大韓放射線醫學會誌 Vo J. XVI. No. 2, 1980 E 大 5R 管讓型結石및 民道結石各一例全北大學校醫科大學放射線科學敎室宋昊永李松珠崔基鐵 Absσact - A case report of Ureteral Cast Stone and Giant Urethral

大韓放射線醫學會誌 Vo J. XVI. No. 2, 1980 E 大 5R 管讓型結石및 民道結石各一例全北大學校醫科大學放射線科學敎室宋昊永李松珠崔基鐵 Absσact - A case report of Ureteral Cast Stone and Giant Urethral Stone, Respectively Ho Yung Song, M.D., Song Joo Rhee, M.D. and Ki Chul Choi, M.D. Department of Radiology, School of Medicine, jeonbug National University Urinary lithiasis is one of the most common disease of the urinary tract. It occurs more frequently in men than in women but rare in children and in blacks; a familial predisposition is often encountered. Ureteral stones originate in the kidney. Gravity and peristalis contribute to spontaneous passage into and down the ureter. Ureterovesical ju nction is the most frequent lodging site of stone. In our hospital one case of ureteral cast stone and giant urethral stone were found respectively and they were confirmed by radiological examination and surgery on Aug. 1978 and Jan. 1979. Ureteral cast stone which had been introduced and named first by Kiyonobu Tari and Kikjiro 50 in 1972 was very giant unusually. It may be the only one till now. Our patient was 36 years old female who has bèe n suffered from intermittent right flank pain for 10 years. On KUB giant cylindrical radiopaque shadow was shown on RLQ extended to right minor pelvis and this was confirmed as a stone by retrograde ureteral cath. eterization. A stone measured 13cm x 1.Scm was found above the ureterovesical junction during operatiòn. Follow up excretory urogram one year after operation showed no functional improvement of right kidney. Urethral stone is also unusual urinary li thiasis. This 60 years old male patie nt has been suffered from non. tender palpable hard mass on scrotal area and intermittent urinary retention. When urinary retention was ccurred it was relieved by manipulation of the mass by himself. On plain filn oval shaped giant radiopaque shadow was shown on cavernous urethral region. On urethrocystogram anterior urethra was opacified, but posterior urethra and bladder were not opacified.and multiple fistulous leakage was identified. A stone mea. sured 6.Scm x 3.5cm was found in cavernous urethra during operation. * 홈 든 i ilflll * 結石은男子에흔하고소아와촉안에서는드물고, 發生頻度가높은 연령층은 50 代이마고 d. r. 5mithJ) 는報告했 며 Wiiliam, H. Boyce 14 ) 동은 2, 510, 791 * 管짧型結石이라는病名으로 19 72 年에 Kjyonobu 名을대상으로조사한결과民結石發生頻度가높은연 Tari 와 Kjkjiro 50 가처음報告했는데結石의걸이령층은 20 代이었고소아와혹인에서는드물마고報告 가 8.5 cm, 우게는 7.5g 이었마. 했마. 原道結 E 은原結石中가장頻度가낮은結石이며 Pa- 本전북의대부속병원방사선과학교실에서는 36 세의 ulk 16 ) 둥이 Mayo Clinic 에 25 年동안來院한思者를女子愚흉의右예下部民管에위치한틴大原管흉흉型結 대상으로조사한결과 * 道結石응단지 47 lle f 列에불과石 - 例와 60 세의男子恩者에서陰짧과樓孔을동반한 했으며그중陰짧과建孔을동반한巨大原道結石은없巨大民道結石 S 로확진펀 - 例를경험하였기에이를 었마고報告했마. 文廠考察파함께報告하는바이다. - 596 -

:JÆ 例 I 愚者 : 오 O 녕, 36 세, 女子主訴 10 年間 f 돼歐的인右떼 l 댔痛 얹往歷. 정상분만이었고위증상이나타나기전까지 는건캉했마. 現 1ff.: 10 年前부터間歐따右떼體痛으로증상적치 료를받아왔으며 A 院 5 個月前부터 1JË 狀이 섬해져 本病院에入院함. 家族歷 특이사항없음 理學的所見. 右페體痛및많痛外에는특이사항없 p. 檢훌所見. 혈액 검사상혈색소가 9.5m/dL 혈쿠백 Fig.2. Case I. Excretory urogram; Faint Visu- 분률이 29% 로감소되었고日血球는 5800/mm 3 호正常 alization of right pelvis and Calyceal 이었다 system. JJJ( 檢훌..t H. P.F 에서 0~2 ~ 血球와않은白血球를보인것외에는正常이었다. 放射線學的所見 : K. U. B 上右떼下뼈部에걸고가장자리가평탄하며약간 laminatiqn 된길이 13.5 cm, 넓이 2cm 의不透明한陰影을볼수있었으며 ( fi g. J, case 1), 경정맥신장조영솔 (fig.2, case 1 ) 과 i효行的 4로揮 A 한不짧明한道管 (f ig. 3, case 1) 에서右없 ~ 下部 JJJ( 管에위치한巨大짧型結石임을확인할수있었다. Fig. 3. Case I. RGP shows the position of Cal. culi in relation to uretet. 勝 wt 鏡所見 :JJJ( 管開口部및 R 종뾰形평는正常이었다. 手術所見放射線所見에서볼수있었던部뾰와 - 致 되는곳에서길이 13 cm, 넓이 1. 5cm 의原管結石을 제거했으며 (f i g. 4, case 1), 右測賢廳은그대로보존 시켰마. 結石을除去한後 10 일만에경과가양호하여퇴원하 Fig. 1. Case L K. U. B. ; A giant cylindrical rad- 였으며 1 년후마시經靜服團嚴造影術을업施해본結果 opaque stone in RLQ extended to right 右測뽑觸의機能은手術前과열짧化가없었마 (f i g.5, minor pelvis. case 1 ). - 597-

家族歷 : 맏형이뼈結核으로 5 年前에사망. 理學的所見 : 앞가슴에크기가마른많은반흔이있 었고右測陰짧에작은달칼크기의단단한많痛이 睡없가觸知되었고體이여러개의擾孔을몽하여 없는 배출 되었마. 檢훌所見 ; 原檢홉上 H.P.F 에서 외에는正常이였다. 白血球가많은것 放射線學的所見 : 單純 film 上치골하부에길이 6 ft'ig.4. Case 1. Ureteral Cast stone after ope- cm, 넓이 3.5 cm 의不透明한陰影이있었고 ( fig. I, ration(i3x 15cm). case ll), 뇨도방광조영술에서前部原道의팽대와陰짧 Fig.5. Case 1. FoIlow up excretory urogram Fig.l. Case ll. Plain fiim shows oval shaped one year after operation; No improv- giant urethral stone on Cavernous urement of right renal function and no ethral region. evidence of recurrent stone formation. 으로不規則한웹出이있었고勝뾰은造影剛로充滿되지 않았마 (f i g. 2, case U). 퍼E 例 H 愚者 : 이 O 석, 60 세, 男子主訴 : 右앵 IJ 쫓 n 部位에단단한睡塊의觸知와樓孔을통한體의배출. ~ 往歷 : 특이사항없음 手術所見 : 放射짧所見에서볼수있었던部位와 - 致되는곳에서걸이 4.5cm, 직경 3cm 의 橋때形結石을제거하였고 ( fig. 3, cas e ll), 右빼陰짧과 '*i훌사 이에覆孔이 동반되어 있음을확인하였다. 考察現 홈 20 年間右 1Jl IJ 뿔 n 部位에 단단하고 痛 1fE이 R. S. Malek 와 w. H. Boyce 13) 는原結石은基質과 없는睡塊가觸知되었으며그睡塊의 위치를변경함으 結옮으로구성되는데훌質은結性蛋 8 0 1 며 그化學成分 로써뇨배설은용이하였었마. 은蛋입質이 65%, 탄수화물이 14%, 물이 10%, inorn 重塊의크기는처음에는성인의염지손가락끝만하 ganic ash 가 12 % 를차지하고있으며, 基質量의 85% 였으며반복원感짧으로陰짧에 癡孔이형성되었고 그 는 Matrix Substance A 로구성된마고報告했마. 覆孔을통하여腦이배출됨 Ma trix Substance A 는뽑結石惠者의뽑組織에서 - 598 -

Fig.2. Case ll. Urethrocystogram; Nonopacification of posterior urethra and bladder with multiple fistulous leackage. osphate hexahydrate, Pure apatite 와 Mixed Ammonium phosphate h exahydrate - apatit e 結石이 19.5% 를차지한마고짧告했으며 d. r. Smith 도原石의 % 가 Calcium Oxalate 또는 Calcium Oxalate 와 Calcium phosphate 의 混合物로구성된마고 報告했마. μ 싸 } 原結石 ~ 成의정확한原因은알려지지않았으며 d. r. Smith ll 는因子로서非? 찜性 '* 成分의 i 圖排빠, 原에서일 어냐는物理的짧化, tt 짧을일으키는核 ( nucl e us, ni Fig.3. Case ll. Giant Urethral stone after Ope- dus), 그러고뽑杯擬張효과嚴質性海縮땐 (Me dullary ration(6.5x3.5cm). sponge kidney) 을포함한構造的騎形을들었고 Em- 면역학적으로발견되고正常웹驗에서발견할수 없는 것으로미루어보아 renaf ori gin 이라했으며 Active stone formers 의 '* 에서는多월, Occasional sto ne formers 에서는小웰發見된마고報告했마. E. L. Prien 등은 '* 結石은結끓고 } 無形體 ( amorphous) 로구성되고結옮의成分은 Calcium oxalate Monohyd rate, Calcium Oxalate dihydrate, Magnesium Ammonium phosphate hexahydrate, Carbonate apatide and hydroxyl apatite, Calcium hydro g en phosphate dihydrate, Uric acid, Cystine 그러고 Sodium acid urat e 이있마고報 Pure Magnes ium Ammonium phmett 3 ) 는原結石을일으키는용病으로 Hyper parathyroidism, sarcoidosis, Hypervitaminosis D, Milka lka li syndrome, Neoplasms, Gout, Chushing s syndrome, Hyperthyroidism, idiopathic infanti le hypercalc emia 등을들었고그외에 immobilization, infection, Urinary Stasis, Low u r ine- output stasis 를들었마. 소아에서는原石이드물지만 Alan. H. Bennett 는 3 가지原因的範짧즉靜止群 (stasis group ), 新陳代謝群 (metabo li c group ), 特짧性群 (I d- iopathi c group) 으로나누고이중 % 는靜止群이 지한마고報告했다. 靜止群에는先天 & 낀 騎形, 1 deal 차 告했다. E. L. Prien 은 Pure Calcium Oxalat e 結石은全 '* 結石의 36.170, Mixed Calcium Oxalate-apatite 結石은 3170, Uric ac id 結石은 6.1%, Cystine 結石 은 3.8% 그러고 conduit 내의結石, immobili zation 異物, Ureterosigmo idost omy 를실시한後풍 5 가지를들었으며先天的騎形의대부분은 ure t ero pe lvic stricture 이라고報告했다. H. 1. Sub y 6) 는 Urea- splitting Bacteria 는 ammoma 플형성하고 Calcium phosphate 를 tt ìl'ßl시키 - 599-

논데이들부류에는 Bacillus prote us, Bacillus infu enza, Bacillus Pyocyaneus Staphylococcus, streptococcus, B. Coli 둥이있마고報告했마. 結論 d. L. Smith 는結石의放射線透明度와結石의密度는 Calcium phosphat e 가가장不透明하며密度는 22.0 이고 Calc ium oxalate 가 10.8, Magn esium a mmonium pho s phat e 가 4.1, Cys tin e 이 3.7 이며 Uri c a cid 와 xanthine 이 1. 4 이어서가장透明하다고報告했다. 또한 T epl i ck 4 ) 동은료狀이나타냐는原結石의 90% 이상이放射線 t 不透明해서題部單純용훌흉 에서냐타난마고報告했마, 臨 J5R ft 狀은뽑 1피痛이가장흔한효狀이며훨짧性의痛 저자들은 10 年間의間없的右얘 ij 睡痛을主訴로來院한 36 세女子愚 홈의 K.U.B, opaque catheter 그러고經靜服賢觸造影術에서右下部民管에위치한巨大原管짧型結石 - 例와 20 年間右예 ( 좋九部位어l 睡塊觸知및複孔을통한眼의웹出을主訴로來院한 60 세男子뿔 者의勝麻造影術上,* ì훌와陰짧사이에樓孔을동만한巨大原道結 E - { 列블발견하였기에이플文廠考察과함께報告하는바이다. ft 이背部또는測題部에서시작되고下題部, 陰部, 大眼內剛으로放散완마 ( 李文鎬 5)). 그외에惡心, 없 Ilt, 題部 REFERENCES 짧眼, 頻民, 蛋白탔, 血康둥이출현하기도한다. 發熱이 나白血球增多 ft 이있 면! 행짧의슴혐을의싱하게한다. 檢훌所見 : 혈액검사에서 800 球 t 뽑多, 民檢흉에서日血球,71ft 血球가 H.P.F..t 많이나올수있고그외에 白, 細園, oxa lat e Body, Ca lc ium phosphate cast 가출현하기도한다. 原結石位置를결정하기위하여 蛋 K. U.B 와斷面最影術, 排빠性原路造影術, 않行性原管,'ii'J~ 振影術그러고 不透明 catheter 와單純 film 등을사용한마 L. W. Paul 2 ) 동은單純 film 上石 Ek 化陰影을일으키는 8월脫內 및其他흉病과는鍵 íluo ] 어려운데그중靜 Hm 石과鍵別方法으로靜 Hm 石의 경우형태가풍글거냐약간타원형이고 크기는아주마양하며쪼骨練下部에주로나타나지만原結 E 은 - 般的으로형태가不規則하고結石의長뼈과原管의長輔이평챙하다는정을들었마. 合病효 d. r. Smith Il 는原結石의슴혐효으로 '* 路 1. D.R., Smith General urology, 8th ed. P. 200-279, 7975. 2. L.W. Paul and j.h. juhl : The essentials of Roentgen interpretation. 3rd ed. P. 429, 7972. 3. Emmett 5 디 inical urography Vol. 4 th ed. P. 7777-7365, 7977. 4. Teplick and Haskin Roentgenologic Diagnosis, 5. Vol. P. 775-880. P. 7287, 7976. 6. Howard. 1. Suby and Robina. M. suby BA Expermental production of kidney stones with urea-splitting organisms, 995. 7. Irvin g Melnick, R. R. Landes A.A. Hoffman and j.f. Burch Magnesium theraphy for recurring ca/cium ora/ate urinary ca/cu/i, the journal of urology, Vo/, 閒塞,! 행짧및뽑魔 f 員屬을報告했는데저자들은 lie17jj 1 705: 7 79, 79 77. 에서뽑굶뽑觸갖을동안했고, ft 例 n 에서는原道와陰짧 8. Seelig, M.S. The requireemnt of magnesium by the 사이에樓孔및感짧을동반한것을판찰했마 norma l adu/t, summary and analysis of pub/ished 治癡및 f 象後 : 原管까지도달한結石은 80% 가 자연 룡과되며抗 @ 흥擊홉U 도유효하고육체적운동파척당량의수액흉수가필요하다고 d. r. Smith 는報告했고, Seeli g 8 ) 은하루에 7~10 m g/k g 의 Magnesium 을吸收항으로써 Negative Magnesium Balance 를막을수있다고報告혔다 Emett 3J 는外科的治續法으로 Transurethra 1 Manipulation 파 Uret erolithot omy를報告했는데저자들은료例 1, II 모두 Ureterolithot - omy 를실시했다. 또한 ft 例 1, II 모두手術後 l 年間追求調훌한결파再發은없었다. data, Amer. j. C/in, Nutr., 74:242, 7964. 9. Kiyonobu tari and kikujiro so :, japanese j ournal of c/inica/ ur%gy, Vo/. 26, No. 84 7972. 10. T.R. Feter M D Paul D. Zimskind MD, Robert. H. Graham MD and Donald. E. Brodie MD : Statistica/ ana/ysis of patients with uretera/ calcu"~ jama Vol. 786, No.: 27-23, 7963. 11. Sandegard E ; Prognosis of stone in ureteη A cta chir scand (suppl) 279: 7-6 기 7956. 12. Alan. H. Bennett and Arnold. H. Colodny Urinary tract calculi in children, Vo/. 709: 378-32α 7973. - 600-

13. R.S. Malek and W.H. Boyce Observation on the 15. Edwin. L. Prien and cliffcrd Frondel Studies in u/tra u/trastructures and genesis of urinary ca/cu/i, uro/ithiasis, P. 949.997. Thejourna/ofur%gy; 777-3477447, 7977. 16. Paulk, S.C., Khan, a.u. Malek, R.S., and Greene, 14. William. H. Boyce MD. Fredk Garvey MD /n- L.F. : Urethra/ Ca/cu/us. j. Uro/. 776:436-439 (Oct.), cidence of urinary ca/cu/i among patients in General 7976. Hospita/s 7948 to 7952, jama 7437-7447, 7956. - 601 -

大韓放射線醫學會誌 Vo J. XVI. No. 2, 1980 E 大 5R 管讓型結石및 民道結石各一例 全北大學校醫科大學放射線科學敎室 宋昊永 李松珠 崔基鐵 Absσact - A case report of Ureteral Cast Stone and Giant Urethral

大韓放射線醫學會誌 Vo J. XVI. No. 2, 1980 E 大 5R 管讓型結石및 民道結石各一例全北大學校醫科大學放射線科學敎室宋昊永李松珠崔基鐵 Absσact - A case report of Ureteral Cast Stone and Giant Urethral