Is It Worth Treating Non-Bothering Nocturia? Results of a Multicenter Prospective Observational Study

PURPOSE: The purpose of this study was to evaluate the efficacy of treatment in patients with non-bothering nocturia. MATERIALS AND METHODS: In this prospective multicenter study, patients who visited hospitals for treatment of voiding symptoms were enrolled. Inclusion criteria were: 1) men >45 years, and 2) nocturia ≥2 confirmed by a three-day voiding diary. Subjects were divided into non-bothering and bothering groups based on International Consultation on Incontinence Questionnaire Nocturia (ICIQ-N) question 2b. Changes in voiding symptoms, frequency of nocturia, and bothersomeness were evaluated with international prostate symptom score (IPSS), ICIQ-N, and three-day voiding diary at 4 and 12 weeks after treatment. RESULTS: A total of 48 patients in the non-bothering nocturia group and 50 patients in the bothering nocturia group who completed the 12-week treatment were analyzed. The total IPSS was decreased by 5.8 in the non-bothering group and 5.2 in the bothering group. There was no significant difference in decrease of IPSS between the two groups. Both groups showed significant reduction in discomfort of nocturia. The ICIQ-N 2b score decreased from 3.9 to 2.7 (p=0.01) in the non-bothering group and from 6.9 to 4.6 (p=0.02) in the bothering group. The number of nocturia episodes was significantly decreased in both groups. CONCLUSIONS: Regardless of discomfort associated with nocturia, both groups showed significant improvement in nocturia-related discomfort and voiding symptoms. These results suggest that patients with nocturia who were unaware of its discomfort benefited from treatment.

The Influence of Urinary Incontinence and Depression in Elderly on the Quality of the Life / 정신신체의학

OBJECTIVES: Little is known about the influence of urinary incontinence and depression on individual's QOL(Quality of life). We aimed to clarify how the interaction between urinary incontinence and depression influences one's QOL. METHODS: A total of 1262 patients were enrolled in this study from April, 2011 to July, 2011. We estimated the severity of depressive symptoms and QOL, using SGDS-K, EQ-5D. We also investigated the morbidity of urinary incontinence for each patient in person or by questionnaire. Comparisons of QOL between groups with or without depression, with or without urinary incontinence were established using t-test, ANOVA and Scheffe's post hoc analysis. The interaction between urinary incontinence and depression was analyzed by each domain of QOL, using multiple regression analysis. RESULTS: Patients with depression and urinary incontinence showed significantly higher EQ-5D scores on every domain of QOL than other patients, which means significantly lower QOL. Patients with depression, no urinary incontinence reported lower QOL, especially in the domain of ‘usual activity’, ‘anxiety’ and ‘visual analogue scale(VAS)’, whereas those with urinary incontinence, no depression showed lower QOL in ‘motility’, ‘usual activities’ and ‘pain’ domain. Statistically significant interaction effects of two diseases were observed in the domain of ‘VAS’, ‘self care’ and ‘anxiety’. CONCLUSIONS: Comorbidity of urinary incontinence and depression showed significantly lower QOL of patients, compared with urinary incontinence or depression respectively, which implies additive interaction effects of the two diseases. Optimal diagnosis and treatment of depression should be emphasized for patients with urinary incontinence.

Diagnosis and Treatment of Premature Ejaculation by Urologists in South Korea

PURPOSE: This study discusses the treatment of premature ejaculation (PE) using various approaches with the goal of evaluating the methods of diagnosis and treatment of PE in clinical practice in 2014 in South Korea. MATERIALS AND METHODS: We surveyed 200 urologists and andrologists who treated patients with PE from July 1, 2014 to July 29, 2014 using an online questionnaire. The questionnaire was composed of 4 parts: disease, comorbidities, diagnosis, and treatment. Using the answers to this survey, current trends in the diagnosis and treatment of PE were investigated using weighted averages. RESULTS: The median number per month of patients who were diagnosed with PE was 14 patients (interquartile range, 7~24). The time to ejaculation necessary for a diagnosis of PE was considered to be <1 minute by 12% of respondents, <2 minutes by 27%, <3 minutes by 28%, <5 minutes by 13%, and 20% stated that diagnosis was based on a patient's subjective complaint. The treatment methods preferred by PE patients were reported to be pharmacological treatment (87%), surgical treatment (9.5%), and behavioral management (3.5%). The treatment methods used by respondents were pharmacological treatment (77%), surgical treatment (15%), and behavioral management (14%). The most commonly used pharmacological treatment was the oral administration of dapoxetine (97%). CONCLUSIONS: In 2014 in South Korea, various methods were used to diagnose and treat PE. The most commonly used treatment for PE was the oral administration of dapoxetine. It was also found that surgical treatment was applied in some cases.

Letter to the Editor regarding ‘Treatment of Men for “Low Testosterone”: A Systematic Review’ by Huo et al.; Testosterone Replacement Therapy: Toward to the Robust Evidence and Facts

No abstract available.

Urologist's Practice Patterns Including Surgical Treatment in the Management of Premature Ejaculation: A Korean Nationwide Survey

PURPOSE: According to previous studies, the prevalence of premature ejaculation (PE) in Korea ranges from 11.3% to 33%. However, the actual practice patterns in managing patients with PE is not well known. In this study, we have endeavored to determine how contemporary urologists in Korea manage patients with PE. MATERIALS AND METHODS: The e-mailing list was obtained from the Korean Urological Association Registry of Physicians. A specifically designed questionnaire was e-mailed to the 2,421 urologists in Korea from May 2012 to August 2012. RESULTS: Urologists in Korea diagnosed PE using various criteria: the definition of the International Society for Sexual Medicine (63.4%), Diagnostic and Statistical Manual of Mental Disorders (43.8%), International Statistical Classification of Disease, 10th edition (61.7%), or perceptional self-diagnosis by the patient himself (23.5%). A brief self-administered questionnaire, the Premature Ejaculation Diagnostic Tool, was used by only 42.5% of the urologists. Selective-serotonin reuptake inhibitor (SSRI) therapy was the main treatment modality (91.5%) for PE patients. 40.2% of the urologists used phosphodiesterase type 5 inhibitors, 47.6% behavior therapy, and 53.7% local anesthetics. Further, 286 (54.3%) urologists managed PE patients with a surgical modality such as selective dorsal neurotomy (SDN). CONCLUSIONS: A majority of Korean urologists diagnose PE by a multidimensional approach using various diagnostic tools. Most urologists believe that medical treatment with an SSRI is effective in the management of PE. At the same time, surgical treatment such as SDN also investigated as one of major treatment modality despite the lack of scientific evidence.

Isolation and Characterization of Smooth Muscle Cells from Rat Corpus Cavernosum Tissue for the Study of Erectile Dysfunction

PURPOSE: Primary culture of the cavernous smooth muscle cells from corpus cavernous tissues is known to be difficult, mainly because of contamination with fibroblasts. We applied a new method for better isolation of rat penile smooth muscle cells (RPSMCs) from rat corpus cavernosum tissue for reliable ex vivo research on erectile dysfunction. MATERIALS AND METHODS: With the use of 8-week-old adult male Sprague-Dawley rats, ex vivo migrations of rat cavernous tissue were measured by penis and aortic ring assay by use of a Matrigel-based D-valine-modified culture method. The expression of alpha-smooth muscle actin (alpha-SMA) and platelet/endothelial cell adhesion molecule (PECAM)-1 in the RPSMCs was determined by standard immunofluorescent staining and immunoblotting. The expression patterns of phosphodiesterase (PDE) family mRNA in RPSMCs were compared with patterns in rat aortic smooth muscle cells (RASMCs) by use of quantitative real-time reverse transcription polymerase chain reaction. RESULTS: Immunocytochemical staining showed greater alpha-SMA-positive and PCAM-1-negative fluorescence. Moreover, whereas the expression of alpha-SMA was detected in the RPSMCs, that of PECAM-1 was not. The levels of PDE1A, PDE1B, PDE1C, PDE2A, PDE3A, PDE4A, PDE4B, PDE4C, PDE4D, and PDE5A mRNA in the RPSMCs were about 3.2-, 4.4-, 3.4-, 29.0-, 3.5-, 2.8-, 2.9-, 6.1-, 45.0-, and 6.0-fold the corresponding expression in RASMCs. CONCLUSIONS: We developed a two-stage tissue culture method utilizing a Matrigel-based sprouting culture system to facilitate stromal cell sprouting and an adherent culture system using D-valine to eliminate the contamination of fibroblasts into the smooth muscle cells.

A Field Study of the Conditions of the Elderly in Rural Community ; The Correlation between of Sleep Quality and Quality of Life / 신경정신의학

OBJECTIVES: This study aimed to investigate how sleep quality affects quality of life in the elderly of rural communities. METHODS: 877 elderly people aged 60 or over living in C towns participated in the study. They responded to the Pittsburgh Sleep Quality Index, EuroQol-5 dimension, Korean version of the short from of Geriatric Depression Scale, Mini-Mental State Examination for Dementia Screening and the presence of urinary incontinence. RESULTS: Most scores of the items of the quality of life index, except self-management, showed significant correlations with the total score of the sleep quality test. Statistically significant differences were found between the positives and the negatives of the sleep quality test in the scores of all the detailed items of the quality of life index. Among the detailed items of quality of sleep, subjective quality of sleep showed the highest correlation. CONCLUSION: The present study found that the subjective indicators such as subjective sleep quality and sleep disturbance affected quality of life in the rural lives of elderly people more than the objective indicators such as sleep durations or sleep latency periods. Based on the results of these studies, we concluded that a methodological approach and a management model to treating insomnia to improve the quality of life of the elderly would need to be developed and applied.

Differential Expression of Proteins Related with Penile Apoptosis in a Rat after Cavernous Nerve Resection / 대한남성과학회지

PURPOSE: The mechanism including changes of proteome within cavernosal tissue after cavernous nerve injury were not evaluated. We performed proteomics and functional analysis to identify proteins of penile corpus cavernosum whose expression was or was not altered by cavernous nerve resection (CNR). MATERIALS AND METHODS: Using 8-week-old male WKY rats, sham and CNR operation under microscope were performed. After 8 weeks, penile tissues of sham and CNR group were harvested. We used 2-DE and MALDI-TOF/TOF (AB 4700) to identify of differently expressed penile proteins. 2-DE gels were stained with silver nitrate and the gels were analyzed with PDQuest. RESULTS: We isolated more than 950 proteins on silver-stained gels of whole protein extracts from normal rat penile corpus cavernous. Of these proteins, 48 prominent proteins were identified using MALDI-TOF/TOF. Protein characterization revealed that the most prominent penile corpus cavernous proteins were those with antioxidant, chaperone, or cytoskeletal structure. Moreover, 11 proteins having levels elevated by CNR were annexin proteins, endoplasmic reticulum protein 29, glutathione s-transferase w-1, and others. In addition, Rho-GDP dissociation inhibitor (RhoGDI), a regulator of Rho proteins, was also increased in CNR rats compared with sham-operated control rats. CONCLUSIONS: The apoptotic signals observed in penile tissues was greatly increased in CNR rats than in sham-operated rats. These results suggest that RhoGDI is one of the proteins regulated by CNR in penile smooth muscle strips, and has a crucial role in the early stage of penile apoptosis.

Proteomic Analysis of Penile Protein Alterations in a Rat Model of Cavernous Nerve Injury

PURPOSE: Cavernous nerve resection (CNR) in rats is a standard model of animal experiments on erectile dysfunction (ED) that occurs after radical prostatectomy (RP). Injured cavernous nerves after surgery can cause fibrosis and apoptosis that lead to penile structural changes that may be accompanied by alterations of protein expression. This study aimed to analyze the changes in protein after CNR in Wistar Kyoto rats. MATERIALS AND METHODS: Using 8-week-old male Wistar Kyoto rats, sham and CNR operation under a microscope were performed. Two and 8 weeks after surgery, we applied 2-DE and MALDI-TOF/TOF (AB 4700) to identify differently expressed penile proteins after CNR. 2-DE gels were stained with silver nitrate and were analyzed with PDQuest. After in-gel digestion, peptide mass spectra were obtained by MALDI-TOF/TOF mass spectrometry in the positive ion reflector mode. The obtained data were screened with a rat database from both the NCBI and the Swiss-Prot/TrFMBL home page. RESULTS: The proteins that were changed more than 1.5-fold compared with the sham group were annexin A4 and pyruvate kinase (PK). Annexin A4 was increased by 1.75-fold after 2 weeks, whereas PK was decreased by 4.16 after 8 weeks. These results were confirmed by immunohistochemistry. CONCLUSIONS: Annexin A4 in the CNR group was increased, which may be related to emiocytosis during apoptosis. The decrease in PK of the CNR group is assumed to be related to a decrease in efficacy during glycolysis. Further study will be needed to elucidate the molecular pathophysiology of ED after cavernous nerve injury.

Bibliometrics Review of the Korean Journal of Urology from 1960 to 2008: Trends and Future Directions

PURPOSE: To identify chronologic trends and characteristics, and to gain some insights into the future direction of the Korean Journal of Urology (KJU), all articles published in the KJU over the past 5 decades were analyzed. MATERIALS AND METHODS: The bibliometric data of the entire 6,730 articles published in the KJU were classified according to publication type (original articles, review articles, case reports), publication content (experimental articles, clinical articles), and 8 genitourinary fields: oncology, voiding dysfunction/female urology, endourology/urolithiasis, urinary tract infection (UTI), sexual dysfunction/infertility, pediatric urology, trauma, and medical/miscellaneous. The data were analyzed in the following chronological order: 1960s, 1970s, 1980s, 1990s, and 2000s. RESULTS: The number of articles published in the KJU has continuously increased annually. The proportion of original articles, which constituted 72.9% of articles overall, significantly increased in the 2000s (79.5%). Articles in the field of oncology constituted the largest proportion (37.6%) of total articles. The oncology and voiding dysfunction/female urology fields showed an increasing trend, but the UTI field showed a decreasing trend. The fields of sexual dysfunction/infertility and voiding dysfunction/female urology began to increase in the 1990s. The percentage of experimental articles, which was 8.4% in the 1970s, and 9.0% in the 1980s, increased to 20.4% in the 1990s. Recently, the KJU was registered in some international journal databases in recognition of its scientific excellence. CONCLUSIONS: These results make up an index reflecting academic and practicing performances in urology. We hope that the KJU will soon be recognized as one of the high-quality international peer-reviewed journals.

The Clinical Implication of Intravesical Prostatic Protrusion to Lower Urinary Tract Symptoms in Patients of Prostatic Volume 30~50gm / 대한남성과학회지

PURPOSE: Intravesical prostatic protrusion (IPP) is a morphological change of prostate protruded into bladder and might be related to bladder outlet obstruction (BOO) depending on the extent of protrusion. There is a high possibility that lower urinary tract symptoms (LUTS) tends to get worse as IPP grows. Therefore, it is necessary to examine the effect of IPP on LUTS after revision of prostate volume in order to identify the direct effect of IPP on BOO and LUTS. MATERIALS AND METHODS: A retrospective study of 296 male patients diagnosed with benign prostate hyperplasia (BPH) between August 2006 and December 2008 were performed. The patients were evaluated with international prostate symptoms score (IPSS) and quality of life (QoL), uroflowmetry (UFR), post-void residual urine volume (PVR), prostate volume and IPP as measured by transurectal ultrasound (TRUS). The changes of IPSS after 8 weeks of medication treatment and the occurrence rates of transurethral resection of prostate (TURP) and acute urinary retention (AUR) were compared. By checking IPSS and UFR, the improvement of voiding symptom was evaluated. RESULTS: The population of patients with moderate enlargement (30-50gm) of prostate extent was 147 (49.6%) out of 296, the whole examined population. There were correlation between IPP and IPSS (p=0.002) and the storage symptoms score was significantly increased (p=0.014). After 8 weeks of medication treatment, both moderate BPH patients with IPP showed similar improvement in storage symptom compared to non-IPP groups. But, the TURP was significantly performed more with IPP (p=0.040) than non-IPP groups and more AUR has occurred (p=0.013). After TURP, IPP group resulted in improvement of IPSS, storage symptoms score and voiding symptoms score statistically compared to non-IPP group. As the change of UFR and IPSS after TURP had shown, the improvements of voiding volume, maximal flow rate (Qmax), and average flow rate (Qavg) in IPP groups were smaller however, it is no correlation in statistical view. CONCLUSIONS: Moderate BPH group with IPP has a higher possibility of having AUR and surgical treatment while showing significant correlation with storage symptoms. A further prospective study is necessary for identification of improvement of IPSS and UFR after TURP and IPP should be checked carefully during TRUS.

An Ileocutaneous Fistula That Developed 12 Years after Repair of an Abdominal Wall Defect Using Intraperitoneal Placement of High-density Polypropylene Mesh (Marlex(R))

Although prosthetic materials are commonly used to repair abdominal wall defects, they are also associated with postoperative complications. These complications could be prevented by the adoption of uniform guidelines on surgical methods and materials, but the best anatomical position for placement of prosthetic meshes is unclear. We report a case of an enterocutaneous fistula that developed after an abdominal wall defect was repaired by intraperitoneal application of a prosthetic mesh (Marlex(R)) to raise awareness of the consequences of improper use of prosthetic materials.

The Correlation of Intravesical Prostatic Protrusion with Storage Symptoms, as Measured by Transrectal Ultrasound / 대한비뇨기과학회지

PURPOSE: Intravesical prostatic protrusion(IPP) is a morphological change that's due to excessive growth of the median and lateral lobes of the prostate into the bladder. Few studies have been performed regarding the correlation between IPP and the voiding/storage symptoms. The aim of this study is to identify the clinical significance of IPP by defining its relationship with the prostate volume(PV), the International Prostate Symptom Score (IPSS), the uroflowmetry results and the medication response. MATERIALS AND METHODS: We performed a retrospective study of 95 male patients who were examined between August 2006 and July 2007. The patients were evaluated with the IPSS/quality of life(QoL) test, uroflowmetry(Urodyn-1000(TM); Medtronic), the post void residual urine(PVR), and IPP and PV by transrectal ultrasound(TRUS)(PROSOUND SSD-3500(TM); ALOKA). The IPP was compared with the total IPSS, the voiding and storage symptom score, uroflowmetry parameters and the flow patterns (normal, obstructive, detrusor impairment, Valsalva). The patients were classified into two groups(the IPP and non-IPP groups) based on the presence of IPP as identified by TRUS. RESULTS: The PV and IPP showed a significant correlation(r=0.627, p<0.001). There was no correlation between IPP and total IPSS(p=0.444); however, the storage symptom score was significantly increased in proportion to IPP(p=0.030). With an IPP increase, the Qmax was decreased (r=??0.319, p<0.001) and the PVR was increased(r=0.388, p=0.002). The IPP group showed a lower decrease of the QoL score after 8 weeks of medication, as compared to the non-IPP group(p=0.034). CONCLUSIONS: The IPP showed significant correlation with the storage symptoms, but not with the total IPSS. Theoretically, IPP is a unique anatomical configuration of the prostate, and it may worsen the prominent storage symptoms that are the result of irritation of the bladder neck and trigone. IPP should be checked carefully during TRUS as IPP could potentially be a useful marker for the assessment and management of lower urinary tract symptoms.

Efficacy and Safety of Propiverine Hydrochloride 40mg in Treatment of Overactive Bladder : Prospective, Multicenter, Observational study

PURPOSE: This study aims to compare the efficacy and safety of propiverine hydrochloride (propiverine) 40mg for the treatment of overactive bladder (OAB). MATERIAL AND METHODS: Total of 284 patients (male:86, female:198) with OAB were included in this study. The patients were treated with propiverine 20mg twice daily or 40mg once daily for 8 weeks. The initial evaluation included with history taking, physical examination, International Prostatic Symptom Score (IPSS), IPSS QoL and consecutive voiding diaries for 3 days. After a 8-week treatment, IPSS, IPSS QoL, patients perception of treatment benefit, global assessment of efficacy by physicain and safety were evaluated. RESULTS: Two hundred eighteen patients were treated with propiverine 20mg twice daily and 66 patients treated with 40mg once daily. The 59 patients had been treated previously with anticholinergics. After a 8-week treatment, IPSS score (total, voiding and storage subscore) and IPSS QoL were improved in all patients (p<0.05). After a 8-week with propiverine 40mg once daily, improvement of IPSS score was noted in the patients non-responsive to anticholinergics previously (p<0.05). The patients treated with propiverine 40mg once daily showed much more symptomatic improvements assessed by physicians than 20mg twice daily (p<0.05). The overall side effect was noted in the 13.4% patients and the most common side effect was dry mouth. CONCLUSION: Propiverine 40mg once daily is considered to reduce the symptom of OAB effectively and can be used safely in the patients with OAB. Treatment with propiverine 40mg is seemed to show more improvement in the unsatisfactory patients with previous anticholinergics.

Usefulness of a Sonographic Bladder Scan for Uroflowmetry and the Evaluation of the Anxiety Level Associated with Uroflowmetry / 대한비뇨기과학회지

PURPOSE: Uroflowmetry (UFM) requires at least 125ml to 150ml of urine volume for an adequate interpretation. It is common to repeat UFM in clinical settings because of an insufficient voided volume, which may be induced by increased anxiety. To reduce performing repeated UFMs, we evaluate the usefulness of performing a prevoiding sonographic bladder scan and we determined the anxiety level before performing UFM. MATERIALS AND METHODS: We enrolled one hundred two patients (mean age: 62.6+/-15.0 years) who visited our clinic due to voiding dysfunction. The bladder volume prior to UFM was measured by an automated bladder scan (Biocon-500(TM), Mcube Technology) when the patients felt a strong fullness sensation. All the patients kept a voiding diary for 3 days, and they underwent the State-Trait Anxiety Inventory questionnaire, the fullness scale and UFM. RESULTS: The mean prevoiding volume was 307+/-124ml and the mean voided volume was 271+/-129ml. There was a correlation between the prevoiding scan volume and the voided volume: voided volume=17.502+(0.724xprevoiding volume) (r=0.851, p<0.001). Among the 333 patients without a bladder scan and who had UFM performed, 25.8% showed insufficient voided volumes of less than 125ml, and 32.4% showed voided volumes of less than 150ml. However, among the 102 patients who underwent a bladder scan, 9.8% showed insufficient voided volumes of less than 125ml and 12.7% showed voided volumes of less than 150ml (p<0.001). The patients who had a higher state of anxiety than trait anxiety before their UFM revealed a relatively decreased functional bladder capacity (p=0.013). CONCLUSIONS: Although UFM is simple, the patient may feel embarrassed before test. Anxiety can cause a decreased functional bladder capacity. A prevoiding sonographic bladder scan can reduce the incidence of insufficiently voided UFM.

Polypharmacy and Central Nervous System Adverse Effects of Anticholinergic Agents in the Men with Benign Prostate Hyperplasia

PURPOSE: Elderly patients commonly receive multiple drugs compared to young patients because of high comorbidity. Some common illnesses in the elderly with underlying diseases are complicated or aggravated by treatment with anticholinergic agents. We evaluated the use of anticholinergic agents and their adverse effects in the men with benign prostate hyperplasia. MATERIALS AND METHODS: One hundred-eighty four patients over 40 years-old who visited hospital for the treatment of benign prostate hyperplasia and prescribed more than one anticholinergic agent from January 2005 to June 2006 were enrolled. The patients who took anticholinergics during less than 2 months or suffered from psychiatric problems were excluded. One hundred-fifteen patients were included and all prescribed drugs were classified and counted. The number of anticholinomimetic agents and their 10 adverse effects were checked. RESULTS: Mean age was 67.0+/-10.6 years and mean cormobidity diseases counted 1.1+/-1.1. Mean pill and mean anticholinergic agents counted 7.3+/-4.3 and 1.8+/-1.1, respectively. Prescribed anticholinergic agents count increased with patient's age(p=0.401). As the patients took more medications, they had higher possibility to take anticholinergic agents. And as the patients took more anticholinergic agents, they showed more anticholinergic adverse effects(p<0.001). CONCLUSION: Elderly patients mistakenly tend to attribute drug-induced changes in memory and cognitive function to aging or comorbid conditions. Therefore prescribers should consider an anticholinergic agent's receptor selectivity, ability to cross the blood-brain barrier, and pateint's medical history in elderly patients. Additionally physicians can actively perform Mini-Mental Status Examination for evaluation of the patient's cognitive functions under anticholinergic medication.

Laparoscopic Management of Complicated Urachal Remnant in a Child

A few cases of laparoscopic surgery for urachal remnant in children has been reported in English literature. With recent developments in minimal invasive surgery, laparoscopic approach for urachal remnant in adulthood is recommended by some laparoscopic surgeons because of its technical feasibility and safety as well as cosmesis. Recently we experienced a case of complicated urachal remnant in a 14-month-old girl, who was managed by laparoscopic approach. At presentation, she complained of high fever and lower urinary tract symptoms. After 6 weeks of antibiotics therapy, laparoscopic surgery was performed transperitoneally via 3 ports. Our experience suggests that laparoscopic excision of urachal remnant can be performed easily and safely in children.

Transcriptional Regulation of the Estrogen Receptor alpha Gene by Testosterone in Cultures of Primary Rat Sertoli Cells / 대한내분비학회지

BACKGROUND: We wanted to identify the presence of the estrogen receptor (ER) alpha in Sertoli cells and gain insight on the regulation of the ER alpha gene expression by testosterone in Sertoli cells. The transcriptional regulation of the ER alpha gene was investigated in primary Sertoli cell cultures by in situ hybridization and reverse transcription-polymerase chain reaction (RT-PCR). METHODS: Primary Sertoli cell culture was performed. The expression levels of ER alpha and ER beta mRNA in Sertoli cells were detected by Northern blot, RT-PCR, immunocytochemistry and in situ hybridization. RESULTS: The ovary, testis and epididymis showed a moderate to high expression of ER alpha while the prostate, ovary and LNCap cells showed the ER beta expression. ER alpha mRNA and protein were detected in the germ cells and Sertoli cells by in situ hybridization and immunocytochemistry. The level of ER alpha mRNA was gradually decreased in a time-dependent manner after testosterone treatment, and the changes of ER alpha mRNA were dependent on the concentration of testosterone. Androgen binding protein and testosterone-repressive prostate message-2 (TRPM-2) mRNA were reduced at 24 hour by estradiol, while the transferrin mRNA was not affected. ER alpha mRNA was strongly detectable in the testes of 7 days-old-rats, but it was gradually decreased from 14 to 21 days of age. The primary Sertoli cells also showed the same pattern. The ER alpha gene expression was also regulated by testosterone in the Sertoli cells prepared from the 14- and 21-day old rats. CONCLUSIONS: These results suggest that ER alpha is transcriptionally regulated by testosterone and it may play some role in the Sertoli cells.

Extraperitoneal Bladder Rupture following a Normal Spontaneous Vaginal Delivery / 대한비뇨기과학회지

The urinary bladder is seldom injured by external forces, as it is located in the pelvic cavity, behind the symphysis pubis, and protected by the bony pelvis. Gynecological procedures are a major cause of bladder injury. Herein, a case of extraperitoneal bladder rupture, identified 6 days after vaginal delivery in a 27-year-old woman, with no history of cesarean section or pelvic surgery, and who was cured of the bladder rupture using conservative treatment with the indwelling of a urethral Foley catheter, is reported.

Psycho-urology: Possible Links between Stress, Anxiety, Depression and Bladder Function

No Abstract available.