Ureteral Obstruction Caused by Pelvic Actinomycosis / 대한비뇨기과학회지

Actinomycosis is a chronic suppurative granulomatous disease caused by anaerobic gram positive Actinomyces. Pelvic actinomycosis is a rare, but not unusual complication in the use of intrauterine contraceptive devices. In most cases, unilateral or bilateral tubo-ovarian abscesses are present. Pelvic actinomycosis can lead to pelvic inflammatory disease, abdominal wall abscess, vesico-uterine fistula, ureteral obstruction, ileopelvic fistula, and pyometra. Only a few cases of ureteral obstruction caused by pelvic actinomycosis in intrauterine contraceptive device users have been reported. We report a case of ureteral obstruction caused by pelvic actinomycosis in a patient with an intrauterine contraceptive device.

Clinical Course of Prenatally Diagnosed Ureteropelvic Junction Obstruction / 대한비뇨기과학회지

PURPOSE: Recently there has been a change in the management concept of ureteropelvic junction obstructions (UPJO) diagnosed prenatally. We retrospectively analyzed our experience in treating neonates, with prenatally detected UPJO, to find a desirable therapy. MATERIALS AND METHODS: 52 neonates (64 kidneys), with prenatally diagnosed UPJO, between 1994 and 2001, were included in this study for evaluation. The patients consisted of 41 males and 11 females. The UPJO was found unilaterally in 40 and bilaterally in 12 of the cases. With all the whole cases, ultrasonography, diuretic renogram and voiding cystourethrography were performed to assess the renal function. Additionally, a 99mTc-DTPA renal scan and monitoring of the glomerular filtration ratio (GFR), were performed in the bilateral UPJO. During the follow up period, including monthly urinalysis, ultrasonography and a 99mTc-DMSA renal scan were performed every 3 to 6 months. Antibiotics were given as a preventive measure. RESULTS: Of the 40 kidneys, a differential renal function above 40% accounted for 36, between 5-40% for 2, and below 5% for 2 of the unilateral UPJO. With the bilateral UPJO, all the cases represented preserved renal function (>40%) and normal GFR. With the unilateral UPJO, pyeloplasty was performed on 23 kidneys (57.5%), and a nephrectomy was performed in 2 (5%). With of the 15 kidneys (37.5%) the obstructions disappeared during the observation period. With the bilateral UPJO, pyeloplasty was performed in 4 kidneys (16.7%), and in 20 (83.3%) the obstructions disappeared during the observation period. Conservative treatment was performed when the differential renal function was above 5%, with no deterioration in the renal function, no febrile urinary tract infection (UTI) and no increase of hydronephrosis. Pyeloplasty was performed on the patients with a recurrence of febrile UTI (19 kidneys), severe hydronephrosis (4) and gradual decrease in renal function (4), during the follow-up period. CONCLUSIONS: With the UPJOs diagnosed prenatally in neonates it seems desirable to wait for the natural disappearance of the obstruction, with conservative treatment, if the renal function is preserved. In cases where there is a progressive loss of renal function, or a secondary effect of the obstruction, pyeloplasty should be considered.

Renal Cell Carcinoma with Absence of Inferior Vena Cava / 대한비뇨기과학회지

The congenital absence of an inferior vena cava is an uncommon abnormality. With the advent of modern imaging techniques, such cases are being found with increasing frequency. Here we report a case of a renal cell carcinoma with the absence of an inferior vena cava in a 44 year-old male. He was referred for a further evaluation of a right renal mass, which was observed by ultrasonography, and for persistent epigastric discomfort. Computed tomography showed a huge mass in the right kidney and multicystic lesions in the left. In addition, the inferior vena cava had disappeared at the infrahepatic portion. He was treated with a right radical nephrectomy.