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Purpose: Typically in Korea, for a standard dose (0.4 mg) of tamsulosin, two low doses (0.2 mg) are administered. The aim of this study was to evaluate and compare the efficacy of tamsulosin (0.2 mg and 0.4 mg) and alfuzosin (10 mg) in the treatment of lower ureteral stones. Materials and Methods: A total of 141 patients presenting with a single 4- to 10-mm sized lower ureteral stone were randomly assigned to 4 groups. Patients in group 1 (n=41) and group 2 (n=30) received an oral dose of 0.2 mg tamsulosin once and twice daily, respectively, and patients in group 3 (n=36) received a daily oral dose of 10 mg alfuzosin. Patients in group 4 (n=34) received trospium chloride only. The spontaneous passage of stones, the stone expulsion time, and adverse effects were evaluated. Results: There were no significant differences in patient background, including age, sex, BMI, stone size, stone side, and symptom duration. The spontaneous stone passage rate through the ureter was higher and the stone expulsion time was faster in groups 1, 2, and 3 than in group 4. There were no statistically different changes in groups 1, 2, and 3. The adverse effects observed in all groups were comparable and were mild. Conclusions: Tamsulosin at 0.2 mg and 0.4 mg and alfuzosin (10 mg) proved to be safe and effective. A first cycle of medical expulsive therapy with tamsulosin 0.2 mg could be considered as an option in the management of single lower ureteral stone.

Purpose: The aim of this study was to evaluate the efficacy of a terpene mixture compared with alpha-blocker in patients with chronic pelvic pain syndrome (CPPS). Materials and Methods: Patients diagnosed with CPPS were included in this study. The patients were randomly placed into three groups. Group 1 was treated with levofloxacin alone (36 patients), group 2 was treated with levofloxacin and alfuzosin (33 patients), and group 3 was treated with levofloxacin and terpene mixture (34 patients) for 8 weeks. The National Institutes of Health Chronic Prostatitis Symptom Index (NIHCPSI) was evaluated in patients in each group at the beginning of the study and after 8 weeks of treatment. Results: Pain domain, urinary domain, quality of life domain, and total score on the NIH-CPSI were not significantly different at the initial visit. After treatment with each medication, improvements on the pain domain and total score of the NIH-CPSI were better in group 3 than in group 1 or group 2 (p

Paragangliomas of the urinary bladder are very rare tumors of the paraganglion system that arise from chromaffin cells in or near the sympathetic ganglia. Only approximately 15% of them develop from extra-adrenal chromaffin tissue. Most of these tumors are hormonally active and secrete mainly noradrenaline (rarely adrenaline), calcitonin, and adrenocorticotropic hormone. Paragangliomas are generally benign tumors, with less than 10% being malignant. Here we report a case of a paraganglioma arising in a urinary bladder with a bladder stone.

Purpose: In bladder cancer screening, many methods such as urinary cytology, bladder tumor antigen, and nuclear matrix protein-22 are well known. To learn the value of urinary melanoma antigen gene expression (MAGE) in bladder cancer screening, we compared the urinary MAGE test with irrigated urinary cytology. Materials and Methods: From July 2000 to July 2007, a total of 142 patients were enrolled in this study. We divided these patients into 2 groups. Eighty-eight patients with bladder cancer were included in group I. Group II consisted of 54 patients who had been treated for bladder cancer and had no evidence of tumor by cystoscopy and irrigated urinary cytology. Urinary cytology, urinary MAGE test, and cystoscopy were performed in all patients. The urinary MAGE test was done by reverse transcriptase polymerase chain reaction (RT-PCR). Sensitivity and specificity were investigated according to cancer grade and stage. Results: The overall sensitivity of the urinary MAGE test and urinary cytology was 69.3% (61/88) and 53.4% (47/88), respectively (p=0.03). The specificity of the urinary MAGE test and urinary cytology was 75.9% (41/54) and 83.3% (45/54), respectively (p=0.34). The sensitivity of each test in superficial tumors (Ta, T1) was 65.5% (38/58) and 46.6% (27/58), respectively (p=0.04). In advanced disease (≥T2), the sensitivity of the tests was 76.7% (23/30) and 66.7% (20/30), respectively (p=0.39). The sensitivity of the urinary MAGE test in grade 1 tumors (60.5%, 23/38) was significantly higher (p=0.01) than that of urinary cytology (31.6%, 12/38). Conclusions: The urinary MAGE test was more sensitive than urinary cytology in bladder cancer screening. We consider the urinary MAGE test to possibly be a valuable test together with urinary cytology, especially for Grade 1 and Ta, T1 bladder cancer. (Korean J Urol 2009;50:739-743) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: We investigated the effect of the level of spinal cord injury and urinary catheterization on sexual function and activity in male patients with upper motor neuron (UMN) injury. Materials and Methods: We reviewed patient's chart, radiologic and urodynamic study. We interviewed patient's sexual activity according to educational status, economic and marriage state, occupation, duration of spinal cord injury and pattern of voiding. A total of 114 male patients with neurogenic bladder due to UMN injury were included in the study. Group 1 consisted of 33 patients who underwent a clean intermittent catheterization (CIC) regimen and group 2 consisted of 81 patients with a suprapubic catheter, condom catheter, or Foley catheter. A detailed sexual behavior was taken for all patients to complete a questionnaire including the 5-item version of the International Index of Erectile Function (IIEF-5). Results: Satisfaction with intercourse (p=0.037) and total score (p=0.032) on the IIEF-5 were significantly higher in group 1 than in group 2. The other items on the IIEF-5 did not differ significantly between the groups. When the subjects were stratified according to level of spinal cord injury, 8 patients (18.6%) with cervical cord injury had no sexual activity, whereas 24 patients (33.8%) with non-cervical-cord injury did (p=0.048). Patients with no sexual activity were 12.1% (4/33) of the patients in the CIC group and 34.6% (28/81) of the patients who underwent other regimens (p= 0.016). Conclusions: Our results demonstrate that level of spinal cord injury and urinary catheterization may influence the sexual activity of male patients with UMN injury. Our results suggest that the CIC regimen had a positive effect on the sexual activity of these patients. (Korean J Urol 2009;50: 1225-1230) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Jung Dam Gim, Hyung Il Lee, Young Jin Seo, Kyung Seop Lee, Ki Ho Kim From the Department of Urology, College of Medicine, Dongguk University, Gyeongju, Korea Adenomatoid tumors arising in the parenchyma of the testes are extremely rare neoplasms, and they uniformly behave in a benign fashion. The long reorted history of these tumors and the absence of distant metastasis suggest a benign nature. Thus, the treatment is surgical excision. We report here on a case of an adenomatoid tumor of the testis. Radical orchiectomy was performed, and this revealed an adenomatoid tumor of the parenchyma of the testis. (Korean J Urol 2008;49:469-471) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: The aim of this study was to evaluate the effect of chronic prostatic inflammation on acute urinary retention(AUR) in the setting of benign prostatic hyperplasia(BPH). Materials and Methods: A total of 132 male patients admitted to our clinic with BPH-related AUR or BPH-related lower urinary tract symptoms (LUTS) were included in this study. These patients were divided into two groups. Group 1 consisted of 58 patients with AUR who underwent transurethral resection of the prostate(TURP), and group 2 consisted of 74 patients with LUTS who underwent TURP. Prostatic infarction, morphology, inflammation were examined. Prostatic infarction was evaluated according to the presence or absence of infarction. Prostatic morphology was assessed according to three categories: mainly glandular hyperplasia, stromal hyperplasia, or a mixture of glandular and stromal hyperplasia. Prostatic inflammation was assessed according to three categories: mild, moderate, and severe. Results: Prostatic infarction was observed in 8.6% of the patients in group 1 and in 8.1% of the patients in group 2(p=1.000). Glandular, stromal, and mixed hyperplasia were detected in 36.2%, 5.2%, and 58.6% of the patients in group 1 and in 35.1%, 6.8%, and 58.1% of the patients in group 2, respectively(p=0.222). Mild, moderate, and severe chronic prostatic inflammation were observed in 39.7%, 31.0%, and 29.3% of the patients in group 1 and in 73.0%, 20.3%, and 6.7% of the patients in group 2, respectively(p＜0.001). Conclusions: Chronic prostatic inflammation may play an important role on AUR developing secondary to BPH.

Purpose: The aim of this study was to evaluate the effect of periurethral prostatic calculi on lower urinary tract symptoms (LUTS) at the initial visit and after treatment with an alpha-blocker in benign prostatic hyperplasia (BPH). Materials and Methods: A total of 223 male patients with LUTS were studied. Group 1 consisted of 81 patients with periurethral prostatic calculi within 5mm from the prostatic urethra of the transitional zone, as determined by transrectal ultrasound. Group 2 consisted of 142 patients without periurethral prostatic calculi within 5mm from the prostatic urethra. The International Prostate Symptom Score (IPSS), maximal urinary flow rate (Qmax) and post voided residual urine (PVR) were measured in patients of both groups at the beginning of the study and at eight weeks after the treatment with 4mg doxazosin gastrointestinal therapeutic system (GITS). Results: Voiding, storage and the total IPSS for Group 1 patients were higher than for Group 2 patients (p

Kyo Ik Mo, Ki Ho Kim, Young Jin Seo, Kyung Seop Lee From the Department of Urology, College of Medicine, Dongguk University, Gyeongju, Korea In some patients with prostate cancer and who manifest disease progression during maximal androgen blockade (MAB) therapy, discontinuation of antiandrogen treatment might result in a significant fall in the level of serum prostate-specific antigen (PSA), and this is often correlated with clinical improvement (antiandrogen withdrawal syndrome). However, a decline in the PSA level after the withdrawal of estramustine phosphate is extremely rare. We report here on a case of dramatic decline in the PSA level after withdrawal of estramustine phosphate in a patient with hormone refractory prostate cancer. (Korean J Urol 2007;48:751-753) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Brucellosis is a zoonosis, which is caused by Brucella abortus, B. melitensis, B. suis and B. canis. Brucellosis has been an emerging disease since the discovery of B. melitensis, by Bruce, in 1887. Worldwide, brucellosis remains a major source of disease in both humans and domesticated animals. A high prevalence in certain geographical areas is well recognized, but has been largely underestimated. In Korea, the first human case of Brucellosis occurred in 2002, but the incidence of human brucellosis has now increased. Herein, a case of epididymorchitis due to brucellosis is reported.

환자는 66세 남자로, 내원 4개월 전 급성 담낭염으로 담 낭 절제술 전 시행한 복부 전산화 단층촬영에서 좌측 부신 에 종물이 발견된 환자로, 전원 당시 환자의 과거력, 가족력 상 특이사항은 없었으며, 신체검사에서도 특이사항은 없었 다. 복부 전산화단층촬영에서는 좌측 신장 상부에 저음영 인 10x8.5cm 크기의 종물이 확인되었으며, 주위와의 경계 는 명확하였고, 복강 내에 림프선 비대나 주위 장기로의 침 윤 등의 소견은 보이지 않았다 (Fig. 1). 술 전 영상학적 검사 에서 부신의 골수지방종을 의심하여 호르몬 검사는 시행하 지 않았다. 손을 이용한 복강경하 경복막 좌측 부신 절제술 을 시행하였으며, 7cm의 좌측 방정중절개와 2개의 10mm trocar를 통하여 수술을 시행하였다. 종양은 주위와의 경계는 명확하였다. 적출된 종양의 육 안적 소견으로 크기는 10x8.5cm로 표면은 윤택이 있는 엷 은 막으로 덮여져 있었으며 (Fig. 2), 현미경적 소견으로는 잘 분화된 지방 세포들이 발견되었고 다량의 조혈세포들이 발견되어 골수지방종으로 확진되었다 (Fig. 3). 환자는 수술 후 특별한 합병증의 발생없이 술 후 5일째 퇴원하였으며, 현재 6개월째 추적관찰 중이다.

Su Hwan Park, Tae Gyun Kwon, Duk Yoon Kim, Chul Hee Park, Jun Hyoung Seo, Ju Hwan Lee, Hee Chang Jung, Young Jin Seo From the Department of Urology, College of Medicine, Dongguk University, Kyungpook National University College of Medicine, Catholic University of Daegu College of Medicine, Keimyung University, Department of Urology, Kumi CHA Medical Center, College of Medicine, Pochon Cha University, Daegu Fatima Hospital, Department of Urology, College of Medicine, Yeungnam University