Penile Augmentation Using Superficial External Pudendal Artery Pedicle and Adipose Tissue / 대한남성과학회지

PURPOSE: Many men are to some degree unsatisfied with the size of their penis, whether it is normal in size and appearance or not. We report a novel surgical technique for penile augmentation using a superficial external pudendal artery pedicle. MATERIALS AND METHODS: In total, 8 patients underwent penile augmentation from March 2003 to February 2004. Their mean age was 37.3 years. Five patients were unsatisfied about the size of their penis, and three patients had complications after insertion of foreign material. This penile augmentation technique was developed by using a low abdominal fat-flap where blood is supplied from the external pudendal artery. Spinal or epidural anesthesia was done during the operation, and the fat-flap was elevated and transpositioned to the site of lesion. RESULTS: All cases of patients were performed successfully by autografting using adipose tissue where blood flow was supplied from the external pudendal artery. There were no complications except one case of hematoma after the operation. The mean operative time was 80 min. The mean follow-up period after operation was about 6 months and all patients had a normal sexual life and no voiding dysfunctions. CONCLUSIONS: This novel surgical technique has several advantages. First, reconstruction without skin necrosis was possible even though the defect was large, because the blood supply was favorable. Second, there was no size limitation in augmentation with dermoplasty. Third, there was no evidence of atrophy of the flap.

Progression of Prostate Cancer Despite an Extremely Low Serum Level of Prostate-Specific Antigen

A 61-year-old man who had been diagnosed with prostate cancer 9 years ago and had been treated with pelvic irradiation and intermittent androgen deprivation therapy visited the emergency room because of back pain and weakness in both legs. Spine magnetic resonance imaging showed a lumbar epidural mass and spine metastasis. The whole-body workup revealed multiple metastases to the lymph nodes, bone, liver, and lung. The serum prostate-specific antigen was 0.02 ng/ml. He underwent laminectomy, posterior fixation, and epidural mass excision, and metastatic adenocarcinoma from the prostate was diagnosed. The patient underwent 1 cycle of docetaxel-based chemotherapy. More chemotherapy could not be done because of his general weakness. The patient died one month later of multiple organ failure.

CyberKnife(TM) for the Treatment of Non-Metastatic Prostate Cancer

PURPOSE: The radiobiology of prostate cancer favors a hypofractionated dose regimen. We report here our experience with the CyberKnife(TM), demonstrating its efficacy, safety, and feasibility as a treatment modality for non-metastatic prostate cancer. MATERIALS AND METHODS: Between October 2002 and April 2006, 20 patients with biopsy-proven prostate cancer were treated with the CyberKnife(TM). The distribution of clinical risks, as assessed by using D'Amico's definition for risk grouping, was as follows: low (4), intermediate (5), and high (11). Three patients received 32 Gy, 7 patients received 34 Gy, and 10 patients received 36 Gy. All patients received the radiation doses in 4 fractions. The rectal and bladder toxicities were graded by using the criteria set forth by the Radiation Therapy Oncology Group (RTOG). RESULTS: The mean patient age was 71.4 years (range, 52-79 years), and the mean follow-up period was 35.5 months (range, 8-74 months). There were 2 acute and 1 late grade 2 gastrointestinal toxicities, and 1 acute and 2 late grade 2 urinary toxicities. The 5-year overall survival rate was 100%, respectively. The 5-year biochemical failure-free rate of the low-risk, intermediate-risk, and high-risk patients was 100%, 100%, and 90.9%, respectively. CONCLUSIONS: CyberKnife(TM) is a safe, well-tolerated, and rather effective treatment for non-metastatic prostate cancer. We obtained a 100% 5-year biochemical failure-free rate in low-risk and intermediate-risk patients. CyberKnife(TM) is a viable option for the treatment of non-metastatic prostate cancer.

Radiofrequency Ablation of Unilateral Kidney VX2 Tumors in the Rabbit Model / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate the effectiveness and indication of radiofrequency ablation(RFA) using renal VX2 tumors by implantation of VX2 tumor cells under the renal capsule in rabbits. MATERIALS AND METHODS: Ten rabbits were injected with 30-40microliter VX2 tumor cells(1.2x10(7) viable cells/ml) under the renal capsule of the right kidney by right subcostal incision. On the 14th day after the tumor cells were implanted, we checked for the development of renal tumors, and the sizes and shapes(exophytic or central) of the tumors by the use of computed tomography. We performed RFA in the renal VX2 tumors with a 17G StarBurst electrode through kidney exposure. After the first and third day following RFA, renal function was checked. On the third day, we performed CT and harvested the kidneys for gross and microscopic evaluation. RESULTS: We confirmed the development of renal VX2 tumors in nine cases. Tumor shapes were exophytic in seven cases and central in two cases; the mean size of the tumors was 2.1 cm(range, 1.1-3.8cm). In all tumors, RFA was performed. From the use of enhanced CT after RFA on the third day, all of the lesions treated with RFA showed no enhancement. From the pathological findings, coagulative necroses were seen on all of the lesions treated with RFA. The necrotized tumor size after RFA was not different statistically as measured by CT and a pathological examination (p=0.833) CONCLUSIONS:: In centrally located renal tumors, we experienced thermal injury in pelvocalyceal systems. RFA is an effective method for nephron sparing surgery as the tumor cells completely disappear and there is preserved renal function and the procedure is easy to apply. We suggest that the RFA method for exophytic renal tumors is more effective than other procedures.

Changes in Semen Parameters After Varicocelectomy: a Comparative Study of the Laparoscopic and Microsurgical Inguinal Approach / 대한남성과학회지

PURPOSE: The purpose of this study was to compare the surgical outcomes of two different surgical methods for varicocelectomy, and to assess the effects of varicocelectomy on semen parameters in subinfertile men. MATERIALS AND METHODS: This study included 63 patients with clinically palpable varicocele and abnormal semen parameters who underwent varicocelectomy. Thirty-three patients underwent laparoscopic varicocelectomy, and 30 received microsurgical inguinal varicocelectomy. Semen analyses were performed 5.3 months later, and compared with the pre-operative data. RESULTS: The mean age of patients was 32.1+/-1.3 years old. Comparison of the semen parameters between pre and post-varicocelectomy revealed significant improvement in the sperm count (p<0.05). In laparoscopic and microsurgical inguinal varicocelectomy, the sperm counts were increased from 16.2+/-4.3 to 30.6+/-7.5 and from 15.4+/-3.8 to 37.5+/-7.7, respectively. Sperm motility also tended to improve. CONCLUSIONS: Varicocelectomy enhanced semen parameters after both laparoscopic and microsurgical methods. In subfertile men, early varicocelectomy is recommended.

Changes in Semen Parameters After Varicocelectomy: a Comparative Study of the Laparoscopic and Microsurgical Inguinal Approach / 대한남성과학회지

PURPOSE: The purpose of this study was to compare the surgical outcomes of two different surgical methods for varicocelectomy, and to assess the effects of varicocelectomy on semen parameters in subinfertile men. MATERIALS AND METHODS: This study included 63 patients with clinically palpable varicocele and abnormal semen parameters who underwent varicocelectomy. Thirty-three patients underwent laparoscopic varicocelectomy, and 30 received microsurgical inguinal varicocelectomy. Semen analyses were performed 5.3 months later, and compared with the pre-operative data. RESULTS: The mean age of patients was 32.1+/-1.3 years old. Comparison of the semen parameters between pre and post-varicocelectomy revealed significant improvement in the sperm count (p<0.05). In laparoscopic and microsurgical inguinal varicocelectomy, the sperm counts were increased from 16.2+/-4.3 to 30.6+/-7.5 and from 15.4+/-3.8 to 37.5+/-7.7, respectively. Sperm motility also tended to improve. CONCLUSIONS: Varicocelectomy enhanced semen parameters after both laparoscopic and microsurgical methods. In subfertile men, early varicocelectomy is recommended.

Diagnostic Value of Polymerase Chain Reaction in Patients with Chronic Pelvic Pain Syndrome: using Semen as a Specimen / 대한비뇨기과학회지

PURPOSE: Specific microorganisms, such as Chlamydia and Mycoplasma, are rarely detected in chronic pelvic pain syndrome, but fastidious and non-culturable microorganisms may be important in its etiology. The objective of this study was to evaluate the usefulness and significance of polymerase chain reaction (PCR) in the diagnosis of the etiologies of chronic pelvic pain syndrome, especially using semen as a specimen. MATERIALS AND METHODS: Between August 2005 and July 2006, 237 patients, with a mean age of 39 years (range 25-67 years), were evaluated for chronic pelvic pain syndrome. PCR testing of the semen was performed in all cases to establish the persistence of C. trachomatis, T. vaginalis, M. hominis, M. genitalium and U. urealyticum. RESULTS: Of the 237 patients, 79 (33.3%) and 158 (66.7%) were categories IIIa and IIIb, respectively. On PCR, using semen, 18 (22.8%) of the 79 category IIIa and 26 (16.5%) of the 158 category IIIb cases were found to have positive PCRs for the causative microorganisms of CPPS. In a total of 53 isolates presenting positive PCR, the common causative microorganisms were U. urealyticum, C. trachomatis, M. genitalium, T. vaginalis and M. hominis in 23 (43.4%), 16 (30.1%), 11 (20.8%), 2 (3.8%) and 1 case (1.9%), respectively. CONCLISIONS: PCR is revolutionizing the diagnosis of many infectious diseases, particularly those caused by microorganisms that are difficult to cultivate. Moreover, PCR shows nearly 100% accuracy in terms of sensitivity and specificity. PCR using semen, which can detect various microorganisms suggestive of the etiologies of chronic pelvic pain syndrome, is expected to play an important role in the diagnosis, treatment and follow up of chronic pelvic pain syndrome in urology.

Clinicopathological Significance of the Lymphovascular Invasion Detected in Specimens from Radical Retropubic Prostatectomies / 대한비뇨기과학회지

PURPOSE: We tried to determine the clinicopathological significance of lymphovascular invasion (LVI) in patients who were treated for prostate cancer with radical retropubic prostatectomy. MATERIALS AND METHODS: From November 2003 to June 2005, 165 patients underwent radical retropubic prostatectomy for clinically-localized prostate cancer at our institution. The results of the final pathologic analyses were reviewed. RESULTS: Of the 165 total patients, foci of LVI were identified in 46 patients. LVI was associated with a higher preoperative serum level of prostate-specific antigen (p=0.006), the Gleason score (p<0.0001), a higher weight of tumor volume (p<0.0001), a higher rate of capsular penetration (p<0.0001), a higher rate of seminal vesicle involvement (p<0.0001), and a higher rate of a positive margin (p<0.0001). CONCLUSIONS: Since the pathological features of LVI appear to be associated with the other established features of more advanced prostate cancers, they may prove to be useful markers for predicting the prognosis of patients who undergo radical prostatectomy. Our findings support performing routine evaluation for LVI in radical prostatectomy specimens and its inclusion in the models for predicting the clinical outcome.

Adenocarcinoma Arising in Augmented Bladder / 대한비뇨기과학회지

Adenocarcinoma arising in an augmented bladder is a relative rare neoplasm. We report here on 2 cases of adenocarcinoma that developed in augmented bladders 23 and 30 years after ileocystoplasty, and both tumors were associated with contracted bladder due to tuberculosis. We also reviewed the literatures related to neoplasms occurring after urinary diversion procedures.

The Clinicopathologic Correlations of Histologic Tumor Necrosis for the Patients with Renal Cell Carcinom / 대한비뇨기과학회지

PURPOSE: The authors investigated the relation of histologic tumor necrosis to the other clinicopathologic factors that are known to be important prognostic indicators for the patients with renal cell carcinoma (RCC). MATERIALS AND METHODS: The records of 89 patients who were surgically treated for RCC between June 2003 and July 2005 were evaluated for their basic clinical, laboratory and pathologic information, including the TNM classification, the nuclear grade and the Ki-67 expression. The association of the presence and extent of histologic tumor necrosis with the clinical, laboratory and pathologic features, and the Ki-67 labeling index were examined with chi-square tests, Fisher's exact test, Pearson's correlation analysis, Spearman correlation analysis and multivariate logistic regression analysis. RESULTS: Histologic tumor necrosis was present in 34 of the 89 (38.2%) total RCCs, 24 of 73 (32.9%) conventional RCCs, 9 of 13 (69.2%) papillary RCCs and 1 of 3 (33.3%) chromophobe RCCs. The presence of histologic necrosis in the primary tumor of the patients with RCC compared to the patients with RCC without necrosis was associated with higher levels of anemia, hypercalcemia, hyperalkaline phosphatemia, a higher TNM stage and grade, more perirenal fat invasion, lymphovascular invasion, sarcomatoid change and renal vein thrombosis, a higher Ki-67 labeling index and a larger tumor size. When classifying the RCC according to the histologic subtype, for the conventional RCC, histologic tumor necrosis was associated with the same clinical, laboratory and pathologic features, and the same Ki-67 labelling index as that of the other types of RCCs. The extent of necrosis in the conventional RCC was associated with the TNM stage (r=0.44, p=0.033). Multivariate analysis demonstrated that a higher TNM stage (odd ratio: 5.667; p=0.036; 95% confidence interval: 2.125-63.120) was an independent predictor of histologic tumor necrosis for conventional RCC. CONCLUSIONS: The presence of histologic necrosis was a predictor of the outcome for conventional RCC, and it should be routinely reported and used in clinical assessment.

Clinical Significance of a Single-Core Positive Prostate Cancers Detected on Extended Prostate Needle Biopsy / 대한비뇨기과학회지

PURPOSE: The widespread use of serum prostate specific antigen and extended needle biopsy of the prostate as screening procedures for prostate cancer has not only led to an increase of detecting prostate cancer as a whole, but also to an increase of detecting small low grade tumors. Still, the clinical significance of small, low grade, single-core positivity on prostate biopsy hasn't yet been determined. So, we tried to investigate the clinicopathological features of prostate cancers that showed only single- core positivity on extended prostate needle biopsy. MATERIALS AND METHODS: 144 patients were managed with radical prostatectomy during 2003-2005 at our institution. Insignificant prostate cancer on biopsy specimens was defined as a single-core positive biopsy containing a focus of 3mm or less of moderately differentiated prostate cancer (Gleason score< or=6) and clinical insignificant cancer in the radical specimens was defined as a low volume (<0.5cc) of moderately differentiated organ- confined prostate cancer. We analyzed the clinicopathological features and the clinical significance in regards to the number of positive cores and the biopsy significance. RESULTS: Of 144 patients, 46 (31.9%) patients were diagnosed on the basis on single-core positive prostate cancer. Of these 114 patients, 32 (69.6%) patients had insignificance prostate cancer on biopsy. Although the single core positive group had more favorable pathologic features than the multiple core positive group, only 5 (10.9%) were found to have clinically insignificant cancer at radical prostatectomy. Also, in the biopsy insignificant group, only 5 patients (15.6%) were found to have clinically insignificant cancer. However, there were no features that could accurately predict insignificant prostate cancer preoperatively. CONCLUSIONS: Although the clinicopathological features of the prostate cancers that were detected in only a single-core on prostate needle biopsy were observed to be suggestive of less advanced disease, most of such single-core positive cancers may be clinically significant disease.

Concordance of Gleason Scores between Prostate Needle Biopsy and Radical Prostatectomy Specimens according to the Number of Biopsy Cores / 대한비뇨기과학회지

PURPOSE: Accurate grading of tumor is critical for administering the correct prostate cancer treatment. Meanwhile, the concordance of Gleason scores (GS) between sextant prostate needle biopsy and the radical prostatectomy (RP) specimen is known to be poor. We investigate if extended needle biopsy could improve the cancer detection rate and GS accuracy. MATERIALS AND METHODS: A total 826 consecutive patients each underwent 12 core prostate biopsies guided by TRUS. Of these patients, 136 consecutive patients underwent RP. Of the systemic 12 cores, we compared the subset of standard sextant cores, the set of lateral sextant cores and the 12 core set. RESULTS: The biopsy were positive in 218 cases (26.4%), 213 cases (25.7%) and 265 cases (32%) for the standard sextant, lateral sextant and twelve core biopsy, respectively. Concordance between prostate biopsy and prostatectomy GS was observed in 71 of 104 cases (68.3%), 80 of 110 cases (72.7%) and 98 of 136 cases (72.1%) for the standard sextant, lateral sextant and twelve core biopsy, respectively. Upgrading of 1 or more points was done in 26 of 104 cases (25.0%), 19 of 110 cases (17.3%) and 26 of 136 cases (19.1%), and downgrading 1 or more point was done in 7 of 104 cases (6.7%), 11 of 110 cases (10.0%) and 12 of 136 cases (8.8%) with the standard sextant, lateral sextant and twelve core biopsy, respectively. CONCLUSIONS: Twelve core needle biopsies lead to a higher cancer detection rate than do the sextant and lateral sextant needle biopsies. Twelve core and lateral sextant needle biopsies lead to higher concordance of the needle biopsy and surgical specimen GS compared with the standard sextant needle biopsy.

Usefulness of the UBC(TM)(Urinary Bladder Cancer) Test Compared to Urinary Cytology for Transitional Cell Carcinoma of the Bladder in Patients with Hematuria / 대한핵의학회잡지

No abstract available.

Two Cases of Prolonged Priapism Caused by Abuse of Intracavernosal Self-injection / 대한남성과학회지

Priapism is a rare disease, but needs early intervention and appropriate management. We present 2 cases of ischemic low-flow priapism after intracavernosal injection of vasoactive drug. 43-year-old man and 61-year-old man visited our clinic complaining of continuous plan and erection persisting for several days after self cavernosal injection for increasing their erectile function. We performed blood gas analysis of cavernosal blood and color doppler ultrasound. And so we confirmed the diagnosis of low-flow priapism. Detumescence was finally achieved after the proximal shunt operation. Their erectile function was not recovered and they became permanent impotence.

Percutaneous Sclerotherapy of Simple Renal Cyst Using Minocycline HCl / 대한비뇨기과학회지

PURPOSE: Sclerotherapy is performed additionally to improve the outcome of aspiration in simple renal cyst. Ethanol has been used most commonly as a sclerosing agent, however, drainage is necessary which complicates the procedure. For this reason, we used minocycline HCl as a sclerosing agent without need to be drained and evaluated the results. MATERIALS AND METHODS: From June 1990 to May 1999, 140 patients who underwent percutaneous minocycline HCl sclerotherapy for simple renal cyst were evaluated. Among them, 10 patients were missed during follow-up and 7 patients had bilateral simple renal cysts. The simple renal cysts were aspirated under ultrasonography, and then minocycline HCl 100mg mixed with 5ml normal saline was injected into the cyst per 50ml of aspirated cyst fluid. The follow-up ultrasonography was performed at posttreatment 3, 6 and 12 months. The recurred cases were retreated with same procedure. RESULTS: Among 137 renal cysts of 130 patients who could be followed up, 70 renal cysts (51.1%) were totally collapsed and 53 renal cysts (38.7%) showed a 50% or more decrease in cyst volume after first treatment. All 14 persistent renal cysts (10.2%) showed a 50% or more decrease in cyst volume after second or third treatment. Catheterization for drainage of the sclerosing agent was not needed. There were only some minor complications such as nausea, vomitting and local pain that subsided within one day with only symptomatic treatment. CONCLUSIONS: These results shows that percutaneous minocycline HCl sclerotherapy is simple, safe and effective and can be a alternative first line therapy of simple renal cyst.

The Experience After Operation Using Tension-free Vaginal Tape for Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The object was to study prospectively the results of a modified intravaginal sling operation for the surgical treatment of female stress urinary incontinence using tension-free vaginal tape (TVT) as a new continence procedure. MATERIALS AND METHODS: 55 women with demonstrable stress urinary incontinence underwent a nonrandomized, prospective study using the TVT sling operation. Preoperatively the patients were evaluated with Stamey grade and urodynamic testing. After having TVT sling operation, we observed the postoperative results throughout the 1-year follow-up. RESULTS: The mean age of the patients was 52.8 years and mean operation time was 26.6 minutes. Mean duration of postoperative catheterization was 1.1 days. 35 patients (63.6%) were completely cured throughout the 1-year follow-up period, and 18 patients (32.7%) were significantly improved. They did not loose urine apart from an occasional leakage during severe cold. CONCLUSIONS: TVT sling operation is a safe, simple and effective procedure for the treatment of stress incontinence.

The Effect of Treatment of Erectile Dysfunction with Electrical Stimulation / 대한남성과학회지

PURPOSE: In recent year, erectile dysfunction patients are increasing, and some of them want to increase their erectile function without using medication or surgical methods, In this study we attempted to find the value of electrical stimulation with electrical stimulation machine Hi-DREAM 328(TM) made in Korea as a treatment method of no definite underling disease caused erectile dysfunction patients. MATERIALS AND METHODS: In 22 cases erectile dysfunction patients we treated them two times per week for 4 weeks totally 8 times above mentioned machine, each session was spent for 1 hour 48 minutes. We checked IIEF-5 (International Index of Erectile Function-5) score repeatedly for comparing the change of IIEF-5 score pretreatment, 1 month after treatment and 3 month after treatment. And we compared the effect of treatment as comparing the IIEF-5 score changing each time. RESULTS: Total IIEF-5 score of pretreatment was 9.6+/-5.5, 1 month and 3 month after electrical stimulation were 17.9+/-2.9, 16.2+/-2.9, respectively. In the patients with venous leakage, IIEF-5 score was no increase definitely following electrical stimulation. But in the case of abnormal SPACE, pretreatment of IIEF-5 score was 12.1+/-5.2, 1 month and 3 month after electrical stimulation were 18.1+/-7.6, 16.5+/-7.4, respectively. We found that IIEF-5 score were increased in no definite organic caused erectile dysfunction patients, and there was significant correlation statistically (p<0.05) in erectile function, maintenance of erection, intercourse satisfaction, overall satisfaction. The remaining effect after treatment was decreased in time follow up. But the erectile function was preserved at comparing before treatment. CONCLUSIONS: We suggest that electrical stimulation is one of the treatment modalities in the treatment of no definite underling disease caused erectile dysfunction patients rather than vascular abnormalities as like venous leakage.