Endourologic Management for Calyceal Diverticular Stone / 대한비뇨기과학회지

PURPOSE: A symptomatic renal calyceal diverticular stone is a rare occurrence. Endourologic techniques, including laparoscopy, retrograde ureterorenoscopy (URS) and percutaneous nephrolithotomy (PNL) have been used for the treatment of this disease. Herein, we reviewed our experiences of treating stones in calyceal diverticulum with URS or PNL. MATERIALS AND METHODS: We retrospectively reviewed 23 patients who underwent PNL (12 cases) or URS (11 cases) for the treatment of symptomatic calyceal diverticular stones. A direct target puncture of the diverticulum was made in the PNL group and a flexible or semi-rigid ureteroscope was used to reach the diverticulum in the URS group. The diverticular neck was either incised with Holmium:YAG laser or dilated. Extracorporeal shockwave lithotripsy (ESWL) was performed prior to the procedure in 9 of the 23 cases (2 in the PNL group and 7 in the URS group). RESULTS: A complete stone-free state, with symptomatic resolution, was obtained in 11 of the 12 in the PNL group and in 7 of the 11 in the URS group. Success in the PNL group depended on an accurate puncture into the diverticulum and successful placement of the nephrostomy catheter into the renal pelvis through the diverticular neck. Success with the URS was achieved when the ureteroscope passed into the diverticulum and the double-J stent had been optimally placed. Seven of the 9 cases with prior ESWL achieved a stone-free state, while all the prior ESWL cases with successful access achieved a stone-free state. CONCLUSIONS: A calyceal diverticular stone can be treated with PNL or URS in most cases, although they are technically challenging procedures. In both procedures, access into the diverticulum is the most important step for a successful outcome. If access can be gained, preoperative ESWL could facilitate clearance of the stone and reduce the operating time, as there is no need for intraoperative lithotripsy.

The Availability of the Supracostal Percutanous Nephrolithotomy / 대한비뇨기과학회지

PURPOSE: The supracostal access for percutanous nephrolithotomy (PCNL) is a more useful approach in certain situations according to the position of the kidney, location of the calculi, or configuration of the collecting system. We attempted to assess the availability of supracostal approach based on the experience with supracostal approach in treating the complex renal stone and upper ureteral stones at our institution. MATERIALS AND METHODS: The medical records of 26 patients who underwent sup racostal PCNL procedure, between April 1996 and January 2001 were reviewed retrospectively. Under the general anesthesia, 11th-12th intercostal space was selected for the puncture site. Before the needle was passed between the ribs, the lung was deflated completely to prevent thoracic injury. RESULTS: Mean operating time and hospital stay were 81 minutes and 6.7 days, respectively. The stone-free rate after supracostal PCNL was 73% (19 patients). Extra corporeal shock wave lithotripsy (ESWL) was needed to treat residual stones in 7 patients (26%). After supracostal PCNL followed by ESWL, the stone-free rate rose to 88% (23 patients). Three patients (11%) developed pleural effusion postoperatively, one of whom had chest tube placed, the others improved with conservative management. Except for the pleural effusion, there were no complications such as atelectasis, pnemothorax, hemothorax, or injury to the liver or spleen. CONCLUSIONS: Since the complication rate can be kept to minimum with strict precaution, there is no reason to hesitate supracosatal PCNL, when upper pole punc ture is needed and the desired puncture site is above 12th rib.

Pediatric Urolithiasis during the Past 10 Years: Retrospective Analysis / 대한비뇨기과학회지

PURPOSE: For better understanding of the clinical characteristics and outcomes of management in pediatric urolithiasis, we report our experience with pediatric urolithiasis during the past 10 years. MATERIALS AND METHODS: We retrospectively reviewed the records of 56 pediatric patients with urolithiasis between May 1990 and May 2000. The mean age of the patients was 8.4 years (3 months-18 years) with sex ratio of 1.2:1.0 (male:female). We described initial symptoms, risk factors, location and size of stones, stone composition, treatment outcomes and complications. Metabolic evaluations were performed in 26 patients. RESUTLS: Metabolic abnormalities were found in 13 (23%) and all of them had hypercalciuria. In 3 of these patients, hyperuricosuria was also detected. Urinary tract anomalies were discovered in 10 (18%), all of whom were under age of 10 and underwent surgical reconstruction except for 1 patient who had horseshoe kidney and was lost during follow-up. For the treatment, 28 patients (50%) were treated by SWL. Other treatment modalities consisted of ureteroscopic lithotripsy in 3, pyelolithotomy in 2 who had large staghorn stone (>5cm), and cystolitholapaxy in 2. Spontaneous stone passage was observed in 8 patients (14%). For those who underwent SWL, stone free rates of the first, second and third session were 78%, 96% and 100% respectively. There were no major complications. CONCLUSIONS: Pediatric patients with urolithiasis requires evaluation for metabolic and structural abnormalities. Most of the urinary stone disease in the pediatric age group without structural anomalies could be effectively treated by SWL with minimal morbidity whereas those with structural anomalies necessitating surgical reconstruction are the best candidates for open surgery.

Ureteroscopic Management of Large Distal Ureteral Stones / 대한비뇨기과학회지

No abstract available.

Laparoscopic Orchiopexy for Intra-abdominal Testis: Complications and Technical Aspects / 대한비뇨기과학회지

No abstract available.

A case of Intrapelvic Wilms' Tumor / 대한비뇨기과학회지

No abstract available.

Early Experiences on the Retrograde Endopyelotomy in Primary Ureteropelvic Junction Obstruction in Adults / 대한비뇨기과학회지

No abstract available.

Granulosa Cell Tumor Arising in the Paratesticular Area: A case report

Granulosa cell tumor of the testis is extremly rare in adult males and granulosa cell tumor occurring in the paratesticular area has not been reported. We report a paratesticular granulosa cell tumor in a 34-year-old man who presented with a 5.5 cm sized scrotal mass. The tumor was present in the paratesticular area near the head of epididymis. It was located in the tunica and completely separated from the testis by thick fibrous tissue. Microscopically, the tumor exhibited solid, microfollicular, and trabecular patterns. The tumor cells had ovoid to elongated nuclei with longitudinal intranuclear grooves and one or two nucleoli and scanty cytoplasm. Mitoses were relatively frequent with an average number of 9/10 HPFs. The tumor extended into the visceral tunica vaginalis and showed multiple lymphatic tumor emboli. Immunohisto chemical stains revealed diffuse strong positivity for inhibin, vimentin, and keratin and diffuse weak positivity for estrogen and progesteron receptor. Placental alkaline phosphatase (PLAP) and epithelial membrane antigen (EMA) were negative. On electron microscopic examination, tumor cells were polygonal and had large indented nuclei. The cytoplasm contained a moderate number of small round mitochondria, abundant rough and smooth endoplasmic reticula, and a few lipid droplets. Small aggregates of intermediate filaments and intercellular junctions were observed. The patient was alive and well 5 months after orchiectomy. This is the first case of adult granulosa cell tumor arising in the paratesticular area.

Optimal Timing of Surgery in Neonatal Ureteropelvic Junction Obstruction / 대한비뇨기과학회지

PURPOSE: There is no agreement in management of ureteropelvic junction obstruction (UPJO) found in neonatal period. We report our clinical results of newborns with UPJO who had been managed with our fixed protocol prospectively. MATERIALS AND METHODS: According to our protocol, we performed ultrasonography and MAG-3 scan to 45 neonatal UPJO patients at 1, 3, 6 month of age. The patients were divided into three groups, Group I(T1/2>20min, RF20min, RF>35%) and Group III(T1/235%) according to the results of MAG-3 renal scan. The patients received pyeloplasty when belonged to Group I on follow-up renal scan or progression of hydronephrosis on ultrasonography. RESULTS: At one month of age, 5 patients belonged to Group I, 13 patients to Group II and 27 patients to Group III. In Group I, we performed the operation to all five patients within three month of age. Thirteen patients of Group II showed deterioration of renal function in 3, improvement of renal excretion in 3 and no change in 7 patients within 6 month follow-up respectively. However operations were performed in 10 patients within 6 month of age. The reasons for operation in Group II were as follows: the deteriorated renal function in 3, progressed or severe hydronephrosis in 4, and, urinary tract infection in 3 patients. All 27 patients of Group III showed no deterioration of renal function and no significant obstruction on follow-up studies. Except one patient with recurrent UTI, all of the operated cases have maintained good renal function and nonoperative cases also have shown good renal function until one year old. CONCLUSIONS: By our management protocol we could choose appropriately the cases which required early intervention or observation without impairment of renal function in neonatal UPJO patients.

Prognostic factors of invasive bladder cancer / 대한내과학회지

Transitional cell carcinoma(TCC) of the bladder is confined to mucosa or submucosa on initial presentation. However, high grade superficial tumors tend to recur and progress to muscle invasive or metastatic diseases. Regardless of radical cystectomy in invasive bladder cancer, a poor prognosis was noted due to local recurrence and distant metastasis in recent studies. In this study, the clinical and pathological factors affecting survival of patients with muscle invasive bladder cancer were analyzed. METHODS: A total of 105 patients with histopathologically verified muscle invasive bladder cancer who were admitted to Asan Medical Center between August 1989 and August 1998 were reviewed retrospectively. The clinical manifestations, laboratory findings, and histopathological findings at initial diagnosis were evaluated. Overall survival, disease free survival, and disease specific survival according to many prognostic factors were also analyzed. RESULTS: The factors affecting overall survival of muscle invasive bladder cancer were age, sex, TNM stage, performance status, tumor size, invasion of deep bladder muscle, tumor grade, lymphovascular invasion, and complete resection of tumors. In patients with completely resected bladder cancer by radical cystectomy, tumor size, deep bladder muscle invasion, stage, and lymph node involvement were significant prognostic factors. In patients who had either incomplete resection of bladder cancer or in whom no operation was performed, the survival rate was lower in cases with lymph node involvement or hemoglobin level of less than 10 g/dl. CONCLUSION: After radical cystectomy, the recurrence rate appeared to be higher in solid tumors with deep bladder muscle invasion and lymphovascular invasion on cystoscopic findings. Overall survival was higher in patients with lower tumor stage, no lymph node involvement, and completely resected bladder cancer. Age and sex had no significant correlation with overall survival. No apparent survival advantage was noted in those patients who received post-operative chemotherapy. However, prospective randomized controlled studies are necessary to evaluate the benefit of adjuvant chemotherapy in muscle invasive bladder cancer.