Gross Hematuria Associated with Genitourinary Tuberculosis / 전남의대학술지

A 27-year-old man presented to the emergency department with sudden onset of massive gross hematuria and urinary retention. Contrast-enhanced computed tomography imaging showed uneven, dilated calices and a narrowing of the renal pelvis in the left kidney; in addition, a large hematoma was noted in the urinary bladder. An emergency cystoscopy was performed following detection of the hematoma and blood clots were removed. A lesional biopsy, a tuberculosis (TB) culture, and urine cytology showed positive results for Mycobacterium tuberculosis. The clinical manifestations of genitourinary tuberculosis are nonspecific and are usually detected at a chronic stage. In conclusion, we report an unusual cause of acute kidney injury associated with a subacute stage of genitourinary tuberculosis that caused mucosal erosion and bleeding in the bladder.

Predicting Factors for Stent Failure-Free Survival in Patients With a Malignant Ureteral Obstruction Managed With Ureteral Stents

PURPOSE: To determine predictive factors for stent failure-free survival in patients treated with a retrograde ureteral stent for a malignant ureteral obstruction. MATERIALS AND METHODS: We retrospectively reviewed 71 patients who underwent insertion of a cystoscopic ureteral stent due to a malignant ureteral obstruction between May 2004 and June 2011. Performance status, type of cancer, hydronephrosis grade, location of the obstruction, presence of bladder invasion, C-reactive protein (CRP), serum albumin, and inflammation-based prognostic score (Glasgow prognostic score, GPS) were assessed using a Cox proportional regression hazard model as predicting factors for stent failure. RESULTS: A univariate analysis indicted that hypoalbuminemia ( or =1 mg/dL; HR, 4.79; 95% CI, 2.0 to 11.1; p=0.001), and presence of a distal ureter obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.021) were associated with stent failure-free survival. A multivariate analysis revealed that the presence of a mid and lower ureteral obstruction (HR, 3.27; 95% CI, 1.19 to 8.95; p=0.007), GPS > or =1 (HR, 7.22; 95% CI, 2.89 to 18.0; p=0.001), and elevated serum creatinine before ureteral stent placement (>1.2 mg/dL; HR, 2.16; 95% CI, 1.02 to 4.57; p=0.044) were associated with stent failure-free survival. CONCLUSIONS: A mid or lower ureteral obstruction, GPS > or =1, and serum creatinine before ureteral stent insertion >1.2 mg/dL were unfavorable predictors of stent failure-free survival. These factors may help urologists predict survival time.

Usefulness of the Ice-Cream Cone Pattern in Computed Tomography for Prediction of Angiomyolipoma in Patients With a Small Renal Mass

PURPOSE: A morphologic contour method for assessing an exophytic renal mass as benign versus malignant on the basis of the shape of the interface with the renal parenchyma was recently developed. We investigated the usefulness of this morphologic contour method for predicting angiomyolipoma (AML) in patients who underwent partial nephrectomy for small renal masses (SRMs). MATERIALS AND METHODS: From January 2004 to March 2013, among 197 patients who underwent partial nephrectomy for suspicious renal cell carcinoma (RCC), the medical records of 153 patients with tumors (AML or RCC) < or =3 cm in diameter were retrospectively reviewed. Patient characteristics including age, gender, type of surgery, size and location of tumor, pathologic results, and specific findings of the imaging study ("ice-cream cone" shape) were compared between the AML and RCC groups. RESULTS: AML was diagnosed in 18 patients and RCC was diagnosed in 135 patients. Gender (p=0.001), tumor size (p=0.032), and presence of the ice-cream cone shape (p=0.001) showed statistically significant differences between the AML group and the RCC group. In the multivariate logistic regression analysis, female gender (odds ratio [OR], 5.20; 95% confidence interval [CI], 1.45 to 18.57; p=0.011), tumor size (OR, 0.34; 95% CI, 0.12 to 0.92; p=0.034), and presence of the ice-cream cone shape (OR, 18.12; 95% CI, 4.97 to 66.06; p=0.001) were predictors of AML. CONCLUSIONS: This study confirmed a high incidence of AML in females. Also, the ice-cream cone shape and small tumor size were significant predictors of AML in SRMs. These finding could be beneficial for counseling patients with SRMs.

Gross Hematuria Associated with Genitourinary Tuberculosis / 전남의대학술지

A 27-year-old man presented to the emergency department with sudden onset of massive gross hematuria and urinary retention. Contrast-enhanced computed tomography imaging showed uneven, dilated calices and a narrowing of the renal pelvis in the left kidney; in addition, a large hematoma was noted in the urinary bladder. An emergency cystoscopy was performed following detection of the hematoma and blood clots were removed. A lesional biopsy, a tuberculosis (TB) culture, and urine cytology showed positive results for Mycobacterium tuberculosis. The clinical manifestations of genitourinary tuberculosis are nonspecific and are usually detected at a chronic stage. In conclusion, we report an unusual cause of acute kidney injury associated with a subacute stage of genitourinary tuberculosis that caused mucosal erosion and bleeding in the bladder.

Expression of Caveolin-1 in Rat Urinary Bladder with Cyclophosphamide-Induced Cystitis / 대한배뇨장애요실금학회지

PURPOSE: The purposes of this study were to investigate the effect of cyclophosphamide (CYP)-induced inflammatory cystitis on caveolin 1 in rat urinary bladder and to determine the role of these molecules in the bladder dysfunction that occurs in inflammatory change in rat urinary bladder. METHODS: Female Sprague-Dawley rats were divided into control (n=30) and experimental (n=30) groups. Cystitis in experimental group was induced by intraperitoneal injection of CYP (200 mg/kg). The control group underwent an intraperitoneal saline injection. After 3 days, urodynamic studies were done to measure the contraction interval and contraction pressure. The expression and cellular localization of caveolin 1 were determined by Western blot and immunofluorescent study in rat urinary bladder. RESULTS: In cystometrograms, the contraction interval (minute) was significantly increased in the CYP-induced cystitis rats (15.8+/-1.5) than in the control group (6.3+/-0.5) (P<0.05). Conversely, the average contraction pressure (mmHg) was significantly higher in the CYP-induced cystitis rats (15.6+/-1.7) than in the control group (11.3+/-0.5) (P<0.05). Caveolin 1 was expressed in the capillaries, arteriols and venules. The protein expression of caveolin 1 was significantly decreased in the CYP-induced cystitis rats (P<0.05). CONCLUSIONS: Inflammatory change of urinary bladder maybe causes a significant change in the expression of caveolin 1. These findings suggest that caveolin 1 might have a functional role in the bladder dysfunction related with cystitis in rat urinary bladder.

Abnormal Dimercaptosuccinic Acid Scan May Be Related to Persistence of Vesicoureteral Reflux in Children with Febrile Urinary Tract Infection

PURPOSE: This study assessed whether 99mtechnetium dimercaptosuccinic acid (DMSA) scintigraphy used for the assessment of renal sequelae after febrile urinary tract infection (UTI) has any prognostic value for outcome measurement of vesicoureteral reflux (VUR) by retrospectively evaluating the correlation between abnormal DMSA scintigraphy results and persistence of VUR in children with febrile UTI. MATERIALS AND METHODS: The medical records of 142 children (57 boys, 85 girls) admitted with febrile UTI from January 2004 to December 2006 and who were followed up for more than 1 year were retrospectively reviewed. At the initial and follow-up visits, renal ultrasound and DMSA scans were performed within 7 days from the diagnosis and voiding cystourethrography (VCUG) was performed within 1 month in all case and follow-up evaluations. RESULTS: The children's mean age was 4.8+/-3.6 years (range, 0.3 to 14 years). The mean follow-up was 28.2+/-4.8 months. At the initial examination, VUR was more often associated with an abnormal DMSA scan result (83.3%) than with a normal DMSA scan result (16.7%, p=0.02). The frequency of VUR with an abnormal DMSA scan during acute UTI was significantly higher than the frequency of VUR with a normal DMSA scan (38.8% vs, 25.8%, respectively, p=0.004). Also, high-grade VUR was associated with an abnormal DMSA scan result (32.5%) more often than with a normal DMSA scan result (0%, p=0.01). Children with an abnormal DMSA scan had a lower resolution rate of VUR (17.5%) than did children with a normal DMSA scan (75.0%) at the follow-up VCUG (p=0.02). CONCLUSIONS: An abnormal result on a DMSA scan during febrile UTI is associated with high-grade and persistent VUR. DMSA scans performed during febrile UTI are useful in reflux resolution in childhood.

Small (<4 cm), Unclassified Renal Cell Carcinoma Presenting with Initial Bone Metastasis: A Case of a Metastatic Lesion Missed at the Initial Diagnosis

A 49-year-old man presented with an incidentally detected right renal mass on a health examination. The abdominal computed tomography and magnetic resonance imaging showed a 3-cm right renal mass suspected of being a hypovascular tumor, such as papillary renal cell carcinoma, and an osteoblastic metastatic lesion on the right iliac bone. However, we missed a bone lesion at the time of diagnosis. A laparoscopic radical nephrectomy was performed and the final pathology confirmed unclassified renal cell carcinoma. The follow-up imaging studies showed several neck lymph nodes and multiple bone metastases at the lumbar spine, right iliac bone, and left femur. Thirteen cycles of temsirolimus were administered to the patient, but follow-up positron emission tomography showed newly developed liver and left adrenal metastasis and increased bone metastasis. It is important to note that T1a renal cell carcinoma can present with distant metastasis and thus demands scrupulous examination even though the tumor size may be small.

Persistent Genital Swelling after Hydrocele Ligation in a Patient Receiving Continuous Ambulatory Peritoneal Dialysis / 대한배뇨장애요실금학회지

We report a case of genital swelling in a patient receiving continuous ambulatory peritoneal dialysis. A physical examination did not identify any defect. Ultrasonography revealed a large hydrocele, and surgical repair brought resolution of the genital swelling. Two months later, however, the genital swelling had recurred and was not improved until peritoneal dialysis was replaced by hemodialysis 3 months later.

Penile Growth in Response to Human Chorionic Gonadotropin (hCG) Treatment in Patients with Idiopathic Hypogonadotrophic Hypogonadism / 전남의대학술지

Penile growth is under androgenic control. Human chorionic gonadotropin (hCG) has a stimulatory effect on testicular steroidogenesis and penile growth. The purpose of this study was to evaluate the effect of hCG treatment on the gonadal response and penile growth in male idiopathic hypogonadotrophic hypogonadism (IHH) presenting with micropenis. A total of 20 IHH patients who met the criteria for micropenis were included in this study. hCG (1,500-2,000 IU) was administrated intramuscularly, 3 times per week, for 8 weeks. Basic laboratory and hormonal indexes (including serum testosterone and LH levels), penis length (flaccid and stretched), and testicular volume were measured before and 24 weeks after hCG treatment. The patients' mean age was 18.9 years (range, 12 to 24 years). The mean serum testosterone level was significantly increased after hCG treatment (baseline, 2, 4, 12, and 24 weeks: 0.90+/-1.35 ng/ml, 1.77+/-1.31 ng/ml, 3.74+/-2.24 ng/ml, 5.49+/-1.70 ng/ml, and 5.58+/-1.75 ng/ml, respectively; p<0.05). Mean penile length also increased significantly 24 weeks after treatment (flaccid length: from 3.39+/-1.03 cm to 5.14+/-1.39 cm; stretched length: from 5.41+/-1.43 cm to 7.45+/-1.70 cm; p<0.001). Mean testicular volumes increased significantly as well (left: from 5.45 cc to 6.83 cc; right: from 5.53 cc to 7.03 cc). There were no remarkable adverse effects of the hCG treatment. The hCG treatment increased the serum testosterone level, penile length, and testicular volume in IHH patients. Our results suggest that hCG treatment has a beneficial effect on gonadal function and penile growth in patients with IHH presenting with micropenis.

Clinical Factors Associated with Low Valsalva Leak Point Pressure Among Women with Stress Urinary Incontinence / 대한배뇨장애요실금학회지

PURPOSE: The purpose of this study is to determine the predictive factors that are associated with stress urinary incontinence (SUI) due to intrinsic sphincter deficiency (ISD) in women. METHODS: Between January 2008 and December 2009, 185 women with urodynamically proven SUI were included in this study and retrospectively reviewed the medical record. Preoperative SUI symptoms were classified by Stamey grade. Valsalva leak point pressure (VLPP) determination series was repeated two times in each subject after finishing one series of VLPP measurement. The patients were classified into three groups according to VLPP; 1) ISD: VLPP90 cm H2O. Chi-square test and multivariate (logistic regression test) analyses were performed to determine the factors associated with ISD. RESULTS: The mean patient age was 54.2 years (range, 44.5 to 68.4 years). Seventy-one women (38.3%) were in the ISD group and 70 (37.8%) in the AI group. The results of univariate and multivariate analyses found that women with ISD had a higher symptom grade than women with AI (P=0.001 and 0.0001, respectively). The number of patients in the ISD and AI group in accordance with the symptom grade were 7 (10%) and 44 (62%) in grade I, 50 (54%) and 23 (25%) in grade II, and 14 (63%) and 3 (14%) in grade III respectively. There was no correlation between VLPP and other clinical factors. CONCLUSIONS: High symptom grade was the only independent clinical factor that predicted the presence of ISD. This should be considered when counseling the patients with SUI.

Prostate Cancer Can Be Detected Even in Patients with Decreased PSA Less than 2.5 ng/ml after Treatment of Chronic Prostatitis

PURPOSE: We evaluated men with documented chronic prostatitis and elevated serum prostate-specific antigen (PSA) to determine whether treatment with antibiotics and anti-inflammatory drugs can lower serum PSA and the cancer detection rate in patients with post-treatment PSA <4 ng/ml. MATERIALS AND METHODS: Eighty-six men who presented with serum PSA greater than 4 ng/ml and who were subsequently diagnosed with chronic prostatitis with greater than 10 white blood cells per high power field in expressed prostatic excretions were included in this prospective study. Patients meeting these criteria underwent treatment with a 4-week course of antibiotics and nonsteroidal anti-inflammatory agents. Follow-up PSA and transrectal ultrasonography-guided prostate biopsy were performed within 2 months of treatment for all patients. RESULTS: Mean patient age was 56.2 years (range, 37-72 years). Mean PSA (ng/ml) decreased by 33.8%, from 8.12 (range, 4.02-24.8) to 5.37 (range, 1.35-12.94), after treatment (p=0.001). Pathological studies revealed prostate cancer in 18 cases (20.9%), chronic inflammation in 64 (74.4%), and benign prostatic hypertrophy in 4 (4.7%). The prostate cancer detection rate according to the follow-up PSA level, below 2.5, from 2.5 to 4.0, and above 4.0, was 13.3% (2/15), 13.6% (3/22), and 26.5% (13/49), respectively. CONCLUSIONS: When chronic prostatitis with elevated PSA is identified, antibiotic and anti-inflammatory treatment can lower these PSA levels. However, the possibility of prostate cancer remains in patients whose PSA level decreases to less than 4 ng/ml, even in those with a PSA level less than 2.5 ng/ml.

Impact of Nocturia on Health-Related Quality of Life and Medical Outcomes Study Sleep Score in Men / 대한배뇨장애요실금학회지

PURPOSE: To evaluate the impact of nocturia on health-related quality of life and sleep in men. METHODS: From January 2008 to December 2008, 284 patients with lower urinary tract symptoms were selected for this study. The participants completed a series of questionnaires on health-related quality of life (the overactive bladder questionnaire, or OAB-q), the Medical Outcomes Study (MOS) sleep scale, and the frequency volume chart. RESULTS: The patient population had a mean age of 60.0+/-13.4 years (range, 40 to 79 years). The mean duration of symptoms was 28.8+/-34.6 months. The mean number of voiding episodes per night was measured as follows: 88 patients (31.0%) reported no nocturia, 60 patients (21.1%) reported 2>voids/night > or =1, 56 patients (19.7%) reported 3>voids/night > or =2, and 80 patients (28.2%) reported > or =3 voids/night. The mean number of nocturia episodes increased with age (P=0.001), and the number of nocturia episodes was significantly associated with the OAB-q symptom score (P=0.001) and symptom bother (P=0.001). Among the categories of the MOS sleep scale, sleep index I (P=0.020), sleep disturbance (P=0.010), adequacy of sleep (P=0.005), and somnolence (P=0.041) were significantly associated with an increased number of nocturia episodes. CONCLUSIONS: The number of nocturia episodes increased with age in men. Nocturia appeared to be associated with further negative effects on sleep quality, health-related quality of life, and symptom bother.

Effects of Estrogens on the Expression of Caveolin-1 in the Urinary Bladders of Female Rats / 대한배뇨장애요실금학회지

PURPOSE: The purposes of this study were to investigate the effect of hormonal alterations on the expression of caveolin-1 in the urinary bladders of ovariectomized rats and to determine the role of caveolin-1 in the overactivity of the detrusor muscle that occurs with hormonal alterations in rats. METHODS: Female Sprague-Dawley rats were divided into three groups: a control group, a group that underwent bilateral ovariectomy (Ovx), and a group that underwent bilateral ovariectomy followed by subcutaneous injections of 17beta-estradiol (Ovx+Est). After 4 weeks, urodynamic studies were done to measure the contraction interval and contraction pressure. The expression and cellular localization of caveolin-1 were determined by Western blot and immunofluorescence in the urinary bladders of rats. RESULTS: On cystometrograms, the contraction interval was significantly shorter in the Ovx group (3.0+/-0.3 minute) than in the control group (5.6+/-0.5 minute) but was longer in the Ovx+Est group (9.2+/- 0.4 minute) (P<0.05). Conversely, the average contraction pressure was higher in the Ovx group (26.4+/-0.48 mmHg) than in the control group (21.8+/-0.37 mmHg) but was lower in the Ovx+Est group (23.9+/-0.76 mmHg) (P<0.05). Caveolin-1 was expressed in the capillaries, arterioles, and venules. Expression of the protein caveolin-1 was significantly lower after ovariectomy and was restored to control levels after treatment with 17beta-estradiol (P<0.05). CONCLUSIONS: Hormonal alterations cause a significant change in the expression of caveolin-1, which suggests that caveolin-1 might have a functional role in the overactivity of the detrusor muscle related to hormonal alterations in the urinary bladders of rats.

Penile Growth in Response to Human Chorionic Gonadotropin (hCG) Treatment in Patients with Idiopathic Hypogonadotrophic Hypogonadism / 전남의대학술지

Penile growth is under androgenic control. Human chorionic gonadotropin (hCG) has a stimulatory effect on testicular steroidogenesis and penile growth. The purpose of this study was to evaluate the effect of hCG treatment on the gonadal response and penile growth in male idiopathic hypogonadotrophic hypogonadism (IHH) presenting with micropenis. A total of 20 IHH patients who met the criteria for micropenis were included in this study. hCG (1,500-2,000 IU) was administrated intramuscularly, 3 times per week, for 8 weeks. Basic laboratory and hormonal indexes (including serum testosterone and LH levels), penis length (flaccid and stretched), and testicular volume were measured before and 24 weeks after hCG treatment. The patients' mean age was 18.9 years (range, 12 to 24 years). The mean serum testosterone level was significantly increased after hCG treatment (baseline, 2, 4, 12, and 24 weeks: 0.90+/-1.35 ng/ml, 1.77+/-1.31 ng/ml, 3.74+/-2.24 ng/ml, 5.49+/-1.70 ng/ml, and 5.58+/-1.75 ng/ml, respectively; p<0.05). Mean penile length also increased significantly 24 weeks after treatment (flaccid length: from 3.39+/-1.03 cm to 5.14+/-1.39 cm; stretched length: from 5.41+/-1.43 cm to 7.45+/-1.70 cm; p<0.001). Mean testicular volumes increased significantly as well (left: from 5.45 cc to 6.83 cc; right: from 5.53 cc to 7.03 cc). There were no remarkable adverse effects of the hCG treatment. The hCG treatment increased the serum testosterone level, penile length, and testicular volume in IHH patients. Our results suggest that hCG treatment has a beneficial effect on gonadal function and penile growth in patients with IHH presenting with micropenis.

Comparison of Ketoconazole and Estramustine for Treating Patients with Castration-Resistant Prostate Cancer

PURPOSE: We investigated the efficacy of ketoconazole and estramustine before chemotherapy for treating patients with progressive castration-resistant prostate cancer (CRPC) after anti-androgen withdrawal syndrome. MATERIALS AND METHODS: Eighty-four patients who were diagnosed with CRPC and were treated between 2005 and 2009 were included. Thirty-nine patients were treated with 600 mg of ketoconazole and 10 mg of prednisolone per day (group I), and 45 patients were treated with 560 mg of estramustine per day (group II). The prostate-specific antigen (PSA) response, progression-free survival, and side effects were compared. RESULTS: The median age of the patients, PSA level, and follow-up period were 72 years, 48.5 ng/ml, and 4 months (range, 1 to 29 months), respectively. The overall PSA response rate was 35.7%, and the PSA response rates were 33.3% for group I and 37.8% for group II (p=0.672). The median progression-free survival times were 8 months (95% confidence interval [CI] 5.9-10.1) overall, 5 months (95% CI 1.6-8.3) in group I, and 8 months (95% CI 5.9-10.0) in group II (p=0.282). The most common complications in groups I and II were nausea and vomiting (51.3%) and anemia (77.8%), respectively. Nausea and vomiting and hepatotoxicity were observed more often in group I, and gynecomastia, neutropenia, and anemia were observed more often in group II. The toxicities of each adverse effect were < or =grade 2. CONCLUSIONS: With a resultant PSA decline and mild adverse effects, both ketoconazole and estramustine are worth consideration as treatment options for progressive CRPC patients after primary hormonal therapy.

Evaluation of Erectile Dysfunction by Penile Duplex Doppler Ultrasonography: Trimix Intracavernosal Injection Versus Vardenafil Oral Medication / 대한남성과학회지

PURPOSE: The aims of this study were to evaluate whether vardenafil, a phosphodiesterase type 5 inhibitor, may be used as a substitute for intracavernosal injection when assessing erectile dysfunction using penile duplex Doppler ultrasonography. MATERIALS AND METHODS: A total of 21 patients with erectile dysfunction underwent penile duplex Doppler ultrasonography after intracavernosal injection of 0.2 ml trimix. Each patient also underwent penile duplex Doppler ultrasonography after a 10-mg oral dose of vardenafil with audio-visual sexual stimulation. There was 1 week interval between each study. In both studies, peak systolic velocity, end-diastolic velocity, and resistive index were measured. Then ultrasonographic diagnoses of erectile dysfunction were classified as arteriogenic, veno-occlusive, and mixed-type. RESULTS: Doppler ultrasonography with trimix intracavernosal injection identified 8(38.1%), 1(4.8%), 10(47.6%), and 2(9.5%) patients with arteriogenic, veno-occlusive, mixed-type, and non-vasculogenic impotence, respectively. After vardenafil oral medication, 10(47.6%), 1(4.8%), and 10(47.6%) patients demonstrated arteriogenic, veno-occlusive, and mixed-type impotence, respectively. There was a difference in diagnosis in 23.8% of cases. CONCLUSIONS: Vardenafil oral administration with audio-visual sexual stimulation showed a similar hemodynamic result compared to trimix intracavernosal injection during penile duplex Doppler ultrasonography. However, there were some differences. These results suggest that vardenafil oral medication may be used as a substitute for intracavernosal injection when assessing erectile dysfunction using penile duplex Doppler ultrasonography. However, further investigation is needed.

Foreign Body Induced Bladder Calculi after Anti-Incontinence Surgery / 대한비뇨기과학회지

There have been several recent reports on bladder calculi in women with a previous history of pelvic operation. We experienced 3 patients with foreign body induced bladder stones within 1 year. These calculi had formed on a retained intravesical non-absorbable sutures or a pledget. The radiological and cystoscopic findings and operative technique are discussed.

Effect of Korean Red Ginseng on Vaginal Blood Flow and Structure in Hypercholesterolemic Female Rats / 대한남성과학회지

PURPOSE: The aims of this study were to investigate the effects of Korean Red Ginseng(KRG) on vaginal blood flow and histological changes in a hypercholesterolemic female rat model. MATERIALS AND METHODS: Female Sprague-Dawley rats were divided into two groups: the control(n=20) and the hypercholesterolemia(n=40). Hypercholesterolemia group was fed a high fat diet(2% cholesterol, 1% cholic acid, 5% coconut oil) for 12 weeks. The hypercholesterolemia group was further divided into the vehicle only and the KRG treatment(50 mg/kg/day) groups. After 4 and 8 weeks of treatment, vaginal blood flow was measured by a laser Doppler flowmeter. Vaginal tissues were processed for histology and Western blot. RESULTS: After 4 and 8 weeks of treatment, serum cholesterol levels(mg/dl) were significantly increased in the hypercholesterolemia group(1185.0+/-736.1, 934.3+/-212.3) compared with the control group(69.7+/-19.5, 67.1+/-7.2), and partially decreased in KRG treatment group(688.2+/-251.5, 694.2+/-150.4), respectively. Vaginal blood flow(ml/min/100 g tissue) after pelvic nerve stimulation was lower in the hypercholesterolemia group(17.3+/-7.9, 17.9+/-5.5) compared with the control group(27.3+/-17.1, 26.9+/-16.4), however, the KRG treatment group(29.5+/-10.3, 27.4+/-11.1) was as high as the control group, respectively. The expressions of TGF-beta1 tended to increase in the vagina of the hypercholesterolemia animals compared to those of the control and the KRG treatment groups. CONCLUSIONS: KRG treatment in hypercholesterolemic female rats decreased serum cholesterol levels and improved vaginal blood flow. These results suggest that KRG treatment may have a beneficial effect in women's sexual health.