Pathophysiology and Management of Long-term Complications After Transvaginal Urethral Diverticulectomy / 대한배뇨장애요실금학회지

Female urethral diverticulum (UD) is a rare and benign condition that presents as an epithelium-lined outpouching of the urethra. It has various symptoms, of which incontinence in the form of postmicturition dribble is the most common. The gold standard for the diagnosis of UD is magnetic resonance imaging, and the treatment of choice is transvaginal diverticulectomy. Despite the high success rate of transvaginal diverticulectomy, postoperative complications such as de novo stress urinary incontinence (SUI), recurrence, urethrovaginal fistula, recurrent urinary tract infections, newly-onset urgency, and urethral stricture can occur. De novo SUI is thought to result from weakening of the anatomical support of the urethra and bladder neck or damage to the urethral sphincter mechanism during diverticulectomy. It can be managed conservatively or may require surgical treatment such as a pubovaginal sling, Burch colposuspension, or urethral bulking agent injection. Concomitant SUI can be managed by concurrent or staged anti-incontinence surgery. Recurrent UD may be a newly formed diverticulum or the result of a remnant diverticulum from the previous diverticulectomy. In cases of recurrent UD requiring surgical repair, placing a rectus fascia pubovaginal sling may be an effective method to improve the surgical outcome. Urethrovaginal fistula is a rare, but devastating complication after urethral diverticulectomy; applying a Martius flap during fistula repair may improve the likelihood of a successful result. Malignancies in UD are rarely reported, and anterior pelvic exenteration is the recommended management in such cases.

Pathophysiology and Management of Long-term Complications After Transvaginal Urethral Diverticulectomy / 대한배뇨장애요실금학회지

Female urethral diverticulum (UD) is a rare and benign condition that presents as an epithelium-lined outpouching of the urethra. It has various symptoms, of which incontinence in the form of postmicturition dribble is the most common. The gold standard for the diagnosis of UD is magnetic resonance imaging, and the treatment of choice is transvaginal diverticulectomy. Despite the high success rate of transvaginal diverticulectomy, postoperative complications such as de novo stress urinary incontinence (SUI), recurrence, urethrovaginal fistula, recurrent urinary tract infections, newly-onset urgency, and urethral stricture can occur. De novo SUI is thought to result from weakening of the anatomical support of the urethra and bladder neck or damage to the urethral sphincter mechanism during diverticulectomy. It can be managed conservatively or may require surgical treatment such as a pubovaginal sling, Burch colposuspension, or urethral bulking agent injection. Concomitant SUI can be managed by concurrent or staged anti-incontinence surgery. Recurrent UD may be a newly formed diverticulum or the result of a remnant diverticulum from the previous diverticulectomy. In cases of recurrent UD requiring surgical repair, placing a rectus fascia pubovaginal sling may be an effective method to improve the surgical outcome. Urethrovaginal fistula is a rare, but devastating complication after urethral diverticulectomy; applying a Martius flap during fistula repair may improve the likelihood of a successful result. Malignancies in UD are rarely reported, and anterior pelvic exenteration is the recommended management in such cases.

Morphological and Functional Changes in the Thyroid Follicles of the Aged Murine and Humans

BACKGROUND: Although both thyroid histology and serum concentrations of hormones are known to change with age, only a few reports exist on the relationship between the age-related structural and functional changes of the thyroid follicles in both mice and humans. Our objectives were to investigate age-related histological changes of the thyroid follicles and to determine whether these morphological changes were associated with the functional activity of the follicles. METHODS: The thyroid glands of mice at 18 weeks and at 6, 15, and 30 months of age were histologically examined, and the serum levels of thyroid hormones were measured in 11-week-old and 20-month-old mice. Samples of human thyroid tissue from 10 women over 70 years old and 10 women between 30 and 50 years of age were analyzed in conjunction with serum thyroid hormone level. RESULTS: The histological and functional changes observed in the thyroid follicles of aged mice and women were as follows: variable sizing and enlargement of the follicles; increased irregularity of follicles; Sanderson’s polsters in the wall of large follicles; a large thyroglobulin (Tg) globule or numerous small fragmented Tg globules in follicular lumens; oncocytic change in follicular cells; and markedly dilated follicles empty of colloid. Serum T3 levels in 20-month-old mice and humans were unremarkable. CONCLUSIONS: Thyroid follicles of aged mice and women show characteristic morphological changes, such as cystic atrophy, empty colloid, and Tg globules.

Risk Factors for Transient Urinary Incontinence after Holmium Laser Enucleation of the Prostate

PURPOSE: To investigate the factors associated with the occurrence of and recovery from transient urinary incontinence (TUI) after holmium laser enucleation of the prostate (HoLEP). MATERIALS AND METHODS: From March 2009 to December 2012, 391 consecutive patients treated with HoLEP for benign prostatic hyperplasia were enrolled. Information regarding age, prostate volume, International Prostate Symptom Score, Overactive Bladder Symptom Score, peak urinary flow rate, postvoid residual urine, and operation time was collected. TUI was defined as a patient complaint of urine leakage, regardless of type. Logistic regression was used to investigate the factors associated with the occurrence of TUI, and the Kaplan-Meier test was used to analyze the TUI recovery period. RESULTS: TUI after HoLEP occurred in 65 patients (16.6%), 52 patients of whom (80.0%) showed recovery within three months. Stress and urge urinary incontinence and postvoid dribbling occurred in 16 patients (4.1%), 29 patients (7.4%), and 33 patients (8.4%), respectively. Age (odds ratio [OR]=3.494; 95% confidence interval [CI]=1.565~7.803; p=0.002) and total operation time (OR=3.849; 95% CI=1.613~9.185; p=0.002) were factors that significantly affected the occurrence of TUI. CONCLUSIONS: TUI, defined as any type of urine leakage, occurred after HoLEP in some patients, most of whom recovered within three months. Stress urinary incontinence occurred in only 4% of patients after HoLEP. Age and total operation time were associated with the occurrence of postoperative TUI.

Torsion of an Indirect Hernia Sac Causing Acute Scrotal Swelling in a Child

Torsion of a hernia sac is an extremely rare condition that presents as acute scrotum in children. We report a case of a 6-year-old boy who presented with an acute scrotum and was found during surgical exploration to have torsion of an indirect hernia sac associated with hydrocele. Upon scrotal exploration, deterioration of the scrotum due to inflammatory changes was found. A necrotic cyst was recognized within a communicating hydrocele of the scrotum and was twisted at an angle of about 360degrees. All urologists should be aware of this special condition in the differential diagnosis of acute scrotum.

Malignant Inflammatory Myofibroblastic Tumor of the Bladder with Rapid Progression

A 71-year-old man was referred for painless hematuria and a bladder tumor. Cystoscopy and computed tomography revealed a 3-cm oval nodular mass on the left lateral side of the bladder. The patient underwent a complete transurethral resection of the lesion and histology showed a proliferation of atypical spindle cells with inflammation consistent with a myofibroblastic tumor. After 4 and 7 months, follow-up cystoscopy demonstrated nodular mass lesions and transurethral resection of bladder tumor was done, which showed chronic cystitis and a recurred myofibroblastic tumor, respectively. Five months later, multiple lymph node, bone, and soft tissue metastases were found by positron emission tomography. The patient was treated first with palliative chemotherapy, including doxorubicin and cisplatin. After that, radiologic studies showed disease progression but the patient refused further treatment and died 6 months later.

Primary Undifferentiated Penile Sarcoma in Adolescence

We report a case of primary penile undifferentiated sarcoma. A 16-year-old adolescent man visited Pusan National University Hospital complaining of a painless mass on his penis that was increasing in size. Magnetic resonance images revealed a 5x5-cm mass and pathological examinations revealed small round cell sarcomas with neuroendocrine differentiation. The tumor, which had metastatic pulmonary nodules, was treated by tumorectomy and systemic chemotherapy. Thirty-four months after the initial diagnosis, the patient was still alive without evidence of local recurrence or metastatic disease. This is our second case of an undifferentiated penile sarcoma.

Isolated Sphenoid Sinus Lesion: A Clinical Analysis of 17 Cases / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: An isolated sphenoid sinus lesion is a rare disorder and is difficult to diagnose for several reasons. This lesion can easily spread to the adjacent structures and lead to severe complications. Thus, early diagnosis and treatments are needed. We experienced 17 cases of isolated sphenoid sinus lesions, including inflammatory, neoplastic, and vascular lesions, and reviewed the clinical findings, radiologic features, treatments and complications of these cases. MATERIALS AND METHOD: Isolated sphenoid sinus lesions were reviewed retrospectively of patients from January 1995 to July 2001. Patients were identified with radiologic findings and intraoperative endoscopic findings excluding other paranasal sinus involvements. RESULTS: The most common symptom was headache, and 13 patients (76%) complained. Nasal symptoms appeared only 4 patients (23%). Pathologic reviews showed 9 cases of acute and chronic sinusitis were 9 cases, 4 fungal sinusitis, 2 neoplastic diseases, 1 polyp, and 1 vascular disease. We carried out medical treatment in 5 cases, and diagnostic biopsy in 3 cases, and therapeutic surgery in 10 cases. In 7 cases, complications including cranial nerve palsy were observed, and 1 patient was expired due to meningitis. CONCLUSION: We can diagnose isolated sphenoid sinus lesions exactly with the use of radiologic findings and endoscopic examinations. With endoscopy, we can operate relatively less invasively and more effectively. It is apparent that early recognition and rapid treatment are essential if complications are to be avoided.

Traumatic Pseudoaneurysm of the External and Internal Carotid Artery Presenting as Epistaxis: Case Report / 대한이비인후과학회지

Post-traumatic pseudoaneurysm of the carotid artery is extremely rare but present with progressively severe, often fatal epistaxis. Because temporal course of epistaxis in patients with traumatic pseudoaneurysm of the carotid artery commonly demonstrates a variable latency period, pseudoaneurysm is often a clinical challenge. Optimal management for this diseases demands rapid recognition and treatment to give the best functional outcome. The authors have experienced three cases of traumatic pseudoaneurysm of the carotid artery resulting in massive epistaxis and showing unusual clinical course that were successfully treated with endovascular techniques. In two patients, pseudoaneurysm formation resulted from hemorrhage of the internal carotid artery (ICA). The other one case resulted from the external carotid artery (ECA).

Diphenylhydantion Induced Gingival Hyperplasia

Hyperplasia of the gingivae may occur as a secondary reaction in the treatment of epilepsy with diphenylhydantoin sodium. This study is intended to investigate the incidence and dharacteristics of gingival hyperplasia in 124 epileptic patients taking diphenylhydantoin longstandingly. The results are as follows: 1. The incidence of diphenylhydantoin induced gingival hyperplasia is approximately 69.4%. 2. The individual tolerance or sensitivity may determine the incidence and severity of gingival hyperplasia and are not directly related with the duration of drug use and its dosage. 3. Gingival hyperplasia is more frequent in female patients and younger patients than male and older. 4. There is no direct relationship betwwen occurance of gingival hyperplasia and meticulous oral hygiene. 5. The mechanism involved in a causation of diphenylhydantoin induced gingival hyperplasia has not been elucidated. 6. We recommand that diphenylhydantoin may be prescribed as the drug of the first choice for the control of epileptic seizure in the adolescent female patients and children especially receiving certain dental treatments.