Penile Reconstruction after Extensive Excision of Sclerosing Lipogranuloma: How to Make the Shape of Scrotum, Penile Shaft and Suprapubic Region with a Rectangular Radial Forearm Free Flap

The authors had five cases of penoplasty from more than half of the scrotum to the suprapubic region using a fasciocutaneous radial forearm free flap (RFFF) after extensive excision of sclerosing lipogranuloma. Although the harvested RFFF was a rectangular shape, the authors made the shape of scrotum, penile shaft, and suprapubic region by using well designed geometry and several quilting sutures on junction of scrotum and penis. The contour of scrotum and penis was well maintained, and there were no complications, such as scrotal contracture, penile deformity, and erectile dysfunction during the one year follow up period in all five cases. There were no recurrent lesions and no need for further surgery.

Role of nitric oxide in penile erection

The present study was undertaken to investigate the role of nitric oxide (NO) in erectile physiology by correlating its action with the existence and activity of nitric oxide synthase (NOS), which produces NO. We applied Western blot analysis in both human and rat penile tissue. In the rat, reduced nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase staining and spectrophotometric assay were also performed, in addition to in vivo electroerection study with pharmacological manipulation. Western blot analysis identified a protein of 155 KDa identical to the neural form of NOS in the human and rat penis. The NOS blot densities in the two species were similar, and both were lower than that in the rat cerebellum. Histochemical staining localized NOS to neurons innervating the corpora cavernosa, including the pelvic plexus, the cavernosal nerves and their terminal fibers within the corporeal erectile tissue, and dorsal penile nerves. NOS activity was also found in the cerebellum, urethra, penis, and urinary bladder, in decreasing order of intensity. Intracavernous injections of NOS inhibitor (L-NOARG or L-NAME in concentrations from 10(-6) M to 10(-3) M suppressed electrostimulation-induced erection in a concentration-dependent manner. Subsequent intracavernous injection of L-Arginine (10(-2) M) partially restored the erection. The neural form of constitutive NOS in the corpora cavernosa synthesizes NO, which mediates penile erection. Determination of cavernosal NOS expression or activity may permit characterization of certain pathological conditions that cause impotence.

Embryologic Discission of the Median Raphe Cyst: Two Cases Report / 영남의대학술지

Median raphe cyst is known as congenital lesion of the perineum and genitalia, but its etiology is unclear. Most investigators believe that the median raphe cyst represent defects in the embryologic developenient bf the male genitalia. Simple surgical excision is effective in most cases. We report our experience with two cases of median raphe cyst without specific symptoms. Even though median raphe cyst is asymptomatic, surgical therapy is worth applicable because it relieve a patient from cosmetic and psychotic problem.

Effect of Hybrid Laser Prostatectomy and Laser Thermotherapy on Benign Prostatic Hyperplasia / 대한비뇨기과학회지

Recently, laser treatment of benign prostatic hyperplasia (BPH) is considered as a promising alternative to traditional transurethral resection of the prostate (TURP). To evaluate the effectiveness and safety of laser therapy on BPH, we compared the results of transurethral balloon laser thermotherapy (TUBALT, n=13) and Hybrid laser prostatectomy (HLP, n=21) with those of TURP (n=25) in 58 patients with mild and moderate BPH. Following data were evaluated at postoperative 1, 3 and 6 months : AUA symptom score (SS), maximal flow rate (Qmax), subjective symptom improvement (SI), postoperative complications. All 3 groups show significant improvement after treatment in the Qmax values. Among 3 groups, the Qmax value was lower in TUBALT group (12.9+/-3.3 ml/sec) than those in HLP group (15.5+/-5.2 ml/sec) and TURP group (18.7+/-5.3 ml/sec) on postoperative 6 months. The Qmax values were not significantly different between HLP and TURP groups. In the SS values, all 3 groups show significant improvement after treatment and, TUBALT (9.9+/-9.7) and HLP (10.3+/-9.4) group were comparable to TURP group (5.2+/-4.2) on postoperative 6 months. In global assessment of SI, both HLP (87.5%) and TUBALT (75%) group were also comparable to TURP (90%) group on postoperative 3 months. but TUBALT group showed delayed symptom improvement compared to TURP group. Postoperative complications were minimal both in HLP and TUBALT groups, compared to TURP group. These results suggest that both HLP and TUBALT are effective in mild and moderate BPH, Further more, HLP treatment could be considered a promising alternative to TURP.

Physiological Role of Vasoactive Intestinal Polypeptide on Penile Erection in Rats / 대한비뇨기과학회지

Vasoactive intestinal polypeptide (VIP) has a vasodilatory effect as a non-adrenergic, non-cholinergic neurotransmitter. The role of VIP on penile erection has been controversial. This study was undertaken to elucidate the effect of VIP on penile erection in-vivo and to predict whether this drug can be clinically applied to the diagnosis and/or treatment of impotence. The results are as follows. Intracavernosal injection of VIP alone (0.000000001to 0.00001M, n=10) did not show any increase in basal ICP Pretreatment of VIP (0.000005M, 0.00001M, n=7) enhanced partial erection induced by electric intensity with suboptimal level(frequency; 1 Hz, intensity; 1.2-2.0 volt, pulse duration, 1 msec.) (p<0.05)Intracavernosal injection of VIP-antagonist (0.000000001 to 0.00001M,n=7) was found to suppress the full erection induced by the optimal electric stimulation(frequency; 1 Hz, intensity; 3-4 volt, pulse duration; 1 msec.) in dose dependent manner (p<0.05). These results suggest that VIP may induce penile erection in rat through its receptor on corpus cavernosum, although it requires the cooperative action of other neurotransmitter(s).

Ureteroappendicocutaneostomy(Appendix conduit): 4 Cases / 대한비뇨기과학회지

Cutaneous urinary diversion with intestinal conduits after cystectomy in bladder cancer has been popular. However, because of loss of continence and storage capacity of the lower urinary tract, the situation of patients with an ileal conduit was far from satisfactory with respect to quality of life. Recently, continent urinary diversion has begun to achieve worldwide popularity as Kock, Mainz, or Indiana pouch techniques have been more feasible and accessible, but these techniques have been known as time consuming procedures. In high risk patients with bladder carcinoma more simple techniques of urinary diversion is needed. Herein, we report the outcome of ureteroappendicocutaneostomy (appendix conduit) with radical cystectomy performed in 4 bladder carcinoma patients in whom unilateral nephroureterectomy was necessary or previously done.