PURPOSE: The purpose of this study was to investigate the pro-erectile potential of various urethral alpha blockers using pharmacological or electrical induction of erection in anesthesized rats. MATERIALS AND METHODS: To evaluate the influence on centrally mediated erection, intravenous administeration of terazosin, doxazosin(3, 10, 30microgram/kg), and tamsulosin (0.3, 1, 3microgram/kg), followed by submaximal subcutaneous apomorphine(50microgram/kg) administration, mean arterial pressure(MAP) and intracavernosal pressure(ICP) were recorded over 30 minutes in male anesthesized rats. The time to first response, peaks within 30 minutes, maximal ICP, area under the curve, percentage of ICP/MAP were compared. To evaluate the influence on peripherally induced erections, various doses of alpha antagonists and submaximal cavernous nerve stimulation(0.5ms, 2V, 10Hz) were combined. The ICP increase and ICP/MAP percentage were also compared. RESULTS: Although various dose response relationships were shown, all three alpha blockers enhanced erectile activity triggered by apomorphine. In terms of time to first response and peaks within 30 minutes, the proerectile effects of terazosin was most prominent whereas those of tamsulosin was minimal, requiring larger doses. In combining with cavernous nerve stimulation, doxazosin and tamsulosin showed moderate proerectile activity, but the highest dose of terazosin was required to enhance ICP increase induced by cavernous nerve stimulation. Despite their pressure lowering effects, all tested alpha adrenergic blockers significantly enhanced the ICP/MAP percentage. CONCLUSIONS: The present finding clearly indicated that alpha 1 selective antagonists can enhance erectile capacity when combined with central or peripheral stimuli for erection.
Adrenergic alpha-Antagonists ; Adrenergic Antagonists ; Animals ; Apomorphine ; Doxazosin ; Humans ; Male ; Models, Animal* ; Rats*

The relationship between central nervous system (CNS) and enuresis has not been sufficiently elucidated despite the presence of several circumstantial evidences. Contrary to common belief, polysomnographic sleep analysis revealed that the disturbance of arousal rather than deep sleep was responsible for enuresis. Subsequent studies confirmed depressed sympathetic tone and retarded brainstem reflex indicating abnormal arousal threshold in enuretics. In accordance with the bladder-brain dialogue, chronic stimulation of bladder may modify the brainstem function elevating arousal threshold. Epidemiological studies have suggested the association between enuresis and various psychosomatic disorders like attention deficit hyperactivity disorder (ADHD), which has shown the abnormal brainstem reflex similar to enuresis. Taken together, CNS is assumed to play a crucial role in the pathogenesis of enuresis. Psychological assessment is vital to understand the psychodynamic effect of enuresis. Studies have shown that the prevalence of psychological problems was higher in enuretic children and externalization of the symptoms was usually found. Several explanations have been brought up regarding the development of enuresis and psychological problems. Enuresis may cause psychological problems and vice versa. Otherwise, both may be associated with other variables, such as socioeconomic status (SES).
Arousal ; Attention Deficit Disorder with Hyperactivity ; Brain ; Brain Stem ; Central Nervous System ; Child ; Enuresis ; Humans ; Prevalence ; Psychophysiologic Disorders ; Reflex ; Social Class ; Urinary Bladder

The history of treatment for cryptorchidism dates back more than 200 years. This review is intended to highlight some historical aspect that led us to our current surgical treatment of this condition. The medical and historical surgical literatures pertaining to cryptorchidism were reviewed. Data sources were PubMed, Embase, conference proceedings, and bibliographies. No language, date, or publication status restrictions were imposed. The study of cryptorchidism began with the anatomical descriptions of Baron Albrecht von Haller and John Hunter. Attempts at surgical correction of the undescended testis began in the early 1800s, culminating in the first successful orchiopexy by Thomas Annandale in 1877. Max Schuller, Arthur Dean Bevan and Lattimer contributed to the establishment of current techniques for standard orchiopexy. Later, laparoscopy, high inguinal incision (Jones' approach) and scrotal approach were added to the list of current orchiopexy.
Chronology as Topic ; Cryptorchidism ; Information Storage and Retrieval ; Laparoscopy ; Male ; Orchiopexy ; Publications

Male circumcision (MC) is one of the most common surgical procedures in the world, but its medical benefits remain under debate. In the context of evidence-based medicine, MC is beneficial in reducing the risks of infantile urinary tract infection, viral-mediated sexually transmitted diseases, penile/cervical cancers, and poor hygiene. The claims of opponents against MC, such as reduced sexual performance, psychological trauma, and an excess of complications, are gradually losing credibility. Possibly influenced by US troops stationed in Korea following the Korean War, MC is highly prevalent in South Korea, though it has been losing popularity recently. The practice of MC in Korea is different from that in other countries, in that most cases of MC are performed in adolescence under local anesthesia. Although this eliminates the benefit of reducing urinary tract infection in neonates, it still offers the benefits of reducing the risk of viral sexually transmitted diseases and penile/cervical cancers. Moreover, MC can lead to improved hygiene for the majority of Koreans who are willing to undergo the procedure. The practice of MC in adolescence may reduce the risk of significant complications, though the risk of bleeding may be higher than for neonates.
Adolescent ; Anesthesia, Local ; Circumcision, Male* ; Evidence-Based Medicine ; Female ; Hemorrhage ; Humans ; Hygiene ; Infant, Newborn ; Korea ; Korean War ; Male ; Male* ; Phimosis ; Psychological Trauma ; Sexually Transmitted Diseases ; Sexually Transmitted Diseases, Viral ; Urinary Tract Infections

To describe how to perform urological evaluation in children with tethered cord syndrome (TCS). Although a common manifestation of TCS is the development of neurogenic bladder in developing children, neurosurgeons often face difficulty in detecting urological problems in patients with TCS. From a urological perspective, diagnosis of TCS in developing children is further complicated due to the differentiation between neurogenic bladder dysfunctions and transient bladder dysfunctions owing to developmental problems. Due to the paucity of evidence regarding evaluation prior to and after untethering, I have shown the purpose and tools for evaluation in my own practice. This may be tailored to the types of neurogenic bladder, developmental status, and risks for deterioration. While the urodynamic study (UDS) is the gold standard test for understanding bladder function, it is not a panacea in revealing the nature of bladder dysfunction. In addition, clinicians should consider the influence of developmental processes on bladder function. Before untethering, UDS should reveal synergic urethral movement, which indicates an intact sacral reflex and lack of TCS. Postoperatively, the measurement of post-void residual urine volume is a key factor for the evaluation of spontaneous voiders. In case of elevation, fecal impaction, which is common in spinal dysraphism, should be addressed. In patients with clean intermittent catheterization, the frequency-volume chart should be monitored to assess the storage function of the bladder. Toilet training is an important sign of maturation, and its achievement should be monitored. Signs of bladder deterioration should be acknowledged, and follow-up schedule should be tailored to prevent upper urinary tract damage and also to determine an adequate timing for intervention. Neurosurgeons should be aware of urological problems related to TCS as well as urologists. Cooperation and regular discussion between the two disciplines could enhance the quality of patient care. Accumulation of experience will improve follow-up strategies.

PURPOSE: Controversy exists regarding the best approach to impalpable testes. We determined the usefulness of diagnostic laparoscopy for the management of impalpable testes. MATERIALS AND METHODS: Between 2000 and 2008, 86 patients with a mean age of 34 months underwent diagnostic laparoscopy. An inguinal canal exploration was performed in all cases, except in patients in whom the internal spermatic vessels terminated intraperitoneally with a blind end. RESULTS: The undescended testis was right-sided in 24 patients (27.9%), left-sided in 47 patients (54.7%), and bilateral in 15 patients (17.4%). Three patients (3.5%) had bilateral impalpable testes. The vas and vessels traversed the internal ring in 51 of 89 impalpable testes (57.3%); 20 (22.5%) were localized intraperitoneally, and 18 (20.2%) were diagnosed as vanishing testes. Open orchiopexies were performed on 24 testes (27.0%) and orchiectomies were performed on 43 nubbin testes (48.3%). After a mean follow-up period of 30 months, 12 of the 14 testes (85.7%) were viable following open conventional orchiopexy, compared with 6 of the 10 testes (60%) following a 1-stage Fowler-Stephens orchiopexy. CONCLUSIONS: Diagnostic laparoscopy is a very helpful and minimally invasive technique in the diagnosis of impalpable testes, especially when preoperative ultrasonography is not sufficiently informative.
Cryptorchidism ; Follow-Up Studies ; Gonadal Dysgenesis, 46,XY ; Humans ; Inguinal Canal ; Laparoscopy ; Male ; Orchiectomy ; Orchiopexy ; Testis

PURPOSE: In pediatric patients with enuresis, the protocol for salvage therapy in patients in whom first-line therapy was not successful has not yet been established. Interferential electrical stimulation (IF-ES) therapy is advantageous because it is noninvasive and shows high compliance. We aimed to investigate the efficacy and safety of IF-ES therapy on pediatric enuresis in a pilot study. METHODS: We investigated 10 patients who underwent IF-ES therapy between August 2012 and March 2013 at our clinic. Patients with a history of previous treatment with desmopressin and anticholinergic agents for at least 3 months and those in whom alarm treatment previously failed or was refused by parents were eligible. Electrical current was given starting at approximately 20 mA and was increased until the patient complained of discomfort. Treatment was performed once a week, 20 minutes per treatment, 6 times per cycle. After each cycle, an interview was performed and voiding diaries were filled. The physician in charge evaluated improvement according to the International Children's Continence Society criteria. RESULTS: A final analysis was performed in 10 patients (5 male and 5 female patients) in whom therapy for nocturnal enuresis had failed. Eight patients had nonmonosymptomatic enuresis and 2 had monosymptomatic enuresis. The mean age of the patients was 8.5+/-2.4 years, and the mean number of treatments was 10.6+/-3.6 times. A full response was observed in 1 patient (10%); a good response, in 1 patient (10%); a partial response, in 7 patients (70%); and no response, in 1 patient (10%). CONCLUSIONS: Our study demonstrated that IF-ES therapy can be a promising treatment for the future, is safe, and can benefit from appropriate clinical trials in carefully selected groups. IF-ES therapy is expected to be a safe and effective treatment modality for children with enuresis.
Child ; Cholinergic Antagonists ; Compliance ; Deamino Arginine Vasopressin ; Electric Stimulation ; Electric Stimulation Therapy ; Enuresis ; Fees and Charges ; Female ; Humans ; Male ; Nocturnal Enuresis ; Parents ; Pilot Projects ; Salvage Therapy

PURPOSE: Since the 1990s, it has been well known that orchiopexies should be performed by no later than 2 years of age. Nevertheless, studies from other countries report a substantial number of delayed orchiopexies. On the basis of an analysis of a tertiary care hospital database, we aimed to investigate the incidence of delayed orchiopexies performed in patients after 5 years of age and to understand the causes of such delays and the possible consequences. MATERIALS AND METHODS: We retrospectively analyzed the surgical database of Seoul National University Hospital between 2004 and 2012 and detected patients who underwent orchiopexy later than 5 years of age. Reasons for delayed orchiopexies were studied and the possible consequences of delayed orchiopexies were assessed with respect to surgical difficulty and testicular volume. RESULTS: We found 160 cases of delayed orchiopexies, which accounted for about 15% of all orchiopexies performed. Two major reasons for delay were related to the parents of the child: parental delay and parental request for the treatment of persistent retractile testis. Acquired cryptorchidism was found in 21 cases (13.1%), mainly associated with hypospadias. Surgical difficulty, especially owing to a short testicular cord, was encountered in 48 cases (30.2%), and a comparison with age-matched normative values showed substantially smaller testicular volume. CONCLUSIONS: Despite well-established guidelines for the optimal age of surgery, 15% of orchiopexies were not performed at a proper time. Improved propagation of an optimal age limit is necessary to reduce the rate of delayed orchiopexies considering increases in surgical difficulty and potential testicular growth retardation.
Child ; Cryptorchidism ; Female ; Humans ; Hypospadias ; Incidence ; Male ; Orchiopexy* ; Parents ; Retrospective Studies ; Seoul ; Tertiary Care Centers ; Tertiary Healthcare* ; Testis

PURPOSE: This case-control study was designed to investigate the possible association of the metabolic syndrome(MS) with benign prostatic hyperplasia(BPH) in healthy males. MATERIALS AND METHODS: We reviewed the data of 702 men who had a general health check-up without significant evidence of disease. The database for health check-ups included demographic, anthropometric, serum-related and prostate-related data. The presence of the MS was determined according to the NCEP-ATPIII criteria. We compared prostate- related data between the MS and the non-MS group. Testing for linear trends and logistic regression were performed to determine whether the presence of the MS was associated with an increased risk for BPH. RESULTS: The MS was identified in 166 men(23.6%). There was an increased prevalence of both the MS and BPH along with increasing age. There was a tendency for the total prostate volume and the PSA to increase along with the an increasing number of factors related to the metabolic syndrome. In a comparison between the MS and non-MS group, there were no differences in the prostate-related variables. However, subgroup analysis in men less than 50 showed significant differences in the PSA, total volume and calculated annual growth rate. In addition, only in this group was the presence of the MS a significant risk factor for BPH(odd ratio; OR=2.21, 95% confidence interval; CI 1.28-4.75). CONCLUSIONS: The results of this study showed a weak but significant relationship between the MS and BPH, especially in men less than 50. Further longitudinal studies with a larger patient population are required to confirm our findings.
Case-Control Studies ; Humans ; Logistic Models ; Male ; Mass Screening* ; Prevalence ; Prostate ; Prostatic Hyperplasia* ; Risk Factors

PURPOSE: To evaluate the combined effect of type 2 dimethylarginine dimethylaminohydrolase (DDAH) gene therapy with vitamin E treatment for the treatment of erectile dysfunction in atherosclerotic rats. Our previous study showed that penile accumulation of asymmetric dimethylarginine (ADMA) which was due to decreased DDAH activity, was responsible for the impairment of erectile function in atherosclerotic rats. MATERIALS AND METHODS: Fourty adult male Sprague-Dawley rats (3 months old) were placed in 5 groups (n=8 per group) as follows: 1) healthy control (C) 2) atherosclerotic (AS) 3) vitamin E daily treatment (E, 30 IU/day) 4) injection of pcDNA3/DDAH2 (G) 5) vitamin E+injection of pcDNA3/DDAH2 (E+G). Except group C, all rats received a 1% cholesterol diet for 6 weeks and an initial 2 weeks of N(G)-nitro-L-arginine methyl ester (L-NAME, 3 mg/ml) treatment to promote systemic atherosclerosis. After induction of the atherosclerosis, pcDNA3/DDAH2 was intracavernosally injected in the G and E+G groups. Also, 2 weeks of daily vitamin E treatment was carried out for E and E+G groups. Erectile function was assessed with cavernous nerve electrostimulation. Penile levels of ADMA and protein expression and activity of DDAH2 were assayed. RESULTS: Compared to the C group, AS rats showed significantly impaired erectile function. No single treatment was enough to maintain their erectile function. Only E+G group maintained their erectile function. As a result?of gene transfection, overexpression of DDAH2 was observed in G and E+G groups. However, only the combination arm showed elevated DDAH activity and normalized penile ADMA level. Systemic antioxidant monotherapy enhanced DDAH activity, though not enough to normalize penile ADMA level. CONCLUSIONS: Penile ADMA accumulation, caused by altered metabolic activity of DDAH was responsible for the erectile impairment of atherosclerotic rats. Gene therapy with DDAH2, when combined with antioxidant treatment, effectively suppressed the increase in penile ADMA level and preserved erectile function in atherosclerotic rats.
Adult ; Animals ; Arm ; Atherosclerosis ; Cholesterol ; Diet ; Erectile Dysfunction* ; Genetic Therapy* ; Humans ; Male ; Models, Animal* ; NG-Nitroarginine Methyl Ester ; Nitric Oxide ; Rats* ; Rats, Sprague-Dawley ; Transfection ; Vitamin E ; Vitamins