Assessment of Bacterial Communities Within the Biofilm of Bladder Calculi in the Neurogenic Bladder Rat Model Following Spinal Cord Injury / 대한배뇨장애요실금학회지

Purpose@#To develop a rat model of bladder calculi in the neurogenic bladder following spinal cord injury (SCI) and assess bacterial communities within the biofilm of bladder calculi using denaturing gradient gel electrophoresis (DGGE). @*Methods@#The silk tied to a small segment of the Teflon IV catheter was implanted through the urethra into the bladder of rats with SCI induced by T9 laminectomy. After 6 months, the rats were sacrificed and their bladder calculi were collected by opening the bladders through the low-midline incision. Genomic DNA was extracted from the biofilm of bladder calculi followed by DGGE to obtain bacterial DNA. The DNA sequences were compared and analyzed using BLAST (Basic Local Alignment Search Tool) to identify bacteria. @*Results@#After placing silk nidus in the bladder for 6 months, all 6 rats developed bladder calculi. According to DGGE analysis, Pseudomonas aeruginosa was the most dominant strain, while Clostridium sp. and Lactobacillus sp. were relatively dominant strains within the biofilm of bladder calculi in the rats with SCI. @*Conclusions@#DGGE analysis showed various microorganisms in the biofilm of calculi arising from a neurogenic bladder rat model. This research design can be the basis for clinical studies and may be applied to calculi in patients with neurogenic bladder following SCI.

Effect of the Sodium-Glucose Cotransporter 2 Inhibitor, Dapagliflozin, on Genitourinary Infection in an Animal Model of Type 2 Diabetes / 대한배뇨장애요실금학회지

Purpose@#To investigate the effect of dapagliflozin, a sodium-glucose cotransporter 2 inhibitor, on inflammatory cytokines of urogenital tissue in a rat model of type 2 diabetes (T2DM) to infer pharmaceutical influence of dapagliflozin on genitourinary infection or inflammation. @*Methods@#Study animals were divided into the following 4 groups of 10 animals each: (1) the Otsuka Long-Evans Tokushima Fatty (OLETF)-DA group treated with dapagliflozin at 1.0 mg/kg/day, (2) the OLETF-VO group treated with voglibose at 0.6 mg/kg/day, (3) the control group (OLETF-CO) given water, and (4) the Long-Evans Tokushima Otsuka (LETO) rats were included as nondiabetic control group. Changes in blood glucose, 24-hour urine volume, and urine glucose were measured. The interleukin-1β (IL-1β) and interleukin-18 (IL-18) levels in the bladder and the urethra were quantified, respectively. @*Results@#The urine glucose level and the 24-hour urine volume at 12 weeks of treatment were significantly higher in the OLETF-DA group than that in any other group (P<0.05). The cytokine analysis of the bladder and urethra showed higher IL18 and IL-1β in the OLETF-DA and the OLETF-CO groups than that in the OLETF-VO and LETO groups (P<0.05). The cytokine levels did not differ between the OLETF-DA and the OLETF-CO groups, and the level of IL-18 in the OLETF-DA group was higher in the urethra than in the bladder. @*Conclusions@#This study revealed that dapagliflozin increased the urine glucose concentration, resulting in an inflammatory response remain in the urogenital tract as the untreated diabetic rats. Therefore, when treating patients with T2DM with dapagliflozin, careful attention should be paid to genitourinary infection or inflammation.

Subtle Dysphagia as an Initial Presentation of Hidden Malignancy: A Report of 2 Cases / 대한연하장애학회지

Subtle dysfphagia, which is increased post-swallowing remnants, is a frequent finding in the elderly with various etiologies. These changes in swallowing are frequently overlooked by physicians. On the other hand, subtle changes evident on a videofluoroscopic swallowing study (VFSS) may suggest hidden disease. Therefore, clinicians should evaluate incidental dysphagia. Case 1: A 65-year-old man with no relevant medical history, presented with dysphagia and residual sensation during meals. VFSS showed moderate post-swallowing remnants in the vallecular fossa and pyriformis sinus. Further examination revealed prostate cancer with multiple bone metastases including the skull. Case 2: A 60-year-old man complained of residual sensation after swallowing, which started 2 months ago. He had a history of lung cancer. Pharyngeal residue was observed on VFSS. A brain metastasis was observed on MRI. Post-swallowing residue is often neglected or overlooked by clinicians who regard them as the features of aging. The present cases show that mild dysphagia with increased post-swallowing remnants may be an initial presentation of a hidden malignancy with metastasis. Physicians should consider unexplained dysphagia or tongue atrophy as possible initial presentations of hidden malignancies.

Prevalence and Antimicrobial Susceptibility of Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum in Individuals With or Without Symptoms of Genitourinary Infections

BACKGROUND: The aim of this study was to determine the prevalence and antimicrobial susceptibility of Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum among patients displaying symptoms of genitourinary infections and asymptomatic volunteers. METHODS: Genitourinary samples were collected from 897 participants (365 symptomatic patients and 532 asymptomatic volunteers). The samples were analyzed using multiplex real-time PCR (Anyplex™ II, Seegene, Korea), multiplex PCR (Seeplex®, Seegene), and Mycoplasma IST 2 Kit (bioMerieux, France). RESULTS: The prevalence of M. hominis, U. urealyticum, and U. parvum in the genitourinary samples of symptomatic patients compared with asymptomatic volunteers was 9.9% vs. 5.5%, 12.3% vs. 9.0%, and 36.4% vs. 30.8%, respectively. After eliminating cases of co-infections with other pathogens, there was a significant difference in the prevalence of M. hominis between symptomatic patients and asymptomatic volunteers (9.1% vs. 5.2%, P<0.05), but not in the prevalence of U. urealyticum and U. parvum organisms. When tested for antimicrobial susceptibility, more than 95.5% of each species were susceptible to tetracycline, doxycycline, josamycin, and pristamycin. More than 78.9% of Ureaplasma spp. were susceptible to azithromycin, erythromycin, and clarithromycin; however less than 4.2% of M. hominis were susceptible to these antibiotics. When tested with ofloxacin and ciprofloxacin, 40.9-58.9% and 9.1-25.0% of the three species were susceptible to these drugs, respectively. CONCLUSIONS: M. hominis is the leading causative pathogen for genitourinary infection; however the involvement of Ureaplasma spp. is debatable. For optimal antimicrobial therapy, the accurate detection of these organisms and determination of antimicrobial susceptibility is crucial considering their diverse antimicrobial susceptibility patterns.

Microbiological Characteristics of Acute Prostatitis After Transrectal Prostate Biopsy

PURPOSE: We aimed to identify microbiological characteristics in patients with acute prostatitis after transrectal prostate biopsy to provide guidance in the review of prevention and treatment protocols. MATERIALS AND METHODS: A retrospective analysis of medical records was performed in 1,814 cases who underwent prostate biopsy at Seoul St. Mary's Hospital and St. Vincent's Hospital over a 5 year period from 2006 to 2011. Cases in which acute prostatitis occurred within 7 days after the biopsy were investigated. Before starting treatment with antibiotics, sample collections were done for culture of urine and blood. Culture and drug susceptibility was identified by use of a method established by the Clinical and Laboratory Standards Institute. RESULTS: A total of 1,814 biopsy procedures were performed in 1,541 patients. For 1,246 patients, the procedure was the first biopsy, whereas for 295 patients it was a repeat biopsy. Twenty-one patients (1.36%) were identified as having acute bacterial prostatitis after the biopsy. Fifteen patients (1.2%) had acute prostatitis after the first biopsy, and 6 patients (2.03%) experienced acute prostatitis after a repeat biopsy. Even though the incidence of acute bacterial prostatitis was higher after repeat biopsy than that after the first biopsy, there was no statistically significant intergroup difference in terms of incidence (chi2=1.223, p=0.269). When the collected urine and blood samples were cultured, Escherichia coli was found in samples from 15 patients (71.4%), Klebsiella pneumoniae in 3 patients (14.3%), Enterobacter intermedius in 1 patient (4.8%), E. aerogenes in 1 patient (4.8%), and Pseudomonas aeruginosa in 1 patient (4.8%). A fluoroquinolone-resistant strain was confirmed in 5 cases (23.8%) in total. Three cases of E. coli and 1 case of Klebsiella had extended-spectrum beta-lactamase activity. CONCLUSIONS: Empirical treatment of acute prostatitis should be done with consideration of geographical prevalence and drug resistance. This study will provide meaningful information for the management of acute prostatitis after transrectal prostate biopsy.

Safety and Efficacy of Bearxat(R)XL Tablet (alfuzosin 10 mg) in Patients with Benign Prostatic Hyperplasia: A Prospective Multicenter Study of Primary Care Clinics / 대한남성과학회지

PURPOSE: A prospective multi-center study was conducted to evaluate the safety and efficacy of alfuzosin (10 mg), for male lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) in primary care clinics. MATERIALS AND METHODS: Three hundred twenty-four patients with complaints of LUTS associated with BPH were enrolled from 17 clinics. Patients received a 12-week course of 10 mg alfuzosin (Bearxat(R)XL Tablet) once daily, and underwent follow-up at 2~4 and 12 weeks post-treatment. The maximum flow rate (Qmax) and residual urine volume (RUV) were measured at each visit. The International Prostate Symptom Score (IPSS), Quality of Life (QoL), and International Index of Erectile Function (IIEF-5) were evaluated at baseline and post-treatment. During the study period, the presence of orthostatic hypotension was evaluated by blood pressure measurement before and after a postural change. Any adverse effects of alfuzosin including retrograde ejaculation were assessed. RESULTS: Of the 324 enrolled patients, 62 (19.1%) patients dropped out and a total of 262 patients were evaluated. Each value of Qmax, RUV, IPSS, QoL, and IIEF-5 was significantly improved from 14.19+/-8.85 ml/sec, 41.10+/-81.44 ml, 18.04+/-7.36, 3.81+/-0.86, and 11.75+/-6.91, respectively, at baseline, to 15.68+/-6.25 ml/sec, 24.29+/-29.46 ml, 12.19+/-5.59, 2.54+/-0.91, and 12.33+/-7.55, respectively, at end-point. Retrograde ejaculation was found in 2 patients (2/255, 0.78%) at 2~4 weeks and 1 patient (1/152, 0.66%) at 12 weeks. The frequency of orthostatic hypotension was 13.27% (30/226) at baseline, 13.11% (27/206, p=0.8658) at 2~4 weeks, and 14.29% (19/133, p=0.8348) at end-point. The number of patients with adverse events was 36 where the number of adverse events was 60. Among those 60 adverse events, 8 events were related to treatment, which consisted of headache (2), dizziness (2), palpitation (1), voiding difficulty (1), erectile dysfunction (1), and arthralgia (1). CONCLUSIONS: Treatment with alfuzosin (10 mg) once daily led to significant improvements in LUTS associated with BPH and QoL in primary care clinic patients. alfuzosin (10 mg) use resulted in few hypotensive events, no deleterious effect on sexual function, and no drug related SAEs during the study. The study findings suggest that alfuzosin (10 mg) can be safely prescribed in primary care clinics for male LUTS with efficacy.

The Prevalence and Characteristic Differences in Prostatic Calcification between Health Promotion Center and Urology Department Outpatients

PURPOSE: We evaluated the differences in calculi characteristics and their prevalence according to the presence of lower urinary tract symptoms between adult patients examined at the Urology Department and those examined at the Health Promotion Center (HPC). MATERIALS AND METHODS: The prevalence of prostatic calcification, characteristics of calculi (number, size, and location), and differences in lower urinary tract symptoms were compared and analyzed for 479 subjects who underwent transrectal ultrasonography at the HPC and the Urology Outpatients Department at our hospital from October 2009 to October 2010. RESULTS: Of 479 subjects, 268 patients were examined at the HPC, and 211 were examined at the Urology Outpatients Department. Between the two groups, age, prostate-specific antigen levels, prostate volume transrectal ultrasonography, International Prostate Symptom Score (total, voiding, and storage), quality of life, and the prostatic calcification rate were significantly higher in the patients who visited the Urology Outpatients Department. The prevalence of prostatic calcification was 41.5% (199/479), with 36.1% (97/268) from the HPC and 48.3% (102/211) from the Urology Outpatients Department. When the characteristics of prostatic calcification were compared, there were no significant differences in the appearance, size, or location of the calculi between the two groups. CONCLUSIONS: The prevalence of prostatic calcification was high in patients complaining of lower urinary tract symptoms; however, there were no significant differences in the characteristics of the calculi. This finding leads us to believe that prostatic calcification can aggravate lower urinary tract symptoms but does not result in differences according to the number, size, or appearance of the calculi.

A survey on the clinical practice and the guidelines for sexually transmitted infections in Korea

Every year 150 million new cases of sexually transmitted infection are expected to occur around the world with high occurrence and morbidity rates in both males and females. To respond to dramatically changing social and cultural environments, clinical treatment guidelines for diagnosis, treatment, and prevention of sexually transmitted infections have been developed in many countries, and South Korea has also prepared treatment guidelines which can be used in medical institutions treating primarily these diseases. Against this background, this study conducted a 31-item questionnaire survey by mail and e-mail to investigate the actual clinical practices of physicians treating sexually transmitted infections. In total, 250 and 1,068 questionnaires were distributed through mail and e-mail, respectively, and 274 of them were completed and returned for a response rate of 20.8%. According to the results, physicians' actual clinical practices were found to be different from textbook guidelines to some degree. Therefore, treatment guidelines that take into account the current situation for sexually transmitted infections should be developed in Korea, and a foundation for national management of the diseases should be established through active advertisements.

Correlation between Serum Testosterone and Lower Urinary Tract Symptoms in Men with Hypogonadism Symptoms / 대한남성과학회지

PURPOSE: We performed this study to estimate the correlation of serum testosterone and lower urinary tract symptom (LUTS) in adult hypogonadism patients. MATERIALS AND METHODS: Medical records of ninety men over forty years old who have LUTS, International Prostate Symptom Score (IPSS) above 7 were reviewed. The correlations of serum testosterone level withage, International Prostate Symptom Score (IPSS), prostate volume, prostate specific antigen (PSA) and maximal flow rate were assessed using Spearman test. The statistical differences of IPSS, prostate volume, PSA and maximal flow rate in 3 groups of patients divided by serum testosterone levels(3.5 ng/ml). RESULTS: Serum testosterone level decreased according to increase of age (r=-0.28, p=0.07). Serum testosterone has no significant correlation with IPSS, prostate volume, PSA and maximal flow rate. There was no significant difference of IPSS, prostate volume, PSA and maximal flow rate according to the levels of testosterone. CONCLUSIONS: Emerging from this analysis, clinical indexes of LUTS may not be connected with testosteronelevel and LUTS may not be affected by hypogonadism. Further more objective and sophisticated studies with large number of subjects are requested for the understanding of pathophysiology of LUTS in hypogonadism.

Laparoscopic Radical Nephrectomy: Results and Oncological Outcome / 대한비뇨기과학회지

Purpose: A laparoscopic radical nephrectomy is known to cause less morbidity than a traditional open radical nephrectomy. In our institution, the laparoscopic approach, with intact specimen removal, has become the standard technique for radical nephrectomies. Herein, we report the results and oncological outcome of the experience of a single center. Materials and Methods: We reviewed 68 transperitoneal laparoscopic radical nephrectomies, performed for suspected renal cell carcinoma between December 1999 and June 2006. All data were collected from the patient's medical records. Results: The mean tumor size, surgical time and estimated blood loss were 4.82cm (1.7-14), 228.5 min (120-480) and 409.1cc (32-1,312), respectively. Conversion to open surgery was required in one case due to Endo-GIA malfunction, and conversion to hand-assisted surgery was performed in one case. The histological findings were pT1, pT2 and pT3 in 40 (59.7%), 9 (13.4%) and 18 patients (26.9%), respectively. In one case, the histology confirmed a non-malignant disease. The follow-up period was from 3 to 80 months (median 18). Distant metastasis was observed in 2 cases, but there was no local recurrence or port metastasis. Conclusions: A laparoscopic radical nephrectomy is a safe and feasible treatment for localized renal cell carcinomas. Longer follow-up and large scale studies are necessary to evaluate the long-term survival and disease- free rates, and confirm the effectiveness of performing a radical laparoscopic nephrectomy.

Anticancer Activity of Intravesical Glyceryl Monooleate (GMO)-Paclitaxel Therapy in Murine Superficial Transitional Cell Carcinoma Model Induced by BBN / 대한비뇨기과학회지

Purpose: Paclitaxel, on systemic administration, is widely known to be effective in the treatment of bladder cancer. However, the intravesical use of paclitaxel has not been attempted because of its liposolubility and direct toxicity to the bladder mucosa. The purpose of this study was to evaluate the efficacy and toxicity of paclitaxel-loaded glyceryl monooleate (GMO) in the intravesical treatment of superficial bladder cancer, by enhancing its bioadhesiveness and bioavailability. Materials and Methods: 12 mice were divided into two groups, and bladder carcinomas induced by the addition of 0.05% BBN to their drinking water for 12 weeks. Group 1 received an intravesical instillation of 0.1ml GMO-paclitaxel-free buffer and Group 2 an intravesical instillation of 0.1ml GMO-paclitaxel. On day 21, the tumor incidence, bladder weight and toxicity were evaluated. Results: The incidence of cancer in groups 1 and 2 were 83 and 17%, respectively. The incidence of cancer was significantly reduced in group 2 compared to group 1 (p<0.05). There was a tendency for the average bladder weight in group 1 to be heavier than that in group 2, but there was no significant difference (p=0.375). There were no liver, kidney or bone marrow toxicities in either group. Conclusions: Intravesical GMO-paclitaxel therapy may have an inhibitory effect on the growth of superficial bladder cancer in a BBN-induced bladder cancer model; therefore, it could potentially be used in those patients showing little to no response to intravesical Bacillus Calmette- Guerin (BCG) or other anticancer drug therapies.

A Fibrotic Nodule in the Corpus Cavernosum / 대한비뇨기과학회지

Fibrotic lesions occurring in the corpus cavernosum are usually cases of Peyronie's disease that originate from the tunica albuginea, or they are the fibrotic result of inflammatory processes. The lesion involving the corpus cavernosum, but not tunica albuginea is rare. We present here a case of fibrotic nodule arising in the corpus cavernosum with the sonographic and magnetic resonance imaging features. A 38-year-old man complained a small nodular mass in the left corpus cavernosum at the level of penoscrotal junction without abnormal curvature of the organ. We performed ultrasonography and magnetic resonance imaging to determine exactly what the lesion was. The lesion was removed and it was pathologically found to be a localized fibrotic nodule of the corpus cavernosum with some narrow-channeled vascular structures.

Superficial Thrombophlebitis of the Dorsal Vein of the Penis (Penile Mondor's Disease) / 대한비뇨기과학회지

Herein, two cases of penile Mondor's disease are described. The first was a 45-year-old man who complained of a small subcutaneous induration, with localized discomfort at the distal rim of the coronal sulcus of the penis. The other was a 46-year-old man who complained of similar symptoms of penile induration. The lesions were surgically removed under local anesthesia, and found to be thromboses of the penile superficial dorsal vein. As a result, the diagnoses of Mondor's disease of the penis were confirmed.