Practice Patterns of Korean Urologists for Screening and Managing Prostate Cancer according to PSA Level

PURPOSE: There are still debates on the benefit of mass screening for prostate cancer (PCA) by prostate specific antigen (PSA) testing, and on systemized surveillance protocols according to PSA level. Furthermore, there is a paucity of literature on current practice patterns according to PSA level in the Korean urologic field. Here, we report the results of a nationwide, multicenter, retrospective chart-review study. MATERIALS AND METHODS: Overall 2122 Korean men (>40 years old, PSA >2.5 ng/mL) were included in our study (from 122 centers, in 2008). The primary endpoint was to analyze the rate of prostate biopsy according to PSA level. Secondary aims were to analyze the detection rate of PCA, the clinical features of patients, and the status of surveillance for PCA according to PSA level. RESULTS: The rate of prostate biopsy was 7.1%, 26.3%, 54.2%, and 64.3% according to PSA levels of 2.5-3.0, 3.0-4.0, 4.0-10.0, and >10.0 ng/mL, respectively, and the PCA detection rate was 16.0%, 22.2%, 20.2%, and 59.6%, respectively. At a PSA level >4.0 ng/mL, we found a lower incidence of prostate biopsy in local clinics than in general hospitals (21.6% vs. 66.2%, respectively). A significant proportion (16.6%) of patients exhibited high Gleason scores (> or =8) even in the group with low PSA values (2.5-4.0 ng/mL). CONCLUSION: We believe that the results from this nationwide study might provide an important database for the establishment of practical guidelines for the screening and management of PCA in Korean populations.

The Effect of Antiviral Therapy on Serum Cholesterol Levels in Chronic Hepatitis C

BACKGROUND/AIMS: The aims of this study were to evaluate the effect of antiviral therapy on serum total cholesterol (TC) levels and to investigate the factors related to serum TC changes in chronic hepatitis C (CHC) patients. METHODS: A total of 94 CHC patients, the majority of whom were infected with genotype 1 or 2 and were receiving antiviral therapy, were consecutively enrolled. TC levels before treatment, at week 4, at the end of treatment (EOT), and at 24 weeks after the EOT were analyzed, along with factors related to pre- and post-treatment TC levels. RESULTS: Pretreatment TC levels in the sustained virologic response (SVR) group (167+/-3.6 mg/dL) and the non-SVR group (158+/-8.3 mg/dL) were similar, and both decreased during antiviral therapy. The TC levels at 24 weeks after the EOT significantly increased in the SVR group (183+/-4.7 mg/dL), but not in the non-SVR group (160+/-7.1 mg/dL, p=0.044) after adjusting for the pretreatment TC levels. The grade of hepatic fi brosis, as measured by the METAVIR score or the aspartate aminotransferase-platelet ratio index (APRI), but not viral load (p=0.119), was an independent variable associated with the pretreatment TC levels (METAVIR score, p=0.011; APRI, p=0.033). After adjusting for the presence of a SVR by longitudinal data analysis using generalized estimating equations, the independent variable APRI was associated with the serum TC level after antiviral therapy (p=0.014), whereas a SVR was associated with the serum TC level only with marginal statistical significance (p=0.084). CONCLUSIONS: Serum TC levels increased in the SVR group after antiviral therapy for CHC; however, this was probably due to an improvement in liver fi brosis rather than the eradication of virus.

The Efficacy of Prostate Biopsy by Use of the Vienna Nomogram

PURPOSE: No standard number of cores is obtained with a prostate needle biopsy. Routinely, we obtain 10 core biopsies but do not consider prostate volume or patient age. Consequently, we evaluated the clinical efficacy of prostate biopsy when taking into account prostate volume and patient age by use of the Vienna nomogram to suggest the proper number of cores. MATERIALS AND METHODS: Transrectal ultrasonography (TRUS)-guided prostate needle biopsies were performed in 326 patients between November 2006 and June 2009. Group A (10 cores biopsy) was 131 patients. Group B (biopsy using Vienna nomogram) was 134 patients. We compared the cancer detection rate between the two groups, especially according to age and prostate volume. The chi-squared test was used for statistical analysis. RESULTS: The overall cancer detection rates in groups A and B were 33.6% and 32.1%, respectively. In older patients (age> or =60 years), group B had a higher detection rate than did group A (37.0% vs. 35.6%). For patients with a small prostate (<30 g), group B had a significantly higher detection rate than did group A (62.1% vs. 30.4%, p=0.023). CONCLUSIONS: There was no significant difference in the overall cancer detection rate. However, in patients with a small prostate and in older patients, the Vienna nomogram was more effective than a 10-core biopsy. The Vienna nomogram could help to establish guidelines for prostate biopsy in Korea that take into account the prostate volume and the age of the patient. It could also help urologists to reduce unnecessary cores when diagnosing prostate cancer in the elderly population and in those with small prostates.

Efficacy of Tamsulosin 0.2 mg/day in Female Patients with Lower Urinary Tract Symptoms

PURPOSE: The study of lower urinary tact symptoms(LUTS) in women is rare except urinary incontinence, and there were even no diagnostic or therapeutic guidelines for female bladder outlet obstruction. The objective of this study was to determine the efficacy of tamsulosin 0.2 mg/day single therapy for the female patients with LUTS. MATERIALS AND METHODS: A total 71 patients were evaluable. Tamsulosin 0.2 mg/day was administered orally in a nonblind design for 8 weeks. The efficacy parameters were International Prostate Symptom Score(IPSS), quality of life(QOL) score, frequency in daytime and night, maximal flow rate(Qmax), post-void residual urine volume(PVR), and changes in blood pressure and pulse rates. Changes in parameters between baseline and 8 weeks were assessed using Student's paired t-test. RESULTS: Statistically significant changes in the total, obstructive and irritative IPSS, QOL score, daytime and night time frequency, Qmax and PVR were observed at week 8. Adverse events included dizziness in 2 patients and increased nocturia in 1 patient. There were no withdrawals resulting from adverse events. There were significant differences in systolic blood pressure, but did not cause significant hypotension events. CONCLUSION: Treatment with tamsulosin 0.2 mg/day in female patients with LUTS was effective and well tolerated in improving LUTS and QOL.

A Case of Enteritis Cystica Profunda in the Duodenal Bulb / 대한소화기내시경학회지

Enteritis cystica profunda (ECP) is characterized by mucin-filled cystic spaces that are partially lined by non-neoplastic columnar epithelium, and these are found in the wall of the small bowel. This is a very rare disease compared to cystica profunda involving the stomach or colon. The cause of ECP is still unclear. Most ECP is related to or it may accompany other intestinal diseases. We encountered one case of ECP of the duodenal bulb that presented as polyp, and this was not related to adenocarcinoma or any other intestinal diseases like Crohn's disease or ulcerative colitis. Endoscopic polypectomy was done and the ECP was later confirmed through histological evaluation.

The Characteristics of Korean Smoker, Enrolled in'5 day Smoking Cessation4 School' and The Effect of Inpatient Smoking Cessation Program / 결핵및호흡기질환

BACKGROUND: Cigarette smoking is the single biggest avoidable cause of death and disability in most countries. Effective prevention of cigarette Smoking and help for those wishing to quit can therefore yield enormous health benefits for populations and individuals. Although most of smokers try to stop smoking for themselves, the success rate of quitting smoking is very low. Promoting and supporting smoking cessation should be an important health policy priority for healthcare professionals in all clinical settings. In this study, we tried to evaluate the effect of the educational program for smoking cessation of our hospital, the smoking pattern, and characteristics of adult smokers enrolled in the program. METHODS: We enrolled 640 smokers, who has visited the '5 day stop smoking school' for smoking cessation from Jan 1998 to 2001. we evaluated the characteristics of the smokers based on the self report questionnaire at the beginning of the program and we also checked 100 smokers, enrolled in Inpatient Smoking Cessation Educational program, their smoking behavior and the cessation rate with postal questionnaire after finishing this program from Nov 2002 to Jan 2003. RESULTS: The health was most common motivation for smoking cessation. The stress was the most important motivation of smoking. The overall smoking cessation rate of the smokers enrolled in inpatient smoking cessation school was 60%. The age of starting smoking and the kind of occupation have a significant difference between the success group and failure group of smoking cessation. CONCLUSION: The inpatient smoking cessation program was effective smoking cessation intervention in the adult smokers who enrolled in '5 day stop smoking school'.

A Case of Atypical McCune-Albright Syndrome Associated with Hyperthyroidism and Hypersecretion of Growth Hormone / 대한내분비학회지

McCune-Albright syndrome is characterized by polyostotic fibrous dysplasia, Caf -au-lait pigmentation and precocious puberty or other endocrinopathy. It can be caused by substitution of His, Cys or Gly for Arg 201st amino acid of the Gs protein subunit. The case of a 32-year-old woman, with atypical McCune-Albright syndrome, is reported. She had no skin lesion or precocity puberty. The polyostotic fibrous dysplasia was examined by a simple radiological image and whole body scan. She developed hyperthyroidism, with a multinodular toxic goiter. No thyroid related autoantibodies were detected. The cause of hyperthyroidism was thought to be a non- autoimmune thyroid hyperfunction. The level of growth hormone was not suppressed by oral glucose load. After a bromocriptine suppression test, the level of growth hormone decreased. There was no mass in the pituitary gland on a sellar MRI. A case of atypical McCune-Albright syndrome, including hyperthyroidism and hypersecretion of growth hormone, is reported.

Diaphragmatic Hernia as a Complication of Pedicled Omentoplasty / 대한흉부외과학회지

Pedicled omentoplasty is effective in thoracic surgery, but it is associated with several postoperative complications. A case of diaphragmatic hernia as a complication of pedicled omentoplasty in a 65-year-old male is reported. Because aortoesophageal fistula occurred three months after the patch aortoplasty for mycotic aneurysm of descending thoracic aorta, he underwent ascending thoracic aorta to abdominal aorta bypass surgery with resection of thoracic aortic aneurysm and esophagorrhaphy with wrapping of the esophageal suture line and the stumps of aorta with pedicled omental flap. Three years after the operation, herniation of the stomach developed. The pedicled omental flap was ligated and divided, and the diaphragm defect was repaired.

Left Lower Lobectomy with Bronchoplasty for Treatment of Bronchial Stricture / 대한흉부외과학회지

A case of endobronchial tuberculosis with left main bronchial stenosis and atelectasis of left lower lobe in a 26-year-old female is reported. She had taken antituberculous agents for 9 months, but she complained of chest pain and coughing. Bronchoscopy revealed patency of left upper bronchus and bronchiectasis of left lower lobe. She underwent left lower lobectomy with bronchoplasty. After the operation she had significant improvement of pulmonary function. Although surgical treatment of endobronchial tuberculosis is controversial, bronchoplastic surgery can be an effective treatment of tuberculous bronchial stenosis because it relieves patients from symptoms by preserving lung functions.

Extralobar Pulmonary Sequestration located in Right Oblique Fissure with Unusual Vascularture / 대한흉부외과학회지

Pulmonary sequestration is an abnormal lung tissue that does not communicate with tracheobronchial tree, and that receives blood supply from anomalous arteries. Pulmonary sequestration is divided into two anatomical forms, intralobar and extralobar. Extralobar pulmonary sequestration is usually located between the diaphragm and the lower lobe and has systemic arterial supply and venous drainage, and most patients are diagnosed in their infancy. We report an extralobar pulmonary sequestration located between the right upper lobe and the lower lobe in a 48-year-old female adult, which has anomalous blood supply from the right pulmonary artery and venous drainage directly into the left atrium.

Endoscopic Treatment of Latrogenic Chylothorax after Thoracic Symphathicotomy: A Case Report / 대한흉부외과학회지

Endoscopic symphathicotomy is an effective treatment for hyperhidrosis. Chylothorax is a rare but life-threatening complication. We recently encountered a case of chylothorax after endoscopic symphathicotomy at T2-T4 symphathetic nerve. We successfully treated chylothorax by electric cauterization with thoracic endoscopy.

Aortoesophageal Fistula after Prosthetic Patch Aortoplasty for Mycotic Aneurysm of the Descending Thoracic Aorta / 대한흉부외과학회지

Aortoesophageal fistula is an uncommon and fatal complication after surgery of aortic aneurysm. A case of aortoesophageal fistula as a complication of synthetis patch aortoplasty for mycotic aneurysm of descending thoracic aorta is described. After 3 months since patch aortoplasty for mycotic aneurysm of descending thoracic aorta this patient visited the emergency room due to melena and hematemesis. After gastrofiberoscopy and computed tomography the patient was taken ot the operating room. The surgical intervention was performed in two steps. Median sternotomy and midline laparotomy were made. Hemashield's Dacron(16mm) bypass between ascending thoracic aorta and infra-renal abdominal aorta was established first. Through the posterolateral thoracotomy false aneurysm and previous Hemashield's Dacron patch of descending aorta were resected. The two ends of the aorta were sutured and esophageal fistula was repaired. The esophageal suture line and the stumps were covered with omental graft. Thirty months later the patient has had no difficulty referable to the aortic surgery.

Results of Arteriovenous Fistula Revision in the Forearm / 대한흉부외과학회지

BACKGROUND: Because the development of medicine, the survival of ESRD(end stage renal disease) patients were improved and the chance of secondary arteriovenous fistula formation was increased. The purpose of this study is to evaluate the patency rate of one of the secondary arteriovenous fistula formation. MATERIAL AND METHOD: From January 1995 to September 1998, arteriovenous fistulae were made in 365 patients with ESRD. Among them, 62 patients underwent revisional arteriovenous fistula. RESULT: The patency rate for revisional arteriovenous fistula was 78.8% at 6 months, 72% at 12 months, 63% at 24 months, 56.9% at 36 months. CONCLUSION: Revision is a reliable procedure for salvaging a failed and inadequate fistula, which yields an acceptable patency rate.

Two Cases of Emphysematous Cystitis / 대한비뇨기과학회지

No abstract available.

Effect of Percutaneous Aspiration and Repeated Sclerotherapy of the Simple Renal Cyst / 대한비뇨기과학회지

Recently the percutaneous aspiration and sclerotherapy has become the most advocated procedure for the symptomatic, large, and simple renal cyst because of its minimal invasiveness and high effectiveness. But the recurrence rate of the simple aspiration and sclerotherapy was reported highly (30-70%). We analysed the effect of percutaneous aspiration and repeated sclerotherapy of the renal cyst in 42 patients from Nov. 1989 to Apr. 1995. Sclerosing agent were 99% ethanol in 33 cases, minocycline in 4 cases, and only aspiration was done in 6 cases. The method of repeated sclerotherapy was achieved about 2.2 times as which aspiration and instillation of sclerosing agent in standing of 8.3 Fr. pigtail catheter during average 2.5 days. After follow up for 17.4 (6-59) months, the complete collapse rate of the renal cyst was 78.7% in the using group of 99% ethanol. 25% in minocycline, 16.696 in the aspiration only. The complete collapse rate according to the times of sclerotherapy was 45.5% in one times, 78.6% in two times, 92% in three times. In conclusion, the sclerotherapy of the simple renal cyst with 99% ethanol was most effective, and we can be expect that the rate of complete collapse has been increased in the repeated sclerotherapy.

A Case of Primary Teratoma of Bladder / 대한비뇨기과학회지

Primary teratomas of bladder are exceedingly rare, it can be easily diagnosed by characteristic symptom, cystoscopy, and X-ray and it can be managed by locally removal of tumor or partial cystectomy. A case of primary teratoma of bladder in a 38 years old woman is presented. The patient was managed by transurethral resection of bladder tumor and followed up for 5 years without recurrence.

Therapeutic Experience of Stamey Operation for Stress Urinary Incontinence / 대한비뇨기과학회지

Endoscopic suspension of bladder neck by Stamey's procedure is a successful technique of correcting female stress urinary incontinence. We treated 27 patients complaining of urinary incontinence with Stamey operation from February, 1988 to March, 1994. The results was as follows l. Patients was distributed in age from 31 to 63 (mean; 48.8) years. All patients except one were multiparous, average 3.6(2-6)times of deliveries 2. Severities of incontinence were Grade I in 2 patients, Grade II in 20, Grade III in 5. 3. On preoperative lateral cystourethrogram, bladder base was descended about 1.1+/-0.57cm in resting, 2.63+/-1.24cm in straining from SCIPP(Sacrococcygeal-inferior point of pubic bone) line. Preoperative average PUVA(Posterior urethrovesical angle) was 142.2+/-53.27 degree, and average functional urethral length was 2.84+/-l.36cm. 4. Postoperative times of catheterization was 5.8 days, the amount of residual urine was lO5+/-10.3cc after removal of catheter. 5. Incontinence was completely disappeared in 24 patients(88.9%), but 3 patients were recurred due to break of suture material.

A Case of Retroperitoneal Neurilemmoma Arising from Adjacent to Adrenal Gland / 대한비뇨기과학회지

Neurilemmoma is well-encapsulated tumor of Schwann cell origin. The majority arise in peripheral nerve or cranial nerve, and rare in retroperitoneum. Although it is incidentally detected by the advances in diagnostic procedures, especially in ultrasound and computed tomography, it is confirmed by pathologic findings. The treatment is surgical excision. We report a case of retroperitoneal neurilemmoma arising from adjacent to adrenal gland, in 45 years old female.

A case of atypical carcinoma of the kidney / 대한비뇨기과학회지

Atypical carcinoma of the kidney arising from the epithelium of renal collecting duct is a rare disease. Clinical manifestations are mimicking that of the renal cell carcinoma. Diagnosis is confirmed by pathology with immunocytochemical study(cytokeratin) using immunoperoxidase technique. Management is not discussed here. The prognosis is poor with a relatively rapid progression of the disease. We present a case of atypical carcinoma of kidney in a 56 years old male patient with brier review of the literature.

A case of perinephric cyst / 대한비뇨기과학회지

The perinephric cyst in which cystic structures are in close relation to the kidney and renal pelvis is rare in occurrence. The causes may be obscure but most perinephric cysts around the kidney are a result of trauma, either accidental or an operative complication and doubtful origin, in which there is an encysted collection of urine or serous fluid lying beside and sometimes compressingthe kidney, and sometimes communicating with the pelvis. Clinical presentation is characterized by palpable flank mass and history of trauma. The diagnosis is made by excretory urography, ultrasonogram and CT scan. The treatment is aspiration or encleation of the cyst, or rarely nephrectomy. We report a case of perinephric cyst with hypertension developed in a 58-year-old woman presented with a child-fist sized palpable mass on right upper abdomen.