Effectiveness of Magnesium Oxide and Sodium Thiosulfate in Calcium Oxalate Crystallization / 대한비뇨기과학회지

We investigated the comparative effect of magnesium and thiosulfate on the calcium oxalate crystallization. Magnesium is a strong inhibitor of calcium oxalate crystallization and it is sported to inhibit calcium phophate by about 20%. Even if it's mechanism is not clearly known, thiosulfat can resolve 250~100,000 times more than other calcium salts when it is combined with calcium. Wistar rats were fed by 1.0% ethylene glycol (EG) mixed with water. 500mg of magnesium oxide (MgO) per 100gm chows and 10mMo1 of S2O3 per 100gm chows were provided by oral intake respectively. Forty eight wistar rats were divided into following 6 groups. Each group has equal 8 wistar rats; A group (normal chow and water), B group (normal chow and 1%EG), C group (MgO and 1%EG), D group (MgO and water), E group (S2O3 and 1%EG), and F group (S2O3 and water). First, we examined calcium oxalate crystallization on bladder aspiration urine for 6 groups before the experiment and every week for 4 weeks after the experiment. Second, we also examined the degree of formation of calcium oxalate crystallization in renal tissue under polarizing microscope. Calcium oxalate crystallization was found in all 8 wistar rats in B group while it was not round in A, D, F group. Calcium oxalate crystallization was also found in one out of 8 wistar rats in C group, and 5 out of 8 wistar rats in E group. In conclusion, we believe that both MgO and sodium thiosulfate are effective in preventing calcium oxalate stone, and we also believe MgO is more elective than sodium thiosulfate. We think that further researches on administrating methods, the side effects and dosage of these two agents in human are necessary.

The Efficacy of Desmopressin Tablets in the Management of Nocturnal Enuresis / 대한비뇨기과학회지

BACKGROUND: In recent years the treatment of primary nocturnal enuresis (PNE) with desmopressin (DDAVP) has been promising. The route of administration until now had been intranasal, but because the tablets were introduced for the treatment of diabetes insipidus they have also become available for the treatment of PNE. PURPOSES: To find the efficacy and safety of the treatment with desmopressin tablets in a group of children with monosymptomatic nocturnal enuresis. Materials and METHODS: The efficacy and safety of at least 3 months of treatment with oral desmopressin (1-deamino-8-D-arginine-vasopressin) (DDAVP tablets, Minirin) at doses of 200 to 600 ug. at bedtime were investigated in 50 children (ages 5 to 15 years) with monosymptomatic nocturnal enuresis. The efficacy of the drug was measured in reductions of the number of wet nights per week. RESULTS: The number of wet nights per week decreased from a mean of 6.1 to 2.0 (p<0.01). During the treatment period, 22 (44%) patients could be classified as good responders (0 to 1 wet night per week) and 15 (30%) as responders (over 50% reduction of wet night) and 13 (26%) as nonresponders (less than 50% reduction of wet night). No side effects we.e observed. CONCLUSION: Oral desmopressin has a clinically significant effect on patients with monosymptomatic nocturnal enuresis, and therapy is safe when administered as long-term treatment.

Priapism Induced by Intracavernous Injection of Vasoactive Agents: Experience in 133 Patients / 대한비뇨기과학회지

Recently, the priapism is mostly seen after intracavernous injection of vasoactive drugs for the diagnosis and therapy of erectile dysfunction. Prompt relief of the priapism is essential to prevent ischemia and fibrosis of the corpora with resultant impotence. Of 2992 patients who have used intracavernous injection of vasoactive agents for diagnostic and therapeutic purposes of erectile dysfunction (August 1986-June 1995), 133 men (4.4%) experienced priapism persisting for more than 4 hours. Mean patient age was 45.6 (23-70) years. The etiology of impotence was psychogenic in 60.2%, unclear in 16.5%, vasculogenic in 10.6%, diabetogenic in 8.3%. The vasoactive agents used for the intracavernous injection were: 1) papaverine, 2) dimix; a mixture of papaverine (27. 3mg/ml) and phentolamine (0.9mg/ml), 3) trimix; a mixture of papaverine (18.8mg/ml), phentolamine (0.5mg/ml) and PGE1 (6.3mg/ml). The incidence of priapism was 3.8% in papaverine, 7. 7% in dimix and 0.7% in trimix. The average doses of papaverine, dimix and trimix to have developed the priapism were 30.3+/-9.8mg, 0.4+/-0.3ml and 0.15+/-0.1ml, respectively. Average duration of the priapism was 8.6 (4-59) hours. Priapism usually developed during diagnostic workup (63.2%) and initial dose determination phase of treatment (32.3%). The priapism resolved spontaneously in 44.4%. The priapism was treated by aspiration alone in 17.3% and irrigation with 0.1% epinephrine solution in 37.6%. One patient required cavernosaphenous shunt operation. The potency became worse after resolution of the priapism in 5 among 34 patients of follow-up. The etiology of impotence in these 5 men was vasculogenic (1/3), psychogenic (2/22) and unclear (2/4). In conclusion, trimix is the best drug among the 3 regimens for the intracavernous self-injection in terms of lowest incidence of drug-induced priapism. Vasculogenic impotence patient seems to have a greater risk of worse potency after resolution of the priapism.

The Effectiveness of Imipramine and Desmopressin in the Treatment of Enuresis / 대한비뇨기과학회지

Nocturnal enuresis is by any standard the most benign voiding dysfunction in children, with a spontaneous cure rate of up to 15% per year. On the other hand it is one of the most sociopsychologically disturbing diseases in children because of its association with taboos and rites, and for families with bedwetters it is also a significant economic burden. Many investigators have reported upon the effectiveness of drugs in alleviating nocturnal enuresis in children and adults. We evaluated the results of drug therapy in 60 children with nocturnal enuresis: 42 boys and 18 girls. mean age 8.7 years(range 5-15). All children were evaluated after treatment with imipramine, and the response rate of imipramine was 76.7%. For the remaining 14 non-responders, desmopressin was given intranasally at bedtime. And the response rate of desmopressin was 64.3%. So, the overall response rate of imipramine and desmopressin was 9l.7%. No serious side effects were observed. These data show that the combined therapy with imipramine and desmopressin is very effective in treating enuresis.

Changing Trend in the Treatment Modalities of Erectile Dysfunction / 대한비뇨기과학회지

There has been remarkable progress in the treatment of erectile dysfunction during last decade. We have analyzed 2,000 patients with erectile dysfunction who had been treated with a variety of treatment modalities during last 10 years to identify the annual changes in the proportion of the respective treatment modality. The most remarkable change was seen in the proportion of patients treated by vasoactive pharmacotherapy The proportion was 12.0% on 1984, which was gradually increased in time, and reached to 82.1% on 1994. Another remarkable change was found in the proportion of patients treated by surgery, especially vascular surgery : The proportion of patients treated by penile prosthesis implantation on 1985 and vein ligation on 1986 was 64.0% and 14.3%, respectively ; whereas, it was decreased to 1.8 % and 0% on 1994, respectively. In conclusion, we could find remarkable change of trend in the primary treatment modality for erectile dysfunction from invasive and costly surgical treatment to less invasive and cheap vasoactive pharmacotherapy. Nowadays, intracavernous self-injection of vasoactive agents plays a primary role in the treatment of impotence. Penile prosthesis implantation remains as the last treatment modality for erectile dysfunction. However, vascular surgery is rarely being performed nowadays because of its poor long-term outcome.

A comparison of the relaxation responses of isolated cavernosal smooth muscles by endothelium-independent and endothelium-dependent vasodilators in diabetic men with impotenc

This study was intended to explore the effects of endothelium-independent, direct smooth muscle relaxants(papaverine, verapamil) and endothelium-dependent vasodilators(acetylcholine, bradykinin, adenosine) on the isolated cavernosal smooth muscle strips taken from diabetic men with impotence. When smooth muscle contraction was evoked with norepinephrine for the study of relaxation to these vasodilators, the tension induced was similar in diabetic and non-diabetic men with importance. Papaverine showed the strongest relaxation response followed by verapamil, acetylcholine, bradykinin and adenosine both in non-diabetic and in diabetic men. Relaxation of the cavernosal tissues to endothelium-independent vasodilators was similar in non-diabetic and diabetic men. However, the relaxation response of the tissues to endothelium-dependent vasodilators was significantly reduced in the diabetic group compared with that in the non-diabetic group (p<0.05). In conclusion, the impairment of endothelium-mediated relaxation of cavernosal smooth muscle seems to play a more important role in the pathogenesis of diabetogenic impotence rather than the problem of smooth muscle itself. This finding forms a rational basis for the use of intracavernosal injections of vasodilators to induce endothelium-independent relaxation of the cavernosal smooth muscle in the patients with diabetogenic impotence.

Bilateral fractures of Hydroflex penile prostheses: an unusual complication

We report bilaterally fractured Hydroflex implants in 2 patients. One fracture was complete and three were incomplete. All the fractures occurred at the junction of the rear reservoir and the inflation chamber.