PURPOSE: Enterocystoplasty is the method commonly used in clinical practice. The use of intestinal segments in the urinary tract for the reconstructive purposes has been reported numerous complications: urinary tract infection, stone formation, hyperchloremic acidosis, hypokalemia, urinary obstruction secondary to mucus plugs, and malignancy developing. We studied on the feasibility of creating an enterocystoplasty with a reversed seromuscular ileal segment to decrease the likelihood of recognized complications in cases of standard bowel replacement. MATERIALS AND METHODS: Augmentation enterocystoplasty was performed in 21 male, 400-450gm, Sprague-Dawley rats with a patch of ileum. There were 3 groups, including 1 group of 9 rats that underwent augmentation conventionally, while another group of 8 rats were augmented using reversed seromuscular flaps and the other rat was died for postoperative ileus. The other group of 3 rats were sham operated. The animals survived without significant complications and were sacrificed at 4 or 12 weeks. RESULTS: The bladder capacities in both group were no significant differences. The size of the intestinal patchs were markedly decreased in reversed seromuscular flaps. The urine white blood cells and mucus production were much higher in the conventional type, but intraperitoneal mucus production and postoperative adhesion were seen mostly in reversed seromuscular types. CONCLUSIONS: Reversed seromuscular flaps showed little mucus production in urine and urinary infection compared to those animals with flaps undergone conventional method. Unfortunately, intraperitoneal mucus production and graft contracture were much higher in those procedures. Further studies would be needed for clinical availability of reversed flap.
Acidosis ; Animals ; Contracture ; Humans ; Hypokalemia ; Ileum ; Ileus ; Leukocytes ; Male ; Mucus ; Rats* ; Rats, Sprague-Dawley ; Transplants ; Urinary Bladder ; Urinary Tract ; Urinary Tract Infections

PURPOSE: We wanted to investigate how transurethral resection of the prostate(TURP), for treating patients with benign prostate hyperplasia(BPH), affected the serum prostate-specific antigen(PSA) levels. MATERIALS AND METHODS: The serum PSA levels were measured before and 12 months after operation in 57 patients who underwent TURP for BPH. The total prostate weight, as measured by transurethral ultrasonography (TRUS), and the weight of the surgical specimen were examined in relation to the pretreatment PSA value and the changes in the PSA levels after the operation. RESULTS: The preoperative mean PSA density was 0.10+/-0.08ng/ml/cc. The postoperative serum PSA levels were decreased significantly after TURP (p=0.002). Removal of 1g of BPH tissue reduced the serum PSA levels by an average of 0.22+/-0.4ng/ml. The changes in the serum PSA level one year after TURP correlated with the resected chip weights[Y=0.406+0.176x (r=0.526, p<0.05)]. CONCLUSIONS: TURP caused a long term decrease in the serum PSA level. One year after TURP, the PSA levels should be expected to decrease according to the resected chip weights.
Humans ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Hyperplasia ; Transurethral Resection of Prostate ; Ultrasonography ; Weights and Measures

A primary genitourinary melanoma is rare, accounting for less than 1% of all cases of melanoma. They have been presented in case reports, with a subsequent paucity of insight into the natural history of the disease and appropriate management of patients. The prognosis of patients with a genitourinary melanoma is poor. Delay in seeking medical attention for symptoms, and misdiagnosis at presentation, contribute to a more advanced stage at diagnosis. Our case involved a 71 year old woman, who came to our hospital due to vaginal spotting. On local excision, mass was found on the vestibule and forward to the urethra. The pathological diagnosis, by special immunohistochemical staining, such as S-100 protein and HMB-45, was that of a malignant melanoma.
Aged ; Diagnosis ; Diagnostic Errors ; Female ; Humans ; Melanoma* ; Metrorrhagia ; Natural History ; Prognosis ; S100 Proteins ; Urethra ; Vagina

PURPOSE: An experience of extracorporeal shock wave lithotripsy (ESWL) using the Piezolith 2300 lithotriptor in 2077 (2223 renal units) patients with urinary tract calculi is presented. MATERIALS AND METHODS: The records of 2077 patients who underwent an ESWL between April 1990 and March 2001 were reviewed retrospectively. The ESWL treatment sessions, success rate, auxiliary procedures, and complications according to the stone size and location were analyzed. RESULTS: Of 2223 renal units (2077 patients), 781 (35.1%) had renal, 1150 (51.7%) had ureteral and 292 (13.2%) had multiple stones. Of these cases 1116 (50.2%) had stones <1cm in size, 805 (36.2%) had stones ranging from 1 to 2cm in size, 194 (8.7%) had stones ranging from 2 to 3cm in size and 108 (4.9%) had stones ranging larger than 3cm in size, including staghorn or multiple stones. The success rate ranged from 96.3% for stones <1.0cm in diameter to 41.7% for stones >3.0cm in size, with an 86.4% overall success rate. For auxiliary measures, the push back procedure was done in 23 cases. The treatment modalities of the unsuccessful cases were open surgery in 95 cases and ureteroscopic stone removal in 31. A stone street developed in 93 patients. However, there were no other significant complications. CONCLUSIONS: Extracorporeal shock wave lithotripsy with a piezolith 2300 lithotriptor is to be a safe and efficient outpatient procedure for the initial treatment of properly selected urinary tract calculi.
Calculi* ; Humans ; Lithotripsy* ; Outpatients ; Retrospective Studies ; Shock* ; Ureter ; Urinary Calculi ; Urinary Tract*

PURPOSE: We evaluated the clinical usefulness of air filled axial computed tomography (CT) images and virtual cystoscopy (VC) with using a 64- channel multidetector-row CT (MDCT) scanner for the detection of bladder tumors. MATERIALS AND METHODS: Fifty-nine patients who displayed gross hematuria or a clinical suspicion of bladder tumor were scanned using a 64-channel MDCT scanner. The unenhanced CT images of the urinary bladder were obtained, with the patients in the supine and prone positions, following drainage of urine and distension of the bladder with approximately 300-500cc of room air through a urethral catheter. The CT data were transferred to a workstation for reconstructing the VC images. Two radiologists independently interpreted the axial and virtual images, and discrepancies were resolved by working in consensus. The results of the VC were compared with the findings of conventional cystoscopy or the operative findings. RESULTS: Abnormal findings were identified by the axial CT images and VC in 54 (91.5%) patients. All bladder lesions demonstrated with the VC were seen on conventional cystoscopy. On the VC, lesions greater or equal to 1.4mm in diameter could be identified. But there were 3 false negative findings in cases of sessile masses smaller than 5mm and cases with a trabeculated bladder. There were no false-positive findings. The sensitivity of the technique was 100% for tumors larger than 0.5cm. CONCLUSIONS: VC with using 64-channel MDCT scanner was very accurate at identifying masses larger than 0.5cm and it can show a mass as small as 1.4mm. Bladder tumors can be diagnosed less invasively using air-filled VC. However, in the case with severe bladder trabeculation or wall thickening, we recommend conventional cystoscopy rather than VC.
Consensus ; Cystoscopy* ; Drainage ; Hematuria ; Humans ; Multidetector Computed Tomography* ; Prone Position ; Tomography, X-Ray Computed ; Urinary Bladder Neoplasms* ; Urinary Bladder* ; Urinary Catheters

Retrocaval ureter is a congenital venous anomaly, in which the ureter passes behind and is compassed by inferior vena cava. We experienced a case of multiple urothelial cell carcinoma in retrocaval ureter in 68 years old male. He was treated with transurethral resection of bladder tumor and right nephroureterectomy with bladder cuff excision.
Aged ; Carcinoma, Transitional Cell ; Humans ; Male ; Retrocaval Ureter* ; Ureter ; Urinary Bladder ; Urinary Bladder Neoplasms ; Vena Cava, Inferior

PURPOSE: The clinical significance of prostatitis associated with benign prostatic hyperplasia (BPH) remains to be determined. We determined the differences in the prevalence, pattern, clinical symptoms and outcome in BPH patients both with, and without prostatitis. MATERIALS AND METHODS: This prospective study included 134 consecutive patients with lower urinary tract symptoms related to BPH. The patients were divided into 2 groups relating to the expressed prostatic secretion caused by prostate massage (group 1: more than 10 leukocytes per high power field, group 2: less than 10 leukocytes per high power field). Tamsulosin, a selective alpha1-blocker, and finasteride were administered at doses of 0.2 and 5mg, respectively, once a day for one year. The primary efficacy criteria included, symptomatic improvement (International Prostate Symptom Score: I-PSS), maximum flow rate (Qmax) and residual urine volume. RESULTS: Prostatitis was identified in 67 of 119 patients (56.3%); the other 15 patients failed the prostatic massage. Of the patients with associated prostatitis, 8 (11.9%) showed bacterial growth. The serum PSA level was higher in group 1 than in group 2, but there were no significant differences in the other clinical parameters. There was no significantly difference in the improvement of the total I-PSS after treatment between the two groups. However, in group 1, the rritative symptom was significantly less improved (p<0.05). CONCLUSIONS: Prostatic inflammation is a common finding in patients with symptoms of BPH. In such cases, the response to medical treatment for irritative symptoms was inferior in the BPH only cases. There is a need for more studies to distinguish chronic prostatitis and BPH, and to ascertain any additional treatment requirements.
Finasteride ; Humans ; Inflammation ; Leukocytes ; Lower Urinary Tract Symptoms ; Massage ; Prevalence ; Prospective Studies ; Prostate ; Prostatic Hyperplasia* ; Prostatitis*

Malacoplakia is a rare granulomatous inflammatory disease that most frequently involves the urinary tract, particularly the urinary bladder and may involve the testis, epididymis, lung, bone, colon, prostate, female genital organs, and the retroperitoneum, etc. A malacoplakia of the prostate is a very rare disease that is associated with a chronic urinary tract infection. It is often misinterpreted as granulomatous prostatitis, and may clinically mimic prostate cancer. The major cellular component of malacoplakia is the macrophage and the diagnostic hallmark is a characteristic inclusion, the Michaelis-Gutmann body. We recently experienced a case of malakoplakia of the prostate in a 74-year-old man, that was found incidentally in a TRUS-guided biopsy to confirm a suspected prostate cancer.
Aged ; Biopsy ; Colon ; Epididymis ; Female ; Genitalia, Female ; Humans ; Lung ; Macrophages ; Malacoplakia* ; Male ; Prostate* ; Prostatic Neoplasms ; Prostatitis ; Rare Diseases ; Testis ; Urinary Bladder ; Urinary Tract ; Urinary Tract Infections

PURPOSE: There is controversy surrounding the benefits and risks to health of a circumcision of the male prepuce. The purpose of this study was to provide educational material to the general population and medical doctors to help them understand appropriate opinions relating to a circumcision. MATERIALS AND METHODS: A prospective study, including 1,124 adult men, 772 women, with sons, and 971 doctors, was performed. The subjects were interviewed, in detail, about their cognition of circumcision, their circumcision status, their age at circumcision, how many men received circumcisions, their reasons and thoughts relating to circumcision, the pros and cons and their current knowledge of the health benefits and risks associated with male circumcision. RESULTS: 81% of the general subjects, and 77% of the doctors, taking part in the study, were circumcised. The most common age at circumcision, accounting for 34% of the subjects, was over 18 years old. 77% of the general subjects, and 80% doctors, agreed with circumcision. The greatest motive for a circumcision, accounting for 38% of the subjects, was their parents wish. The satisfaction rate of a circumcision was 93%. Most Koreans (69%) considered that a circumcision is an ordinary operations in males. CONCLUSIONS: In this study, most Korean men were found to be circumcised, and were very much satisfied with the results, and on most occasions the procedure had been performed after adolescence. These results suggest that, in Korea, circumcision has a position as a customary conduct, and in itself is inevitable. Therefore, it is essential to explain the advantages and disadvantages of a circumcision to patients and their parents.
Adolescent ; Adult* ; Circumcision, Male* ; Cognition ; Consciousness* ; Female ; Humans ; Insurance Benefits ; Korea ; Male ; Parents ; Prospective Studies ; Risk Assessment

PURPOSE: To investigate patients who had transrectal ultrasonography (TRUS)-guided prostate biopsy to define the role of the serum testosterone level in predicting prostate cancer risk and its association with a high Gleason score. MATERIALS AND METHODS: A total of 568 patients who underwent prostate biopsy were entered in this study. We divided the patients into two groups according to serum testosterone level (median level, 3.85 ng/ml): the high-testosterone group (n=285) and the low-testosterone group (n=283). Multivariate regression analysis was used to define the effect of age, prostate volume, serum prostate-specific antigen (PSA) level and PSA density, and serum testosterone level on the risk of prostate cancer and a high Gleason score. RESULTS: Baseline characteristics did not differ significantly between the two groups. Compared with the high-testosterone group, the low-testosterone group had a significantly higher prostate cancer incidence (38.9% vs. 29.5%, p=0.018). Factors associated with an increased risk of prostate cancer were increased age (odds ratio [OR]=1.08, 95% confidence interval [CI]=1.25-3.16, p=0.001), a high serum PSA level (OR=3.35, 95% CI=2.63-4.25, p=0.001), a low prostate volume (OR=0.183, 95% CI=0.11-0.30, p=0.001), and a low serum testosterone level (OR=1.99, 95% CI=1.25-3.16, p=0.001). Among these, only the serum PSA level was a strong predictor of high-grade prostate cancer (Gleason score > or =7) (OR=2.19, 95% CI=1.57-2.95, p=0.001). CONCLUSIONS: Patients with lower levels of serum testosterone had a higher risk of prostate cancer than did patients with high serum testosterone. Even though a lower serum testosterone level was a predictor of prostate cancer risk, it was not associated with an increased risk of high-grade prostate cancer.
Biopsy ; Cohort Studies ; Humans ; Incidence ; Male ; Prostate ; Prostate-Specific Antigen ; Prostatic Neoplasms ; Risk Factors ; Testosterone