Effect of Weight Changes on the Development of Erosive Esophagitis / 가정의학회지

Background@#Gastroesophageal reflux disease is highly prevalent among overweight and obese individuals. This study aimed to investigate the effect of weight change on the development of erosive esophagitis (EE). @*Methods@#A retrospective review of medical records from a university hospital in South Korea identified 7,123 subjects who underwent routine health checkups in 2012 and 2014. We excluded participants with EE in 2012. Body mass index (BMI) changes were classified as loss, stable, mild gain, or moderate gain. @*Results@#Mild and moderate weight gain increased the odds of EE development (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.06–1.84 and OR, 2.80; 95% CI, 1.87–4.21, respectively) relative to weight stability. Weight loss decreased the odds of EE development (OR, 0.58; 95% CI, 0.38–0.90) relative to weight stability. After stratifying subjects into three groups by baseline BMI, those with mild and moderate weight gain in the obese group and moderate gain in the overweight group showed increased odds of EE development relative to members of those groups whose weights remained stable (OR, 2.08; 95% CI, 1.29–3.36; OR, 3.92; 95% CI, 1.99–7.73 in obese group, and OR, 3.30; 95% CI, 1.64–6.64 in overweight group, respectively). In comparison, weight loss in the normal weight group decreased the odds of EE development relative to weight stability (OR, 0.38; 95% CI, 0.15–0.97). @*Conclusion@#Weight gain was positively associated with EE development in overweight or obese individuals. Weight loss was negatively associated with EE development in normal-weight individuals.

Holmium:YAG Laser Coagulation in the Female Patients of Voiding Symptom with Pseudomembranous Trigonitis

PURPOSE: Pseudomembranous trigonitis is a common cystoscopic finding in the female patients with voiding symptoms. We evaluated the changes in voiding symptoms of the patients after coagulating this lesion with Holmium:YAG laser. MATERIALS AND METHODS: Six female patients with voiding symptoms including frequency, dysuria, lower abdominal pain who were refractory to the conservative treatment for more than 1 month were enrolled in this study. The mean age was 35(range: 26~43) years. The patients were treated with cystoscopic evaluation and Holmium:YAG laser with 365 and 500 micrometer probe fibers. Power setting was between 6 and 11 watts. Only the lesions at the trigone and bladder neck were coagulated. No indwelling urethral catheter was used postoperatively. We evaluated patient's symptoms with out-patient follow-up or telephone up to 16 months. RESULTS: The mean duration of symptoms were 3.8(range: 6 months~13 years) years, and the mean follow-up was 13.3(range: 8~16) months. In all cystoscopic evaluations, pseudomembranous trigonitis was seen. After treatment, 3 of the 6 patients showed symptomatic improvements within 3 months and retained the improved state up to the last follow-up period. However, in the other 3 patients, no change in symptoms or initial response with following recurrence was seen. In the 3 patients who showed good response, transient worsening period of 1~3 months preceded the improvement. Follow-up cystoscopy at 3 months showed complete regeneration of the trigone and bladder neck mucosa. CONCLUSION: In the patients of pseudomembranous trigonitis with voiding symptoms refractory to conservative therapy, laser coaulation of the trigonal lesion was not so satisfactory but may be one of therapeutic options. Further investigation is needed.

Combination Therapy of Intraurethral Condyloma Acuminatum with Holmium: YAG Laser and 5-Fluorouracil Instillation / 대한남성과학회지

PURPOSE: Condyloma acuminatum is a common sexually transmitted disease of the external genitalia and anus. Approximately 5% of patients demonstrate urethral involvement. Electrical fulguration or excision using a pediatric resectoscope has been used in the management of such lesions. Holmium(Ho):YAG laser, 5-FU(fluorouracil), or interferon may be helpful in eradicating them. We reviewed the results of intraurethral condyloma acuminatum treatment with Ho:YAG laser and 5-FU solution. MATERIALS AND METHODS: From January 2001 to July 2002, seven patients with intraurethral condylomata acuminata were enrolled in the study. The mean age of the subjects was 19.5(range 25~43) years. Under local anesthesia with 10% lidocaine spray and jelly, all of the intraurethral lesions were removed with the Ho:YAG laser followed by coverage with 10mL of 5% 5-FU solution. Intraurethral injection of 5-FU was performed weekly up to six times. Urethroscopy for detection of recurrence was done 3 months after initial laser therapy. RESULTS: Most patients had multiple intraurethral lesions. Six patients (86%) responded to initial therapy without local recurrence with a mean follow-up of 15.8 (range 9.1-23.2) months. One patient had a recurrence at 2 months. CONCLUSIONS: We believe that the Ho:YAG laser plus 5% 5-FU solution is a useful option for the treatment of intraurethral condyloma acuminatum.

Ureteroscopic Lithotripsy with the Holmium: YAG Laser / 대한비뇨기과학회지

PURPOSE: Holmium: YAG laser (Ho: YAG laser) lithotripsy represents an additional option in the management of urinary tract calculi. We report here on the results for the success and complications of Ho: YAG laser lithotripsy on the management of ureteric calculi. MATERIALS AND METHODS: 132 patients (72 males and 60 females, mean age: 46 years (range: 26-75)) underwent 137 ureteroscopic procedures using a 6/7.5Fr semi-rigid ureterocope (Wolf, Germany). A Ho: YAG laser (Trimedyne Inc., Irvine, USA) was used for laser lithotripsy at a maximum energy of 1.0J/pulse at 10Hz. The calculi were located in the lower ureter in 93 cases, the middle ureter in 20 cases and the upper ureter in 24 cases. The patients were assessed with plain x-ray within 4 weeks postoperatively. RESULTS: The overall stone-free rate was 98%. Stratifying the results by location, the stone-free rate was 99% in the lower ureter, 95% in the middle ureter and 96% in the upper ureter. Fragmentation failed in three cases (2%). Ureteral stricture developed in one case postoperatively. CONCLUSIONS: Ho: YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.

Ureteroscopic Lithotripsy with the Holmium: YAG Laser / 대한비뇨기과학회지

PURPOSE: Holmium: YAG laser (Ho: YAG laser) lithotripsy represents an additional option in the management of urinary tract calculi. We report here on the results for the success and complications of Ho: YAG laser lithotripsy on the management of ureteric calculi. MATERIALS AND METHODS: 132 patients (72 males and 60 females, mean age: 46 years (range: 26-75)) underwent 137 ureteroscopic procedures using a 6/7.5Fr semi-rigid ureterocope (Wolf, Germany). A Ho: YAG laser (Trimedyne Inc., Irvine, USA) was used for laser lithotripsy at a maximum energy of 1.0J/pulse at 10Hz. The calculi were located in the lower ureter in 93 cases, the middle ureter in 20 cases and the upper ureter in 24 cases. The patients were assessed with plain x-ray within 4 weeks postoperatively. RESULTS: The overall stone-free rate was 98%. Stratifying the results by location, the stone-free rate was 99% in the lower ureter, 95% in the middle ureter and 96% in the upper ureter. Fragmentation failed in three cases (2%). Ureteral stricture developed in one case postoperatively. CONCLUSIONS: Ho: YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.

Therapeutic Efficacy of Extracorporeal Magnetic Therapy in Chronic Pelvic Pain Syndrome / 대한비뇨기과학회지

PURPOSE: A physical therapy, with extracorporeal magnetic innervation (ExMi) treatment, has recently substituted direct electrical stimulation for the treatment of many diseases. The efficacy of ExMi treatment was evaluated as a new therapeutic modality in chronic pelvic pain syndrome. MATERIALS AND METHODS: In 30 patients, diagnosed as NIH type III prostatitis, the efficacy of an ExMi was evaluated. Each treatment session was composed of 10 min at 40Hz, 2 min rest and 10 min at 50Hz, with an on-off ratio of 5sec:5sec. Both before and after the completion of 8 sessions of ExMi treatment, self-administered (NIH-CPSI) questionnaire were recorded to assess the changes of patient's symptoms. Three months after treatment, any recurrence was evaluated in patients with symptom improvements of 30% or more by telephone interviews. RESULTS: The mean age of the patients and number of treatment sessions were 39.3 years and 10.5, respectively. Following the ExMi treatments, 20 of the 30 patients (66.7%) experienced a 30% or more improvement of their symptoms. The total NIH-CPSI score was significantly improved, from 23.7 to 15.2 (p<0.01). Each domain of the NIH-CPSI was improved as follows: pain, from 11.37 to 6.77; urination, from 5.03 to 3.27 and the effect on the QOL (quality of life), from 7.27 to 5.17. In responding patients, the improvement remained in 72% of the patients for 3 months after completion of the treatment. CONCLUSIONS: These results suggest that ExMi is an effective and useful tool in the management of chronic pelvic pain syndrome. In chronic pelvic pain syndrome patients, ExMi treatment has advantages over other treatment options due to its easy, comfortable, non-invasive nature.

Tuberculous Epididymo-orchitis in Acquired Immune Deficiency Syndrome Patients / 대한비뇨기과학회지

The urogenital tract manifestations of acquired immune deficiency syndrome (AIDS) include the entire array of voiding symptoms; infections, neurogenic bladder problems, impotence, infertility, neoplasma and AIDS associated renal syndromes. Tuberculosis occurs in approximately 4% of patients with AIDS, and involves at least one extrapulmonary site in nearly 50% of cases. However, tuberculous infection of the testicle in AIDS is rarely seen. Herein, we report a case of tuberculosis epididymoorchitis, which developed as a result of reactivation in an AIDS patient. To the best of our knowledge, this is the first reported case of AIDS presenting as tuberculous epididymoorchitis in Korea.

Clinical Significance of Semen Analysis and Recanalization Rates after Vasectomy / 대한남성과학회지

PURPOSE: We tried to determine how many patients comply with semen analysis recommendations after vasectomy and how often the operation is followed by surgical failure or recanalization. MATERIALS AND METHODS: We determined the percentage of patients who underwent vasectomy from 1995 to 2003 who had follow-up semen analysis. To determine the vasectomy failure or recanalization rate, we evaluated the rates of sperm appearance in patients who were preparing for vasovasostomy and those with chronic prostatitis who had undergone vasectomy in the past. RESULTS: Among the 130 vasectomized patients, 29(22.3%) had received semen analysis, and in 120 healthy vasectomized patients, only 19(9.9%) received semen analysis. Of the 8 semen samples examined before vasovasostomy, 2(25%) had sperm. In the 121 chronic prostatitis patients, 9(7.4%) had sperm in their semen despite earlier vasectomy. Overall, 11 of 129 vasectomized patients(8.5%) were potentially fertile. CONCLUSIONS: The vasectomy failure or recanalization rate is higher than we generally think. Vasectomy failure or recanalization is usually followed by unwanted pregnancy and abortion. Unfortunately, physicians as well as patients are indifferent to the need for post-vasectomy semen analysis, and we need to emphasize its importance.

Seminal PSA and Sperm Motility in Inflammatory Chronic Non-Bacterial Prostatitis/Chronic Pelvic Pain Syndrome / 대한남성과학회지

PURPOSE: Prostate specific antigen(PSA) is present in a 10(6)-fold higher concentration in semen than in plasma, but serum PSA is elevated during inflammatory conditions such as chronic prostatitis. We evaluated the seminal PSA and its effect on sperm motility in inflammatory chronic nonbacterial prostatitis/chronic pelvic pain syndrome(CPPS). MATERIALS AND METHODS: Twenty-three patients with inflammatory CPPS(group P) and 11 normal controls(group NL) were enrolled in this study. The semen analysis was performed with a computerized analyzer, and seminal PSA was measured twice using a ELSA-PSA2 radioimmunometric kit(Cis Biointernational). We compared the result in groups P and NL. The subjects were then re-sorted into two groups according to the seminal PSA concentration, with 3.0 mg/ml as the cutoff value, and sperm motility was compared for the high- and low-PSA groups. Statistical significance was measured using the unpaired t-test. RESULTS: The average concentrations of seminal PSA in groups P and NL were 3.67 mg/ml and 1.79 mg/ml, respectively(p=0.048). Sperm motility was not different in the two groups. However, motility(straight-line velocity and average path velocity) was lower in the patients with high seminal PSA(p<0.05). CONCLUSIONS: Inflammatory chronic non-bacterial prostatitis increases the seminal secretion of PSA, and high seminal PSA is correlated with decreased sperm motility.

A Case of No Residual Cancer in Radical Prostatectomy Specimens Despite Biopsy-proven Prostate Cancer / 대한비뇨기과학회지

In prostate cancer patients without local invasion and metastasis, radical prostatectomy is performed as a rule for the resection of residual cancer. In a few cases, little amount of cancer volume is identified in radical prostatectomy specimens. This finding has been described as 'minimal residual cancer' or 'vanishing cancer phenomenon' and some reports have demonstrated an increase in the incidence of minimal residual prostate cancer. However, only few cases with 'minimal residual cancer' or 'no residual cancer' despite efforts searching for other possibilites have been reported. We report a case of no residual cancer in radical prostatectomy specimens of biopsy-proven prostate cancer.

Analysis on the Correlation Between Transition Zone Index and Bladder Outlet Obstruction Caused by Benign Prostate Hyperplasia / 대한비뇨기과학회지

PURPOSE: Prostate volume has been poorly correlated with various parameters used to assess benign prostate hyperplasia (BPH), including symptom score, total prostate volume, peak flow rate and postvoid residual urine. The purpose of this study is to determine if measurement of the volume and the index of transition zone of the prostate correlated well with other clinical parameters in predicting the degree of obstruction. MATERIALS AND METHODS: 121 men with lower urinary tract symptoms were prospectively evaluated using international prostate symptom score, transrectal ultrasonography, and urodynamic investigation with pressure-flow studies for BPH. Bladder outlet obstruction was defined as the maximal detrusor pressure was greater than 40cmH2O at peak flow and peak flow rate was less than 10ml/sec. Patients were then divided into obstructive and non-obstructive groups. Correlations were evaluated among the total prostatic volume (TPV), transition zone volume (TZV), transition zone index (TZI=TZV/TPV) and other clinical and urodynamically obstructive parameters. RESULTS: Age, IPSS, peak flow rate and PVR were not significantly different between obstructive (n=69) and non-obstructive (n=52) groups. Among the transrectal sonographic parameters, TZV and TZI correlated better with urodynamically obstructive parameters such as detrusor pressure at peak flow rate (r=0.551, 0.544), Abrams Griffiths number (r=0.576, 0.506) and linear passive urethral resistance relation (r=0.560, 0.580) than with TPV. There were no correlations between clinical and volume parameters. All the volume parameters of the prostate were larger in obstructive than in non- obstructive group. CONCLUSIONS: In patients with BPH symptoms, TZV and TZI correlates better with urodynamically obstructive parameters than did the total prostate volume. TZV or TZI may serve as more useful method for evaluating obstruction.