Osteosarcomatous Transformation in Mazabraud Syndrome: A Case Report

Mazabraud syndrome is a rare benign disease that is accompanied by polyostotic fibrous dysplasia and intramuscular myxoma. Malignant transformation of fibrous dysplasia occurs in approximately 1% of cases. To date, only eight cases of malignant transformation, of fibrous dysplasia to osteosarcoma, in Mazabraud syndrome have been reported worldwide. The authors report the first case of osteosarcomatous transformation in a patient with Mazabraud syndrome in the Republic of Korea, focusing on imaging findings.

Osteosarcomatous Transformation in Mazabraud Syndrome: A Case Report

Mazabraud syndrome is a rare benign disease that is accompanied by polyostotic fibrous dysplasia and intramuscular myxoma. Malignant transformation of fibrous dysplasia occurs in approximately 1% of cases. To date, only eight cases of malignant transformation, of fibrous dysplasia to osteosarcoma, in Mazabraud syndrome have been reported worldwide. The authors report the first case of osteosarcomatous transformation in a patient with Mazabraud syndrome in the Republic of Korea, focusing on imaging findings.

Superior Mesenteric Venous Thrombophlebitis with Terminal Ileal Diverticulitis: A Case Report

Mesenteric venous thrombophlebitis secondary to inflammatory processes such as diverticulitis and appendicitis is a rare disease; however, it can nonetheless cause bowel ischemia and infarctions. Radiologic diagnosis is vital for mesenteric venous thrombophlebitis complicated with diverticulitis due to its non-specific clinical presentation and very low incidence. We report a case of a 61-year-old woman with superior mesenteric vein thrombosis and ileocecal diverticulitis on CT, which was resolved after treatment with a combination of antibiotic therapy and right hemicolectomy.

Advances in Female Urology: Stress Urinary Incontinence and Pelvic Organ Prolapse

Pelvic floor disorders, including urinary incontinence and pelvic organ prolapse, are common conditions in women but are under-reported and under-treated. These conditions impose a severe burden of physical and social restrictions, depression and compromised quality of life. There are literally hundreds of surgical procedures used to treat incontinence and prolapse, and they are constantly being revised in ongoing attempts to improve outcomes. Many operations have been developed for stress urinary incontinence but only a few-retropubic colposuspension and sling procedures-have survived and evolved with enough supporting evidence. Although the procedure can be done laparoscopically, results from small case series are conflicting. The technique has been modified greatly from the open approach to use mesh and staples. Pubovaginal slings use a strip of tissue or mesh to support the bladder neck. Although slings have been used in patients who fail primary incontinence surgery, they are becoming more common than primary procedures. Traditional synthetic mesh have a risk of complications of vaginal erosion, urethral erosion, and increased need for removal or revision. A recent modification of the sling, midurethral tension-free vaginal tape, places permanent mesh at the mid-urethra under minimum tension with scarce long-term data. However, appropriate clinical trials and long-term follow-up with all these procedures is specially important in point of the possibility of serious erosion many years later. Concerning the pelvic organ prolapse, there is an increasing interest in the use of synthetic meshes which are at widely used for surgical repair. The use of synthetic meshs may also simplify surgical procedures and reduce operative duration and morbidity. Continuous evaluation is necessary to study replacement synthetic materials which should improve the rate of prolapse recur and complications. Randomized controlled trials are required to determine which surgical procedures and type of prosthesis are most suitable.

The Effect of Long-term Immobilization Stress on Spermatogenesis and Testosterone Production / 대한비뇨기과학회지

Purpose: The aim of this study was to investigate the effects of long-term immobilization stress on spermatogenesis and testosterone production in a rat model. Materials and Methods: Thirty randomly selected adult male rats were divided into 6 groups: immobilization stress groups (I, III, V) and control groups (II, IV, VI). In the immobilization stress groups, 15 rats were immobilized in a steel cage for 6 hours per day for 14 days. Groups I and II were sacrificed just after finishing the immobilization session. Groups III and IV were sacrificed after a 1 week resting period. Groups V and VI were sacrificed after a 2 week resting period. The serum concentrations of corticosterone, luteinising hormone (LH), follicle stimulating hormone (FSH) and testosterone were measured. Specimens of the testis were stained with hematoxylin-eosin and Masson's trichrome. Results: Following 2 weeks of immobilization, the serum concentration of corticosterone was significantly increased; whereas, the serum concentrations of LH and testosterone were decreased. However, the serum FSH concentration remained unchanged. After the 1 week resting period, there were significant recoveries in the serum concentrations of corticosterone, LH and testosterone. From the histology of the immobilization group, the mean testicular biopsy score (Johnsen score) was significantly decreased, but the mean value of the seminiferous tubule luminal diameter was significantly increased; whereas, that of the seminiferous tubule diameter remained unchanged. These changes slowly recovered after the resting period. Conclusions: These results suggest that the exposure to long-term immobilization impairs spermatogenesis and androgenic testicular functions in rats.

A Study of Microsatellite Instability of Upper Urinary Tract Transitional Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: The objective of this study was to evaluate the role of microsatellite instability (MSI) in upper tract transitional cell carcinomas (TCC). MATERIALS AND METHODS: A total of 48 surgically treated renal pelvis and ureteral TCC patients were included in this study. MSI was determined by polymerase chain reaction (PCR) for amplification of the microsatellite sequences at mononucleotides BAT25 and BAT26, and dinucleotides D17S250, D2S123 and D5S346 in DNA and hMLH1 protein, p53 and Ki-67 expressions were determined by immunohistochemistry on retrieved tumor tissue. RESULTS: Twenty seven (56.2%) and 21 (43.8%) of the 48 patients had renal pelvis and ureteral TCC, respectively. Eighteen (37.5%) and 30 (62.5%) patients had superficial and invasive TCC, according to the pathological stage, while 24 each (50%) had low and high grade TCC, respectively. MSI was observed in 20.8% of tumors at mono-MSI and 22.9% at di-MSI. MSI-high and -low (instability >2 and <2 loci, respectively) were observed in 12.5 and 22.9%, respectively. From a univariate analysis, age, stage, tumor grade, tumor recurrence and the expressions of hMLH1 and Ki-67 were not related to MSI. However, in recurred cases, infiltrative tumors had 100% MSI compared to superficial tumors, and the expressions of p53 and Ki-67 were related to the stage and tumor grade, respectively (p<0.05). CONCLUSIONS: These results suggest that MSI may occur in upper tract TCC, as observed in other tumors. MSI was more frequently expressed in ureteral than renal pelvis tumors. However, MSI was not correlated with stage or grade, but was significantly correlated with the stage in recurred cases; and the expressions of p53 and Ki-67 were related to the stage and tumor grade.

Primary Periurethral Malignant Melanoma / 대한비뇨기과학회지

A primary genitourinary melanoma is rare, accounting for less than 1% of all cases of melanoma. They have been presented in case reports, with a subsequent paucity of insight into the natural history of the disease and appropriate management of patients. The prognosis of patients with a genitourinary melanoma is poor. Delay in seeking medical attention for symptoms, and misdiagnosis at presentation, contribute to a more advanced stage at diagnosis. Our case involved a 71 year old woman, who came to our hospital due to vaginal spotting. On local excision, mass was found on the vestibule and forward to the urethra. The pathological diagnosis, by special immunohistochemical staining, such as S-100 protein and HMB-45, was that of a malignant melanoma.

The Effect of PDE 4 Inhibitor on Urinary Bladder Function in Normal Rats

PURPOSE: PDE 4 inhibitor is known to be a bladder relaxant. In this study, the effects of PDE 4 inhibitor on the urinary bladder function were evaluated in vivo experiment. We postulated that PDE 4 inhibitor of appropriate concentration might be helpful in the treatment of overactive bladder. MATERIALS AND METHODS: Fifteen Spraque-dawley female rats, weighing approximately 250~300 mg, were used for this study and divided into three groups. PDE 4 inhibitor 486,051 was administrated to each rat by different drug concentrations(0.5 mg/kg, 1 mg/kg, 5 mg/kg). Cystometrogram(CMG) was performed before and 20~60 minutes afterV), bladder capacity(BC), maximal bladder voiding contraction pressure(MVP), intercontrac drug application considering first voiding. Cystometric parameters investigated were voided volume(VV), residual volume (RV), bladder capacity(BC), maximal bladder voiding contraction pressure(MVP), intercontraction interval(ICI). Mean blood pressure was monitored in all rats. RESULTS: PDE 4 inhibitor of 0.5 mg/kg increased the intercontraction interval but not the bladder capacity significantly. PDE 4 inhibitor of 5 mg/kg increased the bladder capacity significantly, but did not show the increased intercontraction interval compared to other groups, and showed the greatest increased residual volume among three groups. PDE 4 inhibitor of 1 mg/kg showed the most increased intercontraction interval and the bladder capacity, and the least decreased voided volume and maximal bladder voiding contraction pressure change. CONCLUSION: PDE 4 inhibitor of different concentrations affects cystometric parameters variably by bladder smooth muscle relaxant. PDE 4 inhibitor of appropriate concentration may be helpful in the treatment of overactive bladder. PDE 4 inhibitor, at the concentration of 1 mg/kg, increased the bladder capacity and intercontraction interval most significantly. This study may provide an important basic data in the future when drug effects were assessed in variable animal models of overactive bladder, etc. However, main limitations of drug use are the increase of residual urine and the decrease of blood pressure. Therefore more bladder specific drug is needed.

Foreign Body Induced Bladder Calculi after Anti-Incontinence Surgery / 대한비뇨기과학회지

There have been several recent reports on bladder calculi in women with a previous history of pelvic operation. We experienced 3 patients with foreign body induced bladder stones within 1 year. These calculi had formed on a retained intravesical non-absorbable sutures or a pledget. The radiological and cystoscopic findings and operative technique are discussed.

Efficacy of the 3rd Generation Extracorporeal Shock Wave Lithotriptor (Piezolith 3000(R)) for Treating Patients with Urinary Tract Calculi / 대한비뇨기과학회지

PURPOSE: Piezolith 3000(R) is one of the 3rd generation lithotriptors that uses double layered piezoelectric shock waves for the treatment of urinary stone. We evaluated the safety and effectiveness of the Piezolith 3000(R) lithotriptor and we compared it with the previous Piezolith 2300(R) lithotriptor. MATERIALS AND METHODS: We reviewed the records of 500 patients with urinary calculi who had been treated with extracorporeal shock wave lithotripsy (ESWL) from January 2002 to December 2003, but complete follow up data was available for only 385 cases. The distribution of stones, the success rate and the number of ESWL sessions according to the size and location of the stones, the auxiliary procedures and their complications were analyzed. RESULTS: There were 172 cases with renal stone and 213 cases with ureteral calculi. The success rate, defined as being stone-free or having asymptomatic residual fragments measuring 3mm or less, was 82.0% for the renal stones and 93.0% for the ureteral calculi. The overall success rate for all the calculi was 88.1%. The mean number of sessions was 3.6 for the renal stones and 2.3 for the ureteral calculi. The overall mean number of sessions was 2.8. All the treatments were performed without analgesia or sedation except for one child (5 years old) who was given oral sedation. Any serious complications or side effects such as renal hematoma were not observed. CONCLUSIONS: The Piezolith 3000(R) lithotriptor allows shorter treatment sessions and it has more comfortable positioning tools to focus on the stone. It also has the advantage of being anesthesia free and a lower morbidity rate (e.g. pain). Yet we couldn't find any difference of the success rate between the previous standard piezo-system and the Piezolith 3000 .

A Localized Sarcomatoid Carcinoma of a Urinary Bladder Diverticulum / 대한비뇨기과학회지

A sarcomatoid carcinoma is an extremely rare tumor found in the urinary bladder, which accounts for 0.3% of all bladder malignancies. The development of malignancy within the bladder diverticulum often occurs, with the incidence varying between 2.9-4%. A sarcomatoid carcinoma of the urinary bladder is a highly malignant tumor containing both malignant mesenchymal and epithelial elements, which are demonstrated by immunohistochemical study. Recently, a case of a sarcomatoid carcinoma of the bladder diverticulum was experienced in a 41-year-old female. A partial cystectomy was performed under the impression of a bladder carcinoma in the diverticulum. Histopathologically, the tumor mass was composed of an urothelial carcinoma in the peripheral portion and sarcomatoid spindle cells in the central portion. Immunohistochemically, the epithelial components were stained with cytokeratin, but the sarcomatoid components were predominantly stained with vimentin, and focally with cytokeratin. The patient recovered without complications.

Effect of Finasteride on Male Pattern Baldness in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Finasteride, an inhibitor of 5alpha-reductase, is used for the treatment of benign prostatic hyperplasia (BPH) and male pattern baldness, by inhibiting the conversion of testosterone to dihydrotestosterone (DHT). We attempted to determine whether finasteride treatment led to a clinical improvement in BPH patients with male pattern baldness. MATERIALS AND METHODS: This was a one year, single blind, prospective study, conducted on BPH patients. Eighty two men participated in the study, and received either 5mg finasteride plus 0.2mg tamsulosin (group I, n=43) or 0.2mg tamsulosin alone (group II, n=39). The efficacies were evaluated, bimonthly, by baldness grade, international prostate symptom score (IPSS) and peak flow rate (PFR), for 12 months. The estimation of baldness grade was based on the modified Norwood's classification (from grades I to VII). Patients with grade IV or higher were categorized as having moderate to severe male pattern baldness. The numbers of moderate to severe male pattern baldness were 11 and 16 in groups I and II, respectively. RESULTS: At the baseline, there were no significant differences in the baldness grade, age and prostatic volume between the two groups. Group I exhibited a gradual and continuous improvement in the baldness grade at 10 and 12 months compared to baseline (p<0.05), while group II displayed no significant change in the baldness grade. Thirteen patients (30.2%) of group I manifested improvements in their baldness grade, whereas none of group II demonstrated an improvement. In group I, of the eleven patients with moderate to severe male pattern baldness, seven (63.6%) showed an improvement in their baldness grade, whereas of the thirty two mild grade patients, six (18.7%) showed an improvement. The improvement in baldness grade from the baseline to 10 and 12 months were statistically significant, but from the baseline to 8 months was insignificant. CONCLUSIONS: The combined treatment of 5mg finasteride and 0.2mg tamsulosin, for BPH patients, resulted in an improvement in male pattern baldness.

Significance of Thrombocytosis as a Prognostic Factor after Radical Nephrectomy in Patients with Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: It has previously been reported that patients with renal cell carcinomas(RCC) with normal platelet count have an increased survival rate compared with those with thrombocytosis. Whether thrombocytosis was associated with poor prognosis in patients with a renal cell carcinomas was determined. MATERIALS AND METHODS: The record of 161 patients with renal cell carcinomas, who underwent radical nephrectomies, between January 1993 and December 2001, were retrospectively reviewed. The inclusion criteria were at least one perioperative platelet count and a histologic diagnosis of RCC. The survival, pathological tumor stage and grade, histological cell subtype, age, gender, hematuria and history of flank pain were recorded from the charts. Platelet counts were checked, and any patient with at least 1 platelet count greater than 400,000/mm3 was classified with thrombocytosis. RESULTS: Mean patient age and follow-up duration were 56.6, ranging from 30 to 80 years, and 49.8+/-28.8 months, respectively. There were 30 and 131 patients with thrombocytosis and persistently normal platelet counts, respectively. 11 of the 30 patients with thrombocytosis and 7 of the remaining 131 patients died of disease progression. Patients with thrombocytosis had a mean survival of 63.6 months, compared with 115.9 months in those without. The pathological tumor stage, nuclear grade and flank pain were associated with thrombocytosis(p<0.005). However, no statistically significant associations were found between other prognostic factors(cell subtype, gender, age and hematuria) and the presence of thrombocytosis. CONCLUSIONS: Perioperative thrombocytosis was found more frequently in patients with advanced RCC, and those patients showed poorer survival compared with those with a normal platelet count. These results suggest that the perioperative platelet count could be a new prognostic factor in patients with RCC having undergone a radical nephrectomy.

Efficacy of alpha-Blocker and Finasteride Combination Therapy for Benign a Prostatic Hyperplasia with a Prostate Volume Less than 40 Grams / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate the efficacy of a combination drug therapy (tamsulosin plus finasteride) for benign prostatic hyperplasia, with a small prostate volume of less than 40 grams. MATERIALS AND METHODS: One hundred and twenty-three patients, with symptomatic benign prostatic hyperplasia of less than 40 grams, were analysed. Group 1 (n=67) had been treated with a combination of finasteride (5mg/day) and tamsulosin (0.2mg/ day), and Group 2 (n=56) with tamsulosin only (0.2mg/day) over a 12 month period. The patients were periodically assessed by IPSS (international prostate symptom score), uroflowmetry and residual urine, during the treatment period. RESULTS: The mean changes in the total symptom score, obstructive and irritative symptom score for group 1 and group 2 at 1 year were -7.21+/-7.44 (39.86%), -4.79+/-5.07 (45.02%) and -2.42+/-3.25 (48.11%), and -7.39+/-9.98 (43.06%), -4.82+/-6.91 (45.21%) and -2.39+/-4.00 (37.82%) points, respectively. The mean changes in the peak urinary-flow rates and postvoid residual urine for group 1 and group 2 at 1 year were 2.07+/-5.42 (16.65%)ml/s and -31.58+/-60.99 (56.47%)ml, and 2.38+/-6.57 (16.53%)ml/s and -34.78+/-86.77 (50.24%)ml, respectively. The effects of the combination of finasteride and tamsulosin were no greater than the tamsulosin monotherapy (p>0.01). CONCLUSIONS: A combination of finasteride and tamsulosin is no more effective than tamsulosin alone, in patients with benign prostatic hyperplasia, with a prostate volume of less than 40 grams.

Effects of Temperature Change on Heat Shock Protein 70 Expression in Rat Testes / 대한비뇨기과학회지

PURPOSE: It has been reported that exposure of the testes to elevated temperatures results in decreased spermatogenesis. The aim of this study was to investigate the effects of temperature change on the expression of heat shock protein 70 (HSP 70) during spermatogenesis in rat testes. MATERIALS AND METHODS: Twenty-seven Sprague-Dawley rats (200-230g) were randomly divided into control, hot bath and hot bath followed by cold bath, groups. The hot bath consisted of immersion in a 41-43 degrees C water bath for 10 minutes, and the cold bath consisted of immersion in a 18-20 degrees C water bath for 3 minutes. Each bathing was performed twice a day, three times a week, for a total of four weeks. Hematoxylin & Eosin staining was performed to evaluate the degree of spermatogenesis, and Western blot & immunohistochemistry were performed to investigate the expression of HSP 70 in the rat testes. RESULTS: From the histological tests, the spermatogenesis was severely impaired in hot bath group, but preserved in hot bath followed by cold bath group. The expression of HSP 70 in the hot bath group increased 1.5 times compared to that in the control group (p=0.075). However, the hot followed by cold bath group showed similar findings to those in the controls (p=0.934). Immunohistochemical analysis for the expression of HSP 70 demonstrated significant elevations in the hot bath group, and HSP 70 immunoreactivity was found in the Leydig cells and fibroblasts in all three groups, but the levels of expression of the HSP 70 in the control, and the hot followed by cold bath, groups were similar. CONCLUSIONS: The results of this study demonstrate an elevation in the expression of the HSP 70 only occurred in the hot bath group, which suggests the induction of a coping mechanism for exposure to high temperature. As the levels of expression of the HSP 70 in the control, and hot followed by cold bath, groups were comparable, is suggestive of the levels of HSP 70 being consistent with those seen with normal spermatogenesis.

Primitive Neuroectodermal Tumor of the Kidney with CD99 Positive Staining / 대한비뇨기과학회지

Primitive neuroectodermal tumors (PNETs) are primitive neuroblastic tumors that, unlike neuroblastomas, arise outside the autonomic nervous system, but very few cases with a renal origin have been described. The immunohistochemical staining for CD99 is useful in their diagnosis. A case of renal primitive neuroectodermal tumor, in a 61- year-old man presenting with a painless gross hematuria is reported. The immunohistochemical staining of the renal mass was strongly positive for CD99.

Differentiation of Infiltrating Urothelial Tumor of Renal Pelvis from Renal Cell Carcinoma Invading into Renal Pelvis or Calyx / 대한비뇨기과학회지

PURPOSE: It is difficult to differentiate urothelial tumours of the renal pelvis, invading the renal parenchyma, from renal cell carcinomas, invading the renal pelvis or calyx. The purpose of this study was to assess the differences between the two conditions. MATERIALS AND METHODS: We retrospectively reviewed the medical records, and imaging studies, of 17 patients who underwent nephroureterectomy with bladder cuff excision for urothelial tumours of the renal pelvis, with parenchymal invasion, and of 30 patients who underwent radical nephrectomy for renal cell carcinomas, invading into the renal pelvis or calyx. We assessed the differences in clinical symptoms, urine cytology, intravenous urography, and CT findings between the two conditions. Pearson chi-square tests, with continuity corrections, were performed for statistical analyses. RESULTS: Renal cell carcinomas showed gross hematuria in only 10 cases (33%), positive findings of urine cytology in 1 case of 9 cases (11%). CT scans demonstrated contour bulging in 25 cases (83%), preservation of reniform shape in 5 cases (17%), peripheral location of tumour in 25 cases (83%), and abnormal CT nephogram in 1 cases (3%). In contrast, urothelial tumour of the renal pelvis showed gross hematuria in 13 cases (76%), positive findings of urine cytology in 9 cases of 15 cases (60%). CT scans demonstrated contour bulging in 1 cases (6%), preservation of reniform shape in 16 cases (94%), central location of tumour in all cases (100%), and abnormal CT nephogram in 10 cases (59%). There was no significant difference between renal cell carcinomas and urothelial tumours of the renal pelvis in blood chemistry or IVP. There were no cases of renal cell carcinoma concurrently with bladder tumour, while 2 cases (12%) of urothelial tumour of the renal pelvis had bladder tumours at the same time. CONCLUSIONS: The presence of gross hematuria, positive findings in urine cytology, the presence of bladder tumours, and tumour location, renal contour changes and CT nephogram in CT scans may be helpful in distinguishing both disease entities.

The Prognostic Factors Affecting Survival in Muscle Invasive Bladder Cancer Treated with Radiotherapy / 대한방사선종양학회지

PURPOSE: This study analyzed the prognostic factors affecting the survival rate and evaluated the role of radiation therapy in muscle-invading bladder cancer. MATERIALS AND METHODS: Twenty eight patients with bladder cancer who completed planned definitive radiotherapy in the Departments of Therapeutic Radiology and Urology, Chonnam National University Hospital between Jan. 1986 to Dec. 1998 were retrospectively analyzed. The reviews were performed based on the patients' medical records. There were 21 males and 7 females in this study. The median of age was 72 years old ranging from 49 to 84 years. All patients were confirmed as having transitional cell carcinoma with histological grade 1 in one patient, grade 2 in 15, grade 3 in 9, and uninformed in 3. Radiation therapy was performed using a linear accelerator with 6 or 10 MV X-rays. Radiation was delivered daily with a 1.8 or 2.0 Gy fraction size by 4 ports (anterior-posterior, both lateral, alternatively) or 3 ports (Anterior and both lateral). The median radiation dose delivered to the isocenter of the target volume was 61.24 Gy ranging from 59 to 66.6 Gy. The survival rate was calculated by the Kaplan-Meier method. Multivariate analysis was performed on the prognostic factors affecting the survival rate. RESULTS: The survival rate was 76%, 46%, 33%, 33% at 1, 2, 3, 5 years, respectively, with 19 months of median survival. The potential factors of age (less than 70 years vs above 70), sex, diabetes mellitus, hypertension, hydronephrosis, T-stage (T3a vs T3b), TUR, chemotherapy, total duration of radiotherapy, radiation dose (less than 60 Gy vs above 60 Gy), and the treatment response were investigated with uni- and multivariate analysis. In univariate analysis, the T-stage ( p=0.078) and radiation dose ( p=0.051) were marginally significant, and the treatment response ( p=0.011) was a statistically significant factor on the survival rate. Multivariate analysis showed there were no significant prognostic factors affecting the survival rate. CONCLUSION: The treatment response and radiation dose are suggeted as the statistically significant factors affecting the survival rate of muscle invasive bladder cancer. A Further prospective randomized study is needed to confirm these prognostic factors.

Comparison of Lower Urinary Tract Symptoms and Urodynamic Study in BPH Patients with or without Prostatitis / 대한비뇨기과학회지

PURPOSE: Benign prostatic hyperplasia (BPH) and prostatitis may present similar clinical manifestations, although the severity of their symptoms is different. The differences between BPH patients with prostatitis and those without prostatitis were evaluated to help select appropriate therapeutic modalities and predict the prognosis. MATERIALS AND METHODS: 50 patients with BPH who were not associated with a neurogenic bladder, urethral stricture, diabetes, urinary tract infection or a previous prostate operation were studied. Of the 50 patients, 27 patients were free of prostatitis, and 23 patients had prostatitis. The mean ages of the two groups were 65.9+/-7.3 and 60+/-8.3 years, respectively. The evaluation was performed using the International Prostate Symptom Score (IPSS), uroflowmetry, the residual urine volume and urodynamic studies. Statistical analysis was performed using the Mann-Whitney test and the chi-square scales. RESULTS: According to the IPSS, the straining score was 4.3+/-1.0/3.2+/-1.8 (p<0.05) and the urgency score was 2.4+/- 1.9/3.8+/-1.1 (p<0.05) in BPH patients without or with prostatitis. In the L-PURR, grade 3 and higher, which indicated moderate to severe obstruction, was found in 10 patients with BPH alone (37.1%) and 6 patients with BPH associated with prostatitis (26.1%) (p<0.05). Detrusor instability was identified in 22% (6/27) of patients with BPH alone and 56.5% (13/23) of those with prostatitis (p<0.05). CONCLUSIONS: BPH patients associated with prostatitis had considerably more irritative symptoms, non-obstructive patterns and detrusor instability than those without prostatitis. These findings suggest that the relief of an obstruction by means of surgery alone should be reconsidered when treating BPH with prostatitis.

Early Experience of Penile Revascularization Procedure with Anastomosis of Inferior Epigastric Artery to Dorsal Penile Artery in Arteriogenic Impotent Patients / 대한비뇨기과학회지

PURPOSE: We report the results of a penile revascularization procedure of the inferior epigastric artery to the dorsal penile artery in arteriogenic impotent patients. MATERIALS AND METHODS: Microvascular arterial bypass surgery was performed in 5 impotent patients (age 29-40, mean 35 years) in order to treat a cavernosal arterial insufficiency secondary to focal occlusive disease in cavernosal arteries. The surgical procedure was performed on an end-to-side anastomosis of the inferior epigastric artery to the dorsal penile artery. The erectile function was evaluated by the International Index of the Erectile Function questionnaire (IIEF) and penile duplex Doppler ultrasonography before and 6 weeks after surgery. RESULTS: The IIEF score improved in 4 of 5 patients postoperatively. Penile arterial peak systolic velocity (PSV) had improved significantly from 21.4+/-2.2cm/sec to 33.7+/-9.6cm/sec in the right side, from 18.5+/-6.8cm/sec to 36.0+/-10.0cm/sec in the left (p< 0.05), respectively. There were no serious adverse effects of the surgery except for one patient who had a hematoma at the vascular anastomotic site. CONCLUSIONS: A penile revascularization procedure of the inferior epigastric artery to the dorsal penile artery is an effective surgical method for correcting an arteriogenic erectile dysfunction with a normal corporeal veno-occlusive mechanism.