A Study of the Changes of Antibiotic Sensitivity to the Causative Organisms of Urinary Tract Infection for Recent 5 Years / 대한비뇨기과학회지

PURPOSE: The overuse and misuse of antimicrobial agents and their resultant emergence of resistant microorganisms have made choices regarding antimicrobial therapy more difficult. We studied the changes of antibiotic sensitivity to the causative organisms of urinary tract infection(UTI) for recent 5 years in order to give some useful informations about the choice of adequate drug in the treatment of UTI. MATERIALS AND METHODS: We analysed 1191 uropathogens and their antibiotic sensitivities of the 1132 patients who admitted or visited the National Police Hospital and had more than 105cfu/ml on urine culture from January 1994 to December 1998 retrospectively. RESULTS: The common pathogenic organisms were E. coli(51.5%), staphylococcus(15.7%), pseudomonas(9.1%), klebsiella(7.5%) and enterobacter(4.0%), enterococcus(3.4%), proteus(3.1%) in order. The incidence of E. coli decreased from 50.8% in 1994 to 41.3% in 1998 but the incidence of other gram negative organisms like pseudomonas, klebsiella, enterobacter, proteus and acinetobacter increased from 24.8% in 1994 to 42.6% in 1998. In E. coli isolates(the majority of positive cultures), resistance to six antibiotics changed significantly: ampicillin(19.4% to 15.5%), piperacillin(44.1% to 32.0%), cephalothin(70.6% to 58.6%), gentamicin(62.8% to 60.2%), tobramycin(95.0% to 88.1%), and ciprofloxacin(87.6% to 76.3%). The sensitivity rates of the gram negative organisms including E. coli were very low in 1998 (ampicillin 11.6%, piperacillin 36.6%, and trimethoprim/sulfamethoxazole 49.3%). CONCLUSIONS: We think that E. coli is still the most important organism in the UTI but we shoud be concerned about the increasing incidence of other gram negative organisms like pseudomonas, klebsiella, enterobacter, proteus and acinetobacter. And prior to receiving the bacteriological report, using ampicillin, trimethoprim/sulfamethoxazole as the first choice in the treatment of UTI shoud be reconsidered.

Penile Fracture: A Report of 4 Cases / 대한비뇨기과학회지

Traumatic rupture of the corpus cavernosum of the penis is rare and has been reported infrequently. We experienced 4 cases of penile fracture for recent 2 years. They occurred during coitus(1 case), masturbation(2 cases), and through blunt trauma(1 case). The former 3 cases were treated with immediate surgical intervention about 12 hours after injury. When the last case patient visited hospital 5 days after injury, the penile abscess treated immediately with surgical intervention had developed. Surgery consisted of complete evacuation of the hematoma or pus and repairing of the tear at the tunica albuginea. The results were excellent, with complete early recovery of erectile function. Delayed wound healing was observed only in a patient who underwent surgery about 5 days after injury, but this did not cause any complication afterward. In our experiences, immediate surgical treatment is recommended in patients with fracture of the penis.

Scrotal Doppler Ultrasonography in the Assessment of Varicocele / 대한비뇨기과학회지

PURPOSE: To assess the ability of scrotal Doppler ultrasonography to confirm the diagnosis of clinical varicoceles and detect subclinical varicoceles. MATERIALS AND METHOD: Sixty patients with clinically evident varicocele were examined by scrotal doppler ultrasonography(gray scale: 60 patients, spectral Doppler: 35 patients, color Doppler: 22 patients). A control group of 21 patients with no suspected scrotal pathology also were studied. The age range of the varicocele group was 12-49 years. The normal group consisted of 21 subjects aged 19-23 years. Ultrasonographic measurement of scrotal vein diameter of patients before and during Valsalva maneuver, and scrotal vein blood flow reversal with Valsalva maneuver was compared with the findings of varicocele by physical examination. RESULTS: Significant differences were found in scrotal vein diameter before and during Valsalva maneuver between normal and varicocele testicular units. Cut-off points were selected in an arbitrary fashion on the basis of scattergram. Using this cut-off points and blood flow reversal, we found that 12(23%) of 53 patients with a clinically palpable left unilateral varicocele had an ultrasonographically positive subclinical right varicocele. 8(38%) of 21 patients without a clinical varicocele had a positive scrotal ultrasound. CONCLUSIONS: We suggest that scrotal doppler ultrasonography is a reliable means of confirming the clinical varicocele and screening the subclinical varicoceles.

The Role of Ultrasonography in Identifying Testicular Rupture after Blunt Scrotal Trauma / 대한비뇨기과학회지

To determine the value of ultrasonography for the diagnosis of testicular rapture due to blunt trauma, we reviewed 69 patients of blunt scrotal trauma, which were evaluated by ultrasound before treatment. Thirty patients were managed conservatively, of which 3 cases were explored lately due to persistent pain or mass, and 39 explored immediately. Of the 30 patients treated conservatively the injury was resolved in 27. Surgical exploration of the 42 cases revealed testicular rupture in 29 and simple hematocele in 13. Analysis of the 29 cases with testicular rupture demonstrated that orchiectomy rates were 20% in early exploration and 53% in delayed exploration. in the 27 cases the testicular rupture was correctly diagnosed by ultrasonography, and there were 4 false-positive and 2 false-negative diagnoses of rupture. The specificity and sensitivity for the diagnosis of testicular rupture are 70% and 93%, and the positive and negative predictive values are 87% and 82%, respectively. Ultrasonography used in conjunction with a thorough physical examination is highly sensitive in identifying testicular rupture, and can provide objective information supporting the need for early surgical exploration in patients with blunt scrotal trauma.

Small Cell Carcinoma of the Kidney with Spontaneous Rupture of the Kidney / 대한비뇨기과학회지

Small cell carcinoma of the kidney is very rare, but lethal due to early metastasis and rapid progression. We report a case of the primary small cell carcinoma of the kidney with large rena1 calculus resulting in spontaneous rupture of the kidney, and was managed by total nephrectomy and evacuation of retroperitoneal hematoma and calculus. Immunohistochemical studies revealed the positive staining for cytokeratin and neuron-specific enolase, and dense-core neurosecretory granules were identified in the cytoplasm by electron microscopy. This report is the first case of the primary small cell carcinoma of the kidney resulting in spontaneous rupture of the kidney.

Two cases of acute focal bacterial nephritis / 대한비뇨기과학회지

Acute focal bacterial nephritis (AFBN), synonymous with acute lobar nephronia (ALN) or focal pyelonephritis, is an inflammatory mass without liquefaction caused by severe acute bacterial infection of kidney. Unless treated effectively, progression to a renal abscees may ensue. Clinically, AFBN presents as acute pyelonephritis, and radiologically, as focal swelling or mass. The distinction between AFBN and renal abceess or even tumor may be confusing and difficult. Ultrasonography and computerized tomography(CT) aid in establishing the correct diagnosis. However, the appearance of AFBN on sonography and CT is by no means pathognomonic. Benign or malignant renal tumors may have a similar appearance. With the clinical history, a high index of suspicion, and follow-up studies after institution of medical treatment may further aid in the differentiation. Herein we report 2 cases of AFBN, which were presented as renal masses.

Testicular histology and volume according to the grade in adults with varicocele / 대한비뇨기과학회지

Varicocele has been considered the most common identifiable cause of adult infertility. but little has been known on the significance of histology and volume according to the grade in adults with varicocele. Herein, we have assessed bilateral testicular size before surgical ligation and performed bilateral testicular biopsies at the time of surgical ligation. The volume of each testes in adults with varicocele was smaller than those of normal adults and it was statistically significant. The grades of varicocele did not have a significant effect on differential testicular volumes, although the volume of the left testis in adults with varicocele was always less than that of the right testis. Histologic changes were showed degeneration of germinal epithelium, focal tubular atrophy, and premature sloughing of germinal epithelium into the lumen of the tubules. Tubular thickening was seen in most or the cases. Spermatogenesis was generally reduced in patients with varicocele, but there was no difference between the right and left testis. There was no correlation between the grade of the varicocele and the reduction in spermatogenesis.

Two cases of Fournier's gangrene / 대한비뇨기과학회지

In 1883 Fournier, a French venereologist, described 5 patients with unexplained fulminating gangrene of the male genitalia. Fournier emphasized 3 characteristics 1) the abrupt onset in a young, healthy male subjects, 2) the rapid progression to gangrene and 3) the absence of a discernible cause. As currently used by many authors, Fournier's gangrene describes a widely destructive, gangrenous process of the genitalia, with little regard for Fournier's original tenets of patient's age or definable etiology. Early identification and prompt initiation of medical and surgical therapy is imperative. We report two cases of Fournier's gangrene with brief review of the literatures.

A case of fibroepithelial polyp of the ureter / 대한비뇨기과학회지

Fibroepithelial polyp of the ureter is a extremely rare benign tumor which is mesodermal origin. It should be suspected preoperatively in cases with a long history of loin pain or hematuria, or both, in a younger patient with the radiologic finding of long ureteric filling defect. Unfortunately. in the majority of cases reviewed. the diagnosis was not made preoperatively but the diagnostic confirmation was made intraoperatively or postoperatively. Herein, we report a case of fibroepithelial polyp or the ureter which was diagnosed preoperatively with ureteroscope. The management was local segmental excision and end-to-end anastomosis of the ureter.

A case of fibroepithelial polyp of the ureter / 대한비뇨기과학회지

Fibroepithelial polyp of the ureter is a extremely rare benign tumor which is mesodermal origin. It should be suspected preoperatively in cases with a long history of loin pain or hematuria, or both, in a younger patient with the radiologic finding of long ureteric filling defect. Unfortunately. in the majority of cases reviewed. the diagnosis was not made preoperatively but the diagnostic confirmation was made intraoperatively or postoperatively. Herein, we report a case of fibroepithelial polyp or the ureter which was diagnosed preoperatively with ureteroscope. The management was local segmental excision and end-to-end anastomosis of the ureter.

A Case of Pheochromocytoma of the Bladder / 대한비뇨기과학회지

Pheochromocytoma of the bladder is a rare tumor that often occurs with the symptoms complexes of micturitional attacks such as headache, palpitation and hypertension due to increased catecholamine secretion. Hereine we report a case of pheochromocytoma of the bladder the symptom of which was massive bleeding only without hormone related ones.

Clinical Observation of Renal Injury 34 Cases / 대한비뇨기과학회지

A clinical observation was made on 34 patients with renal injury, who were admitted to the Department of Urology, National Police Hospital from January 1982 to December 1986. Most of patients(33 of 34) were male and 22 patients (65%) were in the age group of 3rd decade. Common causes of injury were in order of blow (29.5%), fall down(23.5%), sport mishap(23.5%) and traffic accident (20.5%). Associated injuries were noted in 30% of the cases and rib fracture was most common. Renal injuries were classified as a minor, major and pedicle injury. Of the 34 cases, 30 were minor injury, 4 were major injury, and pedicle injury was absent. Most common symptoms and signs were hematuria and flank pain. Abnormal DIP findings were noted in 11 cases (30%) and renal displacement was showed in 3 cases with perirenal hematoma and incomplete filling and extravasation were revealed in 4 cases with major injury. Of the 30 cases with minor injury conservative treatment was performed in 26, hematoma removal in 3 and nephrectomy in 1 due to UPJ obstruction. Of the 4 cases with major injury conservative treatment was performed in 2 and nephrectomy in 2.

A Case of Leiomyoma in the Female Urethra / 대한비뇨기과학회지

Leiomyoma of the urethra is a rate entity. We experienced a case of leiomyoma in the female urethra recently. A 45 year old multiparous woman was admitted to the Department of Urology, National Police Hospital with the chief complaints of painless mass on the anterior lip of the external urethral meatus and contact bleeding. The mass was enucleated surgically and confirmed to be a leiomyoma pathologically.

A Case of Renal Cell Carcinoma with Hyperglycemia Corrected after Radical Nephrectomy / 대한비뇨기과학회지

Renal cell carcinoma constitutes approximately 2% of all new malignancies and accounts for majority of all primary renal malignant tumors. Because of its bizarre clinical and biologic behaviors, renal cell carcinoma is one of the most interesting malignant tumors. Many paraneoplastic syndromes associated with renal cell carcinoma are known to return to normal following removal of primary lesion. We report a case of renal cell carcinoma with hyperglycemia corrected after radical nephrectomy.

Ectopic Kidney (2 Cases) / 대한비뇨기과학회지

We report two cases of ectopic kidney with the review of literatures.

Scrotal Injuries: 34 Cases / 대한비뇨기과학회지

34 cases of the scrotal injuries were evaluated from Jan. 1, 1980 to Jun. 30, 1984 in National Police Hospital on the testicular salvage rate in relation with the status of preoperative palpation of testis and early or delayed exploration. The rate of orchiectomy was 0 % (0/ 16) in group A(palpable testis in preoperative physical examination) and 55.5% (10/ 18) in group B(impalpable testis). In group B, the testicular salvage rate was 80% with early exploration and 0 %(0/8) with delayed explorations.

Clinical Effect of Rosoxacin on Acute Gonococcal Urethritis / 대한비뇨기과학회지

Fourty gonococcal urethritis patients were treated with Rosoxacin at the Department of Urology, National Police Hospital from December, 1982 to April, 1983. All patients were male and confirmed as acute gonococcal urethritis by Gram stain and culture. A new bactericidal agent, Rosoxacin, was administered orally in a single dose of 300mg in 40 cases of acute gonococcal urethritis and following results were obtained. 1. Gram negative intracellular diplococci were controlled in 30 patients (100%) among 30 patients with pure gonococcal infection with a single oral dose of Rosoxacin. 2. 7 patients (23.3%) of 30 patients with pure gonococcal infection were revealed to nonspecific urethritis, and they were treated with other antibiotics. 3. Gram negative intracellular diplococci were controlled in 10 patients (100%) among 10 mixed infected patients with a single dose of Rosoxacin. 4. 8 patients (80%) of 10 patients with mixed infection were revealed to nonspecific urethritis, and they were treated with other antibiotics. 5. There was no side effect of Rosoxacin in all patients.

A Case of Paratesticular Embryonal Rhabdomyosarcoma / 대한비뇨기과학회지

Rhabdomyosarcoma is the most frequent cancer involving the bladder, prostate, vagina and paratesticular tissues in children, and is highly malignant neoplasm with a tendency toward early infiltration of adjacent structures and metastases to regional lymph nodes and distant organs. We report a case of paratesticular embryonal rhabdomyosarcoma developed in 20-year-old male with brief review of literatures.

A Clinical Observation on 85 Cases of Hydronephrosis / 대한비뇨기과학회지

A Clinical observation was made on 85 cases of hydronephrosis who were admitted to the department of urology in National Police Hospital during 5 years and 4 months from Jan., 1978 to April, 1983. The following results were obtained; 1. The rate of hydronephrosis accounted for 8.6% of the total patients (981 cases) admitted to the urologic department. 2. Age distribution in this series ranged from a 4 years old male to a 69 years old male patient. The most common age group was the 3rd decade (29.4%). The male and female ratio was 2.7:1. 3. The left side was affected 1.4 times more than the right. 9 cases (10.9%) were bilateral. 4. In underlying diseases, the congenital causes were 11 cases (12.9%) and among them congenital ureteropelvic stenosis was the most Common (5 cases). The acquired causes were 74 cases (87.1%) and ureteral stone was the most common acquired cause (39 cases). 5. In the level of the obstruction, the upper tract was 76 cases (89.4%), mid & lower tract were 7 cases (8.2%) and I case was extraurinary tract disease. 6. The most common chief complaints on admission was flank pain (52 cases). 7. In laboratory findings, increased BUN over 20mg% were 8 cases (9.4%) and the increased creatinine over 2.0rag% were 4 cases (4.7%). In urinalysis, pyuria were noticed in 41 cases (48.2%) and among them urine culture were performed to 32 cases. And E. coli were isolated in 12 cases (37.5%). 8. In treatment conservative treatment was done in 18 cases(20%) and surgical treatment was performed in 67 cases (80%). Of the surgical treatment, the most common operation was the ureterolithotomy in 32 cases (37.6%) and nephrectomy was done in 14 cases (16.4%).

Clinical Studies on 51 Cases of Varicocele / 대한비뇨기과학회지

A clinical observation was made on 51 cases of varicocele of the inpatient in the Department of Urology, National Police Hospital, during the period from January 1979 to April 1982. The results are as follows: 1. Left renal vein-internal spermatic confluence was joined right angle in all case and internal spermatic vein was demonstrated atonic, wide structure without constriction indicating valvular insufficiency in 8 cases. 2. The number of internal spermatic vein was between 1 and 4, showing the highest incidence in 2 vessels (8 cases). 3. The diameter of internal spermatic vein was between 2 mm and 6.5 ram, showing the highest incidence in 3 mm (8 cases). 4. This study showed lesser recurrence rate at the ligation of all Of the internal spermatic veins rather than ligation of the most markedly engorged one.