Systematic Literature Review of the Urological Field and Considerations in COVID-19

Joongwon Choi,Hyun Soo Ryoo,Jae Hyun Ryu,Yun Beom Kim,Seung Ok Yang,Jeong Kee Lee,Tae Young Jung,김정훈,김태형 대한요로생식기감염학회 2021 Urogenital Tract Infection Vol.16 No.1

Coronavirus disease 2019 (COVID-19) was declared a worldwide pandemic in March 2020 after originating in China. Widespread uncertainty resulting from the pandemic has revolutionized urology practice worldwide, similar to that observed in other fields. The urological manifestations of COVID-19 were investigated by performing a literature search using a combination of keywords related to COVID-19 and urology. To date, COVID-19 has not been associated with any lower urinary tract symptoms, and there is no level 1 evidence that associates it with urinary malignancy and urolithiasis. Viral RNA has been detected in urine (5.74%), but there is no evidence of actual infection via urine. COVID-19 has transformed the standard urological practice into crisis-based care and has changed the medical and surgical priorities dramatically in the field. Most hospitals have established quarantine guidelines for each hospital, and procedures must be performed according to the present circumstances. Furthermore, in the absence of high-level evidence, specific efforts are needed to minimize the risk of COVID-19 infections during care.

Tethered cord 증후군에서 비뇨기계 증상 및 검사 소견

정태성,김은정,이은실,신손문,문한구,박용훈,Jung Tae-Sung,Kim Eun-Jung,Lee Eun-Sil,Shin Son-Moon,Moon Han-Ku,Park Yong-Hoon 대한소아신장학회 1997 Childhood kidney diseases Vol.1 No.2

목적 : Tethered cord 증후군은 척수내 지방종이나 종사의 섬유대 등에 의해 척수 원추가 천골에 부착, 견인됨으로 하지의 신경 결함이나 족부의 변형을 일으키는 질환군으로 척추 유합부전증의 경우에서 흔히 나타난다. 신경학적 소견 외에 빈뇨, 요실금, 유뇨증, 급뇨, 배뇨 감각 장애 등의 비뇨기계 증상도 높은 빈도로 나타난다고 하며 수술적 치료의 예후는 조기에 진단될수록 양호하다고 알려져 있다. 그러나 tethered cord 증후군에서 나타나는 비뇨기계 증상 및 소견에 관하여 체계적으로 보고된 것이 많지 않다. 저자들은 tethered cord 증후군에서의 비뇨기계 증상을 여러 특징을 파악하여 tethered cord 증후군 환자에서의 조기 진단 및 치료 방침 설정에 도움을 얻고자 본 연구를 시행하였다. 대상 및 방법 : 1991년 11월부터 1997년 7월까지 5년 9개월간 영남 대학 병원에서 tethered cord 증후군으로 진단받은 소아 환자 9례를 대상으로 연령 및 성별분포, 비뇨기계 이상에 관한 증상 및 비정상 검사소견의 여부와 수술 후 경과에 대하여 의무 기록을 조사하는 후향적 연구로 조사하였다. 결 과: 1) 대상 환아 9례의 연령 분포로는 0-2세가 5례, 2-6세가 1례. 6-10세가 3례였으며 남아가 2례, 여아는 1례였다. 2) 요실금, 빈뇨, 유뇨증, 급뇨, 배뇨 감각 장애 등의 비뇨기계 증상을 가진 경우가 6례였으며, 비뇨기계의 방사선학적 검사에서 신경성 방광을 보인 경우가 5례, 수신증과 수뇨관증이 동반된 경우가 3례, 방광-요관 역류를 보인 경우가 3례였다. 3) 요동력학적 검사는 3례에서 시행되었으며 3례 모두에서 이상 소견이 발견되었다. 4) 진단시 비뇨기계 증상 및 이상 검사 소견을 가진 7례 중 5례에서 detethering이 행해졌으나 증상의 호전은 1례에서만 관찰되었다. 결론 : Tethered cord 증후군에서 비뇨기계의 증상 및 비정상 검사 소견이 동반되는 경우가 흔하며 비뇨기계의 이상을 시사하는 증상이 없는 경우에도 검사상 이상이 발견되는 경우가 적지 않다. Tethered cord 증후군 환아의 평가는 신경학적 이상 유무는 물론이고 비뇨기계의 이상 여부에 대한 평가도 필히 포함되어야 할 것으로 생각된다. Purpose : Tethered cord syndrome is characterized by progressive motor and sensory disturbances in lower extremities, foot deformities caused by a pathologic fixation of spinal cord resulting in excessive stretching of the spinal cord. It is also frequently associated with urological symptoms include urinary frequency, incontinence, enuresis, urgency and recurrent urinary tract infection. Because there is few report in the literature about urological manifestations of theterd cord syndrome, we conducted a retrospective study on the patients diagnosed as tethered cord syndrome to delineate the characteristics of urologic manifestations in tethered cord syndrome and to establish the policy to evaluate patients who is suspected of tethered cord syndrome. Method : A retrospective study was conducted by reviewing the medical records of nine patients who was diagnosed as tethered cord syndrome from November 1991 to July 1996 in Yeungnam University Hospital. Result : 1) The age distribution of nine patients was as follows; 5 patients were under 2 years, 1 case from 2 to 6 years and 3 cases from 6 to 10 years. 2) Of 9 patients 6 had voiding frequency, urinary incontinence, enuresis, urgency and loss of micturation sense. Radiologic urodynamic studies revealed neurogenic bladder in 5 patients, hydronephrosis and hydroureter in 3, vesicoureteral reflux in 3. 3) Of 6 patients with urological abnormal manifestations 4 underwent spinal cord surgery (detethering). In spite of surgical intervention, the urological manifestations improved in only one patient. Conclusion : Urological abnormalities were common in tethered cord syndrome. Abnormal laboratory findings including urodynamic study were found even before the onset of urological symptoms. We have to concern tethered cord syndrome as one of common causes of voiding frequency and enuresis and to evaluate urological abnormalities as thetered cord syndrome is diagnosed.

Stent Position Is More Important than a-Blockers or Anticholinergics for Stent-Related Lower Urinary Tract Symptoms after Ureteroscopic Ureterolithotomy: A Prospective Randomized Study

이선주,유창희,오철영,이용성,조성태,이성호,양대열,이상곤,조진선 대한비뇨의학회 2010 Investigative and Clinical Urology Vol.51 No.9

Purpose: To evaluate the clinical factors that impact ureteral stent-related lower urinary tract symptoms (LUTS) after ureteroscopic ureterolithotomy, including the stent position and medication. Materials and Methods: Fifty-three patients who underwent ureteroscopic ureterolithotomy with indwelling a stent were distributed into three groups. On demand analgesics were given to the group 1 (n=18). Daily tamsulosin 0.2 mg was added for group 2 (n=15) and daily tamsulosin 0.2 mg and tolterodine 4 mg was added for group 3 (n=20). The patients were also subclassified into appropriate or inappropriate group according to stent position. All the patients completed a visual analogue scale (VAS) and International Prostate Symptom Score (IPSS) on the 1st and 7th postoperative days. The VAS and IPSS were analyzed according to the medication groups and the stent position. Results: In the appropriate stent potion group, only the storage symptom scores of groups 2 and 3 on the 1st postoperative day were significantly lower than those of the group 1 (p=0.001). This medication effect on LUTS was not observed in the inappropriate stent position group. In this group, total IPSS (p=0.015) and storage symptom scores (p=0.002) were higher than in the appropriate stent position group on the 7th postoperative day. Conclusions: Correct placement of the stent was more important than medication for lessening stent-related storage symptoms. Purpose: To evaluate the clinical factors that impact ureteral stent-related lower urinary tract symptoms (LUTS) after ureteroscopic ureterolithotomy, including the stent position and medication. Materials and Methods: Fifty-three patients who underwent ureteroscopic ureterolithotomy with indwelling a stent were distributed into three groups. On demand analgesics were given to the group 1 (n=18). Daily tamsulosin 0.2 mg was added for group 2 (n=15) and daily tamsulosin 0.2 mg and tolterodine 4 mg was added for group 3 (n=20). The patients were also subclassified into appropriate or inappropriate group according to stent position. All the patients completed a visual analogue scale (VAS) and International Prostate Symptom Score (IPSS) on the 1st and 7th postoperative days. The VAS and IPSS were analyzed according to the medication groups and the stent position. Results: In the appropriate stent potion group, only the storage symptom scores of groups 2 and 3 on the 1st postoperative day were significantly lower than those of the group 1 (p=0.001). This medication effect on LUTS was not observed in the inappropriate stent position group. In this group, total IPSS (p=0.015) and storage symptom scores (p=0.002) were higher than in the appropriate stent position group on the 7th postoperative day. Conclusions: Correct placement of the stent was more important than medication for lessening stent-related storage symptoms.

하부요로증상이 있는 여성에서 압력요류검사 지표들과 요도내압의 연관성

우종현,홍성주,이종복 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.6

Purpose: This study aimed to evaluate the relationship between pressure- flow parameters and urethral pressure in women with lower urinary tract symptoms (LUTS). Materials and Methods: Urodynamic traces of women with stress urinary incontinence (SUI), mixed urinary incontinence (MUI), and detrusor overactivity (DO) were retrospectively studied. The urodynamic parameters such as detrusor opening pressure (DOP), detrusor pressure at maximum flow rate (PdetQmax), maximum flow rate (Qmax), detrusor closing pressure (DCP), and maximal urethral closing pressure (MUCP) were measured and compared. The relationship between pressure-flow parameters and MUCP were evaluated as well as the differences between each urodynamic group. Results: One hundred fifty-one women were investigated between June 2004 and May 2008. One hundred twenty-one (80%) women had good- quality urodynamic studies and were included in the present study. The mean age was 56 years (range, 32-77). Women with DO had higher DOP, PdetQmax, and MUCP than did women with SUI (p<0.05). Qmax was significantly greater in women with SUI than in women who had DO (p<0.05). Women with MUI had DOP, PdetQmax, and Qmax that were intermediate between women with SUI and those with DO. There was a significant positive correlation between DOP, PdetQmax, DCP, and MUCP measurements and a significant negative correlation between Qmax and MUCP measurements (p<0.01). Conclusions: Pressure-flow parameters are reliable surrogates of urethral pressure. Therefore, an accurate evaluation of the pressure-flow parameters might give important information in the assessment of urethral and detrusor function in women with LUTS. Further study is needed to confirm our results. Purpose: This study aimed to evaluate the relationship between pressure- flow parameters and urethral pressure in women with lower urinary tract symptoms (LUTS). Materials and Methods: Urodynamic traces of women with stress urinary incontinence (SUI), mixed urinary incontinence (MUI), and detrusor overactivity (DO) were retrospectively studied. The urodynamic parameters such as detrusor opening pressure (DOP), detrusor pressure at maximum flow rate (PdetQmax), maximum flow rate (Qmax), detrusor closing pressure (DCP), and maximal urethral closing pressure (MUCP) were measured and compared. The relationship between pressure-flow parameters and MUCP were evaluated as well as the differences between each urodynamic group. Results: One hundred fifty-one women were investigated between June 2004 and May 2008. One hundred twenty-one (80%) women had good- quality urodynamic studies and were included in the present study. The mean age was 56 years (range, 32-77). Women with DO had higher DOP, PdetQmax, and MUCP than did women with SUI (p<0.05). Qmax was significantly greater in women with SUI than in women who had DO (p<0.05). Women with MUI had DOP, PdetQmax, and Qmax that were intermediate between women with SUI and those with DO. There was a significant positive correlation between DOP, PdetQmax, DCP, and MUCP measurements and a significant negative correlation between Qmax and MUCP measurements (p<0.01). Conclusions: Pressure-flow parameters are reliable surrogates of urethral pressure. Therefore, an accurate evaluation of the pressure-flow parameters might give important information in the assessment of urethral and detrusor function in women with LUTS. Further study is needed to confirm our results.

가와사키병에서 나타난 급성 음낭증 1예

강하영 ( Ha Young Kang ),주은영 ( Eun Young Joo ),김동현 ( Dong Hyun Kim ),홍영진 ( Young Jin Hong ) 대한소아감염학회 2017 Pediatric Infection and Vaccine Vol.24 No.1

급성 음낭증은 갑작스런 음낭의 부종과 통증을 주소로 하는 음낭의 병적 상태를 말하는 것으로 가와 사키의 드문 합병증으로 알려져 있다. 저자들은 급성 음낭증을 동반한 가와사키병으로 진단된 2개월 남자 환아를 경험하였으며, 환아는 정맥 면역글로불린 및 아스피린 투여 후 발열과 가와사키병의 임상 증상들이 호전되었고 2달째에 고환 초음파검사에서 급성 음낭증의 호전을 확인하고 심장 초음파 검사에서 관상동맥 합병증이 보이지 않아 치료를 종료하였다 Kawasaki disease (KD) is a systemic vasculitis that occurs predominantly in infants and young children. The etiology of KD is unknown and coronary heart disease is a major complication of KD. Acute scrotum is a rare complication of acute KD, and not as well recognized as other manifestations of the disease. We report a 2-month-old boy with acute scrotum in the acute phase of KD. He was treated with intravenous immunoglobulin (total 2 g/kg) and aspirin (50 mg/kg/day). The treatment was effective in resolving his fever and other clinical symptoms, but 2 days after starting treatment he experienced scrotal swelling. Scrotal ultrasound and transillumination were used in the diagnosis of acute scrotum. After 2 months, a follow-up testicular ultrasound revealed a remission of the acute scrotum. Subsequently, he has been followed up for KD.