The Effect of Tamsulosin and Nifedipine on Expulsion of Ureteral Stones after Extracorporeal Shock Wave Lithotripsy / 대한비뇨기과학회지

PURPOSE: We evaluated the effect of tamsulosin and nifedipine on expulsion of ureteral stones after extracorporeal shock wave lithotripsy(ESWL). MATERIALS AND METHODS: We evaluated 96 upper or lower ureteral stone patients. All patients received a single session of ESWL with a piezolith- 3000 and received twice-a-day oral treatment of 5mg trospium chloride. The patients were randomly divided into three groups. Group 1 received once a day oral therapy of 0.2mg tamsulosin. Group 2 received once a day oral therapy of 30mg nifedipine. Group 3 was used as the control group. All patients took oral medication for 2 weeks, and then we analyzed the stone expulsion rate, side effects, and mean numbers of emergency room(ER) visits for pain control. RESULTS: There were no differences in the 3 groups in stone size, location, age, and sex. The total stone expulsion rate was significantly higher in group 1(84.4%) compared with group 3(60.6%)(p=0.032). Patients with lower ureteral stones in group 1 showed a higher expulsion rate(94.1%) than those of group 3(66.7%)(p=0.042). There was no difference in stone expulsion rates between group 2(67.7%) and group 3(60.6%). CONCLUSIONS: These result suggest that adjunctive medical therapy with tamsulosin after an ESWL increased the stone expulsion rate of ureteral stones, especially lower ureteral stones.

Trends in the Emergence of Ciprofloxacin-resistant Escherichia coli and the Relationship with Underlying Diseases in Patients with Urinary Tract Infection / 대한비뇨기과학회지

PURPOSE: The increased use of antibiotics may be the main factor responsible for the development and spread of bacterial resistance. This study demonstrated the relation between quinolone use and the rate of isolating ciprofloxacin-resistant(CIPRO-R) Escherichia coli(E.coli) in patients with urinary tract infection(UTI). MATERIALS AND METHODS: From 2001 to 2006, we determined antimicrobial use for 2,803 in terms of the defined daily dose(DDD) and the antimicrobial use density(AUD), and we surveyed the isolation rates of CIPRO-R E.coli in UTIs in both inpatients and outpatients. We also analyzed the correlation between the number of prescriptions and the resistance rates. RESULTS: Of the 637(22.7%) CIPRO-R E.coli isolates, 297(46.6%) were from inpatients and 340(53.4%) were from outpatients. There was a statistically significant correlation between the rate of isolating CIPRO-R E.coli and the amount of quinolone use for the inpatients(r=0.815, p<0.05) as well as the outpatients(r=0.804, p<0.05). A logistic regression analysis identified previous quinolone use as the independent risk factor(odd ratio: 2.604 [95% confidence interval(CI): 1.639-4.137]) for CIPRO-R E.coli in inpatients. Also, these CIPRO-R E.coli showed low sensitivity to ampicillin and trimethoprim/sufamethoxazole(TMP/SMX) in the inpatients(10.4%, 27.3%) and outpatients(5.1%, 27.1%), respectively. CONCLUSIONS: Our study shows a significant correlation between ciprofloxacin resistance and quinolone use, and previous quinolone use seems to be the risk factor for CIPRO-R E.coli bacteriuria. It is necessary to keep antimictrobial therapy under constant surveillance for the prevention of CIPRO-R E.coli.

Artery to Collecting System Communication after Abdominal Trauma

Degenerative vascular disease, previous arterial surgery, long-term ureteral stenting, pelvis surgery, and radiotheraphy are reported as causes of artery-to-collecting-system communication.. Artery-to-collecting-system- communication associated with blunt trauma is rare, but potentially fatal. The diagnosis is very difficult and requires a high degree of suspicion. We were able to make the diagnosis based on the characteristic finding of contrast-enhanced computed tomography (CT) obtained in the early phase, equivalent to the finding obtained in the corticomedullary phase of the kidney. We report a case of artery to collecting system communication due to blunt abdominal trauma following a fall, which was treated by embolization.

Artery to Collecting System Communication after Abdominal Trauma

Degenerative vascular disease, previous arterial surgery, long-term ureteral stenting, pelvis surgery, and radiotheraphy are reported as causes of artery-to-collecting-system communication.. Artery-to-collecting-system- communication associated with blunt trauma is rare, but potentially fatal. The diagnosis is very difficult and requires a high degree of suspicion. We were able to make the diagnosis based on the characteristic finding of contrast-enhanced computed tomography (CT) obtained in the early phase, equivalent to the finding obtained in the corticomedullary phase of the kidney. We report a case of artery to collecting system communication due to blunt abdominal trauma following a fall, which was treated by embolization.