ABSTRACT
PURPOSE: The clinical and urodynamic effects of intravesical capsaicin, a neurotoxic substance causing a reversible suppression of unmyelinated C fiber afferent neuronal activity, were investigated for treatment of detrusor hyperreflexia in patients with spinal cord injury. MATERIALS AND METHODS: Capsaicin solution (2mM) dissolved in 30% alcohol was instilled intravesically in 7 men with detrusor hyperreflexia due to spinal cord injury. Effects on bladder function and subjective symptoms were evaluated before and after intravesical instillation of capsaicin. RESULTS: Bladder function was improved in all but 1 patient. The improvement was expressed as an increase from 108ml to 270ml in maximal bladder capacity and a decrease from 75cmH2O to 44cmH2O in maximal detrusor pressure. Four patients had subjective improvement following treatment and the effects lasted for 4 to 6 weeks. Immediately after capsaicin instillation the ice water test was negative in 2 patients. Autonomic dysreflexia was observed in 4 patients, suprapubic discomfort in 3 patients and gross hematuria in 1 patient. CONCLUSION: Intravesical capsaicin seems to be a promising method for treatment of detrusor hyperreflexia, but the general use of intravesical capsaicin was limited due to side effects.
Subject(s)
Humans , Male , Administration, Intravesical , Autonomic Dysreflexia , Capsaicin , Hematuria , Ice , Nerve Fibers, Unmyelinated , Neurons, Afferent , Reflex, Abnormal , Spinal Cord Injuries , Urinary Bladder , Urodynamics , WaterABSTRACT
Cholesteatoma of the upper urinary tract is a rare nonmalignant condition histologically characterized by keratinizing desquamative squamous metaplasia (KDSM). Until now about 80 cases including one case from Korea have been reported. Cholesteatoma shows microscopic features of squamous metaplasia of the transitional epithelium and keratinization. These changes with subsequent desquamation of the superficial epithelial layers explain clinical manifestations of the disease. Flank pain, passage of cornified material in the urine and a filling defect on the IVP constitute the characteristic triad. Most cases were managed by extensive ablative surgery for fear of malignant potential. We report a case of renal cholesteatoma which was misdiagnosed as renal stone in 58 year-old female patient who had been suffered from intermittent left flank pain.
Subject(s)
Female , Humans , Middle Aged , Cholesteatoma , Epithelium , Flank Pain , Korea , Metaplasia , Urinary TractABSTRACT
PURPOSE: We investigated if there are some differences in characteristic of recent renal infection from the past one and evaluated the need of ultrasonography in acute renal infection and the efficiency of antibiotics that have been used primarily in treatment of past renal infection. MATERIALS AND METHODS: We reviewed charts of 232 patients with acute renal infection retrospectively, who took admission treatment from 1991 to 1995 at our hospital. The laboratory tests such as complete blood count, urinalysis and urine culture with sensitivity and radiologic evaluations such as abdominal ultrasonography, excretory urography or voiding cystourethrography were performed. RESULTS: The most common age groups were 3rd decade(26.7%) and 4th decade(24.1%). Female was predominant in all age groups(M:F=1:8.7) except 1st decade(M:F=1.6:1). Acute pyelonephritis was the most common disease (87.1%) and then followed by acute focal bacterial nephritis(8.2%), renal abscess(4.3%) and perirenal abscess(0.4%). Five cases(2.2%) were accompanied by vesicoureteral reflux. Abdominal ultrasonography was done in 90.5%, but 74.8% of them were completely normal and most of abnormal findings at abdominal ultrasonography were clinically insignificant. Result of ultrasonography did not affect the outcome of the disease or the treatment plan. The significant bacterial isolation(more than 10(5)CFU/ml) in urine culture was 46.6%. Among them, E. coli was the most common organism(92.6%) and others were Enterobacter, Klebsiella or Pseudomonas. Causative agents were resistant to some drugs such as ampicillin or bactrim which have been usually used for urinary tract infection. CONCLUSIONS: Routine ultrasonography in renal infections without urinary tract obstruction was not helpful in treatment plan or outcome of this disease and selection of antibiotics in treatment of recent renal infection should be changed from the past one.