Compensatory Impotence / 대한비뇨기과학회지

Recently, compensatory impotence has increased with the development of industry, the rise in vehicles, the sexual revolution, the secured legal and insurance services. Compensatory impotence is a medicolegal term for the male erectile dysfunction that requires a doctor's medical certificate and opinion are regarding legal responsibility, reparation or compensation rather than primary medical care of the diagnosis and treatment by the patient or his procurator. We studied 69 cases of compensatory impotence (mean age 38.1, range 24-58) at the Department of Urology, Pusan National University Hospital from January 1987 to December 1995. The marital status were married, separated, single and divorced in 37 (53.6%),14 (20.3%), 13 (18.8%) and 5 (7.3%) cases, respectively. Opinions as to cause of impotence were sought from medical documents of university hospital 34 (49.3%), legal documents required from the court 25 (36.2%) and industrial accident insurance documents 10 (14.5%). Trauma constituted 47 cases (68.1%) while 22 (31.9%) had no history of trauma. With trauma, spinal cord injury was the most common cause of impotence in 18 cases (38.3%), followed by urethral injury in 14 (29.8%), and penoscrotal injury, head trauma, pelvic bone fracture, electrical bum and bladder rupture in 5 (10.6%), 4 (8.5%), 3 (6.4%), 2 (4.3%), and 1 (2.1%), respectively. Organic impotence is predominant cause in trauma group and psychogenic is highest in nontrauma group. Of 34 cases who the impotence therapy was recommended, 14 (41.2%) were accepted. In conclusion, for the evaluation and management of the compensatory impotence with complex issue of legal, financial and social aspects, physician's objective mental attitude and the accurate medical survey with the legal comprehensions are primarily important. Additionally, common criteria for compensation should be established by the cooperative expertise of experts in the fields of medicine, law and insurance.

Comparison of Penile Size and Satisfaction between One Stage and Two Stage Urethroplasty for Hypospadias / 대한비뇨기과학회지

PURPOSE: We studied penile size of children who underwent hypospadias repair. Also we surveyed the degree of satisfaction with, as judged by patient's parents and urologist. MATERIALS AND METHODS: We measured the relaxed and erected penile size of children who underwent hypospadias repair and followed more than one year (28 cases of one stage repair and 20 cases of two stage repair). All of them had no complication. We used age adjusted ANOVA test for penile size, and Wilcoxon matched pairs signed rank test for comparison of satisfaction with penile appearance between one stage group and two stage group. RESULTS: Significant difference was noted between one stage group and two stage group for relaxed and erected penile length (p0.05). Two stage group showed statistically significant larger value than one stage group for glandular size, glandular shape, position of meatus, general appearance, and genital perception score as judged by patient's parents (p<0.05). And two stage group showed statistically larger value than one stage group for genital perception score judged by urologist (p<0.05). CONCLUSIONS: Our study demonstrated that two stage operation met with better penile size and satisfaction judged by patient's parents and urologist than one stage operation for middle and posterior penile hypospadias.

Inflammatory Pseudotumor of the Urinary Bladder: A Case Report / 대한비뇨기과학회지

Inflammatory pseudotumor of urinary bladder is a rare benign entity that clinically and radiologically simulates a malignant tumor. This benign lesion can easily be mistaken for sarcoma, and only careful pathologic examination can provide a definite diagnosis. It is important to recognize this lesion as benign to avoid the potentially serious consequences of misdiagnosis. A 53-year-old man presented with a history of micturition pain and urinary frequency despite of symptomatic treatment with antibiotics for 2 weeks. Cystoscopic examination, ultrasonography and of revealed a well defined mass with central necrosis. The mass was located at the left lateral wall of the bladder, and it was 3x3 cm sized round shape. We suspected benign tumor by above diagnostic modalities and we confirmed inflammatory pseudotumor by frozen section of mass, followed by partial cystectomy was performed. Awareness of this unusual lesion is important to prevent unnecessary surgical procedure. We report a case of inflammatory pseudotumor of the urinary bladder and reviewed 21 cases of this disease including our case.

The Significance of Urodynamic Study in Patients with Non-neoplastic and Non-traumatic Myelopathy / 대한비뇨기과학회지

Voiding functions in patients with non-neoplastic and non-traumatic myelopathy take a variable course according to severity and duration of disease. Fifteen patients of non-neoplastic and non-traumatic myelopathy were investigated neurologically thoroughly. On M.R.I. findings, hyperintense lesion was notified in a half of them but the others were nonspecific. On Pressure-Flow-EMG studies there were 7 cases of detrusor hyperreflexia with DSD, 2 cases of detrusor hyporeflexia with nonrelaxing striated muscle, 1 cases of detrusor hyporeflexia with coordinated striated muscle and 3 cases of normal findings. The thorough examination including M.R.I. and urodynamic study will be needed in patient with non-neoplastic and non-traumatic myelopathy because future possibility of their serious complications such as deterioration of renal function or impotence.

Congenital Patent Urachus: Report of 2 Cases / 대한비뇨기과학회지

The congenital patent urachus is the failure of complete urachal lumen closure and results in a free communication between the bladder and the umbilicus. Embriologically the urachus represents the vestigial remnant of the allantois which, in the fetus, communicates with the cloaca. The first patient is a 6-day-old female infant, and she was transferred due to urine leakage from the reddish hen egg sized protruding mass on the umbilicus. The fistulogram showed a long fistulous tract which communicates with bladder and umbilicus. A complete resection of the patent urachus was done. The second patient is a 1-day-old male infant, and he was transferred for operation of omphalocele from local clinic. Urine leakage was detected from the urachus at operative field, and so complete resection of the urachus was performed, and the one stage repair was performed for treatment of mild intestinal herniation. Postoperative courses of the two cases were uneventful.