Ureteral Obstruction Caused by Periureteral Tuberculous Granuloma after Intravesical BCG Therapy for Superficial Bladder Tumors / 대한비뇨기과학회지

Bacillus Calmette-Guerin (BCG) is an attenuated strain of Mycobacterium bovis (M. bovis) that has been used to treat transitional cell carcinoma. Since the initial report by Morales and associates on the use of intravesical BCG for the treatment of recurrent superficial bladder tumors, intravesical therapy with BCG has proved to be more effective for prophylaxis and the treatment of superficial bladder tumors and carcinoma in situ than most of the standard chemotherapeutic agents. While the majority of patients tolerate BCG treatments well, a number of adverse reaction (e.g., fever, hematuria, dysuria, nausea and malaise) have been reported. More serious complications occur on rare occasions and they include pneumonitis/hepatitis, ureteral obstruction, renal abscess and sepsis. We report here on a case of ureteral obstruction that was caused by periureteral tuberculous granuloma after intravesical BCG therapy for superficial bladder tumors, and the condition required distal ureterectomy & ureteroneocystostomy.

The Effect of the Treatment of Prostatitis on the Serum Prostate Specific Antigen Levels and the Frequency of Prostatic Biopsies / 대한비뇨기과학회지

PURPOSE: We attempted to identify the prostatitis in men with elevated serum prostate specific antigen (PSA) levels, and also determined whether treatment with antibiotics lowers serum PSA, resulting in decreases of the frequency of prostatic biopsies. MATERIALS AND METHODS: Men with lower urinary tract symptoms, and serum PSA greater than 4ng/ml, were evaluated for the presence of prostatitis. Prostatitis was defined as over 20 white blood cells in expressed prostatic secretions. Patients with prostatitis were treated with a 4-week course of antibiotics. Patient without signs of prostatitis underwent transrectal biopsies. PSA blood tests and prostatic massages were repeated 4 weeks later. Patients with PSA levels greater than 25ng/ml were excluded. RESULTS: Of the 49 patients with elevated PSA levels (with a mean PSA level of 9.26ng/ml), 29 (59%) had the laboratory signs of prostatitis. In 18 patients (62%) with prostatitis, the serum PSA level decreased to below 4ng/ml (mean 2.73ng/ml) after treatment. The remaining 11 patients with prostatitis, and the 20 patients without, underwent sextant transrectal ultrasound guided biopsies; which resulted in pathologic confirmation of prostate cancer in 3 out of the 11 patients with prostatitis, and in 4 (20%) out of the 20 patients without. Screening for prostatitis decreased the frequency of a prostatic biopsy by 32.7%. CONCLUSIONS: In over half of the patients with elevated serum PSA levels, the clinical evaluation revealed evidence of prostatitis. The treatment of prostatitis in this study decreased prostate biopsies by 32.7%. We suggest that screening for prostatitis in patients with elevated PSA levels, and it subsequent treatment can decrease the percentage of negative biopsies.

A Case of Retroperitoneal Teratoma in an Adult / 대한비뇨기과학회지

The teratoma is made up of a variety of parenchymal cell types representative of more than one germ layer. Retroperitoneal teratoma is an uncommon neoplasm which occurs in only 10% of all retroperitoneal primary neoplasm. Primary retroperitoneal teratoma has been rarely seen in adults and 3 cases has been reported in Korea. Recently we experienced a case of retroperitoneal teratoma, which was suspected by clinical investigation and confirmed by exploration and microscopic examination. CT scan is very useful in differential diagnosis of this rare tumor. We report a case of retroperitoneal teratoma in 22 year old young woman.

A Case of Paratesticular Embryonal Rhabdomyosarcoma / 대한비뇨기과학회지

No abstract available.

Extracorporeal Shockwave Lithotripsy Versus Ureteroscopic Removal for Lower Ureteral Stones / 대한비뇨기과학회지

No abstract available.

Clinical Experience of Extracorporeal Shock Wave Lithotripsy with Tripter Compact(R) Lithotriptor / 대한비뇨기과학회지

PURPOSE: Extracorporeal shock wave lithotripsy(SWL) is currently prorposed for the first line treatment of most renal and ureteral stones. In general, SWL is very effective and non-invasive method than open surgery or endoscopic lithotripsy. We experienced 350 cases of SWL for 46 months and announced it. MATERIALS AND METHODS: We retrospectively reviewed the data of 324 patients(350 stones) who had been diagnosed as renal or ureteral stones and underwent SWL using Tripter Compact(R) lithotriptor from September 1994 to July 1998. Male to female ratio was 1.9:1 and patient`s ages ranged from 18 to 82 years(mean 43.7 years). We underwent SWL only with parenteral analgesics for pain control. RESULTS: In 350 stones, renal stones were 90 cases(25.7%) and ureteral stones were 260 cases(74.3%). In 90 renal stones, calyceal stones(include 1 staghorn stone) were 62 cases(68.9%) and renal pelvic stones were 28 cases(31.1%). In 260 ureteral stones, upper ureteral stones were 209 cases(80.4%), mid ureteral stones were 10 cases(3.8%), and lower ureteral stones were 41 cases(15.8%). The stones from 10 to 19mm in diameter were the majority of renal stones(53.3%), whereas in ureter, the stones smaller than 10mm in diameter were most common(41.5%). Less than 3 treatment sessions were needed for 147 cases(93.0%) of stones smaller than 10mm and for 146cases(76.0%) stones larger than 10mm. Less than 3 sessions were needed for 68 cases(75.6%) of renal stones and for 225 cases(86.5%) of ureteral stones. All renal stones were fragmented and the success rate for upper ureteral stones was 93.3%(195/209), for mid ureteral stones was 80.0%(8/10), and for lower ureteral stones was 80.5%(33/41). According to the size of stone, the success rate for the stones smaller than 10mm in diameter was 96.2%(152/158) and for the stones larger than 10mm was 90.6%(174/192). Total success rate was 93.1%(326/350). The complications after SWL were gross hematuria over 24hours(64 cases, 18.3%), flank pain(52 cases, 14.9%), gastrointestinal disturbances(7 cases, 2%), and Steinstrasse(31 cases, 8.9%). The causes of failure were incomplete fragmentation(21 cases, 87.5%) and mucosal impact(3 cases, 12.5%) of stones. Re-treatment rate was 59.7% and auxiliary procedure rate was 8.0%(efficiency quotient was 0.56). CONCLUSIONS: Our experiences shows extracorporeal shock wave lithotripsy is a safe and effective method for the treatment of renal and ureteral stones, and we expect the better outcome by development of techniques and equipments.

Ureteroscopic Removal of Stone: Results and Complications / 대한비뇨기과학회지

PURPOSE: This study examined the efficacy of ureteroscopic stone manipulation with comparing the success rates and complications rates. MATERIALS AND METHODS: The manipulation of calculi can be done under the direct vision of ureteroscope using dormia baskets with increasing safety and efficacy. The results of ureteroscopic removal of stones were reviewed in 636 cases. From January 1992 to October 1997, 636 patients underwent ureteroscopic removal of stones. RESULTS: There were 236 female and 400 male patients between 16 and 75 years old. The success rates of ureteroscopic removal of stones were related to location of the calculus: 95.8% in lower ureter, 87.7% in mid ureter and 90% in upper ureter(overall success rate was 95%). 35 cases(5.8%) of complication occurred in 604 cases of success: Severe ureteral mucosal injury in 25 patients, gross hematuria(>48hours) in 4 patients, ureteral mucosal prolapse in 3 patients, flank pain(>48hours) in 2 patients, ureteral perforation in 1 patient. CONCLUSIONS: Ureteroscopic removal of stones can be successful and safe treatment modality for lower urethral stones, especially with plentiful experience and good surgical skill.

A Case of Retroperitoneal Teratoma / 대한비뇨기과학회지

Retroperitoneal teratoma is a rare tumor composed of tissues from all three germ cell layers - endoderm, mesoderm, ectoderm. It is generally known as a disease of baby or children and as 10% of retroperitoneal tumor. Recently, we experienced a case of retroperitoneal teratoma in adult.

A Case of Extra-adrenal Pheochromocytoma / 대한비뇨기과학회지

Pheochromocytoma is one of the surgically curable hypertensive diseases and can arise wherever chromaffin cells are located. Herein, a case of extra-adrenal pheochromocytoma developed in a 51 year-old male is presented with brief review of literatures.

The Efficacy of Allylestrenol in the Treatment of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

Benign Prostatic Hyperplasia is one of the most important desease with a high frequency in urology. There is no doubt that the main stream of treatment is transurethral resection. of the prostate, however, marked improvement in drug therapy has been observed in recent years. Allylestrenol is a synthetic gestagen which was known to act directly on the prostate to exhibit its effect of reducing the size of the prostate by inhibiting the selective uptake of serum testosterone, inhibition of metabolism of testosterone to 5a-DHT (dihydrotestosterone) reductase, inhibition of 5a-DHT receptor binding. Our present study was carried out on 108 patients with benign prostatic hyperplasia to evaluate the efficacy and safety of antiandrogen therapy with allylestrenol. Allylestrenol was administered in a dose of 25 mg twice a day in the morning and evening after meal for 12 weeks to the patients and its efficacy was evaluated with peak urinary flow rate, Madsen Symptom Score at 4, 12 weeks after treatment and prostate volume at 12 weeks after treatment. Of these patients 46 completed the study and only 2 patients withdrew from the study owing to side effects. However,these side effects were not serious. At baseline (mean +SD) the mean peak urinary flow rate was 11.0+/-3.7 ml/sec, mean symptom score 10.2+4.0 and mean ultrasonic assessment of prostatic volume 36.8 +/-9.6 gm. At 4 weeks after treatment(mean + SD) mean peak urinary flow rate was 12+/-3.5 ml/sec, mean symptom score 7.7+/-4.2 (p > .0.05, p 0.05).

Initial Experience of the Effect of Laser CHRP (Coagulation and Hemostatic Resection of the Prostate) for Benign Prostatic Hyperplasia / 대한비뇨기과학회지

Laser CHRP (coagulation and hemostatic resection of the prostate) is a new acceptable treatment modality for benign prostatic hyperplasia. A total of 14 patients with symptomatic bladder outlet obstruction due to benign prostatic hyperplasia was entered into a prospective trial of laser prostatectomy performed with the right- angle firing neodymium: YAG laser fiber and the contact tip firing neodymium: YAG laser fiber at 60 watts power setting. Mean estimated prostatic weight was 36.3gm. Six patients (43%) were in urinary retention requiring catheterization before treatment. Mean energy delivery was 34,442 joules (range 25,360 to 45,000) with a mean operative time of 41 minutes. Efficacy of treatment was assessed at 1, 6 and 12 months postoperatively by Madsen symptom scores, peak urinary flow rates and ultrasonic assessment of prostatic volume. At preoperative baseline the mean symptom score was 19.9, mean peak urinary flow rate 8.6cc per second, and mean ultrasonic assessment of prostatic volume 36.3gm. At 1 year postoperatively mean symptom score was 6.1, mean peak urinary flow rate was 18.3cc per second and mean ultrasonic assessment of prostatic volume was 26.4 gm. One patient required retreatment for residual tissue. There was one bladder neck contracture requiring incision.

Accuracy of Residual Urine Volume Determination by Ultrasonography / 대한비뇨기과학회지

The determination of the residual urine volume is an essential part of the investigation of many urological patients. particularly those with suspected urinary outflow obstruction. In 31 patients, we measured 3 internal bladder diameters ( height, width and depth) by transabdominal ultrasonography and calculated the residual urine volume by formula for ellipsoid (V= phi /6 xH xW xD).The real volume was obtained by the catheterization and compared with the sonographic measurement. There was a best correlation (r=0.9748) between calculated and true volumes provided a correction factor of 1.15 was applied. The advantages of ultrasonography for assessing residual urine volume are that it is simple, quick, harmless, non-invasive and readily repeatable. If the basic equipment is available, the ultrasonography should replace the catheterization.

Initial experience of transurethral radiofrequency thermotherapy for benign prostatic hyperplasia / 대한비뇨기과학회지

Transeurethral Radiofrequency (TURF) Thermotherapy is a new acceptable treatment modality for benign prostatic hyperplasia. We treated 70 cases of BPH patients by TURF Thermotherapy (THERMEX-II). Among them, we got a follow-up observation on 37 patients (urinary retention: 16 cases, non-urinary retention:21 cases) each at 1 month and 3 months after treatment. Mean age of patients was 69.1 years and their mean prostatic weight was 40.5gr by transrectal prostatic ultrasonogram. All patients were treated single session for 2 hours without any sedation, and well tolerated with the temperature of 47-48degree. We evaluate patients with Boyarsky symptom score, urine flow rate, volume of residual urine and patient`s subjective symptoms before and after treat- The results were as follows ; 1. The mean Boyarsky symptom score was 15.4 before treatment, it became 9.9 at 1 month and 8.8 at 3 months after treatment. 2. In the retention patients : Mean maximal flow rate was 6.53ml/sec at 1 month. 8.47ml/sec at 3 months, and residual urine was 70ml at 1 month, 57ml at 3 months after treatment. 3. In the non-retention patients : Mean maximal flow rate increased from 4.74ml/sec to 10.29ml/ sec at 1 month. 10.76ml/sec at 3 months, and residual urine decreased from 60.7ml/ to 20ml at 1 month. 17.2ml at 3 months after treatment. 4. Complications were acute urinary retention (14.3% ) and gross hematuria (8.1%), but it was resolved by conservative treatment. There were no urinary tract infection, bladder spasm or other complications after treatment. We conclude TURF thermotherapy is one of the good and safe treatment in benign prostatic hyperplasia.

Clear cell carcinoma of bladder invading the posterior urethra / 대한비뇨기과학회지

Clear cell carcinoma of the bladder and urethra is very rare entity with its origin unclear. The typical location in the bladder neck and trogon tends to confirm that this neoplasm probably derives from a remnant of the mesonephric duct. But Mullerian remnants or metaplastic paraurethral elands may be the source of origin. We experienced a case of clear cell carcinoma of the bladder invading the posterior urethra occurring in a 68-year-old female treated by radical cystourethrectomy and ileal conduit diversion and 16 month later. we found a hard, fixed, palpable metastatic nodule in the left neck area. Herein we report a metastatic case of clear cell carcinoma or the bladder invading the posterior urethra with review of the literature.

Transurethral balloon dilatation of the prostate: early experience / 대한비뇨기과학회지

Transurethral balloon dilatation using specially designed catheters has been introduced in recent years. We applied endoscopically a high pressure, large diameter balloon dilator to 19 patients with benign prostatic hypertrophy who had high risk to an anesthesia. The patients were followed with clinical evaluation and urine flow rate. Clinical evaluation at 1 month showed normal voiding in 14 (74%) of 19 patients without symptom and signs. In 14 patients (74%) urinary peak flow rates varied between 10 and 20cc per second, and in the remaining they were less than l0cc per second. Gross hematuria occurred in 5 patients (26% ), but it was improved within 48 hours. The numbers of patients with 3 months, 6 months and 9 months follow-up were not so many, but their results were similar to those of 1 month follow-up. We believe that balloon dilatation of the prostate is a safe and simple technique for the patient of benign prostatic hypertrophy who is not allowed prostatectomy.

Transurethral balloon dilatation of the prostate: early experience / 대한비뇨기과학회지

Transurethral balloon dilatation using specially designed catheters has been introduced in recent years. We applied endoscopically a high pressure, large diameter balloon dilator to 19 patients with benign prostatic hypertrophy who had high risk to an anesthesia. The patients were followed with clinical evaluation and urine flow rate. Clinical evaluation at 1 month showed normal voiding in 14 (74%) of 19 patients without symptom and signs. In 14 patients (74%) urinary peak flow rates varied between 10 and 20cc per second, and in the remaining they were less than l0cc per second. Gross hematuria occurred in 5 patients (26% ), but it was improved within 48 hours. The numbers of patients with 3 months, 6 months and 9 months follow-up were not so many, but their results were similar to those of 1 month follow-up. We believe that balloon dilatation of the prostate is a safe and simple technique for the patient of benign prostatic hypertrophy who is not allowed prostatectomy.

Clinical Experience of Prostakath Application in the Treatment of Benign Prostatic Hypertrophy / 대한비뇨기과학회지

Prostakath represents a new idea. The spiral shaped spring inserted in the prostatic urethra keeps the enlarged prostatic lobes compressing the urethra so far apart that self voiding is possible. The physiologic function of the external sphincter is maintained due to the special form of the spiral. Prostakath was inserted in 13 patients with benign prostatic hypertrophy who had long-term indwelling bladder catheters and anesthetic contraindications to an operation. Of the 13 patients 1 did not reach 3 months of follow-up due to removal of Prostakath. The remaining 12 patients were followed with clinical evaluation. urine cultures, retrograde urethrography and urine flow rates at 1 day and 3 months. Final evaluation at 3 months showed normal voiding in 83% of the patients with an absence of significant residual urine in all. In 8 patients (67%) urinary flow rates varied between 10 and 20cc per second and in the remaining it was less than 10cc per second. In 92 % of the patients follow up urine cultures were negative. We believe that placement of Prostakath permits selected patients to be freed from long-term indwelling bladder catheters. This is a valid alternatives a prostatic operation in high risk patients with benign prostatic hypertrophy.

Clinical Experience with Ureteroscopic Management of Ureteral Calculi Including Electrohydraulic Lithotripsy / 대한비뇨기과학회지

Rigid ureteroscopy is new one of established technique for the management of ureteral stones. Manipulation of calculi can be done under direct vision using flexible forceps or stone baskets with increased safety and efficacy. We have used a 5Fr. electrohydraulic lithotripsy to disintegrate stones that were two large to b removed by manipulation. Between May 1988 and October 1989. 140 ureteroscopies were performed for removal of ureteral stones. In 119 cases(85 %) the stone was removed successfully. Electrohydraulic lithotripsy was used successfully to remove the stone in 25 among 28 cases(89.3%). We conclude that ureteroscopic removal of ureteral stone under direct vision is a safe and effective method for treatment of ureteral stone.

A Case of Pituitary Adenoma Combined with Impotence / 대한비뇨기과학회지

The hyperprolactinemia is one of the common endocrinologic cause of impotence. If hyperprolactinemia is noted in serum of an impotence patient, the pituitary adenoma should be suspected. Recently we experienced a case of pituitary adenoma combined with impotence in 65 year old male. Herein we report this case with brief review of the literatures.

A Case of Retroperitoneal Cellular Schwannoma / 대한비뇨기과학회지

Schwannoma also referred to as neurilemmoma, neurinoma, and perineural fibroblastoma, is an encapsulated nerve sheath tumor consisting of two components :a highly ordered cellular component (Antoni A area) and a loose, myxoid component (Antoni B area). It is usually solitary and may be benign or malignant, solid or cystic, encapsulated or diffuse. It is rarely occur in the retroperitoneal space. The term cellular Schwannoma is indicative of a Schwannoma composed predominantly of Antoni A type tissue. We report one case of retroperitoneal with brief review of literatures.