A Case of Nontuberculous Mycobacteria Infection That Was Misdiagnosed as an Invasion of Wegener's Granulomatosis / 대한류마티스학회지

Wegener's granulomatosis is a rare disease that pathologically causes necrotizing granulomatous vasculitis in the arterioles and venules and it can invade the whole body. In addition, it is difficult to distinguish between a nontuberculous mycobacteria infection that shows manifestations of granuloma and Wegener's granulomatosis. There has been no reported on a patient who had the 2 abovementioned two diseases at the same time. A 69 year old male patient had Wegener's granulomatosis that had invaded the prostate. He also had a scrotal swelling and back pain. He had manifestations of granulomatous infection on the scrotum and spine biopsies. However, there was no clinical evidence of Wegener's granulomatosis. As a result, we examined him for other diseases that can cause a granuloma. Consequently, he was also diagnosed as suffering with a nontuberculous mycobacteria infection. We report here on this case and we review the relevant medical literature.

The Prevalence and Risk Factors of Overactive Bladder in Korean Children: A Comparative Analysis according to Definition / 대한비뇨기과학회지

PURPOSE: We wanted to estimate the prevalence and risk factors of overactive bladder(OAB) in Korean children who were 5-13 years of age, according to the definition of OAB. MATERIALS AND METHODS: A randomly selected cross-sectional study was conducted on 26 kindergartens and 27 elementary schools nationwide in Korea. There were 19,240 children; a parent was asked to complete the questionnaires, which included items about OAB and the children's voiding and defecating habits. OAB was defined as urgency with or without urge incontinence, and usually with an increased daytime frequency and nocturia(ICCS 2006, group A) or an increased daytime frequency(>8 times/day) and/or urge urinary incontinence with or without urgency (group B); its prevalence and associated factors were investigated. RESULTS: The response rate for the questionnaires was 85.84%. The overall prevalence of OAB was 16.59%(group A) and 18.79%(group B). For groups A and B, the prevalence of OAB decreased with age from 22.89% to 12.16% and from 40.44% to 9.60%, respectively(p=0.0001). The overall rate of wet and dry OAB was 26.97% and 73.03%, respectively. Compared to the normal group, the children with OAB had a higher prevalence of nocturnal enuresis(NE), constipation, fecal incontinence, a history of urinary tract infection and delayed bladder control in both groups A and B(p<0.05). The rate of increased daytime frequency and urge incontinence were 3.69% and 2.31%(p=0.009), and 26.97% and 14.78%(p=0.0001) in group A and for the non-OAB children, respectively; their prevalence in group A decreased with age from 5.04% to 3.06% and from 45.74% to 18.50%, respectively(p=0.0001). CONCLUSIONS: The overall prevalence of OAB in group A for Korean children 5-13 years of age was similar to that in group B. However, the range of prevalence in group B was much more variable than that in group A. NE, constipation, fecal incontinence, a history of urinary tract infection and delayed bladder control may be risk factors for OAB in children.

A Comparative Study between Standard and Tubeless Percutaneous Nephrolithotomy / 대한비뇨기과학회지

PURPOSE: To compare the clinical parameters and complications between standard and tubeless percutaneous nephrolithotomies (PCNL). The purpose of this study was to assess the efficacy, safety and morbidity of a tubeless percutaneous nephrolithotomy. MATERIALS AND METHODS: A total of 102 patients, who underwent a PCNL at our institution by one surgeon, were enrolled in this study. Of the 102 patients, 30 underwent a standard PCNL between January 2001 and July 2002, and 72 underwent a tubeless PCNL between July 2002 and March 2005. All the PCNL were performed using a balloon tract dilator and 30Fr. working sheath. In the standard PCNL group, a 12Fr. nephrostomy tube was inserted. In the tubeless PCNL group, no nephrostomy tube was inserted, with the skin sutured onto the site of the nephrostomy. The stone volume, operating time, amount of blood loss, complications and hospital stay were compared between the two groups. RESULTS: There were no significant differences in stone volumes, decrease in postoperative 1 day hemoglobin, transfusion rates and complication rates between the two groups. However, the postoperative hemoglobin (p=0.05) and hospital stay (p=0.001) were significantly less in the tubeless compared to the standard PCNL group. CONCLUSIONS: The tubeless PCNL was associated with no more bleeding or complications than the standard PCNL. Tubeless PCNL is a recommendable procedure in percutaneous renal stone surgery.

Prognostic Significance of the Tumor Configuration in Superficial Bladder Tumor / 대한비뇨기과학회지

PURPOSE: The prognostic factors for superficial bladder tumor that affect tumor recurrence and progression have been studied for many years. They are stage, grade, size, multiplicity, microvessel invasion and etc. This study was performed to evaluate the influence of the tumor configuration on predicting its progression and recurrence. MATERIALS AND METHODS: 128 patients who initially presented with superficial bladder tumor (pTis, pTa and pT1) were retrospectively analyzed according to many factors such as stage, grade, size, multiplicity, microvessel invasion and tumor configuration for tumor progression and recurrence after primary transurethral resection. RESULTS: 48 patients (37.5%) experienced recurrent disease and 20 patients (15.6%) had progressive disease. The absence of stalk and microvessel invasion were the statistically significant factors for recurrence. Only microvessel invasion was a significant prognostic factor for progression. CONCLUSIONS: Only two factors, i.e., the absence of tumor stalk and microvessel invasion, were significant prognostic factors for tumor recurrence. Only microvessel invasion was a significant prognostic factor for tumor progression. When tumors are microvessel invasion positive without stalk after primary transurethral resection, these patients might then benefit from being treated with a more aggressive therapeutic modality.

Precise Anatomical Location of the Autonomous Nerve from the Pelvic Plexus to the Corpus Cavernosum / 대한비뇨기과학회지

PURPOSE: We wanted to study the precise anatomical location of the branches of the pelvic plexus from the sacral root to the cavernous nerve. MATERIALS AND METHODS: We performed microdissection on the pelvises from 4 male formalin fixed cadavers under a Zeiss surgical microscope and we traced the location of the branches of the pelvic plexus at a magnification of 6x. RESULTS: The configuration of the pelvic plexus was an irregular diamond shape rather than rectangular. It was located retroperitoneally on the lateral wall of the rectum 8.2 to 11.5cm from the anal verge. Its midpoint was located 2.0 to 2.5cm from the seminal vesicle posterosuperiorly. A prominent neurovascular bundle (NVB) was located on the posterolateral portion of the apex and the mid portion of the prostate. The pelvic splanchnic nerve (PSN) joined the NVB at a point distal and inferior to the bladder-prostate (BP) junction. The PSN components joined the NVB in a spray-like distribution at multiple levels distal to the BP junction. The distance from the membranous urethra to the NVB was 0.5 to 1.2cm. We also found multiple tiny branches on the anterolateral aspect of the prostate apex. CONCLUSIONS: In contrast to the usual concept, the NVB was much wider above the mid portion of the prostrate and it supplied multiple tiny branches on the anterolateral aspect of the prostate. The PSN branches arose from the more posteroinferior area of the pelvic plexus. Therefore, we recommend a more anterior dissection of the lateral pelvic fascia for nerve sparing radical prostatectomy. If surgeons plan a nerve graft after radical prostatectomy, they should consider this neuroanatomy for obtaining a successful outcome.

Antegrade Ureteral Stenting in Ureteral Obstruction / 대한비뇨기과학회지

PURPOSE: Antegrade ureteral stenting was attempted in cases where cystoscopic retrograde ureteral stenting had been unsuccessful in the alleviation of a ureteral rupture, stricture or obstruction. Attempts were made to evaluate the clinical outcomes and technical issues of antegrade ureteral stenting in ureteral obstruction. MATERIALS AND METHODS: Between 1998 and 2003, antegrade ureteral stenting was attempted in 15 patients. Here, the results were retrospectively analyzed. Of the 15 patients, the retrograde ureteral stenting failed in 13. The causes of the ureteral obstructions were urological and nonurological malignancies in 12 patients, genitourinary tuberculosis in 2 and endoscopic ureteral trauma in 1. RESULTS: Thirteen of the 15 patients were successfully stented using the antegrade methods. One cervical cancer patient was stented using a pull-through technique. Four out of 6 patients with radiologically completely obstructed ureters were stented successfully. The ureteral stents were removed in two patients where the causes of the ureteral obstructions were relieved. Seven patients were successfully stented for the relief of obstructive renal failure, and all showed rapid decreases in their serum creatinine level and/or improvements on imaging studies. Five patients were successfully stented for the relief a ureteral obstruction, and all showed improvements on imaging studies. Changes of the ureteral stents were performed by cystoscopy in four patients. CONCLUSIONS: Antegrade ureteral stenting is an alternative technique for the alleviation of a ureteral obstruction should retrograde ureteral stenting not be possible. An antegrade ureteral stenting trail is recommended, even in the case of a radiologically complete obstruction on an antegrade ureterogram. Antegrade ureteral stenting is one of the choices for the alleviation of a ureteral obstruction unless the patient has an intravesical obstruction and the inability to move.

Long-Term Follow-Up of Abnormal Spermatogenesis after Exposure to Solvent Containing 2-Bromopropane / 대한남성과학회지

PURPOSE: Solvent containing 2-bromopropane has been widely used as a detergent in the electronic industries. The long-term toxic effects of this chemical on spermatogenesis were investigated. MATERIALS AND METHODS: All eight employees (mean age 33 years) who were exposed to the solvent underwent semen analysis, hormonal tests, and testicular biopsies 2 to 3 months after cessation of the exposure. The patients' semen quality had been followed at regular intervals for 1 year as long as the results remained abnormal. We monitored the long-term outcome of 3 patients whose semen remained abnormal during 1 year of follow-up. RESULTS: All patients had decreased sperm counts, with azoospermia being found in one patient. Six patients showed abnormal histologic findings such as atrophy of the seminiferous tubules, thickening of the basement membrane, and hyperplasia of Leydig cells. Of 8 patients, 5 (mean age 37.3 years) showed complete recovery of semen quality during the year after exposure ceased. These patients initially had sperm numbers more than 75 104/mL and a normal serum concentration of FSH. Of 3 patients with abnormal serum FSH and sperm numbers below 3,000/mL, 2 recovered normal sperm numbers at 18th and 24th months after cessation of exposure. Their ages and initial serum FSH concentration were 29 and 26 years and 19.6 and 74.7 mIU/mL, respectively. One patient (37 years old) with relatively normal testicular histology and a serum FSH concentration of 23.7 mIU/mL still had abnormal findings at the last semen analysis, performed 6 years after cessation of exposure. CONCLUSIONS: Solvent containing 2-bromopropane can impair spermatogenesis. This process may be reversed by avoidance of the exposure to this chemical substance. However, an abnormally elevated serum FSH concentration after exposure is an ominous sign for recovery of semen quality.

Age-Specific Reference Range for Prostate Specific Antigen at a Health Center in Korea / 대한남성과학회지

PURPOSE: Normal ranges for serum prostate specific antigen(PSA) differ among racial groups and by age. We sought to establish the relation between serum PSA concentration and age in a health care center Korea and to compare the vales with those of other races and other domestic health care centers. PATIENTS AND METHODS: Between January 1997 and December 1998, a total of 2908 Korean men aged 40 to 79 years without clinical evidence of prostate cancer who were examined for serum PSA at Kangnung Hospital using the Tandem assay (Hybritech). Descriptive statistics, including the median value and 95th percentiles of the distribution of serum PSA concentrations, were calculated for 10-year age groups from age 40 through 79. RESULTS: The serum PSA concentration correlated directly with age (p<0.001) using the 95th percentile of PSA. The normal age-specific reference ranges were 0.3 to 2.20 ng/ml for 40-49years, 0.3 to 2.30 ng/ml for 50-59 years, 0.3 to 3.50 ng/ml for 60-69 years, and 0.2 to 5.80 ng/ml for 70-79 years. CONCLUSION: Age-specific reference ranges for serum PSA concentration may be lower for Korean men than for other races. Thus, it would be appropriate to apply different age-specific reference ranges for Koreans.

Benign Prostatic Hyperplasia: Its Feature and Impact on the Quality of Life in Rural Area of Kangwon Province / 대한비뇨기과학회지

PURPOSE: We studied 250 men who are over 50 years of age to evaluate the feature of benign prostatic hyperplasia and its impact on quality of life in rural areas of the Korea. MATERIALS AND METHODS: Two hundred fifty men participated in this study. Urinalysis, urine culture, uroflowmetry, digital rectal examination and serum PSA were examined on all the participants. Transrectal ultrasonography(TRUS) were performed in 234 men. RESULTS: Of these 250 men, symptom prevalence was 78.71%. The age distributions of 50-59, 60-69, 70-79 and > or =80 years of age were 91, 111, 43 and 5 men respectively(mean 62.4). The mean prostatic volumes for 50-59, 60-69, 70-79 and > or =80 years of age group were 27.33cm3, 29.95cm3, 28.89cm3 and 33.55cm3. Of these, its volume difference was not statistically significant. Of 250 men, mildly symptomatic group(IPSS or =20) 34.5%. Severely symptomatic group showed higher mean age(p=0.0478), lower maximal flow rate(MFR)(p=0.024) and average flow rate(AFR)(p=0.003). Mildly symptomatic group showed smaller prostatic volume(p=0.013). Mean quality of life score for mildly, moderately, and severely symptomatic group were 2.09, 3.50, and 4.51 points, the score of which showed statistical difference(p or =15ml/sec, statistical difference for the mean age (p<0.001), voided volume (p<0.001), QOL (p=0.02) and symptom score (p=0.002) was found. But no difference was found in prostatic volume(p=0.261). MFR, AFR and voided volume did not show significant correlation with prostatic volume. But serum PSA level was strongly correlated with prostatic volume. The AFR was a greatest determinant to symptom score in multiple regression analysis. CONCLUSIONS: The symptom prevalence in rural areas of the Korea is not any less than that of western society. This study shows that it too has a great impact on the quality of life in rural Korea. The prostatic volume itself had no significance on symptom score nor uroflowmetric parameters. The uroflowmetric parameter such as MFR is more important in evaluating symptomatic patients than prostatic volume itself.

MR Urography Using HASTE Imaging: Comparison with Intravenous Urography

PURPOSE: To evaluate the usefulness of MR urography(MRU) using Half-Fourier acquisition single-shot turbospin-echo(HASTE) sequence compared with conventional intravenous urography(IVU). MATERIALS AND METHODS: Thirtyfive lesions of 32 patients who underwent MRU because of delayed excretion or nonvisualization of the ureter wereincluded in this study. HASTE MR urography was performed with a 1.0 MR imaging unit. Coronal images includingthose of the kidney, ureter and bladder were obtained in every patient using the multislice technique, and werepostprocessed by means of the maximal intensity projection technique. Scan time was 17-19 seconds. We analyzed theresults of MRU, focusing on level of obstruction, incidence of stone, ureter dilatation, and motion artifact, andin each case compared MRU findings with those of IVU. RESULTS: In 12 of 35 lesions(34.2%), MRU more effectivelydiagnosed causes of obstruction than did IVU, while in seven lesions(20%), MRU and IVU were similar. In eightlesions(22.9%), all of which were caused by a stone, IVU was better than MRU, and in a further eight, neithermodality was able to diagnose the cause. For diagnosis of the level of obstruction, MRU was better than IVU in 20of 35 lesions(57.1%), and similar to IVU in seven(20%). In three lesions(8.6%), neither modality was able todetect the level of obstruction. Four lesions not related to obstruction were polycystic renal disease, cysticrenal change, vesicovaginal fistula and extra-renal pelvis. Dilatation of the ureter was seen in 23lesions(65.8%) on MRU and in seven lesions on IVU. Thus, MRU revealed dilatation of for the ureter more efectivelythan IVU. CONCLUSION: MRU using HASTE was valuable for the detection of underlying causes and levels ofobstruction in the urinary tract, and of abnormalities in surrounding structures in patients with non-visualization of the kidney or delayed contrast excretion of the ureter, as seen on delayed IVU urogram.

Clinical significance of GnRH stimulation test in male infertility / 대한비뇨기과학회지

GnRH stimulation test has been used to distinguish patients with hypogonadotropic hypogonadism of pituitary origin from those with hypothalamic disease. GnRH stimulation test also has been used to identify early stage of Sertoli cell insufficiency and to know the subtle abnormalities or spermatogenesis. Some investigators reported that exaggerated FSH response after GnRH stimulation means the same diagnostic meaning as basely elevated FSH level and this in turn reflects Sertoli cell insutriciency or may help to identify patients with isolated primary germ cell failure in azoospermic patients. So they suggested the possibility that GnRH stimulation test can replace testis biopsy in male infertility. To define the normal range of the gonadotropin response after GnRH stimulation and to know the indications for GnRH stimulation test if it is useful as an evaluation method for spermatogenesis, and especially to test the possibility whether GnRH stimulation test may replace testis biopsy, we performed GnRH stimulation test in 118 infertile men and 20 fertile adult male volunteers and compared the results with testicular histology. Normal basal serum levels for LH, FSH, testosterone were 1.4-18.3( mean 9.9) mIU/ml, 2.8-18.4 (mean 10.0) mIU/ml, 2.0-9.1 (mean 5.0)ng/ml respectively, and 95% confidence intervals for the peak responses to an intravenous bolus injection of 100ug GnRH were 360-1950{mean 1098)% of the basal serum LH level, and 111-318(mean 225)% of the basal FSH level in 20 rertile adult male volunteers. The results of the FSH response in GnRH stimulation test were not helpful in distinguishing patients with bad testicular histology from those with good ones in 118 infertile men. So we came to the conclusion that GnRH stimulation test can not replace testis biopsy as an evaluation method for spermatogenesis in the majority of infertile patients.

Kidney injury in children / 대한비뇨기과학회지

From October 1985 to March 1992 we experienced 18 cases of childhood kidney injury. All cases were blunt injury and could be classified as renal contusion (38.9%), minor renal laceration (16.7%). major renal laceration (33.3%) and renal pedicle injury (11.1%). Thirteen patients were treated conservatively and 3 patients were undergone partial nephrectomy and 2 patien1s were undergone nephrectomy. All five cases were classified as major laceration. One patient of major renal laceration was treated conservatively and recovered without delayed operation and functional impairment on follow-up 99Tc-DTPA. Two vascular injured children were treated conservatively owing to delayed identification. The most important clinical sign of severe injury was the rate of hemoglobin decrease (p<0.05). In case of normal IVP and microscopic hematuria, there was no need to further radiologic work-up and it may be treated conservatively without complication or delayed operation. The computerized tomography was the most accurate diagnostic tool in evaluating renal trauma especially in cases of multiple organ trauma. There was no hypertension secondary to renal trauma in 6 patients whose blood pressure was followed up for average 9 months.

Prognostic significance of nuclear morphometry in T1, grade II bladder tumors / 대한비뇨기과학회지

Prognostic significance of the nuclear morphometry in 60 patients with initial T1 G II bladder tumor was evaluated. Clinical informations such as tumor size. multiplicity. recurrence pattern were abstracted and nuclear morphometric values such as mean nuclear area, standard deviation of nuclear area, mitotic activity index, volume-corrected mitotic index were analyzed from initial pathologic slide using image analyzer(Amersham RAS R-1000 receptor analysis system). Univariate and multivariate analyses were performed to define the influences of clinical informations and nuclear morphometric values on progression or recurrence of the tumors. In univariate analysis, mean nuclear area greater than 90um2, volume-corrected mitotic index greater than 24 and mitotic activity index greater then 15 influenced significantly to the tumor progression as well as recurrence. The standard deviation of nuclear area greater than 18um2 influenced significantly only to the tumor progression. In multivariate analysis, the most significant prognostic factor with respect to the progression was mean nuclear area. The group of patients with mean nuclear area greater than 90um2 showed 7.82 times more likely to progress. No significant prognostic factor was identified in multivariate analysis with respect to the recurrence. Nuclear morphometry provides valuable and objective informations to predict the possibility of progression in individual T1. Grade II bladder tumor patient.

Drug therapy in chilhood enuresis / 대한비뇨기과학회지

We evaluated the results of drug therapy in 76 children with nocturnal enuresis, who were free of other abnormalities in screening tests. History taking, careful physical examination including back area. urinalysis, urine culture, KUB and uroflowmetry were the screening tests. Overall response rate was 69.7 %. We found no statistically significant differences in responses between primary and secondary enuresis to drug therapy. We also found no difference in response according to the drugs including imipramine hydrochloride alone, oxybutynin chloride alone and combining of both. There was no difference in the results of the presence or the absence of daytime frequency and urgency. Two patients who resisted to the long-term therapy of imipramine hydrochloride and oxybutynin chloride showed good responses to the administration of intra-nasal desmopressin acetate. These data suggest that oxybutynin chloride does not show better therapeutic results than imipramine hydrochloride, whereas desmopressin acetate may be used for intractable enuresis to conventional drug therapy.