Lifestyle Modification Strategy for Patients with Premature Ejaculation as Metabolic Syndrome

No abstract available.

Collecting Duct Carcinoma (Bellini Duct Carcinoma) Presented as a Renal Cyst

Renal cysts are frequently seen in the general population. Most small simple renal cysts are managed by conservative treatment. A renal cell carcinoma (RCC) presenting as a renal cyst is extremely uncommon, and collecting duct carcinoma is a rare type of RCC. This report describes a collecting duct carcinoma initially presnted as a renal cyst. The patient was a 52-year-old man who had been diagnosed with a renal cyst in the left lower pole 8 years earlier but was not regularly follow-up. He presented with left flank pain and gross hematuria. Computed tomography revealed a heterogeneous enhanced mass in the left lower pole and multiple para-aortic lymph nodes. He underwent radical nephrectomy and lymph nodes dissection which confirmed collecting duct carcinoma with sarcomatoid differentiation.

Effect of Testosterone Replacement Therapy on Cognitive Performance and Depression in Men with Testosterone Deficiency Syndrome

PURPOSE: We aimed to evaluate the effect of testosterone replacement therapy (TRT) on cognitive function and depression in men with testosterone deficiency syndrome. MATERIALS AND METHODS: We carried out a prospective, placebo-controlled trial involving 106 men with total testosterone levels 0.05). At baseline, no significant differences between the TRT and control groups were noted regarding serum testosterone or prostate-specific antigen levels, or regarding the scores for aging symptoms (Aging Males' Symptoms scale), erectile function (5-item International Index of Erectile Function questionnaire), cognitive function (Korean Mini-Mental State Examination), and depression (Beck Depression Inventory). At 8 months after intervention total serum testosterone levels and erectile function scores had significantly increased (p<0.05), whereas the scores for aging symptoms and depression had significantly decreased (p<0.05) in the TRT group; no significant improvement in any parameters was noted for the control group. Notably, significant improvement in cognitive function was noted among patients with cognitive impairment at baseline (cognitive function score <25) who received TRT. CONCLUSIONS: TRT may be considered in men with testosterone deficiency syndrome if low testosterone levels are associated with depression or cognitive impairment.

Adolescent Varicocele: Are Somatometric Parameters a Cause?

PURPOSE: It has been reported that varicocele is found less frequently in obese men. Accordingly, we evaluated varicocele patients and statistically analyzed the correlation between varicocele and somatometric parameters. MATERIALS AND METHODS: A total of 211 patients underwent surgery for varicoceles. All patients underwent history taking, physical examination, and scrotal ultrasound to determine the presence and severity of varicocele. An age-matched control group consisted of 102 patients who were found not to have varicocele according to physical examinations and scrotal ultrasound. The age, weight, height, and body mass index (BMI) of the two groups were compared. The statistical analyses were performed by use of PASW Statistics ver. 18.0. A p-value of less than 0.05 was used for statistical significance. RESULTS: In the varicocele group, the mean age, height, weight, and BMI were 29.42+/-14.01 years, 168.53+/-9.97 cm, 62.14+/-13.17 kg, and 21.66+/-3.21 kg/m2, respectively. The distribution of varicocele grade was as follows: 103 (48.8%) grade III, 72 (34.1%) grade II, and 36 (17.1%) grade I. In the control group, the mean age, height, weight, and BMI were 30.83+/-17.31 years, 161.93+/-19.83 cm, 64.69+/-17.86 kg, and 24.04+/-3.64 kg/m2, respectively. Analyzing these data specifically in adolescents, they showed significant differences in age, height, and BMI (p=0.000, p=0.000, and p=0.004, respectively) between two groups. There were no significant differences in somatometric parameters between patients with different grades of varicocele. CONCLUSIONS: Our results showed that patients with varicoceles were significantly taller and had a lower BMI than did patients without varicoceles, especially among adolescents. Carefully designed future studies may be needed.

Renal Function Following Curative Surgery for Renal Cell Carcinoma: Who Is at Risk for Renal Insufficiency?

PURPOSE: To investigate the incidence and predictive factors associated with the development of chronic kidney disease (CKD) in patients undergoing curative surgery for renal cell carcinoma. MATERIALS AND METHODS: From 2003 to 2010, we retrospectively investigated 108 patients undergoing partial nephrectomy or radical nephrectomy (RN) for renal tumors with a preoperative glomerular filtration rate (GFR)> or =60. The GFR was calculated by use of the four-variable modification of diet in renal disease (MDRD) formula. CKD was defined as an estimated GFR (eGFR) less than 60 mL/min per 1.73 m2. Demographic and clinicopathologic parameters were evaluated by using the chi-square and Student t-tests and multivariate regression analysis to determine the variables independently associated with the development of postoperative CKD. RESULTS: Of the 108 patients without preoperative CKD, CKD developed in 43 patients (39.8%). In the analysis of clinical factors between patients with and those without CKD development, gender, body mass index, diabetes mellitus, hypertension, and tumor size were not significant clinical factors. Statistical significance for CKD development was found for age of 60 years or greater (p=0.013), decreased preoperative eGFR (p<0.001), and RN group (p<0.001). In the multivariate analysis, decreased preoperative eGFR (p=0.001) and RN group (p=0.002) were significant independent predictors. CONCLUSIONS: The results of our study show that decreased preoperative renal function and RN were significant independent predictors of postoperative CKD. In patients who had a relatively decreased preoperative eGFR, especially when estimated by use of the MDRD formula, nephron-sparing surgery should be considered for the treatment of small renal tumors.

Korean Society for Sexual Medicine and Andrology (KSSMA) Guideline on Erectile Dysfunction

In February 2011, the Korean Society for Sexual Medicine and Andrology (KSSMA) realized the necessity of developing a guideline on erectile dysfunction (ED) appropriate for the local context, and established a committee for the development of a guideline on ED. As many international guidelines based on objective evidence are available, the committee decided to adapt these guidelines for local needs instead of developing a new guideline. Considering the extensive research activities on ED in Korea, data with a high level of evidence among those reported by Korean researchers have been collected and included in the guideline development process. The latest KSSMA guideline on ED has been developed for urologists. The KSSMA hopes that this guideline will help urologists in clinical practice.

Life-Threatening Hypovolemic Shock after Transrectal Ultrasonography Guided Prostate Biopsy: Treatment with Selective Arterial Embolization / 대한남성과학회지

Rectal bleeding is a frequent finding in patients after transrectal ultrasonography (TRUS)-guided prostate biopsy but is usually mild and stops spontaneously. We report herein a case of life-threatening hypovolemic shock due to rectal bleeding after TRUS-guided prostate biopsy that was successfully treated by selective arterial embolization. The aim of this report is to share our experiences of the management of massive rectal bleeding after prostate biopsy.

Malignant Mesothelioma of the Spermatic Cord

Primary tumors arising from the spermatic cord are very rare. Mesothelioma derives from the mesothelial cells lining the serous membrane, such as the pleura, peritoneum, and tunica vaginalis of testis. Paratesticular malignant mesothelioma (MM), which usually presents as a hydrocele or intrascrotal mass, accounts for 0.3% to 1.4% of MMs. MMs of the spermatic cord account for less than 10% of paratesticular MMs. We report a case of MM of the spermatic cord in a 65-year-old man who primarily presented to the hospital with a left inguinal mass. Following the diagnosis after surgery, he was found to have a contralateral right inguinal mass and died in 6 months. Despite their rare occurrence in the spermatic cord, MMs need to be suspected, especially in patients with a history of asbestos exposure.

The Correlation of Duplex Doppler Ultrasonographic Retrograde Venous Flow Volume and Testicular Volume Difference in Patients with Adolescent Varicocele / 대한남성과학회지

PURPOSE: The aim of this study is to assess effects of testicular volume difference and retrograde venous flow of pampiniform plexus measured by Duplex Doppler Ultrasonograpy (DDU) in patients with adolescent varicocele. MATERIALS AND METHODS: Physical examinations and DDU were performed to assess varicocele in fifty five patients with left sided adolescent varicocele. During both normal respiration and the Valsalva's maneuver, the maximum venous diameter (MVD), maximal velocity of reflux and the peak retrograde flow volume (RFV) was measured by DDU. The percentage testicular volume difference (%) between the right and left testicle was calculated as (right testicular volume-left testicular volume)x100/right testicular volume and divided into 3 group; below 10%, 10~20%, >20%. Grade of varicocele, MVD and peak RFV were analyzed as possible determinants of testicular hypotrophy in adolescent varicocele. RESULTS: A total of 55 patients (mean age 17.8 years, range 12 to 20) were included in this study. Of these, physical examination reviewed that 7 (12.7%), 18 (32.7%), 30 (54.6%) patients had grade I, II or III varicoceles on the left side respectively. The mean MVD was significantly higher according to grade of varicocele. The mean maximal velocity of reflux was significantly higher in the patients grade II and III than grade I, but was not significant between grade II and III. The mean peak RFV was significantly higher according to grade of varicocele. RFV was the only significant parameter of predictive value for percentage testicular volume difference. CONCLUSIONS: Patients with peak RFV >35ml minutes showed significant reduction of testicular volume. Measurement of RFV is recommended as predictive tools for assessing the percentage testicular volume difference in patients with adolescent varicocele.

Urodynamic Analysis of Old-aged Men with Persistent Lower Urinary Tract Symptoms after Medical Treatments

PURPOSE: The cause and pathogenesis of lower urinary tract symptoms (LUTS) in elderly men is unclear. We analyzed the clinical and urodynamic findings of elderly patients with LUTS to search for accurate diagnosis and effective treatments. MATERIALS AND METHODS: We performed a retrospective chart review of 154 male patients older than 65 years old with LUTS who underwent urodynamic studies between January 2002 and December 2008. The patients were divided into irritative and obstructive symptom groups according to their chief complaints. The urodynamic findings between two groups were compared. And the prevalence of detrusor dysfunction (either detrusor underactivity; DU or detrusor overactivity; DO) according to age, history of urinary retention, the presence of an indwelling urethral catheter, neurologic disease, or diabetes was estimated. RESULTS: The mean age of men was 70.8+/-4.5 years. On urodynamics, detrusor dysfunction was detected in 116 (75.4%) of 154 patients. Seventy eight (50.6%) patients showed demonstrable evidence of DU of whom 33 (21.4%) had concomitant DO, while 18 (11.7%) had concomitant bladder outlet obstruction (BOO). BOO and DO was identified in 67 (43.5%) and 71 (46.1%) patients, respectively. The prevalence of was significantly greater in the presence of history of acute urinary retention and an indwelling urethral catheter. CONCLUSION: One hundred forty one (91.6%) elderly patients with LUTS showed urodynamic abnormalities such DO, DU and BOO. Urodynamic study would play a important role in establishing a correct diagnosis in elderly patients with LUTS and deciding on additional treatments.

A Patient with Hinman's Syndrome who Underwent Renal Transplantation Using a Pre-existing Cutaneous Ureterostomy / 대한비뇨기과학회지

It is known that many renal transplantation candidates with end stage renal disease have bladder dysfunction. Before 1966, these patients were considered poor candidates for renal transplantation because of their many bladder problems. But it has recently been reported that renal transplantation with an ileal conduit could solve these problems. Herein, we report on a patient with Hinman's syndrome and this patient underwent renal transplantation using a pre-existing cutaneous ureterostomy.

Safety and Efficacy of Bipolar TURP in Large Volume Prostate

PURPOSE: With the development of bipolar device, which complement the weak points of conventional monopolar device, TURP became more appliable in large volume prostate. We evaluated the possibility and effectivity of bipolar TURP in large volume prostate by analysing treatment results. MATERIALS AND METHODS: Total 78 male patients who received bipolar TURP in our center between April 2004 and December 2006, were divided into two groups based on prostate volume (>75g = large volume prostate group, 75g) using bipolar device is as effective as of general (<75g) prostate hyperplasia. Bipolar TURP can be another therapeutic option of large volume prostate, which in the past indicated open prostatectomy, to escape from higher surgical morbidity.

Long-term Follow-up of Bipolar Transurethral Resection of the Prostate Compared with Conventional Monopolar Resectoscope for Patients with Benign Prostatic Hyperplasia / 대한남성과학회지

PURPOSE: We analyzed the long-term efficacy and safety of bipolar transurethral resection of the prostate (TURP) using the Gyrus(TM) PlasmaKinetic System compared with conventional monopolar TURP. MATERIALS AND METHODS: This study included 54 patients with benign prostatic hyperplasia (BPH) who underwent TURP between May 2003 and April 2004. In all, 28 consecutive patients had bipolar and 26 had monopolar TURP. All patients were assessed by preoperative and postoperative International Prostate Symptom Score (IPSS), uroflowmetry, transrectal ultrasonography, operative time, weight of resected tissue, length of hospital stay, duration of catheter use, change in hemoglobin and serum sodium, and complication rates. RESULTS: Significant improvement was seen postoperatively in both groups, and no difference was observed in the resection time, weight of resected tissue, change in hemoglobin and serum sodium, improvement of IPSS and maximum flow rate (Qmax) or complication rates over the 36-month follow up. However, there was a significant difference in duration of catheter use and hospital stay. Duration of catheter use (2.1 days vs. 3.5 days p=0.012) and hospital stay (2.9 days vs. 4.1 days p=0.024) were shorter in the bipolar group. CONCLUSIONS: Bipolar TURP using the Gyrus(TM) PlasmaKinetic System is as effective as conventional monopolar TURP with the advantages of reduced length of catheter use and shorter hospital stay. Both methods have low complication rates. In the long-term comparison, improvements in IPSS and Qmax after bipolar and monopolar TURP are similar. Thus bipolar TURP may be a good alternative to conventional TURP.

The Effect of Testicular Torsion on the Histologic Findings and Apoptosis of the Contralateral Testis at Various Ages in Rats / 대한비뇨기과학회지

PURPOSE: Unilateral testicular torsion, while harming the ipsilateral testis, may also affect the contralateral testis. A reduction in testicular blood flow, immune reactions and biochemical changes have been reported to affect spermatogenesis. However, physiologic fertility, spermatogenesis, the production of sex hormones and the testicualr blood flow might vary according to age. Therefore, an experimental study was conducted to investigate the effects of testicular torsion on the contralateral testis at various ages in rats. MATERIALS AND METHODS: Sprague-Dawley rats, 2, 5 and 8 weeks old were divided into 4 experimental subgroups in the torsion only, detorsion (torsion followed by detorsion at 1 hour), orchiectomy (torsion followed by an orchiectomy at 24 hours) and a control group. Six weeks later, the changes in the testicular weight, the mean tubular diameter, spermatogenesis and apoptosis of the contralateral testicle were determined. RESULTS: The changes in the testicular weight, mean tubular diameter and spermatogenesis were similar in the 2 weeks group regardless of the experimental methods (p>0.05). In the 5 weeks group, the tubular diameter had decreased significantly in the orchiectomy and torsion only group (p< 0.05), and incomplete spermatogenesis was observed in the torsion only group. In the 8 weeks group, the testicular weight and tubular diameter was significantly lower in the orchiectomy and torsion only group (p< 0.05), but spermatogenesis was relatively well preserved. The apoptotic cell index was significantly higher in the orchiectomy and torsion only group at 5 and 8 weeks group (p< 0.05). CONCLUSIONS: Unilateral testicular torsion causes histological changes and incomplete spermatogenesis in the contralateral testicle. These results suggest that the effect of a unilateral testicualr torsion was predominant in untreated and pubertal rats, but is rarely observed in infantile rats.

The Effect of Testicular Torsion on the Histologic Findings and Apoptosis of the Contralateral Testis at Various Ages in Rats / 대한비뇨기과학회지

PURPOSE: Unilateral testicular torsion, while harming the ipsilateral testis, may also affect the contralateral testis. A reduction in testicular blood flow, immune reactions and biochemical changes have been reported to affect spermatogenesis. However, physiologic fertility, spermatogenesis, the production of sex hormones and the testicualr blood flow might vary according to age. Therefore, an experimental study was conducted to investigate the effects of testicular torsion on the contralateral testis at various ages in rats. MATERIALS AND METHODS: Sprague-Dawley rats, 2, 5 and 8 weeks old were divided into 4 experimental subgroups in the torsion only, detorsion (torsion followed by detorsion at 1 hour), orchiectomy (torsion followed by an orchiectomy at 24 hours) and a control group. Six weeks later, the changes in the testicular weight, the mean tubular diameter, spermatogenesis and apoptosis of the contralateral testicle were determined. RESULTS: The changes in the testicular weight, mean tubular diameter and spermatogenesis were similar in the 2 weeks group regardless of the experimental methods (p>0.05). In the 5 weeks group, the tubular diameter had decreased significantly in the orchiectomy and torsion only group (p< 0.05), and incomplete spermatogenesis was observed in the torsion only group. In the 8 weeks group, the testicular weight and tubular diameter was significantly lower in the orchiectomy and torsion only group (p< 0.05), but spermatogenesis was relatively well preserved. The apoptotic cell index was significantly higher in the orchiectomy and torsion only group at 5 and 8 weeks group (p< 0.05). CONCLUSIONS: Unilateral testicular torsion causes histological changes and incomplete spermatogenesis in the contralateral testicle. These results suggest that the effect of a unilateral testicualr torsion was predominant in untreated and pubertal rats, but is rarely observed in infantile rats.

Effect of Ginseng on Penile Erection: A combined in vitro and in vivo study / 대한남성과학회지

PURPOSE: Korean ginseng (KG) has been used as a general tonic in oriental society. The present study was undertaken to investigate the effect of total saponin (TS), a major extract of KG, and non-saponin components of KG on penile erection for evaluation of the possibility of developing KG as an pharmacological agent. MATERIALS AND METHODS: Strips of rabbit corpus cavernosum were mounted in organ chambers to measure isometric tension, with the treatment of TS and non-saponin components including methanol extracts, ethylacetate extract and H2O extract. We observed the relaxing effect of TS and non-saponin components, which were represented by % relaxation compared to 10-3M sodium nitroprusside-induced relaxation. In adult Sprague Dawley rats, we observed the increase of intracavernous pressure (delta ICP) and duration of tumescence (DT) by intracavernosal injection of TS. RESULTS: TS (1-4mg/cc) significantly relaxed the strips precontracted with phenylephrine (10(-5)M) in dose dependent manner (%relaxation: 5.8-36.7%). Intracavernous injections of TS (0.05mg-3.2mg/0.1cc) induced penile erection (delta ICP: 1.3-21.3mmHg, DT: 0.3-5.2min) in dose dependent manner. The cumulative additions of all non-saponin components at concentrations from 0.5mg/cc to 4mg/cc relaxed the strips in concentration-dependent manner. The maximal relaxing effect were 14.7% in methanol extract, 16.9% in H2O extract, 18.2% in ethylacetate extract. CONCLUSIONS: With the results, ginseng induces penile erection by relaxing corpus cavernosum and suggest that ginseng is not doing its action as a single component but ginseng is doing rather its action as complexes with saponin and non-saponin components.

A Case of Congenital Fibroepithelial Polyp of the Ureter in a Child / 대한비뇨기과학회지

The fibroepithelial polyp of the ureter is a rare, benign tumor. Its pathogenesis is unclear, but most investigators agree that it arises from elements of mesodermal origin within the ureteral wall. Symptoms include hematuria and intermittent flank pain secondary to partial ureteral obstruction. Correct radiologic assessment is crucial to direct surgical management. We report a case of a fibroepithelial polyp of the ureter in a child in whom correct preoperative diagnosis was made by correlating the results of excretory urography, sonography, CT and urine cytology.

Anterior Vaginal Wall Sling for Female Stress Urinary Incontinence / 영남의대학술지

BACKGROUND: The purpose of this study was to determine the efficacy and safety of the anterior vaginal wall sling in the management of women with stress urinary incontinence. MATERIALS AND METHODS: From January 1998 to December1999, 42 patients(31 with genuine stress urinary incontinence and 11 with mixed urinary incontinence, 38 with anatomical incontinence and 4 with intrinsic sphincteric deficiency) underwent anterior vaginal wall sling at Yeungnam University Hospital were studied retrospectively. The mean age was 49.3 years(ranging from 34 to 66 years of age) and the mean follow-up period was 29.4 months(ranging from 16 to 40 months). Intra- and postoperative complication, success rate and patient's satisfaction were evaluated. RESULTS: The mean operation time was 79 minutes(ranging from 65 to 124 minutes) and the mean hospital stay was 5.1 days(ranging from 4 to 10 days). Mean postoperative Foley catheter drainage was 2.1 days(ranging from 1 to 5 days). As a complication, bladder perforation occurred in one patient(2.4%), residual urine sensation developed in seven patients(16.7%). and suprapubic pain was complained in five patients(11.9%). which improved gradually. Vaginal epithelial inclusion cyst occurred in one patient(2.4%) at postoperative 31 months. Four(9.4%) patients with de novo instablility were improved by anticholinergics medication. The success rate was 92.9% and 38 patients(90.5%) were satisfied with this procedure. CONCLUSION: We consider that the anterior vaginal wall sling to be a safe and effective surgical procedure for the treatment of female stress urinary incontinence. but a longer follow-up is necessary to determine long term effect.