The Preoperative Risk Factors that Influence the Postoperative Renal Function in Living Donor Nephrectomy: The Impact of Dominant Kidney Nephrectomy / 대한비뇨기과학회지

PURPOSE: We wanted to investigate the effect of dominant kidney nephrectomy on the postoperative renal function and we wanted to determine the preoperative risk factors that influence the postoperative renal function in living donor nephrectomy. MATERIALS AND METHODS: A total of 297 living kidney donors(159 males and 138 females) who underwent nephrectomy were included in this study. Renal function was measured by the serum creatinine levels and (99m)Tc-diethylenetriamine penta-acetic acid(DTPA) renal scanning. Using univariate and multivariate analyses, the following independent variables were evaluated to predict a postoperative serum creatinine level 1.5mg/dl or higher: removal of a functionally dominant kidney or a larger kidney according to the DTPA renal scan or CT, age, gender, body mass index (BMI), comorbidity, preoperative serum creatinine and the preoperative glomerular filtration rate(GFR). RESULTS: Of the 297 subjects, 134(55%) underwent donor nephrectomy on the left side, and 163(45%) underwent donor nephrectomy on the right side. Univariate analysis showed that gender and the preoperative creatinine level were significantly associated with postoperative serum creatinine elevation(1.5mg/dl or higher)(p<0.05). Multivariate analysis showed that the preoperative creatinine level(p<0.001), the preoperative GFR (p=0.015) and removal of a functionally dominant kidney(p=0.049) were significant factors. The cut-off values from the receiver operating characteristics(ROC) curves were 1.0mg/dl for the preoperative creatinine level, 90.24ml/min/1.73m2 for the preoperative GFR, and 10.94% for the difference of the relative renal function on DTPA. CONCLUSIONS: The preoperative serum creatinine level and the preoperative GFR are critical predictive factors for renal function after living donor nephrectomy. The impact of removing a functionally dominant kidney on the postoperative renal function should be cautiously interpreted in patients where the function of the nondominant kidney is favored.

Comparison of the Efficacy, Safety and Patient Preference of the Phosphodiesterase Type 5 Inhibitors for the Patients with Erectile Dysfunction / 대한비뇨기과학회지

PURPOSE: To compare the clinical efficacy and safety of three phosphodiesterase type 5 (PDE5) inhibitors in the treatment of mele erectile dysfunction according to patient preference. MATERIALS AND METHODS: Between January 2004 and August 2005, 113 male erectile dysfunctional patients were enrolled to this randomized, prospective, comparative, open-label, triple-crossover study of three PDE5 inhibitors. Patients were assigned to one of six medication schedules, and were prescribed a full dose of the drugs for 8 weeks, with a week of washout period prior to the next drug cycle. The International Index of Erectile Function (IIEF) scores and side effects related with each medication were obtained at the end of study. 48 patients finished all the medications, and completed the study with a global assessment questionnaire on their drug preference and reasons for that preference. RESULTS: The mean age of the patients was 54.6 (33-73) years. The mean pre-treatment IIEF and EF domain scores (+/-S.D.) were 28.2+/-14.7 and 10.6+/-6.6, respectively. The scores were significantly improved, to 47.9+/-14.6 and 19.9+/-6.6 with sildenafil, to 49.7+/-12.3 and 21.3+/-5.8 with vardenafil, and to 47.9+/-14.9 and 19.8+/-7.2 with tadalafil (p < 0.01). There were no significant differences in the scores or frequencies of side effects between the drugs. The preference percentages were 29.2, 29.2 and 35.4% for sildenafil, vardenafil and tadalafil, respectively. Patient preference was mainly due to improvement in erectile function (70.9%), such as rigid erection, prolonged erection and fast erection, and not to the infrequent rate of side effects (20.8%). CONCLISIONS: There were no significant differences of the efficacy and safety among the three PDE5 inhibitors. The preference for a drug for the treatment of erectile dysfunction was mainly related to the efficacy on the improvement of erectile function rather than the less frequent side effects.