PURPOSE: Painful bladder syndrome/interstitial cystitis (PBS/IC) is a disabling disease of the urinary bladder, and its etiology and treatment are not yet established. Current medications used in the treatment of PBS/IC have shown limited efficacy. This prospective study investigated the efficacy of intravesical resiniferatoxin (RTX) in PBS/IC refractory to medical treatment. METHODS: Patients with proven PBS/IC refractory to traditional medical treatment were enrolled. By randomized trial, a total of 18 consecutive patients were divided into two groups: treatment with hydrodistention and intravesical RTX (group 1) or treatment with hydrodistension only (group 2). We assessed bladder pain by use of a visual analogue pain scale, the maximal urine flow rate, post-void residual urine volume, and a voiding diary before and 3 months after treatment. RESULTS: The median age of the 18 patients was 55.8+/-6.9 years, and the median duration of symptoms before diagnosis was 3.6+/-1.6 years. Frequency, functional bladder capacity, and score on a 5-point pain scale were significantly improved at 3-month after treatment in both groups. Intravesical RTX instillation plus hydrodistention, compared with hydrodistention only, did not have a significant effect on the voiding symptoms or uroflowmetry of the patients but significantly improved scores on the pain scale. CONCLUSIONS: Intravesical RTX instillation plus hydrodistention was effective in relieving pain but was not effective in improving lower urinary tract symptoms. Further larger studies are needed to clarify the efficacy of combination treatment of intravesical RTX instillation and hydrodistention.
Administration, Intravesical ; Cystitis ; Cystitis, Interstitial ; Diterpenes ; Humans ; Lower Urinary Tract Symptoms ; Pain Measurement ; Pain, Intractable ; Pilot Projects ; Prospective Studies ; Urinary Bladder

PURPOSE: Although the measles-mumps-rubella vaccination covers most children against mumps in Korea, the development of mumps has been reported. However, the clinical manifestations of mumps orchitis in postpubertal vaccinated patients have never been investigated. Herein we report the clinical features of mumps orchitis in postpubertal vaccinated patients. MATERIALS AND METHODS: This study included a total of 62 postpubertal males who developed acute mumps orchitis from 2005 to 2010. The clinical manifestations such as the incubation period, febrile duration, and the mean duration of orchitis were retrospectively investigated. The laboratory and sonographic findings were also reviewed and compared with the features of previously reported cases of unvaccinated postpubertal mumps orchitis. RESULTS: The mean age of the 62 patients was 17.56 years (range, 15 to 29 years). All patients were serologically confirmed with acute mumps infection (positive immunoglobulin [Ig] M and negative or positive IgG). The mean incubation period was 5.39 days (range, 0 to 23 days), with a febrile duration of 1.8 days (range, 0.5 to 3 days), and a mean duration of orchitis of 4.96 days (range, 0 to 17 days). Sonography revealed unilateral orchitis in 58 patients (93.6%) and bilateral orchitis in only 6 (6.4%). CONCLUSIONS: In our study, mumps orchitis in postpubertal vaccinated patients showed a relatively shorter febrile duration. In addition, less scrotal swelling and a lower incidence of bilaterality were found upon physical examination and ultrasonography. In the future, additional long-term follow-up is needed to determine the features of mumps orchitis in postpubertal vaccinated males, and an additional booster vaccination should be considered.
Child ; Follow-Up Studies ; Humans ; Immunoglobulins ; Incidence ; Korea ; Male ; Mumps ; Orchitis ; Physical Examination ; Retrospective Studies ; Vaccination ; Young Adult

PURPOSE: This study was conducted to investigate the relationship between serum total testosterone levels and scores on the Aging Male's Symptom (AMS) scale and the International Index of Erectile Function (IIEF) in men with erectile dysfunction with testosterone deficiency syndrome (TDS). MATERIALS AND METHODS: From January 2005 to July 2008, 134 patients who complained of sexual dysfunction such as erectile dysfunction or decreased libido as the main symptoms of TDS with serum total testosterone levels less than 3.5 ng/ml were evaluated by independent t-test and linear regression analysis, respectively. Patients with treated hypogonadism within 6 months, with a history of taking a PDE5 inhibitor or an antidepressant for a depressive disorder, or who had metabolic syndrome were excluded from this study. RESULTS: The AMS scale and its 3 subdomain scores were not significantly correlated with the total testosterone level. By contrast, the total IIEF score and the score of each IIEF domain except sexual desire showed a weakly significantly positive correlation with serum total testosterone. CONCLUSIONS: In TDS patients with erectile dysfunction, there was a low relationship between serum total testosterone levels and the AMS scale and a weakly positive correlation between total testosterone levels and all IIEF domains except sexual desire. There was a low relationship between the AMS scale, the sexual desire domain score of the IIEF, and total testosterone. We should understand these limitations when evaluating patients with erectile dysfunction with TDS. New scales should be developed for the evaluation of erectile dysfunction in these patients.
Aging ; Depressive Disorder ; Erectile Dysfunction ; Humans ; Hypogonadism ; Libido ; Linear Models ; Male ; Sorbitol ; Testosterone ; Tyramine ; Weights and Measures

PURPOSE: This study was designed to evaluate the role of PDE5 inhibitors as combination therapy with conventional treatment of Peyronie's disease (PD). MATERIALS AND METHODS: From July 2007 to October 2010, 35 Patients were divided into two groups. Group I (N=14) received PDE5 inhibitors in addition to conventional treatment with tamoxifen and acetyl L-carnitine, while group II (N=21) received only conventional treatment. The follow-up duration was at least 12 weeks after the active therapy of PD. Outcomes were assessed by pain relief, successful attempts for sexual intercourse, resolution of the plaque and any occurring complications. RESULTS: In the efficacy of overall treatment of 35 patients, 94.3% patients experienced successful sexual intercourse, while 5.7% experienced pain on erection, and 25.7% showed a decrease in plaque size. The analysis of parameters before treatment showed no significant difference between groups in terms of successful attempt at sexual intercourse (p=0.583) and pain on erection (p=0.445). Furthermore, there was no difference between groups after treatment in terms of successful attempts at sexual intercourse (p=0.766), pain on erection (p=0.766) and change in plaque size (p=0.445). However, successful intercourse and pain relief after treatment showed significant change irrespective of groups (p<0.05). While the addition of a PDE5 inhibitor did not show any significant improvement in clinical outcome measures, the satisfaction of patient was higher in patients who received combination treatment (p=0.042). CONCLUSIONS: Although the effect of PDE5 inhibitor for pain relief, successful intercourse and resolution of plaque size was not significant, patients who received PDE5 inhibitors had a more satisfaction of treatment of PD. Further prospective studies on the effect of PDE5 inhibitor in PD will be needed.
Carnitine ; Coitus ; Erectile Dysfunction ; Follow-Up Studies ; Humans ; Male ; Outcome Assessment (Health Care) ; Penile Induration ; Phosphodiesterase 5 Inhibitors ; Tamoxifen

PURPOSE: This study was conducted to investigate the effect of testosterone replacement treatment (TRT) in testosterone deficiency syndrome (TDS) patients with metabolic syndrome. MATERIALS AND METHODS: We reviewed the data of 200 men who were diagnosed with TDS and were undergoing TRT between August 2006 and August 2009. The 200 patients were divided into two groups (group 1: 71 patients with metabolic syndrome, group 2: 129 patients without metabolic syndrome) depending on metabolic syndrome, which was diagnosed according to the NCEP III criteria for Asians. Age, BMI (body mass index), waist circumference, serologic tests, AMS (the Aging Males' Symptoms scale), and IIEF (International Index of Erectile Function) were measured. RESULTS: In group 1, waist circumference and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the somatovegetative scale score of the AMS, the total AMS score, the erectile function score of the IIEF, the overall satisfaction score of the IIEF, and the total IIEF score were significantly improved after TRT. On the other hand, in group 2, waist circumference, BMI, total cholesterol, LDL, and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the 2 subscale scores of the AMS (psychologic and somatovegetative), the total AMS score, all subscale scores of the IIEF, and the total IIEF score were significantly improved after TRT. CONCLUSIONS: Overall, the patients who had TDS with metabolic syndrome showed less improvement in AMS, IIEF, and serum variables. Therefore, the correction of metabolic syndrome, such as diabetes, obesity, and hypertension, should be considered during TRT.
Aging ; Asian Continental Ancestry Group ; Cholesterol, LDL ; Fasting ; Glucose ; Hand ; Hemoglobins ; Hormone Replacement Therapy ; Humans ; Hypertension ; Male ; Metabolic Syndrome X ; Obesity ; Serologic Tests ; Sorbitol ; Testosterone ; Tyramine ; Waist Circumference

PURPOSE: This study was conducted to investigate the effect of testosterone replacement treatment (TRT) in testosterone deficiency syndrome (TDS) patients with metabolic syndrome. MATERIALS AND METHODS: We reviewed the data of 200 men who were diagnosed with TDS and were undergoing TRT between August 2006 and August 2009. The 200 patients were divided into two groups (group 1: 71 patients with metabolic syndrome, group 2: 129 patients without metabolic syndrome) depending on metabolic syndrome, which was diagnosed according to the NCEP III criteria for Asians. Age, BMI (body mass index), waist circumference, serologic tests, AMS (the Aging Males' Symptoms scale), and IIEF (International Index of Erectile Function) were measured. RESULTS: In group 1, waist circumference and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the somatovegetative scale score of the AMS, the total AMS score, the erectile function score of the IIEF, the overall satisfaction score of the IIEF, and the total IIEF score were significantly improved after TRT. On the other hand, in group 2, waist circumference, BMI, total cholesterol, LDL, and fasting glucose were significantly decreased; hemoglobin and total testosterone were increased; and the 2 subscale scores of the AMS (psychologic and somatovegetative), the total AMS score, all subscale scores of the IIEF, and the total IIEF score were significantly improved after TRT. CONCLUSIONS: Overall, the patients who had TDS with metabolic syndrome showed less improvement in AMS, IIEF, and serum variables. Therefore, the correction of metabolic syndrome, such as diabetes, obesity, and hypertension, should be considered during TRT.
Aging ; Asian Continental Ancestry Group ; Cholesterol, LDL ; Fasting ; Glucose ; Hand ; Hemoglobins ; Hormone Replacement Therapy ; Humans ; Hypertension ; Male ; Metabolic Syndrome X ; Obesity ; Serologic Tests ; Sorbitol ; Testosterone ; Tyramine ; Waist Circumference

PURPOSE: To evaluate the effect and improvement of potassium aminobenzoate (500 mg Peyron capsule) in oral therapy for Peyronie's disease. MATERIALS AND METHODS: From February 2011 to September 2011, 31 patients with Peyronie's disease received potassium aminobezoate (500 mg Peyron capsules) and were divided into two groups. Group 1 (N=10) received potassium aminobezoate (500 mg Peyron capsule) 3 g four times daily without previous treatment of Peyronie's disease, while group 2 (N=21) received the same drug with previous treatment of Peyronie's disease (10 mg Tamoxifen +300 mg L-carnitine two times daily). Outcomes were assessed by subjective symptom change, pain relief, resolutions of the plaque, and curvature. RESULTS: After 3 months, there were no significant improvements in clinical outcomes of either group and among all the patients, 23 stopped taking potassium aminobezoate (23/31, 74%). The reasons for ceasing the therapy were gastrointestinal trouble (8/23, 35%), too many doses to take (7/23, 30%), ineffectiveness (6/23, 26%), and high price (2/23, 9%). CONCLUSIONS: Athough the etiology of Peyronie's disease has not been elucidated, potassium aminobenzoate in therapy of Peyronie's disease has been used. The use of this medication has the limitations of gastrointestinal trouble, ineffectiveness, too many doses, and high price. Further evaluations of the effect and appropriate dosing of potassium aminobenzoate are needed.
4-Aminobenzoic Acid ; Carnitine ; Humans ; Male ; Penile Induration ; Potassium ; Tamoxifen

BACKGROUND: Epidural analgesia is the most effective way of providing pain relief during labor.However, its effect on the second stage of labor is controversial.This study examined the effect of epidural analgesia combined with caudal analgesia on the second stage of labor. METHODS: Forty three multiparous women were divided into three groups, non-epidural group, epidural group and epidural with caudal group.Epidural analgesia was maintained with patient-controlled epidural analgesia (0.09375% ropivacaine with 0.0002% fentanyl) in both the epidural and epidural with caudal groups.The epidural with caudal group was injected with 0.09375% ropivacaine into the caudal epidural space after inserting the lumbar epidural catheter.The assessments made throughout labor included the visual analogue score (VAS), patient's satisfaction, motor block and duration of the second stage. RESULTS: There were no significant differences in the patient's satisfaction, VAS and motor block between the epidural group and epidural with caudal group.There were no significant differences in the duration of the second stage between the non-epidural, epidural and epidural with caudal groups. No cesarean or instrumental deliveries were performed. CONCLUSIONS: Epidural with caudal analgesia offers no additional benefit during the second stage of labor.However, it carries no added risk on the maternal outcome.
Amides ; Analgesia ; Analgesia, Epidural ; Epidural Space ; Female ; Humans ; Labor Pain ; Pregnancy

BACKGROUND: The effect of epidural analgesia for labor on obstetric outcome is controversial. The purpose of this study is evaluating the influence of epidural analgesia on cesarean section in nulliparous women. METHODS: We retrospectively investigated 979 nulliparous women ASA graded I - II. EPI (n = 230) was received epidural analgesia with 0.2% ropivacaine and 75microgram fentanyl. N-EPI (n = 749) was received no epidural analgesia but nalbuphine 10 mg intramuscularly. We compared the rate and causes of cesarean section, instrumental delivery rate and fetal outcomes between EPI and N-EPI. RESULTS: Cesarean section rate was not different between the EPI (18%) and N-EPI (23%). Causes of cesarean section were progress failure (83% in EPI and 80% in N-EPI) and fetal distress (17% in EPI and 20% in N-EPI) and there were no differences between two groups. Instrumental delivery rate was higher in EPI (8%) than N-EPI (5%). Fetal outcome was not different between two groups. CONCLUSIONS: Epidural analgesia did not increase cesarean section rate and did not influence on causes of cesarean section. But epidural analgesia increased the vacuum delivery rate.
Amides ; Analgesia, Epidural ; Cesarean Section ; Female ; Fentanyl ; Fetal Distress ; Humans ; Nalbuphine ; Pregnancy ; Retrospective Studies ; Vacuum

Toxic epidermal necrolysis (TEN) is rare but serious cutaneous reaction with significant mortality and long-term morbidity. Various etiologies, particularly numerous medications and infectious agents have been implicated. It is characterized as inflammatory bullous lesions of the skin and mucous membrane and can develop serious complications such as pneumonia, pneumothorax, sepsis and renal failure. In general, patients with TEN are managed as severe second-degree burn patients with preventing excessive fluid deficit and infections. In this case, we aimed to present anesthetic management of a 26-year-old pregnant woman with TEN who received general anesthesia during emergent cesarean section.
Adult ; Anesthesia, General ; Blister ; Burns ; Cesarean Section ; Epidermal Necrolysis, Toxic ; Female ; Humans ; Mucous Membrane ; Pneumonia ; Pneumothorax ; Pregnancy ; Pregnant Women ; Renal Insufficiency ; Sepsis ; Skin