Classification of Primary Non-refluxing Megaureter Depending on Disease Progress / 대한비뇨기과학회지

PURPOSE: We report on the standards for determining the obstructive type and the non-obstructive type of primary non-refluxing megaureter, and we also report on the diagnostic and therapeutic approach for such patients. MATERIALS AND METHODS: We evaluated 28 children diagnosed with primary non-refluxing megaureter from Jan 2000 to Feb 2003. We assessed the changes in hydronephrosis and dilated ureteral diameter at 2 and 6 months after surgery (the surgery group) and on the diagnosed 'wait and see' group. RESULTS: Out of 28 children, 14 children underwent ureteroneocystostomy. The mean diameter of the dilated ureter was decreased significantly from 20.3mm at initial presentation to 9.3mm and 3.4mm at 2 and 6 months, respectively, after surgery in the surgery group (p=0.0063, 0.0027), and from 21.1mm to 6.7mm and 4.8mm at 2 and 6 months, respectively, after diagnosis in the 'wait and see' group (p=0.0247, 0.0154). The mean grade of hydronephrosis was decreased significantly from 3.6 to 2.7 and 2.13, respectively, in the surgery group (p=0.0044, 0.0003), and from 2.35 to 1.53 and 1.12, respectively, in the 'wait and see' group (p=0.0026, 0.0006). However, the difference in the percentage of decrease in the mean ureteral diameter and the grade of hydronephrosis compared to the values at the initial presentation was not significant between the two groups (p=0.4168, 0.8999). When diuretic renography (DRG) was done in the surgery group, only 15 ureters (20%) showed an obstructive pattern with T1/2 above 20 minutes. CONCLUSIONS: The discrimination of obstruction and non-obstruction is the most important factor for the prognosis and treatment plan of primary non-refluxing megaureter. It is possible to correctly evaluate this condition by comparison of the change in the pattern of disease through continuous, periodic evaluation and follow-up. Surgical treatment such as ureteroneocystostomy must be considered when breakthrough urinary tract infection (UTI), aggravation of hydronephrosis or marked decrease of renal function is present during conservative treatment or observation.

Classification of Primary Non-refluxing Megaureter Depending on Disease Progress / 대한비뇨기과학회지

PURPOSE: We report on the standards for determining the obstructive type and the non-obstructive type of primary non-refluxing megaureter, and we also report on the diagnostic and therapeutic approach for such patients. MATERIALS AND METHODS: We evaluated 28 children diagnosed with primary non-refluxing megaureter from Jan 2000 to Feb 2003. We assessed the changes in hydronephrosis and dilated ureteral diameter at 2 and 6 months after surgery (the surgery group) and on the diagnosed 'wait and see' group. RESULTS: Out of 28 children, 14 children underwent ureteroneocystostomy. The mean diameter of the dilated ureter was decreased significantly from 20.3mm at initial presentation to 9.3mm and 3.4mm at 2 and 6 months, respectively, after surgery in the surgery group (p=0.0063, 0.0027), and from 21.1mm to 6.7mm and 4.8mm at 2 and 6 months, respectively, after diagnosis in the 'wait and see' group (p=0.0247, 0.0154). The mean grade of hydronephrosis was decreased significantly from 3.6 to 2.7 and 2.13, respectively, in the surgery group (p=0.0044, 0.0003), and from 2.35 to 1.53 and 1.12, respectively, in the 'wait and see' group (p=0.0026, 0.0006). However, the difference in the percentage of decrease in the mean ureteral diameter and the grade of hydronephrosis compared to the values at the initial presentation was not significant between the two groups (p=0.4168, 0.8999). When diuretic renography (DRG) was done in the surgery group, only 15 ureters (20%) showed an obstructive pattern with T1/2 above 20 minutes. CONCLUSIONS: The discrimination of obstruction and non-obstruction is the most important factor for the prognosis and treatment plan of primary non-refluxing megaureter. It is possible to correctly evaluate this condition by comparison of the change in the pattern of disease through continuous, periodic evaluation and follow-up. Surgical treatment such as ureteroneocystostomy must be considered when breakthrough urinary tract infection (UTI), aggravation of hydronephrosis or marked decrease of renal function is present during conservative treatment or observation.

In Utero Shunting for Fetal Hydrothorax, Ascites and Obstructive Uropathy: A Review of 7 Cases / 대한주산의학회잡지

OBJECTIVE: To evaluate the value of intrauterine shunting and to investigate the complication and outcome of these procedures for different fetal indications. METHODS: 7 fetuses who underwent 13 intrauterine catheter shunting from 1992 to 1997 were reviwed. The indications were uni-or bilateral hydrothorax in 4 cases, ascites in one case, and obstructive uropathy in 2 cases. RESULTS: Catheter migration occurred 6 times out of the 13 shunts (46%). Procedure related death rate was 23% (3/13); within 48 hours of pleuroamniotic shunting, amniorrhexis and coincidental abruptio placenta resulting in one fetal death and each one of amniorrhexis and premature labor resulting in 2 neonatal deaths. Pregnancy was terminated after shunting in one case of urethral atresia. Postnatal survival rate was 50% (3/6). CONCLUSION: A high complication rate requires the selection of cases for shunting. A large prospective controlled trial is needed to determine its value.

The Postoperative Prognosis of Ureteropelvic Junction Obstruction according to the Appearance of the Ureter of Preoperative Retrograde Pyelography / 대한비뇨기과학회지

PURPOSE: Controversy still exists about the necessity for a preoperative RGP (retrograde pyelography) in UPJO (ureteropelvic junction obstruction), but no standard has been established. Therefore, to define the role of preoperative RGP in UPJO, the postoperative prognosis, using the appearance of the ureter in preoperative RGP, was studied. MATERIALS AND METHODS: Between Jan. 1996 and Oct. 2001, the radiological studies of 38 children (mean age: 10.66 months), out of 77 diagnosed with UPJO followed by pyeloplasty, were available for a retrospective review. The subjects were divided into three groups: -group A; UPJ (ureteropelvic junction) narrowing only, group B; multiple narrowing, and group C; a hypoplastic ureter, based on the findings of the preoperative RGP. The improvements in the hydronephrosis, according to the comparison between the preoperative and postoperative U/S (ultrasonography), performed at 6 and 12 months after the operation, were retrospectively analyzed. RESULTS: The number of patients in the groups A, B and C were 15 (16 renal units, one bilateral UPJO), 11 and 12 (13 renal units, one bilateral UPJO), respectively. There were no statistically significant differences in the degree of preoperative hydronephrosis (mean+/-S.D., p>0.5). The degree of hydronephrosis (mean+/-S.D.) found at the U/S 6 and 12 month follow ups were 2.00+/-0.63 and 1.63+/-0.50, 1.91+/-0.70, and 1.45+/-0.52 and 2.92+/-0.76 and 2.62+/-0.77 in groups A, B and C, respectively, with all showing improvements. There were statistically significant differences in the degree of improvement in group C compared to groups A and B (p<0.05). CONCLUSIONS: The current study has shown that hydronephrosis, with a hypoplastic ureter, has a tendency to improve more slowly than other types of ureteral narrowing. Therefore, if the long-term follow-up data show the same results, a preoperative RGP may play an important role in evaluating the postoperative prognosis of UPJO.

Gross and Microscopic Findings of the Testes Ascended into abdomen During Neonatal and Prepubertal age in Rats / 대한비뇨기과학회지

PURPOSE: Because cryptorchid testes are known to undergo histopathologic changes affecting development, maturation, and tertility, early surgical correction is usually recommended. However there are differing opinions concerning whether retractile testes are affected by similar changes and also whether there is a need for surgical treatment. We aimed to assess the histopathologic changes in retractile testis by studying the changes in testes artificially placed back in the abdomen after they have descended to scrotum in experimental rat models. MATERIALS AND METHODS: Male Sprague-Dawley rats were divided into 3 groups; a control group(controls), prepubertal ascent group (P) in which testis were placed back intraabdominally by bilateral inguinal canal obstruction at 6 weeks, a neonatal group(N) in which intraabdminal testis was induced by bilateral inguinal canal obstruction at birth. The relative weight of the testis, morphology of the seminiferous tubules including Leydig cells, tubular degeneration phase(TDP), spermatogonia per tubules(S/T), and Sertoli cell index (SCI) of these three groups were analyzed and compared. RESULTS: The relative weight of testis was significantly decreased in the group of N(0.0016+/-0.001) and P(0.0015+/-0.0002) compared to controls(0.0037+/-0.0002) (p<0.05). The S/T value was also decreased in P(2.05+/-18.2) and N(73.2+/-32.4) when compared to controls (360.2+/-21.3). Similar changes were observed in SCI of both P(64.5+/-6.4) and N (91.2+/-14.2) when compared to controls (227.9+/-31.1). Only minority of N and P showed higher TDP values. However, although statistically insignificant, TDP was increased in both P and N when compared to controls. The Leydig cells in N and P showed cellular distortion and hypertrophy. CONCLUSIONS: This study demonstrate that prepubertal ascent, similar to that of innate cryptorchid testis, also can induce histopathologic changes such as changes in testicular seminiferous tubule, decrease in the S/T value and decrease in SCI value. Our findings supports that hypothesis that retractile testis may cause histological damage thus surgical correction may also be warranted similar to in case of genuine cryptorchism.

Correlation between Ultrasonography and Diuretic Renography in Infants with Ureteropelvic Junction Obstruction / 대한비뇨기과학회지

PURPOSE: Although ultrasonography and diuretic renography are routinely performed for evaluation of ureteropelvic junction obstruction, no reported studies have systemically investigated the correlation of the two methods. We investigated the correlation and values of the two methods. MATERIALS AND METHODS: We studied 44 patients who presented with unilateral hydronephrosis due to ureteropelvic junction obstruction from 1994 to 1999. Patients were evaluated with ultrasound and nuclear renograms with furosemide. Hydronephrosis grade on ultrasonography and the severity of obstruction on diuretic renography were in accordance with the SFU (Society for Fetal Urology) system and "The Well Tempered Renogram", respectively. RESULTS: 27 patients showed grade III hydronephrosis and the remaining 17 patients showed grade IV hydronephrosis on ultrasonography. Kidneys of grade IV hydronephrosis had poorer washout patterns on diuretic renography than those of grade III hydronephrosis (p 0.05). In 37.0% (10/27) and 47.1% (8/17) of patients with grade III and grade IV hydronephrosis, hydronephrotic kidney had a differential function greater than 50%. CONCLUSIONS: Our study suggests that diuretic renography is not always indicated in the patients with grade IV hydronephrosis, but, must be performed to confirm the severity of obstruction in the patients with grade III hydronephrosis.

The Incidence of Contralateral Vesicoureteral Reflux after Endoscopic or Open Surgical Correction of Primary Unilateral Vesicoureteral Reflux in Children / 대한신장학회잡지

The incidence of contralateral reflux after unilateral reimplantation in children with primary unilateral vesicoureteral reflux(VUR) is reported to be 0.8-32%. We evaluated the characteristics of contralateral reflux after endoscopic or open surgical correction of primary unilateral VUR in children. 30 children who underwent unilateral reimplantation by Paquin (25pts) and submucosal Macroplastique injection(5pts) were evaluated. The association between postoperative contralateral reflux and age, sex, ipsilateral implant side, postoperative urinary tract infection, and surgical method were evaluated. There were 18 male and 12 female patients. Initial reflux was observed in the right in 18 and 12 in left. The initial reflux grades were II, III, IV, and V in 2, 11, 14, and 3 patients, respectively. Postoperative urinary tract infection was observed in 4 patients of whom 1 had contralateral reflux. In conclusion, there was no single factor that could predict the development of contralateral reflux after unilateral correction of unilateral primary VUR. Furthermore, the fact that contralateral reflux occurred even after submucosal Macroplastique injection suggests that the method of surgery is not related to the subsequent development of contralateral reflux.

Structural Evidence Against Hormonal Theraphy in Cryptorchid Testis-Abnormal Gubernacular Attachment / 대한비뇨기과학회지

No abstract available.

A Case of Congenital Mesoblastic Nephroma Detected by Prenatal Ultrasonography in Premature Infant / 대한비뇨기과학회지

No abstract available.

Inflammatory pseudotumor of the urinary bladder in a child

The inflammatory pseudotumor of the urinary bladder is rare, especially in children. It is a benign proliferative lesion of the submucosal stroma easily mistaken for a sarcoma clinically, so it should be differentiated from a malignant neoplasm. We report the case of bladder inflammatory pseudotumor in a 7-year-old girl.

Prognostic Factor and Survival Rate of Preoperative and Recurred CasesChemotherapy in Wilms' Tumor / 대한비뇨기과학회지

No abstract available.

Does Every Patient with Ureteropelvic Junction Obstruction Need Voiding Cystourethrography? / 대한비뇨기과학회지

No abstract available.

Prognostic Factor and Survival Rate of Preoperative and Recurred CasesChemotherapy in Wilms' Tumor / 대한비뇨기과학회지

No abstract available.

Does Every Patient with Ureteropelvic Junction Obstruction Need Voiding Cystourethrography? / 대한비뇨기과학회지

No abstract available.

Effects of Exogenous IGF-I on Endogenous IGF-I Production, Function and Hyperplasia/Hypertrophy of Kidney during Compensatory Renal Growth in Hypophysectomized Rats / 대한비뇨기과학회지

PURPOSE: Compensatory renal hypertrophy(CRH) after loss of considerable renal volume is essential process for recovery and maintenance of renal function, but on the other hand CRH induces glomerulosclerosis, eventually renal failure. Recently, the considerable studies reveal that insulin-like growth factor-I(IGF-I) is an important molecule relating to renal hypertrophy. This study investigates the possibility of IGF-I as a therapeutic agent, it should be proved whether external IGF-I affects renal function and glomerulosclerosis or does not affect in devoid state of growth hormone(GH) effect. MATERIALS AND METHODS: 100?150g Sprague-Dawley male rats were hypophysectomized by transpharyngeal approach and hypophysectomy were confirmed by daily monitoring of body weight for 3weeks. The left kidney were removed in the rats of UNX group(uninephrectomy) and UNX+IGF-I group(IGF-I treated after uninephrectomy), and sham operation were done in the other rats of control group and IGF-I group(IGF-I treated). Recombinant IGF-I were administered via Alzet osmotic minipump for 5 days in rats of IGF-I group and UNX+IGF-I group. At the 5th day after uninephrectomy, the glomerular filtration rate(GFR) and the effective renal plasma flow(ERPF) were investigated by measuring recovery of 99mTc-DTPA and 125I-hippurate, and then the rats were sacrificed and the kidneys were removed. The wet kidney weights were measured in removed kidneys, renal IGF-I concentrations were measured by RIA, and cellular proliferation were evaluated by flow-cytometry. RESULTS: 1. The wet kidney weight per body weight significantly increased after uninephrectomy, and had not been affected by IGF-I treatment regardless of uninephrectomy. 2. Renal IGF-I tended to increase after uninephrecromy, and significantly increased with IGF-I treatment in both IGF-I and UNX+IGF-I. The level of renal IGF-I of UNX+IGF-I group was significantly higher than that of IGF-I group. 3. Total GFR tended to decreased after uninephrectomy and were significantly increased by IGF-I treatment regardless of uninephrectomy. 4. The GFR per g wet kidney weight significantly increased after uninephrectomy, and were significantly increased by IGF-I treatment regardless of uninephrectomy. 5. Total ERPF were not significantly changed after uninephrectomy and significantly increased by IGF-I treatment in sham operation group but did not changed by IGF-I treatment in uninephrectomy group. 6. The ERPF per g wet weight significantly increased after uninephrectomy, and significantly increased by IGF-I treatment in sham operation group but did not changed by IGF-I treatment in uninephrectomy group. 7. The mean % of S1 phase cells were 33.6% in UNX+IGF-I group, 23.5% in IGF-I group, 19.96% in UNX group, and 10.4% in control group. The mean % of G2+M phase cells were 2.5% in UNX+IGF-I group, 1.95% in IGF-I group, 1.73% in UNX group, and 1.2% in control group. CONCLUSIONS: GH non-dependent IGF-I participate in CRH, and only IGF-I without GH increases renal function. IGF-I treatment during CRH might increase GFR by changing glomerular efferent arteriol of filtration fraction.

A Case of Mayer-Rokitansky-K ster-Hauser Syndrome combined with Unilateral Renal Agenesis and Pelvic Cystic Mass in Child / 대한비뇨기과학회지

The Mayer-Rokitansky-K ster-Hauser syndrome represents a spectrum of m llerian anomalies, including vaginal agenesis with or without renal anomalies, in genotypically and phenotypically normal female subjects with normal endocrine status. We experienced a case of this anomaly which combined with unilateral renal agenesis and pelvic cystic mass in child.

Four Cases of Unilateral Single Ectopic Ureter with Ipsilateral Dysplastic or Hypoplastic Kidney in Children: the Diagnostic Value of MR Urography / 대한비뇨기과학회지

We report on 4 cases with a unilateral single ectopic ureter associated with ipsilateral dysplastic or hypoplastic kidney and the usefulness of preoperative magnetic resonance(MR) urography in revealing the ureteral course and detecting the insertion site of ectopic ureter. Among two cases of unilateral single ectopic ureter associated with dysplastic kidney, one drains into the seminal vesicle and the other drains into the urethra. The other two cases have unilateral single ectopic ureter associated with hypoplastic kidney that drain into the vagina. In all cases, MR urography shows the ureteral course and insertion site of ectopic ureter regardless of the renal function. We believe that MR urograhy is a useful technique for the diagnosis of unilateral single ectopic ureter associated with hypofunctioning kidney.

Pathological Characteristics in Retractile Testis comparing Cryptorchid Testis / 대한비뇨기과학회지

PURPOSE: Although retractile testes are frequently found in the pediatric population, there are controversies in the management of retractile testes. We investigated the necessity of treatment for retractile testes by analyzing their histologic findings. MATERIALS AND METHODS: Sixty-one testicular biopsies were performed during orchiopexy from 36 boys(range: 1.3-12.9 years, mean: 5.4 years) with retractile testes(11 unilateral, 50 bilateral) and 115 testicular biopsies from 83 cryptorchid patients(range: 0.6-15.0 years, mean: 3.7 years, 51 unilateral, 64 bilateral). Parameters for both Sertoli cell and germ cell were determined in each group. RESULTS: The average tubular degeneration phase(TDP) V-VII were 0.23+/-0.18 for retractile testes and 0.22+/-0.17 for cryptorchid testes and were not statistically different. Both the average sertoli cell index(SCI) and mean spermatogonia per tubules(S/T) value were statistically different between retractile and cryptrochid testes with values of 26.81+/-6.75, 23.04+/-5.85(p<0.01) and 2.96+/-1.33, 0.61+/-0.87(p<0.01), respectively. CONCLUSIONS: Although S/T value of retractile testes was higher than that of cryptorchid testes, Sertoli cell degenerative patterns were similar. These findings might indicate that retractile testis needs treatment like cryptorchid testis does. However, further investigation is warranted to elucidate whether these changes are normal variations since changes are observed in both Sertoli & germ cells in normal boys as they are aging.

Clinical Characteristics in the 45XO/46XY Mosaicism and 45XO with SRY Gene Positive Patients / 대한비뇨기과학회지

PURPOSE: We investigated the clinical characteristics and relationship between chromosome and its phenotypic expression in patients with 45 XO/46XY mosaicism or 45 XO with SRY gene. MATERIALS AND METHODS: 11 patients with 45XO/46XY chromosomal abnormality and 4 patients with 45XO with SRY positive reaction admitted from 1990 to 1996 were evaluated. Patients were grouped according to chromosome and gonadal expression. Group A consisted of patients with 45XO/46XY chromosome and unilateral streak gonad, group B patients with 45XO chromosome, SRY positive reaction and unilateral streak gonad and group C patients with 45XO/46XY chromosome and bilateral streak gonads. RESULTS: Of the total 15 patients, the number of patients in group A, B, and C were 8, 4, and 3, respectively. SRY gene was positive in all group A and B patients but only one patient was positive in group C. Of the 8 patients in group A, 5 patients had a high XY mosaicism ratio compared to XO whereas an equal ratio was observed in the remaining 3 patients. Of the 4 male penotype patients only 1 patient had a high XY mosaicism ratio compared to XO while 3 patients displayed an equal ratio. There was no difference in associated anomaly and the degree of severity of ambiguity according to the mosaicism ratio in all patients. CONCLUSIONS: There was no definite correlation between the mosaicism ratio and phenotypic expression. Presence of SRY gene in 45XO patients may suggest MGD(mixed gonadal dysgenesis) and therefore, the evaluation SRY gene could be useful in the diagnosis of 45XO patients with ambiguous genitalia.

The Role of Initial Relative Renal Function in Unilateral Hydronephrosis

Glassy cell carcinoma is an unusual neoplasm of the uterine cervix with highly aggressive clinical behavior. On cervico-vaginal smear examination, the tumor has well confused of atypical repair cell of the endocervix. Recently, we have experienced two cases of glassy cell carcinoma of the uterine cervix, diagnosed on cervico-vaginal smears and confirmed on following histologic sections. The cervico-vaginal smears revealed abundant clusters with well defined boarders. The cell clusters were composed of large tumor cells. The tumor cells had distinct granular cytoplasm and eosinophilic macronucleoli. Characteristic cytologic features of this tumor were discussed in view of differential diagnosis.