Endoscopic Evaluation Ninty-one Cases of Chronic Prostatitis / 대한비뇨기과학회지

Ninety-one cases of chronic prostatitis were studied endoscopically and the results were evaluated. Endoscopic appearance of the bladder neck in the presence of chronic prostatitis was classified as 1. Normal bladder neck, 16 cases (17.5 per cent) 2. Elevated posterior urethra, 8 cases (8.7 per cent) 3. Contracture of the neck, 19 cases (20.8 per cent) 4. Diffuse, irregular swelling and narrowing of the neck, 19 cases (20.8 per cent) 5. Reversed V-neck, 2S cases (31.8 per cent) In this study it was found that the bladder neck was abnormal in 82.1 per cent of the cases. In 36 instances or 39.5 per cent. the verumontanum appeared normal but abnormal in 55 cases or 60.5 per cent. Bilateral prostatic urethral walls were inflammatory in 57 cases and unilaterally inflammatory in 6 cases. Forty-two cases (46.1 per cent) revealed elevation of the posterior urethra and the prostatic urethral floor was hyperemic and edematous in 44 cases. In 40 cases (43.9 per cent), the normal bladder mucosa was observed, trabeculation and cellulation in 43 cases and trigonal and interureteric thickening in 7 cases were also observed. Decreased libido was present in 12 instances (33.3 per cent) of 36 cases having normal verumontanum and in 25 instances (45.4 per cent) of 55 cases having abnormal one. Urinary symptoms were most frequently positive in cases with bladder neck contracture. The results of treatment using Ultzmann's urethral syringe were evaluated as follows: Complete cure was obtained in 8 cases (19.5 per cent) almost complete cure in 14 cases (34.1 per cent), improvement in 15 cases (36.5 per cent) and no remarkable change in 4 cases (9.7 per cent). Five cases had transurethral resection and four achieved almost complete cure and one improved clinically. Subjective symptoms were completely relieved in 23 cases (56.1 per dent) and more than two thirds of the previous symptoms were gone in 18 cases (43.9 per cent) after treatment. In summary. endoscopic examination on chronic prostatitis is s worthwhile and important procedure in establishing therapeutic criteria.

Thoracoabdominal, Extraperitoneal and Extrapleural Approach to the Kidney in Supine Position / 대한비뇨기과학회지

The authors advocated a new renal approach in which patient is placed in supine, the eleventh rib is resected and incision is made over the thorax and the abdomen. This approach has been used on forty-two consecutive cases of the renal and the upper ureteral surgeries and the following advantages have been experienced.: 1. Patient being placed in comfortable supine position, changes in vital capacity and respiratory volume are very minimal. 2. Muscle layers to be cut being hot heavy, postoperative pain is much decreased. 3. The operating fieldbeing wider and the renal upper pole being exposed well, operative manipulation is easier and safer. 4. The pedicle and the kidney resting on the almost same plane, closer to the skin surface, the pedicle is all visualized without turning the kidney over and manipulation is easier and safer. 5. The approach cna be used for a routine exposure to the kidney and the upper ureter.

Clinical Statistics on Urinary Tuberculosis / 대한비뇨기과학회지

Clinical and statistical observation was made on 358 cases of renal tuberculosis seen during the period from 1954 to 1960. There patients stand for 2.72% of all the urological patients and male to female ratio 54.7%, 45.3%. lateralization, right to left 37.4% to 31.3% and bilateral 18.4%. Age distribution showed that 39.1% of the cases were in 21 to 30 years, 29.0% in 31 to 40 years and 1.1% in below 16 years of age, 24.6% of the patients consulted with the institute within six months to one year after the onset of symptoms, and 10.6% after 5 years. Of subjective complaints, hemato-pyuria, dysuria and frequency were listed in 52.2%. dysuria and frequency in 22.9%. frequency in 7.8%, hematuria in 7.5% and lumbago and flank pain in 32.7%. Bladder lesions were classified into 0. I. II. III. IV, V and VI grades after lnoue and Tada. 32.4 % of the patients showed grade III involvement, mild changes were observed in patients receiving anti-tuberculous agents and marked changes in patients receiving no anti-tuberculous agents. Lesions around the ureteral orifices were observed in 74.0% and at the base in 61.5%. In indigocarmin test, 21.6% of the cases showed excretion within 10 minutes from the diseased side and 11.2 within 5 minutes. Tubercle bacilli were smeared positive in 67.6%; 60.2% in the group treated with anti-tuberculous agents and 72.3% without treatment. In the unilateral kidney lesion, 60.8% showed advanced change and 11.1% primary lesion. Most cases of bilateral kidney tuberculosis showed marked changes. In 6.9%, advanced lesions were involved in both kidney and in 12.0% one side involved markedly and another hydronephrotic. In 32.7% of cases, past history of tuberculosis was noted, of which 63.6% had pleurisy and 22.7 % pulmonary tuberculosis. Period from previous tuberculosis to the onset of kidney tuberculosis was listed as over 10 years in 32.4% and in 23.1% between one and three years. Complications were observed in 18.7% of all cases, epididymitis in 71.8% and prostatitis in 84.2%.

Treatment of Diseased Mate Kidney in Renal Tuberculosis / 대한비뇨기과학회지

Urinary diversions were performed on 15 cases of renal tuberculosis whose mate kidneys were hydronephrotic or hydroureteric due to tuberculous involvement. Of these diversions, permanent cutaneous ureterostomy was performed on 13 cases and permanent nephrostomy on 2 cases. Irrigation through the kidney pelvis or tuberculous cavity was also performed using solutions made up with anti-tuberculous agents, streptomycin and isonicotinic acid hydrazide. Continuous gravity method and intermittent method were employed for irrigation through the indwelling catheters in the kidney pelves or through the nephrostomy tubes. The follow-up periods varied from 4 months to 51 years. The results were evaluated as follows: In 3 cases tubercle bacilli in the urine became negative within 21 days of irrigation and urinary finding improved after a short period of irrigation in 6 instances of 9 cases which showed pyuria. A marked improvement of kidney function was observed in 14 instances of 15 cases within one month after removingobstructive lesions by urinary diversions. Mild pyelonephritis and chronic urinary tract infection developed in all the cases during and after the treatment and renal failure was followed by death in 4 cases. In summary, 11 instances of 15 cases survived; excellent results were obtained in 8 instances with intubated ureterostomy in their solitary kidneys, fair results in 2 cases while one showed poor result and 4 died of uremia.

Detection of Tubercle Bacilli in Urine and in Removed Kidney Lesion in Renal Tuberculosis / 대한비뇨기과학회지

Fifty-four cases of renal tuberculosis who had anti-tuberculous treatment were studied for effect of anti-tuberculous agents on tubercle bacilli in urine and in kidney lesion. Urinary examinations were performed for tubercle bacilli every week by means of smear and culture and caseous substance from the cavity of kidney lesion was also smeared for the bacilli. The patients were divided into five groups as follows Group 1: Treated with anti-tuberculous agents for less than one month, 26 cases.Group 2: Treated with anti-tuberculous agents for one to three months, 15 cases.Group 3: Treated with the agents for three to six months, 6 cases.Group 4: Treated with the agents for six to twelve months, 5 cases.Group 5: Treated with the agents for longer than twelve months, 2 cases.Thirty-four instances (62.9%) of 51 cases revealed positive tubercle bacilli in urine and in the kidney lesion and 13 instances(24.0%) revealed negative bacilli in urine but positive in the kidney lesion while 6 instances(11.1%) revealed negative both in the urine and in the kidney lesion. Three instances of 7 cases treated for longer than six months showed positive smear for the bacilli in the kidney lesion.

Influences of Anti-tuberculous Agents and Cortisone on Renal Tuberculosis Induced in Rabbit / 대한비뇨기과학회지

Effect of cortisone on renal tuberculosis induced experimentally in rabbit and influence of the hormone on the effect of anti-tuberculous agents have been studied. Tubercle bacilli, bovine 123 strain. was inoculated into the rabbit kidneys to induce renal tuberculosis. In one group (A) bacilli were inoculated into the left kidney and into the both kidneys in another group (B). Treatments were started on the 10th post-inoculation day in the former group and on the 50th day in the latter group. Rabbits were divided into four experimental groupsas follows and treatments were continued for one month. After one week of observation animals were sacrificed and kidneys. lunge, livers, spleens and lymphnodes were studied on their tuberculous changes.1. Control. no treatment.2. Injection with cortisone acetate 10mg3. Injection with streptomycin 100mg. and INAH 23.6 mg.4. Injection with streptomycin 100mg. INAH 23.6 mg. and cortisone acetate 10mg.The animals were weighed and tubercle bacilli in the urine were studied every week during the experiment. The following results were obtained: 1) Body weight. Comparing with the control, animals receiving cortisone revealed marked decrease in body weight, while animals receiving anti-tuberculous agents increased their body weights. The animals receiving both cortisone and anti-tuberculous agents showed a decrease in body weight. 2) Urinary tubercle bacilli. After 4 weeks of inoculation, the bacilli were positive in urine. The control and the cortisone receiving animals in both groups A and B manifestated positive bacilli in urine and animals in group A receiving anti-tuberculous agents and both cortisone plus anti-tuberculous agents showed no bacilli in urine. In group B, bacilli were positive in animals receiving anti-tuberculous agents or both cortisone plus anti-tuberculous agents after 30 days of treatment. 3) Tuberculin test. Tuberculin test was weakened or negative after administering cortisone in tuberculous animals 4) Pathological histology. In group A, there was no significant changes between the control and the animals with cortisone. All showed wide-spread tuberculous lesions. Very slight changes were observed in animals receiving anti-tuberculous agents or both anti-tuberculous agents and cortisone, and the lesion showed improvement. Microscopically, animals receiving both anti-tuberculous agents and cortisone revealed cloudy swelling and simple necrosis throughout but no cellular infiltration in the kidney tissue. The affect of treatment was more apparent than in the animals receiving only anti-tuberculous agents. In the group B, lesions in the animals receiving cortisone was more marked than in the control animals. Macroscopically, no significant changes were observed both in the animals receiving cortisone and anti-tuberculous agents, and ones receiving only anti-tuberculous agents. However, microscopically, the former animals showed less fibrosis and calcification than the latters. Dissemination of tuberculous lesion to other organs was not influenced by administration of cortisone but prohibited by anti-tuberculous agents.

The Carbolfuchsin Color Reaction / 대한비뇨기과학회지

The color reaction characteristic of renal tuberculosis was derived by J. Desbordes in 1952 and its clinical value in the diagnosis of genitourinary tuberculosis was confirmed by Yamata-Nagamoto in 1953. The author examined the reaction on renal tuberculosis and lung tuberculosis and leprosy and other various non-tubercular diseases and the method and the results are shown as follows: METHODS: Place 2cc of fresh urine in a small test tube, add 1 or 2 drops of 10% formalin solution, and then 1 drop of Ziehl's carbolfuchsin solution. If purple or violet-red precipitation is present in the test tube, it is positive reaction, if color of fuchsin only, it is negative. When the urine is cloudy, centrifuged or filtered urine should be used for this color reaction. RESULTS: (1) Carbolfuchsin color reaction in the urine of the patients with tuberculosis is present in higher percentage, and the reaction shows positive or weak in the all cases of renal tuberculosis. (2) This color reaction occurs frequently in the urine of the patients with leprosy (3) This color reaction is negative in the diluted solution of tuberculin.

Antegrade Pyelography / 대한비뇨기과학회지

By using antegrade pyelography which was modified from Casey and Goodwin technique, we examined nine patients in whom accurate roentgenographic diagnosis could not be made by excretory or retrograde pyelography. Diagnosis established were three cases of hydronephrosis due to ureteral calculi, three of pyonephrosis due to renal tuberculosis, one of pyonephrosis due to carcinoma of the ureter, one case of pyonephrosis due to carcinoma of the uretero-pelvic junction and one of pyonephrosis due to ureteral obstruction This is the first report of antegrade pyelography in cases of pyonephrotic renal tuberculosis. No complications occurred during or after examinations. In selected cases of hydronephrosis and pyonephrosis, antegrade pyelography is a safe and new diagnostic procedure to other accepted methods of urography.

Clinical Experience with Lederkyn in Genito-urinary Diseases / 대한비뇨기과학회지

Lerderkyn, a recently introduced sulfonamide, has been administrated to 11 cases in doses ranging from 1 to 3 gm daily. The compound is rapidly absorbed from the gastrointestinal tract and therapeutically effective plasma concentration is maintained rapidly and for many hours, following the oral administration. The diffusion of Ledrkyn into the tissue and the body fluid occurs readily and is slowly excreted through the kidney. Maintenance of effective concentration in urine for many hours results in successful treatment especially for genito-urinary tract infection. In this study, five acute gonococcal urethritis, one non-gonococcal urethritis, two acute cystitis, three chronic prostatitis have been treated with this drug in doses of 1 to 3 gm daily and very satisfactory results obtained in acute bacterial infection.