Journal of Yeungnam Medical Science

Case report

Crowned dens syndrome as a rare cause of anterior neck pain after transurethral resection of the prostate: a case report: Myeong Geun Jeong, Bum Soon Park, Eun-Seok Son, Jang Hyuk Cho; J Yeungnam Med Sci. 2023;40(3):289-292. Published online August 5, 2022; DOI: https://doi.org/10.12701/jyms.2022.00388

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Abstract PDF: We describe the case of a 79-year-old man who presented with progressive aggravation of severe axial neck pain and fever 3 days after transurethral resection of the prostate (TURP), despite maintaining neutral neck posture during surgery. Laboratory examination revealed markedly elevated C-reactive protein levels and erythrocyte sedimentation rates. Computed tomography revealed crown-like calcifications surrounding the odontoid process. We diagnosed crowned dens syndrome (CDS) as the cause of acute-onset neck pain after TURP. The patient was treated with nonsteroidal anti-inflammatory drugs for 5 days, and his symptoms resolved completely. CDS is a rare disease characterized by calcific deposits around the odontoid process with acute onset of severe neck pain and restricted motion. Evidence of inflammation on serological testing and fever are typical of CDS. However, the prevalence and pathophysiology of CDS remain unclear. We hypothesized that systemic inflammation after prostate surgery may have induced a local inflammatory response involving calcification around the odontoid process.

Original Article

The Effects of Ginseng Saponin on Relaxation of Smooth Muscle in the Lower Urinary Tract and the Corpus Cavernosum.: Hee Chang Jung, Tae Hee Oh; Yeungnam Univ J Med. 2006;23(1):52-61. Published online June 30, 2006; DOI: https://doi.org/10.12701/yujm.2006.23.1.52

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Abstract PDF: BACKGROUND
Korean ginseng (KG) has been used as a general tonic, and for voiding dysfunction for a long time in oriental society. However, scientific basic studies on the use of KG, have been rare, especially for voiding and erectile dysfunction. This study was performed to investigate the effects of KG on voiding and erectile function by examining the effects of total saponin (TS) on the bladder, urethral and penile cavernosal smooth muscle. MATERILAS AND METHODS: To examine the effects of TS, NewZeland white rabbits were used to obtain tissue strips from the smooth muscle of the bladder, proximal urethra and corpus cavernosum. Adult Sprague Dawley rats were used to examine the changes in urodynamic findings and penile erection after administration of TS. RESULTS: In proximal urethral strips, the rate of relaxation of the proximal urethra was increased from 9.0+/-2.9 to 33.7+/-4.8% in a dose-dependent manner when the concentration of TS was added accumulatively from 0.25 mg/ml to 4.0 mg/ml (p<0.05). However, no significant response was observed in the bladder strips within these concentration ranges. For the corpus cavernosal strips, the rate of relaxation ranged from 5.8+/-2.1 to 36.7+/-5.8%, increasing in a dose-dependent manner when TS was increased from 1.0 mg/ml to 4.0 mg/ml (p<0.05). After administration of 0.1 ml of TS (32 mg/ml) in the rat, the bladder pressure was 37.5+/-8.5 mmHg at 52.1+/-7.0 sec. during isovolumetric bladder contraction, showing no significant differences from 35.7+/-7.8 mmHg and 50.7+/-7.2 sec, respectively, before treatment. However, when 0.1 ml of TS (32 mg/ml) was administered, the relative reduction of urethral pressure was 6.9+/-0.5 mmHg at 62+/-7.5 sec, which was significantly higher compared to 4.6+/-1.1 mmHg at 45+/-10 sec before treatment (p<0.05). For the cavernosal injection study, the change in intracavernosal pressure (delta ICP) was examined after administering 0.1 ml of TS. The cumulative additions of TS at concentrations from 0.5 mg/ml to 32 mg/ml increased delta ICP from 1.3+/-0.5 to 21.3+/-7.8 mmHg in a dose-dependent manner (p<0.05). The duration of tumescence was from 0.3+/-0.1 to 5.2+/-0.2 min, showing dose-dependent increase (p<0.05). Furthermore, the cumulative addition of TS at concentrations from 0.5 mg/ml upto 32 mg/ml did not cause any significant change in systemic blood pressure. CONCLUSION: These results suggest that ginseng improves voiding functions, which is mainly achieved by TS relaxing the proximal urethra, the most important part of the bladder outlet function. In addition, ginseng safely induced a penile erection hemodynamically by relaxing the corpus cavernosum.

Case Reports

Suprameatal Transvaginal Urethrolysis in Urethral Obstruction Associated with Anti-incontinence Surgery: A Case Report.: Jin Wook Yoo, Hee Chang Jung, Tong Choon Park; Yeungnam Univ J Med. 1999;16(2):376-379. Published online December 31, 1999; DOI: https://doi.org/10.12701/yujm.1999.16.2.376

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Abstract PDF: We report our experience with a case of urethrolysis using a transvaginal suprameatal approach without lateral perforation of the urethropelvic ligament. A 43-year-old woman suffered from voiding difficulties such as hesitancy, frequency, urgency, decreased urinary flow, residual urine sensation after Marshall-Marchetti-Krantz operation concurrent with hysterectomy. The results of multidisciplinary work-ups of urethral obstruction such as history, vaginal examination, voiding cystourethrography, urodynamic study, showed that she had urethral obstruction due to a previous operation. Since clean intermittent catheterization and alpha-blocker therapy did not improve her symptoms, suprameatal transvaginal urethrolysis was performed to resolve the symptoms. Postoperative follow-up for 5 months showed that the patient remained free from voiding difficulty in their life. We believe that suprameatal transvaginal urethrolysis is worth attempting for urethral obstruction associated with anti-incontinence surgery.

2 cases of male urethral diverticulum combined with stone.: Hyun Chul Shin, Young Soo Kim, Tong Choon Park; Yeungnam Univ J Med. 1992;9(2):416-421. Published online December 31, 1992; DOI: https://doi.org/10.12701/yujm.1992.9.2.416

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Abstract PDF: Male urethral diverticulum is uncommon lesion, furthermore calculus formation within the male urethral diverticulum is very rare. Generally, urethral diverticula are classified as congenital and acquired. The majority of male urethral diverticula are acquired and approximately 10 to 20 per cent are congenital. Acquired urethral diverticula in the male may arise from many sources, including infection (prostatic abscess, infection of periurethral glands, hematoma or schistosomiasis), obstruction (stricture, impacted stone, Cunningham clamp or condom catheter) and trauma (instrumentation, external injury and pelvic fracture). Calculi formation is more common in the acquired diverticulum owing to stagnation of urine and infection. These calculi in the diverticulum usually are solitary and may attain considerable size with predisposing factors, 1) a ureteral or bladder calculus that is lodged in the urethra 2) urethral trauma or stricture, 3) calcification around a foreign body or hair. The treatment of urethral diverticulum combined with stone is excision of the diverticula with removal of stone. We treated two cases of urethral diverticulum combined with stone in the male, and report with review of literature.

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