About 60,000 men were undergone voluntary sterilization by the 497 designated doctors during the period from 1962 to October 1965 by the government subsidy program. Besides these numbers more than 15,000 private cases were sterilized by private doctors during the period from 1960 to 1964 in Korea. A general comprehension of the sterilization operation for motivation of customers was illustrated. An analysis of the social history and background of the sterilized men were made on the author's private group and the subsidized group. The most common occupation of the private group was commerce and that of the subsidized group was africulture. The duration intervening between marriage and sterilization indicated 13.6 years in the private group and 16.7 years in the subsidized group. An average age of the sterilized men showed 40 and that of their wives 35. An average number of children of the private group showed 4.7 while that of subsidized group indicated 5.3. Sexual drive following the sterilization was not changed in 81 per cent of the private group and in 71 per cent of the subsidized group. Decrease in sexual activity was revealed in 5 per cent of the private group but in 11 per cent of the subsidized group. General health after the sterilization was not changed in 83 per cent of the private group and in 70 per cent of the subsidized group. Decrease in general health was noted in only 6 per cent of the private group but in 11 per cent of the subsidized group. Frequency of sexual intercourse per week of the private group indicated 1.95 times preoperatively and 1.88 times postoperatively whereas that of the subsidized group revealed 2.27 times preoperatively but 1.99 times postoperatively. In regarding the sexual feeling of their wives, more than 87 per cent of the private group showed no change before and after the operation while 71 per cent of the wives of the subsidized group were not changed. Very few wives of the private group complained of some decrease, but 10 per cent of the subsidized group complained decrease. The time lost from work after the sterilization was about 2 days in the private group while about 8 days in the subsidized group. About 93 per cent of the private group were satisfied with the sterilization but 2 per cent of them did not feel happy after the operation. In the subsidized group 88 per cent were satisfied with the operation but 10 per cent were not satisfied. All of the private group and 80 per cent of the subsidized group would recommend the sterilization method to their friends. Untoward effects on sexual drive and general health are found to be higher in the subsidized group than in the private group. These outcomes are partly due to low edcation and low income of the subsidized group compared with the private group and partly due to unsatisfactory operative technique of the designated doctors. Psychological studies by means of MMPI conducted on 20 sterilization neurosis patients and the results were compared with the control nonvasectomized group. The sterilized group had definite psychological instability so that a preoperative psychological interview is found to invariably be necessary to prevent the sterilization neurosis. It is concluded by this preliminary clinical survey of the vasectomized cases through the author's private system and the government subsidy program that the few who told to decrease in sexual capacity and general health were outnumbered by those reporting an increase. The majority of the cases told of no change. The changes noted by a small proportion of patients appeared to be chiefly of psychological origin because there was no physiologic reason why the operation of vasectomy should causes sexual excess or decrease.
Child ; Coitus ; Commerce ; Comprehension ; Financing, Government ; Friends ; Humans ; Interview, Psychological ; Korea ; Male ; Marriage ; MMPI ; Motivation ; Occupations ; Sexual Behavior ; Spouses ; Sterilization ; Sterilization, Reproductive ; Vas Deferens ; Vasectomy*

An anastomosis of the vas deferens was performed on 17 patients since 1963.Semen specimens were examined repeatedly in 15 cases of the series after periods from 2 to 24 weeks following removal of the splint. The fifteen were found to have viable sperm in their ejaculates but one of these patients subsequently became azoospermic again. Three of the fifteen cases had some degree of deteriorated effects after the previous vasectomy but they were free of the complications following the successful anastomosis of the vas deferens. Operative rechnics were discussed. In this series 2-0 dermalon was used as a splint in 15 cases and stainless steel wire was used in 2 cases. Liothyronine was given to 16 of 17 patients at or before the operation for periods from 1 to 6months. Over-all successful results would indicate about 65 per cent of the cases operated in the literature. The author's small series indicates that more than 90 per cent of the operated cases could be successful in this operative procedure from the cytological point of view.
Humans ; Nylons ; Spermatozoa ; Splints ; Stainless Steel ; Surgical Procedures, Operative ; Triiodothyronine ; Vas Deferens* ; Vasectomy*

A total of 42 vas anastomoses was performed on experimental animals and successful anastomoses were obtained 19 of the cases and the over-all rate of success was approximately 46 per cent. But 13 dogs in total of 21 dogs were found to be patent in at least one side of vas, or about 65 per cent of total dogs were restored their fecundity. Splinting materials used in this comparative study are chromic catgut, stainless steel wire, dermalon and polyethylen tube, and dermalon has been proved as the most excellent splinting material among thembecause it is no figid but plable and makes no tissue reaction in the vas. Successful anastomosis of vas deferent is affected by many factors. Among these, an inadequate splinting material has been considered as the most important causes of failures. But it should seem that minimal dissection of the tied points of vas as satisfactory approximation of the free ends of vas exert very important effect upon the successful anastomosis as the splinting material does. Consecutive four successful anastomosis of human cases are highly satisfactory results and are very encouraging even in a small series of cases of the present study.
Animals* ; Catgut ; Dogs ; Fertility ; Humans* ; Nylons ; Splints* ; Stainless Steel ; Vasectomy*

In spite of the great measure of recent success in tuberculosis withchemotherapy, it is still one of the most fundamental questions in what state ofrenal tuberculosis should be treated surgically. So as to set up a criterion onthe chemotherapy, forty-nine extirpated tuberculous kidneys were observed withmy own classification of tuberculous renal lesions. 1. The lesions were classified macroscopically and pyelographically according to the development of renal tuberculosis (1) Those with neither change of calyceo-pelvic system nor pyelographical abnormality were named Class O. representing parenchymal tubercles. (2) Those with only infiltration in the tip of papilla were named Class I, showing caliectasis or clubbing pyelographically. (3) Those with initial minor ulceration in calyceal system were named Class II, showing fuzzy irregular or moth-eaten outline pyelographically (4) Those with progressed distorted ulceration were named Class III, showing definite irregular deformity but still keeping some semblance to the original calyceal form pyelographically. (5) Those with cavitation, open or closed were named Class IV, showing irregularly outlined shadow without original anatomic form pyelographically. (6) Those with tuberculous pyonephrotic ectasis were named Class E, showing less irregularly out lined cavity shadow pyelographically. 2. Tuberculous kidneys might also be graded clinically and pyelographically with the classification of the lesions. (1) The tuberculous kidneys with early lesions,i.e. Class O, Class I and/or Class II were called minimal renal tuberculosis.(2)Those with intermediate lesions. i.e. Class III were called moderate. (3) Those with a progressed lesion, i.e. Class IV or Class E were called advanced. (4) Those with two or more lesions of Class IV and/or Class E were called far advanced. 3. The lesions belong to each Class were divided again into untreated control group and three treated groups with triple drug therapy of different durations and the macroscopical and histopathological appearances in each treated group were compared with in untreated one. 4. Macroscopically the lesions in treated kidney with remaining excretory function and without obstruction showed tendency toward clearing of caseous material in each class.5. The specific reactions in tuberculous tissue were improved histopathologically in proportion to duration of the therapy. (1) Caseous material was cleared up. (2) Epithelioid cells revealed sufficient degeneration and diminution, occasionally complete disappearing. (3) Giant cells also revealed degeneration, vacuolation and diminution, frequently complete disappearing. 6. The severity of non-specific tissue reactions in the lesions. i.e. connectivetissue reaction, parenchymal degeneration and defect, interstitial inflammation and lymphocytic infiltration was not influenced by duration of the therapy, but depended on Class of lesions at the time of therapy began. 7. The repairing reactions in the lesions were increased according as prolongation of the therapy, but there might be some variety between the different reactions. (1) Vascularization: according as the duration, but not remarkable. (2) Regeneration of epithelium: according as the duration, but only partial covering. (3) Vacuolation: significant, however, also noticed in untreated group. (4) Reducing of perifocal reaction: according as the duration, but not sufficient in the progressed lesions.8. In the more progressed tuberculous lesions, specific and non-specific tissuereactions predominsted over repairing, therefore histological healing was more delayed. 9. There were noticeable evidences of histological improving in the specimens from patients with triple drug therapy for more than three months. 10. As a result of these observations, I should like to recommend that: (1) for minimal renal tuberculosis, chemotherapy is continued; (2) for moderate, chemotherapy is tried firstly, and if the lesions are persistent or worsened surgery will be considered; (3) for advanced and far advanced, surgery including partial nephrectomy is preferable after at least three month chemotherapy.
Classification ; Congenital Abnormalities ; Drug Therapy* ; Epithelioid Cells ; Epithelium ; Giant Cells ; Humans ; Inflammation ; Kidney* ; Nephrectomy ; Regeneration ; Tuberculosis ; Tuberculosis, Renal ; Ulcer

Statistical survey was made on out-patients and in-patients in the Department of Urology, Seoul National University Hospital during the period from January to December in 1964. Of 2,873 out-patients including 2,346 males and 527 females, 234 cases (171 males and 63 females) were hospitalized and various operations were performed on 195 occasions. The following tables are self-explanatory.
Female ; Humans ; Male ; Outpatients ; Seoul ; Urology*

In recent years active research on sexual anomalies, especially on the conditionsof intersex is rapidly progressing. It is not until Barr et al, have clarifiedthe epochmaking discovery of sex chromosome test that the concept of chromosomalintersex was firmly established. Reported here are 6 cases of intersex admittedto the Department of Urology, Seoul National University Hospital. Aceerding tothe results of observation on the sex chromatin. external or internal genitalia,in some, hormonal balance, utilizing various methods of urological examination, 6 cases of intersex have been confirmed. These patients consist of 1 case of truehermaphroditism, 2 cases of male pseudohermaphroditism. 2 cases of femalepseudohermaphroditism with congenital adrenogenital syndrome and one case ofKinefelter's syndrome. In summary the first case of true hermspbroditismapparently looked like a hypospadiac male with atrophied testis as gonad but afterpuberty the ovarian activity became manifest and gynecomastia developed. Therefore is out of the question that this case is a true hermaprodite possessing bothtestis and ovary. Considering this patient's sex of rearing, correction of hypospadia was performed. This patient leads his social life by virtue oftestosterone supply. The second case is a male pseudohermaphroditism patientconfirmed by exploratory laparotomy which revealed degenerative change of femalegonads and reproductive organ. However, the active gonad was testis andaccordingly it is apparent that this is a male pseudohermaphroditism case. Thispatient had the hope to live as a female. Therefore according to the patient's own wish, hypospadia correction plus phallectomy and vaginoplasty were performedand was feminized. Estrogen therapy has been received, but masculinizing symptomsare still present. The 3rd case had severe hypospadia with cryptorchism. Theexternal appearance, however, was like that of a female. Laparotomy revealed no gonads or reproductive organ. Biopsy revealed atrophic testis. Therefore thediagnosis of sale pseudohermaphroditism was made. This child was performedhypospadia correction and was decided to be reared as a male. The 4th case afirmly established adrenogenital syndrome patient, has received clitoridectomyand cortisone therapy was indicated and is under observation. The 5th case alsois a child with adrenogenital syndrome. Bilateral partial adrenalectomy wasperformed and simultaneously cortisone therapy was continued. However, clinical manifestations of Cushing's syndrome appeared because of overdosage of cortisone. In this case, clitoridectomy and vaginoplasty were performed. The 6th patient was a chromosomal intersex. Chromosomal test was positive and large gynecomastia was present. Testicular biopsies revealed characteristic findings of the Klinefelter's syndrome. There were hyalinzed seminiferous tubules, hypertrophy of the basement membrane, and an increased number of interstitial cells appearing in clumps. Testosterone therapy was performed to correct mental symptoms and decreased libido. Gynecomastia is to be removed surgically. It is important on the diagnosis of intersex to confirm the existence of urogenital sinus. Urogenital sinus was present in 4 of our cases. As with 2nd case, adaptability of patients with intersex will be more secure to make the social sex as a female than to make it as a male. Recent related literatures were reviewed.
46, XY Disorders of Sex Development ; Adrenalectomy ; Adrenogenital Syndrome ; Basement Membrane ; Biopsy ; Child ; Circumcision, Female ; Commerce ; Cortisone ; Cryptorchidism ; Cushing Syndrome ; Diagnosis ; Disorders of Sex Development ; Estrogens ; Female ; Gonads ; Gynecomastia ; Hope ; Humans ; Hypertrophy ; Hypospadias ; Klinefelter Syndrome ; Laparotomy ; Libido ; Male ; Ovary ; Seminiferous Tubules ; Seoul ; Sex Chromatin ; Sex Chromosomes ; Testis ; Testosterone ; Urology ; Virtues

No abstract available.
Transurethral Resection of Prostate*

Forty five cases of tuberculosis of the epididymis were classified according to grade of invasion and length of antituberculous chemotherapy and the histopathological response to chemotherapy was evaluated as follows: 1) Tuberculosis of the epididymis is graded according to the size and extent of invasion. Grade I (mild) A single nodule in size of small finger tip or smaller in the head, body or tail is palpable. Differentiation with nonspecific lesion is very difficult. Grade II (moderate): A single nodule in size of index finger tip or smaller ie palpable. No adhesion is noticeable. Grade III (advanced): One or two nodules in size of thumb or smaller are palpable. Adhesion is present or absent and the vas shows thickening. Grade IV (far advanced): Tow or more nodules in size of thumb or larger are palpable and scrotal fistula or abscess present. Adhesion is usually present and the beaded vas is palpable. 2) Histopathological response to chemotherapy are as follows: a) Caseation: the longer the duration of chemotherapy the less the caseation is present. b) Epitheloid cells show degeneration, atrophy and decrease. c) Giant cells show degeneration, atrophy, vacuolization and decrease. d) Perifocal reaction is reduced gradually upon chemotherapy. e) Fibrosis is very significant in the group of treatment and vacuolization readily occurred early in the chemotherapy with longer chemotherapy. Hyalinization of fibrous tissue is prominent f) Lymphocytic infiltration and vacuolization are observed both in treated and untreated groups, more significant in the first. g) Almost same grade of reticulosis is observed both in the treated and untreated groups. h) It was observable that among the testis, epididymis and the vas deferens, somewhat faster response to the chemotherapy vas obtained in the vas than in the epididymis and the testis showed the slowest response to the chemotherapy. i) Significant histopathological response is obtained in the group of two months or longer chemotherapy, j) From these observations, the author is of belief that extensive chemotherapy is only indicated for epididymal tuberculosis of grades I and II without surgery. However, the grades III and IV lesions require surgical intervention following a trial with chemotherapy for 2 months or longer.
Abscess ; Atrophy ; Drug Therapy* ; Epididymis* ; Fibrosis ; Fingers ; Fistula ; Giant Cells ; Head ; Hyalin ; Male ; Testis ; Thumb ; Tuberculosis* ; Vas Deferens

Two-hundred and fourteen cases of tuberculosis of the epididymis seen during the period from April 1957 to March 1965 were studied clinically and the following results were obtained: (1) Incidence of tuberculosis of the epididymis is 1.4% of all urological diseases or 22.4% of tuberculosis of the urinary tract of the male. (2) The highest occurrence is observed in the ages of 20 to 39(75.7%) and the lowest in the ages below 9 and above 60 (0.9%) respectively. (3) Lateralization shows 31.8% in the right, 24.3 % in the left and 43.9 % in the both. The site of invasion is most popular in the tail (47.8 %) and the size up to thumb size was observed in 89.4 %. (4) Discovery of tuberculous invasion in the remainder following unilateral epididymal lesion is made within 2 years 7 months. Transfer of tuberculosis of the other organ to the epididymis requires 6 years 3 months. (5) In 42.9 %, tuberculous diseases were present in the past history ; The pleura, the lung and the urinary tract were most frequently invaded. (40.6 %) (6) Approximately half of the cases requested medical care within one month after discovery of the lesion. (7) Of presenting symptoms, swelling of the epididymis was observed in 73.8 %, frequency of urination 27.1 % and hematuria in 20.1 %. (8) Three or more c.c. of ejaculate were observed in 24.1 %, counting of sperm disclosed azoospermia in 41.4 % oligospermia in 35.5 % and normospermia in 20.7 %. (9) In urine examination, W. B. C. 5/H. P. F. or more is observed in 70.7 %, RBC 3/H. P. F. or more in 40.5 %, albumin in 61 % and tubercle bacilli in 27.4 %. (10) In prostatic smear, WBC 10/H.P.F. or more is observed in 69.7 %, RBC 5/H.P.F. or more in 18.3 % and tubercle bacilli in 7.7 %. (11) Proatatic tuberculosis is the commonest complication of epididymal tuberculosis (67,8 %). (12) Local injection with 0.3-0.5 cc of 30 % streptomycid solution directly in the lesion appeared to be very effective in 11 of 13 cases. This treatment is to be used prior to surgery.
Azoospermia ; Epididymis* ; Hematuria ; Humans ; Incidence ; Lung ; Male ; Oligospermia ; Pleura ; Spermatozoa ; Thumb ; Tuberculosis* ; Urinary Tract ; Urination ; Urologic Diseases

A number of chronic inflammatory lesions of unknown etiology in man have recentlybeen understood by the mechanism of so called auto-immune disease and a series of experimental study using animals have been extensively undertaken to reproduce the lesion. Experimental chronic inflammatory diseases induced by repeated injection of homologous or heterologous tissue antigen with adjuvant are based upon immunological process and these are readily reproducible. The author has experimentally studied on any allergic destruction of the epididymis of the rat on immunologic process as in other particular organs and tissue. A total of 59 white healthy male rats were divided into 7 major experimental groups of injection as follows. Group 1: six rats, control, injection with normal saline alone. Group 2: six rats, injection with adjuvant only. Group 3: six rats. injection with epididymal tissue only. Group 4: twenty-three rate, injection with rat epididymal tissue plus adjuvant. A. seven rats, sacrificed on the 64th day B. ten rate, sacrificed on the 92nd day C. six rats, sacrificed on the 128thday Group 5. six rate, injection with rat epididymal tissue plus adjuvant plus prednisolone. Group 6: six rats, injection with rabbit epididymal tissue only Group 7: six rats, injection with rabbit epididymal tissue plus adjuvant Injections were given into the abdominal muscle of the rat once s week for 8 weeks as scheduled in the text and the animals of all groups except the group 4, were sacrificed 8 days after the final injection. In the group 4, animals were further divided into 3 subgroups which were sacrificed on the 61st, 92nd and l28th day of the experiment, respectively. The epididymis and other organs of allexperimental animals were studied histopathologically and the following results were obtained; 1. In all rats of the group 1 receiving homologous epididymal tissue with adjuvant, the epididymis revealed relatively marked and significant inflammatory changes. Histopathology included edema, congestion, fibrosis in the interstitial tissue, and infiltration of inflammatory cells mainly composed of lymphocytes, histiocytes, plasma cells and eosinophils. Flattening and hyperplasia of the epithelial cells and cellular exsudation were observed in the tubules. 2. In the group 1, the lapse of time after injection provoked more marked inflammatory changes. Diffusely mild or moderate degree of inflammation observed on 61st day, was changed to diffusely moderate or marked inflammation on 92nd day and then to significantly more chronic lesion with less exsudation and more fibrosis on 128th day. 3. Homologous tissue antigen without adjuvant andheterologous tissue antigen with or without adjuvant caused no inflammatory changes. 4. Inflammatory changes induced by homologous tissue antigen with adjuvant seem to be readily inhibited or prevented by simultaneous administration of prednisolone.
Abdominal Muscles ; Animals ; Edema ; Eosinophils ; Epididymis ; Epididymitis* ; Epithelial Cells ; Estrogens, Conjugated (USP) ; Fibrosis ; Histiocytes ; Humans ; Hyperplasia ; Inflammation ; Lymphocytes ; Male ; Plasma Cells ; Prednisolone ; Rats