PURPOSE: Shockwave lithotripsy(SWL) and ureteroscopic manipulation became the standard treatments for ureteral stones in recent years. There still exists significant debate as to the most appropriate treatment modality for ureteral stone management. MATERIALS AND METHODS: From January 1994 to December 1995, 651 patients of ureteral stones were treated and 589 patients were retrospectively reviewed excluding 62 patients for incomplete follow ups. Four hundred and forty-two patients were treated with SWL using MPL 9000 with ultrasonic guidance, 115 patients with ureteroscopic manipulation using 7.9 to 11.5Fr rigid and semirigid ureteroscopes. RESULTS: In SWL treatments, overall stone free rate was 74.7% with one session, Stone free rate was significantly affected by the size of stones. Stone free rate was 83.6% when the stone was smaller than 1.0cm and 42.1% when the stone was larger than 1.0cm Stone free rate after second SWL session was 84.4% and 90.3% after third session. The stone free rates according to the site of stones were 72.4(proximal), 70.0(mid), 80.2(distal), respectively. In ureteroscopic manipulation, overall stone free rate of 87.8% was obtained regardless of the size of stones. The success rates according to the location of stones were 75.0(proximal), 94.6(mid), 86.4%(distal), respectively. Open ureterolithotomy was performed in 32 patients with 100% success rate. CONCLUSIONS: In our study, the size of stones was the most important factor influencing the success rate of SWL treatment for ureteral stones. We consider ureteroscopic manipulation as the first line treatment modality when the stone is larger than 1.0cm, especially in distal ureter, Proper selection of patients for in situ SWL or ureteroscopy would improve the results of initial treatment.
Follow-Up Studies ; Humans ; Retrospective Studies ; Ultrasonics ; Ureter* ; Ureteroscopes ; Ureteroscopy

PURPOSE: TUNA is a new minimally invasive treatment modality for the patients with benign prostatic hyperplasia of prostate utilizing low levels of radiofrequency energy. We presented our early experiences of TUNA for the treatment of BPH to evaluate its clinical outcome. MATERIALS AND METHODS: From July 1995 to March 1997, 36 patients were treated with TUNA(15 with manual system, 21 with automatic system). Mean age of the patients was 63.5 years. All patients were evaluated preoperatively with PSA, AUA symptom score, uroflowmetry and transrectal ultrasonography(TRUS). AUA symptom score at 1, 3, 12 month and uroflowmetry at 1, 3 month postoperatively were available for analysis. RESULTS: Mean PSA value was 3.4ng/ml and mean prostate volume by TRUS was 35.5gram preoperatively. Nine out of 36 procedures were performed with local anesthesia. Mean operating time was 45.6 minutes. At postoperative 3 and 12 month, symptom score was improved from 22.0+/-1.5 to 11.7+/-1.6 and 11.0+/-1.9(p<0.05), respectively and maximal flow rate was increased from 11.2+/-0.7ml/sec to 14.4+/-1.5ml/sec at postoperative 3 month(p<0.05). Results have been far better since using automatic system. Complications were observed in one patient with clot retention and in 11 patients with postoperative urinary retention. CONCLUSIONS: TUNA is a simple, safe, efficacious and minimally invasive treatment procedure with short hospital stay, less morbidity for treatment of the patients with BPH. It could also be performed with local anesthesia. We suggest that TUNA would be a new promising treatment modality for BPH.
Anesthesia, Local ; Humans ; Hyperthermia, Induced ; Length of Stay ; Needles* ; Prostate ; Prostatic Hyperplasia ; Tuna ; Urinary Retention

PURPOSE: Solvent 5200(heptane 1.97%, 2-bromopropane 97.92% and 1,2-dibromopropane 0.02%) is a widely used detergent in electronic industries. The toxic effect of this chemical on spermatogenesis were investigated. MATERIALS AND METHODS: Eight employees who showed abnormal semen analyses after exposure to Solvent 5200 for one year to eleven years underwent hormonal tests, semen analyses, testicular biopsies one month after cessation of exposure and then three consecutive semen analyses during 8 months follow-up period. RESULTS: All patients(mean age: 33 years old) had decreased sperm count including azoospermia in one Patient. Five patients also had decreased sperm motility. One azoospermic and two oligospermic patients had elevated serum FSH level. Histology of testes in six patients showed abnormal histologic findings such as atrophy of seminiferous tubules, thickening of the basement membrane and hyperplasia of Leydig cells. Follow-up semen analysis during eight months period after cessation of exposure to Solvent 5200 revealed increased sperm count in all patients including four patients recovering to normal range. Conclusion: Our studies suggest that Solvent 5200 could induce histolcgic change of testes as well as impairment of spermatogenesis and this process could be reversed by avoidance of exposure to this chemical substance.
Atrophy ; Azoospermia ; Basement Membrane ; Biopsy ; Detergents ; Follow-Up Studies ; Humans ; Hyperplasia ; Leydig Cells ; Male ; Reference Values ; Semen Analysis ; Seminiferous Tubules ; Sperm Count ; Sperm Motility ; Spermatogenesis* ; Testis

Premature ejaculation is the most common male sexual dysfunction and defined as persistent or recurrent occurrences of ejaculation before or shortly after penetration. But there has never been any effective oral agents for the patients with premature ejaculation. Recently, fluoxetine, a potent serotonin reuptake inhibitor, being used as antidepressant, has been suggested to be helpful for the patients with premature ejaculation. Twenty three male outpatients with premature ejaculation were randomly divided into fluoxetine (n=12) and placebo (n=11) group. In the fluoxetine group, the dose of fluoxetine was 20 mg/day for the first one week and 40 mg/day for the remaining 5 weeks. Patient and his female partner were interviewed separately before starting medication, three weeks and six weeks after medication. The mean intravaginal ejaculation latency time increased to 187.5 seconds after 3 weeks and 254.2 seconds after 6 weeks front 46.7 seconds before treatment (p<0.05). Only 1 out of 12 patients in the fluoxetine group was able to have thrusts over 30 times before treatment. After 3 weeks of Treatment, 8of 12 patients and after 6 weeks of treatment, 7 patients were able to have thrusts over 30 times. There was no significant improvement of intravaginal ejaculation latency time and number of thrusts in the placebo group. Symptomatic improvement was noticed in 75% with fluoxetine group and 18.2% with placebo group. Side reactions of fluoxetine, fatigue and yawning, were noticed in 41% of the patients, but they did not interfere with their daily activities. These findings suggest that fluoxetine can be safely used as a good pharmacotherapeutic treatment for the patients with premature ejaculation.
Ejaculation ; Fatigue ; Female ; Fluoxetine* ; Humans ; Male ; Outpatients ; Premature Ejaculation* ; Serotonin ; Yawning

Enigmatic chronic pelvic pain is the persistence of unexplained pain in the low abdomen and pelvic lesions without evidence of active disease. One of the most frequent causes is the nonvisceral pain such as myofascial and postsurgical incisional origin. We evaluated the trigger point injection of bupivacaine hydrochloride as a treatment option for chronic nonvisceral pelvic pain. From March, 1995 to May, 1996, 35 female patients (16 to 68 years old, mean 43.7 years ) with localized chronic pelvic pain for 6 months to 10 years were managed by trigger point injection. After confirming the absence of intraabdominal pathology by physical examination and Carnett`s test, 3 to 5 ml of 0.25% bupivacaine hydrochloride was injected to the most hyperpathic foci with 22 gauge, one and half inch needle percutaneously. The mean followup time was 9.7 months. The results were assessed by Visual Analogue Scale(VAS) and subjective symptoms. Twenty six patients had nonincisional pain and 9 had incisional pain. Twenty two patients were treated by only one session while others needed two or more sessions(maximum 4 sessions). The sites of pain were hypogastrium, suprapubic area and iliac fossa in the order of frequency. The mean VAS value at the time of last followup was reduced to 1.7 cm(0 - 5.7 cm) from 6.7 cm(4.9 - 9.1 cm). The improvement of pain occurred mostly within 1 week after treatment and was maintained thereafter. Eighty percent of patients expressed more than 50% reduction of pain by VAS. Sixteen patients(45.7%) responded ""pain free"", 10(28.6%) ""occasional"", 6(17.1%)"" present but better"", and 3(8.6%) ""no change"". The successful responses were noted in 74.3%. No significant complications were identified. These results demonstrated that the trigger point injection is an easy, safe and effective treatment option for chronic nonvisceral pelvic pain.
Abdomen ; Aged ; Bupivacaine* ; Female ; Follow-Up Studies ; Humans ; Needles ; Pathology ; Pelvic Pain* ; Physical Examination ; Trigger Points*

Enigmatic chronic pelvic pain is the persistence of unexplained pain in the low abdomen and pelvic lesions without evidence of active disease. One of the most frequent causes is the nonvisceral pain such as myofascial and postsurgical incisional origin. We evaluated the trigger point injection of bupivacaine hydrochloride as a treatment option for chronic nonvisceral pelvic pain. From March, 1995 to May, 1996, 35 female patients (16 to 68 years old, mean 43.7 years ) with localized chronic pelvic pain for 6 months to 10 years were managed by trigger point injection. After confirming the absence of intraabdominal pathology by physical examination and Carnett`s test, 3 to 5 ml of 0.25% bupivacaine hydrochloride was injected to the most hyperpathic foci with 22 gauge, one and half inch needle percutaneously. The mean followup time was 9.7 months. The results were assessed by Visual Analogue Scale(VAS) and subjective symptoms. Twenty six patients had nonincisional pain and 9 had incisional pain. Twenty two patients were treated by only one session while others needed two or more sessions(maximum 4 sessions). The sites of pain were hypogastrium, suprapubic area and iliac fossa in the order of frequency. The mean VAS value at the time of last followup was reduced to 1.7 cm(0 - 5.7 cm) from 6.7 cm(4.9 - 9.1 cm). The improvement of pain occurred mostly within 1 week after treatment and was maintained thereafter. Eighty percent of patients expressed more than 50% reduction of pain by VAS. Sixteen patients(45.7%) responded ""pain free"", 10(28.6%) ""occasional"", 6(17.1%)"" present but better"", and 3(8.6%) ""no change"". The successful responses were noted in 74.3%. No significant complications were identified. These results demonstrated that the trigger point injection is an easy, safe and effective treatment option for chronic nonvisceral pelvic pain.
Abdomen ; Aged ; Bupivacaine* ; Female ; Follow-Up Studies ; Humans ; Needles ; Pathology ; Pelvic Pain* ; Physical Examination ; Trigger Points*

No abstract available.
Female ; Humans ; Prevalence* ; Urinary Bladder* ; Urinary Incontinence*

Background: The prevalence of psoriasis differs by population, and it appears to be more common among Europeans than in East Asians. Recent genome-wide association studies (GWAS) have identified alleles that increase the risk of psoriasis, and these alleles may present different frequencies in different geographic regions. Objective: We aimed to gain insights into the causes of differences in disease frequencies according to populations and the factors affecting prevalence and pattern differences. Methods: We collected a total of 147 psoriasis-associated single-nucleotide polymorphisms (SNPs) from the GWAS catalog and compared the allele frequency differences in 27 populations using public population frequency in the 1000 Genomes Project phase 3 (n=2,504) and the Korean Reference Genome Database (n=1,722). Additionally, we calculated the composited genetic risk scores across the population groups. Results: There were distinct patterns of allele frequencies in different population groups.In many cases, East Asians exhibited allele frequencies opposite to that of Europeans. The genetic risk score was higher in Europeans (average: 0.487) and Americans (average: 0.492) than in East Asians (average: 0.471). The prevalence of psoriasis correlated with the average genetic risk score of the population. Conclusion We observed a difference in the allele frequencies of psoriasis-associated SNPs between the studied populations. This result suggests that the difference in the prevalence of psoriasis between population groups can be interpreted to some extent by the genotype.

PURPOSE: The sensitivity of antegrade pyelogram (AGP), plain film radiography (KUB) and non-contrast, thin cut abdomen computerized tomography (CT) were prospectively compared for the detection of residual stones following a percutaneous nephrolithotomy. MATERIALS AND METHODS: Fifty patients (53 renal units), who had undergone a percutaneous nephrolithotomy for radiopaque renal pelvis stone, as well as a non-contrast abdomen CT 1 month postoperatively, were prospectively evaluated. The number and size of residual fragments, as determined by immediate postoperative AGP, postoperative 1 month KUB and abdomen CT, were compared. RESULTS: The stone-free rates according to the AGP, KUB and non-contrast CT were 73.6 (39/53), 62.3 (33/53) and 20.8% (11/53), respectively. In terms of clinically insignificant residual fragments (CIRFs), the success rates were 84.9 (45/53), 83.0 (44/53) and 41.5% (22/53), respectively. With respect to the residual stones (22 cases), which were detected by CT, but not by KUB, 45.5% (10 cases) were more than 4mm in size on CT, with a mean size of 7.4mm. The sensitivity for the detection of residual fragments was 47.6% for KUB compared to 100% for non-contrast CT. Seven patients received additional extracorporeal shock wave lithotripsy (ESWL) for residual stones following CT. CONCLUSIONS: Non-contrast, thin cut abdomen CT is the most accurate imaging modality for determination of the stone-free rate following a PCNL. Non-contrast abdomen CT gives accurate information for the selection of patients who may benefit from additional ESWL treatment and for follow-up planning.
Abdomen ; Follow-Up Studies ; Humans ; Kidney Calculi ; Kidney Pelvis ; Lithotripsy ; Nephrostomy, Percutaneous* ; Prospective Studies ; Radiography ; Shock ; Tomography, X-Ray Computed

PURPOSE: Because metastatic renal cell carcinoma responds to various forms of therapy with low remission rates, safe therapeutic agents is urgently needed. Ceramide is a potent and specific suppressor of cell growth and an inducer of apoptosis via an intracellular mediation of the sphingomyelin cycle. The present study was designed to assess the growth inhibitory effects and their mechanisms of C2-ceramide and C6-ceramide in renal cell carcinoma cells. MATERIALS AND METHODS: A standard microculture tetrazolium(MTT) assay was used to measure the cytotoxicity of C2-ceramide and C6-ceramide in renal cell carcinoma cell line A498. Apoptosis was confirmed by DNA fragmentation assay using agarose gel and TdT-mediated biotin-dUTP nicked-end labelling(TUNEL) technique. C2-ceramide and C6-ceramide were injected to the A498 tumor which was formed after A498 cells were implanted subcutaneously in athymic mice. Growth inhibitory effects of ceramides were examined biweekly. RESULTS: The survival fractions of A498 cells were 92.6+/-6.0, 82.8+/-14.0, 66.4+/-11.3, 41.8+/-9.6 and 24.3+/-6.3% for the concentrations of C2-ceramide 2, 4, 6, 8 and 10microM, repectively. IC50 of C2-ceramide was approximately 6.7microM. The survival fractions of A498 cells were 60.9+/-5.0, 23.4+/-3.0, 8.7+/-2.1, 5.0+/-1.2 and 3.3+/-0.6% for the concentrations of C6-ceramide 2, 4, 6, 8 and 10microM, respectively. IC50 of C6-ceramide was about 2.3microM. There were DNA fragmentations in A498 cells treated with C2-ceramide or C6-ceramide on the agarose gel and apoptotic tumor cells were also identified after treatment of C2-ceramide and C6-ceramide in TUNEL method. In in vivo study using athymic mice, the growth of A498 tumors was significantly suppressed by C2-ceramide and C6-ceramide. In vivo tumor suppressive effect was more prominent with C6-ceramide than with C2-ceramide. There`s no toxicity-related death of ceramide-treated athmic mice for 3 months. CONCLUSIONS: C2-ceramide and C6-ceramide have the growth inhibitory effects in human renal cell carcinoma cell line A498 by apoptosis mechanism in vitro and they have the in vivo tumor suppressive effects in athymic mice. C6-ceramide was more effective than C2-ceramide in both in vitro cytotoxicity test and in vivo animal experiment of growth inhibition. Therefore, ceramides may be used to treat metastatic renal cell carcinoma in the future.
Animal Experimentation ; Animals ; Apoptosis ; Carcinoma, Renal Cell* ; Cell Line ; Ceramides* ; DNA ; DNA Fragmentation ; Humans ; In Situ Nick-End Labeling ; Inhibitory Concentration 50 ; Mice ; Mice, Nude ; Negotiating ; Sepharose