Penile Growth in Response to Human Chorionic Gonadotropin (hCG) Treatment in Patients with Idiopathic Hypogonadotrophic Hypogonadism / 전남의대학술지

Penile growth is under androgenic control. Human chorionic gonadotropin (hCG) has a stimulatory effect on testicular steroidogenesis and penile growth. The purpose of this study was to evaluate the effect of hCG treatment on the gonadal response and penile growth in male idiopathic hypogonadotrophic hypogonadism (IHH) presenting with micropenis. A total of 20 IHH patients who met the criteria for micropenis were included in this study. hCG (1,500-2,000 IU) was administrated intramuscularly, 3 times per week, for 8 weeks. Basic laboratory and hormonal indexes (including serum testosterone and LH levels), penis length (flaccid and stretched), and testicular volume were measured before and 24 weeks after hCG treatment. The patients' mean age was 18.9 years (range, 12 to 24 years). The mean serum testosterone level was significantly increased after hCG treatment (baseline, 2, 4, 12, and 24 weeks: 0.90+/-1.35 ng/ml, 1.77+/-1.31 ng/ml, 3.74+/-2.24 ng/ml, 5.49+/-1.70 ng/ml, and 5.58+/-1.75 ng/ml, respectively; p<0.05). Mean penile length also increased significantly 24 weeks after treatment (flaccid length: from 3.39+/-1.03 cm to 5.14+/-1.39 cm; stretched length: from 5.41+/-1.43 cm to 7.45+/-1.70 cm; p<0.001). Mean testicular volumes increased significantly as well (left: from 5.45 cc to 6.83 cc; right: from 5.53 cc to 7.03 cc). There were no remarkable adverse effects of the hCG treatment. The hCG treatment increased the serum testosterone level, penile length, and testicular volume in IHH patients. Our results suggest that hCG treatment has a beneficial effect on gonadal function and penile growth in patients with IHH presenting with micropenis.

Prostate Cancer Can Be Detected Even in Patients with Decreased PSA Less than 2.5 ng/ml after Treatment of Chronic Prostatitis

PURPOSE: We evaluated men with documented chronic prostatitis and elevated serum prostate-specific antigen (PSA) to determine whether treatment with antibiotics and anti-inflammatory drugs can lower serum PSA and the cancer detection rate in patients with post-treatment PSA <4 ng/ml. MATERIALS AND METHODS: Eighty-six men who presented with serum PSA greater than 4 ng/ml and who were subsequently diagnosed with chronic prostatitis with greater than 10 white blood cells per high power field in expressed prostatic excretions were included in this prospective study. Patients meeting these criteria underwent treatment with a 4-week course of antibiotics and nonsteroidal anti-inflammatory agents. Follow-up PSA and transrectal ultrasonography-guided prostate biopsy were performed within 2 months of treatment for all patients. RESULTS: Mean patient age was 56.2 years (range, 37-72 years). Mean PSA (ng/ml) decreased by 33.8%, from 8.12 (range, 4.02-24.8) to 5.37 (range, 1.35-12.94), after treatment (p=0.001). Pathological studies revealed prostate cancer in 18 cases (20.9%), chronic inflammation in 64 (74.4%), and benign prostatic hypertrophy in 4 (4.7%). The prostate cancer detection rate according to the follow-up PSA level, below 2.5, from 2.5 to 4.0, and above 4.0, was 13.3% (2/15), 13.6% (3/22), and 26.5% (13/49), respectively. CONCLUSIONS: When chronic prostatitis with elevated PSA is identified, antibiotic and anti-inflammatory treatment can lower these PSA levels. However, the possibility of prostate cancer remains in patients whose PSA level decreases to less than 4 ng/ml, even in those with a PSA level less than 2.5 ng/ml.

Penile Growth in Response to Human Chorionic Gonadotropin (hCG) Treatment in Patients with Idiopathic Hypogonadotrophic Hypogonadism / 전남의대학술지

Penile growth is under androgenic control. Human chorionic gonadotropin (hCG) has a stimulatory effect on testicular steroidogenesis and penile growth. The purpose of this study was to evaluate the effect of hCG treatment on the gonadal response and penile growth in male idiopathic hypogonadotrophic hypogonadism (IHH) presenting with micropenis. A total of 20 IHH patients who met the criteria for micropenis were included in this study. hCG (1,500-2,000 IU) was administrated intramuscularly, 3 times per week, for 8 weeks. Basic laboratory and hormonal indexes (including serum testosterone and LH levels), penis length (flaccid and stretched), and testicular volume were measured before and 24 weeks after hCG treatment. The patients' mean age was 18.9 years (range, 12 to 24 years). The mean serum testosterone level was significantly increased after hCG treatment (baseline, 2, 4, 12, and 24 weeks: 0.90+/-1.35 ng/ml, 1.77+/-1.31 ng/ml, 3.74+/-2.24 ng/ml, 5.49+/-1.70 ng/ml, and 5.58+/-1.75 ng/ml, respectively; p<0.05). Mean penile length also increased significantly 24 weeks after treatment (flaccid length: from 3.39+/-1.03 cm to 5.14+/-1.39 cm; stretched length: from 5.41+/-1.43 cm to 7.45+/-1.70 cm; p<0.001). Mean testicular volumes increased significantly as well (left: from 5.45 cc to 6.83 cc; right: from 5.53 cc to 7.03 cc). There were no remarkable adverse effects of the hCG treatment. The hCG treatment increased the serum testosterone level, penile length, and testicular volume in IHH patients. Our results suggest that hCG treatment has a beneficial effect on gonadal function and penile growth in patients with IHH presenting with micropenis.

Inflammatory Myofibroblastic Tumor of the Kidney Misdiagnosed as Renal Cell Carcinoma

The inflammatory myofibroblastic tumor (IMT), also knowns as inflammatory pseuduotumor, is a soft tissue lesion of unknown etiology. In the urogenital tract, IMT mainly affects the urinary bladder or prostate, but rarely the kidney. It has been considered as a nonneoplastic reactive inflammatory lesion, but nowadays, it is regarded as a neoplasm due to its high recurrence rate and metastasis. We describe a case of a 61-yr-old woman that had originally been misdiagnosed as renal cell carcinoma, which was pathologically revealed to be an IMT.

The Clinical Roles of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computerized Tomography for Urological Disease / 대한비뇨기과학회지

PURPOSE: We evaluate the clinical roles of 18F-fluorodeoxyglucose positron emission tomography/computerized tomography(18F-FDG PET/CT) for diagnosing disease in the urogenital tract, and we compared this with the other established radiologic and pathologic diagnoses. MATERIALS AND METHODS: From June 2006 to June 2007, the total number of subjects who underwent 18F-FDG PET/CT was 4,438. The mean patient age was 57.4+/-7.6 years and the ratio of males to females was 1.28:1. During the study period, except for 152 patients who had been given a diagnosis of urologic tumor, 614(14.3%) healthy subjects and 3,672(85.7%) patients with non-urologic tumors were enrolled. The results of detecting urologic disease by 18F-FDG PET/CT were compared with the results of detecting urologic disease by conventional imaging techniques and the postoperative histopathological diagnoses. RESULTS: With including 147 healthy subjects and 251 non-urologic tumor patients, 398 (9.3%) urologic diseases were detected on 18F-FDG PET/CT. Diseases of the kidney, adrenal and prostate were frequently found(215, 95 and 52 patients, respectively). A thorough examination was indicated for 153(3.6%) of the patients as a result of positive findings that suggested possible tumor. A total 93 urologic cancers were confirmed, and the overall positive predictive value of 18F-FDG PET/CT was 60.7%. The positive predictive value for adrenal, kidney, bladder and prostate cancer were 87.7%, 73.3%, 57.1% and 14.0%, respectively. CONCLUSIONS: 18F-FDG PET/CT was not superior to conventional imaging for making the diagnosis of urologic disease. But 18F-FDG PET/CT was more predictive for adrenal and renal tumor than for bladder and prostate tumor. So, urologic tumor that is incidentally detected on 18F-FDG PET/ CT, and especially adrenal and renal tumor, should be closely evaluated.

A Recent Study on the Antimicrobial Sensitivity of the Organisms that Cause Urinary Tract Infection / 대한비뇨기과학회지

PURPOSE: The overuse and misuse of antimicrobial agents have made choosing an appropriate antibiotic more difficult. We studied changes in the antibiotic sensitivities of the causative microorganisms of urinary tract infection (UTI), in 2000 versus 2005, in order to provide useful information and to aid physicians to make better choices of adequate drugs for treating UTI. MATERIALS AND METHODS: We retrospectively analyzed 5,266 uropathogens and their antimicrobial sensitivities in 3,346 patients who were admitted to or they had visited two tertiary hospitals located in Honam province, in 2000 versus 2005. This revealed the isolated causative organisms in the urine cultures. RESULTS: The incidence of UTI shows bimodal peaks in the first decade (22.3%) and 7th decade (18.8%). The common pathogens were E. coli (34.4%), Enterococcus (19.0%), Staphylococcus (10.2%), Pseudomonas (9.9%) and Klebsiella (9.8%). The incidence of Gram positive organisms was increased from 35.7% in 2000 to 38.1% by 2005. For the Gram negative isolates, imipenem and amikacin showed relatively higher sensitivity, while ampicillin and ciprofloxacin showed relatively lower sensitivity. For the Gram positive isolates, vancomycin and teicoplanin showed relatively higher sensitivity, while penicillin and ciprofloxacin showed relatively lower sensitivity. Significant declines for the third-generation cephalosporins' and fluoquinolones' sensitivity to E. coli and Klebsiella isolates were found. CONCLUSIONS: E. coli was the most common single organism causing UTI. We should be concerned about the increase of Gram positive organisms, especially Enterococcus. The use of TMP/SMX and nitrofurantoin as the first choices of treatment for UTI should be reconsidered. It is recommended that fluoroquinolone should be restricted because of the high antibiotic resistance and the economic aspects.

Effects of Intracavernosally Injected Embryonic Stem Cells in Aged Rat / 대한남성과학회지

PURPOSE: Stem cell-based cell therapy has recently been tried as a way to restore cavernosal function in an animal model. The aims of this study were to elucidate the effect of intracavernosally injected embryonic stem cells(ESCs) in aged rat. MATERIALS AND METHODS: Male Sprague Dawley rats were divided into 3 groups: young control(12 weeks old; n=10), old with vehicle injection(24 months old; n=7), and old with ESC injection(24 months old; n=8). ESCs were transfected with firefly luciferase attached to adenovirus and then injected intracavernously 2 times with a 1-week interval. Cell survival was assessed by optical molecular imaging 2 days after the last ESC injection. At 4 weeks after the last injection, intracavernosal pressure and systemic arterial pressure were recorded after pelvic nerve stimulation. Serum testosterone levels were measured by radioimmunoassay. RESULTS: We observed fluorescent signals around the external genitalia of animals injected with ESCs. The serum testosterone level of the old group(1.39+/-0.07 ng/ml) was significantly lower compared to the young control group(2.98+/-0.31 ng/ml)(p=0.03). The percentage of intracavernosal pressure/systolic blood pressure was significantly lower in the old group(58.5+/-8.6%) compared to the young control group(69.5+/-6.6%)(p=0.034). However, the old group with ESC injection(61.6+/-9.9%) did not show any significant differences from the old group(p>0.05). The old group with ESC injection showed histomorphometry similar to the old group. CONCLUSIONS: The presence of intracavernosal ESCs can be noninvasively monitored with optical molecular imaging. However, the intracavernosal injection of ESCs did not improve erectile function in the aging rat. Further studies are needed to elucidate the regulatory factors of stem cell differentiation in the corpus cavernosum.

The Need for Routine Ipsilateral Adrenalectomy during Radical Nephrectomy for Renal Cell Carcinoma / 대한비뇨기과학회지

Purpose: The incidence and characteristics of ipsilateral adrenal involvement in patients with renal cell carcinoma (RCC) were assessed to determine whether a routine ipsilateral adrenalectomy is still required during radical nephrectomy.Materials and Methods: Between October 1994 and June 2003, the records of 543 patients with RCC, who underwent radical nephrectomy, were retrospectively reviewed. Patients were divided into two subgroups: 325 patients that had undergone a radical nephrectomy with ipsilateral adrenalectomy, and 218 with adrenal-sparing. The medical records, pathologic specimens, preoperative and postoperative computerized tomography (CT) finding were reviewed. The influence of an adrenalectomy on the disease- specific survival rate was also analyzed by the Kaplan-Meier method. Results: There were no significant differences between the ipsilateral adrenalectomy and adrenal-sparing groups in terms of age, sex, location and T and M stages. There were no significant differences in the disease-specific survival rates between the two groups (p=0.092). Of the 325 patients with ipsilateral adrenalectomy, 12 (3.7%) had adrenal involvement, all of which were diagnosed as cT3 or greater, with 9 detected with preoperative CT. Preoperative CT had 75% sensitive, a 33% positive predictive value, 94.2% specificity and a 99% negative predictive value for adrenal involvement by RCC. Among patients without adrenal involvement, there were no significant differences in the disease-specific survival rates between patients with an ipsilateral adrenalectomy and adrenal-sparing. Conclusions: A routine ipsilateral adrenalectomy during a radical nephrectomy does not improve the survival rate. A routine ipsilateral adrenalectomy may not be needed, particularly when no ipsilateral adrenal involvement is found to exist on the preoperative CT.

High Flow Priapism Developed after Treatment of Low Flow Priapism / 대한비뇨기과학회지

Priapism is a pathologic state of persistent penile erection in the absence of sexual stimulation. Low flow priapism is more common, which is caused by a venous outflow obstruction. However, high flow priapism is rare, and is caused by uncontrolled arterial flow into penis following perineal or penile blunt injuries. We report a case of high flow priapism secondary to the treatment of low flow priapism.