PURPOSE: Delirium in the elderly is common in the postoperative period but there are only few reports on detailed studies of this condition. Number of urologic patients with postoperative delirium was increas ed in our hospital for recent 24 months. The clinical characteristics of patients with postoperative delirium was analyzed retrospectively. MATERIALS AND METHODS: We selected the patients with postoperative delirium from 1010 patients who had undergone urological surgery under general or spinal anesthesia in the period from Jan. 1997 to Dec. 1999. Diagnosis of postoperative delirium was established with Diagnostic and Statistical Manual of Mental Disorders(DAM-III-R) by psychiatric clinicians. Onset and recovery of symptoms, risk factors, previous psychiatric clinicians. Onset and recovery of symptoms, risk factors, previous psychiatric disorder, relationship with anesthesia, drugs, and surgical procedures, concomittant medical conditions, and complications were retrospectively reviewed. RESULTS: Postoperative delirium was observed in 13 patients (1.3%). All patients were male and mean age was 70.4 years (46-86 years). Surgical procedures included TURP(8 patients), cystectomy (3 patients), nephroureterectomy (1 patient), and bladder rupture repair (1 patient). Delirium became apparent between one day and two days after the operation (mean 32.2 hours) and lasted for up to 7 days (mean 53 hours). Several factors such as older age (>65 years), male patient, longterm medication, past history of CVA, memory impairment, hearing difficulty, traumatic brain contusion, and obsessive personality were thought to be risk factors of postoperative delirium. Treatment with Haloperidol(R) intramuscular injection (2.5-5mg, every 30 minutes, 2-4 times until symptom resolution was achieved) with or without Ativan(R) intravenous injection (2mg) were effective. Complete symptom recovery was seen in 92.3% (12/13) of patients. One patient (7.7%) with previous history of dementia had persistent memory disturbance and disorientation during follow-up periods. CONCLUSIONS: Generally, postoperative delirium is an acute transient confusional state without considerable sequeles. Treatment is sedation and prevention of inadvertent accident associated with confusional state. Urologic surgeon must be attentive to the development of this illness especially when high risk factors were present.
Aged ; Anesthesia ; Anesthesia, Spinal ; Brain Injuries ; Cystectomy ; Delirium* ; Dementia ; Diagnosis ; Follow-Up Studies ; Hearing ; Humans ; Injections, Intramuscular ; Injections, Intravenous ; Male ; Memory ; Postoperative Period ; Retrospective Studies ; Risk Factors ; Rupture ; Urinary Bladder

No abstract available.

No abstract available.

Bladder exstrophy is one of the most profound genitourinary anomaly and it affects psychosocial development. Herein author reported a case of female bladder exstrophy in 10 month old baby repaired by primary closure of bladder exstrophy.
Bladder Exstrophy* ; Female* ; Humans ; Infant ; Urinary Bladder*

Carcinoembryonic antigen(CEA) was measured in the serum and urine of 46 patients with bladder cancer and 15 patients with non-cancer disease as control group at the Paik Hospital. Pusan during the period from January, 1986 to June, 1988. The following results were obtained. 1. The upper limits of normal serum and urinary CEA levels in non tumor control group were 3.7 ng/ml and 2.3 ng/ml. Mean and positive rate of serum and urinary CEA levels in bladder cancer group were 4.40 ng/ml(37.0%) and 21.52ng/ml(65.2%). 2. Mean urinary CEA level was correlated significantly with the stage, grade and size of bladder cancer but no significance was seen in serum CEA. In the advanced cases(Stage C, D), serum CEA levels were elevated. 3. The diagnostic rate was not elevated in spite of urinary CEA determination combined with urinary cytology. After transurethral resection of cancer mass and radiation therapy, urinary CEA level decreased. As a result, serum and urinary CEA determinations in bladder cancer have no diagnostic value, but it will be useful in the study of the extent of cancer, effect of therapy, recurrence and prognosis.
Busan ; Carcinoembryonic Antigen ; Humans ; Prognosis ; Recurrence ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: The decision of whether to intubate or not remains largely a matter of individual preference. At our university, we routinely performed tubeless dismembered pyeloplasty and reverse intubated repair only when concomitant pathological conditions dictate intubation. We review our experiences with tubeless pyeloplasty during the last 12 years and evaluate the necessity of intraoperative double-J ureteral stenting. MATERIAL AND METHODS: From January 1985 to January 1996, adults with 49 renal units underwent tubeless dismembered Anderson-Hynes pyeloplasty at our university hospital. RESULTS: Markedly dilated renal pelvis was reduced surgically in 17 renal units (34.6%, reduction pyeloplasty). The success rate of tubeless pyeloplasty was 89.7% (44/49 renal units). In failed 5 renal units, 4 renal units with postoperative persistent urine leakage were managed using a retrograde insertion of Double-J ureteral stent at outpatient basis (8.2%) and 1 renal units with persistent ureteral stricture despite of redo pyeloplasty was removed surgically (2.0%). CONCLUSION: The success rate of our experience (89.7%) was relatively lower than others with intubated pyeloplasty because of persistent urine leakage and ureteral stricture. Urine leakage can be reduced with intraoperative placement of Double-J ureteral stent. Double-J ureteral stent can be easily removed in the outpatient department with minimal complication. Therefore, we would like to recommend the intraoperative placement of Double-J ureteral stent during the adult dismembered pyeloplasty.
Adult* ; Constriction, Pathologic ; Humans ; Intubation ; Kidney Pelvis ; Outpatients ; Stents* ; Ureter* ; Ureteral Obstruction

ESWL is a safe and effective treatment for renal calculi. However, on destruction of the stone, the pressure of shock waves produces renal microdamage. Urinary enzyme testing has been used to diagnosis and monitor various types of renal injured. Three urinary enzymes, N-acetyl-beta- glucosaminidase, beta-galactosidase, gamma-glutamyl transferase in 24 hour urine were monitored in 20 patients before and after ESWL and in 5 controls. The ESWL, a single session treatment, was performed using EDAP LT-01. The amount of the shock wave treated was same regardless of stone size and location. The results were obtained as follows. 1. Post-ESWL N-acetyl-beta-glucosaminidase level was higher than that of control on day 1 and showed a rapid decrease on day 3, and returned to normal by day 28. 2. Post-ESWL beta-galactosidase level was higher than that of control on day 1 and was still higher on day 7, and returned to normal by day 28. 3. Post-ESWL gamma-glutamyl transferase level reached to a peak on day 1 and showed a rapid decrease on day 3, and returned to normal by day 28. In summary, ESWL for renal stones elevates urinary enzymes transiently, which was on peak one day after the treatment and returned to nearly normal level by 1 month after the treatment. Therefore, urinary enzymes seem to be useful in evaluation of the functional recovery of the kidney after ESWL.
beta-Galactosidase ; Diagnosis ; Hexosaminidases ; Humans ; Kidney ; Kidney Calculi ; Shock ; Transferases

Intraarterial digital subtraction angiography(IADSA) was developed to subjugate the disadvantages of intravenous digital subtraction angiography(IVDSA). Recently, its utility has been increased in renal diseases. For investigation of clinical significance of IADSA in renal diseases, we analysed with 22 patients that renal IADSA had been performed in during the period from May, l984 to January, l986. The following results were obtained; l. Indications of the renal IADSA were renal bleeding, flank mass, hypertension and abnormality IVP or RGP only. 2. Diagnostic accuracy of the renal IADSA in renal diseases was 82.4%. 3. Renal toxicity and pain could be reduced due to decreased dose and dilution of contrast material. 4. Utilization of embolotherapy was increased because of better imaging of the renal vascularity and shortened examination-time of renal IADSA. 5. Renal IADSA can be substituted for conventional renal angiography and renal IVDSA in almost all renal diseases.
Angiography ; Angiography, Digital Subtraction* ; Embolization, Therapeutic ; Hemorrhage ; Humans ; Hypertension

Superficial bladder tumors are usually treated by TUR and the result of this treatment was known to have good prognosis. However, recurrence of the tumor after complete resection occurs in about 40-70% of the patients, a significant percentage of these recurrences showing a higher degree of malignancy. There are many factors affecting the recurrence and progression. Understanding the aspect of recurrence will help in the management of patients. So we studied to evaluate the relationship in 43 cases with superficial bladder tumors admitted to the Department of Urology, Inje college of Medicine, Pusan Baik Hospital during the period from April, l981 through March, l986. Thirty three patients were followed up for more than 3 Months. Following results were obtained: 1. No. of patients with recurrence was l8 (54.5 %). 2. Nine cases (50%) were recurred within 1 year and these patients had poor prognosis than patients recurred after 1 year. 3. The recurrence around the initial tumor site were 6 cases (33.3 %) and these patients had poor prognosis than recurrence at other site. 4. There was more significant increase of malignant progression and recurrence in multiple tumor or large tumor than solitary or small one. 5. There was significant increase of malignant progression and recurrence in initial high grade tumor than low grade tumor. 6. The recurrence rate was decreased in patients instilled adriamycin more than 4 times (45.5%, than less than 4 times (75%).
Busan ; Doxorubicin ; Humans ; Prognosis ; Recurrence* ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urology

An experimental study in vitro using piezoelectric extracorporeal shock wave lithotriptor(EDAP LT-01) and urinary stones removed from the patients by surgical method has been performed. The purposes were 1) to correlate the stone components and sizes with the storage of complete fragmentation, 2) to examine the screening effect and 3) to observe the stone fracture mechanism in urinary stones. The following results were obtained. 1. Tribasic calcium phosphate stone, magnesium ammonium phosphate stone and uric acid stone fractured more easily than calcium oxalate stone. In the case of small stones(diameter 0.5 cm), all stones fractured at relatively low storage. Large stones (diameter 1.5 cm) fractured at high storage with wide variations according to components. 2. Magnesium ammonium phosphate stones tested to observe for screening effect showed that a high storage was needed for complete fragmentation(about 2 times) when the stone debris was not removed. 3. Urinary stones fractured first on the front surface. When the stones showed lamellae, which were separated first by shock wave, thereafter each lamella was broken.
Ammonium Compounds ; Calcium ; Calcium Oxalate ; Humans ; Magnesium ; Mass Screening ; Shock* ; Uric Acid ; Urinary Calculi