Metastatic Squamous Cell Carcinoma of the Kidney from Cholangiocarcinoma

We present a rare case of a metastatic renal tumor originating from adenosquamous carcinoma of the intrahepatic bile duct. A 64-year-old man treated with bisegmentectomy and extended cholecystectomy for cholangiocarcinoma had a left cystic renal mass, which had irregular wall thickening, heterogeneously low attenuation, and soft tissue infiltration as determined by a computed tomography scan. The first impression was renal abscess. Left nephrectomy was performed and the nonencapsulated mass was gray in color macroscopically. Histological examination of the specimen revealed alveolar proliferation of small cancer cells, which was consistent with the original tumor of the intrahepatic bile duct. The left renal tumor was misdiagnosed as a renal abscess but finally diagnosed as squamous cell carcinoma metastasized from the intrahepatic bile duct. The patient expired because of lung metastasis after 14 months following left nephrectomy. In our opinion, this case would be the first report of a renal metastasis from a cholangiocarcinoma clinically and was treated with nephrectomy.

Effects of Spinal and Peripheral Injection of alpha1A or alpha1D Adrenoceptor Antagonists on Bladder Activity in Rat Models with or without Bladder Outlet Obstruction / 대한배뇨장애요실금학회지

PURPOSE: Antagonists of alpha1-adrenergic receptors (alpha1ARs) relax prostate smooth muscle and relieve voiding and storage symptoms. Recently, increased expression of alpha1ARs with change of its subtype expression has been proved in bladder outlet obstruction (BOO). To search for the evidence of changes in alpha1ARs subtype expression and activity in the peripheral and spinal routes, the effects of spinal and peripheral administration of tamsulosin (an alpha1A/D-selective AR), naftopidil (an alpha1A/D-selective AR), and doxazosin (non-selective AR) on bladder activity were investigated in a rat model with or without BOO. METHODS: A total of 65 female Sprague-Dawley rats were divided into the BOO surgery group (n=47) and the sham surgery group (n=18). After 6 weeks, cystometry was assessed before and after intrathecal and intra-arterial administrations of tamsulosin, naftopidil, and doxazosin. RESULTS: After intra-arterial administrations of all three drugs, bladder capacity (BC) was increased and maximal intravesical pressure (Pmax) was decreased in both BOO and the sham rat models (P<0.05). After intrathecal administration of all three drugs, BC was increased and Pmax was decreased in only the BOO group. The episodes of involuntary contraction in the BOO rat models were decreased by intra-arterial administration (P=0.031). The increase of BC after intrathercal and intra-arterial administrations of alpha1ARs was significantly greater in the BOO group than in the sham group (P=0.023, P=0.041). In the BOO group, the increase of BC and decrease in Pmax were greater by intra-arterial administration than by intrathecal administration (P=0.035). There were no significant differences of the degrees of changes in the cystometric parameters among the three different alpha1ARs. CONCLUSIONS: Up-regulations of the alpha1ARs in BOO were observed by the greater increases of BC after alpha1AR antagonist administrations in the BOO group than in the sham group. However, there were no subtype differences of the alpha1ARs in functional parameters of bladder activity. In addition, alpha1ARs also act on the lumbosacral cord which implies that the sensitivity of alpha1ARs is increased in pathologic models such as BOO. Further evaluation including differential expression of alpha1ARs in BOO models are need.

Spontaneous Rupture of Renal Angiomyolipoma in a Female Tuberous Sclerosis Patient with Pulmonary Lymphangioleiomyomatosis / 대한비뇨기과학회지

Pulmonary lymphangioleiomyomatosis (LAM) is uncommon debilitating disease, predominantly affecting women of childbearing age. Renal angiomyolipoma (AML) is the most common renal lesion in patients with tuberous sclerosis (TS), but, even without TS, is reported in up to 60% of the patients with LAM, which is frequently diagnosed several years before the LAM itself. However, it is extremely rare for renal AML and pulmonary LAM to simultaneously present in tuberous sclerosis complex. Herein, a case of spontaneous rupture of a renal AML, accompanied by pulmonary LAM, in a reproductive female with TS, managed by selective transcatheter arterial embolization (TAE), is reported.

The Effect of Botulinum Toxin and Resiniferatoxin on the Detrusor Overactivity Induced by Cyclophosphamide in Rat Bladder / 대한비뇨기과학회지

PURPOSE: The purpose of this study was to compare the effects of resiniferatoxin (RTX) and botulinum toxin (BTX) on the bladder detrusor function in a cyclophosphamide (CYP)-induced cystitis rat model. MATERIALS AND METHODS: Sprague-Dawley rats were divided into 5 groups (1: saline treated, 2: CYP and BTX treated, 3: CYP and RTX treated, 4 and 5: CYP treated and sham operated as the counterpart of groups 2 and 3, respectively, with normal saline). 100mg/kg CYP was injected every third day for five weeks. Cystometrograms were performed after the BTX and RTX treatments. RESULTS: 1. The normal control group and the CYP-treated only group. In the CYP-treated group, the time of micturition frequency, the maximal detrusor pressure on the cystometergram (Pvesmax at CMG), the maximal detrusor pressure on the pressure-flow study (Pvesmax at pr/flow) and the episodes of irregular contractions were increased. 2. The CYP-only group and the CYP/BTX or CYP/RTXtreated groups. In the CYP/BTX or CYP/RTX treated groups, the time of micturition frequency, the Pvesmax at CMG, the Pvesmax at pr/flow and the episode of irregular contractions were decreased. 3. The CYP/BTXtreated group and the CYP/ RTXtreated group. There was no statistically significant difference between the two groups regarding micturition frequency, the PvesMax at CMG and the PvesMax at pr/flow, the Dhfo and the episodes of involuntary contractions (p>0.05). CONCLUSIONS: Intravesical administration of BTX or RTX blocked the CYP-induced detrusor overactivity as was shown by the restoration of the micturition frequency, the intravesical pressure and the involuntary contraction episodes to a control level. There was no statistically significant difference between the two groups regarding the urodynamic parameters.

Effectiveness of Two Spots Enuretic Voiding Diary for the Treatment of Nocturnal Enuresis / 대한비뇨기과학회지

PURPOSE: The authors developed a Two Spots Enuretic Voiding Diary (TSEVD) that consisted of the first voiding amount (V1) after awakening and the single voiding amount (V2) for the patient's need to void before sleep. We evaluated the efficacy and usefulness of the TSEVD for the treatment of enuretic children. MATERIALS AND METHODS: From Apr. 2002 to Feb. 2004, 71 patients with monosymptomatic nocturnal enuresis and 55 patients with polysymptomatic nocturnal enuresis were enrolled in this study. The treatment modality and termination were assigned by the V1, V2 and V3 (age- matched normal bladder capacity) on the TSEVD. RESULTS: The percent of patients whose V3 exceeded their V2 and their ratios of V1/V2 and V2/V3 were decreased after treatment in both the monsymptomatic and polysymptomatic group. For the monosymptomatic patients, the submission rate, the good response rate and the cure rate were 73.7%, 19.7% and 65.6%, respectively, whereas the submission rate, the good response rate and cure rate for the polysymptomatic patients were 84.4%, 22.9% and 41.7%, respectively. The recurrence rates in both groups were 14.8% and 35.4%, respectively. Both the patients and parents showed good understanding of the TSEVD, the principles of treatment and their role in the treatment. The Student's t-test (paired) was used for the statistical analysis. CONCLUSIONS: These data suggests that the TSEVD was useful to evaluate the progress of treatment and the treatment goals for each patient suffering with nocturnal enuresis. The treatment end point, based on the TSEVD, was effective in reducing recurrence by determining the treatment effect.

The Early Experience and Technical Aspects of Endoscopic Subureteral Polydimethylsiloxane Injection for Vesicoureteral Reflux / 대한비뇨기과학회지

PURPOSE: We reviewed the operative outcome and the cause of failure for performing subureteral injection of polydimethylsiloxane (PDS, Macroplastique(R), Uroplasty Inc. Geleen, The Netherlands), when it is used as a bulking agent for the endoscopic treatment of vesicoureteral reflux (VUR) patients. MATERIALS AND METHODS: A total of 29 patients (a total of 37 ureters), with primary grades I to V VUR were treated with a single subureteral injection from 2001 to 2004; these patients were followed for an average of 21.5 months. Each patient underwent preoperative voiding cystourethrography, renal ultrasound, a dimercapto-succinic acid (DMSA) scan and urine culture. With the patient under general anesthesia, the PDS implant was injected transurethrally at the 6 o'clock position of the ureteral opening in the affected renal unit by a modified subureteral transurethral injection (STING) procedure. Renal ultrasound was done at 1 week and voiding cystourethrography was done at 3 months to rule out obstruction at the injection site and/or persistent reflux, respectively. Cure was defined as an absence of VUR on voiding cystourethrography at 3 months after injection. Statistical analyses were performed using the chi-square test. RESULTS: The grade of reflux was I, II, III, IV and V in 6, 4, 12, 9 and 6 ureteral units respectively. After a single injection, the VUR was cured in 30 ureteral units (81.1%). There were 7 (18.9%) patients who received a second injection after a failed single injection. In these patients, the injected PDS volume was not changed on ultrasound. On the other hand, cystoscopy showed mound displacement in 4 patients, no volcano appearance but rather a broad elevation in 2 patient, and distal ureteral fistula and mound extrusion in 1 patient. CONCLUSIONS: These results suggest that endoscopic subureteral polydimethylsiloxane injection is an effective treatment of VUR. The efficacy of subureteral injection can be improved by using the correct injection technique.

Bilateral Diverticula with Recurrent Urinary Tract Infection / 대한비뇨기과학회지

Most bladder diverticula are associated with a neurogenic bladder or obstructive condition, but a congenital diverticulum is believed to be a congenital failure of normal muscular development. Often solitary and large congenital bladder diverticulum leads to various complications, including recurrent urinary tract infection, vesicoureteral reflux, stone formation, and incontinence. A diverticulectomy, with ureteral reimplantation, is recommended in Hutch's diverticula, as they are usually accompanied with reflux that does not spontaneously subside. We experienced a case of bilateral Hutch's diverticula, without vesicoureteral reflux, in a 15-month-old boy. This patient was successfully treated using only a bilateral diverticulectomy.

Correlation Among Symptom Score, Peak Urine Flow, Prostate Volume and Obstructive Parameters as analyzed in Pressure-Flow Studies for the Patients wth Benign Prostate Hyperplasia in Whom TURP will be Contemplated

No abstract available.

Incidence of Detrusor Underactivity in Men with Prostatism Older than 50 years / 대한비뇨기과학회지

PURPOSE: It has been well known that 70-80% of men with prostatism actually manifest bladder outlet obstruction(BOO) and the rest have detrusor underactivity(DU) or other abnormalities. Accordingly, the treatment of BPH by the results of symptom score, or uroflow may be partly incorrect. It is also well known that the pressure-flow study is the gold-standard to define the presence and degree of BOO. Therefore, we investigated pressure-flow study to identify non-obstructed, underactive detrusor function among the patients presented with prostatism. MATERIALS AND METHODS: This study included 96 patients older than 50 years (mean 69.6+/-5.8) with prostatism. All patients were assessed by history taking, symptom score, digital rectal examination, uroflowmetry and pressure-flow study. Patients were divided into irritative and obstructive symptom groups according to their chief complaints. Urodynamic parameters between those two groups were analyzed and compared. RESULTS: Of the total 96 patients, detrusor instability was noted in 45(47%) at the filling cystometry. Of the 53 patients presented with irritative symptoms, 33 showed detrusor instability(62%); Of the 43 patients mainly presented with obstructive symptoms, only 12(28%) showed detrusor instability. Statistically significant correlation was found between irritative symptoms and detrusor instability as well as obstructed symptoms and BOO. In the total patients, BOO was found in 49(51%) and detrusor underactivity(DU) was found in 36(37%) with equivocal cases in 11(12%). Of the 43 patients mainly presented with obstructive symptoms, BOO and DU was found in 23(53%) and 13(30%) respectively. Of the 53 patients presented with irritative symptoms, BOO and DU was found in 26(49%) and 23(43%) respectively. There were no significant differences between irritative and obstructive symptom group as well as BOO and DU group in the clinical parameters as determined by symptom score, prostate size, and uroflowmetry. CONCLUSIONS: In this study, significant proportion(37%) of the whole patient population was classified as detrusor underactivity as diagnosed by urodynamics to which treatment for BPH may not be as effective as for those manifested with BOO. It is suggested that pressure-flow study is to be considered to patients with prostatism who didn`t show any symptomatic improvement despite the treatment for BPH.

Usefulness of Transition Zone Index in Assessing Benign Prostatic Hyperplasia: Correlation with Symptom Score and Uroflow / 대한비뇨기과학회지

PURPOSE: Prostate volume has been known to be poorly correlated with other parameters used to assess benign prostatic hyperplasia(BPH), including symptom score, peak flow rate(Qmax), amount of postvoid residuals(PVR). The purpose of this study was to determine if measurement of the transition zone index(TZI) of the prostate correlated well with other clinical parameters in predicting the degrees of obstruction. MATERIALS AND METHOD: We prospectively evaluated 86 men with symptomatic BPH(mean age: 65.4 years) according to symptoms, Qmax, PVR, transrectal ultrasound volume of the entire prostate and the transition zone. TZI was determined as the ratio between transition zone volume(TZV) and total prostate 1 volume(TV). RESULTS: Age correlated with symptoms(r=0.29, p=0.006) and PVR(r=0.466, p=0.001); Qmax negatively correlated with age(r=-0.487, p=0.001), symptoms 1 (r=-0.28, p=0.007) and PVR(r=-0.36, p=0.001). Age also correlated with TV(r=0.4, p=0.001), TZV(r=0.435, p=0.001) and, TZI(r=0.36, p=0.001). There was a weak correlations between TV and symptom r=0.23), Qmax(r=0.28), and PVR(r=0.24); a stronger correlation were noted between TZ and symptoms(r=0.33), Qmax(r=-0.35) or PVR(r=0.28). There were significant correlation between TZI and symptoms(r=0.35), Qmax(r=-0.38) or PVR(r=0.30). Age, PVR, 721, and TZV were significantly greater and Qmax were significantly lower in severe (IPSS > or = 20, N=38) symptom group than in moderate(IPSS or = 15m1/sec) group. No significant differences of TV were noted either between moderate and severe symptom group or low and high Qmax group. CONCLUSIONS: Transition zone volume or index are parameters that correlates significantly with evaluated parameters of BPH and may serve as a useful method for evaluating obstruction. Studies are underway to determine if transition zone index can be used prospectively to predict and correlate response with therapies designed to ablate prostatic tissue medically or surgically.

A Giant Mullerian Duct Cyst in Pelvic Cavity / 대한비뇨기과학회지

A Case of Mullerian duct cyst as a large pelvic mass encountered in 25-year-old man is introduced. The treatment, pathological and radiological appearence are discussed, and also the embryology and history of this entity are reviewed.