Vesicoenteric Fistula due to Bladder Squamous Cell Carcinoma

Vesicoenteric fistula is a rare complication of bladder squamous cell carcinoma. We report the case of a 70-year-old male who complained of painless, total gross hematuria. Abdominopelvic computed tomography (CT) revealed an approximately 2.7-cm lobulated and contoured enhancing mass in the bladder dome. We performed partial cystectomy of the bladder dome after transurethral resection of the bladder. The biopsy result was bladder squamous cell carcinoma, with infiltrating serosa histopathologically, but the resection margin was free. Postoperatively, follow-up CT was done after 3 months. Follow-up CT revealed an approximately 4.7-cmx4.0-cm lobulated, contoured, and heterogeneous mass in the bladder dome. A vesicoenteric fistula was visible by cystography. Here we report this case of a vesicoenteric fistula due to bladder squamous cell carcinoma.

Fungal Urinary Tract Infection in Burn Patients with Long-Term Foley Catheterization

PURPOSE: It is well known that fungi become predominant microorganisms in the urine of patients with long-term Foley catheters. This study was conducted to evaluate the lengths of time for fungi to cause urinary tract infection (UTI) and to identify predictors of fungal UTI in burn patients with long-term Foley catheters. MATERIALS AND METHODS: A total of 93 patients who did not have infection at the time of admission but later had fugal UTI were evaluated. Urinalysis, urine culture, and Foley catheter indwelling were done at admission. All patients were administered prophylactic antibiotics from admission. Urine cultures were run every week, and catheters were changed every 2 weeks for each patient. RESULTS: Three of the 93 patients (3.2%) displayed fungal UTI at the 1st week of catheter indwelling. However, most patients (78.5%) displayed fungal UTI from 2nd to 5th week after catheter indwelling. The most prevalent fungus identified was Candida tropicalis (60.2%). By univariate logistic regression analysis, only the total body surface area burned (TBSAB) was predictive of fungal UTI in burn patients (p=0.010). By multivariate logistic regression analysis, underlying disease (p=0.032) and TBSAB (p=0.036) were predictors of fungal UTI. Patients with higher TBSAB were more likely to display shorter intervals from Foley catheterization to fungal UTI. CONCLUSIONS: Fungal UTI was initially found at the 1st week of urinary catheter indwelling, but the majority of cases occurred after the 1st week and appeared earlier in patients with underlying disease or higher TBSAB. Underlying disease and TBSAB were predictors of early fungal UTI.

Initial Experience with Endoscopic Holmium: YAG Laser Urethrotomy for Incomplete Urethral Stricture

PURPOSE: Endoscopic holmium:yttrium-aluminum-garnet (Ho:YAG) laser urethrotomy is an alternative method in the management of urethral strictures. We report our initial experience in 15 cases of evaluating the therapeutic efficacy of the holmium laser for treating incomplete urethral strictures. MATERIALS AND METHODS: Endoscopic holmium laser urethrotomy was primarily performed on 15 patients with incomplete urethral stricture. Exclusion criteria were complete urethral stricture and previous treatment of urethral stricture. Retrograde urethrography and uroflowmetry were performed preoperatively and were carried out as follow-up studies postoperatively. RESULTS: Successful results without recurrence were achieved in 8 of 15 patients. When we classified the results by stricture length, the success rate was 80% in strictures less than 2 cm, whereas there was no therapeutic effect in strictures over 2 cm. When we classified the results by etiology, the number of successful results in strictures with an inflammatory, trauma, iatrogenic, or unknown cause was 2 (2/8), 3 (3/4), 2 (2/2), and 1 (1/1), respectively. In 7 patients who failed treatment, we repeated holmium laser urethrotomy in 5 patients and urethroplasty in 2 patients. No operative complications occurred in any patients. CONCLUSIONS: Endoscopic holmium laser urethrotomy is a safe and effective minimally invasive therapeutic modality in cases of stricture less than 2 cm. Further data from long-term follow-up are necessary to compare the success rate with that of conventional urethrotomy and urethroplasty.

Nutcracker Syndrome Diagnosed with 3-Dimensional Computed Tomography Angiography

We report a case of nutcracker syndrome diagnosed with 3-dimensional computed tomography angiography (3-D CTA). Nutcracker syndrome had been confirmed by conventional venography until recent years. Nowadays, with the development of imaging techniques, color Doppler sonogram and 3-D CTA are replacing venography for the diagnosis of nutcracker syndrome. The patient, a 20-year-old male, had abrupt gross hematuria and left abdominal pain 6 months previously and intermittent microscopic hematuria thereafter. Including renal biopsy, the results of conventional hematuria study showed no abnormalities. 3-D CTA showed left renal vein compression between the abdominal aorta and superior mesenteric artery and collateral veins. The angle and distance between the superior mesenteric artery and aorta at the level of the left renal vein were 35degrees and 3.0 mm, respectively. We diagnosed nutcracker syndrome and later confirmed the diagnosis with venography.

Evaluation of the Nervous and Vascular Systems in Erectile Dysfunction Patients after Electric Injuries / 대한비뇨기과학회지

PURPOSE: There is a high prevalence of erectile dysfunction (ED) after electric injuries, but our medical understanding of ED after electric injuries is scanty at best. Thus, the authors attempted to investigate nocturnal penile tumescence (NPT), bulbocavernosus reflex latency (BCRL) and penile duplex Doppler ultrasonography (PDDU) for the patients who suffer from ED after electric injuries. MATERIALS AND METHODS: Of the patients who visited our Burn Care Center between January 2005 and February 2006, ten male patients (aged 20 or older) who complaining of ED after electric injuries underwent NPT, BCRL and PDDU. RESULTS: The patients' mean age was 38.1 years (age range: 25-54), and the numbers of patients exposed to whole body, upper-lower extremity and upper-upper extremity pathways of the electrical current were 1, 2 and 7, respectively. For the patient exposed to the whole body pathway, abnormal findings were observed on all the tests. For one patient who experienced two upper-lower extremity pathways, normal findings were seen on all the tests, while the other patient showed an abnormal NPT, an normal BCRL and an arteriogenic ED. Three of the patients who experienced the upper-upper extremity pathway showed normal findings on all the tests. The other two in the group showed an abnormal NPT, a normal BCRL and arteriogenic ED; the other one showed a normal vascular function, a abnormal NPT and no reaction to BCRL; the other one showed an abnormal NPT, a delayed BCRL and an arteriogenic ED. CONCLUSIONS: More abnormal findings were seen in NPT, BCRL and PDDU for the cases associated with upper-lower body or whole body electrical current pathways, as compared to patients whose electrical pathways were limited to the upper body.

Dermatofibrosarcoma Protubrans at Peri-inguinal Area / 대한비뇨기과학회지

Dermatofibrosarcoma protuberans is an unusual locally aggressive cutaneous neoplasm of low grade malignancy. We report the case of a 47 years- old male who presented with an asymptomatic erythematous firm protruding mass in the left peri-inguinal area. Histopathologically, the tumor showed spindle-shape cells, arranged in a storiform pattern. The tumor cells stained positively for Vimentin and CD34 on immunohistochemical staining. Herein, we report a case of dermatofibrosarcoma protuberans.

Erectile Dysfunction in Patients with Electrical Injury / 대한비뇨기과학회지

PURPOSE: The severity of electrical injury depends on the intensity and pathway of the electric current. We hypothesized that erectile dysfunction (ED) may be a sequelae of electrical injury. Therefore, in this study, the prevalence of ED in electrical injury patients was estimated, and the results correlated with the electric voltage and pathway of the electric current at the time of the injury. MATERIALS AND METHODS: Mail and phone surveys were undertaken by 416 electrical injury patients admitted with electrical injury to our burn care center, between November, 1998 and December, 2003. Patients were given a self-administered questionnaire, which included the five item Korean version of the International Index of Erectile Function (IIEF-5). The voltage, pathway of electric current at the time of injury and other diseases, such as hypertension (HTN), diabetes mellitus (DM) and neurological disease, were also reviewed. Of the 416 (66%) subjects, 276 agreed to participate, but 20 (7%) of these were excluded due to HTN, DM and neurological disease. RESULTS: The remaining 256 patients constituted our patient population. The mean age was 39.2 (range 21 to 66) years. 52.7% of the 256 patients had ED. According to age, the prevalence of ED in patients in their third, forth, fifth and sixth decades were 43.8, 54.2, 55.8 and 42.9%, respectively; no patient in their seventh decade showed ED. There was no statistically significant difference among the age groups. 58.4, 21.2 and 33.3% patients with high, low and unknown voltage injuries had ED, which was statistically significant. The prevalence of ED according to the pathway of the electric current were 100, 70.3, 44.4, 31.9, 15.4 and 22.2% for whole body, upper-lower body, lower-lower body, upper-upper body, electrical spark burn and for unknown pathways, respectively. CONCLUSIONS: To our knowledge, this is the first study of ED in electrical injury patients. 52.7% of patients with electrical injury had ED. High voltage injures showed a higher prevalence of ED than low voltage injuries. Whole and upper-lower body pathways of the electric current showed a higher prevalence of ED compared to focal/local involvement (electrical spark burn), lower-lower body and upper-upper body pathways.

Evaluation of Persistent Lower Urinary Tract Symptoms after Transurethral Resection of Prostate / 대한비뇨기과학회지

PURPOSE: The urodynamic findings and subjective symptoms, in patients complaining of persistent lower urinary tract symptoms (LUTS) after a transurethral resection of the prostate (TURP) were evaluated. On the basis of these evaluations, the correlation, if any, between the urodynamic findings and the subjective symptoms was investigated. MATERIALS AND METHODS: A total of 47 men, with persistent voiding dysfunction more than a year following TURP, were evaluated using the international prostate symptom score (IPSS) and multichannel urodynamics. The patients were classified into three groups: obstructed (15ml/sec), according to their Abrams-Griffiths nomogram. RESULTS: From the urodynamic study, after the TURP, 6, 7 and 34 patients were placed into the obstructed, equivocal and unobstructed groups, respectively. There were no significant differences in the IPSS, and irritative and obstructive voiding symptom scores, between the obstructed, equivocal and unobstructed groups. The average IPSS in LUTS, with, and without, detrusor instability were 17.2+/-8.4 and 16.3+/-2.6 (p>0.05). The Qmax, detrusor pressure and residual urine volume, of the unobstructed group was significantly higher than those of the other two groups. CONCLUSIONS: Detrusor instability was the most frequent urodynamic finding in the patients complaining of persistent LUTS after TURP, but it is necessary to perform the urodynamics to decide on the appropriate treatment; either medical treatment, for the detrusor instability without a bladder outlet obstruction, or surgical removal of a bladder outlet obstruction. The symptoms were not reliable in predicting the urodynamic findings in regard to an obstruction and detrusor instability.

Comparative Study of Bacterial Isolation and Antibiotic Sensitivity Test between Long-term Silicone and Nitrofurazone-coated Suprapubic Catheter Indwelling Patients / 대한비뇨기과학회지

PURPOSE: Catheter-associated urinary tract infections are inevitable in patients with a long-term indwelling catheter. The antibacterial activity of nitrofurazone-impregnating compounds has recently been employed in urinary catheter, and may be effective in blocking infections. The aims of this study were to evaluate the bacterial isolation, antibiotic sensitivity test and the efficacy of a nitrofurazone-coated urinary catheter. MATERIALS AND METHODS: A total of 41 patients that required an indwelling urinary catheter for longer than 4 weeks were assigned to receive either a silicone (n=24), or nitrofurazone, coated catheter (n=17). Urine and catheter tip samples were cultured for bacteriological assessment. The results of the bacterial culture and antibiotic sensitivity test, rate of infection from urine and proximal tip were compared between the two groups. RESULTS: The bacterial cultures from the tips of the silicone and nitrofurazone catheters were in 95.8 and 82.4%, respectively, but were statistically insignificant (p=0.064). Bacteriuria developed in 79.2 and 64.7% of the silicone-coated and nitrofurazone-coated catheter groups (p=0.476). Gram negative bacteria were found in 65 (69.8%), with the most three frequent species being Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumonia in 23 (24.7%), 20 (21.5%) and 16 (17.2%), respectively. All the organisms were more susceptible to amikacin, aztreonam and ceftriaxone, but were relatively resistant to ampicillin, gentamycin and ciprofloxacin. CONCLUSIONS: Many of the patients with a long-term indwelling catheter had bacterial infections or colonization in the urine and proximal catheter-tip samples, despite the preventive administration of antibiotics. This study failed to demonstrate any efficacy of a nitrofurazone-coated catheter.

A Urinary Bladder Stone Formed on a Migrated Intrauterine Device / 대한비뇨기과학회지

Intrauterine devices (IUD) can lead to several complications, including uterine perforation, ectopic pregnancy, spontaneous abortion and pelvic inflammatory disease, but these occur infrequently. The migration of an intrauterine device into the bladder, with the formation of a stone, occurs rarely. We report a case of a 45-year-old multiparous woman, with an egg sized and shaped bladder stone around an intrauterine device.

Overactive Bladder

The overactive bladder, according to the original definition by International Continence Society refers to the storage phase of the bladder and is diagnosed by urodynamics. The overactive bladder is a medical condition referring to the symptoms of frequency and urgency, with or without urge incontinence, in the absence of local pathology or metabolic factors that would account for these symptoms. The definition of overactive bladder needs clarification, which would help to overcome the current confusion. Possible neurological, muscular, and metabolic causes have been proposed but in many cases the exact causes remain unclear. The diagnosis depends greatly on a detailed history, clinical examination, and urinalysis. Urodynamic evaluation is indicated when neuropathy is suspected, and the treatment may be unsuccessful without exact knowledge of patients' state. It can be treated conservatively by bladder training, physiotherapy, and drugs alone or with combination. For refractory cases neuromodulation, denervation techniques, and bladder augmentation or substitution can be used with good results.

Mechanism and Type of Dry Ejaculation after Transurethral Microwave Thermotherapy / 대한남성과학회지

PURPOSE: To investigate the mechanism and type of aspermic ejaculatory dysfunction resulting from high-energy transurethral microwave thermotherapy of benign prostatic hyperplasia. MATERIALS AND METHODS: Eleven patients who complained of dry ejaculation longer than 12 months after transurethral microwave thermotherapy were examined. Transrectal ultrasonography as used to assess seminal vesicle or ejaculatory duct dilatation, urethroscopy to identify any ejaculatory duct orifice obstruction, and urinalysis after ejaculation to detect sperm as an indicator of retrograde ejaculation. RESULTS: Four of eight patients with no sperm on urinalysis after ejaculation showed both seminal vesicle dilation and ejaculatory duct orifice obstruction with or without verumontanal scar formation. Another three patients showed either seminal vesicle dilation or ejaculatory duct orifice obstruction, and the final patient with no sperm on urinalysis showed neither seminal vesicle dilation nor ejaculatory duct orifice obstruction. Five patients with no sperm on urinalysis after ejaculation complained of some combination of perineal, scrotal, and urethral discomfort during or immediately after ejaculation. Three patients had sperm in their urine after ejaculation. CONCLUSIONS: In 7 patients (63.6%), dry ejaculation resulted from ejaculatory duct obstruction. Three patients (27.3%) had retrograde ejaculation, and one patient (0.09%) may have had dry ejaculation as a result of failure of spermatogenesis. The main mechanism of dry ejaculation after transurethral microwave thermotherapy seems to be ejaculatory duct obstruction, not failure of bladder neck closure.

Metastases to Ureteral Stump and Bladder from Renal Cell Carcinoma / 대한비뇨기과학회지

Although metastatic renal cell carcinoma is not uncommon, metastases to the ureteral stump and bladder are very rare. A 69-year-old woman who had undergone radical nephrectomy because of right renal cell carcinoma about 8 years ago, visited our hospital for evaluation of painless gross hematuria. Histologic examination of the removed ureteral stump and bladder specimen demonstrated metastatic renal cell carcinoma. We report a case of renal cell carcinoma with metastases to the ureteral stump 5 years after radical nephrectomy and bladder 8 years after radical nephrectomy.

Caspase-3/CPP32 Immunoreactivity and Its Correlation with Frequency of Apoptotic Bodies in Prostate Adenocarcinoma and Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Apoptosis is mediated by apoptosis-specific genes, certain oncogenes and tumor suppressor genes. Caspase-3, a group of cysteine proteases, ier in cases with intermediate (Gleason score 5-7) and high-grade (Gleason score 8-10) PCA than cases with BPH and low-grade PCA (Gleason score 2-4).

Changes and Differences of Sexual Function in Patients with Benign Prostate Hyperplasia Following Transurethral Resection of Prostate and High Energy Transurethral Microwave Thermotherapy / 대한비뇨기과학회지

PURPOSE: To evaluate the usefullness of high energy transurethral microwave thermotherapy (TUMT) for the treatment of BPH in young or sexually active men, this study was performed. MATERIALS AND METHODS: The changes of sexual behaviors and sexual functions after TURP and high energy TUMT in 36 patients treated with TURP and 27 patients treated with high energy TUMT from January 1997 to December 2000 were analysed retrospectively. Assessment parameters were International Prostate Symptom Score (IPSS), uroflowmetry, residual urine and sexual functions such as morning erection, number of coitus, state of ejaculation and sexual satisfaction at 12 months from treatment. RESULTS: In both groups, the voiding function improved significantly after treatment, but TURP was much superior to TUMT in effectiveness. After 12 months of treatment, morning erection maintained 96.3% in TUMT group and 88.9% in TURP group. The number of coitus per month increased to 3.4 from 3.1 in TUMT group, and decreased to 2.2 from 2.8 in TURP group. Ejaculation preserved in 92.6% in TUMT group and 27.8% in TURP group. In sexual satisfaction, "Satisfied" increased to 51.9% from 40.7% in TUMT group, and decreased to 27.8% from 38.9% in TURP group. "Unsatisfied" changed little in TUMT group but changed from 22.2% to 47.2% in TURP group. In 28 patients with anejaculation, 78.6% considered no ejaculation had adverse effect and 21.4% considered it had no adverse effect on sexual satisfaction. CONCLUSIONS: Although both TURP and high energy TUMT significantly improved clinical outcome, the former was far superior to the latter in improving voiding symptoms caused by BPH. However, high energy TUMT was a better therapeutic option than TURP for patients who want to preserve sexual function. In particular, erection and ejaculation were preserved well with high energy TUMT while there was significant deterioration of these functions following TURP.

A Case of Giant Multilocular Prostatic Cystadenoma / 대한비뇨기과학회지

No abstract available.

A Case of Giant Multilocular Prostatic Cystadenoma / 대한비뇨기과학회지

No abstract available.

Apoptosis and Nuclear Shapes in Benign Prosta Hyperplasia and ProstateAdenocarcinoma: Comparsion and Relation / 대한비뇨기과학회지

No abstract available.

Urodynamic Findings in Diabetic Cystopathy / 대한비뇨기과학회지

PURPOSE: To evaluate the urodynamic findings in diabetics complaining of urinary voiding symptoms, the retrospective study was performed. MATERIALS AND METHODS: For 5 years, from Jan. 1992 to Dec. 1997, urodynamic findings on 76 diabetics(49 males and 27 females) with voiding dysfunction were assessed and classified into; 1, detrusor instability, 2, impaired detrusor contractility, 3, detrusor areflexia, 4, indeterminate, 5, normal. Diabetic patients who had diseases of influential potentiality on bladder function were excluded out. A detailed history of diabetes, past and present medical history were reviewed. In addition, a thorough voiding history, urine culture, blood chemistry and physical examination were determinate. Ophthalmic examination by ophthalmologist and sacral reflex arc examination by urologist were also examined. Those with abnormal sacral reflex arc(absent bulbocavernous reflex, lax anal sphincter tone and control) were deemed sacral cord signs positive, and those with intact sacral reflexes were deemed sacral cord signs negative. RESULTS: The urodynamic findings of 76 diabetic patients were distributed into 25(32.9%) detrusor instability 23(30.3%) impaired detrusor contractility, 21 (27.8%) detrusor areflexia, 6(7.9%) indeterminate and 1 (1.3%) normal. Thirty six(47.4%) of them had retinopathy and 27(35.5%) had positive sacral cord sign, those complications took place most frequently in diabetics with detrusor areflexia. CONCLUSIONS: Diabetic cystopathy revealed various patterns of bladder dysfunction, and detrusor areflexia patients showed high incidence of retinopathy and positive sacral cord sign. It is necessary that urodynamic studies should be done in diabetic cystopathy to characterize the treatment of voiding dysfunction.

A Case of Epididymal Metastasis from Mucinous Adenocarcinoma of the prostate / 대한비뇨기과학회지

Mucinous adenocarcinoma of the prostate is very rare tumor and comprises about 0.4% of all prostatic carcinomas. The metastatic form of mucinous adenocarcinoma of the prostate is similar to that of the adenocarcinoma of the prostate. Common sites of metastasis are pelvic lymph node and bone. At presentation, half of patients have evidence of metastasis to pelvic lymph nodes, bone, brain, liver, bladder and seminal vesicles. Especially, epididymal metastasis from mucinous adenocarcinoma of the prostate is uncommon and only 15 cases was reported in the literature. We report a case of mucinous adenocarcinoma of the prostate with metastasis to the epididymis and discuss the clinicopathologic features of this lesion.