Role of Nicotinic Acetylcholine Receptor alpha3 and alpha7 Subunits in Detrusor Overactivity Induced by Partial Bladder Outlet Obstruction in Rats / 대한배뇨장애요실금학회지

PURPOSE: To investigate the role of alpha3 and alpha7 nicotinic acetylcholine receptor subunits (nAChRs) in the bladder, using a rat model with detrusor overactivity induced by partial bladder outlet obstruction (BOO). METHODS: Forty Sprague-Dawley rats were used: 10 were sham-operated (control group) and 30 were observed for 3 weeks after partial BOO. BOO-induced rats were further divided into 3 groups: Two groups of 10 rats each received intravesicular infusions with hexamethonium (HM group; n=10) or methyllycaconitine (MLC group; n=10), which are antagonists for alpha3 and alpha7 nAChRs, respectively. The remaining BOO-induced rats received only saline infusion (BOO group; n=10). Based on the contraction interval measurements using cystometrogram, the contraction pressure and nonvoiding bladder contractions were compared between the control and the three BOO-induced groups. Immunofluorescent staining and Western blotting were used to analyze alpha3 and alpha7 nAChRs levels. RESULTS: The contraction interval of the MLC group was higher than that of the BOO group (P<0.05). Nonvoiding bladder contraction almost disappeared in the HM and MLC groups. Contraction pressure increased in the BOO group (P<0.05) compared with the control group and decreased in the HM and MLC groups compared with the BOO group (P<0.05). Immunofluorescence staining showed that the alpha3 nAChR signals increased in the urothelium, and the alpha7 nAChR signals increased in the urothelium and detrusor muscle of the BOO group compared with the control group. Western blot analysis showed that both alpha3 and alpha7 nAChR levels increased in the BOO group (P<0.05). CONCLUSIONS: Alpha3 and alpha7 nAChRs are associated with detrusor overactivity induced by BOO. Furthermore, nAChR antagonists could help in clinically improving detrusor overactivity.

The Correlation between Erectile Dysfunction and the Severity of Coronary Artery Involvement in Patients with Coronary Artery Disease / 대한비뇨기과학회지

PURPOSE: Erectile dysfunction (ED) may be considered as a clinical manifestation of generalized vascular disease. This study aimed to assess the correlation between ED and the severity of the involved coronary artery in patients with coronary artery disease (CAD). MATERIALS AND METHODS: 255 men with CAD, who underwent coronary angiography (CAG), were evaluated for erectile function using a questionnaire that included a 5-item Version the International Index of Erectile Function (IIEF-5). Cardiovascular risk factors were also reviewed. The correlation between erectile function and the number of involved coronary vessels, age and number of accompanying cardiovascular risk factors were analyzed. RESULTS: Of the patients, 59.6% had various degrees of ED, which were subdivided into mild (21.7%), moderate (14.5%) and complete (63.8%) according to the severity. The cardiovascular risk factors were hypertension, smoking, overweight, age, lipid abnormalities and diabetes in 67.8, 67.5, 47.1, 38.4, 28.6 and 19.6%, respectively. One, two and three coronary vessels were involved in 26.3, 27.4 and 21.2%, respectively, while 25.1% showed non specific finding on CAG, despite abnormal findings in the resting ECG and treadmill exercise test. Erectile function decreased significantly according to the increasing number of involved coronary vessels (p<0.05), age (p<0.001) and accompanying cardiovascular risk factors (p<0.05). Of the cardiovascular risk factors, age, smoking and diabetes had negative effects on erectile function (p<0.05) in patients with CAD. CONCLUSIONS: Statistically significant correlations were demonstrated between ED and the number of involved coronary vessels, age and the number of accompanying cardiovascular risk factors in patients with CAD. Furthermore, in patients with symptoms of chest discomfort, although CAG showed non specific findings, the possibility of hidden ED will need to be investigated.

Erectile Dysfunction in the Patients with Cardiovascular Disease / 대한비뇨기과학회지

PURPOSE: This study was designed to evaluate the prevalence of erectile dysfunction (ED), and the correlations of ED with cardiovascular disease (CVD) and the antihypertensive drugs that are used for CVD patients as risk factors. MATERIALS AND METHODS: A total of 200 cardiology outpatients suffering with CVD were enrolled in this study. The patients were screened for ED by using questionnaire that included the 5-item Version of the International Index of Erectile Function (IIEF-5); the patients were reviewed for a medical history, including the risk factors for CVD and their current antihypertensive medications. RESULTS: Overall, 58% of the patients had various degrees of ED, including mild in 9.5%, moderate in 2.5% and complete dysfunction in 46%. The prevalence of complete ED was significantly higher than the other ED types. The risk factors for patients with CVD were hypertension (70.0%), smoking (61.5%), coronary artery disease (CAD) (55.0%), overweight (47.0%), age (40.5%), lipid abnormalities (24.5%) and diabetes (16.5%). Especially, the patients having an older age, CAD and smoking had a significantly higher prevalence of ED than those patients with the other risk factors. Although the patients treated with angiotensin converting enzyme (ACE) inhibitors showed significant correlations for the antihypertensive drugs with the prevalence of ED, all the antihypertensive drugs were not independently associated with the presence of ED on the multivariable logistic regression test. CONCLUSIONS: This study provides data on the prevalence of ED and the significant correlation of ED with old age, CAD and smoking for the patients with CVD. Although it is a well known fact that CVD is associated with ED, most physicians do not ask the patients questions about it, and most of the patients are too embarrassed to discuss their ED with them. Therefore, understanding the relationship between ED and CVD is essential.

A Fibrotic Nodule in the Corpus Cavernosum / 대한비뇨기과학회지

Fibrotic lesions occurring in the corpus cavernosum are usually cases of Peyronie's disease that originate from the tunica albuginea, or they are the fibrotic result of inflammatory processes. The lesion involving the corpus cavernosum, but not tunica albuginea is rare. We present here a case of fibrotic nodule arising in the corpus cavernosum with the sonographic and magnetic resonance imaging features. A 38-year-old man complained a small nodular mass in the left corpus cavernosum at the level of penoscrotal junction without abnormal curvature of the organ. We performed ultrasonography and magnetic resonance imaging to determine exactly what the lesion was. The lesion was removed and it was pathologically found to be a localized fibrotic nodule of the corpus cavernosum with some narrow-channeled vascular structures.

Idiopathic Retroperitoneal Fibrosis Treated with High Dose Steroids / 대한신장학회잡지

Idiopathic retroperitoneal fibrosis is proliferation of fibrous tissue with inflammatory process due to unknown etiology, that may involve the ureters and other retroperitoneal structures. The majority of reported cases have been treated surgically by ureterolysis or intraperitonealization of the ureters. Recently, successful management of retroperitoneal fibrosis by administration of steroids also has been reported. We report two cases of patients who underwent successful treatment of an idiopathic retroperitoneal fibrosis with high dose steroids therapy.

Prognostic Factors in Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: The prognostic factors influencing the survival rate in patients with renal cell carcinoma were evaluated. MATERIALS AND METHODS: An analysis was performed on 102 patients with renal cell carcinoma who underwent a radical nephrectomy from January 1995 to June 1999. The survival rate according to each prognostic factor such as the 1997 TNM stage, the size, cell type and nuclear grade of the tumor and the presence of symptoms at the point of diagnosis, age and gender, and tumor location was analyzed using the Kaplan-Meier method. The statistics was determined by the log-rank test of a univariate analysis and the Cox proportional hazards model of multivariate analysis. RESULTS: Univariate analysis showed that the TNM stage, size and nuclear grade of tumor, and the presence of symptoms at the point of diagnosis had a significant influence on survival rate of patients with renal cell carcinoma. The tumor cell type, age and gender, the location of the tumors had little statistical significance. Multivariate analysis showed that a distant metastasis was the most significant prognostic factor followed by nuclear grade of the tumor cell, T stage, the presence of symptoms at the point of diagnosis, and lymph node metastasis in this order. CONCLUSIONS: The TNM stage, nuclear grade of the tumor and the presence of symptoms at diagnosis are important prognostic factors in renal cell carcinoma. Analyzing these prognostic factors will be useful as a treatment modality, follow up and prognosis of patients with renal cell carcinoma.

Primary Squamous Cell Carcinoma of the Ureter / 대한비뇨기과학회지

Primary squamous cell carcinoma of the renal pelvis and ureter is a rare tumor, representing only about 0.7 to 7% of all primary tumors of the upper urinary tract. Their pathogenesis is unclear, but it is assumed to begin with urothelial metaplasia resulting from a reaction to chronic irritation by stone or infection. We report a case of primary squamous cell carcinoma of ureter without stone or infection in 71-year-old male patient.

Availability of Walking Cystometrography in the Diagnosis of Patients with Urgency or Urge Incontinence / 대한비뇨기과학회지

PURPOSE: Bladder irritative symptoms such as urinary urgency or urge incontinence could be worse even after proper treatments, if accompanying the unstable bladder with lower urinary tract obstruction or female urinary incontinence was not found before treatments. We performed walking cystometrography to detect unstable bladder which could be masked by cystometrography in sitting position. MATERIALS AND METHODS: We evaluated 133 patients who complained of urinary urgency or urge incontinence. Walking cystometrography (Group 2) was done for pa tients who did not show unstable bladder at cystometrography in sitting position (Group 1). Bladder volume at first desire to void, cystometric maximal bladder capacity, and occurrence of unstable bladder of both groups were compared. RESULTS: In cystometrography performed in sitting position (Group 1), unstable bladder was found in 48 (36.1%) out of 133 patients. Among the rest 85 patients, 23 patients (27.1%) showed unstable bladder in walking cystometrography (Group 2). Conse quently, 71 (53.4%) out of 133 patients showed unstable bladder in both groups. Com paring the bladder capacity of these two measuring methods, we could observe that bladder volume at first desire to void and maximal bladder capacity of walking state were smaller than those of sitting position from 187.4 +/- 36.9ml (Group 1) to 138.5 +/- 31.6ml (Group 2), 413.6 +/- 42.5ml (Group 1) to 342.8 +/- 43.2ml (Group 2), respectively (p <0.05). CONCLUSIONS: We expect that the diagnosis of unstable bladder through walking cysto metrography is meaningful when the method is applied to the patients who have urinary urgency or urge incontinence but seem to be normal by conventional cystometrography.

Computed Tomographic Appearance of Orthotopic Neobladder: Correlation with Voiding Pattern / 대한비뇨기과학회지

PURPOSE: To define computed tomographic (CT) appearance according to voiding patterns and to evaluate the significance of CT in patients with voiding dysfunction after orthotopic bladder substitution following radical cystectomy. MATERIALS AND METHODS: We evaluated a total of 50 male patients in whom 25 had undergone an ileocolic and 25 had undergone an ileal neobladder. We performed uroflowmetry, postoperative voiding cystourethrography (VCUG) and CT for evaluation of configuration of neobladder according to voiding pattern. We defined a good voider (n=37) as the patients with maximum flow rate greater than 15 ml/sec and postvoid residual urine amount less than 200ml and a poor voider (n=13) as those with less than 15 ml/sec or greater than 200ml. RESULTS: Voiding cystourethrography revealed that the neobladder outlet was well funneled and wide open at the most dependent portion of the neobladder in good voider group. However, in poor voider group, the neobladder outlet was not funneled or deviated from its caudal location. CT revealed that the neobladder was symmetric in 28 cases (75.7%) and had soft tissue density in the neobladder base in 9 cases (24.3%) of good voider group. However, neobladder was asymmetric in 8 cases (61.5%) and had soft tissue density in the neobladder base in 8 cases (61.5%) of poor voider group. CONCLUSIONS: The asymmetry of neobladder and soft tissue density around base of neobladder on CT may be associated with the deviated neobladder outlet. This CT finding might be useful to presume the cause of voiding pattern.

Usefulness of Dynamic MRI in Diagnosis of Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: We aimed to define supine static and dynamic magnetic resonance imaging (MRI) appearance of changes in bladder neck and levator ani muscle and find out clinical significance of this method from comparing with valsalva leak point pressure (VLPP) in patients with stress urinary incontinence. MATERIALS AND METHODS: Sixty patients were studied with supine static MR imaging through volumetric axial and sagittal pelvic imaging in the first and second procedures and then were examined with dynamic MR imaging through resting/straining midline sagittal imaging in the third procedure. We evaluated the changes in bladder neck and levator ani muscle of stress urinary incontinence patients from these MR imaging. Patients were divided into two groups according to their responses to VLPP; the group 1 (n=20) with VLPP below 60cmH2O and the group 2 (n=40) with VLPP over 60cmH2O. We analyzed the data taken from comparing MR imaging results with VLPP results. RESULTS: Regarding the degree of changes in bladder neck compared with the results of supine static and dynamic MRI, there were beak shaped changes in the bladder neck in 15 patients from group 1 (75.0%) and especially, in the rest 5 patients excluding 3 patients who had severe cystocele, we could observe 88.2% of beak shaped changes. Beak shaped changes were seen in 5 patients (12.5%) and funnel shaped change or non-specific changes in the rest cases from group 2 (p<0.0001). We could observe the degenerative changes of levator ani muscle in 41 patients from overall (68.3%), which means 13 patients from group 1 (65.0%) and 28 patients from group 2 (70.0%), respectively. CONCLUSIONS: Supine static MRI enables to observe degenerative changes in pelvic floor muscle of stress urinary incontinence while dynamic MRI is deemed to be a relatively comfortable and non-invasive diagnostic method for stress urinary incontinence especially complementing VLLP.

Antibiotic Sensitivity to the Causative Organism of Acute Simple Urinary Tract Infection / 대한비뇨기과학회지

No abstract available.

The Diagnostic Values of the Polymerase Chain Reaction in Prostatitis / 감염

BACKGROUND: Prostatitis is one of the most common prostatic disease. But compared with other prostatic disease, the evaluation of the cause, diagnosis and treatment for prostatitis is not enough yet. So, this study aims to evaluate the usefulness and significance of polymerase chain reaction (PCR) in the diagnosis of prostatitis. MATERIAL AND METHODS: We evaluated the frequency of the causative orgamnism of prostatitis, i.e., C. trachomatis, T. vaginalis, M. hominis, M. genitalium and U. urealyticum, in 104 patients who visited the Department of Urology, Catholic University St. Mary's Hospital and who had prostatitis symptom from January 1999 to August 1999 by using PCR. The enrolled patients were categorized by the definition of the NIH Chronic Prostatitis Work Shop. Among 104 patients, there were Category II (chronic bacterial prostatitis) 3 patients (2.9%), Category IIIa (inflammatory chronic pelvic pain syndrome) 33 patients (31.7%) and Category IIIb (noninflammatory chronic pelvic pain syndrome) 68 patients (65.4%). RESULTS: We found out that causative microorganisms were not detected at Category II; 9 cases (27.3%) in Category IIIa-C. trachomatis 5 cases, U. urealyticum 1 case, M. genitalium 2 cases and both C. trachomatis and M. genitalium 1 case; 5 cases (7.4%) in Category IIIb-C. trachomatis 1 case, U. urealyticum 1 case, M. genitalium 1 case, both C. trachomatis and M. genitalium 1 case and both U. urealyticum and M. hominis 1 case. In a total of 17 cases of positive PCR, the common causative microorganisms were C. trachomatis (8 cases:47.1%), M. genitalium (5 cases), U. urealyticum (3 cases) and M. hominis (1 case) in this order. CONCLUSION: With the invention of PCR, the inconvenience of patients in the process of extracting causative microorganisms decreased and it became possible to get a result within 2~4 hours in technically less difficult way. Moreover, the PCR shows nearly 100% of accuracy in terms of sensitivity and specificity. Like this, it is expected that PCR will play an important role as a way of diagnosis and treatment for prostatitis.

Antibiotic Sensitivity to the Causative Organism of Acute Simple Urinary Tract Infection for Recent 3 Years / 감염

BACKGROUND: We studied the antibiotic sensitivities to the causative microorganisms of acute simple urinary tract infection for recent 3 years. METHODS: We analyzed 112 microorganisms and their antibiotic sensitivities of the 104 patients who were admitted to or visited the Department of Urology, Catholic University St. Marys Hospital and had more than 10cfu/mL on urine culture from June 1996 to January 1999 retrospectively. RESULTS: The chance of gram negative and positive as causative microorganisms was 72.3% and 27.7% respectively. The most common pathogenic microorganisms were Escherichia coli (67.0%) followed by a-hemolytic streptococci, Entercoccus. In gram negative acute UTI, imipenem, sulperanzone showed relatively higher sensitivity, while cotrimoxazole, ampicillin showed relatively lower sensitivity. In gram positive, vancomycin, penicillin showed relatively higher sensitivity, while ampicillin, imipenem showed relatively lower sensitivity. CONCLUSIONS: We consider that gram negative microorganisms, especially E. coli, is the main cause of acute simple UTI. But, we should be concerned about the increase of gram positive organisms and other gram negative organisms besides E. coli. Regarding to the choice of adequate drug in the treatment of UTI, it is necessary to consider the change of pathologic microorganisms.

A Case of Renal Cell Carcinoma with Solitary Metachronous Contralateral Adrenal Metastasis / 대한비뇨기과학회지

No abstract available.

A Case of Renal Cell Carcinoma with Solitary Metachronous Contralateral Adrenal Metastasis / 대한비뇨기과학회지

No abstract available.