We experienced a case of MRKH syndrome in a 24-year-old female which was combined with sacral agenesis, neurogenic bladder, and duplicated ureter associated with vesicoureteral reflux in the right side.
Female ; Humans ; Ureter ; Urinary Bladder, Neurogenic* ; Vesico-Ureteral Reflux ; Young Adult

PURPOSE: There are a variety of open surgical and endoscopic methods to the treatment of urethral injuries. The objective of our study is to evaluate the efficacy of primary endoscopic urethral realignment according to the injury site. MATERIALS AND METHODS: Twenty eight patients with urethral injuries(23 anterior and 5 posterior) were treated by primary endoscopic urethral realignment from March 1990 to August 1997. According to the injury site, age distribution, etiology of injury, associated injuries, time to operation, operating time, duration of urethral Foley catheterization, maximal flow rate, postoperative complications and treatment of post-realignment stricture were reviewed. RESULTS: The age range of our patients was from 20 to 86 years(mean 45.0). Among the 28 patients, 23 were anterior and 5 were posterior urethral injuries. Pelvic bone fracture was associated in 1 patient(20.0%) in the anterior urethral injury group, while 5 patients(100%) in the posterior urethral injury group. The mean time after injury to realignment was 1.9 days (range 0 to 9) and the mean operating time was 53.9 minutes in the anterior urethral injury group(range 20-190) and 79.0 minutes in the posterior urethral injury group(range 25-170). The mean duration of urethral Foley catheterization was 24.5 days in the anterior urethral injury group and 61.4 days in the posterior urethral injury group. The mean maximal flow rate after catheter removal was 31.4ml/sec in the anterior urethral injury group and 24.6ml/sec in the posterior urethral injury group. Of the 23 patients, 9 patients(39.1%) had post-realignment strictures in the anterior urethral injury group and 8 were treated with visual urethrotomy, and only one patient was required open urethroplasty. Of the 5 patients, 4 patients(80.0%) had post-realignment strictures in the posterior urethral injury group and treated with visual urethrotomy. CONCLUSIONS: Primary endoscopic urethral realignment is a safe and simple technique with minimal mobidity regardless of injury site. The stricture formation, impotence and incontinence rates of this technique are comparable to those reported for open surgical methods. Finally, most post-realignment strictures can be treated successfully with visual internal urethrotomy with or without occasional sound dilation.
Age Distribution ; Catheters ; Constriction, Pathologic ; Erectile Dysfunction ; Humans ; Male ; Pelvic Bones ; Postoperative Complications ; Urinary Catheterization

PURPOSE: Taxol, an anticancer drug, blocks cell division by stabilizing microtubules. However, taxol has distinct cell-cycle-independent effects. For example, taxol and interferon gamma(IFN-gamma) induce tumoricidal activity of murine peritoneal macrophages. This study was designed to know whether taxol has indirect tumoricidal effect on murine bladder tumor-2(MBT-2) cells besides its direct cytotoxicity. MATERIALS AND METHODS: The original stock of C57BL/6 mice were used at 8 to 12 weeks of age. Macrophages were obtained by peritoneal lavage from the mice which had been treated with thioglycollate. The tumor target cells were MBT-2 cell line. MBT-2 cells were cultivated in different concentration of taxol for various times and the growth of MBT-2 cells were tested. Tumoricidal activitiy was measured by indirect methylthiazol-2-yl-2,5-diphenyl tetrazolium bromide(MTT) assay after co-cultures of stimulated macrophage and MBT-2 cells with taxol, INF-gamma, lipopolysaccharide(LPS) or with combination of taxol and INF-gamma or LPS and INF-gamma. Nitric oxide(NO) formation was measured by Griess method under the same conditions. Effect of NG -monomethyl-L-arginine(NGMMA) on nitrite formation and cytotoxicity toward MBT-2 cells were also evaluated. RESULTS: Significant retardation of cell growth was observed after treatment of tumor cells with taxol in a dose dependent manner but does not affect cell viability. Taxol(19+/-2%) or LPS(19+/-4%) alone weakly activated macrophages to kill MBT-2 cell lines, whereas combinations of taxol(77+/-3%) or LPS(75+/-4%) with IFN-gamma(control: 2%, IFN-gamma:18+/-3%) synergized to activate macrophages to kill tumor cells in a dose dependent manner. Taxol(20+/-5microM), LPS(15+/-5microM) or IFN-gamma(25+/-3microM) alone induced small amounts of NO secretion but the combinations of either taxol and INF-gamma(73+/-5microM) or LPS and IFN-gamma(77+/-5microM) synergistically induced large amounts of NO secretion. The production of NO(control:<5, IFN-gamma+ taxol: 73+/-5microM, IFN-gamma+ taxol + NGMMA: 15+/-3microM) and tumor cell killing(control: 2%, IFN-gamma+ taxol: 77+/-3%, IFN-gamma+ taxol + NGMMA: 20+/-3%) were blocked in the presence of NGMMA, a competitive inhibitor of NO synthase. CONCLUSIONS: Collectively, the data indicate that taxol is directly non-cytotoxic for MBT-2 cells via its effect on micrtubules but indirectly activates macrophages to kill MBT-2 cells probably via NO secertion.
Animals ; Cell Division ; Cell Line ; Cell Survival ; Coculture Techniques ; Interferons ; Macrophages ; Macrophages, Peritoneal ; Mice ; Microtubules ; Nitric Oxide Synthase ; Nitric Oxide* ; Paclitaxel* ; Peritoneal Lavage ; Urinary Bladder*

PURPOSE: Taxol, an anticancer drug, blocks cell division by stabilizing microtubules. However, taxol has distinct cell-cycle-independent effects. For example, taxol and interferon gamma(IFN-gamma) induce tumoricidal activity of murine peritoneal macrophages. This study was designed to know whether taxol has indirect tumoricidal effect on murine bladder tumor-2(MBT-2) cells besides its direct cytotoxicity. MATERIALS AND METHODS: The original stock of C57BL/6 mice were used at 8 to 12 weeks of age. Macrophages were obtained by peritoneal lavage from the mice which had been treated with thioglycollate. The tumor target cells were MBT-2 cell line. MBT-2 cells were cultivated in different concentration of taxol for various times and the growth of MBT-2 cells were tested. Tumoricidal activitiy was measured by indirect methylthiazol-2-yl-2,5-diphenyl tetrazolium bromide(MTT) assay after co-cultures of stimulated macrophage and MBT-2 cells with taxol, INF-gamma, lipopolysaccharide(LPS) or with combination of taxol and INF-gamma or LPS and INF-gamma. Nitric oxide(NO) formation was measured by Griess method under the same conditions. Effect of NG -monomethyl-L-arginine(NGMMA) on nitrite formation and cytotoxicity toward MBT-2 cells were also evaluated. RESULTS: Significant retardation of cell growth was observed after treatment of tumor cells with taxol in a dose dependent manner but does not affect cell viability. Taxol(19+/-2%) or LPS(19+/-4%) alone weakly activated macrophages to kill MBT-2 cell lines, whereas combinations of taxol(77+/-3%) or LPS(75+/-4%) with IFN-gamma(control: 2%, IFN-gamma:18+/-3%) synergized to activate macrophages to kill tumor cells in a dose dependent manner. Taxol(20+/-5microM), LPS(15+/-5microM) or IFN-gamma(25+/-3microM) alone induced small amounts of NO secretion but the combinations of either taxol and INF-gamma(73+/-5microM) or LPS and IFN-gamma(77+/-5microM) synergistically induced large amounts of NO secretion. The production of NO(control:<5, IFN-gamma+ taxol: 73+/-5microM, IFN-gamma+ taxol + NGMMA: 15+/-3microM) and tumor cell killing(control: 2%, IFN-gamma+ taxol: 77+/-3%, IFN-gamma+ taxol + NGMMA: 20+/-3%) were blocked in the presence of NGMMA, a competitive inhibitor of NO synthase. CONCLUSIONS: Collectively, the data indicate that taxol is directly non-cytotoxic for MBT-2 cells via its effect on micrtubules but indirectly activates macrophages to kill MBT-2 cells probably via NO secertion.
Animals ; Cell Division ; Cell Line ; Cell Survival ; Coculture Techniques ; Interferons ; Macrophages ; Macrophages, Peritoneal ; Mice ; Microtubules ; Nitric Oxide Synthase ; Nitric Oxide* ; Paclitaxel* ; Peritoneal Lavage ; Urinary Bladder*

OBJECTIVE: The purpose of this study is to evaluate the effect of functional electrical stimulation (FES) on hemiplegic shoulder subluxation in post-acute stroke patients. METHOD: Forty-four patients who had shoulder subluxation as a consequence of their first stroke were included and randomly assigned to either a control group (22 subjects) or a study group (22 subjects). Patients in both groups received physiotherapy and used an arm sling. The study group received, FES therapy to shoulder muscles (supraspinatus and posterior deltoid) for 30 minutes, five days a week for 6 weeks. The effect of FES therapy was evaluated by assessment of the severity of subluxation using radiologic measurements before and after treatment. RESULTS: 1) The severity of subluxation was significantly increased after 6 weeks (p<0.05) in the control group. In the study group, it was reduced but the difference was not statistically significant (p>0.05). 2) In the group of patients with early treatment (onset duration, less than 6 months), the control group showed a significant increase in subluxation (p<0.05), but the study group showed significantly reduced (p<0.05) shoulder subluxation after treatment period. 3) In the group of patients with mild shoulder subluxation before treatment (less than 1 finger breadth), the control group showed a significant increase in subluxation (p<0.05), but the study group showed significantly reduced (p<0.05) shoulder subluxation after treatment period. CONCLUSION: The FES therapy is effective in preventing and reducing the severity of hemiplegic shoulder subluxation in post-acute stroke patients, especially if duration since stroke onset was less than six months and the severity of subluxation before treatment was mild.
Arm ; Electric Stimulation* ; Fingers ; Humans ; Muscles ; Shoulder* ; Stroke

PURPOSE: Pseudomonas aeruginosa is an important pathogen in complicated urinary tract infections(UTIs). The aim of this study was to evaluate the isolation rate of Pseudomonas from patients with UTIs and to define the accompanying clinical features. MATERIALS AND METHODS: Between January 2000 and December 2006, we retrospectively reviewed the medical records of 170 urology patients with Pseudomonas UTIs. We analyzed the isolation rate of Pseudomonas in patients with UTIs and determined the antibiotic susceptibilities. We also analyzed the clinical features and underlying diseases in patients with Pseudomonas UTIs. RESULTS: Pseudomonas was cultured in the urine from 234 of 3,470 patients (6.6%) with positive urine cultures. One hundred seventy of 234 patients had underlying urologic disease. Eighty-two patients(48.2%) had indwelling urinary catheters and 34 patients(20.0%) had diabetes. Patients with catheters tended to have febrile UTIs compared to patients without catheters(70.7% vs. 42.0%, respectively). The isolation rate of Pseudomonas increased between 2000 and 2006(2.8% vs. 13.1%, respectively). The sensitivity of Pseudomonas to most antibiotics decreased between 2000 and 2006. Patients with neurogenic disease and catheters were more easily infected with Pseudomonas. CONCLUSIONS: The isolation rate of Pseudomonas in urine cultures is on the rise. Patients with UTIs and catheters, unlike those without, have high fevers. Because the sensitivity of Pseudomonas to antimicrobial agents has decreased, we need to choose appropriate antibiotics through urine cultures and antibiotics sensitivity tests in treating complicated UTIs.
Anti-Bacterial Agents ; Anti-Infective Agents ; Catheters ; Fever ; Humans ; Medical Records ; Pseudomonas ; Pseudomonas aeruginosa ; Retrospective Studies ; Urinary Catheters ; Urinary Tract ; Urinary Tract Infections ; Urologic Diseases ; Urology

Stone-containing urachal cysts are extremely rare in adults. Here, we report the case of a 58-year-old man with a urachal cyst who had lower abdominal pain and urinary frequency. Abdominal ultrasonography and computed tomography showed hyperdense stones in the urachus. He was treated with a laparoscopic excision using a transperitoneal approach. The pathological diagnosis was an inflammed urachal cyst. This rare case illustrates an inflammed urachal cyst containing stones treated with laparoscopy.
Humans ; *Laparoscopy ; Male ; Middle Aged ; Urachal Cyst/pathology/radiography/*surgery ; Urinary Bladder Calculi/pathology/radiography/*surgery

STATEMENT OF PROBLEM: Because dental impression can be a cross-infection source, disinfection, such as immersion disinfection is nessecary. However, the disinfection process may change the volume of the impression cast. PURPOSE: The purpose of this study is to find out the effects on dimensional change of different storage times and methods, of agar-alginate impression when immersed in a 5% idophor disinfectant. MATERIAL AND METHODS: An agar-alginate impression was made from a mandible model and then was disinfected and stored according the experimental conditions and a stone model was produced. Measurements were taken between reference points on the original mandible model and they were compared to measurements taken between reference points on the stone model. The study was divided into 4 groups. In group 1, the impression was stored in a 100% humidor for 30 minutes, 1 hour, 2 hours, 3 hours, 4 hours, 6 hours, 12 hours and 24 hours and stone models were made at each time. In group 2, the impression was immersed in 5% idophor disinfectant and then stored in a 100% humidor for the same length of times as group 1, and stone models were made at each time. In group 3, the impression was stored in extend-A-pourR, a special storage solution for 30 minutes, 1 hour, 2 hours, 3 hours, 4 hours, 6 hours, 12 hours, 24 hours 3 days, and 7 days and stone models were made at each time. In group 4, the impression was immersed in 5% idophor disinfectant and then stored in stored in extend-A-pourR, a special storage solution for the same length of times as group 3, and stone models were made at each time. 5 impressions and stone models were made at each time to make a total of 180. The Student-t test (P < .05) was used to do a statistical analysis of the measurements of the mandible model and stone models. The repeated-measure 2-way analysis of variance (P < .05) was used to do a statistical analysis of the difference in the 4 groups. RESULTS: The percent liner dimensional change was from 0.25+/-0.03% (group 1, 30 minutes) to 0.34+/-0.06% (group 4, 7 days). No significant change was noticed between the 4 groups. CONCLUSION: According to the above study, in both methods, least dimensional change was recorded when the storage times were short and in both methods, immersion in 5% idophor disinfectant did not effect dimensional change in the agar-alginate impression.
Disinfection* ; Immersion ; Mandible

PUSPOSE: To evaluate the results of our experience with a retroperitoneoscopic nephroureterectomy, in patients with transitional cell carcinomas of the renal pelvis and ureter, compared to those treated by open nephroureterectomy. MATERIAL AND METHODS: Between August 2003 and February 2006, 17 patients with a transitional cell carcinoma of the upper urinary tract underwent retroperitoneoscopic nephroureterectomy. The distal ureter and bladder cuff was treated with a Gibson incision in 11 patients, with an endoscopic stapler employed in 6 patients. During the endoscopic stapler firing of the bladder cuff, complete removal of the ureteral orifice was confirmed using a flexible cystoscope. The patients' operative and clinical records were retrospectively reviewed, and compared to 16 patients with a transitional cell carcinoma of the upper urinary tract treated using an open nephroureterectomy. RESULTS: The retroperitoneoscopic nephroureterectomies were successfully performed in all patients. The mean operative time, transfusion rate and time to drain removal were not significantly different between the two groups. The initiations of the postoperative oral intake and ambulation, as well as the hospital stay were shorter in the retroperitoneoscopy than the open group. Complications were detected in 1 and 5 patients of the retroperitoneoscopy and open groups, respectively. With respect to the follow-up results, no statistical differences were seen in either bladder or extravesical recurrence between the two groups. CONCLUSIONS: A retroperitoneoscopic nephroureterectomy is a less invasive technique than an open nephroureterectomy for patients with a transitional cell carcinoma of the renal pelvis and ureter. Especially, using an endoscopic stapler for the lower ureter and bladder cuff may shorten the operative time. However, long term follow-up will be necessary to confirm the cancer control effects.
Carcinoma, Transitional Cell* ; Cystoscopes ; Fires ; Follow-Up Studies ; Humans ; Kidney Pelvis* ; Laparoscopy ; Length of Stay ; Nephrectomy ; Operative Time ; Recurrence ; Retrospective Studies ; Ureter* ; Urinary Bladder ; Urinary Tract ; Walking

PURPOSE: Attempts have been made to insert a urethral Foley catheter as a primary urethral realignment immediately after a urethral injury. There has been much debate about the time and method of the realignment. The feasibility and complications of early primary endoscopic realignment in a urethral injury were evaluated. MATERIALS AND METHODS: From November 1990 to May 2003, 63 patients with urethral injuries received early endoscopic realignment within 72hrs. The diagnosis was made by retrograde urethrography. Primary realignment was successfully performed for 61 patients; 52 (85.2%) had an anterior urethral injury and 9 (14.8%) a posterior urethral injury. All operations were performed under spinal anesthesia. A cystoscope was inserted through the dilated suprapubic cystotomy and a guide wire passed through the cystoscope, and caught by transurethral foreign body forceps just distal to the injured site. The urethral catheter was removed after pericatheter urethrography, usually on the 14th postoperative day. Patients were retrospectively reviewed for complications, including urethral stricture, urinary incontinence and erectile dysfunction. RESULTS: Of the 63 patients, 61 (96.8%) were successfully treated. The mean operation and catheter indwelling times were 71.8 minute (5-109) and 17.4 days (6-32), respectively. The mean follow-up duration was 423.2 days (94-1432). Urethral strictures were detected in 14 patients (23.0%), who were treated with an internal urethrotomy. Urinary incontinence in 5 patients (8.2%) and erectile dysfunction in 14 patients (23.0%) were the observed complications. CONCLUSIONS: Our results show that immediate endoscopic realignment is a less invasive and more feasible therapy for patients with a urethral injury.
Anesthesia, Spinal ; Catheterization ; Catheters ; Cystoscopes ; Cystotomy ; Diagnosis ; Endoscopy ; Erectile Dysfunction ; Follow-Up Studies ; Foreign Bodies ; Humans ; Male* ; Retrospective Studies ; Surgical Instruments ; Urethra ; Urethral Stricture ; Urinary Catheters ; Urinary Incontinence