Implantation of Malleable Penile Prostheses in Peyronie's Disease Associated with Erectile Dysfunction / 대한비뇨기과학회지

Peyronie's disease is an idiopathic disorder of the penis that is unusually associated with erectile dysfunction. We treated 7 cases of Peyronie's disease associated with erectile dysfunction by implantation of malleable penile prostheses(AMS 600) and multiple full thickness transverse incision of the tunica albuginea corresponding to fibrotic plaque. Postoperatively the penile curvatures were corrected in all patients, who were able to engage in sexual intercourse as well . There were no complications such as pain or recurrence of penile curvature. Therefore, we recommend the incision of plaque and implantation of penile prostheses as the worth surgical methods in treatment of patients with Peyronie's disease associated with erectile dysfunction.

Fate of clinically insignificant residual fragment(CIRF) after extracorporeal shock wave lithotripsy with EDAP-LT01 lithotriptor / 대한비뇨기과학회지

The stone-free rate of 248 cases of CIRF was 32.7% by 1 month, 73.0% by 3 months and 92.7% by 6 months of follow-up. The stone-free rate decreased but not remarkably in accordance with the. increment of the calyceal dilatation (92.9%, 94.9%, 85.7 % and 83.3 % for no, mild, moderate and severe dilatation, respectively, by 6 months of follow-up). The clearance of the CIRF was not influenced by the location of CIRF, the pelviocalyceal angle, the infundibular length and number of the lower calices. Of 16 patients who had residual stone fragments by 6 months and underwent an additional session of ESWL, 12 became stone-free by another 6 months of follow-up. Therefore, it is desirable to wait for clearance of CIRF for at least 6 months before offering further treatment regardless of CIRF location and anatomical variation of the calices containing CIRF. Repeated ESWL even for stone fragments of 3-tmm in diameter found initially 1 month after the last session or ESWL might promote clearance of the CIRF, and additional ESWL for persistent CIRF could be an appropriate adjunctive measure.

A comparative study on various methods of cavernosometry as predictors of corporal-venous leakage demonstrated by cavernosography / 대한비뇨기과학회지

A variety of technique of dynamic pharmacocavernosometry have been described to evaluate cavernous veno-occlusive function: however, there is no uniquely reliable and standard method so far After intracavernous (IC) injection of 45 mg papaverine and 2.5 mg phenblamine, we performed gravity cavernosometry(GC) and pump cavernosometry(PC), ie, measurement of saline infusion rate needed to obtain and to maintain an erection and measurement of pressure decay for 30 seconds and pressure drop time to 75 mmHg when pump was turned off at 150 mmHg IC pressure. Final diagnosis of venous leakage was made by cavernosoeraphy done at 90 mmHg IC pressure. The parametric values measured by each method to diagnose venous leakage and correlation among these methods were analyzed. The etiology of impotence in 45 patients studied was psychogenic in 8, venogenic in 21, combined arteriogenic and venogenic in 16. The measurement of induction flow rate was less reliable(p<0.05) for the diagnosis of venous leak than the other methods of PC and GC (p<0.01). The standard deviations of the induction and maintenance flow rate and pressure drop time were similar to or even higher than mean values. There was correlation among all these methods. Therefore, GC and PC, particularly measurement of the intracorporeal pressure decay are believed to be valuable methods for diagnosis of the corporal-venous leakage.

Corporeal blood gas changes according to duration of drug-induced prolonged erection

The corporeal blood gas changes in accordance with the duration of the prolonged erection which developed after intracorporeal pharmacotherapy with papaverine and phentolamine were investigated in 62 impotence patients. The picture of the corporeal blood taken from 15 psychogenic impotence patients (a control group) at 10 minutes after intracavernous injection when they showed full erections was arterial but there was pCO2 rise and pH drop compared to femoral artery blood taken simultaneously. As the erection lasted longer, significant gas changes of the cavernous blood began to appear (p<0.0001): increase in pCO2 and decrease in pO2 from 4 hours, decrease in pH from 5 hours, decrease in O2 saturation from 6 hours. Erections lasting for more than 16 hours showed significantly worse hypoxia (p<0.05). Therefore, to prevent hypoxia and metabolic acidosis, drug-induced prolonged erection would be better decompressed before it lasts for more than 4 hours.

An experimental study on the effect of acidity of papaverine HCl on fibrosis of the corpus cavernosum of rabbit / 대한비뇨기과학회지

This study was designed to investigate whether fibrosis of the corpus cavernoum(CC) induced by repeated intracavernous injection of papaverine HCl was related to pH of the drug. Forty-eight New Zealand White rabbits weighing 2.5kg-3.0kg were divided into 4 groups of 12 animals each. Group 1 received isotonic saline. Group 2; pH 2.0 papaverine HCl. Group 3; pH 3.0 papaverine HCl and Group 4; pH 4.0 papaverine HCl. The solution (0.1ml isotonic saline or 2mg. papaverine HCl of seeh pH) was injected intracorporeally twice every week for 6 months. Every one month since beginning of the injection, 2 animals of each group were sacrificed. the penis was observed with H and E and Masson`s lrichomme stain microscopically. No sign of Fibrosis was found in the CC of the group l even after 6months of injection. However, Group 2. 3 and 4 began to show focal of diffuse thin fibrotic changes after 2 months of injection. The fibrotic changes progressed more and more in accordance with the Frequency of papaverine HCl injection. After 4 months of injection. Group 2 showed diffuse thick fibrosis whereas Group 3 and 4 showed diffuse thin or focal thick fibrosis. In conclusion, intracavernous papaverine itself seems to play a main role to induce fibrosis of CC. However, the acidity of the papaverine HCl also might be responsible to development of the fibrosis when injected repeatedly for a long period.

Successful combination therapy with electroejaculation and in vitro fertilization-embryo transfer in the treatment of a patient with neurogenic anejaculation / 대한비뇨기과학회지

Recent case reports of the successful application of electroejaculation techniques for seminal emission and subsequent pregnancies have offered promising fertility alternative for the men with neurogenic anejaculation. The success of his program requires multidisciplinary couple-oriented therapy combining both turologic and gynecologic infertility therapy. However, despite obtaining often normal numbers of spermatozoa. sperm motility rarely exceeds 10-20% in electroejaculation sample. Therefore, realistic potential for pregnancy with intrauterine insemination technique is extremely low. In this report we present the first domestic successful coordination of both electroejaculation and in vitro fertilization-embryo transfer in a neurogenic anejaculation patient with severe oligoasthenospermia.

An early experience of electroejaculation in anejaculatory men with spinal cord injury / 대한불임학회지

No abstract available.

Bio-chemical assessment of stone metabolic study in patients with calcium oxalate urolithiasis / 대한비뇨기과학회지

A study was done on 200 patients with a diagnosis of calcium oxalate stone and 50 cases of control group to evaluate the chemical relationships between stone formation and a 24-hour excretion or calcium. oxalate, uric acid and citrate. This study was also evaluated by comparing urinary concentrations and total daily output of the above metabolites. Among the 200 patients metabolic disorders included hypercalciuria in 34 (17.0%), hyperoxaluria in 8 (4.0%), hyperuricosuria in 43 (21.5%) and hypocitraturia in 128 (64.0%). The total output of calcium, oxalate, uric acid, citrate were significantly different (p<0.01) and also showed significant differences in the those concentrations between these two groups. Therefore, it is confirmed that the concentration of stone metabolite is also a influential factor of the stone formation as like as total daily output.

Evaluation of urinary enzyme levels after piezoelectric extracorporeal shock wave lithotripsy for renal stones / 대한비뇨기과학회지

Among the patients who underwent piezoelectric extracorporeal shock wave lithotripsy (ESWL) for renal stone between September l99l and December 1991, 20 patients non-selectively participated in this study. Of 20 patients 9 had renal pelvis stones and II had calyceal stones, and all received 45 average storage or shock waves. The changes of NAG, GOT. GPT, LDH, ALP, r-GTP in the blood and 24-hour urine were measured as a marker of renal damage before and after the first session of ESWL treatment. Serum levels of these enzymes did not appear to change with ESWL. As for the changes in the total volume and concentration of these enzymes in 24-hour urine. all 6 enzymes tended to increase though not significantly but the NAG significantly increased after ESWL. Therefore. these data suggest that the evaluation of urinary enzyme levels is an economic, rapid applicable diagnostic method after ESWL of renal stone. Especially. the urinary NAG assay is to be a brief screening test prior to radiographical study.

An experience with piezoelectric extracorporeal shock wave lithotripsy: 2000 cases / 대한신장학회잡지

No abstract available.

An experience with piezoelectric extracorporeal shock wave lithotripsy: 2000 cases / 대한신장학회잡지

No abstract available.

An experience of piezoelectric extracorporeal shock wave lithotripsy monotherapy in 300 patients of lower ureteral stones / 대한비뇨기과학회지

Extracorporeal shock wave lithotripsy (ESWL) monotherapies were performed in 300 patients of lower ureteral stones using EDAP-LT01 piezoelectric lithotripter. Among the 300 patients, 236(78.7%) had a single stone 8(2.6%) multiple stones and 66 (18.7%) fragmented stones following ESWL of renal or upper ureteral stones including 9 cases of steinstrasse. The stone size ranged from 0.3 to 2.6cm (mean 0.9cm) in diameter. In all the patients except one who underwent previous pelvic surgery, the stones were easily localized by ultrasound scanning. The overall success(stone free) rate was 97.0%. The numbers of treatment sessions increased in accordance with stone size with average number of 1.5 sessions in 293 patients of successful results. There were relatively low but no significant complications. Therefore, the in-situ ESWL monotherapy with piezoelctric lithotripter is considered to be a safe, effective and easily appliable outpatient procedure as the first method to treat lower ureteral stones.

An experience of piezoelectric extracorporeal shock wave lithotripsy monotherapy in 300 patients of lower ureteral stones / 대한비뇨기과학회지

Extracorporeal shock wave lithotripsy (ESWL) monotherapies were performed in 300 patients of lower ureteral stones using EDAP-LT01 piezoelectric lithotripter. Among the 300 patients, 236(78.7%) had a single stone 8(2.6%) multiple stones and 66 (18.7%) fragmented stones following ESWL of renal or upper ureteral stones including 9 cases of steinstrasse. The stone size ranged from 0.3 to 2.6cm (mean 0.9cm) in diameter. In all the patients except one who underwent previous pelvic surgery, the stones were easily localized by ultrasound scanning. The overall success(stone free) rate was 97.0%. The numbers of treatment sessions increased in accordance with stone size with average number of 1.5 sessions in 293 patients of successful results. There were relatively low but no significant complications. Therefore, the in-situ ESWL monotherapy with piezoelctric lithotripter is considered to be a safe, effective and easily appliable outpatient procedure as the first method to treat lower ureteral stones.

Dynamic infusion cavernosometry and cavernosography(DICC) / 대한비뇨기과학회지

During the last several years, cavernosography has been commonly used to demonstrate the hemodynemic abnormality of the corpora cavernosa. But this was recognized as a less obvious, physiologic and objective study. Recently a more ideal method has been introduced and resulted in the development of the procedure entitle Dynamic Infusion Cavernosometry and Cavernosography ( DICC). The DICC is done in four phase :phase I involves the determination of equilibrium corporeal body pressure and time required to reach the plateau. Phase S involves the determination of the rate of fall of corporal body pressure from a control pressure (150mmHg) over a defined observation period (30 seconds). Phase III involves the determination of cavernosal arterial systolic occlusion pressure and finally phase IV involves the cavernosography at a predetermined corporael body pressure (90mmHg). Now, this procedure is performed as the first invasive erectile function test in those individuals considered for vascular reconstruction of their erectile problem.

Dynamic infusion cavernosometry and cavernosography(DICC) / 대한비뇨기과학회지

During the last several years, cavernosography has been commonly used to demonstrate the hemodynemic abnormality of the corpora cavernosa. But this was recognized as a less obvious, physiologic and objective study. Recently a more ideal method has been introduced and resulted in the development of the procedure entitle Dynamic Infusion Cavernosometry and Cavernosography ( DICC). The DICC is done in four phase :phase I involves the determination of equilibrium corporeal body pressure and time required to reach the plateau. Phase S involves the determination of the rate of fall of corporal body pressure from a control pressure (150mmHg) over a defined observation period (30 seconds). Phase III involves the determination of cavernosal arterial systolic occlusion pressure and finally phase IV involves the cavernosography at a predetermined corporael body pressure (90mmHg). Now, this procedure is performed as the first invasive erectile function test in those individuals considered for vascular reconstruction of their erectile problem.

Multiple ESWL treatment for renal stones with piezoelectric lithotriptor / 대한비뇨기과학회지

From February 1987 to December 1990, 654 patients with renal stones completed the multiple ESWL monotherapies using the EDAP-LT01 piezoelectric lithotriptor. The location of stones was calyx in 452 patients. pelvis in 1O8. calyx and pelvis in 94 and the stone size ranged from 0.6 to 4.8cm (mean 1.9cm). The number of treatment sessions was 2 to 19 sessions (mean 4.7) with 72.2% of re-treatment rate. In accordance with increment of stone size, number of treatment increased but success rate decreased; 2.8 sessions. 96.2% for 0.6-<1 cm. 4.4, 93.2% for 1-<2 cm, 5.5. 87.7% for 2-<3 cm. 6.3, 65.5% for 3-<4 cm and 6.4, 58.8% for stones larger than 4 cm. Supposing 654 patients had been completed by 5 sessions only. 67.9% of success rate would have been expected. But. 88.4% (578,654) of success rate was obtained by multiple treatment up to 19 sessions, adding 20.5%. Auxiliary ureteral manipulations were required in 88 (13.5%) patients and there were no significant complications. Therefore. multiple ESWL monotherapy is considered to be a efficient. safe procedure as the first applicable method for treatment of larger renal stones and to extend the indications of ESWL for renal stone.

Hypertension Following Extracorporeal Shock Wave Lithotripsy / 대한비뇨기과학회지

Hypertension has been reported as a possible sequela of extracorporeal shock wave lithotripsy. The detailed pre & post-ESWL blood pressure measurements were made for 1-21 months in 1159 patients who were treated with ESWL monotherapy using the EDAP-LT01 piezoelectric lithotriptor between February, 1987 and June, 1989. The following results were obtained : 1. Among 1053 pre-ESWL normotensive patients, normal blood pressure was remained in 1012 (96.1%) and new onset hypertension was noted in 41(3.9%). Moreover, in 106 patients having pre-ESWL hypertension, 78(73.6%) patients were sustained hypertension, mild decrement in 10(9.6%) and increment in 6(5.7%). 2. Of the new onset hypertensive 41 patients, the male to female sex ratio was about 4:1 and their ages ranged from 14 to 68 years with an average of 47.9 years, but most of them were above 40 years. 3. Concerning these 41 patients, they had renal(32 cases) or ureteral(9 cases) stones of which sizes ranged from 0.7 to 3.8cm(mean 1.7cm) and number of treatments were ranged from 1 to 21 with an average of 5 sessions. 4. Of the post-ESWL hypertensive 32 patients who had renal stones, the mean diastolic blood pressure increased from 10 to 50mmHg with an average of 28.1mmHg. Seven of these 32 patients required drug therapy and an additional 25 patients had an increase in diastolic blood pressure not requiring therapy. The rate of hypertension was not increased in accordance with the storage of shock waves. Only 41(3.9%) patients who were normotensive prior to treatment become hypertensive after ESWL. If we assume that the age-dependent increase of hypertension is 0.9% per year, there is not too much evidence at the moment that hypertension is caused by ESWL treatment and requires further study.

Complications of Indwelling Double-J Ureteral Stents / 대한비뇨기과학회지

The silicone rubber double-J ureteral catheter has been popularized as an ideal internal ureteral stent for temporary or permanent urinary diversion and generally is considered to be free of side effects. We review our use of the double-J ureteral stent in 42 patients during a recent 2-year period. 1. Of 42 patients evaluated, the complicated urologic symptoms were revealed ; frequency in 15 ( 35.7% ) patients, lower abdominal pain in 15, flank pain in 10, gross hematuria in 9, nocturia in 8, dysuria in 7, nausea in 2, fever in 1 and urinary debris in 1. The early removal of stent was required in 5 (11.9% ) patients because of severe vesical irritability. 2. Of 31 patients whom indwelled stent less than 6 months, encrustation was occurred in one patient but stent fracture, encrustation and bladder stone formation were developed in 8 (72.7 %) among 11 patients whom kept more than 6 months. Therefore, despite the undoubted benefit in many patients, troublesome symptoms were common. We recommend that a shorter period of double-J stenting or more frequent catheter changes than 6 months may prevent stent fracture, encrustation and bladder stone formation.

Extracorporeal Shock Wave Lithotripsy in 20 Patients with Urinary Stone of Solitary Kidney / 대한비뇨기과학회지

EDAP-LT01 ESWL underwent 71 treatments in 20 patients with urinary stone of solitary kidney between February 25, 1987 and August 18, 1988. 1. The sex ratio was about 2:1, 13(65.0%) in male and 7(35.0%) in female patients. The average patient age was 50 years with a range of 23 to 65 years. The previous nephrectomy was owing to urinary tract stone in 19(95.0% ) and transitional cell carcinoma of renal pelvis in 1 (5.0%). 2. The duration of hospitalization was required from 2 to 7 days and the average post-ESWL stay was 1.5 days. 3. The treated stone locations were kidney in 18(90.0% ) ;calyx in 12(60.0% ) and renal pelvis in 6(30.0%) and ureter in 2(10.0%) ;upper ureter in 1(5.0% ) and lower ureter in 1(5.0%) There were multiple renal stones in 4(20.0% ).The average stone size was 1.6cm with a range of 0.7 to 4.1cm. 4. The average numbers of treatrnent were 2.7 sessions and the average treatment time was 30.2 minutes with a range of 17 to 42 minutes. The average storage was required 180 in one session. Of the patients, 4(20.0% ) were complained severe pain but treatment interruption or anesthesia were not required. 5. The success rate among 11 patients who completed ESWL treatment were 100.0% in 0.7-1.0cm, 60.0% in 1.0-2.0cm, 100.0% in 2.0-3.0cm and 77.8% in calyceal stones, 100.0% in renal pelvis stones. 100.0% in lower ureteral stones. Thus, the total average success rate was 81.8 %. 6. The method of pre-ESWL additional manipulation was used a upper ureteral stone 'push-up' in 1(5.0%). The post-ESWL additional measures were made in 4(20.0 % ) ;'push-up' & double -J stenting in 1(5.0% ) and double-J stenting in 3(15.0% ). The causes of failed ESWL were impacted stone in 1 and 'push-up' failure in 1. 7. None of the patients had significant changes in renal function by shock waves. ESWL complications were not required admission and medical management. Therefore, we confirmed that EDAP-LTOI piezoelectric ESWL is not influenced on renal function and is a safe, effective method for treatment of urinary stones in patients with a solitary kidney.

Complications of Penile Prosthetic Surgery / 대한비뇨기과학회지

We have followed up 85 patients who have underwent penile prosthetic surgeries(Jonas ; 12. AMS 600 ; 33. AMS 700 ; 11, AMS 700 CX ; 5, Mentor ; 1, Hydroflex ; 23) for erectile dysfunction with a mean follow-up period of 28.7 months. Nineteen cases of complications in 15 patients(17.6%) developed of which 17 cases of medico-surgical in 14 patients and 2 cases of mechanical in one patient. As the medico-surgical complications, occurred a crural corporeal perforation, a protrusion of AMS 600 against glans, an acute angled protrusion of Hydroflex on penile base in flaccid state, 2 cases of exposure of Scott's inflatable prostheses through scrotal erosion (a case of tubing exposure and a case of pump exposure), two cases of urethral erosion and urine leak with infected prostheses, a skin necrosis of glans, 2 infected prostheses, 4 cases of urinary retention, and a dehiscence of perineal surgical wound. As the mechanical complications, crevice of the Hydroflex of both sides with fluid leak happened with 9 months interval in one patient.