Recovery of the Spontaneous Erections after Radical Prostatectomy with Early Tadalafil Treatment / 대한남성과학회지

PURPOSE: We evaluated the efficacy of tadalafil for the treatment of erectile dysfunction after nerve-sparing radical prostatectomy. MATERIALS AND METHODS: From April 2004 to February 2005, 28 patients who underwent nerve-sparing radical prostatectomy agreed this study and were enrolled. The subjects were divided into 2 groups: tadalafil group(n=15) and control group(n=13). The tadalafil group started medication(20 mg, 2 or 3 times a week) when daily pad requirement was less than 1(pad-free point, mean 74th day postoperatively). Efficacy assessments included the score on the International Index of Erectile Function(IIEF), erectile function domain(EF domain) and Sexual Encounter Profile questions 2(SEP2), and 3(SEP3). Questions were administered in the preoperative phase, pretreatment, and 6 months post-treatment. RESULTS: The preoperative score for the IIEF and EF domain were 46.0 and 18.5 in the tadalafil group and 44.8 and 17.9 in the control group, respectively(p>0.05, p>0.05). At pad-free point, the IIEF and EF domain scores in the tadalafil group were 9.8+/-7.5, 2.7+/-2.7 and in the control group 10.0+/-6.8, 3.1+/-2.5. The scores were reduced significantly at the pad-free point compared to the preoperative phase, but there was no significant difference between the 2 groups. At 6 months after treatment, the scores for the tadalafil group were 26.6+/-18.2, 10.3+/-7.3 and had increased significantly(p<0.05, p<0.05). There was a borderline difference in the EF domain score between the 2 groups(p=0.085). Four patients in the tadalafil group(26.7%) and 1 patient in the control group(7.7%) could penetrate successfully. CONCLUSIONS: Although there was no statistical significance between the 2 groups, early tadalafil treatment after nerve-sparing radical prostatectomy may enhance the early recovery of erectile function.

Comparison of Treatment Outcomes between Photoselective Vaporization and Transurethral Resection of the Prostate for Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: We prospectively compared the treatment outcomes of photoselective vaporization of the prostate (PVP) with those of the gold standard transurethral resection of the prostate (TURP). MATERIALS AND METHODS: Between October 2004 and April 2006, a prospective clinical trial was performed with 131 and 41 patients treated by PVP and TURP, respectively. The efficacy of the two procedures were compared in terms of the International Prostate Symptom Score, quality of life score, peak urinary flow rate, postvoid residual volume, complications and perioperative outcomes at 1, 3, 6 and 12 months following treatment. RESULTS: The baseline characteristics of the two groups were similar. The operative times, catheter indwelling times and hospital stays were significantly shorter in the PVP group. All efficacy parameters were significantly improved in both groups compared to those obtained preoperatively. In addition, the degrees of improvement in the efficacy parameters were similar between the two groups within 12 months. With respect to the prostatic volume reduction, the difference between the pre- and post-PVP volumes during the study period was less than that of the TURP group (p<0.001). There were no differences in the overall complications between the two groups, with the exception of more common bleeding reguiring a transfusion and capsule perforation in the TURP group. CONCLUSIONS: PVP provides excellent intraoperative and postoperative safety, and facilitates immediate relief from obstructive voiding symptoms; similarly to TURP, but has the advantages of shorter hospital stays and catheter indwelling times. The short-term treatment outcomes 12 months after PVP and TURP were comparable, with the exception of the prostatic volume reduction.

Comparison of the Surgical Outcome and Renal Function between Radical and Nephron-sparing Surgery for Renal Cell Carcinomas / 대한비뇨기과학회지

PURPOSE: We retrospectively evaluated the outcomes of a matched comparison of nephron-sparing surgery(NSS) and radical nephrectomy(RN) for renal cell carcinoma(RCC) that was less than 4cm in size and the renal function after surgery. MATERIALS AND METHODS: Between January 1995 and February 2004, 92 and 200 patients with unilateral RCC and a normal contralateral kidney underwent NSS and RN, respectively. A total 56 patients in each cohort were matched according to the size of tumor, the pathological T stage, the pathological grade and the follow-up time. The Kaplan-Meier method was used to estimate the overall survival, the disease-free survival and the cancer-specific survival. Ninety-seven and 317 patients underwent NSS and RN during the same period, and their impaired renal function after surgery was evaluated. Postoperatively, the impaired renal function was defined as a serum creatinine value greater than 1.6mg/dl. The risk factors for impaired renal function, including diabetes, hypertension, age and the operative method were compared between the two groups. Chi-square tests and Student's t-tests were used to compare the two groups for their renal function after surgery. Multivariate logistic regression analysis was used to evaluate the preoperative risk factors for impaired renal function after surgery. RESULTS: There was no significant difference observed between NSS and RN with respect to overall survival(p=0.63), disease-free survival(p=0.18) and cancer-specific survival(p=0.98). Postoperatively, the impaired renal function was significantly different between the two groups(p=0.045, chi-square). The only preoperative risk factor for impaired renal function after surgery was diabetes(p=0.044). CONCLUSIONS: The surgical outcomes for renal cell carcinoma that's less than 4cm in size were comparable between NSS and RN. The only preoperative risk factor for impaired renal function after surgery was diabetes.

The Effect of Neoadjuvant Hormonal Treatment in Prostate Cancer on Biochemical Recurrence / 대한비뇨기과학회지

PURPOSE: When combined with surgery, neoadjuvant hormonal therapy (NHT) has not demonstrated a significant benefit for meaningful clinical endpoints such as progression-free survival or overall survival. We evaluated the effect of NHT on prostate cancer. MATERIALS AND METHODS: From 1995 to 2004, 519 patients underwent radical retropubic prostatectomy(RRP). One-hundred thirty of them were included in this retrospective case-control study and they were assessed for age, the preoperative prostate-specific antigen(PSA) level, the clinical stage and the biopsy Gleason score(GS). The subjects were divided into two groups: the RRP only group(n=65) and the NHT group(n=65), and these were matched for the 3 above mentioned parameters. The protocols for NHT were maximal androgen blockade(n=40), antiandrogen only(n=8), and LHRH analogue only(n=17). Biochemical recurrence was defined as a level of serum PSA of 0.2ng/ml or greater on 2 consecutive evaluations. RESULTS: The mean age of the RRP only group and the NHT group was 64.2 and 63.5, respectively(p>0.05). The rates of a positive surgical margin and biochemical recurrence in the NHT group were 49.2% and 42.5%, respectively, and they were 46.2% and 46.2%, respectively, in RRP only group, and there was no statistical difference between the two groups. In high risk patients(clinical stage> or =T3, biopsy GS> or =8, serum PSA>20ng/ml), NHT group was not differences compared with the RRP group. Neither the duration (3 months vs. 6 months) of NHT nor the regimens of NHT improved the clinical and surgical outcome. CONCLUSIONS: NHT did not improve biochemical recurrence and the positive surgical margin.