A Case of Testicular Infarct Caused by Cord Compression of Retroperitoneal Liposarcoma Herniating into Inguinal Canal / 대한비뇨기과학회지

A 40-year-old man attended our hospital with presenting symptoms of an acutely swollen, tender testicle and bulging mass on the inguinal area. Considered it as urgent conditions no demonstrating blood flow to the involved testicle on Color Doppler ultrasonography, we underwent scrotal exploration right away. On operative finding the right testis was so enlarged and engorged secondarily to the irreversible ischemic damage, but torsion of spermatic cord was not found. Another inguinal approach revealed herniated mass protruding from internal inguinal ring and compressing the spermatic cord. For further evaluation abdominal ultrasonography and CT scan was done and huge mass occupying right lower quadrant of abdomen and pelvic cavity was noted. The resected tumor through surgical exploration was proved to be a retroperitoneal liposarcoma pathologically. Herein we report an uncommon case of testicular infarct, mimicking torsion of spermatic cord that is a urological emergency, caused by herniated retroperitoneal mass. So the present report suggest that, when adult men attend with symptoms of acutely swollen painful testicle, we pay a more careful attention to patient,s physical findings and recommend further diagnostic evaluation.

Comparison of Microvessel Densities (MVD) between Needle Biopsies and Prostatectomy Specimens in the Patients with Prostate Carcinoma / 대한비뇨기과학회지

PURPOSE: We compared neovascularity with needle biopsies and definitive prostatectomy specimens to examine whether the measurement of microvessel density(MVD) has an ability to predict extracapsular extension with limited tissue sample. MATERIALS AND METHODS: We evaluated total 11 pathologically proven stage T3 lesions. The paraffin embedded tissues from needle biopsies and definitive prostatectomy specimens were sectioned serially. Of the serial sections obtained from prostatectomy specimens 2 showing a relatively uniform histology grade; one identical grade with biopsy sample, another the worst grade within the tumor or different grade from biopsy, and 2 from specific sites of the tumor; center and periphery, selected for examination. MVD determinations were performed immunohistochemically using monoclonal antibodies directed at the CD34 antigens. RESULTS: MVD of total 11 needle biopsies with grade 2-5 (score 4-8) ranged from 73.7 to 170.8 (median 106.7 +/- 10.6). The grade (score 5-9) distributions of prostatectomy specimens were different from those of needle biopsies and the MVD obtained from definitive prostatectomy specimens exhibited a heterogeneity within the individual tumor. The variation in densities between different grade group proved statistically different (p< 0.01, paired t-test). Also, the MVD count in the center of the tumor was higher than that in the periphery of the tumor and the difference between two group of the specific sites was statistically significant (p = 0.015, paired t-test). Finally, although MVD of biopsy sample did not correlated exclusively to that of definitive prostatectomy specimen, there would be a significant correlation of MVD between two groups if their distribution of histological grade were identical (p< 0.01, r2 = 0.889). CONCLUSIONS: Prior to surgical extirpation in the patients of clinically localized prostatic carcinomas, MVD determination of needle biopsies of the prostate would not correlate with that of definitive prostatectomy specimen. Given the limited tissue sampling from a biopsy, understanding of the site specificity of vasculature and analyzing the relationship of angiogenesis and other biologic factors of which histologic grade seems to be involved most importantly, are critical to developing a consistent and effective methodology of microvessel quantification.

Neural Factors Controlling Urethral Outlet Activity in vivo: Role of Nitric Oxide and beta-Adrenergic System in Urethral Relaxation / 대한비뇨기과학회지

AIMS OF STUDY: During reflex micturition, the urethral outlet remains open (relaxed) to promote urinary emptying. The mechanisms involved in the relaxation of urethral outlet is thought to be complex including nitric oxide (NO) pathway and beta-adrenergic activity. The aims of the study focused on these several issues related to the neural control of urethral outlet in vivo. MATERIALS & METHODS: Female rats weighing 200~300 gm were anesthetized wish urethane. Catheters were inserted into femoral artery for drug administration.4 two-way catheter (16 G angiocath) was inserted into the bladder for saline infusion and pressure monitoring. A separate cannula (PE 50) was placed into the urethra via external urethral meatus or proximal urethrat opening to record urethral pressure. The bladder was filled with saline at a rate of 0.1 ml/min to induce reflex micturition. Urethral pressure was recorded via cannula through which saline was infused at a rate of 0.05 ml/min. Isovolumetric bladder contraction and urethral pressure were recorded simultaneously. After an equilibration period of 30 minutes, baseline intravesical and urethral pressure were recorded for 10 minutes prior to drug administration. NG-nitro-L-arginine methylester (L-NAME, 10 to 15 mg/kilrogram, i.v.), L-arginine (150 mg/kilrogram, i.v.), propranolol (1 microM., 0.1 ml/250 mg, i.a.), and phenylephrine (1 0~100 microM, i.a.) were administrated. RESULTS: During isovolumetric bladder contraction, urethral pressure was decreased simultaneously, and then returned to the resting states in conjunction with end of the bladder contraction. After the administration of L-NAME, the magnitude of reflex urethral relaxation was decreased significantly (42.6 +/- 15.1% of the control, p<0.01), and this effect was reversed by addition of L-arginine. Administration of propranolol also inhibited urethral relaxation (66.4% of the control). Administration of L-NAME followed by propranolol almost completely abolished the urethral relaxation. Administration of phenylephrine increased the resting urethral tone (mean; 4 cmH2O) significantly, and the magnitude of urethral relaxation was decreased substantially. CONCLUSION: These RESULTS suggest that urethral relaxation is mediated by several neural factors. NO seems like to a potent mediator in a reflex relaxation of the urethral smooth muscle during micturition. Also, beta-adrenergic stimulation play an important role for urethral relaxation. alpha-adrenergic nerve discharge, contributed to contraction of urethral smooth muscle, shows inhibitory effect against the reflex urethral relaxation.