Evaluation of Short Term Clinical Effects and Presumptive Mechanism of Botulinum Toxin Type A as a Treatment Modality of Benign Prostatic Hyperplasia

The purpose of this study was to evaluate the effect and investigate the putative mechanism of botulinum toxin type A (BTA) applied to the treatment of benign prostatic hyperplasia (BPH). A total of 52 patients with symptomatic BPH were evaluated. Transperineal intraprostatic injection under transrectal ultrasonography was carried out. BTA dissolved in 4 to 9 mL of saline was used from 100 U to 300 U, according to prostate volume. Twenty-six patients received only BTA (BT group), and 26 received both BTA and one month of an alpha-adrenergic antagonist (BTalpha group). The therapeutic outcomes were evaluated by comparing parameters such as international prostate symptom score (IPSS), quality of life, prostate specific antigen, prostate volume, post-void residual urine, and peak urinary flow rate. At the one month follow- up, 18 patients in the BT group and 21 in the BTalpha group had subjective symptomatic relief (p = 0.337). Only IPSS5 (weak stream) was significantly different between the BT group and BTalpha groups (p = 0.034). At the three month follow-up, 39 patients had subjective symptomatic relief. The storage symptoms were improved more than the voiding symptoms. Additionally, about 50 percent of the patients whose voiding symptom improved expressed improved erectile function. BTA injection seems to be an alternative treatment for BPH. The differences after the one month evaluation between the BT and the BTalpha groups might suggest that the adrenergic influence could be relatively reinforced by the anticholinergic effect of BTA. Nitric oxide would thus be involved in a BTA action mechanism in BPH.

Removal of a Penile Metal Ring Using a Nelaton Catheter / 대한비뇨기과학회지

Penile incarceration is a serious disease that requires prompt intervention to prevent various complications. A 76-year-old male visited our emergency room complaining of penile swelling. The penile swelling had been caused by a metallic bearing placed at the base of the penis 7 days earlier. The ring had a 4.7cm outside diameter and 2.1cm internal diameter, with a thickness of 1.5cm. Because the swelling of penis distal to the constricting ring was so severe, removal of the ring was difficult. Several methods were attempted to remove the bearing, such as squeezing, aspiration and cutting with a steel saw, all of which were unsuccessful. A string method, with a Nelaton catheter, was then successfully used, which took just 5 minutes to remove the bearing. Mild abrasion of the penile skin was the only complication.

The Initial Experience of Intraprostatic Injection of Botulinum Toxin Type A for Benign Prostatic Hyperplasia: A Comparative Study of Short-term Effect with Transurethral Resection of Prostate / 대한비뇨기과학회지

PURPOSE: To retrospectively compare the results of botulinum toxin type A (BTA) with those of transurethral resection of the prostate (TURP) in the treatment of benign prostatic hypertrophy (BPH) and to evaluate the effect of BTA. MATERIALS AND METHODS: The changes of symptom after BTA injection into prostate (BIP) and TURP in 26 patients treated with BIP and 81 patients treated with TURP were analysed retrospectively. All BPH-related medications were stopped immediately after BTA administration. To evaluate the effect of BIP, the parameters such as International Prostate Symptom Score (IPSS), quality of life (QoL), prostate-specific antigen (PSA), prostate volume, post-void residual urine and maximum flow rate were measured both before and 1 month after BIP. RESULTS: In both groups, IPSS and QoL were improved significantly after treatment, but the effectiveness of TURP was much superior to that of BIP. Among the patients with a prostate volume under 40ml, IPSS was improved by 27.5% in the BTA group and 38% in the TURP group. QoL was improved by 31.8% in the BTA group and 51% in the TURP group, but the difference between the two groups was not statistically significant. Among the patients with a prostate volume over 40ml, IPSS was improved by 24.7% in the BTA group and 47.6% in the TURP group. QoL was improved by 18.9% in the BTA group and 44.4% in the TURP group, and the difference was statistically significant between the two groups. CONCLUSIONS: Although both BIP and TURP significantly improved the clinical outcome, the latter was far superior to the former in improving voiding symptoms caused by BPH. However, BIP can be a new therapeutic option for patients with a small prostate volume or who want more minimally invasive treatment.

Ureteral Substitution Using Appendix in a Ureteral Defect Caused by a Retroperitoneal Paraganglioma / 대한비뇨기과학회지

Exraadrenal paragangliomas are rare tumors of a neural crest origin. Their preoperative diagnosis can be suspected from the clinical history and biochemical examination of the catecholamines or their metabolic by-products. Surgery is the mainstay of therapy, but surgical removal makes an additional problem for the repair of the ureteral defect if a paraganglioma is located near the ureter or if it encloses the ureter. The ureteral repair often poses a therapeutic dilemma, and especially when the ureteral defect is too extensive to be repaired with traditional methods. We report here on a case of successful replacement with using appendix for the repair of a long ureteral defect that was caused by a retroperitoneal paraganglioma.

Development of Statistical Model for Predicting Prostate Cancer in Patients Requiring Prostate Biopsy / 대한비뇨기과학회지

PURPOSE: Patients with an abnormal digital rectal examination(DRE) or elevated serum prostate specific antigen(PSA) level proceed to a transrectal biopsy of the prostate. However, cancer detection is not predictable. There is a need to develop a statistical model for predicting the likelihood of prostate cancer for there to be confidence about the result of a biopsy. MATERIALS AND METHODS: Patients with prostatism were evaluated based upon the recommendation of the International Consultation on benign prostatic hyperplasia(BPH). Amongst the patients evaluated, 141 revealed an abnormal DRE and/or serum PSA. A transrectal ultrasonography(TRUS) and transrectal biopsy was performed in all the patients. 38 of the above were diagnosed with prostate cancer and 103 with BPH or prostatitis. A logistic regression model was used to identify the variables with the most independent influence on prostate cancer and determine the most parsimonious combination of variables for predicting prostate cancer. RESULTS: Age, hematuria, nocturia and a combination of urinary symptoms (incomplete emptying, frequency, urgency and nocturia), DRE, PSA and TRUS-hypoechoic lesion were significant variables for separately predicting prostate cancer. Among these, age, DRE, PSA and TRUS-hypoechoic lesion were independent predictors. The probability of prostate cancer(P) =exp(-9.7770+0.0807xage+1.4079xDRE+0.0257xPSA+1.0904xTRUS- hypoechoic lesion)/{(1+exp(-9.7770+0.0807xage+1.4079xDRE+0.0257xPSA+1.0904xTRUS-hypoechoic lesion)}. CONCLUSIONS: A useful predictive model of prostate cancer has been developed using logistic regression analysis. This model suggests that patients with a high probability(P), but negative biopsy, would require a repeat biopsy. However, a low probability(P), and negative biopsy, would be suggestive of no hidden disease.