Results of Tubularized Incised Plate (TIP) Urethroplasty with Button Hole Flap in Hypospadias Repair / 대한비뇨기과학회지

PURPOSE: Tubularized incised plate (TIP) urethroplasty, with good results for hypospadias, has recently been reported. We analysed the surgical outcomes according to the site of the urethral opening in children with hypospadias, using TIP urethroplasty with a button hole flap. MATERIALS AND METHODS: Between August 1996 and May 2004, 40 patients with hypospadias were primarily corrected using TIP urethroplasty, with both a conventional and a button hole flap by one surgeon. The medical records of all patients; the levels of meatus, age at surgery, surgical outcomes, complications, methods of second operation and their outcomes, were reviewed retrospectively. The preoperative types of hypospadias were glanular, coronal, anterior penile, mid-shaft, posterior penile and penoscrotal in 8, 7, 9, 6, 4 and 6 boys, respectively. RESULTS: The mean age of the patients was 8.2 years. The overall success rate was 75.0% (30/40). The success rates, according to the type of hypospadias, were 87.5% (7/8), 75.0% (6/8), 77.8% (7/9), 66.7% (4/6), 75.0% (3/4) and 50.0% (3/6) in the glanular, coronal, anterior penile, mid-shaft, posterior penile and penoscrotal types, respectively. Postoperative penile distortion was seen in 37.5 (3/8) and 6.2% (2/32) of the conventional and button hole flap groups, respectively. The incidence of postoperative penile distortion in the button hole flap group was significantly lower than in the conventional group (p=0.046). Complications occurred in eleven patients, including urethrocutaneous fistula (9/11), urethral stricture (2/11) and depressed meatus (1/11). The patients with complications were treated with fistula repair, urethral dilatation and repeated TIP urethroplasty. CONCLUSIONS: Our surgical experiences and outcomes show a high success rate, low complication rate and excellent cosmetic appearance for all types of hypospadias. The incidence of postoperative penile distortion was significantly low. Therefore, TIP urethroplasty, with a button hole flap, can be used as a first choice for all types of hypospadias.

Pre- and Post-operative Assessment of Semen and Hormone Status in Patients with Varicocele / 대한남성과학회지

PURPOSE: We evaluated the result of varicocelectomy on semen and hormone status to assess the effect of the operation. MATERIALS AND METHODS: Between March 2001 and January 2004, 63 men with varicocele underwent microsurgical inguinal varicocelectomy. Based on their chief complaint, they were classified into two groups: scrotal pain group (n=17) and infertility group(n=14). They were checked by semen analysis and hormone status(LH, FSH, testosterone) and GnRH stimulation test before the operation and 3 months after the operation. RESULTS: The mean ages of the pain and infertility groups were 24.8+/-5.2 years and 32.6+/-2.9 years, respectively. The results of postoperative semen analyses were improved in both groups and in all items. In the pain group, postoperative LH, FSH, and testosterone levels were increased, and the ratio of changes of FSH and testosterone after GnRH stimulation were decreased significantly after operation. In the infertility group, post-operative hormone levels were increased, and the ratio of changes of hormone level after GnRH stimulation were decreased, but, the results were not statistically significant. CONCLUSIONS: The results of semen analyses were improved significantly after varicocelectomy. Post-operative hormone levels were increased, and the ratio of changes of hormone level after GnRH stimulation were decreased. We think that the pre- and post-operative semen analyses, hormone level, and GnRH stimulation test could be useful in assessing the success of varicocelectomy.

Grade IV Cystocele with Unilateral Hydronephrosis

A cystocele is present when the bladder base descends below the inferior ramus of the symphysis pubis either at rest or with straining. A severe cystocele can combined with voiding difficulty, back pain, hydronephrosis, and renal failure and it must be corrected surgically. We report a case of grade IV cystocele with unilateral hydronephrosis which was incidentally found in 67-year-old female. She was asymptomatic and underwent cystocele repair using prolene mesh and TVT (Tension-free Vaginal Tape). The left hydronephrosis and marked cystocele were normalized 3 months after operation.

Isolated Ureteral Laceration with Multiple Rib Fracture / 대한비뇨기과학회지

Ureteral injury is rare after blunt trauma, and especially in adults. This unusual scenario for ureteral injury typically occurs at the level of the ureteropelvic junction in children. Proximal and mid ureteral injuries are much less frequent and they are commonly associated with transverse process fracture. To our knowledge, the isolated avulsion of the ureter at this location is very rare. We experienced a longitudinal rupture of the right ureter about 3cm below the ureteropelvic junction in a 44-year-old male after a traffic accident. No other intraabdominal injuries were identified except for the multiple rib fracture. The ureteral injury was immediately diagnosed and repaired first. Intravenous urography was performed 12 weeks after surgery and it revealed normal ureteral patency without any sequelae.

Isolated Ureteral Laceration with Multiple Rib Fracture / 대한비뇨기과학회지

Ureteral injury is rare after blunt trauma, and especially in adults. This unusual scenario for ureteral injury typically occurs at the level of the ureteropelvic junction in children. Proximal and mid ureteral injuries are much less frequent and they are commonly associated with transverse process fracture. To our knowledge, the isolated avulsion of the ureter at this location is very rare. We experienced a longitudinal rupture of the right ureter about 3cm below the ureteropelvic junction in a 44-year-old male after a traffic accident. No other intraabdominal injuries were identified except for the multiple rib fracture. The ureteral injury was immediately diagnosed and repaired first. Intravenous urography was performed 12 weeks after surgery and it revealed normal ureteral patency without any sequelae.

The Effect of Functional Magnetic Stimulation Therapy in Patients with Overactive Bladder / 대한비뇨기과학회지

PURPOSE: There have only been a few reports concerning the treatment of choice for overactive bladder (OAB). The aim of this study was to assess the effect of functional magnetic stimulation (FMS) in patients with an overactive bladder. MATERIALS AND METHODS: Among the demonstrable overactive bladder patients, 21 were selected. They were classified into neuropathic and idiopathic OAB according to their etiology. Voiding diary, quality of life (QOL) questionnaire and urodynamic studies were evaluated before treatment. The treatment was performed for 20 minutes, 2 times a week, for 6 weeks. All of the evaluations were repeated immediately and 3 months after treatment. The treatment outcomes were evaluated for both the neuropathic and idiopathic groups. RESULTS: The overall mean age was 44.0+/-18.6 years. After 6 weeks of treatment, the mean frequency in the idiopathic group significantly decreased from 13.0+/-2.3 to 9.7+/-2.1 times (p<0.05). The mean urgency episodes in the neuropathic and idiopathic groups decreased from 11.3+/-7.5 and 4.5+/-5.8 times to 8.5+/-6.2 and 3.0+/-4.3 times, respectively. Significant improvements were noted in the frequency, mean voided volume, maximal voided volume and QOL in the idiopathic group, which were maintained for 3 months (p<0.05). There were improvements in the symptoms and QOL in the neuropathic group also, but these were minimal. CONCLUSIONS: Our data suggest that the FMS therapy has, at least, a short-term effect on idiopathic OAB. To our knowledge this is the first report on FMS therapy for neuropathic OAB. Although its acute effect on neuropathic OAB was minimal, there was some improvement in the QOL. Therefore, in our opinion, further studies are needed to establish the long-term efficacy of FMS therapy in patients with symptoms of OAB.

The Usefulness of Unenhanced Helical Computerized Tomography in Patients with Urinary Calculi / 대한비뇨기과학회지

PURPOSE: This study was performed to ascertain the usefulness of unenhanced helical computerized tomography(unenhanced CT) in patients with urinary calculi. MATERIALS AND METHODS: Between June 2001 and August 2002, 72 patients with acute flank pain, suspected of having urinary calculi, underwent an unenhanced CT, followed by intravenous urography(IVU) within 24 hours. The unenhanced CT and IVU were compared for the presence and location of the urinary calculi and secondary signs of ureteral obstruction(hydroureter, hydronephrosis, strands of perinephric fat and strands of periureteric fat, tissue-rim sign). RESULTS: 65 of the 72 patients had 74 urinary calculi. Unenhanced CT diagnosed 72 urinary calculi with a sensitivity and specificity of 97.3 and 100%, respectively, with 2.7% false negative. IVU diagnosed 49 urinary calculi with a sensitivity and specificity of 63.5 and 80%, respectively, with 36.5% false negative. For the secondary signs of ureteral obstruction, unenhanced CT diagnosed 71.2% with hydronephrosis, 63.6% with hydroureterosis, 19.7% with tissue rim sign, 15.2% with strands of perinephric fat, and 12.1% with strands of periureteric fat; and IVU diagnosed 76.1% with hydronephrosis, 60.9% with hydroureterosis and 56.5% with delayed ureteral opacification. Besides the urinary calculi, gall bladder stones and renal simple cysts were diagnosed. The cost of the unenhanced CT was about four times higher than that of the IVU. CONCLUSIONS: Unenhanced CT is an accurate, safe and rapid technique for the assessment of urinary stones, and would be a valuable diagnostic tool for urinary calculi.