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Penile Fracture: Clinical Findings and Surgical Treatment.

Hyung Jee KIM ; Wook Young YOON ; Bo Rahm KIM ; Jung Hyun SHIM

Korean Journal of Andrology.2003;21(3):132-135.

PURPOSE: Penile fracture is a relatively rare condition that is defined as a traumatic rupture of the tunica albuginea followed by subsequent subcutaneous hematoma of various degrees. The aim of this study was to evaluate the clinical presentations and outcomes of the treatment according to causes of penile fractures. MATERIALS AND METHODS: Between March 1998 and December 2002, ten patients aged 19 to 65 years underwent immediate surgical repair on the first or second day after fracture of the penis at our hospital. All patients came to the hospital 20 minutes to 34 hours after the injury. A complete history of the patient was taken and a thorough examination was performed including physical examination and cavernosography. RESULTS: All patients had taken cavernosography. Three of the patients showed hematuria(microscopic or gross) and were taken retrograde urethrography. All patients were surgically treated. Nine patients showed unilateral corporal ruptures. Two patients had urethral injuries; one had a total urethral rupture and the other had a corporal spongiosal partial tearing. Regardless of the causes of penile fractures, the lesions on the penile mid-shaft were the most common. Of the direction of lesions the transverse tearings of tunica albuginea at 6 to 8 o'clock position were the most common. At follow-up, all patients who were available reported erections adequate for intercourse without erectile or voiding dysfunction. CONCLUSIONS: All patients were treated successfully by immediate surgical repair regardless of the causes of the penile fractures, which is recommended for penile fracture.
Follow-Up Studies ; Hematoma ; Humans ; Male ; Penis ; Physical Examination ; Rupture

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Characteristics and Meaning of Sildenafil Failure in Patients with Erectile Dysfunction.

Du Geon MOON ; Dae Hee KIM ; Je Jong KIM

Korean Journal of Andrology.2003;21(3):125-131.

PURPOSE: Sildenafil citrate(Viagra(R)) has been accepted as a primary treatment of erectile dysfunction(ED). We performed this study to assess the determinants of sildenafil failure and the status of secondary treatment in sildenafil failure patients. MATERIALS AND METHODS: We reviewed the medical records of 1,023 erectile dysfunction patients who were prescribed sildenafil from September 2001 to June 2003. A specially designed sildenafil failure questionnaire was asked in 236 patients of sildenafil failure(Group I) and 127 of 787 patients with sildenafil success as a control(Group II). RESULTS: Sildenafil failure rate was 23%(236/1023). In Group I, the etiology of ED was psychogenic in 14%, organic in 36%, mixed in 32% and un-classified in 18%. Number of total medication(more than 6 times) was 47% in Group I and 61.4% in Group II. Presence of sexual stimulation after medication was 47% in Group I and 61.4% in Group II. There was no difference in time to intercourse after medication and interval of meal to medication between both groups(p>0.05). The secondary treatment in Group I was intracavernous injection(11.3%), vacuum device(7.2%), penile prosthesis(1.3%) and 81.2% of no further treatment. CONCLUSIONS: Although precise education of taking sildenafil may enhance the response rate, the best predictors for long-term use of sildenafil are the severity and cause of ED and the effectiveness of sildenafil. Due to the high dropout rate of patients who suffer sildenafil failure, precise public education and secondary treatment options should be recommended.
Education ; Erectile Dysfunction* ; Humans ; Male ; Meals ; Medical Records ; Patient Dropouts ; Sildenafil Citrate ; Vacuum

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Surgical Advances in Penile Augmentation.

Nam Cheol PARK

Korean Journal of Andrology.2003;21(3):115-124.

Penile augmentation is an important part of penile surgery, the demand for and supply of which has increased because of mens desire for a larger penis. There is some controversy about the rationality of this operation, because the surgical indications and standardization of surgical techniques are not confirmed. Nevertheless, the clinical necessity for penile augmentation is beginning to be accepted as is aesthetic surgery in women. Penile augmentation is performed mainly by using dermal fat grafting for girth enhancement and skin reconstruction or ligament release for lengthening. Several new techniques and modification have been introduced. This review describes recent advances in the field of penile augmentation surgery.
Female ; Humans ; Ligaments ; Male ; Penis ; Skin ; Surgery, Plastic ; Transplants

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Life-Threatening Hypovolemic Shock after Transrectal Ultrasonography Guided Prostate Biopsy: Treatment with Selective Arterial Embolization.

Hong Seok SHIN ; Young Hwan LEE

Korean Journal of Andrology.2011;29(3):254-257. doi:10.5534/kja.2011.29.3.254

Rectal bleeding is a frequent finding in patients after transrectal ultrasonography (TRUS)-guided prostate biopsy but is usually mild and stops spontaneously. We report herein a case of life-threatening hypovolemic shock due to rectal bleeding after TRUS-guided prostate biopsy that was successfully treated by selective arterial embolization. The aim of this report is to share our experiences of the management of massive rectal bleeding after prostate biopsy.
Biopsy ; Embolization, Therapeutic ; Hemorrhage ; Humans ; Hypovolemia ; Prostate ; Shock

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Laparoscopic Excision of a Congenital Seminal Vesicle Cyst and Coexisting Ipsilateral Renal Agenesis.

Yun Seok JUNG ; Jang Ho WEE ; Jin Bong CHOI ; Myung Sun CHOI ; Seol KIM ; Jun Ho SOHN ; Joon Ho LEE ; Sung Hak KANG ; Yong Seok LEE ; Chang Hee HAN

Korean Journal of Andrology.2011;29(3):251-253. doi:10.5534/kja.2011.29.3.251

Seminal vesicle cyst (SVC) with ipsilateral renal agenesis is a rare congenital anomaly. When the patient is symptomatic, surgical treatment may be necessary. The open surgical approach, traditionally considered the definite form of treatment, has been associated with a high rate of morbidity. The laparoscopic approach for the management of SVCs has recently been described. A 18-year-old man presented with a 2-year history of dysuria and perineal pain. The diagnostic evaluation revealed a 45x35x48 mm sized left seminal vesicle cyst. In addition, he had a solitary, right, functioning kidney, with left renal agenesis. Transperitoneal laparoscopic excision of the cyst was performed successfully. The patient was discharged from the hospital on the fourth postoperative day and did not present with any complaints or complications.
Adolescent ; Congenital Abnormalities ; Dysuria ; Humans ; Kidney ; Kidney Diseases ; Seminal Vesicles

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Comparison of Different Alpha-blocker Combinations in Male Hypertensives with Refractory Lower Urinary Tract Symptoms.

Keon Cheol LEE ; Jong Gu KIM ; Sung Yong CHO ; Joon Sung JEON ; In Rae CHO

Korean Journal of Andrology.2011;29(3):242-250. doi:10.5534/kja.2011.29.3.242

PURPOSE: We compared the efficacy and safety profiles of dose increase, traditional combination methods, and combining different alpha blockers in hypertensive males with lower urinary tract symptom (LUTS) refractory to an initial dose of 4 mg doxazosin. MATERIALS AND METHODS: Between 2000 and 2005, 374 male patients with LUTS and hypertension unresponsive to 4 weeks of 4 mg doxazosin were enrolled. The subjects were randomly classified into 3 groups, 8 mg/day of doxazosin (D group), 4 mg of doxazosin plus 0.2 mg/day of tamsulosin (DT group), and 4 mg doxazosin plus 5 mg/day finasteride (DF group). Patients were evaluated based on their International Prostate Symptom Score (IPSS), quality of life (QOL), uroflowmetry and blood pressure (BP) and adverse events (AEs) at the baseline and 3 and 12 months after treatment. RESULTS: The 269 patients (71.9%) were followed for at least 1 year (D group n=84, DT group n=115, and DF group n=70). The clinical parameters before and after initial 4 mg/day doxazosin were not different among the 3 groups. IPSS improvement after 3 months and maximal flow rate (Qmax) improvement after 3 and 12 months were significantly higher in the D and DT groups than the DF group (p<0.05). Sitting systolic and diastolic BP of the D group decreased larger than those of the other 2 groups (p<0.05). At least one of the AEs was reported by 29.0%, 19.3%, and 17.3% of patients in the D, DT, and DF groups, respectively. In particular, vasodilatory AEs of the D group (28.2%) were higher than those of other groups (p<0.05), and sexual function AEs of the DF group (10.9%) were higher than those of other groups (p<0.05). CONCLUSIONS: Doxazosin 4 mg plus tamsulosin 0.2 mg has comparable efficacy but less vasodilatory AEs than doxazosin 8 mg, and has superior efficacy to but comparable vasodilatory AEs to 4 mg doxazosin plus 5 mg finasteride in hypertensive male LUTS patients.
Blood Pressure ; Doxazosin ; Finasteride ; Humans ; Hypertension ; Lower Urinary Tract Symptoms ; Male ; Prostate ; Quality of Life ; Sulfonamides ; Urinary Tract

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Experience of Combination Therapy with Alpha Adrenergic Receptor Antagonist and Anticholinergic Agent in Patients with Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia: 12 Month Follow-up.

Yu Mi SEO ; Hyung Jee KIM

Korean Journal of Andrology.2011;29(3):236-241. doi:10.5534/kja.2011.29.3.236

PURPOSE: Through more than 12 months of follow-up, the efficacy and safety of combination therapy with alpha adrenergic receptor antagonist and anticholinergic agent was investigated retrospectively. MATERIALS AND METHODS: This study retrospectively analyzed the data of 84 patients with lower urinary tract symptoms (LUTS)/benign prostatic hyperplasia (BPH) who were managed with an alpha adrenergic receptor antagonist and anticholinergic agent for at least 12 months between Jan 2007 and Dec 2010. On patients' first visit to our department, we obtained the patients' demographic data and information about the prostate total volume, serum prostate specific antigen (sPSA), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual (PVR) of each patient. After 12 months, changes in the above factors and the side-effects of anticholinergic agents were investigated. RESULTS: The mean age of the patients was 66.1 years and the total observation period after drug administration was an average 20 months; the total sPSA and prostatic volume of patients was 1.8+/-0.8 ng/dl and 37.3+/-9.5 g, respectively. Qmax in uroflowmetry was improved after 12 months of medication (changed from 9.0+/-3.4 to 13.8+/-4.5 ml/sec; p<0.001). PVR was increased from 35+/-22.2 ml to 49.3+/-37 ml (p<0.001), but the change was not clinically significant, and no acute urinary retention occurred. The total IPSS score decreased from 21.4+/-5.1 to 13.3+/-4.6 (p<0.001), the storage score of IPSS decreased from 9.8+/-2.4 to 5.6+/-2 (p<0.001), and the voiding score was decreased from 11.6+/-3.7 to 7.7+/-3.2 (p<0.001). The QoL with IPSS was improved from 4.2+/-0.8 to 2.8+/-0.7 (p<0.001). During the 12 months there were 34 patients (56 cases) of adverse events. However, no serious adverse events were reported. CONCLUSIONS: Combination therapy with alpha adrenergic receptor antagonist and anticholinergic agent was safe and made an improvement in LUTS in patients with BPH and storage symptoms.
Adrenergic Antagonists ; Cholinergic Antagonists ; Follow-Up Studies ; Humans ; Lower Urinary Tract Symptoms ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia ; Receptors, Adrenergic ; Retrospective Studies ; Urinary Retention ; Urinary Tract

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Urodynamic Findings in Patients with Lower Urinary Tract Symptoms and Small Prostate Volumes.

Jin Bong CHOI ; Hyuk Jin CHO ; Sung Hoo HONG ; Ji Youl LEE ; Tae Kon HWANG ; Sae Woong KIM

Korean Journal of Andrology.2011;29(3):231-235. doi:10.5534/kja.2011.29.3.231

PURPOSE: Lower urinary tract symptoms (LUTS) can be caused by abnormal detrusor activity, bladder outlet obstruction (BOO), or numerous other factors. These factors must be evaluated with scrutiny, especially when prostate volume is small and the patient is about to have invasive treatment. We evaluated the urodynamic findings of patients with LUTS and small prostate volumes. MATERIALS AND METHODS: From January 2006 to December 2008, a total of 140 men with LUTS underwent urodynamic study. Of these 140 men, 51 patients with prostate volume < or =30 ml and an International Prostate Symptom Score (IPSS) > or =8 were evaluated. RESULTS: The average age of the patients was 65.5+/-7.4 years (range 46~86), mean prostate volume was 24.5+/-5.1 (range 13.0~30.0), mean IPSS was 15.5+/-7.7 (range 8~34), and quality of life (QOL) score was 3.4+/-1.5 (range 3~6). BOO was the most common finding, affecting 21 (41.2%) patients. The patients with BOO were significantly older than the unobstructed patients (70.1+/-5.9 and 62.4+/-6.7 years, respectively; p<0.001) and had larger prostates (27.5+/-3.1 and 22.4+/-5.1, respectively; p<0.001). Furthermore, they had higher IPSS, but the difference was not significant (p=0.074). Eighteen (35.5%) patients had normal findings, while detrusor underactivity (DU) was found in 15 (29.4%) and detrusor overactivity (DO) in 3 (5.9%) patients. There was no significant difference in age, prostate volume, or IPSS between men with and without DU. CONCLUSIONS: The most common finding of LUTS with small prostate volume is BOO, even though it accounts for less than half of the patients. However, patients with normal finding or DU on urodynamic study account for majority of cases, emphasizing the value of urodynamic study before invasive treatments.
Humans ; Lower Urinary Tract Symptoms ; Male ; Prostate ; Quality of Life ; Urinary Bladder Neck Obstruction ; Urinary Tract ; Urodynamics

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Efficacy and Safety of Biodegradable Microparticles in the Regeneration of Injured Rabbit Corpus Cavernosum: Primary Report.

Young Joon KIM ; Sung Joo LEE ; Hana YOON ; Wo Sik CHUNG ; Jeoung Yong KIM ; Mi Jung SHIN ; Won Hwa KANG ; Gun Poong KIM

Korean Journal of Andrology.2011;29(3):223-230. doi:10.5534/kja.2011.29.3.223

PURPOSE: This study analyzed the effectiveness of poly (lactic-co-glycolic acid) (PLGA) as a tissue recovery agent and determines the in vivo safety and efficacy of microparticle-based PLGA. MATERIALS AND METHODS: Fifteen 3-month-old male white rabbits were used. Allogenic adipose tissue derived stromal vascular fraction (SVF) was cultured and labeled with the fluorescent dye PKH26. The rabbits were divided into 4 groups: the SVF group, the PLGA group, the normal control group, and the disease control group. The right corpus cavernosal tissue of the rabbits was surgically removed in the selected portion, except in the normal control group. The defect space of each rabbit was replaced with 10(6) SVF cells in the SVF group and 0.1 g of biodegradable polymer solution in the PLGA group. Microscopic confirmation and analysis of tissue regeneration were performed after 8 weeks. Using confocal microscopy, the nuclei of the smooth muscle cells and SVF migration were examined. The composition of smooth muscle and fibrosis of the injured corpus cavernosum were compared and analyzed by Masson's trichrome stain. RESULTS: There were no signs of migration or rejection of the injected materials in any of the experimental groups. The mean amount of smooth muscle in the normal control group was 15.25+/-1.34 microm2 (right) and 13.90+/-0.703 microm2 (left); in the disease control group it was 11.10+/-0.87 microm2 (right) and 12.80+/-1.01 microm2 (left); in the SVF group it was 13.82+/-4.10 microm2 (right) and 13.96+/-3.94 microm2 (left); and in the PLGA group it was 12.89+/-1.39 microm2 (right) and 13.24+/-1.43 microm2 (left). Only the disease control group showed significant decreased smooth muscle in the left cavernosum (p<0.05). No significant difference was found between the left and right side of each rabbit's cavernosal smooth muscle in the SVF or PLGA group (p>0.05). Furthermore, no difference was found between any two groups (normal control versus SVF (p=0.705), normal control versus PLGA (p=0.88), SVF versus PLGA (p=0.23). CONCLUSIONS: PLGA microparticles had the same tissue restoring effect when compared with SVF and no adverse effect or migration of particles was found through the injection of PLGA or SVF. PLGA is safe and has the proper tissue recovery effect, saving additional tissue harvesting.
Adipose Tissue ; Fibrosis ; Humans ; Infant ; Lactic Acid ; Male ; Microscopy, Confocal ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Organic Chemicals ; Penis ; Polyglycolic Acid ; Polymers ; Rabbits ; Regeneration ; Rejection (Psychology) ; Tissue and Organ Harvesting

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The Prevalence of Urologic Disease in Young Men Based on a Review of Korean Military Conscription Examination Results.

Phil Hyun SONG ; Sang Taek KWON ; Hyun Tae KIM ; Ki Hak MOON

Korean Journal of Andrology.2011;29(3):218-222. doi:10.5534/kja.2011.29.3.218

PURPOSE: We aimed to elucidate the prevalence of urologic disease in young men by reviewing the results of military conscription examinations in the Republic of Korea. MATERIALS AND METHODS: The results of 615,382 conscription examinations undertaken by the military manpower administration offices in Seoul, Korea from January, 2006 to December, 2007 were reviewed. The physical examinations were conducted based on the Ministry of National Defense implementing ordinance No. 590. RESULTS: Twenty eight hundred fifty-three (0.46%) examinees were found to have urologic diseases, among which urinary tract infection was the most frequent (0.16%) single disease entity, followed by testicular absence (0.12%), single kidney (0.05%), varicocele (0.04%), urolithiais (0.03%), and cryptorchidism (0.01%). Among the 16 examinees with penile amputation, 15 had been surgically amputated due to gender identity problems. CONCLUSIONS: With modifications of the Korean conscription examination and long-term evaluation, its results could help elucidate the prevalence of urologic diseases in young males in Korea.
Amputation ; Cryptorchidism ; Gender Identity ; Humans ; Kidney ; Korea ; Male ; Military Personnel ; Physical Examination ; Prevalence ; Urinary Tract Infections ; Urologic Diseases ; Varicocele ; Young Adult

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