Biomedical subjects
Publications and source records attributed to Koon Ho Rha.
To overcome the technical difficulties of a third renal transplantation, we developed a refined technique. After native ureteral stenting, the subhepatic retroperitoneum was approached by way of a midline incision. The renal vein was sewn to the vena cava, the artery to the common iliac artery, and the ureter to the native stented ureter.
OBJECTIVES: To evaluate the functional and morphologic changes of the upper urinary tract after radical cystectomy and ileal conduit urinary diversion for bladder cancer. METHODS: Radical cystectomy and ileal conduit urinary diversion were performed in a total of 249 patients with bladder cancer at our hospital from 1980 to 1999. Of the 249 patients, 67 were excluded because of the presence of preoperative lesions in the upper urinary tract or elevated serum creatinine (greater than 1.4 mg/dL). Of the remaining 182 patients, 82 were also excluded because of incomplete follow-up or death less than 5 years after surgery. RESULTS: Of the 249 patients, a total of 100 (40.2%) who had no preoperative lesions in upper urinary tract and normal renal function and survived 5 years or longer were included in this analysis. The median follow-up period was 91 months (range 60 to 193). The serum creatinine was greater than the normal range in 10 patients (10.0%), and radiologic changes in the upper urinary tract were observed in 14 patients (14.0%). They had diabetes mellitus nephropathy (4.0%) or specific comorbidities that could contribute to the deterioration of the upper urinary tract, such as ureteroileal anastomotic stricture (4.0%), chronic pyelonephritis (4.0%), urinary stones (1.0%), and upper urinary tract tumor (1.0%). CONCLUSIONS: The results of our study have shown that the functional and morphologic changes in the upper urinary tract after radical cystectomy and ileal conduit urinary diversion occur in patients with specific comorbidities that could contribute to those changes. Different from previous reports, none of the upper urinary tract changes developed without an obvious cause.
OBJECTIVE: To review the cases of urinary tract injury following major pelvic surgery that were treated in our hospital over the last 12 years, in relation to possible predisposing factors and incidence rates of injury arising in various surgical procedures. MATERIALS AND METHODS: From 8,824 major gynecological operations performed in our department, 29 cases of intraoperative urinary tract injury were found. Thirty eight patients visited the urology department during the same period for the management of urogenital fistula following pelvic surgery. Parameters that were examined included type of urinary tract injury, indication for surgery, type of operation, coexisting pathological conditions, past history of pelvic surgery or pelvic irradiation, and the delay in the recognition and management of the urinary tract injury. RESULTS: The overall incidence of urinary tract injury in pelvic surgery was 0.33%. The incidence of urinary tract injury in radical hysterectomy was higher than that of total abdominal hysterectomy(0.76 vs 0.26%). Of the intraoperative urinary tract injuries, 48.4% coexisted pelvic pathologies. Of all the cases with urinary tract injury, the most common type of operation was total abdominal hysterectomy (n = 45, 67.2%), and the most common indication was uterine myoma (n = 25, 36.9%). The most common type of urinary tract injury was bladder injury, including bladder laceration and vesicovaginal fistula(n = 57, 76.1%). The frequency of reoperation was found to be lower in patients with a shorter delay in the recognition of the injury (p < 0.05). CONCLUSION: Possible predisposing factors for urinary tract injury are coexisting pelvic adhesion, distortion of normal pelvic configuration, previous irradiation history, previous operation history, and the extent of surgery. In high-risk patients, proper evaluation is needed to avoid urology complications before operation.
OBJECTIVES: To make clear the uncertainty of the clinical outcome of extramammary Paget's disease (EMPD). Penile and scrotal involvement of EMPD is exceedingly rare, and only small series or case reports have been reported. METHODS: From 1995 to 2003, 36 patients with penile and scrotal EMPD were treated and followed up. Local wide excision was done in all patients with or without intraoperative frozen biopsy analysis. RESULTS: Of the 36 patients, 13 (36.1%) underwent intraoperative frozen biopsy analysis and only 1 patient (7.7%) had a positive surgical margin. However, 23 (63.9%) underwent local wide excision with excessive surgical margins of up to 1 to 2 cm only by gross examination, but 17 (73.9%) of them had positive surgical margins (P <0.01). Of the 17 patients with positive surgical margins, 8 developed local recurrence at a median of 8 months of follow-up (P <0.05). One patient who had invasion to the subcutaneous tissue died of metastatic EMPD and internal malignancy (renal cell carcinoma) at 17 months after the initial operation. No patient had underlying adnexal carcinoma. CONCLUSIONS: The results of our study indicate that local wide excision with intraoperative frozen biopsy analysis is essential to the complete treatment of EMPD.
We report a case of a giant renal artery aneurysm causing hydronephrosis that initially had erroneously been thought to be a renal cyst. Giant renal artery aneurysms greater than 10 cm in diameter are very rarely reported. The aneurysm was repaired successfully with kidney preservation and closure of the arterial fistula.
We have devised a new surgical method of video-assisted minilaparotomy surgery-live donor nephrectomy (VAMS-LDN), which is a hybridized form of laparoscopic and open surgeries that combines the advantages of both. We present the findings of our series of 239 consecutive patients. Since 1993 we have performed 239 successful VAMS-LND. All 239 healthy kidney donors' characteristics and their postoperative courses were retrospectively reviewed and the data were compared to 95 open donor nephrectomies performed during the same period. The mean age and weight of the patients were 37.9 +/- 11.0 years and 62.4 +/- 7.9 kg, respectively. The mean operating time was 154 +/- 41 minutes, which was similar to open donor nephrectomy but shorter than laparoscopic donor nephrectomy. There were no major intraoperative complications except two tears to lumbar veins which required transfusion. The mean warm ischemic time was 2.1 +/- 0.7 minutes, which was equal to open donor nephrectomy. The patients experienced less postoperative pain and recovered quicker than the open donor nephrectomy patients. VAMS-LDN is a safe and minimally invasive technique for live donor nephrectomy, incorporating advantages of both conventional open and laparoscopic methods. We suggest that VAMS-LDN is a viable option for living donor kidney transplantation.
Minimally invasive surgery has gained wide acceptance as a method of reducing postoperative pain and curtailing the convalescence period. We have devised a modified surgical technique of video-assisted surgery through minilaparotomy (VAMS). This technique is a hybrid of conventional open and laparoscopic surgery that combines the benefits of both techniques by reducing postoperative pain and scarring, as in laparoscopy, but at the same time maintaining the safety of conventional open surgery. Video-assisted procedures have become standard as a result of our experience with 245 consecutive patients operated on between January 1993 and January 2001. The VAMS is a minimally invasive technique that is safe, feasible, standardized, and reproducible with a short learning curve. This technique can be an alternative to open and laparoscopic surgery in daily urologic practice.
OBJECTIVE: To evaluate whether the results of urodynamic tests and the perineal ultrasound were different between grade 1 and 2 stress urinary incontinence. STUDY DESIGN: Forty premenopausal women with a diagnosis of stress urinary incontinence according to urodynamic tests were enrolled in this study. Stress urinary incontinence was defined as urine leakage during stress without detrusor contraction. Twenty patients had grade 1 and 20 had grade 2 stress urinary incontinence. We compared the parameters of uroflowmetry, filling cystometry, urethral pressure profile, dynamic urethral function test, perineal ultrasound and stress urethral axis between grade 1 and 2 levels of stress urinary incontinence. RESULTS: There were no significant differences in age, parity or body mass index between the grade 1 and 2 patients. Uroflowmetry results showed that there were no significant differences in maximal flow rate, average flow rate, voided volume or residual urine between grade 1 and 2. As to cystometry results, only the first desire to void was significantly increased in grade 2 over 1 (304 +/- 113.65 vs. 194 +/- 48.24 [mL], P = .04). There were no significant differences in any of the urethral pressure profile parameters. In the dynamic test, the Valsalva leak point pressure and cough leak point pressure were not significantly different between the 2 groups. There were no significant differences in perineal ultrasound parameters or the stress urethral axis. CONCLUSION: Most stress urinary incontinence-related parameters showed no difference between the grade 1 and 2, and no urodynamic or ultrasonographic evidence for a difference between the grade 1 and 2 was demonstrated.
Disorders of the seminal vesicle have been evaluated mainly via imaging techniques. We developed a technique to examine the interior of seminal vesicles endoscopically. In 37 hemospermic patients, transrectal ultrasound (TRUS) or endorectal MRI were performed preoperatively. When the patients had definite abnormalities on the imaging studies and did not improve after medication over a period exceeding 3 months, transutricular seminal vesiculoscopy was performed using a 6F or a 9F rigid ureteroscope. Patients were then followed for at least 3 months. Endoscopic evaluation was also performed in two patients with stage B(1) and D(2) prostate carcinoma. In hemospermic patients, hemorrhage was found in the seminal vesicles or the ejaculatory ducts in 23 (62.2%) and 3 (8.1%), respectively. Calculi were present in the seminal vesicles or ejaculatory ducts in 6 (16.2%) and 2 (5.4%), respectively. In prostate carcinoma patients, seminal vesiculoscopy was similarly informative. Postoperative complications, including epididymitis or retrograde ejaculation, were not observed. Transutricular seminal vesiculoscopy can be performed easily with conventional endoscopic equipment and provides useful information.
BACKGROUND: Compensatory renal growth consists of cellular enlargement and a small but consistent increase in DNA content. It has been assumed that the increase in the total renal DNA content was due to new cell formation. METHODS: To test the hypothesis of whether cellular hyperplasia is the cause of the compensatory renal growth after the loss of the renal parenchyma and the timing of the DNA increase in neonatal rats, we performed cell cycle analysis using flow cytometry. RESULTS: Following unilateral nephrectomy, the maximum increases of neonatal cortical cells entering the S phase occurred at 72 and 120 h (9.4 and 9.6% compared to 7.0 and 6.1% of the sham-operated group). Peak increases of neonatal kidney cortical cells entering the G2M phase occurred at 48 and 72 h (4.3 and 4.6% compared to 3.3 and 3.9% of the sham-operated group). CONCLUSION: DNA synthesis and replication occurs during compensatory renal growth following unilateral nephrectomy in neonatal rats as evidenced by an increase in cells entering both the S and G2M phases. In neonatal rats these events appear to be completed within 48-120 h after nephrectomy.
The clinical reports on Sildenafil sulfate (Viagra) are mainly based on individual observations. However, there is a paucity of objective studies in the literature. In order to objectively examine the effect of Sildenafil, a SS (Sexual Stimulation)-Penogram that is a non-invasive, simple and physiologic method was developed using a radioisotope (RI). One hundred and four SS-penograms were performed on patients who had a documented erectile dysfunction (ED) lasting for more than 6 months. After an intravenous injection of 99mTc-RBC (15 mCi), the first penogram was taken immediately after sexual stimulation, which was done by 30 minutes of erotic videotape viewing. Forty minutes after administering 25 to 100 mg of Sildenafil, a second penogram was taken. The characteristics of each penogram were analyzed according to a previously reported method. The results were graded as follows; Type I(normal function; 5 min or more of peak erectile response with an induction period of 1 to 6 min), Type II-A (impossible function type; i.e., showing less than 2 times the basal radioactivity level), Type II-B (the unstable type; showing less than 5 min of peak erectile response), and Type II-C (the delayed type; which showed a delay of more than 15 min after the start of sexual stimulation). The patients were grouped according to their response after Sildenafil administration, and the effect of Sildenafil was assessed by comparing the radioactivity from between 7 to 22 minutes and the changes in the characteristics of the penogram. The mean age of the patients was 44.9 +/- 10.2 (23 - 68) years. In the first penogram, Type I was found in 12 patients, and Type II-A in 14, Type II-B in 73, Type II-C in 1 and a mixed (II-B + C) type was found in 4 patients. A second penogram after Sildenafil administration, showed Type I in 46 patients, and Type II-A in 10, Type II-B in 46 and a mixed type was found in 2 patients. The responses after Sildenafil were categorized as follows: 1) An excellent response group (consisting of 56 patients-53.9%); Those who showed greater than 50% increase in the RI area after Sildenafil treatment. 2) A good response group consisting of (23 patients-22.1%); i.e., those who showed a less than 50% but greater than a 20% increase in the RI area after Sildenafil administration. 3) A borderline group (consisting of 15 patients-14.4%); showing less than a 20% change in the RI area after Sildenafil treatment. 4) non-response group (consisting of 10 patients-9.6%). The therapeutic efficacy of Sildenafil, as determined by the SS-penograms, revealed that there was an augmentation in the erectile capabilities in 76% of men (79/104) but a non-response was observed in 9.6% (10/104). The efficacy of Sildenafil on the SS-penogram did not correlate with the patient's age (p=0.198). It is believed that the SS-penogram can be used to accurately evaluate the natural erectile status in sexual and pharmacological stimulation, and provides the most objective erectile response in any therapeutic trial. Consequently, the primary challenge for any erectile dysfunction remedy is to be able to demonstrate its efficacy. A further evaluation is warranted in the non-response group, which was not based on any severe organic dysfunction.
This purpose of this study was to establish a new standard for the surgical management of female genital fistula in Korea. From January 1992 to October 2001, 117 patients with female genital fistula who were admitted to the departments of obstetrics and gynecology, urology and general surgery were analyzed. Nine patients with congenital etiologies and 48 patients who were treated conservatively were excluded. The relationships between surgical outcome and the cause of fistula, the location of fistula, and the various surgical methods were analyzed. In spite of appropriate surgical treatment, fistulas due to cervix cancer management had the worst prognosis. In terms of location, fistula recurrence after surgical repair was most common in the bladder fundus and base. The transvaginal and transrectal approaches are suitable for fistulas located in the lower vagina. The transabdominal approach is appropriate for fistulas located in the functional portions such as the bladder and ureter, for fistulas which are difficult to expose surgically by either the vaginal or rectal approach, or in cases with severe adhesions. In cases of cervix cancer, extra care should be taken during surgical expiration or definitive radiotherapy, especially when the areas involved are the bladder fundus and base. The nature of the surgical approach should be decided by the location of the fistula, the functional importance of the area, and the degree of surgical exposure during the corrective procedures.
OBJECTIVE: To identify whether endogenous steroid hormone metabolism in women with pelvic organ prolapse (POP) is different from that in normal women and the relationship between endogenous steroid hormone metabolites and POP stage. STUDY DESIGN: Twenty postmenopausal women who were clinically diagnosed as having POP and 20 volunteer postmenopausal women without prolapse were included in the study. We compared the urinary profiles of endogenous steroids between the two groups and investigated the relationship between urinary profiles of endogenous steroids and degree of prolapse. Urinary profiles of endogenous steroids were assayed by gas chromatography/mass spectrometry. RESULTS: The ages of the patients and control group were 64.6 +/- 6.5 and 63.5 +/- 3.9 years, and the body mass index was 23.96 +/- 3.14 and 24.11 +/- 2.73 kg/m2 in patients and normal subjects, respectively. The number of patients were 4 at stage I, 4 at stage II, 6 at stage III and 6 at stage IV. 5-Androstene-3 beta,16 beta,17 beta-triol (5-AT), 11 beta-hydroxy an and 17 beta-estradiol were significantly increased in the POP group as compared with the control group (0.76 +/- 0.67 vs. 0.06 +/- 0.03 mumol/g creatinine, P = .002, 1.16 +/- 0.83 vs. 0.65 +/- 0.23 mumol/g creatinine, P = .04; and 15.08 +/- 9.81 vs. 8.53 +/- 6.19 mumol/g creatinine, P = .04). However, tetrahydrocortisone (THE) was significantly increased in the control group as compared with the patient group (9.80 +/- 6.21 vs. 5.22 +/- 4.89 mumol/g creatinine, P = .04). Androgen metabolites 5-AT and THE significantly correlated with the pelvic organ prolapse quantitation (POP-Q) stage (R = .418; P = .027; R = .46, P = .016). Among the estrogen metabolites, 17 beta-estradiol correlated with POP-Q stage, but not significantly so (R = .38, P = .05), and the 17 beta-estradiol/estrone ratio weakly correlated with stage (R = .14, P = .49). CONCLUSION: The metabolites of endogenous steroid hormones could be contributing factors in the pathogenesis of POP.
OBJECTIVE: To identify the relationship of obesity and stress urinary incontinence and of obesity and urodynamic parameters in patients with stress urinary incontinence (SUI). STUDY DESIGN: The study included 98 women who were clinically diagnosed as having stress urinary incontinence and 102 women, the control group, who had no stress urinary incontinence. We compared body mass index (BMI) as a parameter of obesity between the two groups. BMI was defined as weight (in kilograms) divided by height (in square meters). All patients with SUI underwent urodynamic tests, and we determined the relationship between BMI and urodynamic parameters by using the Pearson correlation coefficient. RESULTS: There was no difference in age between the two groups. However, BMI was significantly higher in women with SUI than in the control group. There were more vaginal deliveries and higher parity in women with SUI than in the control group. BMI was significantly higher in women with SUI than in the control group only in the younger group, while parity and number of vaginal deliveries were higher in the SUI group than control group among all age groups. The coefficient of multiple logistic regression between obesity and SUI was .131 (r = .131). There was no relationship between BMI and urodynamic parameters among patients with SUI. The average intraabdominal pressure was significantly increased in the obese group over that in the nonobese group. Correlation between BMI and intraabdominal pressure showed a close relationship. CONCLUSION: BMI was higher in the SUI group than control group. Obesity may be an important etiologic factor in SUI but did not influence urodynamic parameters, and there was no relationship between BMI and urodynamic parameters.