Surgical Outcome of Tubeless Dismembered Pyeloplasty in Adult Ureteropelvic Junction Obstruction and Significance of Double-J Ureteral Stenting / 대한비뇨기과학회지

PURPOSE: The decision of whether to intubate or not remains largely a matter of individual preference. At our university, we routinely performed tubeless dismembered pyeloplasty and reverse intubated repair only when concomitant pathological conditions dictate intubation. We review our experiences with tubeless pyeloplasty during the last 12 years and evaluate the necessity of intraoperative double-J ureteral stenting. MATERIAL AND METHODS: From January 1985 to January 1996, adults with 49 renal units underwent tubeless dismembered Anderson-Hynes pyeloplasty at our university hospital. RESULTS: Markedly dilated renal pelvis was reduced surgically in 17 renal units (34.6%, reduction pyeloplasty). The success rate of tubeless pyeloplasty was 89.7% (44/49 renal units). In failed 5 renal units, 4 renal units with postoperative persistent urine leakage were managed using a retrograde insertion of Double-J ureteral stent at outpatient basis (8.2%) and 1 renal units with persistent ureteral stricture despite of redo pyeloplasty was removed surgically (2.0%). CONCLUSION: The success rate of our experience (89.7%) was relatively lower than others with intubated pyeloplasty because of persistent urine leakage and ureteral stricture. Urine leakage can be reduced with intraoperative placement of Double-J ureteral stent. Double-J ureteral stent can be easily removed in the outpatient department with minimal complication. Therefore, we would like to recommend the intraoperative placement of Double-J ureteral stent during the adult dismembered pyeloplasty.

A Case of Pelvic Lipomatosis Associated with Cystitis Glandularis / 대한비뇨기과학회지

Pelvic lipomatosis is a rare disease of unknown etiology characterized by overgrowth of mature, nonmalignant fat cells in the pelvis, especially in the perivesical and perirenal space. An overgrowth of fat surrounding the bladder and rectosigmoid colon produces a radiologic picture characterized by 1) radiolucent pelvic densities, 2) elevation and vertical elongation of the bladder, 3) straightening and elevation of the rectosigmoid colon and 4) absence of malignant vessels on pelvic angiography. Cystoscopy has shown a high incidence of cystitic changes: chronic inflammation, cystitis glandularis and cystitis cystica. We report a case of pelvic lipomatosis associated with cystitis glandularis.

Effect of Percutaneous Aspiration and Repeated Sclerotherapy of the Simple Renal Cyst / 대한비뇨기과학회지

Recently the percutaneous aspiration and sclerotherapy has become the most advocated procedure for the symptomatic, large, and simple renal cyst because of its minimal invasiveness and high effectiveness. But the recurrence rate of the simple aspiration and sclerotherapy was reported highly (30-70%). We analysed the effect of percutaneous aspiration and repeated sclerotherapy of the renal cyst in 42 patients from Nov. 1989 to Apr. 1995. Sclerosing agent were 99% ethanol in 33 cases, minocycline in 4 cases, and only aspiration was done in 6 cases. The method of repeated sclerotherapy was achieved about 2.2 times as which aspiration and instillation of sclerosing agent in standing of 8.3 Fr. pigtail catheter during average 2.5 days. After follow up for 17.4 (6-59) months, the complete collapse rate of the renal cyst was 78.7% in the using group of 99% ethanol. 25% in minocycline, 16.696 in the aspiration only. The complete collapse rate according to the times of sclerotherapy was 45.5% in one times, 78.6% in two times, 92% in three times. In conclusion, the sclerotherapy of the simple renal cyst with 99% ethanol was most effective, and we can be expect that the rate of complete collapse has been increased in the repeated sclerotherapy.

Megabladder and Bladder Diverticulum Associated With Ehlers-Danlos Syndrome in Female / 대한비뇨기과학회지

The Ehlers-Danlos syndrome is a congenital anomaly having collagen metabolism with clinical and genetic heterogeneity. It has been classified into ten distinct clinical forms. Urinary bladder diverticula associated with Ehlers-Danlos syndrome appear to be relatively rare and all of the reported cases were male. A 7 years old female patient with Ehlers-Danlos syndrome visited to our hospital because of gross hematuria after blunt trauma to lower abdomen. Markedly distended urinary bladder with diverticulum was found on abdominopelvic computed tomography. Upper tract was unremarkable. We report a 7 years old female patient with Ehlers-Danlos syndrome associated with megabladder and bladder diverticulum.

Therapeutic Experience of Stamey Operation for Stress Urinary Incontinence / 대한비뇨기과학회지

Endoscopic suspension of bladder neck by Stamey's procedure is a successful technique of correcting female stress urinary incontinence. We treated 27 patients complaining of urinary incontinence with Stamey operation from February, 1988 to March, 1994. The results was as follows l. Patients was distributed in age from 31 to 63 (mean; 48.8) years. All patients except one were multiparous, average 3.6(2-6)times of deliveries 2. Severities of incontinence were Grade I in 2 patients, Grade II in 20, Grade III in 5. 3. On preoperative lateral cystourethrogram, bladder base was descended about 1.1+/-0.57cm in resting, 2.63+/-1.24cm in straining from SCIPP(Sacrococcygeal-inferior point of pubic bone) line. Preoperative average PUVA(Posterior urethrovesical angle) was 142.2+/-53.27 degree, and average functional urethral length was 2.84+/-l.36cm. 4. Postoperative times of catheterization was 5.8 days, the amount of residual urine was lO5+/-10.3cc after removal of catheter. 5. Incontinence was completely disappeared in 24 patients(88.9%), but 3 patients were recurred due to break of suture material.