The Causes of Elevated Serum Prostatic Specific Antigen (PSA) Concentrations in Nonprostatic Cancer Group / 대한비뇨기과학회지

Elevations of serum PSA concentrations have been widely reported due to prostatic cancer, but other causes haute not been formally characterized or quantified. So that, we evaluated the causes of elevated serum PSA concentrations in men whose prostate biopsy showed no cancer. The effects of prostate volume, inflammation, echogenecity on ultrasound and calculi were examined in 43 men that serum PSA concentrations greater than 4.0 ng/ml with negative biopsy. These men were compared with 16 men who had suspicious rectal examinations, negative biopsy and serum PSA concentrations of 4.0 ng/ml. or less. Prostate volume (22.5%, p4.0 ng/ml) than control group ( or =0.05). In summary, prostate volume and inflammation were the most important factors contributing to increase serum PSA concentration in men that clinically undetectable prostatic cancer.

Intravesical Bacillus Calmette-Guerin Therapy of Superficial Bladder Tumor : Result of Long-Term Follow-Up / 대한비뇨기과학회지

PURPOSE: Bacillus Calmette-Guerin (BCG) is the most effective intravesical agent for patients with superficial bladder cancer, but the long-term efficacy of BCG has not been established. We report our long-term experience of intravesical BCG therapy in the recurrence and progression for superficial bladder cancer. PATIENTS AND METHODS: Between 1985 and 1993. high risk patients with superficial bladder cancer were received complete TURB plus intravesical BCG (n=77). 120mg Tice-Chicago strain BCG was administered weekly for 6 weeks and then monthly for 3 months. Patients were considered treatment failure if either urinary cytology or biopsy results were positive for tumor on every 3 to 6 months followup examination. All patients reported have had a minimum 2-year followup, with the mean of 63 months. RESULTS: The 1st course of BCG was successful in 47 (6696) of 71 patients treated for prophylaxis and 3 (50%) of 6 treated for carcinoma in situ. Subsequent progression of disease occurred in 6 patients (8%) and cystectomy was performed in 2 patients (3%). The response rate for the total patients population treated with the 1st course was 65% (50 of 77). Of 27 patients who failed the 1st treatment course 21 patients were given the 2nd BCG treatment course. Of the 2nd BCG course, subsequent progression of disease occurred in 3 patients (14%), and cystectomy was performed in 2 patients (9%). Thirteen (68%) had complete response and 5 (26%) had new tumors, who had rendered free of disease after TURB plus intravesical therapy (mitomycin and/ or BCG). Although serious BCG complications (hepatitis, miliary Tbc, sepsis) were observed in 2 patients, side-effects were self-limiting and well controlled in the majority of patients (fever, bladder irritability, and hematuria). CONCLUSIONS: Intravesical BCG therapy seems to be effective to prevent recurrence and progression of superficial bladder cancer with long-term follow-up. However, we must note the possibility of fatal generalized complications in patients with grossly trauma of lower urinary tract.

Prostate Cancer Detection in Clinical Urologic Practice : Comparison of Digital Rectal Examination, Serum PSA Level, and Transrectal Ultrasonography / 대한비뇨기과학회지

We examined 990 self-referred men with one of urologic diseases over age 50 years to compare clinical usefulness of digital rectal examination(DRE), serum PSA level, and transrectal ultrasonography of the prostate(TRUS) in a screening program for prostatic cancer. Biopsy was performed in 201(20%) cases, of which 20 percent was diagnosed as prostate cancer. Sensitivity of DRE was 68%, specificity was 91%, and positive predictive value was 53%, respectively. Positive predictive values are 26% in cases with serum PSA level above 4ng/ml, 36% in cases with serum PSA above 10ng/ml and 40% for TRUS, respectively. When serum PSA below 4ng/ml and negative DRE, the positive predictive value was merely 6%. But when serum PSA above 10ng/ml and positive DRE, the positive predictive value increased to 72%. When serum PSA below 4ng/ml, negative DRE and negative TRUS, the positivepredictive value was merely 7%. However when serum PSA above 10ng/ml, positive DRE and positive TRUS, the positive predictive value was 80%. We conclude that DRE has greater diagnostic effect than the serum PSA level greater than 10ng/ml or hypoechoic area on TRUS and DRE with a serum PSA concentration is considered as an effective screening method of prostatic cancer in all urologic patients over 50 years of age. If DRE and serum PSA level are normal, there is no reason to proceed with TRUS and/or biopsy of the prostate.

A Comparison of Stamey with Raz Operation for the Treatment of Stress Urinary Incontinence / 대한비뇨기과학회지

To compare the efficacy of Stamey with that of Raz procedure in the correction of stress urinary incontinence, we studied retrospectively 43 patients who underwent either procedure at our institution between January, 1989 and June, 1994. Of 43 Patients were 23 underwent Stamey and 20 underwent Raz procedures. Patient's characteristics of the 2 groups were similar, but mean operative time was 107 minutes in Stamey and 76 minutes in Raz procedure(P<0.05), a care rate was obtained postoperatively in 65y. of the patient in Stamey and in 85% in Raz procedure(P<0.05). Postoperative complications were similar in 13.5% of the patients in Stamey and in 12.5% in Raz procedure. Although most predictive factors were not associated with cure or failure in our series, the postoperative cure rate was significantly higher in the group with urinary retention of more than a week. It is thought that Raz procedure is more safe and accurate than Stamey procedure by its shorter operation time and higher success rate(P<0.05). although patient's satisfaction with postoperative morbidity is similar between Stamey and Raz procedure.

Extracorporeal Shock Wave Lithotripsy: Experience of the Year with Modulith SLX / 대한비뇨기과학회지

Storz Modulith SLX represents a newly developed third generation lithotriptor with an electromagnetic cylinder as shock wave source and a dual localization system consisting of inline ultrasound and an integrated fluoroscope C-arm. We report our initial experience with in situ ESWL treatment of renal and ureteral stones with Modulith SLX. 282 patients with urinary stones were treated. Stones were located in calices or the renal pelvis in 21.4%, in the upper ureter in 50.5%. in the midureter in 6.1% and in the lower ureter in 22.0%. The age range of the patients was 18 to 73 years (mean of 43.8 years). The male to female ratio was 1.6: 1. The size of the stones ranged from 3 to 48mm (mean of 11.6mm). No general or regional anesthesia was required. The average number of shock waves was 3,250 shock/session and the total number of treatment session was 535 (mean of 1.9/person). The success rate was 84.1% in kidney, 92.6% in upper ureter. 83.3% in midureter and 95.4% in lower ureter respectively (overall 90.8%). The success rate was decreased in accordance with increment of stones size : 93.996 for stones of 1- 10mm, 86.2% for 11-20mm, 44.4% for stones larger than 20mm. There was no significant complications. In conclusion, ESWL with Storz Modulith SLX is the first choice of management for urinary stones less than 20mm in diameter regardless of the stone location. And it is an efficient and safe lithotriptor which allows anesthesia-free lithotripsy and treatment for outpatient basis.

Long-term Followup of Clean Intermittent Catheterization in Patients with Neurogenic Bladder / 대한비뇨기과학회지

From 1986 to 1993, we analyzed experiences in clean intermittent catheterization(CIC) of 62 patients with neurogenic bladder who were closely follow up for averaging 25months. Initial urodynamic study revealed hyperreflexic bladder in 21patients: 11 with detrusor sphincter dyssynergia. Areflexic bladder was found in 41patients: l5 with low compliance. Although positive urine culture were relatively frequent(61%), febrile urinary tract infections were rare(3%) and upper urinary tract function was stable. Other complications of CIC(29%) were burning sensation, resist on urethral catheter, epididymitis, scrotal abscess, bladder stone, etc. Although minor complications are not rare, we can conclude that preservation of renal function and improvement of urinary incontinence can achieved with intermittent catheterization and that patient must be well motivated and cooperative and be able to use their hands for continuation of CIC.