The Urodynamic Findings of Male Patients with LUTS and the Effects of the Pre-operative Parameters on the Outcome of Transurethral Resection of the Prostate / 대한비뇨기과학회지

PURPOSE: We tried to find out the urodynamic features of the male patients suffering with lower urinary tract symptoms (LUTS) and we wanted to know the effects of the preoperative parameters on the outcome of transurethral resection of the prostate (TURP). MATERIALS AND METHODS: One hundred ninety four patients who had LUTS and who had undergone urodynamic study were available for analysis. The history taking and physical examination, urinalysis, International Prostate Symptom Score (IPSS), transrectal ultrasonography, serum prostate-specific antigen (PSA) level check and urodynamic study were performed for all the patients. Also, the postoperative IPSS and satisfaction level were accessed for the patients who had undergone TURP for bladder outlet obstruction (BOO), and the preoperative factors such as age, prostate volume, PSA and urodynamic findings were analyzed. RESULTS: For the total 194 patients, there were 123 BOO patients (63.4%), 62 detrusor overactivity patients (13.4%) and 19 detrusor underactivity patients (9.8%). For the patients who had undergone TURP, the IPSS was decreased from a preoperative value of 20.5 to a postoperative value of 9.0. We divided the patients into two groups in accordance with the level of satisfaction after the operation. Within the two groups, the dissatisfied group showed a preponderance of preoperative detrusor overactivity. When performing IPSS, both groups showed a decreased score with each having a different range: from 20.8 to 6.1 in the satisfied group, and from 23.2 to 14.8 in the dissatisfied group. CONCLUSIONS: BOO is most common cause among the male patients who have LUTS and who are more than 50 years old, but other causes should be considered. Moreover, if BOO accompanies detrusor overactivity, the importance of the preoperative urodynamic findings deserves emphasis, and it will help to predict the results of performing TURP.

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.

Bladder Outlet Obstruction in Female Patients with Lower Urinary Tract Symptom / 대한비뇨기과학회지

PURPOSE: The prevalence of female bladder outlet obstruction(BOO) is not well known and the diagnostic criteria is uncertain. We attempted to find out the features of urodynamic and clinical findings of bladder outlet obstruction in female patients with lower urinary tract symptom. MATERIALS AND METHODS: A total of 251 patients who were referred to urodynamic study for lower urinary tract symptom was available for analysis. Patients who had previous pelvic surgery history or neurologic causes were excluded. History taking, physical examination, voiding diary, urodynamic study were performed. Urodynamic study consisted of free uroflow, urethral pressure profile, cystometry, and pressure flow studies. The criteria of bladder outlet obstruction was peak flow rate at free uroflow less than 12ml/s and detrusor pressure at a maximum flow rate of more than 20cmH2O. Among the patients who were revealed as stress urinary incontinence, but with no other abnormalities at urodynamic study, 30 served as the controls. RESULTS: In 251 patients, 42(16.7%) were BOO patients. There were no significant differences in the clinical features of the two groups, such as age, parity, surgical history. In the urodynamic study, the first voiding sense and maximal bladder capacity were similar in the two groups. Peak flow rate was 24.0+/-10.9ml/s in the control and 7.9+/-1.7ml/s in BOO, the detrusor pressure of maximum flow was 25.8+/-10.4cmH2O and 62.6+/-33.1cmH2O, maximal urethral closing pressure was 55.3+/-20.3cmH2O and 79.5+/-46.8cmH2O, voiding volume was 377.2+/-85.0ml/s and 281.0+/-104.3ml/s, and residual volume was 19.3+/-76.9ml/s and 48.7+/-80.0ml/s, respectively. CONCLUSIONS: Among the female patients who had low urinary tract symptoms, numerous patients were revealed as BOO. BOO must be considered for female patients who have low urinary tract symptoms, and urodynamic studies may play an important role for the diagnosis and treatment of BOO.