Heart Rate Variability in Men with Erectile dysfunction / 대한배뇨장애요실금학회지

PURPOSE: The objective of this study is to investigate alteration of autonomic nervous system (ANS) activity in patients suffering from erectile dysfunction (ED) by comparing parameters of heart rate variability (HRV) between men with ED and healthy subjects. METHODS: A retrospective review was performed on 40 ED patients (mean age, 46.0+/-8.49 years) without any disease and 180 healthy control people (mean age, 44.4+/-7.83 years) without ED in our institution from June 2008 to July 2010. And electrocardiographic signals were obtained to measure HRV parameters for both patients and controls in a resting state. RESULTS: For the time domain analysis, square root of the mean differences between successive RR intervals (RMSSD) representing parasympathetic activity was lower in patients than controls although P-value was not statistically significant (P=0.060). For the frequency domain analysis, high frequency (HF) representing parasympathetic activity was lower in patients than controls (P=0.232) and low frequency (LF) representing mainly sympathetic activity was higher in patients than controls (P=0.416). Lastly, LF/HF ratio reflecting sympathetic/parasympathetic activity ratio was statistically higher in patients than controls (P=0.027). CONCLUSIONS: Patients with ED exhibited different HRV parameters compared with normal controls. This suggests that the patients with ED may have some kind of imbalance in the ANS and it may be possible that general imbalance of the ANS is one of the causes of ED. Thus, HRV analysis may give valuable diagnostic information and serve as a rapid screening tool to evaluate altered ANS activity in patients with ED.

Alteration of Autonomic Function in Female Urinary Incontinence / 대한배뇨장애요실금학회지

PURPOSE: Stress urinary incontinence (SUI) and urge urinary incontinence (UUI) have different mechanisms of action. We believe that alteration of autonomic nervous system (ANS) activity may contribute to UUI because the lower urinary tract is regulated through the sympathetic and parasympathetic nervous systems. Heart rate variability (HRV) allows measurement of autonomic nervous function, therefore we measured and compared HRV parameters in women with urinary incontinence. METHODS: From March 2008 to March 2010, we evaluated all patients who visited 2 university hospitals for treatment of urinary incontinence. Theywere performed 3-day voiding diary, urodynamic study, physical examination and routine laboratory examination. We excluded subjects who had diabetes, cardiovascular problems, or other condition that affect ANS. Patients with mixed urinary incontinence (MUI) were also excluded. Finally 47 women with SUI (group 1) and 29 women with UUI (group 2) were enrolled according to their symptoms and voiding diary. We compared their HRV parameters. And excluding 11 patients who had detrusor underactivity, we divided them again into group A, 53 women without detrusor overactivity (DO) and group B, 12 women with DO. We compared HRV parameters between DO and non-DO group. RESULTS: Older women had a higher incidence of UUI and DO. In HRV parameters, only the ratio of low frequency (LF) and high frequency (HF) was significantly higher in group 2 than group 1 (3.5+/-3.6 vs. 1.6+/-1.1, P<0.05). Also group A had higher mean LF/HF ratio than group B (4.3+/-3.8 vs. 1.9+/-1.9, P<0.05). CONCLUSIONS: Increased LF/HF values indicate relative sympathetic hyperactivity over parasympathetic activity. Changes in ANS activity could indicate the presence of UUI and potentially DO.

Correlation of Caveolin-1 Expression on Tissue Microarray with Prognosis in Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: We investigated the relationship between the expression of caveolin-1, using a tissue microarray (TMA), and the prognosis of patients with renal cell carcinoma (RCC). MATERIALS AND METHODS: TMA sections of formalin-fixed, paraffin-embedded tissues of RCC from 82 patients, who had undergone radical nephrectomy, were stained immunohistochemically with specific antibodies against caveolin-1. The caveolin-1 immunostaining was semi-quantitatively estimated based on intensity. The expression pattern of caveolin-1 was compared with the clinicopathological variables. RESULTS: The expression of caveolin-1 was significantly correlated with tumor size (p=0.002), TNM stage (p<0.001), T stage (p=0.001), M stage (p=0.004), grade (p=0.028) and metastasis (p<0.001), and was also significantly higher in clear cell than non-clear cell RCC (p<0.001). The survival of patients with higher caveolin-1 expression was significantly worse than that of patients with lower caveolin-1 expression (p=0.001). Univariate analyses were able to identify all variables, including caveolin-1 expression as significant prognostic factors for cancer-specific survival; multivariate analyses indicated that TNM stage, M stage and grade were independent prognostic factors. Caveolin-1 expression was not an independent factor. CONCLUSIONS: The increased expression of caveolin-1 is associated with tumor size, stage, grade, metastasis and a worse prognosis in RCC, which suggests that caveolin-1 may be important in the progression of RCC.

Primary Testicular Tumors in Children: Histopathological Distribution and Clinical Behavior / 대한비뇨기과학회지

PURPOSE: It has generally been accepted that the most common primary testicular tumor in the pediatric population is yolk sac tumor. Recently, there have been some reports that teratoma is the most common tumor in this age group. The histopathological distribution and clinical behavior of primary pediatric testicular tumors from three hospitals were retrospectively reviewed. MATERIALS AND METHODS: A retrospective review was performed on 30 pediatric patients, who had been treated for primary testicular tumors, at three hospitals. The records of the patients were reviewed with respect to age at diagnosis, affected sites, presentation, operation, pathology and prognosis. The mean age of the patients was 68.3 months (1-234). RESULTS: The most common presentation was a painless scrotal mass (86.7%). In patients younger than 15 years, the most common testicular tumor was teratoma at one hospital and yolk sac tumor at the other two hospitals. Totally, the most common testicular tumor was teratoma (52%), followed by yolk sac tumor (40%). In 5 patients, aged 15-20 years, the pathological distribution of the testicular tumor was the same as that observed in adults. No patients had had a recurrence after a mean follow- up of 30.6 months (3-109). CONCLUSIONS: Our results suggest that the prognosis for children with testicular tumors is favorable. The most common primary prepubertal testis tumor is teratoma, followed by yolk sac tumor, although yolk sac tumor was the most common tumor at two of the hospitals in this study. A large prospective multi-center study will be required to determine the pathological distribution of pediatric testicular tumors.

Surgical Treatment for Long Term Urethral Obstruction after Tension-Free Vaginal Tape Procedure

Most of anti-incontinence surgeries bear the risk of postoperative complication such as voiding dysfunction due to urethral obstruction. Fortunately, Tension Free Vaginal Tape(TVT) procedure has much lower incidence of postoperative urethral obstruction than other surgical procedures for stress urinary incontinence. There are many reports about the surgical treatments for short-term urethral obstruction after TVT procedure. However, there are few reports on the effect of surgical releasing of the obstruction lasting for a long period. In our case, the patient had urethral obstruction for 32 months after TVT procedure and she was able to void well after surgical releasing of the tape. We suggest that releasing of the tape will be a treatment of choice for long-term urethral obstruction after TVT procedure.

The Clinical Role of Cystourethrography and Urodynamic Study in Patients with Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: Lateral cystourethrography is a radiological method used in the diagnosis and prediction of the degree of stress urinary incontinence. The aim of this study was to evaluate the efficiency of lateral cystourethrography in women with stress urinary incontinence. MATERIALS AND METHODS: In this retrospective study, a total of 76 women who underwent both cystourethrography and urodynamic study were included. The proximal urethral support was evaluated by lateral cystourethrography at rest and during voiding, with the images anatomically superimposed to measure the degree of bladder base descent and the posterior urethro-vesical angle (PUV angle). The urethral diameter was measured at 1cm below the bladder neck. Urodynamic assessments, included valsalva leak point pressure (VLPP), maximal urethral closing pressure (MUCP) and functional urethral length, were compared with the parameters of the cystourethrography. RESULTS: There was a significant correlation between the VLPP and the urethral diameter (p90cmH2O), and into two subgroups, according to their MUCP (25cmH2O), the mean values of bladder base descent and PUV angle among the subgroups showed no significant correlation. CONCLUSIONS: In the current study, the lateral cystourethrography is suggested to not be appropriate for the diagnosis and prediction of stress urinary incontinence.

Xanthogranulomatous Epididymitis / 대한비뇨기과학회지

Xanthogranulomatous epididymitis is an extremely rare disease. Its etiology is unclear, but it is characterized by chronic suppurative granulomatous inflammation. We report on a 53-year-old diabetic man who suffered from left scrotal swelling and pain. Because the condition did not improve with the use of antibiotic therapy, left orchiectomy was performed. Pathological examination revealed a xanthogranulomatous epididymitis.