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.

Screening for Prostatic Cancers in Korean / 대한비뇨기과학회지

Screening for prostate cancer was performed to estimate the incidence of prostate cancers and to detect early prostate cancers in the Korean population. 501 volunteers who were older than 50, not within the urological practice and from the general population of Pusan city were screened from March 1993 to October 1994. The screening methods used were I-PSS, prostate specific antigen (PSA), digital rectal examination (DRE), transrectal ultrasonography (TRUS), and uroflow with or without transrectal systematic biopsy of prostate. Biopsy was recommended in cases of PSA greater than 4 ng/ml or suspicious nodule on DRE or lesion on TRUS or when more than two of these findings were discovered. 443 participants satisfied the criteria for data analysis. The biopsy rate was 47.7%. Prostate cancer was found in eight, yielding a detection rate of 1.8%. Five of these eight cases were localized cancers. These findings suggest that screening for prostate adenocarcinoma on Koreans is efficient and necessary to detect cancers in the early stages. Apparently the detection rate of prostate cancer in Korean population is not low as previously expected.

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.

Complications and Success Rate of Transrectal Systematic Sextant Biopsy of the Prostate under the Finger Guidance / 대한비뇨기과학회지

The complications and the patients' attitude after transrectal systematic sextant biopsy of the prostate were evaluated by the questionnaire retrospectively. One hundred and sixty one of 211 men over 50 years old responded to the questionnaire. Transrectal sextant biopsy of the prostate under the finger guidance was performed by two doctors using Biopty Gun. The first 85 men (group A) received glycerin enema and oral administration of norfloxacin 30 minutes before the biopsy and norfloxacin was administered once again two to three hours after the biopsy. The other 126 men (group B) received the same procedures but the enema was performed using mixture of glycerin & betadine solution and the norfloxacin was administered 30 minutes before and for 3 days after the biopsy. Benign prostatic hyperplasia was diagnosed pathologically in 190 cases(90.1%) and prostate cancer in 8 cases(3.8%). No complication was less found in group A(23.4%) than in group B(40.5%)(P<0.05). Reported complications were perineal tenderness (group A: 42.9%,group B: 31.0%), hematuria (group A: 32.5%, group B: 34.5%), hemospermia (group A: 29.99%, group B: 19.0%), rectal bleeding (group A: 11.7%, group B: 11.9%), fever (group A: 15.69%, group B: 6.0%) and scrotal tenderness (group A: 2.6%, group B: 3.6%). In group A sepsis was developed in one case. Perineal tenderness lasted for 6.7 days in group A 5.1 days in group B. Hematuria was observed for 9.7 days in group A, 7.5 days in group B. Hemospermia was seen for 28.1 days in group A, 13.7 days in group B. Average duration of complications was shorter in group B (P<0.05). The better they understand the procedure of the biopsy, the less pain and the more satisfaction they experience. the rate of failure in obtaining tissue cores was 6.2%. If the doctor experiences more than about 120 cores of the tissue, the learning curve of success rate to obtain the proper specimens arrives to its plateau. In conclusion, the incidence of complications may be decreased by using appropriate pretreatment, especially adequate amount of antibiotics. Patient education is one of the most important steps to reduce the complications of this invasive technique.

An Analysis of Testicular Biopsy in 85 Infertile Men / 대한비뇨기과학회지

We analyzed testicular biopsies in eighty five infertile men with seventy eight azoospermia and seven severe oligospermia (< 1000000/ml) at our hospital from January 1989 to July 1993. The testicular volume was average 15.7ml (10 to 20ml). The most frequent histopathological finding was Sertoli cell only syndrome with 25 cases (29.4%). The second prevalent finding was sloughing and disorganization of germ cells with 22 cases (25.9%) and followed by maturation arrest with 19 cases (22.4%) and hypospermatogenesis with 19 cases (22.4%), in order. In the Sertoli cell only syndrome, sloughing and disorganization of germ cells and maturation arrest, nearly all showed azoospermia in the sperm count comparing to the hypospermatogenesis. Leydig cell abnormalities were hyperplasia in 32 cases (37.6%) and hypoplasia in 4 cases (4.7%). On the aspect of feedback, in Sertoli cell only syndrome and maturation arrest, serum FSH was increased in 21 cases (84.0%) and 7 cases (36.8%), respectively, but in the majority of sloughing and disorganization of germ cells and hypospermatogenesis, not increased. Plasma LH, prolactin, testosterone and estradiol were not correlated with germ cell morphology. Therefore, the testicular biopsy is especially important for aid in the diagnosis and prognosis in the infertile men, and further more to evaluate the testicular paracrinology.

A case of benign nonfunctioning retroperitoneal paraganglioma / 대한비뇨기과학회지

Paraganglioma, a pheochromocytoma arising in extra-adrenal tissue, is less common and more difficult to characterize radiologically. This disease has higher incidence of nonfunctioning and malignancy than adrenal pheochromocytoma, and occurs multiple. mostly around renal hilum. A 35-year-old female was transferred to our hospital complaining of palpable mass on the LUQ for 3 years. On admission, child head-sized fixed hard mass was palpated on LUQ. Urinary VMA, serum catecholamine and other tumor markers were within normal limit. Ultrasonogram and abdominal CT demonstrated inhomogeneous enhanced tumor mass located anteriorly to left kidney. En bloc removal of the mass with ipsilateral kidney and regional lymphadenectomy were done. We confirmed postoperatively the benign nonfunctioning retroperitoneal paraganglioma by histopathological studies.