Influence of Ureteral Stone Components on the Outcomes of Electrohydraulic Lithotripsy

PURPOSE: We evaluated the influence of urinary stone components on the outcomes of ureteroscopic removal of stones (URS) by electrohydraulic lithotripsy (EHL) in patients with distal ureteral stones. MATERIALS AND METHODS: Patients with a single distal ureteral stone with a stone size of 0.5 to 2.0 cm that was completely removed by use of EHL were included in the study. Operating time was defined as the time interval between ureteroscope insertion and complete removal of ureteral stones. Ureteral stones were classified into 5 categories on the basis of their main component (that accounting for 50% or more of the stone content) as follows: calcium oxalate monohydrate (COM), calcium oxalate dihydrate, carbonate apatite (CAP), uric acid (UA), and struvite (ST). RESULTS: A total of 193 patients (131 males and 62 females) underwent EHL. The mean operating time was 25.1+/-8.2 minutes and the mean stone size was 1.15+/-0.44 cm. Calcium oxalate stones accounted for 64.8% of all ureteral stones, followed by UA (19.7%), CAP (8.3%), and ST (7.2%) stones. The mean operating time was significantly longer in the UA group (28.6+/-8.3 minutes) than in the COM group (24.0+/-7.8 minutes, p=0.04). In multivariate analyses, the stone size was negatively associated with the odds ratio (OR) for successful fragmentation. UA as a main component (OR, 0.42; 95% confidence interval, 0.20 to 0.89; p=0.023) was also found to be significantly important as a negative predictive factor of successful fragmentation after adjustment for stone size. CONCLUSIONS: The results of the present study suggest that successful fragmentation by URS with EHL could be associated with the proportion of the UA component.

Our Experiences with Robot-Assisted Laparoscopic Radical Cystectomy: Orthotopic Neobladder by the Suprapubic Incision Method

PURPOSE: To report our technique for and experience with robot-assisted laparoscopic radical cystectomy (RARC) with orthotopic neobladder (ON) formation in a cohort of bladder cancer patients. MATERIALS AND METHODS: Between December 2007 and December 2011, a total of 35 patients underwent RARC. The patients' mean age was 63.3 years and their mean body mass index was 23.7 kg/m2. Thirty patients had a clinical stage of T2 or higher. Postoperative mean follow-up duration was 25.5 months. In 5 patients, a 4-cm midline infraumbilical skin incision was made for an ileal conduit (IC) and the stoma formation was similar to the open procedure. In 30 patients undergoing the ON procedure, the skin for specimen removal and extracorporeal enterocystoplasty was incised infraumbilically in the early 5 cases with redocking (ON-I) and suprapubically in the latter 25 cases without redocking (ON-S). RESULTS: The mean operative times of the IC, ON-I, and ON-S groups were 442.5, 646.0, and 531.3 minutes, respectively (p=0.001). Mean console and lymph node dissection time were not significantly different between the groups. Mean urinary diversion times in each group were 68.8, 125.0, and 118.8 minutes, respectively (p=0.001). In the comparison between the ON-I and ON-S group, only operative time was significant. Four patients required a blood transfusion. We had no cases of intraabdominal organ injury or open conversion. Thiry-three patients (94.2%) had a pathologic stage of T2 or higher. Two patients (5.7%) had lymph node-positive disease. Postoperative complications included ileus (n=4), stricture in the uretero-ileal junction (n=2), and vesicovaginal fistula (n=1). CONCLUSIONS: Our robotic neobladder-suprapubic incision without redocking procedure is easier and more rapid than that of infraumbilical incision with redocking.

Our Experiences with Robot-Assisted Laparoscopic Radical Cystectomy: Orthotopic Neobladder by the Suprapubic Incision Method

PURPOSE: To report our technique for and experience with robot-assisted laparoscopic radical cystectomy (RARC) with orthotopic neobladder (ON) formation in a cohort of bladder cancer patients. MATERIALS AND METHODS: Between December 2007 and December 2011, a total of 35 patients underwent RARC. The patients' mean age was 63.3 years and their mean body mass index was 23.7 kg/m2. Thirty patients had a clinical stage of T2 or higher. Postoperative mean follow-up duration was 25.5 months. In 5 patients, a 4-cm midline infraumbilical skin incision was made for an ileal conduit (IC) and the stoma formation was similar to the open procedure. In 30 patients undergoing the ON procedure, the skin for specimen removal and extracorporeal enterocystoplasty was incised infraumbilically in the early 5 cases with redocking (ON-I) and suprapubically in the latter 25 cases without redocking (ON-S). RESULTS: The mean operative times of the IC, ON-I, and ON-S groups were 442.5, 646.0, and 531.3 minutes, respectively (p=0.001). Mean console and lymph node dissection time were not significantly different between the groups. Mean urinary diversion times in each group were 68.8, 125.0, and 118.8 minutes, respectively (p=0.001). In the comparison between the ON-I and ON-S group, only operative time was significant. Four patients required a blood transfusion. We had no cases of intraabdominal organ injury or open conversion. Thiry-three patients (94.2%) had a pathologic stage of T2 or higher. Two patients (5.7%) had lymph node-positive disease. Postoperative complications included ileus (n=4), stricture in the uretero-ileal junction (n=2), and vesicovaginal fistula (n=1). CONCLUSIONS: Our robotic neobladder-suprapubic incision without redocking procedure is easier and more rapid than that of infraumbilical incision with redocking.

Primary Malignant Melanoma of the Female Urethra

We report here on a rare case of primary malignant melanoma of the female urethra. A 69-year-old female presented at our hospital with a several month history of dysuria, poor stream, gross hematuria, intermittent blood spots, and a painful mass at the external urethral meatus. The physical examination revealed a soft, small, chestnut-sized lesion through the urethral orifice. The mass was tan colored, ulcerated, covered with necrotic tissue, and protruded from the external urethral meatus. The mass was removed by wide local excision under spinal anesthesia. The pathological diagnosis was malignant melanoma of the urethra. Computed tomography of the abdomen as well as a whole-body bone scan showed no evidence of metastasis. The patient has been free of disease for 6 months postoperatively. We discuss the clinicopathologic features and treatment of this tumor.

Investigation of the Location of the Ureteral Stone and Diameter of the Ureter in Patients with Renal Colic

PURPOSE: The objective of this study were to evaluate the location of ureteral stones and the diameter of the ureter in patients with renal colic. MATERIALS AND METHODS: We retrospectively reviewed the records of 95 consecutive patients who presented to the emergency department with renal colic in whom urinary stones were diagnosed by computed tomography between January 2009 and August 2009. The size and location of the stones were investigated. The length and diameter of unaffected ureters were also measured. RESULTS: The mean size of the stones was 4.87+/-3.49 mm (range, 0.9-22 mm). Stones were located at ureterovesical junction (UVJ) in 44 cases (46.3%), proximal ureter in 29 (30.5%), distal ureter in 16 (16.8%), ureteropelvic junction (UPJ) in 5 (5.2%), and the ureter crossing external iliac vessel (UEIV) in 1 case (1%). The mean length of the ureter was 226.8+/-20.8 mm (range, 175-286 mm). The mean diameter of the ureter was 3.40+/-0.61 mm (range, 1.9-5.3 mm). The mean diameter of the UEIV was 3.28+/-0.59 mm (range, 2.2-5.3 mm). CONCLUSIONS: The UPJ and UEIV were not common sites of ureteral stones. The smaller the stones, the closer to the UVJ that the stones were located. Spontaneous passage of the stones was most frequently observed for stones in the UVJ. The UEIV was not significantly narrower than the other parts of the ureter.

Predictors of Postoperative Voiding Dysfunction following Transobsturator Sling Procedures in Patients with Stress Urinary Incontinence / 대한배뇨장애요실금학회지

PURPOSE: We evaluated the influence of preoperative physical examination (PE) and urodynamic study (UDS) findings on objective postoperative bladder emptying, the subjective development of bladder storage symptoms, and patient-reported success of correction of stress urinary incontinence (SUI). MATERIALS AND METHODS: From January 2007 to August 2008, a total of 159 female patients with SUI underwent transobturator midurethral sling surgery (TOT). The patients were selected for SUI, with no overactive bladder (OAB) symptoms, no detrusor overactivity (DO) on UDS, no pelvic organ prolapse, and no history of prior anti-incontinence surgery. Of these patients, 128 patients (aged 38-74 years; mean age, 51.8+/-7.1 years) with follow-up of at least 12 months were included in the analysis. All patients had PE and UDS findings, including Q-tip testing, free maximal flow rates (Qmax), filling cystometry, Valsalva leak point pressure, detrusor pressure at maximal flow, and maximal urethral closing pressure. The primary outcome was postoperative voiding dysfunction, defined as the subjective feeling of not empting one's bladder completely and a postvoid residual > or =100 ml. A secondary outcome, "cure" of SUI, was defined as "a negative result on the cough stress test and no subjective complaint of urine leakage." We analyzed the preoperative parameters by univariate and multivariate regression for voiding dysfunction, de novo OAB, cure rate, and the patients' satisfaction. RESULTS: Patients with a preoperative Qmax < 15 ml/s (7 patients) had a tendency for postoperative voiding dysfunction compared with those with a Qmax 15 ml/s (15 patients) (35.0% vs. 13.9%, respectively; p=0.046). No other preoperative parameters had a statistically significant influence on postoperative voiding dysfunction. Receiver operating characteristic (ROC) analysis revealed that Qmax was a good predictor because the area under the ROC curve value of Qmax was 0.81 (95% CI: 0.73 to 0.89, p<0.001). The univariate and multivariate analysis of the preoperative PE and UDS parameters demonstrated that no significant differences and no independent risk factors were related to the postoperative de novo OAB, cure rate, or the patients' satisfaction. CONCLUSIONS: These findings suggest that preoperative UDS results, especially Qmax, could be used to predict postoperative voiding dysfunction after the TOT procedure.

A Penile Fracture with the Complete Urethral Rupture / 대한남성과학회지

A penile fracture is an injury caused by the rupture of the tunica albuginea. We report an uncommon case of penile fracture with the complete urethral rupture in a 48-year-old man who sustained the injury during the sexual intercourse. He presented with acute penile pain, swelling on the ventral aspect of the penile shaft and the inability to pass urine associated with urethral bleeding. Retrograde urethrography revealed the complete obstruction of the urethra. Exploration and repair of the penile fracture with the urethra rupture were performed. The patient recovered successfully with good erectile and voiding function.

The Effects of Simultaneous Vaginal Hysterectomy on the Outcomes of a Tension-free Vaginal Tape Procedure for Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: Hysterectomy, regardless of the surgical technique, increases the risk of having to undergo stress urinary incontinence surgery later in life. Furthermore, transvaginal hysterectomy may cause some changes in the normal architecture and tension of the tissues surrounding the pelvic floor, and this may also cause some changes in the continence mechanisms of the bladder and urethra. We investigated if there are any adverse effects of concomitant vaginal hysterectomy on the outcomes of a tension-free vaginal tape procedure. MATERIALS AND METHODS: The outcomes of the tension-free vaginal tape (TVT)/transvaginal total hysterectomy(VTH) group were compared with that of the TVT group in terms of cure and improvement of incontinence, satisfaction with the procedure and the complications. The preoperative evaluation included history taking, physical examination and stress tests and determining the stress-related leakage, the emptying ability, the anatomy, the protection and the inhibition(SEAPI) scores. The outcomes were evaluated at over one year after operation. RESULTS: The cure and improvement rates were 77.5% and 15% in the TVT group, and 88.9% and 7.4% in the TVT/VTH group, respectively, without any statistical difference between the two groups. The rates of patient- satisfaction with the procedure were similar in two groups. There were no serious or long term complications related to the procedure except for a case of local hematoma in the hysterectomy site, which was controlled conservatively. CONCLUSIONS: Our findings suggest that a TVT operation can be done simultaneously with vaginal hysterectomy with similar results as those of TVT operation only. In addition, it is thought that the simultaneous TVT operation in a patient who is undergoing hysterectomy and has urinary stress incontinence deserves to be recommended in a positive light

Analysis of the Causes of Nephrectomy in 1980-2005 / 대한비뇨기과학회지

PURPOSE: Neoplastic, infectious and calculous diseases, as well as congenital anomaly and vascular disorder of the kidney, are known to be the main indications of a nephrectomy. However, the incidences of a nephrectomy in various renal diseases differ with respect to several factors, such as the socioeconomic situation, and differences in time and regions. This study was performed to investigate the changes of the causes of a nephrectomy and the associated factors between 1980 and 2005. MATERIALS AND METHODS: All 116,535 in-patients admitted to the Urological Department of Kangnam Sacred Heart Hospital from 1980 to 2005 were enrolled in this study,and divided into 3 groups, Period I from January 1980 to December 1987, Period II from January 1990 to December 1997, and Period III from January 2000 to December 2005. Of these patients, 11,565(9.9%) underwent urological operations, and 234(2.0%) were treated with a nephrectomy for various renal diseases. RESULTS: The causes for the nephrectomy in Period I were renal stones (30%), infection-inflammatory diseases(28.75%), congenital anomalies(15%), renal tumors(13.75%), renal injuries(10%), but tumors(41.7%), renal stones (21.4%), congenital anomalies(19.05%), infection-inflammatory diseases (8.3%) and renal injuries(5.6%) in Period II, and tumors(57.1%), congenital anomalies(17.1%), renal stones(14.3%), infection-inflammatory diseases (8.57%) and renal injuries(1.4%) in Period III, in that order(p<0.001). CONCLUSIONS: The incidence of renal tumors has increased, but those of infection-inflammatory diseases and renal injuries have decreased. Among the renal diseases requiring a nephrectomy, renal tumors were ranked in first position, but the nephrectomy rate for benign renal diseases has markedly decreased over time, which is similar to that of developed countries.

Segmental Testicular Infarction Masquerading as Testicular Neoplasm / 대한비뇨기과학회지

Segmental testicular infarction is an uncommon and usually idiopathic phenomenon. Some case reports have linked segmental infarction to sickle cell anemia, hypersensitivity angiitis, polycythemia, and an idiopathic cause. Magnetic resonance imaginge (MRI) might be of great diagnostic value as the ischemic lesions have a characteristic pattern. Nonetheless, as its clinical and radiological presentation may resemble testicular tumors, a definite diagnosis can only be established following surgery. We report a case of testicular infarction which presented as a malignancy even in the frozen biopsy.

Intrauterine Device Migrating into the Bladder / 대한비뇨기과학회지

Migration of an intrauterine contraceptive device (IUD) into the urinary bladder is very rare. We experienced a case of a foreign-body migrating into the bladder of a 35-year-old women who has been suffering from frequency and dysuria for the recent 5 months. The IUD had originally been inserted 10 years ago. Removal of the IUD had been performed for achieving pregnancy, but the IUD was not detected at the correct site 7 years ago. One year later, the patient had given birth without complication. It is thought that it took less than 6 years for the IUD to invade the bladder wall.

Epidemiologic Study on Phimosis and Circumcision in Elementary School Boys (I) / 대한비뇨기과학회지

PURPOSE: It tends to increase in number of circumcision in neonates and school boys without any logical rationale concering that. So, I investigated what their parents know about phimosis and circumcision, how many boys received circumcision, what are the direct reason or motive of performing circumcision, what kind of complications they had, and finally what they think about circumcision, pros and cons. MATERIALS AND METHODS: 741 boys were chosen for study, who were attending at primary school in Seoul, Kyungkido, Incheon and Kangwondo, 361, 99, 208 and 73, respectively, 1 made a questionnaire and had parents mark personally at the given item (S) without boy's knowing the contents of the questionnaire to avoid error. Result: 52.3% of the answers replied that circumcision may keep penile hygiene clean. 40.9% of the boys were performed circumcision and 21.1% at neonatal period. Circumcisions were performed according to parent's want in 55.7%, boy's own want in 11.4%, nurse or doctor's recommendation in 10.3% and inflammation or urinary tract infection in 14%. There were some inappropriate resections of the prepuce and slight rotations of the penis in 12.5%, without other severe complications. Finally, they answered that circumcision is good for boys in 73%, bad in 0.5% and not necessary in 17.4%. CONCLUSIONS: Many parents tend to think circumcision is advantageous to boys and it is actually performed in large number of boys. However, they are short of knowledge about that. So, I think there must be more activities to let them understand medical basis concerning circumcision.

Preputial condition and urinary tract infections

Recently, an increase in incidences of urinary tract infections in uncircumcised male infants has been reported. However, determining what is the best management for the prepuce of newborns and infants is still to be solved. I investigated prospectively how much foreskins are retracted with age and what correlations it has with urinary tract infection in 122 males children below 15 years of age. Under 6 months of age, the majority of the foreskins were unretractable. As they got older, over 3 years of age, their prepuces became retractable. The incidence of bacteriuria was 11.4% in uncircumcised but none in circumcised and hypospadias. In 8 patients showing bacteriuria, their foreskins were retracted below 25% in length. Among them, 5 patients, in whom E. coli were grown in their urine, showed radiologic renal abnormalities and suffered from high fever indicating systemic infection. However, the other 3 cases infected by Proteus mirabilis in their urine complained of only local penile symptoms.

Condyloma Acuminata in a Child / 대한비뇨기과학회지

Condyloma acuminatum is a rare pediatric entity but its incidence is believed to be increasing in the pediatric population as well as in adults. The most commonly suspected etiology is sexual abuse, although congenital infection and contagious infection are known to occur. So, thorough medical and social evaluation is essential for protection and management of this disease in children. We report a case of condylomata acuminata occurred in 10 year old child's glans.

Pulsed Dye Laser Fragmentation of Urinary Calculi : Clinical Experience / 대한비뇨기과학회지

The pulsed dye laser, emitting at wavelengths of 504nm. for 1 micro sec. at a frequency of 10 Hz. transmitted via a 200 micron in-diameter silicon-coated fiber, was send for fragmentation of urinary stones. The mechanism of stone fragmentation by laser is 'shock wave' formation by laser light ( photoacoustic effect). From Nov. 1988 to Apr. 1990, we performed 89 procedures in 86 patients for the removal of stones (80 procedures in 77 ureteral stones, 3 procedures in bladder stones and 6 procedures in urethral stones). Of the calculi 80 were fragmented to spontaneously passable or easily extractable fragments. There was no significant complications attributable to laser lithotripsy. And there was no significant differences in the fragmentation of stones according to the component. So, we think that laser lithotripsy is a safe and effective modality in management of the urinary stones including renal and upper ureter stones with some exceptions if deflecting ureterorenoscope is available.

Comparison of Shock Wave Lithotripsy and Ureteroscopic Laser Lithotripsy in the Treatment of Lower Urinary Tract Stones / 대한비뇨기과학회지

PURPOSE: In the era of shock wave lithotripsy(SWL), most of the urinary stones are treated with SWL. But, there are some controversies in being SWL always the optimal treatment method for urinary stones, especially for lower urinary stones. To determine what is the most optimal initial treatment method for the lower urinary tract stones, we compared the results of SWL and laser lithotripsy in several aspects. MATERIALS AND METHODS: We compared retrospectively the success(stone free) rate, prevalence day, number of treatment sessions, cost between two groups, SWL and Laser lithotripsy. There were 42 men and 18 women in SWL group(total 60), and 47 men and 20 women in Laser lithotripsy group(total 67). RESULTS: The result were obtained as followings; The success rate were 83.3% in ESWL group during the follow up period, 94.0% in Laser lithotripsy group. The average prevalance days were 20.55 days in ESWL group, 5.5 days in Laser lithotripsy group. The average number of treatment session were 1.37 in ESWL group, 1 in Laser lithotripsy group. The average cost for the treatment of stone were 597,117 won in ESWL group, 652,887 Won in Laser lithotripsy group. CONCLUSIONS: For the lower urinary tract stones, laser lithotripsy got higher success rate in a shorter period with a single treatment session and is more effective for bladder and urethral stones.

The significance of glucose consumption in evaluation of nephrotoxicity on histocultured human renal cortical tissue / 대한비뇨기과학회지

The ability to support the heterogenous cell population having in vivo growth characteristics for in vitro study has been the goal of many investigators. In 1986, an assay offering that three dimensional culture system grows tumors obtained directly from surgery or biopsy at high frequency for long periods of time and has them maintain many of their in vivo properties was reported. In this study, these experimental model for three-dimensional ""native-state"" culture of tissues or collagen gels have been applied to normal human renal cortical tissues obtained directly from the nephrectomized kidney for renal cell carcinoma. Gel specimens histocultured for 4 weeks were treated with cisplalinum with a variety of concentrations and exposure times. Pre-treatment viability of the gel specimens was checked by measuring the amount of glucoseconsumption by viable tissues. Cisplatinum induced toxicities were evaluated by measuring of glucose consumption and [3H] thymidine incorporation. The glucose consumption of renal cortical tissues decreased steadily in the control group. Cisplatinum induced suppression of glucose consumption, starting on 2x 10-5M in concentration, was proportionally increased by concentration and duration of exposure. These results may provide an experimental availability for the three dimensional collagen gel culture method applied to human renal cortical tissue as a tissue culture model and for the glucose consumption as an index representing tissue viability as a whole. It was not found that glucose consumption rate was related to thymidine uptake as a DNA precursor incorporation.

Histopathologic Changes of Undescended Testis / 대한비뇨기과학회지

Undescended testis is one of the most common anomalies of genitourinary tract in children but optimal time for treatment of it has not been determined still. We examined the changes of seminiferous tubules according to ages in 41 patients with undescended testis which orchiectomy or testicular biopsy were performed in the Department of Urology, Kyung Hee University Hospital during the period from January, 1979 to April, 1985 and following results were obtained. l. The ages of 41 patients ranged from 6 years to 48 years. Of these,36 patients were unilateral and 5 patients were bilateral undescended testis. 41 undescended testes were located in inguinal canal, 2 in high scrotum and 3 above the internal inguinal ring. 2. Mean Tubular Diameter was average 48.5 Um from 6 years to 12 years, 81.2 Um at 14 years and 118.4 Um at 24 years. But in normal group, it was average 95.7 Um from 6 years to 12 years, 2l3.6 Um at 14 years and 229.4 Um at 17 years. So, there was already severe damage in development of seminiferous tubules in undescended testis at 6 years. 3. Mean Tubular Fertility Index was average 19.7% from 6 years to 17 years, 42% at 19 years, average 10.8% from 20years to 30 years and 0% at 48 years. But in normal group, it was 78.0% at 6 years and 100% at I4 years. So. there was already severe damage in formation of spermatogonia in undescended testis at 6 years. 4. The thickness of basement membrane of seminiferous tubules in undescended testis was 2.2 Um at 6 years and increased with age to 9.9 Um at 24 years.

Early Complications of Minimally Invasive Surgery in Children / 대한비뇨기과학회지

PURPOSE: To provide for popularization of out-patient surgery, we investigated actual problems occurring after minimally invasive surgery in children. MATERIALS AND METHODS: We reviewed the medical records of 132 patients(154 operations) who performed minimal invasive surgery from January, 1996 to June 1998. All problems following operation were identified in terms of kinds, degrees, and their correlations, including fever, pain, nausea, vomiting, and wound condition, etc. RESULTS: The age of the patients were 0.1 to 16 years(mean, 4.5 years). Of 154 operations hydrocelectomy were 84, orchiopexy 41, and they were 81.2% of all. Operation time were 25 minutes to 150minutes(mean, 63minutes). There were 170 postoperative problems including mild ones, among whom 100 patients revealed changes in body temperature over 37.0degrees C and 43 patients high fever over 37.5degrees C and these fevers were resolved spontaneously even with conservative treatment in short duration excluding one patient who took 39.3degrees C sustaining for 3 days and had a mild touch of flu before operation. 5 patients complained severe wound pain to be injected analgesics without actual wound problem such as bleeding or hematoma, etc. One patient couldn`t void urine to need nelaton catherization one time. CONCLUSIONS: With proper selection and strict preoperative preparation of patients, meticulous anesthesia and operation, careful postoperative check and easy call to doctor, there would be no critical problems following minimally invasive urologic surgery in children.

Factors Concerning Fragmentation of Urinary Stones in Extracorporeal Shock Wave Lithotripsy / 대한비뇨기과학회지

PURPOSE: Majority of the urinary stones are primarily treated by extracorporeal shock wave lithotripsy(SWL). The factors effecting on fragmentation of stones are characteristics of stones, mechanism of fragmentation, and technique of operator. There were many reports concerning stone size, location, composition, and lithotriptor itself, but no report concerning technical aspect in fragmentation of stones. We know the therapeutic results of SWL using same machine and under similar in conditions of stones were different. So, we investigated fragmentation rate of the stones according to gross hematuria and pain as one of parameters on behalf of technical aspects in addition to other characteristics of the stones. MATERIALS AND METHODS: We analysed the results of urinary stone fragmentations in 61 patients for whom SWL had been undergone from March, 1998 to August, 1998. Success rates and their correlations according to the size, location, shape, and radiopacity of the stones, degree of the flank pain and severity of gross hematuria during and after operation. RESULTS: The rates of stone fragmentations according to size, location, shape, and radiopacity of the stones did not show significant differences, wherease severity of gross hematuria and flank pain during and after SWL showed significant correlations to success rates(p<0.01). CONCLUTIONS: In practicing SWL, we think it is helpful to rasing success rate to consider of the severity of gross hematuria and flank pain following SWL.