Gender differences in sexual behavior and condom-related behaviours and attitudes among Korean youths.

We examined gender differences in sexual behaviours, condom-related behaviours and attitudes to premarital sex in order to identify gender differences in young Korean singles aged 19 to 30 years. This study was based on data from the 2003 national survey of attitudes and behaviours towards AIDS in the Korean adult population, which contains information on a national sample of the general population aged 19 to 59 years. We selected 501 unmarried subjects between the ages of 19-30 from 1995 respondents. The selection criterion for the subjects' age was based on the 2003 Korean mean age for marriage which was 29.8 for men and 27.0 for women. Gender differentials in sexual behaviour, condom use and related attitudes toward condom use were assessed. Although men initiated sexual practice earlier and had more multiple partners than women, both genders were equally likely to have engaged in inconsistent condom use, even when having sex with a high risk partner. These findings suggest that sex education focusing on condom use should be included in the school curricula. Implementation of early sexual education should start before the students initiate sexual activity to give them a chance to prepare gradually.

Seroepidemiologic survey of Orientia tsutsugamushi, Rickettsia typhi, and TT118 spotted fever group rickettsiae in rubber estate workers in Malaysia.

The seroprevalence of Orientia tsutsugamushi, Rickettsia typhi, and TT118 spotted fever group (SFG) rickettsiae in 300 rubber estate workers in Slim River, Malaysia was determined in December 1996 and March 1997. In December, which was the wet season, 23.3%, 3.0%, and 57.3% of the population had antibodies detected against the three rickettsiae, respectively. The highest seropositive rate of 40% was detected for single infection with SFG rickettsiae, followed by a rate of 15.3% for both O. tsutsugamushi and SFG rickettsiae among the rubber estate workers. Subjects less than 21 years old had a lower seroprevalence of SFG rickettsiae compared with the other age groups. Indians had a higher seroprevalence of O. tsutsugamushi compared with other ethnic groups. Rubber tappers had a higher seroprevalence of SFG rickettsiae compared with other occupational groups. During the dry season in March 1997, there was a significant increase in the seroprevalence of R. typhi. The seroconversion rates for IgM against O. tsutsugamushi, R. typhi, and SFG rickettsiae were 5.7%, 12.3%, and 15.1%, respectively, during the four-month period. Significant variations of antibody titers towards the three rickettsiae was noted among subjects who were bled twice. This suggests a significant and continual exposure of rubber estate workers to the three rickettsiae.

Holmium:YAG laser endoureterotomy for treatment of ureteral stricture.

OBJECTIVES: Endourologic techniques ranging from balloon dilation to endoincision with electrocautery, cold knife, and lasers have been increasingly used in recent years for the treatment of ureteral strictures. While the long-term results may not be as reliable or as durable as traditional reconstructive surgical techniques, they can be accomplished with much less morbidity. Recently, the holmium:yttrium-aluminum-garnet (YAG) laser, which possesses both cutting and coagulating properties, has been demonstrated to have many applications in urology. We report our experience with this laser in the endoscopic treatment of ureteral strictures. METHODS: We reviewed the charts and follow-up history of 22 patients in whom the holmium:YAG laser was used to treat ureteral strictures from a variety of causes and including those in ureteroenteric anastomoses. Strictures were either approached in a retrograde fashion with a 6.9F ureteroscope or antegrade with flexible instruments in the cases involving ureteroenteric strictures. The only energy source employed was the laser, followed by balloon dilation. Indwelling stents were left in place for at least 4 weeks postoperatively and follow-up was obtained with radiographic imaging. RESULTS: A minimum 9-month follow-up was available for 18 patients. There were 5 patients who had developed recurrent strictures and were therefore considered treatment failures. Each of these patients failed in less than 3 months and all had either lengthy or complex strictures noted at the time of surgery. One patient was lost to follow-up and three recent patients have follow-up of 3 to 6 months showing no evidence of recurrent stricture formation. Overall, 16 of 21 (76%) patients are clinically well with no evidence of stricture recurrence. CONCLUSIONS: Endoureterotomy for ureteral stricture disease is a minimally invasive, less morbid, but ultimately less successful, alternative to open surgical reconstruction. Stricture length and etiology remain the most important determinants of success. The holmium:YAG laser, with its ability to precisely cut tissue and provide hemostasis and its multiuse potential and compatibility with small rigid and flexible endoscopic instruments, is an ideal tool for performing endoureterotomy.

Enhancement of erectile responses to vasoactive drugs by a variable amplitude oscillation device.

The limitations of intracavernosal injection (ICI) of vaso-active drugs as a diagnostic tool in the evaluation of erectile dysfunction are well recognized and, prominently, include the artifacts induced by the unfamiliar environment on the patient. We report on the benefits of adding a vibratory stimulus to ICI to improve the sensitivity of this test in a population of 170 patients with erectile dysfunction who were evaluated using a standard protocol. Intracavernosal pressure was measured following ICI alone and ICI with vibratory stimulation of the penis. A statistically significant improvement in intracavernosal pressure (ICP) with the addition of vibration was observed in 87% of the subjects as compared to ICI. In 52% the improvement in ICP was greater than 20% over that achieved by ICI. This study showed that the addition of vibration to intracavernosal administration of vaso-active drugs significantly increases the erectile response in a controlled and reproducible manner. Vibratory stimulation provides a better reflection of erectile potential than the pharmacological challenge alone.

Soft-tissue applications of the holmium:YAG laser in urology.

The holmium:YAG laser possesses both ablative and hemostatic properties and in preliminary clinical use has demonstrated many potential urologic applications. We review our initial experience in treating a variety of soft-tissue lesions of the urinary tract with this laser. A total of 51 patients underwent 53 procedures including superficial bladder tumor ablation (25), incision of ureteral stricture (15), incision of urethral stricture (6), relief of ureteropelvic junction obstruction (3), incision of bladder neck contracture (2), and ureteral tumor ablation (2). Procedures were considered successful, with no further intervention or alternative energy source required, in 81% of the cases. The laser demonstrated precise hemostatic cutting and warrants further investigation as a multipurpose urologic laser.

Evaluation of Doppler ultrasonography and dynamic contrast-enhanced CT in acute and chronic renal obstruction.

The development of a reliable, minimally invasive method of distinguishing physiologically significant renal obstruction from dilation without obstruction would have important clinical implications. As it is well known that renal blood flow decreases over time in the presence of obstruction, we investigated the ability of color flow Doppler ultrasonography and dynamic contrast-enhanced CT scanning to detect changes in blood flow in unilaterally obstructed porcine kidneys. In the initial phase of this study, the effect of acute unilateral obstruction were studied in nine pigs. The resistive index (RI) was measured with Doppler ultrasonography, and renal blood flow was quantitated with dynamic CT using tracer kinetic principles and deconvolution. The RI measurements were unable to distinguish between the obstructed kidneys and their controls. Dynamic CT scanning demonstrated a greater fall in blood flow in the obstructed kidney, and this change was significantly different from baseline. The same findings were supported by radiolabelled microsphere blood-flow measurement. In the chronic portion of the study, after surgical creation of a partial ureteric obstruction, the kidneys were studied by both techniques at 1, 2, and 3 weeks. Again, RI was unable to demonstrate any difference between obstructed and unobstructed kidneys, while CT showed a progressive fall in blood flow in each successive week that was statistically significant. Dynamic contrast-enhanced CT scanning is a promising diagnostic tool that might be used to distinguish a functionally significant renal obstruction from nonobstructive dilation. Further clinical studies to validate this technique are warranted.

Renal cell carcinoma in von Hippel-Lindau disease: another piece of the puzzle.

The association of von Hippel-Lindau disease and renal call carcinoma is well recognized. However, the most appropriate surgical approach in patients with von Hippel-Lindau disease and renal carcinoma remains controversial. We examine this controversy and report on our experience. Our cohort consisted of 28 affected members of three von Hippel-Lindau kindreds. Screening of these individuals consisted of an abdominal ultrasound (US) in their early teens and a baseline computerized axial tomography (CT) scan in their late teens. To date, nine patients have been found to have renal cell carcinoma. In three of these patients, the surgical specimen revealed multiple small foci of "clear cells" characteristic of renal cell carcinoma that had not been detected by careful radiological assessment prior to surgery. In two patients, these lesions were located at the opposite pole from the radiologically-detected tumor. Nephron-sparing surgery, therefore, risks leaving potential tumor that may be responsible for mortality. Conversely, radical procedures condemn a patient to life-long dialysis and/or transplantation with associated risk and morbidity. The potential for the metachronous emergence of contralateral renal cell carcinoma, however, justifies efforts to preserve normal tissue in patients harboring radiologically-detected lesions; however, we need to know with some certainty the natural history of the correct management of this disorder.

Late fertilization of unfertilized human oocytes in in vitro fertilization and intracytoplasmic sperm injection cycles: conventional insemination versus ICSI.

PURPOSE: The aim of this study was to evaluate the efficacy of intracytoplasmic sperm injection (ICSI) in comparison with conventional reinsemination using fertilization failed oocytes by conventional in vitro fertilization (IVF). METHODS: Oocytes were collected from patients of IVF or ICSI cycles. Patients were grouped by fertilization techniques: group 1: conventional IVF; group 2: reinsemination after conventional IVF failure; group 3: regular ICSI; group 4: 1-day-old ICSI after conventional IVF failure; group 5: 2-day-old ICSI after conventional IVF failure; group 6: re-ICSI after regular ICSI failure. RESULTS: In different insemination groups, normal fertilization rate was higher (P < 0.001) in 1-day-old ICSI (47.1%) and 2-day-old ICSI groups (40.0%) than in reinsemination (14.7%). Abnormal fertilization rate was higher (P < 0.05) in re-ICSI group (21.7%) than any other groups (range: 0-8%). Cleavage rate was higher in 1-day-old (36.7%) and 2-day-old ICSI groups (36.0%) than in reinsemination (5.3%, P < 0.001) or re-ICSI groups (17.4%, P < 0.05). Pregnancy rate was 27.6% and 20.0% in conventional IVF and regular ICSI groups, respectively. However, 1-day-old ICSI (group 4) and 2-day-old ICSI (group 5) were attempted once embryo transfer (ET) but failed pregnancy occurred in each group. CONCLUSIONS: In fertilization failure cycles, late ICSI increases the rate of fertilization and embryonic development and may rescue the completely failed attempt of pregnancy.

Laser prostatectomy with the holmium: YAG laser.

Laser prostatectomy has generated considerable interest amongst urologists as an alternative to traditional transurethral resection for the treatment of benign prostatic hypertrophy. The majority of reports available concerning laser prostatectomy have described use of the neodymium: YAG wavelength delivered via contact or non contact fibers. Recently, a new laser wavelength has become available for urologic use. The holmium: YAG laser is a multipurpose device with many potential applications in urology as well as other surgical disciplines. At a wavelength of 2,100 nm, this laser possesses both ablative and hemostatic properties. Energy and frequency settings can be varied by the operator. Using the holmium: YAG laser as well as the neodymium: YAG laser in a combined procedure, we performed laser prostatectomies in 16 patients. In our series we used the holmium laser to vaporize a channel prior to producing quadrant irradiations with the Nd:YAG laser. At 3-month follow-up there was a mean reduction of AUA symptom scores from 19 to 9 and a mean improvement in peak flows from 13.9 to 16.6 ml/s. Early results show clinical effect but the optimal technique of combined holmium: YAG, Nd:YAG laser prostatectomy is yet to be determined.

Intracorporeal lithotripsy with the Alexandrite laser.

BACKGROUND AND OBJECTIVE: The objective of this study was to evaluate clinical use of an Alexandrite laser lithotripter for intracorporeal lithotripsy of urinary calculi. STUDY DESIGN/MATERIALS AND METHODS: We prospectively evaluated a flash lamp pumped, Q-switched Alexandrite solid-state laser for use in conjunction with ureteroscopy (30 cases) or percutaneous nephrolithotripsy (2 cases). The laser operates at a wavelength of 755 nm in a pulsed mode with pulses of 150-800 ns duration at energy settings of 30-80 mJ. RESULTS: The fragmentation rate with the Alexandrite laser alone was 50% (16/32). Failure of the laser was due to equipment malfunction or technical problems in 11 cases and inability to fragment the stone in 5. All cases of failed Alexandrite laser lithotripsy were successfully salvaged with alternative modalities of endoscopic stone destruction and removal. One intraoperative complication, a ureteral perforation, occurred; however, no long-term sequelae related to laser use was documented. CONCLUSION: Clinical results with the Alexandrite laser appear to be inferior to those reported with Alternative laser systems and other forms of intracorporeal lithotripsy. Whereas some of the inadequacies we have noted may be addressed in the future by modifications in the unit and delivery systems, we would not recommend this device for intracorporeal lithotripsy of urinary calculi in its current form.

Intracorporeal lithotripsy with the holmium:YAG laser.

PURPOSE: Preliminary evaluations of the holmium:YAG laser have demonstrated a variety of potential urological applications, including ablation of soft tissue lesions as well as stone fragmentation. We present our experience with the holmium:YAG laser for intracorporeal lithotripsy of urinary calculi. MATERIALS AND METHODS: During a 24-month period 75 patients underwent 79 laser procedures, including retrograde ureteroscopy for ureteral calculi (71) and fragmentation of caliceal stones remote from the nephrostomy tract during percutaneous nephrolithotripsy (8). RESULTS: Complete stone fragmentation without need for additional procedures or lithotripsy was achieved in 85% of the cases. Treatment failures included 1 case of stone migration, 7 incomplete fragmentation requiring other lithotripsy devices and 3 laser malfunction. One ureteral perforation occurred when the laser was activated without direct visual guidance. CONCLUSIONS: The holmium:YAG laser has demonstrated its efficacy as a method of intracorporeal lithotripsy. Advantages include ability to fragment stones of all composition, and the multipurpose, multispecialty applications of the holmium wavelength. This laser has potential soft tissue effects, and careful attention to technique during lithotripsy is required to avoid ureteral wall injury.