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Ho Geun KWAK ; Seung Ho HAN ; Suk Won KIM ; Tag Keun YOO ; Ro Jung PARK ; Jin KIM

Korean Journal of Urology.1995;36(2):225-228.

Genitourinary gangrene is an uncommon, potentially lethal disorder characterized by the abrupt onset of a rapidly progressive necrotizing soft tissue infection caused by the synergistic action of various organisms that spread along fascial planes, causing subfascial soft tissue necrosis and destruction. Many factors, debilitating condition such as carcinoma, diabetes and alcoholism, contribute to the development and perpetuate the course of Fournier's gangrene. In our two cases , predisposing causes were as follow ; chronic liver disease, diabetes mellitus, chronic alcoholism, perianal abscess. The patients were hemodynamically unstable and extensive necrosis was noted. After aggressive debridement of the wound and triple antibiotic therapy, general condition became improved and then we performed split thickness skin grafts and the results of reconstructive surgery were satisfactory.
Abscess ; Alcoholism ; Debridement ; Diabetes Mellitus ; Fournier Gangrene* ; Gangrene ; Humans ; Liver Diseases ; Necrosis ; Skin ; Soft Tissue Infections ; Transplants ; Wounds and Injuries

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A Case of Retroperitoneal Neurilemmoma Arising from Adjacent to Adrenal Gland.

Sung Gi MIN ; Jae Il JUNG ; Heon Seong LEE ; Se Jong SHIN

Korean Journal of Urology.1995;36(2):222-224.

Neurilemmoma is well-encapsulated tumor of Schwann cell origin. The majority arise in peripheral nerve or cranial nerve, and rare in retroperitoneum. Although it is incidentally detected by the advances in diagnostic procedures, especially in ultrasound and computed tomography, it is confirmed by pathologic findings. The treatment is surgical excision. We report a case of retroperitoneal neurilemmoma arising from adjacent to adrenal gland, in 45 years old female.
Adrenal Glands* ; Cranial Nerves ; Female ; Humans ; Middle Aged ; Neurilemmoma* ; Peripheral Nerves ; Ultrasonography

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A Case of Congenital Megalourethra.

Boquan YAN ; Jin Ik PARK ; Ki Hyun YOON ; Gyung Tak SUNG ; Jin Han YOON

Korean Journal of Urology.1995;36(2):218-221.

Megalourethra is a rare congenital abnormaly characterized by severe dilatation of urethra, the disorder at first reported by Nesbitt in 1955. The scaphoid type is due to poor development of the corpus spongiosum, whereas in the more severe fusiform variety the corpora cavernosa also are affected. We present a case of congenital scaphoid megalourethra associated with acute renal failure, sepsis and grade IV bilateral vesicoureteral reflux. Initial management of this patient was vesicocutaneostomy and urethrocutaneostomy followed later by urethral reconstruction.
Acute Kidney Injury ; Dilatation ; Humans ; Sepsis ; Urethra ; Vesico-Ureteral Reflux

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The 16 Cases of Impotence Due to Pituitary Tumor.

Bong Hwan KIM ; Do Hwan SEONG ; Hyung Ki CHOI

Korean Journal of Urology.1995;36(2):212-217.

Elevated levels of serum prolactin in patients with pituitary tumors have been associated with hypogonadism, frequently manifested in men as impotence and/or loss of libido. Among 2,896 consecutive impotent patients investigated at Severance Hospital 208( 7.2%) patients had serum levels of prolactin greater than 30 ng/ml. Of the 208 patients 16(7.7%) were diagnosed as pituitary tumor. The average age of 16 patients was 37.8 years and mean duration of erectile dysfunction was 4.2 years. The mean serum prolactin level was 238.14 ng/ ml. 13 of these patients were treated with operation, two with bromocriptine, and one was lost. The mean duration of follow up was 2.4 years(1 month-4.2 years). Of the eleven of thirteen who were able to follow up, six were combined with bromocriptine therapy and three were combined with bromocriptine and radiation therapy. Of the two who were managed with only bromocriptine, one was improved after bromocriptine for four months and the other was received penile prosthesis due to no improvement of symptoms. It is emphasized that pituitary tumor should be considered in the investigation of impotence of endocrine causes when markedhyperprolactinemia (specially greater than 100 ng/ml) is noted.
Bromocriptine ; Erectile Dysfunction* ; Follow-Up Studies ; Humans ; Hyperprolactinemia ; Hypogonadism ; Libido ; Male ; Penile Prosthesis ; Pituitary Neoplasms* ; Prolactin

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Clinical Experience with Electroejaculation in Anejaculatory Spinal Cord Injured Men Who Failed in Chemoejaculation Using Physostigmine.

Ho Cheol CHOI ; Won Hee PARK ; Hong Bang SHIM

Korean Journal of Urology.1995;36(2):206-211.

About 85-97% of patients get to lose an ejaculatory function with a little difference according to the level of spinal cord injury. Fifty eight trials of electroejaculation stimulation were performed in total 17 patients that failed in chemoejaculation with physostigmine. Mean age was 36.9 years. Of the 17 spinal cord injured patients, 1 had cervical, 13 thoracic 3 lumbar paraplegia; 7 had complete and 10 had incomplete lesions. Semens could be obtained in 14 patients ( 82.4%) among total 17 patients and in 51 of total 58 trials( 87.9%). Average total sperm counts and motile sperm numbers were 35.98 x 106 and 6.09 x 106 respectively in the obtained semen. However, motility was very poor. We performed more than 4 trials in 6 patients, but there results were not predictable. Two pregnancies were achieved in their spouse after an artificial insemination. Side effects were trivial. and there were lower abdominal discomforts or pains in 7 patients among incomplete paraplegics. In conclusion we could expect high successful rates of ejaculation in anejaculatory spinal cord injured patients by electroejaculation stimulation in case of the failure in chemoejaculation. However, we suggest that in vitro fertilization with advanced recent technology should be tried with adequate preparation after an experimental electroejaculation, because a quality of sperm motility was very poor and sperm motility was not improved after several trials.
Ejaculation ; Fertilization in Vitro ; Humans ; Insemination, Artificial ; Male ; Paraplegia ; Physostigmine* ; Pregnancy ; Semen ; Sperm Count ; Sperm Motility ; Spinal Cord Injuries ; Spinal Cord* ; Spouses

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Experience of Transvaginal Bladder Neck Suspension(Raz Procedure) for Female Genuine Stress Urinary Incontinence.

Il Bong KIM ; Tchun Yong LEE

Korean Journal of Urology.1995;36(2):201-205.

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

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The Factors on Success in Push-up of Ureteral Stone: A Review of 103 Cases.

Cheon Jin PARK ; Kwan Jin KIM

Korean Journal of Urology.1995;36(2):195-200.

The ancillary practice for the management of upper ureteral stones is to push the stone up the renal pelvis before extracorporeal shock wave lithotripsy(ESWL). We evaluated 103 patients with mid and upper ureteral stones for identifying the significant factors of success in push up procedure. The clinical factors of success of push up procedure may be regarded to location (upper, mid), size( 12mm>=,12mm<), duration of impaction( 1Mo>=, 1Mo<), duration of symptoms (1Mo>=, 1Mo<), smoothness of the surface of the stone (Smooth, Rough), degree of obstruction (partial, complete), pyuria or not (WBC> 5, WBC<=5 in microscopic urinalysis) Our results showed that the success rate of push up were 92.7%, 96.3%, 92.9%, 93.3%, 96.6 %, 94.4%, and 93.5% in the case of upper ureter stone, less than 12mm in diameter in stone size, less than 1 month in duration of initial symptoms and impaction, smooth stone surface, partial obstruction, presence of pyuria, respectively compared to 28.6%, 60.7%, 68.4%, 53.3%, 77.8 %, 75%. and 84.2% in the case of mid ureter stone. more than 12mm in diameter, more than 1 month in duration of initial symptoms and impaction, rough stone surface, complete obstruction, absence of pyuria respectively. These are clinically significant factors of affecting success in push up procedure (P<0.05 ) except appearance of pyuria or not (P>0.05). Complications of push up were infrequent, with hematuria (30.7%), flank pain (29.7% ), and ureteral perforation (2.2% ), all of which were managed conservatively. From these data we conclude that upper ureter stones with successful clinical factors should be tried push-up into the renal pelvis before ESWL to improve the therapeutic results.
Flank Pain ; Hematuria ; Humans ; Kidney Pelvis ; Pyuria ; Shock ; Ureter*

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Hypospadias Repair: Current Experience Using Operating Microscope.

Jin Haeng LEE ; Kwang Myung KIM

Korean Journal of Urology.1995;36(2):189-194.

Currently improving results of hypospadias repair depend on careful application of surgical principles. Optical magnification. microsurgical instruments, fine suture materials, less reactive tubes and bio-occlusive dressings have been used to decrease postoperative complications requiring secondary surgery. We evaluated the effectiveness of microscopic surgery which was performed in 28 children with hypospadias from December, 1991 to June, 1994. Nine patients underwent hypospadias repair before 2 years-old whereas 19 patients after 2 years-old, whose success rate was 78% and 63% respectively. One-stage repair was performed in 19 patients and two-stage repairs in 9 patients, whose success rate was 69% and 67% each other. In chronological review, success rate was 50%, 29%, 77% and 100% in 1991, 1992, 1993 and 1994 respectively, which showed a rapidly increasing success rate. According to dressings and catheters, excellent results were obtained when we used Duodenum dressings and silastic Foley catheters, of which each complication rate was 7% and 0% respectively. In 9 patients(32 %), we experienced 20 surgical complications which included urethrocutaneous fistula (9), meatal stenosis(4) stricture(2) and others(5). The success rate of fistula repair was 61% in initial, 40% in secondary and 33% in tertiary repair. From these data, we think that the use of operating microscope with microsurgical principles and proper postoperative managements can improve success rate of hypospadias repair.
Bandages ; Catheters ; Child ; Child, Preschool ; Duodenum ; Female ; Fistula ; Humans ; Hypospadias* ; Male ; Postoperative Complications ; Sutures

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Acute Bacterial Renal Infection: Role of Computed Tomography.

Jong Myung HONG ; Tae Kyu KIM

Korean Journal of Urology.1995;36(2):181-188.

Renal bacterial infection spans a continuum of severity from uncomplicated acute pyelonephritis through progressively worsening stages of interstitial inflammation to abscess formation. This study was done to evaluate CT findings in acute bacterial renal infection and correlation of clinical symptoms and renal scarring with CT findings. We studied 58 cases of acute pyelonephritis who were diagnosed clinically. Most of them had prolonged fever( >72 hours) and some of them suspected severe renal infections. We classified the patients regarding to CT findings. 58 cases were grouped into, 1) Group I (7 cases), normal or renal enlargement only; 2) Group II(31 cases), wedge-shaped lesions ( focal or diffuse) , 3) Group III(6 cases), focal mass-like lesions; 4) Group W(9 cases) , diffuse ( multifocal) mass-like lesions; 5) Group V (5 cases) , renal abscesses. There was the good correlation between the clinical parameters ( duration of fever, duration of hospitalization) and CT findings (P < 0.05). However, another clinical parameters(maximum temperature, duration of fever) were lacked correlation with CT findings(P >0.05). To demonstrate the presence of renal scar, we recommended DMSA scan in 15 cases of ABN (Group III and Group IV). 8 cases were performed DMSA scan and renal scar formation was found in 3 cases( 2 cases in Group III and another 1 case in Group IV). Because the size of abscess was small( <3cm), the patients of renal abscess(5 cases) were treated with antibiotics only and their clinical symptoms were improved. Second CT scanning was performed in 3 cases and their CT findings showed resolution of renal abscess. We concluded that computed tomography is selectively indicated in acute renal bacterial infection for the detection of acute renal inflammatory disease and for defining the extent of disease for planning of treatment.
Abscess ; Anti-Bacterial Agents ; Bacterial Infections ; Cicatrix ; Fever ; Humans ; Inflammation ; Pyelonephritis ; Succimer ; Tomography, X-Ray Computed

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The Clinical Effects of Transurethral Microwave Thermotherapy in Case of Benign Prostatic Hyperplasia with Urinary Retention.

Chun Gu LEE ; Ho Sung KIM ; Joung Sik RIM

Korean Journal of Urology.1995;36(2):176-180.

From February, 1993 to April, 1994, 32 benign prostatic hyperplasia( BPH) patients with urinary retention were treated with transurethral microwave thermotherapy(TUMT). The mean patient age was 74 years(range 59 to 86 years) and the mean duration of retention was 3.7 months(range 1 day to 36 months). The mean follow-up period was 13 months (range 4 to 18 months). In cystoscopic findings, trilobar hyperplasia was diagnosed in 12 patients(37% ), while bilobar and median bar or median lobe enlargement were diagnosed in 11 patients(35% ) and 9 patients( 28% ). Mean prostatic weight was 29gm(range 11.3 to 89.5gm) Of the patients 14(44% ) patients were in the catheter-free state( = Responder) after TUMT and 18(56%) patients had to be in the catheter-indwelling state( = Nonresponder). The 14 responders showed several important parameters: mean peak flow rate was 8.9ml per second ( range 4.5 to 17.5ml per second), mean post-voiding residual urine was 137.5ml( range 80 to 220ml) and a mean symptom score was 10.7 on the modified Boyarski symptom score scale. Also, there was no significant difference in the incidence of catheter-free state in patients with bilobar and trilobar hyperplasia compared to those with median bar or median lobe hyperplasia. Conclusively, one session of TUMT at 50 degrees C for 90 minutes seemed to have minor therapeutic effect on BPH patients with urinary retention. Therefore, the clinical results in treating the BPH patients with urinary retention suggest that the more clinical experiences will be needed about the proper patient selection, the safety introduction of higher temperature, the prolonged treatment time and the numbers of treatment session.
Follow-Up Studies ; Humans ; Hyperplasia ; Incidence ; Microwaves ; Patient Selection ; Prostatic Hyperplasia* ; Transurethral Resection of Prostate* ; Urinary Retention*

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