A Case of Vesical and Scrotal Sparganosis Presenting as a Scrotal Mass

A 59-year-old Korean man complained of a painless scrotal hard nodule and weak urine stream. The ultrasound scan revealed a 2.2-cm sized round heteroechogenic nodule located in the extratesticular area. Microscopic hematuria was detected in routine laboratory examinations. On scrotal exploration, multiple spargana were incidentally found in the mass and along the left spermatic cord. On cystoscopy, a 10-mm sized mucosal elevation was found in the right side of the bladder dome. After transurethral resection of the covered mucosa, larval tapeworms were removed from inside of the nodule by forceps. Plerocercoids of Spirometra erinacei was confirmed morphologically and also by PCR-sequencing analysis from the extracted tissue of the urinary bladder. So far as the literature is concerned, this is the first worm (PCR)-proven case of sparganosis in the urinary bladder.

Efficacy of Standard Diet Therapy for Patients with Urolithiasis / 대한비뇨기과학회지

PURPOSE: To determine the effectiveness of standard diet therapy as a preventive measure against urinary stone recurrence, we compared the metabolic parameters before and after diet recommendation in the patients with urolithiasis. MATERIALS AND METHODS: A total of 40 stone formers participated in this study and none of them had other metabolic disorders. The dietary recommendations for them included the following: large amounts of water and fruit juice, and restriction of animal protein, salt and oxalate-rich foods. Simplified metabolic evaluations were performed before and after the dietary therapy and compared using the Wilcoxon signed rank test and McNemar's test. The urinary volume and creatinine differences between the two tests were also considered for determining the patients' compliance and appropriate 24-hour urine collection. RESULTS: There was no significant change in the patients blood chemistry before and after the diet therapy. Among the urinary parameters, the excretion of citrate (p=0.005) was significantly increased, but the rest of the parameters remained unchanged. With respect to occurrence of urinary metabolic abnormalities, only the frequency of hypocitraturia showed a statistically significant decrease after diet therapy (p=0.039). The results concerning the changes in the urinary volume and creatinine level showed no difference before and after the therapy. CONCLUSIONS: The standard diet therapy applied to the patients with urolithiasis showed a favorable effect on the excretion of urinary citrate, which is an important protective factor against stone formation. However, we could not found any significant changes in the other urinary lithogenic parameters during this short-term evaluation.

Local Effects of Antimuscarinics on Muscarinic Receptors in Bladder Sensory Nerves

PURPOSE: To investigate the role of muscarinic receptors in bladder sensory mechanism. MATERIALS AND METHODS: Normal adult volunteers collected voided urine after taking five days of trospium(20 mg bid), tolterodine LA(4 mg qd) and oxybutynin XL(10 mg qd). The effect of intravesical administration of human urine on carbachol-induced bladder overactivity was studied in female Sprague-Dawley rats. Cystometric parameters during continuous infusion for over one hour each of saline, human urine, then mixture of carbachol and human urine were compared(n=6 in each group). Then 0.1 and 0.5microgram/ml of oxybutynin, trospium, tolerodine, and dimethindene were studied with the same methods. RESULTS: Human urine with or without intake of antimuscarinic agents had no effect on normal bladder function. Bladder capacity and intercontraction intervals were significantly decreased after an addition of carbachol to human urine containing vehicle, tolterodine or oxybutynin. Human urine after ingestion of trospium, however, prevented the carbachol-induced reduction in bladder capacity and intercontraction intervals. Maximum voiding pressure and pressure threshold were not changed in any case. 0.1 and 0.5microgram/ml of oxybutynin, trospium, tolerodine, and dimethindene prevented the decrease of intercontraction interval with intravesical carbachol(65+/-0.1% compared with baseline). CONCLUSION: The excreted urine after oral ingestion of 20 mg bid of trospium has a significant inhibitory effect in a rat model of detrusor overactivity. Intravesical instillation of antimuscarinic agents at clinically meaningful concentrations also suppressed carbachol-induced bladder overactivity. Antimuscarinic agents may be effective in treating bladder overactivity, not only by suppression of muscarinic receptor-mediated detrusor muscle contraction, but also by blocking muscarinic receptors in bladder-afferent pathways.

Survey of Benign Prostatic Hyperplasia Patients' Preference toward the Distant Management System

PURPOSE: Benign prostatic hyperplasia(BPH) is known to be the most common cause of urination disturbance among the men over the age of 50. It is known that the prostate generally increases in size rises along with age. The growing number of the elderly of society requires more consistent care for the chronic diseases like BPH. The recent expansion of telecommunications infrastructure and mobile communications has made it possible for medical services to use mobile communication networks. Hence, we have researched the clinical patients' preference toward the distant management system for BPH patients using mobile communications. MATERIALS AND METHODS: The research proceeded with a questionnaire conducted by 40 BPH patients over the age of 50, who are undergoing out-patient clinic in the Urology Department at Chungbuk University Hospital and East West Neo Medical Center. The same interviewer gave an explanation to the patients through the questionnaire and the person-to-person talk so that the patients could understand for the personal BPH control program(PBCP). The research on patients' preference toward the PBCP as conducted under a few categories as follows: The contents of the questionnaire according to the patient's educational status: for under middle school graduates, under high school graduates, and for a college graduates. Patients were grouped into high, middle and low according to their financial status. International prostate symptom score(IPSS) were divided into mild, moderate and severe by Barry's classification. Patients' ages were grouped into 50s, 60s, and over 60s. Correlation of each categories was made by Pearson' SPSS version 12.0 and patient's preference toward the PBCP were compared with the variables. RESULTS: The higher the financial, educational status of the patient was, the more positive the reaction of the clinical patient was toward the PBCP(p=0.01, 0.038). However, it was irrelevant to the patient's IPSS and age(p=0.626, 0.087). CONCLUSION: It can be a bit hasty to draw conclusions from the evaluation on the PBCP for patients with a few simple elements, and we still need more comprehensive information. However, once it is successfully practiced, we expect to provide elderly or immobile patients with sufficient medical services in homes, which would offer them a great deal of convenience.

The Distant Management System of BPH Patients using the Tele-communications / 대한비뇨기과학회지

PURPOSE: As our society ages, a disease like benign prostatic hyperplasia (BPH) are increasing and needs consequent management. Recently, through the expansion of the communication infrastructure and terminals, a network services can be provided. However, the concern about distant medical management is increasing. We introduce here the Personal BPH Control Program (PBCP) and its application to clinical patients. MATERIALS AND METHODS: We have asked BPH patients to input the variable elements on the digital survey through the Personal Digital Assistant (PDA) once a week. We used the International Prostate Symptom Score (IPSS) and the average flow rate as the variable elements. We have used an algorithm to determine the patients condition. With this, we have developed a program that helps patients to adjust their visits to the hospital. RESULTS: According to the input elements, we have determined that the patients' condition was good (visit the hospital every 3 months) when the IPSS decreased, compared with the baseline and when the average flow rate was up above 2ml/sec. The patients' condition was a warning (visit the hospital every 2 months) when the IPSS was increased to below 3 and the average flow rate was down below +/- 2ml/sec, and the patients' condition was urgent when the IPSS increased to above 4 and the average flow rate was down above 3ml/sec. CONCLUSIONS: We expect that the PBCP has great socioeconomic utility when applying it to patients. A portable personal apparatus for measuring the flow rate is now being developed. When sufficient examples of applying the symptom algorithm have accumulated, we are going to report afterward the prospects of using the PBCP in the future.

The Effects of p21 on Bladder Cancers / 대한비뇨기과학회지

Purpose: p21 protein is an inhibitor of cyclin-dependent kinases, which may be able to arrest the cell cycle at the G1 phase by inhibiting DNA replication through the interaction with proliferating cell nuclear antigen. From experimental studies, p21 has been considered a tumor suppressor gene. Herein, the effects of p21 on the development, stage, grade, recurrence, progression and patient's survival in human bladder cancers were evaluated. Materials and Methods: The mRNA expression levels of p21 were examined in 149 tumor specimens obtained from patients with primary bladder cancer and in 18 normal bladder mucosae using real-time polymerase chain reaction (PCR). Results: p21 was significantly expressed in human bladder tumor tissues at high levels (7.11+/-0.69pg/ml), but was not expressed in the normal bladder mucosae. Compared with invasive bladder cancer (5.03+/-0.95), the p21 expression levels were significantly enhanced in superficial bladder cancer (7.96+/-0.88pg/ml) (p=0.0250); whereas, the grade was not related to the expression of p21. The levels of p21 expression were enhanced in non-recurred (9.33+/-1.38) and non-progressed (8.13+/-0.86) compared with recurred (6.03+/-0.75) and progressed (3.67+/-0.52) patients (each p<0.05). The level of p21 expression was significantly correlated with the disease free survival in patients the bladder cancers. Conclusions: The enhanced expression of p21 is strongly associated with the development of bladder cancer. Moreover, increased expressions of p21 are also positively associated with the low rate of recurrence and progression of bladder cancer. Conversely, an enhanced expression of p21 provides a survival benefit for patients with bladder cancer. These results suggest that p21 might be useful as a marker in assessing tumor diagnosis, recurrence, progression and the survival in human bladder cancer patients.

Effects of Transforming Growth Factor-beta1 and Its Receptor on the Development, Recurrence and Progression of Human Bladder Cancer / 대한비뇨기과학회지

PURPOSE: We investigated whether the expression levels of Transforming growth factor beta1 (TGF-beta1) and its receptors were related to the development, recurrence, progression and disease-free survival in the patients with bladder cancer. MATERIALS AND METHODS: The mRNA levels of TGF-beta1 and its receptors were examined in 102 tumor specimens from patients with primary bladder cancer, 29 corresponding normal bladder mucosae specimens surrounding these tumors and 15 normal bladder mucosae specimens by performing quantitative competitive PCR (QC-PCR). The protein levels of TGF-beta1 and its receptors were investigated by performing immunohistochemical staining on sections cut from 86 archival bladder tissue paraffin blocks. RESULTS: QC-PCR analysis showed that expressions of TGF-beta1, TGF-beta receptor I (TGF-betaRI) and receptor II (TGF-betaRII) in the superficial and low-grade bladder cancers were significantly higher than those in both the corresponding normal bladder mucosae surrounding the cancer (p= 0.0069, 0.0022 and 0.0046, respectively) and the control's normal bladder mucosae (p=0.0014, 0.0125 and 0.0089, respectively). Expressions of TGF-beta1 and its receptors were enhanced in the non-recurred and non-progressed patients compared to the recurred cases (p=0.0022, 0.0003 and 0.0001, respectively) and the progressed cases (p=0.0002, <0.0001 and <0.0001, respectively). Patients with high expression of TGF-beta and its receptors had a significantly higher disease-free survival rate than those patients with low expressions (p=0.0129, 0.0121 and 0.0132, respectively). CONCLUSIONS: The enhanced expression of TGF-beta1 and its receptors was correlated not only with superficial and low-grade bladder cancer, but also with enhanced patient survival. In conclusion, our findings suggest that the expressions of TGF-beta1 and its receptors are useful prognostic markers for a patient's resistance to disease recurrence and/or progression.