Change in Penile Length in Children: Preliminary Study

PURPOSE: Studies of penile length in children have been rarely conducted. In Korea, great improvements in height and weight have been observed because of economic development over the past 25 years. We investigated the current status of penile length in Korean children and compared the results with those of a previous Korean study conducted in 1987. MATERIALS AND METHODS: The subjects in this study were 233 boys aged 1 to 158 months, each of whom had been brought to outpatient clinics between April and October 2011. Penile length was measured according to the stretched penile length (SPL) technique; testicular size was measured (in ml) by using orchidometry. A comparison of penile lengths between the current study and the 1987 study was made by using Student's t-test. RESULTS: SPL increased significantly by 0.7 to 1.1 cm in most age groups (p<0.05). Current anthropometric measures of Korean children such as height, body weight, and testicular size have increased compared with those from 1987. CONCLUSIONS: Penile length has increased significantly over the last quarter century. Therefore, it is suggested that novel reference values for penile length in prepubertal Korean children be determined in studies with a larger community-based population in order to diagnose and treat size-related penile disorders.

Clinical Characteristics and Surgical Outcomes in Adolescents and Adults with Varicocele

PURPOSE: To compare clinical characteristics and surgical results in adolescents and adults with varicocele. MATERIALS AND METHODS: We retrospectively analyzed the characteristics of 93 patients, 34 adolescents (mean age, 14.4+/-2.1 years) and 59 adults (mean age, 30.4+/-12.4 years), who underwent surgical repair of varicocele between 2006 and 2009. Median follow-up time in all patients was 18.7 months. The most bothersome symptoms, bilaterality, grades, surgical methods, artery-sparing rates, operation times, semen analysis, success rates, and recurrence-free period were compared between the two groups. RESULTS: The overall success rate of surgical repair was 92.5%. The most bothersome symptoms were scrotal mass, pain, and hypotrophy in adolescents and pain, scrotal mass, infertility, and hypotrophy in adults (p=0.008). There were no significant between-group differences in bilaterality, grades, surgical methods, operation times, pre- or postoperative semen analyses, success rates, or recurrence-free periods. Patients who underwent artery-sparing surgery had higher recurrence rates than did those who underwent surgery that did not spare arteries. In adults, semen density increased significantly after surgery, from 35.6 million/ml to 49.6 million/ml (p=0.046). CONCLUSIONS: There were no significant differences in clinical characteristics or surgical results between adolescents and adults with varicocele, except for the most bothersome symptoms. Semen density increased after surgery in both groups.

Solitary Penile Neurofibroma with Erectile Dysfunction

Neurofibromas of the penis, although very rare, are often associated with neurofibromatosis type 1. Primary solitary neurofibromas of the penis are extremely rare. We describe a 37-year-old man with a solitary neurofibroma in the dorsum of the penis. The patient reported difficulty with sexual intercourse owing to a penile mass and erectile dysfunction. After surgical excision of the neurofibroma, he had no pain and a normal sensation of the penile glans, and his erectile dysfunction improved. At the present time, 26 months after surgery, there has been no evidence of tumor recurrence.

A New Method of Vasovasostomy with the Prolene Stent

PURPOSE: The methods for vasovasostomy are varied, and many authors have reported various success rates. This study aimed to assess a new method for vasovasostomy with a Prolene stent. MATERIALS AND METHODS: Among 85 patients who underwent vasovasostomy with a Prolene stent, 69 patients were retrospectively reviewed at our hospital between October 2004 and December 2007. The average age at the time of vasovasostomy was 42.2 years (range: 24.0-52.0 years). The obstructive interval was 6.25 years (range: 0.7-20.0 years). The cases were divided into 2 groups according to obstructive interval: group A (above 8 years) and group B (8 years and less), with 18 (26.1%) and 51 (73.9%) cases, respectively. Patency was defined as a sperm concentration of more than 10x106/ml on semen analysis. RESULTS: The overall patency and pregnancy rates were 76.8% and 43.4%, respectively. The patency and pregnancy rates of group A were 61.1% and 33.3%. Those of group B were 82.3% and 47.0%. The mean duration to pregnancy was 10.9 months (range: 4-31 months). The mean operation time was 90.2 minutes (range: 50.0-165.0 minutes). CONCLUSIONS: The new method of vasovasostomy with the Prolene stent has good efficacy and safety. Its benefits are the maintenance of good patency, a good pregnancy rate, and a diminished operating time.

Urachal Xanthogranuloma: Laparoscopic Excision with Minimal Incision

Urachal xanthogranuloma is an extremely rare disease. A 23-year-old man presented with severe lower abdominal pain and voiding frequency. Computed tomography revealed a urachal mass with bladder invasion, which was suspected to be a urachal carcinoma or abscess. Laparoscopic urachal resection was performed with a minimal incision. Histopathologic examination identified the mass as a urachal xanthogranuloma.

Difference in Results of Ultrasonography and Diuretic Renograms after Pyeloplasty in Children with Unilateral Ureteropelvic Junction Obstruction

PURPOSE: Controversies persist on pyeloplasty follow-up, and the aim of this study was to assess the differences and interpretations in results of postoperative ultrasonography and diuretic renograms. MATERIALS AND METHODS: The study population consisted of 46 patients who underwent pyeloplasty between 1997 and 2003. The average patient age was 7.0 months (range, 2-36 months). Serial changes in hydronephrosis were evaluated by consecutive ultrasonography at 1, 4, 10, and 24 months after pyeloplasty, and a diuretic 99mTc-MAG3 renal scan was performed 4 months after the surgery. RESULTS: Ultrasonography showed that 11 (24%), 27 (59%), 35 (76%), and 39 (89%) patients had improved in hydronephrosis at 1, 4, 10, and 24 months after pyeloplasty, respectively. Diuretic renal scans showed that of 27 patients who showed improvements in hydronephrosis at 4 months after pyeloplasty, only 17 (63%) had improved excretion and 22 (81%) had preservation of different renal function (DRF). Among 19 patients with persistent or worsened hydronephrosis, 10 (53%) had improved excretion and 13 (68%) had preserved DRF. CONCLUSIONS: The results of ultrasonography and diuretic renal scan studies can differ in the same case after pyeloplasty. We recommend that improvements in hydronephrosis be assessed individually by ultrasonography, renal scans, and clinical status to determine surgical outcomes.

Extramammary Paget's Disease Involving the Scrotum and Umbilicus

Extramammary Paget's disease (EMPD) is a rare intraepithelial adenocarcinoma. To date, about 200 cases of EMPD have been reported since the first report in 1889. There has been only one case of EMPD involving the umbilicus, in a patient with prostatic carcinoma. This is the first report of EMPD occurring concurrently in the scrotum and umbilicus. The patient had recurrent, eczematous, and pruritic lesions of the left scrotum and umbilicus 2 years previously. Biopsy and surgical resection were performed and EMPD was diagnosed. There was no evidence of recurrence at 34 months after surgery.

Adenomatoid Tumor between the Epididymis and the Testis / 대한남성과학회지

Adenomatoid tumor is the most common paratesticular tumor with an anatomic distribution limited to the epididymis and it rarely invades to the tunica vaginalis, spermatic cord and ejaculatory duct. Adenomatoid tumor is a benign neoplasm that is thought to be of a mesothelial origin. The treatment of choice for adenomatoid tumor is local excision because of its benign nature and the absence of distant metastasis. We report here on a rare case of adenomatoid tumor that was found between the epididymis and the testis, and it was treated by local excision of tumor.

Solitary Fibrous Tumor as Misdiagnosed as Bladder Cancer / 대한비뇨기과학회지

Solitary fibrous tumor(SFT) was previously named localized fibrous mesothelioma, and this is a rare mesenchymal neoplasm that usually shows benign behavior. It is the most commonly recognized tumor of the pleura. These tumors have been recently reported to be found in unexpected locations. To the best of our knowledge, there have been only 2 reports of SFT arising from the urinary bladder in Koreans. We review this third case of SFT that was misdiagnosed as bladder cancer. This tumor was removed from a 40-year-old man who had a history of lower urinary tract symptoms.

Change of Hydronephrosis after Pyeloplasty in Children with Unilateral Ureteropelvic Junction Obstruction / 대한비뇨기과학회지

PURPOSE: In this prospective study, the immediate postoperative changes of hydronephrosis, following pyeloplasty in children with a unilateral ureteropelvic junction obstruction, were evaluated. MATERIALS AND METHODS: The study population consisted of 30 patients with a unilateral ureteropelvic junction obstruction, who underwent open pyeloplasty between September 1997 and December 2003. The serial changes of hydronephrosis in children with consecutive ultrasonography were evaluated at 1, 4 and 10 months after the pyeloplasty. Diuretic renograms were performed before and 4 months after the surgery. RESULTS: Of the thirty patients in whom ultrasonography was serially performed at 1, 4 and 10 months following pyeloplasty, improvements of the hydronephrosis were shown in 20, 66 and 80%, respectively. Of the 24 patients who showed no improvement of the hydronephrosis at 1 month after the pyeloplasty, 18 had improved at 10 months. Two patients underwent a reoperation at 4 and 5 months after the pyeloplasty, respectively. One had persistent severe hydronephrosis and a urinary tract infection, and the other persistent hydronephrosis and a decreased differential renal function on follow-up studies. There was no significant difference between the patients with and without improvements of the hydronephrosis at 4 months after the pyeloplasty in terms of the preoperative factors. CONCLUSIONS: Hydronephrosis can persist following pyeloplasty, but improve with time. Patients with persistent or aggravated hydronephrosis following pyeloplasty can be observed, as long as there is no deterioration in the renal function or a urinary tract infection. No conclusion, with regard to a reoperation, can be drawn from isolated persistent hydronephrosis found during ultrasonography.

A Prospective Randomized Study Comparing Effectiveness of Local Anesthesia Techniques in Patients undergoing Transrectal Ultrasound-guided Prostate Biopsy / 대한비뇨기과학회지

PURPOSE: This study was designed to compare the effectiveness of intrarectal lidocaine gel versus periprostatic lidocaine injection during TRUS-guided biopsies. MATERIALS AND METHODS: From April 2003 to September 2003, 90 men undergoing a transrectal prostate biopsy were randomized into three groups. In group 1, 30 patients intrarectally received 20ml of 2% lidocaine gel; and group 2, 30 patients received 5ml(2.5ml per side) of 2% lidocaine solution injected along each side of the prostate, near the junction of the seminal vesicle and the base of the prostate(along the neurovascular bundles); in group 3, 30 patients received 5ml(2.5ml per side) of normal saline injected along the neurovascular bundles. The pain level after the biopsy was assessed using a 10-point linear visual analog pain scale(VAS). A statistical analysis was performed using the Wilcoxon Rank Sum test, and the results compared. RESULTS: Patient who received lidocaine solution injections along the neurovascular bundles (Group 2) had significantly lower VAS scores compared to the control group(mean score 3.56+/-2.13 versus 5.83+/-1.94, p<0.0001), but patients who received intrarectal lidocaine gel did not (mean score 5.46+/-2.70 versus 5.83+/-1.94, p=0.671). Gross hematuria, rectal bleeding and hemospermia occurred in 36(40.0%), 6(6.7%) and 5(5.6%) subjects, respectively. One patient had a vasovagal syncope. No patient reported febrile UTI or urinary retention. CONCLUSIONS: Bilateral nerve blockade with local anesthetic is a safe technique that significantly reduces pain during a prostate biopsy. However, in this study, intrarectal lidocaine injection did not reduce the pain compared to the control group during the prostate biopsy.

Effect of Subureteral Injection of Polydimethylsiloxane in Women with Vesicoureteral Reflux / 대한비뇨기과학회지

PURPOSE: Subureteral injection of bulking agents is an accepted, less invasive, treatment of vesicoureteral reflux (VUR) in children. Although this treatment modality is applied to adult patients with VUR, there have been few studies on polydimethylsiloxane (Macroplastique(R)) injection therapy for the treatment of VUR in women. We assessed the effectiveness of an endoscopic subureteral polydimethylsiloxane injection in adult women with primary VUR. MATERIALS AND METHODS: 18 patients (27 renal units), aged between 20 and 50 years were included in this study. The vesicoureteral reflux was grade I in 7, grade II in 13, and grade III in 7 renal units. Macroplastique(R) was injected submucosally under the ureteric orifice, converting the opening to allow the elevation of the mucosa, so that the orifices lay on the summit of a small mound, which assumed an elevated crescent appearance by the end of the procedure. The patients were followed up from 12 to 60 months (mean 29.2 months) with voiding cystourethrography. RESULTS: Overall, the reflux was corrected in 23 of the renal units (85.2%), and in one other following a second injection. The correction rates, according to the reflux grade, were 100, 77 and 71% for grades I to III, respectively. There were no associated postoperative complications. The mean hospital stay and injected volume of one renal unit were 1.29 days (1-5 days) and 1.28cc (1.0-2.5cc), respectively. CONCLUSIONS: Subureteral Macroplastique(R) injection therapy could be a primary treatment for low grade VUR in women because it is simple, less invasive, decreases hospital stay and shows a relatively high success rate.

Clinical Efficacy and Safety of Sildenafil in the Men with Erectile Dysfunction in Korea / 대한비뇨기과학회지

PURPOSE: Erectile dysfunction has variety of etiologic factors and it has been a common medical disorder with an estimated prevalence of about 50%. It has been confirmed that sildenafil improved impaired erectile responses in men. We evaluated the efficacy and safety of oral sildenafil for the patients with erectile dysfunction in Korea. MATERIALS AND METHODS: 583 patients were administered sildenafil for erectile dysfunction and 256 of them have been followed up over one month. The initial usual dosage was 50mg and the dosage was titrated based on efficacy and tolerance at every visit. Sexual function was measured before and during the therapy using International Index of Erectile Function (IIEF). RESULTS: Mean IIEF score changed significantly from 27.93+/-18.52 at baseline to 44.57+/-16.56 after treatment with sildenafil (p<0.001) and the mean scores of each IIEF domain (erectile function, orgasmic function, sexual desire, intercourse satisfaction, overall satisfaction) also improved (p<0.001). Q3 (penetration ability) and Q4 (maintenance ability) scores changed from 2.08+/-1.69 to 3.21+/-1.50 (p<0.001) and from 1.77+/-1.50 to 2.96+/-1.44 (p<0.001), respectively. In response to the global efficacy question, 73.4% of patients reported that treatment had improved their erections. With respect to the etiology, IIEF was changed significantly in DM group and no specific underlying disease group (p<0.001), but in radical prostatectomy or cystectomy group no significant change was observed. Side effects were reported in 56 patients (21.9%), including facial flushing (11.7%), headache (7.0%), dyspepsia (2.0%), altered vision (1.6%), nasal congestion (1.6%), conjunctival injection (1.2%), dyspnea (0.8%), dizziness (0.8%), and palpitation (0.8%). Only 4 patients (1.6%) discontinued treatment due to the side effects. CONCLUSIONS: Sildenafil citrate is a highly effective and well-tolerated oral agent for the treatment of erectile dysfunction in Korean men.