Vesicoureteral Reflux Managed with Gil-Vernet Technique / 대한비뇨기과학회지

Vesicoureteral reflux (VUR) is common disease found in up to 70% of children who have urinary tract infection, and the various type of antireflux surgerys were used to correct the problem. Among them, Gil-Vernet antireflux technique is a useful method and it has many advantages such as procedure of simplicity, shorter operative time, and lower complication rate along with maintaining high success rate. We present six cases of vesicoureteral reflux who had been managed with Gil-Vernet antireflux technique, and review the advantages, disadvantages, complications, and usefulness of the procedure.

Preliminary Report of Clinical Experience of Iodine-125 Seed Implant for Early Prostatic Cancer: The First Case in Korea / 대한비뇨기과학회지

Radical prostatectomy, external irradiation, and brachytherapy are currently available for the cure of early localized prostatic cancer. This report documents the first successful Iodine-125 seeds implant treatment of early prostatic cancer in Korea. Patient was 70-year-old man with mild urinary urgency and nocturia. Serum PSA (prostate specific antigen) was 6.51ng/ml. Transrectal ultrasonography showed a small, roundish, low echogenic lesion measuring 8mm in diameter in the left lower peripheral zone of the prostate. The volume of prostate was 27cc and biopsy revealed adenocarcinoma (Gleason score 7). MRI confirmed the presence of a small nodular lesion in the left peripheral zone without evidence of local invasion, and bone scintigraphy was unremarkable. The tumor was staged as T2a. We performed permanent implantation of Iodine-125 seeds using Mick procedure. The patient experienced immediate post-implant irritation of the bladder and urethra with hematuria. Follow up CT and radiography showed all seeds were remained in the same prostate as implanted. Follow up serum PSA was 1.85ng/ml at 3 months and 0.62ng/ml at 9 months after the procedure.

Experience of Extracorporeal Shock Wave Lithotripsy (ESWL) with EDAP-LT01: A Report of 660 Cases / 대한비뇨기과학회지

PURPOSE: Since ESWL had been developed, many experiences of the treatments to urinary stones with various type of lithotriptors were reported. We evaluated the efficacy of EDAP-LT01 piezoelectric lithotriptor according to the size, location of the stone, number of the treatment session, adjuvant therapy and cause of failure. MATERIALS AND METHODS: We retrospectively analyzed the data of 660 cases who had been treated with ESWL. Among the patients, the renal stones were 122, the ureteral stones were 452, and combined with renal and ureteral stones were 43 cases. The mean size of stones was 13mm (range: 4-38mm). ESWL was performed to all the patients with urinary stones except complete staghorn calculi. No anesthesia was performed except in one child (5 years old). RESULTS: Overall success rate was 94.7%, and there were close correlations between the success rate and the size. The mean number of sessions was 2.4. There was no significant complication, but 35 cases were failed by ESWL monotherapy, and auxiliary procedures were done in 21 cases. Efficiency quotient was 0.59. CONCLUSIONS: The ESWL with EDAP-LT01 seems to be effective and safe to treat the urinary stones of various location and size, even compared to the lithotriptors of other type. We also propose that ESWL monotherapy with this machine is efficient for the treatment of the partial staghorn calculi and stones larger than 30mm.

Early Clinical Experience of Interstitial Laser Coagulation(ILC) for the Treatment of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Variable modalities, with more comfortable and less incidence of post-operative complications over TURP, have been used for the treatment of benign prostatic hyperplasia(BPH) with bladder outlet obstruction. Recently, we performed Interstitial Laser Coagulation(ILC) with the 830nm diode laser, which is considered as a method of minimally invasive treatments for BPH, to assess the efficacy and safety of the device, and to evaluate its capability of replacing TURP for managing BPH. MATERIALS AND METHODS: We analysed 16 patients, who had suffered from symptomatic BPH, treated with ILC using diode laser retrospectively from April 1996 to January 1997. Mean age of the patients was 71.7(52-84) years old and mean size of prostates before the treatments was 52.2(26.8-100.7)gm. Treatment outcome was estimated by comparing IPSS, QOL, Qmax, Qave and residual urine before the operations with them of first and second month after the operations. Post-operative transrectal ultrasonography was able to several cooperative cases and they were compared with them of pre-operative volumes, too, although it was unavailable to evaluate statistically. RESULTS: The operation were performed under epidural or spinal anesthesia with average time of 62 minutes and with 10 days of post-operative catheterization. IPSS reduced from 22.25(+/-4.82), mean value before the operation, to 11.00(+/-5.58) and 5.00(+/-3.10) at first and second month after ILC. QOL was gradually decreased from 4.44(+/-0.51) to 2.31(+/-1.20) and 1.19(+/-0.91), too. In terms of Qmax, mean was 12.29(+/-5.55)ml/sec before the operation and it was increased to 15.94(+/-7.38)ml/sec and 20.75(+/-8.48)ml/sec. Average flow rate was also increased from 6.98(+/-2.05)ml/sec to 10.38(+/-3.72)ml/sec and 14.93(+/-4.37)ml/sec. Significant reduction was observed in residual urine volume from 98.13(+/-91.72)ml to 33.19(+/-36.58)ml and 9.56(+/-11.24)ml respectively. Minimal hematuria and mild bladder irritations were common symptoms after the procedure, and possible significant complications as like anemia, electrolyte imbalance(post-TUR syndrome), epididymoorchitis, erectile dysfunction, urethral stricture, retrograde ejaculation had not found in our experience, but 1 patient was retreated with TURP because of continued bladder outlet obstruction. CONCLUSIONS: Our initial results with ILC showed that it is a relatively simple and minimally invasive method with minimal occurrence of bleeding and no electrolyte imbalance. We concluded that ILC is a safe and efficacious treatment modality, and it can be used even for elder patients with co-morbidity illness as well as patients with too large prostate to perform TURP.

A Case of Male Urethral Diverticulum with Giant Calculi / 대한비뇨기과학회지

We present one case report of anterior urethral diverticulum in a male with giant calculi. The patient was a 56-year-old male with the complaints of base-ball sized palpable scrotal mass and post-void dribbling for 15-16 years. The diverticulum was filled with multiple whitish-yellow stones. The largest one was 8X7X6cm in size.

A Case of Foreign Body in the Bladder / 대한비뇨기과학회지

Foreign bodies in the genitourinary tract are relatively common, and almost of them are discovered within the bladder. We had experienced a patient and report herein, who had a plastic tube in the bladder, introduced through urethra during masturbation. The size of the tube was 110cm in length and 0.5cm in diameter, and it was easily diagnosed by history, symptoms, simple KUB, cystoscopy, and was removed by foreign body forceps under the cystoscopy.

A Clinical Comparative Study between Visual Stimulated Erection and Nocturnal Penile Erection by RigiScan / 대한비뇨기과학회지

With 80 cases of impotent patients (30 psychogenic, 50 organic : 39 vasculogenic, 2 neurogenic, 5 vasculogenic + neurogenic, 4 undetermined). we compared the penile rigidity and the change of penile circumference between the visual stimulated erection (VSE) and nocturnal penile erection (NPE) by RigiScan. The results were obtained as follows. 1. In psychogenic impotent patients, the maximal degree of penile rigidity of the basal and tip portions were similar in 21 NPE (70.0%) and 22 VSE (73.3%), and 6 VSE of above showed the rigidity below 10%. All 9 NPE (100%) and 5 VSE (62.5%), out of 9 NPE and 8 VSE dissociated cases, were more higher degree of rigidity in base than that of tip. 2. In organic impotent patients, the maximal degree of penile rigidity of the basal and tip portions were similar in 29 NPE (58.0%) and 39 VSE (78.0%), and 10 NPE (34.5%) and 22 VSE (56.4 %) of above showed the rigidity below 40%. Among the remainders 21 NPE and 11 VSE, the cases who represented dissociation, 18 NPE (85.7%) and 9 VSE (81.8%), the majority, were more higher degree of rigidity in base than that in tip. 3. There were 29 psychogenic (96.7%) and 30 organic (60.0%) impotent patients in NPE, and 7 psychogenic (23.3%) and 5 organic (10.0%) in VSE, who represented over 40% of rigidity more than 5 minutes both in tip and base of penis. 4. Among the all 80 cases, the changes in penile circumferences of the basal and tip portions were similar in 41 NPE (51.3%) and 39 VSE (48.8%), and in remainders, 26 NPE (66.7%) and 34 VSE (82.9%) showed more changes in base than tip. Therefore, we concluded that NPE is more significant than VSE for the diagnosis and evaluating the degree of organic impotence because the rigidity of NPE were more higher than VSE both in psychogenic and organic impotent patients. In the other hand, however, if VSE represents sufficient rigidity, enough rigidity will be expected in NPE, so VSE is useful screening test before NPE.

A Case of Cystic Pheochromocytoma / 대한비뇨기과학회지

Pheochromocytoma is a rare, but an important cause of surgically curable hypertension. Pheochromocytoma is a highly vascular tumor and not infrequently undergoes hemorrhagic necrosis and pseudocyst formation. Such cystic pheochromocytoma may be accompanied by shock and sepsis and commonly invade adjacent organs, in which cases its diagnosis and management may be difficult. Herein we present a case of adrenal cystic pheochromocytoma which was accompanied by sepsis and hypertension and mimicked pararenal abscess with a review of literatures.

MMPI Evaluation of the Erectile Dysfunction / 대한비뇨기과학회지

This study was intended to examine the relationship of the MMPI mean scales in the impotents and Beutler`s decision rules to acertain the empirical utility of the MMPI in discriminating between organic and psychogenic erectile dysfunction. The actual number of cases put into the analysis was 97 including 53 psychogenic and 43 or ganic impotents, who were definitely classified into organic or psychogenic impotents out of 451 impotents on several diagnostic tests. Their age was 34.59+/-10.40. Statistical methods employed were x2 and T score. Results obtained were as follows : 1. The mean overall 4-3/3-4 MMPI profile(17.7%) showed somatic complaints, depression, conflict with spouse and emotionally unstable personality trait. However, there were no significant relationship of mean T score between psychogenic and organic impotence. 2. Applying the Beutler`s rule decision, our hit rate of rule I or rule II were 12.391 and 47.2% respectively. Applying the two rules to 97 cases, the hit rate was 60.4% with non-significant Chi square of 0.017. These results revealed no significant differences between psychogenic and organic subject. Finally, we failed to examine the validity of Beutler`s decision rules adapted to our 97 subjects.

A Case of Hypervascularization of the Glans after Epigastrico-dorsal Vein Anastomosis / 대한비뇨기과학회지

We recently experienced a case of hypervascularization of the glans after arterialization of the deep dorsal vein(Furlow`s method) in a 25-year-old man having vasculogenic impotence due to arterial insufficiency of the penis. The Hypervascularization of the glans was corrected by ligating the branches of the deep dorsal Vein at the corona of the penis.

Experience with Arteriovenous Malformation: A Report of One Case / 대한비뇨기과학회지

Arteriovenous Malformation is a rare condition which represents gross hematuria, bladder tamponade and flank pain. On IVP it shows cobble stone deformity of calyx, infundibulum and pelvis, and for the definitive diagnosis renal angiography is the most helpful method. Treatment of arteriovenous malformation can be obtained with conservative treatment, selective tracscatheter embolization and surgical procedures including nephrectomy, partial nephrectomy and others. Here, we report one case of arteriovenous malformation combined with massive hematuria and left flank pain treated with nephrectomy following selective tracscatheter embolization.