PURPOSE: Extracorporeal shock wave lithotripsy (SWL) has been established as the treatment of choice for the urinary stones. But, for the treatment of staghorn calculi, the efficacy of this therapeutic procedure is controversal. We intended to study the therapeutic results and the usefulness of ureteral stent between 2 types of lithotriptor, EDAP LT-01 and Storz Modulith SLX. MATERIALS AND METHODS: Sixty cases were diagnosed as staghorn calculi from February 1990 to December 1998. Among them, 31 patients were treated with EDAP LT-01 SWL (group A) and 29 patients with Storz Modulith SLX SWL (group B). We inserted a double-J stent in 45 patients that consisted of 24 patients from group A and 21 patients from group B. The number of treatment sessions, complications and success rates were compared regarding each SWL and volume of the stone. RESULTS: The success rates of each SWL were 70.9% in group A and 75.9% in group B. The success rates, according to staghorn morphology, were 71.4% and 85.7% in partial staghorn of group A and B. The average shock wave sessions were 12.0 and 7.4 in partial staghorn of group A and B. The success rates, according to staghorn volume, were 67.8% and 88.9% in less than 60cm3 of group A and B. The average shock wave sessions were 12.6 and 9.6 in less than 60cm3 of group A and B. The findings were statistically significant between the two groups in less than 60cm3 or partial staghorn. After SWL, incidence of steinstrasse was 12.5% and 33.3% in the double-J stent inserted patients of group A and B. CONCLUSIONS: SWL could be a method of primary treatment for staghorn calculi. Storz Modulith SLX SWL was more effective than EDAP LT-01 SWL for staghorn calculi of which the volume was less than 60cm3. Placement of ureteral stents would be effective in the treatment of staghorn calculi by EDAP LT-01 SWL and not in Storz Modulith SLX.
Calculi* ; Humans ; Incidence ; Lithotripsy ; Shock ; Stents ; Ureter ; Urinary Calculi

From February 8. 1990 to November 30, 1991, 25 patients with staghorn calculi were underwent extracorporeal shock wave lithotripsy(ESWL) using the EDAP LT-01 lithotriptor. We reviewed patients with staghorn calculi to evaluate the effectiveness of ESWL as monotherapy for staghorn calculi and determine the selection criteria for the treatment calculi. The results were obtained as follows : l. Ten patients had complete staghorn calculi filling the complete renal collecting system with stone of l7,635 mm3 in mean volume and l3 patients had partial staghorn calculi filling the renal pelvis and partial caliceal groups with stone of 7,017 mm3 in mean volume. 2. Of 17 patients with stone of less than 8,200 mm3 in volume. 10(83.3%)remained free of stone after an average 11.8 sessions. Of 6 patients with stone of between 8,200 to 14,200 mm3 volume, 5(83.3%) remained free of stone after an average 18.3 sessions. Of 7 patients with stone of more than l4,200 mm3 in volume, 2(28.6%) remained free of stone after an average 17.4 sessions 3. When these patients were stratified by stone burden, of 10 patients with stone filling a non-dilated renal collecting system, all(100%) patients remained free of stone. Of 15 patients with filling a dilated renal collecting system. 7 (46.7%) patients remained free of stone. Of 8 cases with residual stones. 2 patients were underwent open surgery(nephrectomy, extended pyelolithotomy), 2 patients were impossible to follow up and 4 patients still are undergoing continuous additional ESWL sessions. 5. Double J stent for the pre-ESWL additional measures were placed in 19 patients(76%); Eight of the complete staghorn calculi and 11 of the partial staghorn calculi. Percutaneous nephrostomy tube was placed in 2 patients. No general or regional anesthesia was required. 6. The post-ESWL complications were ureteral obstruction(steinstrasse) in 7 patients(28%) and high fever(over 38.5 degrees C) in 11 patients( 44.0%). We conclude that partial staghorn calculi, staghorn calculi with stone of less than 14,200 mm3 in volume and staghorn calculi with stone burden filling non-dilated collecting system are eligible for ESWL.
Anesthesia, Conduction ; Calculi* ; Follow-Up Studies ; Humans ; Kidney Pelvis ; Lithotripsy* ; Nephrostomy, Percutaneous ; Patient Selection ; Shock* ; Stents ; Ureter

We compared the roles of urinary cytology and flow cytometric DNA analysis in the evaluation of 26 patients with transitionsl cell carcinoma of bladder from March 1989 to April 1991. When carcinoma was present at the time of specimen collection it was detected by cytology in 65.4 percent and flow cytometric DNA analysis in 73.1 percent. Combination of flow cytemetric DNA analysis and urinary cytology increased the diagnostic yield to 88.5 percent Flow cytometric DNA analysis was slightly more sensitive than urinary cytology for the detection of abnormalities in specimen from low stage. high grade. small size. small number and recurrent cancer but no statistically significant difference was identified. When used in conjunction with urinary cytology. urine flow cytometric DNA analysis was valuable procedure in the diagnosis and follow up of patients with bladder cancer.
Diagnosis ; DNA* ; Follow-Up Studies ; Humans ; Specimen Handling ; Urinary Bladder Neoplasms ; Urinary Bladder*

We attempted to compare the result of EDAP LT-01+ lithotripsy with Modulith SLX lithotripsy for management of urinary stones. We evaluated 1,544 patients (1,731 renal units) treated with EDAP LT-01+ ESWL (Group A) and 668 patients (707 renal units) treated with Modulith SLX ESWL (Group B). The results were obtained as follows; 1. Between the group A and B, stones were located in kidney (except staghorn calculi) in 666 cases (38.5%) and 160 cases (22.6%), in staghorn calculi in 31 cases (1.8%) and 13 cases (1.8%), in ureteropelvic junction (UPJ) in 65 cases (3.8%) and 19 cases (2.7%), in upper ureter in 469 cases (27.0%) and 200 cases (28.3%), in lower ureter in 491 cases (28.4%) and 271 cases (38.3%) and in bladder in 9 cases (0.5%) and 10 cases (1.4%), respectively. 2. Success rates according to stone size were 99.4% and 99.6% in less than 1 cm:, 97.5% and 97.2% in 1 cm2 to 2 cm2, 92.4% and 91.3% in 2 cm2 to 3 cm2 and 82.2% and 78.1% more than 3 cm2 respectively in the group A and B. There. was no statistically significant difference between two groups (,p>0.05). 3. Success rates ccording to stone location were 98.8% and 100% in renal stone (except staghorn calculi) , 83.9% and 84.6% in staghorn calculi,92.3% and 94.7% in UPJ stone, 97.7% and 98.5% in upper ureteral stone, 98.4% and 98.6% in lower ureteral stone and 66.7% and 30% in bladder respectively in the group A and B. There was no statistically significant difference between two groups (p>0.05). 4. Average shock wave sessions and time (min.) were 4.0 and 1.8 and 42.1 and 28.6 respectively in the group A and B. These differences were statistically significant (p<0.05). 5. Complications were gross hematuria (>=3 days) in 1.6% and 10.7%, steinstrasse in 5.1% and 12.5%, fever (>=38 degree C) in 2.1% and 2.3% and perirenal hematoma in 0% and 0.7% respectively in the group A and B. We concluded that success rates according to location and size of urinary stone were similar between two groups. But, treatment time of the group B was significantly shorter than that of the group A. Treatment sessions of the group B were decreased compared with the group A. Gross hematuria and steinstrasse were occurred significantly more in the group B compared to the group A (p<0.05).
Calculi ; Fever ; Hematoma ; Hematuria ; Humans ; Kidney ; Lithotripsy* ; Shock ; Ureter ; Urinary Bladder ; Urinary Calculi*

Trauma is the important cause of death in children and adults. From May 1, 1984 to June 30, 1995, 370 patients were admitted to our hospital for genitourinary injuries. We made clinical observations and compared children with adults on incidence, cause, diagnosis and treatment of genitourinary traumatic patients. As the result, it was no significant difference between children and adults on incidence, sex ratio, cause, hospital stay, and associated injuries. The kidney was the most common organ to be injured and there was no difference in severity of renal injury between two groups. Operative treatments were more common in adults than children, and external genitalia was most common organ to get operation.
Adult* ; Cause of Death ; Child* ; Diagnosis ; Genitalia ; Humans ; Incidence ; Kidney ; Length of Stay ; Sex Ratio

Trauma is the important cause of death in children and adults. From May 1, 1984 to June 30, 1995, 370 patients were admitted to our hospital for genitourinary injuries. We made clinical observations and compared children with adults on incidence, cause, diagnosis and treatment of genitourinary traumatic patients. As the result, it was no significant difference between children and adults on incidence, sex ratio, cause, hospital stay, and associated injuries. The kidney was the most common organ to be injured and there was no difference in severity of renal injury between two groups. Operative treatments were more common in adults than children, and external genitalia was most common organ to get operation.
Adult* ; Cause of Death ; Child* ; Diagnosis ; Genitalia ; Humans ; Incidence ; Kidney ; Length of Stay ; Sex Ratio

Transforming growth factor-B1(TGF-B1) has many fundamental biological processes including cell growth, extracellular matrix deposition and degradation, and inflammatory responses. TGF-B1 is released by platelet and inflammatory cells, and it affects all phases of wound healing after injury. It contributes to the regulation of fibroblast chemotaxis and proliferation, and also controls the synthesis and degradation of extracellular matrix necessary for tissue repair. Clinically, scar tissue formation and subsequent stricture after urethral injury frequently results in troublesome problems to urologists. In the phase I study of this report, we intended to how the histological changes and the involvement of TGF-B1 in the formation of stricture in injured urethrae of rats. We injured urethrae of 24 adult male Sprauge-Dawley rats(200-250 g.) by urethrotome and Dormia basket and then observed histological changes and analysed TGF-f, mRNA levels of the injured urethrae by Northern blot. Northern b1ot analysis showed that TGF-t, mRNA was much expressed on day 1,3,5 after injury. Fibroblasts and deposition of extracellular matrix were markedly increased on day 5. Reepithelialization was completed and urethral lumen was narrowed on day 10. In the phase II study, we tried to know that antisense TGF-B1 oligodeoxynucleotides(ODNs) could inhibit TGF-B1 expression and the formation of stricture in injured urethrae of rats. We injured urethrae of rats and treated the urethral injury with the application of antisense TGF-B1 ODNs. Northern blot analysis showed that TGF-B1 mRNA was little expressed in the urethrae treated with the antisense on day 1,3 after injury. Comparing to the antisense-nontreated urethrae, the antisense-treated urethrae showed decrease of submucosal thickening and maintained normal sized urethral lumens on day 14, 21 after injury. In conclusion, increase of TGF-B1 mRNA in injured urethrae of rats suggests that TGF-B1 could play an important role in repair mechanism. With application of antisense TGF-B1 ODNs in injured urethrae of rats, the expression of TGF-B1 can be inhibited and also the formation of stricture prevented.
Adult ; Animals ; Biological Processes ; Blood Platelets ; Blotting, Northern ; Chemotaxis ; Cicatrix ; Constriction, Pathologic* ; Extracellular Matrix ; Fibroblasts ; Humans ; Male ; Oligodeoxyribonucleotides* ; Rats* ; RNA, Messenger ; Transforming Growth Factor beta1* ; Urethra ; Urethral Stricture ; Wound Healing

The purpose of this study was to examine the effect of smoking on the clinical, radiographic outcome of surgical peridontal therapy. The outcome of periodontal surgery was evaluated in 51 systemically healthy subjects that had received maintenance care. The study subjects consisted of 26 smokers and 25 non-smokers. The average age of smoking patients was 51 years old and non-smoking patients was 48 years old. Changes of probing pocket depth(PPD) and radiographic bone height, and number of missing teeth compared between smokers and non-smokers during maintenance period after surgical therapy. The clinical parameters were less favorable in the smoking group compared with non-smoking group. The number and percentage of missing teeth were greater in smokers(21.6%) than non- smokers(12.4%), especially in molars. The mean presurgery PPD was similar in smokers and non-smokers, molars and premolars, but significantly decreased at least 2 years after surgery. The mean PPD reduction was significantly greater in nonsmokers than smokers. Both in the smoking and non-smoking group, the mean PPD reduction was significantly greater in premolars than molars. The radiographical evaluation was also less favorable in the smoking group than non-smoking group. The radiographic evaluation of bone height in smokers showed bone loss. On the contrary, bone height of nonsmokers showed bone gain during the period of maintenance. But there was no significant difference between molars and premolars. The clinical and radiographic outcomes of the smoking group was less favorable than those of the nonsmoking group. Therefore, smoking seems to influence on the clinical and radiographic outcomes of surgical periodontal therapy.

When surgical treatment for symptomatic seminal vesicle cyst is deemed necessary, conventional surgery is invasive because of the deep location and dissection difficulty of the seminal vesicles in the retrovesical space. Recently, the laparoscopic approach has been advocated as an optimal yet minimally invasive technique for the surgical treatment of seminal vesicle pathology. It provides a good image and easy approach to the seminal vesicles. We report a case of a symptomatic giant cyst of the left seminal vesicle that is associated with ipsilateral renal agenesis, which was treated by transperitoneal laparoscopic excision.
Laparoscopy ; Pathology ; Seminal Vesicles*

PURPOSE: During transrectal ultrasound guided prostate biopsy, 65% to 90% of patients reportedly have discomfort. We compared the anesthetic effects of a periprostatic injection of lidocaine under ultrasound guidance with the effects of a rectal instillation of lidocaine gel before the transrectal ultrasound guided prostate biopsy. MATERIALS AND METHODS: A prospective randomized double-blind study was performed in 72 patients requiring a systematic biopsy of the prostate. Patients were randomized into two groups according to the method of anesthetic delivery that was used. Group 1 consisted of 37 patients who intrarectally received 10 ml of 2% lidocaine gel 10 minutes before biopsy, and 5 ml of normal saline was injected into the periprostatic nerve plexus just before biopsy under ultrasound guidance using an 18 gauge 16 cm needle on each side. Group 2 consisted of 35 patients who received 10 ml of sterile gel without lidocaine and a 5 ml 1% lidocaine injection using the same method as group 1. The pain score was assessed using a visual analogue scale immediately after biopsy. RESULTS: There was a statistical difference in the mean pain score between the two groups (5.1+/-1.7 in group 1 versus 3.3+/-1.5 in group 2) (p<0.001), but The complication rates were not significantly different. CONCLUSIONS: We believe that performing the transrectal ultrasound guided prostatic nerve blockade before biopsy significantly diminishes the discomfort associated with the procedure, which, in turn, improves patient tolerance more so than rectal instillation of lidocaine gel. In addition, this procedure is a safe, simple, and rapid technique that should be considered in all patients undergoing transrectal ultrasound guided prostate biopsy.
Administration, Rectal* ; Anesthetics ; Biopsy* ; Double-Blind Method ; Humans ; Lidocaine* ; Needles ; Nerve Block ; Prospective Studies ; Prostate* ; Ultrasonography*