The Investigation of Split Renal Function after Pyeloplasty Using 99m-Tc-DMSA Renal Uptake Rate in Children with Unilateral Ureteropelvic Junction Obstruction / 대한비뇨기과학회지

Urinary tract obstruction is one of the most common abnormalities of the excretory system in children. It is well known that renal function is progressively deteriorated by urinary tract obstruction and partially recovered by relief of the obstruction. But the reports about the changes of the renal function in contralateral healthy kidney after relief of unilateral obstruction are rare. Thus, we investigated pre- and post-operative changes of renal function not only on the obstructed kidneys but also on the contralateral normal kidneys in twenty-two children(12 were younger than 2 years old) with unilateral hydronephrosis due to ureteropelvic junction obstruction, using 99m-Tc-DMSA renal uptake rate. A marked increase in 99m-Tc-DMSA renal uptake rate was observed in twelve cases(54.5 % ) after pyeloplasty on the obstructed kidney. Among them eight children were younger than 2 years old. In 7 children younger than 2 years old, a preoperative 99m-Tc-DMSA renal uptake rate in contralateral normal kidney was markedly decreased. Among them, marked increase in postoperative 99m-Tc-DMSA renal uptake rate was observed in 5 cases(71.4%). In other words, in 5 children younger than 2 years old, a remarkable increase of 99m-Tc-DMSA renal uptake rate after reconstructive operation was recognized not only on obstructed kidney but also on the contralateral normal kidney. These tendency could not be observed in those older than 3 years old. These results suggest that, in the young children, the obstructed kidney inhibits the contralateral normal and compensatory renal growth, and that the relief of obstruction eliminates this inhibition and causes the renal growth spur in a normal kidney. In summary, we proposed that it is essential to correct unilateral ureteropelvic junction obstruction before two years of age if an improvement of renal function not only on the obstructed kidney but also on the normal kidney is to be expected.

Two Cases of Congenital Urethral Stenosis with Recurrent Urinary Tract Infection / 대한비뇨기과학회지

Congenital urethral stricture are uncommon in boys and occurs at the junction of the endodermal primary urethra and ectodermal secondary urethra. This structure is thought to be related embryonically to failure of complete dissolution of urogenital membrane at the junction of the urogenital sinus and genital fold. Endoscopically, this lesion is recognized as a ring-form stenosis just distal to the external urethral sphincter. Congenital urethral stricture is an important cause of recurrent urinary tract infections, enuresis, failure in thrive or hematuria in pediatric urological practice. The most effective treatment of this lesion is optic internal urethrotomy under direct vision. We report two cases of 6 and 12-year-old boys hospitalized with complaints of high fever, dysuria, urgency and frequency. Six-year-old boy has grade III VUR and 12-year-old boy has grade IV VUR with Hutch diverticulum. We managed with visual internal urethrotomy only in 6-year-old boy but visual internal urethrotomy and bilateral ureteroneocystostomy in 12-year-old boy.

Experimental Study of Laser Welding in Urological Tubular Anastomosis / 대한비뇨기과학회지

Tissue welding is a potentially expectable surgical application in the field of medical laser technology. We investigated to establish the technology of laser welding and its efficacy with auxiliary stent and solder in the anastomosis of urological tubular organs including ureter and urethra of rabbits and vas of human using CO2, laser(Shaplan 1100 System). The objects consist of four groups including control group of the conventional microsuture anastomosis and three experimental groups that included group I of laser welding only, group II of laser welding with stent and group III of laser welding with solder. The overall success rate in control group was 90.7 % and in experimental groups were lower with 58.3% and 73.3% in group I and II , respectively, but higher with 95.5% group III. According to each tubular organ in experimental groups, the overall success rates in ureter, urethra and vas were 83.3%, 75.0% and 76.9% respectively, so that the thinner in the wall thickness of tubular organ revealed the higher success rate. Also, time of procedures was significantly shorter in laser groups than control group. Histological findings of laser welding showed the only localized adventitial reactions with intact subserosal layer. In conclusion, laser welding in the urological tubular organ anastomosis with auxiliary solder is not only a more simple and fast technique but also has higher success rate than conventional microsuture anastomosis.

A case of metastatic choriocarcinoma to kidney and brain / 대한비뇨기과학회지

Uterine choriocarcinoma metastatic to kidney and brain is rare. We experienced a 55-year-old woman with complaints of right flank pain and gross hematuria. On admission urine HCG was positive and serum HCG was elevated to 42,250 mIU/ml. Intravenous pyelography revealed delayed visualization of the right kidney. Ultrasonography and computed tomography of the abdomen showed the irregular, multiloculated, mixed density lesion in the posterolateral parenchyme and a subcapsular hematoma of the right kidney. Three days after admission, the patient suffered a seizure. Computed tomography of brain revealed the mass which was the same density as the right kidney in the midbrain and medial occipital lobe of cerebrum. Cerebrospinal HCG was also elevated Under the impression or choriocarcinoma metastatic to kidney and brain, chemotheraphy (EMA- CO : etoposide, methotrexate, actinomycin D, cyclophosphamide and oncovin) was started.

A case of spontaneous rupture of kidney associated with multiple renal stones during pregnancy / 대한비뇨기과학회지

Spontaneous rupture of kidney is a rare condition which usually presents as an acute abdomen requiring prompt diagnostic evaluation and proper therapy. We experienced a 27-year-old pregnant woman hospitalized with complaint of right flank pain. Ultrasonography and DIP (shield lower abdomen) revealed multiple sandy renal stones and right caliectasis with extravasation of contrast media through renal fornices into perirenal space. We present a case of spontaneous rupture of kidney associated with multiple renal stones during pregnancy, successfully managed with temporary insertion of ureteral catheter.