Comparison of penile length at 6-24 months between children with unilateral cryptorchidism and a healthy normal cohort

Purpose

Urologic diseases affected by testosterone can be associated with smaller penis size compared to the normal population. We sought to compare penile length in children with unilateral cryptorchidism and normative data from a cohort of healthy Korean boys.

Materials and Methods

This study was performed in 259 Korean boys (212, normal cohort; 47, cryptorchidism) aged 6-24 months, each of whom had been brought to an outpatient clinic at one of five tertiary hospitals (Gyeongsangnam-do Province) between April 2014 and June 2015. Penile length was measured via stretched penile length (SPL) and testicular size was measured using orchidometry (mL).

Results

SPL in children with cryptorchidism was significantly shorter compared to a cohort of healthy Korean boys aged 6-24 months (3.7±0.5 cm and 4.3±0.8 cm, p<0.001), although there were no differences with regard to height, body weight and contralateral testicular size between the two groups. According to the stratified ages (6-12, 12-18, and 18-24 months), SPL in children with cryptorchidism was persistently shorter at their ages than those without.

Conclusions

It might be that the penile length aged 6-24 months of children with unilateral cryptorchidism is shorter than that of a cohort of healthy Korean boys.

Efficacy and Tolerability of Solifenacin 5 mg Fixed Dose in Korean Children with Newly Diagnosed Idiopathic Overactive Bladder: a Multicenter Prospective Study

We investigated the efficacy and tolerability of solifenacin 5 mg fixed dose in children with newly diagnosed idiopathic overactive bladder (OAB). A total of 34 children (male/female patients = 16/18) aged under 13 years (mean age: 7.2 ± 2.3; range: 5-12) who were newly diagnosed with OAB from January 2012 to September 2014 were prospectively evaluated with open-label protocol. All patients were treated with solifenacin 5 mg fixed dose once daily for at least 4 weeks. The efficacy and tolerability of solifenacin were evaluated 4, 8, and 12 weeks after the initiation of treatment. The mean voiding frequency during daytime was decreased from 9.4 ± 3.0 to 6.5 ± 2.3 times after the 12-week treatment (P < 0.001). The mean total OAB symptom score (OABSS) decreased from 7.7 ± 4.2 to 3.1 ± 3.1 after the 12-week treatment (P < 0.001). The urgency and urgency urinary incontinence (UUI) domains significantly improved from the 12-week treatment, and complete resolution of urgency occurred in 38.9% of patients and the percentage of children with UUI among urgent patients decreased from 79.4% to 57.1%. According to 3-day voiding diaries, the average bladder capacity increased from 90.4 ± 44.4 to 156.2 ± 67.3 mL (P < 0.001). Drug-induced adverse effects (AEs) were reported in 7 patients (20.6%). Our results indicate that solifenacin 5 mg fixed dose is effective against OAB symptoms, and its tolerability is acceptable without significant AEs in children with OAB.

The Change of Stretched Penile Length and Anthropometric Data in Korean Children Aged 0-14 Years: Comparative Study of Last 25 Years

There has been a great improvement in height and weight of Korean children owing to economic development over the last 25 years. This study aimed to evaluate the penile length of Korean children today and to compare it with a previous Korean study reported in 1987. The cross-sectional study was conducted with 909 Korean boys aged 0-14 years who had been brought to outpatient clinics of five tertiary hospitals (Busan, Ulsan, and Changwon) between September 2013 and May 2015. The stretched penile length (SPL) was measured and the testicular size was measured using orchidometry (mL). Student's t-test or Mann-Whitney U test was used to compare the result of our study and the study reported in 1987. SPL of Korean children gradually increased from 4.1 ± 0.8 cm at 0-1 year old to 9.6 ± 3.0 cm at 13-14 years old, the most rapidly during the age of 13. While body weight and testicular size significantly increased from 1987 in most of age groups, there were no significant changes in SPL although there was in some age groups. Height decreased in the infants < 1 year old and increased in the children > 6 years old. With the great economic development over the last quarter century in Korea, height, body weight, and testicular size of children significantly increased but there was no significant change in SPL except penile growth pattern.

Penile length, digit length, and anogenital distance according to birth weight in newborn male infants

PURPOSE

Anogential distance (AGD) and the 2:4 digit length ratio appear to provide a reliable guide to fetal androgen exposure. We intended to investigate the current status of penile size and the relationship between penile length and AGD or digit length according to birth weight in Korean newborn infants.

MATERIALS AND METHODS

Between May 2013 and February 2014, among a total of 78 newborn male infants, 55 infants were prospectively included in this study. Newborn male infants with a gestational age of 38 to 42 weeks and birth weight>2.5 kg were assigned to the NW group (n=24) and those with a gestational age<38 weeks and birth weight<2.5 kg were assigned to the LW group (n=31). Penile size and other variables were compared between the two groups.

RESULTS

Stretched penile length of the NW group was 3.3 ± 0.2 cm, which did not differ significantly from that reported in 1987. All parameters including height, weight, penile length, testicular size, AGD, and digit length were significantly lower in the LW group than in the NW group. However, there were no significant differences in AGD ratio or 2:4 digit length ratio between the two groups.

CONCLUSIONS

The penile length of newborn infants has not changed over the last quarter century in Korea. With normal penile appearance, the AGD ratio and 2:4 digit length ratio are consistent irrespective of birth weight, whereas AGD, digit length, and penile length are significantly smaller in newborns with low birth weight.

Significance of an endoscopically injected nodule detected on ultrasound as a predictive factor for the resolution of vesicoureteral reflux

Endoscopic treatment of vesicoureteral reflux (VUR) is feasible in pediatric patients. As endoscopic injection has a lower success rate than ureteral reimplantation, a postoperative voiding cystourethrogram (VCUG) is usually performed. The present study evaluated whether the presence of a nodule on noninvasive ultrasound could predict the resolution of VUR and replace invasive VCUG. Patients who received an injection of endoscopic bulking agent for VUR from January 2005 to December 2010 were evaluated retrospectively. It was evaluated whether a nodule, an echogenic mass lesion distinguished from the bladder at the ureteral orifice, was present on the ultrasound one month postoperatively. The success of the injection in the group with nodules was compared with that of the group without nodules by VCUG 3 months postoperatively. A total of 149 patients (220 ureters) met the inclusion criteria. The mean age at surgery was 3.5 years (range, 0.6–18 years). The overall success rate was 73.2%. A nodule was present in 152 cases (69.1%). The group with nodules had a higher success rate than the group without nodules (84.2%, 128/152 vs. 48.5%, 33/68, respectively; P<0.001). According to multivariate analysis, injection nodules were a predictive factor for the success of the endoscopic injection (odds ratio, 6.050; P<0.001). The failure rate increased with increasing injection volume. The sensitivity of sonographic injection nodules for predicting success was 79.5% and the specificity was 59.3%. To conclude, the presence of a postoperative nodule can predict the resolution of VUR.

Erratum: efficacy and tolerability of anticholinergics in korean children with overactive bladder: a multicenter retrospective study

[This corrects the article on p. 1550 in vol. 29, PMID: 25408588.].

Efficacy and tolerability of anticholinergics in Korean children with overactive bladder: a multicenter retrospective study

We investigated the efficacy and tolerability of various anticholinergics in Korean children with non-neurogenic overactive bladder (OAB). A total of 326 children (males:females= 157:169) aged under 18 yr (mean age 7.3±2.6 yr) who were diagnosed with OAB from 2008 to 2011 were retrospectively reviewed. The mean duration of OAB symptoms before anticholinergic treatment was 16.9±19.0 months. The mean duration of medication was 5.6±7.3 months. Urgency urinary incontinence episodes per week decreased from 1.9±3.1 to 0.4±1.5 times (P<0.001). The median voiding frequency during daytime was decreased from 9.2±5.4 to 6.3±4.2 times (P<0.001). According to 3-day voiding diaries, the maximum and average bladder capacity were increased from 145.5±66.9 to 196.8±80.3 mL and from 80.8±39.6 to 121.8±56.5 mL, respectively (P<0.001). On uroflowmetry, maximum flow rate was increased from 17.6±8.4 to 20.5±8.2 mL/sec (P<0.001). Adverse effects were reported in 14 (4.3%) children and six children (1.8%) discontinued medication due to adverse effects. Our results indicate that anticholinergics are effective to improve OAB symptoms and tolerability was acceptable without severe complications in children.

Impact of internal spermatic artery preservation during laparoscopic varicocelectomy on recurrence and the catch-up growth rate in adolescents

OBJECTIVE

To investigate the effectiveness of laparoscopic varicocelectomy (LV) in adolescents with varicocele and analyze the impact of internal spermatic artery (ISA) preservation on surgical outcomes.

MATERIALS AND METHODS

Data on 92 adolescents with left varicocele who underwent LV between December 1998 and January 2011 were retrospectively analyzed. The mean age of the patients was 13.2 ± 2.1 years. Age, grade of disease, number of ligation veins, recurrence rates, and catch-up growth were analyzed in patients who underwent ISA preservation and ligation. The median duration of the follow-up was 21 months.

RESULTS

ISA preservation was performed on 50 patients (54%). There were no significant inter-group differences in terms of age, varicocele grade, number of ligation veins, and catch-up growth (93% vs. 90%). The patients who received artery preservation demonstrated a higher recurrence rate (22%) than those who received artery ligation (5%; p = 0.032). Among 13 patients who had persistent or recurrent varicocele, nine were treated with embolization and one was treated with magnification-assisted subinguinal varicocelectomy. None of these 10 patients demonstrated recurrence or testicular atrophy.

CONCLUSIONS

LV with ISA ligation can reduce the recurrence rate and results in the same catch-up growth rate in comparison with LV with ISA preservation.

Role of prostate volume in the early detection of prostate cancer in a cohort with slowly increasing prostate specific antigen

PURPOSE

To investigate the relationship between prostate volume and the increased risk for being diagnosed with prostate cancer (PCa) in men with slowly increasing prostate specific antigen (PSA).

MATERIALS AND METHODS

A cohort of 1035 men who visited our hospital's health promotion center and were checked for serum PSA levels more than two times between January 2001 and November 2011 were included. Among them, 116 patients had a change in PSA levels from less than 4 ng/mL to more than 4 ng/mL and underwent transrectal ultrasound guided prostate biopsy. Median age was 55.9 years and 26 (22.4%) had PCa. We compared the initial PSA level, the last PSA level, age, prostate volume, PSA density (PSAD), PSA velocity, and follow-up period between men with and without PCa. The mean follow- up period was 83.7 months.

RESULTS

Significant predictive factors for the detection of prostate cancer identified by univariate analysis were prostate volume, follow-up period and PSAD. In the multivariate analysis, prostate volume (p<0.001, odds ratio: 0.890) was the most significant factor for the detection of prostate cancer. In the receiver operator characteristic curve of prostate volume, area under curve was 0.724. At the cut-off value of 28.8 mL for prostate volume, the sensitivity and specificity were 61.1% and 73.1% respectively.

CONCLUSION

In men with PSA values more than 4 ng/mL during the follow-up period, a small prostate volume was the most important factor in early detection of prostate cancer.

Recent advances in robotic surgery in female urology

Pelvic organ prolapse and lower urinary tract fistulas are two disorders frequently managed in female urology. New techniques have been adapted and improved to decrease morbidity and improve clinical outcomes of these disorders. The adaptation of minimally-invasive approaches for the management of pelvic organ prolapse and lower urinary tract fistulas began with laparoscopy. However, laparoscopic surgery has not gained widespread popularity as a result of the associated technical challenges, such as intracorporeal suturing and pelvic dissection. Robotic surgery has been widely carried out in urological oncology since 2001, and has been widely adapted because of its advantages over conventional laparoscopy for the management of pelvic organ prolapse and lower urinary tract fistulas. The current literature has shown the safety, feasibility and favorable clinical outcomes of robotic surgery for the treatment of these disorders. Robotic surgery in the management of pelvic organ prolapse and lower urinary tract fistula repairs might offer a promising advancement and benefits. However, further long-term data should be followed to assess the durability of this newer, and minimally-invasive approach.

Role of Urodynamic Study in Nocturnal Enuresis: Urodynamic Findings and Treatment Outcome Correlation in Children with Pharmacotherapy-resistant Monosymptomatic Nocturnal Enuresis or Severe Non-monosymptomatic Nocturnal Enuresis

OBJECTIVES

This study aimed to determine whether or not a urodynamic study (UDS) is beneficial for management of pediatric nocturnal enuresis (NE), especially in pharmacoresistant monosymptomatic nocturnal enuresis (PRMNE) or severe non-monosymptomatic nocturnal enuresis (NMNE) patients.

METHODS

Children with PRMNE or severe NMNE who underwent a UDS for the process of NE treatment were retrospectively reviewed. The UDS findings of patients and treatment outcomes of subsequent tailored therapies according to the UDS findings were analyzed.

RESULTS

A total of 80 children (50 boys and 30 girls, mean age 8.4 ± 2.2 years), 19 of which were diagnosed with PRMNE and 61 of which were diagnosed with NMNE, were included in the final analysis. Of the 19 PRMNE children, 12 (63.2%) demonstrated abnormal UDS findings. Ten demonstrated detrusor overactivity (DO) with or without decreased cystometric bladder capacity (CBC); the treatment outcomes markedly improved in all of the children after anticholinergics were added to the initial desmopressin therapy. Biofeedback was found to be helpful for two children with detrusor-sphincter dyssynergia. All of the total 61 children with NMNE demonstrated abnormal urodynamic findings of DO with or without decreased CBC, and 42 (68.9%) achieved more than partial response (> 50% decrease in the number of wet nights) when given a combination therapy of anticholinergics and desmopressin.

CONCLUSIONS

The urodynamic findings were helpful for guiding children with PRMNE in the proper choice of further treatment strategies. A routine UDS should not be recommended prior to a first-line combination treatment in children with NMNE.

Clinical Significance of Wnt/β-Catenin Signalling and Androgen Receptor Expression in Prostate Cancer

Purpose

To investigate the relationships among the Wnt/β-catenin pathway, androgen receptor (AR), and clinicopathological factors in hormone-naïve prostate cancer.

Materials and Methods

This study was conducted with132 cases of hormone-naïve prostate cancer treated by prostatectomy and prostate needle biopsy. An immunohistochemical study using antibodies against β-catenin, matrix metalloproteinase-7 (MMP-7), and the AR was performed. For the in vitro study, PC-3, LNCaP, 22Rv1, and DU145 cell lines were used.

Results

The clinical or pathological stage ware a localized cancer in 36 patients (27.3%), locally advanced cancer in 31 (23.5%), and metastatic cancer in 65 (49.2%). We detected increased β-catenin, AR, and MMP-7 expression with a high Gleason grade, disease progression, and increasing serum prostate-specific antigen (PSA) levels (p<0.01). In Spearman's rank correlations, the expression of cytoplasmic β-catenin, MMP-7, and the AR were found to be significantly positively correlated. In addition, the expression of β-catenin, MMP-7, and the AR were significantly correlated with clinicopathological variables indicative of a poor prognosis. Forty-nine patients with primary androgen deprivation had short response durations from hormone therapy to PSA progression with elevated MMP-7 expression on the Kaplan-Meier curve (p=0.0036).

Conclusions

These data show that an activated Wnt/β-catenin pathway and AR expression in prostate cancer are correlated with metastasis and aggressiveness. In addition, the expression of MMP-7 protein, a target of the Wnt/β-catenin pathway, is associated with PSA progression in prostate cancer patients undergoing primary hormone therapy.

Penile abscess secondary to neglected penile fracture after intracavernosal vasoactive drug injection

Penile abscesses are rare, but can develop after trauma, injection therapy, or surgery of the penis, or as an unusual presentation of sexually transmitted diseases. We report a case of penile abscess in a 51-year-old diabetic man, presented 9 days after neglected penile fracture following intracavernosal injection therapy and sexual intercourse. Penile ultrasonography and surgical exploration confirmed the physical examination findings of involvement of the corpus cavernosum. The pus culture from the abscess revealed Enterococcous faecalis. The patient was successfully treated by surgical drainage of the abscess and primary closure of the ruptured tunica albuginea.

Change in penile length in children: preliminary study

Purpose

Studies of penile length in children have been rarely conducted. In Korea, great improvements in height and weight have been observed because of economic development over the past 25 years. We investigated the current status of penile length in Korean children and compared the results with those of a previous Korean study conducted in 1987.

Materials and Methods

The subjects in this study were 233 boys aged 1 to 158 months, each of whom had been brought to outpatient clinics between April and October 2011. Penile length was measured according to the stretched penile length (SPL) technique; testicular size was measured (in ml) by using orchidometry. A comparison of penile lengths between the current study and the 1987 study was made by using Student's t-test.

Results

SPL increased significantly by 0.7 to 1.1 cm in most age groups (p<0.05). Current anthropometric measures of Korean children such as height, body weight, and testicular size have increased compared with those from 1987.

Conclusions

Penile length has increased significantly over the last quarter century. Therefore, it is suggested that novel reference values for penile length in prepubertal Korean children be determined in studies with a larger community-based population in order to diagnose and treat size-related penile disorders.

A case of laparoscopic radical prostatectomy for a prostatic stromal tumor of uncertain malignant potential

Prostatic stromal tumor of uncertain malignant potential (STUMP) is a rare neoplasm with distinctive clinical and pathological characteristics. Here we report a case of laparoscopic radical prostatectomy performed in a patient with prostatic STUMP.

Analysis of the late outcome of laparoscopic heminephrectomy in children with duplex kidneys

OBJECTIVES

To report our experience with laparoscopic heminephrectomy (LHN) in children with duplex kidneys, highlighting the late outcomes, including anatomical and functional aspects.

PATIENTS AND METHODS

We retrospectively analysed the medical records of 17 children (18 renal units) with duplex kidneys who underwent LHN (15) and heminephroureterectomy (three). Before surgery, all patients were evaluated using ultrasonography, voiding cysto-urethrography, computed tomography or magnetic resonance imaging with urography, and nuclear scintigraphy. After surgery patients were evaluated using ultrasonography and nuclear scintigraphy, and by voiding cysto-urethrography if there was a refluxing ureter.

RESULTS

All laparoscopic surgery (17 transperitoneal and one retroperitoneal approach), were completed as planned with no intraoperative complications. Complications after surgery included prolonged urine leakage from a refluxing ureteric stump in one heminephroureterectomy, and a complete functional loss of the remnant pole in one retroperitoneal LHN. The function of the remnant pole was preserved in 17 patients (94%); in these 17 the mean decrease in renal function was 2.8%. Follow-up ultrasonography showed asymptomatic cystic structures in six patients. There was an asymptomatic remnant ureteric stump in two cases (one refluxing, one nonrefluxing).

CONCLUSION

The loss of function caused by surgery is subtle but some remnant pole will be fully lost while experience is gained. Because the functional impairment due to vasospasm or vascular injury might not be recognized, all remnant kidneys must be evaluated using postoperative nuclear scintigraphy.

A double-blind, randomised- placebo, controlled, parallel group, multicentre, flexible-dose escalation study to assess the efficacy and safety of sildenafil administered as required to male outpatients with erectile dysfunction in Korea

The efficacy and safety of sildenafil was evaluated in a randomiSed, double-blind, placebo-controlled, flexible-dose study in Korean men aged 28-78 y with erectile dysfunction (ED) of broad-spectrum aetiology and more than 6 months duration. A total of 133 patients were randomised at six centres in Korea to receive either sildenafil (50 mg initially, increased if necessary to l00 mg or decreased to 25 mg depending on efficacy and tolerance) (n=66) or matching placebo (n=67) taken on an 'as needed' basis l h prior to anticipated sexual activity for a period of 8 weeks. At the end of this time, the primary efficacy variables relating to the achievement and maintenance of erections sufficient for sexual intercourse, and the secondary efficacy variables, which included: (1) the five separate domains of sexual functioning of the International Index of Erectile Function (IIEF) scale, (2) the percentage of successful intercourse attempts, and (3) a global assessment of erections, were all statistically significantly improved by sildenafil in comparison with placebo (P&<0.0001). Treatment-related adverse events occurred in 56.1% of patients receiving sildenafil and 20.9% receiving placebo. The most common adverse events with sildenafil were vasodilatation (flushing), headache and abnormalities in colour vision (31.8, 22.7 and 6.1% of patients, respectively), and most were mild in nature. The efficacy and safety of sildenafil in this population of Korean men appears similar to that reported in other studies in western populations.

A recurred carotid siphon pseudoaneurysm after detachable coil embolization. Successfull endovascular management with detachable balloons

SUMMARY

Massive posterior epistaxis is one of the peculiar symptoms of pseudoaneurysms of the carotid siphon. We experienced a case of trauma- related pseudoaneurysm of the carotid siphon. The lesion was initially silent except for the mass effect. We initially treated the lesion with platinum detachable coil embolization of the pseudoaneurysm sac with preservation of the parent artery. However, the patient had delayed massive epistaxis with recurrence of the pseudoaneurysm. The patient was subsequently managed with endovascular occlusion of the affected internal carotid artery using detachable balloons. Complete internal carotid artery trapping is recommended as an initial treatment modality if the patient can tolerate to the occlusion test. Careful observation and follow-up of the patient is required if the lesion is inevitably managed with coil embolization of the pseudoaneurysm sac alone.

Treatment of internal carotid artery dissections with endovascular stent placement: report of two cases

Extracranial carotid artery dissection may manifest as arterial stenosis or occlusion, or as dissecting aneurysm formation. Anticoagulation and/or antiplatelet therapy is the first-line treatment, but because it is effective and less invasive than other procedures, endovascular treatment of carotid artery dissection has recently attracted interest. We encountered two consecutive cases of trauma-related extracranial internal carotid artery dissection, one in the suprabulbar portion and one in the subpetrosal portion. We managed the patient with suprabulbar dissection using a self-expandable metallic stent and managed the patient with subpetrosal dissection using a balloon-expandable metallic stent. In both patients the dissecting aneurysm disappeared, and at follow-up improved luminal patency was observed.