Percutaneous Nephrolithotomy in a Semi-Lateral Position

PURPOSE: In the treatment of large-sized renal stones, percutaneous nephrolithotomy (PNL) is regarded as a minimally invasive surgery with an easy postoperative recovery. In previous procedures, which were done with the patient in a prone position, appropriate measures could not be taken in cases in which a cardiopulmonary emergency appeared. Given this background, we performed PNL in a manner to which the department of urology was accustomed. Then, we attempted to assess the treatment effect and safety of PNL on the basis of our clinical experiences. MATERIALS AND METHODS: This study was conducted in 14 patients who underwent PNL in a semi-lateral position at our medical institution between April and October of 2008. The complete removal of renal stones, blood transfusion, the period of use of a catheter for nephrostomy, complications, and the need for additional procedures after the surgery were examined. RESULTS: Six patients had stones in the pelvis, three had stones in the lower calyx, and five had multiple stones or pelvocalyceal stones. The mean stone size was 2.66 cm (range, 1.56-6.37 cm). In all patients, the renal stone was completely removed and post-procedure complications were minimal except for blood transfusion in one patient. No additional procedures were required in any of the patients. CONCLUSIONS: PNL was performed in a semi-lateral position, which is a position to which the department of urology is accustomed. By use of this position, surgeons and anesthesiologists can reduce the surgical burden due to posture. Based on our clinical experiences, PNL in a semi-lateral position is an effective, safe modality.

Results of Surgical Correction in Patients with Vesicoureteral Reflux after Kidney Transplantation / 대한이식학회지

PURPOSE: The prevalence and significance of vesicoureteral reflux (VUR) after kidney transplantation has been varies among authors. While these results suggested that VUR can be a source of repeated infections, which might be a prognostic factor impairing long-term graft function. We evaluated the prevalence, clinical manifestations and diagnostic methods of VUR after living donor kidney transplantation and their proper management with the results of each treatment. METHODS: We reviewed thirty-four patients among five hundreds and thirteen living donor kidney transplant recipients, who developed VUR after the transplantations at our center from June 1998 to June 2003. Twenty-three patients underwent a corrective surgical procedure, ureteroneocystostomy, and we excluded 3 patients who underwent the procedure less than 1 year. The patients were divided into three groups: those with severe VUR underwent a corrective surgical procedure with more than 1 year follow-up (group I, n=20), those with mild VUR underwent a conservative management (group II, n=8) and control group of patients without VUR (group III, n=20). The incidence of urinary tract infection (UTI) and graft function were assessed for 1~7 years. Voiding cystoureterography (VCUG) was performed in patients with recurrent urinary tract infections and reflux was classified from Grade I to Grade IV. RESULTS: We examined immunological and non-immunological risk factors such as age, sex, primary diseases, duration on dialysis, diuresis prior to the treatment, donor selection, the degree of HLA mismatches, cold ischemia time, the incidence of acute rejection. There was no significant demographic difference among study groups except sex (female). Analysis of patients and grafts survival rates revealed no statistical differences among three groups. CONCLUSION: VUR dose not seem to negatively affect graft function if surgical correction were performed in proper period after the diagnosis. The indication of surgical correction of VUR is clinically significant UTIs, UTI sepsis, Grade III or IV VUR. Close attention, proper diagnosis and prompt surgical correction are necessary to minimize the adverse influence of VUR after kidney transplantation.

Primary Primitive Neuroectodermal Tumor of the Kidney / 대한비뇨기과학회지

No abstract available.

A case of Primary Transitional Cell Carcinoma of Ureteral Stump Following nephreetomy for renal tuberculosis / 대한비뇨기과학회지

No abstract available.

Influence of Menstrual Cycle on Cystometry / 대한산부인과학회잡지

Alteration in the hormone level associated with menstrual cycle influences the interaction between the urethra and bladder as well as detrusor function, maybe due to the common embryological origin of lower female genital and urinary tract. We tried to investigate the effect of the menstrual cycle on cystometric diagnosis through this retrospective study. 60 women with regular menstruation were enrolled in this study. The study groups were divided into 2 groups, Group I was women whose symptoms were not influenced by the menstrual cycle, Group II was women whose symptoms were adversely affected premenstrually. The majority of normal cystometric diagnosis were made in the luteal phase (Group I: 42.9% vs 4.4%, p<0.05; Group II: 50.0% vs 22.2%, p<0.05). But diagnosis of genuine stress incontinence, detrusor instability, mixed genuine stress incontinence and detrusor instability were frequently made in the follicular phase of mentruation. Normal cystometric diagnosis in the group II were more commom than the group II ( 36.8% vs 19.7%, p<0.05 ). The results of this study reveal that the timing of cystometric evaluation may influence the the detection of a positive diagnosis. In patients whose symptom are influenced by their menstrual cycle, the luteal phase may not be the correct time to make an accurate diagnosis.

A Case of Virilizing Adrenal Cortical Carcinoma / 대한소아내분비학회지

Adrenal cortical carcinoma is a rare disease both in adults and in children. Most of these tumors are functional, especially in children, producing endocrine syndromes such as virilization, Cushing syndrome, hyperaldosteronism or feminization. We experienced a case of adrenal cortical carcinoma in a 7yr old boy who showed features of virilization such as rapid growth rate, penile enlargement, and pubic hair. This case was diagnosed with typical hormonal findings and abdominal MRI and confirmed by pathologic findings. He was successfully treated by total left adrenalectomy and has been followed up without problem over eight months.

A Card of Arthrogryposis Multiplex Congenita with Congenital Hypertropic Pyloric Stenosis

No abstract available.

Major Factors Influencing on the Success of Extracorporeal Shock Wave Lithotripsy / 대한비뇨기과학회지

This study is performed to extend the indication of Extracorporeal Shock Wave Lithotripsy (ESWL) and to help the improvement of treatment results. We analysed the results of urinary stone disintegration for the 345 urinary stones of 271 patients to whom the ESWL had been undergone by Siemens Lithostar from March, 1992 to September, l993, of which the complete data for stone volume, shape, location, catheterization, and intravenous urographic findings were obtained. Also, using the specially devised instrument, we dipped stones of several components that our department have in the solution differentiated by pH, shot a little shock wave and observed the differences of urinary stone destruction. The results of study are as follows. l. The results of stone destruction according to the volume of stone showed the significant differences. 2. Destruction results according to the location of renal stone or ureteral stone did not show the differences. 3. In the destruction of ureteral stone, there are no differences according to the existence of ureteral catheter. 4. It showed a tendency to resist disintegrating in the case of accompanying severe hydronephrosis with stone, however, the destruction results according to the degree of hydronephrosis did not show the differences. 5. The destruction effect in the differentiated pH solution, there is an effect in the uric acid stone and in the struvite stone a little effect but there is no effect in the calcium oxalate and calcium phosphate stone. As the result above, in the view of destruction itself of stone, we can say that the stone destruction is the most influenced by the volume of stone and we cannot expect to be succeeded by one time ESWL in case of the greater than 1,016.691mm3 in stone volume, therefore, it is necessary for us to operate the volume-reductive procedure such as percutaneous nephrolithotripsy, to plan the retreatment of ESWL prior to the first operation. Neither the location of stone nor the ureteral catheterization have particular effects the stone destruction. Effect of hydronephrosis is necessary to make more study. Even though we use the irrigating solution in order to increase the treatment effect of stone, regulating pH, There seems no much help to the treatment except uric acid stone.

The surgical approach to urologic complications of 1,000 renal transplants / 대한이식학회지

No abstract available.

Normal variations of renal vessels based upon the study of 240 living-donor nephrectomies / 대한비뇨기과학회지

A full understanding of the potential anatomical variations of the renal veins and its branches is imperative for donor nephrectomies. Preoperative renal angiography is the most important study to evaluate renal vascular anatomy. By this technique. the renal arteries are well visualized. but it is almost impossible to obtain the exact informations of the renal veins and its branches. To prevent extensive manipulation of the kidney by profuse bleeding. the exact information of the renal veins and its branches is very important. Based on intraoperative observation of 240 consecutive cases of donor nephrectomies. we observett. the common renal vein variants. Left renal veins usually had two branches; adrenal vein proximally and gonadal vein distally. Lumbar veins were identified in 112 cases(56.7%) Lumbar veins were connected to renal veins posteriorly near the draining site of gonadal veins. Therefore it is very important to dissect very carefully the posterior part of renal vein around the insertion of gonadal vein because of the existence of lumbar vein which might cause troublsome bleeding by accidental tearing. Especially when the cases of angulated renal veins were observed by renal angiography. the more attention will be required due to the strong possibility or the existence of lumbar vein.

Clinical experience of ureteral stones by extracorporeal shock wave lithotripsy / 대한비뇨기과학회지

We treated 160 patients with ureteral stones using extracorporeal shock wave lithotripsy (Siemens Lithostar, Germany) and evaluated many factors which influence the results of ESWL such as stone size, location, degree of ureteral obstruction. duration of impaction and adjuvant procedure. Our results showed that. in case of large stones (more than 1 cm in diameter), mid-ureteral stones, long-standing impacted stones or in-situ treatment, the success rates of ESWL were relatively poor. Therefore in cases accompanying the above-mentioned factors, in is necestary to recognize that the patients may be required to repeat ESWL. The results also suggest that the use of an ureteral catheter or stent may contribute to a slightly higher success rate. But we prefer in-situ extracorporeal shock wave lithotripsy to an ureteral stent because it is an invasive procedure.

Extracorporeal shock wave lithotripsy of lower caliceal stone / 대한비뇨기과학회지

We review 66 patients with lower caliceal stones treated with extracorporeal shock wave lithotipsy. One of the major problems involved with extracorporeal shock wave lithotripsy is the high rate of residual stone fragments in the lower calices. We observed the influence of the presence of lower caliceal dilatation, hydronephrosis, and the size of alone on the passage of stone. Thirty-nine of the 66 patients with a lower caliceal stone and no stone fragments. The success rate was only 59 per cent. The stone was completely fragmented in 59 of 66 (89%) patients. Thirty-nine of 59 patients who had completely fragmented stones. had no residual fragments. The patients who had no lower caliceal dilatation and a relativgly small size stone (less than 1.5 x 1.0 cm). such as in group 4. had a high success rate of 70%. The patients with a large stone or the presence of caliceal dilatation. were expected to low success rate, therefore there was a need for repeated treatment with extracorporeal shock wave lithotripsy and combined treatment with percutaneous nephrostomy.

A Clinical Analysis of Renal Transplantation in Children / 대한비뇨기과학회지

Renal transplantation has been considered the optimal therapeutic modality for children afflicted with end-stage renal disease since the capability became available more than three decades ago to prolong the lives of such children. Nowadays, the outcome of renal transplantation was marked improved, due to the development of immunology and new immunosuppressive agent. But the reports on renal transplantation in children were not many. The Severance Hospital of Yonsei University College of Medicine started the renal transplant program in April, 1979. There were 400 transplants from 1979 to August 1989. Among them, there were 13 cases of child age, and the results were summarized & analyzed. 1. The age incidence of recipients was from 8 to 16. Males were 10 cases and females were 3 Cases. 2. Among the primary diseases of recipients, the congenital diseases were 10 cases and the acquired diseases were 8 cases. And 4 cases were received bilateral nephrectomy due to vesicoureteral reflux and severe proteinuria. 3. Among the donors, 6 cases were related and 7 cases were unrelated. Related donors were 1 haplotype mismatch and unrelated, donors were 2 antigen match including DR locus. 4. There were 6 rejections in 13 cases. Among them, acute rejections were 4 cases and chronic rejections were 2 cases. 5. Postoperative complications were found in 6 cases ; peritoneal rupture, hemoperitoneum, urinary tract infection, smallpox, congestive heart failure and sepsis. 6. Among 13 cases, 11 cases of grafts were survived from 3 months to 9 years. The 1 case was expired due to chronic rejection and respiratory infection after postop. 30 months. And the other 1 case was peritoneal dialyzed due to chronic rejection after postop. 6 months. From the results presented here, we think the outcome of renal transplantation in children is good and the indication should be evaluated carefully.

A Case of Malignant Melanoma of Female Urethra and Vulva / 대한비뇨기과학회지

Malignant melanoma of female urethra and vulva is extremely rare and the prognosis remains poor inspite of several types of treatment. We experienced a case of malignant melanoma on urethra and vulva, which was managed by radical cystectomy and vulvectomy with bilateral groin lymphnode dissection. Adjuvant therapy for metastasis following lymphnode dissection with Interferon was done.

Combined Treatment of Staghorn Calculi by Percutaneous Nephrolithotomy and Extracorporeal Shock Wave Lithotripsy / 대한비뇨기과학회지

On the 59 cases of staghorn calculi treated at our institution with either ESWL monotherapy or initial percutaneous nephrolithotomy followed by ESWL between July 1987 and June 1988, 50 cases(22 complete and 28 partial staghorns) have adequate follow up. Using a retrospective cohort design, patients were matched for age, sex, stone size, stone complexity, renal function, urinary tract infection and urinary tract obstruction. Twenty five pairs of combination therapy and ESWL monotherapy patients with complete data were matched. The groups were not significantly different in the matching parameters. A significantly higher stone free rate follows combination therapy versus ESWL monotherapy for complete staghorns(25% vs. 0% in the case of 1 time ESWL treatment : 76% vs. 40% at 3 months follow up visit but the difference is slight for partial staghorns(54% vs. 47% in the case of 1 time ESWL treatment ; 85% vs. 73% at 3 months follow up visit). Both have similar length of hospital stay for complete staghorns(15 days vs. 14 days), but a significantly longer hospital stay follows combination therapy for partial staghorns(13 days vs. 6 days). The morbidity of the combination approach is not greater than that of ESWL monotherapy(40% vs. 36%), where as the need for axillary procedures is significantly lower in this group(16% vs. 36%). Our results indicate that virtually all staghorn calculi are best treated with initial percutaneous nephrolithotomy followed by ESWL. This approach allows for chemolysis and secondary procedures. But small volume partial staghorns in nondilated systems may be considered for ESWL monotherapy with ureteral stenting.

Comparison of Transurethral Ureteroscopy and Extracorporeal Shock Wave Lithotripsy for Treatment of Distal Ureter Calculi / 대한비뇨기과학회지

Either transurethral ureteroscopy(URS) or ESWL was the primary method of intervention in patients with stones located in the ureter distal to the radiological marking of the sacroiliac joint. 185 distal ureter calculi were treated by URS and/or ESWL, and the results, morbidity and complications were compared for the efficacy and safety of each treatment modality. We report the success and morbidity rates in 112cases undergoing URS and 73cases treated with ESWL primarily. The overall success rate was comparable with both modalities, which was 89.3% in URS and 89.0% in ESWL. Patient morbidity rate as measured by length of procedure time & postoperative stay and complication was less with ESWL than with URS. In 5 cases which was failed with ESWL, all stones were removed by URS. We conclude that ESWL or URS is the successful treatment for distal ureter calculi, however, ESWL is a noninvasive, time-saving and easily applicable technique and, therefore ESWL is more effective treatment than URS. In addition, Reserving URS for the small number of distal ureteral calculi proved refractory to ESWL, the distal ureter calculi may be handled completely by a combination of these two techniques.

32 Cases of Residual Stones after Percutaneous Nephrolithotomy / 대한비뇨기과학회지

Even with the current trend toward use of the ESWL as the primary treatment method for urinary stones, the importance of PNL is not at all diminished. In addition to reduced treatment duration with combined ESWL and PNL for urinary stones, quick extrusion of fragmented stones and prevention of ureteral obstruction are also advantages. The possibility of residual stones is the most presenting problem with PNL, thus initial treatment with ESWL or other method of treating residual stones should be considered. Thus at the YUMC Department of Urology, of the 200 cases treated for urinary stones with PNL, 32 cases with residual stones were analyzed and the following results were obtained: 1. Of the 32 cases with residual stones, 12 cases had diameters of more than 3 cm, 21 cases had multiple stones, and 5 cases had single stones with diameters less than 3cm. 2. Of the 6 cases with single stones, 3 cases were located in the renal pelvis, and the remaining 2 stones were etch located in the mid and lower calyx respectively. 3. In 18 cases, more than two sessions were needed, and in all 32 cases the patients were discharged with indwelling of ureteral stent. 4. After one session of PNL, the residual stones measured more than 1cm in 10 cases, 0.5~1 cm in 8 cases and in 14 cases the stones were less than 0.5cm in diameter.

Management of Urinary Calculi in Patients with a Solitary Kidney / 대한비뇨기과학회지

New therapies, percutaneous nephrostolithotomy(PNL), transurethral ureteroscopy (URS) and extracorporeal shock wave lithotripsy(ESWL), are revolutionizing the treatment of urinary tract calculi. Little are known, however, about the efficacy of managing the calculi in patients with a solitary kidney. We study 17 such calculi to determine which techniques can be utilized safely. effectively and efficiently in patients with a solitary kidney. Of 6 calculi treated by PNL, successful evacuation of the stones was achieved in 5 stones. Of 2 calculi treated by URS, successful evacuation of the stones in 1 stone. In the ESWL series of 9 calculi including the 2 stone fragmentation was record. In 2 staghorn stones, combination of PNL and ESWL were done. No significant complications were related in patients with a solitary kidney. Results and morbidity did not differ significantly from the treatment of calculi in patients with both kidneys. It is suggested that endourologic manipulation and ESWL in stone patients with a solitary renal unit are also as effective and safe as in patients with both renal unit, even though staghorn calculi, it may be handled safely by a combination of the 2 techniques as patients with both renal unit.

Endoscopic Surgery for Ureteropelvic Junction Obstruction / 대한비뇨기과학회지

Percutaneous Endopyelotomy is a natural outgrowth of technique developed for percutaneous ureteral and renal stone removal. In it`s comparison to the Davis ureterotomy technique, a rationale for this procedure and explanation for it`s success is provided. Endopyelotomy, which we performed experimentally to prevent recurrent stone formation, has now matured into a viable procedure under the certain guideline. This procedure has become our first choice for secondary ureteropelvic junction obstruction but primary cases were not experienced. Although classical pyeloplasty must be main surgical means to UPJ obstruction, technical and equipmental advanced could be enabled us to perform 8 endopyelotomy. We incised UPJ obstruction in 8 cases with direct vision nephroscope inserted through a percutaneous nephrostomy tract and ureteroscope. In 6 patients, renal calculi were removed endourologically during same and separate session. There were no immediate complication and nephrostogram showed adequate drainage in all cases.

Percutaneous Nephrolithotomy: Experience with 200 Cases / 대한비뇨기과학회지

In 200 patients with renal stone and upper and midureter stone, we have tried 241 sessions of percutaneous nephrolithotripsy. The success rate of nephrolithotripsy for different location and type was as follows. For renal pelvis stone 96.5%, staghorn stone lOO%, calyceal stone 84.4%, UPJ and upper ureter stone 76.8%, midureter stone 66.7%. We were successful in most of cases after preliminary report of earlier experience with 50 cases. And improvement of the result in removal of calyceal stone and upper ureter stone was especially conspicuous. In addition, we have complied experience with percutaneous removal of stone in patient with solitary kidney and of staghorn stone, and the result was satisfactory. Based on the accumulated experience, it was possible to remove almost all renal stones and most of upper and midureter stones by percutaneous approach although residual stones were present in large pelvis stone and staghorn stone. Thus in future, even when ESWL is widely utilized, endourologic management must be included in the algorithm of treatment of stone diseases to expect better success rate and less complications.