Postcircumcision Color Change of the Glans Penis Associated with a 0.2% Lidocaine Dorsal Nerve Block / 대한남성과학회지

We describe a case of temporary ischemic change of the glans penis after circumcision. A 36-year-old male exhibited an ischemic change in the color of the glans penis the day after receiving a dorsal penile nerve block for circumcision. After the third day, the color of the glans changed from black to dark brown. After 7 days, the glans returned to near normal skin color without other sequelae.

Influences of Chronic Indirect Cigarette Smoking on the Expression of TGF-beta1 and eNOS in Rat Vagina / 대한남성과학회지

PURPOSE: The objectives of this study were to evaluate the effects of chronic indirect cigarette smoking on vaginal blood flow and on histological change in a rat model. MATERIALS AND METHODS: Female Sprague-Dawley rats (12 weeks old, n=40) were devided into smoking and control group. For the exposure to passive smoking, the rat, in plastic enclosure, had a constant influx of cigarette smoke using a smoking generator for 8 weeks in smoking group. The experimental group was exposured to cigarette smoke for 1 hour, twice a day, daily for 8 weeks. Vaginal blood flow was measured by laser Doppler flowmeter. Serum estrogen concentration was measured using competitive radioimmunoassay. Immunohistochemistry and western blot analysis was done to observe the expression of TGF-beta1 and e-NOS. RESULTS: Mean vaginal blood flow (ml/min/100g tissue) significantly decreased in smoking group (13.4+/-1.6) compared to control (19.6+/-5.9)(p<0.05). The estimated concentration of serum estradiol (pg/ul) was similar between smoking (1.1+/-0.8) group and control (1.1+/-0.3) group. Vaginal histology of the cigarette smoking group was similar to the control. In the cigarette smoking group, the immunoreactivity of TGF-beta1 increased in the smooth muscle and fibroblasts. The protein expression of TGF-beta1 was increased in the smoking group (p<0.05). There was no significant differences in expression of e-NOS between two groups. CONCLUSIONS: A chronic indirect exposure to cigarette smoke significantly reduces vaginal blood flow and appears to cause vaginal tissue fibrosis in the female rat model. This suggest that cigarette smoking has adverse effects on female sexual functions and may cause sexual arousal disorder in women.

The Expression of AQP1 and eNOS in Menopausal Rat Urinary Bladder / 대한배뇨장애요실금학회지

PURPOSE: Aquaporins (AQPs) have been reported to be expressed in rat and human urothelium. Nitric oxide (NO) is thought to play an important role in the bladder overactivity related to menopause. The purpose of this study was to investigate the effect of hormonal alteration on the expression of AQP1 and eNOS in menopausal rat urinary bladder. MATERIALS AND METHODS: Female Sprague-Dawley rats (230-240 g, N=30) were divided into three groups: control (N=10), bilateral ovariectomy (Ovx, N=10), and bilateral ovariectomy followed by subcutaneous injections of 17beta-estradiol (50 mg/kg/day, Ovx+Est, N=10). After 4 weeks, urodynamic studies measuring the contraction interval and contraction pressure were done. The expression and cellular localization of AQP1 and eNOS were determined by performing Western blotting and immunohistochemistry on the rat urinary bladder. RESULTS: The approximate contraction interval (min) was significantly decreased in the Ovx group (3.9+/-0.25) compared to the control group (6.7+/-0.15), and was increased after estrogen treatment (9.7+/-0.22) (p<0.05). The AQP1 and eNOS immunoreactivities were localized in the same areas: capillaries, arterioles, and venules of the lamina propria. The protein expression of AQP1 was not changed significantly, whereas eNOS expression was significantly decreased in the Ovx group and restored to the control value in the Ovx+Est group. CONCLUSIONS: This study showed that ovariectomy causes a significant change in e-NOS expression without a change in AQP1 in menopausal rat urinary bladder. This may imply that e-NOS has a functional role in the bladder overactivity that occurs in association with menopause.

The Adverse Effects of Cardiovascular Risk Factors on Lower Urinary Tract Symptoms and Erectile Function / 대한남성과학회지

PURPOSE: There are several reports about relationships between cardiovascular risk factors and lower urinary tract symptoms (LUTS). We investigated the effects of risk factors for vascular disease on LUTS and erectile function (ED). MATERIALS AND METHODS: We prospectively analyzed 273 patients who had LUTS or ED. A self administered questionnaire of International Prostate Symptom Score (IPSS) and International Index of Erectile Function (IIEF) were given to patients. Cardiovascular risk factors including hypertension, smoking status, diabetes and dyslipidemia were determined in each patients. RESULTS: Mean age was 60.5+/-9.4 years. Mean IPSS, IIEF and IIEF-EF score were 15.9+/-5.9, 30.1+/-15.4 and 17.35+/-9.0, respectively. There are statistically significant differences in the IPSS (p=0.047), IIEF (p=0.024) and IIEF-EF domain score (p=0.044) between men with no risk factors and men with one or more risk factors. IPSS, IIEF and IIEF-EF score were 11.5+/-6.4, 39.8+/-11.9 and 19.6+/-8.7 in men with no risk factor (n=94), 16.6+/-5.6, 28.4+/-15.0 and 15.1+/-9.3 in men with at least one risk factor (n=179). In men with one to four risk factors, the mean IPSS was 14.5+/-5.1 (n=63), 16.3+/-4.4 (n=45), 21.2+/-5.5 (n=43) and 26.5+/-3.5 (n=28)(p=0.001); the mean IIEF score was 31.4+/-14.2, 27.8+/-16.8, 22.5+/-14.1 and 19.0+/-9.9 (p=0.037); the mean IIEF-EF score was 17.1+/-8.9, 14.7+/-9.0, 10.9+/-9.7 and 8.8+/-4.5 (p=0.023), respectively. CONCLUSIONS: Men with risk factors for vascular disease are more likely to have a higher IPSS and a lower IIEF and IIEF-EF score than men without risk factors. These results suggests that vascular disease of men is significantly related with the progression of LUTS and ED.

Spontaneous Intraperitoneal Rupture of the Urinary Bladder after Radiotherapy for Cervical Cancer

Spontaneous intraperitoneal bladder rupture is a rare complication of radiation therapy. We report an unusual case of spontaneous intraperitoneal bladder rupture 17 years after pelvic radiotherapy for carcinoma of the cervix in a 59-year-old woman who underwent prompt surgical repair.

The Patient Characteristics and Birth Outcomes of Vasovasostomy / 대한남성과학회지

PURPOSE: The purpose of this study was to investigate the characteristics of the patients who had undergone vasovasostomy and to analyze the reasons for an increase in the number of these operations. MATERIALS AND METHODS: From January 1999 to April 2007, 105 patients were analyzed by examining their medical records and conducting telephone surveys. The patients were divided into two groups before and after insurance payments for a vasovasostomy. Analysis of the differences between the two groups was performed by grouping the patients who had a vasovasostomy before July 2004 and those who had a vasovasostomy after July 2004. RESULTS: Among the 105 patients, 35 patients (0.58/month) had a vasovasostomy before receiving their insurance payment. However, the number of operations increased by more than 4 times (70 patients, 2.33/month) after insurance repayment (p<0.05). After the payment, the proportion of patients willing to have a vasovasostomy due to changing their mind increased, whereas the proportion of patients willing to have a vasovasostomy for remarriage and loss of a child decreased (p<0.05). The overall patency and birth rates were 87.6% and 76.1%, respectively (43 boys and 37 girls). Among such factors as the age of the patient and his spouse, the duration of ligation and the presence of seminal fluid and sperm, the duration of ligation was the only factor that showed relevance to the anatomical patency (p<0.05). There were no variables that showed significant relevance to the pregnancy rate. CONCLUSIONS: The main reason of vasectomy reversal was to have another child. The numbers of vasovasostomies were influenced by the medical insurance payment. The duration of ligation affected the anatomical patency rate. The overall patency rate was 87.6% and the birth rate was 76.1% in this study.

Efficacy and safety of oral SK3530 for the treatment of erectile dysfunction in Korean men: a multicenter, randomized, double-blind, placebo-controlled, fixed dose, parallel group clinical trial / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To evaluate the efficacy and safety of SK3530, a newly developed type 5 phosphodiesterase inhibitor (PDE5I), in Korean men with erectile dysfunction (ED).</p><p><b>METHODS</b>A total of 119 patients were randomized at 10 centers in Korea to receive either SK3530 (50, 100, or 150 mg; n = 89) or placebo (n = 30) taken l h before anticipated sexual activity for an 8-week period. The patients were evaluated at baseline and 4 and 8 weeks after beginning therapy. Efficacy was assessed using the International Index of Erectile Function (IIEF), Sexual Encounter Profile (SEP), and the Global Assessment Question (GAQ). Safety was analyzed by adverse events, laboratory values and vital signs.</p><p><b>RESULTS</b>At the end of the study, all the primary and secondary efficacy end-points were statistically significantly improved by SK3530 compared with placebo (P<0.05). Of the 89 patients in the treatment arm, 36 (42.3%) achieved normal erectile function after treatment, including six patients with severe ED. Treatment-related adverse events occurred in 32 patients. The most common adverse events were flushing, headache, dizziness and eye redness (10.9%, 7.6%, 2.5% and 2.5%, respectively), and most were mild. Only two patients discontinued treatment during the study period because of adverse events.</p><p><b>CONCLUSION</b>The results of our phase II study have confirmed the efficacy and safety of SK3530 in a broad population of men with ED of various etiologies and severity. The optimal doses in terms of efficacy and safety were determined to be 50 mg and 100 mg, respectively.</p>

Efficacy of terazosin for overactive bladder symptoms and sexual function in patients with overactive bladder and symptomatic benign prostatic hyperplasia: a prospective multicenter trial

OBJECTIVE: This study is to evaluate the efficacy of terazosin in the treatment of overactive bladder (OAB) symptoms and sexual dysfunction in patients with symptomatic benign prostatic hyperplasia (BPH) and OAB. METHODS: Of 200 men aged 50-80 years with symptomatic BPH, an International Prostatic Symptom Score (IPSS) > or =8 accompanied by OAB symptoms, 185 patients completed treatment with terazosin 2-5 mg once daily for 8 weeks. Patients were asked to complete a voiding diary, the International Index of Erectile Function (IIEF) questionnaire, and the IPSS at baseline, 4 and 8 weeks. RESULTS: 8-week terazosin treatment improved OAB symptoms as well as reducing IPSS (19.8 to 12.7) and IIEF (34.4 to 37.4) scores. OAB symptoms improved significantly, irrespective of symptom severity by the IPSS, but the IIEF score only increased in patients with severe symptoms. CONCLUSIONS: Additional studies are needed to further evaluate the placebo effect. However, terazosin monotherapy is effective in patients with symptomatic BPH and OAB, and may increase sexual function in patients with severely symptomatic BPH.

The Quality of Life after Tension-Free Vaginal Tape and Transobturator Vaginal Tape Inside-Out for the Surgical Treatment of Female Stress Urinary Incontinence

PURPOSE: The change of quality of life following a tension-free vaginal tape (TVT) and transobturator vaginal tape (TVT-O) procedure was investigated in patients with stress urinary incontinence. MATERIALS AND METHODS: We included 86 women with stress urinary incontinence who underwent the TVT or TVT-O procedure and followed up for at least 1 year. Preoperatively, the patients were evaluated with history taking, physical examination, urodynamics to determine abdominal leak point pressure (ALPP) and pre- and postoperative quality of life was evaluated by incontinence quality of life questionnaire (I-QoL). The success after operation was defined as the absence of any subjective complaint of leakage. RESULTS: The rate of cure of TVT and TVT-O procedure were 84%, 92% and the rate of improvement of them were 16%, 8%, respectively. Preoperative patient characteristics including uroflowmetric parameters and ALPP were comparable in the two groups. The I-QoL parameters one year after surgery were statistically significant increase in I-QoL scores in each groups. There were no serious or long-term complications related to both procedures. CONCLUSIONS: These data suggest that the TVT and TVT-O procedure are effective for treating female stress incontinence and also in the aspect of improving quality.

A Comparison of Minimally Invasive Surgical Techniques for Ureteropelvic Junction Obstructions: Endopyelotomy, Acucise Endopyelotomy, and Laparoscopic Pyeloplasty / 대한비뇨기과학회지

PURPOSE: The aim of this study was to compare the efficacy and outcomes of endopyelotomy, Acucise endopyelotomy, and laparoscopic pyeloplasty for patients with ureteropelvic junction obstructions. MATERIALS AND METHODS: We studied 45 patients with ureteropelvic junction obstructions who underwent minimally invasive surgeries between January 2001 and April 2007. Patients were divided into three groups according to operative procedure: group I, endopyelotomy(n=17); group II, Acucise endopyelotomy(n=12; and group III, laparoscopic pyeloplasty(n=16). RESULTS: The mean patient ages in the three groups were 42.7+/-17.2 years, 48.8+/-14.1 years, and 49.5+/-13.6 years for groups I, II, and III, respectively. The mean stricture lengths were 0.99+/-0.25cm, 0.93+/-0.10cm, and 1.03+/-0.38 cm for groups I, II, and III, respectively, and were not significantly different among the groups(p>0.05). The mean operating time for group II(55.7+/-25.3 minutes) was shorter than that for group I(131.7+/-30.5 minutes) and group III(165.2+/-23.7 minutes)(p<0.05). The length of hospital stay for group II(4.7+/-1.6 days) was shorter than that for group I(6.6+/-1.8 days) and group III(7.4+/-0.6 days)(p<0.05). Rates of symptomatic improvement were 58.8%, 66.7%, and 93.8% for groups I, II, and III, respectively. Rates of radiologic improvement were 58.8%, 66.7%, and 93.8% for groups I, II, and III, respectively. There was no significant correlation between success rate and either stricture length or degree of hydronephrosis. CONCLUSIONS: Laparoscopic pyeloplasty had the highest success rate among the minimally invasive surgeries for patients with ureteropelvic junction obstructions. However, when the stricture length is less than 1cm in length, Acucise endopyelotomy may be considered as the first treatment because the associated operating time and hospital stay are short

The Prognostic Significance of Elevated Serum Creatinine for the Recurrence and Progression in Superficial Bladder Tumors / 대한비뇨기과학회지

PURPOSE: There are many prognostic indicators of bladder tumors including clinical, pathological and molecular markers based on tumor-related factors. This study was performed to evaluate the significance of an elevated level of serum creatinine for predicting progression and recurrence of superficial bladder tumors. MATERIALS AND METHODS: One hundred forty-seven patients that initially presented with a superficial bladder tumor(pTa or pT1) except for a carcinoma in situ were retrospectively analyzed according to several factors such as tumor stage, grade, size, multiplicity and serum creatinine for tumor recurrence and progression after a primary transurethral resection. RESULTS: The elevated serum creatinine group consisted of 20 patients 11 patients experienced recurrence(55.0%) and 3 patients experienced progression(15.0%). The control group consisted of 127 patients 39 patients experienced recurrence(30.7%) and 13 patients experienced progression (10.2%). The presence of an elevated level of serum creatinine and tumor multiplicity were statistically significant prognostic factors for tumor recurrence. CONCLUSIONS: These results can be helpful for predicting the prognosis of transitional cell carcinoma of the bladder and for planning therapeutic and follow-up strategies.

Effect of Insulin Therapy on Vagina in Diabetic Rat / 대한해부학회지

The most commonly reported sexual problems in diabetic women are sexual arousal disorder and a lack of vaginal lubrication. The aims of this study were to investigate the vaginal structural changes and expressions of TGF-beta1, Ec-NOS and estrogen receptor alphaby histochemistry, immunohistochemistry and Western blot analysis in diabetic and insulin-treated diabetic rats. The mean blood glucose levels were significantly increased in the diabetic rats (453+/-88.4 mg/dL)compared to the control group (79+/-6 mg/dL)and insulin-treated diabetic rats (56.7+/-0.6 mg/dL).The vaginal wall in control rat showed 6~11 layered stratified squamous epithelial lining and submucosal smooth muscle, connective tissue and vasculatures. In diabetic rat, the vaginal epithelium was reduced to 2~6 layers and the submucosal vasculatures were decreased n size and number.Collagen fibers were increased and irregularly distorted arrangement. Insulin-treated diabetic rat showed similar morphologic features as control rat.In diabetic rat, TGF-beta1 expression was upregulated by 1.65 times and Ec-NOS expression was 40% downregulated compared to control and insulin-treated diabetic rats in Western blot analysis. In control and insulin-treated diabetic rats, TGF-beta1 immunoreactivity was detected in fibroblasts and the collagen fibers, Ec-NOS immunoreactivity in the endothelial cells of blood vessels, and estrogen receptor alphaimmunoreactivity in the basal and intermediate cell layers of stratified squamous epithelium, smooth muscle fibers, and nerve fibers. In diabetic rat, expression of TGF-beta1, Ec-NOS, and estrogen receptor alphawas exhibited comparable cellular patterns of labeling, but signal intensity was increased in TGF-beta1 and decreased in Ec-NOS and estrogen receptor alpha. These results suggest that vaginal tissue fibrosis in diabetes mellitus may be caused by altered expression of TGF-beta1, NOS and estrogen. It also mplies that sexual arousal disorder and lack of vaginal lubrication in the diabetic women could be protected or delayed by controlling blood glucose levels.

Primary Periurethral Malignant Melanoma / 대한비뇨기과학회지

A primary genitourinary melanoma is rare, accounting for less than 1% of all cases of melanoma. They have been presented in case reports, with a subsequent paucity of insight into the natural history of the disease and appropriate management of patients. The prognosis of patients with a genitourinary melanoma is poor. Delay in seeking medical attention for symptoms, and misdiagnosis at presentation, contribute to a more advanced stage at diagnosis. Our case involved a 71 year old woman, who came to our hospital due to vaginal spotting. On local excision, mass was found on the vestibule and forward to the urethra. The pathological diagnosis, by special immunohistochemical staining, such as S-100 protein and HMB-45, was that of a malignant melanoma.

A Localized Sarcomatoid Carcinoma of a Urinary Bladder Diverticulum / 대한비뇨기과학회지

A sarcomatoid carcinoma is an extremely rare tumor found in the urinary bladder, which accounts for 0.3% of all bladder malignancies. The development of malignancy within the bladder diverticulum often occurs, with the incidence varying between 2.9-4%. A sarcomatoid carcinoma of the urinary bladder is a highly malignant tumor containing both malignant mesenchymal and epithelial elements, which are demonstrated by immunohistochemical study. Recently, a case of a sarcomatoid carcinoma of the bladder diverticulum was experienced in a 41-year-old female. A partial cystectomy was performed under the impression of a bladder carcinoma in the diverticulum. Histopathologically, the tumor mass was composed of an urothelial carcinoma in the peripheral portion and sarcomatoid spindle cells in the central portion. Immunohistochemically, the epithelial components were stained with cytokeratin, but the sarcomatoid components were predominantly stained with vimentin, and focally with cytokeratin. The patient recovered without complications.

Multicenter Study on the Efficacy and Safety of Intracavernous 'TM' (Standro(R)) for the Treatment of Erectile Dysfunction in Korean / 대한비뇨기과학회지

PURPOSE: To evaluate the efficacy and safety of an intracavernous injection of lyophilized papaverine/phentolamine/alprostadil (Standro(R)) for the treatment of erectile dysfunction (ED) in Koreans. MATERIALS AND METHODS: 249 men (>20 years old), with ED (>6 month duration), were enrolled from 14 clinical centers. The intracavernous 'TMs' were titrated in a stepwise fashion at the clinic, from 0.05-0.25ml (17.64mg papaverine, 0.6mg phentolamine, and 6mug alprostadil per ml), with increment of 0.02-0.05ml, according to the etiology and severity of the ED and the patients' ages. RESULTS: Of the 249 men, 238 completed the dose titration, and progressed to home treatment of 3 months duration. Of these 238, 193 (psychogenic 13.0%, organic 75.5%, mixed 11.5%) completed the home treatment (4 or more self-injections), with the other 45 dropping out (lost to follow-up in 24, patient refusal in 9, no chance to have intercourse in 7 and omitted recording of patient diary in 2). The success rate per trial (a total number of sufficient erection for vaginal intromission/a total number of injections) and per patient (number of patients who had one or more sufficient erections for vaginal intromission/the enrolled patients at beginning or 193 patients), and the satisfaction rate per patient (number of patients who had both patient and partner satisfaction with erection/193 patients) were 74.1, or 91.2 and 75.1%, respectively. The adverse reactions were prolonged erections in 3, urethral pain in 1 and penile skin edema in 2. Three patients complained of penile pain during an erection, but there was no dropout due to the pain. No significant changes in laboratory tests were found after the home treatment. CONCLUSIONS: A 'TM' seems to be effective and safe for an intracavernous injection for the treatment of men with erectile dysfunction.

Malacoplakia of the Prostate / 대한비뇨기과학회지

Malacoplakia is a rare granulomatous inflammatory disease that most frequently involves the urinary tract, particularly the urinary bladder and may involve the testis, epididymis, lung, bone, colon, prostate, female genital organs, and the retroperitoneum, etc. A malacoplakia of the prostate is a very rare disease that is associated with a chronic urinary tract infection. It is often misinterpreted as granulomatous prostatitis, and may clinically mimic prostate cancer. The major cellular component of malacoplakia is the macrophage and the diagnostic hallmark is a characteristic inclusion, the Michaelis-Gutmann body. We recently experienced a case of malakoplakia of the prostate in a 74-year-old man, that was found incidentally in a TRUS-guided biopsy to confirm a suspected prostate cancer.

Early Experience of Penile Revascularization Procedure with Anastomosis of Inferior Epigastric Artery to Dorsal Penile Artery in Arteriogenic Impotent Patients / 대한비뇨기과학회지

PURPOSE: We report the results of a penile revascularization procedure of the inferior epigastric artery to the dorsal penile artery in arteriogenic impotent patients. MATERIALS AND METHODS: Microvascular arterial bypass surgery was performed in 5 impotent patients (age 29-40, mean 35 years) in order to treat a cavernosal arterial insufficiency secondary to focal occlusive disease in cavernosal arteries. The surgical procedure was performed on an end-to-side anastomosis of the inferior epigastric artery to the dorsal penile artery. The erectile function was evaluated by the International Index of the Erectile Function questionnaire (IIEF) and penile duplex Doppler ultrasonography before and 6 weeks after surgery. RESULTS: The IIEF score improved in 4 of 5 patients postoperatively. Penile arterial peak systolic velocity (PSV) had improved significantly from 21.4+/-2.2cm/sec to 33.7+/-9.6cm/sec in the right side, from 18.5+/-6.8cm/sec to 36.0+/-10.0cm/sec in the left (p< 0.05), respectively. There were no serious adverse effects of the surgery except for one patient who had a hematoma at the vascular anastomotic site. CONCLUSIONS: A penile revascularization procedure of the inferior epigastric artery to the dorsal penile artery is an effective surgical method for correcting an arteriogenic erectile dysfunction with a normal corporeal veno-occlusive mechanism.

Early Experience of Penile Revascularization Procedure with Anastomosis of Inferior Epigastric Artery to Dorsal Penile Artery in Arteriogenic Impotent Patients / 대한비뇨기과학회지

PURPOSE: We report the results of a penile revascularization procedure of the inferior epigastric artery to the dorsal penile artery in arteriogenic impotent patients. MATERIALS AND METHODS: Microvascular arterial bypass surgery was performed in 5 impotent patients (age 29-40, mean 35 years) in order to treat a cavernosal arterial insufficiency secondary to focal occlusive disease in cavernosal arteries. The surgical procedure was performed on an end-to-side anastomosis of the inferior epigastric artery to the dorsal penile artery. The erectile function was evaluated by the International Index of the Erectile Function questionnaire (IIEF) and penile duplex Doppler ultrasonography before and 6 weeks after surgery. RESULTS: The IIEF score improved in 4 of 5 patients postoperatively. Penile arterial peak systolic velocity (PSV) had improved significantly from 21.4+/-2.2cm/sec to 33.7+/-9.6cm/sec in the right side, from 18.5+/-6.8cm/sec to 36.0+/-10.0cm/sec in the left (p< 0.05), respectively. There were no serious adverse effects of the surgery except for one patient who had a hematoma at the vascular anastomotic site. CONCLUSIONS: A penile revascularization procedure of the inferior epigastric artery to the dorsal penile artery is an effective surgical method for correcting an arteriogenic erectile dysfunction with a normal corporeal veno-occlusive mechanism.

The Prognostic Factors Affecting Survival in Muscle Invasive Bladder Cancer Treated with Radiotherapy / 대한방사선종양학회지

PURPOSE: This study analyzed the prognostic factors affecting the survival rate and evaluated the role of radiation therapy in muscle-invading bladder cancer. MATERIALS AND METHODS: Twenty eight patients with bladder cancer who completed planned definitive radiotherapy in the Departments of Therapeutic Radiology and Urology, Chonnam National University Hospital between Jan. 1986 to Dec. 1998 were retrospectively analyzed. The reviews were performed based on the patients' medical records. There were 21 males and 7 females in this study. The median of age was 72 years old ranging from 49 to 84 years. All patients were confirmed as having transitional cell carcinoma with histological grade 1 in one patient, grade 2 in 15, grade 3 in 9, and uninformed in 3. Radiation therapy was performed using a linear accelerator with 6 or 10 MV X-rays. Radiation was delivered daily with a 1.8 or 2.0 Gy fraction size by 4 ports (anterior-posterior, both lateral, alternatively) or 3 ports (Anterior and both lateral). The median radiation dose delivered to the isocenter of the target volume was 61.24 Gy ranging from 59 to 66.6 Gy. The survival rate was calculated by the Kaplan-Meier method. Multivariate analysis was performed on the prognostic factors affecting the survival rate. RESULTS: The survival rate was 76%, 46%, 33%, 33% at 1, 2, 3, 5 years, respectively, with 19 months of median survival. The potential factors of age (less than 70 years vs above 70), sex, diabetes mellitus, hypertension, hydronephrosis, T-stage (T3a vs T3b), TUR, chemotherapy, total duration of radiotherapy, radiation dose (less than 60 Gy vs above 60 Gy), and the treatment response were investigated with uni- and multivariate analysis. In univariate analysis, the T-stage ( p=0.078) and radiation dose ( p=0.051) were marginally significant, and the treatment response ( p=0.011) was a statistically significant factor on the survival rate. Multivariate analysis showed there were no significant prognostic factors affecting the survival rate. CONCLUSION: The treatment response and radiation dose are suggeted as the statistically significant factors affecting the survival rate of muscle invasive bladder cancer. A Further prospective randomized study is needed to confirm these prognostic factors.

The Physiologic Effects of the Urocitra in Patients with Urolithiasis / 대한비뇨기과학회지

PURPOSE: To investigate the biochemical change in serum and 24-hour urine after therapy with Urocitra(R) in patients affected by urolithiasis, who had hypocitraturia alone or associated with other metabolic disorder. MATERIALS AND METHODS: One hundred eighteen patients with evidence of 1 or more stone attacks within the last 3 years participated in the present study. They were 78 men and 40 women (6 to 78 years old, with a mean age of 47.01 12.95 years). All of the patients received 15 to 20ml of Urocitra(R)-solution or 5 g of Urocitra(R)-C powder, three or four times daily for 3 months. Before treatment, 24-hour urine and venous blood samples were obtained, while patients were maintained on a random diet, and analyzed for various stone risk factors. After 1 week, 1 month and 3 months of treatment, samples were again obtained and analyzed in the same manner. Thereafter, we compared the biochemical values before and after treatment. RESULTS: In all three follow-up periods Urocitra(R) induced a significant increase in urinary citrate (p<0.001) level. Urinary potassium (p<0.001), pH (p<0.001) and total volume (p<0.05) also increased significantly after 1 and 3 months of therapy, as did urinary citrate excretion in patients with hypocitraturia and normocitraturia. Urocitra(R) did not alter calcium, sodium or phosphorus urinary excretion. There was no significant change of serum chemistry after administration. CONCLUSIONS: Urocitra(R) was effective in increasing urinary pH and citrate. Furthermore, it was relatively free of side effects, except for minor gastrointestinal distress. Thus, our study provides physiological and clinical validation for the use of Urocitra(R) in patients affected by urolithiasis, who have hypocitraturia alone or associated with another metabolic disorder.