Validation of SwimCount™, a Novel Home-Based Device That Detects Progressively Motile Spermatozoa: Correlation with World Health Organization 5th Semen Analysis

PURPOSE: We evaluated the usefulness of a home-based device (SwimCount™) compared with World Health Organization (WHO) 5th semen analysis in screening for male fertility in Asian men.MATERIALS AND METHODS: One hundred Asian men who visited CHA Seoul Station Fertility Center for evaluation of fertility were included. Semen samples were analyzed and compared with the SwimCount™ results. An aliquot of 0.5 mL of the semen sample was added to the SwimCount™ and a WHO 5th semen analysis was performed. Results were categorized as low (<5×10⁶/mL), and normal to high (≥5×10⁶/mL) total progressively motile sperm concentration. Receiver operating characteristic curve analysis was performed to evaluate the accuracy of the SwimCount™.RESULTS: The mean total progressively motile sperm concentration was 26.7×10⁶/mL. Semen analysis revealed that 28% of the samples were below the threshold count of 5 million/mL total progressively motile sperm concentration. The mean total progressively motile sperm concentration of the light color SwimCount™ result group determined by semen analysis was 7.5×10⁶/mL, and the mean total progressively motile sperm concentration of the moderate to dark color SwimCount™ result group was 34.2×10⁶/mL. An area under the receiver operating characteristic curve of 0.85 (95% confidence interval, 0.77–0.94; p<0.001) was obtained when the SwimCount™ was compared with semen analysis. The sensitivity and specificity were obtained at a cut off value of 5.0×10⁶/mL total progressively motile sperm concentration, giving a sensitivity and specificity of 87.5% and 73.4%.CONCLUSIONS: We confirmed the reliability of the SwimCount™ as a home-based device for male fertility by evaluating the total progressively motile sperm concentration.

Retrograde balloon dilation as a therapeutic option for post-gynecologic surgery ureteral stricture followed by ureteroureterostomy: a comparative study regarding stricture length / 영남의대학술지

BACKGROUND: To evaluate the success rate of balloon dilation and the factors possibly influencing the outcomes of balloon dilation for the ureteric strictured portion of ureteroureterostomy (UUS) site in patients with post-gynecologic surgeries.METHODS: A single institution data base was screened for the patients who received balloon dilation for a treatment of ureteral stricture diagnosed after gynecologic surgery. Overall 114 patients underwent primary intra-operative UUS due to ureteral injury during gynecologic surgery. Among them, 102 patients received balloon dilation, and their medical records were retrospectively reviewed. Success of balloon dilation was defined as the condition that requires no further clinical interventions after 6 months from balloon dilation.RESULTS: The ureter injury rate of women treated with open radical abdominal hysterectomy was highest (32 cases, 31.4%). 60 patients (60.8%) showed successful outcomes regarding dilation. All patients underwent technically successful dilation with a full expansion of balloon during the procedure, but 40 patients (39.2%) were clinically unsuccessful as they showed a recurrence of ureteral stricture on the previous balloon dilation site after the first dilation procedure. Univariate logistic regression analyses showed that stricture length >2 cm was a significant predictor of successful dilation (odds ratio, 0.751; 95% confidence interval, 0.634–0.901; p-value, 0.030), but it failed to achieve independent predictor status in multivariate analysis.CONCLUSION: Balloon dilation can an effective alternative treatment option for strictured portion of the primary UUS in post-gynecologic surgery patients when its length is < 2 cm.

Retrograde balloon dilation as a therapeutic option for post-gynecologic surgery ureteral stricture followed by ureteroureterostomy: a comparative study regarding stricture length / 영남의대학술지

BACKGROUND@#To evaluate the success rate of balloon dilation and the factors possibly influencing the outcomes of balloon dilation for the ureteric strictured portion of ureteroureterostomy (UUS) site in patients with post-gynecologic surgeries.@*METHODS@#A single institution data base was screened for the patients who received balloon dilation for a treatment of ureteral stricture diagnosed after gynecologic surgery. Overall 114 patients underwent primary intra-operative UUS due to ureteral injury during gynecologic surgery. Among them, 102 patients received balloon dilation, and their medical records were retrospectively reviewed. Success of balloon dilation was defined as the condition that requires no further clinical interventions after 6 months from balloon dilation.@*RESULTS@#The ureter injury rate of women treated with open radical abdominal hysterectomy was highest (32 cases, 31.4%). 60 patients (60.8%) showed successful outcomes regarding dilation. All patients underwent technically successful dilation with a full expansion of balloon during the procedure, but 40 patients (39.2%) were clinically unsuccessful as they showed a recurrence of ureteral stricture on the previous balloon dilation site after the first dilation procedure. Univariate logistic regression analyses showed that stricture length >2 cm was a significant predictor of successful dilation (odds ratio, 0.751; 95% confidence interval, 0.634–0.901; p-value, 0.030), but it failed to achieve independent predictor status in multivariate analysis.@*CONCLUSION@#Balloon dilation can an effective alternative treatment option for strictured portion of the primary UUS in post-gynecologic surgery patients when its length is < 2 cm.

Exosomes as a Communication Tool Between the Lymphatic System and Bladder Cancer / 대한배뇨장애요실금학회지

No abstract available.

Intermittent, low-dose, antiandrogen monotherapy as an alternative therapeutic option for patients with positive surgical margins after radical prostatectomy / 亚洲男科学杂志(英文版)

The aim of the present study was to determine whether oncologic outcomes and adverse events associated with active on/off intermittent antiandrogen monotherapy (daily bicalutamide, 50 mg per day) are comparable with those of standard external beam radiation therapy (EBRT) or combined androgen blockade (CAB) therapy in prostate cancers with positive surgical margins after radical prostatectomy. Two hundred twenty-three patients with positive surgical margins post-radical prostatectomy who underwent active surveillance (AS, n = 32), EBRT without hormone therapy (n = 55), intermittent antiandrogen monotherapy without EBRT (IAAM, n = 50), or CAB without EBRT (n = 86), between 2007 and 2014, were reviewed retrospectively. Pathologic outcomes, biochemical recurrence rates, radiological disease progression, and adverse events were collected from medical records. Biochemical recurrence rates, biochemical recurrence-free survival rates, and radiological recurrence were not different between the groups (P = 0.225, 0.896, and 0.284, respectively). Adverse event rates and severities were lower for IAAM compared with EBRT or CAB (both P < 0.05), but were comparable to those for AS (P = 0.591 and 0.990, respectively). Grade ≥3 adverse events were not reported in the IAAM or AS groups. Erectile dysfunction and loss of libido rates were lower in the IAAM group compared with the EBRT and CAB groups (P = 0.032). Gastrointestinal complications were more frequently reported in the EBRT group (P = 0.008). Active on/off IAAM treatment might be an appropriate treatment option for patients with positive surgical margins after radical prostatectomy. Furthermore, regarding oncologic outcomes, IAAM was comparable to standard EBRT but had a milder adverse event profile.

Diagnosis and Management of Pediatric and Adolescent Varicocele: A Survey of Pediatric Urologists in Korea / 전남의대학술지

The aim of this study was to evaluate current practice patterns on diagnosis and management of pediatric varicoceles. Questionnaires of approaches to diagnosis and management of pediatric varicoceles were sent electronically to pediatric urologists. Of the 70 questionnaires e-mailed, 37 (53%) responded to the survey. 10 respondents (27%) chose to operate on varicoceles, whereas 9 (24%) chose to observe, and 18 (49%) chose to decide upon treatment depending on the clinical situation. The most important indication for varicocelectomy was a decrease in ipsilateral testicular size (n=29, 78%) followed by testicular or scrotal pain (n=4, 11%) and varicocele grade (n=4, 11%). The optimal age for varicocelectomy was answered as 13.8±2.3 years mean. 32 respondents (86%) have used ultrasonography to aid in the diagnosis of varicoceles, and 26 respondents (70%) have considered repairing varicocele incidentally detected on ultrasonography. In an otherwise asymptomatic patient with varicocele, 17 respondents (46%) considered surgery for grade 3, but 15 respondents (41%) would not repair the varicocele. The most commonly used surgical approach was subinguinal microsurgical (n=19, 51%), followed by inguinal (n=9, 24%) and laparascopic (n=5, 14%) procedures. The most commonly experienced post-operative complication was recurrence (n=22, 59%) followed by persistence (n=13, 35%) and hydrocele (n=10, 27%). 28 respondents (76%) did not have long-term follow-up data including regarding fertility on their varicocele patients. Our survey demonstrates that there is lack of consensus on diagnosis and management of pediatric and adolescent varicoceles among pediatric urologists. A prospective randomized study of pediatric and adolescent varicoceles is needed to assess the outcomes and develop universal management guidelines.

Diagnosis and Management of Pediatric and Adolescent Varicocele: A Survey of Pediatric Urologists in Korea / 전남의대학술지

The aim of this study was to evaluate current practice patterns on diagnosis and management of pediatric varicoceles. Questionnaires of approaches to diagnosis and management of pediatric varicoceles were sent electronically to pediatric urologists. Of the 70 questionnaires e-mailed, 37 (53%) responded to the survey. 10 respondents (27%) chose to operate on varicoceles, whereas 9 (24%) chose to observe, and 18 (49%) chose to decide upon treatment depending on the clinical situation. The most important indication for varicocelectomy was a decrease in ipsilateral testicular size (n=29, 78%) followed by testicular or scrotal pain (n=4, 11%) and varicocele grade (n=4, 11%). The optimal age for varicocelectomy was answered as 13.8±2.3 years mean. 32 respondents (86%) have used ultrasonography to aid in the diagnosis of varicoceles, and 26 respondents (70%) have considered repairing varicocele incidentally detected on ultrasonography. In an otherwise asymptomatic patient with varicocele, 17 respondents (46%) considered surgery for grade 3, but 15 respondents (41%) would not repair the varicocele. The most commonly used surgical approach was subinguinal microsurgical (n=19, 51%), followed by inguinal (n=9, 24%) and laparascopic (n=5, 14%) procedures. The most commonly experienced post-operative complication was recurrence (n=22, 59%) followed by persistence (n=13, 35%) and hydrocele (n=10, 27%). 28 respondents (76%) did not have long-term follow-up data including regarding fertility on their varicocele patients. Our survey demonstrates that there is lack of consensus on diagnosis and management of pediatric and adolescent varicoceles among pediatric urologists. A prospective randomized study of pediatric and adolescent varicoceles is needed to assess the outcomes and develop universal management guidelines.

Evaluation and Management of Antenatal HydronephrosisEvaluation and Management of Antenatal Hydronephrosis

Antenatal hydronephrosis (ANH) is one of the most common abnormal findings detected on prenatal ultrasound (US), and it has been reported in 1-5% of all pregnancies. The likelihood of significant postnatal pathologic abnormality in the urinary tract correlates with the degree of anterior-posterior diameter (APD) according to the gestational age. Detection of urologic anomalies prenatally permits fetal interventions that avoid complications in rare cases of bladder outlet obstruction with oligohydramnios even though their final benefits still remain controversial. There is no clear consensus on the extent and mode of postnatal imaging after a diagnosis of ANH. US is the mainstay of the postnatal evaluation and helps guide further testing with voiding cystourethrography (VCUG) and diuretic renography. Although most algorithms continue to recommend generous VCUG for identification of lower urinary tract anomalies, VCUG may be safely reserved for high grade ANH cases or any grade of ANH with dilated distal ureter without increasing the risk of urinary tract infection (UTI). There are conflicting studies about efficacy of postnatal prophylactic antibiotics. It still seems reasonable to consider use of a prophylactic antibiotic to prevent infant UTIs in high-risk populations, such as females and uncircumcised males with high grades of hydronephrosis, hydroureteronephrosis, or vesicouretral reflux.

Evaluation and Management of Antenatal HydronephrosisEvaluation and Management of Antenatal Hydronephrosis

Antenatal hydronephrosis (ANH) is one of the most common abnormal findings detected on prenatal ultrasound (US), and it has been reported in 1-5% of all pregnancies. The likelihood of significant postnatal pathologic abnormality in the urinary tract correlates with the degree of anterior-posterior diameter (APD) according to the gestational age. Detection of urologic anomalies prenatally permits fetal interventions that avoid complications in rare cases of bladder outlet obstruction with oligohydramnios even though their final benefits still remain controversial. There is no clear consensus on the extent and mode of postnatal imaging after a diagnosis of ANH. US is the mainstay of the postnatal evaluation and helps guide further testing with voiding cystourethrography (VCUG) and diuretic renography. Although most algorithms continue to recommend generous VCUG for identification of lower urinary tract anomalies, VCUG may be safely reserved for high grade ANH cases or any grade of ANH with dilated distal ureter without increasing the risk of urinary tract infection (UTI). There are conflicting studies about efficacy of postnatal prophylactic antibiotics. It still seems reasonable to consider use of a prophylactic antibiotic to prevent infant UTIs in high-risk populations, such as females and uncircumcised males with high grades of hydronephrosis, hydroureteronephrosis, or vesicouretral reflux.

Laparoscopic Treatment of Appendicovesical Fistula

A 23-year-old man had a history of intermittent episodes of urinary tract infection with associated low abdominal pain for 15 years. Persistent bacteriuria even with prolonged antibiotics was the reason why he was referred to our hospital. Laboratory tests were normal except pyuria and growth of Escherichia coli in the urinary samples. Cystoscopy revealed a small slit-like opening on the right lateral wall of bladder dome. We found some air within the bladder and a suspicious communicating tract between the appendix and bladder on a CT scan. With a strong impression of appendicovesical fistula, a laparoscopy was performed to confirm a diagnosis and to remove the appendicovesical fistula resulting in a satisfactory result without any complication.

Ureteroscopic Lithotripsy Using Swiss Lithoclast for Treatment of Ureteral Calculi: 12-Years Experience

Ureteroscopic lithotripsy using Swiss Lithoclast was performed in 411 cases from January 1996 to September 2007 in a single hospital. Medical records of 341 cases, in which Swiss Lithoclast was successfully applied, were available for this retrospective study. We used 9.5Fr and 10Fr Storz rigid ureteroscopes. A success was defined as being free of stone-related symptoms and residual stones larger than 2 mm. Sixty one stones were located in the upper ureter, 49 stones were in the mid ureter, and 231 stones were in the lower ureter. The overall success rate was 93.5%. The success rate of upper ureter stone (80.3%) was significantly lower compared with those of mid (93.8%) and lower (96.9%) ureter stones (P=0.001). The higher the calculi was located within the ureter, the more chance of upward migration there was (P<0.001). The success rate in male patients was lower than in female patients without a statistical significance (P=0.068). The success rate decreased as the size of the stone increased (P<0.001), and as the degree of hydronephrosis increased (P=0.03). Perforation rates were 4.9%, 4.1%, and 2.6% from upper to lower ureter stone group. Ureteroscopic lithotripsy using Swiss Lithoclast is a safe and useful treatment modality for ureteral calculi.

Efficacy of In Vitro Germ Cell Culture in Nonobstructive Azoospermic Patients with Sertoli Cell Only Syndrome

PURPOSE: We determined the usefulness of in vitro germ cell culture in nonobstructive azoospermic patients diagnosed with Sertoli cell only syndrome, no sperm in testicular sperm extraction. MATERIALS AND METHODS: This study included 44 patients (45 testicular tissues) with nonobstructive azoospermia who were diagnosed with Sertoli cell only syndrome and were found to have no sperm in testicular sperm extraction between January 2006 and July 2008. Among the 45 testicular tissues, 22 tissues were processed for culture. In the in vitro cultures, the testicular tissues were dissociated and plated on gelatin-coated dishes. Patients were divided into 2 groups according to culture success: group I, culture positive (+; n=10); and group II, culture negative (-; n=12). RESULTS: The mean patient ages were 31.73 and 31.68 years for groups I and II, respectively. The mean testicular sizes were 10.19 and 10.42 cc, respectively; the semen volumes were 2.86 and 3.04 cc, respectively; and the mean FSH, LH, and testosterone levels were 18.86 mIU/ml, 5.99 mIU/ml, and 4.46 ng/ml vs. 21.02 mIU/ml, 6.29 mIU/ml, and 4.32 ng/ml for groups I and II, respectively, with no significant differences between the groups (p>0.05). The culture rate of nonobstructive azoospermic patients diagnosed with Sertoli cell only syndrome was 45.5% (10/22). Round spermatid injection was done in 2 patients with consent of the patients, but implantation failed. Among the 45 tissues, germ cells were found in 8 tissues after pathologic reexamination. CONCLUSIONS: The in vitro culture of germ cells would be useful in the advanced treatment of nonobstructive azoospermic patients.

Clinical Trial with Tamsulosin and Doxazosin for the Treatment of Premature Ejaculation in Patients with Co-morbid LUTS: a Comparative Study / 대한남성과학회지

PURPOSE: We wanted to evaluate the therapeutic potential of a low dose of tamsulosin, as compared with doxazosin, for the treatment of premature ejaculation in men with lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: Ninety-six patients (mean age: 55 years) who had LUTS with premature ejaculation were randomly assigned to receive 0.2 mg of tamsulosin and 4 mg of doxazosin daily for a period of 3 months. Patients were evaluated by taking the medical history, the International Prostatic Symptom Score (IPSS) and the Male Sexual Health Questionnaire (MSHQ) for ejaculatory function. The intravaginal ejaculatory latency time (IELT) measured by the patient's estimation and the sexual satisfaction ratio of both the partner and patient were investigated twice during the screening period and after treatment. At 3 months later, we assessed the differences in the IPSS score, the MSHQ score, the IELT and the sexual satisfaction ratio between the two groups. RESULTS: The two alpha 1-adrenoceptor antagonists had significant effects on the IPSS (p<0.05). However, we failed to find a statistically significant difference for each medication and the total MSHQ ejaculatory function score after medication in each group. The IELT was prolonged from 2.7+/-1.6 to 3.5+/-1.5 minutes and from 2.9+/-1.8 to 3.5+/-1.9 minutes in the tamsulosin and doxazosin groups, respectively. However, there was also no statistically significant difference of the IELT and the sexual satisfaction ratio in either group. CONCLUSIONS: For patients with premature ejaculation and LUTS, 0.2mg of tamsulosin improved the voiding symptoms, as assessed with the IPSS, as 4mg of doxazosin did, but neither medication seemed to be effective for the treatment of premature ejaculation.

Midureteral Hypoplasia at Congenital Midureteral Stricture / 대한비뇨기과학회지

Hydronephrosis is the most common abnormal finding of genitourinary tract detected by fetal ultrasonography. The causes of majority are attributed to ureteropelvic junction(UPJ) obstruction. The remaining are secondary to vesicoureteral reflux, megaureter, or posterior urethral valves. Congenital midureteral stricture is an unusual cause of hydronephrosis. We report a case in a one month old male baby with hydronephrosis(grade V, 20mm in AP diameter). He was diagnosed as a ureteropelvic junction obstruction. A mid ureteral stricture was identified with intraoperative anterograde pyelography. After removal of severely strictured ureter, the dilated proximal end was anastomosed to the spatulated distal ureter by microscope. Pathologic finding was subepithelial fibrosis and segmental inner smooth muscle attenuation. Ureteral stent was removed 2 months after surgery. Degree of hydronephrosis was markedly reduced on the follow up ultrasonography(14mm in AP diameter) 6 months after surgery.

The Efficacy of Furosemide-based Medical Expulsive Therapy with Tamsulosin and Deflazacort for Symptomatic Distal Ureter Stones / 대한비뇨기과학회지

PURPOSE: We prospectively evaluated the efficacy of administering tamsulosin with or without deflazacort, combined with furosemide, for treating distal ureteral stones. MATERIALS AND METHODS: A total of 241 patients with symptomatic distal ureteral stones were enrolled in this study between January 2004 and September 2007. They were divided into three treatment groups: group A(n=42) who received furosemide(40mg/day), group B(n=66) who received furosemide and tamsulosin(0.4mg/day) and group C(n=72) who received furosemide and tamsulosin plus deflazacort(24mg/day) for a maximum of 2 weeks. Follow-up visits were made at the 1st and the 2nd week after all the medication had been administered. The efficacy was evaluated in terms of the success rate and the time for achieving expulsion after administering the medication, according to the stone size. RESULTS: The three groups were comparable in terms of age, gender and stone size. The stone diameter was 4.90+/-0.47mm for group A, 5.08+/-0.30mm for group B and 5.04+/-0.36mm for group C. The overall success rate was 64.3%, 80.3% and 91.7%, respectively, and the differences were statistically significant(p=0.001). The mean expulsion time for the smaller stones (or=5mm) was 10.25 days, 8.93 days and 7.32 days, respectively, and the values for both sized stones showed statistically significant differences(p=0.027 for the smaller stones, 0.018 for the larger stones). There was no serious adverse event associated with the medication. CONCLUSIONS: Medical expulsive therapy with tamsulosin and deflazacort combined with furosemide is a time saving, safe and effective method for treating distal ureter stone.

Duplicated Ureter with an Ectopic Ureteral Orifice in a Middle Aged Female Who Complained of Vaginal Discharge / 대한비뇨기과학회지

Duplication is the most common type of congenital anomaly of the ureter. It occurs more frequently in females and it is often accompanied by an ectopic orifice. Ectopic ureter is usually derived from the upper pole of the ipsilateral kidney and its orifice is attached medial & inferior from the normal opening according to Weigert-Meyer's law. Thus, sometimes the ectopic ureteral opening is made at a distal part of the external sphincter or even out of the urinary system. These conditions may result in urinary incontinence in female patients, so they can be treated early at the mean age of 5 and it's not common that ectopic ureter accompanying complete duplication of the ureter is presented in adults. We report here on a case of ectopic ureter accompanying complete duplication of the ureter in a 44 year old female who presented with leukorrhea.

Evaluation of Short Term Clinical Effects and Presumptive Mechanism of Botulinum Toxin Type A as a Treatment Modality of Benign Prostatic Hyperplasia

The purpose of this study was to evaluate the effect and investigate the putative mechanism of botulinum toxin type A (BTA) applied to the treatment of benign prostatic hyperplasia (BPH). A total of 52 patients with symptomatic BPH were evaluated. Transperineal intraprostatic injection under transrectal ultrasonography was carried out. BTA dissolved in 4 to 9 mL of saline was used from 100 U to 300 U, according to prostate volume. Twenty-six patients received only BTA (BT group), and 26 received both BTA and one month of an alpha-adrenergic antagonist (BTalpha group). The therapeutic outcomes were evaluated by comparing parameters such as international prostate symptom score (IPSS), quality of life, prostate specific antigen, prostate volume, post-void residual urine, and peak urinary flow rate. At the one month follow- up, 18 patients in the BT group and 21 in the BTalpha group had subjective symptomatic relief (p = 0.337). Only IPSS5 (weak stream) was significantly different between the BT group and BTalpha groups (p = 0.034). At the three month follow-up, 39 patients had subjective symptomatic relief. The storage symptoms were improved more than the voiding symptoms. Additionally, about 50 percent of the patients whose voiding symptom improved expressed improved erectile function. BTA injection seems to be an alternative treatment for BPH. The differences after the one month evaluation between the BT and the BTalpha groups might suggest that the adrenergic influence could be relatively reinforced by the anticholinergic effect of BTA. Nitric oxide would thus be involved in a BTA action mechanism in BPH.

Ureteroscopic Lithotripsy with Pneumatic Lithotriptor: 274 Cases / 대한비뇨기과학회지

PURPOSE: We retrospectively reviewed cases of ureteroscopic lithotripsy where a pneumatic lithotriptor had been used, and report on the success and complications related to this procedure. MATERIALS AND METHODS: Between October 1996 and September 2005, ureteroscopic lithotripsy was performed in 319 cases. The medical records of 274 of these cases were available for review. The ureteroscopic lithotripsy had been performed using a rigid ureteroscope (Stortz, 10Fr) and pneumatic lithotriptor (Swiss lithoclast). A successful procedure was defined as the absence of a residual stone larger than 2mm in size on postoperative KUB or ultrasonography. RESULTS: 53, 32 and 189 stones were located in the upper, middle and lower ureter, which were defined as groups 1, 2 and 3, respectively. The overall success rate was 92.7%. The success rates of upper, middle and lower ureteral stones were 77.4 (41/53), 93.8 (30/32) and 96.8% (183/189), respectively. The success rate in group 1 was significantly lower than the other two groups (p<0.05). The most common cause of failure was the upward migration of the stone. The rates of stent indwelling were 37.7 (20/53), 34.5 (11/32) and 32.8% (62/189) in groups 1, 2 and 3, respectively. Perforation rates were 5.7 (3/53), 3.1 (1/32) and 2.1% (4/189) in groups 1, 2 and 3, respectively. All patients with a ureteral perforation were successfully treated with a double-J stent indwelling only for a period of 4-6 weeks. The most common complications were pain and gross hematuria. CONCLUSIONS: Ureteroscopic lithotripsy, with a pneumatic lithotriptor, is an effective and safe primary treatment modality for both middle and lower ureteral stones.

The Initial Experience of Intraprostatic Injection of Botulinum Toxin Type A for Benign Prostatic Hyperplasia: A Comparative Study of Short-term Effect with Transurethral Resection of Prostate / 대한비뇨기과학회지

PURPOSE: To retrospectively compare the results of botulinum toxin type A (BTA) with those of transurethral resection of the prostate (TURP) in the treatment of benign prostatic hypertrophy (BPH) and to evaluate the effect of BTA. MATERIALS AND METHODS: The changes of symptom after BTA injection into prostate (BIP) and TURP in 26 patients treated with BIP and 81 patients treated with TURP were analysed retrospectively. All BPH-related medications were stopped immediately after BTA administration. To evaluate the effect of BIP, the parameters such as International Prostate Symptom Score (IPSS), quality of life (QoL), prostate-specific antigen (PSA), prostate volume, post-void residual urine and maximum flow rate were measured both before and 1 month after BIP. RESULTS: In both groups, IPSS and QoL were improved significantly after treatment, but the effectiveness of TURP was much superior to that of BIP. Among the patients with a prostate volume under 40ml, IPSS was improved by 27.5% in the BTA group and 38% in the TURP group. QoL was improved by 31.8% in the BTA group and 51% in the TURP group, but the difference between the two groups was not statistically significant. Among the patients with a prostate volume over 40ml, IPSS was improved by 24.7% in the BTA group and 47.6% in the TURP group. QoL was improved by 18.9% in the BTA group and 44.4% in the TURP group, and the difference was statistically significant between the two groups. CONCLUSIONS: Although both BIP and TURP significantly improved the clinical outcome, the latter was far superior to the former in improving voiding symptoms caused by BPH. However, BIP can be a new therapeutic option for patients with a small prostate volume or who want more minimally invasive treatment.

Removal of a Penile Metal Ring Using a Nelaton Catheter / 대한비뇨기과학회지

Penile incarceration is a serious disease that requires prompt intervention to prevent various complications. A 76-year-old male visited our emergency room complaining of penile swelling. The penile swelling had been caused by a metallic bearing placed at the base of the penis 7 days earlier. The ring had a 4.7cm outside diameter and 2.1cm internal diameter, with a thickness of 1.5cm. Because the swelling of penis distal to the constricting ring was so severe, removal of the ring was difficult. Several methods were attempted to remove the bearing, such as squeezing, aspiration and cutting with a steel saw, all of which were unsuccessful. A string method, with a Nelaton catheter, was then successfully used, which took just 5 minutes to remove the bearing. Mild abrasion of the penile skin was the only complication.