Small cell carcinoma of the ureter with squamous cell and transitional cell carcinomatous components associated with ureteral stone.

We report a case of primary small cell carcinoma of the ureter with squamous cell and transitional cell carcinomatous components associated with ureteral stone, which is unique in that the patient has remained free of tumor recurrence for 36 months after the surgery without adjuvant chemotherapy or radiotherapy. A 60-yr-old man presented himself with a right flank pain. Computed tomography revealed an ill-defined mass and a stone in the lower one third of the right ureter, and hydronephroureterosis above the stone-impacted site. The patient underwent right nephroureterectomy and stone removal. Upon gross examination, a 3.8 x 1.8 x 1.2 cm white and partly yellow mass was noted in the anterior part of the ureter, resulting in indentation of the ureteral lumen on the posterior side. Light microscopic examination revealed that the mass was mainly composed of small cell carcinoma, and partly squamous cell and transitional cell carcinomatous components. The overlying ureteral mucosa and renal pelvis also contained multifocal dysplastic transitional epithelium and transitional cell carcinoma in situ. There was no vascular invasion, and the surgical margins were free of tumor. The small cell carcinomatous component was positive for chromogranin, neuron specific enolase, synaptophysin, and pancytokeratin but negative for high molecular-weight cytokeratin (K-903) by immunohistochemistry.

Prostate shape and symptom score in benign prostatic hyperplasia.

Prostates of the same volumes were found to have very variable shapes, that is, combinations of variably elongated width, height, and lengths. These were believed to be possible causes of the differences in the severity of both the obstructions and symptoms in the prostates even when their volumes were similar. We measured the transverse (width), anterior-posterior (height) and longitudinal (length) diameters of the prostates and the transition zone, and their calculated volumes using transrectal ultrasonography. To establish the relationship between the International Prostate Symptom Score (IPSS) and each of the dimensional parameters of the transition zone and the total prostate, 105 consecutive patients (mean age 66.43 +/- 9.24 years with a range o6f 46 to 90) who had voiding dysfunctions that were presumably related to BPH were analyzed using the t-test. Patients with conditions other than BPH were excluded. The results were as follows: 1. There was no significant correlation between the IPSS and any prostate volume parameter in the constant prostate volume conditions, because of the small numbers in each group. However, in the analysis of the total number of cases in all the volume categories, a significant correlation was found between the IPSS and some prostate dimensions; i.e., the longitudinal parameters in the total prostates (p < 0.01), and the transverse (p < 0.05) and longitudinal parameters (p < 0.05) in the transition zones. 2. Further investigations of the statistics of these significant parameters showed that prostates that were longer than 4 cm had significantly more severe symptoms than prostates shorter than 4 cm (p < 0.05), and that prostates with a ratio of length in the transition zone to the length in the total prostate ratio that was greater than 0.8 had significantly higher symptom scores than those with lower ratios (p < 0.05). When evaluating patients who have BPH, it is important to consider the shape of prostate. More aggressive treatment may be indicated in cases where the transition zone lengths exceeds 4 cm and the transition zone to total prostate length ratio exceeds 0.8.

Role of nitric oxide in penile erection.

The present study was undertaken to investigate the role of nitric oxide (NO) in erectile physiology by correlating its action with the existence and activity of nitric oxide synthase (NOS), which produces NO. We applied Western blot analysis in both human and rat penile tissue. In the rat, reduced nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase staining and spectrophotometric assay were also performed, in addition to in vivo electroerection study with pharmacological manipulation. Western blot analysis identified a protein of 155 KDa identical to the neural form of NOS in the human and rat penis. The NOS blot densities in the two species were similar, and both were lower than that in the rat cerebellum. Histochemical staining localized NOS to neurons innervating the corpora cavernosa, including the pelvic plexus, the cavernosal nerves and their terminal fibers within the corporeal erectile tissue, and dorsal penile nerves. NOS activity was also found in the cerebellum, urethra, penis, and urinary bladder, in decreasing order of intensity. Intracavernous injections of NOS inhibitor (L-NOARG or L-NAME in concentrations from 10(-6) M to 10(-3) M suppressed electrostimulation-induced erection in a concentration-dependent manner. Subsequent intracavernous injection of L-Arginine (10(-2) M) partially restored the erection. The neural form of constitutive NOS in the corpora cavernosa synthesizes NO, which mediates penile erection. Determination of cavernosal NOS expression or activity may permit characterization of certain pathological conditions that cause impotence.

A dose-response study of alprostadil sterile powder (S.Po.) (Caverject) for the treatment of erectile dysfunction in Korean and Indonesian men.

This open-label, dose-escalation study investigated the efficacy and safety of alprostadil (PGE1, prostaglandin E1) Sterile Powder (S.Po.) (Caverject) for treatment of erectile dysfunction (ED) in 84 men with ED of various etiologies lasting > or = 4 months. Doses started with 2.5 micrograms, then 5 micrograms, 10, 15, 20, 30, up to a 40 micrograms maximum. Eligible patients received single alprostadil injections in the physician's office until an erection occurred. Ten minutes after injection, the patient's erection was clinically evaluated. Optimal response was defined as erection sufficient to permit vaginal penetration and lasting 30-60 min. The patient also reported his own evaluation of response and any side effects. Patients were 24-65 y old (mean: 43.7 y), had ED of psychogenic, vascular, or neurogenic origin lasting 4 months-30 y (mean: 3.75 y). Of 84 patients enrolled, 82 completed the study. In the 82 patients who completed the study 78 (92.9%) achieved an optimal response; 18/78 patients (23.1%) had an optimal response at 2.5 micrograms, 9/78 (11.5%) at 5 micrograms, 21/78 (26.9%) at 10 micrograms, 12/ 78 (15.4%) at 15 micrograms, and 11/78 (14.1%) at 20 micrograms. Only 5/78 (6.4%) at 30 micrograms and 2/78 (2.6%) at 40 micrograms achieved an optimal response. Mean optimal alprostadil dose was 11.9 micrograms, and the mean minimal effective dose was 9.9 micrograms. Mean onset of erection was 11.2 min; mean duration of erection was 50.5 min. Penile pain in five patients (6%) was the only reported side effect.

Penile sensitivity in patients with primary premature ejaculation.

PURPOSE: We investigated penile sensory levels in patients with primary premature ejaculation to determine whether there is an etiological basis for this condition. MATERIALS AND METHODS: Penile biothesiometry was performed in 120 patients with primary premature ejaculation without erectile dysfunction and neurological deficit, and in 66 normal potent male volunteers. Vibratory thresholds were recorded at the glans penis, penile shaft, scrotum and index finger using a biothesiometer. RESULTS: On the glans penis and penile shaft the values in patients with premature ejaculation were significantly less than those in normal potent men (p < 0.001). In normal potent men an age dependency of biothesiometric parameters was noted, with a significant increase in vibratory threshold at the glans penis and penile shaft in older patients. However, in patients with premature ejaculation there were consistently decreased values without age dependency at the glans penis and penile shaft (p > 0.05). CONCLUSIONS: Patients with primary premature ejaculation have penile hypersensitivity, which provides further implications for an organic basis of premature ejaculation.

Sensory evoked potential and effect of SS-cream in premature ejaculation.

The cause of premature ejaculation (PE) has been thought to be psychological in the majority of patients but we investigated penile hypersensitivity for an organic basis of PE. For another organic basis of PE, we have suggested hyperexcitability of the ejaculation center. SS-cream is a topical agent containing 9 oriental herbs for treating PE. Clinically SS-cream has been effective in the treatment of PE. Therefore, in order to implicate the organic basis of PE and realize the effect of SS-cream on PE, we investigated the somatosensory evoked potential (SEP) in patients with PE(16 cases) and the effects of SS-cream on SEP for treating PE. The latencies and amplitudes of the evoked responses were measured by two different places in stimuli, one was on the penile shaft with ring electrode and the other on the glans penis with a surface electrode. The latency of SEP stimulated at the glans penis was significantly longer than that stimulated at the penile shaft (p < 0.05). The latency stimulated at the glans penis after applying SS-cream was significantly longer than before applying SS-cream (p < 0.05), which was near the level of a normal potent man. But the latency stimulated at the penile shaft has no significant difference between before and after the application of SS-cream (P > 0.05). The amplitudes of the evoked responses stimulated at the glans penis were significantly higher than those stimulated at penile shaft (p < 0.05). And both these amplitudes were significantly reduced with the application of SS-cream (p < 0.05). With these result, we can suggest that the patients with PE have glans penile hyperexcitability and it provides further implications for an organic basis of PE, SEP stimulated at the glans penis can be a very useful method to evaluate PE, along with SEP stimulated a penile shaft and SS-cream prolongs the sensory conduction and reduces the penile hyperexcitability of the patient with PE.

Clinical efficacy of Korean red ginseng for erectile dysfunction.

To investigate the efficacy in treating erectile dysfunction and to develop a natural drug without complications, the results of ginseng treatments are compared to placebo and other drug. A total of 90 patients with 30 patients in each group were closely followed. Changes in symptoms such as frequency of intercourse, premature ejaculation, and morning erections after treatment were not changed in all three groups (p > 0.05). However in the group receiving ginseng, changes in early detumescence and erectile parameters such as penile rigidity and girth, libido and patient satisfactions were significantly higher than that of other groups (p < 0.05). The overall therapeutic efficacies on erectile dysfunction were 60% for ginseng group and 30% for placebo and trazodone treated groups, statistically confirming the effect of ginseng (p < 0.05). No complete remission of erectile dysfunction was noted, but partial responses were reported. No cases of aggravation of symptoms were reported. AVS-penogram, which is a recording of penile hemodynamic changes during the natural erection after audiovisual erotic stimulation, is not changed after administration of ginseng. However if administered for a prolonged period of time, the cummulative effect on vascular flow might be seen. The administration of Korean red ginseng has shown to have superior effects compared to the placebo or trazodone. Definitely more researches are required to elucidate the mechanism of ginseng. The effects of saponin, extracted from ginseng, on smooth muscle of erectile tissues, can be evaluated using organ chamber or nitric oxide titration, thereby pinpointing the exact action mechanism of saponin. As more informations are available, possible breakthrough in treatment of erectile dysfunction could be arisen from active saponin extracted from red ginseng, bringing hopes to many sufferers of erectile dysfunction.

Living donor nephrectomies-right side--intraoperative assessment of the right renal vascular pedicle in 112 cases.

Generally, the left kidney from a living donor is more commonly preferred but the right kidney is occasionally donated because of multiple left renal arteries or repeated transplantation. The right donor nephrectomy is usually more difficult compared to the left because the right renal vein is often multiple and short, which complicates dissection of the vascular pedicle. From Jan. 1989 to Sep. 1992, 112 consecutive cases of right donor nephrectomies out of a total of 771 cases were retrospectively reviewed with the preoperative renal angiography and the intraoperative assessment of the right renal vascular pedicle. The indications for right donor nephrectomy include 1) multiple or proximal bifurcating renal arteries of the left kidney (89.3%), 2) repeated transplantation in the recipient (9%). In 26.8% of the cases, there were more than two right renal veins. In the right donor nephrectomy, it is often necessary to perform vena cava cuff resection because of short and frequently occurring multiple right renal veins. For the dissection of the inferior vena cava (IVC), the aberrantly occurring right gonadal vein, the adrenal vein draining above the junction of the renal vein and IVC, and the lumbar vein below the junction should always be looked for and must be ligated if any are found.