A case of ureteral stump metastasis from renal adenocarcinoma / 대한비뇨기과학회지

The metastasis of renal cell carcinoma to the ureteral stump is very rare and only a Few cases were reported. In most cases ureteral metastasis appeared after nephrectomy. We are presenting a case of metastatic renal cell carcinoma to the ureteral stump after radical nephrectomy in a 14 years old male with brief review and literature.

Comparison of survival between radical nephrectomy with and without extensive lyphadenectomy in renal cell racinoma / 대한비뇨기과학회지

From 1980 to 1988, 101 patients underwent radical nephrectomy for renal cell carcinoma. Among them, extensive lymphadenectomy was done in 47 patients, and not in the rest of patients. According to cellular grade, tumor size. cell type and stage, survival rates of the two groups were compared. Survival rate of the renal cell carcinoma was decreased in high grade, large size and non-clear cell type, and so they correlated with prognosis. No difference of survival rate was found between extensive lymphadenectomized patients and non-extensive lymphadenectomized patients according to these prognostic factors. Also, no difference or survival rate `in each stage was found between above two groups. An extensive lymphadenectomy is unlikely to increase survival, but we have difficulty in compare the two groups because cases of this study is limited and nodal metastasis can not be confirmed in non-extensive lymphadenectomized patients. Therefore, more randomized controlled study must be performed for accurate result.

A case of retroperitoneal neurilemmoma / 대한비뇨기과학회지

Neurilemmoma is wel1 encapsulated tumor of Schwann cell origin. It is more often solid than cystic and. usually solitary and may be benign. The treatment is surgical excision. We report a 42-year-old man hospitalized with complaints of RUQ pain and palpable mass. There was no endocrinological abnormality. Ultrasonography, computerized tomography and angiography revealed right huge extrarenal mass without metastatic evidence. The patient underwent surgical excision.

The clinical observation on 69 cases of renal injury / 대한비뇨기과학회지

A clinical observation was made with particular attention to radiologic diagnosis, complication and management on 69 patients of renal injury admitted to the Catholic Medical Center during the last 10 years. The results were as follows: 1. Minor renal injury was in 49 cases (71%), major renal injury in 19 cases (27.5%) and pedicle injury in 1 case (1.5%) according to Scott's classification. 2. IVU was performed in 68 cases for initial diagnostic study and 18 cases (31%) needed additional radiologic study for accurate staging. 3. CT was performed in 14 cases and its diagnostic accuracy was 93%. 4. Renal angiography was performed in 6 cases. Angioinfarction was performed in 1 case due to continuous bleeding and the other 5 cases showed localized parenchymal infarction or normal finding. 5. Sonography was performed in 6 cases for initial diagnostic study and in 3 cases for follow up study. 6. In major renal injury patients, the group which decided treatment after CT study revealed 16 7% of complication rate but the group which decided treatment without CT study revealed 38 5% of complication rate. 7. In major renal injury or pedicle injury patients, initial operative treatment group resulted in kidney loss in 70% of cases without complication but initial conservative treatment group resulted in kidney loss in 60% of cases and the delay of operation resulted in 70% of complication rate.From these results, CT is the choice of additional staging technique after initial IVU and initial surgical operation is adequate treatment procedure in major renal injury or pedicle injury patients.

The Therapeutic Effect of Gamma Interferon in Advanced Renal Cell Carcinoma / 대한비뇨기과학회지

We evaluated the antitumor activity and toxicity of recombinant human interferon gamma (LBD -001) as a new modality for advanced renal cell carcinoma from March, 1988 to August, 1989 at the Department of Urology, St. Mary's Hospital, Catholic University Medical College. Eleven patients with advanced renal cell carcinoma were given recombinant gamma interferon at dose of 5.0-7.6 x 106U/day, subcutaneously three days per week. Among eleven patients, only one achieved partial response. Major adverse effects included fever, fatigue, myalgia and leukopenia, but no life threatening side effects were found. Although recombinant human interferon gamma have an antitumor activity against advanced renal cell carcinoma, further study is necessary to define the optimal treatment regimen.

The Clinicopathological Study on Prostatic Carcinoma: The Evaluation of Prognosis by Gleason's Method / 대한비뇨기과학회지

A clinicopathological study based on stages, Gleason's method and srvival rates was carried out in 149 cases of prostatic carcinoma treated at Pusan National University Hospital and five participating hospitals. 1. The distribution of each stage was:17 (11.4%) in stage A, 37 (24.8%) in stage B, 22 (14.8%) in stage C, and 73 cases (49.0%) in stage D. Of Gleason's score between primary and secondary pattern, the uniform cases were in 32%, the cases of 1 step differences were in 59 %, the cases of 2 step differences were in 9%, and none in more than 2 step differences. 2. The score sum of Gleason's method was inclined to be higher as the stage became higher. 3. The survival rates were declining as stages excluding cases between stage A and B became higher. As the Gleason's score (primary and secondary pattern, Gleason's sum, Gleason's category) became higher, the survival rates tended to decline. 4. Comparing the death rates of our cases to that of VACURG study of USA and that of Harada of Japan according to Gleason's score, there were no statistical differences (a>0.05). The prognosis of prostatic carcinoma depends on the histological factor, which in dictates the significance of Gleason's method. Also the authors believe that a common ground of basis such as Gleason's method is useful in comparative studies.

Ileal Ureter with Cecocystoplasty in a Patient of Massive Ureteral Stricture and Contracted Bladder Following Instillation of Formalin into the Bladder: Report of a Case / 대한비뇨기과학회지

Intravesical instillation of formalin has become an accepted therapeutic measure for control of intractable bladder hemorrhage. But the complication rate of formalin instillation is high and severe, including vesicoureteral reflux and hydronephrosis and acute tubular necrosis. We report a case of bilateral ureteral stricture following instillation of formalin into the bladder with unknown cause of massive hematuria, who was treated by ileal ureter with cecocystoplasty.

Renal Cell Carcinoma: A Review of 72 Cases / 대한비뇨기과학회지

A clinical observation was done in 72 patients with renal cell carcinoma admitted to Department of Urology, St. Mary's Hospital, Catholic University Medical College from Jan. 1980 to Jun. 1988 retrospectively. There were 52 men and 20 women, giving a ratio of 2.6 to 1, with the highest incidence in the sixth to seventh decades (66%). The most common symptom and sign were hematuria, flank pain and palpable mass in orders, but classic symptom triad of renal cell carcinoma was present in only 11% of the patients. Symptoms secondary to metastasis were only initial presentations in more than half of the patients with stage IV disease, initially 11% (12 pts.) of all the patients with renal cell carcinoma. CT scan showed a high diagnostic accuracy (78%) as compared to pathologic examination. So recently angiography is not done routinely. In one patient, tumor was not detected by CT scan, but by ultrasonography and angiography. Liver scan is not indicated unless there are 2 or more abnormal values among liver function test including alkaline phosphatase, GOT and GPT. Bone metastasis is not correlated with the elevation of alkaline phosphatase and bone scan is indicated only when bone pain and/or gait disturbance are present. Radical nephrectomy is the choice of treatment and adjunctive therapy including. irradiation, chemotherapy, hormone therapy and immunotherapy were not effective. The majority of distant metastasis (86%) occurred within the first 2 years following nephrectomy and metastatic sites were lung, lymph nodes, liver and bone in orders. Of the 72 patients, it was possible for 36 patients to follow up more than 3 years. Patients with stage 1 disease showed 90%. (9/10) 3 year survival and there were no significant differences in 3 year survival between stage II (50%) and stage III (44%) disease. No patients with stage IV disease survived more than 3 years.

Clinical Experience of Extracorporeal Shock Wave Lithotripsy for Urinary Calculi / 대한비뇨기과학회지

Extracorporeal shock wave lithotripsy has proved to be an effective method of treating urinary calculi. A total of 110 patients underwent 244 treatments with extracorporeal shock wave lithotripsy for urinary calculi from May 1987 to July 1987. Analysis of the first 110 patients shows 80 renal and 30 ureteral stones. The overall(complete and incomplete) success rate was 93.6%, and low morbidity and no mortality were proved. Extracorporeal shock wave lithotripsy is the preferred form of management for renal and ureteral stone less than 2cm in diameter.

Transurethral Resection and Open Surgery in Treatment of Benign Prostatic Hyperplasia : Comparative Study / 대한비뇨기과학회지

The results of TUR and open surgery in benign prostatic hyperplasia were compared in 72 cases of TUR and 48 cases of open surgery from July 1980 to June 1987. The results were as follows; 1. Mean operation time was shorter in TUR than open surgery(106.9min. in open surgery, 87.4min. in TUR). 2. Mean weight of resected prostate was heavier in open surgery than TUR(57.5gm in open surgery, 18.1gm in TUR). 3. Mean blood loss during operation was widely different between two groups(547.2ml in open surgery, 281.6ml in TUR), and no blood was required in 19.4% of TUR. 4. Mean hospitalization and catheter indwelling periods were shorter in TUR than open surgery(mean hospitalization ; 13 days in open surgery and 8.6 days in TUR). 5. Total complication rate was 25.1% in open surgery and 20.8% in TUR, the most predominant complication was rebleeding in open surgery and urinary incontinence in TUR.

Ultrastructure of the Pelvic Epithelium of the rabbit Kidney and Its Morphological Changes in the Experimental Hydronephrosis / 대한비뇨기과학회지

The authors designed experiments to clarify ultrastructure of the renal pelvic epithelium and to observe its morphological changes in the postobstructed kidney by means of light, scanning and transmission electron microscopy. A total of 27 rabbits weighing about 2.5kg body weight, 3 for normal group and 24 for group of postobstruction, were used. Under pentothal sodium anesthesia, complete ureteral obstruction was accomplished by ligation on the left ureter 1cm above the ureterovesical junction. The experimental animals were sacrificed at 1st, 2nd, 3rd and 4th week after unilateral ureteral ligation. The kidneys for light microscopy were fixed in 10% neutral formalin, embedded in paraffin, sectioned at a thickness of 6 um and stained with hematoxylin and eosin. For scanning electron microscopy, tissue specimens taken from the renal papilla, peripelvic column, pelvic pouch and funnelshaped pelvic wall, were fixed in 1.5% paraformaldehyde-1% glutaraldehyde solution prior to fixation in 1% osmium tetroxide, dehydrated in alcohol, transferred to isoamyl acetate and dried in the critical point drier(Polaron E 3,000). Subsequently, specimens were coated with gold and observed by an electron microscope(JSM-35C). For transmission electron microscopy, pre-and post-fixed tissue blocks taken from various portions of the pelvic wall were embedded in Araldite. Ultrathin sections cut with an ultramicrotome(LKB-V) were contrasted with uranyl acetate and lead acitrate, and examined by an electron microscope(JEM-100B). The results were as follows : The renal papilla and peripelvic column were lined with simple cuboidal or columnar epithelium which was composed of the principal cells with a few organelles and numerous short microvilli and the cells with a single cilium. The pelvic pouch was lined with pseudostratified columnar epithelium. The superficial cells were characterized by the presence of numerous secretory granules which were round or oval in shape(668+/-174nm) and showed various electron densities. The funnel-shaped portion of the pelvic wall was lined with transitional epithelium. The superficial cells containing a few fusiform vesicles were expanded in parallel with the luminal surface, and luminal plasma membrane of the cells showed well developed microridges and polygonal plaques consisting of asymmetric unit membrane. The following morphological changes were observed in different portions of the pelvic epithelium of the hydronephrotic kidney after ureteral obstruction. The cell organelles, such as granular endoplasmic reticulum, mitochondria and ribosomes, were obviously increased in the epithelial cells of the renal papilla and peripelvic column. In the superficial cells of the pelvic pouch, the secretory granules were increased, and exocytosis of the granules was noticed at the luminal surface. Superficial epithelial cells of the funnel-shaped pelvic wall were cuboidal in shape, and showed remarkable decrease of microridges on the luminal surface. These morphological changes of the pelvic epithelium gradually occurred until 4th week after ureteral obstruction. From these findings of the rabbit pelvic epithelium, it is suggested that transport of water and solutes of the pelvic urine can take place through the epithelia covering the renal papilla and peripelvic column, the secretory function is accomplished by the epithelium of the pelvic pouch, and the transitional epithelium related to the permeability barrier is only limited to the funnelshaped pelvic wall. In the experimental hydronephrotic kidney, it is postulated that the epithelial cell activities of the renal papilla, peripelvic column and pelvic pouch are increased and permeability barrier of the transitional epithelium is maintained until 4th week after ureteral obstruction.

A Clinical Observation on Urothelial Tumor of the Upper Urinary Tract / 대한비뇨기과학회지

urothelial tumors of the upper urinary tract are relatively uncommon, mostly malignant. 25 patients with urothelial tumor of upper urinary tract seen at St. Mary`s hospital from Jan. 1975 to Dec. 1986 are reviewed retrospectively. The average age was 57.3 years, approximately half of them being more than 60 years old. Gross Hematuria was the most prevalent sign and cytologic examination of the urine has proved not to be diagnostic. The most common findings of excretory urography and retrograde urography were non- visualization of the kidney and filling defect. CT can help to evaluate the extent of disease by determining the invasion or metastasis to surrounding tissues or retroperitoneal node. All 25 patients were surgically explored, 23 patients underwent nephroureterectomy and 6 of them was also done lymphadenectomy, distal ureterectomy with ureteral reimplantation was done in 1 patient and simple nephrectomy was done under the misdiagnosis of renal tuberculosis in 1 patient. There were close relations between histological grade and pathologic grade. Of the 25 patients, stage A and grade II were the most common, each of them were 11 and 16 cases. The over-all 2 year survival rate of 13 patients followed up was seventy percent.

Surgical Management of Staghorn Calculi / 대한비뇨기과학회지

The morbidity and mortality rates are believed to be much higher if the staghorn calculus is left unoperated, since complications resulting from infection and/or obstruction may become life-threating. So, surgical removal is essential element in the successful management of the majority of patients with staghorn calculous disease. To understand better the optimal management, we did a retrospective analysis of 41 patients treated during 12 year periods. Surgical managements were performed in 36 patients (41 kidneys) and no operation in 5. Methods of surgical managements were extended pyelolithotomy in 11 cases, extended pyelolithotomy and pyeloplasty in 1, extended pyelolithotomy with parenchymal extension in 4, ex- tended pyelolithotomy with parenchymal extension and partial nephrectomy in 1, anatrophic nephrolithotomy in 7, antrophic nephrolithotomy with partial nephrectomy in 3, partial nephrectomy in 3, partial nephrectomy in 3 and nephrectomy in 9. Complete removals of calculi were done in 32 kidneys(69.6%). Clinical complications occurred in 14 kidneys(30.4%) ; 5 were remnant stones(10.8%), massive bleeding in 2, renal artery injury in 1, urine leakage in 3, pneumothorax in 2 and hematuria and sepsis in 1. The managements of complications were reoperation in 8 cases, conservative treatment in 5 and no follow up in 1.

Extent of Necrosis of Renal Cut Margin on Three Types of Partial Nephrectomy in Dogs / 대한비뇨기과학회지

Partial nephrectomy frequently accompanies serious complications such as secondary bleeding and urinary fistula and these complications result from necrosis of renal cut margin after partial nephrectomy. We have performed experimental partial nephrectomy to compare the extent of necrosis of renal cut margin after the wedge resection(Group l), the transverse polar resection(Group 2) and the chromic ligature resection(Group 3). In order to investigate which type of 3 partial nephrectomies cause less complications, 15 adult mongrel dogs were divided into three groups and partial nephrectomy was performed at the lower one quarter of 10 kidneys of 5 dogs in each group. The gross and microscopic findings of renal cut margin were observed at 1, 2, and 3 weeks after the operation. The results were as follows; 1. Mean depth of necrosis of the renal cortex at cut margin in Groups 1, 2 and 3 were 1.Ocm, O.2 cm and O.3cm, respectively. 2. Mean depth of necrosis of the renal medulla in Groups 1, 2 and 3 were 1.1cm, O.9cm and O.8cm, respectively. 3. On microscopic examination of the renal cortex at the 3rd week after operation, Groups 2 and 3 showed complete healing of necrosis but Group 1 showed delayed healing with remained necrotic tissue. From the present experiment it was found that both the transverse polar and chromic ligature resection cause less complications than the wedge resection.

A Case of Renal Cell Carcinoma with Contralateral Renal Hypoplasia / 대한비뇨기과학회지

One patient who underwent radical nephrectomy for renal cell carcinoma participated in a follow up study of the contralateral hypoplastic renal function. Compensatory renal enlargement was demonstrated on follow excretory urogram. The enlargement was 12mm in length, 16mm in width. Immediately, postoperative renal function, GFR, was decreased to minimum value, 8.6 ml/min., but GFR of the remaining kidney was increased to maximal value, 37 ml/min. on post-op 5th day, and then decreased. After post-op 2.6 month the GFR was maintained as the level of 13-14 ml/min. Plasma BUN and creatinine was increased to maximum value, BUN 46.1 mg/dl Cr. 4.1mg/dl, on post-op 9th day and then decreased continuously. But these BUN and creatinine level were maintained as 29.3 mg/dl, 3.4 mg/dl on post-up 6th month. We present a case of this renal cell carcinoma with contralateral renal hypoplasia.

Radical Cystectomy with Pelvic Lymphadenectomy in Bladder Tumor: Review of 14 Cases / 대한비뇨기과학회지

A clinical observation was made on 14 patients of bladder tumor who were treated by radical cystectomy with pelvic lymphadenectomy in the Department of Urology, Catholic Medical College during the period from March, 1984 to July, 1986. Metastases to pelvic lymph node were proved histologically in 3 cases among 14 cases. Operative pathologic staging demonstrated an understanding error of 36 per cent, an overstaging error of 28 per cent and an accuracy of 36 per cent. The addition of a meticulous pelvic lymph node dissection did not increase the mortality or morbidity compared to simpler procedures. Results of this study support the early aggressive use of radical cystectomy with pelvic lymphadenectomy and urinary diversion in the management of patients with bladder cancer.

Ultrastructural Changes of the Uriniferous Tubules after Ureteral Ligation in Rabbits / 대한비뇨기과학회지

This study attempted to clarify the morphological changes of the uriniferous tubules in the postobstructed kidneys of rabbits by electron microscopy. A total of l3 rabbits weighing about 2.5 kg were used. Under penthothal sodium anesthesia, complete ureteral obstruction was accomplished by ligation on the left ureter 1 cm above the ureterovesical junction. The experimental animals were sacrificed at the second and fourth week after the unilateral ureteral ligation. Tissue specimens taken from the renal cortex and medulla were fixed in a mixture of 2% paraform-aldehyde-2.5% glutaraldehyde (phosphate buffer, pH 7.2 ) prior to fixation in 1% osmium tetroxide (phosphate buffer, pH 7.2), and embedded in Epon 8l2. The sections were cut with LKB-III ultratome. Ultra thin sections were contrasted with uranyl acetate and lead citrate, and examine with a JEM-100B electron microscope. The results were as follows: 1. In the 2 weeks group of postobstruction, the abnormal morphology of the uriniferous tubules was: diminution in microvilli and basal invaginations, widening of intercellular space, focal necrosis of the epithelium, desquamation of tubular cells and splitting of the basal lamina. The degenerative changes were severe in the distal tubule, loop of Henle and collecting duct. However, the changes were mild in the proximal tubules. 2. In the 4 weeks group of postobstruction, the degenerative changes were more severe and generalized in all portions of the uriniferous tubules, and focal necrosis and desquamation of the epithelial cells were prominent in the distal tubules and collecting ducts. 3. In both groups of postobstruction, the epithelial cells with mild deformity, such as a decrease of microvilli and basal invaginations, were still preserved in all portions of the uriniferous tubules. From these findings in the obstruct nephropathy, degenerative changes are progressively expedited and partially produced in the urinary tubules.

Radical Nephrectomy with Extended Retroperitoneal Lymphadenectomy in Renal Cell Carcinoma: Review of 19 Cases / 대한비뇨기과학회지

A clinical observation was made on 19 patients of renal cell carcinoma who were treated by radical nephrectomy with extended retroperitoneal lymphadenectomy in the Department of Urology, Catholic Medical College during the period from May, 1980 to August, l985. Results were as follows; 1. Clinical stages by Robson`s staging system were 7 cases of stage I, 6 cases of stage II, 5 cases of stage III and 1 case of stage IV. Acuracy rate of clinical staging was 68.4%. 2. Pathologic stages were 8 cases of stage I, 5 cases of stage II, 4 cases of stage HI and 2 cases of stage IV. 3. Metastatic sites were perirenal fat(5 cases), regional lymphnode (2 cases), vessel(4 cases) and lung (2 cases). The rate of regional lymphnode involvement was 10.5%. 4. Postoperative complications were colocutaneous fistula (1 case), prolonged ileus (1 case) and pleural effusion (1 case). 5. Out of 19 cases 13 cases were alive without recurrence, 2 cases were alive with metastasis, 3 cases died with recurrence and 1 case died with other cause. 1 year survival rate was 77.8%.

A Case of Bilateral Pan-caliceal Ileoneocystostomy in Renal Tuberculosis / 대한비뇨기과학회지

Intrarenal scarring with stricture formation that causes interruption of communication to entire caliceal system is not uncommon in late case of tuberculosis. In three situations, the only logical solution is to anastomose all of the calices to ileal ureter through anatrophic nephrotomy. We experienced a case of bilateral pan-caliceal ileoneocystostomy in 23 year old female patient who had intrarenal scarring with severe stricture formation.

Experimental Ureteroneocystostomy in Dogs: Simple Free end Method and Modified Politano-Leadbetter Method / 대한비뇨기과학회지

Politano-Leadbetter method has been widely used in ureteroneocystostomy these days, we encounter some cases not suitable for this method, For example, in case the ureter was not properly long enough or in the process of making submucosal tunnel vesical mucosa happens to be irregulary dissected due to vesical inflammation, other useful method of vesicoureteral reimplantation is necessary. therefore, instead of making the submucosal tunnel, enough length of the intravesical ureter, which was the most important factor in preventing vesicoureteral reflux, was made protruded into the bladder lumen with free end method and modified Politano-Leadbetter method. these maneuvers well permit value-like flatting or closing of the distal ureteral segment during periods of increased intravesical pressure. We have performed experimental ureteroneocystostomy in 8 dogs, 16 ureters with simple free end method (group 1) and modified Politano-Leadbetter method(group 2)in two groups and two dogs were used as control. The procedure of free end method is a no-tunnel `drop-in` with a long segment protruding into the bladder lumen and that of modified Politano-Leadbetter method is as follows. The intravesical ureter is placed beneath the incised bladder mucosa without submucosal tunnelling and the spatulated distal end of the ureter is sutured with bladder mucosa. In control group ureteroneocystomy was performed by Politano-Leadbetter method. The roentgenographic findings and gross appearance of the kidney and ureter were observed in the 5 weeks after the operation. The anastomosis site was also observed histologically. The results obtained were as follows: 1. No vesicoureteral reflux was found cystographically in both group. 2. Hydronephrosis and obstruction at the anastomosis site were found in one out of 8 ureters in each group by intravenous urography. 3. Renal enlargement and chronic inflammation and fibrosis at the anastomosis site were noted in one out of 8 ureters in each group by gross and microscopical examination. 4. In group 2, modified Politano-Leadbetter method, it was found that the intravesical ureter was covered by regenerated vesical submucosal tissue microscopically. Through this study it is concluded that these two methods are useful to be performed for the ureteroneocystostomy when the submucosal tunnel technique is not suitable.