A Case of Renal Angiomyolipoma Extending into the Renal Cyst Which was Confused with Renal Pelvis Tumor / 대한비뇨기과학회지

Renal angiomyolipoma is composed of mature fats, smooth muscles and abnormal blood vessels which arises mainly from renal parenchyme and compresses the calyx or protrudes the renal cortex, but which extends into the renal cyst is rare. Recently it can be easily diagnosed preoperatively by several diagnostic modalities such as ultrasonography, computed tomography and several clinical signs associated with tuberous sclerosis, although it`s clinical and radiological features are similar with renal cell carcinoma. We report a case of renal angiomyolipoma without tuberous sclerosis, extending into the renalcyst, which was confused with renal pelvis tumor in a 73 years old male.

A Case of Retroperitoneal Neurilemmoma Arising from Adjacent to Adrenal Gland / 대한비뇨기과학회지

Neurilemmoma is well-encapsulated tumor of Schwann cell origin. The majority arise in peripheral nerve or cranial nerve, and rare in retroperitoneum. Although it is incidentally detected by the advances in diagnostic procedures, especially in ultrasound and computed tomography, it is confirmed by pathologic findings. The treatment is surgical excision. We report a case of retroperitoneal neurilemmoma arising from adjacent to adrenal gland, in 45 years old female.

Extracorporeal Shock Wave Lithotripsy in 17 Children / 대한비뇨기과학회지

A total of 17 children with 24 renoureteral units underwent 58 treatment with EDAP LT-01 extracorporeal shock wave lithotripsy for urinary tract stones between January 4, 1989 and January 30, 1993. The patients were followed for over two months. The results were obtained as follows ; 1. The distribution of sex was 9(53%) in male and 8(47%) in female. The average patient age was 7 years with a range of 6 months to 16 years. 2. The location of stones were kidney in l8 cases( 75.0%) ; calyx in 10 (41.7% ) and renal pelvis in 8(33.3% ) and ureter in 6(25.0%) ; upper ureter in 2(8.3%) and lower ureter in 4( 16.7%). There were multiple renal stone in 4 and bilateral renal stone in 2. The average stone length was 9mm with a range of 3 to 10mm. 3. Of the 13 patients whose age was less than 10 years, 11(84.6%) required intravenous Ketamine anesthesia. Two patients whose age was more than 10 years and two patients less than 10 years were treated without any type of anesthesia. 4. The average numbers of treatment were 2.1 session and the average storage required was 19.4 in one session The average treatment time was 39.7 minutes. 5. The total average success rate was 87.5% 6. All of the patients were not the pre- and post- ESWL additional manipulation. ESWL complications did not require admission and surgical management. Therefore, we conclude that EDAP LT-01 is an effective and easy procedure for treatment of urinary stones in children.

A case of ureteral ectopia draining into seminal vesicle / 대한비뇨기과학회지

Ectopic ureter entering into the seminal vesicle associated with ipsilateral renal dysplasia is a very rare developmental abnormality. Clinical manifestations consists of dysuria, hematuria, recurrent epididymitis. ejaculatory pain and perineal discomfort and the diagnosis is made by seminal vesiculogram through vas deference. Surgical excision of the seminal vesicle and the ectopic ureter is the best choice or treatment in this entity. We present a case of 34 year old infertile man with ectopic ureter entering into the seminal vesicle associated with ipsilateral renal dysplasia and contralateral cryptorchidism.

Ultrastructural changes of human testis after vasectomy / 대한비뇨기과학회지

Vasectomy is one of the most common forms of male contraception throughout the world. However, more vasectomy reversals are sought each year because of the increasing number of second marriages and other causes. Before recommending vasectomy, urologists may wish to resolve in their own mind the conflict between reports that maintain the testis is harmed by vasectomy and those that slate is not. We studied a group of patients undergoing vasectomy reversal to determine whether histopathologic change on light and electron microscopy would be detected. Only one testis specimen from post-vasectomy patients showed an abnormality correlated with spermatogenesis and five cases showed mild focal interstitial fibrosis without abnormality of spermatogenesis on light and electron microscopy. We found that vasectomy has some influence to the spermatogenesis and pathologic change.

A case of atypical carcinoma of the kidney / 대한비뇨기과학회지

Atypical carcinoma of the kidney arising from the epithelium of renal collecting duct is a rare disease. Clinical manifestations are mimicking that of the renal cell carcinoma. Diagnosis is confirmed by pathology with immunocytochemical study(cytokeratin) using immunoperoxidase technique. Management is not discussed here. The prognosis is poor with a relatively rapid progression of the disease. We present a case of atypical carcinoma of kidney in a 56 years old male patient with brier review of the literature.

ESWL for management of steinstrasse / 대한비뇨기과학회지

Early in the experience of ESWL, steinstrasse was recognized as potential complication and suggestions for management were proposed. including retrograde ureteral manipulation. placement of ureteral stent or percutaneous nephrostomy, etc. Recently ESWL has been challenged due to less invasive and safer procedure. We experienced 18 cases (2.1%) of steinstrasse in 850 patients with ESWL (EDAP LT-01) from February, 1989 to February, l99l and treated with ESWL. The results were obtained as follows. 1. The primary stones in 18 cases of steinstrasse were renal stones in l7 cases (complete staghorn calculi; 4 cases. partial staghorn calculi; 5 cases) and upper ureteral stone in 1 case: 2. The sites of steinstrasse were lower ureter in 13 cases and upper ureter in 5 cases. The lengths of steinstrasse were 1.4~8.3cm (mean: 3.19cm). The site and length of steinstrasse were not related with clinical symptoms. 3. Of l8 cases. 13 cases were type 1. 3 cases type II and 2 cases type III. Type of steinstrasse was not related with clinical symptoms. 4. Six cases were asymptomatic and 3 cases of symptomatic steinstrasse required hospitalization. 5. Fifteen cases were treated with ESWL only and 2 cases of solitary kidney were treated with ESWL, after percutaneous nephrostomy. Early experienced 1 case was treated with ureteroscopic removal of stone. 6. Of 17 cases treated with ESWL, stone fragments expelled out within 1 month in 13 cases, 2 months in 3 cases and 4 months in 1 case of solitary kidney. All symptoms of steinstrasse were relieved within 3 days after ESWL.

Three cases of the emphysematous pyelonephritis / 대한비뇨기과학회지

Emphysematous pyelonephritis is a rare complication of acute pyelonephritis that occurs in diabetics or urinary obstruction and spontaneous gas formation around renal parenchyme. Diagnosis. in appropriate clinical setting. is confirmed radiographically. Plain film demonstrates a surprising pneumonephrogram, mottled gas shadow in the renal parenchyme as well as perirenal gas. Surgical intervention after unsuccessful antibiotics and conventional medical measurement is necessary. We experienced 3 cases of emphysematous pyelonephritis which occurred in diabetic women with brief review of the literature.

Relationship of the patterns of pelvic bone fracture and bladder rupture / 대한비뇨기과학회지

A clinical observation was made on 64 cases of the bladder rupture who were admitted to our hospital during the period from June, 1979 to February, 1991. The results are as following ; 1. Of 355 cases of the genitourinary tract injury, the bladder rupture were 64 cases (18.0%), which were composed of 40 cases (62.5%) of bladder rupture without pelvic bone fracture and 24 cases (37.5%) of bladder rupture with pelvic bone fracture. The bladder rupture without pelvic bone fracture were composed of 35 cases (87.5%) with intraperitoneal bladder rupture and 5 cases (12.5%) with extraperitoneal bladder rupture, the bladder rupture with pelvic bone fracture were composed of 13 cases (12.5%) with intra and extraperitoneal bladder rupture. 2. In 24 patients with pelvic bone fracture, the most common site of bladder ruptures were found on the lateral wall in 12 cases (50%), and followed by the dome in 9 cases (37.5%), multiple areas in 3 cases (12.5%). In 40 patients without pelvic bone fracture, the most common site of bladder ruptures were found on the dome in 33 cases (82.5%), and followed by the multiple areas in 4 cases (10%), lateral wall in 3 cases (7.5%). 3. The average size of the bladder rupture was 6.5cm in cases without pelvic bone fracture, 6. 8cm in cases with pelvic bone fracture, especially comminuted pelvic ring fracture had most severed bladder rupture (average; 8.3cm). 4. Of 24 pelvic bone fractures, pubic rami fractures were most common (41.6%), and followed by comminuted pelvic ring fracture (25%), anterior and posterior pelvic ring fractures (12.5%), acetabulum and isolated fractures (8.3%), symphyseal separation fractures (4.1%) in order of frequency. 5. 5 cases (20%) of pelvic bone fractures were associated with posterior urethral injury, especially 60% in The pubic rami fracture. There was no significant relation between the type of pelvic fracture and the type of bladder rupture, but the fractures involving pubic arch were more often associated with posterior urethral injury.

Clinical evaluation of urethral strictures following urethral catheterization / 대한비뇨기과학회지

A clinical evaluation was made on 19 patients with urethral stricture following urethral catheterization in 155 urethral stricture patients during 12 years from January. 1979 to December. 1990. The following results were obtained. I. In 155 cases of urethral stricture, iatrogenic urethral stricture was 24 cases (15.4%) of which the most common cause was urethral catheterization(19 cases) and followed by instrumentation (2 cases). 2. In 19 cases of urethral stricture following urethral catheterization. the most common site was the anterior urethra (bulbous 10 cases. pendulous 7 cases) and multiple strictures showed 5 of 17 anterior urethral strictures. 3. In 19 cases, 16 cases (84.2%) occurred in patients who have kept the urethral catheter within seven days and 18 cases (94.7%) were inserted and cared the urethral catheter by non-urologist. 4. Treatment was performed internal urethrotomy in 16, dilatation in 2 and catheter indwelling during 1 week in 1. 5. In 24 cases of iatrogenic urethral stricture. mean number of dilation to recurrent strictures after primary procedure had required O.5 time. From our results. we suggest that education for the careful insertion and method of care for the urethral catheter to non-urologist is least likely to induce urethral stricture formation.

A case of the renal medullary fibroma / 대한비뇨기과학회지

Renal medullary fibromas which are arisen from the interstitial cell of the renal medulla show small, multiple nodules on autopsy Findings over age 50, but they are very rare clinically. thus several cases have been reported until 1982. When the tumors are large. their clinical presentation is characterized by loin pain, hematuria and palpable mass. The preoperative diagnosis with radiologic studies is very difficult and the confirmative diagnosis was made with pathologic finding. Nephrectomy has been the most common useful treatment and local excision can be used. We report a case of renal medullary interstitial cell fibroma in a 17-year-old girl presented with a child-head sized palpable mass on the left upper quadrant.

A case of adult Wilms' tumor / 대한비뇨기과학회지

Wilms' tumor is malignant renal tumor, originated from undifferentiated mesonephric blastema. Adult Wilms' tumor, unlike that of childhood, is a rare disease and a total of l67 cases have been reported in the world medical literature until 1980. Diagnosis of adut Wilms` tumor is very difficult preoperatively and the pathologic hallmark is the presence of abortive or embryonal glomerulotubular structure with an immature spindle cell stroma. The therapeutic guidelines and surgical principles that govern childhood Wilms' tumor should be applied to adult Wilms' tumor. We reported a case of Wilms' tumor developed in 34 year-old male patient complaining of right flank pain with gross hematuria for 2 months.

Change of plasma renin activity between pre and post-ESWL / 대한비뇨기과학회지

ESWL is clearly an effective noninvasive treatment for a wide variety of urinary tract calculi. However, numerous clinical and experimental reports present evidence that ESWL can cause acute and chronic complications, especially new onset hypertension. We evaluated that relationship between hypertension and plasma renin activity with follow-up of 1 month after one session ESWL and round that 3.1% of patient showed new onset hypertension. The plasma renin activity was slightly elevated 24 hours after ESWL, but by 1 month after procedure the renin had decreased to near pre-ESWL level. However. these data represented no statistically significant change (p>0.05). Therefore, we believed that at the moment no relation between plasma renin activity and hypertension at least early period of post-ESWL (1 month).

Acute necrotizing fascitis of the male genitalia (Fournire's gangrene) / 대한비뇨기과학회지

We reviewed 15 cases of necrotizing fascitis of the male genitalia. The clinical courses could be divided into two different types. In about one half of the patients the symptoms and signs progressed slowly within 122 weeks and in the remained they progressed rapidly. In the former, the prodromal signs were noted, usually low abdominal and inguinal pain. In 8 of fifteen patients, the locations of infectious focus were difficult to determine. The diagnosis were made after the development of scrotal necrosis in all of the cases. There were no differences in the causative pathogens comparing to 1hose of previous reports. The common underlying diseases were liver cirrhosis and diabetes. Hypoalbuminemia and leukocytosis were found in all. Of course, the strategy of treatment is same between two types, we would like to propose to use the term Fourier`s gangrene, a specific form of necrotizing fascitis, only to whose clinical course in acute and the location of primary infecious foci are obscure.

Acute necrotizing fascitis of the male genitalia (Fournire's gangrene) / 대한비뇨기과학회지

We reviewed 15 cases of necrotizing fascitis of the male genitalia. The clinical courses could be divided into two different types. In about one half of the patients the symptoms and signs progressed slowly within 122 weeks and in the remained they progressed rapidly. In the former, the prodromal signs were noted, usually low abdominal and inguinal pain. In 8 of fifteen patients, the locations of infectious focus were difficult to determine. The diagnosis were made after the development of scrotal necrosis in all of the cases. There were no differences in the causative pathogens comparing to 1hose of previous reports. The common underlying diseases were liver cirrhosis and diabetes. Hypoalbuminemia and leukocytosis were found in all. Of course, the strategy of treatment is same between two types, we would like to propose to use the term Fourier`s gangrene, a specific form of necrotizing fascitis, only to whose clinical course in acute and the location of primary infecious foci are obscure.

A case of XX male syndrome / 대한비뇨기과학회지

The 46, XX male or sex-reversal syndrome is a rare entity, which may be reported first by de la Chapelle and associates in 1964, an additional 135 cases have been recognized, yet only 20 percent of these patients have been diagnosed during childhood. The 46, XX male may be associated with hypogonadism and infertility in adult, and occasionally, sexual ambiguity in the neonate. At least 10% of patients have had hypospadia or ambiguous external genitalia. The 46, XX male was diagnosed with cytogenic study, H-Y antigen, hormonal study testicular biopsy, radiologic study. Here, we report a case of 19 month-old child XX-male with hypospadia and chordee.

Experience of Stamey operation for female stress urinary incontinence / 대한비뇨기과학회지

Stamey endoscopic suspension of bladder neck is a reliable technique among various surgical techniques with high success rate and little morbidity. We treated 8 patients complaining of urinary incontinence with Stamey operation from February 1988 to May 1990 and Follow-up for over 6 months. The results as follows; 1. Patients varied in age from 31 to 63 (mean;45) years. All patients were multiparous average 2.87 (2-4) times of previous deliveries 2. All patients showed frequency and nocturia. Severities of incontinence were Grade I in2 patients, Grade II in 5, Grade III in 1 3. No significant changes were identified between preoperative and postoperative urethral pressure profiles. 4. On preoperative lateral cystourethrograms, bladder base was descended about -2.10+-0.74cm from SCIPP line and elevated about +1.2 cm+/-0.49 cm from SCIPP line on postoperative lateral cystourethrograms. 5. Incontinence was disappeared in 7 patients, but 1 patients was recurred due to rupture of suture material during lifting heavy material.

Initial Experience with ESWL for Urinary Calculi / 대한비뇨기과학회지

ESWL has been demonstrated to be a safe and efficacious means to treatment of urinary calculi. We report the results of 176 patients(203 cases) treated with EDAP LT-01 lithotriptor between January 24 1989 and August 24 1989. The patients were followed for over two months. The results were obtained as follows ; 1. The sex ratio was about 2.4: 1, 125(71.0%) in male and 51(29.0%) in female. The fifth decade(30.1%) was most, followed by fourth decade( 26.7 % ) and sixth decade(18.2%) 2. The stone location showed that kidney was 128 cases( 63.1% ) and ureter was 75 cases( 36.9%), The stone size showed that 94 cases(46.3%) in under 10mm, 75(36.9%) in 11-20mm and 34(16. 8%) in over 21mm. 3. The overall success rate(complete in 74.9% and partial in 23.6% ) was 98.5%. The complete success rate of 122 cases who treated with frequency of 10/sec. was 53.3 %, but 81 cases who treated with frequency of 5/sec. showed the complete success rate of 76.6%. 4. Adjunctive procedures after ESWL were performed 6(3%), including ureterolithotomy in 2(1.0%) and pyelolithotomy, PCNJ PCNL and URS in each 1 case(0.5% ). 5. Complications were showed that gross hematuria for over 1 day in 68.3%, nausea and vomiting in 26%, renal colic in 17.9% and ureteral obstruction in 8.9%. But, all patients re- covered with only conservative treatment except URS and PCN in each 1 case. 6. There were not statistically significant changes in level of BUN, Creatinine, SGOT, SGPT and Creatine phosphokinase, but S-amylase and LDH were significantlychanged(p <0.05).

A Case of Seminal Vesicle Cyst / 대한비뇨기과학회지

Seminal vesicle cysts are rare. Since the first case of a seminal vesicle cyst was reported by Zinner in 1914, about 20 cases have been reported in literature up to 1976. They are presented at the age of high sexual activity. They may be asymptomatic and discovered by rectal examination or may manifest with symptoms of bladder irritation, perineal or testicular pain, pain on ejaculation, etc. Here, we report a case of seminal vesicle cyst in a 38 years-old-man who was admitted under the impression of pelvic abscess.

ESWL of Caliceal Diverticula Calculi / 대한비뇨기과학회지

Caliceal diverticula are eventrations of the upper collecting system lying within the renal parenchyma and communicating with renal pelvis or a calyx through a narrow channel. The incidence on a routine IVP is approximately 0.21 to 0.45 percent and stone formation in a caliceal diverticulum has arised from 9.5 to 50 percent. Traditionally, treatment has included nephrotomy with extraction of the calculi and percutaneous nephrolithotripsy, but more recently ESWL has been challenged due to less invasive and safer procedure. We report the results of 11 patients with calculi in caliceal diverticula treated with EDAP LT-01 lithotriptor. All patients were followed during 2-11 months (average in 6.6) The results were obtained as follows ; 1. The symptoms were included chronic vague flank pain in seven, acute renal colic in two, epigastric discomfort in one and incidentally diagnosed in one. 2. The location of diverticula were upper third in seven, mid third in three and lower third of kidney in one. The stone size showed under 10mm in seven, 11-20mm in three and over 21mm in one. 3. The average numbers of treatment were 2.2 sessions and average storage was 102. 4. The complete success rate in 63.6 % (stone free rate in 45.5 %) and partial success rate in 27.2% were showed. 5. The complete relief of symptom was in eight (72.7% ), partial in one (9.1%) and persistent symptom in two (18.2 9t ). 6. Complication was showed only gross hematuria for 1 day in 63.6 %, but all patients recovered with conservative treatment. Therefore, the possibility of producing a satisfactory result (relief of symptom in 81.1%) and the low morbidity of ESWL suggest that this treatment may be appropriate for calculi in caliceal diverticuli.