Extracorporeal Shock Wave Lithotripsy in 17 Children / 대한비뇨기과학회지

A total of 17 children with 24 renoureteral units underwent 58 treatment with EDAP LT-01 extracorporeal shock wave lithotripsy for urinary tract stones between January 4, 1989 and January 30, 1993. The patients were followed for over two months. The results were obtained as follows ; 1. The distribution of sex was 9(53%) in male and 8(47%) in female. The average patient age was 7 years with a range of 6 months to 16 years. 2. The location of stones were kidney in l8 cases( 75.0%) ; calyx in 10 (41.7% ) and renal pelvis in 8(33.3% ) and ureter in 6(25.0%) ; upper ureter in 2(8.3%) and lower ureter in 4( 16.7%). There were multiple renal stone in 4 and bilateral renal stone in 2. The average stone length was 9mm with a range of 3 to 10mm. 3. Of the 13 patients whose age was less than 10 years, 11(84.6%) required intravenous Ketamine anesthesia. Two patients whose age was more than 10 years and two patients less than 10 years were treated without any type of anesthesia. 4. The average numbers of treatment were 2.1 session and the average storage required was 19.4 in one session The average treatment time was 39.7 minutes. 5. The total average success rate was 87.5% 6. All of the patients were not the pre- and post- ESWL additional manipulation. ESWL complications did not require admission and surgical management. Therefore, we conclude that EDAP LT-01 is an effective and easy procedure for treatment of urinary stones in children.

Urinary enzyme levels after ESWL for renal stone / 대한비뇨기과학회지

ESWL is a safe and effective treatment for renal calculi. However, on destruction of the stone, the pressure of shock waves produces renal microdamage. Urinary enzyme testing has been used to diagnosis and monitor various types of renal injured. Three urinary enzymes, N-acetyl-beta- glucosaminidase, beta-galactosidase, gamma-glutamyl transferase in 24 hour urine were monitored in 20 patients before and after ESWL and in 5 controls. The ESWL, a single session treatment, was performed using EDAP LT-01. The amount of the shock wave treated was same regardless of stone size and location. The results were obtained as follows. 1. Post-ESWL N-acetyl-beta-glucosaminidase level was higher than that of control on day 1 and showed a rapid decrease on day 3, and returned to normal by day 28. 2. Post-ESWL beta-galactosidase level was higher than that of control on day 1 and was still higher on day 7, and returned to normal by day 28. 3. Post-ESWL gamma-glutamyl transferase level reached to a peak on day 1 and showed a rapid decrease on day 3, and returned to normal by day 28. In summary, ESWL for renal stones elevates urinary enzymes transiently, which was on peak one day after the treatment and returned to nearly normal level by 1 month after the treatment. Therefore, urinary enzymes seem to be useful in evaluation of the functional recovery of the kidney after ESWL.

Ultrastructural changes of human testis after vasectomy / 대한비뇨기과학회지

Vasectomy is one of the most common forms of male contraception throughout the world. However, more vasectomy reversals are sought each year because of the increasing number of second marriages and other causes. Before recommending vasectomy, urologists may wish to resolve in their own mind the conflict between reports that maintain the testis is harmed by vasectomy and those that slate is not. We studied a group of patients undergoing vasectomy reversal to determine whether histopathologic change on light and electron microscopy would be detected. Only one testis specimen from post-vasectomy patients showed an abnormality correlated with spermatogenesis and five cases showed mild focal interstitial fibrosis without abnormality of spermatogenesis on light and electron microscopy. We found that vasectomy has some influence to the spermatogenesis and pathologic change.

A case of atypical carcinoma of the kidney / 대한비뇨기과학회지

Atypical carcinoma of the kidney arising from the epithelium of renal collecting duct is a rare disease. Clinical manifestations are mimicking that of the renal cell carcinoma. Diagnosis is confirmed by pathology with immunocytochemical study(cytokeratin) using immunoperoxidase technique. Management is not discussed here. The prognosis is poor with a relatively rapid progression of the disease. We present a case of atypical carcinoma of kidney in a 56 years old male patient with brier review of the literature.

A case of perinephric cyst / 대한비뇨기과학회지

The perinephric cyst in which cystic structures are in close relation to the kidney and renal pelvis is rare in occurrence. The causes may be obscure but most perinephric cysts around the kidney are a result of trauma, either accidental or an operative complication and doubtful origin, in which there is an encysted collection of urine or serous fluid lying beside and sometimes compressingthe kidney, and sometimes communicating with the pelvis. Clinical presentation is characterized by palpable flank mass and history of trauma. The diagnosis is made by excretory urography, ultrasonogram and CT scan. The treatment is aspiration or encleation of the cyst, or rarely nephrectomy. We report a case of perinephric cyst with hypertension developed in a 58-year-old woman presented with a child-fist sized palpable mass on right upper abdomen.

Clinical evaluation of urethral strictures following urethral catheterization / 대한비뇨기과학회지

A clinical evaluation was made on 19 patients with urethral stricture following urethral catheterization in 155 urethral stricture patients during 12 years from January. 1979 to December. 1990. The following results were obtained. I. In 155 cases of urethral stricture, iatrogenic urethral stricture was 24 cases (15.4%) of which the most common cause was urethral catheterization(19 cases) and followed by instrumentation (2 cases). 2. In 19 cases of urethral stricture following urethral catheterization. the most common site was the anterior urethra (bulbous 10 cases. pendulous 7 cases) and multiple strictures showed 5 of 17 anterior urethral strictures. 3. In 19 cases, 16 cases (84.2%) occurred in patients who have kept the urethral catheter within seven days and 18 cases (94.7%) were inserted and cared the urethral catheter by non-urologist. 4. Treatment was performed internal urethrotomy in 16, dilatation in 2 and catheter indwelling during 1 week in 1. 5. In 24 cases of iatrogenic urethral stricture. mean number of dilation to recurrent strictures after primary procedure had required O.5 time. From our results. we suggest that education for the careful insertion and method of care for the urethral catheter to non-urologist is least likely to induce urethral stricture formation.

A case of the renal medullary fibroma / 대한비뇨기과학회지

Renal medullary fibromas which are arisen from the interstitial cell of the renal medulla show small, multiple nodules on autopsy Findings over age 50, but they are very rare clinically. thus several cases have been reported until 1982. When the tumors are large. their clinical presentation is characterized by loin pain, hematuria and palpable mass. The preoperative diagnosis with radiologic studies is very difficult and the confirmative diagnosis was made with pathologic finding. Nephrectomy has been the most common useful treatment and local excision can be used. We report a case of renal medullary interstitial cell fibroma in a 17-year-old girl presented with a child-head sized palpable mass on the left upper quadrant.

Relationship of the patterns of pelvic bone fracture and bladder rupture / 대한비뇨기과학회지

A clinical observation was made on 64 cases of the bladder rupture who were admitted to our hospital during the period from June, 1979 to February, 1991. The results are as following ; 1. Of 355 cases of the genitourinary tract injury, the bladder rupture were 64 cases (18.0%), which were composed of 40 cases (62.5%) of bladder rupture without pelvic bone fracture and 24 cases (37.5%) of bladder rupture with pelvic bone fracture. The bladder rupture without pelvic bone fracture were composed of 35 cases (87.5%) with intraperitoneal bladder rupture and 5 cases (12.5%) with extraperitoneal bladder rupture, the bladder rupture with pelvic bone fracture were composed of 13 cases (12.5%) with intra and extraperitoneal bladder rupture. 2. In 24 patients with pelvic bone fracture, the most common site of bladder ruptures were found on the lateral wall in 12 cases (50%), and followed by the dome in 9 cases (37.5%), multiple areas in 3 cases (12.5%). In 40 patients without pelvic bone fracture, the most common site of bladder ruptures were found on the dome in 33 cases (82.5%), and followed by the multiple areas in 4 cases (10%), lateral wall in 3 cases (7.5%). 3. The average size of the bladder rupture was 6.5cm in cases without pelvic bone fracture, 6. 8cm in cases with pelvic bone fracture, especially comminuted pelvic ring fracture had most severed bladder rupture (average; 8.3cm). 4. Of 24 pelvic bone fractures, pubic rami fractures were most common (41.6%), and followed by comminuted pelvic ring fracture (25%), anterior and posterior pelvic ring fractures (12.5%), acetabulum and isolated fractures (8.3%), symphyseal separation fractures (4.1%) in order of frequency. 5. 5 cases (20%) of pelvic bone fractures were associated with posterior urethral injury, especially 60% in The pubic rami fracture. There was no significant relation between the type of pelvic fracture and the type of bladder rupture, but the fractures involving pubic arch were more often associated with posterior urethral injury.

Three cases of the emphysematous pyelonephritis / 대한비뇨기과학회지

Emphysematous pyelonephritis is a rare complication of acute pyelonephritis that occurs in diabetics or urinary obstruction and spontaneous gas formation around renal parenchyme. Diagnosis. in appropriate clinical setting. is confirmed radiographically. Plain film demonstrates a surprising pneumonephrogram, mottled gas shadow in the renal parenchyme as well as perirenal gas. Surgical intervention after unsuccessful antibiotics and conventional medical measurement is necessary. We experienced 3 cases of emphysematous pyelonephritis which occurred in diabetic women with brief review of the literature.

A case of adult Wilms' tumor / 대한비뇨기과학회지

Wilms' tumor is malignant renal tumor, originated from undifferentiated mesonephric blastema. Adult Wilms' tumor, unlike that of childhood, is a rare disease and a total of l67 cases have been reported in the world medical literature until 1980. Diagnosis of adut Wilms` tumor is very difficult preoperatively and the pathologic hallmark is the presence of abortive or embryonal glomerulotubular structure with an immature spindle cell stroma. The therapeutic guidelines and surgical principles that govern childhood Wilms' tumor should be applied to adult Wilms' tumor. We reported a case of Wilms' tumor developed in 34 year-old male patient complaining of right flank pain with gross hematuria for 2 months.

A case of XX male syndrome / 대한비뇨기과학회지

The 46, XX male or sex-reversal syndrome is a rare entity, which may be reported first by de la Chapelle and associates in 1964, an additional 135 cases have been recognized, yet only 20 percent of these patients have been diagnosed during childhood. The 46, XX male may be associated with hypogonadism and infertility in adult, and occasionally, sexual ambiguity in the neonate. At least 10% of patients have had hypospadia or ambiguous external genitalia. The 46, XX male was diagnosed with cytogenic study, H-Y antigen, hormonal study testicular biopsy, radiologic study. Here, we report a case of 19 month-old child XX-male with hypospadia and chordee.