Epidemiologic Survey Using International Prostate Symptom Score (I-PSS) of Lower Urinary Tract Symptoms (LUTS) in Elderly Men Above 40 Years Old in Seoul Area / 대한비뇨기과학회지

PURPOSE: We tried to determine the prevalence of LUTS and to measure the impact of these symptoms on quality of life (QOL), and to reevaluate the validity of I-PSS in Korea. MATERIALS AND METHODS: A total of 1,356 men ranging from 40 to 79 years old living in Seoul metropolitan area was selected by stepwise random sampling and surveyed with questionnaire including I-PSS. Several risk factors were analyzed to assess the relevance with lower urinary tract symptoms. RESULTS: About 16% had moderate-to-severe LUTS, as assessed by I-PSS more than 7. The prevalence of moderate-to-severe LUTS increased significantly with age (p<0.01); 10%, 16%, 29%, and 45% in the age groups 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years respectively. The most prevalent symptoms were weak stream and nocturia. QOL decreased as urinary symptom severity increased; 5%, 52%, 78% of the men with I-PSS 0 to 7, 8 to 19, and 20 to 35 had poor QOL as assessed by QOL indices more than 2, respectively. A good correlation was found between the total symptom score and the quality of life score that was included in the I-PSS. CONCLUSIONS: Moderate to severe LUTS of elderly men above 40 years old in Seoul metropolitan area are relatively common, and more people suffer from the LUTS as they get older. New modified I-PSS system in Korean elderly men according to the importance of individual symptom in the established I-PSS, will be beneficial in the management of the lower tract symptom associated with BPH.

Ureteral Submucosal Macroplastique Injection in the Treatmenet of vesicoureteral Reflux

No abstract available.

Effect of Oxalate on the Growth of Distal Renal Tubular Epithelial Cells / 대한비뇨기과학회지

PURPOSE: We tried to evaluate the effect of oxalate on the growth of distal renal tubular epithelial cells MATERIALS AND METHODS: Madin-Darby canine kidney(MDCK) cell line, derived from canine distal renal tubular epithelial cell, supplied from American Type Culture Collection was used in this study. RPMI 1640 containing 10mM HEPES-buffer, 100IU/ microliterpenicillin, 100 microgram/ microliterstreptomycin, 300 microgram/ microliterglutamine, and with or without 10% fetal bovine serum(FBS) was used as the culture media. And the cell survivals under various concentrations of ammonium oxalate were assessed by MTT assay. RESULTS: Exposure of MDCK cells to oxalate resulted in a concentration dependent suppression of the cell growth in both 10% FBS supplied media and FBS deprived media. CONCLUSIONS: From these observations we could conclude that oxalate is not a mere constituent of calcium oxalate stone, but oxalate might offer a good environment for calcium oxalate stone formation in the urinary tract via MDCK cellular damage.

Clinical Characteristics of Ileal Neobladder / 대한비뇨기과학회지

PURPOSE: To evaluate clinical characteristics of ileal neobladder as orthotopic bladder substitution, we examined the urodynamic characteristics, clinical symptoms and radiologic findings of 11 patients who had undergone ileal nobladder substitution following cystectomy or cystoprostatectomy. MATERIALS AND METHOD: From February 1993 to July 1996, 11 patients underwent lower urinary tract reconstruction with ileal neobladder. Cystectomy or cystoprostatectomy was done, and reservoirs were connected to the proximal urethra or urethrovesical junction. Urodynamic and radiologic studies were performed to evaluate neobladder function and upper tract. Clinical symptoms were evaluated via a detailed patient questionaire. RESULTS: Mean cystometric capacity was 434m1(293-640m1). All patients voided by Valsalva maneuver and achieved good peak flow rates(mean value was 22.6m1/sec). Of the patients 10 emptied bladder to near completion with a mean post-void residual of 30m1, while 1 had post-void residuals of 110m1 The neobladder demonstrated good compliance for the storage of urine Phasic neobladder contractions were present during filling cystometrography. While the number of phasic contractions increased at higher neobladder volumes, the mean length and mean pressure of phasic contractions were not Increased a higher neobladder volumes. Daytime continence was obtained in all patients(100%), while nighttime continence was achieved in 8 patients (73%). Of these 8 nighttime continent patients, 4 patients(50%) had to void at least once a night to keep dry. No difference was found in any urodynamic parameter between nighttime continent and incontinent patients. There was no difference in any important urodynamic parameter between patients who had and had not received post-operative chemotherapy. Renal function, based on serum creatinine levels, had remained stable and no significant electrolyte or acid-base imbalance was found in all patients. Voiding cystourethrograms obtained in 9 patients revealed 3 patients(33%) had grades ll-lll/V reflux IVP in 9 patients revealed hydronephrosis in 1/18(5.5%) of renal units. CONCLUSIONS: Neobladder constructed from detubularized ileum achieves adequate capacity at low pressures with a satisfactory continence rate. We conclude that neobladder may be the best choice of urinary diversion after cystectomy in the aspect of quality of life.

The Value of Prostate Specific Antigen Density in the Diagnosis of Prostate Adenocarcinoma / 대한비뇨기과학회지

PURPOSE: Most studies have shown considerable overlap between benign prostatic hyperplasia(BPH) and cancer, using a prostate specific antigen(PSA) cut-off point of 4.0ng/ml. Because of lack of sensitivity and specificity, the value of PSA measurement in the diagnosis of prostate cancer has been questioned. The concept of PSA density(PSAD) was introduced to enhance the specificity of serum PSA. To determine the value of PSAD in the diagnosis of prostate cancer, we investigated whether PSAD-based clinical guidelines could help in the diagnosis of prostate cancer and assist in avoiding a significant number of biopsies. MATERIALS AND METHODS: Retrospective data were analysed from a selected population of 130 patients(mean age 66 years, range 42-86), 54 with histopathologically diagnosed prostate cancer and 76 with BPH. DRE(digital rectal examination) and TRUS(transrectal ultrasonography) were performed and PSA and PSAD were determined for each patient. RESULTS: The median PSA level was 7.0ng/ml(range 0.6-87ng/m1) in the patients with a benign diagnosis and 25.5ng/ml(range 2.2-736ng/m1) in those with malignancies. Also, the median PSAD was 0.18ng/m1/cm3(range 0.02-2.56ng/ml/cm3) in the benign group and 0.75ng/m1/cm3(range 0.06-22.3ng/m1/cm3) in the malignant group. Both PSA and PSAD discriminated BPH from cancer in a whole range of PSA level and were statistically significant. Of the 130 patients, 49(377 %) had a PSA level in the intermediate range(4.0-10.0ng/ml). In these patients, the median PSA was 6.5ng/ml(range 4.2-10ng/m1) In the benign group and 5.2ng/ml(range 4.1-9.8ng/ml) in the malignant group. Also, the median PSAD was 0.16ng/m1/cm3(range 0.07-0.39ng/m1/cm3) in the benign group and 0.17ng/m1/cm3 (range 0.08-0.27ng/m1/cm3) in the malignant group Both PSA and PSAD had no discriminating ability between BPH arid cancer in the Intermediate PSA range(4.0-10.0ng/ml). CONCLUSIONS: PSAD was of no additional value over serum PSA measurement in discriminating BPH from cancer for the population with intermediate PSA levels.

Clinical Analysis of Incidentally Found Renal Cell Carcinoma: Experiences of Recent 8 Years / 대한비뇨기과학회지

PURPOSE: The clinical information and survival rate of incidentally found renal cell carcinoma patients were compared with those of symptomatic patients. MATERIALS AND METHODS: We reviewed the hospital records of 267 patients with renal cell carcinoma managed in Seoul National University Hospital during the recent 8 years. Mean followup period was 26+/-21.1 months. Initial presentations, pathologic stages, and survivals were analysed. RESULTS: In 124 patients(46.4%), the tumors were found incidentally. Hematuria, pain and mass were the common presentations in symptomatic patients. The more patients with lower stage(stage T1 and T2) belonged to incidentally found group compared with symptomatic group(81.5% vs 64.3%). The 2 and 5-year survival rates of incidentally found group were 78% and 67%, respectively, which were higher than those of symptomatic group(72% and 56%). The survival rate decreased markedly by increasing size, advanced stage, lymph node involvement and distant metastasis. CONCLUSIONS: Recently, there has been a significant increase of incidentally detected renal cell carcinoma and the incidentally found renal cell carcinoma proved to have better prognosis than symptomatic group. So our effort should be focused on detecting low stage incidentallomas.

The Establishment of Sperm Penetration Assay Using Cryopreserved Hamster Oocyte / 대한비뇨기과학회지

To establish sperm penetrating assay (SPA) with using cryopreserved hamster oocyte, we performed the stepwise SPA with 1) fresh hamster oocyte and hamster sperm, 2) cryopreserved hamster oocyte and hamster sperm, 3) fresh hamster oocyte and human sperm, and 4) cryopreserved hamster oocyte and human sperm, in 4 cases of male hamster and 12 cases of fertile human. In SPA of hamster sperm with fresh hamster oocyte, the oocyte penetration rate (PR) were 100+0%, and the penetration index(mean penetration per oocyte, PI) was 22.4 +/- 1.8. In SPA of hamster sperm with cryopreserved hamster oocyte, the PR were 100 +/- 0%, and the Pl was 14.1 +/- 2.9 (p<0.01). When the oocytes were examined at 1, 2, 3, and 6 hour post insemination, hamster sperm penetration was 1 hour slower in cryopreserved oocytes than in fresh ones. In SPA of human sperm with fresh hamster oocyte, the PR was 79.5 +/- 10%, and the Pl was 2.78 +/- 2.6. In SPA of hamster sperm with cryopreserved hamster oocyte, the PR was 73.9+/- 16%, and the PI was 2.82 +/- 2.7. There`s no significant difference in SPA using human sperm. These results suggest that them may be some functional damages on cryopreserved oocyte, because Pl of fresh oocytes is higher than that of cryopreserved oocytes. However in sperm of human, it dose not make significant difference in Pl between fresh and cryopreserved oocytes. The SPA using cryopreserved hamster oocyte would appear to have wide application of the evaluation of infertility, the assessment of the treatment of infertility and the experiment in infertility field.

Ureteroscopic Removal of Ureteral Calculi without Anesthesia / 대한비뇨기과학회지

Ureteroscopy has been used widely to remove urethral calculi, especially distal ureter stones. In this study we tried to evaluate the exact role of ureteroscopic manipulation for ureter stones in the era of ESWL. We report our experience on performing ureteroscopic removal of ureteral calculi without anesthesia. Between August 1994 and August 1996, ureteroscopy was performed in 62 cases without anesthesia. We examined the feasibility of performing ureteroscopy under sedation only. Age distribution was 17~71 years old (mean 49.3). Overall success rate was 91.9% (57 cases among 62 cases). The success rates according to sex were 92.9% in male and 91.2% in female. The success rates according to location were 100% in proximal ureter, 83.3% in middle ureter and 92.6% in distal ureter. The success rates according to size were 92.7% in 10 mm stone patients. We could not find any statistical meaning about the success rates according to sex, location and size (p>0.05). In 7 cases the procedure were performed at outpatient department. Mean duration of hospitalization (in 55 cases) was 3.83 days. The associated complication rate was relatively low (8.1%), with most patients being treated conservatively. We conclude that ureteroscopy, when performed without general or regional anesthesia, does not increase the risk of complications or compromise the results of treatment. So we recommend ureteroscopy without anesthesia as a primary choice in the manipulation of urethral calculi.