No abstract available.
Humans ; Spinal Cord Injuries* ; Spinal Cord* ; Urinary Bladder*

PURPOSE: Recently the use of penile prostheses in patients with spinal cord injury(SCI) has been beneficial for sexual dysfunction, maintenance of external devices and the treatment of penile skin lacerations. We reviewed 50 patients with SCI who had been followed for more than five years after penile prosthetic implantation, particularly in regard to surgical success rate and complication rate. MATERIALS AND METHODS: From 1988 to 1993, 102 penile prostheses were implanted in 50 patients with SCI. Penile prosthetic implantation was done for sexual dysfunction in 29 patients and for sexual dysfunction and urinary management in 21 patients. The types of penile prostheses were malleable in 13 patients, Dynaflex in 35 patients and AMS 700 CXM in two patients. RESULTS: We experienced prosthetic infection in six patients, mechanical failure in three patients, urethral erosion in two patients and penile skin necrosis in one patient. The overall surgical success rate was 88% and the five-year complication rate was 24%. CONCLUSIONS: Though the complication rate of penile prosthetic implantation in patients with SCI was higher than in the general population, penile prosthetic implantation improves the quality of life with regard to sexual function and urinary management in patients with SCI.
Follow-Up Studies* ; Humans ; Lacerations ; Necrosis ; Penile Prosthesis* ; Quality of Life ; Skin ; Spinal Cord Injuries* ; Spinal Cord*

Recently the use of penile prostheses in spinal cord injury population has been beneficial for sexual dysfunction, maintenance of external devices and the treatment of penile skin lacerations. We have implanted penile prostheses in 38 spinal cord injury patients in the last 2 years. The patients were between 25 and 64 years old(average 40.6 years old). Followup ranged From 4 months to 2 years (average 14.9 months). All the patients received penile prostheses to treat erectile impotence. We used malleable penile prostheses in 13. Hydroflexes in 5 and Dynaflexes in 20 patients. Rod sizes and diameters ranged from 12 to 18 x from 0.9 to 1.15 cm for the malleable type and from 14 to 18 x 1.1 cm for the Hydroflex and Dynaflex. Complications dictating loss of prostheses occurred in 4 cases (10.5%). One pumping failure and one prosthetic infection were developed in Dynaflex and Hydroflex, while one spontaneous intraurethral protrusion and one glandular erosion in malleable types. In the former 2 cases they were successfully exchanged to Dynaflexes and in the latter 2 cases they were removed. As a whole surgical success rate was 92.1 % and sexual satisfaction rate was 78.9%. In conclusion, the penile prosthesis implantation is considered as a useful treatment method for erectile impotence in spinal cord injury patients.
Erectile Dysfunction ; Follow-Up Studies ; Humans ; Lacerations ; Male ; Penile Implantation ; Penile Prosthesis* ; Prostheses and Implants ; Skin ; Spinal Cord Injuries* ; Spinal Cord*

PURPOSE: Autonomic dysreflexia represents one of the most serious medical emergencies in the care and rehabilitation of patients with spinal cord injury. We evaluated the effect of terazosin for the prevention of symptoms due to autonomic dysreflexia in patients with spinal cord injury. MATERIALS AND METHODS: The effect of terazosin was evaluated in 20 spinal cord injury patients with autonomic dysreflexia. All patients received terazosin as the only medication for the autonomic dysreflexia. Baseline measurements of blood pressure, the autonomic dysreflexia severity score and autonomic dysreflexia frequency score were recorded before terazoxin medication. Follow-up measurements were taken at 1 week, 1 month and 3 month after medication. All the data were statistically evaluated and the following results were obtained. RESULTS: The majority of patients(95%) had manifested headache and sweating. The autonomic dysreflexia severity score after terazosin medication decreased from an average of 9.0+/-0.6 at baseline to 6.8+/-0.7, 5.2+/-0.7 and 4.9+/-0.6 at 1 week, 1 month and 3 months repectively(p=0.001). And the autonomic dysreflexia frequency score after terazosin medication decreased from an average of 2.4+/-0.5 to 1.2+/-0.4 at 3 months. CONCLUSION: Tetazosin appears to be effective in preventing symptoms due to autonomic dysreflexia.
Autonomic Dysreflexia ; Blood Pressure ; Emergencies ; Follow-Up Studies ; Headache ; Humans ; Rehabilitation ; Spinal Cord Injuries* ; Spinal Cord* ; Sweat ; Sweating

PURPOSE: Nocturia and enuresis are common voiding problems in spinal cord injured patients despite a variety of management. The purpose of this study is to determine the efficacy of desmopressin, a synthetic analogue of antidiuretic mono, as an alternative treatment in the management of spinal cord injured(SCI) patients with neurogenic bladder dysfunction unresponsive to conventional therapy. MATERIALS AND METHODS: Fourteen SCI patients with nocturia or enuresis were included in this study. The patients received 10microgram desmopressin intranasally at bedtime once every 24 hours. RESULTS: There was a significant decrease in nocturnal urinary volume, frequency of nocturia and nocturnal enuresis during nighttime after desmopressin administration. Two patients stopped desmopressin because of side effects. 8 of 12 patients improved with desmopressin and the remainder had no effect. There was no serum abnormality, although there were side effects in three cases, such as gastro-intestinal trouble, chest discomfort or nasal congestion. CONCLUSIONS: Desmopressin is safe and effective in the management of nocturia or enuresis due to neurogenic bladder dysfunction in selected SCI patients.
Deamino Arginine Vasopressin* ; Enuresis ; Estrogens, Conjugated (USP) ; Humans ; Nocturia ; Nocturnal Enuresis ; Spinal Cord Injuries ; Spinal Cord* ; Thorax ; Urinary Bladder, Neurogenic*

Autonomic dysreflexia is a syndrome characterized by severe hypertension, headache, sweating that is seen in spinal cord injury population. It can be a life-threatening problem if not promptly recognized and treated. Since the most common cause is bladder distention, it is essential that the urologist sh6fild be familiar with this syndrome. Two hundred ninety four patients with spinal cord injury were reviewed for the prevalence rate and clinical manifestations of autonomic dysreflexia. The time of onset post-injury, precipitating causes, presenting symptoms and management were analyzed. 42 patients (34.4%) of 122 patients with lesion above T6 level exhibited autonomic dysreflexia. The majority of patients (61.9%) had manifested signs and symptoms of autonomic dysreflexia within the first year. The precipitating causes were bladder distention (69.0%), bowel distention (23.8%) and urinary tract infection (7.1%). The presenting symptoms of autonomic dysreflexia were headache (88.1%), sweating (88.1%), hot flushing (28.6%), chest discomfort, hyperpnea and spasm. The management of autonomic dysreflexia include prompt bladder erupting, bed rest and appropriate bowel preparation. In conclusion, prompt recognition and appropriate management of autonomic dysreflexia are essential to prevent life-threatening sequelae.
Autonomic Dysreflexia* ; Bed Rest ; Flushing ; Headache ; Humans ; Hypertension ; Prevalence ; Spasm ; Spinal Cord Injuries* ; Spinal Cord* ; Sweat ; Sweating ; Thorax ; Urinary Bladder ; Urinary Tract Infections

Klinefelter's syndrome was described in 1942 as a syndrome of hypogonadal men with small testes, gynecomastia and elevated urinary gonadotropin by Klinefelter et al. for the first time. As the pathogenesis has become better understood the original description has been expanded to include additional features. The presence of supernumerary X chromosome is considered to be the fundamental underlying etiological factor. The clinical triad of the Klinefelter`s syndrome are sterility, male phenotype, and small firm testes. Clinical observation and plasma testosterone, FSH(follicle stimulating hormone), LH(luteinizing hormones measurement were made on the 11 Klinefelter`s syndromes in the Department of Urology, Seoul National University Hospital as follows: 1. The age distribution was from l9 years old to 33 years old and the average span was 28 years old. 2. A11 of the patients had small and firm testes, and showed decreased pubic hair and sparse body hair. Gynecomastia occurred in 5 patients(48%). 3. The average height was 169.3cm and average span was 170. 1 cm and average lower leg length 96.3 cm 4. The chromosomal study showed 47 XXY in the all patients and sex chromatin was positive in the all patients. 5. All of the patients was azoospermia on the semen analysis. 6. Histological structures of the testes were hyalinization with fibrosis of the seminiferous tubule and psuedoadenomatous clumping of the Leydig cell. 7. The average level of plasma testosterone, FSH, LH were 184 ng/d1(range 80-349 ng/d1) 35.25 mI U/ml(range 27-43.3mI U/ml), 14.5mI U/ml(range 7.6-26.52mI U/ ml). 8. Treatment of the patients was hormonal therapy with testosterone.
Adult ; Age Distribution ; Azoospermia ; Fibrosis ; Gonadotropins ; Gynecomastia ; Hair ; Humans ; Hyalin ; Infertility, Male ; Klinefelter Syndrome* ; Leg ; Male ; Phenotype ; Plasma ; Semen Analysis ; Seminiferous Tubules ; Seoul ; Sex Chromatin ; Testis ; Testosterone ; Urology ; X Chromosome

About 85-97% of patients get to lose an ejaculatory function with a little difference according to the level of spinal cord injury. Fifty eight trials of electroejaculation stimulation were performed in total 17 patients that failed in chemoejaculation with physostigmine. Mean age was 36.9 years. Of the 17 spinal cord injured patients, 1 had cervical, 13 thoracic 3 lumbar paraplegia; 7 had complete and 10 had incomplete lesions. Semens could be obtained in 14 patients ( 82.4%) among total 17 patients and in 51 of total 58 trials( 87.9%). Average total sperm counts and motile sperm numbers were 35.98 x 106 and 6.09 x 106 respectively in the obtained semen. However, motility was very poor. We performed more than 4 trials in 6 patients, but there results were not predictable. Two pregnancies were achieved in their spouse after an artificial insemination. Side effects were trivial. and there were lower abdominal discomforts or pains in 7 patients among incomplete paraplegics. In conclusion we could expect high successful rates of ejaculation in anejaculatory spinal cord injured patients by electroejaculation stimulation in case of the failure in chemoejaculation. However, we suggest that in vitro fertilization with advanced recent technology should be tried with adequate preparation after an experimental electroejaculation, because a quality of sperm motility was very poor and sperm motility was not improved after several trials.
Ejaculation ; Fertilization in Vitro ; Humans ; Insemination, Artificial ; Male ; Paraplegia ; Physostigmine* ; Pregnancy ; Semen ; Sperm Count ; Sperm Motility ; Spinal Cord Injuries ; Spinal Cord* ; Spouses

A total of 37 randomized patients with left sided varicocele were investigated for the past 5 years to evaluate the effects of varicocelectomy on semen quality and fecundity. They were 14% of infertile males who hospitalized for surgical treatment except vasectomy reversal cases. According to severity of varicocele, patients were divided into three grades such as Grade I (Valsalva positive, consisted of 8 cases). Grade II (palpable, consisted of 18 cases) and Grade III (visible, consisted of 11 cases). Their, mean age was 29 years(20-40 years) (Table 1), and duration of marital life, 3 years(1-15 years). Mean levels of plasma FSH(6. 39 IU/l), LH(6. 25 IU/I) and testosterone (6. 97 ng/ml) were within normal ranges. There were no significant differences in hormonal levels among the grades of varicocele (Table 2), Oligospermias and normospermias were distributed in these grades of varicoceles almost the same extent. This means that the size or grade of varicocele was not closely correlated with degree of spermatogenic failure. Spermiogram of total patients was as follows: mean volume. 2. 9 ml; motility, 34%; normal shape, 68%; and azoospermia in 3 cases; counts of less than 20 X 10`/ml in 21 cases; and more than 20 x 10 6/ml in 13 cases with mean count of 26 x 10 6/ml(Tables 3 and 4). Of these, 6 subjects with sperm counts of more than 41 x10 6/ml were submitted to control series without surgery and the remaining 31 patients with sperm counts of less than 40 x 10 6/ml underwent varicocelectomy by high ligation of internal spermatic vein. After the operation, sperm appeared in 1 of the 3 azoospermia. Numbers of patients with sperm counts of less than 20 x 10 6/ml decreased from 21 to 19 cases, and those with more than 21 x 10 6/ml increased from 7 to 10 cases following the surgery. No significant changes in volume, motility and morphology could be demonstrated after varicocelectomy(Tables 5. 6 and 7). When judging by tentative criteria of fertility unit (total sperm counts( 10 6) x motility(%) x morphology(%) / 10 6) of more than 1 unit, improvement was observed in only 9 patients(29%) after the operation(Table 5). Three conceptions (10%) occurred in those submitted to varicocelectomy in 1 to 36 months after the operation and 1 pregnancy(17%) resulted in control series. In the present series of patients with varicocele, no significant beneficial effects were observed on semen quality and pregnancy rate after varicocelectomy(Tables 5 and 6).
Azoospermia ; Fertility ; Fertilization ; Humans ; Ligation ; Male ; Oligospermia ; Plasma ; Pregnancy Rate ; Reference Values ; Semen Analysis ; Sperm Count ; Spermatogenesis* ; Spermatozoa ; Testosterone ; Varicocele ; Vasovasostomy ; Veins

PURPOSE: Our study was designed to compare the incidence of urological complications for patients with spinal cord injury in relation to their voiding method, and then we wished to suggest a proper voiding method. MATERIALS AND METHODS: Based on their medical records, questionnaires and upper tract imaging, a total of 301 male spinal cord injury patients were retrospectively analyzed for the outcomes of their voiding method. Our study was performed on 50 patients with urethral Foley catheterization, 106 patients with clean intermittent catheterization, 67 patients with suprapubic catheterization, 51 patients within self voiding and 27 patients with condom catheters. Urological complications such as urinary infection, stone disease, urethral complications, vesicoureteral reflux, radiographic upper tract abnormality and bladder tumor were recorded for each patient. RESULTS: Of the 262 complications that were recorded, 89 developed in 24 (48.0%) patients having urethral Foley catheterization, 41 in 23 (21.7%) patients having clean interemittent catheterization, 72 in 26 (38.8%) patients having suprapubic catheterization. 36 in 15 (39.4%) patients with self voiding and 24 in 9 (33.3%) patients having condom catheters. The urethral Foley catheterization group had the highest complication rates relative to all other voiding methods, and the clean intermittent catheterization group had significantly lower complication rates except for having the highest rate of urethral stricture. CONCLUSIONS: Our study shows that clean intermittent catheterization for spinal cord injury patients significantly reduces the incidence of urological complications and it may be the optimal voiding method.
Catheterization ; Catheters ; Condoms ; Humans ; Incidence ; Intermittent Urethral Catheterization ; Male ; Medical Records ; Surveys and Questionnaires ; Retrospective Studies ; Spinal Cord Injuries* ; Spinal Cord* ; Urethral Diseases ; Urethral Stricture ; Urinary Bladder Neoplasms ; Urinary Catheterization ; Vesico-Ureteral Reflux