After nephrectomy for non-malignant disease, primary tumors of the ureteric stump are extremely rare and present a significant diagnostic problem, and only few cases have been reported in the literature. The very rare adenocarcinoma of the ureter is typically papillary and is associated with urinary tract infection and stones. In adenocarcinoma, because it is often difficult to determine whether the tumor is primary or secondary due to the generalized instability of the urothelium, and its histogenesis and biologic behavior remain uncertain partially due to the rarity of this neoplasm, a diagnostic differentiation pathologically from other tumors is required. We herein describe a case of 68 year old man who had a primary well-differentiated papillary mucigenic. adenocarcinoma of the ureteric stump after nephrectomy for renal stones.
Adenocarcinoma ; Adenocarcinoma, Papillary* ; Aged ; Humans ; Nephrectomy ; Ureter* ; Urinary Tract Infections ; Urothelium

Glans penis augmentation (GPA) has received little attention from experts despite the existence of a subset of patients who may be dissatisfied with a small glans or poor tumescence of the glans during erection. Recently, GPA using an injectable filler or implantation of a graft or filler has been developed. Despite a demanding injection technique and inevitable uneven undulation of the glandular surface, GPA using injectable hyaluronic acid (HA) gel is a novel and useful therapy and an effective and safe procedure for soft tissue enhancement. For long-term presence of implants, timed supplementation can be used similar to that for fascial plasty. In complications such as mucosal necrosis of the glans penis, most cases occur from the use of non-HA gel or an unpurified form and misunderstanding of the management protocol for immediate side effects. Currently, GPA using injectable HA gel is not recommended in the International Society for Sexual Medicine guideline due to possible sensory loss. In a 5-year long-term follow-up of GPA by subcutaneous injection of HA gel, the residual volume of implants decreased by 15% of the maximal glandular circumference, but was still effective for alleviating the hypersensitivity of the glans penis in premature ejaculation patients. For efficacy in premature ejaculation, selection of appropriate candidates is the most important factor for success. GPA does not harm erectile function and is less invasive and irreversible compared to dorsal neurectomy. To refine the procedure, more interest and well-designed studies are required for the establishment of the procedure.
Follow-Up Studies ; Humans ; Hyaluronic Acid* ; Hypersensitivity ; Injections, Subcutaneous ; Male ; Necrosis ; Penis* ; Plastics ; Premature Ejaculation ; Residual Volume ; Transplants

PURPOSE: Previous studies concerning the ischemic priapism revealed that hypoxia alter the erectile and contractile responses of penis. But the effects of accompaning acidosis on the trabecular smooth muscle contractility have not been fully evaluated or understood yet. We performed this study to elucidate the role of acidosis on the trabecular smooth muscle contractility like in ischemic priapism. MATERIALS AND METHODS: Under the general anesthesia, 55 mature male cats were conditioned to systemic metabolic acidosis by hypoventilation with animal ventilator. The changes of intracavernous pressure to erectics(acetylcholine, L-arginine, PGE1), erectolytics(epinephrine, TXA2), K+-channel-related drugs (pinacidil, 4-aminopyridine, TEA, glibenclamide) and calcium ionophore were monitored at Set 1 (PO2>60mmHg, pH>7.25), Set 2(PO2 <30mmHg,7.25>pH>7.0), Set 3(PO2<30mmHg, pH<7.0), and Set 4(PO2>60mmHg, pH<7.0) in vivo. RESULTS: At Set 1 and Set 2, the acetylcholine or PGE1-induced relaxations were suppressed by epinephrine, TXA2 or ionomycin(n=9, p<0.01). The contractility was in order of epinephrine, TXA2 and ionomycin. Cavernous relaxations to acetylcholine or PGE1 were reduced by acidosis(n=8, p<0.01). TXA2 or ionomycin did not produced contraction even with higher concentration but epinephrine maintained contractility with higher concentration at acidosis (n=7, p<0.05). Acidosis-induced relaxation was not prevented by 4-aminopyridine, TEA, or glibenclamide(n=6, p<0.05). Pinacidil did not induced relaxation at acidosis(n=6, p<0.01). CONCLUSIONS: Acidosis impairs the contractile response of cavernous smooth muscle to submaximal stimulation with erectolytics. It may be the results of the interference by(H+) with the intra and extracellular mechanisms that regulate the homeostasis of(Ca2+). Conclusively, acidosis is another limiting factor of trabecular smooth muscle contractility like in ischemic priapism.
4-Aminopyridine ; Acetylcholine ; Acidosis* ; Alprostadil ; Anesthesia, General ; Animals ; Anoxia ; Arginine ; Calcium ; Cats ; Epinephrine ; Homeostasis ; Humans ; Hypoventilation ; Ionomycin ; Male ; Muscle, Smooth* ; Penis ; Pinacidil ; Priapism ; Relaxation ; Tea ; Ventilators, Mechanical

No abstract available.
Osteoporosis* ; Radionuclide Imaging*

PURPOSE: Medical treatment of Peyronie's disease with tamoxifen has been initially proposed as acting upon the early phase of the disease. As recent reports show no significant benefit of tamoxifen, we review the long term results of tamoxifen treatment of Peyronie's disease. MATERIALS AND METHODS: Time to progression during tamoxifen treatment of patients showing acute disease and chronic disease was compared. The acute phase was identified by pain during erection. Progression was defined as enlargement of plaque size or appearance of calcification. RESULTS: The average treatment duration was 15.9+/-13.8 months (range: 3 to 48 months). The median time to progression was 7 months for acute patients and 20 months for chronic patients. Eighty percent of patients in the acute phase showed relief of pain; however, overall progression was 72.1% (78.0% for acute, 66.7% for chronic). Patient history, comorbidities, serum testosterone or initial plaque characteristics, and severity of curvature were not predictive of disease progression. CONCLUSIONS: Tamoxifen showed no significant benefit in slowing the progression of Peyronie's disease in the acute phase over the chronic phase. Peyronie's disease continued to progress, though at a dampened rate for patient's in the chronic phase.
Acute Disease ; Chronic Disease ; Comorbidity ; Humans ; Male ; Penile Induration ; Tamoxifen ; Testosterone

PURPOSE: To see the stability and error in the diffusion-weighted magnetic resonance (MR) imaging technique in the experimental models and to observe the signal intensities in the early cerebral lesions of the animal models. MATERIALS AND METHODS: Diffusion coefficients of acetone and distilled water were measured by diffusion-weighted MR image and were compared with actual values. Differentiation of diffusion from perfusion were done at the resin flow phantom. The signal intensities caused by early parenchymal changes were measured in normal, hypovolemic, and embolic, and dead animal models by using diffusion-weighted image and compared with pathoIogic finding and vital staining. RESULTS: Diffusion coefficients of acetone and distilled water were 4.48 x 10-3 and 2.72 x 10-3 which were very close to the actual values. Diffusion-weighted MR image obtained at flow phantom was not affected by flow (perfusion) at the 100-400 of b-factor range. Animal study done at that b-factor range revealed a significant signal difference between the left and right sides only at the embolic model induced by polyvinyl alchol particles (p<0.05). These changes were not detected in microscopic finding but could be identified in vital staining. CONCLUSION: Diffusion-weighted MR image can be used to detect early parenchymal change when the appropriate b-factor range was applied.
Acetone ; Animals ; Diffusion* ; Hypovolemia ; Models, Animal ; Models, Theoretical* ; Perfusion ; Polyvinyls ; Water

PURPOSE: Ureteroscopic removal of stones (URS) has been widely used to treat ureteral stones because it is comparatively safe, has a high success rate, and enables patients to rapidly return to their daily routines. However, some patients experience pain after URS, but the incidence of acute post-URS pain remains largely unknown. This study aimed to investigate the incidence of acute postoperative pain after URS and the associated risk factors. MATERIALS AND METHODS: Data for 143 consecutive patients who underwent URS from June 2008 to December 2010 were collected. After excluding 8 patients who developed intraoperative complications, the patients were divided into two groups according to postoperative pain on the first postoperative day. Acute postoperative pain was defined as a pain score greater than 4 on a visual analogue pain scale (normal range, 0 to 10). Various factors were analyzed to identify the risk factors that could predict acute postoperative pain after URS. RESULTS: The stone-free rate without URS intraoperative complications was 95.5%. A total of 21 (14.6%) patients experienced postoperative pain on the first postoperative day. Young age, psychiatric illness, history of urinary tract infection, use of a stone basket, large stone size, and prolonged operation time were identified as risk factors for acute postoperative pain. CONCLUSIONS: The incidence of acute postoperative pain is not that low and should not be overlooked, because it is associated with postoperative complications that could result in an unscheduled hospital admission or visit. Active pain control should be contemplated after URS in young patients and in those with a history of urinary tract infection, psychiatric illness, large stone size, and prolonged operation time.
Humans ; Incidence ; Intraoperative Complications ; Pain Measurement ; Pain, Postoperative ; Postoperative Complications ; Risk Factors ; Ureter ; Ureterolithiasis ; Ureteroscopy ; Urinary Tract Infections

PURPOSE: The modified subureteral transurethral injection(STING) has been reported to increase the success of endoscopic treatment of high grade vesicoureteral reflux(VUR). This study was performed to assess the efficacy of the modified STING procedure compared to conventional STING in the setting of high grade VUR. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 40 consecutive children(46 ureters) with a median age of 5.32 years (range 1 to 10 years) who underwent endoscopic treatment of grade IV to grade V VUR between February 2004 and December 2006. The modified STING was performed by applying a direct pressure stream of irrigation fluid into the ureter in order to define the injection site within the ureteral submucosa. The needle was then placed in the ureteral tunnel, and a dextranomer/hyaluronic acid copolymer(Dx/HA) was injected into the submucosal intraureteral space, tracking along the entire length of the detrusor tunnel. Modified STING was performed in 27 ureters(grade IV: 13, grade V: 14), and conventional STING was performed in 19 ureters (grade IV: 12, grade V: 7). Follow-up voiding cystourethrography(VCUG) was performed 3 months later. RESULTS: Complete resolution occurred in 82%(22/27 ureters) of the patients undergoing modified STING, including 92%(12/13) of grade IV patients and 71%(10/14) of grade V patients. Three ureters required a second injection to correct VUR. Conventional STING had a success rate of 63%(12/19), [75%(9/12) in grade IV and 43%(3/7) in grade V]. The mean injected volume for the modified STING was 1.23+/-0.3ml, while that for the conventional STING was 0.95+/-0.2ml(p=0.03). Conclusions: The modified STING was markedly more successful in the treatment of high grade VUR and carried no significant adverse effects.
Child ; Male ; Female ; Humans ; Bites and Sting

PURPOSE: Soft-tissue augmentation using hyaluronic acid (HA) gels is widely used in dermatology and plastic surgery. We performed this study to determine the feasibility of using HA gel to augment the glans penis. MATERIALS AND METHODS: In experiment I, 0.2 cc of HA gel was injected into the dermis of the glans penis of 25 New Zealand White rabbits via a 27-gauge needle. At 3, 7, 14, 30, and 90 days after injection, the histologic changes in the penis and systemic adverse effects were evaluated. In experiment II, 0.5 cc of HA gel was injected into the dermis of the glans penis of 14 Beagle dogs. Two weeks later, an additional 0.2 cc was injected in 7 of the dogs. For 6 months, the changes in the injected area were grossly evaluated using a 10-point visual scale, and at the end of the study, histologic changes were also evaluated. At autopsy, lung, liver, and spleen were studied for systemic adverse reactions. RESULTS: In the dogs receiving double injections, 85% to 90% of the initial volume was maintained at 6 months, with HA being identified in the lamina propria of the glans penis. Encapsulated material was confirmed to be HA by alcian blue stain and hyaluronidase immunohistochemical stain. No systemic adverse reaction was noticed in any animal. CONCLUSIONS: Hyaluronic acid gel is safe and effective for augmentation of the glans penis. Booster injection enhances the injected volume and facilitates injection of HA.
Alcian Blue ; Animals ; Autopsy ; Dermatology ; Dermis ; Dogs ; Gels ; Hyaluronic Acid* ; Hyaluronoglucosaminidase ; Liver ; Lung ; Male ; Mucous Membrane ; Needles ; Penis* ; Rabbits ; Spleen ; Surgery, Plastic

Urinary stones are rarely seen in the urethra and are usually encountered in men with urethral stricture or diverticulum. The case of a 52-year-old woman presented, who consulted for weak stream associated with repeated urinary infections. The diverticulum was approached via vaginal route and the extraction was successful. The patient has been well, with no dysuria, dyspareunia, incontinence for 3-month follow-ups.
Calculi ; Diverticulum ; Dyspareunia ; Dysuria ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Rivers ; Urethra ; Urethral Stricture ; Urinary Calculi