Surgical Treatment of Aldosteronoma / 대한비뇨기과학회지

Primary aldosteronism, characterized by hypertension, hypokalemia, and hyperaldosteronism resulting from oversecretion of aldosterone independent of increased plasma renin activity, is mostly due to adrenocortical adenoma. Twelve hypertensive patients with primary hyperaldosteronism who had been surgically treated, were evaluated retrospectively. The age ranged from 28 to 56 years(mean 42 years) and sex ratio of male to female was 2 to 10. The patients had had a history of hypertension between 2 and 3 years. The diagnosis was made by clinical and laboratory testing which demonstrated elevated plasma aldosterone level with suppressed plasma renin activity and hypokalemia. All patients were revealed to adrenal adenoma. The location of adenoma were left side in 8 and right side in 4. The surgical approaches were transperitoneal in 6 patients (ant. subcostal incision in 5 patients and ant. midline incision in 1 patient) and retroperitoneal in 6 patients(flank incision in 5 patients (2 patients with 10th rib resection, 2 patients with 11th rib resection and 1 patient with 12th rib resection) and posterior incision in 1 patient). The surgical specimens of adrenal gland were revealed as adrenocortical adenoma in all cases. Most patients were normalized in clinical symptoms and postoperative laboratory findings. We think that among the above various surgical approach methods, flank incision with 10th rib resection was best method for getting good operative field and if the familiarity of the surgeon is obtained, posterior approach will be another good approach method.

Ileocolovesical Fistula Caused by Crohn's Disease: Report of a Case / 대한비뇨기과학회지

Enterovesical fistula is a relatively rare disease and usually caused by primary intestinal disease (diverticulitis, colon cancer and inflammatory bowel disease including Crohn's disease etc.). We experienced a rare case of ileocolovesical fistula caused by Crohn's disease. The 34 year old man had had chronic dysuria, lower abdominal pain and turbid urine for 3 years. Contrast studies including cystography, small bowel series, barium enema and abdominal Of showed ileocolovesical fistula. Small bowel segmental resection, Hartmann's colostomy and suprapubic cystostomy were performed. Histological examination of operative specimen showed a granulomatous inflammation caused by Crohn's disease. Our case suggests that Crohn's disease may be a rare cause of enterovesicalfistula in Korean.