The Use of Gonadotropin-Releasing Hormone Agonist Does Not Affect the Development of Cardiovascular Disease in Prostate Cancer Patients: a Nationwide Population-Based Cohort Study

The Use of Gonadotropin-Releasing Hormone Agonist Does Not Affect the Development of Cardiovascular Disease in Prostate Cancer Patients: a Nationwide Population-Based Cohort Study

BACKGROUND@#The objective of this study was to investigate whether androgen deprivation therapy (ADT) with gonadotropin-releasing hormone agonist (GnRHa) in prostate cancer (Pca) patients is associated with cardiovascular disease in the cohort based from the entire Korean population.@*METHODS@#Using the Korean National Health Insurance database, we conducted an observational study of 579,377 men who sought treatment for Pca between January 1, 2012 and December 31, 2016. After excluding patients with previously diagnosed cardiovascular disease or who had undergone chemotherapy, we extracted the data from 2,053 patients who started GnRHa (GnRHa users) and 2,654 men who were newly diagnosed with Pca (GnRHa nonusers) between July 1, 2012, and December 31, 2012, with follow-up through December 31, 2016. The primary outcomes were cerebrovascular attack (CVA) and ischemic heart disease (IHD).@*RESULTS@#GnRHa users were older, were more likely to reside in rural areas, had lower socioeconomic status, and had more comorbidities than nonusers (all P < 0.050). Although GnRHa users had an increased incidence of CVA and IHD (P = 0.013 and 0.048, respectively) in univariate analysis, GnRHa use was not associated with the outcomes in multivariate analysis. Furthermore, the cumulative duration of ADT was not associated with the outcomes whereas the associations between age at diagnosis with all diseases were significant.@*CONCLUSION@#Our complete enumeration of the Korean Pca population shows that ADT is not associated with increased risks of cardiovascular disease.

The Use of Gonadotropin-Releasing Hormone Agonist Does Not Affect the Development of Cardiovascular Disease in Prostate Cancer Patients: a Nationwide Population-Based Cohort Study

BACKGROUND@#The objective of this study was to investigate whether androgen deprivation therapy (ADT) with gonadotropin-releasing hormone agonist (GnRHa) in prostate cancer (Pca) patients is associated with cardiovascular disease in the cohort based from the entire Korean population.@*METHODS@#Using the Korean National Health Insurance database, we conducted an observational study of 579,377 men who sought treatment for Pca between January 1, 2012 and December 31, 2016. After excluding patients with previously diagnosed cardiovascular disease or who had undergone chemotherapy, we extracted the data from 2,053 patients who started GnRHa (GnRHa users) and 2,654 men who were newly diagnosed with Pca (GnRHa nonusers) between July 1, 2012, and December 31, 2012, with follow-up through December 31, 2016. The primary outcomes were cerebrovascular attack (CVA) and ischemic heart disease (IHD).@*RESULTS@#GnRHa users were older, were more likely to reside in rural areas, had lower socioeconomic status, and had more comorbidities than nonusers (all P < 0.050). Although GnRHa users had an increased incidence of CVA and IHD (P = 0.013 and 0.048, respectively) in univariate analysis, GnRHa use was not associated with the outcomes in multivariate analysis. Furthermore, the cumulative duration of ADT was not associated with the outcomes whereas the associations between age at diagnosis with all diseases were significant.@*CONCLUSION@#Our complete enumeration of the Korean Pca population shows that ADT is not associated with increased risks of cardiovascular disease.

Tobacco Growth Promotion by the Entomopathogenic Fungus, Isaria javanica pf185

Isaria javanica pf185 is an important entomopathogenic fungus with potential for use as an agricultural biocontrol agent. However, the effect of I. javanica pf185 on plant growth is unknown. Enhanced tobacco growth was observed when tobacco roots were exposed to spores, cultures, and fungal cell-free culture supernatants of this fungus. Tobacco seedlings were also exposed to the volatiles of I. javanica pf185 in vitro using I-plates in which the plant and fungus were growing in separate compartments connected only by air space. The length and weight of seedlings, content of leaf chlorophyll, and number of root branches were significantly increased by the fungal volatiles. Heptane, 3-hexanone, 2,4-dimethylhexane, and 2-nonanone were detected, by solid-phase micro-extraction and gas chromatography-mass spectrophotometry, as the key volatile compounds produced by I. javanica pf185. These findings illustrate that I. javanica pf185 can be used to promote plant growth, and also as a biocontrol agent of insect and plant diseases. Further studies are necessary to elucidate the mechanisms by which I. javanica pf185 promotes plant growth.

Associations of Upper Arm and Thigh Circumferences with Dementia and Depression in Korean Elders

OBJECTIVE: Previous studies have reported an association between weight loss and cognitive impairment. Changes in anthropometric measurements, such as arm and thigh circumferences, are associated with body mass changes and physical activity. Our aim was to investigate the association of upper arm and thigh circumferences with dementia and depression in the community-dwelling elderly population. METHODS: In total, 2,498 community residents aged 65 years or over were clinically assessed for dementia using the Korean version of the Community Screening Interview for Dementia. Depression was also assessed using the Korean version of the Geriatric Mental State Schedule B3. Arm and thigh circumferences were measured. Complex sample logistic regression was performed to evaluate associations of changes in anthropometric measurements with dementia/depression after controlling for other covariates. RESULTS: In the adjusted analyses, there was an independent association between dementia and arm circumference (OR=1.12; 95% CI=1.06–1.19). This association was significant in the females (OR=1.12; 95% CI=1.05–1.19) but not in males (OR=1.07; 95% CI=0.93–1.28). The association between dementia and thigh circumference was not significant in the adjusted analysis (OR=1.03; 95% CI=0.99–1.07). No significant association was found between either upper arm or thigh circumference and depression. CONCLUSION: In the older female Korean population, decreased upper arm circumference was associated with dementia and may represent a biological marker for this condition. This association may be explained by nutritional deficits or decreased physical activity.

The association between an abnormal post-voiding urine volume and a lower estimated glomerular filtration rate in patients with type 2 diabetes with no voiding symptoms

BACKGROUND/AIMS: Diabetic cystopathy is a frequent complication of diabetes mellitus. This study assessed the association between the post-voiding residual (PVR) urine volume and diabetic nephropathy in type 2 diabetics with no voiding symptoms. METHODS: This study investigated 42 patients with type 2 diabetes who were followed regularly at our outpatient clinic between July 1, 2008 and June 30, 2009. No patient had voiding problems or International Prostate Symptom Scores (IPSSs) > or = 12. An urologist performed the urological evaluations and the PVR was measured using a bladder scan. A PVR > 50 mL on two consecutive voids was considered abnormal, which was the primary study outcome. RESULTS: The mean patient age was 60 +/- 10 years; the IPSS score was 3.7 +/- 3.3; and the diabetes duration was 11.9 +/- 7.8 years. Seven of the 42 patients (16.7%) had a PVR > 50 mL. The presence of overt proteinuria or microalbuminuria was associated with an increased risk of a PVR > 50 mL (p 50 mL had a significantly lower estimated glomerular filtration rate (eGFR) compared with those with a PVR 50 mL. CONCLUSIONS: Patients with diabetic nephropathy had a significantly higher PVR and a lower eGFR was associated with an abnormal PVR.

A Case of Synchronous Presentation of Primary Non-Small Cell Lung Carcinoma and Pheochromocytoma / 결핵및호흡기질환

We report a rare synchronous presentation of primary lung cancer and adrenal pheochromocytoma. A 59-year-old woman was diagnosed with right upper lobe non-small cell lung carcinoma measuring 2.8 cm and a right adrenal gland mass measuring 3.5 cm, which displayed increased metabolic activity on 18F-fluorodeoxyglucose positron emission tomography-computed tomography. The adrenal lesion was revealed to be asymptomatic. The patient underwent right adrenalectomy and histological examination revealed a pheochromocytoma. Ten days later, right upper lobectomy was performed for lung cancer. This case indicates that incidental adrenal lesions found in cases of resectable primary lung cancer should be investigated.

Influence of Ureteral Stone Components on the Outcomes of Electrohydraulic Lithotripsy

PURPOSE: We evaluated the influence of urinary stone components on the outcomes of ureteroscopic removal of stones (URS) by electrohydraulic lithotripsy (EHL) in patients with distal ureteral stones. MATERIALS AND METHODS: Patients with a single distal ureteral stone with a stone size of 0.5 to 2.0 cm that was completely removed by use of EHL were included in the study. Operating time was defined as the time interval between ureteroscope insertion and complete removal of ureteral stones. Ureteral stones were classified into 5 categories on the basis of their main component (that accounting for 50% or more of the stone content) as follows: calcium oxalate monohydrate (COM), calcium oxalate dihydrate, carbonate apatite (CAP), uric acid (UA), and struvite (ST). RESULTS: A total of 193 patients (131 males and 62 females) underwent EHL. The mean operating time was 25.1+/-8.2 minutes and the mean stone size was 1.15+/-0.44 cm. Calcium oxalate stones accounted for 64.8% of all ureteral stones, followed by UA (19.7%), CAP (8.3%), and ST (7.2%) stones. The mean operating time was significantly longer in the UA group (28.6+/-8.3 minutes) than in the COM group (24.0+/-7.8 minutes, p=0.04). In multivariate analyses, the stone size was negatively associated with the odds ratio (OR) for successful fragmentation. UA as a main component (OR, 0.42; 95% confidence interval, 0.20 to 0.89; p=0.023) was also found to be significantly important as a negative predictive factor of successful fragmentation after adjustment for stone size. CONCLUSIONS: The results of the present study suggest that successful fragmentation by URS with EHL could be associated with the proportion of the UA component.

Primary Malignant Melanoma of the Female Urethra

We report here on a rare case of primary malignant melanoma of the female urethra. A 69-year-old female presented at our hospital with a several month history of dysuria, poor stream, gross hematuria, intermittent blood spots, and a painful mass at the external urethral meatus. The physical examination revealed a soft, small, chestnut-sized lesion through the urethral orifice. The mass was tan colored, ulcerated, covered with necrotic tissue, and protruded from the external urethral meatus. The mass was removed by wide local excision under spinal anesthesia. The pathological diagnosis was malignant melanoma of the urethra. Computed tomography of the abdomen as well as a whole-body bone scan showed no evidence of metastasis. The patient has been free of disease for 6 months postoperatively. We discuss the clinicopathologic features and treatment of this tumor.

Hyaline Vascular Castleman Disease Involving Renal Parenchyma and a Lymph Node: A Case Report

Castleman disease is a rare lymphoproliferative lesion that is predominantly found in the mediastinum. Retroperitoneal and pararenal localizations are very rare. We describe a 36-year-old man with a hyaline vascular type of Castleman disease involving renal parenchyma and a paraaortic lymph node. Most reported renal Castleman disease was plasma cell type with systemic symptoms. Herein, we report the first Korean case of the hyaline vascular type of Castleman disease involving the renal parenchyma and the paraaortic lymph node simultaneously.

Our Experiences with Robot-Assisted Laparoscopic Radical Cystectomy: Orthotopic Neobladder by the Suprapubic Incision Method

PURPOSE: To report our technique for and experience with robot-assisted laparoscopic radical cystectomy (RARC) with orthotopic neobladder (ON) formation in a cohort of bladder cancer patients. MATERIALS AND METHODS: Between December 2007 and December 2011, a total of 35 patients underwent RARC. The patients' mean age was 63.3 years and their mean body mass index was 23.7 kg/m2. Thirty patients had a clinical stage of T2 or higher. Postoperative mean follow-up duration was 25.5 months. In 5 patients, a 4-cm midline infraumbilical skin incision was made for an ileal conduit (IC) and the stoma formation was similar to the open procedure. In 30 patients undergoing the ON procedure, the skin for specimen removal and extracorporeal enterocystoplasty was incised infraumbilically in the early 5 cases with redocking (ON-I) and suprapubically in the latter 25 cases without redocking (ON-S). RESULTS: The mean operative times of the IC, ON-I, and ON-S groups were 442.5, 646.0, and 531.3 minutes, respectively (p=0.001). Mean console and lymph node dissection time were not significantly different between the groups. Mean urinary diversion times in each group were 68.8, 125.0, and 118.8 minutes, respectively (p=0.001). In the comparison between the ON-I and ON-S group, only operative time was significant. Four patients required a blood transfusion. We had no cases of intraabdominal organ injury or open conversion. Thiry-three patients (94.2%) had a pathologic stage of T2 or higher. Two patients (5.7%) had lymph node-positive disease. Postoperative complications included ileus (n=4), stricture in the uretero-ileal junction (n=2), and vesicovaginal fistula (n=1). CONCLUSIONS: Our robotic neobladder-suprapubic incision without redocking procedure is easier and more rapid than that of infraumbilical incision with redocking.

Our Experiences with Robot-Assisted Laparoscopic Radical Cystectomy: Orthotopic Neobladder by the Suprapubic Incision Method

PURPOSE: To report our technique for and experience with robot-assisted laparoscopic radical cystectomy (RARC) with orthotopic neobladder (ON) formation in a cohort of bladder cancer patients. MATERIALS AND METHODS: Between December 2007 and December 2011, a total of 35 patients underwent RARC. The patients' mean age was 63.3 years and their mean body mass index was 23.7 kg/m2. Thirty patients had a clinical stage of T2 or higher. Postoperative mean follow-up duration was 25.5 months. In 5 patients, a 4-cm midline infraumbilical skin incision was made for an ileal conduit (IC) and the stoma formation was similar to the open procedure. In 30 patients undergoing the ON procedure, the skin for specimen removal and extracorporeal enterocystoplasty was incised infraumbilically in the early 5 cases with redocking (ON-I) and suprapubically in the latter 25 cases without redocking (ON-S). RESULTS: The mean operative times of the IC, ON-I, and ON-S groups were 442.5, 646.0, and 531.3 minutes, respectively (p=0.001). Mean console and lymph node dissection time were not significantly different between the groups. Mean urinary diversion times in each group were 68.8, 125.0, and 118.8 minutes, respectively (p=0.001). In the comparison between the ON-I and ON-S group, only operative time was significant. Four patients required a blood transfusion. We had no cases of intraabdominal organ injury or open conversion. Thiry-three patients (94.2%) had a pathologic stage of T2 or higher. Two patients (5.7%) had lymph node-positive disease. Postoperative complications included ileus (n=4), stricture in the uretero-ileal junction (n=2), and vesicovaginal fistula (n=1). CONCLUSIONS: Our robotic neobladder-suprapubic incision without redocking procedure is easier and more rapid than that of infraumbilical incision with redocking.

Fungal Urinary Tract Infection in Burn Patients with Long-Term Foley Catheterization

PURPOSE: It is well known that fungi become predominant microorganisms in the urine of patients with long-term Foley catheters. This study was conducted to evaluate the lengths of time for fungi to cause urinary tract infection (UTI) and to identify predictors of fungal UTI in burn patients with long-term Foley catheters. MATERIALS AND METHODS: A total of 93 patients who did not have infection at the time of admission but later had fugal UTI were evaluated. Urinalysis, urine culture, and Foley catheter indwelling were done at admission. All patients were administered prophylactic antibiotics from admission. Urine cultures were run every week, and catheters were changed every 2 weeks for each patient. RESULTS: Three of the 93 patients (3.2%) displayed fungal UTI at the 1st week of catheter indwelling. However, most patients (78.5%) displayed fungal UTI from 2nd to 5th week after catheter indwelling. The most prevalent fungus identified was Candida tropicalis (60.2%). By univariate logistic regression analysis, only the total body surface area burned (TBSAB) was predictive of fungal UTI in burn patients (p=0.010). By multivariate logistic regression analysis, underlying disease (p=0.032) and TBSAB (p=0.036) were predictors of fungal UTI. Patients with higher TBSAB were more likely to display shorter intervals from Foley catheterization to fungal UTI. CONCLUSIONS: Fungal UTI was initially found at the 1st week of urinary catheter indwelling, but the majority of cases occurred after the 1st week and appeared earlier in patients with underlying disease or higher TBSAB. Underlying disease and TBSAB were predictors of early fungal UTI.

Species Distribution and Susceptibilities to Azoles of Candida Species Including C. tropicalis in a Tertiary Burn Center / 대한임상미생물학회지

BACKGROUND: Candida species are the fourth leading cause of nosocomial bloodstream infections and have one of the highest mortality rates among nosocomial pathogens. C. tropicalis has been reported to be one of the leading Candida species other than C. albicans to cause Candida infection in patients who have malignancy, diabetes mellitus, and burn. This study was designed to determine whether burn might influence the species distribution and susceptibilities of azoles against clinical isolates of Candida species including C. tropicalis. METHODS: A total 372 Candida isolates from various samples in a tertiary burn center were studied, and the MICs of Candida isolates to fluconazole, itraconazole, and voriconazole were tested by broth microdilution method of the Clinical and Laboratory Standards Institute (CLSI) M27-A2. A comparison was made between Candida isolates from burn patients and non-burn patients. RESULTS: The percentages of C. albicans, C. tropicalis, C. parapsilosis and C. glabrata isolates from burn patients and non-burn patients were 42.3% and 64.2% (P=0.000), 35.7% and 21.6% (P=0.002), 11.9% and 7.8%, and 10.1% and 6.4%, respectively. Decreased susceptibilities to fluconazole, itraconazole, and voriconazole were observed more frequently in burn patients (4.76%, 19.05%, and 0.60%, respectively) than non-burn patients (2.45%, 14.22%, and 0%, respectively). CONCLUSION: The results of this study suggest that burn may lead to influence the species distribution and susceptibilities to azoles of Candida species.

Stent Position Is More Important than alpha-Blockers or Anticholinergics for Stent-Related Lower Urinary Tract Symptoms after Ureteroscopic Ureterolithotomy: A Prospective Randomized Study

PURPOSE: To evaluate the clinical factors that impact ureteral stent-related lower urinary tract symptoms (LUTS) after ureteroscopic ureterolithotomy, including the stent position and medication. MATERIALS AND METHODS: Fifty-three patients who underwent ureteroscopic ureterolithotomy with indwelling a stent were distributed into three groups. On demand analgesics were given to the group 1 (n=18). Daily tamsulosin 0.2 mg was added for group 2 (n=15) and daily tamsulosin 0.2 mg and tolterodine 4 mg was added for group 3 (n=20). The patients were also subclassified into appropriate or inappropriate group according to stent position. All the patients completed a visual analogue scale (VAS) and International Prostate Symptom Score (IPSS) on the 1st and 7th postoperative days. The VAS and IPSS were analyzed according to the medication groups and the stent position. RESULTS: In the appropriate stent potion group, only the storage symptom scores of groups 2 and 3 on the 1st postoperative day were significantly lower than those of the group 1 (p=0.001). This medication effect on LUTS was not observed in the inappropriate stent position group. In this group, total IPSS (p=0.015) and storage symptom scores (p=0.002) were higher than in the appropriate stent position group on the 7th postoperative day. CONCLUSIONS: Correct placement of the stent was more important than medication for lessening stent-related storage symptoms.

Initial Experience with Endoscopic Holmium: YAG Laser Urethrotomy for Incomplete Urethral Stricture

PURPOSE: Endoscopic holmium:yttrium-aluminum-garnet (Ho:YAG) laser urethrotomy is an alternative method in the management of urethral strictures. We report our initial experience in 15 cases of evaluating the therapeutic efficacy of the holmium laser for treating incomplete urethral strictures. MATERIALS AND METHODS: Endoscopic holmium laser urethrotomy was primarily performed on 15 patients with incomplete urethral stricture. Exclusion criteria were complete urethral stricture and previous treatment of urethral stricture. Retrograde urethrography and uroflowmetry were performed preoperatively and were carried out as follow-up studies postoperatively. RESULTS: Successful results without recurrence were achieved in 8 of 15 patients. When we classified the results by stricture length, the success rate was 80% in strictures less than 2 cm, whereas there was no therapeutic effect in strictures over 2 cm. When we classified the results by etiology, the number of successful results in strictures with an inflammatory, trauma, iatrogenic, or unknown cause was 2 (2/8), 3 (3/4), 2 (2/2), and 1 (1/1), respectively. In 7 patients who failed treatment, we repeated holmium laser urethrotomy in 5 patients and urethroplasty in 2 patients. No operative complications occurred in any patients. CONCLUSIONS: Endoscopic holmium laser urethrotomy is a safe and effective minimally invasive therapeutic modality in cases of stricture less than 2 cm. Further data from long-term follow-up are necessary to compare the success rate with that of conventional urethrotomy and urethroplasty.

Nutcracker Syndrome Diagnosed with 3-Dimensional Computed Tomography Angiography

We report a case of nutcracker syndrome diagnosed with 3-dimensional computed tomography angiography (3-D CTA). Nutcracker syndrome had been confirmed by conventional venography until recent years. Nowadays, with the development of imaging techniques, color Doppler sonogram and 3-D CTA are replacing venography for the diagnosis of nutcracker syndrome. The patient, a 20-year-old male, had abrupt gross hematuria and left abdominal pain 6 months previously and intermittent microscopic hematuria thereafter. Including renal biopsy, the results of conventional hematuria study showed no abnormalities. 3-D CTA showed left renal vein compression between the abdominal aorta and superior mesenteric artery and collateral veins. The angle and distance between the superior mesenteric artery and aorta at the level of the left renal vein were 35degrees and 3.0 mm, respectively. We diagnosed nutcracker syndrome and later confirmed the diagnosis with venography.

Robot-Assisted Laparoscopic Radical Prostatectomy: Four Cases

The role of the da Vinci(TM) robot is being defined in minimally invasive urologic surgery. Robot-assisted laparoscopic radical prostatectomy (rLRP) has emerged as a feasible treatment option for patients with organ-confined prostate cancer. We performed the first four rLRPs on four prostate cancer patients in the Republic of Korea. This is a report of its techniques and outcomes. In all four cases, the surgery was successfully completed with a mean operative time of 392.5 minutes. The mean estimated blood loss was 312.5mL, and catheterization lasted 14 to 21 days. There were no major intraoperative or postoperative complications. The mean hospital stay was 11 days. The rLRP is a safe and feasible approach. It will become one of the standard options for the management of localized prostate cancer.

Comparison of the Prognosis between pT3a Only Patients with Perirenal Fat Invasion and T1/T2 Patients, Respectively: Is It Necessary to Revise Stage T3a? / 대한비뇨기과학회지

PURPOSE: As compared with pathologic stages T1 and T2, we aimed to investigate the difference of the prognosis for the patients with perirenal fat invasion (pT3a), and the patients were divided into two groups by the tumor size of 7cm. MATERIALS AND METHODS: Of the 503 patients who underwent an operation for renal cell carcinoma between June 1995 and April 2004, we retrospectively reviewed the records of 455 patients with T1, T2 and T3a stage renal cell carcinoma without adrenal invasion. We evaluated the cell type, the multifocality of the tumor, the nuclear grade, the presence of a sarcomatoid component and the coagulative histologic necrosis. We divided the patients with pT3a renal cell carcinoma into two groups according to the tumor size of 7cm (Group 1; 7cm pT3a). The overall survival was estimated using the Kaplan-Meier method and the log-rank test. We used Student's t-test to compare each factors between groups 1 and 2 and the T1 and T2 groups, respectively. The prognostic factors that had an influence on survival were estimated using the Cox proportional hazard regression model in each group. RESULTS: After the exclusion criteria (the presence of adrenal invasion in pT3a patients) were applied, 24 patients were in group 1, 23 patients were in group 2, 328 patients had pT1 disease and 80 patients had pT2 disease. The median follow-up was 45.4 months. When group 1 was compared to the pT1 group, there was no significantly difference of the estimated survival (p=0.21). There was a similar result when comparing the estimated survival between group 2 and the pT2 group (p=0.80). CONCLUSIONS: No significant difference exists for the disease specific survival when patients with pT3a disease (Groups 1 and 2) are compared to the patients with either pT1 or pT2 disease. These findings reveal that patients with pT3a disease without adrenal invasion have similar outcomes to patients with either with pT1 or pT2 disease. Therefore, our result suggests that pT3a tumor should be re-classified according to tumor size into pT3a without adrenal invasion.

Inflammatory Myofibroblastic Tumor of Kidney / 대한비뇨기과학회지

Inflammatory myofibroblastic tumor (IMT) is a very rare benign mass lesion. Inflammatory myofibroblastic tumor of genitourinary tract most frequently involves the urinary bladder. Renal inflammatory myofibroblastic tumor is rare. Renal inflammatory myofibroblastic tumor usually remain asymtomatic until the tumor occurs obstructive uropathy. We experienced a case of right renal inflammatory myofibroblastic tumor.