A Case of Urinothorax in Autosomal Dominant Polycystic Kidney Disease Hemodialyzed / 대한신장학회잡지

Urinothorax is rare cause of pleural effusion. Urinothorax should be considered when pleural effusion occurs in patients with urinary tract obstruction accompanied by retroperitoneal urinoma. It has been reported in patients with trauma, malignancy, kidney biopsy and renal transplantation. Most cases are diagnosed retrospectively by promt resolution of symptoms after relief of urinary obstruction. But diagnosis can be made based on clinical suspicion, radiological findings and biochemical analysis of the effusion and most important finding is the pleural level of creatinine is higher than the serum level. We experienced right pleural effusion in autosomal dominant polycystic kidney disease hemodialyzed. The patient had right urinoma in the retroperitoneal space before pleural effusion developed. After 3month, he complained acute dyspnea. There was no effect in resolving effusion by lowering dry weight. We thought alternative diagnostic possibility, urinothorax and checked the pleural fluid to serum creatinine ratio. Finally concluded that pleural effusion was urinothorax secondary to remnant left polycystic kidney rupture and tried left nephrectomy. The patient showed reduction of pleural effusion. It is important to alert physician to this condition and to avoid the other invasive diagnostic study.

Analysis of Radiologic Findings to Predict the Histology of the Small Renal Tumors: A Retrospective Study / 대한비뇨기과학회지

PURPOSE: Recently, incidental small renal tumors detected by computerized tomography(CT) or ultrasonography(US) have been increasing. Differentiation between the small renal cell carcinoma and benign tumorous lesions is often difficult. To reduce the unnecessary surgical interventions for these small renal tumors, we anayzed the radiologic findings of surgically removed small renal tumors(less than 3cm in diameter) and evaluated whether radiologic studies would predict their histologic findings. MATERIALS AND METHODS: Radiologic findings of 28 renal cell carcinomas(RCC), 7 angiomyolipomas(AML), 4 cysts including 2 multilocular cysts and 1 oncocytoma were analyzed, retrospectively. Density, contour, and heterogenity of the tumors on CT were evaluated, while echogenecity, posttumoral enhancement, peritumoral hypoechoic rim, and intratumoral cystic change on US were evaluated. RESULTS: Tiny fat density on CT was found in 4 of 7 AMLs and 1 of 28 RCCs. On US, 3 of 6 AMLs and 1 of 24 RCCs showed marked hyperechogenecity identical to the renal sinus fat. AMLs showed fat density in 4 of 7(57.1%) on CT and marked hyperechogenecity in 5 of 7(71.4%) on US, respectively. Two AMLs which showed hypoechogenecity and no fat density had less than 5% of fat on histologic examination while others had more than 30% of fat. All AMLs, oncocytoma and most RCCs(73%) showed exophytically out-bulging growth pattern while all benign cysts showed endophytic growth. Posttumoral sonic enhancement was found in 3 of 4 cysts and 1 of 24 RCCs. Peritumoral hypoechoic rim and intratumoral cystic changes were identified in 8 of 24(33%) and 7 of 24(29%) RCCs, respectively, while no such findings were detected in other tumors and cysts. CONCLUSIONS: Fat density on CT or marked hyperechogenecity identical to renal sinus fat on US strongly suggest angiomyolipoma, whereas endophytic growth pattern and posttumoral enhancement on US favor benign cyst. In the meantime, absence of above findings combined with peritumoral halo and/or intratumoral cystic change indicate renal cell carcinoma which should be explored.

Analysis of Radiologic Findings to Predict the Histology of the Small Renal Tumors: A Retrospective Study / 대한비뇨기과학회지

PURPOSE: Recently, incidental small renal tumors detected by computerized tomography(CT) or ultrasonography(US) have been increasing. Differentiation between the small renal cell carcinoma and benign tumorous lesions is often difficult. To reduce the unnecessary surgical interventions for these small renal tumors, we anayzed the radiologic findings of surgically removed small renal tumors(less than 3cm in diameter) and evaluated whether radiologic studies would predict their histologic findings. MATERIALS AND METHODS: Radiologic findings of 28 renal cell carcinomas(RCC), 7 angiomyolipomas(AML), 4 cysts including 2 multilocular cysts and 1 oncocytoma were analyzed, retrospectively. Density, contour, and heterogenity of the tumors on CT were evaluated, while echogenecity, posttumoral enhancement, peritumoral hypoechoic rim, and intratumoral cystic change on US were evaluated. RESULTS: Tiny fat density on CT was found in 4 of 7 AMLs and 1 of 28 RCCs. On US, 3 of 6 AMLs and 1 of 24 RCCs showed marked hyperechogenecity identical to the renal sinus fat. AMLs showed fat density in 4 of 7(57.1%) on CT and marked hyperechogenecity in 5 of 7(71.4%) on US, respectively. Two AMLs which showed hypoechogenecity and no fat density had less than 5% of fat on histologic examination while others had more than 30% of fat. All AMLs, oncocytoma and most RCCs(73%) showed exophytically out-bulging growth pattern while all benign cysts showed endophytic growth. Posttumoral sonic enhancement was found in 3 of 4 cysts and 1 of 24 RCCs. Peritumoral hypoechoic rim and intratumoral cystic changes were identified in 8 of 24(33%) and 7 of 24(29%) RCCs, respectively, while no such findings were detected in other tumors and cysts. CONCLUSIONS: Fat density on CT or marked hyperechogenecity identical to renal sinus fat on US strongly suggest angiomyolipoma, whereas endophytic growth pattern and posttumoral enhancement on US favor benign cyst. In the meantime, absence of above findings combined with peritumoral halo and/or intratumoral cystic change indicate renal cell carcinoma which should be explored.

Early Experiences of the Transurethral Needle Ablation(TUNA) in BPH / 대한비뇨기과학회지

PURPOSE: TUNA is a new minimally invasive treatment modality for the patients with benign prostatic hyperplasia of prostate utilizing low levels of radiofrequency energy. We presented our early experiences of TUNA for the treatment of BPH to evaluate its clinical outcome. MATERIALS AND METHODS: From July 1995 to March 1997, 36 patients were treated with TUNA(15 with manual system, 21 with automatic system). Mean age of the patients was 63.5 years. All patients were evaluated preoperatively with PSA, AUA symptom score, uroflowmetry and transrectal ultrasonography(TRUS). AUA symptom score at 1, 3, 12 month and uroflowmetry at 1, 3 month postoperatively were available for analysis. RESULTS: Mean PSA value was 3.4ng/ml and mean prostate volume by TRUS was 35.5gram preoperatively. Nine out of 36 procedures were performed with local anesthesia. Mean operating time was 45.6 minutes. At postoperative 3 and 12 month, symptom score was improved from 22.0+/-1.5 to 11.7+/-1.6 and 11.0+/-1.9(p<0.05), respectively and maximal flow rate was increased from 11.2+/-0.7ml/sec to 14.4+/-1.5ml/sec at postoperative 3 month(p<0.05). Results have been far better since using automatic system. Complications were observed in one patient with clot retention and in 11 patients with postoperative urinary retention. CONCLUSIONS: TUNA is a simple, safe, efficacious and minimally invasive treatment procedure with short hospital stay, less morbidity for treatment of the patients with BPH. It could also be performed with local anesthesia. We suggest that TUNA would be a new promising treatment modality for BPH.

Trimix Intracavernosal Injection Therapy in Patients with Erectile Dysfunction: Long-term Follow-up Result / 대한비뇨기과학회지

PURPOSE: Vasoactive pharmacotherapy is now being widely used as practical and reliable method for the treatment of the patients with erectile dysfunction. The synergistic effect and low drug volume of each vasoactive drug in polypharmacotherapy for erectile dysfunction have made it possible to reduce both systemic and local complications with excellent success rate. We evaluated the treatment outcome of intracavernosal injection therapy with Trimix(the mixture of papaverine, phentolamine and prostaglandin E1). MATERIALS AND METHOD: From July 1993 to June 1997, 1000 patients with erectile dysfunction underwent a trial of intracavernous self injection therapy with Trimix(the mixture of papaverine 4.8mg, phentolamine 0.2mg and prostaglandin E1 1.8 microgram in 0.2ml). Underlying diseases were diabetes mellitus (33.1%), hypertension(7.5%) and others(12.3%). 471(47.1%) patients had no underlying disease. The volume of drug used ranged from 0.03 to 0.6ml(average: 0.18ml). RESULTS: After a mean follow-up of 10.9 months(3-44 months), 524 patients stayed on the home injection program. The drop-out rate was 47.6% with most of the cases during early home phase. The reasons for drop-out were inadequate response to medication, failure of injection, return of spontaneous erection, switch to other treatments, priapism, fear of needle or injection, loss of interest and economic reason. 88.3% of patients and 85.3% of the partners were satisfied wilts the result of home injection program. Priapism(3.9%), pain or discomfort(2.4%) and granuloma on injection site(1.5%) were noticeable complications, but corporal fibrosis and systemic side effect were not noticed. CONCLUSIONS: Trimix intracavernosal injection therapy is minimally invasive, simple, relatively safe and most of all, very effective method for the treatment of the patients with erectile dysfunction.

Relation Between Lower Urinary Tract Symptoms and Erectile Dysfunction: Epidemiologic Study in Jeong-Eup, Korea / 대한남성과학회지

PURPOSE: Lower urinary tract symptoms and erectile dysfunction both have a profound impact on the quality of life elderly men, but there are few reports that would enable us to clearly elucidate the relation between them. We investigated the prevalence of erectile dysfunction and its correlation with the severity of lower urinary tract symptoms as judged by the International Prostatic Symptom Score (I-PSS). MATERIALS AND METHODS: The total sample was 855 men aged 30 years and older (653 aged over 50) in 31 randomly selected areas of Jeong-Eup, Korea. Two questionnaires were sent. The first, on sexual activities, was based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) and was composed of several questions on the frequency of sexual intercourse, erectile ability, and the degree of any erectile dysfunction. The second, for men over 50 years of age, was the I-PSS. We analyzed the results with multivariate logistic analysis using an SAS program running on a personal computer. RESULTS: The response rate was 71.3% (466/653), and data sexual activities and I-PSS from 304 men were suitable for analysis. The prevalence of erectile dysfunction, defined as inability to achieve an erection sufficient for penetration, was 58.9% (179/304), and increased with age: 37.2% in men in their 50s, 69.2% in men in their 60s, 83.3% in men in their 70s, ans 100% in men over age: 37.2% in men in their 50s, 69.2% in men in their 60s, 83.3% in men in their 70s, and 100% in men over age 80 (p = 0.001). According to the intensity of lower urinary tract symptoms - mild (0-7), moderate (8-19), and severe (20-35) - the prevalence of erectile dysfunction was 46.6% (75/161), 68.8% (75.109), and 85.3% (29.34), respectively, and the prevalence of complete erectile dysfunction was 8.7% (14.161), 20.2% (22.109), and 47.1% (16.34), respectively. After adjustment for age, there was a statistically significant correlation between the severity of lower urinary tract symptoms and erectile dysfunction with the odds ratios being 2.395 and 4.125 in the moderately and severely symptomatic groups. CONCLUSIONS: There was a significant correlation between the presence of lower urinary tract symptoms and erectile dysfunction. We suggest that these two conditions are closed related by pathophysiologic mechanism, although clinical and basic research should be advanced to clarify the relation between them.

Relation Between Lower Urinary Tract Symptoms and Erectile Dysfunction: Epidemiologic Study in Jeong-Eup, Korea / 대한남성과학회지

PURPOSE: Lower urinary tract symptoms and erectile dysfunction both have a profound impact on the quality of life elderly men, but there are few reports that would enable us to clearly elucidate the relation between them. We investigated the prevalence of erectile dysfunction and its correlation with the severity of lower urinary tract symptoms as judged by the International Prostatic Symptom Score (I-PSS). MATERIALS AND METHODS: The total sample was 855 men aged 30 years and older (653 aged over 50) in 31 randomly selected areas of Jeong-Eup, Korea. Two questionnaires were sent. The first, on sexual activities, was based on DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed.) and was composed of several questions on the frequency of sexual intercourse, erectile ability, and the degree of any erectile dysfunction. The second, for men over 50 years of age, was the I-PSS. We analyzed the results with multivariate logistic analysis using an SAS program running on a personal computer. RESULTS: The response rate was 71.3% (466/653), and data sexual activities and I-PSS from 304 men were suitable for analysis. The prevalence of erectile dysfunction, defined as inability to achieve an erection sufficient for penetration, was 58.9% (179/304), and increased with age: 37.2% in men in their 50s, 69.2% in men in their 60s, 83.3% in men in their 70s, ans 100% in men over age: 37.2% in men in their 50s, 69.2% in men in their 60s, 83.3% in men in their 70s, and 100% in men over age 80 (p = 0.001). According to the intensity of lower urinary tract symptoms - mild (0-7), moderate (8-19), and severe (20-35) - the prevalence of erectile dysfunction was 46.6% (75/161), 68.8% (75.109), and 85.3% (29.34), respectively, and the prevalence of complete erectile dysfunction was 8.7% (14.161), 20.2% (22.109), and 47.1% (16.34), respectively. After adjustment for age, there was a statistically significant correlation between the severity of lower urinary tract symptoms and erectile dysfunction with the odds ratios being 2.395 and 4.125 in the moderately and severely symptomatic groups. CONCLUSIONS: There was a significant correlation between the presence of lower urinary tract symptoms and erectile dysfunction. We suggest that these two conditions are closed related by pathophysiologic mechanism, although clinical and basic research should be advanced to clarify the relation between them.

Age-specific Reference Ranges for Prostate-specific Antigen from a Community-based Study / 대한비뇨기과학회지

PURPOSE: To analyze the relationship of age to serum prostate-specific antigen (PSA) levels among Koreans without clinically evident prostate cancer in a community-based study. MATERIALS AND METHOD: A total of 375 healthy men aged 50 to 79, residing in the small farming villages of Jeong-Eup county, Korea were examined with serum PSA(Hybritech Tandem-R) and digital rectal examination. One case of patient with prostate cancer was excluded. RESULTS: The serum PSA concentration is correlated with patient age(In PSA=-1.56+0.0257 x Age, r=0.32, p-value<0.0001). The recommended age-specific reference ranges of serum PSA(95th percentile) for men aged 50-59 years is 0-2.80ng/m1; for 60-69 years,0-3.56ng/m1; and for 70-79 years, 0-4.57ng/m1. CONCLUSIONS: The serum PSA concentration is correlated with patient age in Korean men and the age-specific PSA reference ranges for Korean are lower than those for Caucasian.

Use of Serum PSA in Comparison of Biopsy Gleason Score with Radical Prostatectomy Gleason Score / 대한비뇨기과학회지

PURPOSE: The Gleason score of needle biopsies of the prostate and preoperative serum level of prostate-specific antigen(PSA) are two useful factors in predicting the final pathological staging of patients with prostate cancer treated by radical prostatectomy. Unfortunately, the Gleason score of the biopsy cores often differs from the Gleason score of radical prostatectomy specimen. We evaluated the role of Gleason scores of biopsy cores and the influence of PSA in predicting the Gleason scores of prostatectomy specimens and final pathological staging. MATERIALS AND METHODS: The records of 52 patients with prostate cancer treated by radical prostatectomy from June 1990 to June 1997 were reviewed. The patients were divided into three groups according to the sum of the Gleason scores, i.e. well differentiated(Gleason score 2-4), intermediate(5-7) and poorly differentiated tumors(8-10). The concordance between Gleason score of biopsy and prostatectomy specimen was analysed according to the Gleason score of tumor in biopsy specimen. Furthermore, we evaluated the different level of PSA could affect the concordance rate between Gleason scoreofbiopsyandprostatectomyspecimen. RESULTS: In well-differentiated tumors(Gleason score 2-4) in biopsy specimen, the concordance rate was 55.6%, In intermediate(5-7) differentiated cancers the Gleason score remained the same in 68%. In poorly differentiated tumors, the concordance rate was 72.2%. When PSA was less than 10ng/m1, concordance rate of well differentiated tumors and poorly differentiated tumors was 75%, 40%, respectively. Whereas the concordance rate of well differentiated tumors was 50% and that of poorly differentiated tumors was 90% when the PSA was higher than 20ng/m1. Using linear regression analysis, the preoperative PSA highly correlated with radical prostatectomy Gleason score(correlation coefficient(r)=0.38, p =0.005). CONCLUSIONS: The Gleason score of prostatectomy specimen was upgraded in 44.4% when the biopsy Gleason score was well differentiated, especially when preoperative PSA was higher than 20ng/m1. Therefore, the significance of biopsy Gleason score in the clinical application must be used cautiously when it is used to predict the pathological stage or biological potential of the cancer especially when it is low Gleason score with high PSA( > 20ng/m1). In the meantime, the level of PSA plays an significant role in determining organ confined disease, while high Gleason scone reflect the Iymph node positive disease.