Multilocular Cyst of the Kidney with Mature Renal Element in Fibrous Septa / 대한비뇨기과학회지

Multilocular renal cyst is an uncommon lesion which has various terminologies and controversial criteria of definition. Recently, it is said that these can be divided into cystic nephroma(CN) and cystic partially differentiated nephroblastoma(CPDN) based on the presence or absence of blastemal tissue and differentiation of the tissue within the septa of the cyst. We experienced a case of multilocular renal cyst(CN) which contains mature tubular and glomerular structures in the septa without evidence of blastema or embryonal elements and we are going to discuss the significance of this blastemal or embryonal tissue with regard to nature, classification, and prognosis with literatures.

Nomogram in Asymptomatic Elderly Males / 대한비뇨기과학회지

Uroflowmetry is important and simple method in the evaluation of prostatism and lower urinary tract obstruction. But nomogram of old males was not made till now in Korea. And the aim of our study was to provide a control group of males without prostatism who were in relevant age group. So, we investigated 312 males, who were over 50 years and had no subjective voiding problem. And we select 173 males, whose symptom scores were less than 6 out of 27 possible points of Madsen & Iverson's score system and nomogram was made. The 173 males were divided in 5-year groups and we gained maximal flow rate(MFR) and average flow rate(AFR). It was found that the mean value of MFR and AFR decreased from 20.5 t 8.lm1/sec and 13.2+/-5.8ml/sec at the A group( 50-54 years) to 15.4+/-6.1ml/sec and 9.3+/-4.5ml/sec at the G group(over 80 years). The mean voided volume was 211mL. The MFR and AFR are very closely related to the voided volume(P<0.01) and the adjusted maximal flow rate has been tested clinically by comparing preoperative voidings and postoperative voidings of prostatectomy patients. We conclude that this nomogram is very useful in diagnosing and follow-up of patients with BPH or lower urinary tract obstruction.

Pressure/Flow Study in BPH / 대한비뇨기과학회지

BPH is found in 50% of males over the age of 50 and there is increase in incidence with age. But some patients with BPH do not induce bladder outlet obstruction and some patients with prostatism are not caused by bladder outlet obstruction. So, urodynamic study including pressure/flow study was performed in 45 males with prostatism to evaluate the degree of obstruction, and we measured maximal intravesical pressure, maximal detrusor pressure, prostatic urethral length, residual urine, minimal urethral resistance and pressure/flow plots. The 45 males were divided into 3 groups by maximal flow rate(MFR)(A: MFR>=15, B: 10<=MER<=15, C: MFR<10) and there was significant difference between each group only in minimal urethral resistance(P<0.05). The result of pressure/flow plots of A group showed that 93% (13/14) was nonobstructive pattern and the rest one was obstructive pattern which was caused by detrusor hyperreflexia. In B group. we could know the degree of obstruction in 58%(7/12) only with minimal urethral resistance and we could decide the degree of obstruction with pressure/flow plots in rest 5 cases whose minimal urethral resistances were between 0.43 and 0.65 unit. The result of pressure/flow plots of C group showed that 89%(17/19) was obstructive pattern and the rest 2 cases were nonobstructive patterns which were caused by detrusor hyporeflexia. In conclusion, with pressure/flow plots and minimal urethral resistance, we can decide the degree of obstruction in patients with prostatism especially whose MFR are between 10 and 15 ml/sec.

Seven cases of ureteroceles / 대한비뇨기과학회지

Ureterocele represents cystic dilatation of the intravesical segment of the ureter and there are numerous presentation and treatment of ureterocele. Herein, during the last 5 years we experienced 7 adults and children with ureterocele, four of them are single system ureterocele, and the rest three are duplex system ureterocele. Diagnosis was made by IVP, VCUG, USG and Renal scan. In two cases of four single system ureteroceles, transurethral incision of ureterocele were performed, in one case ureterocelectomy was performed, and ureterocelectomy with ureteroneocystostomy was performed in rest one case. In case of duplex system ureterocele, two cases were performed upper pole heminephrectomy with subtotal ureterectomy. and the other case was performed pyeloureterostomy. All patients were followed-up from 6 months to 2 years and we gained satisfactory results. Herein, we reached conclusion that despite of numerous therapeutic options of ureteroceles, it must be selected based on the pathophysiologic condition and on the preservation of the renal function of the involved kidney.