Three-Dimensional Arrangement of Muscle Fibers, Collagen and Elastin Fibers of the Proximal Prostatic Urethra in Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Anatomical change of the prostatic stroma, that is benign prostatic hyperplasia, results in a functional change which manifests as lower urinary tract symptoms (LUTS). We observed/investigated whether there are structural changes in the three-dimensional arrangement of muscle, collagen and elastin fibers of the prostatic urethra which can be another possible mechanism of LUTS. MATERIALS AND METHODS: Hyperplastic nodules, which were surgically en bloc resected, and normal prostate from radical cystectomy specimens were examined. Surgical specimens were fixed in formalin and sectioned serially in a transverse plane along the lumen of the upper segment of the prostatic urethra. Additional sagittal sections were also made serially. All tissue blocks were 2mm thick. All slides were prepared with hematoxylin-eosin, Masson-trichrome and Verhoeff's elastin stain. RESULTS: Muscle and collagen fibers surrounding prostatic acini seemed poorly oriented and blended with the outermost fibers of the urethra. Muscle and stromal fibers surrounding the prostatic urethra seemed to be stretched and oriented mainly in the longitudinal direction with small fibroblastic nodules in the periurethral stroma. A periurethral gland structure was observed between the urethral wall in which the fiber was arranged longitudinally. Circular muscle fibers were not observed in the periurethral area, indicating that the surgical capsule resulted from urethral muscle fibers. CONCLUSIONS: Apparent changes to the 3-dimensional arrangement of collagen, elastin and muscle fibers surrounding the acini and prostatic urethra were not observed in the proximal prostatic urethra or the bladder neck, except that the fibers surrounding the urethra were stretched.

Combination Therapy of Imipramine and Desmopressin in Children with Monosymptomatic Nocturnal Enuresis / 대한비뇨기과학회지

PURPOSE: We prospectively studied to evaluate the therapeutic effect of combination therapy of imipramine and desmopressin on the monosymptomatic nocturnal enuresis. MATERIALS AND METHODS: From April 1997 to July 2000, all of 129 monosymptomatic enuretic patients were randomized to three groups: combination therapy group of imipramine and desmopressin (I+D, 46 cases), imipramine group (I, 43 cases) and desmopressin group (D, 40 cases). We performed motivational counselling, reduction of fluid intake prior to bed time and voiding diary in addition to drug thrapy. Therapeutic response was classified as excellent (0-1 wet night/week), good (over 50% reduction of night) and poor responder (less than 50% reduction of night). RESULTS: Therapeutic response in group I+D, I and D were excellent in 84.8%, 81.4% and 60.0%, good in 10.9%, 11.6% and 35.0% and poor in 4.3%, 7.0% and 5.0%, respectively. As compared with group I and D, average response duration in group I+D was significantly shorter (p<0.05). There was no significant difference of relapse rate at 3 months after cessation of medication in excellent responders among each groups. There were no significant side effects in all of three groups. CONCLUSIONS: These data suggest that combination therapy of imipramine and desmopressin has no better therapeutic effect than impramine or demopressin monotherapy on the monosymptomatic nocturnal enuresis, except shorter average response duration.

Color Doppler Energy(CDE): Initial Ten-Months Experience

PURPOSE: Color Doppler Imaging(CDI) has shortcomings, including random noise, aliasing, and angle dependence. To overcome these, a method using CD US, termed power doppler or Color Doppler Energy(CDE), has recently been introduced. The purpose of this study was to show the clinical usefulness of CDE. MATERIALS AND METHODS: We retrospectively analyzed the CDI and CDE of 61 cases(20 renal pseudotumors, 8 musculoskeletal inflammations, 17epididymitis or epididymo-orchitis, 3 vaicoceles, 1 normal testis, 1 hepatocellualar carcinoma, 7 renal cell carcinomas, 1 renal angiomyolipoma, and 3 splenic varices). CDI and CDE scans were obtained at the same region with constant scan plane. The color gain was increased until noise first became perceptible, and scans were always obtained in such a way that the maximum amount af vascularity was shown. There after, the vascularity, vascular displacement, and the vascular relationship between CDI and CDE were compared. RESULT: In 17 of 20 cases of pseudotumor in the kidney, normal vascularity was identified in CDI and CDE, but was more clearly visible in CDE. In three cases, there was no visible vascularity in CDI, but normal vascularity in CDE. In eight cases of musculoskeletal inflammation and 17 cases of epididymitis with or without or chitis, the vascularity was increased due to hyperemia, which was more prominently seen in CDE than in CDI. In three varicoceles, CDE appeared to bebetter in demonstration low velocity flow. In one patient who was suspected of having acute testicular torsion, CDE was helpful in excluding this suspicion. In one case of hepatocellular carcinoma, seven cases of renal cell carcinoma, one case of renal angiomyolipoma, and three cases of splenic varices, CDE was better than CDI in showing the vascularity, vascular relationship, and vascular displacement. CONCLUSION: CDE is a potential lyuseful adjunct to standard CDI.

Studer's Pouch: Clinical Experience and Evaluation / 대한비뇨기과학회지

Studer's pouch was evaluated clinically and urodynamically. The pouch was constructed for bladder substitution in 18 and for bladder augmentation in 2 from July 1990 to November l995. Three patients of substitution were not included in this review because of operation related death in 1 case and short period(<6 months) of follow-up in 2 cases. Mean age is 53.2(range: 22-69) years. Mean follow-up period is 22.2(range: 2-64) months. Mean cystometric capacity was 445 ml, mean intraluminal pressure at 200 ml and 400 ml filled was 12.8(range: 5-30) and 23.7(range: 5-45) cmH2O, respectively. Maximal urethral closure pressure was 54.3(range: 18-112) cmH2O in bladder substitution cases. Maximal flow rate was 19.1(range: 12.9-26.0) ml/sec. Mean residual urine was 37.8(range: 0-80) ml. Reflux into ileal limb occurred in all patient at mean volume of 227(range : 30-400) ml. Reflux into kidney occurred in 20 of 24 renal units at mean volume of 291(range : 50-450) ml, but it drained completely and rapidly in all cases. No pelvocalyceal ectatic changes were seen. Urine was sterilized in 9 patients. Recurrent bacteriuria occurred in 6 patients. All of them had been controlled by parenteral antibiotic therapy. All of 15 substitution patients were completely continent during daytime. Two had mild daytime stress incontinence in early postoperative period, but which is improved as time passing. Three of them have nighttime incontinence. One of three has intermittent incontinence and is using a diaper for prevention from bed wetting. Two have total nighttime incontinence using a kismo every night. Though longer follow-up should be needed to confirm the safety of upper tract, we think that Studer's pouch seems not only to guarantee the continence but to be rather simple and easy to perform.

Two Cases of Long Ureteral Polyp in Adult / 대한비뇨기과학회지

Benign fibrous polyps of ureter are rare. Recently, the rate of preoperative diagnosis and conservative management was progressively increased due to developed endoscopic procedures. Two additional cases of long, fibrous ureteral polyps, one with obstruction of contralateral ureteropelvic junction and the other with protruding mass to bladder, are reported with a brief review of literatures.

A Case of Obliteration of the Urethral Lumen after Wallstent Implantation / 대한비뇨기과학회지

Endoscopic intraluminal implantation of a self-expandable permanent urethral stent ( Wallstent) has found increased use in patient with recurrent urethral strictures because of its simple implantation technique. But there has been a few reports of explantation due to complete luminal obstruction. Herein we report one with literature.

The Experiences of Cloacal and Bladder Exstrophy: 3 Cases / 대한비뇨기과학회지

The pathogenesis of bladder and cloacal exstrophy is an abnormal development of the cloacal membrane. The incidence of each is one in l0,000-50,000 and 200,000-400,000 live births. Male is more commonly affected than female. We experienced two cases of bladder exstrophy and one cloacal. First case was one-day-old girl who was referred to our department because of urine leakage through defected abdominal wall. We performed primary bladder closure with paraexstrophy skin flap urethroplasty, approximation and traction of pubis without osteotomy and application of hip-spica cast. The second was seven-day-old boy visited our department because of urine and stool leakage. We performed primary bladder closure, bilateral orchiectomy and ileostomy. He recurred bladder exstrophy due to infection of operation site. The third was twenty-day-old boy visited our department because of urine leakage. We recommended admission and treatment, but his parents refused further evaluation.

Multicystic Dysplastic Kidney: Report of Four Cases / 대한비뇨기과학회지

During the last decade, with the advent of prenatal ultrasound, multicystic dysplastic kidney is diagnosed with increasing frequency But the management of multicystic dysplastic kidney continues to be an ongoing controversy regarding both its cause and its current management. Herein we reviewed the records of four cases at our hospital between 1983-1993. All were unilateral and three cases were removed surgically and last one was observed and followed up only. The first case was a ten-month-old girl who was referred to our department because of hydronephrosis of kidney. The second was a five-year-old boy with chief complaints of flank pain. The third was a three-month-old girl, and the fourth was a two-day-old girl. Last two cases were referred to our department because of a sustained cystic dilatation of kidney detected by prenatal ultrasonography.

Components of 213 Cases of Urinary Calculi Analyzed by X-ray Diffraction method / 대한비뇨기과학회지

Two hundred thirteen urinary calculi were analyzed by X-ray diffraction method, which were obtained from the patients who were treated at the Department of Urology, Pusan National University Hospital from May 1989 to October 1993. The composition of our stone is classified to eleven. Pure stone was comprised 59.2 percents of all cases, and mixed stone was 40.8 percents of total. Calcium stone was 78.9 percents of all cases and non-calcium stone was 21.1 percents. Comparison with other clinics result using same study, the ratio of uric acid is significantly high. Calcium oxalate was the most common type in pure calculi( 83.3%) and mixed calcium oxalate and calcium phosphate calculi was the most common type in mixed calculi(52.9%) Calcium oxalate stone was the most common among the stones containing calcium, constituting 110(51.6%). Urate stone was the most common in non-calcium stone, constituting 24(11.3%) Ammonium acid urate containing stone was the largest in their size, uric acid stone was the smallest.

Study of histopathological changes in retrograde pyelonephritis in rabbit / 대한비뇨기과학회지

Although many experiments of renal infection in animals have been studied, its pathway, regional pathogenesis and the healing process are yet to be cleared exactly. Especially in human. we have infrequent opportunities to study the pathologic changes of the acute pyelonephritis by renal biopsy, because ot accompanying general symptoms such as fever and bacteremia. This study underwent to define these changes exactly. A strain of Escherichia coli No.018 :K77 was inoculated to rabbit bladder to produce retrograde pyelonephritis. The histopalho1ogical changes at the early stage of acute pyelonephritis, the pathways of bacterial invasion, distribution in the infected kidneys and healing process were studied by using light and electron microscope. The histopathological changes were characterized by degeneration and destruction of renal pelvis and tubular epithelial cells, and a massive infiltration of polymorphonuclear leukocytes. The inflammatory changes were initially found at renal fornix and progressed to medullar after 7 hours of bacterial inoculation. These changes extended to basement membrane accompanying with discrete chronic inflammatory changes after 9 hours. The inflammatory changes extended to cortex with bacilli within blood vessels after 12 hours and sustained until the end of first week. The chronic inflammatory. changes subsided as a whole of renal parenchyma until eighth weeks. Therefore we concluded that the retrograde pyelonephritis in rabbit extends rapidly from forniceal mucosa to capsule through tubule, interstitium and blood vessels, and the natural healing process occurs diffusery for longer period.