A case of Vulvar Rhabdomyosarcoma in a Young Child / 대한비뇨기과학회지

No abstract available.

Recurrence and Progression of Stage T1 Bladder Tumor after Intravesical Bacillus Calmette-Guerin(BCG) Therapy / 대한비뇨기과학회지

PURPOSE: The management of patients with superficially invasive, stage T1N0M0 bladder cancer remains controversial. While some physicians advocated early cystectomy, others believe that with initial TURB and effective intravesical BCG, local disease control can be achieved in most patients. We evaluated the outcome of stage T1 transitional cell carcinoma of the bladder treated with TURB and intravesical BCG therapy. MATERIALS AND METHODS: We reviwed records of 109 patients with stage T1 bladder tumor who treated with BCG between February 1986 and January 1997 with respect to age, grade, interval of progression and recurrence and current status. Each course of BCG consisted of 6 weekly and subsequent 3 monthly treatments. RSEULTS: Forty five of 109 patients(41.3%) had initial grade I tumors, including 13 patients (28.9%) who had at least one or more local recurrences and 2 patients(4.4%) had disease progression. Fifty seven of 109 patients(52.3%) had grade II tumors, with local recurrence in 23 patients(40.4%) and disease progression in 4 patients(7.0%). Among remaining 7 patients (6.4%) who had grade III tumors had local recurrence in 1 patient(14.3%) and disease progression in 4 patients(57.1%). The median intervals of progression on patients with initial grade I, II and III were 20.5, 15.3 and 16.9 months, respectively. Five of 10 patients who had progressed died because of the metastasis despite salvage therapies. CONCLUSIONS: Intravesical BCG was appropriately treated for patients with initial grade I or II stage T1 tumor because of low risk of disease progression. Patients with initial grade 3 stage T1 tumor had high risk for disease progression and BCG did not seem to decrease this risk. Therefore, grade 3 stage T1 tumor was regarded as high risk of disease progression and should be treated to more aggressive modality like invasive tumor.

Onlay Island Flap Hypospadias Repair ; Experience of 45 Cases / 대한비뇨기과학회지

PURPOSE: The onlay island flap urethroplasty, a variation of the transverse preputial island flap, was originally introduced as an alternative to the meatal-based flap urethroplasty for anterior hypospadias. Recently, the indications for use of the onlay island flap urethroplasty have been extended to include repair of more proximal hypospadias with/without moderate degrees of chordee. We evaluated application and outcome of onlay island flap hypospadias repair. MATERIALS AND METHODS: We analyzed medical records of 126 patients who underwent primary hapospadias repair at our hospital during recent 10 years with respect to age at surgery, type of hypospadias, surgical technique and outcome. A minimum follow-up of 6 months was necessary for inclusion of the study. RESULTS: Age ranged from 7 months to 32 years(mean 6.7 years). For 59 patients with anterior hypospadias, 14 onlay island flap, 21 MAGPI, 14 pyramid, 8 Mathieu and 2 tubularized incised plate urethroplasties were performed. For 67 patients with mid to posterior hypospadias, 31 onlay island flap, 29 transverse island flap, 3 King, 3 augmented Duckett (Transverse island flap+hiersch-Duplay) and 1 tubularized incised plate urethroplasty were performed. Out of total 129 patients, 45 patients underwent onlay island flap repairs including combined with 7 dorsal penile plications. Out of 31 patients who underwent onlay island flap repairs, 3 patients developed complications. Out of 29 patients who underwent transverse preputial island flap repair, 13 patients developed complications. During the period of first 5 years, we performed 10 onlay island flap and 21 transverse island flap repairs for 37 mid to posterior hypospadias, whereas during the second 5 years, we did 21 onlay island and 8 transverse island flap repairs for 30 mid to posterior hypospadias. CONCLUSIONS: The onlay island flap hypospadias repair with/without dorsal penile plication was even applied to mid and posterior hypospadias as well as anterior hypospadias. The onlay island flap hypospadias repair maintained its technical advantages and lower complication rate compared to transverse island flap. More favorable results were obtained through as possible as preservation of urethral plate in hypospadias repair.

Results of Pressure-Flow Studies in Adult Male Patients without Voiding Symptom / 대한비뇨기과학회지

PURPOSE: The pressure-flow study is only objective study that can determine the presence or absence of bladder outlet obstruction and impaired detrusor contractility. Although many results of pressure-flow study are reported in diseased state such as benign prostatic hyperplasia, but are rarely evaluated in adult male patients without voiding symptoms as control group. The purpose of this study was to evaluate the findings of pressure-flow study in asymptomatic male patients. MATERIALS AND METHODS: Twenty-three male patients without voiding symptom were recruited for this study. Mean age of these patients was 49.8 years(range 21-70). Mean AUA symptom score was 1.1(range 0-4) and mean prostatic volume was 27.3gm(range 20-35) on digital rectal examination. The study was done by using 7 Fr. urethral catheter on sitting or standing position. RESULTS: Mean values were followed; PdetQmax was 48.1cmH2O(range 25-94), Qmax was 15.7ml/sec(range 3-23), and postvoid residual urine was 14.5ml(range 0-80). According to the Abrams-Griffiths nomogram, 8 were unobstructed and 4 were obstructed, the remaining 11 falling in the equivocal zone. In each types, mean group specific urethral resistance factor (URA) was 12.8cmH2O in unobstructive type, 51.5 in obstructive type, and 22.1 in equivocal type. CONCLUSIONS: The results were maybe guessed as following; First, the values of defining obstrucion were set too low. Second, obstruction was less relevance in the development of symptoms than had been suggested previosly by some observers. Therefore, we thought that interpretations of pressure-flow finding were carefully considered to method of test, and/or uncomfortable voiding.

Value of the Voiding Cystourethrography prior to Renal Transplantation / 대한비뇨기과학회지

PURPOSE: In many centers, voiding cystourethrography(VCUG) is routinely performed to identify some abnormalities which may compromise the success of transplantation and assess the abnormality of lower urinary tract. To evaluate the value of VCUG as routine pretransplatation workup, we retrospectively reviewed this investigation for renal transplant candidates. MATERIALS AND METHODS: 251 patients underwent transplantation at our center over a 7-year period from August 1990 to July 1996. 229 patients were fully evaluable excluding 22 patients due to incomplete records. All of them were taken VCUG. We tried to find an abnormal VCUG including vesicoureteral reflux, postvoid residual urine(PVR>50ml) and decreased bladder capacity(<100ml). RESULTS: An urological abnormality is identified by VCUG in 29 of 229 patients(12.7%). These abnormalities include 20 patients with VUR alone, 5 patients with increased PVR due to urethral stricture(1), benign prostatic hyperplasia(1), and unknown(3), 1 patient with decreased bladder capacity, 2 patients with unilateral VUR combined PVR, and 1 patient with bilateral VUR combined decreased bladder capacity. 4 of 29 patients had a known urological abnormality as the etiology of end stage renal disease. 41 of 229 patients evaluated had a previous urological history such as frequency, nocturia, urgency, incontinence and dysuria, recurrent UTI and pyelonephritis. But all 29 patients with abnormal VCUGs had a previous those history. 4 of 29 patients were managed due to increased PVR after transplantation as followings: clean intermittent catheterization(3), medication of alpha-blocker for BPH(1). Others were not required further managements. Hence, abnormal findings on VCUG did not lead to a surgical procedure for the abnormality before and/or after transplantation. CONCLUSIONS: These results show that VCUG may be not essential for the routine evaluation for renal transplantation. Therefore, it will necessary in selected individuals with a previous urological history.

The Causes of Elevated Serum Prostatic Specific Antigen (PSA) Concentrations in Nonprostatic Cancer Group / 대한비뇨기과학회지

Elevations of serum PSA concentrations have been widely reported due to prostatic cancer, but other causes haute not been formally characterized or quantified. So that, we evaluated the causes of elevated serum PSA concentrations in men whose prostate biopsy showed no cancer. The effects of prostate volume, inflammation, echogenecity on ultrasound and calculi were examined in 43 men that serum PSA concentrations greater than 4.0 ng/ml with negative biopsy. These men were compared with 16 men who had suspicious rectal examinations, negative biopsy and serum PSA concentrations of 4.0 ng/ml. or less. Prostate volume (22.5%, p4.0 ng/ml) than control group ( or =0.05). In summary, prostate volume and inflammation were the most important factors contributing to increase serum PSA concentration in men that clinically undetectable prostatic cancer.

Spontaneous Rupture of Nonfunctioning Adrenocortical Carcinoma / 대한비뇨기과학회지

Hemorrhage or cystic rupture of adrenal gland is uncommonly reported in infants. However, spontaneously ruptured nonfunctioning adrenocortical carcinoma has not been yet reported in Korean literature We describe a 65-year-old woman who developed unilateral spontaneous adrenal rupture in coexisting nonfunctioning adrenocortical carcinoma without trauma or infection. And our preoperative impression was suspicious ruptured renal cell carcinoma.