Prognostic Significance of Immunohistochemical MSH2 Expression in Prostate Cancer

PURPOSE: There are numerous prostate cancer-related genes that involve in carcinogenesis and tumor progression. Among the genes, DNA mismatch repair genes recognize and repair misincorporated nucleotides during DNA replication. In this analysis, we evaluated the association of hMSH2 which is one of the mismatch repair genes, with risk of aggressive prostate cancer and prostate cancer recurrence. MATERIALS AND METHODS: Immunohistochemistry was performed in 46 patients who diagnosed prostate cancer and underwent radical prostatectomy between January 2006 and December 2012 at Kyung Hee University Hospital at Gangdong. We evaluated an association between the degree of hMSH2 immunohistochemical staining and various clinical variables including prostate-specific antigen (PSA), Gleason score, pathological stage, and biochemical recurrence. The intensity of immunostaining for hMSH2 was divided into 2 groups: low expression group (immunostaining score < 2) and high expression group (immunostaining score ≥2). RESULTS: Although seminal vesicle invasion was marginally associated with the degree of hMSH2 immunohistochemical staining, PSA, Gleason score, lymph node metastasis, presence of lymphatic, perineural, vascular invasion, and extracapsular extension were not associated with the degree of hMSH2 immunohistochemical staining. Furthermore, the association of biochemical recurrence free survival with hMSH2 expression was not statistically significant. CONCLUSIONS: The hMSH2 expression was marginally associated with risk of aggressive prostate cancer such as seminal vesicle invasion. Further evaluation with a larger number of cases is needed to verify these results.

Choroidal Metastasis from Prostate Cancer

Metastasis of choroid from prostate cancer is not common and has not been reported before in Korea. We report a case of decreased vision in a patient with prostate cancer. After external beam radiotherapy, patient had complete response in the choroidal metastasis. Metastasis of choroid secondary to prostate is not common. There have been only 8 cases reported. In this case, we demonstrated that external beam radiotherapy showed a therapeutic effect.

A Prospective Multicenter Trial of the Efficacy and Tolerability of Neoadjuvant Sunitinib for Inoperable Metastatic Renal Cell Carcinoma

This study aimed to evaluate the efficacy, safety, and tolerability of 2-cycled neoadjuvant sunitinib therapy (NST) in patients with inoperable metastatic renal cell carcinoma (mRCC). Between 2009 and 2012, 14 patients with inoperable mRCC from 5 Korean academic centers were prospectively enrolled after collecting their clinicopathological data and completing health-related questionnaires. The best overall response (BOR), safety profile, and changes in quality of life during NST were assessed using the RECIST criteria (version 1.0), CTCAE criteria (version 4.0), and the Cancer Quality of Life Questionnaire (QLQ-C30). Among the 14 patients, 9 patients (64.3%) experienced partial response or stable disease state, and 5 patients (35.7%) did not complete treatment, with 1 case of disease progression (7.1%), 3 grade 3 adverse events (21.4%), and 1 voluntary withdrawal (7.1%). Four patients (28.6%) were successfully converted to an operable state and underwent surgery after NST. The BOR for the primary renal lesions was 22.2%, with a median 1.3-cm diameter reduction (range: 0–2.8 cm) from a baseline diameter of 10.3 cm (range: 6.6–15.8 cm). The other 18 measurable metastatic lesions exhibited a BOR of 55.6%. The QLQ-C30 questionnaire results revealed significant improvements in the quality of life domain, although we observed significant increases in the scores for fatigue, nausea and vomiting, and the financial effects of NST (P < 0.05). Two-cycle NST provided limited efficacy for resectability of inoperable mRCC, despite mild improvements in the BOR of the primary lesion and quality of life (Clinical Trial Registry 1041140-1).

Analysis of NF-κB and Clinical Prognostic Factors in Clear Cell Renal Cell Carcinoma

PURPOSE: A multi-subunit transcription factor NF-κB is associated with anti-apoptotic signals in several cancers including renal cell carcinoma (RCC). In this study, we investigated whether the expression levels of the NF-κB were related to the clinical properties of human renal cell carcinoma such as nuclear grade, TNM stage, and recurrence free survival. MATERIALS AND METHODS: Patients who were diagnosed with clear cell RCC between January 2006 and February 2013 were included. Clinicopathological data and survival were investigated. The expressions of NF-κB were investigated by performing immunohistochemical staining on 61 clear cell RCC. The expression levels of NF-κB were divided two groups by the expression levels. RESULTS: Results on the expression of NF-κB were not significant. Analysis of NF-κB expressions is not associated with any of the clinical properties including age, nuclear grade and TNM stage (p=0.613, p=0.059, p=0.107, p=0.570, and p=0.760, respectively). Also, a statistically correlation was not observed between recurrence free survival and NF-κB expression levels (p=0.573). CONCLUSIONS: The expressions of the NF-κB were not associated with the clinical properties of clear cell RCC such as age, nuclear grade, TNM stage, and recurrence free survival.

Prognostic Factors for Recurrence and Progression in Korean Non-Muscle-Invasive Bladder Cancer Patients: A Retrospective, Multi-Institutional Study

PURPOSE: To identify the prognostic factors related to tumor recurrence and progression in Korean patients with non-muscle-invasive bladder cancer (NMIBC). MATERIALS AND METHODS: Data were collected and analyzed for 2412 NMIBC patients from 15 centers who were initially diagnosed after transurethral resection of bladder tumor (TURBT) from January 2006 to December 2010. Using univariable and multivariable Cox proportional hazards models, the prognostic value of each variable was evaluated for the time to first recurrence and progression. RESULTS: With a median follow-up duration of 37 months, 866 patients (35.9%) experienced recurrence, and 137 (5.7%) experienced progression. Patients with recurrence had a median time to the first recurrence of 10 months. Multivariable analysis conducted in all patients revealed that preoperative positive urine cytology (PUC) was independently associated with worse recurrence-free survival [RFS; hazard ratio (HR) 1.56; p<0.001], and progression-free survival (PFS; HR 1.56; p=0.037). In particular, on multivariable analysis conducted for the high-risk group (T1 tumor/high-grade Ta tumor/carcinoma in situ), preoperative PUC was an independent predictor of worse RFS (HR 1.73; p<0.001) and PFS (HR 1.96; p=0.006). On multivariable analysis in patients with T1 high-grade (T1HG) cancer (n=684), better RFS (HR 0.75; p=0.033) and PFS (HR 0.33; p<0.001) were observed in association with the administration of intravesical Bacillus Calmette-Guérin (BCG) induction therapy. CONCLUSION: A preoperative PUC result may adversely affect RFS and PFS, particularly in high-risk NMIBC patients. Of particular note, intravesical BCG induction therapy should be administered as an adjunct to TURBT in order to improve RFS and PFS in patients with T1HG cancer.

Analysis of factors affecting spontaneous expulsion of ureteral stones that may predict unfavorable outcomes during watchful waiting periods: What is the influence of diabetes mellitus on the ureter?

PURPOSE: The aim of our study was to evaluate the association of several factors with spontaneous stone expulsion, including ureteral stone characteristics (size, location, hydronephrosis, perinephric stranding), types of medications prescribed (alpha-blocker, low-dose steroid), and other possible demographic and health-history factors (gender, age, serum creatinine, underlying diabetes mellitus [DM], and hypertension). MATERIALS AND METHODS: A total of 366 patients with ureteral stones were enrolled. All patients underwent watchful waiting without any invasive procedures. Initial diagnoses of ureteral stones were confirmed by computed tomography scans, which were taken at approximately 1-month intervals to check for stone expulsion. Univariate and multivariate analyses were conducted to identify significant factors that contributed to stone expulsion. RESULTS: Among 366 patients, 335 patients (91.5%) experienced spontaneous stone passage during a mean follow-up period of 2.95+/-2.62 weeks. The patients were divided into two groups depending on the success of spontaneous stone passage. Univariate analyses revealed that stone location (p=0.003), stone size (p=0.021), and underlying DM (p<0.001) were significant predictors of stone passage. Multivariate analyses confirmed that stone size (p=0.010), stone location (p=0.008), and underlying DM (p=0.003) were independent predictive factors affecting stone passage. CONCLUSIONS: Stone size, location, and underlying DM were confirmed to be significant predictive factors for spontaneous passage of ureteral stones. Urologists should consider active procedures, such as shock wave lithotripsy or ureteroscopy, rather than conservative management in patients presenting with proximally located stones, large ureteral stones, or underlying DM.

Establishment of Reference Ranges for Prostate Volume and Annual Prostate Volume Change Rate in Korean Adult Men: Analyses of a Nationwide Screening Population

We aimed to determine normal reference ranges for prostate volume (PV) and annual PV change rate in a Korean nationwide screening population. Data from men who underwent a routine health check-up were collected from 13 university hospitals. The cohort comprised men aged > or =40 yr who had undergone 2 or more serial transrectal ultrasonographies. Men with initial PV>100 mL; serum PSA level>10 ng/mL; PV reduction>20% compared with initial PV, or who had history of prostate cancer or prostate surgery, were excluded. Linear regression and mixed effects regression analyses were used to predict mean PV and longitudinal change in PV over time. A total of 2,967 men formed the study cohort. Age, body mass index (BMI), and serum prostate-specific antigen (PSA) level were found to be significant predictors of PV. A predicted PV table, with a 95% confidence interval (CIs), was developed after adjusting for these 3 variables. Annual PV change rate was 0.51 mL/year (95% CI, 0.47-0.55). Annual PV change rate according to age was 0.68 mL/year, 0.84 mL/year, 1.09 mL/year, and 0.50 mL/year for subjects in their 40s, 50s, 60s, and > or =70 yr, respectively. Predicted annual PV change rate differed depending on age, BMI, serum PSA level and baseline PV. From a nationwide screening database, we established age-, PSA-, and BMI-specific reference ranges for PV and annual PV change rate in Korean men. Our newly established reference ranges for PV and annual PV change rate will be valuable in interpreting PV data in Korean men.

The Relationship Among Obesity, Benign Prostatic Hyperplasia and Erectile Dysfunction in Korea Men

PURPOSE: Pathogenically, both erectile dysfunction (ED) and benign prostatic hyperplasia (BPH) are closely related to vascular problems, and vascular problems are closely associated with obesity. This study evaluated the relationships between obesity, BPH, and ED. MATERIALS AND METHODS: The medical history of male patients, aged > or =40 years, evaluated at urology outpatient clinics of 11 university hospitals in Korea with chief complaints of lower urinary tract symptoms (LUTS)/BPH and ED were retrospectively evaluated. The correlations of medical history, body mass index (BMI), international prostate symptom score (IPSS), prostate volume, International Index of Erectile Function -5 (IIEF-5), and serum testosterone level were assessed. RESULTS: Body mass index showed significant correlations with IPSS (r=0.087, p=0.003), prostate volume (r=0.384, p<0.001), IIEF (r=-0.072, p=0.015), and serum testosterone concentration (r=-0.303, p<0.001). CONCLUSIONS: Body mass index correlates with testosterone concentration, prostate volume, and markers of LUTS and ED in men with the latter conditions.

Rapid Increase of Health Care Utilization and Cost due to Benign Prostatic Hyperplasia in Korean Men: Retrospective Population-based Analysis Using the Health Insurance Review and Assessment Service Data

Using the Korean public health insurance database, we analyzed patients diagnosed as benign prostatic hyperplasia (BPH) from 2004 to 2008. Age and year-specific amount and seasonal variation of hospital visits (HV), duration of treatment (DT), the total and per capita amount of insurance payment (TAIP, PCIP) were evaluated. A total of 12,088,995 HV were studied. Total HV increased 1.7 times and DT almost doubled in 2008 compared to those in 2004. HV, DT, and TAIP showed linearly increasing patterns year by year. In a time series analysis, HV increased in winter and demonstrated seasonality in a 12-month cycle. In a Poisson regression analysis, the annual variations of HV, DT, TAIP, and PCIP were different by age groups. In patients older than 40 yr, HV significantly increased 1.10-1.16 times compared to that of the previous year. DT markedly increased in their 60s and 80s patients. The rate of increase in PCIP was steeper in patients 50 yr and older than in the others.Health care utilization due to BPH was rapidly increasing in Korea and it was remarkable in the elderly population. Seasonal variation of HV demonstrated that health care utilization increased in winter.

Rapid Increase of Health Care Utilization and Cost due to Benign Prostatic Hyperplasia in Korean Men: Retrospective Population-based Analysis Using the Health Insurance Review and Assessment Service Data

Using the Korean public health insurance database, we analyzed patients diagnosed as benign prostatic hyperplasia (BPH) from 2004 to 2008. Age and year-specific amount and seasonal variation of hospital visits (HV), duration of treatment (DT), the total and per capita amount of insurance payment (TAIP, PCIP) were evaluated. A total of 12,088,995 HV were studied. Total HV increased 1.7 times and DT almost doubled in 2008 compared to those in 2004. HV, DT, and TAIP showed linearly increasing patterns year by year. In a time series analysis, HV increased in winter and demonstrated seasonality in a 12-month cycle. In a Poisson regression analysis, the annual variations of HV, DT, TAIP, and PCIP were different by age groups. In patients older than 40 yr, HV significantly increased 1.10-1.16 times compared to that of the previous year. DT markedly increased in their 60s and 80s patients. The rate of increase in PCIP was steeper in patients 50 yr and older than in the others.Health care utilization due to BPH was rapidly increasing in Korea and it was remarkable in the elderly population. Seasonal variation of HV demonstrated that health care utilization increased in winter.

A Nationwide Epidemiological Study of Testicular Torsion in Korea

Testicular torsion is a surgical emergency in the field of urology. Knowledge of the epidemiology and pathophysiology is significant to an urologist. However, the epidemiology of testicular torsion in Korea has not been studied. We performed a nationwide epidemiological study to improve knowledge of the epidemiology of testicular torsion. From 2006-2011, the Korean Urologic Association began the patient registry service. The annual number of patients with testicular torsion from 2006 to 2011 were 225, 250, 271, 277, 345, and 210, respectively. The overall incidence of testicular torsion in males was 1.1 per 100,000; However, the incidence in men less than 25 yr old was 2.9 per 100,000. Adolescents showed the highest incidence. Total testicular salvage rate was 75.7% in this survey. There was no geographic difference of testicular salvage rate. Minimizing the possibility of orchiectomy for testicular torsion is important to improve public awareness to expedite presentation and provider education to improve diagnosis and surgery.

Predictive Value of Preoperative Unenhanced Computed Tomography During Ureteroscopic Lithotripsy: A Single Institute's Experience

PURPOSE: Ureteroscopic stone removal is frequently used to remove ureteral stones. Mucosal edema and bleeding are the two most important obstacles to a successful operation. This study analyzed relationships between unenhanced computed tomography (UECT) findings and ureteroscopic findings to determine whether ureteroscopic results could be predicted preoperatively by using UECT imaging. MATERIALS AND METHODS: From January 2009 to July 2011, 675 patients were diagnosed with ureteral stones through UECT. Among them, we retrospectively reviewed 92 cases of patients who underwent ureteroscopy (URS). We identified findings such as hydronephrosis, rim sign, periureteral fat stranding, and perinephric fat stranding on the UECT and then categorized these findings into four categories (none, mild, moderate, and severe) according to their severity. We also divided the URS findings of mucosal edema and bleeding into four categories (none, mild, moderate, and severe) and compared these findings with the UECT images. RESULTS: A total of 92 study patients were included in this study: 59 were male and 33 were female patients. According to the location of the stone, 31 cases were classified as upper ureteral stones, 15 were midureteral stones, and 46 were lower ureteral stones. Hydronephrosis identified with UECT was correlated with the mucosal edema severity observed during URS (p=0.004). The rim signs identified with UECT were proportional to the grade of mucosal edema (p=0.010). CONCLUSIONS: Hydronephrosis and rim signs observed during UECT can be used as a predictive factor for intraoperative mucosal edema in patients undergoing URS.

Immunoglobulin G4-Related Systemic Sclerosing Disease: A Case Involving the Ureter and Kidney

Immunoglobulin (Ig) G4-related sclerosing disease is a newly defined clinicopathological entity characterized by lymphoplasmacytic infiltration of IgG4-positive plasma cells and varying degrees of fibrosis within affected tissues. Patients usually exhibit multisystem involvement and often respond well to steroid and immunosuppressive therapy. This report presents a case of IgG4-related sclerosing disease involving the ureter and kidney. We hope to bring IgG4-related sclerosing disease to the attention of urologists, because it is an uncommon disease that commonly responds to systemic corticosteroids.

A Rare Case of Upper Ureter Rupture: Ureteral Perforation Caused by Urinary Retention

Perforation of the ureter is a rare condition that causes a series of problems including retroperitoneal urinoma, urosepsis, abscess formation, infection, and subsequent renal impairment. There are causative factors that induce ureteric rupture, including malignancy, urinary calculi, idiopathic retroperitoneal fibrosis, recent iatrogenic manipulation, external trauma, degenerative kidney conditions, urography with external compression, and spontaneous causes. We report a rare case of ureteric rupture caused by urinary retention. The patient was treated with temporary percutaneous drainage and antibiotics. The present case illustrates that urinary retention can induce not only bladder rupture, but also ureteric rupture. It is thus of paramount importance to effectively manage patients with voiding problems.

Ectopic Epididymis in Testicular Appendices: Report of Two Cases

We report two cases of ectopic epididymal ducts and efferent ductules in the testicular appendices (TAs) of adult men with normally descended testes. In both cases, a sessile TA was incidentally found at the upper pole of the right testis during the scrotal hydrocelectomy. Microscopically, a few closely arranged tubules were detected within the TA. In the first case, the tubules were lined with a pseudostratified columnar epithelium with numerous, long microvilli, and were surrounded by a smooth muscle coat. In contrast, in the second case, the tubules had a wavy luminal surface, because ciliated columnar cells alternated with groups of cuboidal cells. In both cases, strong CD10 immunoreactivity was observed in the luminal border of the lining epithelium. Surgical pathologists should be aware of the presence of both ectopic epididymal ducts and efferent ductules that can occur in TAs, in order to avoid misinterpretation as transected, functional reproductive structures.

Renal Function Outcomes in Patients Undergoing Open or Laparoscopic Radical Nephrectomy

PURPOSE: We compared renal function outcomes in patients undergoing open or laparoscopic radical nephrectomy. MATERIALS AND METHODS: Seventy-one patients undergoing open or laparoscopic radical nephrectomy for kidney disease with a normal contralateral kidney were identified between January 2004 and December 2007. Renal function was calculated by using the Cockcroft-Gault formula. Serial renal functions were checked from the day before surgery to 1 year after surgery. Exclusion criteria were preexisting renal insufficiency, urinary stone disease, and pancreatic and liver disorders. RESULTS: Forty-one and 30 patients were treated with open radical nephrectomy or laparoscopic radical nephrectomy, respectively. The operative time and urine output of patients who underwent open and laparoscopic radical nephrectomy were 211.7+/-5.8 and 330.8+/-15.6 and 196.4+/-19.6 and 130.7+/-12.1, respectively (p=0.001, p=0.013). The glomerular filtration rates of patients who underwent open or laparoscopic radical nephrectomy were insignificant from baseline to postoperative day 360 (p>0.05). CONCLUSIONS: No significant differences in renal function were detected in the groups of patients who underwent open or laparoscopic radical nephrectomy from baseline to long-term follow-up.

Effects of tissue-cultured mountain ginseng (Panax ginseng CA Meyer) extract on male patients with erectile dysfunction / 亚洲男科学杂志(英文版)

Korean ginseng and mountain ginseng (Panax ginseng CA Meyer) are important traditional herbal plants whose ginsenosides are generally accepted as serving to improve sexual functions, such as penile erection. We investigated the effects of tissue-cultured mountain ginseng extract (TMGE) on male patients with erectile dysfunction (ED). A double-blind, placebo-controlled study was conducted with 143 patients experiencing ED. Over the course of 8 weeks, one group took 1 000 mg of TMGE twice a day, and the other group took 1,000 mg of placebo twice a day. The effects of the TMGE and the placebo were analyzed using the Korean version of the International Index of Erectile Function (IIEF) questionnaire. A total of 86 patients completed 8 weeks of treatment. The scores on the five domains of the IIEF after medication were significantly higher than the baseline scores in the group treated with TMGE (P<0.05), whereas no significant improvement was observed in the placebo group (P>0.05). Erectile function and overall satisfaction scores after medication were significantly higher in the TMGE group than in the placebo group (P<0.05). Erectile function of patients in the TMGE-treated group significantly improved, suggesting that TMGE could be utilized for improving erectile function in male patients.

Smooth Muscle Hyperplasia of the Epididymis: Report of A Case and Review of the Literature

A 66-year-old man underwent surgery to remove an incidentally discovered non-tender intrascrotal mass. Ultrasonography revealed an irregular-margined, heterogeneous mass-like lesion in the epididymal tail. The mass was relatively well circumscribed but unencapsulated, irregular and firm; it consisted of expansile, increased smooth muscle fascicles originating from the epididymal muscular coat. Its cellular growth pattern lacked the cohesive, well-circumscribed proliferation pattern typical of a leiomyoma. A diagnosis of smooth muscle hyperplasia of the epididymis was made. Although ultrasonography is the imaging modality of choice for evaluating suspected intrascrotal masses, there are times when it cannot reliably identify the character of the masses and distinguish malignant from benign lesions. Ill-defined, solid extratesticular masses, that are ultrasonographically ambiguous, should be excised and confirmed histopathologically and smooth muscle hyperplasia of the epididymis should be included in the differential diagnosis of solid extratesticular masses.

The Factors Affecting Non-Urologic Postoperative Complications after Laparoscopic Surgery in the Urologic Area

PURPOSE: Factors related to nonurologic postoperative complications of laparoscopic surgery in the urologic area were examined. The most significant factors were isolated and analyzed to establish ways to reduce the complication rate. MATERIALS AND METHODS: The medical records of 154 patients who had undergone laparoscopic surgery between March 2004 and March 2008 were reviewed. Age, anesthetic time, American Society of Anesthesiologists physical status classification, operative difficulty, blood loss (ml), body mass index (BMI), and complications were assessed. Complications were divided into 5 groups based on the modified Clavien classification. Grade 0 to 1 was defined as a no complication group and grades 2 to 5 as a complication group. The Armitage trend test was performed to study the relations between the factors and the complications. Univariate and multivariate analyses were performed to determine the risk ratio of each of the factors and the most significant factors. RESULTS: Complications tended to increase as the anesthetic risk and anesthetic time increased (p=0.011, 0.013, respectively). Operative difficulty and blood loss were related to complications (p=0.018, p<0.001, respectively). The univariate analysis revealed that blood loss of more than 400 ml compared with less than 200 ml had a risk ratio of 18.2. Moderate and hard operative difficulties had a significant risk ratio of around 4, and high anesthetic risk had a high risk rate of around 5. The multivariate analysis showed that blood loss and high anesthetic risk were independent risk factors of complications. CONCLUSIONS: Blood loss and high anesthetic risk proved to be independent factors that are associated with complications. Surgeons must keep in mind the patient's anesthetic risk and try to minimize blood loss during the operation to reduce complications after a laparoscopic surgery.

Unilateral Renal Cystic Disease / 대한비뇨기과학회지

Unilateral renal cystic disease (URCD) is a rare, non-familial, non-progressive renal disorder that is not associated with cysts or disorders in other organs, and it is not related to other genetic cystic diseases. URCD is pathologically indistinguishable from autosomal dominant polycystic kidney disease (ADPKD). However, URCD is clinically and radiologically characterized by a negative family history, normal renal function and unilateral localization. We present here a case in which the final diagnosis was made by pathologic documentation through laparoscopic radical nephrectomy. This is the 26th case that has been reported on in the medical literature, and this case was pathologically diagnosed.