Priapism: Current Updates in Clinical Management

송필현,문기학 대한비뇨의학회 2013 Investigative and Clinical Urology Vol.54 No.12

Priapism is a persistent penile erection that continues for hours beyond, or is unrelated to, sexual stimulation. Priapism requires a prompt evaluation and usually requires an emergency management. There are two types of priapism: 1) ischemic (veno-occlusive or low-flow), which is found in 95% of cases, and 2) nonischemic (arterial or high-flow). Stuttering (intermittent or recurrent) priapism is a recurrent form of ischemic priapism. To initiate appropriate management, the physician must decide whether the priapism is ischemic or nonischemic. In the management of an ischemic priapism, resolution should be achieved as promptly as possible. Initial treatment is therapeutic aspiration with or without irrigation of the corpora. If this fails, intracavernous injection of sympathomimetic agents is the next step. Surgical shunts should be performed in cases involving failure of nonsurgical treatment. The first management of a nonischemic priapism should be observation. Selective arterial embolization is recommended for the management of nonischemic priapism in cases that request treatment. The goal of management for stuttering priapism is prevention of future episodes. This article provides a review of recent clinical developments in the medical and surgical management of priapism and an investigation of scientific research activity in this rapidly developing field of study.

OLETF 쥐에서 메트폴민이 음경 Nitric Oxide Synthase 발현에 미치는 영향

송필현,배인수,김용운,문기학 대한비뇨의학회 2009 Investigative and Clinical Urology Vol.50 No.2

Purpose: It is well known that metformin, an oral biguanide insulin- sensitizing agent, targets AMP-activated protein kinase (AMPK), which activates endothelial nitric oxide synthase (eNOS), which may be associated with erectile dysfunction. The aim of this study was to evaluate whether metformin activates eNOS in the penile tissue of a genetically obese rat model. Materials and Methods: We measured phospho-eNOS levels and eNOS expression in the penile tissue of Otsuka Long Evans Tokushima Fatty (OLETF) rats after 3 days of treatment with metformin (150 or 300 mg) to evaluate whether metformin activates eNOS in the penile tissue of this genetically obese rat model. Seven-month-old OLETF rats were used, and eNOS expression was analyzed by real-time polymerase chain reaction (PCR). The experimental groups were compared with use of the Kruskal- Wallis or Mann-Whitney test. Results: Seven-month-old OLETF rats had severe visceral fat deposition and elevated serum leptin concentrations. eNOS expression analyzed by real-time PCR was lower in the penile tissue of OLETF rats than in Long Evans Tokushima Otsuka (LETO) rats. Short-term treatment with metformin did not change visceral fat mass or serum leptin levels. However, metformin treatment increased eNOS mRNA expression in the penile tissue as determined by real-time PCR. The levels of phospho-eNOS and phospho-AMPK (pAMPK) in penile tissue revealed a dose-dependent tendency to increase with metformin treatment; however, there was no statistical difference by Kruskal-Wallis test among the experimental groups. The pAMPK level was dose-dependently elevated in the soleus by metformin treatment. There was no significant change in pSTAT3 by metformin treatment in the soleus. Conclusions: Metformin activates eNOS mRNA expression in the penile tissue of OLETF rats. Further study on the relation between erectile function and eNOS levels is needed for clinical application.

Frailty and elderly in urology: implications for postoperative complications

송필현 영남대학교 의과대학 2020 Yeungnam University Journal of Medicine Vol.37 No.4

The geriatric population is at a greater risk of postoperative complications than young adults. This risk is associated with the physiologic decline seen in this population known as frailty. Unlike fitter patients, frail patients who undergo operative treatment have a greater likelihood of developing postoperative complications and endure prolonged hospital stays. This circumstance is comparable to the urological status. Therefore, tolerable measurement of frailty as a domain of preoperative health status has been suggested to ascertain vulnerability in elderly patients. In this review, we will elaborate on the concept of frailty and examine its importance with respect to surgical complications, focusing on the urological status.

음낭 및 회음부에 발생한 낭종성 림프관종

송필현,문기학,김종민,양소전,최지웅,김미진,김현태 대한남성과학회 2011 The World Journal of Men's Health Vol.29 No.2

Cystic lymphangiomas are a benign tumor caused by lymphatic malformation. They are normally seen in the head and neck region and very rarely occur in the scrotum. We report a rare case of a 20-year-old man who presented with a gradually enlarging, painful scrotal mass which was identified ultrasonographically and histologically as a scrotal cystic lymphangioma and treated by surgical excision.

고환보형물 삽입술 후 환자의 만족도

송필현,배장호,김종민,김현태,문기학 대한남성과학회 2010 The World Journal of Men's Health Vol.28 No.1

Purpose: We investigated the follow-up result and patient satisfaction after testicular prosthesis implantation by the 11-item questionnaire. Materials & Methods: Among 29 patients who underwent testicular prosthesis implantation between January 2000 and April 2009, 24 patients who spent over 6 months after surgery and agreed to this investigation were enrolled in this study. All the patients were evaluated specially designed questionnaires retrospectively. Results: The mean age of subjects was 23.2±7.1 years and mean follow-up duration was 48.9±24.5 months. The domains about size, position, shape, weight and comfort of prostheses showed positive responses with 70.8%, 66.7%, 58.3%, 66.7% and 70.8%, respectively. And 87.5% of the patients replied that they got increased selfconfidence postoperatively. In accordance with this study, all of them would recommend the operation to other patients who suffering from loss of testis. Conclusions: Testicular prosthesis implantation showed simple surgical procedure with low complication rate. It seemed to recover patients’psychiatric trauma and also encourage self-confidence in social life.

Current status of simulation-based training and assessment in urological robot-assisted surgery

송필현 대한비뇨의학회 2016 Investigative and Clinical Urology Vol.57 No.6

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성기능장애 환자에서 HMD(Head Mounted Displayer)의3차원 입체 영상을 이용한 시청각 자극 검사의 유용성

송필현,문기학,박동춘 대한남성과학회 2004 The World Journal of Men's Health Vol.22 No.2

후복막섬유화증에서 동반된 양측 요관폐색에서 Memokath 스텐트 삽입술

송필현,지윤섭,김종민,정희창 대한요로생식기감염학회 2012 Urogenital Tract Infection Vol.7 No.1

Retroperitoneal fibrosis is a rare disease characterized by the presence of a retroperitoneal tissue, consisting of chronic inflammation and marked fibrosis, which often causes ureteral obstruction. Surgical approach is necessary to preserve the renal function, and this is achieved by ureteral stent. The Memokath stent is a new thermo-expandable shape-memory metallic stent. Herein, we report our recent experience of a patient with retroperitoneal fibrosis, which involves bilateral ureter, who underwent successful bilateral Memokath stent insertion.

Renal Venous Perforation during Reinsertion of a Percutaneous Nephrostomy Catheter

송필현,고영휘,옥봉기,김영욱,이권수,권대현,김현태,박신률,정희창 대한요로생식기감염학회 2014 Urogenital Tract Infection Vol.9 No.1

While the sustainment of percutaneous nephrostomy with regular change in chronic un-operable cases is widely performed for relief of urinary obstructions, performance of the blind procedure without fluoroscopic monitoring could result in clinical disaster. We report on a case of direct renal vein injury by mis-guidance of a nephrostomy catheter, which was successfully managed conservatively by serial venography monitoring combined with intensive conservative treatment. To the best of our knowledge, this is the first report on management of a renal vein injury during the percutaneous nephrostomy.

기종성 신우신염 24례의 최고 전략 분석

송필현,김현태 대한감염학회 2011 Infection and Chemotherapy Vol.43 No.4

Background: Emphysematous pyelonephritis (EPN) is a severe gas-forming infection of renal parenchyma with high mortality and its adequate treatment modality remains controversial. There have been only a limited number of studies about EPN,particularly in Korea. Therefore, we present our experience in patients with EPN. Materials and Methods: Twenty-four patients that were diagnosed with EPN between January 1999 and June 2010 at a single medical center were retrospectively evaluated. Patient characteristics, causative pathogens, clinical features, complications,and mortality rates as modalities of managements and radiological classes of EPN were analyzed. Results: All of the 24 patients selected for the study were diabetic. Twentyone patients were positive at urine culture and Escherichia coli (85.7%) was the predominant pathogen identified. Of the 24 patients, 17 were managed by broadspectrum antibiotics and percutaneous renal drainage, whereas 7 were managed by direct nephrectomy. The total mortality rates were 12.5%, regardless of the modalities of management. The mortality rates were 12.5% in Class 3A and 40% in Class 3B, according to computed tomography (CT) findings. Conclusions: Although conservative treatment included antibiotics, and percutaneous renal drainage offered an effective therapy for EPN, nephrectomy should be considered in patients with Class 3 EPN.