ABSTRACT
PURPOSE: To study the cellular events occuring during bladder development and regeneration, we used the human Dura mater (Tutoplast(R)) for augmenting the rat bladder. We compared their intravesical threshold pressure and volume, and observed the regenerative capacity of urothelium and smooth muscle cell within Tutoplast(R). MATERIALS AND METHODS: Among a total of 67 rats, 11 normal rats were checked their intravesical threshold pressure and volume(Group 1). 9 rats underwent only vesicotomy(Sham operation) and were checked their threshold pressure and volume at 2 months and 3 months postoperatively(Group 2). 47 rats underwent augmentation cystoplasty with Tutoplast(R) after partial cystectomy, which were checked pressure and volume at 1 day, 3-7 days, 2-4 weeks, 2-6 months postoperatively(Group 3). Specimens were examined histologically to assess the regeneration of urothelium and smooth muscle cell on the graft. RESULTS: There was a significant increase in intravesical volume of group 3 compared with group 1 and 2. There was a significant decrease in intravesical pressure of group 3 compared with group 2, but there was no significant difference between group 1 and 3. The specimens of 1 day postopratively showed inflammatory findings. Epithelialization on the graft margin was noted at 3 days postoperatively. At 7 days postoperatively, there was epithelial hyperplasia on the graft site. At 2 weeks postoperatively, there was a partial absorption of Tutoplast(R) as well as favorable progression of epithelialization. Smooth muscle regeneration and complete epithelialization were shown at 3 months postoperatively and absorption of Tutoplast(R) was completed thereafter. CONCLUSIONS: The regeneration of bladder cellular constituents within Tutoplast(R) will be valuable for further understanding the mechanism controlling bladder development and regeneration. Further studies will be necessary for using this method as an alternative strategy to the classical bladder augmentation.
Subject(s)
Animals , Humans , Rats , Absorption , Cystectomy , Dura Mater , Hyperplasia , Muscle, Smooth , Myocytes, Smooth Muscle , Regeneration , Transplants , Urinary Bladder , UrotheliumABSTRACT
PURPOSE: This study was to investigate how stomach flaps and graft adapt their normal function to the urinary milieu after gastrocystoplasty. Also, it was studied to find out whether the stomach graft can survive as a part of bladder and function effectively. MATERIALS AND METHODS: The rats were divided into 5 groups; 1) normal 2) partial cystectomy 3) gastrocystoplasty with left gastroepiploic artery 4) gastrocystoplasty with stomach graft 5) gastrocystoplasty with right gastroepiploic artery. Their bladder capacity, end-filling pressure, serum electrolytes, BUN/Cr and urinalysis were measured. And histological examinations were performed periodically on group 3 and 4. RESULTS: All rats of gastrocystoplasty with right gastroepiploic artery expired due to bleeding, vasovagal reflex and urine leakage. But most rats with left gastroepiploic artery and stomach graft survived. Their bladder capacity increased a little more than the partial cystectomy group. Their end-filling pressures were not significantly decreased compared with partial cystectomy group. Renal function and serum electrolytes remained normal throughout the study. Serum Na+ of gastrocystoplasty rats were significantly decreased compared with normal rats(p<0.05). Microscopic hematuria developed in 15% of gastrocystoplasty rats with left gastroepiploic artery. Histological examination showed the urothelialization from the site of anastomosis toward the central portion of the graft. There were hyperplastic and squamous metaplastic changes on the bladder mucosa adjacent to the transplanted gastric patch. Bladder ulceration was observed in the gastrocystoplasty group with left gastroepiploic artery, but not in the gastrocystoplasty group with stomach graft. The gastric glands were observed and alive throughout the study in the gastrocystoplasty group with left gastroepiploic artery, but were not seen at postoperative 4 weeks in the gastrocystoplasty group with stomach graft. CONCLUSIONS: Based on the experimental data, it is suggested that augmentation gastrocystoplasty with left gastroepiploic artery pedicle is preferable to right gastroepiploic artery pedicle. It was concluded that the gastrocystoplasty using stomach graft and flap in rats could adapt to the bladder urodynamically, histologically and biochemically, and that the stomach graft could be used as one method of complete tissue graft.
Subject(s)
Animals , Rats , Cystectomy , Electrolytes , Gastric Mucosa , Gastroepiploic Artery , Hematuria , Hemorrhage , Mucous Membrane , Reflex , Stomach , Transplants , Ulcer , Urinalysis , Urinary BladderABSTRACT
Complete urethral loss with vesicovaginal fistula is very infrequently encountered by the urologist. Urethral reconstruction may be accomplished with either bladder or vaginal wall flap. Moreover, it usually is necessary to reinforce the continence of reconstructed urethra with a well-vascularized pedicle flap from either the Martius labial flap, gracilis, perineum, or rectus. We report a case of the complete urethral loss with vesicovaginal fistula treated successfully with bilateral Martius labial fat graft.
Subject(s)
Female , Humans , Perineum , Transplants , Urethra , Urinary Bladder , Vesicovaginal FistulaABSTRACT
No abstract available.
ABSTRACT
The incidence of acute urinary retention in females is very low but the causes are diverse. So, it is important to verify the causative diseases trough history taking, physical examination including neurologic tests and it is essential to find adequate therapeutic modalities. MATERIALS AND METHODS: We experienced 45 female patients who visited under the chief complaint of acute urinary retention and reviewed, evaluated retrospectively or prospectively during 4 years. The patients are divided 1) transient causes: immobilization after surgery, constipation, medications, herpes zoster, psychogenic causes 2) neurologic causes: cerebral concussion, peripheral neuropathy, brain tumor, herniated nucleus pulposus, spinal cord injury, previously undiagnosed diabetes 3) pelvic causes: difficult labor, uterine prolapse,, pelvic bone tumor, vaginal invasion of rectal cancer, imperforate hymen. RESULTS: Screening test were done through physical examination, history taking, routine urinalysis. Most patients recovered voiding after correction of underlying diseases. CONCLUSIONS: The patients who showed persistent retention were further evaluated through neurologic tests, urodynamics, pelvic ultrasonography and serious diseases as blain tumor, polyneuritis, metastaic pelvic bone tumor were diagnosed.
Subject(s)
Female , Humans , Brain Concussion , Brain Neoplasms , Constipation , Herpes Zoster , Hymen , Immobilization , Incidence , Mass Screening , Neuritis , Pelvic Bones , Peripheral Nervous System Diseases , Physical Examination , Prospective Studies , Rectal Neoplasms , Retrospective Studies , Spinal Cord Injuries , Ultrasonography , Urinalysis , Urinary Retention , Urodynamics , Uterine ProlapseABSTRACT
PURPOSE: The effect of a urethral catheter on pressure-flow study has important implications for the practice and interpretation of pressure flow studies. We wonder which catheter would be adequate for pressure flow study. We report 3 different size of catheters(4Fr, 10Fr, 12Fr) effects on urinary flow rate, voiding pressures and pressure flow plot. MATERIALS AND METHOD: Pressure flow studies were carried out on 141 patients(male;88, female;53), whose diseases were BPH in 22, prostatodynia in 37,urethral syndrome in 36, Hinman syndrome in 2, neurogenic bladder in 28, unstable bladder in 10, urethral stricture in 2 and bladder stone in 2. RESULTS: There was no significant difference between pre- and postcatheterization maximum flow rate in 4Fr group. But there were significant difference between pre- and post-catheterization maximum flow rate in 10Fr and 12Fr group. The detrusor pressure was significantly higher in 10Fr and 12Fr group than in 4Fr group. The larger size of catheter groups had more obstructive patterns in pressure flow plot. CONCLUSIONS: These results showed 4Fr catheter had less effect on pressure flow study than 10Fr, 12Fr catheter.
Subject(s)
Catheters , Urethral Stricture , Urinary Bladder , Urinary Bladder Calculi , Urinary Bladder, Neurogenic , Urinary CathetersABSTRACT
PURPOSE: The Mitrofanoff continent catheterizable stoma is a useful technique in continent reconstruction. Continence is dependent on the formation of a valve mechanism usually in the form of a submucosal tunnel. This mechanism requires careful dissection of the appendix mesentery and may not be appropriate in small bowel pouches, The split cuff nipple technique has been used effectively for ureteral reimplantation into bowel segments, This paper describes the successful combination of these techniques to provide a continent catheterizable stoma. MATERIALS AND METHODS: Five patients(6 cases) have undergone split cuff nipple stoma formation. Appendix was used in 5 cases and ileum was used in 1 case. Underlying disease were 3 bladder cancers and 2 spinal cord injuries. Reservoir was made using 3 patients ileum, 1 right colon and 1 ileocolon. In 3 cases the appendix was brought out through the umbilicus and in another 3 cases the stoma was formed in the right iliac fossa. CONCLUSIONS: The split cuff nipple appendix stoma provides a simple and reliable continent stoma technique, overcoming some of the complexities of reimplantation of the intact appendix. The technique may be suitable for other narrow tubes, mainly the stapled small bowel or gastric tube.
Subject(s)
Humans , Appendix , Colon , Ileum , Mesentery , Nipples , Replantation , Spinal Cord Injuries , Umbilicus , Ureter , Urinary Bladder Neoplasms , Urinary DiversionABSTRACT
PURPOSE: We did electrovaporization to reduce the absorbed volume of irrigant and bleeding during TURP, and compared the effects on intraoperative and postoperative serum electrolyte, osmolality, and blood loss between this method and the classic TURP. MATERIALS AND METHOD: Of the 45 BPH patients, 21 patients underwent TURP (Group l), while the other 24 patients were electrovaporized with vaportrode(Group ll). They were followed preoperatively, 30 min intraoperatively, immediate postoperatively, 6 hours and 24 hours postoperatively with measurements of serum sodium, potassium, glucose and BUN. The amount of absorbed irrigant, serum osmolality, effective osmolality, blood loss were calculated and compared between the two groups. RESULTS: Although the group ll showed a longer operation time and used a larger amount of irrigant than the group l, there was not a significant difference in the amount of blood loss between the two groups and lesser amount of irrigant was absorbed than the group l. There was not a significant decrease in postoperative serum Hb and Hct level compared with preoperative level in the group ll. Serum sodium level were significantly decreased during postoperative period every patients in the group l. The serum osmolality and effective osmolality levels were significantly decreased postoperatively as compared with the preoperative levels in the group l, but were not in the group ll. CONCLUSIONS: These results show that electrovaporization may be the effective method in preventing complications such as hyponatremia and hypoosmolality during perioperative period. This method may also be helpful in reducing blood loss.
Subject(s)
Humans , Glucose , Hemorrhage , Hyponatremia , Osmolar Concentration , Perioperative Period , Postoperative Period , Potassium , Prostatic Hyperplasia , Sodium , Transurethral Resection of ProstateABSTRACT
BPH is found in 50% of males over the age of 50 and there is increase in incidence with age. But some patients with BPH do not induce bladder outlet obstruction and some patients with prostatism are not caused by bladder outlet obstruction. So, urodynamic study including pressure/flow study was performed in 45 males with prostatism to evaluate the degree of obstruction, and we measured maximal intravesical pressure, maximal detrusor pressure, prostatic urethral length, residual urine, minimal urethral resistance and pressure/flow plots. The 45 males were divided into 3 groups by maximal flow rate(MFR)(A: MFR>=15, B: 10<=MER<=15, C: MFR<10) and there was significant difference between each group only in minimal urethral resistance(P<0.05). The result of pressure/flow plots of A group showed that 93% (13/14) was nonobstructive pattern and the rest one was obstructive pattern which was caused by detrusor hyperreflexia. In B group. we could know the degree of obstruction in 58%(7/12) only with minimal urethral resistance and we could decide the degree of obstruction with pressure/flow plots in rest 5 cases whose minimal urethral resistances were between 0.43 and 0.65 unit. The result of pressure/flow plots of C group showed that 89%(17/19) was obstructive pattern and the rest 2 cases were nonobstructive patterns which were caused by detrusor hyporeflexia. In conclusion, with pressure/flow plots and minimal urethral resistance, we can decide the degree of obstruction in patients with prostatism especially whose MFR are between 10 and 15 ml/sec.
Subject(s)
Humans , Male , Incidence , Prostatism , Reflex, Abnormal , Urinary Bladder Neck Obstruction , UrodynamicsABSTRACT
Uroflowmetry is important and simple method in the evaluation of prostatism and lower urinary tract obstruction. But nomogram of old males was not made till now in Korea. And the aim of our study was to provide a control group of males without prostatism who were in relevant age group. So, we investigated 312 males, who were over 50 years and had no subjective voiding problem. And we select 173 males, whose symptom scores were less than 6 out of 27 possible points of Madsen & Iverson's score system and nomogram was made. The 173 males were divided in 5-year groups and we gained maximal flow rate(MFR) and average flow rate(AFR). It was found that the mean value of MFR and AFR decreased from 20.5 t 8.lm1/sec and 13.2+/-5.8ml/sec at the A group( 50-54 years) to 15.4+/-6.1ml/sec and 9.3+/-4.5ml/sec at the G group(over 80 years). The mean voided volume was 211mL. The MFR and AFR are very closely related to the voided volume(P<0.01) and the adjusted maximal flow rate has been tested clinically by comparing preoperative voidings and postoperative voidings of prostatectomy patients. We conclude that this nomogram is very useful in diagnosing and follow-up of patients with BPH or lower urinary tract obstruction.
Subject(s)
Aged , Humans , Male , Follow-Up Studies , Korea , Nomograms , Prostatectomy , Prostatism , Urinary TractABSTRACT
The aim of this investigation was to determine the incidence of sperm antibodies in serum using indirect immunobead test (IBT) in 113 patients of scrotal disease. The results of this survey showed that 17.7% of 113 men had antisperm antibodies of IgG and/or IgA class bound to the surface of at least 20% of motile spermatozoa of normal donor. There were positive immunobead test in 16 of 36(44.4% ) vasovasostomy patients, 1 of 18 testicular trauma, 1 of 15 primary infertility, 1 of 4 obstructive infertility, 1 of 7 hydrocele. There were no statistical differences in sperm count, sperm morphology between the groups of patients with positive or negative IBT results. As for the immunoglobulins, the most frequent class was IgG, and in terms of morphological sites, tail binding was most frequent. The results of this investigation therefore suggest that the IBT is an excellent test for sperm antibodies in scrotal disease.
Subject(s)
Humans , Male , Antibodies , Immunoglobulin A , Immunoglobulin G , Immunoglobulins , Incidence , Infertility , Sperm Count , Spermatozoa , Tissue Donors , VasovasostomyABSTRACT
We measured the concentration of serum PSA and prostatic acid phosphatase for studying the usefulness of PSA in 145 cases with BPH and 24 cases with prostate cancer. PSA was more sensitive and same specific as PAP in diagnosis of prostate cancer(n < or = 20 ng/ml). The diagnostic accuracy and positive predictive rate or PSA were higher than PAP, positive predictive rate war highest in PSA(n < or = 10 ng/ml) with abnormal digital rectal examination. PSA was a simple and useful method for detection of prostate cancer. But, by strict statistical criteria alone, PSA by itself didn`t qualify as an effective screening tool. By combination with digital rectal examination and transrectal ultrasonography, it may be useful in early detection of prostate cancer.
Subject(s)
Acid Phosphatase , Diagnosis , Digital Rectal Examination , Mass Screening , Prostate , Prostate-Specific Antigen , Prostatic Neoplasms , UltrasonographyABSTRACT
Male genital traumas on penis, scrotum and testis primarily result from external violences including motor vehicle accidents, industrial mishaps, gunshots, laceration, rights and sexual intercourse. The loss or function in this system may be not vital but the quality of patient`s life be deleterious if they are not properly managed. So, we reviewed 98 patients with male genital tract trauma in the view point or early and delayed treatment, and concluded that early diagnosis and judicious treatment gave patients the best chances of recovering urinary and genital function after genital trauma.
Subject(s)
Humans , Male , Accidents, Occupational , Coitus , Early Diagnosis , Genitalia, Male , Human Rights , Lacerations , Motor Vehicles , Penis , Scrotum , TestisABSTRACT
To see the effectiveness of preoperatively administered furosemide for preventing Hypo-osmolarity and hyponatremia during TURP, 30 patients undergoing TURP were followed every preoperatively, 30 min intra-operatively as well as immediate postoperatively, 6 hours and 24 hours postoperatively with measurements of serum sodium, serum potassium and serum osmolarity. Among the 30 patients, 15 patients (experimental group) were administered furosemide immediately before TURP, the other 15 patients (control group) were not administered. We compared the changes of serum sodium, serum potassium and osmolarity of experimental group with those of control group. The result showed that the serum sodium and serum osmolarity were decreased significantly (p<0.01) in control group, but were not decreased significantly in experimental group. Thus, the preoperatively administered furosemide may prevent the dilutional hyponatremia and hypo-osmolarity during TURP, and may be helpful in high risk patient such as congestive heart failure and poor renal function.
Subject(s)
Humans , Furosemide , Heart Failure , Hyponatremia , Osmolar Concentration , Potassium , Sodium , Transurethral Resection of ProstateABSTRACT
Between January 1990 and February 1991, ureteroscopic removal of ureteral stone was performed in 40 cases at outpatient department under local anesthesia(36 cases) and epidural anesthesia(4 cases). The results were as follows. The success rate of ureteral stone removal was 82.1% (32 among 39 cases) in lower ureter, 86.7 %(26 among 30 cases) in female and 70.0%(7 among 10 cases) in male. Anesthetic methods were local(36 cases), and epidural(4 cases), Mean duration of hospitalization was 1.4 days(0-7 days). The associated complication rate was low, with most patients being treated conservatively. Therefore, we believe that the ureteroscopic stone removal at outpatient department can be done safely if we select patients properly(especially women). have adequate equipment and execute properly the basic technique.