Urolithiasis is the most common and important disease in the field of Urology, and recently the incidence of urolithiasis has increasing tendency according to the improvement of living condition in Korea. In the management of urolithiasis, open surgery was done mainly until several years ago. But not with the development of extracorporeal shock wave lithotriptor (ESWL), endourology and other new instruments, the urolithiasis is easily treated, not surgically.

The author analyzed patients with urolithiasis who had been admitted to Ewha Womans University Hospital from April 1976 to December 1995 to know the change ofoccurrent trend and treatment for urolithiasis for the past 20 years.

The following results were obtained ;

1) During the periods, 3,069 cases were urolithiasis(31.1%) of the 9,868 total admitted patients in urology. The total number and rate of incidence were increased constantly especially until late eighties, but since the year of 1991 those were slightly decreased.

2) The sex ratio of male to female was not changed significantly. The occurrent rate under age of 20 years old was decreased but increased after 6th decades. The seasonal occurrence was the highest in summer until 1985, but after then there was no seasonal difference.

3) The incidence of ureter, bladder and urethral calculi was decreased but that of renal calculi was increased.

4) In the management, the open surgery and expectant therapy were decreased after October 1986, but the rate of nephrectomy was slightly increased. In endourological management, the success rate of ESWL, PNL and URS was 92.8%, 86.6% and 96.7% respectively.

For the past 20 years, the trend of urolithiasis was changed and modalities of treatment were changed, especially since the late of 1980s.

Chronic kidney disease(CKD) and Sexual dysfunction are important public health problems in older man as a part of life. We investigated the relationship between two groups.

We examined sixty-five CKD patients on glomerular filtration rate (GFR), serum creatinine (sCr), Prevalence period and causative disease. Sexual function was evaluated by International Index of Erectile Function(IIEF-5), libido(2 items), ejaculation(4 items), frequency of sex in a month and serum testosterone. A control group composed of eighteen male adults who had visited to the general medical testing center in the hospital. They didn't have any combined disease and they were similar age range to the group of the CKD. We analyzed correlations between components of the CKD and sexual function.

The study revealed that all sexual components of the CKD group(mean age 51.8±2.6) were significantly worse than the control group; 12.3±3.9 of IIEF-5, 5.4±1.8 of libido and 10.1±2.2 of ejaculation, 1.4±0.7times of sex in a month in the CKD group and 18.3±3.5 of IIEF-5, 7.2±2.1 of libido and 15.3±2.9 of ejaculation, 2.9±1.1 times of sex in a month in the control group. The patients whose prevalence period of CKD was over than 3 years or whose sCr was over than 2.0ng/ml, had all sexual components worse significantly. Comparing by the causative disease of the CKD, there was no any significant difference. Analyzing by correlation, erectile function is related with serum glucose, sCr, Prevalence periods and libido is related with prevalence periods, and ejaculation is related with diabetes.

The patients with CKD may have a sexual dysfunction that make erection, libido and ejaculation and the number of their sex seemed to decrease. Therefore we need to have more attention to their sexual function as an important part of life.

Recently, antibiotic resistant organisms have increasing tendency. So, we studied causative organisms in urinary tract infection and investigated the resistance to each antibiotics.

From January 2004 to March 2004, uropathogens and antibiotic sensitivity tests in urine culture of patients with urinary tract infection were analyzed retrospectively. One hundredeleven women and 51 men in 168 adults were included.

Incidence of positive urine culture was 66.1% in women, and 33.9% in men. Mean age was 62.6 years old in men, and 61.7 years old in women. The most common uropathogen was E. coli(50.4%), followed by K. pneumoniae or(21.3%), P. aeruginosa(9.2%). In adult men, the most common uropathogen was S. marceacencs(46.5%). E. coli has the resistance to almost all antibiotics. In E. coli, the resistant rates on each antibiotic were ampicillin(73.8%), piperacillin(66.7%), levofloxacin(37.2%), gentamicin(35.8%), TMP/SMX(31.7%). ciprofloxacin(30.3%) inodor. Extended Spectrum β-lactamase(ESBL) producing organisms were found in E. coli(20 patients) and K. pneumoniae(3 patients).

E. coli was the most common uropathogen. Especially, ESBL producing organisms were Increasing.

Chemical constituent of urinary stone is important for the management and the prevention of recurrence. We performed chemical analysis of the urinary stone and investigatedits chemical constituent.

From January 2003 to December 2005, stone fragments were collected after extracorporeal shock wave lithotripsy (ESWL, n=43), or removal by endoscopic procedure such as ureteroscopy (URS, n=93) and open surgical procedure such as cystolithotomy (n=8). So we had stone fragments from 144 patients totally.

80 stone fragments were collected from male (55.6%), 64 stones from female (44.4%), and male to female ratio was 1.25 : 1. The mean age between males (mean age ; 47.2 years old)and females (mean age ,47.9 years old) was not different. The most frequently found location of urinary stones was ureter(91.0%) Of 144 patients in urine analysis,54 had pyuria (37.5%). The most frequently found constituent in stone fragments was that of calcium(n=119 , 82.6%). The 2nd constituent was phosphate (n=82 ; 56.9%). The 3^rd was uric acid(n=33 ; 22.9%). The other constituents were ammonium(n=24 ; 16.6%) , carbonate (n=18 , 12.5%), magnesium (n=11 ; 7.6%). oxalate (n=3 ; 2.1%). Struvite stone (MAP stone ; magnesium+ammonium+phosphate)were found in 5 patients (3.5%) All of 5 patients having strivite stone had pyuria(100%).

Calcium is the most common chemical constituent in urinary stone. Urinary infection was complication in 100% of patients with MAP stones.

The aim of this study was to analyze the diskibution pattern of the 38 mineral elements in the patients with chronic urogenital diseases such as benign prostatic hyperplasia(BPH), andropause, erectile dysfunction, menopause, overactive bladder and stress urinary incontinence, which were appeared as the result of various life factors including the ageing.

Hairs were collected in the occipital scalp area and analyzed mineral status in theme thod of inductive coupled plasma mass spectroscopy (Trace Element, INC. ; TEI, USA). 15mandatory nourishment minerals, 15 additional minerals,8 heavy metals and the ratio of Ca/P Na/K, Ca/K, Zn/cu, Na/Mg, Ca/Mg, Fe/Cu were measured. The results were classified as each disease and compared.

The disease which showed high rate of patient with increased calcium was menopause(85.7%) and overactive bladder (OAB) (61.9%). The disease which showed high rate of patient with increased magnesium was menopause (57.1%). The disease which showed high rate of patient with increased sodium was stress urinary incontinence (SH) (42.9%). Other minerals didn't show particular distribution by the disease. The average ratio of Caf was increased in all diseases and the degree of the increase was high in menopause, OAB and SUI. The average ratio of Zn/Cu was increased only in menopause. The average ratio of Ca/K was increased in all diseases and the degree of the increase was high in menopause, OAB and SH. The average ratio of Zn/Cu was within normal range in all diseases. The average ratio of Na/Mg was increased only in BPH and was decreased in menopause, andropause and OAB. The average ratio of Ca/Mg was increased in all diseases and the degree of the increase was the highest in OAB.

The distribution pattern of mineral elements according to chronic urogenital diseases was distinctive. Thus we consider that mineral supplement remedies suitable to the eachdisease can be recommended.

Although chronic prostatitis is extremely frequent, there had been very vague analyses and solutions with regard to this disease and the treatment is still challenging. An antibiotic is usually given for a longer period of time, 4-12 weeks. For years, the cranberry(Vaccinium macrocarpon) has been widely used to prevent and treat urinary tract infections, because cranberry has been shown to interfere with bacterial adherence to urothelium. The main objective of this investigation was to verify whether or not the cranberry juice is capable of the complementary therapy for chronic prostatitis.

The selected subjects were 69 patients diagnosed with NIH-category IIIb chronic prostatitis between the periods of March to October, 2004. The first-line treatment was daily 3 times intake of levofloxacin 100mg for 4 weeks. Randomly selected 34 patients were prescribed with 150ml of cranberry juice intake, two times a day for 12 weeks and the remainder 35 patients were managed conservatively only after ceasing the antibiotic. The patients were reevaluated 4 and 12 weeks later.

At the baseline stage, NIH-CPSI scores were 25.8±7.4 and 25.4±7.0 for the cranberry juice group and the conservative group. 4 weeks after the antibiotic treatment, they were 16.91±4.5 and 17.8±4.8 and thus implied the improvements without difference between the two groups(p>0.05). For the conservative group, there were 6 patients who experienced deteriorations 8 to 12 weeks later and as the NIH-CPSI scores reached 19.2±7.3, thus there were no significant improvements compared to baseline(p>0.05). Within the cranberry juice group, there was no patient with symptoms worsened and the NIH-CPSI scores at 12 weeks reached 13.5±3.9 with significant improvements compared to baseline(p<0.05). All the patients did not experience any side effects due to the cranberry juice intake.

Under the present circumstances of proposing the distinctive standard and providing a suggestion to replace the antibiotics for the treatment of chronic prostatitis, the short timed and limited use of the antibiotics accompanied by the cranberry juice demonstrated sufficient possibility and effectiveness. Thus the cranberry juice could be appointed as the complementary therapy in chronic prostatitis without serious adverse effects.

Chronic prostatitis is difficult to treat and unintelligible disease with multi-factorial etiology, various pathophysiology and several clinical manifestations rather than simple single disease. Therefore, it is thought to be important successful treatment and courtesy call that grasp whether some elements influence incidence of disease. The authors wished to search factors which influence the development and the progress of chronic prostatitis.

From January, 2004 to October, 184 patients who undergo diagnosis as chronic prostatitis were selected, and chose healthy 40 men for comparative analysis to control group. Subjects were investigated for the status of profession and form of work, driving, motorcycle or bicycle utilization, drinking, smoking and sex, and the style of behavior and diet.

Average age of chronic prostatitis(CP) group and control group was no difference. The classification of specific profession did not show relevant difference, but sedentary desk workers were much excellently than CP group(40.0%) by control group(53.8%)(p<0.05). Driver's ratio more than 1 day 1 hour was high in CP group than control group(22.5%) by 28.3%(p<0.05). A person who ride motorcycle or bicycle did not show relevant difference(p>0.05). A person who ejaculate more than once a week through any manner, was less CP group(51.1%) than control group(62.5%), but showed high ratio by person with ejaculation less than 1-2 time a month and daily ejaculation in CP group(p<0.05). A person who drinks more than once a week was many in CP group(p<0.05), and also a person who drink more than 1 bottle of soju expressively high ratio show in CP group(p<0.05), In dietary life habit, CP group showed high ratio by salty food preference degree(p<0.05).

Some factors look that have important effect in disease change for the worse progress of chronic prostatitis. Therefore, it is thought should be gone side by side that reform this detecting eating habit and lifestyle that can exacerbate the disease along with general medication in treatment.

Ureteral stent is commonly used after ureterscopic stone removal(URS). However, there is no definitive clinical criteria in inserting the ureteral stent after URS. Patients often complain of bladder irritative symptoms, hematuria. flank pain and additive endoscopic prodedure is necessary to remove the ureteral stent. Therefore, we studied the clinical epicacy of selective ureteral stenting only when it is required.

Of the patients who was taken URS, the following patients were exclu-ded from stent insertion ; 1) Patients who have mild hydronephrosis or symptoms less than 1week. 2) Patients who were able to insert the ureteroscope through the ureteral orifice without difficulty. 3) Patients who hardly have ureteral mucosal damage seen through the ureteroscopic field after the removal of ureteral stone. 4) Patients who did not need the additional lithoclast during the removal of ureteral stone. Other than the above patients and those with stones above the mid-ureter, a 6Fr. ureteral stent was inserted and kept for 3weeks. There were 29 unstented patients and 38 stented patients.

The average age of the non-stenting and stenting group were 37.5 years old and 39.7 years old and the average stone size were 0.68cm and 0.80cm. The average operation time was 3 minutes in the non-stenting and 8minutes(including ureteral stent insertion time) in the stenting group. Hospital stay was 3 days in both groups. Intermittent gross hematuria and irritative symptoms of the bladder was shown for 3 weeks after operation in most of the patients(32cases, 84.2%) of the stenting group while those in the unstenting group, the symptoms were relieved after2days after operation. Although mild flank pain was shown in few patients(4 cases, 13.8%) of the non-stenting group, severe pain requiring intravenous analgesics was not seen in both groups. There were no specific findings in the intravenous urography which was done at 6 weeks after operation, and no hematuria and pyuria was found in both groups.

The selective placement of ureteral stent following the ureteroscopic removal of stone did not bring specfic complications. We believe that ureteral stent insertion will minimize the inconvenience especially in patients who need to return to their everyday living immediately after operation. Thus ureteral stent insertion should be used in limited situations.

We retrospectively reviewed the cases of transurethral prostatectomy benign prostatic hyperplasia. We defined the morbidity, hospitalization and urethral catheter time, complication and operator's skilled experience and compared to transurethral prostatectomy in the historical series.

A retrospective chart review of 720 consecutive patients who underwent tranasurethral prostatectomy between 1990 and 1999 at our institution for symptomatic benign prostatic hyperplasia was performed. Perioperative and late postoperative morbidity and their risk factors, hospitalization and urethral catheter time, operator's skilled experience were analyzed. The objective cases were divided by operator's experience into 5 groups, and compared in each group.

Patients were identified with an average of 66 years(range 45 to 88). Significant co-morbidity(2 or more co-morbid disease processes) was identified preoperatively in 22.1% of the patients. The most common indication for transurethral prostatectomy was prostatism only(63%). Average weight of resected tissue was 18.6gm. There was no perioperative patient mortality. Blood transfusion rate was 6.9%. The rates of early and late postoperative complications were 13.7% and 6.2%. Total average hospital stay was 5.5 days and 5.3 days from 1995 through 1999. Average preoperative symptom score was 23.8(range 10 to 35) and postoperative symptom score was 9.5(range 3 to 30) with an average follow up of 42 months(range 6 to 44 months).

In the 1990s complications of transurethral prostatectomy were relatively lower than rates in historical series. The average hospital stay and urethral catheter time have steadily decreased during the last 10 years. Transurethral resection of prostate could provide relief of lower urinary tract symptoms with high safety rate and low complication rate. Our study suggest that technique of trnasurthral resection is improving step by step by accumulating experience of operation and stabilized skillful technique will be achieved after experience of more than 150 cases.

I investigated the relationships among International prostate symptom score(IPSS), prostatic size and other factors, and look into the possibility of the expert system for benign prostatic hyperplasia in symptomatic prostatism.

Through the prostate awareness program, 349 men had undergone IPSS questionnaire, uroflownetry and transrectal ultrasonography. I analyzed the correlation coefficient to revel the relationship among age, maximal flow rate(MFR), and prostatic size, according to the several parameters.

The relationships among the age, MFR and prostatic size were statistically significant. When the all men were classified according to the height, weight, educational course and resident place, the relationships were not significant different.

We retrospectively reviewed the cases of ureteroscopic stone removal at our hospital from January, 1994 to August, 1999 and defined the efficiency and complications of ureteroscopic stone removal.

Ureteroscopic stone removal was in 255 cases of ureteral stone from January, 1994 to August, 1999. Patients were 142 males and 113 females, and mean age was 42.5 years. 20 stones were located in the upper ureter, 29 stone in the mid ureter, 206 stones in the lower ureter. The stone size was less than 5mm in 95 cases, from 5 to 10mm in 117 cases and more than 10mm in 43 cases. Ureteroscpic stone ramoval was performed with 7.5Fr, 9.5Fr rigid ureteroscope under general, spinal, and epidural anesthesia.

255 cases of ureteroscopic stone removal were performed and over all success rate of ureteroscopic stone removal was 97 percent. The success rates of upper, mid and lower ureteral stones were 85, 93 and 99 percent. According to the size, the success rate was 99 percent in stones less than 5mm, 98 percent in stones of 5 to 10mm and 90 percent in stones more than 10mm. There were 8 cases of complication and over all complication rate was 3.1 percent. Complications consisted of severe mucosal injury(3 cases), ureteral perforation(3 cases), gross hematuria(1 case), urinary tract infecion(1 case). Complications were treated successfully with conservative treatment except 1 case of severe mucosal injury that required ureteral reimplantaton.

Ureteroscopic stone removal could provide rapid resolution of obstruction and colic due to ureteral calculi with high seccess rate and minimal complications.