The Impact of Pelvic Lymphadenectomy on the Survival of Patients Who Underwent Radical Cystectomy for Transitional Cell Carcinoma of the Bladder / 대한비뇨기과학회지

PURPOSE: We assessed the impact of pelvic lymphadenectomy on the survival of patients who had undergone radical cystectomy. MATERIALS AND METHODS: We retrospectively reviewed 107 patients who underwent radical cystectomy for transitional cell carcinoma of the bladder between January 1991 and December 2000. We preoperatively excluded patients with evidence of pelvic lymphadenopathy and distant metastases from the study. Among 107 patients, 61 patients (Group A) underwent pelvic lymphadenectomy while 46 patients (Group B) did not. The clinicopathological parameters were not significantly different in the two groups. RESULTS: In group A, 12 patients (19.6%) were found to have pelvic node metastases. Five-year overall survival and recurrence-free survival rates were 68% and 75% for Group A, respectively. In group B, 5-year overall survival and recurrence-free survival rates were 36% and 56%, respectively. Multivariate analysis revealed that T stage (p=0.004) and lymphadenectomy (p=0.044) were significant prognostic factors for survival. CONCLUSIONS: The overall survival rates between the two groups were significantly different. Our findings suggested that lymphadenectomy may improve the prognosis of patients who underwent radical cystectomy for transitional cell carcinoma of the bladder.

Epidemiologic Survey of Sexual Life of Middle-Aged Couples in Seoul / 대한남성과학회지

PURPOSE: We investigated libido and sexual life satisfaction of middle-aged couples in Seoul. MATERIALS AND METHODS: A total of 2,034 couples ranging from 40 to 79 years old living in the Seoul metropolitan area were selected by stepwise random sampling. The questionnaires asking about erectile function, sexual performance, sexual life satisfaction, and libido were administered by trained interviewers. RESULTS: Interviews were completed for 1,356 couples(66.7%). The prevalence of severe and moderate loss of libido in the men was 29%. Decrease of libido correlated with increasing age. Higher scores on the erection scale of the O'Leary sexual function questionnaire were closely correlated with greater libido. In sexual function self-assessment, most male subjects did not complain of libido(53.8%), erection(61.7%), or ejaculation(63.8%) difficulties. Most couples(50.3% of the male and 53% of the female subjects) expressed satisfied with their sexual lives. Higher scores on the erection scale correlated with an increase in sexual satisfaction of both men and women. Fewer than half of the female subjects(40.4%) answered that they had 'no' or 'low' sexual interest. Younger age and more education were correlated with greater sexual interest. CONCLUSIONS: With increasing age, middle-aged couples living in Seoul showed a decrease in libido, sexual function, and sexual interest. However, satisfaction with their sexual life was high in general.

The Impact of Transurethral Resection of Bladder Tumor: Clinicopathologic Analysis of Cystectomy Specimen to Evaluate Residual Tumor / 대한비뇨기과학회지

PURPOSE: We analyzed the impact of transurethral resection of the bladder (TUR-B) in patients with bladder cancer, in whom a subsequent cystectomy was performed. MATERIALS AND METHODS: We reviewed the records of 93 patients, with clinical stage T2 or less transitional cell carcinomas of the bladder that underwent a radical cystectomy at our institute. Before the radical cystectomy, TUR-B was performed for diagnostic and therapeutic purposes in all patients. We used the term "complete TUR" for the following procedures. No residual tumors were found after the TUR endoscopically, also, muscle layer should be present in the TUR specimens and no gross residual tumors were found in the cystectomy specimens by the pathologist. RESULTS: Eleven (26.8%) of the 41 patients with superficial bladder cancer had no evidence of residual tumors. Of the 19 patients with superficial bladder cancer that underwent complete TUR-B, 10 (52.6%) had no residual tumors. For the invasive tumors, 10 (19.2%) of the 52 patients that had a T2 stage disease had no residual tumors, and 10 (29.4%) of the 34 patients with a T2 stage disease, who underwent complete TUR-B, had no residual tumors. In the 38 patients with superficial bladder cancer, 17 (44.7%) changed to a higher stage. Of the 17 patients who underwent complete TUR-B, 3 (17.7%) changed to a higher stage. Among the patients with a T2 stage disease, those with the pT0 stage had a better survival than those with the pT2 stage with residual tumors (p=0.04). CONCLUSIONS: The completeness of TUR-B is important in evaluating residual tumors after a previous TUR-B in those patients with both superficial and invasive bladder cancers.

Prevalence of Sexual Dysfunction in Men Older Than 40 Living in Seoul: Epidemiologic Survey Using Questionnaire / 대한비뇨기과학회지

PURPOSE: Information on sexual function including the prevalence of erectile dysfunction, the severity of erectile dysfunction and the risk factors associated with it, from population-based sampled couples in Seoul, Korea was examined. MATERIALS AND METHODS: A total of 2,034 couples ranging from 40 to 79 years old living in the Seoul metropolitan area were selected by stepwise random sampling. The total number of study subjects where sufficient answers were obtained was 1,356. The questionnaire included questions on erectile function, sexual performance, and sex life. RESULTS: The combined prevalence of mild, moderate and severe erectile dysfunction was 84.3%. This correlated well with the score on the erection scale of the O'Leary sexual function inventory. The prevalence of severe erectile dysfunction was 11.8%, which increased from 1.0% in subject aged from 40 years to 68.5% in 70 years. The prevalence of self-reported erectile dysfunction was 12.0%. The subjects' age was most strongly associated with erectile dysfunction. After adjusting for age, a higher probability of erectile dysfunction directly correlated with diabetes, hypertension, heart disease, cigarette smoking, and low level of education. CONCLUSIONS: The population-based epidemiological data showed that male erectile dysfunction is quite common and impacts on quality of life of men.

Epidemiologic Survey Using International Prostate Symptom Score (I-PSS) of Lower Urinary Tract Symptoms (LUTS) in Elderly Men Above 40 Years Old in Seoul Area / 대한비뇨기과학회지

PURPOSE: We tried to determine the prevalence of LUTS and to measure the impact of these symptoms on quality of life (QOL), and to reevaluate the validity of I-PSS in Korea. MATERIALS AND METHODS: A total of 1,356 men ranging from 40 to 79 years old living in Seoul metropolitan area was selected by stepwise random sampling and surveyed with questionnaire including I-PSS. Several risk factors were analyzed to assess the relevance with lower urinary tract symptoms. RESULTS: About 16% had moderate-to-severe LUTS, as assessed by I-PSS more than 7. The prevalence of moderate-to-severe LUTS increased significantly with age (p<0.01); 10%, 16%, 29%, and 45% in the age groups 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years respectively. The most prevalent symptoms were weak stream and nocturia. QOL decreased as urinary symptom severity increased; 5%, 52%, 78% of the men with I-PSS 0 to 7, 8 to 19, and 20 to 35 had poor QOL as assessed by QOL indices more than 2, respectively. A good correlation was found between the total symptom score and the quality of life score that was included in the I-PSS. CONCLUSIONS: Moderate to severe LUTS of elderly men above 40 years old in Seoul metropolitan area are relatively common, and more people suffer from the LUTS as they get older. New modified I-PSS system in Korean elderly men according to the importance of individual symptom in the established I-PSS, will be beneficial in the management of the lower tract symptom associated with BPH.

Size of Prostatitis Symptoms Using Prostatitis Symptom Index(PSI): The Effect of Prostatitis Symptoms on Quality of Life / 예방의학회지

OBJECTIVES: To determine the prevalence of prostatitis symptoms in the general population by questionnaire survey and to measure the effect of prostatitis symptoms on quality of life(QOL). MATERIALS AND METHODS: A cross sectional community-based epidemiologic study was performed on 2,034 men, living in the Seoul metropolitan area using stepwise random sampling. Out of 2,034 interviewees, 1,356 men who were older than 40 and provided sufficient information were selected for this study. The questionnaires were completed by well trained interviewers. Contents of the questionnaires included demographic data, the Prostatitis Symptom Index(PSI), the International Prostate Symptom Score(IPSS), a general health questionnaire section and a sexual health questionnaire section. The PSI was composed of a sum of the scores from three questions about dysuria, penile pain and perineal pain and it ranged 0 to 12. Incidence of prostatitis symptoms was defined by a score of 4 or more and the reference group was defined as consisting of those with a score of 3 or less. The rate of incidence of prostatitis symptoms was assessed according to age and the difference of QOL between the prostatitis symptoms group and the reference group. RESULTS: The overall positive rate of prostatitis symptoms measured by the PSI, in men older than 40, living in the Seoul metropolitan area, was 4.5%(61/1,356), adjusted to 4.8% by the relative proportion of this age group in the general population of the Seoul metropolitan area as compared to Korea and the World. The proportion of the group with prostatitis symptoms assessed by the PSI did not increase with age although the proportion of participants with moderate to severe lower urinary tract symptoms (LUTS) did increase with age. The group with prostatitis symptoms suffered from a much greater incidence of LUTS compared to the reference group (p<0.05). The QOL scores of the IPSS, and the general health and sexual health status of the group with prostatitis symptoms, were worse than those of the reference group.(p<0.05). CONCLUSIONS: The positive rate of prostatitis symptoms in men older than 40, living in the Seoul metropolitan area, was 4.8% and it didn't increase with age. The general QOL of the group with prostatitis symptoms was much worse than that of the reference group.

Adult Testicular Germ Cell Tumor: Clinical Characteristics and Risk Factors for Recurrence / 대한비뇨기과학회지

PURPOSE: We reviewed clinical characteristics and prognostic factors in testicular germ cell tumor in adults. MATERIALS AND METHODS: We reviewed the records of 42 patients with testicular germ cell tumors managed at Seoul National University Hospital between January 1985 and May 1997. Patients were followed regularly to determine clinical outcome with tumor markers, chest X-ray and abdominal CT. Mean follow-up was 5.75 years ranging from 3months to 238months. RESULTS: Painless testiscular enlargement(86%) was the most common presenting symptom and history of cryptorchidism was noted in 6 patients. Among 21 seminoma patients, 11 were stage I, 9 were stage II, and 1 was unknown and among 21 nonseminomatous germ cell tumor(NSGCT) patients, 14 were stage I, 1 was stage II, 5 were stage III, and 1 was unknown. Of the 11 patients with stage I seminoma, there was no recurrence in 7 patients who received retroperitoneal low-dose radiation therapy after orchiectomy, but 2(50%) of 4 patients who had surveillance after orchiectomy, showed relapse at retroperitoneal lymph nodes. One of 3 patients who had elevated level of serum beta-HCG at initial presentation showed tumor relapse at retroperitoneal lymph node. Among 11 patients with stage I NSGCT under surveillance after radical orchiectomy, 7 patients(63.6%) had relapse. Vascular invasion of tumor was noted in orchiectomy specimens in 3 cases of the 7 relapsed cases compared to no vascular invasion in 4 non-relapsed cases. Also, 4 of 7 patients with elevation of tumor marker resulted in relapse. Although primary pathologic stage T2 was noted in 2 patients with clinical stage I NSGCT, no recurrence occurred after adjuvant combined chemotherapy. Fifteen patients with stage II or stage III were treated with systemic combination chemotherapy after radical orchiectomy and 7 of these patients had residual retroperitoneal mass. Of these patients, salvage chemotherpy was done in 2 patients, salvage RPLND and salvage chemotherapy with RPLND was performed in 1 patient respectively. Of the patients with stage II or III, One patient with stage IIB seminoma died despite of salvage chemotherapy with RPLND. The remaining 3 patients with residual mass were followed regulary without further treatment. They had no evidence of recurrence which was evaluated by tumor marker, chest X-ray and abdominal CT. The marked reduction of residual mass after adjuvant therapy were found in this group. The overall survival rate in total patients was 98% at 5.75 years from initial diagnosis. CONCLUSIONS: Adjuvant low-dose radiation therapy after radical orchiectomy was recommended to reduce recurrence rates in stage I seminoma. The vascular invasion, pre-orchiectomy elevation of tumor markers, or pathologic T2 or more stage were risk factors for relapse in stage I NSGCT. In advanced staged germ cell tumor, high survival rate was achieved by cis-platin based combination chemotherapy. Especially, in the patients with marked reduction of tumor mass after chemotherapy, close surveillance might be adequate in stead of second look operation for the retroperitoneal mass. Irrelevant of its histopathologic finding and stage, the testicular germ cell tumor showed excellent therapeutic end-results. Further studies should be directed at developing therapeutic modalities that could achieve better therapeutic results with least therapeutic complication and sequelae.

Clinical Significance of Percent Free PSA as a Marker for Prostate Cancer / 대한비뇨기과학회지

PURPOSE: Prostate-specific antigen(PSA) exist in serum in two major immunodetectable molecular forms: free PSA, and complexed PSA(PSA- alpha-1-antichymotrypsin). Total PSA represents the sum of the free and complexedorms. Preliminary investigations have illustrated the potential benefits of using percent free PSA to enhance the utility of PSA in distinguishing benign prostate disease from prostate cancer. Our study was undertaken to define the effectiveness of precent free PSA in the early detection of prostate cancer and to determine appropriate cutoff points for percent free PSA in Korea when total PSA level is normal or mildly elevated so as to eliminate negative biopsies. MATERIALS AND METHODS: Patient samples consisted of 24 histologically confirmed primary cancer, 83 men with untreated benign prostate disease histologically confirmed by negative sextant biopsies, and 29 men with normal digital rectal examination and PSA values less than 4.0ng/ml. Total PSA and free PSA levels were determined using PSA-RIACT and FPSA-RIACT kit(Cis Bio International, France), respectively. Percent free PSA was calculated for all patients. Within the range of 2.5-20.0ng/ml, receiver operating curve(ROC) was generated and utilized to evaluate cutpoints for percent free PSA to be used in clinical practice. RESULTS: When all subjects were included, both total PSA and percent free PSA significantly discriminated patients with prostate cancer from patients with benign histologic conditions(p=0.0003 and p=0.0001, respectively). However, in men with total PSA values between 2.5 and 20.0ng/ml, the percent free PSA significantly discriminated patients with prostate cancer from patients with benign conditions(p=0.001), whereas the total PSA did not(p=0.14). Among this subgroup of patients, the analysis of sensitivity and specificity showed that the percent free PSA had a clearly higher specificity compared with that of the total PSA at the same level of sensitivity. Within the range of 2.5-20.0ng/ml, the cutoff point for percent free PSA was 20. CONCLUSIONS: Measurement of percent free PSA enhance the ability to discriminate prostate cancer from benign histologic condition while retaining high sensitivity for detecting cancer in men who present with total PSA levels between 2.5 and 20.0ng/ml.

Clinical Analysis of Incidentally Found Renal Cell Carcinoma: Experiences of Recent 8 Years / 대한비뇨기과학회지

PURPOSE: The clinical information and survival rate of incidentally found renal cell carcinoma patients were compared with those of symptomatic patients. MATERIALS AND METHODS: We reviewed the hospital records of 267 patients with renal cell carcinoma managed in Seoul National University Hospital during the recent 8 years. Mean followup period was 26+/-21.1 months. Initial presentations, pathologic stages, and survivals were analysed. RESULTS: In 124 patients(46.4%), the tumors were found incidentally. Hematuria, pain and mass were the common presentations in symptomatic patients. The more patients with lower stage(stage T1 and T2) belonged to incidentally found group compared with symptomatic group(81.5% vs 64.3%). The 2 and 5-year survival rates of incidentally found group were 78% and 67%, respectively, which were higher than those of symptomatic group(72% and 56%). The survival rate decreased markedly by increasing size, advanced stage, lymph node involvement and distant metastasis. CONCLUSIONS: Recently, there has been a significant increase of incidentally detected renal cell carcinoma and the incidentally found renal cell carcinoma proved to have better prognosis than symptomatic group. So our effort should be focused on detecting low stage incidentallomas.

Change of Chemosensitivity and Cellular Characteristics of Cisplatinum Resistant Human Bladder Cancer Cells Induced by Long-term Cisplatinum Treatment / 대한비뇨기과학회지

PURPOSE: Cisplatinum has the therapeutic efficacy against a bladder cancer. However, the response is often limited due to appearance of drug-resistant tumor cells. The studies of establishment and characterization of cisplatinum-resistant tumor cells are considered to be helpful in elucidating the underlying mechanism of acquired resistance to cisplatinum in human tumors. MATERIALS AND METHODS: We established cisplatinum-resistant cell lines sequentially, T24Rl and T24R2, which show resistance to cisplatinum at a concentration of 1 and 2microgram /ml, respectively, by the stepwise exposure of T24 human bladder cancer cell to increasing concentrations of cisplatinum. RESULTS: The resistance to cisplatinum of T24Rl and T24R2 cells was 13- and 18-fold that of the parental T24 cells, respective1y. Growth, DNA synthesis and cell cycle distribution of T24Rl and T24R2 cells were not different from those of the parental T24 cells. CONCLUSIONS: These cisplatinum-resistant bladder tumor cell lines could be a useful model to elucidate the biochemical and molecular mechanism Involved In the cisplatinum resistance.

Trimix Intracavernosal Self-injection Therapy: Long-term Follow-up Results in the Patients with Erectile Dysfunction / 대한비뇨기과학회지

PURPOSE: Trimix, the mixture of papaverine, phentolamine and PGE1 , has been widely used in intracavernosal therapy for patients with erectile dysfunction. Although several results have been reported in Korean patients using the Trimix, no long-term follow-up studies have been carried out. Therefore, we analysed our long-term follow-up results of Trimix therapy PATIENTS AND METHODS: A total of 216 patients(46.2 years of mean age) with erectile dysfunction underwent intracavernosal self-injection therapy with the Trimix(mixture of papaverine 48mg, phentolamine 2mg, PGE1 18microgram in 2 microliter solution). Once chosen, all patients were tested for an appropriate dosage. They were also given education upto 5 times for an successful self-injection therapy. During follow-up periods, ranging 12 to 34 months, evaluations of the effectiveness and safety of the therapy were made by inteNiewing patients upon their visits to our clinic. RESULTS: The final drop-out rate of cases were 107(49.5%). Most drop-out cases (80 cases) occurred within the first month of the therapy. It was also found that drop-out rate was Inversely correlated with number of attendance at the preself-injection education(p< 0.05). A total of 168 patients failed to attend more than 3 times. The drop-out rate of this group was 55%(92 cases) while 31% in those with more than 3 attendances. A total of 109(50.5%) patients completed longer than 12-month follow-up durations and 85(77%) patients were satisfied with the therapy. Their mean dosage was 0.16 microliter and mean frequency of applications was 5.0 times per month, Although no patient developed corporal fibrosis or infection, other side-effects including prolonged erection(14 cases) and penile pain during intercourse(3 cases) were reported. CONCLUSIONS: Trimix intracavernous injection therapy is minimally invasive, safe and effective for the treatment of patients with erectile dysfunction. While high drop-out rate was thought to be a major problem with this therapy, our results suggest that adequate educations can encourage patients to a certain degree.

Change of Cellular Immunity and T Cell Subset of Mouse Immunocytes Activated by Fractionated Bacillus Calmette-Guerin / 대한비뇨기과학회지

PURPOSE: To develope the bacillus Calmette-Guerin(BCG) antitumor component therapy which could reduce the adverse effect of intravesical BCG therapy, we investigated the effect of the fractions of BCG on the immune responses of mouse and compared with whole BCG. MATERIALS AND METHODS: Seven fractions, 4(fraction 1, 2, 3, 4) from BCG cell wall and 1 (fraction 7) front BCG cytoplasm and 2(fraction 5, 6) mixed, were collected by multiple ultrasonification and centrifugation of BCG solution and the difference of each fraction was confirmed by spectrophotometric absorbance. Change of lymphokine killer(LAK), natural killer(NK) and tumor cell dependent cytotoxic(TCDC) activities of mouse spleen cells were investigated by 51Cr releasing assay and proportion of T cell subset in mouse spleen and peritoneal lymhocytes were investigated by flow cytometric analyses using monoclonal antibodies to mouse CD4, CD8 and CD2S cells. RESULTS: In LAK and NK activities, fraction 1, 2 and 3 showed similar results with whole BCG. In TCDC activity, the all 7 fraction showed lower activities compared with BCG. In T cell subset analyses, similar results were found in fraction 1, 2 and 3 compared with whole BCG. CONCLUSIONS: We could suggest that the antitumor activity of BCG seems to be mediated by some component in cell wall. Further investigations which could elucidate these findings should be necessary.

Effect of Intralesional Interleukin-2 on Murine Bladder Tumor / 대한비뇨기과학회지

PURPOSE: We tried to evaluate the anticancer effect of intralesional interleukin-2 on murine bladder tumor. MATERIALS AND METHODS: In vitro direct anticancer effect of interleukin-2 upon MBT-2 cells was examined using MTT colorimetric assay in various concentration of human recombinant interleukin-2. Also in vivo study was carried out measuring the tumor implantation rates and growth of the implanted tumors on C3H/He mice receiving six consecutive injections of various concentrations of interleukin-2. RESULTS: No definite direct anticancer effect was found on in vitro study. Also, the tumor implantation rate and growth of the implanted tumors were similar whether interleukin-2's were injected or not. CONCLUSION: Intralesional injection of interleukin-2 does not seem to be effective upon murine bladder tumor.

Effect of Tumor Necrosis Factor-alpha Gene Transduced Bladder Tumor Cell Xenograft on Survival of C3H/He Mice / 대한비뇨기과학회지

OBJECTIVE: To evaluate the effect of tumor necrosis factor-alpha (TNF-alpha)gene transduced bladder tumor cells on survival of C3H/He mice. MATERIALS AND METHODS: The complete cDNA of TNF-alpha was introduced to mouse bladder tumor cell line(MBT-2) using a retroviral vector. Gene transfer and expression were confirmed by polymerase chain reaction(PCR) and reverse transcription polymerase chain reaction(RT-PCR). Produced TNF-alpha was measured by ELISA. TNF-alpha gene transduced and parental cells were xenografted in C3H/He mice. Implantation and growth rate and survival of experimental animals were analysed. RESULTS: Successful gene transfer and expression were confirmed. TNF-G gene transduced MBT-2 cells secreted TNF-alpha at the concentration of 47.4pg/106cells/24hours. The implantation and growth rate of TNF-t gene transduced MBT-2 cells were much lower than those of parental cells and survival of experimental animals was different between TNF-t gene transduced MBT-2 and parental cells(P<0.05). CONCLUSION: This study shows potential advantages of localized TNF-a secretion to induce potent antitumorigenic response. Tumor cell targeted TNF-a gene therapy could become a useful tool in treatment of bladder cancer.

Effect of Transduced Tumor Necrosis Factor-alpha Gene Expression on Growth of Human Bladder Tumor Cell Lines / 대한비뇨기과학회지

OBJECTIVE: To evaluate the effect of transduced tumor necrosis factor-a(TNF-a) gene expression on growth of human bladder tumor cell lines in vitro. MATERIALS AND METHODS: The complete cDNA of TNF-a was introduced to three human bladder tumor cell lines(F-24, J-82, HT-1197) using a retroviral vector, a recombinant form of Molony murine leukemia virus with TNF-a and Neo gene and transfected cells were selected by exposure to neomycin analog G418. Gene transfer and expression were confirmed by polymerase chain reaction(PCR) and reverse transcription polymerase chain reaction(RT-PCR)-Southern blotting. Cell growth was measured by MTT assay Result is Successful gene transfer and expression were confirmed in all three cell bladder tumor lines. Growth of transfected cells were compared with parental cell lines and no differences were found in all three cell lines(p>0.05). CONCLUSION: Expression of transduced TNF-t gene could not show any effect on growth of human bladder tumor cells in vitro.

Analysis of Antitumor Mechanism of Intravesical BCG Therapy in Tumorigenesis(I): Study About T Cell Dependency / 대한비뇨기과학회지

A study was carried out to define the role of T cells in tumorigenesis and antitumor activity of BCG treatment for superficial transitional cell carcinoma of urinary bladder using an anima1 mode1. We analysed the change of immunocytes and effect on tumor forming rate of BCG in C3H/He inbred mice with bladder tumors induced by N-butyl-N-(4-hydroxybuty1)-nitrosamine(BBN) and determined the relationship between changes of immunocytes and tumor forming rate. The number and distribution of helper(T4), and suppressor/cytotoxic(T8) T cells were studied immunohistochemically in the spleen and urinary bladder. In BBN administered group, helper T cells were increased. in urinary bladder as gross tumor developed, but it seemed to be not effective in tumor prevention, and there was no significant change observed in suppressor/cytotoxic T cells. Depletion of helper T cells in spleen observed in mice with gross tumors suggested the possibility of systemic response to tumor development In BCG treated group, helper in bladder and spleen were all increased markedly and decreased with time sequence. The change of suppressor T cells were not observed. In BBN administered and BCG treated group, the tumor forming rate was initially reduced by 30-40% comparing to the BBN only group, but the rate was subsequently increased gradually with time sequence. The rate became same between 2 groups by 20 weeks. Local reaction as well as cellular immunity which was mediated by systemic immune system appeared to play an important role in antitumor mechanism of BCG Helper T cell was thought to be the major element involved in antitumor activity. Since our result indicated that effect of BCG was time limited, we have to make an effort to modify current method of BCG treatment accordingly.

Estimation of Benign Prostatic Hyperplasia Prevalence in Korea: An Epidemiological Survey Using International Prostatic Symptom Score(IPSS) in Yonchon County / 대한비뇨기과학회지

The prevalence of urinary symptoms associated with benign prostatic hyperplasia(BPH) was studied in a community-based, representative sample of 519 men over 50 years old for estimation of prevalence of BPH in Korea. Symptoms were assessed by the Korean version of International Prostatic Symptom Score(IPSS). Only 5(1%) men reported having undergone prostate surgery due to BPH and excluded from analysis. Among 514 men, nocturia and weak stream were the most prevalent symptoms and urgency was the least. Based on the IPSS, 31.7% of the men were free of urinary symptoms(IPSS 0), 45.1%, 18.7% and 4.5% of the men were minimally(IPSS 1-7), moderately(IPSS 8-19) and severely(IPSS 20-35) symptomatic, respectively. The proportion of severely symptomatic men approximately doubled with each decade of age. A good correlation was found between the total symptom score and the single disease-specific quality of life score that is included in the IPSS. Our estimation indicated that in 1995 approximately 800,000 Korean men had moderate to severe urinary symptoms that were likely to be associated with BPH. These results suggest that the prevalence of BPH in Korean men is substantially similar to Caucasian.

Effect of Verapamil and Cyclosporin A on Cytotoxic Effect of Vinblastine upon Human Renal Cell Carcinoma Cell Lines / 대한비뇨기과학회지

It is well known that renal cell carcinoma shows poor responses upon chemotherapy, and a multidrug-resistance has been suggested as one of the possible mechanisms of their resistances to chemotherapeutics of renal cell carcinoma as well as other malignancies. In our previous study, MDR was expressed relatively high in A-498 cell line, low in Caki-2 cell line. From these observation A-498 was selected as the MDR positive cell line and Caki-2 as the MDR negative cell line and then a study was performed to evaluate the effect of verapamil and cyclosporin A on the cytotoxicity of vinblastine, which are known as the most effective chemotherapeutic agent on human renal cell carcinoma, upon these cell lines. And we tried to evaluate the effect of combination of verapamil and cyclosporin A on the cytotoxicity of vinblastine. Verapamil, in concentration of 0.1 uM, did not enhance the anticancer effect of vinblastine on A-498 cells but with the concentration of 1uM and 10uM, it decreased IC50 of vinblastine from 0.4 ug/ml when only vinblastine was used to 0.05 and 0.08, showing the dose modification effect of 8.40 and 5.25 respectively (p<0.05, by Mann Whitney test) Cyclosporin A, in all the concentration of 0.3, 1, 3uM, also decreased IC of vinblastine on A-498 cells to 0.08, 0.05, 0.08 ug/ml respectively, showing the dose modification effect of 5.25 to 8.40 (p<0.05, by Mann Whiney test). In caki-2 cells in which MDR1 and p-glycoprotein expression were barely detected, verapamil and cyclosporin A did not show any effect upon the cytotoxicity of vinblastine. Combination of 0.3uM of cyclosporin A and 0.1uM or 1uM of verapamil did not resistance modulating agents to enhance the cytotoxicity of vinblastine in renal cell carcinoma with enhanced multidrug resistance, but the combination of these drugs did not show any synergistic effect. And further studies including in vivo study and combination of cyclosporin A are needed before clinical trials to improve chemotherapeutic effect upon renal cell carcinoma.

The Efficacy of Terazosin in the Treatment of Benign Prostatic Hyperplasia: A Randomized, Placebo-controlled Double Blind Study / 대한비뇨기과학회지

Since it has shown that the smooth muscle is the dominant cellular constituent of the hyperplastic prostate and outlet obstruction in benign prostatic hyperplasia (BPH) is mediated by sympathetic nerve system via prostatic smooth muscle alpha 1 receptor, various kinds of alpha blocker have been tried in the treatment of BPH with moderate effectiveness. From May 1994 to December, 1994, a randomized placebo-controlled double blind study of long-acting selective alpha 1 blocker terazosin was undertaken to evaluate short-term effects of pharmacotherapy for BPK Of 80 patients with symptomatic BPH who were randomized to receive placebo or terazosin, 42 completed the study. At baseline, the irritative, obstructive and total symptom score (mean+/-SD) were 8.4+/-3.3, 11.8+/-4.9, 20.2+/-7.6 in placebo group and 8.3+/-4.3, 12.1 +4.6, 20.4 +7.3 in terazosin group and the peak and mean urinary flow rate (ml/ sec) were 10.7+/-2.6 and 5.5+/-2.0 in placebo group and 9.8+/-3.6 and 5.1+/-2.1 in terazosin group. After 28 days trial, the irritative, obstructive and total symptom score (mean+/-SD) were 7.4+/-3.8, 9.3+/-5.6, 16.8+/-9.2 in placebo group and 5.2+/-3.6, 6.2+/-4.0,11.4+/-6.6 in terazosin group(p<0.05, p<0.05 and p<0.01) and the peak and mean urinary flow rate (ml/sec) were 11.1+/-5.1 and 5.8+/-3.1 in placebo group and 14.7+/-6.4, 8.0+/-3.9 in terazosin group. (p<0.01 and p<0.01) At least 30% improvement in total symptom score and peak flow rate were observed in 67% (14/21) and 76% (16/21) of patients respectively in terazosin group. The common side effects were mild dizziness in 5(22%) in terazosin group and 1(5%) in placebo group but premature termination was observed in only 2(9%) patients in terazosin group and 1(5%) in placebo group. The mean change in baseline systolic pressure was 2mmHg for normotensive group and 19mmHg for hypertensive group. In conclusion, this study showed beneficial short term result for the safety and efficacy of long acting selective alpha 1 blocker terazosin in the management of symptoms of BPH However, the durability of the safety and efficacy of terazosin needs to be evaluated for longer periods.

Androgen Dependent Variation of Epidermal Growth Factor and Basic Fibroblast Growth Factor in Rat Ventral Prostate / 대한비뇨기과학회지

The development, growth, differentiation and function of the prostatic gland are considered to be controlled primarily by androgen. Several hypothesis that the growth factors could mediate the effect of androgen in the prostatic cells and the development of the benign prostatic hyperplasia and malignant prostatic growth may be caused by inappropriate expression of these factors are postulated. In order to define the relationship between androgen and growth factors, we evaluated the changes of the levels of epidermal growth factor( EGF) and basic fibroblast growth factor ( basic FGF) in prostatic regression and regrowth induced by androgen modulation in rat. Male inbred Sprague Dawley rats measuring approximately 250gm in weight were used. Prostatic regression was induced by castration and regrowth induced by androgen replacement. The level of EGF and basic FGF were measured by ELISA method in homogenized rat ventral prostate. It was serially determined that the weight of the ventral prostate and the level of EGF and basic FGF on the 1, 3, 5, 7 and 14th day after castration and androgen replacement. The prostatic weight was measured about 350mg in normal controls and decreased about 50mg on 7th day after castration and there was no change thereafter. After androgen replacement, the prostatic weight increased and reached about 500mg which was larger than normal control on 14th day. Normal rat ventral prostate was composed of tubuloalveolar glands lined by two layer of columnar or cuboidal cells and the small amount of stromal tissue. On 7th day after castration, the epithelial cells were atrophied and sloughed. After androgen replacement, the prostatic glands were regrown and restoration of normal glandular structure was noted. On 14th day after androgen replacement, overgrowth of glands and intraluminal proliferation of epithelial cells. The level of EGF changed similarly with the change of prostatic weight. It decreased to undetectable level on 5th day after castration and increased gradually after androgen replacement. The decrease and increase of EGF level preceded the change of prostatic weight. Also, the level of basic FGF changed similarly with the level of EGF and change of prostatic weight. In conclusion, the levels of EGF, basic FGF and prostatic weight were varied according to androgen depletion or replacement. The decrease and increase of EGF and basic FGF level preceded the change of prostatic weight. These results suggest that EGF and basic FGF influence the prostatic growth by androgen dependent pathway.