No abstract available.
Prognosis*

PURPOSE: Laparoscopic bladder neck suspension is an effective treatment for genuine stress urinary incontinence. To decrease the operating time, associated morbidity and hospital stay, we introduced laparoscopic bladder neck suspension using extracorporeal needle. We assessed the feasibility of this new technique, and compared with simple laparoscopic bladder neck suspension and transvaginal Raz procedure. MATERIALS AND METHODS: Eleven patients underwent a laparoscopic bladder neck suspension using extracorporeal needle were compared with 16 patients underwent simple laparoscopic bladder neck suspension and 66 patients treated with transvaginal Raz procedure for genuine stress urinary incontinence. All patients were assessed for their age, duration of symptom, operative time, length of hospital stay, postoperative residual urine volume, complications, and success rate. RESULTS: The result of present method was cure in 82% and improvement in 18% of patients. The overall success rate of three methods were similar. Average duration of postoperative admission was 3.4 days and average residual urine volume at discharge was 12.1 ml (simple laparoscopic Burch procedure: 5.1 days and 22.1 ml; Raz procedure: 7.7 days and 37.5 ml). Operative time of laparoscopic bladder neck suspension using extracorporeal needle was shorter than the simple laparoscopic bladder neck suspension and transvaginal Raz procedure (55 vs. 125 and 102 minutes). CONCLUSION: Laparoscopic bladder neck suspension using extracorporeal needle is a good technique for treatment of genuine stress urinary incontinence. However, additional long term follow-up study will be required.
Follow-Up Studies ; Humans ; Length of Stay ; Neck* ; Needles* ; Operative Time ; Urinary Bladder* ; Urinary Incontinence*

PURPOSE: This study was designed to identify the possible mechanism of insensitivity of DU145 prostate cancer cells to the transforming growth factor (TGF)-beta1-mediated growth inhibition. MATERIALS AND METHODS: DU145 cells were treated with 4, 40, 100 pM TGF-beta1 for 3, 6, 9 days. Initially we performed the growth assay. After that, we analysed the change of cell cycle using fluorescence flow cytometry. At each time point, Western blot analysis with cell pellets was performed to investigate the change of expressions of epidermal growth factor(EGF), TGF-alpha, EGF receptor(EGFR) and TGF receptorII(TbetaR-II) proteins. RESULTS: The growth rate of TGF-beta1-treated cells was initially suppressed, but over time returned to control level. Flow cytometric analysis revealed that TGF-beta1-treated cells showed an increase in apoptotic/G1 phases, and concurrent decrease in S, G2/M phases until 6days. On day 9, however, TGF-beta1-treated cells showed a persistent increase of apoptotic unclei in spite of recovery of apoptotic/G1, S and G2/M phases. Western blot analysis showed that the intensity of EGF or TGF-alpha band decreased in dose-sependent manner on day 6. However, the intensity of each band increased up to the control level on day 9. the expression of EGFR or TbetaR-II protein did not change after treatment of TGF-beta1. CONCLUSIONS: these results suggest that EGF and TGF-alpha sould mediate in part the escape fron the inhibitory effect of TGF-beta1 in DU145 cells.
Blotting, Western ; Cell Cycle ; Epidermal Growth Factor* ; Flow Cytometry ; Fluorescence ; Prostate* ; Prostatic Neoplasms* ; Transforming Growth Factor alpha ; Transforming Growth Factor beta1 ; Transforming Growth Factors ; United Nations

For the treatment of genuine stress urinary incontinence(GSUI), various surgical approaches have been developed since early in this century. Laparoscopic bladder neck suspension has recently been described as an alternative method to the open surgical correction of GSUI. We had treated 16 patients of GSUI with laparoscopic Burch procedure from May to November 1995. Mean age of the patients was 42.5 years(range:28-77years) and mean parity was 3.7. There was no serious operative complications such as bladder rupture or bleeding needed transfusion. The duration of follow up was 6.2 months(range:3-9 months) in average. Incontinence was completely disappeared in 11 patients(68.7%) and significantly improved in 5 patients (31.3%), and no patient was recurred during follow up periods. Postoperatively, there was no significant complication, except two cases of urinary tract infection. Early results of the small number of women studied suggest that this new technique can provide successful outcomes in properly selected patients.
Female* ; Follow-Up Studies ; Hemorrhage ; Humans ; Neck* ; Parity ; Rupture ; Urinary Bladder* ; Urinary Incontinence* ; Urinary Tract Infections

Forty two patients (ages 55 to 88 years) who had bladder outlet obstruction due to benign Prostatic hyperplasia were treated with TULIP procedure from October 1993 to Apri1 1994. Preoperatively, the patients underwent digital rectal examinations, determination of prostate specific antigen levels and transrectal ultrasound guided biopsies when necessary to rule out the presence of prostatic cancer. The overall preoperatively estimated weight of prostate gland was 37.3+/-5.0g by transrectal ultrasonography, and all types of prostatic enlargement, including median lobe obstruction, were treated. The TULIP device incorporates ultrasound visualization with 90 degree angle, side-firing Nd: YAG laser to induce coagulation necrosis of prostatic tissue. Treatment was performed primarily under epidural anesthesia, and the mean irradiated laser energy was 20,315 joules. There were no intraoperative complications such as hemorrhage or post-transurethral resection syndrome, and no blood transfusions were required. The patients were evaluated at three months following treatment. The subjective symptom scores were significantly decreased from 23.7+/-4.3 to 3.2+/-1.9 for a 87% improvement(P<0.001). Maximum flow rate increased from 8.2+/-3.2ml/sec to 13.7+/-3.4ml/sec, for a 67% improvement (P<0.001). For three months follow-up period epididymitis was developed in 2 cases, but these were easily handled with antibiotics. There were no patients of incontinence or impotence, as a complication, after TULIP procedure With these results we can conclude that TULIP is a reliable and effective procedure of little morbidity, especially for the aged patients with various medical problems.
Anesthesia, Epidural ; Anti-Bacterial Agents ; Biopsy ; Blood Transfusion ; Digital Rectal Examination ; Epididymitis ; Erectile Dysfunction ; Follow-Up Studies ; Hemorrhage ; Humans ; Intraoperative Complications ; Lasers, Solid-State ; Male ; Necrosis ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Prostatic Neoplasms ; Tulipa ; Ultrasonography ; Urinary Bladder Neck Obstruction

We report a case of primary ureteral polyp causing UPJ obstruction in l9 year old boy. He presented with intermittent left flank pain and fever for 2 years. RTP, renal ultrasonography, and RGP show a dilated left renal pelvis and linear filling defect in upper ureter the operative findings were as followings : the polyp has five linear polypoid mass, which was originated from left ureteropelvic junction. the base of polyp was protruded like a ureteral tumor with some ecchymosis grossly. We resected left ureteropelvic junction and upper ureter partially, and performed pyeloplasty after confirmation of benign nature of mass by frozen section.
Ecchymosis ; Fever ; Flank Pain ; Frozen Sections ; Humans ; Kidney Pelvis ; Male ; Polyps* ; Ultrasonography ; Ureter*

PURPOSE: The best predictors of prognosis in prostate cancer are the stage of disease and histologic differentiation. But, preoperative prediction of pathologic stage in prostate cancer is currently limited and histologic differentiation may be somewhat subjective. Therefore, more accurate predictors of biological progression are needed. The author designed this study to determine the prediction efficacies of neovascularity and proliferating cell nuclear antigen (PCNA) labeling index using immunohistochemical staining. MATERIALS AND METHODS: Immunohistochemical stains in 48 cases of prostate cancers and 5 cases of benign prostatic hyperplasia (BPH) were performed and analysed. Microvessels were identified by immunostaining of endothelial cells for factor VIII-related antigen. PCNA labeling indices were obtained in 200X field by counting more than 1,000 cells. RESULTS: 1. The mean microvessel count (MVC) was 34.2+/-5.9 per 200X field in BPH group and 63.5+/-38.6 (p<0.05) in prostate cancer group. The mean MVCs were 32.2, 38.3, 58.8, 78.1 and 86.8, from grade I to V respectively. According to stage, the mean MVCs were 40.8, 48.5, 55.0 and 89.0 from A to D. Between well (grade I-III) and poorly (grade IV-V) differentiated cancer group, there was significant difference in MVC (p<0.05). And also, the difference between localized and metastatic groups was statistically significant. High MVC (MVC->60) group survived longer than low MVC group, but the difference was not significant. 2. The mean PCNA labeling indices were 14.6+/-8.0% in BPH group and 32.3 +/- 15.4% in cancer group. According to Gleason grade, the mean PCNA labeling indices showed 33,4%, 30.8%, 26.3%, 38.0% and 36.6% from I to V respectively. The mean values were 23.1%, 27.4%, 30.4% and 36.2% in stage A, B, C and D. Between localized and metastatic groups, the difference of PCNA labeling index was not statistically significant. The mean survival of high labeling index (>=30%) group was 66.0 +/- 12.2 months contrasted with 72.4 +/- 14.6 months of low labeling index group (p>0.05). CONCLUSIONS: Microvessel density in prostate adenocarcinoma may be an another prognostic factor supporting clinical stage and histologic differentiation. But negative results were obtained for PCNA labeling index from this study. To further define MVC as a predictor of prostate cancer, more enthusiastic and well designed studies are needed.
Adenocarcinoma ; Coloring Agents ; Endothelial Cells ; Microvessels ; Neoplasm Metastasis* ; Prognosis* ; Proliferating Cell Nuclear Antigen* ; Prostate* ; Prostatic Hyperplasia ; Prostatic Neoplasms ; von Willebrand Factor

Various surgical approaches have been used for the treatment of genuine stress urinary incontinence. We had treated 30 patients of GSUI (genuine stress urinary incontinence) with modified Pereyra methods, so called Raz procedure. Mean age of the patients was 48.5 years (range; 32- 79 years). The duration of the incontinence was 10.4 years in average (range ; 0.5-26 years) In the degree of severity, Grade 1 was 3.3% (1), Grade II was 86.7% (26) and Grade III was 10% (3). Mean parity was 3.6 and six patients (20% ) had been undergone hysterectomy. The duration of follow up was 17.3 months in average. Incontinence was completely disappeared in 20 patients( 66.7%) and significantly improved in 7 patients ( 23.3% ), but three patients(10%) were recurred. There was no serious operative complication such as bleeding needed transfusion. But temporary urinary retention(8), suprapubic pain(7), vaginitis(2) and urinary tract infection(1) were complained. Raz procedure is a reliable technique among various surgical techniques with little morbidity.
Female* ; Follow-Up Studies ; Hemorrhage ; Humans ; Hysterectomy ; Neck* ; Parity ; Urinary Bladder* ; Urinary Incontinence* ; Urinary Tract

We experienced with 3 cases of penile fractures for recent 2 years, one occurred during masturbation and the others occurred during coitus(one case was associated with urethral injury). While the former was treated with conservative management, the latters were treated with surgical intervention that was immediate removal of hematoma and primary closure of ruptured corpus cavernosum. Penile deformity end decrease in rigidity occurred in conservatively treated case. However, two cases of immediate surgical treatment had a excellent result without complication. Even though we describe only 3 cases and could not compare the degree of injury. our short experiences suggest that immediate surgical intervention is better than conservative management in initial treatment of penile fracture.
Congenital Abnormalities ; Hematoma ; Masturbation

Recently the percutaneous aspiration and instillation with 95% ethanol, for the sclerosing therapy of the renal simple cyst, was widely used because of high recurrence rate in simple needle aspiration. Ten patients were instillated with ethanol after aspiration. Ages of patients were between 37 to 77 years old. Chief complaints were flank pain, gross hematuria, indigestion, epigastric discomfort and hypertension. After local anesthesia, the cysts were punctured with a trocar needle and inserted 8.3 Fr. single J-catheter with guide wire in turn, under ultrasonic guidance. After complete aspiration of the fluid, 95% ethanol was instillated as much as 20-30% of the cystic volume, and kept for 20-30 minutes. The pigtail catheter was removed after one day. The aspirated volume was 166 ml in average and nearly identical to transudate. There was no bacteria or malignant cells. Follow-up period was 7+/-2 months in average. Five cases were completely cured, four cases recurred but the cyst was smaller(< 50% of the original size) and one recurred as its original size. The complications were transient flank pain and facial flushing. In conclusion, aspiration and instillation with ethanol was very easy, safe, fast and effective treatment for the simple renal cyst.
Aged ; Anesthesia, Local ; Bacteria ; Catheters ; Dyspepsia ; Ethanol* ; Exudates and Transudates ; Flank Pain ; Flushing ; Follow-Up Studies ; Hematuria ; Humans ; Hypertension ; Needles ; Recurrence ; Surgical Instruments ; Ultrasonics