Iatrogenic Ureteral Injuries during Radical Hysterectomy: A Review of 23 Cases / 대한비뇨기과학회지

We reviewed 23 patients with iatrogenic ureteral injuries due to radical hysterectomy from May 1981 to April 1994. The overall incidence of iatrogenic ureteral injuries was2.2% and the incidences in cervical cancer stage I, IIa, IIb, and III were 1.2, 4.8, 8.4,and 11.1%, respectively. 13 cases(56.5%) were occurred in right side and 10(43.5%) in left side. The diagnosis of ureteral injury was made intraoperatively in 16 cases(69.6%) and postoperatively in 7 cases (30.4%). The ureteral injuries in intraoperative diagnosis group at recognition were complete transection 10 cases, partial transection 4 and ligation 2. The clinical findings of postoperative diagnosis group were ureterocutaneous fistula 4 cases, ureteral obstruction 2 and ureterovaginal fistula 1, and the presenting symptoms were fever 6 cases, urine leakage 5, flank pain 4. The treatments in intraoperative diagnosis group were ureteroureterostomy 7 cases, ureteroneocystostomy 5 and simple closure 4. In postoperative diagnosis group their treatments were initiated soon after establish of, the diagnosis and consisted of ureteroneocystostomy 3 cases, ureteral stenting with ureteroscope 2, ureteroureterostomy 1 and renal autotransplantation 1. The results were good in 10 cases(76.9%) of intraoperative diagnosis group and 4(57.1%) of postoperative diagnosis group. Of the 6 poor resulted cases 3 cases were managed with percutaneous nephrostomy, 2 cases with ureteral stenting and 1 case was expired due to sepsis. In 2 cases of postoperative diagnosis group and 2 poor resulted cases ureteral stenting with ureteroscope was successful. We concluded that the incidence of iatrogenic ureteral injuries was increased according to the cancer stage, and suggest that the ureteral stenting with ureteroscope is a first recommendable method in postoperative diagnosis group and early surgical approach would be better to the injured area whenever possible.

A Clinical Observation of 13 Testicular Embryonal Carcinomas / 대한비뇨기과학회지

We reviewed 13 patients with testicular embryonal carcinoma from July 1982 to May 1994. Embryonal carcinoma accounted for about 25% of total testicular tumors(13/56) and about 34% of nonseminomatous germ cell tumors(13/38). Among the patients with embryonal carcinoma, about 85% were diagnosed in the 15-to-34 year age group. About seventy percent of the patients had metastatic disease at the time of diagnosis and 66.7% of these had distant metastasis including by lung, bone, retroperitoneal lymph node and cervical lymph node, attesting to the aggressiveness of embryonal carcinoma and its tendency to early hematogenous spread. Serum AFP was elevated in 10 patients(76.9%) and hCG in 6 patients(46.2%). All patients with stage I (4/13) were treated with radical orchiectomy only, and all patients with stage II(3/13) were treated with radical orchiectomy and retroperitoneal lymph node dissection(RPLND) followed by chemotherapy. Of the patients with stage III(6/13), 4 patients were treated with radical orchiectomy and chemotherapy, and 2 patients with radical orchiectomy and early chemotherapy, followed by RPLND. The pathologic findings of lymph node at the time of RPLND in stage III were 1 residual embryonal carcinoma and 1 fibrosis. In stage I and II, all patients were still alive. In stage III, 2 patients were still alive for 22 and 48 months. Among the 4 expired patients, 2 were from lung metastasis and the others from sepsis might caused by chemotherapy. These results suggest that the radical orchiectomy only with close clinical observation for stage l had a good survival, and long term survival in stage II patients treated with radical orchiectomy and RPLND followed by chemotherapy will be expected. And in stage III, if the side effects of the chemotherapy is reduced, the better survival may be obtained.