Urothelial Tumors of the Urinary Bladder in Two Adolescent Patients: Emphasis on Follow-up Methods

Here we describe two cases of papillary urothelial neoplasm of low malignant potential in adolescent boys. One case was a 16-year-old boy with a polypoid mass beside the right ureteral orifice and the other case was a 13-year-old boy with a papillary mass beside the left ureteral orifice. The initial presentation was hematuria in both cases and the bladder mass was detected by ultrasonography. Complete resection of the bladder tumor was performed by using an 11-Fr pediatric resectoscope. Follow-up has been performed with urine analysis, urine cytology, and bladder ultrasonography or cystoscopy every 3 months with no evidence of recurrence.

Factors Affecting the Outcome of Extracorporeal Shock Wave Lithotripsy for Unilateral Urinary Stones in Children: A 17-Year Single-Institute Experience

PURPOSE: Extracorporeal shock wave lithotripsy (ESWL) is a first-line treatment for pediatric urinary stone disease. We aimed to determine the factors affecting the outcome of ESWL for unilateral urinary stones in children. MATERIALS AND METHODS: A total of 81 pediatric patients aged 0 to 16 years with urinary stones treated by ESWL from January 1995 through May 2012 were retrospectively reviewed. All patients were required to have unilateral urinary stone disease. Children who underwent other surgical procedures before ESWL were excluded. Outcomes evaluated after ESWL were the stone-free rate at 3 months after ESWL, success within a single session, and success within three sessions. Factors affecting the success within three sessions were also analyzed. RESULTS: The final analysis was for 42 boys and 22 girls (mean age, 9.2+/-5.2 years). Of these 64 patients, 58 (90.6%) were treated by ESWL without other surgical procedures and 54 (84.4%) were successfully treated within three ESWL sessions. In the multivariate analysis, multiplicity (odds ratio [OR], 0.080; 95% confidence interval [CI], 0.012 to 0.534; p=0.009) and large stone size (>10 mm; OR, 0.112; 95% CI, 0.018 to 0.707; p=0.020) were significant factors that decreased the success rate within three ESWL sessions. CONCLUSIONS: Most of the pediatric urinary stone patients in our study (90.6%) were successfully treated by ESWL alone without additional procedures. If a child has a large urinary stone (>10 mm) or multiplicity, clinicians should consider that several ESWL sessions might be needed for successful stone fragmentation.

Efficacy and Safety of Propiverine in Children with Overactive Bladder

PURPOSE: Antimuscarinic therapy remains one of the most common forms of therapy for overactive bladder (OAB) in children. However, few clinical studies on the outcomes of antimuscarinics in children with OAB have been published. Therefore, we evaluated the efficacy and safety of propiverine, which is frequently prescribed for the treatment of pediatric OAB. MATERIALS AND METHODS: We retrospectively reviewed children with OAB treated with propiverine within the past 5 years. The response rates were compared between the non-urge incontinence (non-UI) and urge incontinence (UI groups). The cumulative response rate by treatment duration was also compared between the two groups. RESULTS: Among a total of 68 children, 50 children (73.5%) experienced UI. The overall response rate was 86.8%. Functional bladder capacity after treatment was 150 ml, which represented an increase compared with the value (140 ml) before treatment. The voiding frequency per day decreased from 14.0 to 8.5 times. The overall response rate (88.0%) in the non-UI group was not significantly different from that seen in the UI group (83.3%; p>0.05). In non-UI children, the cumulative response rates were 36.0%, 54.0%, 68.0%, 74.0%, 76.0%, and 78.0% at 4, 8, 12, 16, 20, and 24 weeks, respectively. The cumulative response rates in the UI children were 11.1%, 33.3%, 44.4%, 50.0%, 50.0%, and 55.6%, respectively during the same respective time periods. Adverse effects were identified in only two (2.9%) patients, and neither case was severe. CONCLUSIONS: Propiverine is effective and well tolerated as a treatment for children suffering from OAB with or without UI.

Difference in Results of Ultrasonography and Diuretic Renograms after Pyeloplasty in Children with Unilateral Ureteropelvic Junction Obstruction

PURPOSE: Controversies persist on pyeloplasty follow-up, and the aim of this study was to assess the differences and interpretations in results of postoperative ultrasonography and diuretic renograms. MATERIALS AND METHODS: The study population consisted of 46 patients who underwent pyeloplasty between 1997 and 2003. The average patient age was 7.0 months (range, 2-36 months). Serial changes in hydronephrosis were evaluated by consecutive ultrasonography at 1, 4, 10, and 24 months after pyeloplasty, and a diuretic 99mTc-MAG3 renal scan was performed 4 months after the surgery. RESULTS: Ultrasonography showed that 11 (24%), 27 (59%), 35 (76%), and 39 (89%) patients had improved in hydronephrosis at 1, 4, 10, and 24 months after pyeloplasty, respectively. Diuretic renal scans showed that of 27 patients who showed improvements in hydronephrosis at 4 months after pyeloplasty, only 17 (63%) had improved excretion and 22 (81%) had preservation of different renal function (DRF). Among 19 patients with persistent or worsened hydronephrosis, 10 (53%) had improved excretion and 13 (68%) had preserved DRF. CONCLUSIONS: The results of ultrasonography and diuretic renal scan studies can differ in the same case after pyeloplasty. We recommend that improvements in hydronephrosis be assessed individually by ultrasonography, renal scans, and clinical status to determine surgical outcomes.

A Multicenter Prospective Study of the Effect of Imipramine and Desmopressin on Arousability in Children with Nocturnal Enuresis / 대한비뇨기과학회지

PURPOSE: We performed a multicenter, prospective study to evaluate the efficacy of imipramine and desmopressin to improve arousability and prevent nocturnal enuresis(NE). MATERIALS AND METHODS: The total of 48 children with NE were given questionnaires that included a scoring system for the assessing arousal from sleep. They were assigned into two groups: group 1(imipramine 25 mg, 3 girls and 16 boys, mean age 7.9 years), group 2(desmopressin 0.2 mg, 9 girls and 9 boys, mean age 7.5 years). The assessment of arousability was repeated 2 weeks and 4 weeks after medication. Eleven children were excluded because of incomplete data. RESULTS: Mean wetting events in group 1 decreased from 8.8 to 5.1 times(2 weeks) and 3.0 times(4 weeks)(p=0.009) versus 10.2 to 5.5 times(2 weeks) and 6.4 times(4 weeks)(p=0.007) for group 2. The mean threshold of arousability in group 1 was 4.9(baseline), 4.4(2 weeks), and 3.7(4 weeks), and, for group 2, 5.1(baseline), 4.8(2 weeks), and 4.8(4 weeks). The two groups were not different(p=0.14, p=0.73). CONCLUSIONS: Imipramine and desmopressin, which are commonly used in treating NE in Korea, influenced wetting events but not arousability.

The Prevalence and Risk Factors of Overactive Bladder in Korean Children: A Comparative Analysis according to Definition / 대한비뇨기과학회지

PURPOSE: We wanted to estimate the prevalence and risk factors of overactive bladder(OAB) in Korean children who were 5-13 years of age, according to the definition of OAB. MATERIALS AND METHODS: A randomly selected cross-sectional study was conducted on 26 kindergartens and 27 elementary schools nationwide in Korea. There were 19,240 children; a parent was asked to complete the questionnaires, which included items about OAB and the children's voiding and defecating habits. OAB was defined as urgency with or without urge incontinence, and usually with an increased daytime frequency and nocturia(ICCS 2006, group A) or an increased daytime frequency(>8 times/day) and/or urge urinary incontinence with or without urgency (group B); its prevalence and associated factors were investigated. RESULTS: The response rate for the questionnaires was 85.84%. The overall prevalence of OAB was 16.59%(group A) and 18.79%(group B). For groups A and B, the prevalence of OAB decreased with age from 22.89% to 12.16% and from 40.44% to 9.60%, respectively(p=0.0001). The overall rate of wet and dry OAB was 26.97% and 73.03%, respectively. Compared to the normal group, the children with OAB had a higher prevalence of nocturnal enuresis(NE), constipation, fecal incontinence, a history of urinary tract infection and delayed bladder control in both groups A and B(p<0.05). The rate of increased daytime frequency and urge incontinence were 3.69% and 2.31%(p=0.009), and 26.97% and 14.78%(p=0.0001) in group A and for the non-OAB children, respectively; their prevalence in group A decreased with age from 5.04% to 3.06% and from 45.74% to 18.50%, respectively(p=0.0001). CONCLUSIONS: The overall prevalence of OAB in group A for Korean children 5-13 years of age was similar to that in group B. However, the range of prevalence in group B was much more variable than that in group A. NE, constipation, fecal incontinence, a history of urinary tract infection and delayed bladder control may be risk factors for OAB in children.

Feasibility of Testis-sparing Surgery for Testicular Tumors in Children / 대한비뇨기과학회지

PURPOSE: We assessed the feasibility of testis-sparing surgery in children with testicular tumors. MATERIALS AND METHODS: Twenty-five pediatric patients who had a testicular tumor were enrolled for retrospective analysis. Testis-sparing surgery was planned in the cases with clinical features that preoperatively suggested the tumors to be benign, which was later determined intraoperatively by frozen section examination. The preoperative-fetoprotein (AFP) and transscrotal ultrasound (US) were evaluated along with the final pathology. We reviewed the immediate and late surgical complications, as well as the tumor recurrence after surgery. RESULTS: Teratoma, epidermoid cyst, yolk sac tumor, and Leydig cell tumor accounted for finding in 40%, 32%, 24%, and 4% of the patients, respectively. Based on the preoperative US, 18 patients had benign-looking tumors. According to the age-matched AFP references, 17 patients showed normal ranges preoperatively. Out of 14 patients, whose US and AFP level suggested the tumors to be benign, 10 (71.4%) were eligible for testis- sparing surgery on retrospective review. Testis-sparing surgery was performed in 5 patients, who showed the same pathology in frozen sections (3 epidermoid cysts, 2 teratomas). None of the 5 patients exhibited perioperative complications, and no recurrence or atrophy was observed at a mean follow-up of 39.8 months. CONCLUSIONS: Out of 14 patients, whose US and AFP analyses were available, 10 (71.4%) were eligible for testis-sparing surgery. Testis-sparing surgery was done in five out of the 10 patients without any complication or recurrence. Testis-sparing surgery is a feasible option in children with testicular tumors if the AFP level is within a normal range and the US suggests benign characteristics.

Experience of Subureteral Polydimethylsiloxane Injection Treatment in Children with Vesicoureteral Reflux / 대한비뇨기과학회지

PURPOSE: Our data was retrospectively reviewed to assess the efficacy, safety and costs of endoscopic subureteral polydimethylsiloxane (PDS, Macroplastique(R)) injection treatment for children with vesicoureteral reflux (VUR). MATERIALS AND METHODS: Between December 1997 and May 2006, a total of 24 (29 renal units) VUR patients, whose parents showed reluctance toward open surgery, underwent subureteral PDS injection treatment. All of the patients were postoperatively assessed by voiding cystourethrography (VCUG) and ultrasound to evaluate any complications and reflux. The medical costs of the injection treatment were compared with those of open surgery for VUR over the same period. RESULTS: The mean follow-up was 15 months (range 2-72). Of the 29 renal units treated, 24 (82.8%) were cured. Hydronephrosis, which postoperatively developed in three renal units, was spontaneously improved or resolved after minimal endourological procedures. Temporary gross hematuria and voiding difficulty occurred in one patient each, but were also improved. The total medical costs of the injection treatment were cheaper than those of open surgery (p<0.05). CONCLUSIONS: An endoscopic subureteral PDS injection is an effective and safe procedure; in addition, compared to open surgery, is an economic treatment for children with VUR.

Urachal Anomalies in Children: A Proper Approach and Treatment Based on the Recent Ten-year Experience / 대한비뇨기과학회지

PURPOSE: To establish the proper approach and management of an urachal anomaly in children. MATERIALS AND METHODS: We retrospectively reviewed the medical records and imaging studies of 33 children (21 boys, 12 girls) treated for an urachal anomaly over a ten-year period. RESULTS: Twenty-four patients were equally diagnosed with either an urachal sinus or urachal cyst; the other nine patients were confirmed to have a patent urachus. Umbilical discharge (14 patients) and umbilical granuloma (9 patients) were the most common presentations. The 12 patients with an urachal sinus underwent ultrasonography (USG) (10; diagnostic), 2 fistulography (all; diagnostic). Those with an urachal cyst underwent either USG (6/12; diagnostic), computed tomography (CT) (3; diagnostic), fistulography (2; diagnostic), or magnetic resonance imaging (MRI) (1; diagnostic). One subject was affected by acute appendicitis, which was confirmed by CT. Of the 9 children with patent urachus, 7 underwent USG (all; diagnostic); exploration without further imaging studies was performed on the remaining 2 subjects. Surgical excision was performed in 30 patients. Omphalomesenteric duct or Meckel's diverticulum were incidental findings, which were simultaneously repaired. Conservative treatment was successful in only 3 patients. CONCLUSIONS: Urachal anomalies in children mainly manifest as umbilical discharges and umbilical granuloma, but may present non-specific symptoms in some cases. USG is a useful method for diagnosis, but other imaging modalities can be useful to establish the differential diagnosis. A limited number of children with urachal anomalies, mainly presenting with an umbilical discharge, can be managed conservatively. However, complete surgical excision of the lesion, with the possible associated anomalies, should be the basic scheme for children with urachal anomalies.

Guidelines for the Management of Hydronephrosis Detected in the Perinatal Period

PURPOSE: Neonatal hydronephrosis is diagnosed with an incidence of 4.5-7% of pregnancies. Recently, early detection of neonatal hydroneprosis with antenatal ultrasonography has become possible. But consensus about its management has not been reached, especially concerning surgical intervention. The purpose of this study is to analyze the natural course of neonatal hydronephrosis and to determine the guideline of surgical intervention and follow up study. METHODS: Sixty nine hydronephrotic kidneys were confirmed from April 2001 to April 2005. All cases were rechecked by ultrasonography once at least and had a minimum follow-up of 6 months. We classified the patients into 4 groups according to the anterior posterior pelvic diameter(APPD) on perinatal ultrasonography. Ultrasonography to measure the APPD diameter and Society for Fetal Urology(SFU) grade, (99m)Tc-MAG3 scan were done to a set protocol. Pyeloplasty was performed according to the protocol. RESULTS: Pyeloplasty was not needed in most cases where the APPD was below 10 mm and where the SFU grade were less than grade 3. Many cases with APPD 10 mm above or SFU grade III above had undergone pyeloplasty. We found a correlation between obstruction grade on MAG3 scan and whether surgery was performed or not. CONCLUSION: If APPD is above 10 mm, SFU grade is above grade 3 or urinary tract obstruction is suspected by MAG3 scan, pyeloplasty must be considered. In cases where APPD is below 10mm and SFU grade is less than grade 3, we can observe the natural course of neonatal hydronephrosis with consecutive follow-up.

Guideline for the Surgical Diagnosis and Treatment of Nonpalpable Testis Based on Experiences with Laparoscopic Procedure / 대한비뇨기과학회지

PURPOSE: We assessed our laparoscopic experiences for the children with nonpalpable testis to evaluated the advantages of performing laparoscopy and we suggest a surgical management guideline for them. MATERIALS AND METHODS: We retrospectively reviewed the medical records of a total of 83 children (97 testes) who underwent diagnostic laparoscopy for nonpalpable testes. We analyzed the surgical decisions and outcomes according to the laparoscopic findings. RESULTS: On the laparoscopic examination, 48 (49.5%) testes were located in the abdominal cavity. We subsequently performed inguinal orchiopexy (28), laparoscopic orchiopexy (8), Fowler-Stephens orchiopexy (10, one or two stage), or orchiectomy (2). The other 40 (41.2%) were suspected to be testicular nubbin, and we managed this by excision of the testicular nubbin by the inguinal (29) or scrotal (10) approach, except for one viable testis in the inguinal canal. When blind-ending vessels were observed, we stopped the procedure under the diagnosis of vanishing testis in 9 cases (9.3%). The testicular survival rates were 92.6% (25/27) for inguinal orchiopexy, 100% (8/8) for laparoscopic orchiopexy and 60% (6/10) for Fowler-Stephen orchiopexy. CONCLUSIONS: We preferred laparoscopic orchiopexy for treating intraabdominal testis when the location was > or=2.5cm from the internal ring. When the testicular location was closer to the internal ring, we recommend inguinal orchiopexy as a viable option. In cases with high riding testis or very short internal spermatic vessels, we recommend Fowler-Stephens orchiopexy. For the suspected testicular nubbin, we preferred trans-scrotal excision when the nubbin was identified in the scrotum. Otherwise, we recommend inguinal exploration.

New Application of the Partial Unilateral Ureteral Obstruction in Neonatal Rat Model / 대한비뇨기과학회지

PURPOSE: An ureteropelvic junction obstruction, which often leads to a partial ureteral obstruction, is the most common cause of neonatal hydronephrosis. The development of an experimental model for representing a neonatal partial ureteral obstruction is mandatory for the investigation of the pathophysiology and natural course of neonatal hydronephrosis. The applicability of a partial unilateral ureteral obstruction was tested in neonatal rat model. MATERIALS AND METHODS: Ninety eight newborn Sprague-Dawley rats (mean age: 5.9 days) were subjected to a partial (n=72) or a complete (n=26) unilateral ureteral obstruction. The partial unilateral ureteral obstruction was made by the surgical technique of embracing the ureter with sterilized polyethylene tubing (PE50). The complete unilateral ureteral obstruction was performed by suture ligature of the upper ureter. The degree of obstruction was evaluated by antegrade pyelography and gross findings of the kidneys on the postoperative 2nd and 5th days as well as the postoperative 1st, 2nd, 4th and 6th weeks, respectively. RESULTS: The overall mortality rate was 19.4%. The mortality rates of the partial and complete obstructions were 22.2 and 11.5%, respectively. The overall success rate of the partial unilateral ureteral obstruction was 52%. The success rate of a partial unilateral ureteral obstruction in a week (63%) was higher than that after more than two weeks (38%). CONCLUSIONS: This model of a partial unilateral ureteral obstruction in neonatal rats is simple, safe and reproducible. This partial unilateral ureteral obstructive model would be applicable in neonatal rats, especially for short term studies.

Behavioral and Emotional Problems in Children with Nocturnal Enuresis: Results of a Multicenter Study / 신경정신의학

OBJECTIVES: The aim of this study was to examine the behavioral and emotional problems associated with nocturnal enuresis in Korean children. METHODS: Three hundred eighteen children with nocturnal enuresis, together with their parents, completed the Child Behavior Checklist (CBCL), Disruptive Behavior Disorder Scale according to DSM-IV (DBDS), Children's Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC), and Piers-Harris Children's Self-Concept Scale (PHCSC). Ninety-three normal students were selected as the control group. RESULTS: Compared to the normal control group, the mean scores with regard to the withdrawn, social problems, attention problems, delinquent behavior, aggressive behavior, externalizing problems and total problems profiles were significantly higher in the nocturnal enuresis group according to the CBCL results. The nocturnal enuresis group also scored significantly higher in the ADHD and ODD profiles of the DBDS. The nocturnal enuresis group was more depressed and anxious than the control group according to the results of the CDI and STAI. The mean score of the PHCSC was significantly lower in the nocturnal enuresis group when compared to the normal control group. CONCLUSION: The results of this study suggest that children with nocturnal enuresis in Korea have clinically relevant behavioral and emotional problems. The findings support the link between nocturnal enuresis and psychopathology in Korean children.

Comparison of the Surgical Outcome between Onlay Island Flap and Tubularized Incised Plate Urethroplasty in Hypospadias Repair / 대한비뇨기과학회지

PURPOSE: The onlay island flap and tubularized incised plate (TIP) urethroplasty commonly preserve the urethral plate during each procedure, but there is a dearth of comparative data. Thus, we retrospectively reviewed our clinical data to compare the surgical outcome of the onlay and TIP urethroplasty for hypospadias correction. MATERIALS AND METHODS: We performed onlay urethroplasty in 23 patients and TIP urethroplasty in 28 patients between 1995 and 2002. The age at the time of surgery, operation time, postoperative complications, and the duration for the development of complications in each procedure were compared. RESULTS: Among the 28 cases of TIP urethroplasty, 21 were primary, 6 were secondary, and the last case was a tertiary repair, while all of the 23 cases of onlay urethroplasty were primary (age range: 8 month to 11 year). The most common complication in both procedures was urethrocutaneous fistula. Residual curvature was more common in the onlay urethroplasty group. Delayed complications, which developed later than 6 months after surgery, were 30% in both groups. The success rate was similar between the two groups, but the TIP urethroplasty group illustrated a significantly shorter operation time than the onlay group. CONCLUSIONS: The most common complication was fistula in both the onlay and TIP urethroplasty groups. Even though the success rate was similar in both groups, the operation time of the TIP urethroplasty group was shorter than that of the onlay group. Also, the TIP urethroplasty procedure resulted in more acceptable cosmetic results including a slit like neourethral meatus.

Normal Size of Fetal Kidneys: Sonographic Measurements / 대한산부인과학회잡지

OBJECTIVE: To establish size ranges of normal fetal kidneys by ultrasonogram during pregnancy. METHODS: The A-P diameter and length of each of 450 kidneys in 225 consecutive fetuses between 19 and 41 weeks of gestation were measured on sonogram from March to August 2001 in Samsung Medical Center. Gestational ages were determined by last menstrual period and Crown-Rump Lengths of early stage of pregnancy. Abnormal fetuses, twins, offspring of diabetic mothers, and fetuses with renal pelvic dilatation of 5 mm or greater were excluded to avoid any questionable measurements. RESULTS: The results showed normal distribution and results were similar to previous reports. There was a strong correlation between fetal renal size and gestational age, but no significant difference between right and left renal sizes in fetuses. Average A-P diameter and renal lengths were significantly different when compared across the range of gestational ages (p<.001). CONCLUSION: As long as we know, this was the first report of size of the normal fetal kidney sonographically during pregnancy in Korea. We think that these results can be used to detect abnormality of fetal kidney and to estimate uncertain gestational age.

Additional Treatment of Enuresis Alarm for Partial Responders to Oral Desmopressin in Enuretic Children / 대한비뇨기과학회지

PURPOSE: We evaluated the additional effect of an enuresis alarm therapy for the partial responders to oral desmopressin in children with monosymptomatic nocturnal enuresis. MATERIALS AND METHODS: A total of 28 nocturnal enuretic children (male:female, 20:8), aged from 5 to 15 years old, were treated with oral desmopressin. After 10 weeks, the short-term effectiveness of oral desmopressin was evaluated. The full responders (enuretic episode1 time/week) (group DA). The medication was continued until the patient showed complete night-time dryness for a whole month. We also followed the long-term responses of these two groups after all the treatments were finished. RESULTS: Fourteen patients were assigned to group A, and the other fourteen to group DA. There was no significant difference between the two groups with regard to mean age and number of wet nights per week before treatment. During the initial short-term follow-up, the mean wet nights per week decreased from 6.60 to 0.25 in group D, and from 5.60 to 2.35 in group DA (p<0.05). Ninety-two percent (13/14) of the patients achieved complete dryness in each group on the long-term follow-up. During the study period, the enuretic episodes recurred in one patient from each group. CONCLUSIONS: The addition of an enuresis alarm treatment for the partial responders to oral desmopressin showed an excellent response, with a similar long term cure rate as for the full responders. Therefore, an enuresis alarm treatment could be a reasonable second line modality for partial responders to oral desmopressin.

Analgesic Effect of Ilioinguinal Nerve Block and Wound Irrigation Using Bupivacaine after Ambulatory Inguinoscrotal Surgery in Children / 대한비뇨기과학회지

PURPOSE: A simple and safe method for postoperative analgesia is required for children, especially with ambulatory surgical procedures. This study aimed to investigate the analgesic effects of ilioinguinal nerve block, and wound irrigation using bupivacaine, compared with those in control after inguinoscrotal operation. MATERIALS AND METHODS: Of 57 patients who underwent unilateral hydrocelectomy or orchiopexy, at our ambulatory surgery center, patients were randomly selected for ilioinguinal nerve block (group 1, n=19) or wound irrigation (Group 2, n=19) using bupivacaine. Normal saline was injected, or irrigated, into the control group (n=19). The analgesic effects were evaluated using the Oucher scale, every 30 min for 3h, and then at 6, 12 and 24h postoperatively, and the number of additional oral analgesic intakes recorded during the period. RESULTS: All three groups were similar in age, type of procedures and duration of the operation or anesthesia. The pain scores were significantly lower in groups 1 and 2 compared to the control, and the pain score, 30 min after the operation, was significantly lower in group 2 than in group 1 (p=0.025, p=0.001 and p=0.045, respectively). Although the pain scores between the 3 groups showed no significantly difference following the procedure, a relatively higher pain score was noted in the control group after 150 min. In groups 1 and 2, there was a lesser number of analgesic intakes than required by the control, although this was not significantly different. CONCLUSIONS: In ambulatory inguinoscrotal surgery, ilioinguinal nerve block, or wound irrigation, using bupivacaine, demonstrated similar analgesic effects in children. Wound irrigation was more effective than nerve block at 30 min postoperatively. Based on these data, wound irrigation or nerve block, using bupivacaine, with the addition of oral analgesics, will minimize the postoperative pain of ambulatory inguinoscrotal surgery in children.

Histological Changes of the Cryptorchid Testis According to the Age / 대한비뇨기과학회지

PURPOSE: To obtain fundamental data for the ideal timing of an orchiopexy, we evaluated the histological findings of the cryptorchid testis based on the childrens age. MATERIALS AND METHODS: A total of 53 patients underwent orchiopexy and testis biopsy. Thirty eight patients with unilateral inguinal cryptorchid testis were divided into 4 groups based on their age; 4 yrs (n=7). The other groups included patients having intraabdominal testis (n=5), bilateral inguinal cryptorchid testis (n=7) and other accompanied diseases with cryptorchid testis (n=3). We measured all the testicular size and analyzed the following histological parameters; mean tubular diameter (MTD), mean tubular fertilization index (MTFI), germ cell count (GCC), Sertoli cell index (SCI) and interstitial cell fibrosis (ICF). RESULTS: In patients younger than 1 year, all the histological parameters such as MTD, MTFI, GCC, SCI and ICF were better than those of patients older. In all patients less than 2 years of age, the testicular size was smaller (p=0.068) but the histological parameters such as MTFI (p=0.011) and GCC (p=0.012) were significantly superior to those of patients older than 2 years. Most of the bilateral inguinal (n=6/7) and intraabdominal cryptorchid testis (n=3) exhibited a significantly lower MTFI and GCC than the age-matched unilateral inguinal cryptorchid testis. CONCLUSIONS: Orchiopexy should be performed within the first 2 years of age in order to prevent significant histological degeneration. Moreover, early orchiopexy is preferred during the first year of life. In particular, based on our limited data, earlier orchiopexy should be considered in patients with bilateral inguinal or intraabdominal cryptorchid testes.

The Role of Neoadjuvant Chemotherapy for Advanced Stage Wilms Tumor

PURPOSE: This study was designed to exclude radiation in advanced(stage 3, 4) Wilms tumor (WT) by increasing the chance of complete surgical removal with preceding neoadjuvant chemotherapy, thereby reducing the incidence of late effects. METHODS: Between December 1998 and July 2002, we conducted neoadjuvant chemotherapy after needle aspiration biopsy on patients who had advanced WT. If needle biopsy was accessible, we conducted neoadjuvant chemotherapy(vincristine, adriamycin, dactinomycin) for 12 weeks and then performed surgical removal, excluded radiation therapy and conducted postoperative chemotherapy (vincristine, dactinomycin+/-adriamycin). In other cases, we firstly conducted the operation and then performed radiation and postoperative chemotherapy. RESULTS: Of the 17 patients diagnosed as WT, 12 patients had an advanced stage of disease. In two of the 12 patients, initial surgical removal was conducted. The median age of patients was 21 months(5-103 months). Of the 10 the patients who received neoadjuvant chemotherapy, eight patients were stage 1, one patient was stage 2, and the other was stage 3 at operation. In nine patients except one with stage 3 disease, we could perform complete surgical resection and there fore could omit radiation. In four cases we could also exclude adriamycin after operation. All but one patient was alive, disease-free, for a median follow-up of 21 months(9-43 months). CONCLUSIONS: After neoadjuvant chemotherapy, we could increase the chance of complete tumor resection, exclude radiation and decrease the intensity of postoperative chemotherapy in selected cases. Long term follow-up is needed to determine whether our method would significantly decrease late effects.

Unenhanced Spiral CT in Acute Ureteral Colic: A Replacement for Excretory Urography?

OBJECTIVE: To compare the usefulness of unenhanced spiral CT (UCT) with that of excretory urography (EU) in patients with acute flank pain. MATERIALS AND METHODS: Thirty patients presenting with acute flank pain under-went both UCT and EU. Both techniques were used to determine the presence, size, and location of urinary stone, and the presence or absence of secondary signs was also evaluated. The existence of ureteral stone was confirmed by its removal or spontaneous passage during follow-up. The absence of a stone was determined on the basis of the clinical and radiological evidence. RESULTS: Twenty-one of the 30 patients had one or more ureteral stones and nine had no stone. CT depicted 22 of 23 calculi in the 21 patients with a stone, and no calculus in all nine without a stone. The sensitivity and specificity of UCT were 96% and 100%, respectively. EU disclosed 14 calculi in the 21 patients with a stone and no calculus in eight of the nine without a stone. UCT and EU demon-strated secondary signs of ureterolithiasis in 15 and 17 patients, respectively. CONCLUSION: For the evaluation of patients with acute flank pain, UCT is an excellent modality with high sensitivity and specificity. In near future it may replace EU.