Hyeon Woo Kim

Malignant Inflammatory Myofibroblastic Tumor of the Bladder with Rapid Progression

A 71-year-old man was referred for painless hematuria and a bladder tumor. Cystoscopy and computed tomography revealed a 3-cm oval nodular mass on the left lateral side of the bladder. The patient underwent a complete transurethral resection of the lesion and histology showed a proliferation of atypical spindle cells with inflammation consistent with a myofibroblastic tumor. After 4 and 7 months, follow-up cystoscopy demonstrated nodular mass lesions and transurethral resection of bladder tumor was done, which showed chronic cystitis and a recurred myofibroblastic tumor, respectively. Five months later, multiple lymph node, bone, and soft tissue metastases were found by positron emission tomography. The patient was treated first with palliative chemotherapy, including doxorubicin and cisplatin. After that, radiologic studies showed disease progression but the patient refused further treatment and died 6 months later.

Risk Factors for Transient Urinary Incontinence after Holmium Laser Enucleation of the Prostate

Purpose To investigate the factors associated with the occurrence of and recovery from transient urinary incontinence (TUI) after holmium laser enucleation of the prostate (HoLEP). Materials and Methods From March 2009 to December 2012, 391 consecutive patients treated with HoLEP for benign prostatic hyperplasia were enrolled. Information regarding age, prostate volume, International Prostate Symptom Score, Overactive Bladder Symptom Score, peak urinary flow rate, postvoid residual urine, and operation time was collected. TUI was defined as a patient complaint of urine leakage, regardless of type. Logistic regression was used to investigate the factors associated with the occurrence of TUI, and the Kaplan-Meier test was used to analyze the TUI recovery period. Results TUI after HoLEP occurred in 65 patients (16.6%), 52 patients of whom (80.0%) showed recovery within three months. Stress and urge urinary incontinence and postvoid dribbling occurred in 16 patients (4.1%), 29 patients (7.4%), and 33 patients (8.4%), respectively. Age (odds ratio [OR]=3.494; 95% confidence interval [CI]=1.565~7.803; p=0.002) and total operation time (OR=3.849; 95% CI=1.613~9.185; p=0.002) were factors that significantly affected the occurrence of TUI. Conclusions TUI, defined as any type of urine leakage, occurred after HoLEP in some patients, most of whom recovered within three months. Stress urinary incontinence occurred in only 4% of patients after HoLEP. Age and total operation time were associated with the occurrence of postoperative TUI.

Microelectrical Impedance Spectroscopy for the Differentiation between Normal and Cancerous Human Urothelial Cell Lines: Real-Time Electrical Impedance Measurement at an Optimal Frequency.

Purpose. To distinguish between normal (SV-HUC-1) and cancerous (TCCSUP) human urothelial cell lines using microelectrical impedance spectroscopy (μEIS). Materials and Methods. Two types of μEIS devices were designed and used in combination to measure the impedance of SV-HUC-1 and TCCSUP cells flowing through the channels of the devices. The first device (μEIS-OF) was designed to determine the optimal frequency at which the impedance of two cell lines is most distinguishable. The μEIS-OF trapped the flowing cells and measured their impedance at a frequency ranging from 5 kHz to 1 MHz. The second device (μEIS-RT) was designed for real-time impedance measurement of the cells at the optimal frequency. The impedance was measured instantaneously as the cells passed the sensing electrodes of μEIS-RT. Results. The optimal frequency, which maximized the average difference of the amplitude and phase angle between the two cell lines (p < 0.001), was determined to be 119 kHz. The real-time impedance of the cell lines was measured at 119 kHz; the two cell lines differed significantly in terms of amplitude and phase angle (p < 0.001). Conclusion. The μEIS-RT can discriminate SV-HUC-1 and TCCSUP cells by measuring the impedance at the optimal frequency determined by the μEIS-OF.

Torsion of an Indirect Hernia Sac Causing Acute Scrotal Swelling in a Child

Torsion of a hernia sac is an extremely rare condition that presents as acute scrotum in children. We report a case of a 6-year-old boy who presented with an acute scrotum and was found during surgical exploration to have torsion of an indirect hernia sac associated with hydrocele. Upon scrotal exploration, deterioration of the scrotum due to inflammatory changes was found. A necrotic cyst was recognized within a communicating hydrocele of the scrotum and was twisted at an angle of about 360°. All urologists should be aware of this special condition in the differential diagnosis of acute scrotum.

Anti-Reflux Ureteral Stent with Polymeric Flap Valve Using Three-Dimensional Printing: An In Vitro Study.

PURPOSE This article aims to describe the design of an anti-reflux ureteral stent with a polymeric flap valve and the fabrication methods using three-dimensional (3D) printing. The stent effectively prevents backward flow with a negligible reduction in forward flow. Fabrication of miniaturized valves was easy with high precision and rapid prototyping. MATERIALS AND METHODS The proposed stent comprised a 7F Double-J (DJ) stent and a polymeric flap valve. The valve was made of Tango Plus FLX980 and was fabricated using a 3D printer. Two types of stent were prepared for in vitro tests: DJ stents with (1) an uncoated valve (UCV) stent and (2) a parylene C coated valve (PCV) stent for enhanced biocompatibility. The flow characteristics of each stent were evaluated considering flow direction, parylene coating, and stent side holes, and were compared to the intact DJ stent. RESULTS The forward flow rate for the distal portion of the UCV and PCV stents was 9.8 mL/min and 7.8 mL/min at applied pressure of 15 cm H2O (normal anterograde pressure in patients with stents), respectively. Backward flow rate for the distal portion of the UCV and PCV stents was decreased by 28 times and 8 times at applied pressure of 50 cm H2O (maximum bladder pressure), respectively, compared with the distal portion of the intact DJ stent. Forward flow rates of whole stents were 22.2 mL/min (UCV stent) and 20.0 mL/min (PCV stent) at applied pressure of 15 cm H2O, and backward flow rates of whole UCV and PCV stents were decreased by 8.3 times and 4.0 times at applied pressure of 50 cm H2O, respectively, compared with the intact DJ stent. CONCLUSIONS The anti-reflux ureteral stent was successfully designed and fabricated using a 3D printer. In vitro studies showed that the stent effectively prevented backward flow while minimizing reduction in forward flow.

Ex vivo characterization of age-associated impedance changes of single vascular endothelial cells using micro electrical impedance spectroscopy with a cell trap

We aimed to characterize aging of single vascular endothelial cells, which are indicators of senescence, using micro electrical impedance spectroscopy (μEIS) for the first time. The proposed μEIS was equipped with two barriers under the membrane actuator near the sensing electrodes, increasing its cell-trapping capability and minimizing the interference between the target cell and subsequent cells. The cell-trapping capability in μEIS with barriers was considerably improved (90%) with a capture time of 5 s or less, compared to μEIS without barriers (30%). Cells were extracted from transgenic zebrafish to minimize an initial discrepancy originating from genetic differences. In order to estimate useful parameters, cytoplasm resistance and membrane capacitance were estimated by fitting an electrical equivalent circuit to the data of ex vivo sensor output. The estimated cytoplasm resistance and membrane capacitance in the younger vascular endothelial cells were 20.16 ± 0.79 kΩ and 17.46 ± 0.76 pF, respectively, whereas those in the older cells were 17.81 ± 0.98 kΩ and 20.08 ± 1.38 pF, respectively. Discrimination of each group with different aging showed statistical significance in terms of cytoplasm resistance (p < 0.001) and membrane capacitance (p < 0.001). Considering both of the sensor and cellular level, the optimal frequency was determined as 1 MHz at which the electrical impedance of each group was clearly discriminated (p < 0.001).

Primary undifferentiated penile sarcoma in adolescence.

We report a case of primary penile undifferentiated sarcoma. A 16-year-old adolescent man visited Pusan National University Hospital complaining of a painless mass on his penis that was increasing in size. Magnetic resonance images revealed a 5×5-cm mass and pathological examinations revealed small round cell sarcomas with neuroendocrine differentiation. The tumor, which had metastatic pulmonary nodules, was treated by tumorectomy and systemic chemotherapy. Thirty-four months after the initial diagnosis, the patient was still alive without evidence of local recurrence or metastatic disease. This is our second case of an undifferentiated penile sarcoma.

Improvement of Depth Profiling into Biotissues Using Micro Electrical Impedance Spectroscopy on a Needle with Selective Passivation.

A micro electrical impedance spectroscopy (EIS)-on-a-needle for depth profiling (μEoN-DP) with a selective passivation layer (SPL) on a hypodermic needle was recently fabricated to measure the electrical impedance of biotissues along with the penetration depths. The SPL of the μEoN-DP enabled the sensing interdigitated electrodes (IDEs) to contribute predominantly to the measurement by reducing the relative influence of the connection lines on the sensor output. The discrimination capability of the μEoN-DP was verified using phosphate-buffered saline (PBS) at various concentration levels. The resistance and capacitance extracted through curve fitting were similar to those theoretically estimated based on the mixing ratio of PBS and deionized water; the maximum discrepancies were 8.02% and 1.85%, respectively. Depth profiling was conducted using four-layered porcine tissue to verify the effectiveness of the discrimination capability of the μEoN-DP. The magnitude and phase between dissimilar porcine tissues (fat and muscle) were clearly discriminated at the optimal frequency of 1 MHz. Two kinds of simulations, one with SPL and the other with complete passivation layer (CPL), were performed, and it was verified that the SPL was advantageous over CPL in the discrimination of biotissues in terms of sensor output.

Micro electrical impedance spectroscopy on a needle for ex vivo discrimination between human normal and cancer renal tissues

The ex-vivo discrimination between human normal and cancer renal tissues was confirmed using μEoN (micro electrical impedance spectroscopy-on-a-needle) by measuring and comparing the electrical impedances in the frequency domain. To quantify the extent of discrimination between dissimilar tissues and to determine the optimal frequency at which the discrimination capability is at a maximum, discrimination index (DI) was employed for both magnitude and phase. The highest values of DI for the magnitude and phase were 5.15 at 1 MHz and 3.57 at 1 kHz, respectively. The mean magnitude and phase measured at the optimal frequency for normal tissues were 5013.40 ± 94.39 Ω and -68.54 ± 0.72°, respectively; those for cancer tissues were 4165.19 ± 70.32 Ω and -64.10 ± 0.52°, respectively. A statistically significant difference (p< 0.05) between the two tissues was observed at all the investigated frequencies. To extract the electrical properties (resistance and capacitance) of these bio-tissues through curve fitting with experimental results, an equivalent circuit was proposed based on the μEoN structure on the condition that the μEoN was immersed in the bio-tissues. The average and standard deviation of the extracted resistance and capacitance for the normal tissues were 6.22 ± 0.24 kΩ and 280.21 ± 32.25 pF, respectively, and those for the cancer tissues were 5.45 ± 0.22 kΩ and 376.32 ± 34.14 pF, respectively. The electrical impedance was higher in the normal tissues compared with the cancer tissues. The μEoN could clearly discriminate between normal and cancer tissues by comparing the results at the optimal frequency (magnitude and phase) and those of the curve fitting (extracted resistance and capacitance).

Mirabegron as a treatment for overactive bladder symptoms in men (MIRACLE study): Efficacy and safety results from a multicenter, randomized, double-blind, placebo-controlled, parallel comparison phase IV study

To evaluate the efficacy and safety of mirabegron in males with overactive bladder (OAB) symptoms.