Intravesical Therapy for Superficial Bladder Cancer: Advances and Future / 대한비뇨기과학회지

No abstract available.

Results of Varicocele Surgery According to Operative Technique / 대한남성과학회지

PURPOSE: A varicocele first develops in early adolescence and can affect testicular growth, function, and histology. Tease gonadotoxic effects, if progressive, may explain why, in adults with infertility, normal fertility returns after varicocele ligation in 20% to 50% of the cases. Therefore, serveral investigators have proposed prophylactic varicocele ligation. Various surgical techniques for varicocelectomy have been described, including high retroperitoneal, inguinal, and laparoscopic approaches. We report our experience using three different operative techniques for surgical correction of varicocele. PATIENTS AND METHODS: Between February 1990 and May 1998, 107 patients with varicocele underwent surgical correction by the Palomo (N=52), modified Palomo (N=32), or Ivanissevich (N=23) technique. All patients had a thorough physical examination, including supine and standing scrotal examination, preoperatively. The indications for surgery included a left testicular volume loss of 3cc or more compared with the right testis, palpable varicocele, and pain. Outcome parameters were persistent or recurrent varicocele and operative time. Postoperative complications were scrotal edema, hydrocele, and testicular atrophy. The postoperative follow-up ranged from 2 to 58 month with an average of 30.2 month. RESULTS: In patients treated with the Palomo technique, postoperative recurrence was seen in one patient, and hydroceles developed in five patients. There was no varicocele recurrence or atrophy of the testis. The mean operative time was 48.2 minutes. Among patients treated with the modified Palomo technique, postoperative persistence and recurrence were seen in three and two patients, respectively. There was no atrophy of the testis. The mean operative time was 54.3 minutes. In patients in whom the Ivanissevich technique was used, postoperative persistence and recurrence were seen in one patient each. Testicular edema or hematoma and atrophy of testis occurred in three patients each. The mean operative time was 62 minutes. CONCLUSIONS: With the Palomo technique, there was only one patient who suffered postoperative recurrence, and there was no significant atrophy of the testis. The mean operative time was shorter than with the other techniques. The Palomo technique is a very effective and relatively fast procedure in our experience.

Clinical Usefulness of Prostatic Acid Phosphatase in Prostate Cancer : A Comparative Study with Prostate Specific Antigen / 대한비뇨기과학회지

PURPOSE: To evaluate the clinical usefulness of PAP in staging and monitoring of patient with prostate cancer, we performed a comparative study with PSA, retrospectively. METHODS: We evaluated 72 patients with prostate cancer. Of these patients 11 had stage A, 6 stage B, 10 stage C, 5 stage D1 and 40 stage D2 prostate cancer. Serum PAP level was measured in all 72 patients and serum PSA level was measured concomitantly in 42 patients. RESULTS: The mean initial PAP value was 13.40+/- 7.00 U/L. But only 40 (55.6%) had elevated PAP value above 1.5U/L at presentation. Of 55 advanced cases (stage C, D), 39 (76.9%) had elevated PAP values. Of the 42 patients, who underwent longitudinal PSA assessment, the mean initial PSA value was 178.0 +/- 33.3 ng/ml. Forty (95.2%) had elevated PSA value above 4 ng/ml at presentation. Of 41 advanced cases (stage C, D1, D2), 33 (80.5%) exceeded 50 ng/ml. None of the patient had elevated PAP value with normal PSA value at presentation. Among 42 patients, who had followed with longitudinal serum PSA and PAP, progression of the disease to the bone, lung, and rectum occurred in 26 patients; in all PSA was the first indicator of progression and in none of them PAP anticipated PSA elevation. CONCLUSIONS: Although PAP value usually reflects advanced prostate cancer (70.9%), serum PSA also reflects it (80.5%). Serum PSA monitoring is superior to serum PAP monitoring in predicting disease progression. The use of PSA and PAP jointly to stage and monitor prostate cancer did not appear to enhance the clinical utility over that of PSA alone.

The Efficacy of Erectile Perineal Ultrasonography in Stress Urinary Incontinence / 대한비뇨기과학회지

To know the diagnostic efficacy of erectile perineal ultrasonography in stress urinary incontinence, We compared erectile perineal ultrasonography with chain cystourethrography in 16 women (mean age: 54 years old) with genuine stress urinary incontinence. We measured the posterior urethrovesical angle (PUVA) at rest and during straining in both tests. The average value of PUVA at rest state was 143.4 in chain cystourethrography and 150.9 in perineal ultrasonography (p<0.001). During straining state, PUVA was 172.4 in chain cystourethrography and 177.2 in perineal ultrasonography (p<0.001). The difference between PUVAs at rest and during straining were 29.0 in chain cystourethrography and 26.3 in perineal ultrasonography U)<0.05). In conclusion, erectile perineal ultrasonography is non-invasive, simple, comfortable and useful diagnostic method in stress urinary incontinence. So we think that erectile perineal ultrasonography can replace the chain cystourethrography to diagnose the stress urinary incontinence.

Intravesical Bacillus Calmette-Guerin Therapy of Superficial Bladder Tumor : Result of Long-Term Follow-Up / 대한비뇨기과학회지

PURPOSE: Bacillus Calmette-Guerin (BCG) is the most effective intravesical agent for patients with superficial bladder cancer, but the long-term efficacy of BCG has not been established. We report our long-term experience of intravesical BCG therapy in the recurrence and progression for superficial bladder cancer. PATIENTS AND METHODS: Between 1985 and 1993. high risk patients with superficial bladder cancer were received complete TURB plus intravesical BCG (n=77). 120mg Tice-Chicago strain BCG was administered weekly for 6 weeks and then monthly for 3 months. Patients were considered treatment failure if either urinary cytology or biopsy results were positive for tumor on every 3 to 6 months followup examination. All patients reported have had a minimum 2-year followup, with the mean of 63 months. RESULTS: The 1st course of BCG was successful in 47 (6696) of 71 patients treated for prophylaxis and 3 (50%) of 6 treated for carcinoma in situ. Subsequent progression of disease occurred in 6 patients (8%) and cystectomy was performed in 2 patients (3%). The response rate for the total patients population treated with the 1st course was 65% (50 of 77). Of 27 patients who failed the 1st treatment course 21 patients were given the 2nd BCG treatment course. Of the 2nd BCG course, subsequent progression of disease occurred in 3 patients (14%), and cystectomy was performed in 2 patients (9%). Thirteen (68%) had complete response and 5 (26%) had new tumors, who had rendered free of disease after TURB plus intravesical therapy (mitomycin and/ or BCG). Although serious BCG complications (hepatitis, miliary Tbc, sepsis) were observed in 2 patients, side-effects were self-limiting and well controlled in the majority of patients (fever, bladder irritability, and hematuria). CONCLUSIONS: Intravesical BCG therapy seems to be effective to prevent recurrence and progression of superficial bladder cancer with long-term follow-up. However, we must note the possibility of fatal generalized complications in patients with grossly trauma of lower urinary tract.

Prostate Cancer Detection in Clinical Urologic Practice : Comparison of Digital Rectal Examination, Serum PSA Level, and Transrectal Ultrasonography / 대한비뇨기과학회지

We examined 990 self-referred men with one of urologic diseases over age 50 years to compare clinical usefulness of digital rectal examination(DRE), serum PSA level, and transrectal ultrasonography of the prostate(TRUS) in a screening program for prostatic cancer. Biopsy was performed in 201(20%) cases, of which 20 percent was diagnosed as prostate cancer. Sensitivity of DRE was 68%, specificity was 91%, and positive predictive value was 53%, respectively. Positive predictive values are 26% in cases with serum PSA level above 4ng/ml, 36% in cases with serum PSA above 10ng/ml and 40% for TRUS, respectively. When serum PSA below 4ng/ml and negative DRE, the positive predictive value was merely 6%. But when serum PSA above 10ng/ml and positive DRE, the positive predictive value increased to 72%. When serum PSA below 4ng/ml, negative DRE and negative TRUS, the positivepredictive value was merely 7%. However when serum PSA above 10ng/ml, positive DRE and positive TRUS, the positive predictive value was 80%. We conclude that DRE has greater diagnostic effect than the serum PSA level greater than 10ng/ml or hypoechoic area on TRUS and DRE with a serum PSA concentration is considered as an effective screening method of prostatic cancer in all urologic patients over 50 years of age. If DRE and serum PSA level are normal, there is no reason to proceed with TRUS and/or biopsy of the prostate.

Significance of Invasion to the Muscularis Mucosae on the Progression of Superficial Bladder Cancer / 대한비뇨기과학회지

We tried to determine the significance of invasion to the muscularis mucosae on the progression and recurrence of the superficial bladder cancer. Muscularis mucosae was composed of the smooth muscle bundles around relatively large vessels and found in the lamina propria approximately midway between the surface mucosa and the true muscular layer, lying parallel to the mucosa. Between January 1984 and December 1993, 81 patients with diagnosed superficial bladder cancer showing lamina propria invasion (pTl) were treated by transurethral resection (TUR) at our hospital. The mean age was 59.4 years ( range, 31-86 years), the mean follow-up period was 35.3 months ( range, 13-120 months) and the male : female ratio was 69 : 12. We subclassified superficial bladder cancer showing lamina propria invasion into two groups with ( pT1b) or without ( pT1a) cancer invasion to the muscularis mucosae. The muscularis mucosae was identified in 58 (71.6%) of 81 cases. In the other cases ( 28.4% ), relatively large vessels were used as the landmark instead of the muscularis mucosae. Of 81 bladder cancers, 52 (64.2%) were diagnosed as pT1a and 29 (35.8%) as pTlb. The progression rate of pT1b cancer (41.4% ) was significantly higher than that of pT1a cancer (3.8% ) (p= 0.001). And the recurrence rate of pT1b cancer (55.2% ) was significantly higher than that of pT1a cancer ( 26.9 %)(p= 0.024). In conclusion, superficial bladder cancer invading to the muscularis mucosae has a high risk for disease progression after TUR. Careful follow-up examination and aggressive therapy should be recommended in patients with these tumors.

Predictive Factors for Successful Surgical Outcome of Benign Prostatic Hypertrophy / 대한비뇨기과학회지

One hundred fifty seven patients with benign prostatic hypertrophy(BPH) under going trans. urethral resection of prostate( TUR - P) entered in this study in order to search for factors predictive of a successful outcome. In the follow-up period of 3 months to 7 years, a strictly successful result was achieved in 122 patients(78% ). On analysis of the success rate, 5 favorable factors and 8 unfavorable factors were noted. A symptomatic large prostatic adenoma proven by IVU, TRUS will imply a higher success rate. On uroflowmetry, obstructive BPH proven by maximal flow rate of less than l0 ml/sec and constrictive obstructive flow pattern can also predict a satisfactory outcome. The unfavorable factors always come from a small adenoma, uncertain irritative symptoms and detrusor underactivity. Patients with more than 2 unfavorable factors should be investigated carefully before surgery. The presence of 2 favorable factors without unfavorable factor will usually predict the best surgical outcome.

Significant Issues Derived from the Choice of a PSA Test for Measuring PSA in Serum: Comparison of IMx Enzyme immunoassay and ELSA Immunoradiometric Assay / 대한비뇨기과학회지

Prostate specific antigen (PSA) has become established as the most useful serological marker for monitoring patients with prostate cancer. However, the benefits of serum PSA values are controversial in screening procedures for prostate cancer due to the rather low specificity of PSA test. To determine if different assays yield comparable results, we compared the IMx PSA enzyme immunoassay and the ELSA PSA monoclonal immunoradiometric assay. We analyzed 72 serum specimens from 68 patients with prostatic disease (12 patients with cancer, 47 benign hyperplasia and 9 prostatitis) and 13 from normal controls by both assays. Results from the assays revealed close linear correlation but the ELSA PSA assay yielded values 1.5 times those of the IMx PSA assay In 13 patients with histologically diagnosed benign prostatic hyperplasia, number of patient with PSA value over l0 ng/ml measured by IMx and ELSA assay were 2(15% ) and 4(31%), respectively. We conclude that the proportional bias between assays demonstrates a need for improved standardization of PSA assays.

Clinical Experience and Indication of Transurethral Microwave Thermotherapy (TUMT) in Benign Prostatic Hyperplasia / 대한비뇨기과학회지

Transurethral microwave thermotherapy (TUMT) is a new treatment modality for benign prostatic hyperplasia (BPH). From October 1992 to May 1993. among patients with BPH who are treated by TUMT (50watt. 915MHz), 40 patients who are followed up appropriately for 3 months are selected to analyze the effectiveness and indication of TUMT. Patients were divided into 4 groups according to voiding symptom and prostatic volume by transrectal ultrasonography (TRUS) : prostatism group (Group A, 27 cases) and urinary retention group (Group B, 13 cases), prostatic volume 40gm and less (Group I, 27 cases) and more than 40gm (Group II, 13 cases). We reviewed subjective symptoms of patients with Madsen & Iversen symptom score and examined urine analysis, PAP, PSA, uroflowmetry and TRUS beforeand after TUMT. The patients underwent 1 hour session on an out-patient basis with local anesthesia. The average age of patients was 70.9. Significant differences in symptom score, maximal flow rate and residual urine volume were observed in Group A and Group I compared with Group B and Group II (p<0.05). Complications were minimal, consisting of bladder spasm(7), urinary retention(4), hematuria(4) and urinary tract infection(1). We could observe the improvement of subjective symptoms and objective parameters after TUMT. Patients without urinary retention or with relatively small prostate ( <40gm) had a superiority in effectiveness. However. we failed in the cases of old age (more than 80 years old), poor in general condition and associated neurogenic bladder. Though TUMT is effective alternative treatment on patients with BPH, we considered that the selection of patient is very important to get better effectiveness.

Results and Indication of Patients with Superficial Bladder Cancer to a Second Course of Intravesical Bacillus Calmette-Guerin / 대한비뇨기과학회지

Although initial and additional course of intravesical bacillus Calmette-Guerin (BCG) immunotherapy have proved effective in the treatment and prophylaxis of superficial bladder cancers, including carcinoma in situ, a significant minority of patients will fail such therapy and criteria for selection of patients who may benefit from an additional course of BCG have not yet been established. In an attempt to identify patients who are likely to respond, we analyzed our experience in patients with superficial bladder cancer treated with a subsequent course of BCG. Of 86 patients who received an initial once a week for 6-week and once a month for 3-month of intravesical BCG for superficial transitional cell carcinoma of the bladder 18(21 per cent) were treated with another course. First course of BCG was successful in 50 (66 per cent) of 76 patients treated for prophylaxis and 4 (40 per cent) of 10 treated for carcinoma in situ. The response rate for the total patients population treated with first course was 62.8 per cent (54 of 86). Of 32 patients who failed the initial treatment course 18 were given an additional BCG therapy, subsequent progression of disease occurred in 2 patients( 11 per cent). Of the l6 patients (89 per cent) without progression 10 (56 percent) had a complete response and 6 (33 per cent) had new tumors. and they were rendered free of disease after transurethral resection. The median interval between course 1 and 2 of intravesical BCG was 12 months (range, 4-40 months) and the median followup after course 2 was 22 months (range, 4-69 months). The median duration of response to course 1 of BCG was shorter for patients with disease progression or recurrence after course 2 than for those with no progression or recurrence (8 and 15 months) . The results suggest that initial and subsequent course of intravesical BCG are effective in the treatment and prophylaxis of superficial bladder cancer, including carcinoma in situ, and a subsequent treatment with BCG is most likely to be useful in patients who have a sustained response to the initial treatment.

Serum Prostate Specific Antigen. Clinical Assessment as a Tumor Marker for the Prostate Cancer / 대한비뇨기과학회지

We evaluated a clinical usefulness of prostate specific antigen (PSA) as a tumor marker for prostate cancer. Serum PSA values were obtained from 32 patients with prostatic adenocarcinoma(group I ),81 with histologically diagnosed BPH(group II ) and 147 with clinically diagnosed BPH(group III). Mean PSA values were 121.5, 9.3 and 3.6ng/ml, respectively. To enhance the accuracy of serum PSA, we have used the quotient of serum PSA and prostatic volume, PSA density. In group I, 31 patients(97%) had PSA values over 10ng/ml and PSA density over 0.15. In group II, 27 patients(33%) had PSA values over 10ng/ml and 35(43%) had PSA density over 0.15. The PSA values of extraprostatic cancer were higher than that of organ-confined cancer in group I (p 0.05). Of 18 patients with stage D2 prostate cancer treated with orchiectomy, 11 had PSA values decreased to normal range within 6 months. Serum PSA values of 2 patients who have clinically progressive disease were increased after 6 months. In 3 of 4 patients treated with radiotherapy during follow-up of 18 months, post irradiation PSA values were 2.4, 5.6 and 11.2ng/ml, respectively. Only 1 patient who have a positive bone scan had an elevated PSA value of more than 100ng/ml. We suggest that serum PSA is not a excellent marker on screening test for prostate cancer because of a high false positive rate. However, PSA is useful for following disease progression, response to therapy and determining indication of bone scan.

Impact of Vesicoureteral Reflux of the Renal Transplantation Candidate on Urinary Tract Infection and Graft Surviva1 / 대한비뇨기과학회지

A policy concerning vesicoureteral reflux (VUR) in the renal transplantation candidate has been surgical correction or nephroureterectomy before renal transplantation because theoretically immunosuppression can favour the occurrence of urinary tract infection(UTI), pyelonephritis or bacteremia. Nevertheless, surgical procedures prior to transplantation are associated with considerable morbidity and majority of teams have adopted a more conservative approach. The post-transplantation urinary morbidity of reflux patients is not well known. From November 1982 to October 1992, 247 living renal transplantation were performed by our kidney transplantation team. Of 247 patients who obtained voiding cystourethrography before transplantation, 209 patients (84.6% ) were checked urinalysis, serum BUN/creatinine and graft status following surgery every a week. Native VUR was seen to occur in 24 of the 209( 11.5%). Acute pyelonephritis( 16.7% vs 8.6% ) and graft survival(29% vs 23%) were not correlated with the presence or absence of reflux. Regardless of reflux, most of UTI episodes(79 %), including, pyelonephritis and asymptomatic UTI, developed within the first year of surgery. In summary, pre-transplantation surgicalcorrection or nephroureterectomy should not be per formed routinely in VUR patients because of a little morbidity and similar incidence of UTI episodes to that of non-reflux patients. Close attention and prompt, specific treatment is necessary to minimize the adverse influence of UTI during the first year following renal transplantation.

Risk factors and survival in patients with recurrence of bladder tumors following surgery for transitional cell carcinoma of the upper urinary tract / 대한비뇨기과학회지

Transitional cell carcinoma (TCC) of the upper urinary tract is a relatively rare malignancy that accounts for only 5 to 10% of all urothelial tumors. A patients with an upper tract TCC has a 25.8 % to 35.8 % probability of developing a subsequent TCC of the bladder. usually on the source of the upper tract TCC lesion. A retrospective analysis of 46 patients with an upper urinary tract (UUT) TCC which was treated surgically. was performed in relation to the development of a subsequent bladder tumor. In this study, we tried to clarify the risk factors of bladder tumor recurrence following surgery for UUT tumor and the survival rates of UUT tumor with and without a subsequent bladder tumor. Treatment for UUT tumor was total nephroureterectomy with bladder cuff excision in all 46 patients. In 25 of the 46 patients (54.3%), bladder tumors developed following surgery of a UUT tumor. Transurethral resection of bladder tumor and intravesical chemo- or immunotherapy were performed in all patients with subsequent bladder tumor. Patients with a subsequent bladder tumor consisted of multiple UUT tumor (12 patients), lower ureteral tumor (7 patients) and renal pelvis tumor (6 patients). The follow-up period varied from 24 months to 118 rnonths, with a mean of 64 months. Mean number of bladder recurrence was 2.5. The interval from surgery for UUT tumor to diagnosis of the initial bladder recurrence ranged from 8 months to 28 months, with a mean of 18 months. High stage and grade (>p T2, >G II), more than two tumors in the UUT and vascular or lymphatic invasion had a significant influence on the rate or bladder tumor recurrence (p<0.05). Difference of 5-rear survival rate of UUT tumor was insignificant in patient with (58%) and without (62%) subsequent bladder tumor (p<0.05).

The correlation of serum prostate specific antigen(PSA) and prostatic volume measured by transrectal ultrasonography in the diagnosis of benign prostatic hyperplasia / 대한비뇨기과학회지

We investigated a correlation of serum prostate specific antigen(PSA) and preoperative prostatic volume measured by transrectal ultrasonography (TRUS) in 66 patients with pathologically con- firmed benign prostatic hyperplasia (BPH), as aids in the early detection of prostate cancer and in the improvement of specificity in BPH. The preoperative serum PSA value was also measured in 18 patients with pathologically confirmed prostate cancer and 15 men without prostatic disease as normal control using Tandem-R PSA radioimmunometric assay. There was a highly significant correlation between natural logarithm transformed PSA(In PSA) and non-transformed prostatic volume by linear regression analysis(r=0.6668, p<0.0001). Given above data, we determined a volume adjusted 95th percentile upper confidence limit for n PSA as an appropriate cutoff between normal and abnormal PSA value, according to prostatic volume in BPH. In the patients with BPH and prostate cancer, sensitivity, specificity, diagnostic accuracy and positive predictive value were 94%, 72%, 68% and 48%, respectively. A statistical results by the volume-adjusted cutoff for in PSA was similar to that at 10 ng/ml as cutoff for PSA value. Above 40ml in prostatic volume, however, a false positive rate was decreased in inverse proportion to prostatic volume in BPH. In summary, the prostatic volume must be considered in BPH patients with elevated serum PSA value, negative digital rectal examination and negative TRUS of prostate. And when the volume adjusted PSA cutoff is clinically applied to BPH patients for the early detection of prostate cancer, we thought that the false positive rate can be decreased in BPH patients.

Combined cisplatin and radiotherapy for patients with invasive bladder carcinoma: a preliminary report / 대한비뇨기과학회지

Ten patients with muscle-invading bladder carcinoma (clinical stage T2-TsB Nx Mo, T.C.C.) who were not candidates for cystectomy were treated with combined cisplatin and external-beam radiotherapy From Mar. 1990 through Feb. 1992. Results of the combined therapy had been compared with those of the radiation therapy alone. Using this combined therapy, 5(71.4%) of 7 patients achieved partial remission with a mean follow-up of 10.8 months. Three patients died of unrelated causes. Partial remission following radialion therapy alone was 6 (60%) of 10 patients. Patients with complete remission was none in the two groups. All patients in the combined therapy group were nauseated on the day treatment was given and 7 patients developed total atopecia. The malaise associated with cisplatin therapy tended to increase with the number of courses. All patients refused further treatment on this account (mean amount of cisplatin received: 3 courses). Combined cisplatin and radiotherapy may be applied to patients unsuited for radical cystectomy. Tolerance to cisplatin and radiotherapy was poor due to relatively severe toxicity, poor performance status with old age and underlying medical disease. Refinement of this protocol, careful selection of patients and longer follow-up will be necessary to determine the real benefit of this alternative modality.

Integrated assessment of clinical parameters for transurethral resection of the prostate / 대한비뇨기과학회지

We reviewed 90 patients of benign prostatic hyperplasia(BPH) to make a integrated assessment of the various clinical parameters that most urologist use to decide when to perform a transurethral resection of the prostate(TURP). Such parameters included symptom score by Madsen & Iversen scoring sheet prostate size by digital rectal examination or transrectal ultrasonography, maximum flow rate by unflowmetry and anatomical obstruction on prostatic urethra by cystoscopy, As compared with each parameter, maximum flow rate and prostate size correlated with anatomical obstruction on prostatic urethra(p0.05). Postoperative symptom score was less than that in preoperation. Postoperative maximum flow rate was improved(p<0.05). In summary. uroflowmetry is the most noninvasive and significant parameter of determining the indication of TURP in symptomatic BPH patients and estimating the postoperative follow-up of urinary outlet obstruction. Transrectal ultrasonography may be helpful to choosing the operative method and symptom score may be helpful to evaluating the results after TURP.

Testis tumor: A clinical experience of 20 years / 대한비뇨기과학회지

Forty-six patients with testicular tumor were treated at our hospital From 1971 to 1990. There were 25 children (13 yolk sac tumors, 10 teratomas, 1 teratocarcinoma and 1 acute lymphocytic leukemia) and 21 adults(11 seminomas, 4 non-seminomatous germ cell tumors and 6 non-germ cell tumors). Testicular lumors with clinical evidence of cryptorchidism were 4 seminomas and 2 non seminomts. Serum AFP or HCG were observed in 8 patients of 8 seminomas, 1 of 5 teratomas, 7 of 9 yolk sac tumors and 4 or 5 non-seminomatous germ cell tumors(NSGCT). Four stage 1 seminomas and 1 NSGCT were tumor free of 2 years after radical orchiectomy and 2 of 4 seminomas were received prophylactic radiotherapy. Two stage II seminomas and 1 NSGCF treated with PVB nomas and radiotherapy were tumor free of 2 years but stage III seminomas and NSGCT died during chemotherapy. All stage 1 yolk sac tumors and teratomas were tumor Free of 2 years by surveillance only following radical orchiectomy but stage II and III yolk sac tumors died during chemotherapy. We have suggested that poor result of stage III testicular tumors can be attributed to few cases with more aggressive and more toxic chemotherapy in the unfavorable prognosis disease(advanced extent) and poor compliance of patient of therapy.

Vesicoureteric reflux following renal transplantation : Urinary tract infection and risks / 대한비뇨기과학회지

Vesicoureteric reflux into the transplanted kidney has been described, but in general it has been disregarded and is not mentioned as a complication in recent reviews. But it may be harmful to the renal function in the long-term and has high incidence of symptomatic pyelonephritis with urinary tract infection in other studies. We studied prospectively 37 patients, who received living renal transplantation without complete antireflux surgery, out of 45 patients during the period from June 1991 to September 1992. Voiding cystourethrogram and urine culture were obtained all least once in 37 of 45 patients (82.2%) and serum BUN/creatinine and urinalysis were checked following surgery, weekly. These patients did not demonstrate an increased incidence of reflux, urinary tract infection or abnormalities of renal function. We conclude that a simple direct implantation of a normal ureter into a normal bladder is safe and should be considered the procedure of choice in renal transplantation and recommend that all functioning transplants be studied at yearly intervals with an IVP and VCUG to determine the true incidence of urologic complications.

An objective score to predict upper tract deterioration in spinal cord injury patients / 대한비뇨기과학회지

The primary objective in taking care of the spinal cord injury patients is preservation of renal function. We evaluated 28 cases with spinal cord injury, who underwent intravenous pyelography, voiding cystourethrography and urodynamic assessment to determine the effects of low bladder compliance, hyperreflexia and detrusor-sphincter dyssynergia on the upper tact during the past 5 years period. And also, an objective hostility score was introduced that would predict the fate of the upper tracts and help to determine the need of treatment. Urodynamic evaluation revealed that 17 or 28 cages (67 %) had detrusor hyperreflexia and 11 cases (33 %) had detrusor areflexia. Of the 28 cases. 12 cases (44 %) had low compliant bladder. Hydronephrosis was present in six of the 12 eases (41 %) that had low compliance. These results were in sharp contrast to the normal compliant bladder in which two of 16 cases (12 %) had hydronephrosis. No case with a hostility score of less than 5 went on to develop upper tract changes. In contrast, eight of 10 cases with scores of 6 or more went on to develop upper tract change. In conclusion, the patients with the hostility score of 6 or more were significantly at risk of developing upper tract damage. So, these patients should have adequate and frequent follow-up evaluation.