The Anti-inflammatory Effect of Cobalt-Protoporphyrin for Rats with Epididymitis Induced by Escherichia coli Infection / 대한비뇨기과학회지

PURPOSE: Heme oxygenase-1 (HO-1), an inducible heat shock protein, catalyzes the heme to iron, biliverdin and carbon monoxide. It also has an inhibitory effect on necrosis and inflammation. Cobalt (III)-protoporphyrin IX (CoPP) is known to be a HO-1 inducer. Our intension was to find whether CoPP has an anti-inflammatory effect through the induction of HO-1 in rats with epididymitis. MATERIALS AND METHODS: Thirty two Sprague-Dawley male rats (age: 8-12 weeks, weight: 200-250gm) were selected for the experiments. Anesthesia was performed with an intraperitoneal injection of ketamine hydrochloride (140mg/kg). Four rats were taken and used as a control group. Epididymitis was induced in 28 rats by an injection of E. coli (1 x 10(5)/ml) to the epididymis. In the first step, groups of 4 rats were sacrificed serially after 4, 12, 48, and 72 hours for Hematoxylin & Eosin (H&E) staining and Western blot for inducible nitric oxide synthase (iNOS) and cyclooxygenase (COX)-2. In the second step, groups of 4 rats were injected with either dimethyl sulphoxide (DMSO) 7 microliter, DMSO 7 microliter with 50mg/ml CoPP or DMSO 7 microliter with 100mg/ml CoPP. They were then sacrificed 72 hours later for H&E staining and Western blot for iNOS and COX-2. RESULTS: In the first step, increased inflammation was evident H&E staining over time. Western blots, iNOS expression was detected after 48 hours and COX-2 was after 12 hours. In the second step, decreased inflammation was evident H&E staining, and the expressions of iNOS and COX-2 were suppressed in the CoPP treated group. CONCLUSIONS: CoPP can reduce the inflammation of epididymis in rats, and the mechanism may be related with HO-1.

Long Term Follow-up Results of Laparoscopic Renal Cyst Marsupialization: Comparison with Alcohol Sclerotherapy / 대한비뇨기과학회지

PURPOSE: Although percutaneous aspiration and sclerotherapy is a simple, noninvasive and cost-effective therapy for symptomatic renal cysts, the recurrence rate is high. Recently, a laparoscopy has been attempted on symptomatic renal cysts. To assess the clinical efficacy and safety of the laparoscopic cyst marsupialization, the clinical characteristics and operative parameters were evaluated, and compared with the results of sclerotherapy. MATERIALS AND METHODS: Between November 1993 and February 2003, 71 patients with symptomatic simple renal cysts were treated with either laparoscopic marsupialization or sclerotherapy. Respectively, 26 of 31 laparoscopy patients and 27 of 40 sclerotherapy patients were followed-up over a 2 months period and included in this study. The laparoscopic marsupialization was accomplished with either transperitoneal (15 patients) or retroperitoneal approaches (11). The sclerotherapy was composed of percutaneous aspiration followed by an injection of 99% ethanol. RESULTS: The clinical characteristics, including cyst size, location and laterality, were no different in either group. The mean follow-up durations were 19.7 and 18.1 months in laparoscopy and sclerotherapy groups, respectively. Comparing the laparoscopy with the sclerotherapy group, the operation time (106.2 vs. 15.3 min.), hospital stay (7.8 vs. 4.6 days) and complication rate (23.1 vs. 3.7%) were significantly decreased in the sclerotherapy group. However, the success rate (96.2 vs. 77.8%) was significantly increased in the laparoscopy group. With either the transperitoneal or retroperitoneal approaches in the laparoscopy group, there was no statistical difference in the operative time, hospital stay and complication and success rates. CONCLUSIONS: For a symptomatic renal cyst, laparoscopic marsupialization is an effective therapy, with a high success rate on the long-term follow-up. The clinical results, according to the approach method, were not different for the transperitoneal and retroperitoneal approaches.

The Success Rate and Complications of the Primary Endoscopic Urethral Realignment within 3 Days in Male Urethral Injury / 대한비뇨기과학회지

PURPOSE: Attempts have been made to insert a urethral Foley catheter as a primary urethral realignment immediately after a urethral injury. There has been much debate about the time and method of the realignment. The feasibility and complications of early primary endoscopic realignment in a urethral injury were evaluated. MATERIALS AND METHODS: From November 1990 to May 2003, 63 patients with urethral injuries received early endoscopic realignment within 72hrs. The diagnosis was made by retrograde urethrography. Primary realignment was successfully performed for 61 patients; 52 (85.2%) had an anterior urethral injury and 9 (14.8%) a posterior urethral injury. All operations were performed under spinal anesthesia. A cystoscope was inserted through the dilated suprapubic cystotomy and a guide wire passed through the cystoscope, and caught by transurethral foreign body forceps just distal to the injured site. The urethral catheter was removed after pericatheter urethrography, usually on the 14th postoperative day. Patients were retrospectively reviewed for complications, including urethral stricture, urinary incontinence and erectile dysfunction. RESULTS: Of the 63 patients, 61 (96.8%) were successfully treated. The mean operation and catheter indwelling times were 71.8 minute (5-109) and 17.4 days (6-32), respectively. The mean follow-up duration was 423.2 days (94-1432). Urethral strictures were detected in 14 patients (23.0%), who were treated with an internal urethrotomy. Urinary incontinence in 5 patients (8.2%) and erectile dysfunction in 14 patients (23.0%) were the observed complications. CONCLUSIONS: Our results show that immediate endoscopic realignment is a less invasive and more feasible therapy for patients with a urethral injury.

Comparison of Tubulized Incised Plate and Other Procedures for Hypospadias / 대한비뇨기과학회지

PURPOSE: While numerous methods have been introduced to repair hypospadias, no single method is effective for repairing all hypospadias. We reviewed our experience of hypospadias repair to determine the best surgical method and the efficacy of the treatment modality. MATERIALS AND METHODS: We reviewed the hospital charts of 32 patients who had undergone hypospadias surgery from January 1993 to January 2002. Group 1 included patients who were operated on before 1998 and group 2 had those who had operations after 1998 with only the TIP(tubularized incised plate) method. The surgical procedures that were performed on the patients were onlay island flap(6), Mathieu(2), Hodgson's type III(2), Mustard(2), TIP(14), Transverse island flap(5), and Thiersch-Duplay(1). The mean operative time, mean hospital days, mean duration of catheter drainge, and complication rates of the two groups were compared. RESULTS: In group 2, operation time was reduced(142.9+/-69.4 versus 172.5+/-93.4 min)(p<0.05), but the two groups showed no significant differences in mean hospital days(11.9+/-2.8 days. versus 12.3+/-1.6 days) and mean duration of catheter drainge (9.8+/-24 versus 10.5+/-3.6 days). In group 1 and group 2, complication rates were 67% (12 of 18) and 14%(2 of 14), respectively(p<0.05). CONCLUSIONS: Our data show shorter operative time and lower complication rates using the TIP method for various types of hypospadias. Therefore, the TIP method seems to be a safe method of surgery for any type of hypospadias.

Malignant Sertoli Cell Tumor of Testis / 대한비뇨기과학회지

A testicular Sertoli cell tumor is a very rare, usually benign, testicular neoplasm. Of the total number of reported Sertoli cell tumors, only 30 cases were malignant. Usually, these patients have a history of a slowly growing scrotal mass and gynecomastia. These neoplasms vary greatly in size and in their microscopic appearances. A radical inguinal orchiectomy is the initial treatment, with the efficacy of chemotherapy or radiotherapy being controversial. They have an aggressive metastatic behavior and a poor prognosis. Herein, the case of 67-year-old man with a malignant Sertoli cell tumor is reported.

Pubovaginal Sling Operation Using Dermal Fat Graft in Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: An autologous dermal fat graft has several advantages, over other viable or synthetic sling materials, in expenditure, postoperative complication and biocompatibility of the host. We investigated the success rate and risk factors of a pubovaginal sling, using an autologous dermal fat graft, in female stress urinary incontinence. MATERIALS AND METHODS: We retrospectively analyzed the medical records of 30 women that underwent a pubovaginal sling, using a dermal fat graft. The preoperative evaluations included: age, Stamey grade, Blaivas type, urodynamic study and previous pelvic operation history. We observed the postoperative results using questionnaire research during the follow-up (cured: no urine leakage and satisfactory, improved: urine leak4 times/week or unsatisfactory). The risk factors affecting the postoperative outcomes and complications were also analyzed. RESULTS: The success rate was 90.0% (success rate was calculated by cured rate plus improved rate, cured rate: 53.3%, improved rate: 36.7%), with the follow-up periods ranging from 6 to 24 months. A wound infection, requiring hospitalization, developed in one patient, but no other significant complications related to dermal graft were noted. Within the preoperative evaluations, the Blaivas type and a previous pelvic operation history were statistically related to the success rate (p<0.05). CONCLUSIONS: The Blaivas type and previous pelvic operation history are meaningful factors for predicting the success rate. The use of a dermal fat graft might be beneficial in the treatment of stress urinary incontinence in terms of its cost and success rate. However, a lower abdominal scar, of more than 5cm in length, and postoperative infections remain in some patients. Therefore it might be necessary to find another useful material for to treat female stress urinary incontinence.