Primary Bladder Signet Ring Cell Carcinoma Extended to Prostate / 대한비뇨기과학회지

A primary signet ring cell carcinoma (PSRCC) of the urinary bladder is a rare variant of a mucin-producing adenocarcinoma. The prognosis of a PSRCC is poor, as silent progression in a linitis platica fashion leads to delayed diagnosis. Herein, the case of a PSRCC of the bladder, which extended to the prostate, which was treated with a cystoprostatectomy, is reported.

A Comparative Study of Patient Experiences of Conventional Fluoroscopic and Four-Hour Ambulatory Urodynamic Studies

We assessed several emotional variables in patients experiencing conventional urodynamic and ambulatory urodynamic monitoring (AUM) to verify the hypothesis that AUM is tolerated as well as conventional urodynamics. A total of 33 women and 7 men from 23 to 72 years of age who were undergoing both procedures were prospectively included in this study. Prior to and immediately after the procedures, each patient completed a self-administered questionnaire. Answers were given on a visual analogue scale. The degree of anxiety was higher for conventional urodynamics than for AUM (p = 0.045), while the degree of boredom experienced during AUM was higher than that during conventional urodynamics (p= 0.013). There was no significant difference in the degree of shame or bother experienced by the patients during the two procedures. In general, patients tolerated both examinations extremely well. The examiner-rated degree of intolerance during conventional urodynamics was influenced by the subjective pain score (p=0.001), while all other emotional variables except bother were not significantly related with the degree of intolerance during AUM (p=0.007). A total of 74.4% and 84.6% responded that they were willing to repeat conventional urodynamics and AUM, respectively, which were not significantly different. Although AUM produced a significantly higher level of boredom than conventional urodynamics, our data demonstrates that patients are as tolerant of AUM as they are of conventional urodynamic procedures.

Psychometric Properties of the Korean Version of the King's Health Questionnaire in Women with Stress Urinary Incontinence

PURPOSE: The purpose of this study is to evaluate the psychometric properties of the Korean version of the King's Health Questionnaire(KHQ) in patients with stress urinary incontinence. MATERIALS AND METHODS: Multicenter prospective study was undertaken in 106 patients with stress urinary incontince. Psychometric properties including discriminant validity, convergent validity were evaluated and the Cronbach's alpha coefficients were calculated. Test-retest analysis was performed and the sensitivity to clinical change before and after treatment was also evaluated. RESULTS: The psychometric properties and clinical validity of the KHQ Korean version were confirmed in 106 study population. The KHQ's good reliability was evidenced by Cronbach's alpha coefficients of>0.60, indicating to change in patients' perception of bladder condition in all domains. CONCLUSION: Our analyses confirm excellent psychometric properties for the Korean version of KHQ, which appears to provide a valid and reliable instrument for clinical usages in Korea.

The Efficacy of Transurethral Resection of Prostate on the Patients with Benign Prostatic Hyperplasia and Detrusor Hyperactivity with Impaired Contractility

PURPOSE: Detrusor hyperactivity with impaired contractility(DHIC) can be found in many elderly patients with benign prostatic hyperplasia(BPH). It is hard to expect the efficacy of transurethral resection of prostate(TURP) on such patients. Therefore, we retrospectively estimated the effect of TURP on BPH patients with DHIC. MATERIALS AND METHODS: Eighteen male patients with BPH and DHIC were underwent TURP. Through urodynamic studies, DHIC was identified. Findings of bladder outlet obstruction were evaluated with TRUS and/or diagnostic cystoscopy in all patients. They were requested to go through uroflowmetry and international prostate symptom score(IPSS), before and after TURP. The subjective satisfaction scale was measured after TURP. RESULTS: Total IPSS(from 20.6 to 12.5), obstructive symptom score(from 11.5 to 6.0), and maximal flow rate (from 6.0 ml/sec to 14.6 ml/sec) of the patients were improved significantly(p0.05). Only 2(12%) of the patients were unsatisfied with the outcomes of TURP. CONCLUSION: We suggest that TURP can be used as a good therapeutic option for selected patients with BPH accompanied with DHIC.

alpha-Adrenoceptor Antagonistic Effect of Palmatine on the Prostatic Urethral Pressure of the Rabbit / 대한비뇨기과학회지

PURPOSE: Palmatine is an isoquinoline alkaloid, with multiple pharmacological actions, including anti-inflammatory activity. The aim of this study was to examine the effect of palmatine on the prostatic urethral pressure in anesthetized rabbit. MATERIALS AND METHODS: 10-week-old male New Zealand White rabbits (3.0-3.5kg) were used in the experiment. After anesthetized with urethane (800mg/kg i.v.), a midline incision was made, and the urinary bladder completely drained. To prevent filling of the bladder, polyethylene tubes were inserted into the bilateral ureters. Using a 3-F MIKRO-TIP catheter transducer positioned in the prostatic urethra, urethral pressure was recorded continuously. To record the blood pressure, the left femoral artery was cannulated with an angiocatheter. After a stabilizing period, phenylephrine (1mug/kg) was intravenously administered two or three times. When the increase in the urethral pressure became stable, palmatine was administered intravenously (0.5-3.0mg/kg), followed by phenylephrine, with no time interval. RESULTS: In the anesthetized rabbits, an intravenous bolus injection of palmatine (0.5-3.0mg/kg) caused no significant change in the resting prostatic urethral pressure (p>0.05), but decreased the blood pressure (p<0.05). After administration of phenylephrine, the urethral pressure increased from 7.5 0.8 mmHg to 26.5 2.6 mmHg, with the difference in the pressure (19.0 3.1 mmHg) being statistically significant (p<0.01). The intravenously administered palmatine (0.5-3.0mg/kg) dose-dependently inhibited the phenylephrine-induced increases in the prostatic urethral pressure and mean blood pressure. The maximal inhibition was obtained when a palmatine dose of 3.0mg/kg was administered, at which point, the decrease in the urethral pressure was 73.1% (p<0.01). CONCLUSIONS: These results indicate that palmatine inhibits the phenylephrine-induced increases in the prostatic urethral pressure and blood pressure in the anesthetized rabbits.

Early Results of SPARC (Suprapubic Arc) Procedures for the Female Patients with Stress Urinary Incontinence

PURPOSE: The Suprapubic Arc (SPARC) procedure has recently been introduced as a new surgical treatment option for stress urinary incontinence in women. We have reported our early results of SPARC procedures. MATERIALS AND METHODS: A total of 23 patients received SPARC procedures at our hospital between November 2002 and August 2003. All the patients were evaluated with history taking, physical examination, urodynamic study and cystography preoperatively. The procedure was carried out under IV propofol or spinal anesthesia. The enrolled patients were followed-up for more than 3 months postoperatively. The cure rate was evaluated and perioperative and postoperative complications were assessed. RESULTS: The mean age of the patients was 48.8 years (ranges from 32 to 67 years) and eight patients had past history of previous abdominal or pelvic surgery. The mean hospital stay was 1.9 days (ranges from 1 to 7 days). Mean follow-up period was 7.9 months (ranges from 3.7 to 14.0 months). Nineteen of the 23 patients (82.6%) were completely cured and 2 patients (8.7%) were much improved, hence the total success rate of the procedure was 91.3%. Bladder perforation during procedure occurred in 7 patients (30.4%) but conservative management sufficed. No serious complication was occurred. CONCLUSION: Our early results show that the SPARC procedure is a effective treatment option for the management of stress urinary incontinence. But we suggest that surgeons should be careful to avoid the bladder injury especially in their early period of experience.

Is the 3-day Stenting Sufficient for Ureteroscopic Lithotripsy? / 대한비뇨기과학회지

PURPOSE: There has been great demand for indwelling stents for preventing pain, obstructive symptoms and other complications after endoscopic procedures. However, there is no consensus on the placement of a ureteral stent after an ureteroscopy. Inherent stent related problems warrant the minimum possible stenting duration without compromising the results of an ureteroscopy. A prospective randomized trial was performed to evaluate whether 3-day stenting is sufficient for ureteroscopic lithotripsy. MATERIALS AND METHODS: A total of 38 patients underwent an ureteroscopic lithotripsy. There were no severe operative complications. The patients were randomized into 2 groups; Group A: 18 patients who had an internal stent for 3 days after the ureteroscopic lithotripsy, and group B: 20 patients with a stent for 2 weeks. The ureteroscopic lithotripsies were performed with an 8Fr. or 10Fr. ureteroscope, under intravenous propofol anesthesia. Postoperative symptom questionnaires were acquired from each patient. A radiological follow-up was performed at least 4 weeks after the stent removal in all patients. RESULTS: There were no significant differences in the age, sex, stone size or usage of the instrument between the 2 groups. Of the 38 patients, 32 (84%) had discomfort associated with the indwelling stent. The most common symptom was irritative voiding symptom. There were no significant differences in the flank pain and ureteral stricture between the 2 groups. CONCLUSIONS: There was no difference between the 3-days and 2-weeks indwelling stented groups with respect to complications. Therefore, 3 days seems to be a more adequate duration for the decrease stent related complications and symptoms after an ureteroscopic lithotripsy, with no serious intraoperative complications.

High Flow Priapism Treated by Repeated Embolization / 대한남성과학회지

We describe a case of priapism after perineal blunt trauma in a 32-year old man who complained of painless and persistent erection. We confirmed high-flow priapism by cavernosal blood gas analysis, Doppler ultrasonography, and arteriography. A pseudoaneurysm was blocked by selective carvernosal artery embolization with autologous clot. Penile tumescence did not completely disappear during the following 4 weeks, and the patient complained of penile discomfort. Reembolization of the cavernosal artery with autologous clot was successful in reversing the erection. The patient has normal erectile status and no complaints during 30 months follow-up.

Ureteroscopy under Intravenous Propofol Anesthesia for the Treatment of Middle and Upper Ureteral Calculi: Comparison with Lower Ureteral Calculi / 대한비뇨기과학회지

PURPOSE: Intravenous propofol anesthesia has been safely and effectively used in the ureteroscopic management of lower ureteral calculi. We investigated whether we can also use propofol anesthesia effectively for the treatment of middle and upper ureteral calculi. MATERIALS AND METHODS: We performed ureteroscopy with intravenous propofol anesthesia in 200 consecutive patients with ureteral calculi from July 1998 to December 2001. We divided them into 2 groups. Group 1 consisted of 59 patients, 48 men and 11 women, with upper and midureteral calculi, and group 2 consisted of 141 patients, 94 men and 47 women, with lower ureteral calculi. We compared safety, success rate, length of hospital stay and complication rate between the two groups. RESULTS: The overall success rate for ureteroscopy was 94.5% (189/200). Seven patients suffered perioperative complications, none of whom needed to change mode of anesthesia or remembered discomfort during the operation. In group 1, stone size, operation time and postoperative hospital stays were 7.5+/-3.2mm, 33.0+/-20.3 minutes and 1.9+/-1.0 days, respectively. The equivalent results were 6.2+/-2.9mm, 22.9+/-15.0 minutes and 1.4+/-0.9 days, respectively, in group 2. There were no significant differences in age, complication rate or success rate between the two groups. CONCLUSIONS: In patients with middle and upper ureteral calculi, ureteroscopic stone removal under intravenous propofol anesthesia can be performed safely and effectively without any significant increase in morbidity or patient discomfort.

Comparison between Anterior Vaginal Wall Sling and Pubovaginal Sling Using Cadaveric Fascia Lata for the Treatment of Female Sphincteric Incontinence / 대한비뇨기과학회지

PURPOSE: Sling procedure has been performed mainly in stress urinary incontinence (SUI) patients with intrinsic sphincteric deficiency (ISD). The purpose of this study was to compare the safety and efficacy of anterior vaginal wall sling with pubovaginal sling using cadaveric fascia lata in the treatment of women with ISD. MATERIALS AND METHODS: Among 43 patients with ISD who had received sling procedure, we retrospectively compared 21 women treated with anterior vaginal wall sling (Group A) to 22 women treated with pubovaginal sling using cadaveric fascia lata (Group B). Preoperative evaluations included cystourethrography, urodynamic study and incontinence staging with SEAPI (stress-related leakage, emptying ability, anatomy, protection and inhibition) classification. The operation time, rate of complication, duration of suprapubic catheterization, length of hospital stay, postoperative presence of stress or urge incontinence, and satisfaction scores were checked. RESULTS: In group A, 17 patients (81.0%) were cured and 3 (14.3%) showed improvement within 14.2 months of mean follow-up, whereas in group B, 18 patients (81.8%) were cured and 3 (13.6%) showed improvement within 13.5 months. De novo urgency was presented in 2 patients (9.5%) from group A and 1 (4.5%) from group B. There was no statistically significant difference between the 2 groups in terms of complication rates and postoperative subjective SEAPI scores. CONCLUSIONS: We concluded that anterior vaginal wall sling and pubovaginal sling using cadaveric fascia lata are both effective surgical treatments for SUI with ISD.

Follow-up Results Exceeding 3 Years of Anterior Vaginal Wall Sling Operation for Female Patients with Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate the long term therapeutic results and complications of an anterior vaginal wall sling (AVWS) for female patients with stress urinary incontinence (SUI) followed up for over 3 years. MATERIALS AND METHODS: We analyzed 23 of 43 patients who could have been followed up for more than 3 years following an AVWS operation. The mean follow-up period was 40.2+/-5.3 months. The cystography and urodynamic study, including preoperative valsalva leak point pressure and subjective SEAPI scores, were examined in the patients. Postoperative analyses, including subjective SEAPI scores, success rates, satisfaction and complications were performed 3 years following the operations. RESULTS: The total preoperative subjective SEAPI score of 6.1+/-3.4 decreased postoperatively to 1.4+/-1.5 (p<0.001). Twenty one patients (91.3%) answered as "completely resolved" and one patient (4.3%) as "improved". Of the 12 patients accompanied by urgency preoperatively, 8 were completely improved directly following the operation, but the remaining 4 suffered longstanding urgency. De novo urgency occurred in 3 patients, but they all improved within 3 months with conservative management. Five patients (21.7%) suffered from postoperative inguinal pain, which improved in 4 after 3 months, an in about 9 months in the other. Subjective satisfaction exceeding 3 years following the operation was "very satisfactory" in 22 patients (95.6%). CONCLUSIONS: After more than 3 years, the 3 year follow-ups after AVWS operations in female patients with SUI showed a high success rate, high patient subjective satisfactions and reasonable complications. We think that an AVWS operation is an effective therapeutic procedure for female patients with SUI.

Pharmacological Effects of Berberine and Palmatine on the Prostatic and Urethral Smooth Muscle of the Rabbit

PURPOSE: One of the major medical treatments for benign prostatic hyperplasia is targeted toward reducing bladder outlet obstruction by alpha-adrenoceptor blockade to relax the smooth muscle tone of the prostate. Berberine and palmatine, an isoquinoline alkaloids, have varied pharmacological actions and have been extensively used in folk medicine. A previous large scale screening test revealed that berberine derivatives have antagonistic effects at the alpha1-adrenoceptors, although they are less potent than prazosin. The aim of this study is to investigate the effect of the berberine and palmatine on the contractility of the isolated prostate, urethral and vascular smooth muscle tissues of the rabbit. MATERIALS AND METHODS: Muscle strips of the prostate, urethra and renal artery were obtained from 10-week-old male New Zealand White rabbits. In vitro isometric contraction was measured using organ bath study. Cumulative concentrations of phenylephrine as an agonist were added to produce concentration-response relationships. Breberin (1-500 microM) and palmatine (1-500 microM) were added to the bath before the repeated phenylephrine-induced concentration-response curve was made. Responses of developed tension to phenylephrine were plotted as percentage of the maximal increase for each concentration-response curve in the prostate, urethra and renal artery strips. RESULTS: Phenylephrine produced concentration-dependent contractions on the rabbit prostatic and urethral preparations. Berberine and palmatine induced a dose-dependent rightward shift of the dose-response curve of phenylephrine-induced contraction of both prostate and urethra with a reduction of maximal response, indicating the interactions of the two agents with phenylephrine in noncompetitive antagonism. The rank order of potency of the inhibitory effect was palmatine > berberine in the urethral tissue, while there was no significant difference between the two agents in the prostatic tissue. In the renal artery strips, both berberine and palmatine did not significantly inhibited the maximal contractile response to phenylephrine (1-50 microM). Higher concentration of berberine (500 microM) and palmatine (100-500 microM) decreased maximal contractile response induced by phenylephrine (0-10 microM), while they paradoxically increased maximal contraction induced by higher concentrations of phenylephrine (50-100 microM). CONCLUSIONS: Our results indicated that berberine or palmatine inhibited phenylephrine-induced contractions in urethral and prostatic smooth muscles, with no significant inhibition in the renal artery smooth muscle at lower concentration ranges of berberine and palmatine. A deeper understanding of the action mechanisms of berberine and palmatine would widen our therapeutic options for voiding disorders.