Epidemiologic Survey Using International Prostate Symptom Score (I-PSS) of Lower Urinary Tract Symptoms (LUTS) in Elderly Men Above 40 Years Old in Seoul Area / 대한비뇨기과학회지

PURPOSE: We tried to determine the prevalence of LUTS and to measure the impact of these symptoms on quality of life (QOL), and to reevaluate the validity of I-PSS in Korea. MATERIALS AND METHODS: A total of 1,356 men ranging from 40 to 79 years old living in Seoul metropolitan area was selected by stepwise random sampling and surveyed with questionnaire including I-PSS. Several risk factors were analyzed to assess the relevance with lower urinary tract symptoms. RESULTS: About 16% had moderate-to-severe LUTS, as assessed by I-PSS more than 7. The prevalence of moderate-to-severe LUTS increased significantly with age (p<0.01); 10%, 16%, 29%, and 45% in the age groups 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years respectively. The most prevalent symptoms were weak stream and nocturia. QOL decreased as urinary symptom severity increased; 5%, 52%, 78% of the men with I-PSS 0 to 7, 8 to 19, and 20 to 35 had poor QOL as assessed by QOL indices more than 2, respectively. A good correlation was found between the total symptom score and the quality of life score that was included in the I-PSS. CONCLUSIONS: Moderate to severe LUTS of elderly men above 40 years old in Seoul metropolitan area are relatively common, and more people suffer from the LUTS as they get older. New modified I-PSS system in Korean elderly men according to the importance of individual symptom in the established I-PSS, will be beneficial in the management of the lower tract symptom associated with BPH.

Immunochemotherapy using Interleukin-2, Interferon-alpha, and 5-fluorouracil for Advanced Renal Cell Carcinoma / 대한비뇨기과학회지

PURPOSE: The role of immunotherapy in the treatment of patients with advanced renal cell carcinoma(RCC) is being evaluated by a number of investigators. In this study, we evaluated the efficacy and toxicity of a low-dose subcutaneous regimen of interferon-alpha(IFN-alpha) in combination with intravenous administration of 5-fluorouracil(5-FU) with or without interleukin-2 (IL-2) in patients with advanced RCC. MATERIALS AND METHODS: 16 patients with advanced RCC were treated with an 8-week cycle of 6 to 9 MU/M2 IFN-alpha given 1 to 3 times a week during the 8 week period, and sequentially combined with 5 to 20 MU/M2 IL-2 given 3 times a week for 4 weeks and 750mg/M2 5-FU once a week for 4 weeks. 5 patients were treated with only IFN-alpha and 5-FU. Treatment schedule was identical except for the exclusion of IL-2 in this group. Among those 16 patients treated with 3-drug regimen(including IL-2), 10 patients had measurable metastatic lesions, and 4 patients had measurable metastatic lesions among 5 patients treated with 2-drug regimen(without IL-2). RESULTS: Among 19 consecutive men and 2 women treated, 14 had measurable metastatic lesion. 10 out of 14 patients with measurable metastatic lesions were treated with 3- drug regimen, and objective tumor regressions were achieved in 4 patients(40%) consisting of complete response in 1(10%) and partial response in the other 3(30%). Metastatic sites were lung in 3 patients, bone in 1 patient. 3 of the 4(75%) patients with pulmonary metastasis showed complete or partial response. Median response duration(complete plus partial response) was 14.3 months(range 11 to 22+). Stable disease lasting 3 months was noted in 1 patients(10%). Other 4 patients out of 14 patients with measurable metastatic lesions were treated with 2-drug regimen, and partial remission lasting 9 months was noted in 1 patient(25%). There were only mild to moderate side effects; maximum toxicity grade of 0 in 10 patients, grade I in 3, II in 7, III in 1 according to the World Health Organization classification. None of the patients experienced major IL-2 related toxicity and no toxic deaths occurred. CONCLUSIONS: This combination immunochemotherapy may be a promising regimen with modest toxicity in advanced RCC. The most favorable response can be expected in pulmonary metastasis. Most of side effects were tolerable. Three-drug regimen including IL-2 showed better response rate than two-drug regimen, suggesting a major role of IL-2. A large prospective randomized trials are required to confirm whether the combination immunochemotherapy has an effect on advanced RCC or not.

Effects of Local Anesthetics on the Intrinsic Nerve and Smooth Muscle in Rat Bladder / 대한비뇨기과학회지

PURPOSE: Local anesthetic effect is thought to be a part of mechanisms of musculotropic agents, and the clinical trials of local anesthetics in the treatment of hyperreflexic neurogenic bladder or in the cystoscopic biopsies have been made, but not much has been uncovered about their exact mechanism of the action on bladder. We attempted to uncover the effects of several local anesthetics on the intrinsic nerve and the smooth muscle of the bladder, and compare the potencies of them. MATERIALS AND METHODS: Male 12 week-old Sprague-Dawley rats(384+/-31gm, n=36) were killed by cervical dislocation and the urinary bladder was immediately obtained. The urinary bladder was dissected free from surrounding tissues and the bladder muscle strips(0.7x1.1x5.6mm) were prepared. The contractile responses were monitored via an FT03 force transducer(Grass) and recorded on a Grass Polyview in 95%O2/5%CO2-bicarbonate solutions. Utilizing electrical field stimulation and carbachol(5.0microM), the inhibitory effect of local anesthetics(lidocaine, bupivacaine, tetracaine) in intrinsic nerves and smooth muscle of the bladder were studied. RESULTS: The contractile response elicited by electrical field stimulation(70V/cm2, 0.8msec duration, 50Hz, trains of 2.5sec every 3 min) in local anesthetics treated Tyrode`s solution were diminished in a dose dependent manner. And their potency was in following order(bupivacaine, tetracaine, lidocaine, IC50=1-10microM) In order to study the effects on the smooth muscle itself, tetrodotoxin(0.3microM) were given to block the intrinsic nerve. After doing this, the contractile response elicited by electrical field stimulation(800msec duration pulse) in local anesthetics treated Tyrode`s solution were diminished in a dose dependent manner. And local anesthetics reduced the maximum contractile response of isolated rat detrusor muscle to carbachol(5microM) in a dose dependent, noncompetitive manner with potency in following order(tetracaine, bupivacaine, lidocaine, IC50=50-500microM). CONCLUSIONS: From these studies, local anesthetics is shown to exert direct inhibitory effect on bladder muscle as well as the intrinsic nerve, and further studies on the exact mechanism of the action on bladder smooth muscle will be needed.

Laparoscopie Nephrectomy and Heminephrectomy in Pediatric Patients / 대한비뇨기과학회지

PURPOSE: Many operative procedures in pediatric urology can be performed by laparoscopy. We report our experiences with laparoscopic nephrectomy and heminephrectomy and evaluate its usefulness in pediatric patients. MATERIALS AND METHODS: Between August 1996 and December 1997, a total of 10 children aged between 2 and 9 years underwent laparoscopic renal surgeries in Seoul National University Hospital. The laparoscopic nephrectomy (including nephroureterectomy) was performed in 8 patients(4 multicystic kidneys, 2 dysplastic kidneys associated with ectopic ureter, 2 nonfunctioning kidneys associated with vesicoureteral reflux), and heminephrectomy was done in the other 2 patients(duplex kidney). RESULTS: All laparoscopic nephrectomies were completed as planned. Operative time ranged 120 to 300 minutes(mean 180 minutes) and there were no intraoperative or postoperative complications. Oral intake and mobilization were started from postoperative one day and the patients had hospitalized for an average 3.6 days. Laparoscopic heminephrectomy in one patient was performed successfully. Total operative time recorded 240 minutes and there were no intraoperative or postoperative complications. But the other patient experienced bleeding from the injured upper pole artery and subsequent conversion to an open surgery was needed. CONCLUSIONS: Laparoscopic nephrectomy in children is feasible as its morbidity and complication rate are low. Laparoscopic heminephrectomy is thonght to be a technically demanding procedure, requiring more experience.

99mTc-DMSA Renal Scan after Anti-reflux Surgery in Children with Primary Vesicoureteral Reflux / 대한비뇨기과학회지

PURPOSE: 99mTc-dimercaptosuccinic acid(DMSA) renal scintigraphy is recognized as the most effective imaging modality for demonstrating renal scarring In children with vesicoureteral reflux. We determined if significant numbers of new scar develop and progression of scarring occur after antireflux surgery. MATERIALS AND METHODS: Retrospective study was undertaken In a series of 102 reflux renal units out of 60 children(male 35, female 25) with vesicoureteral reflux as documented by voiding cystourethrography, whose age was 28(median, range:1-150) months. We carefully examined DMSA renal scans taken in 2(median, range:0.3-58) months before operation and 18(median, range:3-62) months after operation in each patients. Twenty two children(37 renal units) were further followed up by additional scans up to 50(median, range:25-120) months postoperatively. Each scan was blindly reviewed twice in terms of the size, number and zonal location of the cortical defects based on morphology. The Interval changes were categorized into 3 patterns(improved, no change, progressed) based on the review findings RESULTS: There were no patients with postoperative pyelonephritis but asymptomatic bacteriuria were found in 19 patients(31.5%). Most(57 patients, 109 renal units) of the antireflux operation were done by Cohen method and refluxes were still found in 8 renal units(7.8%) in immediately postoperative periods and were ultimately disappeared. No postoperative urethral obstruction was found on intravenous pyelogram. On follow-up renal scintigraphy most of renal units(89, 87.3%) showed no change while 11(10.7%) showed improvement and progression was observed In 2(2.0%). No correlation was established between scintigraphic change and several clinical factors such as sex, age of first pyelonephritis presentation, presence or frequency of pyelonephritis before initial renal scan , nor postoperative episodes of urinary tract infection. CONCLUSIONS: Our results show that on the contrary to the most of the previous reports, no further development of renal scar was found after successful surgery. There was no significant morphologic change in the postoperative follow-up renal scan in most of reflux and if any, most were disappearance or diminution of renal scars.

Self Therapy with Sertraline as Needed Basis in Treatment of Premature Ejaculation: Short Term Follow-up Results / 대한비뇨기과학회지

PURPOSE: Pharmacotherapy using selective serotonin reuptake inhibitors(SSRls) for men with primary premature ejaculation(PE) is promising. Specially, a strategy taking a pill "as needed" may offer an attractive option. To investigate the possibility of self therapy, patients treated for PE with sertraline "as needed" basis were evaluated. MATERIALS AND METHODS: Since 1996 we have treated 24 males with sertraline "as needed" basis for primary PE. We chose sertraline among SSRIs because alarge dose need not to be divided and peak plasma levels occurring 4-8 hours after oral administration makes 5 p.m. suitable for the time of administration. Five p.m. is the time the ordinary men usually fix their evening schedule including intercourses. Each patient was started on 50mg qd for 2 weeks and then the dose was adjusted to 50 or 100mg only on the day of intercourse. RESULTS: After 6 weeks, 18 men continued to take medication and 6 had dropped out. Of 18 men, mean ejaculation latency were 23 +/-19sec before treatment, 5.9 +/-4.2min after 2wks 50mg qd, 5.1 +/-3.8min after 2wks 50/100mg pm and 4.5 +/-2.7min after 4wks 50/100mg prn and mean sexual satisfaction scores ('5"=extremely satisfied, "0"=extremely unsatisfied) of men were 0.8 +/-0.8 before treatment, 3.8 +/-1.2 after 2wks 50mg qd, 3.4 +/-1.0 after 2wks 50/100mg pm and 3.2 +/-0.7 after 4wks 50/100mg pm. And mean sexual satisfaction scores of partners were 1.1 +/-0.7 before treatment, 3.2 +/-1.6 after 2wks 50mg qd,3.1 +/-1.4 after 2wks 50/100mg pm and 3.3 +/-1.2 after 4wks 50/100mg pm. Side effects were intermittent excessive delay in 1 patient, fatigue in 2 patients, numbness in 1 patient. CONCLUSIONS: If our results were supported by additional clinical long term study, self therapy with sertraline given pm at 5 pm in treatment of PE could be as attractive as self injection therapy in the treatment of erectile dysfunction.