Microbiological Features and Clinical Factors Associated with Empirical Antibiotic Resistance in Febrile Patients with Upper Urinary Tract Calculi

Background@#To investigate the clinical and microbiological features of febrile patients with upper urinary tract calculi and factors that affect empirical antibiotic resistance. @*Methods@#A retrospective analysis was performed on 203 febrile patients hospitalized between January 2011 and December 2016 with antibiotic treatment for urinary tract infections and upper urinary tract calculi at three institutions. We collected and analyzed data, including patients' age, sex, body mass index, underlying diseases, stone-related factors, and the results of urine and blood culture examinations and antibiotic sensitivity tests. @*Results@#The male-to-female ratio was 1:2.3. Bacteria were identified in 152 of the 203 patients (74.9%). The most commonly cultured microorganisms included Escherichia coli (44.1%), followed by Enterococci spp. (11.8%), Proteus spp. (8.6%), Streptococcus agalactiae (6.6%), Klebsiella spp. (5.3%), Pseudomonas spp. (4.6%), coagulase-negative Staphylococcus (4.0%), Staphylococcus epidermidis (4.0%), Serratia spp. (2.6%), Enterobacter spp. (0.7%), Acinetobacter spp. (0.7%), and mixed infections (7.2%). Cultured bacterial species showed sex-specific differences. Multivariate analysis revealed that calculi's multiplicity was an independent predictive factor for quinolone resistance (P = 0.008). Recurrent infections were a significant predictor of cefotaxime resistance during multivariable analysis (P = 0.041). @*Conclusion@#Based on the present study results, quinolone was not recommended as the empirical treatment in febrile patients with upper urinary tract calculi. Combination antibiotic therapy is recommended in cases of recurrent infections due to the possible occurrence of cefotaxime resistance.

A Perirenal Abscess Recurring with Methicillin-Resistant Staphylococcus Aureus and Mycobacterium Tuberculosis Co-Infection after Treatment of Escherichia Coli Infection: A Case Report / 대한신장학회지

Renal and perirenal abscesses are disease entities caused by infections in or around the kidneys. As imaging modalities have improved in quality and convenience, diagnosing these diseases has become easier. Some cases are refractory to conventional treatment and require surgical correction, although most patients can be cured by antibiotic treatment and percutaneous drainage. We here report the case of a patient with a perirenal abscess that recurred twice after appropriate antibiotic treatment and percutaneous drainage. Although Gram-negative bacilli are the most common pathogenic cause of these diseases, we isolated methicillin-resistant Staphylococcus aureus and Mycobacterium tuberculosis in our patient. Thus, poor responses to appropriate treatment in patients with a perirenal abscess can result not only from antimicrobial resistance or a co-infection but also from the 2 conditions existing concomitantly.

Comparison of Different Alpha-blocker Combinations in Male Hypertensives with Refractory Lower Urinary Tract Symptoms / 대한남성과학회지

PURPOSE: We compared the efficacy and safety profiles of dose increase, traditional combination methods, and combining different alpha blockers in hypertensive males with lower urinary tract symptom (LUTS) refractory to an initial dose of 4 mg doxazosin. MATERIALS AND METHODS: Between 2000 and 2005, 374 male patients with LUTS and hypertension unresponsive to 4 weeks of 4 mg doxazosin were enrolled. The subjects were randomly classified into 3 groups, 8 mg/day of doxazosin (D group), 4 mg of doxazosin plus 0.2 mg/day of tamsulosin (DT group), and 4 mg doxazosin plus 5 mg/day finasteride (DF group). Patients were evaluated based on their International Prostate Symptom Score (IPSS), quality of life (QOL), uroflowmetry and blood pressure (BP) and adverse events (AEs) at the baseline and 3 and 12 months after treatment. RESULTS: The 269 patients (71.9%) were followed for at least 1 year (D group n=84, DT group n=115, and DF group n=70). The clinical parameters before and after initial 4 mg/day doxazosin were not different among the 3 groups. IPSS improvement after 3 months and maximal flow rate (Qmax) improvement after 3 and 12 months were significantly higher in the D and DT groups than the DF group (p<0.05). Sitting systolic and diastolic BP of the D group decreased larger than those of the other 2 groups (p<0.05). At least one of the AEs was reported by 29.0%, 19.3%, and 17.3% of patients in the D, DT, and DF groups, respectively. In particular, vasodilatory AEs of the D group (28.2%) were higher than those of other groups (p<0.05), and sexual function AEs of the DF group (10.9%) were higher than those of other groups (p<0.05). CONCLUSIONS: Doxazosin 4 mg plus tamsulosin 0.2 mg has comparable efficacy but less vasodilatory AEs than doxazosin 8 mg, and has superior efficacy to but comparable vasodilatory AEs to 4 mg doxazosin plus 5 mg finasteride in hypertensive male LUTS patients.

The Risk Factors for Increased Post-Voiding Residual Urine Volume after Long-Term Anticholinergic Therapy in Patients with Benign Prostatic Hyperplasia and Overactive Bladder

PURPOSE: Adding anticholinergics to the treatment regimen of benign prostatic hyperplasia (BPH) patients with overactive bladder (OAB) elicits concern about deterioration of obstructive symptoms and the possibility of urine retention. We evaluated the risk factors increasing post-voiding residual (PVR) volume with long-term anticholinergics therapy of over 1 year in patients with BPH and OAB. MATERIALS AND METHODS: We selected patients with BPH and OAB from 2005 to 2007 who were more than 40 years old, were treated with alpha-blockers, had an International Prostate Symptom Score (IPSS) of 8 or more, and had an IPSS urgency score of 2 or more for OAB. The 98 patients selected were evaluated by age, diabetes mellitus, central nervous system (CNS) disease above the brain stem, prostate volume, uroflowmetry, PVR volume, prostate-specific antigen (PSA) level, and IPSS retrospectively. We evaluated risk factors for increasing PVR volume over 50 ml and 100 ml after treatment and analyzed the risk factors both univariately and multivariately. RESULTS: Age, diabetes mellitus, CNS disease, PSA level, prostate volume, initial PVR volume, peak urine flow rate ( or=65 years), initial PVR (> or=50 ml), long-term therapy with anticholinergics of over 1 year, and CNS disease appear to be risk factors for increasing PVR volume over 100 ml in patients with BPH and OAB.

A Diagnostically Challenging Case of an Infarcted Adenomatoid Tumor of the Epididymis

We describe a case of an infarcted adenomatoid tumor of the epididymis that was challenging to diagnose. A 20-year-old man presented with acute left scrotal pain. He was found to have a 2x1.5x1 cm tumor that was relatively well circumscribed on gross examination. There was a central necrotic area that exhibited gaping spaces and ghost outlines of epithelial cells. The periphery of the necrotic lesion showed focally viable adenomatoid tumor. The majority of the tissue adjacent to the necrosis consisted of granulation tissue, fibroblastic and myofibroblastic proliferation, and neutrophils. The fibroblasts and myofibroblasts showed plump nuclei, often with small nucleoli. No mitotic activity was present. The differential diagnosis for an infarcted adenomatoid tumor includes malignant mesothelioma, inflammatory myofibroblastic tumor, and inflammatory conditions. The key to diagnosing an infarcted adenomatoid tumor is to consider it in the differential diagnosis of any spindle cell tumor with necrosis occurring in the genital tract.

Prostate Safety of Androgen Replacement Therapy Focusing on Prostate Specific Antigen / 대한남성과학회지

Purpose: The greatest concern in the androgen replacement therapy (ART) is the possible side effects to the prostate. We evaluated the effects of ART focusing on the prostate specific antigen (PSA). Materials and Methods: From 2003 to 2006, 47 patients 44 to 75 years old (mean age 60.1) received ART. At baseline and after ART, digital rectal examination, serum testosterone and PSA measurement and transrectal ultrasonography were evaluated. Mean follow-up was 7.9 months (range 1 to 41). Patients were classified into two groups based on the initial PSA level, as PSA levels of 2.5 ng/ml or greater (group 1) (n=29) and PSA levels of less than 2.5 ng/ml (group 2) (n=18). Results: ART significantly increased serum testosterone, PSA and free PSA levels. However, prostate volume did not change significantly. When serum PSA was compared, the increase of PSA levels was greater than in high PSA group (group 1) than in group 2, although the ratio between the two groups in PSA increase was 38.3% for group 2 and 18.2% for group 1, respectively. A total of 4 patients (16.7% of group 1 and 3.4% of group 2) with a serum PSA level greater than 4 ng/ml after ART underwent a prostate biopsy but no patients were found to have prostate carcinoma. Conclusions: Rates of PSA elevation (>4 ng/ml) and prostate biopsies were higher in patients with high baseline PSA level (> or =2.5 ng/ml) than in those with PSA level less than 2.5 ng/ml who received ART. However, our findings suggest that an increased risk of prostate cancer was not associated with ART.

A Prostate Neoplasm Distantly Metastasized to the Unilateral Ureter / 대한비뇨기과학회지

Neoplasms of the prostate usually metastasize to pelvic lymph nodes or bone, or directly invade the adjacent pelvic organs. Ureteral metastasis of a prostatic carcinoma, without ascending spread along the ureter, is very rare, with only a few having been reported from autopsy series. Herein, the case of a prostatic carcinoma, distantly metastasized to the unilateral ureter, is reported.

The Effect of Lower Urinary Tract Symptoms on Erectile Function and the Frequency of Sexual Intercourse / 대한비뇨기과학회지

PURPOSE: Lower urinary tract symptoms (LUTS) usually co-exist with erectile dysfunction. Although the mechanisms for this are still unknown, there seems to be a correlation between the two diseases. We evaluated the effect of lower urinary tract symptoms on the erectile function and the frequency of sexual intercourse. MATERIALS AND METHODS: 1,216 patients, who visited our hospital due to LUTS from January 2000 to April 2006, were evaluated for their erectile function with using International Index of Erectile Function-Erectile Function (IIEF-EF) domain score, frequency of sexual intercourse per month during the last 3 months, prostate volume, International Prostate Symptom Score (IPSS) and quality of life (QoL). The patients were divided into five groups according to age: younger than 40, 40-49, 50-59, 60-69 and older than 70. The patients were again divided into three group according to IPSS: mild (0-7), moderate (8-19) and severe (20-35). Multiple regression analysis and two-way ANOVA were used to analyze the data. RESULTS: 772 patients were eligible for the analysis. The mean patient age was 53.6+/-12.6 years, the mean IPSS was 13.8 9.2 and the mean IIEF-EF score was 17.0+/-9.4. Among the age and LUTS parameters, only age and IPSS had significant effect on the erectile function (p<0.01). The IIEF-EF domain score showed significant differences among the each age group and also among the age-adjusted IPSS groups (p<0.01, p=0.023). The frequency of sexual intercourse per month during the last 3 months showed a significant difference among the each age group (p<0.01). CONCLUSIONS: Erectile function declines with the age-adjusted LUTS severity as well as with age. The frequency of sexual intercourse per month during the last 3 months declines with age, but not with the age-adjusted LUTS severity.

A Study on the Efficacy of Combination Therapy with Alpha-blockers and Anticholinergics in the Lower Urinary Tract Symptoms Patients Accompanied with Overactive Bladder Symptoms

PURPOSE: Benign prostatic hyperplasia(BPH) patients usually accompanies overactive bladder(OAB) symptoms. Adding anticholinergics in these patients evokes us worrying about deterioration of obstructive symptoms. We evaluated the relative benefit of anticholinergics compared with alpha-blocker only group in terms of emptying efficiency and storing symptoms. MATERIALS AND METHODS: From October 2000 to February 2006, male LUTS(lower urinary tract symptoms) patients with more than 8 IPSS(international prostate symptom score) and more than 2 score in IPSS urgency question(question 4) were selected. 168 patients were eligible without exclusion criteria or drop-out and with follow-up. In 109 patients, alpha-blocker plus anti-cholinergic were used(group I) and in 59 patients alpha-blocker only(group II). Used anti-cholinergics were tolterodine 1 mg, 2 mg and propiverine 10 mg, 20 mg. After mean 15.3 months, follow up evaluation was done. IPSS score was divided as emptying domain(question 1,3,5,6) and storing domain(question 2,4,7). Between the 2 groups the amount of change in each domain of IPSS, urgency question score, total IPSS, QoL, uroflowmetry and RU were compared. According to used anticholinergic and dosage 4 divided groups were also compared as the same methods. RESULTS: The mean age was 64.7+/-9.8 years. Baseline characteristics between the 2 groups were not different in all parameters. After mean 15.3 months later, the changes of storing symptom domain score were -3.3+/-2.7, -2.4+/-2.5 for group I and group II respectively(p=0.041) and urgency question score -1.6+/-1.4, -1.1+/-1.2 (p=0.046) and quality of life score -0.7+/-1.2, -0.4+/-0.8(p=0.028). But the changes of all other parameters were not different between 2 groups. Subdivided 4 cholinergic groups didn't show any differences among groups. CONCLUSIONS: Combination of alpha-blockers with anticholinergics in benign prostatic hyperplasia with overactive bladder patients seems not to lower emptying efficiency significantly but improve storing symptoms significantly.

Prevalence of Premature Ejaculation in Chronic Pelvic Pain Syndrome / 대한남성과학회지

PURPOSE: Premature ejaculation is a common male sexual dysfunction and has an adverse effect on QoL(quality of life). Chronic pelvic pain syndrome(CPPS) is also a common and serious health problem affecting QoL. Although both disorders are common their etiopathogeneses are not well understood. We investigated the prevalence and effect of premature ejaculation on erectile function in CPPS patients and compared these patients with healthy control subjects. MATERIALS AND METHODS: 638 CPPS patients and 102 healthy controls were enrolled in this study. Each patient was given a questionnaire consisting of 3 parts: a demographic data questionnaire, the Korean version of the NIH-CPSI(National Institutes of Health-Chronic Prostatitis Symptom Index), and IIEF(International Index of Erectile Function). Premature ejaculation was defined as intravaginal ejaculation latency of less than 3 minutes with the same partner for at least 6 months. RESULTS: 303 patients with CPPS and 83 healthy controls were eligible for the analysis. The rate of premature ejaculation was much higher in patients with CPPS(71.62%) than healthy controls(22.89%), and this difference was statistically significant(p < 0.01). In the patients with CPPS, the frequency of sexual intercourse per month during the last 3 months was 4.79+/-3.43. In the patients with CPPS, the mean scores for IIEF-EF(erectile function), IIEF-IS(intercourse satisfaction), IIEF-OF(orgasmic function), IIEF-SD(sexual desire) and IIEF-OS(overall satisfaction) were 21.7+/-6.4, 8.5+/-2.9, 7.4+/-2.5, 5.3+/-2.0 and 5.2+/-2.1, respectively. Each mean IIEF domain score was lower than healthy controls, and these differences were statistically significant. But in the patients with CPPS categorized in IIIa and IIIb, the frequency of sexual intercourse and each IIEF domain score showed no difference. CONCLUSIONS: The rate of premature ejaculation was higher in the patients with CPPS than healthy controls.

Comparative Analysis of Clinical Parameters in Acute Pyelonephritis / 대한비뇨기과학회지

PURPOSE: To compare the variable inflammatory parameters of acute pyelonephritis patients treated with inpatient therapy at 13 hospitals, according to the age and gender distributions. MATERIALS AND MATHODS: A total of 3,544 medical records of patients with confirmed acute pyelonephritis, and admitted to hospital between January 2000 and December 2005, were retrospectively analyzed. RESULTS: The mean age of the patients was 43.2+/-16.2 years old, with a male:female ratio of 1 : 5.1. The average duration of hospital admission was 7.9+/-5.3 days. Underlying diseases were found in 23.0% (749/3,252 patient), largely due to diabetes (35.1%). Radiological abnormal findings were found in 13.7%. The leukocyte count, ratio of segmented form, erythrocyte sedimentation rate (ESR), c-reactive protein, pyuria, positive blood culture, positive urine culture were 11,014+/-5,778/mm(3), 74.8+/-14.5%, 44.0+/-32.0 mm/hr, 12.4+/-9.3mg/dl, 83.9%, 10.5% and 46.7%, respectively. E. coli grow in 79% of the urine culture positive patients. In a comparison of 3 age groups (61 years), the elderly patients had a greater number of underlying diseases and more pathogens in cultured blood. When divided into males and females, the elderly male patients had more pathogen in cultured urine, but contrary to the male patients, the elderly female patients had elevated leukocyte count and erythrocyte sedimentation rate. Also, the old patient group had more resistance to ampicillin when they had E. coli as the uropathogen (p=0.021). Patients with higher ESR required longer hospital admission periods. CONCLUSIONS: It was found that variable clinical parameters of acute pyelonephritis patients treated with inpatient therapy differed according to both gender and age group in Korea. Therefore, these factors should be taken into account in the treatment plan.

Elevation of Serum Prostate Specific Antigen in Subclinical Prostatitis: The Role of Pathology of Inflammation / 대한비뇨기과학회지

PURPOSE: We evaluated the correlation of the pathologic diagnosis, including the grade or location of the inflammation on a prostate biopsy specimen, to the serum prostate-specific antigen(PSA) level. MATERIALS AND METHODS: 172 patients(the patients' PSA was> or=4ng/ml) who received prostate biopsy at our department from January 2000 to August 2003 were retrospectively studied. The pre-biopsy PSA and pathology, including the diagnoses and inflammatory patterns, were analyzed. The pathologic patterns of inflammation were divided as acute or chronic by the predominant inflammatory cell type; especially, the chronic inflammation was divided by grade or location, and then this was reviewed by 1 pathologist. Chronic Inflammation was graded as I, II or III according to the severity of inflammation. The PSA levels were compared among the grades. The presence or absence of chronic inflammation was checked in the periglandular, stromal and perivascular areas, respectively. The PSA levels were compared between the presence and absence of inflammation at each location. RESULTS: Among 172 patients, the number of patients with prostate cancer was 37(21.5%), and 68 patients had only BPH(39.5%), 27 had only prostatitis(15.7%) and 40 patients had benign prostatic hyperplasia(BPH) with prostatitis(23.3%). The number of patients with any prostatitis was 67(39.0%). The age of the patients was 68.4+/-8.7 years(45-91), the serum PSA was 13.30+/-14.38ng/ml(4.30-102.48), and the prostate size was 49.5+/-21.1ml(20-126). One case of BPH with prostatitis had a PSA level above 100ng/ml. Among the 67 specimens that showed prostatitis, 16 patients had histologically acute inflammation(23.9%) and 51 patients had chronic inflammation(76.1%). The PSA levels of the acute or chronic inflammation patients were 24.04+/-25.95ng/ml(4.46-102.48) and 9.93+/-4.73ng/ml(4.3-21.12, p=0.047), respectively. The PSA levels were not different among the 3 grades of chronic inflammation. In periglandular, stromal and perivascular locations, the PSA levels were not different between the presence and absence of chronic inflammation. CONCLUSIONS: About 39% of the prostate biopsy specimens showed prostatitis. The PSA level was higher for the acute inflammation than for the chronic inflammation. However, there was no difference in PSA levels among the each of the grades or locations of chronic prostatic inflammation.

A Study of the Correlation between Bladder Capacity or Compliance and Stress Urinary Incontinence Parameters

PURPOSE: After correction of stress incontinence, some patients experience the improvement of overactive bladder symptoms. During urodynamic study of some patients, the leak point pressure has a tendency to decrease at increasing vesical volumes. We evaluated the possibility of a correlation between stress incontinence parameters and bladder capacity or compliance. MATERIALS AND METHODS: 113 stress incontinence patients who received urodynamic study from February 2000 to August 2005, were reviewed retrospectively for this study. In these patients, urodynamic stress incontinence parameters(abdominal leak point pressure: ALPP, maximum urethral closure pressure: MUCP), Q-tip angle and Stamey symptom grade and age were analyzed for a correlation with urodynamic cystometric capacity or compliance. We also compared the cystometric capacity of each symptom grade group to assess the difference among the groups. RESULTS: The mean age of the patients was 49.5+/-10.4 years(29~75), symptom grade was I(37), II(27), III(19), Q-tip angle was 33.6+/-14.0 degrees(10~60), cystometric capacity was 390.2+/-109.7 ml(121~641), compliance was 51.6+/-30.4 ml/cmH2O(9.2~142.5), ALPP was 83.2+/-31.0 cmH2O(24~200), MUCP was 55.4+/-29.3 cmH2O(7~142). In the correlation analysis, cystometric capacity had a correlation of -0.207 with age (p=0.029) and -0.215 with symptom grade(p=0.031). However, bladder compliance had no significant correlation with any of the parameters studied. In each symptom grade, cystometric capacity was 407.0+/-103.1 cc(I), 395.8+/-103.0 cc(II), 324.5+/-124.0 cc(III)(p=0.04) and the age for each symptom grade was 48.5+/-9.7(I), 48.1+/-10.1 (II), 57.3+/-10.1(III)(p=0.005). CONCLUSION: As cystometric capacity decreased, symptom grade of stress incontinence increased and age also increased. However, there were no other correlations between cystometric capacity or compliance and stress incontinence parameters.

Clinical Outcome of Acute Bacterial Prostatitis, a Multicenter Study / 대한비뇨기과학회지

PURPOSE: Few studies have examined acute prostatitis in Korea. To initiate the investigation of this topic, a multi-center retrospective analysis of acute prostatitis was conducted. MATERIALS AND METHODS: The clinical records of 335 patients from 13 hospitals, diagnosed with acute prostatitis, between January of 1994 and October of 2004, were reviewed. For each patient, the urine culture, changes in the PSA (prostate-specific antigen) value and the prostate volume, the incidence of prostate abscess, the use of antibiotics, and whether the disease went into remission or progressed to chronic prostatitis were analyzed. RESULTS: The mean age of the patients, time from the onset of symptom to admission and number of days of admitted were 54.9+/-15.1 (16-85) years, 2.4+/-3.4 (16-85) days and 7.5+/-3.9 (1-25) days, respectively. The chief symptoms of the patients were high fever, dysuria and urinary frequency. Routine urinalysis found pyuria in 82% and hematuria in 70% of patients. The causative organisms of 43.0% of the patients were cultured, with the chief organisms found to be E. coli (67%) and P. aeruginosa (13%), et al. The mean PSA and prostate volume on initial diagnosis were 24.6+/-30.2ng/ml and 45.8 +/-17.4ml, respectively, and a prostate abscess was found in 4 patients (3.1%). The antibiotics injected during patient admission were: cephalosporin family (68%), aminoglycosides (70%) and quinolone family (43%). An additional alpha blocker was used in 49% of cases. Oral quinolone (91%), cephalosporin (9%) and alpha blocker (44%) were prescribed for a mean 32.5 (2-180) days after discharge. 259 (77%) of the patients were available for follow-up. Of these, 21% took antibiotics over an 8 week treatment period, and 8% over a 12 week period. The disappearance of pyuria after treatment was observed in a mean of 13 days after the end of treatment. After 13 weeks of treatment, 11 (50%) of the 22 patients who received prostate massage (4.2% of all follow up patients) were found to have chronic prostatitis. The mean PSA and prostate volume declined during follow up, to 6.13+/-10.38ng/ml and 37.5+/-13.5ml, respectively. CONCLUSIONS: In our study, the most common chief symptom of acute prostatitis was a high fever, with the most common causative organism being E. coli. Patients were admitted for approximately one week, and treated with antibiotic for about one month, after which time PSA elevation was observed in 80% of patients. Although all acute prostatitis patients were treated with proper antibiotics, progression to chronic prostatitis was observed in 4.2% of patients.

Affecting Factors on Erectile Dysfunction after Radical Prostatectomy and Treatment / 대한남성과학회지

PURPOSE: Radical prostatectomy is the gold standard treatment for clinically localized prostate cancer, a disease whose incidence is increasing. Erectile dysfunction(ED) after radical prostatectomy influences a patient's quality of life significantly. So we evaluated the correlation of preoperative and postoperative factors with postoperative ED and its treatment. MATERIALS AND METHODS: Hospital records of 27 patients who underwent radical prostatectomy by one surgeon at our department were retrospectively reviewed. We performed univariate analyses to correlate preoperative prognostic factors with intaoperative factors and postoperative variables. RESULTS: Excluding 10 patients who had preoperative ED, erectile dysfunction developed in 10 of 17 patients, and the rate was higher in the older age group(p=0.02). Patients underwent non-nerve sparing radical prostatectomy maintained their potency in 0.0% (0/1) comparative with 44.4% (4/9) in unilateral nerve sparing and 42.9% (3/7) in bilateral nerve sparing surgery. Patients with preexisting comorbidity, such as cardiovascular disease(OR=2.38) and margin positivity(OR=4.67) had greater risk of postoperative ED. In 8 erectile dysfunction patients, 3 sildenafil-treated and 2 alprostadil-treated patients showed improvement one year after the operation. CONCLUSIONS: Older patients have greater risk of postoperative ED, and they have more preexisting risk factors including hypertension, cardiovascular disease, diabetes mellitus, and margin positivity.

Affecting Factors on Erectile Dysfunction after Radical Prostatectomy and Treatment / 대한남성과학회지

PURPOSE: Radical prostatectomy is the gold standard treatment for clinically localized prostate cancer, a disease whose incidence is increasing. Erectile dysfunction(ED) after radical prostatectomy influences a patient's quality of life significantly. So we evaluated the correlation of preoperative and postoperative factors with postoperative ED and its treatment. MATERIALS AND METHODS: Hospital records of 27 patients who underwent radical prostatectomy by one surgeon at our department were retrospectively reviewed. We performed univariate analyses to correlate preoperative prognostic factors with intaoperative factors and postoperative variables. RESULTS: Excluding 10 patients who had preoperative ED, erectile dysfunction developed in 10 of 17 patients, and the rate was higher in the older age group(p=0.02). Patients underwent non-nerve sparing radical prostatectomy maintained their potency in 0.0% (0/1) comparative with 44.4% (4/9) in unilateral nerve sparing and 42.9% (3/7) in bilateral nerve sparing surgery. Patients with preexisting comorbidity, such as cardiovascular disease(OR=2.38) and margin positivity(OR=4.67) had greater risk of postoperative ED. In 8 erectile dysfunction patients, 3 sildenafil-treated and 2 alprostadil-treated patients showed improvement one year after the operation. CONCLUSIONS: Older patients have greater risk of postoperative ED, and they have more preexisting risk factors including hypertension, cardiovascular disease, diabetes mellitus, and margin positivity.

Effects of Finasteride on Hemospermia / 대한남성과학회지

PURPOSE: We evaluated the therapeutic efficacy of finasteride in the treatment of hemospermia, especially in prostatitis-related hemospermia. MATERIALS AND METHODS: Among the patients who visited our urologic department due to hemospermia from Jan 2000 to Oct 2003, 46 patients enrolled in the study. Semen analysis, expressed prostatic secretion, and transrectal ultrasonography were performed for all patients, and we determined whether or not the hemospermia was caused by inflammatory chronic non-bacterial prostatitis. We sorted all the subjects into 2 groups by the use of finasteride or not. We sub-divided the 2 groups by the presence or absence of prostatitis. In each of the 4 groups, the results were compared. Results were also recalculated after excluding sonographically abnormal cases. RESULTS: In the 35 finasteride-treated patients, the prostatitis group showed a 75% (12/16) success rate whereas the non-prostatitis group showed 31.6% (6/19) success. This difference was statistically significant (p=0.01). In the 11 non-finasteride patients, there was no difference in success rate between the prostatitis group (57.1%) and non-prostatitis group (50.0%). After excluding 15 sonographically abnormal patients, the finasteride-prostatitis group showed an 80% (8/10) success rate whereas the non-prostatitis group showed a 25% (3/12) success rate. CONCLUSIONS: Finasteride treatment in hemospermia was more successful in prostatitis than non-prostatitis patients. Efficacy was more prominent after excluding sonographically abnormal cases. Finasteride could be an useful agent in the treatment of prostatitis-related hemospermia. More extensive study is needed.

The Value of Vascular Endothelial Growth Foctor Expression as a Prognostic Indicator in Renal Cell Caricinoma / 대한비뇨기과학회지

PURPOSE: We evaluated if VEGF (Vascular Endothelial Growth Factor)-immunoreactivity is associated with tumor stage or grade in RCC (renal cell carcinoma), and specifically, if it could serve as a prognostic i ndicator in terms of survival. MATERIALS AND METHODS: Histologic samples of 54 patients in whom radical nephrectomy due to RCC (clear cell type exclusively) from January 1995 to July 1999 were included in this study. VEGF-immunoreactivity was classified as 0 to 3+ according to the ratio of VEGF-positive cells in randomly selected multiple tumor areas. Histologic differentiation was classified according to Fuhrmann's classification and staging was made with TNM classification. RESULTS: The correlation between grade and VEGF-positivity was statistically significant using chi-square analysis. Among the 3 patients with grade I, showed 2, 1, 0 for VEGF 1+, 2+, 3+ respectively. In grade II the cases were 11, 7, 3 respectively. In grade III the cases were 3, 10, 11, and in grade IV the cases were 1, 2, 3 respectively. The correlation between stage and VEGF-positivity didn't show statistical significance. The survival rate for VEGF during the period was 100%, 90%, 76.5% for VEGF 1+, 2+, 3+ respectively. The survival rate for grade was 100%, 100%, 83.3%, 66.7% for grade I, II, III, IV respectively. The survival rate for stage was 95.2%, 85.7%, 87.5%, 66.7% FOR STAGE I, II, III, IV respectively. In the same grade, survival rate decreased apparently according to the increase of VEGF-positivity. For example, in the same grade III, the survival rae was 100%, 90%, 72.7% for VEGF 1+, 2+, 3+ respectively. CONCLUSIONS: The results of this study is that VEGF is correlated with tumor grade and the higher VEGF expression, the lower the survival rate, so we can predict the prognosis by VEGF immunohistochemical staining for supplement of grading system. VEGF alone can be a good predictor for survival, and importantly in the same grade, we can differentiate patient's prognosis with VEGF.