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Purpose The aim of this study was to compare the body images of patients who underwent radical cystectomy with an orthotopic ileal neobladder or an ileal conduit. Materials and Methods A total of 114 adult patients who underwent radical cystectomy between March 2006 and December 2012 at a single institution, Ewha Womans University Mokdong Hospital in Korea, were evaluated in this retrospective chart-review study. Forty-two patients (29 orthotopic ileal neobladder and 13 ileal conduit) who completed questionnaires were included in the final analysis; the remaining patients were excluded. The patients were assessed with two questionnaires: the Korean version of the Body Image Scale (K-BIS) and the self-designed questionnaire. Results The results did not differ significantly by age at surgery, time from surgery to survey, pathologic stage, grade, histologic subtype, education, residency, or Eastern Cooperative Oncology Group performance status, but did differ significantly by age at survey and sex. The mean summary score for K-BIS showed significant differences between the two groups (p=0.001). We found that patients who underwent an orthotopic ileal neobladder had a significantly better body image. The self-designed questionnaire score was not significantly different between the two groups (p=0.572). Conclusions In our retrospective analysis, patients who underwent orthotopic ileal neobladder had a superior body image compared with those who underwent an ileal conduit.

INTRODUCTION AND OBJECTIVES: We have previously demonstrated in animal models that priapism is associated with upregulated expression of the opiorphin gene in corporal smooth muscle (CSM) tissue. In this study we have examined if hypoxia is a determining factor for up-regulated opiorphin expression in CSM, and if the up-regulation of opiorphin regulates other pathways associated with development of priapism. The hypothesis that vascular occlusion and ischemia is a mechanism for the development of vascular diseases associated with sickle cell disease dates back to 1948, although most recent studies have considered priapism to be a result from an imbalance between the “relaxant” and “constrictor” pathways causing heightened relaxation of CSM. METHODS: We have used an in vitro model of hypoxia to determine the genes expression in rat CSM of the rat opiorphin homologue (sialorphin, encoded by the vcsa1 gene) and two other genes associated with the development of priapism (adenosine 2 binding receptor, a2br, and hypoxia induced factor 1a, hif1a). We have looked at the expression of these genes in the CSM from a pre-priapic and priapic sickle cell mouse model. RESULTS: We demonstrate that hypoxia causes up-regulated expression of vcsa1, a2br and hif1a in CSM cells. However, when these cells are pretreated with siRNA against vcsa1 then hypoxia-induced upregulation of a2br and hif1a expression is prevented, suggesting that vcsa1 is important in the regulation of these genes. In the CSM of sickle cell mice the mouse opiorphin homologue is up-regulated in a pre-priapic life stage. The early up-regulation of the mouse opiorphin suggests that this is a response to the hypoxic conditions resulting from sickle cell disease rather than a response to priapism. CONCLUSIONS: Overall our results suggest that sickle cell disease causes hypoxia/ischemia in CSM tissue, resulting in increased opiorphin expression. Opiorphin then acts as a master regulator of compensatory smooth muscle “relaxant” pathways. It is the excessive activation of these “relaxant” pathways that results in priapism. In many aspects this hypothesis connects the 60 year old hypothesis that ischemia associated with sickle cell disease is a mechanism for the development of vascular diseases to the more recent studies where activation of relaxant pathways in corporal tissue are considered a primary mechanism for the development of priapism.

We investigated the functional and histological changes after oophorectomy in the rabbit clitoris and vagina to determine the mechanism responsible for the development of arousal disorder in postmenopausal women. Twenty mature female New Zealand white rabbits were randomly divided into three groups: control; oophorectomy; and estrogen replacement after oophorectomy. We compared the nitric oxide synthase (NOS) activity and the degree of expression of neuronal (nNOS) and endothelial NOS (eNOS) using biochemical and Western blot analysis in clitoral and vaginal tissues. Histological change of smooth muscle and collagen contents in those tissues were also compared using Masson's trichrome staining. NOS activity and the expression of nNOS and eNOS were significantly increased in the oophorectomized group while there was a decrease to the level of the control group in the estrogen replacement group. Histological examination showed that oophorectomy induced a significant increase in collagen and decrease in muscle content in both clitoris and vagina, while the ratio of smooth muscle content was increased significantly after the estrogen replacement. Our results clearly demonstrate that estrogen deficiency induces compensatory NOS production which may be related to decreases in muscle to collagen ratio in female rabbit genital organs.

Purpose: Because acute bacterial prostatitis (ABP) is an urgent condition of the prostate but prostatic massage is contraindicated at the onset of ABP, clinical symptoms and urine tests are used for diagnosis. In this study, we compared the clinical symptoms and treatment outcomes of patients with negative urine culture results, to whom only empirical antibiotics were administered, with those of patients with positive urine culture results. Materials and Methods: Patients were divided into two groups according to the results of urine culture. Then, the clinical symptoms and course of each group were analyzed. In addition, age, symptoms, antibiotics, mean inpatient and outpatient length of treatment, and the treatment outcome of each group were also analyzed. Results: Of the total 144 patients, the positive urine culture group consisted of 51 patients (35.4%) and the most frequent bacterial strain causing ABP was reported to be Escherichia coli. Fever and storage symptoms were significantly more common in the positive urine culture group than in the negative urine culture group (p=0.031 and 0.047, respectively). Only inpatient treatment was significant longer in the positive urine culture group than in the negative urine culture group (p＜0.05). The mean length of treatment of inpatients was 4.8±2.6 days and 6.2±2.9 days in the two groups, respectively. No sequelae such as prostatic abscess or chronic prostatitis were found in either group. Conclusions: In the treatment of ABP, the use of empirical antibiotics can be expected to have sufficient effects regardless of bacterial culture. However, it is hard to determine the causative bacteria of ABP by urine culture results only.

Purpose: The change in arterial flow velocity with age in patients with a normal response to pharmacological injection was evaluated.Materials and Methods: We studied 64 patients with erectile dysfunction who responded well to intracavernous injection of 10 micro g. prostaglandin E1 with well sustained penile rigidity for longer than 1 hour and normal cavernous arterial flow velocities on color Doppler ultrasonography. The men were classified into 4 groups according to age younger than 30 years, and 30 to 39, 40 to 49 and 50 years old or older. Flow parameters were compared.Results: The statistically significant decreasing tendency of peak systolic velocity with age was revealed by a simple regression test (p = 0.003). The greatest decrease was observed between patients in the third and fourth decades. When comparing the peak systolic velocity according to timing of measurement, the greatest velocities occurred at later measurements after the fifth decade, while in younger patients these values we...

This study was undertaken to investigate whether prolonged stress interferes with sexual behavior and changes biochemical and physiologic mechanisms. Experiments were repeated three times with different rats in each period. In all, 63 female Sprague–Dawley rats were employed, with 21 rats in each period, and the control group was maintained at room temperature with free access to food and water. The stress group was maintained under a scheduled stress condition for 10 days, and seven rats from the group were randomly selected and exposed to the control environment for 10 days as the recovery group. Sexual behavior, hormonal values, and neuronal and endothelial nitric oxide synthase (nNOS and eNOS) expressions of vaginal tissue were analyzed and compared. Serum testosterone levels were significantly elevated in the stress and recovery groups (P

To evaluate the penodynamic impact of known vascular risk factors in men with erectile dysfunction, we obtained thorough medical histories covering diabetes, hypertension, heart disease and hypercholesterolemia, alcohol ingestion, and smoking in 265 consecutive patients. We also measured their penile hemodynamic parameters by color duplex ultrasonography after intracavernous prostaglandin E1 injection. In patients with vascular risk factors there was a statistically significant decrease in the peak systolic velocity and increase in the end-diastolic velocity of the cavernosal artery (P < 0.01). Those men who had diabetes had higher average end-diastolic velocities and lower resistance indices (P < 0.01). Smoking and alcohol use also affected penile hemodynamics (P < 0.05). These data confirm that vascular risk factors do increase the likelihood of vasculogenic impotence and that diabetes plays a major role in veno-occlusive dysfunction in the penis.

We conducted a study to evaluate the impact of obesity on erectile function in men with erectile dysfunction.Three hundred and twenty-five consecutive patients with erectile dysfunction were evaluated. We classified the men into 2 groups according to body weight:120% of the ideal body weight, and/=120%. We compared several erectile capacities and the findings of penile duplex ultrasonography.There was a statistically significant decrease in the quality of residual erectile function in patients with obesity (penile rigidity grade 1.32 versus 1.62 in the nonobese patients). Obese patients also have an increased prevalence of vascular risk factors based on a review of the medical records and vascular impairment by duplex ultrasound study (43 and 62% in the obese patients versus 30 and 42% in the nonobese patients, respectively, p0.05). However, when we focused only on the patients without any vascular risk factors, no significant difference between the 2 groups was noted in the quality of residual erectile function and also the prevalence of penile vascular impairments (p0.05).These data demonstrate that obesity in itself does not seem to be an underlying factor, but does impose a risk to vasculogenic impotence by developing chronic vascular disease.

Bladder cancer is the second most common malignancy in urological field. Most new cases are diagnosed as non-muscle invasive bladder cancer (NMIBC), which includes Ta, T1 or carcinoma in situ. Initial management of NMIBC is endoscopic resection, which allows both treatment and pathological staging. Urologist should consider adjuvant intravesical chemotherapy or Bacillus Calmette-Guerin (BCG) immunotherapy, depending on the tumor grade or stage to prevent recurrence and progression. Patients with muscle invasive bladder cancer (MIBC) are best treated with radical cystectomy. However, radical cystectomy should be considered even in patients with NMIBC with high risk of progression and BCG refractory tumors. Delay of radical cystectomy in these patients might lead decreased disease specific survival. Patients treated by radical cystectomy should undergo any form of the urinary diversion. Ileal conduit is still most common method for urinary diversion. Orthotopic neobladder is generally performed by experienced hands in high volume center. Patients undergoing orthotopic neobladder should be educated and manually skillful to manipulate their diversion. Neoadjuvant cisplatin-based chemotherapy is recommended based on level 1 evidence with survival benefit. Recent updated meta-analysis also demonstrated survival benefit in patients with MIBC treated by adju

Purpose We aimed to determine the treatment of choice criteria for benign prostatic hyperplasia (BPH) by analyzing the factors causing alpha-adrenergic receptor blocker (α-blocker) monotherapy failure. Materials and Methods This retrospective study enrolled 129 patients with BPH who were prescribed an α-blocker. Patients were allocated to a transurethral resection of prostate (TURP) group (after having at least a 6-month duration of medication) and an α-blocker group. We compared the differences between the two groups for their initial prostate volume, serum prostate-specific antigen (PSA), maximum urinary flow rate (Qmax), International Prostate Symptom Score (IPSS), and postvoid residual urine volume (PVR). Results Of the 129 patients, 54 were in the TURP group and 75 were in the α-blocker group. Statistically significant differences (p

Purpose: To clarify whether vardenafil can be used as a substitute for intracavernosal injection as a method of induction of penile erection, we compared the outcome of penile duplex Doppler ultrasonography using both methods in the same patient with erectile dysfunction. Materials and Methods: A total of 23 patients underwent penile duplex ultrasonography twice with a one week interval between procedures. Twelve were randomly selected for intracavernosal injection first with prostaglandin E1 (PGE1) 20μg and the remaining 11 were initially treated with oral vardenafil 20mg 1 hour before the Doppler study and in addition had visual sexual stimulation using a head-mounted display during the study. The peak systolic velocity (PSV), end diastolic velocity (EDV) and the degree of maximum erectile response were measured and compared between the two groups. Results: Measurements from the PGE1 treatment were not significantly different from those with the vardenafil treatment. The percentage of compatibility between the two methods with regard to hemodynamic diagnosis and pharmaceutical erectile response was as high as 83% (19 of 23) and 91% (21 of 23), respectively. Both methods were tolerable and safe without severe complications. However, in 4 patients where the diagnosis was uncertain, the injection method provided a more accurate interpretation of the penile vascular status with duplex ultrasonography. Conclusions: These results suggest that oral vardenafil can be used as an initial method for inducing penile erection when assessing erectile dysfunction with penile duplex Doppler ultrasonography in selected patients with erectile dysfunction. (Korean J Urol 2008;49:641-646) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: We evaluated the effectiveness of tamsulosin on the expectant treatment for the patients suffering with lower ureteral stones. Materials and Methods: A total of 67 patients with stones less than 5mm that were located in the lower ureter were enrolled in the study. The patients were randomly divided into two groups. Group 1 (n=32) received 20mg caroverine (a spasmolytic drug) orally three time a day. Group 2 (n=35) received 0.2mg tamsulosin orally one time a day. The treatment was continued until expulsion of stone or to a maximum of 28 days. All patients were allowed 30mg ketorolac trimethamine intramuscular injections on demand. We compared the two groups for stone size, the expulsion rate, the time to expulsion and use of analgesics. Results: The average stone size was 4.3±0.61mm for group 1 and 4.4± 0.51mm for group 2. No statistical difference between two groups was found for stone size, age and sexual distribution. The expulsion rate was significantly higher in group 2 (82.8%), compared with group 1 (53.1%) (p=0.002). The mean expulsion time was 8.3 days for group 1 and 4.6 days for group 2 (p