Penile Injury During Erection: The Clinical Manifestations and Results of Operative Treatment / 대한비뇨기과학회지

This study was designed to evaluate the clinical manifestations and results of operative treatment in penile injury during erection. We reviewed 18 cases of penile injury during erection from December 1992 to June 1996. Of 18 patients, 14 patients were treated with early operation, 3 patients with conservative treatment and followup was 1 to 31 months (mean: 14.1 months). Patients age ranged from 23-76 years old (mean: 39.6 years), common cause of the injury was sexual intercourse (8 cases), masturbation (3 cases) and finger-pressure (2 cases) in order. Of 8 patients who occurred during sexual intercourse, 7 patients were married. The injury developed at midnight in 8 cases (44%), early morning in 7 cases (39%) and the other times in 3 cases (~7%). Of 14 patients who received with early operation, 13 patients revealed rapture of the corpus cavernosum and 1 patient revealed rupture of superficial dorsal vein. The site of penile fracture showed proximal shaft in 8 cases (62%), midshaft in 3 cases (23%) and distal shaft in 2 cases (15%) in order. The overall complication rate of early operative treatment was 15% (2 of 13 cases) compared to a complication rate of 100% (2 of 2 cases) for conservative treatment. In conclusion, our experience demonstrates that the most common cause and site of penile injury are sexual intercourse and proximal shaft, early operative treatment would be an effective treatment of penile injury to prevent complications.

A Case of Metastatic Epididymal and the Other Metastatic Testicular Carcinoma from Sigmoid Carcinoma / 대한암학회지

Metastatic tumor of the epididymis is a rare tumor. There are around 31 cases in the literature until now. The primary tumor was from the prostate in 18 cases, large and small intestine in 6 cases, kidney in 4 cases, stomach in 2 cases and pancreas in 1 case. We recently experienced a case of metastatic carcinoma to the epididymis from a primary cancer in the sigmoid colon and the other case of metastatic carcinoma to the testis and the liver from a sigmoid adenocarcinoma.

Inhibitory Effect of Purinergic Antagonists to the Electrically Stimulated Contraction of Canine Detrusor Muscle / 대한비뇨기과학회지

Cholinergic neurotransmission plays a major role in the postganglionic nerve evoked contractile response of the urinary bladder, but there is atropine-resistant contraction that is not completely blocked by atropine and may be related with nonadrenergic-noncholinergic (NANC) neurotransmission. Among the NANC neurotransmission, adenosine triphosphate(ATP) is an important transmitter in purinergic neurotransmission which is known to many vertebrates including human beings. The aim of this study is to determine the role and existence of purinergic neurotransmission in the canine detrusor muscle. In vitro contractile responses to electrical stimulation after pretreatment with atropine were measured in the presence of purinergic antagonist such as theophylline, b, r-methylene ATP and verapamil. Field stimulation( frequency 0.5-40 Hz; pulse width l ms; 10V square wave) produced a contraction that was abolished by tetrodotoxin( 0.1uM) and reduced by 42.5% after atropine ( 10uM) pretreatment. The contractile response was reduced by 44.1%, 30.3% and 60.1 % after the treatment of theophylline( 1uM, 10uM and 100uM) in the presence of atropine, 11.1%, 22.7% and 30.3% after the treatment of b, r-methylene ATP ( 5uM, 50uM and 500uM) and 17.6%, 39.4% and 60.1 % after the treatment of verapamil( 0.1u M, 1uM and 10uM) at 20 Hz frequency. These reduced contractile responses were statistically significant (p <0.05), especially in higher concentration, and relatively frequency-dependent and verapamil decreased the contractile response most significantly. These data demonstrate that purinergic neurotransmission is related to the contraction of canine detrusor muscle. On the other hand contractile responses were persisted after pretreatment of higher dose antagonist, which suggests that another mechanism such as peptidergic mechanism be related to the contraction of canine detrusor muscle.

Two Cases of Xanthogranulomatous Epididymitis / 대한비뇨기과학회지

Xanthogranulomatous epididymitis is an atypical form of severe destructive epididymal infection, characterized by massive inflammatory cell and foamy histiocyte microscopically. We report two cases of xanthogranulomatous epididymitis that presented as epididymal inflammation with fluid collection in old aged patients, and resulted in orchiectomy. We suggest that xanthogranulomatous epididymitis should be considered as one of the differential diagnosis in epididymitis with abscess formation.

Diagnostic Value of Color Doppler Ultrasonography and Testicular Scintigraphy in Acute Scrotum / 대한비뇨기과학회지

Color Doppler ultrasonography and testicular scintigraphy were used to evaluate 43 patients with acute scrotal pain. Color Doppler ultrasonography predicted properly the need of surgery in 5 of 6 patients with testicular torsion but testicular scintigraphy correctly diagnosed all 11 patients with testicular torsion. Color Doppler ultrasonography demonstrated increased epididymal or testicular flow in all 27 patients with acute epididymitis and testicular scintigraphy showed increased uptake in all 7 patients with acute epididymitis. But Color Doppler ultrasonography misdiagnosed 1 patient with testicular torsion as acute epididymitis and testicular scintigraphy misdiagnosed 1 patient with pyocele as testicular torsion. The authors found that the sensitivity and the specificity of color Doppler ultrasonography were 83% and 100% and the sensitivity and the specificity of testicular scintigraphy were 100 % and 89% in the diagnosis of testicular torsion. Color Doppler ultrasonography is as effective as testicular scintigraphy and it is an accurate and rapid diagnostic method in assessing perfusion and anatomy of the acute scrotal lesions.

The Prospective Study on the Role of Tissue Flow Cytometry in the Superficial Bladder Tumor / 대한비뇨기과학회지

In 69 patients with primary superficial bladder tumor, the DNA flow cytometric analyses with fresh bladder specimen were performed prospectively to investigate the correlation between the DNA ploidy and the tumor recurrence or progression. And we compared it with the histologic parameters such as tumor stage or grade to assess its role as a prognostic indicator. Of the total 69 patients, 28 patients showed aneuploidy patterns, of whom 6 patients in grade 1, 15 patients in grade 2, and 7 patients in grade 3. Mean follow-up was 25.1 months and mean annual recurrence rate was estimated to assess the tumor recurrence. There was significant difference in mean annual recurrence rate between grade 2 and 3 (0.40 and 1.09) but no difference between grade 1 and 2, and stage Ta and T1. Mean ann-ual recurrence rate was 0.89 with aneuploid tumors and 0.29 with diploid tumors (p<0.05 ). And especially in patients with grade 2 tumors which have been known as unpredictable group by classic histologic prognosticator, mean annual recurrence rate was 0.88 with aneuploidy and 0.24 with diploidy. Among 55 patients on follow-up, 6 (10.9% ) have progressed to invasive tumors, of whom two were with T1 grade 2 and four were with T1 grade 3. All but one of them showed aneuploidy on flow cytometry. These results indicated that DNA ploidy using fresh bladder specimen can be used as an effective adjuvant to histologic examination for the prognostication and decision-making in the treatment of superficial bladder tumor patients.

Change of the fraction of immunocompetent cells after intravesical BCG instillation / 대한비뇨기과학회지

Intrarvesical instillation of Bacillus-Calmette-Guerin (BCG) is known to be one of the most effective treatment for prevention of recurrent transitional cell carcinoma of the bladder, but its mechanism of action is not well defined yet. We evaluated the fraction of immunocompetent cells in peripheral blood of 17 patients with transitional cell carcinoma of the bladder before and after intravesical instillation of BCG. Among them, 7 patients had TURB and instillation of BCG(BCG group) and others had TURB only (non-BCG group). The fraction of B cells, total T (T3) cells, helper T (T4) cells, suppresser T (T8) cells, and natural killer (NK) cells in peripheral blood was determined using flowcytometric analysis. No significant changes of the fraction of B cells, T3, T4, T8 cells and T4/T8 ratio were noted after BCG instillation. The fraction of NK cells was significantly increased at 1 month after the start of BCG instillation (P=0.03), however, there was no significant increase in the fraction of them at 1 month after completion of 6 week course BCG instillation. In addition, none of parameters measured in this study showed any significant difference between BCG group and non-BCG group either before or after BCG instillation. Since no significant changes of systemic immune parameters in patients with transitional cell carcinoma of the bladder were observed after BCG instillation, local immune response may play a major role in the mechanism of BCG action for prevention of tumor recurrence.