The overactive bladder, according to the original definition by International Continence Society refers to the storage phase of the bladder and is diagnosed by urodynamics. The overactive bladder is a medical condition referring to the symptoms of frequency and urgency, with or without urge incontinence, in the absence of local pathology or metabolic factors that would account for these symptoms. The definition of overactive bladder needs clarification, which would help to overcome the current confusion. Possible neurological, muscular, and metabolic causes have been proposed but in many cases the exact causes remain unclear. The diagnosis depends greatly on a detailed history, clinical examination, and urinalysis. Urodynamic evaluation is indicated when neuropathy is suspected, and the treatment may be unsuccessful without exact knowledge of patients' state. It can be treated conservatively by bladder training, physiotherapy, and drugs alone or with combination. For refractory cases neuromodulation, denervation techniques, and bladder augmentation or substitution can be used with good results.
Behavior Therapy ; Denervation ; Diagnosis ; Pathology ; Urinalysis ; Urinary Bladder ; Urinary Bladder, Overactive* ; Urinary Incontinence, Urge ; Urodynamics

No abstract available.
Apoptosis* ; Hyperplasia*

From August 1991 to July 1992, 262 patients of benign prostatic hyperplasia (BPH) were treated with transurethral microwave thermotherapy (TUMT). Among those, 64 patients were followed up more than I year and 26 patients were followed up more than 4 years without other treatment. The patient`s age ranged from 49 to 80 years with a mean of 64.3 years. Prostate volume determined by transrectal ultrasonography ranged from 27.0cm3 to 73.6cm3, the mean 40.8cm3. After I year, maximum flow rate increased from 8.1+/-2.3ml/sec to 11.5+/-3.6ml/sec, Madsen symptom score decreased from 12.6 +/-3.8 to 6.6+/-4.7, and residual urine volume decreased from 75.6+/-33.5ml to 43.4+/-35.3ml. Complete response of maximum flow rate and Madsen symptom score observed in 17.2% in each group, partial response in 50.0% and 40.6%, and non-response in 32.8% and 42.2%. Improvement of subjective symptoms were evaluated by patients themselves and divided into 3 groups: ""satisfactory"" was 28.1%, ""acceptable"" 34.4%, and ""not effective"" 37.5%. Complications were i case of erectile dysfunction and 4 cases of dry ejaculation. Among the 64 patients who were followed up more than 1 year, 26 patients (40.6%) were remained without other treatment, 20 (31.3%) patients were medicated additionally, 11 (17.2%) patients required TUR-P during the follow-up period due to persistent symptoms, and 7 (10.9%) patients were performed re-TUMT. In conclusion, TUMT could be useful, safe and inexpensive treatment for BPH when it is applied selectively and should be advanced in mechanism to be more effective in treatment of BPH.
Ejaculation ; Erectile Dysfunction ; Follow-Up Studies* ; Humans ; Male ; Prostate ; Prostatic Hyperplasia ; Transurethral Resection of Prostate* ; Ultrasonography

Foreign bodies in genitourinary tract are not rare and most of them are present in the bladder. Various kinds of object are introduced into bladder through urethra by both male and female patients. Traditionally, they were introduced mainly for the purpose of sexual behavior. But recently like in our cases, many of them are inserted iatrogenically with development of endourologic procedure. We report 14 cases of bladder foreign bodies. Some of them are surprising and beyond common sense in kind of object and aim of insertion. Six cases were inserted by iatrogenic, 5 cases for masturbation, 2 cases by independently of patient`s intention by other person(s). One patient who had history of mental retardation did not remember when, how, why and by whom the foreign body had been introduced. All the foreign bodies could be diagnosed by history, symptom, X-ray and cystoscopy and removed by cystoscopic manipulation or cystostomy with ease and without complication.
Cystoscopy ; Cystostomy ; Female ; Foreign Bodies* ; Humans ; Intellectual Disability ; Intention ; Male ; Masturbation ; Sexual Behavior ; Urethra ; Urinary Bladder*

Foreign bodies in genitourinary tract are not rare and most of them are present in the bladder. Various kinds of object are introduced into bladder through urethra by both male and female patients. Traditionally, they were introduced mainly for the purpose of sexual behavior. But recently like in our cases, many of them are inserted iatrogenically with development of endourologic procedure. We report 14 cases of bladder foreign bodies. Some of them are surprising and beyond common sense in kind of object and aim of insertion. Six cases were inserted by iatrogenic, 5 cases for masturbation, 2 cases by independently of patient`s intention by other person(s). One patient who had history of mental retardation did not remember when, how, why and by whom the foreign body had been introduced. All the foreign bodies could be diagnosed by history, symptom, X-ray and cystoscopy and removed by cystoscopic manipulation or cystostomy with ease and without complication.
Cystoscopy ; Cystostomy ; Female ; Foreign Bodies* ; Humans ; Intellectual Disability ; Intention ; Male ; Masturbation ; Sexual Behavior ; Urethra ; Urinary Bladder*

A diagnostic accuracy was evaluated in total of 65 patients with acute painful scrotal swelling who underwent ultasonography and/or radionuclide scrotal imaging as an initial diagnostic modality. An accuracy with radionuclide scrotal imaging was 77.8% (7/9) in patients with testicular torsion. 92.0% (23,25) in those with epididymoorchitis. Ultasonography showed the diagnostic accuracy of 100% (15,15) in patients with epididymoorchitis. 66.7% (2/3) in those with testicular torsion and 87.5% (14,16) in those with scrotal trauma. One patient with the torsion of appendix testis was not diagnosed by radionuclide scrotal imaging preoperatively. Two of 8 patients (25%) with testis rupture were misdiagnosed by ultrasonography. Scrotal ultrasonography and nuclear medicine scan are useful adjuncts in diagnosis of torsion of appendix testis and testicular abscess. A possibility of misleading for diagnosis should not be overlooked. Scrotal exploration is mandatory in patients whose clinical pictures are not correlated with radiographic findings.
Abscess ; Acute Pain ; Appendix ; Diagnosis* ; Humans ; Nuclear Medicine ; Rupture ; Spermatic Cord Torsion ; Testis ; Ultrasonography*

Urinary tract infections constitute a large clinical problems that particularly affect catheter indwelling patients, causing morbidity and mortality. To investigate 1) the rate of infection by duration of catheter indwelling in patients of several kinds of disease, 2) the kinds of colonized bacteria and the similarity or difference of the bacterial species cultured in the urine and catheter of same patient, and 3) the comparison of sensitivity to antibiotics of cultured bacteria of both material, bacterial culture and antibiotic sensitivity test were done from urine and proximal tip of catheters in 31 catheter indwelling patients who had been administered, sometimes intermittently, various antibiotics. The rate of bacterial infection increased markedly with the lengthening of catheter indwelling period in urine and catheter cultures, 22.2% and 33.3% at 1 week, both 50% at 2-3 weeks, 78.6% and 85.7% at 4 weeks respectively The results of bacterial culture from both material were same in 27 (87.1%) patients. The gram negative bacteria composed of 41 (89.1%) species in cultured bacteria. The three frequent species were 16 (34.8%) Escherichia coli, 9 (19.6%) Klebsiella pneumonia, and 6 (13.0%) Morganella morgagni. The overall sensitivity of urine cultured bacteria to tested antibiotics showed minor difference from that of catheter, susceptible in 70.4%, and 73.8%, resistant in 28. 6%, and 24.6%, respectively. Almost all of the patients indwelling catheter longer than 4 weeks had bacterial infection or colonization in urine and proximal catheter-tip in spite of preventive administration of antibiotics. The urine culture only may be enough instead of culturing both the urine and proximal catheter-tip in long-term catheterized patients. Routine antibacterial drug administration should be taken into consideration not to be overused in long-term catheter indwelling patients.
Anti-Bacterial Agents ; Bacteria ; Bacterial Infections ; Catheters* ; Catheters, Indwelling ; Colon ; Escherichia coli ; Gram-Negative Bacteria ; Humans ; Klebsiella ; Morganella ; Mortality ; Pneumonia ; Urinary Tract Infections

PURPOSE: Catheter-associated urinary tract infections are inevitable in patients with a long-term indwelling catheter. The antibacterial activity of nitrofurazone-impregnating compounds has recently been employed in urinary catheter, and may be effective in blocking infections. The aims of this study were to evaluate the bacterial isolation, antibiotic sensitivity test and the efficacy of a nitrofurazone-coated urinary catheter. MATERIALS AND METHODS: A total of 41 patients that required an indwelling urinary catheter for longer than 4 weeks were assigned to receive either a silicone (n=24), or nitrofurazone, coated catheter (n=17). Urine and catheter tip samples were cultured for bacteriological assessment. The results of the bacterial culture and antibiotic sensitivity test, rate of infection from urine and proximal tip were compared between the two groups. RESULTS: The bacterial cultures from the tips of the silicone and nitrofurazone catheters were in 95.8 and 82.4%, respectively, but were statistically insignificant (p=0.064). Bacteriuria developed in 79.2 and 64.7% of the silicone-coated and nitrofurazone-coated catheter groups (p=0.476). Gram negative bacteria were found in 65 (69.8%), with the most three frequent species being Pseudomonas aeruginosa, Escherichia coli and Klebsiella pneumonia in 23 (24.7%), 20 (21.5%) and 16 (17.2%), respectively. All the organisms were more susceptible to amikacin, aztreonam and ceftriaxone, but were relatively resistant to ampicillin, gentamycin and ciprofloxacin. CONCLUSIONS: Many of the patients with a long-term indwelling catheter had bacterial infections or colonization in the urine and proximal catheter-tip samples, despite the preventive administration of antibiotics. This study failed to demonstrate any efficacy of a nitrofurazone-coated catheter.
Amikacin ; Ampicillin ; Anti-Bacterial Agents ; Aztreonam ; Bacterial Infections ; Bacteriuria ; Catheterization ; Catheters* ; Catheters, Indwelling ; Ceftriaxone ; Ciprofloxacin ; Colon ; Escherichia coli ; Gentamicins ; Gram-Negative Bacteria ; Humans ; Klebsiella ; Nitrofurazone ; Pneumonia ; Pseudomonas aeruginosa ; Silicones* ; Urinary Catheters ; Urinary Tract Infections

No abstract available.
Urinary Tract Infections* ; Urinary Tract*

PURPOSE: To evaluate the usefullness of high energy transurethral microwave thermotherapy (TUMT) for the treatment of BPH in young or sexually active men, this study was performed. MATERIALS AND METHODS: The changes of sexual behaviors and sexual functions after TURP and high energy TUMT in 36 patients treated with TURP and 27 patients treated with high energy TUMT from January 1997 to December 2000 were analysed retrospectively. Assessment parameters were International Prostate Symptom Score (IPSS), uroflowmetry, residual urine and sexual functions such as morning erection, number of coitus, state of ejaculation and sexual satisfaction at 12 months from treatment. RESULTS: In both groups, the voiding function improved significantly after treatment, but TURP was much superior to TUMT in effectiveness. After 12 months of treatment, morning erection maintained 96.3% in TUMT group and 88.9% in TURP group. The number of coitus per month increased to 3.4 from 3.1 in TUMT group, and decreased to 2.2 from 2.8 in TURP group. Ejaculation preserved in 92.6% in TUMT group and 27.8% in TURP group. In sexual satisfaction, "Satisfied" increased to 51.9% from 40.7% in TUMT group, and decreased to 27.8% from 38.9% in TURP group. "Unsatisfied" changed little in TUMT group but changed from 22.2% to 47.2% in TURP group. In 28 patients with anejaculation, 78.6% considered no ejaculation had adverse effect and 21.4% considered it had no adverse effect on sexual satisfaction. CONCLUSIONS: Although both TURP and high energy TUMT significantly improved clinical outcome, the former was far superior to the latter in improving voiding symptoms caused by BPH. However, high energy TUMT was a better therapeutic option than TURP for patients who want to preserve sexual function. In particular, erection and ejaculation were preserved well with high energy TUMT while there was significant deterioration of these functions following TURP.
Coitus ; Ejaculation ; Humans ; Hyperplasia* ; Hyperthermia, Induced ; Male ; Microwaves ; Prostate* ; Prostatic Hyperplasia ; Retrospective Studies ; Sexual Behavior ; Transurethral Resection of Prostate*