We evaluated the results of drug therapy in 76 children with nocturnal enuresis, who were free of other abnormalities in screening tests. History taking, careful physical examination including back area. urinalysis, urine culture, KUB and uroflowmetry were the screening tests. Overall response rate was 69.7 %. We found no statistically significant differences in responses between primary and secondary enuresis to drug therapy. We also found no difference in response according to the drugs including imipramine hydrochloride alone, oxybutynin chloride alone and combining of both. There was no difference in the results of the presence or the absence of daytime frequency and urgency. Two patients who resisted to the long-term therapy of imipramine hydrochloride and oxybutynin chloride showed good responses to the administration of intra-nasal desmopressin acetate. These data suggest that oxybutynin chloride does not show better therapeutic results than imipramine hydrochloride, whereas desmopressin acetate may be used for intractable enuresis to conventional drug therapy.
Child ; Deamino Arginine Vasopressin ; Drug Therapy* ; Enuresis* ; Humans ; Imipramine ; Mass Screening ; Nocturnal Enuresis ; Physical Examination ; Urinalysis

PURPOSE: Normal ranges for serum prostate specific antigen(PSA) differ among racial groups and by age. We sought to establish the relation between serum PSA concentration and age in a health care center Korea and to compare the vales with those of other races and other domestic health care centers. PATIENTS AND METHODS: Between January 1997 and December 1998, a total of 2908 Korean men aged 40 to 79 years without clinical evidence of prostate cancer who were examined for serum PSA at Kangnung Hospital using the Tandem assay (Hybritech). Descriptive statistics, including the median value and 95th percentiles of the distribution of serum PSA concentrations, were calculated for 10-year age groups from age 40 through 79. RESULTS: The serum PSA concentration correlated directly with age (p<0.001) using the 95th percentile of PSA. The normal age-specific reference ranges were 0.3 to 2.20 ng/ml for 40-49years, 0.3 to 2.30 ng/ml for 50-59 years, 0.3 to 3.50 ng/ml for 60-69 years, and 0.2 to 5.80 ng/ml for 70-79 years. CONCLUSION: Age-specific reference ranges for serum PSA concentration may be lower for Korean men than for other races. Thus, it would be appropriate to apply different age-specific reference ranges for Koreans.
Continental Population Groups ; Delivery of Health Care ; Humans ; Korea* ; Male ; Prostate* ; Prostate-Specific Antigen* ; Prostatic Neoplasms ; Reference Values*

From October 1985 to March 1992 we experienced 18 cases of childhood kidney injury. All cases were blunt injury and could be classified as renal contusion (38.9%), minor renal laceration (16.7%). major renal laceration (33.3%) and renal pedicle injury (11.1%). Thirteen patients were treated conservatively and 3 patients were undergone partial nephrectomy and 2 patien1s were undergone nephrectomy. All five cases were classified as major laceration. One patient of major renal laceration was treated conservatively and recovered without delayed operation and functional impairment on follow-up 99Tc-DTPA. Two vascular injured children were treated conservatively owing to delayed identification. The most important clinical sign of severe injury was the rate of hemoglobin decrease (p<0.05). In case of normal IVP and microscopic hematuria, there was no need to further radiologic work-up and it may be treated conservatively without complication or delayed operation. The computerized tomography was the most accurate diagnostic tool in evaluating renal trauma especially in cases of multiple organ trauma. There was no hypertension secondary to renal trauma in 6 patients whose blood pressure was followed up for average 9 months.
Blood Pressure ; Child* ; Contusions ; Follow-Up Studies ; Hematuria ; Humans ; Hypertension ; Kidney* ; Lacerations ; Nephrectomy ; Wounds, Nonpenetrating

PURPOSE: Antegrade ureteral stenting was attempted in cases where cystoscopic retrograde ureteral stenting had been unsuccessful in the alleviation of a ureteral rupture, stricture or obstruction. Attempts were made to evaluate the clinical outcomes and technical issues of antegrade ureteral stenting in ureteral obstruction. MATERIALS AND METHODS: Between 1998 and 2003, antegrade ureteral stenting was attempted in 15 patients. Here, the results were retrospectively analyzed. Of the 15 patients, the retrograde ureteral stenting failed in 13. The causes of the ureteral obstructions were urological and nonurological malignancies in 12 patients, genitourinary tuberculosis in 2 and endoscopic ureteral trauma in 1. RESULTS: Thirteen of the 15 patients were successfully stented using the antegrade methods. One cervical cancer patient was stented using a pull-through technique. Four out of 6 patients with radiologically completely obstructed ureters were stented successfully. The ureteral stents were removed in two patients where the causes of the ureteral obstructions were relieved. Seven patients were successfully stented for the relief of obstructive renal failure, and all showed rapid decreases in their serum creatinine level and/or improvements on imaging studies. Five patients were successfully stented for the relief a ureteral obstruction, and all showed improvements on imaging studies. Changes of the ureteral stents were performed by cystoscopy in four patients. CONCLUSIONS: Antegrade ureteral stenting is an alternative technique for the alleviation of a ureteral obstruction should retrograde ureteral stenting not be possible. An antegrade ureteral stenting trail is recommended, even in the case of a radiologically complete obstruction on an antegrade ureterogram. Antegrade ureteral stenting is one of the choices for the alleviation of a ureteral obstruction unless the patient has an intravesical obstruction and the inability to move.
Constriction, Pathologic ; Creatinine ; Cystoscopy ; Humans ; Nephrostomy, Percutaneous ; Renal Insufficiency ; Retrospective Studies ; Rupture ; Stents* ; Tuberculosis ; Ureter* ; Ureteral Obstruction* ; Uterine Cervical Neoplasms

PURPOSE: To compare the clinical parameters and complications between standard and tubeless percutaneous nephrolithotomies (PCNL). The purpose of this study was to assess the efficacy, safety and morbidity of a tubeless percutaneous nephrolithotomy. MATERIALS AND METHODS: A total of 102 patients, who underwent a PCNL at our institution by one surgeon, were enrolled in this study. Of the 102 patients, 30 underwent a standard PCNL between January 2001 and July 2002, and 72 underwent a tubeless PCNL between July 2002 and March 2005. All the PCNL were performed using a balloon tract dilator and 30Fr. working sheath. In the standard PCNL group, a 12Fr. nephrostomy tube was inserted. In the tubeless PCNL group, no nephrostomy tube was inserted, with the skin sutured onto the site of the nephrostomy. The stone volume, operating time, amount of blood loss, complications and hospital stay were compared between the two groups. RESULTS: There were no significant differences in stone volumes, decrease in postoperative 1 day hemoglobin, transfusion rates and complication rates between the two groups. However, the postoperative hemoglobin (p=0.05) and hospital stay (p=0.001) were significantly less in the tubeless compared to the standard PCNL group. CONCLUSIONS: The tubeless PCNL was associated with no more bleeding or complications than the standard PCNL. Tubeless PCNL is a recommendable procedure in percutaneous renal stone surgery.
Hemorrhage ; Humans ; Length of Stay ; Nephrostomy, Percutaneous* ; Skin

GnRH stimulation test has been used to distinguish patients with hypogonadotropic hypogonadism of pituitary origin from those with hypothalamic disease. GnRH stimulation test also has been used to identify early stage of Sertoli cell insufficiency and to know the subtle abnormalities or spermatogenesis. Some investigators reported that exaggerated FSH response after GnRH stimulation means the same diagnostic meaning as basely elevated FSH level and this in turn reflects Sertoli cell insutriciency or may help to identify patients with isolated primary germ cell failure in azoospermic patients. So they suggested the possibility that GnRH stimulation test can replace testis biopsy in male infertility. To define the normal range of the gonadotropin response after GnRH stimulation and to know the indications for GnRH stimulation test if it is useful as an evaluation method for spermatogenesis, and especially to test the possibility whether GnRH stimulation test may replace testis biopsy, we performed GnRH stimulation test in 118 infertile men and 20 fertile adult male volunteers and compared the results with testicular histology. Normal basal serum levels for LH, FSH, testosterone were 1.4-18.3( mean 9.9) mIU/ml, 2.8-18.4 (mean 10.0) mIU/ml, 2.0-9.1 (mean 5.0)ng/ml respectively, and 95% confidence intervals for the peak responses to an intravenous bolus injection of 100ug GnRH were 360-1950{mean 1098)% of the basal serum LH level, and 111-318(mean 225)% of the basal FSH level in 20 rertile adult male volunteers. The results of the FSH response in GnRH stimulation test were not helpful in distinguishing patients with bad testicular histology from those with good ones in 118 infertile men. So we came to the conclusion that GnRH stimulation test can not replace testis biopsy as an evaluation method for spermatogenesis in the majority of infertile patients.
Adult ; Biopsy ; Germ Cells ; Gonadotropin-Releasing Hormone* ; Gonadotropins ; Humans ; Hypogonadism ; Hypothalamic Diseases ; Infertility, Male* ; Male ; Male* ; Reference Values ; Research Personnel ; Spermatogenesis ; Testis ; Testosterone ; Volunteers

Prognostic significance of the nuclear morphometry in 60 patients with initial T1 G II bladder tumor was evaluated. Clinical informations such as tumor size. multiplicity. recurrence pattern were abstracted and nuclear morphometric values such as mean nuclear area, standard deviation of nuclear area, mitotic activity index, volume-corrected mitotic index were analyzed from initial pathologic slide using image analyzer(Amersham RAS R-1000 receptor analysis system). Univariate and multivariate analyses were performed to define the influences of clinical informations and nuclear morphometric values on progression or recurrence of the tumors. In univariate analysis, mean nuclear area greater than 90um2, volume-corrected mitotic index greater than 24 and mitotic activity index greater then 15 influenced significantly to the tumor progression as well as recurrence. The standard deviation of nuclear area greater than 18um2 influenced significantly only to the tumor progression. In multivariate analysis, the most significant prognostic factor with respect to the progression was mean nuclear area. The group of patients with mean nuclear area greater than 90um2 showed 7.82 times more likely to progress. No significant prognostic factor was identified in multivariate analysis with respect to the recurrence. Nuclear morphometry provides valuable and objective informations to predict the possibility of progression in individual T1. Grade II bladder tumor patient.
Humans ; Mitotic Index ; Multivariate Analysis ; Recurrence ; Urinary Bladder Neoplasms* ; Urinary Bladder*

No abstract available.
Gastric Emptying* ; Hepatitis B, Chronic* ; Hepatitis, Chronic*

PURPOSE: We wanted to study the precise anatomical location of the branches of the pelvic plexus from the sacral root to the cavernous nerve. MATERIALS AND METHODS: We performed microdissection on the pelvises from 4 male formalin fixed cadavers under a Zeiss surgical microscope and we traced the location of the branches of the pelvic plexus at a magnification of 6x. RESULTS: The configuration of the pelvic plexus was an irregular diamond shape rather than rectangular. It was located retroperitoneally on the lateral wall of the rectum 8.2 to 11.5cm from the anal verge. Its midpoint was located 2.0 to 2.5cm from the seminal vesicle posterosuperiorly. A prominent neurovascular bundle (NVB) was located on the posterolateral portion of the apex and the mid portion of the prostate. The pelvic splanchnic nerve (PSN) joined the NVB at a point distal and inferior to the bladder-prostate (BP) junction. The PSN components joined the NVB in a spray-like distribution at multiple levels distal to the BP junction. The distance from the membranous urethra to the NVB was 0.5 to 1.2cm. We also found multiple tiny branches on the anterolateral aspect of the prostate apex. CONCLUSIONS: In contrast to the usual concept, the NVB was much wider above the mid portion of the prostrate and it supplied multiple tiny branches on the anterolateral aspect of the prostate. The PSN branches arose from the more posteroinferior area of the pelvic plexus. Therefore, we recommend a more anterior dissection of the lateral pelvic fascia for nerve sparing radical prostatectomy. If surgeons plan a nerve graft after radical prostatectomy, they should consider this neuroanatomy for obtaining a successful outcome.
Cadaver ; Diamond ; Fascia ; Formaldehyde ; Humans ; Hypogastric Plexus* ; Male ; Microdissection ; Neuroanatomy ; Pelvis ; Prostate ; Prostatectomy ; Rectum ; Seminal Vesicles ; Splanchnic Nerves ; Transplants ; Urethra

PURPOSE: To evaluate the usefulness of MR urography(MRU) using Half-Fourier acquisition single-shot turbospin-echo(HASTE) sequence compared with conventional intravenous urography(IVU). MATERIALS AND METHODS: Thirtyfive lesions of 32 patients who underwent MRU because of delayed excretion or nonvisualization of the ureter wereincluded in this study. HASTE MR urography was performed with a 1.0 MR imaging unit. Coronal images includingthose of the kidney, ureter and bladder were obtained in every patient using the multislice technique, and werepostprocessed by means of the maximal intensity projection technique. Scan time was 17-19 seconds. We analyzed theresults of MRU, focusing on level of obstruction, incidence of stone, ureter dilatation, and motion artifact, andin each case compared MRU findings with those of IVU. RESULTS: In 12 of 35 lesions(34.2%), MRU more effectivelydiagnosed causes of obstruction than did IVU, while in seven lesions(20%), MRU and IVU were similar. In eightlesions(22.9%), all of which were caused by a stone, IVU was better than MRU, and in a further eight, neithermodality was able to diagnose the cause. For diagnosis of the level of obstruction, MRU was better than IVU in 20of 35 lesions(57.1%), and similar to IVU in seven(20%). In three lesions(8.6%), neither modality was able todetect the level of obstruction. Four lesions not related to obstruction were polycystic renal disease, cysticrenal change, vesicovaginal fistula and extra-renal pelvis. Dilatation of the ureter was seen in 23lesions(65.8%) on MRU and in seven lesions on IVU. Thus, MRU revealed dilatation of for the ureter more efectivelythan IVU. CONCLUSION: MRU using HASTE was valuable for the detection of underlying causes and levels ofobstruction in the urinary tract, and of abnormalities in surrounding structures in patients with non-visualization of the kidney or delayed contrast excretion of the ureter, as seen on delayed IVU urogram.
Artifacts ; Diagnosis ; Dilatation ; Humans ; Hydronephrosis ; Incidence ; Kidney ; Magnetic Resonance Imaging ; Pelvis ; Polycystic Kidney Diseases ; Ureter ; Urinary Bladder ; Urinary Tract ; Urography* ; Vesicovaginal Fistula