Laparoscopic Excision of a Congenital Seminal Vesicle Cyst and Coexisting Ipsilateral Renal Agenesis / 대한남성과학회지

Seminal vesicle cyst (SVC) with ipsilateral renal agenesis is a rare congenital anomaly. When the patient is symptomatic, surgical treatment may be necessary. The open surgical approach, traditionally considered the definite form of treatment, has been associated with a high rate of morbidity. The laparoscopic approach for the management of SVCs has recently been described. A 18-year-old man presented with a 2-year history of dysuria and perineal pain. The diagnostic evaluation revealed a 45x35x48 mm sized left seminal vesicle cyst. In addition, he had a solitary, right, functioning kidney, with left renal agenesis. Transperitoneal laparoscopic excision of the cyst was performed successfully. The patient was discharged from the hospital on the fourth postoperative day and did not present with any complaints or complications.

Arterial Injury Associated with Tension-Free Vaginal Tapes-SECUR Procedure Successfully Treated by Radiological Embolization / 대한배뇨장애요실금학회지

Various postoperative complications have been reported after the use of tension-free vaginal tapes (TVT). The transobturator approach was introduced to minimize the potential complications. The next generation of recently introduced TVT-SECUR is intended to minimize the incidence of complications. Herein we report a case of internal pudendal artery injury sustained during this procedure that was successfully treated by radiological embolization. Angiography with vessel embolization, when available, should be considered when the arterial injury is suspected.

Diagnosing Acute Pyelonephritis with CT, (99m)Tc-DMSA SPECT, and Doppler Ultrasound: A Comparative Study

PURPOSE: With growing interest in early imaging, the aim of our study was to define the most practical modality for routine clinical use for the diagnosis of acute pyelonephritis (APN). We compared the sensitivity of enhanced computerized tomography (CT), dimercaptosuccinic acid (DMSA) scintigraphy, and Doppler ultrasonography (DUS) by using clinical findings as the standard of reference. MATERIALS AND METHODS: A total of 207 APN patients (191 women, 16 men; mean age, 49.4 years; range, 17-88 years) were enrolled in this study. All the patients underwent imaging modalities during hospitalization. SPECT images were obtained 4 hours after injection of (99m)Tc-DMSA. Transverse and coronary CT images were obtained before and after injection of the contrast agent. DUS was performed in the longitudinal, transverse, and coronal planes. All the images were read independently by a single radiologist and a nuclear medicine specialist. The sensitivity of each modality for detecting APN was compared. RESULTS: CT showed significantly superior sensitivity compared with that of DUS (81.0% vs. 33.3%, respectively, n=147). DMSA scintigraphy also showed significantly superior sensitivity compared with that of DUS (74.7% vs. 33.3%, respectively, n=150). Compared with DMSA scintigraphy, CT showed superior sensitivity, but the difference was not statistically significant (81.0% vs. 74.8%, respectively, n=147, p=0.163). CONCLUSIONS: For cases of clinically suspected APN, CT and DMSA scintigraphy appear to be equally sensitive and reliable for detecting APN, although CT is more practical in various fields. DUS was significantly less sensitive.

Analysis of Lower Urinary Tract Symptoms Associated with Prostate Findings in Occupational Taxi Drivers and Office Workers in Uijeongbu, Korea

PUROPOSE: To analyze lower urinary tract symptoms associated with prostate findings in occupational taxi drivers compared to office workers in Uijeongbu, Korea. MATERIAL AND METHODS: A population-based cross-sectional survey was conducted among drivers and office workers in Uijeongbu, Korea. All participants filled out the International Prostate Symptom Score (IPSS) questionnaire and the age, career, height and body weight were also recorded. They had uroflowmetry (UFM), transrectal ultrasound (TRUS) and prostatic cancer screening testing (PSA). We evaluated the parameters and compared them between the two groups. RESULTS: There was no significant difference in age, career and BMI between the two groups (p<0.01). For each group, the IPSS was closely related to the maximal flow rate (Qmax) (p<0.01). The mean value of the IPSS was 13.53+/-7.70 in the taxi drivers and 9.71+/-5.72 in office workers; therefore, the IPSSs showed a difference between the two groups (p=0.041). However, there were no significant differences among the other parameters between two groups. The value of Qmax was not significantly different in the comparisons between the two groups (p=0.973). CONCLUSIONS: Although the IPSS in taxi drivers was higher than in office workers, the objective parameters studied were not significantly different between the two groups. Therefore, there was no clinical evidence of higher morbidity associated with prostate abnormalities in taxi drivers compared to office workers.

Cavernous Hemangioma in the Renal Pelvis / 대한비뇨기과학회지

Hemangioma in the urinary tract is a very rare benign tumor that usually causes painless or painful gross hematuria. Its preoperative diagnosis is extremely difficult or even impossible. A female 47-year old patient presented with painless gross hematuria that she'd experience for 4 days. The patient underwent abdominal ultrasound, intravenous pyelography (IVP), cystoscopy, urine cytology, retrograde pyelography (RGP), kidney dynamic computed tomography (CT) and surgical excision. She was finally diagnosed with cavernous hemangioma in the renal pelvis.

Cavernous Hemangioma in the Renal Pelvis / 대한비뇨기과학회지

Hemangioma in the urinary tract is a very rare benign tumor that usually causes painless or painful gross hematuria. Its preoperative diagnosis is extremely difficult or even impossible. A female 47-year old patient presented with painless gross hematuria that she'd experience for 4 days. The patient underwent abdominal ultrasound, intravenous pyelography (IVP), cystoscopy, urine cytology, retrograde pyelography (RGP), kidney dynamic computed tomography (CT) and surgical excision. She was finally diagnosed with cavernous hemangioma in the renal pelvis.

Urethral Diverticulum with Endometriosis / 대한비뇨기과학회지

The differential diagnosis for women presenting with chronic genitourinary symptoms is extensive. Urethral diverticulum has long been thought to be responsible for these symptoms in some women. Although the etiology of urethral diverticulum in women is unclear, a number of different theories have been advanced for the formation of diverticula including either a congenital or acquired etiology. A few cases of acquired urethral diverticulum have been reported that resulted from endometriosis; however, there have been no such cases reported in Korea. We recently treated a 58-year-old woman who presented with complaints of a protruding mass through the vaginal wall. A diagnosis of urethral diverticulum secondary to endometriosis was finally made. The patient underwent surgical repair. Here we report this case and review the medical literature.

Protective Effects of Cranberry on Infection-induced Oxidative Renal Damage in a Vesicoureteral Reflux Rabbit Model / 대한비뇨기과학회지

PURPOSE: We evaluated the protective effects of cranberry, which is known as a fruit with anti-oxidative effects, on infection-induced oxidative renal damage with using a rabbit vesico-ureteral reflux (VUR) model. MATERIALS AND METHODS: New Zealand male rabbits were divided into 5 groups (the control group, VUR group, E. coli group, cranberry group and melatonin group). VUR was created and confirmed at 2 weeks after the operation. Infection was induced by intravesical instillation of an E. coli suspension. Cranberry powder was supplied with the feed. Melatonin was injected into the peritoneal cavity. The rabbit kidneys were obtained 3 weeks after the operation. Histopathologic examination was performed to evaluate for inflammation, fibrosis and the tubular change. The oxidative renal damage was evaluated by measuring malondialdehyde (MDA) in the renal tissue. RESULTS: Grossly, the refluxing kidney was larger than the contralateral normal kidney and the refluxing ureter was dilated and tortuous. The microscopic observation of the kidneys from the E. coli group showed apparent periglomerular mononuclear cell infiltration, tubular dilatation and atrophy, and interstitial fibrosis. The kidneys from the reflux group, cranberry group and melatonin group showed mild mononuclear cell infiltration without interstitial fibrosis. The MDA level in the kidneys of the E. coli group was significantly higher than that in the control, cranberry and melatonin groups (p<0.05). The MDA level in the cranberry and melatonin groups didn't significantly differ from that in the sterile group. CONCLUSIONS: This study demonstrates that cranberry has an anti-inflammatory effect due to an anti-oxidative function and it may prevent infection-induced oxidative renal damage. But application of cranberry in children with VUR needs more clinical studies.

Eosinophilic Cytoplasmic Globules in Papillary Renal Cell Carcinoma: A Case Report

Eosinophilic cytoplasmic globules may be seen in a variety of neoplastic and nonneoplastic conditions and are most often associated with alpha-1-antitrypsin deficiency, several pathologic liver conditions and yolk sac tumors. A few cases of eosinophilic cytoplasmic globules in renal cell carcinoma have been reported but there has only been one report of papillary type. We report another case of papillary renal cell carcinoma with eosinophilic cytoplasmic globules, which is similar to a Mallory body but with different properties.

The Antihyperplastic Effect of Oral Catechin Ingestion in a Rat Model of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Benign prostatic hyperplasia (BPH) is one of the common diseases in elderly men. Recently, the old-aged population has increased, with the interest in the clinical importance of BPH ever growing. Catechin, an extract of green tea, has the effect of the 5-alpha reductase inhibitor. Typically, BPH has been shown to be influenced by 5-alpha reductase. Therefore, the relationship between BPH and catechin was evaluated. MATERIALS AND METHODS: An experimental prostatic hyperplasia was induced in male Wistar rats by the administration of testosterone propionate, 3mg/kg sc, for 4 weeks. The Wistar rats were divided into four experimental groups: the control, BPH-induced, oral finasteride ingestion and oral catechin ingestion groups. After 4 weeks, the prostates were removed, and analyzed for their prostatic weight and histological examination. RESULTS: The prostate weights were measured in each group, and found to be 330.0+/-40.7, 970.0+/-1.1, 358.0+/-39.9 and 415.0+/-45.3mg in the control, BPH-induced, oral finasteride ingestion and oral catechin ingestion groups, respectively. The oral finasteride and catechin ingestion groups showed statistically significant decreases in their prostatic weights compared with the BPH-induced group (p0.05). Histologically injected testosterone lead to prostatic hyperplasia in rats, but oral catechin ingestion decreased this change. CONCLUSIONS: These results suggest that catechin may be effective in BPH, and the consumption of green tea may be effective in preventing BPH.

Shock after Ureteroscopic Lithotripsy: A case report / 대한마취과학회지

One of the most fearful rare complication of ureteroscopic lithotripsy is sepsis. Since sepsis after endourological maneuvers usually occur immediately after procedure, it is important to pay attention to symptoms representing sepsis such as pyrexia, tachycardia, tachypnea, and oliguria. In addition to clinical symptoms, laboratory tests including white blood cell (WBC) count, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and urine and blood cultivating can help to diagnosis of sepsis. We present a case of shock after ureteroscopic lithotripsy, which was suspected with septic shock strongly.

Difference of Brain Activation by Visual Erotic Stimuli in Young and Middle-aged Healthy Males / 대한비뇨기과학회지

PURPOSE: The objectives of this study are to identify the brain centers whose activity changes are related to sexually arousing visual stimuli and to identify the difference between young and middle-aged males by mapping the brain activity with using blood oxygen level dependent functional magnetic resonance imaging (BOLD-fMRI). MATERIALS AND METHODS: Ten young heterosexual, right handed males with normal sexual function (mean age: 27 years, age range: 24 to 31) and ten middle-aged heterosexual, right handed males with normal sexual function (mean age: 52 years, age range: 46 to 55) were enrolled into this study. Real-time visual stimulation was performed with the subjects alternatively viewing erotic and non-erotic films to identify the activated brain regions associated with sexual response. Assessments with using a five-point scale were determined after visual stimulation to evaluate the subjective sexual arousal. Brain activity was mapped by performing BOLD-fMRI on a 1.5T MR scanner. After functional scanning, the high-resolution data was analyzed with the SPM analyzing program; the significance of activation was set at p<0.01 or p<0.001. RESULTS: The parietal lobe, frontal lobe, cingulate gyrus, caudate nucleus, thalamus and hypothalamus were noted as the areas of activation specifically associated with viewing the erotic film segments by the young males. For the middle-aged males, these areas were the parietal lobe, frontal lobe, right temporal lobe, cingulate gyrus and caudate nucleus. The thalamus and hypothalamus were activated in only the young males. CONCLUSIONS: We suggest that the non-activation of the hypothalamus and thalamus in middle-aged males may be associated with the lesser physiological arousal in response to the erotic visual stimuli. The non-invasive visualization of the central nervous system by functional MRI in healthy males has shown the possibility for evaluating the neuroanatomy of the brain that is associated with sexual arousal and its clinical application by comparing young and middle-aged males.

Effect of Testosterone Replacement on Penile Erection in Castrated Rat / 대한남성과학회지

PURPOSE: This study examined the changes in intracavernous pressure, expression of nitric oxide synthase(NOS), and content of penile smooth muscle in castrated rats and testosterone-supplied castrated rats. MATERIALS AND METHODS: Sprague Dawley rats were used for this study and divided into control, castrated, and testosterone-supplied castrated groups. Castration was performed by bilateral orchietomy under general anesthesia, and testosterone propionate 3 mg/kg was injected subcutaneously daily for a week beginning 4 weeks after orchiectomy. Intracavernous pressure was measured by stimulating the cavernous nerve at 10 volts, 2.4 mA. Expression of NOS was measured by immunohistochemical staining for NADPH diaphorase, and content of penile smooth muscle was measured by H&E staining of the corpus cavernosum. The stained area-to-tissue ratio was calculated by computer scanning for each case. RESULTS: Compared with the control group(3.45+/-0.25 ng/ml), the serum testosterone level of the castrated group (0.78+/-0.34 ng/ml) was lower. Serum testosterone level was restored in the testosterone-supplied castrated group. Compared with the(67.2+/-14.3 cmH2O) was decreased (p <0.05). There was no significant difference between the testosterone-supplied group(94.7+/-11.4 cmH2O) and control group, so intracavernosal pressure was restored by testosterone treatment. Immunohistochemical staining for NOS showed that NADPH diaphorase was stained as brown nerve fiber. Compared with the control group(37.5+/-2.8%), the NOS activity of the castrated group(7.5+/-2.1%) was significantly decreased(p <0.05). NOS activity was slightly increased in the testosterone-supplied group(47.5+/-2.4%) compared with the control group, but the difference was not statistically significant. Thus, testosterone treatment restored NOS activity after castration. By H&E staining, the content of penile smooth muscle was 76.5+/-2.8% in the control group, but significantly lower in the castrated group(46.2+/-3.4% p <0.05). Smooth muscle content was slightly decreased in the testosterone-supplied group(63.8+/-4.7%) compared with control group, but the difference was not statistically significant. Thus, smooth muscle content was restored by testosterone treatment after castration. CONCLUSIONS: Decline of factors involved in erectile function can be restored by testosterone replacement after castration.

Clinical Characteristics of Urinary-Vaginal Fistulas After Various types of hysterectomy / 대한산부인과학회지

OBJECTIVE: We reviewed the frequency and characteristics of urinary-vaginal fistulas after various types of total hysterectomy. METHODS: We analyzed retrospectively 12 women with urinary-vaginal fistulas (10 vesicovaginal, 2 ureterovaginal) after total hysterectomy from January 1994 to December 2003. Hysterectomies included total abdominal hysterectomies (TAH), vaginal hysterectomies (TVH), laparoscopic hysterectomies (TLH), radical hysterectomies (RH), and cesarean hysterectomies (CH). The parameters that were analyzed included age, incidence with respect to the type of hysterectomy, past history, time of onset of the urine leakage and interval between leakage, corrective surgery, location of fistula, type of repair, and results. RESULTS: During the study period, 3,561 hysterectomies were carried out. TAH accounted for 68.9% of procedures, TVH for 14.4%, TLH for 11.6%, RH for 3.3%, and CH for 1.7%. The incidence of vesicovaginal and ureterovaginal fistula was 0.24% and 0% for TAH, 0.48% and 0.48% for TLH, 0.84% and 0% for RH, and 1.67% and 0% for CH, respectively. No fistula was developed after TVH. Urine leakages were developed 5 to 28 days (mean, 14.5 days) after hysterectomies and the intervals between urine leakage and corrective surgery were 7 to 28 days (mean, 16.3 days). The intervals between hysterectomy and corrective surgery were 21 to 54 days (mean, 34.6 days). Corrective surgeries (10 suprapubic transvesical repairs for vesicovaginal fistulas and 2 ureteroneocystostomies for ureterovaginal fistulas) were performed soon after establishment of diagnosis. There was no significant complication and recurrence of fistula after corrective surgery. CONCLUSION: The overall incidence of urinary-vaginal fistula was 0.3%, respectively. The fistulas were more frequently developed after CH than other types of hysterectomy. And the fistulas may be repaired definitively soon after diagnosis of the problem with good results.

Change of Symptom Characteristics with Time in Patients with Indwelling Double-J Ureteral Stents / 대한비뇨기과학회지

PURPOSE: This study was designed to assess the prevalence of various urinary tract symptoms and the development of tolerance over time in patients with short term, indwelling, double-J (D-J) ureteral stents using a specially designed questionnaire and a 10cm linear visual analogue scale (VAS). MATERIALS AND METHODS: Fifty-nine patients (median age 46.0 years, range 18-65; 32 men and 27 women) who underwent ureteroscopic surgery for ureteral obstruction caused by benign conditions (stone or stricture) completed the study. All patients received polyurethane D-J ureteral stents (5 or 6Fr, 24 or 26cm) which were removed 19-55 days postoperatively. Urinary symptoms and pain questionnaires were obtained from each patient at postoperative 24 hours, one week, and on the day before stent removal. Tolerance to the stent was also assessed. RESULTS: All patients reported one or more urinary symptoms. Flank and suprapubic pain were reported more often on voiding or when walking than at rest. Although urgency was reported more frequently over time, the other urinary symptoms remained unchanged. There was no significant difference between the VAS scores for 24 hours, the first week and the day before removal, either overall or when stratified by gender or type of occupation. A factorial analysis of variance analyzing the VAS score for the first week as a function of gender and type of occupation showed no significant effect. CONCLUSIONS: Almost all patients with short-term placement of indwelling D-J ureteral stent had untoward symptoms. Although the prevalence of urgency was significantly increased over time, the general tolerance remained unchanged.

Effect of Aging on Androgen, Penile Structure and Nitric-oxide Synthase in Rat / 대한비뇨기과학회지

PURPOSE: The purpose of this study was to investigate the changes of serum testosterone, intracavernous pressure, expression of nitric-oxide synthase (NOS) and content of penile smooth muscle in aged rat. MATERIALS AND METHODS: Sprague Dawley rats were used for this study and divided into control and aging groups. Intracavernous pressure was measured by stimulating the cavernous nerve with 10volt, 2.4mA. Expression of NOS was measured by immunohistochemical staining for NADPH (nicotinamide adenine dinucleotide phosphate) diaphorase and the content of penile smooth muscle was measured by Masson's trichrome staining for corpus cavernosum. In each case the stained area-tissue ratio was calculated by computer scanning. RESULTS: Compared with the control group (3.34-0.25ng/ml), the serum testosterone level of the aged group (1.41-0.37ng/ml) was decreased significantly. Compared with the control group (106.7-13.2cmH2O), the intracavernosal pressure of the aged group (71.2-12.3cmH2O) was decreased significantly. Immunohistochemical staining for NOS showed that NADPH diaphorase was stained as brown nerve fiber. Compared with the control group (40.5-3.1%), NOS activity of the aged group (9.5-2.5%) was decreased significantly. On Masson's trichrome staining, the content of penile smooth muscle was 62.8 3.9% in the control group. Compared with the control group, the smooth muscle content of the aged group (35.2-2.4%) was decreased significantly. CONCLUSIONS: In conclusion, the factors involved in erectile function were decreased in aged rats.

Vaso-cutaneous Fistula after Vasectomy / 대한비뇨기과학회지

A vasectomy is a safe and effective method of sterilization for men, with a low complication rate. Typical complications of a vasectomy include: wound infection, scrotal hematoma, epididymitis and sperm granuloma. However, vaso-cutaneous fistulae after a vasectomy are extremely rare. Herein is reported a case of a vaso-cutaneous fistula after a vasectomy for the sterilization of a 35-year-old man.

Vaso-cutaneous Fistula after Vasectomy / 대한비뇨기과학회지

A vasectomy is a safe and effective method of sterilization for men, with a low complication rate. Typical complications of a vasectomy include: wound infection, scrotal hematoma, epididymitis and sperm granuloma. However, vaso-cutaneous fistulae after a vasectomy are extremely rare. Herein is reported a case of a vaso-cutaneous fistula after a vasectomy for the sterilization of a 35-year-old man.

Antitumor Activity of Keyhole Limpet Hemocyanin on N-butyl-N-(4-hydroxybutyl) Nitrosamine Induced Bladder Carcinoma in Mice / 대한비뇨기과학회지

Purpose: The antitumor activity and toxicity of keyhole limpet hemocyanin (KLH) on bladder carcinomas induced by N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) were investigated. Materials and Methods: Sixty 6 to 8-week-old female C3H2 mice were divided into three groups. Bladder carcinomas were induced by the addition of 0.05% BBN to the drinking water for 8 weeks. Group A received an intravesical instillation of 0.25ml KLH-free buffer, Group B received 0.5mg KLH in 0.1ml buffer subcutaneously and Group C received an intravesical instillation of 2mug KLH in 0.25ml buffer twice weekly for 8 weeks (day 15 to day 70). On day 91, all the animals were sacrificed. The tumor incidence, bladder weight and toxicity were evaluated. Results: The incidences of cancer in groups A, B and C were 80, 40 and 60%, respectively. The incidence of cancer was significantly reduced in group B compared to group A (p<0.05). The average bladder weights were 93.63+/-17.746, 71.5+/-7.540 and 77.5+/-9.530mg in groups A, B and C, respectively. The bladder weights in groups B and C were significantly reduced compared to group A (p<0.05). There was no liver, kidney or bone marrow toxicities in groups B and C. Conclusions: These results suggest that KLH act as an effective and safe immunotherapeutic agent for bladder cancer. Prospective randomized clinical trials should be used to evaluate the role of KLH as an immunotherapeutic agent in the prophylaxis of recurrent bladder cancer.

Efficacy and Toxicity of Gemcitabine Plus Cisplatin Chemotherapy in Advanced Urothelial Cancer / 대한비뇨기과학회지

PURPOSE: To assess the response to, and toxicity of, combination chemotherapy, with gemcitabine and cisplatin, in patients with advanced transitional cell carcinoma of the urothelial tract. MATERIALS AND METHODS: Thirty-seven patients with advanced transitional cell carcinomas were treated with gemcitabine, 1,000mg/m2, intravenously for 30 minutes, on days 1, 8 and 15 and cisplatin, 70mg/m2, for 1 hour on day 2 of each 28-day cycle. Twenty-four that completed more than 3 cycles were evaluated for their response, but all patients were evaluated for the toxicity. The full dose of the drugs was administered to all patients. RESULTS: Three(12.5%) of the 24 patients achieved a complete response and 2 (37.5%) achieved a partial response, showing an overall response rate of 50%. The main toxicities were myelosupression, with an incidence of 34% thrombocytopenia, 40% leukopenia and 28% anemia, but only 6% of grades 3 to 4. Non-hematological toxicity was mild, with a low incidence of 46% nausea and vomiting, and only 6% of grades 3 to 4. CONCLUSIONS: Combination chemotherapy, with gemcitabine and cisplatin, exhibits significant activity and favorable toxicity in advanced transitional carcinomas, although long-term follow-up and further studies are warranted.