Urodynamic studies in patients with CNS lesion / 대한비뇨기과학회지

Urodynamic evaluation was undertaken in 46 patients who were admitted to neurologic department in the last year and diagnosed to have brain or spinal cord lesion. Computerized tomography (CT) and magnetic resonance imaging (MRI) were performed to localize the area of central nervous system(CNS) lesion. Damage to the basal ganglia and/or internal capsule(4 or the 6 patients) and cerebral cortex(3 of the 7 patients) showed frequent detrusor hyperreflexia, while thalamus and/or brain stem lesion seldom results in voiding dysfunction. Correlation of sphincter function with the area of brain injury was not conclusive. The mechanism of detrusor areflexia (5 of the 31 patients). Following recovery from brain injury and incompatibility between urodynamic findings and injury level of spinal cord lesion (3 of the 15 patients) should be studied with careful follow up to clarify this issue.

Caudal anesthesia in pediatric urology / 대한비뇨기과학회지

Caudal anesthesia has become increasingly widespread in pediatric surgery in recent years, especially for operation below the umbilicus. A prospective study was made to determine the efficacy of caudal anesthesia for pediatric urologic surgery. Seventy five patients who had analogous age and disease were entered in this study (caudal block with light general anesthesia in 47 patients and general anesthesia alone in 28 patients). The children who had caudal block were in psychologically ideal condition with reduced postoperative pain and less demand of analgesics during postoperative period. There were no toxic reactions of local anesthetics and technical faults in the caudate anesthesia. In conclusion, caudal anesthesia was notable for its simplicity, safety and effectiveness and was particularly useful in patients who have the propensity to develop bladder spasm.

Ectopic ureterocele in children / 대한비뇨기과학회지

Ectopic ureteroceles have a broad spectrum of presentation, anatomy and pathophysiology and the management is controversial. Herein, we report our experience of the management in 7 children with 8 ectopic ureteroceles associated with complete duplicated systems. Two functioning upper renal segments were able to be salvaged with ureteropyeIostomy and common sheath ureteral reimplantation. Four small ureteroceles not associated with reflux managed successfully with upper tract correction only(3 heminephrectomy and 1 ureteropyelostomy). Three children with ectopic ureteroceles associated with reflux and/or outlet obstruction underwent successful one stage total reconstruction which included heminephrectomy, ureterectomy, ureterocelectomy and lower pole ureter reimplantation. In summary, the management of ectopic ureterocele must be individualized taking into considerations the salvageability of renal segments, presence of reflux and/or outlet obstruction.

Determination and its significance of the amount of irrigating fluid absorbed during TURP by use of plasma sorbitol concentration / 대한비뇨기과학회지

The main problems of transurethral prostatectomy were intraoperative blood loss and absorption or irrigating fluid. The reduced serum sodium concentration and osmolality. regarded as cause of TURP syndrome. was caused by dilution by several liters of irrigating fluid. Early recognition. while surgery is being performed is important to prevent development of hypovolemia. especially in the aged group. From January 1990 to June 1990. prospective study for the determination of the amount of irrigating fluid absorbed by use of plasma sorbitol concentration, serum electrolytes change and other related factors was undertaken in 30 patients undergoing TURP with manufactured URIONE solution (sorbitol 2.7 gm+mannitol 0.54 gm/100 ml distilled water) as irrigating fluid. An accurate measurement of plasma sorbitol concentration absorbed was obtained by Beutler`s enzymatic sorbitol analysis. Statistical evaluation of all data obtained was made using the `t-test` with significance at 0.1 percent or less. Mean plasma sorbitol concentration absorbed, blood loss. absorbed irrigating fluid volume were 474.2+/-344.3 mg/1.216 ml and 554.3+/-300.2 ml, respectively. A statistically significant positive interrelationship was found among absorbed plasma sorbitol concentration, serum sodium change and absorbed irrigating fluid volume (p<0.001). Also significant correlations could be obtained between absorbed irrigating fluid volume and serum sodium change (p<0.001).

Laparoscopy for nonpalpable testes / 대한비뇨기과학회지

Laparoscopy was performed successfully at operation in 18 consecutive boys who had 19 nonpalpable testes Of the testes. 2 were in the inguinal region. 6 were in the just proximal to the internal inguinal ring. 2 were high intra-abominal position. and 9 were vanished testes (intracana1icular). In every case of vanished inguinal testis and intracanalicular testis. vas and gonadal vessels were observed laparoscopically to exit the internal inguinal ring. In these vanished testes. hernia or patent processus vaginalis was not observed and contralateral testes were located normally in the scrotum. OF 8 intraabdominal testes. 6 were detected laparoscopically. Laparoscopy provided localization or either testis or the course of spermatic vessels in all patients and these information facilitated accurate planning of operative repair.

Impalpable Testis: Localization and Management / 대한비뇨기과학회지

Between January 1987 and February 1990, records of 5Z patients with 60 impalpable testes who had surgery were reviewed retrospectively regarding localization and management of the testes. Seven out of 60 testes turned out to be palpable by careful examination under anesthesia. Ultrasonogram detected 8 testes (5 intracanalicular and 3 preperitoneal) out of 25 testes. Laparoscopy provided and in planning the appropriate surgical approach in all 8 testes. Of the 47 testes found at surgery 19 were intraabdominal, 14 intracanalicular, 12 in preperitoneal and 1 located in superficial inguinal area. Also 13 vanished testes were confirmed during surgery examining blind end of spermatic vessels and vasa. Two patients with intersex ( true hermaphroditism and hernia uteri inguinalis) were presented as unilateral impalpable testes. 42 testes were brought down surgically utilizing regular orchiopexy in 26 testes, transabdominal orchiopexy in 8 testes, Fowler-Stephens orchiopexy in 7 testes and staged orchiopexy in 1 testis were done with acceptable results. transabdominal approach is recommended in cases of suspecting intraabdominal testis or intersex.

A Study of Blood Loss and Change of Serum Electrolytes During Transurethral Prostatic Resection / 대한비뇨기과학회지

The main problems of transurethral prostatectomy were operative blood loss and absorption of irrigating fluid. Blood loss is a significant factor in the morbidity and mortality of prostatic surgery. Early recognition while surgery is being performed is important to prevent development of hypovolemia, especially in the aged group. The reduced serum sodium and osmolarity concentration, regarded as cause of TURP syndrome, was caused by dilution by several liters of irrigating fluid. To better understand the hemodynamic changes occurring in patients undergoing transurethral prostatectomy, from January 1989 to July 1989, a program for prospective study of blood loss measurement, serum electrolytes change and other related factors was undertaken in 21 patients undergoing TURP by use of manufactured URIONE solution(Sorbitol 2.7gm + Mannitol 0.54gm/ 100ml distilled water) solution as irrigating fluid. An accurate measurement of blood was obtained by Hemoglobincyanide method, a colorimetric determination of hemoglobin in the irrigating fluid. Statistical evaluation of all data obtained was made using the "t test" with significance at 6 percent or less. There was a significant postoperative decrease in serum sodium and osmolality concentration, respectively averaging 3.7 +/- 3.8mEq/1, 8.4 +/- 8.1mOsm/kg. They were not correlated with absorbed irrigant fluid volume, resection time, weight of tissue resected( P>0.05). Blood loss ranged from 18 to 1250ml and its mean was 178ml. A statistically significant positive interrelationship was found among operative blood loss, resection time, irrigating fluid volume. Also significant correlation could be gained between absorbed irrigant fluid volume and serum sodium change(P<0.05 ), and resection weight and irrigation fluid volume(P<0.05).

Spectrum of Multicystic Dysplastic Kidney / 대한비뇨기과학회지

Multicystic dysplastic kidney is the most frequent cause of abdominal mass in the neonate, but its presentation is variable depending on the size of cystic kidney, state of the opposite kidney and associated anomalies. multicystic dysplastic kidney also represents a spectrum of pathology from unilateral multicystic kidney through segmental and focal multicystic dysplasia to bilateral multicystic kidney. Herein we report 5 cases of MCK with different presentation and histology, a bilateral MCK associated with horseshoe kidney, a large MCK with uremia, a focal segmental MCK with contralateral UPJ obstruction, a small focal segmental MCK with contralateral megaureter and a small MCK detected by ultrasonogram for localization of impalpable testis.