The Prevalence of Lower Urinary Tract Symptoms and Overactive Bladder in South Korea: A Cross-Sectional, Population-Based Study / 대한배뇨장애요실금학회지

Purpose@#Lower urinary tract symptoms (LUTS) affect over half of the adults’ population worldwide, with an increasing prevalence among the older age groups. Therefore, with the increasing elderly population, LUTS is an important disease, highlighting the need for accurate data on its prevalence. This present study aimed to investigate the prevalence of LUTS in South Korea. @*Methods@#The study targeted individuals aged at least 19 years nationwide. We conducted computer-assisted telephone interviews, 80% mobile random digital dialing (RDD) sampling frame, and 20% landline RDD sampling frame between April and May 2020. Questionnaires included The International Prostate Symptom Score (IPSS), the overactive bladder symptom score (OABSS), and the characteristics of respondents. Current International Continence Society definitions were used for individual LUTS and OAB. @*Results@#There were 2,000 respondents, 1,009 (50.4%) were women and 546 (27.3%) were aged ≥60 years. Based on our IPSS questionnaire survey results, 77.9% of the respondents had LUTS; 63.7% had mild symptoms (1–7), 11.7% had moderate symptoms (8–19), and 2.4% had severe symptoms (20–35). The prevalence and severity of LUTS increased with age with 22.1% of respondents aged 60 years and above complaining of moderate or severe LUTS. According to the survey through OABSS, the prevalence of OAB was 9.6%, males were 10.3% and females were 9.0%. @*Conclusions@#Based on our survey results, 77.9% of the Korean adult population (over the age of 19) experienced at least one LUTS, and the severity increased with age. The prevalence and severity of OAB increased with age, especially after 40 years; the prevalence of OAB was 9.6%, and 13.4% of them were over 60 years old.

Oral pharmacological therapy for urinary incontinence

Urinary incontinence (UI) has been a serious health problem which can significantly affect quality of life. UI may occur at any age but more common in the elderly population. Many conditions may leak to UI and differential diagnosis is critical to guide appropriate manage strategy. After a brief description of the pathophysiology, classification, and diagnostic evaluation of UI, this review highlights oral pharmacological therapy mainly in clinical point of view. For urge UI, antimuscarinic are the most commonly used medication supported with high level of evidence. Antimuscarinics competitively block muscarinic receptors with variations in selectivity for the different subtypes. Common adverse effects are dry mouth, constipation, and blurred vision. High caution for cognitive function should be applied in the use of antimuscarinics in the elderly. Mirabegron, a beta3-agonist, is a new class of drug targeting urge UI, which reported similar efficacy with antimuscarinics and favorable adverse effect profile. For stress UI, various type of medications have been clinically investigated but so far none showed satisfactory resolution of stress UI. Duloxetine is the only medication approved for stress UI in European countries but not in US Food and Drug Administration and Korean Food and Drug Administration due to low benefit-risk profile for UI. Conclusively, pharmacological therapy should be tailored to the type of UI. Recent options of medications may give further treatment possibilities for the optimal treatment for each patient.

Origin of Urgency Symptom in Underactive Bladder: Commentary on "Underactive Bladder: Clinical Features, Urodynamic Parameters, and Treatment" (Int Neurourol J 2015;19:185-9) / 대한배뇨장애요실금학회지

No abstract available.

Laparoscopic Stone Surgery With the Aid of Flexible Nephroscopy

PURPOSE: To report the outcome of laparoscopic pyelo- and ureterolithotomies with the aid of flexible nephroscopy. MATERIALS AND METHODS: A retrospective analysis was performed in 71 patients with complex renal stones or large and impacted proximal ureteral stones. Patients underwent laparoscopic pyelo- or ureterolithotomies with or without the removal of small residual stones by use of flexible nephroscopy between July 2005 and July 2010. Operative success was defined as no residual stones in the intravenous pyelogram at 12 weeks postoperatively. Perioperative results and surgical outcomes were analyzed. RESULTS: The patients' mean age was 54.7+/-13.7 years, and 53 males (74.6%) and 18 females (25.4%) were included. The mean maximal stone size was 19.4+/-9.4 mm. A total of 47 cases were complex renal stones and 24 cases were impacted ureteral stones. Mean operative time was 139.0+/-63.7 minutes. Stones were completely removed in 61 cases (85.9%), and no further ancillary treatment was needed for clinically insignificant residual fragments in 7 cases (9.9%). For complex renal stones, the complete stone-free rate and clinically significant stone-free rate were 80.9% and 93.6%, respectively. Multivariate analysis showed that the use of flexible nephroscopy for complex renal stones can reduce the risk of residual stones. A major complication occurred in one case, in which open conversion was performed. CONCLUSIONS: Laparoscopic stone surgery is a safe and minimally invasive procedure with a high success rate, especially with the aid of flexible nephroscopy, and is not associated with procedure-specific complications.

Effect of Patient-Optimized Doses of Tamsulosin on Erectile Function in Men With Erectile Dysfunction and Lower Urinary Tract Symptoms

PURPOSE: To investigate the relationship of improvement in erectile function (EF) with improvement in lower urinary tract symptoms (LUTS) and to assess the contribution of tamsulosin dose to the improvement of EF apart from the indirect influence of LUTS improvement in men with LUTS and erectile dysfunction (ED). MATERIALS AND METHODS: Fifty patients received tamsulosin 0.2 mg/d for the first 4 weeks and were subsequently divided into two groups by patient-reported outcomes. Nonescalators were maintained starting dose and escalators increased to 0.4 mg for the remaining 8 weeks. International Prostatic Symptom Score (IPSS) and International Index of Erectile Function (IIEF-5), and underwent uroflowmetry were evaluated at baseline, and weeks 4 and 12. RESULTS: LUTS parameters were significantly improved in both groups but insignificant between the 2 groups. The degree of the improvement in the total IPSS and in the voiding, storage, and quality of life (QoL) subscores were significantly correlated with the degree of the improvement in EF; this was especially prominent in patients successfully treated LUTS. The escalators experienced a significantly greater increase in IIEF-5 scores than did the nonescalators (3.3 vs. 1.5). CONCLUSIONS: Dose escalation provided similar LUTS improvement in patients with refractory to starting dose. The improvements of LUTS were correlated with the improvement of EF. The increase in the IIEF-5 score was significantly higher in escalators. These findings imply that tamsulosin may contribute to the improvement in EF through the improvement of LUTS and QoL and direct relaxation of the corpus cavernosum in a dose-dependent fashion.

A Case of Paratesticular Leiomyosarcoma Successfully Treated with Orchiectomy and Chemotherapy / Journal of the Korean Cancer Association, 대한암학회지

A 50-year-old male patient presented with a right scrotal mass that had been growing rapidly for more than one year. A heterogeneous enhancing right scrotal mass (12x9 cm) with para-aortic and peri-caval lymphadenopathies was found on abdominal computed tomography (CT). Right orchiectomy was performed and the gross finding had shown intact testis with a well-defined, huge, whitish solid mass adjacent to the testis. According to pathology, the mass was characterized as a leiomyosarcoma, grade 3 (by National Cancer Instituted [NCI] system). Therefore, the diagnosis was stage III, grade 3 paratesticular leiomyosarcoma. The patient underwent additional systemic chemotherapy using ifosfamide and adriamycin. After nine cycles of chemotherapy, positron emission tomography-CT was performed and no FDP uptake was observed. The patient has been followed up for 12 months after systemic chemotherapy, and he has maintained a complete response. We report here on a rare case of paratesticular leiomyosarcoma treated successfully with orichiectomy and additional systemic chemotherapy.

Sex- and Age-Related Changes in Connexin 43 Expression in Normal Rat Bladder / 대한배뇨장애요실금학회지

PURPOSE: Gap junctions are intercellular channels to facilitate electrical and metabolic communication between adjacent cells. Connexin 43 is the most predominant type of connexin expressed on rat detrusor muscle cells. We investigated the connexin 43 expressions in various age groups of either sex in normal rats. METHODS: Eighty Sprague-Dawley rats were used for analysis. Each group was quantified by 8 rats at 1 week, 2 weeks, 1 month, 3 months, and 6 months of age in either sex. In each animal, bladder was removed without any kind of intervention and fresh-frozen in liquid nitrogen. Total RNA extraction was done with easy-BLUE total RNA extraction kit. Reverse transcription polymerase chain reaction was done for connexin 43 and glyceraldehyde-3-phosphate dehydrogenase as an internal control using ImProm-II Reverse Transcription System. RESULTS: In female rats, no age-related change was detected in connexin 43 expressions. In male rats, connexin expression at 3 months of age showed significant decrease compared with 1 week, 2 weeks, and 6 months of age (P<0.05). When connexin expression at the same age in male and female were compared, only 3 months group in male showed significant decrease than the same age group in female. CONCLUSIONS: Our data suggest that the expressions of connexin 43 mRNA in normal detrusor muscle cell showed age-related changes especially in male rats. Although it is difficult to interpret these findings at this stage, age should be considered as a possible compounding factor affecting connexin 43 expressions in male rats.

Association of Metabolic Syndrome and Benign Prostate Enlargement in Young Korean Males

PURPOSE: This study was designed to evaluate the association of metabolic syndrome and benign prostate enlargement in young Korean males. We analyzed the clinical data associated with metabolic syndrome and prostate volume in the study population. MATERIALS AND METHODS: We retrospectively analyzed the clinical data obtained from 1,506 young men under the age of 60 who visited the health promotion center in our institution for routine checkups. The patients were interviewed with a questionnaire including the International Prostate Symptom Score (IPSS) and were evaluated by medical history, blood chemistry, digital rectal examination, and prostate volume via transrectal ultrasonography. The presence of metabolic syndrome was determined according to the modified National Cholesterol Education Program Expert Panel on Detection, Evalution, And Treatment of High Blood Cholesterol in Adults criteria. We divided the subjects into two groups: those with metabolic syndrome and those without. Logistic regression analysis was carried out to determine which metabolic components were associated with an increased risk of benign prostate enlargement. RESULTS: Significant differences in prostate volume were noted between the groups. The prostate volumes were significantly larger in the metabolic syndrome group than in the non-metabolic syndrome group in all subgroups divided by age (in decades). However, no significant differences in IPSS or voiding or storage subscore were noted. In the multivariate regression analysis, only diabetes and obesity were identified as risk factors for benign prostate enlargement among the metabolic components. CONCLUSIONS: Metabolic syndrome and prostate volume were significantly related, even in young males. Diabetes and obesity were identified as significant risk factors for benign prostate enlargement in young males under the age of 60.

Testosterone Replacement in Men with Late-onset Hypogonadism Symptoms and Loss of Diurnal Rhythm of Total Testosterone / 대한남성과학회지

PURPOSE: It is known that the loss of diurnal rhythm of testosterone by age is related to late-onset hypogonadism (LOH). Currently testosterone replacement therapy (TRT) has been recommended only in men with hypogonadism. We evaluated the effectiveness and safety of TRT for men with LOH symptoms and the loss of diurnal rhythm of total testosterone but normal values of total testosterone. MATERIALS AND METHODS: We enrolled 62 patients in whom the difference in testosterone between morning and evening was lower than 108 ng/dl, whose morning values were higher than 300 ng/dl, and who were diagnosed with LOH using the Androgen Deficiency in Aging Male (ADAM) questionnaire. Among the 62 patients enrolled, 44 completed the daily application of 1% testosterone gel or the intramuscular injection of long-acting testosterone undecanoate for the full 20-week period. We compared the data at baseline, and the 8th and 20th week using the Aging Males' Symptoms (AMS) scale, the International Index of Erectile Function (IIEF)-15, the International Prostate Symptoms Score (IPSS), and the serum levels of total testosterone, prostate specific antigen (PSA), complete blood cell count (CBC), and lipid profile. RESULTS: The mean age was 54.9+/-7.2 years. Subjects main symptoms were sexual dysfunction and decrease of ejaculate volume. AMS scales before and after TRT were 41.3+/-18.5 and 35.8+/-19.7 (p<0.05). IIEF total scores before and after TRT were 29.7+/-13.7 and 38.9+/-17.4 (p<0.001). However, 18 patients (40.9%) were not satisfied with TRT and only 11% were fully satisfied. Total testosterone and estradiol were higher after TRT but the other values had not changed. The most common adverse event (27.3%) was erythrocystosis (18.2%). CONCLUSIONS: TRT could induce total testosterone to reach the mid-normal level and was relatively effective for aging male symptoms and sexual function. It is essential for physician to inform patients about potential adverse events and the low satisfaction rate associated with TRT even though TRT has generally been effective.

Successful Percutaneous Coronary Intervention for Acute Coronary Syndrome in a Patient With Severe Hemophilia A

Patients with hemophilia generally have a reduced frequency of coronary artery disease compared to the general population. As advances in the management of hemophilia have increased their life expectancy, the prevalence of coronary artery disease also has increased. However, there are no standard treatment guidelines for coronary artery disease in patients with hemophilia, especially in the field of coronary intervention. We report the case of a patient with severe hemophilia A who presented with acute coronary syndrome and was successfully treated with percutaneous coronary intervention.

Comparison of Patient Satisfaction with Treatment Outcomes between Ureteroscopy and Shock Wave Lithotripsy for Proximal Ureteral Stones

PURPOSE: We examined patient satisfaction with treatment outcomes after shock wave lithotripsy (SWL) and ureteroscopic removal of stone (URS) for proximal ureteral stones. MATERIALS AND METHODS: We evaluated 224 consecutive patients who underwent SWL (n=156) or URS (n=68) for a single radiopaque proximal ureteral stone. Stone-free rates, defined as no visible fragment on a plain X-ray; complications; and patient satisfaction were compared. Patient satisfaction was examined through a specifically tailored questionnaire that included overall satisfaction (5 scales) and 4 domains (pain, voiding symptoms, cost, and stone-free status). RESULTS: The stone-free rates after the first, second, and third sessions of SWL were 36.5%, 65.4%, and 84.6%, respectively. The overall stone-free rate of URS was 82.4%, which was comparable to that of the third session of SWL. Complications were similar between the two groups except for greater steinstrasse in the SWL group. Overall satisfaction and voiding symptoms, cost, and stone-free status showed no significant difference between the groups. In the pain domain, the SWL group had a relatively lower satisfaction rate than did the URS group (p=0.05). Subanalysis showed that the satisfaction rate of the URS group with stone-free status was significantly lower than that of the SWL group in patients with > or =10 mm stones (p=0.032). CONCLUSIONS: Overall treatment outcomes and patient satisfaction were not significantly different between SWL and URS. However, patients undergoing URS for > or =10 mm proximal ureteral stones had lesser satisfaction with stone-free status, because of relatively lower stone-free rates due to upward stone migration. We suggest that factors regarding the subjective satisfaction of patients be included in counseling about treatment options for proximal ureteral stones.

Types of Male Incontinence and the Strategy for its Management

Although the incidence of urinary incontinence in men is lower than in women, the prevalence of male incontinence shows increasing tendency with aging. The author reviewed the types, assessments, and managements of male incontinence.

Contralateral Patent Processus Vaginalis in Unilateral Undescended Testis: Comparison between Preoperative Ultrasonographic and Transinguinal Laparoscopic Inspection

PURPOSE: The presence of a contralateral patent processus vaginalis (CPPV) is a risk factor for a metachronous hernia and may alter the surgical approach in unilateral cryptorchidism. We prospectively investigated the prevalence of a CPPV and compared the results between ultrasound (US) and transinguinal laparoscopy (TIL). MATERIALS AND METHODS: We analyzed a single surgeon's experience with preoperative US, TIL, and inguinal orchiopexy. We included 74 patients with a palpable (or identified by US) cryptorchidism with patent processus vaginalis who underwent inguinal orchiopexy. We performed an inguinal exploration when we could identify an opened internal ring through TIL. RESULTS: The prevalence of a CPPV was 18.9%. There was no significant difference in the occurrence of a CPPV by laterality, age, gestational age, or location of testis. A CPPV was detected 10 patients by US and in 15 patients by TIL, but one of them was revealed to be a blind pouch. The sensitivity and the specificity of US were 71.4% and 100%, respectively. Four CPPV cases were undiagnosed by US; all had a narrow internal ring. The accuracy of US was dependent on the width of the CPPV and the morphology of the internal ring. CONCLUSIONS: It was considerable that about 20% of patients with unilateral cryptorchidism had a CPPV, a risk factor for metachronous hernia. The presence of a CPPV in unilateral cryptorchidism should be considered in clinical practice.

Physiologic and Pathophysiologic Functions of Purinoceptors in Voiding Reflex

Purinergic neurotransmission has been regarded as major component of non-adrenergic, noncholinergic (NANC) contraction in detrusor smooth muscle. Although in normal human detrusor, this contraction seems to be small, the importance of the NANC component for detrusor contraction in disease conditions such as detrusor overactivity remains to be established. Based on many evidences for purinergic contributions in lower urinary tract, ATP and purinoceptors has been suggested to be involved in both efferent and afferent mechanism in voiding reflex. ATP signaling via P2X1 receptors plays an important role in efferent neural control of urinary bladder function, although to varying degrees across species from experimental animals to men. The efferent function of purinoceptors may be enhanced in detrusor overactivity and aging. ATP also suggested being involved in mechanosensory transmission, via activation of P2X3 and P2X2/3 receptors on sensory afferent nerves. The afferent function of purinoceptors may be related with pathophysiology of overactive bladder or interstitial cystitis, mediating bladder hyperexicitability. These results suggest that the selective antagonists for the purinoceptors may offer better relief of sensory and motor symptoms for overactive bladder or interstitial cystitis patients in the future.

Laparoscopic Partial Nephrectomy: An Useful Method of Decision Making for Determining the Approach and Surgical Method Based on the Systematic Classification of Tumor Location / 대한비뇨기과학회지

PURPOSE: Laparoscopic patial nephrectomy is still one of challenging surgeries in laparoscopic urologic field and needs skillful technique of surgeons. When performing laparoscopic partial nephrectomy, initial plan of how to approach affects the whole course of the surgery. To propose a systematic decision guideline, we used the tumor location as the determining factor for selecting initial plan and analyzed our initial experience. MATERIALS AND METHODS: From September 2005 to April 2008, we performed 22 LPNs for small renal tumors less than 40mm in diameter, as measured from the preoperative computed tomography scans. We divided the tumor locations into 18 categories with the combinations of the anterior and posterior renal axes, and the upper, middle, lower parts of the kidney and the peripheral, central and hilar locations of the tumor. According to the tumor location categories, we performed LPNs through the retroperitoneal simple and complex approaches, and the transperitoneal simple and complex approaches. RESULTS: Twenty of twenty-two tumors(91%) were removed successfully through 4 different approaches, but 2 cases were converted to laparoscopic radical nephrectomies(LRNs). The mean operation time was 203 minutes, including a mean warm ischemic time(WIT) of 30.7 minutes. Among the 17 cases of RCC, 15 tumors were successfully removed via LPNs, and there were no cases with positive margins and no tumor recurrence during a mean of 14.9 months follow-up with a maximum follow-up period of 34 months. CONCLUSIONS: Dividing the tumor location into 18 categories is useful for deciding on the appropriate laparoscopic approach.

Influence of Prostate Volume in the Medical Treatment of Male Lower Urinary Tract Symptoms with Tamsulosin

PURPOSE: To evaluate the influence of prostate volume on the changes of International Prostate Symptoms Score(IPSS) and other clinical parameters in men with lower urinary tract symptoms(LUTS) undergoing tamsulosin treatment. MATERIALS AND METHODS: Patients were evaluated initially by IPSS/QoL questionnaire, digital rectal examination(DRE), transrectal ultrasonography(TRUS), urinalysis, serum prostate-specific antigen(PSA), maximal urine flow rate(Qmax) and post-void residual urine(PVR). Patients were grouped according to baseline prostate volume(PV): PV or =40 ml(group D). All the patients were given tamsulosin 0.2 mg per day. After 8 weeks of tamsulosin treatment, clinical efficacy was determined by changes of IPSS/QoL scores, Qmax and PVR volumes. RESULTS: Overall 672 patients were enrolled initially and 580 patients have finished the protocol. After treatment, total IPSS score was decreased by 6.2 point(31.7%) and Qmax was increased by 1.8ml/sec(29.7%). When clinical outcomes were compared according to the different PV groups, there were no statistically significant differences among groups except significant Qmax changes between group B and D. CONCLUSION: Clinical efficacy of short term tamsulosin medication is not affected by the prostate volume. It may be necessary that the results of this study should be confirmed in further long term follow-ups.

Content Analysis of the Health Counseling by the Intranet in a University: 2000-2004 / 農村醫學 地域保健

OBJECTIVES: The research was aimed at analyzing the contents of university intranet for systematically execution of the healthy information provision and healthy consultation services from 2000 January to 2004 December. METHODS: We have analyzed 300(28.3%) the instances of accomplished health consultation cases from the whole 1,059 instances which were the replied in a university intranet. RESULTS: According to the contents of health consultation in ICPC code, a general symptom 91 cases(30.3%) was most, muscle-skeletal system 44 cases(14.7%), and digestive system 43 cases(14.3%) in order of cases of health counselling. The symptoms and complaint with 155 cases(51.7%) were most in the distribution of the health counselling contents by 17 charter of ICPC. The most common reason of counselling by 17 charter of ICPC were as follows; questions about the symptom and diagnosis(118 cases, 39.3%), the preventive and treatment methods(91 cases, 30.0%), and medical fee(20cases, 6.7%) in order. We mainly answer on the content of health counselling were as follows; make an offer of medical information and knowledge(48.3%), recommend visit clinic or hospital(23.7%), guide to treatment(12.7%), and so on. CONCLUSIONS: This research showed that the program of health counselling may not meet completely the high quality and adequate distribution of health counselling by the intranet in a university by content analysis. The finding suggests that health counselling by intranet in a university may be used to supplement of systemic improvement on the intranet Q/A format from current lack of essential health information and security for the quality of the health counselling.

The Related Factors of Willingness to Have an Additional Childbirth of Mother with Children in an Urban-Rural Area / 農村醫學 地域保健

OBJECTIVES: This study was conducted to investigate how willingness to have an additional childbirth was related to mother's general characteristics and various reasons for avoiding an additional childbirth. METHODS: By using organized questionnaire, we had face-to-face interviews with 722 mothers who had 12 to 36 months child in a urban-rural area of Chungcheongnam-do from 14 February to 19 February in 2005. Questionnaires included general characteristics composed of age, monthly income, number of children, major carers and mother's job status, and 6 reasons for avoiding an additional childbirth. We performed chi-square test and multiple logistic regression analysis. RESULTS: Of 722 mothers, 66.5% had no willingness to have an additional childbirth. In the multiple logistic regression analysis, old age of mother(95% CI of OR: 1.084-1.190), two or more children(95% CI of OR: 6.97-15.602) and weak norm about need for a child(95% CI of OR: 1.633-29.352) were independent related factors with willingness to have an additional childbirth. CONCLUSIONS: In our study, 2/3 women who already had children were appeared to have no willingness to have additional childbirth. Policies about family planning and controlling birth rate should be focused on eliminating barrier to additional childbirths.

Risk Factors Associated with Hemodynamic Instability during Stent Implantation in Unprotected Left Main Lesions without Routine IABP: Identification of the High Risk Patients

BACKGROUND AND OBJECTIVES: Percutaneous coronary intervention (PCI) of unprotected left main coronary artery (LMCA) stenosis is a promising approach during this era of drug-eluting stents. However, there is no available hemodynamic data on these type patients during the performance of LMCA stenting. The purpose of this study was to determine the risk factors affecting hemodynamic stability during LMCA stenting, and to evaluate whether hemodynamic support such as inotropics or intra-aortic balloon pump (IABP) is needed, based on the risk factors. SUBJECTS AND METHODS: From July 2003 to January 2006, we enrolled 92 study patients (Male=55) who had visited Yeungnam University Hospital, Keimyung University Dongsan Hospital and InJe University Baik Hospital in Busan and they were all were diagnosed with angiographically detected unprotected LMCA stenosis. Group 1 (n=69) included those patients who did not need hemodynamic support during PCI. Group 2 (n=23) included patients who needed hemodynamic support during PCI. All patients had stents deployed in the LMCA lesions without hemodynamic support; the clinical, angiographic and procedural outcomes were compared between the two groups after the procedure. RESULTS: The baseline patient characteristics were not statistically different between the two groups. On univariate analysis, Group 2 had more patients diagnosed with acute myocardial infarction (AMI) than Group 1 (40% vs. 15%, respectively, p=0.014). Group 1 had a greater frequency of an increased left ventricular (LV) ejection fraction than Group 2 (60+/-10 vs. 47+/-11, respectively, p=0.01). Regarding the lesion location in the LMCA, Group 2 had relatively more lesions at bifurcated locations than Group 1 (44% vs. 78%, respectively, p=0.004). Group 2 required more complex techniques to repair lesions, such as kissing or crush stenting, than did Group 1 (19% vs. 48%, respectively, p=0.006). Multivariate logistic regression analysis showed that the presence of AMI (Odds Ratio (OR)=3.74, p=0.014), a complex stenting procedure such as kissing or crushing (OR=3.99, p=0.006), a bifurcated lesion (OR=4.58, p=0.004) and poor LV function (OR=9.95, p=0.0001) were independent risk factors for hemodynamic instability during LMCA stenting. CONCLUSION: The most important risk factor for hemodynamic instability during LMCA stenting was LV function. Therefore, preparation for hemodynamic support, including IABP before the procedure, is necessary for the high risk patients.

Lesion Location: Its Impacts on the Procedural and Postprocedural Outcomes of Unprotected Left Main Coronary Stenting

BACKGROUND AND OBJECTIVES: Percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) stenosis is a promising technique in the drug-eluting stent era. However, there is a lack of data as to the impact of the lesion location in the LMCA on the procedural and postprocedural outcomes. The aim of this study is to evaluate the effect of lesion location on the procedural and postprocedural outcomes. SUBJECTS AND METHODS: From July 2003 to January 2006, we enrolled 82 patients (Males: n=49), who underwent PCI for unprotected LMCA stenosis at Yeungnam University Medical Center, Keimyung University Dong-san Hospital and In-je University Baik Hospital in Busan. The patients were divided into two groups according to the lesion location. Group 1 (n=38) was defined as those patients who had a significant stenosis in the ostium and/or body. Group 2 (n=44) was defined as those patients had a left main coronary lesion involving a bifurcation. All the patients had a sirolimus eluting stent (Cypher, Cordis) deployed into the LMCA stenosis. Stenting techniques such as the T, crush and kissing stent techniques for treating the LMCA were used at the discretion of the operator and according to the characteristics of the lesion location. The in-hospital outcomes were compared between the two groups and follow-up coronary angiography was performed after 6 months; the major adverse cardiac events (MACE) and restenosis were analyzed between the two groups. RESULTS: The baseline characteristics between the two groups were not statistically different. The procedural outcomes showed that for the stenting methods, the conventional stent technique was the only one used in all cases of Group 1, but the kissing, T stenting and Crush techniques were also used in Group 2 (p=0.001). The clinical outcomes showed that that there was no statistical difference for the in-hospital MACEs between the two groups, but for the out-of hospital MACEs at 6 month, the target lesion revascularizatin rates, including PCI or bypass graft operation, in Group 1 were higher than those in Group 2 (0% vs 13.6%, respectively p=0.043). Both groups had one cardiac death each (2.3% vs 2.6% respectively) and there was 1 MACE in Group 1 and 7 MACEs in Group 2 (2.6% vs 16%, respectively, p=0.045). The angiographic outcomes at 6 month showed that all 8 significant restenosis cases were included in Group 2 (18%, 9.7% in the total population); the restenosis site was the left circumflex artery in all cases. CONCLUSION: PCI with using drug eluting stents in the left main lesion showed favorable short term outcomes in selected patients. The lesion location is also an important factor for the clinical and angiographical outcomes.