The Effects of Ethanol and Acetaldehyde on Corpus Cavernosal Smooth Muscle of the Rabbit / 대한남성과학회지

PURPOSE: This study is to assess the pharmacologic effects of ethanol and its metabolite, acetaldehyde on potassium channels of the corpus cavernosal smooth muscle of the rabbit. MATERIALS AND METHODS: Cavernosal strips from New Zealand white rabbits were harvested and pharmacophysiologic organ bath studies were executed. In equilibrium state after incubation, zaprinast (PDE5 inhibitor) induced relaxations were monitored in strips precontracted with phenylephrine (PE, 10(-4)M). The inhibitory effects of ethanol and acetaldehyde (2, 20, 40, 80 mmol) on zaprinast-induced relaxations were recorded. Pinacidil (K(ATP) channel opener) and phloretin (BK channel opener) were tested to reverse the inhibitory effects of ethanol and acetaldehyde on zaprinast-induced relaxations. RESULTS: Both ethanol and acetaldehyde inhibited the zaprinast-induced relaxations in a dosedependent manner (p<0.05). Both pinacidil and phloretin abolished the inhibition by both ethanol and acetaldehyde (p<0.05). Ethanol and acetaldehyde inhibits cavernosal relaxation, possibly through BK channels and K(ATP) channels. CONCLUSIONS: These results suggest that ethanol and its metabolite may affect the corpus cavernosal smooth muscle directly and lead to consequent erectile dysfunction. Furthermolecular and electrophysiological studies will help reveal the underlying mechanisms to which this process occurs.

Primary Vesical Actinomycosis: A Case Diagnosed by Multiple Transabdominal Needle Biopsies

Primary vesical actinomycosis is an extremely rare disease. In most cases it is misdiagnosed as vesical or urachal tumor and usually diagnosed through post-operative pathologic confirmation. Here we report a case of primary vesical actinomycosis confirmed by preoperative repeated multiple transabdominal biopsies. The patient was a 49-yr-old woman who presented with frequency, dysuria, and intermittent gross hematuria for 2 months. Computed tomography and cystoscopic examination showed broad-based, edematous, and protruding mass at the dome and anterior portion of the bladder. The clinical and imaging findings of the patient initially suggested vesical malignancy. Transurethral resection and multiple biopsies of the mass were performed. Pathologic examination demonstrated fibrosis with chronic inflammation. We performed repeated transabdominal multiple needle biopsies for further pathologic confirmation. Histopathologic examination demonstrated typical sulfur granules, which were consistent with actinomycosis.

Clinical Significance of Calculated Prostate Cancer Volume as the Predictor of Pathologic Stage / 대한비뇨기과학회지

PURPOSE: Pathologic tumor volume is closely related with pathologic stage, pathologic Gleason grade, surgical margin status, and disease progression after radical prostatectomy. Therefore, an accurate assessment of prostate cancer volume is essential in prediction of pathologic stage. We evaluated that the calculated prostate cancer volume (cVca), a new clinical parameter, can predict for pathologic stage T3 in patients with clinical stage T1, 2 prostate cancer. MATERIALS AND METHODS: The cVca was determined in 26 men treated with radical prostatectomy in clinically localized prostate cancer (clinical stage T1, T2) based on pretreatment PSA, biopsy Gleason score, and prostate ultrasound volume. Logistic regression analysis evaluating the value of the PSA, biopsy Gleason score, cVca was performed. RESULTS: The mean of cVca was 4.07cm3 and the mean of cVca in localized and extensive prostate cancer was 1.77cm3 and 6.74cm3, respectively. The difference between the mean of cVca in localized and extensive prostate cancer was statistically significant (p<0.05). PSA and cVca were significant predictors of pathologic stage T3 disease in patients with clinical stage T1, T2 disease on univariate analysis, but cVca was only significant predictor on multivariate analysis. CONCLUSIONS: The cVca was more reliable parameter than PSA and Gleason score in predicting of pathologic stage T3 disease in patients with clinical stage T1 and T2 prostate cancer. Therefore, this new parameter can be used to select patients who are likely to have pathologic organ-confined disease.

The Clinical Significance of Detrusor Contraction Duration as a Predicting Parameter for Evaluaing Bladder Outlet Obstruction with Lower Urinary Symptoms in Men / 대한비뇨기과학회지

PURPOSE: Recently, detrusor contraction duration (DCD) has been suggested to be a useful urodynamic parameter for differentiating bladder outlet obstruction. Therefore, we studied the relationship between DCD and bladder outlet obstruction to determine whether DCD is a useful parameter for characterizing bladder outlet obstruction with lower urinary tract symptoms in men. MATERIALS AND METHODS: The urodynamic records of 212 consecutive male patients with lower urinary tract symptoms subdivided into 4 groups as bladder outlet obstruction (BOO), detrusor underactivity (DU), detrusor instability (DI), and normal (NL). DCD was defined as the contraction time elapsed between the first rise in detrusor pressure from baseline to the time at which detrusor pressure returned to baseline at the end of voiding. The correlations of DCD with other urodynamic parameters were assessed. RESULTS: DCD was significantly increased in patients with BOO and DU groups compared to other groups (DI, NL) (p<0.05). However, DCD were only weakly correlated with other urodynamic obstructive parameters in the BOO groups. CONCLUSIONS: Since DCD may also depend on detrusor contractility and bladder volume, DCD alone cannot be used as obstructive parameters to diagnose bladder outlet obstruction. However, considering the fact that the bladder outlet obstruction can be easily differentiated from the decreased detrusor contractility with other urodynamic parameters, DCD seems to be useful proxy for evaluating bladder outlet obstruction.

Analysis on the Correlation Between Transition Zone Index and Bladder Outlet Obstruction Caused by Benign Prostate Hyperplasia / 대한비뇨기과학회지

PURPOSE: Prostate volume has been poorly correlated with various parameters used to assess benign prostate hyperplasia (BPH), including symptom score, total prostate volume, peak flow rate and postvoid residual urine. The purpose of this study is to determine if measurement of the volume and the index of transition zone of the prostate correlated well with other clinical parameters in predicting the degree of obstruction. MATERIALS AND METHODS: 121 men with lower urinary tract symptoms were prospectively evaluated using international prostate symptom score, transrectal ultrasonography, and urodynamic investigation with pressure-flow studies for BPH. Bladder outlet obstruction was defined as the maximal detrusor pressure was greater than 40cmH2O at peak flow and peak flow rate was less than 10ml/sec. Patients were then divided into obstructive and non-obstructive groups. Correlations were evaluated among the total prostatic volume (TPV), transition zone volume (TZV), transition zone index (TZI=TZV/TPV) and other clinical and urodynamically obstructive parameters. RESULTS: Age, IPSS, peak flow rate and PVR were not significantly different between obstructive (n=69) and non-obstructive (n=52) groups. Among the transrectal sonographic parameters, TZV and TZI correlated better with urodynamically obstructive parameters such as detrusor pressure at peak flow rate (r=0.551, 0.544), Abrams Griffiths number (r=0.576, 0.506) and linear passive urethral resistance relation (r=0.560, 0.580) than with TPV. There were no correlations between clinical and volume parameters. All the volume parameters of the prostate were larger in obstructive than in non- obstructive group. CONCLUSIONS: In patients with BPH symptoms, TZV and TZI correlates better with urodynamically obstructive parameters than did the total prostate volume. TZV or TZI may serve as more useful method for evaluating obstruction.

Comparison of the Clinical Effects after Finasteride Treatment for Benign Prostatic Hyperplasia according to the Transition Zone Volume and Transition Zone Index / 대한비뇨기과학회지

PURPOSE: Recent studies suggest that the symptomatic improvement in benign prostatic hyperplasia significantly related with transition zone volume (TZV). The purpose of this study was to determine the clinical significance of TZV and transition zone index (TZI) in changes of prostate volume (PV) and clinical parameters following finasteride therapy. MATERIALS AND METHODS: 140 patients over 50 years of age with symptomatic benign prostatic hyperplasia were treated with finasteride (5mg/d) for 12 months and underwent transrectal ultrasound evaluation of PV and TZV prior to initiating therapy and after 12 months. Patients were grouped according to the results of PV (> OR =40ml or OR =0.45 or OR =2.5 or <2.5). The responders was determined as improvement in peak flow rate more than 3mL/sec. RESULTS: PV decreased by 14.11% in patients with TZI less than 0.45, while the decrease was 19.25% for men with TZI greater than 0.45 (p<0.01). In addition, PV was significantly decreased by 16.72% in patients with PV less than 40cc and TZI greater than 0.45 (p<0.01). PV decreased by 17.37% in patients with PSA less than 2.5, while the decrease was 18.92% in men with PSA greater than 2.5. In responders, only TZI was significantly different among PSA, PV and TZI (p<0.05). CONCLUSIONS: Treatment effect of finasteride on symptomatic benign prostatic hyperplasia patients was increased in proportion to enlarged PV, increased TZI, increased PSA. TZI was a useful proxy for predicting clinical outcomes in initiating finasteride therapy on benign prostatic hyperplasia.

A Case of No Residual Cancer in Radical Prostatectomy Specimens Despite Biopsy-proven Prostate Cancer / 대한비뇨기과학회지

In prostate cancer patients without local invasion and metastasis, radical prostatectomy is performed as a rule for the resection of residual cancer. In a few cases, little amount of cancer volume is identified in radical prostatectomy specimens. This finding has been described as 'minimal residual cancer' or 'vanishing cancer phenomenon' and some reports have demonstrated an increase in the incidence of minimal residual prostate cancer. However, only few cases with 'minimal residual cancer' or 'no residual cancer' despite efforts searching for other possibilites have been reported. We report a case of no residual cancer in radical prostatectomy specimens of biopsy-proven prostate cancer.