Relationship Between Uncommon Computed Tomography Findings and Clinical Aspects in Patients With Acute Pyelonephritis

PURPOSE: Computed tomography (CT) has become popular in the diagnosis of acute pyelonephritis (APN) and its related complications in adults. The aim of this study was to investigate the relationship between uncommon CT findings and clinical and laboratory data in patients with APN. MATERIALS AND METHODS: From July 2009 to July 2012, CT findings and clinical data were collected from 125 female patients with APN. The six uncommon CT findings (excluding a wedge-shaped area of hypoperfusion in the renal parenchyma) studied were perirenal fat infiltration, ureteral wall edema, renal abscess formation, pelvic ascites, periportal edema, and renal scarring. The clinical parameters analyzed were the age and body mass index of the patients as well as the degree and duration of fever. Laboratory parameters related to inflammation and infection included white blood cell count, C-reactive protein (CRP) level, erythrocyte sedimentation rate, pyuria, and bacteriuria. RESULTS: The most common CT finding was perirenal fat infiltration (69 cases, 55%). A longer duration of fever, higher CRP level, and grade of pyuria were related with perirenal fat infiltration (p=0.010, p=0.003, and p=0.049, respectively). The CRP level was significantly higher in patients with renal abscess and ureteral wall edema (p=0.005 and p=0.015, respectively). CONCLUSIONS: The uncommon CT findings that were related to aggravated clinical and laboratory parameters of APN patients were perirenal fat infiltration, ureteral wall edema, and renal abscess formation. The inflammatory reaction and tissue destruction may be more aggressive in patients with these CT findings.

Effect of Transurethral Resection With Hydrodistention for the Treatment of Ulcerative Interstitial Cystitis

PURPOSE: Many treatment options to help relieve the symptoms of interstitial cystitis (IC) are available, but none are effective. Because no reports of transurethral ulcer resection with hydrodistention are available, we assessed the effects of such combined surgery for ulcerative IC. MATERIALS AND METHODS: Between June 2006 and June 2011, 87 female patients with IC who underwent transurethral resection with hydrodistention and were followed up for at least 12 months were included. Improvements in patients' voiding symptoms and pain were analyzed retrospectively by using a 3-day micturition chart and a 10-point visual analogue scale (VAS) before and after the operation. The global response assessment (GRA) was used to assess treatment satisfaction. RESULTS: The mean age of the 87 female patients was 59.1+/-10.1 years, and the mean follow-up period was 26.7+/-14.4 months. Mean maximum functional bladder capacity increased from 168.4+/-92.4 mL to 276.3+/-105.4 mL (1 month) and to 227.3+/-91.7 mL (12 months). The mean frequency of voiding decreased from 17.2+/-8.5 before to 10.6+/-5.3 after (1 month) surgery; however, it increased again to 13.3+/-4.8 at 12 months. The 10-point VAS score decreased from 9.1+/-0.8 to 1.2+/-0.3 (1 month); however, it increased again to 2.5+/-0.4 (3 months), 3.2+/-0.4 (6 months), and 5.3+/-0.5 (12 months) (p<0.001). Symptom improvement based on the GRA was observed in 83 of the 87 patients (95.4%) at 1 month and in 55 of 87 patients (63.2%) at 12 months. CONCLUSIONS: Transurethral resection with hydrodistention is an effective treatment option for ulcerative IC because it provides improvements in voiding symptoms and pain.

A Case of Juxtaglomerular Cell Tumor Combined with Focal Segmental Glomerulosclerosis / 대한신장학회지

Juxtaglomerular cell tumor is a rare cause of secondary hypertension. Focal segmental glomerulosclerosis (FSGS) is a clinicopathological entity associated with renal insufficiency and proteinuria. The exact diagnosis and proper management are important in both juxtaglomerular cell tumor and FSGS. We experienced a 26-year-old male who complained of a palpable abdomen mass associated with proteinuria and hypertension. Ultimately, he was diagnosed with a juxtaglomerular cell tumor combined with FSGS after nephrectomy. After operation, his hypertension normalized, while his renal function deteriorated.

Virulence Characteristics and Phylogenetic Background of Ciprofloxacin Resistant Escherichia coli in the Urine Samples from Korean Women with Acute Uncomplicated Cystitis

To clarify the characteristics of the virulence factors (VFs) of ciprofloxacin resistant Escherichia coli (CFRE) with acute uncomplicated cystitis (AUC), we determined the VFs and the phylogenetic background of all 54 CFRE strains and the 55 randomly selected ciprofloxacin sensitive E. coli strains (CFSE) from patients with AUC in 22 Korean hospitals. The prevalence of the VFs was as follows: fimA, papEF, papGIII, sfaI, dafaBC, cnf1, and hlyA were presented in 96%, 54%, 68%, 91%, 49%, 72%, and 29% of the samples, respectively. The expressions of papEF, cnf1, and hlyA were significantly more prevalent in the CFSE. Moreover, the expressions of cnf, and papEF significantly reduced the risk of ciprofloxacin resistance. The CFSE was also marginally associated with the group B2 (P=0.05). Although the presence of pyuria and a previous cystitis history were not related with the phylotyping and the expressions of VFs, group B2, and fimA and papEF were more expressed in the younger age patients (P<0.05). In conclusion, the CFRE exhibits a selective loss of VFs and the non-B2 phylotype in Korean AUC patients. The group B2 and the presence of fimA and papEF are associated with a younger age of AUC patients.

Development of a Korean Version of the Urinary Tract Infection Symptoms Assessment Questionnaire

PURPOSE: The aim of this study was to translate the Urinary Tract Infection Symptoms Assessment (UTISA) questionnaire, which assesses the severity and nuisance of symptoms and signs of uncomplicated urinary tract infection, into Korean with subsequent linguistic validation for clinical use and research. MATERIALS AND METHODS: This self-administered questionnaire is composed of 14 items that cover the 7 most frequent symptoms and signs. After acquiring permission for use of the questionnaire in Korea from Bayer Health Care Pharmaceuticals Global Health Economics and Outcome Research, 2 bilingual linguists individually translated the original English version of the UTISA questionnaire into Korean, and the translations were then reconciled by the linguists and the authors. A preliminary Korean version was translated back into English and reconciled by another bilingual linguist to confirm proper forward translation of the UTISA questionnaire, and then a complete Korean version of the UTISA questionnaire was finished. Ten women with acute cystitis completed the Korean UTISA questionnaire and were then interviewed to confirm the final Korean version through cognitive debriefing. RESULTS: Linguistic validation of the Korean version of the UTISA questionnaire was completed through forward translation and reconciliation, back-translation and reconciliation, cognitive debriefing, and finally, proof-reading of the questionnaire as a instrument for assessing symptoms and signs of uncomplicated urinary tract infection. CONCLUSIONS: The UTISA questionnaire was translated into a Korean, and the translation was validated linguistically. Psychometric validation will be needed in a large set of patients with uncomplicated urinary tract infection.

Predictive Factors of the Long-term Medical Treatment Failure in Benign Prostatic Hyperplasia / 대한비뇨기과학회지

PURPOSE: The aim of this study was to identify the clinical baseline factors that affect failure of medical treatment(and especially surgical treatment) for benign prostatic hyperplasia(BPH) in spite of long-term medication. MATERIALS AND METHODS: 802 men who were over 50 years of age with BPH were enrolled for this study. Patients were allocated to a medication group and a surgical treatment group(after having at least a 12 month duration of medication). We compared the differences between the two groups for their initial International Prostate Symptom Score(IPSS), the uroflowmetry, the prostate volume, the postvoid residual urine and the serum prostate specific antigen(PSA). RESULTS: 397 patients had surgical treatment following medication due to BPH progression(acute urinary retention, aggravating LUTS) and 405 patients were given maintenance medical treatment during follow-up. Statistically significant differences were found in the IPSS(23.3+/-6.6 vs. 12.7+/-8.4), the prostate volume(53.5+/-28.1ml vs. 38.3+/-12.6ml), the maximal flow rate(7.8+/-4.7ml/sec vs. 12.7+/-5.4ml/sec), the postvoid residual urine volume(92.7+/-144.4cc vs. 36.5+/-147.1cc), and the PSA(6.1+/-7.6ng/ml vs. 2.8+/- 2.8ng/ml) between the surgical and medication groups. According to the area under the curve(AUC), the IPSS, prostate volume, maximal flow rate, postvoid residual urine volume and PSA are important in descending order. According to the receiver operating characteristic(ROC) curve- based prediction of the surgical intervention, the best cutoff value for the IPSS and prostate volume were 17(area under ROC curve: 0.83) and 40ml (area under ROC curve: 0.68), respectively. Conclusions: The results show that BPH patients with more severe IPSS (>or=17) and a larger prostate volume(>40ml) have a higher risk of surgical intervention, and this suggests that the IPSS and prostate volume may be useful predictors at the initial visit for surgical intervention.

Urothelial Carcinoma in a 17-year-old Boy / 대한비뇨기과학회지

Urothelial neoplasms in patients younger than 20 years old are extremely rare, and there is no established etiology, treatment guidelines, or surveillance for urothelial carcinoma in the pediatric population. A 17-year-old boy who presented with gross hematuria showed a smooth, round mass on the left lateral wall of the urinary bladder on cystoscopy. Histologic examination showed low grade papillary urothelial carcinoma of the urinary bladder without muscle layer invasion. We report a case of papillary urothelial carcinoma of the urinary bladder in a pediatric patient treated with transurethral resection.

Radiological Findings of Multiple Peritoneal Calcifying Fibrous Tumors: A Case Report

Peritoneal calcifying fibrous tumor is a rare tumor in the peritoneal cavity. In this case, plain radiography showed multiple conglomerated calcifications and several separate calcifications scattered in the lower abdomen and pelvic cavity. CT showed several well-circumscribed masses with a group of conglomerated nodular calcifications in their centers, and these were surrounded by three bands with different attenuation. Ultrasonography showed a well-circumscribed mass with strong posterior shadowing from its anterior surface and hyperechoic calcifications in its center. The histopathological diagnosis was calcifying fibrous tumor. The mass was well circumscribed and non-encapsulated and it was mainly composed of hyalinized fibrosclerotic tissue and dystrophic calcification with no inflammatory cells. We report here on a case of peritoneal calcifying fibrous tumor, along with a review of the relevant literature.

Symptom Changes and Ureaplasma urealyticum Reculture after Treatment with Broad-spectrum Antibiotics for Patients with Urinary Tract Infection / 대한비뇨기과학회지

PURPOSE: To evaluate urinary tract infections that are caused by Ureaplasma urealyticum(U. urealyticum) in female patients, we compared the positive reculture rate and the improvement of acute lower urinary tract symptoms after treatment with broad-spectrum antibiotics. MATERIALS AND METHODSaterials and Methods: From January 2006 to June 2007, 89 female patients who were experiencing acute lower urinary tract symptoms were culture positive for U. urealyticum culture, but they were negative on routine urine culture. U. urealyticum reculture after a 7 day regimen of broad spectrum antibiotic treatment and evaluation of symptoms were conducted in 74 patients. RESULTS: The symptoms improved in 35 patients(mean age: 44.0 years), but they did not improve in 39 patients(mean age: 44.1 years). A significant difference in the reculture rate of U. urealyticum was evident between the improved symptom group(40%) and the persistent symptom group (87.2%). Of the 39 patients in the latter group, 22 improved after treatment with anti-ureaplasma antibiotics, including azithromycin and doxycycline. CONCLUSIONS: The continued presence of U. urealyticum correlates with persistent acute lower urinary tract symptoms after broad-spectrum antibiotic treatment. Culture examination for U. urealyticum should be considered for those female patients with persistent acute lower urinary tract symptoms after treatment with broad-spectrum antibiotics.

Comparative Analysis of Clinical Parameters in Acute Pyelonephritis / 대한비뇨기과학회지

PURPOSE: To compare the variable inflammatory parameters of acute pyelonephritis patients treated with inpatient therapy at 13 hospitals, according to the age and gender distributions. MATERIALS AND MATHODS: A total of 3,544 medical records of patients with confirmed acute pyelonephritis, and admitted to hospital between January 2000 and December 2005, were retrospectively analyzed. RESULTS: The mean age of the patients was 43.2+/-16.2 years old, with a male:female ratio of 1 : 5.1. The average duration of hospital admission was 7.9+/-5.3 days. Underlying diseases were found in 23.0% (749/3,252 patient), largely due to diabetes (35.1%). Radiological abnormal findings were found in 13.7%. The leukocyte count, ratio of segmented form, erythrocyte sedimentation rate (ESR), c-reactive protein, pyuria, positive blood culture, positive urine culture were 11,014+/-5,778/mm(3), 74.8+/-14.5%, 44.0+/-32.0 mm/hr, 12.4+/-9.3mg/dl, 83.9%, 10.5% and 46.7%, respectively. E. coli grow in 79% of the urine culture positive patients. In a comparison of 3 age groups (61 years), the elderly patients had a greater number of underlying diseases and more pathogens in cultured blood. When divided into males and females, the elderly male patients had more pathogen in cultured urine, but contrary to the male patients, the elderly female patients had elevated leukocyte count and erythrocyte sedimentation rate. Also, the old patient group had more resistance to ampicillin when they had E. coli as the uropathogen (p=0.021). Patients with higher ESR required longer hospital admission periods. CONCLUSIONS: It was found that variable clinical parameters of acute pyelonephritis patients treated with inpatient therapy differed according to both gender and age group in Korea. Therefore, these factors should be taken into account in the treatment plan.

A Preliminary Study of Troublesome Symptoms in Women with Acute Uncomplicated Cystitis / 대한비뇨기과학회지

PURPOSE: Although acute uncomplicated cystitis in women is relatively common, there have been few studies on lower urinary tract symptoms (LUTS) related to cystitis. The aim of this study was to assess characteristic troublesome symptoms in female patients with acute uncomplicated cystitis using a symptom questionnaire designed at our clinic. MATERIALS AND METHODS: An routine urinalysis and urine cultures were performed in 310 women who had visited our clinic between January 2005 and June 2006. Of these patients, 172 who had pyuria(mean age, 47.4+/-15.3 years) were screened for major symptoms using the questionnaire. The questionnaire included four categories of symptoms(14 symptoms): LUTS, local symptoms, general symptoms, and pain-related symptoms. The severity of symptoms was rated on a 4-point scale from 0(no symptoms) to 3(severe symptoms). The severity of symptoms was compared with the results of the routine urinalysis and urine cultures. RESULTS: Urine cultures were positive in 107(62.2%) patients. Themost frequent and distressing symptom was dysuria, a pain-related symptom (89.0%, 1.78 points). Frequency was most common among LUTS(71.5%), and unwell was most common among the general symptoms(87.2%). In patients that were positive for urine cultures, the occurrence rate of low abdominal discomfort(81.3%, p=0.038) and irritability(72.9%, p=0.026) were significantly higher. CONCLUSIONS: The questionnaire may be useful to assess duration and relief time of LUTS and to determine the progress and treatment outcomes of acute uncomplicated cystitis. Further studies will be required to investigate the effects of acute uncomplicated cystitis related to LUTS.

Efficacy and Safety of Uro-Vaxom Treatment for Patients with Recurrent Cystitis: An Open Multicenter Study / 대한비뇨기과학회지

PURPOSE: We wanted to investigate the efficacy and safety of the immunotherapeutic Uro-Vaxom for treating uncomplicated recurrent cystitis in female patients only. MATERIALS AND METHODS: Adult female patients were enrolled in this multicenter, open-label study if they had acute cystitis at the enrollment visit and positive results on urine culture (> or =10(3)CFU/ml). The patients were treated for 3 months with one capsule daily of Uro-Vaxom after antibiotic therapy, and they were observed for another 3 months. The primary efficacy criteria were the cystitis recurrence rates over 6 months, the distribution of cystitis and the proportion of patients with cystitis. RESULTS: A total of 50 patients were evaluated. During the 6-month trial, the number of cystitis recurrences was significantly reduced in comparison with the 6-month pretrial period (on the average 0.64 as compared to 3.0 recurrences, respectively p<0.001). The incidences of frequency, urgency and dysuria remained low until the end of the trial. Uro-Vaxom was well tolerated: side-effects were mentioned by 8% of the 50 patients, and there was no case leading to treatment withdrawal. CONCLUSIONS: Uro-Vaxom significantly reduced the incidence of cystitis during the 6 months of this study, including the 3 months of treatment. These results demonstrate that Uro-Vaxom is a valuable agent for prophylaxis of recurrent cystitis.

The Expression of Proinflammatory Cytokine and Macrophage Migration Inhibitory Factor in a Rat Lipopolysaccharide-Induced Cystitis Model / 대한비뇨기과학회지

PURPOSE: We wanted to evaluate the changes of the expression of macrophage migration inhibitory factor(MIF) according to time, so we determined the semiquantitative score from immunostaining in a bladder inflammatory rat model. MATERIALS AND METHODS: A total of 25 female Sprague-Dawley rats were divided into 5 groups according to the time course. Group 1 was the control group that was treated with an intravesical instillation of saline. Groups 2-5 were evaluated at 4 hours, 24 hours, 48 hours and 7 days after the instillation of lipopolysaccharide(LPS), respectively. H&E staining and immunohistochemical staining for MIF were performed after removing the bladder. A semiquantitative score was used to evaluate the cystitis(bladder inflammation score; BIS). The expression of MIF in the bladder was graded from 0 to 3+(MIF score; MIFS). RESULTS: The staining of MIF was the most intense in the basal layer of the urothelium in the control group(BIS 0, MIFS 3). The degree of bladder inflammation was highest in group 3, and MIF was not expressed even in the urotherlium without inflammation(BIS 2.2, MIFS 0.6). The bladder inflammation was decreased after 48 hours, and the expression of MIF was increased after 48 hous(BIS 1.7, MIFS 1.6). The severity of bladder inflammation and the expression of MIS were significantly changed with the time course(p<0.001). CONCLUSIONS: These results suggest that pre-formed MIF is stored in the cytoplasm of the basal cells in the urothelium, and it is released into the lumen of the bladder after a noxious stimulus like LPS.

Ureteral Endometriosis / 대한비뇨기과학회지

Endometriosis is defined as the presence of functional endometrial tissue in an ectopic site. The incidence of endometriosis is from 10% to 20% for women of reproductive age. From 1% to 2% of woman with endometriosis have urinary tract lesions, of which from 70% to 80% involve the bladder. Yet ureteral endometriosis is very uncommon, and it is noted in only 0.1% to 0.4% of these cases. We report here on one case of ureteral endometriosis.

Expression Pattern of Neuroendocrine Cells and Survivin in the Prostate of Rabbits / 대한비뇨기과학회지

PURPOSE: The neuroendocrine cell (NE cell) is thought to play an important role in the development of hormone-refractory prostate cancer. Survivin is one of the IAPs (inhibitors of apoptosis), and it is expressed in the NE cell and in most of the common cancers, but not in normal tissue. The objective of this study was to investigate the expression pattern of the NE cell and survivin in the prostate of rabbits. MATERIALS AND METHODS: The 9 rabbits underwent orchiectomy and their prostates were removed at 0 weeks (control), 2 weeks and 6 weeks after orchiectomy. Each of the prostatic tissue specimens was stained with H&E; immunohistochemical staining was done for chromogranin A, synaptophysin and survivin, and the tissue specimens were then examined by microscopy. RESULTS: In the prostate of rabbits, most of the NE cells were located between the epithelial gland and the stroma. NE differentiation occurred 6 weeks after orchiectomy. The location of cells that were positive for survivin was almost same as that of the NE cells. CONCLUSIONS: The main location of NE cells in the prostate of rabbits was between the epithelial gland and the stroma, and NE differentiation occurred 6 weeks after orchiectomy, the same as in a human or a dog. The location of survivin positive cells coincided with that of the NE cells. Therefore, a rabbit seems to be a suitable animal model for the study of the NE cell.

Urinary Survivin Test Compared to the Nuclear Matrix Protein (NMP)-22 Test and Urine Cytology for the Diagnosis of Bladder Cancer / 대한비뇨기과학회지

PURPOSE: The aim of this study was to compare the sensitivity and specificity of the urinary survivin test for the diagnosis of bladder cancer with the nuclear matrix protein (NMP)-22 test and the urine cytology, and we wanted to correlate survivin with the tumor stage and grade. MATERIALS AND METHODS: Between October 2002 and March 2004, voided urine samples were obtained from 41 patients with bladder cancer and also from 36 controls who had no evidence of bladder cancer. The urinary survivin and NMP-22 levels were measured using a DuoSet IC ELISA kit and an automated chemiluminescent assay system. The results were compared with the cytologic results and the pathologic findings. RESULTS: The comparative results showed the higher sensitivity for the urinary survivin test (78.0%) and the NMP-22 test (75.6%) than for the urine cytology (65.8%) for the detection of bladder cancer. The specificity of urinary survivin (86.1%) and urine cytology (97.2%) were higher than that for the NMP-22 test (66.6%). Measuring the urinary survivin level was a more accurate test than the urinary NMP-22 test and the urine cytology for the detection of lower grade and superficial bladder cancer. CONCLUSIONS: The urinary survivin test was superior to urine cytology for sensitivity and specificity, and these two parameters of the urinary survivin test were higher than those of the NMP-22 test. Especially, the urinary survivin test is an accurate diagnostic test for superficial and lower grade bladder tumor. Our results suggested that the urinary survivin test appears to be a reliable diagnostic test to identify patients with bladder cancer.

Comparison of the Cost and Effectiveness of Different Medical Options for Treating Lower Calyceal Stones Less than 2cm: Extracorporeal Shock Wave Lithotripsy versus Percutaneous Nephrolithotomy / 대한비뇨기과학회지

PURPOSE: We wanted to evaluate the cost and effectiveness of different medical options for treating lower calyceal stones that measure less than 2cm, and specifically percutaneous nephrolithotomy (PNL) versus extracorporeal shock wave lithotripsy (ESWL). MATERIALS AND METHODS: A total of 61 patients with lower calyceal stones that measured less than 2cm were divided into two groups according to the first-line of treatment modality: the PNL (group 1) group and the ESWL (group 2) group. Each group was divided into two sub-groups; subgroup A, which included stones less than 1cm (group 1A and 2A) and subgroup B, which included stones that measured 1-2cm (group 1B and 2B). The stone-free rate and many other factors were analyzed. RESULTS: The success rates of treatment for group 1A and 2A were 100% (8/8) and 76.4% (13/17), respectively (p=0.269). However, in groups 1B and 2B, the success rates of treatment were 100% (14/14) and 63.6% (14/22), respectively (p=0.013), with group 1B showing a higher success rate. The total cost of treatment and the average of a patient's expenditure per group were as follows: group 1 with 2,622,501 won and 1,093,508 won, respectively; group 2 with 938,225 won and 447,935 won, respectively (p<0.001). CONCLUSIONS: The results of this study indicate that ESWL can serve as an effective first-line treatment modality for lower calyceal stones that measured less than 2cm. However, when considering other factors, such as the expensive burden of additional treatment and our national health insurance system, PNL may be an acceptable first-line treatment modality for lower calyceal stones that measure 1-2cm.

Screening for Chlamydia and Gonorrhea by Strand Displacement Amplification in Homeless Adolescents Attending Youth Shelters in Korea

We conducted the screening of sexually transmitted infections to define the prevalence of genital Chlamydia trachomatis and Neisseria gonorrhoeae infections and status of sexual risk behavior among homeless adolescents (10-19 yr old) in Korea. Adolescents who ran away from home and are under the care of youth shelters in ten cities in Korea served as the study population. Participants filled out a self-administered questionnaire related to sexuality. First-void urine was analyzed for chlamydial and gonococcal infection by strand displacement amplification (BDProbTec(TM)ET, BD Diagnostic Systems, MD, U.S.A.). A total of 175 adolescents from 15 youth shelters took part in the study. Their median age was 16 yr, and 54.9% of them reported having sexual intercourse at least once. The prevalence of C. trachomatis and N. gonorrhoeae among homeless adolescents was 12.6% and 15.4%, respectively. Factors significantly associated with the infections were number of sexual partners during the past year and lifetime. This is the first community-based sexually transmitted infection (STI) screening among adolescent in Korea. Screening programs targeting sexually active adolescents are important for detection of STIs. They should be considered an alternative population-based surveillance system in order to control STIs nationally.

Expression of Urinary Survivin as a New Tumor Marker for the Detection of Bladder Cancer / 대한비뇨기과학회지

PURPOSE: Survivin is a novel member of the inhibitor of apoptosis (IAP) gene family, which is over-expressed in many human tumors include bladder cancer. This prospective study was performed to investigate the clinical usefulness of a test for urinary survivin for the detection of bladder cancer. MATERIALS AND METHODS: From September 2002 and July 2003, voided urine samples were obtained from 86 healthy volunteers (group 1), from 25 patients having urologic diseases except bladder cancer (group 2), and from 48 patients with bladder cancer (group 3). One patient with small cell carcinoma, and three cases of adenocarcinoma of the bladder were included in group 3. Quantitative measurement of urinary survivin was analyzed using the DuoSet IC enzyme-linked immunosorbent assay (ELISA) kit and a microplate luminometer, DML2000. RESULTS: The mean urine level of survivin was 7.9pg/ml (1-23) in group 1, 6.0pg/ml (1-12) in group 2 and 63.3pg/ml (1-745) in group 3. Urinary survivin was over-expressed in group 3 more than group 1 and 2 (p<0.01). When we decided that the cut-off value of urinary survivin was to be past the mean 2SD in group 1, the normal upper limit was then 16.5pg/ml. The sensitivity and specificity for the detection of the bladder cancer were 77.1% and 86.8% respectively. The sensitivity and specificity of urinary survivin for urothelial cancer of the bladder were 85.0% and 96.0% respectively. The survivn expression for the high grade tumor was significantly higher than the low grade tumor (p=0.048), but there was no significant difference in the expression of urinary survivin according to the TNM staging (p=0.058). CONCLUSIONS: The results of our study showed that a diagnostic test with urinary survivin had a high sensitivity and specificity when the cut-off value of survivin was decided to be 16.5pg/ml. This suggests that urinary survivin might be an available tumor marker for the detection of bladder cancer.

Is There Any Relationship between Upper Urinary Tract Stone Development and Sleep Posture? / 대한비뇨기과학회지

PURPOSE: Recurrent stone formers are usually presented with calculi on the ipsilateral side. It has been postulated that sleep posture may alter renal hemodynamics and urinary flow during sleep and promote stone formation. We investigated the correlation of sleep posture with unilateral stone formation and the influence of body position on renal hemodynamics and urinary flow. MATERIALS AND METHODS: We prospectively evaluated the sleep posture of 106 patients with unilateral urolithiasis. A questionnaire was used to evaluate sleep posture of the patients. Sixteen normal volunteers were studied. They were evaluated in the supine, left and right lateral decubitus positions with separate diuretic renograms spaced one week apart. Renal scans were obtained using diethylenetriamine-pentaacetic acid (99mTc- DTPA) after the patient was equilibrated in the specific body position for 30 minutes. RESULTS: Of the patients, 66 slept consistently with 1 side in a dependent position, and the side of the stone was identical to the dependent sleep side in 80.2% (p<0.01). Renal perfusion and the T1/2 for clearances in the dependent kidney in the left and right decubitus positions were significantly increased when compared to the same kidney in the supine position (p<0.01). CONCLUSIONS: Specific sleeping position has significant effects on renal perfusion and urinary flow as measured by nuclear renal scintigraphy. This finding may help explain the correlation of sleep posture with unilateral urolithiasis. Even though this observation needs further investigation, it should be factored into the evaluation and prevention of unilateral stone disease.