The Expression of Interleukin-6 and Its Receptor in the Developing Rat Kidney / 체질인류학회지

Interleukin-6 (IL-6) and its receptor are presumed to play important roles in the developing nervous system. However, little is known about their potential role(s) in the developing kidney. To investigate this, we have studied the expression of IL-6 and its receptor (IL-6R) in the developing rat kidney. Kidneys from 16- (F16), 18- and 20-day-old (F20) fetuses, 1- (P1), 3- (P3), 7- (P7) and 14-day-old (P14) pups, and adult rats were extracted. Renal expressions of IL-6 and its receptors were examined by immunohistochemistry and in situ hybridization respectively. Il-6 protein already appeared in F16. The early stage of renal development before birth, IL-6 showed strong immunoreactivity in the ureteric bud, metanephric mesenchymal cells (MMC) and developing glomerulus. The expression pattern of IL-6 in nephrogenic zone are very similar even after birth. In matured nephron after birth, IL-6 immunoreactivities were detected in distal tubules strongly, and collecting ducts moderately and thick ascending limb weekly. IL-6R hybridization signals have also already appeared in 16-day old fetal kidney. Before birth, IL-6R mRNAs were expressed in ureteric bud, MMC and developing glomerulus. In the matured nephron after birth, IL-6R mRNA was expressed in the thick ascending limb, distal tubules, collecting ducts and S3 segment of proximal tubule. These results suggest that IL-6 and its receptor may be involved in regulation of nephron formation in nephrogenic zone of rat, and play a role in distal nephron including collecting duct after birth.

Pelvic Hematoma following a Transobturator Vaginal Tape Surgery for Treating Stress Urinary Incontinence

The transobturator tape surgery is the most recent minimally invasive midurethral sling procedure. This technique is introduced with the expect of decreasing some of the complications such as bladder, bowel and blood vessel injury that is associated with retropubic passage of needles. Reported is a 48-year-old woman who underwent a transobturator tape(TVT-O) procedure and who developed a retropubic hematoma at the pelvic cavity.

The Efficacy of Repeated Sclerotherapy after Percutaneous Aspiration of the Simple Renal Cyst / 대한비뇨기과학회지

PURPOSE: Percutaneous aspiration with sclerotherapy is widely used as a treatment for simple symptomatic renal cysts because percutaneous aspiration with sclerotherapy is minimally invasive and cost-effective. Sclerotherapy is usually performed in combination with aspiration due to the high recurrence rate, 30-70%, for the simple aspiration. We conducted an analysis of percutaneous aspiration with repeated sclerotherapy, and we report the results of sclerotherapy after percutaneous aspiration of simple renal cysts and we also review the results of the other previous studies. MATERIALS AND METHODS: Between January 2001 and April 2004, the results of percutaneous aspiration with repeated sclerotherapy in 39 cases of simple renal cysts were evaluated. We evaluated the operation time, the hospital stay, the success rate, the complication rate and the follow-up period. All patients were available for follow-up over a period of 3 months by conducting ultrasound exams and computed tomography (CT) scans. RESULTS: Complete collapse, partial collapse and recurrence of the renal cysts occurred in 24/39 (61.5%), 13/39 (33.3%), and 2/39 (5.1%) cases, respectively. The mean operative time was 50.3 minutes and the mean hospital stay was 4.5 days. The cost of two sessions of sclerotherapy was about 240,000 won and that of three sessions of sclerotherapy was about 300,000 won. The size of the cyst was not related to the rate of collapse. Any complication related to percutaneous aspiration with repeated sclerotherapy were not noted. CONCLUSIONS: With regard for the success rate and cost-effectiveness, percutaneous aspiration with repeated sclerotherapy is considered a primary treatment for simple symptomatic renal cysts.

Clinical Trial of SPARC Procedure in Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: A suprapubic approach to the suburethral polypropylene (SPARC) procedure was reported as a new technique for urethral support in the treatment of stress urinary incontinence in women. The safety and efficacy of the SPARC procedure were evaluated in women with stress urinary incontinence. MATERIALS AND METHODS: 50 women (mean age 48.6) with stress urinary incontinence underwent the SPARC procedure under general anesthesia between October 2002 and May 2004. The preoperative evaluations included: the patients history, a physical examination, urinalysis, an urodynamic test and incontinence staging for the Stamey grade. 2 and 5 women had previously experienced failed anti-incontinence surgery and pelvic surgery, respectively. The mean follow-up period was 8.01 months, with all patients assessed for the procedural outcome, subjective satisfaction and complications. RESULTS: The mean follow-up period, hospital stay and operation time were 8.01 months (3-15), 3.7 days (2-6) and 23 minutes (18-45), respectively. The success rate was 94%. There were no significant perioperative and postoperative complications. 3 patients (6%) had bladder perforation during the operation that necessitated an indwelling Foley catheter (mean period 7.3 days). 3 patients (6%) each had postoperative cystitis and immediate voiding difficulty that necessitated an indwelling Foley catheter (mean period 3.0 days) and bladder training, but without cutting or releasing of the tapes. 7 patients (14%) had postoperative de novo urge symptoms. CONCLUSIONS: The SPARC procedure is a simple, safe and effective treatment for female stress urinary incontinence in terms of the short operation time and hospital day, and low complication and relatively high success rates. However, a longer follow-up will be necessary to determine its long term effect and efficacy.

Efficacy of Bicalutamide Monotherapy in Locally Advanced Prostate Cancer / 대한비뇨기과학회지

PURPOSE: Nonsteroidal antiandrogen monotherapy may be a treatment option for some patients with locally advanced prostate cancer. We report the efficacy, advantage, and adverse events of bicalutamide monotherapy in patients with locally advanced prostate cancer. MATERIALS AND METHODS: We retrospectively reviewed 13 patients with locally advanced prostate cancer who were treated with bicalutamide 150mg monotherapy. Serum PSA reduction was evaluated with periodic PSA follow-ups. If clinical progression was suspected, pelvic CT or bone scan was performed for the evaluation of disease progression. The changes of sexual function were assessed with the IIEF questionnaires prior to treatment and after 6 months of medication. RESULTS: Serum PSA declined to less than 2ng/ml within 3 months after treatment in most patients. A high serum PSA level was maintained in only 1 patient, and this patient showed disease progression. There were no significant differences between the mean scores of the pretreatment and post-treatment erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction (p>0.05). Of the 13 patients, 2 patients (15.5%) showed adverse events, such as breast pain and gynecomastia. However, the symptoms were mild to moderate. There was no withdrawal to medication due to drug-related adverse events. CONCLUSIONS: From the viewpoint of the fall in serum PSA levels after 3 months, bicalutamide monotherapy was effective in the treatment of locally advanced prostate cancer. There were benefits to the patients in terms of the quality of life parameters, sexual function, and tolerability, which make bicalutamide monotherapy an attractive treatment option for patients with locally advanced prostate cancer. (Korean J Urol 2004;45: 108-113)

Crossed Renal Ectopia Accompanied with VUR without Fusion / 대한비뇨기과학회지

Crossed renal ectopia, without fusion, is a very rare congenital anomaly of the urinary tract, and can be frequently accompanied with hydronephrosis due to vesico-ureteral reflux (VUR) or ureteropelvic junction stenosis, renal atrophy, or ectopic ureterocele. We report a case of vesicoureteral reflux is reported in an infant with crossed renal ectopia without fusion.

Efficacy and Toxicity of Gemcitabine Plus Cisplatin Chemotherapy in Advanced Urothelial Cancer / 대한비뇨기과학회지

PURPOSE: To assess the response to, and toxicity of, combination chemotherapy, with gemcitabine and cisplatin, in patients with advanced transitional cell carcinoma of the urothelial tract. MATERIALS AND METHODS: Thirty-seven patients with advanced transitional cell carcinomas were treated with gemcitabine, 1,000mg/m2, intravenously for 30 minutes, on days 1, 8 and 15 and cisplatin, 70mg/m2, for 1 hour on day 2 of each 28-day cycle. Twenty-four that completed more than 3 cycles were evaluated for their response, but all patients were evaluated for the toxicity. The full dose of the drugs was administered to all patients. RESULTS: Three(12.5%) of the 24 patients achieved a complete response and 2 (37.5%) achieved a partial response, showing an overall response rate of 50%. The main toxicities were myelosupression, with an incidence of 34% thrombocytopenia, 40% leukopenia and 28% anemia, but only 6% of grades 3 to 4. Non-hematological toxicity was mild, with a low incidence of 46% nausea and vomiting, and only 6% of grades 3 to 4. CONCLUSIONS: Combination chemotherapy, with gemcitabine and cisplatin, exhibits significant activity and favorable toxicity in advanced transitional carcinomas, although long-term follow-up and further studies are warranted.

Antibacterial Effect of an Intraprostatic Zinc Injection in a Rat Model of Chronic Bacterial Prostatitis / 대한비뇨기과학회지

PURPOSE: High levels of prostatic zinc are associated with prostatic antimicrobial activity and are depressed in patients with chronic prostatitis. We investigated the inhibition of bacterial growth in the rat prostate with chronic prostatitis after an intraprostatic injection of zinc and compared the two different types of zinc delivery. MATERIALS AND MTHODS: Ninety male Wistar rats were used in the study. Experimental chronic bacterial prostatitis was induced by the instillation of a bacterial suspension (Escherichia coli 108/ml) into the prostatic urethra. The animals were followed-up for 4 weeks and then injected intraprostatically with either 0.2ml of a zinc liposome or a zinc solution (0.04M zinc sulfate). Animals were sacrificed 4, 6, and 8 weeks after the injection. The inhibition of inflammation and its consequences were analyzed both microbiologically and histologically. The prostatic zinc concentrations were measured by inductively coupled plasma atomic emission spectrometry. RESULTS: The average infection rates and mean Log10cfu/g of the zinc-treated groups were significantly lower than the controls. The histopathology showed resolving prostatitis in the zinc-treated groups compared with the controls. The prostatic zinc levels were higher in the zinc-treated groups than in the controls 4 and 6 weeks after the zinc injection (p<0.05). However, the zinc liposome and zinc solution groups were found to be effectively identical. CONCLUSIONS: An intraprostatic injection of zinc inhibited bacterial growth by increasing the zinc levels in the rat prostatitis model. These results suggest that a local application of zinc to the prostate presents a new treatment modality for chronic bacterial prostatitis at the point of its pathogenesis.

Antibacterial Effect of an Intraprostatic Zinc Injection in a Rat Model of Chronic Bacterial Prostatitis / 대한비뇨기과학회지

PURPOSE: High levels of prostatic zinc are associated with prostatic antimicrobial activity and are depressed in patients with chronic prostatitis. We investigated the inhibition of bacterial growth in the rat prostate with chronic prostatitis after an intraprostatic injection of zinc and compared the two different types of zinc delivery. MATERIALS AND MTHODS: Ninety male Wistar rats were used in the study. Experimental chronic bacterial prostatitis was induced by the instillation of a bacterial suspension (Escherichia coli 108/ml) into the prostatic urethra. The animals were followed-up for 4 weeks and then injected intraprostatically with either 0.2ml of a zinc liposome or a zinc solution (0.04M zinc sulfate). Animals were sacrificed 4, 6, and 8 weeks after the injection. The inhibition of inflammation and its consequences were analyzed both microbiologically and histologically. The prostatic zinc concentrations were measured by inductively coupled plasma atomic emission spectrometry. RESULTS: The average infection rates and mean Log10cfu/g of the zinc-treated groups were significantly lower than the controls. The histopathology showed resolving prostatitis in the zinc-treated groups compared with the controls. The prostatic zinc levels were higher in the zinc-treated groups than in the controls 4 and 6 weeks after the zinc injection (p<0.05). However, the zinc liposome and zinc solution groups were found to be effectively identical. CONCLUSIONS: An intraprostatic injection of zinc inhibited bacterial growth by increasing the zinc levels in the rat prostatitis model. These results suggest that a local application of zinc to the prostate presents a new treatment modality for chronic bacterial prostatitis at the point of its pathogenesis.

Two Cases of Congenital Scrotal Anomalies: Ectopic Scrotum, Accessory Scrotum / 대한비뇨기과학회지

The three major scrotal anomalies are bifid scrotum, penoscrotal transposition, and ectopic or accessory scrotum. Bifid scrotum occurs if the genital swellings fail to fuse at the scrotal septum. Penoscrotal transposition results from abnormal genital tubercle development. This is associated with delay in the midline fusion of the urethral folds. Ectopic and accessory scrotum result from cleavage or abnormal migration of the genital swellings. Ectopic scrotum is extremely rare. His right scrotum was normal in position and size, and contained a normal palpable testis. The penis was showed externally normal appearance. At operation it was possible to excise the scrotal wall, preserving the vas deferens and the testicular vessels. Accessory scrotum has not been recorded in Korea. We experienced a case of unilateral ectopic scrotum and a case of accessory scrotum.

Extracorporeal Shockwave Lithotripsy vs Ureteroscopy in the Treatment of Lower Ureteral Stones / 대한비뇨기과학회지

PURPOSE: To determine the efficacy and outcome of extracorporeal shock-wave lithotripsy (SWL) compared with ureteroscopy (URS) in the treatment of lower ureteric calculi. MATERIALS AND METHODS: The records of patients treated primarily by SWL and URS were analysed retrospectively. Treatment with SWL included 198 patients (103 men and 95 women). All patients received 2500-3000 shocks waves at a mean energy setting of 16-20kV. URS was used in 194 patients (91 men and 103 women), with 7Fr, 8Fr, 9.5Fr rigid Storz ureteroscope. All ureteroscopies were performed with the patient under general or spinal anesthesia. The outcome was assessed by stone-free rates, retreatment rates, auxiliary treatment, Efficiency quotient (EQ), complications. RESULTS: SWL and URS for lower ureteric calculi resulted in a success rate 75.3% and 95.8%, respectively. Including the number of auxiliary procedures, we calculated the Efficiency Quotient (EQ) as 66.6 for SWL and 72.3 for URS. The mean treatment time for SWL was 30 minutes and for URS 38.1 minutes. General anesthesia was more frequently needed in URS patients. Complications occurred more often in the URS group. These were mostly mild, and all could be treated with a double-J stent, antibiotics, or analgesics. A lower stone-free rate was achieved in patients with larger(> OR = 10mm) stones (56.9% vs 82.9%) for smaller stones (<10mm) in the SWL group and 90.0% vs 97.9% for smaller stones in the URS group. Compared with SWL, URS was more time consuming; entailed placement of a ureteral stent and more often led to hospitalization. On the other hand, stone clearance was rapid after URS. CONCLUSIONS: The stone-free rate after URS is much higher than after SWL. Our study demonstrates that URS is highly effective treatment option for lower ureteral stones.

A Case of Idiopathic Calcinosis of the Scrotum / 대한비뇨기과학회지

The idiopathic calcinosis of the scrotum is multiple and asymptomatic nodules of scrotal skin which can onset either in childhood or early adulthood. It increases in size and number, while breakingdown to discharge chalky contents on occasions. We report a case of a 68-year-old-man who was effectively treated with a simple excision of the affected skin with an idiopathic scrotal calcinosis. There is no family history of scrotal calcification. Histopathologically, multiple nodules showed the epidermal cyst with partially degenerated wall and calcium deposits with a foreign body reaction in the dermis in this case. In most reported cases, some intact epidermal cysts are also present, and dystrophic calcification, and possible inflammation and rupture of epidermal cysts regarded as be the main pathogenetic mechanism of the disease.

Voiding Dysfunction associated with Herpes Zoster / 대한비뇨기과학회지

PURPOSE: Herpes zoster infection involving the lumbosacral dermatomes may cause voiding dysfunction. In this study, we investigated the clinical features and urologic manifestations in patients suffering from voiding dysfunction caused by herpes zoster infection. MATERIALS AND METHODS: We have reviewed the whole medical records in 5 patients who showed voiding dysfunction concomitant with herpes zoster infection. RESULTS: Dermatome levels of zoster infection were thoracic in 1, lumbar in 1 and sacral in 3 patients. Urologic symptoms were acute urinary retention in 4, who showed detrusor areflexia in the cystometrogram, and cystitis-like symptom with detrusor hyperreflexia in 1 patient. 3 of five patients showed weak anal tonus and constipation. 4 patients who showed detrusor areflexia were managed by indwelling catheter or clean intermittent catheterization with alpha-blocker and 1 patient who showed detrusor hyerreflexia was managed by anticholinergics. The mean time of recovery from voiding dysfunction was 2.2weeks(range:1-5weeks). CONCLUSIONS: Herpes zoster infection should be considered in patients presenting with an acute neurogenic bladder of unknown cause. However, the prognosis is favorable and most of the patients regain normal bladder function within 2 weeks.

Change of Collagen after Partial Ureteral Obstruction in Rat Kidney / 대한비뇨기과학회지

PURPOSE: Chronic ureteral obstruction results in changes in renal hemodynamics, tubular function, and subsequently fibrosis of the tubulointerstitium. The pathologic marker of irreversible renal injury is interstitial fibrosis. The degree of interstitial fibrosis is the most useful measure of the degree of renal injury. This study in rats with partial ureteral obstruction was performed to describe and quantify the changes in collagen deposition. MATERIALS AND METHODS: Female Sprague-Dawley rats weighing 300-400g were used. Individual kidneys were obtained from rats at 1, 2, 3, 4 weeks after partial ureteral obstruction and sham operation. The total amount of collagen was measured from its contents of hydroxyproline by assuming that hydroxyproline is 14% in weight of the collagen. Collagen types I, III, and IV were localized by immunohistochemical staining and the distribution of each collagen type was analized using differences of their staining densities. RESULTS: After 2 weeks of partial ureteral obstruction, the total amount of collagen in affected kidney was significantly increased compared to control and 1 week groups(P<0.05). All of the collagen types in the interstitium of the affected kidney was gradually increased parallel to the duration of partial ureteral obstruction. Collagen type IV was increased significantly in tubular basement membrane and interstitium after 2 weeks of partial obstruction compared to control and 1 week groups. CONCLUSIONS: The partial ureteral obstruction causes progressive increase of amount of collagen according to the duration of obstruction, especially after 2 weeks, and tubulointerstitial fibrosis of obstructive nephropathy is closely related to collagen type I, III, and IV. Infiltration of collagen type IV in tubular basement membrane may play a major role in obstructive nephropathy.

Change of Collagen after Partial Ureteral Obstruction in Rat Kidney / 대한비뇨기과학회지

PURPOSE: Chronic ureteral obstruction results in changes in renal hemodynamics, tubular function, and subsequently fibrosis of the tubulointerstitium. The pathologic marker of irreversible renal injury is interstitial fibrosis. The degree of interstitial fibrosis is the most useful measure of the degree of renal injury. This study in rats with partial ureteral obstruction was performed to describe and quantify the changes in collagen deposition. MATERIALS AND METHODS: Female Sprague-Dawley rats weighing 300-400g were used. Individual kidneys were obtained from rats at 1, 2, 3, 4 weeks after partial ureteral obstruction and sham operation. The total amount of collagen was measured from its contents of hydroxyproline by assuming that hydroxyproline is 14% in weight of the collagen. Collagen types I, III, and IV were localized by immunohistochemical staining and the distribution of each collagen type was analized using differences of their staining densities. RESULTS: After 2 weeks of partial ureteral obstruction, the total amount of collagen in affected kidney was significantly increased compared to control and 1 week groups(P<0.05). All of the collagen types in the interstitium of the affected kidney was gradually increased parallel to the duration of partial ureteral obstruction. Collagen type IV was increased significantly in tubular basement membrane and interstitium after 2 weeks of partial obstruction compared to control and 1 week groups. CONCLUSIONS: The partial ureteral obstruction causes progressive increase of amount of collagen according to the duration of obstruction, especially after 2 weeks, and tubulointerstitial fibrosis of obstructive nephropathy is closely related to collagen type I, III, and IV. Infiltration of collagen type IV in tubular basement membrane may play a major role in obstructive nephropathy.

Expression of M llerian Inhibiting Substance in Cryptorchidism at the Descending Level of Testis / 대한비뇨기과학회지

PURPOSE: To investigate the relationship of MIS and cryptorchidism according to the descending level of testis into scrotum, we studied expression degree of MIS by immunohistochemical analysis using anti-human MIS polyclonal antibody in testicular specimen. MATERIALS AND METHODS: MIS were stained in excised testis by trauma on each 8 patients as control group and age-matched abdominal, inguinal and prepubic cryptorchidism. The expression were classified as score 1, 2, 3 and 4 according to stained degree of percentage in randomized 16 fields(x400) under the light microscope. RESULTS: Of the degree of MIS expression in control group, 87.5% were category 3 or more. The mean score was 3.13+/-0.62. 2. Of the degree of MIS expression in abdominal type cryptorchid testis group that underwent orchiectomies, 68.7% were category 1. The mean score, 1.31 +/- 0.48, showed significant difference compared to control group(p0.05). 4. Of the degree of MIS expression in prepubic type, 75.0% were category 3 or more. And the mean score, 2.88+/-0.62, showed no significant difference compared to control group(p>0.05). CONCLUSIONS: Expression of MIS is different according to descending level of testis and may play a role in physiologic changes of testicular descent.

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No abstract available.

Changes of Contractility of the Vas Deferens to Field Stimulation in Diabetic Rats / 대한비뇨기과학회지

Diabetes is known to induce autonomic dysfunction and most experiments have been focused on the smooth muscle dysfunctions of the urinary bladder and corpus cavernosum in the genitourinary tract. The contractile response of the vas deferens is also decreased in diabetic rats and this effect may cause impairment of sperm transportation. However, few studies have been investigated the changes of contractility of the vas deferens in diabetic animals and little attention has been given to the differences between the contractilities of the prostatic and epididymal ends of the vas deferens in diabetic rats. In this study, the whole vas deferens was divided into two portions, prostatic and epididymal ends, and we examined the contractility of both segments to field stimulation at various frequencies from 4 to 64 Hz for 30 sec with pulses of 1 msec duration at 80 V in organ bath containing modified Tyrode's solution. Both initial twitch and the last contraction after 30 sec elicited by field stimulation were compared to clarify which component was more susceptible to field stimulation in control and diabetic rats. In the prostatic end, initial twitch was more impaired than the last contraction, which is believed that in diabetic rats, ATP(adenosine triphosphate) is more affected than NA(noradrenaline). In contrast, in the epididymal and the last contraction was more impaired than the initial twitch. In 64 Hz, initial twitch and the secondary contractions were not distinguished in the epididymal end of control rats, but in diabetic rats both phases were distinct. This means that the release of NA to field stimulation in the epididymal end is delayed in diabetic rats.

Clinical Experience of In Situ Extracorporeal Shock Wave Lithotripsy for Ureteral Stones / 대한비뇨기과학회지

We reviewed our experience of in situ extracorporeal shock wave lithotripsy(ESWL) for primary ureteral stones in 284 patients between March 1994 and October 1995. The second-generation lithotripter, Direx Compact, was used for stone disintegration without any manipulation of stone and only parenteral analgesics were used for pain control during ESWL. The locations of stones were upper in 140(49.3%), mid in 39(13.8%) and lower ureter in 105(36.9%) cases. Of the 284 patients, 250(88.0%) were stone free and 5(1.7%) had some residual stones, while 29(10.2%) patients were failed to respond to the treatment. The stone size was significant factor influencing the final result. Re-ESWL was necessary in 48 patients(16.9%) and auxillary procedures including percutaneous nephrostomy and double-J catheterization were required in 18 patients(6.3%). The over all efficiency quotient was 71.4. The 29 patients who were refractory to in situ ESWL were managed by ureteroscopic manipulation(10 cases) or open surgery(19 cases). The complications were mild but admission was required in 8 patients(2.8%) with colic pain or fever. Our experience shows that in situ ESWL is a noninvasive and efficient method to treat ureteral stones within whole length of ureter.

A Case or Unilateral Ureteral Triplication Associated with Ipsilateral Vesicoureteral reflux / 대한비뇨기과학회지

We report one case of ureteral triplication associated with ipsilateral vesicoureteral reflux and the relevant literatures are reviewed. A 26-year-old female was referred to our hospital with a history of fever, chilling and recurrent left flank pain. Referral was prompted by documentation of urinary tract infection. Intravenous pyelogram showed 3 ureters, which were drained into bladder separately and cystoscopy revealed only two ureteral orifices in left side. It can be classified as type I according to Smith's classification. Vesicoureteral reflux (Grade I) was found on voiding cystourethrogram.