The Effects of the Designated Doctor System on Health Care Utilization of Medical Aid Beneficiaries with Chronic Diseases

PURPOSE: This study was conducted to examine differences in health care utilization and related costs between before and after the introduction of the designated doctor system, and to find out factors making the differences. METHODS: Data were collected from 200 medical aid beneficiaries having one or more chronic diseases, registered in the designated doctor system during the year of 2012, and the relationship between the use of health services and claimed medical expenses was analyzed through paired t-test and multiple regression analysis using the SPSS 18.0 program. RESULTS: There was a decrease in the number of total benefit days and the number of outpatient and medication days, but some cases showed an increase after the designation of medical institution. In general, hospital stay increased after the introduction of the system. However, the number of medical institutions utilized was reduced in most cases after designation. Conversely, medical expenses increased in most cases after the designation of medical institution. CONCLUSION: These results suggest that a detailed scheme to designate medical institutions should be made in consideration of the seriousness of illness and classification of medical institutions not only for the beneficiaries' enhanced health but for the effective management of medical aid fund.

Effect of Transurethral Ethanol Injection of Prostate for Recurrent Urinary Retention in Patients with a Poor Performace Status / 대한남성과학회지

PURPOSE: The goal of this study is to show the effect of Transurethral Ethanol Ablation of Prostate(TEAP) on voiding symptoms in patients with benign prostatic hyperplasia. MATERIALS AND METHODS: Between May 2003 and May 2005, 17 patients diagnosed with BPH who were not appropriate candidates for anesthesia because of their poor general condition underwent TEAP and were evaluated. Ethyl alcohol(99%) was injected into the prostate with endoscopic guidance. A urethral catheter was inserted postoperatively. All patients were evaluated with uroflowmetry, postvoid residual urine, international prostatic symptom score(IPSS), and quality of life at 3 months post-operatively. RESULTS: The mean total alcohol dose was 9.5 cc, and a catheter was required for a mean of 4.8 days postoperatively. The subjects' mean International prostate symptom score was 29.9 points before TEAP, and decreased to 24.5 points after 3 months(p=0.001). Mean quality of life index decreased from 4.2 points before TEAP to 3.1 points after 3 months(p=0.002). There were no major complications such as severe bleeding, incontinence, or urethral injury. However, 7 patients needed additional medication to improve voiding symptoms. CONCLUSIONS: TEAP caused minimal complications while improving the international prostate symptom score and quality of life. TEAP may be considered an effective minimally invasive treatment option for patients with benign prostatic hyperplasia who are not appropriate for anesthesia because of their poor general condition.

Inflammatory Pseudotumor of the Urinary Bladder which Induced Acute Urinary Retention

Inflammatory pseudotumors of the urinary bladder are rare, benign and nonepithelial tumors characterized by proliferative myofibroblast, fibroblast, histiocytes, and occasionally by plasma cell and lymphocytes. Microscopically, inflammatory pseudotumors present as either pedunculated intraluminal tumors that can be seen readily during cystourethroscopy or as submucosal mural lesions that may be easily overlooked. Histological features of this benign lesion mimic those of malignant neoplasm but their clinical course is benign. Although inflammatory poseudotumors can occur anywhere in the body, they are rare in the bladder. We report a case in which induced acute urinary retention and describe the clinical presentation, and radiographic and histologic findings.

Expression of Cyclooxygenase-2 and Microsomal Prostaglandin E2 Synthase-1 in Human Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: There is ample evidence suggesting an important role for cyclooxygenase-2 (COX-2) and microsomal prostaglandin E2 synthase-1 (mPGES-1) in tumorigenesis. This study aimed at evaluating the clinical significance of the expressions of COX-2 and mPGES-1 in the development and progression of human renal cell carcinomas (RCC). MATERIALS AND METHODS: Tumor samples were obtained from 27 RCC patients who had undergone a radical nephrectomy. The expressions of COX-2 and mPGES-1 were evaluated using immunohistochemistry and Western blot analyses. RESULTS: COX-2 and mPGES-1 were expressed in 16 (59.3%) and in 11 (40.7%) of the 27 RCC patients. The expressions of COX-2 and mPGES-1 were correlated with the tumor grade, but not with the pathological stage. Western blot analysis confirmed a higher COX-2 expression in the RCC than non-tumorous tissues, but that of mPGES-1 was similar between the tumorous and non-tumorous portions. CONCLUSIONS: Our results suggest that the expression of COX-2 in RCC patients may be associated with carcinogenesis and; therefore, a useful biomarker in RCC.

Effects of Doxazosin on Sexual Function in Patients with Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The goal of this study is to estimate the effect of doxazosin GITS on sexual function of patients with benign prostatic hyperplasia using the validated international index of erectile function (IIEF). MATERIALS AND METHODS: We prospectively examined a total of 60 patients with benign prostatic hyperplasia who were treated with doxazosin by using the IIEF questionnaires prior to treatment and after 3 months of medication. The patients whose total IIEF scores were under 21 and treated with finasteride were excluded. RESULTS: The mean total IIEF scores after treatment with doxazosin increased from 41.4+/-10 to 44.2+/-9.3 (p<0.001). The mean scores of IIEF according to the patient's age for the men in their fifties, sixties, and seventies were 48.6+/-8.3, 41.5+/-9.5, and 36.6+/-9.7, respectively, and the mean scores decreased as the patient's age increased. Among the mean scores of each IIEF domain, the erectile function scores increased from 16.4+/-4.8 to 18.2+/-4.2 (p<0.001), the intercourse satisfaction scores increased from 6.9+/-2.3 to 7.3+/-2.2 (p<0.001), the orgasm function scores increased from 6.4+/-1.7 to 6.5+/-1.8 (p=0.038), the sexual desire scores increased from 6.6+/-1.3 to 6.8+/-1.3 (p=0.164), and the overall satisfaction scores increased from 5.4+/-1.9 to 5.8+/-1.7 (p<0.001). CONCLUSIONS: According to the IIEF questionnaire, the generalized sexual function increased after doxazosin treatment in patients with benign prostatic hyperplasia, especially, in the erectile function and intercourse satisfaction domain.

Relationship between Parameters of Perineal Ultrasonography and Severity of Symptom in Genuine Stress Urinary Incontinence Patients

PURPOSE: The goal of this study is to know the relationship between the parameters of perineal ultrasonography and severity of symptom in stress urinary incontinence patients. MATERIALS AND METHODS: We retrospectively examined total 68 patients with stress urinary incontinence who were diagnosed by physical examination, history, urinalysis and urodynamic study. The patients were divided into three group, 1, 2, 3 by Stamey grade in order of each grade I, II, III. We measured the posterior urethrovesical angle(PUVA) at rest and during strain, descent and funneling of bladder neck using perineal ultrasonography. RESULTS: The mean PUVA at rest was 123.9+/-24.0degrees. In group 1, the angle was 124.6+/-20.6degrees, in group 2, 121.4+/-27.1degrees, in group 3, 138.6+/-4.9degrees(p=0.320). During strain state, the mean PUVA was 139.5+/-24.8degrees. In group 1, the angle was 140.6+/-23.7degrees, in group 2, the angle was 136.9+/-26.5degrees, in group 3, 154.0+/-10.8degrees(p=0.346). The mean descent of bladder neck was 10.8+/-4.4mm. In group 1, the descent was 9.9+/-5.8mm, in group 2, 11.3+/-3.5 mm, in group 3, 11.8+/-0.8 mm(p=0.455). The number of cases presenting funneling of bladder neck was 3, 4, 2 in each group(p=0.150). CONCLUSION: There was no relationship between the parameters of perineal ultrasonography and the severity of symptom in stress urinary incontinence patients.