The Trend Change of Incidence and Treatment of Urolithiasis between the 1980s and 2000s / 대한비뇨기과학회지

PURPOSE: The incidence of urolithiasis has recently shown an increasing tendency in relation to improvements in living conditions in Korea. With the development of extracorporeal shock wave lithotriptor (ESWL), endourology and other new instruments, urolithiasis has become easier to treat, without surgical intervention. The incidence and treatment of urolithiasis, between the 1980 and 2000, were evaluated. MATERIALS AND METHODS: 328 and 1,142 patients with urolithiasis, either admitted between January 1981 and December 1984 or treated at the out-patient clinic between January 2001 and December 2004, respectively, were analyzed. RESULTS: In the early 1980s, 328 (27.3%) patients of the total 1,203 admitted to the urology department had urolithiasis. In the early 2000s, 1,142 patients were treated for urolithiasis. The total number and incidence constantly increased over the stated period. The ratio of males to females was 1.3:1 in the 1980s and 2.0:1 in the 2000s. The occurrence rate for those under 20 years decreased, but increased after the 6th decade. And the seasonal occurrence was highest during the summer of the early 1980s, but there was no seasonal difference during the early 2000s. The incidences of lower ureteral, bladder and urethral calculi were decreased, but those of renal and upper ureteral calculi increased. In the management of urolithiasis, open surgery and expectant therapy decreased during the 2000s. In the endourological management of urolithiasis, the success rates of ESWL, percutaneous nephrolithotomy (PNL) and ureteroscopic removal of stone (URS) were 94.5, 86.6 and 96.4%, respectively. CONCLUSIONS: The incidence and treatment modalities of urolithiasis have changed, especially since the late 1980s.

Prevention of Relapse with the Cranberry Juice in Chronic Pelvic Pain Syndrome / 대한비뇨기과학회지

PURPOSE: The treatment of chronic pelvic pain syndrome (CPPS) is based on antibiotic therapy, but many patients experience a relapse after treatment. Cranberry juice is known for its roles in both the treatment and prevention of urinary tract infections. This study was performed to evaluate the effectiveness of cranberry juice in the prevention of a relapse after the treatment of CPPS. MATERIALS AND METHODS: Fifty patients, diagnosed as CPPS (National Institutes of Health; NIH-catagory IIIa), were included in this study. All the patients had initially been treated with levofloxacin and supportive treatment for 8-12 weeks. After completion of the initial treatment, 26 volunteer patients were recommended to drink 150ml of cranberry juice twice a day, 24 patients, as a control group, received no cranberry juice and all the patients re-evaluated after 3 months. RESULTS: On initial diagnosis, the white blood cell (WBC) count in the high power field (HFP) of expressed prostatic secretions (EPS) and the NIH-Chronic Prostatitis Symptom Index (NIH-CPSI) in cranberry group were 18.2 3.4 and 23.1 4.4 and those of the control group 16.4 4.8 and 22.4 3.7, respectively. When the medical treatment was ended, the WBC of the EPS and NIH-CPSI in the cranberry group were 2.5 2.1 and 14.1 4.1, and those of the control group were 2.7 1.9 and 13.7 2.1, respectively. After the three month follow-up, the cranberry group showed a WBC of 2.2 2.5 in the EPS and a NIH-CPSI of 12.7 3.9, a slight decrease or similar result compared to the treatment completion period. No patient showed aggravation of symptoms after drinking cranberry juice, whereas five from the control group did. CONCLUSIONS: Cranberry juice showed an effect in the prevention of a relapse in CPPS patients, with no adverse effects.

The Long-term Outcome of Fascial Sling Operation in Female Stress Urinary Incontinence: Multicenter Study in Korea / 대한비뇨기과학회지

PURPOSE: To evaluate the long-term outcomes of fascial sling operation conducted at multicenters in Korea. MATERIALS AND METHODS: 564 patients, who underwent fascial sling operation for stress urinary incontinence, between December 1996 and May 2001, at 10 institutions in Korea, were included in this study. They were all followed up for a period of at least 2 years. History taking, a physical examination, and urodynamic studies, including Valsalva leak point pressure (VLPP), were conducted before the operation. Postoperative symptoms and satisfaction were assessed using a questionnaire. The 269 (47.7%), 266 (47.2%) and 29 (5.1%) patients underwent operations with autologous rectus fascia, cadaveric allograft fascia and autologous fascia lata, respectively. RESULTS: The mean follow up period was 43.6 months, ranging from 24 to 77 months. Stress urinary incontinence was cured in 485 (86.0%) patients and improved in 31 (5.5%). In autologous fascia group, 252 (84.6%) patients were cured and 18 (6.0%) improved; whereas, in allograft fascia group 233 (87.6%) patients were cured and 13 (4.9%) improved. 253 (84.9%) patients with autologous fascia and 228 (85.7%) patients with allograft fascia were satisfied, making a total of 481 patients (85.3%) that were satisfied with the operation. According to the fascia length and preoperative VLPP value, there were no differences in the success and patient satisfaction rates. There were 197 (34.9%) patients with preoperative urge urinary incontinence, and 92 (46.7%) of these were either cured or improved postoperatively. However, de novo urge urinary incontinence was noted in 8 patients (1.4%). CONCLUSIONS: Our results suggest that the long-term outcome of fascial sling operation for the treatment of stress urinary incontinence was satisfactory.

Clinical Significance of Sensory Nerve Tests on External Genitalia for Diagnosis of Female Sexual Dysfunction / 대한비뇨기과학회지

PURPOSE: It is thought that neurological disorders are one of the main causes of organic female sexual dysfunction. However, it is difficult to diagnose due to the lack of measuring tools for assessing genital neural function. Sensory nerve tests on external genitalia is a new challenge for diagnosing female sexual dysfunction. In this study, we aimed to evaluate the clinical significance of the quantitative measurement of the genital sensory threshold in female sexual dysfunction. MATERIALS AND METHODS: Forty women with complaints of sexual dysfunction were evaluated with physical and vagina examination, serum hormonal tests, routine urinalysis and a questionnaire (the brief index of sexual function for women). A genitosensory analyzer (GAS, Medoc, Israel) was used to quantitative measure the vaginal and clitoral warm, cold and vibratory sensory thresholds. RESULTS: Of the 40 women, an arousal disorder was reported in 40%, orgasmic disorder in 82.5%, sexual pain disorder in 17.5% and a decreased libido in 17.5%. Of the 40 women, 86.4 and 91.2% showed impairment of vaginal cold (A-delta fiber) and warm (unmyelinated C fiber) sensations, respectively. However, the touch and vibratory sensations (A-beta fiber) showed relatively lower impairments; vagina and clitoris in 20.0 and 89.2% of the patients, respectively. CONCLUSIONS: In this study, most of the patients with sexual problems had significant vaginal and clitoral sensory nerve fiber impairments. The results support the significance of organic origins in female sexual dysfunction and the usefulness of quantitative analysis of genital sensation in diagnosing the etiology. (Korean J Urol 2005;46:610-615)

The Efficacy and Safety of Midazolam Induced Sedative Cystoscopy / 대한비뇨기과학회지

PURPOSE: Cystoscopy is very common and is one of the major office based procedures used in urologic clinics. However, a majority of patients complain of fear, pain, and discomfort when performing the procedure in an alert state. Routine administration of sedative and analgesic drugs is widely provided for gastorintestinal endoscopy to prevent patient discomfort and increase tolerance. Based on this, we investigated the safety and efficacy of midazolam induced sedative cystoscopy. MATERIALS AND METHODS: One hundred and twenty patients were enrolled in this study. They were divided into two groups; group I (n=80) consisted of patients who were sedated by midazolam 2.5mg IV before cystoscopy, and group II (n=40) consisted of patients who were not sedated and diclopenac 90mg was injected in them intramuscularly before cystoscopy to prevent pain. All patients in group I were reversed from the sedative state by flumazenil 0.5mg IV right after the completion of the cystoscopic procedure. The two groups were not significantly different in their age, sex, and weight distribution (p>0.05). Blood pressure, pulse, and respiratory rates were monitored pre-, intra-, and post procedure. The status of consciousness was monitored every three minutes by the OAA/S (Observer's Assessment of Alertness/Sedation) scale. Pain scale, anxiety scale, satisfaction score from patients and operators were measured using a specified questionnaire. RESULTS: In group I, the pain scale and anxiety scale were significantly reduced compared to group II (p<0.001). There were temporary changes in blood pressure and pulse rate in group I, but they were not clinically significant and no specific management was required. Group I patients were significantly more satisfied with their procedures compared to the patients of group II (p<0.001). CONCLUSIONS: Midazolam induced sedative cystoscopy can be applied safely and effectively as an outpatient base procedure. Further, we expect to apply this sedative procedure to other urologic procedures.

Diagnosis and Treatment of Female Sexual Dysfunction

Woman's sexual response is composite and complex. However, recent understanding of the causes of sexual dysfunction in women highlights not only psychological but also organic aspects. Taking patients' medical and sexual history and careful physical examinations are very important to make diagnosis and uncover conditions that cause problems in their sexual activities. Multimodal treatment with good support from the sexual partner is usually essential.

Effects Estrogen on the Expression of NOS and Histologic Composition in Rabbit Clitoris / 대한비뇨기과학회지

PURPOSE: Many investigators suggested that changes in hormonal environment in the postmenopausal women functionally or histologically effect the clitoris and vagina. We investigated the mechanism of female se xual dysfunction occurring in the decreased hormonal status, and aimed to establish and experimental base for the hormone replacement in postmenopausal women to correct sexual dysfunction. MATERIALS AND METHODS: Twenty mature female New Zealand white rabbits were randomly divided into three groups; control group, oophorectomy group, estrogen replacement group after oophorectomy. Nitric oxide synthase (NOS) activity and the degree of expression of neuronal NOS (nNOS) and endothelial NOS (eNOS), collagen content in clitoral tissues were analysed. RESULTS: nNOS and eNOS were significantly increased in the oohporectomized group while decreased in the estrogen replacement group (p<0.01). NOS activity showed the similar pattern of change (p<0.05). Oophorectomy induced a significant increase in collagen content, while the ratio of smooth muscle content was increased significantly after the estrogen replacement (p<0.01). CONCLUSIONS: Estrogen deficiency induces collagen synthesis and decreases the content of smooth muscle in clitoris, resulting in a structural relaxation difficulty. We believe that NOS becomes more active to improve the relaxation difficulty and that hormone replacement helps to restore the normal state of smooth muscle relaxation. Considering these findings, we suggest that estrogen down-regulates NOS and its activity.

Early Experience with Extracorporeal Magnetic Innervation (ExMI) Therapy for Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The purpose of this study is to assess if extracorporeal magnetic innervation (ExMI) can be successful in treating stress urinary incontinence (SUI). MATERIALS AND METHODS: We studied 38 women with demonstrable stress urinary incontinence. Evaluation before treatment included history, physical examination, voiding diary, perineometer that measures the strength and endurance of pelvic floor muscle contractions, urodynamic study and quality of life questionnaires. Treatments were performed for 20 minutes (10Hz for 10 minutes and 50Hz for 10 minutes), twice a week for 6 weeks. After ExMI therapy, all of the evaluations were repeated at the eighth week. RESULTS: The follow up care was continued on the patients for longer than 2 months. Fourteen out of the 38 patients (36%) were dry after the ExMI treatment. The frequency of leak episodes was reduced from 2.8 to 1.7 in 2 months. Pelvic floor muscle contraction (PMC) pressure was increased from 10.42 4.35 to 17.02 4.04mmHg. CONCLUSIONS: Our early results suggest that ExMI therapy is an effective approach for the treatment of SUI. However, longer follow-up is required to determine how long the benefits of treatment last, whether re-treatment will be necessary, and what the effective treatment strategies are.

Diagnosis and Treatment of Dyspareunia / 대한남성과학회지

No abstract available.

Surgical Management of the Failed Anti-incontinence Surgery / 대한비뇨기과학회지

PURPOSE: Various surgical methods have been using to treat female stress urinary incontinence. However, significant numbers of those patients suffered from immediate or delayed recurrences. The aims of this study were to analyze the etiology of recurrent stress urinary incontinence and evaluate the efficacy of each operation which was used as methods of treating recurrent stress urinary incontinence. MATERIALS AND METHODS: Data of 16 female patients with recurrent stress urinary incontinence who visited and treated at our urologic department from January 1995 to March 1998 were analyzed. All patients were assessed for their age, types of previous and current anti-incontinence operations, urodynamic findings and final outcomes. RESULTS: Mean age was 48.8 years old. 12 patients were taken anti-incontinence operations only once before recurrence, and 4 patients experienced two times of anti-incontinence operations. Two of 16(12%) patients were diagnosed as anatomic incontinence(AI), 3(19%) patients were diagnosed as intrinsic sphincteric dysfunction(ISD), and 11(69%) patients had both AI and ISD. Two AI patients were finally managed by Raz bladder neck suspension with anterior and posterior colporrhaphy(APR), and Burch colposuspension, respectively. Three ISD patients were treated by sling operation & APR, collagen injection, and Burch colposuspension, repectively. 11 mixed incontinence patients were treated by sling operations & APR(7), Burch colposuspension(3), Stamey`s needle suspension & APR(1). None of 16 patients has developed recurrent urinary incontinence so far. CONCLUSIONS: Basic principle in treating AI is the correction of the urethral hypermobility. However, 81%(13/16) of patients still had urethral hypermobility in spite of previous anti-incontinence surgery, and it seems that those anti-incontinence surgeries were improperly selected or urethral hypermobility reappeared. Patients who showed urinary incontinence in spite of well supported bladder neck suggest the possibility of undetected or secondary ISD. These findings support the importance of selection of proper initial surgical management. In recurrent urinary incontinence, majority of them show undetected or newly appeared ISD component regardless of urethral hypermobility. In those situations, sling operation can be a safe and effective procedure in the management of patients with failed anti-incontinence surgery.

Role of Growth Factors in Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The enlargement of a prostate afflicted with benign prostatic hyperplsia(BPH) is known to be caused by the proliferation of prostatic cells under the influence of androgen, growth factors and interaction among cells. However, their roles are not yet to be clearly identified. Thus, we studied about the role of the growth factors in development of BPH. MATERIALS AND METHODS: We randomly selected 46 patients who received transurethral resection of prostate(TURP) due to prostatic enlargement and were confirmed as BPH pathologically. Their prostatic sizes were measured using transurethral ultrasonography. Paraffin embedded specimens from the TURP were stained with H&E (hematoxylin-eosin). Point count method was applied to obtain the ratio among the sizes of stroma, epithelium, and glandular lumen. Immunohistochemical stain was conducted on bFGF(basic fibroblast growth factor: goat polyclonal antibody), and TGF-beta 2(transforming growth factor-beta2: rabbit polyclonal antibody). The intensity of fluorescence (stroma; 0+1+,2, glandular epithelium 0,+1,+2,+3) of bFGF and TGF-beta2 was obseNed in 20 low power field under the light microscope, then measured to get an average. RESULTS: The mean sixte of prostate was 44.2(+/-21.0)ml and the ratio among the sizes of stroma, glandular epithelium, and gladular lumen was 5.6:4:2.1, meaning that stroma took up the largest part of a prostate. The degree of expression of bFGF and TGF-beta2 was significantly different between actively proliferating group and inactively proliferating group(when the proliferation rate was less than 3%, n=26). CONCLUSIONS: This study showed that growth factors such as bFGF and TGF-beta2 affected the proliferation rate, with individual differences and differences in time. We think they play different roles in influencing the rate according to cellular components such as stromal and glandular epithelial cells.

Effect of M-VAC(Methotrexate, Vinblastine, Adriamycin and Cisplatin) Chemotherapy in Locally Invasiue T3a/T3b) Transitional Cell Carcinoma of the Bladder / 대한비뇨기과학회지

PURPOSE: Since a significant number of patients with locally invasive bladder tumor(T3a/T3b) subsequently develop distant metastases, there have been lots of controversies in deciding treatment modalities. In the past decade, progress has been made in the development of effective chemotherapy for the treatment of advanced transitional cell carcinoma of the urothelium. Thus, we reviewed the effectiveness of the M-VAC(methotrexate, vinblastine, adriamycin, and cisplatin) chemotherapy for locally invasive transitional cell carcinoma (TCC) of the bladder. MATERIALS AND METHODS: We reviewed 36 patients who were diagnosed as T3a/T3b TCC and treated with aggressive transurethral resection of the bladder tumor(TURBt) and M-VAC chemotherapy Remission was defined in case of complete disappearance of the tumor or downstaging, and progression was defined in case of persistent disease or upstaging. RESULTS: Mean age of the patients was 60.4 years old(33 males; 3 females), and mean follow up was 12.2 +/- 8.9 months. Response rate considering loss of follow up according to the Kaplan-Meyer's method, was 79, 49, 44, 37% at 6, 12, 18, 24th month, respectively. Disease progressions were found in 19 patients during follow up, and the mean duration to progression was 9.2 +/- 5.0(1-19)months. 79% of the patients with disease progression showed progression within 12 months. Lymph node metastases or distant metastases were confirmed in 68% of progressed patients. CONCLUSIONS: M-VAC chemotherapy after aggressive TURBt is limited, but erective treatment modality, and it is also useful in deciding the prognosis of cancer with its responsiveness.

Removal of a Strangulating Polyethylene Ring from the Penis with a Heated Blade / 대한남성과학회지

Methods of removing strangulating objects from the penis have been described in many cases. We report a unique method, namely, melting a polyethylene tereftalate ring with a heated blade, which was very effective and safe for removal.

A Case of Unrecognized Bilateral Renal Cell Carcinoma / 대한비뇨기과학회지

Renal cell carcinoma is a relatively rare tumor, accounting for approximately 3 percent of adult malignancies. Bilateral renal cell carcinoma, either synchronous or asynchronous, very rarely occurs and makes another urological dilemma. We experienced a case of unrecognized bilateral renal cell carcinoma ; which had been treated by radical nephrectomy after diagnosed as a left renal cell carcinoma, Robson stage IIIa, about 18 months later another mass was found in remaining kidney. Therefore, we performed wedge resection of the mass, and it was also diagnosed as a renal cell carcinoma. Reviewing of the initial abdomen-pelvis CF scan, mass in Rt. kidney had already been existed when left. renal cell carcinoma was diagnosed. This case was finally diagnosed with unrecognized bilateral synchronous renal cell carcinoma.