Acupuncture in the treatment of renal colic

A prospective randomized study was performed to compare the effect of acupuncture and intramuscular Avafortan injection in the treatment of renal colic. Our results showed that acupuncture is as effective in relieving renal colic as Avafortan but it had a more rapid analgesic onset (3.14 +/- 2.88 minutes versus 15.44 +/- 7.55 minutes, p less than 0.05). Of the patients in the Avafortan group 7 (43.8%) had side effects, including skin rash in 3, tachycardia in 2, drowsiness in 1 and facial flush in 1. No side effects were noted in the acupuncture group. During 2 hours of observation acupuncture and Avafortan seemed to be ineffective in promoting stone passage. However, patients receiving Avafortan treatment were more likely to have paralytic ileus. In summary, acupuncture can be a good alternative for the treatment of renal colic.

A second observation of the fetal methemoglobin variant Hb F-M-Fort Ripley or alpha 2G gamma 2(92)(F8)His----Tyr

We have identified a second baby with the fetal methemoglobin F-M-Fort Ripley. It was observed in a Caucasian infant from Canada; at least eleven additional members of that family were known to have had a neonatal cyanosis similar to that seen in the propositus and in a previously described baby (2). Sequencing of amplified DNA that included (part of) the G gamma gene greatly facilitated the characterization. The G gamma X chain was readily isolated by reversed phase high performance liquid chromatography; its quantity was approximately 12.5% of total gamma. Interestingly, the baby also carried the A gamma T mutation on one chromosome, either in cis or in trans to the G gamma X mutation. Hb F-M-Fort Ripley could be isolated in reasonably pure form by DEAE-cellulose chromatography. The isolated Hb FX was unstable, had spectral changes characteristic for the M-hemoglobins, while its methemoglobin derivative reacted rapidly with cyanide. Oxygen affinity data could not be obtained. It is suggested that the formation of a rather large amount (approximately 25%) of mixed hybrids (alpha 2G gamma X.gamma) with low oxygen affinity is the main cause for the occurrence of the neonatal cyanosis.

Dissociation of lethal toxicity and enzymic activity of notexin from Notechis scutatus scutatus (Australian-tiger-snake) venom by modification of tyrosine residues

Notexin from Notechis scutatus scutatus snake venom was subjected to tyrosine modification with p-nitrobenzenesulphonyl fluoride (NBSF), and four modified derivatives were separated by h.p.l.c. The results of amino acid analysis and sequence determination revealed that only Tyr-7, Tyr-70 and Tyr-77 were modified in notexin. Modification of Tyr-7 resulted in decreases in lethal toxicity and enzymic activity by 70.2% and 22.7% respectively. Conversely, modification of Tyr-77 caused a 1.8-fold increase in enzymic activity, in contrast with the loss of 52.5% of lethality. A drastic decrease in lethal toxicity was observed when both Tyr-7 and Tyr-70 were modified, whereas the enzymic activity decreased by only 35.8%. Likewise, the derivative in which Tyr-7 and Tyr-77 were modified retained 44.4% of enzymic activity, but showed a marked decrease in lethal toxicity. It is obvious that modification of tyrosine residues causes a decrease in lethal toxicity of notexin, which does not directly correlate with the change in enzymic activity. On the other hand, the antigenicity of NBS derivatives remained unchanged. The modified derivatives retained their affinity for Ca2+, indicating that the modified tyrosine residues did not participate in Ca2+ binding. These results indicate that modification of tyrosine residues can differentially influence the enzymic activity and lethal toxicity of notexin, and suggest that notexin might possess two functional sites, one being responsible for the catalytic activity and the other associated with its lethal effect.

Autonomic hyperreflexia in spinal cord injury patient during percutaneous nephrolithotomy for renal stone: a case report

Autonomic hyperreflexia or autonomic dysreflexia is a syndrome seen in approximately 85% of all quadriplegic patients and constitutes the only medical emergency related to spinal cord injury. We report on a paraplegic patient with a C5 to C7 spinal cord injury who suffered autonomic hyperreflexia during percutaneous nephrolithotomy for a right renal stone. The reflex-induced hypertension subsided with termination of the operation, and administration of an alpha and beta-adrenergic blocking agent (labelatol hydrochloride). The stone was removed successfully by pyelolithotomy with the patient under general anesthesia 4 days later.

A polymerase chain reaction mediated by a single primer: cloning of genomic sequences adjacent to a serotonin receptor protein coding region

Under appropriate conditions, specific double-stranded DNA product was generated after amplification of genomic DNA sequences in a polymerase chain-like reaction that contained only a single primer. This type of amplification reaction was performed with a variety of primers and substrate DNAs. In addition to nonspecific heterogeneous products, 5 of 11 primers reproducibly directed synthesis of double-stranded DNA that corresponded to the region of the template that contained the authentic primer annealing site. Three of these amplified products were cloned and their ends were sequenced. All three contained a copy of the primer at both 5' ends, and the position of one of the primers represented the authentic primer binding site. In each case, the location of the second copy of the primer indicated that it had initially hybridized to a partially homologous sequence in the template DNA. This single primer reaction makes it possible to amplify and clone a DNA region of unknown sequence that is adjacent to a known DNA sequence. One of the single primer reaction products described here included sequence to the 5' side of the coding region of a serotonin receptor gene that contained a functional promoter.

Transcriptional repression by YY1, a human GLI-Krüppel-related protein, and relief of repression by adenovirus E1A protein

A sequence within the transcription control region of the adeno-associated virus P5 promoter has been shown to mediate transcriptional activation by the adenovirus E1A protein. We report here that this same element mediates transcriptional repression in the absence of E1A. Two cellular proteins have been found to bind to overlapping regions within this sequence element. One of these proteins, YY1, is responsible for the repression. E1A relieves repression exerted by YY1 and further activates transcription through its binding site. A YY1-specific cDNA has been isolated. Its sequence reveals YY1 to be a zinc finger protein that belongs to the GLI-Krüppel gene family. The product of the cDNA binds to YY1 sites. When fused to the GAL4 DNA-binding domain, it is capable of repressing transcription directed by a promoter that contains GAL4-binding sites, and E1A proteins can relieve the repression and activate transcription through the fusion protein.

[Idiopathic retroperitoneal fibrosis causing obstructive uropathy: a case report]

Idiopathic retroperitoneal fibrosis leading to obstructive uropathy is a rare disease in our country, so a typical case deserves presentation. The patient is a 56-year-old female to have a clinical manifestation of obstructive uropathy. Retrograde pyelogram permitted 5 Fr. ureteral catheter to pass the stenotic segment. At the mean-time, there was hydronephrosis, medial deviation and gradual thinning and pointing of the middle segment of the ureter (classic triad). Computed tomography revealed that retroperitoneal soft tissue plaque enveloped aorta, inferior vena cava, and bilateral ureters. The patient received ureterolysis with ureter intraperitonealization and lateralization. The plaque was pathologically proved fibrosis. Renal function became normal postoperatively.

Neobladder construction using completely detubularized sigmoid colon after radical cystoprostatectomy

To improve the quality of life of the patient we used completely detubularized sigmoid colon for bladder reconstruction along with radical cystoprostatectomy in 6 men with invasive bladder cancer. Followup was 8 to 20 months. Postoperatively, all of the patients were continent during the day but only 4 (66.7%) were continent at night, although they had to awaken twice to remain dry. Neocystourethroscopy in 4 of the 6 patients revealed no tumor and no stricture at the urethrocolonic anastomosis. However, a stone in the neobladder was found in 1 patients. Urodynamic study of the neobladder showed a low pressure (mean 16.7 cm. water) at the filling phase of water cystometry and an adequate maximal urethral closure pressure (mean 52.0 cm. water) and functional profile length (mean 3.8 cm.). The uroflow rate in all patients was good (1 patient even had a maximal uroflow rate of 31 ml. per second). There was no reflux in any patient. One patient had intestinal obstruction 5 months postoperatively and died 5 months later of widespread metastasis. The remaining 5 patients are alive with a satisfactory quality of life. In conclusion, use of completely detubularized sigmoid colon may be an ideal operation for neobladder construction after radical cystoprostatectomy.

Prospective radionuclide renal function evaluation and its correlation with radiological findings in patients with Kock pouch urinary diversion

In an attempt to understand better the status of renal function after Kock pouch urinary diversion we conducted a prospective evaluation of renal function in 25 patients using the radionuclide 131iodine-hippurate. Studies were done before, and at 1 month and every 6 months for 30 months postoperatively. The radionuclide results were then compared to excretory urography and contrast study of the reservoir. Our renal function study included the determination of individual and total effective renal plasma flow (ml. per minute), the time to maximal radioactivity over the kidney (peak time in minutes) and a renogram. The mean total (both kidneys) effective renal plasma flow rates before (25 patients) and at month 1 (19), month 6 (14), month 12 (12), month 18 (6), month 24 (6) and month 30 (7) after operation were 385.5 +/- 112.2, 310.5 +/- 109.9, 362.7 +/- 69.2, 442.0 +/- 97.5, 468.2 +/- 82.5, 405.7 +/- 70.6 and 414.0 +/- 65.1, respectively. A comparison of individual and total effective renal plasma flow before and after operation revealed that only the change of the flow at each or both sides of the kidney before and at 1 month after the operation reached statistically significant differences, respectively (p less than 0.05, paired t test). Postoperatively 5 of 6 patients with hydronephrosis had abnormal peak time and a third segment on the renogram was performed on the corresponding side of the kidney. No reflux was noted on contrast study of the reservoir of any patient followed for up to 30 months. In conclusion, the radionuclide renal function evaluation showed a significant decrease of renal function 1 month after Kock pouch diversion, then it resumed and remained stable (neither improved nor deteriorated) for 30 months. Also the abnormal peak time and third segment on the renogram usually implicated a dilated upper urinary tract.

Comparison between histopathology and DNA histogram of testis

From January to July 1989, the DNA histogram of testicular open biopsies was done for 11 patients of primary infertility and 7 patients of a control group. There were 2 failures in these 36 specimens. The flow cytometric analysis revealed characteristic patterns in the relative numbers of haploid (1C), diploid (2C), and tetraploid (4C) cells. In the presence of normal spermatogenesis, the haploid compartment contained the majority of cells, followed by the diploid, and then the tetraploid (1C greater than 2C greater than 4C). The other diagnostic criteria of flow cytometry were as follows: hypospermatogenesis (2C greater than 1C greater than 4C), the maturation arrest (2C greater than 4C greater than 1C), and Sertoli-cell-only syndrome (2C, near 100%). According to the aforementioned diagnostic criteria, the results of DNA histograms were compared with the histopathology diagnosed by junior or senior pathologists. These patterns of DNA histograms correlated with the diagnoses by senior pathologists in 28 of 34 specimens (82.6%), while there were only 20 of 36 pathologic diagnoses (55.6%) which matched between junior and senior pathologists. It is shown that abundant experience is needed for testis pathologists to diagnose accurately. The DNA histograms correlate well with pathological findings, with the advantages of quantification and fewer specimens needed. In conclusion, testicular tubular cell DNA histograms appear to be a reliable modality in the evaluation of spermatogenesis. They provide the quantitative information of sperm maturation and help in making appropriate decisions in the management of male infertility.

A convenient method to differentiate the monoclonal antibodies with differing immunochemical properties

Three monoclonal antibodies (mAbs) against Naja naja atra phospholipase A2 (PLA2) were prepared by hybridoma technique. Of which two mAbs, 1E531 and 5F92 inhibited the enzymatic activity of PLA2, but 5F6F10 did not. 1E531 and 5F92 nearly exhibited the same binding patterns which was different from that observed with 5F6F10 toward the chemically modified derivatives and homologous variants of PLA2 as revealed by enzyme immunoassay. This suggests that, based on the results of comparative analysis on their relative reactivity with modified derivatives and PLA2 homologues, the mAbs with different immunochemical properties could be differentiated.

The incidence and prognostic significance of humoral hypercalcemia in renal cell carcinoma

This retrospective study was conducted to evaluate the incidence and prognostic significance of humoral hypercalcemia in 218 renal cell carcinoma patients during the last 20 years. Of 218 patients 20 (9.2%) were hypercalcemic, with serum calcium levels ranging from 10.7 to 16.0 mg./dl. The respective incidence of humoral hypercalcemia was 3% in patients with stage I, 5.9% with stage II, 14.1% with stage III and 18.9% with stage IV disease without bone metastasis. The survival curves between the hypercalcemic and eucalcemic groups among stages I to III cancer patients showed no statistical significance (p greater than 0.05). The survival curve deteriorated significantly in stage IV cancer patients with humoral hypercalcemia (p less than 0.005), with a median survival of 45.0 +/- 39.7 days versus 286.4 +/- 27.6 days in eucalcemic patients. No specific correlation was found between pathological cell type and humoral hypercalcemia.

Repressed expression of the HER-2/c-erbB-2 proto-oncogene by the adenovirus E1a gene products

The E3 region of adenovirus induces down-regulation of epidermal growth factor receptor (EGFR) through endocytosis. Here we report that an EGFR-related protein, the HER-2/c-erbB-2 gene product, p185, is also down-regulated by adenovirus, but via a different mechanism. We found that the adenovirus E1a gene is responsible for the repression of HER-2/c-erbB-2 at the RNA level.

Stone incrustation: a relevant complication of the intraprostatic spiral

Six high operative risk patients with urinary retention caused by benign prostatic hyperplasia were managed with an intraprostatic spiral at our hospital. Three of them had severe coronary artery disease, 1 had uremia, 1 had cerebral stroke and 1 had poorly controlled diabetes mellitus. The urinary retention was successfully relieved by the intraprostatic spiral in all patients. No operative mortality or severe complication was encountered. One patient experienced a repeat attack of urinary retention due to proximal migration of the spiral. Four patients complained of urgency, which was relieved by anticholinergic agents. Stone incrustation was found on 2 out of 3 spirals removed (66%), and the stone turned out to be calcium phosphate and struvite by scanning electron microscopy and infrared spectrophotometry. In 1 patient, stone formation was so abundant that it almost obstructed the lumen of the redundant tip of the spiral. From our preliminary results, the intraprostatic spiral seems to be a good alternative to an indwelling catheter for patients awaiting prostatectomy. Nevertheless, the potential complication of stone incrustation should be anticipated and it is suggested to remove the device as soon as possible or to replace it at regular intervals.

Venom constituents of Notechis scutatus scutatus (Australian tiger snake) from differing geographic regions

Column chromatography and polyacrylamide gel electrophoresis of Notechis scutatus scutatus venom showed that the venoms from different geographical locations had variations in their constituents. The venom collected from South Australia region contained both notexin and notechis II-5. The relative quantity of notechis II-5 was about three times that of notexin. On the other hand, the venom from Victoria region contained large amounts of notexin, but lacked notechis II-5. Instead, an unknown nontoxic protein, designated as notechis II-5b, exhibiting weak phospholipase A2 activity appeared in the position of notechis II-5 elution. This protein had an N-terminal sequence of N-L-I-Q-L-S-N-M-I-K-C-A-I-P-G-S-Q-P-L-F, sharing 45% homology with notexin and notechis II-5 and 60% homology with notechis II-1. The antibodies raised against Trp-modified notexin inhibited the enzymatic activities of notexin and notechis II-5 by 88 and 68%, respectively. However, the affinity of notexin for the antibodies was nine-fold greater than that of notechis II-5. This result is contrary to the previous finding (Mollier et al., FEBS Lett. 250, 479-482, 1989) in which notexin and notechis II-5 had similar binding affinities for antibodies raised against native notexin. This observation suggests that the antibodies prepared in this study could differentiate between isoforms of notexin.

Serum iron as a tumor marker in renal cell carcinoma

To evaluate the feasibility of using serum iron as a tumor marker for renal cell carcinoma, a retrospective review of serum iron, hemoglobin, hematocrit, mean corpuscular volume and pathology in patients with renal cell carcinoma was carried out. From January 1985 to December 1989, preoperative serum iron was obtained in 82 patients; 27 had stage I, 5 stage II, 23 stage III and 27 had stage IV disease. The serum iron levels (micrograms/dl) were 81.6 +/- 33.2 in stage I, 57.8 +/- 18.9 in stage II, 59.6 +/- 34.6 in stage III and 45.6 +/- 32.7 in stage IV disease, which were significantly lower as compared with the data (114.6 +/- 38.9) of a control group. Postoperative serum iron levels were available in 31 patients following nephrectomy and all showed an increase as compared with preoperative data except 2: 1 with recurrence and the other with progression of disease. It was concluded that the serum iron level may be used as a useful tumor marker in staging and follow-up of renal cell carcinoma.

Experience with percutaneous nephrostomy, extracorporeal shock wave lithotripsy and chemolysis in the treatment of obstructive uric acid stones

Intravenous pyelography (IVP), retrograde ureteral catheterization and percutaneous nephrostomy (PCN) have been used to locate radiolucent stones during ESWL in an X-ray localization system lithotripter. We also used an alternative method combining PCN, ESWL and chemolysis to treat 8 obstructive uric acid stones. The average number of shock wave pulses was 1,725 (range 1,000-2,000), the generator voltage of the HM-3 Dornier lithotripter was 20-22 kV, and the local chemolysis lasted 4 days (range 2-7). All radiolucent uric acid stones were successfully disintegrated. Of the 8 patients treated, 5 were completely free of stones and the other 3 had insignificant residual stones after 3 months. Three patients who developed fever during local chemolysis with 0.1 M sodium bicarbonate solution were managed conservatively without severe sequelae. Only 1 patient retained a PCN tube after discharge. Because PCN can provide a path for local chemolysis and better localization, it is especially helpful in treating obstructive uric acid stones.

Incidental adenocarcinoma of the prostate: a retrospective analysis

Between January 1980 and June 1990, 5875 patients underwent either TURP (5,529) or open prostatectomy (346) for the management of benign prostatic hyperplasia. Incidental carcinoma was identified in 53 patients (0.9%) - 49 in the TURP group and 4 in the open prostatectomy group. The overall incidence of stage A prostate carcinoma during the same period was 13.1% (53/406). Of those 50 regularly followed patients, only 6 (12.0%) underwent subsequent radical prostatectomy with pelvic lymphadenectomy, and residual tumors were identified in 4 patients (66.7%). The progression rate was 33.3% (3/9) in high-grade tumors (Gleason's score greater than 6) and 7.7% (2/26) in low-grade tumors (Gleason's score less than 5). In those 50 patients, 41 (82.0%) presented no evidence of disease and 9 (18.0%) stayed alive with progression. The mean length of follow-up was 34 months (range: 2-108 months). Our study demonstrates that the outcome of incidental carcinoma of the prostate is good. However, the residual tumor rate still remains high at 66.7%. Radical prostatectomy is recommended in young patients or in patients with high grade tumor.

Factors influencing radiation exposure during the extracorporeal shock wave lithotripsy

A prospective evaluation of 89 consecutive sessions of extracorporeal shock wave lithotripsy (ESWL) was undertaken to try and find the best way of minimising the amount of exposure to radiation. Forty-two patients were randomly allocated to undergo ESWL treatment by experienced surgeons (group A), and 47 to undergo the treatment by inexperienced surgeons (group B). The mean calculated entrance radiation exposure was 3.01 rads (group A: 2.64 (0.97) rads, range 1.00-4.48, group B: 3.38 (0.86) rads, range 1.11-5.75). Among factors that influenced radiation exposure, the tissue: air ratio should be borne in mind and the level of skill in controlling movement of gantry was the most important in reducing the exposure to radiation.

Penile brachial index in impotent patients with coronary artery disease

From March to July 1989, a total of 40 patients, who had received coronary catheterization, answered questionnaires concerning sexual potency. In those 30 patients with a diseased coronary artery, only 2 (6.6%) had no erectile dysfunction subjectively. On the contrary, 4 of 10 (40%) patients with angiographically proven normal coronary artery complained of erectile dysfunction. Penile Doppler ultrasonography was performed in 30 patients. The mean penile brachial index (PBI) of 8 patients with a normal coronary artery was 0.82 +/- 0.1, as compared with the diseased group, 0.73 +/- 0.1 (p = 0.05). When these patients were further divided into two groups by a PBI of greater or less than 0.65, there was also no significant difference in the degree of obstruction of the three main coronary arteries between these two groups. There was no correlation between PBI and obstruction of the left anterior descending artery (r = 0.316, p = 0.689). Most of the patients (93.4%) with an abnormal coronary artery had erectile dysfunction. Nevertheless a poor correlation was noted between the PBI and the severity of coronary artery obstruction. Our study suggests that it is hard to use PBI alone as a predictor of future major thromboembolic heart attack.

Retroperitoneal abscesses

Abscesses developing within the retroperitoneal spaces are complicated serious surgical infections marked by an insidious, occult process lead to considerable mortality and morbidity. In a retrospective review of 39 retroperitoneal abscesses in our hospital. Attention is directed to clinical presentation, diagnosis and treatment. On average, 19.2 days was required to establish the diagnosis and overall mortality is 7.7%. Two patients suffered from complications of discharged sinus and recurrent abscess respectively. Computed tomography (CT) is thought to be the best diagnostic modality of retroperitoneal abscesses. Only 2 patients (5.3%) shows bilateral lesions. Detailed anatomic reviews detailing the pathogenesis of bilateral retroperitoneal abscess are also discussed.

The N-terminal amino group essential for the biological activity of notexin from Notechis scutatus scutatus venom

Notexin from Notechis scutatus scutatus snake venom was modified with trinitrobenzenesulfonic acid, and the major trinitrophenylated (TNP) derivative was separated by high-performance liquid chromatography. Modification resulted in the incorporation of only one TNP group on the N-terminal alpha-amino group. The TNP derivative showed a precipitous decrease in enzymatic activity and lethal toxicity, whereas the antigenicity remained unchanged. However, trinitrophenylation did not significantly affect the secondary structure of the toxin molecule as revealed by the CD spectra. The results, that the modification reaction was accelerated by the Ca2+ and that the TNP derivative retains its affinity for Ca2+, indicate that the N-terminal alpha-amino group did not participate in the Ca2(+)-binding. The TNP derivative could be regenerated with hydrazine hydrochloride. The biological activities of the regenerated notexin are almost the same as those of native notexin. These results suggest that the N-terminal alpha-amino group is essential for the phospholipase A2 activity and lethal toxicity of notexin, and that incorporation of the TNP group on the N-terminal alpha-amino group might give rise to a distortion of the active conformation of notexin.

Transcriptional repression of the neu protooncogene by the adenovirus 5 E1A gene products

Amplification/overexpression of the human neu protooncogene has been frequently found in human primary breast and ovarian cancers and is correlated with the number of axillary lymph nodes positive for metastasis in breast cancer patients. Identification of the factors controlling transcription of the neu gene is essential for understanding the mechanisms of neu gene regulation and its role in tumorigenicity. The adenovirus early region 1A (E1A) gene products are pleiotropic transcription regulators of viral and cellular genes and have been identified as a viral suppressor gene for metastasis. Here we demonstrate that transcription of neu can be strongly repressed by the E1A gene products. The 13S and 12S products of E1A gene are effective at repressing neu transcription and the transcriptional repression requires the conserved region 2 of the E1A proteins. The target for E1A repression was localized within a 139-base-pair DNA fragment in the upstream region of the neu promoter. In addition, competition experiments suggest that the sequence TGGAATG, within the 139-base-pair fragment, is an important element for the E1A-induced repression. These results indicate that E1A negatively regulates neu gene expression at the transcriptional level by means of a specific DNA element.

The adenovirus DNA-binding protein stimulates the rate of transcription directed by adenovirus and adeno-associated virus promoters

The DNA-binding protein (DBP) encoded by the E2A region of adenovirus type 5 was found to enhance the expression of a reporter gene controlled by several different promoters within transfected cells. The rate of synthesis of correctly initiated transcripts was increased by the DBP. The adeno-associated virus P5 promoter and the adenovirus E1A and E2A early and major late promoters responded to the DBP by increases in expression ranging from 6- to 27-fold, while the adenovirus E4 promoter was slightly inhibited by DBP. The adenovirus major late promoter showed a greater response to DBP than to the E1A transactivator protein, suggesting that the DBP plays a central role in activation of the late promoter.

Clinical experience of Kock pouch continent urinary diversion

Kock continent ileal reservoir for urinary diversion was performed in 53 patients with invasive bladder cancer (52) or neurogenic bladder (1). The postoperative follow-up period was from six to thirty-nine months. The clinical results showed no metabolic disturbance of blood electrolytes or acidity. Prolapse of efferent nipple valve developed in 4 patients (7.6%); and 2 underwent revisional surgery with a good result. Another 4 patients (7.6%) suffered from poor continence and relatively frequent catheterization to empty the pouch was necessary to prevent urine leakage through the stoma. Urodynamic study of the Kock pouch in these 4 patients showed a short functional nipple valve length and small pouch capacity. The other 45 patients (84.8%) had good continence. Urodynamic study of the pouch in 20 patients showed low pressure (mean of 13.3 cm H2O) in the pouch and high pressure (mean of 72.1 cm H2O) at the efferent nipple valve. Three patients had unilateral hydronephrosis in the follow-up intravenous urography. Corrective surgery for stenosis at the right ureteroileal anastomosis was done in 1 patient with normalization of the upper urinary tract afterward. The other 2 patients were managed by close observation for the mild hydronephrosis. Symptomatic bacteriuria developed in only 3 patients (5.7%) and responded well to antibiotic management. Reservoirography demonstrated no reflux into the upper urinary tract in all the follow-up patients. There was no significant change of the renal function at twenty-four months after operation detected by radionuclide (131I-Hippuran) renal functional study. All patients were satisfied with Kock urinary diversion.