A Prospective Multi-center Trial of Escherichia coli Extract for the Prophylactic Treatment of Patients with Chronically Recurrent Cystitis

We have assessed the efficacy and safety of Escherichia coli extract (ECE; Uro-Vaxom(R)) which contains active immunostimulating fractions, in the prophylactic treatment of chronically recurrent cystitis. Forty-two patients with more than 2 episodes of cystitis in the proceeding 6 months were treated for 3 months with one capsule daily of ECE and observed for a further 6 months. The primary efficacy criterion was the number of episodes of recurrent cystitis during the 6 months after treatment compared to those during the 6 months before treatment. At the end of the 9-month trial, 34 patients (all women) were eligible for statistical analysis. Their mean age was 56.4 yr (range, 34-75 yr), and they had experienced recurrent urinary tract infections for 7.2+/-5.2 yr. The number of recurrences was significantly lower during the 6-month follow-up period than during the 6 months preceding the trial (0.35 vs. 4.26, P<0.001). During the follow-up, 28 (82.4%) patients had no recurrences and 4 (11.8%) had 1 each. In patients who relapsed, ECE alleviated cystitis symptoms, including painful voiding, frequency and urgency. There were no serious adverse events related to the study drug. Our study demonstrates the efficacy and safety of ECE in the prophylactic treatment of chronically recurrent cystitis.

The Mechanism of Damage to the Contralateral Testis Following Testicular Torsion and Detorsion in Rats and the Effect of Allopurinol Administration / 대한비뇨기과학회지

PURPOSE: This study was performed to determine the mechanism of contralateral testis damage after repair of testicular torsion. In addition, we investigated the effect of allopurinol pretreatment on the contralateral testis damage. MATERIALS AND METHODS: The levels of malondialdehyde (MDA) in the testes, kidneys and serum samples were determined in rats following torsion, detorsion or detorsion after allopurinol pretreatment, as were the levels of superoxide dismutase (SOD) in the testes samples. H&E staining was performed on the testes specimens and we calculated the mean numbers of spermatids per tubule in each group. RESULTS: Torsion caused a significant increase in the MDA levels in the contralateral testes, and detorsion caused a further significant increase in MDA in the contralateral testes and in the serum. Moreover, pretreatment with allopurinol prevented this further increase. The levels of SOD in the contralateral testes were not significantly different between the sham and torsion groups, whereas detorsion caused a significant reduction in SOD. In addition, pretreatment with allopurinol also prevented this decrease. The contralateral testes were histologically normal in all groups and the mean numbers of spermatids per tubule in the ipsilateral and contralateral testes were similar in all groups. CONCLUSIONS: Injury of the contralateral testis after the repair of testicular torsion seems to be caused by lipid peroxidation that is due to oxygen free radicals induced by the reperfusion of ischemic torsed testis. Toxic substances such as oxygen free radicals seem to be transferred to the contralateral testes through the blood stream, and allopurinol appears to protect the contralateral testes from the injury caused by detorsion.

Bladder Dysfunction in Focal Cerebral Ischemia of Rat / 대한비뇨기과학회지

Purpose: The purpose of this study was to evaluate the active contractile properties of detrusor smooth muscle from bladders of cerebral-infarcted rats (CI rats). Materials and Methods: The cerebral infarction was induced in 8 to 9 week-old male Sprague-Dawley rats by occlusion of the left middle cerebral artery. At 2 and 4 weeks after the operation, bladder muscle strips were evaluated for force development in response to electrical field, 5 micrometer carbachol (Cch) and 60mM KCl stimulation using an isometric transducer. The contractile response to field stimulation on the additions of 1micrometer atropine and 5micrometer alpha, beta-methylene ATP (abmATP) were measured, and the contributions of cholinergic and purinergic transmissions determined. Cystometrography (CMG) was also performed in anaesthetized rats. Results: In comparison with sham-operated rats, the CI rats showed a shorter voiding interval, smaller peak voiding pressure, smaller voiding volume and greater residual urine volume on CMG. The CI rats also showed smaller tension at maximum contraction induced by Cch and a quicker response to maximum contraction induced by KCl than the sham operated rats. The CI rats showed time-dependent increases and decreases in the proportions of abmATP-sensitive (purinergic) and atropine-sensitive (cholinergic) components, respectively. Conclusions: CI rats showed changes in detrusor activity, contractility and the proportions of cholinergic and purinergic components. The increase in the purinergic contraction of the detrusor muscle was believed to be related to bladder instability. The results of this study will be useful in explaining detrusor hyperactivity, with impaired contractility (DHIC), in patients with cerebral infarction.

Endourologic Procedures and Laparoscopic Surgery in Urology Training Hospitals: The Report of Nationwide Survey / 대한비뇨기과학회지

PURPOSE: To assess the current status of endourology and laparoscopy in Korea. MATERIALS AND METHODS: Using the database directory of the Korean Urological Association, 83 urology training hospitals were identified. A detailed questionnaire was designed and sent by post and e-mail. The questionnaire included questions regarding the number of various endourological and laparoscopic procedures between 1998 and 2002. The questionnaires of those responding were analyzed. RESULTS: Responses were received from 45 hospitals (response rate 54.2%). 133 antegrade and 626 retrograde endourological procedures for urinary strictures were performed during the period of the study in 12 and 35 hospitals, respectively. 42 hospitals (93.3%) were performing shock wave lithotripsy for urinary stone disease. 29 hospitals (64.4%) reported having performed more than one laparoscopic procedure during the five years. The annual total numbers of laparoscopic procedures increased from 217 in 1998 to 725 in 2002. Simple laparoscopic nephrectomy was the most widely accepted procedure, and was being performed in 18 hospitals. Laparoscopic adrenalectomy, radical nephrectomy, diagnostic laparoscopy, laparoscopic renal cyst marsupialization, nephroureterectomy and donor nephrectomy were performed in more than 10 hospitals. However, the actual number of laparoscopic procedures was limited in most hospitals. More than 40 laparoscopic procedures per year were performed by only four hospitals. CONCLUSIONS: This survey revealed an increasing number of endourological and laparoscopic procedures. However, laparoscopy seems to be mainly a larger hospital-based technology in Korea. These results can be utilized as fundamental data for establishing future developmental requirements of endourology and laparoscopy in Korea.

The Effects of Bilateral Ureteroneocystostomy Performed during the Infantile Period on Bladder Function: Questionnaire Study / 대한비뇨기과학회지

PURPOSE: There has been a non evidence-based reluctance among pediatric urologists to perform trigonal surgery during infancy in fear of damaging the young developing bladder. The effects of a bilateral ureteroneocystostomy on the bladder function, which was performed during the infantile period, were evaluated. MATERIALS AND METHODS: 53 children who underwent a bilateral ureteroneocystostomy during the infantile period, between June 1987 and December 2002 were enrolled in this study. 40 of the 53 enrolled subjects could be contacted by mail, and they were subsequently sent a voiding abnormality symptom score form (10 items, 3 points for each item), which was developed to quantify the degree of voiding abnormality among children, and a newly-developed enuresis questionnaire. RESULTS: Among the 40 who received the questionnaire forms, 29 (72.5%) responded, but 3 had to be subsequently excluded due to incomplete forms. As a result, the responses from 26 subjects (Male to Female Ratio, 7.7:1) were analyzed. The mean ages at the time of operation, at responding to our survey, and mean time interval from the time of operation were 7.88 (2.53-11.9) months, 8.09 (2.51-16.7) years, and 7.45 (1.8-16.2) years, respectively. The mean age at the point of attaining daytime dryness was 23.4 (18-36) months. The mean total voiding abnormality symptom score was 3.23 (0-11) with the mean scores for each individual item being less than 1. CONCLUSIONS: A bilateral ureteroneocystostomy, performed during the infantile period, does not appear to induce a bladder function abnormality or voiding difficulty after the operation. Thus, a bilateral ureteroneocystostomy may be considered a safe treatment option for infants under appropriate indications.

Clinical Characteristics and Outcome of Fetal Hydronephrosis / 대한비뇨기과학회지

PURPOSE: We performed a retrospective study to determine the clinical characteristics and outcome of fetal hydronephrosis. MATERIALS AND METHODS: The records of the children diagnosed with fetal hydronephrosis between 1990 and 2001 were retrospectively analyzed. In the postnatal follow-up period, the children were followed by sequential ultrasonography and urinalysis. Diuretic renal scanning and voiding cystourethrography were performed in selected cases. The clinical characteristics and outcome were evaluated and compared to the degree of hydronephrosis. RESULTS: The study comprised 341 children with 427 dilated kidneys. Mild (Grade 1), moderate(Grade 2 or 3) and severe(Grade 4) hydronephrosis were present in 21.8%, 60.4% and 17.8% respectively. Hydronephrosis resolved spontaneously in 126(29.5%) kidneys, including 52.7% of mild and 2.6% of severe hydronephrosis. Mean interval to spontaneous resolution was 1.39(+/-1.41, SD) years. Dilatation of the renal pelvis was caused by primary ureteropelvic junction obstruction in 65.6%, multicystic kidney in 9.4%, vesicoureteral reflux in 7.0%, duplex system in 5.4%, ureterovesical junction obstruction in 4.0%, and posterior urethral valves in 3.0%. Surgery was performed in 174 kidneys, consisting of pyeloplasty in 105, ureteroneocystostomy in 23, transurethral incision in 11, and nephrectomy in 9. Most patients had initially high-grade hydronephrosis (p<0.05). CONCLUSIONS: Mild hydronephrosis appears to be relatively benign, and in most cases dilatation improves with time with surgical intervention thereby not required. On the other hand, moderate or severe hydronephrosis often RESULTS in a significantly poorer outcome and requires surgical intervention, and hence closer follow-up both antenatally and postnatally.

The Effects of Local Anesthetics on the Human Bladder Contractility: Organ Bath Study / 대한비뇨기과학회지

PURPOSE: We investigated the in vitro effects of local anesthetics on the contractility of the human bladder. MATERIALS AND METHODS: Using human bladder strips obtained from 20 patients undergoing cystectomy, we investigated the effects of tetracaine, bupivacaine, lidocaine, and ropivacaine on the basal spontaneous contractions and contractions induced by various stimuli: KCl, carbachol (CCh), and electrical field stimulation (EFS). The effect of local anesthetic agents on the Ca2+ -independent sustained tonic contraction (SuTC) was also investigated. RESULTS: Spontaneous contraction was not observed in 181 out of 187 bladder strips. Local anesthetics inhibited nerve-mediated contractions (EFS, 0.8msec) in a concentration-dependent manner and also inhibited non-nerve mediated contractions induced by KCl, long pulse EFS (direct muscle stimulation, 100msec), and CCh. The rank order of inhibitory potency on nerve-mediated contractions and CCh-induced contractions was ropivacaine, tetracaine, bupivacaine, and lidocaine, while the rank order on KCl-induced contractions was ropivacaine, tetracaine, lidocaine, and bupivacaine, both in decreasing order. Higher concentrations of local anesthetics were needed to inhibit the non-nerve-mediated bladder contraction than the nerve-mediated contraction. SuTC was also suppressed by all local anesthetics in a concentration dependent manner. CONCLUSIONS: Our study demonstrates that local anesthetics have inhibitory effects on the contraction of human bladder that is induced by various stimuli. These effects suggest that local anesthetics may be useful as diagnostic and therapeutic agents for bladder dysfunction.

Sildenafil Compliance after Restoration of Erectile Function / 대한남성과학회지

PURPOSE: Regarding for erectile dysfunction(ED), Sildenafil has produced satisfactory clinical results. However, Some patient discontinue sildenafil treatment for a variety of reasons after successful restoration of erectile function. We investigated the reasons for such discontinuations of sildenafil after restoration of erectile function by sildenafil medication. MATERIALS AND METHODS: After sildenafil medication, one hundred fifty six patients whose score of erectile function domain of the 15-item International Index of Erectile Function(IIEF) increased to 26 or more, were included in this study. Six-months after the first sildenafil prescription, compliance to medication and the reason for discontinuity were reviewed by chart or surveyed by telephone. RESULTS: In 156 successfully treated patients, 54(34.6%) discontinued sildenafil medication. The 2 most common reasons for discontinuation were trouble in the partners' or patients' emotional readiness for restoration of sexual activity after long-term abstinence and fear of possible side effects. CONCLUSIONS: After restoration of erectile function, many patients discontinued the use of sildenafil medication. The reasons for discontinuing the medication were primarily emotional or relationship-oriented issues. The counseling of both partners and education about the effects and side effects of the drugs are recommended to promote the successful recovery of sexual activity.

Effect of Periprostatic Nerve Blockade for Transrectal Ultrasound Guided Biopsy of the Prostate / 대한비뇨기과학회지

PURPOSE: The analgesic efficacy of the periprostatic nerve blockade during transrectal ultrasound guided prostatic biopsies was evaluated. MATERIALS AND METHODS: A transrectal ultrasound guided prostate biopsy was performed in 90 men due to abnormal digital rectal examinations or elevated prostate specific antigens. During the biopsy, two groups of 45 patients were randomly assigned to receive either an injection of 1% lidocaine or no prior analgesia. Immediately after the biopsy the pain score was independently recorded by the patients using a 10-point linear scale. RESULTS: The mean intraoperative pain scores were 2.7+/-1.7 and 4.9+/-2.6 in the lidocaine and control groups, respectively, and were significantly different (p<0.001). The mean immediate postoperative pain scores were 0.7+/-0.7 and 1.5+/-1.3 in the lidocaine and control groups, respectively, and were not significantly different (p=0.057). There were no differences in the complication rates between the two groups. CONCLUSIONS: Our results show a significant benefit of periprostatic anesthesia over that in the controls (no anesthesia applied) in our randomized trial. This safe, simple and rapid technique should be applied before a transrectal ultrasound guided prostatic biopsy to reduce undue patient discomfort.

Epidemiologic Survey of Sexual Life of Middle-Aged Couples in Seoul / 대한남성과학회지

PURPOSE: We investigated libido and sexual life satisfaction of middle-aged couples in Seoul. MATERIALS AND METHODS: A total of 2,034 couples ranging from 40 to 79 years old living in the Seoul metropolitan area were selected by stepwise random sampling. The questionnaires asking about erectile function, sexual performance, sexual life satisfaction, and libido were administered by trained interviewers. RESULTS: Interviews were completed for 1,356 couples(66.7%). The prevalence of severe and moderate loss of libido in the men was 29%. Decrease of libido correlated with increasing age. Higher scores on the erection scale of the O'Leary sexual function questionnaire were closely correlated with greater libido. In sexual function self-assessment, most male subjects did not complain of libido(53.8%), erection(61.7%), or ejaculation(63.8%) difficulties. Most couples(50.3% of the male and 53% of the female subjects) expressed satisfied with their sexual lives. Higher scores on the erection scale correlated with an increase in sexual satisfaction of both men and women. Fewer than half of the female subjects(40.4%) answered that they had 'no' or 'low' sexual interest. Younger age and more education were correlated with greater sexual interest. CONCLUSIONS: With increasing age, middle-aged couples living in Seoul showed a decrease in libido, sexual function, and sexual interest. However, satisfaction with their sexual life was high in general.

Urodynamic Effect of Oxybutynin Chloride on Bladder Dysfunction in Rats with Focal Cerebral Ischemia

PURPOSE: The purpose of this study was to evaluate the urodynamic effect of oxybutynin chloride on bladder dysfunction in rats with focal cerebral ischemia. MATERIALS AND METHODS: The cerebral infarction of 8 to 9 week-old male Sprague-Dawley rats was induced by occlusion of the left middle cerebral artery. The control groups received sham operation. At 1, 2 and 4 weeks after operation, cystometrogram (CMG) was performed before and after intravesical instillation of 0.5 ml of oxybutynin chloride (0.005 and 0.05 mg/ml) (n=7). RESULTS: The body weight of cerebral-infarcted (CI) rats was smaller than that of sham-operated rats. Compared to sham-operated rats, CI rats showed a shorter voiding interval, smaller micturition pressure, smaller voiding volume and more residual urine. in CMG. After intravesical instillation of oxybutynin, CMG showed dose-dependent increase of voiding interval and functional bladder volume and decrease of peak micturition pressure. The effects of oxybutynin on CI rats were more prominant than that of sham-operated rats. CONCLUSIONS: CI rats showed urinary frequency and decrease of micturition pressure in CMG. The result of this study will be useful for explanation of the detrusor hyperactivity with impaired contractility (DHIC) in patients with cerebral infarction. These results suggest that treatment with intravesical oxybutynin will be an effective alternative treatment of detrusor hyperactivities with cerebral infarction.

Clinical Characteristics and Outcome of Hydronephrosis Detected by Prenatal Ultrasonography

The widespread use of prenatal ultrasound results in an increased recognition of fetal hydronephrosis. To determine clinical characteristics and postnatal outcome of fetal hydronephrosis, we performed a retrospective study in children diagnosed as having fetal hydronephrosis between 1990 and 2001. 341 children with 427 dilated kidneys were included. Dilatation of the renal pelvis was caused by primary ureteropelvic junction obstruction in 65.6%, multicystic kidney in 9.4%, vesicoureteral reflux in 7.0%, duplex system in 5.4%, ureterovesical junction obstruction in 4.0%, and posterior urethral valves in 3.0%. Hydronephrosis resolved spontaneously in 126 (29.5%) kidneys, with 52.7% of mild hydronephrosis, and 2.6% of severe hydronephrosis. Mean interval to spontaneous resolution was 1.39 (+/-1.41, SD) yr. Surgery was performed in 174 kidneys, including pyeloplasty in 105, ureteroneocystostomy in 23, transurethral incision in 11 and nephrectomy in 9. Most patients had initially high-grade hydronephrosis (p<0.05). Mild hydronephrosis appears to be relatively benign, and in most cases, dilatation improves with time, and thus surgical intervention is not required. On the other hand, moderate or severe hydronephrosis often results in a significantly poor outcome and requires surgical intervention, and therefore, requires closer follow-up both antenatally and postnatally.