Comparative study of off-clamp, laparoscopic partial nephrectomy (OCLPN) and conventional hilar control, laparoscopic partial nephrectomy (HCLPN) for renal tumors: One-year follow-up results of renal function change / 고신대학교의과대학학술지

OBJECTIVES: We designed the study to compare the oncologic and renal function outcomes of off-clamp, laparoscopic partial nephrectomy (OCLPN) and conventional laparoscopic partial nephrectomy (HCLPN) for renal tumors. METHODS: Between March 2008 and July 2015, 114 patients who underwent laparoscopic partial nephrectomy (LPN) of a renal neoplasm were studied. We performed LPN without hilar clamp on 40 patients (OCLPN, Group 1), and conventional LPN with hilar control and renorrhaphy on another 40 patients (HCLPN, Group 2). We retrospectively reviewed the medical records of each patient's age, sex, R.E.N.A.L. nephrometry score (RNS), operation time, complications, hospitalization period, tumor size, positive resection margin, histologic classification of tumor, pathologic stage, Fuhrman grade, estimated blood loss (EBL), warm ischemic time (WIT), and estimated glomerular filtration rate (eGFR) before and one year after surgery. RESULTS: There were no significant differences in age, sex, preoperative eGFR, EBL, surgical (anesthesia) time, and tumor size between the two groups. The mean eGFR was not significantly different between the OCLPN and HCLPN groups 1 month (95 and 86.2 mL/min/1.73 m², respectively; P = 0.106), 6 months (92.9 and 83.6 mL/min/1.73 m², respectively; P = 0.151) and 12 months (93.8 and 84.7 mL/min/1.73 m², respectively; P = 0.077) postoperatively. The change in eGFR after one year was 3.9% in the OCLPN group and −7.9% in the HCLPN group. CONCLUSIONS: OCLPN was superior to HCLPN in preserving renal function one year after surgery, and there was no statistically significant difference in tumor treatment results.

Metachronous anterior urethral metastasis of prostatic ductal adenocarcinoma / 고신대학교의과대학학술지

Prostate cancer is increasing in frequency in Korea. Among them, ductal adenocarcinoma (DCP) has a more aggressive and poor prognosis than acinar adenocarcinoma (ACP), despite its low incidence. Patients usually present with symptoms of lower urinary tract symptoms and hematuria due to increasing tumor mass within the lumen of the prostatic urethra, making diagnosis of DCP by the transrectal prostate biopsy difficult. DCP is often metastasized at the time of diagnosis. DCP is transferable to most other organs but the metastasis to the anterior urethra is rare. There is no doubt that localized DCP requires radical prostatectomy (RP) but the guidelines for adjuvant therapy after RP have not yet been established. Methods of the treatment are confounded by individual differences, and arriving at a consensus is challenging due to insufficient data. We report a case of DCP and urethral metastasis after RP, thus aiding in the determination of treatment guidelines.

Factors Influencing the Operative Approach to Renal Tumors: Analyses According to RENAL Nephrometry Scores

PURPOSE: To evaluate the relationship between RENAL nephrometry score (RNS) and operative approach for renal masses. MATERIALS AND METHODS: This study included 206 consecutive patients who underwent renal tumor surgery between January 2008 and October 2012. We divided the patients into four groups by surgical approach: open radical nephrectomy (ORN, 53 patients), laparoscopic radical nephrectomy (LRN, 83 patients), open partial nephrectomy (OPN, 31 patients), and laparoscopic partial nephrectomy (LPN, 39 patients). We retrospectively assessed the RNS for each surgery group and evaluated the relationship between this score and operative approach. RESULTS: The mean RNSs of the ORN, LRN, OPN, and LPN groups were 9.75, 8.35, 6.72, and 5.76, respectively. When the RNS was analyzed according to nephron-sparing, the mean RNSs of the RN groups (ORN and LRN) and the PN groups (OPN and LPN) were significantly different (8.89 and 6.09, respectively; p<0.001). All the individual components of the RNS were significantly different between RN and PN. In the RN groups, the criteria for open versus laparoscopic surgery were based on tumor size ('R' score=2.43 for open, 1.54 for laparoscopic, p<0.001) and tumor location relative to the polar line ('L' score=2.55 for open, 2.09 for laparoscopic, p=0.006). In the PN groups, the criteria for open or laparoscopic surgery were based only on exophytic/endophytic property ('E' score=1.87 for open, 1.41 for laparoscopic, p=0.046). CONCLUSIONS: The RNS was significantly different in all surgery groups. The decision to take a laparoscopic approach was primarily influenced by the R and L scores for RN and by the E score for PN.

Changes in Renal Function After Laparoscopic Partial Nephrectomy: Comparison With Laparoscopic Radical Nephrectomy

PURPOSE: To evaluate alterations in renal function after laparoscopic radical nephrectomy (LRN) and laparoscopic partial nephrectomy (LPN) for renal tumors. MATERIALS AND METHODS: From March 2008 to August 2011, we performed 175 cases of laparoscopic kidney resection. Among these, we excluded patients who received perioperative immunotherapy or target therapy and also patients with a preoperative estimated glomerular filtration rate (eGFR) <60 mL/min. A total of 32 patients undergoing LPN and 92 patients undergoing LRN were enrolled. We retrospectively reviewed the changes in eGFR (by the modification of diet in renal disease method) at the following time points: preoperative, postoperative 1 week, and postoperative 1, 3, 6, and 12 months. RESULTS: The mean warm ischemia time of the LPN group was 22 minutes (range, 0 to 47 minutes). Mean eGFR values (mL/min/1.73 m2) during postoperative week 1 and 1, 3, 6, and 12 months were 70.8, 71.5, 76.7, 76.0, and 75.3 in the LPN group and 52.1, 50.6, 52.8, 53.4, and 52.4 in the LRN group, respectively. One year after the operation, 6.3% (2 patients) of LPN patients and 68.5% (63 patients) of LRN patients had progressed to chronic renal insufficiency (eGFR<60 mL/min/1.73 m2). CONCLUSIONS: Renal function recovered slightly after LPN and LRN and was maintained constantly after 3 months. However, renal function showed different patterns of decrease. Despite the concern for warm ischemia, LPN can preserve renal function better than can LRN. LPN should be considered for selected patients to prevent chronic renal insufficiency.

Pilot Study of the Clinical Significance of Serum and Urinary HER-2/neu Protein in Bladder Cancer Patients

PURPOSE: HER-2/neu overexpression is documented in some bladder cancers. To our knowledge, there are no current studies evaluating urine HER-2/neu levels. Therefore, we examined the clinical significance of serum and urine HER-2/neu protein in bladder cancer. MATERIALS AND METHODS: Urothelial bladder carcinoma patients (n=38, including 31 men and 7 women) and healthy controls (n=25, including 20 men and 5 women) were included in the study. Urine cytology and serum and urine HER-2/neu levels were measured before the transurethral resection of bladder tumor procedure. Prognostic factors including tumor stage, histologic grade, tumor size, multiplicity, and preoperative urine cytology and their association with urinary HER-2/neu were analyzed by simple and multiple regression analyses. RESULTS: There was no significant difference in serum HER-2/neu between the two groups (p=0.489). The mean urinary HER-2/neu was 7,586.82 relative luminescence unit (RLU) in bladder cancer patients and 4,245.84 RLU in healthy controls. The mean RLU values of urinary HER-2/neu in the bladder cancer patient group were significantly higher than in healthy controls (p=0.012). An receiver operating characteristic curve was generated, and using the cutoff value of > or =4,800 RLU of urinary HER-2/neu, 71.1% sensitivity and 84.0% specificity were obtained. Among the clinical factors, only positive preoperative urine cytology samples were associated with urinary HER-2/neu levels by both simple and multiple regression analyses. CONCLUSIONS: Bladder cancer patients demonstrated significantly higher urinary HER-2/neu than did healthy controls. These findings suggest that urinary HER-2/neu may be valuable as a new urinary marker. The application of urinary HER-2/neu needs additional investigation.

Efficacy of Androgen Deprivation Therapy in Patients with Clinically Localized Prostate Cancer

PURPOSE: The purpose of this study was to evaluate the characteristics of patients who received primary androgen deprivation therapy (PADT) for clinically localized prostate cancer and the clinical efficacy of this treatment. MATERIALS AND METHODS: Between January 1998 and August 2007, patients who underwent PADT for clinically localized prostate adenocarcinoma were analyzed. The patients studied could not receive definitive therapy owing to old age or medical comorbidities. All patients' Gleason score, pretreatment prostate-specific antigen (PSA) value, time to PSA progression, and D'Amico's risk criteria were analyzed. RESULTS: A total of 72 patients were analyzed. The patients' mean age was 75.29 years (range, 57-92 years) and their median pretreatment PSA was 13.52 ng/ml (range, 1.27-74.82 ng/ml). The median follow-up duration was 39 months (range, 18-115 months). Thirteen patients (18.57%) had PSA progression after reaching a PSA nadir. The mean time to PSA progression was 14 months (range, 7-55 months). Among these 13 patients, 2 patients had low-risk prostate cancer and 11 patients had high-risk prostate cancer by D'Amico's risk criteria. Three of the 13 patients are now receiving chemotherapy, 2 patients died from cancer progression, 3 patients died of a non-cancer cause, and 5 patients are now being conservatively managed. Of the total 72 patients, 70.83% of the patients are still receiving PADT. A total of 11 patients died; however, only 2 deaths were caused by prostate cancer. CONCLUSIONS: In patients with localized prostate cancer who could not receive definitive therapy for several reasons, the cancer-caused death rate was very low, even in patients with PSA progression. PADT is an effective therapeutic option in patients with localized prostate cancer.

Clinical Follow-Up Study for Brain Metastases of Renal Cell Carcinoma

PURPOSE: We reviewed the records of renal cell carcinoma (RCC) patients with brain metastases, analyzed about survival and prognosis after several palliative management. MATERIALS AND METHODS: Between June 1998 and January 2008, 22 patients diagnosed to have brain metastases from RCC. We retrospectively reviewed their medical records, and analyzed clinical properties. RESULTS: Of 278 patients with RCC, 22 patients (7.9%) diagnosed to have brain metastases. The pathological T stages and Fuhrman nuclear grade of RCC at the time of initial diagnosis were various (T1: 1 patient, T2: 5, T3: 8, T4: 3, Fuhrman grade 1: 0, 2: 4, 3: 10, 4: 6, unknown: 2). Most of RCC was clear cell carcinoma (17/22). Most symptoms suggesting brain metastases were neurologic. Median cancer specific survival (CSS) of WBRT, radiosurgery, or surgery group (13/22) was 4 months, conservative management group (9/22) was 1.5 months and CSS of the former group was significantly better. Median duration of development of brain metastasis after diagnosis of RCC was 28 month (1-120). There was no difference in CSS between patients with brain metastasis developed before and after 28 month (p=0.361). CONCLUSIONS: Brain metastases of RCC have poor prognostic course. Development interval of brain metastases did not affect survival. WBRT, radiosurgery or surgery group showed better survival. Active intervention may improve survival.

Predictive Factors of the Long-term Medical Treatment Failure in Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The aim of this study was to identify the clinical baseline factors that affect failure of medical treatment(and especially surgical treatment) for benign prostatic hyperplasia(BPH) in spite of long-term medication. MATERIALS AND METHODS: 802 men who were over 50 years of age with BPH were enrolled for this study. Patients were allocated to a medication group and a surgical treatment group(after having at least a 12 month duration of medication). We compared the differences between the two groups for their initial International Prostate Symptom Score(IPSS), the uroflowmetry, the prostate volume, the postvoid residual urine and the serum prostate specific antigen(PSA). RESULTS: 397 patients had surgical treatment following medication due to BPH progression(acute urinary retention, aggravating LUTS) and 405 patients were given maintenance medical treatment during follow-up. Statistically significant differences were found in the IPSS(23.3+/-6.6 vs. 12.7+/-8.4), the prostate volume(53.5+/-28.1ml vs. 38.3+/-12.6ml), the maximal flow rate(7.8+/-4.7ml/sec vs. 12.7+/-5.4ml/sec), the postvoid residual urine volume(92.7+/-144.4cc vs. 36.5+/-147.1cc), and the PSA(6.1+/-7.6ng/ml vs. 2.8+/- 2.8ng/ml) between the surgical and medication groups. According to the area under the curve(AUC), the IPSS, prostate volume, maximal flow rate, postvoid residual urine volume and PSA are important in descending order. According to the receiver operating characteristic(ROC) curve- based prediction of the surgical intervention, the best cutoff value for the IPSS and prostate volume were 17(area under ROC curve: 0.83) and 40ml (area under ROC curve: 0.68), respectively. Conclusions: The results show that BPH patients with more severe IPSS (>or=17) and a larger prostate volume(>40ml) have a higher risk of surgical intervention, and this suggests that the IPSS and prostate volume may be useful predictors at the initial visit for surgical intervention.

Renal and Perinephric Abscesses: Ten Years Experience at a Single Center / 대한비뇨기과학회지

PURPOSE: We analyzed the clinical experiences of patients with renal, perinephric, and mixed abscesses during the last 10 years in a single center. MATERIALS AND METHOS: We reviewed the medical records of 33 patients with renal, perinephric, and mixed abscesses treated at our hospital between January 1998 and March 2008. The medical records, including predisposing conditions, clinical manifestations, physical examination, laboratory and radiologic findings, duration of hospitalization, types of uropathogens, time to clinical improvement, time to laboratory improvement, treatment, and clinical outcomes, were retrospectively analyzed. RESULTS: Renal, perinephric and mixed abscesses occurred in 22(66.7%), 4(12.1%), and 7(21.2%) patients. The most common predisposing conditions were diabetes mellitus(39.4%) and liver disease(27.3%). Flank pain (57.6%) and fever(54.5%) were the most common symptoms. Urine and blood cultures were positive in 23.3 and 19.2% of patients, respectively. The most common isolated uropathogen in the urine, blood, and purulent cultures was E. coli. The time to clinical and laboratory improvement was not significantly different between the patients with renal, perinephric, and mixed abscesses. Patients with renal, perinephric, and mixed abscesses received antibiotic therapy only in 59.1, 50.0, and 42.9% of cases, respectively. Similarly, patients with renal, perinephric, and mixed abscesses underwent percutaneous or surgical drainage in 22.7, 50.0, and 14.3% of cases, respectively. Patients required a nephrectomy in 18.2 and 42.9% of renal and mixed abscess cases, respectively. Most patients were cured(54.5%) or improved(42.4%) at the time of discharge from the hospital. CONCLUSIONS: We suggest that renal, perinephric, and mixed abscesses are successfully managed by proper medical or interventional treatment. However, the cases suspicious for renal cancer or with non-functioning kidneys must be evaluated carefully for nephrectomy.

Nomograms for Prediction of Disease Recurrence in Patients with Primary Ta, T1 Transitional Cell Carcinoma of the Bladder

We developed nomograms to predict disease recurrence in patients with Ta, T1 transitional cell carcinoma of the bladder. Thirty-eight training hospitals participated in this retrospective multicenter study. Between 1998 and 2002, a total of 1,587 patients with newly diagnosed non-muscle invasive bladder cancer were enrolled in this study. Patients with prior histories of bladder cancer, non-transitional cell carcinoma, or a follow-up duration of less than 12 months were excluded. With univariate and multivariate logistic regression analyses, we constructed nomograms to predict disease recurrence, and internal validation was performed using statistical techniques. Three-year and five-year recurrence-free rates were 64.3% and 55.3%, respectively. Multivariate analysis revealed that age (hazard ratio [HR]=1.437, p<0.001), tumor size (HR=1.328, p=0.001), multiplicity (HR=1.505, p<0.001), tumor grade (HR=1.347, p=0.007), concomitant carcinoma in situ (HR=1.611, p=0.007), and intravesical therapy (HR=0.681, p<0.001) were independent predictors for disease recurrence. Based on these prognostic factors, nomograms for the prediction of disease recurrence were developed. These nomograms can be used to predict the probability of disease recurrence in patients with newly diagnosed Ta, T1 transitional cell carcinoma of the bladder. They may be useful for patient counseling, clinical trial design, and patient follow-up planning.

The Clinical Behavior, Histopathologic Observation and Follow-up of Bowenoid Papulosis / 대한피부과학회지

BACKGROUND: Bowenoid papulosis occurs primarily on the genitalia of young adults and this is characterized by multiple, apparently benign maculopapular lesions. Bowenoid papulosis shows the histopathological findings of a squamous cell carcinoma in situ, but it follows a largely benign clinical course. If it is misdiagnosed as malignant tumor, unnecessary excessive therapy may be performed. Therefore, exact recognition of this entity is important. OBJECTIVE: The purpose of this study is to examine the clinical and histopathologic features and outcomes of Bowenoid papulosis. METHODS: Twelve patients who had been diagnosed with Bowenoid papulosis between June 1996 and September 2007 were reviewed clinicopathologically. RESULTS: The mean age of the patients was 34.8 years (range: 23~57 years), and the mean duration of Bowenoid papulosis until presentation was 6.3 months (range: 5~48 months). Nine patients were males and 3 patients were females. Eleven patients (92%) had multiple lesions. The average size of the individual lesions was 1.4x0.6 cm in diameter. The colors of the papules were red to black. Seven of 9 male patients had lesions on the penile shaft, with 6 of those occurring at the proximal shaft. The other 2 male patients had lesions on the scrotum and perianal area, respectively. Three female patients had lesions on the labium major, labium major and clitoris, and perianal area respectively. Nine patients (75%) presented without symptom and 3 (25%) presented with mild pruritus. The histopathologic features were as follows: a rete ridge of approximately equal length and breadth throughout the entire lesion (100%), skipped areas of normal keratinocytes between zones of atypical keratinocytes (100%). necrotic keratinocytes (92%), parakeratosis (83%), mitotic figures (83%), vacuolated cells resembling owl's eyes (83%), multinucleated cells (67%), residual changes of typical condyloma acuminatum (17%), involvement of acrotrichia (100%) and involvement of acrosyringia (100%). Eleven patients were effectively treated with surgical excision (8 patients), CO2 laser (2 patients), diphenylcyclopropenone (DPCP) and immunotherapy (1 patient) and 1 patient underwent biopsy only. We followed 12 patients for an average 78.1 months (from 24 to 137 months). During this period, no recurrence or malignant transformation was observed. CONCLUSION: Bowenoid papulosis shows a form of squmaous cell carcinoma in situ for its histopathology, but it hardly ever progresses to squmaous cell carcinoma. On our long term follow-up, there was no malignant transformation. Thus, excessive treatment of Bowenoid papulosis by amputation of the external genitalia is not necessary. Therefore, a through understanding of the clinical and histopathologic features of this entity is necessary for making the diagnosis, the treatment planning and determining the prognosis.

The Influence of Chlormadinone Acetate on the Total and Free Serum Prostate Specific Antigen Levels in Men with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Chlormadinone acetate (CMA) therapy for benign prostatic hyperplasia (BPH) may lower the serum prostate specific antigen (PSA) level. However, little is known about the effect of CMA on the total or free serum PSA levels of PSA. Such information would be important since PSA testing is useful for prostate cancer screening. Thus, we prospectively studied the effect of CMA therapy on the total and free serum PSA levels. MATERIALS AND METHODS: The patients with lower urinary tract symptoms (LUTS) and BPH who were aged over 50 years were treated with 50mg CMA for 6 months. Men with a PSA level greater than 10ng/ml were excluded to reduce the likelihood of including cases of occult prostate cancer. Those with suspicious findings on the digital rectal examination and serum PSA testing were biopsied to rule out prostate cancer. alpha- blocking agents were permitted to treat the men with LUTS. Serum levels of the total and free PSA were measured at the study baseline and after approximately 3 and 6 months. The prostate volume (PV) was assessed by transrectal ultrasonography. RESULTS: The analysis included 170 patients with a mean age of 67.9 years, a baseline PV of 47.3ml and a baseline total PSA of 4.1ng/ml. The total PSA levels declined from 4.1ng/ml at baseline to 2.0ng/ml after 6 months of treatment (50.7% decrease, p<0.01). The mean percent free PSA (21% to 22% at baseline) was not significantly altered by CMA treatment. The PSA levels and PV at baseline did not affect the rate of decline of PSA. CONCLUSIONS: The total PSA serum levels decreased by an average of 50% during CMA therapy, but the percent free PSA did not change significantly. This information is potentially useful in the interpretation of the PSA data that's used for early detection of prostate cancer in the men receiving CMA.

Comparative Study on the Treatment Outcome and Safety of TURP, ILC, TUNA and TEAP for Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: We wanted to compare the treatment outcome, safety, efficacy and complications of transurethral resection of the prostate (TURP), interstitial laser coagulation (ILC), transurethral needle ablation (TUNA) and transurethral ethanol ablation of the prostate (TEAP) for the treatment of benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: In this prospective, randomized study, a total of 403 patients with symptomatic BPH were treated by TURP, ILC, TUNA or TEAP from January 1998 to December 2002. ILC was performed using the Indigo 830e LaserOptic(TM) System with a specially designed interstitial thermotherapy light guide, TUNA was performed using the VidaMed TUNA System and TEAP was performed using the Prostaject(TM) device. The treatment outcomes were evaluated at 3 months, 6 months and 1 year with the International Prostate Symptom Score (IPSS), the prostate volume, the maximal urinary flow rate (Qmax), the post-void residual urine (PVR), and the quality of life (QoL) assessment score. RESULTS: All the patients in the four groups showed significant improvement for all the parameters. After 1 year, the four groups showed significant improvement in the clinical and voiding parameters (IPSS, Qmax, PVR, prostate volume and QoL). Our results did not show significant differences in the IPSS, prostate volume and QoL among the four groups. However, the TURP group showed a higher Qmax, and the TEAP group showed a less reduced prostate volume than the other groups during the follow-up period (p<0.05). The period of hospital admission showed no significant difference between the ILC, TUNA and TEAP groups, but the TURP group showed a longer hospital admission period compared to the other groups. The TURP group was markedly associated with more complications than the other groups. CONCLUSIONS: These early results indicate that ILC, TUNA and TEAP are safe, effective and useful alternative therapies to TURP for the patients with symptomatic BPH.

A Case of Urinary Calculus in Transplanted Kidney Treated with Extracorporeal Shock Wave Lithotripsy / 대한이식학회지

Urinary calculi are a rare clinical problem in kidney transplantation; the reported incidence is about 0.2% to 1.7%. The incidence is decreasing due to the use of absorbable suture stitches and the early treatment of hyperparathyroidism. Symptoms of renal transplant lithiasis are absent typical abdominal pain due to the denervated renal transplant. We experienced a case of obstructive uropathy due to urinary calculus in transplanted kidney. The stone was 9.8 mm sized and removed by ESWL. No further calculi have developed during observational period and renal function improved.

Xanthogranulomatous Cystitis Presenting as a Urachal Carcinoma / 대한비뇨기과학회지

Xanthogranulomatous cystitis (XC) is a very rare benign chronic inflammatory disease of unclear etiology. Herein is reported the case of a 46-year-old woman who presented with a painless lower abdominal palpable mass. According to the cystoscopic, ultrasonographic and enhanced computed tomographic (CT) findings, a urachal carcinoma could be suggested. Partial cystectomy was performed as the presence of a urachal carcinoma could not be ruled out. There was no recurrence of the XC more than 12 months after the partial cystectomy.

Xanthogranulomatous Cystitis Presenting as a Urachal Carcinoma / 대한비뇨기과학회지

Xanthogranulomatous cystitis (XC) is a very rare benign chronic inflammatory disease of unclear etiology. Herein is reported the case of a 46-year-old woman who presented with a painless lower abdominal palpable mass. According to the cystoscopic, ultrasonographic and enhanced computed tomographic (CT) findings, a urachal carcinoma could be suggested. Partial cystectomy was performed as the presence of a urachal carcinoma could not be ruled out. There was no recurrence of the XC more than 12 months after the partial cystectomy.

A Case of Echinococcal Hydatid Cyst as Misdiagnosed to the Bladder Cancer / 대한비뇨기과학회지

Hydatid disease is a parasitic infection that is caused by the larval stage of Echinococcus granulosus. This disease is widely distributed in a temperate and subtropical countries, and it is especially prevalent in sheep and cattle raising countries. The most common infection site is the liver, and the second most common site is the lung. We report here on our experience with Echinococcal hydatid cysts that were found in the bladder of a 38 year old worker from Uzbekistan. The cysts were surgically removed and the patient was managed postoperatively with albendazole.

A Case of Echinococcal Hydatid Cyst as Misdiagnosed to the Bladder Cancer / 대한비뇨기과학회지

Hydatid disease is a parasitic infection that is caused by the larval stage of Echinococcus granulosus. This disease is widely distributed in a temperate and subtropical countries, and it is especially prevalent in sheep and cattle raising countries. The most common infection site is the liver, and the second most common site is the lung. We report here on our experience with Echinococcal hydatid cysts that were found in the bladder of a 38 year old worker from Uzbekistan. The cysts were surgically removed and the patient was managed postoperatively with albendazole.

Improving the Accuracy of Hemodynamics Using a Vasoactive Medication Re-dosing during Dynamic Infusion Cavernosometry and Cavernosography / 대한비뇨기과학회지

PURPOSE: Dynamic infusion cavernosometry and cavernosography (DICC) is a recognized technique for evaluating the hemodynamics of an erection. During DICC, complete corporeal smooth muscle relaxation is essential for obtaining accurate data. A means of promoting maximal smooth muscle relaxation is repeat doses of vasoactive medication during vascular testing. The effect of re-dosing with vasoactive medication on the hemodynamics was investigated in impotent men undergoing DICC. MATERIALS AND METHODS: A total of 81 patients having undergone DICC, between January 2002 and December 2003, were prospectively reviewed. When the veno-occlusive parameters were abnormal, the intracavernous vasoactive agent dose was repeated a maximum of 3 times. Arterial insufficiency was diagnosed when the cavernosal artery systolic occlusion pressure was less than 100mmHg or more than 30mmHg below brachial arterial pressure. Venous leakage was diagnosed when the flow-to- maintain value was greater than 3ml/min or the pressure decay was greater than 45mmHg/30sec. The proportion of men in whom the vascular diagnosis had altered was analyzed using this regimen. RESULTS: Of the 81 subjects, 69 (85.2%) warranted re-dosing based on their abnormal veno-occlusive parameter. Of these 69 patients, the veno- occlusive values were corrected in 22 (31.9%) by repeat medication; therefore, they would have been falsely diagnosed with venous leakage during vascular evaluation. 13 patients (59.1%) of all corrections occurred with the second dose, while 9 patients (40.9%) of the patients required a third dose of medication. CONCLUSIONS: Re-dosing with a vasoactive agent should be considered during vascular evaluation where incomplete corporeal smooth muscle relaxation is suspected. This approach increases the likelihood of a more accurate diagnosis and decreases the risk of a false diagnosis of venous leakage.

Effects of Nitric Oxide on the Induction of Experimental Allergic Orchitis in Guinea Pig

BACKGROUND: Production of nitric oxide (NO) by inducible NO synthase (iNOS) has been implicated in the pathology of autoimmune disease. It is unknown whether iNOS expression is increased within testes and whether iNOS and NO have essential roles in the pathogenesis of EAO. METHODS: EAO was induced in guinea pig testes at 17 days after secondary immunization by administration of crude extract (CE) and purified glycoprotein 1 (GP1) from normal guinea pig testes. iNOS gene expression was assessed by RT-PCR and Northern blot analysis in testes. Localization of iNOS and Mac-1 and the indicator of NO-mediated tissue injury, nitrotyrosine, were detected in the testicular lesion by immunohistochemistry. RESULTS: In control testes, inflammation and iNOS gene expression were not detected, whereas, in CE- and GP1-injected testes, inflammation and marked iNOS gene expression were evident at day 17 after secondary immunization. Immunohistochemistry of Mac-1 showed the colocalization with iNOS protein and nitrotyrosyl proteins in intertubules, suggesting that NO produced by infiltrated macrophages may be involved in inflammatory lesions of intertubules. Intraperitoneal administration of aminoguanidine significantly prevented EAO with reduction of inflammation, iNOS expression and nitrotyrosine formation. CONCLUSION: These results suggest that NO production by macrophages may be important in the pathogenesis of CE- and GP1-induced EAO. Furthermore, this study demonstrated the therapeutic potential of iNOS inhibitor in the treatment of inflammatory and autoimmune mediated-diseases.