Impact of Multiple Prostate Biopsies: Risk of Perioperative Complications and Biochemical Recurrence After Radical Prostatectomy

Purpose@#The aim of this study was to analyze the perioperative complications and oncological outcomes of radical prostatectomy (RP) in patients who underwent multiple prostate biopsies. @*Materials and Methods@#A total of 1,112 patients who underwent RP between January 2009 and April 2016 at 4 different centers were included in this study. We divided these patients into 2 groups: patients who underwent only 1st biopsy, and those who underwent 2nd or more repeated biopsies. The association between the number of prior biopsies and perioperative complications and biochemical recurrence (BCR) was analyzed. @*Results@#Of 1,112 patients, 1,046 patients (94.1%) underwent only 1st biopsy, and 66 (5.9%) underwent 2nd or more repeated biopsies. There were no significant differences in preoperative prostate-specific antigen levels, operation times, blood loss volumes, or hospital stay durations (all p＞0.05). Patients who underwent multiple prostate biopsies presented with a localized tumor significantly more often (p＜0.05). The Gleason score and rate of positive surgical margins were significantly lower in patients with multiple biopsies (all p＜0.05). The Cox proportional hazards model analysis indicated that there was no association between the number of prior prostate biopsies and BCR (p＞0.05). Kaplan-Meier curve analysis indicated that BCR-free survival rates between the 2 groups were similar (p＞0.05). @*Conclusions@#Multiple prostate biopsies are not associated with an increased risk of perioperative complications, adverse pathological outcomes, or higher rates of BCR in patients who have undergone RP. (Korean J Urol Oncol 2020;18:24-31)

Efficacy of Androgen Deprivation Therapy in Patients with Metastatic Castration-Resistant Prostate Cancer Receiving Docetaxel-Based Chemotherapy

PURPOSE: The purpose of this study was to determine the comparative effectiveness of androgen deprivation therapy (ADT) combined with docetaxel (DTX)-based chemotherapy in Korean and Japanese castration-resistant prostate cancer (CRPC) patient cohorts.MATERIALS AND METHODS: Metastatic CRPC patients who underwent more than three DTX-based chemotherapy cycles in Korea and Japan between 2002 and 2017 were retrospectively analyzed and divided into the DTX-only (DTX, n=30) and combination (DTX+ADT, n=46) groups. Progression-free survival (PFS) was calculated as the time from the start of chemotherapy to the occurrence of either disease progression (prostate-specific antigen [PSA] progression or radiographic progression) or death. The primary end point was PFS and the secondary end point was overall survival (OS).RESULTS: In the DTX and DTX+ADT groups, the median PFS was 6.0 and 11.0 months (log-rank p=0.053). The multivariate Cox regression analysis revealed that the significant predicting factors of PFS were ADT administration (hazard ratio [HR], 0.478; 95% confidence interval [CI], 0.284–0.804; p=0.005) and number of DTX-based chemotherapy cycles (HR, 0.934; 95% CI, 0.899–0.970; p<0.001). In the DTX and DTX+ADT groups, the median OS was 16.0 and 19.5 months (log-rank p=0.825). Through multiple Cox regression analysis, we found that the significant predicting factors of OS were the PSA nadir level (HR, 1.001; 95% CI, 1.000–1.002; p<0.001) and number of DTX-based chemotherapy cycles (HR, 0.932; 95% CI, 0.876–0.991; p=0.024).CONCLUSIONS: Concurrent DTX-based chemotherapy and ADT may be beneficial compared with DTX-based chemotherapy alone in chemotherapy-naïve metastatic CRPC patients in terms of the PFS, but not the OS.

Clinical Characteristics of Ureteral Duplication in Children

PURPOSE: Ureteral duplication is a relatively common congenital urinary tract abnormality that can be associated with various clinical problems such as vesicoureteral reflux (VUR), hydronephrosis, and ectopic ureters. The purpose of this study was to analyze the clinical characteristics of pediatric patients with recently diagnosed ureteral duplication and to identify any differences from those described in previous reports.METHODS: We retrospectively reviewed the clinical characteristics and course of pediatric patients who were diagnosed with ureteral duplication between January 2008 and June 2017.RESULTS: A total of 32 pediatric patients were diagnosed with ureteral duplication during the study period. The male to female ratio was 1:2.2. Twenty-seven patients (84.4%) were first diagnosed with ureteral duplication at less than 3 months of age, and 26 (81.3%) were first diagnosed by prenatal ultrasonography. Four of the 32 patients were diagnosed with bilateral ureteral duplication, for a total of 36 occurrences of ureteral duplication. In 17 occurrences of complete ureteral duplication (47.2%), other urinary tract anomalies were also found; namely, ureterocele (7), VUR (11), and ectopic ureter (5). However, none of the patients with incomplete ureteral duplication had ureterocele or VUR.CONCLUSION: With the advent of routine prenatal ultrasound, ureteral duplication is being diagnosed earlier than was previously possible, enabling timely treatment of the various accompanying urinary tract anomalies. Multicenter studies are needed to establish guidelines for standardized evaluation and treatment of ureteral duplication.

Susceptibility of the Index Urinary Tract Infection to Prophylactic Antibiotics Is a Predictive Factor of Breakthrough Urinary Tract Infection in Children with Primary Vesicoureteral Reflux Receiving Continuous Antibiotic Prophylaxis

BACKGROUND: Few studies have reported on breakthrough urinary tract infection (UTI) associated with the susceptibility of index UTI to prophylactic antibiotics in children with primary vesicoureteral reflux (VUR) receiving continuous antibiotic prophylaxis (CAP). We assessed the impact of the susceptibility of index UTI to prophylactic antibiotics in breakthrough UTIs in children with primary VUR receiving CAP. METHODS: We retrospectively reviewed the medical records of 81 children with primary VUR who were diagnosed after febrile or symptomatic UTI and subsequently received trimethoprim-sulfamethoxazole (TMP-SMX) as CAP between January 2010 and December 2013. We allocated children to a susceptible group or a resistant group based on the susceptibility of index UTI to TMP-SMX. We evaluated patient demographics and clinical outcomes after CAP according to the susceptibility of index UTI to TMP-SMX. Multivariate analysis was used to identify the predictive factors for breakthrough UTI. RESULTS: Of the 81 children, 42 were classified into the susceptible group and 39 into the resistant group. The proportion of breakthrough UTI was 31.0% (13/42) in the susceptible group and 53.8% (21/39) in the resistant group (P = 0.037). Progression of renal scarring was observed in 0% of children in the susceptible group and 15% in the resistant group (P = 0.053). Multivariate analysis showed that TMP-SMX resistance and initial renal scarring were significant predictors of breakthrough UTI. CONCLUSION: Susceptibility of index UTI to prophylactic antibiotics is a risk factor of breakthrough UTI and is associated with poor clinical outcomes in children with primary VUR receiving CAP.

In Vivo Safety and Regeneration of Long-Term Transported Amniotic Fluid Stem Cells for Renal Regeneration

BACKGROUND: Despite major progress in stem cell therapy, our knowledge of the characteristics and tissue regeneration potency of long-term transported cells is insufficient. In a previous in vitro study, we established the optimal cell transport conditions for amniotic fluid stem cells (AFSCs). In the present study, the target tissue regeneration of long-term transported cells was validated in vivo. METHODS: For renal regeneration, transported AFSCs were seeded on a poly(lactide-co-glycolide) scaffold and implanted in a partially resected kidney. The target tissue regeneration of the transported cells was compared with that of freshly harvested cells in terms of morphological reconstruction, histological microstructure reformation, immune cell infiltration, presence of induced cells, migration into remote organs, expression of inflammation/fibrosis/renal differentiation-related factors, and functional recovery. RESULTS: The kidney implanted with transported cells showed recovery of total kidney volume, regeneration of glomerular/renal tubules, low CD4/CD8 infiltration, and no occurrence of cancer during 40 weeks of observation. The AFSCs gradually disappeared and did not migrate into the liver, lung, or spleen. We observed low expression levels of proinflammatory cytokines and fibrotic factors; enhanced expression of the genes Wnt4, Pax2, Wt1, and Emx2; and significantly reduced blood urea nitrogen and creatinine values. There were no statistical differences between the performance of freshly harvested cells and that of the transported cells. CONCLUSION: This study demonstrates that long-term transported cells under optimized conditions can be used for cell therapy without adverse effects on stem cell characteristics, in vivo safety, and tissue regeneration potency.

A Novel Dorsal Slit Approached Non-Ischemic Partial Nephrectomy Method for a Renal Tissue Regeneration in a Mouse Model

BACKGROUND: Kidney ischemia-reperfusion (IR) via laparotomy is a conventional method for kidney surgery in a mouse model. However, IR, an invasive procedure, can cause serious acute and chronic complications through apoptotic and inflammatory pathways. To avoid these adverse responses, a Non-IR and dorsal slit approach was designed for kidney surgery. METHODS: Animals were divided into three groups, 1) sham-operated control; 2) IR, Kidney IR via laparotomy; and 3) Non-IR, Non-IR and dorsal slit. The effects of Non-IR method on renal surgery outcomes were verified with respect to animal viability, renal function, apoptosis, inflammation, fibrosis, renal regeneration, and systemic response using histology, immunohistochemistry, real-time polymerase chain reaction, serum chemistry, terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining, and Masson's trichrome staining. RESULTS: The Non-IR group showed 100% viability with mild elevation of serum blood urea nitrogen and creatinine values at day 1 after surgery, whereas the IR group showed 20% viability and lethal functional abnormality. Histologically, renal tubule epithelial cell injury was evident on day 1 in the IR group, and cellular apoptosis enhanced TUNEL-positive cell number and Fas/caspase-3 and KIM-1/NGAL expression. Inflammation and fibrosis were high in the IR group, with enhanced CD4/CD8-positive T cell infiltration, inflammatory cytokine secretion, and Masson's trichrome stain-positive cell numbers. The Non-IR group showed a suitable microenvironment for renal regeneration with enhanced host cell migration, reduced immune cell influx, and increased expression of renal differentiation-related genes and anti-inflammatory cytokines. The local renal IR influenced distal organ apoptosis and inflammation by releasing circulating pro-inflammatory cytokines. CONCLUSION: The Non-IR and dorsal slit method for kidney surgery in a mouse model can be an alternative surgical approach for researchers without adverse reactions such as apoptosis, inflammation, fibrosis, functional impairment, and systemic reactions.

Pre-Clinical Efficacy and Safety Evaluation of Human Amniotic Fluid-Derived Stem Cell Injection in a Mouse Model of Urinary Incontinence

PURPOSE: Stem cell-based therapies represent new promises for the treatment of urinary incontinence. This study was performed to assess optimized cell passage number, cell dose, therapeutic efficacy, feasibility, toxicity, and cell trafficking for the first step of the pre-clinical evaluation of human amniotic fluid stem cell (hAFSC) therapy in a urinary incontinence animal model. MATERIALS AND METHODS: The proper cell passage number was analyzed with hAFSCs at passages 4, 6, and 8 at week 2. The cell dose optimization included 1x10(4), 1x10(5), and 1x10(6) cells at week 2. The in vivo cell toxicity was performed with 0.25x10(6), 0.5x10(6), and 1x10(6) cells at weeks 2 and 4. Cell tracking was performed with 1x10(6) cells at weeks 2 and 4. RESULTS: The selected optimal cell passage number was smaller than 6, and the optimal cell dose was 1x10(6) for the mouse model. In our pre-clinical study, hAFSC-injected animals showed normal values for several parameters. Moreover, the injected cells were found to be non-toxic and non-tumorigenic. Furthermore, the injected hAFSCs were rarely identified by in vivo cell trafficking in the target organs at week 2. CONCLUSION: This study demonstrates for the first time the pre-clinical efficacy and safety of hAFSC injection in the urinary incontinence animal model and provides a basis for future clinical applications.

Urethroplasty by Use of Turnover Flaps (Modified Mathieu Procedure) for Distal Hypospadias Repair in Adolescents: Comparison With the Tubularized Incised Plate Procedure

PURPOSE: The purpose of this study was to examine whether urethroplasty with a turnover flap, as an alternative method of distal hypospadias repair in adolescents, improves the outcome of surgery. MATERIALS AND METHODS: Between January 2004 and December 2013, a total of 38 adolescents (aged 11-17 years) underwent distal hypospadias repair with either the tubularized incised plate (TIP) procedure (n=25) or the turnover flap procedure (n=13). The turnover flap procedure was performed with a proximal, ventral penile flap that was turned over to cover the urethral plate. Patient demographics, perioperative outcomes, complications, and postoperative uroflowmetry in each surgical group were analyzed retrospectively. RESULTS: The patient demographics were similar in the two groups. There were no significant differences in perioperative outcomes between the groups, including mean operative time, duration of hospital stay, and urethral catheterization. The number of patients with at least one complication, including wound dehiscence, urethrocutaneous fistula, meatal stenosis, and urethral stricture, was lower in the turnover flap group (1/13, 7.7%) than in the TIP group (11/25, 44%, p=0.030). The incidence of meatal stenosis was lower in the turnover flap group (0/12, 0%) than in the TIP group (6/25, 24%). In postoperative uroflowmetry, the plateau-shaped curve rate was lower in the turnover flap group (1/12, 8.3%) than in the TIP group (5/19, 26.3%); the peak flow was higher (p=0.030). CONCLUSIONS: The turnover flap procedure is clinically useful for repairing adolescent distal hypospadias because it offers lower complication rates and better functional outcomes than TIP.

Two Different Surgical Approaches for Prostatic Stromal Sarcoma: Robot-Assisted Laparoscopic Radical Prostatectomy and Open Radical Cysto-Prostatectomy With Ileal Conduit

Stromal sarcoma of the prostate is very rare and shows rapid growth, which consequently is related to poor prognosis. Recently, we treated two cases of prostatic stromal sarcoma: one with robot-assisted laparoscopic radical prostatectomy and the other with open radical cysto-prostatectomy with an ileal conduit. To the best of our knowledge, this is the first case report of a prostatic stromal sarcoma managed by use of a robotic procedure. Here, we report of our experiences in the treatment of prostatic stromal sarcoma by use of two different methods.

Two Different Surgical Approaches for Prostatic Stromal Sarcoma: Robot-Assisted Laparoscopic Radical Prostatectomy and Open Radical Cysto-Prostatectomy With Ileal Conduit

Stromal sarcoma of the prostate is very rare and shows rapid growth, which consequently is related to poor prognosis. Recently, we treated two cases of prostatic stromal sarcoma: one with robot-assisted laparoscopic radical prostatectomy and the other with open radical cysto-prostatectomy with an ileal conduit. To the best of our knowledge, this is the first case report of a prostatic stromal sarcoma managed by use of a robotic procedure. Here, we report of our experiences in the treatment of prostatic stromal sarcoma by use of two different methods.

A Case of Duplicated Vas Deferens Found Incidentally during Varicocelectomy

Duplication of the vas deferens is a very rare congenital anomaly in which two vasa deferentia coexist within the spermatic cord. Duplication of the vas deferens can be found during herniorrhaphy, vasectomy, and varicocelectomy performed on the spermatic cord or around the spermatic cord. However, it is estimated that the incidence of duplication of the vas deferens is under-reported and under-recognized. Unless anomalies of the vas deferens such as duplication of the vas deferens are recognized by surgeons, it will be difficult to reduce vas deferens injuries and achieve a satisfactory surgical outcome. In addition, care should be taken in cases of duplication of the vas deferens because it can be complicated by non-testicular genitourinary anomalies. We report a case of duplication of the vas deferens discovered during routine varicocelectomy.

Long-Term Outcomes of Retractile Testis

PURPOSE: Retractile testis is considered to be a variant of normal testis in prepubertal boys. There is no agreed-upon management of retractile testis. The aim of this study was to provide data on the long-term outcomes of patients with retractile testis. MATERIALS AND METHODS: This study retrospectively reviewed the medical record of 43 boys who were referred for suspected undescended or retractile testis and were finally diagnosed with retractile testis between January 2001 and December 2008. All boys were biannually examined by a pediatric urologist to evaluate the presence of retractile, descended, or undescended testis and testicular volume. RESULTS: Of 43 boys, there were 22 boys with unilateral retractile testis (51.1%) and 21 boys with bilateral retractile testis (48.9%). Their mean age was 3.0+/-2.7 years and the follow-up duration was 4.4+/-1.7 years. Of 64 retractile testes, 29 (45.3%) succeeded in descending, 26 (40.6%) remained retractile, and 9 (14.1%) became undescended testis or of a decreased size requiring orchiopexy. The mean initial diagnostic age of the patients who underwent orchiopexy was 1.3+/-0.9 years; meanwhile, the mean initial diagnostic age of those who went on to have normal testis was 4.3+/-3.3 years (p=0.009). The mean follow-up duration was 3.6+/-1.5 years in the orchiopexy group, 4.0+/-1.4 years in the descended testis group, and 5.1+/-1.8 years in group with remaining retractile testis. CONCLUSIONS: Retractile testis has a risk of requiring orchiopexy. The risk is higher in the population diagnosed at a younger age. Boys with retractile testis should be observed periodically until the testis is descended in the normal position.

Risk Factors for the Development of Urethrocutaneous Fistula after Hypospadias Repair: A Retrospective Study

PURPOSE: The purpose of this study was to investigate the risk factors for urethrocutaneous fistula development after hypospadias repair. MATERIALS AND METHODS: Between January 1990 and May 2010, 348 patients underwent hypospadias repair. This study included 294 patients who were followed up for more than 6 months. Potential risk factors for the development of fistula after operation included age, location of hypospadias, type of hypospadias repair, suture materials and methods, methods and duration of catheterization, combined congenital urologic disorders, timing of presentation and repair of fistula, and location of fistula. Data were analyzed retrospectively. Binary logistic regression analysis was used for univariate and multivariate analysis. RESULTS: Out of 294 patients, 63 patients (21.4%, 63/294) developed urethrocutaneous fistulas after hypospadias repair. In the univariate analysis, fistula formation was statistically related with type of hypospadias and type of hypospadias repair. In the multivariate analysis with stratification by hypospadias site, however, only the location of hypospadias was a significant independent risk factor in urethrocutaneous fistula development after hypospadias repair (p<0.001). CONCLUSIONS: Our results suggest that the risk of developing urethrocutaneous fistula after hypospadias repair is associated with the location of hypospadias (more proximal-type hypospadias). Type of hypospadias repair, suture materials, suture techniques, and number of other combined urologic disorders were not related to the development of urethrocutaneous fistulas.

Investigation of the Requirements of 'Good Teaching' to Improve Teaching Professionalism in Medical Education / 한국의학교육

PURPOSE: The purpose of this study is to survey the awareness of faculty (F) and students (S) on 'good teaching' and to analyze an example of good lesson, finally to identify the requirements of 'good teaching' in medical education. METHODS: Quantitative and qualitative methods were applied simultaneously. First, survey using a questionnaire was analyzed by frequency analysis and verified using chi-square-test, Mann-Whitney test. Second, the case of good teaching and qualitative data were analyzed by 'priori codes coding' and 'open coding'. RESULTS: The results of survey are as follows: Both faculty and students regarded lessons that taught important content easy to understand (F: 50%; S: 69.1%); Lessons that allow students make sure important information (F: 48.6%; S: 51.4%); Lessons that prepare and plan considering the student's level and interest (F: m=3.78; S: m=3.76) were good lessons. Faculty wanted lessons that improve student's academic achievement (35.7%), while students choose lessons that deliver curriculum effectively using appropriate teaching method (47.1%). According to the results of case analysis, it turned out that characteristics of good teaching were as follows: Thorough plan and preparation of content, various teaching methods and materials, encouragement of intellectual inquiry and curiosity, active interaction between faculty and students, clear feedback and reasonable evaluation. CONCLUSION: Requirements of good teaching are open to faculty at school of medicine and are to be utilized as guidelines to monitor and improve their instruction.

The Value of Estimation of Distal Ureteral Dilatation in Primary Vesicoureteral Reflux

PURPOSE: Recently, several studies have suggested that distal ureteral dilatation is an important factor influencing the spontaneous resolution of primary vesicoureteral reflux (VUR). We evaluated the relationship between distal ureteral dilatation and the spontaneous resolution of primary VUR. MATERIALS AND METHODS: The medical records of 114 patients with primary VUR maintained on prophylactic antibiotics from April 1999 to August 2008 were retrospectively reviewed. The patients' mean age was 24.2 months (range, 6-108 months). There were 66 male patients and 48 female patients. The mean follow-up was 37.6 months (range, 12-102 months). We analyzed various factors including age, gender, grade of reflux, laterality, and ureteral diameter ratio (UDR; the largest ureteral diameter was divided by the distance from the L1-4 vertebral body to minimize the differences in diameter by age) to determine whether these factors influenced the spontaneous resolution of primary VUR. RESULTS: Unilateral, low-grade reflux and low UDR were significantly associated with the spontaneous resolution of reflux (p=0.048, p<0.001, and p<0.001, respectively). The multivariate analysis revealed that the spontaneous resolution rate of primary reflux was significantly higher in patients with low UDR than in patients with high UDR (p<0.001). CONCLUSIONS: The degree of distal ureteral dilatation is expected to be another important factor in determining therapeutic course and predicting the spontaneous resolution of VUR.

Risk Factors for Treatment Failure after Endoscopic Subureteral Injection of Dextranomer/Hyaluronic Acid Copolymer (Deflux(R)) for Vesicoureteral Reflux / 대한비뇨기과학회지

PURPOSE: Endoscopic subureteral injection of dextranomer/hyaluronic acid copolymer (Deflux(R)) has become an established alternative to long-term antibiotic prophylaxis and open ureteral reimplantation for the management of vesicoureteral reflux (VUR) in children. We retrospectively evaluated the risk factors for treatment failure after endoscopic correction of VUR. MATERIALS AND METHODS: Between 2005 and 2007, 23 boys and 26 girls (total of 69 ureters) with VUR underwent endoscopic subureteral injection of Deflux(R) primarily. VUR was unilateral in 29 patients and bilateral in 20 patients. Of the 69 ureters, VUR was grade II to V in 13, 28, 20, and 8, respectively. Follow-up urinalysis and ultrasonography were performed 1 and 3 months after the procedure, and a voiding cystourethrogram was performed at 6 or 9 months postoperatively. RESULTS: Treatment failure was defined as persistent VUR of grade II or over grade II. Endoscopic correction failed in 22 of 69 refluxing ureters. Age, sex, laterality, number of preoperative urinary tract infections, time from diagnosis to operation, presence of renal scarring, and injection volume did not influence outcome. However, preoperative presence of voiding symptoms, high-grade reflux and hydronephrosis, and having a horseshoe or golf-hole shaped ureteral orifice had a negative influence on the treatment result by univariate analysis. Severe dilatation of the lower ureter was the only statistically significant factor by multivariate analysis. CONCLUSIONS: Severity of lower ureteral dilatation is the most significant factor influencing the failure of endoscopic subureteral injection of Deflux(R). Other factors significantly involved in failure are the presence of voiding symptoms, high-grade reflux and hydronephrosis, and a horseshoe or golf-hole shaped ureteral orifice. Success rates may improve if we carefully consider these influencing factors before choosing an operative method.

Efficacy of Dextranomer/Hyaluronic Acid Copolymer (Deflux(R)) Injection for Vesicoureteral Reflux in Children

PURPOSE: The aim of this study was evaluating the efficacy of endoscopic Deflux(R) submucosal injection in children with primary vesicoureteral reflux (VUR). METHODS: Retrospective analysis of medical record was conducted on 38 children (59 ureters) who underwent endoscopic Deflux(R) injection due to primary VUR. Data were collected from March 2000 to February 2006. Mean infused amount of Deflux(R) was 0.77 cc. After Deflux(R) injection, patients were reassessed by voiding cystourethrogram (VCUG) 6 months later. RESULTS: The success rate of endoscopic Deflux(R) submucosal injection 6 months later by VCUG was 100% for grade 1 VUR, 87.5% for grade 2, 60% for grade 3, 26.6% for grade 4, 16.6% for grade 5, respectively and there was negatively significant correlation between success rate and grade of VUR (P<0.01). Degree of improvement of VUR by endoscopic Deflux(R) submucosal injection was not related to age at diagnosis, time to operation, existence of voiding dysfunction or constipation and infused amount of Deflux(R). However, group with anticholinergics medication had significantly lower success rate than non-medication group (P<0.047). CONCLUSION: Endoscopic Deflux(R) submucosal injection is effective therapy in patient with primary VUR, especially low grade VUR. It can be not only a useful substitute for prophylaxis with antibiotics, but also an effective management prior to ureteroneocystostomy in children with primary VUR.

Development of Computer-Based Test (CBT) and Student Recognition Survey on CBT / 한국의학교육

PURPOSE: The purpose of this study is to understand student recognition of CBT as well as its strengths and weaknesses, and to explore the improvement methodologies for the effective development and implementation of CBT. METHODS: A questionnaire survey was conducted twice (before and after implementation of CBT) with a total of 17 multiple-choice and 2 essay-type questions. The multiple-choice questions were analyzed by frequency analysis and the essay-type questions were coded by content analysis. RESULTS: The results are as follows. First, the overall satisfaction with CBT was shown to be high. Second, students listed the merits of CBT as follows: simple correction of answers (before: 89.4%; after: 80.8%), presentation of realistic materials (before: 72.9%; after: 84.7%), prompt feedback on grades (before: 60.3%; after: 71.1%), shortened exam time and effective time scheduling (before: 86.5%; after: 66.4%), accurate estimation of abilities (before: 70.2%; after: 36.6%), and assistance in academic improvement (before: 70.9%; after: 22.1%). Drawbacks of CBT were: inconvenience of review (before: 70.9%; after: 22.1%), inconvenient screen organizations (before: 0%; after: 48.1%), possibility of cheating (before: 73.9%; after: 31.8%), and equality issue of test (before: 47.3%; after: 17.3%). CONCLUSION: Assessment paradigms are currently shifting from summative evaluation to formative evaluation, from one-off assessment to continuous assessment, and from output assessment to process assessment. Therefore, CBT must be expanded to move from result-oriented summative evaluation to formative evaluation continuously monitoring the student learning process.

Clinical Course of Pediatric Ureteropelvic Junction Obstruction according to the Age at Diagnosis / 대한비뇨기과학회지

PURPOSE: There is no agreement concerning the management of ureteropelvic junction obstruction(UPJO) in children. We reviewed our experience over 10 years for children with UPJO to analyze the clinical course and desirable treatment modality. MATERIALS AND METHODS: We reviewed the medical records of 80 consecutive children with UPJO and they were diagnosed between December 1994 and November 2004. There were 67 boys and 13 girls. A total of 94 kidneys in 80 patients were evaluated with urinalysis, ultrasonography, diuretic renogram and (99m)Tc-DMSA renal scanning. The natural progression of disease, the management method and the perioperative outcomes were retrospectively compared. RESULTS: Fifty of the 80 patients were prenatally diagnosed by fetal hydronephrosis or who were diagnosed at younger than 1 year(group A), and 30 patients were diagnosed at older than 1 year(group B). In group A, 18 patients underwent dismembered pyeloplasty before 1 year(A1) and 2 patients underwent nephrectomy due to severe deterioration of their renal function(<5%). Among the other 30 patients, delayed pyeloplasties were performed in 20 patients(A2) and 10 patients were managed conservatively(A3). In group B, 22 patients underwent pyeloplasty immediately (B1), and the other 8 patients underwent delayed pyeloplasty(B2). On the comparison of renal functional change among the patients in group A, the A1 patients had better renal functional improvement than the A2 and A3 patients. However, there was no statistical difference between the patients in B1 and B2. The postoperative complication rates were not significantly different in all the groups. CONCLUSIONS: It is thought that early operation is more effective for improving the renal function in children younger than one year.

Clinical Experience of 27 Pediatric Renal Transplantation at a Single Center / 대한비뇨기과학회지

PURPOSE: Renal transplantation is considered the treatment of choice for children with end-stage renal disease (ESRD). The results of renal transplantation were retrospectively analyzed to assess certain aspects of pediatric renal transplantation. MATERIALS AND METHODS: Between January 1989 and January 2005, 27 pediatric kidney transplantations were carried out at our center. Fifteen (55.5%) patients underwent hemodialysis, two (7.4%) peritoneal dialysis and ten (37.0%) were conservative managed prior to treatment. Living- related donors provided 25 (92.6%) of the transplanted organs, with cadaver sources utilized for 2 (7.4%) patients. The donor age, organ source, etiology of ESRD, hospitalization period, postoperative complications, occurrence and number of acute rejections, and graft survival were assessed. RESULTS: The causes of renal failure were chronic glomerulonephritis in 10 patients [IgA 3 nephropathy, 3 membranoproliferative glomerulonephritis (MPGN), 2 nephrotic syndrome and 2 focal segmental glomerulosclerosis (FSGS)], urinary tract anomalies in 6 (4 reflux nephropathy and 2 polycystic kidney), Alport syndrome in 1, hypertensive nephropathy in 2, systemic immunological disease in 1 and unknown causes in a further 5. Acute rejection occurred in 12 patients, all of who recovered after steroid pulse therapy. Growth and development failed in 2 patients. The postoperative complications included 4 urinary tract infections, 3 retroperitoneal hematomas, 2 lymphoceles and 1 acute ureteral obstruction. Four patients expired due to post-operative complications, such as disseminated intravascular coagulation (DIC), intracranial hematoma, sepsis and renal failure. CONCLUSIONS: Pediatric renal transplantation can be successful, even in young children with ESRD.