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Background Monotropein, astragalin, and spiraeoside (MAS) are active compounds extracted from medicinal herbs; monotropein from Morinda officinalis How (Rubiaceae), astragalin (kaempferol 3-O-glucoside) from Cuscuta chinensis Lamark (Convolvulaceae) and spiraeoside from the outer scales of Allium cepa L. (Liliceae) in a ratio of 6.69:0.41:3.61. Monotropein, astragalin, and spiraeoside are well-known antioxidants, anti-inflammatory, and antinociceptive agents. The current investigation aims to study the molecular mechanism of varicocele-induced male infertility and the underlying pharmacological mechanisms of MAS. Methods Four groups were included: control (CTR), MAS 200 group (MAS 200 mg/kg), varicocele group (VC), and VC + MAS 200 group (MAS 200 mg/kg). Sprague-Dawley (SD) rats were treated with 200 mg/kg MAS or vehicle once daily for 28 days. The possible signaling mechanism and effects of MAS were measured via histological staining, immunohistochemistry, western blot, and biochemical assays. Results Parameters such as sperm motility and count, Johnsen’s scores, spermatogenic cell density, serum testosterone, testicular superoxide dismutase (SOD), catalase, glutathione peroxidase (GPx) and expression of the steroidogenic acute regulatory protein (StAR) improved significantly in the VC + MAS 200 group compared with the VC group. MAS treatment of varicocele-induced group significantly decreased the levels of serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH), as well as testicular interleukin-6 (IL6), tumor necrosis factor-α (TNF-α), ROS/RNS, and malondialdehyde (MDA). It also decreased the apoptotic index and reduced the expression of endoplasmic reticulum (ER) protein levels (Grp78, p-IRE1α, and p-JNK) and apoptotic markers such as cleaved caspase-3 and Bax/Bcl2 ratio. Conclusion This study suggests that the crosstalk between oxidative stress, ER stress, and mitochondrial pathway mediates varicocele-induced testicular germ cell apoptosis. MAS promotes spermatogenesis in varicocele-induced SD rat, probably by decreasing cytokines (IL-6, TNF-α) levels, regulating abnormal sex hormones, and decreasing oxidative stress, ER stress, and apoptosis.

It is well established that physiological stress has an adverse effect on the male reproductive system. Experimental studies have demonstrated the promising effects of MOTILIPERM in male infertility. MOTILIPERM extract is composed of three crude medicinal herbs: Morinda officinalis How (Rubiaceae) roots, Allium cepa L. (Liliaceae) outer scales, and Cuscuta chinensis Lamark (convolvulaceae) seeds. The present study aimed to investigate the possible mechanisms responsible for the effects of MOTILIPERM on testicular dysfunction induced by immobilization stress. Fifty male Sprague Dawley rats were divided into five groups (10 rats each): a normal control group (CTR), a control group administered MOTILIPERM 200 mg/kg (M 200), an immobilization-induced stress control group (S), an immobilization-induced stress group administered MOTILIPERM 100 mg/kg (S + M 100), and MOTILIPERM 200 mg/kg (S + M 200). Stressed rats (n = 30) were subjected to stress by immobilization for 6 h by placing them in a Perspex restraint cage, while controls (n = 20) were maintained without disturbance. Rats were administrated 100 or 200 mg/kg MOTILIPERM once daily for 30 days 1 h prior to immobilization. At the end of the treatment period, we measured body and reproductive organ weight; sperm parameters; histopathological damage; reproductive hormone levels; steroidogenic acute regulatory protein (StAR); biomarkers of oxidative stress; and apoptosis markers. MOTILIPERM treatment improved testicular dysfunction by up-regulating (p < 0.05) sperm count, sperm motility, serum testosterone level, StAR protein level, Johnsen score, and spermatogenic cell density in stressed rats. MOTILIPERM decreased oxidative stress by increasing (p < 0.05) testicular superoxide dismutase (SOD), glutathione peroxidase (GPx), glutathione peroxidase-4 (GPx 4), catalase, nuclear factor erythroid 2-related factor 2 (Nrf2), and heme oxygenase 1 (HO-1) levels and decreasing (p < 0.05) malondialdehyde (MDA) and reactive oxygen species/reactive nitrogen species (ROS/RNS) levels. Furthermore, MOTILIPERM down-regulated (p < 0.05) cleaved caspase 3 and BCL2 associated X protein (Bax) levels; increased pro caspase-3 and B-cell lymphoma 2 (Bcl-2) levels; and upregulated testicular germ cell proliferation in stressed rats. The number of terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL)-positive cells and serum luteinizing hormone (LH) and follicle stimulating hormone (FSH) levels also significantly (p < 0.05) decreased after pretreatment with MOTILIPERM in stressed rats. Collectively, our results suggest that, in immobilization-mediated stress-induced testicular dysfunction, MOTILIPERM sustains normal spermatogenesis via antioxidant and anti-apoptotic activities by activating the NRF/HO-1 signaling pathway.

Context: MOTILIPERM was prepared as a mixture of extracts of three medicinal herbs [roots of Morinda officinalis How (Rubiaceae), outer scales of Allium cepa L. (Liliaceae) and seeds of Cuscuta chinensis Lamark (Convolvulaceae)]. Objective: To investigate the role of reactive oxygen species (ROS)-based endoplasmic reticulum (ER) stress in a rat model of varicocele and the therapeutic efficacy of MOTILIPERM in this model. Materials and methods: Sixty male rats were divided into five experimental groups: a normal control group (CTR + vehicle), a control group administered MOTILIPERM 200 mg/kg (CTR + M 200), a varicocele-induced control group (VC + vehicle) and two varicocele-induced groups administered MOTILIPERM 100 (VC + M 100) or 200 (VC + M 200) mg/kg for 4 weeks. Testis weights were recorded and serums were assayed for hormone concentrations. Tissues were subjected to semen analysis, histopathology, analyses of ER response protein expression levels and oxidative stress were assessed by measuring ROS, reactive nitrogen species (RNS), malondialdehyde (MDA) level and ratios of total glutathione (GSH)/oxidized GSH (GSSG). Results: MOTILIPERM treatment of varicocele-induced groups significantly increased left testis weight, testosterone level, sperm motility, count and spermatogenic cell density. ER-response protein expression levels were dose-dependently decreased in VC + M 200 group compared with VC + vehicle group. MOTILIPERM treatment also decreased MDA and ROS/RNS level but increased GSH/GSSG ratio. Discussion and conclusions: This study suggests that ROS-related ER stress may play a major role in varicocele-induced infertility and MOTILIPERM, a novel compound targeting ROS-based ER stress, may be therapeutically useful in treatment of varicocele, or as a supplement for the treatment of infertility.

Kiran Kumar Soni,1 Hye Kyung Kim,2 Bo Ram Choi,1 Keshab Kumar Karna,1 Jae Hyung You,1 Jai Seong Cha,1 Yu Seob Shin,1 Sung Won Lee,3 Chul Young Kim,4 Jong Kwan Park1 1Department of Urology, Institute for Medical Sciences, Chonbuk National University Medical School– Biomedical Research and Institute and Clinical Trial Center for Medical Devices, Chonbuk National University Hospital, Jeonju, 2College of Pharmacy, Kyungsung University, Busan, 3Department of Urology, Samsung Medical Center, Samsung Biomedical Research Institute, Sungkyunkwan University Medical School, Seoul, 4College of Pharmacy, Hanyang University, Ansan, Republic of Korea Abstract: Cisplatin (CIS) is used in the treatment of cancer, but its nonspecific systemic actions lead to toxic effects on other parts of the body. This study investigated the severity of CIS toxicity by increasing its dose over a constant time period. Sprague Dawley rats were divided into five treatment groups and control group with CIS (2, 4, 6, 8, and 10 mg/kg) administered intraperitoneally for 5 days. The body and organs were weighed, epididymal sperm was counted, and sperm motility and sperm apoptosis were evaluated. Blood samples were evaluated for complete blood count, reactive oxygen and nitrogen species, malondialdehyde levels, and total testosterone. The testicular tissue was examined for steroidogenic acute regulatory protein and endoplasmic reticulum stress protein. Epididymal sperm was collected for CatSper Western blot. The toxic effects of different doses of CIS on the testis and kidney were compared histologically. The weights of body, testis, epididymis, prostate, seminal vesicle, and kidney; sperm count; sperm motility; steroidogenic acute regulatory protein level; and epididymal sperm count were significantly lower in the CIS-treated groups than in the control group. In contrast, sperm apoptosis, plasma reactive oxygen and nitrogen species, and malondialdehyde, testosterone, red blood cell, hematocrit, hemoglobin, and endoplasmic reticulum stress protein levels all increased. Though CIS effectively treats cancer, at an increased dose it is toxic and life-threatening to the genitourinary system and other parts of the body. Keywords: cisplatin, testicular toxicity, oxidative stress, StAR protein, CatSper, endoplasmic reticulum stress

Yu Seob Shin,1,* Li Tao Zhang,1,* Jae Hyung You,1 In Sung Choi,1 Chen Zhao,2 Jong Kwan Park1 1Department of Urology, Chonbuk National University and Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute and Medical Device Clinical Trial Center of Chonbuk National University, Jeonju, Republic of Korea; 2Department of Urology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, and Shanghai Institute of Andrology, Shanghai, People’s Republic of China *These authors contributed equally tothis work Objective: The objective of this study was to evaluate the safety and efficacy of tamsulosin hydrochloride 0.2mg (TAM) and its combination with solifenacin succinate 5mg (SOL) after transurethral resection of the prostate (TURP).Patients and methods: The patients were randomized into three groups: TURP (group 1), TURP plus TAM (group 2), and TURP plus TAM + SOL (group 3). Patients in group 2 and group 3 received medication for 4weeks. The primary efficacy end points were the mean change in total International Prostate Symptom Score (IPSS) and IPSS subscores. The secondary end points included quality-of-life score, Overactive Bladder Symptom Score, and short-form voiding and storage score of International Continence Society.Results: In total, 37 men (31.8%) in group 1, 37 men (31.8%) in group 2, and 42 men (36.2%) in group 3 completed the study. In total IPSS, no significant improvement was seen from baseline to the end of treatment in groups 2 and 3 compared with group 1. However, in group 2, the decrement in the IPSS storage score was smaller than group 1 (P=0.02), and in group 3, the decrement in the IPSS voiding score was smaller than group 1 (P=0.05). In groups 2 and 3 compared with group 1, improvements in the quality of life score, total score of Overactive Bladder Symptom Score, and short-form voiding score and storage score of International Continence Society were not statistically significant.Conclusion: Treatment with TAM and combination of TAM and SOL did not have significant additional benefits for lower urinary tract symptoms during the early recovery period afterTURP. Keywords: benign prostate hyperplasia, tamsulosin, solifenacin, combination, transurethral resection of the prostate

Clear cell adenocarcinoma of the female urethra is extremely rare. Because the primary urethral carcinomas are rare, standard diagnostic algorism and management has not been established yet. We report a case of clear cell adenocarcinoma of the proximal urethra in a 76-year-old female. She was presented with voiding difficulty for several years after pubovaginal sling operation due to stress urinary incontinence twelve years ago. Before this period, she had managed with medication for detrusor hypocontractility. Recently she complained bloody vaginal discharge, and her vaginal examination revealed palpable mass on the anterior vaginal wall. Pelvic MRI showed a 5x4.5cm sized tumor surrounding the proximal urethra which was mimicking prostate with no lymphadenopathy. Biopsy of the mass confirmed it to be clear cell adenocarcinoma. She underwent anterior pelvic exenteration and ileal conduit with bilateral pelvic lymph node dissection. The patient received adjuvant radiotherapy and chemotherapy as treatment. We should carefully evaluate patients with voiding symptom after anti-incontinence surgery and multimodal treatment should be applied for locally advanced urethral carcinoma.

Introduction: We aimed to evaluate the effect of preoperative urethral dilatation during holmium laser enucleation of the prostate (HoLEP) on the prevention of urethral stricture. Methods: A total of 72 patients without urethral stricture underwent HoLEP for benign prostatic hyperplasia (BPH). Recruited patients were randomly divided into two groups (groups A and B). Patients in group A (36 patients, experimental group) received preoperative urethral dilatation and patients in group B (36 patients, control group) did not. Each patient was evaluated at four weeks, 12 weeks, and 24 weeks after surgery. The effectiveness of preoperative urethral dilatation was evaluated based on the International Prostate Symptom Score (IPSS), peak urine flow rate (Qmax), voided volume, and post-void residual (PVR) volume. To diagnose urethral stricture, Qmax

Background DA-9401 was prepared as a mixture of Chinese medicinal herb extracts from roots of Morinda officinalis How (Rubiaceae), outer scales of Allium cepa L. (Liliceae) and seeds of Cuscuta chinensis Lamark (Convolvulaceae). The present study was designed to investigate the possible protective role of DA-9401 in adriamycin (ADR)-induced testicular toxicity associated with oxidative stress, endoplasmic reticulum (ER) stress, and apoptosis. Methods Fifty healthy 8-week-old male Sprague–Dawley rats were equally divided into five groups. The first CTR group was treated with normal saline 2 ml/day by gavage. The second was treated with DA-100 (DA-9401 100 mg/kg/day). The third (ADR) group received ADR (2 mg/kg/once a week) intraperitoneally, while the combination of ADR and DA-9401 was given to the fourth ADR + DA-100 (100 mg/kg/day p.o) group and fifth ADR + DA-200 (200 mg/kg/day p.o) group. At the end of the 8-week treatment period, body weight, reproductive organ weights, fertility rate, pups per female were recorded, and serum were assayed for hormone concentrations. Tissues were subjected to semen analysis, histopathological changes, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), oxidative stress markers and expression levels of endoplasmic reticulum (ER) stress markers, apoptosis markers, tight junction protein markers, steroidogenic acute regulatory protein (StAR), cation channel of sperm (CatSper) and glycogen synthase kinase-3 (GSK-3) by western blot. Results DA-9401 administration to ADR-treated rats significantly decreased serum luteinizing hormone (LH) and follicle-stimulating hormone (FSH) levels, interleukin-6, TNF-α, MDA level, ROS/RNS level, ER stress response protein levels, tunnel positive cells, cleaved caspase-3, and Bax/Bcl2 ratio. Moreover, pretreatment with DA-9401 significantly increased body weight, reproductive organ weights, fertility rate, pups per female, Johnsen’s score, spermatogenic cell density, sperm count and sperm motility, serum testosterone concentration, testicular superoxide dismutase (SOD), catalase, glutathione peroxidase (GPx), tight junction protein markers, star protein level, CatSper, and GSK-3 level. Conclusions ADR treatment can markedly impair testicular function and induce testicular cell death presumably by causing significant changes in oxidative stress, ER stress, and mitochondrial pathway. DA-9401 exerts beneficial effects against oxidative stress, ER stress, and mitochondria-mediated cell death pathway in testis tissue by up-regulating expression levels of tight junction protein markers, steroidogenic acute regulatory protein, GSK-3 alpha, and cation channels of sperm. Electronic supplementary material The online version of this article (10.1186/s12935-019-0805-2) contains supplementary material, which is available to authorized users.

Yu Seob Shin, Jae Hyung You, Ji Won On, Myung Ki Kim Department of Urology, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University – Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Republic of Korea Objective: To evaluate the association between the length of the female urethra and urodynamic study (UDS) parameters in patients presenting with stress urinary incontinence (SUI).Patients and methods: We retrospectively enrolled 391 women who underwent a transobturator adjustable tape sling implantation for the management of SUI between April 2009 and March 2016. All patients underwent a physical examination and UDS. Filling cystometry data that were evaluated included the Valsalva leak point pressure, and the cough leak point pressure. The maximal urethral closure pressure, the functional urethral length (FUL), and the length of the continence zone (LCZ) were measured using the urethral profile obtained from the UDS. The anatomical urethral length (AUL) was measured intraoperatively using a Foley catheter. We calculated the LCZ/FUL ratio to determine the anatomical continence length for this study.Results: We noted that 299 patients completed the study. The mean AUL was 26.25±3.59mm. The mean FUL and LCZ were 41.37±15.05mm and 24.15±13.90mm, respectively. The mean LCZ/FUL was 0.57±0.19. Using the Pearson correlation coefficient, we observed that the AUL showed a correlation with the FUL (0.168, P=0.034), the LCZ (0.212, P=0.007), the LCZ/FUL ratio (0.190, P=0.016), the Valsalva leak point pressure (0.223, P=0.005), the cough leak point pressure (0.215, P=0.006), and the maximal urethral closure pressure (0.178, P=0.043).Conclusion: Our results show that the AUL in women is associated with UDS parameters relating to SUI. Keywords: stress urinary incontinence, urethral length, urodynamics, women

Introduction: A trocar is used to pierce the muscle and skin to insert the wound drainage tube into the operating field to drain excess blood and fluid just after the operation.1 However, the handle of the trocar always becomes slippery, making it difficult for the operator to control it. Sometimes, the lack of control of a trocar may lead the trocar tip to protrude forward in an unwanted direction and penetrate into another organ of the patient. Sometimes, the operator could hurt his hand while pulling the trocar out by the sharp edge of trocar tip. In this video clip, we would like to introduce a brand new trocar that can be used to insert the wound drainage tube. Materials and Methods: The new trocar has two quadrangle grips (SUNGWON MEDICAL CO., LTD., Korea Patent; 10-1540199). One of the grips has an embossing surface to prevent the trocar from rotating unnecessarily when the operator pushes the trocar to penetrate the muscle and skin. The upper side of the grip has a sunken surface that helps the operator to direct the trocar tip using tactile sensation in the absence of visibility. The other grip has a smooth surface near the trocar tip to prevent it from slipping when the operator picks, by hand, the trocar that has emerged out of the skin. We measured the roughness and friction of the hand grip of the trocars by using Optical 3D Surface Measurement System and scanning of electron microscope. In addition, we assessed the questionnaires answered by surgeons on three domains, including the unwanted turn of the trocar tip, the unwanted sliding of the trocar grip, and the directivity of the trocar tip. The three domains were calculated by the amount of degree that a surgeon felt ranging across a continuum from 0 to an extreme amount of 10 subscales. Results: This trocar is routinely used for all open procedures. The roughness and friction of the brand new trocar had higher roughness and friction than the old trocar (roughness: 0.4365 ± 0.2664 and 1.9988 ± 0.72783 Ra, p

Purpose There is some debate over the necessity of ureteral stenting after laparoscopic ureterolithotomy. We evaluated the need for ureteral stenting after retroperitoneal laparoscopic ureterolithotomy (RLU). Materials and Methods Between January 2009 and January 2013, 41 patients underwent RLU to remove upper ureteral stones. The retroperitoneal approach was used in all patients by a single surgeon. A double J (D-J) stent was placed in the first 17 patients after the procedure but not in any of the next 24 patients. Results The mean patient age, serum creatinine levels, and stone size were not significantly different between the two groups. The stone-free rate was 100%. The mean operative time was significantly shorter in the stentless group than in the stent group (59.48 minutes vs. 77.88 minutes, p

Straddle injury is a type of blunt injury to the bulbous urethra mainly caused by falling on a fence or saddle [1]. No symptoms other than bleeding from the urethral meatus can give signs of urethral injury [2], but the bleeding sign does not necessarily mean the incidence of urethral injury. However, the case that we present here proves that other factors can provoke massive urethral bleeding after straddle injury. Our extremely rare case is, based on the review of the literature, the first finding of the isolated psudoaneurysm formation in the penile corpus spongiosum and bulbous urethra after straddle injury.

To investigate the relationship between serum total testosterone (TT) and free testosterone (FT) levels in men with anemia.We reviewed the records of 1221 subjects between March 2009 and December 2014. All the subjects' blood samples were drawn for TT and FT assays. Their serum hemoglobin (Hb) and serum hematocrit (Hct) levels were measured. The primary objective of our study was to investigate the association between TT and FT levels with Hb and Hct levels.The mean age was 59.82 ± 12.71 years. The mean TT and FT levels were 4.54 ± 2.02 ng/mL and 10.63 ± 3.69 pg/mL, respectively. The mean Hb and Hct levels were 14.72 ± 1.34 g/dL and 43.11 ± 3.75%, respectively. Subjects with low TT (2.35 ng/mL) had low Hb and Hct levels (p 0.001, p 0.001, respectively). TT was positively associated with FT, Hb, and Hct. TT and FT levels were significantly lower in older men.Subjects with low TT and FT levels had low Hb and Hct levels. This suggests that TT and FT play a significant role in erythropoiesis. Testosterone replacement therapy may be effective in men with hypogonadism to reduce the incidence of anemia.

Purpose Friction underwear was developed by adding small silicon dots in front of the underwear to decrease the time for pulling down underwear in elderly patients with urge incontinence. We studied about the effects of the friction underwear for elderly overactive bladder (OAB) patients. Materials and methods Male patients over 60 years of age diagnosed with OAB were prospectively enrolled and randomized to either the friction underwear first group (measuring for the time taken to pull down the friction underwear first and the non-friction underwear second) or the friction underwear later group (non-friction underwear first and the friction underwear second). An investigator measured the time to pulling down the underwear. And we measured the coefficient of friction of underwear. Results A total of 56 male patients were randomly divided into two groups using a random number table envelope method. There were no significant differences in demographics and clinical characteristics between the two groups. Of the total 56 patients, the time taken to pull down underwear for the friction underwear (3.79±0.15 seconds) was found significantly shorter than that for the non-friction underwear (4.10±0.17 seconds) (p=0.03). The static and dynamic coefficients of friction of the friction were 4.21 and 2.88, respectively, while those of the non-friction underwear were 0.64 and 0.45, respectively. Conclusions Our study demonstrates that friction underwear significantly shortened the time to pull down underwear. This functional underwear may be effective in preventing the underwear from getting wet in patients who suffer from urge incontinence.

PURPOSE The purpose of this study is to evaluate the effect of diabetes mellitus (DM) and preoperative glycemic control on prognosis in Korean patients with upper tract urothelial carcinoma (UTUC) who underwent radical nephroureterectomy (RNU). MATERIALS AND METHODS A total of 566 patients who underwent RNU at six institutions between 2004 and 2014 were reviewed retrospectively. Kaplan-Meier and Cox regression analyses were performed to assess the association between DM, preoperative glycemic control, and recurrence-free, cancer-specific, and overall survival. RESULTS The median follow-up period was 33.8 months (interquartile range, 41.4 months). A total of 135 patients (23.8%) had DM and 67 patients (11.8%) had poor preoperative glycemic control. Patients with poor preoperative glycemic control had significantly shorter median recurrence-free, cancer-specific, and overall survival than patients with good preoperative glycemic control and non-diabetics (all, p=0.001). In multivariable Cox regression analysis, DM with poor preoperative glycemic control showed association with worse recurrence-free survival (hazard ratio [HR], 2.26; 95% confidence interval [CI], 1.31 to 3.90; p=0.003), cancer-specific survival (HR, 2.96; 95% CI, 1.80 to 4.87; p=0.001), and overall survival (HR, 2.13; 95% CI, 1.40 to 3.22; p=0.001). CONCLUSION Diabetic UTUC patients with poor preoperative glycemic control had significantly worse oncologic outcomes than diabetic UTUC patients with good preoperative glycemic control and non-diabetics. Further investigation is needed to elucidate the exact mechanism underlying the impact of glycemic control on UTUC treatment outcome.

Objective Transurethral resection of the prostate (TURP) is a gold standard surgical procedure to treat the bothersome BPH induced LUTS within the range less than 100 mL. Just after a complete resection of the prostate, especially the posterior portion, however, the insertion of a Foley catheter could be very difficult or impossible, even while using a stylet. We demonstrates two techniques to more easily insert a Foley catheter just after performing the TURP. Methods Among 152 men who underwent TURP by bipolar surgical unit, we found that 27 men experienced the Foley catheter getting stuck while being inserted in the usual way. This was because of the excessive resection of the posterior portion of the prostate just underneath the bladder neck. In the 27 men, we then inserted a 20 Fr sized Foley catheter through an anterior- and upward-movement of posterior prostatic capsule by pressing the rectal wall using a finger and a flexible urethral catheter instead of a stylet. We filmed the inside view of the patient who underwent suprapubic open prostatectomy and transurethral adjustment continuously. Results For the case of the 27 men concerned, by adopting this novel technique, the Foley catheter was completely and safely inserted just after the TURP without any complication. Conclusions The two techniques to insert a Foley catheter just after the TURP can be performed safely within the set time limit without having to use any other medical device such as the stylet.

A 48-year-old male patient had an injection of industrial silicone under the penile skin for augmentation by non-medical practitioners a week before. There was complete necrosis of the dorsal part of the penile skin and soft tissue. In a penile magnetic resonance image, big masses of silicone under the penile skin were found and a part of the silicone was partially exposed. Debridement of the necrotic tissue was done. As the right side of the tunica albuginea was thin-walled, a silicone-induced infection developed. Because of this, the wet dressing was done daily without closing the wound for the next 23 days. Finally, both scrotal skins were drawn and sutured to the dorsal glandular skin after the total penile skin was completely removed and sutured with T-style anastomosis. The ventral flap was anastomosed to the ventral glandular skin with the end-to-end technique with inverted V incision at 1 cm proximal from the sutured margin. Flaps survived completely without skin necrosis or dehiscence.

Purpose: To compare suprapubic open prostatectomy (SOP) and a novel SOP with transurethral adjustment of residual adenoma and bleeding (TURARAB) for large sized prostates. Methods: Between March 2010 and March 2014, 49 patients with symptomatic BPH (>100 g) were scheduled for SOP or SOP with TURARAB. The patients were subdivided into two groups. In Group I, each patient underwent SOP. In Group II, each patient underwent SOP with TURARAB. Additional transurethral resection of residual adenoma and bleeding control were done through the urethra after enucleation of the prostate adenoma by SOP. Prior to intervention, all patients were analyzed by preoperative complete blood count, blood chemistry, prostate specific antigen, International Prostate Symptom Scores, and transrectal ultrasound of the prostate and uroflowmetry. SOP was performed by a suprapubic transvesical approach via a midline incision. The bladder neck mucosa was circularly incised to expose the prostate adenoma, and the plane between the adenoma and surgical capsule was developed by finger dissection. In addition, in Group II TURARAB was performed using Urosol. Postoperative outcome data were compared in the 1st month and 3rd month. Results: There were no statistically significant differences in baseline characteristics between the two groups. Group I required a longer operative time than Group II. Blood transfusion during the operation was unnecessary due to the short amount of time available to control arterial bleeding in the prostatic fossa leading to a marked decrease in perioperative bleeding in Group II. Postoperative voiding function improved significantly in both groups. Conclusions: Even for large prostate glands, our novel procedure appears to be an effective and safe operation to reduce operation time, bleeding, and complications.

The orchid symbiotic fungi were isolated from the roots of Korean native orchid (Cymbidium goeringu) collected and Chinese orchid (C. sinense) obtained from greenhouses. They were identified as a species of Rhizoctonia, based on the sequences of 18 r rDNA, the microscopic observations of mycelia, and the symbiotic relationships with commercial orchids. The isolate collected from Chinese orchids was revealed to be a species of Ceratobasidium endophytica, and to be different from the other isolates at the thickness of the mycelia stained in the root cells of Korean native orchids. The other isolates collected from the Korean native orchids were considered to be a species of Tulsanella repens (anamorphic: Epulorliiza repens) or its related one. The physiologic or microscopic variations were oftenly observed among them, but the tendency of grouping these in the 18s rDNA sequences were observed to be consistent with those of the localities collected. The further taxonomical segregating for Korean symbiotic fun...

Introduction: We describe laparoscopic ureterolithotomy with renal stone extraction using a stone basket under flexible ureteroscopy. We describe its efficacy through a laparoscopic port and a ureterotomy site in patients with large upper ureteral stone and small renal stones.Methods: Between January 2009 and February 2012, we performed laparoscopic ureterolithotomy with renal stone extraction using a stone basket under flexible ureteroscopy in 11 patients who had upper ureteral and renal stones. The retroperitoneal approaches were used in all patients using 3-4 trocars.Results: All procedures were performed successfully without significant complications. Mean operative time was 78.5 minutes (range: 52-114 minutes). The mean size of ureteral stone was 19.91 mm (range: 15-25 mm). In addition, 25 renal stones (mean size 7.48 mm, range: 2-12 mm) were removed from 11 patients. The mean length of hospital stay was 3.5 days (range: 2-6 days).Conclusions: Laparoscopic ureterolithotomy with renal stone extraction using a stone basket under flexible ureteroscopy can be considered one of treatment modalities for patients with large upper ureteral stones accompanied by renal stones who are indicated in laparoscopic ureterolithotomy.

Ureteral obstruction caused by a fungal ball is rare. Diabetes mellitus and immunocompromised conditions constitute the predisposing factors. Urosepsis due to unilateral ureteral obstruction with a fungal ball is extremely rare. The radiologic findings of fungal ball have been described as nonspecific. We report on a female patient with urosepsis that occurred by unilateral ureteral obstruction by a fungal ball, mimicking a ureteral stone. She was managed with systemic antibiotics, percutaneous nephrostomy, and ureteroscopic fungal ball removal.