Impotence due to Traumatic Urethrocavernous Fistula: Two Cases Report / 대한비뇨기과학회지

Penile fracture associated with urethra or corpus spongiosum Injury is rare. We report two cases of impotences due to urethrocavernous fistula following blunt penile trauma during sexual intercourse. In each case the fistulous tracts were well outlined by cavernosography or retrograde urethrography. Erectile function was completely recovered by conservative treatment including urethral catheterization, intracavernous injection of vasoactive agents and oral medication of fibrolytic agent in one and surgical intervention with resection of the fistulous tract and Dartos fascia interposition in the other.

Screening for Asymptomatic Bacteriuria in Korean Preschool Children / 대한비뇨기과학회지

PURPOSE: To determine the incidence of asymptomatic bacteriuria in Korean preschool children, we performed national survey. MATERIALS AND METHODS: We surveyed kindergardens in seven representative cities of Korea. Before performing urine culture, we selected children by urine dipstick screening method(leukocyte esterase and nitrite test). And we analysed the incidence according to sex, age and socioeconomic status. RESULTS: Total registered population was 2,239 children and male to female ratio was 1.16. Overall, asymptomatic bacteriuria was found in 1.03%(23 children). In the male the incidence was 0.3%(3 children) and in the female it was 2.0%(19 children). Less than 4 years old children showed higher incidence (2.9%) than those of any other age groups, such as, 0.5% in 4, 1.1% in 5 and 1.3% in 6 years old. High, middle and low socioeconomic status groups showed the incidence as 0%, 0.9% and 1.4%, respectively The number of leukocyte esterase positive children was 184(8.2%) and that of nitrite positive children was 115(5.1%). Among them urine culture was performed in 175children and 23 children showed significant bacteriuria(colony count> 100,000/ml), so predictability of asymptomatic bacteriuria by dipstick test was 13.1% Radiologic study was performed in 9 children who had bacteriuria, but none of them showed urological abnormalities. CONCLUSIONS: From the above data, we found that asymptomatic bacteriuria is more common in female, younger age and lower socioeconomic status among the Korean preschool children. Considering cost-benefit aspects of the screening for asymptomatic bacteriuria, however, we should re-evaluate the necessity of our study on these particular age groups.

Autopsy Findings in Fetuses with Oligohydramnios / 대한비뇨기과학회지

PURPOSE: After 16 weeks of gestational age, amniotic fluid is mainly consisted fetal urine. There is a close correlation between oligohydramnios associated with urinary tract anomaly and pulmonary development. Therefore, fetuses with oligohydramnios starting in the second trimester are considered to have uniformly fatal outcomes. We try to survey clinical characteristics of fetuses with oligohydramnios on autopsy and to find the need of perinatal management in fetuses with urinary tract anomaly and oligohydramnios which is occurred since second trimester. MATERIALS AND METHODS: We retrospectively analysed gestational age at presentation, maternal age, causes of oligohydramnios, external physical examination, prenatal sonographic findings, underlying urologic anomalies, associated anomalies of other organs and ultimate outcomes in eighteen fetuses with oligohydramnios among 301 autopsy fetuses from 1986 to 1991. RESULTS: It occurred predominantly in male as a ratio of 2.6:1 Gestational age of fetuses at presentation ranged from 21 to 47 weeks(average: 32.6) and maternal age from 20 to 33 years(average: 28.3). Causes of oligohydramnios in 18 fetuses ware fetal renal anomalies with intrauterine growth retardation(IUGR)(6), fetal renal anomalies(3), fetal death in uterine(3), urinary tract obstruction with IUGR(2) et al Inaccuracy rate between prenatal sonographic findings and autopsy findings was 53.8%, 0% in fetuses with urologic anomalies and with non-urologic anomalies, respectively. Underlying urinary tract anomalies consisted of bilateral renal dysplasia(4), posterior urethral valves(2), bilateral renal agenesis(1), bilateral renal hypoplasia(1), unilateral renal dysplasia and contralateral renal hypoplasia(1), infantile polycyctic kidney(1) et al. The most frequent anomaly of other organ was respiratory system anomalies, especially pulmonary hypoplasia. The prognosis in our cases with oligohydramnios was dismal as much as all fetuses except one, still birth, died of respiratory failure at perinatal periods. CONCLUSIONS: Based on these experiences we have the policy to induce delivery and early perinatal management in cases with second or third trimester onset of severe oligohydramnics with urinary tract abnormalites.

A Case of Megacystis Associated with Primary Chronic Intestinal Pseudoobstruction / 대한비뇨기과학회지

Primary chronic intestinal pseudo-obstruction is a rare condition characterized by the symptoms and signs of the functional intestinal obstruction due to intestinal motility dysfunction in the absence of an anatomic obstruction. Megacystis associated with primary chronic intestinal pseudo-obstruction is very rare. Herein we report a case of megacystis associated with primary chronic intestinal pseudo-obstruction.

Effect of Metal Components in Seminal Plasma on Seminal Parameter and Male Fertile Ability / 대한불임학회지

To determine the concentration and the physiologic role of metal components in blood plasma and seminal plasma in relation to male infertility, the concentrations of twelve metal components in blood plasma and seminal plasma including Na, Mg, K, Ca, Cr, Mn, Fe, Cu, Zn, Se, Cd and Pb were measured by atomic absorbance spectrophotometery or ion selective electrode analysis. Semen and blood samples were obtained from a total of 110 men including 70 male infertility patients, 20 vasectomized persons and 20 fertility proven volunteers visited to the Male Infertility Clinic of Pusan National University Hospital. The concentrations of Ca, Zn, Mg, Cr and Cd in control group were higher in seminal plasma than in blood plasma, and additionally Pb were higher in infertility group. The concentrations of all metal components revealed no significant difference according to patients' age, resident, occupation, sperm density, motility and hormone level in blood plasma, but some metal components including Ca, Mg, Cu, Mn, Cd and Pb revealed a significant difference according to each these parameters except patient's age in seminal plasma. The concentrations of Mn, Cd and Pb in the vasectomy persons were higher than in the infertility group III including testicular and epididymal factors, but not in blood plasma. We conclude that the quantitative changes of metal components in the seminal plasma may have effects on not only spermatogenesis and sperm function, but also contribute to diagnostic parameter according to organ specificity of the metal in the male reproduction.

The Effect of Testosterone on the Rat Penis and Accessory Sex Glands Following Castration / 대한비뇨기과학회지

Testosterone is required for the development and maintenance of the male accessory sex organs and their normal function. And it was reported that castration affect cells in the adult male rat accessory sex glands by induction of programmed cell death (apoptosis). So, in this study, the authors made an experiment to evaluate the effect of testosterone in the maure male rat penis and accessory sex glands following castration. Also, we utilized actinomycin D, a potent inhibitor of messenger and ribosomal RNA synthesis, in the experiment herein to assess the significance of regression process in the glands. Following are the changes in the serum testosterone level, the weight of the penis, ventral prostate and seminal vesicles and apoptosis occurrence of the control (castration, castration normal saline) and experimental (castration AD25, castration AD50) group of mature rats. 1. After castration, the control group and the experimental group showed decreased level of serum testosterone. 2. In the both groups, the weight of the penis, ventral prostate and seminal vesicles decreased gradually. 3. Compared to the control group, the castration AD25 did not show the inhibition of castration induced regression of penis and ventral prostate. However, castration AD50 showed the inhibition. 4 In the H-E staining and ApoTag in situ staining, the ventral prostate showed the most prominent apoptosis occurrence followed by the seminal vesicles and penis. These results suggest that after castration of the mature rat, due to testosterone deficiency, the weight of penis, ventral prostate and seminal vesicles decreased with the occurrence of apoptosis. Also, actinomycin D 50 micrometer seems to delay the regression process.

Clinical Pediatric Statistics on Inpatients and Operations in the Department of Urology; College of Medicine, Pusan National University for 40 years, 1957-1996 / 대한비뇨기과학회지

Statistical clinical studies of pediatric urology were made on 2,803 inpatients and 2,335 operative procedures at our department from Jan. 1957 to Dec. 1996. The statistical clinical studies of pediatric urology were summarized as follows: 1. Total number of inpatients and operations was 2,586 and 2,208 in male, 217 and 127 in female, respectively. 2. Total number of pediatric inpatients and operative procedures was markedly increased since 1980. Neonates and infants were also increased since late 1980 according to activation of antenatal clinics, especially. 3. The main diseases were cryptorchidism, hypospadias, obstruction of ureteropelvic junction (UPJO), hydrocele and urethral injury. The most common involved organ was penis and scrotum followed by urethra, kidney, ureter and bladder. 4. The main operations were orchiopexy, urethroplasty, circumcision, hydrocelectomy and pyeloplasty.

Inflammatory Pseudotumor of the Urinary Bladder: A Case Report / 대한비뇨기과학회지

Inflammatory pseudotumor of urinary bladder is a rare benign entity that clinically and radiologically simulates a malignant tumor. This benign lesion can easily be mistaken for sarcoma, and only careful pathologic examination can provide a definite diagnosis. It is important to recognize this lesion as benign to avoid the potentially serious consequences of misdiagnosis. A 53-year-old man presented with a history of micturition pain and urinary frequency despite of symptomatic treatment with antibiotics for 2 weeks. Cystoscopic examination, ultrasonography and of revealed a well defined mass with central necrosis. The mass was located at the left lateral wall of the bladder, and it was 3x3 cm sized round shape. We suspected benign tumor by above diagnostic modalities and we confirmed inflammatory pseudotumor by frozen section of mass, followed by partial cystectomy was performed. Awareness of this unusual lesion is important to prevent unnecessary surgical procedure. We report a case of inflammatory pseudotumor of the urinary bladder and reviewed 21 cases of this disease including our case.

Male Infertility: The Clinicostatistical Analysis of Recent 10 Years Cumulative Data / 대한비뇨기과학회지

A clinicostatistical analysis of 683 males with infertility who visited the Pusan National University Hospital between January 1986 and December 1995 was performed. We divided the patients into 5 groups by Shirataki classification as follows, group I, sperm concentration above 20 x 106/ml, group II, oligozoospermia with a sperm concentration above 10 x 100000/ml, but below 20 x 1000000/ml, group III,oligozoospermia with a sperm concentration below 10x 100000/ml, group IV, primary azoospermia, group V, obstructive azoospermia. The mean age was 33.1 years. The mean duration of infertility was 48.2 months. The frequency in each groups were group IV 383 cases (56.1%), group III 127 cases (18.6%), group I 111 cases (16.3%), group II 37 cases (5.4%), and group V 25 cases (3.7%), respectively. Except group V, as decreasing the sperm density, testicular volume tended to reduce (p<0.01). The semen volume in group V was significantly less than that in other groups (p<0.05). As sperm density decreased, the sperm motility tended to reduce (p<0.05). The levels of serum luteinizing hormone (LH) and follicular stimulating hormone (FSH) in group IV were significantly the higher than other groups (p<0.05). As for serum prolactin and testosterone, there were no significant differences between each 5 group. Of etiologic factors of male infertility, idiopathic was the most common cause with 489 cases (71. 6%), and followed by varicocele 71 cases (10.4%), seminal tract obstruction 44 cases (6.4%), chromosome abnormality 30 cases (4.4%), infection 20 cases (2.9%), testicular trauma 13 cases (1.9%), cryptorchidism 10 cases (1.5%), hyperprolactinemia 4 cases (0.6%) and retrograde ejaculation 2 cases (0.3%). A total of 391 cases had a management for male infertility which consisted of medical treatments 291 cases (74.4%), surgical treatments 89 cases (22.8%) and assisted reproductive technologies 11 cases (2.8%). In conclusion, We think the more clear clarification of physiology of male reproductive system, the development of new drugs for the improvement of spermatogenesis and the application of advanced assisted reproductive technique would be needed to handle properly the patients with male infertility.

Retroperitoneal Liposarcoma (Pleomorphic Type): A Case Report / 대한비뇨기과학회지

A 66-year-old woman was admitted to our hospital because of a mass in the left abdomen. Ultrasonography, aortography and computed tomographic (CF) scanning revealed the mass occupying the entire left abdominal cavity and the left kidney displaced by huge and avascular mass. Also CT guided needle biopsy demonstrated liposarcoma. At operation, a huge yellow-brownish tumor found in the retroperitoneal space, was removed incompletely due to severe adhesion to the left external iliac artery The tumor was 12x11x10cm and weighed 560gm. Histologically, it was a pleomorphic type liposarcoma. She bas received adjuvant radiotherapy but recurred 10 months later.

Comparison of Penile Size and Satisfaction between One Stage and Two Stage Urethroplasty for Hypospadias / 대한비뇨기과학회지

PURPOSE: We studied penile size of children who underwent hypospadias repair. Also we surveyed the degree of satisfaction with, as judged by patient's parents and urologist. MATERIALS AND METHODS: We measured the relaxed and erected penile size of children who underwent hypospadias repair and followed more than one year (28 cases of one stage repair and 20 cases of two stage repair). All of them had no complication. We used age adjusted ANOVA test for penile size, and Wilcoxon matched pairs signed rank test for comparison of satisfaction with penile appearance between one stage group and two stage group. RESULTS: Significant difference was noted between one stage group and two stage group for relaxed and erected penile length (p0.05). Two stage group showed statistically significant larger value than one stage group for glandular size, glandular shape, position of meatus, general appearance, and genital perception score as judged by patient's parents (p<0.05). And two stage group showed statistically larger value than one stage group for genital perception score judged by urologist (p<0.05). CONCLUSIONS: Our study demonstrated that two stage operation met with better penile size and satisfaction judged by patient's parents and urologist than one stage operation for middle and posterior penile hypospadias.

Effects of Estrogen on the Urinary Symptoms and Urodynamic Parameters in Postmenopausal Women / 대한비뇨기과학회지

Effects of oral estrogen (Tibolone) on the urinary symptoms and urodynamics parameters were assessed by a double-blind prospective trial in 24 postmenopausal women. Patients were assessed subjectively and objectively before and after treatment by symptom score change, urethral pressure profiles and uroflow. There was statistical difference in the subjective response (symptom score) to treatment between the two groups (p 0.05). Although there was no significant urodynamic changes, estrogen treatment in postmenopausal women was effective to improve urinary symptoms. Careful observation with periodic follow up will be needed because of possible harmful side effects of estrogen.

A Case or Synchronous Bilateral Testicular Torsion in the Neonate / 대한비뇨기과학회지

Synchronous bilateral testicular torsion in the neonate, although very rare, is being reported with increasing frequency. It is usually extravaginal and occurs either in utero or in the several days or weeks of life before the testicular tunics are firmly attached to the scrotum. Controversy exists concerning the urgency of exploration and removal of necrotic testis since some reports suggest that the interstitial tissue may survive and reduce the need for future androgenic replacement therapy. We report a case of synchronous bilateral neonatal testicular torsion in a full term. We have adopted a policy of prompt exploration with bilateral orchiectomy.

The Role of K+Channels in Rabbit Cavernous Smooth Muscle Relaxation by Acetylcholine and Nitroprusside / 대한비뇨기과학회지

It is well known that nitric oxide (NO) mediates smooth muscle relaxation via an increase in cyclic GMP (cGMP) 1evels. Acetylcholine (ACh) and nitroprusside (SNP) are known to mediate relaxation of cavernous smooth muscle via increasing the levels of NO. In recent years, the role of K+ channels in the hyperpolarization induced by nitrates and ACh in smooth muscle have been investigated. In this study, we attempted to characterize the role of K+ channel in rabbit cavernous smooth muscle relaxation by ACh and SNP under organ bath. Changes in isometric tension of corporal strips were monitored. The results were as follows; 1. The relaxant effects of ACh and SNP on contracted smooth muscle induced by 80 mM K' were less than those by phenylephrine. The ACh-induced relaxation was almost abolished in rabbit cavernous smooth muscle which endothelium was denuded, but the that of SNP was not affected by removal of endothelium. 2. Ng-nitro-L-arginine(L-NOARG) (3x0.00001M) and methylene blue (3x0.00001M) significantly inhibited the relaxant effect of ACh in cavernous smooth muscle, but that of SNP was not influenced by these drugs. The inhibition of L-NOARG on the relaxant effect of Ach was reversed by the addition of L-arginine(3x0.0001M). 3. Charybdotoxin (ChTx, 0.0000001M), significantly inhibited the relaxant effects of ACh,SNP and 8-Br-cGMP, but glibenclamide (0.00001M) and apamin (0.00001M) did not influence those of ACh and SNP 4. ACh (0.0001M} and SNP (0.0001M) increased the tissue content of cGMP The effect of ACh on the tissue content of cGMP was significantly affected by L-NOARG (3x0.00001M) and methylene blue (3x0.0000lM), but that of SNP was not influenced by these drugs. ChTx (0.000000lM) did not attenuate the accumulation of cGMP induced by ACh and SNP. Above results suggest that the relaxing effect of Ach and SNP on the isolated rabbit cavernous smooth muscle is associated with an increase in the tissue content of cGMP. Furthermore, ChTx sensitive-K+ channel-mediated hyperpolarization by increased cGMP may play a part in the relaxation of rabbit cavernous smooth muscle by ACh and SNP

The Significance of Urodynamic Study in Patients with Non-neoplastic and Non-traumatic Myelopathy / 대한비뇨기과학회지

Voiding functions in patients with non-neoplastic and non-traumatic myelopathy take a variable course according to severity and duration of disease. Fifteen patients of non-neoplastic and non-traumatic myelopathy were investigated neurologically thoroughly. On M.R.I. findings, hyperintense lesion was notified in a half of them but the others were nonspecific. On Pressure-Flow-EMG studies there were 7 cases of detrusor hyperreflexia with DSD, 2 cases of detrusor hyporeflexia with nonrelaxing striated muscle, 1 cases of detrusor hyporeflexia with coordinated striated muscle and 3 cases of normal findings. The thorough examination including M.R.I. and urodynamic study will be needed in patient with non-neoplastic and non-traumatic myelopathy because future possibility of their serious complications such as deterioration of renal function or impotence.

Penile Dorsal Skin Flap Urethroplasty in Extensive Traumatic Urethral Stricture / 대한비뇨기과학회지

Most patients of urethral stricture can be cured by urethral dilatation or visual internal urethrotomy. But, it is necessary to perform accurate surgical urethroplasty in complex urethral stricture such as extensive or multiple urethral strictures, urethrocutaneous fistula, urethral diverticulum, periurethral scar and chronic inflammation. Usually urethroplasty can be performed in one-stage, using standard end-to-end urethral anastomosis or full thickness skin graft or vascularized skin flap urethroplasty. But, in high risk cases, sometimes, two-stage scrotal inlay operation is adopted. We report 3 successful results with urethroplasty using vascularized penile dorsal skin flap which was made from rectangularily designed penile dorsal skin with longitudinal incision, one was inflammatory posterior urethral stricture associated with traumatic urethrocutaneous fistula the other was extensive and multiple inflammatory bulbous urethral stricture and another was intractable penile urethral stricture; totally in 3 cases.

The Efficacy of Intravesical Irrigation with Distilled Water After Transurethral Resection for Superficial Bladder Tumor / 대한비뇨기과학회지

We evaluated the prophylactic efficacy of intravesical irrigation with distilled water immediately after transurethral resection(IUR) of superficial bladder tumor patients. Control group(n=30), with normal saline irrigation immediately after TUR(=15 min.) and continuous intravesical instillation of adriamycin 150mg with 3000ml normal saline for 2 days postoperatively. Distilled water group(n=28), with the same modality as control group, except for distilled water as the irrigation solution. The overall recurrence rates were 35.7% in distilled water group, which were more effective than 60.0% in control group. The 2 yeas tumor free rates by Kaplan-Meier method was higher in distilled water group ( 71.4% ) than control group (46.4% ), respectively with statistical significance. But, the mean time to recurrence were 13.3 months in control group and 14.1 months in distilled water group, without significant differences between two groups. These results support that the reasonable benefits of distilled water for prophylaxis of recurrence in superficial bladder tumor.

Congenital Patent Urachus: Report of 2 Cases / 대한비뇨기과학회지

The congenital patent urachus is the failure of complete urachal lumen closure and results in a free communication between the bladder and the umbilicus. Embriologically the urachus represents the vestigial remnant of the allantois which, in the fetus, communicates with the cloaca. The first patient is a 6-day-old female infant, and she was transferred due to urine leakage from the reddish hen egg sized protruding mass on the umbilicus. The fistulogram showed a long fistulous tract which communicates with bladder and umbilicus. A complete resection of the patent urachus was done. The second patient is a 1-day-old male infant, and he was transferred for operation of omphalocele from local clinic. Urine leakage was detected from the urachus at operative field, and so complete resection of the urachus was performed, and the one stage repair was performed for treatment of mild intestinal herniation. Postoperative courses of the two cases were uneventful.

The Investigation of Split Renal Function after Pyeloplasty Using 99m-Tc-DMSA Renal Uptake Rate in Children with Unilateral Ureteropelvic Junction Obstruction / 대한비뇨기과학회지

Urinary tract obstruction is one of the most common abnormalities of the excretory system in children. It is well known that renal function is progressively deteriorated by urinary tract obstruction and partially recovered by relief of the obstruction. But the reports about the changes of the renal function in contralateral healthy kidney after relief of unilateral obstruction are rare. Thus, we investigated pre- and post-operative changes of renal function not only on the obstructed kidneys but also on the contralateral normal kidneys in twenty-two children(12 were younger than 2 years old) with unilateral hydronephrosis due to ureteropelvic junction obstruction, using 99m-Tc-DMSA renal uptake rate. A marked increase in 99m-Tc-DMSA renal uptake rate was observed in twelve cases(54.5 % ) after pyeloplasty on the obstructed kidney. Among them eight children were younger than 2 years old. In 7 children younger than 2 years old, a preoperative 99m-Tc-DMSA renal uptake rate in contralateral normal kidney was markedly decreased. Among them, marked increase in postoperative 99m-Tc-DMSA renal uptake rate was observed in 5 cases(71.4%). In other words, in 5 children younger than 2 years old, a remarkable increase of 99m-Tc-DMSA renal uptake rate after reconstructive operation was recognized not only on obstructed kidney but also on the contralateral normal kidney. These tendency could not be observed in those older than 3 years old. These results suggest that, in the young children, the obstructed kidney inhibits the contralateral normal and compensatory renal growth, and that the relief of obstruction eliminates this inhibition and causes the renal growth spur in a normal kidney. In summary, we proposed that it is essential to correct unilateral ureteropelvic junction obstruction before two years of age if an improvement of renal function not only on the obstructed kidney but also on the normal kidney is to be expected.

Venous Hypertension after Internal Arteriovenous Anastomosis on the Forearm for Hemodialysis: Report of 2 Cases / 대한비뇨기과학회지

Venous hypertension is caused by the inflow of the arterial blood to the dis-tal venous system due to an obstruction or stenosis of the proximal venous branch in the Patients with internal arteriovenous shunt for hemodialysis. We report the two cases of venous hypertension in patients with internal shunt between the radial artery and the cephalic vein for the first time in Korea. Clinical manifestations were severe pain, swelling, tenderness, hyperpigmentation and ulceration on the involved hand and/or fingers. Venogram showed an obstruction or stenosis of the cephalic vein proximal to the shunt and congestion in the cephalic vein distally. There was no obstruction or stenosis of the ipsilateral subclavian vein. We corrected venous hypert6nsion by ligation of the cephalic vein distal to the shunt and end to end anastomosis between the distal cephalic vein and the basilic vein with interposition of the artificial vessel(Gore-tex(R)). In the follow-up, skin lesions and edema were completely resolved by the second week postoperatively.