Can Prostate-Specific Antigen Kinetics before Prostate Biopsy Predict the Malignant Potential of Prostate Cancer?

PURPOSE: To predict the malignant potential of prostate cancer (PCa) according to prostate-specific antigen velocity (PSAV), PSA density (PSAD), free/total PSA ratio (%fPSA), and digital rectal examination (DRE). MATERIALS AND METHODS: From January 2009 to December 2012, 548 adult male patients were diagnosed with PCa by prostate biopsy at four hospitals in Korea. We retrospectively analyzed 155 adult male patients with an initial PSA level or =8 (n=21)] and the presence of extracapsular invasion [organ confined (n=129) or extracapsular invasion (n=26)]. Differences between the groups were compared. RESULTS: The group with a Gleason sum > or =8 or extracapsular invasion of PCa showed high PSAV and significantly lower %fPSA. There were no significant differences in PSAD and the presence of an abnormality on DRE between two groups. CONCLUSION: In PCa patients treated with other therapies besides prostatectomy, a high PSA velocity and a low %fPSA may predict high grade PCa with a Gleason sum > or =8 or the presence of extracapsular invasion.

Castleman's Disease of the Renal Sinus Presenting as a Urothelial Malignancy: A Brief Case Report

Castleman's disease is a rare benign lymphoproliferative disorder that frequently affects lymph nodes of the mediastinal thorax and the neck. It very rarely affects the renal sinus. We report a case of Castleman's disease arising in the renal sinus in a 64-year-old man. The patient visited the hospital with the chief complaint of hematuria. Abdominal computed tomography revealed a homogeneous mass in the sinus of the left kidney, radiologically interpreted as a malignant urothelial tumor. Subsequently, nephroureterectomy was performed, after which microscopic examination of the specimen revealed a diffuse lymphoproliferative lesion with reactive lymphoid follicles of various sizes and prominent plasma cell infiltration of interfollicular spaces, highlighted by immunohistochemical staining for CD138. The lesion was diagnosed as Castleman's disease of the plasma cell type. Although preoperative diagnosis of Castleman's disease is difficult and the incidence is exceedingly rare, it should be considered in the differential diagnosis of renal sinus tumors.

PCR for Diagnosis of Male Trichomonas vaginalis Infection with Chronic Prostatitis and Urethritis

The aim of this study was to assess the usefulness of PCR for diagnosis of Trichomonas vaginalis infection among male patients with chronic recurrent prostatitis and urethritis. Between June 2001 and December 2003, a total of 33 patients visited the Department of Urology, Hanyang University Guri Hospital and were examined for T. vaginalis infection by PCR and culture in TYM medium. For the PCR, we used primers based on a repetitive sequence cloned from T. vaginalis (TV-E650). Voided bladder urine (VB1 and VB3) was sampled from 33 men with symptoms of lower urinary tract infection (urethral charge, residual urine sensation, and frequency). Culture failed to detect any T. vaginalis infection whereas PCR identified 7 cases of trichomoniasis (21.2%). Five of the 7 cases had been diagnosed with prostatitis and 2 with urethritis. PCR for the 5 prostatitis cases yielded a positive 330 bp band from bothVB1 and VB3, whereas positive results were only obtained from VB1 for the 2 urethritis patients. We showed that the PCR method could detect T. vaginalis when there was only 1 T. vaginalis cell per PCR mixture. Our results strongly support the usefulness of PCR on urine samples for detecting T. vaginalis in chronic prostatitis and urethritis patients.

The Influence of an Overactive Bladder on Falling: A Study of Females Aged 40 and Older in the Community / 대한배뇨장애요실금학회지

PURPOSE: An overactive bladder (OAB) affects a person's quality of life. Patients who suffer from OAB run to the toilet frequently to prevent incontinence, and this behavior increases their risk of falling and fear of falling. This study evaluated the influence of OAB on falls and concern about falling in females aged 40 and over living in urban and rural communities. METHODS: We conducted a population-based cohort study using King's Health Questionnaire (KHQ), the Korean version of Falls Efficacy Scale-International (KFES-I) and a questionnaire regarding falls, in females aged 40 and over in Guri city and Yangpyeong county. The data from 514 responders were analyzed. The definition of OAB was 'moderately' or 'a lot' of urgency, or urge incontinence in KHQ. Falls was defined as experience of falls in the last year. High fear of falling was defined as a score of 24 or over in KFES-I. The factors were analyzed by the exact chi-square test and Student's t-test. The multivariate logistic regression model was adopted in order to examine the effects of OAB on falls and concern about falling. RESULTS: Of the 514 responders, 98 fitted the criterion of OAB. Eighty-nine (17.3%) of the responders had experienced falls in the last year: twenty-seven (27.5%) in the group with OAB and 62 (14.9%) in the group without OAB. There was a significant association between falls and OAB (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.00 to 3.08; P=0.0485), and between high fear of falling and OAB (OR, 2.72; 95% CI, 1.42 to 5.20; P=0.0024). CONCLUSIONS: Urgency and symptoms of urge incontinence increase the risk of falls in women aged 40 or older in the community. Early diagnosis and proper treatment may prevent falls and improve quality of life in OAB patients.

Analysis of Content Legibility for Smartphones of Websites of the Korean Urological Association and Other Urological Societies in Korea

PURPOSE: We performed an analysis of the smartphone legibility of the websites of the Korean Urological Association (KUA) and other urological societies. MATERIALS AND METHODS: This study was conducted on the websites of the KUA and nine other urological societies. Each website was accessed via iPhone Safari and Android Chrome, respectively, to evaluate the establishment and readability of the mobile web pages. The provision of Really Simple Syndication (RSS) feeds by the websites and whether the websites had Twitter and Facebook accounts were evaluated. In addition, a validation test on the web standards was performed by using the World Wide Web Consortium (W3C(R)) Markup Validation Service, and subsequently the numbers of errors and warnings that occurred were analyzed. RESULTS: When accessed via Safari, two websites were legible, four were somewhat legible, and four were somewhat illegible. When accessed via Chrome, two websites were legible, six were somewhat legible, and two were somewhat illegible. One website provided an RSS feed and two websites managed members via separate Twitter accounts. No website supported mobile web pages. The result of the W3C(R) Markup Validation test on 10 websites showed a mean error rate of 221.6 (range, 13-1,477) and a mean warning rate of 127.13 (range, 0-655). CONCLUSIONS: The smartphone legibility level of the websites of urological societies was relatively low. Improved smartphone legibility and web standard compliance of the websites of urological societies are required to keep up with the popularity of smartphones.

Clinical Characteristics of Genitourinary Tuberculosis during a Recent 10-Year Period in One Center

PURPOSE: This study was conducted to analyze the clinical characteristics and treatments of patients with genitourinary tuberculosis (GUTB) over the past 10 years. MATERIALS AND METHODS: The study population comprised 101 patients who were diagnosed with GUTB and hospitalized from January 2000 to December 2009. Acid-fast bacilli (AFB) smear, urine tuberculosis culture, urine tuberculosis polymerase chain reaction (PCR), intravenous urography, cystoscopy, and histopathologic findings were used for patient selection. Yearly proportion, gender, patient distribution according to age, history of tuberculosis, and presence of other organ tuberculosis were analyzed. RESULTS: The patients hospitalized with GUTB counted for 0.9% of all patients admitted to the department of urology. The sex ratio was 1:1.53 (male:female), and the patients' mean age was 45.57+/-12.55 years (range, 19-81 years). Among the patients, there was one immunocompromised patient. A total of 22 patients (21.8%) had a medical history of tuberculosis, mostly pulmonary tuberculosis (90.9%). The sensitivity of AFB stain, tuberculosis culture, and PCR was 41.6%, 55.4%, 33.7%, respectively. A total of 54 patients required additional surgical treatment: 30 cases of nephrectomy, 8 cases of epididymectomy, 8 cases of ureteral stent, 5 cases of nephrostomy, 1 case of ureterectomy, 1 case of augmentation cystoplasty, and 1 case of transurethral resection of prostate. CONCLUSIONS: The frequency of GUTB tended to decrease progressively. However, GUTB is still a threat to public health. There was no previous history of tuberculosis in two-thirds of the cases of GUTB and more than half of them required further surgical treatment.

Effects of Tamsulosin, Solifenacin, and Combination Therapy for the Treatment of Ureteral Stent Related Discomforts

PURPOSE: To evaluate the effect of tamsulosin, solifenacin, and combination therapy of two agents in improving the lower urinary tract symptoms of patients with indwelling double-J ureteral stents. MATERIALS AND METHODS: A total of 168 patients underwent placement of a double-J ureteral stent after retrograde ureteroscopy for urinary stone disease. All patients received polyurethane double-J ureteral stents (6 Fr, 24 or 26 cm), which were removed a mean of 14 days postoperatively. A total of 48 patients were given no medication (Group 1), 43 patients were given tamsulosin 0.2 mg once daily (Group 2), 45 patients were given solifenacin 5 mg once daily (Group 3), and 32 patients were given a combination of two agents postoperatively (Group 4). International Prostate Symptom Score/quality of life (IPSS/QoL) and visual analogue pain scale (VAPS) questionnaires were completed by each patient at 1 day postoperatively and on the day of stent removal. RESULTS: In the total group of patients, the mean age was 50.24+/-12.90 years. There was a significant difference in the IPSS total score between group 1 and groups 3 and 4. Group 4 also differed significantly from group 1 in the irritative subscore. The obstructive subscore differed between groups 2 and 4 and group 1. There was a statistically significant difference between group 1 and group 4 in the QoL score. There were no significant differences in the VAPS. CONCLUSIONS: Combination therapy with tamsulosin and solifenacin improved both irritative and obstructive symptoms more than in the other groups. Combination therapy should be strongly considered for patients who complain of stent-related symptoms.

Initial Experience with Laparoendoscopic Single-Site Surgery by Use of a Homemade Transumbilical Port in Urology

PURPOSE: We present our initial experience with laparoendoscopic single-site surgery (LESS) by a single surgeon in the urologic field. MATERIALS AND METHODS: From May 2009 to April 2010, 30 consecutive patients underwent LESS including seven cases of nephrectomy, five cases of nephroureterectomy with bladder cuff excision, four cases of ureterolithotomy, eight cases of marsupialization, and six cases of varicocelectomy. We performed a retrospective analysis of the medical records of the above patients. The single port was made with a surgical glove and an Alexis(R) wound retractor (Applied Medical, Rancho Santa Margarita, CA, USA). The wound retractor was put into the peritoneal space through an umbilical incision, and a laparoscopic triangle was secured by crossing both instruments. All operations were performed by the transperitoneal approach. RESULTS: Mean patient age was 54.8 years. Mean operative time was 171.2+/-109.1 minutes. Mean estimated blood loss was 265.0+/-395.5 ml. Mean incision length was 3.2+/-1.4 cm. Mean length of hospitalization was 5.2+/-2.9 days. There was one laparoscopic conversion and two open conversions. There were two cases of transient ileus that improved with conservative treatment. Mean visual analogue pain scales on the operative day and first postoperative day were 6.3/10 and 3.1/10, respectively. CONCLUSIONS: In our experience, LESS for urologic surgery is feasible, safe, and clinically applicable. We consider the homemade single-port device to be a relatively cost-effective and convenient device. If surgical instruments for LESS and appropriate ports specified for LESS are developed, LESS would be a surgical treatment technique that could be used as an alternative to the conventional types of laparoscopic surgery.

Efficacy and Safety of Tadalafil 5 mg Administered Once Daily in Korean Men with Erectile Dysfunction: A Prospective, Multicenter Study

PURPOSE: The aim of this study was to evaluate the efficacy of a daily dose of tadalafil 5 mg as well as its safety for the cardiovascular system in men with erectile dysfunction. MATERIALS AND METHODS: This study included a total of 162 men who were administered a daily dose of tadalafil 5 mg between April and December of 2009. A total of 127 men completed the 8-week clinical trial. The International Index of Erectile Function (IIEF)-5, blood pressure, and heart rate were measured before treatment with tadalafil (V1) and 4 (V2) and 8 weeks (V3) after treatment with tadalafil. Adverse effects were assessed at V1, V2, and V3. In cases in which the International Prostate Symptom Score (IPSS) was > or =8 at V1, maximal flow rate (Qmax) and postvoid residual volume (PVR) were measured. RESULTS: The IIEF-5 values were 11.25+/-3.18, 14.56+/-3.79, and 16.91+/-3.56 at V1, V2, and V3, respectively, with significant improvement (V1 vs. V2, p<0.001; V1 vs. V3, p<0.001). The IPSS values were 10.59+/-5.56, 9.07+/-6.06, and 8.15+/-6.10 at V1, V2, and V3, respectively, and the differences were statistically significant (V1 vs. V2, p<0.001; V1 vs. V3, p<0.001). There were no significant differences in blood pressure or heart rate. Adverse effects were observed in 7 men (5.51%) at V2 and in 5 men (3.94%) at V3. CONCLUSIONS: Tadalafil 5 mg administered once-a-day may be effective in improving erectile function. Adverse effects on the cardiovascular system may be minimal. In addition, it is believed that this may also be effective in improving voiding symptoms.

The Role of TURP in the Detection of Prostate Cancer in BPH Patients with Previously Negative Prostate Biopsy

PURPOSE: We aimed to investigate the significance of early detection of transition zone prostate cancer by transurethral resection of prostate (TURP) in benign prostatic hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) in whom prostate cancer was suspected despite a negative transrectal ultrasonography (TRUS) biopsy result. MATERIALS AND METHODS: From January 2006 to January 2009, a total of 165 patients who underwent TURP were evaluated. The prostate cancer detection rate was compared between patients who underwent TRUS biopsy before TURP (group A) and those who did not (group B). All charts were evaluated retrospectively, including prostate-specific antigen (PSA), digital rectal examination (DRE), TURP results (including resection volume and pathology report), TRUS, and TRUS biopsy results. Group A was subdivided into group A1, who were diagnosed with prostate cancer after TURP, and group A2, who were diagnosed with BPH after TURP. RESULTS: The cancer detection rate showed no significant difference between groups A and B (8.9% vs. 7.5%, p>0.05). The mean PSA levels in groups A1 and A2 were 15.5+/-14.0 ng/ml and 9.1+/-5.1 ng/ml, respectively (p>0.05). In group A1, 40% had an abnormal DRE, compared with 6.7% in group A2 (p<0.05). After TURP, the mean percentage of resected prostatic chips of the prostate cancer group and BPH group were 33.9% and 18.6%, respectively (p=0.001). A positive correlation was found between the detection rate of prostate cancer and PSA (p=0.01). CONCLUSIONS: BPH patients in whom prostate cancer is suspected and who have lower urinary tract symptoms (LUTS) with a previously negative TRUS biopsy result can undergo TURP, which results in immediate improvement in bladder outlet obstruction and early diagnosis of clinically significant transition zone prostate cancer.

Initial Experience with Robotic-Assisted Laparoscopic Partial Cystectomy in Urachal Diseases

PURPOSE: In this study, we report our initial experience with robot-assisted laparoscopic partial cystectomy (RLPC) in urachal diseases. MATERIALS AND METHODS: Two men and two women with a mean age of 51.5+/-9.3 years underwent RLPC between June 2009 and December 2009. In each case, a single surgeon using the da Vinci-S robotic system (Intuitive Surgical, Sunnyvale, CA, USA) used a transperitoneal approach with a 0 degrees robotic camera. After careful observation of the intravesical portion of the mass, the mass was excised by use of monopolar scissors circumferentially. The bladder was closed in two layers with watertight running sutures made with 2-0 Vicryl. RESULTS: The mean operative time was 198 minutes (range, 130-260 minutes), the mean console time was 111 minutes (range, 70-150 minutes), and the mean estimated blood loss was 155 ml. The urethral catheter was removed on postoperative day 7 after a normal cystogram, and the surgical drain was removed on postoperative day 2.5 (range, 2-3 days). The mean hospital stay was 6 days (range, 4-7 days). There were no major complications. The pathology report revealed that one patient had a urachal cystadenoma, two patients had a urachal cyst, and one patient had a patent urachus. CONCLUSIONS: Our initial experience with RLPC for benign urachal disease is that it is a safe and feasible treatment modality. However, more cases are required to confirm the efficacy of RLPC.

Predictive Factors of Gleason Score Upgrading in Localized and Locally Advanced Prostate Cancer Diagnosed by Prostate Biopsy

PURPOSE: The Gleason score (GS) is an important factor that is considered when making decisions about prostate cancer and its prognosis. However, upgrading of the GS can occur between transrectal ultrasonography (TRUS) biopsy and radical prostatectomy. This study analyzed the clinical factors predictive of upgrading of the GS after radical prostatectomy compared with that at the time of TRUS biopsy. MATERIALS AND METHODS: We analyzed the medical records of 107 patients who had undergone radical prostatectomy. Patients were divided into two groups. Group 1 consisted of patients in whom the GS was not upgraded, and group 2 consisted of patients in whom the GS was upgraded. Associations between preoperative clinical factors and upgrading of the GS were analyzed. Preoperative clinical factors included age, prostate-specific antigen (PSA), prostate volume, PSA density, GS of TRUS biopsy, maximum core percentage of cancer, percentage of positive cores, number of biopsies, location of positive core with maximum GS, high-grade prostatic intraepithelial neplasia (HGPIN), inflammation on biopsy, and clinical stage. RESULTS: Among 85 patients, 42 (49%) patients had an upgraded GS after operation. TRUS biopsy core number of 12 or fewer (p=0.029) and prostate volume of 36.5 ml or less (p<0.001) were associated with upgrading of the GS. Preoperative clinical factors associated with nonupgrading of the GS were the detection of positive cores with a maximum GS at the apex (p=0.002) or in a hypoechoic lesion (p=0.002) in TRUS. CONCLUSIONS: If the positive cores with maximum GS are located at the apex or in a hypoechoic lesion in TRUS, we can expect that the GS will not be upgraded. In patients with the clinical predictive factors of a prostate volume of 36.5 ml or less and TRUS biopsy core number of less than 12, we can expect upgrading of the GS after radical prostatectomy, and more aggressive treatment may be needed.

The Association of Metabolic Syndrome and Prostate-Specific Antigen

PURPOSE: Recent studies have reported the association between metabolic syndrome and benign prostatic hyperplasia. This study was conducted to evaluate the relation between metabolic syndrome and prostate-specific antigen (PSA). MATERIALS AND METHODS: From January 2004 to December 2007, a total of 4,115 male outpatients (aged 40 to 79 years) who visited the health care center at our medical center were examined. Eligible men were classified according to the presence or absence of metabolic syndrome and the number of components of the metabolic syndrome. The association between the sum of metabolic syndrome components and PSA level was evaluated. The association between each metabolic syndrome component and PSA level was also evaluated. RESULTS: The PSA level of metabolic syndrome patients was lower than that of the control group (p=0.022). An increased number of metabolic syndrome components was significantly associated with a linear, decreasing trend in PSA levels (p-trend=0.040). When a Pearson's correlation was performed, only obesity was inversely associated with PSA level in the metabolic syndrome group. There was no significant factor that was related to having a PSA level greater than or equal to 2.5 ng/ml. CONCLUSIONS: Metabolic syndrome should be considered as a factor associated with reduced PSA levels. If the patient with metabolic syndrome is obese, the PSA cutoff value should be lower than 4 ng/ml.

Predictive Factors for Recovery from Acute Urinary Retention after Non-Urogenital Surgery

PURPOSE: We performed this study to investigate the predictive factors that are related to recovery from acute urinary retention after non-urogenital surgery. MATERIALS AND METHODS: We retrospectively analyzed the records of 160 patients who were referred to the department of urology because of lasting acute urinary retention after non-urogenital surgery at our institution between January 2004 and December 2006. Patients were divided into two groups: a transient retention group, which included patients who recovered voiding capability after urinary catheterization for 7 days, and the unresponsive retention group, which included patients who did not recover voiding capability. Surgical factors, patient factors, use of patient-controlled analgesia (PCA), amount of residual urine, and medications during catheterization were analyzed. RESULTS: In the chi-square analysis, gender (female, p=0.006), age (> or=60 years old, p or =4,000 ml, p=0.002), and intraoperative indwelling of Foley catheter (p=0.026) were found to differ significantly between the two groups. In the multivariate logistic regression analysis, gender (female, p=0.002; OR=5.6), age (> or=60 years old, p=0.001; OR=5.9), hypertension (p=0.049; OR=2.6), location of surgery (pelvic cavity, p or =4,000 ml, p=0.001; OR=8.5) were found to increase the risk of unresponsive urinary retention. The residual urine volume of the unresponsive urinary retention group was larger than that of the transient urinary retention group (741+/-306 ml vs. 614+/-222 ml, p=0.003). CONCLUSIONS: Use of a preoperative indwelling catheter and careful management of urination is necessary to prevent unresponsive urinary retention in patients with risk factors such as female gender, old age, hypertension, surgery in the pelvic cavity, and a large amount of intraoperative fluid injection.

Assessment of the Quality of Information Concerned with Benign Prostatic Hyperplasia and Prostate Cancer on the Related Korean Internet Web Sites / 대한비뇨기과학회지

PURPOSE: We assessed the quality of information available to patients on benign prostatic hyperplasia(BPH) and prostate cancer on the Korean internet web sites. MATREIALS AND METHODS: This research was undertaken by surfing the internet on the world wide web sites, including naver, nate, daum, yahoo and empas. The key words for the search were 'BPH' and 'prostate cancer'. We evaluated two main themes, and these were aspect of the contents and the technical contents. The aspects of the contents were the content and authorship, and the technical aspects were related to design and efficiency. RESULTS: We evaluated 45 web sites that focused on BPH and 24 web sites that focused on prostate cancer. From among the web sites, 27(60%) of the 45 BPH sites and 16(67%) of the 24 sites gave medical information. Only 14(31%) of the 27 BPH sites and 12(50%) of the 24 prostate cancer sites dealt with full information. The average score of these 43 web sites was only 34.5+/-13.6 of a perfect score of 100. The mean score of the content was 10+/-5.1 of 40 points, authorship was 4.3+/-3.3 of 20 points, design was 10.4+/-3.3 of 20 points and efficiency was 9.8+/-4.6 of 20 points. A total of 28(65%) out of the 43 providers of information were urologists and 23 (82%) out of the 28 were general practitioners. The rate of research on prostatic disease was lower than that for 'hypertension', 'diabetes', 'stroke' and 'hepatitis'. CONCLUSIONS: There is need for more accurate information on prostatic diseases on the Korean internet. It is essential to set up an institution for qualifying the medical information on web sites & evaluating the web sites on the Korean internet.

Assessment of the Quality of Information Concerned with Benign Prostatic Hyperplasia and Prostate Cancer on the Related Korean Internet Web Sites / 대한비뇨기과학회지

PURPOSE: We assessed the quality of information available to patients on benign prostatic hyperplasia(BPH) and prostate cancer on the Korean internet web sites. MATREIALS AND METHODS: This research was undertaken by surfing the internet on the world wide web sites, including naver, nate, daum, yahoo and empas. The key words for the search were 'BPH' and 'prostate cancer'. We evaluated two main themes, and these were aspect of the contents and the technical contents. The aspects of the contents were the content and authorship, and the technical aspects were related to design and efficiency. RESULTS: We evaluated 45 web sites that focused on BPH and 24 web sites that focused on prostate cancer. From among the web sites, 27(60%) of the 45 BPH sites and 16(67%) of the 24 sites gave medical information. Only 14(31%) of the 27 BPH sites and 12(50%) of the 24 prostate cancer sites dealt with full information. The average score of these 43 web sites was only 34.5+/-13.6 of a perfect score of 100. The mean score of the content was 10+/-5.1 of 40 points, authorship was 4.3+/-3.3 of 20 points, design was 10.4+/-3.3 of 20 points and efficiency was 9.8+/-4.6 of 20 points. A total of 28(65%) out of the 43 providers of information were urologists and 23 (82%) out of the 28 were general practitioners. The rate of research on prostatic disease was lower than that for 'hypertension', 'diabetes', 'stroke' and 'hepatitis'. CONCLUSIONS: There is need for more accurate information on prostatic diseases on the Korean internet. It is essential to set up an institution for qualifying the medical information on web sites & evaluating the web sites on the Korean internet.

Retroperitoneal Castleman's Disease Incidentally Detected due to Urinary Calculus / 대한비뇨기과학회지

Castleman's disease(CD) is a rare benign tumor characterized by hyperplasia of lymphoid tissue. It can occur in almost any l ocation, with 70% in the mediastinum, 7% in the retroperitoneum, and only 2% in the perirenal area. Approximately 80% of primary retroperitoneal tumors are malignant, so tumor resection and differential diagnosis with other retroperitoneal tumors is important. We present a case of a hyaline-vascular type CD in the pararenal area, detected incidentally during evaluation of a urinary calculus, with a review of the literature.

The Prevalence and Risk Factors of Nocturia for Males Participating in a Prostate Examination Survey / 대한비뇨기과학회지

PURPOSE: Elderly men are often troubled by lower urinary tract symptoms (LUTS), including frequency, urgency, incontinence and nocturia. Especially, nocturia is one of the frequently complained about urologic symptoms and this can be combined with sleep disorders. We investigated the prevalence and risk factors for nocturia in males who participated in a prostate examination survey. MATERIALS AND METHODS: A total of 7,299 men participated in a prostate examination survey from March 2003 to December 2006; these men were given an International Prostate Symptom Score(IPSS) and they underwent transrectal ultrasonography of the prostate. The prevalence of nocturia and its associated factors, which included age, the IPSS severity, the prostate volume and the place of residence, were evaluated. RESULTS: Among the men who were evaluated, 23.4% reported voiding once per night and 68% reported voiding twice or more per night. The severe IPSS group revealed a significantly higher nocturia score compared to the mild and moderate IPSS group. While the nocturia score and the other LUTS score increased significantly with age, only the nocturia score increased significantly with age in each of the IPSS severity groups. The nocturia score increased significantly with a prostate volume >or=30g. Men living in Seoul showed a significantly lower nocturia score than that for men living in other areas. Multiple logistic regression analysis also indicated that an older age, a severe IPSS score, the country of residence were the independent risk factors. Multiple regression analysis revealed the nocturia score to have the highest correlation with the quality of life. CONCLUSIONS: For Korean males, the prevalence of nocturia >or=2 is 68% and the incidence of nocturia increased significantly according to age, the IPSS severity, the prostate volume and the place of residence.

Change of the Testicular Volume after Mumps Orchitis / 대한비뇨기과학회지

PURPOSE: Mumps orchitis rarely occurs in prepubescent boys, but it is common in adolescents and adults. Approximately 30-40% of the affected testes are said to atrophy within several months as a complication, but any study on this is lacking. We studied the clinical outcomes and the ultrasonographic findings of mumps orchitis. MATERIALS AND METHODS: We studied 15 patients who had been hospitalized and followed up for more than 3 months from July 2003 to June 2005. The average age of the patients was 16 years old. The patients' medical history, therapeutic measures and clinical outcomes were recorded, and scrotal color doppler ultrasonography was performed at the follow up sessions after the treatment. The criteria for testicular atrophy have been set according to the contralateral testicular volume reduction of 20% or 2ml. RESULTS: During an average of 10 months of follow up period, 9 of 15 patients experienced atrophy and the contraction rate of the affected testes was about 39.8%. Two of 5 patients who under systemic interferon-alpha2b treatments experienced atrophy and their contraction rate was about 46.5%. On the ultrasonography, inhomogeneous and decreased echogenicity was noted in the atrophic testes and the blood flow comparably decreased. CONCLUSIONS: From the study, it has been confirmed that the interfereon-alpha2b treatment was not adequate to completely prevent the atrophy. Scrotal ultrasonography is a useful examination that is able to measure the correct testicular volume and judge testicular atrophy. As mumps orchitis seem to induce testicular atrophy, periodic check up may be required after the acute stage.

The Intestinal Type of Florid Cystitis Glandularis Mimics Bladder Tumor: A Case Report

Cystitis glandularis is a benign metaplastic proliferative lesion of the urinary bladder which usually occurs in the setting of chronic irritation and infection or in some cases as a congenital process. Sometimes it presents as a tumor mass-like florid lesion, grossly mimicking malignancy. We report a case of 59-year-old man with multiple mass lesions around the trigone and the neck portion, which suggested the possibility of malignancy in clinical and radiological evaluations. Final diagnosis was confirmed by transurethral resection. The surface urothelial lining was intact. The submucosa showed von Brunn's nests, cystitis glandularis and cystitis cystica in the edematous lamina propria. There were numerous glands lined by tall columnar, mucin producing epithelium without atypia, conforming to the appearance of the intestinal variant of cystitis glandularis. The cystitis glandularis may mimic a neoplasm on gross evaluation. The intestinal variant of cystitis glandularis is particularly likely to be problematic when florid.