A Case of High Flow Priapism / 대한비뇨기과학회지

High flow priapism is a nonischemic form of priapism. This results from unregulated, continuous arterial inflow to the lacunar spaces by trauma or idiopathic causes. It is clinically recognizable because the erection is painless and coporal aspiration yields bright red blood with a high pO2. We report a case of arterial high flow priapism secondary to perineal blunt trauma in 29-year-old man treated with embolization of cavernosal artery.

Anatomic Factors that Affect Lower Caliceal Stone Clearance after Shock Wave Lithotripsy / 대한비뇨기과학회지

PURPOSE: Shock wave lithotripsy(SWL) has become the preferred modality of treatment for the most kidney stones. But there is a consensus that success rate of SWL is relatively poor for the lower caliceal stones. We assessed the influence of spatial anatomy of the lower calyx on stone clearance after SWL. MATERIALS AND METHODS: We retrospectively reviewed 92 patients with 5-20mm sized solitary lower caliceal stone who had undergone SWL between March 1992 and February 1998. The clearance rate at three months was compared according to lower pole anatomy, such as infundibulopelvic angle, infundibular length and infundibular width. RESULTS: Overall stone free rate was 59.8 percent. In 67 cases whose infundibulopelvic angle greater than 90 degree, stone free rate was 68.7 percent, whereas in 25 cases less than 90 degree, it was only 36.0 percent(p<0.05). In 36 cases whose infundibular length greater than 3cm stone free rate was 38.9 percent, whereas in 56 cases less than 3cm it was 73.2 percent(p<0.05). In 70 cases whose infundibular width greater than 5mm stone free rate was 57.1 percent, whereas in 22 cases less than 5mm it was 68.2 percent. CONCLUSIONS: The lower pole infudibulopelvic angle and infundibular length has a significant role in the stone clearance after SWL of lower caliceal stones. The infundibulopelvic angle less than 90 degree and infundibular length greater than 3cm are individually unfavorable factors. We believe that these anatomic factors have to be considered when the physician decides SWL as a first line treatment of lower caliceal stones.

376 Cases of Ureteroscopic Stone Removal / 대한비뇨기과학회지

PURPOSE: We retrospectively reviewed the cases of ureteroscopic stone removal at our institution to define the efficiency of ureteroscopy for treatment of ureteral calculi. MATERIALS AND METHODS: Ureteroscopic stone removal was performed in 376 cases of ureteral stone from August, 1989 to December, 1997. There are 241 males and 135 females, and mean age was 45.6 years. Nine stones were located in the upper ureter, 27 in the mid ureter, 340 in the lower ureter. The stone size was less than 5mm in 125 cases, from 5 to 10mm in 185 cases and more than 10mm in 66 cases. Ureteroscopy was performed with 9.5Fr, 10Fr or 12.5Fr rigid ureteroscope under spinal, general or epidural anesthesia. RESULTS: Overall success rate of ureteroscopic stone removal was 95.1 percent. The success rates of upper, mid and lower ureteral stones were 55.6, 88.9 and 97.1 percents, respectively. According to the stone size, the success rates was 97.6 percent in stones less than 5mm, 94.6 percent in stones of 5 to 10mm and 92.4 percent in stones more than 10mm. Over all complication rate was 9.6 percent. Complications consisted of severe ureteral mucosal tearing(20 cases), ureteral perforation(8 cases), gross hematuria(3 cases), infection(3 cases) and urethral stricture(2 cases). All complications were treated successfully with conservative treatment except 2 cases of urethral stricture that required visual urethrotomies. CONCLUSIONS: Ureteroscopic stone removal could offer rapid relief of obstruction and colic due to mid and lower ureteral calculi with high success rate and minimal complications.