, Dong Hyeon Lee, Kwang Hyun Kim, Dong-Ryeol Ryu, Seung-Jung Kim, Duk-Hee Kang, Kyu Bok Choi, Shina Lee Metabolic acidosis frequently develops in patients after neobladder reconstruction. However, the incidence of metabolic acidosis in patients with neobladder and the factors associated with the development of metabolic acidosis have not been well elucidated. We aimed to investigate the incidence and the potential predictors for the development of metabolic acidosis after neobladder reconstruction with intestinal segment.
We included patients who underwent neobladder reconstruction using intestinal segment at Ewha Womans University Mokdong Hospital between January 1, 2005 and December 31, 2014. A subgroup of patients according to the time of metabolic acidosis occurrence was further analyzed in order to characterize predictors for metabolic acidosis.
Metabolic acidosis was encountered in 79.4% of patients with neobladder during follow up period. When patients were divided into 2 groups according to anion gap (AG), total CO2 (18.9±2.1 mEq/L vs. 20.0±1.3 mEq/L, P=0.001) and chloride (106.6±4.9 mE/L vs. 109.4±3.6 mEq/L, P<0.001) were significant different between groups with AG>12 and AG≤12. Furthermore, when patients were divided into 3 groups; patients with metabolic acidosis at postoperative day (POD) 1; from POD 2 to 14 days; after 14 days, there was significant difference among those subgroups.
Our study showed the rate of metabolic acidosis in patients underwent neobladder reconstruction and the difference between patients with metabolic acidosis and those without metabolic acidosis for the first time in Korea. In the future, well designed prospective study will be needed to prevent metabolic acidosis after neobladder reconstruction.
, Dong Hyeon Lee Robot-assisted laparoscopic radical cystectomy (RARC) for the treatment of muscle invasive bladder cancer is being increasingly applied. Radical cystectomy is complex procedure which should be performed with extensive lymph node dissection and urinary diversion. Currently, the techniques of RARC are well-described, and the feasibility and safety of RARC has been demonstrated. While extracorporeal approach is preferred method for urinary diversion, intracorporeal urinary diversion is gaining popularity. Positive surgical margins are similar to large open series but inferior for locally advanced disease. However, local recurrence and survival rates seem equivalent to open series at short and mid-term follow up. Randomized controlled trial should be conducted to rigorously assess the oncologic outcomes of RARC compared to open radical cystectomy.
, Jun Young Shin, Sang Hun Lee, Sung Jae Park, Dong Won Byon, Dong Hyeon Lee A 41-year-old male visited Ewha womans university hospital with the symptom of frequency, dysuria and residual urine sensation. We could find a Mullerian duct cyst by Transrectal ultrasonography(TRUS) and MRI image. Mullerian duct cyst was incised by transutricular seminal vesiculoscopy(TUS). The symptom was decreased significantly after surgical treatment. Presently, We report this case with a review of the Mullerian duct cyst.
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