A Comparative Analysis between Flexible Ureteroscopic Lithotripsy and Tubeless Percutaneous Nephrolithotomy in the Treatment of >15 mm Non-Obstructing Proximal Ureteral Stones.

BACKGROUND: The proper surgical modality for large non-obstructing proximal ureteral stones is disputed. We compare effectiveness and safety of flexible ureteroscopic lithotripsy (FURL) and tubeless percutaneous nephrolithotomy (TPNL) in treatment of upper ureteral stones larger than 1.5 cm. METHODS: We reviewed the medical records of patients who performed FURL or TPNL for upper ureteral stones between June 2016 and November 2018. Comparative analysis was conducted regarding demographic parameters, stone free rate, postoperative pain and complications. RESULTS: This study included 58 patients treated with FURL and 60 patients treated with TPNL owing to upper ureteral stones larger than 1.5 cm. Stone size was similar in the FURL and TPNL groups (17.6 ± 2.6 vs. 18.0 ± 2.1 mm, p = 0.194). The overall 3-month stone clearance rate was 95.8% for FURL versus 96.0% for TPNL (p = 0.575). There was no difference between the FURL and TPNL groups for hospital stay (p = 0.280) and postoperative complications. On the other hand, patients treated with FURL had longer operative time (p = 0.012) and less postoperative pain (p = 0.008). CONCLUSIONS: Both surgical techniques were considered feasible and effective surgical procedures in the treatment of large upper ureteral stones.

Are hemostatic agents for selective cases of tubeless percutaneous nephrolithotomy necessary for access tract control? A randomized control trial.

PURPOSE: To evaluate the efficacy of percutaneous nephrolithotomy (PCNL) access tract sealing agent. Fibrin glue and Tachosil® were used for sealing the access tract and compared to the control. Post operative computed tomography (CT) scan was used to evaluate those efficacies. METHODS: A total of 108 patients were randomized to three groups: In group 1, the access tract was sutured, and compressive dressing was done. In group 2, the fibrin glue was injected into the access tract with a tip applicator at the end of operation. And group 3, Tachosil® was rolled on its longitudinal axis and plugged into the access tract. Non-contrast CT at POD 1 was taken and perirenal hematoma thickness was measured and graded. Hemoglobin, hematocrit, VAS score, stone-free status, and hospital stay were analyzed. RESULTS: Preoperative demographic differences were not significant in all three arms. Postoperative CT scans in all groups demonstrated mostly minimal grade access tract hematomas. Mean perirenal hematoma thickness showed no significant differences (2.66 ± 3.74, 2.73 ± 3.85, 2.54 ± 4.37 mm, p = 0.981), respectively. Postoperative hemoglobin drop (0.75 ± 0.58, 0.84 ± 0.47, 0.91 ± 0.60 g/dl, p = 0.74), stone-free rate (93.75, 87.87, 87.87%, p = 0.121), VAS (p = 0.499) and hospital stay (1.81 ± 0.84, 1.48 ± 0.71, 1.59 ± 0.75 day, p = 0.127) were not significantly different between the groups. CONCLUSION: Fibrin glue and Tachosil® in tubeless PCNL were not necessary for postoperative access tract control.

Trends of genital wart in Korea according to treatment method classification: Big data analysis of health care in 2010-2019.

PURPOSE: The purpose of this study is to investigate disease trend of genital wart through changes in each treatment method over the past 10 years in Korea. MATERIALS AND METHODS: From 2010 to 2019, surgical treatment including cauterization, excision, cryotherapy, and laser therapy, non-surgical treatment such as podophyllin, and surgical treatment for anorectal lesion were extracted and analyzed from 2010 to 2019. For each treatment method, characteristics such as sex, age, region, medical cost and average number of procedures were analyzed. RESULTS: The number of patients following all treatment modalities increased every year. Surgical treatment of genital wart and anorectal wart showed a significant increase in male patients. Number of non-surgical treatment decreased in males but increased in females. Surgical removal of the anorectal wart increased more than 250% in over 10 years, and males underwent surgery 4 times more than females. In both surgery and non-surgery, the mean session was higher in males. Most of them were carried out in primary medical institutions. In Seoul and Gyeonggi-do, the largest number of patients received treatment regardless of treatment method. CONCLUSIONS: Treatment for genital warts has increased rapidly over the past 10 years, and the increase in males is remarkable. The main treatment was surgery, and males mainly received surgical treatment, and females mainly received drug treatment. The primary medical institution was in charge of the most treatment. As the number of patients and related medical expenses are increasing rapidly, more attention and response to diseases are needed.

Holmium laser-assisted laparoscopic partial cystectomy for bladder cancer: a single-institutional pilot study with technical feasibility and short-term oncological outcome.

BACKGROUND: In selected patients with bladder cancer, partial cystectomy is an alternative treatment for bladder preservation with fair oncologic result. During partial cystectomy, tumor margin demarcation is difficult. Various methods were adopted, however, there is no standard for tumor margin demarcation. We aimed to introduce and provide our experience with holmium laser-assisted method with ten patients. METHODS: From March 2016 and February 2019, patients who want partial cystectomy for bladder cancer were enrolled in this study. Inclusion criteria were stage T2 or T3 disease and tumor location restricted within the dome, and lateral, posterior side of the bladder were included. Transurethral holmium laser-assisted mucosal incision was made and deepened until perivesical fat. Minimal Safety margin for 5-10 mm were spared, and tumor removal was done laparoscopically. RESULTS: Ten patients underwent holmium laser-assisted laparoscopic partial cystectomy. All procedures were done without complication. The tumor locations were laterally in seven patients, dome in two patients, and posterior wall in one patient. Pathologic examination of surgical margin showed no cancer cell involvement in all cases. There were no recurrences or metastases for 12 months follow up. CONCLUSIONS: Holmium laser-assisted laparoscopic partial cystectomy is effective and safe technique in carefully selected patients. To achieve precise and appropriate surgical margin during the laparoscopic partial cystectomy, holmium laser resection provides feasible and safe method that assists in bladder incision with minimal ureteral orifice involvement. TRIAL REGISTRATION: Retrospectively registered.

Efficacy of Low-Intensity Extracorporeal Shock Wave Therapy for the Treatment of Chronic Pelvic Pain Syndrome IIIb: A Prospective-Randomized, Double-Blind, Placebo-Controlled Study.

PURPOSE: There is no definite treatment method for chronic pelvic pain syndrome (CPPS). The purpose of this study was to compare and assess the effectiveness and safety of low-intensity extracorporeal shockwave therapy (Li-ESWT) versus placebo treatment in CPPS IIIb patients. MATERIALS AND METHODS: Thirty participants with CPPS IIIb were included and randomized in this prospective, double-blind, placebo-controlled study. Li-ESWT was performed at the perineum without anesthesia once per week for 8 weeks. CPPS-related symptoms were evaluated using the National Institutes of Health-chronic prostatitis symptom index (NIH-CPSI). Pain and erectile function were appraised using the Visual Analogue Scale (VAS) and International Index of Erectile Function-Erectile Function (IIEF-EF), respectively. The Global Efficacy Assessment Question (GEAQ) was also assessed. The parameters were evaluated immediately after the last Li-ESWT treatment and 4 weeks after Li-EWST treatment. RESULTS: Fifteen subjects each in the Li-ESWT and placebo groups completed this study. Amelioration of NIH-CPSI total, pain, and quality of life score in the Li-ESWT group was found compared to the placebo group (p=0.002, 0.02, 0.001, respectively). Improvement of the VAS score was observed in the Li-ESWT group (p=0.002). The differences in the GEAQ "Yes" responses were also significant in the Li-ESWT group. No patients experienced side effects related to ESWT during therapeutic period or follow-up duration. CONCLUSIONS: Results indicated that Li-ESWT improved the NIH-CPSI score, pain, and the quality of life in CPPS IIIb patients. Li-ESWT could be an effective alternative treatment modality for CPPS IIIb.

Clinical Efficacy of Multi-Focal Low-Intensity Extracorporeal Shockwave Therapy in the Treatment of Chronic Prostatitis/Chronic Pelvic Pain Syndrome: Prospective-Randomized, Double Blind, Placebo-Controlled Study.

PURPOSE: To assess the safety and effect of the multifocal low-intensity extracorporeal shockwave therapy (MESWT) in the treatment of chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). MATERIALS AND METHODS: We randomly separated 30 patients with CP/CPPS into a MESWT and placebo group of same number using prospective-randomized, double-blind design. The participants' National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) total and subdomain scores, International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and visual analogue scale (VAS) were assessed and compared at baseline and at finishing immediately and 4 weeks after procedure and also were compared between MESWT and placebo group. RESULTS: A total of 30 participants were randomized a MESWT or placebo group. Twenty of thirty participants completed this trial. NIH-CPSI total and subdomain scores, IPSS, IIEF-5, and VAS had significantly ameliorated compared with baseline in the MESWT group at 4 weeks assessment. Furthermore, comparison of the results from MESWT and placebo groups represented statistically significant differences in NIH-CPSI total and subdomain scores, IPSS, IIEF-5, and VAS. No side effects or events were occurred in both groups of the participants during study periods. CONCLUSIONS: MESWT can be an effective treatment modality in patients with CP/CPPS as it improves pain and QoL.

Incidence of posterolateral and retrorenal colon in supine and prone position in percutaneous nephrolithotomy.

Colon injury is a distressing complication during percutaneous nephrolithotomy (PCNL). Posterolateral colon (PLC) and retrorenal colon (RRC) are known to be the risk factors of colonic injury during PCNL. We evaluated the incidence of PLC and RRC in both supine and prone position of patients who underwent PCNL in our institution, and determined the risk factors of PLC and RRC through a review of computed tomography (CT) scan. To define PLC and RRC, we divided kidney into anterior, anterolateral, posterolateral and retrorenal zone by drawing three parallel lines in the CT scan. Among a total of 102 patients, PLC and RRC were identified in 16 (15.7%) cases in supine, and 25 (24.5%) cases in the prone position. PLC and RRC were most frequently present in the upper and lower pole of the left kidney in prone position compared to supine (p value less than 0.001). Risk factors of PLC and RRC in the prone position were old age (over 68), lower body mass index (BMI), and thinner perirenal fat layer. Therefore, an initial percutaneous puncture in PCNL needs to be carefully accessed to those patients with such high risks of colon injury.

Effect of high-BDNF microenvironment stem cells therapy on neurogenic bladder model in rats.

BACKGROUND: The purpose of this study is to explore the effects of high-BDNF microenvironment produced by engineered immortalized mesenchymal stem cells (imMSCs) on the neurogenic bladder (NB) and investigate underlying mechanism. METHODS: Male Sprague-Dawley rat (12-week-old, weighing about 370-400 g) were purchased from a Korean company (Orient Bio Co. Seongnam, Korea) and divided into the following groups (n=32): sham control group (n=8), NB group (n=8), NB + ImMSCs group (n=8), NB + ImMSCs (BDNF) group (n=8). The major pelvic ganglion (MPG) was observed under anesthesia. Three NB groups of rats were then subjected to bilateral MPG injury. The sham control group of rats was treated with sham surgery. Cystometry were performed before the rats were sacrificed, and then MPG and bladder were collected for histochemical and Western blot analysis. RESULTS: MSCs treatment improves lower urinary tract function, and the NB + ImMSCs (BDNF) group is better than the NB + ImMSCs group (P<0.01). MSCs treatment accelerates recovery of injured nerve tissue, and the NB + ImMSCs (BDNF) group is better than the NB + ImMSCs group (P<0.01). In high BDNF environment, apoptosis was reduced more significantly and muscle tissue recovered more rapidly (P<0.01). High-BDNF microenvironment activates more BDNF/TrkB/CREB signaling pathways (P<0.01). CONCLUSIONS: In a rat NB model caused by nerve injury, imMSCs have certain effects on nerve tissue repair. At the same time, it was proved that increasing the expression of BDNF which had specific effect on nerve injury repair could more effectively repair injured MPG in local microenvironment. The mechanism may be related to the activation of the BDNF/TrkB/CREB signaling pathway and the reduction of apoptosis by highly expressed BDNF.

Comparison of Penile Cuff Test and Conventional Urodynamic Study Prior to Photoselective Vaporization of Prostate for Benign Prostate Hyperplasia Using a 120 W GreenLight High Performance System Laser.

BACKGROUND: We compared the utility of the penile cuff test (PCT) and the conventional urodynamic study (UDS) for the preoperative assessment of patients undergoing scheduled photoselective vaporization of the prostate (PVP) for benign prostate hyperplasia (BPH). METHODS: Fifty-nine patients with voiding lower urinary tract symptoms (LUTS) underwent a simultaneous PCT and conventional UDS before PVP. The modified International Continence Society (ICS) nomogram was used to confirm bladder outlet obstruction after measuring maximum urinary flow rate and highest pressure at flow interruption. The PCT and UDS results, in terms of modified ICS nomogram predictions, were compared. Their sensitivities, specificities, and positive and negative predictive values were calculated. RESULTS: Thirty-six patients were diagnosed as obstructed and 23 as non-obstructed/equivocal using the modified ICS nomogram during the PCT. All 36 of the first group were confirmed as obstructed by UDS. Of the 23 diagnosed as non-obstructed/equivocal by the PCT, 14 were confirmed to be non-obstructed by UDS, with nine diagnosed as obstructed. The PCT showed a sensitivity of 80% and a specificity of 100%. The positive and negative predictive values were 100% and 60.9%, respectively. CONCLUSIONS: In conclusion, despite our small number of patients, the PCT's high sensitivity and specificity suggest that it may provide diagnostic information about bladder outlet obstruction before PVP for patients with voiding LUTS. Evidently, the PCT has the potential to be used for some patients as a screening alternative to invasive UDS.

Evolution of Laparoscopic Donor Nephrectomy Techniques and Outcomes: A Single-Center Experience with More than 1000 Cases.

BACKGROUND Laparoscopic donor nephrectomy (LDN) has evolved and has been established as a surgical standard of care for kidney transplantation. MATERIAL AND METHODS This study retrospectively reviews 1132 patients who underwent 4 different laparoscopic living-donor nephrectomies: hand-assisted laparoscopic nephrectomy (HALDN), pure laparoscopic donor nephrectomy (PLDN), laparoendoscopic single-site plus 1-port donor nephrectomy (LESSOP-DN), and mini laparoscopic donor nephrectomy (MLDN). RESULTS The mean estimated blood loss (EBL) for the HALDN group was meaningfully higher than those of LESSOP-DN and MLDN (57.5±52.2 mL versus 21.0±30.0 mL versus 18.2±28.7 mL) (P<0.001). The EBL for PLDN (53.3±35.3 mL) was also significantly higher than those of LESSOP-DN and MLDN (P<0.001). Length of stay (LOS) for HALDN was longer than that for LESSOP-DN (4.2±1.2 day versus 4.0±1.4 days, P=0.002). There was 1 intraoperative open conversion in the HALDN group and 2 HALDN surgeries that required postoperative exploratory laparotomy. LESSOP-DN had 3 (0.8%) postoperative incisional hernias. For recipients, the results revealed no significant differences between all 4 groups in terms of estimated glomerular filtration rate (eGFR) and the 1-year graft failure rate. CONCLUSIONS The LESSOP-DN group was associated with a shorter incision length than those of HALDN and PLDN and shorter LOS than that of HALDN. Recipient results showed no meaningful difference regarding laparoscopic donor nephrectomy technique.

Inhibition of Proliferation of Prostate Cancer Cell Line DU-145 in vitro and in vivo Using Salvia miltiorrhiza Bunge.

OBJECTIVE: To investigate the antiproliferative activity of Salvia miltiorrhiza Bunge. (SM) on the castration-resistant prostate cancer (CRPC) cell line DU-145, in vitro and in vivo. METHODS: Prostate cancer cell line (DU-145) and normal prostate cell line (RWPE-1) were treated with SM at different concentrations (3.125, 12.5, 25 and 50 µg/mL) to investigate the antiproliferative effects. DNA laddering analysis was performed to investigate the apoptosis of DU-145 cells. Molecular mechanism was investigated by Western blot analysis of p53, Bcl-2, prostate specific antigen (PSA), and androgen receptor (AR). Six-week-old male BALB/c nude mice were randomly divided into normal control group (n=101) and treated group (n=101) which administered 500 mg/kg SM for 2 weeks. Tumor volumes were measured. RESULTS: Treatment with SM resulted in a dose-dependent decrease in cell number of DU-145 cells in comparison with RWPE-1. DNA laddering analysis indicated the apoptosis of DU-145 cells. Treatment with SM increased the expression of p53 and reduced the expression of Bcl-2 proteins. The levels of PSA were considerably reduced in SM-treated group compared to the controls, and a decrease in AR expression was observed when cells were treated with SM in the same pattern as a reduction in PSA. In the tumour xenograft study, SM given once a day for 2 weeks significantly inhibited tumour growth. CONCLUSION: SM might contribute to the anticancer actions such as induction of apoptosis and inhibition of proliferation of prostate cancer cells.

Electromagnetic Low-Intensity Extracorporeal Shock Wave Therapy in Patients with Erectile Dysfunction: A Sham-Controlled, Double-Blind, Randomized Prospective Study.

PURPOSE: The aim of the present study was to evaluate the efficacy and safety of the electromagnetic-type low-intensity extracorporeal shock wave therapy (Li-ESWT) in patients with erectile dysfunction (ED). MATERIALS AND METHODS: The randomized, sham-controlled, double-blind prospective study was performed at two referral hospitals. Participants were randomized in a 1:1 ratio to receive sham or Li-ESWT for 6 weeks. ED was evaluated at screening and at 4 and 7 weeks after treatment. Participants were asked to complete the international index of erectile function-erectile function (IIEF-EF) domain questionnaire, erection hardness scale (EHS), and sexual encounter profile questionnaire (SEPQ 2 and 3). The development of complications was investigated. RESULTS: Eighty-one of 96 patients completed the study. The median change in the IIEF-EF score in the Li-ESWT and sham groups was 5.1 and -2.2 (p<0.001), respectively, at the 7-week follow-up; 47.4% (18/38) patients had EHS <3, of which 77.8% (14/18) showed significant improvement in virtue of Li-ESWT treatment (p=0.001). A significant improvement was observed in the percentage of "Yes" responses to SEPQ 2 and 3 in the Li-ESWT group vs. sham group from baseline to 7-week follow-up (91.3% vs. 69.4%; p=0.008 and 50.0% vs. 14.3%; p=0.002, respectively). No patients reported pain or other adverse events during treatment or follow-up. CONCLUSIONS: Thus, Li-ESWT could have a role in improving erectile function. Furthermore, it is safe. We believe that Li-ESWT is an attractive new treatment modality for patients with ED.

A Novel Method of Locating Foramen Ovale for Percutaneous Approaches to the Trigeminal Ganglion.

BACKGROUND: For patients with trigeminal neuralgia who do not respond to medication and for whom surgical approaches are too risky, percutaneous procedures targeting the trigeminal ganglion are the current standard treatment. Percutaneous procedures are performed via the transoval approach under radiologic guidance. Identification of the foramen ovale (FO) under fluoroscopic guidance is an important part of determining the success or failure of the procedures. OBJECTIVES: Previous studies have described how to visualize the FO under fluoroscopic guidance, but those methods are limited by poor reproducibility. In this study, we have investigated how to visualize the FO clearly and easily under fluoroscopic guidance. STUDY DESIGN: Retrospective analysis. SETTING: University hospital in Korea. METHODS: Seventy-two 3-dimensional facial computed tomography scans without anatomic abnormalities of the skull base were analyzed for verifying the novel method. First, the mandibular angle and the occipital cortical line were overlapped and then turned by 15° oblique rotation using the software package. After these manipulations, the visualization of the FO was graded according to a 4-point scale (0: poor; 1: fair; 2: good; 3: excellent), and the inferior transfacial and oblique angles were measured. RESULTS: This enabled clear visualization of the FO. The mean visual grade of 54 right and 46 left FO (total 100) was 2.74 (0: poor; 1: fair; 2: good; 3: excellent). All recorded FOs had at least grade 2 visibility. LIMITATIONS: This study is lacking application in clinical practice and comparative data to the submental view. CONCLUSIONS: The mandible angle and the occipital cortex line are obvious anatomic landmarks and are visible even to nonexperienced practitioners. Therefore, our method using these anatomic landmarks can improve the reproducibility and accuracy of FO visualization. KEY WORDS: Trigeminal neuralgia, foramen ovale, trigeminal ganglion, 3-dimensional (3D) facial computed tomography (CT) scans.

Comparison of Bipolar Plasma Vaporization versus Standard Holmium Laser Enucleation of the Prostate: Surgical Procedures and Clinical Outcomes for Small Prostate Volumes.

Bipolar plasma vaporization of the prostate (BPVP) is an attractive alternative to resection. There are numerous studies comparing transurethral resection of prostate or photoselective vaporization of the prostate with BPVP; however, there is a lack of data comparing holmium laser enucleation of the prostate (HoLEP) with BPVP. We aimed to compare HoLEP and BPVP with a focus on functional outcomes, safety, and complications. METHODS: From January 2017 to June 2018, patients who underwent HoLEP or BPVP for benign prostatic hypertrophy were enrolled in this study. Inclusion criteria were a prostate volume <40 mL measured by transrectal ultrasound, international prostate symptom score (IPSS) >7, maximum urinary flow rate (Qmax) <15 mL/s, and postvoiding residual volume (PVR) >100 mL. Perioperative and postoperative parameters including IPSS, Qmax, quality of life, PVR, and complications were compared between groups. RESULTS: Sixty-three patients were enrolled in this study. There were small differences in perioperative parameters. Hospital stays and catheterization periods were significantly shorter in the BPVP group. The postoperative complications were comparable between groups. PVR was comparable in both groups except for 1 month postoperatively. The incontinence rate was higher in the HoLEP group, but without statistical significance. CONCLUSION: In terms of surgical safety and efficacy as well as patient comfort, BPVP is comparable with HoLEP for small prostate volumes. BPVP can be a viable alternative technique in small BPH surgical treatment.

Experience with AMS 700 LGX penile prostheses for preserving penile length in Korea.

BACKGROUND: The purpose of this study was to report the outcomes of patients who underwent penile implantation with AMS 700 LGX inflatable penile prosthesis (IPP) in a single center by a single surgeon. METHODS: A total of 342 patients with erectile dysfunction who underwent AMS 700 LGX IPP implantation between October 2014 and April 2016 were included in this study. All patients were evaluated using the International Index of Erectile Function questionnaire preoperatively and at 3, 6, and 12 months postoperatively. We also investigated the mean stretched flaccid penile length before and after surgery as well as the complications related to and the mechanical reliability of the IPP. RESULTS: The questionnaire scores at 12 months were statistically significantly higher than the baseline scores. The mean stretched flaccid penile length was 11.1 ± 0.8 cm at baseline and was longer at 3 (11.9 ± 0.9 cm, P < 0.001), 6 (12.0 ± 0.9 cm, P < 0.001), and 12 (12.2 ± 0.7 cm, P < 0.001) postoperatively. There were no intraoperative or perioperative complications. However, one patient had infection and 10 patients developed mechanical failure during the follow-up duration. CONCLUSIONS: The results of our study suggest that the AMS 700 LGX IPP could be used to prevent penile shortening in patients undergoing IPP implantation. Furthermore, erectile function and patient satisfaction were improved excellently.

Effect of Korean Herbal Formula (Modified Ojayeonjonghwan) on Androgen Receptor Expression in an Aging Rat Model of Late Onset Hypogonadism.

PURPOSE: Testosterone replacement therapy is an effective treatment for late-onset hypogonadism (LOH) despite a few contraindications and side-effects. The aim of this study was to determine whether modified Ojayeonjonghwan (KH-204, Korean herbal formula) improved LOH. KH-204 is a strong antioxidant herbal formula. We evaluated the effect of Korean herbal prescription on androgen receptor (AR) expression in an aged rat model of LOH. MATERIALS AND METHODS: Eighteen-month-old rats were used as aged LOH rat models. Eighteen Sprague-Dawley rats were randomly divided into three equal groups of six animals each and treated with one of the following: 1) normal control group (oral administration with distilled water, n=6), 2) KH-204 200 group (oral administration with 200 mg/kg of KH-204, n=6), and 3) KH-204 400 group (oral administration with 400 mg/kg of KH-204, n=6). After four weeks of treatment (once daily, distilled water or KH-204), serum testosterone levels, changes in testicular and epididymal weight, Western blotting analysis of AR expression and measurement of oxidative stress were examined. RESULTS: Treatment with the herbal formulation KH-204 200 mg/kg and 400 mg/kg (1) increased the weights of testis and epididymis; (2) increased the level of serum testosterone; (3) increased the level of superoxide dismutase and reduced the level of 8-hydroxy-20-deoxyguanosine; and (4) upregulated AR expression in testicular tissue. CONCLUSIONS: KH-204 might be an effective alternative for LOH. It improves antioxidant mechanisms and increases testicular AR expression without side-effects.

Efficient Promotion of Autophagy and Angiogenesis Using Mesenchymal Stem Cell Therapy Enhanced by the Low-Energy Shock Waves in the Treatment of Erectile Dysfunction.

BACKGROUND: Mesenchymal stem cell therapy (MSCT) and defocused low-energy shock wave therapy (ESWT) has been shown to ameliorate erectile dysfunction (ED). However, the interactions and effects of action between MSCT and ESWT remain poorly understood. In this study, we investigated the mechanisms of combination therapy with MSCT and ESWT in a rat model of diabetic ED. MATERIALS AND METHODS: Eight-week-old male Sprague-Dawley rats were randomly divided into 2 parts. Diabetic rats induced by streptozotocin (65 mg/kg) were randomly divided into 4 groups: (1) DM control group, (2) DM + ESWT group, (3) DM + MSCT group, and (4) DM + ESWT + MSCT group. The sham group was a normal control group (without streptozotocin). MSCT and (or) ESWT were, respectively, administered to each group according to the proposal for 8 weeks. Immediately after recording of intracavernous pressure (ICP), the penis was then harvested for histologic analysis, ELISA, and Western blotting. RESULTS: The ratio of ICP/MAP was significantly higher in the DM + ESWT + MSCT group than in ESWT or MSCT treated group (P < 0.05). Also, the treatment stimulated angiogenesis and vasodilatation in the corpus cavernosum (P < 0.05). ESWT increased the quantity of MSCs in the corpus cavernosum and also induced MSCs to express more VEGF in vitro and vivo (P < 0.05) which activated the PI3K/AKT/mTOR and NO/cGMP signaling pathways in the corpus cavernosum. The combination approach stimulated autophagy and decreased apoptosis in the corpus cavernosum. NGF and BDNF expressions were higher in the DM + ESWT + MSCT group than in the DM control group (P < 0.01). Furthermore, the treatment promoted the MSC recruitment by inducing penile tissues to express more PECAM and SDF-1. CONCLUSIONS: Combination of LI-ESWT and MSCT can get a better result than a single treatment by expressing more VEGF which can take part in autophagy by triggering the PI3K/AKT/mTOR signaling pathway. This cooperative therapy would provide a new research direction in ED treatment for the future.

Outcomes of ureteroscopic double-J ureteral stenting for distal ureteral injury after gynecologic surgery.

INTRODUCTION AND HYPOTHESIS: Ureteral injuries are well-known complications of any gynecologic surgery. We evaluated the safety and feasibility of ureteroscopic double-J (DJ) ureteral stenting in patients with distal ureteral injuries after gynecologic surgery. METHODS: Eleven consecutive patients with an iatrogenic ureteral injury in the distal ureter secondary to gynecologic surgery underwent DJ ureteral stenting between March 2008 and January 2016. Ureteral leakage and stricture were appraised using intravenous pyelography. The operative and clinical outcomes were evaluated. RESULTS: The DJ ureteral stent was successfully inserted using ureteroscopy in all patients, none of whom showed major or minor complications during the intraoperative and perioperative follow-up periods. Intravenous pyelography performed every 3 months during the follow-up period verified recovery at the ureteral injury site, without urine leakage. However, five patients experienced ureteral stricture. Balloon dilatation or Holmium laser endoureterotomy was performed successfully in all patients. One patient with recurring ureteral stricture was retreated using Holmium laser endoureterotomy and balloon dilatation; during 12 months of follow-up, there was no recurrence. Overall long-term success rate was 100%, with a mean follow-up of 20.4 months. CONCLUSION: DJ stenting using ureteroscopy diminishes the necessity for invasive surgical procedures and is regarded as one of the available management options for patients with an iatrogenic ureteral injury before considering an invasive operation. However, since ureteral stricture frequently occurs after ureteroscopic procedures, it is essential to select the appropriate patients.

Effects of Next-Generation Low-Energy Extracorporeal Shockwave Therapy on Erectile Dysfunction in an Animal Model of Diabetes.

PURPOSE: Gene therapy, stem cell therapy, and low-energy extracorporeal shockwave therapy (ESWT) have been investigated as treatments for refractory erectile dysfunction (ED), but inconclusive evidence has been obtained. We investigated the effect of a next-generation electromagnetic cylinder ESWT device on an animal model of ED. MATERIALS AND METHODS: Diabetes mellitus (DM)-induced rats were divided into 3 groups: group 1, control; group 2, DM; and group 3, DM+ESWT. Rats were treated with ESWT 3 times a week for 2 weeks. After the treatment course, intracavernous pressure was measured and the corpus cavernosum and cavernous nerve were evaluated. RESULTS: In the DM group, all parameters predicted to be significantly lower in the ED model had statistically significantly decreased (p<0.01). As a measurement of erectile function, intracavernous pressure was evaluated. The DM+ESWT group exhibited significantly restored erectile function compared to the DM group (p<0.05). Moreover, ESWT treatment restored smooth muscle content, as assessed by Masson's trichrome staining (p<0.05). Finally, corporal tissue and the dorsal nerve were evaluated by immunohistochemistry, Western blotting, and ELISA. After ESWT treatment, vascular endothelial growth factor (VEGF), endothelial nitric oxide synthase (eNOS), platelet endothelial cell adhesion molecule-1, cyclic guanosine monophosphate, and neuronal nitric oxide synthase (nNOS) expression levels were restored to levels in the DM group (p<0.05). CONCLUSIONS: Electromagnetic cylinder ESWT device resulted in increased VEGF, nNOS, and eNOS expression; reduced smooth muscle atrophy; and increased endothelial cell regeneration in a DM-associated ED model. Our data suggest that safe and effective application could be possible in future clinical studies.

Antioxidant and Antifibrotic Effect of a Herbal Formulation In Vitro and in the Experimental Andropause via Nrf2/HO-1 Signaling Pathway.

The Korean herbal formulation Ojayeonjonghwan is used for improving late-onset hypogonadism (LOH) symptoms such as erectile dysfunction (ED). A previous research suggested that a modified Ojayeonjonghwan (KH-204) could be used as an alternative to the treatment for ED. The pharmacological effects were examined in different conditions, including in vitro and in vivo. We measured the survival rate of TM3 Leydig cells under the oxidative stress condition. The s.c. injection of leuprorelin was used to induce androgen deprivation. We measured serum testosterone levels, oxidative stress, and apoptosis. The results of the treatment by KH-204 (1) preserved TM3 cells from oxidative stress by improving the expression of nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1); (2) lowered the expression of transforming growth factor-beta (TGF-ß) 1/SMAD; (3) increased the average of serum testosterone in androgen-deprived male rats; (4) kept the activation of spermatogenesis; (5) upgraded the contents of 8-hydroxy-20-deoxyguanosine (8-OHdG) and degraded the contents of superoxide dismutase (SOD); and (6) reduced apoptosis. We studied that KH-204 improved testicular dysfunction in LOH. It is likely, at least in part, to degrade oxidative stress through the Nrf2/HO-1 pathway. These findings may offer credible evidences for the use of new alternative therapies to treat LOH.