Adult Type Granulosa Cell Tumor of the Testis / 대한비뇨기과학회지

Testicular granulosa cell tumor(GCT) is a rare neoplasm. We report here on an incidentally discovered testicular granulosa cell tumor in a 36-year-old man. The serum tumor markers were within the normal limits. The ultrasonographic findings revealed a mass with a heterogenous hypoechoic echotexture, including multiple variable sized cystic components. The histology on the orchiectomy specimen demonstrated a gonadal stromal tumor with granulosa cell features. Testicular granulosa cell tumor of the adult type is a very rare tumor, and there have been several isolated case reports and small serial studies described in the literature.

Predicting Factors for Spontaneous Passage of Ureteral Calculi Based on Unenhanced Helical CT Findings / 대한비뇨기과학회지

PURPOSE: We performed a prospective study to determine whether unenhanced helical computed tomography(UHCT) findings predict the spontaneous passage of ureteral calculi. MATERIALS AND METHODS: Between April 2006 and June 2007, 175 patients with a single ureteral calculus <1cm in diameter were enrolled in this study, and a UHCT was performed. All of the patients were managed conservatively for 2 weeks. Patients without spontaneous passage of ureteral calculi within 2 weeks were treated by ureteroscopy or extracorporeal shock wave lithotripsy(ESWL). The secondary signs (hydronephrosis, perinephric edema, and the tissue rim sign) were graded on a scale of 0-3. We evaluated whether spontaneous passage of ureteral calculi was associated with stone diameter, location, Hounsfield units(HU), and the degree of secondary signs. RESULTS: Ninety-two patients(52.6%) had spontaneous passage of ureteral calculi. The mean stone diameter was significantly smaller in the passage group than the non-passage group(4.28mm vs. 6.73mm, p=0.002). The rate of spontaneous passage was significantly higher involving distal ureteral calculi(66.1%) than proximal ureteral calculi(30.3%, p<0.001). The incidences of hydronephrosis and perinephric edema were significantly lower in the spontaneous passage group than the non-passage group(8.7% vs. 73.5% and 5.4% vs. 69.9%, respectively). The grades of hydronephrosis and perinephric edema were significantly lower in the spontaneous passage group than the non-passage group(p=0.001). Although there was a tendency toward increasing grades of hydronephrosis and perinephric edema with increasing stone size, the grades were more frequent and severe in the non-passage group in patients with similarly sized stones. CONCLUSIONS: The degree of hydronephrosis and perinephric edema are useful ancillary signs in predicting the likelihood of spontaneous passage of ureteral calculi.

Vaginal Erosion and Pelvic Abscess after Anterior Intravaginal Slingplasty (IVS) in Patient with Stress Urinary Incontinence

Midurethral slings are increasingly popular for the surgical treatment of stress urinary incontinence. They are relatively simple to implant and shorten operating time, hospital stay, and recovery time. Tension free vaginal tape (TVT) and Intravaginal slingplasty (IVS) mesh are both polypropylene mesh. TVT is a type I totally macroporous mesh which, because of pores larger than 75 microns, admits bacteria, macrophages, and fibroblasts into the pores. IVS is a type III mesh with microporous components which admits bacteria but not macrophages. So anterior IVS appear to be more at risk of infection or vaginal erosion than other monofilament mesh. We report our experience with a patient who underwent anterior IVS and developed erosion of the mesh through vagina, creating pelvic abscess.

Mixed Hemangioma of the Epididymis / 대한비뇨기과학회지

A hemangioma is a benign tumor arising in the vessels, but an intrascrotal hemangioma is rare, and a hemangioma of the epididymis is extremely rare. Ultrasound and MRI (magnetic resonance imaging) are mainly used for the diagnosis of an intrascrotal hemangioma, with surgical excision being the appropriate treatment. We report on the case of a 24 year- old-man with a mixed hemangioma of the epididymis.

Expression of Bcl-2 Gene in Human Renal Cell Carcinoma Associated with Drug Resistance and Metastatic Potential / 대한비뇨기과학회지

PURPOSE: To investigate whether the up-regulation of Bcl-2 gene expression may be associated with chemotherapy resistance and malignant progression in human renal cell carcinomas (HRCC). MATERIALS AND METHODS: The HRCC cell line, SN12C, was cultured in MEM medium, supplemented with 10% FBS. Full length of Bcl-2 cDNA was obtained using the sense primer (5'-ATGGCGCACGCTGGGAGAACGG-3') and the antisense primer (5'-TCACTTGTGGCTCAGATAGG-3') and inserted into SN12C cells to establish stable cells expressing the Bcl-2 gene (SN12C/smcb2). To investigate the response to doxorubicin in orthotropic organs, SN12C/smcb2 and parental cells were implanted into the subcapsular renal tissue of nude mice (n=5). The mice were treated with doxorubicin (8mg/kg) on days 8 and 15 following tumor cell implantation. Tumor tissues, obtained from the kidneys and lungs, were ex vivo cultured (SN12C/smcb2-kidney and SN12C/smcb2-lung, respectively). To compare the metastatic potential in these cell lines, the gelatinolytic activity was measured by zymogram and the expression of type IV collagenase (MMP-9) examined by western blot. RESULTS: In the in vitro study, the SN12C/smcb2 was more resistant to doxorubicin than the parental cells, and treatment and those cells produced a higher rate of tumor formation and metastasis. The SN12C/ smcb2-kidney showed higher gelatinolytic activity than the parental cells. Higher expression levels of type IV collagenase were detected in the SN12C/smcb2-lung and SN12C/smcb2-kidney, but barely detected in SN12C. CONCLUSIONS: The up-regulation of Bcl-2 gene expression in HRCC cells induces drug resistance to doxorubicin and increases the metastatic potential. Although the drug resistance induced by Bcl-2 over-expression enhances distant metastasis (lung), the up-regulation of Bcl-2 may enhance the malignant potential of tumor cells and produce distant metastasis.

The Early Experience of Sling Procedure Used Remnant Anterior Vaginal Wall Tissue with Grade III Cystocele / 대한비뇨기과학회지

PURPOSE: In patient with grade III cystocele, to determine whether the anterior vaginal wall tissue, remnant at the anterior colporrhaphy, is an appropriate sling material, we retrospectively reviewed the outcomes of sling operations that used remnant anterior vaginal wall tissue. MATERIALS AND METHODS: An anterior colporrhaphy and sling operation using remnant vaginal wall tissue was undertaken in 21 patients. The preoperative evaluation included the patients' history, a physical examination, urinalysis, an urodynamic test, a voiding cystourethrogram and incontinence staging with Stamey grade. The surgical outcomes and stress- related leakage, emptying ability, anatomy, protection, inhibition (SEAPI) were assessed. RESULTS: The mean follow-up period, operation time and hospital stay were 18 months (12-36), 45.4 minutes and 8.6 days, respectively. 18 patients (85.7%) were cured and 3 (14.3%) improved. The total subjective SEAPI score of 8.48 decreased postoperatively to 1.78. The pre- and post-operative complications were unremarkable. CONCLUSIONS: The remnant anterior vaginal wall sling was helpful in minimizing the postoperative complications and cost effectiveness. Although long-term follow-up data might be required, this technique could be a good alternative method to replace conventional fascial or synthetic pubovaginal slings with grade III cystocele.

Clinical Experience of Holmium:YAG Laser in Ureteroscopic Removal of Ureteral Calculi / 대한비뇨기과학회지

PURPOSE: We report our experience to assess the effectiveness and safety of Holmium:YAG laser lithotripsy for managing ureteral calculi. MATERIALS AND METHODS: Ureteroscopic Holmium:YAG laser lithotripsy was performed in 116 cases from November 1999 to October 2003. Calculi were located at the upper ureter in 9%, mid ureter in 19% and lower ureter in 72%. The mean stone size was 1.2cm. A 8Fr semirigid ureterorenoscope, 7.5Fr flexible ureterorenoscope and holmium:YAG laser (Trimedyne, Irvine, USA) with 365mul laser fiber were used. RESULTS: Stones were completely cleared in 113 cases among 116 cases. Stone-free rates according to stone position were 97.6% in the lower ureter, 100% in the mid ureter and 90.9% in the upper ureter. Stone-free rates according to stone size were 100%, 100% and 85.7% in the cases of which diameter is below 10mm, between 10mm and 15mm and above 15mm respectively. Fragmentation was incomplete in 3 cases, so ESWL was performed in 2 cases and repeated procedure in on case. Ureteral perforation was developed in 1 case. CONCLUSIONS: The Holmium:YAG laser lithotripsy was highly effective and safe in managing ureteral calculi irrespective of their location.

Up-Regulation of Differentiation Related Gene-1 Expression in the Androgen Independent Prostate Cancer / 대한비뇨기과학회지

PURPOSE: To determine whether the up-regulation of the differentiation related gene (Drg-1) enhances the progression of prostate cancer into the androgen independent phenotype, via escaping androgen signal transduction. MATERIALS AND METHODS: A full length of Drg-1 cDNA was obtained using the Drg-1 primer, which was inserted into LNCaP cells. The sensitivities of dihydrotestosterone and bicalutamide were then examined. In addition, the level of the Drg-1 gene expression was examined in derivatives of the LNCaP cell lines obtained from the orthotopic animal model. RESULTS: The Drg-1 transfected LNCaP cells, which highly expressed the Drg-1, were established (LNCaP/D2). The LNCaP/D2 slowly grew in a culture medium, supplemented with 10% charcoal stripped fetal bovine serum, whereas the control cells did not. When the sensitivities of DHT and bicalutamide were examined, the PC-3 and LNCaP/D2 cells were not sensitive to either. The metastatic androgen independent prostate cancer cells (LNCaP-AI-Lung), which were obtained from the orthotopic animal model, showed higher levels of Drg-1 expression than the parental cells. CONCLUSIONS: Androgen dependent prostate cancer cells, expressing high levels of the Drg-1 gene, behave like androgen independent prostate cancer cells. This finding suggest that the Drg-1 gene may play an important role in the initiation of an androgen-independent state.

Male Urethral Diverticulum Combined with Stone and Urethrocutaneous Fistula / 대한비뇨기과학회지

A male urethral diverticulum is a relatively uncommon abnormality. It usually occurs at the penoscrotal junction and most of these lesions develop as secondary disorder after a urethral trauma, obstruction or infection. Here we report a case of a male urethral diverticulum combined with a stone and a urethrocutaneous fistula.

Male Urethral Diverticulum Combined with Stone and Urethrocutaneous Fistula / 대한비뇨기과학회지

A male urethral diverticulum is a relatively uncommon abnormality. It usually occurs at the penoscrotal junction and most of these lesions develop as secondary disorder after a urethral trauma, obstruction or infection. Here we report a case of a male urethral diverticulum combined with a stone and a urethrocutaneous fistula.

A Case of Renal Teratoma / 대한비뇨기과학회지

No abstract available.

Genetic Susceptibility of CYP1A1 and GSTM1 to the Risk for Korean Bladder Transitional Cell Carcinoma / 대한비뇨기과학회지

No abstract available.

Genetic Susceptibility of CYP1A1 and GSTM1 to the Risk for Korean Bladder Transitional Cell Carcinoma / 대한비뇨기과학회지

No abstract available.

Surgical Outcome of Proximal Hypospadias with Penoscrotal Transposition / 대한비뇨기과학회지

PURPOSE: Penoscrotal transposition is found in cases with severe form of hypospadias. In those cases, severe chordee generally coexists and a long length of urethra may be necessary for its correction. We evaluated the clinical outcome of surgical repairs for 12 patients of proximal hypospadias with penoscrotal transposition. MATERIALS AND METHODS: Out of 12 cases, there were 2 with penoscrotal type, 7 with scrotal type and 3 with perineal type hypospadias. All cases had moderate to severe chordee. Five cases were treated with one-stage repair and seven cases with multi-stage repair. We analysed operative methods, postoperative complications and those managements between the cases of one-stage and multi-stage repairs. RESULTS: For one-stage repair, we used transverse preputial island flap method in 3 cases and urethroplasty using scrotal skin flap in 2 cases. For multi-stage repair, we performed Thiersh-Duplay urethroplasty in 2 cases, bladder mucosal graft in 2 cases and Belt-Fugua urethroplasty in 3 cases. Correction of penoscrotal transposition was performed successfully in all cases. In all cases, a paucity of skin was the most difficult problem. The overall complication rate was 50.0%. In cases treated with one-stage repair, there were two cases with urethrocutaneous fistulas. However, in cases treated with multi-stage repair, there were four cases with complications such as urethral strictures, urethrocutaneous fistulas with or without large skin defect. Overall the complications in cases with multi-stage repair were more severe than those in cases with one-stage repair. CONCLUSIONS: Our experience suggests that multi-stage operation may be not superior to one-stage operation in cases with proximal hypospadias associated with penoscrotal transposition. Thus we recommand one-stage repair in those cases despite a paucity of foreskin.

Effective Predicting Succes Factors of Retrograde Ureteral Stenting in Patients with Malignant Ureteral Obstruction / 대한비뇨기과학회지

PURPOSE: We have endeavored to find the factors predicting the success of ureteral stenting before cystoscopic retrograde ureteral catheterization in the patients with malignant ureteral obstruction. MATERIALS AND METHODS: 38 patients(51 kidneys) were analyzed, who were treated by retrograde ureteral stenting or percutaneous nephrostomy due to ureteral obstruction in non-urologic malignancy during the past 3 years. The sorts of primary tumors were cervix cancer in 14 cases(18 kidneys), stomach cancer in 12 cases(18 kidneys), colo-rectal cancer in 7 cases(9 kidneys), ovary cancer in 4 cases(5 kidneys), and endometrial cancer in 1 case(1 kidney). The cause of the ureteral obstruction was direct tumor invasion in 26 kidneys, lymphadenopathy in 23 kidneys and post radiation therapy in 2 kidneys. Retrograde ureteral stenting had failed in 22 kidneys(ureteral orifice could not be found in 14 kidneys, guide wire could not be advanced in 8 kidneys). RESULTS: Among the 51 kidneys, 29 kidneys(57%) were succeeded, and 22 kidneys(43%) were failed in retrograde ureteral catheterization. In fourteen of 22 kidneys(64%) ureteral orifice could not identified due to hemorrhage and edema of mucosa of bladder, and in 8 kidneys(36%) ureteral catheter could not be advanced to the renal pelvis. The cause of failure of the retrograde ureteral catheterization were direct tumor invasion in 10/26 kidneys(39%), and lymphnode enlargement in 4 of 23 kidneys(17%)(p=0.0007). According to the presence of ureteral obstructive symptoms, 8/29 kidneys(28%) were with the presence of ureteral obstruction symptoms, whereas 14/22 kidneys(64%) were failed with the absence of ureteral obstructive symptoms(p=0.0051). Of the obstruction site, 4/21 kidneys(19%) of upper to mid ureteral obstruction and 18/30 kidneys(79%) of lower ureteral obstruction were failed(p=0.0056). Of the degree of hydronephrosis, 18/47 kidneys(38%) of mild to moderate degree of hydronephrosis and 4/4 kidneys(100%) of severe hydronephrosis were failed(p=0.0022). CONCLUSIONS: This study shows that direct tumor invasion to the ureter, asymptomatic ureteral obstruction, lower ureteral obstruction, and high grade hydronephrosis were regarded as a high failure factors for the retrograde ureteral catheterization. Thus, we should not hesitate to choose percutaneous nephrostomy, in such condition that makes difficult for retrograde ureteral catheterization in malignant ureteral obstruction patients.

Comparison of Penetration Capability of Levofloxacin and Ciprofloxacin into Prostatic Tissue / 대한비뇨기과학회지

PURPOSE: To evaluate the penetration capability of Levofloxacin and Ciprofloxacin into prostatic tissue, we analysed the concentration of each drug in serum and prostatic tissue simultaneously after oral administration. MATERIALS AND METHODS: Eleven patients with benign prostatic hyperplasia treated with transurethral resection of the prostate were entered in this study. A single dose of 200mg Levofloxacin(LVFX) and 250mg ciprofloxacin(CPFX) were administered orally. Two hours after administration, blood and prostatic tissue samples were taken during operation. Concentration of each drug in serum and prostatic tissue was measured simultaneously by high performance liquid chromatography. RESULTS: The mean concentration of LVFX in serum was 1.970 +/- 0.759 microgram/ml, which was significantly higher than that of CPFX(0.903 +/- 0.291 microgram /ml)(p < 0.05). The mean concentration of LVFX in prostatic tissue(2.256 +/- 1.121 microgram/g), however, was not significantly different from that of CPFX(2.395 +/- 0.846 microgram/g). And the concentration ratio(tissue/serum concentration) of LVFX and CPFX was 1.16 and 2.76, respectively. CONCLUSIONS: These results show that LVFX is not superior to CPFX with respect to the penetration capability into prostatic tissue. Considering that the concentration of LVFX in prostatic tissue was higher than that in serum and not different from that of CPH, LVFX may be another potential effective agent in treating patients with chronic bacterial prostatitis.