Deep Vein Thrombosis after ESWL in Patient with Protein S Deficiency / 대한비뇨기과학회지

ESWL is an effective treatment for renal and ureteral calculi with few serious side effects. Most complications are related to an obstruction from stone fragments lodged within the ureter with an accompanying colic and/or infection and subcapsular or perirenal hematoma. Here we report a patient with a protein S deficiency sustaining a deep vein thrombosis following an ESWL for a mid ureter stone.

Deep Vein Thrombosis after ESWL in Patient with Protein S Deficiency / 대한비뇨기과학회지

ESWL is an effective treatment for renal and ureteral calculi with few serious side effects. Most complications are related to an obstruction from stone fragments lodged within the ureter with an accompanying colic and/or infection and subcapsular or perirenal hematoma. Here we report a patient with a protein S deficiency sustaining a deep vein thrombosis following an ESWL for a mid ureter stone.

Spontaneous Urine Extravasation Caused by Ureteral Metastasis from a Cervical Adenocarcinoma / 대한비뇨기과학회지

Spontaneous urine extravasation due to metastatic cancer is extremely rare. We experienced a case of urine extravasation caused by ureteral metastasis from a cervical adenocarcinoma in a 69-year-old woman. On operating, a 3cm length ureter stricture was found in the upper third of the left ureter. There were no malignant cells in a frozen biopsy, and no urine leakage site was detected. An end-to-end ureteroureterostomy was performed by the tension-free method. The permanent histology of the ureterectomy specimen revealed a metastatic adenocarcinoma, identical to that obtained from the punch biopsy of the cervix. The urine leakage persisted following the end-to-end ureteroureterostomy, whereupon a nephroureterectomy was performed.

Clinical Experience of Transurethral Needle Ablation (TUNA) for the Treatment of Benign Prostatic Hyperplasia with Low Compliance to Medication and High Risk Operative Morbidity and Mortality / 대한비뇨기과학회지

PURPOSE: We investigated the efficacy of transurethral needle ablation (TUNA) of prostate for benign prostatic hyperplasia (BPH) in patients with low compliance to medical therapy and high risk operative morbidity and mortality. MATERIALS AND METHODS: Total 38 patients with BPH and low compliance to medical therapy and high risk operative morbidity and mortality were treated with TUNA under the local anesthesia and evaluated prospectively using the international prostate symtom score (IPSS), Qmax, satisfaction score and postvoid residuals (PVRs), and followed for 3 months after treatment. RESULTS: The mean pretreatment symptom score was 24.82+/-5.76. At 1 and 3 months after treatment, the mean symptom score was decreased to 13.63+/-7.07 and 9.21+/-6.28, respectively (p<0.01). The mean pretreatment satisfaction score was 4.63+/-0.85. It was decreased to 2.84+/-1.26, 1.92+/-1.34 at 1, 3 months (p<0.01). The mean pretreatment Qmax was 5.26+/-3.37mL/s. It was increased to 9.53+/-4.54mL/s, 11.97+/-4.52mL/s at 1, 3 months (p<0.01). The mean pretreatment PVRs were 131.85+/-123.05mL. It was decreased to 49.68+/-38.28mL, 26.77+/-17.92mL at 1, 3 months (p<0.01). CONCLUSIONS: TUNA treatment in the management of BPH improved symptom scores, peak flow rates with lower morbidity. TUNA appears to be a useful alternative treatment for BPH in patients with low compliance to medical therapy and high risk operative morbidity and mortality.

Prognostic Implication of p53 Immunohistochemical Staining in Patients with Localized Renal Cell Carcinoma after Radical Nephrectomy / 대한비뇨기과학회지

PURPOSE: p53 gene is a well-known suppressor gene of tumor. And the p53 protein expression in immunohistochemical staining acts a role as a prognostic indicator in prostate and bladder tumor. However, the validity of p53 protein expression was not determined as an independent factor of prognosis in renal cell carcinoma(RCC). Furthermore, there were not enough studies about whether the expression of p53 protein plays a role as a prognostic indicator in RCC or not. Therefore, we evaluate the prognostic significance of p53 protein expression in RCC. MATERIALS AND METHODS: To evaluate the prognostic significance of p53 immunohistochemical staining in RCC, paraffin embedded specimens taken from 84 patients with RCC were studied from January 1982 to April 1997, retrospectively. In addition to the prognostic significance of p53 immunohistochemical staining, correlation between p53 immunohistochemical staining and pT category, nuclear grade, and histologic type was studied. RESULTS: The expression rate of p53 protein was 19.0%(16/84). The most important prognostic indicator of RCC was pT category(relative risk=2.19, p=0.007). And the second important prognostic indicator was the expression of p53 protein(relative risk=1.82, p=0.017). Nuclear grade had prognostic significance(p=0.027) but was not an independent prognostic indicator. The expression of p53 protein did not correlate with pT category, nuclear grade or histologic pattern. CONCLUSIONS: We have shown that the expression of p53 protein in RCC is the second most important prognostic indicator. In conclusion p53 immunohistochemical staining can be used to predict the prognosis in patients with localized RCC after radical nephrectomy.

Clinical Significance of Serum Prostate Specific Antigen in Orchiectomized Patients with Metastatic Prostate Cancer / 대한비뇨기과학회지

To identify clinical significance of prostate specific antigen (PSA) in orchiectomized patients with metastatic prostate cancer, we longitudinally investigated significant factors in the progression of the advanced prostate cancer in 28 patients who were comparatively well followed after subcapsular orchiectomy. Following results were obtained. 1) The mean followup interval was 25.9 months (1 to 68 months). Mean patient age was 67.6 years (50 to 82 years). 2) Eleven of 28 patients were expired during follow-up. Death rate was 39.3 percent. 3) Patients whose post-treatment nadir PSA level decreased below 2.8 ng/ml had a significantly longer remission duration rate than those whose nadir PSA remained elevated (mean survival times 53.9 versus 25.4 months, survival rate 85.0 versus 0%, p 0.05). As the result of the above, we conclude that serial serum PSA levels in advanced prostate cancer patients after endocrinal therapy can aid in distinguishing favorable from nonfavorable responders early in the course of therapy and greatly assist in monitoring for progression.

Clinical Study of Stage I Renal Cell Carcinoma / 대한암학회지

PURPOSE: This study was attemped to investigate the prognostic factors for the outcome of stage I renal cell carcinoma after radical nephrectomy. MATERIALS AND METHODS: Twenty nine patients treated from 1984 to 1995 at Kyung Hee University Medical Center were studied retrospectively. All of them were diagnosed with pathologic Robson stage I renal cell carcinoma after radical nephrectomy. RESULTS: Males were affected three times more frequently than females. The tumor was detected on the right kidney in 15 cases, and on the left in 14. Average follow up period was 36.6 months, average disease free interval was 29.4 months and median survival was 30 months. During the follow up, 9 patients (31.0%) expired due to liver and lung metastasis at postoperate 21.6 months on average. Eleven patients (37.9%) developed distant metastasis in the follow up. There was no local recurrence of tumor. Seventeen patients were diagnosed incidentally without clinical symptoms. In our retrospective study for stage I renal cell carcinoma, there were no predictive prognostic parameters for predicting the outcome of patients, except for the incidental diagnosis of the tumor. CONCLUSIONS: These results suggest that incidental diagnosis of the tumor may be the most important prognostic factor for the outcome of stage I renal cell carcinoma. Although the patients were confirmed as stage I renal cell carcinoma pathologically after radical nephrectomy, close follow up is very important, because of high incidence of metastasis. We recommand that chest X-ray, abdominal ultrasonogram and bone scan should be checked at 3 months interval for postoperative one year even though stage I renal cell carcinoma.

Foreign Body Induced Bladder Stone After Bladder Neck Suspension: A Case Report / 대한비뇨기과학회지

Bladder stone formation may be associated with the intravesical foreign body. Frequency of bladder foreign body in female is less than male. We present a case of bladder stone formation for nylon suture materials in a 47-year-old female patient who has been treated by bladder neck suspension for stress incontinence. Patient was successfully treated by surgical removal of suture materials without recurrence of stress incontinence.

Clinical Observations in 4468 Cases of Patients with Urinary Stones / 대한비뇨기과학회지

4468 cases of patients with urinary stones between 1985 and 1995 have been clinically evaluated. The sex ratio was about 1.8: 1 (M: F). 1359 urinary stones have been analysed by infra-red spectrophotometer, calcium containing stones were the most common (80%), magnesium ammonium phosphate (MAP) and uric acid stone was 13.6% and 9.9%, respectively. Among the 212 patients (7%) with urinary tract infection (UTI), Escherichia coli was the most frequently isolated in 85 patients (40.1%). Patients with staghorn calculi and bladder stone were associated with MAP stone and UTI significantly more than other type of stone (p<0.05 by chi-square test). Hypercalciuria was found 275 patients (16%) in male, 208 patients (23.2%) in female, respectively. Primary hyperparathyroidism was diagnosed in 15 cases (0.3%), patients with hypercalcemia were 15, hypercalciuria in 10. 298 cases of 4468 cases (6.7%) were recurrent stone. There was no correlation with clinical parameters for stone formation but MAP stone in female significantly associated with recurrent stone. The duration of stone recurrence was 37.8+/-29.1 months (average). Pediatric stone was 40 cases, there was no clinical difference compared with adult stone. The management of stone with pregnancy was conservative in major. In treatment of renal stone, ESWL was 78.7%, pyelolithotomy in 5.0%, nephrolithotomy in 0.6% and combination therapy with ESWL and surgery was 3.2%. In ureter stone, ESWL was 55.2%, ureterolithotomy in 10.0%, ureteroscopic removal in 8.7% and combination therapy with ESWL and surgery or ureteroscopic removal was 5.5%. Even though the advance in disintegration of stone and removal technique have radically altered the approach to urinary stones, but it is desirable that stone analysis should be performed in all patients and the metabolic evaluation in patients with multiple stones or recurrent disease.

High Stage Prostate Cancer with Low Serum PSA Level: A Case Report / 대한비뇨기과학회지

Serum prostatic specific antigen (PSA) will be elevated in cases of BPH, prostatitis, prostatic cancer, and other conditions of prostate. Generally PSA is proportional to increased the size of the transitional zone of the prostate, but the PSA production by malignant glands is variable PSA production is depend on the degree of histologic differentiation in case of prostate cancer, with well-differentiated glands producing more PSA and undifferentiated cancer producing less PSA. Significant elevations of PSA, greater than 10 to 20 ng/ml, in the absence of prostatitis, or recent prostatic biopsy are strongly suggestive of cancer of the prostate. Several large scale studies have demonstrated that serum PSA correlates well with advancing clinical stage, tumor volume and pathological stage. We report a case in which high stage and poorly differentiated pathologic grade prostate cancer with low serum PSA level.

Inverted Papilloma of the Urinary Bladder: 3 Cases / 대한비뇨기과학회지

Inverted papilloma of the urinary bladder is a rare urothelial neoplasm, almost benign in its histologic morphology and clinical behavior. It occurs mainly in males and in the region of the trigone of bladder, or posterior urethra. But, it may arise in the renal pelvis. The characteristic downward proliferation of urothelial cells within the underlying lamina propria is of such magnitude as to an exophytic papillomatous tumor. The lesion may be easily mistaken for a low- grade papillary transitional cell carcinoma, although the histologic appearance is distinctly different, as is its subsequent behavior. Because of distinctive histologic features and patterns of growth it is possible to differentiate between two basic types of inverted papillomatous which were termed "trabecular" and "glandular". The trabecular type consists of widely branched, anastomosing cords of urothelial cells originating directly from the overlying transitional epithelium. The glandular type develops apparently from a proliferative cystitis cystica and glandularis which, therefore, should be considered a potentially preneoplastic lesion. The malignant tendency is now being reported with inverted papillomas of urinary tract and therefore they are no longer regarded as innocuous benign neoplasms. We report the 3 cases of inverted papilloma of the urinary bladder with a brief review of literature.

Fibroepithelial ureteral polyp: a case report; endoscopic removal of large ureteral polyp

We report a case of primary fibroepithelial polyp of the right midureter. The patient was a 41-year-old-woman, complaining of right flank pain. An excretory urogram revealed right hydronephrosis and a filling defect of the the right midureter. The filling defect was produced by a large fibroepithelial polyp that was diagnosed and removed by ureteroscopy without open surgery. Large fibroepithelial ureteral polyps are relatively rare and ureteroscopy is the gold standard of diagnosis for ureteral filling defect.

Small Renal Cell Carcinoma Associated with Inferior Vena Cava Thrombus / 대한비뇨기과학회지

Renal cell Carcinoma is an unusual cancer with the propensity to invade not only the renal vein but to propagate into the inferior vena cava(IVC) as a tumor thrombus. No tumor thrombus extending to the IVC was seen in a renal cell carcinoma less than 4.5 cm in the greatest diameter among 431 consecutive patients in the Mayo Clinic from January 1976 to January 1992. The present case was a 3.5 cm in size small renal cell carcinoma on the right upper pole which had a tumor thrombus which extended to the inferior vena cava.