Successful reinstitution of peritoneal dialysis after retroperitoneal nephroureterectomy / 대한내과학회지

Peritoneal dialysis is an important therapeutic option for patients with end-stage renal disease, and the peritoneal membrane is the lifeline for peritoneal dialysis patients. Therefore, strategies to maintain the health of the peritoneal membrane are very important. A 64-year-old female who had been undergoing continuous ambulatory peritoneal dialysis (CAPD) for the past 6 years was admitted because of painless gross hematuria. On abdominal computed tomography (CT), a mass was found in her left renal pelvis. A nephroureterectomy was performed via a retroperitoneal approach without any complications. Peritoneal dialysis was resumed 4 hours later. We report peritoneum-preserving nephroureterectomy via a retroperitoneal approach in a patient on CAPD.

Efficacy and Safety of Uro-Vaxom Treatment for Patients with Recurrent Cystitis: An Open Multicenter Study / 대한비뇨기과학회지

PURPOSE: We wanted to investigate the efficacy and safety of the immunotherapeutic Uro-Vaxom for treating uncomplicated recurrent cystitis in female patients only. MATERIALS AND METHODS: Adult female patients were enrolled in this multicenter, open-label study if they had acute cystitis at the enrollment visit and positive results on urine culture (> or =10(3)CFU/ml). The patients were treated for 3 months with one capsule daily of Uro-Vaxom after antibiotic therapy, and they were observed for another 3 months. The primary efficacy criteria were the cystitis recurrence rates over 6 months, the distribution of cystitis and the proportion of patients with cystitis. RESULTS: A total of 50 patients were evaluated. During the 6-month trial, the number of cystitis recurrences was significantly reduced in comparison with the 6-month pretrial period (on the average 0.64 as compared to 3.0 recurrences, respectively p<0.001). The incidences of frequency, urgency and dysuria remained low until the end of the trial. Uro-Vaxom was well tolerated: side-effects were mentioned by 8% of the 50 patients, and there was no case leading to treatment withdrawal. CONCLUSIONS: Uro-Vaxom significantly reduced the incidence of cystitis during the 6 months of this study, including the 3 months of treatment. These results demonstrate that Uro-Vaxom is a valuable agent for prophylaxis of recurrent cystitis.

Analysis of Risk Factors for Acute Urinary Retention after Non-urogenital Surgery / 대한비뇨기과학회지

PURPOSE: We performed this study to analyze the risk factors that are related to acute urinary retention in patients undergoing non-urogenital surgery. MATERIALS AND METHODS: We retrospectively analyzed the records of 127 patients who were referred to the urology department because of acute urinary retention after non-urogenital surgery at our institution between January 2004 and December 2005, and we also recuited 258 consecutive patients who were undergoing non-urogenital surgery at our institution during the same period as a control group. Multiple parameters were divided into patient factors, surgical factors and anesthetic factors, and these factors were analyzed using univariate and multivariate regression analyses between the non-retention and the retention groups. RESULTS: On the multivariate analysis, age(> or =50 years, p=0.037; odds ratio (OR)=2.8), gender(women, p=0.028; OR=2.5), comorbidity with diabetes mellitus(p=0.003; OR=5.8) were found to independently increase the risk of acute urinary retention. After re-adjustment for the patients' gender, age, body mass index, diabetes, hypertension, the inability to self-ambulate after the removal of a Foley catheter(p=0.001; adjusted odds ratio (AOR)= 3.8), the amount of intraoperative fluids(> or =4,000ml, p=0.017; AOR=4.8) were found to independently increase the risk of acute urinary retention. CONCLUSIONS: The possibility of acute urinary retention for patients undergoing non-urogenital surgery and who have these risk factors is high; therefore, carefully managing urination for the prevention of postoperative acute urinary retention is needed. It is also necessary to make doctors in other departments recognize the importance of this issue.

The Factors Affecting the Outcome after Medical Management of Vesicoureteral Reflux / 대한비뇨기과학회지

Purpose: We analyzed the outcome of medical management for children with vesicoureteral reflux (VUR) and we determined the factors affecting the outcome. Materials and Methods: We retrospectively reviewed the records of 37 patients (56 kidneys) who were diagnosed with VUR between 1995 and 2004. All the patients were maintained on prophylactic antibiotics and had regular follow up. The subjects were stratified according to the grade of reflux at the time of diagnosis into the low grade group (grade III or below) or the high grade group (grade IV or above), based upon the International Classification System. The effects of the reflux grade, the presence or absence of renal scar, the age at diagnosis, laterality of disease and gender on the improvement/resolution rate of VUR were analyzed. Results: The mean duration until resolution was 35 months. Improvement occurred in 48 kidneys, including resolution in 27 kidneys. The resolution rate was higher in the kidneys with low grade reflux than that in the kidneys with high grade reflux. The resolution rate was higher in kidneys without scar than that in the kidneys with scar. A significantly higher improvement rate was observed for the children diagnosed before 1 year of age than that for the children diagnosed after 1 year of age. Conclusions: The most significant factor determining the outcome of medical management for children with VUR is the reflux grade at diagnosis. Medical management is appropriate in the management of low grade VUR. It may also be a viable treatment option for high grade VUR in selected cases.

Prognostic Significance of E2F3 Expression in Bladder Cancer / 대한비뇨기과학회지

PURPOSE: E2F3 is important for cell cycle regulation and DNA replication. Recent studies have reported that members of the E2F family can play specific and diverse roles in the tumorigenesis of human malignancies, and the E2F3 expression appears to provide a growth advantage to tumor cells by activating cell proliferation in bladder tumors. We studied the prognostic significance of E2F3 expression in bladder cancer. MATERIALS AND METHODS: We examined the expression of E2F3 with using immunohistochemical staining in the tumor samples from 109 patients suffering with bladder cancer, and we analyzed the prognostic significance of E2F3 according to the grade, stage, recurrence and progression of bladder cancer. RESULTS: We found positive staining for E2F3 in 23 cases (21.1%). The E2F3 expression was correlated with the tumor stage (superficial vs. invasive, p<0.001) and the tumor grade (p=0.001). The E2F3 expression was not correlated with the recurrence and progression of superficial bladder cancer. CONCLUSIONS: In this study, our results showed that the E2F3 expression was observed in a portion of the bladder cancer specimens. These results suggest that E2F3 may contribute to the development of bladder cancer, but it may not play a role as a prognostic factor of bladder cancer.

Primitive Neuroectodermal Tumor of the Kidney / 대한비뇨기과학회지

Primitive neuroectodermal tumor (PNET), also referred to as extraskeletal Ewing's sarcoma, is a highly aggressive tumor, and it is seen typically in the soft tissues of the chest wall and paraspinal region but rarely arises in the kidney. A 27-year-old woman was presented with a left renal mass and underwent a radical nephrectomy. The pathological diagnosis was a primitive neuroectodermal tumor. Microscopically, there were sheets and lobules of cells with round to oval nuclei and coarse chromatin, as well as a Homer Wright rosette formation. Immunohistochemical analysis showed strongly positive staining of CD99 and negative staining of other neuroendocrine markers, such as synaptophysin and chromogranin.

Clinical Course after External Beam Radiation Therapy for Localized Prostate Cancer / 대한비뇨기과학회지

PURPOSE: External beam radiation therapy (EBRT) is a standard treatment modality for localized prostate cancer (PC), and its efficacy compares favorably to radical prostatectomy. We evaluated the outcomes of conventional EBRT for the clinically localized PC performed on patients during the last 9 years. MATERIALS AND METHODS: We retrospectively reviewed the data from 28 men who were treated with external beam radiation with curative intent at our institution from 1995 and 2002. The histologic diagnosis was established by transurethral resection or transrectal ultrasonography guided biopsy. There was no evidence of lymph node invasion or metastasis in all the patients. None of the patients were treated with hormonal therapy until they exhibited a clinical recurrence of their condition. The 4 field pelvic brick technique was used for a dose of 45 Gy or 50.4 Gy at 1.8 Gy per day during 5 to 6 weeks of treatment; after this, a small boost field was delivered (2.9 Gy per day) for a total dose of 66 to 70 Gy. PSA failure was defined according to the consensus guidelines of the American Society for Therapeutic Radiation Oncology. The mean follow- up was 31 months. RESULTS: The mean patient age at treatment was 70 years. The mean time to PSA nadir and the mean PSA at nadir were 13 months and 0.88 ng/ml, respectively. There were 8 (28.6%) biochemical failures and 1 clinical recurrence. The 36 and 60 months biochemical disease-free survival rates were 89% and 43%, respectively. Mild to moderate complications were observed in 25% of patients, but severe complications requiring intensive or surgical procedures were not observed. CONCLUSIONS: EBRT for localized PC is effective and safe. A greater number of cases and longer follow-up are required to provide more accurate baseline data on the PSA kinetics following EBRT in the Korean population.

Clinical Course after External Beam Radiation Therapy for Localized Prostate Cancer / 대한비뇨기과학회지

PURPOSE: External beam radiation therapy (EBRT) is a standard treatment modality for localized prostate cancer (PC), and its efficacy compares favorably to radical prostatectomy. We evaluated the outcomes of conventional EBRT for the clinically localized PC performed on patients during the last 9 years. MATERIALS AND METHODS: We retrospectively reviewed the data from 28 men who were treated with external beam radiation with curative intent at our institution from 1995 and 2002. The histologic diagnosis was established by transurethral resection or transrectal ultrasonography guided biopsy. There was no evidence of lymph node invasion or metastasis in all the patients. None of the patients were treated with hormonal therapy until they exhibited a clinical recurrence of their condition. The 4 field pelvic brick technique was used for a dose of 45 Gy or 50.4 Gy at 1.8 Gy per day during 5 to 6 weeks of treatment; after this, a small boost field was delivered (2.9 Gy per day) for a total dose of 66 to 70 Gy. PSA failure was defined according to the consensus guidelines of the American Society for Therapeutic Radiation Oncology. The mean follow- up was 31 months. RESULTS: The mean patient age at treatment was 70 years. The mean time to PSA nadir and the mean PSA at nadir were 13 months and 0.88 ng/ml, respectively. There were 8 (28.6%) biochemical failures and 1 clinical recurrence. The 36 and 60 months biochemical disease-free survival rates were 89% and 43%, respectively. Mild to moderate complications were observed in 25% of patients, but severe complications requiring intensive or surgical procedures were not observed. CONCLUSIONS: EBRT for localized PC is effective and safe. A greater number of cases and longer follow-up are required to provide more accurate baseline data on the PSA kinetics following EBRT in the Korean population.

A Fistula between Ileal Conduit and Iliac Artery after Radical Cystectomy with Ileal Conduit Urinary Diversion / 대한비뇨기과학회지

A radical cystectomy, including a pelvic lymphadenectomy, is a standard treatment for a muscle invasive bladder tumor, but it is considered a major operation, with serious complications, and most complications develop in the early postoperative period. After a radical cystectomy, with ileal conduit urinary diversion (ICUD), bleeding is a common and well known complication in the early postoperative period, but rare in the later period. Here we report a case of massive bleeding from an ileal conduit 3 months after a radical cystectomy, with ICUD, due to a rupture of the iliac artery pseudoaneurysm, which was treated by vascular suture of the right iliac artery.

Perforated Appendicitis Presenting as a Bladder Tumor in a 3 Year-Old Girl / 대한비뇨기과학회지

Large bladder masses in children are extremely rare pathological lesions. They can present as a gross hematuria, with irritable or obstructive voiding symptoms and a urinary tract infection. Their differential diagnosis must include for genitourinary malignancies, such as rhabdomyosarcoma, as well as benign inflammatory lesions. A case of a bladder mass in a three-year-old girl is reported, which was finally diagnosed as localized perforated appendicitis.

The Experience of Ureterorenoscopic Lithotripsy with Insertion of Ureterorenoscope between Two Safety Guide Wires Serving as an Access Port / 대한비뇨기과학회지

PURPOSE: Although ureterorenoscopic lithotripsy (URSL) is highly successful in urinary calculous disease, there are still several problems associated with the procedure, such as the difficulty in learning the procedure and the relatively high risk of ureteral injury. We performed an URSL, with the insertion of an ureterorenoscope between two safety guide wires, which served as an access port, without the need for ureteral dilatation (new URSL), and evaluated the usefulness and efficacy of this method by a comparison of our results with those of a series of conventional URSL. MATERIALS AND METHODS: Sixty-six ureteral stones (63 cases) were treated by a new URSL procedure. At the beginning of the procedure, two safety guide wires were inserted into the ureter. The ureterorenoscope was then inserted into the ureter between the safety guide wires. The outcomes were assessed, and compared to 140 cases of conventional URSL performed by the same operator. RESULTS: The overall success rate of the new URSL procedure was 98%. The mean operation time and postoperative hospital stay were 33 minutes (10-70min) and 1.4 days (1-6 day), respectively. Complications were observed in 5 cases (7.5%), and included, an ureteral perforation in 1 case, mild to moderate ureteral injury in 2, a gross hematuria in 1 (>48 hr) and flank pain in another. CONCLUSIONS: Based on our experience, the new URSL has several merits compared to the conventional procedure, such as no need for ureteral dilatation, easiness of the insertion of the ureterorenoscope into the ureter, prevention of upward migration of the stone during the procedure, and the better visual operation field. The new URSL procedure is relatively easy to perform, with few complications, and would, therefore, be an alternative to conventional URSL.

Prognostic Factors in Transitional Cell Carcinoma of the Renal Pelvis: Multivariate Analysis / 대한비뇨기과학회지

Purpose: This study was designed to assess the prognostic factors in patients with transitional cell carcinoma of the renal pelvis (renal pelvis tumor) using multivariate analysis. MATERIALS AND METHODS: Fifty six patients (43 males and 13 females), who were treated surgically for a renal pelvis tumor, were enrolled in this study. The traditional prognostic factors including age, sex, initial symptoms and duration, urine cytology, excretory urographic findings, location, method of surgical treatment, tumor stage, grade, size of tumor, and multiplicity were analyzed with respect to the disease recurrence and survival rate using an univariate log-rank test, Kaplan-Meier's survival curve and a multivariate Cox regression analysis model. RESULTS: The mean age of the patients was 58.9 years and the mean duration of follow up was 50.5 months. Recurrences occurred in 26 patients, and 9 patients died from cancer. On univariate analysis, the initial tumor stage (p=0.013) and tumor grade (p=0.023) are prognostic factors for the recurrence of a renal pelvis tumor, and the initial tumor stage (p<0.001), tumor grade (p=0.001), tumor size (p=0.013), multiplicity (p=0.034), and tumor recurrence (p=0.012) are prognostic factors for the tumor specific survival rate. However, on multivariate analysis, the initial tumor stage is a prognostic factor for tumor recurrence and survival. The interval between the initial surgery and recurrence is an important prognostic factor of the disease specific survival rate without statistical significance (p=0.067) CONCLUSIONS: The primary tumor stage is the only independent prognostic factor of both the disease recurrence and disease specific survival rate on multivariate analysis. The duration between the initial surgery and recurrence is an important prognostic factor of the disease specific survival rate. Further studies are necessary to clarify this result.

The Value of Tumor Size as a Prognostic Factor in Patients with Localized Renal Cell Carcinomas / 대한비뇨기과학회지

PURPOSE: In the TNM staging system of renal cell carcinomas, the tumor size has been considered an important prognostic factor in predicting the survival of patients with localized renal cell carcinomas. We tried to determine a size cutoff point that maximizes its value as a prognostic factor. MATERIALS AND METHODS: We reviewed the records of 70 patients who had undergone a radical nephrectomy for a renal cell carcinoma, and were pathologically classified as stage I (T1N0M0) and II (T2N0M0) carcinomas, based on the 1997 TNM staging system, between May 1987 and December 1998. Of the 70 patients, there were 50 men and 20 women, with a mean age of 52.4 years (range 35 to 78 years). The postoperative follow-ups ranged from 10 to 170 months, with a mean of 83 months. The survival curves were calculated by the Kaplan-Meier method at a 7cm cutoff point. The patients were divided into two groups for each size cutoff point from 2.5 to 9cm by 0.5cm intervals. The statistical significance of difference in 5-year survivals between the groups was calculated by log rank tests. RESULTS: Of the 70 patients, metastases occurred in 7 (5 lung, 1 brain and 1 liver and bone). From the analysis of survival based on tumor size, no statistically significant differences were noted between the size cutoff points. With a present tumor size cutoff point of 7cm, the Fuhrman nuclear grade (p=0.01) was the only statistically different factor between the two groups, with no statistical difference between the two groups for: patient age, sex, tumor histopathology or microscopic intrarenal vascular invasion. Although, there was a significant difference in the 5-year survival in the microscopic intrarenal vascular invasion (p=0.03) and the other prognostic factors. CONCLUSIONS: Tumor size had no significant influence on the survival of patients with localized renal cell carcinomas treated by a radical nephrectomy.

Renal Scarring in Surgically Treated Primary Vesicoureteral Reflux / 대한비뇨기과학회지

PURPOSE: We investigated the relationship of vesicoureteral reflux (VUR) and renal scarring in children who were treated surgically due to failure of initial medical management. MATERIALS AND METHODS: Thirty two children (51 renal units), 15 boys and 17 girls, aged 1-8 (median 3.2) years, with VUR were analyzed retrospectively. All children were initially treated with antibiotic prophylaxis for median 15.2 months (10-19 months). In 51 renal units, reflux grade at presentation was grade II in 8, III in 14, IV in 25 and V in 4. Renal scars were evaluated with dimercaptosuccinic acid (DMSA) scan and classified into three grades. We analyzed the incidence and severity of renal scar according to various clinical characteristics and discussed the optimal treatment in vesicoureteral reflux with respect to the development of renal scar. RESULTS: DMSA scan revealed that 69% (35/51) of the renal units had renal scars. Scarring at presentation was grade I in 10, II in 20 and III in 5 renal units. The incidence of renal scar was 86% at ages less than 2 years, 72% at ages 2 to 5 and 27% at ages greater than 5, of which the difference was statistically significant. And the incidence of renal scar according to the reflux grade was 38% in II, 50% in III, 84% in IV and 100% in V, of which the differnce was also statistically significant. However, the sex and laterality did not affect the incidence of renal scar in this study. With respect to the scar grade, the grade of refux was the only statistically significant determining factor. Especially, grade IV reflux resulted in much more severe scarring than grade III reflux. Comparing the result of DMSA scan at presentation with that just before operation in 13 children (18 renal units), only two renal units with grade IV reflux showed increase in renal scar. CONCLUSIONS: The most important factor to affect the development and severity of renal scar was the reflux grade. Considering relatively higher incidence of renal scar and more severe scarring in grade IV reflux than grade III reflux, early surgical management may be a possible option in the treatment of children with grade IV reflux.

Genetic Susceptibility of CYP1A1 and GSTM1 to the Risk for Korean Bladder Transitional Cell Carcinoma / 대한비뇨기과학회지

No abstract available.

Genetic Susceptibility of CYP1A1 and GSTM1 to the Risk for Korean Bladder Transitional Cell Carcinoma / 대한비뇨기과학회지

No abstract available.

Effects of Human Recombinant Interferon-Gamma and Tumor Necrosis Factor-Alpha on Expressions of Matrix Metalloproteinases and Their Activity Human Bladder Cancer Cell Lines / 대한비뇨기과학회지

No abstract available.

Effects of Human Recombinant Interferon-Gamma and Tumor Necrosis Factor-Alpha on Expressions of Matrix Metalloproteinases and Their Activity Human Bladder Cancer Cell Lines / 대한비뇨기과학회지

No abstract available.

The Significance of Renal Pelvic Diameter in the Neonates with Congential Ureteropelvic Junction Obstruction / 대한비뇨기과학회지

No abstract available.

Radiologic Findings of Renal Hemangioma: Report of Three Cases

Renal hemangioma is an uncommon benign tumor which usually causes painless or painful gross hematuria. Its preoperative diagnosis is extremely difficult or even impossible. We experienced three cases of renal hemangioma, located mainly at the pelvocalyceal junction or in the inner medulla. US demonstrated variable echogenecity, and CT revealed a lack of significant enhancement. Where there is gross hematuria in a young adult, especially when the renal mass located in the pelvocalyceal junction or inner medulla shows little enhancement on CT, renal heman-gioma should form part of the differential diagnosis.