Warm Sitz Bath: Are There Benefits after Transurethral Resection of the Prostate?

PURPOSE: We aimed to evaluate the efficacy of warm water sitz baths in patients who have undergone transurethral resection of the prostate (TURP) owing to lower urinary tract symptoms secondary to benign prostatic hyperplasia. MATERIALS AND METHODS: We reviewed the records of 1,783 patients who had undergone TURP between 2001 and 2009. In the warm water sitz bath group, patients were instructed to sit in a tub containing lukewarm water at 40-45degrees C for 10 minutes each time. Patients were advised to perform the procedure for at least 5 days immediately after the removal of a Foley urethral catheter. The differences in post-TURP complications between the warm water sitz bath group and the no sitz bath group were compared. RESULTS: After TURP, 359 of the 1,561 patients performed a warm water sitz bath. Complications after TURP, such as hemorrhage, urinary tract infection, urethral stricture, and acute urinary retention were found in 19 (5.3%) and 75 (6.2%) patients in the sitz bath and no sitz bath groups, respectively (p=0.09). There was a significant difference in postoperative complications such as urethral stricture between the warm sitz bath group and the no sitz bath group (p=0.04). The group that did not undergo warm water sitz bath treatment showed a 1.13-fold increased risk of rehospitalization within 1 month after TURP due to postoperative complications compared with the warm water sitz bath group (odds ratio [OR]=1.134; 95% confidence interval [CI], 1.022 to 1.193; p=0.06). CONCLUSIONS: Warm water sitz bath treatment reduced postoperative complications such as urethral stricture. These results suggest that large-scale prospective studies are needed to establish an ideal method and optimal duration of sitz baths.

Renal Abscesses Measuring 5 cm or Less: Outcome of Medical Treatment without Therapeutic Drainage

PURPOSE: Diagnosis and proper treatment of renal abscesses remains a challenge for physicians. We investigated the characteristics and comorbidity factors of renal abscesses measuring 5 cm or less and critically examined the effectiveness of conservative treatment. MATERIALS AND METHODS: Between February 2001 and March 2009 the records of 63 patients initially diagnosed at our hospital with renal or perirenal abscesses were retrospectively reviewed. In 63 patients with renal and perirenal abscesses, 51 abscesses measured 5 cm or less, and 49 abscesses were treated with intravenous antibiotics alone. RESULTS: Most patients were women (91.8%), and their mean age was 42.3 years. The mean size of renal abscesses was 3.6 cm. The most common predisposing condition was diabetes mellitus (DM) (46.9%). Common clinical features were fever (83.7%) and flank pain (53.1%). On urinalysis, 31 (64.6%) cases had positive bacterial cultures with Escherichia coli (50.0%) being the most common pathogen. All 49 patients were treated with broad-spectrum intravenous antibiotics alone. All patients showed complete clinical regression and resolution of the renal lesions shown by CT between 3 and 14 weeks. The average hospital stay was 15.3 days (range, 5-31 days). Significant predictors of a long hospital stay were age, abscess size, and DM. CONCLUSION: Medium-sized as well as small-sized renal abscesses were treated successfully with intravenous antibiotics alone. DM was a significant predictor of prolonged hospital stay. If therapeutic drainage is believed to involve considerable risk, then intravenous antimicrobial therapy may be a good alternative treatment.

Long-term Follow up of Augmentation Ileocystoplasty with Goodwin's Ileal Cup Patched Bladder / 대한비뇨기과학회지

PURPOSE: We evaluated the long-term outcomes in patients undergoing augmentation ileocystoplasty with Goodwin(')s ileal cup patched bladder. MATERIALS AND METHODS: This was a retrospective study of 72 consecutive patients who underwent augmentation ileocystoplasty because of decreased bladder capacity, vesico-ureteral reflux and urinary incontinence. The outcomes assessed included the continence status, bladder capacity, upper tract status, and significant post-operative complications. RESULTS: The 72 patients studied(61 men and 11 women) were 12 to 62 years old(mean age 35.6). The follow up was 0.3 to 7.9 years(mean 5.4). The preoperative diagnoses were a neurogenic bladder from spinal cord injury in 54 patients, meningomyelocele in 5, pelvic trauma in 3, polymyelitis in 2, GU tuberculosis in 2, cerebrovascular diseases in 2, and disc rupture in 2. The bladder capacity was significantly increased from 168cc to 392cc postoperatively and the maximal bladder capacity was increased along with the decreased number of daily clean intermittent catheterizations. The most common complication related to surgery was a paralytic ileus. While most cases of unilateral reflux disappeared, bilateral or high grade reflux remained during the postoperative follow up period. CONCLUSIONS: Bladder augmentation provided durable clinical and urodynamic improvement for patients with neurogenic and contracted bladders.

Twenty Years of Experience with Artificial Urinary Sphincter Implantation / 대한비뇨기과학회지

PURPOSE: The efficacy of the artificial urinary sphincter(AUS) in treating sphincteric incontinence has been clearly demonstrated. We report on 20 years of experience using artificial sphincter implantation at a single institute. MATERIALS AND METHODS: The follow-up data for 37 patients who received AUS(AMS 800(TM)) implantation between 1987 and 2006 at Yonsei University were available for this study. We investigated various components of the medical records, such as the number of pads used per day, results of pre-operative urodynamic studies, operative and post-operative complications, and revision rate. RESULTS: Mean patient age was 35.6 years(range 15-64 years), and mean follow-up duration was 12.4 years(range 1.4-19.8 years). Of the 37 patients, 21 had neurogenic bladder, and 9 had traumatic injury. Other causes of incontinence included post-operative complications(4 patients) and congenital anomalies(3 patients). The cuffs were placed were in the bladder necks of 21 patients and in the bulbous urethrae of 16 patients. The average number of pads used daily decreased significantly from 6.2 to 1.2 after the operation, and 27 patients(72.9%) were able to maintain 'dry-up status' (number of pads used< or=1). A total of 32 artificial sphincters remained in place(86.4% survival rate), with 8 revisions(21.6%) required secondary to infection, mechanical failure, or urethral stone. CONCLUSIONS: AUS implantation is a safe and durable treatment for urinary incontinence in patients with intrinsic sphincter deficiency from various underlying diseases.

The Difference in Mode of Administration of International Prostate Symptom Score (IPSS) in Patients with Lower Urinary Tract Symptoms / 대한비뇨기과학회지

PURPOSE: The International Prostate Symptom Score (IPSS) is generally self- administrated; however, it is doubtful that the self-administrated IPSS score correctly reflects patients' symptoms; therefore, the difference in the IPSS self-administrated score and physician-interviewed patients was studied. MATERIALS AND METHODS: A total of 202 patients completed two IPSS questionnaires during the same office visit, one by self-administration and the other by physician-interview, at two medical centers, one located in an urban area and the other in a rural area. The mean total symptom score and the score for each question, and the quality of life score were compared between the two modes of administration. A multi-logistical regression analysis was performed to identify differences due to the effects of age, the order of administration, location and educational level. RESULTS: The mean total symptom score and quality of life score were higher in the self-administrated than physician-interviewed group (14.16 vs. 13.07, p=0.001, 3.27 vs. 3.2, p=0.090). The residual sense (2.03 vs. 1.97, p=0.20), frequency (2.07 vs. 1.97, p=0.026), interruption (1.83 vs. 1.61, p=0.002), urgency (1.89 vs. 1.55, p=0.001), weak stream (2.74 vs. 2.60, p=0.042), hesitancy (1.77 vs. 1.59, p=0.005) and nocturia (1.82 vs. 1.77, p=0.12) were also higher in the self-administrated group. The multi- logistical regression analysis revealed statistically significant differences in relation to age and location. CONCLUSIONS: The self-administrated IPSS score was higher than the physician-interview score, especially in relation to an older age and an urban location. Therefore, active intervention should be considered during the administration of the IPSS, especially for old aged patients living in urban areas.

Duloxetine versus Placebo for the Treatment of Korean Women with Stress Predominant Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: To compare duloxetine with placebo for the treatment of Korean women with stress urinary incontinence (SUI). MATERIALS AND METHODS: This was a phase 3, double-blind, stratified, randomized, parallel, placebo-controlled, multi-center study investigating efficacy and safety of a of duloxetine compared with placebo in the treatment of SUI. After a 2-week no-drug screening period, women ages 29-69 were randomly assigned to placebo (n=60) or duloxetine (n=61) as 40mg twice daily for 8 weeks followed by a 2 week no-drug period. Women were seen at 4-week intervals. The primary efficacy variable was percent change in incontinence episodes frequency (IEF)/week. Secondary variables included percent change in, changes in Incontinence Quality of Life (I-QoL) total and 3 sub-scale scores, and Patient Global Impression of Improvement (PGI-I) ratings. Safety was evaluated by treatment emergent adverse events (TEAE), discontinuations due to adverse events, vital signs measurements, and clinical laboratory tests. RESULTS: There were statistically significant improvements with duloxetine compared with placebo in IEF (duloxetine baseline 16.4IEF/wk, endpoint 7.7IEF/wk, median percent reduction=50.0% vs placebo baseline 13.3IEF/ wk, endpoint 8.8IEF/wk, median percent reduction=37.1%, p=0.033), and avoidance and limiting behavior subscale (p=0.006) in I-QoL. TEAEs were reported significantly more often in the duloxetine group compared with the placebo group (82.0% vs 31.7%; por=5% in duloxetine-treated subjects and p<0.05) were nausea, dizziness, anorexia, fatigue, lethargy, abdominal discomfort, and constipation. Discontinuation rates because of AEs were 34.4% for duloxetine and 8.3% for placebo. CONCLUSIONS: These data provide evidence for the safety and efficacy of duloxetine for the treatment for Korean women with SUI.

Desire to Void in Patients with Complete Spinal Cord Injury

OBJECTIVE: To classify complete spinal cord injury (SCI) patients based on the preservation of desire to void and to make clear the difference between each group METHOD: This study was performed retrospectively on 117 complete SCI patients with lesions above T11 who were referred to the urodynamic laboratory. Patients were classified according to the preservation of desire to void during conventional urodynamic study. The clinical and urodynamic characteristics of each group were analyzed. RESULTS: There were 37 patients (31.6%) with the preservation of desire to void. There were significantly lower compliance of bladder and longer duration from onset to examination in the sensory preservation group than the nonpreservation group (p<0.05). There were no significant difference in clinical features such as voiding method, the presence of autonomic dysreflexia between each group. CONCLUSION: The presence of desire to void was noted in 31.6% of complete SCI patients observed.

The Significance of Repeat Prostate Biopsy for the Detection of Prostate Cancer / 대한비뇨기과학회지

PURPOSE: To evaluate the results of serial prostate biopsy in men with elevated prostate-specific antigen (PSA) levels, where the initial biopsies were negative for cancer. MATERIALS AND METHODS: Between January 2000 and December 2003, 750 men with a serum PSA level of 4.0ng/ml or greater underwent transrectal ultrasound guided needle biopsy of the prostate, with 218 (29.1%) diagnosed as having prostate cancer. Of the other 532 men, 104 (19.5%), whose follow-up PSA level was persistently elevated beyond the normal range, underwent a second biopsy, with 26 (4.9%) undergoing third and subsequent biopsies for the same reason. The cancer detection rates after each biopsy session, and reliable predictors for prostate cancer after the 2nd biopsy in those whose PSA level was in the gray zone, were evaluated. RESULTS: The cancer detection rates of the 1st, 2nd and 3rd biopsies were 29.1, 16.3 and 30.7%, respectively, with 10.3% of the prostate cancers detected in this study missed on the initial biopsy. The detection rate of the second biopsy in gray zone patients was 13.1%, which was comparable to the first biopsy result (12.7%) for the same range group. The median PSA, % free PSA and PSA density were significantly different between the prostate cancer and non-cancer groups after the second biopsy in gray zone patients (p<0.05). CONCLUSIONS: 10.3% of the prostate cancers detected in this study were missed on the initial biopsy. The median PSA, % free PSA and PSA density are reliable predictors of prostate cancer after the second biopsy in gray zone patients.

Primary Amyloidosis of the Urinary Tract / 대한비뇨기과학회지

Primary localized amyloidosis of the urinary tract is very rare disease. A 72-year-old man, with a history of urethral injury, had a stricture of the anterior urethra about 6cm in length. A segmental resection of urethra and urethroplasty, with penile skin flap, was performed. The resected urethral segment was diagnosed as urethral amyloidosis. There was no involvement of amyloidosis oin the other organs (heart, gastrointestinal system, joint, kidney, skin etc) and no underlying disease (multiple myelomas, rheumatism, cancer, chronic inflammation etc). Also, a 75-year-old woman, with a history of intermittent gross hematuria, had a stricture of the lower ureter. During diagnostic ureteroscopy, there was an irregular mucosal change of her lower ureter. An intraoperative biopsy showed ureteral amyloidosis. Here, we report on these two cases of primary amyloidosis of the urinary tract.

The Clinical Experience of the Bladder Augmentation with Goodwin's Ileal Cup-patched Bladder / 대한비뇨기과학회지

PURPOSE: Augmentation enterocystoplasty is a valuable technique, as a surgical repertoire, for urologists treating a myriad of conditions that cause either a small anatomic or functional bladder capacity. A variety of surgical techniques for augmentation cystoplasty have been developed. The clinical availability of augmentation cystoplasty was evaluated using a Goodwin's ileal cup-patched bladder in patients with a small capacity, high pressure, poorly compliant and unstable bladder. MATERIALS AND METHODS: At our institute, 21 patients, with a neurogenic bladder, have undergone augmentation cystoplasty using a Goodwin's ileal cup-patched bladder, since July 1999. The mean age at operation and follow-up period were 32 years and 11 months, respectively. 9 patients had various degrees of vesicoureteral reflux. The preoperative assessments included urinalysis, urine culture, renal function tests, voiding cystourethrography and urodynamic evaluation. RESULTS: The mean bladder capacity increased from 170cc preoperatively to 438cc postoperatively. The mean maximal end-filling intravesical pressure decreased from 55cmH2O to 22cmH2O, with a significant increase in bladder compliance. There were no significant complications that required surgical revision. CONCLUSIONS: Augmentation cystoplasty using a Goodwin's ileal cup-patched bladder offers a high success rate, with low complications, in selected patients with neurogenic bladder dysfunction.

Age-Specific Reference Ranges for Serum Prostate-Specific Antigen: Community-based Survey in Namhae Region / 대한비뇨기과학회지

PURPOSE: To establish the relationship between serum prostate specific antigen (PSA) concentration and age in a community-based population without clinically evident prostate cancer, a population based screening study was performed in a rural area in Southern Korea. MATERIALS AND METHODS: From January 1999 to December 1999, 1,278 volunteer men aged from 40 to 89 years in Namhae, Korea participated in a clinical examination that included a serum PSA determination (TANDEM-R assay), digital rectal examination and transrectal ultrasonography. The subjects who had clinical evidence of prostate cancer and high PSA concentration (>10ng/ml) were excluded. The PSA levels were compared with age using Pearson correlation and linear regression analysis. RESULTS: The serum PSA concentration correlated with patient age (r=0.129, p=0.001). The observed 95th percentile increased from 1.37ng/ml for subjects in the 40's to 6.18ng/ml for subjects in the 80'2. The reference range for serum PSA (95 percentile) for men in the 40's was 0.24 to 1.37ng/ml; for 50 to 59 years, 0.27 to 2.68ng/ml; for 60 to 69 years, 0.25 to 4.00ng/ml; for 70 to 79 years, 0.29 to 4.55ng/ml; and for 80 to 89 years, 0.31 to 6.18ng/ml. CONCLUSIONS: Our data showed that the serum PSA concentration directly correlated with patient age (Pearson correlation coefficient=0.129, P=0.001). Thus, rather than relying on a single reference range regardless of different age groups, it may be more appropriate to have age-specific reference ranges. Our data were lower than that of the Western data, and could provide an adjunctive information in interpreting PSA data in Korean men, especially in the elderly population.

Prostate Volume Variation with Age: Community-based Survey in Namhae Region / 대한남성과학회지

PURPOSE: The size of prostate increases with age, but there has been few Korean data on the prostate size in the general population. We thereby report the size of prostate with respect to age in Korean men residing in Namhae, Korea. MATERIALS AND METHODS: To determine the prostate size, 1421 men from Namhae, Korea underwent transrectal ultrasonography. Size of the prostate was estimated as a weight by the elliptical method. RESULTS: The mean prostate weight was 33.5 10.6 ml. The relationship between prostate volume and age was statistically significant in 1421 men (Pearson correlation coefficient=0.156, p=0.0001). Also, between the normal group and the groups of men with lower urinary tract symptoms (LUTS), there was significant correlation with age (Pearson correlation coefficient=0.162, p=0.0001), while results were insignificant with size (Pearson correlation coefficient= 0.170, p=0.0001). CONCLUSIONS: Size and rate of growth of the prostate were smaller compared to the Western society, nevertheless, prostate size increased with age. For accurate and reasonable age-specific size of the prostate of Korean male, more community based multicenter study will be needed with more refined measurement techniques such as step-section planimetry for the prostatic volume estimation.

Dorsal Nerve Somatosensory Evoked Potential Test for Localizing the Lesion in Neurogenic Erectile Dysfunction / 대한비뇨기과학회지

No abstract available.

Effects of Androgen on Telomerase Activity in the Adult Rat Penis / 대한비뇨기과학회지

PURPOSE: Telomerase functions to maintain telomere length and its activity are generally present in most cancer cells, germ line cells but typically are not present in normal somatic cells. Among few exceptions, telomerase activity is detected in hematopoietic stem cells and in physiologically renewable cell populations. The adult rat penis exhibits the ability to regenerate during androgen replacement after castration, we hypothesized that a pool of cells with regenerating potential is present in the adult rat penis, and therefore assayed for the telomerase activity in the castrated and androgen replaced adult rat penis. MATERIALS AND METHODS: Adult male Sprague Dawley rats were divided into 4 groups; control, castration, and androgen(testosterone, DHT) replacement after castration. Percentage of apoptotic cells assessed by morphological analysis(apoptotic index, TUNEL), and proliferating cells incorporating Ki-67(proliferating index) were analyzed. Telomerase activity was detected by using a PCR-based telomerase assay(Telomeric repeat amplification protocol). RESULTS: Following castration, serum testosterone significantly decreased from day 1. Normal penis was found to be telomerase positive. Since serum testosterone decreased after castration, a significant decrease for the activity of telomerase was noted with a decrease in the proliferating index and an increase in apoptotic index in the penis. Replacement of androgen after castration increased the telomerase activity with an increase in the proliferating index and a decrease in apoptotic index in the penis. CONCLUSIONS: These results provide evidence for the ability of androgen to regulate telomerase activity in the adult rat penis, and the adult rat penis retains throughout life the potential to regenerate in response to androgen replacement following castration-induced apoptotic cell death.

Effect of Glucocorticoid on Rabbit Corpus Cavernosum Smooth Muscle / 대한비뇨기과학회지

PURPOSE: Glucocorticoid contribute to the pathogenesis of hypertension through intracellular signals that stimulate vascular smooth muscle contraction. However, some in vitro and in vivo studies have shown that glucocorticoid has the potential role of vasorelaxation. Therefore, we tried to investigate the effect of short acting glucocorticoid (hydrocortisone; HCS) on the isolated rabbit cavernosal smooth muscle for evaluation of the possibility of using this material as a pharmacoerecting agent. MATERIALS AND METHODS: Strips of rabbit corpus cavernosum were mounted in organ chambers. On the precontracted muscle strips with phenylephrine(PHE; 5x10-6M), HCS was treated with increasing concentration from 10microgram/mL. The relaxing activity of ACh(10-7M), phentolamine(10-8M), papaverine(10-8M), verapamil(10-6M), PGE1(10-2M), SNAP(5x10-5M) were observed with the preparation of HCS. Depolarization by KCl were observed with HCS to investigate the relationship of HCS effects to K+. RESULTS: Pretreatment of muscle strips with low dose of HCS caused concentration-related increase of a PHE induced contraction. On muscle strips submaximally precontracted with PHE, HCS(10microgram/mL to 100microgram/mL) showed no relaxations. Pretreatment of muscle strips with 10microgram/mL dose of HCS caused a potentiation of a relaxation effects of ACh, papaverine, verapamil, SNAP, PGE1 and 50microgram/mL dose of HCS caused a potentiation of a relaxation effects of ACh, phentolamine. However, 100microgram/mL dose of HCS did not produce changes of these potentiating responses to relaxation. Also, HCS did not influenced the depolarization with any concentrations of KCl. CONCLUSIONS: HCS has the potentiating effect of both the PHE-induced contraction, and the relaxation of the ACh, phentolamine, papaverine, verapamil, SNAP, PGE1 at 10-50microgram/mL concentration on the cavernosal smooth muscle.

Incidence of Flutamide-induced Liver Toxicity in Patients with Prostate Cancer in Korea / 대한비뇨기과학회지

PURPOSE: The incidence of flutamide-related liver toxicity was studied in 56 korean patients, treated for advanced prostate cancer with flutamide combined with a LHRH agonist or orchiectomy. MATERIALS AND METHODS: Serum glutamic oxaloacetic transaminase(SGOT), serum glutamic pyruvic transaminase(SGPT), total bilirubin and alkaline phosphatase were measured to assess liver function at baseline, 1, 2 and 3 months and every 3 months thereafter. When they were elevated three-fold or more than upper normal levels, we regarded it as a presence of liver toxicity. Viral marker studies (Hepatitis B, C) were performed in patients with elevated SGOT and/or SGPT after flutamide administration. RESULTS: Ten patients(17.9%) showed elevated SGOT and/or SGPT at an average of 3 months after flutamide administration. All patients who performed viral marker studies revealed negative results. Total serum bilirubin was elevated in three(5.4%) patients and clinical jaundice appeared in one(1.8%). All clinical and biochemical manifestations of liver toxicity disappeared within two months after discontinuation of flutamide and no sequelae was observed for 15 months. CONCLUSIONS: The Incidence of flutamide-Induced hepatotoxicity seems to be higher In Korea than in North America. But this might not be due to the fact that Korea is an endemic area of viral hepatitis. Further study will be necessary for the verification of dose-related toxicity of flutamide in Korean prostate cancer patients. We recommend liver function test periodically to patients treated with flutamide.

Urodynamic Studies of the Voiding Disorders in Patients with Idiopathic Parkinson`s Disease and Multiple System Atrophy / 대한비뇨기과학회지

PURPOSE: The onset and severity of voiding dysfunction in multiple system atrophy(MSA) is more early and severe than that of idiopathic Parkinson's disease(IPD). We compared the voiding symptoms and urodynamic findings in patients with MSA and IPD in order to elucidate the characteristics of their voiding dysfunction. MATERIALS AND METHODS: We reviewed urodynamic data from 19 men and 10 women with parkisonism. Of the 29 patients(mean age 66.5 years), 19 patients (mean age 68.7 years) had IPD and 10 patients(mean age 62.4 years) had MSA. The mean duration of the disease in all patients was 4 years and 10 months, and there was no significant difference between IPD and MSA. RESULTS: Detrusor hyperreflexia(DH) was seen in 8 patients, detrusor hypereflexia with impaired detrusor contractility(DHIC) in 3, detrusor hyperreflexia with bladder outlet obstruction(DHOB) in 4, impaired detrusor contractility(If) in 8, and normal findings in 6. In IPD, DH was noted in 5 patients, DHIC in 3, DHOB in 2, IC in 5 and normal in 4, and a similar distribution was seen in MSA. However, there was no significant difference in the prevalence of involuntary detrusor contraction between IPD and MSA. Irritative voiding symptoms were seen in 11 patients, obstructive symptoms in 10, and both in 8. Obstructive symptoms were dominate in IPD and irritative symptoms in MSA. Impaired relaxation of the voluntary sphincter was seen in 12(41%) patients with parkisonism,8 in IPD, and 4 in MSA. CONCLUSIONS: There was no difference between idiopathic Parkinson's disease and multiple system atrophy in mean age, sex, mean duration of disease, subjective voiding symptoms and urodynamic findings. Disease specific findings were not identified in patients with parkinsonism.

Clinical and Urodynamic Effects of Propiverine Hydrochloride for Neurogenic Bladder Patient with Urinary Frequency and Incontinence / 대한비뇨기과학회지

PURPOSE: Patients with neurogenic bladder ultimately undergo morphometric and functional changes of their bladder and urethra. As a result, voiding symptoms such as frequency, nocturia, urgency and incontinence appear Propiverine hydrochloride(BUP-4) is a benzylic acid derivative with musculotropic antispamodic activity and moderate anticholinergic effect. We evaluated the clinical and urodynamic effects of BUP-4 for patients with neurogenic urinary frequency and incontinence MATERIALS AND METHODS: Twenty six patients with neurogenic bladder suffering from urinary frequency and incontinence(including 5 placebo) were given 20mg of BUP-4 orally a day and its clinical and urodynamic effect were evaluated. RESULTS: In the group treated with BUP-4 for four weeks, 57.9% in 19 patients with frequency, 53.3% in 15 nocturia, 50.0% in 14 weak stream, 55.6% in 9 intermittency, 50.0% in 10 dribbling, 64.3% in 14 urgency, 55.6% in 9 hesitancy, 73.7% in 19 incontinence showed improvement of their symptom. Urodynamic study performed after treatment with BUP-4 for 4 weeks or more revealed greater than 10% increase in bladder capacity compared to pretreatment study in 11 patients out of 21(52.4%) and their maximum bladder capacity increased significantly from 181.7+/-101.3 to 249.4+/- 184.7mL(p=0.012). Maximum detrusor pressure decreased from 52.5+/-35.6 to 50.9+/- 26.8cmH2O(p=0.010). Changes in compliance and volume on the first urge sense were statistically insignificant. In placebo group, no significant symptomatic and urodynamic improvement were reported. Side effects of the drug had appeared in 7 patients(33.3%) out of 21 after 4 weeks of treatment -5 cases of dry mouth and 2 cases of nausea - but they were not severe enough to stop the treatment. CONCLUSIONS: The use of BUP-4 in patients with neurogenic bladder results in improvement of symptoms and urodynamic profile(bladder capacity and maximum detrusor pressure). Thus, BUP-4 could be used as one of the first line drugs in the treatment of patients with neurogenic bladder.

The distribution of nitric oxide synthase in human corpus cavernosum on various impotent patients

Recent evidence implicates NO (Nitric oxide) as the principal mediator in an erection. To investigate the role of NO in the human erectile function, we studied the distribution pattern of nitroxergic fibers in the corpus cavernosum specimens obtained from 38 men using nicotinamide adenine dinucleotide phosphate diaphorase (NADPH-d) histochemistry. Diffusely scattered delicate nerve fibers showing blue color reaction after NADPH-d histochemical staining were observed in normal control specimens from potent men. The neurogenic impotence group showed a statistically-significant decrease in the number of positive fibers compared to the normal control group. The number of positive fibers in the non-neurogenic impotence group was decreased compared to the normal control group but was statistically insignificant. With nitric oxide synthase (NOS) immunohistochemical stain, immunoreactive nerve bundles were easily seen in normal control specimens from potent men. NOS immunoreactive nerve bundles were contained within the corpus cavernosa which stained with NADPH-d reaction. Our results suggest that nitric oxide, a potent smooth muscle relaxing neurotransmitter in the autonomic nervous system, plays a physiologic role in erectile function and NADPH-d enzyme histochemical staining on the biopsied corpus cavernosum may be used as an important diagnostic method in the evaluation of neurogenic impotence.

The Effect of Temperature and Electrical Energy on Sperm Motility / 대한비뇨기과학회지

Electrical ejaculation is widely used for semen collection in ejaculation failure patients with various causes including spinal cord injury. Semen collected by this method show sperm with low quality, and decrease in sperm motility is especially evident; multifactors are responsible but there are some reports that electrical current and increased temperature during electrical ejaculation are the cause. To confirm this theories, we observed the direct effect of variable electrical current and temperature to the motility of normal sperm in vitro. Semen analysis was performed after temperature was maintained at 37, 39, 41, and 43 `C for 10 minutes and electrical current at 5, 10, 15, 20 Volts for 3, 7, and 10 minutes. 1. Sperm motility change with temperature: The ratio of motile sperm decreased significantly (n=32, p<0.01) from 82.20, 70.12, 60.93, 48.87% as the temperature rose 37, 39, 41, 43 `C, respectively. Factors related to motility (distribution of progressive form and rapid velocity) decreased as well and the distribution of static velocity increased. However, additional semen analysis 20 minutes after rests were not significantly different in sperm motility before and after any temperature changes. 2. Sperm change with electrical energy: The motility of the sperm decreased significantly according to increasing volts and time, which showed a time-dependent and voltage-dependent decrease. The ratio of motile sperm decreased significantly to increasing volts and time and factors related to motility (distribution of progressive form and rapid velocity) also decreased. The distribution of static velocity increased. However, additional semen analysis 20 minutes after rests were not significantly different in sperm motility before and after inducing electrical energies. These data suggest that the effect of electrical current and temperature to sperm motility is temporary and that the low quality of sperm collected by electrical ejaculation in patients with ejaculation failure may not be due to the effect of electrical ejaculation but the various conditions of the patients themselves.