When should Videourodynamic Study be Performed after Correcting the Defect in Patients with Myelodysplasia? / 대한비뇨기과학회지

PURPOSE: Because vesicourethral dysfunction in myelodysplasia patients is a major cause of upper urinary deterioration and urinary incontinence, urodynamic evaluation should be performed as early as possible. We attempted to establish the proper time when videourodynamic study should be performed and which patients require early interventional therapy. MATERIALS AND METHODS: Out of the 222 patients seen in the pediatric urology department, 22 patients underwent correction of myeloplasia defect from January 2001 to September 2004. Preoperatively, the patients were assessed with videourodynamic study, and the postoperative videourodynamic studies were repeated at 2 to 6 months intervals. Four urodynamic parameters (bladder volume, compliance, detrusor activity and detrusor sphincteric synergy) were identified, graded and then added to obtain the urodynamic score. RESULTS: There was no statically significant difference in all urodynamic parameters between the preoperative and postoperative 2 month videourodynamic studies, but a statistically significant difference was noted in compliance between the preoperative and postoperative 6 month videourodynamic studies. The compliance was more decreased in the patients who had received surgical correction in their older age and high detrusor activity was observed for these patients on the preoperative videourodynamic study. CONCLUSIONS: Postoperative videourodynamic study and early treatment are recommended for the patients who are at high risk for upper urinary tract deterioration. However, for the low risk patients, postoperative 2 month videourodynamic study can prevent unnecessary treatment.

Intravesical Electrical Stimulation in Infrequent Voider Syndrome / 대한비뇨기과학회지

PURPOSE: Intravesical electrical stimulation (IVES) has been performed at the Severance Hospital for various purposes in children with voiding difficulty due to neurogenic or non-neurogenic causes. The effect of IVES in children with infrequent voider syndrome is controversial. The aim of this study was to investigate the effect of IVES in children with infrequent voider syndrome. MATERIALS AND METHODS: Between September 1999 and August 2001, 12 children diagnosed with infrequent voider syndrome, who received IVES at the Severance Hospital, were retrospectively analyzed. We investigated the changes in abdominal straining voiding, a voiding interval more than 8 hours, urgency and overflow incontinence after IVES. We also compared the uroflowmetry curve, maximal urine flow rate, maximal detrusor contraction pressure and residual urine volume after IVES. RESULTS: Abdominal straining voiding, a voiding interval more than 8 hours, urgency and overflow incontinence were decreased from 83.3 to 25.0%, 50.0 to 16.7%, 25.0 to 0% and 58.3 to 25.0%, respectively. After IVES, fractionated voiding and flat-shape voiding were decreased from 66.7 to 16.7% and 33.3 to 8.3%, respectively. Whereas, bell-shape voiding was increased from 0 to 75.0%. The maximal urine flow rate was increased significantly, from 5.6 3.7 to 11.2 4.2m/s (p=0.002), but the residual urine volume was decreased significantly, from 71.7 47.5 to 9.2 13.8ml (p=0.0001). The maximal detrusor contraction pressure was increased in some children. CONCLUSIONS: The maximal urine flow rate was significantly increased after IVES in children with infrequent voider syndrome, but the residual urine volume was decreased significantly. There was a significant treatment effect in flat-voiding children, leading to the conclusion that IVES can be particularly effective in this specific group of children with infrequent voider syndrome.

Distribution and Change of Total Astigmatism, Corneal Astigmatism and Residual Astigmatism with Age in Patient with Emmetropia

PURPOSE: We evaluated the distribution and change of total, corneal and residual astigmatism with age in patients with emmetropia. METHODS: We examined the visual acuity, refraction, and corneal curvature in 263 persons aged from 3 to 83 years (mean, 38 years), with a spherical equivalent refraction of under +/-0.75 diopter (D). We analysed the distribution and change of the astigmatism. RESULTS: Total astigmatism was changed from with-the-rule (WTR) to against-the-rule (ATR) with aging based on WTR of 0.31 +/- 0.48 D in the 3-10 year-old group, ATR of 0.02 +/-0.52 D in the 31-40 year-old group and ATR of 0.65 +/- 0.66 D in the 71-83 year-old group. Corneal astigmatism showed a similar pattern to that of total astigmatism with WTR of 1.03 +/- 0.47 D, WTR of 0.37 +/- 0.78 D, ATR of 0.05 +/- 0.59 D and ATR of 0.31 +/- 0.64 D in the 3-10, 31-40, 61-70 and 71-83 year-old groups, respectively. Residual astigmatism showed ATR astigmatism in all age groups such as ATR of 0.71 +/- 0.48 D, ATR of 0.60 +/- 0.44 D and ATR of 0.35 +/- 0.71 D in the 3-10, 41-50 and 71-83 year-old groups, respectively. CONCLUSIONS: Total and corneal astigmatism showed the change from WTR to ATR, and residual astigmatism showed the pattern of decreasing ATR with aging in patients with emmetropia. The change of total astigmatism with aging seems to be influenced by that of corneal astigmatism rather than by that of residual astigmatism.

Change of Neuropeptides of Bladder Afferents after Intravesical Electrical Stimulation in Spinalized Rat / 대한비뇨기과학회지

PURPOSE: The clinical benefits of intravesical electrical stimulation (IVES), in patients with increased residual urine or reduced bladder capacity, have been reported. However, studies on the underlying mechanism of IVES have been limited to the Adelta afferent in healthy rats. This study investigated the changes in the calcitonin gene- related peptide (CGRP) and substance P (SP) expressions, in the lumbosacral dorsal root ganglia (DRG) and the bladder of spinalized rats, to determine the effect of IVES on the C fiber afferent nerve. MATERIALS AND METHODS: Forty Sprague-Dawley rats were divided into normal controls (n=10); IVES treated normal rats (n=10); spinalized rats (n=10) and IVES treated spinalized rats (n=10). The IVES was performed for 2 weeks (5 days a week), 3 weeks after the spinalization in the spinalized animals. All animals had their DRG removed at the lumbosacral (L5-S1) level. Changes in the CGRP and SP, at the DRG and bladder, were measured by western-blot analysis. RESULTS: The relative density of the CGRP and SP following spinalization was significantly higher than those in the controls in both the DRG and the bladder. However, IVES in the spinalized rat significantly decreased the relative density of the SP, in both the DRG and the bladder, compared to the rats with spinalization alone. IVES in the spinalized rats significantly decreased the relative density of the CGRP, in the DRG only, compared to the rats with spinalization. CONCLUSIONS: IVES significantly reduced the CGRP and SP levels in the DRG of spinalized rats, but only the SP levels in the bladder. CGRP and SP are the main factors contributing to the hyper-excitability of the micturition reflex following spinal cord injury. These results suggest that the bladder C fiber afferents are also involved in modulating the micturition reflex with IVES.

What Causes Bladder Fibrosis?: Abnormal Innervation or Abnormal Bladder Dynamics / 대한비뇨기과학회지

PURPOSE: Bladder tissue fibrosis is characterized by the abnormal deposition of connective tissue within different layers of the bladder wall, resulting in "non-compliance". The different etiologies of bladder fibrosis are either neurogenic, which encompasses myelodysplasia and spinal cord injury, or nonneurogenic, due to a bladder outlet obstruction. In this study, bladder fibrosis was examined to see if it was due to the effect of an abnormal innervation or to abnormal bladder dynamics. MATERIALS AND METHODS: Thirty-five male Sprague-Dawley rats (250-300g) were divided into four groups; the normal (n=5), bilateral pelvic nerve transection; denervation (n=10), vesicostomy (n=10) and vesicostomy after denervation (n=10) groups. After 4 weeks, the bladders of the animals in each group were obtained. In the histological study, the collagen to muscle ratio from Masson's trichrome staining, and the elastin density (%) from Van Gieson staining, were determined using a Metamorph ver 4.6r5 image analyzer. The TGF-beta1 and collagen III protein expressions were detected by Western blotting. RESULTS: The collagen to muscle ratios of the normal, vesicostomy, denervation and vesicostomy after denervation groups were; 0.67+/-0.04*, 0.67+/-0.04*, 1.25+/-0.03* and 0.96+/-0.02 (*pvesicostomy after denervation>vesicostomy>normal from the histological study. The levels of TGF-beta1 and of collagen III in the denervation group were higher than those in the vesicostomy after denervation group. The above findings show that pressure and nerve innervation in the bladder both have significant effects on the process of bladder fibrosis. Meanwhile, a vesicostomy could reduce the fibrotic effect caused by denervation, although this is not complete.

Change of Bladder Afferent Neuron after Intravesical Electrical Stimulation / 대한비뇨기과학회지

PURPOSE: There have been reports on the clinical benefits of intravesical electrical stimulation (IVES) in patients with an increased residual urine or reduced bladder capacity. However, studies on the underlying mechanism of IVES have been limited to the A delta afferent and parasympathetic neurons. This study sort to investigate the changes in the expression of the C-fos protein in the thoracolumbar and lumbosacral spinal cord in order to determine the effect of IVES on the C fiber afferent nerve. MATERIALS AND METHODS: Twenty Sprague-Dawley rats were divided into four groups; group 1 (n=5) served as a sham operation, groups 2 (n=5) were instilled with normal saline, groups 3 (n=5) were instilled with 1% acetic acid, and group 4 (n=5) received IVES prior to the administration of 1% acetic acid. The spinal cord was removed at the thoracolumbar (T13-L2) and lumbosacral (L5-S1) levels. Changes in the levels of the C-fos protein in the spinal cord were measured by western-blot analysis. RESULTS: The relative density of the C-fos expression, 2 hours after IVES, was significantly higher, and the fos protein expression induced by IVES was decreased to the sham levels by the 5th day following the IVES. Therefore, it was decided that a 5 day interval between the IVES and the noxious stimulation with acetic acid should be used to avoid the superimposition of C-fos expression. The relative density of the C-fos protein, following noxious stimulation with 1% acetic acid, was significantly higher compared to the saline distension in both the T13-L2 and L5-S1 levels of the spinal cord. However, the IVES prior to the administration of 1% acetic acid significantly decreased the relative density of the C-fos protein at both the T13-L2 and L5-S1 levels of the spinal cord compared to the rats with noxious stimulation alone. CONCLUSIONS: IVES reduces the expression of C-fos, which is mainly conveyed by the unmyelinated C fibers in the noxiously stimulated rats. These results suggest that the bladder C fiber afferent is also involved in modulating the micturition reflex caused by IVES.

Gianturco Metallic Biliary Stent in Malignant Biliary Obstruction: Results of Follow-up in Dead Patients

PURPOSE: In order to study the patency, restenosis, efficacy, and complications of the metallic stent in the course of treatment of malignant biliary obstruction,the results of follow up of the dead patients after stent insertion were reviewed. MATERIALS AND METHODS: Self-expandable Gianturco metallic stent with 10-mm diameter was successfully inserted in 33 patients :10 with Klatskin tumor, 7 with common bile duct cancer, 7 with gallbladder cancer, 5 with pancreatic cancer, 2 with recurred stomach cancer, one with periampullary cancer, one with hepatocellular carcinoma. RESULTS: The overall duration of survival and patency of the stents in 33 patients were 5.2 months(1-12 months) and 4.9 months(1.14 months), respectively. Restenosis of metallic stents was found in 9 cases(27%), after 6.1 months in average. Causes of stent occlusion were overgrowing of tumor in 5, overgrowing and ingrowing of tumor in 3, extraductal dislodgement in one case. Two cases of symptomatic cholangitis after stent placement were successfully treated with percutaneous cholecystostomy. Three cases of destruction and migration of metallic stents were found after 6 months. CONCLUSION: On the basis of our experience, insertion of Gianturco metallic biliary stent is an acceptable treatment method in the malignant biliary obstruction, especially for whom short term survival is expected.

99mTc-red blood cell scintigraphy of sonographically atypicalhemangioma / 대한핵의학회잡지

No abstract available.