Comparison of Microsurgical One-layer Vasovasostomy Techniques / 대한비뇨기과학회지

PURPOSE: The purpose of the study is to compare the outcomes between three different one-layer vasovasostomy techniques: original one-layer, modified one-layer, and V-V type one-layer microsurgical vasovasostomy. MATERIALS AND METHODS: We retrospectively reviewed the charts and surgical records of all surgical procedures performed on a series of 117 consecutive patients undergoing a microsurgical one-layer, modified one-layer or V-V type one-layer vasovasostomy between May 1995 and March 2000. An original one-layer vasovasostomy was used in 48 men (group 1), a modified one-layer vasovasostomy in 35 men (group 2), and V-V type one-layer vasovasostomy in 34 men (group 3). A successful outcome (patency) was defined as sperm presenting at the follow-ups. RESULTS: The sperm concentration (million/ml) and motility (%) were as follows: in original one-layer vasovasostomy 17.5 and 32.9, in modified one-layer vasovasostomy 26.1 and 28.5 and in V-V type vasovasostomy 30.5 and 32.3. There were no significant differences in patency (85.4%, 91.4% and 91.2%) and pregnancy rate (56%, 62.5% and 63.6%) of the procedures. If the obstructive interval had been less than 4 years, patency was 87.5% and pregnancy rate was 61.5%, 5 to 9 years 95.8% and 63.4% and 10 years or more 83% and 58.3%. There were no correlations between obstructive interval and rates of patency and pregnancy. CONCLUSIONS: The patency and pregnancy rate revealed slightly better result in modified one-layer or V-V type one-layer microsurgical vasovasostomy than in original one-layer microsurgical vasovasostomy. However, they had statistically no significant differences in overall.

The Clinical Coures of Mild Neonatal Hydronephrosis / 대한비뇨기과학회지

No abstract available.

Treatment of Chronic Bacterial and Nonbacterial Prostatitis by Local Injection of Amikacin Sulfate / 대한남성과학회지

PURPOSE: Prostatitis causes significant morbidity and represents a major indication for diagnostic procedures and treatment with antibiotics or other medications. Chronic bacterial prostatitis is effectively controlled by local injection of antibiotics and can be diagnosed by tissue culture. Also, chronic nonbacterial prostatitis often proves to be of bacterial origin by tissue culture. We introduced intraprostatic injection of antibiotic (amikacin sulfate) for chronic bacterial and nonbacterial prostatitis PATIENTS AND METHODS: From March 1996 to January 1998, we treated 42 patients complaining of prostatitis symptoms and showing >10 leukocytes/high-power field in expressed prostatic secretions (EPS). All patients had suffered prostatitis for more than 6 months and had histories of use of medications. Eight patients proved to have bacterial prostatitis and 34 patients nonbacterial prostatitis. We injected 500 mg of amikacin sulfate via the transperineal approach under the guidance of transrectal ultrasonography. RESULTS: Of the 42 patients, 27 (64%) improved symptomatically and showed normal EPS finding. Twenty-two patients (65%) in the nonbacterial prostatitis group and 5 patients (63%) in the bacterial prostatitis group were cured, with 23 patients (85%) requiring only one or two intraprostatic injections to obtain the cure. Complications occurred during and after the procedure in eight patients: severe pain, hemospermia, gross hematuria, and dysuria. CONCLUSIONS: Intraprostatic injection of amikacin sulfate is an alternative treatment for chronic bacterial and nonbacterial prostatitis. The advantage of this therapy is that it provides high concentration of the antibiotic at the infection focus without any risk of metabolic activation.

Investigations on the Factors Predicting the Results of Testis Sperm Extraction / 대한비뇨기과학회지

PURPOSE: Testis sperm extraction and intracytoplasmic sperm injection(TESE-ICSI) has been widely used for the treatment of non-obstructive azoospermia and obstructive azoospermia which cannot be corrected by any other surgical method. We evaluate the results of TESE between groups of obstructive and non-obstructive azoospermia and determine whether there is a significant relationship between the testicular histology, biophysical and endocrine profiles, and the results of TESE in the non-obstructive azoospermia group. MATERIALS AND METHODS: Between 1997 and 1998, a total of 64 patients underwent TESE procedures, including 23 patients with non-obstructive azoospermia and 41 with obstructive azoospermia, who were beyond the reach of surgical correction and microsurgical epididymal sperm aspiration(MESA). We compared TESE results between two groups. We investigated the factors predicting the results of TESE and tried to correlate the results with biophysical, endocrine profiles and testicular histology. RESULTS: Non-obstructive azoospermia group had significantly smaller testes, fewer motile sperm, and lower sperm retrieval rate than obstructive group. Statistically significant differences were detected in plasma FSH, LH, and testis volume according to different histology patterns in the non-obstructive azoospermia group. There were no significant differences in age, testis volume, semen volume, plasma FSH, LH, and testis histology between the patients with successful and failed sperm retrieval in the non-obstructive azoospermia group. CONCLUSIONS: Obstructive azoospermia group is expected to have better chance of pregnancy than non-obstructive azoospermia group due to a difference of sperm retrieval rate. In non-obstructive azoospermia group, sperm retrieval has poor correlations with biophysical and endocrine profiles, and with histological patterns. No single variable can provide a perfect discrimination between the groups with successful and failed TESE. TESE should be performed in carefully selected cases until a reliable criteria predicting the TESE result is established.

A Case of Reconstruction of Abdominal Wall Defect using Tensor Fascia Lata Myocutaneous Flap: The Defect Caused by a Wide Resection of Squamous Cell Carcinoma of Bladder Invading Abdominal Wall / 대한비뇨기과학회지

Squamous cell carcinoma of bladder is best treated with a radical cystectomy. Squamous cell carcinoma of bladder invading the abdominal wall is not commonly reported and hard to manage surgically. Abdominal wall defect caused by a wide resection of squamous cell carcinoma invading abdominal wall can be reconstructed using various muscle flaps. We performed a salvage cystectomy for a patient with squamous cell carcinoma of bladder invading abdominal wall up to skin, and the abdominal wall defect was successfully reconstructed using a unilateral tensor fascia lata myocutaneous flap.

Analysis of Marker Chromosomes in Renal Cell Carcinoma Cell Line Caki-1 by Chromosome Microdissection / 대한비뇨기과학회지

PURPOSE: The analysis of recurring chromosome aberrations has become an integral part of the diagnostic and prognostic workup of many human cancers, and their molecular analyses have facilitated the identification of genes related to the pathogenesis of cancer But the technical limitation of conventional cytogenetic method makes unable us to characterize all recognizable chromosome rearrangements. The generation of chromosome region specific painting probe by PCR amplification of microdissected chromosomal DNA has proven extremely useful in identification of chromosomal derivation for marker chromosomes which are indeterminable by routine chromosome banding analysis. In this study we have constructed and analyzed the band-specific painting probe for unidentified marker chromosomes of renal cell carcinoma cell line, Caki-1 to determine the derivative chromosomes and the painting probes applied to CURC-II to compare the marker chromosomes. MATERIALS AND METHODS: Microdissection was performed on 9q+ and unidentified one of Caki-1, and chromosomal BNAs were amplified by PCR using topoisomerase I and T7 DNA polymerase. Fluorescent in situ hybridization was conducted with biotin labeled PCR products to normal, Caki-1 and CURC- II metaphase chromosomes. RESULTS: With this method, it was possible to construct the band-specific painting probes for markers and the probes hybridized specifically to the dissected regions and derivative chromosomes. The 9q+ and unidentified one were identified as t(9;17)(q34;q21) and t(15;20) respectively. The marker chromosomes - t(9;I 7), der(1 ;17)(ql0;q10), t(15;20), t(?;15), der(1 ;20), t(14;89) were examined same in Caki-1 and CURC-II. CONCLUSIONS: Thus this methodological advance significantly extends the limits of conventional cytogenetic analysis by enabling the analysis of unknown chromosome regions, and these painting probes can be applied to detect the similar marker chromosomes in renal cell carcinoma, and the probe pools for markeys may be used to identify the cancer-relevant genes.

Pelvic Floor Exercise

No abstract available.

Leiomyoma of the Urinary Bladder

Leiomyoma is commonly found in the female genital tract, but occurrence in the urinary bladder is very rare with only 235 cases reported in the literature. These tumors have been classified as intravesical (63%), intramural (7%) and extravesical (30%) depending on the direction of the growth. We report a case of intravesical leiomyoma of the urinary bladder in a 36 year-old woman who exhibited dysuria and urinary retention. The gross and microscopical findings of leiomyoma of the bladder are similar to those of the uterus. Immunohistochemical stains for estrogen receptor (ER) and progesterone receptor (PR) revealed diffuse nuclear staining in smooth muscle cells, supporting the hypothesis of hormonal influence in tumorigenesis.

Leiomyomas on the Bilateral Corpus Cavernosa of the Penis: A Case Report / 대한비뇨기과학회지

Leiomyoma is a benign tumor, which usually occur at the smooth muscle of the gastrointestinal tract and uterus but rarely occurs on the corpus cavernosum of the penis. We experienced a patient with leiomyomas on the bilateral corpus cavernosa of the penis accompanied with impotence in a 60-year-old man. The patient was treated with complete local excision and has remained well without recurrence for l year, So we report this case with review of literatures.

Candidal Prostatic Abscess in a Young Diabetes Patient / 대한비뇨기과학회지

Although fungal infections involving the genitourinary system are increasing in case, those involving the prostate are uncommon and fungal prostatic abscesses are especially rare. There are a few sporadic reports in the literature of fungal prostatic abscess. We thought that a high index of suspicion for fungal prostatic infection must be maintained especially in high risk patients. We report a case of candidal prostatic abscess in a 37-year old man with diabetes. The diagnosis and management are discussed, and the literature is reviewed.

Clinical Application of 'Scrotogram' / 대한비뇨기과학회지

A study was undertaken during the past 2 years of patients who visited the infertility clinic of this hospital. The patients included those with male infertility, scrotal mass, scrotal pain or impotence. These patients were studied by means of reviewing the clinical applications of 'Scrotogram' and the following results were obtained. A total of 122 cases underwent a 'Scrotogram' study and among them 80 cases were diagnosed as varicocele, which included 14 cases( 18%) of subclinical varicocele which are difficult to be diagnosed by initial physical examination. There was statistical significance in the varicocele index between the control group and the Grade I varicocele group(p<0.01) and between the control group and subclinical varicocele group(p<0.01), and between the Grade I and Grade II group.(p<0.01), and between the Grade II and Grade II group(p<0.05). Among 66 clinical varicocele patients, 63 cases(80% ) were diagnosed by varicocele index, and 54 cases(82% ) were diagnosed by static image. A combination of the above two methods allowed 61 cases(92%) to be diagnosed. Among 48 patients who underwent high ligation of internal spermatic vein, 25 patients were subject to postoperative follow-up 'Scrotogram', which revealed 12 cases with excellent results, 8 cases with good results, and 5 cases with poor results. The average varicocele index before and after surgery was 1.78 and 1.24 and there were statistical significance(p<0.01). There was statistical significance, in sperm count and motility between the control group and clinical varicocele group(p <0.01) and between the control group and subclinical varicocele group(p <0.01). However, there appeared no statistical significance in semen character between the clinical varicocele and subclinical varicocele group. Among the 13 patients who were subject to postoperative follow-up semen analysis 11 patient showed improved results, and there was marked improvement in sperm count(p<0.05). There was slight improvement in sperm motility and morphology but showed no statistical significance. At present, 2 patients were impreged. Among 110 patients with infertility and olieoasthenoteratozoospermia, 22 were initially diagnose as varicocele by physical examination only, and 7 patients were diagnosed as subclinical varicocele after a 'Scrotogram' was taken. In conclusion, the 'Scrotogram' is able to identify varicocele objectively, and also identify subclinical varicocele which is an important contributing factor to male infertility. Also, this method of study is able to assess the postoperative result of varicocele accurately.

The Clinical and Urodynamic Features of Diabetic Cystopathy / 대한비뇨기과학회지

Twenty one ratients diagnosed with diabetic cystopathy in Yongdong Severance Hospital for 6 years were analysed for the clinical and urodynamic features. The mean age was 65.4 years (33-83) and females were twice in number when compared to males. The mean duration of diabetes was 9.7 years. The symptoms were urinary retention, residual urine sensation, abdominal straining, hesitancy, interruption, impaired voiding desire, dysuria in order of frequency. Significant bacteriuria was found in 62% of patients and was more frequent in females, In cases with confirmed bacteriuria, 62% of the identified bacteria was E. coli. Diabetic neuropathy was present in 100% and nephropathy in 77%, nephropathy in 43%. In the presence of one complication, there was a tendency for other concurrent complications. In urodynamic study, the residual urine volume, volume at first sensation, maximum intravesical pressure. compliance were larger than in normal persons and loss of reflex detrusor contraction was more frequent which means impaired bladder sensation and detrusor contractility in diabetic cystopathic patients. The age of patients, duration of diabetes, treatment mode of diabetes, level of blood sugar do not influence the severity of diabetic cystopathy Administration of cholinergics and intermittent catheterization showed a high cure rate and was throughout to be a good treatment mode.

A Case of Renal Cyst with Peripheral Thick Egg-shell Calcification / 대한비뇨기과학회지

Calcification is found in 4% to 12% of renal masses due to a number of causes and can be seen in various patterns. This is found in 1% to 3% of the simple renal cysts. Among these a peripheral egg-shell type of calcification is more rare. We experienced the simple renal cyst associated with the thick egg-shell calcification on the renal upper pole in a 66-year-old female complaining upper abdominal discomfort, so we report that with literature.

A Case of Urinary Incontinence Treated with AMS 800 Artificial Sphincter / 대한비뇨기과학회지

A 31 year old male patient presenting urinary incontinence 2 years after the traumatic injury of the posterior urethra and bladder neck, fails to respond to the alpha-adrenaergic agents and other ordinary methods. However, using the artificial sphincter(Model AMS 800) implantation, he successfully voided freely without urinary incontinence and the residual urine. The urethral closing pressure was significantly increased. The radiographic findings of inflation and deflation of the sphincter revealed satisfactory functions.

Scrotal Blunt Trauma: 3 Cases / 대한비뇨기과학회지

Because of its motility and position, the scrotum is infrequently injured after blunt trauma. We have recently experienced traumatic testicular torsion, testicular rupture, and epididymal rupture with abscess formation after blunt scrotal trauma. We have explored early and treated properly.