하부요로증상을 보이는 환자들에서 악성종양의 진단

박동춘 ( Tong Choon Park ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

Some patients, especially with chronic disease such as diabetes, who suffer from lower urinary tract symptoms (LUTS) just want to take prolonged oral medication (anticholinergics or alpha blockers) without proper evaluation for basic causes. LUTS is commonly occurred by urinary tract infection, several chronic diseases and/or aging itself. However, we should not pass over the fact that LUTS also can be evoked by malignancy. Because there is a higher detection rate of malignancy in patients with microscopic hematuria, urine cytology must be done with ultrasonography, IVP and cystoscopy. In those patients aged over 50 years or high risk group for urothelial carcinoma, it is mandatory to undergo ultrasonography and cystoscopy, even if there is no abnormalities on their urinalysis and urine cytology.

전립선암으로 사망한 환자에서 사망에 영향을 미치는 위험 인자

박수환(Su Hwan Park),권태균(Tae Gyun Kwon),김대곤(Dae Gon Kim),김덕윤(Dae Gon Kim),김법완(Bup Wan Kim),김천일(Chun Il Kim),박동춘(Tong Choon Park),박재신(Jae Shin Park),박철희(Chol Hee Park),정희창(Hee Chang Jung),조성룡(Sung Ryong C 대한비뇨기종양학회 2006 대한비뇨기종양학회지 Vol.4 No.4

신장에 발생한 원시신경외배엽종양

정석영(Seok Young Chung),송필현(Phil Hyun Song),최우석(Woo Seok Choi),박동춘(Tong Choon Park),김용진(Yong Jin Kim),조재호(Jae Ho Cho) 대한비뇨기종양학회 2003 대한비뇨기종양학회지 Vol.1 No.3

인체 정관의 약리학적 검색 -아드레날린성 및 콜린성 수용체의 공존과 Diazepam의 작용-

김원준(Won Joon Kim),이광윤(Kwang Youn Lee),하정희(Jeoung Hee Ha),박동춘(Tong Choon Park) 대한약리학회 1988 대한약리학잡지 Vol.24 No.2

인체 정관 평활근에서 각종 자율신경전달체 수용체의 유무를 조사하고 benzodiazepine계의 진정-항불안제인 diazepam이 평활근 운동성에 미치는 작용을 관찰하기 위하여, 32내지 45세의 건강한 지원자로부터 정관절편을 얻었다. 정관 절제술은 국소마취하에 시행되었고, 정관절편의 수축력 측정은 등장성장력측정기에 의하였다. 적출장기실험조 내에서 정관절편의 자율수축은 관찰되지 않았으나, norepinephrine에 대한 반응성은 33˚C에서 가장 예민하였던 바, 이 norepinephrine에 의한 농도의존적 수축력증가작용은 알파-아드레날린성 차단제인 phentolamine에 의해 억제되었다. 또 인체 정관절편은 본 실험의 조건하에서 isoproterenol 의하여 수축하였고, 이 수축작용은 베타-아드레날린성 차단제인 propranolol 의하여 완전히 제거되었다. 동시에 인체 정관절편은 acetylcholine에의해서도 비교적 강하게 수축하였고, 이 수축작용은 콜린성 무스카린성 차단제인 atropine에 의하여 완전히 억제되었다. Diazepam은 norepinephrine에 의한 수축을농도 의존적으로 억 제 하였다. 이상의 결과를 종합하면, 인체 정관 평활근은 체온보다 낮은 33˚C에서 그 활동성이 가장 강하고, 자율신경에 대하여서는 아드레날린성 및 콜린성 수용체가 공존하고 있으며, diazepam은 그 수축력을 약화시킨다고 사료된다. This study aimed to investigate the autonomic innervations of human vas deferens and the effect of diazepam, a benzodiazepine sedative antianxiety drug, on the smooth muscle contractility of vas deferens. The specimens were obtained from healthy volunteers undergoing elective vasectomy with local anesthesia. The muscle preparation did not show any spontaneous contraction, but showed a good contraction induced by norepinephrine exerting the strongest response at 33˚C. Phentolamine inhibited the norepinephrine-induced contraction concentration-dependently. Isoproterenol, a beta-adrenergic agonist evoked a considerable extent of contraction, and this contractile activity was antagonized by propranolol, a beta-adrenergic blocking agent. Acetylcholine induced a dashing contraction of the human vas deferens, and atropine, a muscarinic receptor blocking agent abolished the acetylcholine-induced contraction. Diazepam inhibited the norepinephrine-induced contraction in a concentration dependent manner. These results suggest that the smooth muscle of human vas deferens has cholinergic muscarinic and beta adrenergic receptors as well as the predominant alpha adrepergic receptor. Diazepam inhibits the motility, especially norepinephrine-induced contraction of human vas deferens.

증상의 유무에 따른 신세포암의 예후

이경섭(Kyung Seop Lee),김기호(Ki Ho Kim),권태균(Tae Gyun Kwon),김법완(Bup Wan Kim),박철희(Choal Hee Park),김천일(Chun Il Kim),김덕윤(Duk Yoon Kim),박재신(Jae Shin Park),조성룡(Seong Ryung Jo),정희창(Hee Chang Jung),박동춘(Tong Choon 대한비뇨기종양학회 2007 대한비뇨기종양학회지 Vol.5 No.2

重複尿管의 外科的 處置

朴東春 慶北大學校 醫科大學 1981 慶北醫大誌 Vol.22 No.2

最近 3年間 慶北醫大 泌尿器科學敎室에서 治驗한 重複尿管患者 8例中 5例에서 上極腎半切除術, 尿管腎盂吻合術, 同側尿管尿管吻合術, 尿管 tapering 後 再移植術, 一次縫合術 等의 各種 術式을 施行하여 좋은 結果를 얻었기에 報告하고 이들 術式의 適應症에 대해 簡略히 考察하였다. Personal experience with various surgical procedures, such as heminephroureterectomy, urete-ropyelostomy, ipsilateral uretero-ureterostomy, ureteral reimplantation with ureteral tapering, and primary repair of the separated segments, in ureteral duplication in 5 patients during the last 3 years is reported. All patients have done well clinically and radiologically. The operative techniques employed in each patient are briefly discussed.

하부 요관결석환자에서 Dormia Stone Dislodger를 이용한 경뇨도적 요관배석술의 의의

김은길,서준규,김영수,박동춘 영남대학교 의과대학 1985 Yeungnam University Journal of Medicine Vol.2 No.1

저자들은 하부 요관결석에서 경뇨도적배석술의 유용성을 알아보고자1983년 9월부터 1985년 8월까지 만 2년동안 영남대학병원 비뇨기과에 입원한 하부 요관결속 환자중 결석의 크기가 1.0㎝ 이하이며 방광경 조작의 적응이 되는 37명에서 Dormia stone dislodger를 이용한 경뇨도적 배석술을 시행하여 다음과 같은 결과를 얻었다. 1.37명의 환자중 16명에서 결석이 조작 즉시 배출되었고, 5명에서는 유치한 catheter 제거시 동시에 배출되었으며, 4명에서는 조작후 1주이내에 자연배출되어 68%의 성공률를 얻었다. 2.결석의 크기에 따른 성공률은 결석의 장경이 0.4㎝ 이하인 경우 77%, 0.4∼0.6㎝인 경우 58%, 0.6㎝ 이상에서 33%로서 결석의 크기가 작을수록 성공률이 높았다. 3.합병증으로는 배석기의 파손으로 요관 절석술을 시행한 1례, 요관협착으로 중등도의 수신증이 병발한 1례, 지속적인 혈뇨가 생긴 1례로서 8.1%의 합병증률을 보였다. 이상의 결과로 1.0㎝ 이하의 하부 요관결석에서 경뇨도적 요관배석술을 시행하여 비교적 높은 성공률과 낮은 합병증률을 보였다. 이에 저자들은 하부 요관결석 환자에서, 특히 결석의 크기가 작고 반복적인 동통이 동반된 경우에는 일차적으로 경뇨도적 요관배석술을 시행해 보는 것이 바람직하다 하겠다. Management of the small lower ureteral stone has been attempted by either transurethral manipulation or expectant therapy. To date, however, the choice of proper method has depended mostly on clinician's preference, and the effectiveness of the transurethral stone manipulation has remained controversial. Herein we evaluated the effectiveness of the transurethal stone manipulation, using with the Dormia dislodger, in 37 patients with lower ureteral stone less than 10㎜ in greatest diameter. The result are summarized as follows. 1.The overall success rate was 68%(25 of 37 patients); Immediate delivery of the stone was observed in 16 of 37 patients. In another 5 patients the stone was removed at the time when the indwelled ureteral catheter was taken out. In the remaining 4 patients the stone passed spontaneously within a week following the procedure. 2.Higher success rate was observed in smaller stone;79% in less than 4mm,58% in 4-6mm, and 33% in 6-10mm in it's greatest diameter, respectively. 3.The morbidity rate was 8.1%(3 of 37 patients); In one patient a broken basket was retained in the ureter, which was removed at the time of ureterolithotomy.In another patient a ureteral stricture requiring periodic dilation was complicated. And in the other patient persistent hematuria was observed, which was relieved by conservative management. These results suggest that transurethal manipulation might have to be initially applied to unremittingly painful patients with small lower ureteral stone.

경요도전립선전기기화술이 초기 임상경험 : 경요도전립선절제술 및 레이저 전립선절제술과의 비교

김정현,문기학,정희창,박동춘 영남대학교의과대학 1998 Yeungnam University Journal of Medicine Vol.15 No.2

최근에 Roller loop electrode를 이용한 경요도전립선전기기화술에 관심이 집중되고 있다. 저자들은 전립선비대중에서 전립선전기기화술의 가치를 알아보기 위해 Roller loop electrode를 이용한 전립선전기기화술(TEVP, 17례)을 레이저전립선절제술(VLAP, 39례)과 전통적 경요도전립선절제술(TURP, 59례)과 비교 분석해 보았다. TEVP는 효과 면에서는 전통적인 경요도전립선절제술에는 미치진 못하지만 VLAP과는 유사한 효과를 보였으며 안전성면과 경제적인 면에서는 VLAP을 능가하는 치료법으로 사료된다. 본 연구가 적은 환자를 대상으로 10개월까지 관찰한 결과이고 경요도전립선전기기화술의 초기 경험이라 명확한 결론을 내리기에는 다소 성급한 면이 있으나 전통적인 전립선절제술에 비해 짧은 입원기간, 짧은 요도관유치기간 및 적은 출혈 등을 보여주며 레이저 시술의 단점인 고가장비가 필요 없다는 점에서는 전통적 전립선절제술의 대체 술기로 높이 평가되어진다. Recently, several alternatives have been attempted in the management of benign prostatic hyperplasia (BPH) to reduce morbidity of traditional transurethral resection of the prostate (TURP). Among new modalities, transurethral electrovaporization (TEVP) is considered as a promising altermative. To evaluate the safety and initial efficacy of TEVP using the roller loop electrode (ProSurg Inc. USA) on BPH patients, we compared the results of TEVP with those of TURP and visual laser ablation of the prostate (VLAP). In this study, a total of 115 patients with symptomatic BPH were underwent TEVP (n=17), TURP (n=59) or VLAP (n=39) since 1995. Before treatment, patients were evaluated with an International Prostate Symptom Score (IPSS) and the measurement of maximal uroflow rate (MFR) and postvoid residual urine (PVR). After treatment, the operative and hospital records were reviewed. The uroflowmetry and IPSS were re-evaluated 3-10 months after treatment. In clinical outcome of re-evaluation compared to the preoperative parameters, there was a clinically significant improvement in three procedures. TEVP resulted in 62% reduction in IPSS (TURP, 73% : VLAP, 69%), 84% improvement in MFR (TURP, 113% : VLAP, 91%), and 74% reduction in PVR (TURP, 88% : VLAP, 78%). TEVP had shorter duration of hospitalization and catheterization than the others. TEVP was associated with lower rates of treatment-related complication than TURP. In conclusions, TEVP is considered as a useful procedure to treat symptomatic BPH. And, the advantages of TEVP over TURP include excellent intraoperative hemostasis, lower morbidity, shorter hospital stay and simple technique. In addition the advantages over VLAP include lower cost, shorter duration of catheterization and early symptom improvement.

요실금 수술후 발생한 요도 폐색에서 외요도구 상방 질벽을 통한 요도 박리술 : 치험 1례 보고 A Case Report

박동춘,정희창,유진욱 영남대학교 의과대학 1999 Yeungnam University Journal of Medicine Vol.16 No.2

We report our experience with a case of urethrolysis using a transvaginal suprameatal approach without lateral perforation of the urethropelvic ligament. A 43-year-old woman suffered from voiding difficulties such as hesitancy, frequency, urgency, decreased urinary flow, residual urine sensation after Marshall-Marchetti-Krantz operation concurrent with hysterectomy. The results of multidisciplinary work-ups of urethral obstruction such as history, vaginal examination, voiding cystourethrography, urodynamic study, showed that she had urethral obstruction due to a previous operation. Since clean intermittent catheterization and alpha-blocker therapy did not improve her symptoms, suprameatal transvaginal urethrolysis was performed to resolve the symptoms. Postoperative follow-up for 5 months showed that the patient remained free from voiding difficulty in their life. We believe that suprameatal transvaginal urethrolysis is worth attempting for urethral obstruction associated with anti-incontinence surgery.

결석이 동반된 남성 요도게실 2례

신현철,김영수,박동춘 영남대학교 의과대학 1992 Yeungnam University Journal of Medicine Vol.9 No.2

저자들은 결석이 동반된 남성에서의 요도게실 2례를 치험하였기에 그 희귀성에 비추어 문헌고찰과 함께 보고하는 바이다. Male urethral diverticulum is uncommon lesion, furthermore calculus formation within, the male urethral diverticulum is very rare. Generally, urethral diverticula are classified as congenital and acquired. The majority of male urethral diverticula are acquired and approximately 10 to 20 per cent are congenital. Acquired urethral diverticula in the male may arise from many sources, including infection (prostatic abscess, infection of periurethral glands, hematoma or schistosomiasis), obstruction(stricutre, impacted stone, Cunningham clamp or condom catheter) and trauma (instrumentation, external injury and pelvic fracture). Calculi formation is more common in the acquired diverticulum owing to stagnation of urine and infection. These calculi in the diverticulum usually are solitary and may attain considerable size with predisposing factors, 1) a ureteral or bladder calculus that is lodged in the urethra, 2) urethral trauma or stricture, 3) calcification around a foreign body or hair. The treatment of urethral diverticulum conbined with stone is excision of the diverticula with removal of stone. We treated two cases of urethral diverticulum combined with stone in the male, and report with review of literature.