Symptomatic Analysis of Men with Chronic Prostatitis/Chronic Pelvic Pain Syndrome

PURPOSE: Prostatitis is an extremely common syndrome that afflicts 2~10% of men and is now classified into NIH category. Of these, NIH category III(Chronic Prostatitis/Chronic Pelvic Pain Syndrome, CP/CPPS) varies widely in clinical presentation and response to treatment. We evaluated the characteristic symptoms of CP/CPPS based on NIH chronic prostatitis symptom index(NIH-CPSI), International Prostate Symptom Score(IPSS) and International Index of Erectile Function-5(IIEF-5) for the exploration of the future prospects of treatment. MATERIALS AND METHODS: 114 subjects agreed to participate in the study. The data from 99 patients were available for evaluation. The candidates with category IIIa and IIIb chronic pelvic pain syndrome were from 3rd decade to 6th decade for exclusion of effect of BPH. The NIH-CPSI, IPSS, IIEF-5 were used to grade symptoms and the quality of life impact at the start of the study. We investigated the correlation of the each domain of the scales categorized by age, location and multiplicity of the pain, and duration of the disease. Pearson's correlation method and ANOVA test were used for statistical analysis. RESULTS: Mean age of the patients was 41.1+/-8.5(3rd decade; 8 patients, 4th decade; 30, 5th decade 47, 6th decade 14). There were significant correlation between IPSS total score and urinary domain of NIH-CPSI (R=0.82), and irritative domain of IPSS and urinary domain of NIH-CPSI(R=0.76) with pearson's method. Analysis of the scores categorized by age revealed that there were no difference in 2nd, 3rd, 4th decade, but 6th decades had high IPSS total score. Analysis of the scores categorized by location and multiplicity of the pain revealed that the most common site of the pain was perineum(34.3%), and the patients who had 3 or more painful area had higher scores in all domains of CPSI and IPSS except pain domain of NIH-CPSI than the patients who had 1 painful area. Analysis of the scores categorized by duration of the disease revealed that the IPSS scores of the patients suffered during 1 year or more were higher than the patient suffered during 6months or less. There was no significant correlation between IIEF-5 and other scales. CONCLUSION: In our study there was significant correlation between urinary domain of NIH-CPSI and total score of IPSS. So, urinary domain of NIH-CPSI could be helpful index when alpha-blocker is used for the treatment of CP/CPPS. And alpha-blocker could be more effective in patients who are older and have longer duration of the disease and have multiple painful areas.

Follow-up Treatment of Benign Prostatic Hyperplasia with Acute Urinary Retention / 대한비뇨기과학회지

PURPOSE: One of the most serious complications of benign prostatic hyperplasia (BPH) is acute urinary retention (AUR). Up to now, many papers have evaluated the short term treatment of patients with AUR that is due to BPH. Therefore, we evaluated the long term follow-up of BPH patients with AUR. MATERIALS AND METHODS: 154 BPH patients with AUR were divided into two groups. One group was considered to be the failure cases of urethral catheter removal, and this group (55 patients) had undergone immediately transurethral resection of prostate (TURP). The other group was considered to be the successful cases of urethral catheter removal. The latter group was divided into 3 groups: the alpha-blocker group, the alpha-blocker with 5alpha- reductase inhibitor group and the suprapubic cystostomy with medical treatment group. We evaluated the long term follow-up of these groups and the changes of treatment for 1 month, 3 months, 6 months and 12 months. RESULTS: The mean volume of the prostate was 54.2ml. When the patients were admitted to the hospital due to AUR, 53% of the patients had previously experienced AUR, and the mean number of previous AUR episodes were 1.4 times. The initial management of AUR due to BPH was urethral catheter indwelling with medical treatment. If the catheter removal failed, TURP was perfomed (35%) and when successful, medical treatment was then done. CONCLUSIONS: The primary management of AUR due to BPH is urethral catheter indwelling with medical treatment (alpha-blocker). However, if the patients have a large size prostate, we should first consider hormone treatment (5alpha-reductase inhibitor) rather than surgical treatment. The management methods of some patients were changed during the follow-up. Therefore, when following up these cases, we should be careful to prevent the recurrence of AUR and to allow self-voiding.

Cryptic Plasmid Amplification of Chlamydia trachomatis at a Korean Health Center for Female Commercial Sex Workers / 대한비뇨기과학회지

PURPOSE: Chlamydia trachomatis infection is the most common bacterial sexually transmitted disease. It is generally accepted that female commercial sex workers (FCSWs) are at an increased risk of incurring sexually transmitted disease (STD) because of their high numbers of sexual partners. Even though chlamydial infections in FCSWs have been linked with serious public health problems, there are very few reports about the prevalence of chlamydial infection in FCSWs in Korea. The purpose of this study was to determine the prevalence of chlamydial infection in FCSWs by performing cryptic plasmid gene amplification. MATERIALS AND METHODS: Genomic DNAs were extracted from the endo- cervical cotton swabs taken from 410 FCSWs in one Korean health center from April 2004 to August 2004; these FCSWs had visited there for periodic STD check ups. The human beta-globin and cryptic plasmid of Chlamydia trachomatis from the genomic DNA were amplified by the polymerase chain reaction (PCR) method. RESULTS: Four hundred and ten FCSWs (mean age: 25+/-6 years) were enrolled. A total of 410 endo-cervical samples from the FCSWs showed beta-globin bands in 1.5% agarose gel, and all the samples were included in this study. The cryptic plasmid was identified in 82 of the 410 FCSWs (20%). CONCLUSIONS: We confirmed the FCSWs were a core group that spread Chlamydia. To promote public health and for cost effectiveness, massive screenings with gene amplification methods for the FCSWs to detect chlamydial infection are needed.

Purple Urine Bag Syndrome in Male / 대한비뇨기과학회지

Purple urine bag syndrome (PUBS) was first reported in 1978, and is a rare phenomenon in which purple staining of the bags occurs, with a violet discoloration of the plastic of the catheter bag due to fine blue crystals of indigo in the urine. PUBS occurs predominantly in chronically catheterized constipated women, and is associated with urinary tract infections due to bacteria that produce sulphatase/phosphatase. A 70-year old male patient, who as used a suprapubic cystocatheter for almost 12 months, due to acute urinary retention, visited to our department with a purple colored urine bag. PUBS has previously been reported to be observed mostly in female patients. Herein, we report a rare case of PUBS in male patient.

Investigation of Early Protein Changes in the Urinary Bladder Following Partial Bladder Outlet Obstruction by Proteomic Approach

We investigated the pathophysiological mechanism by proteomic approach as a possible tool to detect the marker proteins to develop lower urinary tract symptoms following bladder outlet obstruction (BOO). Rats were randomized into 3 groups; control, sham operation and BOO groups. BOO group was divided into 1, 3, and 5 day-group. Conventional proteomics was performed with high resolution 2-D gel electrophoresis followed by computational image analysis and protein identification using mass spectrometry using rat urinary bladders. A comparison of bladder of BOO group with control bladder showed that three proteins of optineurin, thioredoxin and preprohaptoglobin were over-expressed in the bladder of BOO group. In addition, four proteins, such as peroxiredoxin 2, transgelin, hippocampal cholinergic neurostimulating peptide (HCNP) and beta-galactoside-binding lectin, were under-expressed in the bladder of BOO group. These data supported that downregulation of HCNP might make detrusor muscle be supersensitive to acetylcholine, up-regulation of optineurin means the protection of nerve injury, and down-regulation of transgelin means the decreased contractility of detrusor muscle. Beside these proteins, other proteins are related to oxidative stress or have a nonspecific function in this study. However more information is needed in human bladder tissue for clinical usage.

Primary Sclerosing Lipogranuloma of the Scrotum / 대한비뇨기과학회지

A primary sclerosing lipogranuloma of the scrotum is a rare disease, the cause and pathogenesis of which are still unknown. We experienced a 38-year-old man with a painless intrascrotal mass. The mass was firm, and rapidly increased in size in 3 weeks. The patient denied a history of injection of exogenous materials, or of trauma to the scrotum or penis. During the surgical operation, the mass was found to be partly fixed to the scrotal skin, but not to the corpus cavernosum, corpus spongiosum or bilateral spermatic cords. The mass extended deeply into the perineal region. The pathological findings were epithelioid granulomas, with multinucleated giant cells, lymphocytes and eosinophils. Herein, we report a case of a primary sclerosing lipogranuloma in the scrotum.

Long Term Follow up of Suprapubic Cystostomy

PURPOSE: We assessed the clinical significance of suprapubic cystostomy in the treatments of patients with voiding difficulty and analyzed the complications of it and their courses. Also we compared the results with our previous study. PATIENTS AND Methods: We reviewed 30 patients managed with suprapubic cystostomy. The changes in serum Cr, urinary pH and white blood cell values after suprapubic cystostomy were evaluated. We investigated complications of these patient. The stone-free rate after suprapubic catheter insertion was estimated by the Kaplan-Meier method. RESULTS: The original diseases were spinal cord injury in 19 (63.3%), cerebrovascular accident in 3 (10%), inoperable benign prostatic hyperplasia in 2 (6.7%), diabetic cystopathy in 2 (6.7%), recurrent urethral stricture in 2 (6.7%) and prostatic cancer in 2 (6.7%). The most common complication was the formation of the bladder calculi in 8 cases (26.7%). There were no serious complications associated with the procedure and no deterioration of the renal function. The mean serum creatinine level changed from 1.15+/-0.06 mg/dl to 1.13+/-0.07 mg/dl without statistical significance. The stone-free rates 1 and 7 years after the procedure were 96.7% and 73.3%, respectively. The urinary pH of the stone-forming group was significantly higher than that of the stone-free group (p<0.05). CONCLUSION: Suprapubic cystostomy is an alternative method for patients of voiding dysfunction in cases of severe urethral damage or limited activity of upper extremities. In spite of advantage of suprapubic cystostomy, we must make an effort on preventing bladder stone, urinary tract infection in patients with suprapubic catheter.

Effects of acetaldehyde on responses of rabbit corpus cavernosal smooth muscle

Ethanol has various effects on male sexual activity under the influence of direct and indirect, in acute and chronic alcohol ingestion. However, whether acetaldehyde, a principal metabolite of ethanol, may affect penile erection directly has still not been elucidated. This present study was, therefore, designed to clarify the pharmacologic effects of the acetaldehyde on corpus cavernosal smooth muscle. Corpus cavernosal strips were prepared from rabbit penises. Isometric tension changes of rabbit corpus cavernosal strips to various drugs and electrical field stimulation (EFS) in an organ chamber were recorded with a pressure transducer after active muscle tone had been induced by phenylephrine (10(-5) mol/L). At the concentrations employed, acetaldehyde had no effect on the pH of the bathing medium. Acetaldehyde in each concentration did not significantly affect resting tone of the smooth muscle during 30 min incubation. Acetaldehyde suppressed contractility induced by phenylephrine and KCI at 10(-4) mol/L, and relaxation induced by EFS and bethanechol at 10(-3) mol/L and 10(-4) mol/L respectively, but acetaldehyde enhanced relaxation induced by ATP at high acetaldehyde level. Sodium nitroprusside-induced relaxation was not affected at any employed acetaldehyde concentration. This suggests that increasing the acetaldehyde level may contribute to male erectile dysfunction mainly by the inhibition of nitric oxide formation.

Effects of acetaldehyde on responses of rabbit corpus cavernosal smooth muscle

Ethanol has various effects on male sexual activity under the influence of direct and indirect, in acute and chronic alcohol ingestion. However, whether acetaldehyde, a principal metabolite of ethanol, may affect penile erection directly has still not been elucidated. This present study was, therefore, designed to clarify the pharmacologic effects of the acetaldehyde on corpus cavernosal smooth muscle. Corpus cavernosal strips were prepared from rabbit penises. Isometric tension changes of rabbit corpus cavernosal strips to various drugs and electrical field stimulation (EFS) in an organ chamber were recorded with a pressure transducer after active muscle tone had been induced by phenylephrine (10(-5) mol/L). At the concentrations employed, acetaldehyde had no effect on the pH of the bathing medium. Acetaldehyde in each concentration did not significantly affect resting tone of the smooth muscle during 30 min incubation. Acetaldehyde suppressed contractility induced by phenylephrine and KCI at 10(-4) mol/L, and relaxation induced by EFS and bethanechol at 10(-3) mol/L and 10(-4) mol/L respectively, but acetaldehyde enhanced relaxation induced by ATP at high acetaldehyde level. Sodium nitroprusside-induced relaxation was not affected at any employed acetaldehyde concentration. This suggests that increasing the acetaldehyde level may contribute to male erectile dysfunction mainly by the inhibition of nitric oxide formation.

The Urodynamic Study in Vertebral Disorders with Nerve Root Compression / 대한비뇨기과학회지

PURPOSE: Nerve root compression from spinal stenosis or herniated intervertebral disc(HIVD) may affect bladder function by the disease itself, operation or inappropriate general postoperative care. Preoperative urodynamic study seems to be needed for differential diagnosis of postoperative bladder dysfunction. MATERIALS AND METHODS: Thirty three patients diagnosed as nerve root compression were analysed for urodynamic features prospectively and classified into type I(hyporeflexic, hyposensitive, normal sphincter and hypocontractile, high compliance), type II(hyperreflexic, hypersensitive, normal sphincter and hypocontractile, low compliance), type III(hyperreflexic, hypersensitive, normal sphincter and hypercontractile, low compliance) and normal. Correlation with voiding symptoms, duration of the disease and urodynamic findings was evaluated. RESULTS: The mean age of patients was 56.2 years(29-80 years old), including 21 men and 12 women. Among thirty three patients, 21 had spinal stenosis and twelve patients were diagnosed as HIVD. Urodynamically, there were 16 cases(48.5%) showing type II, 6 cases(18.2%) for type I and 2 cases(6%) for type III. Normal finding was shown in 9 cases(27.3%). No significant difference was shown in mean duration of disease and in urodynamic findings. Patients with voiding symptoms or abnormal urodynamic finding were 20 cases(60.6%) and 24 cases(72.7%), respectively. Among thirteen patients without voiding symptoms, eight patients(61.5%) had abnormal urodynamic findings. CONCLUSIONS: Voiding symptoms and urodynamic findings in patients with nerve root compression were various. Because there is no consistent pattern of dysfunction with any type of nerve root compression disease, preoperative urodynamic study seems to the cornerstone for rational therapy and gives the exact information of bladder function to orthopedic operator.