A Case of Growth Hormone Deficiency that Induced Erectile Dysfunction / 대한남성과학회지

Growth hormone deficiency is the medical condition of inadequate production of growth hormone. Growth hormone deficiency in adults is not common, but it may feature a diminished, lean body mass, poor bone density and a number of physical and psychological symptoms, including poor memory, social withdrawal and even depression. Abnormally low growth hormone levels in adults typically result in a diminished quality of life and it can even be disabling. The physical symptoms include loss of strength, stamina, and musculature. Growth hormone deficiency can also impair the biological and physiological/functional substrate of penile erection, which can be, at least in part, restored by the normalization of the plasma levels of growth hormone. This is a report on a 63-year-old man who suffered with severe erectile dysfunction and loss of libido due to growth hormone deficiency. Upon growth hormone administration, his erectile function improved dramatically.

Effect of Topical Steroids(0.05% Clobetasol Propionate) in Children with Phimosis / 대한비뇨기과학회지

PURPOSE: We evaluated the effect of a topical steroid(0.05% clobetasol propionate[Dermovate(R)]) on phimosis. MATERIALS AND METHODS: Between May 2005 and May 2007, 30 boys with phimosis were assigned to receive topical application of Dermovate(R). Of the 30 boys, 19 boys had concealed penises. The parents of the boys were instructed to retract the foreskin gently without causing pain, and to apply the topical steroid over the stenotic opening of the prepuce twice daily for 4 weeks then for another 4 weeks if no improvement was achieved. Retractibility of the prepuce was graded from 1-6. Response to treatment was arbitrarily defined as improvement in the retractibility score(complete response, score 5 and 6; partial response, score 3 and 4; no response, score 1 and 2). The effect of treatment was studied with respect to the duration of treatment, age, and an associated concealed penis. RESULTS: The pretreatment grade in all patients was a retractibility score of 1. The mean age of the patients was 48.5+/-27.6 months(range, 7-108 months). The complete response rates in boys treated for 4 and 8 weeks were 50% and 73.3%, respectively. In boys younger than 3 years of age (n=12) and older than 3 years of age(n=18), the complete response rates were 75% and 72.2%, respectively(p=0.866). In boys with or without an associated concealed penis(n=19 and n=11, respectively), the complete response rates were 63.1% and 90.9%, respectively(p=0.199). No adverse effect was encountered in all patients. CONCLUSIONS: Our data suggest that the application of topical steroids for 8 weeks as a first line treatment of phimosis may be effective, although further studies are needed to establish the definite efficacy and safety of this procedure.

Ten-year Experience of Adult Hypospadias Repairs at a Single Center / 대한비뇨기과학회지

PURPOSE: We retrospectively evaluated the results and complications of urethroplasty in adult patients with hypospadias. MATERIALS AND METHODS: Between February 1997 and June 2007, 21 adult patients with hypospadias underwent urethroplasty. The types of hypospadias were as follows: megameatus intact prepuce(MIP; n=4), subcoronal(n=5), distal penile(n=3), midshaft(n=2), penile(n=2), penoscrotal(n=2), and scrotal(n=3). Among the 21 patients, 13 were in the primary operative (group A) and 8 were in the re-operative(group B). RESULTS: The mean age of the patients was 32.4+/-6.4 years(group A, 33.1+/-6.0 years; group B, 31.1+/-7.8 years). The mean duration of catheter drainage was 8.0+/-2.4 days(group A, 7.9+/-1.8 days; group B, 8.0+/-2.1 days). The surgical procedures included tubularized incised plate urethroplasty(n=14), Thiersch-Duplay(n=3), pyramid(n=3), and transverse preputial island flap (n=1). The overall success rate was 61.9%(group A, 92.3%; group B, 12.5%). Urethrocutaneous fistulas and a meatal stricture occurred in 6 and 1 patients, respectively, with both occurring in 1 patient(38.1% overall complication rate). Fistula repairs were performed successfully in 4 patients and another fistula resolved spontaneously. The meatal strictures were treated with simple dilatation. CONCLUSIONS: Our data demonstrated a very high success rate in the treatment of primary adult hypospadias. And more careful surgical procedure is needed in patients who had history of previous failure more than 2 times because of significantly high complacation rate.

The Effect of Expressions of Vasoactive Intestinal Polypeptide and Nicotinamide Adenine Dinucleotide Phosphate Diaphorase in the Anterior Vaginal Wall on Female Urinary Incontinence and Sexual Function / 대한비뇨기과학회지

PURPOSE: We performed immunohistochemical analysis of vasoactive intestinal polypeptide (VIP) and nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase in the anterior vaginal wall, and we investigated their relations to the females sexual life and their stress urinary incontinence. MATERIALS AND METHODS: From December 2002 to April 2003, 55 urinary incontinent women, who were treated with tension-free vaginal tape (TVT), participated in this study. Their average age was 52.3 years old. We evaluated their sexual function with the Korean version of female sexual function index (FSFI). Anterior vaginal wall tissues 1x1cm in size were obtained during the TVT operation, and they were analyzed by immunohistochemical technique for VIP and NADPH diaphorase. We counted the number of nerve fibers containing VIP or NADPH diaphorase in the microscopic field of view. We verified the results with a Student's t-test and spearman test to identify the relations immunohistochemical results to the females sexual function and urinary incontinence. RESULTS: Expression of VIP was significantly low in grade III incontinence, but there was not a significant difference for the other parameters of incontinence. Expression of NADPH diaphorase had no significant relation with any factor of incontinence. For the relation between expression of VIP and NADPH diaphorase and the FSFI score, the domain of arousal shows a significant difference with the expression of VIP and NADPH diaphorase, according to FSFI score. CONCLUSIONS: From the above results, we suggest that VIP and NADPH diaphorase may affect the structure and functions of the female pelvic floor and these neurotransmitters act on the arousal phase of female sexual function.

The Effect of Expressions of Vasoactive Intestinal Polypeptide and Nicotinamide Adenine Dinucleotide Phosphate Diaphorase in the Anterior Vaginal Wall on Female Urinary Incontinence and Sexual Function / 대한비뇨기과학회지

PURPOSE: We performed immunohistochemical analysis of vasoactive intestinal polypeptide (VIP) and nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase in the anterior vaginal wall, and we investigated their relations to the females sexual life and their stress urinary incontinence. MATERIALS AND METHODS: From December 2002 to April 2003, 55 urinary incontinent women, who were treated with tension-free vaginal tape (TVT), participated in this study. Their average age was 52.3 years old. We evaluated their sexual function with the Korean version of female sexual function index (FSFI). Anterior vaginal wall tissues 1x1cm in size were obtained during the TVT operation, and they were analyzed by immunohistochemical technique for VIP and NADPH diaphorase. We counted the number of nerve fibers containing VIP or NADPH diaphorase in the microscopic field of view. We verified the results with a Student's t-test and spearman test to identify the relations immunohistochemical results to the females sexual function and urinary incontinence. RESULTS: Expression of VIP was significantly low in grade III incontinence, but there was not a significant difference for the other parameters of incontinence. Expression of NADPH diaphorase had no significant relation with any factor of incontinence. For the relation between expression of VIP and NADPH diaphorase and the FSFI score, the domain of arousal shows a significant difference with the expression of VIP and NADPH diaphorase, according to FSFI score. CONCLUSIONS: From the above results, we suggest that VIP and NADPH diaphorase may affect the structure and functions of the female pelvic floor and these neurotransmitters act on the arousal phase of female sexual function.

Outcomes of Tension-free Vaginal Tape According to Postoperative Period in the Treatment of Female Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: To study the outcomes and complications of tension-free vaginal tape(TVT) operations, according to postoperative period, and compare our results with those in the literature. MATERIALS AND METHODS: 340 patients were followed up for at least 3 months, between March 1999 and September 2001. During the postoperative period, the objective and subjective success rate, along with the postoperative complications, were evaluated. The mean age was 50.6+/-10.1 years. Among the 340 patients, 279(81.8%) and 61(19.4%) were diagnosed with stress and mixed incontinences, respectively. The patients were classified according to their symptom grades; grade I(n=66, 19.4%), grade II (n=240, 70.6%) and grade III(n=34, 10.0%). RESULTS: 113, 117, 44 and 66 of the 340 patients were observed postoperatively for 1, 1-2, 2-3 and for over 3 years, respectively. Of these, 137 completed questionnaires for evaluation of the subjective outcome. The objective success rates were high, irrespective of the extent of the postoperative period. The 1, 1-2, 2-3 and over 3 years postoperative period objective success rates were 93.8, 87.5, 89.5 and 93.3%, respectively. The subjective success rates were also high, irrespective of the extent of the postoperative period; 87.5, 75.0, 84.3 and 90.0% 1, 1-2, 2-3 and beyond 3 years, respectively. Postoperative complications occurred in 15 cases, including 12 bladder perforation due to the TVT device, 2 cases of bladder injury due to guide wire and one of vessel injury. 13 cases developed de novo urgency, although, they were cured with anticholinergic medication. Other serious complications, such as wound infection, hemorrhage requiring transfusion and nerve injury, were absent. CONCLUSIONS: Both the short and long term results were excellent, regardless of the extent of the postoperative follow-up period. TVT should play a significant role in treating female urinary incontinence, due to its availability and stability.

The Early Outcomes of Extraperitoneal Radical Cystectomy / 대한비뇨기과학회지

PURPOSE: Radical cystectomy with pelvic lymphadenectomy is an effective therapeutic modality in invasive bladder cancer. The development of another technique for a radical cystectomy for the early recovery and reduction of complications was attempted. MATERIALS AND METHODS: Between March 1997 and June 2003, an extraperitoneal radical cystectomy was attempted in 18 patients with invasive bladder cancer (pT1-pT4). Not only standard or extended pelvic lymphadenectomy, but also re-positioning of the ureter to the opposite side, could be performed extraperitoneally. An intestinal segment could be taken out through a small window within the peritoneum and manipulated as desired. The clinical safety and complications of other surgical approaches for radical cystectomy were also investigated. RESULTS: The procedure was successful in 15 of the 18 patients (4 studer pouches, 3 ileal conduits and 8 ureterocutaneostomies). Failure to peel out the peritoneum occurred in 3 cases, 1 each due to technical difficulties, tumor invasion at the bladder dome and adhesion due to a previous radical prostatectomy. Complications occurred in 8 cases (53.1%). The intestinal obstruction progressed in 1 case (12.5%) due to a high positioned mesentery of the Studer pouch. There were no significant gastrointestinal complications in any of the 8 patients that underwent the extraperitoneal radical cystectomy with ureterocutaneostomy. CONCLUSIONS: An extraperitoneal radical cystectomy seems to reduce the gastrointestinal complications and be worthwhile in certain cases with advanced bladder cancer. Despite the visual limitation, it is an acceptable surgical technique compared to the conventional transperitoneal methods.

Emphysematous Cystitis Complicated with Diabetic Nephropathy / 대한비뇨기과학회지

Emphysematous cystitis is an uncommon condition in which pockets of gas are formed in and around the bladder wall by gas-forming organisms. Patients with diabetes, neurogenic bladder and chronic urinary infection are predisposed to the disease. Severity of illness ranges from an asymptomatic condition to life-threatening cystitis. Successful management depends on early diagnosis with correction of underlying causes, administration of appropriate antibiotics, establishment of adequate bladder drainage and surgical excision of involved tissue when required. Early detection and prompt treatment are encouraged. We report one case of emphysematous cystitis complicated with diabetic nephropathy in a 68-year-old woman.