Management of Patients With Advanced Prostate Cancer: Establishment ofTreatment Guidelines Through Prostate Cancer Summit (PCAS) 2016Composed of Korean Prostate Cancer Experts

Purpose@#The Advanced Prostate Cancer Consensus Conference (APCCC) 2015 was based on topics withcontroversy in the field of advanced prostate cancer. To understand the Korean urologists perspective regardingthe issues, we have conducted a questionnaire named Prostate Cancer Summit (PCAS) 2016, with 9 importantsubtopics. @*Materials and Methods@#Total 9 subtopics have been decided and questions were developed regarding eachsubtopic. The questions were based on that of APCCC 2015 and translated into Korean for better understanding.Total 51 panelists have voted online on 85 different questions. @*Results@#The survey concluded that testosterone should be measured as a diagnostic criterion for castrationresistance prostate cancer (CRPC) and that consensus was reached on issues such as the use of androgenreceptor pathway inhibitors in the treatment of predocetaxel and postdocetaxel in CRPC patients. In addition,76% of the participants agreed that imaging tests were needed before new treatment in CRPC patients, anda majority of participants agreed that periodic imaging tests are necessary regardless of symptoms during treatmentfor CRPC. However, some issues, such as the use of prostate-specific antigen-based triggers for remediationin CRPC patients, the endocrine manipulation in nonmetastatic CRPC patients, and the onset of treatment inasymptomatic metastatic CRPC patients, were not agreed. @*Conclusions@#The results from PCAS 2016 has addressed some of the issues with controversy. Although thevoting results are subjective, it will help guide treatment decisions in topics with less evidence.

Ureteral Injury in Gynecologic Surgery: A 5-Year Review in A Community Hospital

PURPOSE: We reviewed the cases of ureteral injury during gynecologic surgeries in a community hospital and attempted to find possible options for alleviating these distressing situations. MATERIALS AND METHODS: A total of 2,927 patients underwent gynecologic surgeries in the last 5 years at our hospital. We retrospectively analyzed the cases, particularly the possible risk factors and management according to the time of detection of the injury. Thirty-five cases (1.2%) were identified with ureteral injury in a total of 2,927 gynecologic surgeries. Risk factors included endometriosis, pelvic inflammatory disease, previous pelvic surgery, history of pelvic radiation, and congenital anomalies. Among 2,927 patients, 522 had predisposing factors for ureteral injuries. RESULTS: The incidence of ureteral injury in laparoscopic cases was 1.1%, similar to the cases of laparotomy (1.2%). The rate of ureteral injury was significantly higher in the group with risk factors (2.7%) than in the group without risk factors (0.9%; p=0.002). Prophylactic ureteral stenting was performed in 101 of 522 patients with risk factors according to the gynecologic surgeon's preference. The injury rate (1.0%) in the stenting group was lower than that in the non-stenting group (3.1%; p=0.324). Management of ureteral injuries was successful in all cases. Of the patients with postoperatively diagnosed injuries, two patients were managed with secondary procedures, such as retrograde balloon dilatation or ureteroneocystostomy. CONCLUSIONS: The incidence of ureteral injury was significantly higher in cases having risk factors than in cases without risk factors. Surgeons should be cautious to avoid ureteral injury during gynecologic surgery, especially in patients with risk factors.

Palliative Care of Malignant Ureteral Obstruction with Polytetrafluoroethylene Membrane-Covered Self-Expandable Metallic Stents: Initial Experience

PURPOSE: We assessed the efficacy and safety of insertion of a polytetrafluoroethylene membrane-covered self-expandable metallic stent (UVENTA stent) for palliation of malignant ureteral obstruction on the basis of our early results. MATERIALS AND METHODS: Eighteen patients underwent UVENTA stent insertion for extrinsic malignant ureteral obstructions of 20 ureters. The UVENTA stents were deployed retrogradely under cystoscopy and fluoroscopy. Candidates for the procedure had preexisting double-J stents that were nonfunctional or caused excessive bladder irritation. We recorded the success and patency rate in addition to any complications associated with the procedure. RESULTS: The mean length of obstruction was 10.6 cm (range, 2 to 20 cm). Two ureters were obstructed in the upper ureter, 9 in the lower ureter, and 9 in multiple levels of ureter. Simultaneous balloon dilation was performed in 12 ureters. UVENTA stents were successfully inserted in all patients. No obstruction of the UVENTA stents occurred during the mean follow-up period of 7.3 months (patency rate 100%), but de novo ureteral obstruction developed in 4 ureters. There were no instances of stone formation, hyperplastic reaction, encrustation, or migration. Abnormally elevated serum creatinine decreased to normal levels and hydronephrosis gradually resolved during the 4 weeks after UVENTA insertion. No significant complications developed except for transient and self-limiting hematuria and mild lower abdominal pain. CONCLUSIONS: UVENTA stents may relieve malignant ureteral obstruction safely and easily. Long-term follow-up is necessary to assess the role of this stent in the treatment of malignant ureteral obstruction.

Voiding and Sexual Function after Autonomic-Nerve-Preserving Surgery for Rectal Cancer in Disease-Free Male Patients

PURPOSE: We evaluated the effects of surgery for rectal cancer on postoperative voiding and sexual function over the course of time. MATERIALS AND METHODS: Data from 28 patients who underwent autonomic nerve preserving rectal cancer surgery were retrospectively analyzed. Operations were performed between October 2005 and July 2007 and all patients were followed-up for more than 3 years. Preoperatively, all patients underwent urodynamic studies including uroflowmetry, and filled out the International Prostate Symptom Score (IPSS). The evaluation of sexual function consisted of Erectile Function domain score in International Index of Erectile Function (IIEF-EFD) and Ejaculation domain score in Male Sexual Health Questionnaire (MSHQ-EjD). Data from uroflowmetry and questionnaires were examined. RESULTS: At 3 years postoperatively the prostate volume was similar to the preoperative value (P=0.727). There were no statistically significant postoperative changes in the average maximum flow rate (15.9 ml/s vs. 16.2 ml/s, p=0.637) and post-void residual urine volume (34.7 ml vs. 36.8 ml, p=0.809). No statistically significant differences were observed in the IPSS (13.2 vs. 12.2, p=0.374). However, although pelvic autonomic nerve preservation have been performed, a significant proportion of rectal cancer patients suffer from sexual dysfunction and the average of IIEF-EFD and MSHQ-EjD scores was decreased postoperatively until 3 years (25.1 vs. 16.1 and 28.3 vs. 14.2 respectively, p<0.001). CONCLUSIONS: Voiding function was not affected after autonomic nerve-preserving rectal cancer surgery, however sexual function was significantly aggravated. We recommend that the baseline genitourinary function should be evaluated before the treatment for male rectal cancer patients, and penile rehabilitation is necessary for their quality of life after treatment.

Progression of Prostate Cancer Despite an Extremely Low Serum Level of Prostate-Specific Antigen

A 61-year-old man who had been diagnosed with prostate cancer 9 years ago and had been treated with pelvic irradiation and intermittent androgen deprivation therapy visited the emergency room because of back pain and weakness in both legs. Spine magnetic resonance imaging showed a lumbar epidural mass and spine metastasis. The whole-body workup revealed multiple metastases to the lymph nodes, bone, liver, and lung. The serum prostate-specific antigen was 0.02 ng/ml. He underwent laminectomy, posterior fixation, and epidural mass excision, and metastatic adenocarcinoma from the prostate was diagnosed. The patient underwent 1 cycle of docetaxel-based chemotherapy. More chemotherapy could not be done because of his general weakness. The patient died one month later of multiple organ failure.

CyberKnife(TM) for the Treatment of Non-Metastatic Prostate Cancer

PURPOSE: The radiobiology of prostate cancer favors a hypofractionated dose regimen. We report here our experience with the CyberKnife(TM), demonstrating its efficacy, safety, and feasibility as a treatment modality for non-metastatic prostate cancer. MATERIALS AND METHODS: Between October 2002 and April 2006, 20 patients with biopsy-proven prostate cancer were treated with the CyberKnife(TM). The distribution of clinical risks, as assessed by using D'Amico's definition for risk grouping, was as follows: low (4), intermediate (5), and high (11). Three patients received 32 Gy, 7 patients received 34 Gy, and 10 patients received 36 Gy. All patients received the radiation doses in 4 fractions. The rectal and bladder toxicities were graded by using the criteria set forth by the Radiation Therapy Oncology Group (RTOG). RESULTS: The mean patient age was 71.4 years (range, 52-79 years), and the mean follow-up period was 35.5 months (range, 8-74 months). There were 2 acute and 1 late grade 2 gastrointestinal toxicities, and 1 acute and 2 late grade 2 urinary toxicities. The 5-year overall survival rate was 100%, respectively. The 5-year biochemical failure-free rate of the low-risk, intermediate-risk, and high-risk patients was 100%, 100%, and 90.9%, respectively. CONCLUSIONS: CyberKnife(TM) is a safe, well-tolerated, and rather effective treatment for non-metastatic prostate cancer. We obtained a 100% 5-year biochemical failure-free rate in low-risk and intermediate-risk patients. CyberKnife(TM) is a viable option for the treatment of non-metastatic prostate cancer.

Clinical Role of F-18 Fluorodeoxyglucose Positron Emission Tomography for Follow-up of Patients with Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: To evaluate the role of [(18)F]fluorodeoxyglucose-positron emission tomography(FDG-PET) for the follow-up of patients with a renal cell carcinoma(RCC), and compare FDG-PET with conventional imaging modalities, including computerized tomography(CT), chest PA, bone scan and brain magnetic resonance imaging(MRI). MATERIALS AND METHODS: FDG-PET and conventional imaging techniques, includingCT, chest PA, bone scan and brain MRI, were performed on 69 patients who had undergone a radical nephrectomy and/or metastatectomy, with a final pathological diagnosis of a RCC. The final diagnoses of recurrences/metastases were established from the histopathological or clinical findings. RESULTS: Recurrences and metastases were present at 47 sites(34 patients). The results of FDG-PET were true positive and false negative in 44 and 3 of the 47 sites, respectively. The results of conventional imaging techniques were true positive and false negative in 40 and 7 of the 47 sites, respectively. The results of FDG-PET were true negative and false positive in 34 and 1 of the 35 patients, respectively. The results of conventional imaging techniques were true negative and false positive in 30 and 5 of the 35 patients, respectively. Therefore, FDG-PET was more sensitive, specific and accurate than conventional imaging techniques for the follow-up of patients with a RCC. CONCLUSIONS: FDG-PET accurately detected the postoperative recurrences and metastases in patients with a RCC. FDG-PET may have a role in the follow-up of patients with a RCC.

Serum Levels of Vascular Endothelial Growth Factor(VEGF) as a Prognostic Factor in Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: Vascular endothelial growth factor(VEGF) is recognized as a potent constituent of the vascularization and growth of solid tumors. We assessed the serum levels of VEGF and we evaluated its correlation to the clinicopathologic findings and clinical outcome of patients with renal cell carcinoma(RCC). MATERIALS AND METHODS: Serum samples were collected before surgery from patients with RCC. The levels of serum VEGF were assessed by using quantitative enzyme immunoassay. Comparison of the serum VEGF level with the tumor stage, grade, cell type and clinical outcome was performed, and the survival rate between the RCC patients above and below the mean VEGF level was evaluated. RESULTS: The mean follow-up was 5.1 years. The serum VEGF level was significantly higher in the patients with RCC(mean: 497pg/ml) than that in the controls(mean: 211pg/ml)(p<0.001). The serum VEGF level was correlated with the tumor size, the pathologic T stage and the clinical stage and histologic nuclear grade, but not with the histologic subtype. Patients with a lower VEGF level(<497pg/ml) showed longer survival(p=0.0207 on univariate analysis, p=0.04 on multivariate analysis). CONCLUSIONS: Our study indicated that the serum VEGF level was significantly correlated with the clinical or pathologic stage, the nuclear grade and adverse survival. These results suggest that the serum VEGF level could be a comparable prognostic factor to the tumor stage and grade.

Sclerosing Epithelioid Fibrosarcoma of the Kidney / 대한비뇨기과학회지

Sclerosing epithelioid fibrosarcoma(SEF) is an uncommon tumor of the deep soft tissue. It was first described in 1995 by Meis-Kindblom et al. Histologically, this tumor is characterized by uniform, small, round to ovoid epithelioid cells with clear cytoplasm, and the cells are arranged in distinct nests and cords. On immunohistochemistry, the most consistently positive marker is vimentin, although other antigens(cytokeratin, epithelial membrane antigen, S100 protein and neuron specific enolase) have been recorded as being inconsistently positive. We report here on a case of a 46-year-old woman who presented with back pain. The radiologic findings revealed a right renal mass and multiple bone metastases. The patient underwent radical nephrectomy and the pathologic finding was primary SEF of the kidney.

The Relationship between the Metabolic Syndrome and the Risk of Benign Prostatic Hyperplasia: a Hospital-Based Study from a Health Screening Population / 대한비뇨기과학회지

PURPOSE: This case-control study was designed to investigate the possible association of the metabolic syndrome(MS) with benign prostatic hyperplasia(BPH) in healthy males. MATERIALS AND METHODS: We reviewed the data of 702 men who had a general health check-up without significant evidence of disease. The database for health check-ups included demographic, anthropometric, serum-related and prostate-related data. The presence of the MS was determined according to the NCEP-ATPIII criteria. We compared prostate- related data between the MS and the non-MS group. Testing for linear trends and logistic regression were performed to determine whether the presence of the MS was associated with an increased risk for BPH. RESULTS: The MS was identified in 166 men(23.6%). There was an increased prevalence of both the MS and BPH along with increasing age. There was a tendency for the total prostate volume and the PSA to increase along with the an increasing number of factors related to the metabolic syndrome. In a comparison between the MS and non-MS group, there were no differences in the prostate-related variables. However, subgroup analysis in men less than 50 showed significant differences in the PSA, total volume and calculated annual growth rate. In addition, only in this group was the presence of the MS a significant risk factor for BPH(odd ratio; OR=2.21, 95% confidence interval; CI 1.28-4.75). CONCLUSIONS: The results of this study showed a weak but significant relationship between the MS and BPH, especially in men less than 50. Further longitudinal studies with a larger patient population are required to confirm our findings.

Primary Urethral Adenocarcinoma in a Young Man Who Presented with Voiding Dysfunction / 대한비뇨기과학회지

Primary urethral carcinoma accounts for less than 1% of the malignancies in males and adenocarcinoma accounts for 5% of all urethral carcinomas. A 36-year-old man with a history suggestive of urethral stricture was scheduled to undergo retrograde urethrography and visual urethrotomy. On urethroscopic examination, an abnormal polypoid mass was found in the proximal bulbous urethra, so transurethral resection biopsy was added to the urethrotomy. Histopathologic examination demonstrated urethral adenocarcinoma with no invasion to the corpus spongiosum and cavernosa on the magnetic resonance imaging. There was no evidence of metastasis and the search for the primary focus of adenocarcinoma revealed that the tumor originated from the urethra. The patient underwent segmental urethral resection and there has been no recurrence for 1-year follow-up.

CyberKnife for the Treatment of Nonmetastatic Prostate Cancer: Preliminary Results / 대한비뇨기과학회지

Purpose: Herein is reported our initial experience of the CyberKnife to show its safety and feasibility as a treatment modality for non-metastatic prostate cancer. Materials and Methods: Twenty patients, with biopsy-proven prostate cancers, were recruited into a phase I clinical trial using the CyberKnife. The distribution of clinical risks, as assessed using the ASTRO criteria, was as follows: low (4), intermediate (5) and high (11). The mean age and follow up of the patients were 71.4 years and 15 months, respectively. The patients received 7.5-9Gy of radiation in a single fraction for 4-5 days. The total radiation dose to the prostate was 34-37.5Gy, which approximates to 86.4Gy in 2Gy fractions. The rectal and bladder acute toxicities were graded using the criteria of the Radiation Therapy Oncology Group (RTOG). The results of acute toxicities were compared to those of the historical control, which had been treated with conventional four field box techniques (received median dose 70.2Gy). The prostate-specific antigen (PSA)- based short-term efficacy was described. Results: The acute rectal toxicity scores were 0, 1 and 2 in 13, 5, and 2 patients, respectively. The acute bladder toxicity scores were 0, 1 and 2 in 16, 3 and 1 patient, respectively. No grade 3 or 4 acute toxicity was noted. These figures contrast sharply with those found for the historical control. All toxicities spontaneously subsided within 3 months after treatment. Continuous PSA reduction was noted in all patients, and no PSA failure was noted during the follow up period. Conclusions: Our data show the feasibility of the CyberKnife in terms of its efficacy and acute toxicity. Moreover, the capability of using a hypo-fractionation schedule lead to marked improvement in patient convenience, with substantial resource savings.

The Serial Microscopic Changes of Cell Proliferative and Apoptotic Phenomenon in Obstructed Ureters in the Rat / 대한비뇨기과학회지

Purpose: Obstructive uropathy due to a ureteral obstruction is one of the most common diseases of the urinary tract, and can lead to severe renal injury and ureteral damage. This study performed to elucidate the histological findings and serial changes in the apoptotic and proliferative phenomena in the pathogenesis of ureteral damage during the course of obstructive uropathy in ligated rat ureters. Materials and Methods: After unilateral ligation of the ureter, each group of five Sprague-Dawley rats was sacrificed, and examined 1, 5, 10, 15, 20, 25, 30 and 35 days after ligation: five rats with normal ureters were also examined as controls. The cell proliferation and apoptosis were detected with proliferating cell nuclear antigen (PCNA) immunohistochemistry and a terminal deoxynucleotidyl transferase (TdT)-mediated deoxyuridine triphosphate (dUTP) in situ nick-end labeling (TUNEL) study, respectively, in 45 Sprague-Dawley rats. Results: The epithelial layer was thickened in the 5 day-obstructed ureters (DOUs). The severity of thickening of the fibrous and smooth muscle layers progressed consistently to the 15 DOUs, which was maintained until day 35. The expression of PCNA in the epithelial layer was present in every ureter, with a significant increase of labeled cells in the 1 and 5 DOUs. The expressions of PCNA in the fibrous and smooth muscle layers were present from day 10 after ligation and maintained until day 20, but then significantly declined at 25 DOUs. TUNEL-positive cells were shown in the epithelial layer in the 10, 15, 20, 25, 30 and 35 DOUs. The mean numbers of TUNEL-positive cells in the 20, 25 and 30 DOUs were significantly higher than those in the 10 DOUs, and reached their peak in the 25 DOUs. Positive cells were shown in the fibrous and smooth muscle layers in the 25, 30 and 35 DOUs. Conclusions: Apoptosis and cell proliferation may play an important role in the pathogenesis of ureteral damage in obstructed ureters. The peak of apoptosis was shown in the 25 DOUs.

Clinical Role of F-18 Fluorodeoxyglucose Positron Emission Tomography for Diagnosis and Staging of Renal Tumors / 대한비뇨기과학회지

PURPOSE: The role of [18F]fluorodeoxyglucose-positron emission tomography (FDG-PET) in renal cell carcinoma remains to be clearly defined. The sensitivity, specificity and accuracy of FDG-PET to detect renal cell carcinomas and a distant metastatic disease were compared with other established imaging modalities, including computerized tomography (CT), chest PA and bone scan. MATERIALS AND METHODS: FDG-PET and conventional imaging techniques, including CT, chest PA and bone scan, were performed in 43 patients with primary renal tumors and/or metastatic diseases. Radical nephrectomy and metastatectomy were then performed. The results of FDG-PET were compared with the conventional imaging techniques and postoperative histopathological diagnoses. RESULTS: The postoperative histopathological diagnoses of the 43 patients were renal cell carcinomas in 41 and benign renal tumors in 2. The results of FDG-PET were true positive, equivocal and false negative in 26, 8 and 9 of the 41 patients with renal cell carcinomas, respectively. The results of the CT were true positive in all patients. The results of FDG-PET were true negative in 2 patients, but those of CT were false positive in 2 patients with benign renal leiomyoma and angiomyolipoma. Therefore, FDG-PET was less sensitive, but more specific and accurate, than CT for the evaluation of primary renal tumors. CT was false positive for retroperitoneal lymph node metastasis and at the ascending colon in each of 1 patient, but FDG-PET was true negative. FDG-PET detected unsuspected pulmonary metastatic diseases that were not detected on chest PA in 4 patients. FDG-PET was more sensitive, specific and accurate than CT in the evaluation of metastasis. CONCLUSIONS: FDG-PET was complementary to conventional imaging in the initial staging of renal cell carcinomas, but superior in evaluating the metastasis.

Epidemiologic Survey of Sexual Life of Middle-Aged Couples in Seoul / 대한남성과학회지

PURPOSE: We investigated libido and sexual life satisfaction of middle-aged couples in Seoul. MATERIALS AND METHODS: A total of 2,034 couples ranging from 40 to 79 years old living in the Seoul metropolitan area were selected by stepwise random sampling. The questionnaires asking about erectile function, sexual performance, sexual life satisfaction, and libido were administered by trained interviewers. RESULTS: Interviews were completed for 1,356 couples(66.7%). The prevalence of severe and moderate loss of libido in the men was 29%. Decrease of libido correlated with increasing age. Higher scores on the erection scale of the O'Leary sexual function questionnaire were closely correlated with greater libido. In sexual function self-assessment, most male subjects did not complain of libido(53.8%), erection(61.7%), or ejaculation(63.8%) difficulties. Most couples(50.3% of the male and 53% of the female subjects) expressed satisfied with their sexual lives. Higher scores on the erection scale correlated with an increase in sexual satisfaction of both men and women. Fewer than half of the female subjects(40.4%) answered that they had 'no' or 'low' sexual interest. Younger age and more education were correlated with greater sexual interest. CONCLUSIONS: With increasing age, middle-aged couples living in Seoul showed a decrease in libido, sexual function, and sexual interest. However, satisfaction with their sexual life was high in general.

Pelvic Cavernous Hemangioma / 대한비뇨기과학회지

The majority of hemangiomas are small, benign vascular tumors. They can regress spontaneously as a result of fibrosclerosis, suggesting a conservative approach whenever possible. They require little, if any, treatment and are easy to differentiate from malignant tumors clinically and radiologically, and there is no evidence that hemangiomas ever become malignant. We report a case of a 54-year old man with extravesical cavernous hemangioma who was diagnosed with a malignant tumor preoperatively.

Sarcomatoid Renal Cell Carcinoma / 대한비뇨기과학회지

Cases of sarcomatoid renal cell carcinoma are very rare. It has been known that sarcomatoid renal cell carcinoma is an epithelial cell variant that has been metaplastically transformed with a very poor prognosis. Diagnosis of sarcomatoid renal cell carcinoma is performed by examining a nephrectomy specimen to see if epithelial and sarcomatoid components are variously mixed together. Therefore, the aim of this paper is to report five cases of sarcomatoid renal cell carcinoma.

Clinical Features and Urologic Evaluation in Young Male Patients with Asymptomatic Microscopic Hematuria / 대한비뇨기과학회지

PURPOSE: The commonly accepted diagnostic algorithm for hematuria includes excretory urography (IVU) and cystoscopy at a urologic department. The clinical courses was determined and a less invasive algorithm for young male patients with asymptomatic microscopic hematuria is suggested. MATERIALS AND MTHODS: A total of 310 males with an asymptomatic microscopic hematuria were enrolled retrospectively in the study at our clinic between January 1997 and December 2000. The mean age of the patients was 20.9 years (range 19 to 25). The initial urologic evaluation consisted of a urinalysis. If the results of the initial urologic evaluation were within the normal range, a cystoscopic examination was recommended as a further evaluation. Ninety-two patients underwent a cystoscopy. All patients were followed by urinalysis. The grade of microscopic hematuria with persistency, and the detection rate of abnormal findings in urologic evaluation were compared. RESULTS: There was a relationship between the grade of hematuria and the rate of the persistency of hematuria, but no relationship between the grade of hematuria and the detection rate of abnormal findings in a urologic evaluation was found. The results of the excretory urography and ultrasound showed an interdependence. There were no significant findings in the cystoscopic examination. CONCLUSIONS: A periodical follow-up of urinalysis is a proper study for young male patients with asymptomatic microscopic hematuria. In order to rule out upper urinary tract diseases, ultrasound and excretory urography can be useful. Furthermore, it is recommended that cystoscopy be done for selected cases in young male patients.

Clinical Features and Urologic Evaluation in Young Male Patients with Asymptomatic Microscopic Hematuria / 대한비뇨기과학회지

PURPOSE: The commonly accepted diagnostic algorithm for hematuria includes excretory urography (IVU) and cystoscopy at a urologic department. The clinical courses was determined and a less invasive algorithm for young male patients with asymptomatic microscopic hematuria is suggested. MATERIALS AND MTHODS: A total of 310 males with an asymptomatic microscopic hematuria were enrolled retrospectively in the study at our clinic between January 1997 and December 2000. The mean age of the patients was 20.9 years (range 19 to 25). The initial urologic evaluation consisted of a urinalysis. If the results of the initial urologic evaluation were within the normal range, a cystoscopic examination was recommended as a further evaluation. Ninety-two patients underwent a cystoscopy. All patients were followed by urinalysis. The grade of microscopic hematuria with persistency, and the detection rate of abnormal findings in urologic evaluation were compared. RESULTS: There was a relationship between the grade of hematuria and the rate of the persistency of hematuria, but no relationship between the grade of hematuria and the detection rate of abnormal findings in a urologic evaluation was found. The results of the excretory urography and ultrasound showed an interdependence. There were no significant findings in the cystoscopic examination. CONCLUSIONS: A periodical follow-up of urinalysis is a proper study for young male patients with asymptomatic microscopic hematuria. In order to rule out upper urinary tract diseases, ultrasound and excretory urography can be useful. Furthermore, it is recommended that cystoscopy be done for selected cases in young male patients.

Prevalence of Sexual Dysfunction in Men Older Than 40 Living in Seoul: Epidemiologic Survey Using Questionnaire / 대한비뇨기과학회지

PURPOSE: Information on sexual function including the prevalence of erectile dysfunction, the severity of erectile dysfunction and the risk factors associated with it, from population-based sampled couples in Seoul, Korea was examined. MATERIALS AND METHODS: A total of 2,034 couples ranging from 40 to 79 years old living in the Seoul metropolitan area were selected by stepwise random sampling. The total number of study subjects where sufficient answers were obtained was 1,356. The questionnaire included questions on erectile function, sexual performance, and sex life. RESULTS: The combined prevalence of mild, moderate and severe erectile dysfunction was 84.3%. This correlated well with the score on the erection scale of the O'Leary sexual function inventory. The prevalence of severe erectile dysfunction was 11.8%, which increased from 1.0% in subject aged from 40 years to 68.5% in 70 years. The prevalence of self-reported erectile dysfunction was 12.0%. The subjects' age was most strongly associated with erectile dysfunction. After adjusting for age, a higher probability of erectile dysfunction directly correlated with diabetes, hypertension, heart disease, cigarette smoking, and low level of education. CONCLUSIONS: The population-based epidemiological data showed that male erectile dysfunction is quite common and impacts on quality of life of men.