Multilocular cyst of the kidney is a rare pathologic entity, noninherited benign renal neoplasm occurring in the both children and adults. The entities commonly were known as multilocular cyst of the kidney or multilocular cystic nephroma. The controversy over the pathogenesis of multilocular cyst-neoplasm versus developmental anomaly- is still unsettled. We report two cases of multilocular renal cyst, one in a 8-year-old child with a chief complaint of gross hematuria and another in a 44-year-old woman with epigastric discomfortness. They were preoperatively suspected multilocular cyst by ultrasonography and computed tomography. We performed a simple nephrectomy as the treatment of choice because of the difficulty in accurate diagnosis and the documented association with renal neoplasia.
Adult ; Child ; Diagnosis ; Female ; Hematuria ; Humans ; Kidney ; Kidney Neoplasms ; Nephrectomy ; Ultrasonography

The ultrasonographic features in 26 cases of blunt testicular trauma were reviewed. Ultrasonography diagnosed correctly in 11 surgically proven cases of testicular rupture. There were three false-positive cases, two with a large scrotal hematocele and one with epididymis rupture. there were no false-negative cases. The sensitivity and specificity of ultrasonographic diagnosis were 100% and 80% respectively. The positive and negative predictive values were 78. 6% and 100% respectively. Therefore, the negative diagnosis by ultrasonography can warrant conservative therapy.
Diagnosis ; Epididymis ; Hematocele ; Male ; Rupture ; Sensitivity and Specificity ; Ultrasonography*

We reviewed our experience retrospectively with 65 patients who had post-traumatic complete urethral stricture secondary to pelvic bone fracture or other causes during last 10 years. All patients underwent delayed endoscopic internal urethrotomy (EIU) 3 to 9 months later after immediate suprapubic diversion. Prior to EIU, the antegrade-retrograde urethrogram demonstrated a complete urethral disruption, and the length of urethral obstruction was measured from 0.5cm to 3.5cm (mean 1.4cm). Of 65 patients, 61 patients (94%) had successful operations, 4 patients (6%) whose strictures were measured more than 2.5cm were failed and treated with open urethroplasty. Sixty-one patients who eventually underwent successful endoscopic internal urethrotomy; 28 patients (46%) achieved satisfactory urethral voiding after first EIU; 33 patients (54%) took operations more than twice due to recurred partial urethral stricture. After 6 to 53 months (average-21months), fifty-six (86%) of 65 patients voided satisfactorily (incontinence in 3 patients). Five patients who did not void well even after successful EIU were diagnosed to have neurogenic bladder (detrusor areflexia). Of 65 patients, 16 patients (25%) had post-traumatic impotence. After the EIUs were performed, there were no newly developed impotences. There were no serious major complications. We concluded that direct visual internal urethrotomy was useful and safe as a primary minimally invasive therapeutic modality for post-traumatic complete urethral stricture in selected patients with relatively short urethral defect (less than 2.5cm).
Constriction, Pathologic ; Erectile Dysfunction ; Humans ; Male ; Pelvic Bones ; Retrospective Studies ; Urethral Obstruction ; Urethral Stricture* ; Urinary Bladder, Neurogenic

To evaluate the etiology and treatment of options in patients with hemospermia, we retrospectively reviewed 21 patients who had both transrectal ultrasound and MRI and have been followed for more than 6 months after initiation of treatment. Mean age was 40 years (range 20 - 50 years) with duration of infliction being 24 months (range 1 week to 16 years). Among the 14 patients with prostatic cyst, 9 patients underwent transurethral unroofing (TUUR) of cyst. All 9 patients were completely cured, but one patient developed postoperative epididymitis. Among the 6 patients with prostatitis, hemospermia was resolved in 4 patients after mean treatment of 12 weeks with antibiotics. In DES (Diethylstilbestrol) group, 50 % showed resolution of symptoms among 6 patients after 4 weeks of treatment, and two patients complained breast discomfort which were developed after medication. In conclusion, the antibiotic treatment is advisable in hemospermia patients with prostatitis. Prostatic cystic lesion is believed to be a factor in hemospermia, thus TUUR of cyst wall and removal of stone and hematoma in cyst can be a viable option.
Anti-Bacterial Agents ; Breast ; Epididymitis ; Hematoma ; Hemospermia* ; Humans ; Magnetic Resonance Imaging ; Male ; Prostatitis ; Retrospective Studies ; Ultrasonography

PURPOSE: We attempt to compare the impact of transurethral microwave thermotherapy (TUMT) with alpha-1 blocker (terazosin) on the symptom score, flow rate and residual urine. MATERIALS AND METHOD: A total of 29 patients underwent TUMT and 20 patients were treated by terazosin. FDA symptom score, urinary flow rate and residual urine before and after therapy were analyzed. RESULTS: Although an improvement in symptom score, flow rate and residual urine was noted at 6 months in both groups, there was no statistic significance between two groups in symptom score and flow rate. Reduction of residual urine only showed marginally significant difference in two groups. CONCLUSION: Except patients with absolute indications for transurethral resection of the prostate (TURP), those with symptomatic benign prostatic hyperplasia (BPH) will be benefited by these two modalities and TUMT is more effective than alpha-1 blocker in reducing residual urine.
Humans ; Hyperthermia, Induced ; Microwaves ; Prostate ; Prostatic Hyperplasia* ; Transurethral Resection of Prostate*

We reviewed 42 cases (mean age 48.3+/-7.6 years, range 30 to 63 years) who underwent the modified Gittes bladder neck suspension for female stress urinary incontinence between January 1990 and May 1995 to evaluate the efficacy of two different suspension suture materials and new suspension suture carrier. At first we used the No. 1-0 Prolene as suspension suture in 24 cases (group I) and secondly No. 1-0 Ethibond in 18 cases (group II) with Ostycut bone biopsy needle (Angiomed) as suture carrier Following results were obtained. 1. The patient's ages ranged from 30 to 63 years (mean age 48.3+/-7.6 years), and most patients were multiparous with an average of 3.3+/-1.2 deliveries and we classified the patients according to Blaivas classification and there was statistically no difference of variables in both groups except the parity. 2. The mean values of operative time, postoperative days on catheter, and postoperative hospitalization were 65.5+/-11.4 minutes, 6.9+/-1.6 days, 7.3+/-1.4 days respectively. 3. The postoperative complications were transient urinary retention 8 cases (21.1%), vaginitis or cystitis 5 cases (11.9%), wound bleeding 1 case (2.4%) and deviation of urinary steam 1 case (2.4%). 4. The success rate was 83.3% in the group I, 94.4% in group II with minimum followup of 12 months (mean 24.6+/-5.0 months) but the latter wasn't significantly higher than the former statistically. The overall success rate was 88.1%. 5. The Ostycut bone biopsy needle as suspension suture carrier was simple and safe in the bladder neck suspension treatment. With above results, we recommend the No. 1-0 Ethibond as suspension suture material rather than the Prolene in bladder neck suspension and Ostycut bone biopsy needle as suspension suture carrier.
Biopsy ; Catheters ; Classification ; Cystitis ; Female ; Follow-Up Studies ; Hemorrhage ; Hospitalization ; Humans ; Neck* ; Needles ; Operative Time ; Parity ; Polypropylenes ; Postoperative Complications ; Steam ; Sutures* ; Urinary Bladder* ; Urinary Incontinence ; Urinary Retention ; Vaginitis ; Wounds and Injuries

Interstitial cystitis is prevalent in the 5th decade women, characterized by frequency, urgency and pelvic pain. To diagnose interstitial cystitis, NIH diagnostic criteria was used. Patients underwent overdistention and all patients were evaluated with IPSS symptom score and urodynamic study in preoperative period, post operative(POD) 1 week and 1 month. The age distribution was 4th decade in 1 patient, 5th decade in 3, 6th decade in 2, 7th decade in 4 and then above 7th decade in 2. Symptom durations was less than 7 years in 7 patients, between 7-10 years in 2 and more than 10 years in 3. Changes in bladder irritative symptom score between preop. and POD 1 week, and preop. and POD 1 month were 6.00+/-4.40(p<0.05) and 6.36+/-2.29(p<0.05) with statistical significance, respectively. Changes in obstructive symptom scores were 4.91+/-4.27(P<0.05) and 3.91+/-4.76(P<0.05) with statistical significance. On urodyna-mic study, the volume of first voiding sensation between preop and POD 1 week was 29.45+/-52.04(p>0.05) but statistically insignificant. However, the change between pre op. and POD 1 month was 97.45+/-90.29(p<0.05) with statistical significance. Difference in maximal capacity between preop. and POD 1 week was statistically significant as 87.55+/-126.39(p<0.05). Bladder functional capacity changes between with and without anesthesia was statistically significant(p<0.05) Postop. complications were bladder rupture in 1 case, and hematuria in 12. The results of overdistention was useful in the diagnosis and treatment of interstitial cystitis. Then more evaluation and follow up will be needed.
Age Distribution ; Anesthesia ; Cystitis, Interstitial* ; Diagnosis ; Female ; Follow-Up Studies ; Hematuria ; Humans ; Pelvic Pain ; Preoperative Period ; Rupture ; Sensation ; Urinary Bladder ; Urodynamics

Effects of oral estrogen (Tibolone) on the urinary symptoms and urodynamics parameters were assessed by a double-blind prospective trial in 24 postmenopausal women. Patients were assessed subjectively and objectively before and after treatment by symptom score change, urethral pressure profiles and uroflow. There was statistical difference in the subjective response (symptom score) to treatment between the two groups (p<0.001), there was no significant urodynamic changes (p> 0.05). Although there was no significant urodynamic changes, estrogen treatment in postmenopausal women was effective to improve urinary symptoms. Careful observation with periodic follow up will be needed because of possible harmful side effects of estrogen.
Estrogens* ; Female ; Follow-Up Studies ; Humans ; Prospective Studies ; Urodynamics*

Hypospadias can be repaired in the majority cases in 1-stage with a high success rate. We reviewed clinical experience of 50 patients who underwent primary hypospadias repair by 1 surgeon using 1-stage repairs except 3 cases in a 30-month period. The results were 1). The half of patients were younger than 5 years (48%). 2). A total of 34 cases (68.0%) had an associated ventral curvature. The dorsal tunica albuginea plication to correct intrinsic curvature was done in 21 cases (61.8%) and dividing the urethral plate in only 3 cases (8.8%). 3). Associated anomalies were cryptorchidism in 7, hydrocele in 3 and severe penoscrotal transposition in 8 cases. 4). 19 cases of anterior hypospadias were repaired by meatoplasty using Heineke-Mikulicz tissue rearrangement (9 cases), MAGPI (3 cases), pyramid procedure (4 cases), Mathieu urethroplasty (2 cases) and onlay island flap (1 case). Of the 31 cases of middle and posterior hypospadias onlay island flap repair was performed in 24 cases (77.4%). 5). The success rates in anterior, middle and posterior hypospadias were 94.7, 64.7 and 42.9%, respectively. The overall success rate was 70%. 6). The most commonly used procedure was onlay island flap urethroplasty. Only 14 of 25 cases (56.0%) were successful with this method but the last 8 cases were repaired with no complications. 7). The most common complications were urethrocutaneous fistula (11 cases) and meatal retraction (3 cases). The complications were managed by rotational advancement flap (11 cases), meatal based flap (2 cases) and urethral advancement (1 case) and the success rate was 73.3%. In conclusion, to achieve more satisfactory results the choice of operation depends on the configuration of either glans or meatus, presence or absence of chordee and status of ventral penile skin in anterior hypospadias. Although the 2-stage repair remains a safe and reliable alternatives for severe hypospadias 1-stage repair was more useful except severe hypospadias combined with penoscrotal transposition."
Cryptorchidism ; Female ; Fistula ; Humans ; Hypospadias* ; Inlays ; Male ; Skin

PURPOSE: We studied penile size of children who underwent hypospadias repair. Also we surveyed the degree of satisfaction with, as judged by patient's parents and urologist. MATERIALS AND METHODS: We measured the relaxed and erected penile size of children who underwent hypospadias repair and followed more than one year (28 cases of one stage repair and 20 cases of two stage repair). All of them had no complication. We used age adjusted ANOVA test for penile size, and Wilcoxon matched pairs signed rank test for comparison of satisfaction with penile appearance between one stage group and two stage group. RESULTS: Significant difference was noted between one stage group and two stage group for relaxed and erected penile length (p<0.05), but penile circumference was not (p>0.05). Two stage group showed statistically significant larger value than one stage group for glandular size, glandular shape, position of meatus, general appearance, and genital perception score as judged by patient's parents (p<0.05). And two stage group showed statistically larger value than one stage group for genital perception score judged by urologist (p<0.05). CONCLUSIONS: Our study demonstrated that two stage operation met with better penile size and satisfaction judged by patient's parents and urologist than one stage operation for middle and posterior penile hypospadias.
Child ; Female ; Humans ; Hypospadias* ; Male ; Parents