A Case of in-utero Vesicoamniotic Shunting and Postnatal Vesicostomy in Very Low Birth Weight Baby with Posterior Urethral Valve Syndrome

We present a case of in-utero vesicoamniotic shunting and postnatal vesicostomy in a very low birth weight baby with posterior urethral valve syndrome. He was diagnosed as posterior urethral valve at 24(+5) weeks' gestation. Because of severe hydronephrosis and oligohydroamnios, the shunt was established by basket-shaped catheter at 27(+0) weeks' gestation. After shunt, hydronephrosis improved. At 29(+4) weeks' gestation, the shunt catheter escaped from its position and severe urinary ascites and hydronephrosis developed. At 30 weeks' gestation, the baby was born and showed elevated BUN and creatinine. On the 10th day of birth, vesicostomy was done for urinary drainage. Thereafter, the baby has been followed up for 10 months and has had recurrent episodes of urinary infection. We report the case with a brief review of literature.

A study of alpha adrenergic receptors in human and rabbit corpus cavernosum tissue / 대한비뇨기과학회지

The relaxation of the corpus cavernosum smooth muscle, which is main process in penile erection, is controlled by nerves that release cholinergic and nonadrenergic-noncholinergic neurotransmitters as well as vascular endothelium derived relaxing factor(EDRF). But the adrenergically-induced tone maintains the penis in flaccid state. In order to define the physiological role of adrenergic neurotransmission in the local control of penile erection we studied the distribution of alpha adrenergic receptor subtypes and their pharmacological potency in human and rabbit corpus cavernosum tissue. In this study we used yohimbine as the alpha-2 antagonist, which is known to have beneficial therapeutic effect for organic impotence, to assess its neuropharmacological mechanism in the treatment of erectile dysfunction. The alpha-1 : alpha-2 receptor potency was approximately 7.4:1 and 2.2:1 in human and rabbit tissue respectively. These results indicate that the predominant alpha adrenergic receptor is alpha-1 type and alpha-2 receptor antagonist, yohimbine, can not play a main role on the local control of penile erection because of its low receptor potency especially in human corpus cavernosum tissue. It remains possible that yohimbine partially antagonizes the postsynaptic alpha-1 mediated effect or activation of central sympathetic pathway is necessary for the therapeutic effect of yohimbine in human.

Clinical significance of GnRH stimulation test in male infertility / 대한비뇨기과학회지

GnRH stimulation test has been used to distinguish patients with hypogonadotropic hypogonadism of pituitary origin from those with hypothalamic disease. GnRH stimulation test also has been used to identify early stage of Sertoli cell insufficiency and to know the subtle abnormalities or spermatogenesis. Some investigators reported that exaggerated FSH response after GnRH stimulation means the same diagnostic meaning as basely elevated FSH level and this in turn reflects Sertoli cell insutriciency or may help to identify patients with isolated primary germ cell failure in azoospermic patients. So they suggested the possibility that GnRH stimulation test can replace testis biopsy in male infertility. To define the normal range of the gonadotropin response after GnRH stimulation and to know the indications for GnRH stimulation test if it is useful as an evaluation method for spermatogenesis, and especially to test the possibility whether GnRH stimulation test may replace testis biopsy, we performed GnRH stimulation test in 118 infertile men and 20 fertile adult male volunteers and compared the results with testicular histology. Normal basal serum levels for LH, FSH, testosterone were 1.4-18.3( mean 9.9) mIU/ml, 2.8-18.4 (mean 10.0) mIU/ml, 2.0-9.1 (mean 5.0)ng/ml respectively, and 95% confidence intervals for the peak responses to an intravenous bolus injection of 100ug GnRH were 360-1950{mean 1098)% of the basal serum LH level, and 111-318(mean 225)% of the basal FSH level in 20 rertile adult male volunteers. The results of the FSH response in GnRH stimulation test were not helpful in distinguishing patients with bad testicular histology from those with good ones in 118 infertile men. So we came to the conclusion that GnRH stimulation test can not replace testis biopsy as an evaluation method for spermatogenesis in the majority of infertile patients.

A case of endometrioid carcinoma of prostate / 대한비뇨기과학회지

In the rare group of atypical adenocarcinomas of the prostate, endometrioid carcinoma is thought to be in unique but controversial position among them. In 1967, Melicow and pachter first reported a prostatic malienancy whose pattern was similar to endometrial adenocarcinoma of the female uterus. Because of the distinctive morphologic appearance and location near the prostatic verumontanum, it was suggested that it might originate from the mtllerian (female) remnant, the prostatic utricle, and consequently display estrogen dependence. But recent immunohistochemical and ultrastructural studies suggests that endometriold carcinoma of prostate is a unusual histologic variant of prostatic duct adenocarcinoma. We experienced a case of endometriold carcinoma of prostate, who was treated by radital surgery and pelvic lymph node dissection with radiation. And this may be the first reported case of its kind in Korea. Till now he is under the follow up for 2 years and 2 months after surgery with no evidence of disease.