The Effects of Parathyroid Hormone-related Protein (PTHrP) (1-34) on the Detrusor Muscle Contraction of Rabbits / 대한비뇨기과학회지

Purpose: We have studied the effect of Parathyroid hormone-related protein (PTHrP) (1-34) on the contraction of bladder muscle induced by various stimulations. MATERIALS AND METHODS: Bladder muscle strips were prepared from the urinary bladder obtained from male New Zealand White rabbits (2-2.5Kg, n=20). The isometric contractile force responses were monitored via a FT03 force transducer. PTHrP (1-34) was introduced in spontaneous contraction, carbachol (CCh) (0.5microM)-induced the contraction, and a high potassium solution (60mM) induced the contraction to monitor the responses. In addition, the effect of PTHrP (1-34) was monitored in the pre-treatment of a calcium channel blocker, nicardipine. RESULTS: PTHrP (1-34) (10 10-10 7M) reduced most of the basal spontaneous contractile responses. According to the increasing concentration, PTHrP (1-34) (10 10 -10 7M) reduced 64.6+/-8.4% of the CCh (0.5microM) induced contractions, and 34.3+/-17.4% of the high concentration potassium solution (60mM) doses induced a contraction. After nicardipine (5.0microM) treatment, pretreating with PTHrP (1-34) (10 7M) showed a 33.5+/-15.5% CCh (0.5microM) increase in induced contractions compared to thr control. CONCLUSIONS: PTHrP (1-34) reduced the spontaneous phasic activity of the smooth muscle strip and caused a concentration-dependent relaxation of the contraction, which induced by carbachol or a high concentration potassium solution. These results support the hypothesis that PTHrP is a regulator of bladder tones. This study results suggested that there is some other mechanism of PTHrP (1-34) on the smooth muscles of the bladder, which is not related to a voltage-sensitive calcium channel.

The Psychologic Study on the Self Esteem about Penile Size of the Third Decade Men in Korea / 대한남성과학회지

PURPOSE: The penile augmentation operation is becoming popular in Korea, but there is not enough data about psychologic aspects of Korean male's thoughts about their penile size. We investigated the flaccid and stretched penile sizes of young Korean males and their penile size complex or pride. We performed Minnesota Multiphasic Personality Inventory (MMPI) test. This study may be used for better patient consultation in penile augumentation. MATERIALS AND METHODS: After explanation and agreement to the purpose and methods of this study, 123 Korean male in early 20's who visit our institution were studied. We measured their pre-pubic bone fat pad depth, flaccid penile length, flaccid mid-shaft circumferences and stretched length under warm and comfortable private environment. Because the stretched penile length closely correlated with the erect length, we did not measure the erect length. Then they were asked to answer questions of MMPI and other questions including, 'how do you think about your penile size?'. We used the student t-test to analyze our data statistically. RESULTS: In 123 subjects, mean flaccid length, flaccid circumference, stretched length and fat pad depth were 6.9 0.8cm, 8.5+/-1.1cm, 9.6+/-0.8cm and 1.1+/-0.4cm respectively (Table 1). In 123 subjects, the distribution of the answer about penile size was 1 (0.8%) 'very small', 29 (23.6%) 'small', 86 (69.9%) 'normal', 6 (4.9%) 'large', and 1 (0.8%) 'very large'. Compared to the subjects who thought their penis was normal, the subjects who thought their penile size was small, showed high hypochondriasis and psychasthenia scale and the subjects who thought their penile size was large, showed high hysteria scale in MMPI test. Subjects who underestimated their penile size, showed high depression, psychasthenia scale in MMPI test CONCLUSIONS: In consultation of the patient who want penile augmentation, urologist should consider psychologic tendency of the patients about their penile size.

Ultrastructural Changes of Detrusor Muscle by Partial Obstruction of the Bladder Outlet in the Rat / 대한비뇨기과학회지

PURPOSE: Previous infravesical outflow obstruction study of rat bladder has demonstrated the increased expression of collagen genes after partial obstruction. But there are few reports about the electromicroscopic findings of rat urinary bladder after partial outlet obstruction. This investigation was carried out to study the ultrastructural changes in smooth muscle cells and collagen fibers after partial obstruction of rat bladder. MATERIALS AND METHODS: Infravesical outflow obstruction was induced in Sprague-Dawley female rats. After 1, 2 and 4 weeks, the hypertrophied bladders were removed, fixated, embedded for electron microscopy and examined the ultrastructure of the bladder musculature. RESULTS: Clumping of nuclear chromatin, dilated sarcoplasmic reticulum and mitochondrias, depletion of ribosomes, disarrangement of the myofilaments and dense bodies, collagen deposition, and thickening and multiplying of basal lamina were observed. CONCLUSIONS: These results demonstrate that partial bladder outlet obstruction in the rat results in numerous changes of the organelles of smooth muscle cells and collagen deposition in the detrusor, which will be able to explain the resultant alteration in detrusor contractility and compliance.

Clinical Features and Management in Patients with Prenatally Detected Duplex System Ureteroceles / 대한비뇨기과학회지

PURPOSE: Prenatal sonography resulted in increased recognition of renal duplication anomalies and, therefore, earlier urological referral and evaluation. However, surgical approach in very young children is debating. We attempt to investigate clinical features and to propose the management strategies in patients with prenatally detected ureteroceles. MATERIALS AND METHODS: From 1982 to 1997, there has been 35 patients (47 units) of duplex system ureter in which both preoperative and postoperative imaging studies including DMSA renal scan were available. Among these, detailed diagnosis and treatment of prenatally detected (PreD) ureteroceles associated with duplex system (9 patients or 12 ureteroceles) were assessed compared with post-natally detected (PND) ones (26 patients or 35 ureteroceles). RESULTS: There were 2 males and 7 female patients in PreD group, whose ureteroceles presented as 6 unilateral (right 1, left 5) and 3 bilateral units. There were 3 patients (33%) presented with urinary tract infection in PreD group and 24 patients (92%) in PND group. Functional evaluation by DMSA renal scan revealed that 8 units (67%) were functioning in PreD group while 37% in PND group, which was not significantly different between two groups. Initial treatment in PreD group were performed in 11 units; transurethral ureterocele incision (TUI, 8 units), ureteroureterostomy (UUO, 1) and upper pole nephrectomy (UPNx, 2). Additional surgery was performed in 8 units, all of which were initially performed TUI. When initial functional status of the upper pole (UP) determined by renal scan were analyzed by ultimate mode of treatment, initially nonfunctioning parenchyme resulted in UPNx in 4 units and 8 functioning moiety were led to parenchyme-sparing surgery, implying TUI actually had not modified ultimate clinical course. Taken both PreD and PND together, UUO and ureteral reimplantation showed lower secondary operation rate. CONCLUSIONS: Although statistics did not fully support our clinical impression, patients with PreD ureterocele have higher proportion in preserving UP function compared with that of a PND. Our results shows direct approach to the upper pole according to the functional status is preferred.

The Usefulness of Three Dimensional Reconstruction Imaging using Spiral CT: an Experience in the Bilateral Wilms` Tumor Surgery / 대한비뇨기과학회지

Conventional angiography has been used to identify detailed vascular anatomy for surgery in which parenchymal salvage should be necessary. Recently, we experienced a case in which 3-dimensional CT was very helpful in salvaging the part of the kidney. A 2 year-old girl was diagnosed as bilateral Wilms` tumor. Conventional CT scan showed right huge mass and left upper pole mass of the kidney. The patient was planned to have neoadjuvant chemotherapy. Spiral CT scan with three-dimensional reconstruction was performed after 3-month chemotherapy and detailed anatomical information regarding vessels, tumor mass and normal parenchyma was obtained. Based on these anatomical information, right radical nephrectomy and left partial nephrectomy was successfully performed. Surgical findings was quite similar to that obtained by preoperative 3-dimensional CT images. Three-dimensional reconstruction of spiral CT imaging is considered to be useful in the evaluation of surgical anatomy in kidney-saving surgery preoperatively.

Comparative Studies on the Fatigue of Urinary Bladder following Repeated Contractions in Neonatal and Adult Rats / 대한비뇨기과학회지

PURPOSE: The function of urinary bladder in neonate and adult are regarded as different but little is investigated on the physiological function of the neonatal urinary bladder. In this study, we compared the contractile responses of bladder muscle strips between neonate and adult rats to repeated electrical field stimulations(EFSs). MATERIALS AND METHODS: Postnatal 1 to 3-day-old Sprague-Dawley(SD) rats (7.3+/-1.5gm, mean+/-SE, n=15) and 12-week-old adult SD rat(386+/-21gm, n=15) were sacrificed and longitudinal strips of the anterior wall of the bladder were prepared. Each preparation was mounted in a vertical chamber and connected to a force transducer (FT03, Grass, U.S.A.). Isometric contractions were induced by three different methods; 1) intrinsic nerve activation by applying EFSs(5, 20, or 60Hz frequency, square pulse of 0.8ms width, 70V/cm, 2,5s duration) every 50 seconds, 2) the activation of muscarinic receptors on smooth muscle cell membrane with 5.0microM carbachol(CCh), 3) direct smooth muscle stimulation by applying EFSs(60Hz frequency, 50ms width, 70V/cm, 2.5s duration) in the presence of tetrodotoxin every 50 seconds. RESULTS: Contractile responses to intrinsic nerve stimulations reached maximal amplitude at 60Hz stimulation in both adult and neonate rat bladder. Recovery from the fatigue in neonate and adult bladder muscle was evaluated by the amplitude changes in contractions evoked by EFS with 3 min. or 1 min. rest periods. Poor recovery was induced in neonates even by 3 min. rest period. In neonate group, the amplitude of contractions declined gradually (fatigue response) with 20 and 60Hz stimulations, while the fatigue responses were negligible in adult group. The responses to the exogenous CCh before and immediately after the repeated stimulations were not significantly different in both groups. Repeated direct muscle stimulations did not induce significant decreases of contractile responses in both groups. CONCLUSIONS: These results demonstrate that neonatal bladder becomes fatigued faster than adult bladder and the fatigue seems to occur at pre-receptor level of the smooth muscle cells rather than at the muscle itself.

Comparative Studies on the Active Contractile Properties and Passive Properties of the Urinary Bladder between Adult and Neonatal Rats / 대한비뇨기과학회지

PURPOSE: Voiding function of the neonate is considered to be different from that of adult. Although immaturity in the central nervous system that governs urinary bladder is thought to be the cause, few well-designed physiological studies on the properties of bladder itself have been reported. MATERIALS AND METHODS: Urinary bladders were removed from male Sprague-Dawley rats, 1 to 3-day old neonate and 12 week-old adult. Anterior longitudinal muscle strips without mucosa were obtained and isometric contractions were recorded. Contractile responses induced by carbachol (CCh 0.05-10.0 microM) were obtained. To investigate length-tension relationship between adult and neonate bladder, each strip was stepwise stretched up to 300% L (taking L, 100% length in a resting state) by micropositioner. In each step it was fully permitted to reach steady state in which electrical field stimulations (0.8ms, 50Hz, 2.5s duration) were applied to assess optimal length for contraction. RESULTS: CCh produced a large phasic contraction followed by a sustained tonic contraction superimposed by rapid phasic activities (RPAs) in both group but the patterns were quite different. Neonatal bladder was characterized by its tonic contractions; lesser tone increase with dose increment and taller RPAs of shorter duration. Amplitude of CCh-induced contraction were corrected by tissue weight, neonatal bladder generated greater force than that of adult. Length-tension analysis revealed that the range of active contraction in neonatal bladder according to the stretch were similar, while passive properties were quite different from that of adult bladder. Stress in the muscle strips was derived from tension divided by cross-sectional area of the strip (g/cm2). Steep increase in total tension per area as stepwise stretch was observed in neonatal bladder, which was mainly ascribed to passive properties of the bladder. Optimal length of maximal active force generation was noted in 220% of resting length in both neonatal and adult bladder. CONCLUSIONS: Our results demonstrated that CCh-induced contractile pattern and length-tension relationship in neonatal bladder are quite different from those of adult bladder in the rats, which suggests, aside from the neural immaturity, functional difference exists in the bladder itself. During development, neonatal urinary bladder seems to undergo remarkable changes in both active and passive properties.

Effects of Interferon Gamma on Collagen Expression in the Partially Obstructed Urinary Bladder of Rat / 대한비뇨기과학회지

PURPOSE: Recent studies have proved that bladder compliance is closely related to the collagen content of the bladder. It has been shown through human fibroblast, condrocyte, and rat myofibroblasts that interferon(IFN)-gammadecreased collagen synthesis. The objective of this study was to investigate the alteration of collagen deposition and gene expressions in collagen types I and III by partial bladder outlet obstruction and to compare the changes during IFN-gamma treatment. MATERIALS AND METHODS: Following 4 weeks of partial bladder outlet obstruction in 200-250gm. SD rats, the bladder tissues were evaluated for collagen deposition by an immunohistochemical staining using the polyclonal antibodies and the messenger ribonucleic acid(mRNA) contents of the collagen type I and III were evaluated by Northern hybridization. Recombinant IFN-gamma(100,000 units) was administered once a day for 4 weeks by subcutaneous injection. RESULTS: In the control bladders, the immunohistochemical staining for type I and type III collagen protein showed an intense localization in the lamina propria with modest localization in the inter-fascicular region. With obstruction type I and type III collagen staining intensified, especially in the inter-fascicular region. The IFN-gamma administration reduced the inter-fascicular deposition of collagen type I and III. There was an up-regulation of collagen type I and III gene expression after the obstruction. In the obstructed bladders proalpha1(I) and proalpha1(III) collagen mRNA intensity was increased 3.4 and 5.1 folds than the control groups, respectively. This up-regulation was down-regulated by IFN-gamma administration. CONCLUSIONS: The down regulation of collagen types I and III gene expression, and decreased protein deposition after IFN-gamma treatment demonstrated that the effect of IFN-gamma was, in part, transcriptionally regulated. These results suggest that the recombinant IFN-gamma may be beneficial in the treatment of patients with poorly compliant bladder.

Early Expression of Collagen Type I, III and IV and Matrix-Metalloproteinase(MMP)-2 mRNA in the Rat Bladder Subjected to Partial Outlet Obstruction / 대한비뇨기과학회지

PURPOSE: Partial obstruction of the rat bladder outlet induces a rapid hypertrophy characterized by increased smooth muscle content and collagen deposition. This increased collagen is likely to reduce the quality of the contraction and compliance of the bladder wall. Also it has been reported that an alteration in the ratio of type I and III collagen may be more important than the amount of collagen in determining compliance. To evaluate the genetic basis of collagen deposition in the partially obstructed rat bladder, the author observed the change of proalpha1(I) collagen, proalpha1(III) collagen, proalpha(IV) collagen and matrix-metalloproteinase(MMP)-2 mRNA after partial urethral obstruction. MATERIALS AND METHODS: Female Sprague-Dawley rats weighing 150-200g were used. Individual bladders were obtained from unoperated rats, and from rats at 6, 12, 48, 72, hours, 5 and 7 days after partial urethral obstruction and sham operation. Total RNA was extracted from each of these tissue, The expression of mRNAs were assessed by Northern blot analysis. The band intensities of the autoradiographs measured by densitometry were compared between the obstructed and sham group. RESULTS: Partial urethral obstruction induced a gradual increase in bladder weights, The expression of mRNA for proalpha1(I) collagen was generally attenuated within 24hours after obstruction. In extended period of obstruction, the expression of mRNA for proalpha1(I)collagen reached a peak at day 3-5(219% increase), and remained elevated through day 7. The expression of mRNA for proalpha1(I)collagen was coregulated with that of pro alpha1(I) collagen, however, the mean ratio to control value of band intensity for proalpha1(III)collagen mRNA was 2 times higher than that of proalpha1(I) collagen, during days 3-7. The expression of mRNA for proalpha1(IV)collagen showed a sharp increase at 48 hours(438% increase)after obstruction earlier than proalpha1(I)collagen and proalpha1(III)collagen mRNA. In extended period of obstruction the expression reached a peak at 72 hours(883% increase) and the mean ratio to control value of band intensity for proalpha alpha collagen mRNA was much higher than those of proalpha1(I) collagen and proalpha1(III) collagen. The expression of MMP-2 mRNA increased from 48hours after obstruction, and reached a peak at day 3-5. CONCLUSIONS: These results sugges that the increase of collagen in the rat bladder after partial urethral obstruction results from an increase of expression of collagen genes, and the decrease of bladder wall compliance results from an increased transcription of type I collagen gene and increase of the ratio of proalpha1(III)collagen to proalpha1(I)collagen mRNA. Because expression of proalpha1(I), (III), (IV) collagen and MMP-2 mRNA increased sharply after 48hours, it is suggested that genetic events leading to remodeling of bladder start at 48hours after partial urethral obstruction.

Clinical Experience of Testicular Germ Cell Tumor in Infants and Children / 대한비뇨기과학회지

PURPOSE: The relative rarity of prepubertal testis tumors has resulted in poor understanding about incidence, histologic distribution and prognosis of germ cell tumors in children. We attempted to elucidate overall clinical features of testicular germ cell tumors in infants and children, to analyze risk factors for relapse in stage A yolk sac tumor(YST) and to find out possibility of testis-sparing surgery in prepubertal testicular teratoma. MATERIALS AND METHODS: Retrospectively, we reviewed 74 cases of primary testicular germ cell tumors of infants and children(under 15 years old) experienced in Seoul National University Hospital from January 1970 to November 1995. RESULTS: There were 38 YSTs(stage A, 34 cases, stage B; 3, stage C; 1), 32 teratomas(all stage A) and 4 teratocarcinomas(stage A, 3, stage C; 1). Median age of presentation was 2.0(range 0.4-15.0) years. Preoperative serum alpha-fetoprotein (alpha-FP) elevation was observed in 37 patients(100%) with YST, 2(7%) with teratoma, 3(100%) with teratocarcinoma and elevated serum beta human chorionic gonadotropin(beta-HCG) was observed in one patient(33%) with teratocarcinoma. Orchiectomy including 4 partial orchiectomy(all with teratoma) was done in all patients, chemotherapy in all patients with teratocarcinoma and stage B, C YST. Two-year survival rate was 92%(22 out of 24 patients who had been followed up) and 100%(19/19) with teratoma. Out of 4 patients with teratocarcinoma, 2 patients with stage A disease showed no evidence of disease, one patient progressed to death and follow-up was lost in the other one patient with stage C. In 9 patients with YST who had ultimately presented recurrence, initial symptoms and signs for recurrence were as follows; marker elevation(4), abdominal mass(3), inguinal mass(1) and scrotal mass(1). Their mean duration of relapse after surgery was 7.0 months. On pathologic review, 7 patients among total 34 patients with YST had at least one risk factors such as epididymal involvement(2), microangioinvasion(3) and focal embryonal component(2). Out of them(7), 5 patients proved to have relapse. There was statistically significant relationship between having risk factors and relapse(Fisher's exact test, p=0.0086). Complete remission rate after chemotherapy In all relapsed patients was 83%(5/6). Until now, there is no evidence of recurrence in 4 patients with teratoma who underwent partial orchiectomy CONCLUSIONS: YST is characterized as early presentation, high relapse rate and short relapse interval and had high response rate to chemotherapy and high survival rate. Therefore, careful surveillance is needed at least for 2 year in stage A patients with high risk group on pathology(microangioinvasion etc). Testis-sparing surgery may be considered as one of treatment options in prepubertal teratoma.

Laparoscopie Nephrectomy and Heminephrectomy in Pediatric Patients / 대한비뇨기과학회지

PURPOSE: Many operative procedures in pediatric urology can be performed by laparoscopy. We report our experiences with laparoscopic nephrectomy and heminephrectomy and evaluate its usefulness in pediatric patients. MATERIALS AND METHODS: Between August 1996 and December 1997, a total of 10 children aged between 2 and 9 years underwent laparoscopic renal surgeries in Seoul National University Hospital. The laparoscopic nephrectomy (including nephroureterectomy) was performed in 8 patients(4 multicystic kidneys, 2 dysplastic kidneys associated with ectopic ureter, 2 nonfunctioning kidneys associated with vesicoureteral reflux), and heminephrectomy was done in the other 2 patients(duplex kidney). RESULTS: All laparoscopic nephrectomies were completed as planned. Operative time ranged 120 to 300 minutes(mean 180 minutes) and there were no intraoperative or postoperative complications. Oral intake and mobilization were started from postoperative one day and the patients had hospitalized for an average 3.6 days. Laparoscopic heminephrectomy in one patient was performed successfully. Total operative time recorded 240 minutes and there were no intraoperative or postoperative complications. But the other patient experienced bleeding from the injured upper pole artery and subsequent conversion to an open surgery was needed. CONCLUSIONS: Laparoscopic nephrectomy in children is feasible as its morbidity and complication rate are low. Laparoscopic heminephrectomy is thonght to be a technically demanding procedure, requiring more experience.

Laparoscopy-Assisted Extracorporeal Ureteral Anastomosis : a New Technique / 대한비뇨기과학회지

We investigated the feasibility of the extracorporeal suture technique in laparoscopic pyeloplasty and laparoscopic ipsilateral ureteroureterostomy in child with ureteropelvic junction obstruction or duplex kidney. Laparoscopic pyeloplasty and laparoscopic ureteroureterostomy were performed in a child with ureteropelvic junction obstruction and in a 3-year old child with duplex kidney, respectively. Ureteropelvic junction or ureters were dissected laparoscopically and were drawn out of the abdominal cavity through the 10mm trocar tracts and subsequently anastomosed extracorporeally. We were able to draw the ureteropelvic junction or the ureters out of the abdominal cavity without difficulty owing to the laxity and thin abdominal wall in children. Operating time was 120 minutes in both cases, and all anastomses between ureter and pelvis were completed without any intraoperative complication. There was no postoperative complication. Significant improvements in urinary drainage were shown in both children on postoperative intravenous pyelogram. These early results suggest that the extracorporeal suture technique in children is feasible and easy to perform. Therefore, the drawbacks of intracorporeal suture technique during the laparoscopic pyeloplasy or ureteroureterostomy could be overcome by using this novel teehnique.

Two Cases of Gasless Laparoscopic Ureterolithotomy / 대한비뇨기과학회지

Laparoscopic ureterolithotomy has been attempted in the management of the large, long-standing, impacted ureter stone. However it was not commonly used because of difficulties in technique. So we report 2 cases of laparoscopic ureterolithotomy using the gasless technique. We performed the laparoscopic ureterolithotomy in two patients with ureter stones by transperitoneal approach. We used the laparolift system which was connected by laparofan retractor. The abdominal wall was elevated effectively, and the ureters were exposed with ease. The stone was successfully removed in all two cases. The operative time was 120 and 140 miniutes respectively. There was no intraoperative or postoperative complication including urinary leak in all cases. Postoperative pain was minimal. This gasless technique is convenient and safe because an operator can use the conventional surgical instruments and avoid the complications directly associated with pneumoperitoneum.

Prostate-specific Antigen Density: Correlation with Prostatic Histological Composition in Men with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Pretreatment knowledge of prostate gland histology may help to select medical therapy for men with benign prostatic hyperplasia(BPH). Our objective was to determine whether prostate-specific antigen density(PSAD) correlated to the relative amount of epithelium in BPH tissue. MATERIALS AND METHODS: We evaluated 32 men with pathologically proven BPH who underwent transurethral resection of the prostate. All clinical findings which were age, symptom scores, maximal flow rate, total serum PSA, PSAD, prostate volume, transitional zone volume, transitional zone ratio were correlated with mean epithelial score(MES), which measures semi-quantitatively to represent the relative amount of epithelium in the resected BPH tissues. RESULTS: Prostatic size, serum PSA and PSAD showed significant correlation with MES in univariate analysis, but multivariate analysis showed that only PSAD was statistically significant(p<0.05). CONCLUSIONS: These data suggest that PSAD be related to the histological composition of the prostate in men with BPH. Therefore it might be useful as an evaluation to direct BPH therapy.

Morphological and Quantitative Analysis on the Expression of Bax in the Rat Prostate following Castration / 대한비뇨기과학회지

PURPOSE: Bax promotes apoptosis and is up-regulated by p53, which is not required for androgen ablation-induced apoptosis of the prostatic cells. We investigated the change of lax during the involution of the rat prostate following castration. MATERIALS AND METHOD: Adult male rats were castrated and the ventral prostatic glands were removed daily for a week following castration. Western blot and immunohistochemical analysis of lax protein were performed using anti-bax rabbit polyclonal IgG. RESULTS: The prostatic weight decreased and the apoptotic cells began to appear 2 days following castration. Western blot analysis showed that lax was absent in the control prostate but began to increase 4 days following castration. Immunohistochemical analysis showed that bars was confined to the cells which had morphological characteristics of the late stage of programmed cell death. CONCLUSIONS: Present results suggest that bars might be involved in the late stage of castration-induced apoptosis of the rat prostatic cells.

99mTc-DMSA Renal Scan after Anti-reflux Surgery in Children with Primary Vesicoureteral Reflux / 대한비뇨기과학회지

PURPOSE: 99mTc-dimercaptosuccinic acid(DMSA) renal scintigraphy is recognized as the most effective imaging modality for demonstrating renal scarring In children with vesicoureteral reflux. We determined if significant numbers of new scar develop and progression of scarring occur after antireflux surgery. MATERIALS AND METHODS: Retrospective study was undertaken In a series of 102 reflux renal units out of 60 children(male 35, female 25) with vesicoureteral reflux as documented by voiding cystourethrography, whose age was 28(median, range:1-150) months. We carefully examined DMSA renal scans taken in 2(median, range:0.3-58) months before operation and 18(median, range:3-62) months after operation in each patients. Twenty two children(37 renal units) were further followed up by additional scans up to 50(median, range:25-120) months postoperatively. Each scan was blindly reviewed twice in terms of the size, number and zonal location of the cortical defects based on morphology. The Interval changes were categorized into 3 patterns(improved, no change, progressed) based on the review findings RESULTS: There were no patients with postoperative pyelonephritis but asymptomatic bacteriuria were found in 19 patients(31.5%). Most(57 patients, 109 renal units) of the antireflux operation were done by Cohen method and refluxes were still found in 8 renal units(7.8%) in immediately postoperative periods and were ultimately disappeared. No postoperative urethral obstruction was found on intravenous pyelogram. On follow-up renal scintigraphy most of renal units(89, 87.3%) showed no change while 11(10.7%) showed improvement and progression was observed In 2(2.0%). No correlation was established between scintigraphic change and several clinical factors such as sex, age of first pyelonephritis presentation, presence or frequency of pyelonephritis before initial renal scan , nor postoperative episodes of urinary tract infection. CONCLUSIONS: Our results show that on the contrary to the most of the previous reports, no further development of renal scar was found after successful surgery. There was no significant morphologic change in the postoperative follow-up renal scan in most of reflux and if any, most were disappearance or diminution of renal scars.

Therapeutic Laparoscopy for Impalpable Testis / 대한비뇨기과학회지

Management of impalpable testis is one of the most controversial issues in cryptorchidism. There is wide variation in approach to this subset of patients. In the child with an impalpable testis, laparoscopy is increasingly used as the diagnostic study of choice. We have recently extended its value by using it as a therapeutic tool. Ten laparoscopic surgical procedures were performed in 10 patients with 12 intra-abdominal testes. In 2 adults with a small intra-abdominal testis and normal contralateral testis, laparoscopic orchiectomy was performed. In 3 patients with 5 intra-abdominal testes, the first phase of two-stage Fowler-Stephens orchiopexy was performed. These patients underwent an open surgical procedure three or four months later. In 3 patients, one stage orchiopexy was performed without dividing the spermatic vessels. In 2 Patients these testes could be mobilized after division of the spermatic vessels (laparoscopic one-stage Fowler-stephens orchiopexy). follow-up ranged from 3 months to 35 months (mean 16.8 months). At follow up 9 of 10 testes (90%) are in the scrotum without atrophy, while 1 (10%) is atrophic. Our early results suggest that increased experience will allow laparoscopic surgery to be a valuable option in the treatment of impalpable testis

Ureterocystoplasty: Experiences in Two Cases of Posterior Urethral Valve / 대한비뇨기과학회지

Ureterocystoplasty is a known useful method for the management of selected cases with dilated ureters, high pressure and poorly compliant bladders. It precludes the potential complications of enterocystoplasty. In two cases of posterior urethral valve with urinary incontinence, bilateral dilated ureters, and poorly compliant bladders, we performed ureterocystoplasties using dilated lower end of the ureter after transuretero-ureterostomy and ureteral reimplantation. Both patients were almost continent day and night. The bladder capacities and compliances were improved. There was no deterioration of renal functions. In conclusion, we suggest that the ureterocystoplasty using dilated distal ureter after transureteroureterostomy is an appropriate procedure in selected cases of posterior urethral valve.

Multicystic Kidney: Clinical Features and Management / 대한비뇨기과학회지

Multicystic kidney is one of the most frequent causes of neonatal abdominal mass. Controversy continues as to the optimal management of these lesions since little is known about their natural history. Most multicystic kidneys are presented as asymptomatic abdominal mass or detected incidentally on prenatal ultrasonography. Recently in Korea, diagnosis of multicystic kidney is increasing as prenatal ultrasonography becomes more popular. Herein we observed clinical features of the 24 cases of multicystic kidney including the 16 cases of prenatal diagnosis. Male patients were predominant( 15:9) and the right kidney was found slightly more often than the left kidney ( 14 : 10). Contralateral kidney abnormality were found in 3 cases( 29% ). In 24 cases, 21 were managed nonoperatively, and nephrectomy was performed in 3 cases: a case of huge abdominal mass, a case of infection after antegrade pyelography and a case misdiagnosed as UPJ obstruction preoperatively. In 19 cases during the average 27.1 months ultrasound followup, the size of multicystic kidney has been unchanged or decreased. There were no medical complication and no evidence of malignant development. Our data shows that the patients of multicystic kidney can be managed conservatively on the basis of features of followup ultrasonography and clinical symptoms. But complete urologic evaluation is necessary to identify abnormalities in the contralateral kidney. We believe that surgery is option in those patients in whom the cystic mass appears to be growing, hypertension develops, or Malignancy is in question.