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

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

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*

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: We investigated whether chronic treatment with a type 5 phosphodiesterase inhibitor (PDE5I) could suppress corporal apoptosis and improve erectile function in diabetic erectile dysfunction. MATERIALS AND METHODS: Sprague-Dawley rats (12 weeks old) were assigned into 1) normal control 2) diabetes, and 3) diabetes with PDE5I treatment groups (n=12 per group). After inducing diabetes with intraperitoneal injection of streptozotocin, the diabetic and PDE5I-treatment groups were treated with vehicle or PDE5I (mirodenafil, 10 mg/kg) for 4 weeks. To examine the effect on erectile response, 6 rats in each group underwent cavernosometry under cavernous nerve electrostimulation (2 V, 0.2 msec, 50 sec, 2.5~20 Hz). The penile tissues from the remaining 6 rats were used for immunohistochemical evaluation of apoptosis. RESULTS: The diabetic group showed markedly lower mean intracavernosal pressure/mean arterial pressure (ICP/MAP) and area under the curve of cavernosometry than normal controls, whereas the diabetes with PDE5I treatment group showed normal results. Despite persistent hyperglycemia, PDE5I treatment significantly reduced the mean apoptotic index (39.6+/-4.6 vs 21.8+/-5.1, p<0.05). CONCLUSIONS: Chronic administration of PDE5I suppressed apoptosis of corporal smooth muscle and improved erectile function in a rat model of diabetic erectile dysfunction.
Animals ; Apoptosis ; Arterial Pressure ; Erectile Dysfunction ; Hyperglycemia ; Injections, Intraperitoneal ; Male ; Models, Animal ; Muscle, Smooth ; Rats* ; Rats, Sprague-Dawley ; Streptozocin

Although studies on pediatric dysfunctional voiding are increasing, there have not been enough efforts to validate the Dysfunctional Voiding Symptom Score (DVSS) questionnaire. Therefore, we aimed to translate and validate the DVSS into Korean. The DVSS questionnaire was validated between January and October, 2013. Two bilinguals independently translated the English version of the DVSS questionnaire into Korean, and then reconciled the forward translation of the Korean version. The original DVSS was back-translated into English, then assessed for equivalence to the original. Cognitive debriefing interviews with 5 patients to test the interpretation of the translation were made, then modified and distributed to 48 patients for re-evaluation. A statistical analysis of inter-scale correlation, and test re-test consistency was performed with the Cronbach's alpha coefficient. The changes from patient interviews were reflected in the final version. In an intra-class correlation, the Cronbach's alpha was high in all of the questions (0.97, P < 0.001). Test re-test Cronbach's alpha analysis of reproducibility was higher than 0.8 for all of the 10 questions (P < 0.001). Translation and linguistic validation of Korean version of the DVSS questionnaire was completed by a proper process, with high reliability and validity.
Child ; Cross-Cultural Comparison ; Female ; Humans ; Interviews as Topic ; Male ; Questionnaires/*standards ; Republic of Korea ; *Translations ; Urination Disorders/*diagnosis

PURPOSE: Varicocelectomy is a commonly performed procedure for the treatment of uncomfortable scrotal swelling as well as for infertile males. It is well known that conventional varicocelectomy is often associated with substantial risks of hydrocele formation, varicocele recurrence, and ligation of testicular artery. In 1992, Goldstein et al described the microsurgical technique of varicocelectomy. For this study we have performed 32 cases of microsurgical subinguinal varicocelectomies and analysed the results to verify their efficacy and safety. MATERIALS AND METHODS: For this study we performed microscopic varicocelectomies in 32 patients, and the follow-up period extended from 11 months to 56 months(mean 27 months). Preoperative and regular postoperative semen analyses were obtained on patients who underwent varicocelectomy for the treatment of infertility. During the operation the testicle is delivered through a small subinguinal incision, and all external spermatic and gubernacular veins are ligated. Then the testis is returned to the scrotum, and the spermatic cord is dissected under the operating microscopy. The testicular artery, vas deference, and lymphatics are identified and preserved, and all internal spermatic veins are ligated. RESULTS: During the follow-up there was no hydrocele and no clinical recurrence. One testicular artery was cut accidently during operation and immediately reanastomosized. And one case of hematoma and two cases of mild testicular discomfort were observed. The changes in sperm count, percent of motility, and percent of normal forms were highly significant. The pregnancy rate was 39%. CONCLUSIONS: Delivery of testis through a small inguinal incision provides direct visual access to all possible avenues of testicular venous drainage. The operating microscope allows identification of the testicular artery, lymphatics and small venous channels. This minimally invasive technique results in a significant decrease in the incidence of hydrocele formation, testicular arterial injury and recurrence.
Arteries ; Drainage ; Follow-Up Studies ; Hematoma ; Humans ; Incidence ; Infertility ; Ligation ; Male ; Microscopy ; Microsurgery ; Pregnancy Rate ; Recurrence ; Scrotum ; Semen Analysis ; Sperm Count ; Spermatic Cord ; Testis ; Varicocele ; Veins

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