Current Concepts in Bacterial Sexually Transmitted Diseases

Sexually transmitted diseases (STDs) are the most common infectious diseases worldwide, with over 350 million new cases occurring each year, and have far-reaching health, social, and economic consequences. Failure to diagnose and treat STDs at an early stage may result in serious complications and sequelae. STDs are passed from person to person primarily by sexual contact and are classified into varied groups. Some cause mild, acute symptoms and some are life-threatening. They are caused by many different infectious organisms and are treated in different ways. Syphilis and gonorrhea are ancient afflictions. Now, however, Chlamydia is prevalent and has become the most common bacterial STD. Antimicrobial resistance of several sexually transmitted pathogens is increasing, rendering some regimens ineffective, adding to therapeutic problems. A standardized treatment protocol for STDs is recommended to ensure that all patients receive adequate treatment. Appropriate treatment of STDs is an important public health measure.

A Comparative Study of Clinical Symptoms and Treatment Outcomes of Acute Bacterial Prostatitis According to Urine Culture

PURPOSE: Because acute bacterial prostatitis (ABP) is an urgent condition of the prostate but prostatic massage is contraindicated at the onset of ABP, clinical symptoms and urine tests are used for diagnosis. In this study, we compared the clinical symptoms and treatment outcomes of patients with negative urine culture results, to whom only empirical antibiotics were administered, with those of patients with positive urine culture results. MATERIALS AND METHODS: Patients were divided into two groups according to the results of urine culture. Then, the clinical symptoms and course of each group were analyzed. In addition, age, symptoms, antibiotics, mean inpatient and outpatient length of treatment, and the treatment outcome of each group were also analyzed. RESULTS: Of the total 144 patients, the positive urine culture group consisted of 51 patients (35.4%) and the most frequent bacterial strain causing ABP was reported to be Escherichia coli. Fever and storage symptoms were significantly more common in the positive urine culture group than in the negative urine culture group (p=0.031 and 0.047, respectively). Only inpatient treatment was significant longer in the positive urine culture group than in the negative urine culture group (p<0.05). The mean length of treatment of inpatients was 4.8+/-2.6 days and 6.2+/-2.9 days in the two groups, respectively. No sequelae such as prostatic abscess or chronic prostatitis were found in either group. CONCLUSIONS: In the treatment of ABP, the use of empirical antibiotics can be expected to have sufficient effects regardless of bacterial culture. However, it is hard to determine the causative bacteria of ABP by urine culture results only.

Significance of Serum Testosterone for Prostate-Specific Antigen (PSA) Elevation and Prediction of Prostate Cancer in Patients with PSA Above 10 ng/ml

PURPOSE: Testosterone is essential for the prostate gland's normal growth and development and is also a possible risk factor for prostate cancer. This study's aim was to determine the significance of serum testosterone for prostate-specific antigen (PSA) elevation and prostate cancer prediction in high-risk men. MATERIALS AND METHODS: The study included 120 patients with PSA >10 ng/ml who underwent a transrectal-prostate biopsy. Serum testosterone, prostate volume, and PSA density (PSAD) were checked in all patients. Patients were divided into two groups, patients with and those without prostate cancer; and testosterone-related factors, prostate volume, PSA, PSAD, age, prostate cancer prediction rate, and cancer aggressiveness were evaluated. RESULTS: Thirty-five patients (30.2%) were confirmed as having prostate cancer. The average serum testosterone level in patients without and in those with prostate cancer was 452.25+/-154.62 ng/dl and 458.10+/-158.84 ng/dl, respectively; average PSA was 17.58+/-9.02 ng/ml and 18.62+/-6.53 ng/ml, respectively; and average age was 69.02+/-7.52 years and 70.69+/-7.02 years, respectively (p>0.05). Hypogonadal and eugonadal patients showed no significant difference in cancer prevalence (30.3% vs. 32.0%, respectively). The testosterone level did not differ significantly in patients with and those without prostate cancer in either hypogonadal or eugonadal men (p>0.05). Serum testosterone showed no correlation with PSA, PSAD, or age in either group (p>0.05) and was unrelated to prostate cancer risk or aggressiveness (p>0.05). CONCLUSIONS: In our study's results, serum testosterone at the time of diagnosis was unrelated to PSA elevation, prostate cancer risk, and aggressiveness.

Early Experience with Hyaluronic Acid Instillation to Assist with Visual Internal Urethrotomy for Urethral Stricture

PURPOSE: The clinical usefulness of hyaluronic acid (HA) instillation during visual internal urethrotomy (VIU) for decreasing the incidence of recurrent urethral stricture was assessed. MATERIALS AND METHODS: Twenty-eight patients were treated by VIU with HA instillation between May 2007 and June 2009. After insertion of a Foley catheter following urethrotomy, HA was instilled via an 18-gauge tube catheter between the urethral lumen and Foley catheter. Seventeen cases were analyzed retrospectively 12 months postoperatively. We evaluated the success rate of this procedure by comparing retrograde urethrography (RGU) results, maximum flow rates, and postvoid residual urine volumes preoperatively and 3 and 12 months postoperatively. Success was defined as either a maximum flow rate of at least 15 ml/s or no visible urethral stricture on RGU at 12 months postoperatively. RESULTS: Total success rates were 76.5% (13/17) and 52.9% (9/17) at 3 and 12 months postoperatively, respectively. By etiology, success rates at 3 and 12 months postoperatively, respectively, were 66.7% and 33.3% for inflammation, 66.7% and 50.0% for trauma, and 83.3% and 66.7% for unknown causes. Success rates were 63.6% for strictures less than 10 mm in length and 33.3% for strictures of 10 mm or more in length at 12 months postoperatively. Success rates were 61.5% for single strictures and 25% for multiple strictures at 12 months postoperatively. CONCLUSIONS: The success rate of VIU with HA instillation was not better than that observed in the literature for conventional VIU.

Prostate Cancer Metastasis to the Stomach

Prostate cancer commonly manifests with bony metastases. Visceral metastasis can also occur in the lungs and liver. However, stomach metastasis related to prostate cancer is rare. Here, we report a case of prostate cancer metastatic to the stomach. A 66-year-old male was diagnosed with prostate adenocarcinoma. He was noted as having abdominal discomfort, nausea, and vomiting 18 months after the diagnosis. A histopathologic examination and an esophagogastroduodenoscopic gastric biopsy revealed stomach-metastatic adenocarcinoma. He was also noted as having cerebellar metastatic lesions, which were identified by using a brain magnetic resonance imaging (MRI) scan. The patient died of cardiovascular complications 5 months after the diagnosis of stomach metastasis.

Correlation between Nocturia and Sleep: A Questionnaire Based Analysis

PURPOSE: This study evaluated the effectiveness and quality of sleep (QoS) in adult patients with nocturnal lower urinary tract symptoms (LUTS) including nocturia and nocturnal polyuria. MATERIALS AND METHODS: A total of 102 patients with nocturia and daytime LUTS were enrolled in this study. All patients completed a questionnaire that included the International Prostate Symptom Score (IPSS), quality of life score (QoL), overactive bladder questionnaire (OABq), and a sleepiness index. The sleepiness index was measured with the Korean Beck Depression Inventory (K-BDI), Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), Berlin Questionnaire (BQ), and the International Restless Legs Syndrome Study Group (IRLSSG). Statistical analyses included the Student's t-test and chi-square test. Differences were considered significant at a p-value of less than 0.05. RESULTS: Nocturia during sleep was experienced by 68 (66.7%) out of 102 patients. There was no significant association between the nocturia- and the sleep-related scales, but with multiple regression analysis for sex and age, the K-BDI score (p=0.05), IPSS score (p=0.05), and OABq (p=0.02) were significantly higher in patients who woke up to void during sleep. A total of 57 (55.9%) patients diagnosed with overactive bladder with nocturia had severe daytime sleepiness on the ESS questionnaire (p=0.019) and more urgency symptoms on the IPSS questionnaire (p=0.007). CONCLUSIONS: Patients with nocturia had a greater risk of being depressive and felt sleepier during the daytime. LUTS including nocturia and sleep quality closely affected each other. Therefore, clinicians should consider patients' LUTS and sleep problems or QoS as well to provide more satisfying outcomes.

Risk Factors for Antimicrobial Resistance Among the Escherichia coli Strains Isolated from Korean Patients with Acute Uncomplicated Cystitis: A Prospective and Nationwide Study

We investigated the risk factors for resistance to ciprofloxacin, cefazolin, ampicillin and co-trimoxazole in Escherichia coli isolates from urine of Korean female patients with acute uncomplicated cystitis (AUC). A total of 225 patients and their E. coli isolates were prospectively and nationwidely enrolled between May and October, 2006. All the antimicrobials did not show any differences according to the age group. A higher rate of ciprofloxacin resistance was observed in the south (OR: 3.04, 95% CI: 1.19-7.80 for Chungcheong-do & Jeolla-do; OR: 3.04, 95% CI: 1.22-7.58 for Gyeongsang-do) compared to Gyeonggi-do. Two recurrences of AUC in the past year was an important risk factor for antimicrobial resistance (ciprofloxacin; OR: 6.71, 95% CI: 1.86-24.11 and cefazolin; OR: 5.72, 95% CI: 1.20-27.25). However, the resistance to co-trimoxazole and ampicillin was not associated with any of the risk factors. This study also revealed the pattern of multi-drugs resistance in ciprofloxacin resistant E. coli strains. In conclusion, for Korean patients with two more recurrences of AUC in the past year, it is strongly recommended to perform an antimicrobial sensitivity test with a urine sample before empirical treatment.

Correlation between Metabolic Syndrome and Lower Urinary Tract Symptoms of Males and Females in the Aspect of Gender-Specific Medicine: A Single Institutional Study

PURPOSE: We attempted to examine the correlation between metabolic syndrome and lower urinary tract symptoms (LUTS) in the aspect of gender-specific medicine. MATERIALS AND METHODS: A total of 922 patients participating in a health examination completed the International Prostate Symptom Score (IPSS) questionnaire and the Overactive Bladder Questionnaire Short Form (OABq-SF) symptom bother scale from March 2008 to July 2009. Metabolic syndrome was defined by using the National Cholesterol Education Program Adult Treatment Panel III criteria announced in 2001. We analyzed differences in lower urinary tract symptoms according to the presence of metabolic syndrome and the component elements of metabolic syndrome. RESULTS: The subjects were 538 males and 384 females with a mean age of 48.8+/-6.8 years. Among all patients, the number of patients with metabolic syndrome was 143 (15.5%); there were 110 males (20.4%) and 33 females (8.6%), showing a significant difference. There were no differences in scores on the IPSS or OABq-SF with respect to the presence or absence of metabolic syndrome in males. In females, however, there were significant differences in the IPSS and OABq-SF depending on the presence or absence of metabolic syndrome. In males and females, the IPSS total score was significantly correlated with age. Also, high-density lipoprotein (HDL) cholesterol in males and triglyceride in females was significantly correlated with the IPSS total score. CONCLUSIONS: There are sex differences in the morbidity rate of metabolic syndrome and its effect on lower urinary tract symptoms. Therefore, it is necessary to consider gender-specific medicine in the diagnosis and treatment of LUTS.

Laser Doppler Flowmetry: Usefulness in Female Sexual Dysfunction / 대한남성과학회지

Purpose: Various diagnostic tools have been developed to diagnose and differentiate the causes of female sexual dysfunction. In this study, we used laser Doppler flowmetry to measure the genital blood flow and analyzed its usefulness as a diagnostic tool in patients with sexual dysfunctions. Materials and Methods: We enrolled 50 female patients with sexual difficulties(45.8+/-9.8 years old). Ten sexually healthy women were enrolled as a control group. We measured the superficial blood flow of the clitoral glans, vestibule, and anterior wall of the vagina using laser Doppler flowmetry(Periflux 5000, Permed AB, Sweden), and compared these measurements with blood flow measured in response to sexual stimulation induced by an erotic film. Medical and personal histories, physical examinations, and self-reporting questionnaires were taken from the patients for classifying their sexual problems. Results: The patients complained of problems with desire(46 patients, 92%), arousal(41, 82%), orgasm(49, 98%), pain(10, 20%), and satisfaction(32, 64%). Most patients had more than one problem. In patients with sexual dysfunction, baseline blood flows at all measuring sites were significantly lower than in the control group(p<0.05). After the sexual stimulation, the blood flows of the glans, vestibule, and anterior vaginal wall were significantly increased(p<0.0001). In the groups with desire and arousal problems, blood flow changes were significantly less than in the control group. Conclusions: Laser Doppler flowmetry can provide very useful information on whether patients have hemodynamic-based sexual problems. We can approach the causes of sexual difficulties, particularly sexual desire or arousal problems, using this novel technological instrument.

Can the PDE5 Inhibitor Replace Intracavernosal Injection as a Method for Inducing a Penile Erection during the Evaluation of Erectile Dysfunction Using Penile Duplex Ultrasonography? / 대한비뇨기과학회지

PURPOSE: To clarify whether vardenafil can be used as a substitute for intracavernosal injection as a method of induction of penile erection, we compared the outcome of penile duplex Doppler ultrasonography using both methods in the same patient with erectile dysfunction. MATERIALS AND METHODS: A total of 23 patients underwent penile duplex ultrasonography twice with a one week interval between procedures. Twelve were randomly selected for intracavernosal injection first with prostaglandin E1(PGE1) 20microgram and the remaining 11 were initially treated with oral vardenafil 20mg 1 hour before the Doppler study and in addition had visual sexual stimulation using a head-mounted display during the study. The peak systolic velocity(PSV), end diastolic velocity(EDV) and the degree of maximum erectile response were measured and compared between the two groups. RESULTS: Measurements from the PGE1 treatment were not significantly different from those with the vardenafil treatment. The percentage of compatibility between the two methods with regard to hemodynamic diagnosis and pharmaceutical erectile response was as high as 83%(19 of 23) and 91%(21 of 23), respectively. Both methods were tolerable and safe without severe complications. However, in 4 patients where the diagnosis was uncertain, the injection method provided a more accurate interpretation of the penile vascular status with duplex ultrasonography. CONCLUSIONS: These results suggest that oral vardenafil can be used as an initial method for inducing penile erection when assessing erectile dysfunction with penile duplex Doppler ultrasonography in selected patients with erectile dysfunction.

Analysis of risk factors associated with male lower urinary tract symptoms in the metabolic syndrome

PUROPOSE: The purpose of this study was to evaluate the relationship between lower urinary tract symptoms (LUTS) and the metabolic syndrome in the elderly male. MATERIAL AND METHODS: The metabolic syndrome group of 348 patients (64.4+/-8.6 years old) and the control group of 150 patients (66.0+/-7.0 years old) were included in the study. The voiding factors, such as International Prostate Symptom Score (IPSS), quality of life score, prostate volume, maximal urine flow rate, residual urine volume, and prostate-specific antigen (PSA) were investigated. Waist circumference, blood pressure, fasting glucose, HDL-cholesterol, triglyceride were measured for the evaluation of the metabolic syndrome. RESULTS: Waist circumference (beta=0.025, p<0.001), systolic (beta=0.004, p<0.05) and diastolic blood pressure (beta=0.006, p<0.05) were positively correlated with prostate volume. In the logistic regression analysis of voiding factors according to metabolic syndrome factors, the patients who have central obesity (Odds ratio [OR]=2.931), central obesity and hypertension (OR=3.598), central obesity and diabetes (OR=2.508), hypertension and low HDL-cholesterolemia (OR=2.326), central obesity, hypertension and diabetes (OR=3.083), central obesity, hypertension and low HDL cholesterolemia (OR=3.440) represented a significantly increased age-adjusted risk of benign prostatic enlargement (25g or more). OR of symptomatic benign prostatic hyperplasia (BPH) was 3.178 in the patients with cental obesity, and 2.381 in the patients with both central obesity and hypertension. CONCLUSIONS: In male elderly, the metabolic syndrome was closely related with LUTS and its main risk factor was central obesity, represented as waist circumference.

The Trend Change of Incidence and Treatment of Urolithiasis between the 1980s and 2000s / 대한비뇨기과학회지

PURPOSE: The incidence of urolithiasis has recently shown an increasing tendency in relation to improvements in living conditions in Korea. With the development of extracorporeal shock wave lithotriptor (ESWL), endourology and other new instruments, urolithiasis has become easier to treat, without surgical intervention. The incidence and treatment of urolithiasis, between the 1980 and 2000, were evaluated. MATERIALS AND METHODS: 328 and 1,142 patients with urolithiasis, either admitted between January 1981 and December 1984 or treated at the out-patient clinic between January 2001 and December 2004, respectively, were analyzed. RESULTS: In the early 1980s, 328 (27.3%) patients of the total 1,203 admitted to the urology department had urolithiasis. In the early 2000s, 1,142 patients were treated for urolithiasis. The total number and incidence constantly increased over the stated period. The ratio of males to females was 1.3:1 in the 1980s and 2.0:1 in the 2000s. The occurrence rate for those under 20 years decreased, but increased after the 6th decade. And the seasonal occurrence was highest during the summer of the early 1980s, but there was no seasonal difference during the early 2000s. The incidences of lower ureteral, bladder and urethral calculi were decreased, but those of renal and upper ureteral calculi increased. In the management of urolithiasis, open surgery and expectant therapy decreased during the 2000s. In the endourological management of urolithiasis, the success rates of ESWL, percutaneous nephrolithotomy (PNL) and ureteroscopic removal of stone (URS) were 94.5, 86.6 and 96.4%, respectively. CONCLUSIONS: The incidence and treatment modalities of urolithiasis have changed, especially since the late 1980s.

The Long Term Effect of Extracorporeal Magnetic Innervation Therapy with Pelvic Floor Muscle Exercise for Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: Extracorporeal magnetic innervation (ExMI) therapy has been known to be safe and immediately effective in stress urinary incontinence (SUI). However, no long term follow-up results have been reported. Therefore; herein, are reported our results from a two year follow-up study on ExMI therapy, with pelvic floor muscle exercises, for SUI. MATERIALS AND METHODS: The study group was comprised of 94 patients with SUI. ExMI therapy was performed for 20 minutes (10Hz and 50Hz for each 10 minutes), twice a week, for 6 weeks. Thereafter, 44 of the 94 patients underwent pelvic floor muscle exercises. Objective measures (quality-of-life surveys, pad changes, and leak episodes per day) were evaluated before, immediately after and 24 months after the ExMI therapy. RESULTS: After 6-week of ExMI therapy, the quality-of-life score improved from 5.1+/-0.9 to 1.8+/-1.1. The mean frequency of pad changes was reduced from 2.1+/-1.6 to 1.1+/-1.0. The mean frequency of leak episodes was also reduced from 2.8+/-1.8 to 1.7+/-1.5 times. After 24 months, the 44 patients having also undergone pelvic floor muscle exercise had persistent improvements in their leak episodes per day compared to the 50 patients that had not. CONCLUSIONS: When ExMI therapy was followed by pelvic floor muscle exercises, the favorable effect in leak episodes per day after ExMI therapy may persist for at least 24 months.

The Recurrence of Chronic Pelvic Pain Syndrome and the Role of Uro-Vaxom(R) / 대한비뇨기과학회지

PURPOSE: Chronic pelvic pain syndrome (CPPS) is the most common urogenital disease in middle aged men, and it shows various symptoms and a high recurrent rate. Uro-Vaxom(R) is effective for the treatment of urinary tract infection via the activation of the urothelial immune system. The main objectives of this study were to investigate the recurrence of CPPS and to find out if Uro-Vaxom(R) is helpful to suppress the recurrence of this condition. MATERIALS AND METHODS: After completing treatment for CPPS (NIH-IIIa 45, NIH-IIIb 85), 130 patients were given a 12 week course of Uro-Vaxom(R) 60mg once a day before breakfast. Sixty patients were also included in the study as a control group after they completed the treatment for CPPS (NIH-IIIa 22, NIH-IIIb 38). All of patients were reevaluated 12 weeks and 24 weeks later with the NIH-CPSI criteria and the EPS findings. RESULTS: The overall recurrent rate for NIH-IIIa disease was 22.7%, and it was 26.3% for the patients with NIH-IIIb disease in the control group, and it was 6.7% for the patients with NIH-IIIa disease and 7.1% for the patients with NIH-IIIb disease in the Uro-Vaxom(R) group (p<0.05). The classification of the recurrent CPPS was 46.7% NIH-IIIa and 53.3% NIH- IIIb in the control group, and 11.1% NIH-IIIa and 88.9% NIH-IIIb in the Uro-Vaxom(R) group. The possible predisposing factors related to the recurrence of CPPS were excessive alcoholic drinking (29.2%), overwork (25.0%) and stress (16.7%). In the non-recurrent patients, there was no change of the NIH-Chronic Prostatitis Symptom Index and the EPS findings for all patients during the follow-up period. CONCLUSIONS: There was about a 30% recurrence rate of CPPS within 6 months after treatment, and Uro-Vaxom(R) may play a significant role to suppress the recurrence of CPPS.

The Effect of Palliative Transurethral Resection of Prostate(Channel TURP) for Acute Urinary Retention in Patients with Metastatic Prostatic Cancer

PURPOSE: Obstructive voiding difficulties were frequent in the patients with metastatic prostatic cancer, and sometimes acute urinary retention may be developed even though medical treatments. We performed channel transurethral resection of prostate(TURP) as palliative treatment for those patients and reported the results. MATERIALS AND METHODS: Fifteen patients with metastatic prostatic cancer were taken TURP aiming for relief of infravesical obstruction. All patients were under the anti-androgen hormonal therapy and had sudden onset of acute urinary retention. TURP was done under general or epidural anesthesia. After TURP, 30~50 cc ballooning urethral Foley catheter was placed for 4 days. We analyzed voiding parameters comparatively before and 3 months after TURP. RESULTS: The mean age of patients was 75.6+/-5.7 years old. Mean prostatic volume was 47.8+/-1.4 cc. Mean resected prostatic tissue was 6.4+/-2.1 cc. All patients had stage D prostatic cancer. Mean serum PSA was 75.2+/-73.8 ng/ml and mean gleason score was 7.8+/-0.9. After TURP, mean international prostatic symptom score(IPSS) was improved from 25.5+/-2.0 to 13.8+/-2.0, mean quality of life score(QOL) was improved from 4.4+/-0.5 to 2.0+/-0.5, and mean maximum uroflow rate was increased from 5.0+/-1.1 ml/sec to 6.0+/-1.6 ml/sec. All patients did not have any complications according to TURP. CONCLUSION: In patients with metastatic prostatic cancer, channel TURP could be considered as a treatment option to relieve severe obstructive voiding difficulty.

Effect of Tamsulosin on the Expectant Treatment of Lower Ureteral Stones / 대한비뇨기과학회지

PURPOSE: We evaluated the effectiveness of tamsulosin on the expectant treatment for the patients suffering with lower ureteral stones. MATERIALS AND METHODS: A total of 67 patients with stones less than 5mm that were located in the lower ureter were enrolled in the study. The patients were randomly divided into two groups. Group 1 (n=32) received 20mg caroverine (a spasmolytic drug) orally three time a day. Group 2 (n=35) received 0.2mg tamsulosin orally one time a day. The treatment was continued until expulsion of stone or to a maximum of 28 days. All patients were allowed 30mg ketorolac trimethamine intramuscular injections on demand. We compared the two groups for stone size, the expulsion rate, the time to expulsion and use of analgesics. RESULTS: The average stone size was 4.3+/-0.61mm for group 1 and 4.4+/-0.51mm for group 2. No statistical difference between two groups was found for stone size, age and sexual distribution. The expulsion rate was significantly higher in group 2 (82.8%), compared with group 1 (53.1%) (p=0.002). The mean expulsion time was 8.3 days for group 1 and 4.6 days for group 2 (p<0.0001). The average number of intramuscular analgesic injections was 3.9 for group 1 and 1.1 for group 2 (p<0.0001). CONCLUSIONS: Tamsulosin was proved to be effective and safe, as demonstrated by the increased stone expulsion rate, the decreased expulsion time and the reduced use of pain control in the expectant treatment of the lower ureter stones.

Additive Expulsion Effect of Tamsulosin after Shock Wave Lithotripsy for Upper Ureteral Stones / 대한비뇨기과학회지

PURPOSE: We evaluates if the administration of tamsulosin increases the efficacy of extracorporeal shock wave lithotripsy (ESWL) in the patients with upper ureteral stones and if this decreased the use of analgesic drugs after the procedure. MATERIALS AND METHODS: A total of 45 patients with stones 6-12mm in size that were located in the upper ureter were enrolled in the study. The patients were randomly divided into two groups. Group 1 (n=23) received 3 times a day oral treatment of 20mg caroverine (a spasmolytic drug). Group 2 (n=22) received one time a day oral therapy of 0.2mg tamsulosin. All the patients received oral treatment for 14 days. Both groups of patients were allowed to use 30mg ketorolac trimethamine intramuscular injections on demand. The endpoint of the study was the stone expulsion rate, the use of analgesics and the drug adverse effects during treatment. RESULTS: The average stone size was 7.9+/-2.79mm for group 1 and 8.2+/-3.14mm for group 2. No statistical difference between the two groups was found for the stone size, age and gender distribution. The expulsion rate was significantly higher in group 2 (90.9%) compared with group 1 (65.2%) (p=0.038). The average number of pain control injections was 0.78 for group 1 and 0.23 for group 2, and there was a statistically significant difference between the two groups (p=0.042). CONCLUSIONS: The use of tamsulosin proved to be effective and safe, as demonstrated by the increased stone expulsion rate and the lesser need for pain control than that when using just a spasmolytic drug for ESWL of upper ureter stones.

Voiding Dysfunction of Women Associated with Metabolic Syndrome / 대한비뇨기과학회지

Purpose: The occurrence of coronary artery disease is rising with the recent changes in diet and the westernization of lifestyle. In 1998, the World Health Organization (WHO) defined "metabolic syndrome" as a condition in which all the risk factors of coronary artery disease exist in an elderly individual. We investigated the relationship between metabolic syndrome and voiding difficulty of women. Materials and Methods: In 2004, we investigated 66 female out-patients who visited the endocrinology department and health care center between the months of March and October. We divided the patients into two groups: one which corresponded to the metabolic syndrome criteria (n=42, 56.0+/-5.6 years old) and one which did not (n=24, 55.7+/-05.2 years old), and we compared the voiding factors of these two groups. Results: When comparing the components of metabolic syndrome in the patient study group to that in the control study group, the metabolic syndrome patients scored poorly for all the metabolic syndrome components in comparison to the control group (p<0.05). On comparing the voiding factors of metabolic syndrome patients to that of the control group, the metabolic syndrome patient group scored substantially lower than the control group for all voiding factors (p<0.05). Conclusions: We proved that metabolic syndrome and voiding difficulty of women were related based on the results of this study. Therefore, performing more active investigation for metabolic syndrome in the patients who are admitted with voiding difficulty, earlier diagnosis of metabolic syndrome would be possible.

Voiding Dysfunction of Men is Associated with Metabolic Syndrome / 대한비뇨기과학회지

PURPOSE: With the recent changes in eating habits and the westernization of peoples' lifestyle, the occurrence of coronary artery disease is on the rise. In 1998, the World Health Organization (WHO) defined "metabolic syndrome" as a condition in which all the risk factors of coronary artery disease exist in an elderly individual. We investigated the relationship between metabolic syndrome and voiding difficulty. MATERIALS AND METHODS: In 2004, we investigated 123 male out-patients who visited the endocrinology department and the health care center between the months of March and October. We divided the patients into two groups: one group met the criteria for metabolic syndrome (n=90, 58.7+/-8.9 years old) and one group didn't met the criteria (n=33, 57.8+/-9.5 years old), and we compared factors of voiding difficulty between the these two groups. RESULTS: When comparing the components of metabolic syndrome in the patient study group to the control study group, the metabolic syndrome patients scored poorly for all the metabolic syndrome components in comparison to the control group (p<0.05). When comparing the voiding factors of the metabolic syndrome patients to the control group, the metabolic syndrome patient group scored substantially lower than the control group for all the voiding factors (p<0.05). CONCLUSIONS: The results of this study proved that metabolic syndrome and voiding difficulty are related. Therefore, the earlier diagnosis of metabolic syndrome should be possible by performing a more active investigation for metabolic syndrome in the patients who are admitted with voiding difficulty.

Prevention of Relapse with the Cranberry Juice in Chronic Pelvic Pain Syndrome / 대한비뇨기과학회지

PURPOSE: The treatment of chronic pelvic pain syndrome (CPPS) is based on antibiotic therapy, but many patients experience a relapse after treatment. Cranberry juice is known for its roles in both the treatment and prevention of urinary tract infections. This study was performed to evaluate the effectiveness of cranberry juice in the prevention of a relapse after the treatment of CPPS. MATERIALS AND METHODS: Fifty patients, diagnosed as CPPS (National Institutes of Health; NIH-catagory IIIa), were included in this study. All the patients had initially been treated with levofloxacin and supportive treatment for 8-12 weeks. After completion of the initial treatment, 26 volunteer patients were recommended to drink 150ml of cranberry juice twice a day, 24 patients, as a control group, received no cranberry juice and all the patients re-evaluated after 3 months. RESULTS: On initial diagnosis, the white blood cell (WBC) count in the high power field (HFP) of expressed prostatic secretions (EPS) and the NIH-Chronic Prostatitis Symptom Index (NIH-CPSI) in cranberry group were 18.2 3.4 and 23.1 4.4 and those of the control group 16.4 4.8 and 22.4 3.7, respectively. When the medical treatment was ended, the WBC of the EPS and NIH-CPSI in the cranberry group were 2.5 2.1 and 14.1 4.1, and those of the control group were 2.7 1.9 and 13.7 2.1, respectively. After the three month follow-up, the cranberry group showed a WBC of 2.2 2.5 in the EPS and a NIH-CPSI of 12.7 3.9, a slight decrease or similar result compared to the treatment completion period. No patient showed aggravation of symptoms after drinking cranberry juice, whereas five from the control group did. CONCLUSIONS: Cranberry juice showed an effect in the prevention of a relapse in CPPS patients, with no adverse effects.