Impact of Treatment With Statins on Prostate-Specific Antigen and Prostate Volume in Patients With Benign Prostatic Hyperplasia

PURPOSE: We investigated the impact on prostate-specific antigen (PSA) and prostate volume (PV) of statin medication for 1 year in patients with benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: We retrospectively investigated 791 patients in whom BPH was diagnosed. For analysis, the patients were divided into four groups according to their medications: group A, alpha-blocker; group B, alpha-blocker+statin; group C, alpha-blocker+dutasteride; group D, alpha-blockers+statin+dutasteride. To investigate changes in serum PSA, PV, and total cholesterol, we analyzed the data at the time of initial treatment and after 1 year of medication. RESULTS: After 1 year, group A showed a 1.3% increase in PSA and a 1.0% increase in PV. Group B showed a 4.3% decrease in PSA and a 1.8% decrease in PV. The difference in PV reduction between groups A and B was statistically significant (p<0.001). Group C showed a 49.1% reduction in PSA and a 22.9% reduction in PV. Group D showed a 51.6% reduction in PSA and a 24.5% reduction in PV. The difference in PV reduction between groups C and D was not statistically significant (p=0.762). By use of a multivariate logistic regression model, we found that the probability of PV reduction after 1 year was more than 14.8 times in statin users than in statin nonusers (95% confidence interval, 5.8% to 37.6%; p<0.001). CONCLUSIONS: Statin administration reduced PSA and PV in BPH patients. This finding may imply the improvement of lower urinary tract symptoms and prevention of cardiovascular disease and chemoprevention of prostate cancer with statin treatment.

Wilms' Tumor in a Horseshoe Kidney

The incidence of horseshoe kidney is about 1 in 400 cases. The presence of Wilms' tumor with a horseshoe kidney is unusual, and the occurrence of Wilms' tumor in a horseshoe kidney is estimated at 0.4 to 0.9% of all Wilms' tumors. We report the case of a 5-year-old boy who presented with a stage IV Wilms' tumor in a horseshoe kidney. The patient was treated with preoperative chemotherapy followed by surgical resection and adjuvant chemotherapy. This case illustrates the role of preoperative chemotherapy for preserving renal function and aims to highlight the multimodality treatment of Wilms' tumor.

Tumor Establishment Features of Orthotopic Murine Bladder Cancer Models

PURPOSE: Animal tumor models are important for the evaluation of novel therapeutic modalities. Since the initial report of an orthotopic bladder tumor model, several modifications have been proposed to improve the tumor take rate. Here we compared the HCl-pretreated and electrocauterization-pretreated orthotopic murine bladder tumor models. MATERIALS AND METHODS: MBT-2 murine bladder cancer cells were transurethrally implanted in the bladder of syngeneic C3H/He mice. The mice were divided into three groups according to pretreatment methods (electrocautery, HCl, and control group) and were subjected to pretreatment before instillation of MBT-2 tumor cells into the bladder. Mice were sacrificed on day 21, and bladders were harvested, weighed, and examined histopathologically. RESULTS: The tumor take rate of the control, electrocautery, and HCl groups was 0%, 54%, and 100%, respectively. The tumor take rate of the HCl group was significantly higher than that of the control group (p<0.01) and the electrocautery group (p=0.01). Pathologic reports revealed that all established bladder tumors were high-grade papillary urothelial carcinomas. CONCLUSIONS: The HCl pretreatment model was a preferable murine bladder tumor model for evaluating further therapeutic interventions.

Clinical Predictive Factors in Patients with Prostate Cancer Diagnosed by Repeat Prostate Biopsy / 대한남성과학회지

PURPOSE: We investigated the predictive factors in patient with prostate cancer diagnosed by repeat prostate biopsy, where initial prostate biopsy results were negative for malignancy. MATERIALS AND METHODS: Between March 2000 and June 2007, 1280 men with suspected prostatic cancer underwent transrectal ultrasound guided needle biopsy of the prostate, with 148 (11.6%) diagnosed as having prostate cancer. Of 1132 men whose biopsy results were negative for malignancy, 655 whose prostate specific antigen (PSA) was elevated persistently underwent second biopsy, and 462 underwent third biopsy as the same course. Twelve core biopsies were performed in the majority of patients. To determine predictive factors, we evaluated prostate volume, serum PSA, percent free PSA, PSA density (PSAD), transition zone PSAD, PSA velocity (PSAV) and pathological report of previous biopsy between the men with cancer detection and the men with negative biopsy in second and third biopsy. RESULTS: Overall cancer detection rate was 16.3% (208/1280). From the first, second and third biopsies, the cancer detection rate were 11.6, 5.5 and 5.2%, respectively. There were significant differences in percent free PSA, transition zone PSAD, PSAV between cancer and negative biopsy groups after serial repeat biopsies (p<0.05). Multivariate logistic regression analysis revealed that the transition zone PSAD, PSAV, and presence of either atypical small acinar proliferation (ASAP) or high grade prostatic intraepithelial neoplasia (HGPIN) in initial biopsy specimen were significant predictors for prostate cancer diagnosed by repeat biopsy. CONCLUSIONS: Of the men with negative results on the first biopsy, 60 (5.4%) were diagnosed prostate cancer after serial biopsies. The transition zone PSAD, PSAV, and presence of either ASAP or HGPIN in initial biopsy specimen are predictable factors for prostate cancer detection on repeat biopsy.

Porcine vesical acellular matrix graft of tunica albuginea for penile reconstruction / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To characterize the feasibility of the surgical replacement of the penile tunica albuginea (TA) and to evaluate the value of a porcine bladder acellular matrix (BAM) graft.</p><p><b>METHODS</b>Acellular matrices were constructed from pigs' bladders by cell lysis, and then examined by scanning electron microscopy (SEM). Expression levels of the mRNA of the vascular endothelial growth factor (VEGF) receptor, fibroblast growth factor (FGF)-1 receptor, neuregulin, and brain-derived neurotrophic factor (BDNF) in the acellular matrix and submucosa of the pigs'bladders were determined through the reverse transcription-polymerase chain reaction (PCR). A 5 mm X 5 mm square was excised from the penile TA of nine rabbits. The defective TA was then covered in porcine BAM. Equal numbers of animals were sacrificed and histochemically examined at 2, 4 and 6 months after implantation.</p><p><b>RESULTS</b>SEM of the BAM showed collagen fibers with many pores. VEGF receptor, FGF-1 receptor and neuregulin mRNA were expressed in the porcine BAM; BDNF mRNA was not detected. Two months after implantation, the graft sites exhibited excellent healing without contracture, and the fusion between the graft and the neighboring normal TA appeared to be well established. There were no significant histological differences between the implanted tunica and the normal control tunica at 6 months after implantation.</p><p><b>CONCLUSION</b>The porcine BAM graft resulted in a structure which was sufficiently like that of the normal TA. This implantation might be considered applicable to the reconstruction of the TA in conditions such as trauma or Peyronie's disease.</p>

Comparative Analysis of the Prostate Cancer Detection Rate according to Region and Number of Biopsy in Patient with Elevated Serum PSA / 대한비뇨기과학회지

PURPOSE: We evaluated the rate of prostate cancer detection according to the region and number of biopsies in patients with an elevated level of serum prostate-specific antigen (PSA). MATERIALS AND METHODS: Transrectal ultrasound (TRUS) guided prostate biopsies were performed at 12 regions, using the standard sextant, with an additional 6 cores far lateral peripheral zone, in 178 men with an elevated PSA level, and with no suspicious lesions of prostate cancer on digital rectal examination (DRE) and TRUS. We analyzed the rate prostate cancer detection according to the region, number of biopsies, the PSA level, prostate volume and PSA density (PSAD). RESULTS: The rates of cancer detection were 12.9, 11.8 and 7.4% in the 12 core, lateral 6 core and medial 6 core (standard sextant) biopsies, respectively (p<0.05). There were no differences in overall cancer detection rates between 12 core and lateral 6 core plus apex medial 2 core biopsies (12.9%). In men with a PSA level greater than 20ng/ml, no difference in cancer detection was found with the 12 core or either of the 6 core biopsies (positive rate 33.3%). In men with a PSA level over 10ng/ml, a prostate volume less than 49cc or a PSAD greater than 0.15, a lateral 6 core biopsy made no difference to the diagnosis of prostate cancer compared to a 12 core biopsy. CONCLUSIONS: A lateral 6 core biopsy, combined with an apex medial 2 core biopsy, is a more efficient method for the detection of prostate cancer than the standard sextant biopsy in men with an elevated serum PSA level without a suspicious lesion on DRE and TRUS.

Ureteral Endometriosis

Endometriosis represents extrauterine nonneoplastic endometrial tissue. It is most commonly diagnosed in women of childbearing age, with a peak age of 40 to 44 years. The incidence of genitourinary involvement ranges from 1% to 2%. Ureteral endometriosis is a rare entity, and its diagnosis requires a high index of suspicion. We report a case of ureteral endometriosis in a 44-year-old multiparous woman with a brief review of literature.

Papillary Urothelial Tumor of Bladder in 5-year-old Girl / 대한비뇨기과학회지

The occurrence of bladder tumors in the first 2 decades of life are rare neoplasias. Transitional cell tumors of the bladder are extremely a rare clinical disease entity. Here, a case of a papillary urothelial tumor in a 5-year-old girl is reported, with a brief review of the literature. Histologically, the tumor was a solitary and papillary urothelial tumor of low malignant potential (by WHO and the ISUP).

Development of Experimental Model of Chronic Renal Failure in the Rat / 대한비뇨기과학회지

PURPOSE: An animal model with experimental uremia is an important research tool for the study of pathophysiological events that take place during chronic renal failure. Among the several techniques of making uremic models, the two-stage 5/6 nephrectomized rat model is the most popular method, but this modality has some disadvantages. The aim of this study was to simplify the complicated method for experimental uremic animal models in the rat. MATERIALS AND METHODS: Forty Sprague-Dawley rats were used for this study. They were divided into three groups: 20 in the experimental group, 10 in the control group, and 10 in the Sham operation group. The ligation of the left renal vessels and 2/3 right renal partial nephrectomy using the 3-0 Silk tie of renal parenchyme were performed simultaneously in the experimental group. The BUN and serum creatinine were measured in all groups in intervals of every two weeks for a total time of nine weeks after nephrectomy. The kidneys of experimental rats were harvested and analyzed histologically. RESULTS: One week after operation, BUN and creatinine of the experimental group were increased compared to the control group and Sham operation group (p<0.001). At 9 weeks, increased levels of BUN and creatinine were maintained in the experimental group (p<0.001). Histologically, fibrotic changes of partially nephrectomized kidneys and decreased numbers of microorgans, such as the glomeruli and tubules, were observed in the experimental group. Four rats (4/20) in the experimental group died during this experiment. CONCLUSIONS: To induce chronic renal failure in rats, the one-stage procedure (2/3 nephrectomy using the suture tie and ligation of contralateral renal vessels) is an acceptable method with a low mortality rate.

Alcohol Induced Apoptosis on Leydig Cell Line, TM3 / 대한비뇨기과학회지

PURPOSE: It is well known that alcoholics with hepatic cirrhosis exhibit alterations in the hypothalamic-pituitary-gonadal axis as well as vitamins and trace element deficiencies leading to an inadequate testicular function, which is related to impotence and infertility. Several studies on chronic alcoholics have revealed that alcohol exerts cytotoxic effect at the testicular level. However, the exact mechanisms of alcohol cytotoxicity on testicular cells have not been clarified. In this study, it was determined whether or not alcohol induces apoptosis in Leydig cells. MATERIALS AND METHODS: The Leydig cells, TM3, were grown in culture. The cells were exposed to various alcohol (Ethanol) concentrations for 3 hours, ranging from 50mM to 500mM. The cells without alcohol treatment served as the controls. The cell viability and proliferative activities were determined using a 3-(4,5-dimethylthiazol-2-yl)-2,5- diphenyltetrazolium bromide (MTT) assay. The apoptotic cellular changes were assessed by 4,6-diamidino-2-phenylindole (DAPI) staining, a terminal deoxynucleotidyl transferase (TdT)-mediated dUTP nick end-labeling (TUNEL) assay, which were confirmed with a DNA fragmentation assay. A further investigation with reverse transcription-polymerase chain reaction (RT-PCR), caspase-3 enzyme assay, and Western blot analysis was performed. RESULTS: The MTT assay revealed that alcohol induces Leydig cell cytotoxicity in a concentration dependent manner. Alcohol treatment resulted in definitive apoptotic features including DNA fragmentation, increased caspase-3 enzyme activity, mRNA expression, and protein. CONCLUSIONS: In this study, alcohol was shown to induces typical apoptosis on Leydig cells via caspase-3 activation. It is suggested that alcohol-induced apoptosis is one of the important mechanisms in male urogenital disorders including erectile dysfunction and infertility. Further studies to clarify the detailed mechanisms of alcohol-induced apoptosis on Leydig cells are recommended.

Primary Squamous Cell Carcinoma of Prostate with Rectal Invasion / 대한비뇨기과학회지

Primary squamous cell carcinoma (SCC) is an uncommon tumor of the prostate, with a median incidence of 0.5-1% of all prostate malignancies. Only one case of prostate SCC has been reported in Korean medical literature. Prostate SCC usually presents clinical and evolutive aspects that are different from those of prostate adenocarcinoma, have poor response to any therapy, and shows extremely poor prognosis. We report a case of prostate SCC with rectal invasion in a 64-year-old man who complained of acute urinary retention.

Significance of Expressions of bcl-2 and p53 Protein as the Prognostic Factor in Metastatic Prostate Adenocarcinoma / 대한비뇨기과학회지

PURPOSE: We investigated the significance of bcl-2 and p53 protein expressions as the prognostic factor in metastatic prostate adenocarcinoma. MATERIALS AND METHODS: Nineteen paraffin-embedded prostatic cancer tissues were examined using immunohistochemical staining for bcl-2 and p53 protein. We evaluated correlation of bcl-2 and p53 protein expressions with cancer progression free interval, pretreatment PSA and Gleason score. RESULTS: Seven out of 19 cases (36.9%) were positive for p53 and 3 cases (15.8%) were positive for bcl-2 protein. Mean disease progression free interval in positive patients for bcl-2 and p53 protein expressions was 8.7 months and 10.3 months, respectively. However, it was 18.3 months and 21 months in negative expressions, respectively. The difference of mean disease progression free interval between positive and negative groups for p53 protein expression was statistically significant (p<0.05) but not in bcl-2 protein groups. The rates of positive staining for bcl-2 and p53 protein were 0% (0/8) and 37.5% (3/8), respectively, in Geason score 5-7 groups, 27.3% (3/11) and 36.4% (4/11) in 8-10 groups. Neither of proteins had significant correlation with Gleason score and pretreatment PSA. CONCLUSIONS: The expression of p53 protein was correlated with significant short disease progression free interval but bcl-2 overexpression had relative short disease progression interval without statistical significance. These results suggest that expressions of bcl-2 and p53 have considerable prognostic impact and these gene products would provide useful information about prognosis of metastatic prostate adenocarcinoma.

A Case of Congenital Nephrogenic Diabetes Insipidus with Megaureter and Megabladder / 대한신장학회잡지

A case of a 37 year-old man of congenital diabetes insipidus is reported. He complained of polydipsia, which began from his youth, drinking about 10 L of water every day. He didn't look ill or mentally retarded. In his family, his only brother has shown similar symptoms and his older sister had no symptom. On radiologic study, both kidneys showed severe hydronephrosis and the bladder was markedly distended. Water deprivation test was performed. The result was consistent with diabetes insipidus and the urine osmolality didn't respond to antidiuretic hormone injection, and he was diagnosed as nephrogenic diabetes insipidus. We began to treat him with thiazide and amiloride. The amount of water he's been drinking daily has decreased to 3-4 L per day. We discuss this case with a brief review of literature.

Massive Inguinal Bladder Hernia into the Scrotum / 대한비뇨기과학회지

It is generally accepted that 1-3% of all inguinal hernias involve the bladder. However herniation of the bladder deep into the scrotum is rare. We report a case of massive bladder hernia of paraperitoneal type in a 58-year-old male with scrotal pain and palpable scrotal mass. Treatment consisted of partial cystectomy and herniorrhaphy. The postoperative result was good without complications.

Engineered Tissue for Augmentation Penoplasty Using Chondrocytes and Biodegradable Polymers / 대한비뇨기과학회지

PURPOSE: Materials used in penoplasty have several disadvantages upto now. It would be attractive to make enough tissue without any drawbacks for plastic surgery from autologous tissue. In this study we have pursued to reconstruct cartilaginous tissue feasible for penoplasty by tissue engineering using chondrocytes and polyglycolic acid (PGA) polymers. MATERIALS AND METHODS: Chondrocytes were harvested from articular joint of swine and expanded by culture. Cells were seeded onto sterilized PGA scaffolds designed in various shapes at a concentration of 5x107/ml. Total 28 cell-polymer complexes and 8 polymers without cell (control) were implanted onto 12 nude mice. They were sacrificed 1, 2, 4 and 8 weeks after implantation to get the implants. Gross and histologic analysis were performed including hematoxylin & eosin (H-E) stain, toluidine blue stain. RESULTS: All the animals were grown without any complications. Milky firm predesigned-shaped cartilaginous tissues were obtained at 8 weeks after implantation grossly. Histologically mature cartilage-like structures were found in the 8 week's retrived tissue in H-E and toluidine blue stains. Almost all the polymer structures were degraded at 8 weeks. CONCLUSIONS: Cartilaginous tissues were reconstructed successfully using chondrocytes and PGA polymers by tissue engineering in vivo. These elastic structures could be used for penoplasty instead of other materials if confirmed about safty in human. This study showed possibilities to apply this technique in the fields of plastic and reconstructive surgery.

The Outcome of Endourologic Treatment for Benign Ureteral Strictures / 대한비뇨기과학회지

PURPOSE: We reviewed the results of endoureterotomy and balloon dilation for benign ureteral strictures to determine the efficacy of these procedures. MATERIALS AND METHODS: We treated 19 patients who had benign ureteral stricture by retrograde endoureterotomy or balloon dilation followed by placement of a 6-8Fr stent for 6 weeks. Mean follow up period was 14 months (6-27 months). Eight patients were treated by endoureterotomy using cold knife under direct vision and 11 patients were treated by balloon dilation. The causes of ureteral strictures were abdominal surgery in 8 patients, urinary tuberculosis in 6 patients, radiation therapy in 2 patients, rigid ureteroscopy in 2 patients and periureteral abscess in 1 patient. The length of strictures was shorter than 1cm in 14 patients and over 1cm in 5 patients. The etiology of strictures was ischemic origin in 11 patients and nonischemic in 8 patients. One patient had poor ipsilateral renal function (<25%). RESULTS: The overall success rate was 78.9% (15/19). The success rate of balloon dilation was 81.8% (9/11) and that of endoureterotomy was 75% (6/8). No significant complication such as high fever or sepsis was observed. Strictures shorter than 1cm had 92.9% (13/14) success rate while strictures over 1cm had 40% (2/5) success rate (p <0.05). The nonischemic strictures had better success rate (87.5%) compared to ischemic strictures (72.7%) without statistical significance. CONCLUSIONS: We would suggest the use of balloon dilation or endoureterotomy as the initial treatment of benign ureteral stricture regarding the safety and efficiency. The better outcome would be expected in the strictures shorter than 1cm in length.

Clinical Significance ad Asymptomatic Residual Renal Stone Fragments after Shock Wave Lithotripsy / 대한비뇨기과학회지

No abstract available.

376 Cases of Ureteroscopic Stone Removal / 대한비뇨기과학회지

PURPOSE: We retrospectively reviewed the cases of ureteroscopic stone removal at our institution to define the efficiency of ureteroscopy for treatment of ureteral calculi. MATERIALS AND METHODS: Ureteroscopic stone removal was performed in 376 cases of ureteral stone from August, 1989 to December, 1997. There are 241 males and 135 females, and mean age was 45.6 years. Nine stones were located in the upper ureter, 27 in the mid ureter, 340 in the lower ureter. The stone size was less than 5mm in 125 cases, from 5 to 10mm in 185 cases and more than 10mm in 66 cases. Ureteroscopy was performed with 9.5Fr, 10Fr or 12.5Fr rigid ureteroscope under spinal, general or epidural anesthesia. RESULTS: Overall success rate of ureteroscopic stone removal was 95.1 percent. The success rates of upper, mid and lower ureteral stones were 55.6, 88.9 and 97.1 percents, respectively. According to the stone size, the success rates was 97.6 percent in stones less than 5mm, 94.6 percent in stones of 5 to 10mm and 92.4 percent in stones more than 10mm. Over all complication rate was 9.6 percent. Complications consisted of severe ureteral mucosal tearing(20 cases), ureteral perforation(8 cases), gross hematuria(3 cases), infection(3 cases) and urethral stricture(2 cases). All complications were treated successfully with conservative treatment except 2 cases of urethral stricture that required visual urethrotomies. CONCLUSIONS: Ureteroscopic stone removal could offer rapid relief of obstruction and colic due to mid and lower ureteral calculi with high success rate and minimal complications.

Anatomic Factors that Affect Lower Caliceal Stone Clearance after Shock Wave Lithotripsy / 대한비뇨기과학회지

PURPOSE: Shock wave lithotripsy(SWL) has become the preferred modality of treatment for the most kidney stones. But there is a consensus that success rate of SWL is relatively poor for the lower caliceal stones. We assessed the influence of spatial anatomy of the lower calyx on stone clearance after SWL. MATERIALS AND METHODS: We retrospectively reviewed 92 patients with 5-20mm sized solitary lower caliceal stone who had undergone SWL between March 1992 and February 1998. The clearance rate at three months was compared according to lower pole anatomy, such as infundibulopelvic angle, infundibular length and infundibular width. RESULTS: Overall stone free rate was 59.8 percent. In 67 cases whose infundibulopelvic angle greater than 90 degree, stone free rate was 68.7 percent, whereas in 25 cases less than 90 degree, it was only 36.0 percent(p<0.05). In 36 cases whose infundibular length greater than 3cm stone free rate was 38.9 percent, whereas in 56 cases less than 3cm it was 73.2 percent(p<0.05). In 70 cases whose infundibular width greater than 5mm stone free rate was 57.1 percent, whereas in 22 cases less than 5mm it was 68.2 percent. CONCLUSIONS: The lower pole infudibulopelvic angle and infundibular length has a significant role in the stone clearance after SWL of lower caliceal stones. The infundibulopelvic angle less than 90 degree and infundibular length greater than 3cm are individually unfavorable factors. We believe that these anatomic factors have to be considered when the physician decides SWL as a first line treatment of lower caliceal stones.

A Case of High Flow Priapism / 대한비뇨기과학회지

High flow priapism is a nonischemic form of priapism. This results from unregulated, continuous arterial inflow to the lacunar spaces by trauma or idiopathic causes. It is clinically recognizable because the erection is painless and coporal aspiration yields bright red blood with a high pO2. We report a case of arterial high flow priapism secondary to perineal blunt trauma in 29-year-old man treated with embolization of cavernosal artery.