Repeated ESWL Treatment on Steinstrasse / 대한비뇨기과학회지

We analyzed the incidence and treatment of steinstrasse in 470 patients(renal units-521 cases) who underwent ESWL treatment for renal stones using a Piezolith 2300 piezoelectric lithotriptor between April 1990 and July 1993. Of 521 renal stones, a total of 44 cases(8.5%) developed steinstrasse. The most common location for steinstrasse was in the lower ureter(72.7%), followed by upper ureter(22.7%) and mid-ureter(4.6%). In these 44 cases, stone fragments passed spontaneously in 23 cases(52.3%) and mean duration to spontaneous passage was 15.7 days(range 1-43 days). Repeated ESWL was performed on steinstrasse in 20 cases. Successful treatment (no residual stone fragments in the ureter) was achieved in 18 cases(90%) and the mean number of sessions was 1.3. There was no significant complication after repeated ESWL. Only 2 patients who failed ESWL treatment required open ureterolithotomy. The remained 1 patient with mid-ureteral steinstrasse underwent ureteroscopic management. With this result, repeated ESWL seems to be effective and safe in the treatment of steinstrasse which is not expected to pass spontaneously.

Study on Correlation between the Expression of P-Glycoprotein and the Effect of Chemotherapy in Transitional Cell Carcinoma / 대한비뇨기과학회지

The resistance of neoplastic cells to chemotherapeutic agents may develops by a variety mechanisms. One of these mechanisms seems to be the amplification or overexpression of the multidrug resistance(MDR) gene. The MDR phenotype is conferred by a 170kD membrane protein, P-glycoprotein. This protein acts as a drug efflux pump for a variety of structurally unrelated antineoplastic agents, especially hydrophobic natural products such as adriamycin and vincristine. In the present study, immunohistochemical stain for P-glycoprotein was performed in paraffin section of 41 specimens of transitional cell carcinoma of the bladder obtained prior to chemotherapy to investigate the usefulness of P-glycoprotein as a predictor of response to M-VAC ( methotrexate, vinblastine, adriamycin and cisplatin) chemotherapy. The overall clinical response rate to chemotherapy was 65.9%. The overall 3- year survival rate was 63%, with 80% in responder group( clinical complete and partial remission) and 36.3% non-responder group(minor response, stabilization and progression ) (P<0.05). In the responder group, 7.4% expressed strongly positive P-glycoprotein, 63% weakly positive and 29.6% negative. In the non-responder group, 28.6% expressed strongly positive P-glycoprotein, 64.3% weakly positive and 7.1% negative. The negative expression rate was high in responder group than non-responder, but this difference was not statistically significant. There was no correlation of expression of P-glycoprotein with either tumor stages or grades. In conclusion, these results suggest that tumors with negative expression of P-glycoprotein seem to have a better clinical response to chemotherapy, and further investigation of other mechanisms of cellular drug resistance should be required.

The Study of Expression of Proliferating Cell Nuclear Antigen(PCNA) and Nucleolar Organizer Regions(NORs) in Transitional Cell Carcinoma of the Urinary Bladder / 대한비뇨기과학회지

The expression of two cell proliferation indices, the proliferating cell nuclear antigen( PCNA), using the monoclonal antibody in the immunoperoxidase method, and the nucleolar organizer regions (NORs), using silver nitrate staining technique, were assessed in formalin-fixed paraffin embedded material of transitional cell urinary bladder carcinomas. The aim of our study was to examine comparatively the expression of PCNA and the number of NORs in 37 transitional cell bladder carcinomas and to investigate how they correlate with tumor grade and the disease stage. It was noticed that the PCNA expression rate(%) related to grade was statistically significant only between grades II and III (p 0.05). The mean number of AgNORs per nucleus between grades I and II and between grades II and III were statistically significant(p<0.05). As far as the correlation of PCNA expression rate(%) with the stage is concerned, PCNA expression rate (%) was higher in the invasive tumors(p<0.05) than in the superficial tumors and AgNOR Numbers was also greater in the invasive tumors(p <0.05). The linear correlation coefficient between PCNA expression rate (%) and AgNOR counts was 0.52(p <0.001) In conclusion, a considerable relationship was found between the histological grade and each of the two indices used. A good correlation was also demonstrated between each of PCNA expression rate(%) and AgNOR scores to the pathologic stage. Our results suggest that PCNA expressionrate( % ) and AgNOR scores may be prognostic induces in urinary bladder cancer.

Extracorporeal Shock Wave Lithotripsy Monotherapy for Staghorn Stones / 대한비뇨기과학회지

During recent 3 years, we reviewed 42 patients with staghorn stones, who underwent extracorporeal shock wave lithotripsy (ESWL) with the Wolf Piezolith 2300 lithotriptor, to deter- mine whether ESWL monotherapy is a successful alternative. The results were obtained as follows: 1. Of 42 patients 10 had complete staghorn stones with 88.7mL in mean volume and 32 incomplete staghorn stones with 22.6mL in mean volume. 2.Mean session of ESWL was 7.8 in overall cases(8.8 in complete staghorn stones and 7.5 in incomplete staghorn stones). The overall success rate was 66%(60% in the complete staghorn stone and 69% in the incomplete staghorn stone). 3. Of 10 patients with stone less than 15mL, 8(80 %) showed stone -free after 5 mean sessions. Of 12 patients with stone between 15mL to 25mL, 9(76%) revealed stone-free after 6.6 mean sessions. Of 11 patients with stone between 25mL to 50mL, 6(55%) showed stone-free after 10.1 mean sessions. Of 9 patients with stone more than 50mL, 5 (56% ) revealed stone-free after 9.4 mean sessions. 4. Twelve patients showed partial response and 2 patients non-response. Of these 14 patients 6 underwent Open surgery, 5 still had remnant stones and 3 were lost to follow up. 5. The post-ESWL complications were flank pain in 18 patients(43% ), gross hematuria in 11 (26%), high fever in 4(10%) and steinstrasse in 13(31%). We conclude that ESWL monotherapy for staghorn stones is considered to be a safe and effective modality, except for bringing partial response in some cases and requiring long durations to get stone-free.

A Computer Program for Searching the Korean Journal of Urology / 대한비뇨기과학회지

Building a database file in the medical literature using personal computer enables individualized computer user to search with a small amount of time and effort. We developed a computer program for searching medical literature. This program was developed with Clipper database language, and runs on IBM-PC-compatible computers. The data is based on the Index of Korean Journal of Urology which was revised in 1991. The program is focused on the function of retrieving and printing of keywords, authors and titles, etc. We expect more advanced and beneficial program for searching of medical literature based on this program.

Changes of Nitric Oxide Metabolite and Tumor Necrosis Factor-alpha in the Urine of Patients with Superficial Bladder Tumors after BCG Immunotherapy / 대한비뇨기과학회지

Bacillus Calmette-Guerin(BCG) is widely used in the therapy of superficial bladder tumors. Clinical and animal studies suggest that immunological responsiveness to BCG antigens correlates with anti-tumor activity. But its mode of action is unclear. In this studies, we evaluated the changes of nitric oxide(NO) metabolite and tumor necrosis factor-alpha(TNF-alpha) in the urine of patients with superficial bladder tumors after BCG immunotherapy. Both NO and TNF-alpha in the urine specimens of patients treated with BCG were analyzed prior to BCG instillation and 4, 8 and 24 hours afterwards. After 6th BCG instillation. urinary NO increased significantly and showed a maximum of secretion at eight hours(p<0.05). After 6th BCG instillation, urinary TNF-alpha increased and showed a maximum of secretion at eight hours but had no statistical significance. These results suggest that intravesical BCG therapy increased the urinary NO and TNF-alpha secretion which may be related to the anti-tumor activity.

A Case of Ectopic Thoracic Kidney / 대한비뇨기과학회지

Ectopic thoracic kidney is an extremely rare developmental anomaly. Most cases are discovered incidentally on a routine chest roentgenogram. Since the ectopic thoracic kidney may be mistaken for a space-occupying lesion originating above the diaphragm, it is of clinical and diagnostic importance to the thoracic surgeon. We report a case of ectopic thoracic kidney that was diagnosed by chest roentgenogram, intravenous pyelogram, computerized tomogram, and aortogram.

Transrectal prostatic needle biopsy using the bioty gun with needle-protecting sheath / 대한비뇨기과학회지

Biopty gun is an instrument designed for obtaining the prostatic tissue. But there is danger of injury or an examiner`s finger by the sharp needle and risk of unnecessary injury of the rectal mucosa during transrectal approach to the prostate. Therefore we designed the needle-protecting sheath over Biopty gun to eliminate these problems and conduct safe maneuver.

Extracorporeal shock wave lithotripsy experience with wolf piezolith 2300 device in 500 patients with upper urinary tract calculi / 대한비뇨기과학회지

An experience of extracorporeal shock wave lithotripsy (ESWL) using the Wolf Piezolith 2300 lithotriptor in 500 patients with upper urinary tract calculi is presented. Between April 1990 and April 1992, 500 patients (526 renal units) 8 to 78 years old were treated and followed up for at least 3 months. Of 526 renal units, 199 (37.8 per cent) had renal, 275 (52.3 per cent) ureteral and 52 (9.9 per cent) multiple stones. Of these cases 50.4 per cent had stones smaller than 1cm, 33.7 per cent from 1 to 2cm, 8.5 per cent from 2 to 3cm and 7.4 per cent larger than 3cm, including staghorn or multiple stones. The success rate ranged from 100 per cent for stones smaller than 1.0cm in diameter to 71.8 per cent for stones larger than 3.0cm, with a 94.5 per cent of overall success rate. For auxiliary measures, push back procedure was done in 19 patients, Double J stents placed in 3 and nephrostomy performed in 6 patients. There were no significant complications. Stone street developed in 74 patients. Of these, stone fragments passed spontaneously in 37 and treated successfully with repeat ESWL in 24 and with manipulation by ureteral catheter in 12. Only 1 patient required percutaneous nephrostomy because of ureteral obstruction by stone fragments. Therefore. extracorporeal shock wave lithotripsy with piezoelectric lithotriptor is considered to be a safe and efficient outpatient procedure for the initial treatment of upper urinary tract calculi.

A case of transsacral approach for traumatic urethrorectal fistula / 대한비뇨기과학회지

The causes of urethrorectal fistula are multiple such as trauma, open prostatectomy, radiation therapy, infection and congenital anomaly and so forth. In considering the injured area, length and the condition or periurethral tissue, numerous approaches have been advocated for the treatment of the traumatic urethrorectal fistula. Herein we report the experience of successful transsacral repair of traumatic urethrorectal fistula in a 14 year-old male patient 3 months after cystostomy and colostomy installed.

Incidence estimation of genitourinary cancer in Korea

A nation-wide study was performed to estimate the incidence of bladder, kidney, renal pelvis and ureter, prostate, testicular and other genitourinary cancer among Koreans in Korea using medical records of the inpatients of the beneficiaries of the Korea Medical Insurance Corporation (KMIC) from Jan. 1, 1989 to Dec. 31, 1989. The crude incidence rate of bladder cancer (ICD-9 188) is estimated to be 4.43 and 0.98 per 100,000 in males and females, respectively. Around 1,093 new cases of bladder cancer (895 male and 198 female) are estimated to occur in a year. The adjusted rate for the world population is 7.76 in males and 1.19 in females which is similar to that of Japanese in Osaka and Chinese in Shanghai, but lower than in American whites and blacks. The crude incidence of kidney, renal pelvis and ureteral cancer (ICD-9 189) is estimated to be 1.61 and 0.87 in males and females, respectively. Around 507 new cases of kidney, renal pelvis and ureteral cancer (332 male and 175 female) are estimated to occur in a year. The adjusted rate for the world population is 2.69 in males and 1.04 in females. In the prostate (ICD-9 185), the crude incidence rate of cancer is estimated to be 1.36. Around 274 new cases of prostate cancer are occurring in a year. The adjusted rate for the world population is 2.98 which is similar to the Chinese rate. The incidence of genitourinary cancer continuously increases with age.

The result of primary in situ extracorporeal shock wave lithotripsy for ureteral stones / 대한비뇨기과학회지

We reviewed our experience with in situ treatment of ureteral stones by extracorporeal shock wave lithotripsy(ESWL) using the wolf Piezolith 2300 device in 110 patients(114 stones) who were follow up for more than 3-months. The stone-free rate was 86 per cent(49 of 57 stones) for upper, 88.9 per cent(48 of 54 stones) for lower and 33.3 per cent(1 of 3 stones) for mid ureteral stones. The over-all stone-free rate was 85.9 per cent. For ureteral stones treated in situ the best results were obtained in non obstructing stones with 93.2 per cent and also in stones less than 10mm with 94.1 percent at 3 months after initial treatment, while the mid ureteral and impacted stones were difficult to treat successfully in situ on the Wolf piezolith device. The auxiliary measurements such as hydration with diuresis(21 cases, 18.4%), double J stent or nephrostomy(15 cases, 4.4%) were needed. Most of post-ESWL complications were mild and managed conservatively. These results suggest that in situ ESWL is an effective and noninvasive method to treat ureteral stones.

Expression of c-ras oncogene and DNA ploidy in urinary bladder tumors / 대한비뇨기과학회지

Biological behavior of transitional cell tumors of the urinary bladder is related to many parameters, such as clinical staging, vascular invasion, expression of blood group antigens or oncogenes and DNA ploidy as well as histopathological grading. In most. however, the parameters have been evaluated separately in relation to histopathological grading or prognosis. although it is well known that biological behavior of a tumor can be predicted more reliable by analysis multiple parameters. In this study. the author tried to see the prognostic Relation ship between histopathological grading and expression of c-ras oncogene and DNA ploidy which have been defined recently. Immunohistochemical staining for c-ras oncogene products was performed in 40 cases of transitional cell tumors and positive tumor cells were estimated by light microscopy. DNA ploidy was determined by flow cytometry using the paraffin-embedded tissue. 1. By immunohistochemistry For c-ras oncogene products. the mean value of the positive cells was 35.1% in papillomas. 79.4% in grade I. 81.9% in grade X and 87.6% in grade III transitional cell carcinomas. 2. Analysis of DNA ploidy revealed diploidy in 8 and aneuploidy in 2 of 10 cases of papilloma, diploidy in 7 and aneuploidy in 3 of 10 cases of grade I diploidy in 4. tetraploidy in 1 and aneuploidy in 6 of 10 cases of grade II , diploidy in 3, tetraploidy in 1 and aneuploidy in 6 10 cases of grade III transitional cell carcinoma. In conclusion, high grade tumors showed more marked augmentation of the oncogene expression and higher incidence of DNA aneuploidy and tetraploidy, suggesting a close relationship among the histopathological grading, oncogene expression and DNA ploidy.

A case of adult Wilms' tumor associated with spontaneous renal rupture / 대한비뇨기과학회지

Wilms' tumor is composed of a mixture of epithelial, stromal and blastematous elements in varing proportions. Adult Wilms' tumor, unlike that of childhood is a rare disease. Spontaneous rupture of the kidney with subcapsular or perirenal hematoma also is rarely seen in malignant renal tumor. A case of adult Wilms' tumor in 65-year old female is here reported, associated with spontaneous renal rupture, which was treated with radical nephrectomy and chemotherapy (vincristine, actinomycin D and doxorubicin).

A case of transplanted kidney stone treated by ESWL / 대한비뇨기과학회지

Urinary calculi are an uncommon complication in renal transplant recipients. We report a case of transplanted kidney stone preexisting in the donor kidney. which was treated successfully with extracorporeal shock wave lithotripsy.

Initial clinical experience of extracorporeal shock wave lithotripsy using the Wolf Piezolith 2300 lithotriptor / 대한비뇨기과학회지

During 5 months from April to August, 1990, 114 patients with urinary stone were treated without anesthesia by extracorporeal shock wave lithotripsy (ESWL) with the Wolf Piezolith 2300 lithotriptor. Of these 114 patients, 95 comprising 98 renal units with stones followed more than 1 month after ESWL, were evaluated. The results were obtained as follows ; l. The average patient age was 44 years, with a range of 19 to 65 years. The sex ratio was similar, All cases were treated on the out-patient basis. 2. The locations of stones were kidney in 61 cases ( 62.2%) including 8 cases of staghorn calculi and ureter in 37 cases (37.8%). 3. The average sessions of treatment were 2.6 and average treatment time was 31 minutes. 4. Pain from ESWL was tolerable for almost all patients in whom ESWL were performed without anesthetics or analgesics. Only 2 of 95 patients required analgesics. 5.Complete fragmentation (into particles less than 2mm in size) was achieved in 94.9% of the cases, with 75.5% being completely free of stone at 1 month. 6.The auxiliary measurements such as hydration with diuresis, ureteral stenting were needed in 11.2% of cases. Hydration with diuresis was induced in 7 cases for the localization of the ureteral stone. 7. The post-ESWL complications were mild and controlled with conservative management. We conclude that extracorporeal shock wave lithotripsy monotherapy with Wolf Piezolith 2300 lithotriptor was considered to be effective and safe procedure for the treatment of urinary stones.

A Case of Aldosteronoma / 대한비뇨기과학회지

Primary Aldosteronism is characterized by hypertension, hypokalemic alkalosis and increased aldosterone secretion. It is important to distinguish between adenoma and hyperplasia for the treatment of primary aldosteronism because the hypertension associated with the adenomatous form is more likely to respond to operative removal. We report a case of aldosterone producing adrenal adenoma which was diagnosed by postural stimulation test of aldosterone and abdominal computed tomography, and was treated by adrenalectomy. A week after surgery, the blood pressure and laboratory data returned to normal.

A Case of Successful Penile Replantation / 대한비뇨기과학회지

Traumatic amputation of a penis is an unusual injury. Amputation of the penis occurs most commonly as an act of self-emasculation, but has also been reported as resulting from assaults or accidental dismemberments. We report a case of successful clinical replantation of an amputated penis resulting from assaults by using a microvascular surgery.

A Case of Seminoma in Abdominal Cryptorchid Testis / 대한비뇨기과학회지

Seminomatous testis tumors are treated highly effectively with irradiation and chemotherapy following orchiectomy according to stage. We report a relatively rare case of seminoma developed in abdominal cryptorchid testis of 35 years old man, which was treated with surgery including the segmental resection of sigmoid colon involved.

The Clinicopathological Study on Prostatic Carcinoma: The Evaluation of Prognosis by Gleason's Method / 대한비뇨기과학회지

A clinicopathological study based on stages, Gleason's method and srvival rates was carried out in 149 cases of prostatic carcinoma treated at Pusan National University Hospital and five participating hospitals. 1. The distribution of each stage was:17 (11.4%) in stage A, 37 (24.8%) in stage B, 22 (14.8%) in stage C, and 73 cases (49.0%) in stage D. Of Gleason's score between primary and secondary pattern, the uniform cases were in 32%, the cases of 1 step differences were in 59 %, the cases of 2 step differences were in 9%, and none in more than 2 step differences. 2. The score sum of Gleason's method was inclined to be higher as the stage became higher. 3. The survival rates were declining as stages excluding cases between stage A and B became higher. As the Gleason's score (primary and secondary pattern, Gleason's sum, Gleason's category) became higher, the survival rates tended to decline. 4. Comparing the death rates of our cases to that of VACURG study of USA and that of Harada of Japan according to Gleason's score, there were no statistical differences (a>0.05). The prognosis of prostatic carcinoma depends on the histological factor, which in dictates the significance of Gleason's method. Also the authors believe that a common ground of basis such as Gleason's method is useful in comparative studies.