Effect of Urgency Symptoms on the Risk of Depression in Community-Dwelling Elderly Men

PURPOSE: To evaluate the association of a specific type of lower urinary tract symptom (LUTS) and the depression in community-dwelling elderly Korean men. MATERIALS AND METHODS: A total of 392 men aged 65 years or older, who completed urological and psychiatric evaluations as a participant of the Korean Longitudinal Study on Health and Aging, were included. From each subject, an interview on the demographic characteristics and medical history, IPSS, and psychiatric questionnaire were taken. Subjects were divided into two groups; depression and euthymic. Subjects with IPSS subscore more than 3 points was considered 'high' subscore. IPSS subscores were compared between the two groups, and the relationship between depression and LUTS severity was assessed. RESULTS: The mean age of the subjects was 75, and 6.4% of the subjects were diagnosed to have major depressive disorders. The depression group showed higher IPSS scores than the euthymic group (16.1+/-9.9 vs. 11.6+/-8.6, p=0.01). IPSS subscores of question 1 (incomplete empty), question 3 (intermittency), question 4 (urgency) and question 6 (straining to void) were higher in the depression group compared with the euthymic group. Chi-square test revealed subjects with high IPSS 1, 3, 4, and 6 score were associated with depression, but multivariate analysis identified only high IPSS question 4 as a significant prognostic factor for depression. CONCLUSIONS: Elderly population with depression is more likely to have more severe LUTS than population without depression. Among the urinary symptoms, urgency was strongly associated with depression. Patients with moderate to severe LUTS and especially urgency may need their mental health status evaluation.

The Relationship between Insulin-like Growth Factor Binding Protein-3 Promoter Polymorphism and Growth / 대한소아내분비학회지

PURPOSE: The variability in insulin-like growth factor binding protein-3 (IGFBP-3) levels is related to polymorphic variants of the promoter region of the gene. The most common single nucleotide polymorphism of IGFBP promoter region is -202 locus. In vitro, significantly higher promoter activity of the A allele at the -202 locus compared with the C allele, consistent with the relationship observed between genotype and circulating IGFBP-3 was documented. The polymorphic variation occurs frequently and may influence GH responsiveness, somatic growth, but the effects of IGFBP-3 promoter polymorphism on growth in children are unknown. METHODS: RFLP genotyping of the -202 single nucleotide polymorphism was performed in 33 Korean children who visited our clinic for evaluation of their growth. The serum levels of IGF-I and IGFBP-3 were compared according to genotyping. RESULTS: Height SDS of subjects was -1.48+/-1.10. 11 of 33 children (33%) were heterozygous AC and the others are homozygous AA in genetic distribution, but no homozygous CC was detected. C allele frequency was 16.7%. There were no significant differences in height, body mass index, serum IGF-I and IGFBP-3 levels between AC and AA groups. CONCLUSION: The effects of IGFBP-3 promoter polymorphism on growth at the -202 locus deserve investigation because there is no CC and the children were relatively short in this study.

Intracavernosal Injection of Insulin Like Growth Factor-1 Improves Erectile Function in Aging Rat / 대한남성과학회지

PURPOSE: Insulin like growth factor-1 (IGF-1) is known to promote the proliferation and migration of penile cavernous smooth muscle cells in rat. The purpose of this study was to investigate whether IGF-1 could restore erectile function in the aging rat. MATERIALS AND METHODS: Male Sprague-Dawley rats were divided into two groups: young (4~5 months; n=10) and old (24 months; n=30). The old group was further divided into vehicle only (phosphate buffered saline plus 0.1% bovine serum albumin; n=10) and IGF-1 treatment (100 microgram; n=20) groups. Half of the IGF-1 dose (50 microgram) was injected on the first day, and half was injected on the third day. After 2 and 4 weeks of treatment, erectile function was evaluated by hemodynamic study, and corpus cavernosal histology was examined by histomorphometric analysis. RESULTS: The ratio of peak intracavernosal pressure to systemic arterial blood pressure was significantly lower in the vehicle-only old rats (63.1 8.5%) compared to young rats (74.6 3.2%) (p=0.016). However, after 4 weeks of treatment, the ratio was significantly increased in the IGF-1 treatment group (77.2 7.0%) compared to the vehicle-only group (p<0.05). The percentage of smooth muscle was significantly lower in the vehicle-only old rats (12.8 2.2%) compared to young rats (17.8 3.7%) (p=0.047), whereas, it was significantly increased in the IGF-1 treatment group (19.4 3.3%) compared to the vehicle-only group (p=0.014). CONCLUSIONS: Intracavernosal injection of IGF-1 in the old rats resulted in increased intracavernosal pressure and higher percentage of cavernosal smooth muscle. These results suggest that intracavernosal injection of IGF-1 appears to restore smooth muscle integrity and improve erectile function in aged rats.

Comparison of Two Local Anesthestic Methods for Transrectal Ultrasound Guided Prostate Biopsy: Periprostatic Injection of Lidocaine and Rectal Instillation of Lidocaine Gel / 대한비뇨기과학회지

PURPOSE: During transrectal ultrasound guided prostate biopsy, 65% to 90% of patients reportedly have discomfort. We compared the anesthetic effects of a periprostatic injection of lidocaine under ultrasound guidance with the effects of a rectal instillation of lidocaine gel before the transrectal ultrasound guided prostate biopsy. MATERIALS AND METHODS: A prospective randomized double-blind study was performed in 72 patients requiring a systematic biopsy of the prostate. Patients were randomized into two groups according to the method of anesthetic delivery that was used. Group 1 consisted of 37 patients who intrarectally received 10 ml of 2% lidocaine gel 10 minutes before biopsy, and 5 ml of normal saline was injected into the periprostatic nerve plexus just before biopsy under ultrasound guidance using an 18 gauge 16 cm needle on each side. Group 2 consisted of 35 patients who received 10 ml of sterile gel without lidocaine and a 5 ml 1% lidocaine injection using the same method as group 1. The pain score was assessed using a visual analogue scale immediately after biopsy. RESULTS: There was a statistical difference in the mean pain score between the two groups (5.1+/-1.7 in group 1 versus 3.3+/-1.5 in group 2) (p<0.001), but The complication rates were not significantly different. CONCLUSIONS: We believe that performing the transrectal ultrasound guided prostatic nerve blockade before biopsy significantly diminishes the discomfort associated with the procedure, which, in turn, improves patient tolerance more so than rectal instillation of lidocaine gel. In addition, this procedure is a safe, simple, and rapid technique that should be considered in all patients undergoing transrectal ultrasound guided prostate biopsy.

Laparoscopic Excision of Congenital Seminal Vesicle Cyst Associated with Ipsilateral Renal Agenesis / 대한비뇨기과학회지

When surgical treatment for symptomatic seminal vesicle cyst is deemed necessary, conventional surgery is invasive because of the deep location and dissection difficulty of the seminal vesicles in the retrovesical space. Recently, the laparoscopic approach has been advocated as an optimal yet minimally invasive technique for the surgical treatment of seminal vesicle pathology. It provides a good image and easy approach to the seminal vesicles. We report a case of a symptomatic giant cyst of the left seminal vesicle that is associated with ipsilateral renal agenesis, which was treated by transperitoneal laparoscopic excision.

Renal Cell Carcinoma Associated with Von Hippel-Lindau Disease Treated by Wedge Resection / 대한비뇨기과학회지

The Von Hippel-Lindau disease is an autosomal dominant condition manifested by the cerebellar hemangioblastomas, retinal angiomas, cysts of the pancreas, the kidney, and the epididymis, pheochromocytoma, and renal cell carcinoma. Renal cell carcinoma occurs in 35% to 38% of affected individuals and may cause pain or a palpable mass. We report a case of a 45-year-old female with renal cell carcinoma, cerebellar hemangioblastoma, and cysts of the pancreas and kidney, to which a wedge resection was performed.

Prostate Cystic Adenocarcinoma / 대한비뇨기과학회지

We report a case of cystic adenocarcinoma of the prostate in a 67-year-old man who showed severe obstructive voiding symptoms. In this case, the mechanism of the cyst formation from the prostate cancer is thought to be related to the secondary cystic formation, which was due to either the central necrosis of the cancer tissue or intracancerous tissue hemorrhage. Prostate cystic adenocarcinoma is a rare disease, and there are only a few cases reported in the literature. A cyst of the prostate may be either congenital or acquired. A congenital cyst arises from the mesonephric (Wolffian) or paramesonephric (Mullerian) duct system, while an acquired cyst is subdivided into the retention, malignant, and parasitic cyst. A huge prostatic cyst was found in a 67-year-old man. The lesion was presumed to be a prostate cystic adenocarcinoma.

Comparison of Tubulized Incised Plate and Other Procedures for Hypospadias / 대한비뇨기과학회지

PURPOSE: While numerous methods have been introduced to repair hypospadias, no single method is effective for repairing all hypospadias. We reviewed our experience of hypospadias repair to determine the best surgical method and the efficacy of the treatment modality. MATERIALS AND METHODS: We reviewed the hospital charts of 32 patients who had undergone hypospadias surgery from January 1993 to January 2002. Group 1 included patients who were operated on before 1998 and group 2 had those who had operations after 1998 with only the TIP(tubularized incised plate) method. The surgical procedures that were performed on the patients were onlay island flap(6), Mathieu(2), Hodgson's type III(2), Mustard(2), TIP(14), Transverse island flap(5), and Thiersch-Duplay(1). The mean operative time, mean hospital days, mean duration of catheter drainge, and complication rates of the two groups were compared. RESULTS: In group 2, operation time was reduced(142.9+/-69.4 versus 172.5+/-93.4 min)(p<0.05), but the two groups showed no significant differences in mean hospital days(11.9+/-2.8 days. versus 12.3+/-1.6 days) and mean duration of catheter drainge (9.8+/-24 versus 10.5+/-3.6 days). In group 1 and group 2, complication rates were 67% (12 of 18) and 14%(2 of 14), respectively(p<0.05). CONCLUSIONS: Our data show shorter operative time and lower complication rates using the TIP method for various types of hypospadias. Therefore, the TIP method seems to be a safe method of surgery for any type of hypospadias.

The Analysis of Persistent Overactive Bladder Syndrome after Sling Surgery in Female Stress Urinary Incontinence / 대한비뇨기과학회지

PURPOSE: The ability of preoperative findings, to identify patients where an overactive bladder syndrome failed to resolve postoperatively, was assessed. The clinical outcome of a pubovaginal sling was also evaluated to determine the correlation between the postoperative success rate (subjective, objective) and satisfaction in overactive bladder syndrome. MATERIALS AND METHODS: Thirty three women, with stress urinary incontinence, received a pubovaginal sling procedure using polypropylene mesh. All the preoperative factors that affect the presence of preoperative overactive bladder syndrome, and the postoperative changes in overactive bladder syndrome, were analyzed and evaluated. The correlation between the changes in overactive bladder syndrome and the success rate (subjective, objective) and satisfaction were also analyzed. RESULTS: The presence of preoperative overactive bladder syndrome was significantly related to a decrease in the Valsalva leak point pressure (p=0.05) and an increase of the Stamey grade (p<0.05), and was closely related to the Valsalva type (p=0.07) and the open bladder neck at rest, with the patient erect (p=0.07). The differences in the Blaivas type, Q tip angle, posterior urethrovesical angle and bladder neck descending in the strain lateral view of a cystourethrogram, between the resolved and persistent patients of overactive bladder syndrome postoperatively, were statistically significant (p<0.05). Preoperative urgency, urge incontinence and persistence of postoperative overactive bladder syndrome, are significant factors contributing to decreases in the subjective success rate and patient satisfaction (p<0.05). CONCLUSIONS: Preoperative overactive bladder syndrome was closely associated with the variables related to incompetence of the urethra, and the postoperative persistence of overactive bladder syndrome was associated with the variables related not only to incompetence of the urethra, but also to the urethral hypermobility.

IGF-I on the Expression of Gene Associated with Hypoxic Ischemic Brain Injury in the Neonatal Rats

PURPOSE: To investigate the effect of intraperitoneal injection of IGF-I after hypoxic ischemic brain injury on neuronal cell necrosis, apoptosis and expression of proapoptotic and antiapoptotic proteins bax and bcl-2, respectively. METHODS: The right carotid artery was cut between the double ligation. Then allowed to recover for 30 minutes followed by exposure to 8% oxygen at 37degree C for 2 hours. Devided 2 groups, control group(N=30) and IGF-I treated group(N=30). IGF-I treated group received IGF-I 20 microg 2 hours after hypoxic ischemic injury intraperitoneally. Rates were decapitated at 24 hours and 72 hours following hypoxic ischemic brain injury. After then, right hippocampal CA1 and CA3 neuronsof rat brains were examined. RESULTS: The apoptosis and necrosis was significantly less in IGF-I treated group than control group and necrosis was more prominent in CA1 neurons than CA3 neurons. Necrosis was slightly decreased at 72 hours in both groups(P<0.05). The apoptosis was more prominent at 24 hours than 72 hours after hypoxic ischemic injury(P<0.05). Bax protein expression was prominent in control group, especially at 72 hours(P<0.05) and less in the IGF-I treated group than control group. Bcl-2 protein expression was not detected in both group. CONCLUSION: The results from this study suggest that exogenous systemic IGF-I had a neuroprotective effect by inhibition of up-regulation of bax protein expression after hypoxic ischemic brain injury.

Clinical Significance of Serum IGF-I Level in Short Stature Children / 대한소아내분비학회지

PURPOSE: Insulin-like growth factor I(IGF-I) is a polypeptide mitogen and mediates growth effect of growth hormone(GH). The lack of daily variation of IGF-2 allows their measurements to be reliable in screening for growth disorders. The aims of this study are to evaluate the mean levels of IGF-I and also to evaluate whether IGF-I has diagnostic significance as a screening test in short stature children. METHODS: We studied 71 short stature children(Male 43, Female 28)whose test results were normal after GH provocation test(L-dopa and/clonidine). Control group was 13 children with GH deficiency(complete GH deficiency 6 cases, partial GH deficiency 7 cases). Serum GH level was measured with radioimmunoassay(RIA, Diagnostic system laboratories, USA) kit. and serum IGF-I level was measured with RIA kit(Nichols co., USA). RESULTS : 1) Study group included 71 short stature children(male 43, female 28) without GH deficiency and 13 short stature children with GH deficiency(complete GH deficiency 6, partial GH deficiency 7). 2) The height of 43 male children was below 50 percentile except in 3 cases. And 28 female children was below 50 percentile except 1 case. In Tanner standard growth curve. But, 7 male chidren with GH deficiency was below -1SD and 6 female children with GH deficiency was below -2SD. 3) Serum IGF-I level in short stature children without GH deficiency was seen to increase with age and serum IGF-1 level of female was higher than that of male. 4) Serum IGF-I level was correlated with height percentile in study group(male: Y=0.017X+0.243, r=0.294, P=0.03, female: Y=1.248X+0.716, r=0.384, P=0.01). 5) Serum IGF-I level was -2SD in most GH deficient children. Conclusions: The height was mostly below 50 percentile of the Tanner growth curve in short stature children without GH deficiency. Serum IGF-I level was weakly correlated with the height percentile in both male and female study group. But, serum IGF-I level has limited value of screening test in diagnosis of short stature. However, if serum IGF-I level below -2SD, it could be anti pate the sign for further evaluation of GH deficiency.

Expression of Insulin-like Growth Factor I (IGF-I) and Its Binding Proteins in Rat Tissues / 대한소아내분비학회지

covered with liguid nitrozen and pulverized with a pestle. To the powered tissue 5ml of 3.3M formic acid/0.5% Tween 20 was added and centrifuged at 40,000*g for 10 min. An aliquot of supernate was put into C18 sepak minicolumn to eliminates IGF-BPs. Measurement of IGF-I in rat tissues was done by RIA with anti-hIGF-I antibody and hIGF-I(PSIII) standard which was prepared by Drs. L. E. Underwood and J. J. Van Wyk UNC at Chapel Hill, NC, USA and distributed through the National Hormone and Pituitary Distribution Program. Distribution of IGF-I in rat tissue was seen by SDS-PAGE and ligand blotting method. A cDNA library in lambda gt11 of rat liver was used to isolate the cDNA of IGF-I. Phage containing inserts encoding rat IGF-I were identified by hybridization with biotin labeled synthesized oligomer which was the sequence from 1 to 8 aminoacids of known rat IGF-I. The EcoRI inserts were subcloned into PBluescript SK. The nucleotide sequence of both strands was determined by the dideoxy chain termination method. RESULTS: 1)IGF-BPs in tissue extract which could compete with antibody for IGF-I in measureing the IGF-I were eluted at 50Kdalton molecular weight marker using Protein-pak 300SW column. Using C18-sepak minicolumn, IGF-BPs were completely eliminated from tissue extract as much as possible, using Protein-pak 300SW column. 2)The amount of IGF-I in tissues was as folows: liver 575+/-41.6ng/g, lung 552.0+/-40.8ng/g. kidney 503+/-30.8ng/g, heart 449.0+/-30.4ng/g, testis 225+/-18.8ng/g, spleen 146+/-26.4ng/g, muscle 92+/-7.6ng/g and brain 49.0+/-5.8ng/g. The amount of IGF-I in blood was 1403+/-60.8ng/ml. 3)Banding patterns of IGF-BPs in rat tissues extract were obtained using ligand blotting. IGF-BP3 bands at 50 Kdalton molecular weight marker were strongly shown in testis, heart, and lung extracts but not in brain and muscle. IGF-BP1 and 2 band at 30Kdalton molecular weight marker was strongly shown in liver, kidney, spleen, testis, heart and lung. IGF-BP4 band at 21 Kdalton molecular weight marker was weakly shown only in spleen and muscle. 4) The nucleotide sequence of cloned cDNA of rat IGF-I is as follows. 5 10 15 5'----- CC CTT TGC GGG GCT GAG CTG GTG GAC GCT CTT CAG TTC GTG TGT 20 25 30 -GGA CCA AGG GGC TTT TAC TTC AAC AAG CCC ACA GGC TAT GGC- 35 40 45 -TCC AGC ATT CGG AGG GCA CCA CAG ACG GGC ATT GTG GAT GAG------3 CONCLUSION: This study suggests that tissue extraction method for IGF-I from tissues and elimination of IGF-BPs using C18 sepak minicolumn is suitable for measuring in large numbers of samples. Expression of IGF-I and IGF-BPs in multiple tissues suggests some phsiologic function at each tissue level. Subcloning of cDNA of exon 3 and 4 of IGF-I was useful for studying regulation of IGF-IA and IB mRNA in rat tissue.

The Characteristics of Insulin-like Growth Factor Binding Protein-3(IGFBP-3) in Serum; The Diagnostic Utility of IGFBP-3 in Growth Hormone Deficiency

PURPOSE: For diagnosis of growth hormone(GH) deficiency in short stature, peak growth hormone levels after pharmacologic stimulation are usually used. In this study, we measured serum IGFBP-3, which is a major binding protein in serum and is considered to be GH-IGF-I axis dependent, levels by radioimmuno assay(RIA) in sera from normal short stature(NSS) children, and patients with GH deficiency children to clarify the utility of IGFBP-3 level as a diagnostic marker for GH deficiency. METHODS: At the department of Pediatrics, Hanyang University Hospital from November, 1992 to July, 1995, we selected 32 GH deficiency-suspected children on the base of their growth data and bone age. After GH stimulation with clonidine(100-150mug/m2) and L-dopa(200-250 mg/m2), we measured their peak GH levels by the immunoradiometric assay(IRMA) kit(Immunodiagnostic system, UK), IGFBP-3 level by radioimmuno assay(RIA) kit(Diagnostic system labortories, USA). RESULTS: 1) The mean IGFBP-3 levels of eight normal short stature(NSS) in Tanner stage I is 2.4+/-1.5mug/ml and their stimulated mean peak GH level is 18.7+/-7.5ng/ml. However, one child in Tanner stage I with nutritional deficiency, IGFBP-3 level is 0.717mug/ml and stimulated peak GH level is 12.2ng/ml. And the mean IGFBP-3 and peak GH levels of two Tanner stage II NSS are 2.2+/-1.2mug/ml and 14.3+/-5.2ng/ml, respectively. 2) The mean IGFBP-3 level of five partial GH deficient(PGHD) children in Tanner stage I is 1.8+/-1.1mug/ml, and their stimulated mean peak GH level is 8.2+/-1.3ng/ml. The mean IGFBP-3 level of five PGHDs in Tanner stage II is 2.2+/-0.8mug/ml, and their stimulated mean peak GH level is 7.5+/-1.5ng/ml. 3) The mean IGFBP-3 level of six complete GH deficient(CGHD) children in Tanner stage I is 0.7+/-0.6mug/ml, and their stimulated peak GH level is 1.0+/-1.2ng/ml. The mean IGFBP-3 level of three complete GH deficient(CGHD) children in Tanner stage II is 2.2+/-0.2mug/ml, and their stimulated peak GH level is 2.5+/-1.4ng/ml. Only one CGHD child in Tanner stageIII, IGFBP-3 level is 5.943mug/ml, and his stimulated peak GH level is 3.3ng/ml. 4) There is no significant difference of mean IGFBP-3 levels between NSS and PGHD in Tanner stage I, but the mean IGFBP-3 level is significant difference between NSS and CGHD in Tanner stage I(p<0.05). 5) The sensitivity of IGFBP-3 for CGHD and PGHD less than 9 years old is 83%, 75% and for all age is 80%, 55%, respectively. The sensitivity of IGFBP-3 for GH deficiency in less than and older than 9 years is 80%, 67%, respectively. The specificity of IGFBP-3 for NSS is 64%. CONCLUSIONS: Because serum IGFBP-3 levels may increased during puberty due to mechanisms independent of the GH-IGF-I axis, it is difficult to distinguish GH deficiency from NSS in older children, but CGHD in Tanner stage I, we may use the basal plasma IGFBP-3 level as a screening test for diagnosing GH deficiency.