The Clinical Implication of Intravesical Prostatic Protrusion to Lower Urinary Tract Symptoms in Patients of Prostatic Volume 30~50gm / 대한남성과학회지

PURPOSE: Intravesical prostatic protrusion (IPP) is a morphological change of prostate protruded into bladder and might be related to bladder outlet obstruction (BOO) depending on the extent of protrusion. There is a high possibility that lower urinary tract symptoms (LUTS) tends to get worse as IPP grows. Therefore, it is necessary to examine the effect of IPP on LUTS after revision of prostate volume in order to identify the direct effect of IPP on BOO and LUTS. MATERIALS AND METHODS: A retrospective study of 296 male patients diagnosed with benign prostate hyperplasia (BPH) between August 2006 and December 2008 were performed. The patients were evaluated with international prostate symptoms score (IPSS) and quality of life (QoL), uroflowmetry (UFR), post-void residual urine volume (PVR), prostate volume and IPP as measured by transurectal ultrasound (TRUS). The changes of IPSS after 8 weeks of medication treatment and the occurrence rates of transurethral resection of prostate (TURP) and acute urinary retention (AUR) were compared. By checking IPSS and UFR, the improvement of voiding symptom was evaluated. RESULTS: The population of patients with moderate enlargement (30-50gm) of prostate extent was 147 (49.6%) out of 296, the whole examined population. There were correlation between IPP and IPSS (p=0.002) and the storage symptoms score was significantly increased (p=0.014). After 8 weeks of medication treatment, both moderate BPH patients with IPP showed similar improvement in storage symptom compared to non-IPP groups. But, the TURP was significantly performed more with IPP (p=0.040) than non-IPP groups and more AUR has occurred (p=0.013). After TURP, IPP group resulted in improvement of IPSS, storage symptoms score and voiding symptoms score statistically compared to non-IPP group. As the change of UFR and IPSS after TURP had shown, the improvements of voiding volume, maximal flow rate (Qmax), and average flow rate (Qavg) in IPP groups were smaller however, it is no correlation in statistical view. CONCLUSIONS: Moderate BPH group with IPP has a higher possibility of having AUR and surgical treatment while showing significant correlation with storage symptoms. A further prospective study is necessary for identification of improvement of IPSS and UFR after TURP and IPP should be checked carefully during TRUS.

An Ileocutaneous Fistula That Developed 12 Years after Repair of an Abdominal Wall Defect Using Intraperitoneal Placement of High-density Polypropylene Mesh (Marlex(R))

Although prosthetic materials are commonly used to repair abdominal wall defects, they are also associated with postoperative complications. These complications could be prevented by the adoption of uniform guidelines on surgical methods and materials, but the best anatomical position for placement of prosthetic meshes is unclear. We report a case of an enterocutaneous fistula that developed after an abdominal wall defect was repaired by intraperitoneal application of a prosthetic mesh (Marlex(R)) to raise awareness of the consequences of improper use of prosthetic materials.

The Correlation of Intravesical Prostatic Protrusion with Storage Symptoms, as Measured by Transrectal Ultrasound / 대한비뇨기과학회지

PURPOSE: Intravesical prostatic protrusion(IPP) is a morphological change that's due to excessive growth of the median and lateral lobes of the prostate into the bladder. Few studies have been performed regarding the correlation between IPP and the voiding/storage symptoms. The aim of this study is to identify the clinical significance of IPP by defining its relationship with the prostate volume(PV), the International Prostate Symptom Score (IPSS), the uroflowmetry results and the medication response. MATERIALS AND METHODS: We performed a retrospective study of 95 male patients who were examined between August 2006 and July 2007. The patients were evaluated with the IPSS/quality of life(QoL) test, uroflowmetry(Urodyn-1000(TM); Medtronic), the post void residual urine(PVR), and IPP and PV by transrectal ultrasound(TRUS)(PROSOUND SSD-3500(TM); ALOKA). The IPP was compared with the total IPSS, the voiding and storage symptom score, uroflowmetry parameters and the flow patterns (normal, obstructive, detrusor impairment, Valsalva). The patients were classified into two groups(the IPP and non-IPP groups) based on the presence of IPP as identified by TRUS. RESULTS: The PV and IPP showed a significant correlation(r=0.627, p<0.001). There was no correlation between IPP and total IPSS(p=0.444); however, the storage symptom score was significantly increased in proportion to IPP(p=0.030). With an IPP increase, the Qmax was decreased (r=??0.319, p<0.001) and the PVR was increased(r=0.388, p=0.002). The IPP group showed a lower decrease of the QoL score after 8 weeks of medication, as compared to the non-IPP group(p=0.034). CONCLUSIONS: The IPP showed significant correlation with the storage symptoms, but not with the total IPSS. Theoretically, IPP is a unique anatomical configuration of the prostate, and it may worsen the prominent storage symptoms that are the result of irritation of the bladder neck and trigone. IPP should be checked carefully during TRUS as IPP could potentially be a useful marker for the assessment and management of lower urinary tract symptoms.

Multiple Cavernous Hemangiomas of the Glans Penis, Penis, and Scrotum / 대한비뇨기과학회지

Although a hemangioma is usually found in childhood, a cavernous hemangioma of the genitalia is rarely found. Urologists often face difficulty when making the decision for surgery to treat a genital cavernous hemangioma. We report here on a case of a cavernous hemangioma that extended into the glans penis, penile shaft and scrotum. Immediately after surgical excision of the hemangiomas in the penile shaft and scrotum, the worm-like lesions subsided. The protruding lesions of the glans penis were naturally relieved after 12 months follow up.

Polypharmacy and Central Nervous System Adverse Effects of Anticholinergic Agents in the Men with Benign Prostate Hyperplasia

PURPOSE: Elderly patients commonly receive multiple drugs compared to young patients because of high comorbidity. Some common illnesses in the elderly with underlying diseases are complicated or aggravated by treatment with anticholinergic agents. We evaluated the use of anticholinergic agents and their adverse effects in the men with benign prostate hyperplasia. MATERIALS AND METHODS: One hundred-eighty four patients over 40 years-old who visited hospital for the treatment of benign prostate hyperplasia and prescribed more than one anticholinergic agent from January 2005 to June 2006 were enrolled. The patients who took anticholinergics during less than 2 months or suffered from psychiatric problems were excluded. One hundred-fifteen patients were included and all prescribed drugs were classified and counted. The number of anticholinomimetic agents and their 10 adverse effects were checked. RESULTS: Mean age was 67.0+/-10.6 years and mean cormobidity diseases counted 1.1+/-1.1. Mean pill and mean anticholinergic agents counted 7.3+/-4.3 and 1.8+/-1.1, respectively. Prescribed anticholinergic agents count increased with patient's age(p=0.401). As the patients took more medications, they had higher possibility to take anticholinergic agents. And as the patients took more anticholinergic agents, they showed more anticholinergic adverse effects(p<0.001). CONCLUSION: Elderly patients mistakenly tend to attribute drug-induced changes in memory and cognitive function to aging or comorbid conditions. Therefore prescribers should consider an anticholinergic agent's receptor selectivity, ability to cross the blood-brain barrier, and pateint's medical history in elderly patients. Additionally physicians can actively perform Mini-Mental Status Examination for evaluation of the patient's cognitive functions under anticholinergic medication.