We reviewed 113 patients of renal trauma between May, 1989 and May, 1995 to clarify the characteristics of the patients who need surgical management. Of the 113 renal trauma patients, 80 were treated conservatively and remaining 33 were treated with surgically. The causes of injury were blunt trauma in 112 and penetrating injury with gunshot in 1. The grade of injury was contusion in 48 (42.5%), simple laceration in 25 (22.1 %), deep laceration into collecting system in 26 (23.0%), shattered kidney in 7 (6.2%), and pedicle injuries in 7 (6.2%). Aside from 1 case of grade 2 Wilms' tumor patient, all the surgically treated patients were over grade 3. Surgically treated patients had more associated trauma, especially in nephrectomy cases. Shock is the characteristic feature of surgically treated patients' symptom. All the 33 case of exploration was done without preliminary vascular pedicle control prior to opening the Gerota's fascia. Nephrectomy was done in 15 cases, and partial nephrectomy or renorrhaphy was done in 18 cases. Comparing the two groups, the former showed more shock rate (53.3 vs.33.3%), combined organ injuries (2.05 vs 1.32), and death rate (6.67 vs. 0%) (P<0.05). Gender ratio, patients' age and transfusion amount (2,984 vs 3,204ml.) did not show difference in both groups. The latter group took more time (98 vs. 128 min.) during operation. The causes of nephrectomy were renal pedicle injuries in 5 cases, shattered kidney in 7 cases and Grade III/V renal injuries with underlying anomalies in 2 cases (polycystic degeneration in one and hydronephrosis in the other case). One case was traumatic rupture of Wilms' tumor. In the management of traumatic renal injuries, patients who have more severe and associated organ injury, especially in the nephrectomy group, received surgical treatment. Shock is the only characteristic sign of surgical treatment group.
Contusions ; Fascia ; Humans ; Hydronephrosis ; Kidney ; Lacerations ; Mortality ; Nephrectomy ; Rupture ; Shock ; Wilms Tumor

A 4 day old male neonate with severe dehydration, uremia, and hyperbilirubinemia presented with bilateral renal vein thrombosis. Following exchange transfusion and peritoneal dialysis renal function returned to normal without nephrectomy. The importance of adequate and prompt management of renal failure to expect the spontaneous recanalization is stressed. Because of the high mortality rate associated with the nephrectomy in neonates, adequate and prompt medical management including peritoneal dialysis or exchange transfusion, if indicated, with expectation of spontaneous recovery is considered the treatment of choice in this age group.
Dehydration ; Humans ; Hyperbilirubinemia ; Infant, Newborn* ; Male ; Mortality ; Nephrectomy ; Peritoneal Dialysis ; Renal Insufficiency ; Renal Veins* ; Thrombosis* ; Uremia

A clinical evaluation was made with particular attention to surgical management on 156 patients with renal calculi who had been admitted to the Department of Urology, Kyungpook National University Hospital during 1O years periods from January, 1976 to December, l985. The results were as follows: 1. The calculus was unilateral in 144 patients (right in 73 and left in 71) and bilateral in l2.57 patients had staghorn calculi, 62 either single or multiple pelvic calculi, 20 either single or multiple calyceal calculi, and 17 multiple pelvic and calyceal calculi. 2. The treatment modality was surgical intervention in l39 patients(143 operations) and conservative management in 17.143 surgical interventions were nephrectomy in 17 and conservative surgery in 126. Conservative surgery was simple pyelolithotomy in 14, extended pyelolithotomy in 59, extended pyelolithotomy with parenchymal extension in 21, radial nephrolithotomy in 4, anatrophic nephrolithotomy in l4, partial nephrectomy in l3, and extended pyelolithotomy with ureterocalycostomy in 1. 41 operations with nephrotomy were done using in situ hypothermia. 3. 60 surgical interventions for pelvic calculi were simple pyelolithotomy in 14, extended pyelolithotomy in 40, extended pyelolithotomy with parenchymal extension in 2, and nephrectomy in 4.l9 surgical interventions for calyceal calculi were extended pyelolithotomy in 4, extended pyelolithotomy with parenchymal extension in 4, radial nephrolithotomy in 3, partial nephrectomy in 6, and nephrectomy in 2. 14 surgical interventions for pelvic and calyceal calculi were extended pyelolithotomy in 1, extended pyelolithotomy with parenchymal extension in 3, radial nephrolithotomy in l, anatrophic nephrolithotomy in 2, and partial nephrectomy in 5. 50 surgical interventions for stag horn calculi were extended pyelolithotomy in 14, extended pyelolithotomy with parenchymal extension in 2, anatrophic nephrolithotomy in 14, partial nephrectomy in 5, and nephrectomy in 6. 4. Except for 15 cases with remnant calculi and 1 with nephrectomy, no mortality nor significant morbidity was found 126 cases with renal calculi treated by conservative surgery. Cases found to have remnant calculi after surgical procedures were 1 out of 14 pyelolithotomies, 6 out of 59 extended pyelolithotomies, 4 out of 21 extended pyelolithotomy with parenchymal 2 extension, out of 14 anatrophic nephrolithotomies, and 1 out of 4 radial nephrolithotomies.
Animals ; Calculi ; Gyeongsangbuk-do ; Horns ; Humans ; Hypothermia ; Kidney Calculi* ; Mortality ; Nephrectomy ; Urology

A clinical evaluation was made with particular attention to surgical management on patients with staghorn calculi who had been admitted to the Department of Urology, Kyungpook National University Hospital during 10 years periods from January, 1975 to December, 1984. The results were as follows: 1. Out of total 2,634 in-patients, 469 were due to urinary stones and 51 due to staghorn calculi. 51 patients with staghorn calculi were 2% of total admission and 11% of patients with urinary stones. 2. The calculus was unilateral in 50 patients (right in 25 and left in 25) and bilateral in 1. Of 5O unilateral staghorn calculi l was in left solitary kidney. 3. 49 patients had presenting symptomatology and 2 patients had no symptoms. The most common symptom was flank Rain(80.4 %). 4. Excretory urogram showed marked hydronephrosis in 8 cases, mild to moderate hydronephrosis in 3O normal collecting system in 3 and non-visualized kidney in 10. 5. Urine cultures yielded organism in 19 of 41 cases: E. coli, Klebsiella and Staphylococci in 4 respectively and Enterobacter in 3. 6. The treatment modality was surgical intervention .in 47 patients (48 operations) and conservative management in 4. 4S surgical interventions were nephrectomy in 10 and conservative treatment 38. Conservative surgery was extended pyelolithotomy in 12, extended pyelolithotomy with parenchymal extension in 11, anatrophic nephrolithotomy in 9, partial nephrectomy in 5, and extended pyelolithotomy with ureterocalicostomy in 1. 7. Except 6 cases with remnant calculi, no mortality and significant morbidity was found in 38 cases with staghorn calculi treated by conservative surgery.
Calculi* ; Enterobacter ; Gyeongsangbuk-do ; Humans ; Hydronephrosis ; Kidney ; Klebsiella ; Mortality ; Nephrectomy ; Urinary Calculi ; Urology

Emphysematous pyelonephritis is an uncommon, but life-threatening necrotizing inflammation of renal parenchyme and perinephric tissue by gas-forming organisms. This disease is encountered mainly in patients with uncontrolled diabetes mellitus and/or urinary tract obstruction etc. Though the pathogenesis of this diseases is still poorly understood, radiographic demonstration of gas shadow in renal parenchyme and peri-nephric tissue establishes the diagnosis of emphysematous pyelonephritis. The identification of this finding has been believed to consider incision and drainage or nephrectomy in addition to medical treatment, because of high mortality rate of this disease in spite of vigorous medical management. We report two cases of emphysematous pyelonephritis complicated in 62-year-old female and 48- year-old male patients with diabetes mellitus. Nephrectomies were not performed because of bilateral emphysematous pyelonephritis in one patient and of refusal of nephrectomy by the other patient. But patients were recovered completely on medical management.
Diabetes Mellitus ; Diagnosis ; Disulfiram ; Drainage ; Female ; Humans ; Inflammation ; Male ; Middle Aged ; Mortality ; Nephrectomy ; Pyelonephritis* ; Urinary Tract

PURPOSE: A retroperitoneoscopic adrenalectomy is theoretically the ideal procedure for an adrenalectomy. However, it is not popular due to its technical difficulty. Herein, we report our experience with retroperitoneoscopic adrenalectomies and describe the difficulties encountered during the operations. METHODS: From November 1996 to October 1999, a total of 41 retroperitoneoscopic adrenalectomies were performed. Forty (40) patients had a unilateral adrenal tumor (size: 1?? cm): 21 aldosteronomas, 12 Cushing adenomas, 3 neurogenic tumors, 2 nonfunctioning adenomas, 1 vascular cyst, and 1 angiomyolipoma of the kidney. One (1) had bilateral hyperplasia. The operations were carried out in prone position in all cases with 3 trochars. RESULTS: Thirty five (35) operations were completed endoscopically. Five were converted to open procedures, and one was converted to a transperitoneal laparoscopic approach. The causes of conversion were 1 severe subcutaneous emphysema, 2 technical difficulties, 1 bleeding, 1 partial nephrectomy, and 1 missing tumor. The average operating time for the complete endoscopic adrenalectomies was 183 minutes in the first 14 cases and 142 minutes in the next 21 cases. There was no operative morbidity or mortality. The average hospital stay was 4.3 days in the first 14 cases and 2.8 days in the next 21 cases. CONCLUSION: A retroperitoneoscopic adrenalectomy is a less invasive procedure than any other adrenalectomy procedure, and its only disadvantage is technical difficulty. However, the technical difficulty can be overcome with increasing experience.
Adenoma ; Adrenalectomy* ; Angiomyolipoma ; Hemorrhage ; Humans ; Hyperplasia ; Kidney ; Length of Stay ; Mortality ; Nephrectomy ; Prone Position ; Subcutaneous Emphysema

PURPOSE: A retroperitoneoscopic adrenalectomy is theoretically the ideal procedure for an adrenalectomy. However, it is not popular due to its technical difficulty. Herein, we report our experience with retroperitoneoscopic adrenalectomies and describe the difficulties encountered during the operations. METHODS: From November 1996 to October 1999, a total of 41 retroperitoneoscopic adrenalectomies were performed. Forty (40) patients had a unilateral adrenal tumor (size: 1?? cm): 21 aldosteronomas, 12 Cushing adenomas, 3 neurogenic tumors, 2 nonfunctioning adenomas, 1 vascular cyst, and 1 angiomyolipoma of the kidney. One (1) had bilateral hyperplasia. The operations were carried out in prone position in all cases with 3 trochars. RESULTS: Thirty five (35) operations were completed endoscopically. Five were converted to open procedures, and one was converted to a transperitoneal laparoscopic approach. The causes of conversion were 1 severe subcutaneous emphysema, 2 technical difficulties, 1 bleeding, 1 partial nephrectomy, and 1 missing tumor. The average operating time for the complete endoscopic adrenalectomies was 183 minutes in the first 14 cases and 142 minutes in the next 21 cases. There was no operative morbidity or mortality. The average hospital stay was 4.3 days in the first 14 cases and 2.8 days in the next 21 cases. CONCLUSION: A retroperitoneoscopic adrenalectomy is a less invasive procedure than any other adrenalectomy procedure, and its only disadvantage is technical difficulty. However, the technical difficulty can be overcome with increasing experience.
Adenoma ; Adrenalectomy* ; Angiomyolipoma ; Hemorrhage ; Humans ; Hyperplasia ; Kidney ; Length of Stay ; Mortality ; Nephrectomy ; Prone Position ; Subcutaneous Emphysema

PURPOSE: A retroperitoneoscopic adrenalectomy is theoretically the ideal procedure for an adrenalectomy. However, it is not popular due to its technical difficulty. Herein, we report our experience with retroperitoneoscopic adrenalectomies and describe the difficulties encountered during the operations. METHODS: From November 1996 to October 1999, a total of 41 retroperitoneoscopic adrenalectomies were performed. Forty (40) patients had a unilateral adrenal tumor (size: 1-6 cm): 21 aldosteronomas, 12 Cushing adenomas, 3 neurogenic tumors, 2 nonfunctioning adenomas, 1 vascular cyst, and 1 angiomyolipoma of the kidney. One (1) had bilateral hyperplasia. The operations were carried out in prone position in all cases with 3 trochars. RESULTS: Thirty five (35) operations were completed endoscopically. Five were converted to open procedures, and one was converted to a transperitoneal laparoscopic approach. The causes of conversion were 1 severe subcutaneous emphysema, 2 technical difficulties, 1 bleeding, 1 partial nephrectomy, and 1 missing tumor. The average operating time for the complete endoscopic adrenalectomies was 183 minutes in the first 14 cases and 142 minutes in the next 21 cases. There was no operative morbidity or mortality. The average hospital stay was 4.3 days in the first 14 cases and 2.8 days in the next 21cases. CONCLUSION: A retroperitoneoscopic adrenalectomy is a less invasive procedure than any other adrenalectomy procedure, and its only disadvantage is technical difficulty. However, the technical difficulty can be overcome with increasing experience.
Adenoma ; Adrenalectomy* ; Angiomyolipoma ; Hemorrhage ; Humans ; Hyperplasia ; Kidney ; Length of Stay ; Mortality ; Nephrectomy ; Prone Position ; Subcutaneous Emphysema

Intraoperative pulmonary thromboembolism (PTE) is rare, but is nevertheless one of the important causes of morbidity and mortality in patient undergoing surgery. However, The detection of PTE is difficult because it's clinical symptoms and signs are nonspecific during surgery, and specialized diagnostic tools are not readily available in the operating room. We report a case of PTE due to cancer emboli with thrombi encountered during a nephrectomy in patient with renal cell cancer, and demonstrate that one-lung ventilation can aid in the diagnosis of massive PTE when the evaluation is suspected.
Carcinoma, Renal Cell ; Diagnosis ; Humans ; Mortality ; Nephrectomy ; One-Lung Ventilation* ; Operating Rooms ; Pulmonary Embolism*

The morbidity and mortality rates are believed to be much higher if the staghorn calculus is left unoperated, since complications resulting from infection and/or obstruction may become life-threating. So, surgical removal is essential element in the successful management of the majority of patients with staghorn calculous disease. To understand better the optimal management, we did a retrospective analysis of 41 patients treated during 12 year periods. Surgical managements were performed in 36 patients (41 kidneys) and no operation in 5. Methods of surgical managements were extended pyelolithotomy in 11 cases, extended pyelolithotomy and pyeloplasty in 1, extended pyelolithotomy with parenchymal extension in 4, ex- tended pyelolithotomy with parenchymal extension and partial nephrectomy in 1, anatrophic nephrolithotomy in 7, antrophic nephrolithotomy with partial nephrectomy in 3, partial nephrectomy in 3, partial nephrectomy in 3 and nephrectomy in 9. Complete removals of calculi were done in 32 kidneys(69.6%). Clinical complications occurred in 14 kidneys(30.4%) ; 5 were remnant stones(10.8%), massive bleeding in 2, renal artery injury in 1, urine leakage in 3, pneumothorax in 2 and hematuria and sepsis in 1. The managements of complications were reoperation in 8 cases, conservative treatment in 5 and no follow up in 1.
Calculi* ; Follow-Up Studies ; Hematuria ; Hemorrhage ; Humans ; Mortality ; Nephrectomy ; Pneumothorax ; Renal Artery ; Reoperation ; Retrospective Studies ; Sepsis