Percutaneous Nephrolithotomy: Comparison of the Efficacies and Feasibilities of Regional and General Anesthesia

PURPOSE: To compare surgical outcomes and complications after percutaneous nephrolithotomy (PCNL) under regional or general anesthesia. MATERIALS AND METHODS: One hundred and one patients who underwent PCNL as a first-line treatment for kidney calculi between June 2004 and June 2013 were enrolled in this retrospective study. Patients were classified into two groups by anesthetic method: 77 were allocated to the regional anesthesia group and 24 to the general anesthesia group. Patient general characteristics, stone features, surgical outcomes, and complications were compared between the two groups. RESULTS: The two groups were similar in terms of mean age and stone size, number, and type. Furthermore, they did not differ significantly in terms of general characteristics, treatment outcomes, or complications excluding postoperative fever. However, mean hospital stay was significantly shorter in the regional anesthesia group than in the general anesthesia group (8.9+/-3.2 days vs. 11.5+/-6.9 days, respectively, p=0.025). Also, the postoperative fever rate was significantly higher in the general anesthesia group (53.2% vs. 83.3%, respectively, p=0.007). CONCLUSIONS: Regional anesthesia is as effective as general anesthesia during percutaneous nephrolithotomy and is associated with shorter hospital stays and lower rates of postoperative fever.

Efficacy and Safety of Emergency Ureteroscopic Management of Ureteral Calculi

PURPOSE: To evaluate the efficacy and safety of the ureteroscopic management of ureteral stones immediately after a first colic attack. MATERIALS AND METHODS: We retrospectively analyzed the data of 226 patients with obstructive ureteral stones who underwent ureteroscopy with stone retrieval. The 67 patients in group A underwent ureteroscopy within 48 hours of admission to our emergency department, whereas the 159 patients in group B underwent ureteroscopy more than 48 hours after admission. The chi-square test was used to evaluate and compare stone-free status, auxiliary procedures, and complications and the Kruskal-Wallis and Fisher's exact tests were used to analyze qualitative data. RESULTS: Mean stone sizes in groups A and B were 2.41+/-1.62 mm and 4.11+/-2.64 mm, respectively. No patient experienced a major complication during or after the procedure. Stone-free rates were 89.55% and 89.93%, respectively. CONCLUSIONS: Emergency ureteroscopy in cases of obstructive ureteral stones is both safe and effective and offers the advantages of immediate stone fragmentation and the relief of acute-onset colic pain.

Cystic Nephroma: A Case Report and Comparing Literature Review with Mixed Epithelial and Stromal Tumor of Kidney

Cystic nephroma (CN) is a benign cystic neoplasm composed of mixed epithelial and stromal elements. Less than 200 cases have been reported. We had a patient, a 41-year-old woman, who had a huge typical CN. The patient was admitted for a right renal mass that was found incidentally. On laparaoscopic right nephrectomy, there was an encapsulated 7 cm multilocular cystic mass at the upper pole. Microscopically, the cystic wall was lined by a single layer of low cuboidal or hobnail epithelium without a solid area. The thin septa were composed of bland, ovarian type spindle cells. The main differential diagnoses were mixed epithelial and stromal tumor (MEST), low grade multilocular renal cell carcinoma, and tubulocystic carcinoma. The results of immunohistochemical staining were cytokeratin 7/19(+/+) and CD10(-) in lining epithelium, estrogen receptor/progesterone receptor(+/+) in stromal cells. After surgery, she was free of recurrence for 10 months. We report this rare case and compare it with other cystic renal tumors, especially MEST.

Outbreak of Swine-Origin Influenza A (H1N1); Experience of a Regional Center in Seoul during a Month, August-September 2009 / 대한임상미생물학회지

BACKGROUND: The aim of this study is to clarify the epidemiology of swine-origin influenza A (H1N1) virus 2009 (S-OIV) during the first month of outbreak at one of influenza clinic in Seoul, Korea. METHODS: We documented the epidemiologic and clinical features of S-OIV-confirmed cases who visited a university hospital in Northeastern Seoul between August 21 and September 20, 2009. Nasopharyngeal swab of patients with acute febrile respiratory illnesses were evaluated with rapid influenza antigen tests and multiplex RT-PCR for S-OIV and seasonal influenza A. RESULTS: A total of 5,322 patients with acute febrile respiratory illnesses were identified at our influenza clinic for the study period. S-OIV was confirmed in 309 patients by RT-PCR. The patients ranged from 2 months to 61 years of age and 189 patients (61.2%) were teenagers. Eighty-one patients had known contact with S-OIV-confirmed patients in schools (N=61), households (N=15), and healthcare facilities (N=3). Frequent symptoms were fever (94.5%), cough (73.1%), sore throat (52.1%), and rhinorrhea (50.5%). Gastrointestinal symptoms were also present in 10 patients (4.9%). Ten patients (4.9%) required hospitalizations. Seventy patients (22.7%) could not take oseltamivir at the first visits, however, all of them recovered without complication. Rapid antigen tests showed the sensitivity of 44.4% (130/294). Patients with positive antigen tests, compared with negative antigen tests, showed higher frequencies of rhinorrhea (60.8% vs 43.3%, P=0.004) and stuffy nose (33.8% vs 20.1%, P=0.012). CONCLUSION: S-OIV infections spread predominately in school-aged children during the early accelerating phase of the outbreak. Rapid influenza antigen tests were correlated with nasal discharge and obstruction.

Comparison of Percutaneous Nephrolithotomy Using Pneumatic Lithotripsy (Lithoclast(R)) Alone or in Combination with Ultrasonic Lithotripsy

PURPOSE: Percutaneous nephrolithotomy (PCNL) is the procedure of choice for treating large renal stones. Pneumatic lithotripsy (Lithoclast(R)) is effective regardless of the stones' composition, and ultrasonic lithotripsy allows the aspiration of small debris during lithotripsy. We investigated the efficacy and safety of PCNL via Lithoclast(R) alone or combined with ultrasonic lithotripsy. MATERIALS AND METHODS: Thirty-five (group A) and 39 (group B) patients underwent Lithoclast(R) PCNL and combination therapy, respectively, from May 2001 to March 2010, and the two groups were compared in terms of stone size, location, and composition; operative time; average number of treatments; hospital days; hemoglobin loss; ancillary procedures; rate of device failure; and initial and total stone-free rates. RESULTS: The two groups did not differ significantly in preoperative stone size, location, or composition; the average number of treatments; or the initial and overall stone-free rates. However, combination therapy was associated with a significantly lower operative time (181+/-50 vs. 221+/-65 min, respectively, p=0.004), number of hospital days (11.6+/-3.8 vs. 14.2+/-4.4 days, respectively, p=0.009), and average hemoglobin loss (1.12+/-0.61 vs. 1.39+/-1.02 g/dl, respectively, p=0.013). Transfusions were required in 6 patients (4 and 2 in each group, respectively), but there were no significant complications related to percutaneous access. There were 2 (5.7%) mechanical failures (Lithoclast(R) probe fracture) in the group A and 5 (12.8%) in the group B (2 cases of suction tube obstruction, 3 cases of overheating). CONCLUSIONS: The combination of ultrasonic lithotripter and Lithoclast(R) is more effective than Lithoclast(R) alone because it significantly decreases operative time, hemoglobin loss, and the hospital stay. This may reflect the superior power of Lithoclast(R) and the ability to aspirate the debris during ultrasonic lithotripsy.

Long-Term Results of Immediate Surgical Treatment of Penile Fracture

PURPOSE: Penile fracture is a rare but serious urological condition. Immediate surgical repair is widely accepted as the treatment of choice in penile fracture. The aim of this study is to investigate the long-term outcome of immediate surgical treatment of penile fracture. MATERIALS AND METHODS: This is a retrospective study of 12 men with penile fracture who were treated in the Department of Urology, Sanggyepaik Hospital, Seoul, Korea from January 2000 to June 2005. Diagnosis was made clinically and was confirmed by cavernosography in all our patients. All patients underwent immediate surgical repair, within two days after trauma, using a degloving incision. The long term results of the immediate surgical repair were evaluated using questionnaire on outpatient department visiting or telephoning. RESULTS: The median patient age was 43 years (range, 18 to 57 years). The median follow-up was 32 months (range, 14 to 60 months). Of these patients, 8 (66.7%) patients were injured during sexual intercourse, whereas 4 (33.3%) patients were injured during masturbation. All patients were treated by immediate surgery. All patients reported satisfactory, painless erectile function; two developed penile curvature and one had a penile nodule. CONCLUSIONS: Immediate surgical repair of penile fracture is effective, restores erectile function, and the incidence of complications is low.

Treatment in Pediatric Renal Trauma: A Conservative Management Approach

PURPOSE: The management of pediatric trauma is substantially derived from the results of adult trauma patient. Despite the increasing of pediatric renal trauma, the management of them still remains controversial. The aim of this study is to evaluate our experience with the expectant conservative management of blunt trauma in children. MATERIALS AND METHODS: We retrospectively studied 45 pediatric patients with renal trauma between 1995 and 2007. We reviewed medical records for clinical symptoms, mechanism of injury, assigned grade of renal injury, associated injuries, indication of surgery, and treatment outcomes. We graded renal injuries according to the American Association for the Surgery of Trauma Organ Injury Scale. RESULTS: All patients of grade I, II, III, and IV were managed conservatively at beginning, if the hemodynamic state is stable. Among them, 2 patients of grade IV were done delayed operation. One patient underwent delayed renorrhaphy for persistent anemia and hypotension, and the other patient needed delayed nephrectomy because of persistent fever and worsening abdominal pain with significant urinary extravasation. All patients of grade V were undergone early nephrectomy. CONCLUSIONS: Except for persistent fever with significant extravasation and grade V injury, initial conservative management of blunt renal trauma in children is effective and recommendable at beginning, if the hemodynamic state is stable. Prospective larger randomized controlled trials will be needed.

Staghorn Stones Combined with Transitional Cell Carcinoma of the Renal Pelvis

Longstanding, unrecognized staghorn stones remain a major cause of morbidity in the form of pain, infection, and functional impairment of the affected kidney. Squamous cell carcinoma of the upper urinary tract is associated with stone disease and chronic infection, but the association with transitional cell carcinoma (TCC) has not been proven. We report a case of a 73-year-old man presenting with right flank pain with episodes of total gross hematuria for 1 year. An abdominopelvic computed tomography scan showed decreased parenchymal enhancement and staghorn stones in the right renal pelvis and multiple tiny calyceal stones with severe hydronephrosis. The patient underwent a simple nephrectomy. Histopathologic analysis revealed staghorn stones combined with high-grade papillary TCC of the renal pelvis. The tumor was extended into the peripelvic fat and renal parenchyme (pT3NoMo).

Suprapubic Arch Procedure for the Treatment of Urinary Incontinence in Elderly Female Patients / 대한비뇨기과학회지

PURPOSE: There has been considerable controversy regarding the treatment of urinary incontinence(UI). The aim of our study was to investigate the efficacy and safety of the suprapubic arch(SPARC) procedure for the management of UI in elderly women. MATERIALS AND METHODS: A retrospective analysis was conducted on 301 women who underwent the SPARC procedure for SUI. The patients were divided into two groups: group A( or=65 years). Among these patients, women with mixed urinary incontinence(MUI) were assigned to either group C( or=65 years). The objective and subjective SPARC success rates were evaluated postoperatively. RESULTS: There were 258 patients in group A, 43 patients in group B, 44 patients in group C, and 11 patients in group D. The objective surgical success rates for groups A and B were 97.7% and 95.3%, respectively (p=0.304). The subjective success rates for groups A and B were 97.3% and 95.3%, respectively(p=0.311). Recommendation rates for the SPARC procedure were 93% in group A and 93% in group B(p=0.5). In patients with MUI(groups C and D), the objective success rates were 93.2%(group C) and 81.8%(group D)(p=0.286). The subjective success rates were 93.2% (group C) and 81.8%(group D)(p=0.286). The complication rates were similar between the two study groups: 5.4%(group A) vs 7.0%(group B) (p=0.359). CONCLUSIONS: The SPARC procedure is effective and safe, and it offers a satisfactory success rate in elderly women with UI.

The Effectiveness of Transurethral Resection of the Prostate Combined with High Power Potassium-titanyl-phosphate(KTP) Laser Vaporization for Patients with a Prostate Volume Greater than 45cc / 대한비뇨기과학회지

PURPOSE: We compared the effectiveness of transurethral resection of the prostate(TURP) with the effectiveness of high power potassium-titanyl-phosphate(KTP) laser vaporization combined with TURP in patients with a prostate volume over 45cc. MATERIALS AND METHODS: Between March 2004 and March 2007, we analyzed all the patients with a prostate volume over 45cc and who underwent TURP or KTP laser vaporization combined with TURP for treating symptomatic benign prostatic hyperplasia(BPH). The patients were divided into two groups(Group I: TURP: n=53, Group II: KTP laser vaporization combined with TURP: n=54). The initial evaluation included a digital rectal examination, urinalysis, determining the hemoglobin, electrolyte and prostate-specific antigen(PSA) levels, the International Prostate Symptom Score(IPSS), the quality of life(QoL), the maximum urine flow rate (Qmax), the postvoiding residual urine(PVR), transrectal ultrasonography (TRUS) and urodynamic study. The postoperative hemoglobin and electrolyte levels were checked promptly, and the total operation time, the foley indwelling period and the number of hospital days were recorded afterwards. The IPSS, QoL, Qmax, and PVR were evaluated at 1 and 3 months postoperatively. RESULTS: The baseline characteristics and postoperative outcomes of the two groups were similar. The total blood loss during operation was significantly lower in Group II(p=0.02). CONCLUSIONS: KTP laser vaporization combined with TURP resulted in less blood loss than TURP and it provided a good operation field in those patients who have over 45cc of prostate. Thus, KTP laser vaporization combined with TURP is safer than performing only TURP.

Comparative Analysis of Clinical Parameters in Acute Pyelonephritis / 대한비뇨기과학회지

PURPOSE: To compare the variable inflammatory parameters of acute pyelonephritis patients treated with inpatient therapy at 13 hospitals, according to the age and gender distributions. MATERIALS AND MATHODS: A total of 3,544 medical records of patients with confirmed acute pyelonephritis, and admitted to hospital between January 2000 and December 2005, were retrospectively analyzed. RESULTS: The mean age of the patients was 43.2+/-16.2 years old, with a male:female ratio of 1 : 5.1. The average duration of hospital admission was 7.9+/-5.3 days. Underlying diseases were found in 23.0% (749/3,252 patient), largely due to diabetes (35.1%). Radiological abnormal findings were found in 13.7%. The leukocyte count, ratio of segmented form, erythrocyte sedimentation rate (ESR), c-reactive protein, pyuria, positive blood culture, positive urine culture were 11,014+/-5,778/mm(3), 74.8+/-14.5%, 44.0+/-32.0 mm/hr, 12.4+/-9.3mg/dl, 83.9%, 10.5% and 46.7%, respectively. E. coli grow in 79% of the urine culture positive patients. In a comparison of 3 age groups (61 years), the elderly patients had a greater number of underlying diseases and more pathogens in cultured blood. When divided into males and females, the elderly male patients had more pathogen in cultured urine, but contrary to the male patients, the elderly female patients had elevated leukocyte count and erythrocyte sedimentation rate. Also, the old patient group had more resistance to ampicillin when they had E. coli as the uropathogen (p=0.021). Patients with higher ESR required longer hospital admission periods. CONCLUSIONS: It was found that variable clinical parameters of acute pyelonephritis patients treated with inpatient therapy differed according to both gender and age group in Korea. Therefore, these factors should be taken into account in the treatment plan.

Malignant Pheochromocytoma that Recurred in the Contralateral Adrenal Gland and Metastasized to the Bladder / 대한비뇨기과학회지

Pheochromocytoma is an uncommon neoplasm and it is derived from the neural crest. It is one of the surgically curable hypertensive syndromes. The sequela of this disease can be serious if definite treatment is not promptly performed. We report here on a case of malignant pheochromocytoma that recurred in the contralateral adrenal gland and it subsequently metastasized to the bladder after the patient refused treatment of the contralateral adrenal tumor.

Comparison between Rigid Ureteroscopic Stone Removal (URS) and Extracorporeal Shock Wave Lithotripsy (ESWL) for Large (>10mm) Upper Ureteral Stones / 대한비뇨기과학회지

Purpose: The aim of this study was to compare the efficacy, safety and compliance of ureteroscopic stone removal (URS) patients who were treated with extracorporeal shock wave lithotripsy (ESWL) for large (>10mm) proximal ureteral stones. Materials and Methods: We reviewed 123 patients who were treated for upper ureteral stones (>10mm) between January 2000 and March 2005. URS and ESWL were performed in 51 and 72 patients, respectively. Success was defined as the patients achieving a stone-free status on radiography at 1 month after treatment. We analyzed the success rates of stone removal, the reasons for failure and the complication rates of each procedure. Results: The overall success rate of URS was 90.2%. For the ESWL treatments, the overall success rates after the first, second, third and more sessions were 47.2%, 61.1%, 76.4% and 81.9%, respectively. Notably, the stone free rate of the URS group was better than that of the 1st, 2nd and 3rd session ESWL group (p10mm) upper ureteral calculi. Thus, this procedure should be considered as first line therapy for large (>10mm) upper ureteral stones. In addition, for the proper selection of patients for ESWL and URS, analysis of the cost effectiveness, compliance and recurrence rates of the two groups should be done in the future.

The Usefulness of Ureteral Stenting for Acute Ureteral Obstruction in Pregnancy / 대한비뇨기과학회지

Purpose: An acute ureteral obstruction during pregnancy presents both diagnostic and therapeutic challenges. When conservative therapy fails, temporary measures, such as ureteral stenting, are often chosen as a first- line intervention, which postpones definitive management until delivery. The usefulness of ureteral stenting was evaluated as an emerging strategy for the symptoms of an acute ureteral obstruction during pregnancy. Materials and Methods: Between 1996 and 2005, a retrospective analysis was performed on 53 pregnant patients with an acute ureteral obstruction. Eighteen of the patients were treated by ureteral stenting, as they failed to improve with conservative management. They were followed up until the removal of the ureteral stent. Results: Seventeen patients (95%) experienced significant pain relief within at least 2 days, but one patient (5%) did not. On ultrasound, 16 patients (88%) had resolution of hydronephrosis. Twelve patients (66%) continued to have problems with post-therapeutically irritative voiding symptoms, but 11 (61%) experienced relief of symptoms within 10 days. One patient (5%) had the ureteral stent removed due to the continuous complaint of irritative voiding symptoms. After delivery, all patients were taken intravenous pyelography (IVP). Fourteen patients showed normal findings, but 4 were diagnosed with a ureteral stone. Three patients were treated by extracorporeal shock wave lithotripsy (ESWL) for a stone in the upper and lower urinary tract. One patient, with a mid ureteral stone, was treated by ureteroscopic lithotripsy. Conclusions: Ureteral stents were usually placed without any major problems, and well tolerated, with only minor and short post-therapeutic discomfort. We concluded that ureteral stenting is a simple, safe and effective first-line therapeutic option in case of symptomatic and acute ureteral obstruction during pregnancy.

The Influence of Chlormadinone Acetate on the Total and Free Serum Prostate Specific Antigen Levels in Men with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Chlormadinone acetate (CMA) therapy for benign prostatic hyperplasia (BPH) may lower the serum prostate specific antigen (PSA) level. However, little is known about the effect of CMA on the total or free serum PSA levels of PSA. Such information would be important since PSA testing is useful for prostate cancer screening. Thus, we prospectively studied the effect of CMA therapy on the total and free serum PSA levels. MATERIALS AND METHODS: The patients with lower urinary tract symptoms (LUTS) and BPH who were aged over 50 years were treated with 50mg CMA for 6 months. Men with a PSA level greater than 10ng/ml were excluded to reduce the likelihood of including cases of occult prostate cancer. Those with suspicious findings on the digital rectal examination and serum PSA testing were biopsied to rule out prostate cancer. alpha- blocking agents were permitted to treat the men with LUTS. Serum levels of the total and free PSA were measured at the study baseline and after approximately 3 and 6 months. The prostate volume (PV) was assessed by transrectal ultrasonography. RESULTS: The analysis included 170 patients with a mean age of 67.9 years, a baseline PV of 47.3ml and a baseline total PSA of 4.1ng/ml. The total PSA levels declined from 4.1ng/ml at baseline to 2.0ng/ml after 6 months of treatment (50.7% decrease, p<0.01). The mean percent free PSA (21% to 22% at baseline) was not significantly altered by CMA treatment. The PSA levels and PV at baseline did not affect the rate of decline of PSA. CONCLUSIONS: The total PSA serum levels decreased by an average of 50% during CMA therapy, but the percent free PSA did not change significantly. This information is potentially useful in the interpretation of the PSA data that's used for early detection of prostate cancer in the men receiving CMA.

Clinical Outcome of Acute Bacterial Prostatitis, a Multicenter Study / 대한비뇨기과학회지

PURPOSE: Few studies have examined acute prostatitis in Korea. To initiate the investigation of this topic, a multi-center retrospective analysis of acute prostatitis was conducted. MATERIALS AND METHODS: The clinical records of 335 patients from 13 hospitals, diagnosed with acute prostatitis, between January of 1994 and October of 2004, were reviewed. For each patient, the urine culture, changes in the PSA (prostate-specific antigen) value and the prostate volume, the incidence of prostate abscess, the use of antibiotics, and whether the disease went into remission or progressed to chronic prostatitis were analyzed. RESULTS: The mean age of the patients, time from the onset of symptom to admission and number of days of admitted were 54.9+/-15.1 (16-85) years, 2.4+/-3.4 (16-85) days and 7.5+/-3.9 (1-25) days, respectively. The chief symptoms of the patients were high fever, dysuria and urinary frequency. Routine urinalysis found pyuria in 82% and hematuria in 70% of patients. The causative organisms of 43.0% of the patients were cultured, with the chief organisms found to be E. coli (67%) and P. aeruginosa (13%), et al. The mean PSA and prostate volume on initial diagnosis were 24.6+/-30.2ng/ml and 45.8 +/-17.4ml, respectively, and a prostate abscess was found in 4 patients (3.1%). The antibiotics injected during patient admission were: cephalosporin family (68%), aminoglycosides (70%) and quinolone family (43%). An additional alpha blocker was used in 49% of cases. Oral quinolone (91%), cephalosporin (9%) and alpha blocker (44%) were prescribed for a mean 32.5 (2-180) days after discharge. 259 (77%) of the patients were available for follow-up. Of these, 21% took antibiotics over an 8 week treatment period, and 8% over a 12 week period. The disappearance of pyuria after treatment was observed in a mean of 13 days after the end of treatment. After 13 weeks of treatment, 11 (50%) of the 22 patients who received prostate massage (4.2% of all follow up patients) were found to have chronic prostatitis. The mean PSA and prostate volume declined during follow up, to 6.13+/-10.38ng/ml and 37.5+/-13.5ml, respectively. CONCLUSIONS: In our study, the most common chief symptom of acute prostatitis was a high fever, with the most common causative organism being E. coli. Patients were admitted for approximately one week, and treated with antibiotic for about one month, after which time PSA elevation was observed in 80% of patients. Although all acute prostatitis patients were treated with proper antibiotics, progression to chronic prostatitis was observed in 4.2% of patients.

Traumatic Dislocation of Testis / 대한비뇨기과학회지

Traumatic dislocation of the testis is defined as an ectopically displaced testis as the result of trauma. It is usually associated with motorcycle accidents, but a few cases have been reported from incidents ranging from kicks to the perineum to falling accidents. Traumatic dislocation of the testis occurs as a result of direct pressure exerted on the scrotum causing the testicle to be expelled into the surrounding tissue. We experienced 3 varying cases of superficial inguinal dislocations of the testis. One was due to a motorcycle accident, another to kicks and one to a falling accident. Spontaneous reduction is rare, and early surgical reduction is often required.

The Effect of Imipramine and Desmopressin on Sleep Arousal in Nocturnal Enuresis / 대한비뇨기과학회지

PURPOSE: High arousal threshold, nocturnal polyuria and small nocturnal functional bladder capacity have been implicated as causes of nocturnal enuresis. The two medications most widely used for the treatment of enuresis are imipramine and desmopressin. This study evaluated the effects of imipramine and desmopressin on sleep arousal. MATERIALS AND METHODS: A total of 50 enuretic patients who had responded to medications from Mar 1999 to Dec 2001 were evaluated. The mean age was 7 years old(range, 5-16), and there were 40 boys and 10 girls. They were classified into three groups according to their medication: imipramine group(22 patients), desmopressin group(7) and the combination group (imipramine+desmopressin, 21 patients). The parents were asked to record whether the patients woke up or not for 100 consecutive nights. RESULTS: The mean number of nights/100 nights that the patients woke up in each group was 3.2+/-7.2 in the imipramine group, 1.2+/-0.7 in the desmopressin group and 5.0+/-7.6 in the combination group. CONCLUSIONS: The main mechanism of imipramine and desmopressin for the treatment of enuresis does not seem to be associated with sleep arousal.

The Usefulness of GnRH Stimulation Test as a Predictor for Testicular Dysfunction in Adolescent Varicocele / 대한비뇨기과학회지

PURPOSE: We analyzed the RESULTS of the GnRH stimulation test to assess its usefulness as a predictor for testicular dysfunction in adolescent varicocele. MATERIALS AND METHODS: We studied 20 adolescents with unilateral varicocele from January 1998 to January 2001. Eight patients were grade II and 12 were grade III. Testicular volume was measured using an orchidometer. The responses of the gonadotropins to GnRH stimulus were compared between grade II and III patients. All patients had varicocelectomy and 7 were followed up. RESULTS: After GnRH stimulus, all patients except one showed excessive response in LH and FSH. LH response(8-fold greater than the baseline) was more exaggerated than that of FSH(1.8-fold greater than the baseline). The 12 patients of grade III varicocele presented greater excessive responses in LH and FSH to GnRH stimulus than those of grade II(p>0.05). After surgical treatment, the exaggerated gonadotropin response to GnRH was not normalized. But the response was less exaggerated, suggesting an improvement of testicular dysfunction. CONCLUSIONS: In this study, the grade of the varicocele was correlated with the excessive responses of the gonadotropins to the GnRH stimulus. Nevertheless, we suggest that the deterioration of the testicular function in adolescents with varicocele was a progressive phenomenon. We think that the GnRH stimulation test could be useful in assessing the testicular dysfunction in adolescent varicocele patients.

Bladder Stone Formation on Intra-uterine Contraceptive Device Perforated into the Bladder / 대한비뇨기과학회지

Various intravesical foreign bodies have been extracted from the bladder. Their introduction into the bladder may be through self-insertion, iatrogenic insertion or migration from the adjacent organs. The means of extracting the foreign bodies differ according to the nature and characteristics of the foreign bodies and to minimize bladder and urethral injury. However, complete extraction should also be confirmed after the extraction procedure. Bladder stone formation in an intra-uterine contraceptive device that perforates into the bladder seldom occurs. We experienced a case of a bladder stone that formed in an intra-uterine contraceptive device, which had perforated into the bladder. The possibility of an intravesical foreign body should be considered in any patient with chronic unexplained lower urinary tract symptoms.