Study on Differences of Inducible Nitric Oxide Synthase Gene Expression in Vesical Tissue after Intravesical Instillation of Three Different strains of BCG in Rat / 대한비뇨기과학회지

Recently, BCG infection is known to induce nitric oxide(NO) production by macrophages through T cell mediated process and NO is known to be microbicidal and tumoricidal. There are several strains of BCG which are commercially available and vary in the number, pathogenicity, viability, and immunogenicity of organisms. Therefore, we wanted to know if there are any differences between three different strains of BCG(Pasteur, Connaught or Tice strain) on the induction of inducible NO synthase(iNOS) and the histological changes in vesical tissue after intravesical instillation of BCG in rats. Thirty two Sprauge-Dowley female rats were equally divided into 4 groups. In group 1, normal saline(0.85 ml/kg) was intravesically instilled one time. In group 2, 3, and 4, BCG of Pasteur strain(2mg/kg, normal saline 0.85ml/kg), Connaught strain(1.35mg/kg, normal saline 0.85ml/kg), Tice strain(0.21mg/kg, normal saline 0.85ml/kg) was instilled one time, respectively. The bladders were excised from each group on day 1, 3, 7, and 14 after BCG instillation. iNOS mRNA was not detected in the vesical tissues of control group, whereas it was strongly detected in group 2, 3, or 4. Also, iNOS mRNA was more strongly detected on day 1, 3, and 7 after intravesical BCG instillation than day 14 in the vesical tissues of group 2, 3, and 4. Histologic findings were well related with expression of iNOS mRNA. Our results indicate that intravesical BCG instillation of rat induces expression of iNOS mRNA in the vesical tissue accompanying the infiltration of inflammatory cells and suggest that all of the 3 strains of BCG including Pasteur, Connaught, and Tice are good at inducing expression of iNOS mRNA without significant differences between the strains.

Expression of Inducible Nitric Oxide Synthase in Vesical Tissue after Intravesical BCG Instillation in Rat / 대한비뇨기과학회지

Intravesical bacillus calmette-guerin( BCG) therapy for superficial bladder carcinoma is believed to exert its antitumor effects through immune mechanisms which have yet to be more clearly defined. Recently, BCG infection is known to induce nitric oxide(NO) production by macrophages through a T cell mediated process. NO is known to be microbicidal and tumoricidal. Therefore, we studied the effects of intravesical BCG instillation on the induction of inducible NO synthase(iNOS) which is responsible for the production of NO in the vesical tissue of rat Forty Sprauge-Dawley female rats were equally divided into 5 groups. In group 1, normal saline( 0.85 ml/kg) was intravesically instilled one time. In group 2 and group 3, BCG of Pasteur strain(2 mg/kg, normal saline 0.85 ml/kg) was instilled one time and 3 times weekly respectively. In group 4, 10-fold dose of the strain( 20 mg/kg, 0.86 ml/kg) and in group 5, 1/10-fold dose of the strain (0.2 mg/kg, 0.85 ml/kg) were instilled one time respectively. We sacrificed two rats to excise the bladders in each group 1, 3, 7, and 14 days after the instillation( after the last instillation in group 3). iNOS mRNA was not detected in the vesical tissues from the rats of group 1, whereas it was strongly detected in all the vesical tissues from the rats in group 2, 3. or 4. More iNOS mRNA was detected 14 days after the instillation in group 3 than group 2 or 4. In group 5, iNOS mRNA was weakly detected 1, 3, and 7 days and not detected 14 days after the instillation. Our results indicate that intravesical BCG instillation of rat induces the expression of iNOS mRNA in the vesical tissue and suggest that the duration and degree of iNOS mRNA expression is dependent on the dose of BCG and the frequency of the instillations. On the basis of these observations, we conclude that adequate dose and frequency are required for effective treatment of superficial bladder carcinoma in the intravesical BCG therapy.

The Clinical Effects of Transurethral Microwave Thermotherapy in Case of Benign Prostatic Hyperplasia with Urinary Retention / 대한비뇨기과학회지

From February, 1993 to April, 1994, 32 benign prostatic hyperplasia( BPH) patients with urinary retention were treated with transurethral microwave thermotherapy(TUMT). The mean patient age was 74 years(range 59 to 86 years) and the mean duration of retention was 3.7 months(range 1 day to 36 months). The mean follow-up period was 13 months (range 4 to 18 months). In cystoscopic findings, trilobar hyperplasia was diagnosed in 12 patients(37% ), while bilobar and median bar or median lobe enlargement were diagnosed in 11 patients(35% ) and 9 patients( 28% ). Mean prostatic weight was 29gm(range 11.3 to 89.5gm) Of the patients 14(44% ) patients were in the catheter-free state( = Responder) after TUMT and 18(56%) patients had to be in the catheter-indwelling state( = Nonresponder). The 14 responders showed several important parameters: mean peak flow rate was 8.9ml per second ( range 4.5 to 17.5ml per second), mean post-voiding residual urine was 137.5ml( range 80 to 220ml) and a mean symptom score was 10.7 on the modified Boyarski symptom score scale. Also, there was no significant difference in the incidence of catheter-free state in patients with bilobar and trilobar hyperplasia compared to those with median bar or median lobe hyperplasia. Conclusively, one session of TUMT at 50 degrees C for 90 minutes seemed to have minor therapeutic effect on BPH patients with urinary retention. Therefore, the clinical results in treating the BPH patients with urinary retention suggest that the more clinical experiences will be needed about the proper patient selection, the safety introduction of higher temperature, the prolonged treatment time and the numbers of treatment session.

A Comparison of Clinical Result of Radiofrequency and Microwave Thermotherapy for BPH / 대한비뇨기과학회지

From July, 1992 to June, 1993, 32 patients with BPH were treated with transurethral radio frequency thermotherapy(TURT) and 54 patients with transurethral microwave thermotherapy (TUMT). Of the patients 15 and 19 were followed for 3 month(range 2-6 months) and analysed to compare the effectiveness of TURT and TUMT respectively. Mean age was 70.3(range 55-88) and 68.7( 54-82) and mean prostatic weight was 30.3gm ( 14-52gm) and 33.8gm(11 -60gm). These patients were treated by one session for 1 hour. The improved response rate with TURT versus TUMT in residual urine volume and maximal flow rate were 40%, 57% and 47%, 32%. The improved response rate more than 6 points in modified Boyarsky symptom score were 73% and 63%. The side effects were urinary retention, dysuria, hematuria and perineal discomfort in both types. We conclude there were no differences in the effectiveness according to electromagnetic wave types and these transurethral thermotherapies are safe and simple method for patients who are not candidates for surgery because of medical illness or personal favorites.

Retreatment Experience in Recurred Congenital Renal A-V Fistula after Intra-arterial Selective Embolization by Gianturco Steel Coil / 대한비뇨기과학회지

Although rare, renal arteriovenous fistulas have been discovered with increasing frequency since they were first described by Varela in 1923. Arteriovenous fistulas are classified as either congenital or acquired. The diagnosis of this condition is usually made by use of renal angiograms. In case of hematuria and/or hypertension either intra-arterial embolization or surgical excision and clipping of the arterial branch can be done. Intra-arterial superselective embolization seems to cause less functional loss of the renal parenchyme, whereas excision often leads to heminephrectomy or even total nephrectomy. Herein, we describe a case treated successfully in recurred renal A-V fistula after transcatheter embolization by Gianturco steel coil and reviewed the literature of renal A-V fistulas.