The Early Outcomes of Extraperitoneal Radical Cystectomy / 대한비뇨기과학회지

PURPOSE: Radical cystectomy with pelvic lymphadenectomy is an effective therapeutic modality in invasive bladder cancer. The development of another technique for a radical cystectomy for the early recovery and reduction of complications was attempted. MATERIALS AND METHODS: Between March 1997 and June 2003, an extraperitoneal radical cystectomy was attempted in 18 patients with invasive bladder cancer (pT1-pT4). Not only standard or extended pelvic lymphadenectomy, but also re-positioning of the ureter to the opposite side, could be performed extraperitoneally. An intestinal segment could be taken out through a small window within the peritoneum and manipulated as desired. The clinical safety and complications of other surgical approaches for radical cystectomy were also investigated. RESULTS: The procedure was successful in 15 of the 18 patients (4 studer pouches, 3 ileal conduits and 8 ureterocutaneostomies). Failure to peel out the peritoneum occurred in 3 cases, 1 each due to technical difficulties, tumor invasion at the bladder dome and adhesion due to a previous radical prostatectomy. Complications occurred in 8 cases (53.1%). The intestinal obstruction progressed in 1 case (12.5%) due to a high positioned mesentery of the Studer pouch. There were no significant gastrointestinal complications in any of the 8 patients that underwent the extraperitoneal radical cystectomy with ureterocutaneostomy. CONCLUSIONS: An extraperitoneal radical cystectomy seems to reduce the gastrointestinal complications and be worthwhile in certain cases with advanced bladder cancer. Despite the visual limitation, it is an acceptable surgical technique compared to the conventional transperitoneal methods.

The Treatment Outcomes of a Partial Nephrectomy in the Management of Renal Cell Carcinomas / 대한비뇨기과학회지

PURPOSE: Although a radical nephrectomy is the mainstay in the surgical management of renal cell carcinomas, a partial nephrectomy is indicated in certain situations where a radical nephrectomy would render the patients in a state of renal insufficiency. Furthermore, the indications are being expanded to include incidentally found small unilateral renal cell carcinomas with a normal contralateral kidney. Therefore, the outcomes between patients treated with partial and radical nephrectomies for renal cell carcinomas were compared. MATERIALS AND METHODS: Between January 1997 and March 2004, 171 nephrectomy operations were performed as curative treatments for renal masses at the urooncology department of our hospital. The study group was composed of 93 and 32 cases of radical and partial nephrectomies, respectively, with a final pathologic diagnosis of a renal cell carcinoma. The operations for renal cell carcinomas were performed by the same surgeon. The survival rate, time of local recurrence, complication and outcomes were compared and the records of 125 patients who underwent a nephrectomy for a renal cell carcinoma were retrospectively reviewed. RESULTS: The overall mean postoperative follow-up was 25.9, ranging from 2 to 72 months. All the long-term outcomes of a partial nephrectomy for renal cell carcinoma were comparable to those of a radical nephrectomy, especially for localized renal cell carcinomas. CONCLUSIONS: A partial nephrectomy could be a better treatment option for localized renal cell carcinomas in appropriately selected cases with normal contralateral kidneys as well as in the absolute indication, with comparable outcomes to a radical nephrectomy, but the more groups and a long-term follow up are required if a partial nephrectomy is to become the standard operation for localized renal cell carcinoma treatment.

The Experience of Calycoileoureterostomy in Severe Ureteropelvic Junction Stricture / 대한비뇨기과학회지

The treatment of a long segment stricture of the upper ureter, destroyed pelvis and ureteropelvic junction obstruction with intrarenal pelvis presents a difficult surgical question. A small isolated segment of the ileum was interposed between the lower pole calyx of the kidney and the ureter. This procedure takes advantage of the presence of normal and nonrefluxing ureterovesical junctions, and serves to diminish any potential problems of electrolyte imbalance and restricture of the ileal ureter. Here, a case of calycoileoureterostomy in a 32-year-old man, with an intrarenal pelvis and a severe ureteropelvic junction obstruction following pyelolithotomy, is described.

Emphysematous Cystitis Complicated with Diabetic Nephropathy / 대한비뇨기과학회지

Emphysematous cystitis is an uncommon condition in which pockets of gas are formed in and around the bladder wall by gas-forming organisms. Patients with diabetes, neurogenic bladder and chronic urinary infection are predisposed to the disease. Severity of illness ranges from an asymptomatic condition to life-threatening cystitis. Successful management depends on early diagnosis with correction of underlying causes, administration of appropriate antibiotics, establishment of adequate bladder drainage and surgical excision of involved tissue when required. Early detection and prompt treatment are encouraged. We report one case of emphysematous cystitis complicated with diabetic nephropathy in a 68-year-old woman.

The Antioxidant Effect of Rebamipide in Human Semen Specimens / 대한비뇨기과학회지

PURPOSE: Rebamipide is a propionic acid derivative that inhibits superoxide production and removes hydroxyl radicals. This study was performed to investigate the effects of adding rebamipide to semen, in an effort to determine if reactive oxygen species (ROS) production and lipid peroxidation of the sperm cell membrane as well as an improvement in seminal parameter and fertilizing capacity under oxidative stress was inhibited. MATERIALS AND MTHODS: Semen was collected from 30 normal healthy volunteers by masturbation after at least 48 hours abstinence. After liquefaction of the semen at room temperature, the prepared sperm was diluted with a sperm wash media to a uniform density of 20x106/ml. The semen was treated with 0.25ml of 0.2mM FeSO4 and 1mM sodium ascorbate for 60 min in the presence of various rebamipide concentrations (0, 10, 30, 100, and 300microM). ROS production, sperm motility, vitality, fertilizing capacity and the level of lipid peroxidation were analyzed by chemiluminescence, computer assisted semen analysis, eosin-nigrosin staining, a hypo-osmotic swelling test and the thiobarbituric acid method, respectively. RESULTS: Rebamipide at 100 and 300microM increased the sperm motility (p<0.05) but did not affect the sperm vitality. The ROS production and lipid peroxidation in the sperms treated with FeSO4/sodium ascorbate were inhibited by rebamipide in a dose-dependent fashion (p<0.05 in each). The total swelling rate of the hypo-osmotic swelling test was also increased by high rebamipide concentrations (100 and 300microM), respectively 49.2 17.9 and 50.8 21.7% (p<0.05). CONCLUSIONS: These results suggest rebamipide is an effective free radical scavenger and may be useful as an oral antioxidant in patients with male infertility due to increased ROS generation. However, further study to be possible the clinical use of rebamipide for improve the fertilizing capacity in male infertility is required.

The Antioxidant Effect of Rebamipide in Human Semen Specimens / 대한비뇨기과학회지

PURPOSE: Rebamipide is a propionic acid derivative that inhibits superoxide production and removes hydroxyl radicals. This study was performed to investigate the effects of adding rebamipide to semen, in an effort to determine if reactive oxygen species (ROS) production and lipid peroxidation of the sperm cell membrane as well as an improvement in seminal parameter and fertilizing capacity under oxidative stress was inhibited. MATERIALS AND MTHODS: Semen was collected from 30 normal healthy volunteers by masturbation after at least 48 hours abstinence. After liquefaction of the semen at room temperature, the prepared sperm was diluted with a sperm wash media to a uniform density of 20x106/ml. The semen was treated with 0.25ml of 0.2mM FeSO4 and 1mM sodium ascorbate for 60 min in the presence of various rebamipide concentrations (0, 10, 30, 100, and 300microM). ROS production, sperm motility, vitality, fertilizing capacity and the level of lipid peroxidation were analyzed by chemiluminescence, computer assisted semen analysis, eosin-nigrosin staining, a hypo-osmotic swelling test and the thiobarbituric acid method, respectively. RESULTS: Rebamipide at 100 and 300microM increased the sperm motility (p<0.05) but did not affect the sperm vitality. The ROS production and lipid peroxidation in the sperms treated with FeSO4/sodium ascorbate were inhibited by rebamipide in a dose-dependent fashion (p<0.05 in each). The total swelling rate of the hypo-osmotic swelling test was also increased by high rebamipide concentrations (100 and 300microM), respectively 49.2 17.9 and 50.8 21.7% (p<0.05). CONCLUSIONS: These results suggest rebamipide is an effective free radical scavenger and may be useful as an oral antioxidant in patients with male infertility due to increased ROS generation. However, further study to be possible the clinical use of rebamipide for improve the fertilizing capacity in male infertility is required.

The Clinical Efficacy of Topical Agents for Premature Ejaculation / 대한남성과학회지

PURPOSE: The penile hypersensitivity is one of the complicated causes of premature ejaculation so that it has been applied to the local anesthesia or the penile dorsal neurectomy in the cases of treatment. The authors had compared the clinical efficacy of various kinds of OTC topical agents which were designed for premature ejaculation and were approved of selling in Korean market. MATERIALS AND METHODS: 10 normal adult male with ages from 29 to 24 years (ave. 33.4) were enrolled in this study. 8 topical agents of cream-type such as SS-cream(R), gel-type such as Power gel(R), B.M. gel(R), BIGTO gel(R) and Control gel(R), solution-type such as E.L.T soln(R), and spray type such as Sanova(R), Tstone(R) were applicated. With exception of SS-cream(R) which was natural medicine, the rest of them were made from lidocane 9.6%. We evaluated characteristics, efficacy, satisfaction and adverse reactions in treatment of premature ejaculation with 8 topical agents. RESULTS: In concerning of their odor, SS-sream(R) was the strongest (p<0.05). The viscosity was the highest in cream-type agent as SS-cream(R). However washing after sexual intercourse is relatively easy in every cases with the lowest necessity of washing in solution-type E.L.T soln(R) (p<0.05). The main causes of feeling the usage of drugs by partners were delay of ejaculation time, feeling of foreign bodies in genital organ, and the odor of drugs itself. Except SS-cream(R) with 60 minutes, the interval time of drug effect was about 15 to 20 minutes in every cases without any significant difference as well as adequate duration of drug efficacy. The times of usage per one pack was more in both E.L.T(R). soln which was make-up compact-type, and Sanova(R), Tstone(R) which was spray-type than the rest of drugs which were contained in disposal pack or tube. Also E.L.T soln(R), Sanova(R) and Tstone(R) had showed the convenience of usage (p<0.05). With overall satisfaction, there was excellent convenience of usage in E.L.T. soln which was packed in make-up compact (p<0.05). CONCLUSIONS: Topical anesthetic agents designed for premature ejaculation are safe and effective medical treatment with no significant difference in their characteristics, efficacy, and occurrence of adverse reaction among the various topical agents. Therefore, we suggest that the most important factors which influence the satisfaction and selectivity to topical anesthetic agents for premature ejaculations are the preserving container and method of application.

Dandy-Walker Syndrome with Wilms' Tumor and Congenital Cataract / 대한비뇨기과학회지

Dandy-Walker syndrome, with a Wilms' tumor, is a very rare disease. To the best of our knowledge, only 3 cases have been reported in the literature, and no case has been reported in Korea. The etiology of the two diseases combined is not known. Here we describe one case of Dandy-Walker syndrome with a Wilms' tumor and a congenital cataract in a 42-month-old female infant, with a review of the previous reports.

The Clinical Experience of Leiomyoma of the Female Urethra / 대한비뇨기과학회지

PURPOSE: Leiomyoma of the urethra is a rare disease entity. We treated leiomyoma of the female urethra surgically during the period from 1981 to 1997 and retrospectively reviewed the results. MATERIALS AND METHODS: We have experienced 11 cases of the leiomyoma of the female urethra. History taking, clinical symptoms, urinalysis, laboratory findings, cystoscopic finding, postoperative complication and follow-up examination were observed retrospectively. Also, we checked pelvic computed tomography in 2 cases which had been detected uterine mass at pelvic ultrasonography. RESULTS: Average age of the patients was 40 years (28-51) and the chief complaint was a painless mass of anterior vaginal wall. All masses were removed surgically and confirmed as leiomyoma histologically. The uterine leiomyoma was combined in 2 cases. There were no recurrence or complication after surgery until now. CONCLUSIONS: A surgical removal of the leiomyoma of the female urethra provided a long term disease free survival and the search for the associated pelvic leiomyoma should be done.