Extracorporeal shock-wave lithotripsy (ESWL) is a safe and widespread modality for the treatment of renal stones. Although rarely used for treatment of subcapsular hematoma of the kidney, this procedure may sometimes be required in critical case for possible renal loss. This study investigated 10 subcapsular hematomas that were encountered during a 10-year period using ESWL treatment in patients with renal stones. This history revealed eight with hypertension, four with urinary tract infection (UTI), two with diabetes mellitus (DM) and 1 with peptic ulcer. None of the patients died. One Dm patient with coexisting UTI underwent nephrectomy due to the occurrence of perirenal abscess. Age older than 50 years and multiple stones might be risk fac-tors of the occurrence of perirenal hematoma after ESWL.(J Urol R.O.C., 10:164-167,1999)
<i>Introduction: </i>Urinary stone disease is one of the most commonly seen urological diseases in Taiwan. Single nucleotide polymorphisms (SNPs) are commonly used for the investigation of genetic markers for stone disease. E-cadherin (CDH-1) is one of the cellular junction proteins related to the integrity of epithelial cells. Our aim was to investigate a polymorphism of the CDH-1 gene 3′-UTR as a possible genetic marker in the search for the genetic causes. <i>Materials and Methods:</i> 148 patients with calcium oxalate stone were compared with 103 healthy controls for the frequency of CDH-1 3′-UTR polymorphisms. The polymorphism was detected by polymerase chain reaction-based restriction analysis (<i>Pml</i> I endonuclease). <i>Results and Conclusions:</i> The results revealed significant differences between normal individuals and calcium stone disease patients (p = 0.0013). The distribution of genotype TT homozygote was higher in stone patients (51.5%) than in the control group (43.4%). The odds ratio for T allele compared to C allele was 2.0. We have concluded that polymorphisms of CDH-1 3′-UTR is a valid genetic marker for calcium stone disease.
Tethered cord syndrome is infrequently seen in out-patient urological department as urological problems do not present as the initial signs or symptoms for this syndrome. The symptom of voiding dysfunction is frequently confused with other causes of urinary incontinence. Due to long-term complications which can result in hemodialysis, early diagnosis of tethered cord syndrome is important. The aim of this study was to investigate the clinical manifestation and severity of tethered cord syndrome. From January 1995 through April 1999, we retrospectively collected the medical records of 5 patients with tethered cord syndrome who had an aver-age age of 30 yrs. They all presented with urological symptoms as the initial call for help. Four patients had predominant symptoms of lower abdominal fullness and pain. Detrusor hyperre-flexia with detrusor-sphincteric dyssynergia were seen in 4 patients. One patient presented with detrusor hyporeflexia and poor compliance as seen on the cystometrogram. Untethering surgeries with removal of lipoma were performed in 4 patients. One patient developed hemodi-alysis during the 1-yr follow-up period. Two patients showed persistent chronic renal insufficiency. Only l patient maintains normal renal function because of early diagnosis and early treatment. This result indicates that prognosis is poor when the diagnosis is delayed. We suggest early diagnosis and early treatment as the preferred way to resolve the problem of progressively worsening renal function. Because only a small number of patients were available, more studies of tethered cord syndrome would be helpful to clarify the clinical presentations of urological problems.
Carcinosarcoma is a malignancy that occurs very rarely in the renal pelvis; thus, only a very limited number of cases has been documented. These tumors are composed of both carcinomatous and sarcomatous elements. We report here a case of a carcinosarcoma composed of well-differentiated, keratinizing, squamous carcinoma cells and high-grade sarcoma cells. Differently from the cases described so far, this carcinosarcoma of the renal pelvis was characterized by the quick recurrence, following complete surgical resection, as a highly disseminated high-grade sarcoma.
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