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The synthetic, tension-free midurethral sling procedure using transobturator tape (TOT) was introduced in 2001 and has become the most widely used procedure for the treatment of female urinary incontinence worldwide. However, infectious complications associated with erosions have occasionally been reported because of a foreign body reaction to the polypropylene mesh. We observed a case of a bilateral recurrent thigh abscess manifesting 5 years after a TOT sling procedure. The patient had recurrent thigh abscesses with repeated incisions and drainages in the past 1 year. Five months earlier, she had undergone a procedure to remove the eroded suburethral mesh, but incompletely. The right thigh abscess recurred, and ultimately the residual mesh was completely excised with abscess drainage. Complete mesh removal is very important to prevent abscess recurrence, and it is necessary for any urologist treating women who have undergone the TOT procedure to be aware of the possibility of abscesses occurring for a long time after the operation.

Purpose The location of acetylcholinesterase-containing nerve fibers suggests a role for acetylcholine in both contractility and secretion in the prostate gland. The colocalization of nitrergic nerves with cholinergic nerves, and the cotransmission of nitric oxide with acetylcholine in cholinergic nerves, has been demonstrated in the prostate glands of various species. Thus, we investigated the effects of acetylcholine on phenylephrine-induced contraction and the correlation between cholinergic transmission and nitric oxide synthase by using isolated prostate strips of rabbits. Materials and Methods Isolated prostate strips were contracted with phenylephrine and then treated with cumulative concentrations of acetylcholine. Changes in acetylcholine-induced relaxation after preincubation with NG-nitroarginine methyl ester, 7-nitroindazole, and aminoguanidine were measured. The effects of selective muscarinic receptor antagonists were also evaluated. Results In the longitudinal phenylephrine-contracted strip, the cumulative application of acetylcholine (10-9 to 10-4 M) elicited a concentration-dependent relaxation effect. Acetylcholine-induced relaxation was inhibited not only by nitric oxide synthase inhibitors (10 µM L-NAME or 10 µM 7-nitroindazole) but also by 10 µM atropine and some selective muscarinic receptor antagonists (10-6 M 11-([2-[(diethylamino)methyl]-1-piperdinyl]acetyl)-5,11-dihydro-6H-pyrido[2,3-b][1,4]benzodiazepine-6-one and 10-6 M 4-diphenylacetoxy-N-methyl-piperidine). In contrast, relaxation was significantly increased by pretreatment of the strips with 10 mM L-arginine. Conclusions Acetylcholine relaxed phenylephrine-induced contractions of isolated rabbit prostate strips. This relaxation may be mediated via both cholinergic and constitutive nitric oxide synthase with both the M2 and M3 receptors possibly playing key roles.

Purpose The effects of leptin on female sexual behaviors are controversial, and studies on this topic are limited. The objectives of this study were to evaluate the direct effects of leptin on clitoral vasoreactivity in vitro and to determine the mechanism of action. Materials and Methods Isometric tension studies were conducted to determine the effects of pretreatment with leptin (10-8 M) on the contractile responses of rabbit clitoral corpus cavernosal smooth muscle strips. The effects of leptin were assessed on precontraction induced by phenylephrine (PE; 10-9-10-4 M) and KCl (35-140 mM). We also examined the effect of leptin on relaxation induced by acetylcholine (ACh; 10-9-10-4 M), verapamil (10-10-10-6 M), and sodium nitroprusside (10-9-10-4 M) in PE-precontracted (10-5 M) strips. Results Leptin enhanced ACh-induced relaxation in PE-precontracted strips. L-NAME pretreatment significantly reduced the effect of leptin on ACh-induced relaxation, whereas L-arginine potentiated the effect of leptin. Leptin decreased the KCl-induced contractile responses. Leptin increased verapamil-induced relaxation responses. The relaxation effects of leptin on KCl-induced contraction were inhibited by 10-5 M methylene blue and L-NAME pretreatment. Conclusions A high concentration of leptin enhances ACh-dependent relaxation in clitoral cavernosal smooth muscles. These relaxation effects of leptin may occur through an NO-dependent mechanism and voltage-dependent calcium channel blockade.

Purpose: This study examined the significance of tubulin α and βII expression in benign prostatic hyperplasia (BPH) and prostate cancer. Materials and Methods: A total 103 cases diagnosed with either BPH or prostate cancer were divided into 4 groups: BPH (n=25), localized prostate cancer (n=41), locally advanced prostate cancer (n=18), metastatic prostate cancer (n=18). The tissues were taken through a transurethral resection of the prostate, suprapubic prostatectomy, prostatic needle biopsy or radical retropubic prostatectomy. The expression was measured by immunohistochemical staining. The degree of expression was graded on a 4-point scale. The data was compared in terms of stage, the serum prostatic specific antigen (PSA) level and Gleason score. The statistical comparisons were made using one-way ANOVA test and a Fisher's exact test. Results: The levels of tubulin α and βII expression were stronger in the patients with prostate cancer than those with BPH (p 0.05). The level of tubulin α expression was stronger in the patients with a Gleason score ≥8 than in those of Gleason score ≤7 (p

Purpose: This study compared the clinicopathological features, diagnosis and prognosis of an incidental renal cell carcinoma with those of a symptomatic carcinoma. Materials and Methods: The medical records of 140 renal cell carcinoma patients at our hospital between 1995 and 2004 were reviewed. The patients were divided into two groups: asymptomatic and symptomatic patients. The patients’ characteristics, radiologic studies, tumor stage, tumor size, nuclear grade, and survival rates were investigated. The data was analyzed using a chi-square test, Student's t-test and Kaplan-Meier survival curve. Results: Of the 140 patients 57 (41%) were asymptomatic and 83 (59%) were symptomatic. The median tumor size was 5.2cm for incidental cancer and 8.1cm for symptomatic cancer. The 5-year cancer specific survival rate was significantly higher for the incidental tumors than the symptomatic tumors (78.9% versus 45.8%). When adjusted for stage, there was no difference in survival in those with stage I to IV disease between the 2 groups. Stage I, II lesions were present in 82.5% of patients in the incidental group and 39.7% in the symptomatic group. In contrast, a stage III, IV lesion was present in 17.5% of the patients in the incidental group compared with 60.3% in the symptomatic group. A higher tumor grade of symptomatic lesions was also noted. Conclusions: The incidental group showed a significantly lower stage and grade, and a higher 5-year survival rate. This result was attributed to the early detection of renal cell carcinoma before the onset of symptoms. Overall, early detection of renal cell carcinoma using radiologic tools will improve the prognosis of renal cell carcinoma. (Korean J Urol 2008;49: 675-681) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Purpose: This study aimed at evaluating the expected additive blood pressure (BP) lowering effect of vardenafil when administered in the background of chronic α1-blocker therapy. Materials and Methods: Patients (n=90) with symptomatic benign prostatic hypertrophy (BPH) and erectile dysfunction (ED) took vardenafil 20mg in the morning following repeated doxazosin g astro in testin a l th era p eu tic system (GITS) 4mg (n=60) or tamsulosin 0.2mg (n=30) HS a day for 30 days. The standing and sitting BP at baseline, before taking the vardenafil and 30 minutes and 1 hour post vardenafil were measured 3 consecutive times. The data were analyzed by Student's t-test (p aired ), repeated measures of two-way ANOVA, chi-square tests and Pearson correlation analysis. Results: Doxazosin produced a significant reduction in systolic/diastolic BP (-12.3/-6.7mmHg), but tamsulosin did not. In the doxazosin group, the average reductions in BP from baseline (-24.7/-15.8mmHg) were significantly higher than that for the tamsulosin group (-14.6/-7.5mmHg). However, the average BP change was not different in both group (-12.4/ -9.1mmHg in the doxazosin group and -11.3/-6.4mmHg in the tamsulosin group) following a single dose of 20mg vardenafil. The higher the BP was at baseline, the more the reduction in BP was in both the doxazosin and tamsulosin groups. Two patients of tamsulosin showed a sitting systolic BP

Purpose: Hypocitraturia is cited as one of the risk factors promoting stone formation or recurrence of nephrolithiasis. We estimated the relationship between hypocitraturia and other metabolic abnormalities, such as hypercalciuria, hyperuricosuria and hyperoxaluria. The effects of potassium citrate medication were also investigated. Materials and Methods: We selected 706 renal stone patients with hypocitraturia (