Introital Ultrasonography in Female Urinary Incontinence

PURPOSE: To evaluate the usefulness of introital ultrasonography in the assessment of female urinary incontinence. MATERIALS AND METHODS: Introital ultrasonography was performed in fifteen patients with stress urinasy incontinence(mean age 50) and six patients without symptoms of incontinence(mean age 37). Using a sagittalsection of the anterior pelvis in the plane of the symphysis pubib the posterior rethrovesical angle, the pubourethral distance and the pubo-yretgrak abgle were measured at rest and during stree(Valsalva's maneuverstate). The student T-test and the ANOVA test were used in statistical analysis. RESULTS: The posterior urethrovesical angles of the controls were 125.3 degrees (+/- 10.9) at rest and 125.7 degrees (+/-7.6) during stress. In thepatients, the corresponding angles were 135.3 degrees (+/-11.3) and 139.6 degrees (+/-10.8). The posterior urethrovesical angles increased 0.3 degrees (+/-4.7) in the controls and 5.6 degrees (+/-4.0) in the patients(p=0.018). In the controls, thepubo-urethral distances were 21.8mm(+/- 5.8) at rest and 18.2mm(+/-7.1) during stress, while in the patients thesedistances were 18.4mm(+/-3.9) and 12.6mm(+/-4.4). The pubo-urethra distance decreased 3.5mm(+/-1.5) in the controls and 5.8mm(+/-2.3) in the patients(p=0.039). In the patients with mild incontinence(Gradel), the posterior urethrovesical angles increased 3.4 degrees (+/-2.8) : 132.3 degrees (+/-12.5) at rest and 135.6 degrees (+/-12.8) during stress. In the patients with moderate incontinence(Grade II), the angles increased 8.1 degrees (+/-3.8) : 136.0 degrees (+/-6.5) at rest and 144.1 degrees (+/-5.9) during stress. The change of the posterior urethrovesical angle was related to the grade of urinary incontinence in the patients(p<0.05). There was no statistical significancy in the pubo-urethral angle(p=0.315). CONCLUSION: Introital ultrasonography may be useful for assessment of stress urinary incontinence.

Effect of Protein Kinase C Inhibitor (Staurosporine) in Human Invasive Bladder Tumor Cells / 대한비뇨기과학회지

Protein Kinase C which is a Ca++ -activated, phospholipid - dependent enzyme phosphorylates numerous protein substrates and participates in intracellular signaling processes. Protein kinase C is associated with a wide range of biological effects including stimulus-secretion coupling, induction of cellular proliferation and differentiation, activation of nuclear transcription factors and cell surface receptors and tumor promotion. Programmed cell death, referred to apoptosis is an active, energy-dependent process in which the cell participates in its own destruction during apoptosis. There is condensation and fragmentation of nuclear chromatin, accompanied by a marked decline in total cell volume, dilation of the endoplasmic reticulum and general compacting of cellular organelles. Thereafter, there is fragmentation of both nucleus and cytoplasm to give rise to small membrane-bound vesicles known as apoptotic bodies. Protein kinase C may have the regulatory role in apoptosis. Staurosporine is a potent protein kinase C inhibitor. Staurosporine inhibited the growth of human invasive bladder tumor cells, T24 in MTT test. The survival fractions of human invasive bladder tumor cells T24 were 100.0%, 76.0%, 62.5% and 18.1% with staurosporine concentration 0nM, 10nM, 100nM and 1000nM, respectively. From the results we identified that staurosporine inhibited the growth of T24 cells markedly in a dose dependent manner(P<0.05). 12-hour exposure of T24 cells to staurosporine failed to induce DNA fragmentation at the concentrations of 0nM, 10nM and 100nM but promoted fragmentation at the concentration of 1000nM, showing typical ladder pattern on agarose gel electrophoresis. On the examination of cellular morphology, T24 cells showed the features of apoptosis such as cell shrinkage, nuclear condensation and formation of bleb and apoptotic bodies after exposure to staurosporine of 10nM, 100nM and 1000nM concentrations. These results suggest that staurosporine have remarkable cytotoxic effect against human invasive bladder tumor cells T 24 and the mechanism of cytotoxicity may be apoptosis.

Trimix Intracavernosal Injection Therapy in the Patients with Erectile Dysfunction / 대한비뇨기과학회지

Vasoactive pharmacotherapy is now being widely used as practical and reliable method for the treatment of the patients with erectile dysfunction. But the individual vasoactive agent has limitations in its clinical success and potential for side effects. So, the synergistic effect and low drug volume of each vasoactive drug in polypharmacotherapy of erectile dysfunction have made it possible to reduce both systemic and local complications with excellent success rate. A total of 223 patients with erectile dysfunction underwent a trial of intracavernous self injection therapy with Trimix(the mixture of papaverine, phentolamine and prostaglandin E1). Major underlying diseases were DM(115patients, 51.6%), hypertension(11 patients, 4.9%), spinal injury(three patients, 1.3%) and prior pelvic surgery(three patients, 1.3%). The volume of drug used ranged between 0.04 and 0.6ml(average:0.19ml). After a mean followup of 7.6 months(3-15 months), 141 patients(63.2%) left in the home injection program and among them, 125 patients(88.6%) had very high satisfaction. The drop-out rate was 36.8%(82 of 223) with most of the cases during early home phase. The causes of drop-out were the fear of needle or injection, inadequate response to injection, loss of interest and complications. Priapism(six patients, 3.8%), pain(six patients, 3.8%) and granuloma on injection site(one patient, 0.6%) were noticeable complications, but coporal fibrosis and systemic side effect were not noticed. In conclusion, Trimix intracavernosal injection therapy is minimally invasive, simple, relatively safe and, most of all, very effective method for the treatment of the patients with erectile dysfunctions.

The Role of Nitric Oxide in the Relaxation of Canine Corpus Cavernosum Smooth Muscle / 대한비뇨기과학회지

Nitric Oxide(NO) has been known to be endothelium-derived relaxing factor in blood vessels, and to be nonadrenergic-noncholinergic(NANC) neurotransmitter involved in the relaxation of corpus cavernosum smooth muscle of man and rabbit. This study was initiated to determine NANC inhibitory neurotransmission in the canine corpus cavernosum. Using organ bath, isometric tension measurements were made in strips of canine corpus cavernosum. Transmural electrical stimulation of corporal tissue strips, in the presence of adrenergic blockade with bretylium and muscarinic receptor blockade with atropine, caused frequency-dependent relaxation. This relaxation was inhibited significantly by nitric oxide synthase inhibitor, N-nitro-L-arginine methyl ester(L-NAME). Our findings suggest that there should be nonadrenergic-noncholinergic neurotransmitter in the canine corpus cavernosum smooth muscle and it could be nitric oxide. Canine erectile tissue might serve as in vitro model for further investigation of corpus cavernosal smooth muscle pathophysiology.

Urodynamic study in children with myelodysplasia / 대한비뇨기과학회지

A selection of particular type of neurogenic bladder with a high risk for renal function from urodynamic study in myelodysplasia patients is important to predict prognosis and to determine treatment plan. With video urodynamic study we tried to know which type of bladder dysfunction had a possibility of renal deterioration. Among 39 patients with myelodysplasia. 10 patients had vesicoureteral reflux. In these patients. vesicoureteral reflux was found in 3 of 7 patients with hyperreflexia showing detrusor-sphincter dyssynergia, 2 of 6 patients with hyperreflexia without showing detrusor-sphincter dyssynergia and 5 of 10 patients with areflexia showing low compliance. All normal and any other areflexic bladders including relatively high compliance didn`t show vesicoureteral reflux. Upper tract dilatation also showed similar findings. These data show that with careful urodynamic study high risk neurogenic bladder type can be determined and it requires more aggressive treatment to preserve renal function.

Vesicoureteral Reflux in Children with Neuropathic Bladder / 대한비뇨기과학회지

During the lest 7 years 21 children with vesicoureteral reflux and neurogenic bladder dysfunction and 46 children with primary vesicoureteral reflux were followed. At the time of initial presentation, the mean age of the former group was 5.5 years and the letter group, 2.8 years. The grade of reflux and the nephropathy were more severe in the children with neuropathic bladder than in the children with primary vesicoureteral reflux But in the same reflux grade, there was no statistical difference in the nephropathy between the two groups. The children with vesicoureteral reflux and neuropathic bladder were managed with drug therapy, intermittent catheterization, urinary diversion and ureteral reimplantation. Radiological followup revealed that resolution or improvement of reflux occurred in 36 per cent of renal units managed by intermittent catheterization and 100 per cent in which the ureters were reimplanted. As in the non-neurogenic bladder successful management of reflux and prevention of upper tract deterioration can be achieved by conservative management as well as by ureteroneocystostomy.

The Urologic Abnormalities of Urinary Tract Infection in Children and their Detection / 대한비뇨기과학회지

We have reviewed 251 children with urinary tract infection who were seen in our hospital during the last 5 years. Underlying abnormalities of the urinary tract were found in 154 patients(61 %). This figure is high because referred patients from other physicians for further treatment are included here. Of these 154 patients, surgical treatments were required in 85. The most frequent finding was vesicoureteral reflux(110 pts). Obstructive lesions were found in 44 pts ; UPJ obstruction in 9, megaureter in 6, obstruction associated with duplication in 6, urethral valve in 5, neurogenic bladder in 11, and others in 7. Abnormal findings without clinical significance were found in additional 17 pts. To evaluate the role of ultrasonography(US), we have compared findings of intravenous pyelography(IVP) and US. Of 58 pts who had both studies, 52 showed identical findings. US failed in detection of small renal scar and duplication of collecting system. US in combination with voiding cystourethrography(VCU) identified abnormal findings in most cases. It is our impression that US can replace IVP as a screening procedure which should be performed with VCU in every child with proven UTI. And as IVP is superior in imaging anatomical details than US, we recommend IVP before any surgical attempt.

The Effects of Experimental Varicocele on Testis in Adolescent Rats / 대한비뇨기과학회지

Varicocele has been implicated as a cause of infertility in adult men, but little has been known on the significance of varicocele in adolescents. We created experimental varicoceles by partial ligation of the left renal vein in rats at 4 weeks, 7 weeks and 12 weeks of age to understand the effects of varicocele on testis in different stages of development ; preadolescence, adolescence and adulthood. Effects of varicocele on testis were studied with observation of the changes of testicular weights and testicular histology 4 weeks and 8 weeks after creation of varicocele. The experimental groups in which varicoceles were induced at 4 weeks and 12 weeks of age showed minimal testicular weight changes and minimal histologic changes. The experimental group of 7 weeks of age showed the marked changes on testis ; mean weight of the left testis was significantly reduced in experimental group (1.03+/-0.31) compared with control group (1.51+/-0.12g) (p<0,05). Histologic changes such as degeneration of germinal epithelium, tubular atrophy, Sertoli cell hyperplasia and interstitial edema were more frequently observed in this group. We measured the mean seminiferous tubular diameter as a means of quantitative evaluation of spermatogenesis and found it decreased significantly in this group (219+/-37 micrometer) compared with control group (270+/-141 micrometer) (p<0.05). Above results suggest that varicocele which occurred in adolescence has the most damaging effects on testis.

Characteristics of Upper Urinary Tract Change in Lower Urinary Tract Obstructive Lesions / 대한비뇨기과학회지

Reviewing the radiologic studies of the 402 patients with infravesical obstructive lesions, we studied the pattern of upper urinary tract change in children and adults. The following results were obtained. 1. The upper tract dilatation was shown in 68 patients : 9 of 11 posterior urethral valve patients(82 percent), 22 of 280 benign prostatic hyperplasia patients(7.9 percent), 11 of 57 urethral stricture patients(19 percent), 26 of 54 neurogenic bladder patients(48 per cent). 2. Upper tract dilatation in infravesical obstructive diseases occurred on one side in 32 percent of the cases : 24 percent in children and 38 percent in adults. 3. Of 68 patients with upper tract dilatation, 40 patients had voiding cystourethrography. Vesicoureteral reflux was observed in 30 of 69 dilated kidney units : 25 of 49 kidney units (51 percent) in children and 5 of 20 kidney units(25 percent) in adults. Vesicoureteral reflux was more frequently occurred in children than in adults.