Cross-Sectional Association of Metabolic Syndrome and Its Components with Serum Testosterone Levels in a Korean-Screened Population

It's Time to Take Advantage of Robotic Assisted Simple Prostatectomy in Large Benign Prostatic Hyperplasia

No abstract available.

Holmium Laser Enucleation of the Prostate is Safe for Patients Above 80 Years: A Prospective Study / 대한배뇨장애요실금학회지

PURPOSE: To evaluate the effect of age on the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for the treatment of symptomatic benign prostatic hyperplasia (BPH). METHODS: A total of 579 patients underwent HoLEP procedure performed by a single surgeon (SJO) between December 2009 and May 2013. The perioperative and functional outcomes of patients in the age groups of 50-59 (group A, n=44), 60-69 (group B, n=253), 70-79 (group C, n=244), and ≥80 years (group D, n=38) were compared. The Clavien-Dindo system was used to evaluate clinical outcomes. The International Prostate Symptom Score (IPSS), maximum urinary flow rate (Qmax), postvoid residual (PVR) urine volume, and urinary continence were used to assess functional outcomes. RESULTS: In this study, the patients ≥80 years had significantly higher presence of hypertension (P=0.007), total prostate volumes (P=0.024), transitional zone volume (P=0.002), American Society of Anesthesiologists scores (P=0.006), urinary retention (P=0.032), and anticoagulation use (P=0.008) at preoperative period. Moreover, the mean values of operation time, enucleation time, morcellation time, and enucleation weight were higher in group D compared with other group patients (P=0.002, P=0.010, P0.05). All the patients in the present study showed improvement in functional outcomes after HoLEP. By the sixth month, there were no significant differences in IPSS, quality of life, Qmax, and PVR among the groups (P>0.05). CONCLUSIONS: Compared with younger patients, the patients aged ≥80 years had a similar overall morbidity and 6-month functional outcomes of HoLEP. HoLEP is a safe and effective treatment for BPH among the elderly.

Urodynamic assessment of bladder and urethral function among men with lower urinary tract symptoms after radical prostatectomy: A comparison between men with and without urinary incontinence

PURPOSE: We compared bladder and urethral functions following radical prostatectomy (RP) between men with and without urinary incontinence (UI), using a large-scale database from SNU-experts-of-urodynamics-leading (SEOUL) Study Group. MATERIALS AND METHODS: Since July 2004, we have prospectively collected data on urodynamics from 303 patients with lower urinary tract symptoms (LUTS) following RP at three affiliated hospitals of SEOUL Study Group. After excluding 35 patients with neurogenic abnormality, pelvic irradiation after surgery, or a history of surgery on the lower urinary tract, 268 men were evaluated. We compared the urodynamic findings between men who had LUTS with UI (postprostatectomy incontinence [PPI] group) and those who had LUTS without UI (non-PPI group). RESULTS: The mean age at an urodynamic study was 68.2 years. Overall, a reduced bladder compliance (< or =20 mL/cmH2O) was shown in 27.2% of patients; and 31.3% patients had idiopathic detrusor overactivity. The patients in the PPI group were older (p=0.001) at an urodynamic study and had a lower maximum urethral closure pressure (MUCP) (p<0.001), as compared with those in the non-PPI group. Bladder capacity and detrusor pressure during voiding were also significantly lower in the PPI group. In the logistic regression, only MUCP and maximum cystometric capacity were identified as the related factor with the presence of PPI. CONCLUSIONS: In our study, significant number of patients with LUTS following RP showed a reduced bladder compliance and detrusor overactivity. PPI is associated with both impairment of the urethral closuring mechanism and bladder storage dysfunction.

Efficacy and safety of holmium laser enucleation of the prostate for extremely large prostatic adenoma in patients with benign prostatic hyperplasia

PURPOSE: To evaluate the efficacy and safety of holmium laser enucleation of the prostate (HoLEP) for extremely large prostates. MATERIALS AND METHODS: Patients undergoing HoLEP between July 2008 and December 2013 from the Seoul National University Hospital Benign Prostatic Hyperplasia Database Registry were retrospectively analyzed. The patients were divided into three groups according to their total prostate volume (TPV): group A (TPV or =200 mL); the clinical data of the three groups were compared. All patients were followed up 2 weeks, 3 months, and 6 months after surgery. RESULTS: A total of 502 patients (group A, 426; group B, 70; group C, 6) with a mean age of 69.0 (standard deviation, +/-7.3) years were included in our analysis. The mean prostate volume and prostate-specific antigen level were 68.7+/-36.9 mL and 4.15+/-4.24 ng/mL, respectively. The enucleation and morcellation times were longer in group C (p<0.001), and the enucleation efficacy was higher in this group (p<0.001, R2=0.399). Moreover, the mean postoperative catheterization and hospitalization periods were significantly longer in group C (p=0.004 and p=0.011, respectively). However, there were no significant differences between the groups in any other postoperative events, including recatheterization, reoperation, urinary tract infection, clot retention, and bladder neck contracture (p range, 0.516-0.913). One patient in group C experienced recurrence of the urethral stricture. CONCLUSIONS: HoLEP in patients with an extremely large prostate can be performed efficiently and safely.

Changes in Bladder Wall Thickness and Detrusor Wall Thickness After Surgical Treatment of Benign Prostatic Enlargement in Patients With Lower Urinary Tract Symptoms: A Preliminary Report

PURPOSE: The purpose of the present study was to evaluate the perioperative changes in bladder wall thickness and detrusor wall thickness after transurethral prostatectomy. MATERIALS AND METHODS: Fifty-one men who were treated for benign prostatic hyperplasia/lower urinary tract symptoms with transurethral prostatectomy were prospectively analyzed from May 2012 to July 2013. Prostate size, detrusor wall thickness, and bladder wall thickness were assessed by transrectal and transabdominal ultrasonography perioperatively. All postoperative evaluations were performed 1 month after the surgery. RESULTS: The patients' mean age was 69.0 years, the mean prostate-specific antigen concentration was 8.1 ng/mL, and the mean prostate volume was 63.2 mL. The mean bladder wall thickness was 5.1 mm (standard deviation [SD], +/-1.6), 5.1 mm (SD, +/-1.6), and 5.0 mm (SD, +/-1.4) preoperatively and 4.5 mm (SD, +/-1.5), 4.5 mm (SD, +/-1.3), and 4.6 mm (SD, +/-1.2) postoperatively in the anterior wall, dome, and trigone, respectively (p=0.178, p=0.086, and p=0.339, respectively). The mean detrusor wall thickness was 0.9 mm (SD, +/-0.4) preoperatively and 0.7 mm (SD, +/-0.3) postoperatively (p=0.001). A subgroup analysis stratifying patients into a large prostate group (weight, > or =45 g) and a high Abrams-Griffiths number group (>30) showed a significant decrease in detrusor wall thickness (p=0.002, p=0.018). CONCLUSIONS: There was a decrease in detrusor wall thickness after transurethral prostatectomy. The large prostate group and the high Abrams-Griffiths number group showed a significant decrease in detrusor wall thickness after surgery.

Factors Influencing Nonabsolute Indications for Surgery in Patients With Lower Urinary Tract Symptoms Suggestive of Benign Prostatic Hyperplasia: Analysis Using Causal Bayesian Networks / 대한배뇨장애요실금학회지

PURPOSE: To identify the factors affecting the surgical decisions of experienced physicians when treating patients with lower urinary tract symptoms that are suggestive of benign prostatic hyperplasia (LUTS/BPH). METHODS: Patients with LUTS/BPH treated by two physicians between October 2004 and August 2013 were included in this study. The causal Bayesian network (CBN) model was used to analyze factors influencing the surgical decisions of physicians and the actual performance of surgery. The accuracies of the established CBN models were verified using linear regression (LR) analysis. RESULTS: A total of 1,108 patients with LUTS/BPH were analyzed. The mean age and total prostate volume (TPV) were 66.2 (+/-7.3, standard deviation) years and 47.3 (+/-25.4) mL, respectively. Of the total 1,108 patients, 603 (54.4%) were treated by physician A and 505 (45.6%) were treated by physician B. Although surgery was recommended to 699 patients (63.1%), 589 (53.2%) actually underwent surgery. Our CBN model showed that the TPV (R=0.432), treating physician (R=0.370), bladder outlet obstruction (BOO) on urodynamic study (UDS) (R=0.324), and International Prostate Symptom Score (IPSS) question 3 (intermittency; R=0.141) were the factors directly influencing the surgical decision. The transition zone volume (R=0.396), treating physician (R=0.340), and BOO (R=0.300) directly affected the performance of surgery. Compared to the LR model, the area under the receiver operating characteristic curve of the CBN surgical decision model was slightly compromised (0.803 vs. 0.847, P<0.001), whereas that of the actual performance of surgery model was similar (0.801 vs. 0.820, P=0.063) to the LR model. CONCLUSIONS: The TPV, treating physician, BOO on UDS, and the IPSS item of intermittency were factors that directly influenced decision-making in physicians treating patients with LUTS/BPH.

Short-term Effects of a Systematized Bladder Training Program for Idiopathic Overactive Bladder: A Prospective Study / 대한배뇨장애요실금학회지

PURPOSE: This study was to investigate whether a systematized bladder training (BT) program is effective for patients with idiopathic overactive bladder (OAB). METHODS: A prospective study was conducted on 105 patients with OAB from March 2009 to November 2011. We developed a 30 minutes BT program, which consisted of first, refraining from going to the bathroom after feeling an urge to void, second, in order to stop thinking about voiding, ceasing action and thought temporarily, and third, performing pelvic floor exercises 5 to 6 times. Before and after BT, the patients filled out voiding diaries as well as the following questionnaires; International Consultation on Incontinence Questionnaire for overactive bladder (ICIQ-OAB), International Prostate Symptom Score (IPSS), overactive bladder questionnaire (OAB-q), the short form 36-item health survey (SF-36) questionnaire, the work productivity and activity impairment questionnaire, and a patients' perception of treatment benefit (PPTB). RESULTS: A final analysis was performed from on 85 patients (38 male, 47 female) with idiopathic OAB. After the first BT, the results of the ICIQ-OAB showed improvement in frequency, nocturia, and urgency (P<0.05), and all domains of IPSS questionnaires showed significant improvement (P<0.05). Among the SF-36 domains, the role-physical domain showed significant improvement after the first BT, and the general health domain showed significant improvement after the second. The voiding diaries showed statistically significant changes in maximal voided volume after the first BT, and nocturia index and nocturnal polyuria index after the second BT. According to the PPTB questionnaire, the perceived usefulness of BT increased after each session, and almost all of the patients replied that BT improved their symptoms. CONCLUSIONS: Our results demonstrated that BT was effective in improving many OAB related symptoms and quality of life in patients with idiopathic OAB. More clinical application of BT could be implemented in the future.

Technical Aspects of Holmium Laser Enucleation of the Prostate for Benign Prostatic Hyperplasia

Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure and a size-independent treatment for benign prostatic hyperplasia with excellent long-term surgical outcome. HoLEP has become an alternative to conventional transurethral resection of the prostate or open prostatectomy owing to its efficacy and safety. Although HoLEP is known to have a steep learning curve, very few articles have addressed the technical aspects of HoLEP. Herein, we described detailed techniques and tips for HoLEP as performed at Seoul National University Hospital in a step-by-step manner with extensive review of the literature.

Prophylactic Effects of a Fixed Dorsolamide/Timolol Combination on IOP Elevation before Intravitreal Anti-VEGF Injection

PURPOSE: The purpose of the present study was to investigate the prophylactic effects of a fixed combination of dorsolamide/timolol on intraocular pressure (IOP) elevation before intravitreal anti-VEGF injection. METHODS: A prospective, randomized clinical trial was conducted on 91 eyes of 91 patients undergoing intravitreal anti-VEGF injection. The eyes were randomly divided into 2 groups, the eyes which had used the fixed prophylactic dorsolamide/timolol combination (group 1, 58 eyes) and the eyes which had not used the combination (group 2, 15 eyes). The IOP was measured one hour and 5 minutes prior to the procedure, 5 minutes interval up to 30 minutes after the procedure and one hour, 1 day, 7 days, and one month after the procedure. The IOP changes were analyzed. RESULTS: The mean 5 minutes and 30 minutes postoperative IOPs were 14.12 +/- 4.18 mm Hg and 10.87 +/- 1.58 mm Hg in group 1 and 28.21 +/- 3.16 mm Hg and 17.48 +/- 2.34 mm Hg in group 2, respectively. After IVBI, the mean 5 min postoperative IOP was 12.17 +/- 1.13 mm Hg in group 1 and 27.12 +/- 3.35 mm Hg in group 2. After IVRI, the mean 5 minutes postoperative IOP was 15.98 +/- 4.14 mm Hg in group 1 and 25.19 +/- 1.04 mm Hg in group 2. CONCLUSIONS: Prophylactic use of a fixed dorsolamide/timolol combination before intravitreal anti-VEGF injection is an easy and safe method of preventing IOP elevation immediately after intravitreal injection of bevacizumab or ranibizumab.

Oncological and Surgical Outcomes of Pure Laparoscopic Radical Nephrectomy and Hand-Assisted Laparoscopic Radical Nephrectomy for pT1 Renal Cell Carcinoma: Comparison with Open Radical Nephrectomy

PURPOSE: We compared the surgical and oncologic outcomes of pure laparoscopic radical nephrectomy (PLRN) and hand-assisted laparoscopic radical nephrectomy (HLRN) with those of open radical nephrectomy (ORN) in patients with pT1 renal cell carcinoma (RCC). MATERIALS AND METHODS: Between 1999 and 2007, a total of 269 patients underwent PLRN (n=77), HLRN (n=87), and ORN (n=105) for pT1 RCC. Follow-up data consisted of clinical, pathologic, and oncologic results and were reviewed retrospectively. Kaplan-Meier survival curves were constructed for progression and survival endpoints. RESULTS: Mean operative time was 184.0, 164.0, and 132.6 minutes (p<0.001); mean estimated blood loss was 196.7, 147.8, and 232.6 ml (p<0.001); and mean postoperative hospital stay was 5.7, 7.2, and 7.8 days (p<0.001) for the PLRN, HLRN and ORN groups, respectively. The major complication rate after surgery was 2.6%, 2.3%, and 3.8%, respectively (p=0.807). Median follow-up periods were 32 months in the PLRN group, 48 months in the HLRN group, and 37 months in the ORN group. Five-year progression-free survival was 97.4%, 96.6%, and 98.1% (p=0.557), and 5-year cancer-specific survival was 98.7%, 96.6%, and 98.1% (p=0.508), respectively. CONCLUSIONS: PLRN and HLRN are safe treatment options with comparable oncologic results to ORN for pT1 RCC.

Onset of Action of Phosphodiesterase Type 5 Inhibitors in the Treatment of Erectile Dysfunction / 대한남성과학회지

PURPOSE: After the market launch of multiple phosphodiesterase type 5 inhibitors (PDE5Is), a considerable amount of information has emerged regarding the efficacy and the time of initiation of these drugs. In clinical situations, however, many patients with erectile dysfunction (ED) have complained about the onset of erection occurring later than expected or desired. We therefore studied the time course for initiating an erection after usage of PDE5Is. MATERIALS AND METHODS: One hundred forty-one patients who were medicated with PDE5Is > 4 times in the most recent 3 months were included for study. The patients were divided into 3 groups: sildenafil (n=51), vardenafil (n=51), and tadalafil (n=39). The choice of PDE5I was made according to the patient's and/or doctor's preferences. Regardless of the type of drug selected, the patients were recommended to have sexual stimulation 15 minutes after taking the medication. RESULTS: The onset of action of the 3 drug groups were significantly different (sildenafil, 57.0+/-38.5 min; tadalafil, 79.5+/-50.6 min; and vardenafil, 44.4+/-26.6 min; p<0.05). Psychogenic causes of ED resulted in a shorter PDE5I onset of action than organic causes of ED. Other factors, such as body mass index and international index of erectile function erectile function domain score, were shown not to differ with respect to the onset of action of PED5Is. CONCLUSION: In clinical situations, patients need more time for the onset of erections after taking PDE5Is. For restoration of a healthy sexual life, patients needs more time to achieve an erection after taking PDE5Is.

Comparison of Corneal Thickness Measured by Specular, US Pachymetry, and Orbscan in Post-PKP Eyes

PURPOSE: To compare the accuracy and reproducibility of central corneal thickness measured by non-contact specular microscopy, ultrasound pachymetry, and Orbscan in the post-penetrating keratoplasty eyes. METHODS: Central corneal thickness was prospectively measured in eyes that had recieved penetrating keratoplasty at least 1 month before. One experienced technician measured all eyes using three methods; non-contact specular microscopy (Topcon SP-2000P; Topcon Corporation, Tokyo, Japan), Orbscan IIz (Orbtek; Bausch & Lomb, Rochester, USA), and ultrasound pachymetry (AL-2000; Tomey, Erlangen, Germany). Three consecutive measurements were performed using each method and the mean values and coefficient of variation were compared. RESULTS: The mean values of central corneal thickness were 550.7+/-63.3 micrometer with specular microscopy, 548.2+/-72.5 micrometer with ultrasound pachymetry, and 472.5+/-151.7 micrometer with Orbscan. There was no significant difference between the measurements obtained by specular microscopy and ultrasound pachymetry (p=0.53), and both methods showed high reproducibility. The corneal thickness measured by Orbscan was remarkably variable and in some patients, Orbscan was unable to measure corneal thickness. CONCLUSIONS: Non-contact specular microscopy appears to be an effective technique, potentially replacing ultrasound pachymetry for measuring central corneal thickness in the post-penetrating keratoplasty eyes.

Ileoureteral Substitution for Complex Ureteral Reconstruction using Refluxing, Non-tailoring Vesicoileal Anastomosis / 대한비뇨기과학회지

PURPOSE: Ileoureteral substitution could be the viable option for the cases with long defects of the ureter that cannot be repaired using intrinsic urinary tract tissues. Yet it is controversial whether anti-refluxing and tailoring vesicoileal anastomosis is necessary. We evaluated the safety and efficacy of ileoureteral substitution using refluxing, non-tailoring technique. MATERIALS AND METHODS: A total of 6 patients (8 ureters) underwent ileoureteral substitution at our institution between July 2002 and March 2006. We reviewed the follow up data including clinical evaluation, excretory urography or equivalent imaging results, serum creatinine and blood gases of the patients who underwent ileoureteral substitution using refluxing, non-tailoring technique. RESULTS: Mean follow up duration was 16 months (range: 1-44). Mean operation time was 332.5 minutes (range: 285-480), estimated blood loss was 366.7ml (range: 200-900), time to oral intake was 5 days (range: 3-7) and postoperative hospital stay was 12.7 days (range: 8-27). Most postoperative complications, which occurred in 3 patients (50%), were minor in nature, including mild ileus and wound dehiscence. On the last excretory urography, there was no evidence of obstruction in any patient. None of the patients experienced worsened renal function or metabolic derangements. CONCLUSIONS: Ileoureteral substitution using refluxing, non-tailoring vesicoileal anastomosis can be used safely without renal deterioration or metabolic derangement for patients suffering with complex and difficult ureteral strictures that are not amenable to more conservative measures. Further studies are needed to determine the long-term safety and efficacy.

The Distribution of the Extraocular Pulley Smooth Muscle in the Rabbit

PURPOSE: We evaluated the structure, innervation of the extraocular pulley smooth muscle in the rabbit. METHODS: A rabbit was transcardially perfused with physiological saline followed by 4% formalin. The rabbit orbit was dissected en bloc, paraffin processed, and serially sectioned for Hematoxylin-Eosin and Masson's trichrome stain. The distribution of the extraocular pulley smooth muscle was confirmed by immunohistochemistry with human smooth muscle(SM) alpha-actin. RESULTS: We found that the pulley structure consisted of focal condensations of eleastin and collagenous connective tissue in relationship to the rectus muscle in the equatorial Tenon's fascia. The pulley smooth muscle in relation to medial rectus muscle was immunostained with TH and nNOS. CONCLUSIONS: The data support the presence of the extraocular pulley smooth muscle in the rabbit orbit having both parasympathetic and sympathetic innervation.

Right Superior Oblique Paralysis associated with Idopathic Hypertropic Cranial Pachymeningitis

PURPOSE: Idiopathic hypertrophic cranial pachymeningitis (IHCP) is a rare disase, which causes chronic progressive inflammation and thickening of the basal dura mater. We report a case of IHCP associated with superior oblique paralysis and present a review of the literature. METHODS: An 8-year-old boy presented with binocular diplopia and left side head tilting. Suspecting right superior oblique muscle paralysis, an alternating prism test, head tilt test, fundus examinations, neurologic examination, and brain MRI were performed. RESULTS: The brain MRI revealed abnormal enhancement of the right tentorium in the course of the right fourth cranial nerve, leading to a diagnosis of IHCP with paralytic strabismus and the patient was treated with systemic steroid therapy. CONCLUSIONS: We report a case of IHCP with right superior oblique paralysis. Patients with recent onset paralytic strabismus require appropriate neurolgic and neuroimaging examinations.

A Case of Comamonas Acidovorans Corneal Ulcer

PURPOSE: To report a case of a Comamonas acidovarans corneal ulcer treated with antibiotics in Korea. Comamonas acidovarans corneal ulcer has not been previously reported to our knowledge. METHODS: A 70-year-old woman visited our clinic complaining of left ocular pain and decreased visual acuity for six days. We performed a smear and culture on the corneal lesion and treated it with topical and systemic antibiotics. RESULTS: Comamonas acidovorans was cultured from ulcer lesion. Corneal ulcer improved with the administration of ciprofloxacin and tobramycin.

A Case of Sarcoidosis with Cavitation / 결핵및호흡기질환

Sarcoidosis is a rare systemic disorder with unknown cause that is characterized pathologically by non-caseating granuloma. The lung and mediastinal lymph nodes are almost always involved, and most patients experience acute or insidious respiratory symptom. Because sarcoidosis is an interstitial lung disorder involving the alveoli and bronchioles, the most common radiological finding is a reticularnodular lesion with lymphatic distribution. However, cavitation is quite rare. Sarcoidosis is also a major cause of hepatic granuloma in Western countries, accounting for 12% to 30% of cases. In most patients, the course of hepatic sarcoidosis is benign. However, chronic intrahepatic cholestasis or portal hypertension may develop in some patients. We report a case of sarcoidosis with cavitation and hepatic involvement.

Isolation of Antimicrobial Substances from Hericium erinaceum

Mycelium of Hericium erinaceum isolate KU-1 was cultured in liquid medium (HL medium) and solid medium (Ko medium) at pH 4.0 in 28degrees C. 1.0% glucose or fructose was the most favorable carbon source, and 0.2% amonium acetate or NaNO3 was an exellent nitrogen source for mycelial growth as well as production of antimicrobial substances. The mixture of saw dust 70% with rice bran 30% (SR medium) was the substrate for formation of sporophores. The active substrates in extracts from mycelium, culture filtrate and fruiting body were separated by TLC. The solvent for TLC was EtOAc: Chloroform: MeOH (10 : 5 : 10). Phenol-like substances appeared at Rf 0.5~0.9, and fatty acid-like substances appeared at Rf 0.1~0.2. The purified materials from the extracts showed antimicrobial effects to Escherichia coli, Bacillus subtilis, Staphylococcus aureus, Aspergillus niger, Candida albicans and Microsporum gypseum. The S. aureus was the most inhibited. Minimal inhibitory concentration (MIC) of purified white powder and the Hercenone derivatives against S. aureus were 5.65microg/ml and 1.85microg/ml, respectively.

Significance of trilineage myelodysplasia in de novo acute myeloid leukemia / 대한임상병리학회지

BACKGROUND: The findings of dysplastic features in haemopoietic cells in de novo acute myeloid leukemia(AML) is defined as AML with trilineage myelodysplasia(AML/TMDS). These cases have been reported accounting for 10-5% of de novo AML. The rate of complete remission(CR) in AML/TMDS to conventional chemotherapy is poor and relapse occur much earlier than in patients without dysplastic features. TMDS features are also observed during remission and termed this de novo AML with myelodysplastic remission marrow(AML/MRM). Recent report described that TMDS during remission was more closely related to prognosis than dysplastic features at diagnosis. We investigated the incidence of AML/TMDS and AML/MRM and evaluated the impending role of dysplasia in prognosis. METHOD: Ninety-ive patients with de novo AML from March 1994 to December 1998 were enrolled according to the FAB classifiction. To determine AML/TMDS and AML/MRM, we used Brito-abapulle's criteria and Kazuhiro's criteria. Prognosis was aalysed by the means of disease free survival(DFS) and overall survival(OS). RESULTS: Nine(9.5%) patients had AML/TMDS and it was 7.7%, 17.2%, 50% of patients with M2, M4 and M6. CR rate was 44.4% for TMDS patients compared to 76.7% for patients without TMDS(p<0.05). AML/TMDS also showed significantly shorter DFS and OS. The incidence of AML/MRM was higher in the group of AML/TMDS(44.4%) compared to AML without TMDS(8.1%) but was not related to prognosis. CONCLUSION: We concluded that the presence of TMDS in de novo AML exerts a negative effect on the ability to achieve CR and in the prognosis. But the MRM has no significance to predict poor prognosis and early relapse.