Clinical Outcomes of Continuous Addition of Androgen Deprivation Therapy During Docetaxel Chemotherapy for Patients With Castration-Resistant Prostate Cancer

PURPOSE: This study compared the oncologic results of docetaxel chemotherapy (DOC) in castration-resistant prostate cancer (CRPC) according to continuous addition of androgen deprivation therapy (ADT) during chemotherapy. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 106 patients who received DOC in 6 medical institutes. Among them, 72 patients had a complete medical record: 28 patients with ADT (DOC+continuous ADT group) and 44 without ADT (DOC only group). We compared the progression-free survival of these groups after DOC. RESULTS: Docetaxel was administered an average of 28 months after primary ADT as the first treatment. A median number of 6 cycles of DOC was administered in both groups. In the DOC+continuous ADT group, orchiectomy was performed in 18 patients and luteinizing hormone-releasing hormone agonist was injected in 10 patients. During DOC treatment, prostate-specific antigen (PSA) progression-free survival was statistically different (6.0±4.75 months in DOC+continuous ADT group vs. 4.8±3.2 months in DOC only group, p=0.024), whereas radiologic progression-free survival was not statistically different (5.0±3.12 months in DOC+continuous ADT group vs. 5.0±2.79 months in DOC only group, p=0.387). CONCLUSIONS: In our cohort, continuous addition of ADT showed a significant benefit in PSA progression-free survival during DOC in CRPC patients. Further prospective studies are needed to confirm these observations.

Erratum: Acknowledgments. The Efficacy and Safety of Tadalafil 5 mg Once Daily in the Treatment of Erectile Dysfunction After Robot-Assisted Laparoscopic Radical Prostatectomy: 1-Year Follow-up

In this paper, acknowledgments section was omitted unintentionally.

Perirenal Lymphangiomatosis

Lymphangioma is a rare, benign mesenchymal neoplasm, which is characterized by numerous intercommunicating cystic spaces containing lymphatic fluid. It is considered a congenital disease resulting from the obstruction of regional lymph drainage during the developmental period. Lymphangioma may be focal/unilateral or diffuse/bilateral, and in the latter case, it is referred to as lymphangiomatosis. Here, we report a case of a 38-year-old man with perirenal lymphangiomatosis. The patient's chief complaint was left flank pain, and left pleural effusion was found on radiological examination. After radical nephrectomy, the pathological examinations revealed that the kidney was enclosed by a multicystic mass with intrarenal cystic dilatations. We report the case and discuss the management of perirenal lymphangiomatosis with a literature review.

Perirenal Lymphangiomatosis

Lymphangioma is a rare, benign mesenchymal neoplasm, which is characterized by numerous intercommunicating cystic spaces containing lymphatic fluid. It is considered a congenital disease resulting from the obstruction of regional lymph drainage during the developmental period. Lymphangioma may be focal/unilateral or diffuse/bilateral, and in the latter case, it is referred to as lymphangiomatosis. Here, we report a case of a 38-year-old man with perirenal lymphangiomatosis. The patient's chief complaint was left flank pain, and left pleural effusion was found on radiological examination. After radical nephrectomy, the pathological examinations revealed that the kidney was enclosed by a multicystic mass with intrarenal cystic dilatations. We report the case and discuss the management of perirenal lymphangiomatosis with a literature review.

The Efficacy and Safety of Tadalafil 5 mg Once Daily in the Treatment of Erectile Dysfunction After Robot-Assisted Laparoscopic Radical Prostatectomy: 1-Year Follow-up

PURPOSE: To evaluate the efficacy and safety of tadalafil 5 mg once daily use in the treatment of erectile dysfunction (ED) after robot-assisted laparoscopic radical prostatectomy (RALP). MATERIALS AND METHODS: The study retrospectively evaluated 92 patients who underwent RALP at Dong-A University Hospital. The patients were surveyed by use of the abridged five-item version of the International Index of Erectile Function (IIEF-5) questionnaire, which was self-administered before surgery and at 6 months and 1 year after surgery. The 92 patients were classified into the tadalafil group (n=47) and the non-tadalafil group (n=45). Each group was then classified depending on the nerve-sparing (NS) procedure used: bilateral NS or unilateral NS. RESULTS: At 6 months, the total IIEF-5 scores of the tadalafil group and the non-tadalafil group were 10.0+/-3.4 and 7.0+/-4.0, respectively. At 1 year, the total IIEF-5 score in the tadalafil group was significantly greater than that in the non-tadalafil group (13.2+/-5.6 vs. 7.7+/-4.8, p<0.0001). Statistically significant improvements (p<0.05) were observed in the tadalafil group for all 5 domains of the IIEF-5 score, whereas in the non-tadalafil group there was no significant improvement in any of the domains at 1 year. The reported side effects were flushing (8.5%, n=4), headache (4.3%, n=2), and dizziness (2.1%, n=1). CONCLUSIONS: In ED patients after NS RALP, a once-daily dose of tadalafil 5 mg was well tolerated and significantly improved EF compared with that in the non-tadalafil group.

Laparoendoscopic Single-Site Surgery With the Second-Generation Single Port Instrument Delivery Extended Reach Surgical System in a Porcine Model

PURPOSE: To describe our initial experience with the second-generation Single Port Instrument Delivery Extended Reach (SPIDER) laparoendoscopic single-site surgical system in a porcine model. MATERIALS AND METHODS: In four swine weighing approximately 32 to 35 kg, five nephrectomies, four adrenalectomies, three pyeloplasties, and three partial cystectomies and closures were performed by a single surgeon. The swine were placed in the lateral flank position under general anesthesia. The SPIDER surgical system was introduced through a single incision and the various urological procures were performed by use of flexible instrumentation. RESULTS: All five nephrectomies, four adrenalectomies, three pyeloplasties, and three partial cystectomies and closures were performed successfully without additional skin incisions. The mean time to set up the SPIDER platform was 3.5 minutes. The mean operative time for the right and left nephrectomies was 45.4 minutes and 47.8 minutes, respectively. The mean operative time for the right and left adrenalectomies was 37.6 minutes and 35.4 minutes, respectively. The mean operative time for the pyeloplasties for one right and two left ureters was 45.6 minutes and 47.3 minutes, respectively. The mean operative time for the partial cystectomies and closures was 18.6 minutes. There were no noticeable intraoperative complications except for minimal urine leakage in the first pyeloplasty. CONCLUSIONS: In this initial pilot evaluation, the second-generation SPIDER surgical system offered intuitive instrument maneuverability and restored triangulation. However, retraction was challenging because of the lack of strength and the limited ability for precise manipulation of the tip. Future refinements of the technology and prospective studies are needed to optimize the application of this technology in urology.

Efficacy of Extracorporeal Shock Wave Lithotripsy in Pediatric and Adolescent Urolithiasis

PURPOSE: To retrospectively evaluate the efficacy of extracorporeal shock wave lithotripsy (ESWL) by age and current condition as a first-line treatment for pediatric and adolescent urolithiasis. MATERIALS AND METHODS: The computerized records of 55 children were retrospectively reviewed from March 1991 to July 2007. The children were below 18 years of age and had undergone ESWL monotherapy for urolithiasis. There were 36 boys (65.5%) and 19 girls (34.5%), with a mean age of 8.5 years (range, 0.5-18 years). There were 24 patients aged 7 years or less and 31 patients aged more than 7 years. RESULTS: The mean size of the stones was 9.48 mm (range, 4-22 mm). The overall success rate of ESWL was 90.9% (50 children). The mean number of ESWL sessions was 2.02 (range, 1-10). The mean number of ESWL sessions for the patient group aged 7 years or less was 1.16 (range, 1-2) and that for the patient group aged more than 7 years was 2.97 (range, 1-10; p=0.037). There was also a statistically significant difference in the mean number of ESWL sessions between the younger and older patients who needed general anesthesia (1.16 vs. 2.2 sessions, respectively; 0.042). CONCLUSIONS: In the patient group aged 7 years or less, the number of ESWL sessions and the complication rate were comparable with those for endoscopic management. Thus, ESWL is an effective first-line treatment modality for patients aged less than 7 years.

Radiofrequency Ablation of Renal Tumors: Four-Year Follow-Up Results in 47 Patients

OBJECTIVE: To retrospectively evaluate the intermediate results of radiofrequency ablation (RFA) of small renal masses (SRMs). MATERIALS AND METHODS: Percutaneous or laparoscopic RFA was performed on 48 renal tumors in 47 patients. The follow-up studies included a physical examination, chest radiography, creatinine level, and contrast-enhanced CT or MRI. To confirm the pathologic criteria of complete ablation, 35 patients underwent a follow-up biopsy. Recurrence was defined as contrast enhancement on imaging studies after 3 months, lesion growth at subsequent imaging, or viable cancer cells on follow-up biopsy. RESULTS: Technical success was achieved in 43 (89.6%) of 48 renal tumors. The mean tumor size was 2.3 cm and the mean follow-up period was 49.6 months. Repeated RFA was necessary in 5 tumors due to incomplete ablation. The overall complication rate was 35.8%, of which 96.2% were mild complications. Serum creatinine levels at 12 months after RFA did not differ from those before RFA (1.28 vs. 1.36 mg/dL). Four patients were found to have recurrence at various follow-up intervals, and distant metastasis was not found in any cases. CONCLUSION: RFA appears to be a useful treatment for selected patients with SRMs. Our 4-year follow-up results disclose an excellent therapeutic outcome with RFA, while achieving effective local tumor control.

Radiofrequency Ablation of Renal Tumors: Our Experience

PURPOSE: To report our results of nephron-sparing radiofrequency ablation (RFA) of renal tumors. MATERIALS AND METHODS: Since August 2004, 49 patients with renal tumors were treated with either percutaneous or laparoscopic RFA. All patients underwent preoperative imaging with contrast-enhanced computed tomography (CT) or magnetic resonance imaging (MRI) and were suspected to have renal cell carcinoma. The follow-up for each patient included a physical examination, chest radiography, liver function tests, and a contrast-enhanced CT or MRI. To confirm the pathologic criteria of complete ablation, 30 patients underwent 6-month or 1-year follow-up biopsy. Recurrence was defined as growth of the tumor or any new enhancing portions at 3 months after confirmed nonenhancement of the initial RFA lesion. RESULTS: Technical success was achieved in 46/49 cases (94%). The mean tumor size was 2.4 cm and the mean follow-up period was 31.7 months (range, 6-68 months). Of 49 patients, repeated RFA was necessary in 7 patients (14%). Three patients were found to have recurrence at various follow-up intervals. Twenty-three patients (47%) experienced complications, and all but one necessitated intervention. No distant metastasis was found in any cases, and all patients are alive and are being serially followed up. CONCLUSIONS: Percutaneous or laparoscopic RFA is considered to be a useful treatment for selected patients with small renal masses and for nephron-sparing. With a mean follow-up of 31.7 months, our intermediate data suggest excellent therapeutic outcome with RFA with effective local tumor control and preservation of renal function. The ultimate role of this modality will continue to evolve and warrants further studies.

Clinical Usefulness of Implanted Fiducial Markers for Hypofractionated Radiotherapy of Prostate Cancer / 대한방사선종양학회지

PURPOSE: To assess the usefulness of implanted fiducial markers in the setup of hypofractionated radiotherapy for prostate cancer patients by comparing a fiducial marker matched setup with a pelvic bone match. MATERIALS AND METHODS: Four prostate cancer patients treated with definitive hypofractionated radiotherapy between September 2009 and August 2010 were enrolled in this study. Three gold fiducial markers were implanted into the prostate and through the rectum under ultrasound guidance around a week before radiotherapy. Glycerin enemas were given prior to each radiotherapy planning CT and every radiotherapy session. Hypofractionated radiotherapy was planned for a total dose of 59.5 Gy in daily 3.5 Gy with using the Novalis system. Orthogonal kV X-rays were taken before radiotherapy. Treatment positions were adjusted according to the results from the fusion of the fiducial markers on digitally reconstructed radiographs of a radiotherapy plan with those on orthogonal kV X-rays. When the difference in the coordinates from the fiducial marker fusion was less than 1 mm, the patient position was approved for radiotherapy. A virtual bone matching was carried out at the fiducial marker matched position, and then a setup difference between the fiducial marker matching and bone matching was evaluated. RESULTS: Three patients received a planned 17-fractionated radiotherapy and the rest underwent 16 fractionations. The setup error of the fiducial marker matching was 0.94+/-0.62 mm (range, 0.09 to 3.01 mm; median, 0.81 mm), and the means of the lateral, craniocaudal, and anteroposterior errors were 0.39+/-0.34 mm, 0.46+/-0.34 mm, and 0.57+/-0.59 mm, respectively. The setup error of the pelvic bony matching was 3.15+/-2.03 mm (range, 0.25 to 8.23 mm; median, 2.95 mm), and the error of craniocaudal direction (2.29+/-1.95 mm) was significantly larger than those of anteroposterior (1.73+/-1.31 mm) and lateral directions (0.45+/-0.37 mm), respectively (p<0.05). Incidences of over 3 mm and 5 mm in setup difference among the fractionations were 1.5% and 0% in the fiducial marker matching, respectively, and 49.3% and 17.9% in the pelvic bone matching, respectively. CONCLUSION: The more precise setup of hypofractionated radiotherapy for prostate cancer patients is feasible with the implanted fiducial marker matching compared with the pelvic bony matching. Therefore, a less marginal expansion of planning target volume produces less radiation exposure to adjacent normal tissues, which could ultimately make hypofractionated radiotherapy safer.

The Prevalence and Management of Urinary Incontinence in Elderly Patients at Sanatorium in Busan Area

PURPOSE: Prevalence estimates and management methods for urinary incontinence among elderly patients aged 65 and over at sanatoriums in Busan area were investigated. MATERIALS AND METHODS: A sample of 834 institutionalized patients was randomly selected from 13 sanatoriums with 100 and more beds in Busan. The study was designed as a cross-sectional study. Data were collected via face-to-face interviews using Appendix about general status, obstetric history, incontinence, and management method for incontinence. The survey was conducted from February to September 2008. RESULTS: Overall prevalence of urinary incontinence in all of 834 respondents was found to be 48.1%: prevalences of stress incontinence, urge incontinence, mixed incontinence, and functional incontinence were 25.7%, 6.5%, 8.0% and 59.9%, respectively. Among the patients with urinary incontinence symptoms, 28.6% had associated-dermatologic problems. CONCLUSIONS: The estimated prevalence of incontinence for elderly patients aged 65 and more cared at Sanatoriums in Busan area was 48.1%. However, systemic approaches in the management of urinary incontinence in such patients were lacking. Further efforts should be made for proper management of urinary incontinence among elderly patients cared at Sanatorium.

Effect of Posterior Urethral Reconstruction (PUR) in Early Recovery of Urinary Continence after Robotic-Assisted Radical Prostatectomy

PURPOSE: Prolonged urinary incontinence is one of the greatest concerns for patients undergoing radical prostatectomy. One of the possible causes for this urinary incontinence is a postoperative deficiency of the external striated urethral sphincter (EUS) complex and continence nerves. We evaluated the effect of posterior urethral reconstruction (PUR) in the early recovery of urinary continence after robotic-assisted radical prostatectomy. MATERIALS AND METHODS: Between January 2008 and March 2009 we performed robotic-assisted radical prostatectomy with PUR in 30 patients (PUR group) and without PUR in 30 patients (non-PUR group). We compared perioperative parameters and postoperative continence rates between the two groups. Continence was defined as no pads or one diaper per 24 hours and was assessed 1 month, 3 months, and 6 months after the procedure. RESULTS: Patients in the PUR group achieved better continence rates at 1 month (43% vs. 35%) and 3 months of follow-up (89% vs. 64%). At 6 months of follow-up, the continence rate was similar between the two groups (96% vs. 90%). No major complications were observed in the PUR group. However, 2 cases of anastomotic site leakage and 1 case of delayed bleeding were observed in the non-PUR group. CONCLUSIONS: Posterior urethral reconstruction appears to be an easy and reproducible technique in robotic-assisted radical prostatectomy. Our early experience demonstrates that PUR in robotic-assisted radical prostatectomy appears to confer early continence recovery and reduce intraoperative complications.

Effects of Psychodrama on the Elderly Patients with Dementia

OBJECTIVES: This study was to evaluate the cognitive and noncognitive effects of Psychodrama on elderly dementia patients. METHODS: The psychodrama treatment group was composed of 16 elderly dementia patients and control group was matched the psychodrama group. The psychodrama group received 8 session of psychodrama therapy every week. Cognitive function and non-cognitive function of two groups were evaluated by MMSE-KC, K-BNT, Geriatric Depression Scale, Barthel Activities of Daily Living, Self-Esteem Scale before and after Psychodrama. RESULTS: Improvement of Self esteem was observed in psychodrama group. Worsening of depression was observed in control group, but psychodrama group was not observed. CONCLUSION: Psychodrama with elderly dementia can be useful to enhance Self esteem and to prevent worsening of depression

Effects of Psychodrama on the Elderly Patients with Dementia

OBJECTIVES: This study was to evaluate the cognitive and noncognitive effects of Psychodrama on elderly dementia patients. METHODS: The psychodrama treatment group was composed of 16 elderly dementia patients and control group was matched the psychodrama group. The psychodrama group received 8 session of psychodrama therapy every week. Cognitive function and non-cognitive function of two groups were evaluated by MMSE-KC, K-BNT, Geriatric Depression Scale, Barthel Activities of Daily Living, Self-Esteem Scale before and after Psychodrama. RESULTS: Improvement of Self esteem was observed in psychodrama group. Worsening of depression was observed in control group, but psychodrama group was not observed. CONCLUSION: Psychodrama with elderly dementia can be useful to enhance Self esteem and to prevent worsening of depression

Urethrovaginal Fistula due to Behcet's Disease / 대한비뇨기과학회지

Behcet's disease is a multisystem disorder presented with recurrent oral and genital ulcerations as well as ocular involvement. The principal manifestations in the urinary system are glomerulonephritis, cystitis, epididymitis, orchitis, and genital ulcerations. Urethrovaginal fistula is an unusual complication. The primary lesion of the disease is a small vessel vasculitis with endothelial deposition of immunocomplexes, and consequent inflammatory and necrotizing process of the vascular wall. We experienced a 19-year-old woman with Behcet's disease, who had a large urethrovaginal fistula on the anterior vaginal wall. The size of fistula was 2x1cm. For this patient, we tried combining bulbocavernosus muscle and labial fat pad flap (Martius flap) urethral reconstruction. This operative method seemed to be safe and effective for the urethral defect with Behcet's disease.

Epidemiological Survey of Prostate Cancer Prevalence in Kangseo-Gu, Busan, Korea / 대한비뇨기과학회지

PURPOSE: The prevalence of prostate cancer is increasing in the general population. This study aimed to determine the prevalence of prostate cancer in the general population of Kangseo-Gu, Busan, Korea and to estimate the overall prevalence of prostate cancer in Korea. MATERIALS AND METHODS: We studied 497 community volunteers of a random selection from August to September 2001. The included volunteers were older than 50 years and were not within the area of general urologic practice. Screening protocols included International Prostatic Symptom Score(I-PSS), digital rectal examination(DRE) and serum prostate specific antigen(PSA) with an immunoenzymatic assay(Tandem-E). Transrectal ultrasound guided prostate biopsy was recommended in patients with a PSA value higher than 4ng/ml, suspicious nodules on DRE or a hypoechoic region on TRUS, or more than two of these findings. RESULTS: The mean age of the volunteers was 61.0 years old with a range of 50-88 years. The most common age range for men was 50-54 years old in Kangseo-Gu with a total of 144 men(28.3%). Overall, the age distribution of Kangseo-Gu residents was similar to that of the study population. Estimated prostate cancer prevalence was 1.81%, and 9 out of the 497 men were diagnosed with prostate cancer based on prostate biopsy. CONCLUSIONS: Our study indicated prostate cancer detection rate of 1.8% in Kangseo-Gu which translates to an estimated 77,400 men who suffer from prostate cancer in Korea. This result reflects an increase in the prevalence of prostate cancer of 43% in 2002 as compared with the reported value of 1.27% in 1996.

Laparoscopic Radical Cystectomy with Extracorporeal Ileal Conduit Diversion / 대한비뇨기과학회지

Since January 2003, two male patients, 60 and 47 years old, with muscle-invasive, organ-confined, transitional cell carcinomas of the urinary bladder underwent laparoscopic radical cystoprostatectomy with extracorporeal ileal conduit urinary diversion (LRCEIC). The surgical time was 8.5 hours in the first patient and 10 hours in the second. The respective blood losses were 350 and 380ml. In the first patient, ambulation resumed on day 2, bowel sounds on day 3 and oral intake on day 4, with a hospital stay of 8 days. In the second patient, due to inadvertent rectal injury, which was discovered on day 3, ambulation, bowel sounds and oral intake could not be determined. A pathological examination revealed a pT1N0M0 transitional cell carcinoma of the bladder, with the surgical margins negative for cancer, in the first patient, and a pT3bN1M0, with the surgical margins positive for cancer, in the second. Immediate postoperative complications included rectal injury and ileus in the second patient. With further experience and refinement in the operative technique, it is believe that LRCEIC can be performed safely and efficaciously in selected muscle-invasive bladder cancers.