Necessity of Research on Thirdhand Smoke for Maternal and Child Health

The causal relationship between cigarette smoking during pregnancy and adverse maternal and child health outcomes, such as preterm birth, low birth weight, and sudden infant death syndrome are well known. In addition, cigarette compounds are neurotoxic even at extremely low levels. Thirdhand smoke (THS) is the contamination that persists after secondhand tobacco smoke has been emitted into air. It refers to the tobacco-related gases and particles that become embedded in materials such as carpets, walls, furniture, blankets, and toys. THS is not strictly smoke but chemicals that adhere to surfaces from which they can be released back into the air, undergo chemical transformations, and/or accumulate. The concept of THS is a relatively new phenomenon in the environmental and public health field. Currently, the hazards of THS are not as well documented as the hazards of secondhand smoke. Furthermore, its health effects and biological effects are largely unknown. This review summarizes recent research progress in reproductive toxicology studies that use animal models and in vitro systems, studies of environmental contamination by THS, human exposure studies, and priorities for further research. Future research must be conducted to facilitate hazard identification, and exposure and risk assessment to address its health effect on susceptible populations, such as pregnant women and children. In addition, policies and laws concerning tobacco smoke will need to be reviewed and possibly revised with the role of THS considered as an indispensable component of a broader tobacco control strategy in maternal and child health.

Preconception Care for Men

Pregnancy planning is critical to ensuring optimal conditions for conception, gestation, and the subsequent birth of a healthy child. Preconception care for men is important for reproductive life as much as women's preconception health and healthcare; however, little attention has been paid to male preconception care in Korea. Appropriate preconception care seeks to guide reproductive life planning, improve pregnancy outcomes, ensure a man's capacity for parenthood and fatherhood, and enhance reproductive health. Additionally, preconception care for either sex offers the opportunity for disease prevention and health promotion. Clinicians thus have the opportunity to positively impact the reproductive health of men. Although men are less likely than women to consistently seek medical services, an office visit for any reason should be seen as an opportunity to introduce the idea of reproductive health. The recommendation of a subsequent office visit for physical examination with a focus on health promotion, disease prevention, and reproductive assessment is strongly encouraged. This paper focuses on risk assessment, one of the key elements of comprehensive optimization of male preconception care.

Success Rate of Microsurgical Multiple Testicular Sperm Extraction and Sperm Presence in the Ejaculate in Korean Men With Y Chromosome Microdeletions

PURPOSE: We assessed the frequency of azoospermia factor a (AZFa), AZFb, and AZFc deletions and examined correlations between the deletion sites and the success rates of sperm presence within the ejaculate and surgical sperm retrieval in Korean men. MATERIALS AND METHODS: A total of 1,919 azoospermic and severely oligozoospermic men were assessed for Y chromosome microdeletions. Among them, 168 men with AZF deletions were identified and their medical records were reviewed. RESULTS: Of the total 168 men with AZF deletions, there were 13 with AZFa, 10 with AZFb, 95 with AZFc, 37 with AZFbc, and 13 with AZFabc deletions. Of the 95 men with isolated AZFc deletion, 51 had the presence of sperm in the ejaculate. Of the infertile men with any other deletion, however, only two patients (one man with AZFb deletion and another with AZFbc deletion) showed the presence of sperm in the ejaculate. The success rates for surgical sperm retrieval were 7.1% (1/14) in men with AZFbc deletion and 54.8% (17/31) in the isolated AZFc deletion group. No sperm was obtained from the patients with AZFa or AZFb deletions who underwent microsurgical sperm retrieval. In the isolated AZFc deletion group, there were significant differences between azoospermic and severely oligozoospermic patients in terms of testicular volume and serum levels of follicle-stimulating hormone and luteinizing hormone, whereas no significant differences were found when the group was divided by surgical sperm retrieval outcomes. CONCLUSIONS: Deletions of the AZFa and AZFb regions are associated with severe spermatogenetic impairment. However, more than half of men with an AZFc deletion had sperm within the ejaculate or testis for in vitro fertilization with intracytoplasmic sperm injection.

Causes and classification of male infertility in Korea / 대한생식의학회지

OBJECTIVE: The aim of this study is to investigate the various causes of male infertility using multiple approaches. METHODS: Nine-hundred-twenty infertile male patients were analyzed at their first visit with one physician between January 1 and December 31, 2009. All patients were subjected to physical examination, semen analysis and azoospermic patients underwent hormonal testing, chromosomal tests, and testicular biopsy. Semen analysis was based on the definition of the World Health Organization. RESULTS: Among the 920 patients, 555 patients (60.3%) had semen results within the normal range, 269 patients (29.2%) within the abnormal range, and 96 (10.5%) were diagnosed with azoospermia. Varicoceles were diagnosed in 84 of the 555 normal-range patients (15.1%) and in 113 of the 269 abnormal-range patients (42.0%). Of the 96 patients with azoospermia, 24 patients (25%) were diagnosed with obstructive azoospermia, 68 patients (71%) with non-obstructive azoospermia, and 4 patients (4%) with retrograde ejaculation. CONCLUSION: Various causes of male infertility have been reported and diverse treatment methods can be adopted for each cause. In this regard, research must be conducted on a larger number of patients to accurately assess the various causes of infertility in Korean patients and to investigate various infertility treatment methods.

Urologic Complications Following Obstetric and Gynecologic Surgery

PURPOSE: Urologic injuries occur frequently during surgery in the pelvic cavity. Inadequate diagnosis and treatment may lead to severe complications and side effects. This investigation examined the clinical features of urologic complications following obstetric and gynecologic surgery. MATERIALS AND METHODS: We accumulated 47,318 obstetric and gynecologic surgery cases from 2007 to 2011. Ninety-seven patients with urological complications were enrolled. This study assessed the causative disease and surgical approach, type, and treatment method of the urologic injury. RESULTS: Of these 97 patients, 69 had bladder injury, 23 had ureteral injury, 2 had vesicovaginal fistula, 2 had ureterovaginal fistula, and 1 had renal injury. With respect to injury rate by specific surgery, laparoscopic-assisted radical vaginal hysterectomy was the highest with 3 of 98 cases, followed by radical abdominal hysterectomy with 15 of 539 cases. All 69 cases of bladder injury underwent primary suturing during surgery without complications. Of 14 cases with an early diagnosis of ureteral injury, 7 had a ureteral catheter inserted, 5 underwent ureteroureterostomy, and 2 underwent ureteroneocystostomy. Of nine cases with a delayed diagnosis of ureteral injury, ureteral catheter insertion was carried out in three cases, four cases underwent ureteroureterostomy, and two cases underwent ureteroneocystostomy. CONCLUSIONS: Bladder injury was the most common urological injury during obstetric and gynecologic surgery, followed by ureteral injury. The variety of injured states, difficulty of diagnosis, and time to complete cure were much greater among patients with ureteral injuries. Early diagnosis and urologic intervention is important for better outcomes.

One-Year Surgical Outcomes and Quality of Life after Minimally Invasive Sling Procedures for the Treatment of Female Stress Urinary Incontinence: TVT SECUR(R) vs. CureMesh(R)

PURPOSE: We compared the efficacy and safety of two minimally invasive sling procedures used to treat female stress urinary incontinence (SUI), tension-free vaginal tape (TVT) SECUR(R) and CureMesh(R), and assessed the 1-year surgical outcomes. MATERIALS AND METHODS: Sixty women with SUI were assigned to undergo either the TVT SECUR (n=38) or CureMesh (n=22) procedures between April 2007 and June 2008. Patients were monitored via outpatient visits at 1 month, 3 months, and 1 year after surgery. The efficacy of these procedures was evaluated by the cough test or by a urodynamic study. At these postoperative visits, the patients also completed several questionnaires, including incontinence quality of life, patient's perception of urgency severity, the scored form of the Bristol Female Lower Urinary Tract Symptoms, visual analog scale, and questions about perceived benefit, satisfaction, and willingness to undergo the same operation again. The objective cure rate was defined as no leakage during the cough test with a full bladder. The subjective cure rate was evaluated by self-assessment of goal achievement performed 1 year postoperatively. RESULTS: The two groups were similar in preoperative characteristics and urodynamic parameters. The objective cure rates were similar between TVT SECUR and CureMesh (68.4% vs. 77.3%). All respondents reported improvement after surgery. There were no intra-operative complications. CONCLUSIONS: Our results showed that the TVT SECUR and CureMesh procedures are both safe and simple to perform and have no significant differences in efficacy. Comparative studies with long-term follow-up are warranted to determine the true efficacy of these procedures.

Complications Related to Scrotal Surgery for Male Infertility / 대한남성과학회지

PURPOSE: We reviewed our experience of various scrotal surgeries for male infertility to determine the postoperative complication rates, and how our experience might differ from other series. MATERIALS AND METHODS: The medical records of 356 male patients, performed scrotal surgery for infertility from 2005 to 2006 were reviewed retrospectively. All features of postoperative complications were analyzed according to the operative procedures, use of microscope, spermatic cord incision, and type of anesthesia. RESULTS: All 356 patients of scrotal surgeries were consisted of testicular biopsy (27.2%), microsurgical multiple testicular sperm extraction (m-TESE) (26.4%), vasectomy (17.1%), vasovasostomy (12.6%), scrotal exploration (6.5%), vasoepididymostomy (5.3%) and TESE (4.8%). Complications occurred in 11 (3.1%) procedures and included petechia (27.3%), scrotal edema (27.3%), wound disruption (18.2%), hematoma (18.2%) and hemospermia (9.1%). Most complications were improved by conservative treatments such as compressive scrotal dressing with elevation and resuture was done in 18.2 % (2/11) of patients with wound disruption. In patients of spermatic cord incision, complication rates was higher than in those who did not (8.0% vs. 1.5%, respectively) (p=0.006). There were no significant differences in complication rates regarding type of anesthesia or use of microscope. CONCLUSIONS: To prevent probable complications following scrotal surgery for male infertility, intraoperative meticulous control of bleeding, compressive scrotal dressing or elevation should be considered. Especially, in surgery combined with spermatic cord incision, physicians should pay more attention to minimize postoperative complications.

Efficacy of Maximal Electrical Stimulation for Treatment of Overactive Bladder

PURPOSE: To evaluate the efficacy of acute maximal functional electrical stimulation(AMFES) for the treatment of overactive bladder(OAB). MATERIALS AND METHODS: Twenty-eight patients(male 3, female 25) with OAB symptoms were treated with AMFES(10Hz biphasic alternating pulse, 20 min per session, 10 sessions) via intravaginal or anal electrode. They were divided into OAB symptoms with and without detrusor overactivity(DO) based on urodynamic study (n=15 vs. 13, respectively). DO-present group was subdivided into idiopathic DO subgroup (IDO, n=9) and neurogenic DO subgroup(NDO, n=6). The outcomes were assessed by 3-day frequency-volume chart and the Bristol Female Lower Urinary Tract Symptoms Questionnaire Changes in OAB symptoms at 1 and 3 months after discontinuing the stimulation were evaluated. RESULTS: Cure rates for urgency and urge incontinence at 1-month after stimulation were determined as 62.5% and 50% in IDO group, 66.7% and 66.7% in NDO group, respectively, which were higher compared to DO-absent group. At 3-month after treatment most patients in IDO and DO-absent group who achieved a cure at 1 month, maintained improvement, however three(75%) of 4 patients in NDO group recurred. There were no significant changes in urodynamic parameters. The detrusor overactivity was no longer observed in 5(55.6%) patients in IDO group and none in NDO group. CONCLUSION: AMFES has a beneficial effect on women with OAB. Our data suggest electrical stimulation may have a significant carry-over effect in well-selected OAB patients although further studies with large population are needed to establish long-term results.

Routine screening for classical azoospermia factor deletions of the Y chromosome in azoospermic patients with Klinefelter syndrome / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To evaluate the occurrence of classical azoospermia factor (AZF) deletions of the Y chromosome as a routine examination in azoospermic subjects with Klinefelter syndrome (KS).</p><p><b>METHODS</b>Blood samples were collected from 95 azoospermic subjects with KS (91 subjects had a 47,XXY karyotype and four subjects had a mosaic 47,XXY/46,XY karyotype) and a control group of 93 fertile men. The values of testosterone, follicle stimulating hormone (FSH) and luteinizing hormone (LH) were measured. To determine the presence of Y chromosome microdeletions, polymerase chain reaction (PCR) of five sequence-tagged site primers (sY84, sY129, sY134, sY254, sY255) spanning the AZF region, was performed on isolated genomic DNA.</p><p><b>RESULTS</b>Y chromosome microdeletions were not found in any of the 95 azoospermic subjects with KS. In addition, using similar conditions of PCR, no microdeletions were observed in the 93 fertile men evaluated. The level of FSH in KS subjects was higher than that in fertile men (38.2 +/- 10.3 mIU/mL vs. 5.4 +/- 2.9 mIU/mL, P < 0.001) and the testosterone level was lower than that in the control group (1.7 +/- 0.3 ng/mL vs. 4.3 +/- 1.3 ng/mL, P < 0.001).</p><p><b>CONCLUSION</b>Our data and review of the published literature suggest that classical AZF deletions might not play a role in predisposing genetic background for the phenotype of azoospermic KS subjects with a 47,XXY karyotype. In addition, routine screening for the classical AZF deletions might not be required for these subjects. Further studies including partial AZFc deletions (e.g. gr/gr or b2/b3) are necessary to establish other mechanism underlying severe spermatogenesis impairment in KS.</p>

Comparative Study of the Tension-Free Vaginal Tape (TVT) Procedure and the Suprapubic Arc Sling (SPARC) Procedure for Treating Female Stress Urinary Incontinence: a 1-Year Follow-Up / 대한비뇨기과학회지

PURPOSE: We wanted to compare the efficacy and outcomes of two retropubic mid-urethral sling procedures, tension-free vaginal tape (TVT) and suprapubic arc sling (SPARC), in the women suffering with stress urinary incontinence (SUI). MATERIALS AND METHODS: A total of 124 women with SUI were assigned to either the TVT group (n=62) or the SPARC group (n=62) within a same period. Only the patients with a follow-up of at least 12 months were included and those patients who underwent conjoined pelvic reconstructive surgeries for coexisting pelvic organ prolapse were excluded from this study. Finally, 90 patients (TVT: 42, SPARC: 48) remained in the study. The objective cure rate was evaluated by clinical and urodynamic examinations; the satisfaction rate was determined by using a questionnaire via the telephone or a self-addressed, stamped envelope. The mean follow-up period was 16.3 months in the TVT group and 16.3 months in the SPARC group. RESULTS: Two groups were similar in their preoperative characteristics and the perioperative parameters. There was no significant difference between the 2 groups in terms of the cure rate: cure (91.7% vs. 100%, p=0.056), improvement (6.2% vs. 0%, p=0.099), and failure (2.1% vs. 0%, p=0.347) for SPARC and TVT, respectively. In addition, the patient satisfaction rate was not different significantly between 2 groups. The main complication was urinary retention, and this was diagnosed in 6 patients; 3 (7.1%) in the TVT group and 3 (6.3%) in the SPARC group. De novo urge symptoms were observed in 3 patients (1 in the TVT group and 2 in the SPARC group). CONCLUSIONS: SPARC sling and TVT appears to be equally effective and safe for the surgical treatment of female SUI at the 1-year follow-up, although further studies are needed to establish the long-term efficacy and safety of these procedures.

Quality of Life and Sexual Outcomes: Radical Prostatectomy and External Beam Radiation Therapy for Prostate Cancer / 대한비뇨기과학회지

PURPOSE: We assessed the impact of treatment modalities, such as radical prostatectomy or external beam radiation therapy, for prostate cancer on the health related quality of life (HRQoL) and sexual function of patients. MATERIALS AND METHODS: 137 eligible patients, with localized or locally advanced prostate cancer, were enrolled from two treatment groups: radical prostatectomy (RP) and external beam radiation therapy (EBRT). To compare changes in the HRQoL and sexual function after treatment with these two modalities, an interview or postal survey was performed for the patients that were followed up at least 12 months after treatment. Finally, 57 patients (RP 34 and EBRT 23) were eligible to remain on the study. Standardized questionnaires, including the EORTC QLQ-C30 (version 3.0) and QLQ-PR25, for evaluation of HRQoL, and the International Index of Erectile Function (IIEF), for sexual function, were employed. RESULTS: On global health status and functional scales, the progression in the mean scores between the baseline and treatment were worse in the PR group. The PR group also had worse urinary incontinence, erection and ejaculation problems than the EBRT group. EBRT was associated with adverse bowel function. The IIEF demonstrated significant changes between the baseline and post-treatment scores across all five domains with the two treatment modalities, especially with a RP. CONCLUSIONS: The majority of prostate cancer patients were unable to return to functional sexual activity after both a RP and EBRT. The assignment of patients to the two treatment modalities entails different risks of urinary leakage and bowel dysfunction. These findings will help facilitate counseling, with regard to sexual function and HRQoL expectations, for prostate cancer patients.

Long-Term Health-Related Quality of Life in Patients with Prostate Cancer after Treatment / 대한비뇨기과학회지

PURPOSE: The study of quality of life issues has been gaining importance because treatment significantly impacts on the ability of a patient to continue social and occupational activities. The impact of treatment modalities for localized or locally advanced prostate cancer on the quality of life of patients was compared. MATERIALS AND METHODS: 186 eligible patients with localized or locally advanced prostate cancer were enrolled from four treatment groups: radical prostatectomy (RP), external beam radiotherapy (EBRT), hormonal therapy (HT) and watchful waiting (WW). To compare changes in the Health Related Quality of Life (HRQoL) after treatment by these modalities, the patients were given questionnaires, with self-addressed, stamped envelopes, for completion and return both before and after treatment. The questionnaire was mailed to the patients that were followed up for more than 12 months after treatment. Finally, 98 patients (RP 36, EBRT 31, HT 13, and WW 18) remained on the study. The sexual, urinary and bowel functions, and certain aspects of the HRQoL of these treatment groups were examined. The general HRQoL was evaluated with the EORTC QLQ-C30 (version 3.0), and the prostate cancer-specific QoL measured using EORTC QLQ-PR25. RESULTS: On global health status and functional scales, the RP group showed the worst progression in their mean scores between baseline and treatment, and had the worst urinary incontinence, erection and ejaculation problems of the groups. EBRT was associated with adverse bowel function, HT tended to produce more sexual functioning symptoms and WW had the least erection and ejaculation problems. CONCLUSIONS: The assignment of patients to several treatment modalities entails different risks of erectile dysfunction, urinary leakage, and bowel dysfunction. These findings will help facilitate patient counseling with regard to the HRQoL expectations of patients.

Female Bladder Outlet Obstruction: Clinical Characteristics, Urodynamic Findings, and Treatment Responses

PURPOSE: Bladder outlet obstruction(BOO) in women is an uncommon condition with an incidence range of 2.7~29%. It is difficult to predict because there is a result of the lack of standard diagnostic definition for the evaluation and no typical diagnostic symptoms. We analyzed the clinical manifestation, urodynamic findings, and response to treatment in female BOO. MATERIALS AND METHODS: 140 women with non-neuropathic voiding dysfunction were evaluated. In all, 27 women had bladder outlet obstruction as indicated by our diagnostic criteria: non-neuropathic voiding dysfunction, maximal flow rate(Q(max)) or =30 cmH2O. Using 16 Fr urethral metal soundation for urethral evaluation, we classified the patients into two groups, the anatomical BOO group in case of resistance to soundation or the functional BOO group, for cases without resistance. We managed these patients with urethral dilation of up to 28 Fr in combination with the administration of alpha 1-blocker. RESULTS: The etiology of BOO was anatomical(37%, n=10), and functional(63%, n=17). In patients with anatomical and functional BOO, urodynamic parameters were similar in each group. In women with BOO, the management with alpha 1-blocker and/or urethral dilation significantly reduced International Prostate Symptom Score(IPSS) and residual urine volume. CONCLUSION: In patients with P(det)Q(max)>or=30 cmH2O, Q(max)

Analgesic Effect of Ilioinguinal Nerve Block and Wound Irrigation Using Bupivacaine after Ambulatory Inguinoscrotal Surgery in Children / 대한비뇨기과학회지

PURPOSE: A simple and safe method for postoperative analgesia is required for children, especially with ambulatory surgical procedures. This study aimed to investigate the analgesic effects of ilioinguinal nerve block, and wound irrigation using bupivacaine, compared with those in control after inguinoscrotal operation. MATERIALS AND METHODS: Of 57 patients who underwent unilateral hydrocelectomy or orchiopexy, at our ambulatory surgery center, patients were randomly selected for ilioinguinal nerve block (group 1, n=19) or wound irrigation (Group 2, n=19) using bupivacaine. Normal saline was injected, or irrigated, into the control group (n=19). The analgesic effects were evaluated using the Oucher scale, every 30 min for 3h, and then at 6, 12 and 24h postoperatively, and the number of additional oral analgesic intakes recorded during the period. RESULTS: All three groups were similar in age, type of procedures and duration of the operation or anesthesia. The pain scores were significantly lower in groups 1 and 2 compared to the control, and the pain score, 30 min after the operation, was significantly lower in group 2 than in group 1 (p=0.025, p=0.001 and p=0.045, respectively). Although the pain scores between the 3 groups showed no significantly difference following the procedure, a relatively higher pain score was noted in the control group after 150 min. In groups 1 and 2, there was a lesser number of analgesic intakes than required by the control, although this was not significantly different. CONCLUSIONS: In ambulatory inguinoscrotal surgery, ilioinguinal nerve block, or wound irrigation, using bupivacaine, demonstrated similar analgesic effects in children. Wound irrigation was more effective than nerve block at 30 min postoperatively. Based on these data, wound irrigation or nerve block, using bupivacaine, with the addition of oral analgesics, will minimize the postoperative pain of ambulatory inguinoscrotal surgery in children.

The Significance of an Open Bladder Neck in the Evaluation of the Female Stress Urinary Incontinence / 대한산부인과학회잡지

OBJECTIVE: To determine the prevalence of an open bladder neck in women with stress urinary incontinence and to assess its clinical and urodynamic significance. METHODS: To evaluate the presence of an open bladder neck, a total of 356 women with stress incontinence were evaluated by static cystourethrography (CUG). An open bladder neck is a finding defined as the appearance of contrast medium in the proximal urethra at resting state (like a 'beak') without overt leakage. We classified the patients into two groups according to the presence of an open bladder neck on static CUG and compared 13 clinical parameters between the two groups. RESULTS: The open bladder neck finding was observed in 192 (53.9%) patients. Open bladder neck was more common in higher symptom grade, older age, more delivery history, greater bladder neck descent, and estrogen depleted patients. There was a significantly higher rate of intrinsic sphincteric deficiency (ISD) in the open bladder neck-positive group (37.5%) than the open bladder neck-negative group (23.2%) (p=0.01). The average abdominal leak point pressure (ALPP) of women with open bladder neck (82.8 cmH2O) was lower than that of women without open bladder neck (96.4 cmH2O) (p=0.003). CONCLUSION: The open bladder neck on static CUG has clinical and urodynamic significance. Although it is not diagnostic of ISD, the finding may reflect functional deficiencies of intrinsic sphincter. One should consider this parameter when evaluating patients, especially in the equivocal zone of ALPP 61-90 cmH2O.

Factors Predicting Intrinsic Sphincter Deficiency in Female Stress Urinary Incontinence

PURPOSE: This study was conducted to investigate whether predictive factors are associated with stress urinary incontinence due to intrinsic sphincter deficiency (ISD). MATERIALS AND METHODS: We reviewed retrospectively the records of 254 women with the diagnosis of genuine stress incontinence. All women had undergone a detailed history by questionnaire and interview, physical examination and multi-channel urodynamic study, including the determination of VLPP. The patients were classified into three groups according to VLPP regardless of the presence of hypermobility; 1) ISD: VLPP90cmH2O. The ISD group was compared with the AI group using 15 clinical factors. Univariate (t-test, chi-square test) and multivariate (logistic regression test) analyses were performed to determine which clinical factors were associated with ISD. RESULTS: The mean patient age was 51 years (range 25 to 77). Eighty-two women (32%) were in the ISD group and 98 (38%) 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 11 (15%) and 61 (85%) in grade I, 53 (62%) and 33 (38%) in grade II, and 18 (82 %) and 4 (18%) in grade III respectively. There was no correlation between VLPP and other clinical factors. CONCLUSIONS: The only clinical factor that predicted the presence of ISD, as defined by VLPP of 60cmH2O or less, was the symptom grade. Higher grades of stress urinary incontinence have a higher possibility of ISD. One should consider this factor when evaluating patients, especially in the equivocal group.