Two Cases of Unusual Form of Prostatic Abscess / 대한비뇨기과학회지

Abscess of prostate has become a rare disease due to development of modern antibiotics and decreasing incidence of gonococcal infection. Recently the pathogen of prostatic abscess is almostly E. coli, the others are pseudomonas, staphylococcus, obligate anaerobic bacteria. Staphylococcus aureus infected rostatic abscess arises from other inflammatory focus as a complication of a skin infection by hematogenous route most commonly. We encountered two cases of Staphylococcus aureus infected prostatic abscess in diabetes mellitus patients. There had been no primary inflammatory focus in both cases moreover no fever in the first case. He did not complain of specific symptoms of prostatic abscess such as fever, dysuria, pyuria and perineal pain. The other one complained of fever and acute urinary retention. In both cases, prostatic abscess was suspected by transrectal ultrasonography and confirmed by percutaneous needle aspiration. The patients were treated with pathogen sensitive antibiotics combined with transurethral resection drainage of prostate.

Voiding Difficulty Secondary to the Detrusor Hyperreflexia with Impaired Contractility (DHIC) Observed in the Patients with Supraspinal Lesions and in Aged Peoples / 대한비뇨기과학회지

Urge incontinence with uninhibited detrusor contraction has been known to be a typical findings observed in the supraspinal neurologic disorders such as cerebrovascular accident(CVA). However, voiding difficulty with significant amounts of residual urine are frequently noted in the patients with organic brain diseases. Also, little is known about the exact causes of voiding difficulty in aged people without obstruction. Herein, Resnik at all have identified a specific physiological abnormality-detrusor hyperreflexia with impaired contractility (DHIC)- a distinct physiological subset of detrusor hyperreflexia. DHIC presents with a seemingly paradoxical set of findings: the bladder is overactive but empties ineffectively. We evaluated the symptoms and urodynamic findings for the 50 patients with supraspinal neuropathies and, also for the 28 elderly peoples complaining voiding dysfunction without evidence of bladder outlet obstruction or, pathologies in the brain. Of the 50 patients with parenchymal brain disease, 41 had CVA, 6 had Parkinson's disease and, 3 had senile dementia. Age of patients ranged from 52 to 89 years and 63 patients of them was man. As a results of urodynamic study; DHIC was noted in 36, DH (detrusor hyperreflexia) in 24, DH with obstructive pattern in 8, ID (impaired detrusor contractility) in 5, normal findings in 5 patients. Of the 36 patients with DHIC, CVA were noted in 19, senile dementia in 1, and, normal aged peoples in 16 cases. In 24 patients with DH, CVA were noted in 9, senile dementia in 1, Parkinson's disease in 6 and, normal aged peoples in 8 cases. Of the 8 patients showed DH with obstruction, CVA was present in 7 and, senile dementia in 1 cases. Of the 5 patients with IDC, CVA was present in 2 and, normal aged peoples in 3 cases. Patients showed DHIC, DH with obstruction and IDC complained obstructive symptoms more frequently than irritative symptoms. On the contrary, DH patients complained irritative symptoms more frequently than obstructive symptoms. Mean fraction of volume voided was 48% in DHIC and 23% in DH with obstruction, which were significantly less than 77% in DH. With this study, hyperreflexic contraction of detrusor was observed in 68(87%), and decreased contractility in 41 patients(53%). The fact that the patients showed DHIC was substantially older than those with DH may imply the decreased contractile function of the detrusor muscle by the aging process. It is also interesting that more than 90% (27/28) of the aged peoples without any pathologies exhibited abnormal findings in urodynamic study explain that the aging process itself may induce the changes of the bladder contractility. Urge incontinence due to DH has been known to be the most common findings in supraspinal lesion. However, these results showed that the impairment of detrusor contractility was also commonly found in the patients with supraspinal lesions and, in aged peoples. Treatment for the DHIC seem to be a dilemma for both the patients and physicians, and it may need emptying of residual urine in addition to the administration of anticholinergics or smooth muscle relaxants.

The Experience of the Percutaneous Balloon Dilatation in the Treatment of Ureteral Stricture / 대한비뇨기과학회지

Surgical treatment have been gold standard in most cases of ureteral stricture and it`s effects were not satisfactory. Recently nonoperative dilatation offer attractive alternatives to surgery in the treatment of urodynamically significant ureteral strictures. Wide spread acceptance of balloon and other catheter techniques in dilating stenotic blood vessels, biliary tree and urinary tract led us to try these modalities for the treatment of ureteral strictures. So we tried percutaneous balloon dilatation in 5 failed retrograde ureteral dilatation cases. 4 tuberculous ureteritis and 1 postureterolithotomy state. We used the balloon catheter with techniques of percutaneous transluminal manipulation for dilatation of the ureteral stricture under fluoroscopic guidance. The results of dilatation were successful in 4 cases and failed in 1 tuberculous ureteral stricture. In successfu1 4 cases, there was no evidence of symptomatic and radiologic recurrence for 7 to 29 months of follow up period. The percutaneous balloon dilatation can be useful in case of alternative to surgery and failed retrograde balloon dilatation.

A Case of Solitary Metastasis of Renal Cell Carcinoma to Left Calf Muscle / 대한비뇨기과학회지

A patient is described who was presented with a little finger tip sized palpable nodular mass on left calf muscle for 2 years of duration. The pathologic result of the biopsy specimen for nodular mass showed a clear cell carcinoma. The full metastatic work up demonstrated tumor in the right kidney, with no other detectable primary focus. Result of the radical nephrectomy exhibited renal cell carcinoma confined within renal parenchyme. The patient was treated with IFN-alpha-2b as adjuvant therapy and now is on close observation without the evidence of tumor recurrence.