Unrecognized Kinetics of Serum Testosterone: Impact on Short-Term Androgen Deprivation Therapy for Prostate Cancer

PURPOSE: To evaluate the kinetics of serum testosterone (T) recovery following short-term androgen deprivation therapy (ADT), as the understanding thereof is essential for the proper management of prostate cancer (PCa), especially intermittent ADT. MATERIALS AND METHODS: This prospective analysis included male sex offenders who voluntarily received leuprolide acetate in order to alleviate sexual aberrance. Thirty-three and 25 patients who received 3 and 6 months of ADT were assigned to Group A and Group B, respectively. Serum T levels were obtained every week during the on-cycle period, then monthly during the off-cycle period for at least 12 months. RESULTS: The kinetics of serum T during the on-cycle period were similar in both groups. After flare reaction at week 2, a nadir of 0.45+/-0.29 ng/mL was achieved. In Group A, an abrupt rebound-upsurge was observed during the first 2 month off-cycle period, which surpassed the baseline level and reached a plateau level of 8.74+/-2.11 ng/mL during the flare (p<0.001). This upsurge was followed by a gradual decline back to baseline over the following 10 months. In Group B, a gradual increase was observed, and a baseline level of 7.26+/-1.73 ng/mL was reached at 5 months. Thereafter, an ongoing upsurge that surpassed baseline levels was observed until 12 months (8.81+/-1.92 ng/mL; p=0.002). CONCLUSION: The kinetics of serum T recovery during the off-cycle period varied according to the duration of ADT. Serum T should be monitored beyond normalization, as an excessive rebound may improve quality-of-life, but hamper the treatment efficacy of PCa.

Feasibility and Efficacy of Intermediate-Supine Percutaneous Nephrolithotomy: Initial Experience / 전남의대학술지

We evaluated the feasibility and efficacy of intermediate-supine percutaneous nephrolithotomy (PCNL) in patients with renal calculi. Fifteen patients were included in this study. The intermediate-supine operative position was modified by using a 1-L saline bag below the ipsilateral upper flank. A nephrostomy and stone extraction were performed as usual. After completion of the stone removal, a nephrostomy tube was used when necessary according to the surgeon's decision. If there was no significant bleeding or renal pelvic injury, tubeless PCNL was performed. The mean stone size was 5.48+/-5.69 cm2, the mean operative time was 78.93+/-38.72 minutes, and the mean hospital stay was 2.60+/-1.29 days. Tubeless PCNL was performed in 13 cases (86.7%), and retrograde procedures were simultaneously performed without a change of position in 2 patients (ureteroscopic ureterolithotomy in one patient and transurethral placement of an occlusion catheter in one patient). There were two complications according to the Clavien-Dindo classification (Grade I in one patient and Grade II in one patient). The success rate was 80.0% and the complete stone-free rate was 73.3%. Three patients with a significant remnant stone were also successfully managed with additional procedures (one patient underwent a second-look operation, and the remaining two patients were treated with shock wave lithotripsy). In the treatment of renal calculi, intermediate-supine PCNL may be a safe and effective choice that offers several advantages with excellent outcomes. Thus, a prospective study with a larger population is needed to verify our outcomes.

Feasibility and Efficacy of Intermediate-Supine Percutaneous Nephrolithotomy: Initial Experience / 전남의대학술지

We evaluated the feasibility and efficacy of intermediate-supine percutaneous nephrolithotomy (PCNL) in patients with renal calculi. Fifteen patients were included in this study. The intermediate-supine operative position was modified by using a 1-L saline bag below the ipsilateral upper flank. A nephrostomy and stone extraction were performed as usual. After completion of the stone removal, a nephrostomy tube was used when necessary according to the surgeon's decision. If there was no significant bleeding or renal pelvic injury, tubeless PCNL was performed. The mean stone size was 5.48+/-5.69 cm2, the mean operative time was 78.93+/-38.72 minutes, and the mean hospital stay was 2.60+/-1.29 days. Tubeless PCNL was performed in 13 cases (86.7%), and retrograde procedures were simultaneously performed without a change of position in 2 patients (ureteroscopic ureterolithotomy in one patient and transurethral placement of an occlusion catheter in one patient). There were two complications according to the Clavien-Dindo classification (Grade I in one patient and Grade II in one patient). The success rate was 80.0% and the complete stone-free rate was 73.3%. Three patients with a significant remnant stone were also successfully managed with additional procedures (one patient underwent a second-look operation, and the remaining two patients were treated with shock wave lithotripsy). In the treatment of renal calculi, intermediate-supine PCNL may be a safe and effective choice that offers several advantages with excellent outcomes. Thus, a prospective study with a larger population is needed to verify our outcomes.

Can Western Based Online Prostate Cancer Risk Calculators Be Used to Predict Prostate Cancer after Prostate Biopsy for the Korean Population?

PURPOSE: To access the predictive value of the European Randomized Screening of Prostate Cancer Risk Calculator (ERSPC-RC) and the Prostate Cancer Prevention Trial Risk Calculator (PCPT-RC) in the Korean population. MATERIALS AND METHODS: We retrospectively analyzed the data of 517 men who underwent transrectal ultrasound guided prostate biopsy between January 2008 and November 2010. Simple and multiple logistic regression analysis were performed to compare the result of prostate biopsy. Area under the receiver operating characteristics curves (AUC-ROC) and calibration plots were prepared for further analysis to compare the risk calculators and other clinical variables. RESULTS: Prostate cancer was diagnosed in 125 (24.1%) men. For prostate cancer prediction, the area under curve (AUC) of the ERSPC-RC was 77.4%. This result was significantly greater than the AUCs of the PCPT-RC and the prostate-specific antigen (PSA) (64.5% and 64.1%, respectively, p<0.01), but not significantly different from the AUC of the PSA density (PSAD) (76.1%, p=0.540). When the results of the calibration plots were compared, the ERSPC-RC plot was more constant than that of PSAD. CONCLUSION: The ERSPC-RC was better than PCPT-RC and PSA in predicting prostate cancer risk in the present study. However, the difference in performance between the ERSPC-RC and PSAD was not significant. Therefore, the Western based prostate cancer risk calculators are not useful for urologists in predicting prostate cancer in the Korean population.

Impact of Surgical Varicocele Repair on Pregnancy Rate in Subfertile Men With Clinical Varicocele and Impaired Semen Quality: A Meta-Analysis of Randomized Clinical Trials

PURPOSE: To elucidate the impact of surgical varicocele repair on the pregnancy rate through new meta-analyses of randomized clinical trials that compared surgical varicocele repair and observation. MATERIALS AND METHODS: The PubMed and Embase online databases were searched for studies released before December 2012. References were manually reviewed, and two researchers independently extracted the data. To assess the quality of the studies, the Cochrane risk of bias as a quality assessment tool for randomized controlled trials was applied. RESULTS: Seven randomized clinical trials were included in our meta-analyses, all of which compared pregnancy outcomes between surgical varicocele repair and control. There were differences in enrollment criteria among the studies. Four studies included patients with clinical varicocele, but three studies enrolled patients with subclinical varicocele. Meanwhile, four trials enrolled patients with impaired semen quality only, but the other three trials did not. In a meta-analysis of all seven trials, a forest plot using the random-effects model showed an odds ratio (OR) of 1.90 (95% confidence interval [CI], 0.77 to 4.66; p=0.1621). However, for subanalysis of three studies that included patients with clinical varicocele and abnormal semen parameters, the fixed-effects pooled OR was significant (OR, 4.15; 95% CI, 2.31 to 7.45; p<0.001), favoring varicocelectomy. CONCLUSIONS: Varicocelectomy for male subfertility is proven effective in men with clinical varicocele and impaired semen quality. Therefore, surgical repair should be offered as the first-line treatment of clinical varicocele in subfertile men.

Change in Expression of Rho-kinase and Nitric Oxide Synthase in Penile Tissue of Rats Under Stress / 대한남성과학회지

PURPOSE: The autonomic nervous system (ANS) and stress hormones are important mediators in the stress response. The ANS controls the tone of corpus cavernosal smooth muscle. Clinically, it is not uncommon to develop erectile dysfunction as the sequelae of acute or chronic stress, with or without loss of libido. In this study, we investigated the effect of stress on the expression of mediators of penile corpus cavernosal smooth muscle relaxation and contraction. MATERIALS AND METHODS: Forty-eight male Sprague-Dawley rats were used, with 8 rats in each group. They were divided into six groups; stress+10, stress+20, and stress+30, which were named after their duration (days) of exposure, and a control group for each stress group. The stress group was maintained under a scheduled stress condition, while the control group was provided a comfortable general environment. Penile tissues were sampled and expressions of Rho-kinase, inducible nitric oxide synthase (iNOS), endothelial NOS (eNOS) and neuronal NOS (nNOS) were measured and analyzed by Western blotting. RESULTS: Penile Rho-kinase expression was significantly increased in the stress groups compared with the control group (p<0.05), with a greater increase during longer stress. Expression of iNOS was increased in stress+30 group (p<0.05). Expression of eNOS, nNOS, and Rho-kinase were increased in stress+20, stress+30 group (p<0.05). CONCLUSIONS: These results suggest that stress may alter penile corpus cavernosal smooth muscle relaxation by affecting mediators.

Change in Expression of Rho-kinase and Nitric Oxide Synthase in Penile Tissue of Rats Under Stress / 대한남성과학회지

PURPOSE: The autonomic nervous system (ANS) and stress hormones are important mediators in the stress response. The ANS controls the tone of corpus cavernosal smooth muscle. Clinically, it is not uncommon to develop erectile dysfunction as the sequelae of acute or chronic stress, with or without loss of libido. In this study, we investigated the effect of stress on the expression of mediators of penile corpus cavernosal smooth muscle relaxation and contraction. MATERIALS AND METHODS: Forty-eight male Sprague-Dawley rats were used, with 8 rats in each group. They were divided into six groups; stress+10, stress+20, and stress+30, which were named after their duration (days) of exposure, and a control group for each stress group. The stress group was maintained under a scheduled stress condition, while the control group was provided a comfortable general environment. Penile tissues were sampled and expressions of Rho-kinase, inducible nitric oxide synthase (iNOS), endothelial NOS (eNOS) and neuronal NOS (nNOS) were measured and analyzed by Western blotting. RESULTS: Penile Rho-kinase expression was significantly increased in the stress groups compared with the control group (p<0.05), with a greater increase during longer stress. Expression of iNOS was increased in stress+30 group (p<0.05). Expression of eNOS, nNOS, and Rho-kinase were increased in stress+20, stress+30 group (p<0.05). CONCLUSIONS: These results suggest that stress may alter penile corpus cavernosal smooth muscle relaxation by affecting mediators.

The Effect of Stress on Bladder Stability / 대한비뇨기과학회지

PURPOSE: This study was designed to examine the effect of stress on the pathophysiology of bladder stability via the Rho-kinase and nitric oxide synthase activity, which are required for muscle contraction and relaxation within the bladder. MATERIALS AND METHODS: Animal testing was conducted in two separate sessions. In the first experiment, 36 female Sprague-Dawley rats weighing about 230-270g each were employed. 18 rats were placed in the control group and 18 rats were placed in the test group. The second testing was conducted using metabolic cages. Six rats were placed in the control group and six rats were placed in the test group under a stressful environment. RESULTS: The results showed that the frequency of urination was significantly increased with time in the test group(p<0.05). However, the volume of voided urine decreased, thereby suggesting stress was a cause of overactive bladder. Analysis of bladder tissue for nitric oxide synthase (NOS) and RhoA-binding kinase(ROKalpha), important components of contraction and relaxation of bladder muscle, revealed that the levels of iNOS and ROKalpha were significantly increased with continued application of stress. This suggests that stress affects the levels of NOS and ROKalpha in an overactive bladder to influence contraction and relaxation of the bladder muscle. CONCLUSIONS: An increase in the ROKalpha expression and changes of the NOS expressions in the rats with chronic stress pathophysiologicaly support that stress contributes to the clinical symptoms of overactive bladder.

Xanthogranulomatous Pyelonephritis in an Infant / 대한비뇨기과학회지

Xanthogranulomatous pyelonephritis (XGP) is an uncommon, severe, chronic infection of the kidney, which results in the normal renal parenchyma being replaced by characteristic lipid-laden macrophages (foam cells). It can occur at any age, but is extremely rare in children. Herein, the case of a 6-month-3-week-old girl with XGP, pre-operatively diagnosed with a Wilms' tumor, is reported. This is the youngest age of any patient with such a condition reported in the Korean literatures. Excretory urography, abdominal sonogram, computed tomogram and magnetic resonance imaging revealed a right renal round mass, without any calcifications. Her pathological findings after a radical nephrectomy revealed XGP.

Association of a Polymorphism in the Promoter Region of Apo-1/Fas Gene with Bipolar Disorder

OBJECTIVE: Recently, many experimental evidences have been reported that psychiatric diseases are closely related with neurodevelopmental abnormalities and this can be properly explained by apoptosis. It is known that Apo-1/Fas is one of the genes in charge of apoptosis related with neurodevelopmental abnormalities. In this study, the association between bipolar disorder and functional polymorphism in Apo-1/Fas promoter gene has been investigated. METHOD: For 81 bipolar disorder patients and 217 healthy control subjects, MvaI restriction fragment length polymorphism(RFLP) of Apo-1/Fas promoter gene was analyzed after polymerase chain reaction(PCR) amplification. RESULT: There was a statistical significant difference in genotypic distribution(chi2=16.656, df=2, p=0.0002) and allelic frequencies(chi2=14.225, df=1, p=0.0002) between bipolar disorder patients and healthy control subjects. CONCLUSION: Our results suggest an association between functional polymorphism in Apo-1/Fas promoter gene and bipolar disorder and provide the important genetic information related with the pathogenesis of the disease. Further studies employing larger samples are required to clarify the present results.

Comparison of Results Following Patellar Resurfacing and Non-Resurfacing in Total Knee Arthroplasty

PURPOSE: To evaluate the changes of clinical findings depending on the duration after total knee arthroplasty with or without patellar resurfacing. MATERIALS AND METHODS: Retrospective study of 145 total knee arthroplasties with (70 cases) or without (75 cases) patellar resurfacing was carried out clinically and radioilogically. Patients were evaluated using the knee society score, and the patellar score. RESULTS: No significant difference was found between patellar resurfacing and non-resurfacing knees regarding the knee society score, and the patellar score. The postoperative clinical scores, the postoperative development of anterior knee pain were not influenced by the presence of preoperative anterior knee pain, obesity, the grade of chondromalacia observed intraoperatively, preoperative anteroposterior alignment, or preoperative Insall-Salvati ratio. CONCLUSION: There was no specific difference between the two groups regarding clinical findings, so patellar non-resurfacing should be considered in patients who have relatively normal articular cartilage and patellofemoral joint space width.

Confocal Microscopic Corneal Findings in the Normal Rabbit and Human

PURPOSE: Although a confocal microscopy has been largely used, there has been no domestic report concerning the normal structure of rabbit and human cornea by confocal microscope. In this study, we investigated confocal microscopic morphology of normal cornea of rabbit and human. MEHTODS: Using confocal microscope (ConfoScan 2.0, Fortune Technology, Italy), cross-sectioned corneal images of the corneal epithelium, Bowman's layer, stromal layer (anterior, middle, and posterior keratocyte), Descemet 's membrane, and endothelium were examined in vivo. RESULTS: In normal rabbit corneas, the superficial epithelium was polygonal and Bowman's layer was wrinkled. The stromal keratocyte nuclei was elliptical anteriorly and was with less cellularity posteriorly. The endothelium of rabbit was uniform, hexagonal in shape and had highly reflective cell borders. In human corneas, the superficial epithelium had highly reflective nuclei and regular wing cell or subepithelial nerve plexus was visible. Bowman's layer was fold-like structure. The shape of anterior and middle keratocyte nuclei were polygonal, but posterior keratocyte was oval shape. Also the nerve plexus of middle stromal layer was visible and the nucleus of endothelial cell was reflective hexagonal shape. CONCLUSIONS: The normal corneal morphological findings were studied by confocal microscopy. These data might provide the useful informations for the diagnosis of corneal disease.

Clinical Experience of Automated Percutaneous Lumbar Discectomy / 대한척추외과학회지

No abstract available.