A Case of Adrenal Cavernous Hemangioma / 대한비뇨기과학회지

No abstract available.

An Evaluation of Vesical Urodynamics before and after Renal Transplantation in the Patients of Chronic Renal Failure / 대한비뇨기과학회지

PURPOSE: There are ample experimental and clinical data showing that if the bladder does not receive a significant urine input for a prolonged period it suffers a reduction in capacity and develops hypertonicity. We investigated the urodynamic changes before and after renal transplantation in the patients of chronic renal failure(CRF) under dialysis. MATERIALS AND METHODS: Urodynamic evaluations were performed in 47 CRF patients(25 males and 22 females, average age : 39 years) prior to renal transplantation and 4 weeks after renal transplantation. The clinical notes of each of the patients were reviewed to ascertain the cause of renal failure, duration and type of dialysis. RESULTS: The maximal flow rate , voiding volume, voiding time, volume of first sensation of fullness and the volume of urge sense were abnormally low in the patients of CRF, and the degree of deterioration was more remarkable in the patients of longer duration of dialysis, but the voiding detrusor pressure was within normal range in the patients of CRF irrespective of duration and type of dialysis. The maximal flow rate, voiding volume, voiding time, volume of first sensation of fullness and the volume of urge sense were increased significantly after successful renal transplantation, but the change of voiding detrusor pressure was not significant. CONCLUSIONS: The bladder capacity of CRF patients under dialysis is decreased to physiologic disuse state because of decreased urine input into the bladder for a prolonged period, but the contractility is well preserved irrespective of duration of dialysis, and the bladder capacity is recovered in the course of time after successful renal transplantation.

Transitional Zone Index: a Predictor of Acute Urinary Retention in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: To investigate the efficacy of age, International Prostate Symptom Score(I-PSS), quality of life(QOL) score, various parameters obtained by transrectal ultrasonography(TRUS) as predictors of the onset of acute urinary retention in patients with benign prostatic hyperplasia(BPH). MATERIALS AND METHODS: From January 1996 to December 1997, 101 men(mean age 70years, range 52-92) with symptoms of BPH were enrolled in this study. Among them, 36 patients had suffered from acute urinary retention. TRUS was used to calculate the total prostate(TP) volume, the transitional zone(TZ) volume, the transitional zone index(TZ index=TZ volume/TP volume). To compare the usefulness of various indices, the area under the receiver-operator characteristic(ROC) curve was calculated for each index. RESULTS: There were significant differences in age, TP volume, TZ volume, TZ index between patients with and without acute urinary retention, but no significant differences in I-PSS and QOL score. In patients with acute urinary retention, the area under the ROC curve was 0.911 for the TZ index, 0.892 for the TZ volume, 0.769 for the TP volume and 0.660 for the age. CONCLUSIONS: The TZ index is a useful predictor of acute urinary retention in patients with BPH and may be a useful parameter for decision of surgical intervention.

An Experience of Vaginoplasty with Rectos Abdominis Myocutaneous Flap for Testicular Feminization Syndrome / 대한비뇨기과학회지

Testicular feminization syndrome is characterized by 46,XY karyotype, bilateral testes, absent or hypoplastic wolffian duct, female appearing external genitalia, blind vaginal pouch, and absent or rudimentary muillerian derivatives. We experienced vaginoplasty using rictus abdominis myocutaneous flap with modified Burch bladder neck suspension in a 51-year-old patient with testicular feminization syndrome combined with stress urinary incontinence.

Transrectal Ultrasonography in Female Stress Urinary Incontinence / 대한비뇨기과학회지

Radiologic chain cystourethrography for stress urinary incontinence (SUI) has several disadvantages including the risk of excessive radiation, the time required for the test, and the discomfort of the patients. Nowadays it is widely accepted that transrectal ultrasonography for evaluating bladder and urethra provides similar information about SUI comparing with the conventional radiographic examination. We evaluated the effectiveness of transrectal ultrasonography in the diagnosis of SUI in 30 women with SUI and in normal 20 women as a control. The results of evaluation were as follows: 1. Mean age was 52.9 in SUI group and 48.5 in control group, and mean parity was 2.8 in SUI group and 3 In control group. 2. According to the symptom grading by Stamey, 8 patients (27%) were Grade I and 22 (73%) were Grade II. 3. The mean value of posterior urethrovesical angle (PUVA) at resting state was 139 +/- 14.7 degrees in control group and 145 +/- 15.2 degrees in SUI group (p>0.05). 4. The mean value of PUVA at strain state was 146 +/- 7.9 degrees in control group and 169 +/- 12.1 degrees in SUI group (p<0.05). 5, Bladder neck descent was 7.3 +/- 2.7 mm (mean+/-SD.) in control group and 13.7+/-6.2 mm in SUI group (p<0.05). 6. Diagnostic criteria of SUI in transrectal ultrasonography are more than 149.5 degrees in PUVA at strain state, and more than 9.1 millimeter in bladder neck descent. 7. Sensitivity and specificity of transrectal ultrasonography in the diagnosis of SUI were 86% and 80% in PUVA at strain state, 80% and 80% in bladder neck descent, respectively. 8. There was significant change of transrectal ultrasonographic finding in pre and post-bladder neck suspension (p<0.05). In conclusion, transrectal ultrasonography is simple, non-invasive, not shameful, and free of radiation, so might be a useful diagnostic method in female SUI.

Correlation of Histologic Types With Clinical findings and Transrectal Ultrasonographic Pictures in Benign Prostatic Hyperplasia / 대한비뇨기과학회지

Tissues obtained by transurethral prostatectomies were evaluated histologically and correlated with the clinical findings and the transrectal ultrasonographic pictures of 104 patients with benign prostatic hyperplasia (BPH). The patients were divided into 3 groups according to the following histology. predominantly glandular types (30 patients), predominantly stromal types (35 patients) and mixed types which have equal proportions of glandular and stromal hyperplasia (39 patients). The average age was highest in the glandular group. Postoperative obstructive symptom scores were significantly lower in the stromal type as compared to the glandular and the mixed type. The maximal flow rates at three months following the operations were highest in the stromal type. In comparison of the histologic findings with preoperative transrectal echographic pictures, the transverse and the longitudinal diameter of the transitional zone were significantly lower in the stromal type than in the glandular and the mixed type. The weight of transitional zone was significantly smaller in the stromal type than in the glandular and the mixed type. The echogenicity showed hyperechoic and isoechoic pattern in the stromal and the mixed type and hypoechoic and isoechoic pattern in the glandular type. The echographic homogeneity, the frequency of prostatic calculi and cyst formation, and the margination of the transitional zone did not show any significant difference among each group. In conclusion, the histologic types of BPH have correlations with the clinical findings and the transrectal ultrasonographic pictures. Furthermore precise interpretation of the histologic types of BPH by transrectal ultrasonography will be helpful in decision making about the treatment modality and in prediction of the clinical progress after some treatment for the patients with BPH.

A Case of Huge Retroperitoneal Lipoma / 대한비뇨기과학회지

Retroperitoneal lipoma probably constitute the group of the most massive solid abdominal tumors; their etiology is unknown; their symptoms insidious; and recurrence and sarcomatous change frequent. The clinical diagnosis was made by clinical symptoms, physical findings and radiologic evaluation such as intravenous urography, ultrasonography, computed tomography, angiography and so on. Abdominal CF scan provided clinically the most useful information regarding the state of tumors and also their effect on adjacent structures and shows homogenous appearing fat tissue with a low attenuation coefficient identical to that found in the subcutaneous fat. We present a case of treatment for a huge retroperitoneal lipoma in a 46-year-old man.

Significance of Resistive index in Renal Transplantation / 대한비뇨기과학회지

The increasing use and availability of renal transplantation has resulted in a demand for noninvasive methods to study possible complications. One of the most serious adverse reactions is acute rejection, a possibly reversible cause of transplant failure if treated promptly. Sixty-six donors and recipients were evaluated by duplex Doppler examination of intrarenal arteries. A simplified formula, resistive index(RI) ([peak systolic frequency shift-lowest diastolic frequency shift]/[peak systolic frequency shift]), were used to diagnose rejection. All RI values of donors were within normal limit. RI values of recipients were not significantly different according to the number of renal artery and the ischemic time during operation. With a RI greater than 0.90, a 100% positive predictive value was obtained for the diagnosis of acute rejection. A 88% positive predictive value of acute rejection was obtained with a RI greater than 0.80. A value less than 0.70 was unlikely to be rejection(negative predictive value, 95%). The results suggest that the duplex Doppler examination and the resistive index obtained by simple analysis of the wave form would be used as a valuable noninvasive method for the detection of acute renal transplant rejection. The findings of Doppler examination are not necessarily pathognomonic for one specific process, but they can aid the clinician in deciding the kind of treatment necessary and the need for biopsy.

A Clinical Study about Operator's Skilled Experience in Transurethral Resection of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

A clinical observation was made on 261 cases of transurethral resection of benign prostatic hyperplasia (TURP) by the same operator, admitted during the period of 10 years from January 1984 to December 1993. The objective cases were divided by every 50 cases into 5 groups, and the operation results were compared in each group respectively. The results showed the tendency of increasing weight of resected prostatic tissue and decreasing operating time, consumed time for the resection of l gm of prostatic tissue, blood loss during operation, duration of postoperative gross hematuria and incidence of postoperatively complicated cases, as experiencing more TURP cases. The operation results were markedly improved and stabilized after experience of 150 cases of TURP. Our study suggests that TUR technique of the operator is improving step by step by accumulating experiences of TURP and the expert and stabilized skillful technique will be achieved after experience of more than 150 cases of TURP but the improvement of TUR technique may be accelerated by aid of better TUR instrument and teaching system.

A Case of Leiomyoma of the Kidney / 대한비뇨기과학회지

Renal leiomyoma, a rare benign tumor, is a challenging diagnostic and therapeutic condition. The preoperative diagnosis of renal leiomyoma is very difficult, and the only definite method to distinguish between a leiomyoma and other renal tumor is postoperative microscopic evaluation. We report a case of leiomyoma of the kidney which was managed by radical nephrectomy under the impression of malignant renal mass which was incidentally found by ultrasonographic examination for health check in a 43-year-old woman.

Flow cytometric DNA ploidy and proliferating cell nuclear antigen in prostatic adenocarcinoma / 대한비뇨기과학회지

Clinical significance of flow cytometric DNA ploidy and proliferating cell nuclear anrigen (PCNA) was evaluated in terms of clinical stage. histological grade and tumor markers. using the materials obtained from paraffin embedded blocks of 47 patients with prostatic adenocarcinoma. The incidence of DNA aneuploidy in total population was 51.1 %. Although no significant correlation between histological grade or clinical stage and DNA ploidy pattern was demonstrated, the frequency or aneuploidy was shown to increase as the poorer the histological grade and the higher the clinical stage. All patients in aneuploidy group and 66.7% of the patients in diploidy group had PSA levels of more than 4ng/ml, and 57.1% of those in aneuploidy group and 50% of those in diploidy group had PAP levels of more than 3.2ng/mI. Overall, the difference in survival curves for diploidy and aneuploidy group was not significant. But. in patients of stage D with intermediate histological grade, the survival difference between diploid and aneuploidy tumors was obvious. The PCNA related proliferating index was significantly increased with the progression of the clinical stage. And the proliferating index was inversely related to the degree of glandular differentiation. but without statistical significance. Although proliferating index of prostatic adenocarcinoma didn`t have any significant correlation with the survival, the statistically significant difference was shown in survival between PCNA score+/-group and PCNA score + to +++ group.

Comparative study on the morphology of renal pelvoclyceal systems of healthy persons and urinary stone formers by excretory urography / 대한비뇨기과학회지

Until recently almost exclusively clinicochemical urine parameters have been used to determine the risk of urinary stone formation, because the urinary stone disease is considered as one of metabolic disorders. But the morpholgy of renal pelvocalyceal system also affects on the formation of stone particle and its growth, mainly by establishing urinary stasis. We reviewed 163 excretory urograms retrospectively, and pelvocalyceal systems of healthy persons and urinary stone formers were compared with regard to their morphology. In summary of the study, the majority of pelvocalyceal systems of urinary stone formers showed (1) an increased number of papillae; (2) a greater cranial and caudal exlension of pelvocalyceal sysrem:(3) an increased circular radius of the pelvocalyceal system and hence an increased pelvocalyceal system volume ;(4) an increased pelvic area, especially an enlarged total calyx area and hence a larger total area. (5) a higher degree of ramification and a higher number of branches in the calyx groups ; (6) a more sharp angle between the most caudally situated calyx neck and the direction of pelvic outlet :(7) a highly situated origin or the ureter more frequently ;(8) more frequent ampullary patterns of pelvocalyceal system. But the number of major calyx, the total calyx angle and the angle between the direction of pelvic outlet and the main direction of the ureter showed no statistically significant difference between the urinary stone formers and the healthy persons. The results indicate that the study on the morphology of the renal pelvocalyceal system by excretory urography may be used as a screening test to determine the risk of urinary stone formation.

A case of malignant melanoma of the urinary badder / 대한비뇨기과학회지

Malignant melanoma of the urinary bladder is very rare, 7 cases were reported in the literature. The tumor shows early metastasis with poor prognosis. Treatment measures include surgical extirpation, radiotherapy and chemotherapy but the results were bad.Herein, we report a case of malignant melanoma of the urinary bladder in a 45-year-old man which was managed by transurethral resection and combination chemotherapy.