Effects of Varicocele Treatments in Adolescents: Changes of Semen Parameters after Early Varicocelectomy / 대한비뇨기과학회지

Purpose: The aim of this study was to evaluate the role of semen analysis in adolescent varicocele patients, and determine the deleterious effects of varicocele on spermatogenesis, as reflected by semen analysis, in adolescent boys compared to infertile adults. Materials and Methods: The seminal follow-up data of 47 adolescent patients (age range 16-20 years) and 68 adult patients (age range 29-50 years), who underwent a varicocelectomy for infertility, were compared. The results of the andrological and hormonal evaluations were also compared. Results: The percentage of abnormal seminal parameters was lower in the adolescent group. Multiple seminal abnormalities were also less common in the adolescent group. Of the 18 adolescents who showed seminal abnormality, testicular volume discrepancy was demonstrated in only 5 (27.8%). The varicocelectomy significantly improved all the tested mean seminal parameters in both groups. However, the adolescent group showed earlier and more complete recovery than the infertile adult group. In a comparison of the patients with preoperative abnormal seminal parameters, only the adolescent group showed improvements in the mean seminal parameters 3 month after the varicocelectomy. Conclusions: In late pubertal varicocele patients, semen analysis may be a useful tool in identifying those at risk of future subfertility. The comparison of the seminal results revealed less preoperative derangement and more prompt response to varicocelectomy in the adolescent than in the infertile adult group. Therefore, an early varicocelectomy may be advocated for adolescent patients with preoperative seminal abnormalities. (Korean J Urol 2005;46:481-486)

Outcome of Mid-urethral Sling Procedures in Korean Women with Stress Urinary Incontinence according to Body-mass Index

PURPOSE: The aim of this study is to determine whether the outcome of the mid-urethral sling procedures may be influenced by the body-mass index in Korean women with stress urinary incontinence(SUI). MATERIALS AND METHODS: A total of 285 women 28 to 80 years old with a minimum follow-up of 6 months were included in the study. Patients were stratified as follows: normal weight, 18.5~23 kg/m2; overweight, 23~27.5 kg/m2; obesity, 27.5 kg/m2 or higher. RESULTS: There was no significant complication. Bladder perforations were noted in 11 cases(4.9%, 3.8% and 2.2% in the normal weight, overweight and obesity group, p=0.449). There was no significant difference between the three groups for cure rate(p=0.173). The rates of postoperative urinary retention were 9.9%, 10.1% and 15.6% in the normal weight, overweight and obesity group(p=0.396). No significant difference was found between the three groups in the persistence of urgency(p=0.312). Seventy-nine patients(27.7%) had symptoms suggestive of voiding disorder, postoperatively. The incidence of these symptoms was not significant difference in the three groups(p=0.106). CONCLUSION: Our results demonstrate the feasibility and safety of the mid-urethral sling procedures for obese Korean women with SUI. Additional studies, including prospective randomized trials with longer follow-up, are needed to verify these findings.

Putative Asymmetric Dimethyl Arginine-Dimethylarginine Dimethylaminohydrolase Pathway in Rat Penile Tissue: A Biochemical and Functional Study / 대한남성과학회지

PURPOSE: Asymmetrical NG,NG-dimethyl-L-arginine (ADMA) is an endogenous inhibitor of nitric oxide synthase (NOS) and is metabolized by NG,NG-dimethylarginine dimethylaminohydrolase (DDAH). Although the ADMA-DDAH axis is widely distributed in human as well as rat tissues, the existence and the pathophysiologic role of DDAH in erectile function has not yet been studied. Therefore, we sought to demonstrate the presence of DDAH and investigate the relative amounts of two types of DDAH in rat cavernosal tissue. Also, we studied the effect of DDAH inhibition on erectile function in rats. MATERIALS AND METHODS: We developed cDNA probes for rat DDAH 1 and 2 by specific reverse-transcriptase mediated polymerase chain reaction (PCR). The presence and relative distribution of both types of DDAH gene expression were assessed using real time PCR and immunoblotting. To inhibit cavernosal DDAH, a specific inhibitor of DDAH (S-2-amino-4(3-methylguadino)butanoic acid) was administered to anesthesized rats via intracavernosal injection. The corporal level of ADMA was measured by high performance liquid chromatography. Erectile function was assessed by comparing the results of cavernous electrostimulation before and 30 minutes after drug administration. RESULTS: The presence of DDAH is demonstrated by the results of real time PCR and immunoblotting. Although both types were identified in rat penile tissue, type 2 was dominant. Intracavernosal injection of DDAH inhibitor markedly elevated the level of ADMA (0.86 nmol/g wet wt pretreatment to 4.25 nmol/g wet wt post-treatment) and resulted in a significant decrease of ICP/MAP in the anesthesized rats during cavernous electrostimulation. CONCLUSIONS: Our study is the first to demonstrate the existence of the ADMA-DDAH axis in the rat penile tissue. Since inhibition of DDAH impeded erectile function, alteration of this axis may be another cause of erectile dysfunction.

Predictive Factors for Persistent Urgency or Urge Incontinence after Tension-Free Vaginal Tape Procedure in Mixed Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The factors for predicting persistent urge symptom and urge incontinence following a tension-free vaginal tape (TVT) procedure were investigated in patients with mixed urinary incontinence. MATERIALS AND METHODS: Two hundred and seventy-four women, with a mean age of 55 years, ranging from 28 to 80, with female urinary incontinence (stress urinary incontinence; 201, mixed urinary incontinence; 73) were the subjects of this study. After a TVT procedure, the patients were followed up at 1, 6 and 12 months and every 1 year thereafter. Cure of incontinence after the procedure was defined as the absence of a subjective complaint of leakage and the absence of objective leakage on stress testing, with all other cases considered as failures. RESULTS: There was no significant difference in the cure rates for stress urinary incontinence in patients with stress and mixed urinary incontinence. However, of 73 patients with mixed urinary incontinence, 20 (27.4%) ans 12 (16.4%) had persistent urgency and continued urge incontinence, respectively. In a multivariate analysis, a low maximal urethral closure pressure (MUCP) was found to be associated with an increased likelihood of persistent urgency (odds ratio, 0.94; 95% confidence interval, 0.38-0.99; p=0.029) and the persistent urge incontinence (odds ratio, 0.94; 95% confidence interval, 0.88-0.99; p=0.030) after a TVT procedure in patients with mixed urinary incontinence. CONCLUSIONS: Our findings suggest that a low MUCP may be associated with the persistent urgency and urge incontinence after a TVT procedure in patients with mixed urinary incontinence.

Sildenafil Compliance after Restoration of Erectile Function / 대한남성과학회지

PURPOSE: Regarding for erectile dysfunction(ED), Sildenafil has produced satisfactory clinical results. However, Some patient discontinue sildenafil treatment for a variety of reasons after successful restoration of erectile function. We investigated the reasons for such discontinuations of sildenafil after restoration of erectile function by sildenafil medication. MATERIALS AND METHODS: After sildenafil medication, one hundred fifty six patients whose score of erectile function domain of the 15-item International Index of Erectile Function(IIEF) increased to 26 or more, were included in this study. Six-months after the first sildenafil prescription, compliance to medication and the reason for discontinuity were reviewed by chart or surveyed by telephone. RESULTS: In 156 successfully treated patients, 54(34.6%) discontinued sildenafil medication. The 2 most common reasons for discontinuation were trouble in the partners' or patients' emotional readiness for restoration of sexual activity after long-term abstinence and fear of possible side effects. CONCLUSIONS: After restoration of erectile function, many patients discontinued the use of sildenafil medication. The reasons for discontinuing the medication were primarily emotional or relationship-oriented issues. The counseling of both partners and education about the effects and side effects of the drugs are recommended to promote the successful recovery of sexual activity.

Pathophysiologic Investigation of Vasculogenic Erectile Dysfunction Using Newly Developed Rat Model / 대한남성과학회지

PURPOSE: We developed a novel rat model to investigate vasculogenic erectile dysfunction(ED) and investigated the possible mechanisms of atherosclerosis-induced ED. MATERIALS AND METHODS: Twenty male Sprague-Dawley rats(3 months old) were divided into control(n=10) and atherosclerosis(n=10) group. The control group was placed on a regular diet, while the atherosclerosis group received a 1% cholesterol diet for 6 weeks. To induce endothelial dysfunction, which is essential to the development of atherosclerosis, NG-nitro-l-arginine methyl ester(L-NAME) 1 mg/ml was added to the drinking water for the first 2 weeks. After six weeks, erectile function was assessed with cavernous nerve electrostimulation. Measurement of blood levels of cholesterol and histopathologic examination of the aorta and iliac artery were done. Semiquantitative RT-PCR for hypoxia-induced factor(HIF)-1alpha mRNA and Western blotting for HIF-1alpha and transforming growth factor (TGF)-beta1 were carried out on the penile tissues. RESULTS: Compared with the control group, both serum cholesterol level and arterial pressure were significantly elevated in the atherosclerosis group. The atherosclerosis group also showed prolonged and diminished erectile responses during cavernous nerve stimulation. Histologic study revealed definite atherosclerosis in the aorta and internal iliac artery, and the severity of atherosclerosis correlated well with decreased erectile function. Although RT-PCR did not show differences in the expression of HIF-1alpha mRNA, expression of HIF-1alpha and TGF-beta1 was significantly higher in the atherosclerosis group than in the control animals. CONCLUSIONS: In the rat, vasculogenic ED secondary to atherosclerosis could be generated by a high-cholesterol diet combined with an NOS inhibitor. Atherosclerosis might hamper erectile function by cavernosal ischemia secondary to a reduced blood supply and possibly by cavernosal fibrosis.

Tension Free Vaginal Tape Procedure in Incontinent Patients with Low Valsalva Leak Point Pressure

PURPOSE: To evaluate the outcome after the tension free vaginal tape (TVT) procedure in stress urinary incontinence with low Valsalva leak point pressure (VLPP), and identify factors predicting the outcome. MATERIALS AND METHODS: Two hyndred twenty-one women from 29 to 80 years old (mean 55.2) were included in the study. The TVT procedure was mostly performed under local anesthesia. The mean follow-up time was 10.5 months (range 6~52). Patients were divided into two groups (Group I: VLPP or = 60 cmH2O, n=160). Cure of incontinence was defined as the absence of a subjective complaint of leakage and the absence of objective leakage on stress test. RESULTS: The overall cure rate was significantly lower in Group I than in Group II (82.0% versus 93.1%, p= 0.013). In women with low VLPP, multivariate analysis indicated that urge symptom and low maximal urethral closure pressure were independent factors for the treatment failure: (odds ratio, 15.12; 95% confidence interval, 1.90~120.61; p=0.010) for urge symptom and (odds ratio, 0.92; 95% confidence interval, 0.86~0.99; p=0.018) for maximal urethral closure pressure. CONCLUSION: The cure rate after the TVT procedure is lower in women with low VLPP, when compared to those with higher VLPP. Our findings suggest that urge symptom and low maximal urethral closure pressure should be considered to be at high risk of the failure after the TVT procedure in these patients.

A case of acute disseminated encephalomyelitis with liver abscess / 대한내과학회지

Acute disseminated encephalomyelitis (ADEM) is an acute inflammatory demyelinating disease of central nervous system, and is related to allergic or immune-mediated reaction to systemic viral infection or vaccination, which is usually self limited monophasic illness. As the clinical manifestations or laboratory findings is nonspecific, it is diagnosed by brain magnetic resonance imaging (MRI) showing multiple foci of increased T2 signal within white matter. We report the clinical and radiologic imaging findings in a 36-year-old man in whom acute disseminated encephalomyelitis developed after serologically proven herpes infection combined with liver abscess. His clinical course, despite without corticosteroid or plasmapheresis because of liver abscess, was shown spontaneous remission.

A case of aplastic anemia after habitual sniffing of glue and volatile substances / 대한내과학회지

The inhalation of volatile substances has becoming a popular fad among adolescents in the world. Glue sniffing is associated with injury of nervous system, liver and kidney. And rarely abnormality of blood and bone marrow suppression can develop. The main components of volatile substances that cause hematologic abnormality is thought to be benzene, toluene, and xylene. A 24 year-old male was admitted to our hospital due to gum bleeding. He was a chronic glue and organic solvents sniffer for 6 years, and quit sniffing 1 year before admission. He had no specific drug history. On admission, CBC was as follows: WBC 2,500/mm3; hemoglobin 8.9g/dl; hematocrit 25.1%; platelet 2,000/mm3. Bone marrow biopsy showed severe hypocellular marrow compatible with aplastic anemia. We report a case of aplastic anemia after habitual sniffing of glue and volatile substances with brief review of the literature.

A Case of Systemic Lupus Erythematosus with Mediastinal Lymphadenopathy / 대한류마티스학회지

Approximately half of the patients with systemic lupus erythematosus(SLE) develop localized or diffuse lymphadenopathy during the evolution of the disease. But hilar and mediastinal lymph node enlargement due to SLE is rare. The histologic findings of lupus lymphadenitis range from nonspecific lymphadenitis with variable degrees of cellular necrosis to the less common but more specific appearance of extensive necrosis. Advanced lesions are characterized by hematoxylin bodies and condensation of DNA on the vessel walls. Hematoxylin bodies are amorphous homogeneous violet or lilac colored structures composed of partially depolymerized DNA, mixed with protein, carbohydrates and globulins which may be seen deposited on vessel walls and within the paracortex of lymph node. They are virtually diagnostic of SLE and would exclude malignant lymphoma. SLE with mediastinal lymphadenopathy is rare so we report this case with a review of literatures, which was diagnosed by hematoxylin bodies on pathologin findings of cervical lymph node.