Risk Factors of the Infectious Complications and Causative Microorganisms after Transrectal Ultrasound-guided Prostate Needle Biopsy / 대한남성과학회지

PURPOSE: Transrectal ultrasound-guided prostate needle biopsy (TRUS-PBx) is the standard procedure to diagnose prostate cancer. We evaluated the incidence and risk factors of infectious complications, the species cultured and rates of resistance for antibiotics of microorganism in infectious complications after TRUS-PBx. MATERIALS AND METHODS: We retrospectively evaluated the medical records of 742 patients who underwent TRUS-PBx from January 2004 to May 2007. All patients were treated with intravenous ciprofloxacin and oral ciprofloxacin for 1 week after discharge. Patients who presented infectious complications were performed chest x-ray, blood analysis, urine analysis and culture studies. RESULTS: Among 742 patients, 15 patients (2.0%) developed infectious complications. There were no significant differences between the complication and non-complications groups in age, PSA, prostate volume, nodule, hypoechoic lesion on transrectal sonography and underlying medical diseases. Twelve cases were performed in outpatient department and 3 cases were in operation room and that suggests high frequency of infectious complication when transrectal prostate biopsy is performed in outpatient department (p=0.007). Six kinds of microorganisms were cultivated in 12 patients (1.9%). E. coli (7/12) was most common. Extended-spectrum beta-lactamase suggesting nosocomial infection was positive in 3 cases of outpatient department. On logistic regression analysis, urethral catheter indwelling was a significant risk factor increasing infectious complications. CONCLUSIONS: After TRUS-PBx, the rate of severe infectious complications and nosocomial infections were more frequent in outpatient department. And urethral catheter indwelling significantly increased infectious complication rate. So we should sublate the urethral catheter and keep in mind the aseptic technique at outpatient department.

Efficacy of the Modified STING Procedure for the Treatment of High Grade Vesicoureteral Reflux / 대한비뇨기과학회지

PURPOSE: The modified subureteral transurethral injection(STING) has been reported to increase the success of endoscopic treatment of high grade vesicoureteral reflux(VUR). This study was performed to assess the efficacy of the modified STING procedure compared to conventional STING in the setting of high grade VUR. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 40 consecutive children(46 ureters) with a median age of 5.32 years (range 1 to 10 years) who underwent endoscopic treatment of grade IV to grade V VUR between February 2004 and December 2006. The modified STING was performed by applying a direct pressure stream of irrigation fluid into the ureter in order to define the injection site within the ureteral submucosa. The needle was then placed in the ureteral tunnel, and a dextranomer/hyaluronic acid copolymer(Dx/HA) was injected into the submucosal intraureteral space, tracking along the entire length of the detrusor tunnel. Modified STING was performed in 27 ureters(grade IV: 13, grade V: 14), and conventional STING was performed in 19 ureters (grade IV: 12, grade V: 7). Follow-up voiding cystourethrography(VCUG) was performed 3 months later. RESULTS: Complete resolution occurred in 82%(22/27 ureters) of the patients undergoing modified STING, including 92%(12/13) of grade IV patients and 71%(10/14) of grade V patients. Three ureters required a second injection to correct VUR. Conventional STING had a success rate of 63%(12/19), [75%(9/12) in grade IV and 43%(3/7) in grade V]. The mean injected volume for the modified STING was 1.23+/-0.3ml, while that for the conventional STING was 0.95+/-0.2ml(p=0.03). Conclusions: The modified STING was markedly more successful in the treatment of high grade VUR and carried no significant adverse effects.

Metachronous Bilateral Renal Lymphangiomatosis Mimicking as a Simple Renal Cyst / 대한비뇨기과학회지

Renal lymphangiomatosis is a rare developmental malformation of the perirenal lymphatic system, and this can result in the development of cystic masses in the peri-pelvic or peri-renal areas. This is difficult to differentiate from other cystic renal disease on imaging studies. We present here a case of metachronous bilateral renal lymphangiomatosis that was falsely diagnosed as a simple renal cyst. A 47 year-old man was referred for a large amount of drainage after right renal cyst marsupialization. The abdominal computed tomography(CT) findings and fluid analysis were compatible with a lymphangiomatosis. After 6 month, he presented with flank pain on his left side and CT showed intracystic hemorrhage on the left renal lymphangiomatosis. Percutaneus drainage and conservative management were done.

Metachronous Bilateral Renal Lymphangiomatosis Mimicking as a Simple Renal Cyst / 대한비뇨기과학회지

Renal lymphangiomatosis is a rare developmental malformation of the perirenal lymphatic system, and this can result in the development of cystic masses in the peri-pelvic or peri-renal areas. This is difficult to differentiate from other cystic renal disease on imaging studies. We present here a case of metachronous bilateral renal lymphangiomatosis that was falsely diagnosed as a simple renal cyst. A 47 year-old man was referred for a large amount of drainage after right renal cyst marsupialization. The abdominal computed tomography(CT) findings and fluid analysis were compatible with a lymphangiomatosis. After 6 month, he presented with flank pain on his left side and CT showed intracystic hemorrhage on the left renal lymphangiomatosis. Percutaneus drainage and conservative management were done.

Polycythemia as a Complication of Long-acting Injectable Testosterone Undecanoate / 대한남성과학회지

Polycythemia is a condition in which the red blood cell count is increased due to an inherited or acquired mutation, a physiologic response to hypoxia, autonomous erythropoietin production, or deliberate erythropoietin administration. Higher testosterone levels appear to act as a stimulus for erythropoiesis and testosterone replacement therapies have rarely been reported as causes of polycythemia. We report here a case of a 51-year-old man with polycythemia that was caused by long-acting testosterone undecanoate (Nebido(R)).

Combination Therapy of Sildenafil with Trazodone in Erectile Dysfunction Patients with Decreased Libido and Normal Serum Testosterone / 대한남성과학회지

Purpose: This study was done to assess the therapeutic effect of trazodone, an antidepressant agent in combination with sildenafil in patients with erectile dysfunction (ED) and decreased libido with normal serum testosterone level. Materials and Methods: From March 2005 to February 2006, 90 patients with ED complaining of decreased libido but whose serum testosterone level was within normal range were screened and enrolled in this study. The subjects were randomly treated by sildenafil only (group 1) and combination of sildenafil with trazodone (group 2). Patients received trazodone for at least 3 consecutive months, with daily doses starting at 50 mg. By intention-to-treat basis, the period of study was extended by 9 month. The intention-to-treat population included 39 sildenafil recipients and 35 sildenafil with trazodone recipients. The patients were asked to make up two questions, Q1: 'Did you experience improvement of erection after treatment?' and Q2: 'Did you experience improvement of libido after treatment?' and the change of International index of erectile function (IIEF) scores before and after the treatment were analyzed to assess the efficacy of treatment. Results: After 3 month treatment period, 70% of group 1 and group 2 answered 'yes' to Q1. Twenty seven percents of group 1 and 51% of group 2 answered 'yes' to Q2 and 20% of group 1 and 24% of group 2 answered 'yes' to both Q1 and Q2. In the intention-to-treat population, seventy-two percents of group 1 and 71% of group 2 answered 'yes' to Q1 and 28% of group 1 and 52% of group 2 answered 'yes' to Q2, 21% of group 1 and 26% of group 2 answered 'yes' to both Q1 and Q2. The change of IIEF scores before and after the treatment at 3 month and 9 month showed similar results. Both group 1 and group 2 showed significant improvement on scores of IIEF-5 and question 15 of IIEF after treatment (p<0.01). Meanwhile, only group 2 showed significant improvement on question 11 and 13 of IIEF after the treatment compared to group 1 (p<0.05). Two patients with high dose of trazodone complained of headache and drowsiness, but the symptoms disappeared by dose reduction. Conclusions: The combination therapy of trazodone with sildenafil increased libido and sexual satisfaction on patients with ED. Therefore, combination of trazodone with sildenafil might be considered in ED patients of decreased libido with normal serum testosterone level rather than sildenafil monotherapy.

Etiologic Classification of Female Urethral Syndrome by Urodynamic Study / 대한비뇨기과학회지

PURPOSE: The symptoms of female urethral syndrome (FUS) can originate from mechanical or functional obstructions of the bladder neck or urethra. From retrospective reviews of women referred for evaluation of lower urinary tract symptoms (LUTS), 2.7 to 23% had urodynamic evidence of a bladder outlet obstruction (BOO). However, few urodynamic studies (UDS) have been performed on the prevalence of BOO in FUS. This study was aimed at identifying the causative factors of FUS symptoms, including BOO, as evidenced by UDS. MATERIALS AND METHODS: One hundred and sixteen women with FUS were enrolled in our UDS evaluations. An additional 247 patients, presenting for evaluation of stress urinary incontinence (SUI), served as controls. Comparisons of the maximum flow rate (Qmax), voided volume, post-void residual, detrusor pressure at maximum flow rate (PdetQmax), maximum detrusor pressure (Pdetmax) were made between the FUS and SUI cases. By definition, the FUS cases were divided into normal, BOO, detrusor under activity, detrusor instability and low compliance. These sub-groups were compared with controls in a similar way. RESULTS: Women with FUS showed a lower Qmax (15.9 versus 23.8ml/sec, p<0.05), higher post-void residual (86 versus 22ml, p<0.05), PdetQmax (24.0 versus 18.0 cmH2O, p<0.05) and Pdetmax (33.3 versus 27.9cmH2O, p<0.05) compared to those with SUI. The incidence of BOO, detrusor under activity and detrusor instability were 31.9, 25 and 16%, respectively, in the FUS group. Only 22% of women with FUS showed normal UDS findings. CONCLUSIONS: These results indicated the importance of UDS in identifying the causative factors of the symptoms of FUS. Treatment of a BOO will help provide new treatment modalities for FUS.

Etiologic Classification of Female Urethral Syndrome by Urodynamic Study / 대한비뇨기과학회지

PURPOSE: The symptoms of female urethral syndrome (FUS) can originate from mechanical or functional obstructions of the bladder neck or urethra. From retrospective reviews of women referred for evaluation of lower urinary tract symptoms (LUTS), 2.7 to 23% had urodynamic evidence of a bladder outlet obstruction (BOO). However, few urodynamic studies (UDS) have been performed on the prevalence of BOO in FUS. This study was aimed at identifying the causative factors of FUS symptoms, including BOO, as evidenced by UDS. MATERIALS AND METHODS: One hundred and sixteen women with FUS were enrolled in our UDS evaluations. An additional 247 patients, presenting for evaluation of stress urinary incontinence (SUI), served as controls. Comparisons of the maximum flow rate (Qmax), voided volume, post-void residual, detrusor pressure at maximum flow rate (PdetQmax), maximum detrusor pressure (Pdetmax) were made between the FUS and SUI cases. By definition, the FUS cases were divided into normal, BOO, detrusor under activity, detrusor instability and low compliance. These sub-groups were compared with controls in a similar way. RESULTS: Women with FUS showed a lower Qmax (15.9 versus 23.8ml/sec, p<0.05), higher post-void residual (86 versus 22ml, p<0.05), PdetQmax (24.0 versus 18.0 cmH2O, p<0.05) and Pdetmax (33.3 versus 27.9cmH2O, p<0.05) compared to those with SUI. The incidence of BOO, detrusor under activity and detrusor instability were 31.9, 25 and 16%, respectively, in the FUS group. Only 22% of women with FUS showed normal UDS findings. CONCLUSIONS: These results indicated the importance of UDS in identifying the causative factors of the symptoms of FUS. Treatment of a BOO will help provide new treatment modalities for FUS.

The Correlation of an ICS-male Questionnaire for Lower Urinary Tract Symptoms and Bladder Outlet Obstruction Parameters in Korea / 대한비뇨기과학회지

PURPOSE: We investigated the prevalence of lower urinary tract symptoms (LUTS), and the inconvenience of each symptom, using an ICS-male Questionnaire (ICS-mQ) in Korean man. We also evaluated the relationships between symptoms, prostate volume and urodynamic parameters of a bladder outlet obstruction (BOO). MATERIALS AND METHODS: 180 male LUTS patients, from 7 urological institutions, were enrolled in this study. The ICS-mQ was used to measure the severity of the symptoms, with a bothersomeness scale. Transrectal sonography and urodynamic studies, including Schaefer linear passive urethral resistance relation (L-PURR), were performed. RESULTS: The 5 most frequent symptoms were voiding symptoms, such as reduced stream, terminal dribbling, incomplete emptying, intermittency and hesitancy, in that order. However, the 5 most bothersome symptoms included 2 voiding, and 3 storage, symptoms, such as incomplete emptying, urge incontinence, pain in bladder, nocturnal incontinence and hesitancy. 34.4% of the nocturia patients felt quite, or severely, bothered, but only 1.1% felt no problem. The mean value of estimated prostate volume, by sonography, was 29.8+/-14.1ml. There were no correlations between the severity of symptoms and the prostate size. There were also little, or no, correlations between a wide range of symptoms and the urodynamic parameters of BOO. CONCLUSIONS: The most frequent symptoms of male patients with LUTS are voiding symptoms, but they suffered more from storage, than from voiding, symptoms. The severities of the symptoms, or the bothersomeness, were not correlated with the prostate size or the urodynamic parameters of a bladder outlet obstruction. Therefore, the relief of a bladder outlet obstruction is not crucial to relieve the symptoms.

The Correlation of an ICS-male Questionnaire for Lower Urinary Tract Symptoms and Bladder Outlet Obstruction Parameters in Korea / 대한비뇨기과학회지

PURPOSE: We investigated the prevalence of lower urinary tract symptoms (LUTS), and the inconvenience of each symptom, using an ICS-male Questionnaire (ICS-mQ) in Korean man. We also evaluated the relationships between symptoms, prostate volume and urodynamic parameters of a bladder outlet obstruction (BOO). MATERIALS AND METHODS: 180 male LUTS patients, from 7 urological institutions, were enrolled in this study. The ICS-mQ was used to measure the severity of the symptoms, with a bothersomeness scale. Transrectal sonography and urodynamic studies, including Schaefer linear passive urethral resistance relation (L-PURR), were performed. RESULTS: The 5 most frequent symptoms were voiding symptoms, such as reduced stream, terminal dribbling, incomplete emptying, intermittency and hesitancy, in that order. However, the 5 most bothersome symptoms included 2 voiding, and 3 storage, symptoms, such as incomplete emptying, urge incontinence, pain in bladder, nocturnal incontinence and hesitancy. 34.4% of the nocturia patients felt quite, or severely, bothered, but only 1.1% felt no problem. The mean value of estimated prostate volume, by sonography, was 29.8+/-14.1ml. There were no correlations between the severity of symptoms and the prostate size. There were also little, or no, correlations between a wide range of symptoms and the urodynamic parameters of BOO. CONCLUSIONS: The most frequent symptoms of male patients with LUTS are voiding symptoms, but they suffered more from storage, than from voiding, symptoms. The severities of the symptoms, or the bothersomeness, were not correlated with the prostate size or the urodynamic parameters of a bladder outlet obstruction. Therefore, the relief of a bladder outlet obstruction is not crucial to relieve the symptoms.

Functioning Adrenocortical Carcinoma in a Child / 대한비뇨기과학회지

Adrenocortical carcinoma is a rare tumor in children. This tumor is more likely to be hormonally active in children than in adults and tends to cause a variety of symptoms. These tumors are usually diagnosed at the advanced stages and have a dismal prognosis. Here we report a case of a functioning adrenocortical carcinoma in a child with a review of the relevant literature.