고추의 자가활성 Nucleotide-binding Leucine-rich Repeat 유전자가 유도하는 세포사멸기작 연구

학위논문 (박사)-- 서울대학교 대학원 : 농업생명과학대학 원예학과, 2019. 2. 최도일.Plants possess hundreds of intracellular immune receptors encoding nucleotide-binding domain and leucine-rich repeat (NLR) proteins that can recognize pathogen effectors. Activated NLRs confer disease resistance that is often accompanied by localized cell death termed by hypersensitive response. NLR proteins typically consist of three major domains, an N-terminal TOLL/interleukin-1 receptor (TIR) or coiled-coil (CC) domain, a central nucleotide binding (NB-ARC) domain, and a C-terminal leucine-rich repeat (LRR) domain. The CC domain is known to function as a signal inducer and remains in an auto-inhibited state through intramolecular interaction with NB-ARC and LRR domains in absence of pathogen infection. In this study, cell death induced by genome-wide autoactive pepper NLRs and their N-terminal domain was analyzed by transient overexpression in Nicotiana benthamiana. The screening assay revealed that CC domain of group 10 (G10)-NLRs specifically trigger HR-like cell death. Moreover, G10-CC domain from other Solanaceae plants (tomato and tobacco) induced cell death. The G10-NLR or G10-CC domain-mediated cell death appears to mimic the HR cell death triggered by resistance protein and effector as demonstrated by the requirement of molecular chaperone complex for NLR immune signaling and upregulation of HR- and defense-related genes. VIGS-based screen designed to identify G10-NLR signaling components revealed that cell death induced by G10-NLR and G10-CC domain occurred in a SA/JA-independent manner. In addition, deletion and mutation analyses showed that the primary α-helix in G10-CC domains contribute to cell death signaling rather than to the proper targeting of the protein to the plasma membrane. To understand the molecular basis of G10-NLR-mediated ell death, I identified S-adenosyl homocysteine hydrolase (SAHH) as a candidate of interacting protein with G10-CC domain using pull-down experiment coupled with LC-MS/MS analysis. Cell death induced by G10-NLR and G10-CC domain was compromised by co-expression with SAHH, suggesting that SAHH may function as a negative regulator of G10-NLRs. In addition, the SAHH-silenced plants exhibited constitutive H2O2 accumulation in absence of pathogen, implying that SAHH is a negative regulator of reactive oxygen species production. How G10-NLRs trigger cell death response remains unclear, but this study gives a clue to understand the molecular mechanisms underlying HR cell death induced by activated NLRs and the distinct role of G10-NLRs in plant immune responses.식물은 오랜 시간 동안 병원균에 대응해오면서 다양한 저항성 기작을 진화시켜 왔다. 그 중 nucleotide-binding domain and leucine-rich repeat (NLR) 유전자는 병원균이 식물에 병을 내기 위해 식물 세포 내로 분비하는 effector 단백질을 인지하여, 식물이 저항성 반응들을 나타낼 수 있도록 하는 대표적인 저항성 유전자이다. Effector를 인지한 NLR 단백질은 구조 변화를 통해 활성 상태로 전환되고 그 이후 저항성 반응을 유도하게 하는데, 그 중 가장 강력한 저항성 반응으로 세포사멸 (hypersensitive cell death)이 있다. NLR은 크게 3개의 주요 도메인으로 구성되어 있다. C-말단에는 LRR도메인, 중앙에는 NB-ARC 도메인, 그리고 N-말단에는 TIR 또는 CC도메인이 존재한다. NLR은 N-말단 도메인에 따라 TNL 과 CNL 로 나누어 진다. N-말단 도메인은 NLR 단백질의 신호를 전달하는 역할을 하며 병원균이 존재하지 않은 상황에서는 NB-ARC 또는 LRR도메인과 상호작용을 통해 그 기능이 억제 되고 있다고 알려져 있다. 본 연구에서는 고추에 존재하는 NLR 유전자 415개에 대하여 NLR전체와 N-말단 도메인의 세포사멸활성을 Agrobacterium을 이용한 일시적 과발현을 통해 스크리닝하였다. 그 결과 그룹10번 NLR의 CC도메인이 특이적으로 높은 비율로 세포사멸활성을 가지는 것으로 확인되었다. 고추 외 다른 가지과 식물인 토마토와 담배의 그룹10번 NLR의 CC도메인도 세포사멸활성을 가지는 것으로 나타났다. 그룹10번 NLR의 CC도메인이 유도하는 세포사멸이 일어나는데 있어 NLR의 molecular chaperone complex 가 필요하며, 세포사멸이 진행되는 동안 식물의 저항성반응에 관여하는 유전자들의 발현이 증가됨을 통해 그룹10번 NLR의 CC도메인의 과발현을 통해 유도된 세포사멸이 식물의 저항성 기작과 관련 있음을 입증하였다. 다음으로 그룹10번 NLR의 CC도메인이 유도하는 세포사멸에 관여하는 하위 신호전달 체계를 규명하기 위하여 VIGS를 이용한 스크리닝을 진행하였다. NLR 타입 저항성 유전자가 매개하는 저항성의 중요 조절인자인 EDS1과 NDR1, 그리고SA 호르몬 생합성 및 하위 신호전달은 그룹10번 NLR의 CC도메인이 유도하는 세포사멸에 있어 필수적이지 않음을 밝혔다. 또한 그룹10번 NLR의 CC도메인들의 구조 분석을 통한 기능 연구를 통해 CC도메인의 첫번째 α-helix가 세포사멸활성에 중요함을 확인하였다. 그룹10번 NLR의 CC도메인의 세포사멸 기작을 이해하기 위하여 CC 도메인의 상호작용인자를 동정하기 위한 pull-down 및 LC-MS/MS실험을 진행한 결과 S-adenosyl homocysteine hydrolase (SAHH) 가 CC도메인의 상호작용 후보 유전자로 동정되었다. SAHH는 CC도메인과 동시 과발현시 CC도메인이 유도하는 세포사멸을 억제하는 것으로 보아 CC도메인의 세포사멸활성의 negative regulator로서의 역할을 하는 것으로 추측된다. SAHH유전자의 발현이 감소한 담배식물체에서는 병원균 접종 없이도 ROS가 과다 축적되었고, 이를 통해 CC도메인이 SAHH를 비활성화 시킴으로써 ROS가 증가되어 세포사멸을 유도하는 것으로 유추할 수 있었다. 본 연구를 통해 그룹 10번 NLR의 CC도메인이 특이적으로 세포사멸을 유도한다는 것이 밝혀졌다. 그룹 10번 NLR의 CC 도메인이 유도하는 세포사멸기작에 대한 연구는 NLR 단백질이 어떻게 세포사멸을 유도하는 지, 더 나아가 식물의 병 저항성에 있어 고추의 그룹 10번 NLR유전자들의 기능에 대한 이해를 돕는 데 실마리가 될 것이다.ABSTRACT CONTENTS LIST OF TABLES LIST OF FIGURES LIST OF ABBREVIATIONS LITERATURE REVIEW Plant immune system Nucleotide-binding domain and leucine-rich repeat (NLR) genes in plant immunity Hypersensitive response in disease resistance Autoactivation of NLRs Cell death induced by autoactive N-terminal domain of NLRs INTRODUCTION MATERIALS AND METHODS RESULTS The autoactive N-terminal domain of pepper G10-NLRs causes cell death in N. benthamiana Cell death induced by G10-NLR or CC domain is associated with defense signaling pathway The N-terminal motif of G10-CCs is critical for autoactivity The TAILSP motif does not affect the localization of G10-CCs Defining minimal region of G10-CC as a signaling module The G10-NLR mediated cell death does not require EDS1, NDR1 and SA-related signaling pathway SAHH is a candidate interacting protein of G10-CCs DISCUSSION REFERENCES ABSTRACT IN KOREANDocto

Appropriate Follow-up Ultrasonography Interval after Pyeloplasty in Children with Ureteropelvic Junction Obstruction

PURPOSE: Serial ultrasonography(US) is routinely performed after pyeloplasty in the setting of pediatric ureteropelvic junction obstruction(UPJO). We evaluated the adequacy of the follow-up US interval we are currently using, which calls for US at 1, 3, 6, 9, and 12 months following surgery. MATERIALS AND METHODS: Between January 2002 and August 2005, 102 patients underwent dismembered pyeloplasty for unilateral UPJO. Within this group, we selected 95 patients with high grade hydronephrosis to participate in this study. The degree of hydronephrosis was graded according to the classification issued by the Society for Fetal Urology(SFU). Improvement was defined as at least one grade of reduction. Serial sonograms were performed at 1, 3, 6, 9, and 12 months postoperatively. RESULTS: On follow-up US, 33.7%, 69.5%, 77.9%, 80.0%, and 83.2% of the patients showed improvement in their hydronephrosis at 1, 3, 6, 9, and 12 months, respectively. One patient presented with aggravation at 1 month. However, at 3 months, this patient had returned to the preoperative grade. There was no significant difference between the mean hydronephrosis grades at 6 and 12 months. No patient showed hydronephrosis aggravation at the 12-month follow-up examination. CONCLUSIONS: US at 1, 3, and 6 months revealed significant improvements in hydronephrosis. However, no significant change in hydronephrosis occurred beyond 6 months. Therefore, US performed between 6 and 12 months after pyeloplasty may be inefficient, and we propose follow-up US at the following time points: 1 month, 3 to 6 months, 12 months, and then annuallyope

Atrial fibrillation and the risk of myocardial infarction : a nation-wide propensity-matched study

Department of Medicine/박사목적 : 심방세동은 심근경색 환자에서 그 예후에 좋지 않은 영향을 미치는 요인으로 이미 알려져 있다. 최근 연구에서 심방세동이 심근경색의 위험을 높인다고 보고한 바 있다. 본 연구는 심방세동과 연관된 심근 경색의 위험도를 전체 인구를 대상으로 하여 조사하고자 하였다 방법 : 한국 국민건강보험 자료를 분석하여 기존에 심방세동이나 심근경색의 기왕력이 없는 497,366명(평균연령 47.6세, 250,569 여성)을 5년간 추적 관찰하였으며 이 기간동안 심방세동이 새로 발생한 3,295명과 성향점수 매칭으로 선별된 심방세동이 없는 13,159명을 대상으로 심근경색 발생율을 비교 분석하였다. 결과 : 4.2년의 추적관찰 기간 동안 총 137건의 심근경색이 발생하였으며 심방세동 진단시점에서 심근경색 발생까지의 기간은 4년이었다. 연령 보정 심근경색 발생율은 심방세동이 있는 군에서 그렇지 않은 군보다 더 높았다 [발생율, 4.42 (95% 신뢰구간; 3.25-5.98 대 1.42 (95% 신뢰구간. 1.07-1.87)/1000 인년]. 심방세동은 심근경색 발생 위험을 3배 증가시키며 [위험비율, 3.25 (95% 신뢰구간; 2.24-4.7), 추적 기간 동안 심근경색의 누적 발생율은 항응고제와 지질 강하제를 복용한 군에서 그렇지 않은 군에 비해 유의하게 작았다. 결론 : 심방세동은 심근경색의 위험을 증가시키며, 그 위험도는 항응고제와 지질 강하제의 사용에 의해 감소된다. 본 연구의 결과는 심방세동의 합병증이 뇌졸중뿐만 아니라 심근경색에 의한 사망률까지 고려해야 함을 시사한다.open박

Ureteropelvic Junction Obstruction: What We Know and What We Don't Know

PURPOSE: Ureteropelvic junction (UPJ) obstruction is by far the most common cause of pediatric hydronephrosis. The widespread use of antenatal ultrasonography and modern imaging techniques has resulted in earlier and more common diagnosis of hydronephrosis. However, compared with this increased earlier detection, little has changed regarding the management of hydronephrosis. Through this review, we wish to provide an overview of the studies done to date and search for areas that warrant further study. MATERIALS AND METHODS: Through PubMed, we reviewed the literature on the subject of UPJ obstruction in the pediatric population. We also present data from our institution regarding recent trends in the evaluation and treatment of UPJ obstructions. RESULTS: In addition to conventional imaging studies, attempts are being made at making use of biochemical parameters (e.g., beta2 m, N-acetyl-beta-D-glucosaminidase [NAG], transforming growth factor [TGF]-beta, etc.) as not only indicators of intervention but also prognostic factors during follow-up. Although we routinely use radionuclide imaging to evaluate renal function, a more accurate novel tool that can represent true renal function is needed. With the development in the field of laparoscopic and minimally invasive surgery, the role of laparoscopy and robot-assisted laparoscopic pyeloplasty is expanding, even in the pediatric population. However, relatively little is known about the factors that might be associated with postoperative outcomes. CONCLUSIONS: Not missing the optimal time for surgical intervention is as important as avoiding unnecessary surgery. Continuous development and refining of surgical skills for UPJ obstruction repair are requisites for (pediatric) urologists as is in-depth basic research of the disease.ope

Postoperative Outcome of Upper Pole Kidney with a Complete Ureteral Duplication and Complicated with Ureterocele or Ectopic Ureter after Pyeloureterostomy

Purpose Non conservative treatment such as heminephrectomy is considered the treatment of choice when the upper pole kidney in children with a complete ureteral duplication complicated with ureterocele or ectopic ureter is nonfunctional. The postoperative outcome of the upper pole kidney with a complete ureteral duplication after pyeloureterostomy was evaluated, and we focused on those children with undetected functions on the upper pole kidney before surgery. Materials and Methods Between May 2002 and March 2006, we evaluated 28 children, 10 boys and 18 girls, who had undergone pyeloureterostomy for a complete ureteral duplication that was complicated with ureterocele or ectoplic ureter. Their mean age was 12.3 months. Ultrasound, 99mTc-dimercaptosuccinic acid (DMSA) scanning and voiding cystourethrography (VCUG) were performed preoperatively. The clinical courses were followed up with ultrasound at 1, 3, 6 and 12 months, and DMSA scanning was done between 6 and 12 months after surgery. The median follow-up period was 21.5 months. Results Among the 12 children with cortical thinning seen on ultrasound, 10 showed thickening of the renal cortex within 12 months. All 16 children with Grade III or less hydronephrosis on the upper pole kidney were downgraded, and 10 out of them showed complete resolution or Grade I hydronephrosis within 6 months. 4 cases with no visible photon uptake at the upper pole kidney preoperatively showed hot uptakes at the defective spot between 6 to 12 months after pyeloureterostomy. 5 out of 28 children had urinary tract infection (UTI) within 3 months after surgery; however, this was easily controlled with oral antibiotics. Conclusions The function of the upper pole kidney is recovered within 1 year after pyeloureterostomy in most of the cases with a complete ureteral duplication, regardless of the severity of hydronephrosis at the upper pole kidney. Pyeloureterostomy can be an alternative treatment modality for treating a complete ureteral duplication that's complicated with ureterocele or ectopic ureter due to pyeloureterostomy's lower morbidity compared to non-conservative surgery such as heminephrecotmy.ope

대기환경정책 성과의 영향요인 분석

학위논문 (석사)-- 서울대학교 행정대학원 : 공기업정책학과, 2014. 8. 박정훈.본 연구의 목적은 대기환경에 관한 대표적 정책인 대기오염물질 배출허용기준과 수도권 사업장 대기오염물질 총량관리제 두 정책의 비교·분석을 통해 환경정책의 성공적인 집행 요인을 도출하는 것이다. 연구의 외적타당성을 높이고 객관적인 비교를 위해 정책집행연구의 이론적 틀인 하향식 접근방법과 과거 선행연구를 통해 제시된 변수를 기준으로 분석 변수를 설정하였다. 해당 기준변수로 정책의 내용에서는 분명하고 일관된 정책목표, 인과이론 그리고 정책의 합리성, 형평성을, 정책의 집행환경에서는 정책의 집행집단의 전문성 및 기술성, 정치적 지지와 정책이 갈등, 반발 등을 해결할 수 있는 제도를 포함하고 있는지의 여부를 설정하였다. 총량관리제는 각 변수에 대해 규제기준을 농도에서 총량으로 변경함으로써, 정책목표와 관련된 환경기준의 설정이 가능하게 됨에 따라 합리성이 제고된 것으로 판단하였으며 또한 집단별 일관된 기준을 적용하는 농도규제와 달리 시설별 특성이 고려된 할당량을 기준으로 설정함으로써 형평성이 제고된 것으로 보았다. 집행환경에 있어서도 총량관리제는 그 실시 근거로 수도권대기환경개선에 관한 특별법(2003)의 제정 그리고 수도권 대기환경청의 신설(2005)을 통해 정책적지지 및 정책에 대한 실천의지를 확보했음을 확인하였고 마지막으로 총량관리제는 기존의 농도규제와 달리 배출권거래제, 자발적 감축협약 등을 운영함으로써 집행대상자의 순응을 확보할 수 있는 제도가 운영되고 있음을 확인하였다. 정책의 성과분석에서는 성공적인 집행에 대한 기준을 정책의 지속가능성으로 보았으며 이는 정책의 목표와 산출물이 일치하는지, 그리고 순응이 제고되었는지를 그 기준으로 삼았다. 총량관리제가 적용되는 수도권지역에서의 대기오염물질의 감축량이 농도규제가 적용되는 다른 지역에 비해 더 크게 산정되었으며 순응제도에서 배출권거래제 또한 아직 활성화되진 않았지만 배출권이 거래되는 양이나 건수가 지속적으로 증가하는 것을 확인할 수 있었다. 이를 통해 총량관리제를 농도규제와 비교해 성공한 정책으로 판단하였으며 그 결과 정책이 가지는 합리성, 정치적지지 그리고 순응을 제고할 수 있는 제도를 포함하고 있음을 총량관리정책의 성공적 집행 요인으로 제시하였다. 과거 연구에서는 환경정책에 대해 변화가 지속적으로 요구되어져 왔다. 본 연구에서는 총량관리제가 기존의 환경정책들과 달리 과거 연구에서 요구되었던 내용들이 일부 포함되어 있는 정책으로서 성공적 집행에 따른 그 영향요인을 도출하였고 이를 통해 앞으로 환경정책에 있어 더 개선된 방향으로의 정책 수립 및 시행에 영향을 미칠 것으로 예상한다.1. 서 론 ................................................................... 1 2. 연구목적 및 필요성................................................. 3 3. 이론 및 선행연구.................................................... 4 3.1 이론적배경 .......................................................... 4 3.1.1 굴뚝원격감시체계제도.......................................... 4 3.1.2 수도권 사업장 대기오염물질 총량관리제.................. 6 3.2 이론적 논의 .......................................................... 9 3.2.1 환경정책 ........................................................... 9 3.2.2 환경규제 .......................................................... 10 3.2.3 정책순응 ........................................................... 11 3.2.4 지속가능성 ....................................................... 13 3.3 선행연구 ............................................................. 14 3.3.1 환경정책 .......................................................... 14 3.3.2 대기오염 .......................................................... 17 3.3.3 대기환경정책 .................................................... 18 3.3.4 정책집행연구 .................................................... 20 3.3.5 기존연구의 한계 ................................................ 21 4. 연구대상 및 연구방법 ............................................. 23 4.1 연구대상 ............................................................. 23 4.2 연구방법 ............................................................. 24 5. 대기환경정책의 평가 .............................................. 27 5.1 환경정책의 특성 ................................................... 27 5.1.1 정책목표의 특성 ................................................. 27 5.1.2 환경정책 디자인 ................................................ 30 5.2 정책집행환경의 특성 ............................................. 34 5.2.1 정책집행환경 .................................................... 34 5.2.2 법적구조화 능력 ................................................ 37 5.3 환경정책의 지속가능성 .......................................... 41 5.3.1 환경정책의 목표달성 .......................................... 41 5.3.2 대기오염물질 배출권거래제.................................. 47 5.3.3 자발적 감축협약 ................................................ 49 5.3 성공적 집행에 따른 요인 분석 ................................. 51 6. 결론 및 고찰 ......................................................... 54 7. 참고 문헌 ............................................................. 59 Abstract .................................................................. 64Maste

Hinman Syndrome: Long Term Follow up of 14 Cases

Purpose Hinman syndrome is the most severe form of nonneurogenic neurogenic bladder causing damage of the upper urinary tract. Fourteen patients with Hinman syndrome followed at our institution were evaluated for their clinical characteristics and prognosis. Here we report the findings of this series of patients for this poorly understood syndrome. Materials and Methods The medical records of 14 patients, 8 boys and 6 girls, diagnosed with Hinman syndrome from March 1993 to June 2006 were reviewed. The mean duration of follow up was 69 months. The ultrasonography, 99m Tc-dimercaptosuccinic acid renal scan (DMSA), voiding cystourethrogram (VCUG), and urodynamic study (UDS) results were retrospectively analyzed and efficacy of each treatment method was evaluated based on the medical records on follow up. Results Hydronephrosis of grade III or greater on ultrasonography and renal scarring of both kidneys on the DMSA renal scan were observed in 12 and 14 patients, respectively. Severe bladder trabeculation and high grade VUR (IV, V) were observed on the VCUG in 14 and 8 patients, respectively. Decreased bladder compliance on the UDS was noted in 13 and detrussor-sphincter dyssynergia (DSD) was observed in eight. Medical treatment was not effective in all 14 cases and six patients who underwent botulinum injection of the bladder were unresponsive to that treatment as well. In spite of conservative treatments such as clean intermittent catheterization (CIC), seven patients eventually underwent bladder augmentations after a mean period of thirty-seven months from diagnosis because of concern about the loss of bladder capacity and renal function. One patient who did not perform CIC progressed to end-stage renal disease and had to be transferred to pediatric nephrology for dialysis. Conclusions Patients diagnosed with the Hinman syndrome were treated similar to patients with neurogenic bladder. However, from the long-termfollow up data at our outpatient clinic, many patients eventually had bladder augmentation to prevent further loss of bladder capacity and renal function. Therefore, urologists must not hesitate in performing such treatment when necessary.ope

The Significance of the Parents' Description of Constipation in Pediatric Voiding Dysfunction

PURPOSE: Dysfunctional voiding is closely related to constipation, and accurate evaluation of constipation is important. We investigated the accuracy and reliability of several methods that are used to evaluate constipation. MATERIALS AND METHODS: We collected data from the parents of 168 dysfunctional voiders, and the data was collected using the Bristol stool form scale and the Leech method. We then analyzed the results of the questionnaire and compared them with the Paris Consensus on Childhood Constipation Terminology(PACCT). RESULTS: Among the 168 dysfunctional voiders, 71(42%) were diagnosed with constipation according to PACCT. Of the 39 children who were considered constipated, none were constipated according to PACCT. However, 35 of the 129 children whose parents denied they were constipation were in fact diagnosed with constipation. When the Leech method and the Bristol stool form scale were both used, the sensitivity of diagnosis rose to as high as 75%, and when the statement of the guardian was added, the sensitivity rose to as high as 85%. CONCLUSIONS: Since constipation can be a rather subjective condition, it would be appropriate to respect and incorporate the parents' statement into the diagnosis. However, for making a more accurate diagnosis, comprehensive evaluation based on specific symptoms and the Bristol stool form scale and the Leech method may be helpful.ope

Clinical Characteristics of Children with Persistent Cloaca: A Urological Perspective

PURPOSE: Persistent cloaca is a rare multiple anomalous condition which involves the gastrointestinal, neurological and urogenital systems. We evaluated the clinical characteristics and urogenital anomalies of patients with persistent cloaca, and we investigated the factors that must be considered from a urological perspective. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 11 patients who were diagnosed with persistent cloaca at our institution during the last 7 years. RESULTS: Nine of the 11 patients who were followed up at the urology clinic were subjected to this study. Nonspecific abnormalities, such as antenatal hydronephrosis, were noted in 5 of 9 patients. The chief complaints upon visits to the urologic clinic were recurrent urinary tract infections in 3, preoperative evaluation before neurosurgery in 3, urinary incontinence in 1, urinary retention in 1 and an elevated creatinine level in 1. The urological anomalies included 2 cases of renal agenesis and 1 horseshoe kidney. Vesicoureteral reflux was noted in 6 patients, and 4 of these patients underwent antireflux surgery. Videourodynamic study was performed in 8 patients and all of them were diagnosed with neurogenic bladder. Currently, 5 children are on intermittent catheterization, 2 have undergone vesicostomy and 2 void spontaneously. CONCLUSIONS: Most patients with persistent cloaca had urological anomalies of the upper urinary tract and neurogenic bladder. Therefore, a multidisciplinary approach for diagnosis and treatment from various departments, including the urology, pediatric surgery, neurosurgery departments is mandatoryope

Long-term Outcome and Parents’ Satisfaction after the Correction of Concealed Penis

Purpose: Although there are multiple published report of surgical technique for concealed penis and the short-term result of the surgical correction, but there is a paucity of report concerning of the long term follow up data and parents’ satisfaction. We report our long-term results of the surgical treatment of concealed penis focus on parent satisfaction Patients and Methods: Medical data of 45 patients treated for concealed penis in Severance hospital from 1999 to 2001 were collected and reviewed retrospectively. The parents were questioned about the initial problem that they associated with concelaled penis, such as appearance, hygiene problem and infection problem via telephone interview. Results: Thirty two patients visited the OPD of pediatric urology because of the problem of hygiene, negative appearance and medical problem such as balanoposthitis (group 1) while 13 patients were referred by primary physician (group 2). Mean age was 2.6 yrs and mean duration of follow up was 7.8 yrs. All patients in group 1 and 89% of group 2 complained of difficulty with hygiene before surgery. Following surgery, group 1 patients fared better reporting improvements in hygiene (91%), accessibility (86%) and improved appearance of the penis (97%). Results from surgical intervention were less successful in group 2, with improved hygiene in 85%, improved penile lengthening in 75% and improved appearance in 77% of patients. Conclusions: Our long term outcome data demonstrate that most parents thought that surgical correction is helpful to keep hygiene of penis and improve the appearance of penis. Most parents still viewed surgery as a positive intervention and would recommend it to a friend with similar conditionope