Effect of Testosterone Replacement Therapy on Bone Mineral Density in Patients with Klinefelter Syndrome

PURPOSE: Klinefelter syndrome (KS) is related to testicular insufficiency, which causes low testosterone levels in serum. Generally, sex hormone levels and bone mineral density (BMD) are lower in patients with KS than normal. We investigated the effects of testosterone replacement on serum testosterone levels and BMD in KS patients. MATERIALS AND METHODS: From December 2005 to March 2008, 18 KS patients with a 47, XXY karyotype were treated with initial intramuscular injections of long-acting testosterone undecanoate (Nebido(R), 1000 mg/4 mL) at baseline and second injections after six weeks. An additional four injections were administered at intervals of 12 weeks after the second injection. BMD was measured at the lumbar spine (L2-4), the left femoral neck and Ward's triangle, using dual energy X-ray absorptiometry. Medical histories, physical examinations and prostate specific antigen, hematology and serum chemistry were conducted for each patient. In addition, total testosterone and sex hormone-binding globulin levels were measured. RESULTS: Following testosterone replacement, mean serum total testosterone increased significantly from baseline (0.90 vs. 4.51 ng/mL, p<0.001), and total testosterone rose to normal levels after replacement in all patients. The mean BMD of the lumbar spine increased significantly (0.91 vs. 0.97 g/cm2, p<0.001). Similar increases of BMD were also observed at the femoral neck, but this increase was not significant. CONCLUSION: These findings suggest that testosterone replacement therapy may be effective in treating BMD deficiency in men with testosterone deficiency, especially those with Klinefelter syndrome.

One-Year Surgical Outcomes and Quality of Life after Minimally Invasive Sling Procedures for the Treatment of Female Stress Urinary Incontinence: TVT SECUR(R) vs. CureMesh(R)

PURPOSE: We compared the efficacy and safety of two minimally invasive sling procedures used to treat female stress urinary incontinence (SUI), tension-free vaginal tape (TVT) SECUR(R) and CureMesh(R), and assessed the 1-year surgical outcomes. MATERIALS AND METHODS: Sixty women with SUI were assigned to undergo either the TVT SECUR (n=38) or CureMesh (n=22) procedures between April 2007 and June 2008. Patients were monitored via outpatient visits at 1 month, 3 months, and 1 year after surgery. The efficacy of these procedures was evaluated by the cough test or by a urodynamic study. At these postoperative visits, the patients also completed several questionnaires, including incontinence quality of life, patient's perception of urgency severity, the scored form of the Bristol Female Lower Urinary Tract Symptoms, visual analog scale, and questions about perceived benefit, satisfaction, and willingness to undergo the same operation again. The objective cure rate was defined as no leakage during the cough test with a full bladder. The subjective cure rate was evaluated by self-assessment of goal achievement performed 1 year postoperatively. RESULTS: The two groups were similar in preoperative characteristics and urodynamic parameters. The objective cure rates were similar between TVT SECUR and CureMesh (68.4% vs. 77.3%). All respondents reported improvement after surgery. There were no intra-operative complications. CONCLUSIONS: Our results showed that the TVT SECUR and CureMesh procedures are both safe and simple to perform and have no significant differences in efficacy. Comparative studies with long-term follow-up are warranted to determine the true efficacy of these procedures.

Complications Related to Scrotal Surgery for Male Infertility / 대한남성과학회지

PURPOSE: We reviewed our experience of various scrotal surgeries for male infertility to determine the postoperative complication rates, and how our experience might differ from other series. MATERIALS AND METHODS: The medical records of 356 male patients, performed scrotal surgery for infertility from 2005 to 2006 were reviewed retrospectively. All features of postoperative complications were analyzed according to the operative procedures, use of microscope, spermatic cord incision, and type of anesthesia. RESULTS: All 356 patients of scrotal surgeries were consisted of testicular biopsy (27.2%), microsurgical multiple testicular sperm extraction (m-TESE) (26.4%), vasectomy (17.1%), vasovasostomy (12.6%), scrotal exploration (6.5%), vasoepididymostomy (5.3%) and TESE (4.8%). Complications occurred in 11 (3.1%) procedures and included petechia (27.3%), scrotal edema (27.3%), wound disruption (18.2%), hematoma (18.2%) and hemospermia (9.1%). Most complications were improved by conservative treatments such as compressive scrotal dressing with elevation and resuture was done in 18.2 % (2/11) of patients with wound disruption. In patients of spermatic cord incision, complication rates was higher than in those who did not (8.0% vs. 1.5%, respectively) (p=0.006). There were no significant differences in complication rates regarding type of anesthesia or use of microscope. CONCLUSIONS: To prevent probable complications following scrotal surgery for male infertility, intraoperative meticulous control of bleeding, compressive scrotal dressing or elevation should be considered. Especially, in surgery combined with spermatic cord incision, physicians should pay more attention to minimize postoperative complications.

Can EUS Help to Differentiate Macrocystic Serous Cystadenoma from Mucinous Cystadenoma of the Pancreas by Its Morphologic Characteristics? / 대한소화기내시경학회지

BACKGROUND/AIMS: A macrocystic variant of a serous cystadenoma (M-SCA) is usually indistinguishable from a mucinous cystadenoma (MCA) as a result of their morphologic similarity on conventional imaging studies. However, a MCA requires a resection due to its malignant potential. The aim of this study was to determine the EUS morphological characteristics of a M-SCA to determine if they could be used to help differentiate it from MCA. METHODS: The clinical and EUS morphologic characteristics were examined in 31 consecutive patients with M-SCA and MCA who underwent surgery. RESULTS: Resected specimens were available from 11 M-SCAs and 20 MCAs. Significant differences were observed with regard to the age and location within the pancreas. On EUS, most of the M-SCA contained microcysts (82%) compared with only 15% of MCA cases, and a lobulated configuration of the cyst was observed more frequently in the M-SCA cases than in the MCA (91% vs. 25%). The combination of microcysts and the lobulated configuration of the cysts had a 100% specificity and positive predictive value for differentiating M-SCA from MCA. CONCLUSIONS: M-SCA tends to occur at a relatively younger age than MCA, and is located mainly in the head of the pancreas. Although there is considerable morphological similarity between M-SCA and MCA on the conventional imaging modalities, the morphological characteristics obtained from EUS including microcysts with a lobulated configuration may help to make a distinction between M-SCA and MCA.