Urinary Tract Fistula / 대한비뇨기과학회지

Ninety-six cases of urinary tract fistulas, which were admitted to Severance Hospital during the period from Jan. , 1960 to Dec. 1969, were analyzed clinically and statistically. They were investigated by comparing with previous papers. 1) The rate of urinary tract fistulas accounted for 2.4 per cent of the total admissions to the Urologic Department and 0.057 per cent of Obstetrics and Gynecologic Department during 10 years. Twenty-eight cases of all fistulas were in men and sixty-eight in women. The age distribution was much the same as that found in previous literature. The most common age was from 20~50 years with 91.7 per cent. 2) The most commonly involved site was the bladder with 64.5 per cent and the most common fistula type was vesicovaginal with 42.6 per cent of those involving bladder. 3) About forty-seven per cent of all fistulas occurred after previous pelvic operation, seventeen per cent due to carcinoma of pelvic organs and thirteen per cent due to abnormal delivery. Chemicals, radiation, infection, trauma, foreign body and stone of the urinary tract were listed frequently as an etiologic factors. 4) The incidence of ureteral injury during radical hysterectomy was variable in the literature, but it accounted for 10 per cent generally. Among the 10 per cent of ureteral injury, ureteral fistulas developed in 20 per cent of our cases, but in 12 per cent of Meig's. 5) There are many surgical approaches to repair urinary tract fistulas according to the surgeon's taste, fistula type, location, size or number, previous attempts and adhesion of surrounding tissues. No two fistulas are exactly alike, and surgical approach to any fistula must be well thought before the time of operation. The operation must be fitted to the fistula, not the fistula to the operation. 6) To repair urinary tract fistula is today a somewhat difficult problem, and the operative failure rate in our 41 cases of vesicovaginal fistula was 34.4 per cent.

Fractionated Cystogram in Bladder Tumors / 대한비뇨기과학회지

Temeliescu first demonstrated that bladder expansion could be evaluated by serial instillations of contrast medium. If bladder capacity is not exceeded, each instillation results in a symmetrical expansion of the normal bladder. When the muscular wall of the bladder is infiltrated by tumor, its capacity to expand is lost at the site of invasion. There are several methods of staging bladder tumors. To standardize the nomenclature and to facilitate the exchange of information, the I.U.C.C. had adopted a clinical stage classification. The value of a standardized classification is obvious. From a prognostic point of view one of the most important features is to determine if the tumor has invaded muscle. Careful bimanual examination under anesthesia will properly stage the tumor in about 80 per cent of cases. However, this degree of accuracy is only achieved by those seeing large numbers of bladder tumors. In certain instances, accurate staging of this disease is still a problem, which has led to the development of additional X-ray technique and non-operative means of more precisely staging the tumors. Angiography, double contrast barium cystography and perivesical gas insufflation have been used to visualized bladder tumors. However, these various techniques are of little assistance in determine the degree of invasion and, consequently, little additional information may be obtained, furthermore, certain techniques are distressing to the patient and are not without serious morbidity. Complications of angiography include hemorrhage, aneurysm formation, impaired vascular supply to the lower limbs and embolism. In addition these techniques require highly skilled personnel and elaborate equipment, thereby restriction their use. Fractionated cystography is a simple method of evaluating muscle invasion by a bladder tumor. It requires no complicated equipment and carries little or no morbidity. The time required for doing the procedure is little more than that for conventional cystograms. 10 cases of bladder tumors done fractionated cystography, which were admitted to our Urologic Department during Jan., 1970 to present, were reported. Utilizing a modification of Temeliescu's technique, we have been studying bladder tumors since Jan. 1970. They were investigated by comparing with previous papers.