Radiculopathy as Delayed Presentations of Retained Spinal Bullet

Bullet injuries to the spine may cause injury to the anatomical structures with or without neurologic deterioration. Most bullet injuries are acute, resulting from direct injury. However, in rare cases, delayed injury may occur, resulting in claudication. We report a case of intradural bullet at the L3-4 level with radiculopathy in a 30-year-old male. After surgical removal, radicular and claudicating pain were improved significantly, and motor power of the right leg also improved. We report the case of intradural bullet, which resulted in delayed radiculopathy.

Abnormal Dimercaptosuccinic Acid Scan May Be Related to Persistence of Vesicoureteral Reflux in Children with Febrile Urinary Tract Infection

PURPOSE: This study assessed whether 99mtechnetium dimercaptosuccinic acid (DMSA) scintigraphy used for the assessment of renal sequelae after febrile urinary tract infection (UTI) has any prognostic value for outcome measurement of vesicoureteral reflux (VUR) by retrospectively evaluating the correlation between abnormal DMSA scintigraphy results and persistence of VUR in children with febrile UTI. MATERIALS AND METHODS: The medical records of 142 children (57 boys, 85 girls) admitted with febrile UTI from January 2004 to December 2006 and who were followed up for more than 1 year were retrospectively reviewed. At the initial and follow-up visits, renal ultrasound and DMSA scans were performed within 7 days from the diagnosis and voiding cystourethrography (VCUG) was performed within 1 month in all case and follow-up evaluations. RESULTS: The children's mean age was 4.8+/-3.6 years (range, 0.3 to 14 years). The mean follow-up was 28.2+/-4.8 months. At the initial examination, VUR was more often associated with an abnormal DMSA scan result (83.3%) than with a normal DMSA scan result (16.7%, p=0.02). The frequency of VUR with an abnormal DMSA scan during acute UTI was significantly higher than the frequency of VUR with a normal DMSA scan (38.8% vs, 25.8%, respectively, p=0.004). Also, high-grade VUR was associated with an abnormal DMSA scan result (32.5%) more often than with a normal DMSA scan result (0%, p=0.01). Children with an abnormal DMSA scan had a lower resolution rate of VUR (17.5%) than did children with a normal DMSA scan (75.0%) at the follow-up VCUG (p=0.02). CONCLUSIONS: An abnormal result on a DMSA scan during febrile UTI is associated with high-grade and persistent VUR. DMSA scans performed during febrile UTI are useful in reflux resolution in childhood.

Impact of Nocturia on Health-Related Quality of Life and Medical Outcomes Study Sleep Score in Men / 대한배뇨장애요실금학회지

PURPOSE: To evaluate the impact of nocturia on health-related quality of life and sleep in men. METHODS: From January 2008 to December 2008, 284 patients with lower urinary tract symptoms were selected for this study. The participants completed a series of questionnaires on health-related quality of life (the overactive bladder questionnaire, or OAB-q), the Medical Outcomes Study (MOS) sleep scale, and the frequency volume chart. RESULTS: The patient population had a mean age of 60.0+/-13.4 years (range, 40 to 79 years). The mean duration of symptoms was 28.8+/-34.6 months. The mean number of voiding episodes per night was measured as follows: 88 patients (31.0%) reported no nocturia, 60 patients (21.1%) reported 2>voids/night > or =1, 56 patients (19.7%) reported 3>voids/night > or =2, and 80 patients (28.2%) reported > or =3 voids/night. The mean number of nocturia episodes increased with age (P=0.001), and the number of nocturia episodes was significantly associated with the OAB-q symptom score (P=0.001) and symptom bother (P=0.001). Among the categories of the MOS sleep scale, sleep index I (P=0.020), sleep disturbance (P=0.010), adequacy of sleep (P=0.005), and somnolence (P=0.041) were significantly associated with an increased number of nocturia episodes. CONCLUSIONS: The number of nocturia episodes increased with age in men. Nocturia appeared to be associated with further negative effects on sleep quality, health-related quality of life, and symptom bother.

Factors Affecting the Outcome of Extraperitoneal Laparoscopic Radical Prostatectomy: Pelvic Arch Interference and Depth of the Pelvic Cavity

PURPOSE: To determine the effect of pelvic arch interference and the depth of the pelvic cavity, as shown on preoperative magnetic resonance imaging (MRI), on the performance of extraperitoneal laparoscopic radical prostatectomy (ELRP). MATERIALS AND METHODS: In 115 patients, pelvic bone images were obtained at the time of prostate MRI before ELRP. In the reconstructed sagittal plane, we measured the true conjugate diameter, the obstetric conjugate diameter, the difference between the true and obstetric diameters, and the distance between the true conjugate and the prostate apex (pelvic depth). We analyzed which factors were associated with operative time (OT), estimated blood loss (EBL), and positive surgical margins (PSMs). RESULTS: The difference between the true and obstetric conjugate diameters was 12.7+/-3.7 mm, and the pelvic depth was 59.9+/-6.0 mm. The OT, EBL, and the rate of PSMs were 260.1+/-91.1 minutes, 633.3+/-524.7 ml, and 19% (22/115), respectively. According to multiple linear regression analysis, predictors of a higher EBL included pelvic depth (3.0% higher per 1 mm increase in diameter difference, p=0.01) and prostate volume (1.5% higher per 1 cc increase in prostate volume, p=0.002). Factors associated with a longer OT were pelvic depth (p=0.04), serum prostate-specific antigen (p=0.04), prostate volume (p=0.02), and Gleason score (p=0.001). For PSMs, only pT2 was an independent factor. CONCLUSIONS: Our results suggest that the depth of the pelvic cavity and prostate volume may increase surgical difficulty in patients undergoing ELRP.

Accuracy and Factors Affecting the Outcome of Multi-Detector Computerized Tomography Urography for Bladder Tumors in the Clinical Setting

PURPOSE: The objective of this study was to investigate the diagnostic accuracy of multi-detector computerized tomography urography (MDCTU) for the detection of bladder tumors. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 143 patients who were scanned by use of 64-channel MDCTU and who underwent cystoscopy due to painless hematuria or a clinical suspicion of bladder tumor. We examined the accuracy of MDCTU for the detection of bladder tumors by comparing the results obtained by MDCTU with those obtained by cystoscopy. The associations between tumor characteristics, frequency of transurethral resection (TUR), and bladder volume and detectability of bladder tumors on MDCTU were also analyzed. RESULTS: Of 143 patients, 50 patients had a history of urothelial carcinomas. In these patients, the sensitivity and specificity of MDCTU were 60.0% and 80.0%, respectively. In 93 patients without previous urothelial carcinomas, the sensitivity and specificity of MDCTU were 86.7% and 96.8%, respectively. Falsely diagnosed cases had a smaller distended bladder volume (p=0.014) and a smaller tumor size (p=0.022) than did true diagnosed cases. The false-negative rate increased when the bladder tumor was located at the bladder neck. In the univariate analysis, the tumor location, size, frequency of TUR, bladder volume, and initial hematuria were associated with detectability by MDCTU (p<0.05). CONCLUSIONS: To improve the accuracy of MDCTU for diagnosing bladder tumors, bladder filling is recommended. Thus, cystoscopy should be considered as a standard diagnostic tool for bladder tumors even in patients with normal MDCTU results, especially in the evaluation of recurrent, bladder neck-located, small, or sessile bladder tumors.

Clinical Significance of Transrectal Ultrasonography and Efficacy of Dutasteride Treatment in Patients with Hemospermia / 대한남성과학회지

PURPOSE: The aims of this study were to investigate the clinical significance of transrectal ultrasonography (TRUS) and the efficacy of dutasteride (5alpha-reductase inhibitor) in patients with hemospermia. MATERIALS AND METHODS: From January 2005 to December 2008, 60 patients with hemospermia were enrolled in the study. All patients underwent a digital rectal examination and TRUS; serum prostate specific antigen was also measured. The management of hemospermia was one of the following: watchful waiting, dutasteride treatment, or antibiotics with dutasteride. RESULTS: Thirty-four patients (56.7%) had positive findings on TRUS. There were 16 cases (26.7%) of prostate calcification, 13 cases (21.7%) of ejaculatory duct cyst, 3 cases (5%) of ejaculatory duct calcification, a case of seminal vesicle inflammation, and a case of ejaculatory duct dilation. Dutasteride treatment resulted in improvement of symptoms in 87.9% (29/33) of the cases, whereas treatment with antibiotics or antibiotics with dutasteride resulted in a 100% (6/6) success rate. However, among 14 watchful waiting patients, only 3 patients (21.4%) showed an improvement of symptoms. CONCLUSIONS: This study showed that TRUS is an easy and effective method for the assessment of hemospermia, and also revealed that dutasteride could be a useful agent in the treatment of hemospermia.

Prostate Cancer Can Be Detected Even in Patients with Decreased PSA Less than 2.5 ng/ml after Treatment of Chronic Prostatitis

PURPOSE: We evaluated men with documented chronic prostatitis and elevated serum prostate-specific antigen (PSA) to determine whether treatment with antibiotics and anti-inflammatory drugs can lower serum PSA and the cancer detection rate in patients with post-treatment PSA <4 ng/ml. MATERIALS AND METHODS: Eighty-six men who presented with serum PSA greater than 4 ng/ml and who were subsequently diagnosed with chronic prostatitis with greater than 10 white blood cells per high power field in expressed prostatic excretions were included in this prospective study. Patients meeting these criteria underwent treatment with a 4-week course of antibiotics and nonsteroidal anti-inflammatory agents. Follow-up PSA and transrectal ultrasonography-guided prostate biopsy were performed within 2 months of treatment for all patients. RESULTS: Mean patient age was 56.2 years (range, 37-72 years). Mean PSA (ng/ml) decreased by 33.8%, from 8.12 (range, 4.02-24.8) to 5.37 (range, 1.35-12.94), after treatment (p=0.001). Pathological studies revealed prostate cancer in 18 cases (20.9%), chronic inflammation in 64 (74.4%), and benign prostatic hypertrophy in 4 (4.7%). The prostate cancer detection rate according to the follow-up PSA level, below 2.5, from 2.5 to 4.0, and above 4.0, was 13.3% (2/15), 13.6% (3/22), and 26.5% (13/49), respectively. CONCLUSIONS: When chronic prostatitis with elevated PSA is identified, antibiotic and anti-inflammatory treatment can lower these PSA levels. However, the possibility of prostate cancer remains in patients whose PSA level decreases to less than 4 ng/ml, even in those with a PSA level less than 2.5 ng/ml.

Single Scrotal Incision Orchiopexy for Children with Palpable Low-Lying Undescended Testis: Early Outcome of a Prospective Randomized Controlled Study

PURPOSE: We prospectively evaluated the surgical outcomes of single scrotal incision orchiopexy in children with a palpable undescended testis compared with the traditional two incision orchiopexy. MATERIALS AND METHODS: A total of 398 orchiopexies (292 children) were included and randomly assigned to the single scrotal incision orchiopexy group (Group I, 147 children, 201 testes) or the traditional inguinal incision orchiopexy group (Group II, 145 children, 197 testes). The final number of patients enrolled (excluding those lost to follow-up) was 107 children (146 testes) in group I and 105 children (141 testes) in group II. Success was defined as no complications, postoperative intrascrotal location of the testis, and no conversion to the traditional inguinal approach. Surgical outcomes and complications were compared between the two groups. Testicular location, complications, and subjective satisfaction rate were assessed at the follow-up evaluation at least 12 months postoperatively. RESULTS: The overall success rate in group I was 92.5% in 135 of 146 testes; the remaining 9 testes required conversion to traditional two incision orchiopexy. In group II, orchiopexy was successful in 136 of 141 testes (96.5%). The operation time and hospital stay were significantly shorter in group I (40.5+/-25.9 minutes, 2.1+/-0.8 days) than in group II (62.3+/-35.6 minutes, 2.5+/-0.7 days), respectively (p<0.001, p=0.03). Postoperative complications were found in two cases (hematoma, wound dehiscence) in group I and in one case (wound dehiscence) in group II; all cases with complications recovered with conservative care. The subjective rate of satisfaction with the cosmetic result was 96.6% in group I and 96.5% in group II (p=0.97). CONCLUSIONS: We conclude that single scrotal incision orchiopexy is a simple technique that is associated with a shorter operation time and hospital stay than the traditional method and that is more feasible cosmetically.

Comparison of Ketoconazole and Estramustine for Treating Patients with Castration-Resistant Prostate Cancer

PURPOSE: We investigated the efficacy of ketoconazole and estramustine before chemotherapy for treating patients with progressive castration-resistant prostate cancer (CRPC) after anti-androgen withdrawal syndrome. MATERIALS AND METHODS: Eighty-four patients who were diagnosed with CRPC and were treated between 2005 and 2009 were included. Thirty-nine patients were treated with 600 mg of ketoconazole and 10 mg of prednisolone per day (group I), and 45 patients were treated with 560 mg of estramustine per day (group II). The prostate-specific antigen (PSA) response, progression-free survival, and side effects were compared. RESULTS: The median age of the patients, PSA level, and follow-up period were 72 years, 48.5 ng/ml, and 4 months (range, 1 to 29 months), respectively. The overall PSA response rate was 35.7%, and the PSA response rates were 33.3% for group I and 37.8% for group II (p=0.672). The median progression-free survival times were 8 months (95% confidence interval [CI] 5.9-10.1) overall, 5 months (95% CI 1.6-8.3) in group I, and 8 months (95% CI 5.9-10.0) in group II (p=0.282). The most common complications in groups I and II were nausea and vomiting (51.3%) and anemia (77.8%), respectively. Nausea and vomiting and hepatotoxicity were observed more often in group I, and gynecomastia, neutropenia, and anemia were observed more often in group II. The toxicities of each adverse effect were < or =grade 2. CONCLUSIONS: With a resultant PSA decline and mild adverse effects, both ketoconazole and estramustine are worth consideration as treatment options for progressive CRPC patients after primary hormonal therapy.

Prostate Cancer with Solitary Metastases to the Bilateral Testis

We present the case of an 81-year-old patient with testicular metastasis from prostate carcinoma. After the initial diagnosis of prostate cancer, he had an 8-year course of hormonal therapy and showed no clinical evidence of metastasis to other organs. Asymptomatic metastasis of prostate carcinoma to the testis is a rare clinical condition. We diagnosed his condition, based on histopathology following a subcapsular orchiectomy and transurethral resection of the prostate.

Multiple, Bilateral Fibroepithelial Polyps Causing Acute Renal Failure in a Gastric Cancer Patient

We report a case of primary fibroepithelial polyps (FEPs) in the middle of both ureters in a patient with advanced gastric cancer and acute renal failure. Ureteral FEPs are rare benign lesions, and multiple, bilateral lesions are extremely rare. To our knowledge, this report is the seventh case of bilateral FEPs in the literature. Our case has clinical implications because FEPs should be considered as a cause of ureteral obstruction inducing acute renal failure in advanced gastric cancer.

The Expression of AQP1 and eNOS in Menopausal Rat Urinary Bladder / 대한배뇨장애요실금학회지

PURPOSE: Aquaporins (AQPs) have been reported to be expressed in rat and human urothelium. Nitric oxide (NO) is thought to play an important role in the bladder overactivity related to menopause. The purpose of this study was to investigate the effect of hormonal alteration on the expression of AQP1 and eNOS in menopausal rat urinary bladder. MATERIALS AND METHODS: Female Sprague-Dawley rats (230-240 g, N=30) were divided into three groups: control (N=10), bilateral ovariectomy (Ovx, N=10), and bilateral ovariectomy followed by subcutaneous injections of 17beta-estradiol (50 mg/kg/day, Ovx+Est, N=10). After 4 weeks, urodynamic studies measuring the contraction interval and contraction pressure were done. The expression and cellular localization of AQP1 and eNOS were determined by performing Western blotting and immunohistochemistry on the rat urinary bladder. RESULTS: The approximate contraction interval (min) was significantly decreased in the Ovx group (3.9+/-0.25) compared to the control group (6.7+/-0.15), and was increased after estrogen treatment (9.7+/-0.22) (p<0.05). The AQP1 and eNOS immunoreactivities were localized in the same areas: capillaries, arterioles, and venules of the lamina propria. The protein expression of AQP1 was not changed significantly, whereas eNOS expression was significantly decreased in the Ovx group and restored to the control value in the Ovx+Est group. CONCLUSIONS: This study showed that ovariectomy causes a significant change in e-NOS expression without a change in AQP1 in menopausal rat urinary bladder. This may imply that e-NOS has a functional role in the bladder overactivity that occurs in association with menopause.

Age Related Change of Nocturia in Women / 대한배뇨장애요실금학회지

PURPOSE: The precise etiology and classification of nocturia in women is not enough. We evaluated age related changes and classified the type of nocturia by age in women. METHODS: We included 118 women 20 years or older with nocturia at least one time during night time. Subjects were divided into three groups by the age: group 1, under 40 years; group 2, 40 through 59 years; group 3, 60 years and above. The causes of nocturia and its pattern changed by age in women were evaluated using 3 days frequency volume chart. Nocturia was devided into three types: nocturnal polyuria, decreased nocturnal bladder capacity and mixed type. RESULTS: The mean age was 57.2+/-11.8 and the mean nocturnal frequency was 2.7+/-1.8. In all age group, noctural polyuria was the major cause for noturia (40.8%), followed by low nocturnal bladder capacity (23.7%). As a major cause of nocturia, there was a significant increase of the incidence of nocturnal polyuria in aged people: group 1, 32.4%; group 2, 41.0%; group 3: 47.6% (P<0.04). CONCLUSIONS: Nocturnal polyuria and decreased nocturnal bladder capacity are the major causes of nocturia in women. Nocturnal polyuria was the major cause of nocturia with age over 60 years old. In aged women, nocturnal polyuria should be considered as a main cuase of nocturia and treated based on these result.

Delayed Diagnosis of an Intraurethral Foreign Body Causing Urosepsis and Penile Necrosis

Cases of self-inserted foreign bodies in the male urethra and urinary bladder are unusual. In most cases, the type of foreign body can be identified by taking a history or from radiological findings; sometimes, however, it is difficult to identify the foreign body because of decreased mental capacity of the patient or unknown radiological characteristics of the foreign body. We experienced a chronic alcoholic patient with septicemia and penile necrosis in whom a fragment of mirror glass had passed through the urethra into the bladder. The glass, 2 cm in length and 0.7 cm in diameter, was detected by cystoscopy and was removed by using a resectosope.

Inflammatory Myofibroblastic Tumor of the Kidney Misdiagnosed as Renal Cell Carcinoma

The inflammatory myofibroblastic tumor (IMT), also knowns as inflammatory pseuduotumor, is a soft tissue lesion of unknown etiology. In the urogenital tract, IMT mainly affects the urinary bladder or prostate, but rarely the kidney. It has been considered as a nonneoplastic reactive inflammatory lesion, but nowadays, it is regarded as a neoplasm due to its high recurrence rate and metastasis. We describe a case of a 61-yr-old woman that had originally been misdiagnosed as renal cell carcinoma, which was pathologically revealed to be an IMT.

Is a Decreased Serum Testosterone Level a Risk Factor for Prostate Cancer? A Cohort Study of Korean Men

PURPOSE: To investigate patients who had transrectal ultrasonography (TRUS)-guided prostate biopsy to define the role of the serum testosterone level in predicting prostate cancer risk and its association with a high Gleason score. MATERIALS AND METHODS: A total of 568 patients who underwent prostate biopsy were entered in this study. We divided the patients into two groups according to serum testosterone level (median level, 3.85 ng/ml): the high-testosterone group (n=285) and the low-testosterone group (n=283). Multivariate regression analysis was used to define the effect of age, prostate volume, serum prostate-specific antigen (PSA) level and PSA density, and serum testosterone level on the risk of prostate cancer and a high Gleason score. RESULTS: Baseline characteristics did not differ significantly between the two groups. Compared with the high-testosterone group, the low-testosterone group had a significantly higher prostate cancer incidence (38.9% vs. 29.5%, p=0.018). Factors associated with an increased risk of prostate cancer were increased age (odds ratio [OR]=1.08, 95% confidence interval [CI]=1.25-3.16, p=0.001), a high serum PSA level (OR=3.35, 95% CI=2.63-4.25, p=0.001), a low prostate volume (OR=0.183, 95% CI=0.11-0.30, p=0.001), and a low serum testosterone level (OR=1.99, 95% CI=1.25-3.16, p=0.001). Among these, only the serum PSA level was a strong predictor of high-grade prostate cancer (Gleason score > or =7) (OR=2.19, 95% CI=1.57-2.95, p=0.001). CONCLUSIONS: Patients with lower levels of serum testosterone had a higher risk of prostate cancer than did patients with high serum testosterone. Even though a lower serum testosterone level was a predictor of prostate cancer risk, it was not associated with an increased risk of high-grade prostate cancer.

Changes in Aquaporin 1 Expression in Rat Urinary Bladder after Partial Bladder Outlet Obstruction: Preliminary Report

PURPOSE: Aquaporins (AQPs) are membrane proteins that facilitate water movement across biological membranes. AQPs are also called water channels, and they have recently been reported to be expressed in rat and human urothelium. The purposes of this study were to investigate the effect of bladder outlet obstruction (BOO) on the rat urothelium and AQP1 expression in rat urothelium. MATERIALS AND METHODS: Female Sprague-Dawley rats (230-240 g each, n=20) were divided into 2 groups: the sham group (the Con group, n=10) and the partial BOO group (the BOO group, n=10). The BOO group underwent a partial BOO. The expression and cellular localization of AQP1 were determined by performing Western blotting and immunohistochemistry on the rat urinary bladder. RESULTS: AQP1 immunoreactivity in both the control and the BOO groups was localized in the capillaries, arterioles, and venules of the lamina propria of the urinary bladder. The protein expression of AQP1 was significantly increased in the BOO group. CONCLUSIONS: This study showed that BOO causes a significant increase in the expression of AQP1. This may imply that AQP1 has a functional role in the detrusor instability that occurs in association with BOO.

Retrovesical Multilocular Prostatic Cystadenoma Mimicking a Pelvic Cavity Tumor

We report the case of a 58-year-old man with a multilocular prostatic cystadenoma in the retrovesical space that mimicked a pelvic cavity tumor. Multilocular prostatic cystadenoma is a rare form of benign prostatic hyperplasia that originates from the prostate with extensive spread into the pelvis. Histologically, the tumor consisted of glands and cysts lined by prostatic-type epithelium lying in a hypocellular fibrous stroma. For a cystic tumor adjacent to the urinary tract, ectopic prostatic cystadenoma is needed to be considered in the differential diagnosis of pelvic cavity tumors.

Effect of Tamsulosin HCl (0.2 mg) on Female Lower Urinary Tract Symptoms with Maximal Urinary Flow Rate Less Than 12 ml/sec

PURPOSE: Alpha adrenergic components do not seem prevalent in the female bladder neck. Nevertheless, some studies using alpha-blockers in women suffering from obstructed urine flow have been reported. We assessed the effectiveness of administering an alpha 1-adrenoceptor antagonist, tamsulosin, in patients with a maximal flow rate less than 12 ml/sec. MATERIALS AND METHODS: From January 2007 to December 2007, 150 patients with a maximal flow rate less than 12 ml/sec were selected for this study. Patients were treated with tamsulosin at a dose of 0.2 mg per day. The effectiveness of tamsulosin was assessed by analyzing the International Prostate Symptom Score (IPSS) and other parameters, including the maximal urinary flow rate (Qmax) and the amount of postvoid residual urine. The data for these parameters were acquired at baseline and after 4 and 12 weeks of treatment. RESULTS: Of the 150 patients, 113 patients (75.3%) completed the study. Except for the storage symptom score, all clinical parameters, including total IPSS, voiding symptom score, Qmax, and the amount of residual urine, showed significant improvement after 4 and 12 weeks of treatment (p<0.05). The incidence of adverse events was only 4.4%, including dizziness in 3 patients, stress incontinence in 1 patient, and lethargy in 1 patient. CONCLUSIONS: The alpha-1 adrenoceptor antagonist tamsulosin significantly improved subjective symptoms and uroflowmetric parameters in female patients with a low maximal flow rate of less than 12 ml/sec. The use of tamsulosin may be an initial treatment option in females with a low maximal urinary flow rate.

Spontaneous Intraperitoneal Rupture of the Urinary Bladder after Radiotherapy for Cervical Cancer

Spontaneous intraperitoneal bladder rupture is a rare complication of radiation therapy. We report an unusual case of spontaneous intraperitoneal bladder rupture 17 years after pelvic radiotherapy for carcinoma of the cervix in a 59-year-old woman who underwent prompt surgical repair.