Metastatic Squamous Cell Carcinoma of the Kidney from Cholangiocarcinoma

We present a rare case of a metastatic renal tumor originating from adenosquamous carcinoma of the intrahepatic bile duct. A 64-year-old man treated with bisegmentectomy and extended cholecystectomy for cholangiocarcinoma had a left cystic renal mass, which had irregular wall thickening, heterogeneously low attenuation, and soft tissue infiltration as determined by a computed tomography scan. The first impression was renal abscess. Left nephrectomy was performed and the nonencapsulated mass was gray in color macroscopically. Histological examination of the specimen revealed alveolar proliferation of small cancer cells, which was consistent with the original tumor of the intrahepatic bile duct. The left renal tumor was misdiagnosed as a renal abscess but finally diagnosed as squamous cell carcinoma metastasized from the intrahepatic bile duct. The patient expired because of lung metastasis after 14 months following left nephrectomy. In our opinion, this case would be the first report of a renal metastasis from a cholangiocarcinoma clinically and was treated with nephrectomy.

Effects of Combination Treatment of Intravesical Resiniferatoxin Instillation and Hydrodistention in Patients with Refractory Painful Bladder Syndrome/Interstitial Cystitis: A Pilot Study / 대한배뇨장애요실금학회지

PURPOSE: Painful bladder syndrome/interstitial cystitis (PBS/IC) is a disabling disease of the urinary bladder, and its etiology and treatment are not yet established. Current medications used in the treatment of PBS/IC have shown limited efficacy. This prospective study investigated the efficacy of intravesical resiniferatoxin (RTX) in PBS/IC refractory to medical treatment. METHODS: Patients with proven PBS/IC refractory to traditional medical treatment were enrolled. By randomized trial, a total of 18 consecutive patients were divided into two groups: treatment with hydrodistention and intravesical RTX (group 1) or treatment with hydrodistension only (group 2). We assessed bladder pain by use of a visual analogue pain scale, the maximal urine flow rate, post-void residual urine volume, and a voiding diary before and 3 months after treatment. RESULTS: The median age of the 18 patients was 55.8+/-6.9 years, and the median duration of symptoms before diagnosis was 3.6+/-1.6 years. Frequency, functional bladder capacity, and score on a 5-point pain scale were significantly improved at 3-month after treatment in both groups. Intravesical RTX instillation plus hydrodistention, compared with hydrodistention only, did not have a significant effect on the voiding symptoms or uroflowmetry of the patients but significantly improved scores on the pain scale. CONCLUSIONS: Intravesical RTX instillation plus hydrodistention was effective in relieving pain but was not effective in improving lower urinary tract symptoms. Further larger studies are needed to clarify the efficacy of combination treatment of intravesical RTX instillation and hydrodistention.

Clinical Features of Mumps Orchitis in Vaccinated Postpubertal Males: A Single-Center Series of 62 Patients

PURPOSE: Although the measles-mumps-rubella vaccination covers most children against mumps in Korea, the development of mumps has been reported. However, the clinical manifestations of mumps orchitis in postpubertal vaccinated patients have never been investigated. Herein we report the clinical features of mumps orchitis in postpubertal vaccinated patients. MATERIALS AND METHODS: This study included a total of 62 postpubertal males who developed acute mumps orchitis from 2005 to 2010. The clinical manifestations such as the incubation period, febrile duration, and the mean duration of orchitis were retrospectively investigated. The laboratory and sonographic findings were also reviewed and compared with the features of previously reported cases of unvaccinated postpubertal mumps orchitis. RESULTS: The mean age of the 62 patients was 17.56 years (range, 15 to 29 years). All patients were serologically confirmed with acute mumps infection (positive immunoglobulin [Ig] M and negative or positive IgG). The mean incubation period was 5.39 days (range, 0 to 23 days), with a febrile duration of 1.8 days (range, 0.5 to 3 days), and a mean duration of orchitis of 4.96 days (range, 0 to 17 days). Sonography revealed unilateral orchitis in 58 patients (93.6%) and bilateral orchitis in only 6 (6.4%). CONCLUSIONS: In our study, mumps orchitis in postpubertal vaccinated patients showed a relatively shorter febrile duration. In addition, less scrotal swelling and a lower incidence of bilaterality were found upon physical examination and ultrasonography. In the future, additional long-term follow-up is needed to determine the features of mumps orchitis in postpubertal vaccinated males, and an additional booster vaccination should be considered.

Correlation between Serum Total Testosterone and the AMS and IIEF Questionnaires in Patients with Erectile Dysfunction with Testosterone Deficiency Syndrome

PURPOSE: This study was conducted to investigate the relationship between serum total testosterone levels and scores on the Aging Male's Symptom (AMS) scale and the International Index of Erectile Function (IIEF) in men with erectile dysfunction with testosterone deficiency syndrome (TDS). MATERIALS AND METHODS: From January 2005 to July 2008, 134 patients who complained of sexual dysfunction such as erectile dysfunction or decreased libido as the main symptoms of TDS with serum total testosterone levels less than 3.5 ng/ml were evaluated by independent t-test and linear regression analysis, respectively. Patients with treated hypogonadism within 6 months, with a history of taking a PDE5 inhibitor or an antidepressant for a depressive disorder, or who had metabolic syndrome were excluded from this study. RESULTS: The AMS scale and its 3 subdomain scores were not significantly correlated with the total testosterone level. By contrast, the total IIEF score and the score of each IIEF domain except sexual desire showed a weakly significantly positive correlation with serum total testosterone. CONCLUSIONS: In TDS patients with erectile dysfunction, there was a low relationship between serum total testosterone levels and the AMS scale and a weakly positive correlation between total testosterone levels and all IIEF domains except sexual desire. There was a low relationship between the AMS scale, the sexual desire domain score of the IIEF, and total testosterone. We should understand these limitations when evaluating patients with erectile dysfunction with TDS. New scales should be developed for the evaluation of erectile dysfunction in these patients.

Effect of Testosterone Replacement Treatment in Testosterone Deficiency Syndrome Patients with Metabolic Syndrome

PURPOSE: This study was conducted to investigate the effect of testosterone replacement treatment (TRT) in testosterone deficiency syndrome (TDS) patients with metabolic syndrome. MATERIALS AND METHODS: We reviewed the data of 200 men who were diagnosed with TDS and were undergoing TRT between August 2006 and August 2009. The 200 patients were divided into two groups (group 1: 71 patients with metabolic syndrome, group 2: 129 patients without metabolic syndrome) depending on metabolic syndrome, which was diagnosed according to the NCEP III criteria for Asians. Age, BMI (body mass index), waist circumference, serologic tests, AMS (the Aging Males' Symptoms scale), and IIEF (International Index of Erectile Function) were measured. RESULTS: In group 1, waist circumference and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the somatovegetative scale score of the AMS, the total AMS score, the erectile function score of the IIEF, the overall satisfaction score of the IIEF, and the total IIEF score were significantly improved after TRT. On the other hand, in group 2, waist circumference, BMI, total cholesterol, LDL, and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the 2 subscale scores of the AMS (psychologic and somatovegetative), the total AMS score, all subscale scores of the IIEF, and the total IIEF score were significantly improved after TRT. CONCLUSIONS: Overall, the patients who had TDS with metabolic syndrome showed less improvement in AMS, IIEF, and serum variables. Therefore, the correction of metabolic syndrome, such as diabetes, obesity, and hypertension, should be considered during TRT.

Effect of Testosterone Replacement Treatment in Testosterone Deficiency Syndrome Patients with Metabolic Syndrome

PURPOSE: This study was conducted to investigate the effect of testosterone replacement treatment (TRT) in testosterone deficiency syndrome (TDS) patients with metabolic syndrome. MATERIALS AND METHODS: We reviewed the data of 200 men who were diagnosed with TDS and were undergoing TRT between August 2006 and August 2009. The 200 patients were divided into two groups (group 1: 71 patients with metabolic syndrome, group 2: 129 patients without metabolic syndrome) depending on metabolic syndrome, which was diagnosed according to the NCEP III criteria for Asians. Age, BMI (body mass index), waist circumference, serologic tests, AMS (the Aging Males' Symptoms scale), and IIEF (International Index of Erectile Function) were measured. RESULTS: In group 1, waist circumference and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the somatovegetative scale score of the AMS, the total AMS score, the erectile function score of the IIEF, the overall satisfaction score of the IIEF, and the total IIEF score were significantly improved after TRT. On the other hand, in group 2, waist circumference, BMI, total cholesterol, LDL, and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the 2 subscale scores of the AMS (psychologic and somatovegetative), the total AMS score, all subscale scores of the IIEF, and the total IIEF score were significantly improved after TRT. CONCLUSIONS: Overall, the patients who had TDS with metabolic syndrome showed less improvement in AMS, IIEF, and serum variables. Therefore, the correction of metabolic syndrome, such as diabetes, obesity, and hypertension, should be considered during TRT.

Effect of PDE5 Inhibitor in Nonsurgical Management of Peyronie's Disease: Preliminary Study / 대한남성과학회지

PURPOSE: This study was designed to evaluate the role of PDE5 inhibitors as combination therapy with conventional treatment of Peyronie's disease (PD). MATERIALS AND METHODS: From July 2007 to October 2010, 35 Patients were divided into two groups. Group I (N=14) received PDE5 inhibitors in addition to conventional treatment with tamoxifen and acetyl L-carnitine, while group II (N=21) received only conventional treatment. The follow-up duration was at least 12 weeks after the active therapy of PD. Outcomes were assessed by pain relief, successful attempts for sexual intercourse, resolution of the plaque and any occurring complications. RESULTS: In the efficacy of overall treatment of 35 patients, 94.3% patients experienced successful sexual intercourse, while 5.7% experienced pain on erection, and 25.7% showed a decrease in plaque size. The analysis of parameters before treatment showed no significant difference between groups in terms of successful attempt at sexual intercourse (p=0.583) and pain on erection (p=0.445). Furthermore, there was no difference between groups after treatment in terms of successful attempts at sexual intercourse (p=0.766), pain on erection (p=0.766) and change in plaque size (p=0.445). However, successful intercourse and pain relief after treatment showed significant change irrespective of groups (p<0.05). While the addition of a PDE5 inhibitor did not show any significant improvement in clinical outcome measures, the satisfaction of patient was higher in patients who received combination treatment (p=0.042). CONCLUSIONS: Although the effect of PDE5 inhibitor for pain relief, successful intercourse and resolution of plaque size was not significant, patients who received PDE5 inhibitors had a more satisfaction of treatment of PD. Further prospective studies on the effect of PDE5 inhibitor in PD will be needed.

Effect of Potassium Aminobezoate in Oral Therapy for Peyronie's Disease: Preliminary Study / 대한남성과학회지

PURPOSE: To evaluate the effect and improvement of potassium aminobenzoate (500 mg Peyron capsule) in oral therapy for Peyronie's disease. MATERIALS AND METHODS: From February 2011 to September 2011, 31 patients with Peyronie's disease received potassium aminobezoate (500 mg Peyron capsules) and were divided into two groups. Group 1 (N=10) received potassium aminobezoate (500 mg Peyron capsule) 3 g four times daily without previous treatment of Peyronie's disease, while group 2 (N=21) received the same drug with previous treatment of Peyronie's disease (10 mg Tamoxifen +300 mg L-carnitine two times daily). Outcomes were assessed by subjective symptom change, pain relief, resolutions of the plaque, and curvature. RESULTS: After 3 months, there were no significant improvements in clinical outcomes of either group and among all the patients, 23 stopped taking potassium aminobezoate (23/31, 74%). The reasons for ceasing the therapy were gastrointestinal trouble (8/23, 35%), too many doses to take (7/23, 30%), ineffectiveness (6/23, 26%), and high price (2/23, 9%). CONCLUSIONS: Athough the etiology of Peyronie's disease has not been elucidated, potassium aminobenzoate in therapy of Peyronie's disease has been used. The use of this medication has the limitations of gastrointestinal trouble, ineffectiveness, too many doses, and high price. Further evaluations of the effect and appropriate dosing of potassium aminobenzoate are needed.

The Impact of Renal Tumor Size on the Efficacy of Laparoscopic Renal Cryoablation

PURPOSE: We evaluated the impact of renal tumor size on the oncologic and surgical efficacy of laparoscopic renal cryosurgery (LRC) according to our intermediate-term experience in Korea. MATERIALS AND METHODS: From June 2005 to October 2008, we enrolled 37 patients who underwent LRC for 40 renal tumors. Patients were stratified into four groups according to renal tumor size. Patients who presented with a maximum tumor diameter (MTD) of at least 1 cm but less than 2 cm were assigned to Group 1, those with an MTD equal to or greater than 2 but less than 3 cm were assigned to Group 2, those with an MTD equal to or greater than 3 but less than 4 cm were assigned to Group 3, and those with an MTD equal to or greater than 4 cm were assigned to Group 4. Oncologic and clinical outcomes in each group were compared. RESULTS: The four groups showed no statistically significant differences in preoperative variables, including age, sex, body mass index, American Society of Anesthesiologists scores, baseline renal function and hemoglobin, and length of hospital stay. Regarding surgical aspects, however, operation time, estimated blood loss, and postoperative complications were significantly increased in patients with larger tumors. Three patients in Group 3 required postoperative transfusions, and 1 patient in Group 4 required conversion to open renal cryosurgery. During the mean follow-up period of 31.6 months, radiologic evidence of tumor recurrence was found in only 2 patients in Group 4. CONCLUSIONS: In this series, LRC for renal tumors smaller than 3 cm was conducted safely without radiologic evidence of tumor recurrence during intermediate-term follow-up. For tumors larger than 3 cm, however, the transfusion rate increased, and for renal tumors larger than 4 cm, the tumor recurrence rate increased significantly.

A Comparison of Outcomes between Transurethral Resection of the Prostate and High Power Potassium-titanyl-phosphate Laser Vaporization of the Prostate / 대한남성과학회지

PURPOSE: Transurethral resection of the prostate (TURP) is the gold standard for the surgical treatment for benign prostatic hyperplasia (BPH), but the procedure's limitations are its invasiveness and the high prevalence of complications. Photoselective vaporization of the prostate (PVP) using an 80w high power potassium-titanyl-phosphate (KTP) laser has recently been developed as a less invasive treatment. We assessed the efficacy of PVP as an alternative to TURP for the treatment of BPH. MATERIALS AND METHODS: The medical records of 324 patients who were surgically treated for BPH from July 2005 to December 2007 were retrospectively reviewed. Among the 324 patients, 190 patients of Group I were treated by TURP and 134 patients of Group II were treated by PVP. Before treatment, assessing the serum PSA level transrectal ultrasound and urodynamic study were done. The primary efficacy parameters were the postoperative international prostatic symptom score and the uroflow parametersat 6 months after the operation. The secondary efficacy parameters were perioperative factors such as the duration of the hospital stay, the operative time and the catheter-indwelling period. Any adverse reactions were monitored. RESULTS: There was no significant difference in the basal characteristics of the study subjects between both the groups. The primary efficacy parameters, the IPSS, the Qmax and thepostvoid residual urine volume were significantly improved in both groups, but there were no significant differences between both the groups. In group II, the perioperative parameters such as the operation time, the hospitalization day and the catheter-indwelling periodwere significantly shorter than those of group I (p<0.05). But the urethral complications such as urethral stricture, dysuria and bladder neck contracture were more common in group II. CONCLUSIONS: These results suggest that PVP using an 80w high power KTP could be an alternative for TURP in terms of efficacy. For the general, safe use of PVP, PVP should be carefully done until the causes of the urethral complications of PVP are determined.