A Blind-Ending Bifid Ureter with Stones / 대한비뇨기과학회지

Blind-ending bifid ureter represents a rare anomaly in the development of the ureteric bud, and a case associated with stone formation is extremely rare. We report a case of blind-ending bifid ureter with stones in the blind segment with a brief review of literature.

Distribution of Carcinoma in Situ in the Adjacent Mucosa to the Overt Carcinomas of Urinary Bladder - A Histotopographic Approach / 대한비뇨기과학회지

Fourteen total cystectomy specimens with primary carcinoma of urinary bladder were investigated to illustrate the overall prevalence and nature of mucosal changes adjacent to the overt carcinoma and to clarify the distribution pattern and extent of carcinoma in situ in regard with multiplicity, histological type and depth of invasion of the macroscopically visible tumor mass. Of 14 cases subjected to this study were 12 cases of transitional cell carcinoma of varying degree of differentiation and invasion, one adenocarcinoma, and the another one with no grossly detectable tumor but history of previous cystoscopic removal of papillary transitional cell carcinoma. Each specimen was processed by a histotopographic technique developed by authors, an easy access to reconstruct the mucosal changes using reconstruction paper. For the histological grading and staging of the overt carcinomas, Ash's and Collins' classifications were applied, respectively. Carcinoma in situ (CIS) was found in 10 out of 11 cases with overt urothelial carcinoma of urinary bladder and one case with no grossly visible neoplasm, in which cystoscopic removal of papillary carcinoma was carried out previously. Distribution pattern of CIS was mostly circular (group I) or arborizing (group II) , located around the overt carcinoma within 0.5 to 2.0cm., but not beyond 3.0cm. from its margin. Correlation between multiplicity of overt carcinomas and presence of CIS was evident together with irregularity of its distribution, but no significance was found with gross appearance, histological grading or with staging.

An Experimental Study on the Sequential Changes of the Irradiated Transitional Epithelium of the Urinary Bladder in Rats. An Ultrastructural Observation with Special Reference to Polyploid Cells / 대한비뇨기과학회지

Polyploid cells in the urinary sediments often give an erroneous clinical judgement in cases of post-pelvic irradiation follow-up, but their nature and evolution have remained unclarified. An experimental induction of polyploid cells in the transitional epithelium of the urinary bladder was carried out in Sprague-Dawley rats by administration of 3,000 rads in a single dose, and their sequential morphological changes were analysed under light and electron microscopes. 1. The acute post-irradiation changes of transitional epithelial cells were manifested with two consecutive phases of degenerative process ; the early lesion started to appear from the first day after irradiation and diminished partly at the 7th day; the later changes became enhanced progressively from the 2nd week and maximized at the 3rd week, but regressed thereafter . 2. The general histological alterations of the transitional epithelial cells in the acute stage were characterized by cytoplasmic vacuolization due to profound widening of intercellular cisternal spaces and dilatation of smooth endoplasmic reticulum aside from severe disruption of mitochondria and increase of lysosomes, especially in the superficial and intermediate cells, and by eventual outcome of cell death by nuclear pyknosis and karyorrhexis. 3. The polyploid cell change was demonstrated as a spectrum of the later alterations of acute irradiation injury to the basal layer cells, and appeared early from the 2nd week and regressed after the 4th week. 4. Based on their increased size and nuclear abnormalities, those polyploid cells exhibited features of both amitotic nuclei and cytoplasmic degenerative processes ultrastructurally, and in the acute phase the nuclear indentation and lobulation were associated with increased amount of heterochromatins and margination together with nucleolar enlargement and increase in number. 5. The above cells started to regress thereafter, being terminated by nuclear pyknosis and karyolysis, and numerical reduction of the polyploid cells was accompanied concomitantly with basal (reserve) cell hyperplasia of the remained epithelium. It is of the author's assumption that the polyploid cell phenomenon induced by irradiation onto the transitional epithelium of the urinary bladder is a transient manifestation of irradiated amitotic basal cells during the later phase of acute post-irradiation injury and is subsequently removed out by nuclear pyknosis and karyolytic processes.

A Clinical Observation on 112 Cases of Hypospadias / 대한비뇨기과학회지

A clinical observation was made on 112 cases of hypospadias which were treated at the Department of Urology, Seoul National University Hospital during the period June 1977 through May 1982. The results were as follows: 1. The ages were distributed from 7 months to 31 years and most of the cases (64.3%) was treated in the age group of less than 7 years. 2. Most of the types of hypospadias was penoscrotal type (43.8%). 3. Cryptorchism was the most frequent associated anomalies with 21 cases (18.8%). 4. The complication rate of other anomalies was greatest in the perineal type (81.8%). 5. Success rate of one-stage urethroplasty was 52.9%. 6. In two-stage operation, the first stage operation of 97 cases was successful except one of incomplete chordee release and the success rate of Thiersch-Duplay and Johanson second stage urethroplasty was 44.4% and 66.7% respectively. 7. As the urethral stent was used in the urethroplasty, the success rate of use of silastic tube was better than red rubber and feeding tube.

Uretero-Ileo-Cutaneous Anastomosis for Urinary Diversion -6Year Experience in 52 Patients- / 대한비뇨기과학회지

The records of fifty two cases of the ileal conduit at the Seoul National University Hospital during a 6-year period from January 1, 1975 to December 31, 1980 were reviewed. 1. There were 42 males and 10 females (ratio of 4.2:1) ranged in age from 5 to 74 years with peak incidence in the 6th decade. 2. The most common indication of this procedure was bladder tumor and other indications were neurogenic bladder, bilateral ureteral stricture, genitourinary tuberculosis, actinomycosis, urethral stricture. urethral cancer and colon cancer. 3. Seventy seven percent of patients with abnormal renal function preoperatively improved postoperatively. 4. Operative mortality was 3.8%. Early complication included wound infection and disruption, sepsis, obstruction and urine leakage in ileoureteral junction, pneumonia, fecal leakage from ileoileal junction, postoperative acute renal failure, bleeding from ileal loop, and urethral bleeding. Late complication included intestinal obstruction, parastromal dermatitis, acute pyelonephritis, ureteral obstruction and incisional hernia. 5. Thirty three of 43 patients developed bacteriuria, 30.3% of the patients showed mixed infection and major causative organisms were Pseudomonas, Enterobacter, E. coli and Serratia.

Urinary Prostaglandin E in Female Urethral Syndrome / 대한비뇨기과학회지

The levels of prostaglandin E were studied in the urine of 25 female patients with irritative bladder symptoms but no evidence of organic disease or urinary infection (female urethral syndrome). Twenty five healthy women served as a control group. A significant elevation of prostaglandin E in the urine of patient with female urethral syndrome was demonstrated (by Wilcoxon rank sum test; z= -2.32, p<0.05). The results suggest that prostaglandins may be responsible for the lower urinary tract symptoms in the patients. The potential beneficial clinical effects of prostaglandin syntheses inhibitors in treatingthe severe discomfort associated with urethral syndrome need to be evaluated further.

Three Cases of Cystitis Confused with Bladder Tumor on the Cystogram / 대한비뇨기과학회지

Three cases of cystitis are described which showed irregular filling defect on the excretory cystogram and were confused with the proliferative neoplasm of bladder. Urine examination, cystoscopy and biopsy demonstrated chronic non-specific cystitis in two cases and tuberculous cystitis in another one.

Evaluation of Renal Function before and/or after Operation Using 99mTc-DTPA Renal Scan / 대한비뇨기과학회지

Radioactive chelate such as 99mTechnetium-diethylene triaminepentaacetic acid (99mTc-DTPA) is an excellent renal imaging agent which is not metabolized and is excreted exclusively in the urine by glomerular filtration. In addition to defining the gross structure and function of the collecting system, the 99mTc-DTPA dynamic renal scan permits evaluation of early renal perfusion, regional glomerular function and gross renal structure. Twenty cases were studied with 99mTc-DTPA renal scan before and/or after urological surgery in order to evaluate their renal function. Of 20 cases, 5 cases were described precisely. The 99mTc-DTPA dynamic renal scan is a sensitive examination for determining the surgical approach method and predicting renal salvageability. It is also helpful as a follow-up method of postoperative recovery of renal function.

Evaluation of Renal Function before and/or after Operation Using 99mTc-DTPA Renal Scan / 대한비뇨기과학회지

Radioactive chelate such as 99mTechnetium-diethylene triaminepentaacetic acid (99mTc-DTPA) is an excellent renal imaging agent which is not metabolized and is excreted exclusively in the urine by glomerular filtration. In addition to defining the gross structure and function of the collecting system, the 99mTc-DTPA dynamic renal scan permits evaluation of early renal perfusion, regional glomerular function and gross renal structure. Twenty cases were studied with 99mTc-DTPA renal scan before and/or after urological surgery in order to evaluate their renal function. Of 20 cases, 5 cases were described precisely. The 99mTc-DTPA dynamic renal scan is a sensitive examination for determining the surgical approach method and predicting renal salvageability. It is also helpful as a follow-up method of postoperative recovery of renal function.

Overall Clinical Statistics in the Urology Department of Seoul National University Hospital for the Past 24 Years (1954~1977) / 대한비뇨기과학회지

A clinical and statistical observation was made on out-patients and in-patients admitted to the Department of Urology, Seoul National University Hospital for the past 24 years from 1954 to 1977. The observations were summarized as follows. 1. During the period, the total number of out-patients was 63,438 and that of in-patients, 6,028. 2. In the out-patients, lower urinary tract infections such as urethritis and prostatitis were the most common diseases regardless of the time period. 3. In the in-patient, the frequency of the disease has been changed with the lapse of time in the order of the occurrence. The interesting changes of the disease order related to the time period were noted as follows. 1954-1960 : genitourinary tuberculosis, urolithiasis, tumor, injury and congenital anomaly. 1961-1970 : urolitiasis, tumor, genitourinary tuberculosis, injury, infection and congenital anomaly. 1971-1977 : tumor. urolithiasis, genitourinary tuberculosis, congenital anomaly, injury and infection. 4. In 1977, 10 major diseases were tumor, ureteral stone, infertility, renal tuberculosis, B. P. H. hypospadias, varicocele, renal stone, scrotal injury and renal tumor 5. Major operations were performed on 4,122 cases during the period. Nephrectomy and ureterolithotomy were the most common operations. Recently, total cystectomy with ileal loop diversion, transurethral procedure and vasovasostomy, which require more skillful techniques, are increasing in number.

Free Water Clearance: A Clinical marker of Patients with Obstructive Uropathy / 대한비뇨기과학회지

Renal functional changes following relief of obstruction were investigated with a prospective aspect in a series of 15 postoperative patients using standard renal function measurements with emphasis on osmolar and free water clearance. Sequential measurements of free water clearance revealed earlier changes of postoperative renal function than that of standard renal function. The advantage of this measurement was in postoperative patients with adequate amount of urine output or diuresis. It may be helpful to the management of patients with obstructive uropathy and to early prediction of acute renal failure, especially in patients with post-obstructive diuresis.

The Effects of Acute Variations in Plasma pH and Pco2 on Renal Bicarbonate Reabsorption in the Dog / 대한비뇨기과학회지

This study was aimed to comprehend the pattern of renal response in bicarbonate reabsorption during various alterations in acid-base equilibrium in twelve dogs. In metabolic acidosis induced by infusion of hydrochloric acid, as the plasma bicarbonate and filtered load of bicarbonate decreased eminently, urinary excretion of bicarbonate was found to be negligible. which was attributable to almost complete reabsorption via the hydration of CO2. In metabolic alkalosis induced by infusion of sodium bicarbonate, along with an increment of plasma concentration of bicarbonate, all filtered bicarbonate was reabsorbed, with negligible amount of excretion until the plasma level attains the renal bicarbonate threshold. During the respiratory acidosis and alkalosis with higher or lower arterial Pco2, the bicarbonate reabsorption varied linearly with plasma Pco2. The linear relationship indicated that the hydration of CO, was an important source of hydrogen ion for the reabsorption of bicarbonate. In this regards, however, in metabolic alkalosis the renal bicarbonate threshold was found to be much higher than that of respiratory acidosis. The characteristics of renal bicarbonate reabsorption, during the mixed acid-base disturbances of metabolic and respiratory origin with no considerable alteration of plasma pH, induced by hydrochloric acid infusion with hyperventilation or sodium bicarbonate infusion with CO2 inhalation, were quite similar to those in metabolic acidosis and alkalosis caused by simple hydrochloric acid or sodium bicarbonate infusion, respectively.

Two Cases of Foreign Bodies in the Bladder / 대한비뇨기과학회지

We discovered two plastic tubes which were used as masturbating tools in the bladder. The following is a report of two young boys who slipped plastic tubes into the bladder through the urethra for the purpose of masturbation and lost them in the bladder while attempting to remove them. Case 1. : Y. D. S., 18 years-old, Admitted because of hematuria for 5 days. Cystoscopically, the bladder showed diffuse hyperemia and a coiled calcified plastic tube. It was removed by operation. The length of the tube was 0.58m and the diameter was O.4 cm. Case 2. : K. S. K., 18 years-old. Admitted because of urinary incontinence for 4 months. Cystoscopically. the bladder showed diffuse hyperemia and a coiled calcified plastic tube. It was removed by surgical operation. The length of the tube was 1.2m and the diameter was 0.5cm.

A Case of Fibroma in the Female Urethra / 대한비뇨기과학회지

Fibromas of the urethra are extremely rare. We experienced a case of fibroma in the female urethra recently. 48-year-old female patient was admitted to the Department of Urology of Seoul National University Hospital due to a protruded mass on external urethral meatus. The mass was removed surgically and confirmed as a fibroma pathologically. It was a huge mass, 17 X 9 X 7 cm in size, irregularly lobulated, firm and well encapsulated. Histologically it was composed of loosely textiled spindle cells of fibroblastic origin with myxoid changes.

Clinical Observation of Sulfobenzylpenicillin(Sulbencillin) in Urinary Tract Infection / 대한비뇨기과학회지

The effectiveness of Sulfobenzylpenicillin in the treatment of urinary tract infection was evaluated in the Department of Urology, Seoul National University Hospital during the period from May to November, 1973. Our clinical study was performed on the 28 patients who visited the outpatients clinic and admitted to the ward. These patients were studied by bacterioscopy with Gram's method of staining. and culture in blood agar plate and chocolate agar plate In this studies. the causative organisms were divided into 8 groups; E. coli (5), coagulase positive staphylococcus (5), pseudomonas (2), Corynebacterium spp. (1), a-hemolytic etreptococcus (2), N. Gonorrheae (10), Proteus (2) and KIebsiella (1). The dosage schedule was 1 gm. of Sulfobenzylpenicillin at intervals of 12 hours for consecutive 5 days in gonococcal urethritis and nongonococcal urethritis. But in upper urinary tract infections and post-operative infections, it lasted for 7 to 10 days or more. And following results were obtained. Effectiveness on Urological diseases 1) Gonococcal urethritis; Satisfactory clinical results were obtained with Sulfobenzylpenicillin for five days. Results were excellent in 5 cases, good in 4 cases and negative effect in 1 case. 2) Non-gonococcal urethritis; In this group, the therapeutic results were favorable in 90% of all cases. (excellent-4, good-5, fail-l) 3) Urethral stricture and fistula (2 cases); AII cases were responded to the Sulbenicillin. 4) Cystitis including Prostatism; Two of three cases were caused by E. coli and they had a good response to sulbenicillin. 5) Two cases of pyelonephritis and two cases of postoperative infections were studied with sulbenicillin and more than 60% of cases were effective with sulbenicillin. Side effects were not remarkable but in a few cases who received intramuscular injection, pain on the injection site was noticed.In summary, this new semi-synthetic penicillin is considered to be a useful chemotherapeutic weapon against a variety of infection in the urological field including those due to Gram negative bacilli such as pseudomonas and proteus sp.

Studies of Various Salt Administrations on Changes in Blood pH and Serum Electrolytes of Rabbit / 대한비뇨기과학회지

The present study is an attempt to delineate the effect of various salt administrations on the changes of blood pH and electrolytes, especially the nature of serum calcium, total and ionic, and serum magnesium. Thirty five male rabbits weighing 1.9 to 2. 5kg were used in this experiment. At the end of the three days diet adjustment period, the animals were divided into seven groups; Group I; Control, Group II; Ammonium chloride oral administration, Group III; Oral administration of sodium bicarbonate, Group IV; Potassium chloride intraveneous injection, Group V; Sodium chloride intravenous injection, Group VI; Calcium chloride intravenous injection, and Group VII; Magnesium chloride intravenous injection. The blood pH was determined by the method by Astrup and bicarbonate in serum by the method of Van Slyke and Neill. Sodium and potassium in serum were determined with an EEL flame photometer. Chloride was determined by the method of Schales and Schales and inorganic phosphorous by the method of Fiske and Subbarrow. Serum total calcium and magnesium were determined according to the method of chelometric titration with Eriochrome blue S.E. Serum ionic calcium was determined by the method of Yanagisawa. The results of this study are as follows: 1. The oral administration of ammonium chloride produced a significant decrease in blood pH. The serum concentrations of bicarbonate, magnesium and potassium were steadily decreased, but serum chloride, serum total and ionic calcium concentrations were increased through the experiment. 2. Sodium bicarbonate ingestion increased the concentration of bicarbonate, magnesium and serum ionic calcium markedly and serum ionic calcium slightly. The blood pH was significantly increased but serum chloride concentration was markedly reduced after ingestion of sodium bicarbonate However, serum potassium and inorganic phosphorus concentrations were decreased slightly. 3. The blood pH was dropped in the first two hours of intravenous injection of potassium chloride and tended to rise again significantly. the concentration of sodium and chloride in serum was increased markedly in two hours of injection but reduced after six hours to control level. Serum phosphorus, total and ionic calcium were reduced steadily, but serum concentration of magnesium, potassium and bicarbonate concentrations were slightly increased through the experiment 4. After sodium chloride was given, intravenously, there was a sustained increase in the concentration of serum sodium, potassium, phosphorus and bicarbonate but the blood pH was decreased in the first two hours and significantly elevated through the experiment. The serum concentration of chloride, magnesium, total and ionic calcium was decreased slightly. 5. B100d pH was slightly increased and the concentration of chloride was elevated sharply after injection of calcium chloride intravenously in the first two hours and come to control level in twenty-four hours. Serum sodium concentration was elevated steadily through the experiment. The concentration of total and ionic calcium in serum was elevated after injection but come to control level in twenty four hours of injection. Serum potassium and magnesium concentrations were decreased slightly in the first two hours and increased in four hours of injection. 6. Magnesium chloride intravenous injection produced a decrease in blood pH and serum concentration of bicarbonate in the first few hours and increase after 6 hours of injection. Serum magnesium, and inorganic phosphorus levels were increased after injection but the concentration of inorganic phosphrous was decreased markedly in twenty four hours of injection. Serum concentration of chloride, ionic calcium and potassium wag markedly reduced.

Two Cases of Primary Ureteral Tumor / 대한비뇨기과학회지

Additional two cases of the primary ureteral tumor with a literatural review were presented.

Clinical Observation on the Non-calculous Obstruction at the Ureteropelvic Juncture / 대한비뇨기과학회지

A clinical observation was made on the obstruction at the ureteropelvic Juncture of the inpatient in the Department of Urology. Seoul National University Hospital during the period September, 1961 through August, 1968 and the following results were observed. 1. Of 1824 cases hospitalized, 33 cases werehydronephrosis of non-calculous origin. Among the 33 cages 10 were obstruction ofthe ureteropelvic juncture giving a rate of 30.3%. Age distribution ranged from 4to 48 years with average of 26 years. 2. As to the origin of the obstruction, 5 cases were due to aberrant vessel one congenital stricture one fibrous band and one fibrosis, respectively. The causes were unknown in 2 cases. 3. The most common complaints were pain on the involved site in 8 cases. Palpable mass, gastrointestinal trouble and general weakness were found in 6 cases. Loss of weight and pollakisuria were noted in 3 cases. Hypertension. hematuria, fever andedema were found respectively in one case. 4. All cases including two which showed non-function on IVP showed markedly dilated pelvis and marked narrowing ofthe ureteropelvic juncture. 5. Nephrectomy was performed in 5 cases, removal of aberrant vessel in 2, ureteroplasty in one and ureteral dilation with contralateral nephrectomy in 2.

Clinical Observation on the Bladder Neck Obstruction Treated with Transurethral Resection / 대한비뇨기과학회지

A clinical observation was made on twenty cases, 18 males and 2 females, haying transurethral resection for the bladder neck obstructions in the Department of Urology, Seoul National University Hospital during the period September, l967 through August 1968. And the following results were Obtained: 1. Diseases necessitating T.U.R. were bladder neck contracture; 10 cases, benign prostatic hyperplasia; 9 cases and adenocarcinoma of the prostate; 1 case. 2. Age distribution ranged from 29 years to 83 years with the average of 59.4 years. 10 cases or 50% were in the age group of 60-79. 3. Dysuria which occurredin 14 cases (70 %) is the most common initial disturbance. The other common manifestations were hesitancy, frequency, acute urinary retention, nocturia and emal1 urinary stream as in order. 4. There was no operative complication in all but in 2 cases of hemorrhage which required multiple transfusions and one case ofurinary retention. 5. Postoperative results 1 to 2 weeks after T.U.R, were excellent' in 13, "fair" or "improved" in 4 "poor" in 3.

Clinical Observation on the Renal Tumors / 대한비뇨기과학회지

A clinical observation was made on the renal tumors of the in-patients in the Department of Urology, Seoul National University Hospital during the period October, 1965 through September, 1967 and the following results were obtained. 1. During the period, of 300 cases (227 males and 73 females) hospitalized, 10 cases had tumors of the kidneys giving a rate of 3.3%. Among the 10 cases 7 cases were male and 3 cases were female with ratio of 2.3 to 1. 2. Age distribution ranged from 2 years to 67 years with average of 40 years. Of 10 cases, 5 cases or 50% were seen by us at the ages of 50 years or more. 3. Tumors involved right and left kidneys equally. 4. The most common complaints on admission were hematuria and pain followed by palpable mass. 5. Excretory urogram was taken in all patients. In 5 cases the diseased kidney was not visualized. Remaining 5 cases gave compression deformities compatible with renal tumor. 6. All patients underwent nephrectomy and two of them had postoperative x-ray irradiation. 7. Renal cell carcinoma is observed in 7 cases, Wilms' tumor in 2 cases and leiomyofibrolipoangioma, so called hamartoma, in 1 case.