Simple Retrograde Balloon Dilation for the Treatment of Ureteral Strictures: an Etiology-based Analysis / 대한비뇨기과학회지

PURPOSE: The results of a simple retrograde balloon dilation for treating ureteral strictures was analyzed in order to evaluate the efficacy of this procedure and the factors affecting the success rate. MATERIALS AND MTHODS: A prospective study was performed on 43 ureteral strictures (22 malignant, 21 benign) from 37 patients, who were treated with retrograde balloon dilation from October 1997 to May 1999. After the stricture segments were dilated, ureteral stents were indwelled uniformly for 3 weeks. The strictures were followed up radiographically at 1, 3, 6, 12 and 24 months after treatment. The success was defined by a symptomatic and radiographic improvement. The follow-up period ranged from 3 to 43 months (mean 21 months). The prognostic factors affecting the success rate were analyzed. RESULTS: The success rate of the benign strictures at 12 months was much higher than that of malignant strictures (60% vs, 15%, p=0.0019). Although 48% of the patients with strictures shorter than 2cm were successful after 12 months, only 9% of those with strictures longer than 2cm were successful (p=0.0124). Other prognostic factors such as sex, age, location, presence of immediate success and the grade of hydronephrosis were has little effect on the success rate. Multivariate analysis revealed that etiology was the only significant prognostic factor affecting the final outcome (p=0.0371), and that stricture length was the only significant prognostic factor in the benign cases (p=0.0375). CONCLUSIONS: Considering its minimal invasiveness, a simple retrograde balloon dilation appears to be a reasonably effective treatment modality for a benign ureteral stricture with a short segment (2cm).

Simple Retrograde Balloon Dilation for the Treatment of Ureteral Strictures: an Etiology-based Analysis / 대한비뇨기과학회지

PURPOSE: The results of a simple retrograde balloon dilation for treating ureteral strictures was analyzed in order to evaluate the efficacy of this procedure and the factors affecting the success rate. MATERIALS AND MTHODS: A prospective study was performed on 43 ureteral strictures (22 malignant, 21 benign) from 37 patients, who were treated with retrograde balloon dilation from October 1997 to May 1999. After the stricture segments were dilated, ureteral stents were indwelled uniformly for 3 weeks. The strictures were followed up radiographically at 1, 3, 6, 12 and 24 months after treatment. The success was defined by a symptomatic and radiographic improvement. The follow-up period ranged from 3 to 43 months (mean 21 months). The prognostic factors affecting the success rate were analyzed. RESULTS: The success rate of the benign strictures at 12 months was much higher than that of malignant strictures (60% vs, 15%, p=0.0019). Although 48% of the patients with strictures shorter than 2cm were successful after 12 months, only 9% of those with strictures longer than 2cm were successful (p=0.0124). Other prognostic factors such as sex, age, location, presence of immediate success and the grade of hydronephrosis were has little effect on the success rate. Multivariate analysis revealed that etiology was the only significant prognostic factor affecting the final outcome (p=0.0371), and that stricture length was the only significant prognostic factor in the benign cases (p=0.0375). CONCLUSIONS: Considering its minimal invasiveness, a simple retrograde balloon dilation appears to be a reasonably effective treatment modality for a benign ureteral stricture with a short segment (2cm).

Molecular Biological Analysis of the Collagen Changes by Interferon Gamma Following Partial Unilateral Ureteral Obstruction / 대한비뇨기과학회지

No abstract available.

The Effects of Oxalate on the DNA Synthesis in LLC-PK1 Cells / 대한비뇨기과학회지

No abstract available.

Experience with 129 Pediatric (<21 yr) Kidney Transplantations

BACKGROUND: Renal transplantation has become widely accepted as the treatment of choice for children with end-stage renal disease (ESRD). Two important criteria for successful pediatric renal transplantation are achievement of optimal growth, developement, and possession of a long functioning renal transplant. METHODS: In order to establish better strategies for successful pediatric renal transplantation outcome, we reviewed the results of 129 primary renal transplantations performed at our institution. One hundred twenty-nine renal allografts were transplanted to 129 pediatric ESRD patients under the age of 21 between July 1979 and November 1997. Mean age at transplantation was 13.4 yrs ( or =10 yrs: 100) and male to female ratio was 87:42. Original renal diseases were known in 90 recipients (69.8%) including 7 congenital or hereditary diseases (5.4%). Donor kidneys were obtained from 93 living-related donors (LRD), 20 living-unrelated donors (LUD), and 16 cadavers (CAD). Mean follow-up period was 57.8 months. Immunosuppression was done with AZA Pds (n=5) before 1985 and with CyA Pds (n=79) and AZA CyA Pds (n=45) thereafter. RESULTS: Twenty five grafts were lost (20.7%) due to 20 chronic rejections, 3 recurrences of the original renal disease and 2 patient deaths with functioning graft. Overall 1-, 3-, 5-, 10-yr graft and patient survival rates were 95.1%, 88.2%, 80.2%, 61.0% and 98.5%, 96.7%, 95.2%, 95.2%, respectively. In the multivariate analysis, the presence of acute rejection (p=0.014) and LUD (p=0.015) were significant prognostic factors for poor graft survival. Significantly superior growth in height after transplantation was observed in children transplanted at prepubertal age ( or =13 yrs). CONCLUSIONS: Long-term graft survival in pediatric renal transplantation can be obtained by aggressivemanagement of acute rejection, judicious surveillance for immunosuppression, and preferred selection of LRD. In addition, we recommend early renal transplantation in prepubertal children with ESRD on the basis of the significant posttransplant increment in height in prepubertal children.

Comparative Studies on the Active Contractile Properties and Passive Properties of the Urinary Bladder between Adult and Neonatal Rats / 대한비뇨기과학회지

PURPOSE: Voiding function of the neonate is considered to be different from that of adult. Although immaturity in the central nervous system that governs urinary bladder is thought to be the cause, few well-designed physiological studies on the properties of bladder itself have been reported. MATERIALS AND METHODS: Urinary bladders were removed from male Sprague-Dawley rats, 1 to 3-day old neonate and 12 week-old adult. Anterior longitudinal muscle strips without mucosa were obtained and isometric contractions were recorded. Contractile responses induced by carbachol (CCh 0.05-10.0 microM) were obtained. To investigate length-tension relationship between adult and neonate bladder, each strip was stepwise stretched up to 300% L (taking L, 100% length in a resting state) by micropositioner. In each step it was fully permitted to reach steady state in which electrical field stimulations (0.8ms, 50Hz, 2.5s duration) were applied to assess optimal length for contraction. RESULTS: CCh produced a large phasic contraction followed by a sustained tonic contraction superimposed by rapid phasic activities (RPAs) in both group but the patterns were quite different. Neonatal bladder was characterized by its tonic contractions; lesser tone increase with dose increment and taller RPAs of shorter duration. Amplitude of CCh-induced contraction were corrected by tissue weight, neonatal bladder generated greater force than that of adult. Length-tension analysis revealed that the range of active contraction in neonatal bladder according to the stretch were similar, while passive properties were quite different from that of adult bladder. Stress in the muscle strips was derived from tension divided by cross-sectional area of the strip (g/cm2). Steep increase in total tension per area as stepwise stretch was observed in neonatal bladder, which was mainly ascribed to passive properties of the bladder. Optimal length of maximal active force generation was noted in 220% of resting length in both neonatal and adult bladder. CONCLUSIONS: Our results demonstrated that CCh-induced contractile pattern and length-tension relationship in neonatal bladder are quite different from those of adult bladder in the rats, which suggests, aside from the neural immaturity, functional difference exists in the bladder itself. During development, neonatal urinary bladder seems to undergo remarkable changes in both active and passive properties.

Physiologic Changes during Laparoscopic Surgery for Upper Urinary Tract / 대한비뇨기과학회지

PURPOSE: Presently laparoscopic urologic surgical procedures are being performed with increasing frequency. Despite the evolution of laparoscopic technique and instruments, the large set of physiologic alteration associated with laparoscopy are poorly understood. We have recently performed prospective study to evaluate the physiologic effects of pneumoperitoneum created during laparoscopic surgery. MATERIALS AND METHODS: Seventeen consecutive patients with various upper urinary tract diseases underwent laparoscopic surgeries at our institution. They were checked pre and postoperatively for such parameters as blood pressure, heart rate, arterial blood gas analysis(ABGA), end tidal CO2(ETCO2), peak airway pressure, temperature. Every patient was classified as ASA class 1 or 2 preoperatively. All insufflrated pressure was adjusted not to go over 14mmHg. All patients were positioned laterally for easier access to retroperitoneum. We evaluated the differences of various physiologic indices with statistical means. RESULTS: After 2hr insufflation, a marked hypercarbia and acidemia was observed intraoperatively suggesting that capnography may be an inadequate guide in controlling ventilation during the state of CO2 pneumoperitoneum in the upper urinary tract laparoscopic surgery. Eight patients suffered perioperative hypothermia(below 35.5degrees C). In the four of eight patients prolonged stay in recovery room were necessary due to their hypothermia. CONCLUSIONS: Because the upper urinary tract laparoscopic surgery causes many physiologic changes, surgeons should be aware of its meanings and clinical implications prior to achieving technical skillfulness in laparoscopic surgery.

No Title

No abstract available.

Clinical Characteristics of Ileal Neobladder / 대한비뇨기과학회지

PURPOSE: To evaluate clinical characteristics of ileal neobladder as orthotopic bladder substitution, we examined the urodynamic characteristics, clinical symptoms and radiologic findings of 11 patients who had undergone ileal nobladder substitution following cystectomy or cystoprostatectomy. MATERIALS AND METHOD: From February 1993 to July 1996, 11 patients underwent lower urinary tract reconstruction with ileal neobladder. Cystectomy or cystoprostatectomy was done, and reservoirs were connected to the proximal urethra or urethrovesical junction. Urodynamic and radiologic studies were performed to evaluate neobladder function and upper tract. Clinical symptoms were evaluated via a detailed patient questionaire. RESULTS: Mean cystometric capacity was 434m1(293-640m1). All patients voided by Valsalva maneuver and achieved good peak flow rates(mean value was 22.6m1/sec). Of the patients 10 emptied bladder to near completion with a mean post-void residual of 30m1, while 1 had post-void residuals of 110m1 The neobladder demonstrated good compliance for the storage of urine Phasic neobladder contractions were present during filling cystometrography. While the number of phasic contractions increased at higher neobladder volumes, the mean length and mean pressure of phasic contractions were not Increased a higher neobladder volumes. Daytime continence was obtained in all patients(100%), while nighttime continence was achieved in 8 patients (73%). Of these 8 nighttime continent patients, 4 patients(50%) had to void at least once a night to keep dry. No difference was found in any urodynamic parameter between nighttime continent and incontinent patients. There was no difference in any important urodynamic parameter between patients who had and had not received post-operative chemotherapy. Renal function, based on serum creatinine levels, had remained stable and no significant electrolyte or acid-base imbalance was found in all patients. Voiding cystourethrograms obtained in 9 patients revealed 3 patients(33%) had grades ll-lll/V reflux IVP in 9 patients revealed hydronephrosis in 1/18(5.5%) of renal units. CONCLUSIONS: Neobladder constructed from detubularized ileum achieves adequate capacity at low pressures with a satisfactory continence rate. We conclude that neobladder may be the best choice of urinary diversion after cystectomy in the aspect of quality of life.

Morphological and Quantitative Analysis on the Expression of Bax in the Rat Prostate following Castration / 대한비뇨기과학회지

PURPOSE: Bax promotes apoptosis and is up-regulated by p53, which is not required for androgen ablation-induced apoptosis of the prostatic cells. We investigated the change of lax during the involution of the rat prostate following castration. MATERIALS AND METHOD: Adult male rats were castrated and the ventral prostatic glands were removed daily for a week following castration. Western blot and immunohistochemical analysis of lax protein were performed using anti-bax rabbit polyclonal IgG. RESULTS: The prostatic weight decreased and the apoptotic cells began to appear 2 days following castration. Western blot analysis showed that lax was absent in the control prostate but began to increase 4 days following castration. Immunohistochemical analysis showed that bars was confined to the cells which had morphological characteristics of the late stage of programmed cell death. CONCLUSIONS: Present results suggest that bars might be involved in the late stage of castration-induced apoptosis of the rat prostatic cells.

Penile Nomogram in Korean Males / 대한남성과학회지

PURPOSE: The definition of normal penile length is of considerable importance to urologist who is asked to perform penile augmentation surgery, because such knowledge will lead to better counseling about the relation between penile size in the flaccid and erect states and to develop guidelines for penile augmentation. SUBJECTS AND METHODS: Tape measurements of the flaccid and erect penis were obtained to the nearest 0.5 cm in 309 Korean men by a single examiner. Measurements were made of flaccid length and circumference, depth of the prepubic fat pad, and stretched penile length. After full erection had been obtained by self-stimulation or injection of prostaglandin E, penile length and circumference were measured again. RESULTS: The mean flaccid and erectile length were 7.78+/-1.19 cm and 11.88+/-1.32 cm, respectively. The stretched length demonstrated a more predictable relation to erectile length than flaccid length than flaccid length (Pearson correlation coefficient, R=0.648:0.549). Subjects were grouped by age ad over and under 40 years to study the effect of age on fat pad depth, flaccid length, stretched length, and erectile length increase. Only erectile length increase differed significantly, being greater in younger subjects(ANOVA, p=0.03). When the subjects were grouped by flaccid length as short( OR =9 cm), we discovered that a penis that was long in the flaccid state remained long in the erect state. However, there were no statistical differences in erect length among three groups. In other words, we cannot predict the erect length on the bais of the flaccid value. CONCLUSIONS: To define guidelines for penile augmentation, we can choose the cut-off value of 5 cm(flaccid) and 9 cm (erect) based on statistical considerations. Only 1.1% of the patients in our series were below this cut-off value. Thus, it is concluded that only a small number of Korea men should be candidates for penile augmentation.

Trimix Intracavernosal Self-injection Therapy: Long-term Follow-up Results in the Patients with Erectile Dysfunction / 대한비뇨기과학회지

PURPOSE: Trimix, the mixture of papaverine, phentolamine and PGE1 , has been widely used in intracavernosal therapy for patients with erectile dysfunction. Although several results have been reported in Korean patients using the Trimix, no long-term follow-up studies have been carried out. Therefore, we analysed our long-term follow-up results of Trimix therapy PATIENTS AND METHODS: A total of 216 patients(46.2 years of mean age) with erectile dysfunction underwent intracavernosal self-injection therapy with the Trimix(mixture of papaverine 48mg, phentolamine 2mg, PGE1 18microgram in 2 microliter solution). Once chosen, all patients were tested for an appropriate dosage. They were also given education upto 5 times for an successful self-injection therapy. During follow-up periods, ranging 12 to 34 months, evaluations of the effectiveness and safety of the therapy were made by inteNiewing patients upon their visits to our clinic. RESULTS: The final drop-out rate of cases were 107(49.5%). Most drop-out cases (80 cases) occurred within the first month of the therapy. It was also found that drop-out rate was Inversely correlated with number of attendance at the preself-injection education(p< 0.05). A total of 168 patients failed to attend more than 3 times. The drop-out rate of this group was 55%(92 cases) while 31% in those with more than 3 attendances. A total of 109(50.5%) patients completed longer than 12-month follow-up durations and 85(77%) patients were satisfied with the therapy. Their mean dosage was 0.16 microliter and mean frequency of applications was 5.0 times per month, Although no patient developed corporal fibrosis or infection, other side-effects including prolonged erection(14 cases) and penile pain during intercourse(3 cases) were reported. CONCLUSIONS: Trimix intracavernous injection therapy is minimally invasive, safe and effective for the treatment of patients with erectile dysfunction. While high drop-out rate was thought to be a major problem with this therapy, our results suggest that adequate educations can encourage patients to a certain degree.

Effect of Oxalate on the Growth of Distal Renal Tubular Epithelial Cells / 대한비뇨기과학회지

PURPOSE: We tried to evaluate the effect of oxalate on the growth of distal renal tubular epithelial cells MATERIALS AND METHODS: Madin-Darby canine kidney(MDCK) cell line, derived from canine distal renal tubular epithelial cell, supplied from American Type Culture Collection was used in this study. RPMI 1640 containing 10mM HEPES-buffer, 100IU/ microliterpenicillin, 100 microgram/ microliterstreptomycin, 300 microgram/ microliterglutamine, and with or without 10% fetal bovine serum(FBS) was used as the culture media. And the cell survivals under various concentrations of ammonium oxalate were assessed by MTT assay. RESULTS: Exposure of MDCK cells to oxalate resulted in a concentration dependent suppression of the cell growth in both 10% FBS supplied media and FBS deprived media. CONCLUSIONS: From these observations we could conclude that oxalate is not a mere constituent of calcium oxalate stone, but oxalate might offer a good environment for calcium oxalate stone formation in the urinary tract via MDCK cellular damage.

Prostate-specific Antigen Density: Correlation with Prostatic Histological Composition in Men with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: Pretreatment knowledge of prostate gland histology may help to select medical therapy for men with benign prostatic hyperplasia(BPH). Our objective was to determine whether prostate-specific antigen density(PSAD) correlated to the relative amount of epithelium in BPH tissue. MATERIALS AND METHODS: We evaluated 32 men with pathologically proven BPH who underwent transurethral resection of the prostate. All clinical findings which were age, symptom scores, maximal flow rate, total serum PSA, PSAD, prostate volume, transitional zone volume, transitional zone ratio were correlated with mean epithelial score(MES), which measures semi-quantitatively to represent the relative amount of epithelium in the resected BPH tissues. RESULTS: Prostatic size, serum PSA and PSAD showed significant correlation with MES in univariate analysis, but multivariate analysis showed that only PSAD was statistically significant(p<0.05). CONCLUSIONS: These data suggest that PSAD be related to the histological composition of the prostate in men with BPH. Therefore it might be useful as an evaluation to direct BPH therapy.

Ureteroscopic Removal of Ureteral Calculi without Anesthesia / 대한비뇨기과학회지

Ureteroscopy has been used widely to remove urethral calculi, especially distal ureter stones. In this study we tried to evaluate the exact role of ureteroscopic manipulation for ureter stones in the era of ESWL. We report our experience on performing ureteroscopic removal of ureteral calculi without anesthesia. Between August 1994 and August 1996, ureteroscopy was performed in 62 cases without anesthesia. We examined the feasibility of performing ureteroscopy under sedation only. Age distribution was 17~71 years old (mean 49.3). Overall success rate was 91.9% (57 cases among 62 cases). The success rates according to sex were 92.9% in male and 91.2% in female. The success rates according to location were 100% in proximal ureter, 83.3% in middle ureter and 92.6% in distal ureter. The success rates according to size were 92.7% in 10 mm stone patients. We could not find any statistical meaning about the success rates according to sex, location and size (p>0.05). In 7 cases the procedure were performed at outpatient department. Mean duration of hospitalization (in 55 cases) was 3.83 days. The associated complication rate was relatively low (8.1%), with most patients being treated conservatively. We conclude that ureteroscopy, when performed without general or regional anesthesia, does not increase the risk of complications or compromise the results of treatment. So we recommend ureteroscopy without anesthesia as a primary choice in the manipulation of urethral calculi.

Development of Animal Model of Nephrolithiasis / 대한비뇨기과학회지

To develop an animal model of nephrolithiasis similar to the pattern of human renal stone disease, we adopted a protocol of administration of stone substrates along with induction of renal tubular injuries. Male Wister rats fed with 3% ammonium oxalate containing chows with or without additional 40 mg/kg/day of gentamicin for 8 days were compared with those fed with normal chows. On dissecting microscopic examination, rats receiving oxalate and gentamicin showed more crystals and plaques than rats receiving oxalate only, both in 15 days and 22 days after feeding, and most of the crystals were located at renal papilla. Average score of crystal abundance was 0.4, 1.15, respectively in rats receiving oxalate only and oxalate plus gentamicin after 15 days of feeding, and 0.9 and 1.55, respectively after 22 days. Little crystals were found in rats fed with normal chow with or without gentamicin. Urinary excretion of tubular epithelial brush border enzyme, gamma-glutamyl transpeptidase(GGT), was increased by gentamicin administration whereas creatinine clearance rate was not changed. Urinary excretion of oxalate was unchanged, but calcium and uric acid was markedly decreased in rats fed with oxalate and formed crystals, and citrate and magnesium excretion was also decreased. These results indicate that administration of oxalate along with inducing renal tubular damages by subcutaneous injection of gentamicin seems to form crystals and plaques in the kidney more rapidly and abundantly than feeding with oxalate alone.

Characteristics and Treatment of Steinstrasse after ESWL / 대한비뇨기과학회지

To evaluate the predisposing factors and characteristics of the steinstrasse after ESWL and to suggest the proper management of it, we analyzed 1,144 urolithiasis patients who were managed by ESWL with the second generation lithotripter, Siemens Lithostar, at Seoul National University Hospital from March 1989 to October 1995. Steinstrasse developed in 72 patients with the incidence of 6.3% after ESWL. As the risk factor for developing steinstrasse after ESWL, stone size and volume significantly influenced the development of steinstrasse (p<0.01, by student t-test), and multiple stones induced steinstrasse more frequently than single stones (p<0.05, by chi-square test). Stones located at renal pelvis induced more steinstrasse after ESWL than calyceal stones or ureter stones t<0.05, by chi-square test). Clinically, 61.1% of the patients who developed steinstrasse didn't have any symptoms or upper tract changes. Nineteen steinstrasse (26.4%) were resolved spontaneously without any intervention, with the median duration of 12 days after detection of the steinstrasse. In 51 steinstrasse which was not resolved spontaneously or with severe symptoms, ESWL was performed resulting in successful resolution in 94.1% of the patients. These results suggest that expectancy could be the first line strategy of the management of steinstrasse, and repeated ESWL could be recommended for patients refractory to expectancy and patients with severe symptoms.

Analysis of the Urinary Stone Components Using Chemical Analysis Method / 대한비뇨기과학회지

We analyzed the composition of urinary stones using chemical analysis method. From 1985 to 1995, 495 urinary calculi were eligible for stone analysis. Forty six per cent of the stones were composed of single chemical component, and pure calcium oxalate stone was the most common type of the stones consisting 34.9% of all stones, followed by 23.8% of mixture of calcium oxalate and calcium phosphate, and 92.7% of the stones had calcium component. Calcium oxalate crystal was found in 82.6% of the stones, calcium phosphate in 50.5%, ammonium magnesium phosphate in 26.7%, uric acid in 11.3% and cystine in 0.4%. Nation-wide extension of this study using chemical analysis will be mandatory for a proper assessment of the stone composition of Koreans and for planning of the proper management strategies for urinary stones in Korea.

The Effect and Mechanism of the Specific Phosphodiesterase (PDE) III-Inhibitor Milrinone on Human and Rabbit Corpus Cavernosum / 대한비뇨기과학회지

Milrinone is a positive inotropic/vasodilator agent in both preclinical and clinical studies. Milrinone has been shown previously to inhibit specific type III PDE isolated from different sources. To investigate the effect and the mechanism of milrinone on the corpus cavernosum, we have studied on the human and rabbit corpus cavernosum using organ bath and measured the levels of cAMP and cGMP after treatment of milrinone and papaverine. Our results show that milrinone relaxes human and rabbit corpus cavernosal tissue in a dose- dependent manner. And significant increases in cAMP content were evident with milrinone. These indicate that the accumulation of cAMP resulting from the inhibition of type III PDE plays an important role in milrinone on rabbit corpus cavernosum. And these may reflect the impotence of cAMP dependent second messenger systems for the relaxation of penile smooth muscle. These results suggest a possible potential for milrinone in the treatment of impotence.

Effects of Reactive Oxygen Species on Hyperactivation of Human Sperms / 대한비뇨기과학회지

capacitation of human sperm is essential for fertilization and is characterized visually by hyperactivated motility. There is a controversy whether reactive oxygen radicals cause infertility or stimulate sperm-zona interaction. We investigated the exact role of reactive oxygen radicals on hyperactivation (HA) of human sperm which could be a part of the capacitation process. Hyperactivation of human sperm was compared to the Ham's F-10 controls by the addition of superoxide anion and hydrogen peroxide generating enzymes on the percale treated sperms. The motility parameters of human sperms were estimated by computer assisted semen analysis system. The addition of xanthine + xanthine oxidase + catalase (generating system of superoxide anion and removal of hydrogen peroxide) on the sperms induced levels of HA (10.5% at 2 hour, 11.3% at 5 hour) which were about 2 times higher than those of controls (HA: 5.4% at 2 hour, 5.6% at 5 hour). The addition of glucose + glucose oxidase (generation of hydrogen peroxide) decreased the levels of HA (0.0% at 2 and 5 hour) significantly. Superoxide dismutase, the scavenger of superoxide anion inhibited HA significantly, whereas catalase, the scavenger of hydrogen peroxide promoted HA significantly These results suggest that the reactive oxygen radicals may be involved in hyperactivation of human sperms by the way that superoxide anion promotes and hydrogen peroxide inhibits hyperactivation of the fertile human sperms. It may be very important in the process of fertilization that promotion or inhibition of hyperactivation occurs at the proper time and location of female genital organ.