Living Donor Nephrectomy: Surgical Selection Criteria of Laterality / 대한비뇨기과학회지

PURPOSE: This study was aimed at deciding the surgical selection criteria in laterality of donor nephrectomy. MATERIALS AND METHODS: We studied 179 patients undergoing living donor nephrectomy for renal transplantation. We performed preoperative studies, including blood ABO type, optimum HLA typing, renal arteriography, check of child-bearing age, excretory urography and a DTPA renal scan for differential renal function. RESULTS: Of the 179 patients, 139 underwent donor nephrectomy on the left side, and 40 on the right side. Of the 139 patients undergoing surgery on the left side, 135 had a single renal artery, with the other 4 having both left and right multiple renal arteries. Of the 40 patients undergoing surgery on the right side, 18 had a right single renal artery, with multiple left renal arteries. Of all the patients, 15 were of child-bearing aged women, 1 had a left double ureter and 6 had a better functioning kidney on the left side inform the DTPA renal scan. CONCLUSIONS: A DTPA renal scan for the evaluation of differential renal function contributed to our decision, especially in making surgical selection criteria of laterality, in order to reserve the better functioning kidney in donors.

Value of the Voiding Cystourethrography Prior to Renal Transplantation / 대한비뇨기과학회지

PURPOSE: A retrospective review of the medical records of 168 patients who were evaluated for renal transplantation was undertaken to determine whether a voiding cystourethrography (VCUG) influenced the surgi cal care of the recipient. MATERIALS AND METHODS: Between June 1989 to May 1998, 168 patients received a transplantation at our center. These patients proceeded to transplantation, with all of them receiving a VCUG as part of their evaluation. We compared incidence of postoperative complications between normal VCUG group and abnormal group during follow up period (mean 31. 6 months). RESULTS: An urologic abnormality was identified by VCUG in 15 (8.9%) of 168 patients and all of them were vesicoureteral reflux (VUR). In 15 patients with VUR, grade of VUR were grade I in 2, grade II in 10, grade III in 2 and grade IV in 1. None of them with VUR required surgical intervention and had postoperative complications related to VUR. CONCLUSIONS: The VCUG is not essential for the preparation of potential recipients for renal transplantation and should be utilized selectively in individuals with a history of urologic disease or when urinary tract abnormalities are identified by physical examination or an abnormal urine analysis.

Comparison of the Survival Rates of Spousal Kidney Transplantation and Parental Donor Kidney Transplantation / 대한이식학회지

PURPOSE: The continuing shortage of donors has escalated the waiting times for kidney transplantation in most nations. In instances where first-degree relatives of the patient are not appropriate, living unrelated transplantations are considered as the next possible choice. In this category, genetically unrelated but emotionally related spouses are always preferred for organ donation rather than both genetically and emotionally unrelated donors. The aim of this study was to compare the results of parental donor kidney transplantation with spousal kidney transplantation. METHODS: Patient and graft survival were assessed with the Kaplan- Meier curve and statistical significance was determined by log-rank comparisons. RESULTS: In the spousal group, 1-, 3-, and 5-year graft survival rate were 84.6%, 72.3%, and 66.3%, in the parental donor group, 89.2%, 75.4% and 62.3% respectively. 1-, 3-, and 5-year patient survival rate were 84.6%, 80.4%, and 71.5% in the spousal group and 97.3%, 94.3% and 90.6% respectively in the parental donor group. Survival rate of grafts from spouses was comparable to that of parental-donor grafts, despite the average of 4.1 HLA mismatches in the spousal group, as compared with one haplotype sharing in the latter group (P<0.001) and higher donor age in the parental donor group (P<0.001). The survival rates were similar in the wife-to-husband and the husband-to-wife groups. CONCLUSION: While providing the couple with a better quality of life, spousal kidney transplantation also enables the couple to share the joy of giving and receiving the "gift of life" from one another. We believe that transplantation from a healthy volunteer spouse is a good alternative resource to years of dialysis while waiting for another donor that may never appear, to increase the donor pool and reduce the increasing length of waiting lists.

Malignancy Following Renal Transplantation / 대한이식학회지

PURPOSE: Survival rate after renal transplantation has increased after intense immunosuppressive agents and sophisticated operative techniques were introduced, but incidences of malignancy increase with time after transplantation. METHODS: We reviewed our experiences about post-transplant malignancy in patients who received renal allografts in our hospital from January 1981 to December 1999. The incidences and types of malignancy were analysed in 241 renal allograft recipients, who were followed-up for 1265 patient-years. RESULTS: Seven malignancies were found in 241 patients (2.9%). The mean age of these patients at diagnosis of malignancy was 45.5 years and the average interval between transplantation and diagnosis of malignancy was 34.9 (9.8-71.6) months. The types of malignancy were non-Hodgkin's lymphoma (n=2; CNS and nasal cavity), colon cancer with metastasis (n=2), in situ carcinoma of uterine cervix (n=1), follicular carcinoma of thyroid (n=1) and transitional cell carcinoma of bladder (n=1). Surgical resection was performed in 5 patients and 2 of them developed distant metastasis during follow-up periods. Radiotherapy was performed in 2 patients with non-Hodgkin's lymphoma and 1 patient with cord compression due to vertebral metastasis. Four patients are now alive and 3 of them have functioning renal allografts. CONCLUSION: We reviewed the incidences and types of post-transplant malignancy in our center and concluded that regular screening for malignancy and meticulous diagnostic approach for suspected symptoms or signs are important to immunosuppressed renal allograft recipients.

Molecular Staging of Micrometastasis in Prostatic Cancer using RT-PCR / 대한비뇨기과학회지

PURPOSE: Despite advances in the treatment of cancer, recurrence and metastasis continue to pose major problems in clinical mamagement. Recently, molecular based peripheral blood assay using the reverse transcriptase-polymerase chain reaction(RT-PCR) has been shown to be highly sensitive molecular staging modality for detecting extraprostatic disease pre-and post-operatively. The assay uses primers those are specific for prostate specific antigen(PSA) and prostate specific membrane antigen(PSMA). MATERIALS AND METHODS: We compared the application of RT-PCR assay for PSA versus PSMA. These assays were applied to ribonucleic acids extracts from the peripheral blood lymphocyte fraction of 29 patients with metastaic prostate cancer, in which, 13 cases were non neoadjuvant hormonal therapy(NHT) group. In addition, blood specimens from 5 clinically localized cancer were tested. RESULTS: Of 13 metastatic untreated patients 6 had positive for PSA, while 10 cases had positive results for PSMA. Among the 16 patients with hormone treated metastatic cancer patients, 8 (50%) had positive for PSMA while only 1 had positive for PSA. Of 5 localized prostatic cancer, only 1 had positive result just for PSMA. In neoadjuvant hormone treated group, marked reduction in incidence of positive RT-PCR for PSA was noted. An additional explanation is that PSMA may be expressed in hormone refractory cancer. CONCLUSIONS: Presently RT-PCR assay using PSMA is highly sensitive and more accurate than PSA RT-PCR for predicting micrometastasis. We are continuing to increase our patient number and may increase our ability to detect early localized cancer using a molecular approach.

Properties of Incidentaloma in Adrenal and Renal Tumors / 대한비뇨기과학회지

PURPOSE: Recent advances and wider application of imaging diagnostic techniques, especially ultrasonography(USG) and computed tomography(CT), account for the increasing incidentaloma in adrenal and renal tumors. We have studied these incidentalomas to investigate the incidences, occasions of detection, pathological findings, prognosis and other clinical properties. MATERIALS AND METHODS: The 186 cases of adrenal and renal tumors, treated surgically in Kyoungpook National University Hospital between 1987 and 1997 were reviewed and compared incidentally detected group(59cases) to symptomatically suspected group(127cases). RESULTS: The analysis of 186 cases demonstrated a marked increase in the frequency of incidentaloma from 15.6%(1987?1992) to 43.1%(1993?1997). The proportions of incidentaloma in adrenal and renal tumors were 20.4% in adrenal tumor, 36.4% in renal tumor and 31.7% in total. The chief method of detection was USG(57.6%), followed by CT(33.9%) and IVP(6.8%). The main reasons for examination leading to the diagnosis in incidentaloma were evaluation of unrelated symptoms(44.1%), follow up of other diseases(35.6%), general health check(18.6%) and during other operation(1.7%). In case of adrenal incidentaloma, the mean tumor diameter was larger than in suspected group(4.8+/-3.4cm vs 3.1+/-2.3cm). The main histologic diagnosis of adrenal incidentaloma was adrenal adenoma and hormonally functional tumors were less than suspected group (63.6% vs 88.4%). In case of renal incidentaloma, the mean tumor diameter was smaller than in suspected group(5.3+/-2.1cm vs 8.7+/-2.2cm) and paraneoplastic syndromes were less than in suspected group(20.8% vs 57.1%). The grade and stage of renal incidentaloma were lower and survival rate was higher than suspected group(5 year survival rate, 83.3% vs 64.3%). CONCLUSIONS: These results indicated that abdominal USG or CT should be performed with special attention to adrenal and renal lesions, where at a health examination or evaluation to unrelated disease.

The Effect of Donor Age on the Outcome of One HLA-haplotype Mismatched Living Related Kidney Transplantation / 대한내과학회지

OBJECTIVES: Renal transplantation has become the ther apy of choice for patients suffering from end-stage renal disease. But because of progressive disparity between the number of patients in needs of a transplant and the num ber of ideal kidneys available for transplantation, increas ing numbers of kidneys are recovered for transplantation from donors that are not considered ideal, especially from donors over the age of 55. In country such as Korea, the number of cadaveric transplants is limited due to cultural and religious prejudices of the population, poor legal def inition and deficient organization of cadaveric donor work-up. Therefore the main source is living related donors(LRD), especially the parent. But in Korea, there is few reports about the influence of donor age on outcome in living related kidney transplantation. Thus we per formed this study to estimate the influence of donor age in itself on the outcome of the one HLA-haplotype mis matched living related kidney transplantation. METHODS: The effect of donor age on the outcome of One HLA-haplotype mismatched living related kidney transplantation was studied in 71 recipients who under went kidney transplantation from January 1981 to March 1995. The outcomes of 25 recipients from the older age group(> OR =55 years: Group A) and 46 recipients from the younger age group(<55 years: Group B) were retro spectively reviewed. Patient death with a functioning graft was considered graft loss. RESULTS: Demographic characteristics between 2 groups were similar. The 1-year and 3-year patient survival rates in recipients(group A and B) were similar regard less of donor age(96.0% and 90.8% vs.97.4% and 90.3%, respectively). The 1-year and 3-year graft survival rates in recipients(group A and B) were not significantly dif ferent (91.4% and 63.9% vs 92.7% and 79.3%, respec tively). The mean levels of serum creatinine at discharge were significantly higher in group A. Short-term and intermediate-term renal function, as assessed by serum creatinine, was inferior in the group A throughout the follow-up periods of 3 years. The causes of graft loss in the first 3 years after transplantation were irreversible rejection(71%) and the patient death with functioning graft(29%) in group A, while the causes of graft loss in group B were irreversible rejection(50%), patient death with a functioning graft(40%) and technical reason(10%). CONCLUSION: These results of our analysis suggest that similar outcome can be achieved after living related renal transplantation from older donor. Therefore the kid neys may be used from donors over 55 years old on con dition that the donors undergo complete and exhaustive work-up.

Altered Expressions and Point Mutations of p53 in Human Bladder Transitional Cell Carcinomas / 대한비뇨기과학회지

The objective of this study was to characterise the pattern of p53 mutations in bladder tumor. In this study, 25 bladder transitional cell carcinomas were analyzed by immunohisochemistry (IHC) for p53 nuclear overexpression, and the results were compared with those of polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) analysis in exon 5-8 of the p53 gene and DNA sequencing analysis. 15 out of 20 cases (75%) showed p53 nuclear immunoreactivities on IHC. On PCR-SSCP analysis, 10 out of 25 cases (40%) had abnormal shifts in mobility. 62% of the mutations were in exon 8. Direct DNA sequencing analysis were performed in these 10 cases to confirm the presence of mutated p53 genes and to determine the type of mutations. Sixteen point mutations were detected in 10 cases. Two specimens had double mutations and another two had triple mutations. G:C-->A:T transitions were the most frequent patterns (62.5%). One mutation was a premature stop codon and two were silent mutations. Three out of 10 had a point mutation at codon 285 (GAG/Glu-->AAG/Lys) and two had at codon 280 (AGA/Arg-->AAA/Lys). One of 16 mutations was transition at hot spot codon 273 with CpG site. These results suggest that altered expressions and point mutations of p53 occured in all grade of bladder cancer, but are more associated with high grade bladder tumors. To elucidate the carcinogenesis of bladder cancer, further studies should be carried out.

Percutaneous Embolization of the Internal Spermatic Vein for the Treatment of Childhood and Adolescent Varicocele / 대한비뇨기과학회지

Proper management of childhood and adolescent varicocele remains still controversial. In general, all methods for varicocele ablation for adults are available and include open surgical ligation, laparoscopic ligation, or percutaneous ablation. We evaluated the usefulness of percutaneous embolization of internal spermatic vein in boys with varicocele. Between February 1988 to May 1996, 48 boys of 53 varicoceles underwent percut aneous embolization. In 49 cases, the embolization were technically possible and in the other 4 cases, we could not access the internal spermatic vein because of vasospasm and venous abnormality. The results were successful in 40 cases (81.6%) and failed in 9 cases (18.4%), including 4 (8.2%) of persistent and 5 (10.2%) of recurred cases. There were no major complications except 3 cases of extravasation of contrast material. Percutaneous embolization may be recommended as a primary treatment for childhood and adolescent varicocele.

A Case of Pediatric Renal Cell Carcinoma with Multiple Hepatic Cyst / 대한비뇨기과학회지

Renal cell carcinoma in the pediatric age group has been considered as a rare clinical disease entity but perhaps not as rare as once thought. This neoplasm should be considered in the differential diagnosis of hematuria and/or abdominal masses in children. Herein a case of pathologically confirmed pediatric renal cell carcinoma with multiple cysts in liver is presented with a brief review of literature.

Three Cases of Angioembolization in Renal Angiomyolipoma / 대한비뇨기과학회지

Renal angiomyolipomas are uncommon benign neoplasms composed of mature adipose tissue, thick walled blood vessels and smooth muscle in varying proportions. Accurate preoperative diagnosis of renal angiomyolipoma is essential if conservative resection or angiographic embolization is to be used. In recent years, abdominal computerized tomography (CT) and renal ultrasonography have resolved the diagnostic dilemma, making detection of angiomyolipomas possible in almost all cases. Recently, we performed selective renal angioembolizations in 3 patients (2 females, 1 male). After followup period of 6 months to 1 year, all patient got better in clinical symptoms. In two of them the lesions decreased in size on followup CT but one patient showed suspicious malignant change and we performed the exploration to rule out renal malignancy. In our opinion, it is appropriate to perform the selective renal angioembolization for initial treatment of renal angiomyolipomas.

Common Variations of Renal Vessels in Donor Kidneys / 대한비뇨기과학회지

To prevent extensive manipulation of the kidney and profuse bleeding, the exact information of the renal vessels is very important. On the basis of the intraoperative observations of 127 donor kidneys and preoperative angiography, we studied the renal vascular variations. Both kidneys had single renal arteries in 70.1% of the cases and multiple renal arteries were found in 29.9% of the cases. 89% of the cases had single renal arteries and single renal veins, and 4.8% of the cases were drained by multiple renal veins on operative field. Left renal veins had three branches, adrenal vein, gonadal vein and lumbar vein in 84% of the cases. Only adrenal vein and gonadal vein were identified in 13% of the cases. Anomalies of the IVC were identified in two cases. One case was left postrenal IVC and the other case was persisting left IVC. Right renal veins had no branch in 88.9% of the cases and gonadal vein was identi5ed in 11.1% of the cases in our study. In surgical procedures about the renal area, familiarity with common variations of the renal vessels and anomalies of IVC is very important for the surgeon.

The Diagnosis of von Hippel-Lindau Disease Gene Carrier by DNA Polymorphism / 대한비뇨기과학회지

von Hippel-Lindau disease(VHL) is an autosomal dominant disorder, associated with tumors and cysts in multiple organ systems, whose expression and age of onset are highly variable There has been considerable progress in the molecular genetics of VHL disease. The VHL disease gene belongs to the family of tumor suppressor genes. The disease gene has been located in 6 to 8 centimorgan interval between RAF1 and D3S18, an anonymous DNA marker located at 3p26. It should be possible for the probe that flank the disease genes to identify carrier of the disease gene by DNA polymorphism analysis. We tested the feasibility of this approach by prospectively comparing the results of restriction fragment length polymorphism(RFLP) analysis with a comprehensive clinical examination in asymptomatic, at risk members of family with VHL disease. We found that RFLP analysis can distinguish VHL disease gene carriers from their healthy siblings. The result of this study suggests that the inheritance of the VHL gene was linked to RAF1. Deletions of chromosome 3p25-26 region were also detected in other VHL disease patient and a recurrent abortion case through karyotyping and RAF1 southern blotting. DNA polymorphism analysis can identify individuals likely to carry the VHL disease gene among asymptomatic members of disease families.

Urologic Complication of Extravesical Ureteroneocystostomy in Renal Transplantation / 대한비뇨기과학회지

Since the first successful kidney transplant in 1954, many advances have been made in renal transplantation technique and urinary reconstruction. Recently, there has been increasing interest in the use of extravesical technique to perform ureteroneocystostomy in renal transplantation. From January 1985 to September 1994, 93 patients underwent renal transplant ureteroneocystostomy by an extravesical technique. Complications related to the anastomosis and/or ureter were reviewed. There were 5 total complications, for an over-all urologic complication rate 5.4 percent. Of these complications one was related to the ureteroneocystostomy, for an anastomotic complication rate of 1.07 percent We report our experience with the simple extravesical technique for ureteroneocystostomy that has provided excellent results and minimal morbidities.

A Case of Renal Cell Carcinoma in Children / 대한비뇨기과학회지

Renal cell carcinoma in children has been considered as a rare clinical disease entity. A case of right renal cell carcinoma in a 13-year-old boy is presented with a brief review of literature.

Histopathologic findings of bladder in chronic renal failure / 대한비뇨기과학회지

A variety or physical or functional changes are anticipated for the bladder in patients with chronic renal failure due to their long term exposure to many factors including uremia, oliguria, drugs and dialysis. We analyzed the histopathological changes of 10 bladders, from chronic renal failure patients who undergone renal transplantation, by H-E and Toluidine blue stain under light microscopic examination. The mucosa was thinned by a decreased layer of transitional cells; cellular swelling and mild inflammatory changes were noted. The submucosal layer showed inflammatory change, fibrosis, vasodilatation and infiltration of mast cells. Most marked changes were noted in the muscular layer by severe atrophy, fibrosis and fatty degeneration. Especially, marked atrophy or fibrosis was noted in patients with long term history of renal failure and marked fatty degeneration was noted in patients with anuria or oliguria. As a result, we concluded that the most significant changes the bladder suffered from chronic renal failure were atrophy or fibrosis of muscular layer. These changes should be of concern in performing ureteroneocystostomy and assessing restoration of normal voiding function in the recipient bladder. Afterward, more study about functional changes in these bladders will be needed to clarify completely the significance of chronic renal failure on the bladder.

First experience in treatment of urolithiasis using therasonic LT-1000 / 대한비뇨기과학회지

Two hundred sixteen patients with symptomatic urinary calculi underwent extracorporeal shock wave lithotripsy utilizing Therasonic Lithotripsy System (Theratonic LT -1000) at Kyunepook National Universily Hospital from April 1991 to march 1992. About 95.O per cent of stones were completely treated with one to nine session. The stone-free rate for patients with renal, upper and lower ureteral calculi was 93.9, 94.4 and 97.8 per cent respectively. Stone-free rate for individual patient depended on stone size. location. composition. and quality of disintegration. Postextracorporeal shock wave lithotripsy complications were minimal, these were gross hematuria. fever. flank pain, gastrointestinal trouble and stein strasse. Combined therapy utilizing percutaneous surgery or multiple sequential ESWL treatments is necessary for complex stones. In our opinion. ESWL utilizing Therasonic Lithotripsy System is more safe and effective treatment modality for urinary calculi except midureter and bladder than others.

Interventional uroradiologic management of ureteral stricture / 대한비뇨기과학회지

Interventional uroradiologic management of ureteral stricture is recently getting more interest due to its greater advantages than surgical management and rapid development of radiologic imagine technique. We performed 47 interventional management for ureteral stricture during 7 years between March 1986 and February 1993. The underlying diseases or conditions of the ureteral stricture were invasion of tumor in 22 cases, tuberculous ureteritis in 13, surgery to ureter in 8, ureteroneocystostomy in renal transplantation in 2 and retroperitoneal fibrosis in 2. According to their individual conditions such as underlying cause, location. age and severity of stricture. ureteral managements by balloon dilatation only or stenting only or balloon dilatation combined with stenting were performed As a result of these managements and follow up of at least 2 months, complete relief of uretera1 obstruction and marked improvement of renal function were observed in 9 cases(19%), preservation or renal function and minimal improvement of obstruction were observed in 24(51%) and progression of ureteral stricture and aggravation of renal function were observed in 14(30%). So. this study showed that if we are aimed at prevention of progression of ureteral stricture and preservation of renal function. interventional management had great merit of 70% of success rate. Complications occurred in 7 cases which consisted of obstruction in 3, migration of stent in 2, urinary tract infection in 1, irritation in 1 and severe hematuria in 1. These complications were managed by conservative treatments with no sequelae.

A clinical analysis of retroperitoneal tumors / 대한비뇨기과학회지

This study is based on the clinical analysis of 14 patients with retroperitoneal tumors experienced at the Department of Urology. Kyungpook University Hospital during the period from February 1980 to May 1991. The results were as follows ; l. The patients age ranged from 27 to 73 years and the ratio of male to female was 1.8: 1. 2. The most common chief complaint was abdominal mass (57.2% ) and 9 of 14 patients (64.4%) had presented symptoms for 1 year or less prior to visiting the hospital. 3. The clinical diagnosis was made by the clinical symptoms, physical findings and radiologic evaluations such as intravenous pyelography, ultrasonography. computerized tomography, angiography and so on. Abdominal CF scan provided clinically the most useful information regarding the state of tumors and also their effect on adjacent structures. 4. There were 5 benign and 9 malignant tumors including 4 metastatic tumors and 3 leiomyosarcomas. 5. Complete excision was performed in all 5 benign tumors and 2 malignant tumors (50%), and others were treated with partial excision followed by radiation therapy and/or chemotherapy or biopsy only.

A clinical analysis of the upper urinary tract transitional cell carcinoma and associated bladder tumor / 대한비뇨기과학회지

Urothelial tumor is characterized by a tendency of multicentricity. We analyzed retrospectively 43 cases of the upper urinary tract transitional cell carcinoma from June 1980 to May 1990. Of these cases. 16 (37.2%) cases involved the transitional cell carcinoma of the bladder (synchronous 6. metachronous 10). Of the metachronous group, the interval between treatment of the upper urinary tract lesion and the diagnosis of initial bladder tumor was within 1 year in 7 cases (70%) To compare the synchronous group to the metachronous group, the primary site of the upper urinary tract tumor was pelvis (1:4), ureter (2:2), pelvis + ureter (3:4). By histologic diagnosis, high grade (III, IV) and high stage (PT2-PT4) lesions of the upper urinary tract were 3:5 and 5:8. The 3 year cumulative survival rate of the upper urinary tract tumor without a history of bladder tumor, with the synchronous group and with the metachronous group was 59%, 50% and 62% respectively. There was no significant value (P>0.05) among them. Therefore it was considered that longer follow-ups and a larger series of patients were required.