Clinical Study of Stage I Renal Cell Carcinoma / 대한암학회지

PURPOSE: This study was attemped to investigate the prognostic factors for the outcome of stage I renal cell carcinoma after radical nephrectomy. MATERIALS AND METHODS: Twenty nine patients treated from 1984 to 1995 at Kyung Hee University Medical Center were studied retrospectively. All of them were diagnosed with pathologic Robson stage I renal cell carcinoma after radical nephrectomy. RESULTS: Males were affected three times more frequently than females. The tumor was detected on the right kidney in 15 cases, and on the left in 14. Average follow up period was 36.6 months, average disease free interval was 29.4 months and median survival was 30 months. During the follow up, 9 patients (31.0%) expired due to liver and lung metastasis at postoperate 21.6 months on average. Eleven patients (37.9%) developed distant metastasis in the follow up. There was no local recurrence of tumor. Seventeen patients were diagnosed incidentally without clinical symptoms. In our retrospective study for stage I renal cell carcinoma, there were no predictive prognostic parameters for predicting the outcome of patients, except for the incidental diagnosis of the tumor. CONCLUSIONS: These results suggest that incidental diagnosis of the tumor may be the most important prognostic factor for the outcome of stage I renal cell carcinoma. Although the patients were confirmed as stage I renal cell carcinoma pathologically after radical nephrectomy, close follow up is very important, because of high incidence of metastasis. We recommand that chest X-ray, abdominal ultrasonogram and bone scan should be checked at 3 months interval for postoperative one year even though stage I renal cell carcinoma.

Clinical Observations in 4468 Cases of Patients with Urinary Stones / 대한비뇨기과학회지

4468 cases of patients with urinary stones between 1985 and 1995 have been clinically evaluated. The sex ratio was about 1.8: 1 (M: F). 1359 urinary stones have been analysed by infra-red spectrophotometer, calcium containing stones were the most common (80%), magnesium ammonium phosphate (MAP) and uric acid stone was 13.6% and 9.9%, respectively. Among the 212 patients (7%) with urinary tract infection (UTI), Escherichia coli was the most frequently isolated in 85 patients (40.1%). Patients with staghorn calculi and bladder stone were associated with MAP stone and UTI significantly more than other type of stone (p<0.05 by chi-square test). Hypercalciuria was found 275 patients (16%) in male, 208 patients (23.2%) in female, respectively. Primary hyperparathyroidism was diagnosed in 15 cases (0.3%), patients with hypercalcemia were 15, hypercalciuria in 10. 298 cases of 4468 cases (6.7%) were recurrent stone. There was no correlation with clinical parameters for stone formation but MAP stone in female significantly associated with recurrent stone. The duration of stone recurrence was 37.8+/-29.1 months (average). Pediatric stone was 40 cases, there was no clinical difference compared with adult stone. The management of stone with pregnancy was conservative in major. In treatment of renal stone, ESWL was 78.7%, pyelolithotomy in 5.0%, nephrolithotomy in 0.6% and combination therapy with ESWL and surgery was 3.2%. In ureter stone, ESWL was 55.2%, ureterolithotomy in 10.0%, ureteroscopic removal in 8.7% and combination therapy with ESWL and surgery or ureteroscopic removal was 5.5%. Even though the advance in disintegration of stone and removal technique have radically altered the approach to urinary stones, but it is desirable that stone analysis should be performed in all patients and the metabolic evaluation in patients with multiple stones or recurrent disease.

Clinical Evaluation of the Renal Cystic Disease and Analysis of the Cystic Fluid / 대한비뇨기과학회지

Renal cyst is a common renal disease. It rarely produces symptoms, and thus rarely require treatment. But the treatment is necessary when the cyst is symptomatic or complicated. The possible approach includes surgical unroofing or cyst puncture with or without intracystic injection of sclerosing agents. Thus we evaluated the efficacies of treatments in renal cystic disease. Cystic diseases were treated with percutaneous aspiration in 18 cases, percutaneous aspiration with sclerosing therapy in 26 cases. Overall efficacies were 22.2% with aspiration only and 95% with combined sclerosing therapy without no specific complications. Sclerosing therapy is relatively safe, less hazardous to the patient and shows high success rate in the treatment of cyst. We concluded that combined percutaneous cystic aspiration and sclerosing therapy was the best treatment of renal cystic disease. We assessed cystic fluid of 34 cases of simple renal cyst and 3 cases of polycystic kidney. The cystic fluid were analyzed for color, lipid profile, glucose, lactic acid dehydrogenase, amylase, electrolytes, culture and cell cytology. All aspirates of simple cyst were similar to composition of transudate. But aspirates of polycystic kidney were different from simple cyst.

Clinical Review of Pediatric Urolithiasis: Etiology and Treatment / 대한비뇨기과학회지

A series of 38 pediatric stone patients was studied retrospectively according to the clinical patterns of urolithiasis, etiology of stone disease, and management. The idiopathic cause was the most common of stone formation in the children. The most common type of stone in analysis was calcium oxalate. Thus, the etiology of stone disease and composition of stone was not definitely different in comparison with adult stone disease. We treated almost of stone patients with ESWL and peration was done in case of EWSL failure. And ESWL is the most effective and safe treatment of pediatric urolithiasis at present time. But anesthesia is needed to perform ESWL, especially younger children.

High Stage Prostate Cancer with Low Serum PSA Level: A Case Report / 대한비뇨기과학회지

Serum prostatic specific antigen (PSA) will be elevated in cases of BPH, prostatitis, prostatic cancer, and other conditions of prostate. Generally PSA is proportional to increased the size of the transitional zone of the prostate, but the PSA production by malignant glands is variable PSA production is depend on the degree of histologic differentiation in case of prostate cancer, with well-differentiated glands producing more PSA and undifferentiated cancer producing less PSA. Significant elevations of PSA, greater than 10 to 20 ng/ml, in the absence of prostatitis, or recent prostatic biopsy are strongly suggestive of cancer of the prostate. Several large scale studies have demonstrated that serum PSA correlates well with advancing clinical stage, tumor volume and pathological stage. We report a case in which high stage and poorly differentiated pathologic grade prostate cancer with low serum PSA level.

Clinical Observation of the Ureterocele: 29 Cases / 대한비뇨기과학회지

Ureterocele, congenital dilatation of the terminal or intramural portion of the ureter, may be classified as either simple or ectopic and has a broad spectrum of presentation, anatomy and treatment must be individualized. From February, 1986 to March, 1994, our experiences with 8 single system ureteroceles and 12 duplex system ureteroceles were reviewed. Their presentation, radiographic findings, operative management and postoperative results were discussed. The patients in this series were distribution from 1 year old to 66 years old and the male and female ratio was 4:16. The most presenting symptom was flank pain, affecting 7 cases, and ureterocele was associated with ureteral stone: 7 cases, VUR: 2 cases, renal cyst: 1 case, and IgA nephropathy:1 case. In 8 cases of single system ureterocele, Transurethral incision(TUI) of ureterocele in 1 case, ureterocelectomy with ureteroneocystostomy in 3 cases were done. In 12 cases of duplex system ureterocele, TUI of ureterocele in 2 cases, heminephrectomy with partial ureterocelectomy in 2 cases were done. After operation was done, there was no evidence of complication. We conclude that the surgical approach to the problems associated with a ureterocele is modified by patient age, renal anomaly and the pathological condition of the lower urinary tract.