Recent Trends in Transurethral Surgeries and Urological Outpatient Procedures: a Nationwide Populationbased Cohort Study

Background@#Demographic change and advances in technology affect transurethral surgery and outpatient procedures in the urologic field. There are few population-based studies that accurately assess the trend of transurethral surgery and outpatient procedures including diagnostic tests. We investigated the recent epidemiologic trends in transurethral surgeries and urological outpatient procedures from 2009 to 2016 in Korea using the entire populationbased cohort. @*Methods@#We analyzed medical service claim data of transurethral surgery, urological outpatient procedures submitted by medical service providers from the Health Insurance Review and Assessment Service from 2009 to 2016. @*Results@#Transurethral ureter surgery increased by 134.9% from 14,635 in 2009 to 34,382 in 2016 (B = 2,698; R 2 = 0.98; P 2 = 0.97; P 2 = 0.04; P = 0.617) and urethral surgery (B = −12; R 2 = 0.18; P = 0.289). The significantly increasing trends in cystoscopy (B = 5,260; R 2 = 0.95; P 2 = 0.99; P 2 = 0.77; P = 0.003) and electrical stimulation treatment (EST: B = −1,034; R 2= 0.87; P < 0.001) significantly decreased. @*Conclusion@#In Korea, transurethral ureter surgery and transurethral bladder surgery have been continuously increasing. Transurethral prostate surgery and transurethral urethral surgery remained constant with no increase or decrease. Cystoscopy and uroflowmetry continue to increase, while UDS and EST continue to decrease.

Postmicturition Dribble Is Associated with Erectile Dysfunction in Middle-Aged and Older Men with Lower Urinary Tract Symptoms

PURPOSE: Lower urinary tract symptoms (LUTS) are correlated with erectile dysfunction (ED), but research on whether postmicturition dribble (PMD) is related to ED is limited. We assessed the correlation between PMD and ED in middle-aged and older Korean men with LUTS. MATERIALS AND METHODS: In our prospective, cross-sectional, observational, multicenter study, we enrolled 205 men (age >40 years) with LUTS. LUTS and ED were assessed using the International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5), respectively. PMD was assessed using the Hallym PostMicturition Dribble Questionnaire, Question 1, and the PMD volume was calculated in a paper test. Age, prostate volume, serum prostate-specific antigen, maximum urinary flow rate, and postvoid residual urine were also evaluated. RESULTS: There were significant differences in the total and voiding IPSS between men with and without ED (p=0.042 and 0.043, respectively). The Hallym PostMicturition Dribble Questionnaire 1 score was inversely well correlated with the IIEF-5 score (r=−0.388, p < 0.001). Also, the PMD volume was inversely correlated with the IIEF-5 score (r=−0.138, p=0.042). ED prevalence increased as the Hallym PostMicturition Dribble Questionnaire 1 score increased (p=0.002). Further, incorporating the Hallym PostMicturition Dribble Questionnaire 1 into the IPSS tended to increase the predictive accuracy of LUTS by 4.2% in ED patients (p=0.082). CONCLUSIONS: PMD was significantly correlated with ED and reinforced the relationship between LUTS and ED in middle-aged and older men. PMD might be an important component of the association between LUTS and ED.

Bioglue-Coated Teflon Sling Technique in Microvascular Decompression for Hemifacial Spasm Involving the Vertebral Artery

OBJECTIVE: Microvascular decompression (MVD) for hemifacial spasm (HFS) involving the vertebral artery (VA) can be technically challenging. We investigated the therapeutic effects of a bioglue-coated Teflon sling technique on the VA during MVD in 42 cases. METHODS: A bioglue-coated Teflon sling was crafted by the surgeon and applied to patients in whom neurovascular compression was caused by the VA. The radiologic data, intra-operative findings with detailed introduction of the procedure, and the clinical outcomes of each patient were reviewed and analyzed. RESULTS: The 42 patients included in the analysis consisted of 22 females and 20 males, with an average follow-up duration of 76 months (range 24–132 months). Intraoperative investigation revealed that an artery other than the VA was responsible for the neurovascular compression in all cases : posterior inferior cerebellar artery (PICA) in 23 patients (54.7%) and anterior inferior cerebellar artery (AICA) in 11 patients (26.2%). All patients became symptom-free after MVD. Neither recurrence nor postoperative neurological deficit was noted during the 2-year follow-up, except in one patient who developed permanent deafness. Cerebrospinal fluid (CSF) leak occurred in three patients, and one required dural repair. CONCLUSION: Transposition of the VA using a bioglue-coated Teflon sling is a safe and effective surgical technique for HFS involving the VA. A future prospective study to compare clinical outcomes between groups with and without use of this novel technique is required.

Tolfenamic Acid Suppresses Inflammatory Stimuli-Mediated Activation of NF-kappaB Signaling

Tolfenamic acid (TA) is a traditional non-steroid anti-inflammatory drug (NSAID) and has been broadly used for the treatment of migraines. Nuclear factor kappa B (NF-kappaB) is a sequence-specific transcription factor and plays a key role in the development and progression of inflammation and cancer. We performed the current study to investigate the underlying mechanisms by which TA suppresses inflammation focusing on NF-kappaB pathway in TNF-alpha stimulated human normal and cancer cell lines and lipopolysaccharide (LPS)-stimulated mouse macrophages. Different types of human cells (HCT116, HT-29 and HEK293) and mouse macrophages (RAW264.7) were pre-treated with different concentrations of TA and then exposed to inflammatory stimuli such as TNF-alpha and LPS. Transcriptional activity of NF-kappaB, IkappaB-alpha-degradation, p65 translocation and mitogen-activated protein kinase (MAPK) activations were measured using luciferase assay and Western blots. Pre-treatment of TA repressed TNF-alpha- or LPS-stimulated NF-kappaB transactivation in a dose-dependent manner. TA treatment reduced degradation of IkappaB-alpha and subsequent translocation of p65 into nucleus. TA significantly down-regulated the phosphorylation of c-Jun N-terminal kinase (JNK). However, TA had no effect on NF-kappaB signaling and JNK phosphorylation in HT-29 human colorectal cancer cells. TA possesses anti-inflammatory activities through suppression of JNK/NF-kappaB pathway in different types of cells.

ATF3 Mediates Anti-Cancer Activity of Trans-10, cis-12-Conjugated Linoleic Acid in Human Colon Cancer Cells

Conjugated linoleic acids (CLA) are a family of isomers of linoleic acid. CLA increases growth arrest and apoptosis of human colorectal cancer cells through an isomer-specific manner. ATF3 belongs to the ATF/CREB family of transcription factors and is associated with apoptosis in colorectal cancer. The present study was performed to investigate the molecular mechanism by which t10, c12-CLA stimulates ATF3 expression and apoptosis in human colorectal cancer cells. t10, c12-CLA increased an apoptosis in human colorectal cancer cells in dose dependent manner. t10, c12-CLA induced ATF3 mRNA and luciferase activity of ATF3 promoter in a dose-dependent manner. The responsible region for ATF3 transcriptional activation by t10, c12-CLA is located between -147 and -1850 of ATF3 promoter. mRNA stability of ATF3 was not affected by t10, c12-CLA treatment. t10, c12-CLA increases GSK3beta expression and suppresses IGF-1-stimulated phosphorylation of Akt. The knockdown of ATF3 suppressed expression of GSK3beta and NAG-1 and PARP cleavage. The results suggest that t10, c12-CLA induces apoptosis through ATF3-mediated pathway in human colorectal cancer cells.

Alcohol, Smoking, Physical Activity, Protein, and Lower Urinary Tract Symptoms: Prospective Longitudinal Cohort / 대한배뇨장애요실금학회지

PURPOSE: To evaluate risk factors for deterioration of lower urinary tract symptoms (LUTS) in elderly men in a community-based, prospective longitudinal cohort study. METHODS: In a suburban area in Korea, 1,514 subjects aged > or =45 years were randomly selected by systematic sampling. A total of 918 elderly subjects were enrolled in this in-depth clinical study in 2004. Of these, 547 participants were followed up for 3 years and the data was analyzed in 2014. Standard questionnaires were administered face-to-face by trained interviewers. After excluding women, 224 male participants with complete data including transrectal ultrasonography were included in the final analysis. LUTS were diagnosed using the International Prostate Symptom Score (IPSS) questionnaire. Symptom deterioration was defined as a score of > or =8 points during the 3-year follow-up period. RESULTS: LUTS prevalence increased to 13.1% and the mean IPSS increased by 2.6 points during the 3-year period. After adjusting for confounders, a smoking history of > or =50 pack-years was an independent risk factor for deterioration of LUTS and storage subsymptoms compared with no history of smoking (3.1 and 5.1 odds, respectively). Physical activity had a protective effect on voiding subsymptoms. However, high protein diet and alcohol intake were not associated with LUTS deterioration. CONCLUSIONS: The LUTS prevalence among elderly men living in a suburban area increased to 13.1% and the IPSS increased by 2.6 points during the 3-year period. A history of heavy smoking, low physical activity, and high protein intake were associated with LUTS deterioration. However, there was no significant association between alcohol intake and LUTS deterioration.

Detection of Ocular Toxoplasma gondii Infection in Chronic Irregular Recurrent Uveitis by PCR

Toxoplasma gondii is a zoonotic parasite resulting in human infections and one of the infectious pathogens leading to uveitis and retinochoroiditis. The present study was performed to assess T. gondii infection in 20 ocular patients with chronic irregular recurrent uveitis (20 aqueous humor and 20 peripheral blood samples) using PCR. All samples were analyzed by nested PCR targeting a specific B1 gene of T. gondii. The PCR-positive rate was 25% (5/20), including 5% (1) in blood samples, 25% (5) in aqueous humor samples, and 5% (1) in both sample types. A molecular screening test for T. gondii infection in ocular patients with common clinical findings of an unclear retinal margin and an inflammatory membrane over the retina, as seen by fundus examination, may be helpful for early diagnosis and treatment.

Influence of Donor's Renal Function on the Outcome of Living Kidney Transplantation: 10-Year Follow-up

PURPOSE: With the improved surgical techniques and immunosuppression available today, conventional prognostic factors have taken on less significance. Accordingly, the native renal function of the donor is thought to be more important. Thus, we analyzed the prognostic significance of the donor's renal function as assessed by 24-hour urine creatinine clearance on kidney graft survival for 10 years after living kidney transplantation. MATERIALS AND METHODS: From January 1998 to July 2000, 71 living kidney transplantations were performed at a single institution. From among these, 68 recipients were followed for more than 6 months and were included in the present analysis. We analyzed kidney graft survival according to clinical parameters of the donor and the recipient. RESULTS: Mean follow-up duration of recipients after living kidney transplantation was 115.0+/-39.4 months (range, 10 to 157 months), and 31 recipients (45.6%) experienced kidney graft loss during this time period. Estimated mean kidney graft survival time was 131.8+/-6.2 months, and 5-year and 10-year kidney graft survival rates were estimated as 88.2% and 61.0%, respectively. Donor's mean 24-hour urine creatinine clearance (Ccr) before kidney transplantation was 122.8+/-21.2 ml/min/1.73 m2 (range, 70.1 to 186.6 ml/min/1.73 m2). The 10-year kidney graft survival rates for cases stratified by a donor's Ccr lower and higher than 120 ml/min/1.73 m2 were 39.0% and 67.2%, respectively (p=0.005). In univariate and multivariate analysis, donor's Ccr was retained as an independent prognostic factor of kidney graft survival (p=0.001 and 0.005, respectively). CONCLUSIONS: Donor's 24-hour urine Ccr before living kidney transplantation was an independent prognostic factor of kidney graft survival. Therefore, it should be considered before living kidney transplantation.

Is High-Sensitivity C-Reactive Protein Associated with Lower Urinary Tract Symptoms in Aging Men? Results from the Hallym Aging Study

PURPOSE: The pathogenesis of lower urinary tract symptoms (LUTS) is uncertain. We investigated the potential role of inflammation in the development of LUTS, with the use of high-sensitivity C-reactive protein (hsCRP) as an inflammatory marker, in a population-based study of aging men in Korea. MATERIALS AND METHODS: Our study used a multistage stratified design to recruit a random sample of 1,510 men aged 45 years or older in Chuncheon, Korea, in 2003. Men with urologic or neurologic diseases that could cause voiding dysfunction were excluded. Also, men with medical conditions that could affect inflammation, such as infection or the use of nonsteroidal anti-inflammatory drugs, were excluded. LUTS were defined according to the International Prostate Symptom Score (IPSS). Various potential confounding factors were included in the analyses. RESULTS: A total of 330 subjects were included in the final analyses. There were 155 (47.0%) with an IPSS or =8. The mean age of all subjects was 69.2+/-8.4 years. The mean hsCRP level of all subjects was 2.30+/-3.27 (median, 1.19) mg/l. The hsCRP levels in subjects with an IPSS> or =8 differed significantly from those in subjects with an IPSS or =8, storage symptom score> or =4, incomplete voiding, intermittency, and QoL) after adjustment for variable possible confounding factors. CONCLUSIONS: Our results suggest that inflammatory processes may play an important role in the pathogenesis of LUTS and that hsCRP levels may indicate the severity of LUTS in aging men.

Spontaneous Recovery of Cavernous Nerve Crush Injury

PURPOSE: To investigate pathophysiological consequences and spontaneous recovery after cavernous nerve crush injury (CNCI) in a rat model. MATERIALS AND METHODS: Twenty 4-week-old male Sprague-Dawley rats were divided into the following groups: sham-operated group (n=10) and bilateral CNCI groups (n=10) for two different durations (12 and 24 weeks). At both time points, CN electrical stimulation was used to assess erectile function by measuring the intracavernous pressure. The expression of hypoxia inducible factor (HIF)-1alpha and sonic hedgehog (SHH) was examined in penile tissue. Immunohistochemical staining was performed for nerve growth factor (NGF), endothelial nitric oxide synthase (eNOS), neuronal nitric oxide synthase (nNOS), and smooth muscle alpha-actin. RESULTS: CNCI significantly decreased erectile function at 12 weeks (51.7% vs. 71.9%, mean ICP/BP ratio, p<0.05) and increased the expression of HIF-1alpha and decreased the expression of eNOS, nNOS, and SHH. At 24 weeks, erectile function in the CNCI group was improved with no significant difference versus the sham group (70.5% vs. 63.3%, mean ICP/BP ratio, p<0.05) or the CN group at 12 weeks (51.7% vs. 63.3%, mean ICP/BP ratio, p<0.05). By RT-PCR, the increase in HIF-1alpha and decrease in SHH mRNA was restored at 24 weeks. By immunohistochemistry, the expression of eNOS and nNOS was increased at 24 weeks. CONCLUSIONS: CN injury induces significantly impaired erectile function and altered gene and protein expression, which suggests that local hypoxic and inflammatory processes may contribute to this change. Significant spontaneous recovery of erectile function was observed at 6 months after CN crush injury.

Spontaneous Recovery of Cavernous Nerve Crush Injury

PURPOSE: To investigate pathophysiological consequences and spontaneous recovery after cavernous nerve crush injury (CNCI) in a rat model. MATERIALS AND METHODS: Twenty 4-week-old male Sprague-Dawley rats were divided into the following groups: sham-operated group (n=10) and bilateral CNCI groups (n=10) for two different durations (12 and 24 weeks). At both time points, CN electrical stimulation was used to assess erectile function by measuring the intracavernous pressure. The expression of hypoxia inducible factor (HIF)-1alpha and sonic hedgehog (SHH) was examined in penile tissue. Immunohistochemical staining was performed for nerve growth factor (NGF), endothelial nitric oxide synthase (eNOS), neuronal nitric oxide synthase (nNOS), and smooth muscle alpha-actin. RESULTS: CNCI significantly decreased erectile function at 12 weeks (51.7% vs. 71.9%, mean ICP/BP ratio, p<0.05) and increased the expression of HIF-1alpha and decreased the expression of eNOS, nNOS, and SHH. At 24 weeks, erectile function in the CNCI group was improved with no significant difference versus the sham group (70.5% vs. 63.3%, mean ICP/BP ratio, p<0.05) or the CN group at 12 weeks (51.7% vs. 63.3%, mean ICP/BP ratio, p<0.05). By RT-PCR, the increase in HIF-1alpha and decrease in SHH mRNA was restored at 24 weeks. By immunohistochemistry, the expression of eNOS and nNOS was increased at 24 weeks. CONCLUSIONS: CN injury induces significantly impaired erectile function and altered gene and protein expression, which suggests that local hypoxic and inflammatory processes may contribute to this change. Significant spontaneous recovery of erectile function was observed at 6 months after CN crush injury.

Effect of Desmopressin with Anticholinergics in Female Patients with Overactive Bladder

PURPOSE: The aim of this study was to evaluate the effect of desmopressin combined with anticholinergics on daytime frequency and urgency in female patients with overactive bladder (OAB). MATERIALS AND METHODS: We included 68 female patients with OAB. Patients were randomly assigned to receive 5 mg of solifenacin (group I) or 5 mg of solifenacin and 0.2 mg of desmopressin (group II) for 2 weeks. A pre/post-treatment 3-day voiding diary and the Urinary Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7) were used to assess changes in voiding symptoms and quality of life (QoL); results were compared between the two groups. RESULTS: Groups I and II included 31 and 37 patients, respectively. Time to first void was 12 min later in group II (105 min vs. 117 min), but this difference was not statistically significant. However, time to the second and third voids (203 min vs. 255 min, 312 min vs. 368 min) and the first urgency episode (212 min vs. 255 min) were significantly longer in group II. Compared with group I, patients in group II showed significant improvement in QoL scores. When improvement after treatment was defined as increase in time to first void of greater than 10% after 2 weeks of treatment, desmopressin with anticholinergics was more effective in patients over the age of 65 years and with more than 150 ml of voided volume. CONCLUSIONS: Desmopressin combined with anticholinergics was more effective than anticholinergics only in the treatment of female patients with OAB.

Stent Position Is More Important than alpha-Blockers or Anticholinergics for Stent-Related Lower Urinary Tract Symptoms after Ureteroscopic Ureterolithotomy: A Prospective Randomized Study

PURPOSE: To evaluate the clinical factors that impact ureteral stent-related lower urinary tract symptoms (LUTS) after ureteroscopic ureterolithotomy, including the stent position and medication. MATERIALS AND METHODS: Fifty-three patients who underwent ureteroscopic ureterolithotomy with indwelling a stent were distributed into three groups. On demand analgesics were given to the group 1 (n=18). Daily tamsulosin 0.2 mg was added for group 2 (n=15) and daily tamsulosin 0.2 mg and tolterodine 4 mg was added for group 3 (n=20). The patients were also subclassified into appropriate or inappropriate group according to stent position. All the patients completed a visual analogue scale (VAS) and International Prostate Symptom Score (IPSS) on the 1st and 7th postoperative days. The VAS and IPSS were analyzed according to the medication groups and the stent position. RESULTS: In the appropriate stent potion group, only the storage symptom scores of groups 2 and 3 on the 1st postoperative day were significantly lower than those of the group 1 (p=0.001). This medication effect on LUTS was not observed in the inappropriate stent position group. In this group, total IPSS (p=0.015) and storage symptom scores (p=0.002) were higher than in the appropriate stent position group on the 7th postoperative day. CONCLUSIONS: Correct placement of the stent was more important than medication for lessening stent-related storage symptoms.

Association between Lower Urinary Tract Symptoms and Vascular Risk Factors in Aging Men: The Hallym Aging Study

PURPOSE: The aim of this study was to investigate the relationship between lower urinary tract symptoms (LUTS) and risk factors for vascular diseases in a population-based cohort study, the Hallym Aging Study (HAS). MATERIALS AND METHODS: Among the 1,520 participants in HAS, 280 men aged more than 50 years, who underwent detailed health evaluations, including health-related questionnaires, evaluations of their medical history, and various life style factors, as well as clinical measurements, were included in the study. Vascular risk factors used in the present study including hypertension, diabetes mellitus, hyperlipidemia, and smoking and were assessed by medical history and clinical measurements. LUTS were assessed by validated questionnaires, the International Prostate Symptom Score (IPSS), and the relationship between LUTS and vascular risk factors was investigated. RESULTS: Of the 280 men, 175 (62.5%) had moderate/severe LUTS (IPSS>7) and 260 (93%) had one or more vascular risk factors. The IPSS was similar in those with no (11.6+/-9.7) and one or two (11.5+/-8.5) vascular risk factors, but increased to 15.1+/-9.3 in those with 3 or more vascular risk factors (p<0.05). The multiple logistic regression analysis, controlling for age and body mass index (BMI) showed that men with 3 or more vascular risk factors were 3 times more likely to have moderate/severe LUTS than men without vascular risk factors (p<0.05). CONCLUSIONS: Men with risk factors for vascular diseases are more likely to have LUTS and these findings suggest that vascular risk factors play a role in the development of LUTS.

Association between Lower Urinary Tract Symptoms and Vascular Risk Factors in Aging Men: The Hallym Aging Study

PURPOSE: The aim of this study was to investigate the relationship between lower urinary tract symptoms (LUTS) and risk factors for vascular diseases in a population-based cohort study, the Hallym Aging Study (HAS). MATERIALS AND METHODS: Among the 1,520 participants in HAS, 280 men aged more than 50 years, who underwent detailed health evaluations, including health-related questionnaires, evaluations of their medical history, and various life style factors, as well as clinical measurements, were included in the study. Vascular risk factors used in the present study including hypertension, diabetes mellitus, hyperlipidemia, and smoking and were assessed by medical history and clinical measurements. LUTS were assessed by validated questionnaires, the International Prostate Symptom Score (IPSS), and the relationship between LUTS and vascular risk factors was investigated. RESULTS: Of the 280 men, 175 (62.5%) had moderate/severe LUTS (IPSS>7) and 260 (93%) had one or more vascular risk factors. The IPSS was similar in those with no (11.6+/-9.7) and one or two (11.5+/-8.5) vascular risk factors, but increased to 15.1+/-9.3 in those with 3 or more vascular risk factors (p<0.05). The multiple logistic regression analysis, controlling for age and body mass index (BMI) showed that men with 3 or more vascular risk factors were 3 times more likely to have moderate/severe LUTS than men without vascular risk factors (p<0.05). CONCLUSIONS: Men with risk factors for vascular diseases are more likely to have LUTS and these findings suggest that vascular risk factors play a role in the development of LUTS.

The effect of infusion rate and catheter length on the temperature of warming fluid / 대한마취과학회지

BACKGROUND: We used warming fluid for maintenance of body temperature in operating room or intensive care unit. This study was aimed to investigate the effect of infusion rate and catheter length on the temperature of warming fluid. METHODS: Normal saline was used for testing infusion and temperature of infusion was maintained by a warmer as 40degrees C. The temperatures of solution in infusion line were measured at 0, 25, 50, 75, and 100 cm apart from warmer at six different flow rates (100, 200, 300, 700, 1,400, and 2,100 ml/h). We also measured the temperature changes at room temperature (RT) and 5degrees C, 10degrees C, and 15degrees C above RT. RESULTS: The time to maintain solution temperature as 40degrees C was 165, 122, 37, 37, 21, and 19 s at flow rate 100, 200, 300, 700, 1,400, and 2,100 ml/h. The peak temperature was 43.58 +/- 0.58, 44.43 +/- 1.18, 44.37 +/- 0.70, 43.79 +/- 0.61, 42.82 +/- 0.97, and 42.11 +/- 0.92degrees C according to increasing flow rate. The temperature at 100 cm apart from warmer was 23.96 +/- 1.53, 25.46 +/- 2.76, 29.32 +/- 3.47, 31.40 +/- 5.38, 31.39 +/- 6.75, and 38.14 +/- 0.96degrees C according to increasing flow rate. CONCLUSIONS: These results suggested that the decreasing rate of temperature was related inversely to the flow rate and directly to the catheter length. There may be needed a rapid infusion pump with adequate heating system at a high flow rate and to locate the warmer close to patient for reserving a heating effect.

Respiratory failure due to myotonic dystrophy combined with peripartum cardiomyopathy: A case report / 대한마취과학회지

Myotonic dystrophy is an autosomal-dominant inherited neuromuscular disorder that's characterized by slowly progressive muscular dystrophy, muscle weakness and myotonia. The clinical features may vary from just cataracts to involvement of multiple organ systems such as various muscles, the heart, lung and intestine. Its most common complication is postoperative respiratory failure. We encountered a patient who developed sudden unexpected peripartum cardiomyopathy (PPCM) and respiratory failure due to presumed myotonic dystrophy after cesarean section. We report here on our clinical experience with this malady and we include a brief review of the medical literature on myotonic dystrophy.

A Study of Minimal Change in Nocturia Affecting Quality of Life

PURPOSE: It is well known that nocturia is a bothersome symptom that affects the quality of life (QoL). However, it is not known how much of a decrease in nocturnal frequency is needed to improve the QoL. We determined the minimal change in nocturnal frequency affecting the QoL of patients with nocturia. MATERIALS AND METHODS: A total of 87 patients with BPH and nocturia were treated with alpha-blocker and desmopressin for 8 weeks. Considering that the minimal clinically important change (MCIC) is different according to the baseline value, we divided the patients into two groups (group I, II). Group I had mild to moderate nocturia with voiding or =4 times per night. Voiding diaries and King's Health Questionnaires (KHQs) were evaluated before and after treatment. To determine the minimal change in nocturia affecting the QoL, statistical analysis was performed by Student's t-test and ANOVA test with the change in KHQ score according to decreased numbers of nocturnal frequency. RESULTS: Groups I and II had 35 and 52 patients, respectively. The minimal decrease in nocturnal frequency associated with a statistically significant decrease in sleep/energy domain scores was 1 time in Group I and 2 times in Group II. CONCLUSIONS: These data show that decreases in nocturia of at least 1 time in patients with mild to moderate nocturia ( or =4 times/night) are needed to improve the QoL.

Association between Erectile Dysfunction and Metabolic Syndrome in Aging Men: Hallym Aging Study

PURPOSE: The aim of this study was to investigate the relationship between erectile dysfunction (ED) and metabolic syndrome (MS) in a population-based cohort study, the Hallym Aging Study (HAS). MATERIALS AND METHODS: Among the 1,520 participants in HAS, 278 men aged more than 50 years, who underwent detailed health evaluations, including health-related questionnaires, evaluation of their medical history and various lifestyle factors, as well as clinical measurements, were included in the study. ED and MS were assessed by using a 5-item version of the International Index of Erectile Function (IIEF-5) and the guidelines of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), respectively, and the relationship between ED and MS was investigated. RESULTS: Of the 278 men, 120 (43.2%) had MS. Ninety percent of men with MS and 78.5% of men without MS had ED (p<0.05), and chi-square analysis revealed significant differences in the rate of MS between groups when stratified by ED severity (p<0.001). The multivariate logistic regression analysis, with control for age and comorbidities, showed that men with MS were 3 times as likely to have ED as were men without MS. Among the metabolic risk factors, only waist circumference (WC) was significantly associated with the presence and severity of ED (p<0.05). CONCLUSIONS: The presence of MS was an independent risk factor for ED, and WC was the most significant metabolic risk factor predicting the risk of ED. These results highlight the clinical importance of evaluating ED in patients with MS, especially in patients with abnormal WC.

Comparison with hemodynamic changes of laparoscopic surgery by body position

BACKGROUND: The authors evaluated the hemodynamic effects of body position measured by esophageal Doppler monitor (EDM) during laparoscopic cholecystectomy or gynecologic laparoscopic surgery. METHODS: Fifty patients scheduled to undergo laparoscopic cholecystectomy (Group C) or gynecologic laparoscopic surgery (Group G), were divided into two groups. Pneumoperitoneum was instituted by CO2 gas and the intraperitoneal pressure was kept under 12 mmHg. Hemodynamic parameters at critical points were measured by the use of EDM: before skin incision (T1), 5, 10 and 15 min after changing position (T2, T3 and T4), and 5 min after CO2 exsufflation (T5). RESULTS: MAP (mean arterial pressure) was significantly higher in Group G when compared with Group C 10 min after changing position (T3) (P< 0.05). CO (cardiac output) was significantly decreased in Group G when compared with Group C 10 min after changing position (T3) (P< 0.05). And there were not significant differences in HR (heart rate) between two groups. PV (peak velocity) was significantly decreased in Group G when compared with Group C 10 min after changing position (T3) (P< 0.05). And there were not significant differences in FTc (corrected flow time) between two groups. But FTc in Group C was restored after CO2 exsufflation, FTc in Group G was not restored after CO2 exsufflation. CONCLUSIONS: Changing position in the gynecologic laparoscopic surgery group can elevate MAP and decrease CO. Therefore, careful caution is required in patients with cardiovascular disease who are undergoing gynecologic laparoscopic surgery.