Retrocaval ureter is a rare congenital anomaly. We experienced a case of retrocaval ureter with double inferior vena cava and with intermittent right flank pain in 54 years old female. We performed IVU, RGP, Venacavogram, MRI, and diuretic DTPA renal scan. MRI is the best single study to delineate the anatomy clearly and noninvasively. She was treated with conservative treatment.
Female ; Flank Pain ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Pentetic Acid ; Retrocaval Ureter* ; Vena Cava, Inferior*

Von Recklinghausen`s neurofibromatosis is an unusual disorder with a wide variety Of manifestations. The initial findings may at times involve the female genitalia. When the phallus is affected, the urologist has an opportunity for the establishment of an accurate diagnosis as well as for cosmetic correction. We report a case of neurofibromatosis with an involvement of clitoris in 1l-year-old girl.
Clitoris ; Diagnosis ; Female ; Genitalia, Female ; Humans ; Neurofibromatoses* ; Neurofibromatosis 1

Malignant Leydig cell tumor of the testis is a very rare condition. A case of the malignant Leydig cell tumor arised from the right testis of seventy-year-old man is reported. The patient presented painless, 4 x 8 x 5 cm sized, mass without endocrinological manifestations and the mass was removed and diagnosed as a malignant Leydig cell tumor histologically showing frequent mitosis, pleomorphic cells in trabecular pattern with nuclear atypia, clear cells with foamy cytoplasm, and vascular invasion of tumor emboli in tumor capsule. No Reinke`s crystalloid was seen. The patient is now being followed in disease free state.
Cytoplasm ; Humans ; Leydig Cell Tumor* ; Mitosis ; Testis

PURPOSE: We aimed to elucidate the expression and intracellular localization of sperm-specific cation channel CatSper in human spermatozoa. Moreover, the relationship between the expression of CatSper mRNA and the motility of ejaculated human spermatozoa were investigated. MATERIALS AND METHODS: Using cDNAs extracted from the ejaculated sperm of patients (n=39), the expression of CatSper mRNA was observed by RT-PCR. Semi-quantitative analysis of the CatSper mRNA expression was performed by comparing with the expression of GAPDH mRNA. To elucidate the expression and intracellular localization of CatSper protein, double fluorescent immunocytochemistry for CatSper and beta-tubulin was performed. RESULTS: The CatSper mRNA was expressed in all of the sperm samples. Using semi-quantitative analysis for the amount of CatSper mRNA expression, no significant difference was found between the normozoospermia and asthenozoospermia groups (1.5+/-0.6 vs. 1.4+/-0.6, p=0.623). Polyclonal antiserum, generated against a recombinant protein of the N-terminal 160 amino acids of human CatSper, was used. In double fluorescent immunocytochemistry, CatSper protein was found to be expressed in the flagellum of the ejaculated human spermatozoa, and localized in the connecting piece, mid-piece and principal piece, with the exception of the end piece of the flagellum. Moreover, the proportion of CatSper-positive sperm was similar in both the normozoospermia and asthenozoospermia groups. CONCLUSIONS: To the best of our knowledge, this is the first time ejaculated human spermatozoa have been shown to express the mRNA and protein of CatSper. The results of our RT-PCR and immunocytochemistry suggest that CatSper may play a role in the motility of ejaculated human spermatozoa.
Amino Acids ; Asthenozoospermia ; DNA, Complementary ; Flagella ; Humans* ; Immunohistochemistry ; RNA, Messenger ; Sperm Motility ; Spermatozoa* ; Tubulin

PURPOSE: Although percutaneous aspiration and sclerotherapy is a simple, noninvasive and cost-effective therapy for symptomatic renal cysts, the recurrence rate is high. Recently, a laparoscopy has been attempted on symptomatic renal cysts. To assess the clinical efficacy and safety of the laparoscopic cyst marsupialization, the clinical characteristics and operative parameters were evaluated, and compared with the results of sclerotherapy. MATERIALS AND METHODS: Between November 1993 and February 2003, 71 patients with symptomatic simple renal cysts were treated with either laparoscopic marsupialization or sclerotherapy. Respectively, 26 of 31 laparoscopy patients and 27 of 40 sclerotherapy patients were followed-up over a 2 months period and included in this study. The laparoscopic marsupialization was accomplished with either transperitoneal (15 patients) or retroperitoneal approaches (11). The sclerotherapy was composed of percutaneous aspiration followed by an injection of 99% ethanol. RESULTS: The clinical characteristics, including cyst size, location and laterality, were no different in either group. The mean follow-up durations were 19.7 and 18.1 months in laparoscopy and sclerotherapy groups, respectively. Comparing the laparoscopy with the sclerotherapy group, the operation time (106.2 vs. 15.3 min.), hospital stay (7.8 vs. 4.6 days) and complication rate (23.1 vs. 3.7%) were significantly decreased in the sclerotherapy group. However, the success rate (96.2 vs. 77.8%) was significantly increased in the laparoscopy group. With either the transperitoneal or retroperitoneal approaches in the laparoscopy group, there was no statistical difference in the operative time, hospital stay and complication and success rates. CONCLUSIONS: For a symptomatic renal cyst, laparoscopic marsupialization is an effective therapy, with a high success rate on the long-term follow-up. The clinical results, according to the approach method, were not different for the transperitoneal and retroperitoneal approaches.
Ethanol ; Follow-Up Studies* ; Humans ; Laparoscopy ; Length of Stay ; Operative Time ; Recurrence ; Sclerotherapy*

PURPOSE: Vesicoureteral reflux (VUR) in a transplanted kidney may affect the function of a grafted kidney with a recurrent urinary tract infection (UTI), and is a factor of graft failure. Our experience of surgical correction was investigated by performing transvesical ureteral reimplantation in VUR recipients. MATERIALS AND METHODS: Among 2,265 recipients, who had received a living kidney transplantation at Yonsei University Severance Hospital between April 1979 and October 2003, and 29 VUR recipients (7 Men, 22 Women), diagnosed with VCUG after recurrent UTI, were retrospectively analyzed. The mean age of the patients was 43.9, ranging from 24 to 61 years, with a mean follow up of 3.6, ranging from 0.7 to 8.0 years. The changes in the serum creatinine and complications after a transvesical ureteral reimplantation were analyzed. RESULTS: The incidence of VUR was 1.28% (29/2,265) and the mean diagnosis was made after 5.0, ranging from 0.8 to 13.4 years. The grades of VUR were 2 (I), 2 (II), 20 (III) and 5 (IV). Twenty-five recipients underwent a transvesical ureteral reimplantation. The mean serum creatinine decreased from 2.5+/-2.2 to 1.8+/-1.4mg/dl (p=0.14) 1 year after surgical correction, and was significantly decreased from 2.5+/-2.2 to 1.4+/-0.7mg/dl (p=0.017) 3 years after surgical correction. There were no UTI and acute pyelonephritis after a ureteral reimplantation. CONCLUSIONS: VUR, with recurrent UTI, in recipients administered an immunosuppressive agent may cause deterioration of the graft function. The suspicion of VUR should be borne in mind for renal recipients with recurrent UTI, which can be safely corrected by a transvesical ureteral reimplantation.
Creatinine ; Diagnosis ; Follow-Up Studies ; Humans ; Incidence ; Kidney ; Kidney Transplantation ; Male ; Pyelonephritis ; Replantation ; Retrospective Studies ; Transplantation* ; Transplants ; Ureter ; Urinary Tract Infections ; Vesico-Ureteral Reflux*

PURPOSE: This study was performed to investigate whether rebamipide is useful in the treatment of male infertility due to oxidative damage. MATERIALS AND METHODS: 50 infertile males with elevated reactive oxygen species (ROS) in their semen were enrolled. All patients were given an oral daily dose of 900mg rebamipide for at least 3 months. The concentrations of rebamipide and ROS, and the levels of lipid peroxidation, sperm motility, vitality and fertilizing capacity were measured by a high-performance liquid chromatography (HPLC) fluorescent method, chemiluminescence, the thiobarbituric acid method, a computer assisted semen analyzer, eosin-nigrosin staining and hypo-osmotic swelling test, respectively. Additionally, the clinical outcomes, including pregnancy and delivery, were observed at the gynecology outpatient and IVF clinics. RESULTS: The rebamipide concentration in semen after medication was 220.77+/-327.84ng/ml (SD), with a large deviation, but this was higher than the level found in the serum, which was 126+/-76ng/ml (SD). The levels of seminal ROS and lipid peroxidation were significantly decreased according to the duration of treatment (p<0.05). The sperm vitality and fertilizing capacity were also significantly improved at 2-3 months post treatment (p<0.05). Out of the 41 cases with trial pregnancies, 20 (48.8%) became pregnant, consisting of childbirth, miscarriage or ongoing in 17, 2 and 1 case, respectively. Side effects were observed in only 1 case (2%) with self-limits. CONCLUSIONS: These results suggest that rebamipide is an effective free radical scavenger, which may be useful as an oral antioxidant in patients with male infertility due to oxidative damage caused by high tissue affinity to the male accessory organ, antioxidant effect and the improving effect of seminal parameters.
Abortion, Spontaneous ; Antioxidants ; Chromatography, Liquid ; Female ; Gynecology ; Humans ; Infertility, Male ; Lipid Peroxidation ; Luminescence ; Male ; Outpatients ; Oxidative Stress* ; Parturition ; Pregnancy ; Reactive Oxygen Species ; Semen ; Sperm Motility ; Spermatozoa

PURPOSE: The 1-hour pad-weighing test was compared with the cystourethrogram as a method for the preoperative diagnostic assessment of female stress urinary incontinence. MATERIALS AND METHODS: The records of 80 women, with stress urinary incontinence that had undergone anti-incontinence surgery, were reviewed. The 1-hour pad weighing test, proposed by the International Continence Society in 1988, was performed for the objective assessment of the degree of incontinence in all patients. History taking, physical examinations and cystourethrograms were also performed and the correlation between the 1-hour pad-weighing test and the results from the above procedures evaluated. RESULTS: The urinary leakage was examined in all patients during the 1-hour pad-weighing test, with an average urine loss of 50g (5-150). In 13 patients, no urinary leakage was demonstrated during straining on the cystourethrogram. Thus, compared with the 1-hour pad-weighing test, the cystourethrography was less sensitive in the diagnosis of incontinence, with a 16% false negative rate. The bladder neck position and degree of descent were measured on the cystourethrogram during resting and straining. The position of the bladder neck averaged 2.2 (0.5-6.0) and 4.2cm (1.0-8.0) from the upper margin of the symphysis pubis at rest, and during straining, respectively. The difference between these two parameters averaged 2.0cm (0.2-4.0). The number of type III stress urinary incontinence patients, based on the Blaivas classification, was 9. There were statistically significant correlations between the 1-hour pad-weighing test and the bladder neck positions during resting (r=0.296, p=0.008) and straining (r=0.356, p=0.001) on the cystourethrograms. There was a statistically significant difference between the 1-hour pad-weighing test and bladder neck opening during resting (p=0.001). CONCLUSIONS: It seems that the 1-hour pad-weighing test is an easy, inexpensive and non-invasive method for the preoperative diagnostic assessment of female stress urinary incontinence.
Classification ; Diagnosis ; Female* ; Humans ; Incontinence Pads ; Neck ; Physical Examination ; Urinary Bladder ; Urinary Incontinence* ; Urinary Incontinence, Stress

PURPOSE: The aim of the study was to evaluate the clinical outcome, according to the body mass index (BMI), of tension-free vaginal tape (TVT) for the surgical treatment of stress urinary incontinence. MATERIALS AND METHODS: Women were classified as being of normal weight (BMI 20-25), overweight (BMI 26-30) or obese (BMI>30). The patients characteristics and clinical outcomes of the operation were analyzed according to the BMI. RESULTS: There were no significant differences in the patients characteristics, with the exception of the pre-operative posterior urethrovesical angle (PUVA). The subjective cure rate, satisfaction rate and complications of the normal BMI patients did not significantly differ from the women with the high BMI. CONCLUSIONS: The TVT procedure in stress urinary incontinence patient's results in similar subjective cure rates, satisfaction rates and post-operative complications, irrespective of the BMI, which makes it safe for overweight and obese women, and would appear to be an adequate treatment for future use.
Body Mass Index* ; Female ; Humans ; Overweight ; Suburethral Slings* ; Urinary Incontinence* ; Urinary Incontinence, Stress

PURPOSE: The factors for predicting persistent urge symptom and urge incontinence following a tension-free vaginal tape (TVT) procedure were investigated in patients with mixed urinary incontinence. MATERIALS AND METHODS: Two hundred and seventy-four women, with a mean age of 55 years, ranging from 28 to 80, with female urinary incontinence (stress urinary incontinence; 201, mixed urinary incontinence; 73) were the subjects of this study. After a TVT procedure, the patients were followed up at 1, 6 and 12 months and every 1 year thereafter. Cure of incontinence after the procedure was defined as the absence of a subjective complaint of leakage and the absence of objective leakage on stress testing, with all other cases considered as failures. RESULTS: There was no significant difference in the cure rates for stress urinary incontinence in patients with stress and mixed urinary incontinence. However, of 73 patients with mixed urinary incontinence, 20 (27.4%) ans 12 (16.4%) had persistent urgency and continued urge incontinence, respectively. In a multivariate analysis, a low maximal urethral closure pressure (MUCP) was found to be associated with an increased likelihood of persistent urgency (odds ratio, 0.94; 95% confidence interval, 0.38-0.99; p=0.029) and the persistent urge incontinence (odds ratio, 0.94; 95% confidence interval, 0.88-0.99; p=0.030) after a TVT procedure in patients with mixed urinary incontinence. CONCLUSIONS: Our findings suggest that a low MUCP may be associated with the persistent urgency and urge incontinence after a TVT procedure in patients with mixed urinary incontinence.
Exercise Test ; Female ; Humans ; Multivariate Analysis ; Suburethral Slings* ; Surgical Mesh ; Urinary Incontinence* ; Urinary Incontinence, Urge*