The Influence of Age and Prostate Volume on the Cancer Detection Rate in Korean Men with PSA Levels of 4.0 to 10.0ng/ml: a Multicenter, Retrospective Study / 대한비뇨기과학회지

PURPOSE: We retrospectively investigated how patients age and prostate volume influence on the cancer detection rate in Korean men with prostate-specific antigen (PSA) levels of 4.0 to 10.0ng/ml. MATERIALS AND METHODS: 791 Korean men who underwent transrectal ultrasound guided prostate biopsies (TRBx) at 12 medical centers were analyzed retrospectively during the previous 10 years. TRBx were performed in cases with PSA levels of 4.0 to 10.0ng/ml. The biopsy-proven cancer patient group was compared to the non-cancer patient group according to age, PSA, prostate volume and PSAD. RESULTS: Among the 791 patients who underwent TRBx, prostate cancer was detected in 123 patients (15.5%). The mean age (cancer group vs non-cancer group=69.1 vs 63.8 year-old), prostate volume (38.0 vs 42.5ml, respectively) and PSAD (0.21 vs 0.18ng/ml/ml, respectively) were found in statistically significant between the two groups. The cancer detection rate (20.1%) in the small prostate (less than 40ml) was significantly higher than that (10.3%) of the large prostate. The cancer detection rate was significantly increased with age: from 14.4% for the 50 to 59 year-old patients to 31.6% for the 80 or more year-old patients. CONCLUSIONS: The cancer detection rate in Korean men with a gray zone PSA level is lower than that of Caucasians. However, regarding the detection of prostate cancer in Korean men, the older age group and the patients with less than 40ml of prostate volume among the patients with gray zone PSA levels are considered as the important factors to decide whether biopsy of prostate is needed.

A Multicenter Study of the Detection Rate for Prostate Cancer according to the Serum Prostate-Specific Antigen Level in Korean Men / 대한비뇨기과학회지

PURPOSE: The incidence of prostate cancer is increasing in Korea, but compared with western counties, the incidence is relatively low. The detection rate of prostate cancer, according to the serum prostate-specific antigen (PSA) level, is reportedly different in Korean men, but this remains to be confirmed. We retrospectively reviewed the data of prostate biopsies, and evaluated the detection rate of prostate cancer from biopsies, according to the serum PSA level in Korean men. MATERIALS AND METHODS: We retrospectively reviewed the results of 2,422 Korean men who had undergone prostate biopsies at 12 medical centers. Prostate biopsies were performed in cases of high PSA levels, greater than 4ng/ml, or abnormal findings on digital rectal examination. RESULTS: Of the 2,422 men, 39.7% had a positive biopsy. With PSA levels between 4 and 10ng/ml, the detection rate of prostate cancer was 15.9%. This rate was similar to that of the Japanese (15.8%), but quite different from that of American men (25%). With PSA levels above 10ng/ml, 59.5% of men had a positive biopsy. For PSA levels > or= 4ng/ml and > or= 10ng/ml, the detection rates were 42.1 and 59.5%, respectively. CONCLUSIONS: When the serum PSA levels were divided into 4 subdivisions (4.0-10.0, 10.0-20.0 and 20.0-100.0ng/ml and more than 100.0ng/ml), the detection rates were 15.9, 34.1, 66.2 and 93.8%, respectively.

Detrusor and Blood Pressure Responses to Dorsal Penile Nerve Stimulation during Hyper-reflexic Bladder Contraction in Patients with Cervical Cord Injury

OBJECTIVE: To investigate the immediate effect of dorsal penile nerve (DPN) stimulation on detrusor pressure (Pdet) and blood pressure (BP) during hyper-reflexic contractions of the bladder in patients with cervical spinal cord injury (SCI). METHOD: The subjects were eight male patients with cervical SCI who had symptoms of autonomic dysreflexia. During water-cystometry, BP was monitored using an intra-arterial catheter into the radial artery, and was recorded simultaneously with the Pdet. Electrical stimulation was applied to the DPN, using surface electrodes each time a bladder contraction was detected. Baseline BP and BP at the first and the last hyper-reflexic contractions of bladder were measured with Pdet, respectively. RESULTS: As Pdet increased, the BP increased in all cases. The reflex contractions of the bladder were effectively suppressed by DPN stimulation, and as the Pdet decreased during stimulation, radial arterial pressure also decreased immediately and significantly. CONCLUSION: DPN stimulation can lower both Pdet and the elevated BP.

Inhibition of Hyper-reflexic Detrusor Contraction by Sacral Afferent Nerve Stimulation in Spinal Cord Injury

OBJECTIVE: To evaluate the inhibition effects of hyper-reflexic detrusor activity by sacral afferent nerve stimulation in spinal cord injury (SCI) patients. METHOD: The subjects were thirteen patients with SCI who had symptoms of urinary incontinence, because of hyper-reflexic bladder contractions. According to the level and severity of injury, the patients were divided into groups of tetraplegia/paraplegia and complete/incomplete. We applied dorsal penile nerve (DPN) stimulation using portable stimulator during the continuous bladder filling. Stimulation parameters were biphasic rectangular pulses of 25 Hz frequency, 250 microseconds pulse width. Stimulation intensity was twice the threshold of pudendo-anal reflex. The one minute stimulation was repeated to every reflex contraction during the cystometry. Immediate suppressive effect of DPN was analyzed. RESULTS: Of 13 patients who had a reflex bladder, hyper-reflexic detrusor contractions were suppressed effectively in 12 by DPN stimulation. The suppressive effect in groups of level and severity was not statistically significant. CONCLUSION: DPN stimulation for inhibition of hyper-reflexic bladder contraction is an adjunctive method of incontinence management in SCI patients of different level and severity.

A New Surgical Approach to the Rectal Anastomotic Stricture: Endoscopic

Rectal stricture is an occasional complication of abdominoperineal pull-through and low anterior resection of the rectum and irradiation injury. Although the causes and pathogenesis of this phenomenon are poorly understood, various techniques for stricture dilatation have been described. In this article, we present two cases of severe postoperative rectal stricture that were not amenable to conventional methods of dilation but were succesfully managed by transanal electroresection using endoscopic transurethral electroreectoscope.

Clinical Observation of Bladder Rupture due to Blunt Trauma / 대한비뇨기과학회지

From 1980 to 1986, 32 patients had suffered from bladder rupture. Among these patients 14 were due to direct blow, 10 due to traffic accident, 2 due to slip down, 1 due to falling down, and unknown origin was seen in 4 cases. We evaluated these patients with age, sex, presence of pelvic bone fracture, urologic sign and symptom, size and site of ruptured bladder due to blunt trauma.

A Case of Prenephrectomy Renal Artery Embolization for Renal Cell Carcinoma / 대한비뇨기과학회지

Prenephrectomy therapeutic renal artery embolization by injecting gelfoam into therenal artery was done in a 47 year-old female patient with hypernephroma. This technique facilitated nephrectomy and decreased blood loss. A post-infarction syndrome characterized by flank pain, fever and nausea also occurred in this patient. We report our experience herein with review of literature.