ABSTRACT
PURPOSE: A complete duplicated collecting system complicated with an ectopic ureter or ureterocele results in renal damage due to a ureteral obstruction or reflux. The clinical outcome of ureteropyelostomy in complicated complete duplicated collecting system was evaluated. MATERIALS AND METHODS: 20 children received a ureteropyelostomy for either an ectopic ureter or ureterocele with a complete duplicated collecting system anomaly. The median age was 3.2 months. Of the children, 11 had ureteroceles including 7 cecoureteroceles, and 9 had ectopic ureters. The associated anomalies were 3 UPJ obstructions of the lower pole and 9 VUR. All received a ureteropyelostomy. The lower pole ureter was used as the common ureter except in 2 cases with a lower ureter in poor condition. A lower pole pyeloplasty was combined in 3 cases with UPJ obstructions of the lower pole. A distal ureteral stump was left open except in the cecoureterocele in order to prevent VUR. Their clinical courses were followed up with an ultrasonogram and 99mTc-DMSA scan. The median follow-up after surgery was 17.8 months. RESULTS: A reduced upper pole hydronephrosis was observed in 19 patients and an improvement in the differential renal function was noted in 17 patients on the follow-up studies. All ureteroceles had either disappeared or were reduced in size. 7 patients showed an intermittent asymptomatic bacteriuria and 1 patient showed symptomatic UTI who required an ureteroneocystostomy during the follow-up. CONCLUSIONS: A ureteropyelostomy is recommended as a first-line treatment modality for patients with a complicated complete duplicated collecting system owing to the lower chance of secondary surgery, the prevention of deterioration in the bladder function and the possibility of early correction.
Subject(s)
Child , Humans , Bacteriuria , Follow-Up Studies , Hydronephrosis , Technetium Tc 99m Dimercaptosuccinic Acid , Ultrasonography , Ureter , Ureteral Obstruction , Ureterocele , Urinary BladderABSTRACT
PURPOSE: A complete duplicated collecting system complicated with an ectopic ureter or ureterocele results in renal damage due to a ureteral obstruction or reflux. The clinical outcome of ureteropyelostomy in complicated complete duplicated collecting system was evaluated. MATERIALS AND METHODS: 20 children received a ureteropyelostomy for either an ectopic ureter or ureterocele with a complete duplicated collecting system anomaly. The median age was 3.2 months. Of the children, 11 had ureteroceles including 7 cecoureteroceles, and 9 had ectopic ureters. The associated anomalies were 3 UPJ obstructions of the lower pole and 9 VUR. All received a ureteropyelostomy. The lower pole ureter was used as the common ureter except in 2 cases with a lower ureter in poor condition. A lower pole pyeloplasty was combined in 3 cases with UPJ obstructions of the lower pole. A distal ureteral stump was left open except in the cecoureterocele in order to prevent VUR. Their clinical courses were followed up with an ultrasonogram and 99mTc-DMSA scan. The median follow-up after surgery was 17.8 months. RESULTS: A reduced upper pole hydronephrosis was observed in 19 patients and an improvement in the differential renal function was noted in 17 patients on the follow-up studies. All ureteroceles had either disappeared or were reduced in size. 7 patients showed an intermittent asymptomatic bacteriuria and 1 patient showed symptomatic UTI who required an ureteroneocystostomy during the follow-up. CONCLUSIONS: A ureteropyelostomy is recommended as a first-line treatment modality for patients with a complicated complete duplicated collecting system owing to the lower chance of secondary surgery, the prevention of deterioration in the bladder function and the possibility of early correction.
Subject(s)
Child , Humans , Bacteriuria , Follow-Up Studies , Hydronephrosis , Technetium Tc 99m Dimercaptosuccinic Acid , Ultrasonography , Ureter , Ureteral Obstruction , Ureterocele , Urinary BladderABSTRACT
PURPOSE: Although ultrasonography and diuretic renography are routinely performed for evaluation of ureteropelvic junction obstruction, no reported studies have systemically investigated the correlation of the two methods. We investigated the correlation and values of the two methods. MATERIALS AND METHODS: We studied 44 patients who presented with unilateral hydronephrosis due to ureteropelvic junction obstruction from 1994 to 1999. Patients were evaluated with ultrasound and nuclear renograms with furosemide. Hydronephrosis grade on ultrasonography and the severity of obstruction on diuretic renography were in accordance with the SFU (Society for Fetal Urology) system and "The Well Tempered Renogram", respectively. RESULTS: 27 patients showed grade III hydronephrosis and the remaining 17 patients showed grade IV hydronephrosis on ultrasonography. Kidneys of grade IV hydronephrosis had poorer washout patterns on diuretic renography than those of grade III hydronephrosis (p 0.05). In 37.0% (10/27) and 47.1% (8/17) of patients with grade III and grade IV hydronephrosis, hydronephrotic kidney had a differential function greater than 50%. CONCLUSIONS: Our study suggests that diuretic renography is not always indicated in the patients with grade IV hydronephrosis, but, must be performed to confirm the severity of obstruction in the patients with grade III hydronephrosis.
Subject(s)
Humans , Infant , Furosemide , Hydronephrosis , Kidney , Radioisotope Renography , UltrasonographyABSTRACT
PURPOSE: We investigated the trends and results of the outcome in patients with localized and locally advanced prostatic cancer treated with neoadjuvant androgen deprivation (NAAD) and external beam radiotherapy. MATERIALS AND METHODS: 14 patients with localized prostate cancer were treated with a 4 month-scheduled treatment that consisted of NAAD and radiotherapy. The number of patients in the clinical stage T1, T2, T3, and T4 were 3, 5, 2, and 4, respectively. External beam radiotherapy was performed for 6 weeks during NAAD period. After treatment, PSA relapse was evaluated with periodic PSA follow-up. RESULTS: There was no lymph node or distant metastasis in 14 patients. In all cases, PSA was less than 1ng/ml within 3 months of treatment. The number of patients with Gleason scores 2-4, 5-7 and 8-10 were 1, 7, and 4, respectively. In only one case with preradiotherapy PSA nadir level of 0.23ng/ml, the rising PSA level (>2.5ng/ml) was observed at 6 months after the end of the treatment, and the androgen deprivation resumed 10 months after the end of the treatment. No severe complication was observed in all patients, and the observed minor complications were dysuria (3; 21.4%), frequency (2; 14.3%), urgency (1; 7.1%), urethral stricture (1; 7.1%), proctitis (2; 14.3%) and gastrointestinal discomfort (1; 7.1%). CONCLUSIONS: In patients treated with NAAD and radiation therapy for localized or locally confined prostate carcinoma, generally good responses were observed. No se vere complication was observed and more patients and follow up are required for the further conclusion.