Factor Analysis of Intraoperative Radical Conversion During Partial Nephrectomy: Single Surgeon Experience

PURPOSE: Preoperative aspects and dimensions used for an anatomical (PADUA) classification is useful to predict perioperative complications and warm ischemia time. However, it remains uncertain whether PADUA classification can predict intraoperative conversion from partial nephrectomy (PN) to radical nephrectomy (RN). We evaluate whether PADUA classification parameters can predict conversion to RN during PN. MATERIALS AND METHODS: We retrospectively assessed data of 593 patients who underwent open PN and robotic PN for renal tumors by a single surgeon at a single tertiary center between December 2003 and September 2017. Intraoperative conversion to RN was performed in 17 of 593 patients who initially underwent PN. We evaluated the factors influencing the surgical modalities including PN and radical conversion cases. Then, the factors significantly associated with conversion to RN were further analyzed. RESULTS: There were no significant differences between the 2 groups in age, longitudinal location, exophytic rate, and rim or face locations of renal masses. Renal sinus involvement, urinary collecting system involvement, and renal mass size were variables that predicted radical conversion, using univariate analysis. Renal sinus involvement (odds ratio [OR], 9.075; p=0.049) and urinary collecting system involvement (OR, 3.944; p=0.029) were independent predictors of intraoperative radical conversion, using multivariate analysis. CONCLUSIONS: The PADUA classification is a useful tool to predict intraoperative conversion from PN to RN. Renal sinus involvement and urinary collecting system involvement are the best predictors of intraoperative conversion from PN to RN.

The Nephrometry Score: Is It Effective for Predicting Perioperative Outcome During Robot-Assisted Partial Nephrectomy?

PURPOSE: Robot-assisted partial nephrectomy (RPN) has emerged as an alternative treatment for the management of small renal masses. This study was designed to investigate parameters that predict perioperative outcomes during RPN. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 113 patients who underwent RPN between September 2008 and May 2012 at the Seoul National University Bundang Hospital. Clinical parameters, including warm ischemia time (WIT), estimated blood loss (EBL), and R.E.N.A.L and PADUA scores, were evaluated to predict perioperative outcomes. RESULTS: Of the 113 patients, 81 were men and 32 were women. The patients' mean age was 53.5 years, and their mean body mass index was 22.3 kg/m2. Age, gender, and mass laterality had no effect on perioperative complications, WIT, or EBL. Univariate analysis revealed that a distance between the tumor and the collecting system of 4 cm were associated with adverse profiles of complications, WIT, and EBL. However, multivariate analysis showed no association between the predictive parameters and tumor complexity as assessed by nephrometry scores. Tumor size of >4 cm increased the risk of blood loss >300 mL (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.3.9.7; p=0.016). A distance between the tumor and the collecting system of < or =4 mm was associated with increased risk of WIT exceeding 20 minutes (OR, 2.8; 95% CI, 1.3.6.3; p=0.012). CONCLUSIONS: Tumor size and proximity of the mass to the collecting system showed significant associations with EBL and WIT, respectively, during RPN. The R.E.N.A.L and PADUA nephrometry scoring systems did not predict perioperative outcomes.

Comparison and Efficacy of Low-Dose and Standard-Dose Tamsulosin and Alfuzosin in Medical Expulsive Therapy for Lower Ureteral Calculi: Prospective, Randomized, Comparative Study

PURPOSE: Typically in Korea, for a standard dose (0.4 mg) of tamsulosin, two low doses (0.2 mg) are administered. The aim of this study was to evaluate and compare the efficacy of tamsulosin (0.2 mg and 0.4 mg) and alfuzosin (10 mg) in the treatment of lower ureteral stones. MATERIALS AND METHODS: A total of 141 patients presenting with a single 4- to 10-mm sized lower ureteral stone were randomly assigned to 4 groups. Patients in group 1 (n=41) and group 2 (n=30) received an oral dose of 0.2 mg tamsulosin once and twice daily, respectively, and patients in group 3 (n=36) received a daily oral dose of 10 mg alfuzosin. Patients in group 4 (n=34) received trospium chloride only. The spontaneous passage of stones, the stone expulsion time, and adverse effects were evaluated. RESULTS: There were no significant differences in patient background, including age, sex, BMI, stone size, stone side, and symptom duration. The spontaneous stone passage rate through the ureter was higher and the stone expulsion time was faster in groups 1, 2, and 3 than in group 4. There were no statistically different changes in groups 1, 2, and 3. The adverse effects observed in all groups were comparable and were mild. CONCLUSIONS: Tamsulosin at 0.2 mg and 0.4 mg and alfuzosin (10 mg) proved to be safe and effective. A first cycle of medical expulsive therapy with tamsulosin 0.2 mg could be considered as an option in the management of single lower ureteral stone.

Comparison of the Efficacy of a Terpene Mixture and Alpha-Blocker for Treatment of Category III Chronic Prostatitis/Chronic Pelvic Pain Syndrome: A Prospective Study

PURPOSE: The aim of this study was to evaluate the efficacy of a terpene mixture compared with alpha-blocker in patients with chronic pelvic pain syndrome (CPPS). MATERIALS AND METHODS: Patients diagnosed with CPPS were included in this study. The patients were randomly placed into three groups. Group 1 was treated with levofloxacin alone (36 patients), group 2 was treated with levofloxacin and alfuzosin (33 patients), and group 3 was treated with levofloxacin and terpene mixture (34 patients) for 8 weeks. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) was evaluated in patients in each group at the beginning of the study and after 8 weeks of treatment. RESULTS: Pain domain, urinary domain, quality of life domain, and total score on the NIH-CPSI were not significantly different at the initial visit. After treatment with each medication, improvements on the pain domain and total score of the NIH-CPSI were better in group 3 than in group 1 or group 2 (p<0.05). Improvement on the urinary domain of the NIH-CPSI was better in group 2 than in group 1 or group 3 (p=0.014). Changes in the quality of life domain of the NIH-CPSI were not significant among the three groups. CONCLUSIONS: This study suggests that the terpene mixture and alpha-blockers may have significant benefit for symptomatic relief, especially in the pain and urinary domains, respectively.

Effect of Level of Spinal Cord Injury and Urinary Catheterization on Sexual Function and Activity in Male Patients with Upper Motor Neuron Injury

PURPOSE: We investigated the effect of the level of spinal cord injury and urinary catheterization on sexual function and activity in male patients with upper motor neuron (UMN) injury. MATERIALS AND METHODS: We reviewed patient's chart, radiologic and urodynamic study. We interviewed patient's sexual activity according to educational status, economic and marriage state, occupation, duration of spinal cord injury and pattern of voiding. A total of 114 male patients with neurogenic bladder due to UMN injury were included in the study. Group 1 consisted of 33 patients who underwent a clean intermittent catheterization (CIC) regimen and group 2 consisted of 81 patients with a suprapubic catheter, condom catheter, or Foley catheter. A detailed sexual behavior was taken for all patients to complete a questionnaire including the 5-item version of the International Index of Erectile Function (IIEF-5). RESULTS: Satisfaction with intercourse (p=0.037) and total score (p=0.032) on the IIEF-5 were significantly higher in group 1 than in group 2. The other items on the IIEF-5 did not differ significantly between the groups. When the subjects were stratified according to level of spinal cord injury, 8 patients (18.6%) with cervical cord injury had no sexual activity, whereas 24 patients (33.8%) with non-cervical-cord injury did (p=0.048). Patients with no sexual activity were 12.1% (4/33) of the patients in the CIC group and 34.6% (28/81) of the patients who underwent other regimens (p=0.016). CONCLUSIONS: Our results demonstrate that level of spinal cord injury and urinary catheterization may influence the sexual activity of male patients with UMN injury. Our results suggest that the CIC regimen had a positive effect on the sexual activity of these patients.

The Effect of Periurethral Prostatic Calculi on Lower Urinary Tract Symptoms in Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate the effect of periurethral prostatic calculi on lower urinary tract symptoms(LUTS) at the initial visit and after treatment with an alpha-blocker in benign prostatic hyperplasia (BPH). MATERIALS AND METHODS: A total of 223 male patients with LUTS were studied. Group 1 consisted of 81 patients with periurethral prostatic calculi within 5 mm from the prostatic urethra of the transitional zone, as determined by transrectal ultrasound. Group 2 consisted of 142 patients without periurethral prostatic calculi within 5 mm from the prostatic urethra. The International Prostate Symptom Score(IPSS), maximal urinary flow rate (Qmax) and post voided residual urine(PVR) were measured in patients of both groups at the beginning of the study and at eight weeks after the treatment with 4 mg doxazosin gastrointestinal therapeutic system (GITS). RESULTS: Voiding, storage and the total IPSS for Group 1 patients were higher than for Group 2 patients(p>0.05). Quality of life(QoL), Qmax, and PVR were not significantly different at the initial visit. After treatment with 4 mg doxazosin GITS, an improvement of voiding, storage and the total IPSS for Group 2 patients was seen as compared to Group 1 patients (p<0.05). The mean improvement of QoL was 0.44+/-0.73 for group 1 patients and 1.13+/-0.82 for group 2 patients(p<0.001). The mean change of Qmax was 1.02+/-1.40 ml/sec for Group 1 patients and 1.52+/-1.84ml/sec for Group 2 patients(p=0.035). Changes of PVR were not significant between the two groups. CONCLUSIONS:This study suggests that the periurethral prostatic calculi may aggravate lower urinary tract symptoms and decrease the effect of alpha- blockers.

Expression of Survivin and Bcl-2 in Benign Prostatic Hyperplasia Treated with a 5-alpha-reductase Inhibitor / 대한비뇨기과학회지

PURPOSE: A 5-alpha-reductase inhibitor(5 alpha RI) can induce apoptosis and decrease the prostatic volume in patients with benign prostatic hyperplasia (BPH). In this study we assessed the expression of survivin and bcl-2 in the epithelium of BPH patients treated with finasteride. MATERIALS AND METHODS: Group 1 consisted of 39 patients who underwent transurethral resection of the prostate(TURP) without medication and Group 2 consisted of 31 patients who underwent TURP and were treated with finasteride for more than three months. The mean age of both groups of patients was 73.03+/-7.02 years and 74.71+/-5.99 years, respectively. Immunohistochemical staining for survivin, bcl-2 and ki-67 was performed in prostatic tissues. The percentage of cells that expressed survivin and bcl-2 were classified into four categories based on the staining intensity. The expression of ki-67 in nuclei using 10 random cells per specimen was obtained. The relationship between 5alphaRI and the expression of survivin, bcl-2 and ki-67 was analyzed. RESULTS: The total mean prostate volume of group 1 patients and group 2 patients was 45.51ml and 37.23ml, respectively (p<0.001) and the mean serum total prostate-specific antigen(PSA) level of group 1 patients and group 2 patients was 5.09ng/ml and 3.75ng/ml, respectively(p=0.105). Decreased expression of survivin and bcl-2 in specimens from group 2 patients was observed as compared to the level of expression in group 1 patients(p<0.001, p=0.001). Expression of ki-67 determined in samples from both groups was not significantly different(p=0.345). CONCLUSIONS: We suggest that finasteride may induce apoptosis of prostatic epithelial cells in BPH patients by reducing the expression of survivin and bcl-2. These findings may indicate a reduction of prostatic volume.

The Effect of Chronic Prostatic Inflammation on Acute Urinary Retention in the Setting of Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The aim of this study was to evaluate the effect of chronic prostatic inflammation on acute urinary retention(AUR) in the setting of benign prostatic hyperplasia(BPH). MATERIALS AND METHODS: A total of 132 male patients admitted to our clinic with BPH-related AUR or BPH-related lower urinary tract symptoms (LUTS) were included in this study. These patients were divided into two groups. Group 1 consisted of 58 patients with AUR who underwent transurethral resection of the prostate(TURP), and group 2 consisted of 74 patients with LUTS who underwent TURP. Prostatic infarction, morphology, inflammation were examined. Prostatic infarction was evaluated according to the presence or absence of infarction. Prostatic morphology was assessed according to three categories: mainly glandular hyperplasia, stromal hyperplasia, or a mixture of glandular and stromal hyperplasia. Prostatic inflammation was assessed according to three categories: mild, moderate, and severe. RESULTS: Prostatic infarction was observed in 8.6% of the patients in group 1 and in 8.1% of the patients in group 2(p=1.000). Glandular, stromal, and mixed hyperplasia were detected in 36.2%, 5.2%, and 58.6% of the patients in group 1 and in 35.1%, 6.8%, and 58.1% of the patients in group 2, respectively(p=0.222). Mild, moderate, and severe chronic prostatic inflammation were observed in 39.7%, 31.0%, and 29.3% of the patients in group 1 and in 73.0%, 20.3%, and 6.7% of the patients in group 2, respectively(p<0.001). CONCLULSIONS: Chronic prostatic inflammation may play an important role on AUR developing secondary to BPH.

Brucella Epididymorchitis: A Rare Cause of Testicular Mass / 대한비뇨기과학회지

Brucellosis is a zoonosis, which is caused by Brucella abortus, B. melitensis, B. suis and B. canis. Brucellosis has been an emerging disease since the discovery of B. melitensis, by Bruce, in 1887. Worldwide, brucellosis remains a major source of disease in both humans and domesticated animals. A high prevalence in certain geographical areas is well recognized, but has been largely underestimated. In Korea, the first human case of Brucellosis occurred in 2002, but the incidence of human brucellosis has now increased. Herein, a case of epididymorchitis due to brucellosis is reported.