Bladder cancer is the second most common malignancy in urological field. Most new cases are diagnosed as non-muscle invasive bladder cancer (NMIBC), which includes Ta, T1 or carcinoma in situ. Initial management of NMIBC is endoscopic resection, which allows both treatment and pathological staging. Urologist should consider adjuvant intravesical chemotherapy or Bacillus Calmette-Guerin (BCG) immunotherapy, depending on the tumor grade or stage to prevent recurrence and progression. Patients with muscle invasive bladder cancer (MIBC) are best treated with radical cystectomy. However, radical cystectomy should be considered even in patients with NMIBC with high risk of progression and BCG refractory tumors. Delay of radical cystectomy in these patients might lead decreased disease specific survival. Patients treated by radical cystectomy should undergo any form of the urinary diversion. Ileal conduit is still most common method for urinary diversion. Orthotopic neobladder is generally performed by experienced hands in high volume center. Patients undergoing orthotopic neobladder should be educated and manually skillful to manipulate their diversion. Neoadjuvant cisplatin-based chemotherapy is recommended based on level 1 evidence with survival benefit. Recent updated meta-analysis also demonstrated survival benefit in patients with MIBC treated by adjuvant chemotherapy.

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• Clinical Study for the One Case that Sequela of Bladder Cancer Patient Treatments by Korean Medicine
  Seong-Hee Cho, Yu-Rim Song
  The Journal of Oriental Obstetrics and Gynecology.2015; 28(2): 156.     CrossRef

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• A Clinical Case Report of Severe Hematuria Patient after Ureterolith Lithotripsy
  Sang Hyun Lee, Ju Yong Jeong, Myoung Rae Cho
  Korean Journal of Acupuncture.2015; 32(3): 144.     CrossRef

Wilms' tumor is the most frquent malignant abdominal tumor in children but is rare in adults. Adult Wiulms' tumor is less than 1% of all wilms' tumor, and has poor prognosis than childhood Wilms' tumor. Wilms' tumor in children classically demonstrate the curative potential of combined modality cancer therapy. However, guide line for management in adult Wilms' tumor is less clear.

We reported a case of adult Wilms' tumor developed in 18 year-old male patient which was presented with right flank pain after slip-down for 1day.

Choriocarcinonla is very rare malignancy, accounting for less than 1% of all testicular germcell tumor. However, it is an important disease in the field of oncology, as it represents ahighly curable malignancy. and one in which the incidence is focused on young patients attheir peak of productivity. In nonserninomatous germ cell testis tumor, assessment of prognosticfactors is related to develop a basis for more rational therapy for each individual patient.Along with prognostic staging, appropriate treatment shoud be applied to each patient to improve disease-free survival. And. surgical resection of residual masses after cisplatin-based chemotherapy is an established adjuvant to chemotherapy, because complete remission can be improvedabout 10% with appropriately timed complete resection of residual diseases. So, we reporta case of a 27-year old male patient with testicular choriocarcinoma who presented with multiplelung metastases after radical orchiectomy. He recieved lung wedge resection after 8 cycles ofcisplatin, etoposide, ifosfamide combination chemotherapy. and complete remission was confirmed and maintained.

We report a case of carcinosarcoma of the bladder in a 78 year-old female patient. Carcinosar-voma is a tumor consisting of malignant epithelial and mesenchymal elements, which occurs rarely in the bladder. The prognosis of bladder carcinosarcoma is poor and the best methods of treatment are uncertain. The literature is reviewed and the clinicopathologic condition of carcimosarcoma of the bladder id discussed.

The largest character of the modern society, so called the era of the information. is 'C&C'(Computer and communication). As the up-to-date science and new knowledges develope,so far there is increasement of the real necessity of the computer to use huge medical informationmore rapidly and effectively.

As the electronic industry is developed, it is possible to do a business with the personalcomputer(PC), which was possible only by a large-computer at past.

After the recognition of the rational inevitability of the business computerization, and ifsomeone looks for the sujects to computerize. they must choose the supervision of the clinicaldata about the in-patient first of all.

The patient supervising system should retain the databases which serve the reference functionto user's requirements. Under these purposes, it is very important to classify the cases dependingon the names of the diagnoses and operations, and easy and rapid recollect of the appropriatedata. And of course this system also be able to contribute to the research and education aswell as the preservation of the patient data.

So, we report the results of 2-year practice in urologic patient supervising program, whichwe enlighted for presenting the guidelines for Program making of the in-patinent data- supervi-sion and the standard for the mandatory clause and database files so that in order to gaugethe ability of the computerization of the patient supervision with PC from now on.

Ureteral obstruction is a common and important urologic disorder and may cause a hydronephrosis and result in the deterioration of renal function.

We made a clinical analysis on the cause and management of the 69 cases of the ureteral obstruction of the patients in the Department of Urology. Ewha Womans University Hospital during the period from January 1981 to December 1990.

The following results were obtained;

1) There were 36 cases(52.2%) of male and 33 cases(47.8%) of female and the major range of age distribution was between 30 decade to 50 decade, 45 cases(65.2%).

2) The level of obstruction was the upper ureter in 37 cases(51.4%), the mid in 2 cases(4.2%) and the lower in 32 cases(44.4%). The affected site was the right in 29 cases(40.3%), the left in 43 cases(59.7%) and the bilateral in 3 cases.

3) In etiology, 59 cases were caused by intrinsic factors, among which chronic inflammation of the ureter was the most common in 36 cases, and the extrinsic causative factors were found in 13 cases.

4) The degree of hydronephrosis was severe in 33 cases(45.8%), moderate in 22 cases(30.6%). mild in 6 cases(8.3%). and non-visualization of kidney in 11 cases (15.3%).

5) As the management of ureteral strictures. nephrectomy was done in 14 cases (19.4%). pyeloplasty in 11 cases(15.3%). ureteroneocystostomy in 5 cases (6.9%), segmental resection and end to end anastomosis in 8 cases(11.1%), ureteral dilation and stenting in 19 cases (26.4%) and percutaneous nephrostomy in 6 cases (8.3%).

6) The improvement of hydroncphrosis was observed in-85.7% on excretory urography, 6 months after treament.

Renal cysts are usually asymptomatic. produce no harm to the kidney and require no treatment.

Percutaneous cystic puncture is performed only for specific indications including the diagnosis of cysts which are indeterminated with ultrasonography or computerized tomography, and the treatment of symptomatic cysts. But simple aspiration of renal cysts frequently recurred. so a combination of aspiration and sclerotherapy with variable materials can be used.

We treated 12 cases of renal cyst with aspiration and selerothrapy with 95% ethanol without specific complications the last 33 months period between January 1988 and September 1990. Major(91.7%) of cases showed remarkable reduction in size of renal cyst or disappearance of cyst on follow-up ultrasonography.

Therfore aspiration and selerotherapy with 95% ethanol is safe and efficient for the treatment of simple renal cyst.

Treatment of benign urethral strictures frequently is difficult because of a high rate of recurrence.

In general electrocautery resection of fibrous scar tissue has been unsatisfactory. since the irregular thermal injury may only promote further scarring. Because of their unique physical properties and tissue effects lasers theoretically offer advantages over conventional techniques for treatment of urethral strictures. The thermal injury resulting from neodymium : YAG laser irradiation may heal with more elastic properties and less fibrous contraction than an electrocautery burn. Accordingly endoscopic application of laser energy could produce thermal coagulation of the fibrous area with a secondary slough of the scar tissue and re-epithelialization without scar.

A total of 19 cases with benign urethral strictures underwent treatment with circumferential application of neodymium : YAG laser irradration to the scarred area after endoscopic cold urethrotomy.

There were no adverse effects and although one patient suffered recurrent stricture within 2 months, the postoperative results were good in all patients including recurrent case.

We reviewd our experience with neodymium : YAG laser treatment of benign urethral strictures.

Urolithiasis is common but one the most important disease in the field of urology. Recently the incidence of urolithiasis is increasing according to the improvement of living standards in Korea. Althought the etiology and pathogenesis of urolithiasis are interactions of a very complex process ans has not yet been clearly established, it is believed that diet containing calcium, a one of the stone forming-components, such as milk may play a principle role in the stone formation.

We carried out epidemiologic study to determine the relationship between urilithiasis and dietary pattern changes to westernized food in Korean people. Comparision study was carried out between 1970s and 1980s.

The following results were obtained :

1) The yearly personal consumption of rice was not much changed in 1970s but in 1980s it continued to decrease. The yearly barley consumption continued to decrease after late 1970s, declining to level below 2kg in 1987.

2) The yearly personal comsumption of meat was not much changed upto mid 1970s but after 1977 it continueed to increase, showing 2.7 times increase in 1989 compared to that of 1977.

3) The yearly personal consumption of milk and dairy products was markedly increased ; 8.4 times in 1970s and 3.6 times in 1980s. In 1989 it increased 35.2 times compared to that of 1970.

4) Changes in the ratio of patients with urolithiasis to the total patients admitted to urologic department was not remarkable, but yearly, number of patients with urolithiasis continued to increase, especially from the late 1970s to the early 1980s. In 1970s the urolithiasis prevalence was highest in the regious such as Pusan, Kyungbook, Honam but in 1980s it changed its stage to Seoul.

5) Age distribution revealed under the age of 20, no specific changes were noted in both 1970s and 1980s. In 1970s urolithiasis patients over the age of 40 revealed high increase rate 3.4 times, but in 1980s age group over 40 only showed 1.6 times increase. to the surprise, age group between 20-40 showed 1.4 times increase, indicating not much differences between both age groups in patient numbers of increase rate.

6) Sex prevalence was greater in famale than male in both 1970s and 1980s.

7) Locational prevalence of urolithiasis showed increased rate of renal stone in both 1970s and 1980s. But that of bladder stone was not remarkable.

8) Seasonal prevalence revealed highest prevalence rate in summber and lowest in winter.

9) Through analysis of following factors ; higher living standards due to ecnomic growith, increased milk and meat concumption due to change in dietary pattern to westernized food, decrease carbohydrates such as rice and barley, we can conclude that dietary change is closely related to urolithiasis and its correlation is more significant in 1980s than 1970s.

Superfical bladder tumor can be easily treated by transurethral resection, but the recurrent rate is up to 40~70% and if recurred it is more invasive.

Lasers can not only destroy tumor tissuebut but also seal up vessels and lymphatics with vaporization and coagulation by virtue of the hyperthermic effect that can occur when intense energy of laser is absorbed and transformed into heat. So it is more effective and safe on treatment of superficial bladder tumor than eletric coagulation.

The authors used the Nd-YAG laser for the treatment of 70 patients with superficial bladder tumor and followed more than 12 months at Ewha Womans University hospital from Oct. 1985 to July 1987.

The following results were obtained ;

1) Patients' age ranged from 33 to 82 years(mean 57.1) 63 of 70 patients were male and 7 of those were female, Follow up interval ranged from 12 to 52 months(mean 29).

2) Average energy of application was 4,509 joules. Average energy application for single lesion less than 2 cm was 2,977 and that for multiple lesion or more than 2 cm was 16,231 joules, respectively. No spectively. No specific complications were observed.

3) Of 70 patients, 15 patients were recurred and the recurrent rate was 21.4%. The range or currence interval was 3 to 37 months(average 12.1).

4) Of the recurred patients, 73.3% of all cases was recurred within one year. Two cases were progressive to invasive type.

5) Grade was more important factor than stage recurred rate and time.

Recurrence rate by grade was 20% in grade II and 50% in grade III. And recurrence interval by grade were 13.5 month in grade II and 4.7 month in grade III respectively.

We concluded that Neodymium-YAG laser was excellent and safe on treatment of superficial bladder tumor.

Cholesteatoma is a form of squamous metaplasia resulting in a collection of keratin composed of desquamated epithelial cells and occurs extremely rarely in the urinary tract.

Cholesteatoma of the renal plvis was first described by Ebstein in 1982. Since the fewer than 30 cases have been reported until now in the literatures.

The authors experienced a cholesteatoma of the renal pelvis in 42 years old female patient who had been suffered from intermittent right flank pain, and reported the case with review of the literatures.

Retrocaval ureter is a rare congenital anomaly that occurs is patients almost exclusively on the right side. The usual cause is the persistence of fetal posterior cardinal vein, then the ureter passes posterior to the vena cava and is deviated medially as the vena cava migrates medially to its normal position. This produces the typical S-shaped configuration of retrocaval ureter. Since 1983, when Hochstetter first described this condition. about 200 cases have been reported(8 cases in Korea).

Herein we will report on 2 cases with the brief review of literatures.

Primary non-refluxing, non-obstructed megaureter is a rare condition among the megaureter.

A 11 month old monozygote twin baby had been admitted due to blood and pus tinged spotson a diaper. Although the excretory urogram showed moderately dilated left ureter, but the voiding cystogram and diruetic renogram showed no reflux and no obstruction. So we diagnosed as a primary non-refluxing, non-obstructed megaureter.

We report this case with the review of literatures.

Acute scrotum is any pathologic condition of the scrotum or intrascrotal contents that requires emergency medical or surgical management. Among the acute scrotum acute epididymitis and spermatic cord torsion are most difficult to differentiate each other because of their similar symptoms and sings.

Clinical analysis was undertaken on 45 patients with acute epididymitis and spermatic cord torsion.

The following results were obtained.

1) There were 36 patients with acute epididymitis and 9 spermatic cord torsion.

2) Mean ages were 32.6 year old in acute epidiymitis and 12.5 spermatic cord torsion.

3) Symptoms and sings showed no significant differences from each other, but Prehn's sign was somewhat useful.

4) In 5 patients with spermatic cord torsion that had arrived to the hospital within 24 hours from onset of symptoms, the testis could be saved.

5) Testicular scan with 99mTc-pertechnetate was performed in 17 patients and the diagnostic accuracy was 94%.

6) Twenty-one patients with acute epididymitis had urinary tract infections and 3 spermatic cord torsion had cryptorchidisms.

Hydrocele, an abnormal accumulation of fluid between the parietal and visceral layers of the tunica vaginalis of the testis is the most frequently encountered mass of the scrotum. There are two types of treatment for hydrocele : Surgery and Sclerotherphy. Surgical treatment is generally considered the most effective. However, due to the frequent occurrence of complications of surgical procedure, sclerotheraphy may provide an alternative means of treatment. We here report the results of study using aspiration and subsequent injection of tetracycline as definitive treatment of testicular hydrocele. Four patients were treated after informed consent and followed for 5 to 10 months after sclerotheraphy. All treatment were given as an out-patient procedure. The aspiration were performed under local anesthesia, and the mean volume aspirated was 225ml(range : 150-350ml). Hereafter, 500mg of tetracycline diluted to a volume of 5ml in isotonic saline and 3ml in 2% lidocaine was injected. At 5 to 10 months follow up, all patients were cured-3 patients after one, and 1 patient after two injections. In one patient, the injection was immediately followed by scrotal pain which was relieved by spermatic cord block. The pain of the other patient were relieved by some oral analgesic medication. No infection or hematoma occured. In conclusion, aspiration and sclerotheraphy using tetracycline seems a favorable alternative to surgery for hydreceles. Tetracycline is both sclerosing, antibacterial and cheap. Further, the technique is simple, it carries a low morbidity and does not require hospitalization.