An Experience of Spastic Neurogenic Bladder Treated with Augmentation Cystoplasty and External Urethral Sphincterotomy / 대한비뇨기과학회지

A 41-year-old man with a 12-year history of urinary incontinence and frequency was presented our hospital. He had a spinal cord injury after fell down from a utility pole. Spastic neurogennic bladder and detrusor external sphincter dyssynergia was diagnosed and augmentation cystoplasty was performed. And we performed additional external sphincterotomy to avoid intrmittent self catheterization. He can retain as much as 800m1 of urine without urinary incontinence and voids with abdominal pressure and retains little residual urine. We report the good result of additional external urethral sphincterotomy after augmentation cystoplasty.

A Case of Neurogenic Bladder Combined with Mayer-Rokitansky- K ster-Hauser Syndrome / 대한비뇨기과학회지

We experienced a case of MRKH syndrome in a 24-year-old female which was combined with sacral agenesis, neurogenic bladder, and duplicated ureter associated with vesicoureteral reflux in the right side.

Effects of Nitric Oxide and Peroxynitrite Peroxynitrite on Sperm Motility and Viability / 대한비뇨기과학회지

PURPOSE: Recently, in assisted reproductive technologies(ART) programs theme Is an increasing Interest in the use of agents for the enhancement of sperm motility for assisted fertilization. In an attempt to improve the motility at the cryopreserved human semen and hence the fertilizing capacity of asthenospermic semen samples, different semen preparation techniques have been attempted and the effects of chemical stimulants as nitric oxide(NO) have been studied extensively. Superoxide anions cause lipid peroxidative damage to cell membrane phospholipids, and sperm are known to be particularly susceptible to lipid peroxidation. Such sperm with damaged membranes are impaired functionally. Recently, peroxynitrite, an anion and a potent oxidant, generated by the interaction of nitric oxide and superoxide anions has been demonstrated In macrophages and other cellular systems. Also this anion cause lipid peroxidative damage to cell membrane phospholiplds. We therefore Investigated whether NO and peroxynitrite have the roles to modulate sperm motility and to affect Its viability. MATERIALS AND METHODS: Normal human semen samples(as per World health Organization (WHO) criteria) were obtained after 3day period of abstinence by donors. The samples(n=5) were incubated with either sodium nitroprusside(SNP; 0.1, 05, 1 or 2mM) or peroxynitrite (10, 50 or 100 micrometer ) and the percent viability and motility were assessed at various time inteval up to 4hr. The human semen samples were treated with N-acetyl-L-cystein(NAC;10mM), SNP (0.5mM), phorbol myristate acetate(PMA; 100nM), of SNF plus PMA. Both superoxide and peroxynitrite release were measured directly by chemiluminometer. Percent viability and motility were assessed at 4hr of Incubation. A sample of each aliquot was placed in a Mauler chamber for videomicrography Percent motility were analyzed by using the sperm analysis imaging system. The sperm vlability was assessed by flow cytometer using LIVE/DEAD sperm viability kIt. The production of superoxide and peroxynitrite were measured by the method of chemiluminescence assay. Result : All results represent a mean +/-SEM, n=5. Treatment of human semen samples for 4hr with SNP, a NO generating agent, significantly decreased sperm motility and viability in high concentration [relative motility(% of control); 38 +/-4 and 30 +/-5, relative viability; 42 +/-4 and 30 +/-3 by 1 and 2mM of SNP]. In the presence of low concentration SNP(0.5mM), the sperm viability was not significantly affected(82 +/-3), whereas the sperm motility was affected(64 2). SNP(0.5mM) also decreased sperm motility(80 +/-2 at 2hr 64 +/-3 at 4hr, 44 +/-3 at 6hr, and 38 +/-4 at 8hr) in a time dependent manner. Since it was demonstrated that superoxide anions are one of the common source of lipid peroxidation, we investigated whether superoxide anions produced by human semens could Interact wlth NO to generate peroxynitrite. Adding N-acetyl-L-cystein(NAC) to the human semen samples partially blocked spontaneous release of superoxide, whereas PMA augmented the release of superoxide from human semen samples (control:0.9 106 0.3, NAC: 0.5 106 +/-0.4, and PMA: 2.5 106 +/-0.4photons/60min). The production of superoxide was corresponded with the production of peroxynltrite(control: 1.0 104CPM, SNP: 3.8 106CPM, SNP plus PMA. 12chi106CPM). In addition, SNP in combination with PMA(65 +/-3) markedly decreased sperm motility than that of SNP alone(77 +/-2.5) at 4hr, implying that nitric oxide might inhibit sperm motility via the formation of peroxynitrite In human semen samples. Exogenous peroxynitrite also decreased sperm motility in a dose dependent manner(10 micrometer : 64 +/-2, 50rM: 53 +/-3, and 1 0 micrometer of peroxynitrite: 23 4). CONCLUSIONS: These results suggest that NO inhibits sperm motility via the formation of peroxynltrite and further demonstrate that NO-induced inhibition of sperm motility is depended on the production of superoxide from human semens because peroxynitrite is generated by the interaction of NO and superoxide.

Comparison of Split Renal Function on DTPA Renal Scan and Endogenous Creatinine Clearance Ratio in Obstruction of Upper Urinary Tract / 대한비뇨기과학회지

PURPOSE: Split renal function on diuretic renography has been considered to be a good tool for evaluating renal function, selecting treatment modalities and assessing efficacy of surgery in hydronephrosis, especially in ureteropelvic junction(UPJ) obstruction. However, contradictory supranormal function on renography has provided controversy with urologists. Is the phenomenon the result of fact or artifact? The authers thought that contradictory supranormal renal function measured with 99mTc-DTPA Is fundamentally related with a question. How accurately does the split renal function test represent the real renal function, namely, glomerular filtration rate(GFR)? To know relation of split renal function with real renal function(GFR) and to disclose clinical significance of contradictory supranormal renal function on diuretic renal scan, a prospective study was performed. MATERIALS AND METHODS: Diuretic renography was done in 14patients with upper urinary tract obstruction including UPJ obstruction, ureteral stone and lower urethral obstruction. Afer the first diuretic renography using 99mTc-DTPA percutaneous nephrostomy was performed on affected kidney, which was followed by the second diuretic renography. Endogenous creatinine clearance tests were done on the patients. Urine was collected through the nephrostomy tube, self voiding or indwelling Foley catheter, respectively So the endogenous creatinine clearance was determined respectively on both the renal unit. Also the endogenous creatinine clearance ratio of affected kidney was determined to compare with split renal function on renography. RESULTS: In 7patients, ratio of endogenous creatinine clearance on affected kidney was less than 40%. In the other 7patients, the ratio was more than 48%. In patients with less than 40% of endogenous creatinine clearance ratio on affected kidney, split renal function was overestimated by 10.3% to 27.5%(19.5+/-4.9%) comparing to endogenous creatinine clearance ratio. In the other 7patients split renal function had a little difference from endogenous creatinine clearance ratio (4.5+/-2.5%). The endogenous creatinine clearance ratio was not closely related with split renal function(correlation coefficients: 0.65). Split renal function of the first renography was closely related with that of the second renography(correlation coefficients: 0.88). Contradictory supranormal function occurred in 4cases. In 2cases it was real finding, in the other it was not. CONCLUSIONS: It appears that split renal function is overestimated in poor renal function and split renal function is closely related with real renal function in good renal function slate. Supranormal renal function is real finding in part, not in part. Clinical significance of split renal function should be cautiously and basically reevaluated through further study.

Early Experience of Laparoscopic Renal Cyst Marsupialization / 대한비뇨기과학회지

PURPOSE: To evaluate the eligibility of laparoscopic surgery for the treatment of renal cysts, we analysed our clinical results of laparoscopic renal cyst marsupialization in 9 patients. MATERIALS AND METHODS: Between January 1994 and February 1997, a total of 9 patients with renal cyst underwent laparoscopic surgery. They were 2 men and 7 women 42 to 67 years old. Mean cyst size of the patient was 7.3cm(5-10cm). Presenting symptoms were flank pain in 8 and palpable mass in 1. One patient had previously undergone ultrasonography guided percutaueous aspiration and ablation. One patient had bilateral renal cyst. Initially the procedures had been performed via the transperitoneal approach in 4 patients after that we attempted retroperitoneal access for laparoscopy in 5 patients(6 renal units). During the operation cyst fluid was obtained for cytologic examination and cyst walls were excised and sent for pathological examination. RESULTS: Mean operation time was 2 hours and 14 minutes. Mean hospital stay was 5.9 days. Perioperative complications were pain(20%), bleeding(10%), subcutaneous emphysema(20%) and pneumothorax(10%). Bleeding was minimal but 2 units of packed red cell were needed in 1 patient. Conversion to open surgery from laparoscopic procedure was needed in 1 patient. Biopsy results were negative for carcinoma. All patients were asymptomatic at a mean follow up of 12.5 months. CONCLUSIONS: Laparoscopic renal cyst marsupialization for symptomatic renal cysts seems to be a safe and effective alternative to open surgery.

Clinical Observation on the Role of Ureteroscopy / 대한비뇨기과학회지

Today, Ureteroscopy is used for the diagnosis and treatment of various pathologies in the or urinary tract. From March 1987 to September 1996, we retrospectively evaluated our experiences with rigid ureteroscopy in 137 ureteral units in which therapeutic applications were 127 (92.7%) and diagnostic applications were 10 cases (7.3%). The causes ol therapeutic intervention were ureteral stones in 118 cases, upward migrated double J-stent in 6 cases, urethral foreign body (double J stent retention) in 2 cases and stenosis of ileoureteral anastomosis in 1 case. Success rate was 81.9% : 80.5% in the treatment of urethral stones, 100% in the treatment of urethral stenosis, 100% in the reposition or removal of retained catheter. Ureteroscopic stone extracton were performed in 77 cases (before introduction of ESWL) and in 41 cases (after introduction of ESWL). The latter was significantly decreased (78 of 288 or 32.4% versus 59 of 1588 or 3.7%). The success rate were 75.3% (58/77) before introduction of ESWL and 90.2% (37/41) after introduction of ESWL. The latter success rate was significantly increased. The causes of diagnostic intervention were upper tract bleeding in 2 cases, ureteral filling defect or delayed visualization at intravenous urography in 8 cases. The diagnostic results showed 1 case of ureteral transitional cell carcinoma, 1 case of ureteral stones, 1 case of urethral stricture, 3 cases of ureteral stones, 1 case of chronic ureteral inflammation and 3 cases of normal findings. Success rate was 90%. The frequency of diagnostic intervention increased from 1.3% for the 78 procedures done before introduction of ESWL to 15.3% for the 59 procedures done after introduction of ESWL. The minor complications (managed conservatively or with temporary stent drainage) occurred: flank pain in 35 cases (25.5%), gross hematuria in 10 cases (7.3%), high fever of over 38 degrees C in 5 cases (3.7%), ureteral perforations in 3 cases (2.2%) and urethral mucosal avulsion in 2 cases (1.5%). There were no major complications (all requiring an open surgery). In conclusion, after the introduction of ESWL the frequency of ureteroscpoic stone extraction decreased (p<0.05) and the frequency of diagnostic intervention increased (p<0.05). In the hands of experienced urologists the success rate of ureteroscopy increased.

A Case of Sarcomatoid Renal Cell Carcinoma with Multiple Renal Stones and Pyonephrosis / 대한비뇨기과학회지

Sarcomatoid renal cell carcinoma is uncommon and constitutes approximately 1.0% to 1.5% of all renal parenchymal tumors. Renal tumors that consist of epithelial and sarcomatoid components were called Sarcomatoid renal cell carcinomas. Its distinction from other morphological variants of renal cell carcinoma is significant, because it has been shown to have a much poorer prognosis than the purely epithelial tumors. The diagnosis of sarcomatoid renal cell carcinoma is usually made when epithelial and sarcomatoid components are mixed in nephrectomy specimen. A case of sarcomatoid renal cell carcinoma is herein presented in a 77 year-old women. she complained right flank pain and high fever for 3 days, radical nephrectomy was performed and diagnosis was made by H-E stains and immunohistochemical stains of nephrectomy specimen. A brief review about sarcomatoid renal cell carcinoma is made.

An Experience of Vaginoplasty with Bilateral Labioscrotal Flap (M-shaped flap) for Female Pseudohermaphroditism in Congenital Adrenal Hyperplasia / 대한비뇨기과학회지

The most common etiology for female pseudohermaphroditism is congenital adrenal hyperplasia, which accounts for more than 60 percent of children with ambiguous genitalia, and is treated with cortisol replacement and surgical correction of ambiguous genitalia. Flap vaginoplasty, the inverted U-Shaped type has been applied worldwide to the patient with low vaginal entry. The most frequent complication of the operation is contraction of the new vaginal introitus as a result of ischemic and fibrotic changes in the overlapping suture line between the flap and posterior vaginal wall. Maintenance of a good blood supply for the flap and tension free anastomosis should always be kept in mind to avoid this complication. We experienced a vaginoplasty with labioscrotal flap instead of the inverted U-shaped flap and achieved a good result in a 14-year-old girl with low vaginal entry due to congenital adrenal hyperplasia. The labioscrotal flap seems to be more suitable than inverted U-shaped flap for vaginoplasty because the labioscrotal skin is more elastic and more easily elongated than the perineal skin.

Clinical experience with EDAP LT-01+ extracorporeal shock wave lithotripsy in 25 staghorn calculi / 대한비뇨기과학회지

From February 8. 1990 to November 30, 1991, 25 patients with staghorn calculi were underwent extracorporeal shock wave lithotripsy(ESWL) using the EDAP LT-01 lithotriptor. We reviewed patients with staghorn calculi to evaluate the effectiveness of ESWL as monotherapy for staghorn calculi and determine the selection criteria for the treatment calculi. The results were obtained as follows : l. Ten patients had complete staghorn calculi filling the complete renal collecting system with stone of l7,635 mm3 in mean volume and l3 patients had partial staghorn calculi filling the renal pelvis and partial caliceal groups with stone of 7,017 mm3 in mean volume. 2. Of 17 patients with stone of less than 8,200 mm3 in volume. 10(83.3%)remained free of stone after an average 11.8 sessions. Of 6 patients with stone of between 8,200 to 14,200 mm3 volume, 5(83.3%) remained free of stone after an average 18.3 sessions. Of 7 patients with stone of more than l4,200 mm3 in volume, 2(28.6%) remained free of stone after an average 17.4 sessions 3. When these patients were stratified by stone burden, of 10 patients with stone filling a non-dilated renal collecting system, all(100%) patients remained free of stone. Of 15 patients with filling a dilated renal collecting system. 7 (46.7%) patients remained free of stone. Of 8 cases with residual stones. 2 patients were underwent open surgery(nephrectomy, extended pyelolithotomy), 2 patients were impossible to follow up and 4 patients still are undergoing continuous additional ESWL sessions. 5. Double J stent for the pre-ESWL additional measures were placed in 19 patients(76%); Eight of the complete staghorn calculi and 11 of the partial staghorn calculi. Percutaneous nephrostomy tube was placed in 2 patients. No general or regional anesthesia was required. 6. The post-ESWL complications were ureteral obstruction(steinstrasse) in 7 patients(28%) and high fever(over 38.5 degrees C) in 11 patients( 44.0%). We conclude that partial staghorn calculi, staghorn calculi with stone of less than 14,200 mm3 in volume and staghorn calculi with stone burden filling non-dilated collecting system are eligible for ESWL.

Comparative study on results between urine flow cytometric DNA analysis and urine cytology in transtional cell carcinoma of bladder / 대한비뇨기과학회지

We compared the roles of urinary cytology and flow cytometric DNA analysis in the evaluation of 26 patients with transitionsl cell carcinoma of bladder from March 1989 to April 1991. When carcinoma was present at the time of specimen collection it was detected by cytology in 65.4 percent and flow cytometric DNA analysis in 73.1 percent. Combination of flow cytemetric DNA analysis and urinary cytology increased the diagnostic yield to 88.5 percent Flow cytometric DNA analysis was slightly more sensitive than urinary cytology for the detection of abnormalities in specimen from low stage. high grade. small size. small number and recurrent cancer but no statistically significant difference was identified. When used in conjunction with urinary cytology. urine flow cytometric DNA analysis was valuable procedure in the diagnosis and follow up of patients with bladder cancer.

A case of persistent Mullerian duct syndrome / 대한비뇨기과학회지

A small number of patients have been described in whom normal male development of the external genitalia has occurred but whom the Mullerian ducts persist. The retention of Mullerian structures can be ascribed to the failure of the Sertoli cells to synthesize Mullerian duct inhibitory factor or to a defect in the response of the duct to that factor. We experienced a case of persistent Mullerian duct syndrome. which is phenotypically normal male with bilateral undescended testes, bilateral fallopian tubes and a uterus. Herein we report a case with brief review of the literatures.

A case of persistent Mullerian duct syndrome / 대한비뇨기과학회지

A small number of patients have been described in whom normal male development of the external genitalia has occurred but whom the Mullerian ducts persist. The retention of Mullerian structures can be ascribed to the failure of the Sertoli cells to synthesize Mullerian duct inhibitory factor or to a defect in the response of the duct to that factor. We experienced a case of persistent Mullerian duct syndrome. which is phenotypically normal male with bilateral undescended testes, bilateral fallopian tubes and a uterus. Herein we report a case with brief review of the literatures.

A case of congenital retroperitoneal immature teratoma / 대한비뇨기과학회지

The immature teratoma is extremely rare tumor consisting of mature tissues and immature embryonal tissues. The immature teratoma in children occurs more frequently at the sacrococcygeal bone, testis and ovary. Only 9.5 percent of immature teratomas occur in retroperitoneum. Often the presenting manifestation is asymptomatic with increasing abdominal distention or mass discovered during physical examination. We report a case of congenital retroperitoneal immature teratoma in 3-week-old boy who was treated by surgical excision.