Urology Journal

Purpose: To investigate and compare the stone clearence and complication rates of flexible ureteroscopy (URS) with semirigid URS in patients having proximal ureteral stones. Materials and Methods: The data of 124 patients with proximal ureteral stones who underwent semirigid or flexible ureterorenoscopic lithotripsy between March 2008 and December 2012 were retrospectively investigated. The patients were divided into 2 groups according to the operation types. Group 1 included 63 patients who were treated with semirigid URS and group 2 was consisted from 61 patients who underwent flexible URS. Each group was compared in terms of stone diameter, successful access to the stone, operation time, reoperation rates, stone free status at postoperative 1st and 3rd month and complications. Results: Successful access was achieved in 48/63 (76%) of the cases in group 1 and 57/61 (93%) of the patients in group 2 (P < .05). Initial stone free status was 63.4% (40/63) and 86.8% (53/61) in groups 1 and 2, respectively (P < .05). Third month radiologic investigations revelaed a stone free rate of 77.7% (49/57) in group 1 and 93.4% (57/61) in group 2 (P < .05). Reoperation was required in 20.6% (13/63) of cases in group 1 and this value was only 6% (4/61) in group 2 (P < .05). There was not any statistically significant difference between 2 groups in terms of complication rates (P > .05). Conclusion: Flexible URS is a favorable option for patients having proximal ureteral stones with higher stone free rate; on the other hand semirigid URS seems a less successful alternative for treatment of proximal ureteral stones.

Purpose: To analyze the characteristics of nonmetastatic papillary renal cell carcinomas (RCC) and the prognostic value of RCC histologic subtyping, based on a large multicenter experience in Korea. Materials and Methods: A total of 2,905 patients with nonmetastatic RCC (TxN0M0) at the time of surgery were retrospectively enrolled from five institutions between 1999 and 2011 in Korea. Among these, patients with clear cell subtype (n = 2,488, 85.6%) and papillary subtype (n = 192, 6.6%) were included in our study. Results: Patients with papillary subtype did not differ significantly from those with clear cell subtype on the following parameters: age (P = .694), gender (P = .511), body mass index (P = .136), patient performance status (P = .419), symptoms at presentation (P = .419), tumor size (P = .778) and pathologic stage (P = .367). However, high Fuhrman’s grades were more common in papillary subtypes compared with clear cell subtypes (P = .001). The 5-year recurrence-free survival rates in patients with clear cell subtype and papillary subtype were 84.9% and 86.7%, respectively (P = .167). The 5-year cancer-specific survival rates in patients with clear cell subtype and papillary subtype were 92.0% and 93.1%, respectively (P = .931). Histologic subtype was not an independent prognostic factor of recurrence-free and cancer-specific survival (P = .107 and P = .998, respectively). Conclusion: Our study suggests that the characteristics and prognosis of papillary subtype might be comparable to those of clear cell subtype in non-metastatic renal cell carcinoma, especially in Asia.

Purpose: To determine the proportion of benign and malignant testicular lesions among patients with nonpalpable incidental testicular masses. Methods and Materials: Ten patients with nonpalpable incidental testicular masses underwent surgical exploration. Surgery was performed via an inguinal approach with temporary cord occlusion and frozen section examination (FSE) of the lesions. Benign findings allowed for testicular sparing surgery (TSS), whereas cancer prompted total orchiectomy. Results: The lesions measured 6-19 mm in the largest diameter. Four of the 10 lesions were benign (40%) and TSS was accomplished in these cases. Complete concordance was observed between the results of FSE and permanent histopathology examination. Of the six patients with cancer, four had pure seminoma and two were mixed germ cell tumor. Surveillance was applied in four of these patients, radiotherapy was used in one patient with seminoma and retroperitoneal lymph node dissection was done in one patient with mixed germ cell tumor. With an average follow-up duration of 24 months, all patients were alive and free of disease. All four patients in whom TSS was accomplished had an uneventful postoperative course, and after an average follow-up duration of 20 months, all had normal results in scrotal physical examination and ultrasound. Conclusion: Malignant lesion always should be considered in nonpalpable incidental testicular masses and surgical exploration is mandatory. TSS is safe and effective in patients with small benign lesions. Cancer is reliably detected by FSE.

Purpose: The control of the Dorsal Venous Complex (DVC) is crucial to the recovery of urinary continence during Laparoscopic Radical Prostatectomy (LRP). The size of DVC may affect the venous control. We developed a trick to simplify the suturing of the DVC. Materials and Methods: Forty-seven patients with localized prostate cancer were divided in two groups: group 1 (n = 24) underwent LRP with a conventional ligature of DVC, and in group 2 (n = 23) the venous control was done with “Narrowing” of DVC technique (N-DVC). Our technique involves maintaining pressure on a metallic urethral sound inserted into the urethra, just at the time of ligature. The width of DVC in group 2 was measured before and after applying the technique. The numbers of attempts to place the stitch adequately were recorded and compared in both groups. The demographic dates, perioperative dates and results were compared retrospectively. Results: Operative time, estimated blood loss, prostate weight, positive surgical margins rates and potency results showed no significant differences between the groups. The immediate 1-month, and 3-month continence rates were significantly greater in group 2 (30.4% vs. 12.5%, P = .048; 73.9% vs. 50%, P = .037, respectively). For all patients in group 2, width of DVC decreased and the ligation stitch was effective at the first attempt. In 37.5% of patients in group 1, the controlling of the DVC was obtained in more than one attempt. Conclusion: The N-DVC simplifies the control of DVC during LRP and may contribute to the early recovery of continence.

Purpose: Although laparoscopic partial nephrectomy (LPN) has been increasingly adopted in the treatment of small localized renal tumor, technical changes remain nowadays. The current study aimed to evaluate the safety and efficacy of the novel QUILLTM Self-Retaining System (SRS) for renorrhaphy during LPN. Materials and Methods: Sixty-eight patients with kidney neoplasm that accepted LPN at the Peking Union Medical College Hospital from July 2010 to March 2013 were retrospectively analyzed. Thirty-five patients who received renal sutures with QUILLTM SRS constituted group 1. The control group (group 2) was composed of 33 patients who received standard absorbable Vicryl sutures by the same surgeon. Renorrhaphy was performed in both groups using two layers, with a closure of the deep vessels and collecting system, followed by a running closure of the renal capsule. The demographic and perioperative parameters (gender, laterality of the tumor, body mass index (BMI), tumor size, standardized nephrometry scoring system (R.E.N.A.L. Nephrometry Score), estimated blood loss and warm ischemic time (WIT)) were compared between the groups. Risk factors of WIT and blood loss were analyzed using logistic regression analysis. Results: Renorrhaphy was successfully completed in both groups. The baseline data of two groups did not differ significantly. Logistic regression analysis showed WIT decreased when the QUILLTM SRS was used (21.8 ± 3.5 min vs. 25.6 ± 4.0 min; ? = -4.109, P < .001). Suture methods were an independent predictor of WIT rather than blood loss (115.7 ± 57.9 mL vs. 137.9 ± 68.5 mL; P = .329). Conclusion: QUILLTM SRS can be effectively and safely used for renorrhaphy during LPN with the potential advantage of shortening WIT.

Purpose: To present the clinical experience in the management of Skene’s duct cysts (paraurethral cysts) in women. Materials and Methods: A retrospective chart review of patients who have underwent surgical treatment for paraurethral cyst between 2002 and 2012 was performed. A total of 85 women were diagnosed with paraurethral cyst over a 10-year period. The paraurethral cysts were detected at vaginal examination. Evaluations consisted of urine analysis and culture and urinary tract ultrasound. The first 20 cases underwent cystourethroscopy as well. All patients underwent surgical incision, drainage and marsupialization of the cyst. They were followed for evidence of any complications and recurrence. Results: The mean follow up time was 5.5 years. Totally, 83 patients (97.6%) were cured. There were two cases of recurrence which were treated with second surgical attempt. Conclusion: Most paraurethral cysts in women may be diagnosed by history and physical examination alone. Simple incision and marsupialization of the female paraurethral cyst was effective in more than 97% of our patients, without recurrence.

Purpose: To investigate the long term effects of laparoscopic varicocelectomy (LV) and microsurgical subinguinal varicocelectomy (MV) on ipsilateral testicular microcirculation using Color Doppler Flow Imaging (CDFI). Materials and Methods: A total of 29 patients with left varicocele who underwent LV and 30 patients who underwent MV were examined with CDFI for intratesticular flow parameters before and at 3- and 6-month after surgery. Preoperative and postoperative semen parameters were also evaluated. Results: The mean values of peak systolic velocity, pulsatility index (PI) and resistive index (RI) of capsular artery (CA) and intratesticular artery (ITA) decreased significantly after LV and MV, whereas no significant change was observed in end-diastolic velocity. Comparing between two groups, the PI and RI values of left CA and ITA on 3rd month and of ITA on 6th month postoperatively in MV group were significantly lower than those in LV group. LV and MV resulted in a statistically increase in the sperm density, morphology and total motile sperm count. Moreover, the PI and RI values of ipsilateral CA and ITA seemed negatively correlated with sperm quality. Conclusion: A significant improvement occurs in testicular blood supply and sperm parameters after either LV or MV, among MV advances an early and a more obvious hemodynamics promotion than LV. The values of RI and PI of ipsilateral CA and ITA are two important indexes for the prognosis after varicocelectomy.