Association between Erectile Dysfunction and Metabolic Syndrome in Aging Men: Hallym Aging Study

PURPOSE: The aim of this study was to investigate the relationship between erectile dysfunction (ED) and metabolic syndrome (MS) in a population-based cohort study, the Hallym Aging Study (HAS). MATERIALS AND METHODS: Among the 1,520 participants in HAS, 278 men aged more than 50 years, who underwent detailed health evaluations, including health-related questionnaires, evaluation of their medical history and various lifestyle factors, as well as clinical measurements, were included in the study. ED and MS were assessed by using a 5-item version of the International Index of Erectile Function (IIEF-5) and the guidelines of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), respectively, and the relationship between ED and MS was investigated. RESULTS: Of the 278 men, 120 (43.2%) had MS. Ninety percent of men with MS and 78.5% of men without MS had ED (p<0.05), and chi-square analysis revealed significant differences in the rate of MS between groups when stratified by ED severity (p<0.001). The multivariate logistic regression analysis, with control for age and comorbidities, showed that men with MS were 3 times as likely to have ED as were men without MS. Among the metabolic risk factors, only waist circumference (WC) was significantly associated with the presence and severity of ED (p<0.05). CONCLUSIONS: The presence of MS was an independent risk factor for ED, and WC was the most significant metabolic risk factor predicting the risk of ED. These results highlight the clinical importance of evaluating ED in patients with MS, especially in patients with abnormal WC.

Sclerosing Epithelioid Fibrosarcoma of the Kidney / 대한비뇨기과학회지

Sclerosing epithelioid fibrosarcoma(SEF) is an uncommon tumor of the deep soft tissue. It was first described in 1995 by Meis-Kindblom et al. Histologically, this tumor is characterized by uniform, small, round to ovoid epithelioid cells with clear cytoplasm, and the cells are arranged in distinct nests and cords. On immunohistochemistry, the most consistently positive marker is vimentin, although other antigens(cytokeratin, epithelial membrane antigen, S100 protein and neuron specific enolase) have been recorded as being inconsistently positive. We report here on a case of a 46-year-old woman who presented with back pain. The radiologic findings revealed a right renal mass and multiple bone metastases. The patient underwent radical nephrectomy and the pathologic finding was primary SEF of the kidney.

Primary Urethral Adenocarcinoma in a Young Man Who Presented with Voiding Dysfunction / 대한비뇨기과학회지

Primary urethral carcinoma accounts for less than 1% of the malignancies in males and adenocarcinoma accounts for 5% of all urethral carcinomas. A 36-year-old man with a history suggestive of urethral stricture was scheduled to undergo retrograde urethrography and visual urethrotomy. On urethroscopic examination, an abnormal polypoid mass was found in the proximal bulbous urethra, so transurethral resection biopsy was added to the urethrotomy. Histopathologic examination demonstrated urethral adenocarcinoma with no invasion to the corpus spongiosum and cavernosa on the magnetic resonance imaging. There was no evidence of metastasis and the search for the primary focus of adenocarcinoma revealed that the tumor originated from the urethra. The patient underwent segmental urethral resection and there has been no recurrence for 1-year follow-up.

CyberKnife for the Treatment of Nonmetastatic Prostate Cancer: Preliminary Results / 대한비뇨기과학회지

Purpose: Herein is reported our initial experience of the CyberKnife to show its safety and feasibility as a treatment modality for non-metastatic prostate cancer. Materials and Methods: Twenty patients, with biopsy-proven prostate cancers, were recruited into a phase I clinical trial using the CyberKnife. The distribution of clinical risks, as assessed using the ASTRO criteria, was as follows: low (4), intermediate (5) and high (11). The mean age and follow up of the patients were 71.4 years and 15 months, respectively. The patients received 7.5-9Gy of radiation in a single fraction for 4-5 days. The total radiation dose to the prostate was 34-37.5Gy, which approximates to 86.4Gy in 2Gy fractions. The rectal and bladder acute toxicities were graded using the criteria of the Radiation Therapy Oncology Group (RTOG). The results of acute toxicities were compared to those of the historical control, which had been treated with conventional four field box techniques (received median dose 70.2Gy). The prostate-specific antigen (PSA)- based short-term efficacy was described. Results: The acute rectal toxicity scores were 0, 1 and 2 in 13, 5, and 2 patients, respectively. The acute bladder toxicity scores were 0, 1 and 2 in 16, 3 and 1 patient, respectively. No grade 3 or 4 acute toxicity was noted. These figures contrast sharply with those found for the historical control. All toxicities spontaneously subsided within 3 months after treatment. Continuous PSA reduction was noted in all patients, and no PSA failure was noted during the follow up period. Conclusions: Our data show the feasibility of the CyberKnife in terms of its efficacy and acute toxicity. Moreover, the capability of using a hypo-fractionation schedule lead to marked improvement in patient convenience, with substantial resource savings.

Short-term Morphological and Growth Factor Changes in Rat Bladders Augmented with a Porcine Small Intestinal Submucosa / 대한비뇨기과학회지

PURPOSE: This study was performed to investigate the short-term changes in the morphology and growth factors after the augment of rat bladders with a porcine small intestinal submucosa (SIS). MATERIALS AND METHODS: The experiments were performed in 39 female Sprague- Dawley rats, comprised of 3 controls, 18 sham-operated and 18 SIS-augmented rats. The sham-operated group underwent a primary closure after a longitudinal incision of the bladder. The augmentation cystoplasty was performed using a porcine SIS after a hemi-cystectomy. The rats were postoperatively sacrificed at periods ranging between 12 hours and 14 days, and their bladders procured for histological examination. Reverse transcription-polymerase chain reactions (RT-PCR) were performed to evaluate the expressions of the keratinocyte growth factor (KGF) and the transforming growth factor-alpha (TGF-alpha). RESULTS: Both groups showed an acute inflammatory reaction during the immediate postoperative period, and chronic inflammatory cells appeared 48 hours postoperatively, with new capillaries and fibroblasts appearing 4 days postoperatively. The disrupted urothelial barrier was restored on the 7th postoperative day in the sham group, and epithelialization began to appear on day 4 in the augmented group. New granulation tissue covered the small intestinal submucosa, like a sheet of membrane, by the 4th postoperative day, and its thickness and cellularity increased with time. The mRNA expressions of the KGF and TGF-alpha increased during the initial postoperative period, but tended to derease with time. Their expressions coincided with acute inflammatory reactions. CONCLUSIONS: In conclusion, the short-term morphological changes after the augmentation cystoplasty, with a porcine small intestinal submucosa, were initially composed of acute inflammation, chronic inflammation, fibroblast aggregation, neoangiogenesis, epithelialization and formation of granulation tissue. The mRNA expressions of the KGF and TGF-alpha coincided with acute inflammatory reactions.

Apoptosis of Prostate Cancer by Bax Gene Expression / 대한비뇨기과학회지

PURPOSE: To evaluate the antitumor effect of the proapoptotic Bax gene in prostate cancer cells, in vitro, using a plasmid vector expressing the human Bax gene. MATERIALS AND METHODS: cDNA of the human Bax gene, amplified by RT-PCR, was cloned to pCR@3.1. The expression of the cloned Bax (pCR3.1-Bax) was observed by RT-PCR and Western blot analyses. The efficacy of growth inhibition by the cloned Bax gene was tested, in vitro, on PC-3 and DU145 human prostate cancer cell lines using the MTT assay. Immunoblot analysis for the expressions of Bcl-2 and Bcl-xL were performed. Assays were also performed to evaluate the apoptosis, DNA fragmentation and CPP32. RESULTS: The Bax protein was expressed in the parental PC-3 cells, but not in the DU-145 cells. The expressions of Bax mRNA in the transfected PC-3 and DU-145 cells had increased by 24 hr, and those of Bax protein in the transfected PC-3 and DU-145 cells had increased by 48 and 24 hr, respectively, compared with the control cell lines. The cytotoxicity of pCR3.1-Bax on PC-3 and DU-145 cells increased significantly compared with an empty vector, pCR3.1 (p<0.05, respectively). An increased cytotoxicity of the Bax-transfected cell lines was associated with enhanced apoptosis. The Bcl-2 protein was not expressed in the transfected cells, and the levels of Bcl-xL protein expression in transfected cells were no different to those in the parenteral cells. The Bax/Bcl-xL ratio was increased by the transfection of the Bax expression vector. CONCLUSIONS: Our results show that the cloned Bax-expression plasmid vector efficiently inhibits the growth of PC-3 and DU145 human prostate cancer cell lines. These data suggest that exogenous Bax expression may have therapeutic applications in prostate cancer.

Postoperative Adjuvant Systemic Chemotherapy for Locally Advanced Transitional Cell Carcinoma of the Upper Urinary Tract / 대한비뇨기과학회지

PURPOSE: The outcome of adjuvant systemic chemotherapy, in patients with a locally advanced transitional cell carcinoma of the upper urinary tract, was analyzed. MATERIALS AND METHODS: Between January 1990 and June 2001, a total of 97 patients underwent surgery for a transitional cell carcinoma of the upper urinary tract at our institute. Forty-five had a locally advanced disease (T3, N1, N2, lymphovascular invasion). Of these, 33 patients (chemotherapy group) underwent a median of four courses of cisplatin-based adjuvant systemic chemotherapy (M-VAC in 23, gemcitabine plus cisplatin in seven, CISCA in three), whereas 12 (Observation group) refused chemotherapy. To define possible prognostic factors in these patients, various factors, including age, sex, location, surgical method, pT stage and number of involved lymph nodes, were analyzed using the Cox's regression model. RESULTS: The mean follow-up was 39 months, ranging from 8 to 98 months; the median survival time in the chemotherapy and observation groups were 65 and 31 months, respectively. Five-year disease-specific survival rates in the chemotherapy and control groups were 71.1 and 40.9%, respectively. Of the several factors, adjuvant chemotherapy (p=0.016) and lymph node metastasis (p=0.017) both had prognostic significance. In the chemotherapy group, 21 (63.6%) were given a reduced dose for at least one cycle due to a reduced renal function. However, there was no fatal febrile neutropenia, while cellulitis or grade 3 neutropenia occurred in six patients during the chemotherapy. CONCLUSIONS: Our findings suggest that adjuvant systemic chemotherapy, for a locally advanced transitional cell carcinoma of the upper urinary tract, may lead to a significant prolongation in the survival time.

Carcinoma of the Upper Urinary Tract: Clinical Analysis on Patients during Recent 10 Years / 대한비뇨기과학회지

PURPOSE: We reviewed our experiences, at a single-center, of patients with upper tract urothelial cancer in order to assess treatment outcomes and to determine the prognostic factors of the condition. MATERIALS AND METHODS: We retrospectively reviewed 115 patients, with urothelial tumors of the renal pelvis and ureter, treated at Seoul National University Hospital. The mean age of the patients was 61.1 years, with a mean follow-up of 35.5 months. Traditional prognostic factors, including age, sex, and tumor stage, grade, location, and type of surgical treatment, were analyzed with respect to disease recurrence and survival. RESULTS: Ninety six patients (83.4%) were treated surgically. A nephroureterectomy was performed in 88 patients (91.8%); 74 with bladder cuffing and 14 without. Actuarial 5-year survival rates, by tumor stage, were 100% for Ta, 90% for T1, 76.3% for T2 and 55.6% for T3. From the multivariate analysis, the T (p=0.008), N (p=0.017) and M (p=0.002) stages were significant prognostic factors for survival. A recurrence occurred in 46 (47.9%) patients at a mean of 13.1 months. Recurrent bladder tumors developed in 36.5 and 33.3% of patients treated with conventional nephroureterectomy, with bladder cuffing and other treatments, respectively. CONCLUSIONS: Tumor stage was a unique significant prognostic factor for survival on multivariate analysis and there is no significant difference in recurrence rate of bladder tumor regardless of surgical method. Bladder tumor surveillance should be carefully performed due to the high rates of recurrence in the bladder within 2 years postoperatively.

Carcinoma of the Upper Urinary Tract: Clinical Analysis on Patients during Recent 10 Years / 대한비뇨기과학회지

PURPOSE: We reviewed our experiences, at a single-center, of patients with upper tract urothelial cancer in order to assess treatment outcomes and to determine the prognostic factors of the condition. MATERIALS AND METHODS: We retrospectively reviewed 115 patients, with urothelial tumors of the renal pelvis and ureter, treated at Seoul National University Hospital. The mean age of the patients was 61.1 years, with a mean follow-up of 35.5 months. Traditional prognostic factors, including age, sex, and tumor stage, grade, location, and type of surgical treatment, were analyzed with respect to disease recurrence and survival. RESULTS: Ninety six patients (83.4%) were treated surgically. A nephroureterectomy was performed in 88 patients (91.8%); 74 with bladder cuffing and 14 without. Actuarial 5-year survival rates, by tumor stage, were 100% for Ta, 90% for T1, 76.3% for T2 and 55.6% for T3. From the multivariate analysis, the T (p=0.008), N (p=0.017) and M (p=0.002) stages were significant prognostic factors for survival. A recurrence occurred in 46 (47.9%) patients at a mean of 13.1 months. Recurrent bladder tumors developed in 36.5 and 33.3% of patients treated with conventional nephroureterectomy, with bladder cuffing and other treatments, respectively. CONCLUSIONS: Tumor stage was a unique significant prognostic factor for survival on multivariate analysis and there is no significant difference in recurrence rate of bladder tumor regardless of surgical method. Bladder tumor surveillance should be carefully performed due to the high rates of recurrence in the bladder within 2 years postoperatively.

The Prognostic Significance of Ipsilateral Adrenalectomy during Radical Nephrectomy for Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: To review the result of a radical nephrectomy for renal cell carcinomas and investigate whether an ipsilateral adrenalectomy, during a radical nephrectomy, has a favorable prognostic effect in patients with renal cell carcinomas. MATERIALS AND METHODS: The medical records of 365 patients, who underwent a radical nephrectomy, between January 1995 and December 1999, were retrospectively reviewed. All patients had unilateral renal cell carcinomas, and nephrectomies were performed either with (adrenalectomy group, 193 patients) or without (non-adrenalectomy group, 172 patients) an ipsilateral adrenalectomy. The survival rate was assessed using the Kaplan-Meier method. In conjunction with a univariate analysis, a multivariate analysis was performed, using a Cox regression analysis, to determine the independent prognostic factors. RESULTS: The ages of the adrenalectomy and non-adrenalectomy groups ranged from 21 to 78 (mean age: 54.7 years) and 28 to 77 years (mean age: 54.0 years), respectively. The durations of the follow-up periods in the adrenalectomy and non-drenalectomy groups were 62.4 and 62.6 months, respectively. There were no significant differences in the clinicopathological characteristics, including the T stage, between the two groups. The 3-year survival rates of the adrenalectomy and non-adrenalectomy group were 82.8 and 91.2%, respectively, and the 5-year survival rates were 75.4 and 85.3%, respectively (p=0.095). In the adrenalectomy group, distant metastasis, high T-stage and adrenal involvement were identified as prognostic factors by the multivariate statistical analysis (p=0.002, p=0.008 and p<0.001, respectively). CONCLUSIONS: Our results reveal that an ipsilateral adrenalectomy, during a radical nephrectomy, does not improve the prognosis of patients with renal cell carcinomas.

Effects of Transurethral Alprostadil on Motility Parameters and Acrosomal Reaction of Human Sperm / 대한비뇨기과학회지

PURPOSE: Transurethral alprostadil, newly developed treatment modality for patients with erectile dysfunction, may have untoward effects on human sperm. Although previous studies indicated that remained alprostadil had no significant effects on the motility, viability and membrane integrity of human sperm, the possibility that alprostadil might have roles in sperm hyperactivation and acrosomal reaction still exists. So we have evaluated the effects of alprostadil on motility parameters and acrosomal reaction of human sperm in vitro. MATERIALS AND METHODS: Eight healthy volunteers provided semen samples that were incubated with 0.1mg/ml and 0.4mg/ml of alprostadil which respectively represented similar and exaggerated concentration after transurethral administration. Control incubations included polyethylene glycol 1450, the fomulation vehicle, and Ham's F-10 buffer. Serial evaluations of several computer generated measurements of sperm motion were performed after 30, 60 and 120 minutes of incubation. After 120 minutes, we performed simultaneous fluorescein isothiocyanate labelled Pisum sativum lectin/Hoechst 33258 staining to evaluate acrosomal status. RESULTS: The alprostadil group showed decreases in linearity, increases in amplitude of lateral head displacement, and increased fraction of hyperactivated sperm with statistical significance (ANOVA, p<0.05). The fraction of spontaneous acrosomal reaction was increased significantly in the alprostadil group compared with that of control group without a dose- response relationship. CONCLUSIONS: Alprostadil administration in vitro changed several computer assisted sperm motion analysis parameters and increased spontaneous acrosomal reaction. For further evaluation of the effects of remained alprostadil on sperm and fertility, a well- controlled in vivo study will be needed.

Renal Cell Carcinoma with Deep Vein Thrombosis / 대한비뇨기과학회지

The association between cancer and deep vein thrombosis or pulmonary embolism has been recognized by most clinicians. Adenocarcinoma of the pancreas, female reproductive organs, breast, colon, lung, and prostate have been found to be associated with the highest risk of deep vein thrombosis. However, the isolated deep vein thrombosis is a rare phenomenon in renal cell carcinoma. Only two cases of deep vein thrombosis in renal cell carcinoma were reported in the literature. The tumor thrombi of renal cell carcinoma is found in renal vein and inferior vena cava, with the incidence of 20-49% and 5-10%, respectively. We report two cases of renal cell carcinoma which are associated with the deep vein thrombosis due to the obstruction of inferior vena cava by the tumor thrombi.

Prevalence and Epidemiological Characteristics of Urolithiasis for Adults Aged 40-79 in Seoul, Korea / 대한비뇨기과학회지

No abstract available.

Penile Nomogram in Korean Males / 대한남성과학회지

PURPOSE: The definition of normal penile length is of considerable importance to urologist who is asked to perform penile augmentation surgery, because such knowledge will lead to better counseling about the relation between penile size in the flaccid and erect states and to develop guidelines for penile augmentation. SUBJECTS AND METHODS: Tape measurements of the flaccid and erect penis were obtained to the nearest 0.5 cm in 309 Korean men by a single examiner. Measurements were made of flaccid length and circumference, depth of the prepubic fat pad, and stretched penile length. After full erection had been obtained by self-stimulation or injection of prostaglandin E, penile length and circumference were measured again. RESULTS: The mean flaccid and erectile length were 7.78+/-1.19 cm and 11.88+/-1.32 cm, respectively. The stretched length demonstrated a more predictable relation to erectile length than flaccid length than flaccid length (Pearson correlation coefficient, R=0.648:0.549). Subjects were grouped by age ad over and under 40 years to study the effect of age on fat pad depth, flaccid length, stretched length, and erectile length increase. Only erectile length increase differed significantly, being greater in younger subjects(ANOVA, p=0.03). When the subjects were grouped by flaccid length as short( OR =9 cm), we discovered that a penis that was long in the flaccid state remained long in the erect state. However, there were no statistical differences in erect length among three groups. In other words, we cannot predict the erect length on the bais of the flaccid value. CONCLUSIONS: To define guidelines for penile augmentation, we can choose the cut-off value of 5 cm(flaccid) and 9 cm (erect) based on statistical considerations. Only 1.1% of the patients in our series were below this cut-off value. Thus, it is concluded that only a small number of Korea men should be candidates for penile augmentation.

Effect of Retinoic Acid on Growth and Transduced Tumor Necrosis Factor-alpha Gene Expression of Human Bladder Tumor Cell Lines / 대한비뇨기과학회지

INTRODUCTION AND OBJECTIVES: Retinoic acid (RA) is known as a potent chemopreventive agent in bladder tumor. Recently, RA has gained attention for up-regulation of transduced gene expression via long terminal repeat (LTR) transcriptional promotion. In this study, we investigated the possible dual effect of RA, growth inhibition and up-regulation of transduced gene expression which contains LTR promoter in human bladder carcinoma cell lines. MATERIALS AND METHODS: Human bladder carcinoma cell lines CY-24, J-82, HT-1197, ATCC) were transduced with Moloney murine leukemia virus containing cDNA of TNF-alpha. The growth of transduced and parent cell line was measured by tetrazolium based colorimetric assay (MTF). Transduced TNF-alpha gene expression was determined by ELISA method. RESULTS: TNF-alpha production was increased approximately twofold after treatment with RA (10 uM) in all three cell lines. This increase was dependent on RA concentration. RA treatment of transduced and parent cell line resulted in dose dependent inhibition of cell proliferation(up to 80% inhibitionwith 10 uM RA) in all parental and transduced cell lines. CONCLUSIONS: These results indicate that RA shows dual effect in cytokine gene transduced bladder carcinoma cells with retroviral vector containing LTR promoter and could be a supplement to the gene therapy of bladder cancer.

Ureteroureterostomy for the Management of Iatrogenic Lower Ureter Injury / 대한비뇨기과학회지

Ten cases of lower ureteral injuries resulting from pelvic surgery, all females with an average age of 48.8 years. were treated by a end-to-end ureteroureterostomy at the Seoul National University Hospital between January 1987 and December 1993, Of the patients nine were from gynecologic surgery and one was from general surgery. Only one case was detected intraoperatively and the others were referred post-operatively. A watertight, tensionless, spatulated anastomosis with double J stenting was performed to all as soon as the diagnosis was made. In one patient renal mobilization was necessary because of the long ureteral defect. The mean length of the resected sections of the ureter and the distal ureteral stumps were 26 mm and 27 mm, respectively. The mean duration of followup was 3 years. Good results with no morbidity were achieved in all. Our results suggest that ureteroureterostomy is a good operative method having great success rate in the treatment of lower ureter injury. And it thought be a good alternative to Boari flap or psoas hitch technique when the distal ureteral stump is preserved.

Effect of Tamsulosin, a Selective alpha1A-adrenoreceptor Antagonist, in Benign Prostatic Hyperplasia / 대한비뇨기과학회지

OBJECTIVE: To evaluate the efficacy and safety of tamsulosin, a selective alpha1Aadrenoreceptor antagonist in the treatment of urinary outflow obstruction associated with benign prostatic hyperplasia (BPH) in Korean patients. PATIENTS AND METHODS: The study was a single-blind and randomized design. Tamsulosin, fixed dose of 0.2 mg was taken once daily for 8 weeks. In control group, terazosin, a non-selective c 1-adrcnoreceptor antagonist was administrated with escalating dose of 1 to 5 mg once daily. The study enrolled 98 patients, and 72 patients were included in the analyses at weeks 4 and 8. RESULTS: Both tamsulosin and terazosin had similar significant improvements in subjective and objective symptoms of urinary outflow obstruction (p<0.05). Systolic and diastolic blood pressures decreased significantly in the terazosin-treated patients (p<0.05). Adverse events, most frequently dry mouth and dizziness, usually mild and transient, were observed significantly more in patients on terazosin (18 patients versus I patients on tamsulosin, p<0.001) and led to discontinuation of therapy in two patients on terazosin. CONCLUSION: Tamsulosin, a selective 1A-adrcnorcccptor antagonist, was effective in urinary outflow obstruction associated with BPH. The efficacy of tamsulosin was similar to terazosin, but had a marked better safety profile.

Effect of Retinoic Acid on Proliferation and Invasiveness of PC-3 and DU-145,Hormone Resistant Prostatic Cancer Cell Lines / 대한비뇨기과학회지

We studied the effect of retinoic acid, a potent differentiation inducer, on the proliferation and invasiveness of hormone resistant prostatic cancer cell lines, PC-3 and DU-145. Cellular growth measurement by MTY assay, flow cytometry for cell cycle analysis, Papanicolaou staining for examining the change of morphologic features and in vitro invasion assay using artificial basement membrane, matrigel, were performed under various concentration of all-trans-retinoic acid. Inhibition of cellular proliferation was retinoic acid dose dependent in both cell lines. Decreased S-phase and increased G-1 phase fraction were identified with time dependent manner in both cell lines. Less prominent chromatin and nucleotide, decreased nucleus/cytoplasm ratio were shown in Papanicolaou staining after 7 days culture with 10 uM of retinoic acid. In in vitro invasion assay, PC-3 cells showed decreased netlike formation and penetration though matrigel, and DU-145 cells showed decreased colony formation with 10 uM of retinoic acid. These findings suggest that the retinoic acid could ave the possibility of clinical application in hormone resistant prostatic cancer patients as a new therapeutic modality, differentiation therapy.

Change of MDR Gene Expression and Glutathione Metabolism during Long Standing Low-dose Cisplatin Exposure in Bladder Carcinoma Cell Line / 대한비뇨기과학회지

Resistance to anticancer chemotherapeutic drugs remains a major obstacle in cancer chemotherapy. A variety of mechanisms responsible for drug resistance has been posed. Mdr gene overexpression and detoxification by glutathione are believed to be involved in such mechanisms. Recently, we established two low-dose cisplatin-resistant human bladder cancer cell lines, T24RO.5 and T24R1, which showed resistance at O.5 hg/ml and 1 hg/ml of cisplatin, respectively. The resistance of T24RO.5 and T24R1 cells to cisplatin were 9.4 and 9.37 fold compared to that of the parental T24 cells In this study, we investigated the total glutathione content and p-glycoprotein expression, a mdr gene product, in parent and resistant cell lines to elucidate the drug resistance mechanism to cisplatin. Glutathione content was measured by biochemical method. P-glycoprotein expression was measured by flowcytometry using monoclonal antibody to p-glycoprotein. Glutathione content and p-glycoprotein expression were not different between parental and all resistant cell lines. These results suggest that mdr gene and glutathione do not play a role in cisplatin resistance mechanism in these low-dose cisplatin-resistant cell lines. Further work will be necessary to determine the mechanism of drug resistance in this model.

The Effects and Complications of Transurethral Resection for Benign Prostatic Hyperplasia : Results of Long-term Follow-up / 대한비뇨기과학회지

To evaluate the long-term effect and complications of the transurethral resection of the prostate (TUR-P), we analyzed its results of 404 patients who were followed properly out of 827 patients who underwent TUR-P at Seoul National University Hospital from January 1980 to December 1993. Various pre-existing medical problems were associated in 173 patients(42.8%). The mean weight of the resected tissue was 15.6 grams and the mean operation time was 78.9 minutes with the resection amount per minute of 0.2 gm/min. Improvement of the symptoms was reported in 304 patients(75.2%) postoperatively. International prostate symptom score(IPSS) was 22.6 preoperatively, 15.4 at 3 months, 9.8 at one year and 9.3 at 3 years after TUR-P: Maximum urinary flow rate(MFR) was 9.7 ml/sec preoperatively, 15.5 at 3 months and 15.9 at one year after TUR- P The perioperative mortality rate was 0.4%, and the perioperative complications occurred in 120 patients(29.7%); including 15.8% of bleeding and 2.2% of the transurethral resection syndrome. The morbidity increased significantly with the increasing resection amount and the operation time. But not only age but also pre-existing cardiopulmonary diseases and azotemia did not influence the morbidity. Only age over 80 and preoperative urinary tract infection increased the perioperative morbidity slightly. Late complication developed in 54 patients(13.4%); urinary tract infection in 18 (4.5%), urethral stricture in 16 (4.0%), impotence in 9 (2.2%), urinary in- continence in 5 (1.2%), bladder neck contracture in 4 (1.0%) and bleeding in 2 (0.5%). Persistent voiding difficulties were reported in 100 patients(25.7%), causes were neurogenic bladder in 32, inappropriate indication of TUR-P in 32, and incomplete resection in 18 patients and so on. Repeated TUR-P was done in 16(4.0%) patients.