PURPOSE: We compared bladder and urethral functions following radical prostatectomy (RP) between men with and without urinary incontinence (UI), using a large-scale database from SNU-experts-of-urodynamics-leading (SEOUL) Study Group. MATERIALS AND METHODS: Since July 2004, we have prospectively collected data on urodynamics from 303 patients with lower urinary tract symptoms (LUTS) following RP at three affiliated hospitals of SEOUL Study Group. After excluding 35 patients with neurogenic abnormality, pelvic irradiation after surgery, or a history of surgery on the lower urinary tract, 268 men were evaluated. We compared the urodynamic findings between men who had LUTS with UI (postprostatectomy incontinence [PPI] group) and those who had LUTS without UI (non-PPI group). RESULTS: The mean age at an urodynamic study was 68.2 years. Overall, a reduced bladder compliance (< or =20 mL/cmH2O) was shown in 27.2% of patients; and 31.3% patients had idiopathic detrusor overactivity. The patients in the PPI group were older (p=0.001) at an urodynamic study and had a lower maximum urethral closure pressure (MUCP) (p<0.001), as compared with those in the non-PPI group. Bladder capacity and detrusor pressure during voiding were also significantly lower in the PPI group. In the logistic regression, only MUCP and maximum cystometric capacity were identified as the related factor with the presence of PPI. CONCLUSIONS: In our study, significant number of patients with LUTS following RP showed a reduced bladder compliance and detrusor overactivity. PPI is associated with both impairment of the urethral closuring mechanism and bladder storage dysfunction.
Aged ; Humans ; Male ; Middle Aged ; Prospective Studies ; Prostatectomy/*adverse effects/methods ; Urethra/*physiopathology ; Urinary Bladder/*physiopathology ; Urinary Bladder, Overactive/complications ; Urinary Incontinence/*etiology/physiopathology ; Urodynamics/physiology

OBJECTIVETo analyze the parameters of urodynamic tests for patients with type-III B prostatitis and evaluate the significance of the results of urodynamic tests in the choice of therapies for this disease.

METHODSUrodynamic tests were performed for 87 type-III B prostatitis patients aged 22-45 (30.7 ± 8.5) years, who had moderate or severe lower urinary tract symptoms (LUTS) and failed to respond to routine therapy. Different treatments were administered according to the results of urodynamic tests followed by observation of the therapeutic effects.

RESULTSUrodynamic abnormalities were found in 70 of the 87 patients, bladder outlet obstruction in 28 (32.2%), detrusor overactivity in 25 (28.7%), bladder hyperesthesia in 18 (20.7%), low compliance in 10 (11.5%), detrusor-external urethral sphincter dyssynergia in 1 (1.1%), and impaired detrusor contractile function in 1 (1.1%). Treatments achieved obvious effectiveness in 26 cases (29.9%), effectiveness in 51 (58.6%), and no effectiveness in 10 (11.5%).

CONCLUSIONUrodynamic tests contribute significantly to the choice of therapies for type-III B prostatitis patients with moderate or severe LUTS.

Adult ; Humans ; Lower Urinary Tract Symptoms ; physiopathology ; therapy ; Male ; Middle Aged ; Prostatitis ; physiopathology ; therapy ; Urethra ; physiopathology ; Urinary Bladder Neck Obstruction ; physiopathology ; Urinary Bladder, Overactive ; physiopathology ; Urodynamics

A 32-year old single man presented with azoospermia and low semen volume which was noted one and half a year ago. Transrectal ultrasonography and seminal vesiculography were performed to evaluate ejaculatory duct obstruction, and transurethral resection of the ejaculatory duct was performed using a hybrid technique of holmium:yttriumaluminium garnet laser with monopolar transurethral resection to overcome the narrow prostatic urethra. To our knowledge, this is the first report on the successful outcome of a hybrid technique applied for transurethral resection of the ejaculatory duct.
Adult ; Azoospermia/diagnosis/physiopathology/surgery ; Ejaculatory Ducts/abnormalities/*surgery/ultrasonography ; Holmium ; Humans ; Infertility, Male/physiopathology/*surgery ; Laser Therapy/*methods ; Male ; Treatment Outcome ; Urethra ; Yttrium

OBJECTIVETo assess the functional result of a "Two in One" urethroplasty which combined oral mucosa graft and local flap.

METHODS17 patients with hypospadias underwent a "Two in One" urethroplasty, which combined buccal mucosa and local flap for urethral reconstruction. Uroflowmetry was performed 1 day before and 1 year after operation. The urine flow rate, voided volume and urine flow curves were detected using a rotating sensor. The results of maximum urine flow rate (Qmax) were expressed as percentiles and compared to the Toguri value from normal children.

RESULTSBefore corrective operation, 12 of 17 patients (70.6%) produced a plateau urine flow curve. 5 patients (29.4%) produced a very low flow curve. The average maximum flow rate was (7.89 +/- 2.29) ml/s per second compared to Toguri values, 12 of 17 patients (70.6%) had a Qmax below the normal 5th percentile. After a "Two in One" urethroplasty, a hell-shaped curve was obtained in 10 patients (58.8%). The maximum flow rate was (11.30 +/- 3.01) mL/s per second. 7 of 17 patients (41.2%) had a Qmax above the normal 25th percentile, 8 patients (47.1%) had a Qmax between the normal 25th percentile and 5th percentile, only 2 patients (11.8%) had a Qmax below the 5th percentile.

CONCLUSIONSThe functional result of the "Two in One" urethroplasty is ideal. The maximum urine flow rate of the patients increases after the operation.

Child, Preschool ; Humans ; Hypospadias ; physiopathology ; surgery ; Male ; Treatment Outcome ; Urethra ; physiopathology ; surgery

OBJECTIVETo evaluate the effect of daily low-dose tadalafil on erectile dysfunction (ED) induced by pelvic fracture urethral disruption (PFUD).

METHODSThis study included 46 cases of PFUD-induced ED treated from Jan 2008 to Dec 2011. The patients were aged 33.9 +/- 7.2 years (range 25 -51 yr), and the interval between injury and treatment was 19.6 +/- 12.7 months (range 3 - 72 mo), all with normal erectile function before PFUD. Based on the nocturnal penile tumescence and rigidity (NPTR) recorded by erectometry without medication of phosphodiesterase type 5 inhibitor (PDE-5I), the patients were divided into an abnormal nocturnal erection group and a non-nocturnal erection group, and treated with tadalafil 10 mg once daily for 3 months. The therapeutic effect was evaluated by IIEF-5 scores and the rate of yes responses to questions 2 and 3 of the Sexual Encounter Profile (SEP).

RESULTSTotally 38 (82.6%) of the patients accomplished the treatment and follow-up, 26 (68.4%) in the abnormal nocturnal erection group and 12 (31.6%) in the non-nocturnal erection group. After 3 months of daily tadalafil treatment at 10 mg, the IIEF-5 scores were significantly improved in the abnormal nocturnal erection group than in the non-nocturnal erection group (P < 0.05), and the rate of yes responses to SEP2 and SEP3 was remarkably higher in the former than in the latter (76.9% vs 41.7% and 65.4% vs 25.0%, P < 0.05).

CONCLUSIONSDaily low-dose tadalafil can effectively improve the erectile function of PFUD-induced ED patients, particularly in those with nocturnal erection.

Adult ; Carbolines ; administration & dosage ; therapeutic use ; Dose-Response Relationship, Drug ; Erectile Dysfunction ; drug therapy ; etiology ; physiopathology ; Fractures, Bone ; complications ; Humans ; Male ; Middle Aged ; Pelvis ; injuries ; Penile Erection ; Tadalafil ; Treatment Outcome ; Urethra ; injuries

While oral agents are currently suggested for the initial treatment of erectile dysfunction, penile prosthesis implantation (malleable or inflatable) is accepted as a third-line therapy if intracorporeal injection and intraurethral treatment fail as a secondary choice. Urethral erosion of the malleable penile prosthesis is a well-known complication, mostly due to the indwelling catheter. We report a case of urethral erosion of the malleable penile prosthesis after 23 years. The patient was a 45-year-old man without any underlying risk factors. He subsequently underwent a unilateral rod extraction under regional anaesthesia. It appears that urethral erosion of penile prostheses can appear at any time post operation, without any known facilitative factors and in any age group. Furthermore, simple office manoeuvres may not be possible in some patients.
Catheters, Indwelling ; adverse effects ; Erectile Dysfunction ; surgery ; Humans ; Male ; Middle Aged ; Penile Implantation ; adverse effects ; Penile Prosthesis ; adverse effects ; Prosthesis Failure ; Time Factors ; Treatment Outcome ; Urethra ; physiopathology ; surgery

OBJECTIVETo observe the clinical therapeutic effect of electroacupuncture for chronic prostatitis and investigate its mechanism.

METHODSForty-eight cases were randomly divided into an electroacupuncture group and a western medicine group, 24 cases in each group. The electroacupuncture group was treated by electroacupuncture and Guanyuan (CV 4), Zhongji (CV 3). Ciliao (BL 32) and Huiyang (BL 35) were selected as main acupoints. The western medicine group was treated by oral administration of Sparfloxacin tablets and Prostat tablets. The scores of NIH-CPSI, changes in uroflow rate-urethral sphincter EMG and their therapeutic effects were observed.

RESULTSThe total effective rate was 87.5 % in the electroacupuncture group which, was better than 62. 5% in the western medicine group (P(<0. 05). There were significant differences in the scores of NIH-CPSI and Q(max), Q(ave), TL value before and after treatment in the electroacupuncture group (all P<0.05), and with a significant difference in the scores of NIH-CPSI and Q(max). Q(ave), TL value after treatment between the two groups (all P<0.05).

CONCLUSIONElectroacupuncture based on syndrome differentiation has better therapeutic effect on chronic prostatitis than that of routine clinical medicine.

Acupuncture Points ; Adult ; Chronic Disease ; therapy ; Electroacupuncture ; Electromyography ; Humans ; Male ; Middle Aged ; Prostatitis ; physiopathology ; therapy ; Treatment Outcome ; Urethra ; chemistry ; physiopathology ; Young Adult

We conducted a prospective study of erectile dysfunction (ED) after urethral reconstructive surgery, using the 5-item International Index of Erectile Function (IIEF-5), the Sexual Life Quality Questionnaire (SLQQ) and the Quality of Life Questionnaire (QoLQ). Between January 2003 and July 2007, 125 male patients with urethral strictures underwent urethroplasty, and pre- and post-surgery erectile function was assessed using these three questionnaires. A formula to predict the probability of ED after urethroplasty was derived. At 3 months post-operatively, there was a significant decrease in IIEF-5 (16.57 +/- 7.98) and SLQQ scores (28.71 +/- 14.84) compared with pre-operative scores (P < 0.05). However, the IIEF-5 scores rebounded at 6 months post-operatively (17.22 +/- 8.41). Logistical regression analysis showed that the location of the urethral stricture, the recurrence of strictures and the choice of surgical technique were predictive of the post-operative occurrence of ED. This study identified the clinical risk factors for ED after urethroplasty. Posterior urethral stricture and end-to-end anastomosis were found to have a strong relationship with erectile function. The logistical model derived in this study may be applied to clinical decision algorithms for patients with urethral strictures.
Adult ; Erectile Dysfunction ; etiology ; physiopathology ; Humans ; Male ; Middle Aged ; Postoperative Complications ; etiology ; physiopathology ; Prospective Studies ; Quality of Life ; Reconstructive Surgical Procedures ; adverse effects ; Self-Examination ; Surveys and Questionnaires ; Urethra ; pathology ; surgery ; Urethral Stricture ; pathology ; surgery

Advances in urogenital plastic surgical tissue transfer techniques have enabled urethral reconstruction surgery to become the new gold-standard for treatment of refractory urethral stricture disease. Questions remain, however, regarding the long-term implications on sexual function after major genital reconstructive surgery. In this article, we review the pathologic features of urethral stricture disease and urologic trauma that may affect erectile function (EF) and assess the impact of various specific contemporary urethroplasty surgical techniques on male sexual function.
Erectile Dysfunction ; Humans ; Male ; Reconstructive Surgical Procedures ; methods ; Urethra ; surgery ; Urethral Stricture ; physiopathology ; surgery

OBJECTIVETo evaluate the effect of silk fibroin film for repairing urethral defect in rabbits.

METHODSTwenty-four male New Zealand rabbits were randomized into experimental group, control group I and control group II. In the experimental group, a urethral defect of 1.5 cm was induced in the 12 rabbits and repaired with silk fibroin film. The 6 rabbits in control group I without the surgically induced defect served as the sham operation group, and in control group II consisting of 6 rabbits the urethral defect of 1.5 cm was induced without repair. Histological observation and immunohistochemistry were conducted to examine the regenerative segments of the urethra at regular time points between 2 and 16 weeks postoperatively.

RESULTSThe 12 rabbits in the experimental group did not show signs of urethral stricture following the surgery. The implanted silk fibroin film for defect repair was degraded completely at 16 weeks and the defect was repaired with smooth urethral mucous membrane lining and orderly arranged smooth muscle cells. Immunohistochemistry identified the cells lining the defect area as the urethral epithelial cells.

CONCLUSIONSilk fibroin film can promote the repair of urethral defect by inducing the growth of the urethral epithelial cells and smooth muscle cells.

Animals ; Biocompatible Materials ; chemistry ; Fibroins ; chemistry ; Guided Tissue Regeneration ; methods ; Immunohistochemistry ; Male ; Membranes, Artificial ; Rabbits ; Random Allocation ; Regeneration ; Silk ; chemistry ; Tissue Engineering ; Urethra ; injuries ; physiopathology ; surgery ; Wound Healing