Influence of Daytime or Nighttime Dosing with Solifenacin for Overactive Bladder with Nocturia: Impact on Nocturia and Sleep Quality

We compared changes in nocturia and sleep-related parameters between daytime and nighttime solifenacin dosing in patents with overactive bladder (OAB) and nocturia. We comparatively analyzed the data of a 12-week prospective, open-label, multicenter, randomized study. All 127 patients who presented to 5 centers in Korea for the treatment of OAB with nocturia between January 2011 and December 2013 were enrolled in this study. The patients were divided into 2 groups by medication timing: group 1, daytime (n = 62); and group 2, nighttime (n = 65). The International Prostate Symptom Score (IPSS), Overactive Bladder Symptom Score (OABSS), and Athens Insomnia Scale (AIS) were used to assess OAB symptoms and sleep quality. We evaluated the parameter changes before and 12 weeks after daytime or nighttime solifenacin administration. Baseline data, which included sex, age, body mass index (BMI), total AIS, IPSS, and OABSS, did not differ between the 2 groups. Total IPSS, OABSS, and total AIS significantly improved after solifenacin administration regardless of timing (P < 0.001). After solifenacin administration, the number of nocturia episodes decreased in the group 1 and 2 (P < 0.001). There were no significant intergroup differences in changes in AIS, IPSS, OABSS, and number of nocturia episodes 12 weeks after solifenacin administration. Treating OAB with solifenacin may improve nocturia and sleep quality, but advantages did not differ significantly by medication timing.

Primary Androgen Deprivation Therapy for Prostate Cancer in Koreans: A Retrospective Multicenter Study

PURPOSE: To evaluate the characteristics of patients who received primary androgen deprivation therapy (PADT) for prostate cancer and the clinical efficacy of this treatment. MATERIALS AND METHODS: Two hundred forty patients treated by PADT were reviewed. These patients could not receive definitive therapy owing to old age, patient need, and medical comorbidity. The patients were divided into three groups according to the extent of prostate cancer: localized, locally advanced, and metastatic. Then, prostate-specific antigen (PSA) progression in these groups was analyzed. RESULTS: The median age of the patients was 73.0 years, and the median pretreatment PSA level was 47.0 ng/mL. Of the patients, 91.7% were treated with combined androgen blockade, and 8.3% were treated with monotherapy. Clinical factors for PSA progression were a PSA nadir and a high clinical stage. Estimated PSA recurrence-free median survival time in each group was 57, 24, and 12 months, respectively. A PSA nadir of >0.2 ng/mL and metastatic stage were independent factors for expecting a poor response to PADT (hazard ratio 4.26, p<0.001; and 2.60, p<0.001). CONCLUSIONS: Patients with localized or locally advanced prostate cancer who did not receive definitive therapy had lower PSA progression rates than those at metastatic stage during PADT. Further, a PSA nadir of < or =0.2 ng/mL showed better progression-free survival. Therefore, PADT can be another therapeutic option in well-selected patients with localized or locally advanced prostate cancer and PSA change should be checked carefully.

Urologist's Practice Patterns Including Surgical Treatment in the Management of Premature Ejaculation: A Korean Nationwide Survey

PURPOSE: According to previous studies, the prevalence of premature ejaculation (PE) in Korea ranges from 11.3% to 33%. However, the actual practice patterns in managing patients with PE is not well known. In this study, we have endeavored to determine how contemporary urologists in Korea manage patients with PE. MATERIALS AND METHODS: The e-mailing list was obtained from the Korean Urological Association Registry of Physicians. A specifically designed questionnaire was e-mailed to the 2,421 urologists in Korea from May 2012 to August 2012. RESULTS: Urologists in Korea diagnosed PE using various criteria: the definition of the International Society for Sexual Medicine (63.4%), Diagnostic and Statistical Manual of Mental Disorders (43.8%), International Statistical Classification of Disease, 10th edition (61.7%), or perceptional self-diagnosis by the patient himself (23.5%). A brief self-administered questionnaire, the Premature Ejaculation Diagnostic Tool, was used by only 42.5% of the urologists. Selective-serotonin reuptake inhibitor (SSRI) therapy was the main treatment modality (91.5%) for PE patients. 40.2% of the urologists used phosphodiesterase type 5 inhibitors, 47.6% behavior therapy, and 53.7% local anesthetics. Further, 286 (54.3%) urologists managed PE patients with a surgical modality such as selective dorsal neurotomy (SDN). CONCLUSIONS: A majority of Korean urologists diagnose PE by a multidimensional approach using various diagnostic tools. Most urologists believe that medical treatment with an SSRI is effective in the management of PE. At the same time, surgical treatment such as SDN also investigated as one of major treatment modality despite the lack of scientific evidence.

Clinical Significance of Wnt/beta-Catenin Signalling and Androgen Receptor Expression in Prostate Cancer

PURPOSE: To investigate the relationships among the Wnt/beta-catenin pathway, androgen receptor (AR), and clinicopathological factors in hormone-naive prostate cancer. MATERIALS AND METHODS: This study was conducted with132 cases of hormone-naive prostate cancer treated by prostatectomy and prostate needle biopsy. An immunohistochemical study using antibodies against beta-catenin, matrix metalloproteinase-7 (MMP-7), and the AR was performed. For the in vitro study, PC-3, LNCaP, 22Rv1, and DU145 cell lines were used. RESULTS: The clinical or pathological stage ware a localized cancer in 36 patients (27.3%), locally advanced cancer in 31 (23.5%), and metastatic cancer in 65 (49.2%). We detected increased beta-catenin, AR, and MMP-7 expression with a high Gleason grade, disease progression, and increasing serum prostate-specific antigen (PSA) levels (p<0.01). In Spearman's rank correlations, the expression of cytoplasmic beta-catenin, MMP-7, and the AR were found to be significantly positively correlated. In addition, the expression of beta-catenin, MMP-7, and the AR were significantly correlated with clinicopathological variables indicative of a poor prognosis. Forty-nine patients with primary androgen deprivation had short response durations from hormone therapy to PSA progression with elevated MMP-7 expression on the Kaplan-Meier curve (p=0.0036). CONCLUSIONS: These data show that an activated Wnt/beta-catenin pathway and AR expression in prostate cancer are correlated with metastasis and aggressiveness. In addition, the expression of MMP-7 protein, a target of the Wnt/beta-catenin pathway, is associated with PSA progression in prostate cancer patients undergoing primary hormone therapy.

Urothelial Carcinoma Arising from a Large Ureteral Polyp

We report an unusual case of a urothelial tumor on a ureteral polyp without hydronephrosis. The patient was a 50-year-old male. He had experienced several episodes of gross hematuria. Cystoscopy revealed a tumor that periodically prolapsed into the bladder. The tumor had a smooth-surfaced stalk with an erythematous, edematous lesion at the end. Tomography showed a mass and filling defect at the left ureterovesical junction. The results of urine cytology tests were negative. After the tumor was identified as a urothelial carcinoma by frozen biopsy analysis, a ureteroscopic resection was performed. The final pathological diagnosis was urothelial carcinoma arising in a ureteral polyp. No recurrence of the tumor or polyp was observed at the 3-month follow-up. To our knowledge, this is the first report in the Korean population of a urothelial tumor arising from a ureteral polyp.

Effects of alpha-Lipoic Acid on the Antioxidant System in Prostate Cancer Cells / 대한비뇨기과학회지

PURPOSE: Overproduction of lipid peroxidation byproducts and disturbances in the antioxidant defense system have been implicated in the pathogenesis of several diseases, including prostate cancer. Although several studies have investigated the level of lipid peroxidation and antioxidants in prostate cancer, there are no reports on alpha-lipoic acid (ALA) in prostate cancer. Here we assessed the effects of ALA on the antioxidant system in prostate cancer cells. MATERIALS AND METHODS: PC-3, LNCaP, and RWPE-2 cell lines were used in this study. Redox factor (Ref)-1 protein was measured by Western blot analysis after treatment with ALA. Real-time polymerase chain reaction (RT-PCR) was performed to detect superoxide dismutase (SOD)-1 and -2, catalase, and glutathione peroxidase (GSH-Px) mRNA expression. RESULTS: Ref-1 was expressed in the PC-3, LNCaP, and RWPE-2 cell lines. The expression of Ref-1 protein was increased after treatment with 125, 250, and 500 microM ALA in the PC-3 (p0.05) cells compared with the RWPE-2 cells at 48 hours. In PC-3 cells, the mRNA expression of SOD-1, SOD-2, catalase, and GSH-Px decreased at 24 and 48 hours dose-dependently compared with that in RWPE-2 cells (p<0.05). The mRNA expression of SOD-2, catalase, and GSH-Px in LNCaP cell decreased at 48 hours dose-dependently (p<0.05). CONCLUSIONS: The expression of Ref-1 protein and antioxidant enzymes changed after ALA exposure in prostate cancer cells. Our findings suggest that ALA affects the antioxidant system in prostate cancer cells and may be related to compensatory changes in the antioxidant defense system of the cells.

Effect of Decursin on the Expression of beta-Catenin and Matrix Metalloproteinase-7 in Prostate Cancer Cell Lines / 대한비뇨기과학회지

PURPOSE: Alterations in the Wnt/beta-catenin pathway are associated with the development and progression of human prostate cancer. Decursin can attenuate the Wnt/beta-catenin pathway. We investigated the relationship between the Wnt/beta-catenin pathway and decursin in prostate cancer cells. MATERIALS AND METHODS: PC-3 and LNCaP cell lines were used. Cell viability was measured with methyl-thiazole tetrazolium bromide (MTT) assays, and cell apoptosis analysis was performed by FACScan. The amount of beta-catenin protein after treatment with decursin was measured by Western blot analysis. Expression of MMP-7 mRNA was detected by real-time polymerase chain reaction (RT-PCR). RESULTS: Death and apoptosis were increased after treatment with decursin 0.5-100 micrometer in PC-3 and LNCaP cells. This was revealed dose and time-dependent increase of cancer cell death on 24, 48 and 72 hours. FACScan showed an increment of apoptosis on 24, 48 hours. Expression of intracellular beta-catenin protein was decreased dose-dependently in both of prostate cancer cell lines. Decursin reduced MMP-7 mRNA expression on 6, 12, 24, 48 hours dose-dependently. CONCLUSIONS: Decursin affects the viability of prostate cancer cells. Increased cancer cell death was associated with increased apoptosis. This study suggests that decursin may play a role in the treatment of prostate cancer.

Primary Signet Ring Cell Carcinoma of the Urinary Bladder

Primary signet ring cell carcinoma of the urinary bladder is a relatively rare histological variant of mucus-producing adenocarcinoma usually of poor prognosis. We report two cases of primary bladder signet ring carcinoma. The first patient underwent a radical cystectomy with ileal conduit (pT3bN1M0), radiotherapy, and chemotherapy (M-VAC regimen) and subsequently expired 37 months after surgery. The other was initially diagnosed with peritoneal metastasis from the primary bladder signet ring cell carcinoma and was treated with partial cystectomy (pT3bNOM1). Postoperative adjuvant therapy was not done because of patient's refusal.

Construction of an Explanatory Model of Female Sexual Dysfunction / 간호학회지

PURPOSE: Although concerns of female sexual dysfunction (FSD) are increasing in Korea, sexual dysfunction related factors are limited in research studies. The aim of this study was to develop an explanatory model that will further explain the continuously increasing female sexual dysfunction cases in Korea. METHODS: Survey visits were conducted to four hundred and eighty five women, over 25 years of age and presently residing in either urban or rural areas. All of them were analyzed using a structured questionnaire. A total of 8 instruments were used in this model. The analysis of data was done with both SPSS WIN for descriptive statistics and AMOS 5.0 for covariance structure analysis. RESULTS: As a result, variables that showed notably direct effects on FSD were: sexual concept (sexual attitude), sexual distress, and psychosocial health (depression, crisis, traumatic life events). On the other hand, variables such as age, educational level, economic status, and marital status showed indirect influences on health-promoting behaviors. CONCLUSION: By comprehensively addressing the factors related to sexual dysfunction, and comparing each influence, this study can contribute to designing an appropriate sexual dysfunction prevention strategy in tune with the particular characteristics and problems of a client.

The Efficacy and Safety of a Once-daily Extended-release Ciprofloxacin Tablet for the Empirical Treatment of Symptomatic Uncomplicated Cystitis in Korean Women / 대한비뇨기과학회지

PURPOSE: To compare the efficacy and safety of a 3-day regimen of extended-release ciprofloxacin (ciprofloxacin ER), 500mg qd, with trimethoprim-sulfamethoxazole (TMP/SMX), 800mg/160mg bid, for the empirical treatment of acute uncomplicated cystitis in Korean women. MATERIALS AND METHODS: A randomized, single-blind treatment trial of 75 women with acute uncomplicated cystitis was conducted. The women were prescribed ciprofloxacin ER, 500mg qd, or TMP/SMX, 800mg/160 mg, bid for 3 days. The patients were assessed in terms of the clinical and microbiological outcome and safety 7 days after treatment. RESULTS: Sixty-five women were eligible for the analyses (32 ciprofloxacin ER and 33 TMP/SMX). The most prevalent causative organism was Escherichia coli (76.9%), followed by Proteus (6.2%) and coagulase-negative Staphylococcus (6.2%). The rates of in vitro susceptibility to ciprofloxacin and TMP/SMX were 86.2 (56/65) and 73.4% (48/65), respectively. The clinical cure rates with ciprofloxacin ER and TMP/SMX were 87.5 and 78.8%, respectively. Microbiological cures at 7 days were observed in 25 of the 32 (78.1%) with ciprofloxacin ER and 18 of the 33 (54.5%) with TMP/SMX. The mean interval to improvement in the clinical symptoms after ciprofloxacin and TMP/SMX medications were 1.93+/-0.55 and 2.92+/-0.48 days, respectively. Adverse events with ciprofloxacin and TMP/SMX occurred in 28.1 and 15.5%, respectively, but both treatments were well tolerated. CONCLUSIONS: Although some organisms were resistant (13.8%) to ciprofloxacin, ciprofloxacin ER was superior to TMP/SMX in terms of the clinical and microbiological cure rates and the mean interval to improvement in the clinical symptoms. The high prevalence of resistance and low microbiological cure rates for TMP/SMX suggest that this drug does not provide an adequate initial therapy, while once-daily ciprofloxacin ER was safe and effective in the empirical treatment of symptomatic uncomplicated cystitis.

Etiology and Antimicrobial Susceptibility of Bacterial Pathogens Causing Community-Acquired Urinary Tract Infection at a Tertiary-care Hospital / 대한임상미생물학회지

BACKGROUND: Resistant organisms are now a growing and frequent problem in community-acquired infections. There is little information on the etiology and antimicrobial susceptibility patterns of community-acquired urinary tract infection (CA-UTI) at a tertiary-care hospital. METHODS: We evaluated the distribution of etiological organisms with their antimicrobial susceptibility patterns of CA-UTI in the patients visiting a tertiary-care hospital during the period of three years from 2001 through 2003. RESULTS: In total, 1,753 bacterial isolates yielded a significant growth as pathogens of CA-UTI in this study. The most common pathogen was Escherichia coli (38.3%), followed by Pseudomonas aeruginosa (10.8%), Enterococcus faecalis (7.3%), Klebsiella pneumoniae (6.4%), coagulase negative staphylococci (CoNS) (5.4%) and Staphylococcus aureus (5.2%). The prevalence of E. coli was significantly higher in females (P < 0.001), whereas P. aeruginosa, E. faecalis, and S. aureus were significantly more common in male group (P < 0.001). The susceptibility rate of E. coli was 26.0% to ampicillin, 65.8% to gentamicin, 51.3% to co-trimoxazole, and 62.5% to ciprofloxacin. The susceptibility patterns of Enterobacteriaceae other than E. coli were different from those of E. coli. Extended spectrum beta-lactamase was detected in 7.9% of E. coli and 15.6% of K. pneumoniae. CONCLUSION: This study demonstrates a diversity of etiological organisms and a high rate of resistance to commonly used antimicrobials of CA-UTI in patients visiting a tertiary-care hospital.