, Ji Hyen Lee, Jung Won Lee Primary vesicoureteral reflux is a common genetically determined condition that is associated with varying degrees of renal scarring and represents one of the main causes of chronic kidney disease in children. Usually vesicoureteral reflux is common in urinary tract infection patient under 5 years of age. However, we report a rare case of high-grade vesicoureteral reflux and chronic kidney disease in a 10-year-old boy who was referred to the pediatric department for incidentally detected asymptomatic bacteriuria. Our case demonstrated that high grade vesicoureteral reflux patient with reduced renal function, bladder and bowel dysfunction at presentation is more likely to progress to chronic kidney disease.
, Su Jin Cho, Hae Soon Kim Pseudohypoaldosteronism (PHA) in infants is manifested by presence of hyperkalemia, hyponatremia, and metabolic acidosis. At initial stages, PAH is generally suspected as congenital adrenal hyperplasia. Transient PHA has been reported in infants with urinary tract infection and urinary tract malformation. We report a case of 5-month-old infant with failure to thrive and finally diagnosed with transient PHA due to urinary tract infection with vesicoureteral reflux.
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, Sung Min Kong, Dong Gyu Lee, Seong Min Kim, Yoonjung Jang, Sung Rok Kim, Yu-Ji Lee Urolithiasis is an uncommon complication in renal transplantation. We report a case of hypocitraturia-related ureteral steinstrasse which was spontaneously formed in a renal transplant recipient. The patient who underwent renal transplantation was admitted with acute pyelonephritis. Hydronephrosis in the transplanted kidney and multiple stones (steinstrasse) in the distal ureter were incidentally found on computed tomography scanning. After a failed attempt of ureteroscopic removal of stones, the patient underwent open ureterolithotomy and ureteroureterostomy. On stone analysis, carbonate apatite was confirmed. Urinary citric acid levels were decreased to 127.6 mg/day. Potassium citrate was administered to prevent stone recurrence by increasing urinary citrate excretion. No recurrence of stones was shown six months later. Urolithiasis in renal transplant recipients requires a high index of suspicion. Hypocitraturia can increase the risk for urolithiasis. Rapid recognition by careful surveillance, prompt removal of stones, and precautionary efforts to prevent recurrence are needed.
, Min Cheol Han, Sung Jae Park, Jun Ho Jung, Bong Suk Shim, Min Sun Cho Ectopic ureteral orifice presents predominantly in young girls with duplicated kidneys and ureters, and mostly drains from ectopic ureters were associated with non-duplicated upper urinary systems and it is called a single system ectopic ureter. It is frequently associated with renal dysplasia or agenesis and ureterocele. Compared with ectopic ureter draining from the duplicated kidney, the diagnosis of single system ectopic ureter is often delayed because the ectopic ureter may be associated with a single small dysplastic, poorly functioning kidney. We report a case of single system ectopic ureter associated with dysplastic and poorly functioning kidney.
, Ha Na Yoon, Bong Suk Shim, Si Nae Lee Ureteral stent is commonly used after ureterscopic stone removal(URS). However, there is no definitive clinical criteria in inserting the ureteral stent after URS. Patients often complain of bladder irritative symptoms, hematuria. flank pain and additive endoscopic prodedure is necessary to remove the ureteral stent. Therefore, we studied the clinical epicacy of selective ureteral stenting only when it is required.
Of the patients who was taken URS, the following patients were exclu-ded from stent insertion ; 1) Patients who have mild hydronephrosis or symptoms less than 1week. 2) Patients who were able to insert the ureteroscope through the ureteral orifice without difficulty. 3) Patients who hardly have ureteral mucosal damage seen through the ureteroscopic field after the removal of ureteral stone. 4) Patients who did not need the additional lithoclast during the removal of ureteral stone. Other than the above patients and those with stones above the mid-ureter, a 6Fr. ureteral stent was inserted and kept for 3weeks. There were 29 unstented patients and 38 stented patients.
The average age of the non-stenting and stenting group were 37.5 years old and 39.7 years old and the average stone size were 0.68cm and 0.80cm. The average operation time was 3 minutes in the non-stenting and 8minutes(including ureteral stent insertion time) in the stenting group. Hospital stay was 3 days in both groups. Intermittent gross hematuria and irritative symptoms of the bladder was shown for 3 weeks after operation in most of the patients(32cases, 84.2%) of the stenting group while those in the unstenting group, the symptoms were relieved after2days after operation. Although mild flank pain was shown in few patients(4 cases, 13.8%) of the non-stenting group, severe pain requiring intravenous analgesics was not seen in both groups. There were no specific findings in the intravenous urography which was done at 6 weeks after operation, and no hematuria and pyuria was found in both groups.
The selective placement of ureteral stent following the ureteroscopic removal of stone did not bring specfic complications. We believe that ureteral stent insertion will minimize the inconvenience especially in patients who need to return to their everyday living immediately after operation. Thus ureteral stent insertion should be used in limited situations.
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, Sung Jae Park, Dong Won Byun, Sang Hoon Lee, Ho Joon Chung, Bong Suk Shim A case of a female subject with a unilateral vaginal ectopic ureter associated with a single system, ipsilateral hypoplastic pelvic kidney and bicornuate uterus is reported. Although there are many reports of concomitant urinary and reproductive system malformations, a review of the literature shows these unique associations in the same patient to be extremely rare. This malformation is not limited to any combination of abnormal development of the mesonephric(wolffian) and paramesonephric(mllerian) ducts in the development of the urogenital system. Embryological aspects as well as clinical presentation, diagndstic approach and treatment applicable to this case are discussed.
, Kyung Hun Kim, Ji Seok Leem, Sung Han Lee, Bong Suk Shim, Young Yo Park, Sung Won Kwon We retrospectively reviewed the cases of ureteroscopic stone removal at our hospital from January, 1994 to August, 1999 and defined the efficiency and complications of ureteroscopic stone removal.
Ureteroscopic stone removal was in 255 cases of ureteral stone from January, 1994 to August, 1999. Patients were 142 males and 113 females, and mean age was 42.5 years. 20 stones were located in the upper ureter, 29 stone in the mid ureter, 206 stones in the lower ureter. The stone size was less than 5mm in 95 cases, from 5 to 10mm in 117 cases and more than 10mm in 43 cases. Ureteroscpic stone ramoval was performed with 7.5Fr, 9.5Fr rigid ureteroscope under general, spinal, and epidural anesthesia.
255 cases of ureteroscopic stone removal were performed and over all success rate of ureteroscopic stone removal was 97 percent. The success rates of upper, mid and lower ureteral stones were 85, 93 and 99 percent. According to the size, the success rate was 99 percent in stones less than 5mm, 98 percent in stones of 5 to 10mm and 90 percent in stones more than 10mm. There were 8 cases of complication and over all complication rate was 3.1 percent. Complications consisted of severe mucosal injury(3 cases), ureteral perforation(3 cases), gross hematuria(1 case), urinary tract infecion(1 case). Complications were treated successfully with conservative treatment except 1 case of severe mucosal injury that required ureteral reimplantaton.
Ureteroscopic stone removal could provide rapid resolution of obstruction and colic due to ureteral calculi with high seccess rate and minimal complications.
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