Diagnostic Clue of Meningeal Melanocytoma: Case Report and Review of Literature

In this report, the patient was pre-diagnosed as meningioma before surgery, which turned out to be meningeal melanocytoma. Hence, we will discuss the interpretation of imaging and neurological statuses that may help avoid this problem. A 45-year-old man had increasing pain around the neck 14 months prior to admission. His cervical spine MR imaging revealed a space-occupying, contrast-enhancing mass within the dura at the level of C1. The neurologic examination revealed that the patient had left-sided lower extremity weakness of 4+, decreased sensation on the right side, and hyperreflexia in both legs. Department of Neuroradiology interpreted CT and MR imaging as meningiom. The patient underwent decompression and removal of the mass. We confirmed diagnosis as meningeal melanocytoma through pathologic findings. Afterwards, we reviewed the patient's imaging work-up, which showed typical findings of meningeal melanocytoma. However, it was mistaken as meningioma, since the disease is rare.

Metastatic Intracranial Hemangiopericytoma to the Spinal Column: A Case Report

Intracranial hemangiopericytoma (HPC) is a rare brain tumor with aggressive biologic behavior associated with high recurrence rate and often with extracranial metastasis. The most common sites of extracranial metastasis of the intracranial HPC are the long bones, lung, liver and abdominal cavity in the order of frequencies. Extracranial metastases usually occur long after the initial diagnosis of the primary tumor. Metastatic intracranial HPC to the vertebra has been rarely reported. We present a case of intracranial HPC metastasized to the L2 vertebral body 13 years after multiple surgical resections and radiotherapy of the primary intracranial HPC.

Roles of Urology as Assessed by an Analysis of Inpatients Referred to Urology

PURPOSE: The purpose of this study was to identify the necessity for professional urology treatment and the roles of urology in the treatment of inpatients referred to the urology department. MATERIALS AND METHODS: The subjects were patients referred to the department of urology among the inpatients of Chosun University Hospital from January 1, 2009, to December 31, 2011. The patients' sex and age, the referring department, and the disease group were extracted from the patients' medical records. Disease groups were classified as urination disorder, infection, tumor, calculus, trauma, pediatrics, andrology, and others. The urination disorder group was classified into the subcategories of neurogenic bladder, benign prostatic hypertrophy, urinary retention, urinary incontinence, and overactive bladder. RESULTS: The total number of referrals was 3,261, and males made up 54.79%. In the age distribution, 2,321 patients (71.17%) were over 60 years of age and the largest population group was patients in their 70s (32.72%). According to the department referring the patients, internal medicine (34.06%) and orthopedic surgery (16.83%) made up a high percentage. Concerning the disease group, urination disorder was the highest, being 61.26%. In the subclassification of the urination disorder group, benign prostatic hypertrophy was the highest category at 32.23%. CONCLUSIONS: In this urology cooperative behavior analysis of our hospital over 3 years, a high percentage of older patients over 60 years of age and a high percentage of urination disorders were found. Urination disorder-related diseases in persons of advanced age are expected to increase as Korea becomes an aged society, and doctors in other departments should be aware that professional treatment and management by a urologist is needed for the treatment of these disorders.

Is the Index Finger and Ring Finger Ratio (2D:4D) Reliable Predictor of Semen Quality?

PURPOSE: The purpose of this paper is to test the validity of hypothesis that the index finger and ring finger ratio (2D:4D) is related with men's semen quality. MATERIALS AND METHODS: We set two groups of healthy young male student (mean age 23.9) who have different 2D:4D ratio from different departments of Chosun University. One group consists of 26 men whose 2D:4D ratio is higher than 1 (mean 1.06), and the other group consists of 33 men whose 2D:4D ratio is lower than 1 (mean 0.94). Their semen was collected by masturbation and examined. RESULTS: A comparative analysis revealed that there is no relation between semen quality and the 2D:4D ratio. The group of 2D:4D> or =1 showed a semen volume of 3.66+/-1.64 ml, on the other hand, the group of 2D:4D<1 showed a semen volume of 3.73+/-1.40 ml. No statistical correlation was found (p=0.82). The view of sperm count and motile sperm in single ejaculated semen also showed no statistically significance with 2D:4D ratio (p=0.84, p=0.43, respectively). CONCLUSIONS: The 2D:4D ratio has no statistically significant correlation with the semen quality of health young male. Thus, measurements of finger length cannot be a reliable indicator of semen quality and testicular function.

Effect of Mitomycin-C on Experimentally Induced Urethral Stricture in Rats

PURPOSE: Urethral stricture is a fibrotic process and, although it is one of the oldest known urologic diseases, it remains a common problem with a high recurrence rate. Mitomycin-C has been reported to have anti-replication properties in animal and clinical studies. The aim of this study was to observe the intraurethral impact of the use of mitomycin-C on scar formation and fibrosis in an experimental rat model of urethral stricture. MATERIALS AND METHODS: Twelve male Sprague-Dawley rats were used. With the animals under deep anesthesia, an internal urethrotomy was made with a cold knife. After the urethral injury, the rats were grouped randomly as follows: group 1 (control, n=4), group 2 (3 mg/l of mitomycin-C, n=4), and group 3 (5 mg/l of mitomycin-C, n=4). The rats were sacrificed 14 days later to evaluate epithelial proliferation and fibrosis. The penile urethra was removed and histopathologically examined by H&E staining, Masson trichrome staining, and immunohistochemistry with anti-collagen type I antibody. RESULTS: The stained specimens were examined under a light microscope. The extent of fibrosis and re-epithelization after urethral injury was greater in the areas with trauma than in those without. These findings were significantly reduced in the groups treated with mitomycin-C as compared with group 1, but there was no statistical difference between group 2 and group 3. Mitomycin-C treatment also prevented increases in collagen type I, whereas group 1 showed increases in collagen type I and collagen contents at the stricture site. CONCLUSIONS: These results suggest that mitomycin-C might inhibit the renewal of the epithelium and the synthesis of collagen secreted by fibroblasts in the affected urethra and then prevent scar formation. This raises the possibility of the use of mitomycin-C to prevent urethral stricture caused by trauma.

Bladder Hemangioma as a Cause of Massive Hematuria: Treatment with Selective Arterial Embolization / 대한비뇨기과학회지

Hemangioma of the urinary bladder is a benign, congenital tumor that accounts for 0.6% of all primary bladder neoplasms. The most common symptom is gross hematuria. However, bladder hemangioma as a cause of massive hematuria is rare. The management of patients with hemangioma is controversial and numerous therapeutic approaches are available. Herein, we describe the use of selective arterial embolization to terminate an episode of massive hematuria in an 87-year-old woman with bladder hemangioma.

A Comparative Study of the Tension-free Vaginal Tape and Transobturator Vaginal Tape Inside-out for the Surgical Treatment of Female Stress Urinary Incontinence

PURPOSE: We compared the preoperative with the postoperative outcomes between tension-free vaginal tape (TVT) and transobturator vaginal tape inside-out(TVT-O) for the surgical treatment of female stress urinary incontinence MATERIALS AND METHODS: From January 2003 to December 2005, 72 women, one is TVT group(n=52) and the other is TVT-O group(n=20), after operation following were assigned. The preoperative and postoperative evaluations analysis and urodynamic study and Korean version of I-QoL, surgical outcomes, complications and uroflowmetry were analysed. RESULTS: All outcomes included the patients`states, incontinence quality of life(I-QoL)(p=0.013), the success rate of the cure(p=0.003) and the rate of the patient satisfaction(p=0.001) were not comparable statistically between two groups and there are no differences and no long-term complications such as bladder perforation or prolonged voiding difficulty. Preoperative and postoperative uroflowmetry was similar between the two groups. Mean operation time(TVT: 15.6 min, TVT-O: 13.2 min) was significantly shorter in TVT-O than in TVT. CONCLUSION: The observation of 1-year following-up shows the equally effectiveness between two groups(TVT and TVT-O) as the surgical treatment of stress urinary incontinence.

Complications of Retroperitoneal Laparoscopic Surgery / 대한비뇨기과학회지

PURPOSE: Laparoscopic surgery is known to be safe and have low morbidity. Herein, all the complications of retroperitoneal laparoscopic procedures were evaluated. MATERIALS AND METHODS: A total of 120 retroperitoneal laparoscopic surgeries were performed between January 2002 and December 2005. Every abnormal event was investigated retrospectively, and classified in detail according to the surgical steps and severity. RESULTS: The complication ratio (total complications/total surgeries) was 0.38 (46/120). Open conversion was performed in 5 (4.2%). A transfusion was performed in 8 (6.7%) patients. 5 patients (4.2%) had neuromuscular problem related to position and 9 (7.5%) had access and insufflation related complications, including subcutaneous emphysema, abdominal wall hemorrhage, pneumothorax and pneumomediastinum. The intraoperative complications (5.8%) included peritoneal tearing, vascular injury and diaphragmatic injury. Postoperative complications occurred in 25 patients (20.8%), including pleural effusion, atelectasis/pulmonary infiltrate, wound dehiscence, paralytic ileus, retroperitoneal hematoma and urine leakage. 5 complications (4.2%) were classified as being major; main vascular injury (1.7%), urine leakage (1.7%) and diaphragmatic injury (0.8%). No serious complications, such as death, bowel injury, deep vein thrombosis, with pulmonary embolism, or gas embolism occurred. Other complications (41/46) were minor and managed conservatively, without any problem. CONCLUSIONS: The most common complications of retroperitoneal laparoscopic surgery seem to occur during the postoperative period, and are nonspecific to retroperitoneoscopy. Most complications are subclinical problems, which can be managed by conservative treatment. Retroperitoneal laparoscopic surgery is a safe procedure, with a low potential for complications.

Penile Necrosis by Longtime Installation of a Constriction Ring in a Patient using a Vacuum Constriction Device / 대한비뇨기과학회지

A vacuum constriction device has been described as a safe and satisfactory treatment for erectile dysfunction. The main complications of the device are mostly minor symptoms and serious side effects are rarely reported. We report here on a case of wide ischemic necrosis of the penis including the skin, subcutaneous tissue, tunica albuginea and corpus cavernosum by a constriction ring that had been installed for 72 hours in a 61 year old patient.

Psychometric Properties of the Korean Version of the King's Health Questionnaire in Women with Stress Urinary Incontinence

PURPOSE: The purpose of this study is to evaluate the psychometric properties of the Korean version of the King's Health Questionnaire(KHQ) in patients with stress urinary incontinence. MATERIALS AND METHODS: Multicenter prospective study was undertaken in 106 patients with stress urinary incontince. Psychometric properties including discriminant validity, convergent validity were evaluated and the Cronbach's alpha coefficients were calculated. Test-retest analysis was performed and the sensitivity to clinical change before and after treatment was also evaluated. RESULTS: The psychometric properties and clinical validity of the KHQ Korean version were confirmed in 106 study population. The KHQ's good reliability was evidenced by Cronbach's alpha coefficients of>0.60, indicating to change in patients' perception of bladder condition in all domains. CONCLUSION: Our analyses confirm excellent psychometric properties for the Korean version of KHQ, which appears to provide a valid and reliable instrument for clinical usages in Korea.

Comparison of Hand-assisted Laparoscopic Donor Nephrectomy with Open Donor Nephrectomy / 대한비뇨기과학회지

PURPOSE: To assess the efficacy, morbidity and patient recovery of hand- assisted laparoscopic donor nephrectomy (HALDN), we compared our initial experience with HALDN to that of the standard open donor nephrectomy (ODN). MATERIALS AND METHODS: Between March 2002 and March 2004, one surgeon performed 18 cases of HALDN and 9 cases of ODN at our institution. Operative outcome were reviewed, including operative time, warm ischemic time, blood loss, time to oral intake, length of hospital stay, postoperative analgesic requirement, complications and graft function. RESULTS: The mean operative time was 232 minutes and 192 minutes (p<0.01), and the mean warm ischemic time was 185 seconds and 168 seconds (p=0.28) for HALDNs and ODNs, respectively. The mean blood loss and time to oral intake were similar. The mean hospital stay was 4.3 days and 8.7 days (p<0.01), and the mean analgesic dose was 80mg of piroxicam and 260mg of piroxicam (p<0.01) for HALDNs and ODNs, respectively. No patient required open conversion. Complications occurred in 2 cases in HALDNs and in 1 case in ODNs. All donated kidneys were transplanted with immediate good function. The recipients' serum creatinine level at 1, 2, and 3 years after transplantation showed no significant difference between the two groups. CONCLUSIONS: HALDN is technically feasible and appears to be a safe and effective surgical method. HALDN provides the donor with faster convalescence, while maintaining a healthy renal allograft function for the recipient.

Non-surgical Treatment of Voiding Dysfunction Following Tension-Free Vaginal Tape Procedure in Female Stress Urinary Incontinence

The tension-free vaginal tape procedure(TVT) has become a state of the art operation for female stress urinary incontinence. The most common problems after the TVT seen are voiding difficulties. Although the incidence of urinary retention appears to be low after the TVT procedure, it is recommended that patients be counseled about the risk and carefully monitored for voiding symptoms during the first 3 weeks postoperatively. When obstruction after the TVT is clinically evident, immediate tape adjustment in the operating room by open vaginal incision, may be indicated. We report of voiding difficulty 8 weeks after the TVT who was successfully managed with urethral dilation.

Primary Small Cell Carcinoma of the Kidney / 대한비뇨기과학회지

Small cell carcinoma is a malignant neoplasm, which has neuroendocrine and epithelial features immunohistochemically and ultrastructurally. Primary small cell carcinoma originating from the kidneys is extremely rare, aggressive and lethal. Approximately half the reported cases show combined features of transitional cell carcinoma. A case of primary renal small cell carcinoma without features of transitional cell carcinoma is reported, which was studied under light microscopy and by immunohistochemistry and treated by retroperitoneal laparoscopic radical nephrectomy and chemotherapy.

Clinical Experience of Extracorporeal Shock Wave Lithotripsy with the Dornier Compact Delta(R) / 대한비뇨기과학회지

PURPOSE: To report our experience of extracorporeal shock wave lithotripsy (ESWL), with the Dornier Compact Delta(R). MATERIALS AND METHODS: A total of 361 cases underwent EWSL using Dornier Compact Delta(R). The location and sizes of stones, session, success rate, and causes of failure and complications of ESWL, were retrospectively reviewed. The mean diameter of the stones was 8.7mm, ranging from 5 to 37mm. RESULTS: Of the 361 cases, there were 71 (19.7%) and 290 (80.3%) cases of renal stones and ureteral stones, respectively. The overall success rate was 92.5%, with success rates of 98.2, 86.2, 62.5 and 100% for stone sizes

Laparoscopic Intraperitoneal Drainage of Lymphocele Developed Adjacent to the Kidney Transplanted / 대한비뇨기과학회지

Lymphoceles are the most frequent surgical complications following kidney transplantation. Symptomatic lymphoceles following kidney transplantation are managed best by surgical marsupialization with intraperitoneal drainage. We performed laparoscopic intraperitoneal drainage in a patient with a large lymphocele and secondary hydronephrosis following a kidney transplant.

Relationship between Galloway's Hostility Score and Upper Urinary Tract Abnormalities in Neuropathic Bladder Caused by Spinal Cord Injury / 대한비뇨기과학회지

PURPOSE: The primary objective in the management of neuropathic bladder caused by spinal cord injury is the preservation of renal functions because renal failure is the cause of death in neuropathic bladder patients. We evaluated risk factors for upper urinary tract abnormalities in neuropathic bladder caused by spinal cord injury. MATERIALS AND METHODS: From July 1997 to February 2001, total of 48 patients of neuropathic bladder caused by spinal cord injury were evaluated by urodynamic study, excretory urography, voiding cystourethrography, and DMSA renal scan. The risk factors associated with upper urinary tract abnormalities were analyzed. RESULTS: Urodynamic evaluation revealed that 7 (15%) of 48 cases had detrusor hyperreflexia without detrusor external sphincter dyssynergia (DESD), 20 (42%) had detrusor hyperreflexia with DESD, and 18 (38%) had detrusor areflexia. 20 (42%) of 48 cases had low compliance. Upper urinary tract abnormalities were present in 15 (75%) of 20 cases that had DESD and in 12 (60%) of 20 cases that had low compliance. In addition, 19 (86%) of 22 cases with a hostility score of more than 6 went on to develop upper urinary tract changes. CONCLUSIONS: In the management of neuropathic bladder caused by spinal cord injury, the abnormal urodynamic parameters (DESD and low compliance) and hostility score of more than 6 should be factored into the assessment of upper urinary tract deterioration.

Molecular Typing of Urinary Isolates of Candida tropicalis by Pulsed-Field Gel Electrophoresis (PFGE) and Random Amplified Polymorphic DNA (RAPD) Analysis / 감염

BACKGROUND: Despite the recognized increase of frequency of candiduria due to Candida tropicalis, little was known of its molecular epidemiology. We applied PFGE and RAPD assay for urinary C. tropicalis isolates and evaluated the utilities of PFGE and RAPD for the epidemiological typing of C. tropicalis isolates. METHODS: A total of urinary 57 isolates of C. tropicalis from 40 patients at two hospitals was analyzed. PFGE analysis were performed by electrophoretic karyotyping (EK) and restriction endonuclease analysis of genomic DNA (REAG) using two restriction enzymes (BssHII and SfiI). For RAPD, a total of 31 primers (30 random 10-mer primers and M13 primer) were used. RESULTS: EK and RAPD analysis showed the same or similar patterns among the isolates. REAG with BssHII separated 57 isolates into 28 distinct types. Six patterns were generated by REAG with using SfiI. By combining the two REAG, a total of 31 different DNA types were identified among 57 isolates from 40 patients. Three strain types were common to 23 isolates from 12 patients of a University Hospital, which suggested possible nosocomial transmission. In 19 patients with serial urinary isolates, the sequential strains from each patient exhibited the same REAG pattern. CONCLUSION: These suggest that REAG with BssHII and SfiI is useful for the investigation of molecular epidemiology of C. tropicalis isolates. In addition, some clusters of C. tropicalis isolates with the same DNA type suggest that nosocomial transmission may occur.

A Case of Pseudovaginal Perineoscrotal Hypospadias with 5alpha-reductase Deficiency / 대한비뇨기과학회지

Male pseudohermaphroditism can be caused by absent m llerian regression, inadequate synthesis of testosterone, inadequate synthesis of dihydrotestosterone, or androgen receptor deficiency. Defects in either the production or the action of androgenic steroids have been demonstrated to cause pseudovaginal perineoscrotal hypospadias, a syndrome of male pseudohermaphroditism. This is mostly caused by a deficiency of 5alpha-reductase, which controls the conversion of testosterone to 5alpha-dihydrotestosterone. We report a case of male pseudohermaphroditism due to 5alpha-reductase deficiency who was born with ambiguous genitalia and was reared as female.

A Case of Vesical Endometriosis / 대한비뇨기과학회지

Endometriosis is defined as the presence of endometrial tissue (gland and stroma) outside the uterus. The most frequent sites of implantation are the pelvic viscera and the peritoneum. About 1% of woman with endometriosis have urinary tract lesions, of which 85% involve the bladder. We report one case of vesical endometriosis that have been treated by partial cystectomy.

Nonobstructive Right Retrocaval Ureter Associated with Double Inferior Vena Cava / 대한비뇨기과학회지

Retrocaval ureter is a rare congenital anomaly. We experienced a case of retrocaval ureter with double inferior vena cava and with intermittent right flank pain in 54 years old female. We performed IVU, RGP, Venacavogram, MRI, and diuretic DTPA renal scan. MRI is the best single study to delineate the anatomy clearly and noninvasively. She was treated with conservative treatment.