Clinical Manifestation and Heredity Feature in Five Pedigrees with Porokeratosis / 中华皮肤科杂志

Objective To analyze the clinic features and hereditary characteristics of three subtypes of porokeratosis, namely disseminated superficial actinic porokeratosis (DSAP), porokeratosis palmaris et plantaris disseminata(PPPD) and porokeratosis of Mibelli (PM) in five pedigrees with porokeratosis. Meth-ods After clinical and pathological diagnosis, every living family member of the five pedigrees with poro-kerotosis was undergoing medical examination and genetics analysis. These five pedigrees consisted of three DSAP pedigrees (totally 266 family members including 100 patients), and one PPPD pedigree (composing of 90 members including 26 patients), one PM pedigree (cornposing of 34 members including 17 patients). Results While diagnosed as porokeratosis, the five pedigrees included three distinctive variants, each with its own clinic characteristics. The lesions was initiated on the face in DSAP subtype, on palms and the flex-ion side of fingers in PPPD subtype; or involving sun-covered areas in PM subtype. Of the three subtypes of porokeratosis, the onset age in DSAP subtype was earliest, usually about 8-20 years old, about 14-20 years old in PPPD subtype, but PM subtype about 20-30 years old. Conclusions As a group of autosomal dominant genodermatosis, porokeratosis presented various clinic variants with different genetic basis. And, different subtype could be seen in a same patient or same pedigree.

Two-staged Nd:YAG Laser Internal Urethrotomy for Complete Urethral Stricture / 대한비뇨기과학회지

In complete urethral stricture, visual internal urethrotomy has not so high success rate because of the difficulty in determining the precise direction of incision and the inadequacy in scar tissue removal. Nd:YAG laser internal urethrotomy vaporizes the fibrotic scar tissue on strictured urethra and make for re-epithelization of urethra without scar tissue formation. We report experiences of 11 cases of two-staged Nd:YAG laser internal urethrotomy for complete urethral stricture. Age of patients was ranged from 25 to 61 (mean; 42) years old. All of 11 cases developed after urethral injury and was complete urethral stricture. The aim of first stage of operation is to make communication through region of urethral stricture. At second stage of operation, we reconfirmed the direction of neourethra, excised and vaporized the fibrotic scar tissue on strictured urethra using Nd:YAG laser at all directions to achieve normal appearance as possible. Follow-up duration was 6-18 (mean; 14) months. There was no recurrence at all. After 6 months, maximal flow rate was 21-29 (mean; 23.7) ml/sec, and we could not find any stricture portion on retrograde urethrogram. As a conclusion, two-staged Nd:YAG laser internal urethrotomy for complete urethral stricture is a new alternative method, which has many advantages such as technical simplicity, clear operative field due to less bleeding, unnecessity, of adjuvant urethral dilation, and no recurrence rate after the operation.

Treatment of BPH with a Memotherm Urethral Stent / 대한비뇨기과학회지

We describe the use of a new urethral stent implanted in 6 patients with prostatic outflow obstruction. All patients were in a high risk group for surgery and treated successfully, for a follow-up of 6 to 13 (mean 8.5) months. The majority of patients were satisfied with the procedure, which provided a quick, safe and effective results, compared with conventional surgical treatment. The stent, woven from nitinol in the form of a tubular mesh, was inserted into the prostatic urethra via a delivery device using endoscopic control under local anesthesia. During follow-up period, the stent remained in situ and there were no urinary incontinence or other complications. The average maximum flow rate at postoperative 6 months was 19.5 ml/sec. This stent is a useful alternative to conventional surgical treatment in the high risk and large prostate patient.

Sling Operation for the Genuine Stress Incontinence Patients with Intrinsic Sphincter Dysfunction / 대한비뇨기과학회지

The sling operation is especially indicated in patients with intrinsic sphincter dysfunction (ISD). We evaluated of the effectiveness of the sling operation for the treatment of genuine stress incontinence patients with ISD. We operated 7 patients and followed up all of the patients for 214 (mean 8) months. Preoperative maximal urethral closure pressure was ranged from 23 to 74 (mean 38.4) cmH2O and valsalva leak point pressure (VLPP) was ranged from 41 to 78 (mean 59.5) cmH2O. We applied rectus fascia or GoreTex mesh as sling material. As a results, genuine stress incontinence (GSI) had completely cured in all of 7 cases. However, postoperative urinary retention was developed in two cases. In one of these, we released suspension suture, and in another case, urethrolysis and Raz operation was underwent in other hospital. All of these two cases showed improvement of voiding and any recurrence of incontinence was not noted. In conclusion, GSI due to ISD can be cured by the technique of the sling operation, so we suggest that the sling operation is one of the treatment for GSI patient with ISD.