Effect of Mitomycin-C on Experimentally Induced Urethral Stricture in Rats

PURPOSE: Urethral stricture is a fibrotic process and, although it is one of the oldest known urologic diseases, it remains a common problem with a high recurrence rate. Mitomycin-C has been reported to have anti-replication properties in animal and clinical studies. The aim of this study was to observe the intraurethral impact of the use of mitomycin-C on scar formation and fibrosis in an experimental rat model of urethral stricture. MATERIALS AND METHODS: Twelve male Sprague-Dawley rats were used. With the animals under deep anesthesia, an internal urethrotomy was made with a cold knife. After the urethral injury, the rats were grouped randomly as follows: group 1 (control, n=4), group 2 (3 mg/l of mitomycin-C, n=4), and group 3 (5 mg/l of mitomycin-C, n=4). The rats were sacrificed 14 days later to evaluate epithelial proliferation and fibrosis. The penile urethra was removed and histopathologically examined by H&E staining, Masson trichrome staining, and immunohistochemistry with anti-collagen type I antibody. RESULTS: The stained specimens were examined under a light microscope. The extent of fibrosis and re-epithelization after urethral injury was greater in the areas with trauma than in those without. These findings were significantly reduced in the groups treated with mitomycin-C as compared with group 1, but there was no statistical difference between group 2 and group 3. Mitomycin-C treatment also prevented increases in collagen type I, whereas group 1 showed increases in collagen type I and collagen contents at the stricture site. CONCLUSIONS: These results suggest that mitomycin-C might inhibit the renewal of the epithelium and the synthesis of collagen secreted by fibroblasts in the affected urethra and then prevent scar formation. This raises the possibility of the use of mitomycin-C to prevent urethral stricture caused by trauma.

Squamous Cell Carcinoma of an Ileal Neobladder: A Case Report

Bladder reconstruction using bowel segments, especially the ileum, has become a realistic option for urinary diversion. There is only one prior case of squamous cell carcinoma of the ileal neobladder that has been reported in the clinical literature. Here we report a patient with a spectrum of squamous cell lesions, including squamous cell carcinoma, sarcomatoid carcinoma, squamous papilloma and squamous metaplasia that developed in the ileal neobladder. A 46-year-old woman underwent a hysterectomy, cystectomy and ileocystoplasty for tuberculosis 25 years previously complained of urinary frequency and gross hematuria for one week. A pelvic CT revealed a 6.3 cm mass in the neobladder. The histopathological examination showed an 11x8 cm polypoid fragile mass with a microscopically well-differentiated squamous cell carcinoma, squamous papilloma and non-tumor squamous metaplasia.

Bladder Hemangioma as a Cause of Massive Hematuria: Treatment with Selective Arterial Embolization / 대한비뇨기과학회지

Hemangioma of the urinary bladder is a benign, congenital tumor that accounts for 0.6% of all primary bladder neoplasms. The most common symptom is gross hematuria. However, bladder hemangioma as a cause of massive hematuria is rare. The management of patients with hemangioma is controversial and numerous therapeutic approaches are available. Herein, we describe the use of selective arterial embolization to terminate an episode of massive hematuria in an 87-year-old woman with bladder hemangioma.

Relationship between the Success of Extracorporeal Shock Wave Lithotripsy (ESWL) and the Degree of Hydronephrosis when Treating Patients with Upper Ureteral Stones / 대한비뇨기과학회지

PURPOSE: We tried to determine the relation between the degree ofstone- induced hydronephrosis and the outcome of extracorporeal shock wave lithotripsy (ESWL) when treating patients with solitary upper ureteral stone. MATERIALS AND METHODS: 260 proximal ureteral stone patients with or without hydronephrosis were treated with ESWL between January 2003 and December 2006 and 8 of these patients were lost to follow up. The degree of hydronephrosis was defined by performing renal ultrasound. The patients were divided into four groups according to the degree of hydronephrosis. Group 0 (n=30) had no urinary system dilatation, group 1 (n=123) had a mild dilatation of the renal pelvis but no renal calices, group 2 (n=75) had a moderate dilatation of the renal pelvis and group 3 (n=24) had a severe dilatation of the renal pelvis and calices. In addition to the degree of hydronephrosis, the stone size, number of sessions, number of shockwave treatments applied and the success rate of ESWL were recorded. RESULTS: The success rate after ESWL treatment was 92.9% (n=234). There were no statistically significant differences among the groups for the stone size, number of sessions and number of applied shockwave treatments. There were a trend for a decreased success rate of ESWL with an increased degree of hydronephrosis, but this did not reach statistical significance (p=0.436). After ESWL, a few patients encountered minor complications such as gross hematuria, flank pain, stone street, fever and perirenal hematoma. Yet most cases were treated conservatively and there was no need for hospitalization. CONCLUSIONS: For the patients in our study who had a solitary calculus in the upper ureter, the degree of hydronephrosis caused by the stone does not affect the success rate after ESWL.

Efficacy of the NTrap(R) for the Treatment of Ureteral Stone: An Initial Clinical Experience / 대한비뇨기과학회지

PURPOSE: Retrograde migration of stone fragments is common when performing lithotripsy. A new device, the NTrap(R), is a device that prevents stone migration and it extracts calculi and other foreign bodies in the urinary tract. The aim of this study was to assess the efficacy and safety of ureteroscopic stone removal by using the NTrap(R). MATERIALS AND METHODS: From January 2006 to December 2006, 64 consecutive patients underwent endoscopic lithotripsy by using the NTrap(R), rigid ureteroscopy(8.6Fr) and pneumatic lithoclast. We analyzed the success rate of stone removal and the complication rate. RESULTS: The mean stone size and mean operation time were 9.36mm and 32 minutes, respectively. The overall stone-free rate was 100% and no patient had residual fragments greater than 3mm and they didn't require auxiliary treatment. The most common complications were gross hematuria and pain. CONCLUSIONS: The NTrap(R) is new ureteroscopic instrument that's a highly effective, safe modality for the treatment of ureteral stone.

The Expressions of p53, gamma-H(2)AX and Ku70/Ku80 That was Caused by Hydronephrosis in the Kidney of Rats / 대한비뇨기과학회지

PURPOSE: There are little research about the factors of DNA damage and repair that might cause renal parenchymal damage under the condition of hydronephrosis. In this study, we studied the expressions of p53, gamma-H(2)AX and Ku70/Ku80 in rat kidney under the condition of hydronephrosis. MATERIALS AND METHODS: 16 Sprague-Dawley rats that were 7~8 weeks old were used. Partial ureteral obstruction was induced in 12 rats. And for the other 4 rats, a sham-operation was done as a control. The hydronephrosis-induced rats had their right kidney removed after 1, 2 and 3 weeks and the sham-operated rats underwent nephrectomy after 3 weeks. Those removed tissues were examined with immunohistochemical staining and western blot to confirm the degree of expression of p53, gamma-H(2)AX and Ku70/Ku80. RESULTS: The expressions of p53, gamma-H(2)AX and Ku70/Ku80 caused by hydronephrosis in the rat increased as time passed, and these expressions of controls were in a low level or they were negative. These results were similar with the results of the immunohistochemical staining and Western blot. CONCLUSIONS: This study confirmed that the protein expressions of gamma- H(2)AX, p53, and Ku70/Ku80 are increased, and these expressions are the DNA damage-related factors in the renal parenchyma of hydronephrosis-induced rats. We confirmed the possibility that DNA double strand breaks (DSBs) might be the main mechanism that induces renal parenchymal damage under the condition of hydronephrosis.

Penile Necrosis by Longtime Installation of a Constriction Ring in a Patient using a Vacuum Constriction Device / 대한비뇨기과학회지

A vacuum constriction device has been described as a safe and satisfactory treatment for erectile dysfunction. The main complications of the device are mostly minor symptoms and serious side effects are rarely reported. We report here on a case of wide ischemic necrosis of the penis including the skin, subcutaneous tissue, tunica albuginea and corpus cavernosum by a constriction ring that had been installed for 72 hours in a 61 year old patient.

Inhibition of p65 Nuclear Translocation by KIOM-79 / 대한해부학회지

We demonstrate that KIOM-79, combined extracts isolated from Magnolia officinalis, Pueraria lobata, Glycyrrhiza uralensis, and Euphorbia pekinensis, inhibits LPS-induced expression of iNOS gene in RAW 264.7 cells. Treatment of RAW 264.7 cells with KIOM-79 inhibited LPS-stimulated nitric oxide production in a doserelated manner. Immunohisto-chemical staining of iNOS and RT-PCR analysis showed that the decrease of NO was due to the inhibition of iNOS gene expression. Immunostaining of p65 and EMSA showed that KIOM-79 inhibited NF-kappa/Rel nuclear translocation and DNA binding, respectively. Collectively, this series of experiments indicates that KIOM inhibits iNOS gene expression by blocking NF-kappa/Rel. Due to the critical role that NO release plays in mediating inflammatory responses, the inhibitory effects of KIOM-79 on iNOS suggest that KIOM-79 may represent a useful anti-inflammatory agent.

The Expression of P53 and Phosphorylation of H2AX in Germ Cells of Varicocele Rats / 대한비뇨기과학회지

PURPOSE: To explore the expressions of P53 and phosphorylation-H2AX in varicocele-induced rat testes. MATERIALS AND METHODS: A total of 16 adult male Sprague-Dawley rats underwent an operation; 12 underwent an experimental varicocele and 4, as controls, were sham-operated. Groups of 4 varicocele-induced rats underwent a left orchiectomy after 2 or 3 weeks, or both orchiectomies after 4 weeks. The sham-operated rats underwent both orchiectomies after 4 weeks. Sections of both testes from each animal were studied. The changes in the expressions of P53 and phosphorylation of H2AX were determined using immunohistochemistry and western blot. RESULTS: Immunohistochemical staining of the left testes in the varicocele- induced rats showed that the expressions of P53 and phosphorylation of H2AX had not begun 2 weeks postoperatively, but remarkable results were observed after 3 and 4 weeks. Both testes of the varicocele-induced rats showed the expressions of P53 and phosphorylation of H2AX after 4 weeks, with the left testes being more distinctive in immunohistochemical staining compared to the right. Western blot of the left testes in the varicocele- induced rats also showed unclear expressions of P53 and gamma-H2AX after 2 weeks. Considerable distinction was seen after 3 and 4 weeks compared to the control group. CONCLUSIONS: Our results suggest that experimental varicocele is associated with increased sperm DNA damage. These changes may be related to abnormal spermatogenesis.

Ureteral Stricture from Retroperitoneal Fibrosis Caused by Isolated Common Iliac Artery Aneurysm / 대한비뇨기과학회지

Retroperitoneal fibrosis sometimes causes urological problem involving the ureter, but the mechanism is uncertain. An aortic aneurysm, including an iliac artery aneurysm, is thought to be one of the mechanisms of retroperitoneal fibrosis. However, cases caused by an isolated iliac artery aneurysm are very rare, and symptoms tend to be non-specific; therefore, no definitive treatment has been established. Herein, we report our recent experience of a patient with a left common iliac artery aneurysm involving the ureter, who underwent successful surgical therapy.

Non-surgical Treatment of Voiding Dysfunction Following Tension-Free Vaginal Tape Procedure in Female Stress Urinary Incontinence

The tension-free vaginal tape procedure(TVT) has become a state of the art operation for female stress urinary incontinence. The most common problems after the TVT seen are voiding difficulties. Although the incidence of urinary retention appears to be low after the TVT procedure, it is recommended that patients be counseled about the risk and carefully monitored for voiding symptoms during the first 3 weeks postoperatively. When obstruction after the TVT is clinically evident, immediate tape adjustment in the operating room by open vaginal incision, may be indicated. We report of voiding difficulty 8 weeks after the TVT who was successfully managed with urethral dilation.

Preoperative Reno-vascular Evaluation of Living Renal Donors with Contrast Enhanced Magnetic Resonance Angiography / 대한비뇨기과학회지

PURPOSE: The purpose of this study was to evaluate the accuracy of contrast enhanced magnetic resonance angiography (CE-MRA) in the visualization of the renovascular anatomy for the preoperative evaluation of living renal donors. MATERIALS AND METHODS: Thirty-one consecutive potential living renal donors were investigated. Ten patients underwent both digital subtraction angiography (DSA) and CE-MRA, and twenty-one underwent CE-MRA alone before the donor nephrectomy. The intraoperative findings on the number of renal vessels were compared with those of the DSA and CE-MRA. RESULTS: DSA and CE-MRA showed 100% agreement in identifying the main renal arteries, accessory renal artery, and renal veins before surgery. In the DSA and CE-MRA group (n=10), the accuracy relative to the intraoperative findings was 92.3% (12/13) for the renal artery and 100% (10/10) for the renal vein. In the CE-MRA alone group (n=21), 93.3% (28/30) accuracy was shown for the renal artery and 91.3% (21/23) for the renal vein compared with the intraoperative findings. CONCLUSIONS: CE-MRA showed similar agreement and accuracy to DSA. As a minimally invasive technique, CE-MRA has the potential to replace DSA.

Primary Amyloidosis of the Bladder / 대한비뇨기과학회지

Amyloidosis is a systemic disease characterized by the deposition of homogenous, eosinophilic and hyaline protein. Most cases of amyloidosis occur as a systemic disease, with a poor prognosis. Conversely, primary localized amyloidosis of the bladder has an excellent prognosis in most cases, it is, therefore, important to distinguish primary localized from systemic amyloidosis. Primary localized amyloidosis of the bladder is a rare disease, causing hematuria, which is often confused with bladder cancer. The diagnosis is usually made from a biopsy and subsequent pathological examination. We report a case of primary localized amyloidosis of the bladder, occurring in a 73 year old man, treated with a transurethral resection.

Laparoscopic Intraperitoneal Drainage of Lymphocele Developed Adjacent to the Kidney Transplanted / 대한비뇨기과학회지

Lymphoceles are the most frequent surgical complications following kidney transplantation. Symptomatic lymphoceles following kidney transplantation are managed best by surgical marsupialization with intraperitoneal drainage. We performed laparoscopic intraperitoneal drainage in a patient with a large lymphocele and secondary hydronephrosis following a kidney transplant.