Surgical Removal of Intrahepatic Bile Duct Stones Using a Rigid Nephroscope: A First Case Report

Hepatolithiasis is characterized by its frequent recurrence, and its requirement for multiple interventions which can be performed radiologically, endoscopically or surgically. Although hepatic resection - concomitant removal of hepatic stones and its provocative pathology as well - has remained the definitive treatment of hepatolithiasis, the burden of the surgery limits its widespread application. In a certain proportion of patients, those for whom hepatic resection and endoscopic/percutaneous approaches are not indicated, surgical removal of intrahepatic stones can be attempted. In those circumstances, hepatic stones located outside the direct visual field can make the stone-extracting procedure cumbersome. We experienced an operation of a 66-year-old patient who had already received left lateral sectionectomy, cholecystectomy and choledochojejunostomy. His condition was due to impacted, recurrent stones packed between the hepatic hilum and the second confluence of the hepatic duct. Instead of revising the prior choledochojejunostomy site, after entering the jejunum 4 cm below the choledochojejunostomy site, we inserted a rigid nephroscope into the hepatic duct. Under the magnified view presented by a telescope inside the nephroscope, stone extracting was easily done using forceps inserted into the nephroscope. We think a nephroscope is useful in extracting intrahepatic stones, especially for large impacted stones located below the second confluence of the hepatic duct.

Changes in Causative Organisms and Antibiotic Sensitivity in Intensive Care Unit-Acquired Urinary Tract Infection

PURPOSE: Patients in the intensive care unit (ICU) are usually at greater risk for acquiring urinary tract infection (UTI). Few studies have focused on UTI specifically acquired within the ICU. We retrospectively studied and compared the microbiology and antibiotic sensitivity of UTI in ICU-admitted patients between 2001 and 2008. MATERIALS AND METHODS: We reviewed the medical records of a total of 1,818 ICU patients who had undergone a urine culture exam in 2001 and 2008 in a single hospital. Changes in causative organisms and their antibiotic sensitivity between 2001 and 2008 were analyzed. RESULTS: The common pathogens in 2008 were Escherichia coli (20.3%), Pseudomonas (19.5%), Enterococcus (18.0%), Klebsiella (7.8%), coagulase-negative Staphylococcus (CNS) (4.3%), and Staphylococcus (4.3%). Pseudomonas species significantly increased in 2008 compared with 2001 (p=0.002). Gram-negative organisms showed relatively higher sensitivities to amikacin, imipenem, and Tazocin (72.1%, 76.2%, and 74.6%, respectively), whereas they showed relatively lower sensitivities to third-generation cephalosporins and ciprofloxacin (43% to 59%). Gram-positive organisms showed high sensitivities to teicoplanin and vancomycin (91.2% and 86.8%, respectively), whereas they showed low sensitivities to ampicillin and ciprofloxacin (25% and 26.5%, respectively). The antibiotic resistance of Pseudomonas species was nearly double that of E. coli. CONCLUSIONS: E. coli, Pseudomonas, and Enterococcus were the three most common organisms in ICU-acquired UTI in our study. In particular, Pseudomonas species were found to have increased significantly in recent years. Pseudomonas species had a significantly lower susceptibility to antibiotic sensitivity than did the other organisms.

The Effect of Cardiovascular Risk Factors on the Patient with Erectile Dysfunction and Diabetes and the Response to Phosphodiesterase Type 5 Inhibitors / 대한남성과학회지

PURPOSE: Erectile dysfunction (ED) is a common comorbidity with diabetes mellitus (DM). The goal of this study was to evaluate the effect of cardiovascular risk factors (CVRF) on ED patients with DM and the response to phosphodiesterase type-5 (PDE5) inhibitors. MATERIALS AND METHODS: We performed a retrospective study on 32 patients with ED and type II DM. The CVRFs were defined as hypertension, coronary artery disease, hyperlipidemia, smoking and obesity. All the patients were checked for CVRFs and the erectile function was assessed with the International Index of Erectile Function (IIEF) score. Tadalafil (20mg) was taken for 3 months, and then the IIEF score was checked again. The scores of the IIEF-EF, Q3 and Q4 and the number of risk factors were analyzed. RESULTS: The scores of the IIEF-EF, Q3 and Q4 were higher in the non-risk factor group than that in the risk factor group. After Tadalafil treatment, the score of the group that had less than 1 risk factor was significantly improved, but the score of the group that had more than 2 risk factors showed little change. CONCLUSIONS: To treat ED patients with DM, their cardiovascular risk factors must be assessed.

The Effect of Human Umbilical Cord Blood Derived Mesenchymal Stem Cell Therapy in Rat Model of Cavernosal Nerve Injury / 대한남성과학회지

PURPOSE: To find out the effect of transplanted umbilical cord blood derived human mesenchymal stem cells (hUCB- MSCs) in the rat model of bilateral cavernosal nerve injury (BCNX) MATERIALS AND METHODS: Male Sprague Dawley rats were divided into three groups: Group I (7 rats, Control, Sham operation) had only bilateral cavernosal nerve crushing injury. PKH-26 fluorescent cell linker was labeled to hUCB- MSCs Group II (7 rats) had transplantation of hUCB- MSCs (3x10(5)cells/50microliter PBS) into MPG after BCNX. Group III (7 rats) had transplantation of hUCB- MSCs (3x10(5)cells/50microliter PBS) into the CC after BCNX. We detected the PKH-26 labeled MSCs in Group II, and III at four weeks after transplantation. Peak intracavernosal pressure (ICP) and ICP/mean arterial pressure (MAP) were recorded after pelvic nerve stimulation at 12 weeks after transplantation. RESULTS: PKH-26 labeled hUCB-MSCs were detected in MPG and CC of group II and III at four weeks after transplantation. The peak ICP was significantly higher in the Group II (69.6+/-5.9mmHg) and Group III (59.7+/-7.6mmHg) compared to Group I40.6+/-10.5mmHg) at 12 weeks after transplantation. The rates of ICP/MAP were significantly higher in Group II (32.2+/-6.4%) and Group III (57.8+/-4.9%) compared to Group I (49.5+/-2.9%) at 12 weeks after transplantation. CONCLUSIONS: The intracavernosal and major pelvic ganglion transplantation of hUCB- MSCs improve erectile function in a rat model of neurogenic impotence.

The Effect of Human Umbilical Cord Blood Derived Mesenchymal Stem Cell Therapy in Rat Model of Cavernosal Nerve Injury / 대한남성과학회지

PURPOSE: To find out the effect of transplanted umbilical cord blood derived human mesenchymal stem cells (hUCB- MSCs) in the rat model of bilateral cavernosal nerve injury (BCNX) MATERIALS AND METHODS: Male Sprague Dawley rats were divided into three groups: Group I (7 rats, Control, Sham operation) had only bilateral cavernosal nerve crushing injury. PKH-26 fluorescent cell linker was labeled to hUCB- MSCs Group II (7 rats) had transplantation of hUCB- MSCs (3x10(5)cells/50microliter PBS) into MPG after BCNX. Group III (7 rats) had transplantation of hUCB- MSCs (3x10(5)cells/50microliter PBS) into the CC after BCNX. We detected the PKH-26 labeled MSCs in Group II, and III at four weeks after transplantation. Peak intracavernosal pressure (ICP) and ICP/mean arterial pressure (MAP) were recorded after pelvic nerve stimulation at 12 weeks after transplantation. RESULTS: PKH-26 labeled hUCB-MSCs were detected in MPG and CC of group II and III at four weeks after transplantation. The peak ICP was significantly higher in the Group II (69.6+/-5.9mmHg) and Group III (59.7+/-7.6mmHg) compared to Group I40.6+/-10.5mmHg) at 12 weeks after transplantation. The rates of ICP/MAP were significantly higher in Group II (32.2+/-6.4%) and Group III (57.8+/-4.9%) compared to Group I (49.5+/-2.9%) at 12 weeks after transplantation. CONCLUSIONS: The intracavernosal and major pelvic ganglion transplantation of hUCB- MSCs improve erectile function in a rat model of neurogenic impotence.

Clinical Features of Prostate Cancer Detected on Initial and Repeated Biopsy / 대한남성과학회지

Purpose: To determine the clinical differences between prostate cancer detected on initial biopsy and repeated biopsy Materials and Methods: Between January 2003 and December 2006, 67 patients were evaluated in this study who were diagnosed prostate cancer by transrectal ultrasound-guided biopsies and their prostate specific antigen (PSA) were below 20 ng/ml and clinical stages were less than T2. Among 67 patients, 43 patients were diagnosed at the first biopsies (group A) and others were diagnosed at the repeate biopsies (group B). We retrospectively characterized differences in clinical features such as age, digital rectal examination (DRE), prostate volume, the number of biopsy core, rate of positive core, PSA, % free PSA, Gleason score and rate of insignificant cancer. Results: There were no significant differences in age, PSA, % free PSA, rate of insignificant cancer between groups A and B. However, positive rate of DRE, prostate volume and rate of patients whose PSA were 7 ng/ml or higher in group A were significantly higher than those in group B. Despite the number of biopsy core was higher in group A, there were no differences in the number of positive biopsy core. Conclusions: Compared to the patients who were diagnosed as prostate cancer in the initial biopsies, prostate volume, positive rate of DRE and rate of Gleason score 7 or more were significantly lower in repeated biopsy group. From now on we are planning to include more patients and compare these characteristics of biopsies with the final pathological features after radical prostatectomy.

Primary Cavernous Hemangioma of Penile Shaft with Painful Erection and Penile Curvature / 대한남성과학회지

Hemangiomas result from proliferation of immature capillary vessels. This disorder in the genitourinary tract is a rare lesion. We experienced one case of a 31 years old man suffered from cavernous hemangioma of the penis shaft with painful erection. He was treated successfully with surgical excision. Herein, we report our experience and a critical review of the literature.

The Changes of the Erectile Function and Histology of the Corpus Cavernosum in a Rat Model of Metabolic Syndrome / 대한남성과학회지

PURPOSE: We evaluated the changes of the erectile function and histology of the corpus cavernosum in a rat model of metabolic syndrome. MATERIALS AND METHODS: We used male spontaneous hypertensive rats (SHRs) as an experimental group (n=6) and Wistar-Kyoto rats as a control group (n=6). The SHRs were fed with a high fat diet, but the Wistar-Kyoto rats were fed with a normal fat diet for 12 weeks. All the groups were then checked for body weight and various biochemiclal parameters. To investigate penile erection, the intracavernosal pressure (ICP), mean arterial pressure (MAP) and cGMP level of the corpus cavernosum were recorded for all the groups. Serial sections of the penis were used to perform Masson's trichrome staining and immunohistochemistry for determining the TGF-beta 1 expression. RESULTS: We confirmed that metabolic syndrome was induced in the experimental group by the significant difference of the various biochemical parameters. (ED note: For the results of erectile function? This wasn't clear.)As a result of erectile function, the ICP/MAP ratios were checked as 51.0+/-7.5% and 31.0+/-5.5%, respectively, for the control and experimental groups. So the ICP/MAP ratio of the latter was markedly decreased compared with the former and the cGMP level of the corpus cavernosum was the same for both groups. On Masson's trichrome staining, the number of smooth muscle cell was decreased and the collagen fibers with an irregular, distorted arrangement were increased in the experimental group. The immunoreactivity for TGF-beta 1 tended to increase in the experimental group. These histological findings revealed that fibrosis of the corpus cavernosum occurred in the experimental group. CONCLUSIONS: Our results demonstrate that metabolic syndrome is harmful to erectile function and it leads to histological changes of the corpus cavernosum according to a rat model of metabolic syndrome.

Effectiveness of Emergency Ureterorenoscopic Lithotripsy for Distal Ureter Stones / 대한비뇨기과학회지

PURPOSE: We performed this study to determine the efficacy between the use of emergency ureterorenoscopic lithotripsy(URSL) and emergency shock wave lithotripsy(SWL) for distal ureter stones in terms of stone-free rates, complication rates and patient satisfaction. MATERIALS AND METHODS: This prospective study included 145 patients with distal ureter stones who underwent emergency URSL(URSL group, n=64) and emergency SWL(SWL group, n=81). All emergency URSL and SWL procedures were performed within eight hours of admission. Stone status was evaluated with either an intravenous pyelogram or the use of non- enhanced CT. URSL was performed with 7.5 Fr semi-rigid ureterorenosope and SWL was performed with Sonolith PRACTIS V.5.0(EDAP TECHNOMED). The stone-free rates, complication rates, visual analogue pain scale and patient satisfaction scores were analyzed for each group of patients. RESULTS: The overall stone-free rates of the URSL and SWL group of patients at two weeks were 96.8% and 74%, respectively(p=0.001). Complication rates were similar(28.1% versus 27.1%, p=0.897). The patient satisfaction score was statistically significant in favor of patients that underwent emergency URSL. CONCLUSIONS: In our single-center study, treatment with emergency URSL provided higher stone-free rates and superior patient satisfaction, as compared with treatment with emergency SWL. Emergency URSL was considered as attractive modality for the management of distal ureter stones.

Correlation between Serum Testosterone and Lower Urinary Tract Symptoms in Men with Hypogonadism Symptoms / 대한남성과학회지

PURPOSE: We performed this study to estimate the correlation of serum testosterone and lower urinary tract symptom (LUTS) in adult hypogonadism patients. MATERIALS AND METHODS: Medical records of ninety men over forty years old who have LUTS, International Prostate Symptom Score (IPSS) above 7 were reviewed. The correlations of serum testosterone level withage, International Prostate Symptom Score (IPSS), prostate volume, prostate specific antigen (PSA) and maximal flow rate were assessed using Spearman test. The statistical differences of IPSS, prostate volume, PSA and maximal flow rate in 3 groups of patients divided by serum testosterone levels(3.5 ng/ml). RESULTS: Serum testosterone level decreased according to increase of age (r=-0.28, p=0.07). Serum testosterone has no significant correlation with IPSS, prostate volume, PSA and maximal flow rate. There was no significant difference of IPSS, prostate volume, PSA and maximal flow rate according to the levels of testosterone. CONCLUSIONS: Emerging from this analysis, clinical indexes of LUTS may not be connected with testosteronelevel and LUTS may not be affected by hypogonadism. Further more objective and sophisticated studies with large number of subjects are requested for the understanding of pathophysiology of LUTS in hypogonadism.

Arterio-Ureteral Fistula due to External Iliac Artery Pseudo-aneurysm Rupture / 대한비뇨기과학회지

Arterio-ureteral fistulas are uncommon but potentially cause a life-threatening hemorrhage that manifest as gross hematuria. Approximately 90 cases of arterio-ureteral fistulas have been reported in the English-language literature. To our knowledge, there have been no report about this issue in Korea. We experienced 1 patient with arterio-ureteral fistula after pelvic operation and radiation therapy followed by ureteral stent. Arterio- ureteral fistula was diagnosed by selective arteriography and treated by surgical management successfully without complications.

The Difference of Pelvic Floor with Dynamic MRI before and after Tension Free Vaginal Tape Procedure in Female Stress Urinary Incontinence

PURPOSE: Tension-free vaginal tape(TVT) procedure is an effective surgical procedure for the treatment of female urinary stress incontinence. The purpose of this study was to evaluate the changes of pelvic floor MR imaging findings after tension-free vaginal tape procedure on stress urinary incontinent women. MATERIALS AND METHODS: Thirty two women with complaint of stress urinary incontinence(mean age, 56 years; age range 32~73 years) were included in this study. Pelvic floor MR imaging were performed preoperatively and one month after surgery. The position of the bladder neck in relation to the pubococcygeal line, the position of the bladder neck in relation to a perpendicular line through the posterior edge of symphysis pubis, the angle of urethral inclination were measured. We also measured the position of anterior wall of the urethra in relation to posterior edge of the symphysis pubis and cystocele during resting and pelvic straining and thickness of the anterior wall. We compared all parameters between resting and stress. RESULTS: Twenty nine patients(91%) had normal voiding pattern after TVT procedure. three patients(9%) had voiding difficulty. The position and mobility of the bladder neck during straining showed significant improvement after surgery(p<0.01). During straining, the length between the urethra and the inferior edge of the pubic symphysis with mid-urethra angulation was shorten in twenty eight patients(88%). There is no significant difference among three groups in all parameters. However, 3 patients with voiding difficulty had the significant high bladder neck and moderate cystocele. CONCLUSION: The TVT procedure provides decrease of urethral hypermobility and increase of mid-urethral angulation. MR imaging demonstrate well that urinary continence after surgery is most probably achieved by creating a dynamic mid-urethral knee angulation by which the urethra is closed at stress. Postoperative voiding difficulty may be related to remaining cystocele and high bladder neck.

Anticancer Efficacy and Toxicity of Oral GMO-paclitaxel in a Hormone Refractory Prostate Cancer Model / 대한비뇨기과학회지

PURPOSE: We wanted to evaluate the efficacy and toxicity of the newly developed oral glyceryl monooleate (GMO)-paclitaxel in a hormone refractory prostate cancer model. MATERIALS AND METHODS: A paclitaxel formulation was prepared from GMO, tricaprylin, Tween(R) 80 and paclitaxel. The tumor cells of prostate cancer (DU-145 cells) were incubated and then put into different paclitaxel concentrations. The tumoricidal activity was measured by using an indirect methylthiazol-2-yl-2,5-diphenyl tetrazolium bromide (MTT) assay. Cells of the DU-145 cell line were subcutaneously heterotransplanted into 18 nude mice, and they developed prostate cancer. The 18 mice were divided into 3 groups; the control group was injected with the DU-145 cell line (n=6), the GMO group was injected with GMO after the DU-145 cells were injected (n=6), and the oral GMO-paclitaxel group was injected with oral GMO-paclitaxel after the DU-145 cells were injected (n=6). The tumor volume was measured every week and the main organs were evaluated pathologically to determine the toxicity. RESULTS: On the MTT assay, the control group and the GMO group did not display cytotoxicity. However, treatment with the various GMO-paclitaxel formulations (0.1 microgram/ml, 1 microgram/ml, 10 microgram/ml) for treating the DU-145 cell line cancer induced cytotoxicity in a dose dependent fashion. The tumor volumes were not significantly changed in the group that was administered oral GMO-paclitaxel. However, there were significantly increased tumor volumes in the control group and the GMO group (p<0.05). Toxic changes were not detected in liver and kidney, and there was normal cellularity with a normal myeloid:erythroid ratio in the mice after the administration of oral GMO-paclitaxel. CONCLUSIONS: The newly developed oral GMO-paclitaxel has a remarkable cytotoxic effect against DU-145 cells without systemic toxicity. Therefore, oral GMO-paclitaxel therapy promises to be a safe and effective modality for treating hormone refractory prostate cancer, and it can possibly replace IV paclitaxel.

Endopyelotomy and Endoureterotomy with the Ureteral Cutting Balloon Device (Acucise(R)) / 대한비뇨기과학회지

PURPOSE: Endourological management of ureteropelvic junction obstruction (UPJO) has gained increased acceptance with high procedural success rates and low morbidity being reported. It has been suggested that Acucise endopyelotomy should be the procedure of choice for patients with UPJO. The purpose of this study is to determine the efficacy of the Acucise balloon for the treatment of ureteral strictures and UPJO. MATERIALS AND METHODS: Between March 2004 and June 2005, 13 consecutive patients (8 primary and 5 secondary cases of UPJO) underwent Acucise endopyelotomy at our institution. The preoperative evaluation included ultrasound and/or intravenous urogram with diuretic renography. The success of the procedure was based on objective radiologic improvement and the subjective resolution of symptoms. RESULTS: The mean follow-up was 6.77+/-3.83 months (range: 3-14). The mean operating time was 64.23+/-34.87 min and the mean hospital stay was 4.15+/-2.44 days. The objective success rate was 61.5% and the subjective success rate was 69.2%. There were no major complications such as vascular injury requiring transfusion. Yet a small urinoma developed in one patient. Of the 5 objective failures, 3 patients have since successfully undergone open pyeloplasty. CONCLUSIONS: In this small series, Acucise endopyelotomy is a safe and minimally invasive procedure that offered effective first-line treatment for UPJO, although multicenter randomized trials are needed to make a better comparison with the other techniques.

Effects of Connexin Expression on Unstable Bladder after Relief of Bladder Outlet Obstruction in Rat / 대한비뇨기과학회지

PURPOSE: Connexins (Cx) constitute a family of transmembrane proteins that form gap junction channels, and allow metabolic and electrical coupling of cellular networks. This study was undertaken to evaluate the regulation of Cx expression, according to bladder function, after the relief of a bladder outlet obstruction in rat. MATERIALS AND METHODS: 50 Wistar male rats were used for this study. They were divided into two groups: 10 in a control group, and 40 in an experimental group. The experimental group was partially obstructed for 3 weeks, after which the obstruction was relieved by urethral deligation. 3 weeks after the deligation, cystometrograms (CMG) were performed. On the basis of the CMG results, the experimental group was subdivided into the normalized and unstable groups. The bladders from each group were dissected after the CMG, and weighed. The expressions of Cx43 and Cx40 mRNA in each group were analyzed by a reverse transcriptase polymerase chain reaction (RT-PCR). RESULTS: The bladder weights of both the normalized and unstable groups increased compared with the control group (p<0.05). On CMG, the contraction interval of the unstable group was markedly decreased compared with that of the control and normalized groups (p<0.05). The semiquantitative RT-PCR revealed that there was no significant difference in the expressions of Cx43 mRNA between the control and normalized groups. However, the expression of Cx43 mRNA of the unstable group was significantly increased compared with the control and normalized groups. The expression of Cx40 mRNA was no different between the groups. CONCLUSIONS: Our results show that there is a change in the expressions of the onnexins according to bladder function, which may be related to a persistent unstable bladder or irritative symptoms following the relief of a bladder outlet obstruction.

The Effect of Nerve Growth Factor and Vanilloid Receptor Subtype 1 on Bladder Function after Relief of Bladder Outlet Obstruction in Rats / 대한비뇨기과학회지

PURPOSE: This study was performed to investigate the changes in nerve growth factor (NGF), and vanilloid receptor subtype 1 (VR1), after the relief of bladder outlet obstruction, and to look at how these changes participate in functional changes of the bladder. MATERIALS AND METHODS: 50 Wistar male rats, weighing approximately 250-300g, were used for this study, and divided into two groups: 10 controls and 40 experimental. The control group consisted of sham operated animals. The experimental group was obstructed for 3 weeks by partial urethral ligation. After 3 weeks, the obstruction was relieved by urethral deligation. Cystometrograms (CMG) were performed 3 weeks after deligation. On the basis of CMG, the experimental group was subdivided into normalised, and unstable, bladder groups. The bladders of each group were dissected out, weighed and immunohistochemical staining for NGF and VR1 analysis, performed. RESULTS: Compared with the control group, bladder weights of the normalised, and unstable, bladder groups were increased (p<0.05). On CMG, there was no significant difference in contraction pressure among the 3 groups. The contraction interval of the unstable bladder group was markedly decreased compared with that of the control and normalised groups. On immunohistochemical staining, contrary to the control and normalised groups, the intensity of staining for NGF in the unstable bladder group increased in the basal layer, submucosa and interfascicular layers. VR1-immunoactive nerve fibre-like structures were seen in the basal and submucosal layers in the unstable bladder group, and there were no VR1-like structures in the muscle layer. However, there were no VR1-like structures any of the layers of the control and normalised groups. CONCLUSIONS: Increased NGF and VR1 may be related to persistent unstable bladder or bladder irritative symptoms after rectifying a bladder outlet obstruction.

Laparoscopic Radical Prostatectomy / 대한비뇨기과학회지

We report our initial experiences of a laparoscopic radical prostatectomy through an intraperitoneal approach. Two patients with an adenocarcinoma of the prostate underwent operations. The procedures for achieving a complete removal, vesicourethral anastomosis, operative time, blood loss, hospital stay, pathologic findings, continence, and potency were evaluated in both cases. Complete removals of the prostates and seminal vesicles were achieved in both cases. Reconstructions of the bladder neck with a watertight anastomosis were successful. The surgery time was 9 hours and 5 minutes, 6 hours and 30 minutes in each, with an estimated blood loss of approximately 800 and 400cc. The hospital stay was 15 days and 12 days. The final pathologic evaluation was a stage T3a (Gleason score; 7) and stage T2a (Gleason score; 6) disease with a negative margin. A laparoscopic radical prostatectomy is feasible and offers an advantage over open surgery with regard to the length of stay, convalescence time, cosmetic results, continence, and potency.

Laparoscopic Radical Prostatectomy / 대한비뇨기과학회지

We report our initial experiences of a laparoscopic radical prostatectomy through an intraperitoneal approach. Two patients with an adenocarcinoma of the prostate underwent operations. The procedures for achieving a complete removal, vesicourethral anastomosis, operative time, blood loss, hospital stay, pathologic findings, continence, and potency were evaluated in both cases. Complete removals of the prostates and seminal vesicles were achieved in both cases. Reconstructions of the bladder neck with a watertight anastomosis were successful. The surgery time was 9 hours and 5 minutes, 6 hours and 30 minutes in each, with an estimated blood loss of approximately 800 and 400cc. The hospital stay was 15 days and 12 days. The final pathologic evaluation was a stage T3a (Gleason score; 7) and stage T2a (Gleason score; 6) disease with a negative margin. A laparoscopic radical prostatectomy is feasible and offers an advantage over open surgery with regard to the length of stay, convalescence time, cosmetic results, continence, and potency.

Changes of Urinary Nerve Growth Factor and Transforming Growth Factor beta-1 in Male Patients with Lower Urinary Tract Symptom / 대한비뇨기과학회지

PURPOSE: Increased expression of the nerve growth factor (NGF) in the urinary bladder may contribute to irritative bladder symptoms in patients with benign prostatic hyperplasia. It has been reported that the transforming growth factor beta (TGF-beta) can initiate NGF synthesis. This study investigated the changes in the urinary NGF and TGF-beta1 in male patients with lower urinary tract symptoms. MATERIALS AND METHODS: The study groups included 25 male patients with lower urinary tract symptom and 10 normal male patients used as the reference controls. The evaluation included history taking, urinalysis, international prostatic symptom score (IPSS), and urodynamics. Voided urine was collected in all patients. The urinary NGF and TGF-beta1 concentration was analyzed by using an enzyme linked immunosorbent assay and these results were compared with the control group. RESULTS: From the analysis of the IPSS, the obstructive and irritative symptom scores were higher. The urodynamic study showed that more than half of the patients had detrusor instability and bladder outlet obstruction (BOO). The NGF and TGF-beta1 urinary concentration were significantly higher in patients with lower urinary tract symptoms compared to the control. Furthermore, the NGF and TGF-beta1 urinary concentration were significantly higher in patients with BOO compared with patients with non-BOO. CONCLUSIONS: NGF and TGF-beta1 may play a role in the lower urinary tract symptoms and these changes can be detected in urine samples. Therefore, these growth factors may be used as markers to evaluate lower urinary tract symptoms.