Guidelines for Diagnosis and Treatment of Pancreatic Cystic Neoplasms Based on Radiology / 中国医学科学院学报

As the detection rate of pancreatic cystic neoplasms (PCN) increases,recommendations or guidelines for the diagnosis and treatment of PCN have been released from professional organizations.From the perspective of radiology,we compared seven guidelines in terms of general introduction,preoperative monitoring methods and strategies,stratification of risk factors,surgical indications,and postoperative follow-ups,aiming to provide references for the evaluation of images and the formulation of individualized approach for the treatment of PCN.

Patient-Controlled Nutrition After Abdominal Surgery: Novel Concept Contrary to Surgical Dogma

PURPOSE: According to surgical dogma, patients who are recovering from general anesthesia after abdominal surgery should begin with a clear liquid diet, progress to a full liquid diet and then to a soft diet before taking regular meals. We propose patient-controlled nutrition (PCN), which is a novel concept in postoperative nutrition after abdominal surgery. METHODS: A retrospective pilot study was conducted to evaluate the feasibility and effects of PCN. This study was carried out with a total of 179 consecutive patients who underwent a laparoscopic appendectomy between August 2014 and July 2016. In the PCN group, diet was advanced depending on the choice of the patients themselves; in the traditional group, diet was progressively advanced to a full liquid or soft diet and then a regular diet as tolerated. The primary endpoints were time to tolerance of regular diet and postoperative hospital stay. RESULTS: Time to tolerance of a regular diet (P < 0.001) and postoperative hospital stay (P < 0.001) showed statistically significant differences between the groups. Multivariate analysis using linear regression showed that the traditional nutrition pattern was the only factor associated with postoperative hospital stay (P < 0.001). Multivariate analysis using logistic regression showed that traditional nutrition was the only risk factor associated with prolonged postoperative hospital stay (≥3 days). CONCLUSION: After abdominal surgery, PCN may be a feasible and effective concept in postoperative nutrition. In our Early Recovery after Surgery program, our PCN concept may reduce the time to tolerance of a regular diet and shorten the postoperative hospital stay.

Pregnane X Receptor agonist Increases the Expression Levels of the Plasma Membrane Monoamine Transporter

We evaluated the effect of the pregnane X receptor agonist, pregnenolone 16 alpha-carbonitrile (PCN) on the expression levels of plasma monoamine transporter (PMAT) in the intestine. Male C57/BL6 mice were divided into two 2 groups: mice in the PCN group (n=3) were administered PCN once a day for 4 days, while those in the control group (n=3) received the same volume of vehicle once a day for 4 days. After the mice were killed 24 h after administration of the last dose of PCN or vehicle, and the expression levels of PMAT in the intestine tissues were isolated and measured the expression level of PMAT using immunohistochemical and western blotting analyses. The expression level of PMAT expression levels in the small intestine increased after PCN treatment. These results suggest that the induction of PMAT may play a clinically significant role by increasing intestinal absorption of PMAT substrates such as metformin.

Availability of hs-C-reactive protein as Predictive Value of Acute Pyelonephritis with Patient of Urolithiasis

PURPOSE: The aim of this study was to determine early predictive value of acute pyelonephritis and urosepsis in patients with urolithiasis in the emergency department. METHODS: We retrospectively reviewed medical records of patients who visited the emergency department and were diagnosed with urolithiasis by computed tomography for three years. Patients with urolithiasis were grouped according to the presence of computed tomography (CT) findings with acute pyelonephritis. In baseline characteristics, laboratory and CT findings of the two groups were compared. Group 1 was defined as urolithiasis without acute pyelonephritis and group 2 was defined as urolithiasis with acute pyelonephritis. In addition, we compared the sepsis versus non-sepsis and percutaneous nephrostomy (PCN) versus non-PCN group in Group 2 for analysis of the hs-CRP level of each group. RESULTS: The total number of urolithiasis patients was 744. Among the patients, 84 (11.3%) had urolithiasis with acute pyelonephritis in CT findings. Age, sex, history of diabetes, history of urolithiasis, size of stone, duration of symptom, body temperature, blood pressure, heart rate, respiratory rate, leukocyte count, existence of pyuria, and hs-CRP differed significantly between the two groups, respectively. In multivariate logistic regression analysis, age, history of urolithiasis, existence of pyuria, and hs-CRP were shown to be independent predictors affecting acute pyelonephritis in patients with urolithiasis. The area under the receiving operator characteristics (ROC) curve for CRP was 0.820 (95% CI, 0.754-0.886) and leukocyte count was 0.631 [95% confidence interval (CI), 0.542-0.721]. Sepsis and PCN groups showed significantly higher hs-CRP level than non-sepsis and non-PCN groups. CONCLUSION: There were some independent predictive values of urolithiasis with acute pyelonephritis. It can be useful in early detection of acute pyelonephritis or sepsis, and it can be helpful in making treatment plans for patients of urolithiasis.

Efficacy of Percutaneous Nephrostomy During Flexible Ureteroscopy for Renal Stone Management

PURPOSE: Preoperative percutaneous nephrostomy (PCN) can be applied to urinary stone patients with pyelonephritis as well as obstructive uropathy; thus, some patients undergo flexible ureteroscopy (fURS) in the presence of a PCN tube. We evaluated the effectiveness of PCN during fURS for the management of renal stones. MATERIALS AND METHODS: We retrospectively analyzed 130 consecutive patients who underwent fURS for renal stones between January 2009 and December 2011. All fURS procedures were performed by a single experienced surgeon. The patients were divided into two groups depending on the presence of PCN during the surgery: patients with PCN (group 1, n=41) and patients without PCN (group 2, n=89). To evaluate operative outcomes, we compared success rates, operative times, and complication rates. We defined success as the absence of any residual stones in the kidney or stone fragments less than 2 mm that were too small to be extracted during follow-up. RESULTS: There were no significant differences in age, sex, body mass index, stone laterality, burden, or location between the two groups. The mean operative times of groups 1 and 2 were 50.1 and 58.3 minutes, respectively (p=0.102). The success rates of groups 1 and 2 were 95.1% and 82.0%, respectively (p=0.044). There was no statistically significant difference in the complication rate between groups 1 and 2 (p=0.888). CONCLUSIONS: Flexible ureteroscopy in the presence of PCN produced a superior outcome in terms of the success rate without increasing the operative time or complication rate. PCN may be helpful to induce better outcomes of fURS.

Application of Percutaneous Cervical Nucleoplasty Using the Navigable Disc Decompression Device in Patient of Cervical Herniated Intervertebral Disc: A Case Report

Recent years, various percutaneous procedures including cervical nucleoplasty have been developed for disc decompressions to relieve radicular pains caused by disc herniations. We report the application of percutaneous cervical nucleoplasty (PCN) by using the navigable disc decompression device in two patients of cervical herniated intervertebral discs (HIVD). A 38-year-old female diagnosed with C4-C5 disc extrusion with bilateral C5 roots impingement received nucleoplasty twice at C4-C5 disc level. After second procedure, her pain was improved from 6-7/10 to 1-2/10 by visual analog scale (VAS). The second case, a 51-year-male was diagnosed with C6-C7 disc extrusion with right C7 roots impingement and received the procedure at C6-C7 disc level. The pain improved from 8/10 to 3-4/10 by VAS. Successfully, we decompressed cervical herniated discs in 2 HIVD patients without major complications. The PCN with the navigable device will be recommended as an alternative treatment method for cervical HIVD.

Fragmented Pigtail Percutaneous Nephrostomy Tubes: Etiology and Management

PURPOSE: To review our experience with the management of fragmented and retained pigtail percutaneous nephrostomy (PCN) tubes and to explore the reasons for the fragmentation. MATERIALS AND METHODS: We retrospectively reviewed our institute database from January 2006 to December 2011 for patients who had undergone retrieval of fragmented PCN tubes. We assessed the preoperative factors, operative technique, and post-operative outcomes. RESULTS: A total of seven patients (4 males and 3 females) had been diagnosed with fragmented PCN tubes. The mean age of the patients was 41.5 years. Of the seven patients, five required antegrade instrumentation by way of a percutaneous tract to remove the foreign body, mostly along with stone retrieval. One patient underwent ureterorenoscopy and pneumolithotripsy for a ureteric stone along with ureteroscopic removal of the PCN fragment. Another patient underwent nephrectomy of the kidney containing the PCN fragment because it had become nonfunctioning. All patients were free of stones and symptoms on follow-up. CONCLUSIONS: A prolonged waiting period for definitive surgery, urinary infection, and associated stone disease are significant factors causing fragmentation of PCN tubes. Proper insertion techniques, regular timed changes of the PCN tube, appropriate care of the PCN tube, and early surgery for underlying stone disease are required to avoid this complication. Patients with retained PCN tubes can be managed effectively with antegrade or retrograde endoscopic techniques while definitive management of the primary pathology is carried out, without any additional morbidity.

Effect of pravastatin on transportation of scutellarin in mouse liver and its mechanism / 药学学报

This study is to investigate the transportation of scutellarin in cell and live models and study on mechanism of absorption and transport of scutellarin in mouse liver. The concentration of scutellarin in plasma and liver from control and pretreated groups was determined by high performance liquid chromatography. The uptake of scutellarin was examined in control hepatocytes group, induced hepatocytes group and induced hepatocytes plus pravastatin group. Pravastatin can affect the pharmacokinetics of scutellarin in mouse: CL is decreased while AUC is increased. The scutellarin absorption of hepatocyte induced group was higher than that of control group, but was decreased in the group with pravastatin added. The research showed that there was potential drug interaction between pravastatin and scutellarin. The drugs may compete for oatp2 mediated transport pathway consisted in the uptake of scutellarin in liver.

The Clinical Characteristics of Malignant Ureteral Obstruction Secondary to Non-genitourinary Malignancy / 대한비뇨기과학회지

PURPOSE: We assessed the success rate of internal ureteral stenting and the complications for patients with ureteral obstruction secondary to non-genitourinary malignancy. MATERIALS AND METHODS: Between January 2001 and December 2005, ureteral stenting were attempted in 62 patients with ureteral obstruction secondary to non-genitourinary malignancy. Their medical records were reviewed for the primary diagnosis, the symptoms, the degree of hydronephrosis, the location of obstruction, stent failure, the time period until stent replacement due to stent failure, the complications and the status at the last followup. RESULTS: A total 62 patients underwent an attempt at retrograde ureteral stenting for malignant extrinsic obstruction. The mean patient age was 57.6 years(range: 32-84) and the mean follow-up was 12.6 months. 44 patients(71%) were women, and the most common cancer diagnoses were cervical cancer(19), rectal cancer(16) and stomach cancer(11). A total of 23 patients(37%) required immediate percutaneous nephrostomy(PCN) referral. A total of 14 patients experienced late failure and required PCN. A total of 39 patients underwent stent replacement at a mean interval of 3.5 months. CONCLUSIONS: At almost 1 year follow-up, stent failure due to extrinsic compression occurred in 55.7% of the patients(37 of 62). We should carefully monitor patient who undergo ureteral stenting for ongoing obstruction and complication.

Bilateral Hydronephrosis Caused by Huge Uterine Myoma / 대한신장학회지

A 67-year old woman was admitted due to left femur neck fracture. Pre-operative laboratory data revealed azotemia, and kidney ultrasonogram and pelvis MRI showed bilateral hydronephrosis and huge uterine myoma. On past history, she had uterine myoma since her thirties, but she refused to undergo operation. We initially planned percutaneous nephrostomy (PCN). After stabilization of renal function, we performed subsequent total hysterectomy after insertion of catheters on both ureters, and PCN catheters were removed after confirming that both ureteral catheters worked well. During follow up period of two months after PCN, renal function was gradually improved, but it was not normalized. Size of removed myoma was about 25x15 cm, and histopathologic findings were consistent with leiomyoma. In conclusion, myoma uteri is one of the rare causes of bilateral hydronephrosis, and it may lead to irreversible damage to kidney if left untreated for a long time.

Comparison of the Two-stage Procedure with the One- stage Procedure for Percutaneous Nephrolithotomy / 대한비뇨기과학회지

PURPOSE: We evaluated the advantages of the two-stage procedure for percutaneous nephrolithotomy (PNL) for the management of renal calculi. MATERIALS AND METHODS: Between November 1999 and November 2003, 49 patients with renal calculi were treated with one-stage or two-stage PNL. The medical records of all the patients were retrospectively reviewed for complications associated with percutaneous nephrostomy (PCN), stone size, operation time, success rate, treatments for the postoperative remnant stones, the hospital stay and the complications associated with operation. RESULTS: Thirty cases underwent two-stage PNL and 19 cases underwent one-stage PNL. The mean age of the one-stage PNL group and the two- stage group were 55.6+/-14.7 years old and 58.9+/-12.5 years old, respectively. There were no significant differences between the two-stage PNL and one-stage PNL for the complications associated with the PCN procedure, stone size, the success rate and the hospital stay. The total operative time was significantly different between the two-stage and one stage PNL groups (136.1+/-51.6 min vs 191.1+/-56.9 min, respectively, p=0.02). Eleven total patients with postoperative remnant stones underwent additional extracorporeal shock wave lithotripsy in 8 cases, ureteroscopic removal of stone in 2 cases and PNL in 1 case. The complications associated with two-stage and one-stage PNL were fever, ureteral obstruction by fragmented stones, A-V fistula and discharge through the percutaneous nephrostomy catheter. CONCLUSIONS: Two-stage PNL is a more effective approach for the patients with renal calculi comparing to one-stage PNL in terms of the operation time, the operation-associated complications and the psychological and physical pressures on the patients and operators.

Renal Cyst Excision Through Camera Port Incision / 대한비뇨기과학회지

PURPOSE: In the treatment of symptomatic renal cysts, sclerotherapy has high recurrence rate. Laparoacopic cyst excision has high success rate but has some limitations concerning expensive devices, CO2 use and requiring trained laparoscopist. We conceived less invasive surgical technique for renal cyst excision. MATERIALS AND METHODS: The method is as follows. 1) Minimal skin incision of camera port size at PCN site nearest to the cyst. 2) Access to retroperitoneum by Kelly clamp and finger dilatation. 3) Finger dissection with or without ballooning. 4) Aspiration of cystic fluid. 5) Drawing the redundant cyst wall out of the incision. 6) Excision of the redundant cyst wall by open surgical method. RESULTS: Clinical trials of 5 patients have been performed since March 1999, with a mean age for the patients of 60 years old (range, 56-66), cyst size of 8.3cm (7.7-9.8), wound length of 2.4cm (2.1-3), operation time of 28 minutes (20-35) and blood loss of 1.6 Hb (0.5-3). There was no drain insertion except in one case, and no use of narcotics post op 2 days. Patients were discharged post op 3 days (2-5). There is no evidence of recurrence in short term follow up (mean 8 months, range 3-15). CONCLUSIONS: Though limited trials, we think expected merits over conventional laparoscopic surgery are better or comparative cosmetic results, no CO2 use, short operation time, less technical expertise and additionally economical advantages. If necessary, conversion to laparoscopic surgery, using the initial incision as camera port is possible during the procedures. So we suggest trial of this method before conventional laparoscopic renal cyst excision.

The Role of Endourologic Management for Tuberculous Ureteral Stricture / 대한비뇨기과학회지

PURPOSE: Tuberculous ureteral stricture causing a progressive obstructive uropathy is a common complication of renal tuberculosis. The aim of our study was to evaluate the effectiveness of early ureteral stenting or percutaneous nephrostomy (PCN) in patients with tuberculous ureteral stricture. MATERIALS AND METHODS: Seventy seven patients (84 renal units) with tuberculous ureteral strictures were analysed respectively. We evaluated the final outcome of involved kidneys according to the two different managements; medication only versus medication plus ureteral stenting or medication plus PCN. RESULTS: In our series, nephrectomy rate was about 51%. In cases treated with medication only, the nephrectomy rate was about 73%. While the nephrectomy rate was about 34% when treated with medication plus early ureteral stenting or PCN. The rate of reconstructive surgery for ureteral strictures was significantly different between the cases treated with medication only (8%) and medication plus early ureteral stenting or PCN (49%). Moreover, spontaneous resolution of the ureteral strictures was noted in 6 out of 12 renal units which had strictures in the course of medical therapy and were managed with early ureteral stenting. CONCLUSIONS: Early ureteral stenting or PCN in patients with tuberculous ureteral stricture may increase the opportunity for later reconstructive surgery and decrease the possibility of renal loss.

Histopathologic Changes of Kidney in Pediatric UPJ Obstruction / 대한비뇨기과학회지

INTRODUCTION AND OBJECTIVES: A kidney in the growing state and the possibility of spontaneous improvement are characteristics of the pediatric ureteropelvic junction obstruction (UPJO) that make the treatment of this disease difficult. We have tried to determine the histopathologic changes of the kidneys with UPJO relating to age, differential renal function and urinary tract infection (UTI). METHODS: The total number of patients was 38 (40 kidneys). The age at the operation time was under 3 months in 9 cases (9 kidneys), 3 to 12 months in 10 cases (10 kidneys), and 1 to 18 years in 20 cases (21 kidneys). Needle biopsies from 3 different sites at the lower pole of the kidney were taken. The tissue was blindly observed for the presence of irreversible change (arteriolar thickening, glomerulosclerosis, interstitial fibrosis and periglomerular fibrosis) and reversible change (inflammatory cell infiltration) by light microscopy. Each pathological finding was graded as I, II or III, and each grade was given a numerical value. Statistical analysis was done with ANOVA. RESULTS: Although the kidneys from patients under 3 months tended to show better histopathologic findings, there was no statistically significant difference in all 5 pathologic findings regardless of patient age. 5 cases (5 kidneys) with previous percutaneous nephrostomy (PCN) were not included in any group for analysis due to possible histologic changes of the renal parenchyma. Inflammatory cell infiltration, arteriolar thickening, glomerulosclerosis and periglomerular fibrosis were statistically significant in patients with previous or present UTI (14 kidneys) compared to the patients without UTI (26 kidneys). The patients with a mean differential renal function less than 30% (7 kidneys) as measured by DTPA or DMSA renal scan showed statistically significant changes in all of the 5 histopathologic findings compared to the patients with differential renal function greater than 30% (27 kidneys). 4 cases with bilateral UPJO (6 kidneys) were excluded from comparing the differential renal function. 5 kidneys with previous PCN had statistically significant degree of glomerulosclerosis compared to others. CONCLUSIONS: Although we did not determine whether pediatric UPJO affects renal growth, it is probable that statistically significant irreversible histopathologic changes do not occur according to age. Considering histopathologic findings only, differential renal function and UTI Should be key factors in deciding the management of pediatric UPJO. In addition, PCN seems to induce more severe histopathologic changes of the kidney.

Review or Ureteral Obstruction during ESWL Monotherapy without Ureteral Stenting for Staghorn Calculi / 대한비뇨기과학회지

ESWL monotherapy has been considered a valid initial treatment for staghorn calculi. In an effort to reduce post-ESWL obstruction, many urologists place ureteral stents before ESWL. The use of ureteral stents has proved to contribute to successful stone passage and to reduce post- ESWL morbidity but there also have been reports of complications that might have been caused by indwelling ureteral stents. From January 1989 to December 1995, we reviewed 29 patients with ureteral obstruction after ESWL (EDAP LT-01 & 02) monotherapy without ureteral stenting in 47 patients with staghorn calculi. Ureteral obstruction was occurred in 29 patients (61.7%); 16 (55.2%) in the upper ureter, 11 (37.9%) in the lower ureter, and 2 (6.9%) in the mid-ureter. Steinstrasse was occurred in 13 patients (13/29, 44.8%); 8 (61.5%) in the lower ureter, 4 (30.7%) in the upper ureter, and 1 (7.7%) in the mid-ureter. Ureteral obstruction was occurred regardless of the size of the staghorn calculi(length, breadth, volume). The method of resolving ureteral obstruction was additional ESWL (21 patients, 72.4%), and auxillary procedures including PCN (4 patients, 13.8%), push up procedure (1 patient, 3.4%), push up & double J stenting (1 patient, 3.4%), and ureterolithotomy (2 patient, 6.9%). Mean number of session of ESWL resolving ureteral obstruction was 3.27. Overall complete stone-free rate of staghorn calculi was 55.3%(26 patients). Our results indicate that postoperative ureteral obstruction is easily relieved without major complication by additional ESWL or auxillary procedures. Therefore, ie believe that ESWL monotherapy without ureteral stenting may be adequate treatment modality of staghorn calculi.

Endourologic Treatment of the Upper Urinary Tract Obstruction in the Advanced Cancer Patients / 대한비뇨기과학회지

Palliative endourologic treatment was done in 94 cases for ureteral obstruction secondary to advanced malignancy The average survival was 4.2 months. The obstruction were caused by metastases or invasion of cancer in all patients. First we tried to insert a double J stent(STENT), when it failed percutaneous nephrostomy(PCN) was performed. Initially 16 patients were treated by STENT and 8 patients by PCN. The SIENT was changed 2.2 times on the average in all patients. 75% of the patients who had been treated by STENT experienced only one or two times of STENT changes before dying. Patency period of the STENT was 57.6 days on the average. The patency period was shorter in the patients who showed gross hematuria at the time of STENT insertion. Although survival was not so long, 60.6% patients were able to return to their homes. The endourologic management of the upper urinary tract obstruction will play a more important role and offer a better quality of life for end stage cancer patients.

A Comparative Study of PCNA(Proliferating Cell Nuclear Antigen) and AgNORs(Argyrophilic Nucleolar Organizer Regions) in Malignancy of Brain Tumors

The authors studied the expression of proliferating cell nuclear antigen (PCNA) and the number of argyrophilic nucleolar organizer regions (AgNORs) in 94 cases of various brain tumors and in 5 cases of normal brains. PCN was recognized immunohistochemically in paraffin sections by the monoclonal antibody PC-10. AgNORs could be demonstrated using the silver impregnation method. The PCNA index was not significantly different from the histological grading of glioma(glioblastoma multiforme: 41.40+/-29.14%, anaplastic astrocytoma: 35.00+/-41.02%, and low grade astrocytoma: 22.37+/-30.85%) and there was a wide range of staining even in the same tissue section. However, the AgNORs count per cell correlated well with the pathologic grading of glioma (glioblastoma multiforme : 3.19+/-0.71, anaplastic astrocytoma : 2.06+/-0.16, and low grade astrocytoma : 1.27+/-0.29) with statistical significance. In meningiomas, AgNORs were useful to differentiate benign meningiomas(1.25+/-0.19) and malignant meningiomas(1.78+/-0.35) The authors suggest that the AgNORs count is a faster, less expensive, and a more predictive method in the malignancy of brain tumors than the PCNA immunochemistry expression.

Percutaneous Nephrostomy in Infants and Children / 대한비뇨기과학회지

Percutaneous nephrostomy (PCN) is an established technique in urology but there have been few reports in pediatric urology. We reviewed retrospectively 48 cases for evaluation of the indication, results, complications, and the methods of follow-up after PCN. From October '85 to December '95, on 50 kidneys of 48 patients, 64 PCN were performed. Male patients were predominant (39:9). The indication of PCN were the functional evaluation of huge hydronephrotic kidneys (23 PCN), the relieve of urinary obstruction (10), the urinary diversion (9), the urinary tract infection (11), the differential diagnosis of hydronephrosis (1) and re-PCN after catheter displacement or obstruction (10). 23 patients for the functional evaluation of huge hydronephrotic kidneys that had poor function in the intravenous pyelography or the radioisotope renal scan, and/or the thin parenchyme in ultrasound, had got the regular follow-up with check of the daily urine output, the creatinine clearance after 2-14 days. 19 who showed good urine output (200-1000ml/day) and good creatinine clearance (average 22.4% of total creatinine clearance) after 2-14 days, were managed by reconstructive surgery and nephrectomy was performed in 4 patients who showed poor urine output (less than 10 ml/ day) or poor creatinine clearance( 1.1 and 3.5 % of total creatinine clearance). After PCN, there were mild infection in 3 cases and no serious complication. But there were catheter displacement in 13 cases and catheter obstruction in 3 cases, and in 13 cases of catheter displacement, 8 (53.3%, 8/15) were under 1 year-old, 4 (25%, 4/16) were between 1 and 5 year-old, and 1 (5.9%, 1/17) was over 6 year-old. In 2 cases of UPJ obstruction, the thickening of renal pelvis had made pyeloplasty difficult. Our data shows that a brief period (within 2 weeks) of nephrostomy drainage allows the kidney to display its potential for recovery of function, as measured by differential creatinine clearance and daily urine output. In pediatrics, PCN should be performed carefully in the selected cases and the duration of nephrostomy should be shortened as possible.

Percutaneous Nephrostomy in Patients with Ureteral Obstruction Secondary to Pelvic Tumor / 대한비뇨기과학회지

Percutaneous nephrostomy was done in 18 cases for ureteral obstruction secondary to advanced pelvic malignancy from Jan.1990 to Apr.1993. The most common site of the primary malignancy was cervix ( 77% ). The mean survival time after diversion was 4.2 months ; 22.2% (4/18) of the patients lived more than 6 months, and 1 patient is alive at 4 months. In 4 patients the renal function was not improved, whose mean survival time was 1.4 months. We consider that close. periodic follow-up is mandatory to detect the ureteral obstruction in patients With malignant pelvic tumor and early management may improve the survival time. The patients who had previously urinary diversion for unilateral ureteral obstruction should be evaluated periodically for contralateral renal function. However, the exact criteria for the selection of patients for urinary diversion is, not obvious.

Nephropexy Using Percutaneous Nephrostomy (PCN) / 대한비뇨기과학회지

For the past two years, nephropexy using PCN was underwent in 9 cases of nephroptosis (8 patients) with variable degrees of flank pain. All were female and 6 on right, 1 on left and 1 on bilateral. All patients had a very mobile kidney and exact distance of movement measured on the film was greater than 6cm (6 to 15 cm). After this operation, 14-20 Fr. nephrostomy catheter was indwelled for about two weeks. All patients were followed at least 3 months(3 to 32, median 17 months). We followed the patients with symptom relief and IVP after 3 months. Nephropexy was regarded as success if she remained asymptomatic for more than 3 months. Five cases were successful and four cases felt recurrent flank pain within 1 month after the surgery. Among four cases of recurrence, one had repeated PCN and got successful result, another had open nephropexy and the others have been followed so far So overall success rate was 67% (6/9). In conclusion, nephropexy using PCN is less invasive, needs shorter period of admission and leaves ignorable scars postoperatively. Furthermore it can be repeated even in the case of failure or recurrence, which would make this new technique available as the first step for the surgical treatment of nephroptosis. And the success rate could be increased if the nephrostomy tract is dilated upto 30 Fr. and the PCN catheter is placed about 4 weeks.