Jun Cheon

Human glans penis augmentation using injectable hyaluronic acid gel

Although augmentation phalloplasty is not an established procedure, some patients still need enlargement of their penis. Current penile augmentation is girth enhancement of penile body by dermofat graft. We performed this study to identify the efficacy and the patient’s satisfaction of human glans penis augmentation with injectable hyaluronic acid gel. In 100 patients of subjective small penis (Group I) and 87 patients of small glans after dermofat graft (Group II), 2u2009cm3 of hyaluronic acid gel was injected into the glans penis, subcutaneously. At 1u2009y after injection, changes of glandular diameter were measured by tapeline. Patient’s visual estimation of glandular size (Gr 0–4) and patient’s satisfaction (Grade (Gr) 0–4) were evaluated, respectively. Any adverse reactions were also evaluated. The mean age of patients was 42.2 (30–70)u2009y in Group I and 42.13 (28–61)u2009y in Group II. The maximal glandular circumference was significantly increased compared to basal circumference of 9.13±0.64u2009cm in Group I (P<0.01) and 9.49±1.05u2009cm in Group II (P<0.01) at 1u2009y after injection. Net increase of maximal glandular circumference after glans augmentation was 14.93±0.80u2009mm in Group I and 14.78±0.89u2009mm in Group II. In patient’s visual estimation, more than 50% of injected volume was maintained in 95% of Group 1 and 100% of Group II. The percentage of postoperative satisfaction (Gr 4, 5) was 77% in Group 1 and 69% in Group II. There was no abnormal reaction in area feeling, texture, and color. In most cases, initial discoloration by glandular swelling recovered to normal within 2 weeks. There were no signs of inflammation and no serious adverse reactions in all cases. These results suggest that injectable hyaluronic acid gel is a safe and effective material for augmentation of glans penis.

Bisphenol A inhibits penile erection via alteration of histology in the rabbit

Despite extensive research into the toxicity of bisphenol A (BPA), no report of its effect on erectile function exists. We performed this study to investigate the effect of BPA on erectile function. New Zealand white rabbits were treated intraperitoneally with 150u2005mg/kg of BPA every other day for 12 days (cumulative dose of 900u2005mg/kg). Four and 8 weeks after administration of BPA, the contractions and relaxation of cavernosal tissue strips were significantly suppressed in the BPA-treated animals compared to the control animals. Histologically, thickening of tunica albuginea, subtunical deposition of fat and decreased sinusoidal space with consequent increase of trabecular smooth muscle content were observed in the BPA-treated animals. These results suggest that xenoestrogen BPA may affect the erectile function through evident histological changes of the penis.

Predictive Factors for Acute Renal Cortical Scintigraphic Lesion and Ultimate Scar Formation in Children With First Febrile Urinary Tract Infection

PURPOSEnWe assessed predictive factors for acute renal cortical scintigraphic lesion and ultimate scar formation in children with a first febrile urinary tract infection.nnnMATERIALS AND METHODSnA total of 89 girls and 138 boys with a first febrile urinary tract infection were included in the study. We analyzed radiological (ultrasound, dimercapto-succinic acid scintigraphy, voiding cystourethrogram), clinical (age, gender, peak fever, therapeutic delay time) and laboratory (complete blood count with differential count, absolute neutrophil count, blood urea nitrogen, creatinine, urinalysis, Grams stain, culture, C-reactive protein, erythrocyte sedimentation rate) variables. Dimercapto-succinic acid scintigraphy was performed within 5 days and at 6 months after diagnosis of urinary tract infection. Voiding cystourethrogram was performed after the acute phase of the urinary tract infection. Predictive factors for acute scintigraphic lesion and ultimate scar formation were assessed using logistic regression analysis.nnnRESULTSnOf 227 patients enrolled 140 had a refluxing and 87 a nonrefluxing urinary tract infection. On logistic regression analysis therapeutic delay time (p = 0.001) and presence of reflux (p = 0.011) were predictive of acute scintigraphic lesion and ultimate scar formation (p = 0.001 and p = 0.0001, respectively) in children with a first febrile urinary tract infection.nnnCONCLUSIONSnSince vesicoureteral reflux is the common risk factor for acute scintigraphic lesion and ultimate scar formation, voiding cystourethrogram must be considered as an initial study in patients with acute febrile urinary tract infection.

Is There a Correlation Between the Presence of Idiopathic Detrusor Overactivity and the Degree of Bladder Outlet Obstruction

OBJECTIVEnTo assess the factors associated with the presence of idiopathic detrusor overactivity (IDO) in male patients with clinical benign prostatic hyperplasia (BPH).nnnMATERIALS AND METHODSnWe prospectively evaluated 193 men who presented with lower urinary tract symptoms. Each patient underwent urodynamic evaluation, International Prostate Symptom Score (IPSS), uroflowmetry, residual volume check, and transrectal ultrasound for estimation of prostate volume. IDO was defined according to the new International Continence Society classification (2002) as involuntary detrusor contractions during cystometry, which may be spontaneous or provoked, regardless of amplitude. Patients were divided into groups according to the presence of detrusor overactivity and bladder outlet obstruction index (BOOI) greater than 40. Variables associated with the presence of IDO were analyzed using Students t-test, chi-square test, linear-by-linear association test, and logistic regression analysis.nnnRESULTSnOf 193 patients, IDO was present in 49 (25.4%). BOOI and prostate volume showed significant but weak correlation. On univariate analysis, patients with IDO were older and showed smaller maximal bladder capacity (MBC), higher BOOI, higher maximal detrusor pressure at maximal flow rate, and higher irritative IPSS subscores. On logistic regression analysis, MBC and BOOI were the factors affecting the presence of IDO, with odds ratios of 0.981 and 1.046, respectively. Positive linear association was noted between BOOI and prevalence of DO by linear association test with prevalence of DO rising continuously with increasing BOOI.nnnCONCLUSIONnBOO is responsible for IDO and because the prevalence of IDO is inversely associated with the degree of obstruction, the treatment of BOO is potentially able to reverse the DO.

In vivo characterization of a prostate-specific antigen promoter-based suicide gene therapy for the treatment of benign prostatic hyperplasia.

To develop a novel gene therapeutic modality for the effective treatment of benign prostatic hyperplasia (BPH), we investigated the properties of toxic gene therapy utilizing prostate-specific antigen (PSA) promoter driving herpes simplex virus thymidine kinase (HSV-TK) suicide gene to induce highly selective molecular ablation of epithelial cells with minimal systemic toxicity in canine prostate. Replication-defective recombinant adenoviral vectors containing HSV-TK gene under transcriptional control of long PSA promoter (Ad-PSA-HSV-TK) were developed and delivered in an situ manner. Briefly, laparotomies were performed and Ad-PSA-HSV-TK (1 × 109u2009PFUs) was injected into the left lateral lobe of prostate only on days 1 and 7 with appropriate prodrug acyclovir in adult Beagle dogs. The therapeutic efficacy was evaluated on the 56th experimental day. The striking apoptosis of epithelial cells was identified in the treated left half of canine prostate on TUNEL assay. On immunohistochemical studies, there was markedly decreased number of PSA-secreting epithelial cells compared to control. Also significant atrophy of prostate glands, associated with dense infiltration of lymphocytes and plasma cells, was identified in the treated side. The PSA promoter-based suicide gene therapy induced highly selective and definite ablation of epithelial cells in benign canine prostate. Our novel approach could open opportunity of gene therapeutic modality for the treatment of clinical BPH.

Comparison of the efficacy and safety of 5-mg once-daily versus 5-mg alternate-day tadalafil in men with erectile dysfunction and lower urinary tract symptoms

The purposeof this study is to investigate and compare the effects of 5-mg once-daily tadalafil versus 5-mg alternate-day tadalafil in men with moderate-to-severe erectile dysfunction (ED) and lower urinary tract symptoms (LUTS). Between January 2012 and June 2013, 144 men presenting with an International Index of Erectile Function-5 (IIEF-5) score of <18 and an International Prostate Symptom Score (IPSS) of >8 were enrolled to the study. Patients were allocated the simple alternate randomization into Group I (5-mg once-daily tadalafil) and Group II (5-mg alternate-day tadalafil). Changes in IIEF scores, Sexual Encounter Profile Question 3 (SEP Q3) percentage, IPSS, uroflowmetry and post void residual at the first visit (V1), week 4 (V2) and week 12 (V3) were compared. No significant difference was found between the baseline patient characteristics of Group I and Group II. Treatment with 5-mg daily tadalafil demonstrated improvement in IIEF, SEP Q3 percentage and IPSS score between V1 and V2, and that between V1 and V3. Patients receiving 5-mg alternate-day tadalafil also showed a significant improvement in IIEF, SEP Q3 percentage, and IPSS score between V1 and V2, and that between V2 and V3. However, no significant improvements were found in any other parameters. There were no significant differences between Group I and Group II apart from IIEF scores in V2 (19.4 versus 17.9, respectively). The SEP Q3 percentage was also higher at the V2 visit for Group I and Group II (35.6 versus 30.9%). Even with no placebo control and short of LUTS medication control, the use of 5-mg once-daily or alternate-day treatment with tadalafil was well tolerated in patients and effectively improved the IIEF score, IPSS score and SEP Q3 percentage. Management of patients with 5-mg alternate-day tadalafil could be adequate for regular use in patients with ED and LUTS.

Differences in Urodynamic Parameters Between Women With Interstitial Cystitis and/or Bladder Pain Syndrome and Severe Overactive Bladder

OBJECTIVEnTo identify differences in urodynamic parameters between female outpatients with interstitial cystitis (IC) and/or bladder pain syndrome (BPS) and severe overactive bladder (OAB).nnnMATERIALS AND METHODSnThis cross-sectional study included 24 and 28 consecutive IC/BPS and severe OAB female patients, respectively. IC/BPS was defined based on the American Urological Association guideline, and severe OAB was defined based on baseline symptoms recorded in a voiding diary. Before treatment, symptom assessment using questionnaires and a 3-day voiding diary, as well as laboratory tests, were performed at the initial visit. The patients baseline characteristics and urodynamic parameters were compared between the IC/BPS and severe OAB groups.nnnRESULTSnThe IC/BPS group showed fewer episodes of urge incontinence and shorter duration of symptoms than the severe OAB group (Pu2009=u2009.019, Pu2009=u2009.017, respectively). Volumes at first sense, normal desire, strong desire, and maximal capacity during filling cystometry (MBC) were significantly higher in the severe OAB group than in the IC/BPS group (Pu2009<.001, Pu2009<.001, Pu2009=u2009.006, Pu2009<.001, respectively). The IC/BPS and severe OAB groups showed significant differences in urodynamic parameters in terms of MBC and the volume discrepancy between MBC and maximal voided volume (Pu2009<.001, both). The receiver operating characteristic curve also showed an area under the curve of 0.760 and 0.783 for MBC and volume discrepancy, respectively (both Pu2009<.001).nnnCONCLUSIONnData from our study suggest that combined with other clinical findings, urodynamic studies could provide useful information to differentiate between a diagnosis of IC/BPS or severe OAB.

Predictive Validation of a Robotic Virtual Reality Simulator: The Tube 3 module for Practicing Vesicourethral Anastomosis in Robot-Assisted Radical Prostatectomy

OBJECTIVEnTo predict actual performance in real surgery when vesicourethral anastomosis (VUA) is performed in patients after Tube 3 module training of robot-naive surgeons.nnnMETHODSnForty-five patients were enrolled and divided into 3 groups according to chronological trends (each containing 15 patients). Three robot-naive surgeons in a single center completed VUA in robot-assisted radical prostatectomy (RARP) following robotic virtual reality simulator (RVRS) training. The practicing tool used in robotic virtual reality simulator was Tube 3, which was invented for the dV-Trainer that imitates a VUA in RARP. The effects of performance were investigated by analyzing the number of repetitions and the time required to complete the task until achieving the predetermined proficiency level.nnnRESULTSnThe targeted time (predetermined proficiency level) for completing tasks of Tube 3 and the number of required task repetitions to achieve the proficiency level were 283.1 s and 36 times, respectively, whereas in actual VUA procedures, the number of required attempts was 24, with an average time of 14.9 minutes. The mean time for completing VUA in real surgery significantly decreased with serial cases among all surgeons (1-15 vs 16-30 vs 31-45 cases, P <.001), as well as comparisons between groups (P <.001).nnnCONCLUSIONnThe Tube 3 module can represent a valuable educational tool for procedure-specific robotic training by bridging the gap between safe acquisition of surgical skills and effective performance during actual VUA in RARP.