 hour after the operation is safe and well tolerated and resulting in faster recovery of bowel function and higher patients' satisfaction. (Korean J Anesthesiol 2008; 55: 282~5)

There are 3 surgical treatments for the management of post-prostatectomy incontinence, including endoscopic injection of periurethral bulking agent, perineal sling procedure, and artificial urinary sphincter (AUS). 4 patients with post-prostatectomy incontinence in our hospital underwent sling procedure using polypropylene mesh. All patients were evaluated for urodynamic result, pad count, operative time, hospital stay, complication, success, and satisfaction. Mean age was 67.8years (64-75). Mean follow-up time was 38.5months (30-51). 2 patients underwent radical prostatectomy, and other 2 patients underwent transurethral prostatectomy. Of the 4 patients, 3 (75%) were successful. In satisfaction, 2 (50%) were unsatisfied due to recurrent incontinence and erectile dysfunction. The male sling procedure using polypropylene mesh is a simple, effective treatment and an additional therapeutic option. (J Korean Continence Soc 2008;12:81-87)

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