The Outcome of Endourologic Treatment for Benign Ureteral Strictures / 대한비뇨기과학회지

PURPOSE: We reviewed the results of endoureterotomy and balloon dilation for benign ureteral strictures to determine the efficacy of these procedures. MATERIALS AND METHODS: We treated 19 patients who had benign ureteral stricture by retrograde endoureterotomy or balloon dilation followed by placement of a 6-8Fr stent for 6 weeks. Mean follow up period was 14 months (6-27 months). Eight patients were treated by endoureterotomy using cold knife under direct vision and 11 patients were treated by balloon dilation. The causes of ureteral strictures were abdominal surgery in 8 patients, urinary tuberculosis in 6 patients, radiation therapy in 2 patients, rigid ureteroscopy in 2 patients and periureteral abscess in 1 patient. The length of strictures was shorter than 1cm in 14 patients and over 1cm in 5 patients. The etiology of strictures was ischemic origin in 11 patients and nonischemic in 8 patients. One patient had poor ipsilateral renal function (<25%). RESULTS: The overall success rate was 78.9% (15/19). The success rate of balloon dilation was 81.8% (9/11) and that of endoureterotomy was 75% (6/8). No significant complication such as high fever or sepsis was observed. Strictures shorter than 1cm had 92.9% (13/14) success rate while strictures over 1cm had 40% (2/5) success rate (p <0.05). The nonischemic strictures had better success rate (87.5%) compared to ischemic strictures (72.7%) without statistical significance. CONCLUSIONS: We would suggest the use of balloon dilation or endoureterotomy as the initial treatment of benign ureteral stricture regarding the safety and efficiency. The better outcome would be expected in the strictures shorter than 1cm in length.

Massive Inguinal Bladder Hernia into the Scrotum / 대한비뇨기과학회지

It is generally accepted that 1-3% of all inguinal hernias involve the bladder. However herniation of the bladder deep into the scrotum is rare. We report a case of massive bladder hernia of paraperitoneal type in a 58-year-old male with scrotal pain and palpable scrotal mass. Treatment consisted of partial cystectomy and herniorrhaphy. The postoperative result was good without complications.

Clinical Significance ad Asymptomatic Residual Renal Stone Fragments after Shock Wave Lithotripsy / 대한비뇨기과학회지

No abstract available.

A Case of High Flow Priapism / 대한비뇨기과학회지

High flow priapism is a nonischemic form of priapism. This results from unregulated, continuous arterial inflow to the lacunar spaces by trauma or idiopathic causes. It is clinically recognizable because the erection is painless and coporal aspiration yields bright red blood with a high pO2. We report a case of arterial high flow priapism secondary to perineal blunt trauma in 29-year-old man treated with embolization of cavernosal artery.

Comparison of Shock Wave Lithotripsy and Ureteroscopy as a Primary Therapy for Lower Ureteral Calculi / 대한비뇨기과학회지

PURPOSE: Controversy continues over the initial approach to lower ureteral calculi; in situ shock wave lithotripsy(SWL) versus ureteroscopy(URS). We compared the efficacy and the safety of each procedure to help determine which is more appropriate as initial management for lower ureteral calculi. MATERIALS AND METHODS: From May 1996 through August 1997, 70 patients had been treated at our department for lower ureteral stones. 35 patients underwent URS and 35 patients underwent SWL with SDS-3000. We retrospectively reviewed success rate of stone removal, complication rate, anesthesia and hospitalization. RESULTS: Patient age and stone size were similar in two groups. Stone free rates were 94.3% for URS, 57.1% after 1 session and 77.1% after 3 sessions of SWL. 2 cases of ureteral injuries were developed in URS group while there was no complication in SWL group. CONCLUSIONS: Regarding our results, SWL is safer than URS, but has lower stone free rate than URS. Although URS is more invasive procedure with higher complication rate, it has higher stone free rate. URS is indicated especially in patients who want to become stone-free as soon as possible.

376 Cases of Ureteroscopic Stone Removal / 대한비뇨기과학회지

PURPOSE: We retrospectively reviewed the cases of ureteroscopic stone removal at our institution to define the efficiency of ureteroscopy for treatment of ureteral calculi. MATERIALS AND METHODS: Ureteroscopic stone removal was performed in 376 cases of ureteral stone from August, 1989 to December, 1997. There are 241 males and 135 females, and mean age was 45.6 years. Nine stones were located in the upper ureter, 27 in the mid ureter, 340 in the lower ureter. The stone size was less than 5mm in 125 cases, from 5 to 10mm in 185 cases and more than 10mm in 66 cases. Ureteroscopy was performed with 9.5Fr, 10Fr or 12.5Fr rigid ureteroscope under spinal, general or epidural anesthesia. RESULTS: Overall success rate of ureteroscopic stone removal was 95.1 percent. The success rates of upper, mid and lower ureteral stones were 55.6, 88.9 and 97.1 percents, respectively. According to the stone size, the success rates was 97.6 percent in stones less than 5mm, 94.6 percent in stones of 5 to 10mm and 92.4 percent in stones more than 10mm. Over all complication rate was 9.6 percent. Complications consisted of severe ureteral mucosal tearing(20 cases), ureteral perforation(8 cases), gross hematuria(3 cases), infection(3 cases) and urethral stricture(2 cases). All complications were treated successfully with conservative treatment except 2 cases of urethral stricture that required visual urethrotomies. CONCLUSIONS: Ureteroscopic stone removal could offer rapid relief of obstruction and colic due to mid and lower ureteral calculi with high success rate and minimal complications.

Anatomic Factors that Affect Lower Caliceal Stone Clearance after Shock Wave Lithotripsy / 대한비뇨기과학회지

PURPOSE: Shock wave lithotripsy(SWL) has become the preferred modality of treatment for the most kidney stones. But there is a consensus that success rate of SWL is relatively poor for the lower caliceal stones. We assessed the influence of spatial anatomy of the lower calyx on stone clearance after SWL. MATERIALS AND METHODS: We retrospectively reviewed 92 patients with 5-20mm sized solitary lower caliceal stone who had undergone SWL between March 1992 and February 1998. The clearance rate at three months was compared according to lower pole anatomy, such as infundibulopelvic angle, infundibular length and infundibular width. RESULTS: Overall stone free rate was 59.8 percent. In 67 cases whose infundibulopelvic angle greater than 90 degree, stone free rate was 68.7 percent, whereas in 25 cases less than 90 degree, it was only 36.0 percent(p<0.05). In 36 cases whose infundibular length greater than 3cm stone free rate was 38.9 percent, whereas in 56 cases less than 3cm it was 73.2 percent(p<0.05). In 70 cases whose infundibular width greater than 5mm stone free rate was 57.1 percent, whereas in 22 cases less than 5mm it was 68.2 percent. CONCLUSIONS: The lower pole infudibulopelvic angle and infundibular length has a significant role in the stone clearance after SWL of lower caliceal stones. The infundibulopelvic angle less than 90 degree and infundibular length greater than 3cm are individually unfavorable factors. We believe that these anatomic factors have to be considered when the physician decides SWL as a first line treatment of lower caliceal stones.

Two Cases of Transitional Cell Carcinoma of the Bladder in Patient Younger than 20 Years Old / 대한비뇨기과학회지

Transitional cell carcinoma of the bladder in children and adolescents is extremely rare. In patients younger than 20, bladder cancer tends to express a well-differentiated histology and behave in a more indolent fashion. Younger patients appear to have a more favorable prognosis because they present more frequently with superficial and low-grade tumors, We report two cases of transitional cell carcinoma of the bladder in patient younger than 20 years old.

The Efficacy of Ureteral Stents in Shock Wave Lithotripsy of Medium Sized Renal Calculi / 대한비뇨기과학회지

PURPOSE: Although double-J ureteral stents are used prophylactically to reduce morbidity and complications following shock wave lithotripsy(SWL), the efficacy is still controversial. To evaluate the efficacy of urethral stunting in SWL of medium sized(1.5-2.5cm) renal calculi, we performed a randomized study. MATERIALS AND METHODS: We analysed the outcome of SWL in 46 patients with medium sized(1.5-2.5cm) solitary renal calculi. The study population was divided Into two groups, group 1 consisting of patients who had urethral stents before SWL(n=21) and group 2 of those who did not(n=25). Several variables, including complications, operation requirements and stone free rates, were evaluated. RESULTS: There were no statistical differences between group 1 and group 2 in the incidence of ureteral obstruction or steinstrasse(19% vs 20%), hospitalization (10% vs 16%), operation requirements(10% vs 12%) and stone free rate after 3 months(81% vs 76%). Of 21 patients with stunts, 4(19%) had urinary frequency or urgency and 4(19%) had dysuria. CONCLUSIONS: Regarding our results, placement of urethral stents would not be useful in SWL of medium sized renal calculi.

Complications of ureteroscopic stone removal / 대한비뇨기과학회지

We performed 113 ureteroscopies for stone removal in 110 patients between August 1989 and March 1992. The stones were removed successfully in 107 cases(94.7%) and complications occurred in l6 cases ( 14.2%). In 6 cases, we failed to remove ureteral stones due to inability to introduce ureteroscope at UVJ (one case). severe angulation of ureter (2 cases), inadequate illumination due to bleeding (one case) and upward migration of stones (2 cases). Complications consisted of tearing or ureteral mucosa (5 cases), ureteral perforation (5 cases), fever (2 cases). gross hematuria (2 cases) and infection (2 cases). There was no evidence of ureteral stricture on excretory urograms of 52 patients taken at 3 months postoperatively. Complication rate decreased according to accumulation or experience and it had no correlation with stone site or location. All complications were treated successfully with conservative measures. We conclude that ureteroscopic stone removal is a safe and effective method for treatment of mid-and lower ureteral stones.