Preoperative Factors Influencing Postoperative Results after Vasovasostomy

PURPOSE: The purpose of this study is to evaluate the preoperative factors that influenced postoperative sperm concentration after vasovasostomy. MATERIALS AND METHODS: We retrospectively reviewed 97 consecutive single-layer vasovasostomy procedures performed by a single surgeon between March 2003 and September 2010. The patients were stratified into three groups based on sperm concentration at 1 month follow-up: group I-azoospermia, group II-oligospermia, and group III-normal. We evaluated the preoperative factors that may have influenced sperm concentration at postoperative 1 month. Patients with serial semen analysis were divided into four groups according to the change in postoperative sperm concentration at the 6-month visit: group II-N-from oligospermia to normal, group II-O-from oligospermia to oligospermia, group III-O-from normal to oligospermia, group III-N-from normal to normal. We compared the pregnancy rate among the four groups. RESULTS: The mean obstructive interval was 9.69 years in group I, 6.02 years in group II, and 7.82 years in group III. There were significant differences found among the groups (p=0.035). There was significantly different change in sperm concentration, sperm motility, and sperm morphology between each of the groups. A total of 32 patients underwent serial semen analyses at 1 month, 3 months, and 6 months after vasovasostomy. There was no significant difference in patient age, obstructive interval, or follicle-stimulating hormone among the groups. The natural pregnancy rate in group II-O was lower than that in group II-N, and in group III-O was lower than that in group III-N. However, there was no significant difference among each of the groups. CONCLUSIONS: The sperm concentration after vasovasostomy was significantly related to the obstructive interval between vasectomy and reversal.

Proper Mesh Placement Using the Outer Cylinder of a Ballpoint Pen in the Transobturator Adjustable Tape Sling Procedure for Female Stress Urinary Incontinence

PURPOSE: The transobturator adjustable tape (TOA) sling operation is an effective procedure that allows for correction of postoperative incontinence or obstruction through adjustment of the mesh tension. During the operation, the outer cylinder of a ballpoint pen was used for proper mesh placement with less dissection. We evaluated the efficacy and safety of the TOA sling operation with the use of the outer cylinder of a ballpoint pen. MATERIALS AND METHODS: A total of 127 consecutive women with stress urinary incontinence underwent the TOA sling operation with the use of the outer cylinder of a ballpoint pen. The preoperative evaluations included a stress cough test, urodynamic study, and questionnaires related to quality of life. The mesh tension was adjusted 1 day after the operation. Postoperative evaluation was done at 1 month and included a stress cough test, uroflowmetry, questionnaires, and asking about satisfaction. At 1 year, we evaluated the patients with a stress cough test and by asking about their satisfaction with the procedure. RESULTS: The overall cure rate was 95.3% at 1 month and 96.8% at the 1-year follow-up. Postoperative adjustment of the mesh tension was done for 22 patients (17.3%). Eight patients needed increased tension for remaining stress urinary incontinence, and 14 patients needed reduced tension for urinary obstruction. The maximal flow rate was decreased significantly. However, the residual urine volume was not increased significantly. The total score on the questionnaires increased significantly. CONCLUSIONS: Results were excellent compared with outcomes of the traditional TOA sling procedure. Proper mesh placement by use of the outer cylinder of a ballpoint pen with less dissection and tension adjustment could improve the success rate of the TOA sling operation.

Role of Phosphodiesterase Type 5 Inhibitor on Benign Prostatic Hyperplasia/Lower Urinary Tract Symptoms / 대한남성과학회지

There is strong evidence from multiple epidemiological studies that benign prostate hyperplasia (BPH) induced lower urinary tract symptoms (LUTS) are correlated with erectile dysfunction (ED). Although a direct causal relationship is not established yet, four pathophysiological mechanisms can explain the relationship. These include alteration in activity of nitric oxide (NO)-cyclic GMP signal pathway, autonomic hyperactivity, increased Rho kinase/Rho A pathway and pelvic atherosclerosis. Androgens have been suggested to have an important role in the maintenance of the functional and structural integrity of the urinary tract. Sexual function should be assessed and discussed with the patient when choosing the appropriate management strategy for LUTS, as well as when evaluating the patient's response to treatment. Multiple large clinical trials have shown an improvement in LUTS after phosphodiesterase-5 (PDE5)-inhibitor treatment. Sildenafil is a pioneer of this clinical trial and appears to improve both erectile function and LUTS in subjects with ED. Basically PDE5 I with long half life is an appropriate candidate, therefore tadalafil and undenafil had been used to evaluate both diseases. Placebo-controlled trials of tadalafil showed improvement of LUTS secondary to BPH, but none of the studies showed a significant effect on urodynamic measures. PDE5 Is, such as sildenafil and tadalafil, increase the concentration of cGMP in plasma and smooth muscle, facilitating erection of the penis, relaxation of the bladder neck and prostate and subsequent bladder emptying. And theses PDE5 Is increase cAMP and cGMP levels and are more highly distributed in the prostate than plasma. These findings may help in the assessment of the feasibility of using PDE5 Is to concurrently treat both LUTS and ED.

Unusual Presentation of Bilateral Adrenocortical Carcinoma Mimicking Adrenal Metastasis

A 75-year-old female visited our hospital with bilateral adrenal masses that were detected incidentally during lumbar spine magnetic resonance imaging (MRI) for the evaluation of radiating flank pain. Consecutive computed tomography and MRI revealed bilateral adrenal masses with no evidence of lymph node enlargement or local invasion; 2[(18)F]fluoro-2-deoxyglucose (FDG)-positron emission tomography showed an intense FDG accumulation in both adrenal glands without abnormal FDG uptake in extra-adrenal regions. The laboratory test results were within normal ranges. We performed a bilateral adrenalectomy. The pathologic diagnosis of both adrenal masses was consistent with adrenocortical carcinoma. The patient recovered well with no complications.

Ameliorative Effect of Palmiwon on Polychlorinated Biphenyl (PCB, Aroclor 1254)-Induced Spermiotoxicity in the Rat / 대한남성과학회지

PURPOSE: Polychlorinated biphenyls (PCBs, Aroclor 1254), synthetic chlorinated organic compounds, are known to decrease thyroid function, sperm count, and fertility, and increase the risk of testicular cancer; they may have serious effects on male reproduction. The aim of this study was to investigate the possible protective role of palmiwon on PCB-induced spermiotoxicity in rats. MATERIALS AND METHODS: 90-day-old male Sprague Dawley rats were randomly divided into three groups, each consisting of ten animals. The control group (Group I) received corn oil, the second group of rats (Group II) was administered 2 mg/kg body weight/day of Aroclor 1254+corn oil intraperitoneally for 30 days. The third group of rats (Group III) was treated with 2 mg/kg body weight/day of Aroclor 1254+corn oil intraperitoneally plus palmiwon (300 mg/day) orally for 30 days. Twenty-four hours after the last treatment, the animals were killed by decapitation. Their serum testosterone levels was measured before and after the experimental medication was taken, and the number and motility of sperm, which had been collected from the cauda epididymal region, were evaluated. RESULTS: The results of this experiment show that treatment with palmiwon significantly improved sperm motility and number in rats that had been exposed to PCBs. There was no marked difference in body weight, testis weight, or epididymis weight among the groups. Nor were there any significant pathological differences in the testes among the groups. CONCLUSIONS: Palmiwon has the potential for treating PCB-induced spermiotoxicity. More experiments with larger samples and a longer period of treatment are needed.

Crystal Deposits on Renal Papillae in Stone Formers

PURPOSE: Papillary "Randall's plaques" are theorized to act as nidi for urinary stone formation. In this study, we used endoscopic examination and intraoperative biopsy of renal papilla in stone formers undergoing percutaneous nephrolithotomy (PNL) to investigate the correlation between Randall's papillary plaque and primary stone composition and metabolic risk factors. MATERIALS AND METHODS: A total of 34 patients with renal stones were enrolled. During PNL performed for stone removal, biopsy specimens were taken from selected papilla. We evaluated constituents such as volume, sodium, uric acid, calcium, oxalate, and citrate from 24-hour urine samples, and calcium, sodium, uric acid, phosphate, potassium, and chloride from serum samples 1 month after PNL. RESULTS: We identified Randall's plaque in 26 patients as irregular, whitish lesions, generally located on the papillary tip. We performed intraoperative biopsies of papilla in the kidneys of stone formers and of known regions of crystal deposits in the interstitial tissue surrounding the ducts. There was no correlation between serum variables, 24-hour urine constituents, and presence of plaque. However, 24-hour urine volume was negatively correlated with the presence of plaque. The incidence of papillary plaques varied with the primary composition of extracted stones and was 80% for calcium oxalate, 92% for calcium phosphate, 50% for uric acid, and 25% for struvite stones (p=0.035). CONCLUSIONS: The incidence of papillary Randall's plaques in patients with nephrolithiasis varied with the primary composition of formed urinary stones. Randall's plaques are found in most patients with calcium stones. Our findings suggest that the presence of papillary plaque is associated with calcium nephrolithiasis and may contribute to the pathogenesis, treatment, and prevention of calcium urinary stones.

Therapy with Human Chorionic Gonadotropin and Human Menopausal Gonadotropin in Men with Hypogonadotropic Hypogonadism / 대한남성과학회지

PURPOSE: Hypogonadotropic hypogonadism (HH) is an uncommon cause of virilization and male infertility. We evaluated the effect of the combination therapy with human chorionic gonadotropin (hCG) and human menopausal gonadotropin (hMG) in patients with HH. MATERIALS AND METHODS: Between May 2000 and April 2007, we evaluated 15patients with HH. Testicular volume, serum luteinizing hormone (LH), follicle stimulating hormone (FSH), total testosterone, and semen analysis were consecutively monitored at 6, 12, 24, 36 and 48 months after hCG/hMG combination therapy. Statistical analysis was performed by Paired Student's t-test. RESULTS: Testicular volume showed a time-dependent increase in all patients who received hCG/hMG combination therapy (p<0.01). At 12 months, 12 patients showed and were significant improvement in FSH (1.6+/-0.97mIU/ml, p<0.033) and in serum total testosterone (71+/-2.73ng/ml, p=0.003), respectively. During hCG/hMG combination therapy, semen volume, sperm number, sperm motility, and sperm morphology were improved. However, there was no significant change in LH levels. CONCLUSIONS: Our experience in the management of the patients with HH suggests that hCG/hMG combination therapy might be effective in improving the sperm volume, sperm number, sperm motility, sperm morphology, plasma FSH, total testosterone level, and testicular volume. Thus hCG/hMG therapy seems a better choice in the patients with HH who want pregnancy.

Effect of Microsurgical Bilateral Varicocelectomy on Patients with a Left Varicocele Diagnosed by Color Doppler Ultrasonography / 대한남성과학회지

PURPOSE: The objective of this study was to evaluate the accuracy of color Doppler ultrasonography (CDU) and to assess the effects of microsurgical bilateral varicocelectomy on patients diagnosed with a left varicocele by CDU. MATERIALS AND METHODS: 69 patients with varicocele were enrolled between March 2005 and May 2007. The patients were randomized into 2 groups: group I-preoperative bilateral varicoceles were diagnosed by color CDU, and group II-only a left varicocele was diagnosed by CDU. All patients underwent an inguinal microsurgical varicocelectomy bilaterally. Statistical analysis was performed by paired Student's t-test and one way ANOVA. RESULTS: Mean age of the patients was 27.5+/-7.9 years. After surgery, semen parameters were significantly improved in sperm number in group I (p=0.002) and semen volume in group II (p<0.005). At the time of surgery, we found that 16 (88.9%) of 18 patients had bilateral varicoceles in group II. The accuracy of CDU to diagnose varicoceles was not perfect. CONCLUSIONS: The bilateral microsurgical varicocelectomy in patients with only a left varicocele diagnosed by CDU significantly increased their semen volume. Most (88.9%) patients diagnosed with a left varicocele actually had bilateral varicoceles. Therefore, microsurgical bilateral varicocelectomy may be appropriate for infertile men with a left varicocele diagnosed by CDU.

Effect of Microsurgical Bilateral Varicocelectomy on Patients with a Left Varicocele Diagnosed by Color Doppler Ultrasonography / 대한남성과학회지

PURPOSE: The objective of this study was to evaluate the accuracy of color Doppler ultrasonography (CDU) and to assess the effects of microsurgical bilateral varicocelectomy on patients diagnosed with a left varicocele by CDU. MATERIALS AND METHODS: 69 patients with varicocele were enrolled between March 2005 and May 2007. The patients were randomized into 2 groups: group I-preoperative bilateral varicoceles were diagnosed by color CDU, and group II-only a left varicocele was diagnosed by CDU. All patients underwent an inguinal microsurgical varicocelectomy bilaterally. Statistical analysis was performed by paired Student's t-test and one way ANOVA. RESULTS: Mean age of the patients was 27.5+/-7.9 years. After surgery, semen parameters were significantly improved in sperm number in group I (p=0.002) and semen volume in group II (p<0.005). At the time of surgery, we found that 16 (88.9%) of 18 patients had bilateral varicoceles in group II. The accuracy of CDU to diagnose varicoceles was not perfect. CONCLUSIONS: The bilateral microsurgical varicocelectomy in patients with only a left varicocele diagnosed by CDU significantly increased their semen volume. Most (88.9%) patients diagnosed with a left varicocele actually had bilateral varicoceles. Therefore, microsurgical bilateral varicocelectomy may be appropriate for infertile men with a left varicocele diagnosed by CDU.

The Changes of Serum Prostate-specific Antigen after Ejaculation / 대한비뇨기과학회지

PURPOSE: Prostatic manipulation and surgery have been shown to increase serum prostate-specific antigen (PSA). We studied the effect of ejaculation on the serum PSA levels. MATERIALS AND METHODS: We evaluated 131 men(16 to 64 years old) who had no history of surgery or inflammatory disease of the urogenital tract. The total serum PSA, free PSA, serum total testosterone, free testosterone, luteinizing hormone(LH), and follicular stimulating hormone(FSH) were evaluated 1 hour after ejaculation. RESULTS: A PSA level was detected in all the men. There were statistically significant changes of the serum PSA level before and after ejaculation. We compared the parameters between increased PSA group and the decreased PSA group. There were significant differences between the two groups on comparison of the total prostate volume(25.4+/-3.6g vs 15.1+/-4.2g, respectively) and the transition zone volume(7.1+/-2.7g vs 5.3+/-1.1g, respectively). CONCLUSIONS: Based on our data, ejaculation affects the serum PSA concentration in young men, and there seems to be a physiological relationship between ejaculation and the PSA level. The larger the prostate volume, the more ejaculation has an effect on the serum PSA level.