(Background) There are many reports on the effects of ESWL, but few reports on the complications, especially remaining ureteral stricture after this treatment. Therefore we have retrospectively reviewed our cases to define the predisposing factors of this complication. (Methods) Since 1991 we have treated urolithiasis with ESWL using a Siemens Lithostar for the first therapy. We had 16 cases of ureteral stricture after this treatment. Ureteral stricture is the most common complication after ESWL treatment. To define the risk factor of the stricture we have compared 549 cases that were successfully treated between 1994 and 1996 without this complication. In these two groups we examined ages, sexes, chief complaints, size, position and components of the calculi, the degree of hydronephrosis, the frequency of ESWL, the presence of urinary tract infection, the duration of stone impaction and the after endourological treatment using multiple logistic regression analysis. (Results) Patients with the stone incidentally found and those with the UTI seemed to be more frequently associated with ureteral stricture, however there was not a significant difference. The hydronephrosis more than grade 3 (p=0.025), the frequency of ESWL (p=0.0325) and the after endourological treatment, especially TUL (p=0.0184) were statistically significant among the other factors. The stricture occurred in 5 out of 29 patients with the hydronephrosis of grade 4 and 5 between 1994 and 1996. (Conclusion) We should carefully treat patients with grade 3 or more hydronephrosis with ESWL. We should not repeatedly treat the patients with ESWL. We should take care of TUL treatment after ESWL.
(Objective) To evaluate incidence and treatments of urolithiasis in myelodysplastic patients. Patients and methods: During the past 27 years 303 myelodysplastic patients, 160 men and 143 women, have been treated and 50 of them were operated on with bladder augmentation procedures. Their medical records were retrospectively reviewed. (Results) Urolithiasis occurred 20 times in 15 patients, 11 men and 4 women, where calculi developed 18 times in the bladder and twice in the kidney. Prevalence of urolithiasis was 20% (10/50) in those who had undergone bladder augmentation and 2% (5/253) in those who had not had this surgery, where the difference was statistically significant between the two groups (p<0.01). Overall, 5% of all the patients suffered from stones in the urinary tract. Bladder calculi were endoscopically treated in 11 occasions or were resolved with suprapubic lithotomy in 4 cases. Small stones in the bladder were spontaneously delivered 3 times and extracorporeal shock wave lithotripsy (ESWL) was necessary for a renal calculus in one patient. The last patient having a renal stone has been put under care. Majority of stone compositions consisted of magnesium ammonium phosphate (MAP). (Conclusion) It was found that urolithiasis was 10 times more prevalent in those patients operated on with enterocystoplasty than those without bladder augmentation and that intermittent clean catheterization and regular bladder irrigation were of necessity to prevent urolithiasis for those having enterocystoplasty.
(Purpose) We evaluated the usefulness and morbidity of laparoscopic pelvic lymph node dissection (LPLND) as a staging procedure for prostate cancer. (Materials and Methods) Twenty-seven patients with T1-T3 prostate cancer scheduled for conformal radiation therapy underwent LPLND. (Results) The median operation time was 103 minutes (range; 58-137 minutes), and the median intraoperative estimated blood loss was 5ml. (range; very little-273ml.). This procedure covered obturator nodes and the median number of dissected lymph nodes was 8.0. Median days to oral intake and return to normal activity were 1.0 days and 1.0 days, respectively. (Conclusions) LPLND appears to be a safe, minimally invasive and useful procedure as a means of accurate staging for patients with prostate cancer undergoing radiation therapy.
(Purpose) We report the clinical results and efficacy of acute normovolemic hemodilution (ANH) in urologic surgery. (Patients and Methods) Between October 1996 and February 2001 we performed ANH on 47 patients who were expected to have moderate blood loss during surgical procedures in our hospital. We then evaluated the postoperative hematological features and avoidance of homologous transfusion. (Results) Estimated median surgical blood loss was 400ml (range 10-2, 340ml), and the median amount of whole blood collection was 800ml (300-1, 023ml). In 14 patients whose blood loss was more than 1, 000ml, the hematocrit (Hct) level in the day after surgery was significantly higher than the Hct level calculated by blood loss. Ninety-eight percent of the series (46/47cases) and ninety-four percent of patients (15/16cases) who were underwent radical cystectomy and radical prostatectomy could avoid homologous transfusion. (Conclusions) Our results indicate that ANH is useful during urological surgery, especially in patients with a blood loss of more than 1, 000ml during surgery. ANH is an efficient method for autologous transfusion by means of not only avoidance of homologous transfusion but also by saving red blood cells during surgeries.
This report describes a 56-year old woman with an unusual form of chronic pyelonephritis mimicking tuberculosis on histopathological findings. She visited our hospital complaining of left flank pain. Left staghorn calculus and retroperitoneal abscess extending from the kidney were demonstrated on CT. No bacteria, including mycobacteria were identified in preoperative urine bacterial culture. Left nephrectomy with drainage of retroperitoneal abscess was performed. Microscopically, the nephrectomy specimen showed caseating granulomas, formed by epitheloid cells, highly suggestive renal tuberculosis. In spite of these findings, acid-fast bacteria were not revealed in the renal lesion nor the abscess, and cultures of the abscess for mycobacteria were also negative. Because of failure of identifying Mycobacterium tuberculosis, this case should be diagnosed as not renal tuberculosis, but pseudotuberculous pyelonehritis, which has been mentioned in recent literatures. Although this disease is not widely recognized, we must be aware of it to avoid unnecessary antituberculous therapy.
We report a case of urolithiasis associated with short bowel syndrome. A 56-year-old woman was admitted to our hospital for asymptomatic bilateral renal stones. She had received extensive resection of small intestine due to strangulating obstructive ileus 7 years ago (residual intestine, only 20cm). Subsequently, she was in a state of short bowel syndrome. Plain film of kidney, uteter, bladder and computed tomography revealed bilateral renal stones (right 4mm, left 10mm). The left renal stone was successfully treated by extracorporeal shock wave lithotripsy. Since the right renal stone was small, no treatment was perfomed. The stone fragments were composed of calcium oxalate and calcium phosphate, and excessive urinary excretion of oxalate (103.8mg/day) was observed. In this patient, urolithiasis was diagnosed to be due to enteric hyperoxaluria caused by short bowel syndrome. To prevent the recurrence of stone formation, she was treated with oral administration of calcium lactate, sodium/potassium citrate and magnesium oxide. We review the Japanese literatures on urolithiasis with short bowel syndrome.