The effects of vasectomy on the autonomic innervation of the rat vas deferens / 대한비뇨기과학회지

Immunohistochemical techniques have been employed to observe the arrangement and distribution or the autonomic nervous systems in the normal rat vas deferens and to observe periodic alterations or the innervation patterns following surgical division of the vas. 18 male Sprague-Dawley rat were divided into 6 groups: normal control group, 1 week after vasectomy group, 3 weeks after vasectomy group. 5 weeks after vasectomy group. 8 weeks after vasectomy group and 16 weeks after vasectomy group. Samples from sites on the testicular and urethral sides of the original vasectomy have been compared with the other group specimens as to the arrangement and distribution of autonomic nerves containing vasoactive intestinal polypeptide (VIP) and catecholamine. The VIPergic and adrenergic innervation patterns of the normal control group is almost identical with that of a normal human vas. In contrast with tissues from the testicular portions and from the controls. the testicular specimens were devoid of autonomic nerve fibers, which were neither re-innervated nor re distributed in every vasectomy group. In the urethral portion of the vas, it was observed that the adrenergic nerve fibers had few changes after vasectomy and the VIPergic nerve fibers became thicker from 3 weeks after vasectomy. showing axonal growth into the smooth muscle coat from 6 weeks after it. and showing axonal growth into the deep muscle coat from 16 weeks after it. These findings indicate firstly that the autonomic nerve fibers run from the urethral portion towards the testis ; secondly that VIPergic nerve fibers have high a possibility to be re-innervated by axonal growth from the urethral portion to the testicular portion after vasovasostomy; thirdly that injuring autonomic nerves to the vas deferens during vasectomy could result in poor function of the vas after vasovasostomy in relation to the contractile and secretory activities of the vas that may be of importance to the maturation and fertility of spermatozoa.

Evaluation of the renal function using 99mTc dimercaptosuccinic acid (DMSA) / 대한비뇨기과학회지

99mTc-DMSA is a new renal scanning agent that provides a good quality of renal image as a result of preferential cortical accumulation and also makes feasible a quantitative assessment of separate kidney functions. Using 99mTc-DMSA renal scan. we evaluated renal functions in 26 patients who had unilateral non-functioning obstructed kidneys on intravenous pyelogram (IVP) and normal contralateral kidneys for recent 2 years and decided whether to perform surgeries for relief of obstructions or nephrectomies. In the patients who undertook surgeries for relief of obstructions for the recovery of renal functions, we compared renal functions of preoperative and postoperative obstructed kidneys. The results were as follows: 1. Etiologic diseases in 26 patients were urinary stones in 13. ureteropelvic junction obstructions in 7 and renal tuberculosis in 6. 2. Nephrectomies were performed in 13 patients who showed less than 15% of the total renal functions as determined by a preoperative 99mTc-DMSA scans. 3. Surgeries for relief of obstructions were performed in the other 13 patients for the recovery of the renal functions. The functions of the obstructed kidneys as determined by preoperative 99m Tc-DMSA scans were from 23% to 42% (mean 29.3%) and by postoperative 99mTc-DMSA scans were from 24% to 47 % (mean 34.4 %). The functions of the obstructed kidneys were recovered from 1% to 12% (mean 43.5 %) after surgeries for relief of obstructions. The follow-up periods were from 1 to 13 months (mean 6.6 month).

One-Stage Microsurgical Phalloplasty using the Free Radial Forearm Osteocutaneous Sensory Flap / 대한비뇨기과학회지

We performed one-stage microsurgical phalloplasty on a 17-year-old male-pseudohermaphroditism patient after bilateral orchiopexy and urethroplasty, using the free radial forearm osteocutaneous sensory flap. The main advantages of this technique are not only the one-stage reconstruction and the satisfactory cosmetic and functional solution, but also the possibility of obtaining normal erogenous and tactile sensibility. One week after the operation, the urethrocutaneous fistula was developed between the native proximal urethra and the constructed neourethra, but seven weeks after the development, it spontaneously healed well. The results of our S-month follow-up are satisfactory in the following respects : 1) satisfactory cosmetic appearance 2) voluntary control of transurethral urination while standing 3) tactile and thermal sensibility. Further follow-up study is necessary for the confirmation of erogenous sensibility, successful sexual life and late complication.