Multicenter Study on the Efficacy and Safety of Intracavernous 'TM' (Standro(R)) for the Treatment of Erectile Dysfunction in Korean / 대한비뇨기과학회지

PURPOSE: To evaluate the efficacy and safety of an intracavernous injection of lyophilized papaverine/phentolamine/alprostadil (Standro(R)) for the treatment of erectile dysfunction (ED) in Koreans. MATERIALS AND METHODS: 249 men (>20 years old), with ED (>6 month duration), were enrolled from 14 clinical centers. The intracavernous 'TMs' were titrated in a stepwise fashion at the clinic, from 0.05-0.25ml (17.64mg papaverine, 0.6mg phentolamine, and 6mug alprostadil per ml), with increment of 0.02-0.05ml, according to the etiology and severity of the ED and the patients' ages. RESULTS: Of the 249 men, 238 completed the dose titration, and progressed to home treatment of 3 months duration. Of these 238, 193 (psychogenic 13.0%, organic 75.5%, mixed 11.5%) completed the home treatment (4 or more self-injections), with the other 45 dropping out (lost to follow-up in 24, patient refusal in 9, no chance to have intercourse in 7 and omitted recording of patient diary in 2). The success rate per trial (a total number of sufficient erection for vaginal intromission/a total number of injections) and per patient (number of patients who had one or more sufficient erections for vaginal intromission/the enrolled patients at beginning or 193 patients), and the satisfaction rate per patient (number of patients who had both patient and partner satisfaction with erection/193 patients) were 74.1, or 91.2 and 75.1%, respectively. The adverse reactions were prolonged erections in 3, urethral pain in 1 and penile skin edema in 2. Three patients complained of penile pain during an erection, but there was no dropout due to the pain. No significant changes in laboratory tests were found after the home treatment. CONCLUSIONS: A 'TM' seems to be effective and safe for an intracavernous injection for the treatment of men with erectile dysfunction.

Renal Pseudoaneurysm after Percutaneous Nephrolithotomy / 대한비뇨기과학회지

Renal hemorrhage is a most distressing complication of percutaneous renal surgery. Two cases of renal pseudoaneurysm that occurred as a complication of percutaneous nephrolithotomy (PNL) for staghorn calculi are presented. Two male patients were admitted to our hospital for treatment of staghorn calculi. Laboratory data on admission revealed no significant abnormality. They underwent PNL, and most of the calculi were removed. Two nephrostomys were placed in the middle and lower calyces, and were removed at two and three days postoperatively, respectively. Significant bleeding, uncontrolled by the usual measures, developed for six and eight days following the removal of the nephrostomy tubes. Renal angiography was performed and demonstrated pseudoaneurysms. At the same time the pseudoaneurysms were treated by superselective embolization with a coil. We keep in mind the late hemorrhage after PNL, even when there was no hemorrhage from nephrostomy removal.

The Value of Magnetic Resonance Imaging in the Diagnosis of Penile Fracture / 대한비뇨기과학회지

Penile fracture is known as a rupture of the tunica albuginea occurring during erection. Diagnosing a penile fracture is usually not difficult, and often is based on the patients history and a physical examination. However, patients with atypical clinical findings may require an accurate diagnostic procedure. Immediate surgical intervention is normally used for treating a penile fracture due to the high risk of complications associated with conservative management. The authors recently experienced 2 cases of a penile fracture and the superiority of magnetic resonance imaging (MRI) over ultrasonographic imaging for diagnosing a suspected penile fracture was shown. Therefore, MRI is recommended for diagnosing a suspected atypical penile fracture.

Clinical Significance of PTEN Expression in Bladder Cancer / 대한비뇨기과학회지

PURPOSE: PTEN (phosphatase and tensin homolog) is a tumor suppressor gene located on the chromosome 10q23. PTEN plays a role in inducing cell cycle arrest and apoptosis. We determined the PTEN expression to evaluate the role of PTEN in aggressiveness and invasiveness of bladder cancer. MATERIALS AND METHODS: PTEN expression was evaluated immunohistochemically in 73 patients with bladder cancer according to grade, stage and lymph node involvement. Cases were considered positive when granular cytoplasmic staining was seen in tumor cells and negative when the tumor tissue was not stained. RESULTS: PTEN was expressed in 50 (68.5%) of 73 patients. In superficial bladder cancer (n=40), 37 patients (92.5%) were positive. Thirteen patients (39.4%) were positive in T2 or higher bladder cancer (n=33). In low grade bladder cancer (n=47), 40 patients (85.1%) were positive. Ten patients (38.5%) were positive in high grade bladder cancer (n=26). PTEN expressions were positive in 1 (11.1%) of 9 lymph node-positive and 12 (50%) of 24 lymph node-negative bladder cancers. CONCLUSIONS: These data demonstrate that loss of PTEN expression has a correlation with aggressiveness and invasiveness in bladder cancer. Therefore, our results suggest that loss of PTEN protein may be a useful marker of poor prognosis in bladder cancer.

Clinical Outcome Between Fixations of the Rectus Fascia to the Cooper's Ligament and Abdominal Wall in Pubovaginal Sling Operation

PURPOSE: Pubovaginal fascial sling for stress urinary incontinence has never achieved widespread application because of a perception that the complication rate (prolonged urinary retention and secondary detrusor instability) is relatively high. We performed modified pubovaginal fascial sling operation and compared the safety and efficacy of the Cooper's ligament fixation with those of abdominal wall fixation of rectus fascia in pubovaginal sling. MATERIALS AND METHODS: We retrospectively compared 30 women treated with pubovaginal fascial sling procedure as Blaivas described in 1995(Group I) with 30 women treated with a modified technique included fixation of sling to the Cooper's ligament(Group II). Patients were evaluated preoperatively with detailed history, physical examination, urodynamic study and incontinence staging. Postoperative outcome measures and complications were checked. RESULTS: Preoperative parameters, such as clinical and urodynamic data were comparable for both groups. With a mean follow-up of 5.4 months(range 1-14) for group I, 27(90%) were cured. In group II, with a mean follow-up of 6.7 months(range 1-11), 28(93%) were cured. Postoperative de novo urge incontinence was present in 6(20%) patients in group I. The hospital stays, periods of residual urine below 50ml and postoperative lower abdominal pain of group II were significantly lower than those of group I. Each group(97%) was either very satisfied or somewhat satisfied with their outcome. CONCLUSION: Modified pubovaginal fascial sling operation including the use of small piece of rectus fascia and fixation of sling to the Cooper's ligament is an effective treatment for stress incontinence with high cure and low complication rate. However, larger followup is needed to confirm our results.