A Case of Laparoscopic Radical Prostatectomy for a Prostatic Stromal Tumor of Uncertain Malignant Potential

Prostatic stromal tumor of uncertain malignant potential (STUMP) is a rare neoplasm with distinctive clinical and pathological characteristics. Here we report a case of laparoscopic radical prostatectomy performed in a patient with prostatic STUMP.

A Case of Laparoscopic Radical Prostatectomy for a Prostatic Stromal Tumor of Uncertain Malignant Potential

Prostatic stromal tumor of uncertain malignant potential (STUMP) is a rare neoplasm with distinctive clinical and pathological characteristics. Here we report a case of laparoscopic radical prostatectomy performed in a patient with prostatic STUMP.

Outcomes of Transurethral Removal of Intravesical or Intraurethral Mesh Following Midurethral Sling Surgery

PURPOSE: To present outcomes of transurethral removal (TUR) of intravesical or intraurethral mesh after midurethral slings. MATERIALS AND METHODS: This was a retrospective chart review of 23 consecutive women: 20 with intravesical mesh and 3 with intraurethral mesh. RESULTS: To remove the mesh, transurethral resection with an electrode loop (TUR-E) was used in 16 women and transurethral resection with a holmium laser (TUR-H) was used in 7. The median follow-up was 2.1 months. Twenty-six percent of the women (6/23) had a mesh remnant: 6.2% (1/16) of the women treated with TUR-E and 71.4% (5/7) of the women treated with TUR-H. Of the 5 women treated with TUR-H, 3 underwent concomitant transvaginal removal. On the follow-up cystoscopic exam, a mesh remnant was observed in 3 women (1 treated with TUR-E and 2 treated with TUR-H). Vesico-vaginal fistulas were found in 2 women during and after TUR-E, respectively. Stress urinary incontinence recurred in 1 woman. CONCLUSIONS: TUR-E has a high success rate but carries a risk of bladder perforation. Complete resection using TUR-H depends on the location of the mesh and the range of motion of the instrument.

The Utility of Fluorescence In Situ Hybridization for Detection of Bladder Urothelial Carcinoma in Routine Clinical Practice

To evaluate the ability of fluorescence in situ hybridization (FISH) in detecting bladder urothelial carcinoma (BUC), FISH and cytology were compared for the evaluation of 308 consecutive urine samples from patients suspected of having BUC. All patients underwent cystoscopy for identification of bladder lesions. The FISH results were compared with the cytology assessment. In all, 122 patients had confirmed BUC. Among them, 68 (55.7%) were FISH-positive, while only 33 (27%) were positive on cytology. According to disease stage (superficial vs. invasive) and grade (low vs. high), the sensitivities of FISH were also significantly higher than those of cytology in all categories. Moreover, in 36 patients who had no visible tumor with flat, erythematous mucosa (suspicious lesion), FISH was more sensitive than cytology for the detection of BUC (83.3% vs. 33.3%, P=0.002). The FISH was negative in 168 (90.3%) of 186 patients with no histological evidence of BUC or negative cystoscopy findings. The sensitivity of FISH for detecting BUC was superior to that of cytology, regardless of tumor stage and grade. FISH is a significant additional and complementary method for detection of BUC in patients who have suspicious lesions on cystoscopy.

New Thresholds for Prostate-specific Antigen Velocity for Prostate Cancer Screening in Korean Patients Younger than 60 Years Old / 대한비뇨기과학회지

PURPOSE: We identified new thresholds for prostate-specific antigen velocity(PSAV) for screening of prostate cancer in Korean patients younger than 60 years old based on PSA serial data obtained from our hospital's health promotion center. MATERIALS AND METHODS: The study population was retrieved from 10,011 patients, 40 to 79 years old, with 2 or more PSA values within five years who visited our hospital's health promotion center between January 2002 and December 2006, including 100 patients with prostate cancer. These subjects were divided into 2 age groups, 40-59 years old and 60-79 years old, and their PSAV were calculated as the rate of PSA change using the first and last values only. A receiver operating characteristic(ROC) curve was used to analyze the performance of PSAV in the screening of prostate cancer, and we developed new PSAV thresholds by comparing sensitivity and specificity at different PSAV levels. RESULTS Overall prostate cancer prevalence was 0.6%(45) in younger(40-59 years old) patients and 2.1%(55) in older(60 to 79 years old) patients. The median PSAV in the normal control group and the cancer group were 0.047ng/ml/year vs 0.877ng/ml/year in younger patients(p<0.0001) and 0.067ng/ml/year vs 0.642ng/ml/year in older patients(p<0.0001). For younger patients, the sensitivity and specificity were 55.6% and 99.2% at PSAV 0.75ng/ml/year, but decreasing the PSAV cut-points to 0.35ng/ ml/year improved sensitivity to 78% for cancer detection in this age group. CONCLUSIONS: The previous PSAV threshold for prostate biopsy, 0.75 ng/ml/year or greater, probably underestimate cancer risk in younger Korean men. Decreasing PSAV thresholds to 0.35ng/ml/year would improve screening sensitivity.

Pathologic Features of Renal Masses, 4cm or Less in Diameter: The Prevalence of Benign Tumors / 대한비뇨기과학회지

PURPOSE: We examined the clinical and pathologic findings of small renal masses that were suspected to be malignant. We investigated the prevalence and the predictors of benign tumors. MATERIALS AND METHODS: We retrospectively reviewed the medical records of the patients who underwent surgeries for renal lesions between September 1994 and June 2007. We analyzed the pathologic reports and medical records of 586 patients who had a renal mass that was 4cm or less. The mean patient age was 53 years(age range: 15-82). There were 418 male patients(71.3%) and 168 females(28.7%). Multiple logistic regression analysis was done to determine the clinical factors associated with benign renal masses, including the radiological tumor size, a cystic versus solid appearance, gender, age and the presenting symptoms. RESULTS: Of the 586 renal masses, 62(10.6%) were benign, 520(88.7%) were renal cell carcinoma and 4(0.7%) were other malignancies. The proportion of benign lesions was significantly higher in the females than that in the males(21.4% vs. 6.2%, respectively, p<001) and the proportion of benign lesions was significantly higher for the smaller masses(0-2cm) than for the 2.1-4cm sized tumors(14.7% vs. 9.1%, respectively, p=0.048). On multivariate analysis, gender and tumor size were significantly associated with malignant histology with the males having an odds ratio(OR) of 4.16 (95% CI 2.41-7.19, p<0.001) and the tumor size more than 2cm having an OR of 1.93(95% CI 1.08-3.44, p=0.03). CONCLUSIONS: A considerable number(10.6%) of benign lesions 4cm or less in the radiological diameter were operated on based on suspicious preoperative imaging. The results of this study seem to help not only for counseling the patients, but also for deciding on a therapeutic modality preoperatively.

The Diagnostic Value of Predictive Factors for Clinically Insignificant Prostate Cancer / 대한비뇨기과학회지

PURPOSE: In the present study, we identified the pre-operative predictive factors of insignificant prostate cancer and we analyzed their diagnostic accuracy. MATERIAL AND METHODS: Of a total 343 patients who had undergone radical prostatectomy, 33 patients(9.6%) were diagnosed with insignificant cancer that was characterized by a total cancer volume < or=0.5cc, a Gleason score (GS)< or=6, a T stage< or=2c and no positive surgical margin. We found the statistically significant factors after comparing of preoperative clinico- pathological findings between two groups and determined the diagnostic accuracy of the identified predictors. RESULTS: Of several factors, prostate-specific antigen(PSA) level(p=0.04, odds ratio(OR)=4.3 3.589< or=95%confidence interval(CI)< or=5.692), PSA density(PSAD)(p=0.01, OR=6.6, 2.115< or=95%CI< or=278.826), biopsy GS(p=0.03, OR=4.6, 1.114< or=95%CI< or=12.568) and volume of the largest cancer(p=0.02, OR=5.6, 2.471< or=95%CI< or=9.725) were analyzed as independent predictors of insignificant cancer. The volume of the largest cancer was the most precise predictor(AUC=0.791), followed by the PSAD (AUC=0.748) and the PSA level(AUC=0.677) in the ROC (receiver operating characteristic) curve analysis. The sensitivity, specificity and positive predictive value for predicting insignificant cancer were 10.3%, 63.7% and 12.8% at a PSA level of 10ng/ml, and 44.8%, 16.8% and 26.3% at a PSAD of 0.15ng/ml/ml, and 13.8%, 53.8% and 14.2% at a volume of the largest cancer of 50%, respectively. Even with using a combination of these three factors as well as a biopsy GS< or=6, only 53% of insignificant prostate cancer could be predicted preoperatively. CONCLUSIONS: In our study, PSA level, PSAD, biopsy GS and volume of the largest cancer were identified as predictors of insignificant cancer in spite of their unsatisfactory diagnostic accuracy.

Grade Concordance between Transitional Cell Carcinoma of the Bladder and the Upper Urinary Tract / 대한비뇨기과학회지

PURPOSE: Transitional cell carcinoma(TCC) is thought to involve the entire urothelium as a multifocal field change. The tumor grade is a major prognostic factor in TCC and predicting the grade of TCC may be of clinical significance. The objective of this study is to clarify the grade concordance between upper tract TCC and bladder TCC. MATERIALS AND METHODS: From 1994 to 2006, a total of 241 patients underwent nephroureterectomy for upper tract TCC. Seventy-four of the 241 patients who had a history of previous bladder cancer and/or synchronous or metachronous bladder TCC were included in this study. The grade was recorded for each tumor. Fisher's exact test of concordance was used for statistical analysis. RESULTS: For the 74 patients who were analyzed, 42 patients(56.8%) developed bladder TCC during their follow up after nephroureterectomy, 14 patients(18.9%) had a history of bladder TCC prior to nephroureterectomy and 18 patients(24.3%) had a synchronous bladder tumor. In the case of developing bladder TCC during their follow up after nephroureterectomy, the grade concordance is highest between upper tract TCC and bladder TCC in 81.0% of the cases(p=0.005). Overall, the concordance rate between the upper tract TCC grade and the bladder TCC grade was 77.0%(p<0.001). CONCLUSIONS: Concordance of the TCC in the upper urinary tract and bladder was present in 77.0% of the cases. The patients who developed bladder tumor during their follow up after nephroureterectomy had the highest grade concordance between upper tract TCC and bladder TCC in 81.0% of the cases. This knowledge can have a significant impact on the therapeutic and follow up plans for transitional cell carcinoma.

A Difference in Testicular Volumes Measured by Prader Orchidometer and Scrotal Ultrasound / 대한남성과학회지

PURPOSE: The aim of this study was to compare testicular volumes measured by Prader orchidometer and scrotal ultrasound. MATERIALS AND METHODS: The volumes of 467 adult male testes were measured by Prader orchidometer and scrotal ultrasound. The testicular volumes on ultrasound were calculated by the formula: length x width x height x 0.71. The testicular volumes of the Prader orchidometer were divided into two groups: 15 ml or less, and over 15 ml. The two measurements were compared for each group. RESULTS: In the group with testicular volumes of 15 ml or less, the testicular volumes measured by orchidometer(13.29+/-1.94 ml) were significantly smaller than those measured by ultrasound(14.83+/-2.76 ml). In contrast, the group with over 15 ml did not show any significant difference in the volumes measured by orchidometer(21.21+/-2.58 ml) versusultrasound(20.77+/-4.26 ml). Mean paired differences of the testicular volumes between the orchidometer and ultrasound were 1.54+/-2.65 ml for the group with 15 ml or less and -0.44+/-3.38 ml for the group over15 ml these values are significantly different. CONCLUSIONS: In cases of testicular volume of 15 ml or less measured by Prader orchidometer, scrotal ultrasound is necessary for an accurate measurement of the volume.

Effects of Oral Sildenafil on Erectile Function according to the Number of Accompanied Cardiovascular Risk Factors / 대한비뇨기과학회지

PURPOSE: This study aimed to examine the effects of oral sildenafil on erectile function according to the number of accompanying cardiovascular risk factors. MATERIALS AND METHODS: The Q3 (the ability to achieve an erection) and Q4 (the ability to maintain an erection) scores of the International Index of Erectile Function (IIEF) were obtained, before and after the administration of oral sildenafil at least 4 times, in a total of 195 patients (mean age: 57.9 8.9 years) with erectile dysfunction. Of these, 125 had 1 (n=76), 2 (n=33) or 3 (n=16) cardiovascular risk factors. The effects of oral sildenafil for each group were compared by mean paired differences of the Q3 and Q4 scores after treatment. RESULTS: The mean Q3 and Q4 scores increased significantly in all patients, regardless of the presence and number of risk factors (p<0.001). The greater the number of risk factors, the lower the Q3 and Q4 scores, while the mean paired differences in the scores before and after treatment were not significantly different between patients without and with cardiovascular risk factors. CONCLUSIONS: Oral sildenafil improves the erectile function in patients with cardiovascular risk factors, and combined erectile dysfunction and the degree of improvement seem to be similar, regardless of the number of cardiovascular risk factors.

Contraction and Relaxation Responses of Isolated Rabbit Seminal Vesicle to Selective beta Subtypes-adrenoceptor Agonists and Antagonists / 대한비뇨기과학회지

PURPOSE: This study was aimed at investigating the role of betaadrenoceptor subtypes in mediating the relaxation and contraction of seminal vesicles in rabbits. MATERIALS AND METHODS: Relaxation or contractile responses of epithelium- removed muscle strips of a rabbit seminal vesicle, which were precontracted with 10-5M norepinephrine, to selective betasubtypes-adrenoceptor agonists were observed in an organ bath. The contractile responses induced by isoproterenol were also observed after application of selective antagonists. RESULTS: Isoproterenol showed a concentration-dependent contractile response, but the contractility was weaker than those with phenylephrine and norepinephrine. The betaselective-agonists(xamoterol for beta, clenbuterol for beta and BRL37344 for beta) alone evoked neither contraction nor relaxation. However, the beta- and beta-agonists inhibited the contraction of the precontracted strips with 10-5M norepinephrine, while the beta-agonist enhanced the contraction. The pretreatment with a beta-antagonist(ICI118551) reduced the tension of the strips developed by 10-4M isoproterenol, but the beta-(atenolol) and beta-(SR59230A) antagonists showed no changes in the response. CONCLUSIONS: beta- and beta-adrenoceptors seem to mediate the relaxation of the seminal vesicle, while the beta-adrenoceptor may have a supplementary role in contraction.