Characteristics of Bacterial Colonization and Urinary Tract Infection after Double-J Ureteral Stent Indwelling / 대한비뇨기과학회지

PURPOSE: This study aimed to determine the exact characteristics of bacterial colonization after a ureteral stent indwelling. MATERIALS AND MTHODS: The natural history of bacterial colonization on the stent itself and urine samples after different periods of stent indwelling was examined. A total of 57 double-J stents from 52 patients (21 male; 31 female) with mean age of 52 (range 20-79) years were examined. In all patients, short-term (for 2-3 days) antimicrobial therapy was done at the time of stenting. Regular urinalysis and urine culture were performed until the stent was removed. The stents were removed under aseptic conditions and the proximal and distal tip segments were obtained. Three culture specimens were acquired from each stent segments (inner surface washing suspension, outer surface washing suspension and the stent tip itself). RESULTS: Bacterial colonies were found in 44% (25/57). Multiple pathogens were identified, and Enterococcus species (6/25) was the most common pathogen followed by E. coli (5/25). The bacteria did not colonize within the first 2 weeks of indwelling. However, the colonization rate increased, as the duration of the indwelling was further increased. Colonization in the stent was followed by the colonization in the urine. CONCLUSIONS: Bacterial colonization does not occur during the initial 2 weeks after stent indwelling. This suggests that antibiotics for short-term indwelling of ureteral stents are not necessary.

Characteristics of Bacterial Colonization and Urinary Tract Infection after Double-J Ureteral Stent Indwelling / 대한비뇨기과학회지

PURPOSE: This study aimed to determine the exact characteristics of bacterial colonization after a ureteral stent indwelling. MATERIALS AND MTHODS: The natural history of bacterial colonization on the stent itself and urine samples after different periods of stent indwelling was examined. A total of 57 double-J stents from 52 patients (21 male; 31 female) with mean age of 52 (range 20-79) years were examined. In all patients, short-term (for 2-3 days) antimicrobial therapy was done at the time of stenting. Regular urinalysis and urine culture were performed until the stent was removed. The stents were removed under aseptic conditions and the proximal and distal tip segments were obtained. Three culture specimens were acquired from each stent segments (inner surface washing suspension, outer surface washing suspension and the stent tip itself). RESULTS: Bacterial colonies were found in 44% (25/57). Multiple pathogens were identified, and Enterococcus species (6/25) was the most common pathogen followed by E. coli (5/25). The bacteria did not colonize within the first 2 weeks of indwelling. However, the colonization rate increased, as the duration of the indwelling was further increased. Colonization in the stent was followed by the colonization in the urine. CONCLUSIONS: Bacterial colonization does not occur during the initial 2 weeks after stent indwelling. This suggests that antibiotics for short-term indwelling of ureteral stents are not necessary.

Effects of Interferon Gamma on Collagen Expression in the Partially Obstructed Urinary Bladder of Rat / 대한비뇨기과학회지

PURPOSE: Recent studies have proved that bladder compliance is closely related to the collagen content of the bladder. It has been shown through human fibroblast, condrocyte, and rat myofibroblasts that interferon(IFN)-gammadecreased collagen synthesis. The objective of this study was to investigate the alteration of collagen deposition and gene expressions in collagen types I and III by partial bladder outlet obstruction and to compare the changes during IFN-gamma treatment. MATERIALS AND METHODS: Following 4 weeks of partial bladder outlet obstruction in 200-250gm. SD rats, the bladder tissues were evaluated for collagen deposition by an immunohistochemical staining using the polyclonal antibodies and the messenger ribonucleic acid(mRNA) contents of the collagen type I and III were evaluated by Northern hybridization. Recombinant IFN-gamma(100,000 units) was administered once a day for 4 weeks by subcutaneous injection. RESULTS: In the control bladders, the immunohistochemical staining for type I and type III collagen protein showed an intense localization in the lamina propria with modest localization in the inter-fascicular region. With obstruction type I and type III collagen staining intensified, especially in the inter-fascicular region. The IFN-gamma administration reduced the inter-fascicular deposition of collagen type I and III. There was an up-regulation of collagen type I and III gene expression after the obstruction. In the obstructed bladders proalpha1(I) and proalpha1(III) collagen mRNA intensity was increased 3.4 and 5.1 folds than the control groups, respectively. This up-regulation was down-regulated by IFN-gamma administration. CONCLUSIONS: The down regulation of collagen types I and III gene expression, and decreased protein deposition after IFN-gamma treatment demonstrated that the effect of IFN-gamma was, in part, transcriptionally regulated. These results suggest that the recombinant IFN-gamma may be beneficial in the treatment of patients with poorly compliant bladder.

Early Expression of Collagen Type I, III and IV and Matrix-Metalloproteinase(MMP)-2 mRNA in the Rat Bladder Subjected to Partial Outlet Obstruction / 대한비뇨기과학회지

PURPOSE: Partial obstruction of the rat bladder outlet induces a rapid hypertrophy characterized by increased smooth muscle content and collagen deposition. This increased collagen is likely to reduce the quality of the contraction and compliance of the bladder wall. Also it has been reported that an alteration in the ratio of type I and III collagen may be more important than the amount of collagen in determining compliance. To evaluate the genetic basis of collagen deposition in the partially obstructed rat bladder, the author observed the change of proalpha1(I) collagen, proalpha1(III) collagen, proalpha(IV) collagen and matrix-metalloproteinase(MMP)-2 mRNA after partial urethral obstruction. MATERIALS AND METHODS: Female Sprague-Dawley rats weighing 150-200g were used. Individual bladders were obtained from unoperated rats, and from rats at 6, 12, 48, 72, hours, 5 and 7 days after partial urethral obstruction and sham operation. Total RNA was extracted from each of these tissue, The expression of mRNAs were assessed by Northern blot analysis. The band intensities of the autoradiographs measured by densitometry were compared between the obstructed and sham group. RESULTS: Partial urethral obstruction induced a gradual increase in bladder weights, The expression of mRNA for proalpha1(I) collagen was generally attenuated within 24hours after obstruction. In extended period of obstruction, the expression of mRNA for proalpha1(I)collagen reached a peak at day 3-5(219% increase), and remained elevated through day 7. The expression of mRNA for proalpha1(I)collagen was coregulated with that of pro alpha1(I) collagen, however, the mean ratio to control value of band intensity for proalpha1(III)collagen mRNA was 2 times higher than that of proalpha1(I) collagen, during days 3-7. The expression of mRNA for proalpha1(IV)collagen showed a sharp increase at 48 hours(438% increase)after obstruction earlier than proalpha1(I)collagen and proalpha1(III)collagen mRNA. In extended period of obstruction the expression reached a peak at 72 hours(883% increase) and the mean ratio to control value of band intensity for proalpha alpha collagen mRNA was much higher than those of proalpha1(I) collagen and proalpha1(III) collagen. The expression of MMP-2 mRNA increased from 48hours after obstruction, and reached a peak at day 3-5. CONCLUSIONS: These results sugges that the increase of collagen in the rat bladder after partial urethral obstruction results from an increase of expression of collagen genes, and the decrease of bladder wall compliance results from an increased transcription of type I collagen gene and increase of the ratio of proalpha1(III)collagen to proalpha1(I)collagen mRNA. Because expression of proalpha1(I), (III), (IV) collagen and MMP-2 mRNA increased sharply after 48hours, it is suggested that genetic events leading to remodeling of bladder start at 48hours after partial urethral obstruction.

Expression of Inducible Nitric Oxide Synthase (iNOS) mRNA in the Rat Bladder Subjected to Partial Bladder Outlet Obstruction / 대한비뇨기과학회지

Persistent vesical dysfunction is often encountered after long term bladder overdistension caused by urinary retention. Experimentally, acute overdistension has also been implicated in the pathogenesis of the response to partial outlet obstruction. In the present study, we evaluated the expression of iNOS in the partially obstructed rat bladder and presupposed that NO is responsible for the prolonged micturition problem after partial outlet obstruction of the rat bladder. Female Sprague-Dawley rats weighing 150~200g were used. Individual bladders were obtained from unoperated control rats, and from rats at 6, 12, 48, 72 hours, 5 and 7 days after partial urethral obstruction. Total RNA was extracted from each of these tissue. The expression of mRNAs were assessed by Northern blot analysis. The band intensity of the autoradiographs measured by densitometry were compared between the obstructed and control group. The expression of mRNA for iNOS was detected in the control rats. The expression showed a sharp increase at 6 hours (342% increase) after obstruction and returned to normal by 24 hours. In this study, we show that iNOS increases in the rat bladder after operation and these results suggest that overproduction of NO may be a possible mechanism for the prolonged bladder dysfunction after partial bladder outlet obstruction.

Clinical and Histopathologic Behaviors of Testicular Tumors / 대한비뇨기과학회지

Clinical observations and histopathologic behaviors of testicular tumors were made on 39 cases who were admitted to the Department of Urology, Seoul National University Hospital, during the period from January, 1966 to December, 1979. The results are summarized as follows; 1) Among the 4220 cases of male inpatients, 718 (17. 0%) were G. U tract tumors and 39(0. 92%) were testicular tumors. 2) Age distribution was between 8 months and 72 years old, showing the highest incidence under the 5 year-old age group (38%). 3) Twenty one cases (53. 8%) arose on the right and eighteen cases (46. 2%) on the left. 4) Twenty two cases (56. 4%) visited the hospital within 6 months after the onset of the symptoms and 30 cases (77. 1%) within 1 year. 5) The presenting symptoms were painless scrotal mass (79. 5%). painful scrotal mass (7.7%) and metastatic symptoms (12. 8%) 6) Three cases (7.7%) arose from undescended testis. 7) Twelve cases (30. 8%) had already metastasis when first seen. 8) We had measured the level of serum A. F. P. by gel agar precipitation method or radioimmunoassay in 18 cases. Normal levels of A. F. P. were seen it seminoma and nongerminal testicular tumor. Of 11 cases with no metastatic non-seminomatous germinal cell tumor, 5 had elevated serum A. F. P. All the 3 cases with metastatic non-seminomatous germinal cell tumor had elevated serum A. F. P 9) These patients were managed by surgery, radiotherapy and chemotherapy. Serum and urine H. C. G. was checked during chemotherapy on 1 case for the evaluation of response to chemotherapy.