Clinical Experiences of Extracorporeal Shock Wave Lithotripsy Monotherapy in the Treatment of the Staghorn Calculi / 대한비뇨기과학회지

We reviewed 26 patients with staghorn calculi to determine whether extracorporeal shock wave lithotripsy (ESWL) monotherapy with Dornier MPL-9000X lithotriptor is a successful alternative to the classical approaches. Of the staghorn calculi 5 cases were complete and 21 cases were incomplete staghorn. Double-J ureteral stents were placed in 24 of 26 patients before the ESWL. Of 15 patients with stone volume less than 20ml, 12(80%) showed stone-free after 5.7 mean session of ESWL. Of 11 patients with stone volume more than 20 ml, 7 (64%) became stone-free after 7.1 mean session of ESWL. The post-ESWL complications were flank pain in 9 patients (35%), gross hematuria in 24 (92%), high fever in 3 (13%) and steinstrasse in 24 (92%). Frank pain and high fever were managed successfully with analgesics and antibiotics. Gross hematuria disappeared spontaneously within 2 days. For the steinstrasse, the stone fragments passed spontaneously in 15 cases (62.5%) and ESWL to the steinstrasse was needed in other 9 cases (37.5%). Though the treatment of choice for the staghorn stones is combination therapy (PNL and ESWL) at the present, we experienced good results by ESWL monotherapy in staghorn calculi with Dornier MPL-9000X.

The effects of Intraurethral Stent (Intraurethral Cath) for the Treatment of Benign Prostatic Hypertrophy / 대한비뇨기과학회지

Transurethral resection of Prostate(TURP) is the current optimal therapy for benign prostatic hypertrophy. But in some cases of BPH patients, TURP cannot be performed because the patients have medical disorders not to be operated. Thus several alternatives have been used in the management of BPH patients, especially who had anesthetic contraindications to an operation. We experienced 12 cases of BPH patients applied with Intraurethral Cath(IUC) from April 1991 to September 1995. Eleven patients became able to void after IUC insertion. The maximal flow rates were 5.1 to 15.7 ml/sec and average value was 11.8 ml/sec. Almost all patients showed irritative voiding symptoms such as urgency, urge incontinence, frequency, and dysuria at first. In 7 patients, these symptoms disappeared spontaneously within 2 to 5 days and oxybutynin chloride was used orally in 2 patients. Suprapubic cystostomy was done in three patients because two patients had severe irritative voiding symptoms and one patient had persistent urinary retention. The stent was changed every 3 to 6 months. Stone formation around the device was noted in 2 patients and migration of device into the bladder was found in 2 patients. In 4 patients, TURP was performed when the patient's condition improved enough to be operated under epidural anesthesia. In conclusion, the use of IUC is thought to be a valid, cost effective and safe alternative to TURP in the treatment of highly operative risk patients with benign prostatic hypertrophy.

Torsion of Appendix Testis: 14 Cases / 대한비뇨기과학회지

In spite of today's striking development of radiologic studies, the differential diagnosis of acute scrotal diseases is difficult. We studied 14 cases of appendix testis torsion that had visited our hospital from May 1991 to October 1994 in order to be diagnosed accurately and made appropriate treatment. The torsion of appendix testis occurred during prepubertal ages, and ages of our 14 cases were from 3 to 13, and average age was 9.6 years old. In all of our cases the chief complaint was scrotal pain. The localized pain and palpable tender mass of testicular upper pole were present in only 8 of 14 cases and 5 cases had blue dot sign. These were very helpful in diagnosis of torsion of appendix testis. Doppler ultrasonography was done in 9 cases and radionuclide scrotal imaging was done in 3 cases, but none of these studies were diagnosed as torsion of appendix testis definitely. But in 8 cases that had positive blue dot sign and/or localizing tender mass in upper pole of testis, we could diagnose torsion of appendix testis certainly. We operated 11 of l4 cases( scrotal exploration and excision of torsed appendix testis) and treated conservatively 3 of 14. Most 11 operated cases were revealed that scrotal pains were relieved within 24 hours of postoperative period and secondary complications did not occurred in 3 cases treated conservatively. In summary, the early surgical exploration is necessary to improve maximal testicular salvage when testis torsion cannot be ruled out completely in acute scrotal diseases. But if testis torsion can be ruled out completely, conservative treatment may be considered in torsion of appendix testis.